-infectives - healthscope benefits pdl january 2015.pdf · anti-infectives ... tier 01 mefenamic...
TRANSCRIPT
Table of Contents
ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
ANTIFUNGALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
CEPHALOSPORINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
PENICILLINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
QUINOLONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
TETRACYCLINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
ANTI-INFLAMMATORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
NSAIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
AUTO-IMMUNE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
CARDIOVASCULAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
ACE-INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
ANGIOTENSIN RCPTR BLOCKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
BETA BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
CALCIUM CHANNEL BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
NITRATES & NITRITES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
ANTI-HTN COMBINATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
ANTIHYPERLIPIDEMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
STATINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
FIBRATES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
BILE ACID SEQUESTRANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
CHOLEST ABS INHBTR/COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
NIACIN/COMBINATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
OMEGA-3 FATTY ACIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
DERMATOLOGICALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
ACNE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
TOPICAL ANTI-INFLAMMATORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
ENDOCRINE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
CONTRACEPTIVE AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
ESTROGENS/COMBINATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
TESTOSTERONE AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
INSULIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
NON-INSULIN HYPOGLYCEMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
BIGUANIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
BIGUAN/SULFONYLUREA COMB. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
BIGUAN/THIAZOLIDEINEDIONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
SULFONYLUREAS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
SULFONYLUREA/TZD COMB. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
INCRETINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
AMYLIN ANALOGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
ANTIHYPOGLYCEMIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
GASTROINTESTINAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
ULCER DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
GROWTH HORMONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
HEPATITIS C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
ANTIVIRALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
INTERFERONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
MULTIPLE SCLEROSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
NEUROLOGICALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
ALZHEIMER'S DISEASE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
ANTICONVULSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
MIGRAINE/HEADACHE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
OPHTHALMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
ANTI-ALLERGIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
ANTI-GLAUCOMA AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
ANTI-INFLAMMATORY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
CORTICOSTEROIDS/RELATED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
MIOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
MISCELLANEOUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
OSTEOPOROSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
BISPHOSPHONATES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
SERM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
PSYCHOTHERAPEUTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
ATYPICAL ANTIPSYCHOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
PSYCHOTHERAPEUTICS, MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
SNRI ANTIDEPRESSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
SSRI ANTIDEPRESSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
RESPIRATORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
ANAPHYLAXIS TX AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
ANTICHOLINERGICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
ANTICHLNRGC/BETA AGONIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
BETA AGONISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
LEUKOTRIENE RCPTR ANTGNST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
PULMONARY CORTICOSTEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
NASAL ANTIHISTAMINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
NASAL CORTICOSTEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
STEROID/BETA AGONIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
UROLOGICALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
BENIGN PRSTATC HYPRPLSIA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
ERECTILE DYSFUNCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
URINARY ANTISPASMODICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
BLOOD GLUCOSE TEST STRIPS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Ceftriaxone/Dextrose
flurbiprofen
Cefuroxime/Dextrose
ibuprofen
Cephalexin
indomethacin
TIER 02 PREFERRED
indomethacin sodium
January 2015
Ceftin
indomethacin ER
ketoprofen
NATIONAL FORMULARY PREFERRED DRUG LIST
PENICILLINS
ketorolac tromethamine
TIER 01 GENERIC
mefenamic acid
The Catamaran Preferred Drug List is a guide identifying preferred brand-name medicines within select therapeutic categories. The Preferred Drug 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.
amoxicillin
meloxicam
amoxicillin/clavulanate potassium
nabumetone
amoxicillin/clavulanate potassium ER
naproxen
ampicillin
naproxen sodium
ampicillin sodium
oxaprozin
ampicillin-sulbactam
piroxicam
dicloxacillin sodium
sulindac
nafcillin sodium
tolmetin sodium
oxacillin sodium
Fenoprofen Calcium
penicillin v potassium
Indomethacin
penicillin G potassium
Ketoprofen ER
piperacillin sodium/ tazobactam sodium
Ketorolac Tromethamine
Meclofenamate Sodium
piperacillin sodium/tazobactam sodium
Meloxicam
Tolmetin Sodium
piperacillin/tazobactam
TIER 02 PREFERRED
ANTI-INFECTIVES
Amoxicillin
celecoxib
ANTIFUNGALS
Ampicillin
TIER 01 GENERIC
Ampicillin Sodium
AUTO-IMMUNE
fluconazole
Penicillin G Potassium IN Iso-osmotic Dextrose
fluconazole IN dextrose
TIER 02 PREFERRED
Penicillin G Procaine
fluconazole IN NACL
CimziaPA
Penicillin G Sodium
griseofulvin microsize
Cimzia Starter KitPA
Pfizerpen-G
griseofulvin ultramicrosize
EnbrelPA
TIER 02 PREFERRED
itraconazole
Enbrel SureclickPA
Augmentin
ketoconazole
HumiraPA
nystatin
Humira Pediatric Crohns Disease Starter PackPA
QUINOLONES
terbinafine HCL
TIER 01 GENERIC
voriconazole
Humira PenPA
ciprofloxacin
Amphotericin B
Humira Pen-crohns DiseasestarterPA
ciprofloxacin ER
Fluconazole IN NACL
Humira Pen-psoriasis StarterPA
ciprofloxacin HCL
TIER 02 PREFERRED
OrenciaPA
ciprofloxacin I.V.-IN D5W
flucytosine
RemicadePA
levofloxacin
Lamisil
levofloxacin IN D5W
Noxafil
CARDIOVASCULAR
moxifloxacin HCL
Sporanox
ACE-INHIBITORS
ofloxacin
TIER 00 VALUE BASED BENEFIT
TIER 02 PREFERRED
CEPHALOSPORINS
benazepril HCL
Noroxin
TIER 01 GENERIC
captopril
cefaclor
enalapril maleate
TETRACYCLINES
cefadroxil
fosinopril sodium
TIER 01 GENERIC
cefazolin sodium
lisinopril
demeclocycline HCL
cefdinir
moexipril HCL
doxycycline
cefepime
perindopril erbumine
doxycycline hyclate
cefotaxime sodium
quinapril HCL
doxycycline monohydrate
cefoxitin sodium
ramipril
minocycline HCL
cefpodoxime proxetil
trandolapril
minocycline HCL ER
cefprozil
TIER 01 GENERIC
Morgidox 1X100MG
ceftazidime
enalaprilat
Morgidox 2X100MG
ceftriaxone sodium
Ocudox
cefuroxime axetil
ANGIOTENSIN RCPTR BLOCKER
Tetracycline HCL
cefuroxime sodium
TIER 00 VALUE BASED BENEFIT
cephalexin
losartan potassium
ANTI-INFLAMMATORY
Cefaclor
TIER 01 GENERIC
NSAIDS
Cefaclor ER
candesartan cilexetil
TIER 01 GENERIC
Cefazolin Sodium
eprosartan mesylate
diclofenac potassium
Cefazolin Sodium/Dextrose
irbesartan
diclofenac sodium DR
Cefditoren Pivoxil
telmisartan
diclofenac sodium ER
Cefotetan
valsartan
diclofenac sodium/misoprostol
Cefotetan/Dextrose
etodolac
Ceftazidime/Dextrose
BETA BLOCKERS
etodolac ER
Ceftriaxone IN Iso-osmotic Dextrose
TIER 01
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 1
GENERIC
GENERIC
sodium sulfacetamide/sulfur cleanser
acebutolol HCL
amlodipine besylate/benazepril hydrochloride
sodium sulfacetamide/sulfur cleansing cloths
atenolol
amlodipine besylate/benazepril HCL
sodium sulfacetamide/sulfur green
betaxolol HCL
amlodipine besylate/valsartan
sodium sulfacetamide/sulfur wash
bisoprolol fumarate
amlodipine/valsartan/hctz
sulfacetamide sodium
esmolol HCL
atenolol/chlorthalidone
sulfacetamide sodium/sulfur cleanser
metoprolol succinate ER
bisoprolol fumarate/hydrochlorothiazide
tretinoinPA
metoprolol tartrate
tretinoin microspherePA
nadolol
candesartan cilexetil/hydrochlorothiazide
tretinoin microsphere P.M.PA
pindolol
Claravis
propranolol HCL
fosinopril sodium/hydrochlorothiazide
Clindacin PAC
propranolol HCL ER
irbesartan/hydrochlorothiazide
Sodium Sulfacetamide/Sulfur
sotalol HCL
metoprolol/hydrochlorothiazide
Sodium Sulfacetamide/Sulfur Cleanser IN Urea
sotalol HCL (AF)
moexipril/hydrochlorothiazide
Propranolol HCL
nadolol/bendroflumethiazide
Sodium Sulfacetamide/Sulfur IN Urea
Timolol Maleate
quinapril/hydrochlorothiazide
TIER 02 PREFERRED
telmisartan/amlodipine
Finacea
CALCIUM CHANNEL BLOCKERS
telmisartan/hydrochloroth
TIER 00 VALUE BASED BENEFIT
telmisartan/hydrochlorothiazide
TOPICAL ANTI-INFLAMMATORY
amlodipine besylate
valsartan/hydrochlorothiazide
TIER 01 GENERIC
diltiazem HCL
Clorpres
alclometasone dipropionate
verapamil HCL
Methyldopa/Hydrochlorothiazide
augmented betamethasone dipropionate
TIER 01 GENERIC
Propranolol/Hydrochlorothiazide
diltiazem CD
betamethasone dipropionate
diltiazem HCL ER
ANTIHYPERLIPIDEMICS
betamethasone valerate
felodipine ER
STATINS
clobetasol propionate
nicardipine HCL
TIER 00 VALUE BASED BENEFIT
clobetasol propionate emollient
nifedipine
atorvastatin calcium
desonide
nifedipine ER
lovastatin
desoximetasone
nimodipine
pravastatin sodium
diflorasone diacetate
nisoldipine
simvastatin
fluocinolone acetonide
verapamil HCL ER
TIER 01 GENERIC
fluocinonide
verapamil HCL SR
fluvastatin
fluocinonide emollient base
Diltiazem HCL
FIBRATES
fluocinonide-e
Isradipine
TIER 01 GENERIC
fluticasone propionate
Nisoldipine
fenofibrate
halobetasol propionate
Nisoldipine ER
fenofibrate micronized
hydrocortisone
Verapamil HCL
gemfibrozil
hydrocortisone acetate/aloe
TIER 02 PREFERRED
Fenofibric AcidST
hydrocortisone butyrate
Cardizem LA
BILE ACID SEQUESTRANTS
hydrocortisone valerate
TIER 01 GENERIC
hydrocortisone IN absorbase
NITRATES & NITRITES
cholestyramine
mometasone furoate
TIER 00 VALUE BASED BENEFIT
cholestyramine light
prednicarbate
Nitrostat
colestipol HCL
triamcinolone acetonide
TIER 01 GENERIC
colestipol HCL for oral suspension
Amcinonide
isosorbide dinitrate
TIER 02 PREFERRED
Apexicon E
isosorbide dinitrate ER
Welchol
Desowen
isosorbide mononitrate
CHOLEST ABS INHBTR/COMBO
Desoximetasone
isosorbide mononitrate ER
TIER 02 PREFERRED
Diflorasone Diacetate
nitroglycerin
Zetia
Triamcinolone Acetonide
nitroglycerin lingual
NIACIN/COMBINATIONS
Trianex
nitroglycerin transdermal
TIER 01 GENERIC
U-cort
nitroglycerin IN dextrose 5%
niacin ER
TIER 02 PREFERRED
nitroglycerin IN 5% dextrose
OMEGA-3 FATTY ACIDS
hydrocortisone butyrate (lipid)
Isosorbide Dinitrate
TIER 02 PREFERRED
hydrocortisone butyrate (lipophilic)
Nitroglycerin
omega-3-acid ethyl esters
Capex
Nitroglycerin IN Dextrose 5%
KynamroPA
Clobex
Nitroglycerin Lingual
Cordran Tape
TIER 02 PREFERRED
DERMATOLOGICALS
Locoid
Dilatrate SR
ACNE
Pramosone
TIER 01 GENERIC
ANTI-HTN COMBINATIONS
adapalenePA
ENDOCRINE
TIER 00 VALUE BASED BENEFIT
clindamycin phosphate
CONTRACEPTIVE AGENTS
benazepril HCL/hydrochlorothiazide
clindamycin/benzoyl peroxide
TIER 00 GENERIC
enalapril maleate/hydrochlorothiazide
erythromycin
drospirenone/ethinyl estradiol
lisinopril/hydrochlorothiazide
erythromycin/benzoyl peroxide
levonorgestrel and ethinyl estradiol
losartan potassium/hydrochlorothiazide
metronidazole
levonorgestrel/ethinyl estradiol
sodium sulfacetamide
norethindrone
Captopril/Hydrochlorothiazide
sodium sulfacetamide/sulfur
norgestimate/ethinyl estradiol
TIER 01
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 2
Amethyst
TIER 02 PREFERRED
PREFERRED
Beyaz
Apidra
GenotropinPA
Generess FE
Apidra Solostar
Genotropin MiniquickPA
Loseasonique
Humalog Kwikpen
HumatropePA
Natazia
Humalog Mix 50/50 Kwikpen
Humatrope Combo PackPA
Necon 1/50-28
Humalog Mix 75/25 Kwikpen
OmnitropePA
Necon 10/11-28
Lantus Solostar
Norinyl 1+35
Levemir Flexpen
HEPATITIS C
Ogestrel
Novolog Flexpen
ANTIVIRALS
Ortho Tri-cyclen LO
Novolog Mix 70/30 Prefilled Flexpen
TIER 01 GENERIC
Ortho-novum 7/7/7
Novolog Penfill
ribavirin
Safyral
Ribasphere
Zovia 1/50e
NON-INSULIN HYPOGLYCEMICS
Ribasphere Ribapak
TIER 01 GENERIC
BIGUANIDES
desogestrel/ethinyl estradiol
TIER 00 VALUE BASED BENEFIT
INTERFERONS
levonorgestrel
metformin HCL
TIER 02 PREFERRED
norethindrone acetate/ethinyl estradiol
metformin HCL ER
Peg-intronPA
BIGUAN/SULFONYLUREA COMB.
Peg-intron RedipenPA
norethindrone acetate/ethinyl estradiol/ferrous fumarate
TIER 00 VALUE BASED BENEFIT
Peg-intron Redipen PAK 4PA
glyburide/metformin HCL
PegasysPA
Brevicon-28
TIER 01 GENERIC
Pegasys ProclickPA
TIER 02 PREFERRED
glipizide/metformin HCL
PegintronPA
Depo-provera
BIGUAN/THIAZOLIDEINEDIONE
Desogen
TIER 01 GENERIC
MULTIPLE SCLEROSIS
pioglitazone HCL
ESTROGENS/COMBINATIONS
pioglitazone HCL/metformin HCL
TIER 02 PREFERRED
TIER 01 GENERIC
SULFONYLUREAS
AvonexPA
estradiol
TIER 00 VALUE BASED BENEFIT
Avonex PenPA
estradiol valerate
glimepiride
BetaseronPA
estradiol/norethindrone acetate
glipizide
CopaxonePA
estropipate
glipizide ER
ExtaviaPA
Estropipate
glyburide
RebifPA
Jinteli
glyburide micronized
Rebif Titration PackPA
TIER 02 PREFERRED
Glyburide
Cenestin
TIER 01 GENERIC
NEUROLOGICALS
Climara
tolazamide
ALZHEIMER'S DISEASE
Combipatch
Chlorpropamide
TIER 01 GENERIC
Divigel
Tolazamide
donepezil HCL
Enjuvia
Tolbutamide
galantamine
Estring
SULFONYLUREA/TZD COMB.
galantamine hydrobromide
Evamist
TIER 02 PREFERRED
rivastigmine tartrate
Premarin
pioglitazone HCL-glimepiride
Galantamine Hydrobromide
Premphase
Duetact
TIER 02 PREFERRED
Prempro
INCRETINS
Exelon
Vagifem
TIER 02 PREFERRED
Vivelle-dot
ByettaPA
ANTICONVULSANTS
AMYLIN ANALOGS
TIER 01 GENERIC
TESTOSTERONE AGENTS
TIER 02 PREFERRED
carbamazepine
TIER 01 GENERIC
Symlinpen 120PA
carbamazepine ER
danazol
Symlinpen 60PA
clonazepam
testosterone cypionate
ANTIHYPOGLYCEMIC AGENTS
clonazepam odt
testosterone enanthate
TIER 02 PREFERRED
divalproex sodium
AndroxyPA
Glucagon Emergency Kit
divalproex sodium DR
TestosteronePA
divalproex sodium ER
Testosterone P.M.PA
GASTROINTESTINAL
ethosuximide
TIER 02 PREFERRED
ULCER DRUGS
felbamate
AndrodermPA
TIER 01 GENERIC
fosphenytoin sodium
AndrogelPA
cimetidine
gabapentin
Androgel P.M.PA
cimetidine HCL
lamotrigine
famotidine
lamotrigine ER
INSULIN
misoprostol
levetiracetam
TIER 00 VALUE BASED BENEFIT
nizatidine
levetiracetam ER
Humalog
ranitidine HCL
oxcarbazepine
Humalog Mix 50/50
sucralfate
phenytoin sodium
Humalog Mix 75/25
Famotidine Premixed
phenytoin sodium extended
Humulin R U-500 (concentrated)
primidone
Lantus
GROWTH HORMONE
topiramate
Levemir
valproate sodium
Novolog
TIER 02
valproic acid
Novolog Mix 70/30
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 3
zonisamide
Travoprost
PREFERRED
Diazepam
ibandronate sodium
Levetiracetam
ANTI-INFECTIVES
ActonelQL,ST
Topiramate ER
TIER 01 GENERIC
Zoledronic AcidPA
TIER 02 PREFERRED
ciprofloxacin HCL
ZometaPA
phenytoin
erythromycin
tiagabine hydrochloride
gatifloxacin
SERM
Banzel
gentamicin sulfate
TIER 02 PREFERRED
Celontin
levofloxacin
raloxifene hydrochloride
Dilantin
ofloxacin
Dilantin Infatabs
tobramycin sulfate
PSYCHOTHERAPEUTICS
Fycompa
Bacitracin
ATYPICAL ANTIPSYCHOTICS
Gabitril
TIER 02 PREFERRED
TIER 01 GENERIC
Lamictal Starter/Not Taking Carbamazepine
Ciloxan
chlorpromazine HCL
Tobrex
clozapine
Lamictal Starter/Taking Carbamazepine/Not Taking Valproate
Vigamox
fluphenazine decanoate
fluphenazine HCL
Lyrica
ANTI-INFLAMMATORY AGENTS
haloperidol
Onfi
TIER 01 GENERIC
haloperidol decanoate
Peganone
bromfenac
haloperidol lactate
Potiga
cromolyn sodium
lithium carbonate
Tegretol-XR
diclofenac sodium
lithium carbonate ER
Vimpat
flurbiprofen sodium
loxapine
ketorolac tromethamine
loxapine succinate
MIGRAINE/HEADACHE
olanzapine
TIER 01 GENERIC
CORTICOSTEROIDS/RELATED
olanzapine odt
dihydroergotamine mesylatePA
TIER 01 GENERIC
perphenazine
naratriptan HCLQL
dexamethasone sodium phosphate
prochlorperazine
rizatriptan benzoatePA
fluorometholone
prochlorperazine edisylate
rizatriptan benzoate odtPA
neomycin/polymyxin/bacitracin/hydrocortisone
prochlorperazine maleate
sumatriptan succinateQL
quetiapine fumarate
sumatriptan succinate refill
neomycin/polymyxin/dexamethasone
risperidone
zolmitriptanPA
prednisolone acetate
risperidone odt
zolmitriptan odtPA
sulfacetamide sodium/prednisolone sodium phosphate
thioridazine HCL
Migergot
thiothixene
SumatriptanPA
tobramycin/dexamethasone
trifluoperazine HCL
TIER 02 PREFERRED
Neomycin/Polymyxin/Hydrocortisone
ziprasidone HCL
Ergomar
Prednisolone Sodium Phosphate
Chlorpromazine HCL
RelpaxQL
TIER 02 PREFERRED
Clozapine Odt
Alrex
Fluphenazine HCL
OPHTHALMICS
Blephamide S.o.p.
Lithium
ANTI-ALLERGIC AGENTS
Lotemax
Lithium Carbonate
TIER 01 GENERIC
Pred Mild
TIER 02 PREFERRED
azelastine HCL
Tobradex
Seroquel XR
cromolyn sodium
Zylet
epinastine HCL
PSYCHOTHERAPEUTICS, MISC.
TIER 02 PREFERRED
MIOTICS
TIER 01 GENERIC
Pataday
TIER 01 GENERIC
amphetamine/dextroamphetamineQL
Patanol
pilocarpine HCL
clonidine HCL ER
Isopto Carpine
dexmethylphenidate HCLQL
ANTI-GLAUCOMA AGENTS
TIER 02 PREFERRED
dexmethylphenidate HCL ERQL
TIER 01 GENERIC
Isopto Carbachol
dextroamphetamine sulfateQL
apraclonidine
Phospholine Iodide
dextroamphetamine sulfate ERQL
betaxolol HCL
Pilopine HS
guanfacine ER
brimonidine tartrate
methamphetamine HCLQL
carteolol HCL
MISCELLANEOUS
methylphenidate hydrochloride
dorzolamide HCL
TIER 02 PREFERRED
methylphenidate HCLQL
dorzolamide HCL/timolol maleate
Lacrisert
methylphenidate HCL CDQL
latanoprost
RestasisPA
methylphenidate HCL ERQL
levobunolol HCL
methylphenidate HCL SRQL
timolol maleate
OSTEOPOROSIS
modafinilPA
timolol maleate ophthalmic gel forming
BISPHOSPHONATES
Methylphenidate HCL ERQL
TIER 01 GENERIC
TIER 02 PREFERRED
Levobunolol HCL
alendronate sodiumQL
DaytranaQL
TIER 02 PREFERRED
pamidronate disodium
StratteraQL,ST
Alphagan P
risedronate sodiumQL
VyvanseQL
Azopt
zoledronic acidPA
Betimol
Alendronate SodiumQL
SNRI ANTIDEPRESSANTS
Betoptic-s
Etidronate Disodium
TIER 01
Travatan Z
TIER 02
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 4
GENERIC
Asmanex Twisthaler 120 Metered Doses
TIER 02 PREFERRED
venlafaxine HCLQL
Accu-chek Active Strips
Asmanex Twisthaler 14 Metered Doses
venlafaxine HCL ERQL
Accu-chek Comfort Curve Test Strips
Venlafaxine HCL ERQL
Fasttake Compact Monitoring System
Asmanex Twisthaler 30 Me Tered Doses
TIER 02 PREFERRED
Fasttake Test Strips
duloxetine HCLQL
Onetouch Basic System
Asmanex Twisthaler 30 Metered Doses
PristiqQL
Onetouch Basic/Profile Test Strips
Onetouch Profile System
Asmanex Twisthaler 60 Metered Doses
SSRI ANTIDEPRESSANTS
Onetouch Ultralink System (hex)
TIER 01 GENERIC
Asmanex Twisthaler 7 Metered Doses
Onetouch Ultralink System (DEC)
citalopram hydrobromideQL
Flovent Diskus
Onetouch Ultrasmart
escitalopram oxalateQL
Flovent HFA
Surestep Pro Test Strips
fluoxetine DRQL
Pulmicort Flexhaler
Surestep Test Strips
fluoxetine HCLQL
Qvar
fluvoxamine maleateQL
TIER 02 PREFERRED
fluvoxamine maleate ERQL
Pulmicort
Formulary Disclaimer: Coverage for some drugs may be limited to specific dosage forms and/or strengths. The benefit design determines what is covered and the applicable co-payment. The medications listed on this formulary are subject to change pursuant to the formulary management activities of Catamaran. The presence of a medication on this formulary list does not guarantee coverage. To determine the most up-to-date formulary status of your medication, please visit your member website or call member services at the number listed on your ID card.
paroxetine HCLQL
paroxetine HCL ERQL
NASAL ANTIHISTAMINES
sertraline HCLQL
TIER 01 GENERIC
azelastine HCL
RESPIRATORY
olopatadine HCL
ANAPHYLAXIS TX AGENTS
TIER 01 GENERIC
NASAL CORTICOSTEROIDS
Adrenaclick
TIER 01 GENERIC
Auvi-q
budesonide
Epinephrine
flunisolide
Epipen 2-PAK
fluticasone propionate
Epipen-JR 2-PAK
Flunisolide
ANTICHOLINERGICS
STEROID/BETA AGONIST
TIER 01 GENERIC
TIER 00 VALUE BASED BENEFIT
ipratropium bromide
Advair Diskus
TIER 02 PREFERRED
Advair HFA
Atrovent HFA
Dulera
Spiriva Handihaler
Symbicort
ANTICHLNRGC/BETA AGONIST
UROLOGICALS
TIER 01 GENERIC
BENIGN PRSTATC HYPRPLSIA
ipratropium bromide/albuterol sulfate
TIER 01 GENERIC
TIER 02 PREFERRED
alfuzosin HCL ER
Combivent
finasteride
tamsulosin HCL
BETA AGONISTS
TIER 00 VALUE BASED BENEFIT
ERECTILE DYSFUNCTION
Proair HFA
TIER 02 PREFERRED
TIER 01 GENERIC
Cialis
albuterol sulfate
Viagra
albuterol sulfate ER
albuterol TAB 4MG
URINARY ANTISPASMODICS
terbutaline sulfate
TIER 01 GENERIC
Metaproterenol Sulfate
bethanechol chloride
TIER 02 PREFERRED
flavoxate HCL
levalbuterol
oxybutynin chloride
levalbuterol HCL
oxybutynin chloride ER
Foradil Aerolizer
tolterodine tartrate
Maxair Autohaler
tolterodine tartrate ER
Perforomist
trospium chloride
Serevent Diskus
trospium chloride ER
Xopenex HFA
BLOOD GLUCOSE TEST STRIPS
LEUKOTRIENE RCPTR ANTGNST
TIER 01 GENERIC
TIER 00 VALUE BASED BENEFIT
montelukast sodium
Accu-chek Aviva
zafirlukast
Accu-chek Aviva Plus
Accu-chek Compact Plus Care Kit
PULMONARY CORTICOSTEROIDS
Accu-chek Compact Test Drum
TIER 00 VALUE BASED BENEFIT
Onetouch Ultra Blue
budesonide
Onetouch Ultra Mini
Onetouch Ultra 2
Effective January 1, 2015
PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits (higher quantity may require a PA) 5
Index
A
2
Cefuroxime/Dextrose, 1
Augmentin, 1
celecoxib, 1
Accu-chek Active Strips, 5
Auvi-q, 5
Celontin, 4
Accu-chek Aviva, 5
Avonex, 3
Cenestin, 3
Accu-chek Aviva Plus, 5
Avonex Pen, 3
cephalexin, 1
Accu-chek Comfort Curve Test Strips, 5
azelastine HCL, 4, 5
Cephalexin, 1
Accu-chek Compact Plus Care Kit, 5
Azopt, 4
chlorpromazine HCL, 4
Accu-chek Compact Test Drum, 5
B
Chlorpromazine HCL, 4
acebutolol HCL, 2
Chlorpropamide, 3
Actonel, 4
Bacitracin, 4
cholestyramine, 2
adapalene, 2
Banzel, 4
cholestyramine light, 2
Adrenaclick, 5
benazepril HCL, 1
Cialis, 5
Advair Diskus, 5
benazepril HCL/hydrochlorothiazide, 2
Ciloxan, 4
Advair HFA, 5
betamethasone dipropionate, 2
cimetidine, 3
albuterol sulfate, 5
betamethasone valerate, 2
cimetidine HCL, 3
albuterol sulfate ER, 5
Betaseron, 3
Cimzia, 1
albuterol TAB 4MG, 5
betaxolol HCL, 2, 4
Cimzia Starter Kit, 1
alclometasone dipropionate, 2
bethanechol chloride, 5
ciprofloxacin, 1
alendronate sodium, 4
Betimol, 4
ciprofloxacin ER, 1
Alendronate Sodium, 4
Betoptic-s, 4
ciprofloxacin HCL, 1, 4
alfuzosin HCL ER, 5
Beyaz, 3
ciprofloxacin I.V.-IN D5W, 1
Alphagan P, 4
bisoprolol fumarate, 2
citalopram hydrobromide, 5
Alrex, 4
bisoprolol fumarate/hydrochlorothiazide, 2
Claravis, 2
Amcinonide, 2
Climara, 3
Amethyst, 3
Blephamide S.o.p., 4
Clindacin PAC, 2
amlodipine besylate, 2
Brevicon-28, 3
clindamycin phosphate, 2
amlodipine besylate/benazepril HCL, 2
brimonidine tartrate, 4
clindamycin/benzoyl peroxide, 2
amlodipine besylate/benazepril hydrochloride, 2
bromfenac, 4
clobetasol propionate, 2
budesonide, 5(2)
clobetasol propionate emollient, 2
amlodipine besylate/valsartan, 2
Byetta, 3
Clobex, 2
amlodipine/valsartan/hctz, 2
C
clonazepam, 3
amoxicillin, 1
clonazepam odt, 3
candesartan cilexetil, 1
Amoxicillin, 1
clonidine HCL ER, 4
candesartan cilexetil/hydrochlorothiazide, 2
amoxicillin/clavulanate potassium, 1
Clorpres, 2
amoxicillin/clavulanate potassium ER, 1
clozapine, 4
Capex, 2
amphetamine/dextroamphetamine, 4
Clozapine Odt, 4
captopril, 1
Amphotericin B, 1
colestipol HCL, 2
Captopril/Hydrochlorothiazide, 2
ampicillin, 1
colestipol HCL for oral suspension, 2
carbamazepine, 3
Ampicillin, 1
Combipatch, 3
carbamazepine ER, 3
ampicillin sodium, 1
Combivent, 5
Cardizem LA, 2
Ampicillin Sodium, 1
Copaxone, 3
carteolol HCL, 4
ampicillin-sulbactam, 1
Cordran Tape, 2
cefaclor, 1
Androderm, 3
cromolyn sodium, 4(2)
Cefaclor, 1
Androgel, 3
D
Cefaclor ER, 1
Androgel P.M., 3
cefadroxil, 1
Androxy, 3
danazol, 3
cefazolin sodium, 1
Apexicon E, 2
Daytrana, 4
Cefazolin Sodium, 1
Apidra, 3
demeclocycline HCL, 1
Cefazolin Sodium/Dextrose, 1
Apidra Solostar, 3
Depo-provera, 3
cefdinir, 1
apraclonidine, 4
Desogen, 3
Cefditoren Pivoxil, 1
Asmanex Twisthaler 120 Metered Doses, 5
desogestrel/ethinyl estradiol, 3
cefepime, 1
desonide, 2
cefotaxime sodium, 1
Asmanex Twisthaler 14 Metered Doses, 5
Desowen, 2
Cefotetan, 1
desoximetasone, 2
Cefotetan/Dextrose, 1
Asmanex Twisthaler 30 Me Tered Doses, 5
Desoximetasone, 2
cefoxitin sodium, 1
dexamethasone sodium phosphate, 4
cefpodoxime proxetil, 1
Asmanex Twisthaler 30 Metered Doses, 5
dexmethylphenidate HCL, 4
cefprozil, 1
dexmethylphenidate HCL ER, 4
ceftazidime, 1
Asmanex Twisthaler 60 Metered Doses, 5
dextroamphetamine sulfate, 4
Ceftazidime/Dextrose, 1
dextroamphetamine sulfate ER, 4
Ceftin, 1
Asmanex Twisthaler 7 Metered Doses, 5
Diazepam, 4
Ceftriaxone IN Iso-osmotic Dextrose, 1
atenolol, 2
diclofenac potassium, 1
ceftriaxone sodium, 1
atenolol/chlorthalidone, 2
diclofenac sodium, 4
Ceftriaxone/Dextrose, 1
atorvastatin calcium, 2
diclofenac sodium DR, 1
cefuroxime axetil, 1
Atrovent HFA, 5
diclofenac sodium ER, 1
cefuroxime sodium, 1
augmented betamethasone dipropionate,
diclofenac sodium/misoprostol, 1
dicloxacillin sodium, 1
finasteride, 5
Humatrope, 3
diflorasone diacetate, 2
flavoxate HCL, 5
Humatrope Combo Pack, 3
Diflorasone Diacetate, 2
Flovent Diskus, 5
Humira, 1
dihydroergotamine mesylate, 4
Flovent HFA, 5
Humira Pediatric Crohns Disease Starter Pack, 1
Dilantin, 4
fluconazole, 1
Dilantin Infatabs, 4
fluconazole IN dextrose, 1
Humira Pen, 1
Dilatrate SR, 2
fluconazole IN NACL, 1
Humira Pen-crohns Diseasestarter, 1
diltiazem CD, 2
Fluconazole IN NACL, 1
Humira Pen-psoriasis Starter, 1
diltiazem HCL, 2
flucytosine, 1
Humulin R U-500 (concentrated), 3
Diltiazem HCL, 2
flunisolide, 5
hydrocortisone, 2
diltiazem HCL ER, 2
Flunisolide, 5
hydrocortisone acetate/aloe, 2
divalproex sodium, 3
fluocinolone acetonide, 2
hydrocortisone butyrate, 2
divalproex sodium DR, 3
fluocinonide, 2
hydrocortisone butyrate (lipid), 2
divalproex sodium ER, 3
fluocinonide emollient base, 2
hydrocortisone butyrate (lipophilic), 2
Divigel, 3
fluocinonide-e, 2
hydrocortisone IN absorbase, 2
donepezil HCL, 3
fluorometholone, 4
hydrocortisone valerate, 2
dorzolamide HCL, 4
fluoxetine DR, 5
I
dorzolamide HCL/timolol maleate, 4
fluoxetine HCL, 5
ibandronate sodium, 4
doxycycline, 1
fluphenazine decanoate, 4
ibuprofen, 1
doxycycline hyclate, 1
fluphenazine HCL, 4
indomethacin, 1
doxycycline monohydrate, 1
Fluphenazine HCL, 4
Indomethacin, 1
drospirenone/ethinyl estradiol, 2
flurbiprofen, 1
indomethacin ER, 1
Duetact, 3
flurbiprofen sodium, 4
indomethacin sodium, 1
Dulera, 5
fluticasone propionate, 2, 5
ipratropium bromide, 5
duloxetine HCL, 5
fluvastatin, 2
ipratropium bromide/albuterol sulfate, 5
E
fluvoxamine maleate, 5
irbesartan, 1
fluvoxamine maleate ER, 5
enalapril maleate, 1
irbesartan/hydrochlorothiazide, 2
Foradil Aerolizer, 5
enalapril maleate/hydrochlorothiazide, 2
Isopto Carbachol, 4
fosinopril sodium, 1
enalaprilat, 1
Isopto Carpine, 4
fosinopril sodium/hydrochlorothiazide, 2
Enbrel, 1
isosorbide dinitrate, 2
fosphenytoin sodium, 3
Enbrel Sureclick, 1
Isosorbide Dinitrate, 2
Fycompa, 4
Enjuvia, 3
isosorbide dinitrate ER, 2
G
epinastine HCL, 4
isosorbide mononitrate, 2
Epinephrine, 5
gabapentin, 3
isosorbide mononitrate ER, 2
Epipen 2-PAK, 5
Gabitril, 4
Isradipine, 2
Epipen-JR 2-PAK, 5
galantamine, 3
itraconazole, 1
eprosartan mesylate, 1
galantamine hydrobromide, 3
J
Ergomar, 4
Galantamine Hydrobromide, 3
Jinteli, 3
erythromycin, 2, 4
gatifloxacin, 4
K
erythromycin/benzoyl peroxide, 2
gemfibrozil, 2
escitalopram oxalate, 5
Generess FE, 3
ketoconazole, 1
esmolol HCL, 2
Genotropin, 3
ketoprofen, 1
estradiol, 3
Genotropin Miniquick, 3
Ketoprofen ER, 1
estradiol valerate, 3
gentamicin sulfate, 4
ketorolac tromethamine, 1, 4
estradiol/norethindrone acetate, 3
glimepiride, 3
Ketorolac Tromethamine, 1
Estring, 3
glipizide, 3
Kynamro, 2
estropipate, 3
glipizide ER, 3
L
Estropipate, 3
glipizide/metformin HCL, 3
ethosuximide, 3
Glucagon Emergency Kit, 3
Lacrisert, 4
Etidronate Disodium, 4
glyburide, 3
Lamictal Starter/Not Taking Carbamazepine, 4
etodolac, 1
Glyburide, 3
etodolac ER, 1
glyburide micronized, 3
Lamictal Starter/Taking Carbamazepine/Not Taking Valproate, 4
Evamist, 3
glyburide/metformin HCL, 3
Exelon, 3
griseofulvin microsize, 1
Lamisil, 1
Extavia, 3
griseofulvin ultramicrosize, 1
lamotrigine, 3
F
guanfacine ER, 4
lamotrigine ER, 3
H
Lantus, 3
famotidine, 3
Lantus Solostar, 3
Famotidine Premixed, 3
halobetasol propionate, 2
latanoprost, 4
Fasttake Compact Monitoring System, 5
haloperidol, 4
levalbuterol, 5
Fasttake Test Strips, 5
haloperidol decanoate, 4
levalbuterol HCL, 5
felbamate, 3
haloperidol lactate, 4
Levemir, 3
felodipine ER, 2
Humalog, 3
Levemir Flexpen, 3
fenofibrate, 2
Humalog Kwikpen, 3
levetiracetam, 3
fenofibrate micronized, 2
Humalog Mix 50/50, 3
Levetiracetam, 4
Fenofibric Acid, 2
Humalog Mix 50/50 Kwikpen, 3
levetiracetam ER, 3
Fenoprofen Calcium, 1
Humalog Mix 75/25, 3
levobunolol HCL, 4
Finacea, 2
Humalog Mix 75/25 Kwikpen, 3
Levobunolol HCL, 4
levofloxacin, 1, 4
neomycin/polymyxin/dexamethasone, 4
Peg-intron, 3
levofloxacin IN D5W, 1
Neomycin/Polymyxin/Hydrocortisone, 4
Peg-intron Redipen, 3
levonorgestrel, 3
niacin ER, 2
Peg-intron Redipen PAK 4, 3
levonorgestrel and ethinyl estradiol, 2
nicardipine HCL, 2
Peganone, 4
levonorgestrel/ethinyl estradiol, 2
nifedipine, 2
Pegasys, 3
lisinopril, 1
nifedipine ER, 2
Pegasys Proclick, 3
lisinopril/hydrochlorothiazide, 2
nimodipine, 2
Pegintron, 3
Lithium, 4
nisoldipine, 2
penicillin G potassium, 1
lithium carbonate, 4
Nisoldipine, 2
Penicillin G Potassium IN Iso-osmotic Dextrose, 1
Lithium Carbonate, 4
Nisoldipine ER, 2
lithium carbonate ER, 4
nitroglycerin, 2
Penicillin G Procaine, 1
Locoid, 2
Nitroglycerin, 2
Penicillin G Sodium, 1
losartan potassium, 1
nitroglycerin IN 5% dextrose, 2
penicillin v potassium, 1
losartan potassium/hydrochlorothiazide, 2
nitroglycerin IN dextrose 5%, 2
Perforomist, 5
Nitroglycerin IN Dextrose 5%, 2
perindopril erbumine, 1
Loseasonique, 3
nitroglycerin lingual, 2
perphenazine, 4
Lotemax, 4
Nitroglycerin Lingual, 2
Pfizerpen-G, 1
lovastatin, 2
nitroglycerin transdermal, 2
phenytoin, 4
loxapine, 4
Nitrostat, 2
phenytoin sodium, 3
loxapine succinate, 4
nizatidine, 3
phenytoin sodium extended, 3
Lyrica, 4
norethindrone, 2
Phospholine Iodide, 4
M
norethindrone acetate/ethinyl estradiol, 3
pilocarpine HCL, 4
norethindrone acetate/ethinyl estradiol/ferrous fumarate, 3
Pilopine HS, 4
Maxair Autohaler, 5
pindolol, 2
Meclofenamate Sodium, 1
norgestimate/ethinyl estradiol, 2
pioglitazone HCL, 3
mefenamic acid, 1
Norinyl 1+35, 3
pioglitazone HCL-glimepiride, 3
meloxicam, 1
Noroxin, 1
pioglitazone HCL/metformin HCL, 3
Meloxicam, 1
Novolog, 3
piperacillin sodium/ tazobactam sodium, 1
Metaproterenol Sulfate, 5
Novolog Flexpen, 3
metformin HCL, 3
Novolog Mix 70/30, 3
piperacillin sodium/tazobactam sodium, 1
metformin HCL ER, 3
Novolog Mix 70/30 Prefilled Flexpen, 3
piperacillin/tazobactam, 1
methamphetamine HCL, 4
Novolog Penfill, 3
piroxicam, 1
Methyldopa/Hydrochlorothiazide, 2
Noxafil, 1
Potiga, 4
methylphenidate HCL, 4
nystatin, 1
Pramosone, 2
methylphenidate HCL CD, 4
O
pravastatin sodium, 2
methylphenidate HCL ER, 4
Pred Mild, 4
Methylphenidate HCL ER, 4
Ocudox, 1
prednicarbate, 2
methylphenidate HCL SR, 4
ofloxacin, 1, 4
prednisolone acetate, 4
methylphenidate hydrochloride, 4
Ogestrel, 3
Prednisolone Sodium Phosphate, 4
metoprolol succinate ER, 2
olanzapine, 4
Premarin, 3
metoprolol tartrate, 2
olanzapine odt, 4
Premphase, 3
metoprolol/hydrochlorothiazide, 2
olopatadine HCL, 5
Prempro, 3
metronidazole, 2
omega-3-acid ethyl esters, 2
primidone, 3
Migergot, 4
Omnitrope, 3
Pristiq, 5
minocycline HCL, 1
Onetouch Basic System, 5
Proair HFA, 5
minocycline HCL ER, 1
Onetouch Basic/Profile Test Strips, 5
prochlorperazine, 4
misoprostol, 3
Onetouch Profile System, 5
prochlorperazine edisylate, 4
modafinil, 4
Onetouch Ultra 2, 5
prochlorperazine maleate, 4
moexipril HCL, 1
Onetouch Ultra Blue, 5
propranolol HCL, 2
moexipril/hydrochlorothiazide, 2
Onetouch Ultra Mini, 5
Propranolol HCL, 2
mometasone furoate, 2
Onetouch Ultralink System (DEC), 5
propranolol HCL ER, 2
montelukast sodium, 5
Onetouch Ultralink System (hex), 5
Propranolol/Hydrochlorothiazide, 2
Morgidox 1X100MG, 1
Onetouch Ultrasmart, 5
Pulmicort, 5
Morgidox 2X100MG, 1
Onfi, 4
Pulmicort Flexhaler, 5
moxifloxacin HCL, 1
Orencia, 1
Q
N
Ortho Tri-cyclen LO, 3
Ortho-novum 7/7/7, 3
quetiapine fumarate, 4
nabumetone, 1
oxacillin sodium, 1
quinapril HCL, 1
nadolol, 2
oxaprozin, 1
quinapril/hydrochlorothiazide, 2
nadolol/bendroflumethiazide, 2
oxcarbazepine, 3
Qvar, 5
nafcillin sodium, 1
oxybutynin chloride, 5
R
naproxen, 1
oxybutynin chloride ER, 5
naproxen sodium, 1
raloxifene hydrochloride, 4
P
naratriptan HCL, 4
ramipril, 1
Natazia, 3
pamidronate disodium, 4
ranitidine HCL, 3
Necon 1/50-28, 3
paroxetine HCL, 5
Rebif, 3
Necon 10/11-28, 3
paroxetine HCL ER, 5
Rebif Titration Pack, 3
neomycin/polymyxin/bacitracin/hydrocortisone, 4
Pataday, 4
Relpax, 4
Patanol, 4
Remicade, 1
Restasis, 4
tobramycin sulfate, 4
Ribasphere, 3
tobramycin/dexamethasone, 4
Ribasphere Ribapak, 3
Tobrex, 4
ribavirin, 3
tolazamide, 3
risedronate sodium, 4
Tolazamide, 3
risperidone, 4
Tolbutamide, 3
risperidone odt, 4
tolmetin sodium, 1
rivastigmine tartrate, 3
Tolmetin Sodium, 1
rizatriptan benzoate, 4
tolterodine tartrate, 5
rizatriptan benzoate odt, 4
tolterodine tartrate ER, 5
S
topiramate, 3
Topiramate ER, 4
Safyral, 3
trandolapril, 1
Serevent Diskus, 5
Travatan Z, 4
Seroquel XR, 4
Travoprost, 4
sertraline HCL, 5
tretinoin, 2
simvastatin, 2
tretinoin microsphere, 2
sodium sulfacetamide, 2
tretinoin microsphere P.M., 2
sodium sulfacetamide/sulfur, 2
triamcinolone acetonide, 2
Sodium Sulfacetamide/Sulfur, 2
Triamcinolone Acetonide, 2
sodium sulfacetamide/sulfur cleanser, 2
Trianex, 2
Sodium Sulfacetamide/Sulfur Cleanser IN Urea, 2
trifluoperazine HCL, 4
trospium chloride, 5
sodium sulfacetamide/sulfur cleansing cloths, 2
trospium chloride ER, 5
U
sodium sulfacetamide/sulfur green, 2
Sodium Sulfacetamide/Sulfur IN Urea, 2
U-cort, 2
sodium sulfacetamide/sulfur wash, 2
V
sotalol HCL, 2
Vagifem, 3
sotalol HCL (AF), 2
valproate sodium, 3
Spiriva Handihaler, 5
valproic acid, 3
Sporanox, 1
valsartan, 1
Strattera, 4
valsartan/hydrochlorothiazide, 2
sucralfate, 3
venlafaxine HCL, 5
sulfacetamide sodium, 2
venlafaxine HCL ER, 5
sulfacetamide sodium/prednisolone sodium phosphate, 4
Venlafaxine HCL ER, 5
verapamil HCL, 2
sulfacetamide sodium/sulfur cleanser, 2
Verapamil HCL, 2
sulindac, 1
verapamil HCL ER, 2
Sumatriptan, 4
verapamil HCL SR, 2
sumatriptan succinate, 4
Viagra, 5
sumatriptan succinate refill, 4
Vigamox, 4
Surestep Pro Test Strips, 5
Vimpat, 4
Surestep Test Strips, 5
Vivelle-dot, 3
Symbicort, 5
voriconazole, 1
Symlinpen 120, 3
Vyvanse, 4
Symlinpen 60, 3
W
T
Welchol, 2
tamsulosin HCL, 5
Tegretol-XR, 4
X
telmisartan, 1
Xopenex HFA, 5
telmisartan/amlodipine, 2
telmisartan/hydrochloroth, 2
Z
telmisartan/hydrochlorothiazide, 2
zafirlukast, 5
terbinafine HCL, 1
Zetia, 2
terbutaline sulfate, 5
ziprasidone HCL, 4
Testosterone, 3
zoledronic acid, 4
testosterone cypionate, 3
Zoledronic Acid, 4
testosterone enanthate, 3
zolmitriptan, 4
Testosterone P.M., 3
zolmitriptan odt, 4
Tetracycline HCL, 1
Zometa, 4
thioridazine HCL, 4
zonisamide, 4
thiothixene, 4
Zovia 1/50e, 3
tiagabine hydrochloride, 4
Zylet, 4
Timolol Maleate, 2
timolol maleate, 4
timolol maleate ophthalmic gel forming, 4
Tobradex, 4