fox army health center jan 201… · sulindac 200mg tabs tramadol (ultram equiv) immediate-release...
TRANSCRIPT
FOX ARMY HEALTH CENTER
PHARMACY FORMULARY REFERENCE
HOURS OF OPERATION:
Monday thru Friday 7:30am – 4:30pm
Peak times are between 11:30 – 13:30 and all day Fridays
Please check our website’s Live Wait-Time Tracker for current
wait times: www.redstone.amedd.army.mil
FY19 Holiday and Training Closure Schedule on last page
**Please check our monthly training closure schedule as it varies!**
ORDER REFILLS AHEAD OF TIME BY:
Phone: 256-842-7337or 800-223-9531 or
Online: www.redstone.amedd.army.mil
This FORMULARY can also be found on line at
www.redstone.amedd.army.mil
Click on .pdf (paper form)
Suzette Baker, RPh, BS, Pharm CHIEF, PHARMACY SERVICE
REDSTONE ARSENAL, AL 35809-7000
JANUARY 2019
2
FOREWARD This guide is published for the use of the customers of Fox Army Health Center. It is intended as an
aid to understanding the services available at Fox Army Health Center’s Pharmacy and is not an official publication of this organization of the Department of the Army. While we have attempted
to provide information representative of the questions most often asked by our customers, this guide does not portend to be all inclusive or exclusive to services offered. Specific questions should
be directed to the pharmacy staff.
GENERAL INFORMATION
AR 40-3 requires that medical care and services be provided only to eligible beneficiaries. The military I.D. card is a tool that helps us meet this requirement. Medication will not be issued for a patient who is over the age of 10 years unless a valid military I.D. card (or a paper photocopy of the front and back of the ID Card) for that patient is presented to pharmacy services. (Electronic devices with picture of ID Cards are not accepted.)
TELEPHONE NUMBERS:
Outpatient pharmacy: (256) 955-8888 ext. # 1701 (allow 24 business hours for return call)
Automated phone-in refill system: (256) 842-7337 or 1-800-223-9531 On-line refill requests: www.redstone.amedd.army.mil
GENERAL DISPENSING POLICIES
Maintenance medications:
Maintenance Medication (NON-controlled) Physicians may write for up to a 90 day supply with 3 refills
Narcotics and Scheduled III-V Controlled Substances: Physicians may write for a maximum of a 30 day supply with 5 refills (for a total of six months)
Schedule II Substances: drugs may be written for a maximum of a one month supply and are NOT refillable. Schedule II narcotic (controlled substance) prescriptions must be hand-carried with
original signature of prescriber (electronic or verbal submissions are not accepted). Narcotic prescription refills may be filled no sooner than two (2) days prior to actual due
date of refill prescription (28 days from the date it was last picked up).
Exception: Ritalin, Adderall, Concerta (or equivalents) may be given up to a 90-day supply for Attention Deficit Disorder and No Refills. Testosterone and seizure products may be given up to a 90-day supply with one refill.
Electronically transmitted prescriptions from providers are not filled until the patient presents to pharmacy, pulls appropriate category service ticket and requests the prescription.
Prescriptions expire after ONE year from the original date it was written for most medications
Controlled substances prescriptions expire SIX months from the original date written.
FAHC follows dispensing policy outlined by the Dept. of the Army; Health Affairs and TRICARE which include quantity limits and formulary/Non-formulary designations.
FORMULARY INDEX
Therapeutic Category – page # Therapeutic Category – page#
Alzheimers/Dementia - 4
Analgesics/Anti-Inflammatory/Opioids - 4
Anti-Anxiety - 4
Anti-Coagulants/Blood Thinner (Circulation) - 4
Anti-Convulsants (Epilepsy,Parkinsons) - 5
Anti-Depressants / Bipolar - 5
Anti-Emetics (Nausea/Vomiting) - 5
Anti-Histamine/Decongestant/Cough/Allergy - 5, 6
Anti-Microbials(Antibiotics/Bacteria/ Fungal/ Parasitic/Viral) -6,7
Anti-Psychotics (Psychiatrics) - 7
Anti-Rheumatics (Arthritis/RheumatoidArthritis) -7
Attention Deficit/Narcolepsy - 7
Attention Deficit/Non-Stimulants - 7
Cholesterol/Lipid Lowering - 7
Contraceptives (Birth Control) – 8, 9
Corticosteroids- Oral - 9
Dental Agents - 9
Diabetic Agents & Supplies - 9
Diuretic (Fluid Retention) - 10
Dry Mouth - 10
Electrolyte Replacement - 9 Emergency Meds (Insect Sting/Substance Abuse)- 10
Erectile Dysfunction - 10
Fertility Medication - 10
Gastro-IntestinalAgents (Acid Reflux/Heartburn)- 10
G-I Agents Other (GI Prep kits/IBS/Gall Bladder/etc)- 10,11
Genito-Urinary Agents (Bladder/Prostate) -11
Gout Agents - 11
Hormones (Estrogen/Progestin/Testosterone) - 11
Hypertensive/Cardiac(Blood Pressure/Heart)- 12,13
Immunologic/Biologic(RA/Psoriasis/Crohn’s) - 13
Migraine Agents - 13
Multiple Sclerosis Agent -13
Muscle Relaxants - 13
Myesthenia Gravis - 13
Nasal Sprays/Rinses – 14 Neurological Agent (Nerve Pain/Restless Leg) - 14
Oncology/Cancer - 14 Ophthalmics (Eye Care) - Antibiotics/Antivirals - 14
Ophthalmics (Eye Care)- (Glaucoma/allergy/etc) -14, 15
Osteoporosis/Bone Loss - 15
Otic (Ear Care) Preparations - 15
Prostate Medication - 15
Respiratory- 16
Sedative Hypnotics (Sleep Aids) - 16
Smoking Cessation - 16
Thyroid/Anti-Thyroid Agents - 16
Topical Agents - 16, 17
Vaginal Preparations - 17
Vitamins and Minerals – 18
*Dye-free products are not stocked and are not available for order at this pharmacy*
4
Alzheimers / Dementia
Donepezil (Aricept equiv) 5mg; 10mg tabs
Memantine (Namenda equiv) immediate release tablets only – 5mg & 10mg (excludes Namenda XR)
Rivastigmine patch (Exelon equiv) 4.6mg/24 hrs; 9.5mg/24 hrs; 13.3mg/24 hrs patch
ANALGESICS / ANTI-INFLAMMATORY / OPIOIDS
Acetaminophen (Tylenol equiv) 325mg tabs
Acetaminophen elixir for Children (Tylenol Elixir equiv) 160mg/5ml
Acetaminophen w/ Codeine elixir (Tylenol w/Codeine Elixir equiv) 120mg/12mg per 5mls *controlled substance**
Acetaminophen w/ Codeine #3 (Tylenol#3 equiv) 300mg/30mg tabs *controlled substance*
Analpram HC (pramoxine/ 1%/HC 2.5%) cream
Arthrotec equiv (diclofenac/misoprostol) 75/200mg tabs
Aspirin (enteric coated and chewable) 81mg tabs; 325mg enteric-coated tabs
Celecoxib (Celebrex equiv) 100mg; 200mg caps
Diclofenac (Voltaren, Voltaren DR equiv) 75mg delayed-release tabs, 50mg immediate release tabs
Etodolac (Lodine, Lodine XL equiv) 400mg; 500mg; 500mg XL tabs
Fentanyl transdermal system (Duragesic equiv) 25; 50; 75; 100 mcg/hour patch *controlled substance*
Ibuprofen (Motrin equiv) 400; 600; 800mg tabs
Indomethacin (Indocin, Indocin SR equiv) 25mg; 50mg; 75mg SR caps
Ketorolac Tromethamine (Toradol equiv) 10mg tabs *maximum qty of #24 tabs*
Lidocaine (Lidoderm) Adhesive Patch 5% (700mg/patch) maximum 3 boxes/30 days
Meloxicam (Mobic equiv) 7.5mg; 15mg tabs
Mefenamic acid (Ponstel equiv) 250mg caps
Meperidine (Demerol equiv) – 50mg tabs only *controlled substance*
Morphine immediate release oral (MSIR equiv) 15mg; 30mg tabs *controlled substance*
Morphine sustained-release (Ms Contin equiv) 15mg; 30mg; 60mg; 100mg; 200mg tabs *controlled substance*
Nabumetone (Relafen equiv) 500mg; 750mg tabs
Naproxen immediate-release (Naprosyn; Anaprox DS equiv) 250mg; 375mg; 500mg; 550mg tabs
Hydrocodone/Acetaminophen (Norco tabs equiv) 5/325mg; 7.5/325mg; 10/325mg tabs *controlled substance*
Hydrocodone /Acetaminophen (Norco liquid equiv) 7.5/325mg per 15ml (tablespoonful) *controlled substance*
Oxycodone immediate-release (Roxicodone, Oxy IR equiv) 5mg; 10mg; 15mg;, 20mg; 30mg tabs *controlled substance*
Oxycodone sustained-release (Oxycontin equiv) 10mg; 15mg; 20mg; 30mg; 40mg; 60mg; 80mg tabs *controlled substance*
Oxycodone/Acetaminophen (Percocet equiv) 5/325mg; 7.5/325mg; 10/325mg tabs *controlled substance*
Piroxicam (Feldene equiv) 10mg; 20mg caps
Salsalate (Disalcid equiv) 500mg tabs
Sulindac 200mg tabs
Tramadol (Ultram equiv) Immediate-Release only 50mg; QTY LIMIT: 30-day limit for controlled substances; Excludes Tramadol ER
Ultracet equiv (Tramadol/Acetaminophen) 37.5mg/325mg; QTY LIMIT: 30-day limit/controlled substance; maximum of 240 tabs/30 days
Anti-Anxiety
Buspirone (Buspar equiv) 5mg; 10mg 15mg tabs
Clonazepam oral (Klonopin) 0.5mg; 1mg; 2mg tabs *controlled substance*
Clorazepate oral (Tranxene) 7.5mg tabs only *controlled substance*
Diazepam (Valium) 2mg; 5mg tabs *controlled substance*
Hydroxyzine HCL oral (Atarax) 10mg; 25mg tabs
Hydroxyzine Pamoate (Vistaril equiv) 25mg caps
Chlordiazepoxide/Clidinium (Librax equiv) 5mg/2.5mg caps
Lorazepam (Ativan) 0.5mg, 1mg, 2mg tabs *controlled substance*
Anti-Coagulants - (Circulation/Blood Thinners)
Apixaban (Eliquis) 2.5mg; 5mg tabs
Cilostazole (Pletal equiv) 50mg; 100mg tabs
Clopidogrel (Plavix) 75mg tabs
Dipyridamole (Persantine equiv) 25mg tabs
Enoxaparin (Lovenox equiv) 30mg; 40mg; 60mg; 80mg; 100mg; 120mg; 150mg injection
Pentoxifylline (Trental) 400mg tabs Prasugrel (Effient) 10mg tabs
Rivaroxaban (Xarelto) 10mg; 15mg; 20mg tabs
Ticagrelor (Brilinta) 60 mg, 90 mg tabs
Warfarin sodium (GENERIC only) all strengths
5
Anti-Convulsants/ Epilepsy/Parkinson
Amantadine (Symmetrel equiv) 100mg caps
Benztropine (Cogentin equiv) 0.5mg; 2mg tabs
Carbamazepine (Tegretol equiv) 100mg; 200mg tabs
Carbamezapine XR (Tegretol XR equiv) 100mg; 200mg; 400mg tabs
Carbamezapine Suspension (Tegretol Suspension equiv) 100mg/5ml
Clonazepam (Klonopin equiv) 0.5mg; 1mg; 2mg tabs *controlled substance*
Clorazepate (Tranxene equiv) 7.5mg tabs only *controlled substance*
Diazepam (Valium equiv) 2mg; 5mg tabs *controlled substance*
Divalproex (Depakote, Depakote ER, Depakote Sprinkles equiv) 250mg SR; 250mg ER and 500mg ER; 125mg sprinkles
Lacosamide (Vimpat) tablets all strengths – QTY limit – controlled substance
Lamotrigine (Lamictal equiv) 25mg; 50mg; 150mg; 200mg tabs and 5mg; 25mg Chewtabs
Leviteracetam (Keppra equiv) 250mg; 500mg; 750mg; 1000mg; 500mg XR; 750mg XR tabs
Oxcarbazepine (Trileptal) 150mg; 300mg; 600mg tabs
Phenobarbital 32.4 mg tabs *controlled substance*
Phenytoin (Dilantin brand only) 30mg; 100mg caps; 50mg chew tabs; 125mg/5ml suspension
Primidone (Mysoline) 50mg; 250mg tabs
Rasagiline (Azilect) 0.5mg, 1mg tabs
Sinemet equiv (Carbidopa/Levodopa) – Immediate-release 10/100, 25/100, 25/250mg tabs
Sinemet ER equiv (Carbidopa/Levodopa ER) 25/100mg; 50/200mg tablet
Stalevo equiv (Carbidopa-Levodopa-Entacapone) all strengths tabs
Topiramate (Topamax equiv) 25mg; 50mg; 100mg; 200mg tabs; and 15mg & 25mg sprinkle capsules
Trihexyphenidyl (Artane equiv) 2mg tabs
Zonisamide (Zonegran equiv) 25mg; 100mg caps **allergy alert - this is a SULFA drug**
Anti-Depressants / Bipolar
Amitriptyline (Elavil) 10mg; 25mg; 50mg; 100mg tabs Bupropion SR (Wellbutrin SR equiv) 100mg; 150mg tabs
Bupropion XL (Wellbutrin XL equiv) 150mg; 300mg tabs
Citalopram (Celexa equiv) 10mg; 20mg; 40mg tabs
Doxepin (Sinequan equiv) 10mg; 25mg; 50mg caps
Duloxetine (Cymbalta equiv) 20mg; 30mg; 60mg caps
Escitalopram (Lexapro equiv) 10mg; 20mg tabs
Fluoxetine (Prozac equiv) 10mg; 20mg caps
Fluvoxamine (Luvox equiv) 50mg; 100mg caps (Excludes Luvox CR)
Imipramine (Tofranil equiv) 10mg; 25mg tabs
Lurasidone (Latuda) 20mg; 40mg; 60mg; 80mg tabs
Mirtazapine (Remeron equiv) 15mg, 30mg tabs
Nefazodone (Serzone equiv) 150mg; 200mg; 250mg tabs
Nortriptyline (Pamelor equiv) 10mg; 25mg caps
Paroxetine (Paxil equiv) 10mg, 20mg; 30mg tabs
Paroxetine CR (Paxil CR equiv) 25mg caps
Sertraline (Zoloft equiv) 25mg; 50mg; 100mg tabs
Trazodone (Desyrel equiv) 50mg; 100mg tabs
Venlafaxine Immediate-release (Effexor equiv) 25mg; 75mg tabs
Venlafaxine XR (Effexor XR equiv) 37.5mg; 75mg; 150mg caps
Anti-Emetics (Nausea/Vomiting)
Ondansetron liquid (Zofran equiv) 4mg/5ml
Ondansetron tablets (Zofran equiv) – 8mg oral tabs; 4mg ODT and 8mg ODT (Oral Disintegrating Tabs)
Prochlorperazine (Compazine equiv) – 5mg; 10mg tabs
Promethazine (Phenergan equiv) 25mg tabs
Promethazine liquid (Phenergan equiv) 6.25mg/5ml
Promethazine (Phenergan equiv) 12.5mg; 25mg suppositories
Scopolamine Base (Transderm Scop patch) 1.5mg/72hr (Motion sickness prevention only)
Anti-Histamines / Decongestants / Cough Suppressants / Allergy
Benzonatate Perles (Tessalon equiv) 100mg
Brompheniramine/Pseudoephedrine (Bromfed DM liquid equiv) 2/30/10mg per 5ml **Limit 1 mo. w/refills**
Cetirizine liquid (Zyrtec liquid for Children) 5mg/5ml
Cetirizine (Zyrtec equiv) 10mg tabs only
Cetirizine-D (Zyrtec-D equiv) 12-hour *Available only in 12 count boxes*Limit 1 mo. w/refills**
6
Anti-Histamines / Decongestants / Cough Suppressants / Allergy cont.
Brompheniramine/Pseudephedrine (Lodrane –D equiv) 12/120mg tabs **Only available in 60 count btl***Limit 1 mo. w/refills**
Chlorpheniramine (Chlortrimeton equiv) 4mg tabs
Cyproheptadine liquid (Periactin equiv) 4mg tabs and 2mg/5ml oral solution
Diphenhydramine liquid (Benadryl equiv) – 25mg caps and 12.5ml/5ml
Fexofenadine (Allegra equiv) 60mg 180mg tabs
Fexofenadine liquid (Children’s Allegra equiv) 30mg/5ml suspension
Fexofenadine/Pseudoephedrine (Allegra-D 12-hr equiv ) 60/120mg tab**Only available in 30 count boxes**Limit 1 mo. w/refills**
Hydrocodone/Chlorpheniramine (Tussionex equiv ) 10/8mg suspension –**Max qty of 4 ounces (115ml) dispensed**controlled substance
Hydroxyzine (Atarax) 10mg; 25mg tabs and 10mg/5ml liquid
Guaifenesin sustained release (Mucinex equiv) 600mg tabs only
Guaifenesin (Robitussin-generic) 100mg/5ml syrup
Guaifenesin/Dextromethorphan (Robitussin DM-generic) 100mg/5mg per 5ml syrup
Guaifenesin/Codeine (Cheratussin AC) syrup *controlled substance*
Guaifenesin/Codeine/pseudoephedrine (Cheratussin DAC) syrup *controlled substance*
Guaifenesin/Pseudoephedrine (Mucinex-D 12 hour equiv) 600mg/60mg tabs **Only available in 36 count boxes***Limit 1 mo. w/refills*
Loratadine (Claritin equiv) 10mg Swallow tablets and Children’s Oral solution 5mg/5ml
Loratadine/Pseudoephedrine (Claritin-D equiv) 10/240mg tabs 24-hr **Only available in 15 count boxes** Limit 1 mo. w/refills**
Meclizine (Antivert) 25mg tabs
Montelukast (Singular equiv) – 4mg granules; 4mg & 5mg chewtabs; 10mg tabs
Phenylephrine (Sudafed PE) 10mg tabs
Phenylephrine/Chlorpheniramine/Acetaminophen/ (Norel AD equiv) 10/4/325mg tabs
Phenylephrine, Dextromethorphan, Acetaminophen (DayQuil) 5/10/325mg caps
Phenylephrine, Dextromethorphan, Acetaminophen, Doxylamine (NyQuil Severe Cold and Flu) 5/10/325/6.25mg caplets
Promethazine w/DM syrup (Phenergan DM Syrup generic)
Pseudoephedrine (Sudafed) 60mg tablets only (by prescription only)
Anti-Microbials (Antibiotics, Anti-Virals, Antifungals, Antiparasitic)
Acyclovir (Zovirax equiv) 200mg tabs and 400mg caps
Albendazole (Albenza eqiuv) 200mg tabs
Amantadine (Symmetrel equiv) 100mg caps
Amoxicillin (Amoxil) 250mg; 500mg; 875mg tabs/caps
Amoxicillin (Amoxil) 250mg/5ml; 400mg/5ml suspension
Amoxicillin/clavulanate (Augmentin equiv) 250mg; 500mg; 875mg tabs and 1000mg XR tabs
Amoxicillin/clavulanate (Augmentin equiv) 200mg/5ml; 250mg/5ml; 400mg/5ml; 600mg/5ml suspension
Azithromycin (Zithromax, Zpack equiv) 250mg tabs and 100mg/5ml; 200mg/5ml suspension
Cefprozil (Cefzil) 250mg tabs or 250mg/5ml suspension
Cefuroxime (Ceftin) tablets only
Cephadroxil (Duricef equiv) 500mg caps
Cephalexin (Keflex equiv) 250mg; 500mg caps
Cephalexin (Keflex equiv) 250mg/5ml suspension
Cefdinir (Omnicef equiv) 300mg caps only
Cefdinir (Omnicef equiv) 125mg/5ml; 250mg/5ml suspension
Ciprofloxan (Cipro equiv) 250mg; 500mg tabs
Clarithromycin (Biaxin & Biaxin XL equiv) 500mg tabs and 250mg/5ml suspension
Clindamycin (Cleocin equib) 150mg; 300mg caps and 75mg/5ml oral suspension
Dapsone 25mg; 100mg tabs
Dicloxacillin oral (Dynapen equiv) 250mg caps
Doxycycline Hyclate (Vibramycin equib) 20mg; 100mg oral tabs/cap (excludes Doryx extended release)
Doxycycline Monohydrate (Monodox equiv) 50mg; 100mg caps
Doxycycline, USP (ORACEA equiv) 40mg caps for ACNE
Erythromycin (Erythrocin equiv) and ERYC delayed release 250mg caps/tabs
Ethanbutol (Myambutol) 400mg tabs
Famcyclovir (Famvir equiv) 250mg; 500mg tabs
Fluconazole (Diflucan equiv) 100mg; 150mg; 200mg tabs
Griseofulvin oral (Gris-peg equiv) 250mg ultramicrosize tabs; 125mg/5ml microsize oral suspension.
Isoniazid oral (INH) 100mg; 300mg tabs
Ivermectin 3mg tabs
Ivermectin (Sklice equiv) 0.5% Lotion
Itraconazole (Sporonox eqiuv) 200mg caps
Levofloxacin (Levaquin equiv) 250mg; 500mg; 750mg tabs
Methenamine (Hiprex, Urex) 1gm tabs
Metronidazole (Flagyl) 250mg; 500mg tabs
Minocycline (Minocin) 50mg; 100mg caps
Naftifine (Naftin equiv) 2% cream
Nitrofurantoin USP (Macrodantin equiv) 50mg caps and Nitrofurantoin Monohydrate/Macrocyrstals (Macrobid equiv) 100mg caps
7
Anti-Microbials (Antibiotics, Anti-Virals, Antifungals, Antiparasitic) cont.
Nystatin 500,000U oral tabs (does not include Mycostatin Pastilles)
Penicillin VK (Pen VK) 250mg; 500mg tabs and 250mg/5ml suspension
PrevPac (H.pylori) equiv
Rifampin (Rifadin equiv) 300mg caps
Sulfamethoxazole/trimethoprim (Bactrim DS/Septra DS equiv) 160mg/800mg tabs and 200mg/40mg per 5ml pediatric suspension
Terbinafine (Lamisil equiv) 250mg tabs and cream
Tetracycline 250mg caps
Trimethoprim (Proloprim) 100 mg tabs
Valacyclovir (Valtrex equiv) 500mg; 1gm tabs
Antipsychotics (Psychiatrics) Aripiprazole (Ability) all strengths
Chlorpromazine (Thorazine equiv) 25mg; 50mg tabs
Lithium (Lithobid equiv) 300mg tabs/caps and 300mg XR, 450mg XR tabs
Lurasidone (Latuda equiv) 40mg; 60mg tabs
Olanzapine (Zyprexa equiv) 2.5mg; 5mg; 10mg tabs
Quetiapine (Seroquel and Seroquel XR equiv) all strengths for both
Risperidone (Risperdal equiv) 0.25mg; 0.5mg; 1mg; 2mg; 4mg tabs
Ziprasidone (Geodon equiv) 20mg; 40mg; 60mg; 80mg tabs
Anti-rheumatics (Arthritis/Rheumatoid Arthritis)
Azathioprine (Imuran equiv) 50mg tabs
Hydroxychloroquine (Plaquenil equiv) 200mg tabs
Humira (Adalimumab) 40mg injection (2 injections per box)
Leflunomide (Arava equiv) 20mg tabs
Attention Deficit/Narcolepsy/STIMULANT
**Per AR 40-3 Adderal (amphetamine) will not be dispensed to prevent drowsiness**
Adderall (mixed amphetamine salts equiv) 5mg; 10mg; 20mg; 30mg tabs *controlled substance*
Adderall XR (mixed amphetamine equiv) 5mg; 10mg; 20mg; 25mg; 30mg tabs *controlled substance*
Armodafinil (Nuvigil) 50mg; 150mg; 200mg; and 250mg tabs *controlled substance*
Dexmethylphenidate IR (Focalin IR) 5mg; 10mg tabs *controlled substance*
Dextroamphetamine (Dexedrine equiv) 5mg caps and 5mg; 10mg; 15mg spansules *controlled substance*
Methylphenidate (Ritalin, Concerta equiv) 5mg; 10mg; 20mg tabs *controlled substance*
Methylphenidate LA (Ritalin LA equiv) GENERIC ONLY 20mg; 30mg; 40mg caps *controlled substance*
Methylphenidate XR (Quillivent XR Reconstitute equiv) 5mg/ml suspension *ordered upon request only-requires 3 business days)
Modafinil (Provigil) 100mg & 200mg tabs *controlled substance*
Attention Deficit/NON-STIMULANT
Atomoxetine (Strattera equiv) all strengths caps
Clonidine ER (Kapvay ER) 0.1mg
Guanfacine ER (Intuniv equiv) 1mg; 2mg; 3mg 4mg tabs
Cholesterol / Lipid Lowering
Atorvastatin (Lipitor) 10mg; 20mg; 40mg; 80mg tabs
Cholestyramine (Questran equiv) powder cans
Colestipol (Colestid equiv) 1gm tabs
Ezetimibe (Zetia equiv) 10mg tabs
Fenofibrate (Triglide equiv) 160mg tabs (only)
Fenofibrate Nanocrystallized (Tricor equiv) 48mg; 54mg; 145mg tabs (excludes Trilipix delayed release)
Fish Oil (Omega 3 Fatty Acid) 1000mg caps {NOT equiv. to Lovaza}
Gemfibozil (Lopid equiv) 600mg tabs
Niacin SR (Niaspan equiv) 500mg; 750mg; 1000mg extended-release tabs
Pravastatin (Pravachol equiv) 10mg; 20mg; 40mg; 80mg tabs
Rosuvastatin (Crestor equiv) 10mg; 20mg; 40mg tabs
Simvastatin (Zocor equiv) 5mg; 10mg; 20mg; 40mg; 80mg tabs
8
Contraceptives (Birth control)
LOW-DOSE MONOPHASIC
Product Estrogen Progestin
Orsythia Lutera Sronyx
Ethinyl Estradiol 20 mcg Levonorgestrel 0.1 mg
Gildess FE 1/20 Junel FE 1/20
Microgestin FE 1/20 Trina FE 1/20
Ethinyl Estradiol 20 mcg Norethindrone 1 mg
Levora Ethinyl Estradiol 30 mcg Levonorgestrel 0.15 mg
Cryselle-28 Elinest – 28
Low-Orgestrel-28 Ethinyl Estradiol 30 mcg Norgestrel 0.3 mg
Junel FE 1.5/30 Ethinyl Estradiol 30 mcg Norethindrone 1.5 mg
Apri Ethinyl Estradiol 30 mcg Desogestrel 0.15 mg
Ocella; Safyral; Syeda; Yasmin; Zarah Ethinyl Estradiol 30 mcg Drospirenone 3 mg
Zovia 1/35E Ethinyl Estradiol 35 mcg Ethynodiol Diacetate 1 mg
Estarylla; Mono-Linyah; MonoNessa; Ortho-Cyclen; Preifem, Sprintec
Ethinyl Estradiol 35 mcg Norgestimate 0.25 mg
Alyacen 1/35; Cyclafem 1/35; Dasetta 1/35; Necon 1/35-28;
Norinyl 1/35; Nortrel 1/35; Pirmella 1/35
Ethinyl Estradiol 35 mcg Norethindrone 1 mg
HIGH-DOSE MONOPHASIC
Product Estrogen Progestin
Ogestrel 0.5/50-28 Ethinyl Estradiol 50 mcg Norgestrel 0.5 mg
Kelnor; Zovia 1/50E-28 Ethinyl Estradiol 50 mcg Ethynodiol Diacetate 1 mg
TRIPHASIC
Product Estrogen Progestin
Trinessa Lo Ortho Tri-Cyclen Lo
Ethinyl Estradiol 25 mcg
Norgestimate:
0.18 mg x 7 days
0.215 mg x 7 days
0.25 mg x 7 days
Caziant; Cyclessa Velivant
Ethinyl Estradiol 25 mcg
Desogestrel:
0.1 mg x 7 days
0.125 mg x 7 days
0.15 mg x 7 days
Trivora Myzilra
Levonest Enpresse
Ethinyl Estradiol:
30 mcg x 6 days
40 mcg x 5 days
30 mcg x 10 days
Levonorgestrel:
0.05 mg x 6 days
0.075 mg x 5 days
0.125 mg x 10 days
TriNessa Ethinyl Estradiol 35 mcg
Norgestimate:
0.18 mg x 7 days
0.215 mg x 7 days
0.25 mg x 7 days
Aranelle; Leena; Tri-Norinyl
Ethinyl Estradiol 35 mcg
Norethindrone:
0.5 mg x 7 days
1 mg x 9 days
0.5 mg x 5 days
Alyacen 7/7/7; Cyclafem 7/7/7; Dasetta 7/7/7; Necon 7/7/7; Nortrel 7/7/7; Pirmella 7/7/7
Ethinyl Estradiol 35 mcg
Norethindrone:
0.5 mg x 7 days
0.75 mg x 7 days
1 mg x 7 days
EXTENDED CYCLE
Product Estrogen Progestin
Jolessa Introvale; Quasense
Ethinyl Estradiol 30 mcg x 84 days Levonorgestrel 0.15 mg x 84 days
Gianvi; Loryna; Nikki; Vestura; Yaz
Ethinyl Estradiol 20 mg x 24 days Drosperidone 3 mg x 24 days
9
Contraceptives (Birth control) cont.
PROGESTIN ONLY PILLS
Product Progestin
Nora-BE (Camila, Errin, Heather, Jencycla, Jolivetta, Lyza,
Ortho Micronor)
Norethindrone 0.35 mg
Contraceptive Alternatives
Nuvaring (estonogestrel/Ethinyl Estradiol) vaginal ring
Xulane Patch (equiv to Ortho Evra)
Contraceptive (Emergency)
Ella (Ulipristal Acetate) 30mg *dispensing limitations*
Plan – B (Levonorgestrel 1.5mg) *dispensing limitations*
Corticosteroids – Oral
Budesonide (Entocort equiv) 3mg caps (Crohn’s Disease) Dexamethasone (Decadron equiv) 0.5mg, 0.75mg; 1.5mg, 4mg tabs and DexPak 1.5mg tabs (6-day, 10-day, 13-day pack)
Fludrocortisone (Florinef equiv) 0.1mg tabs
Methylprednisolone (Medrol, Medrol Dose Pack equiv) 4mg tabs
Prednisone (Deltasone equiv) 5; 10; 20mg tabs
Prednisolone (Pediapred, Prelone equiv) 5mg/5ml; 15mg/5ml liquid
Dental Agents
Chlorhexidine oral rinse (Peridex, PerioGard)
Sodium Fluoride (PreviDent 5000 Plus) 1.1% paste Spearmint
Triamcinolone (Kenalog-in-Orabase) paste
Viscous Lidocaine (Xylocaine) 2% oral gel 100ml
Diabetic Agents/Supplies Alcohol pads Box of 100
Acarbose (Precose) 50mg tabs
Exenatide (Bydureon) 2mg SQ pen (4 injections per box) REQUIRES PRIOR AUTHORIZATION FORM
Exenatide ER (Bydureon BCise 2mg SQ pen (4 injections per box) REQUIRES PRIOR AUTHORIZATION FORM
Empagliflozin (Jardiance) 10mg; 25mg tab
Glucometer Free Style Lite (only one type of meter on formulary)
Glucometer Strips Free Style Lite test strips
Lancets (generic)
Glimepiride (Amaryl equiv) 2mg; 4mg tabs
Glipizide IR (Glucotrol immediate-release equiv) 5mg; 10mg tabs
Glipizide XL (Glucotrol XL equiv) 5mg; 10mg XL tabs
Glucogon Emergency Injectable Kit #1
Glyburide (Micronase) 0.25mg; 5mg tabs
Insulin aspart (Novolog & Novolog mix) vials and Flexpens
Insulin detemir (rDNA origin) (Levemir) vials only
Insulin glargine (rDNA origin) Lantus Vials and Solostar pens
Insulin human 70/30 NPH and Regular vials
Insulin Lispro (HUMALOG) vials, Kwikpen,
Insulin Lispro MIX 75/25 (Humalog Mix) Kwikpen
Insulin PEN Needles Short – 1/4” (6mm) length, 32 gauge
Metformin (Glucophage equiv) 500mg; 850mg; 1000mg tabs
Metformin XR (Glucophage XR equiv) 500mg and 750mg XR tabs (Excludes 1000mg XR)
Metformin/Glyburide (Glucovance) 1.25mg/250mg; 2.5mg/500mg; 5mg/500mg tabs
Nateglinide (Starlix) 60mg; 120mg tabs
Pioglitazone (Actos equiv) 15mg; 30mg; 45mg tabs
Sitagliptin (Januvia) 25mg; 50mg; 100mg tabs
Sitagliptin/Metformin (Janumet) 50/500mg; 50/1000mg tabs
Sitagliptin/Metformin XR (Janumet XR) 50/500mg; 50/1000mg; 100/1000mg tabs (once daily dosing)
Syringes, Insulin - Available in 1/2cc and 1cc, ½” 30G
10
Diuretics (Fluid Retention)
Bumetanide (Bumex) 1mg tabs
Chlorthalidone (Hygroton) 25mg; 50mg tabs
Furosemide (Lasix equiv) 20mg; 40mg tabs
Hydrochlorothiazide (HCTZ) 12.5mg tabs; 25mg tabs; 50mg tabs
Hydrochlorothiazide/triamterene (Maxzide equiv) 25mg/37.5mg; 50mg/75mg tabs
Indapamide (Lozol equiv) 1.25mg; 2.5mg tabs
Metolazone (Zaroxolyn equiv) 2.5mg; 5mg tabs
Spironolactone (Aldactone equiv) 25mg; 50mg tabs
Torsemide (Demadex equiv) 5mg; 20mg tabs
Dry Mouth
Biotene Dry Mouth Oral Rinse 1 liter bottles
Cevimeline (Evoxac) 30mg caps
Electolyte Replacement
Magnesium Oxide (MagOx) 400mg tabs
Potassium chloride (KDur, Klor) 8 mEq;, 10mEq; 20mEq tabs
Potassium chloride powder for solution (KLor 20mEq packets) 100 packets/box
Emergency Kit (Insect Sting / Substance Abuse)
Glucagon Emergency Kit
Insect sting kit (Epi-Pen and Epi-pen Jr.) **Pharmacy needs to annotate allergy on file** (Manufacture shortage check with pharmacy)
Naloxone (Narcan equiv) Nasal Spray
Naltrexone (Naltrexone) 50mg tabs
Erectile Dysfunction
Sildenafil (Viagra equiv) 25mg; 50mg; 100mg tabs (Limit 6 tabs/month –Maximum 3 months/18 tabs)
Fertility Drugs
Clomiphene (Clomid equiv) 50mg tabs
Gastrointestinal Reflux Disease (GERD) Agents/Acid Reflux/Heartburn/Gas
Cimetidine (Tagamet equiv) 300mg; 400mg tabs
Famotidine (Pepcid equiv) 20mg; 40mg tabs
Omeprazole (Prilosec equiv) 20mg; 40mg caps
Omeprazole (FIRST-Omeprazole KIT) 2mg/ml suspension
Pantoprazole (Protonix equiv) 20mg; 40mg tabs
Rabeprazole (Aciphex equiv) 20mg tabs
Simethicone 80mg chew tabs
Gastrointestinal Agents (GI Prep Kits/ Diarrhea/Constipation/IBS/Crohn’s/Gallbladder)
Budesonide (Entocort equiv) 3mg caps (for Crohn’s disease)
Chlordiazepoxide/clidinium (Librax equiv)
Colyte / Golytely Bowel Prep **See other Bowel Prep kits below*
Dicyclomine (Bentyl equiv) 10mg caps; 20mg tabs
Docusate sodium (Colace equiv) 100mg caps
Flavoxate (Urispas equiv) 100mg tabs
Hyoscyamine (Levsin, LevBid equiv) 0.125mg SL; 0.375 tabs
Lactulose (Cephulac equiv) Syrup 10gm/15ml
Linaclotide (Linzess equiv) 145mcg; 290mcg tabs
Lomotil (diphenoxylate/atropine) 2.5mg/0.025mg tabs *controlled substance*
Loperamide (Imodium equiv) 2mg caps
Lubiprostone (Amitiza equiv) 8mcg, 24mcg tabs
Mesalamine (Lialda equiv) 1.2G delayed release
Miralax equiv (propylene glycol 3350) powder for suspension (Max Qty Limit = 1 x 527gm bottle per 30 days) 17gm/dose
11
Gastrointestinal Agents (GI Prep Kits/ Diarrhea/Constipation/IBS/Crohn’s/Gallbladder)
Metoclopramide (Reglan equiv) 10mg tablets
Misoprostol (Cytotec equiv) 200mg tabs
Moviprep Bowel Prep kit
Naldemidine (Symproic) 0.2mg tabs (opioid induced constipation)
Pancrelipase (Creon equiv) delayed release capsules 3000mg; 6000mg; 12,000mg; 24,000mg; 36,000mg caps
Prochlorperazine (Compazine equiv) – 5mg tabs
Prepopik Bowel Prep kit
Ranitidine (Zantac equiv) 300mg; 400mg (Excludes EFFERdos or GELdose)
SuPrep Bowel Prep Kit
Sucralfate (Carafate equiv) 1gm tabs and 1gm/10ml suspension
Ursodiol (Actigal equiv) 300mg; 500mg caps
Gastrointestinal Agents (Other)
Probiotic (Culturelle) (Lactobacillus Rhamnosus GG) one tab daily max – no refrigeration required; contains 15 Billion Units CFUs. >12yo
Genitourinary Agents (Bladder/Prostate)
Alfuzosin (Uroxatral equiv) 10mg tabs
Doxazosin (Cardura equiv) 2mg; 4mg; 8mg tabs
Desmopressin (DDAVP equiv) Nasal spray
Desmopressin (DDAVP equiv) 0.1mg; 0.2mg tabs
Oxybutynin (Ditropan equiv) 5mg Immediate-Release tabs
Oxybutynin XL (Ditropan XL equiv) 5mg; 10mg XL tabs
Prazosin (Minipres equiv) 1mg; 2mg; 5mg caps
Phenazopyridine (Pyridium equiv) 100mg; 200mg tabs
Potassium Citrate (Urocit-K) 5 mEq; 10 mEq; 15 mEq tabs
Solifenacin (Vesicare equiv) 5mg; 10mg tabs
Tamsulosin (Flomax equiv) 0.4mg caps
Terazosin (Hytrin equiv) 1mg; 2mg; 5mg; 10mg caps
Tolterodine LA (Detrol LA equiv) 2mg; 4mg caps (Excludes immediate-release tabs)
Urogesic Blue equiv (hyoscyamine/methenamine/methylene blue/NaPhosphate) tabs
Ustell equiv (methanamine/NaPhosphate/phenylsalicylate/methylene blue/hyoscyamine) caps
Gout Agents
Allopurinol (Zyloprim equiv) 100mg; 300mg tabs
Colbenemid equiv (colchicine/probenecid) 0.5mg/500mg tabs
Colchicine 0.6mg only
Probenecid (Benemid equiv) 500mg tabs
Hormones – Estrogen/ Progestin/Testosterone
Activella equiv (estradiol & norethindrone) 0.5mg/0.1mg; 1mg/0.5mg tabs
Prempro equiv (conjugate estrogens/medroxyprogesterone acetate) 0.3/1.5; 0.45/1.5; 0.625/2.5; 0.625/5mg tabs
Combipatch equiv (estradiol/norenthindrone) 50/140mcg (0.05/0.14mg) ; 50/250mcg (0.05/0.25mg) patch
Conjugated estrogens (Premarin equiv) 0.3mg; 0.45mg; 0.625mg; 0.9mg;1.25mg tabs
Conjugated estrogens (Premarin Vaginal Cream equiv) vaginal cream
Estradiol (Estrace Vaginal Cream equiv) vaginal cream
Estradiol (Vagifem equiv) 10mcg vaginal tab
Estradiol 2mg Ring (ESTRING equiv)
Estradiol patch equiv (Alora Patch: 0.05mg; 0.1mg) Twice-a-week dosing
Estradiol patch equiv (Climara Patch) Once-a-week dosing
Estradiol (Estrace equiv) 0.5mg; 1mg; 2mg tabs
Estradiol (Minivelle; Vivelle Dot- transdermal equiv) 0.1mg/24hr patch
Estratest equiv (Estradiol/Methyltestosterone) tablets *controlled substance*
Medroxyprogesterone (Provera equiv) 5mg; 10mg tabs
Progesterone (Prometrium equiv) 100mg; 200mg caps
Testosterone Cypionate (Depo-Testosterone) 200mg/ml injectable (Enanthate is EXCLUDED) *controlled substance*
Testosterone Gel (Fortesta equiv) 60gm canister *controlled substance* 120 pumps/can
12
HYPERTENSIVE/CARDIAC MEDICATIONS (Blood Pressure/Heart)
Ace Inhibitors/Angiotensin II Blocker – all generic only
Benazepril (Lotensin equiv) 5mg; 10mg; 20mg; 40mg tabs
Captopril (Capoten) 25mg tabs
Enalapril (Vasotec equiv) 5mg; 10mg tabs
Fosinopril (Monopril equiv) 10mg; 20mg tabs
Irbesartan (Avapro) 150mg; 300mg
Irbesartan/HCTZ (Avalide) 150mg/12.5mg; 300mg/12.5mg
Lisinopril (Zestril, Prinivil equiv) 2.5mgl 5mgl 10mg; 20mg tabs
Lisinopril-HCTZ (Zestoretic equiv) 10/12.5; 20/12.5; 20/25mg tabs
Losartan (Cozaar equiv) 25mg; 50mg; 100mg tabs
Losartin-HCTZ (Hyzaar equiv) 50/12.5; 100/12.5; 100/25mg tabs
Ramipril (Altace equiv) 1.25mg; 2.5mg; 5mg; 10mg caps
Telmisartan (Micardis equiv) 20mg; 40mg; 80mg tabs
Telmisartan-HCT (Micardis/HCT equiv) 40/12.5; 80/12.5; 80/25mg tabs
Aldosterone Antagonists
Eplerenone (Inspra) 25mg; 50mg tabs
Spironolactone (Aldactone) 25mg; 50mg tabs
Alpha-1-Adrenergic Blocker
Doxazosin oral (Cardura equiv) 2mg; 4mg; 8mg tabs
Prazosin (Minipres equiv) 1mg; 2mg; 5mg caps
Terazosin (Hytrin equiv) 1mg; 2mg; 5mg; 10mg caps
Alpha/Beta-Adrenergic Blocker
Carvedilol (Coreg equiv) 3.125mg; 6.25mg; 12.5mg; 25mg tabs
Carvedilol CR (Coreg equiv) 10mg; 20mg; 40mg; 80mg caps
Antiadrenergic – Centrally Acting
Clonidine (Catapres) 0.1mg; 0.2mg; 0.3mg tabs
Clonidine (Catapress TTS) patches 0.1mg; 0.2mg; 0.3mg
Beta-Adrenergic Blockers – all generic only
Atenolol (Tenormin equiv) 25mg; 50mg tabs
Bisoprolol (Zebeta equiv) 5mg; 10mg tabs
Bisoprolol/ Hydrochlorothiazide (Ziac equiv) 5/6.25mg tabs
Labetalol (Normodyne) 100mg; 200mg tabs
Metoprolol (Lopressor equiv) 25mg; 50mg; 100mg tabs
Metoprolol Succinate (Toprol XL equiv) 25mg; 50mg; 100mg tabs
Nadolol (Corgard equiv) 40mg; 80mg tabs
Propranolol (Inderal, Inderal LA equiv) 10mg; 20mg; 40mg; 80mg tabs and 60mg; 80mg; 120mg; 160mg LA caps
Calcium Channel Blockers
Amlodipine (Norvasc equiv) tablets 2.5mg; 5mg; 10mg tabs
Amlodipine/Benazepril (Lotrel equiv) 2.5/10mg; 5/10mg; 5/20mg; 10/20mg, 5/40mg; 10/40mg caps
Diltiazem (Cardizem equiv) 30mg; 60mg; 90mg tabs
Diltiazem Sustained Release (Tiazac equiv) 120mg; 180mg; 240mg; 300mg; 360mg; 420mg SR caps
Felodipine (Plendil equiv) 2.5mg; 5mg; 10mg tabs
Nifedipine Sustained Release (Adalat CC equiv) 30mg; 60mg; 90mg SR tabs
Verapamil (Calan, Calan SR) 80mg; 180mg; 240 SR tabs (Excludes Verelan extended-release)
13
HYPERTENSIVE/CARDIAC MEDICATIONS (Blood Pressure/Heart)
Cardiac Agents
Amiodarone (Pacerone equiv) 200mg tabs
Digoxin (Lanoxin equiv) 0.125mg, 0.25 tabs
Dipyridamole (Persantine equiv) 0.25 tabs
Dronedarone (Multaq) 400mg tabs
Flecainide (Tambocor equiv) 50mg; 100mg; 150mg tabs
Magnesium Oxide (MagOx) 400mg tabs
Propafenone (Rythmol) 150mg, 225mg, 325mg caps
Ranolazine (Ranexa equiv) 500mg; 1,000mg tabs
Sotalol (Betapace equiv) 80mg; 120mg; 160mg; 240mg tabs
Combination
Amlodipine/Valsartan (Exforge equiv) 5/160mg; 5/320mg; 10/160mg; 10/320mg tabs
Amlodipine/Valsartan/HCTZ (Exforge HCT equiv) 5/12.5/160mg; 5/25/160mg; 10/12.5/160mg; 10/25/160mg; 10/25/320mg tabs
Vasodilators
Hydralazine oral (Apresoline equiv) 10mg; 25mg; 50mg tabs
Isosorbide dinitrate oral (Isordil equiv) 10mg tabs only
Isosorbide mononitrate (Imdur,Ismo equiv) 30mg; 60mg tabs
Minoxidil (Loniten) 2.5mg; 10 mg tabs
Nitroglycerin patches (Nitro-Dur equiv) 0.2mg; 0.4mg patches
Nitroglycerin sublingual (Nitrostat equiv tabs and sublingual spray)
Immunologics / Biologic Agent (Rheumatoid Arthritis/Psoriasis/Crohn’s)
Adalimumab (Humira) 40mg/0.8ml Pen Inj Kit & 40mg/0.8ml Syringe Kit *(limited to these two only)
Leflunomide (Arava equiv) 10mg; 20mg tabs
Mycophenolate (Cellcept equiv) 250mg caps and 500mg tabs
Tacrolimus (Prograf) 1mg caps
Migraine Agents
Acetaminophen/Butalbital/Caffeine (Fioricet equiv) 325/50/40mg tabs (only) *controlled substance*
Aspirin/Butalbital/Caffeine (Fiorinal equiv) 325/50/40mg caps/tabs *controlled substance*
Eletriptan (Relpax equiv) 20mg; 40mg tabs *Quantity limit: 12 tabs per 30 days*
Imitrex *generic only* Quantity limits : 25mg & 50mg tabs limited to 18 tabs/30 days ; 100mg tabs limited to 9 tabs/30 days
Imitrex Stat Dose equiv syringes Quantity limits : 8 syringes/30 days
Imitrex *generic only* Nasal spray 20mg per unit Quantity limits: 6 units per 30 days; 18 units per 90 days
Rizatriptan (Maxalt and Maxalt MLT equiv) 5mg; 10mg tabs Quantity limits: 12 tabs/30 days
Topiramate (Topamax equiv) tabs all strengths (excludes extended release tables)
Zolmitriptan (Zomig equiv) 5mg tabs only Quantity limits: 12 tabs/30days
Zolmitriptan (Zomig-ZMT equiv) 2.5mg; 5mg orally disintegrating tabs Quantity limit: 12 tabs/30 days
Multiple Sclerosis Agent
Interferon Beta-1b (Betaseron) 0.3mg *(vial or kit only on BCF)*
Muscle Relaxants
Baclofen (Lioresal equiv) 10mg tabs
Cyclobenzaprine (Flexeril equiv) 5mg; 10mg tabs
Metaxalone (Skelaxin equiv) 400mg; 800mg tabs
Methocarbamol (Robaxin equiv) 500mg; 750mg tabs
Tizanidine (Zanaflex equiv) 4mg tabs only
Myesthenia Gravis
Pyridostigmine (Mestinon equiv) 60mg caps
14
Nasal Sprays and Rinses
Azelastine (Astelin equiv) Nasal Spray (Excludes Astepro)
Budesonide (Rhinocort AQ equiv) Nasal Spray
Flunisolide (Nasalide equiv) nasal spray
Fluticasone (Flonase equiv) nasal spray
Ipratropium Bromide (Atrovent equiv) 0.03% and 0.06% nasal spray Saline (Ocean spray equiv) nasal spray
Saline Rinse (Neil-Med) Starter Kit contains reusable bottle and 50 prefilled packets
Saline Rinse (Neil-Med) Refill Kit contains 100 prefilled packets
Triamcinolone Acetonide (Nasacort) nasal spray- Alcohol free
Neurological Agents (Nerve Pain/Restless Leg Syndrome)
Gabapentin (Neurontin equiv) 100mg; 300mg; 400mg 600mg; 800mg caps
Pramipexole (Mirapex equiv) 0.125mg; 0.25mg; 0.5mg tabs (immediate release) only (for Restless Legs Syndrome)
Ropinirole (Requip equiv) (immediate release only) 0.25mg; 0.5mg; 1mg; 2mg; 3mg; 4mg; 5mg tabs
Oncology/Cancer
Antiandrogen
Bicalutamide (Casodex equiv) 50mg tab
Antiestrogen
Anastrazole (Arimidex equiv) 1mg tabs
Exemestane (Aromasin equiv) 25mg tabs
Letrozole (Femara equiv) 2.5mg tabs
Tamoxifen (Nolvadex equiv) 10mg; 20mg tabs
Antimetabolite/Folic Acid Antagonist
Methotrexate (Trexall equiv) 2.5mg tablets only (excludes injectable)
Eye Care: Ophthalmics – Antibiotics/Antivirals
Azasite (azithromycin equiv) 1% solution
Bacitracin ointment
Besifloxacin (Besivance) 0.6% Ophthalmic suspension (5ml)
Ciprofloxacin (Ciloxan equiv) ophthalmic drops and ointment
Erythromycin (Ilotycin equiv) ointment
Ganciclovir (Zirgan equiv) 0.15% GEL
Gentamycin (Garamycin equiv) drops and ointment
Moxifloxacin (Vigamox equiv) drops 0.5%
Neomycin/Polymyxin B sulfates/Gramicidin (Neosporin equiv) solution
Neomycin/Polymyxin B sulfates/Hydrocortisone (Cortisporin equiv) drops and ointment
Ofloxacin (Ocuflox equiv) 0.3% solution
Sulfacetamide (Sulamyd equiv) solution
Tobramycin (Tobrex equiv) drops and ointment
Tobramycin/Dexamethasone (Tobradex equiv) drops and ointment
Trimethoprim/Polymixin B (Polytrim equiv) drops
15
Eye Care: Ophthalmics – other (glaucoma, moisturizing, allergy, anti-inflammatory, other)
Atropine 1% solution 5ml bottle
Azelastine (Optivar) 0.05% solution
Betaxolol (Betoptic-S equiv) 0.25%; 0.5% drops
Bimatoprost (Lumigan equiv) 0.01% solution
Brimonidine (Alphagan-P) 0.1%; 0.15% and 0.2% drops
Brinzolamide/Brimonidine (Simbrinza equiv) 1%/0.2% drops
Carboxymethylcellullose (Refresh Celluvisc PF equiv) 30ct/box- Preservative Free
Diclofenac (Voltaren equiv) drops
Difluprednate (Durezol equiv) 0.05% drops
Dorzolamide (Trusopt equiv) drops
Fluorometholone (FML equiv) 0.1% suspension
Isopto Hyoscine (Scopolamine) drops
Ketorolac Tromethamine (Acular) 0.5% drops; no refills
Ketotifen (Zaditor equiv) 0.025% solution 5ml bottle
Latanoprost (Xalatan equiv) solution *Generic only* <must be refrigerated>
Levobunolol (Betagan equiv) 0.5% solution ONLY
Loteprednol etabonate (Alrex equiv) suspension
Loteprednol etabonate (Lotemax equiv) 0.5% gel only
LiquifilmTears equiv (1.4% polyvinyl alcohol / 0.5% chlorobutanol, NaCl) with preservatives only (drops)
Nepafenac (Ilevro equiv) 0.3% suspension (once daily dosage)
Nepafenac (Nevanac equiv) 0.1% suspension
Olopatadine HCL (Patanol equiv) 0.1% solution
Olopatadine HCL (Pazeo equiv) 0.7% solution
Pilocarpine 1%; 2%; 4% SOLUTION only
Prednisolone (Pred-Forte equiv) 1% solution 5ml bottle
Prednisolone (Pred-Mild equiv) 0.25% solution 5ml bottle
Sodium Chloride (Muro-128 equiv) 5% drops and 5% ointment
Timolol, Timolol GFS (Timoptic, Timoptic XE equiv) 0.25%; 0.5% solution
Timolol/Brimonidine (Combigan equiv) 0.2%/0.5% drops
Timolol/Dorzolamide (Cosopt Plus equiv) solution
Osteoporosis / Bone Loss
Alendronate (Fosamax equiv) 10mg; 35mg; 70mg tabs (Excludes Fosamax-D)
Calcitrol (Rocaltrol equiv) 0.25mcg; 0.5mcg caps
Calcitonin-salmon (Miacalcin Nasal spray equiv) - Store unopened bottle in fridge; open bottles at room temp & discard after 30 days
Ibandronate (Boniva equiv) 150mg tabs (once monthly)
Raloxifene (Evista equiv) 60mg tabs
Ear Care: Otic Preparations
Acetic Acid 2% Otic Solution
Carbamide peroxide (Debrox equiv) drops
Ciprofloxacin/Dexamethasone (Ciprodex equiv) drops
Fluocinolone (Dermotic) 0.1% solution
Neomycin/Polymixin B/Hydrocortisone (Cortisporin equiv) solution and suspension
Prostate Medication
Alfuzosin (Uroxatral equiv) 10mg tabs
Bicalutamide (Casodex equiv) 50mg tabs
Doxazosin (Cardura equiv) 2mg; 4mg; 8mg tabs
Finasteride (Proscar equiv) 5mg tabs
Tamsulosin (Flomax equiv) 0.4mg caps
Terazosin (Hytrin equiv) 1mg; 2mg; 5mg; 10mg caps
16
Respiratory (COPD, Asthma, Bronchodilator)-oral inhalers provided as HFA when available
Advair (Salmeterol/fluticasone) HFA and discus
Albuterol MDI (ProAir) HFA inhaler
Albuterol oral liquid
Albuterol nebulizer solution for inhalation 1.25mg/3ml; 2.5mg/3ml – 30 per box
Umeclidinium/Vilanterol (Anora Ellipta inhaler) 62.5mcg/25mcg MDI
Budesonide nebulizer solution for inhalation (Pulmicort Respules) 0.25mg; 0.5mg; 1mg vials **30 per box
Albuterol/Ipratropium (Combivent Respimat) inhaler *dosed 1 puff four times daily*
Albuterol/Ipratropium (Duoneb equiv) 3mg nebulizer solution for inhalation – 30 per box
Fluticasone oral inhaler (Flovent) HFA and diskus
Glycopyrrolate (Robinul) 1 mg tab
Ipatropium oral inhaler (Atrovent) MDI
Ipatropium (Atrovent) nebulizer solution for inhalation **30 per box**
Levalbuterol (Xopenex equiv) MDI inhaler
Levalbuterol (Xopenex equiv) 0.31mg/3ml, 0.63mg/3ml, 1.25mg/3ml nebulizer solution
Montelukast (Singulair) 10mg tabs and 4mg; 5mg chewable tabs and 4mg granules
Roflumilast (Daliresp) 500 mg tabs
Spacer (Aerochamber) and also Aerochamber w/mask (S, M, L)
Salmeterol (Serevent) discus
Terbutaline (Brethine) 2.5mg; 5mg tabs
Theophylline SR 200mg; 400mg; 600mg
Tiotropium (Spiriva) HandiHaler
Tiotropium (Spirivia) RESPIMAT *ONE inhaler per 30 DAYS* 1.25mg/actuation and 2.5mcg/actuation
Trelegy Ellipta (fluticasone furoate, umeclidinium & vilanterol) inhaler *dosed 1 puff daily*
Umeclidinium (Incruse Ellipta) 62/5mg MDI inhaler
Sedative Hypnotic Agents / Insomnia (Sleep Aids)
Eszopiclone (Lunesta equiv) 1mg; 2mg; 3mg tabs (30 day qty limit) *controlled substance*
Melatonin 1mg, 3mg tabs
Temazepam (Restoril equiv) 7.5mg; 15mg; 30mg caps (30 day qty limit) *controlled substance*
Trazodone (Desyrel equiv) 50mg; 100mg tabs
Zolpidem (Ambien equiv) 5mg; 10mg tabs *controlled substance-30 day supply w/refills* *Max 5mg for females*
Zolpidem (Ambien CR equiv) 6.25mg and 12.5mg *controlled substance-30 day supply w/refills*
Smoking Cessation Agents
Nicoderm Patches 7mg; 14mg; 21mg
Nicorette gum 50 pieces/box
Thyroid/Antithyroid Agents
Armour Thyroid 15mg; 30mg; 60mg; 90mg; 120mg (1/4gr, 1/2gr, 1gr, 1.5gr, 2 grain) tabs
Levothyroxine (Synthroid brand only) all strengths tabs (excludes: Tirosint capsules)
Liothyronine (Cytomel equiv) 5mcg; 25mcg; 50mcg tabs
Methimazole (Tapazole equiv) 5mg; 10mg tabs – for Hyperthyroidism
Propylthiouracil (PTU) 50mg tabs
Topical Agents
Acyclovir (Zovirax) 5% ointment
Adapalene (Differin) 0.1% gel
Adapalene/Benzoyl Peroxide (Epiduo gel equiv) 0.1/2.5% gel
Aluminum chloride hexahydrate (Drysol equiv)
Augmented Betamethasone Dipropionate (Diprolene AF equiv) cream 15 gram and 50 gram
Bacitracin topical ointment 30 gram
Betamethasone Valerate (Valisone equiv) 0.1% cream 15gm tube
Betamethasone (Topicort) 0.25% spray
Calcipotriene (Dovonex) cream and ointment
Calcipotriene/betamethasone (Taclonex) ointment
CeraVe Cream
Ciclopirox (Penlac equiv) 8% solution only
Clindamycin (Cleocin-T equiv) solution only 60 ml
Clindamycin gel, cream, lotion
Clindamycin/Benzoyl Peroxide (Duac gel equiv) 1.2/5% gel
17
Topical Agents cont.
Clobetasol cream (Temovate equiv) 0.05% cream/ointment/gel 15 gram; shampoo 118ml
Clobetasol Foam (Olux equiv)
Clotrimazole/Betamethasone dipropionate cream (Lotrisone equiv)
Colloidal Sulfur/Salicylic Acid (Sebex equiv) 2% Shampoo
Desonide (DesOwen equiv) cream
Diclofenac (Voltaren GEL equiv) 1% gel (only) –100gram
Diclofenac (PENNSAID equiv) 1.5% solution (**excluding 2% solution)
Erythromycin 1.5% solution *excludes pads*
Fluocinolone (Synalar equiv) 0.01% cream and solution
Fluocinolone (Synalar equiv) 0.025% cream and ointment
Fluocinonide (Lidex equiv) 0.05% cream; ointment; solution
Fluocinonide (Lidex equiv) 0.1% cream
Fluorouracil (Efudex equiv) 5% cream
Fluticasone (Cutivate ) cream and ointment
Gentamycin 0.1% (Garamycin equiv) cream
Halobetasol (Ultravate equiv) cream/ointment
Hydrocortisone 0.5%; 1%; 2.5% cream 2.5% lotion
Hydrocortisone Valerate (Westcort equiv) cream
Hydrocortisone (Anusol-HC equiv) rectal cream and suppositories
Hydrocortisone/Pramoxine (Proctofoam HC equiv) foam
Hydroquinone (Eldoquin equiv) 4% cream
Imiquimond (Aldara equiv) 5% cream Box of 24 single use packets
Ivermectin (Sklice equiv) 0.5% Lotion
Ketaconazole (Nizoral equiv) 2% Shampoo
Lidocaine 2% JELLY 30gram
Lidocaine 4% CREAM 30gram
Lidocaine 5% OINT 35gram
Lidocaine (Lidoderm) Adhesive Patch 5% (700mg/patch) maximum 3 boxes/30 days
Metronidazole (Metrocream equiv) 0.75% cream
Metronidazole (Metrogel equiv) gel
Mometasone (Elocon equiv) 0.1% cream
Mupirocin (Bactroban equiv) ointment and cream
Nystatin ointment & powder
Permethrin (Elimite equiv) cream
Pimecrolimus (Elidel equiv) cream
Pramoxine/Hydrocortisone (Analpram HC equiv) 1/2.5% cream
Prilocaine/Lidocaine (EMLA equiv) 2.5/2.5% cream 30gram
Selenium sulfide (Selsun equiv) 2.5% lotion (**excludes 1% Selsun Blue which is OTC)
Silver sulfadiazine (Silvadene equiv) cream
Sulfacetamide (Klaron equiv) 10% lotion
Tacrolimus (Protoptic equiv) 0.3% (<16yrs) and 0.1% (>15yrs) ointment
Tazarotene (Tazorac equiv) 0.1% gel
Terbinafine (Lamisil Equiv) 1% cream
Tretinoin (Retin-A equiv) CREAM only *NOT FOR COSMETIC USE* (excludes gel, ointment, and 0.1% MICRO)
Triamcinolone acetonide (Kenalog equiv) 0.1% cream, ointment, spray
Triamcinolone/Nystatin (Mycolog equiv) cream
Urea 20%; 40% cream
Vaginal Preparations
Clindamycin phosphate (Cleocin equiv) cream
Clotrimazole (Gyne-Lotrimin-7 equiv) cream
Conjugated Estrogens (Premarin equiv) cream
Estradiol (Vagifem equiv) 10mcg tabs
Estradiol (Estrace equiv) cream
Metronidazole (Metrogel equiv) cream
Miconazole (Monistat-7 equiv) 2% cream
18
Vitamins and Minerals
B12 1000mcg tabs
B12 (Cyanocobalamine) 1000mcg/ml injection (note: prescription is needed for syringes)
Calcium Carbonate & Vitamin D3 600mg tabs
Cyanocobalamine (Nascobal) spray 500mcg/spray (once per week dosing)
Cardiotex Rx (Bioperine/Folic acid/B12/B6/L-Arginine) 5mg/2mg/500mcg/50mg/500mg tabs
Cerefolin NAC (Methylfolate/N-acetyl-L-cysteine/Methylcobalamine/Algae-S powder) 6/600/2/90.314mg tabs
Ferrous Citrate (Auryxia) 210 mg tabs
Ferrous Sulfate (Iron) 325mg immediate-release tabs
Ferrous sulfate (Slow-Fe) slow release 42mg
Fish oil (Omega-3 Fatty Acid) 1000mg {NOT equiv. to Lovaza}
Folic Acid 1mg tabs
Cyanocobalamine/Pyridoxine/L-methylfolate (Foltx) 2/25/1.13mg tabs
ICAR-C equiv (Carbonyl iron/Vit C) 100/250mg tabs
ICAR-C Plus equiv (Carbonyl iron/Folic acid/Cyanocobalamine/Vit C) 100mg/1mg/25mcg/250mg tabs
Magnesium Oxide (MagOx) 400mg tabs
Prenatal vitamins with folic acid tabs *Limited to women of child bearing age
Prenatal Multi + DHA 200mg tabs
Prenatal + low iron 27mg tabs
Calcitrol (Rocaltrol equiv) 0.25mcg; 0.5mcg caps
Vitamin D daily 1,000U and 5,000U
Vitamin D2 50,000 IU (ergocalciferol) gel caps only
Vitamin D3 50,000 IU (cholecalciferol) oral capsules (once weekly)
**** Note: In the event of a medication recall, if your medication
is affected, a FAHC Pharmacy staff member will contact you.
Otherwise, continue to take your medication as directed.***
19
Fox has no emergency room or emergency
medical services (EMS).
Dial 911 to activate EMS.
Advice Nurses are available 24 hours a day, at (256) 955-8888 or
1-800-223-9531, to provide care advice.
Pharmacy business hours: 07:30am – 4:30pm MON-FRI
CLOSURES
**Varying days of each Month for training check schedule for updates
**Saturdays and Sundays
**All noted Federal and Training Holidays – See schedule next page
Check out the Live Wait-Time Tracker on the website:
www.redstone.amedd.army.mil
New patient information packets are available on our webpage
Information on how to transfer prescriptions TO our facility is available on our web page
Electronic prescriptions can be sent to: DOD REDSTONE
Electronic prescriptions sent by your doctor are not processed until you pull a ticket and request the prescription.
20
FOX ARMY HEALTH CENTER HOLIDAY and TRAINING SCHEDULE
Calendar Year 2019 (Subject to mission requirement changes)
Federal /Training Holiday observed (Full Day Closures):
Monday 21 JAN 2019 Thursday 11 NOV 2019 Monday 18 FEB 2019 Thursday 28 NOV 2019 Monday 27 MAY 2019 Friday 29 NOV 2019 Thursday 4 JUL 2019 Tuesday 24 DEC 2019 Monday 2 SEP 2019 Wednesday 25 DEC 2019 Monday 14 OCT 2019 Routine/Individual Training, and Organizational Activity Days (Partial day closure):
Wednesday 30 JAN 2019 Closed from 0730 – 1300 Wednesday 24 APR 2019 Closed from 0730 – 1300 Wednesday 24 JUL 2019 Closed from 0730 – 1300 Thursday 03 OCT 2019 Closed from 1130 – 1630 Wednesday 23 OCT 2019 Closed from 0730 - 1300
Nurse Advice Lines (NALs) are available during non-duty hours at (256) 955-8888 or 1-800-223-9531 to provide care advice. Fox Army Health Center is an ambulatory care clinic, and does not have an emergency room. In case of emergency, dial 911.