Drug Class and Medication* | Dispensing Limit |
Bone Health |
Alendronate 40 mg | 30 tabs/30 days |
Atelvia (risedronate delayed-release) | 4 tabs/28 days |
Binosto (alendronate) | 4 tabs/28 days |
Male Hormones |
Androgel 1.62%, 1.25 g (testosterone) | 30 packets/30 days |
Androgel 1.62%, 2.5 g (testosterone) | 60 packets/30 days |
Pain Relief |
Exalgo (hydromorphone) | 60 tabs/30 days |
Ulcer/GERD |
Prilosec 2.5 mg, 10 mg oral suspension (omeprazole) | 60 packets/30 days |
Viral Infections |
Aptivus 100 mg/mL oral solution (tipranavir) | 380 mL/30 days |
Aptivus 250 mg (tipranavir) | 120 caps/30 days |
Atripla (efavirenz/emtricitabine/tenofovir) | 30 tabs/30 days |
Combivir (lamivudine/zidovudine) | 60 tabs/30 days |
Complera (emtricitabine/rilpivirine/tenofovir) | 30 tabs/30 days |
Crixivan 100 mg (indinavir) | 90 caps/30 days |
Crixivan 200 mg (indinavir) | 270 caps/30 days |
Crixivan 400 mg (indinavir) | 180 caps/30 days |
Edurant (rilpivirine) | 30 tabs/30 days |
Emtriva 10 mg/mL oral solution (emtricitabine) | 720 mL/30 days |
Emtriva 200 mg (emtricitabine) | 30 caps/30 days |
Epivir 10 mg/10 mL oral solution (lamivudine) | 960 mL/30 days |
Epivir 150 mg, 300 mg (lamivudine) | 30 tabs/30 days |
Epzicom (lamivudine/abacavir) | 30 tabs/30 days |
Fuzeon (enfuvirtide) | 60 vials/30 days |
Intelence 25 mg (etravirine) | 120 tabs/30 days |
Intelence 100 mg, 200 mg (etravirine) | 60 tabs/30 days |
Invirase 200 mg (saquinavir) | 300 caps/30 days |
Invirase 500 mg (saquinavir) | 120 tabs/30 days |
Isentress 25 mg, 100 mg chewable (raltegravir) | 180 tabs/30 days |
Isentress 400 mg (raltegravir) | 60 tabs/30 days |
Kaletra 80 mg/20 mg/mL oral solution (lopinavir/ritonavir) | 320 mL/30 days |
Kaletra 100mg/25 mg (lopinavir/ritonavir) | 300 tabs/30 days |
Kaletra 200 mg/50 mg (lopinavir/ritonavir) | 120 tabs/30 days |
Lexiva 50 mg/mL oral suspension (fosamprenavir) | 1,800 mL/30 days |
Lexiva 700 mg (fosamprenavir) | 120 tabs/30 days |
Norvir 80 mg/mL oral solution (ritonavir) | 480 mL/30 days |
Norvir 100 mg (ritonavir) | 360 caps/30 days |
Norvir 100 mg (ritonavir) | 360 tabs/30 days |
Prezista 75 mg (darunavir) | 300 tabs/30 days |
Prezista 150 mg (darunavir) | 180 tabs/30 days |
Prezista 400 mg, 600 mg (darunavir) | 60 tabs/30 days |
Prezista 800 mg (darunavir) | 30 tabs/30 days |
Rescriptor 100 mg (delavirdine) | 90 tabs/30 days |
Rescriptor 200 mg (delavirdine) | 180 tabs/30 days |
Reyataz 100 mg, 150 mg, 300 mg (atazanavir) | 30 caps/30 days |
Reyataz 200 mg (atazanavir) | 60 caps/30 days |
Selzentry 150 mg (maraviroc) | 60 tabs/30 days |
Selzentry 300 mg (maraviroc) | 120 tabs/30 days |
Stribild (elvitegravir/cobicistat/emtricitabine/tenofovir) | 30 tabs/30 days |
Sustiva 50 mg (efavirenz) | 90 caps/30 days |
Sustiva 200 mg (efavirenz) | 60 caps/30 days |
Sustiva 600 mg (efavirenz) | 30 tabs/30 days |
Trizivir (abacavir/lamivudine/zidovudine) | 60 tabs/30 days |
Truvada (emtricitabine/tenofovir) | 30 tabs/30 days |
Videx 10 mg/mL oral suspension (didanosine) | 1,200 mL/30 days |
Videx 125 mg, 200 mg, 250 mg, 400 mg (didanosine) | 30 caps/30 days |
Viracept 250 mg (nelfinavir) | 270 tabs/30 days |
Viracept 625 mg (nelfinavir) | 120 tabs/30 days |
Viramune 50 mg/5 mL oral suspension (nevirapine) | 1,200 mL/30 days |
Viramune 200 mg (nevirapine) | 60 tabs/30 days |
Viramune XR (nevirapine extended-release) | 30 tabs/30 days |
Viread 40 mg/1 g oral powder for suspension (tenofovir) | 240 g/30 days |
Viread 150 mg, 200 mg, 250 mg, 300 mg (tenofovir) | 30 tabs/30 days |
Zerit 1 mg/mL oral solution (stavudine) | 2,400 mL/30 days |
Zerit 15 mg, 20 mg, 30 mg, 40 mg (stavudine) | 60 caps/30 days |
Ziagen 20 mg/mL oral solution (abacavir) | 960 mL/30 days |
Ziagen 300 mg (abacavir) | 60 tabs/30 days |
zidovudine 50 mg/5 mL syrup | 1,920 mL/30 days |
zidovudine 100 mg | 180 caps/30 days |
zidovudine 300 mg | 60 tabs/30 days |