tcatamaran

January 2013

NATIONAL FORMULARY DRUG LISTUniversity of Toledo

The Catamaran Drug List is a guide identifyingpreferred brand-name medicines within selecttherapeutic categories. The Drug List may notinclude all drugs covered by your prescription drugbenefit. Generic medicines are available withinmany of the therapeutic categories listed, in additionto categories not listed, and should be consideredas the first line of prescribing.

For benefit coverage or restrictions please checkyour benefit plan document(s). This listing is revisedperiodically as new drugs and new prescribinginformation becomes available. It is recommendedthat you bring this list of medications when you or acovered family member sees a physician or otherhealthcare provider.

cefuroxime sodiumcephalexintazicefNON PREFERREDCedaxCeftinClaforanFortazKeflexRocephinSpectracefSupraxZinacef

PÿlIElÿl iIÿ.'I ÿliÿ P".III I[O] =!b'dl

ANTIFUNGALSGENERICamphotericin bfluconazoleflucytosinegriseofulvin microsizegriseofulvin ultramicrosizeitraconazoleketoconazolenystatinterbinafine hclvoriconazolePREFERRED BRANDNoxafilNON PREFERREDAncobonBio-statinDiflucanGrifulvin VGris-pegLamisilOnmelSporanoxSporanox PulsepakTerbinexVfend

PENICILLINSGENERICamoxicillinamoxicillin/clavulanate potassiumamoxicillin/clavulanate potassium eramoxicillin/potassium clavulanateampicillinampicillin sodiumampicillin-sulbactamdicloxacillin sodiumnafcillin sodiumoxacillin sodiumpenicillin g potassiumpenicillin g procainepenicillin g sodiumpenicillin v potassiumpfizerpen-gPREFERRED BRANDAugmentinNON PREFERREDAugmentin Es-600Augmentin XrBicillin C-rBicillin L-aMoxatagUnasynUnasyn Bulk Pack

NSAIDS

tetracycline hclNON PREFERREDAdoxaAdoxa Pak 1/100Adoxa Pak 11150Adoxa Pak 2/100AIodox Convenience KitDoryxDynacinMinocinMinocin KitMonodoxNutridoxOcudoxOraxylSolodynVibramycin

CEPHALOSPORINSGENERICcefaclorcefaclor ercefadroxilcefazolin sodiumcefdinirCefditoren Pivoxilcefepimecefotaxime sodiumcefotetancefoxitin sodiumcefpodoxime proxetilcefprozilceftazidimeceftriaxone sodiumcefuroxime axetil

QUlNOLONESGENERICciprofloxacin erciprofloxacin hcllevofloxacinofloxacinPREFERRED BRANDAveloxAvelox Abc PackNON PREFERREDCiproCipro XrFactiveLevaquinNoroxin

TETRACYCLINESGENERICavidoxydemeclocycline hcldoxycyclinedoxycycline hyclatedoxycycline monohydrateminocycline hclminocycline hcl ermorgidox lxl 00ragmorgidox 2xl00mg

GENERICdiclofenac potassiumdiclofenac sodium drdiclofenac sodium erDiclofenac Sodium Xrdiclofenac sodium/misoprostoletodolacetodolac erfenoprofen calciumflurbiprofenibuprofenindomethacinindomethacin erketoprofenketoprofen erketorolac tromethaminemeclofenamate sodiummefenamic acidMeloxicamnabumetonenaproxennaproxen drnaproxen sodiumoxaprozinpiroxicamsulindactolmetin sodiumPREFERRED BRANDCelebrexVimovoNON PREFERREDAnaproxAnaprox DsArthrotec 50Arthrotec 75CataflamClinorilDayproDuexisEc-naprosynFeldeneIbuprofen Comfort PacIc 400Ic 800IndocinMeloxicam Comfort PacMobicNalfonNaprelan

Effective January 1, 2013

NaprosynNaproxen Comfort PacPonstelSprixVoltaren-xrWound GelZipsor

PREFERRED BRANDEnbrelEnbrel SureclickHumiraHumira PenHumira Pen-crohns DiseasestarterHumira Pen-psoriasis StarterNON PREFERREDCimziaCimzia Starter KitKineretOrenciaSimponiXeljanz

ACE-INHIBITORSGENERICbenazepril hclcaptoprilenalapril maleatefosinopril sodiumlisinoprilmoexipril hclperindopril erbuminequinapril hclramipriltrandolaprilNON PREFERREDAccuprilAceonAltaceLotensinMavikPrinivilUnivascVasotecZestril

ANGIOTENSlN RCPTR BLOCKERGENERICeprosartan mesylateirbesartaniosartan potassiumPREFERRED BRANDAtacandBenicarDiovanMicardisNON PREFERREDAvaproCozaarEdarbiTeveten

BETA BLOCKERSGENERICacebutolol hclatenolol

betaxolol hclbisoprolol fumaratemetoprolol succinate ermetoprolol tartratenadololpindololpropranolol hclpropranolol hc! ersorinesotalol hclsotalol hcl (af)timolol maleatePREFERRED BRANDBystolicNON PREFERREDBetapaceBetapace AfCorgardInderal LaInnopran XlKerloneLevatolLopressorMetoprololSectralTenorminToprol XIZebeta

CALCIUM CHANNEL BLOCKERSGENERICafeditab cramlodipine besylatecartia xtdilt-cddilt-xrdiltiazem cddiltiazem hclDiltiazem Hcl Cddiltiazem hcl erdiltzacfelodipine erisradipinematzim lanicardipine hclnifediac ccnifedical xlnifedipinenifedipine ernimodipinenisoldipinenisoldipine ertaztia xtverapamil hclverapamil hcl erVerapamil Hcl SrPREFERRED BRANDCardizem LaNON PREFERREDAdalat CcCalanCalan SrCardene SrCardizemCardizem CdCovera-hsDilacor XrDynacirc CrIsoptin Sr

NimotopNorvascProcardiaProcardia XISularTiazacVerelanVerelan Pm

NITRATES & NITRITESGENERICamyl nitriteisochronisoditrate erisosorbide dinitrateisosorbide dinitrate erisosorbide mononitrateisosorbide mononitrate erminitrannitroglycerinNitroglycerin Lingualnitroglycerin transdermalPREFERRED BRANDDilatrate SrNitro-bidNitro-durNitrolingual PumpsprayNitrostatNON PREFERREDImdurIsordil TitradoseMonoketNitromist

ANTI-HTN COMBINATIONSGENERICamlodipine besylate/benazepril hclamlodipine besylate/benazeprilhydrochlorideatenolol/chlorthalidonebenazepril hc!/hydrochlorothiazidebisoprololfumarate/hydrochlorothiazidecandesartancilexetil/hyd rochlorothiazidecaptopril/hydrochlorothiazideenalapril maleate/hyd rochlorothiazidefosinopril sodium/hydrochlorothiazideirbesartan/hydrochlorothiazidelisinopril/hydrochlorothiazideIosartanpotassium/hydrochlorothiazidemethyldopa/hydrochlorothiazidemetoprolol/hyd rochlorothiazidemoexipril/hydrochlorothiazidenadolol/bendroflumethiazidepropranolol/hyd rochlorothiazideq uinapril/hydrochlorothiazidevalsartan/hydrochlorothiazidePREFERRED BRANDAmturnideAzorBenicar HctExforgeExforge HctMicardis HctTarkaTekamloTekturna HctTribenzor

Effective January l, 2013

TwynstaValturnaNON PREFERREDAccureticAtacand HctAvalideClorpresCorzideDiovan HctDutoprolEdarbyclorHypertensololHyzaarLopressor HctLotensin HctLotrelLytensoprilLytensopril-90PrinzideTenoretic 100Tenoretic 50Teveten HctUnireticVasereticZestoreticZiac

ANTIHYPERLIPIDEMICSS TA TINS

GENERICatorvastatin calciumfluvastatinIovastatinpravastatin sodiumsimvastatinPREFERRED BRANDAltoprevCrestorNON PREFERREDLescolLescol XILipitorLivaloMevacorPravacholZocor

FIBRA TESGENERICFenofibratefenofibrate micronizedFenofibric AcidgemfibrozilPREFERRED BRANDAntaraFenoglideLipofenTriglideTrilipixNON PREFERREDFibricorLofibraLopidTricor

BILE ACID SEQUESTRANTSGENERICcholestyraminecholestyramine lightcolestipol hclcolestipol hcl for oral suspensionMicronized Colestipol Hcl

prevalitePREFERRED BRANDWelcholNON PREFERREDColestidColestid FlavoredQuestranQuestran Light

CHOLEST ABS INHBTR/COMBOPREFERRED BRANDVytorinZetia

NIA CIN/C OMBINA TIONSPREFERRED BRANDNiaspanSimcorNON PREFERREDAdvicor

OMEGA-3 FATTY AClDSPREFERRED BRANDLovaza

ACNEGENERICadapaleneamnesteemavar cleanseravar-e emollientavar-e green

Avitabenzeprobenzepro short contactbenziq washbenzoyl peroxidebenzoyl peroxide cleanserbenzoyl peroxide cleansingbenzoyl peroxide short contactbenzoyl peroxide washbenzoyl peroxide wash acne treatmentpackbp cleanserbp cleansing washbp washbp 10-1bpobpo creamy wash complete packbpo 3% foaming clothsbpo 6% foaming clothsbpo 9% foaming clothscerisa washclaravisclaris clarifying washclearplex xcleniaclenia foaming washclindacin-pclindamaxclindamycin phosphateclindamycin/benzoyl peroxideclindareacheryerythromycinerythromycin/benzoyl peroxidelavoclen-4 acne wash kitlavoclen-4 creamy washlavoclen-8 acne wash kitlavoclen-8 creamy washmetronidazole

myorisanoscion cleanserpacnex washpr benzoyl peroxide washprascionprascion fcprascion ra with sunscreensra renewal medicated acne treatmentmaximum strengthrosadanrosanil cleanserse bpo washse bpo 3% foaming clothsse bpo 6% foaming clothsse bpo 7-5.5 wash kitse bpo 9% foaming clothsse 10-5 ssSodium Sulfacetamidesodium sulfacetamide/sulfursodium sulfacetamide/sulfur cleansersodium sulfacetamide/sulfur cleanserin ureasodium sulfacetamide/sulfur cleansingclothssodium sulfacetamide/sulfur greensodium sulfacetamide/sulfur in ureasodium sulfacetamide/sulfur washsotretsulfacetamide sodiumsulfacetamide sodium/sulfur cleansersulfacleanse 8/4supheratl bpo mx cleanserTretinoinvirti-sulfvitazolzaclir cleansingzenciaPREFERRED BRANDAcanyaAczoneAtralinAzelexEpiduoFinaceaMetrogelOraceaVeltinNON PREFERREDAbsoricaAkne-mycinAvar Ls CleanserAvar-e LsBenzac Ac WashBenzac W WashBenzaclinBenzaclin With PumpBenzamycinBenzamycinpakBenzefoamBenzefoamultraBenziqBenziq LsClarifoam EfCleocin-tClindacin PacClindagelDelosDesquam-x WashDifferinDuac

Effective Janual2¢ l, 2013

EvoclinFinacea PlusInovaInova 4/1 Acne Control TherapyInova 8/2 Acne Control TherapyKlaronMetrocreamMetrolotionNeobenz MicroNeobenz Micro Plus PackNeobenz Micro SdNeobenz Micro WashNeobenz Micro Wash Plus PackNoritateNuoxPacnex HpPacnex LpPacnex MxPlexion CleanserPlexion Cleansing ClothPlexion SctRetin-aRetin-a MicroRetin-a Micro PumpRosadan KitRosanilSss 10-4SulfoamSumadan KitSumadan WashSumaxinSumaxin Cp KitSumaxin TsSumaxin WashTretin-xTriazTriaz CleanserTriaz Foaming ClothsVanoxide HcVanoxide-hcZacare 4% KitZacare 8% KitZiana

TOPICAL ANTI-INFLAMMATORYGENERICala cortalclometasone dipropionatealphatrexamcinonideapexiconapexicon eaugmented betamethasonedipropionatebetamethasone dipropionatebetamethasone valerateclobetasol propionateclobetasol propionate eclobetasol propionate emollientcormaxcormax scalp applicationcor[alodesonidedesoximetasonediflorasone diacetatefluocinolone acetonidefluocinolone acetonide bodyfluocinolone acetonide scalpfluocinonide

fluocinonide emollient basefluocinonide-efluticasone propionatehalachalobetasol propionatehalonate pachydrocortisonehydrocortisone acetate/aloehydrocortisone butyratehydrocortisone in absorbasehydrocortisone valerateLokaramometasone furoatepramcor[prednicarbatescalacortsynalartriamcinolone acetonidetriamcinolone acetonide in absorbasetrianextridermu-cort

PREFERRED BRANDCapexCordran TapeHalogKenalogLocoid LipocreamTaclonexNON PREFERREDAclovateAla ScalpAqua Glycolic Hc Scalp & BodyCarmol-hcCIobeta CreamClobeta OintmentClobexClodermCloderm PumpCordranCordran SpCutivateDerma-smoothe/fs Body OilDerma-smoothe/fs Scalp OilDermatopDesonateDesonilDesowenDesowen Cream/cetaphil LotionDesowen Lotion/cetaphil CreamDesowen Ointment/cetaphil LotionDiproleneDiprolene AfEloconEpifoamFirst-hydrocortisoneHalonateLidamantle HcLocoidLuxiqMomexinNucortNuzonOluxOlux-ePandelPediaderm HcPediaderm TaPramosoneScalacort Dk

Synalar Cream KitSynalar Ointment KitSynalar TsTemovateTemovate ETexacortTopicortUltravateUltravate PacUltravate XVanosVerdesoWestcort

CONTRACEPTIVE AGENTSPREFERRED BRANDDepo-provera

ESTROGENS/COMBINATIONSGENERICestradiolestradiol valerateestradiol/norethindrone acetateestropipateJevantiquejintelimimveyor[ho-estPREFERRED BRANDCenestinCombipatchEnjuviaEstringEvamistPremphasePremproVagifemVivelle-dotNON PREFERREDActivellaAloraAngeliqClimaraClimara ProDelestrogenDepo-estradiolDivigelElestrinEstraceEstradermEstrasorbEstrogelFemhrt Low DoseFemhrt 1/5FemringFemtraceMenestMenostarMinivellePrefestPremarin

TESTOSTERONE AGENTSGENERICdanazoltestosterone cypionatetestosterone enanthate

Effective January 1,20134

PREFERRED BRANDAndrodermAndrogelAndrogel PumpAndroxyAxironFortestaMethitestNON PREFERREDandroidDelatestrylDepo-testosteroneFirst-testosteroneFirst-testosterone Mc CompoundingKitStriantTestimTestopeltestred

INSULINPREFERRED BRANDApidraApidra SolostarHumalogHumalog KwikpenHumalog Mix 50/50Humalog Mix 50/50 KwikpenHumalog Mix 75/25Humalog Mix 75/25 KwikpenHumulin R U-500 (concentrated)LantusLantus SolostarLevemirLevemir FlexpenNovologNovolog FlexpenNovolog Mix 70/30Novolog Mix 70/30 Prefilled FlexpenNovolog Penfill

NON-INSULIN HYPOGLYCEMICSBIGUANIDES

GENERICmetformin hclmetformin hcl erPREFERRED BRANDRiometNON PREFERREDFortametGlucophageGlucophage XrGlumetza

BIGUAN/SULFONYLUREA COMB.GENERICglipizide/metformin hclglyburide/metformin hclNON PREFERREDGlucovanceMetaglip

BIGUAN/THIAZOLIDEINEDIONEGENERICPioglitazone HclPioglitazone Hcl/metformin HclPREFERRED BRANDActoplus Met XrNON PREFERREDActoplus MetActosAvandamet

AvandiaDPP-4 INHIBITORS

PREFERRED BRANDJanuviaOnglyzaTradjenta

BIGUANIDE/DPP-4 COMB.PREFERRED BRANDJanumetJanumet XrJentaduetoKombiglyze Xr

SULFONYLUREASGENERICchlorpropamideglimepirideglipizideglipizide erGlipizide Xlglyburideglyburide micronizedtolazamidetolbutamideNON PREFERREDAmarylDiabetaGlucotrolGlucotrol XIGlynase

SULFONYLUREA/TZD COMB.PREFERRED BRANDDuetactNON PREFERREDAvandaryl

INCRETINSPREFERRED BRANDBydureonByettaVictoza

AMYLIN ANALOGSPREFERRED BRANDSymlinSymlinpen 120Symlinpen 60

A N TIH YPO GL YCEMIC A GENTSPREFERRED BRANDGlucagon Emergency KitNON PREFERREDGlucagenGlucagen HypokitProglycem

Protonix

ULCER DRUGSGENERICcimetidinecimetidine hclfamotidinemisoprostolnizatidineranitidine hclsucralfatePREFERRED BRANDCarafateNON PREFERREDAxidCytotecPepcidZantac

PUMP INHIBITORSGENERIClansoprazoleLansoprazole OdtomeprazolePantoprazole SodiumPREFERRED BRANDNexiumNON PREFERREDAciphexDexilantFirst-lansoprazoleFirst-omeprazolePrevacidPrevacid SolutabPrilosec

Effective January 1, 2013

PROTON

ANTIVIRALSGENERICribapakribasphereribatabribavirinNON PREFERREDCopegusRebetol

INTERFERONSPREFERRED BRANDPeg-intronPeg-intron RedipenPeg-intron Redipen Pak 4PegasysPegasys ProclickNON PREFERREDInfergen

PROTEASE INHIBITORSPREFERRED BRANDIncivekVictrelis

PREFERRED BRANDAmpyraAvonexAvonex PenCopaxoneRebifRebif Titration PackNON PREFERREDAubagioBetaseronExtaviaGilenya

ALZHEIMER'S DISEASEGENERICdonepezil hclgalantaminegalantamine hydrobromiderivastigmine tartratePREFERRED BRANDNamendaNamenda Titration PakNON PREFERREDAriceptAricept OdtExelonRazadyneRazadyne Er

ANTICONVULSANTSGENERICcarbamazepineCarbamazepine Erclonazepamclonazepam odtDiazepamdivalproex sodiumdivalproex sodium drdivalproex sodium erepitolethosuximideFelbamatefosphenytoin sodiumgabapentinlamotriginelevetiracetamlevetiracetam eroxcarbazepinephenytoinphenytoin sodiumphenytoin sodium extendedprimidonetiagabine hydrochloridetopiragentopiramatevalproic acidzonisamidePREFERRED BRANDBanzelCelontindiastat pediatricDilantin InfatabsLamictal OdtLamictal XrLyricaPeganone

PotigaTegretol-xrVimpatNON PREFERREDCarbatrolDepakeneDepakoteDepakote ErDepakote Sprinklesdiastat acudialDilantinFelbatolGabitrilKeppraKeppra XrKlonopinLamictalLamictal Chewable DispersibleLamictal Starter/not TakingCarbamazepineLamictal Starter/takingCarbamazepine/not Taking ValproateLamictal Startedtaking ValproateMysolineNeurontinOnfiPhenytekSabrilStavzorTegretolTherapentin-60Therapentin-90TopamaxTopamax SprinkleTrileptalZarontinZonegran

ANTI-ALLERGIC AGENTSGENERICazelastine hclcromolyn sodiumepinastine hclPREFERRED BRANDPatadayPatanolNON PREFERREDAlamastAlocrilAlomideBepreveElestatEmadineLastacaftOptivar

MIGRAINE/HEADACHEGENERICdihydroergotamine mesylatenaratriptan hclSumatriptansumatriptan succinateSumatriptan Succinate RefillPREFERRED BRANDCafergotErgomarMaxaltMaxalt-mltRelpaxTreximetZomigZomig ZmtNON PREFERREDAlsumaAmergeAxertCambiaD.h.e. 45

FrovaImitrexImitrex Statdose RefillImitrex Statdose SystemMigergotMigralMigranalSumavel Dosepro

ANTI-GLAUCOMA AGENTSGENERICapraclonidinebetaxolol hclbrimonidine tartratecarteolol hcldorzolamide hcldorzolamide hcl/timolol maleatelatanoprostlevobunolol hclMetipranololtimolol maleateTimolol Maleate Ophthalmic GelFormingPREFERRED BRANDAzoptBetoptic-sCombiganLumiganTravatan ZNON PREFERREDAlphagan PBetaganBetimolCosoptCosopt PfIopidineIstalolOptipranololTimopticTimoptic OcudoseTimoptic-xeTrusoptXalatanZioptan

ANTI-INFECTIVESGENERICbacitracinciprofloxacin hclerythromycingaramycingentakgentamicin sulfateilotycinlevofloxacinofloxacinromycintobramycin sulfatetobrasol

Effective January 1,2013

PREFERRED BRANDBesivanceCiloxanMoxezaVigamoxZymaxidNON PREFERREDAzasiteIquixMitosolOcufloxQuixinTobrex

ANTI-INFLAMMATORY AGENTSGENERICbromfenaccromolyn sodiumdiclofenac sodiumflurbiprofen sodiumketorolac tromethaminePREFERRED BRANDAcuvailBromdayNevanacNON PREFERREDAcularAcular LsIlevroOcufenVoltaren

MIOTICSGENERICpilocarpine hclPREFERRED BRANDIsopto CarbacholPhospholine iodidePilopine HsNON PREFERREDIsopto Carpine

MISCELLANEOUSPREFERRED BRANDLacrisertRestasis

BISPHOSPHONATESGENERIC_alendronate sodiumetidronate disodiumibandronate sodiumPREFERRED BRANDActonelAtelviaNON PREFERREDBinostoBonivaDidronelFosamaxFosamax Plus DSkelid

PREFERRED BRANDAbilifyAbilify DiscmeltLatudaSeroquel XrNON PREFERREDClozarilEquetroFanaptFanapt Titration PackFazacloGeodonHaldolHaldol Decanoate 100Haldol Decanoate 50InvegaInvega SustennaLithobidLoxitaneNavaneRisperdalRisperdal ConstaRisperdal M-tabSaphrisSeroquelZyprexaZyprexa RelprevvZyprexa Zydis

CORTICOSTEROIDS/RELATEDGENERICdexamethasone sodium phosphatefluor-opFluorometholoneneomycinlpolymyxinlbacitracinlhydrocortisoneneomycin/polymyxin/dexamethasoneneomycin/polymyxin/hydrocortisonepoly-dexPrednisolone Acetateprednisolone sodium phosphatesulfacetamide sodium/prednisolonesodium phosphatetobramycin/dexamethasonePREFERRED BRANDAlrexBlephamide S.o.p.DurezolFmlLotemaxPred MildTobradex StZyletNON PREFERREDBlephamideFlarexFml ForteFml LiquifilmMaxidexMaxitrolOmnipredPoly-predPred FortePred-gPred-g S.o.p.

TobradexVexol

SERMPREFERRED BRANDEvista

ATYPICAL ANTIPSYCHOTICSGENERICchlorpromazine hclclozapineClozapine Odtcomprofluphenazine decanoatefluphenazine hclhaloperidolhaloperidol decanoatehaloperidol lactateLithium Carbonatelithium carbonate erLithium CitrateIoxapineIoxapine succinateolanzapineolanzapine odtperphenazineprochlorperazineprochlorperazine edisylateprochlorperazine maleatequetiapine fumaraterisperidoneRisperidone M-tabrisperidone odtthioridazine hclthiothixenetrifluoperazine hclziprasidone hcl

CNS STIMULANTSGENERICAmphetamine/dextroamphetaminedexmethylphenidate hcldextroamphetamine sulfatedextroamphetamine sulfate ermetadate ermethamphetamine hclmethylinmethylin ermethylphenidate hclmethylphenidate hcl cdmethylphenidate hcl erMethylphenidate Hcl Srmethylphenidate hydrochloridemodafinilPREFERRED BRANDDaytranaIntunivVyvanseNON PREFERREDAdderallAdderall XrConcertaDesoxynDexedrineFocalinFocalin XrKapvayKapvay Dose PackMetadate CdNuvigilProcentraProvigilQuillivant XrRitalinRitalin LaRitalin Sr

Iÿ.'ÿ'ÿ1: [oÿ:[uJnl[o.];.l

Effective January l, 2013

SNRI ANTIDEPRESSANTSGENERICvenlafaxine hclvenlafaxine hcl erPREFERRED BRANDCymbaltaPristiqNON PREFERREDEffexor Xr

SSRI ANTIDEPRESSANTSGENERICcitalopram hydrobromideescitalopram oxalatefluoxetine drfluoxetine hclfluvoxamine maleateparoxetine hclparoxetine hcl ersertraline hclPREFERRED BRANDPaxilNON PREFERREDCelexaLexaproLuvox CrPaxil CrPexevaProzacProzac WeeklyZoloft

PREFERRED BRANDForadil AerolizerPerforomistProair HfaSerevent DiskusVentolin HfaNON PREFERREDAccunebArcapta NeohalerBrovanaIsuprelMaxair AutohalerProventil HfaVospire ErXopenexXopenex ConcentrateXopenex Hfa

STEROID/BETA AGONISTPREFERRED BRANDAdvair DiskusAdvair HfaDuleraSymbicort

BENIGN

ANTICHLNRGC/BETA AGONISTGENERICipratropium bromide/albuterol sulfatePREFERRED BRANDCombiventCombivent RespimatNON PREFERREDDuoneb

BETA AGONISTSGENERICalbuterol sulfatealbuterol sulfate erlevalbuterolLevalbuterol Hclmetaproterenol sulfateterbutaline sulfate

Effective January 1,2013

LEUKOTRIENE RCPTR ANTGNSTGENERICmontelukast sodiumZafirlukastNON PREFERREDAccolateSingulair

PULMONARY CORTICOSTEROIDSGENERICbudesonidePREFERRED BRANDAlvescoAsmanex 120 Metered DosesAsmanex 14 Metered DosesAsmanex 30 Metered DosesAsmanex 60 Metered DosesAsmanex 7 Metered DosesPulmicort FlexhalerQvarNON PREFERREDFlovent DiskusFlovent HfaPulmicort

NASAL ANTIHISTAMINESGENERICazelastine hclPREFERRED BRANDAsteproNON PREFERREDAstelinPatanase

NASAL CORTICOSTEROIDSGENERICflunisolidefluticasone propionatetriamcinolone acetonidePREFERRED BRANDNasonexQnaslRhinocort AquaVeramystNON PREFERREDBeconase AqFlonaseNasacort AqOmnarisZetonna

ANTICHOLINERGICSGENERICipratropium bromidePREFERRED BRANDAtrovent HfaSpiriva HandihalerTudorza Pressair

ANAPHYLAXIS TX AGENTSGENERICEpinephrinePREFERRED BRANDEpipenEpipen 2-pakEpipen-jrEpipen-jr 2-pakNON PREFERREDTwinject

PRSTATC HYPRPLSIAGENERICalfuzosin hcl erfinasteridetamsulosin hclPREFERRED BRANDRapafloNON PREFERREDAvodartCardura XlFlomaxJalynProscarUroxatral

URINARY ANTISPASMODICSGENERICbethanechol chlorideflavoxate hcloxybutynin chlorideoxybutynin chloride erTolterodine Tartratetrospium chloridetrospium chloride erPREFERRED BRANDDetrol LaEnablexGelniqueOxytrolToviazVesicareNON PREFERREDDetrolDitropan XIMyrbetriqSancturaSanctura XrUrecholine

Formulary Disclaimer: Coverage for some drugsmay be limited to specific dosage forms and/orstrengths. The benefit design determines what iscovered and the applicable co-payment. Themedications listed on this formulary are subject tochange pursuant to the formulary managementactivities of Catamaran. The presence of amedication on this formulary list does not guaranteecoverage.