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PRESCRIPTION DRUG FORMULARY Updated January 2005 Subject to change at any time. 12/04 P41208 Si necesita una versión de este documento en español, por favor llame al Departamento de Servicios a la Membresía, de lunes a viernes de 8 a.m. a 5 p.m., al (505) 923-6060 o 1-800-797-5343, o a la línea de acceso para personas con problemas auditivos al 1-888-625-8818. Presbyterian Senior Care

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  • PRESCRIPTION DRUG

    FORMULARY

    Updated January 2005

    Subject to change at any time.

    12/04 P41208

    Si necesita una versión de este documento en español, por favor llame al Departamento de Servicios a la Membresía, de lunes a viernes de 8 a.m. a 5 p.m., al (505) 923-6060 o 1-800-797-5343, o a la línea de acceso para

    personas con problemas auditivos al 1-888-625-8818.

    Presbyterian Senior Care

  • Table of Contents

    Forward. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

    Drugs by Therapeutic Class . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

    Alphabetical Index of Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

  • 2

    To help you get the most out of your prescription drug coverage, we have designed this booklet for you. This booklet identifies which prescription drugs are covered by your benefit plan. Please show this list to any Presbyterian Senior Care practitioner who may write a prescription for you. This list will help them choose a drug that your insurance covers.

    If you have questions about this list of drugs, contact Presbyterian Senior Care Member Services via e-mail at [email protected] or by telephone at (505) 923-6060 or 1-800-797-5343, or the TDD Hearing Impaired Access Line at 1-888-625-8818, Monday through Friday between 8 a.m. and 5 p.m.

    Key to abbreviations and symbols used in this booklet:

    (R) = Restricted. Restricted drugs may require prior authorization, or there may be a limited number of doses dispensed.

    $ = Least Expensive

    $$$$$$$$ = Most Expensive

    * = Indicates Generic substitution is required. If no asterisk,

    Generic drug is not yet available.

    What is a Formulary? A Formulary is a list of medications that are covered under your Presbyterian Health Plan, Presbyterian Senior Care prescription drug benefit. Knowing that the medical treatment of our members is often dependent upon the effective use of medications, the Formulary is continually revised and updated by Presbyterian Health Plan’s Pharmacy & Therapeutics Committee. The Formulary ensures our Presbyterian Senior Care members receive optimal cost-effective care. You may want to take the Formulary with you each time you visit your practitioner to discuss which formulary medication would work best for you.

  • Prescription drugs listed in the Formulary are classified by specific tier categories based on their type and use. The tier categories are:

    Tier 1: Preferred Generic Drugs, covered at the Generic copayment. All Generic Drugs are covered under this tier.

    Tier 2: Preferred Brand drugs covered at the Brand Name copayment.

    Tier 3: Non-Formulary Brand drugs covered at the non-formulary copayment. Your Primary Care Practitioner (PCP) must request prior authorization (also known as requesting a medical exception) before prescribing the following drugs: Elidel, Lamisil, Meridia, Penlac, Prilosec 40 mg, Relenza, Sporanox, Tamiflu, Xenical, Xopenex and Zetia.

    A drug may be added or deleted from the Formulary or a drug may be moved from a Brand Name status to a Generic status at any time during the year.

    For selected prescription drugs, a medical exception, also know as pre-authorization, is required in order to receive benefits for those drugs. When available, Federal Drug Administration (FDA) approved generic drugs will be dispensed regardless of the brand name indicated. If the member or practitioner requests the brand name in place of the generic, the member will be responsible for payment of the generic copayment plus the difference in the cost (if any) between the generic and brand drug.

    If you have complaints about which drugs are or are not included in the Formulary, or about the administration of the drug Formulary, you may file a grievance with Presbyterian Senior Care.

    If your Presbyterian Senior Care practitioner determines that you need a medication not on the Presbyterian Senior Care Formulary and Presbyterian Health Plan has denied the request, you have the right to appeal Presbyterian Health Plan’s decision.

    You may file a grievance by calling Presbyterian Senior Care Member Services Monday through Friday from 8 a.m. to 5 p.m. at (505) 923-6060 or 1-800-797-5343, the TDD Hearing Impaired Access Line is 1-888-625-8818. You may also file an appeal in writing to

    3

  • Presbyterian Senior Care at:

    Presbyterian Senior Care PO Box 27489 Albuquerque, New Mexico 87125-7489

    For further information on the Appeal and Grievance procedures, please refer to your Evidence of Coverage/Member Handbook.

    Most pharmacies offer Presbyterian Senior Care members a 10% -15% discount off the Average Wholesale Price after a member has reached the maximum of their prescription drug benefit on their Basic Plan, Basic Plan with Standard Rider, or Employer Group plan drug benefits for a calendar year. Participating pharmacies include selected network retail pharmacies noted in your Presbyterian Senior Care 2005 Provider Directory or through Mail Order.

    This discount can also be applied to Brand Name prescriptions for members whose coverage is limited to Generic drug coverage.

    This value-added pharmacy discount described is neither offered nor guaranteed under Presbyterian Health Plan’s contract with the Medicare program, but is made available to all enrollees who are members of Presbyterian Senior Care. This service is not subject to the Medicare appeals process. Disputes regarding this service discount may be subject to the Presbyterian Senior Care grievance process. Should a problem arise with this value-added service, please contact Presbyterian Senior Care Member Services by e-mail at [email protected] or by telephone Monday through Friday, 8 a.m. to 5 p.m. at (505) 923-6060 or 1-800-797-5343 or the TDD Hearing Impaired Access Line at 1-888-625-8818.

    Visit us on the internet. The Formulary can be found on-line at http://www.phs.org/resources/documents/formulary.pdf

    Thank you for your continued membership in Presbyterian Senior Care. We are committed to improving your health and to helping you get the care you deserve.

    4

  • GENERIC NAME BRAND NAME TIER

    *Indicates Generic substitution is required

    peph = phenylephrine cpm = chlorpheniramine dm = dextromethorphan

    1 ALLERGY

    1.1 Antihistamines - Sedating

    $ * hydroxyzine hcl ATARAX 1 $ * cyproheptadine PERIACTIN 1 $ * hydroxyzine pamoate VISTARIL 1 $ * promethazine PHENERGAN 1 $ * diphenhydramine BENADRYL 1 $$ dexchlorpheniramine POLARAMINE 2

    1.2 Non/low-sedating Antihistamines

    $$$$ fexofenadine ALLEGRA 3 $$$$ cetirizine ZYRTEC 3

    1.3 Antihistamine/decongestant combinations

    $ * peph/ccpm pediatric RYNATAN 1 $$ * chlorpheniramine/phenylephrine/ scopolamine AH-CHEW 1

    1.4 Nasal steroids/antihistamines

    $$ * flunisolide nasal solution NASALIDE 1 $$ flunisolide nasal solution NASAREL 2 $$ triamcinolone AQ nasal inhaler NASACORT AQ 2 $$$ azelastine nasal spray ASTELIN 2 $$$ beclomethasone nasal inhaler BECONASE 2 $$$ beclomethasone nasal inhaler AQ BECONASE AQ 2 $$$$ beclomethasone nasal inhaler DS VANCENASE AQ 84 mcg 2 $$$$ budesonide nasal spray RHINOCORT AQUA 2 $$$$ mometasone nasal inhaler NASONEX 2 $$$$ fluticasone nasal inhaler FLONASE 2

    1.5 Allergy - misc.

    $$ epinephrine self-injection device EPIPEN 2 $$ phenylephrine AH-CHEW D 2

    2 RESPIRATORY AGENTS

    2.1 Oral sympathomimetic (adrenergic) agents

    $$ * albuterol tabs PROVENTIL 1 $$$ albuterol repetabs PROVENTIL REPETABS 2 $$$ terbutaline tabs BRETHINE 2

    5

  • 2.2 Inhaled sympathomimetic (adrenergic) agents

    $ * albuterol PROVENTIL, VENTOLIN 1 $$ albuterol HFA inhaler PROVENTIL HFA 2 $$ metaproterenol inhaler ALUPENT 3 $$ pirbuterol acetate inhaler MAXAIR 2 $$$$ formoterol inhaler FORADIL 2 $$$$ salmeterol inhaler SEREVENT DISKUS 2 2.3 Theophylline preparations

    $ caffeine citrate CAFFEINE CITRATE 1 $$ * theophylline immediate release THEOLAIR 1 $$ * theophylline elixir ELIXOPHYLLIN 1 $$ theophylline timed release 12 hr caps SLOBID 2 $$$ theophylline timed release 24 hr UNIPHYL 2 2.4 Anticholinergic

    $$ * ipratropium bromide solution ATROVENT for nebs solution for nebs 1 $$$ ipratropium bromide inhaler ATROVENT 2 $$$ tiotropium inhaler SPIRIVA 2 $$$ ipratropium/albuterol inhaler COMBIVENT 2 2.5 Mast cell stabilizers

    $$$ nedocromil inhaler TILADE 2 $$$$ cromolyn sodium inhaler INTAL 2 2.6 Oral inhaled steroids

    $ beclomethasone inhaler QVAR 2 $$ triamcinolone inhaler AZMACORT 3 $$$$ fluticasone inhaler FLOVENT 2 $$$$$ fluticasone/salmeterol inhaler ADVAIR 2 $$$$$$ budesonide suspension for inhalation PULMICORT RESPULES 2(R) $$$$$$ budesonide inhaler PULMICORT TURBUHALER 2

    2.7 Leukotriene blockers

    $$$$ zafirlukast ACCOLATE 2 $$$$$ montelukast SINGULAIR 2

    GENERIC NAME BRAND NAME TIER

    *Indicates Generic substitution is required6

  • *Indicates Generic substitution is required

    3 COUGH AND COLD

    3.1 Antitussive combinations

    $ * pseudoephedrine/codeine/ guaifenesin ROBITUSSIN-DAC 1 $ * promethazine/codeine liquid PHENERGAN W/CODEINE 1 $ * hydrocodone/homatropine syrup HYCODAN 1 $ * pseudoephedrine/cpm/ codeine liquid NOVAHISTINE DH 1 $ * peph/cpm/hydrocodone HISTUSSIN HC 1 $ * hydrocodone/guaifenesin HYCOTUSS 1 $ * codeine/guaifenesin syrup ROBITUSSIN AC 1 $ * peph/promethazine/codeine liquid PHENERGAN VC 1

    3.2 Non-narcotic antitussives

    $ * promethazine dm PHENERGAN DM 1 $ * pseudoephedrine/carbinoxamine CARDEC 1 $ * dextromethorphan/guaifenesin TUSSI-ORGANIDIN DM 1 $ * benzonatate TESSALON PERLES 1 $ * pseudoephedrine/ carbinoxamine/dm CARDEC-DM 1

    3.3 Expectorants & decongestant combinations

    $ * guaifenesin/pseudoephedrine ENTEX PSE 1 $ * potassium iodide SSKI 1 $ guaifenesin/phenylephrine ENTEX LA 2 $$ * guaifenesin sustained release HUMIBID LA 1 4 ANTI-INFECTIVE AGENTS

    4.1 Antihelmintics

    $$$$ mebendazole VERMOX 2 4.2 Antifungal agents

    $$ * griseofulvin ultramicrosize FULVICIN P/G 1 $$ * nystatin MYCOSTATIN 1 $$ fluconazole DIFLUCAN 2(R) $$$ clotrimazole troche MYCELEX TROCHE 2 $$$ * ketoconazole tabs NIZORAL 1 $$$$$$$ terbinafine LAMISIL 3(R)

    GENERIC NAME BRAND NAME TIER

    7

  • 4.3 Cephalosporins first generation

    $ * cephalexin KEFLEX 1 4.4 Cephalosporins second generation

    $$$ * cefaclor CECLOR 1 $$$$ cefaclor CD CECLOR CD 2 $$$$$ cefprozil CEFZIL 2 $$$$$ cefuroxime CEFTIN 2 4.5 Cephalosporins third generation

    $$$$ cefixime SUPRAX 2 4.6 Cephalosporins carbacephems

    $$$$ loracarbef suspension LORABID SUSPENSION 2 4.7 Macrolides

    $ * erythromycin base ERY-TAB 1 $ * erythromycin stearate ERYTHROCIN 1 $ * erythromycin ethylsuccinate EES 1 $ * erythromycin estolate ILOSONE 1 $$ * erythromycin/sulfisoxazole PEDIAZOLE 1 $$$ azithromycin ZITHROMAX 2 $$$$ clarithromycin BIAXIN 2(R) $$$$ clarithromycin extended release BIAXIN XL 2(R)

    4.8 Penicillins

    $ * penicillin v potassium PEN-VEE K 1 $ * amoxicillin AMOXIL, TRIMOX 1 $ * ampicillin PRINCIPEN 1 $$ * dicloxacillin DYNAPEN 1 4.9 Tetracyclines

    $ * tetracycline ACHROMYCIN 1 $ * doxycycline VIBRAMYCIN 1 $$$$$ demeclocycline DECLOMYCIN 2

    GENERIC NAME BRAND NAME TIER

    *Indicates Generic substitution is required8

  • *Indicates Generic substitution is required

    4.10 Quinolones

    $ * ciprofloxacin CIPRO 1 $$$ moxifloxacin AVELOX 2 $$$$$ levofloxacin LEVAQUIN 3 4.11 Antituberculosis

    $$ * isoniazid ISONIAZID 1 $$ aminosalicylic PASER 2 $$$ * pyrazinamide PYRAZINAMIDE 1 $$$ cycloserine SEROMYCIN 3 $$$$ rifabutin MYCOBUTIN 2 $$$$ ethambutol MYAMBUTOL 2 $$$$ * rifampin RIFADIN 1 4.12 Antivirals

    $$ * amantadine SYMMETREL 1 $$$$ * acyclovir ZOVIRAX 1 $$$$ valacyclovir VALTREX 2 $$$$$ oseltamivir TAMIFLU 3(R) $$$$$ zanamivir RELENZA 3(R) $$$$$$ valganciclovir VALCYTE 2 4.13 HIV antivirals

    $$ lamivudine EPIVIR 2 $$ zalcitabine (ddc) HIVID 2 $$ didanosine (ddi) VIDEX 2 $$$ stavudine ZERIT 2 $$$ nevirapine VIRAMUNE 2 $$$ zidovudine (azt) RETROVIR 2 $$$ delavirdine RESCRIPTOR 2 $$$ amprenavir AGENERASE 2 $$$ emtricitabine EMTRIVA 2 $$$ atazanavir REYATAZ 2 $$$$ indinavir CRIXIVAN 2 $$$$ efavirenz SUSTIVA 2 $$$$ abacavir ZIAGEN 2 $$$$ tenofovir VIREAD 2 $$$$$ lamivudine/zidovudine COMBIVIR 2 $$$$$ ganciclovir CYTOVENE 2 $$$$$ emtricitabine/tenofovir TRUVADA 2 $$$$$$ saquinavir FORTOVASE, INVIRASE 2

    GENERIC NAME BRAND NAME TIER

    9

  • $$$$$$ ritonavir NORVIR 2 $$$$$$ nelfinavir VIRACEPT 2 $$$$$$ lopinavir/ritonavir KALETRA 2 $$$$$$$ fosamprenavir LEXIVA 2 $$$$$$$ abacavir/zidovudine/lamivudine TRIZIVIR 2 $$$$$$$ abacavir/lamivudine EPZICOM 2 4.14 Antimalarial agents

    $ * quinine sulfate QUININE 1 $$ * chloroquine phosphate ARALEN PHOSPHATE 1 $$ primaquine PRIMAQUINE 2 $$ pyrimethamine/sulfadoxine FANSIDAR 2 $$$ * hydroxychloroquine PLAQUENIL 1 4.15 Sulfonamides

    $ * sulfamethoxazole/trimethoprim BACTRIM, SEPTRA 1 $$$ * sulfisoxazole GANTRISIN 1 4.16 Sulfones

    $$$ dapsone DAPSONE 1 4.17 Urinary

    $ * nitrofurantoin MACRODANTIN 1 $ * trimethoprim PROLOPRIM, TRIMPEX 1 $$ nitrofurantoin macrocrystals MACROBID 2 $$$$ nitrofurantoin suspension FURADANTIN 2 4.18 Anti-Infectives - misc.

    $ * metronidazole FLAGYL 1 $ * neomycin NEOMYCIN 1 $$ clofazimine LAMPRENE 2 $$$ * clindamycin CLEOCIN 1 $$$$$ furazolidone FUROXONE 2 $$$$$ * pentamidine PENTAM 1 $$$$$ atovaquone MEPRON 2

    4.19 Immunologic Agents

    $$$$$$$ interferon beta-1a AVONEX 2

    GENERIC NAME BRAND NAME TIER

    *Indicates Generic substitution is required10

  • *Indicates Generic substitution is required

    5 ANTINEOPLASTIC AGENTS/IMMUNOSUPPRESSANTS

    5.1 Alkylating agents

    $$$ chlorambucil LEUKERAN 2 $$$ lomustine CEENU 2 $$$ melphalan ALKERAN 2 $$$ busulfan MYLERAN 2 $$$$ * cyclophosphamide CYTOXAN 1 5.2 Antimetabolites

    $$$ * methotrexate RHEUMATREX 1 $$$ * methotrexate injection METHOTREXATE INJ 1 $$$$ mercaptopurine PURINETHOL 2 $$$$ thioguanine THIOGUANINE 2 5.3 Androgens

    $$$$ testolactone TESLAC 2 5.4 Anti-androgen

    $$$$$$$ bicalutamide CASODEX 2 $$$$$$$ * flutamide EULEXIN 1 5.5 Progestin

    $$$$ * megestrol acetate MEGACE 1 5.6 Antiestrogen

    $$$$$ * tamoxifen citrate NOLVADEX 1 $$$$$$$ anastrazole ARIMIDEX 2 5.7 Antineoplastics Agents/Immunosuppressants - misc.

    $$$ * leucovorin WELLCOVORIN 1 $$$ procarbazine MATULANE 2 $$$$ * hydroxyurea HYDREA 1 $$$$$ mitotane LYSODREN 2

    5.8 Immunosuppressants

    $$ * azathioprine IMURAN 1 $$$$$$$ * cyclosporine SANDIMMUNE 1 $$$$$$$ * cyclosporine microemulsion NEORAL 1

    GENERIC NAME BRAND NAME TIER

    11

  • $$$$$$$ mycophenolate CELLCEPT 2 $$$$$$$ tacrolimus PROGRAF 2

    5.9 Immune Globulins

    $$$$$$$ immune globulin (Rho [D] IGIM) RhoGAM 2 6 AUTONOMIC AGENTS

    6.1 Parasympathomimetic (cholinergic) agents

    $ * bethanechol URECHOLINE 1 $ * pyridostigmine MESTINON 1 6.2 Anticholinergic agents

    $$ * benztropine mesylate COGENTIN 1 $$$ * trihexyphenidyl ARTANE 1 6.3 Antiparkinsonian agents

    $ * amantadine SYMMETREL 1 $ * selegiline ELDEPRYL 1 $$ * levodopa and carbidopa SINEMET 1 $$$ * levodopa/carbidopa sustained release SINEMET CR 1 $$$$ * bromocriptine PARLODEL 1 $$$$ ropinirole REQUIP 2 $$$$$ entacapone COMTAN 2 $$$$$ pramipexole MIRAPEX 2 $$$$$$ pergolide PERMAX 2 6.4 Antimuscarinics / antispasmodics

    $ * chlordiazepoxide/clidinium bromide LIBRAX 1 $ * dicyclomine BENTYL 1 $ * belladonna alkaloids/phenobarb DONNATAL 1 $$ * hyoscyamine LEVSIN 1 $$ * propantheline PRO-BANTHINE 1 $$$ hyoscyamine sustained release LEVBID 2 $$$ * belladonna/phenobarb/ergotamine BELLERGAL S 1 6.5 Alpha-adrenergics (vasopressors)

    $$$$$$$ midodrine PROAMATINE 2

    GENERIC NAME BRAND NAME TIER

    *Indicates Generic substitution is required12

  • *Indicates Generic substitution is required

    7 ANTICOAGULANTS

    7.1 Anticoagulants

    $$ * heparin sodium injection HEPARIN 1 $$$ * warfarin (BARR MFR ONLY) COUMADIN 1 $$$$$ enoxaparin LOVENOX 2(R)

    7.2 Anti-platelets

    $ * ticlopidine TICLID 1 $$$$ clopidogrel PLAVIX 2 7.3 Anticoagulants and Anti-Platelet misc.

    $ * pentoxifylline TRENTAL 1 $$$$ dipyridamole/aspirin AGGRENOX 3 $$$$$$$ aminocaproic acid AMICAR 2 8 CARDIOVASCULAR AGENTS

    8.1 Cardiac glycosides

    $ * digoxin tabs LANOXIN TABS 1

    8.2 Calcium Antagonists

    $ * verapamil CALAN 1 $$ * diltiazem CARDIZEM 1 $$ felodipine PLENDIL 2 $$ * nifedipine ADALAT 1 $$ nisoldipine SULAR 2 $$$ * verapamil sustained release CALAN SR 1 $$$ nifedipine sustained release ADALAT CC 2 $$$ * diltiazem sustained release DILACOR XR 1 $$$$ amlodipine NORVASC 2 $$$$$$$ nimodipine NIMOTOP 2 8.3 Beta-Adrenergic Antagonists - Nonselective

    $ * propranolol sustained release INDERAL LA 1 $ * propranolol INDERAL 1

    8.4 Beta-Adrenergic Antagonists - Selective

    $ * atenolol TENORMIN 1 $ * metoprolol LOPRESSOR 1 $$$ metoprolol sustained release TOPROL XL 2

    GENERIC NAME BRAND NAME TIER

    13

  • 8.5 Beta-Adrenergic Antagonists - Combination Alpha and Beta Blocker

    $$$ * labetalol NORMODYNE, TRANDATE 1 $$$$$ carvedilol COREG 3 8.6 Beta-Adrenergic Antagonists - Combination Products

    8.7 Anti-Arrhythmic Drugs - Class Ia

    $ * quinidine sulfate QUINIDINE SULFATE 1 $$ * procainamide PRONESTYL 1 $$ * quinidine gluconate sustained release QUINAGLUTE DURA-TABS 1 $$$ * procainamide sustained release PROCAN SR 1 $$$$ procainamide BID PROCANBID 2 $$$$ * disopyramide NORPACE 1 $$$$$ * disopyramide controlled release NORPACE CR 1 8.8 Anti-Arrhythmic Drugs - Class Ib

    $$$$$ * mexiletine MEXITIL 1 $$$$$ tocainide TONOCARD 2 8.9 Anti-Arrhythmic Drugs - Class Ic

    $$$ flecainide TAMBOCOR 2 $$$$$ * propafenone RYTHMOL 1 8.10 Anti-Arrhythmic Drugs - Class III

    $$$$$$$ * amiodarone CORDARONE 1 $$$$$$$ * sotalol BETAPACE 1 8.11 Angiotensin converting enzyme inhibitor

    $ * captopril CAPOTEN 1 $$ * enalapril VASOTEC 1 $$ * lisinopril ZESTRIL 1 $$ * benazepril LOTENSIN 1 $$$ ramipril ALTACE 3 $$$$$ quinapril ACCUPRIL 2

    GENERIC NAME BRAND NAME TIER

    *Indicates Generic substitution is required14

  • *Indicates Generic substitution is required

    8.12 Angiotensin combination products

    $$ * benazepril/hctz LOTENSIN HCT 1 $$$$ benazepril/amlodipine LOTREL 2

    8.13 Angiotensin receptor antagonist

    $$$ olmesartan BENICAR 2 $$$ olmesartan/hctz BENICAR HCT 2 $$$$ irbesartan AVAPRO 2 $$$$ irbesartan/hctz AVALIDE 2 $$$$ valsartan DIOVAN 2 $$$$ valsartan/hctz DIOVAN HCT 2 8.14 Anti-Lipemics - HMG-CoA Reductase Inhibitors

    $$ * lovastatin MEVACOR 1 $$$ fluvastatin LESCOL 2 $$$ fluvastatin XL LESCOL XL 80 mg 2 $$$$ atorvastatin LIPITOR 2 8.15 Anti-Lipemics - misc. Antihyperlipidemics

    $$$ * cholestyramine QUESTRAN, QUESTRAN LITE 1 $$$ * gemfibrozil LOPID 1 $$$ niacin sustained release NIASPAN, SLO-NIACIN 2 8.16 Alpha Blockers

    $ * prazosin MINIPRESS 1 $$$ * doxazosin CARDURA 1 $$$$ tamsulosin FLOMAX 2 $$$$ * terazosin HYTRIN 1

    8.17 Centrally Acting Antihypertensives

    $ * clonidine tablets CATAPRES tablets 1 $$ * methyldopa/hctz ALDORIL 1 $$ * methyldopa ALDOMET 1 $$$ * guanfacine TENEX 1 8.18 Vasodilating Agents

    $ * dipyridamole PERSANTINE 1 $ * hydralazine APRESOLINE 1 $$ * minoxidil LONITEN 1

    GENERIC NAME BRAND NAME TIER

    15

  • 8.19 Nitrates

    $ nitroglycerin sublingual NITROSTAT 2 $ * nitroglycerin ointment NITRO-BID OINTMENT 1 $ * isosorbide dinitrate ISORDIL 1 $ * isosorbide dinitrate sustained release ISORDIL TEMBIDS 1 $$$ nitroglycerin transdermal NITRO-DUR 2 $$$$ * isosorbide mononitrate IMDUR 1 8.20 Hematopoietic Agents

    $$$$$$ darbepoetin alfa ARANESP 2

    9 RHEUMATOLOGIC AGENTS

    9.1 Nonsteroidal anti-inflammatory agents

    $ * diflunisal DOLOBID 1 $ * ibuprofen MOTRIN 1 $ * indomethacin INDOCIN 1 $ * naproxen NAPROSYN 1 $ * naproxen sodium ANAPROX 1 $ * naproxen sodium DS ANAPROX DS 1 $ * piroxicam FELDENE 1 $$ * flurbiprofen ANSAID 1 $$ * ketoprofen ORUDIS 1 $$ * salsalate DISALCID 1 $$ * sulindac CLINORIL 1 $$$ * diclofenac sodium VOLTAREN 1 $$$ * indomethacin sustained release INDOCIN SR 1 $$$$ * oxaprozin DAYPRO 1 $$$$$* nabumetone RELAFEN 1 $$$$$$ celecoxib CELEBREX 3

    9.2 Anti-gout

    $ * allopurinol ZYLOPRIM 1 $$ * probenecid/colchicine COLBENEMID 1 $$ * probenecid BENEMID 1 $$ * colchicine COLCHICINE 1

    9.3 Rheumatologic Agents - misc.

    $$$$ penicillamine CUPRIMINE 2 $$$$ auranofin RIDAURA 2

    GENERIC NAME BRAND NAME TIER

    *Indicates Generic substitution is required16

  • *Indicates Generic substitution is required

    10 SKELETAL / MUSCLE RELAXANTS

    10.1 Skeletal / Muscle Relaxants - misc.

    $$ * chlorzoxazone PARAFON FORTE DSC 1 $$ * carisoprodol SOMA 1 $$ * baclofen LIORESAL 1 $$ * methocarbamol ROBAXIN 1 $$ * carisoprodol/asa SOMA COMPOUND 1 $$ * cyclobenzaprine FLEXERIL 1

    11 ANALGESICS

    11.1 Opiate agonists

    $ * apap/codeine TYLENOL #3, TYLENOL #4 1 $ * asa/codeine EMPIRIN #3, EMPIRIN #4 1 $ * butalbital/apap/codeine FIORICET W/CODEINE 1 $ * butalbital/asa/codeine FIORINAL W/CODEINE 1 $ * codeine CODEINE 1 $ * oxycodone/apap PERCOCET, TYLOX 1 $ * oxycodone/asa PERCODAN 1 $ * propoxyphene hcl DARVON 1 $ * propoxyphene napsylate/apap DARVOCET N 1 $ * propoxyphene/asa/caffeine DARVON COMPOUND 1 $$ * carisoprodol/asa/codeine SOMA COMPOUND W/ CODEINE 1 $$ * hydrocodone/apap VICODIN 1 $$ * morphine MORPHINE 1 $$ * tramadol ULTRAM 1 $$$ * hydromorphone DILAUDID 1 $$$ * oxycodone ROXICODONE 1 $$$$ * meperidine DEMEROL 1 $$$$ * morphine sustained release ORAMORPH SR 1 $$$$$$$ fentanyl patches DURAGESIC PATCHES 2(R) 11.2 Migraine treatment

    $ ergotamine/caffeine CAFERGOT 2 $ * isometheptene/ dichloralphenazone/apap MIDRIN 1 $$ * butalbital/325mg apap/caffeine FIORICET 1 $$ * butalbital/500mg apap/caffeine ESGIC PLUS 1 $$ * butalbital/asa/caffeine FIORINAL 1 $$$$ dihydroergotamine mesylate nasal spray MIGRANAL 2

    GENERIC NAME BRAND NAME TIER

    17

  • $$$$$ dihydroergotamine mesylate DHE-45 2 $$$$$ eletriptan RELPAX 2(R) $$$$$$ rizatriptan MAXALT/MAXALT MLT 2(R) $$$$$$$ sumatriptan IMITREX 2(R) 12 ANTI CONVULSANTS

    12.1 Barbiturates

    $ * phenobarbital PHENOBARBITAL 1 $$ * primidone MYSOLINE 1 $$$ mephobarbital MEBARAL 2 12.2 Hydantoins

    $ * phenytoin DILANTIN 1 12.3 Succinimides

    $$ * ethosuximide ZARONTIN 1 12.4 Anticonvulsants - misc.

    $ * carbamazepine TEGRETOL 1 $$ carbamazepine extended release CARBATROL 2 $$$ carbamazepine sustained release TEGRETOL-XR 2 $$$ * clonazepam KLONOPIN 1 $$$$ divalproex sodium DEPAKOTE 2 $$$$ divalproex sodium extended release DEPAKOTE ER 2 $$$$$ diazepam gel DIASTAT 2 $$$$$ gabapentin NEURONTIN 2 $$$$$ topiramate TOPAMAX 2 $$$$$$ lamotrigine LAMICTAL 2 $$$$$$ oxcarbazepine TRILEPTAL 2 $$$$$$ valproic acid DEPAKENE 2 $$$$$$ zonisamide ZONEGRAN 2 13 PSYCHOTHERAPEUTIC AGENTS

    13.1 Antidepressants - Tertiary Amines

    $ * doxepin SINEQUAN 1 $ * amitriptyline ELAVIL 1 $ * imipramine TOFRANIL 1 $$$ * clomipramine ANAFRANIL 1

    GENERIC NAME BRAND NAME TIER

    *Indicates Generic substitution is required18

  • *Indicates Generic substitution is required

    13.2 Antidepressants - Secondary Amines $ * desipramine NORPRAMIN 1 $ * nortriptyline PAMELOR 1 $$ * amoxapine ASENDIN 1 13.3 Antidepressants - SSRI’s

    $ * fluoxetine capsules PROZAC 1 $$ escitalopram LEXAPRO 2 $$$ * citalopram CELEXA 1 $$$$ sertraline ZOLOFT 2 $$$$ * paroxetine PAXIL 1 $$$$ paroxetine controlled release PAXIL CR 2 13.4 Antidepressants - misc.

    $ * trazodone DESYREL 1 $ * perphenazine/amitriptyline ETRAFON, TRIAVIL 1 $$$$ venlafaxine sustained release EFFEXOR XR 2(R) $$$$ venlafaxine EFFEXOR 2 $$$$ nefazodone SERZONE 2 $$$$ * mirtazapine REMERON 1 $$$$ mirtazapine SOL-TAB REMERON SOL-TAB 2 $$$$ * bupropion sustained release WELLBUTRIN SR 1 $$$$ * bupropion WELLBUTRIN 1 13.5 Antidepressants - MAO Inhibitors

    $$$ phenelzine NARDIL 2 $$$ tranylcypromine PARNATE 2 13.6 Antipsychotics - Phenothiazines

    $ * chlorpromazine THORAZINE 1 $ * perphenazine TRILAFON 1 $ * thioridazine MELLARIL 1 $$ * trifluoperazine STELAZINE 1 $$ * fluphenazine PROLIXIN 1 13.7 Antipsychotics - Thioxanthenes

    $$ * thiothixene NAVANE 1

    GENERIC NAME BRAND NAME TIER

    19

  • 13.8 Antipsychotics - Butyrophenones

    $ * haloperidol HALDOL 1 13.9 Antipsychotics - Dibenzoxazepines

    $$$$$$$ * clozapine CLOZARIL 1 13.10 Antipsychotics - Dihydroindolones

    $$$$$ molindone MOBAN 2 13.11 Antipsychotics - Benzisoxazoles

    $$$$ ziprasidone GEODON 2 $$$$$ risperidone RISPERDAL 2 13.12 Antipsychotics - Thienbenzodiazepines

    $$$$$$ quetiapine SEROQUEL 2 $$$$$$$ olanzapine ZYPREXA 2 13.13 Cerebral Stimulants

    $ * dextroamphetamine DEXEDRINE 1 $$ * methylphenidate RITALIN 1 $$ * methylphenidate sustained release RITALIN SR 1 $$ methylphenidate extended release METADATE CD 2(R) $$$ * amphetamine mixture ADDERALL 1(R) $$$$$ methylphenidate extended release CONCERTA 2(R) $$$$$ amphetamine mixture extended release ADDERALL XR 2(R) 13.14 Anxiolytics, Sedatives, and Hypnotics - Benzodiazepines

    $ * prazepam CENTRAX 1 $ * oxazepam SERAX 1 $ * temazepam RESTORIL 1 $ * triazolam HALCION 1 $ * diazepam VALIUM 1 $ * chlordiazepoxide LIBRIUM 1 $ * alprazolam XANAX 1 $$ * lorazepam ATIVAN 1

    GENERIC NAME BRAND NAME TIER

    *Indicates Generic substitution is required20

  • *Indicates Generic substitution is required

    13.15 Anxiolytics, Sedatives & Hypnotics - misc.

    $ * chloral hydrate NOCTEC 1 $ * meprobamate MEPROBAMATE 1 $$$$$ zolpidem AMBIEN 2(R)

    13.16 Antimanic agents

    $ * lithium carbonate immediate release ESKALITH 1 $$ * lithium citrate syrup LITHIUM CITRATE 1 $$ * lithium carbonate sustained release LITHOBID 1 $$ * lithium carbonate controlled release ESKALITH CR 1

    13.17 Alzheimer’s

    $$$$$ donepezil ARICEPT 2(R)

    13.19 Antipsychotics - Quinolinone Derivatives

    $$$$$$$ aripiprazole ABILIFY 2 14 GASTRO-INTESTINAL AGENTS

    14.1 Antidiarrheal agents

    $ * diphenoxylate/atropine LOMOTIL 1 14.2 Cathartics and laxatives

    $ * lactulose CEPHULAC 1 $ * peg-electrolyte bowel evacuant COLYTE 1 14.3 Pancreatic enzymes

    $$$ * pancreatin CREON 1 $$$ pancrelipase PANCREASE, ULTRASE, VIOKASE 2 14.4 Antiemetics

    $ * meclizine ANTIVERT 1 $ * prochlorperazine maleate COMPAZINE 1 $ * promethazine PHENERGAN 1 $$ * trimethobenzamide TIGAN 1 $$$ thiethylperazine TORECAN 2 $$$$ ondansetron ZOFRAN 2(R)

    GENERIC NAME BRAND NAME TIER

    21

  • 14.5 Anti-Ulcer Drugs - H2 Antagonists

    $ * cimetidine TAGAMET 1 $$ * ranitidine ZANTAC 1 14.6 Anti-Ulcer Drugs - misc.

    $$$ * sucralfate CARAFATE 1 $$$ misoprostol CYTOTEC 2 $$$$$ pantoprazole PROTONIX 2 $$$$$$ rabeprazole ACIPHEX 2 14.7 Antispasmodics

    $ * dicyclomine BENTYL 1 $$ * propantheline PRO-BANTHINE 1 $$ * metoclopramide REGLAN 1 $$ * hyoscyamine LEVSIN 1

    14.8 GI Anti-Inflammatory

    $ * hydrocortisone suppositories ANUSOL-HC 1 $$ hydrocortisone enema CORTENEMA 2 $$ * sulfasalazine AZULFIDINE 1 $$$ pramoxine/hydrocortisone foam PROCTOFOAM HC 2 $$$$ mesalamine ASACOL 2 $$$$ olsalazine DIPENTUM 2 $$$$$ mesalamine enemas ROWASA 3 14.9 Gallstone Solubilizing Agents

    $$$$$$$ * ursodiol ACTIGALL 1 15 ANTI-DIABETIC AGENTS

    15.1 Insulins

    $ insulins NOVOLIN 2 $$ insulins NOVOLlN INNOLET 2 $$$ insulin aspart NOVOLOG, NOVOLOG MIX 70/30 2 $$$ insulin glargine LANTUS 2

    GENERIC NAME BRAND NAME TIER

    *Indicates Generic substitution is required22

  • *Indicates Generic substitution is required

    15.2 Sulfonylureas

    $ * glipizide GLUCOTROL 1 $ * glyburide DIABETA, MICRONASE 1 $ * tolazamide TOLINASE 1 $$ glimepiride AMARYL 2 $$ * glipizide sustained release GLUCOTROL XL 1 15.3 Agents - misc.

    $$ glucagon GLUCAGON 2 $$$ acarbose PRECOSE 2 $$$ * metformin GLUCOPHAGE 1 $$$$$$$ rosiglitazone AVANDIA 2

    16 HORMONES & SYNTHETIC SUBSTITUTES

    16.1 Adrenals

    $ * hydrocortisone CORTEF 1 $ * methylprednisolone MEDROL 1 $ * dexamethasone DECADRON 1 $ * prednisone DELTASONE 1 $$ fludrocortisone acetate FLORINEF 2 16.2 Androgens

    $$$$ fluoxymesterone HALOTESTIN 2 $$$$ methyltestosterone METANDREN 2 $$$$$ testosterone transdermal 2.5mg or 5mg/day ANDRODERM 2 $$$$$ testosterone transdermal 5 mg/day TESTODERM 2 $$$$$$$ * danazol DANOCRINE 1 16.3 Contraceptives

    $ * ethynodiol 1mg/estradiol 35mcg ZOVIA 1/35E 1 $ * levonorgestrel 0.15mg/estradiol 30mcg LEVORA 1 $ * levonorgestrel 0.1mg/estradiol 20mcg AVIANE 1 $ levonorgestrel 0.75mg PLAN B 2 $ * levonorgestrel triphasic/estradiol triphasic TRIVORA 1 $ * norethindrone 0.35mg MICRONOR 1

    GENERIC NAME BRAND NAME TIER

    23

  • $ * norgestrel 0.3mg/estradiol 30mcg LOW OGESTREL 1 $$ desogestrel triphasic/estradiol 0.025mcg CYCLESSA 2 $$ drospirenone 3mg/estradiol 30mcg YASMIN 2 $$ * ethynodiol 1mg/estradiol 50mcg ZOVIA 1/50E 1 $$ norethindrone 0.4mg/estradiol 35mcg OVCON-35 2 $$ norethindrone 1.5mg/estradiol 30mcg LOESTRIN 1.5/30, LOESTRIN FE 1.5/30 2 $$ norethindrone 1mg/estradiol 20mcg LOESTRIN 1/20, LOESTRIN FE 1/20 2 $$ norethindrone 1mg/estradiol 50mcg OVCON-50 2 $$ norethindrone 1mg/estradiol triphasic ESTROSTEP 2 $$ norethindrone triphasic / estradiol 35mcg TRI-NORINYL 2 $$$ * desogestrel 0.15mgl/estradiol 30mcg ORTHO-CEPT 1 $$$ norelgestromin 0.15mg/estradiol 0.02mg/24hr ORTHO EVRA 2 $$$ * norethindrone 0.35mg NOR-QD 1 $$$ * norethindrone 1mg/estradiol 35mcg ORTHO-NOVUM 1/35 1 $$$ * norethindrone 1mg/mestranol 50mcg ORTHO-NOVUM 1/50 1 $$$ norethindrone triphasic/estradiol 35mcg ORTHO-NOVUM 7/7/7 2 $$$ norgestimate 0.25mg/estradiol 35mcg ORTHO CYCLEN 2 $$$ norgestimate triphasic/estradiol 35mcg ORTHO TRICYCLEN 2 $$$ norgestimate triphasic/estradiol 25mcg ORTHO TRICYCLEN LO 2 $$$ norgestrel 0.075mg OVRETTE 2 $$$$ etonogestrel/estradiol NUVARING 2 $$$$ * norethindrone 0.5mg/estradiol 35mcg MODICON 1 $$$$ * norethindrone biphasic/estradiol 35mcg ORTHO NOVUM 10/11 1

    GENERIC NAME BRAND NAME TIER

    *Indicates Generic substitution is required24

  • *Indicates Generic substitution is required

    GENERIC NAME BRAND NAME TIER

    25

    $$$$$$ *norgestrel 0.5mg/estradiol 50mcg OVRAL 1 16.4 Estrogens

    $$ * estropipate OGEN 1 $$ * estradiol ESTRACE 1 $$ esterified estrogens ESTRATAB, MENEST 2 $$ dienestrol vaginal DIENESTROL 2 $$ conjugated estrogens PREMARIN 2 $$$ estradiol/norethindrone tablets FEMHRT 2 $$$ conjugated estrogens/ medroxyprogesterone PREMPHASE, PREMPRO 2 $$$ conjugated estrogens/ medroxyprogesterone PREMPRO LOW DOSE 2 $$$ estradiol patch, weekly CLIMARA 3 $$$ estradiol patch, bi-weekly ESTRADERM, VIVELLE, VIVELLE DOT 3 $$$ estradiol vaginal tablet VAGIFEM 2 $$$$ estradiol/norethindrone tablets ACTIVELLA 2 $$$$ estradiol/norgestimate ORTHO-PREFEST 2 $$$$$ estradiol/norethindrone patch COMBIPATCH 3 $$$$$ esterified estrogen/testosterone ESTRATEST, ESTRATEST HS 2 $$$$$ raloxifene EVISTA 2 16.5 Progestins

    $$ progesterone suppository PROGESTERONE SUPPOSITORY 2 $$ * medroxyprogesterone CYCRIN 1 $$ norethindrone 5mg AYGESTIN 2 $$$ medroxyprogesterone Inj. DEPO-PROVERA 2 $$$ progesterone micronized PROMETRIUM 2 17 ENDOCRINE AGENTS

    17.1 Osteoporosis Prevention

    $$$ risedronate ACTONEL 2(R) $$$$ calcitonin MIACALCIN 2 $$$$ alendronate FOSAMAX 2(R) $$$$ etidronate DIDRONEL 2

  • 17.2 Pituitary

    $$$$ lypressin nasal spray DIAPID 2 $$$$ * desmopressin acetate nasal spray DDAVP nasal spray 1(R)

    17.3 Other Endocrine

    $$ aminoglutethimide CYTADREN 2

    17.4 Thyroid Agents

    $ * levothyroxine LEVOTHROID, LEVOXYL 1 $ * levothyroxine SYNTHROID 1 $ thyroid ARMOUR THYROID 3 $$ liothyronine CYTOMEL 2

    17.5 Antithyroid Agents

    $$ * propylthiouracil PROPYLTHIOURACIL 1 $$$ * methimazole TAPAZOLE 1

    18 OXYTOCICS

    18.1 Oxytocics - misc.

    $$ methylergonovine maleate METHERGINE 2 $$$ ergonovine maleate ERGOTRATE 2 19 DIURETICS

    19.1 Loop

    $ * furosemide LASIX 1 $$$ ethacrynic acid EDECRIN 2 19.2 Thiazides

    $ * hydrochlorothiazide ORETIC 1 $$ metolazone ZAROXOLYN 3 19.3 Potassium-sparing diuretics

    $ triamterene DYRENIUM 2 $ * triamterene/hctz DYAZIDE, MAXZIDE 1 $$ * amiloride MIDAMOR 1 $$ * spironolactone ALDACTONE 1 $$$ * amiloride/hctz MODURETIC 1 $$$ * spironolactone/hctz ALDACTAZIDE 1

    GENERIC NAME BRAND NAME TIER

    *Indicates Generic substitution is required26

  • *Indicates Generic substitution is required

    GENERIC NAME BRAND NAME TIER

    27

    20 ELECTROLYTE REPLACEMENTS

    20.1 Alkalinizing agents

    $ potassium citrate UROCIT-K 2 $ * sodium citrate/citric acid BICITRA 1 20.2 Potassium supplements

    $ * potassium cl controlled release 10meq TEN- K 1 $ * potassium cl controlled release 8meq SLOW-K 1 $ * potassium cl effervescent powder K-LOR 1 $ * potassium cl effervescent tab K-LYTE 1 $ * potassium cl liquid KAOCHLOR 1 $$ * potassium cl controlled release 20meq K-DUR 1 20.3 Phosphate binders

    $$ calcium acetate PHOS-LO 2 20.5 Potassium binders

    $$$$ * sodium polystyrene sulfonate KAYEXALATE 1 21 URINARY TRACT AGENTS

    21.1 Antispasmodics

    $ * oxybutynin DITROPAN 1 $$$$$ tolterodine, tolterodine extended release DETROL, DETROL LA 3 21.2 Analgesics

    $ * phenazopyridine PYRIDIUM 1 $$ * methenamine/belladonna URISED 1 22 EYE PREPARATIONS

    22.1 Anti-infectives

    $ * bacitracin ophth BACITRACIN 1 $ * erythromycin ophth ILOTYCIN 1 $ * gentamicin ophth GENOPTIC, GARAMYCIN 1

  • 28

    $ * neomycin/polymyxin/ gramicidin ophth NEOSPORIN 1 $ * sulfacetamide ophth BLEPH-10, SULAMYD 1 $$ * tobramycin ophth TOBREX 1 $$ sulfisoxazole ophth GANTRISIN OPHTH 2 $$ * polymixin b/trimethoprim ophth POLYTRIM 1 $$$ ciprofloxacin ophth CILOXAN 2 $$$ ofloxacin ophth OCUFLOX 2 22.2 Anti-infectives/steroid

    $ sulfacetamide/prednisolone ophth BLEPHAMIDE 2 $$ * dexamethasone/neomycin/ polymyxin ophth MAXITROL 1 $$ * neomycin/polymyxin/hc ophth CORTISPORIN OPHTH 1 $$ tobramycin/dexamethasone ophth TOBRADEX 2 22.3 Antivirals $$ idoxuridine ophth HERPLEX 2 $$ vidarabine ophth VIRA A OPHTH 2 $$$$$ * trifluridine ophth VIROPTIC 1 22.4 Anti-inflammatory agents

    $ * prednisolone acetate ophth PRED FORTE, PRED MILD 1 $ * prednisolone phosphate ophth INFLAMASE 1 $ * dexamethasone ophth DECADRON 1 $$ * fluorometholone ophth suspension FML 1 $$ fluorometholone ophth ointment FML-SOP 2 $$$ loteprednol etabonate LOTEMAX 2 22.5 Misc. anti-inflammatory agents

    $$$ diclofenac ophth VOLTAREN 3 $$$ ketorolac ophth ACULAR 2 22.6 Carbonic anhydrase inhibitors

    $ * acetazolamide DIAMOX 1 $ methazolamide NEPTAZANE 2 $$$ brinzolamide ophth AZOPT 2 $$$ dorzolamide ophth TRUSOPT DROPS 2

    GENERIC NAME BRAND NAME TIER

    *Indicates Generic substitution is required

  • GENERIC NAME BRAND NAME TIER

    22.7 Miotics

    $ * pilocarpine ophth ISOPTO CARPINE 1 $$$ carbachol ophth ISOPTO CARBACHOL 2 $$$ echothiophate iodide ophth PHOSPHOLINE IODIDE 2 22.8 Mydriatics

    $ * atropine sulfate ophth ISOPTO ATROPINE 1 $ * cyclopentolate ophth CYCLOGEL 1 $$ * dipivefrin ophth PROPINE 1 $$ * homatropine ophth ISOPTO HOMATROPINE 1 $$ * phenylephrine ophth NEO-SYNEPHRINE 1 $$ scopolamine ophth ISOPTO HYOSCINE 2 $$ * tropicamide ophth MYDRIACYL 1 22.9 Antihistamines

    $$$$ olopatadine ophth PATANOL 2 22.10 Glaucoma

    $$$ * levobunolol ophth BETAGAN 1 $$$$ * timolol ophth TIMOPTIC 1 $$$$ * carteolol ophth OCUPRESS 1 $$$$ brimonidine ophth ALPHAGAN, ALPHAGAN P 2 $$$$ betaxolol ophth BETOPTIC-S 2 $$$$ * timolol xe ophth TIMOPTIC XE 1 $$$$$ latanoprost ophth XALATAN 2 $$$$$ bimatoprost ophth LUMIGAN 2 22.11 Mast Cell stabilizers

    $ * cromolyn sodium 4% ophth CROLOM 1 $$$ lodoxamide ophth ALOMIDE 2 23 OTIC PREPARATIONS

    23.1 Anti-Infectives

    $ * acetic acid 2% otic DOMEBORO OTIC, VOSOL 1 $ * acetic acid/hydrocortisone otic VOSOL HC OTIC 1 $ * hydrocortisone/neomycin/ colistin otic COLY-MYCIN S OTIC 1

    *Indicates Generic substitution is required29

  • 30

    GENERIC NAME BRAND NAME TIER

    *Indicates Generic substitution is required

    $ * hydrocortisone/neomycin/ polymyxin otic CORTISPORIN OTIC 1 $$ * chloramphenicol 0.5% otic CHLOROMYCETIN OTIC 1 $$$$ ofloxacin otic solution FLOXIN OTIC 2 $$$$ ciprofloxacin 0.3%/ dexamethasone 0.1% otic CIPRODEX 2

    23.2 Anesthetics

    $ * benzocaine/antipyrine otic AURALGAN 1 23.3 Otic Drugs - misc.

    $$$$ * triethanolamine/chlorobutanol otic CERUMENEX 1

    24 ORAL AND DENTAL PRODUCTS

    24.1 Oral and Dental Products - misc.

    $ * lidocaine viscous VISCOUS XYLOCAINE 1 $$ * triamcinolone oral gel KENALOG IN ORABASE 1 25 SKIN & MUCOUS MEMBRANE AGENTS

    25.1 Antibiotics, topical

    $$ * gentamicin sulfate topical GARAMYCIN TOPICAL 1 $$ * silver sulfadiazine topical SILVADENE 1 $$$ metronidazole topical gel METROGEL 2 $$$ mupirocin topical BACTROBAN 2 $$$ metronidazole topical cream METROCREAM 2 $$$ azelaic acid topical AZELEX 2 25.2 Antivirals

    $$$ acyclovir topical ZOVIRAX OINTMENT 2

  • *Indicates Generic substitution is required

    GENERIC NAME BRAND NAME TIER

    X

    25.3 Antifungals $ * nystatin topical NILSTAT 1 $ * nystatin/triamcinolone topical MYCOLOG II 1 $$$ ciclopirox topical LOPROX 3 $$$ clotrimazole/betamethasone topical LOTRISONE 2 $$$ econazole topical SPECTAZOLE 2 $$$ ketoconazole topical NIZORAL 3 $$$$ amphotericin b topical FUNGIZONE 2

    25.4 Scabicides & pediculicides

    $ * lindane KWELL 1 $ permethrin 1% NIX 2 $$ crotamiton EURAX 2 $$$ permethrin 5% ELIMITE 2

    25.5 Local Anti-Infectives - misc.

    $ selenium sulfide 2.5% SELSUN 3 $$$$ hexachlorophene cleaning emulsion PHISOHEX 2 25.6 Anti-Inflammatory Agents - low potency

    $ * hydrocortisone topical HYTONE 1 $ * hydrocortisone/pramoxine PROCTOCREAM-HC 1 $ * fluocinolone acetonide topical SYNALAR 1 $$ * desonide topical DESOWEN 1

    25.7 Anti-Inflammatory Agents - medium potency

    $ * triamcinolone topical KENALOG 1 $ * betamethasone valerate topical VALISONE 1 $$$ mometasone topical ELOCON 2

    25.8 Anti-Inflammatory Agents - high potency

    $ * betamethasone dipropionate topical DIPROLENE, DIPROSONE, MAXIVATE 1 $$$ fluocinolone acetonide topical - HP SYNALAR-HP 2 $$$ * fluocinonide topical LIDEX 1

    31

  • GENERIC NAME BRAND NAME TIER

    *Indicates Generic substitution is required

    X

    25.9 Anti-Inflammatory Agents - very high potency $$$ * clobetasol topical TEMOVATE 1 $$$$ * augmented betamethasone dipropionate DIPROLENE AF 1 $$$$ halobetasol topical ULTRAVATE 2

    25.10 Antipruritics & Local Anesthetics

    $ * lidocaine ointment LIDOCAINE OINTMENT 1

    25.11 Anti-Acne - Antibacterial

    $ * erythromycin topical A/T/S 1 $$ * clindamycin topical CLEOCIN T 1 $$$ sulfacetamide/sulfur topical SULFACET-R 2

    25.12 Anti-Acne - Cell Stimulants and Proliferants

    $$$$ adapalene topical DIFFERIN 2 $$$$ tazarotene topical TAZORAC 2

    25.13 Anti-Acne - Keratolytic Agents

    $ benzoyl peroxide/sulfur SULFOXYL LOTION 2 $$ benzoyl peroxide/clindamycin BENZACLIN 2 $$$ * benzoyl peroxide/erythromycin BENZAMYCIN 1

    25.14 Anti-Acne - Oral Agents

    $$$ methoxsalen OXSORALEN 3 $$$$$$$ *isotretinoin ACCUTANE 1

    25.15 Skin & Mucous Membrane Agents - misc.

    $$$ fluorouracil EFUDEX 2 $$$ hydrocortisone w/clioquinol VIOFORM-HC 2

    25.16 Antipsoriatics

    $$$$ calcipotriene DOVONEX 2

    32

  • *Indicates Generic substitution is required

    GENERIC NAME BRAND NAME TIER

    X

    25.17 Vaginal Preparations

    $ acetic acid vaginal jelly ACI-JEL 2 $ triple sulfa vaginal SULTRIN 2 $$ metronidazole vaginal METROGEL-VAGINAL 2 $$$$ clindamycin vaginal CLEOCIN VAGINAL CREAM 2 $$$$ miconazole vaginal MONISTAT-3 3 $$$$ terconazole vaginal TERAZOL 2

    25.18 Topical Immunomodulators

    $$$$ tacrolimus ointment PROTOPIC 2

    26 VITAMINS

    26.1 Vitamin B Complex

    $ * folic acid FOLIC ACID 1

    26.2 Vitamin D

    $ ergocalciferol CALCIFEROL 2 $$$ calcitriol ROCALTROL 3

    26.3 Vitamin K Activity

    $$ phytonadione MEPHYTON 2

    26.4 Multivitamins

    $ * prenatal vitamins PRENATAL VITAMINS 1 $$ renal multivitamin NEPHROVITE 2 27 ALCOHOL ABUSE PREVENTION/SMOKING CESSATION

    27.1 Alcohol Abuse Prevention - misc.

    $$ * disulfiram ANTABUSE 1

    27.2 Smoking Cessation

    $$$ bupropion sustained release ZYBAN 2(R) $$$ nicotine nasal spray NICOTROL NASAL SPRAY 2(R) $$$$$ nicotine inhaler NICOTROL INHALER 3(R)

    33

  • GENERIC NAME BRAND NAME TIER

    *Indicates Generic substitution is required

    X

    28 DEVICES/DIAGNOSTIC AIDS

    28.1 Devices/Diagnostic Aids - misc.

    $ diaphragms 2 $ sodium cl 0.9%, sterile 1 $ spacer for inhalers 2 $$ insulin syringes, disposable lancets 1 $$ peak flow meter TRUZONE PEAK FLOW METER ONLY No Copay $$ urine acetone test strips KETOSTIX 2 $$ glucose & ketone urine test kit KETO-DIASTIX 2 $$ glucose & ketone urine test kit CHEMSTRIP uGK 2 $$$ glucose blood test strips ACCU-CHEK 2

    34

  • Drug Page Therapeutic Class

    A/T/S . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 . . . . . . . . . . . 25.11abacavir . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . 4.13abacavir/lamivudine . . . . . . . . . . . . . . . . . 10 . . . . . . . . . . . . 4.13 abacavir/zidovudine/lamivudine . . . . . . . . . 10 . . . . . . . . . . . . 4.13ABILIFY . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 . . . . . . . . . . . 13.19 acarbose . . . . . . . . . . . . . . . . . . . . . . . . . . 23 . . . . . . . . . . . 15.3 ACCOLATE . . . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . . . . . 2.7 ACCU-CHEK . . . . . . . . . . . . . . . . . . . . . . . . 34 . . . . . . . . . . . 28.1ACCUPRIL . . . . . . . . . . . . . . . . . . . . . . . . . 14 . . . . . . . . . . . . 8.11ACCUTANE . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 . . . . . . . . . . . . .25.14acetazolamide . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . . . . . 22.6acetic acid 2% otic . . . . . . . . . . . . . . . . . . 29 . . . . . . . . . . . 23.1acetic acid vaginal jelly . . . . . . . . . . . . . . . 33 . . . . . . . . . . . 25.17acetic acid/hydrocortisone otic . . . . . . . . . 29 . . . . . . . . . . . 23.1ACHROMYCIN . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.9ACI-JEL . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 . . . . . . . . . . . 25.17ACIPHEX . . . . . . . . . . . . . . . . . . . . . . . . . . 22 . . . . . . . . . . . 14.6ACTIGALL . . . . . . . . . . . . . . . . . . . . . . . . . 22 . . . . . . . . . . . 14.9ACTIVELLA . . . . . . . . . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . 16.4ACTONEL . . . . . . . . . . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . 17.1ACULAR . . . . . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . . . . . 22.5acyclovir . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . 4.12acyclovir topical . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . . . . 25.2ADALAT . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 . . . . . . . . . . . . 8.2ADALAT CC . . . . . . . . . . . . . . . . . . . . . . . . 13 . . . . . . . . . . . . 8.2adapalene topical . . . . . . . . . . . . . . . . . . . . . . 32 . . . . . . . . . . . . .25.12ADDERALL . . . . . . . . . . . . . . . . . . . . . . . 20 . . . . . . . . . . . 13.13ADDERALL XR . . . . . . . . . . . . . . . . . . . . . . 20 . . . . . . . . . . . 13.13ADVAIR . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . . . . . 2.6AGENERASE . . . . . . . . . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . 4.13AGGRENOX . . . . . . . . . . . . . . . . . . . . . . . . 13 . . . . . . . . . . . . 7.3 AH-CHEW . . . . . . . . . . . . . . . . . . . . . . . . . . 5 . . . . . . . . . . . . 1.3AH-CHEW D . . . . . . . . . . . . . . . . . . . . . . . . . 5 . . . . . . . . . . . . 1.5albuterol . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . . . . . 2.2albuterol HFA inhaler . . . . . . . . . . . . . . . . . . 6 . . . . . . . . . . . . 2.2 albuterol repetabs . . . . . . . . . . . . . . . . . . . . 5 . . . . . . . . . . . . 2.1albuterol tabs . . . . . . . . . . . . . . . . . . . . . . . 5 . . . . . . . . . . . . 2.1ALDACTAZIDE . . . . . . . . . . . . . . . . . . . . . . 26 . . . . . . . . . . . 19.3

    ALPHABETICAL INDEX

    35

  • Drug Page Therapeutic Class

    ALDACTONE . . . . . . . . . . . . . . . . . . . . . . . 26 . . . . . . . . . . . 19.3ALDOMET . . . . . . . . . . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . 8.17ALDORIL . . . . . . . . . . . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . 8.17alendronate . . . . . . . . . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . 17.1ALKERAN . . . . . . . . . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . . . 5.1ALLEGRA . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 . . . . . . . . . . . . 1.2allopurinol . . . . . . . . . . . . . . . . . . . . . . . . . 16 . . . . . . . . . . . . 9.2ALOMIDE . . . . . . . . . . . . . . . . . . . . . . . . . 29 . . . . . . . . . . . 22.11ALPHAGAN . . . . . . . . . . . . . . . . . . . . . . . . 29 . . . . . . . . . . . 22.10ALPHAGAN P . . . . . . . . . . . . . . . . . . . . . . . 29 . . . . . . . . . . . 22.10alprazolam . . . . . . . . . . . . . . . . . . . . . . . . 20 . . . . . . . . . . . 13.14ALTACE . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 . . . . . . . . . . . . 8.11ALUPENT . . . . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . . . . . 2.2amantadine . . . . . . . . . . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . 4.12amantadine . . . . . . . . . . . . . . . . . . . . . . . . 12 . . . . . . . . . . . . 6.3AMARYL . . . . . . . . . . . . . . . . . . . . . . . . . . 23 . . . . . . . . . . . 15.2AMBIEN . . . . . . . . . . . . . . . . . . . . . . . . . . 21 . . . . . . . . . . . 13.15 AMICAR . . . . . . . . . . . . . . . . . . . . . . . . . . 13 . . . . . . . . . . . . 7.3 amiloride . . . . . . . . . . . . . . . . . . . . . . . . . . 26 . . . . . . . . . . . 19.3amiloride/hctz . . . . . . . . . . . . . . . . . . . . . . 26 . . . . . . . . . . . 19.3aminocaproic acid . . . . . . . . . . . . . . . . . . . 13 . . . . . . . . . . . . 7.3 aminoglutethimide . . . . . . . . . . . . . . . . . . . 26 . . . . . . . . . . . 17.3aminosalicylic . . . . . . . . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . 4.11amiodarone . . . . . . . . . . . . . . . . . . . . . . . . 14 . . . . . . . . . . . . 8.10amitriptyline . . . . . . . . . . . . . . . . . . . . . . . 18 . . . . . . . . . . . 13.1amlodipine . . . . . . . . . . . . . . . . . . . . . . . . 13 . . . . . . . . . . . . 8.2amoxapine . . . . . . . . . . . . . . . . . . . . . . . . 19 . . . . . . . . . . . 13.2amoxicillin . . . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.8AMOXIL . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.8amphetamine mixture . . . . . . . . . . . . . . . . 20 . . . . . . . . . . . 13.13amphetamine mixture extended release . . . 20 . . . . . . . . . . . 13.13amphotericin b topical . . . . . . . . . . . . . . . . 31 . . . . . . . . . . . 25.3ampicillin . . . . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.8amprenavir . . . . . . . . . . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . 4.13ANAFRANIL . . . . . . . . . . . . . . . . . . . . . . . . 18 . . . . . . . . . . . 13.1ANAPROX . . . . . . . . . . . . . . . . . . . . . . . . . 16 . . . . . . . . . . . . 9.1ANAPROX DS . . . . . . . . . . . . . . . . . . . . . . 16 . . . . . . . . . . . . 9.1anastrazole . . . . . . . . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . . . 5.6

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    ANDRODERM . . . . . . . . . . . . . . . . . . . . . . 23 . . . . . . . . . . . 16.2ANSAID . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 . . . . . . . . . . . . 9.1ANTABUSE . . . . . . . . . . . . . . . . . . . . . . . . 33 . . . . . . . . . . . 27.1ANTIVERT . . . . . . . . . . . . . . . . . . . . . . . . . 21 . . . . . . . . . . . 14.4ANUSOL-HC . . . . . . . . . . . . . . . . . . . . . . . . 22 . . . . . . . . . . . 14.8apap/codeine . . . . . . . . . . . . . . . . . . . . . . 17 . . . . . . . . . . . 11.1APRESOLINE . . . . . . . . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . 8.18ARALEN PHOSPHATE . . . . . . . . . . . . . . . . . 10 . . . . . . . . . . . . 4.14ARANESP . . . . . . . . . . . . . . . . . . . . . . . . . 16 . . . . . . . . . . . . 8.20ARICEPT . . . . . . . . . . . . . . . . . . . . . . . . . . 21 . . . . . . . . . . . 13.17ARIMIDEX . . . . . . . . . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . . . 5.6 aripriprazole . . . . . . . . . . . . . . . . . . . . . . . 21 . . . . . . . . . . . 13.19 ARMOUR THYROID . . . . . . . . . . . . . . . . . . 26 . . . . . . . . . . . 17.4ARTANE . . . . . . . . . . . . . . . . . . . . . . . . . . 12 . . . . . . . . . . . . 6.2asa/codeine . . . . . . . . . . . . . . . . . . . . . . . 17 . . . . . . . . . . . 11.1ASACOL . . . . . . . . . . . . . . . . . . . . . . . . . . 22 . . . . . . . . . . . 14.8ASENDIN . . . . . . . . . . . . . . . . . . . . . . . . . . 19 . . . . . . . . . . . 13.2ASTELIN . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 . . . . . . . . . . . . 1.4 ATARAX . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 . . . . . . . . . . . . 1.1atazanavir . . . . . . . . . . . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . 4.13 atenolol . . . . . . . . . . . . . . . . . . . . . . . . . . 13 . . . . . . . . . . . . 8.4ATIVAN . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 . . . . . . . . . . . 13.14atorvastatin . . . . . . . . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . 8.14atovaquone . . . . . . . . . . . . . . . . . . . . . . . . 10 . . . . . . . . . . . . 4.18 atropine sulfate ophth . . . . . . . . . . . . . . . . 29 . . . . . . . . . . . 22.8ATROVENT . . . . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . . . . . 2.4ATROVENT solution for nebs . . . . . . . . . . . . 6 . . . . . . . . . . . . 2.4 augmented betamethasone dipropionate . . 32 . . . . . . . . . . . 25.9AURALGAN . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . . . . 23.2auranofin . . . . . . . . . . . . . . . . . . . . . . . . . . 16 . . . . . . . . . . . . 9.3AVALIDE . . . . . . . . . . . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . 8.13 AVANDIA . . . . . . . . . . . . . . . . . . . . . . . . . . 23 . . . . . . . . . . . 15.3AVAPRO . . . . . . . . . . . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . 8.13 AVELOX . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . 4.10 AVIANE . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 . . . . . . . . . . . 16.3AVONEX . . . . . . . . . . . . . . . . . . . . . . . . . . 10 . . . . . . . . . . . . 4.19AYGESTIN . . . . . . . . . . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . 16.5azathioprine . . . . . . . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . . . 5.8

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  • Drug Page Therapeutic Class

    azelaic acid topical . . . . . . . . . . . . . . . . . . 30 . . . . . . . . . . . 25.1 azelastine nasal spray . . . . . . . . . . . . . . . . . 5 . . . . . . . . . . . . 1.4 AZELEX . . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . . . . 25.1 azithromycin . . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.7AZMACORT . . . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . . . . . 2.6AZOPT . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . . . . . 22.6AZULFIDINE . . . . . . . . . . . . . . . . . . . . . . . 22 . . . . . . . . . . . 14.8BACITRACIN . . . . . . . . . . . . . . . . . . . . . . . 27 . . . . . . . . . . . 22.1bacitracin ophth . . . . . . . . . . . . . . . . . . . . 27 . . . . . . . . . . . 22.1baclofen . . . . . . . . . . . . . . . . . . . . . . . . . . 17 . . . . . . . . . . . 10.1BACTRIM . . . . . . . . . . . . . . . . . . . . . . . . . 10 . . . . . . . . . . . . 4.15BACTROBAN . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . . . . 25.1beclomethasone inhaler . . . . . . . . . . . . . . . . 6 . . . . . . . . . . . . 2.6beclomethasone nasal inhaler . . . . . . . . . . . 5 . . . . . . . . . . . . 1.4beclomethasone nasal inhaler AQ . . . . . . . . 5 . . . . . . . . . . . . 1.4beclomethasone nasal inhaler DS . . . . . . . . 5 . . . . . . . . . . . . 1.4BECONASE . . . . . . . . . . . . . . . . . . . . . . . . . 5 . . . . . . . . . . . . 1.4 BECONASE AQ . . . . . . . . . . . . . . . . . . . . . . 5 . . . . . . . . . . . . 1.4belladonna alkaloids/phenobarb . . . . . . . . 12 . . . . . . . . . . . . 6.4belladonna/phenobarb/ergotamine . . . . . . 12 . . . . . . . . . . . . 6.4BELLERGAL S . . . . . . . . . . . . . . . . . . . . . . 12 . . . . . . . . . . . . 6.4BENADRYL . . . . . . . . . . . . . . . . . . . . . . . . . 5 . . . . . . . . . . . . 1.1benazepril . . . . . . . . . . . . . . . . . . . . . . . . . 14 . . . . . . . . . . . . 8.11benazepril/amlodipine . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . 8.12BENEMID . . . . . . . . . . . . . . . . . . . . . . . . . 16 . . . . . . . . . . . . 9.2BENICAR . . . . . . . . . . . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . 8.13 BENICAR HCT . . . . . . . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . 8.13BENTYL . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 . . . . . . . . . . . 14.7BENTYL . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 . . . . . . . . . . . . 6.4BENZACLIN . . . . . . . . . . . . . . . . . . . . . . . . 32 . . . . . . . . . . . 25.13benazepril/hctz . . . . . . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . 8.12 BENZAMYCIN . . . . . . . . . . . . . . . . . . . . . . 32 . . . . . . . . . . . 25.13benzocaine/antipyrine otic . . . . . . . . . . . . 30 . . . . . . . . . . . 23.2benzonatate . . . . . . . . . . . . . . . . . . . . . . . . 7 . . . . . . . . . . . . 3.2benzoyl peroxide/clindamycin . . . . . . . . . . 32 . . . . . . . . . . . 25.13benzoyl peroxide/erythromycin . . . . . . . . . 32 . . . . . . . . . . . 25.13benzoyl peroxide/sulfur . . . . . . . . . . . . . . . 32 . . . . . . . . . . . 25.13benztropine mesylate . . . . . . . . . . . . . . . . . 12 . . . . . . . . . . . . 6.2

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  • BETAGAN . . . . . . . . . . . . . . . . . . . . . . . . . 29 . . . . . . . . . . . 22.10betamethasone dipropionate topical . . . . . 31 . . . . . . . . . . . 25.8betamethasone valerate topical . . . . . . . . . 31 . . . . . . . . . . . 25.7BETAPACE . . . . . . . . . . . . . . . . . . . . . . . . . 14 . . . . . . . . . . . . 8.10betaxolol ophth . . . . . . . . . . . . . . . . . . . . . 29 . . . . . . . . . . . 22.10bethanechol . . . . . . . . . . . . . . . . . . . . . . . 12 . . . . . . . . . . . . 6.1BETOPTIC-S . . . . . . . . . . . . . . . . . . . . . . . 29 . . . . . . . . . . . 22.10BIAXIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.7BIAXIN XL . . . . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.7 bicalutamide . . . . . . . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . . . 5.4BICITRA . . . . . . . . . . . . . . . . . . . . . . . . . . 27 . . . . . . . . . . . 20.1bimatoprost ophth . . . . . . . . . . . . . . . . . . . 29 . . . . . . . . . . . 22.10BLEPH-10 . . . . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . . . . . 22.1BLEPHAMIDE . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . . . . . 22.2BRETHINE . . . . . . . . . . . . . . . . . . . . . . . . . . 5 . . . . . . . . . . . . 2.1brimonidine ophth . . . . . . . . . . . . . . . . . . . 29 . . . . . . . . . . . 22.10brinzolamide ophth . . . . . . . . . . . . . . . . . . 28 . . . . . . . . . . . 22.6bromocriptine . . . . . . . . . . . . . . . . . . . . . . 12 . . . . . . . . . . . . 6.3budesonide inhaler . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . . . . . 2.6 budesonide nasal spray . . . . . . . . . . . . . . . . 5 . . . . . . . . . . . . 1.4 budesonide suspension for inhalation . . . . . . 6 . . . . . . . . . . . . 2.6bupropion . . . . . . . . . . . . . . . . . . . . . . . . . 19 . . . . . . . . . . . 13.4bupropion sustained release . . . . . . . . . . . 33 . . . . . . . . . . . 27.2bupropion sustained release . . . . . . . . . . . 19 . . . . . . . . . . . 13.4busulfan . . . . . . . . . . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . . . 5.1butalbital/325mg apap/caffeine . . . . . . . . 17 . . . . . . . . . . . 11.2butalbital/500mg apap/caffeine . . . . . . . . 17 . . . . . . . . . . . 11.2butalbital/apap/codeine . . . . . . . . . . . . . . 17 . . . . . . . . . . . 11.1butalbital/asa/caffeine . . . . . . . . . . . . . . . 17 . . . . . . . . . . . 11.2butalbital/asa/codeine . . . . . . . . . . . . . . . 17 . . . . . . . . . . . 11.1CAFERGOT . . . . . . . . . . . . . . . . . . . . . . . . 17 . . . . . . . . . . . 11.2caffeine citrate . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . . . . . 2.3CAFFEINE CITRATE . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . . . . . 2.3 CALAN . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 . . . . . . . . . . . . 8.2CALAN SR . . . . . . . . . . . . . . . . . . . . . . . . . 13 . . . . . . . . . . . . 8.2CALCIFEROL . . . . . . . . . . . . . . . . . . . . . . . 33 . . . . . . . . . . . 26.2calcipotriene . . . . . . . . . . . . . . . . . . . . . . . 32 . . . . . . . . . . . 25.16 calcitonin . . . . . . . . . . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . 17.1

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  • Drug Page Therapeutic Class

    calcitriol . . . . . . . . . . . . . . . . . . . . . . . . . . 33 . . . . . . . . . . . 26.2calcium acetate . . . . . . . . . . . . . . . . . . . . 27 . . . . . . . . . . . 20.3CAPOTEN . . . . . . . . . . . . . . . . . . . . . . . . . 14 . . . . . . . . . . . . 8.11captopril . . . . . . . . . . . . . . . . . . . . . . . . . . 14 . . . . . . . . . . . . 8.11CARAFATE . . . . . . . . . . . . . . . . . . . . . . . . . 22 . . . . . . . . . . . 14.6carbachol ophth . . . . . . . . . . . . . . . . . . . . 29 . . . . . . . . . . . 22.7carbamazepine . . . . . . . . . . . . . . . . . . . . . 18 . . . . . . . . . . . 12.4carbamazepine extended release . . . . . . . . 18 . . . . . . . . . . . 12.4carbamazepine sustained release . . . . . . . . 18 . . . . . . . . . . . 12.4CARBATROL . . . . . . . . . . . . . . . . . . . . . . . 18 . . . . . . . . . . . 12.4CARDEC . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 . . . . . . . . . . . . 3.2CARDEC-DM . . . . . . . . . . . . . . . . . . . . . . . . 7 . . . . . . . . . . . . 3.2CARDIZEM . . . . . . . . . . . . . . . . . . . . . . . . 13 . . . . . . . . . . . . 8.2CARDURA . . . . . . . . . . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . 8.16carisoprodol . . . . . . . . . . . . . . . . . . . . . . . 17 . . . . . . . . . . . 10.1carisoprodol/asa . . . . . . . . . . . . . . . . . . . . 17 . . . . . . . . . . . 10.1carisoprodol/asa/codeine . . . . . . . . . . . . . 17 . . . . . . . . . . . 11.1carteolol ophth . . . . . . . . . . . . . . . . . . . . . 29 . . . . . . . . . . . 22.10carvedilol . . . . . . . . . . . . . . . . . . . . . . . . . 14 . . . . . . . . . . . . 8.5CASODEX . . . . . . . . . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . . . 5.4CATAPRES tablets . . . . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . 8.17CECLOR . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.4CECLOR CD . . . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.4CEENU . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . . . 5.1cefaclor . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.4cefaclor CD . . . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.4cefprozil . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.4cefixime . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.5 cefprozil . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.4 CEFTIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.4 cefuroxime . . . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.4 CEFZIL . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.4CELEBREX . . . . . . . . . . . . . . . . . . . . . . . . 16 . . . . . . . . . . . . 9.1celecoxib . . . . . . . . . . . . . . . . . . . . . . . . . 16 . . . . . . . . . . . . 9.1CELEXA . . . . . . . . . . . . . . . . . . . . . . . . . . 19 . . . . . . . . . . . 13.3CELLCEPT . . . . . . . . . . . . . . . . . . . . . . . . . 12 . . . . . . . . . . . . 5.8CENTRAX . . . . . . . . . . . . . . . . . . . . . . . . . 20 . . . . . . . . . . . 13.14cephalexin . . . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.3

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  • CEPHULAC . . . . . . . . . . . . . . . . . . . . . . . . 21 . . . . . . . . . . . 14.2CERUMENEX . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . . . . 23.3cetirizine . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 . . . . . . . . . . . . 1.2CHEMSTRIP uGK . . . . . . . . . . . . . . . . . . . 34 . . . . . . . . . . . 28.1chloral hydrate . . . . . . . . . . . . . . . . . . . . . 21 . . . . . . . . . . . 13.15chlorambucil . . . . . . . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . . . 5.1chloramphenicol 0.5% otic . . . . . . . . . . . . . 30 . . . . . . . . . . . 23.1chlordiazepoxide . . . . . . . . . . . . . . . . . . . . 20 . . . . . . . . . . . 13.14chlordiazepoxide/clidinium bromide . . . . . . 12 . . . . . . . . . . . . 6.4CHLOROMYCETIN OTIC . . . . . . . . . . . . . . . 30 . . . . . . . . . . . 23.1chloroquine phosphate . . . . . . . . . . . . . . . . 10 . . . . . . . . . . . . 4.14chlorpheniramine/phenylephrine/scopolamine . 5 . . . . . . . . . . . . 1.3chlorpromazine . . . . . . . . . . . . . . . . . . . . . 19 . . . . . . . . . . . 13.6chlorzoxazone . . . . . . . . . . . . . . . . . . . . . . 17 . . . . . . . . . . . 10.1cholestyramine . . . . . . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . 8.15ciclopirox topical . . . . . . . . . . . . . . . . . . . . 31 . . . . . . . . . . . 25.3CILOXAN . . . . . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . . . . . 22.1cimetidine . . . . . . . . . . . . . . . . . . . . . . . . . 22 . . . . . . . . . . . 14.5CIPRO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . 4.10CIPRODEX . . . . . . . . . . . . . . . . . . . . . . . . . 30 . . . . . . . . . . . 23.1 ciprofloxacin . . . . . . . . . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . 4.10ciprofloxacin 0.3%/dexamethasone 0.1% otic 30 . . . . . . . . . . . 23.1 ciprofloxacin ophth . . . . . . . . . . . . . . . . . . 28 . . . . . . . . . . . 22.1citalopram . . . . . . . . . . . . . . . . . . . . . . . . . 19 . . . . . . . . . . . 13.3clarithromycin . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.7 clarithromycin extended release . . . . . . . . . 8 . . . . . . . . . . . . 4.7 CLEOCIN . . . . . . . . . . . . . . . . . . . . . . . . . . 10 . . . . . . . . . . . . 4.18CLEOCIN T . . . . . . . . . . . . . . . . . . . . . . . . 32 . . . . . . . . . . . 25.11CLEOCIN VAGINAL CREAM . . . . . . . . . . . . 33 . . . . . . . . . . . 25.17CLIMARA . . . . . . . . . . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . 16.4clindamycin . . . . . . . . . . . . . . . . . . . . . . . . 10 . . . . . . . . . . . . 4.18clindamycin topical . . . . . . . . . . . . . . . . . . 32 . . . . . . . . . . . 25.11clindamycin vaginal . . . . . . . . . . . . . . . . . . 33 . . . . . . . . . . . 25.17CLINORIL . . . . . . . . . . . . . . . . . . . . . . . . . 16 . . . . . . . . . . . . 9.1clobetasol topical . . . . . . . . . . . . . . . . . . . 32 . . . . . . . . . . . 25.9clofazimine . . . . . . . . . . . . . . . . . . . . . . . . 10 . . . . . . . . . . . . 4.18 clomipramine . . . . . . . . . . . . . . . . . . . . . . 18 . . . . . . . . . . . 13.1clonazepam . . . . . . . . . . . . . . . . . . . . . . . . 18 . . . . . . . . . . . 12.4

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    clonidine tablets . . . . . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . 8.17clopidogrel . . . . . . . . . . . . . . . . . . . . . . . . 13 . . . . . . . . . . . . 7.2clotrimazole troche . . . . . . . . . . . . . . . . . . . 7 . . . . . . . . . . . . 4.2clotrimazole/betamethasone topical . . . . . 31 . . . . . . . . . . . 25.3clozapine . . . . . . . . . . . . . . . . . . . . . . . . . . 20 . . . . . . . . . . . 13.9CLOZARIL . . . . . . . . . . . . . . . . . . . . . . . . . 20 . . . . . . . . . . . 13.9CODEINE . . . . . . . . . . . . . . . . . . . . . . . . . . 17 . . . . . . . . . . . 11.1codeine . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 . . . . . . . . . . . 11.1codeine/guaifenesin syrup . . . . . . . . . . . . . . 7 . . . . . . . . . . . . 3.1COGENTIN . . . . . . . . . . . . . . . . . . . . . . . . . 12 . . . . . . . . . . . . 6.2COLBENEMID . . . . . . . . . . . . . . . . . . . . . . 16 . . . . . . . . . . . . 9.2COLCHICINE . . . . . . . . . . . . . . . . . . . . . . . 16 . . . . . . . . . . . . 9.2colchicine . . . . . . . . . . . . . . . . . . . . . . . . . 16 . . . . . . . . . . . . 9.2COLY-MYCIN S OTIC . . . . . . . . . . . . . . . . . 30 . . . . . . . . . . . 23.1COLYTE . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 . . . . . . . . . . . 14.2COMBIPATCH . . . . . . . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . 16.4COMBIVENT . . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . . . . . 2.4COMBIVIR . . . . . . . . . . . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . 4.13COMPAZINE . . . . . . . . . . . . . . . . . . . . . . . 21 . . . . . . . . . . . 14.4COMTAN . . . . . . . . . . . . . . . . . . . . . . . . . . 12 . . . . . . . . . . . . 6.3CONCERTA . . . . . . . . . . . . . . . . . . . . . . . . 20 . . . . . . . . . . . 13.13conjugated estrogens . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . 16.4conjugated estrogens/medroxyprogesterone 25 . . . . . . . . . . . 16.4CORDARONE . . . . . . . . . . . . . . . . . . . . . . . 14 . . . . . . . . . . . . 8.10COREG . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 . . . . . . . . . . . . 8.5CORTEF . . . . . . . . . . . . . . . . . . . . . . . . . . 23 . . . . . . . . . . . 16.1CORTENEMA . . . . . . . . . . . . . . . . . . . . . . . 22 . . . . . . . . . . . 14.8CORTISPORIN OPHTH . . . . . . . . . . . . . . . . 28 . . . . . . . . . . . 22.2CORTISPORIN OTIC . . . . . . . . . . . . . . . . . . 30 . . . . . . . . . . . 23.1COUMADIN . . . . . . . . . . . . . . . . . . . . . . . . 13 . . . . . . . . . . . . 7.1CREON . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 . . . . . . . . . . . 14.3CRIXIVAN . . . . . . . . . . . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . 4.13CROLOM . . . . . . . . . . . . . . . . . . . . . . . . . . 29 . . . . . . . . . . . 22.11cromolyn sodium 4% ophth . . . . . . . . . . . . 29 . . . . . . . . . . . 22.11cromolyn sodium inhaler . . . . . . . . . . . . . . . 6 . . . . . . . . . . . . 2.5crotamiton . . . . . . . . . . . . . . . . . . . . . . . . 31 . . . . . . . . . . . 25.4CUPRIMINE . . . . . . . . . . . . . . . . . . . . . . . . 16 . . . . . . . . . . . . 9.3CYCLESSA . . . . . . . . . . . . . . . . . . . . . . . . 24 . . . . . . . . . . . 16.3

    42

  • cyclobenzaprine . . . . . . . . . . . . . . . . . . . . . 17 . . . . . . . . . . . 10.1CYCLOGEL . . . . . . . . . . . . . . . . . . . . . . . . 29 . . . . . . . . . . . 22.8cyclopentolate ophth . . . . . . . . . . . . . . . . . 29 . . . . . . . . . . . 22.8cyclophosphamide . . . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . . . 5.1cycloserine . . . . . . . . . . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . 4.11cyclosporine . . . . . . . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . . . 5.8cyclosporine microemulsion . . . . . . . . . . . . 11 . . . . . . . . . . . . 5.8CYCRIN . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . 16.5cyproheptadine . . . . . . . . . . . . . . . . . . . . . . 5 . . . . . . . . . . . . 1.1CYTADREN . . . . . . . . . . . . . . . . . . . . . . . . 26 . . . . . . . . . . . 17.3CYTOMEL . . . . . . . . . . . . . . . . . . . . . . . . . 26 . . . . . . . . . . . 17.4CYTOTEC . . . . . . . . . . . . . . . . . . . . . . . . . 22 . . . . . . . . . . . 14.6CYTOVENE . . . . . . . . . . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . 4.13CYTOXAN . . . . . . . . . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . . . 5.1danazol . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 . . . . . . . . . . . 16.2DANOCRINE . . . . . . . . . . . . . . . . . . . . . . . 23 . . . . . . . . . . . 16.2DAPSONE . . . . . . . . . . . . . . . . . . . . . . . . . 10 . . . . . . . . . . . . 4.16dapsone . . . . . . . . . . . . . . . . . . . . . . . . . . 10 . . . . . . . . . . . . 4.16darbepoetin alfa . . . . . . . . . . . . . . . . . . . . 16 . . . . . . . . . . . . 8.20 DARVOCET N . . . . . . . . . . . . . . . . . . . . . . . 17 . . . . . . . . . . . 11.1DAYPRO . . . . . . . . . . . . . . . . . . . . . . . . . . 16 . . . . . . . . . . . . 9.1 DARVON . . . . . . . . . . . . . . . . . . . . . . . . . . 17 . . . . . . . . . . . 11.1DARVON COMPOUND . . . . . . . . . . . . . . . . 17 . . . . . . . . . . . 11.1DDAVP nasal spray . . . . . . . . . . . . . . . . . . 26 . . . . . . . . . . . 17.2DECADRON . . . . . . . . . . . . . . . . . . . . . . . . 23 . . . . . . . . . . . 16.1DECADRON . . . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . . . . . 22.4DECLOMYCIN . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.9 delavirdine . . . . . . . . . . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . 4.13DELTASONE . . . . . . . . . . . . . . . . . . . . . . . . 23 . . . . . . . . . . . 16.1demeclocycline . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.9 DEMEROL . . . . . . . . . . . . . . . . . . . . . . . . . 17 . . . . . . . . . . . 11.1DEPAKENE . . . . . . . . . . . . . . . . . . . . . . . . 18 . . . . . . . . . . . 12.4DEPAKOTE . . . . . . . . . . . . . . . . . . . . . . . . 18 . . . . . . . . . . . 12.4DEPAKOTE ER . . . . . . . . . . . . . . . . . . . . . . 18 . . . . . . . . . . . 12.4DEPO-PROVERA . . . . . . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . 16.5desipramine . . . . . . . . . . . . . . . . . . . . . . . 19 . . . . . . . . . . . 13.2desmopressin acetate nasal spray . . . . . . . 26 . . . . . . . . . . . 17.2desogestrel 0.15mgl/estradiol 30mcg . . . . 24 . . . . . . . . . . . 16.3

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    desogestrel triphasic/estradiol 0.025mcg . 24 . . . . . . . . . . . 16.3desonide topical . . . . . . . . . . . . . . . . . . . . 31 . . . . . . . . . . . 25.6DESOWEN . . . . . . . . . . . . . . . . . . . . . . . . . 31 . . . . . . . . . . . 25.6DESYREL . . . . . . . . . . . . . . . . . . . . . . . . . . 19 . . . . . . . . . . . 13.4DETROL . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 . . . . . . . . . . . 21.1DETROL LA . . . . . . . . . . . . . . . . . . . . . . . . 27 . . . . . . . . . . . 21.1dexamethasone . . . . . . . . . . . . . . . . . . . . . 23 . . . . . . . . . . . 16.1dexamethasone ophth . . . . . . . . . . . . . . . . 28 . . . . . . . . . . . 22.4dexamethasone/neomycin/polymyxin ophth 28 . . . . . . . . . . . 22.2dexchlorpheniramine . . . . . . . . . . . . . . . . . . . . . .5 . . . . . . . . . . . . . .1.1 DEXEDRINE . . . . . . . . . . . . . . . . . . . . . . . . 20 . . . . . . . . . . . 13.13dextroamphetamine . . . . . . . . . . . . . . . . . . 20 . . . . . . . . . . . 13.13dextromethorphan/guaifenesin . . . . . . . . . . 7 . . . . . . . . . . . . 3.2DHE-45 . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 . . . . . . . . . . . 11.2 DIABETA . . . . . . . . . . . . . . . . . . . . . . . . . . 23 . . . . . . . . . . . 15.2DIAMOX . . . . . . . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . . . . . 22.6diaphragms . . . . . . . . . . . . . . . . . . . . . . . . 34 . . . . . . . . . . . 28.1DIAPID . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 . . . . . . . . . . . 17.2DIASTAT . . . . . . . . . . . . . . . . . . . . . . . . . . 18 . . . . . . . . . . . 12.4diazepam . . . . . . . . . . . . . . . . . . . . . . . . . 20 . . . . . . . . . . . 13.14diazepam gel . . . . . . . . . . . . . . . . . . . . . . . 18 . . . . . . . . . . . 12.4diclofenac ophth . . . . . . . . . . . . . . . . . . . . 28 . . . . . . . . . . . 22.5diclofenac sodium . . . . . . . . . . . . . . . . . . . 16 . . . . . . . . . . . . 9.1dicloxacillin . . . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.8dicyclomine . . . . . . . . . . . . . . . . . . . . . . . . 22 . . . . . . . . . . . 14.7dicyclomine . . . . . . . . . . . . . . . . . . . . . . . . 12 . . . . . . . . . . . . 6.4didanosine (ddi) . . . . . . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . 4.13DIDRONEL . . . . . . . . . . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . 17.1DIENESTROL . . . . . . . . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . 16.4dienestrol vaginal . . . . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . 16.4DIFFERIN . . . . . . . . . . . . . . . . . . . . . . . . . 32 . . . . . . . . . . . 25.12DIFLUCAN . . . . . . . . . . . . . . . . . . . . . . . . . . 7 . . . . . . . . . . . . 4.2diflunisal . . . . . . . . . . . . . . . . . . . . . . . . . . 16 . . . . . . . . . . . . 9.1digoxin tabs . . . . . . . . . . . . . . . . . . . . . . . 13 . . . . . . . . . . . . 8.1dihydroergotamine mesylate . . . . . . . . . . . 18 . . . . . . . . . . . 11.2 dihydroergotamine mesylate nasal spray . . 17 . . . . . . . . . . . 11.2DILACOR XR . . . . . . . . . . . . . . . . . . . . . . . 13 . . . . . . . . . . . . 8.2DILANTIN . . . . . . . . . . . . . . . . . . . . . . . . . 18 . . . . . . . . . . . 12.2

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    DILAUDID . . . . . . . . . . . . . . . . . . . . . . . . . 17 . . . . . . . . . . . 11.1diltiazem . . . . . . . . . . . . . . . . . . . . . . . . . . 13 . . . . . . . . . . . . 8.2diltiazem sustained release . . . . . . . . . . . . 13 . . . . . . . . . . . . 8.2DIMETANE DC . . . . . . . . . . . . . . . . . . . . . . . 7 . . . . . . . . . . . . 3.1DIOVAN . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . 8.13DIOVAN HCT . . . . . . . . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . 8.13DIPENTUM . . . . . . . . . . . . . . . . . . . . . . . . 22 . . . . . . . . . . . 14.8diphenhydramine . . . . . . . . . . . . . . . . . . . . . 5 . . . . . . . . . . . . 1.1diphenoxylate/atropine . . . . . . . . . . . . . . . 21 . . . . . . . . . . . 14.1dipivefrin ophth . . . . . . . . . . . . . . . . . . . . . 29 . . . . . . . . . . . 22.8DIPROLENE . . . . . . . . . . . . . . . . . . . . . . . . 31 . . . . . . . . . . . 25.8DIPROLENE AF . . . . . . . . . . . . . . . . . . . . . 32 . . . . . . . . . . . 25.9DIPROSONE . . . . . . . . . . . . . . . . . . . . . . . . 31 . . . . . . . . . . . 25.8dipyridamole . . . . . . . . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . 8.18dipyridamole/aspirin . . . . . . . . . . . . . . . . . 13 . . . . . . . . . . . . 7.3 DISALCID . . . . . . . . . . . . . . . . . . . . . . . . . 16 . . . . . . . . . . . . 9.1disopyramide . . . . . . . . . . . . . . . . . . . . . . . 14 . . . . . . . . . . . . 8.7disopyramide controlled release . . . . . . . . . 14 . . . . . . . . . . . . 8.7disulfiram . . . . . . . . . . . . . . . . . . . . . . . . . 33 . . . . . . . . . . . 27.1DITROPAN . . . . . . . . . . . . . . . . . . . . . . . . . 27 . . . . . . . . . . . 21.1divalproex sodium . . . . . . . . . . . . . . . . . . . 18 . . . . . . . . . . . 12.4divalproex sodium extended release . . . . . . 18 . . . . . . . . . . . 12.4DOLOBID . . . . . . . . . . . . . . . . . . . . . . . . . . 16 . . . . . . . . . . . . 9.1DOMEBORO OTIC . . . . . . . . . . . . . . . . . . . 29 . . . . . . . . . . . 23.1donepezil . . . . . . . . . . . . . . . . . . . . . . . . . . 21 . . . . . . . . . . . 13.17DONNATAL . . . . . . . . . . . . . . . . . . . . . . . . 12 . . . . . . . . . . . . 6.4dorzolamide ophth . . . . . . . . . . . . . . . . . . . 28 . . . . . . . . . . . 22.6DOVONEX . . . . . . . . . . . . . . . . . . . . . . . . . 32 . . . . . . . . . . . 25.16 doxazosin . . . . . . . . . . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . 8.16doxepin . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 . . . . . . . . . . . 13.1doxycycline . . . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.9drospirenone 3mg/estradiol 30mcg . . . . . . 24 . . . . . . . . . . . 16.3 DURAGESIC PATCHES . . . . . . . . . . . . . . . . 17 . . . . . . . . . . . 11.1DYAZIDE . . . . . . . . . . . . . . . . . . . . . . . . . . 26 . . . . . . . . . . . 19.3DYNAPEN . . . . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.8DYRENIUM . . . . . . . . . . . . . . . . . . . . . . . . 26 . . . . . . . . . . . 19.3echothiophate iodide ophth . . . . . . . . . . . . 29 . . . . . . . . . . . 22.7econazole topical . . . . . . . . . . . . . . . . . . . 31 . . . . . . . . . . . 25.3

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    EDECRIN . . . . . . . . . . . . . . . . . . . . . . . . . . 26 . . . . . . . . . . . 19.1EES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.7efavirenz . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . 4.13EFFEXOR . . . . . . . . . . . . . . . . . . . . . . . . . 19 . . . . . . . . . . . 13.4EFFEXOR XR . . . . . . . . . . . . . . . . . . . . . . . 19 . . . . . . . . . . . 13.4EFUDEX . . . . . . . . . . . . . . . . . . . . . . . . . . 32 . . . . . . . . . . . 25.15ELAVIL . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 . . . . . . . . . . . 13.1ELDEPRYL . . . . . . . . . . . . . . . . . . . . . . . . . 12 . . . . . . . . . . . . 6.3eletriptan . . . . . . . . . . . . . . . . . . . . . . . . . 18 . . . . . . . . . . . 11.2ELIMITE . . . . . . . . . . . . . . . . . . . . . . . . . . 31 . . . . . . . . . . . 25.4ELIXOPHYLLIN . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . . . . . 2.3ELOCON . . . . . . . . . . . . . . . . . . . . . . . . . . 31 . . . . . . . . . . . 25.7EMPIRIN #3 . . . . . . . . . . . . . . . . . . . . . . . 17 . . . . . . . . . . . 11.1EMPIRIN #4 . . . . . . . . . . . . . . . . . . . . . . . 17 . . . . . . . . . . . 11.1emtricitabine . . . . . . . . . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . 4.13 emtricitabine/tenofovir . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . 4.13 EMTRIVA . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . 4.13 enalapril . . . . . . . . . . . . . . . . . . . . . . . . . . 14 . . . . . . . . . . . . 8.11enoxaparin . . . . . . . . . . . . . . . . . . . . . . . . 13 . . . . . . . . . . . . 7.1entacapone . . . . . . . . . . . . . . . . . . . . . . . . 12 . . . . . . . . . . . . 6.3ENTEX LA . . . . . . . . . . . . . . . . . . . . . . . . . . 7 . . . . . . . . . . . . 3.3ENTEX PSE . . . . . . . . . . . . . . . . . . . . . . . . . 7 . . . . . . . . . . . . 3.3epinephrine self-injection device . . . . . . . . . 5 . . . . . . . . . . . . 1.5EPIPEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 . . . . . . . . . . . . 1.5EPIVIR . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . 4.13EPZICOM . . . . . . . . . . . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . 4.13 ergocalciferol . . . . . . . . . . . . . . . . . . . . . . 33 . . . . . . . . . . . 26.2ergonovine maleate . . . . . . . . . . . . . . . . . . 26 . . . . . . . . . . . 18.1ergotamine/caffeine . . . . . . . . . . . . . . . . . 17 . . . . . . . . . . . 11.2ERGOTRATE . . . . . . . . . . . . . . . . . . . . . . . 26 . . . . . . . . . . . 18.1ERY-TAB . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.7ERYTHROCIN . . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.7erythromycin base . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.7erythromycin estolate . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.7erythromycin ethylsuccinate . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.7erythromycin ophth . . . . . . . . . . . . . . . . . . 27 . . . . . . . . . . . 22.1erythromycin stearate . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.7erythromycin topical . . . . . . . . . . . . . . . . . 32 . . . . . . . . . . . 25.11

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  • Drug Page Therapeutic Class

    erythromycin/sulfisoxazole . . . . . . . . . . . . . 8 . . . . . . . . . . . . 4.7escitalopram . . . . . . . . . . . . . . . . . . . . . . . 19 . . . . . . . . . . . 13.3ESGIC PLUS . . . . . . . . . . . . . . . . . . . . . . . 17 . . . . . . . . . . . 11.2ESKALITH . . . . . . . . . . . . . . . . . . . . . . . . . 21 . . . . . . . . . . . 13.16ESKALITH CR . . . . . . . . . . . . . . . . . . . . . . 21 . . . . . . . . . . . 13.16esterified estrogen/testosterone . . . . . . . . 25 . . . . . . . . . . . 16.4esterified estrogens . . . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . 16.4ESTRACE . . . . . . . . . . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . 16.4ESTRADERM . . . . . . . . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . 16.4estradiol . . . . . . . . . . . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . 16.4estradiol patch, bi-weekly . . . . . . . . . . . . . 25 . . . . . . . . . . . 16.4estradiol patch, weekly . . . . . . . . . . . . . . . 25 . . . . . . . . . . . 16.4estradiol vaginal tablet . . . . . . . . . . . . . . . 25 . . . . . . . . . . . 16.4estradiol/norethindrone patch . . . . . . . . . . 25 . . . . . . . . . . . 16.4estradiol/norethindrone tablets . . . . . . . . . 25 . . . . . . . . . . . 16.4estradiol/nogestimate . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . 16.4ESTRATAB . . . . . . . . . . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . 16.4ESTRATEST . . . . . . . . . . . . . . . . . . . . . . . . 25 . . . . . . . . . . . 16.4ESTRATEST HS . . . . . . . . . .