docHospitality Rx Formulary 2016 Preferred Medications List
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Hospitality Rx Formulary 2016 Preferred Medications List
Hospitality Rx Formulary 2016 Preferred Medications List This is a list of commonly prescribed generic and formulary brand-name drugs. Changes to this list may occur throughout the year. Generic drugs have the lowest copay; the copay for formulary brand-name drugs is higher; non-formulary brand-name drugs have the highest copay of all. Take this list with you each time you visit a doctor. Generic Drugs can help you save. Ask your doctor for generics whenever possible. • Generic Drugs = lower case • Formulary Brand Name Drugs = UPPER CASE ANTI-INFECTIVES ANTIFUNGALS GENERIC fluconazole fluconazole IN dextrose fluconazole IN NACL flucytosine griseofulvin microsize griseofulvin ultramicrosize itraconazole ketoconazole nystatin terbinafine HCL voriconazole NON PREFERRED Abelcet Ambisome Amphotec Amphotericin B Ancobon Cresemba Diflucan Fluconazole IN NACL Grifulvin V Gris-peg Lamisil Noxafil Onmel Sporanox Sporanox Pulsepak Terbinex Vfend Vfend IV CEPHALOSPORINS GENERIC cefaclor cefadroxil cefazolin sodium cefdinir cefepime cefixime cefotaxime sodium cefoxitin sodium cefpodoxime proxetil cefprozil ceftazidime ceftriaxone sodium cefuroxime axetil cefuroxime sodium cephalexin PREFERRED Cefaclor Cephalexin NON PREFERRED Ancef Avycaz Cedax Cefaclor ER Cefazolin Sodium Cefazolin Sodium/Dextrose Cefditoren Pivoxil Cefepime Cefotetan Cefotetan/Dextrose Cefoxitin Sodium Ceftazidime/Dextrose Ceftibuten Ceftin Ceftriaxone IN Iso-osmotic Dextrose Ceftriaxone Sodium Ceftriaxone/Dextrose Cefuroxime Sodium Cefuroxime/Dextrose Claforan Claforan/D5W Fortaz Keflex Maxipime Mefoxin Rocephin Spectracef Suprax Tazicef Teflaro Zerbaxa Zinacef PENICILLINS GENERIC amoxicillin amoxicillin/clavulanate potassium amoxicillin/clavulanate potassium ER ampicillin ampicillin sodium ampicillin-sulbactam dicloxacillin sodium nafcillin sodium oxacillin sodium penicillin v potassium penicillin G potassium piperacillin sodium/ tazobactam sodium piperacillin sodium/tazobactam sodium piperacillin/tazobactam PREFERRED Amoxicillin Ampicillin NON PREFERRED Amoxicillin ER Ampicillin Sodium Ampicillin-sulbactam Augmentin Augmentin ES-600 Augmentin XR Bactocill IN Dextrose Bicillin C-R Bicillin L-a Moxatag Nafcillin Sodium Nallpen Iso-osmotic IN Dextrose Nallpen/Dextrose Penicillin G Potassium IN Iso-osmotic Dextrose Penicillin G Procaine Penicillin G Sodium Pfizerpen-G Timentin Unasyn Unasyn Bulk Pack Zosyn QUINOLONES GENERIC ciprofloxacin ciprofloxacin ER ciprofloxacin HCL ciprofloxacin I.V.-IN D5W levofloxacin levofloxacin IN D5W moxifloxacin HCL ofloxacin Ciprofloxacin HCL Ofloxacin NON PREFERRED Avelox Avelox Abc Pack Cipro Cipro I.V.-IN D5W Cipro XR Factive Levaquin Moxifloxacin HCL Noroxin TETRACYCLINES GENERIC demeclocycline HCL doxycycline doxycycline hyclate doxycycline hyclate DR doxycycline monohydrate minocycline HCL minocycline HCL ER Tetracycline HCL NON PREFERRED Acticlate Adoxa Adoxa PAK 1/100 Adoxa PAK 1/150 Adoxa PAK 2/100 Alodox Convenience Kit Doryx Minocin Minocin Kit Monodox Morgidox 1X100MG Morgidox 2X100MG Nutridox Ocudox Solodyn Targadox Vibramycin ANTI-INFLAMMATORY Effective January 1, 2016 v.1 1 NSAIDS GENERIC celecoxib diclofenac potassium diclofenac sodium DR diclofenac sodium ER diclofenac sodium/misoprostol etodolac etodolac ER flurbiprofen ibuprofen indomethacin indomethacin ER ketoprofen ketorolac tromethamine mefenamic acid meloxicam nabumetone naproxen naproxen sodium naproxen sodium CR naproxen sodium ER oxaprozin piroxicam sulindac tolmetin sodium Meclofenamate Sodium Tolmetin Sodium PREFERRED Fenoprofen Calcium Ketoprofen ER Meloxicam Naproxen NON PREFERRED Anaprox Anaprox DS Arthrotec 50 Arthrotec 75 Caldolor Cataflam Celebrex Daypro Derma Silkrx Anodynexa PAK Derma Silkrx Diclopak Dermacinrx Inflammatral PAK Duexis Dyloject EC-naprosyn Feldene Ibuprofen Comfort PAC Indocin Indomethacin Indomethacin Sodium IC 400 IC 800 Ketorocaine-l Ketorocaine-lm Ketorolac Tromethamine Meloxicam Comfort PAC Mobic Nalfon Naprelan Naprosyn Naproxen Comfort PAC Neoprofen Ponstel Sprix Tivorbex Vimovo Voltaren-XR Zipsor Zorvolex AUTO-IMMUNE PREFERRED Cimzia Cimzia Starter Kit Humira Humira Pediatric Crohns Disease Starter Pack Humira Pen Humira Pen-crohns Diseasestarter Humira Pen-psoriasis Starter Remicade Simponi Simponi Aria NON PREFERRED Actemra Enbrel Enbrel Sureclick Kineret Orencia Xeljanz CARDIOVASCULAR ACE-INHIBITORS GENERIC benazepril HCL captopril enalapril maleate enalaprilat fosinopril sodium lisinopril moexipril HCL perindopril erbumine quinapril HCL ramipril trandolapril NON PREFERRED Accupril Aceon Altace Epaned Lotensin Mavik Prinivil Univasc Vasotec Zestril ANGIOTENSIN RCPTR BLOCKER GENERIC candesartan cilexetil irbesartan losartan potassium telmisartan valsartan Eprosartan Mesylate PREFERRED Benicar NON PREFERRED Atacand Avapro Cozaar Diovan Edarbi Micardis Teveten BETA BLOCKERS GENERIC acebutolol HCL atenolol betaxolol HCL bisoprolol fumarate carvedilol esmolol HCL labetalol HCL metoprolol succinate ER metoprolol tartrate nadolol pindolol propranolol HCL propranolol HCL ER sotalol HCL sotalol HCL (AF) PREFERRED Bystolic Propranolol HCL Timolol Maleate NON PREFERRED Betapace Betapace AF Brevibloc Coreg Coreg CR Corgard Hemangeol Hypertenevide-12.5 Inderal LA Inderal XL Innopran XL Kerlone Levatol Lopressor Sectral Sotalol Hydrochloride Sotylize Tenormin Toprol XL Trandate Zebeta CALCIUM CHANNEL BLOCKERS GENERIC amlodipine besylate diltiazem CD diltiazem HCL diltiazem HCL ER felodipine ER isradipine nicardipine HCL nifedipine nifedipine ER nimodipine nisoldipine verapamil HCL verapamil HCL ER verapamil HCL SR Verapamil HCL NON PREFERRED Adalat CC Calan Calan SR Cardene I.v. Cardene IV Cardene SR Cardizem Effective January 1, 2016 2 Cardizem CD Cardizem LA Cleviprex Dilacor XR Diltiazem HCL Nisoldipine Nisoldipine ER Norvasc Nymalize Procardia Procardia XL Sular Tiazac Verelan Verelan PM trandolapril/verapamil HCL ER valsartan/hydrochlorothiazide PREFERRED Azor Benicar HCT Captopril/Hydrochlorothiazide Dutoprol Methyldopa/Hydrochlorothiazide Propranolol/Hydrochlorothiazide Tekturna HCT Tribenzor NON PREFERRED Accuretic Amturnide Atacand HCT Avalide Clorpres Corzide Diovan HCT Edarbyclor Exforge Exforge HCT Hypertensolol Hyzaar Lopressor HCT Lotensin HCT Lotrel Lytensopril Kit Lytensopril-90 Lytensopril-90 Kit Micardis HCT Prestalia Tarka Tekamlo Tenoretic 100 Tenoretic 50 Teveten HCT Twynsta Uniretic Vaseretic Zestoretic Ziac NITRATES & NITRITES GENERIC isosorbide dinitrate isosorbide mononitrate isosorbide mononitrate ER nitroglycerin lingual nitroglycerin transdermal nitroglycerin ER nitroglycerin IN dextrose 5% nitroglycerin IN 5% dextrose Isosorbide Dinitrate Nitroglycerin Lingual PREFERRED Dilatrate SR Isosorbide Dinitrate ER Nitro-bid Nitro-dur Nitrostat NON PREFERRED Imdur Isordil Titradose Nitroglycerin Nitroglycerin IN Dextrose 5% Nitrolingual Pumpspray Nitromist Nitronal ANTI-HTN COMBINATIONS GENERIC amlodipine besylate/benazepril hydrochloride amlodipine besylate/benazepril HCL amlodipine besylate/valsartan amlodipine/valsartan/hctz atenolol/chlorthalidone benazepril HCL/hydrochlorothiazide bisoprolol fumarate/hydrochlorothiazide candesartan cilexetil/hydrochlorothiazide enalapril maleate/hydrochlorothiazide fosinopril sodium/hydrochlorothiazide irbesartan/hydrochlorothiazide lisinopril/hydrochlorothiazide losartan potassium/hydrochlorothiazide metoprolol/hydrochlorothiazide moexipril/hydrochlorothiazide nadolol/bendroflumethiazide quinapril/hydrochlorothiazide telmisartan/amlodipine telmisartan/hydrochloroth telmisartan/hydrochlorothiazide trandolapril/verapamil HCL ANTIHYPERLIPIDEMICS STATINS GENERIC atorvastatin calcium fluvastatin fluvastatin sodium ER lovastatin pravastatin sodium simvastatin PREFERRED Crestor NON PREFERRED Altoprev Lescol Lescol XL Lipitor Livalo Mevacor Pravachol Zocor FIBRATES GENERIC fenofibrate fenofibrate micronized fenofibric acid DR gemfibrozil Fenofibric Acid PREFERRED Fibricor Lipofen NON PREFERRED Antara Fenofibrate Fenoglide Lofibra Lopid Tricor Triglide Trilipix BILE ACID SEQUESTRANTS GENERIC cholestyramine cholestyramine light colestipol HCL colestipol HCL for oral suspension PREFERRED Welchol NON PREFERRED Colestid Colestid Flavored Questran Questran Light CHOLEST ABS INHBTR/COMBO PREFERRED Vytorin NON PREFERRED Zetia NIACIN/COMBINATIONS GENERIC niacin ER PREFERRED Niacor Simcor NON PREFERRED Advicor Niaspan OMEGA-3 FATTY ACIDS GENERIC omega-3-acid ethyl esters PREFERRED Vascepa NON PREFERRED Kynamro Lovaza DERMATOLOGICALS ACNE GENERIC adapalene benzoyl peroxide benzoyl peroxide SHORT contact clindamycin phosphate clindamycin/benzoyl peroxide erythromycin erythromycin/benzoyl peroxide metronidazole sodium sulfacetamide sodium sulfacetamide/sulfur sodium sulfacetamide/sulfur cleanser sodium sulfacetamide/sulfur cleansing cloths sodium sulfacetamide/sulfur green sodium sulfacetamide/sulfur w/sunscreen sodium sulfacetamide/sulfur wash sulfacetamide sodium sulfacetamide sodium/sulfur cleanser Effective January 1, 2016 3 tretinoin tretinoin microsphere tretinoin microsphere P.M. Doxycycline PREFERRED Benzamycinpak Clindagel Finacea Retinoic Acid Retinoic Acid-all Trans Tretinoin Tretinoin (all-trans Retinoic Acid) NON PREFERRED Absorica Acanya Aczone Adapalene Akne-mycin Atralin Avar Avar LS Avar LS Cleanser Avar-e LS Azelex Benzac Ac Wash Benzac W Wash Benzaclin Benzaclin With P.M. Benzamycin Benzefoam Benzefoamultra Benziq Benziq LS Clarifoam EF Cleocin-t Clindacin Etz Clindacin PAC Clindap-t Clinoin Dermapak Plus Differin Duac Epiduo Epiduo Forte Erygel Evoclin Fabior Inova Inova 4/1 Acne Control Therapy Inova 8/2 Acne Control Therapy Klaron Metrocream Metrogel Metrolotion Mirvaso Neuac Kit Noritate Nuox Onexton Oracea Plexion Plexion Cleanser Plexion Cleansing Cloths Prascion Ra With Sunscreens Retin-a Retin-a Micro Retin-a Micro P.M. Riax Rosadan Kit Rosanil Rosula Sodium Sulfacetamide/Sulfur Sodium Sulfacetamide/Sulfur Cleanser IN Urea Sodium Sulfacetamide/Sulfur IN Urea Soolantra Sulfoam Sumadan Kit Sumadan Wash Sumadan XLT Sumaxin Sumaxin CP Kit Sumaxin Ts Sumaxin Wash Tretin-x Triseon Vanoxide-HC Veltin Zacare 4% Kit Zacare 8% Kit Ziana TOPICAL ANTI-INFLAMMATORY GENERIC alclometasone dipropionate augmented betamethasone dipropionate betamethasone dipropionate betamethasone valerate calcipotriene/betamethasone dipropionate clobetasol propionate clobetasol propionate emollient desonide desoximetasone fluocinolone acetonide fluocinonide fluocinonide-e fluticasone propionate halobetasol propionate hydrocortisone hydrocortisone acetate/aloe hydrocortisone butyrate hydrocortisone butyrate (lipid) hydrocortisone butyrate (lipophilic) hydrocortisone valerate hydrocortisone IN absorbase mometasone furoate prednicarbate triamcinolone acetonide Amcinonide Desoximetasone Diflorasone Diacetate PREFERRED Pramosone Triamcinolone Acetonide NON PREFERRED Aclovate Advanced Allergy Collection Kit Ala Scalp Capex Carmol-HC Clobex Clocortolone Pivalate Clocortolone Pivalate P.M. Clodan Kit Cloderm Cloderm P.M. Cordran Cordran Tape Cortalo Cutivate Derma Silkrx Sds PAK Derma-smoothe/FS Body Derma-smoothe/FS Scalp Dermasorb HC Dermasorb Ta Dermatop Desonate Desowen Desowen Cream/Cetaphil Lotion Desowen Lotion/Cetaphil Cream Desowen Ointment/Cetaphil Lotion Diprolene Diprolene AF Elocon Epifoam First-hydrocortisone Halog Halonate Kenalog Locoid Locoid Lipocream Luxiq Nucort Nuzon Olux Olux-e Pandel Pediaderm HC Pediaderm Ta Scalacort DK Synalar Synalar Cream Kit Synalar Ointment Kit Synalar Ts Taclonex Temovate Temovate E Texacort Topicort Triamsil Combipak Trianex Triderma Forte Ultravate Ultravate PAC Ultravate X Validerm Vanos Verdeso Westcort ENDOCRINE CONTRACEPTIVE AGENTS GENERIC desogestrel/ethinyl estradiol drospirenone/ethinyl estradiol levonorgestrel levonorgestrel and ethinyl estradiol levonorgestrel/ethinyl estradiol norethindrone norethindrone & ethinyl estradiol ferrous fumarate norethindrone acetate/ethinyl estradiol norethindrone acetate/ethinyl estradiol/ferrous fumarate norgestimate/ethinyl estradiol Levonorgestrel Effective January 1, 2016 4 PREFERRED Natazia Necon 1/50-28 Necon 10/11-28 Norinyl 1+50 Nuvaring Zovia 1/50e NON PREFERRED Beyaz Brevicon-28 Cyclessa Depo-provera Desogen Ella Estrostep FE Falessa Femcon FE Generess FE Loestrin FE 1.5/30 Loestrin FE 1/20 Loestrin 1.5/30-21 Loestrin 1/20-21 Loseasonique LO Loestrin FE LO Minastrin FE Minastrin 24 FE Mircette Modicon Nor-QD Norinyl 1+35 Ortho Evra Ortho Micronor Ortho Tri-cyclen Ortho Tri-cyclen LO Ortho-cept Ortho-cyclen Ortho-novum 1/35 Ortho-novum 7/7/7 Ovcon-35 Plan B Plan B One-step Quartette Safyral Seasonique Tri-norinyl 28 Yasmin 28 Yaz Combipatch Delestrogen Depo-estradiol Divigel Elestrin Enjuvia Estrace Estradiol Estrasorb Estring Estrogel Evamist Femhrt Low Dose Femring Menostar Minivelle Prefest Premarin Vagifem Vivelle-dot TESTOSTERONE AGENTS GENERIC danazol testosterone cypionate testosterone enanthate Testosterone Testosterone P.M. PREFERRED Androderm Androgel P.M. Androxy NON PREFERRED Androgel Android Aveed Axiron Depo-testosterone First-testosterone First-testosterone Mc Compounding Kit Fortesta Natesto Striant Testim Testone Cik Testopel Testred Vogelxo Vogelxo P.M. ESTROGENS/COMBINATIONS GENERIC estradiol estradiol valerate estradiol/norethindrone acetate estropipate norethindrone acetate/ethinyl estradiol PREFERRED Alora Climara Pro Duavee Estropipate Menest Premphase Prempro NON PREFERRED Activella Angeliq Biest/Progesterone Cenestin Climara INSULIN PREFERRED Humalog Humalog Kwikpen Humalog Mix 50/50 Humalog Mix 50/50 Kwikpen Humalog Mix 75/25 Humalog Mix 75/25 Kwikpen Humulin N Humulin N Kwikpen Humulin N U-100 Pen Humulin R Humulin R U-500 (concentrated) Humulin 70/30 Humulin 70/30 Kwikpen Humulin 70/30 Pen Lantus Lantus Solostar Levemir Levemir Flexpen Levemir Flextouch Novolin N Novolin N Relion Novolin R Novolin R Relion Novolin 70/30 Novolin 70/30 Relion Novolog Novolog Flexpen Novolog Mix 70/30 Novolog Mix 70/30 Prefilled Flexpen Novolog Penfill Toujeo Solostar NON PREFERRED Afrezza Apidra Apidra Solostar NON-INSULIN HYPOGLYCEMICS BIGUANIDES GENERIC metformin HCL metformin HCL ER NON PREFERRED Fortamet Glucophage Glucophage XR Glumetza Riomet BIGUAN/SULFONYLUREA COMB. GENERIC glipizide/metformin HCL glyburide/metformin HCL NON PREFERRED Glucovance BIGUAN/THIAZOLIDEINEDIONE GENERIC pioglitazone HCL pioglitazone HCL/metformin HCL NON PREFERRED Actoplus Met Actoplus Met XR Actos Avandamet Avandia DPP-4 INHIBITORS PREFERRED Januvia Onglyza NON PREFERRED Nesina Tradjenta BIGUANIDE/DPP-4 COMB. PREFERRED Janumet Janumet XR Kombiglyze XR NON PREFERRED Jentadueto Kazano SULFONYLUREAS GENERIC glimepiride glipizide glipizide ER glyburide glyburide micronized tolazamide Glyburide Effective January 1, 2016 5 PREFERRED Chlorpropamide Diabeta Tolazamide Tolbutamide NON PREFERRED Amaryl Glucotrol Glucotrol XL Glynase SULFONYLUREA/TZD COMB. GENERIC pioglitazone HCL-glimepiride NON PREFERRED Avandaryl Duetact INCRETINS PREFERRED Bydureon Byetta Victoza NON PREFERRED Tanzeum Trulicity AMYLIN ANALOGS NON PREFERRED Symlinpen 120 Symlinpen 60 DIABETIC OTHER PREFERRED Glucagen Hypokit Glucagon Emergency Kit Invokamet Invokana Jardiance Proglycem NON PREFERRED Farxiga Synjardy Xigduo XR GASTROINTESTINAL PROTON PUMP INHIBITORS GENERIC esomeprazole magnesium esomeprazole sodium lansoprazole omeprazole pantoprazole sodium rabeprazole sodium Esomeprazole Sodium PREFERRED Dexilant Nexium Nexium 24HR NON PREFERRED Aciphex Aciphex Sprinkle Esomeprazole Strontium First-lansoprazole First-omeprazole Nexium I.v. Omeprazole + Syrspend SF Alka Prevacid Prevacid Solutab Prilosec Protonix ULCER DRUGS GENERIC cimetidine cimetidine HCL famotidine misoprostol nizatidine ranitidine HCL sucralfate Famotidine PREFERRED Carafate NON PREFERRED Axid Cytotec Deprizine Fusepaq Famotidine Premixed Pepcid Zantac GROWTH HORMONE PREFERRED Nutropin AQ Nuspin 10 Nutropin AQ Nuspin 20 Nutropin AQ Nuspin 5 Nutropin AQ Pen Saizen Saizen Click.easy Serostim NON PREFERRED Genotropin Genotropin Miniquick Humatrope Humatrope Combo Pack Norditropin Cartridge Norditropin Flexpro Norditropin Nordiflex Pen Omnitrope Tev-tropin Zomacton Zorbtive HEPATITIS C ANTIVIRALS GENERIC ribavirin PREFERRED Harvoni Ribatab Sovaldi NON PREFERRED Copegus Moderiba Moderiba 1200 Dose Pack Moderiba 800 Dose Pack Rebetol Ribasphere Ribasphere Ribapak Technivie Viekira PAK INTERFERONS PREFERRED Pegasys Pegasys Proclick NON PREFERRED Infergen Peg-intron Peg-intron Redipen Peg-intron Redipen PAK 4 Pegintron PROTEASE INHIBITORS NON PREFERRED Olysio Victrelis MULTIPLE SCLEROSIS PREFERRED Ampyra Avonex Copaxone Plegridy Plegridy Starter Pack Tecfidera Tecfidera Starter Pack NON PREFERRED Aubagio Avonex Pen Betaseron Extavia Gilenya Lemtrada Rebif Rebif Rebidose Rebif Rebidose Titration Pack Rebif Titration Pack Tysabri NEUROLOGICALS ALZHEIMER'S DISEASE GENERIC donepezil HCL galantamine hydrobromide memantine HCL memantine HCL titration PAK rivastigmine tartrate rivastigmine transdermal system Galantamine Hydrobromide PREFERRED Namenda Namenda XR Namenda XR Titration Pack NON PREFERRED Aricept Aricept Odt Exelon Namenda Titration PAK Namzaric Razadyne Razadyne ER ANTICONVULSANTS GENERIC carbamazepine carbamazepine ER clonazepam clonazepam odt divalproex sodium divalproex sodium DR divalproex sodium ER ethosuximide felbamate fosphenytoin sodium gabapentin lamotrigine Effective January 1, 2016 6 lamotrigine odt lamotrigine ER levetiracetam levetiracetam ER oxcarbazepine phenytoin phenytoin sodium phenytoin sodium extended primidone tiagabine hydrochloride topiramate valproate sodium valproic acid zonisamide PREFERRED Diastat Acudial Diastat Pediatric Diazepam Lamictal Lamictal Chewable Dispersible Lamictal Starter/Not Taking Carbamazepine Lamictal Starter/Taking Carbamazepine/Not Taking Valproate Lamictal Starter/Taking Valproate Lyrica Phenytek NON PREFERRED Aptiom Banzel Carbatrol Celontin Cerebyx Depacon Depakene Depakote Depakote ER Depakote Sprinkles Dilantin Dilantin Infatabs Dilantin-125 Fanatrex Fusepaq Felbatol Fycompa Gabitril Keppra Keppra XR Klonopin Lamictal Odt Lamictal XR Levetiracetam Mysoline Neurontin Onfi Oxtellar XR Peganone Potiga Qudexy XR Sabril Stavzor Tegretol Tegretol-XR Therapentin-60 Therapentin-90 Topamax Topamax Sprinkle Topiramate ER Trileptal Trokendi XR Vimpat Zarontin Zonegran MIGRAINE/HEADACHE GENERIC almotriptan malate dihydroergotamine mesylate naratriptan HCL rizatriptan benzoate rizatriptan benzoate odt sumatriptan succinate sumatriptan succinate refill zolmitriptan zolmitriptan odt Dihydroergotamine Mesylate Sumatriptan Succinate PREFERRED Sumatriptan Zomig Nasal Spray NON PREFERRED Alsuma Amerge Axert Cafergot Cambia D.h.e. 45 Ergomar Frova Imitrex Imitrex Statdose Refill Imitrex Statdose System Maxalt Maxalt-MLT Migergot Migral Migranal Relpax Sumavel Dosepro Treximet Zecuity Zomig Zomig ZMT OPHTHALMICS ANTI-ALLERGIC AGENTS GENERIC azelastine HCL cromolyn sodium epinastine HCL PREFERRED Pataday Patanol NON PREFERRED Alocril Alomide Bepreve Elestat Emadine Lastacaft Optivar Pazeo ANTI-GLAUCOMA AGENTS GENERIC apraclonidine betaxolol HCL brimonidine tartrate carteolol HCL dorzolamide HCL dorzolamide HCL/timolol maleate latanoprost levobunolol HCL timolol maleate timolol maleate ophthalmic gel forming Bimatoprost Metipranolol PREFERRED Alphagan P Azopt Betoptic-s Combigan Levobunolol HCL Lumigan Timoptic Ocudose Travatan Z Travoprost NON PREFERRED Betagan Betimol Cosopt Cosopt PF Iopidine Istalol Rescula Timoptic Timoptic-xe Trusopt Xalatan Zioptan ANTI-INFECTIVES GENERIC ciprofloxacin HCL erythromycin gatifloxacin gentamicin sulfate levofloxacin ofloxacin tobramycin sulfate PREFERRED Bacitracin Moxeza Vigamox NON PREFERRED Azasite Besivance Ciloxan Garamycin Mitosol Ocuflox Tobrex Zymaxid ANTI-INFLAMMATORY AGENTS GENERIC bromfenac cromolyn sodium diclofenac sodium flurbiprofen sodium ketorolac tromethamine NON PREFERRED Acular Acular LS Acuvail Ilevro Nevanac Ocufen Prolensa Effective January 1, 2016 7 Reclast Zoledronic Acid Zometa CORTICOSTEROIDS/RELATED GENERIC dexamethasone sodium phosphate fluorometholone neomycin/polymyxin/bacitracin/hydroco rtisone neomycin/polymyxin/dexamethasone prednisolone acetate sulfacetamide sodium/prednisolone sodium phosphate tobramycin/dexamethasone PREFERRED FML FML Forte Pred Mild Prednisolone Sodium Phosphate NON PREFERRED Alrex Blephamide Blephamide S.o.p. Durezol Flarex FML Liquifilm Lotemax Maxidex Maxitrol Neomycin/Polymyxin/Hydrocortisone Omnipred Pred Forte Pred-G Pred-G S.o.p. Tobradex Tobradex ST Vexol Zylet MIOTICS GENERIC pilocarpine HCL PREFERRED Isopto Carbachol Phospholine Iodide NON PREFERRED Isopto Carpine MISCELLANEOUS NON PREFERRED Lacrisert Restasis OSTEOPOROSIS BISPHOSPHONATES GENERIC alendronate sodium ibandronate sodium pamidronate disodium risedronate sodium risedronate sodium DR zoledronic acid PREFERRED Alendronate Sodium NON PREFERRED Actonel Atelvia Binosto Boniva Etidronate Disodium Fosamax Fosamax Plus D Pamidronate Disodium SERM GENERIC raloxifene hydrochloride NON PREFERRED Evista Osphena Rexulti Risperdal Risperdal Consta Risperdal M-TAB Seroquel Versacloz Zyprexa Zyprexa Relprevv Zyprexa Zydis PSYCHOTHERAPEUTICS, MISC. PSYCHOTHERAPEUTICS ANTIPSYCHOTICS/ANTIMANIC GENERIC aripiprazole chlorpromazine HCL clozapine fluphenazine decanoate fluphenazine HCL haloperidol haloperidol decanoate haloperidol lactate lithium carbonate lithium carbonate ER loxapine loxapine succinate olanzapine olanzapine odt paliperidone ER perphenazine prochlorperazine prochlorperazine edisylate prochlorperazine maleate quetiapine fumarate risperidone risperidone odt thioridazine HCL thiothixene trifluoperazine HCL ziprasidone HCL Clozapine Odt PREFERRED Abilify Discmelt Fluphenazine HCL Saphris Seroquel XR NON PREFERRED Abilify Abilify Maintena Adasuve Chlorpromazine HCL Clozaril Compazine Equetro Fanapt Fanapt Titration Pack Fazaclo Geodon Haldol Haldol Decanoate 100 Haldol Decanoate 50 Invega Invega Sustenna Invega Trinza Latuda Lithium Lithium Carbonate Lithobid Loxitane GENERIC amphetamine/dextroamphetamine clonidine HCL ER dexmethylphenidate HCL dexmethylphenidate HCL ER dextroamphetamine sulfate dextroamphetamine sulfate ER guanfacine ER methamphetamine HCL methylphenidate hydrochloride methylphenidate HCL methylphenidate HCL CD methylphenidate HCL ER methylphenidate HCL SR modafinil Methylphenidate HCL ER PREFERRED Strattera Vyvanse NON PREFERRED Adderall Adderall XR Aptensio XR Concerta Daytrana Desoxyn Dexedrine Evekeo Focalin Focalin XR Intuniv Kapvay Kapvay Dose Pack Metadate CD Methylin Nuvigil Procentra Provigil Quillivant XR Ritalin Ritalin LA Ritalin SR Zenzedi SNRI ANTIDEPRESSANTS GENERIC duloxetine HCL venlafaxine HCL venlafaxine HCL ER Venlafaxine HCL ER PREFERRED Pristiq NON PREFERRED Cymbalta Desvenlafaxine ER Duloxetine HCL Effexor XR Fetzima Effective January 1, 2016 8 Fetzima Titration Pack Irenka Khedezla SSRI ANTIDEPRESSANTS GENERIC citalopram hydrobromide escitalopram oxalate fluoxetine DR fluoxetine HCL fluvoxamine maleate fluvoxamine maleate ER paroxetine HCL paroxetine HCL ER sertraline HCL PREFERRED Fluoxetine HCL Paxil NON PREFERRED Celexa Lexapro Luvox CR Paxil CR Pexeva Prozac Prozac Weekly Zoloft RESPIRATORY ANAPHYLAXIS TX AGENTS PREFERRED Epipen 2-PAK Epipen-JR 2-PAK NON PREFERRED Adrenaclick Adrenalin Auvi-q Epinephrine Episnap ANTICHOLINERGICS GENERIC ipratropium bromide PREFERRED Incruse Ellipta Spiriva Handihaler Spiriva Respimat Tudorza Pressair NON PREFERRED Atrovent HFA ANTICHLNRGC/BETA AGONIST GENERIC ipratropium bromide/albuterol sulfate PREFERRED Combivent Respimat NON PREFERRED Anoro Ellipta Duoneb BETA AGONISTS GENERIC albuterol sulfate albuterol sulfate ER albuterol TAB 4MG levalbuterol levalbuterol HCL terbutaline sulfate PREFERRED Foradil Aerolizer Metaproterenol Sulfate Proair HFA Proair Respiclick Serevent Diskus Ventolin HFA NON PREFERRED Arcapta Neohaler Brovana Isuprel Maxair Autohaler Perforomist Proventil HFA Striverdi Respimat Vospire ER Xopenex Xopenex Concentrate Xopenex HFA LEUKOTRIENE RCPTR ANTGNST GENERIC montelukast sodium zafirlukast NON PREFERRED Accolate Singulair PULMONARY CORTICOSTEROIDS GENERIC budesonide PREFERRED Flovent Diskus Flovent HFA Pulmicort Flexhaler Qvar NON PREFERRED Aerospan Alvesco Arnuity Ellipta Asmanex HFA Asmanex Twisthaler 120 Metered Doses Asmanex Twisthaler 14 Metered Doses Asmanex Twisthaler 30 Metered Doses Asmanex Twisthaler 60 Metered Doses Asmanex Twisthaler 7 Metered Doses Pulmicort NASAL ANTIHISTAMINES GENERIC azelastine HCL olopatadine HCL NON PREFERRED Astelin Astepro Patanase NASAL CORTICOSTEROIDS GENERIC budesonide flunisolide fluticasone propionate triamcinolone acetonide PREFERRED Nasonex Veramyst NON PREFERRED Beconase AQ Flonase Omnaris Qnasl Qnasl Childrens Rhinocort Aqua Zetonna STEROID/BETA AGONIST PREFERRED Advair Diskus Advair HFA Breo Ellipta Symbicort NON PREFERRED Dulera MISCELLANEOUS NON PREFERRED Dymista UROLOGICALS BENIGN PRSTATC HYPRPLSIA GENERIC alfuzosin HCL ER finasteride tamsulosin HCL PREFERRED Avodart Jalyn Rapaflo NON PREFERRED Cardura XL Flomax Proscar Uroxatral ERECTILE DYSFUNCTION PREFERRED Cialis Stendra NON PREFERRED Levitra Staxyn Viagra URINARY ANTISPASMODICS GENERIC bethanechol chloride flavoxate HCL oxybutynin chloride oxybutynin chloride ER tolterodine tartrate tolterodine tartrate ER trospium chloride trospium chloride ER PREFERRED Gelnique Vesicare NON PREFERRED Detrol Detrol LA Ditropan XL Enablex Myrbetriq Oxytrol Sanctura Sanctura XR Effective January 1, 2016 9 Toviaz Urecholine Effective January 1, 2016 v.1 10
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