-infectives - healthscope benefits pdl january 2015.pdf · anti-infectives ... tier 01 mefenamic...

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


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


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


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


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


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



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


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


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


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


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



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



GENERIC

Asmanex Twisthaler 120 Metered Doses

TIER 02 PREFERRED

venlafaxine HCLQL

Accu-chek Active Strips


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


PristiqQL

Onetouch Basic/Profile Test Strips

Onetouch Profile System


SSRI ANTIDEPRESSANTS

Onetouch Ultralink System (hex)

TIER 01 GENERIC


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


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


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


montelukast sodium

Accu-chek Aviva

zafirlukast

Accu-chek Aviva Plus

Accu-chek Compact Plus Care Kit

PULMONARY CORTICOSTEROIDS

Accu-chek Compact Test Drum


Onetouch Ultra Blue

budesonide

Onetouch Ultra Mini

Onetouch Ultra 2



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


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


dexmethylphenidate HCL, 4

cefprozil, 1

dexmethylphenidate HCL ER, 4

ceftazidime, 1


dextroamphetamine sulfate, 4

Ceftazidime/Dextrose, 1

dextroamphetamine sulfate ER, 4

Ceftin, 1


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

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