Allergy 2Nd Gen Antihistamine & Decongestant Combinations CLARINEX-D 12 HOUR ORAL TABLET , ER MULTIPHASE 12 HR 2.5-120 MG
fexofenadine-pseudoephedrine oral tablet extended release 24 hr 180-240 mg Allergenic Extracts , Therapeutics GRASTEK SUBLINGUAL TABLET 2,800 BAU ODACTRA SUBLINGUAL TABLET 12 SQ-HDM ORALAIR SUBLINGUAL TABLET 100 INDX REACTIVITY , 300 INDX REACTIVITY ORALAIR SUBLINGUAL TABLET 100 IR ( 3 ) / 300 IR ( 6 ) PALFORZIA ( LEVEL 1 ) ORAL CAPSULE , SPRINKLE 3 MG ( 1 MG X 3 ) PALFORZIA ( LEVEL 2 ) ORAL CAPSULE , SPRINKLE 6 MG ( 1 MG X 6 ) PALFORZIA ( LEVEL 3 ) ORAL CAPSULE , SPRINKLE 12 MG ( 1 MG X 2 , 10 MG X 1 ) PALFORZIA ( LEVEL 4 ) ORAL CAPSULE , SPRINKLE 20 MG PALFORZIA ( LEVEL 5 ) ORAL CAPSULE , SPRINKLE 40 MG ( 20 MG X 2 ) PALFORZIA ( LEVEL 6 ) ORAL CAPSULE , SPRINKLE 80 MG ( 20 MG X 4 ) PALFORZIA ( LEVEL 7 ) ORAL CAPSULE , SPRINKLE 120 MG ( 20 MG X 1 , 100 MG X 1 ) PALFORZIA ( LEVEL 8 ) ORAL CAPSULE , SPRINKLE 160 MG ( 20 MG X 3 , 100 MG X1 ) PALFORZIA ( LEVEL 9 ) ORAL CAPSULE , SPRINKLE 200 MG ( 100 MG X 2 ) PALFORZIA ( LEVEL 10 ) ORAL CAPSULE , SPRINKLE 240 MG ( 20 MG X 2 , 100 MG X 2 ) PALFORZIA ( LEVEL 11 UP-DOSE ) ORAL POWDER IN PACKET 300 MG
Tier 3
( Allegra-D 24 Hour ) Tier 1
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ST : Requires prior prescription for Desloratadine or Levocetirizine tablets within the past 120 days ; QL ( 2 EA per 1 day )
PA
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3