This section consolidates formulary drug listings that appear in the source but do not include explicit coverage criteria (Prior Authorization, Quantity Limits, Step Therapy, Specialty flags) within the extracted fragments. These entries are informational listings of drug names and strengths from the formulary where no Requirements/Limits data was present in the source text.
The following drug entries were present in the source text without accompanying coverage criteria or Requirements/Limits annotations (listed as found in the document):
epinephrine solution auto-injector 0.15 mg/0.3ml (1:2000) (Epipen-jr 2-pack)
epinephrine solution auto-injector 0.3 mg/0.3ml (1:1000) (Epipen 2-pack)
midodrine hcl tab 2.5 mg, 5 mg, 10 mg
atorvastatin calcium tab 10 mg (base equivalent), 20 mg (base equivalent)
lovastatin tab 40 mg (Mevacor)
bempedoic acid tab 180 mg (NEXLETOL)
bempedoic acid-ezetimibe tab 180-10 mg (NEXLIZET)
niacin tab er 500 mg, 750 mg (antihyperlipidemic)
pravastatin sodium tab 10 mg; 20 mg; 40 mg; 80 mg (Pravachol)
amlodipine besylate-benazepril hcl cap 2.5-10 mg; 5-10 mg; 5-20 mg; 5-40 mg; 10-20 mg; 10-40 mg (Lotrel)
amlodipine besylate-valsartan tab 5-160 mg; 5-320 mg; 10-160 mg; 10-320 mg (Exforge)
amlodipine-valsartan-hydrochlorothiazide tab 5-160-12.5 mg
atenolol & chlorthalidone tab 50-25 mg (Tenoretic 50); atenolol & chlorthalidone tab 100-25 mg (Tenoretic 100)
benazepril & hydrochlorothiazide tab 5-6.25 mg; 10-12.5 mg; 20-12.5 mg; 20-25 mg (Lotensin hct)
benazepril hcl tab 5 mg; 10 mg; 20 mg; 40 mg (Lotensin)
bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg; 5-6.25 mg; 10-6.25 mg (Ziac)
candesartan cilexetil tab 4 mg; 8 mg; 16 mg; 32 mg (Atacand)
candesartan cilexetil-hydrochlorothiazide tab 16-12.5 mg; 32-12.5 mg; 32-25 mg (Atacand hct)
clonidine hcl tab 0.1 mg; 0.2 mg; 0.3 mg (Catapres)
clonidine td patch weekly 0.1 mg/24hr (Catapres-tts-1); 0.2 mg/24hr (Catapres-tts-2); 0.3 mg/24hr (Catapres-tts-3)
doxazosin mesylate tab 1 mg; 2 mg; 4 mg; 8 mg (Cardura)
enalapril maleate & hydrochlorothiazide tab 5-12.5 mg; 10-25 mg (Vaseretic)
enalapril maleate tab 2.5 mg; 5 mg; 10 mg; 20 mg (Vasotec)
eplerenone tab 25 mg; 50 mg (Inspra)
epinephrine autoinjectors and midodrine entries were repeated multiple times in the source without distinct Requirements/Limits annotations
Numerous anti-infective and antifungal entries (e.g., amoxicillin formulations, cefdinir cap 300 mg, cefixime cap 400 mg (Suprax), fluconazole formulations, posaconazole entries) appeared in the Requirements/Limits sections but several specific lines in the extracted fragments lacked explicit PA/QL/SP flags — those product names are retained here as listing-only entries where the source did not supply a clear coverage flag.
Several contraceptive and estrogenic products (multiple formulations of MYFEMBREE, norethindrone acetate-ethinyl estradiol combinations, COMBIPATCH, estradiol preparations) were repeatedly listed in the source; portions of those listings did not include clear Requirements/Limits annotations in the extracted fragments and are therefore included here as entries without explicit criteria.
Other products with no clear coverage annotation in the provided fragments: digoxin oral soln 0.05 mg/ml (Digoxin); digoxin tab 125 mcg, 250 mcg (Lanoxin); isosorbide dinitrate tabs; isosorbide mononitrate ER; nitroglycerin SL tabs; nitroglycerin TD patches.