adenosine receptor antagonist€¦ · web viewchemotherapy adjuncts - hyperuricemia agents33...

ADENOSINE RECEPTOR ANTAGONIST.............................................................................................................................. 18

ADENOSINE RECEPTOR ANTAGONIS................................................................................................................................................18

ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS.............................................................................................18

ADHD AGENT - SELECTIVE ALPHA ADRENERGIC AGONISTS........................................................................................................18ADHD AGENT - SELECTIVE NOREPINEPHRINE REUPTAKE INHIBITOR...........................................................................................18AMPHETAMINE MIXTURES.................................................................................................................................................................18AMPHETAMINES.................................................................................................................................................................................18ANALEPTICS...................................................................................................................................................................................... 18ANOREXIANTS NON-AMPHETAMINE..................................................................................................................................................18STIMULANTS - MISC..........................................................................................................................................................................18

ALS AGENTS - MISCELLANEOUS........................................................................................................................................ 18

ALS AGENTS - MISCELLANEOUS.....................................................................................................................................................18

AMINOGLYCOSIDES............................................................................................................................................................... 18

AMINOGLYCOSIDES...........................................................................................................................................................................18

ANALGESICS - ANTI-INFLAMMATORY................................................................................................................................ 19

ANTIRHEUMATIC - JANUS KINASE (JAK) INHIBITORS.....................................................................................................................19ANTIRHEUMATIC ANTIMETABOLITES.................................................................................................................................................19ANTI-TNF-ALPHA - MONOCLONAL ANTIBODIES..............................................................................................................................19ANTI-TNF-ALPHA - MONOCLONOAL ANTIBODIES...........................................................................................................................19CYCLOOXYGENASE 2 (COX-2) INHIBITORS.....................................................................................................................................19GOLD COMPOUNDS...........................................................................................................................................................................19INTERLEUKIN-1 BLOCKERS...............................................................................................................................................................19INTERLEUKIN-1 RECEPTOR ANTAGONIST (IL-1RA).........................................................................................................................19INTERLEUKIN-1BETA BLOCKERS......................................................................................................................................................19INTERLEUKIN-6 RECEPTOR INHIBITORS...........................................................................................................................................19NONSTEROIDAL ANTI-INFLAMMATORY AGENT COMBINATIONS.......................................................................................................19NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS).............................................................................................................19PYRIMIDINE SYNTHESIS INHIBITORS.................................................................................................................................................19SELECTIVE COSTIMULATION MODULATORS.....................................................................................................................................19SOLUBLE TUMOR NECROSIS FACTOR RECEPTOR AGENTS............................................................................................................19

ANALGESICS - NONNARCOTIC............................................................................................................................................ 19

ANALGESICS OTHER.........................................................................................................................................................................19ANALGESICS-SEDATIVES..................................................................................................................................................................19SALICYLATE COMBINATIONS............................................................................................................................................................20SALICYLATES.................................................................................................................................................................................... 20SELECTIVE N-TYPE NEURONAL CALCIUM CHANNEL BLOCKERS...................................................................................................20

ANALGESICS - OPIOID........................................................................................................................................................... 20

CODEINE COMBINATIONS..................................................................................................................................................................20DIHYDROCODEINE COMBINATIONS...................................................................................................................................................20HYDROCODONE COMBINATIONS.......................................................................................................................................................20OPIOID AGONISTS.............................................................................................................................................................................20OPIOID COMBINATIONS.....................................................................................................................................................................20OPIOID PARTIAL AGONISTS..............................................................................................................................................................20TRAMADOL COMBINATIONS..............................................................................................................................................................20

ANDROGENS-ANABOLIC....................................................................................................................................................... 20

ANDROGENS......................................................................................................................................................................................20

Updated July 1, 2020 Page

ANORECTAL AGENTS............................................................................................................................................................ 21

INTRARECTAL STEROIDS...................................................................................................................................................................21NITRATE VASODILATING AGENTS.....................................................................................................................................................21RECTAL ANESTHETIC/STEROIDS......................................................................................................................................................21

ANTHELMINTICS..................................................................................................................................................................... 21

ANTHELMINTICS.................................................................................................................................................................................21

ANTIANGINAL AGENTS.......................................................................................................................................................... 21

ANTIANGINALS-OTHER......................................................................................................................................................................21NITRATES...........................................................................................................................................................................................21

ANTIANXIETY AGENTS.......................................................................................................................................................... 21

ANTIANXIETY AGENTS - MISC..........................................................................................................................................................21BENZODIAZEPINES............................................................................................................................................................................ 21

ANTIARRHYTHMICS................................................................................................................................................................ 21

ANTIARRHYTHMICS - MISC................................................................................................................................................................21ANTIARRHYTHMICS TYPE I-A............................................................................................................................................................21ANTIARRHYTHMICS TYPE I-B............................................................................................................................................................21ANTIARRHYTHMICS TYPE I-C............................................................................................................................................................21ANTIARRHYTHMICS TYPE III..............................................................................................................................................................22

ANTIASTHMATIC AND BRONCHODILATOR AGENTS....................................................................................................... 22

ADRENERGIC COMBINATIONS...........................................................................................................................................................22ANTI-IGE MONOCLONAL ANTIBODIES..............................................................................................................................................22ANTI-INFLAMMATORY AGENTS.........................................................................................................................................................22BETA ADRENERGICS.........................................................................................................................................................................22BRONCHODILATORS - ANTICHOLINERGICS.......................................................................................................................................22LEUKOTRIENE RECEPTOR ANTAGONISTS........................................................................................................................................22SELECTIVE PHOSPHODIESTERASE 4 (PDE4) INHIBITORS...............................................................................................................22STEROID INHALANTS.........................................................................................................................................................................22XANTHINES........................................................................................................................................................................................ 22

ANTICOAGULANTS................................................................................................................................................................. 22

COUMARIN ANTICOAGULANTS..........................................................................................................................................................22DIRECT FACTOR XA INHIBITORS......................................................................................................................................................23HEPARINS AND HEPARINOID-LIKE AGENTS.....................................................................................................................................23LOW MOLECULAR WEIGHT HEPARINS.............................................................................................................................................23SYNTHETIC HEPARINOID-LIKE AGENTS...........................................................................................................................................23THROMBIN INHIBITORS - HIRUDIN TYPE...........................................................................................................................................23THROMBIN INHIBITORS - SELECTIVE DIRECT & REVERSIBLE..........................................................................................................23

ANTICONVULSANTS............................................................................................................................................................... 23

AMPA GLUTAMATE RECEPTOR ANTAGONISTS..............................................................................................................................23ANTICONVULSANTS - BENZODIAZEPINES.........................................................................................................................................23ANTICONVULSANTS - MISC...............................................................................................................................................................23CARBAMATES....................................................................................................................................................................................23GABA MODULATORS.......................................................................................................................................................................23HYDANTOINS..................................................................................................................................................................................... 23SUCCINIMIDES................................................................................................................................................................................... 23VALPROIC ACID.................................................................................................................................................................................23

ANTIDEPRESSANTS............................................................................................................................................................... 24


ALPHA-2 RECEPTOR ANTAGONISTS (TETRACYCLICS)....................................................................................................................24ANTIDEPRESSANTS - MISC...............................................................................................................................................................24MODIFIED CYCLICS........................................................................................................................................................................... 24MONOAMINE OXIDASE INHIBITORS (MAOIS)...................................................................................................................................24SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS)...............................................................................................................24SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS)....................................................................................................24TRICYCLIC AGENTS...........................................................................................................................................................................24

ANTIDIABETICS....................................................................................................................................................................... 24

ALPHA-GLUCOSIDASE INHIBITORS...................................................................................................................................................24ANTIDIABETIC - AMYLIN ANALOGS...................................................................................................................................................24BIGUANIDES.......................................................................................................................................................................................24DIABETIC OTHER...............................................................................................................................................................................24DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITORS..............................................................................................................................24DIPEPTIDYL PEPTIDASE-4 INHIBITOR-BIGUANIDE COMBINATIONS..................................................................................................24HUMAN INSULIN.................................................................................................................................................................................24INCRETIN MIMETIC AGENTS (GLP-1 RECEPTOR AGONISTS)..........................................................................................................25INSULIN-INCRETIN MIMETIC COMBINATIONS....................................................................................................................................25MEGLITINIDE ANALOGUES................................................................................................................................................................25MEGLITINIDE-BIGUANIDE COMBINATIONS........................................................................................................................................25SGLT2 INHIBITOR - DPP-4 INHIBITOR - BIGUANIDE COMB............................................................................................................25SGLT2 INHIBITOR - DPP-4 INHIBITOR COMBINATIONS..................................................................................................................25SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITORS.....................................................................................................25SODIUM-GLUCOSE CO-TRANSPORTER 2 INHIBITOR-BIGUANIDE COMB.........................................................................................25SULFONYLUREA-BIGUANIDE COMBINATIONS...................................................................................................................................25SULFONYLUREAS.............................................................................................................................................................................. 25SULFONYLUREA-THIAZOLIDINEDIONE COMBINATIONS.....................................................................................................................25THIAZOLIDINEDIONE-BIGUANIDE COMBINATIONS.............................................................................................................................25THIAZOLIDINEDIONES........................................................................................................................................................................25

ANTIDIARRHEALS................................................................................................................................................................... 25

ANTIPERISTALTIC AGENTS................................................................................................................................................................25

ANTIDOTES.............................................................................................................................................................................. 26

ANTIDOTES........................................................................................................................................................................................ 26ANTIDOTES - CHELATING AGENTS...................................................................................................................................................26BENZODIAZEPINE ANTAGONISTS......................................................................................................................................................26OPIOID ANTAGONISTS.......................................................................................................................................................................26

ANTIDOTES AND SPECIFIC ANTAGONISTS....................................................................................................................... 26

ANTIDOTES AND SPECIFIC ANTAGONISTS........................................................................................................................................26

ANTIEMETICS.......................................................................................................................................................................... 26

5-HT3 RECEPTOR ANTAGONISTS....................................................................................................................................................26ANTIEMETIC COMBINATIONS.............................................................................................................................................................26ANTIEMETICS - ANTICHOLINERGIC....................................................................................................................................................26ANTIEMETICS - MISCELLANEOUS......................................................................................................................................................26SUBSTANCE P/NEUROKININ 1 (NK1) RECEPTOR ANTAGONISTS...................................................................................................26

ANTIFUNGALS......................................................................................................................................................................... 26

ANTIFUNGAL - GLUCAN SYNTHESIS INHIBITORS (ECHINOCANDINS)...............................................................................................26ANTIFUNGALS....................................................................................................................................................................................26IMIDAZOLES....................................................................................................................................................................................... 27TRIAZOLES.........................................................................................................................................................................................27


ANTIHEMOPHILIC PRODUCTS - MONOCLONAL ANTIBODIES........................................................................................27

ANTIHEMOPHILIC PRODUCTS - MONOCLONAL ANTIBODIES............................................................................................................27

ANTIHISTAMINES.................................................................................................................................................................... 27

ANTIHISTAMINES - ALKYLAMINES.....................................................................................................................................................27ANTIHISTAMINES - ETHANOLAMINES................................................................................................................................................27ANTIHISTAMINES - NON-SEDATING..................................................................................................................................................27ANTIHISTAMINES - PHENOTHIAZINES................................................................................................................................................27ANTIHISTAMINES - PIPERIDINES........................................................................................................................................................27

ANTIHYPERLIPIDEMICS......................................................................................................................................................... 27

ANTIHYPERLIPIDEMICS - MISC..........................................................................................................................................................27BILE ACID SEQUESTRANTS..............................................................................................................................................................27FIBRIC ACID DERIVATIVES................................................................................................................................................................27HMG COA REDUCTASE INHIBITORS................................................................................................................................................27INTEST CHOLEST ABSORP INHIB-HMG COA REDUCTASE INHIB COMB........................................................................................28INTESTINAL CHOLESTEROL ABSORPTION INHIBITORS.....................................................................................................................28MICROSOMAL TRIGLYCERIDE TRANSFER PROTEIN INHIBITORS......................................................................................................28NICOTINIC ACID DERIVATIVES..........................................................................................................................................................28

ANTIHYPERTENSIVES............................................................................................................................................................ 28

ACE INHIBITOR & CALCIUM CHANNEL BLOCKER COMBINATIONS.................................................................................................28ACE INHIBITORS...............................................................................................................................................................................28ACE INHIBITORS & THIAZIDE/THIAZIDE-LIKE..................................................................................................................................28ADRENOLYTICS-CENTRAL & THIAZIDE/THIAZIDE-LIKE COMB........................................................................................................28AGENTS FOR PHEOCHROMOCYTOMA...............................................................................................................................................28ANGIOTENSIN II RECEPTOR ANTAG & CA CHANNEL BLOCKER COMB..........................................................................................28ANGIOTENSIN II RECEPTOR ANTAG & THIAZIDE/THIAZIDE-LIKE....................................................................................................28ANGIOTENSIN II RECEPTOR ANTAGONISTS......................................................................................................................................28ANGIOTENSIN II RECEPTOR ANT-CA CHANNEL BLOCKER-THIAZIDES...........................................................................................28ANTIADRENERGICS - CENTRALLY ACTING.......................................................................................................................................28ANTIADRENERGICS - PERIPHERALLY ACTING..................................................................................................................................29BETA BLOCKER & ANGIOTENSIN II RECEPTOR ANTAGONIST COMB.............................................................................................29BETA BLOCKER & DIURETIC COMBINATIONS..................................................................................................................................29DIRECT RENIN INHIBITORS................................................................................................................................................................29DIRECT RENIN INHIBITORS & THIAZIDE/THIAZIDE-LIKE COMB........................................................................................................29RESERPINE........................................................................................................................................................................................ 29SELECTIVE ALDOSTERONE RECEPTOR ANTAGONISTS (SARAS)...................................................................................................29VASODILATORS................................................................................................................................................................................. 29

ANTI-INFECTIVE AGENTS - MISC......................................................................................................................................... 29

ANTI-INFECTIVE AGENTS - MISC......................................................................................................................................................29ANTI-INFECTIVE MISC. - COMBINATIONS..........................................................................................................................................29ANTIPROTOZOAL AGENTS................................................................................................................................................................29CARBAPENEM COMBINATIONS.........................................................................................................................................................29CARBAPENEMS..................................................................................................................................................................................29CYCLIC LIPOPEPTIDES......................................................................................................................................................................29GLYCYLCYCLINES..............................................................................................................................................................................29LEPROSTATICS..................................................................................................................................................................................29LINCOSAMIDES.................................................................................................................................................................................. 29OXAZOLIDINONES..............................................................................................................................................................................30POLYMYXINS......................................................................................................................................................................................30STREPTOGRAMIN COMBINATIONS....................................................................................................................................................30


ANTIMALARIALS..................................................................................................................................................................... 30

ANTIMALARIAL COMBINATIONS........................................................................................................................................................30ANTIMALARIALS................................................................................................................................................................................ 30

ANTIMYASTHENIC AGENTS.................................................................................................................................................. 30

ANTIMYASTHENIC AGENTS...............................................................................................................................................................30ANTIMYASTHENIC/CHOLINERGIC AGENTS........................................................................................................................................30

ANTIMYCOBACTERIAL AGENTS.......................................................................................................................................... 30

ANTIMYCOBACTERIAL AGENTS.........................................................................................................................................................30

ANTINEOPLASTIC - BCL-2 INHIBITORS.............................................................................................................................. 30

ANTINEOPLASTIC - BCL-2 INHIBITORS............................................................................................................................................30

ANTINEOPLASTIC - FGFR KINASE INHIBITORS................................................................................................................ 30

ANTINEOPLASTIC - FGFR KINASE INHIBITORS................................................................................................................................30

ANTINEOPLASTIC - TROPOMYOSIN RECEPTOR KINASE INHIBITORS.........................................................................30

ANTINEOPLASTIC - TROPOMYOSIN RECEPTOR KINASE INHIBITORS...............................................................................................30

ANTINEOPLASTIC - XPO1 INHIBITORS............................................................................................................................... 30

ANTINEOPLASTIC - XPO1 INHIBITORS.............................................................................................................................................30

ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES......................................................................................................... 30

ALKYLATING AGENTS.......................................................................................................................................................................30ANDROGEN BIOSYNTHESIS INHIBITORS...........................................................................................................................................31ANTIADRENALS................................................................................................................................................................................. 31ANTIANDROGENS.............................................................................................................................................................................. 31ANTIESTROGENS...............................................................................................................................................................................31ANTIMETABOLITES............................................................................................................................................................................ 31ANTINEOPLASTIC - AUTOLOGOUS CELLULAR IMMUNOTHERAPY....................................................................................................31ANTINEOPLASTIC - BISPECIFIC T-CELL ENGAGERS........................................................................................................................31ANTINEOPLASTIC - BRAF KINASE INHIBITORS...............................................................................................................................31ANTINEOPLASTIC - HEDGEHOG PATHWAY INHIBITORS...................................................................................................................31ANTINEOPLASTIC - HISTONE DEACETYLASE INHIBITORS................................................................................................................31ANTINEOPLASTIC - IMMUNOMODULATORS.......................................................................................................................................31ANTINEOPLASTIC - MEK INHIBITORS...............................................................................................................................................31ANTINEOPLASTIC - MONOCLONAL ANTIBODIES...............................................................................................................................31ANTINEOPLASTIC - MTOR KINASE INHIBITORS...............................................................................................................................32ANTINEOPLASTIC - MULTIKINASE INHIBITORS..................................................................................................................................32ANTINEOPLASTIC - PROTEASOME INHIBITORS.................................................................................................................................32ANTINEOPLASTIC - TYROSINE KINASE INHIBITORS..........................................................................................................................32ANTINEOPLASTIC ANTIBIOTICS.........................................................................................................................................................32ANTINEOPLASTIC -ANTIBODY FOR RADIOPHARMACEUTICAL THERAPY..........................................................................................32ANTINEOPLASTIC ANTIBODY-DRUG COMPLEXES............................................................................................................................32ANTINEOPLASTIC COMBINATIONS....................................................................................................................................................32ANTINEOPLASTIC ENZYMES..............................................................................................................................................................32ANTINEOPLASTIC RADIOPHARMACEUTICALS...................................................................................................................................32ANTINEOPLASTICS - INTERLEUKINS..................................................................................................................................................32ANTINEOPLASTICS - PHOTOACTIVATED AGENTS.............................................................................................................................32ANTINEOPLASTICS MISC...................................................................................................................................................................32AROMATASE INHIBITORS...................................................................................................................................................................33CARBOXYPEPTIDASE ENZYME AGENTS...........................................................................................................................................33CARDIAC PROTECTIVE AGENTS.......................................................................................................................................................33


CHEMOTHERAPY ADJUNCTS - HYPERURICEMIA AGENTS................................................................................................................33CHEMOTHERAPY ADJUNCTS - KERATINOCYTE GROWTH FACTORS...............................................................................................33CYCLIN-DEPENDENT KINASES (CDK) INHIBITORS..........................................................................................................................33ESTROGEN RECEPTOR ANTAGONIST...............................................................................................................................................33ESTROGENS-ANTINEOPLASTIC.........................................................................................................................................................33FOLIC ACID ANTAGONISTS RESCUE AGENTS..................................................................................................................................33GONADOTROPIN RELEASING HORMONE (GNRH) ANTAGONISTS...................................................................................................33IMIDAZOTETRAZINES..........................................................................................................................................................................33ISOCITRATE DEHYDROGENASE-2 (IDH2) INHIBITORS.....................................................................................................................33JANUS ASSOCIATED KINASE (JAK) INHIBITORS.............................................................................................................................33LHRH ANALOGS...............................................................................................................................................................................33MITOTIC INHIBITORS..........................................................................................................................................................................33NITROGEN MUSTARDS......................................................................................................................................................................33NITROSOUREAS.................................................................................................................................................................................33PROGESTINS-ANTINEOPLASTIC........................................................................................................................................................34RETINOIDS......................................................................................................................................................................................... 34SELECTIVE RETINOID X RECEPTOR AGONISTS...............................................................................................................................34TOPOISOMERASE I INHIBITORS.........................................................................................................................................................34URINARY TRACT PROTECTIVE AGENTS...........................................................................................................................................34VASCULAR ENDOTHELIAL GROWTH FACTOR (VEGF) INHIBITORS................................................................................................34

ANTIPARKINSON AGENTS.................................................................................................................................................... 34

ANTIPARKINSON ANTICHOLINERGICS...............................................................................................................................................34ANTIPARKINSON DOPAMINERGICS....................................................................................................................................................34ANTIPARKINSON MONOAMINE OXIDASE INHIBITORS.......................................................................................................................34LEVODOPA COMBINATIONS..............................................................................................................................................................34NONERGOLINE DOPAMINE RECEPTOR AGONISTS...........................................................................................................................34PERIPHERAL COMT INHIBITORS......................................................................................................................................................34

ANTIPSYCHOTICS/ANTIMANIC AGENTS............................................................................................................................. 34

ANTIMANIC AGENTS..........................................................................................................................................................................34ANTIPSYCHOTICS - MISC..................................................................................................................................................................34BENZISOXAZOLES............................................................................................................................................................................. 34BUTYROPHENONES........................................................................................................................................................................... 34DIBENZODIAZEPINES.........................................................................................................................................................................35DIBENZOTHIAZEPINES.......................................................................................................................................................................35DIBENZOXAZEPINES.......................................................................................................................................................................... 35PHENOTHIAZINES...............................................................................................................................................................................35QUINOLINONE DERIVATIVES.............................................................................................................................................................35THIENBENZODIAZEPINES...................................................................................................................................................................35THIOXANTHENES............................................................................................................................................................................... 35

ANTIRETROVIRALS - CD4-DIRECTED POST-ATTACHMENT INHIBITOR.......................................................................35

ANTIRETROVIRALS - CD4-DIRECTED POST-ATTACHMENT INHIBITOR............................................................................................35

ANTISEPTICS & DISINFECTANTS......................................................................................................................................... 35

CHLORINE ANTISEPTICS...................................................................................................................................................................35

ANTIVIRALS............................................................................................................................................................................. 35

ANTIRETROVIRAL COMBINATIONS....................................................................................................................................................35ANTIRETROVIRALS - CCR5 ANTAGONISTS (ENTRY INHIBITOR)......................................................................................................35ANTIRETROVIRALS - FUSION INHIBITORS.........................................................................................................................................35ANTIRETROVIRALS - INTEGRASE INHIBITORS...................................................................................................................................35ANTIRETROVIRALS - PROTEASE INHIBITORS....................................................................................................................................35


ANTIRETROVIRALS - RTI-NON-NUCLEOSIDE ANALOGUES..............................................................................................................36ANTIRETROVIRALS - RTI-NUCLEOSIDE ANALOGUES-PURINES.......................................................................................................36ANTIRETROVIRALS - RTI-NUCLEOSIDE ANALOGUES-PYRIMIDINES................................................................................................36ANTIRETROVIRALS - RTI-NUCLEOSIDE ANALOGUES-THYMIDINES.................................................................................................36ANTIRETROVIRALS - RTI-NUCLEOTIDE ANALOGUES.......................................................................................................................36CMV AGENTS................................................................................................................................................................................... 36HEPATITIS B AGENTS.......................................................................................................................................................................36HEPATITIS C AGENTS.......................................................................................................................................................................36HERPES AGENTS - PURINE ANALOGUES.........................................................................................................................................36HERPES AGENTS - THYMIDINE ANALOGUES....................................................................................................................................36INFLUENZA AGENTS..........................................................................................................................................................................36NEURAMINIDASE INHIBITORS............................................................................................................................................................36RSV AGENTS - NUCLEOSIDE ANALOGUES......................................................................................................................................36

ASSORTED CLASSES............................................................................................................................................................ 36

ANTILEPROTICS.................................................................................................................................................................................36ASSORTED CLASSES.................................................................................................................................................................36B-LYMPHOCYTE STIMULATOR (BLYS)-SPECIFIC INHIBITORS.........................................................................................................36CHELATING AGENTS.........................................................................................................................................................................36CYCLOSPORINE ANALOGS................................................................................................................................................................37ENZYMES........................................................................................................................................................................................... 37IMMUNE GLOBULIN IMMUNOSUPPRESSANTS....................................................................................................................................37IMMUNOMODULATORS FOR MYELODYSPLASTIC SYNDROMES.........................................................................................................37INOSINE MONOPHOSPHATE DEHYDROGENASE INHIBITORS.............................................................................................................37MACROLIDE IMMUNOSUPPRESSANTS...............................................................................................................................................37MONOCLONAL ANTIBODIES..............................................................................................................................................................37POTASSIUM REMOVING RESINS........................................................................................................................................................37PROSTAGLANDINS.............................................................................................................................................................................37PURINE ANALOGS.............................................................................................................................................................................37SCLEROSING AGENTS.......................................................................................................................................................................37SELECTIVE T-CELL COSTIMULATION BLOCKERS............................................................................................................................37

ATOPIC DERMATITIS - MONOCLONAL ANTIBODIES........................................................................................................ 37

ATOPIC DERMATITIS - MONOCLONAL ANTIBODIES..........................................................................................................................37

BETA BLOCKERS.................................................................................................................................................................... 37

ALPHA-BETA BLOCKERS..................................................................................................................................................................37BETA BLOCKERS CARDIO-SELECTIVE.............................................................................................................................................37BETA BLOCKERS NON-SELECTIVE...................................................................................................................................................38

BILE ACID SYNTHESIS DISORDER AGENTS...................................................................................................................... 38

BILE ACID SYNTHESIS DISORDER AGENTS.....................................................................................................................................38

BIOLOGICALS MISC................................................................................................................................................................ 38

ALLERGENIC EXTRACTS...................................................................................................................................................................38BIOLOGICALS MISC...........................................................................................................................................................................38

CALCITONIN GENE-RELATED PEPTIDE (CGRP) RECEPTOR ANTAG............................................................................38

CALCITONIN GENE-RELATED PEPTIDE (CGRP) RECEPTOR ANTAG..............................................................................................38

CALCIUM CHANNEL BLOCKERS.......................................................................................................................................... 38

CALCIUM CHANNEL BLOCKERS........................................................................................................................................................38

CARDIOTONICS....................................................................................................................................................................... 38


CARDIAC GLYCOSIDES..................................................................................................................................................................... 38PHOSPHODIESTERASE INHIBITORS...................................................................................................................................................38

CARDIOVASCULAR AGENTS - MISC................................................................................................................................... 38

PULMONARY HYPERTENSION - ENDOTHELIN RECEPTOR ANTAGONISTS........................................................................................38

CARDIOVASCULAR AGENTS - MISC................................................................................................................................... 38

CALCIUM CHANNEL BLOCKER & HMG COA REDUCTASE INHIBIT COMB.....................................................................................38PERIPHERAL VASODILATORS............................................................................................................................................................38PROSTAGLANDIN - IMPOTENCE AGENTS..........................................................................................................................................38PROSTAGLANDIN VASODILATORS....................................................................................................................................................38PULM HYPERTEN-SOLUBLE GUANYLATE CYCLASE STIMULATOR (SGC)......................................................................................39PULMONARY HYPERTENSION - ENDOTHELIN RECEPTOR ANTAGONISTS........................................................................................39PULMONARY HYPERTENSION - PHOSPHODIESTERASE INHIBITORS................................................................................................39SELECTIVE CGMP PHOSPHODIESTERASE TYPE 5 INHIBITORS.......................................................................................................39VASOACTIVE NATRIURETIC PEPTIDES..............................................................................................................................................39

CARDIOVASCULAR, HYPERTENSION & LIPIDS................................................................................................................ 39

MISC. CARDIOVASCULAR AGENTS........................................................................................................................................39MISC. COAGULATION AGENTS................................................................................................................................................39

CEPHALOSPORIN COMBINATIONS..................................................................................................................................... 39

CEPHALOSPORIN COMBINATIONS.....................................................................................................................................................39

CEPHALOSPORINS................................................................................................................................................................. 39

CEPHALOSPORINS - 1ST GENERATION............................................................................................................................................39CEPHALOSPORINS - 2ND GENERATION............................................................................................................................................39CEPHALOSPORINS - 3RD GENERATION............................................................................................................................................39CEPHALOSPORINS - 4TH GENERATION............................................................................................................................................39CEPHALOSPORINS - 5TH GENERATION............................................................................................................................................39

CONTRACEPTIVES................................................................................................................................................................. 39

BIPHASIC CONTRACEPTIVES - ORAL................................................................................................................................................39COMBINATION CONTRACEPTIVES - ORAL........................................................................................................................................39COMBINATION CONTRACEPTIVES - VAGINAL...................................................................................................................................40CONTINUOUS CONTRACEPTIVES - ORAL..........................................................................................................................................40EMERGENCY CONTRACEPTIVES.......................................................................................................................................................40EXTENDED-CYCLE CONTRACEPTIVES - ORAL.................................................................................................................................40FOUR PHASE CONTRACEPTIVES - ORAL.........................................................................................................................................40PROGESTIN CONTRACEPTIVES - IMPLANTS.....................................................................................................................................40PROGESTIN CONTRACEPTIVES - INJECTABLE..................................................................................................................................40PROGESTIN CONTRACEPTIVES - IUD...............................................................................................................................................40PROGESTIN CONTRACEPTIVES - ORAL............................................................................................................................................40TRIPHASIC CONTRACEPTIVES - ORAL..............................................................................................................................................40

CORTICOSTEROIDS................................................................................................................................................................ 41

GLUCOCORTICOSTEROIDS................................................................................................................................................................41MINERALOCORTICOIDS......................................................................................................................................................................41

COUGH/COLD/ALLERGY........................................................................................................................................................ 41

ANTITUSSIVE - NONNARCOTIC..........................................................................................................................................................41ANTITUSSIVE - OPIOID...................................................................................................................................................................... 41DECONGESTANT................................................................................................................................................................................41DECONGESTANT-ANTIHISTAMINE.....................................................................................................................................................41


DECONGESTANT-ANTIHISTAMINE W/ EXPECTORANT.......................................................................................................................41MUCOLYTICS..................................................................................................................................................................................... 41NON-NARC ANTITUSSIVE-ANTIHISTAMINE......................................................................................................................................41NON-NARC ANTITUSSIVE-DECONGESTANT-ANTIHISTAMINE...........................................................................................................41OPIOID ANTITUSSIVE-ANTIHISTAMINE..............................................................................................................................................41OPIOID ANTITUSSIVE-DECONGESTANT-ANTIHISTAMINE..................................................................................................................41

CYCLIN-DEPENDENT KINASES (CDK) INHIBITORS.......................................................................................................... 41

CYCLIN-DEPENDENT KINASES (CDK) INHIBITORS..........................................................................................................................41

CYSTIC FIBROSIS AGENT - COMBINATION........................................................................................................................ 41

CYSTIC FIBROSIS AGENT - COMBINATIONS.....................................................................................................................................41

CYSTIC FIBROSIS AGENT - COMBINATIONS..................................................................................................................... 41

CYSTIC FIBROSIS AGENT - COMBINATIONS.....................................................................................................................................41

DERMATOLOGICALS.............................................................................................................................................................. 42

ACNE ANTIBIOTICS............................................................................................................................................................................42ACNE COMBINATIONS.......................................................................................................................................................................42ACNE PRODUCTS..............................................................................................................................................................................42ANTIBIOTICS - TOPICAL.................................................................................................................................................................... 42ANTIFUNGALS - TOPICAL..................................................................................................................................................................42ANTIFUNGALS - TOPICAL COMBINATIONS........................................................................................................................................42ANTI-INFLAMMATORY AGENTS - TOPICAL........................................................................................................................................42ANTINEOPLASTIC ALKYLATING AGENTS - TOPICAL........................................................................................................................42ANTINEOPLASTIC ANTIMETABOLITES - TOPICAL.............................................................................................................................42ANTINEOPLASTIC OR PREMALIGNANT LESIONS - TOPICAL MISC...................................................................................................42ANTIPSORIATICS................................................................................................................................................................................42ANTIPSORIATICS - SYSTEMIC............................................................................................................................................................42ANTISEBORRHEIC PRODUCTS...........................................................................................................................................................42ANTIVIRALS - TOPICAL......................................................................................................................................................................43BURN PRODUCTS..............................................................................................................................................................................43CORTICOSTEROIDS - TOPICAL..........................................................................................................................................................43DEPIGMENTING AGENTS...................................................................................................................................................................43EMOLLIENT/KERATOLYTIC AGENTS.................................................................................................................................................43EMOLLIENTS......................................................................................................................................................................................43ENZYMES - TOPICAL......................................................................................................................................................................... 43IMIDAZOLE-RELATED ANTIFUNGALS - TOPICAL...............................................................................................................................43IMMUNOMODULATORS IMIDAZOQUINOLINAMINES - TOPICAL...........................................................................................................43KERATOLYTIC/ANTIMITOTIC AGENTS...............................................................................................................................................43LOCAL ANESTHETICS - TOPICAL......................................................................................................................................................43MACROLIDE IMMUNOSUPPRESSANTS - TOPICAL.............................................................................................................................43MISC. DERMATOLOGICAL PRODUCTS..............................................................................................................................................43PIGMENTING AGENTS........................................................................................................................................................................44ROSACEA AGENTS............................................................................................................................................................................44SCABICIDES & PEDICULICIDES.........................................................................................................................................................44TOPICAL ANESTHETIC COMBINATIONS.............................................................................................................................................44TOPICAL SELECTIVE RETINOID X RECEPTOR AGONISTS................................................................................................................44TOPICAL STEROID COMBINATIONS...................................................................................................................................................44WOUND DRESSINGS..........................................................................................................................................................................44

DIAGNOSTIC PRODUCTS....................................................................................................................................................... 44

DIAGNOSTIC BIOLOGICALS...............................................................................................................................................................44DIAGNOSTIC DRUGS..........................................................................................................................................................................44


DIAGNOSTIC RADIOPHARMACEUTICALS - CARDIAC.........................................................................................................................44MISCELLANEOUS CONTRAST MEDIA................................................................................................................................................44RADIOGRAPHIC CONTRAST MEDIA - IODINATED..............................................................................................................................44

DIAGNOSTICS & MISCELLANEOUS AGENTS..................................................................................................................... 44

IRRIGATING SOLUTIONS............................................................................................................................................................44MISCELLANEOUS AGENTS.......................................................................................................................................................44NEUTRACEUTICALS....................................................................................................................................................................44

DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS..........................................................................................44

DIETARY MANAGEMENT PRODUCT COMBINATIONS.........................................................................................................................44

DIGESTIVE AIDS...................................................................................................................................................................... 45

DIGESTIVE ENZYMES.........................................................................................................................................................................45

DIURETICS................................................................................................................................................................................ 45

CARBONIC ANHYDRASE INHIBITORS................................................................................................................................................45DIURETIC COMBINATIONS.................................................................................................................................................................45LOOP DIURETICS...............................................................................................................................................................................45OSMOTIC DIURETICS.........................................................................................................................................................................45POTASSIUM SPARING DIURETICS.....................................................................................................................................................45THIAZIDES AND THIAZIDE-LIKE DIURETICS......................................................................................................................................45

DOPAMINE AND NOREPINEPHRINE REUPTAKE INHIBITORS (DNRIS).........................................................................45

DOPAMINE AND NOREPINEPHRINE REUPTAKE INHIBITORS (DNRIS)..............................................................................................45

ENDOCRINE AND METABOLIC AGENTS - MISC................................................................................................................ 45

BISPHOSPHONATES...........................................................................................................................................................................45CALCIMIMETIC AGENTS.....................................................................................................................................................................45CALCITONINS.....................................................................................................................................................................................45CARNITINE REPLENISHER - AGENTS................................................................................................................................................45DOPAMINE RECEPTOR AGONISTS....................................................................................................................................................45FABRY DISEASE - AGENTS...............................................................................................................................................................45GAA DEFICIENCY TREATMENT - AGENTS.......................................................................................................................................45GROWTH HORMONE RECEPTOR ANTAGONISTS..............................................................................................................................46GROWTH HORMONE RELEASING HORMONES (GHRH)..................................................................................................................46GROWTH HORMONES........................................................................................................................................................................46HEREDITARY OROTIC ACIDURIA TREATMENT - AGENTS.................................................................................................................46HEREDITARY TYROSINEMIA TYPE 1 (HT-1) TREATMENT - AGENTS...............................................................................................46HOMOCYSTINURIA TREATMENT - AGENTS.......................................................................................................................................46HYPERAMMONEMIA TREATMENT - AGENTS.....................................................................................................................................46HYPERPARATHYROID TREATMENT - VITAMIN D ANALOGS.............................................................................................................46HYPOPHOSPHATASIA (HPP) AGENTS..............................................................................................................................................46INSULIN-LIKE GROWTH FACTORS (SOMATOMEDINS)......................................................................................................................46LHRH/GNRH AGONIST ANALOG PITUITARY SUPPRESSANTS.......................................................................................................46LYSOSOMAL ACID LIPASE (LAL) DEFICIENCY - AGENTS...............................................................................................................46MUCOPOLYSACCHARIDOSIS I (MPS I) - AGENTS............................................................................................................................46MUCOPOLYSACCHARIDOSIS II (MPS II) - AGENTS..........................................................................................................................46MUCOPOLYSACCHARIDOSIS VI (MPS VI) - AGENTS.......................................................................................................................46OVULATION STIMULANTS-GONADOTROPINS....................................................................................................................................46OVULATION STIMULANTS-SYNTHETIC..............................................................................................................................................46PARATHYROID HORMONE AND DERIVATIVES..................................................................................................................................46PHENYLKETONURIA TREATMENT - AGENTS.....................................................................................................................................46RANK LIGAND (RANKL) INHIBITORS.............................................................................................................................................46


SELECTIVE ESTROGEN RECEPTOR MODULATORS (SERMS).........................................................................................................47SELECTIVE VASOPRESSIN V2-RECEPTOR ANTAGONISTS...............................................................................................................47SOMATOSTATIC AGENTS..................................................................................................................................................................47UREA CYCLE DISORDER - AGENTS..................................................................................................................................................47VASOPRESSIN....................................................................................................................................................................................47

ESTROGENS............................................................................................................................................................................ 47

ESTROGEN & ANDROGEN.................................................................................................................................................................47ESTROGEN & PROGESTIN.................................................................................................................................................................47ESTROGENS.......................................................................................................................................................................................47

ESTROGEN-SELECTIVE ESTROGEN RECEPTOR MODULATOR COMB........................................................................47

ESTROGEN-SELECTIVE ESTROGEN RECEPTOR MODULATOR COMB..............................................................................................47

FLUOROQUINOLONES........................................................................................................................................................... 47

FLUOROQUINOLONES........................................................................................................................................................................47

GASTROINTESTINAL AGENTS - MISC................................................................................................................................. 47

FARNESOID X RECEPTOR (FXR) AGONISTS...................................................................................................................................47GALLSTONE SOLUBILIZING AGENTS................................................................................................................................................47GASTROINTESTINAL CHLORIDE CHANNEL ACTIVATORS.................................................................................................................47GASTROINTESTINAL STIMULANTS....................................................................................................................................................47IBS AGENT - GUANYLATE CYCLASE-C (GC-C) AGONISTS...........................................................................................................48IBS AGENT - MU-OPIOID RECEPTOR AGONISTS.............................................................................................................................48IBS AGENT - SELECTIVE 5-HT3 RECEPTOR ANTAGONISTS...........................................................................................................48INFLAMMATORY BOWEL AGENTS.....................................................................................................................................................48PERIPHERAL OPIOID RECEPTOR ANTAGONISTS..............................................................................................................................48PHOSPHATE BINDER AGENTS..........................................................................................................................................................48TUMOR NECROSIS FACTOR ALPHA BLOCKERS..............................................................................................................................48

GENERAL ANESTHETICS...................................................................................................................................................... 48

ANESTHETICS - MISC........................................................................................................................................................................48BARBITURATE ANESTHETICS............................................................................................................................................................48

GENITOURINARY AGENTS - MISCELLANEOUS................................................................................................................. 48

5-ALPHA REDUCTASE INHIBITORS...................................................................................................................................................48ALPHA 1-ADRENOCEPTOR ANTAGONISTS.......................................................................................................................................48CITRATES...........................................................................................................................................................................................48CYSTINOSIS AGENTS........................................................................................................................................................................ 48GENITOURINARY IRRIGANTS.............................................................................................................................................................48INTERSTITIAL CYSTITIS AGENTS.......................................................................................................................................................48URINARY ANALGESICS......................................................................................................................................................................48

GLYCOPEPTIDES.................................................................................................................................................................... 49

GLYCOPEPTIDES................................................................................................................................................................................49

GOUT AGENTS........................................................................................................................................................................ 49

GOUT AGENTS.................................................................................................................................................................................. 49URICOSURICS.................................................................................................................................................................................... 49

HEMATOLOGICAL AGENTS - MISC...................................................................................................................................... 49

ANTIHEMOPHILIC PRODUCTS............................................................................................................................................................49BRADYKININ B2 RECEPTOR ANTAGONISTS.....................................................................................................................................49C1 INHIBITORS.................................................................................................................................................................................. 49


COMPLEMENT INHIBITORS................................................................................................................................................................49CYCLOPENTYLTRIAZOLOPYRIMIDINE (CPTP) DERIVATIVES............................................................................................................49GLYCOPROTEIN IIB/IIIA RECEPTOR INHIBITORS..............................................................................................................................49HEMATORHEOLOGIC AGENTS...........................................................................................................................................................49HEMIN................................................................................................................................................................................................ 49HUMAN PROTEIN C...........................................................................................................................................................................49PHOSPHODIESTERASE III INHIBITORS...............................................................................................................................................49PLASMA EXPANDERS........................................................................................................................................................................49PLASMA KALLIKREIN INHIBITORS.....................................................................................................................................................50PLASMA PROTEINS........................................................................................................................................................................... 50PLATELET AGGREGATION INHIBITOR COMBINATIONS.....................................................................................................................50PLATELET AGGREGATION INHIBITORS.............................................................................................................................................50PROTAMINE....................................................................................................................................................................................... 50QUINAZOLINE AGENTS......................................................................................................................................................................50THIENOPYRIDINE DERIVATIVES.........................................................................................................................................................50TISSUE PLASMINOGEN ACTIVATORS................................................................................................................................................50

HEMATOPOIETIC AGENTS.................................................................................................................................................... 50

AGENTS FOR GAUCHER DISEASE....................................................................................................................................................50COBALAMINS.....................................................................................................................................................................................50CXCR4 RECEPTOR ANTAGONIST....................................................................................................................................................50CYTOTOXIC AGENTS.........................................................................................................................................................................50ERYTHROPOIESIS-STIMULATING AGENTS (ESAS)...........................................................................................................................50ERYTHROPOIETINS............................................................................................................................................................................ 50FOLIC ACID/FOLATE COMBINATIONS...............................................................................................................................................50FOLIC ACID/FOLATES.......................................................................................................................................................................50GRANULOCYTE COLONY-STIMULATING FACTORS (G-CSF)...........................................................................................................50GRANULOCYTE/MACROPHAGE COLONY-STIMULATING FACTOR(GM-CSF)..................................................................................50IRON...................................................................................................................................................................................................50IRON COMBINATIONS........................................................................................................................................................................ 50IRON W/ FOLIC ACID.........................................................................................................................................................................51IRON-B12-FOLATE............................................................................................................................................................................51THROMBOPOIETIN (TPO) RECEPTOR AGONISTS.............................................................................................................................51

HEMOSTATICS......................................................................................................................................................................... 51

HEMOSTATICS - SYSTEMIC...............................................................................................................................................................51

HEPATITIS C AGENT - COMBINATIONS.............................................................................................................................. 51

HEPATITIS C AGENT - COMBINATIONS.............................................................................................................................................51

HISTAMINE H3-RECEPTOR ANTAGONIST/INVERSE AGONISTS....................................................................................51

HISTAMINE H3-RECEPTOR ANTAGONIST/INVERSE AGONISTS........................................................................................................51

HYPNOTICS.............................................................................................................................................................................. 51

BARBITURATE HYPNOTICS................................................................................................................................................................51BENZODIAZEPINE HYPNOTICS...........................................................................................................................................................51NON-BENZODIAZEPINE - GABA-RECEPTOR MODULATORS...........................................................................................................51SELECTIVE MELATONIN RECEPTOR AGONISTS...............................................................................................................................51

IBS AGENT - 5-HT4 RECEPTOR PARTIAL AGONISTS....................................................................................................... 51

IBS AGENT - 5-HT4 RECEPTOR PARTIAL AGONISTS.....................................................................................................................51

INSULIN-LIKE GROWTH FACTOR-1 RECEPTOR INHIBITORS(IGF-1R)...........................................................................51

INSULIN-LIKE GROWTH FACTOR-1 RECEPTOR INHIBITORS(IGF-1R).............................................................................................51Updated July 1, 2020 Page

INTEGRIN RECEPTOR ANTAGONISTS................................................................................................................................ 52

INTEGRIN RECEPTOR ANTAGONISTS................................................................................................................................................52

INTERLEUKIN-4 ALPHA ANTAGONISTS.............................................................................................................................. 52

INTERLEUKIN-4 ALPHA ANTAGONISTS.............................................................................................................................................52

INTERLEUKIN-6 (IL-6) ANTAGONISTS................................................................................................................................. 52

INTERLEUKIN-6 (IL-6) ANTAGONISTS...............................................................................................................................................52

LAXATIVES............................................................................................................................................................................... 52

BOWEL EVACUANT COMBINATIONS.................................................................................................................................................52LAXATIVES - MISCELLANEOUS.........................................................................................................................................................52

LEPTIN ANALOGUES.............................................................................................................................................................. 52

LEPTIN ANALOGUES......................................................................................................................................................................... 52

LOCAL ANESTHETICS-PARENTERAL................................................................................................................................. 52

LOCAL ANESTHETIC & SYMPATHOMIMETIC.....................................................................................................................................52LOCAL ANESTHETICS - AMIDES.......................................................................................................................................................52LOCAL ANESTHETICS - ESTERS.......................................................................................................................................................52

MACROLIDES........................................................................................................................................................................... 52

AZITHROMYCIN.................................................................................................................................................................................. 52CLARITHROMYCIN..............................................................................................................................................................................52ERYTHROMYCINS...............................................................................................................................................................................52

MEDICAL DEVICES................................................................................................................................................................. 52

CERVICAL CAPS................................................................................................................................................................................52GLUCOSE MONITORING TEST SUPPLIES..........................................................................................................................................53NEEDLES & SYRINGES......................................................................................................................................................................53

MIGRAINE PRODUCTS........................................................................................................................................................... 53

ERGOT COMBINATIONS.....................................................................................................................................................................53MIGRAINE PRODUCTS.......................................................................................................................................................................53SELECTIVE SEROTONIN AGONIST-NSAID COMBINATIONS.............................................................................................................53SELECTIVE SEROTONIN AGONISTS 5-HT(1)....................................................................................................................................53

MINERALS & ELECTROLYTES.............................................................................................................................................. 53

BICARBONATES.................................................................................................................................................................................53CALCIUM............................................................................................................................................................................................53ELECTROLYTES & DEXTROSE..........................................................................................................................................................53ELECTROLYTES PARENTERAL..........................................................................................................................................................53IODINE PRODUCTS.............................................................................................................................................................................54MAGNESIUM.......................................................................................................................................................................................54MANGANESE......................................................................................................................................................................................54PHOSPHATE.......................................................................................................................................................................................54PHOSPHATES.....................................................................................................................................................................................54POTASSIUM........................................................................................................................................................................................54TRACE MINERAL COMBINATIONS.....................................................................................................................................................54TRACE MINERALS............................................................................................................................................................................. 54

MIXED ALLERGENIC EXTRACTS.......................................................................................................................................... 54

MIXED ALLERGENIC EXTRACTS........................................................................................................................................................54


MONOBACTAMS...................................................................................................................................................................... 54

MONOBACTAMS.................................................................................................................................................................................54

MOUTH/THROAT/DENTAL AGENTS..................................................................................................................................... 54

ANTI-INFECTIVE COMBINATIONS - THROAT......................................................................................................................................54FLUORIDE DENTAL PRODUCTS.........................................................................................................................................................54SALIVA STIMULANTS.........................................................................................................................................................................54

MUCOPOLYSACCHARIDOSIS IV (MPS IV) - AGENTS........................................................................................................ 54

MUCOPOLYSACCHARIDOSIS IV (MPS IV) - AGENTS.......................................................................................................................54

MUCOPOLYSACCHARIDOSIS VII (MPS VII) - AGENTS...................................................................................................... 55

MUCOPOLYSACCHARIDOSIS VII (MPS VII) - AGENTS.....................................................................................................................55

MULTIPLE SCLEROSIS AGENTS - ANTIMETABOLITES....................................................................................................55

MULTIPLE SCLEROSIS AGENTS - ANTIMETABOLITES......................................................................................................................55

MULTIVITAMINS....................................................................................................................................................................... 55

B-COMPLEX VITAMINS......................................................................................................................................................................55B-COMPLEX W/ C & FOLIC ACID.....................................................................................................................................................55MULTIPLE VITAMINS W/ CALCIUM.....................................................................................................................................................55MULTIPLE VITAMINS W/ MINERALS...................................................................................................................................................55MULTIPLE VITAMINS W/ MINERALS & CALCIUM-FOLIC ACID..........................................................................................................55MULTIPLE VITAMINS W/ MINERALS & FOLIC ACID..........................................................................................................................55MULTIVITAMINS..................................................................................................................................................................................55PED MULTI VITAMINS W/FL & FE....................................................................................................................................................55PED MV W/ FLUORIDE......................................................................................................................................................................55PEDIATRIC MULTIPLE VITAMINS.......................................................................................................................................................55PRENATAL MV & MIN W/FE-FA......................................................................................................................................................55PRENATAL MV & MIN W/FE-FA-CA-OMEGA 3 FISH OIL..............................................................................................................56PRENATAL MV & MIN W/FE-FA-DHA............................................................................................................................................56PRENATAL VITAMINS.........................................................................................................................................................................56

MUSCULOSKELETAL THERAPY AGENTS.......................................................................................................................... 56

CENTRAL MUSCLE RELAXANTS.......................................................................................................................................................56DIRECT MUSCLE RELAXANTS...........................................................................................................................................................56VISCOSUPPLEMENTS.........................................................................................................................................................................56

NASAL AGENTS - SYSTEMIC AND TOPICAL...................................................................................................................... 56

ANTIHISTAMINE-STEROID..................................................................................................................................................................56NASAL ANTICHOLINERGICS..............................................................................................................................................................56NASAL ANTIHISTAMINES...................................................................................................................................................................56NASAL STEROIDS..............................................................................................................................................................................56

NEPRILYSIN INHIB (ARNI)-ANGIOTENSIN II RECEPT ANTAG COMB.............................................................................56

NEPRILYSIN INHIB (ARNI)-ANGIOTENSIN II RECEPT ANTAG COMB...............................................................................................56

NEUROMUSCULAR AGENTS................................................................................................................................................. 57

BENZATHIAZOLES..............................................................................................................................................................................57DEPOLARIZING MUSCLE RELAXANTS...............................................................................................................................................57NEUROMUSCULAR BLOCKING AGENT - NEUROTOXINS...................................................................................................................57

NUTRIENTS.............................................................................................................................................................................. 57

AMINO ACID MIXTURES.................................................................................................................................................................... 57Updated July 1, 2020 Page

CARBOHYDRATES............................................................................................................................................................................. 57LIPIDS................................................................................................................................................................................................ 57

OPHTHALMIC AGENTS.......................................................................................................................................................... 57

BETA-BLOCKERS - OPHTHALMIC......................................................................................................................................................57BETA-BLOCKERS - OPHTHALMIC COMBINATIONS............................................................................................................................57CYCLOPLEGIC MYDRIATICS..............................................................................................................................................................57LYMPHOCYTE FUNCTION-ASSOCIATED ANTIGEN-1 (LFA-1) ANTAG.............................................................................................57MIOTICS - CHOLINESTERASE INHIBITORS.........................................................................................................................................57MIOTICS - DIRECT ACTING................................................................................................................................................................57OPHTHALMIC ANTIALLERGIC............................................................................................................................................................57OPHTHALMIC ANTIBIOTICS................................................................................................................................................................57OPHTHALMIC ANTIFUNGAL...............................................................................................................................................................58OPHTHALMIC ANTI-INFECTIVE COMBINATIONS................................................................................................................................58OPHTHALMIC ANTIVIRALS.................................................................................................................................................................58OPHTHALMIC CARBONIC ANHYDRASE INHIBITORS..........................................................................................................................58OPHTHALMIC ENZYMES.................................................................................................................................................................... 58OPHTHALMIC IMMUNOMODULATORS................................................................................................................................................58OPHTHALMIC IRRIGATION SOLUTIONS..............................................................................................................................................58OPHTHALMIC LOCAL ANESTHETICS.................................................................................................................................................58OPHTHALMIC NONSTEROIDAL ANTI-INFLAMMATORY AGENTS........................................................................................................58OPHTHALMIC PHOTODYNAMIC THERAPY AGENTS...........................................................................................................................58OPHTHALMIC RHO KINASE INHIBITORS............................................................................................................................................58OPHTHALMIC SELECTIVE ALPHA ADRENERGIC AGONISTS.............................................................................................................58OPHTHALMIC STEROID COMBINATIONS...........................................................................................................................................58OPHTHALMIC STEROIDS....................................................................................................................................................................58OPHTHALMIC SULFONAMIDES...........................................................................................................................................................58OPHTHALMICS - CYSTINOSIS AGENTS.............................................................................................................................................59PROSTAGLANDINS - OPHTHALMIC....................................................................................................................................................59VASCULAR ENDOTHELIAL GROWTH FACTOR (VEGF) ANTAGONISTS...........................................................................................59

OPHTHALMIC GENE THERAPY............................................................................................................................................. 59

OPHTHALMIC GENE THERAPY..........................................................................................................................................................59

OPHTHALMIC KINASE INHIBITORS - COMBINATIONS..................................................................................................... 59

OPHTHALMIC KINASE INHIBITORS - COMBINATIONS........................................................................................................................59

OREXIN RECEPTOR ANTAGONISTS.................................................................................................................................... 59

OREXIN RECEPTOR ANTAGONISTS...................................................................................................................................................59

OTIC AGENTS.......................................................................................................................................................................... 59

OTIC AGENTS - MISCELLANEOUS.....................................................................................................................................................59OTIC ANALGESIC COMBINATIONS....................................................................................................................................................59OTIC ANTI-INFECTIVES......................................................................................................................................................................59OTIC STEROID-ANTI-INFECTIVE COMBINATIONS..............................................................................................................................59OTIC STEROIDS.................................................................................................................................................................................59

OXYTOCICS.............................................................................................................................................................................. 59

ABORTIFACIENTS/CERVICAL RIPENING - PROSTAGLANDINS...........................................................................................................59OXYTOCICS........................................................................................................................................................................................59

PASSIVE IMMUNIZING AGENTS............................................................................................................................................ 59

ANTITOXINS-ANTIVENINS..................................................................................................................................................................59ANTIVIRAL MONOCLONAL ANTIBODIES............................................................................................................................................59


IMMUNE SERUMS...............................................................................................................................................................................59

PCSK9 INHIBITORS................................................................................................................................................................. 60

PCSK9 INHIBITORS..........................................................................................................................................................................60

PENICILLINS............................................................................................................................................................................. 60

AMINOPENICILLINS............................................................................................................................................................................60NATURAL PENICILLINS......................................................................................................................................................................60PENICILLIN COMBINATIONS...............................................................................................................................................................60PENICILLINASE-RESISTANT PENICILLINS..........................................................................................................................................60

PHOSPHATIDYLINOSITOL 3-KINASE (PI3K) INHIBITORS.................................................................................................60

PHOSPHATIDYLINOSITOL 3-KINASE (PI3K) INHIBITORS..................................................................................................................60

PHOSPHODIESTERASE 4 (PDE4) INHIBITORS - TOPICAL...............................................................................................60

PHOSPHODIESTERASE 4 (PDE4) INHIBITORS - TOPICAL................................................................................................................60

POLY (ADP-RIBOSE) POLYMERASE (PARP) INHIBITORS................................................................................................60

POLY (ADP-RIBOSE) POLYMERASE (PARP) INHIBITORS...............................................................................................................60

POSTHERPETIC NEURALGIA (PHN)/NEUROPATHIC PAIN AGENTS..............................................................................60

POSTHERPETIC NEURALGIA (PHN)/NEUROPATHIC PAIN AGENTS.................................................................................................60

PROGESTINS........................................................................................................................................................................... 60

PROGESTINS......................................................................................................................................................................................60

PROTEASE-ACTIVATED RECEPTOR-1 (PAR-1) ANTAGONISTS.....................................................................................60

PROTEASE-ACTIVATED RECEPTOR-1 (PAR-1) ANTAGONISTS.......................................................................................................60

PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC....................................................................................60

AGENTS FOR NARCOTIC WITHDRAWAL...........................................................................................................................................60ALCOHOL DETERRENTS....................................................................................................................................................................60ANTI-CATAPLECTIC AGENTS............................................................................................................................................................61ANTIDEMENTIA AGENT COMBINATIONS............................................................................................................................................61BENZODIAZEPINES & TRICYCLIC AGENTS.......................................................................................................................................61CHOLINOMIMETICS - ACHE INHIBITORS..........................................................................................................................................61FIBROMYALGIA AGENT - SNRIS......................................................................................................................................................61MOVEMENT DISORDER DRUG THERAPY..........................................................................................................................................61MS AGENTS - PYRIMIDINE SYNTHESIS INHIBITORS.........................................................................................................................61MULTIPLE SCLEROSIS AGENTS........................................................................................................................................................61MULTIPLE SCLEROSIS AGENTS - INTERFERONS..............................................................................................................................61MULTIPLE SCLEROSIS AGENTS - MONOCLONAL ANTIBODIES........................................................................................................61MULTIPLE SCLEROSIS AGENTS - NRF2 PATHWAY ACTIVATORS....................................................................................................61MULTIPLE SCLEROSIS AGENTS - POTASSIUM CHANNEL BLOCKERS.............................................................................................61N-METHYL-D-ASPARTATE (NMDA) RECEPTOR ANTAGONISTS.....................................................................................................61PHENOTHIAZINES & TRICYCLIC AGENTS..........................................................................................................................................61PSEUDOBULBAR AFFECT AGENT COMBINATIONS...........................................................................................................................61SMOKING DETERRENTS....................................................................................................................................................................61SPHINGOSINE 1-PHOSPHATE (S1P) RECEPTOR MODULATORS.....................................................................................................61THIENBENZODIAZEPINES & SSRIS...................................................................................................................................................61VASOMOTOR SYMPTOM AGENTS - SSRIS.......................................................................................................................................61

PULMONARY HYPERTENSION - PROSTACYCLIN RECEPTOR AGONIST.....................................................................61

PULMONARY HYPERTENSION - PROSTACYCLIN RECEPTOR AGONIST............................................................................................61


RESPIRATORY AGENTS - MISC............................................................................................................................................ 62

ALPHA-PROTEINASE INHIBITOR (HUMAN)........................................................................................................................................62CFTR POTENTIATORS......................................................................................................................................................................62HYDROLYTIC ENZYMES.....................................................................................................................................................................62INTERLEUKIN-5 ANTAGONISTS (IGG1 KAPPA).................................................................................................................................62PULMONARY FIBROSIS AGENTS.......................................................................................................................................................62

SCLEROSTIN INHIBITORS..................................................................................................................................................... 62

SCLEROSTIN INHIBITORS...................................................................................................................................................................62

SINUS NODE INHIBITORS...................................................................................................................................................... 62

SINUS NODE INHIBITORS...................................................................................................................................................................62

SPINAL MUSCULAR ATROPHY AGENTS (SMA)................................................................................................................ 62

SPINAL MUSCULAR ATROPHY AGENTS (SMA)...............................................................................................................................62

TETRACYCLINES.................................................................................................................................................................... 62

TETRACYCLINES................................................................................................................................................................................62

TETRAHYDROISOQUINOLINES............................................................................................................................................ 62

TETRAHYDROISOQUINOLINES............................................................................................................................................................62

THYROID AGENTS.................................................................................................................................................................. 62

ANTITHYROID AGENTS......................................................................................................................................................................62THYROID HORMONES........................................................................................................................................................................62

TOXOIDS................................................................................................................................................................................... 62

TOXOID COMBINATIONS....................................................................................................................................................................62

TRIPEPTIDYL PEPTIDASE 1 DEFICIENCY TREATMENT - AGENTS................................................................................62

TRIPEPTIDYL PEPTIDASE 1 DEFICIENCY TREATMENT - AGENTS.....................................................................................................62

TRYPTOPHAN HYDROXYLASE INHIBITORS...................................................................................................................... 63

TRYPTOPHAN HYDROXYLASE INHIBITORS........................................................................................................................................63

ULCER DRUGS........................................................................................................................................................................ 63

ANTISPASMODICS..............................................................................................................................................................................63BELLADONNA ALKALOIDS................................................................................................................................................................63H-2 ANTAGONISTS............................................................................................................................................................................63MISC. ANTI-ULCER............................................................................................................................................................................63PROTON PUMP INHIBITOR-ANTACID COMBINATIONS.......................................................................................................................63PROTON PUMP INHIBITORS...............................................................................................................................................................63QUATERNARY ANTICHOLINERGICS...................................................................................................................................................63ULCER ANTI-INFECTIVE W/ PROTON PUMP INHIBITORS..................................................................................................................63ULCER DRUGS - PROSTAGLANDINS.................................................................................................................................................63

URINARY ANTI-INFECTIVES.................................................................................................................................................. 63

URINARY ANTI-INFECTIVES...............................................................................................................................................................63URINARY ANTISEPTIC-ANTISPASMODIC &/OR ANALGESICS...........................................................................................................63

URINARY ANTISPASMODICS................................................................................................................................................ 63

BETA-3 ADRENERGIC AGONISTS.....................................................................................................................................................63URINARY ANTISPASMODIC - ANTIMUSCARINIC (ANTICHOLINERGIC)...............................................................................................63URINARY ANTISPASMODICS - CHOLINERGIC AGONISTS (NEW).......................................................................................................64


URINARY ANTISPASMODICS - DIRECT MUSCLE RELAXANTS..........................................................................................................64

VACCINES................................................................................................................................................................................ 64

BACTERIAL VACCINES......................................................................................................................................................................64VIRAL VACCINE COMBINATIONS.......................................................................................................................................................64VIRAL VACCINES...............................................................................................................................................................................64

VAGINAL PRODUCTS............................................................................................................................................................. 64

IMIDAZOLE-RELATED ANTIFUNGALS................................................................................................................................................64VAGINAL ANTI-INFECTIVES...............................................................................................................................................................64VAGINAL ESTROGENS.......................................................................................................................................................................64VAGINAL PROGESTINS......................................................................................................................................................................64

VASOPRESSORS.................................................................................................................................................................... 64

ANAPHYLAXIS THERAPY AGENTS....................................................................................................................................................64VASOPRESSORS................................................................................................................................................................................64

VITAMINS.................................................................................................................................................................................. 65

VITAMIN A......................................................................................................................................................................................... 65VITAMIN B-1......................................................................................................................................................................................65VITAMIN B-6......................................................................................................................................................................................65VITAMIN C......................................................................................................................................................................................... 65VITAMIN K......................................................................................................................................................................................... 65

VITAMINS, HEMATINICS & ELECTROLYTES...................................................................................................................... 65

VITAMINS & HEMATINICS...........................................................................................................................................................65

X-LINKED HYPOPHOSPHATEMIA (XLH) TREATMENT - AGENTS...................................................................................65

X-LINKED HYPOPHOSPHATEMIA (XLH) TREATMENT - AGENTS.....................................................................................................65


Adenosine Receptor Antagonist

Adenosine Receptor AntagonisNON PREFERRED NOURIANZ

ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/

ANOREXIANTS

ADHD Agent - Selective Alpha Adrenergic AgonistsGENERIC clonidine hcl er guanfacine er

ADHD Agent - Selective Norepinephrine Reuptake Inhibitor

GENERIC atomoxetine hcl

NON PREFERRED STRATTERA

Amphetamine MixturesGENERIC amphetamine salt combo er

PREFERRED MYDAYIS

NON PREFERRED ADDERALL ADDERALL XR

AmphetaminesGENERIC dextroamphetamine sulfate dextroamphetamine sulfate er methamphetamine hcl

PREFERRED VYVANSE

NON PREFERRED EVEKEO

AnalepticsGENERIC caffeine citrated caffeine/sodium benzoate

Anorexiants Non-AmphetamineGENERIC benzphetamine hcl diethylpropion hcl phendimetrazine tartrate phendimetrazine tartrate er phentermine hcl

Stimulants - Misc.GENERIC armodafinil dexmethylphenidate er dexmethylphenidate hcl dexmethylphenidate hcl er methylphenidate cd methylphenidate er methylphenidate hcl methylphenidate hcl er (cd) methylphenidate la modafinil

NON PREFERRED ADHANSIA XR CONCERTA DAYTRANA FOCALIN FOCALIN XR JORNAY PM METADATE CD QUILLICHEW ER QUILLIVANT XR RITALIN RITALIN LA

ALS Agents - Miscellaneous

ALS Agents - MiscellaneousNON PREFERRED RADICAVA

AMINOGLYCOSIDES

AminoglycosidesGENERIC gentamicin sulfate gentamicin sulfate in ns neomycin sulfate paromomycin sulfate tobramycin sulfate tobramycin sulfate in ns

PREFERRED AMIKACIN BETHKIS KITABIS PAK

NON PREFERRED GENTAMICIN SULFATE 60MG/ML VIAL GENTAMICIN SULFATE IN NS 100MG/50ML GENTAMICIN SULFATE IN NS 120MG/0.1L STREPTOMYCIN SULFATE TOBI PODHALER


ANALGESICS - ANTI-INFLAMMATORY

Antirheumatic - Janus Kinase (JAK) InhibitorsPREFERRED XELJANZ XELJANZ XR

NON PREFERRED RINVOQ

Antirheumatic AntimetabolitesNON PREFERRED OTREXUP RASUVO

Anti-TNF-alpha - Monoclonal AntibodiesPREFERRED HUMIRA

NON PREFERRED SIMPONI ARIA

Anti-TNF-alpha - Monoclonoal AntibodiesNON PREFERRED SIMPONI

Cyclooxygenase 2 (COX-2) InhibitorsGENERIC celecoxib

NON PREFERRED CELEBREX

Gold CompoundsNON PREFERRED RIDAURA

Interleukin-1 BlockersNON PREFERRED ARCALYST

Interleukin-1 Receptor Antagonist (IL-1Ra)NON PREFERRED KINERET

Interleukin-1beta BlockersNON PREFERRED ILARIS

Interleukin-6 Receptor InhibitorsNON PREFERRED ACTEMRA ACTEMRA ACTPEN KEVZARA

Nonsteroidal Anti-inflammatory Agent CombinationsGENERIC diclofenac sodium/misoprostol del rel

Nonsteroidal Anti-inflammatory Agents (NSAIDs)GENERIC diclofenac potassium diclofenac sodium etodolac etodolac er fenoprofen calcium flurbiprofen ibuprofen ibuprofen lysine indomethacin indomethacin er ketoprofen er ketorolac tromethamine meclofenamate sodium mefenamic acid meloxicam nabumetone naproxen naproxen sodium oxaprozin piroxicam sulindac tolmetin sodium

NON PREFERRED CALDOLOR FENOPROFEN CALCIUM NEOPROFEN QMIIZ ODT TIVORBEX ZORVOLEX

Pyrimidine Synthesis InhibitorsGENERIC leflunomide

Selective Costimulation ModulatorsNON PREFERRED ORENCIA ORENCIA CLICKJECT

Soluble Tumor Necrosis Factor Receptor AgentsPREFERRED ENBREL

ANALGESICS - NonNarcotic

Analgesics OtherGENERIC acetaminophen-diphenhydramine clonidine

NON PREFERRED OFIRMEV

Analgesics-SedativesGENERIC butalbital compound butalbital/apap/caffeine butalbital/aspirin/caffeine


Salicylate CombinationsGENERIC choline mag trisalicylate

SalicylatesGENERIC diflunisal salicylamide salsalate

NON PREFERRED DISALCID

Selective N-Type Neuronal Calcium Channel BlockersNON PREFERRED PRIALT

ANALGESICS - OPIOID

Codeine CombinationsGENERIC acetaminophen/codeine butalbital compound/codeine butalbital/caff/apap/codeine

Dihydrocodeine CombinationsGENERIC dihydrocodeine/aspirin/caffeine

Hydrocodone CombinationsGENERIC hydrocodone/acetaminophen hydrocodone/ibuprofen

Opioid AgonistsGENERIC alfentanil hcl codeine sulfate fentanyl citrate hydrocodone bitartrate er hydromorphone hcl levorphanol tartrate meperidine hcl methadone hcl morphine sulfate morphine sulfate cr morphine sulfate er oxycodone hcl oxycodone hcl/ibuprofen oxymorphone hcl oxymorphone hcl er remifentanil hcl sufentil 50mcg/ml ampul tramadol hcl tramadol hcl er

PREFERRED OXYCONTIN ROXYBOND XTAMPZA ER

NON PREFERRED ABSTRAL CODEINE SULFATE SOLUTION DSUVIA FENTANYL CITRATE 100MCG/2ML FENTORA HYDROMORPHONE HCL 0.5MG/0.5ML SYRINGE HYSINGLA ER INFUMORPH MORPHINE SULFATE NUCYNTA NUCYNTA ER SUBSYS SUFENTIL 50MCG/ML VIAL TRAMADOL HCL ER ULTIVA ZOHYDRO ER

Opioid CombinationsGENERIC oxycodone w/aspirin oxycodone/acetaminophen

Opioid Partial AgonistsGENERIC buprenorphine buprenorphine/naloxone butorphanol nalbuphine hcl

PREFERRED BELBUCA SUBOXONE ZUBSOLV

NON PREFERRED BUTRANS SUBLOCADE SUBOXONE (FILM)

Tramadol CombinationsGENERIC tramadol/acetaminophen

ANDROGENS-ANABOLIC

AndrogensGENERIC danazol oxandrolone testosterone cypionate testosterone enanthate testosterone gel

NON PREFERRED ANDRODERM AXIRON METHITEST TESTOSTERONE GEL


ANORECTAL AGENTS

Intrarectal SteroidsPREFERRED CORTIFOAM

NON PREFERRED UCERIS FOAM

Nitrate Vasodilating AgentsNON PREFERRED RECTIV

Rectal Anesthetic/SteroidsGENERIC hydrocortisone hydrocortisone/pramoxine lidocaine-hc pramcort

NON PREFERRED LIDOCAINE-HC PROCTOFOAM-HC

ANTHELMINTICS

AnthelminticsGENERIC praziquantel

PREFERRED ALBENZA

NON PREFERRED BENZNIDAZOLE BILTRICIDE EMVERM STROMECTOL

ANTIANGINAL AGENTS

Antianginals-OtherGENERIC ranolazine er

NON PREFERRED RANEXA

NitratesGENERIC isosorbide dinitrate isosorbide mononitrate isosorbide mononitrate er minitran nitroglycerin nitroglycerin er nitroglycerin spray nitroglycerin tablets

PREFERRED DILATRATE-SR

NON PREFERRED NITRO-DUR NITROGLYCERIN IN D5W NITROSTAT

ANTIANXIETY AGENTS

Antianxiety Agents - Misc.GENERIC buspirone hcl droperidol hydroxyzine hcl hydroxyzine pamoate

NON PREFERRED VISTARIL

BenzodiazepinesGENERIC alprazolam alprazolam er alprazolam odt chlordiazepoxide hcl clorazepate dipotassium diazepam lorazepam oxazepam

NON PREFERRED XANAX XANAX XR

ANTIARRHYTHMICS

Antiarrhythmics - Misc.GENERIC adenosine

Antiarrhythmics Type I-AGENERIC procainamide hcl quinidine gluconate quinidine gluconate er quinidine sulfate

PREFERRED QUINIDINE SULFATE

Antiarrhythmics Type I-BGENERIC lidocaine hcl in 7.5% dextrose mexiletine hcl


Antiarrhythmics Type I-CGENERIC flecainide acetate propafenone hcl propafenone hcl er

Antiarrhythmics Type IIIGENERIC amiodarone hcl dofetilide ibutilide fumarate

NON PREFERRED NEXTERONE

ANTIASTHMATIC AND BRONCHODILATOR AGENTS

Adrenergic CombinationsGENERIC fluticasone-salmeterol ipratropium-albuterol wixela inhub

PREFERRED ADVAIR HFA ANORO ELLIPTA BREO ELLIPTA COMBIVENT RESPIMAT STIOLTO RESPIMAT SYMBICORT TRELEGY ELLIPTA

NON PREFERRED ADVAIR DISKUS BEVESPI AEROSPHERE DULERA UTIBRON NEOHALER

Anti-IgE Monoclonal AntibodiesNON PREFERRED XOLAIR

Anti-Inflammatory AgentsGENERIC cromolyn sodium

Beta AdrenergicsGENERIC albuterol sulfate albuterol sulfate hfa levalbuterol hcl metaproterenol sulfate terbutaline sulfate

PREFERRED ALBUTEROL ARCAPTA NEOHALER PERFOROMIST PROAIR RESPICLICK SEREVENT DISKUS

NON PREFERRED PROAIR HFA STRIVERDI RESPIMAT VENTOLIN HFA VOSPIRE ER

Bronchodilators - AnticholinergicsGENERIC ipratropium bromide ipratropium/albuterol nebulization

PREFERRED INCRUSE ELLIPTA SPIRIVA RESPIMAT

NON PREFERRED SEEBRI NEOHALER TUDORZA PRESSAIR YUPELRI

Leukotriene Receptor AntagonistsGENERIC montelukast sodium zafirlukast

NON PREFERRED ACCOLATE

Selective Phosphodiesterase 4 (PDE4) InhibitorsPREFERRED DALIRESP

Steroid InhalantsGENERIC budesonide

PREFERRED ARNUITY ELLIPTA ASMANEX, HFA FLOVENT DISKUS FLOVENT HFA PULMICORT FLEXHALER QVAR QVAR REDIHALER

NON PREFERRED ALVESCO ARMONAIR RESPICLICK

XanthinesGENERIC aminophylline theophylline anhydrous drops er 12 hr theophylline anhydrous er

NON PREFERRED AMINOPHYLLINE 500MG/20ML AMPUL


ANTICOAGULANTS

Coumarin AnticoagulantsGENERIC warfarin sodium

NON PREFERRED COUMADIN

Direct Factor Xa InhibitorsPREFERRED ELIQUIS XARELTO

Heparins And Heparinoid-Like AgentsGENERIC heparin lock flush heparin sodium in 0.45% nacl heparin sodium in 5% dextrose heparin sodium syringe

NON PREFERRED HEPARIN SODIUM IN 0.45% NACL 12500/500

Low Molecular Weight HeparinsGENERIC enoxaparin sodium

NON PREFERRED FRAGMIN

Synthetic Heparinoid-Like AgentsGENERIC fondaparinux sodium

Thrombin Inhibitors - Hirudin TypeGENERIC bivalirudin

NON PREFERRED ANGIOMAX

Thrombin Inhibitors - Selective Direct & ReversibleNON PREFERRED ARGATROBAN

ANTICONVULSANTS

AMPA Glutamate Receptor AntagonistsNON PREFERRED FYCOMPA

Anticonvulsants - BenzodiazepinesGENERIC clobazam clonazepam clonazepam odt diazepam rectal gel

NON PREFERRED NAYZILAM ONFI SYMPAZAN VALTOCO

Anticonvulsants - Misc.GENERIC carbamazepine carbamazepine er gabapentin lamotrigine lamotrigine er levetiracetam levetiracetam er oxcarbazepine pregabalin primidone roweepra topiramate zonisamide

PREFERRED ROWEEPRA XR

NON PREFERRED BANZEL DIACOMIT LAMICTAL XR LYRICA OXTELLAR XR POTIGA QUDEXY XR VIMPAT ZONISAMIDE

CarbamatesGENERIC felbamate

NON PREFERRED XCOPRI

GABA ModulatorsGENERIC tiagabine hcl vigabatrin

NON PREFERRED GABITRIL SABRIL

HydantoinsGENERIC fosphenytoin sodium phenytoin phenytoin sodium

NON PREFERRED DILANTIN DILANTIN 30MG PEGANONE


SuccinimidesGENERIC ethosuximide

NON PREFERRED CELONTIN

Valproic AcidGENERIC divalproex sodium divalproex sodium er valproate sodium valproic acid

PREFERRED VALPROIC ACID

ANTIDEPRESSANTS

Alpha-2 Receptor Antagonists (Tetracyclics)GENERIC mirtazapine mirtazapine disintegrating

NON PREFERRED REMERON REMERON ODT

Antidepressants - Misc.GENERIC bupropion hcl bupropion hcl er bupropion hcl xl er bupropion sr

Modified CyclicsGENERIC trazodone hcl

NON PREFERRED VIIBRYD

Monoamine Oxidase Inhibitors (MAOIs)GENERIC phenelzine sulfate tranylcypromine sulfate

Selective Serotonin Reuptake Inhibitors (SSRIs)GENERIC citalopram hbr escitalopram oxalate fluoxetine fluvoxamine maleate er paroxetine hcl paroxetine hcl er

NON PREFERRED CELEXA PROZAC

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)GENERIC desvenlafaxine succinate er duloxetine venlafaxine hcl venlafaxine hcl er

PREFERRED FETZIMA

NON PREFERRED EFFEXOR XR PRISTIQ

Tricyclic AgentsGENERIC amitriptyline hcl amoxapine 150mg amoxapine 25mg clomipramine hcl desipramine hcl doxepin hcl imipramine hcl imipramine pamoate nortriptyline hcl trimipramine maleate

ANTIDIABETICS

Alpha-Glucosidase InhibitorsGENERIC acarbose

Antidiabetic - Amylin AnalogsNON PREFERRED SYMLINPEN 120 SYMLINPEN 60

BiguanidesGENERIC metformin hcl metformin hcl er

NON PREFERRED RIOMET

Diabetic OtherPREFERRED BAQSIMI GLUCAGON

NON PREFERRED GLUCAGEN PROGLYCEM

Dipeptidyl Peptidase-4 (DPP-4) InhibitorsPREFERRED JANUVIA ONGLYZA TRADJENTA


Dipeptidyl Peptidase-4 Inhibitor-Biguanide Combinations

PREFERRED JANUMET JANUMET XR JENTADUETO JENTADUETO XR

NON PREFERRED KOMBIGLYZE XR

Human InsulinGENERIC insulin lispro

PREFERRED HUMULIN R 500 UNITS HUMULIN R U-500 KWIKPEN LANTUS LANTUS SOLOSTAR LEVEMIR LEVEMIR, FLEXTOUCH NOVOLIN 70-30 NOVOLIN N NOVOLIN R NOVOLOG NOVOLOG FLEXPEN NOVOLOG MIX 70-30 TOUJEO MAX SOLOSTAR TOUJEO SOLOSTAR TRESIBA TRESIBA FLEXTOUCH

NON PREFERRED BASAGLAR KWIKPEN U-100 HUMALOG HUMALOG JUNIOR KWIKPEN HUMALOG KWIKPEN HUMULIN 70/30 KWIKPEN HUMULIN 70-30 HUMULIN N HUMULIN N KWIKPEN

Incretin Mimetic Agents (GLP-1 Receptor Agonists)PREFERRED BYETTA OZEMPIC TRULICITY VICTOZA

NON PREFERRED BYDUREON BYDUREON BCISE BYDUREON PEN

Insulin-Incretin Mimetic CombinationsPREFERRED SOLIQUA 100-33 XULTOPHY 100-3.6

Meglitinide AnaloguesGENERIC nateglinide repaglinide

Meglitinide-Biguanide CombinationsGENERIC repaglinide/metformin

SGLT2 Inhibitor - DPP-4 Inhibitor - Biguanide CombNON PREFERRED TRIJARDY XR

SGLT2 Inhibitor - DPP-4 Inhibitor CombinationsNON PREFERRED GLYXAMBI STEGLUJAN

Sodium-Glucose Co-Transporter 2 (SGLT2) InhibitorsPREFERRED FARXIGA INVOKANA

NON PREFERRED JARDIANCE STEGLATRO

Sodium-Glucose Co-Transporter 2 Inhibitor-Biguanide Comb

PREFERRED INVOKAMET INVOKAMET XR XIGDUO XR

NON PREFERRED SEGLUROMET SYNJARDY SYNJARDY XR

Sulfonylurea-Biguanide CombinationsGENERIC glyburide/metformin hcl

SulfonylureasGENERIC glimepiride glipizide glipizide er glyburide glyburide micronized tolazamide tolbutamide

Sulfonylurea-Thiazolidinedione CombinationsGENERIC pioglitazone/glimepiride

Thiazolidinedione-Biguanide CombinationsGENERIC pioglitazone/metformin

NON PREFERRED ACTOPLUS MET ACTOPLUS MET XR


ThiazolidinedionesGENERIC pioglitazone hcl

NON PREFERRED ACTOS

ANTIDIARRHEALS

Antiperistaltic AgentsGENERIC diphenoxylate/atropine opium paregoric

NON PREFERRED LOMOTIL TABLET

ANTIDOTES

AntidotesGENERIC deferoxamine fomepizole physostigmine salicylate

PREFERRED PHYSOSTIGMINE SALICYLATE VISTOGARD

NON PREFERRED SODIUM THIOSULFATE

Antidotes - Chelating AgentsGENERIC deferasirox

NON PREFERRED CHEMET EXJADE FERRIPROX JADENU JADENU SPRINKLE

Benzodiazepine AntagonistsGENERIC flumazenil

Opioid AntagonistsGENERIC naloxone hcl naltrexone hydrochloride

PREFERRED NARCAN

NON PREFERRED VIVITROL

ANTIDOTES AND SPECIFIC ANTAGONISTS

Antidotes and Specific AntagonistsGENERIC methylene blue

NON PREFERRED BAL IN OIL PROTOPAM CHLORIDE

ANTIEMETICS

5-HT3 Receptor AntagonistsGENERIC granisetron hcl ondansetron hcl ondansetron odt palonosetron hcl

PREFERRED SANCUSO

NON PREFERRED ALOXI

Antiemetic CombinationsNON PREFERRED AKYNZEO

Antiemetics - AnticholinergicGENERIC dimenhydrinate meclizine hcl scopolamine patch trimethobenzamide hcl

NON PREFERRED SCOPOLAMINE HYDROBROMIDE TRANSDERM SCOP

Antiemetics - MiscellaneousGENERIC dronabinol

Substance P/Neurokinin 1 (NK1) Receptor AntagonistsGENERIC aprepitant fosaprepitant

PREFERRED VARUBI

NON PREFERRED EMEND


ANTIFUNGALS

Antifungal - Glucan Synthesis Inhibitors (Echinocandins)

GENERIC caspofungin acetate micafungin sodium

NON PREFERRED CANCIDAS MYCAMINE

AntifungalsGENERIC amphotericin flucytosine griseofulvin griseofulvin ultramicrosize nystatin terbinafine

PREFERRED NYSTATIN TERBINAFINE

NON PREFERRED AMBISOME LAMISIL LAMISIL 250MG TABLET

ImidazolesGENERIC ketoconazole

NON PREFERRED KETOCONAZOLE CRYSTALS

TriazolesGENERIC fluconazole fluconazole in dextrose fluconazole in saline itraconazole posaconazole voriconazole

PREFERRED CRESEMBA

NON PREFERRED FLUCONAZOLE 100MG/50ML PIGGYBACK NOXAFIL SPORANOX CAPSULE SPORANOX SOLUTION

Antihemophilic Products - Monoclonal Antibodies

Antihemophilic Products - Monoclonal AntibodiesNON PREFERRED HEMLIBRA

ANTIHISTAMINES

Antihistamines - AlkylaminesGENERIC dexchlorpheniramine maleate er

Antihistamines - EthanolaminesGENERIC arbinoxa carbinoxamine clemastine fumarate diphenhydramine diphenhydramine hcl

Antihistamines - Non-SedatingGENERIC cetirizine syrup desloratadine desloratadine disintegrating tablets levocetirizine dihydrochloride

Antihistamines - PhenothiazinesGENERIC promethazine hcl promethegan

Antihistamines - PiperidinesGENERIC cyproheptadine hcl

ANTIHYPERLIPIDEMICS

Antihyperlipidemics - Misc.GENERIC omega-3-acid ethyl esters

PREFERRED VASCEPA

Bile Acid SequestrantsGENERIC cholestyramine cholestyramine light colesevelam hcl colestipol hcl

NON PREFERRED WELCHOL

Fibric Acid DerivativesGENERIC fenofibric acid fenofibric acid dr gemfibrozil

PREFERRED FENOFIBRATE LIPOFEN


HMG CoA Reductase InhibitorsGENERIC atorvastatin calcium fluvastatin sodium lovastatin pravastatin sodium rosuvastatin simvastatin

PREFERRED LIVALO

NON PREFERRED EZALLOR SPRINKLE

Intest Cholest Absorp Inhib-HMG CoA Reductase Inhib Comb

GENERIC ezetimibe/simvastatin

NON PREFERRED VYTORIN

Intestinal Cholesterol Absorption InhibitorsGENERIC ezetimibe

NON PREFERRED ZETIA

Microsomal Triglyceride Transfer Protein InhibitorsNON PREFERRED JUXTAPID

Nicotinic Acid DerivativesGENERIC niacin er

ANTIHYPERTENSIVES

ACE Inhibitor & Calcium Channel Blocker Combinations

GENERIC trandolapril/verapamil er

NON PREFERRED PRESTALIA TARKA

ACE InhibitorsGENERIC benazepril hcl captopril enalapril maleate enalaprilat fosinopril sodium lisinopril moexipril hcl perindopril erbumine quinapril ramipril

trandolapril

NON PREFERRED MAVIK VASOTEC

ACE Inhibitors & Thiazide/Thiazide-LikeGENERIC benazepril/hctz captopril/hydrochlorothiazide enalapril maleate/hctz fosinopril/hydrochlorothiazide lisinopril/hctz moexipril/hydrochlorothiazide quinapril/hydrochlorothiazide

Adrenolytics-Central & Thiazide/Thiazide-Like CombGENERIC methyldopa/hydrochlorothiazide

Agents for PheochromocytomaGENERIC phentolamine mesylate

NON PREFERRED DEMSER PHENTOLAMINE MESYLATE VIAL

Angiotensin II Receptor Antag & Ca Channel Blocker Comb

GENERIC amlodipine/olmesartan amlodipine/valsartan

NON PREFERRED AZOR

Angiotensin II Receptor Antag & Thiazide/Thiazide-LikeGENERIC candesartan/hydrochlorothiazide irbesartan/hydrochlorothiazide losartan/hydrochlorothiazide olmesartan medoxomil/hctz valsartan/hydrochlorothiazide

NON PREFERRED BENICAR HCT EDARBYCLOR

Angiotensin II Receptor AntagonistsGENERIC candesartan cilexetil irbesartan losartan potassium olmesartan medoxomil valsartan

NON PREFERRED BENICAR EDARBI


Angiotensin II Receptor Ant-Ca Channel Blocker-Thiazides

GENERIC amlodipine/valsartan/hctz olmesartan/amlodipine/hctz

NON PREFERRED TRIBENZOR

Antiadrenergics - Centrally ActingGENERIC clonidine hcl guanfacine hcl methyldopa methyldopate hcl

Antiadrenergics - Peripherally ActingGENERIC doxazosin mesylate prazosin hcl terazosin hcl

Beta Blocker & Angiotensin II Receptor Antagonist Comb

NON PREFERRED BYVALSON

Beta Blocker & Diuretic CombinationsGENERIC atenolol/chlorthalidone bisoprolol fumarate/hctz metoprolol/hydrochlorothiazide nadolol-bendroflumethiazide propranolol/hctz

Direct Renin InhibitorsGENERIC aliskiren fumarate

NON PREFERRED TEKTURNA

Direct Renin Inhibitors & Thiazide/Thiazide-Like CombNON PREFERRED TEKTURNA HCT

ReserpineGENERIC reserpine

Selective Aldosterone Receptor Antagonists (SARAs)GENERIC eplerenone

VasodilatorsGENERIC hydralazine hcl minoxidil

ANTI-INFECTIVE AGENTS - MISC.

Anti-infective Agents - Misc.GENERIC bacitracin colistimethate metronidazole pentamidine isethionate tinidazole trimethoprim

PREFERRED XIFAXAN

NON PREFERRED FLAGYL IMPAVIDO NEBUPENT TINDAMAX VANCOMYCIN-D5W VANCOMYCIN-NS

Anti-infective Misc. - CombinationsGENERIC sulfamethoxazole/trimethoprim

NON PREFERRED BACTRIM BACTRIM DS

Antiprotozoal AgentsGENERIC atovaquone

NON PREFERRED ALINIA MEPRON

Carbapenem CombinationsGENERIC imipenem-cilastatin

CarbapenemsNON PREFERRED DORIBAX INVANZ MEROPENEM - 0.9% NACL

Cyclic LipopeptidesGENERIC daptomycin

PREFERRED CUBICIN RF

NON PREFERRED CUBICIN

GlycylcyclinesGENERIC tigecycline


NON PREFERRED TYGACIL

LeprostaticsGENERIC dapsone

LincosamidesGENERIC clindamycin hcl clindamycin palmitate hcl clindamycin phosphate clindamycin phosphate/dextrose

PREFERRED CLINDAMYCIN PHOSPHATE

OxazolidinonesGENERIC linezolid

NON PREFERRED SIVEXTRO TABLET SIVEXTRO VIAL

PolymyxinsGENERIC polymyxin b sulfate

Streptogramin CombinationsNON PREFERRED SYNERCID

ANTIMALARIALS

Antimalarial CombinationsGENERIC atovaquone/proguanil hcl

NON PREFERRED COARTEM MALARONE

AntimalarialsGENERIC chloroquine phosphate hydroxychloroquine sulfate mefloquine hcl primaquine pyrimethamine quinine sulfate

NON PREFERRED DARAPRIM

ANTIMYASTHENIC AGENTS

Antimyasthenic AgentsGENERIC neostigmine methylsulfate pyridostigmine bromide

NON PREFERRED NEOSTIGMINE METHYLSULFATE

Antimyasthenic/Cholinergic AgentsGENERIC guanidine hcl

NON PREFERRED MESTINON MESTINON ER

ANTIMYCOBACTERIAL AGENTS

Antimycobacterial AgentsGENERIC ethambutol hcl isoniazid pyrazinamide rifabutin

NON PREFERRED CAPASTAT SULFATE PRETOMANID PRIFTIN RIFADIN SIRTURO

Antineoplastic - BCL-2 Inhibitors

Antineoplastic - BCL-2 InhibitorsNON PREFERRED VENCLEXTA VENCLEXTA STARTER PACK

Antineoplastic - FGFR Kinase Inhibitors

Antineoplastic - FGFR Kinase InhibitorsNON PREFERRED PEMAZYRE

Antineoplastic - Tropomyosin Receptor Kinase Inhibitors

Antineoplastic - Tropomyosin Receptor Kinase Inhibitors

NON PREFERRED ROZLYTREK


Antineoplastic - XPO1 Inhibitors

Antineoplastic - XPO1 InhibitorsNON PREFERRED XPOVIO

ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES

Alkylating AgentsGENERIC carboplatin cisplatin

PREFERRED CISPLATIN POWDER HEXALEN MYLERAN

NON PREFERRED BENDAMUSTINE HCL BENDEKA BUSUFLEX OXALIPLATIN THIOTEPA TREANDA

Androgen Biosynthesis InhibitorsGENERIC abiraterone acetate

NON PREFERRED YONSA ZYTIGA

AntiadrenalsPREFERRED LYSODREN

AntiandrogensGENERIC bicalutamide flutamide nilutamide

PREFERRED XTANDI

NON PREFERRED ERLEADA NILANDRON NUBEQA

AntiestrogensGENERIC tamoxifen citrate toremifene citrate

NON PREFERRED FARESTON

AntimetabolitesGENERIC azacitidine capecitabine cladribine cytarabine decitabine floxuridine fludarabine phosphate mercaptopurine methotrexate

PREFERRED ARRANON TABLOID

NON PREFERRED ALIMTA CLOLAR DEPOCYT FOLOTYN GEMCITABINE HCL INFUGEM PURIXAN TREXALL

Antineoplastic - Autologous Cellular ImmunotherapyNON PREFERRED KYMRIAH PROVENGE YESCARTA

Antineoplastic - Bispecific T-cell EngagersNON PREFERRED BLINCYTO

Antineoplastic - BRAF Kinase InhibitorsNON PREFERRED BRAFTOVI TAFINLAR ZELBORAF

Antineoplastic - Hedgehog Pathway InhibitorsNON PREFERRED ERIVEDGE

Antineoplastic - Histone Deacetylase InhibitorsNON PREFERRED ISTODAX ZOLINZA

Antineoplastic - ImmunomodulatorsNON PREFERRED POMALYST

Antineoplastic - MEK InhibitorsNON PREFERRED COTELLIC KOSELUGO MEKINIST MEKTOVI


Antineoplastic - Monoclonal AntibodiesPREFERRED ONTAK

NON PREFERRED ARZERRA BAVENCIO DARZALEX ERBITUX GAZYVA HERCEPTIN HERZUMA IMFINZI KEYTRUDA LARTRUVO OGIVRI OPDIVO ONTRUZANT PERJETA RITUXAN TECENTRIQ TRAZIMERA TRUXIMA UNITUXIN VECTIBIX YERVOY

Antineoplastic - mTOR Kinase InhibitorsGENERIC everolimus

NON PREFERRED AFINITOR AFINITOR DISPERZ TORISEL

Antineoplastic - Multikinase InhibitorsPREFERRED NEXAVAR SUTENT

NON PREFERRED RYDAPT STIVARGA

Antineoplastic - Proteasome InhibitorsNON PREFERRED KYPROLIS NINLARO VELCADE

Antineoplastic - Tyrosine Kinase InhibitorsGENERIC erlotinib hcl imatinib mesylate

PREFERRED SPRYCEL TASIGNA XALKORI

NON PREFERRED ALECENSA BOSULIF BRUKINSA

CAPRELSA GILOTRIF ICLUSIG IMBRUVICA INLYTA IRESSA LENVIMA NERLYNX TAGRISSO TARCEVA TUKYSA TYKERB VOTRIENT ZYKADIA

Antineoplastic AntibioticsGENERIC bleomycin dactinomycin daunorubicin doxorubicin hcl doxorubicin hcl liposomal epirubicin hcl

NON PREFERRED DAUNOXOME IDARUBICIN HCL MITOMYCIN MITOXANTRONE VALSTAR

Antineoplastic -Antibody for Radiopharmaceutical Therapy

NON PREFERRED ZEVALIN

Antineoplastic Antibody-Drug ComplexesNON PREFERRED ADCETRIS BESPONSA KADCYLA MYLOTARG

Antineoplastic CombinationsNON PREFERRED LONSURF RITUXAN HYCELA VYXEOS LIPOSOME

Antineoplastic EnzymesNON PREFERRED ONCASPAR

Antineoplastic RadiopharmaceuticalsNON PREFERRED LUTATHERA QUADRAMET XOFIGO

Antineoplastics - InterleukinsNON PREFERRED PROLEUKIN


Antineoplastics - Photoactivated AgentsNON PREFERRED PHOTOFRIN

Antineoplastics Misc.GENERIC arsenic trioxide dacarbazine hydroxyurea

PREFERRED INTRON A MATULANE

NON PREFERRED ACTIMMUNE ALFERON N SYLATRON SYNRIBO THERACYS TICE BCG TRISENOX

Aromatase InhibitorsGENERIC anastrozole exemestane letrozole

NON PREFERRED ARIMIDEX AROMASIN FEMARA

Carboxypeptidase Enzyme AgentsPREFERRED VORAXAZE

Cardiac Protective AgentsGENERIC dexrazoxane

Chemotherapy Adjuncts - Hyperuricemia AgentsNON PREFERRED ELITEK

Chemotherapy Adjuncts - Keratinocyte Growth FactorsNON PREFERRED KEPIVANCE

Cyclin-Dependent Kinases (CDK) InhibitorsPREFERRED IBRANCE

Estrogen Receptor AntagonistGENERIC fulvestrant

NON PREFERRED FASLODEX

Estrogens-AntineoplasticPREFERRED EMCYT

Folic Acid Antagonists Rescue AgentsGENERIC leucovorin calcium levoleucovorin calcium

NON PREFERRED FUSILEV

Gonadotropin Releasing Hormone (GnRH) AntagonistsNON PREFERRED FIRMAGON

ImidazotetrazinesNON PREFERRED TEMODAR 100MG VIAL TEMODAR CAPSULES TEMOZOLOMIDE

Isocitrate Dehydrogenase-2 (IDH2) InhibitorsNON PREFERRED IDHIFA

Janus Associated Kinase (JAK) InhibitorsNON PREFERRED INREBIC JAKAFI

LHRH AnalogsPREFERRED ELIGARD LUPRON DEPOT 11.25MG LUPRON DEPOT 3.75MG

NON PREFERRED LEUPROLIDE ACETATE LUPRON DEPOT (FOR PROSTATE CANCER) TRELSTAR MIXJECT (LA) TRELSTAR VIAL VANTAS ZOLADEX

Mitotic InhibitorsGENERIC docetaxel etoposide

NON PREFERRED ABRAXANE DOCEFREZ ETOPOPHOS HALAVEN IXEMPRA JEVTANA MARQIBO PACLITAXEL TENIPOSIDE VINBLASTINE SULFATE


Nitrogen MustardsGENERIC cyclophosphamide ifosfamide-mesna melphalan hcl

PREFERRED LEUKERAN

NON PREFERRED ALKERAN 2MG ALKERAN 50MG IFOSFAMIDE MUSTARGEN

NitrosoureasNON PREFERRED BICNU GLEOSTINE LOMUSTINE ZANOSAR

Progestins-AntineoplasticGENERIC hydroxyprogesterone caproate megestrol acetate

PREFERRED DEPO-PROVERA 400 MG/ML

RetinoidsNON PREFERRED TRETINOIN CAP

Selective Retinoid X Receptor AgonistsNON PREFERRED TARGRETIN 75 CAPSULE

Topoisomerase I InhibitorsNON PREFERRED HYCAMTIN 4MG VIAL HYCAMTIN CAPSULES IRINOTECAN HCL ONIVYDE TOPOTECAN HCL

Urinary Tract Protective AgentsGENERIC amifostine

PREFERRED MESNEX 400MG TABLET

NON PREFERRED MESNA MESNEX 100MG/ML VIAL

Vascular Endothelial Growth Factor (VEGF) InhibitorsNON PREFERRED AVASTIN CYRAMZA

ZALTRAP ZIRABEV

ANTIPARKINSON AGENTS

Antiparkinson AnticholinergicsGENERIC benztropine benztropine mesylate trihexyphenidyl hcl

Antiparkinson DopaminergicsGENERIC amantadine hcl

Antiparkinson Monoamine Oxidase InhibitorsGENERIC rasagiline mesylate selegiline hcl

NON PREFERRED AZILECT

Levodopa CombinationsGENERIC carbidopa/levodopa carbidopa/levodopa er carbidopa/levodopa odt carbidopa/levodopa/entacapone

Nonergoline Dopamine Receptor AgonistsGENERIC pramipexole er ropinirole hcl ropinirole hcl er

NON PREFERRED APOKYN

Peripheral COMT InhibitorsGENERIC entacapone

ANTIPSYCHOTICS/ANTIMANIC AGENTS

Antimanic AgentsGENERIC lithium carbonate lithium carbonate er

Antipsychotics - Misc.GENERIC ziprasidone hcl

NON PREFERRED CAPLYTA LATUDA


BenzisoxazolesGENERIC risperidone

PREFERRED PERSERIS

NON PREFERRED RISPERDAL RISPERDAL CONSTA RISPERDAL M-TAB DISINTEGRATING

ButyrophenonesGENERIC haloperidol haloperidol decanoate haloperidol lactate

NON PREFERRED HALDOL

DibenzodiazepinesGENERIC clozapine clozapine odt

NON PREFERRED CLOZAPINE ODT

DibenzothiazepinesGENERIC quetiapine fumarate quetiapine fumarate er

DibenzoxazepinesGENERIC loxapine succinate

PhenothiazinesGENERIC chlorpromazine fluphenazine decanoate fluphenazine hcl prochlorperazine edisylate prochlorperazine maleate thioridazine hcl trifluoperazine hcl

Quinolinone DerivativesGENERIC aripiprazole odt aripiprazole tablets

PREFERRED ABILIFY MAINTENA, ER

NON PREFERRED ARISTADA

ThienbenzodiazepinesGENERIC olanzapine olanzapine odt

ThioxanthenesGENERIC thiothixene

Antiretrovirals - CD4-Directed Post-Attachment Inhibitor

Antiretrovirals - CD4-Directed Post-Attachment Inhibitor

NON PREFERRED TROGARZO

ANTISEPTICS & DISINFECTANTS

Chlorine AntisepticsGENERIC chlorhexidine gluconate

NON PREFERRED CHLORHEXIDINE GLUCONATE CHLORHEXIDINE GLUCONATE 0.2 SOLUTION

ANTIVIRALS

Antiretroviral CombinationsGENERIC abacavir sulfate/lamivudine abacavir/lamivudine/zidovudine lamivudine/zidovudine lopinavir-ritonavir oral soln

PREFERRED SYMFI SYMFI LO TRUVADA

NON PREFERRED ATRIPLA BIKTARVY COMPLERA DESCOVY DOVATO EPZICOM GENVOYA KALETRA ODEFSEY STRIBILD TRIUMEQ

Antiretrovirals - CCR5 Antagonists (Entry Inhibitor)NON PREFERRED SELZENTRY


Antiretrovirals - Fusion InhibitorsNON PREFERRED FUZEON

Antiretrovirals - Integrase InhibitorsNON PREFERRED ISENTRESS ISENTRESS HD TIVICAY

Antiretrovirals - Protease InhibitorsGENERIC atazanavir sulfate capsule fosamprenavir calcium ritonavir

NON PREFERRED APTIVUS CRIXIVAN INVIRASE LEXIVA NORVIR PREZISTA REYATAZ CAPSULE REYATAZ ORAL POWDER VIRACEPT

Antiretrovirals - RTI-Non-Nucleoside AnaloguesGENERIC efavirenz

PREFERRED SUSTIVA

NON PREFERRED EDURANT INTELENCE RESCRIPTOR RETROVIR VIAL VIRAMUNE

Antiretrovirals - RTI-Nucleoside Analogues-PurinesGENERIC abacavir didanosine

NON PREFERRED VIDEX VIDEX EC ZIAGEN

Antiretrovirals - RTI-Nucleoside Analogues-PyrimidinesNON PREFERRED EMTRIVA LAMIVUDINE

Antiretrovirals - RTI-Nucleoside Analogues-ThymidinesGENERIC stavudine zidovudine

NON PREFERRED RETROVIR

Antiretrovirals - RTI-Nucleotide AnaloguesGENERIC tenofovir disoproxil 300mg tablet

NON PREFERRED VIREAD

CMV AgentsGENERIC cidofovir valganciclovir hcl

NON PREFERRED GANCICLOVIR PREVYMIS VALCYTE

Hepatitis B AgentsGENERIC adefovir dipivoxil entecavir lamivudine hbv

NON PREFERRED TYZEKA VEMLIDY

Hepatitis C AgentsPREFERRED PEGASYS PEGASYS PROCLICK

NON PREFERRED DAKLINZA RIBAVIRIN SOVALDI

Herpes Agents - Purine AnaloguesGENERIC acyclovir valacyclovir

Herpes Agents - Thymidine AnaloguesGENERIC famciclovir

Influenza AgentsGENERIC rimantadine hcl

Neuraminidase InhibitorsGENERIC oseltamivir phosphate

NON PREFERRED RAPIVAB RELENZA TAMIFLU


RSV Agents - Nucleoside AnaloguesGENERIC ribavirin inh

ASSORTED CLASSES

AntileproticsPREFERRED THALOMID

ASSORTED CLASSESNON PREFERRED PROGRAF

B-Lymphocyte Stimulator (BLyS)-Specific InhibitorsNON PREFERRED BENLYSTA

Chelating AgentsGENERIC penicillamine

PREFERRED DEPEN

NON PREFERRED CUPRIMINE

Cyclosporine AnalogsGENERIC cyclosporine

NON PREFERRED SANDIMMUNE SOLUTION SANDIMMUNE SOLUTION 100MG/ML SOLUTION

EnzymesNON PREFERRED XIAFLEX

Immune Globulin ImmunosuppressantsNON PREFERRED ATGAM THYMOGLOBULIN

Immunomodulators for Myelodysplastic SyndromesPREFERRED REVLIMID

Inosine Monophosphate Dehydrogenase InhibitorsGENERIC mycophenolate acid del rel mycophenolic acid del rel

PREFERRED CELLCEPT 500MG VIAL

NON PREFERRED CELLCEPT ORAL SUSP MYCOPHENOLATE MOFETIL

Macrolide ImmunosuppressantsGENERIC everolimus sirolimus tacrolimus

NON PREFERRED RAPAMUNE ZORTRESS

Monoclonal AntibodiesNON PREFERRED SIMULECT

Potassium Removing ResinsGENERIC sodium polystyrene sulfonate

NON PREFERRED LOKELMA VELTASSA

ProstaglandinsGENERIC alprostadil

Purine AnalogsGENERIC azathioprine azathioprine sodium

NON PREFERRED AZASAN

Sclerosing AgentsPREFERRED ETHAMOLIN

NON PREFERRED SOTRADECOL

Selective T-Cell Costimulation BlockersNON PREFERRED NULOJIX

Atopic Dermatitis - Monoclonal Antibodies

Atopic Dermatitis - Monoclonal AntibodiesNON PREFERRED DUPIXENT


BETA BLOCKERS

Alpha-Beta BlockersGENERIC carvedilol er labetalol hcl

NON PREFERRED COREG CR

Beta Blockers Cardio-SelectiveGENERIC acebutolol hcl atenolol betaxolol hcl bisoprolol fumarate metoprolol succinate er metoprolol tartrate

PREFERRED BYSTOLIC

NON PREFERRED SECTRAL TENORMIN

Beta Blockers Non-SelectiveGENERIC nadolol pindolol propranolol hcl propranolol hcl er sotalol timolol maleate

NON PREFERRED BETAPACE BETAPACE AF SOTALOL HCL SOTYLIZE

Bile Acid Synthesis Disorder Agents

Bile Acid Synthesis Disorder AgentsNON PREFERRED CHOLBAM

BIOLOGICALS MISC

Allergenic ExtractsPREFERRED GRASTEK

NON PREFERRED RAGWITEK

Biologicals MiscNON PREFERRED ADAGEN

Calcitonin Gene-Related Peptide (CGRP) Receptor Antag

Calcitonin Gene-Related Peptide (CGRP) Receptor Antag

PREFERRED AIMOVIG EMGALITY UBRELVY

NON PREFERRED AJOVY NURTEC VYEPTI

CALCIUM CHANNEL BLOCKERS

Calcium Channel BlockersGENERIC amlodipine besylate diltiazem diltiazem 24hr cd diltiazem er diltiazem er 24 hour diltiazem hcl felodipine er isradipine nicardipine hcl nimodipine verapamil er verapamil er pm verapamil hcl

NON PREFERRED CLEVIPREX KATERZIA

CARDIOTONICS

Cardiac GlycosidesGENERIC digoxin

NON PREFERRED LANOXIN LANOXIN PEDIATRIC

Phosphodiesterase InhibitorsGENERIC milrinone in 5% dextrose milrinone lactate

CARDIOVASCULAR AGENTS - MISC

Pulmonary Hypertension - Endothelin Receptor Antagonists

NON PREFERRED LETAIRIS


CARDIOVASCULAR AGENTS - MISC.

Calcium Channel Blocker & HMG CoA Reductase Inhibit Comb

GENERIC amlodipine-atorvastatin

Peripheral VasodilatorsGENERIC isoxsuprine hcl papaverine hcl papaverine hcl er

Prostaglandin - Impotence AgentsNON PREFERRED CAVERJECT MUSE

Prostaglandin VasodilatorsGENERIC epoprostenol treprostinil sodium

NON PREFERRED FLOLAN REMODULIN TYVASO VENTAVIS

Pulm Hyperten-Soluble Guanylate Cyclase Stimulator (sGC)

PREFERRED ADEMPAS

Pulmonary Hypertension - Endothelin Receptor Antagonists

GENERIC ambrisentan bosentan

PREFERRED OPSUMIT

NON PREFERRED TRACLEER

Pulmonary Hypertension - Phosphodiesterase Inhibitors

GENERIC sildenafil citrate (pah) tadalafil

NON PREFERRED ADCIRCA REVATIO

Selective cGMP Phosphodiesterase Type 5 InhibitorsGENERIC sildenafil citrate tablet

NON PREFERRED CIALIS VIAGRA

Vasoactive Natriuretic PeptidesNON PREFERRED NATRECOR

Cardiovascular, Hypertension & Lipids

MISC. CARDIOVASCULAR AGENTSNON PREFERRED RETAVASE

MISC. COAGULATION AGENTSNON PREFERRED ATRYN

Cephalosporin Combinations

Cephalosporin CombinationsPREFERRED AVYCAZ

NON PREFERRED ZERBAXA

CEPHALOSPORINS

Cephalosporins - 1st GenerationGENERIC cefazolin cephalexin

NON PREFERRED CEFAZOLIN/DEXTROSE KEFLEX

Cephalosporins - 2nd GenerationGENERIC cefaclor cefoxitin cefoxitin/dextrose cefprozil cefuroxime axetil cefuroxime sodium

Cephalosporins - 3rd GenerationGENERIC cefdinir cefotetan cefpodoxime proxetil ceftazidime ceftibuten ceftriaxone


NON PREFERRED CEFTAZIDIME IV PIGGYBACK CEFTRIAXONE 100G BULK BAG

Cephalosporins - 4th GenerationGENERIC cefepime cefotaxime

NON PREFERRED CEFEPIME/DEXTROSE

Cephalosporins - 5th GenerationNON PREFERRED TEFLARO

CONTRACEPTIVES

Biphasic Contraceptives - OralGENERIC azurette kariva viorele

Combination Contraceptives - OralGENERIC altavera alyacen apri aubra aviane balziva briellyn caziant chateal cryselle cyclafem dasetta drospirenone/eth estra/levomef elinest emoquette enskyce estarylla falmina gianvi gildagia gildess gildess fe junel junel fe kelnor 1-35 kurvelo lessina levora loryna low-ogestrel lutera marlissa microgestin microgestin fe mono-linyah mononessa necon norethindrone/eth estradiol/iron norethindrone/ethinyl estradiol norethin-eth estra ferrous fum

nortrel ocella ogestrel orsythia philith pirmella portia reclipsen sprintec sronyx syeda vestura wera wymzya fe zarah zenchent zenchent fe zeosa zovia

PREFERRED LO LOESTRIN FE MINASTRIN 24 FE

NON PREFERRED BEYAZ SAFYRAL TAYTULLA

Combination Contraceptives - VaginalGENERIC eluryng ring etonogestrel-ethinyl estradiol ring

NON PREFERRED NUVARING

Continuous Contraceptives - OralGENERIC amethyst

Emergency ContraceptivesGENERIC levonorgestrel

Extended-Cycle Contraceptives - OralGENERIC amethia amethia lo camrese camrese lo daysee introvale jolessa quasense

Four Phase Contraceptives - OralPREFERRED NATAZIA


Progestin Contraceptives - ImplantsNON PREFERRED IMPLANON NEXPLANON

Progestin Contraceptives - InjectableNON PREFERRED DEPO-PROVERA

Progestin Contraceptives - IUDNON PREFERRED KYLEENA MIRENA SKYLA

Progestin Contraceptives - OralGENERIC errin heather jencycla jolivette lyza nora-be

Triphasic Contraceptives - OralGENERIC aranelle enpresse leena myzilra tilia fe tri-estarylla tri-legest fe tri-linyah trinessa trivora velivet

CORTICOSTEROIDS

GlucocorticosteroidsGENERIC a-hydrocort budesonide budesonide ec budesonide er cortisone acetate dexamethasone dexamethasone sodium phosphate methylprednisolone methylprednisolone acetate methylprednisolone sod succ prednisolone prednisolone sodium phosphate prednisone triamcinolone veripred 20

PREFERRED BETAMETHASONE BETAMETHASONE ACETATE BETAMETHASONE SODIUM PHOSPHATE

NON PREFERRED ARISTOSPAN DEPO-MEDROL KENALOG MEDROL SOLU-CORTEF SOLU-MEDROL VIAL UCERIS ER

MineralocorticoidsGENERIC fludrocortisone acetate

COUGH/COLD/ALLERGY

Antitussive - NonnarcoticGENERIC benzonatate

Antitussive - OpioidGENERIC hydrocodone/homatropine

DecongestantGENERIC pseudoephedrine hcl er

NON PREFERRED PSEUDOEPHEDRINE SULFATE ER

Decongestant-AntihistamineGENERIC brompheniramine/pseudoephedrine phenylephrine/chlorpheniramine 10peh-4cpm

Decongestant-Antihistamine w/ ExpectorantNON PREFERRED PSEUDOEPH/CHLOPHEDIANOL/GG 12.5CPD-100GFN-30PSE

MucolyticsGENERIC acetylcysteine

Non-Narc Antitussive-AntihistamineGENERIC promethazine/dextromethorphan

Non-Narc Antitussive-Decongestant-AntihistamineGENERIC chlorphen/pse/dm tannate d-chlorphenira/pse/chlophedian 12.5cpd-1dcpm-30pse dm/phenyleph/chlorpheniramine 10peh-4cpm-20dm

Opioid Antitussive-AntihistamineGENERIC promethazine w/codeine


NON PREFERRED TUSSICAPS TUSSIONEX TUXARIN ER

Opioid Antitussive-Decongestant-AntihistamineGENERIC dihydrocodeine/bpm/pe promethazine vc/codeine

Cyclin-Dependent Kinases (CDK) Inhibitors

Cyclin-Dependent Kinases (CDK) InhibitorsNON PREFERRED VERZENIO

Cystic Fibrosis Agent - Combination

Cystic Fibrosis Agent - CombinationsNON PREFERRED ORKAMBI

Cystic Fibrosis Agent - Combinations

Cystic Fibrosis Agent - CombinationsNON PREFERRED TRIKAFTA

DERMATOLOGICALS

Acne AntibioticsGENERIC clindamycin phosphate topical dapsone gel erythromycin solution sulfacetamide sodium

NON PREFERRED ACZONE CLINDAMYCIN PHOSPHATE GEL (ONCE DAILY) SULFACETAMIDE SODIUM

Acne CombinationsGENERIC clindamycin phos-tretinoin erythromycin-benzoyl peroxide sodium sulfacetamide/sulfur

PREFERRED EPIDUO EPIDUO FORTE ONEXTON

NON PREFERRED SODIUM SULFACETAMIDE/SULFUR GEL ZIANA

Acne ProductsGENERIC adapalene cream, gel adapalene-benzoyl peroxide gel benzoyl peroxide clindamycin/benzoyl peroxide isotretinoin tretinoin tretinoin microsphere

NON PREFERRED ABSORICA ADAPALENE LOTION ARAZLO AZELEX DIFFERIN TRETIN-X

Antibiotics - TopicalGENERIC gentamicin sulfate mupirocin

Antifungals - TopicalGENERIC ciclopirox nystatin

PREFERRED NYSTATIN

NON PREFERRED LOPROX GEL & SHAMPOO PENLAC

Antifungals - Topical CombinationsGENERIC clotrimazole/betamethasone nystatin w/triamcinolone

Anti-inflammatory Agents - TopicalGENERIC diclofenac epolamine diclofenac sodium gel

NON PREFERRED FLECTOR VOLTAREN GEL

Antineoplastic Alkylating Agents - TopicalNON PREFERRED VALCHLOR

Antineoplastic Antimetabolites - TopicalGENERIC fluorouracil

NON PREFERRED CARAC FLUOROURACIL 0.5% CREAM


Antineoplastic or Premalignant Lesions - Topical Misc.NON PREFERRED PICATO

AntipsoriaticsGENERIC calcipotriene tazarotene cream

PREFERRED TAZORAC GEL

NON PREFERRED CALCITRIOL TAZORAC CREAM

Antipsoriatics - SystemicGENERIC acitretin

PREFERRED COSENTYX SKYRIZI STELARA

NON PREFERRED TREMFYA

Antiseborrheic ProductsGENERIC selenium sulfide

Antivirals - TopicalGENERIC acyclovir

NON PREFERRED DENAVIR ZOVIRAX

Burn ProductsGENERIC mafenide acetate silver sulfadiazine

NON PREFERRED SILVADENE SULFAMYLON CREAM SULFAMYLON PACKET

Corticosteroids - TopicalGENERIC alclometasone dipropionate amcinonide betamethasone dipropionate augment betamethasone valerate betamethasone valerate foam clobetasol e clobetasol propionate desonide

desoximetasone diflorasone diacetate cream diflorasone diacetate oint fluocinolone acetonide fluocinonide fluticasone propionate halobetasol propionate hydrocortisone hydrocortisone acetate hydrocortisone butyrate hydrocortisone butyrate/emoll hydrocortisone valerate mometasone furoate

NON PREFERRED DESONATE DESOWEN DIPROLENE AF CREAM DIPROLENE LOTION DIPROLENE OINT FLUTICASONE PROPIONATE 50MCG SPRAY LUXIQ PSORCON CREAM VERDESO

Depigmenting AgentsGENERIC alphaquin hp hydroquinone cream hydroquinone er cream

Emollient/Keratolytic AgentsGENERIC urea

EmollientsGENERIC ammonium lactate lactic acid

Enzymes - TopicalNON PREFERRED SANTYL

Imidazole-Related Antifungals - TopicalGENERIC clotrimazole econazole nitrate

Immunomodulators Imidazoquinolinamines - TopicalGENERIC imiquimod

Keratolytic/Antimitotic AgentsGENERIC podofilox salicylic acid

PREFERRED SALICYLIC ACID


NON PREFERRED CONDYLOX GEL

Local Anesthetics - TopicalGENERIC cocaine hcl

PREFERRED COCAINE HCL

Macrolide Immunosuppressants - TopicalGENERIC primecrolimus

NON PREFERRED ELIDEL

Misc. Dermatological ProductsGENERIC eletone emulsion sb hpr hpr plus mb hydrogel pruclair prumyx tl-cermide

PREFERRED ETHYL ALCOHOL LACTIC ACID 88 TO 92 % UREAM POWDER, BEADS

NON PREFERRED ETHYL ALCOHOL 1 LIQUID

Pigmenting AgentsPREFERRED OXSORALEN 1% LOTION

Rosacea AgentsGENERIC ivermectin

NON PREFERRED FINACEA MIRVASO ORACEA SOOLANTRA

Scabicides & PediculicidesGENERIC lindane malathion permethrin

NON PREFERRED ELIMITE SPINOSAD

Topical Anesthetic CombinationsGENERIC lidocaine/prilocaine

Topical Selective Retinoid X Receptor AgonistsPREFERRED TARGRETIN GEL

Topical Steroid CombinationsGENERIC calcipotriene-betameth diprop

NON PREFERRED ENSTILAR TACLONEX OINTMENT TACLONEX SUSPENSION

Wound DressingsGENERIC avo cream prutect sonafine

DIAGNOSTIC PRODUCTS

Diagnostic BiologicalsGENERIC candin

PREFERRED TUBERSOL

NON PREFERRED APLISOL

Diagnostic DrugsGENERIC cosyntropin

NON PREFERRED ACTHREL KINEVAC LEXISCAN THYROGEN

Diagnostic Radiopharmaceuticals - CardiacNON PREFERRED THALLOUS CHLORIDE TL-201

Miscellaneous Contrast MediaNON PREFERRED EOVIST MAGNEVIST PROHANCE

Radiographic Contrast Media - IodinatedGENERIC md-gastroview


NON PREFERRED ISOVUE ISOVUE-M OMNIPAQUE VISIPAQUE

DIAGNOSTICS & MISCELLANEOUS AGENTS

IRRIGATING SOLUTIONSGENERIC neomycin-polymyxin b

MISCELLANEOUS AGENTSNON PREFERRED PROSTAMEN

NEUTRACEUTICALSPREFERRED UVA URSI LEAF FLUID EXTRACT

DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS

Dietary Management Product CombinationsGENERIC folbic foltanx metafolbic metafolbic plus

NON PREFERRED FOLBIC RF FOLIC ACID-VIT B12 METHYLFOLATE MECOBALAMIN-NAC 6-600-2MG

DIGESTIVE AIDS

Digestive EnzymesGENERIC pancrelipase

PREFERRED CREON SUCRAID VIOKACE ZENPEP DEL-REL

NON PREFERRED PANCREAZE

DIURETICS

Carbonic Anhydrase InhibitorsGENERIC acetazolamide acetazolamide er methazolamide

NON PREFERRED DIAMOX SEQUELS

Diuretic CombinationsGENERIC amiloride hcl w/hctz spironolactone/hctz

Loop DiureticsGENERIC bumetanide ethacrynate sodium furosemide torsemide

NON PREFERRED EDECRIN TABLET EDECRIN VIAL FUROSEMIDE 40MG/4ML SOLUTION TORSEMIDE

Osmotic DiureticsGENERIC mannitol

Potassium Sparing DiureticsGENERIC amiloride hcl spironolactone

Thiazides and Thiazide-Like DiureticsGENERIC chlorothiazide chlorothiazide sodium chlorthalidone hydrochlorothiazide indapamide methyclothiazide metolazone

Dopamine and Norepinephrine Reuptake Inhibitors (DNRIs)

Dopamine and Norepinephrine Reuptake Inhibitors (DNRIs)

NON PREFERRED SUNOSI

ENDOCRINE AND METABOLIC AGENTS - MISC.

BisphosphonatesGENERIC alendronate sodium etidronate disodium ibandronate risedronate dr risedronate sodium zoledronic acid


NON PREFERRED ACTONEL BONIVA FOSAMAX PAMIDRONATE DISODIUM ZOMETA

Calcimimetic AgentsGENERIC cinacalcet hcl

NON PREFERRED SENSIPAR

CalcitoninsGENERIC calcitonin salmon nasal

NON PREFERRED MIACALCIN VIAL

Carnitine Replenisher - AgentsGENERIC levocarnitine

Dopamine Receptor AgonistsGENERIC cabergoline

Fabry Disease - AgentsNON PREFERRED FABRAZYME

GAA Deficiency Treatment - AgentsNON PREFERRED LUMIZYME

Growth Hormone Receptor AntagonistsNON PREFERRED SOMAVERT

Growth Hormone Releasing Hormones (GHRH)NON PREFERRED EGRIFTA

Growth HormonesPREFERRED GENOTROPIN NORDITROPIN OMNITROPE

NON PREFERRED HUMATROPE SEROSTIM

Hereditary Orotic Aciduria Treatment - AgentsNON PREFERRED XURIDEN

Hereditary Tyrosinemia Type 1 (HT-1) Treatment - Agents

GENERIC nitisinone

NON PREFERRED NITYR ORFADIN

Homocystinuria Treatment - AgentsNON PREFERRED CYSTADANE

Hyperammonemia Treatment - AgentsNON PREFERRED CARBAGLU

Hyperparathyroid Treatment - Vitamin D AnalogsGENERIC calcitriol doxercalciferol paricalcitol

NON PREFERRED HECTOROL ZEMPLAR

Hypophosphatasia (HPP) AgentsNON PREFERRED STRENSIQ

Insulin-Like Growth Factors (Somatomedins)NON PREFERRED INCRELEX

LHRH/GnRH Agonist Analog Pituitary SuppressantsPREFERRED LUPRON DEPOT-PED

NON PREFERRED SYNAREL

Lysosomal Acid Lipase (LAL) Deficiency - AgentsNON PREFERRED KANUMA

Mucopolysaccharidosis I (MPS I) - AgentsNON PREFERRED ALDURAZYME

Mucopolysaccharidosis II (MPS II) - AgentsNON PREFERRED ELAPRASE


Mucopolysaccharidosis VI (MPS VI) - AgentsNON PREFERRED NAGLAZYME

Ovulation Stimulants-GonadotropinsPREFERRED FOLLISTIM AQ

NON PREFERRED BRAVELLE CHORIONIC GONADOTROPIN GONAL-F GONAL-F RFF GONAL-F RFF REDI-JECT MENOPUR NOVAREL PREGNYL

Ovulation Stimulants-SyntheticGENERIC clomiphene citrate

Parathyroid Hormone And DerivativesPREFERRED FORTEO TYMLOS

NON PREFERRED NATPARA

Phenylketonuria Treatment - AgentsNON PREFERRED KUVAN

RANK Ligand (RANKL) InhibitorsPREFERRED PROLIA

NON PREFERRED XGEVA

Selective Estrogen Receptor Modulators (SERMs)NON PREFERRED OSPHENA

Selective Vasopressin V2-Receptor AntagonistsNON PREFERRED SAMSCA

Somatostatic AgentsGENERIC octreotide acetate

NON PREFERRED SANDOSTATIN SANDOSTATIN LAR DEPOT SIGNIFOR SOMATULINE DEPOT

Urea Cycle Disorder - AgentsGENERIC sodium phenylbutyrate

NON PREFERRED AMMONUL BUPHENYL RAVICTI

VasopressinGENERIC desmopressin acetate vasopressin vasopressin-ns

NON PREFERRED STIMATE SPRAY

ESTROGENS

Estrogen & AndrogenGENERIC estrogen/methyltestosterone

Estrogen & ProgestinGENERIC estradiol/norethindrone acetate

PREFERRED PREMPHASE PREMPRO

NON PREFERRED COMBIPATCH

EstrogensGENERIC estradiol patch estradiol tablet/cream estradiol valerate estropipate

PREFERRED PREMARIN

NON PREFERRED DEPO-ESTRADIOL DIVIGEL ENJUVIA ESTRACE TABLET MINIVELLE

Estrogen-Selective Estrogen Receptor Modulator Comb

Estrogen-Selective Estrogen Receptor Modulator CombPREFERRED DUAVEE


FLUOROQUINOLONES

FluoroquinolonesGENERIC ciprofloxacin ciprofloxacin er ciprofloxacin suspension ciprofloxacin/dextrose levofloxacin/d5w moxifloxacin hcl ofloxacin ofloxacin tablets

NON PREFERRED AVELOX IV LEVOFLOXACIN HEMIHYDRATE SOLUTION MOXIFLOXACIN HCL IV PIGGYBACK

GASTROINTESTINAL AGENTS - MISC.

Farnesoid X Receptor (FXR) AgonistsNON PREFERRED OCALIVA

Gallstone Solubilizing AgentsGENERIC ursodiol

NON PREFERRED ACTIGALL CHENODAL URSO URSO FORTE

Gastrointestinal Chloride Channel ActivatorsPREFERRED AMITIZA

Gastrointestinal StimulantsGENERIC metoclopramide hcl

IBS Agent - Guanylate Cyclase-C (GC-C) AgonistsPREFERRED LINZESS

IBS Agent - Mu-Opioid Receptor AgonistsNON PREFERRED VIBERZI

IBS Agent - Selective 5-HT3 Receptor AntagonistsNON PREFERRED LOTRONEX

Inflammatory Bowel AgentsGENERIC balsalazide disodium mesalamine sulfasalazine

sulfasalazine dr

NON PREFERRED ASACOL HD CANASA DELZICOL LIALDA PENTASA

Peripheral Opioid Receptor AntagonistsPREFERRED MOVANTIK

NON PREFERRED RELISTOR

Phosphate Binder AgentsGENERIC calcium acetate lanthanum carbonate sevelamer carbonate

PREFERRED VELPHORO

NON PREFERRED CALCIUM ACETATE FOSRENOL CHEW TABLET PHOSLYRA RENVELA

Tumor Necrosis Factor Alpha BlockersNON PREFERRED CIMZIA INFLECTRA REMICADE RENFLEXIS

GENERAL ANESTHETICS

Anesthetics - Misc.GENERIC etomidate ketamine hcl propofol

NON PREFERRED KETAMINE HCL 50MG/ML SYRINGE

Barbiturate AnestheticsNON PREFERRED BREVITAL

GENITOURINARY AGENTS - MISCELLANEOUS

5-Alpha Reductase InhibitorsGENERIC finasteride


NON PREFERRED PROSCAR

Alpha 1-Adrenoceptor AntagonistsGENERIC alfuzosin hcl er tamsulosin hcl er 24 hr

PREFERRED RAPAFLO

NON PREFERRED FLOMAX

CitratesGENERIC potassium citrate er

Cystinosis AgentsNON PREFERRED CYSTAGON

Genitourinary IrrigantsGENERIC acetic acid irrigation glycine

PREFERRED AMINOACETIC ACID

NON PREFERRED RENACIDIN RESECTISOL

Interstitial Cystitis AgentsNON PREFERRED ELMIRON

Urinary AnalgesicsGENERIC phenazopyridine hcl

Glycopeptides

GlycopeptidesGENERIC vancomycin hcl

PREFERRED VANCOMYCIN HCL

NON PREFERRED DALVANCE ORBACTIV VIBATIV

GOUT AGENTS

Gout AgentsGENERIC allopurinol allopurinol sodium febuxostat

NON PREFERRED COLCHICINE COLCRYS KRYSTEXXA MITIGARE ULORIC

UricosuricsGENERIC probenecid

HEMATOLOGICAL AGENTS - MISC.

Antihemophilic ProductsNON PREFERRED ADVATE ADYNOVATE AFSTYLA ALPHANATE ALPHANINE SD ALPROLIX BEBULIN BENEFIX COAGADEX CORIFACT ELOCTATE ESPEROCT FEIBA NF HELIXATE FS HEMOFIL HUMATE-P IXINITY KOATE-DVI KOGENATE FS KOVALTRY MONOCLATE-P MONONINE NOVOEIGHT NOVOSEVEN RT NUWIQ OBIZUR PROFILNINE PROFILNINE SD RECOMBINATE RIASTAP TRETTEN VONVENDI WILATE XYNTHA XYNTHA SOLOFUSE

Bradykinin B2 Receptor AntagonistsGENERIC icatibant acetate

NON PREFERRED FIRAZYR


C1 InhibitorsNON PREFERRED BERINERT CINRYZE

Complement InhibitorsNON PREFERRED SOLIRIS

Cyclopentyltriazolopyrimidine (CPTP) DerivativesPREFERRED BRILINTA

Glycoprotein IIb/IIIa Receptor InhibitorsGENERIC eptifibatide

NON PREFERRED AGGRASTAT INTEGRILIN REOPRO

Hematorheologic AgentsGENERIC pentoxifylline

HeminNON PREFERRED PANHEMATIN

Human Protein CNON PREFERRED CEPROTIN

Phosphodiesterase III InhibitorsGENERIC cilostazol

Plasma ExpandersGENERIC hetastarch w/sodium chloride

NON PREFERRED HEXTEND LACTATED ELECTROLYTE

Plasma Kallikrein InhibitorsNON PREFERRED KALBITOR

Plasma ProteinsGENERIC albumin

NON PREFERRED THROMBATE III

Platelet Aggregation Inhibitor CombinationsGENERIC aspirin / dipyridamole er

Platelet Aggregation InhibitorsGENERIC dipyridamole

ProtamineGENERIC protamine sulfate

Quinazoline AgentsGENERIC anagrelide hydrochloride

Thienopyridine DerivativesGENERIC clopidogrel prasugrel hcl

NON PREFERRED EFFIENT

Tissue Plasminogen ActivatorsNON PREFERRED ACTIVASE CATHFLO ACTIVASE

HEMATOPOIETIC AGENTS

Agents for Gaucher DiseaseNON PREFERRED CERDELGA CEREZYME ELELYSO VPRIV ZAVESCA

CobalaminsGENERIC hydroxocobalamin

NON PREFERRED NASCOBAL

CXCR4 Receptor AntagonistNON PREFERRED MOZOBIL

Cytotoxic AgentsPREFERRED DROXIA


Erythropoiesis-Stimulating Agents (ESAs)PREFERRED EPOGEN PROCRIT

NON PREFERRED ARANESP

ErythropoietinsPREFERRED EPOGEN MIRCERA

Folic Acid/Folate CombinationsGENERIC fabb folbee folplex 2.2 tl gard rx

Folic Acid/FolatesGENERIC folic acid

NON PREFERRED FOLIC ACID 20MG CAP

Granulocyte Colony-Stimulating Factors (G-CSF)PREFERRED NEULASTA NEUPOGEN ZARXIO

NON PREFERRED GRANIX UDENYCA

Granulocyte/Macrophage Colony-Stimulating Factor(GM-CSF)

NON PREFERRED LEUKINE

IronNON PREFERRED FERAHEME INFED VENOFER

Iron CombinationsGENERIC centratex ferocon ferrocite plus ferrogels forte hematinic plus hematogen hematogen fa hematogen forte iferex 150 forte multigen multigen folic multigen plus poly-iron 150 forte

polysaccharide iron forte se-tan plus taron forte tl icon tl-hem 150 er 24 hr tricon trigels-f forte

Iron w/ Folic AcidGENERIC hematinic with folic acid therapeutic hematinic

Iron-B12-FolateGENERIC ferraplus 90 hemetab

NON PREFERRED FE 90 PLUS

Thrombopoietin (TPO) Receptor AgonistsNON PREFERRED NPLATE PROMACTA

HEMOSTATICS

Hemostatics - SystemicGENERIC tranexamic acid

NON PREFERRED AMICAR CYKLOKAPRON LYSTEDA

Hepatitis C Agent - Combinations

Hepatitis C Agent - CombinationsPREFERRED EPCLUSA HARVONI MAVYRET VOSEVI

NON PREFERRED TECHNIVIE VIEKIRA PAK VIEKIRA XR ZEPATIER

Histamine H3-Receptor Antagonist/Inverse Agonists

Histamine H3-Receptor Antagonist/Inverse AgonistsNON PREFERRED WAKIX


HYPNOTICS

Barbiturate HypnoticsGENERIC phenobarbital

NON PREFERRED AMYTAL NEMBUTAL SODIUM PHENOBARBITAL SODIUM SECONAL SODIUM

Benzodiazepine HypnoticsGENERIC flurazepam hcl midazolam hcl temazepam triazolam

NON PREFERRED MIDAZOLAM HCL/SODIUM CHLORIDE

Non-Benzodiazepine - GABA-Receptor ModulatorsGENERIC zaleplon zolpidem tartrate zolpidem tartrate er

NON PREFERRED AMBIEN AMBIEN CR SONATA

Selective Melatonin Receptor AgonistsGENERIC ramelteon

NON PREFERRED ROZEREM

IBS Agent - 5-HT4 Receptor Partial Agonists

IBS Agent - 5-HT4 Receptor Partial AgonistsNON PREFERRED ZELNORM

Insulin-Like Growth Factor-1 Receptor Inhibitors(IGF-

1R)

Insulin-Like Growth Factor-1 Receptor Inhibitors(IGF-1R)

NON PREFERRED TEPEZZA

Integrin Receptor Antagonists

Integrin Receptor AntagonistsNON PREFERRED ENTYVIO

Interleukin-4 Alpha Antagonists

Interleukin-4 Alpha AntagonistsNON PREFERRED DUPIXENT

Interleukin-6 (IL-6) Antagonists

Interleukin-6 (IL-6) AntagonistsNON PREFERRED SYLVANT

LAXATIVES

Bowel Evacuant CombinationsGENERIC peg 3350-electrolyte polyethylene glycol

PREFERRED CLENPIQ POLYETHYLENE GLYCOL SUPREP

NON PREFERRED POLYETHYLENE GLYCOL PREPOPIK SUCLEAR

Laxatives - MiscellaneousGENERIC lactulose

Leptin Analogues

Leptin AnaloguesNON PREFERRED MYALEPT

LOCAL ANESTHETICS-Parenteral

Local Anesthetic & SympathomimeticGENERIC bupivacaine/epinephrine lidocaine hcl w/epinephrine

NON PREFERRED BUPIVACAINE/EPINEPHRINE CARTRIDGE LIDOCAINE HCL W/EPINEPHRINE


Local Anesthetics - AmidesGENERIC bupivacaine hcl bupivacaine/dextrose lidocaine lidocaine hcl ropivacaine sensorcaine 2.5mg/ml vial sensorcaine 5mg/ml vial

NON PREFERRED CARBOCAINE LIDOCAINE LIDOCAINE HCL

Local Anesthetics - EstersGENERIC chloroprocaine

NON PREFERRED NESACAINE

MACROLIDES

AzithromycinGENERIC azithromycin

NON PREFERRED ZITHROMAX

ClarithromycinGENERIC clarithromycin clarithromycin er

ErythromycinsGENERIC erythromycin erythromycin del rel erythromycin ethylsuccinate erythromycin stearate erythromycin/sulfisoxazole

NON PREFERRED E.E.S.200MG/5ML ORAL RECON SUSP ERYTHROCIN LACTOBIONATE

MEDICAL DEVICES

Cervical CapsNON PREFERRED FEMCAP

Glucose Monitoring Test SuppliesPREFERRED ACCU-CHEK SOFTCLIX LANCETS DEVICE FORA LANCING DEVICE FREESTYLE CONTROL SOLUTION

FREESTYLE FREEDOM KIT FREESTYLE FREEDOM LITE FREESTYLE FREEDOM LITE METER FREESTYLE INSULINX FREESTYLE INSULINX GLUCOSE SYSTEM FREESTYLE INSULINX TEST STRIPS FREESTYLE LITE METER FREESTYLE LITE TEST STRIPS FREESTYLE TEST STRIPS ONE TOUCH ULTRA 2 ONE TOUCH ULTRA TEST STRIPS ONE TOUCH VERIO ONE TOUCH VERIO FLEX ONE TOUCH VERIO IQ ONE TOUCH VERIO SYNC PRECISION XTRA B-KETONE STRIPS PRECISION XTRA MONITOR PRECISION XTRA TEST STRIPS

NON PREFERRED ACCU-CHEK FASTCLIX, MULTICLIX, SOFTCLIX LANCETS DEXCOM G4 METER DEXCOM G4 SENSOR DEXCOM G4 TRANSMITTER DEXCOM G5 METER DEXCOM G5 TRANSMITTER OPTIUM EZ

Needles & SyringesPREFERRED MINIMED MINIMED RESERVOIR NOVOFINE NOVOFINE AUTOCOVER PRODIGY INSULIN SYRINGE PRODIGY PEN NEEDLE SOFT TOUCH

MIGRAINE PRODUCTS

Ergot CombinationsGENERIC ergotamine-caffeine

Migraine ProductsGENERIC dihydroergotamine mesylate ergoloid mesylates

NON PREFERRED MIGRANAL

Selective Serotonin Agonist-NSAID CombinationsNON PREFERRED TREXIMET


Selective Serotonin Agonists 5-HT(1)GENERIC eletriptan hbr naratriptan hcl rizatriptan rizatriptan disintegrating tablets sumatriptan succinate zolmitriptan zolmitriptan odt

PREFERRED REYVOW TOSYMRA

NON PREFERRED ONZETRA XSAIL RELPAX SUMAVEL DOSEPRO ZOLMITRIPTAN ZOMIG SPRAY ZOMIG TABLET

MINERALS & ELECTROLYTES

BicarbonatesGENERIC sodium acetate sodium lactate

NON PREFERRED NEUT

CalciumGENERIC calcium chloride calcium gluconate

PREFERRED CALCIUM CHLORIDE CALCIUM GLUCONATE 61MG

NON PREFERRED CALCIUM GLUCONATE 50MG

Electrolytes & DextroseGENERIC dextrose in lactated ringers dextrose with sodium chloride potassium chloride/dextrose

Electrolytes ParenteralGENERIC nutrilyte nutrilyte ii potassium chloride ringers ringers irrigation

PREFERRED POTASSIUM CHLORIDE

NON PREFERRED ISOLYTE S NORMOSOL-M AND DEXTROSE NORMOSOL-R AND DEXTROSE NORMOSOL-R PH 7.4 PLASMA-LYTE 148

Iodine ProductsNON PREFERRED IODOPEN

MagnesiumGENERIC magnesium sulfate

PREFERRED MAGNESIUM SULFATE MAGNESIUM SULFATE IN DEXTROSE

NON PREFERRED MAGNESIUM SULFATE 100MG CAPSULE

ManganeseGENERIC manganese manganese sulfate

PhosphateGENERIC sodium phosphate 3mmol/ml vial

PREFERRED SODIUM PHOSPHATE

NON PREFERRED GLYCOPHOS K-PHOS

PhosphatesNON PREFERRED K-PHOS NEUTRAL

PotassiumGENERIC klor-con pot chloride/dextrose/ns potassium acetate potassium bicarbonate potassium chl-normal saline

PREFERRED POTASSIUM ACETATE POTASSIUM BICARBONATE

NON PREFERRED K-TAB potassium chloride er

Trace Mineral CombinationsPREFERRED MULTITRACE-5


NON PREFERRED ADDAMEL N MULTITRACE-4 PEDITRACE TRACE ELEMENTS

Trace MineralsGENERIC copper chloride selenium

NON PREFERRED SELENIUM

Mixed Allergenic Extracts

Mixed Allergenic ExtractsNON PREFERRED ODACTRA

Monobactams

MonobactamsGENERIC aztreonam

PREFERRED AZACTAM-ISO-OSMOTIC DEXTROSE

NON PREFERRED CAYSTON

MOUTH/THROAT/DENTAL AGENTS

Anti-infective Combinations - ThroatNON PREFERRED FIRST-MOUTHWASH BLM

Fluoride Dental ProductsGENERIC sodium fluoride

PREFERRED SODIUM FLUORIDE

Saliva StimulantsGENERIC cevimeline hcl pilocarpine hcl

Mucopolysaccharidosis IV (MPS IV) - Agents

Mucopolysaccharidosis IV (MPS IV) - AgentsNON PREFERRED VIMIZIM

Mucopolysaccharidosis VII (MPS VII) - Agents

Mucopolysaccharidosis VII (MPS VII) - AgentsNON PREFERRED MEPSEVII

Multiple Sclerosis Agents - Antimetabolites

Multiple Sclerosis Agents - AntimetabolitesNON PREFERRED MAVENCLAD

MULTIVITAMINS

B-Complex VitaminsGENERIC b-complex

NON PREFERRED B-COMPLEX

B-Complex w/ C & Folic AcidGENERIC dailyvite folbee plus mynephrocaps renal caps rena-vite rx reno caps triphrocaps

Multiple Vitamins w/ CalciumGENERIC advanced am/pm

Multiple Vitamins w/ MineralsGENERIC folivane-plus strovite v-c forte vp-zel

Multiple Vitamins w/ Minerals & Calcium-Folic AcidGENERIC tl g-fol os

Multiple Vitamins w/ Minerals & Folic AcidGENERIC corvita

MultivitaminsGENERIC m.v.i. adult

PREFERRED M.V.I.-12

NON PREFERRED INFUVITE


Ped Multi Vitamins w/Fl & FEGENERIC multivitamin w/fluoride & iron

Ped MV w/ FluorideGENERIC multivitamin with fluoride

Pediatric Multiple VitaminsNON PREFERRED M.V.I. PEDIATRIC

Prenatal MV & Min w/FE-FAGENERIC bal-care dha elite ob elite-ob folcaps folivane-ob hemenatal ob inatal advance inatal ultra mynatal mynatal advance mynatal caps mynatal plus mynatal-z mynate 90 plus er obstetrix dha pnv-omega pnv-select pnv-total prenaplus prenatabs fa prenatabs rx prenatal low iron prenatal plus prenatal-u relnate dha se-natal 19 taron-bc tl-care dha tl-fol 500 er triadvance trinatal gt trinatal rx 1 trinate ultimatecare one ultimatecare one nf vena-bal dha vinacal vinate ic vinate ii vinate one vinate-m virt-pn virt-pn plus vol-care rx vol-nate vol-plus vol-tab rx vp-ch plus zatean-pn plus

NON PREFERRED STUART ONE VITAFOL-OB

Prenatal MV & Min w/FE-FA-CA-Omega 3 Fish OilGENERIC complete natal dha pr natal 400 pr natal 400 ec pr natal 430 pr natal 430 ec triveen-duo dha

Prenatal MV & Min w/FE-FA-DHAGENERIC folivane-prx dha nf hemenatal ob + dha macnatal cn dha pnv ob+dha pnv-dha prena1 prenaissance prenaissance 90 dha prenaissance dha prenaissance harmony dha prenaissance plus taron-c dha tl-select triveen-prx rnf vemavite-prx 2 venatal-fa vinate dha virt-pn dha virt-select vp-ch-pnv vp-heme one zatean-ch zatean-pn dha

PREFERRED LEVOMEFOLATE DHA

Prenatal VitaminsGENERIC prena1 chew prenaissance next

MUSCULOSKELETAL THERAPY AGENTS

Central Muscle RelaxantsGENERIC baclofen chlorzoxazone cyclobenzaprine hcl cyclobenzaprine hcl er methocarbamol orphenadrine citrate orphenadrine compound tizanidine hcl

PREFERRED CYCLOBENZAPRINE HCL

NON PREFERRED GABLOFEN LIORESAL OZOBAX ROBAXIN


Direct Muscle RelaxantsGENERIC dantrolene sodium

ViscosupplementsPREFERRED HYALGAN SYNVISC-ONE

NON PREFERRED MONOVISC ORTHOVISC SYNVISC

NASAL AGENTS - SYSTEMIC AND TOPICAL

Antihistamine-SteroidGENERIC azelastine-fluticasone

NON PREFERRED DYMISTA

Nasal AnticholinergicsGENERIC ipratropium bromide spray

NON PREFERRED ATROVENT SPRAY

Nasal AntihistaminesGENERIC azelastine hcl

Nasal SteroidsGENERIC flunisolide nasal spray fluticasone nasal spray mometasone furoate nasal triamcinolone acetonide

PREFERRED QNASL

NON PREFERRED BECONASE AQ NASONEX

Neprilysin Inhib (ARNI)-Angiotensin II Recept Antag Comb

Neprilysin Inhib (ARNI)-Angiotensin II Recept Antag Comb

PREFERRED ENTRESTO

NEUROMUSCULAR AGENTS

BenzathiazolesGENERIC riluzole

Depolarizing Muscle RelaxantsGENERIC anectine

Neuromuscular Blocking Agent - NeurotoxinsNON PREFERRED BOTOX MYOBLOC

NUTRIENTS

Amino Acid MixturesNON PREFERRED AMINO ACID 700MG TABLETS AMINOSYN CLINIMIX CLINIMIX E FREAMINE HBC FREAMINE III HEPATAMINE NEPHRAMINE PREMASOL PROCALAMINE PROSOL TRAVASOL TROPHAMINE

CarbohydratesGENERIC dextrose in water

LipidsGENERIC intralipid

NON PREFERRED INTRALIPID

OPHTHALMIC AGENTS

Beta-blockers - OphthalmicGENERIC betaxolol ophth solution carteolol hcl levobunolol hcl drops metipranolol drops

PREFERRED BETOPTIC S

NON PREFERRED BETAGAN


Beta-blockers - Ophthalmic CombinationsGENERIC dorzolamide/timolol

PREFERRED COMBIGAN

Cycloplegic MydriaticsGENERIC atropine sulfate cyclopentolate ophth solution homatropine hydrobromide tropicamide

PREFERRED HOMATROPINE HYDROBROMIDE

NON PREFERRED CYCLOGYL MYDRIACYL

Lymphocyte Function-Associated Antigen-1 (LFA-1) Antag

PREFERRED XIIDRA

Miotics - Cholinesterase InhibitorsNON PREFERRED PHOSPHOLINE IODIDE DROPS

Miotics - Direct ActingGENERIC pilocarpine hcl

NON PREFERRED ISOPTO CARPINE

Ophthalmic AntiallergicGENERIC azelastine hcl ophth solution cromolyn sodium epinastine hcl olopatadine hcl (ophthalmic)

PREFERRED PAZEO

NON PREFERRED BEPREVE ELESTAT PATADAY PATANOL ZERVIATE

Ophthalmic AntibioticsGENERIC bacitracin ciprofloxacin ophth solution erythromycin ointment gatifloxacin levofloxacin hemihydrate moxifloxacin hcl

tobramycin sulfate drops

PREFERRED BESIVANCE

NON PREFERRED AZASITE MOXEZA OCUFLOX TOBREX VIGAMOX

Ophthalmic AntifungalNON PREFERRED NATACYN

Ophthalmic Anti-infective CombinationsGENERIC bacitracin/polymyxin ophth oint neomycin/polymyxin/gramicidin

Ophthalmic AntiviralsGENERIC trifluridine

NON PREFERRED VIROPTIC

Ophthalmic Carbonic Anhydrase InhibitorsGENERIC dorzolamide hcl

Ophthalmic EnzymesNON PREFERRED JETREA

Ophthalmic ImmunomodulatorsPREFERRED RESTASIS RESTASIS MULTIDOSE

Ophthalmic Irrigation SolutionsGENERIC balanced salt ophth irrigation

Ophthalmic Local AnestheticsGENERIC proparacaine hcl tetcaine drops

Ophthalmic Nonsteroidal Anti-inflammatory AgentsGENERIC bromfenac ophth flurbiprofen sodium ketorolac tromethamine drops

PREFERRED ILEVRO


NON PREFERRED NEVANAC PROLENSA

Ophthalmic Photodynamic Therapy AgentsNON PREFERRED VISUDYNE

Ophthalmic Rho Kinase InhibitorsPREFERRED RHOPRESSA

Ophthalmic Selective Alpha Adrenergic AgonistsGENERIC apraclonidine ophth solution brimonidine ophth solution

PREFERRED ALPHAGAN P 0.001%

NON PREFERRED ALPHAGAN P 0.0015%

Ophthalmic Steroid CombinationsGENERIC neomycin/bacitracin/poly/hc sulfacetamide w/prednisolone tobramycin/dexamethasone

PREFERRED TOBRADEX OINTMENT TOBRADEX ST

NON PREFERRED BLEPHAMIDE S.O.P. TOBRADEX SUSPENSION ZYLET

Ophthalmic SteroidsGENERIC dexamethasone sod phos ophth fluorometholone loteprednol etabonate susp prednisolone acetate prednisolone sodium phosphate drops

PREFERRED DUREZOL FML S.O.P.

NON PREFERRED ALREX LOTEMAX PRED MILD

Ophthalmic SulfonamidesGENERIC sulfacetamide sodium

NON PREFERRED BLEPH-10

Ophthalmics - Cystinosis AgentsNON PREFERRED CYSTARAN

Prostaglandins - OphthalmicGENERIC bimatoprost latanoprost drops travoprost

PREFERRED LUMIGAN

NON PREFERRED TRAVATAN Z XALATAN

Vascular Endothelial Growth Factor (VEGF) Antagonists

NON PREFERRED EYLEA LUCENTIS

Ophthalmic Gene Therapy

Ophthalmic Gene TherapyNON PREFERRED LUXTURNA

Ophthalmic Kinase Inhibitors - Combinations

Ophthalmic Kinase Inhibitors - CombinationsPREFERRED ROCKLATAN

Orexin Receptor Antagonists

Orexin Receptor AntagonistsPREFERRED BELSOMRA

OTIC AGENTS

Otic Agents - MiscellaneousGENERIC acetic acid otic solution acetic acid/aluminum otic sol

PREFERRED ACETIC ACID

Otic Analgesic CombinationsGENERIC antipyrine/benzocaine otic sol antipyrine/benzocaine/poly otic sol chloroxylenol/benzocaine/hc acetate otic susp


Otic Anti-infectivesGENERIC ciprofloxacin hcl ofloxacin otic drops

PREFERRED CIPROFLOXACIN HCL

Otic Steroid-Anti-infective CombinationsGENERIC neomycin/polymyxin/hc otic susp & soln

PREFERRED CIPRODEX

NON PREFERRED CIPRO HC COLY-MYCIN S OTOVEL

Otic SteroidsGENERIC acetic acid/hydrocortisone otic sol

NON PREFERRED DERMOTIC

OXYTOCICS

Abortifacients/Cervical Ripening - ProstaglandinsGENERIC carboprost

NON PREFERRED HEMABATE

OxytocicsGENERIC methylergonovine maleate oxytocin

PASSIVE IMMUNIZING AGENTS

Antitoxins-AntiveninsNON PREFERRED CROFAB

Antiviral Monoclonal AntibodiesNON PREFERRED SYNAGIS

Immune SerumsPREFERRED GAMUNEX

NON PREFERRED CYTOGAM GAMASTAN S-D GAMMAGARD LIQUID GAMMAGARD S-D

GAMUNEX-C HEPAGAM B HIZENTRA HYPERHEP B S-D HYPERRAB S-D HYPERRHO S-D HYPERTET S-D IMOGAM RABIES-HT PRIVIGEN VARIZIG

PCSK9 Inhibitors

PCSK9 InhibitorsPREFERRED PRALUENT PEN PRALUENT SYRINGE REPATHA PUSHTRONEX REPATHA SURECLICK REPATHA SYRINGE

PENICILLINS

AminopenicillinsGENERIC amoxicillin ampicillin

Natural PenicillinsGENERIC penicillin g potassium penicillin g procaine penicillin g sodium penicillin v potassium

NON PREFERRED BICILLIN L-A PENICILLIN GK-ISO-OSM DEXTROSE

Penicillin CombinationsGENERIC amoxicillin/clavulanate er ampicillin/sulbactam piperacillin-tazobactam

NON PREFERRED AUGMENTIN BICILLIN C-R ZOSYN IV SOLUTION ZOSYN VIAL

Penicillinase-Resistant PenicillinsGENERIC dicloxacillin sodium nafcillin dextrose nafcillin sodium oxacillin sodium


Phosphatidylinositol 3-Kinase (PI3K) Inhibitors

Phosphatidylinositol 3-Kinase (PI3K) InhibitorsNON PREFERRED ALIQOPA ZYDELIG

Phosphodiesterase 4 (PDE4) Inhibitors - Topical

Phosphodiesterase 4 (PDE4) Inhibitors - TopicalPREFERRED EUCRISA

Poly (ADP-ribose) Polymerase (PARP) Inhibitors

Poly (ADP-ribose) Polymerase (PARP) InhibitorsNON PREFERRED LYNPARZA RUBRACA TALZENNA ZEJULA

Postherpetic Neuralgia (PHN)/Neuropathic Pain Agents

Postherpetic Neuralgia (PHN)/Neuropathic Pain AgentsNON PREFERRED GRALISE LYRICA CR

PROGESTINS

ProgestinsGENERIC medroxyprogesterone acetate norethindrone acetate progesterone in oil progesterone micronized

NON PREFERRED MAKENA

Protease-Activated Receptor-1 (PAR-1) Antagonists

Protease-Activated Receptor-1 (PAR-1) AntagonistsNON PREFERRED ZONTIVITY

PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC.

Agents for Narcotic WithdrawalNON PREFERRED LUCEMYRA

Alcohol DeterrentsGENERIC acamprosate calcium disulfiram

Anti-Cataplectic AgentsPREFERRED XYREM

Antidementia Agent CombinationsPREFERRED NAMZARIC THERAPY PACK

NON PREFERRED NAMZARIC

Benzodiazepines & Tricyclic AgentsGENERIC amitriptyline/chlordiazepoxide

Cholinomimetics - ACHE InhibitorsGENERIC donepezil hcl galantamine rivastigmine

Fibromyalgia Agent - SNRIsPREFERRED SAVELLA

Movement Disorder Drug TherapyGENERIC tetrabenazine

NON PREFERRED XENAZINE

MS Agents - Pyrimidine Synthesis InhibitorsPREFERRED AUBAGIO

Multiple Sclerosis AgentsNON PREFERRED COPAXONE GLATOPA

Multiple Sclerosis Agents - InterferonsPREFERRED AVONEX BETASERON PLEGRIDY

NON PREFERRED EXTAVIA REBIF REBIF REBIDOSE


Multiple Sclerosis Agents - Monoclonal AntibodiesNON PREFERRED LEMTRADA OCREVUS TYSABRI

Multiple Sclerosis Agents - Nrf2 Pathway ActivatorsPREFERRED TECFIDERA

NON PREFERRED VUMERITY

Multiple Sclerosis Agents - Potassium Channel Blockers

NON PREFERRED AMPYRA

N-Methyl-D-Aspartate (NMDA) Receptor AntagonistsGENERIC memantine memantine dose pack

NON PREFERRED NAMENDA XR

Phenothiazines & Tricyclic AgentsGENERIC perphenazine/amitriptyline

Pseudobulbar Affect Agent CombinationsPREFERRED NUEDEXTA

Smoking DeterrentsGENERIC buproban bupropion er (12 hour)

NON PREFERRED CHANTIX ZYBAN

Sphingosine 1-Phosphate (S1P) Receptor ModulatorsPREFERRED GILENYA

Thienbenzodiazepines & SSRIsGENERIC olanzapine/fluoxetine hcl

Vasomotor Symptom Agents - SSRIsNON PREFERRED BRISDELLE

Pulmonary Hypertension - Prostacyclin Receptor Agonist

Pulmonary Hypertension - Prostacyclin Receptor Agonist

NON PREFERRED UPTRAVI

RESPIRATORY AGENTS - MISC.

Alpha-Proteinase Inhibitor (Human)NON PREFERRED ARALAST NP PROLASTIN C ZEMAIRA

CFTR PotentiatorsNON PREFERRED KALYDECO

Hydrolytic EnzymesNON PREFERRED PULMOZYME

Interleukin-5 Antagonists (IgG1 kappa)PREFERRED FASENRA

NON PREFERRED NUCALA

Pulmonary Fibrosis AgentsNON PREFERRED ESBRIET

Sclerostin Inhibitors

Sclerostin InhibitorsNON PREFERRED EVENITY

Sinus Node Inhibitors

Sinus Node InhibitorsPREFERRED CORLANOR

Spinal Muscular Atrophy Agents (SMA)

Spinal Muscular Atrophy Agents (SMA)NON PREFERRED SPINRAZA


TETRACYCLINES

TetracyclinesGENERIC coremino demeclocycline hcl doxycycline hyclate doxycycline monohydrate minocycline hcl minocycline hcl er

PREFERRED TETRACYCLINE XIMINO

NON PREFERRED MINOCIN MINOCIN 100MG VIAL SEYSARA SOLODYN ER

Tetrahydroisoquinolines

TetrahydroisoquinolinesNON PREFERRED YONDELIS

THYROID AGENTS

Antithyroid AgentsGENERIC methimazole propylthiouracil

NON PREFERRED TAPAZOLE

Thyroid HormonesGENERIC levothyroxine sodium liothyronine sodium

NON PREFERRED ARMOUR THYROID CYTOMEL SYNTHROID TIROSINT

TOXOIDS

Toxoid CombinationsPREFERRED INFANRIX PEDIARIX TETANUS DIPHTHERIA TOXOIDS - PED

NON PREFERRED ADACEL BOOSTRIX PENTACEL

QUADRACEL DTAP-IPV TETANUS DIPHTHERIA TOXOIDS

Tripeptidyl Peptidase 1 Deficiency Treatment - Agents

Tripeptidyl Peptidase 1 Deficiency Treatment - AgentsNON PREFERRED BRINEURA

Tryptophan Hydroxylase Inhibitors

Tryptophan Hydroxylase InhibitorsNON PREFERRED XERMELO

ULCER DRUGS

AntispasmodicsGENERIC dicyclomine hcl

Belladonna AlkaloidsGENERIC hyoscyamine sulfate hyoscyamine sulfate disinegrating tablets hyoscyamine sulfate er

NON PREFERRED ATROPEN LEVSIN 0.125MG TABLET LEVSIN 0.5MG/ML AMPUL

H-2 AntagonistsGENERIC cimetidine famotidine nizatidine ranitidine hcl

NON PREFERRED ZANTAC RX

Misc. Anti-UlcerGENERIC sucralfate

NON PREFERRED CARAFATE

Proton Pump Inhibitor-Antacid CombinationsGENERIC omeprazole sodium bicarbonate

NON PREFERRED OMEPRAZOLE SODIUM BICARBONATE


Proton Pump InhibitorsGENERIC esomeprazole lansoprazole omeprazole pantoprazole sodium

NON PREFERRED NEXIUM NEXIUM (RX) VIAL

Quaternary AnticholinergicsGENERIC glycopyrrolate

Ulcer Anti-Infective w/ Proton Pump InhibitorsGENERIC lansoprazole/amoxicillin/clarithromycin

Ulcer Drugs - ProstaglandinsGENERIC misoprostol

NON PREFERRED CYTOTEC

URINARY ANTI-INFECTIVES

Urinary Anti-infectivesGENERIC methenamine hippurate methenamine mandelate nitrofurantoin nitrofurantoin macrocrystal

NON PREFERRED MACROBID MACRODANTIN

Urinary Antiseptic-Antispasmodic &/or AnalgesicsGENERIC hyophen phosphasal uretron d-s urimar-t urin d.s. urogesic ustell

URINARY ANTISPASMODICS

Beta-3 Adrenergic AgonistsPREFERRED MYRBETRIQ ER 24 HR

Urinary Antispasmodic - Antimuscarinic (Anticholinergic)

GENERIC darifenacin er oxybutynin chloride oxybutynin chloride er solifenacin succinate tolterodine tartrate trospium chloride er

NON PREFERRED DITROPAN XL ENABLEX GELNIQUE TOVIAZ VESICARE

Urinary Antispasmodics - Cholinergic Agonists (new)GENERIC bethanechol chloride

Urinary Antispasmodics - Direct Muscle RelaxantsGENERIC flavoxate hcl

VACCINES

Bacterial VaccinesPREFERRED VIVOTIF BERNA DEL REL

NON PREFERRED ACTHIB BEXSERO BIOTHRAX MENACTRA MENOMUNE-A-C-Y-W-135 PEDVAXHIB PNEUMOVAX 23 PREVNAR 13 TRUMENBA TYPHIM VI VAXCHORA VACCINE

Viral Vaccine CombinationsPREFERRED TWINRIX

NON PREFERRED M-M-R II VACCINE W/DILUENT PROQUAD

Viral VaccinesPREFERRED AFLURIA AFLURIA QUAD FLUAD FLUBLOK FLUBLOK QUAD FLUCELVAX QUAD FLULAVAL QUAD FLUMIST FLUZONE HIGH-DOSE FLUZONE QUAD


RABAVERT SHINGRIX VAQTA VIAL

NON PREFERRED ENGERIX-B GARDASIL 9 HAVRIX IMOVAX RABIES VACCINE IPOL IXIARO RECOMBIVAX HB ROTATEQ STAMARIL VAQTA SYRINGES VARIVAX VACCINE YF-VAX

VAGINAL PRODUCTS

Imidazole-Related AntifungalsGENERIC miconazole 1 terconazole

PREFERRED MICONAZOLE 1

Vaginal Anti-infectivesGENERIC clindamycin phosphate vaginal

Vaginal EstrogensGENERIC yuvafem

PREFERRED PREMARIN CREAM

NON PREFERRED ESTRACE CREAM ESTRING FEMRING

Vaginal ProgestinsPREFERRED CRINONE

NON PREFERRED ENDOMETRIN

VASOPRESSORS

Anaphylaxis Therapy AgentsGENERIC epinephrine auto-injector

PREFERRED SYMJEPI

NON PREFERRED EPIPEN EPIPEN JR.

VasopressorsGENERIC dobutamine dobutamine/dextrose dopamine hcl dopamine hcl in 5% dextrose ephedrine sulfate epinephrine ampule/vial midodrine hcl norepinephrine bitartrate phenylephrine hcl phenylephrine hcl-ns

PREFERRED PHENYLEPHRINE HCL-NS

NON PREFERRED EPINEPHRINE 1MG/ML AMPUL LEVOPHED AMPULE/VIAL PHENYLEPHRINE HCL-NS 200MCG/5ML SYRINGE PHENYLEPHRINE HCL-NS 40MG/5ML SYRINGE

VITAMINS

Vitamin AGENERIC vitamin a

PREFERRED VITAMIN A

NON PREFERRED AQUASOL A VITAMIN A

Vitamin B-1GENERIC thiamine hcl

NON PREFERRED THIAMINE HCL

Vitamin B-6GENERIC pyridoxine hcl

PREFERRED PYRIDOXINE HCL

NON PREFERRED PYRIDOXINE HCL 500MG TABLETS

Vitamin CGENERIC ascorbic acid


PREFERRED ASCORBIC ACID

Vitamin KGENERIC phytonadione

PREFERRED PHYTONADIONE

NON PREFERRED MEPHYTON

VITAMINS, HEMATINICS & ELECTROLYTES

VITAMINS & HEMATINICSGENERIC elite-ob 400 folivane-f

NON PREFERRED VYNATAL-FA

X-Linked Hypophosphatemia (XLH) Treatment - Agents

X-Linked Hypophosphatemia (XLH) Treatment - AgentsPREFERRED CRYSVITA


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