Zyvox (linezolid suspension, tablet) - PA Zyvox (linezolid injection) - PA Zytiga (abiraterone 250 mg, 500 mg) BP - PA Zyprexa Zydis (olanzapine orally disintegrating tablet) - PA; See Table 24; See Table 71 Zyprexa Relprevv (olanzapine 405 mg extended-release injection) - PA < 6 years and PA > 1 injection/month; See Table 24; See Table 71 Zyprexa Relprevv (olanzapine 210 mg, 300 mg extended-release injection) - PA < 6 years and PA > 2 injections/month; See Table 24; See Table 71 Zyprexa # (olanzapine injection) Zyprexa # (olanzapine 2.5 mg, 5 mg, 7.5 mg, 10 mg, 20 mg tablets) - PA < 6 years and PA > 30 units/month; See Table 24; See Table 71 Zyprexa # (olanzapine 15 mg tablet) - PA < 6 years and PA > 60 units/month; See Table 24; See Table 71 Zymaxid (gatifloxacin ophthalmic solution) - PA Zyloprim # (allopurinol) Zylet (tobramycin / loteprednol ophthalmic suspension) - PA Zykadia (ceritinib) - PA Zyflo CR (zileuton extended-release) BP - PA Zyflo (zileuton) - PA Zydelig (idelalisib) - PA Zyclara (imiquimod 2.5%, 3.75% cream) BP - PA Zyban # (bupropion hydrochloride sustained-release-zyban) - PA < 6 years Zurampic (lesinurad) - PA Zuplenz (ondansetron film) - PA Zubsolv (buprenorphine / naloxone tablet-zubsolv) - PA Zovirax # (acyclovir capsule, suspension, tablet) Zovirax (acyclovir ointment) - PA Zovirax (acyclovir cream) - PA Zosyn # (piperacillin / tazobactam) zoster vaccine recombinant, adjuvanted - PA < 50 years Zostavax (herpes zoster vaccine) - PA < 50 years Zorvolex (diclofenac 18 mg, 35 mg capsule) - PA Zortress (everolimus-zortress) Zorbtive (somatropin-zorbtive) - PA Zontivity (vorapaxar) - PA zonisamide; See Table 20; See Table 71 Zonegran # (zonisamide); See Table 20; See Table 71 Zonalon (doxepin cream-zonalon) - PA GOUT AGENTS SMOKING CESSATION GOUT AGENTS ALCOHOL AND DRUG CESSATION AGENT NONSTEROIDAL ANTI-INFLAMMATORY IMMUNOMODULATOR HORMONE AGENTS ANTIPLATELET AGENT
Zomig ZMT (zolmitriptan orally disintegrating tablet) - PA Zomig (zolmitriptan tablet) - PA Zomig (zolmitriptan nasal spray) - PA Zometa # (zoledronic acid 4 mg) Zomacton (somatropin-zomacton) - PA Zolpimist (zolpidem oral spray) - PA; See Table 15; See Table 71 zolpidem oral spray - PA; See Table 15; See Table 71 zolpidem extended-release tablet - PA; See Table 15; See Table 71 zolpidem 5 mg tablet - PA < 6 years and PA > 45 units/month; See Table 15; See Table 71 zolpidem 5 mg, 10 mg sublingual tablet - PA; See Table 15; See Table 71 zolpidem 10 mg tablet - PA < 6 years and PA > 30 units/month; See Table 15; See Table 71 zolpidem 1.75 mg, 3.5 mg sublingual tablet - PA; See Table 15; See Table 71 Zoloft # (sertraline) - PA < 6 years; See Table 17; See Table 71 zolmitriptan tablet - PA zolmitriptan orally disintegrating tablet - PA zolmitriptan nasal spray - PA Zolinza (vorinostat) zoledronic acid 5 mg - PA zoledronic acid 4 mg Zoladex (goserelin) - PA Zohydro ER (hydrocodone extended-release capsule) - PA Zofran ODT # (ondansetron orally disintegrating tablet) Zofran # (ondansetron injection) Zofran # (ondansetron 4 mg, 8 mg tablet) Zofran (ondansetron solution) - PA Zocor # (simvastatin 80 mg) - PA > 30 units/month Zocor # (simvastatin 5 mg, 10 mg, 20 mg, 40 mg) - PA > 45 units/month Zmax (azithromycin extended-release) - PA ziv-aflibercept - PA Zithromax # (azithromycin); See Table 35; See Table 66 Zirgan (ganciclovir ophthalmic gel) Zipsor (diclofenac 25 mg capsule) - PA ziprasidone injection HORMONE AGENTS ANTIDEPRESSANTS OPIOID ANALGESICS NONSTEROIDAL ANTI-INFLAMMATORY 2
ziprasidone capsule - PA < 6 years and PA > 60 units/month; See Table 24; See Table 71 Zioptan (tafluprost) - PA Zinplava (bezlotoxumab) - PA Zingo (lidocaine powder intradermal injection system) - PA Zinecard # (dexrazoxane) zinc sulfate zinc oxide * Zincate (zinc sulfate) Zinbryta (daclizumab) - PA Zinacef # (cefuroxime sodium) Zilretta (triamcinolone extended-release injectable suspension) - PA zileuton - PA zileuton extended-release BP - PA zidovudine ziconotide - PA Ziana (clindamycin / tretinoin-ziana) - PA Ziagen # (abacavir) Ziac # (bisoprolol / hydrochlorothiazide) Zetonna (ciclesonide nasal aerosol, 37 mcg) - PA Zetia (ezetimibe) - PA Zestril # (lisinopril) Zestoretic # (lisinopril / hydrochlorothiazide) Zerit # (stavudine) Zerbaxa (ceftolozane / tazobactam) - PA Zepatier (elbasvir / grazoprevir) - PA Zenpep DR (pancrelipase-zenpep DR) Zemplar (paricalcitol injection) ^ Zemplar (paricalcitol capsule) - PA Zembrace (sumatriptan injection-zembrace) - PA Zemaira (alpha-1-proteinase inhibitor, human-zemaira) Zelboraf (vemurafenib) - PA Zelapar (selegiline orally disintegrating tablet) - PA Zejula (niraparib) - PA ANESTHETICS ANTIDOTES MULTIPLE SCLEROSIS AGENTS GLUCOCORTICOIDS ANALGESICS NASAL PREPARATIONS ANTIPARKINSON 3
Zegerid (omeprazole / sodium bicarbonate) - PA Zavesca (miglustat) BP - PA Zarxio (filgrastim-sndz) - PA Zarontin # (ethosuximide); See Table 20; See Table 71 Zantac # (ranitidine tablet) * Zantac # (ranitidine injection) Zanosar (streptozocin) zanamivir - PA all quantities (June 1st to September 30th); PA < 5 years of age and > 20 inhalations/season (October 1st to May 31st) Zanaflex # (tizanidine tablet) Zanaflex (tizanidine capsule) - PA Zaltrap (ziv-aflibercept) - PA zaleplon - PA < 6 years and PA > 30 units/month; See Table 15; See Table 71 zafirlukast - PA ANTI-ULCER PREPARATIONS HEMATINIC AGENT H2 ANTAGONISTS H2 ANTAGONISTS MUSCLE RELAXANT MUSCLE RELAXANT 4