Advanced Reference Formulary Member Guide - lee.netlee.net/app/formulary/formulary.pdf · The Advanced Reference Formulary Member Guide is ... generic and preferred brand-name drugs

Advanced Reference FormularyMember GuidePlease take this guide with you on your next doctor visit.

Express Scripts manages your prescription benefit for your health plan.

Express Scripts manages your prescription drug benefit for yourhealth plan. The Advanced Reference Formulary Member Guide isa formulary list of medications that may be covered under your prescription drug plan. This list was reviewed by an independentgroup of practicing doctors and pharmacists, and it contains medications made by most pharmaceutical manufacturers. Itincludes medications for many covered conditions.

SAVING MONEY ON PRESCRIPTIONSYour plan may prefer some medications over others. These arecalled preferred drugs.

You may pay:•! Lowest co-payment/co-insurance for generic drugs•! Higher co-payment/co-insurance for preferred brand-name

drugs•! Highest co-payment/co-insurance for nonpreferred

brand-name drugs

Your doctor may be able to help you save money by prescribinggeneric and preferred brand-name drugs if appropriate. So besure to take this guide with you on every visit to your doctor.Some commonly prescribed nonpreferred drugs are also listed inthis guide for your reference.

Please note: This guide does not contain a complete list of preferred and nonpreferred drugs.

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FINDING MEDICATIONS WITH LOWERCO-PAYMENTS/CO-INSURANCEThis guide lists medications two ways to help you find somegeneric, preferred, and nonpreferred brand-name drugs.

SECTION I - ALPHABETICALLY BY DRUG CATEGORY (SUCH AS RESPIRATORY)Within each category, medications are listed in alphabetical order, with generic, preferred brand-name, and nonpreferredbrand-name drugs sorted separately:

G Means a preferred generic medicationP Means a preferred brand-name medicationNP Means a nonpreferred brand-name medication

SECTION II - ALPHABETICALLY BY BRAND NAMEAfter each nonpreferred brand-name drug, you will find possible generic and preferred brand-name alternatives.

SAFETY CONSIDERATION SYMBOLSHere is a quick guide for you and your doctor, which explains our safety symbols. These symbols appear next to certain medications.

Means weigh risk of birth defects or other adverse outcomes. Means do not use in pregnancy.

The information in this guide was in effect at the time of printing and maybe subject to change.

Key:G = Means a preferred generic medication.P = Means a preferred brand-name medication.NP = Means a nonpreferred brand-name medication.

= Means weigh risk of birth defects or other adverse outcomes.= Means do not use in pregnancy.

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SECTION I: THERAPEUTIC DRUG CATEGORIES

Oral PenicillinsG amoxicillin trihydrateG amoxicillin trihydrate/

potassium clavulanateG ampicillin trihydrateG dicloxacillin sodiumG penicillin v

potassiumP Augmentin

Suspension 125 - 31.25mg/5

NP Augmentin ESNP Augmentin

Suspension 250 - 62.5mg/5

NP Augmentin TabletNP Augmentin XRNP MoxatagOral TetracyclinesG doxycycline hyclateG doxycycline

monohydrateG minocycline HClG tetracycline HClP OraceaNP AdoxaNP DoryxNP DynacinNP MinocinNP MonodoxNP PeriostatNP Solodyn

NP VibramycinOral CephalosporinsG cefaclorG cefadroxil hydrateG cefdinirG cefpodoxime proxetilG cefprozilG cefuroxime axetilG cephalexin

monohydrateNP CedaxNP CeftinNP KeflexNP OmnicefNP SpectracefNP SupraxOral ErythromycinsG azithromycinG clarithromycinG clarithromycin ERG erythromycin baseG erythromycin

ethylsuccinateG erythromycin

ethylsuccinate/sulfisoxazole acetyl

G erythromycin stearateNP BiaxinNP Biaxin XLNP DificidNP EryPed

ANTI-INFECTIVES (Antibiotics/Antifungals)



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NP PCENP ZithromaxNP ZmaxOral QuinolonesG ciprofloxacin HClG levofloxacinG moxifloxacinG ofloxacinNP AveloxNP Cipro SuspensionNP Cipro TabletNP Cipro XRNP FactiveNP LevaquinNP NoroxinNP Proquin XROral SulfasG erythromycin

ethylsuccinate/sulfisoxazole acetyl

G sulfadiazineG sulfamethoxazole/

trimethoprimG sulfisoxazoleNP Bactrim DSNP Septra DSOral Urinary TractAgentsG methenamine

hippurateG methenamine

mandelateG nitrofurantoinG nitrofurantoin

macrocrystalG phenazopyridine HClG trimethoprim

NP FuradantinNP HiprexNP MacrobidNP MacrodantinNP MonurolNP PrimsolOral AntifungalAgentsG clotrimazoleG fluconazoleG flucytosineG griseofulvin G griseofulvin

ultramicrosizeG itraconazoleG ketoconazoleG nystatinG terbinafine HClG voriconazoleP Lamisil Oral GranulesP NoxafilP Sporanox Oral

SolutionNP AncobonNP DiflucanNP Grifulvin VNP Gris-PegNP Lamisil TabletNP MycostatinNP NizoralNP OravigNP Sporanox CapsuleNP Vfend



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Hypnotic AgentsG estazolamG eszopliconeG flurazepam HClG zaleplonG zolpidem tartrateG zolpidem tartrate

controlled releaseNP AmbienNP Ambien CRNP DoralNP EdluarNP HalcionNP LunestaNP Restoril NP RozeremNP SonataTricyclicAntidepressantsG amitriptyline HClG amoxapineG clomipramine HClG desipramine HClG doxepin HClG imipramine HClG nortriptyline HClG protriptyline HClG trimipramine maleateNP AnafranilNP NorpraminNP PamelorNP Surmontil NP TofranilNP Tofranil-PMNP Vivactil

MiscellaneousAntidepressantsG bupropion HCl tabletG bupropion HCl tablet,

sustained actionG desvenlafaxine ER G duloxetineG maprotiline HClG mirtazapineG mirtazapine orally

disintegrating tabletsG trazodone HClG venlafaxine HClG venlafaxine HCl ERNP CymbaltaNP DesyrelNP EffexorNP Effexor XRNP Pristiq ERNP RemeronNP WellbutrinNP Wellbutrin SRNP Wellbutrin XLAntipsychoticsG chlorpromazine HClG clozapineG fluphenazine HClG haloperidolG haloperidol lactate

concentrate, oralG loxapine succinateG olanzapineG quetiapineG risperidoneG trifluoperazine HCl

PSYCHOTHERAPEUTICS (Anxiety/Depression)



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G ziprasidone HClP MobanP OrapP Seroquel XRNP AbilifyNP ClozarilNP FanaptNP GeodonNP InvegaNP LatudaNP RisperdalNP SaphrisNP SeroquelNP SymbyaxNP ZyprexaAnxiolyticsG alprazolamG alprazolam XRG buspirone HClG chlordiazepoxide

HClG clorazepate

dipotassiumG diazepamG lorazepamG oxazepamNP AtivanNP BusparNP NiravamNP Tranxene T-TabNP ValiumNP XanaxNP Xanax XR

MAOIAntidepressantsG phenelzine sulfateG tranylcypromine

sulfateNP EmsamNP NardilNP ParnateSSRI AntidepressantsG citalopram HBrG escitalopram oxalateG fluoxetine HClG fluvoxamine ERG fluvoxamine maleateG paroxetine HClG sertraline HClNP CelexaNP LexaproNP Luvox CRNP PaxilNP Paxil CRNP PexevaNP ProzacNP Prozac WeeklyNP SarafemNP Zoloft



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Beta BlockersG acebutolol HClG atenololG betaxolol HClG bisoprolol fumarateG carvedilolG labetalol HClG metoprolol succinateG metoprolol tartrateG nadololG pindololG propranolol HClG propranolol HCl

capsule, sustainedaction 24 hr

G timolol maleateP BystolicP Coreg CRNP CoregNP CorgardNP InderalNP Inderal LANP Innopran XLNP KerloneNP LevatolNP LopressorNP SectralNP TenorminNP Toprol XLNP TrandateNP ZebetaCalcium BlockersG diltiazem HClG diltiazem HCl capsule,

sustained release 12 hr

G diltiazem HCl capsule,sustained release 24 hr

G nimodipineG verapamil HClG verapamil HCl

capsule, 24 hr sustained release

G verapamil HCl tablet,sustained action

NP Calan SRNP CardizemNP Cardizem CDNP Cardizem LANP Covera-HSNP Isoptin S.R.NP TiazacNP VerelanNP Verelan PMDihydropyridinesG amlodipine besylateG felodipineG isradipineG nifedipineG nifedipine tablet,

sustained releaseG nisoldipineNP Adalat CCNP Cardene SRNP DynaCirc CRNP NorvascNP Procardia XLNP Sular

CARDIOVASCULAR(Blood Pressure/Heart/Cholesterol)



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Nitroglycerin PatchesG nitroglycerin patch,

sprayNP Minitran PatchNP Nitro-Dur PatchAdrenergicAntagonists &Related DrugsG clonidine HClG clonidine transdermal

patchG doxazosin mesylateG guanfacine HClG methyldopaG prazosin HClG reserpineG terazosin HClNP CarduraNP Cardura XLNP CatapresNP Catapres-TTSNP HytrinNP MinipressNP Nexiclon XRNP TenexAngiotensin IIBlockers & ReninInhibitorsG amlodipine/valsartanG candesartanG candesartan/HCTG irbesartan G irbesartan HCTZG losartan potassiumG losartan potassium/

HCTZG telmisartan/

amlodipineG valsartan

G valsartan HCTZ P BenicarP Benicar HCTP TekturnaP Tekturna HCTNP AtacandNP Atacand HCTNP AvalideNP AvaproNP CozaarNP DiovanNP Diovan HCTNP ExforgeNP Exforge HCTNP HyzaarAntilipidemicsG atorvastatinG cholestyramine/

aspartameG cholestyramine/

sucroseG colestipol HClG fenofibrate,

micronizedG fenofibrate tablet G fenofibric acid delayed

release G fluvastatinG gemfibrozilG lovastatinG niacinG omega-3-acid ethyl

estersG pravastatinG simvastatinNP AdvicorNP AntaraNP AltoprevNP CaduetNP Colestid



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NP CrestorNP FenoglideNP LescolNP Lescol XLNP LipitorNP LivaloNP LofibraNP LopidNP LovazaNP MevacorNP NiaspanNP PravacholNP QuestranNP Questran LightNP SimcorNP TricorNP TriglideNP TrilipixNP VytorinNP WelcholNP ZetiaNP ZocorACE InhibitorsG benazepril HClG captoprilG enalapril maleateG fosinopril sodiumG lisinoprilG moexiprilG perindopril erbumineG quinaprilG ramiprilG trandolaprilNP AccuprilNP AceonNP AltaceNP LotensinNP MavikNP PrinivilNP Univasc

NP VasotecNP ZestrilCombinationAntihypertensivesG amlodipine besylate/

benazeprilG atenolol/

chlorthalidoneG benazepril HCl/HCTZG bisoprolol fumarate/

HCTZG captopril/HCTZG enalapril maleate/

HCTZG fosinopril/HCTZG hydralazine HCl/HCTZG lisinopril/HCTZG methyldopa/HCTZG metoprolol/HCTZG moexipril/HCTZG nadolol/

bendroflumethiazideG propranolol HCl/HCTZG quinapril/HCTZG trandolapril/

verapamilNP AccureticNP AzorNP ClorpresNP CorzideNP Lopressor HCTNP Lotensin HCTNP Lotrel NP PrinzideNP TarkaNP TenoreticNP UnireticNP VasereticNP ZestoreticNP Ziac



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Insulin TherapyP HumalogP Humalog Mix 50/50P Humalog Mix 75/25P HumulinP LantusP Lantus SoloStarNP LevemirNon-InsulinHypoglycemic AgentsG acarboseG chlorpropamideG glimepirideG glipizideG glipizide/

metformin HClG glyburideG glyburide/

metformin HClG glyburide, micronizedG metformin HClG metformin HCl tablet,


G nateglinide G pioglitazone G pioglitazone/

metformin HClG repaglinide G tolazamideG tolbutamideP AvandametP Avandaryl

P AvandiaP Bydureon P JanumetP JanuviaP Kombiglyze XRP SymlinNP Actoplus MetNP ActosNP AmarylNP ByettaNP CyclosetNP DiaBetaNP DuetactNP FortametNP GlucophageNP Glucophage XRNP GlucotrolNP Glucotrol XLNP GlucovanceNP GlynaseNP GlysetNP MetaglipNP PrandimetNP PrandinNP PrecoseNP RiometNP StarlixBlood Glucose TestStripsG alcohol antiseptic

padsP One Touch Test StripsP One Touch Ultra Test

Strips

ENDOCRINE (Diabetes/Hormones/Contraceptives)



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Contraceptive AgentsG desogestrel-ethinyl

estradiolG desogestrel-ethinyl

estradiol/ethinylestradiol

G ethinyl estradiol/drospirenone

G ethynodiol d-ethinylestradiol

G levonorgestrelG levonorgestrel-

ethinyl estradiolG levonorgestrel-

ethinyl estradiol/ethinyl estradiol

G norethindroneG norethindrone a-e

estradiolG norethindrone a-e

estradiol/ferrousfumarate

G norethindrone-ethinyl estradiol

G norethindrone-mestranol

G norgestimate-ethinyl estradiol

G norgestrel-ethinylestradiol

P BeyazP EllaP Loestrin 24 FeP Lo Loestrin FeP NataziaP NuvaRingP SafyralNP BreviconNP Cyclessa

NP DemulenNP DesogenNP Estrostep FeNP Femcon FeNP LoestrinNP Loestrin FeNP Lo/OvralNP LoSeasoniqueNP LybrelNP MircetteNP ModiconNP NordetteNP NorinylNP Ortho-CeptNP Ortho-CyclenNP Ortho EvraNP Ortho MicronorNP Ortho-NovumNP Ortho Tri-CyclenNP Ortho Tri-Cyclen LoNP OvconNP OvralNP Plan B One-StepNP SeasonaleNP SeasoniqueNP Tri-NorinylNP YasminNP YazEstrogens/EstrogenCombinationsG estradiolG estradiol/

norethindroneacetate

G estropipateG methyl-

testosterone/estrogens, esterified



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G norethindrone/ethinyl estradiol

P CenestinP CombipatchP EnjuviaP Estrace Vaginal

CreamP EstradermP EstringP EvamistP Premarin Tablet P PremphaseP PremproP VagifemP VivelleP Vivelle-DotNP ActivellaNP AloraNP AngeliqNP ClimaraNP Climara ProNP DivigelNP Elestrin

NP Estrace TabletNP EstrasorbNP EstrogelNP FemhrtNP FemringNP FemtraceNP MenestNP MenostarNP OgenNP Ortho-PrefestNP PrefestNP Premarin Vaginal

Cream

Ulcer DrugsG cimetidine HCl liquidG cimetidine tabletG famotidineG lansoprazoleG misoprostolG nizatidineG omeprazoleG omeprazole/sodium

bicarbonate

G pantoprazole sodiumG rabeprazoleG ranitidine HClP Nexium NP AciphexNP Axid CapsuleNP Axid Oral SolutionNP CytotecNP DexilantNP Pepcid

G I (Ulcer)



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NSAIDsG diclofenac sodiumG etodolacG etodolac tablet,


G flurbiprofenG ibuprofenG indomethacin

capsule, sustainedaction

G ketoprofenG ketoprofen capsule,

24 hr sustainedrelease pellets

G meclofenamatesodium

G meloxicamG nabumetoneG naproxenG naproxen sodiumG oxaprozinG piroxicamG sulindacG tolmetin sodiumNP Anaprox DSNP AnsaidNP Arthrotec

NP ClinorilNP DayproNP diclofenac

potassiumNP EC-NaprosynNP FeldeneNP IndocinNP indomethacinNP LodineNP MobicNP MotrinNP NaprelanNP NaprosynNP naproxen sodium

tablet, sustainedaction

NP RelafenNP ToradolNP VoltarenNP Voltaren-XRP FlectorNSAID COX-2InhibitorsP Celebrex

NSAIDS (Pain Relievers)

NP PrevacidNP Prilosec RxNP ProtonixNP Tagamet

NP Zantac RxNP Zegerid Rx



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G acetaminophen/butalbital

G acetaminophen/caffeine/butalbital

G aspirin/caffeine/butalbital

G dihydroergotaminemesylate

G ergotamine/caffeineG isometheptene

mucate/acetaminophen/dichloralphenazone

G naratriptan HClG rizatriptanG rizatriptan/MLT G sumatriptan succinateG zolmitriptanP ErgomarNP AmergeNP AxertNP Cafergot tablet

NP ImitrexNP MaxaltNP Maxalt MLTNP MidrinNP MigranalNP PhrenilinNP Phrenilin ForteNP RelpaxNP TreximetNP ZomigNP Zomig ZMT

MIGRAINE/HEADACHE THERAPY

G donepezil HClG galantamine ERG rivastigmineNP AriceptNP Exelon patchNP NamendaNP RazadyneNP Razadyne ER

DRUGS TO TREAT ALZHEIMER’S DISEASE



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Beta Agonists OralG albuterol sulfateG albuterol sulfate SRG metaproterenol

sulfateG terbutaline sulfateBeta Agonist InhalersG albuterolG albuterol sulfateG levalbuterol HCl

nebulizer solutionP ForadilP Proair HFAP Serevent DiskusP Ventolin HFANP AccunebNP ArcaptaNP BrovanaNP PerforomistInhaled SteroidsG budesonide

G fluticasone propionateP AsmanexP Pulmicort FlexhalerP Pulmicort RespulesP QVARNP AerobidNP Aerobid-MNasal CorticosteroidsG flunisolideG fluticasone propionateG triamcinolone

acetonideP QnaslNP FlonaseNP Nasacort AQNP NasonexMiscellaneousPulmonary AgentsG acetylcysteineG cromolyn sodium

ampul for nebulization

RESPIRATORY (Allergy/Asthma)

G flavoxateG oxybutynin chloride G oxybutynin chloride

ERG tolterodine G trospium G trospium ERP GelniqueP Toviaz

P VesicareNP DetrolNP Detrol LANP Ditropan XLNP EnablexNP OxytrolNP SancturaNP Sanctura XR

DRUGS TO TREAT OVERACTIVE BLADDER



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G desloratadine G ipratropium/albuterol

sulfateG ipratropium bromide

solutionG montelukastG sildenafil citrateG zafirlukastP Atrovent HFAP CombiventP PulmozymeP SpirivaP TracleerP VentavisNP AccolateNP AdcircaNP Atrovent Inhalation

SolutionNP CinryzeNP DalirespNP DuonebNP KalbitorNP LetairisNP Revatio TabletNP SingulairNP SymbicortNP XolairNP ZyfloNP Zyflo CR

Antihistamine/DecongestantCombinationsG pseudoephidrine

w/chlorpheniramineNP Clarinex-D 12 hrNP Clarinex-D 24 hrNP Deconamine LiquidAntihistaminesG clemastine fumarateG cyproheptadine HClG diphenhydramine HClG fexofenadine HClG hydroxyzine HClG hydroxyzine pamoateG levocetirizineG promethazine HClNP Allegra ODTNP Allegra Oral

SuspensionNP ClarinexNP PhenerganNP VistarilNP Xyzal



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G alendronate sodiumG calcitonin, salmon,

syntheticG ibandronate sodiumG raloxifeneG risedronate 150mgP AtelviaP ForteoNP ActonelNP Boniva 150mgNP EvistaNP Fosamax Plus DNP Fosamax SolutionNP Fosamax TabletNP Prolia

OSTEOPOROSIS/PAGET’S DISEASE

Nonpreferred Possible Preferred ProductsProduct

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SECTION II: NONPREFERRED DRUGS AND THEIR POSSIBLE PREFERRED

ALTERNATIVES

Abilify® clozapine (generic), quetiapine (generic), risperidone(generic), ziprasidone HCl (generic), Seroquel XR®

(AstraZeneca)Accolate® zafirlukast (generic)Accuneb® albuterol sulfate (generic)Accupril® quinapril (generic)Accuretic® quinapril/hydrochlorothiazide (generic)Aceon® enalapril (generic), lisinopril, (generic), benazepril

(generic), Aciphex® omeprazole (generic), pantoprazole (generic),

rabeprazole (generic), Nexium® (AstraZeneca)Activella® 1-0.5mg estradiol/norethindrone acetate (generic)Activella® estradiol/norethindrone acetate (generic),

0.5-0.1mg Premphase® (Wyeth), Prempro® (Wyeth)Actonel® alendronate sodium (generic), Ibandronate sodium

with Calcium (generic) Adalat CC® nifedipine ER (generic), amlodipine besylate (generic)Adcirca® sildenafil citrate (generic)Adderall XR® amphetamine aspartate/amphetamine sulfate/

dextroamphetamine (generic), dexmethylphenidate(generic), methylphenidate SR (generic), D-amphetamine sulfate (generic), methylphenidate(generic)

Advicor® lovastatin (generic), omega-3-acid ethyl esters (generic),Niaspan® (Abbot)

Aerobid® fluticasone propionate (generic), Asmanex® (Schering),Pulmicort Inhaler® (AstraZeneca), QVAR® (Ivax)

Aerobid-M® fluticasone propionate (generic), Asmanex® (Schering),Pulmicort Inhaler® (AstraZeneca), QVAR® (Ivax)

Aggrenox® dipyridamole (generic), ticlopidine (generic), cilostazol(generic), aspirin (generic)

Allegra® ODT OTC fexofenadine HCl (generic)Alora® estradiol patch (generic), Estraderm® (Novartis), Vivelle®

(Novartis)Altoprev® atorvastatin (generic), lovastatin (generic), omega-3-

acid ethyl esters (generic), simvastatin (generic),pravastatin (generic)

Amaryl® glimepiride (generic)

*Branded generics have the same co-payment as regular generics.


19*Branded generics have the same co-payment as regular generics.

Ambien® eszoplicone (generic), zolpidem tartrate (generic), zaleplon (generic)

Ambien CR® eszoplicone (generic), zolpidem tartrate controlledrelease (generic)

Amerge® naratriptan HCl (generic), sumatriptan succinate(generic)

Anafranil® clomipramine HCl (generic)Anaprox DS® naproxen sodium (generic)Angeliq® estradiol/norethindrone acetate (generic),

Premphase® (Wyeth), Prempro® (Wyeth)Ansaid® flurbiprofen (generic)Antara® fenofibrate (generic), gemfibrozil (generic)Anzemet® granisetron (generic), ondansetron (generic)Aricept® donepezil HCl (generic)Arixtra® enoxaparin (generic), fondaparinux (generic)Arthrotec® ibuprofen (generic), naproxen (generic)Atacand® candesartan (generic), telmisartan/amlodipine

(generic)Atacand HCT® candesartan/HCT (generic), telmisartan/amlodipine

(generic) Ativan® lorazepam (generic)Atrovent® ipratropium bromide (generic)

solutionAugmentin® amoxicillin trihydrate/potassium clavulanate (generic)chewable tablet125-31.25mg200-28.5mg,400-57mg

Augmentin® amoxicillin trihydrate/potassium clavulanate (generic)suspension200-28.5mg/5, 250-62.5mg/5, 400-57mg/5

Augmentin® amoxicillin trihydrate/potassium clavulanate (generic)tablet

Augmentin ES® amoxicillin trihydrate/potassium clavulanate (generic)Augmentin XR® amoxicillin trihydrate/potassium clavulanate (generic)Avalide® irbesartan/HCTZ (generic), telmisartan/amlodipine

(generic)Avapro® irbesartan (generic), telmisartan/amlodipine (generic)Avelox® levofloxacin (generic)Avodart® dutaseride (generic), finasteride (generic)Axert® naratriptan HCl (generic), sumatriptan succinate

(generic)Axid® Capsule nizatidine (generic), rabeprazole (generic)


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Azilect® selegiline (generic)Azor® amlodipine besylate (generic)Bactrim DS® sulfamethoxazole/trimethoprim (generic)Biaxin® clarithromycin (generic)Biaxin XL® clarithromycin ER (generic)Boniva® ibandronate sodium (generic)Brevicon® Necon® (Watson-branded generic*), Nortrel®

(Barr-branded generic*)Brovana® Foradil® (Schering),Proair HFA® (Teva), Serevent Diskus®

(GlaxoSmithKline)Buspar® buspirone HCl (generic)Butisol Sodium®

Byetta® Bydureon® (Amylin), Januvia® (Merck), Janumet® (Merck)Caduet® amlodipine besylate (generic), atorvastatin (generic),

lovastatin (generic), omega-3-acid ethyl esters (generic), pravastatin (generic), simvastatin (generic)

Calan SR® verapamil HCl tablet, sustained action (generic)Carafate® Tablet sucralfate (generic)Cardene SR® amlodipine besylate (generic), nifedipine ER (generic)Cardizem® diltiazem HCl (generic)Cardizem CD® diltiazem HCl capsule, sustained release 24 hr

(generic)Cardizem LA® diltiazem HCl (generic), verapamil SR (generic), Cardura® doxazosin mesylate (generic)carisoprodol chlorzoxazone (generic), cyclobenzaprine (generic),

diazepam (generic)Cataflam® etodolac (generic), ibuprofen (generic), naproxen

(generic)Catapres® clonidine HCl tablet (generic)Catapres-TTS® clonidine HCl patch (generic)Ceclor CD® cefaclor (generic), cefdinir (generic),

cefuroxime axetil (generic)Cedax® cefaclor (generic), cefdinir (generic),

cefuroxime axetil (generic)Ceftin® cefuroxime axetil (generic)Cefzil® cefaclor (generic), cefdinir (generic),

cefuroxime axetil (generic)Celexa® citalopram (generic)Celontin® ethosuximide (generic)Cipro® Tablet ciprofloxacin HCl tablet (generic)Clarinex® desloratadine (generic), OTC fexofenadine (generic), OTC

Claritin, OTC Zyrtec, OTC Benadryl (diphenhydramine)


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Clarinex Reditabs® OTC fexofenadine (generic), OTC Claritin, OTC Zyrtec,OTC Benadryl (diphenhydramine)

Cleocin HCl® clindamycin HCl (generic)Climara Pro® Combipatch® (Novartis)Clinoril® sulindac (generic)Clorpres® clonidine HCl (generic), chlorthalidone (generic)Colestid® cholestyramine (generic), colestipol (generic),

omega-3-acid ethyl esters (generic)Coreg® carvedilol (generic)Corgard® nadolol (generic)Concerta® amphetamine aspartate/amphetamine sulfate/


Corzide® bisoprolol fumarate/hydrochlorothiazide (generic),metoprolol/hydrochlorothiazide (generic), propranololHCl/hydrochlorothiazide (generic)

Covera-HS® verapamil HCl capsule, 24 hr sustained release (generic)Cozaar® losartan potassium (generic), telmisartan/amlodipine

(generic)Crestor® atorvastatin (generic), fluvastatin (generic), lovastatin

(generic), simvastatin (generic), omega-3-acid ethylesters (generic), pravastatin (generic)

Cyclessa® Caziant® (Watson-branded generic*), Cesia® (Pharmedix-branded generic*), Velivet® (Barr-branded generic*)

Cycloset® metformin HCl (generic), Januvia® (Merck), Janumet®

(Merck)Cymbalta® bupropion SR (generic), bupropion XL (generic),

desvenlafaxine (generic), duloxetine HCl (generic), mirtazapine (generic), venlafaxine (generic), venlafaxine HCl ER (generic)

Cytotec® misoprostol (generic), rabeprazole (generic)Daypro® oxaprozin (generic)Daytrana® amphetamine aspartate/amphetamine sulfate/


Demulen® Zovia® (Watson-branded generic*)Desogen® Apri® (Barr-branded generic*),

Solia® (Prasco Labs-branded generic*)Desyrel® trazodone HCl (generic)Detrol® tolterodine (generic)




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Detrol LA® tolterodine (generic) Dexilant® omeprazole (generic), pantoprazole (generic),

rabeprazole (generic)DiaBeta® glyburide (generic)Diclofenac etodolac (generic), ibuprofen (generic), naproxen

Potassium (generic)Diclofenac etodolac (generic), ibuprofen (generic), naproxen

Sodium (generic)Diflucan® fluconazole (generic)Dilacor XR® diltiazem XR (generic)Dilatrate SR® isosorbide dinitrate (generic), isosorbide mononitrate

(generic), isosorbide mononitrate sustained release(generic)

Dilaudid® liquid oxycodone (generic), morphine sulfate sustainedrelease (generic), morphine sulfate (generic), codeinesulfate (generic), fentanyl (generic), hydromorphone(generic)

Diovan® candesartan (generic), losartan (generic), telmisartan/amlodipine (generic), valsartan (generic)

Dispermox® amoxicillin trihydrate suspension (generic),amoxicillin trihydrate chewable tablet (generic)

Ditropan XL® oxybutynin chloride ER (generic)Doral® eszoplicone (generic), zaleplon (generic), zolpidem

tartrate (generic)Doryx® doxycycline hyclate (generic)Duoneb® ipratropium/albuterol sulfate (generic)Dynacin® minocycline HCl (generic)DynaCirc CR® amlodipine besylate (generic), nifedipine ER (generic)EC-Naprosyn® naproxen (generic)Edluar® eszoplicone (generic), zolpidem tartrate (generic)Effexor® desvenlafaxine (generic), venlafaxine HCl (generic)Effexor XR® venlafaxine HCl ER (generic)Elestrin® estradiol patch (generic), Estraderm® (Novartis), Vivelle®

(Novogyne)Emsam® tranylcypromine sulfate (generic), Nardil® (Parke-Davis)Enablex® oxybutynin (generic), oxybutynin chloride (generic),

oxybutynin chloride ER (generic), tolterodine (generic),trospium (generic), trospium ER (generic)

Enduronyl Forte® hydrochlorothiazide (generic), methyldopa/HCTZ(generic)

EryPed® Chewable erythromycin ethylsuccinate (generic)Tablet 200mg


23

EryPed® erythromycin ethylsuccinate (generic)Suspension 400mg/5ml

Estrace® Tablet estradiol (generic)Estrasorb® estradiol patch (generic)Estrogel® estradiol patch (generic), Estraderm® (Novartis), Vivelle®

(Novartis)Estrostep Fe® Apri® (Barr-branded generic*), Kariva® (Barr-branded

generic*), Microgestin Fe® (Watson-branded generic*)Exforge® amlodipine/benazepril (generic), amlodipine/lisinopril

(generic), amlodipine/enalapril (generic),amlodipine/valsartan (generic)

Exforge HCT® amlodipine/benazepril (generic), amlodipine/lisinopril(generic), amlodipine/enalapril (generic),amlodipine/valsartan (generic), hydrochlorothiazide(generic)

Factive® ciprofloxacin (generic), levofloxacin HCl (generic)Feldene® piroxicam (generic)Femcon Fe® Zeosa (Teva-branded generic*)Femhrt® estradiol/norethindrone acetate (generic),

Premphase® (Wyeth), Prempro® (Wyeth)Femring® Estring® (Pfizer), Premarin Vaginal Cream® (Wyeth)Femtrace® estradiol (generic)Fenoglide® fenofibrate micronized (generic), gemfibrozil (generic),

omega-3-acid ethyl esters (generic)Flomax® doxazosin (generic), terazosin (generic) Flonase® fluticasone propionate (generic)Fortamet® metformin HCl ER (generic), metformin HCl tablet

(generic)Fosamax® alendronate sodium (generic)Fragmin® enoxaparin (generic), fondaparinux (generic)Geodon® ziprasidone (generic), olanzapine (generic)Glucophage® metformin HCl (generic)Glucophage XR® metformin HCl ER (generic), metformin HCl tablet

(generic)Glucotrol® glipizide (generic)Glucotrol XL® glipizide ER (generic)Glucovance® glyburide/metformin HCl (generic)Glynase® glyburide, micronized (generic)Glyset® acarbose (generic)




24

Grifulvin V® griseofulvin ultramicrosize (generic), itraconazole(generic), ketoconazole (generic), terbinafine HCl(generic)

Gris-Peg® griseofulvin ultramicrosize (generic), itraconazole(generic), ketoconazole (generic), terbinafine HCl(generic)

Guanabenz clonidine HCl (generic), methyldopa (generic)Acetate®

Halcion® estazolam (generic), eszoplicone (generic), zolpidem tartrate (generic)

Hiprex® methenamine hippurate (generic)Hytrin® terazosin (generic)Hyzaar® losartan potassium/HCTZ (generic),

telmisartan/amlodipine (generic)Imitrex® sumatriptan succinate (generic)Inderal® propranolol HCl (generic)Inderal LA® propranolol capsule, sustained action (generic)Indocin® indomethacin (generic)Innopran XL® propranolol capsule, sustained action (generic)Invega® quetiapine (generic), risperidone (generic), ziprasidone

HCl (generic), Seroquel XR® (AstraZeneca)Isoptin S.R.® verapamil HCl tablet, sustained action (generic)Kapidex® omeprazole (generic), pantoprazole (generic), Nexium®

(AstraZeneca)Keflex® cephalexin monohydrate (generic)Kerlone® betaxolol HCl (generic)Ketek® amoxicillin trihydrate/potassium clavulanate (generic),

azithromycin (generic), levofloxacin HCl (generic)Lamisil® terbinafine HCl (generic)Lescol® atorvastatin (generic), fluvastatin (generic), lovastatin

(generic), omega-3-acid ethyl esters (generic), pravastatin (generic), simvastatin (generic)

Lescol XL® atorvastatin (generic), fluvastatin (generic), lovastatin(generic), omega-3-acid ethyl esters (generic),pravastatin (generic), simvastatin (generic)

Letairis® Tracleer® (Actelion)Levaquin® levofloxacin (generic)Levatol® acebutolol HCl (generic), atenolol (generic),

metoprolol tartrate (generic)Levemir® Lantus® (Aventis), Humulin N® (Eli Lilly and Company)Levlen® Levora® (Watson-branded generic*), Portia®

(Barr-branded generic*)


25

Lexapro® escitalopram (generic), paroxetine CR (generic), paroxetine (generic), fluoxetine (generic), citalopram(generic), sertraline (generic)

Lexapro® solution escitalopram (generic), citalopram solution (generic),fluoxetine HCl solution (generic), paroxetine HCl suspension (generic)

Lipitor® atorvastatin (generic), fluvastatin (generic), lovastatin(generic), simvastatin (generic), omega-3-acid ethylesters (generic), pravastatin (generic)

Lodine® etodolac (generic)Loestrin® Junel® (Barr-branded generic*), Microgestin®

(Watson-branded generic*)Loestrin Fe® Junel Fe® (Barr-branded generic*), Microgestin Fe®

(Watson-branded generic*)Loestrin 24 Fe® Junel Fe® (Barr-branded generic*), Microgestin Fe®

(Watson-branded generic*)Lofibra® fenofibrate (generic), omega-3-acid ethyl esters

(generic)Lo Loestrin Fe® Junel Fe® (Barr-branded generic*), Microgestin Fe®

(Watson-branded generic*)Lo/Ovral® Low-Ogestrel® (Watson-branded generic*)Lopid® gemfibrozil (generic), omega-3-acid ethyl esters

(generic)Lopressor® metoprolol tartrate (generic)Lopressor HCT® metoprolol/hydrochlorothiazide (generic)LoSeasonique® Aviane® (Barr-branded generic*), Lutera®

(Watson-branded generic*)Lotensin® benazepril HCl (generic)Lotensin HCT® benazepril HCl/hydrochlorothiazide (generic)Lotrel® amlodipine besylate/benazepril (generic)Lotrel® 5-40mg, amlodipine/benazepril (generic), amlodipine/lisinopril

10-40mg (generic), amlodipine/enalapril (generic),amlodipine/valsartan (generic)

Lovaza® fenofibrate micronized (generic), gemfibrozil (generic),OTC Fish Oil, omega-3-acid ethyl esters (generic)

Lovenox® enoxaparin (generic)Luvox CR® fluvoxamine maleate (generic), fluvoxamine ER

(generic)Lyrica® carbamazepine (generic), gabapentin (generic),

lamotrigine (generic), topiramate (generic)Macrobid® nitrofurantoin macrocrystal (generic)Macrodantin® nitrofurantoin (generic)Mandelamine® methenamine mandelate (generic)Mavik® trandolapril HCl (generic)




26

Maxalt® naratriptan HCl (generic), rizatriptan (generic), sumatriptan (generic)

Maxalt MLT® naratriptan HCl (generic), rizatriptan/MLT (generic),sumatriptan (generic)

Menest® estradiol (generic), estropipate (generic), Cenestin®

(Duramed/Barr), Enjuvia® (Duramed/Barr),Premarin® (Wyeth)

Menostar Patch® Vivelle Patch® (Novartis)Metadate CD® amphetamine aspartate/amphetamine sulfate/


Metadate ER® amphetamine aspartate/amphetamine sulfate/dextroamphetamine (generic), dexmethylphenidate(generic), methylphenidate SR (generic), D-amphetamine sulfate (generic), methylphenidate(generic)

Metaglip® glipizide/metformin (generic)Mevacor® lovastatin (generic), omega-3-acid ethyl esters (generic)Midrin® isometheptene/apap/dichloralphenazone (generic)Migranal® naratriptan HCl (generic), sumatriptan nasal spray

(generic), Zomig® Nasal Spray (AstraZeneca)Minipress® prazosin HCl (generic)Minocin® minocycline HCl (generic)Mircette® Kariva® (Barr-branded generic*)Mobic® meloxicam (generic)Modicon® Necon® (Watson-branded generic*), Nortrel®

(Barr-branded generic*)Monistat 3 Vaginal miconazole 3 vaginal suppository (generic)

Suppository®

Monodox® doxycycline monohydrate (generic)Monurol® ciprofloxacin HCl (generic), sulfamethoxazole/

trimethoprim (generic), trimethoprim (generic)Motrin® ibuprofen (generic)Moxatag® amoxicillin (generic)Nalfon® etodolac (generic), ibuprofen (generic), indomethacin

(generic), meclofenamate sodium (generic), naproxen (generic), sulindac (generic)

Namenda donepezil HCl (generic), galantamine (generic), Dose Pack® galantamine ER (generic), rivastigmine (generic)

Namenda® Oral galantamine oral solution (generic), Exelon Oral Solution Solution® (Novartis)

Namenda® Tablet donepezil HCl (generic), galantamine (generic), galantamine ER (generic), rivastigmine (generic)


27

Naprelan® naproxen sodium (generic)Naprosyn® naproxen (generic)Nasacort AQ® flunisolide (generic), fluticasone propionate (generic),

triamcinolone acetonide (generic)Nasonex® flunisolide (generic), fluticasone propionate (generic),

triamcinolone acetonide (generic)Natazia® Necon® (Watson-branded generic*)Nexiclon XR® clonidine HCl (generic)Niravam® alprazolam (generic)Nitrostat® nitrolingual (generic), nitroglycerine (generic)Nizoral® ketoconazole (generic)Nordette® Levora® (Watson-branded generic*), Portia®

(Barr-branded generic*)Norinyl® Necon® (Watson-branded generic*), Nortrel®

(Barr-branded generic*)Norpramin® desipramine HCl (generic)Norvasc® amlodipine besylate (generic)Ogen® estropipate (generic)Omnicef® cefdinir (generic)Oravig® clotrimazole (generic), fluconazole (generic), nystatin

(generic)Ortho-Cept® Apri®(Barr-branded generic*), Solia®

(Prasco Labs-branded generic*)Ortho-Cyclen® MonoNessa® (Watson-branded generic*), Previfem®

(Teva-branded generic*), Sprintec® (Barr-branded generic*)

Ortho Evra® MonoNessa® (Watson-branded generic*), TriNessa®

(Watson-branded generic*)Ortho Micronor® norethindrone acetate (generic)Ortho-Novum® Necon® (Watson-branded generic*), Nortrel®

1/35, 7/7/7 (Barr-branded generic*)Ortho-Novum® Necon® (Watson-branded generic*)

1/50Ortho-Prefest® estradiol/norethindrone acetate (generic),

Premphase® (Wyeth), Prempro® (Wyeth)Ortho Tri-Cyclen® TriNessa® (Watson-branded generic*), Tri-Previfem®

(Teva-branded generic*), Tri-Sprintec® (Barr-brandedgeneric*)

Ortho Tri-Cyclen TriNessa® (Watson-branded generic*), Tri-Previfem®

Lo® (Teva-branded generic*), Tri-Sprintec® (Barr-brandedgeneric*)

Ovcon® Necon® (Watson-branded generic*)Ovral® Ogestrel® (Watson-branded generic*)




28

Oxycontin® oxycodone (generic), morphine sulfate sustainedrelease (generic), morphine sulfate (generic), codeinesulfate (generic), fentanyl (generic), hydromorphone(generic)

OxyFAST® oxycodone (generic), morphine sulfate sustainedrelease (generic), morphine sulfate (generic), codeinesulfate (generic), fentanyl (generic), hydromorphone(generic)

OxyIR® oxycodone (generic), morphine sulfate sustainedrelease (generic), morphine sulfate (generic), codeinesulfate (generic), fentanyl (generic), hydromorphone(generic)

Oxytrol® oxybutynin (generic), oxybutynin chloride (generic),oxybutynin chloride ER (generic), tolterodine (generic),trospium (generic), trospium ER

Pacerone® 100mg, amiodarone (generic)200mg, 300mg

Pamelor® nortriptyline HCl (generic)Parnate® tranylcypromine sulfate (generic)Paxil® paroxetine HCl (generic)Paxil CR® paroxetine HCl sustained release tab (generic)PCE® erythromycin (generic)Pepcid famotidine (generic), cimetidine HCl liquid (generic),

Suspension® rabeprazole (generic)Pepcid Tablet® famotidine (generic), rabeprazole (generic)Perforomist® Foradil® (Schering Corporation), Serevent Diskus®

(GlaxoSmithKline)Periostat® doxycycline hyclate (generic)Pexeva® paroxetine HCl (generic)Phenergan® promethazine HCl (generic)Phrenilin® acetaminophen/caffeine/butalbital (generic),

aspirin/caffeine butalbital (generic)Phrenilin Forte® acetaminophen/caffeine/butalbital (generic),

aspirin/caffeine butalbital (generic)Plavix clopidogrel (generic)Ponstel® etodolac (generic), ibuprofen (generic), indomethacin

capsule (generic), meclofenamate sodium (generic), naproxen (generic), sulindac (generic)

Prandimet® metformin HCl (generic), Prandin® (Novo Nordisk)Pravachol® pravastatin (generic), omega-3-acid ethyl esters

(generic)Precose® acarbose (generic)Prevacid® lansoprazole (generic), omeprazole (generic),

pantoprazole (generic), rabeprazole (generic), Nexium®

(AstraZeneca)


29

Prilosec Rx® omeprazole (generic), pantoprazole (generic), rabeprazole (generic), Nexium® (AstraZeneca)

Primsol® trimethoprim (generic)Prinivil® lisinopril (generic)Prinzide® lisinopril/hydrochlorothiazide (generic)Pristiq ER® citalopram (generic), desvenlafaxine ER (generic),

paroxetine CR 12.5mg and 25mg, paroxetine (generic),fluoxetine (generic), sertraline (generic)

Procardia XL® nifedipine ER tablet, sustained release osmotic push(generic)

Proquin XR® ciprofloxacin HCl (generic) ProSom® estazolam (generic)Protonix® Nexium® Suspension (AstraZeneca), rabeprazole

Suspension (generic)Protonix® Tablet pantoprazole sodium (generic), omeprazole (generic),

rabeprazole (generic), Nexium® (AstraZeneca)Provigil® amphetamine aspartate/amphetamine sulfate/

dextroamphetamine (generic), dexmethylphenidate(generic), methylphenidate SR (generic), D-amphetamine sulfate (generic), methylphenidate(generic), modafinil (generic)

Prozac® fluoxetine HCl (generic)Prozac Weekly® fluoxetine HCl (generic)Questran® cholestyramine (generic), omega-3-acid ethyl esters

(generic), prevalite (generic)Questran Light® cholestyramine/aspartame (generic), omega-3-acid

ethyl esters (generic), prevalite (generic)Raniclor® cefaclor suspension (generic), cefaclor capsule

(generic)Razadyne® galantamine (generic)Razadyne ER® galantamine ER (generic)Relafen® nabumetone (generic)Relpax® naratriptan HCl (generic), sumatriptan (generic)Remeron® mirtazapine soltabs (generic), mirtazapine tabs

(generic)Restoril® eszoplicone (generic)Riomet Solution® metformin HCl (generic)Risperdal risperidone (generic)

Oral Solution®

Risperdal Tablet® risperidone (generic)Risperdal M Tab® risperidone orally disintegrating tablet (generic)Rozerem® estazolam (generic), eszoplicone (generic), zolpidem

tartrate (generic)




30

Sanctura® trospium (generic)Sanctura XR® trospium ER (generic)Sarafem® fluoxetine HCl (generic)Seasonale® Jolessa® (Barr-branded generic*), Quasense®

(Watson-branded generic*), Lybrel® (Wyeth),Seasonique® (Duramed/Barr)

Seconal Sodium®

Sectral® acebutolol HCl (generic)Septra DS® sulfamethoxazole/trimethoprim (generic)Serophene® clomiphene citrate (generic)Seroquel quetiapine (generic)Simcor® omega-3-acid ethyl esters (generic), simvastatin

(generic)Skelaxin® cyclobenzaprine (generic), chlorzoxazone (generic),

diazepam (generic)Solodyn® minocycline HCl (generic), doxycycline monohydrate

(generic)Sonata® eszoplicone (generic), zaleplon (generic)Spectracef® cefaclor (generic), cefdinir (generic), cefuroxime axetil

(generic)Sporanox® itraconazole (generic)

capsuleStarlix® repaglinide (generic)Suboxone® tablets buprenorphine/naloxone (generic), Suboxone® filmSular® nisoldipine (generic)Suprax® cefdinir (generic), cefuroxime axetil (generic)Surmontil® trimipramine maleate (generic)Symbicort®

Symbyax® olanzapine (generic), fluoxetine HCl (generic),quetiapine (generic), risperidone (generic), Seroquel XR® (AstraZeneca)

Tagamet® cimetidine (generic), rabeprazole (generic)Tarka® amlodipine besylate/benazepril (generic)Tenex® guanfacine HCl (generic)Tenoretic® atenolol/chlorthalidone (generic)Tenormin® atenolol (generic)Terazol® terconazole (generic) Thioridazine HCl® chlorpromazine HCl (generic), haloperidol (generic),

quetiapine (generic), risperidone (generic)Tiazac® 120mg, diltiazem HCl capsule, sustained release 24 hr

180mg, 240mg, (generic)300mg, 360mg

Tiazac® 420mg diltiazem HCl capsule (generic)


31

Tofranil® imipramine HCl (generic)Tofranil® PM amitriptyline, (generic), desipramine (generic),

nortriptyline (generic), trimipramine maleate (generic)Toprol XL® metoprolol succinate (generic)Toradol® etodolac (generic), ibuprofen (generic), indomethacin

capsule (generic), meclofenamate sodium (generic), naproxen (generic), sulindac (generic)

Trandate® labetalol HCl (generic)Tranxene T-Tab® clorazepate dipotassium (generic)Tri-Levlen® Enpresse® (Barr-branded generic*), Trivora®

(Watson-branded generic*)Tri-Norinyl® Necon® (Watson-branded generic*), Nortrel®

(Barr-branded generic*)Tricor® fenofibrate micronized (generic), fenofibrate tablet

(generic), gemfibrozil (generic), omega-3-acid ethylesters (generic)

Triglide® fenofibrate micronized (generic), gemfibrozil (generic),omega-3-acid ethyl esters (generic)

Triphasil® Enpresse® (Barr-branded generic*), Trivora®

(Watson-branded generic*)Tussionex dextromethorphan HBr/pseudoephedrine HCl/

brompheniramine (generic), guaifenesin/dextromethorphan HBr tablet (generic),guaifenesin/codeine phosphate

Uniretic® moexipril/hydrochlorothiazide (generic)Univasc® benazepril (generic), enalapril maleate (generic),

lisinopril (generic), moexipril (generic)Uroxatral® alfuzosin (generic), doxazosin (generic), terazosin

(generic) Valium® diazepam (generic)Vantin® cefpodoxime proxetil (generic)Vaseretic® enalapril maleate/hydrochlorothiazide (generic)Vasotec® enalapril maleate (generic)Verelan® verapamil ER (generic)Verelan PM® verapamil ER PM (generic)Vfend® voriconazole (generic)Vibramycin® Syrup doxycycline monohydrate suspension (generic)Vistaril® hydroxyzine pamoate (generic)Vivactil® protriptyline HCl (generic)Voltaren® etodolac (generic), ibuprofen (generic), naproxen

(generic)Voltaren-XR® etodolac (generic), ibuprofen (generic), naproxen

(generic)




Vytorin® atorvastatin (generic), fluvastatin (generic), lovastatin(generic), simvastatin (generic), omega-3-acid ethylesters (generic), pravastatin (generic)

Vyvanse® amphetamine aspartate/amphetamine sulfate/dextroamphetamine (generic), dexmethylphenidate(generic), methylphenidate SR (generic), D-amphetamine sulfate (generic), methylphenidate(generic)

Welchol® cholestyramine (generic), colestipol (generic), lovastatin (generic), simvastatin (generic), omega-3-acid ethyl esters (generic), pravastatin (generic)

Wellbutrin® bupropion HCl (generic)Wellbutrin SR® bupropion HCl tablet, sustained release (generic)Wellbutrin XL® bupropion tablet, sustained release (generic)Wytensin® clonidine HCl (generic), methyldopa (generic)Xanax® alprazolam (generic)Xanax XR® alprazolam XR (generic)Xifaxan® 200mg azithromycin (generic), ciprofloxacin HCl (generic)Xolair® fluticasone propionate (generic), Asmanex® (Schering),

Pulmicort® (AstraZeneca), QVAR® (Ivax)Xopenex® Solution albuterol (generic), metaproterenol (generic)Xyrem® amphetamine aspartate/amphetamine sulfate/


Xyzal Solution® OTC fexofenadine HCl (generic), Allegra Suspension®

(Aventis)Xyzal Tablet® levocetirizine (generic)Yasmin® Ocella® (Barr-branded generic*)Zantac Rx® Syrup rabeprazole (generic), ranitidine HCl tablet (generic)Zantac Rx® Tablet rabeprazole (generic), ranitidine HCl tablet (generic)Zebeta® bisoprolol fumarate (generic)Zegerid® omeprazole (generic), rabeprazole (generic), Nexium®

(AstraZeneca)Zestoretic® lisinopril/hydrochlorothiazide (generic)Zestril® lisinopril (generic)Zetia® lovastatin (generic), simvastatin (generic), omega-3-

acid ethyl esters (generic), pravastatin (generic)Ziac® bisoprolol fumarate/hydrochlorothiazide (generic)Zithromax® azithromycin (generic)Zmax® azithromycin (generic)


Zocor® atorvastatin (generic), fluvastatin (generic), lovastatin(generic), omega-3-acid ethyl esters (generic), pravastatin (generic), simvastatin (generic)

Zoloft® sertraline HCl (generic)Zomig® naratriptan HCl (generic), sumatriptan (generic)Zomig ZMT® naratriptan HCl (generic), sumatriptan (generic),

zolmitriptan (generic)Zyflo® montelukast (generic)Zyflo CR® montelukast (generic)Zyprexa® olanzapine (generic), ziprasidone (generic)



34

2015 PREFERRED DRUG LIST EXCLUSIONS

The excluded medications shown below are not covered on the ExpressScripts drug list. In most cases, if you fill a prescription for one of thesedrugs, you will pay the full retail price.

TAKE ACTION TO AVOID PAYING FULL PRICE.If you are currently using one of the excluded medications, please askyour doctor to consider writing a new prescription for one of the following preferred alternatives.

Drug Class ExcludedMedications

PreferredAlternatives

AUTONOMIC & CENTRALNERVOUS SYSTEM

Interferon BetaMedications for Multiple Sclerosis

Betaseron Avonex, Extavia,Plegridy, Rebif

Long-Acting Opioid Oral Analgesics

Kadian, Oxycodone ER,Zohydro ER

morphine sulfate ER,oxymorphone ER,Nucynta ER, OpanaER, Oxycontin

Transmucosal FentanylAnalgesics

Abstral, Fentora,Subsys

fentanyl lozenge,Lazanda

Triptans Axert, Frova rizatriptan, sumatriptan,zolmitriptan, Relpax

CARDIOVASCULARAngiotensin II ReceptorAntagonists + DiureticCombinations

Edarbi/Edarbyclor,Teveten HCT

candesartan/HCTZ, ,irbesartan/HCTZ,losartan/HCTZ, valsartan/HCTZ,Benicar/HCT

DERMATOLOGICALTopical Acne/AntibioticCombinations

BenzaClin Gel Pump,Veltin

clindamycin/benzoylperoxide, clindamycin PLUStretinoin, Acanya,Ziana

DIABETESBlood Glucose Meters &Strips

Abbott (Freestyle,Precision), Bayer(Breeze, Contour),Nipro (TRUEtest,TRUEtrack), Roche(Accu-Chek)

LifeScan (OneTouch)

35



Dipeptidyl Peptidase-4Inhibitors &Combinations

Jentadueto, Kazano,Nesina, Tradjenta

Janumet, JanumetXR, Januvia,Kombiglyze XR,Onglyza

Glucagon-Like Peptide-1Agonists

Tanzeum, Victoza Bydureon, Byetta,Trulicity

Insulins Novolin HumulinApidra, NovoLog Humalog

EAR/NOSENasal Steroids

Beconase AQ,Omnaris, Veramyst,Zetonna

flunisolide, fluticasone propionate, triamcinolone acetonide, Nasonex,Qnasl

Otic FluoroquinoloneAntibiotics

Cetraxal ciprofloxacin oticsolution, Ciprodex

ENDOCRINE (OTHER)Growth Hormones

Nutropin/NutropinAQ, Omnitrope,Saizen, Tev-Tropin

Genotropin,Humatrope,Norditropin

Topical TestosteroneProducts

Fortesta, Testim,Testosterone Gel,Vogelxo

AndroGel, Axiron

GASTROINTESTINAL Anti-Inflammatory/Anti-Ulcer Agents

Duexis famotidine PLUSibuprofen

Vimovo omeprazole PLUSnaproxen

Pancreatic Enzymes Pancreaze, Pertzye,Ultresa

pancrelipase, Creon,Zenpep

HEMATOLOGICALErythropoiesis-Stimulating Agents

Aranesp, Epogen Procrit

HEPATITISAntivirals

Moderiba, RibaPak,RibaTab

ribavirin capsules,ribavirin tablets

Hepatitis C (genotype 1) Harvoni, Incivek,Olysio, Sovaldi*

Viekira Pak

Pegylated Interferons PegIntron Pegasys

INFLAMMATORY CONDITIONS

Tumor Necrosis FactorAntagonists and OtherDrugs for InflammatoryConditions

Cimzia, Simponi,Xeljanz

Enbrel, Humira,Stelara

36



OBSTETRICAL & GYNECOLOGICAL

Ovulatory Stimulants(Follitropins)

Bravelle, Follistim AQ Gonal-f

OPHTHALMICAntiglaucoma Drugs(OphthalmicProstaglandins)

Zioptan latanoprost ophthalmic solution,travoprost ophthalmic solution,Lumigan, Travatan Z

OSTEOARTHRITISHyaluronic AcidDerivatives

Euflexxa, Gel-One,Hyalgan, Supartz

Monovisc, Orthovisc,Synvisc, Synvisc-One

RESPIRATORYPulmonary Anti-InflammatoryInhalers

Alvesco, ArnuityEllipta, FloventDiskus/HFA

AsmanexTwisthaler/HFA,Pulmicort Flexhaler,QVAR

Pulmonary Anti-Inflammatory/Beta AgonistCombination Inhalers

Breo Ellipta Dulera, Symbicort

Short-Acting Beta-2Adrenergic Inhalers

Proventil HFA,Xopenex HFA

ProAir HFA, VentolinHFA

UROLOGICALErectile Dysfunction OralAgents

Levitra, Staxyn,Stendra

Cialis, Viagra

Additional covered alternatives may be available. Costs for covered alternatives may vary. Log on to Express-Scripts.com/covered to comparedrug prices. Other prescription benefit considerations may apply.

37

EXCLUDED MEDICATIONS/PRODUCTS AT A GLANCE

Abbott (FreeStyle, Precision)AbstralAlvescoApidraAranespArnuity ElliptaAxertBayer (Breeze, Contour)Beconase AQBenzaClin Gel PumpBetaseronBravelleBreo ElliptaCetraxalCimziaDuexisEdarbi/EdarbyclorEpogenEuflexxaFentoraFlovent Diskus/HFAFollistim AQFortestaFrovaGel-OneHarvoniHyalganIncivekJentaduetoKadianKazanoLevitraModeribaNesinaNipro (TRUEtest, TRUEtrack)NovolinNovoLog

Nutropin/Nutropin AQOlysioOmnarisOmnitropeOxycodone ERPancreazePegIntronPertzyeProventil HFARibaPakRibaTabRoche (Accu-Chek)SaizenSimponiSovaldi*StaxynStendraSubsysSupartzTanzeumTestimTestosterone GelTeveten HCTTev-TropinTradjentaUltresaVeltinVeramystVictozaVimovoVogelxoXeljanzXopenex HFAZetonnaZioptanZohydro ER

* Sovaldi may be covered for chronic hepatitis C genotypes 2-6 with a coverage review

This guide does not contain a complete list of formulary and nonformulary drugs. It only liststhe most commonly prescribed drugs.

Documents

Advanced Reference Formulary Member Guide - lee.netlee.net/app/formulary/formulary.pdf · The Advanced Reference Formulary Member Guide is ... generic and preferred brand-name drugs