2018 Preferred Drug List -...

2018 Preferred Drug List

Effective 07/01/2018

The Formulary List is a guide providing copay designation for common medicines within select therapeutic categories. The Formulary List may not include all drugs covered by your prescription drug benefit. Generic medicines are available within many of the therapeutic categories listed, in addition to categories not listed, and should be considered as the first line of prescribing.

For benefit coverage or restrictions please check your benefit plan document(s). This listing is revised periodically as new drugs and new prescribing information becomes available. It is recommended that you bring this list of medications when you or a covered family member sees a physician or other healthcare provider.

Abbreviations:

(ST) Step Therapy(PA) Prior Authorization

Major Drug Class OverviewNon-Preferred Drugs With Preferred Options

2018

PreferredNon-PreferredDrug Class

ANALGESICSANTIARTHRITICS EUFLEXXA, GEL-ONE, HYALGAN,

MONOVISC, ORTHOVISC

DUROLANE, GELSYN-3, SUPARTZ FX,

SYNVISC, SYNVISC ONE

NARCOTICS ABSTRAL, HYSINGLA ER, KADIAN,

OXYCONTIN, ZOHYDRO ER

fentanyl, fentanyl citrate oral

transmucosal, morphine sulfate er,

oxycodone hcl, EMBEDA, FENTORA,

NUCYNTA ER

ANTI-INFECTIVESANTIVIRALS REBETOL moderiba, ribavirin, ribavirin, RIBASPHERE

RIBAPAK

HEPATITIS C DAKLINZA, EPCLUSA, HARVONI, SOVALDI,

TECHNIVIE, VIEKIRA PAK, ZEPATIER

MAVYRET

TETRACYCLINES DOXYCYCLINE, ORACEA

CARDIACANGIOTENSIN RECEPTOR BLOCKER BENICAR HCT, EDARBI, EDARBYCLOR candesartan cilexetil/hydrochlorothiazide,

irbesartan/hydrochlorothiazide, losartan

potassium/hydrochlorothiazide,

valsartan/hydrochlorothiazide

ANTICOAGULANTS PRADAXA clopidogrel, ELIQUIS, XARELTO

STATINS VYTORIN atorvastatin calcium, rosuvastatin calcium,

simvastatin, LIVALO

CNSADHD ADDERALL XR amphetamine/dextroamphetamine,

amphetamine/dextroamphetamine

ANTIDEPRESSANTS PEXEVA, SARAFEM citalopram hydrobromide, escitalopram

oxalate, escitalopram oxalate, fluoxetine

hcl, fluvoxamine maleate, paroxetine hcl er,

sertraline hcl, trazodone hcl, VIIBRYD

ANTI-PSYCHOTIC FANAPT, REXULTI aripiprazole, olanzapine, olanzapine odt,

quetiapine fumarate, quetiapine fumarate

er, LATUDA, SAPHRIS

SLEEP ZOLPIMIST eszopiclone, zaleplon, zolpidem tartrate er,

BELSOMRA, ROZEREM

DIABETESDPP-4 ALOGLIPTIN, KAZANO, KOMBIGLYZE XR,

NESINA, ONGLYZA, OSENI

JANUMET XR, JANUVIA, JENTADUETO,

TRADJENTA

INCRETINS BYDUREON PEN, BYETTA, TANZEUM OZEMPIC, TRULICITY, VICTOZA

INSULIN AFREZZA, APIDRA FIASP, FIASP FLEXTOUCH, HUMALOG,

HUMALOG MIX 50/50, HUMALOG MIX

75/25, HUMULIN 70/30, HUMULIN N,

HUMULIN R, NOVOLIN 70/30, NOVOLOG

FLEXPEN, NOVOLOG MIX 70/30,

NOVOLOG PENFILL

INSULIN: LONG ACTING BASAGLAR KWIKPEN LANTUS, LANTUS SOLOSTAR, LEVEMIR,

TOUJEO SOLOSTAR, TRESIBA

FLEXTOUCH

OTHER GLUMETZA, RIOMET metformin hcl

SGLT-2 INVOKAMET, INVOKANA FARXIGA, JARDIANCE, SYNJARDY,

XIGDUO XR


TESTING ACCU-CHEK AVIVA CONNECT, ACCU-CHEK

AVIVA PLUS, ADVOCATE BLOOD GLUCOSE

MONITORING SYSTEM, BAYER BREEZE 2

TEST DISC, BAYER CONTOUR BLOOD

GLUCOSE TEST STRIPS, EMBRACE BLOOD

GLUCOSE TEST STRIPS, PRODIGY

AUTOCODE BLOOD GLUCOSE MONITORING

SYSTEM, TRUE METRIX BLOOD

GLUCOSETEST STRIPS, TRUE METRIX SELF

MONITORING BLOOD GLUCOSE STRIPS,

TRUETEST STRIPS, TRUETRACK SMART

SYSTEM, UNISTRIP1 GENERIC

FREESTYLE TEST STRIPS, ONETOUCH

ULTRA BLUE, ONETOUCH VERIO TEST

STRIPS

ENDOCRINEESTROGENS estradiol, ESTRING, PREMARIN

GONADOTROPIN PREGNYL W/DILUENT

BENZYLALCOHOL/NACL

CETROTIDE, GANIRELIX ACETATE,

NOVAREL

OVULATORY STIMULANTS BRAVELLE, FOLLISTIM AQ, FOLLISTIM AQ clomiphene citrate, GONAL-F, MENOPUR

PROGESTINS CRINONE, ENDOMETRIN

TESTOSTERONE AXIRON, FORTESTA, NATESTO, STRIANT,

TESTIM, VOGELXO

ANDROGEL PUMP

GASTROINTESTINALDIGESTIVE ENZYMES PANCREAZE, PERTZYE, VIOKACE CREON, ZENPEP

OTHER DIPENTUM, LIALDA, LINZESS, PENTASA balsalazide disodium, AMITIZA, APRISO,

DELZICOL

PROTON PUMP INHIBITORS DEXILANT lansoprazole, omeprazole, pantoprazole

sodium

GROWTH HORMONESGENOTROPIN, HUMATROPE, NUTROPIN AQ

NUSPIN 10, OMNITROPE, SAIZEN

CLICK.EASY, ZOMACTON, ZORBTIVE

NORDITROPIN FLEXPRO

HEMATOLOGYARANESP ALBUMIN FREE, EPOGEN, MIRCERA PROCRIT

MUSCULOSKELETALANTI-INFLAMMATORY ** ACTEMRA, CIMZIA, ENBREL SURECLICK,

OTEZLA, REMICADE, SILIQ, SIMPONI,

STELARA, TALTZ, TALTZ, XELJANZ

COSENTYX, COSENTYX SENSOREADY

PEN, ENTYVIO, HUMIRA PEN, ORENCIA

OPHTHALMICGLAUCOMA COSOPT PF, SIMBRINZA, ZIOPTAN dorzolamide hcl, AZOPT, COMBIGAN,

TRAVATAN Z

NSAIDS ACUVAIL bromfenac, diclofenac sodium, ketorolac

tromethamine, ILEVRO, NEVANAC,

PROLENSA

OTICMISCELLANEOUS CETRAXAL ciprofloxacin

RESPIRATORYDULERA, TUDORZA PRESSAIR ADVAIR DISKUS, ANORO ELLIPTA, BREO

ELLIPTA, INCRUSE ELLIPTA, SPIRIVA

HANDIHALER, STIOLTO RESPIMAT,

SYMBICORT

BETA AGONISTS ARCAPTA NEOHALER, PERFOROMIST,

PROVENTIL HFA, XOPENEX HFA

PROAIR HFA, SEREVENT DISKUS,

VENTOLIN HFA

INHALED STEROIDS ALVESCO, ASMANEX TWISTHALER 120

METERED DOSES, PULMICORT FLEXHALER

ARNUITY ELLIPTA, FLOVENT DISKUS,

FLOVENT HFA, QVAR

NASAL STEROIDS BECONASE AQ, NASONEX, OMNARIS,

ZETONNA

flunisolide, DYMISTA, QNASL

TOPICALACNE ATRALIN, AVAGE, AZELEX, BENZACLIN

WITH PUMP, EPIDUO, TAZORAC, VELTIN

adapalene, clindamycin

phosphate/tretinoin, clindamycin/benzoyl

peroxide, erythromycin, tretinoin, ACANYA


MISCELLANEOUS ALDARA, FLUOROURACIL, ZYCLARA PUMP fluorouracil, imiquimod, PICATO

ROSACEA metronidazole, FINACEA

UROLOGICALANTISPASMODICS ENABLEX, GELNIQUE, TOVIAZ tolterodine tartrate, MYRBETRIQ,

VESICARE

ERECTILE DYSFUNCTION LEVITRA, STAXYN, STENDRA, VIAGRA sildenafil, sildenafil citrate, CIALIS

Additional covered alternatives m ay be available. Costs for covered alternatives m ay vary. Other

prescription benefit considerations m ay apply.

ANALGESICSANTIARTHRITICS

Prefilled Syringe

DUROLANE Preferred Brand

Solution Prefilled Syringe

GELSYN-3 Preferred Brand


SUPARTZ Preferred Brand


SUPARTZ FX Preferred Brand


SYNVISC Preferred Brand


SYNVISC ONE Preferred Brand

HEADACHE

Solution

dihydroergotamine mesylate Generic

Capsule

isometheptene/dichloralphenazone/acetaminophen Generic

Tablet

naratriptan hcl Generic

Tablet

rizatriptan benzoate Generic

Solution

sumatriptan Generic

Tablet

sumatriptan succinate Generic

Solution Auto-injector

sumatriptan succinate Generic

Tablet

zolmitriptan Generic

Tablet Disintegrating

zolmitriptan odt Generic

Solution Jet-injector

SUMAVEL DOSEPRO Preferred Brand

Solution

ZOMIG Preferred Brand

MISCELLANEOUS

Tablet

diflunisal Generic

Tablet

salsalate Generic

Tablet

tramadol hcl Generic

Tablet Extended Release 24 Hour

tramadol hcl er Generic

Tablet

tramadol hydrochloride/acetaminophen Generic

NARCOTIC ANTAGONISTS

Tablet Sublingual

buprenorphine hcl/naloxone hcl Generic

Tablet

naltrexone hcl Generic


EVZIO Preferred Brand

Liquid

NARCAN Preferred Brand

Film

SUBOXONE Preferred Brand

NARCOTICS

Solution

acetaminophen/codeine Generic

Tablet

acetaminophen/codeine Generic

Tablet Sublingual

buprenorphine hcl Generic

Tablet

butalbital/acetaminophen/caffeine Generic

Capsule

butalbital/acetaminophen/caffeine/codeine Generic

Capsule

butalbital/aspirin/caffeine Generic

Capsule

butalbital/aspirin/caffeine/codeine Generic

Tablet

codeine sulfate Generic

Patch 72 Hour

fentanyl Generic

Lozenge on a Handle

fentanyl citrate oral transmucosal Generic

Solution

hydrocodone bitartrate/acetaminophen Generic

Tablet

hydrocodone/acetaminophen Generic

Tablet

hydrocodone/ibuprofen Generic

Tablet

hydromorphone hcl Generic

Solution

meperidine hcl Generic

Solution

methadone hcl Generic

Tablet Soluble

methadone hcl Generic

Suppository

morphine sulfate Generic

Tablet Extended Release

morphine sulfate er Generic

Solution

oxycodone hcl Generic

Tablet

oxycodone/acetaminophen Generic

Tablet

oxycodone/aspirin Generic

Tablet

oxycodone/ibuprofen Generic

Tablet

oxymorphone hydrochloride Generic

Capsule Extended Release

EMBEDA Preferred Brand

Tablet

FENTORA Preferred Brand

Patch

FLECTOR Preferred Brand

Printed Date:6/27/2018

| 2018 Preferred Drug ListData Last Updated:6/27/2018

NARCOTICS

Tablet

NUCYNTA Preferred Brand


NUCYNTA ER Preferred Brand

NSAIDS

Capsule

celecoxib Generic

Tablet

diclofenac potassium Generic


diclofenac sodium er Generic

Tablet Delayed Release

diclofenac sodium/misoprostol Generic

Tablet

etodolac Generic

Tablet

fenoprofen calcium Generic

Tablet

flurbiprofen Generic

Capsule

indomethacin Generic

Capsule

ketoprofen Generic

Tablet

ketorolac tromethamine Generic

Capsule

meclofenamate sodium Generic

Capsule

mefenamic acid Generic

Suspension

meloxicam Generic

Tablet

meloxicam Generic

Tablet

nabumetone Generic

Tablet

naproxen Generic

Tablet

naproxen sodium Generic

Tablet

oxaprozin Generic

Capsule

piroxicam Generic

Tablet

sulindac Generic

Capsule

tolmetin sodium Generic

ANTI-INFECTIVESANTIFUNGAL

Troche

clotrimazole Generic

Suspension Reconstituted

fluconazole Generic

Tablet

fluconazole Generic

Capsule

flucytosine Generic

Tablet

griseofulvin microsize Generic

Suspension

griseofulvin microsize Generic

Tablet

griseofulvin ultramicrosize Generic

Capsule

itraconazole Generic

Tablet

ketoconazole Generic

Suspension

nystatin Generic

Tablet

nystatin Generic

Tablet

terbinafine hcl Generic

Tablet

voriconazole Generic


voriconazole Generic

Suspension

NOXAFIL Preferred Brand

Solution

SPORANOX Preferred Brand

ANTIMALARIALS

Tablet

atovaquone/proguanil hcl Generic

Tablet

chloroquine phosphate Generic

Tablet

hydroxychloroquine sulfate Generic

Tablet

mefloquine hcl Generic

Capsule

quinine sulfate Generic

Tablet

COARTEM Preferred Brand

Tablet

DARAPRIM Preferred Brand

Tablet

PRIMAQUINE PHOSPHATE Preferred Brand

ANTIMYCOBACTERIALS

Capsule

cycloserine Generic

Tablet

ethambutol hcl Generic

Tablet

isoniazid Generic

Tablet

pyrazinamide Generic

Capsule

rifampin Generic

Tablet

SIRTURO Preferred Brand

ANTIPARASITICS



ANTIPARASITICS

Tablet

metronidazole Generic

Capsule

paromomycin sulfate Generic

Tablet

tinidazole Generic

Tablet

ALBENZA Preferred Brand

Tablet

ALINIA Preferred Brand


ALINIA Preferred Brand

Tablet

BILTRICIDE Preferred Brand

ANTIVIRALS

Capsule

acyclovir Generic

Tablet

acyclovir Generic

Suspension

acyclovir Generic

Syrup

amantadine hcl Generic

Capsule

amantadine hcl Generic

Tablet

famciclovir Generic

Tablet

lamivudine Generic

Tablet

moderiba Generic

Capsule

ribasphere Generic

Capsule

ribavirin Generic

Tablet

ribavirin Generic

Tablet

rimantadine hcl Generic

Tablet

valacyclovir hcl Generic

Solution

EPIVIR HBV Preferred Brand

Tablet

RIBASPHERE RIBAPAK Preferred Brand

CEPHALOSPORINS

Capsule

cefaclor Generic


cefaclor Generic

Capsule

cefadroxil Generic


cefadroxil Generic

Capsule

cefdinir Generic


cefdinir Generic


cefprozil Generic

Tablet

cefprozil Generic

Capsule

ceftibuten Generic


ceftibuten Generic

Tablet

cephalexin Generic


cephalexin Generic

ERYTHROMYCINS/MACROLIDS


azithromycin Generic

Tablet

clarithromycin Generic


clarithromycin Generic


clarithromycin er Generic


ery-tab Generic

Tablet

erythromycin base Generic

Tablet

erythromycin ethylsuccinate Generic

HEPATITIS C

Tablet

MAVYRET Preferred Brand

HIV

Tablet

abacavir Generic

Tablet

abacavir sulfate/lamivudine/zidovudine Generic

Capsule Delayed Release

didanosine Generic

Tablet

lamivudine/zidovudine Generic

Suspension

nevirapine Generic

Tablet

nevirapine Generic

Solution Reconstituted

stavudine Generic

Capsule

stavudine Generic

Syrup

zidovudine Generic

Capsule

zidovudine Generic

Tablet

zidovudine Generic

Solution

APTIVUS Preferred Brand



HIV

Capsule

APTIVUS Preferred Brand

Tablet

ATRIPLA Preferred Brand

Tablet

COMPLERA Preferred Brand

Capsule

CRIXIVAN Preferred Brand

Tablet

DESCOVY Preferred Brand

Tablet

EDURANT Preferred Brand

Capsule

EMTRIVA Preferred Brand

Solution

EMTRIVA Preferred Brand

Tablet

GENVOYA Preferred Brand

Tablet

INTELENCE Preferred Brand

Tablet

INVIRASE Preferred Brand

Tablet

ISENTRESS Preferred Brand

Tablet

KALETRA Preferred Brand

Suspension

LEXIVA Preferred Brand

Tablet

NORVIR Preferred Brand

Solution

NORVIR Preferred Brand

Tablet

ODEFSEY Preferred Brand

Suspension

PREZISTA Preferred Brand

Tablet

PREZISTA Preferred Brand

Tablet

RESCRIPTOR Preferred Brand

Tablet

SELZENTRY Preferred Brand

Tablet

STRIBILD Preferred Brand

Tablet

TIVICAY Preferred Brand

Tablet

TRUVADA Preferred Brand


VIDEXPEDIATRIC Preferred Brand

Tablet

VIRACEPT Preferred Brand

MISCELLANEOUS

Capsule

clindamycin hcl Generic


clindamycin palmitate hcl Generic

Tablet

dapsone Generic

Tablet

linezolid Generic

Tablet

methenamine hippurate Generic

Tablet

methenamine mandelate Generic

Capsule

nitrofurantoin macrocrystals Generic

Capsule

nitrofurantoin monohydrate Generic

Tablet

sulfadiazine Generic

Tablet

sulfamethoxazole/trimethoprim Generic

Suspension

sulfamethoxazole/trimethoprim Generic

Tablet

trimethoprim Generic

Capsule

vancomycin hcl Generic

Capsule

TOBI PODHALER Preferred Brand

Tablet

XIFAXAN Preferred Brand

PENICILLINS

Tablet

amoxicillin Generic


amoxicillin Generic


amoxicillin/clavulanate potassium Generic

Tablet

amoxicillin/clavulanate potassium Generic


amoxicillin/clavulanate potassium er Generic


ampicillin Generic

Capsule

ampicillin Generic

Capsule

dicloxacillin sodium Generic

Tablet

penicillin v potassium Generic


penicillin v potassium Generic

QUINOLONES


ciprofloxacin er Generic

Tablet

ciprofloxacin hcl Generic

Solution

levofloxacin Generic



QUINOLONES

Tablet


TETRACYCLINES

Tablet

demeclocycline hcl Generic

Tablet

doxycycline hyclate Generic

Capsule

doxycycline monohydrate Generic

Capsule

minocycline hcl Generic

Capsule

morgidox 1x100mg Generic

Capsule

tetracycline hcl Generic


SOLODYN Preferred Brand

VAGINAL

Cream

clindamycin phosphate Generic

Gel

metronidazole vaginal Generic

Suppository

miconazole 3 Generic

Suppository

terconazole Generic

Cream

terconazole Generic

CARDIACACE INHIBITORS

Capsule

amlodipine besylate/benazepril hydrochloride Generic

Tablet

benazepril hcl Generic

Tablet

benazepril hcl/hydrochlorothiazide Generic

Tablet

captopril Generic

Tablet

captopril/hydrochlorothiazide Generic

Tablet

enalapril maleate Generic

Tablet

fosinopril sodium Generic

Tablet

fosinopril sodium/hydrochlorothiazide Generic

Tablet

lisinopril Generic

Tablet

lisinopril/hydrochlorothiazide Generic

Tablet

moexipril hcl Generic

Tablet

moexipril/hydrochlorothiazide Generic

Tablet

perindopril erbumine Generic

Tablet

quinapril hcl Generic

Tablet

quinapril/hydrochlorothiazide Generic

Capsule

ramipril Generic

Tablet

trandolapril Generic

ANGIOTENSIN RECEPTOR BLOCKER

Tablet

candesartan cilexetil Generic

Tablet

candesartan cilexetil/hydrochlorothiazide Generic

Tablet

eprosartan mesylate Generic

Tablet

irbesartan Generic

Tablet

irbesartan/hydrochlorothiazide Generic

Tablet

losartan potassium Generic

Tablet

losartan potassium/hydrochlorothiazide Generic

Tablet

olmesartan medoxomil Generic

Tablet

olmesartan medoxomil Generic

Tablet

telmisartan Generic

Tablet

telmisartan/amlodipine Generic

Tablet

telmisartan/hydrochlorothiazide Generic

Tablet

valsartan Generic

Tablet

valsartan/hydrochlorothiazide Generic

Tablet

TEKAMLO Preferred Brand

Tablet

TEKTURNA Preferred Brand

Tablet

TEKTURNA HCT Preferred Brand

ANTIARRHYTHMIC

Tablet

amiodarone hcl Generic

Tablet

digoxin Generic

Solution

digoxin Generic

Capsule

disopyramide phosphate Generic

Tablet

flecainide acetate Generic

Capsule

mexiletine hcl Generic



ANTIARRHYTHMIC

Tablet

pacerone Generic

Solution

procainamide hcl Generic

Tablet

propafenone hcl Generic

Solution

quinidine gluconate Generic

Tablet

quinidine sulfate Generic


quinidine sulfate er Generic

Tablet

sorine Generic

Tablet

sotalol hcl Generic

Tablet

sotalol hcl (af) Generic

Tablet

MULTAQ Preferred Brand

Capsule Extended Release 12 Hour

NORPACE CR Preferred Brand

ANTICOAGULANTS

Tablet

cilostazol Generic

Tablet

clopidogrel Generic

Tablet

dipyridamole Generic

Solution

enoxaparin sodium Generic

Solution

fondaparinux sodium Generic

Solution

heparin sodium Generic

Tablet

jantoven Generic


pentoxifylline er Generic

Tablet

ticlopidine hcl Generic

Tablet

warfarin sodium Generic

Tablet

BRILINTA Preferred Brand

Tablet

ELIQUIS Preferred Brand

Solution

FRAGMIN Preferred Brand

Tablet

MEPHYTON Preferred Brand

Tablet

XARELTO Preferred Brand

Tablet Therapy Pack

XARELTO STARTER PACK Preferred Brand

BETA BLOCKERS

Capsule

acebutolol hcl Generic

Tablet

atenolol Generic

Tablet

atenolol/chlorthalidone Generic

Tablet

betaxolol hcl Generic

Tablet

bisoprolol fumarate Generic

Tablet

bisoprolol fumarate/hydrochlorothiazide Generic

Tablet

carvedilol Generic

Tablet

labetalol hcl Generic

Tablet

metoprolol tartrate Generic

Tablet

nadolol Generic

Tablet

nadolol/bendroflumethiazide Generic

Tablet

pindolol Generic

Tablet

propranolol hcl Generic

Solution

propranolol hcl Generic

Tablet

propranolol/hydrochlorothiazide Generic

Tablet

timolol maleate Generic

Tablet

BYSTOLIC Preferred Brand

Solution

HEMANGEOL Preferred Brand

CALCIUM CHANNEL BLOCKERS


afeditab cr Generic

Tablet

amlodipine besylate Generic


cartia xt Generic


diltiazem cd Generic

Tablet

diltiazem hcl Generic


diltiazem hcl er Generic


felodipine er Generic

Capsule

isradipine Generic

Capsule

nifedipine Generic


nifedipine er Generic



CALCIUM CHANNEL BLOCKERS

Capsule

nimodipine Generic


nisoldipine er Generic


taztia xt Generic

Tablet

verapamil hcl Generic


verapamil hcl er Generic

DIURETICS

Tablet

acetazolamide Generic

Tablet

amiloride hcl Generic

Tablet

amiloride/hydrochlorothiazide Generic

Tablet

bumetanide Generic

Tablet

chlorothiazide Generic

Tablet

eplerenone Generic

Solution

furosemide Generic

Tablet

hydrochlorothiazide Generic

Tablet

indapamide Generic

Tablet

methazolamide Generic

Tablet

methyclothiazide Generic

Tablet

metolazone Generic

Tablet

spironolactone Generic

Tablet

spironolactone/hydrochlorothiazide Generic

Tablet

torsemide Generic

Tablet

triamterene/hydrochlorothiazide Generic

NITRATES

Tablet

isosorbide dinitrate Generic

Tablet

isosorbide mononitrate Generic

Patch 24 Hour

minitran Generic

Aerosol Solution

nitroglycerin lingual Generic

Patch 24 Hour

nitroglycerin transdermal Generic


DILATRATE SR Preferred Brand

Ointment

NITRO-BID Preferred Brand

Patch 24 Hour

NITRO-DUR Preferred Brand

OTHER

Tablet

ENTRESTO Preferred Brand


RANEXA Preferred Brand

OTHER ANTI-HYPERTENSIVES

Tablet

clonidine hcl Generic

Tablet

clorpres Generic

Tablet

doxazosin mesylate Generic

Tablet

guanfacine hcl Generic

Tablet

hydralazine hcl Generic

Tablet

methyldopa Generic

Tablet

methyldopa/hydrochlorothiazide Generic

Tablet

minoxidil Generic

Capsule

prazosin hcl Generic

Tablet

reserpine Generic

Capsule

terazosin hcl Generic

STATINS

Tablet

amlodipine besylate/atorvastatin calcium Generic

Tablet

atorvastatin calcium Generic

Packet

cholestyramine Generic

Tablet

colestipol hcl Generic

Tablet

fenofibrate Generic


fenofibric acid dr Generic

Capsule

fluvastatin Generic

Tablet

gemfibrozil Generic

Tablet

lovastatin Generic


niacin er Generic

Tablet

pravastatin sodium Generic

Packet

prevalite Generic



STATINS

Tablet

rosuvastatin calcium Generic

Tablet

simvastatin Generic

Tablet

LIVALO Preferred Brand

Solution Pen-injector

PRALUENT Preferred Brand


PRALUENT Preferred Brand

Capsule

VASCEPA Preferred Brand

Tablet

WELCHOL Preferred Brand

Packet

WELCHOL Preferred Brand

CNSADHD


amphetamine/dextroamphetamine Generic

Tablet

amphetamine/dextroamphetamine Generic

Tablet

dexmethylphenidate hcl Generic


dexmethylphenidate hcl er Generic

Solution

dextroamphetamine sulfate Generic

Tablet

dextroamphetamine sulfate Generic

Tablet

guanidine hcl Generic

Tablet

methylphenidate hcl Generic

Tablet

methylphenidate hcl Generic


methylphenidate hcl cd Generic

Solution

methylphenidate hydrochloride Generic

Patch

DAYTRANA Preferred Brand


MYDAYIS Preferred Brand

Tablet Chewable Extended Release

QUILLICHEW ER Preferred Brand


QUILLIVANT XR Preferred Brand

Tablet Chewable

VYVANSE Preferred Brand

Capsule

VYVANSE Preferred Brand

ALZHEIMER'S


galantamine hydrobromideer Generic

Capsule

rivastigmine tartrate Generic


NAMENDA XR Preferred Brand

Capsule ER 24 Hour Therapy Pack

NAMZARIC Preferred Brand


NAMZARIC Preferred Brand

ANTICONVULSANTS

Tablet

carbamazepine Generic

Suspension

carbamazepine Generic


carbamazepine er Generic


carbamazepine er Generic

Tablet

clonazepam Generic


clonazepam odt Generic

Gel

diazepam Generic


divalproex sodium dr Generic


divalproex sodium er Generic

Tablet

epitol Generic

Capsule

ethosuximide Generic

Capsule


Solution


Tablet

felbamate Generic

Suspension

felbamate Generic

Solution

fosphenytoin sodium Generic

Capsule

gabapentin Generic

Tablet

gabapentin Generic

Tablet

lamotrigine Generic

Tablet

levetiracetam Generic

Solution

levetiracetam Generic

Suspension

oxcarbazepine Generic

Tablet

oxcarbazepine Generic

Elixir

phenobarbital Generic



ANTICONVULSANTS

Tablet

phenobarbital Generic

Suspension

phenytoin Generic

Capsule

phenytoin sodium extended Generic

Tablet

primidone Generic

Tablet

tiagabine hydrochloride Generic

Tablet

topiramate Generic

Solution

valproic acid Generic

Capsule

valproic acid Generic

Capsule

zonisamide Generic

Tablet

BANZEL Preferred Brand

Tablet

FYCOMPA Preferred Brand

Tablet

GABITRIL Preferred Brand

Kit

LAMICTAL XR Preferred Brand

Capsule

LYRICA Preferred Brand


LYRICA CR Preferred Brand

Suspension

ONFI Preferred Brand


OXTELLAR XR Preferred Brand

Tablet

PEGANONE Preferred Brand

Tablet

POTIGA Preferred Brand

Tablet

SABRIL Preferred Brand


TROKENDI XR Preferred Brand

Tablet

VIMPAT Preferred Brand

Solution

VIMPAT Preferred Brand

ANTIDEPRESSANTS

Tablet

amitriptyline hcl Generic

Tablet

amoxapine Generic

Tablet

bupropion hcl Generic


bupropion hcl xl Generic

Tablet

chlordiazepoxide/amitriptyline Generic

Solution

citalopram hydrobromide Generic

Tablet

citalopram hydrobromide Generic

Capsule

clomipramine hcl Generic

Tablet

desipramine hcl Generic

Capsule

doxepin hcl Generic

Concentrate

doxepin hcl Generic

Capsule Delayed Release Particles

duloxetine hcl Generic

Tablet

escitalopram oxalate Generic

Solution

escitalopram oxalate Generic

Capsule

fluoxetine hcl Generic

Solution

fluoxetine hcl Generic

Tablet

fluvoxamine maleate Generic

Tablet

imipramine hcl Generic

Capsule

imipramine pamoate Generic

Tablet

maprotiline hcl Generic

Tablet

mirtazapine Generic

Tablet

nefazodone hcl Generic

Capsule

nortriptyline hcl Generic

Solution

nortriptyline hcl Generic

Tablet

paroxetine hcl Generic


paroxetine hcl er Generic

Tablet

perphenazine/amitriptyline Generic

Tablet

phenelzine sulfate Generic

Tablet

protriptyline hcl Generic

Tablet

sertraline hcl Generic

Tablet

tranylcypromine sulfate Generic

Tablet

trazodone hcl Generic



ANTIDEPRESSANTS

Tablet

venlafaxine hcl Generic


venlafaxine hcl er Generic


FETZIMA Preferred Brand

Capsule ER 24 Hour Therapy Pack

FETZIMA TITRATION PACK Preferred Brand

Tablet

TRINTELLIX Preferred Brand

Kit

VIIBRYD Preferred Brand

Tablet

VIIBRYD Preferred Brand

Kit

VIIBRYD STARTER PACK Preferred Brand

ANTIPARKINSONISM

Tablet

benztropine mesylate Generic

Tablet

bromocriptine mesylate Generic

Tablet

carbidopa/levodopa Generic


carbidopa/levodopa er Generic

Tablet

carbidopa/levodopa/entacapone Generic

Tablet

entacapone Generic

Tablet

ropinirole hcl Generic

Tablet

selegiline hcl Generic

Tablet

trihexyphenidyl hcl Generic

Elixir

trihexyphenidyl hcl Generic

Patch 24 Hour

NEUPRO Preferred Brand

Tablet

XADAGO Preferred Brand


ZELAPAR Preferred Brand

ANTI-PSYCHOTIC

Tablet

aripiprazole Generic

Tablet

chlorpromazine hcl Generic

Tablet

clozapine Generic


clozapine odt Generic

Concentrate

fluphenazine hcl Generic

Tablet

fluphenazine hcl Generic

Tablet

haloperidol Generic

Concentrate

haloperidol Generic

Solution

haloperidol decanoate Generic

Capsule

loxapine succinate Generic

Tablet

olanzapine Generic


olanzapine odt Generic

Capsule

olanzapine/fluoxetine Generic

Tablet

perphenazine Generic

Tablet

quetiapine fumarate Generic


quetiapine fumarate er Generic

Tablet

risperidone Generic


risperidone odt Generic

Tablet

thioridazine hcl Generic

Capsule

thiothixene Generic

Tablet

trifluoperazine hcl Generic

Capsule

ziprasidone hcl Generic

Prefilled Syringe

ABILIFY MAINTENA Preferred Brand

Suspension

INVEGA SUSTENNA Preferred Brand

Suspension

INVEGA TRINZA Preferred Brand

Suspension

INVEGA TRINZA Preferred Brand

Tablet

LATUDA Preferred Brand


RISPERDAL CONSTA Preferred Brand

Tablet Sublingual

SAPHRIS Preferred Brand

Capsule Therapy Pack

VRAYLAR Preferred Brand

Capsule

VRAYLAR Preferred Brand

ANXIOLYTICS

Tablet

alprazolam Generic


alprazolam er Generic


alprazolam odt Generic



ANXIOLYTICS


alprazolam xr Generic

Tablet

buspirone hcl Generic

Capsule

chlordiazepoxide hcl Generic

Tablet

clorazepate dipotassium Generic

Tablet

diazepam Generic

Concentrate

diazepam intensol Generic

Tablet

lorazepam Generic

Concentrate

lorazepam intensol Generic

Syrup

midazolam hcl Generic

Capsule

oxazepam Generic

MISCELLANEOUS

Tablet

armodafinil Generic

Solution

lithium Generic

Capsule

lithium carbonate Generic


lithium carbonate er Generic

Tablet

modafinil Generic

Tablet

BELVIQ Preferred Brand

Capsule

NUEDEXTA Preferred Brand

MS


AMPYRA Preferred Brand

Tablet

AUBAGIO Preferred Brand


COPAXONE Preferred Brand

Capsule

GILENYA Preferred Brand

SLEEP

Tablet

estazolam Generic

Tablet

eszopiclone Generic

Capsule

flurazepam hcl Generic

Tablet

quazepam Generic

Capsule

temazepam Generic

Capsule

zaleplon Generic


zolpidem tartrate er Generic

Tablet

BELSOMRA Preferred Brand

Tablet

ROZEREM Preferred Brand

DIABETESDPP-4

Tablet

JANUMET Preferred Brand


JANUMET XR Preferred Brand

Tablet

JANUVIA Preferred Brand

Tablet

JENTADUETO Preferred Brand

Tablet

TRADJENTA Preferred Brand

INCRETINS


OZEMPIC Preferred Brand


TRULICITY Preferred Brand


VICTOZA Preferred Brand

INSULIN

Solution

FIASP Preferred Brand


FIASP FLEXTOUCH Preferred Brand

Suspension

NOVOLIN 70/30 Preferred Brand

Suspension

NOVOLIN N Preferred Brand

Solution

NOVOLIN R Preferred Brand

Solution

NOVOLOG Preferred Brand


NOVOLOG FLEXPEN Preferred Brand

Suspension

NOVOLOG MIX 70/30 Preferred Brand

Suspension Pen-injector

NOVOLOG MIX 70/30 PREFILLED FLEXPEN Preferred Brand

Solution Cartridge

NOVOLOG PENFILL Preferred Brand


SOLIQUA 100/33 Preferred Brand


XULTOPHY 100/3.6 Preferred Brand

INSULIN: LONG ACTING

Solution

LANTUS Preferred Brand


LANTUS SOLOSTAR Preferred Brand



INSULIN: LONG ACTING

Solution

LEVEMIR Preferred Brand


LEVEMIR FLEXTOUCH Preferred Brand


TOUJEO SOLOSTAR Preferred Brand


TRESIBA FLEXTOUCH Preferred Brand

OTHER

Tablet

acarbose Generic

Tablet

metformin hcl Generic


metformin hcl er Generic

Tablet

nateglinide Generic

Tablet

repaglinide Generic

Tablet

CYCLOSET Preferred Brand


GLUCAGEN HYPOKIT Preferred Brand

Kit

GLUCAGON EMERGENCY KIT Preferred Brand


SYMLINPEN 120 Preferred Brand

SGLT-2

Tablet

FARXIGA Preferred Brand

Tablet

JARDIANCE Preferred Brand

Tablet

SYNJARDY Preferred Brand


SYNJARDY XR Preferred Brand


XIGDUO XR Preferred Brand

SGLT-2 / DPP-4

Tablet

GLYXAMBI Preferred Brand

SULFONYLUREAS

Tablet

glimepiride Generic


glipizide er Generic

Tablet

glipizide/metformin hcl Generic

Tablet

glyburide Generic

Tablet

glyburide micronized Generic

Tablet

glyburide/metformin hcl Generic

TESTING

Miscellaneous

BD INSULIN SYRINGE MICROFINE IV/U-100/1ML/28G X 1/2"Preferred Brand

Miscellaneous

BD NEEDLE/27G X 1/2" Preferred Brand

Miscellaneous

BD PEN NEEDLE/MINI/ULTRAFINE/31G X 3/16" Preferred Brand

Device

DEXCOM G4 PLATINUM RECEIVER KIT Preferred Brand

Device

DEXCOM G5 MOBILE RECEIVERKIT Preferred Brand

Miscellaneous

INSULIN SYRINGE/U-100/1ML/28G X 1/2" Preferred Brand

Miscellaneous

NOVOFINE 30GX8MM Preferred Brand

Miscellaneous

NOVOFINE 32GX6MM Preferred Brand

Miscellaneous

NOVOFINE AUTOCOVER 30GX8MM Preferred Brand

Miscellaneous

NOVOFINE PLUS 32GX4MM Preferred Brand

Miscellaneous

NOVOTWIST 30GX8MM Preferred Brand

Miscellaneous

NOVOTWIST 32GX5MM Preferred Brand

Kit

ONETOUCH ULTRA 2 Preferred Brand

Strip

ONETOUCH ULTRA BLUE Preferred Brand

Kit

ONETOUCH VERIO FLEX BLOODGLUCOSE MONITORING SYSTEMPreferred Brand

Kit

ONETOUCH VERIO IQ BLOOD GLUCOSE MONITORING SYSTEMPreferred Brand

Kit

ONETOUCH VERIO SYNC BLOODGLUCOSE MONITORING SYSTEMPreferred Brand

Strip

ONETOUCH VERIO TEST STRIPS Preferred Brand

TZD

Tablet

pioglitazone hcl Generic

Tablet

pioglitazone hcl/metformin hcl Generic

Tablet

pioglitazone hcl-glimepiride Generic

ENDOCRINEADRENAL HORMONES

Tablet

dexamethasone Generic

Tablet

fludrocortisone acetate Generic

Tablet

hydrocortisone Generic

Suspension

methylprednisolone acetate Generic

Tablet Therapy Pack

methylprednisolone dose pack Generic

Solution

prednisolone Generic

Tablet

prednisone Generic



ADRENAL HORMONES


SOLU-CORTEF Preferred Brand

CONTRACEPTIVES

Tablet

altavera Generic

Tablet

alyacen 1/35 Generic

Tablet

amethia Generic

Tablet

amethyst Generic

Tablet

apri Generic

Tablet

aranelle Generic

Tablet

aubra Generic

Tablet

aviane Generic

Tablet

azurette Generic

Tablet

balziva Generic

Tablet

briellyn Generic

Tablet

camrese Generic

Tablet

caziant Generic

Tablet

chateal Generic

Tablet

cryselle-28 Generic

Tablet

cyclafem 1/35 Generic

Tablet

dasetta 7/7/7 Generic

Tablet

daysee Generic

Tablet

elinest Generic

Tablet

emoquette Generic

Tablet

enpresse-28 Generic

Tablet

enskyce Generic

Tablet

estarylla Generic

Tablet

falmina Generic

Tablet

gianvi Generic

Tablet

gildagia Generic

Tablet

introvale Generic

Tablet

jolessa Generic

Tablet

junel 1.5/30 Generic

Tablet

kariva Generic

Tablet

kelnor 1/35 Generic

Tablet

kurvelo Generic

Tablet

larin fe 1.5/30 Generic

Tablet

leena Generic

Tablet

lessina Generic

Tablet

levonest Generic

Tablet

levora 0.15/30-28 Generic

Tablet

lomedia 24 fe Generic

Tablet

loryna Generic

Tablet

low-ogestrel Generic

Tablet

lutera Generic

Tablet

marlissa Generic

Tablet

microgestin 1/20 Generic

Tablet

mono-linyah Generic

Tablet

mononessa Generic

Tablet

myzilra Generic

Tablet

necon 1/50-28 Generic

Tablet

nortrel 1/35 Generic

Tablet

ocella Generic

Tablet

orsythia Generic

Tablet

philith Generic

Tablet

pimtrea Generic

Tablet

pirmella 7/7/7 Generic

Tablet

portia-28 Generic



CONTRACEPTIVES

Tablet

previfem Generic

Tablet

quasense Generic

Tablet

reclipsen Generic

Tablet

sprintec 28 Generic

Tablet

sronyx Generic

Tablet

syeda Generic

Tablet

tilia fe Generic

Tablet

tri-estarylla Generic

Tablet

tri-linyah Generic

Tablet

trinessa Generic

Tablet

tri-previfem Generic

Tablet

tri-sprintec Generic

Tablet

trivora-28 Generic

Tablet

velivet Generic

Tablet

vestura Generic

Tablet

viorele Generic

Tablet

wera Generic

Tablet Chewable

wymzya fe Generic

Tablet

zarah Generic

Tablet

zenchent Generic

Tablet

zovia 1/35e Generic

Tablet

LO LOESTRIN FE Preferred Brand

Tablet

NATAZIA Preferred Brand

Ring

NUVARING Preferred Brand

Tablet

OGESTREL Preferred Brand

Tablet

SAFYRAL Preferred Brand

Intrauterine Device

SKYLA Preferred Brand

Capsule

TAYTULLA Preferred Brand

ESTROGENS

Tablet

esterified estrogens/methyltestosterone hs Generic

Patch Weekly

estradiol Generic

Tablet

estradiol/norethindrone acetate Generic

Tablet

jinteli Generic

Patch Twice Weekly

COMBIPATCH Preferred Brand

Gel

DIVIGEL Preferred Brand

Tablet

DUAVEE Preferred Brand

Ring

ESTRING Preferred Brand

Patch Twice Weekly

MINIVELLE Preferred Brand

Cream

PREMARIN Preferred Brand

Tablet

PREMARIN Preferred Brand

Tablet

PREMPHASE Preferred Brand

Tablet

PREMPRO Preferred Brand

GONADOTROPIN

Kit

CETROTIDE Preferred Brand

Solution

GANIRELIX ACETATE Preferred Brand


NOVAREL Preferred Brand

MISCELLANEOUS

Tablet

cabergoline Generic

Capsule

calcitriol Generic

Tablet

desmopressin acetate Generic

Solution

desmopressin acetate Generic

Tablet

ADDYI Preferred Brand

OVULATORY STIMULANTS

Tablet

clomiphene citrate Generic


GONAL-F Preferred Brand


MENOPUR Preferred Brand

PROGESTINS

Tablet

camila Generic

Tablet

errin Generic



PROGESTINS

Tablet

heather Generic

Tablet

jencycla Generic

Tablet

jolivette Generic

Tablet

lyza Generic

Tablet

nora-be Generic

Tablet

norethindrone Generic

Capsule

progesterone Generic

Gel

CRINONE Preferred Brand

Insert

ENDOMETRIN Preferred Brand

TESTOSTERONE

Tablet

androxy Generic

Capsule

danazol Generic

Tablet

oxandrolone Generic

Solution

testosterone cypionate Generic

Gel

ANDROGEL Preferred Brand

Gel

ANDROGEL PUMP Preferred Brand

THYROID

Tablet

levothyroxine sodium Generic

Tablet

levoxyl Generic

Tablet

liothyronine sodium Generic

Tablet

methimazole Generic

Tablet

nature-throid Generic

Tablet

unithroid Generic

GASTROINTESTINALANTIDIARRHEALS

Capsule

dicyclomine hcl Generic

Capsule

dicyclomine hcl Generic

Tablet

diphenoxylate/atropine Generic

Liquid

diphenoxylate/atropine Generic

Tablet

glycopyrrolate Generic

Solution

hyoscyamine sulfate Generic

Capsule

loperamide hcl Generic

Tablet

methscopolamine bromide Generic

ANTIEMETIC

Capsule

dronabinol Generic

Tablet

granisetron hcl Generic

Tablet

meclizine hcl Generic

Solution

ondansetron hcl Generic

Tablet

ondansetron hcl Generic


ondansetron odt Generic

Suppository

prochlorperazine Generic

Tablet

prochlorperazine maleate Generic

Capsule

trimethobenzamide hcl Generic


BONJESTA Preferred Brand


DICLEGIS Preferred Brand

BOWEL EVACUANTS


MOVIPREP Preferred Brand

DIGESTIVE ENZYMES


CREON Preferred Brand

Solution

SUCRAID Preferred Brand


ZENPEP Preferred Brand

H2 ANTAGONISTS

Tablet

cimetidine Generic

Solution

cimetidine hcl Generic

Tablet

famotidine Generic


famotidine Generic

Tablet

misoprostol Generic

Capsule

nizatidine Generic

Syrup

ranitidine hcl Generic

Tablet

ranitidine hcl Generic

OTHER



OTHER

Capsule

balsalazide disodium Generic


budesonide Generic

Capsule

chlordiazepoxide hcl/clidinium bromide Generic

Solution

constulose Generic

Solution

lactulose Generic

Solution

metoclopramide hcl Generic

Tablet

metoclopramide hcl Generic

Tablet

sulfasalazine Generic


sulfasalazine Generic

Capsule

ursodiol Generic

Capsule

AMITIZA Preferred Brand


APRISO Preferred Brand

Tincture

BELLADONNA Preferred Brand

Tablet

CHENODAL Preferred Brand


DELZICOL Preferred Brand


KINEVAC Preferred Brand

Tablet

MOVANTIK Preferred Brand


UCERIS Preferred Brand

Tablet

VIBERZI Preferred Brand

OTHER ULCER THERAPY

Miscellaneous

lansoprazole/amoxicillin/clarithromycin Generic

Tablet

sucralfate Generic

Suspension

CARAFATE Preferred Brand

PROTON PUMP INHIBITORS


lansoprazole Generic


omeprazole Generic

Capsule

omeprazole/sodium bicarbonate Generic


pantoprazole sodium Generic


rabeprazole sodium Generic

RECTAL

Suppository

anucort-hc Generic

Enema

colocort Generic

Enema

mesalamine Generic

Foam

CORTIFOAM Preferred Brand

Foam

UCERIS Preferred Brand

GROWTH HORMONES

Solution

NORDITROPIN FLEXPRO Preferred Brand

HEMATOLOGY

Solution

PROCRIT Preferred Brand


ZARXIO Preferred Brand

IMMUNOSUPPRESSANTS

Tablet

azathioprine Generic

Solution

cyclosporine modified Generic

Capsule

cyclosporine modified Generic

Solution

gengraf Generic

Capsule

gengraf Generic

Capsule

mycophenolate mofetil Generic

Tablet

sirolimus Generic

Capsule

tacrolimus Generic

Tablet

AZASAN Preferred Brand

Solution

RAPAMUNE Preferred Brand

Solution

SANDIMMUNE Preferred Brand

Tablet

ZORTRESS Preferred Brand

INTERFERONS

Solution

ACTIMMUNE Preferred Brand

Solution

ALFERON N Preferred Brand

Kit

BETASERON Preferred Brand


INTRON A W/DILUENT Preferred Brand

Solution

PEGASYS Preferred Brand



Kit

PEGINTRON Preferred Brand

Kit

PEG-INTRON REDIPEN Preferred Brand


REBIF Preferred Brand


REBIF REBIDOSE Preferred Brand


REBIF REBIDOSE TITRATIONPACK Preferred Brand


REBIF TITRATION PACK Preferred Brand

Kit

SYLATRON Preferred Brand

MISCELLANEOUS


bupropion hcl sr Generic

Solution

calcitonin salmon Generic

Capsule

cevimeline hcl Generic

Tablet

disulfiram Generic


epinephrine Generic


epinephrine Generic


epipen 2-pak Generic


epipen-jr 2-pak Generic

Tablet

etidronate disodium Generic

Tablet

midodrine hcl Generic

Tablet

riluzole Generic

Tablet

CARBAGLU Preferred Brand

Tablet

CHANTIX CONTINUING MONTHPAK Preferred Brand

Tablet Soluble

EXJADE Preferred Brand

MUSCULOSKELETALANTI-INFLAMMATORY


OTREXUP Preferred Brand


RASUVO Preferred Brand


COSENTYX Preferred Brand

* Coverage based on indication.


COSENTYX SENSOREADY PEN Preferred Brand



ENTYVIO Preferred Brand


Pen-injector Kit

HUMIRA PEN Preferred Brand



KINERET Preferred Brand



ORENCIA Preferred Brand



ORENCIA CLICKJECT Preferred Brand


Tablet

SAVELLA Preferred Brand


Tablet

SAVELLA Preferred Brand


GOUT THERAPY

Tablet

allopurinol Generic

Tablet

probenecid Generic

Tablet

COLCRYS Preferred Brand

Tablet

ULORIC Preferred Brand

MUSCLE RELAXANTS

Tablet

baclofen Generic

Tablet

carisoprodol Generic

Tablet

carisoprodol/aspirin Generic

Tablet

carisoprodol/aspirin Generic

Tablet

carisoprodol/aspirin/codeine Generic

Tablet

chlorzoxazone Generic

Tablet

cyclobenzaprine hcl Generic

Capsule

dantrolene sodium Generic

Tablet

meprobamate Generic

Tablet

metaxalone Generic

Tablet

methocarbamol Generic


orphenadrine citrate er Generic

Tablet

tizanidine hcl Generic



OSTEOPOROSIS

Solution

alendronate sodium Generic

Tablet

alendronate sodium Generic

Tablet

ibandronate sodium Generic

Solution

FORTEO Preferred Brand

ONCOLOGY

Tablet

anastrozole Generic

Tablet

bicalutamide Generic

Solution

cytarabine Generic

Tablet

exemestane Generic

Capsule

flutamide Generic

Capsule

hydroxyurea Generic

Tablet

imatinib mesylate Generic

Tablet

letrozole Generic

Tablet

leucovorin calcium Generic

Suspension

megestrol acetate Generic

Tablet

megestrol acetate Generic

Tablet

mercaptopurine Generic

Tablet

methotrexate Generic

Tablet

tamoxifen citrate Generic

Capsule

temozolomide Generic

Tablet

AFINITOR Preferred Brand

Tablet Soluble

AFINITOR DISPERZ Preferred Brand

Capsule

ALECENSA Preferred Brand

Tablet

BOSULIF Preferred Brand

Tablet

CAPRELSA Preferred Brand

Capsule

DROXIA Preferred Brand

Kit

ELIGARD Preferred Brand

Capsule

EMCYT Preferred Brand

Tablet

FARESTON Preferred Brand

Tablet

GILOTRIF Preferred Brand

Capsule

HYCAMTIN Preferred Brand

Tablet

ICLUSIG Preferred Brand

Capsule

IMBRUVICA Preferred Brand

Tablet

INLYTA Preferred Brand

Tablet

JAKAFI Preferred Brand

Tablet

LEUKERAN Preferred Brand

Tablet

LYSODREN Preferred Brand

Capsule

MATULANE Preferred Brand

Tablet

MEKINIST Preferred Brand

Tablet

MESNEX Preferred Brand

Tablet

NEXAVAR Preferred Brand

Capsule

POMALYST Preferred Brand

Capsule

REVLIMID Preferred Brand

Tablet

SPRYCEL Preferred Brand

Tablet

STIVARGA Preferred Brand

Capsule

SUTENT Preferred Brand

Tablet

TABLOID Preferred Brand

Capsule

TAFINLAR Preferred Brand

Tablet

TARCEVA Preferred Brand

Capsule

TASIGNA Preferred Brand

Capsule

THALOMID Preferred Brand

Tablet

TREXALL Preferred Brand

Tablet

TYKERB Preferred Brand

Tablet

VOTRIENT Preferred Brand

Capsule

XALKORI Preferred Brand

Tablet

ZELBORAF Preferred Brand



Capsule

ZOLINZA Preferred Brand

Tablet

ZYTIGA Preferred Brand

OPHTHALMICANTIBIOTICS

Ointment

bacitracin Generic

Ointment

bacitracin Generic

Ointment

bacitracin/polymyxin b Generic

Solution

ciprofloxacin hcl Generic

Ointment

erythromycin Generic

Solution

gatifloxacin Generic

Solution

gentamicin sulfate Generic

Ointment

gentamicin sulfate Generic

Solution


Ointment

neomycin/bacitracin/polymyxin Generic

Ointment

neomycin/polymyxin/bacitracin/hydrocortisone Generic

Suspension

neomycin/polymyxin/dexamethasone Generic

Ointment

neomycin/polymyxin/dexamethasone Generic

Solution

neomycin/polymyxin/gramicidin Generic

Solution

neomycin/polymyxin/hc Generic

Suspension

neomycin/polymyxin/hydrocortisone Generic

Solution

ofloxacin Generic

Solution

sodium sulfacetamide Generic

Solution

sulfacetamide sodium/prednisolone sodium phosphateGeneric

Solution

tobramycin sulfate Generic

Suspension

tobramycin/dexamethasone Generic

Solution

trimethoprim sulfate/polymyxin b sulfate Generic

Solution

AZASITE Preferred Brand

Suspension

BESIVANCE Preferred Brand

Suspension

CIPRODEX Preferred Brand

Solution

MOXEZA Preferred Brand

Suspension

NATACYN Preferred Brand

Ointment

TOBRADEX Preferred Brand

Suspension

TOBRADEX ST Preferred Brand

Suspension

ZYLET Preferred Brand

BETA BLOCKERS

Solution

betaxolol hcl Generic

Solution

carteolol hcl Generic

Solution

levobunolol hcl Generic

Solution

metipranolol Generic

Solution

timolol maleate Generic

GLAUCOMA

Solution

dorzolamide hcl Generic

Solution

dorzolamide hcl/timolol maleate Generic

Solution

latanoprost Generic

Solution

pilocarpine hcl Generic

Suspension

AZOPT Preferred Brand

Solution

COMBIGAN Preferred Brand

Solution

LUMIGAN Preferred Brand

Kit

MITOSOL Preferred Brand

Solution

TRAVATAN Z Preferred Brand

Solution

VYZULTA Preferred Brand

MISCELLANEOUS

Solution

altacaine Generic

Solution

apraclonidine Generic

Solution

azelastine hcl Generic

Solution

brimonidine tartrate Generic

Solution

cromolyn sodium Generic

Solution

epinastine hcl Generic

Solution

flucaine Generic



MISCELLANEOUS

Solution

fluorescein-benoxinate Generic

Solution

proparacaine hcl Generic

Solution

tetravisc Generic

Solution

trifluridine Generic

Solution

ALPHAGAN P Preferred Brand

Solution

BEPREVE Preferred Brand

Solution

CYSTARAN Preferred Brand

Emulsion

RESTASIS Preferred Brand

Emulsion

RESTASIS MULTIDOSE Preferred Brand

Gel

ZIRGAN Preferred Brand

MYDRIATICS

Solution

atropine sulfate Generic

Solution

cyclopentolate hcl Generic

Solution

homatropine hbr Generic

Solution

tropicamide Generic

NSAIDS

Solution

bromfenac Generic

Solution

diclofenac sodium Generic

Solution

flurbiprofen sodium Generic

Solution

ketorolac tromethamine Generic

Suspension

ILEVRO Preferred Brand

Suspension

NEVANAC Preferred Brand

Solution

PROLENSA Preferred Brand

STEROIDS

Solution

dexamethasone sodium phosphate Generic

Suspension

fluorometholone Generic

Suspension

prednisolone acetate Generic

Suspension

ALREX Preferred Brand

Emulsion

DUREZOL Preferred Brand

Ointment

LOTEMAX Preferred Brand

Suspension


Gel


Suspension

PRED MILD Preferred Brand

VASOCONSTRICTOROTICMISCELLANEOUS

Solution

acetasol hc Generic

Solution

acetic acid Generic

Solution

ciprofloxacin Generic

Solution

hydrocortisone/acetic acid Generic

RESPIRATORY

Solution

ipratropium bromide/albuterol sulfate Generic

Packet

montelukast sodium Generic

Tablet

montelukast sodium Generic

Tablet

zafirlukast Generic

Tablet

ADCIRCA Preferred Brand

Aerosol Powder Breath Activated

ADVAIR DISKUS Preferred Brand

Aerosol

ADVAIR HFA Preferred Brand


ANORO ELLIPTA Preferred Brand


BREO ELLIPTA Preferred Brand

Aerosol Solution

COMBIVENT RESPIMAT Preferred Brand

Tablet

DALIRESP Preferred Brand


INCRUSE ELLIPTA Preferred Brand

Tablet

KALYDECO Preferred Brand

Solution

PULMOZYME Preferred Brand

Capsule

SPIRIVA HANDIHALER Preferred Brand

Aerosol Solution

SPIRIVA RESPIMAT Preferred Brand

Aerosol Solution

STIOLTO RESPIMAT Preferred Brand


XOLAIR Preferred Brand

ANTIHISTAMINES



ANTIHISTAMINES

Tablet

arbinoxa Generic

Solution

carbinoxamine maleate Generic

Tablet

carbinoxamine maleate Generic

Tablet

clemastine fumarate Generic

Tablet

cyproheptadine hcl Generic

Tablet

desloratadine Generic

Elixir

diphenhydramine hcl Generic

Syrup

hydroxyzine hcl Generic

Tablet

hydroxyzine hcl Generic

Capsule

hydroxyzine pamoate Generic

Capsule

hydroxyzine pamoate Generic

Tablet

levocetirizine dihydrochloride Generic

Tablet

promethazine hcl Generic

ANTITUSSIVE

Capsule

benzonatate Generic

Syrup

bromfed dm Generic

Solution

guaifenesin/codeine Generic

Tablet

hydrocodone bitartrate/homatropine methylbromide Generic

Suspension Extended Release

hydrocodone polistirex/chlorpheniramine polistirex Generic

Syrup

promethazine vc/codeine Generic

Syrup

promethazine-dm Generic


TUSSICAPS Preferred Brand

BETA AGONISTS

Tablet

albuterol sulfate Generic

Syrup


Nebulization Solution


Nebulization Solution

levalbuterol hcl Generic

Syrup

metaproterenol sulfate Generic

Tablet

metaproterenol sulfate Generic

Tablet

terbutaline sulfate Generic

Aerosol Solution

PROAIR HFA Preferred Brand


PROAIR RESPICLICK Preferred Brand


SEREVENT DISKUS Preferred Brand

Aerosol Solution

STRIVERDI RESPIMAT Preferred Brand

Aerosol Solution

VENTOLIN HFA Preferred Brand

INHALED STEROIDS

Suspension

budesonide Generic


ARNUITY ELLIPTA Preferred Brand


FLOVENT DISKUS Preferred Brand

Aerosol

FLOVENT HFA Preferred Brand

Aerosol Solution

QVAR Preferred Brand


TRELEGY ELLIPTA Preferred Brand

NASAL STEROIDS

Solution

flunisolide Generic

Suspension

fluticasone propionate Generic

Suspension

DYMISTA Preferred Brand

Aerosol Solution

QNASL Preferred Brand

OTHER

Solution

azelastine hcl Generic

Solution

ipratropium bromide Generic

Solution

theophylline Generic


theophylline er Generic

Miscellaneous

AEROCHAMBER PLUS FLOW-VU/SMALL MASK Preferred Brand

Miscellaneous

AEROCHAMBER/FLOWSIGNAL Preferred Brand

PAH

Tablet

ADEMPAS Preferred Brand

Tablet

LETAIRIS Preferred Brand

Tablet

TRACLEER Preferred Brand

TOPICALACNE

Gel

adapalene Generic



ACNE

Foam

benzoyl peroxide Generic

Capsule

claravis Generic

Swab


Solution


Lotion


Foam


Gel


Gel

clindamycin phosphate/tretinoin Generic

Gel

clindamycin/benzoyl peroxide Generic

Solution


Gel


Gel

erythromycin/benzoyl peroxide Generic

Capsule

myorisan Generic

Liquid

pr benzoyl peroxide wash Generic

Lotion

sodium sulfacetamide/sulfur Generic

Emulsion

sodium sulfacetamide/sulfur cleanser in urea Generic

Gel

tretinoin Generic

Cream

tretinoin Generic

Gel

tretinoin microsphere Generic

Capsule

ABSORICA Preferred Brand

Gel

ACANYA Preferred Brand

Gel

ONEXTON Preferred Brand

ANESTHETICS

Ointment

lidocaine Generic

Cream

lidocaine hcl/hydrocortisone acetate Generic

Cream

lidocaine/prilocaine Generic

ANTIBACTERIALS

Ointment

mupirocin Generic

Cream

SULFAMYLON Preferred Brand

ANTIFUNGALS

Suspension

ciclopirox Generic

Shampoo

ciclopirox Generic

Gel

ciclopirox Generic

Cream


Solution


Lotion

clotrimazole/betamethasone dipropionate Generic

Cream

clotrimazole/betamethasone dipropionate Generic

Cream

econazole nitrate Generic

Shampoo


Cream


Ointment

nystatin Generic

Cream

nystatin/triamcinolone Generic

Solution

JUBLIA Preferred Brand

Cream

LUZU Preferred Brand

ANTIPSORIATIC

Capsule

acitretin Generic

Solution

calcipotriene Generic

Cream


Ointment


Ointment

calcitrene Generic

Cream

dritho-creme hp Generic

Lotion

selenium sulfide Generic

Shampoo

selenium sulfide Generic

Shampoo

sodium sulfacetamide Generic

Liquid

sodium sulfacetamide wash Generic

Suspension

TACLONEX Preferred Brand

ANTIVIRALS

Ointment

acyclovir Generic

CORTICOSTEROIDS HIGH POTENCY

Cream

amcinonide Generic



CORTICOSTEROIDS HIGH POTENCY

Lotion

amcinonide Generic

Ointment

amcinonide Generic

Cream

augmented betamethasone dipropionate Generic

Ointment

betamethasone dipropionate Generic

Lotion

betamethasone dipropionate Generic

Ointment

betamethasone valerate Generic

Ointment

desoximetasone Generic

Cream


Gel


Cream

diflorasone diacetate Generic

Ointment

fluocinonide Generic

Cream


Cream


Cream

fluocinonide emulsified base Generic

Cream

triamcinolone acetonide Generic

CORTICOSTEROIDS VERY HIGH POTENCY

Shampoo

clobetasol propionate Generic

Solution


Ointment


Cream

clobetasol propionate emollient Generic

Ointment

halobetasol propionate Generic

MISCELLANEOUS

Cream

fluorouracil Generic

Cream

imiquimod Generic

Lotion

malathion Generic

Cream

permethrin Generic

Solution

podofilox Generic

Cream

silver sulfadiazine Generic

Cream

thermazene Generic

Cream

ELIDEL Preferred Brand

Ointment

EUCRISA Preferred Brand

Shampoo

LINDANE Preferred Brand

Gel

PICATO Preferred Brand

Gel

REGRANEX Preferred Brand

Ointment

SANTYL Preferred Brand

Cream

TOLAK Preferred Brand

ROSACEA

Lotion


Cream


Gel


Cream

rosadan Generic

Gel

rosadan Generic

Foam

FINACEA Preferred Brand

Cream

RHOFADE Preferred Brand

TOPICAL CORTICOSTEROIDS LOW POTENCY

Cream

alclometasone dipropionate Generic

Ointment

alclometasone dipropionate Generic

Ointment

desonide Generic

Lotion

desonide Generic

Solution

fluocinolone acetonide Generic

Cream

fluocinolone acetonide Generic

Cream

hydrocortisone Generic

TOPICAL CORTICOSTEROIDS MEDIUM POTENCY

Lotion


Cream


Lotion


Cream


Cream

hydrocortisone butyrate Generic

Solution

hydrocortisone butyrate Generic



TOPICAL CORTICOSTEROIDS MEDIUM POTENCY

Solution

mometasone furoate Generic

Ointment

mometasone furoate Generic

Ointment

prednicarbate Generic

Cream

triderm Generic

UROLOGICALANTISPASMODICS

Tablet

bethanechol chloride Generic

Tablet

flavoxate hcl Generic

Syrup

oxybutynin chloride Generic

Tablet

oxybutynin chloride Generic


oxybutynin chloride er Generic

Tablet

tolterodine tartrate Generic


tolterodine tartrate er Generic

Tablet

trospium chloride Generic


MYRBETRIQ Preferred Brand

Tablet

VESICARE Preferred Brand

BPH

Tablet

finasteride Generic

Capsule

RAPAFLO Preferred Brand

ERECTILE DYSFUNCTION

Tablet

sildenafil Generic

Tablet

sildenafil citrate Generic

Tablet

CIALIS Preferred Brand

VACCINES

Suspension

BOOSTRIX Preferred Brand

Suspension

CERVARIX Preferred Brand

Suspension

ENGERIX-B Preferred Brand

Suspension

GARDASIL Preferred Brand

Suspension

HAVRIX Preferred Brand

Suspension

INFANRIX Preferred Brand

Injectable

PNEUMOVAX 23/1 DOSE Preferred Brand

Suspension

PREVNAR 13 Preferred Brand

Suspension

RECOMBIVAX HB Preferred Brand

Solution

ROTATEQ Preferred Brand

Suspension

TWINRIX Preferred Brand


ZOSTAVAX Preferred Brand

VITAMINS/ELECTROLYTES

Capsule

calcium acetate Generic

Tablet

dialyvite Generic

Tablet Chewable

fluoride Generic

Tablet

folic acid Generic

Packet

klor-con Generic

Solution

potassium chloride Generic

Solution

potassium chloride Generic

Tablet

ELITE-OB Preferred Brand

Solution

NASCOBAL Preferred Brand



2018 Preferred Drug List -...

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