adhd/anti-narcolepsy/anti … · web viewestrogen & androgen generic...

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

AMETHYST TABLET 90-20 MCG ORAL.........................................................................................................................................18

CONTRACEPTIVES.......................................................................................................................................................................18

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

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

ANALGESICS - ANTI-INFLAMMATORY.........................................................................................................................................18

ANTIRHEUMATIC - JANUS KINASE (JAK) INHIBITORS.......................................................................................................................18ANTIRHEUMATIC ANTIMETABOLITES..................................................................................................................................................18ANTI-TNF-ALPHA - MONOCLONAL ANTIBODIES................................................................................................................................18ANTI-TNF-ALPHA - MONOCLONOAL ANTIBODIES.............................................................................................................................19CYCLOOXYGENASE 2 (COX-2) INHIBITORS.....................................................................................................................................19GOLD COMPOUNDS...........................................................................................................................................................................19INTERLEUKIN-1 BLOCKERS................................................................................................................................................................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.............................................................................................................................................................19SALICYLATES..................................................................................................................................................................................... 19SELECTIVE N-TYPE NEURONAL CALCIUM CHANNEL BLOCKERS.....................................................................................................19

ANALGESICS - OPIOID.....................................................................................................................................................................19

CODEINE COMBINATIONS..................................................................................................................................................................19DIHYDROCODEINE COMBINATIONS....................................................................................................................................................20HYDROCODONE COMBINATIONS.......................................................................................................................................................20OPIOID AGONISTS............................................................................................................................................................................. 20OPIOID COMBINATIONS.....................................................................................................................................................................20OPIOID PARTIAL AGONISTS...............................................................................................................................................................20TRAMADOL COMBINATIONS...............................................................................................................................................................20

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

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

ANORECTAL AGENTS......................................................................................................................................................................20Updated January 1, 2019 Page

INTRARECTAL STEROIDS...................................................................................................................................................................20NITRATE VASODILATING AGENTS.....................................................................................................................................................20RECTAL ANESTHETIC/STEROIDS.......................................................................................................................................................20

ANTHELMINTICS................................................................................................................................................................................20

ANTHELMINTICS.................................................................................................................................................................................20

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..............................................................................................................................................................21

ANTIASTHMATIC AND BRONCHODILATOR AGENTS...............................................................................................................21

ADRENERGIC COMBINATIONS...........................................................................................................................................................21ANTI-IGE MONOCLONAL ANTIBODIES...............................................................................................................................................21BETA ADRENERGICS......................................................................................................................................................................... 21BRONCHODILATORS - ANTICHOLINERGICS........................................................................................................................................22LEUKOTRIENE RECEPTOR ANTAGONISTS.........................................................................................................................................22SELECTIVE PHOSPHODIESTERASE 4 (PDE4) INHIBITORS...............................................................................................................22STEROID INHALANTS......................................................................................................................................................................... 22XANTHINE-EXPECTORANTS...............................................................................................................................................................22XANTHINES........................................................................................................................................................................................ 22

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

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

ANTICONVULSANTS.........................................................................................................................................................................22

AMPA GLUTAMATE RECEPTOR ANTAGONISTS................................................................................................................................22ANTICONVULSANTS - BENZODIAZEPINES..........................................................................................................................................23ANTICONVULSANTS - MISC................................................................................................................................................................23CARBAMATES.....................................................................................................................................................................................23GABA MODULATORS........................................................................................................................................................................23HYDANTOINS......................................................................................................................................................................................23SUCCINIMIDES................................................................................................................................................................................... 23VALPROIC ACID................................................................................................................................................................................. 23

ANTIDEPRESSANTS.........................................................................................................................................................................23

ALPHA-2 RECEPTOR ANTAGONISTS (TETRACYCLICS).....................................................................................................................23

Updated January 1, 2019 Page

ANTIDEPRESSANTS - MISC................................................................................................................................................................23MODIFIED CYCLICS............................................................................................................................................................................23MONOAMINE OXIDASE INHIBITORS (MAOIS)....................................................................................................................................23SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS)................................................................................................................23SEROTONIN-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)..........................................................................................................24INSULIN-INCRETIN MIMETIC COMBINATIONS.....................................................................................................................................24MEGLITINIDE ANALOGUES.................................................................................................................................................................24MEGLITINIDE-BIGUANIDE COMBINATIONS.........................................................................................................................................25SGLT2 INHIBITOR - DPP-4 INHIBITOR COMBINATIONS...................................................................................................................25SODIUM-GLUCOSE CO-TRANSPORTER 2 (SGLT2) INHIBITORS......................................................................................................25SODIUM-GLUCOSE CO-TRANSPORTER 2 INHIBITOR-BIGUANIDE COMB..........................................................................................25SULFONYLUREAS...............................................................................................................................................................................25SULFONYLUREA-THIAZOLIDINEDIONE COMBINATIONS......................................................................................................................25THIAZOLIDINEDIONE-BIGUANIDE COMBINATIONS..............................................................................................................................25THIAZOLIDINEDIONES.........................................................................................................................................................................25

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

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

ANTIDOTES.........................................................................................................................................................................................25

ANTIDOTES........................................................................................................................................................................................ 25ANTIDOTES - CHELATING AGENTS....................................................................................................................................................25BENZODIAZEPINE ANTAGONISTS.......................................................................................................................................................25OPIOID ANTAGONISTS.......................................................................................................................................................................25

ANTIDOTES AND SPECIFIC ANTAGONISTS...............................................................................................................................25

ANTIDOTES AND SPECIFIC ANTAGONISTS........................................................................................................................................25

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

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

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

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

ANTIHEMOPHILIC PRODUCTS - MONOCLONAL ANTIBODIES..............................................................................................26

ANTIHEMOPHILIC PRODUCTS - MONOCLONAL ANTIBODIES.............................................................................................................26

ANTIHISTAMINES..............................................................................................................................................................................26Updated January 1, 2019 Page

ANTIHISTAMINES - ALKYLAMINES......................................................................................................................................................26ANTIHISTAMINES - ETHANOLAMINES.................................................................................................................................................26ANTIHISTAMINES - 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.........................................................................................27INTESTINAL CHOLESTEROL ABSORPTION INHIBITORS......................................................................................................................27MICROSOMAL TRIGLYCERIDE TRANSFER PROTEIN INHIBITORS.......................................................................................................27NICOTINIC ACID DERIVATIVES...........................................................................................................................................................27

ANTIHYPERTENSIVES.....................................................................................................................................................................27

ACE INHIBITOR & CALCIUM CHANNEL BLOCKER COMBINATIONS...................................................................................................27ACE INHIBITORS............................................................................................................................................................................... 27ACE INHIBITORS & THIAZIDE/THIAZIDE-LIKE...................................................................................................................................27ADRENOLYTICS-CENTRAL & THIAZIDE/THIAZIDE-LIKE COMB..........................................................................................................28AGENTS FOR PHEOCHROMOCYTOMA...............................................................................................................................................28ANGIOTENSIN II RECEPTOR ANTAG & CA CHANNEL BLOCKER & DIURETIC COMB.......................................................................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 - CENTRALLY ACTING & THIAZIDE/THIAZIDE-LIKE COMB.................................................................................28ANTIADRENERGICS - PERIPHERALLY ACTING...................................................................................................................................28BETA BLOCKER & ANGIOTENSIN II RECEPTOR ANTAGONIST COMB...............................................................................................28BETA BLOCKER & DIURETIC COMBINATIONS...................................................................................................................................28DIRECT RENIN INHIBITORS................................................................................................................................................................28DIRECT RENIN INHIBITORS & THIAZIDE/THIAZIDE-LIKE COMB.........................................................................................................28RESERPINE........................................................................................................................................................................................ 28SELECTIVE ALDOSTERONE RECEPTOR ANTAGONISTS (SARAS)....................................................................................................28VASODILATORS..................................................................................................................................................................................28

ANTI-INFECTIVE AGENTS - MISC..................................................................................................................................................28

ANTI-INFECTIVE AGENTS - MISC.......................................................................................................................................................28ANTI-INFECTIVE MISC. - COMBINATIONS..........................................................................................................................................29ANTIPROTOZOAL AGENTS.................................................................................................................................................................29CARBAPENEM COMBINATIONS..........................................................................................................................................................29CARBAPENEMS.................................................................................................................................................................................. 29CYCLIC LIPOPEPTIDES.......................................................................................................................................................................29GLYCYLCYCLINES..............................................................................................................................................................................29LEPROSTATICS.................................................................................................................................................................................. 29LINCOSAMIDES...................................................................................................................................................................................29OXAZOLIDINONES.............................................................................................................................................................................. 29POLYMYXINS......................................................................................................................................................................................29STREPTOGRAMIN COMBINATIONS.....................................................................................................................................................29

ANTIMALARIALS................................................................................................................................................................................29

ANTIMALARIAL COMBINATIONS..........................................................................................................................................................29


ANTIMALARIALS..................................................................................................................................................................................29

ANTIMYASTHENIC AGENTS...........................................................................................................................................................29

ANTIMYASTHENIC AGENTS................................................................................................................................................................29ANTIMYASTHENIC/CHOLINERGIC AGENTS.........................................................................................................................................30

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

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

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

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

ANTINEOPLASTIC & IMMUNOSUPPRESANT DRUGS..............................................................................................................30

ADJUNCTIVE AGENTS.................................................................................................................................................................30

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

ALKYLATING AGENTS........................................................................................................................................................................ 30ANDROGEN BIOSYNTHESIS INHIBITORS............................................................................................................................................30ANTIADRENALS.................................................................................................................................................................................. 30ANTIANDROGENS...............................................................................................................................................................................30ANTIESTROGENS............................................................................................................................................................................... 30ANTIMETABOLITES.............................................................................................................................................................................30ANTINEOPLASTIC - AUTOLOGOUS CELLULAR IMMUNOTHERAPY......................................................................................................30ANTINEOPLASTIC - 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.................................................................................................................................31ANTINEOPLASTIC - MULTIKINASE INHIBITORS...................................................................................................................................31ANTINEOPLASTIC - PROTEASOME INHIBITORS..................................................................................................................................31ANTINEOPLASTIC - TYROSINE KINASE INHIBITORS...........................................................................................................................31ANTINEOPLASTIC ANTIBIOTICS..........................................................................................................................................................31ANTINEOPLASTIC -ANTIBODY FOR RADIOPHARMACEUTICAL THERAPY............................................................................................31ANTINEOPLASTIC ANTIBODY-DRUG COMPLEXES.............................................................................................................................31ANTINEOPLASTIC COMBINATIONS.....................................................................................................................................................32ANTINEOPLASTIC ENZYMES..............................................................................................................................................................32ANTINEOPLASTIC RADIOPHARMACEUTICALS.....................................................................................................................................32ANTINEOPLASTICS - INTERLEUKINS...................................................................................................................................................32ANTINEOPLASTICS - PHOTOACTIVATED AGENTS..............................................................................................................................32ANTINEOPLASTICS MISC................................................................................................................................................................... 32AROMATASE INHIBITORS...................................................................................................................................................................32CARBOXYPEPTIDASE ENZYME AGENTS............................................................................................................................................32CARDIAC PROTECTIVE AGENTS........................................................................................................................................................32CHEMOTHERAPY ADJUNCTS - HYPERURICEMIA AGENTS.................................................................................................................32CHEMOTHERAPY ADJUNCTS - KERATINOCYTE GROWTH FACTORS................................................................................................32CYCLIN-DEPENDENT KINASES (CDK) INHIBITORS...........................................................................................................................32ESTROGEN RECEPTOR ANTAGONIST................................................................................................................................................32ESTROGENS-ANTINEOPLASTIC..........................................................................................................................................................32FOLIC ACID ANTAGONISTS RESCUE AGENTS...................................................................................................................................32GONADOTROPIN RELEASING HORMONE (GNRH) ANTAGONISTS....................................................................................................32IMIDAZOTETRAZINES..........................................................................................................................................................................32


ISOCITRATE DEHYDROGENASE-2 (IDH2) INHIBITORS......................................................................................................................32JANUS ASSOCIATED KINASE (JAK) INHIBITORS...............................................................................................................................32LHRH ANALOGS............................................................................................................................................................................... 32MITOTIC INHIBITORS..........................................................................................................................................................................33NITROGEN MUSTARDS......................................................................................................................................................................33NITROSOUREAS.................................................................................................................................................................................33PROGESTINS-ANTINEOPLASTIC.........................................................................................................................................................33RETINOIDS......................................................................................................................................................................................... 33SELECTIVE RETINOID X RECEPTOR AGONISTS................................................................................................................................33TOPOISOMERASE I INHIBITORS.........................................................................................................................................................33URINARY TRACT PROTECTIVE AGENTS............................................................................................................................................33VASCULAR ENDOTHELIAL GROWTH FACTOR (VEGF) INHIBITORS..................................................................................................33

ANTIPARKINSON AGENTS..............................................................................................................................................................33

ANTIPARKINSON ANTICHOLINERGICS................................................................................................................................................33ANTIPARKINSON DOPAMINERGICS....................................................................................................................................................33ANTIPARKINSON MONOAMINE OXIDASE INHIBITORS........................................................................................................................33LEVODOPA COMBINATIONS...............................................................................................................................................................33NONERGOLINE DOPAMINE RECEPTOR AGONISTS............................................................................................................................33PERIPHERAL COMT INHIBITORS.......................................................................................................................................................34

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

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

ANTIRETROVIRALS - CD4-DIRECTED POST-ATTACHMENT INHIBITOR.............................................................................34

ANTIRETROVIRALS - CD4-DIRECTED POST-ATTACHMENT INHIBITOR.............................................................................................34

ANTISEPTICS & DISINFECTANTS.................................................................................................................................................34

CHLORINE ANTISEPTICS....................................................................................................................................................................34

ANTIVIRALS........................................................................................................................................................................................ 34

ANTIRETROVIRAL COMBINATIONS.....................................................................................................................................................34ANTIRETROVIRALS - CCR5 ANTAGONISTS (ENTRY INHIBITOR).......................................................................................................35ANTIRETROVIRALS - FUSION INHIBITORS..........................................................................................................................................35ANTIRETROVIRALS - INTEGRASE INHIBITORS....................................................................................................................................35ANTIRETROVIRALS - PROTEASE INHIBITORS.....................................................................................................................................35ANTIRETROVIRALS - RTI-NON-NUCLEOSIDE ANALOGUES...............................................................................................................35ANTIRETROVIRALS - RTI-NUCLEOSIDE ANALOGUES-PURINES........................................................................................................35ANTIRETROVIRALS - RTI-NUCLEOSIDE ANALOGUES-PYRIMIDINES..................................................................................................35ANTIRETROVIRALS - RTI-NUCLEOSIDE ANALOGUES-THYMIDINES...................................................................................................35ANTIRETROVIRALS - RTI-NUCLEOTIDE ANALOGUES........................................................................................................................35CMV AGENTS....................................................................................................................................................................................35HEPATITIS B AGENTS........................................................................................................................................................................35HEPATITIS C AGENTS........................................................................................................................................................................36


HERPES AGENTS - PURINE ANALOGUES..........................................................................................................................................36HERPES AGENTS - THYMIDINE ANALOGUES....................................................................................................................................36INFLUENZA AGENTS...........................................................................................................................................................................36NEURAMINIDASE INHIBITORS.............................................................................................................................................................36

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

ANTILEPROTICS................................................................................................................................................................................. 36B-LYMPHOCYTE STIMULATOR (BLYS)-SPECIFIC INHIBITORS..........................................................................................................36CHELATING AGENTS..........................................................................................................................................................................36CYCLOSPORINE ANALOGS................................................................................................................................................................36ENZYMES........................................................................................................................................................................................... 36IMMUNE GLOBULIN IMMUNOSUPPRESSANTS....................................................................................................................................36INOSINE MONOPHOSPHATE DEHYDROGENASE INHIBITORS.............................................................................................................36IRRIGATION SOLUTIONS.....................................................................................................................................................................36MACROLIDE IMMUNOSUPPRESSANTS................................................................................................................................................36MONOCLONAL ANTIBODIES...............................................................................................................................................................36PERITONIAL DIALYSIS SOLUTIONS....................................................................................................................................................37POTASSIUM REMOVING RESINS........................................................................................................................................................37PROSTAGLANDINS............................................................................................................................................................................. 37PURINE ANALOGS..............................................................................................................................................................................37SCLEROSING AGENTS.......................................................................................................................................................................37SELECTIVE T-CELL COSTIMULATION BLOCKERS..............................................................................................................................37

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

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

BILE ACID SYNTHESIS DISORDER AGENTS..............................................................................................................................37

BILE ACID SYNTHESIS DISORDER AGENTS......................................................................................................................................37

BIOLOGICALS MISC..........................................................................................................................................................................37

ALLERGENIC EXTRACTS....................................................................................................................................................................37BIOLOGICALS MISC............................................................................................................................................................................37

CALCITONIN GENE-RELATED PEPTIDE (CGRP) RECEPTOR ANTAG.................................................................................37

CALCITONIN GENE-RELATED PEPTIDE (CGRP) RECEPTOR ANTAG...............................................................................................37

CALCIUM CHANNEL BLOCKERS...................................................................................................................................................37

CALCIUM CHANNEL BLOCKERS.........................................................................................................................................................37

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

CARDIAC GLYCOSIDES......................................................................................................................................................................38PHOSPHODIESTERASE INHIBITORS...................................................................................................................................................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)........................................................................................38PULMONARY HYPERTENSION - ENDOTHELIN RECEPTOR ANTAGONISTS.........................................................................................38PULMONARY HYPERTENSION - PHOSPHODIESTERASE INHIBITORS.................................................................................................38SELECTIVE CGMP PHOSPHODIESTERASE TYPE 5 INHIBITORS.......................................................................................................38


VASOACTIVE NATRIURETIC PEPTIDES..............................................................................................................................................38

CARDIOVASCULAR, HYPERTENSION & LIPIDS........................................................................................................................38

ANTICOAGULANTS.......................................................................................................................................................................38MISC. CARDIOVASCULAR AGENTS.........................................................................................................................................38MISC. COAGULATION AGENTS.................................................................................................................................................38

CEPHALOSPORIN COMBINATIONS..............................................................................................................................................38

CEPHALOSPORIN COMBINATIONS.....................................................................................................................................................38

CEPHALOSPORINS...........................................................................................................................................................................38

CEPHALOSPORINS - 1ST GENERATION.............................................................................................................................................38CEPHALOSPORINS - 2ND GENERATION............................................................................................................................................39CEPHALOSPORINS - 3RD GENERATION............................................................................................................................................39CEPHALOSPORINS - 4TH GENERATION.............................................................................................................................................39CEPHALOSPORINS - 5TH GENERATION.............................................................................................................................................39

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

BIPHASIC CONTRACEPTIVES - ORAL.................................................................................................................................................39COMBINATION CONTRACEPTIVES - ORAL.........................................................................................................................................39COMBINATION CONTRACEPTIVES - VAGINAL....................................................................................................................................39EMERGENCY 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.........................................................................................................................................................................40

GLUCOCORTICOSTEROIDS.................................................................................................................................................................40

COUGH/COLD/ALLERGY.................................................................................................................................................................40

ANTITUSSIVE - NONNARCOTIC..........................................................................................................................................................40ANTITUSSIVE - OPIOID.......................................................................................................................................................................40DECONGESTANT................................................................................................................................................................................40DECONGESTANT-ANTIHISTAMINE......................................................................................................................................................40DECONGESTANT-ANTIHISTAMINE W/ EXPECTORANT........................................................................................................................40MUCOLYTICS......................................................................................................................................................................................40NON-NARC ANTITUSSIVE-ANTIHISTAMINE.......................................................................................................................................40NON-NARC ANTITUSSIVE-DECONGESTANT-ANTIHISTAMINE............................................................................................................41OPIOID ANTITUSSIVE-ANTIHISTAMINE...............................................................................................................................................41OPIOID ANTITUSSIVE-DECONGESTANT-ANTIHISTAMINE...................................................................................................................41OPIOID ANTITUSSIVE-EXPECTORANT................................................................................................................................................41

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

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

DERMATOLOGICALS........................................................................................................................................................................41

ACNE ANTIBIOTICS............................................................................................................................................................................41ACNE COMBINATIONS........................................................................................................................................................................41ACNE PRODUCTS.............................................................................................................................................................................. 41ANTIBIOTICS - TOPICAL.....................................................................................................................................................................41


ANTIFUNGALS - TOPICAL...................................................................................................................................................................41ANTIFUNGALS - TOPICAL COMBINATIONS.........................................................................................................................................41ANTI-INFLAMMATORY AGENTS - TOPICAL.........................................................................................................................................41ANTINEOPLASTIC ALKYLATING AGENTS - TOPICAL..........................................................................................................................41ANTINEOPLASTIC ANTIMETABOLITES - TOPICAL...............................................................................................................................41ANTINEOPLASTIC OR PREMALIGNANT LESIONS - TOPICAL MISC.....................................................................................................41ANTIPERSPIRANTS......................................................................................................................................................................42ANTIPSORIATICS................................................................................................................................................................................42ANTIPSORIATICS - SYSTEMIC............................................................................................................................................................42ANTISEBORRHEIC PRODUCTS...........................................................................................................................................................42ANTIVIRALS - TOPICAL.......................................................................................................................................................................42BURN PRODUCTS..............................................................................................................................................................................42CORTICOSTEROIDS - TOPICAL..........................................................................................................................................................42DEPIGMENTING AGENTS................................................................................................................................................................... 42EMOLLIENT/KERATOLYTIC AGENTS...................................................................................................................................................42EMOLLIENTS...................................................................................................................................................................................... 42ENZYMES - TOPICAL..........................................................................................................................................................................42IMIDAZOLE-RELATED ANTIFUNGALS - TOPICAL................................................................................................................................42IMMUNOMODULATORS IMIDAZOQUINOLINAMINES - TOPICAL............................................................................................................42KERATOLYTIC/ANTIMITOTIC AGENTS................................................................................................................................................43LOCAL ANESTHETICS - TOPICAL.......................................................................................................................................................43MACROLIDE IMMUNOSUPPRESSANTS - TOPICAL..............................................................................................................................43MISC. DERMATOLOGICAL PRODUCTS...............................................................................................................................................43PIGMENTING AGENTS........................................................................................................................................................................43ROSACEA AGENTS............................................................................................................................................................................ 43SCABICIDES & PEDICULICIDES..........................................................................................................................................................43TOPICAL ANESTHETIC COMBINATIONS..............................................................................................................................................43TOPICAL ANESTHETIC GASSES.........................................................................................................................................................43TOPICAL SELECTIVE RETINOID X RECEPTOR AGONISTS.................................................................................................................43TOPICAL STEROID COMBINATIONS...................................................................................................................................................43WOUND CARE - GROWTH FACTOR AGENTS....................................................................................................................................43WOUND DRESSINGS..........................................................................................................................................................................43

DIAGNOSTIC PRODUCTS................................................................................................................................................................43

DIAGNOSTIC BIOLOGICALS................................................................................................................................................................43DIAGNOSTIC DRUGS..........................................................................................................................................................................43DIAGNOSTIC 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.........................................................................................................................44DIETARY MANAGEMENT PRODUCTS.................................................................................................................................................44

DIGESTIVE AIDS................................................................................................................................................................................44

DIGESTIVE ENZYMES.........................................................................................................................................................................44

DILUENT.............................................................................................................................................................................................. 44

DILUENT.............................................................................................................................................................................................44


DIURETICS..........................................................................................................................................................................................44

CARBONIC ANHYDRASE INHIBITORS.................................................................................................................................................44DIURETIC COMBINATIONS..................................................................................................................................................................44LOOP DIURETICS...............................................................................................................................................................................44OSMOTIC DIURETICS.........................................................................................................................................................................45POTASSIUM SPARING DIURETICS.....................................................................................................................................................45THIAZIDES AND THIAZIDE-LIKE DIURETICS.......................................................................................................................................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...............................................................................................................................45GROWTH HORMONE RELEASING HORMONES (GHRH)...................................................................................................................45GROWTH HORMONES........................................................................................................................................................................45HEREDITARY OROTIC ACIDURIA TREATMENT - AGENTS..................................................................................................................45HEREDITARY TYROSINEMIA TYPE 1 (HT-1) TREATMENT - AGENTS................................................................................................45HOMOCYSTINURIA TREATMENT - AGENTS........................................................................................................................................45HYPERAMMONEMIA TREATMENT - AGENTS......................................................................................................................................45HYPERPARATHYROID TREATMENT - VITAMIN D ANALOGS...............................................................................................................45HYPOPHOSPHATASIA (HPP) AGENTS...............................................................................................................................................46INSULIN-LIKE GROWTH FACTORS (SOMATOMEDINS).......................................................................................................................46LHRH/GNRH AGONIST ANALOG PITUITARY SUPPRESSANTS.........................................................................................................46LYSOSOMAL ACID LIPASE (LAL) DEFICIENCY - AGENTS.................................................................................................................46LYSOSOMAL STORAGE DISEASE TREATMENT - 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...............................................................................................................................................46SELECTIVE ESTROGEN RECEPTOR MODULATORS (SERMS)..........................................................................................................46SELECTIVE VASOPRESSIN V2-RECEPTOR ANTAGONISTS................................................................................................................46SOMATOSTATIC AGENTS...................................................................................................................................................................46UREA CYCLE DISORDER - AGENTS..................................................................................................................................................46VASOPRESSIN....................................................................................................................................................................................46

ENDOCRINE/DIABETES...................................................................................................................................................................46

INSULIN SYRINGES/MISCELLANEOUS DME..........................................................................................................................46

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

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

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

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


FENTANYL COMBINATIONS...........................................................................................................................................................47

FENTANYL COMBINATIONS................................................................................................................................................................47

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

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

GASTROENTEROLOGY...................................................................................................................................................................47

ANTIVERTIGO & ANTIEMETIC AGENTS..................................................................................................................................47MISC. GASTROINTESTINAL AGENTS......................................................................................................................................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.............................................................................................................47IBS AGENT - MU-OPIOID RECEPTOR AGONISTS.............................................................................................................................47IBS 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.......................................................................................................................................................48PHOSPHATES.....................................................................................................................................................................................48URINARY ANALGESICS...................................................................................................................................................................... 48

GOUT AGENTS...................................................................................................................................................................................48

GOUT AGENTS...................................................................................................................................................................................48URICOSURICS.................................................................................................................................................................................... 49

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

ANTIHEMOPHILIC PRODUCTS............................................................................................................................................................49BRADYKININ B2 RECEPTOR ANTAGONISTS......................................................................................................................................49C1 INHIBITORS...................................................................................................................................................................................49COMPLEMENT INHIBITORS.................................................................................................................................................................49CYCLOPENTYLTRIAZOLOPYRIMIDINE (CPTP) DERIVATIVES.............................................................................................................49GLYCOPROTEIN IIB/IIIA RECEPTOR INHIBITORS...............................................................................................................................49HEMATORHEOLOGIC AGENTS...........................................................................................................................................................49HEMIN................................................................................................................................................................................................ 49HUMAN PROTEIN C...........................................................................................................................................................................49PHOSPHODIESTERASE III INHIBITORS...............................................................................................................................................49PLASMA EXPANDERS.........................................................................................................................................................................49PLASMA KALLIKREIN INHIBITORS.......................................................................................................................................................49


PLASMA PROTEINS............................................................................................................................................................................49PLATELET AGGREGATION INHIBITOR COMBINATIONS.......................................................................................................................49PLATELET 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)...........................................................................................................................50FOLIC ACID/FOLATES........................................................................................................................................................................50GRANULOCYTE COLONY-STIMULATING FACTORS (G-CSF)............................................................................................................50GRANULOCYTE/MACROPHAGE COLONY-STIMULATING FACTOR(GM-CSF)....................................................................................50IRON...................................................................................................................................................................................................50IRON COMBINATIONS.........................................................................................................................................................................50IRON W/ FOLIC ACID..........................................................................................................................................................................50THROMBOPOIETIN (TPO) RECEPTOR AGONISTS.............................................................................................................................50

HEMOSTATICS...................................................................................................................................................................................50

HEMOSTATICS - SYSTEMIC................................................................................................................................................................50

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

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

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

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

IMMUNOLOGY, VACCINES & BIOTECHNOLOGY.......................................................................................................................51

VACCINES & MISCELLANEOUS IMMUNOLOGICALS............................................................................................................51

IMPLANON IMPLANT 68 MG SUBCUTANEOUS..........................................................................................................................51

CONTRACEPTIVES.......................................................................................................................................................................51

INTEGRIN RECEPTOR ANTAGONISTS........................................................................................................................................51

INTEGRIN RECEPTOR ANTAGONISTS................................................................................................................................................51

INTERLEUKIN-6 (IL-6) ANTAGONISTS..........................................................................................................................................51

INTERLEUKIN-6 (IL-6) ANTAGONISTS................................................................................................................................................51

LAXATIVES..........................................................................................................................................................................................51

BOWEL EVACUANT COMBINATIONS..................................................................................................................................................51LAXATIVES - MISCELLANEOUS..........................................................................................................................................................51

LEPTIN ANALOGUES........................................................................................................................................................................51

LEPTIN ANALOGUES..........................................................................................................................................................................51

LOCAL ANESTHETICS-PARENTERAL..........................................................................................................................................51


LOCAL ANESTHETIC & SYMPATHOMIMETIC......................................................................................................................................51LOCAL ANESTHETICS - AMIDES........................................................................................................................................................52LOCAL ANESTHETICS - ESTERS........................................................................................................................................................52

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

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

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

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

MIGRAINE PRODUCTS.....................................................................................................................................................................52

ERGOT COMBINATIONS.....................................................................................................................................................................52MIGRAINE PRODUCTS................................................................................................................................................................53SELECTIVE SEROTONIN AGONIST-NSAID COMBINATIONS..............................................................................................................53SELECTIVE SEROTONIN AGONISTS 5-HT(1)....................................................................................................................................53

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

BICARBONATES..................................................................................................................................................................................53CALCIUM............................................................................................................................................................................................ 53CHLORIDE.......................................................................................................................................................................................... 53CITRATE.............................................................................................................................................................................................53ELECTROLYTES & DEXTROSE...........................................................................................................................................................53ELECTROLYTES PARENTERAL...........................................................................................................................................................53IODINE PRODUCTS.............................................................................................................................................................................53MAGNESIUM.......................................................................................................................................................................................53MANGANESE...................................................................................................................................................................................... 53PHOSPHATE.......................................................................................................................................................................................53POTASSIUM........................................................................................................................................................................................53TRACE MINERAL COMBINATIONS......................................................................................................................................................54TRACE MINERALS..............................................................................................................................................................................54ZINC................................................................................................................................................................................................... 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..........................................................................................................................................................................54TRIPEPTIDYL PEPTIDASE 1 DEFICIENCY TREATMENT - AGENTS.....................................................................................................54

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

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

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

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


MULTIVITAMINS.................................................................................................................................................................................54

B-COMPLEX VITAMINS.......................................................................................................................................................................54B-COMPLEX W/ C & FOLIC ACID......................................................................................................................................................54B-COMPLEX W/ C-BIOTIN-E-MINERALS & FOLIC ACID....................................................................................................................54B-COMPLEX W/ C-ZN & FOLIC ACID................................................................................................................................................54MULTIPLE VITAMINS W/ CALCIUM.....................................................................................................................................................54MULTIPLE VITAMINS W/ MINERALS...................................................................................................................................................55MULTIPLE VITAMINS W/ MINERALS & CALCIUM-FOLIC ACID............................................................................................................55MULTIPLE VITAMINS W/ MINERALS & FOLIC ACID............................................................................................................................55MULTIVITAMINS..................................................................................................................................................................................55PRENATAL MV & MIN W/FE-FA.......................................................................................................................................................55PRENATAL MV & MIN W/FE-FA-CA-OMEGA 3 FISH OIL................................................................................................................55PRENATAL MV & MIN W/FE-FA-DHA.............................................................................................................................................55PRENATAL 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.............................................................................................................................................................................. 56TOPICAL DECONGESTANTS...............................................................................................................................................................56

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

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

NEUROMUSCULAR AGENTS..........................................................................................................................................................56

BENZATHIAZOLES.............................................................................................................................................................................. 56DEPOLARIZING MUSCLE RELAXANTS................................................................................................................................................56NEUROMUSCULAR BLOCKING AGENT - NEUROTOXINS....................................................................................................................56

NUTRIENTS.........................................................................................................................................................................................56

AMINO ACID MIXTURES.....................................................................................................................................................................56CARBOHYDRATES..............................................................................................................................................................................57LIPIDS................................................................................................................................................................................................ 57

OBSTETRICS & GYNECOLOGY.....................................................................................................................................................57

DIAPHRAGMS AND OTHER NON-ORAL CONTRACEPTIVES.............................................................................................57

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

ARTIFICIAL TEARS............................................................................................................................................................................. 57BETA-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................................................................................................................................................................57


OPHTHALMIC ANTI-INFECTIVE COMBINATIONS.................................................................................................................................58OPHTHALMIC ANTIVIRALS..................................................................................................................................................................58OPHTHALMIC CARBONIC ANHYDRASE INHIBITORS...........................................................................................................................58OPHTHALMIC DECONGESTANTS........................................................................................................................................................58OPHTHALMIC DIAGNOSTIC PRODUCTS.............................................................................................................................................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..............................................................................................................................................58PROSTAGLANDINS - OPHTHALMIC.....................................................................................................................................................58VASCULAR ENDOTHELIAL GROWTH FACTOR (VEGF) ANTAGONISTS.............................................................................................59

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

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

OPHTHALMOLOGY........................................................................................................................................................................... 59

MACULAR DEGENERATION.................................................................................................................................................................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

ANTIVIRAL MONOCLONAL ANTIBODIES.............................................................................................................................................59IMMUNE SERUMS...............................................................................................................................................................................59

PCSK9 INHIBITORS...........................................................................................................................................................................59

PCSK9 INHIBITORS...........................................................................................................................................................................59

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

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

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

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

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


POLY (ADP-RIBOSE) POLYMERASE (PARP) INHIBITORS...............................................................................................................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.............................................................................................................................................................60ANTIDEMENTIA AGENT COMBINATIONS.............................................................................................................................................60BENZODIAZEPINES & TRICYCLIC AGENTS........................................................................................................................................60CHOLINOMIMETICS - ACHE INHIBITORS...........................................................................................................................................61FIBROMYALGIA AGENT - SNRIS.......................................................................................................................................................61MOVEMENT DISORDER DRUG THERAPY..........................................................................................................................................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....................................................................................................................................................61

ALPHA-PROTEINASE INHIBITOR (HUMAN).........................................................................................................................................61CFTR POTENTIATORS......................................................................................................................................................................61CYSTIC FIBROSIS AGENT - COMBINATIONS......................................................................................................................................61HYDROLYTIC ENZYMES.....................................................................................................................................................................61INTERLEUKIN-5 ANTAGONISTS (IGG1 KAPPA)..................................................................................................................................62PULMONARY FIBROSIS AGENTS........................................................................................................................................................62

SGLT2 INHIBITOR - DPP-4 INHIBITOR COMBINATIONS..........................................................................................................62

SGLT2 INHIBITOR - DPP-4 INHIBITOR COMBINATIONS...................................................................................................................62

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

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

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


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

TAZAROTENE CREAM 0.1 % EXTERNAL.....................................................................................................................................62

DERMATOLOGICALS....................................................................................................................................................................62

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

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

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

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

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

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

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

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

TRYPTOPHAN HYDROXYLASE INHIBITORS..............................................................................................................................62

TRYPTOPHAN HYDROXYLASE INHIBITORS........................................................................................................................................62

ULCER DRUGS...................................................................................................................................................................................62

ANTISPASMODICS..............................................................................................................................................................................62BELLADONNA ALKALOIDS..................................................................................................................................................................62H-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 ANTISPASMODIC - ANTIMUSCARINICS (ANTICHOL)(NEW).................................................................................................63URINARY ANTISPASMODICS - CHOLINERGIC AGONISTS (NEW)........................................................................................................63URINARY ANTISPASMODICS - DIRECT MUSCLE RELAXANTS............................................................................................................63

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.............................................................................................................................................................................. 64Updated January 1, 2019 Page

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

VITAMINS.............................................................................................................................................................................................64

VITAMIN A..........................................................................................................................................................................................64VITAMIN 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


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

AmphetaminesGENERIC dexmethylphenidate er dextroamphetamine sulfate dextroamphetamine sulfate er methamphetamine hcl

PREFERRED EVEKEO VYVANSE

AnalepticsGENERIC caffeine citrated caffeine/sodium benzoate

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

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

PREFERRED DAYTRANA QUILLICHEW ER

QUILLIVANT XR

NON PREFERRED FOCALIN XR

ALS Agents - Miscellaneous

ALS Agents - MiscellaneousNON PREFERRED RADICAVA

Amethyst TABLET 90-20 MCG Oral

CONTRACEPTIVESGENERIC amethyst

AMINOGLYCOSIDES

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

PREFERRED AMIKACIN GENTAMICIN SULFATE IN NS 100MG/50ML KANAMYCIN SULFATE POWDER

NON PREFERRED BETHKIS CAYSTON GENTAMICIN SULFATE 60MG/ML VIAL GENTAMICIN SULFATE IN NS 120MG/0.1L KITABIS PAK TOBI PODHALER TOBRAMYCIN SULFATE 300MG/5ML AMPUL

ANALGESICS - ANTI-INFLAMMATORY

Antirheumatic - Janus Kinase (JAK) InhibitorsNON PREFERRED XELJANZ XELJANZ XR

Antirheumatic AntimetabolitesPREFERRED OTREXUP

Anti-TNF-alpha - Monoclonal AntibodiesPREFERRED


HUMIRA SIMPONI ARIA

Anti-TNF-alpha - Monoclonoal AntibodiesPREFERRED SIMPONI 100MG/ML

NON PREFERRED SIMPONI 50MG/0.5ML

Cyclooxygenase 2 (COX-2) InhibitorsGENERIC celecoxib

NON PREFERRED CELEBREX

Gold CompoundsPREFERRED RIDAURA

Interleukin-1 BlockersNON PREFERRED ARCALYST

Interleukin-1beta BlockersNON PREFERRED ILARIS

Interleukin-6 Receptor InhibitorsNON PREFERRED ACTEMRA

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 ibuprofen ibuprofen lysine indomethacin indomethacin er ketoprofen er meclofenamate sodium mefenamic acid meloxicam nabumetone naproxen naproxen sodium oxaprozin piroxicam sulindac tolmetin sodium

PREFERRED

CALDOLOR DICLOFENAC SODIUM POWDER

NON PREFERRED FENOPROFEN CALCIUM NEOPROFEN 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

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 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 INFUMORPH OXYCONTIN ER ULTIVA

NON PREFERRED CODEINE SULFATE SOLUTION DILAUDID-HP FENTANYL CITRATE 100MCG/2ML FENTORA HYDROMORPHONE HCL 0.5MG/0.5ML SYRINGE MORPHINE SULFATE NUCYNTA NUCYNTA ER ROXYBOND SUFENTIL 50MCG/ML VIAL TRAMADOL HCL ER

Opioid CombinationsGENERIC oxycodone w/aspirin oxycodone/acetaminophen

Opioid Partial AgonistsGENERIC buprenorphine buprenorphine/naloxone butorphanol

nalbuphine hcl pentazocine lactate

PREFERRED BUTRANS SUBOXONE ZUBSOLV

NON PREFERRED BELBUCA SUBLOCADE SUBOXONE TABLET TALWIN

Tramadol CombinationsGENERIC tramadol/acetaminophen

ANDROGENS-ANABOLIC

AndrogensGENERIC danazol oxandrolone testosterone cypionate testosterone enanthate testosterone gel

PREFERRED ANDRODERM FLUOXYMESTERONE METHITEST

NON PREFERRED AXIRON TESTOSTERONE GEL

ANORECTAL AGENTS

Intrarectal SteroidsPREFERRED CORTIFOAM

NON PREFERRED UCERIS FOAM

Nitrate Vasodilating AgentsPREFERRED RECTIV

Rectal Anesthetic/SteroidsGENERIC hydrocortisone/pramoxine lidocaine-hc pramcort

NON PREFERRED LIDOCAINE-HC PROCTOFOAM-HC


ANTHELMINTICS

AnthelminticsGENERIC ivermectin praziquantel

PREFERRED ALBENZA BENZNIDAZOLE EMVERM

NON PREFERRED BILTRICIDE STROMECTOL

ANTIANGINAL AGENTS

Antianginals-OtherPREFERRED RANEXA

NitratesGENERIC isosorbide dinitrate isosorbide mononitrate isosorbide mononitrate er minitran nitroglycerin nitroglycerin er nitroglycerin in d5w nitroglycerin spray nitroglycerin tablets

PREFERRED DILATRATE-SR

NON PREFERRED NITRO-DUR NITROSTAT

ANTIANXIETY AGENTS

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

NON PREFERRED VISTARIL

BenzodiazepinesGENERIC alprazolam alprazolam er alprazolam odt chlordiazepoxide hcl clorazepate dipotassium 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

ANTIASTHMATIC AND BRONCHODILATOR AGENTS

Adrenergic CombinationsPREFERRED ADVAIR DISKUS ADVAIR HFA ANORO ELLIPTA BREO ELLIPTA COMBIVENT RESPIMAT DULERA STIOLTO RESPIMAT SYMBICORT TRELEGY ELLIPTA

NON PREFERRED BEVESPI AEROSPHERE UTIBRON NEOHALER

Anti-IgE Monoclonal AntibodiesNON PREFERRED XOLAIR


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

PREFERRED ALBUTEROL ARCAPTA NEOHALER PERFOROMIST PROAIR HFA PROAIR RESPICLICK SEREVENT DISKUS VENTOLIN HFA

NON PREFERRED STRIVERDI RESPIMAT VOSPIRE ER

Bronchodilators - AnticholinergicsGENERIC ipratropium bromide ipratropium/albuterol nebulization

PREFERRED INCRUSE ELLIPTA SPIRIVA RESPIMAT

NON PREFERRED ATROVENT SPRAY SEEBRI NEOHALER TUDORZA PRESSAIR

Leukotriene Receptor AntagonistsGENERIC montelukast sodium zafirlukast

NON PREFERRED ACCOLATE

Selective Phosphodiesterase 4 (PDE4) InhibitorsPREFERRED DALIRESP

Steroid InhalantsPREFERRED ARMONAIR RESPICLICK ARNUITY ELLIPTA ASMANEX, HFA FLOVENT DISKUS FLOVENT HFA PULMICORT FLEXHALER QVAR QVAR REDIHALER

NON PREFERRED ALVESCO

Xanthine-ExpectorantsGENERIC difil-g

XanthinesGENERIC aminophylline theophylline anhydrous drops er 12 hr theophylline anhydrous er

NON PREFERRED AMINOPHYLLINE 500MG/20ML AMPUL

ANTICOAGULANTS

Coumarin AnticoagulantsGENERIC warfarin sodium

PREFERRED COUMADIN 5MG VIAL

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 clonazepam clonazepam odt diazepam diazepam rectal gel

NON PREFERRED ONFI

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

PREFERRED LYRICA ROWEEPRA XR

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

CarbamatesGENERIC felbamate

GABA ModulatorsGENERIC tiagabine hcl

NON PREFERRED GABITRIL SABRIL

HydantoinsGENERIC fosphenytoin sodium phenytoin phenytoin sodium

PREFERRED DIAZEPAM POWDER DILANTIN 30MG PEGANONE

NON PREFERRED DILANTIN

SuccinimidesGENERIC ethosuximide

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 er (12 hour) bupropion hcl bupropion hcl er bupropion hcl xl er bupropion sr

Modified CyclicsGENERIC trazodone hcl

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

PREFERRED FLUOXETINE POWDER

NON PREFERRED CELEXA FLUOXETINE 60MG 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 AnalogsPREFERRED SYMLINPEN 120 SYMLINPEN 60

BiguanidesGENERIC metformin hcl metformin hcl er

NON PREFERRED RIOMET

Diabetic OtherPREFERRED GLUCAGEN GLUCAGON PROGLYCEM

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

NON PREFERRED ONGLYZA

Dipeptidyl Peptidase-4 Inhibitor-Biguanide Combinations

PREFERRED JANUMET JANUMET XR JENTADUETO JENTADUETO XR

NON PREFERRED KOMBIGLYZE XR

Human InsulinPREFERRED HUMALOG HUMALOG JUNIOR KWIKPEN HUMULIN 70/30 KWIKPEN HUMULIN N HUMULIN N KWIKPEN 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 FLEXTOUCH U-100 TRESIBA FLEXTOUCH U-200

NON PREFERRED BASAGLAR KWIKPEN U-100

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 CombinationsNON PREFERRED GLYXAMBI

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

SulfonylureasGENERIC glimepiride glipizide glipizide er glyburide glyburide micronized glyburide/metformin hcl tolazamide tolbutamide

Sulfonylurea-Thiazolidinedione CombinationsGENERIC pioglitazone/glimepiride

NON PREFERRED ACTOPLUS MET ACTOPLUS MET XR

Thiazolidinedione-Biguanide CombinationsGENERIC

pioglitazone/metformin

ThiazolidinedionesGENERIC pioglitazone hcl

NON PREFERRED ACTOS

ANTIDIARRHEALS

Antiperistaltic AgentsGENERIC diphenoxylate/atropine opium paregoric

NON PREFERRED LOMOTIL TABLET

ANTIDOTES

AntidotesGENERIC deferoxamine fomepizole physostigmine salicylate sodium thiosulfate

PREFERRED PHYSOSTIGMINE SALICYLATE SODIUM THIOSULFATE VISTOGARD

Antidotes - Chelating AgentsPREFERRED CHEMET

NON PREFERRED EXJADE FERRIPROX JADENU JADENU SPRINKLE

Benzodiazepine AntagonistsGENERIC flumazenil

Opioid AntagonistsGENERIC naloxone hcl naltrexone hydrochloride

PREFERRED NALOXONE HCL POWDER NARCAN

NON PREFERRED VIVITROL


ANTIDOTES AND SPECIFIC ANTAGONISTS

Antidotes and Specific AntagonistsPREFERRED BAL IN OIL PROTOPAM CHLORIDE

ANTIEMETICS

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

PREFERRED SANCUSO

NON PREFERRED ONDANSETRON HCL

Antiemetic CombinationsPREFERRED AKYNZEO

Antiemetics - AnticholinergicGENERIC dimenhydrinate trimethobenzamide hcl

PREFERRED MECLIZINE HCL POWDER

Substance P/Neurokinin 1 (NK1) Receptor AntagonistsGENERIC aprepitant capsule, dose pack

PREFERRED EMEND 40MG; 125MG CAPSULE VARUBI

NON PREFERRED ALOXI EMEND 125MG/80MG DOSEPACK EMEND 80MG CAPSULE

ANTIFUNGALS

Antifungal - Glucan Synthesis Inhibitors (Echinocandins)

GENERIC caspofungin acetate

PREFERRED MYCAMINE

NON PREFERRED CANCIDAS

AntifungalsGENERIC amphotericin flucytosine griseofulvin griseofulvin ultramicrosize nystatin nystatin terbinafine

PREFERRED AMBISOME LAMISIL NYSTATIN NYSTATIN TERBINAFINE

NON PREFERRED LAMISIL 250MG TABLET

ImidazolesGENERIC ketoconazole

NON PREFERRED KETOCONAZOLE CRYSTALS

TriazolesGENERIC fluconazole fluconazole in dextrose fluconazole in saline itraconazole voriconazole

PREFERRED CRESEMBA NOXAFIL SPORANOX SOLUTION

NON PREFERRED FLUCONAZOLE 100MG/50ML PIGGYBACK ITRACONAZOLE 1GM POWDER SPORANOX CAPSULE

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

PREFERRED DOXYLAMINE SUCCINATE

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

Antihistamines - PhenothiazinesGENERIC promethazine hcl promethegan

Antihistamines - PiperidinesGENERIC cyproheptadine hcl

NON PREFERRED CYPROHEPTADINE HCL 4MG/10ML SYRUP

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 SIMCOR ER

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 InhibitorsPREFERRED JUXTAPID

Nicotinic Acid DerivativesGENERIC niacin er

ANTIHYPERTENSIVES

ACE Inhibitor & Calcium Channel Blocker Combinations

GENERIC trandolapril/verapamil er

NON PREFERRED 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

PREFERRED DEMSER

NON PREFERRED PHENTOLAMINE MESYLATE VIAL

Angiotensin II Receptor Antag & Ca Channel Blocker & Diuretic Comb

GENERIC amlodipine/valsartan/hctz

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 olmesartan/amlodipine/hctz

NON PREFERRED TRIBENZOR

Antiadrenergics - Centrally ActingGENERIC clonidine hcl guanfacine hcl methyldopa methyldopate hcl

Antiadrenergics - Centrally Acting & Thiazide/Thiazide-Like Comb

GENERIC clonidine/chlorthalidone

Antiadrenergics - Peripherally ActingGENERIC doxazosin mesylate prazosin hcl terazosin hcl

Beta Blocker & Angiotensin II Receptor Antagonist Comb

PREFERRED BYVALSON

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

Direct Renin InhibitorsNON 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 bacitracin colistimethate metronidazole tinidazole trimethoprim

PREFERRED NEBUPENT VIBATIV XIFAXAN

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

Anti-infective Misc. - CombinationsGENERIC sulfamethoxazole/trimethoprim

NON PREFERRED BACTRIM BACTRIM DS

Antiprotozoal AgentsGENERIC atovaquone

PREFERRED ALINIA

NON PREFERRED MEPRON

Carbapenem CombinationsGENERIC imipenem-cilastatin

CarbapenemsPREFERRED DORIBAX INVANZ MEROPENEM - 0.9% NACL

Cyclic LipopeptidesPREFERRED 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 CombinationsPREFERRED SYNERCID

ANTIMALARIALS

Antimalarial CombinationsGENERIC atovaquone/proguanil hcl

PREFERRED COARTEM

NON PREFERRED MALARONE

AntimalarialsGENERIC chloroquine phosphate hydroxychloroquine sulfate mefloquine hcl quinine sulfate

PREFERRED DARAPRIM PRIMAQUINE


ANTIMYASTHENIC AGENTS Antimyasthenic Agents

GENERIC guanidine hcl neostigmine methylsulfate pyridostigmine bromide

NON PREFERRED NEOSTIGMINE METHYLSULFATE

Antimyasthenic/Cholinergic AgentsPREFERRED MESTINON SYRUP

NON PREFERRED MESTINON MESTINON ER

ANTIMYCOBACTERIAL AGENTS

Antimycobacterial AgentsGENERIC ethambutol hcl isoniazid pyrazinamide rifabutin

PREFERRED CAPASTAT SULFATE PRIFTIN SIRTURO

NON PREFERRED RIFADIN

Antineoplastic - BCL-2 Inhibitors

Antineoplastic - BCL-2 InhibitorsNON PREFERRED VENCLEXTA VENCLEXTA STARTER PACK

ANTINEOPLASTIC & IMMUNOSUPPRESANT DRUGS

ADJUNCTIVE AGENTSGENERIC amifostine

ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES

Alkylating AgentsGENERIC carboplatin cisplatin

PREFERRED BUSULFEX CISPLATIN POWDER HEXALEN

MYLERAN

NON PREFERRED BENDEKA OXALIPLATIN THIOTEPA TREANDA

Androgen Biosynthesis InhibitorsPREFERRED ZYTIGA

NON PREFERRED YONSA

AntiadrenalsPREFERRED LYSODREN

AntiandrogensGENERIC bicalutamide flutamide

PREFERRED ERLEADA XTANDI

NON PREFERRED NILANDRON NILUTAMIDE

AntiestrogensGENERIC tamoxifen citrate

PREFERRED FARESTON

AntimetabolitesGENERIC azacitidine capecitabine cladribine cytarabine decitabine floxuridine fludarabine phosphate mercaptopurine methotrexate

PREFERRED ARRANON CLOLAR PURIXAN RASUVO TABLOID

NON PREFERRED ALIMTA DEPOCYT FOLOTYN GEMCITABINE HCL


TREXALL

Antineoplastic - Autologous Cellular ImmunotherapyPREFERRED 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 - ImmunomodulatorsPREFERRED REVLIMID

NON PREFERRED POMALYST

Antineoplastic - MEK InhibitorsNON PREFERRED COTELLIC MEKINIST MEKTOVI

Antineoplastic - Monoclonal AntibodiesPREFERRED MYLOTARG ONTAK

NON PREFERRED ARZERRA BAVENCIO DARZALEX ERBITUX GAZYVA HERCEPTIN IMFINZI KEYTRUDA LARTRUVO OPDIVO PERJETA TECENTRIQ UNITUXIN VECTIBIX YERVOY

Antineoplastic - mTOR Kinase InhibitorsPREFERRED AFINITOR AFINITOR DISPERZ

NON PREFERRED TORISEL

Antineoplastic - Multikinase InhibitorsPREFERRED NEXAVAR SUTENT

NON PREFERRED RYDAPT STIVARGA

Antineoplastic - Proteasome InhibitorsNON PREFERRED KYPROLIS NINLARO VELCADE

Antineoplastic - Tyrosine Kinase InhibitorsPREFERRED SPRYCEL TARCEVA TASIGNA XALKORI

NON PREFERRED ALECENSA BOSULIF CAPRELSA GILOTRIF ICLUSIG IMATINIB MESYLATE IMBRUVICA INLYTA LENVIMA NERLYNX TAGRISSO 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

PREFERRED ZEVALIN

Antineoplastic Antibody-Drug ComplexesNON PREFERRED ADCETRIS BESPONSA KADCYLA

Antineoplastic CombinationsPREFERRED LONSURF

NON PREFERRED RITUXAN RITUXAN HYCELA VYXEOS LIPOSOME

Antineoplastic EnzymesNON PREFERRED ONCASPAR

Antineoplastic RadiopharmaceuticalsPREFERRED QUADRAMET XOFIGO

NON PREFERRED LUTATHERA

Antineoplastics - InterleukinsNON PREFERRED PROLEUKIN

Antineoplastics - Photoactivated AgentsNON PREFERRED PHOTOFRIN

Antineoplastics Misc.GENERIC dacarbazine hydroxyurea

PREFERRED HYDROXYUREA POWDER INTRON A MATULANE THERACYS

NON PREFERRED ACTIMMUNE ALFERON N SYLATRON SYNRIBO TICE BCG TRISENOX

Aromatase InhibitorsGENERIC anastrozole exemestane letrozole

PREFERRED ANASTROZOLE POWDER

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) InhibitorsNON PREFERRED IBRANCE

Estrogen Receptor AntagonistNON PREFERRED FASLODEX

Estrogens-AntineoplasticPREFERRED EMCYT

Folic Acid Antagonists Rescue AgentsGENERIC calcium folinate 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 JAKAFI

LHRH AnalogsPREFERRED LUPRON DEPOT 11.25MG LUPRON DEPOT 3.75MG TRELSTAR VIAL ZOLADEX

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

Mitotic InhibitorsGENERIC etoposide

PREFERRED ETOPOSIDE POWDER JEVTANA MARQIBO

NON PREFERRED ABRAXANE DOCEFREZ DOCETAXEL ETOPOPHOS HALAVEN IXEMPRA PACLITAXEL TENIPOSIDE VINBLASTINE SULFATE

Nitrogen MustardsGENERIC cyclophosphamide ifosfamide-mesna

PREFERRED CYCLOPHOSPHAMIDE

NON PREFERRED ALKERAN 2MG ALKERAN 50MG IFOSFAMIDE MELPHALAN HCL MUSTARGEN

NitrosoureasPREFERRED BICNU CEENU

LEUKERAN

NON PREFERRED 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 AgentsPREFERRED MESNEX 400MG TABLET

NON PREFERRED MESNA MESNEX 100MG/ML VIAL

Vascular Endothelial Growth Factor (VEGF) InhibitorsPREFERRED ZALTRAP

NON PREFERRED AVASTIN CYRAMZA

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

PREFERRED LATUDA

BenzisoxazolesGENERIC risperidone

PREFERRED RISPERDAL CONSTA

NON PREFERRED RISPERDAL 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 perphenazine prochlorperazine edisylate prochlorperazine maleate thioridazine hcl trifluoperazine hcl

PREFERRED FLUPHENAZINE DECANOATE 2.5%

NON PREFERRED FLUPHENAZINE DECANOATE 1GM LIQUID PERPHENAZINE

Quinolinone DerivativesGENERIC aripiprazole odt aripiprazole tablets

PREFERRED ABILIFY MAINTENA, ER 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

ANTIVIRALS

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

PREFERRED ATRIPLA KALETRA TABLETS TRUVADA

NON PREFERRED BIKTARVY COMPLERA DESCOVY EPZICOM GENVOYA KALETRA ORAL SOLN ODEFSEY STRIBILD SYMFI SYMFI LO 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

PREFERRED APTIVUS CRIXIVAN INVIRASE LEXIVA ORAL SUSP NORVIR CAPSULE, ORAL SOLN & PACKET NORVIR TABLET VIRACEPT

NON PREFERRED APTIVUS SOLN LEXIVA TABLETS PREZISTA REYATAZ CAPSULE

Antiretrovirals - RTI-Non-Nucleoside AnaloguesGENERIC efavirenz

PREFERRED RESCRIPTOR SUSTIVA

NON PREFERRED EDURANT INTELENCE RETROVIR VIAL VIRAMUNE

Antiretrovirals - RTI-Nucleoside Analogues-PurinesGENERIC abacavir didanosine

PREFERRED VIDEX SOLN

NON PREFERRED VIDEX ZIAGEN

Antiretrovirals - RTI-Nucleoside Analogues-PyrimidinesGENERIC lamivudine hbv

PREFERRED EMTRIVA

NON PREFERRED LAMIVUDINE

Antiretrovirals - RTI-Nucleoside Analogues-ThymidinesGENERIC stavudine zidovudine


NON PREFERRED RETROVIR

Antiretrovirals - RTI-Nucleotide AnaloguesGENERIC tenofovir disoproxil 300mg tablet

PREFERRED VIREAD TABLET 150MG; 200MG; 250MG

NON PREFERRED VIREAD 300MG TABLET

CMV AgentsGENERIC cidofovir valganciclovir hcl

NON PREFERRED CIDOFOVIR GANCICLOVIR PREVYMIS VALCYTE

Hepatitis B AgentsGENERIC adefovir dipivoxil entecavir

PREFERRED VEMLIDY

NON PREFERRED TYZEKA

Hepatitis C AgentsPREFERRED PEGASYS PEGASYS PROCLICK VICTRELIS

NON PREFERRED DAKLINZA RIBAVIRIN SOVALDI

Herpes Agents - Purine AnaloguesGENERIC acyclovir valacyclovir

Herpes Agents - Thymidine AnaloguesGENERIC famciclovir foscarnet sodium

Influenza AgentsGENERIC rimantadine hcl

Neuraminidase InhibitorsGENERIC oseltamivir phosphate

PREFERRED RELENZA

NON PREFERRED RAPIVAB TAMIFLU

ASSORTED CLASSES

AntileproticsPREFERRED THALOMID

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

Chelating AgentsPREFERRED CUPRIMINE DEPEN

Cyclosporine AnalogsGENERIC cyclosporine

PREFERRED SANDIMMUNE SOLUTION 100MG/ML SOLUTION

NON PREFERRED SANDIMMUNE SOLUTION

EnzymesNON PREFERRED XIAFLEX

Immune Globulin ImmunosuppressantsNON PREFERRED ATGAM THYMOGLOBULIN

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

PREFERRED CELLCEPT 500MG VIAL

NON PREFERRED CELLCEPT ORAL SUSP MYCOPHENOLATE MOFETIL


Irrigation SolutionsGENERIC water water intravenous solution water solution; irrigation

PREFERRED WATER

Macrolide ImmunosuppressantsGENERIC sirolimus tacrolimus

PREFERRED RAPAMUNE SOLUTION

NON PREFERRED PROGRAF 5MG/ML AMPUL PROGRAF CAPSULES RAPAMUNE ZORTRESS

Monoclonal AntibodiesPREFERRED BEXXAR 14MG/ML SIMULECT

NON PREFERRED BEXXAR

Peritonial Dialysis SolutionsGENERIC delflex w/dextrose

PREFERRED EXTRANEAL ICODEXTRIN DIALYSIS

NON PREFERRED DELFLEX W/DEXTROSE

Potassium Removing ResinsGENERIC sodium polystyrene sulfonate

PREFERRED VELTASSA

ProstaglandinsGENERIC alprostadil

Purine AnalogsGENERIC azathioprine azathioprine sodium

NON PREFERRED AZASAN

Sclerosing AgentsPREFERRED ETHAMOLIN SOTRADECOL

Selective T-Cell Costimulation BlockersPREFERRED NULOJIX

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

PREFERRED SOTALOL HCL SOTYLIZE

NON PREFERRED BETAPACE BETAPACE AF

Bile Acid Synthesis Disorder Agents

Bile Acid Synthesis Disorder AgentsNON PREFERRED CHOLBAM


BIOLOGICALS MISC

Allergenic ExtractsPREFERRED GRASTEK RAGWITEK

Biologicals MiscNON PREFERRED ADAGEN

Calcitonin Gene-Related Peptide (CGRP) Receptor Antag

Calcitonin Gene-Related Peptide (CGRP) Receptor Antag

PREFERRED AIMOVIG

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

CARDIOTONICS

Cardiac GlycosidesGENERIC digoxin

PREFERRED LANOXIN PEDIATRIC

NON PREFERRED LANOXIN

Phosphodiesterase InhibitorsGENERIC milrinone in 5% dextrose milrinone lactate

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 AgentsPREFERRED CAVERJECT MUSE

Prostaglandin VasodilatorsGENERIC epoprostenol

NON PREFERRED FLOLAN REMODULIN TYVASO VENTAVIS

Pulm Hyperten-Soluble Guanylate Cyclase Stimulator (sGC)

PREFERRED ADEMPAS

Pulmonary Hypertension - Endothelin Receptor Antagonists

PREFERRED LETAIRIS OPSUMIT TRACLEER

Pulmonary Hypertension - Phosphodiesterase Inhibitors

GENERIC tadalafil

NON PREFERRED ADCIRCA REVATIO SILDENAFIL CITRATE

Selective cGMP Phosphodiesterase Type 5 InhibitorsGENERIC sildenafil citrate tablet

PREFERRED CIALIS

NON PREFERRED VIAGRA


Vasoactive Natriuretic PeptidesPREFERRED NATRECOR

Cardiovascular, Hypertension & Lipids

ANTICOAGULANTSPREFERRED REFLUDAN

MISC. CARDIOVASCULAR AGENTSPREFERRED RETAVASE

MISC. COAGULATION AGENTSNON PREFERRED ATRYN HELIXATE FS

Cephalosporin Combinations

Cephalosporin CombinationsPREFERRED AVYCAZ ZERBAXA

CEPHALOSPORINS

Cephalosporins - 1st GenerationGENERIC cefazolin cephalexin

NON PREFERRED CEFAZOLIN/DEXTROSE KEFLEX

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

PREFERRED CEFUROXIME 75G BULK BAG

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

PREFERRED CEFTAZIDIME IV PIGGYBACK FORTAZ IN ISO-OSMOTIC DEXTROSE

NON PREFERRED CEFTRIAXONE 100G BULK BAG

Cephalosporins - 4th GenerationGENERIC cefepime cefotaxime

NON PREFERRED CEFEPIME/DEXTROSE

Cephalosporins - 5th GenerationPREFERRED TEFLARO

CONTRACEPTIVES

Biphasic Contraceptives - OralGENERIC kariva

Combination Contraceptives - OralGENERIC altavera alyacen apri aubra aviane azurette balziva briellyn caziant chateal cryselle cyclafem dasetta drospirenone/eth estra/levomef elinest emoquette enpresse enskyce estarylla falmina gianvi gildagia gildess gildess fe junel junel fe kelnor 1-35 kurvelo leena lessina levora loryna low-ogestrel lutera marlissa microgestin microgestin fe


mono-linyah mononessa myzilra 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 viorele wera wymzya fe zarah zenchent zenchent fe zeosa zovia

PREFERRED LO LOESTRIN FE MINASTRIN 24 FE TAYTULLA

NON PREFERRED BEYAZ SAFYRAL

Combination Contraceptives - VaginalPREFERRED NUVARING

Emergency ContraceptivesGENERIC levonorgestrel

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

Four Phase Contraceptives - OralPREFERRED NATAZIA

Progestin Contraceptives - ImplantsPREFERRED NEXPLANON

Progestin Contraceptives - InjectableNON PREFERRED DEPO-PROVERA

Progestin Contraceptives - IUDPREFERRED KYLEENA MIRENA SKYLA

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

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

CORTICOSTEROIDS

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

PREFERRED ARISTOSPAN BETAMETHASONE BETAMETHASONE ACETATE BETAMETHASONE SODIUM PHOSPHATE

NON PREFERRED DEPO-MEDROL KENALOG MEDROL SOLU-CORTEF SOLU-MEDROL VIAL


UCERIS ER

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 hydrocodone/chlorpheniramine er promethazine w/codeine

NON PREFERRED TUSSICAPS

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

Opioid Antitussive-ExpectorantGENERIC guaifenesin/codeine

NON PREFERRED GUAIFENESIN/CODEINE

Cyclin-Dependent Kinases (CDK) Inhibitors

Cyclin-Dependent Kinases (CDK) InhibitorsNON PREFERRED VERZENIO

DERMATOLOGICALS

Acne AntibioticsGENERIC clindamycin phosphate topical erythromycin solution sulfacetamide sodium sulfacetamide sodium

NON PREFERRED ACZONE SULFACETAMIDE SODIUM

Acne CombinationsGENERIC erythromycin-benzoyl peroxide sodium sulfacetamide/sulfur

PREFERRED EPIDUO FORTE ONEXTON

NON PREFERRED EPIDUO SODIUM SULFACETAMIDE/SULFUR GEL ZIANA

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

PREFERRED ABSORICA DIFFERIN

NON PREFERRED ADAPALENE LOTION ISOTRETINOIN TRETINOIN TRETIN-X

Antibiotics - TopicalGENERIC mupirocin


Antifungals - TopicalGENERIC ciclopirox clotrimazole

NON PREFERRED LOPROX GEL & SHAMPOO PENLAC

Antifungals - Topical CombinationsGENERIC clotrimazole/betamethasone nystatin w/triamcinolone

Anti-inflammatory Agents - TopicalPREFERRED FLECTOR

Antineoplastic Alkylating Agents - TopicalPREFERRED VALCHLOR

Antineoplastic Antimetabolites - TopicalGENERIC fluorouracil

PREFERRED CARAC

NON PREFERRED FLUOROURACIL 0.5% CREAM

Antineoplastic or Premalignant Lesions - Topical Misc.PREFERRED PICATO

ANTIPERSPIRANTSGENERIC aluminum chloride topical

AntipsoriaticsGENERIC calcipotriene calcitriol

PREFERRED ANTHRALIN TAZORAC GEL

NON PREFERRED CALCITRIOL TAZORAC CREAM

Antipsoriatics - SystemicGENERIC acitretin

PREFERRED STELARA

NON PREFERRED COSENTYX TREMFYA

Antiseborrheic ProductsGENERIC selenium sulfide

Antivirals - TopicalGENERIC acyclovir 5% oint

PREFERRED ZOVIRAX 5% CREAM

NON PREFERRED ZOVIRAX 5% OINT

Burn ProductsGENERIC mafenide acetate silver sulfadiazine

PREFERRED SULFAMYLON CREAM

NON PREFERRED SILVADENE 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 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 lustra-ultra

Emollient/Keratolytic AgentsGENERIC urea

EmollientsGENERIC ammonium lactate hpr hpr plus lactic acid

PREFERRED AMMONIUM LACTATE

Enzymes - TopicalPREFERRED SANTYL

Imidazole-Related Antifungals - TopicalGENERIC econazole nitrate

Immunomodulators Imidazoquinolinamines - TopicalGENERIC imiquimod

Keratolytic/Antimitotic AgentsGENERIC podofilox salicylic acid

PREFERRED SALICYLIC ACID

NON PREFERRED CONDYLOX GEL/SOLUTION

Local Anesthetics - TopicalGENERIC cocaine hcl lidocaine lidocaine hcl

PREFERRED COCAINE HCL

NON PREFERRED LIDOCAINE LIDOCAINE HCL

Macrolide Immunosuppressants - TopicalPREFERRED ELIDEL

Misc. Dermatological ProductsGENERIC dexpanthenol eletone emulsion sb mb hydrogel nuquin hp pruclair prumyx tl-cermide

PREFERRED CHLORHEXIDINE GLUCONATE 0.2 SOLUTION DEXPANTHENOL DUPIXENT ETHYL ALCOHOL LACTIC ACID 88 TO 92 % UREAM POWDER, BEADS

NON PREFERRED ETHYL ALCOHOL 1 LIQUID

Pigmenting AgentsPREFERRED OXSORALEN 1% LOTION

Rosacea AgentsPREFERRED FINACEA MIRVASO ORACEA SOOLANTRA

Scabicides & PediculicidesGENERIC lindane malathion permethrin spinosad

PREFERRED PERMETHRIN

NON PREFERRED ELIMITE

Topical Anesthetic CombinationsGENERIC lidocaine/prilocaine

Topical Anesthetic GassesGENERIC ethyl chloride

Topical Selective Retinoid X Receptor AgonistsPREFERRED TARGRETIN GEL


Topical Steroid CombinationsPREFERRED ENSTILAR TACLONEX SUSPENSION

NON PREFERRED TACLONEX OINTMENT

Wound Care - Growth Factor AgentsPREFERRED REGRANEX

Wound DressingsGENERIC avo cream prutect sonafine

DIAGNOSTIC PRODUCTS

Diagnostic BiologicalsGENERIC candin

PREFERRED APLISOL TUBERSOL

Diagnostic DrugsGENERIC cosyntropin

PREFERRED KINEVAC LEXISCAN

NON PREFERRED ACTHREL COSYNTROPIN THYROGEN

Diagnostic Radiopharmaceuticals - CardiacNON PREFERRED THALLOUS CHLORIDE TL-201

Miscellaneous Contrast MediaPREFERRED EOVIST

NON PREFERRED MAGNEVIST PROHANCE

Radiographic Contrast Media - IodinatedGENERIC md-gastroview

PREFERRED OMNIPAQUE

NON PREFERRED ISOVUE ISOVUE-M VISIPAQUE

DIAGNOSTICS & MISCELLANEOUS AGENTS

IRRIGATING SOLUTIONSGENERIC neomycin-polymyxin b

MISCELLANEOUS AGENTSPREFERRED BROMHEXINE HYDROCHLORIDE SEROTONIN HCL TRYPSIN

NON PREFERRED KALEXATE PROSTAMEN

NEUTRACEUTICALSPREFERRED UVA URSI LEAF FLUID EXTRACT

DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS

Dietary Management Product CombinationsGENERIC folbee folbic folic acid folic acid/cyancobal/pyridoxine foltanx l-mefolate-pyridox-mecobalamin l-methyl-b6-b12 l-methylfolate-mecobalamin-nac metafolbic metafolbic plus methyl-b6-b12 virt-vite forte

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

Dietary Management ProductsGENERIC l-methylfolate calcium

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 metolazone spironolactone

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

ENDOCRINE AND METABOLIC AGENTS - MISC.

BisphosphonatesGENERIC alendronate sodium etidronate disodium ibandronate risedronate dr risedronate sodium

PREFERRED ZOMETA INFUSION BOTTLE

NON PREFERRED ACTONEL BONIVA FOSAMAX HECTOROL IBANDRONATE SODIUM PAMIDRONATE DISODIUM ZOLEDRONIC ACID ZOMETA VIAL

Calcimimetic AgentsPREFERRED SENSIPAR

CalcitoninsGENERIC calcitonin salmon nasal

PREFERRED MIACALCIN VIAL

NON PREFERRED MIACALCIN AEROSOL

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)PREFERRED GENOTROPIN NORDITROPIN


NON PREFERRED EGRIFTA HUMATROPE OMNITROPE

Growth HormonesNON PREFERRED SEROSTIM

Hereditary Orotic Aciduria Treatment - AgentsPREFERRED XURIDEN

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

NON PREFERRED NITYR ORFADIN

Homocystinuria Treatment - AgentsPREFERRED CYSTADANE

Hyperammonemia Treatment - AgentsNON PREFERRED CARBAGLU

Hyperparathyroid Treatment - Vitamin D AnalogsGENERIC doxercalciferol paricalcitol

NON PREFERRED ZEMPLAR

Hypophosphatasia (HPP) AgentsNON PREFERRED STRENSIQ

Insulin-Like Growth Factors (Somatomedins)NON PREFERRED INCRELEX

LHRH/GnRH Agonist Analog Pituitary SuppressantsPREFERRED LUPRON DEPOT-PED SYNAREL

Lysosomal Acid Lipase (LAL) Deficiency - AgentsNON PREFERRED KANUMA

Lysosomal Storage Disease Treatment - AgentsPREFERRED MYOZYME

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 NOVAREL 5000 UNIT

NON PREFERRED BRAVELLE CHORIONIC GONADOTROPIN GONAL-F GONAL-F RFF GONAL-F RFF REDI-JECT MENOPUR NOVAREL 10000 UNIT PREGNYL

Ovulation Stimulants-SyntheticGENERIC clomiphene citrate

Parathyroid Hormone And DerivativesPREFERRED FORTEO

NON PREFERRED NATPARA TYMLOS

Phenylketonuria Treatment - AgentsNON PREFERRED KUVAN

RANK Ligand (RANKL) InhibitorsNON PREFERRED XGEVA

Selective Estrogen Receptor Modulators (SERMs)NON PREFERRED OSPHENA

Selective Vasopressin V2-Receptor AntagonistsNON PREFERRED SAMSCA

Somatostatic AgentsPREFERRED SANDOSTATIN KIT SIGNIFOR


NON PREFERRED OCTREOTIDE ACETATE SANDOSTATIN SANDOSTATIN LAR DEPOT SOMATULINE DEPOT

Urea Cycle Disorder - AgentsGENERIC sodium phenylbutyrate

PREFERRED AMMONUL

NON PREFERRED BUPHENYL RAVICTI

VasopressinGENERIC desmopressin acetate vasopressin vasopressin-ns

NON PREFERRED STIMATE SPRAY

ENDOCRINE/DIABETES

INSULIN SYRINGES/MISCELLANEOUS DMEPREFERRED SOLOSITE SURE-T PARADIGM VGO 20 VGO 30 VGO 40

ESTROGENS

Estrogen & AndrogenGENERIC estrogen/methyltestosterone

Estrogen & ProgestinGENERIC estradiol/norethindrone acetate

PREFERRED COMBIPATCH PREMPHASE PREMPRO

EstrogensGENERIC estradiol patch estradiol tablet/cream estradiol valerate estropipate yuvafem

PREFERRED DEPO-ESTRADIOL DIVIGEL MINIVELLE PREMARIN

NON PREFERRED ENJUVIA ESTRACE TABLET

Estrogen-Selective Estrogen Receptor Modulator Comb

Estrogen-Selective Estrogen Receptor Modulator CombPREFERRED DUAVEE

Fentanyl Combinations

Fentanyl CombinationsGENERIC fentanyl

NON PREFERRED FENTANYL

FLUOROQUINOLONES

FluoroquinolonesGENERIC ciprofloxacin ciprofloxacin er ciprofloxacin suspension ciprofloxacin/dextrose moxifloxacin hcl

PREFERRED MOXIFLOXACIN HCL IV PIGGYBACK

NON PREFERRED AVELOX IV LEVOFLOXACIN HEMIHYDRATE SOLUTION

GASTROENTEROLOGY

ANTIVERTIGO & ANTIEMETIC AGENTSGENERIC dronabinol droperidol meclizine hcl

MISC. GASTROINTESTINAL AGENTSGENERIC citra ph sodium bicarbonate

PREFERRED GLUTAMENT GLUTASOLVE


NON PREFERRED SODIUM CHLORIDE/SODIUM BICARB

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 AgonistsPREFERRED VIBERZI

IBS Agent - Selective 5-HT3 Receptor AntagonistsNON PREFERRED LOTRONEX

Inflammatory Bowel AgentsGENERIC balsalazide disodium mesalamine sulfasalazine sulfasalazine dr

PREFERRED CANASA DELZICOL PENTASA

NON PREFERRED ASACOL HD LIALDA

Peripheral Opioid Receptor AntagonistsPREFERRED MOVANTIK RELISTOR

Phosphate Binder AgentsGENERIC eliphos lanthanum carbonate sevelamer carbonate

PREFERRED PHOSLYRA VELPHORO

NON PREFERRED FOSRENOL CHEW TABLET RENVELA

Tumor Necrosis Factor Alpha BlockersNON PREFERRED REMICADE RENFLEXIS

GENERAL ANESTHETICS

Anesthetics - Misc.GENERIC etomidate ketamine hcl midodrine hcl propofol

NON PREFERRED KETAMINE HCL 50MG/ML SYRINGE

Barbiturate AnestheticsPREFERRED 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 tricitrates

Cystinosis AgentsPREFERRED CYSTAGON

Genitourinary IrrigantsGENERIC acetic acid irrigation glycine

PREFERRED AMINOACETIC ACID RENACIDIN RESECTISOL

Interstitial Cystitis AgentsPREFERRED ELMIRON

PhosphatesGENERIC k-phos neutral

PREFERRED K-PHOS ORIGINAL

Urinary AnalgesicsGENERIC phenazopyridine hcl phenazopyridine plus

GOUT AGENTS

Gout AgentsGENERIC allopurinol allopurinol sodium

PREFERRED COLCRYS ULORIC

NON PREFERRED COLCHICINE KRYSTEXXA MITIGARE

UricosuricsGENERIC probenecid

HEMATOLOGICAL AGENTS - MISC.

Antihemophilic ProductsPREFERRED ADVATE H ADVATE L ADVATE N ADVATE SH ADVATE UH BEBULIN VH IMMUNO CORIFACT OBIZUR TRETTEN XYNTHA

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

Bradykinin B2 Receptor AntagonistsNON PREFERRED FIRAZYR

C1 InhibitorsNON PREFERRED BERINERT CINRYZE

Complement InhibitorsNON PREFERRED SOLIRIS

Cyclopentyltriazolopyrimidine (CPTP) DerivativesPREFERRED BRILINTA


Glycoprotein IIb/IIIa Receptor InhibitorsGENERIC eptifibatide

PREFERRED REOPRO

NON PREFERRED AGGRASTAT INTEGRILIN

Hematorheologic AgentsGENERIC pentoxifylline

HeminPREFERRED PANHEMATIN

Human Protein CNON PREFERRED CEPROTIN

Phosphodiesterase III InhibitorsGENERIC cilostazol

Plasma ExpandersGENERIC hetastarch w/sodium chloride

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 ActivatorsPREFERRED CATHFLO ACTIVASE

NON PREFERRED ACTIVASE

HEMATOPOIETIC AGENTS

Agents for Gaucher DiseaseNON PREFERRED CERDELGA CEREZYME ELELYSO VPRIV ZAVESCA

CobalaminsGENERIC hydroxocobalamin

PREFERRED NASCOBAL

CXCR4 Receptor AntagonistPREFERRED MOZOBIL

Cytotoxic AgentsPREFERRED DROXIA

Erythropoiesis-Stimulating Agents (ESAs)PREFERRED PROCRIT

NON PREFERRED ARANESP

Folic Acid/FolatesNON PREFERRED FOLIC ACID 20MG CAP

Granulocyte Colony-Stimulating Factors (G-CSF)PREFERRED GRANIX NEULASTA


NEUPOGEN

NON PREFERRED ZARXIO

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

NON PREFERRED LEUKINE

IronGENERIC dexferrum

PREFERRED VENOFER

NON PREFERRED INFED

Iron CombinationsGENERIC centratex fe 90 plus fe c ferocon ferotrinsic ferraplus 90 ferrex 150 forte ferrex 150 forte plus ferrex 28 ferrocite plus ferrogels forte tl-hem 150 er 24 hr

Iron w/ Folic AcidGENERIC therapeutic hematinic vp-heme one

Thrombopoietin (TPO) Receptor AgonistsNON PREFERRED NPLATE PROMACTA

HEMOSTATICS

Hemostatics - SystemicGENERIC tranexamic acid

PREFERRED AMICAR

NON PREFERRED CYKLOKAPRON LYSTEDA

Hepatitis C Agent - Combinations

Hepatitis C Agent - CombinationsNON PREFERRED EPCLUSA MAVYRET TECHNIVIE VIEKIRA PAK VIEKIRA XR VOSEVI ZEPATIER

HYPNOTICS

Barbiturate HypnoticsGENERIC phenobarbital phenobarbital sodium seconal sodium

PREFERRED AMYTAL NEMBUTAL SODIUM

Benzodiazepine HypnoticsGENERIC flurazepam hcl midazolam hcl temazepam triazolam

NON PREFERRED MIDAZOLAM HCL

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

NON PREFERRED AMBIEN AMBIEN CR SONATA

Selective Melatonin Receptor AgonistsPREFERRED ROZEREM

IMMUNOLOGY, VACCINES & BIOTECHNOLOGY

VACCINES & MISCELLANEOUS IMMUNOLOGICALSPREFERRED CERVARIX COMVAX CROFAB

NON PREFERRED BOTOX


Implanon IMPLANT 68 MG Subcutaneous

CONTRACEPTIVESPREFERRED IMPLANON

Integrin Receptor Antagonists

Integrin Receptor AntagonistsNON PREFERRED ENTYVIO

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 PREPOPIK SUCLEAR SUPREP

NON PREFERRED POLYETHYLENE GLYCOL

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 ropivacaine sensorcaine 5mg/ml vial

PREFERRED BENZOCAINE

NON PREFERRED CARBOCAINE MEPIVACAINE HCL 30MG/ML CARTRIDGE NESACAINE SENSORCAINE 2.5MG/ML VIAL

Local Anesthetics - EstersGENERIC chloroprocaine

MACROLIDES

AzithromycinGENERIC azithromycin

NON PREFERRED ZITHROMAX

ClarithromycinGENERIC clarithromycin clarithromycin er

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

PREFERRED ERYTHROCIN LACTOBIONATE

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

MEDICAL DEVICES

Cervical CapsPREFERRED FEMCAP

DiaphragmsPREFERRED ORTHO-DIAPHRAGM


Glucose Monitoring Test SuppliesPREFERRED 1ST CHOICE LANCETS ACCU-CHEK FASTCLIX, MULTICLIX, SOFTCLIX LANCETS ACCU-CHEK SOFTCLIX LANCETS DEVICE DEXCOM G4 METER DEXCOM G4 SENSOR DEXCOM G4 TRANSMITTER DEXCOM G5 METER DEXCOM G5 TRANSMITTER 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 MEDISENSE MEDISENSE GLUCOSE KETONE CONTR 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 OPTIUM EZ

Needles & SyringesPREFERRED MINIMED MINIMED RESERVOIR NOVOFINE NOVOFINE AUTOCOVER PARADIGM INFUSION PARADIGM INSULIN PUMP PARADIGM SILHOUETTE POLYFIN QR PRODIGY INSULIN SYRINGE PRODIGY PEN NEEDLE QUICK RELEASE SOFT TEFLON SILHOUETTE SNAP INSULIN PUMP CONTROLLER SOF-SET SOF-SET MICRO SOFT TOUCH

MIGRAINE PRODUCTS

Ergot CombinationsGENERIC ergotamine-caffeine

MIGRAINE PRODUCTSPREFERRED ISOMETHEPTENE MUCATE

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 ZOMIG SPRAY

NON PREFERRED RELPAX SUMAVEL DOSEPRO ZOLMITRIPTAN ZOMIG TABLET

MINERALS & ELECTROLYTES

BicarbonatesGENERIC sodium acetate sodium lactate

PREFERRED NEUT SODIUM LACTATE

CalciumGENERIC calcium acetate calcium chloride calcium gluconate

PREFERRED CALCIUM CHLORIDE CALCIUM GLUCONATE 61MG

NON PREFERRED CALCIUM ACETATE CALCIUM GLUCONATE 50MG

ChloridePREFERRED AMMONIUM CHLORIDE

CitrateGENERIC citric acid

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


PREFERRED IONOSOL B WITH DEXTROSE 5% ISOLYTE S

Electrolytes ParenteralGENERIC nutrilyte nutrilyte ii potassium chloride ringers ringers irrigation

PREFERRED NORMOSOL-M AND DEXTROSE NORMOSOL-R AND DEXTROSE NORMOSOL-R PH 7.4 PLASMA-LYTE 148 POTASSIUM CHLORIDE TPN ELECTROLYTES 18-18-5MEQ

NON PREFERRED TPN ELECTROLYTES 35-20-5MEQ

Iodine ProductsPREFERRED 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 GLYCOPHOS SODIUM PHOSPHATE

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

PREFERRED POTASSIUM ACETATE POTASSIUM BICARBONATE

Trace Mineral CombinationsPREFERRED MULTITRACE-4 MULTITRACE-5 PEDITRACE

Trace MineralsGENERIC chromium chloride copper chloride selenium

PREFERRED ADDAMEL N TRACE ELEMENTS

NON PREFERRED CUPRIC SULFATE SELENIUM

ZincGENERIC zinc chloride

PREFERRED ZINC CHLORIDE

Mixed Allergenic Extracts

Mixed Allergenic ExtractsPREFERRED ODACTRA

Monobactams

MonobactamsGENERIC aztreonam

PREFERRED AZACTAM-ISO-OSMOTIC DEXTROSE

MOUTH/THROAT/DENTAL AGENTS

Anti-infective Combinations - ThroatPREFERRED FIRST-BXN FIRST-MOUTHWASH BLM

Fluoride Dental ProductsGENERIC sodium fluoride

PREFERRED SODIUM FLUORIDE


Saliva StimulantsGENERIC cevimeline hcl

Tripeptidyl Peptidase 1 Deficiency Treatment - AgentsNON PREFERRED BRINEURA

Mucopolysaccharidosis IV (MPS IV) - Agents

Mucopolysaccharidosis IV (MPS IV) - AgentsNON PREFERRED VIMIZIM

Mucopolysaccharidosis VII (MPS VII) - Agents

Mucopolysaccharidosis VII (MPS VII) - AgentsNON PREFERRED MEPSEVII

MULTIVITAMINS

B-Complex VitaminsGENERIC b-complex

NON PREFERRED B-COMPLEX

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

B-Complex w/ C-Biotin-E-Minerals & Folic AcidGENERIC dialyvite 800

NON PREFERRED DIALYVITE 800

B-Complex w/ C-Zn & Folic AcidGENERIC nephplex rx

Multiple Vitamins w/ CalciumGENERIC advanced am/pm

Multiple Vitamins w/ MineralsGENERIC folivane-plus nutri-tab ob strovite therapeutic vitamin/minerals 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 INFUVITE M.V.I. PEDIATRIC M.V.I.-12

Prenatal MV & Min w/FE-FAGENERIC bal-care dha elite ob elite-ob fabb folcaps folcaps omega-3 folivane-ob hemenatal ob inatal advance inatal gt inatal ultra mynatal mynatal advance mynatal caps mynatal plus mynatal-z mynate 90 plus er obstetrix dha pnv-first pnv-omega pnv-select pnv-total prenaplus prenatabs fa prenatabs rx prenatal ad prenatal low iron prenatal plus prenatal-u relnate dha se-natal 19 se-tan plus taron forte taron prenatal taron-bc tl-fol 500 er tri rx triadvance trinatal gt


trinatal rx 1 trinate vena-bal dha vinate gt vinate ic vinate ii vinate one vinate ultra vinate-m virt-pn plus virt-vite v-natal vol-care rx vol-nate vol-plus vol-tab rx vp-ch plus zatean-pn 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 natal-v rx natalvirt 90 dha natalvirt ca natalvirt flt pnv ob+dha pnv-dha prefol-dha prena1 prena1 plus prenaissance prenaissance 90 dha prenaissance balance prenaissance dha prenaissance harmony dha prenaissance plus se-tan dha prenatal taron-c dha taron-duo ec tl-select triveen-prx rnf ultimate ob dha vemavite-prx 2 venatal complete dha venatal-fa vinate dha virt-bal dha virt-pn dha virt-select vitafol-pn vp-ch-pnv zatean-ch

zatean-pn dha

PREFERRED LEVOMEFOLATE DHA

Prenatal VitaminsGENERIC prena1 chew prenaissance next

MUSCULOSKELETAL THERAPY AGENTS

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

PREFERRED CYCLOBENZAPRINE HCL

NON PREFERRED GABLOFEN LIORESAL ROBAXIN

Direct Muscle RelaxantsGENERIC dantrolene sodium

ViscosupplementsNON PREFERRED MONOVISC ORTHOVISC SYNVISC SYNVISC-ONE

NASAL AGENTS - SYSTEMIC AND TOPICAL

Antihistamine-SteroidPREFERRED DYMISTA

Nasal AnticholinergicsGENERIC ipratropium bromide 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

Topical DecongestantsGENERIC oxymetazoline hcl 12 hour

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 MYOBLOC

NUTRIENTS

Amino Acid MixturesGENERIC amino acid

PREFERRED CLINIMIX CLINIMIX E PROCALAMINE

NON PREFERRED AMINO ACID 700MG TABLETS AMINOSYN FREAMINE HBC FREAMINE III HEPATAMINE NEPHRAMINE PREMASOL PROSOL TRAVASOL TROPHAMINE

CarbohydratesGENERIC dextrose in water

LipidsGENERIC intralipid

NON PREFERRED INTRALIPID

OBSTETRICS & GYNECOLOGY

DIAPHRAGMS AND OTHER NON-ORAL CONTRACEPTIVES

PREFERRED TODAY CONTRACEPTIVE SPONGE

OPHTHALMIC AGENTS

Artificial TearsGENERIC sodium chloride drops

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 InhibitorsPREFERRED PHOSPHOLINE IODIDE DROPS

Miotics - Direct ActingGENERIC pilocarpine hcl pilocarpine hcl

PREFERRED CARBACHOL ISOPTO CARBACHOL 0.015 PILOPINE HS

NON PREFERRED ISOPTO CARBACHOL 0.03 ISOPTO CARPINE

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

PREFERRED PAZEO

NON PREFERRED ELESTAT PATADAY

Ophthalmic AntibioticsGENERIC ciprofloxacin ophth solution erythromycin ointment gatifloxacin gentasol levofloxacin hemihydrate neomycin/polymyxin/gramicidin ofloxacin tobramycin sulfate drops

PREFERRED AZASITE BESIVANCE MOXEZA

NON PREFERRED OCUFLOX TOBREX VIGAMOX

Ophthalmic AntifungalPREFERRED NATACYN

Ophthalmic Anti-infective CombinationsGENERIC bacitracin/polymyxin ophth oint

Ophthalmic AntiviralsGENERIC trifluridine

NON PREFERRED VIROPTIC

Ophthalmic Carbonic Anhydrase InhibitorsGENERIC dorzolamide hcl

Ophthalmic DecongestantsGENERIC naphazoline hcl

Ophthalmic Diagnostic ProductsGENERIC proparacaine/fluorescein

PREFERRED FLUORESCEIN SODIUM

Ophthalmic EnzymesNON PREFERRED JETREA

Ophthalmic ImmunomodulatorsPREFERRED RESTASIS RESTASIS MULTIDOSE

Ophthalmic Irrigation SolutionsGENERIC balanced salt ophth irrigation

PREFERRED BEPREVE

NON PREFERRED PATANOL

Ophthalmic Local AnestheticsGENERIC proparacaine hcl tetcaine drops

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

PREFERRED ILEVRO 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 ZYLET

NON PREFERRED BLEPHAMIDE S.O.P. TOBRADEX SUSPENSION

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

PREFERRED ALREX FML S.O.P. LOTEMAX

NON PREFERRED PRED MILD

Ophthalmic SulfonamidesNON PREFERRED BLEPH-10

Ophthalmics - Cystinosis AgentsPREFERRED CYSTARAN

Prostaglandins - OphthalmicGENERIC bimatoprost latanoprost drops travoprost

PREFERRED TRAVATAN Z

NON PREFERRED LATANOPROST DROPS 1GM OIL LUMIGAN

Vascular Endothelial Growth Factor (VEGF) Antagonists

NON PREFERRED LUCENTIS

Ophthalmic Gene Therapy

Ophthalmic Gene TherapyPREFERRED LUXTURNA

OPHTHALMOLOGY

macular degenerationNON PREFERRED EYLEA

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 CIPRO HC CIPRODEX OTOVEL

NON PREFERRED COLY-MYCIN S

Otic SteroidsGENERIC acetic acid/hydrocortisone otic sol

NON PREFERRED DERMOTIC

OXYTOCICS

Abortifacients/Cervical Ripening - ProstaglandinsPREFERRED HEMABATE

OxytocicsGENERIC methylergonovine maleate oxytocin

PREFERRED ERGONOVINE MALEATE

PASSIVE IMMUNIZING AGENTS

Antiviral Monoclonal AntibodiesNON PREFERRED SYNAGIS

Immune SerumsPREFERRED CYTOGAM GAMASTAN S-D GAMUNEX HYPERHEP B S-D HYPERTET S-D VARIZIG

NON PREFERRED GAMMAGARD LIQUID GAMMAGARD S-D GAMUNEX-C HEPAGAM B HIZENTRA HYPERRAB S-D HYPERRHO S-D IMOGAM RABIES-HT PRIVIGEN

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

PREFERRED PENICILLIN GK-ISO-OSM DEXTROSE

NON PREFERRED BICILLIN L-A

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

PREFERRED AUGMENTIN 125-31.25 MG/5ML TIMENTIN ZOSYN IV SOLUTION

NON PREFERRED AUGMENTIN BICILLIN C-R ZOSYN VIAL

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

NON PREFERRED ORABACTIV


Phosphatidylinositol 3-Kinase (PI3K) Inhibitors

Phosphatidylinositol 3-Kinase (PI3K) InhibitorsNON PREFERRED ALIQOPA ZYDELIG

Poly (ADP-ribose) Polymerase (PARP) Inhibitors

Poly (ADP-ribose) Polymerase (PARP) InhibitorsNON PREFERRED LYNPARZA

Poly (ADP-ribose) Polymerase (PARP) Inhibitors

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

Postherpetic Neuralgia (PHN)/Neuropathic Pain Agents

Postherpetic Neuralgia (PHN)/Neuropathic Pain AgentsNON PREFERRED GRALISE

PROGESTINS

ProgestinsGENERIC medroxyprogesterone acetate progesterone in oil progesterone micronized

PREFERRED MAKENA

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

Protease-Activated Receptor-1 (PAR-1) AntagonistsPREFERRED 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 NAMZARIC THERAPY PACK

Benzodiazepines & Tricyclic AgentsGENERIC amitriptyline/chlordiazepoxide

Cholinomimetics - ACHE InhibitorsGENERIC donepezil hcl galantamine rivastigmine

Fibromyalgia Agent - SNRIsPREFERRED SAVELLA

Movement Disorder Drug TherapyNON PREFERRED XENAZINE

Multiple Sclerosis AgentsNON PREFERRED COPAXONE GLATOPA

Multiple Sclerosis Agents - InterferonsPREFERRED AVONEX PLEGRIDY

NON PREFERRED BETASERON EXTAVIA REBIF REBIF REBIDOSE

Multiple Sclerosis Agents - Monoclonal AntibodiesNON PREFERRED LEMTRADA OCREVUS TYSABRI

Multiple Sclerosis Agents - Nrf2 Pathway ActivatorsPREFERRED TECFIDERA

Multiple Sclerosis Agents - Potassium Channel Blockers

NON PREFERRED AMPYRA


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

PREFERRED NAMENDA XR

Phenothiazines & Tricyclic AgentsGENERIC perphenazine/amitriptyline

Pseudobulbar Affect Agent CombinationsPREFERRED NUEDEXTA

Smoking DeterrentsGENERIC buproban

PREFERRED CHANTIX

NON PREFERRED ZYBAN

Sphingosine 1-Phosphate (S1P) Receptor ModulatorsPREFERRED GILENYA

Thienbenzodiazepines & SSRIsGENERIC olanzapine/fluoxetine hcl

Vasomotor Symptom Agents - SSRIsPREFERRED BRISDELLE

Pulmonary Hypertension - Prostacyclin Receptor Agonist

Pulmonary Hypertension - Prostacyclin Receptor Agonist

PREFERRED UPTRAVI

RESPIRATORY AGENTS - MISC.

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

CFTR PotentiatorsNON PREFERRED KALYDECO

Cystic Fibrosis Agent - CombinationsPREFERRED SYMDEKO

NON PREFERRED ORKAMBI

Hydrolytic EnzymesNON PREFERRED PULMOZYME

Interleukin-5 Antagonists (IgG1 kappa)PREFERRED FASENRA

NON PREFERRED NUCALA

Pulmonary Fibrosis AgentsNON PREFERRED ESBRIET

SGLT2 Inhibitor - DPP-4 Inhibitor Combinations

SGLT2 Inhibitor - DPP-4 Inhibitor CombinationsNON PREFERRED STEGLUJAN

Sinus Node Inhibitors

Sinus Node InhibitorsPREFERRED CORLANOR

Spinal Muscular Atrophy Agents (SMA)

Spinal Muscular Atrophy Agents (SMA)PREFERRED SPINRAZA

Tazarotene CREAM 0.1 % External

DERMATOLOGICALSGENERIC tazarotene cream

TETRACYCLINES

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


PREFERRED COREMINO MINOCIN 100MG VIAL SOLODYN ER TETRACYCLINE

NON PREFERRED MINOCIN

Tetrahydroisoquinolines

TetrahydroisoquinolinesNON PREFERRED YONDELIS

THYROID AGENTS

Antithyroid AgentsGENERIC methimazole propylthiouracil

NON PREFERRED TAPAZOLE

Thyroid HormonesGENERIC levothyroxine sodium liothyronine sodium

PREFERRED ARMOUR THYROID LEVOTHYROXINE SODIUM

NON PREFERRED CYTOMEL SYNTHROID TIROSINT

TOXOIDS

Toxoid CombinationsPREFERRED ADACEL BOOSTRIX INFANRIX PEDIARIX PENTACEL QUADRACEL DTAP-IPV TETANUS DIPHTHERIA TOXOIDS TETANUS DIPHTHERIA TOXOIDS - PED

Tryptophan Hydroxylase Inhibitors

Tryptophan Hydroxylase InhibitorsNON PREFERRED XERMELO

ULCER DRUGS

AntispasmodicsGENERIC dicyclomine hcl

Belladonna AlkaloidsGENERIC hyoscyamine sulfate hyoscyamine sulfate disinegrating tablets hyoscyamine sulfate er

PREFERRED LEVSIN 0.5MG/ML AMPUL

NON PREFERRED ATROPEN LEVSIN 0.125MG TABLET

H-2 AntagonistsGENERIC cimetidine famotidine nizatidine ranitidine hcl

NON PREFERRED ZANTAC RX

Misc. Anti-UlcerGENERIC carafate 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

PREFERRED NEXIUM (RX) SUSP NEXIUM 24HR

NON PREFERRED NEXIUM (RX) CAPSULE 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 trospium chloride er

NON PREFERRED ENABLEX

Urinary Antispasmodic - Antimuscarinics (Antichol)(new)

GENERIC oxybutynin chloride oxybutynin chloride er tolterodine tartrate

PREFERRED GELNIQUE TOVIAZ VESICARE

NON PREFERRED DITROPAN XL

Urinary Antispasmodics - Cholinergic Agonists (new)GENERIC bethanechol chloride

Urinary Antispasmodics - Direct Muscle RelaxantsGENERIC flavoxate hcl

VACCINES

Bacterial VaccinesPREFERRED ACTHIB BEXSERO BIOTHRAX MENACTRA MENOMUNE-A-C-Y-W-135 PEDVAXHIB PNEUMOVAX 23 PREVNAR 13 TRUMENBA TYPHIM VI VAXCHORA VACCINE VIVOTIF BERNA DEL REL

Viral Vaccine CombinationsPREFERRED M-M-R II VACCINE W/DILUENT PROQUAD TWINRIX

Viral VaccinesPREFERRED AFLURIA AFLURIA QUAD ENGERIX-B FLUAD FLUBLOK FLUBLOK QUAD FLUCELVAX QUAD FLULAVAL QUAD FLUMIST FLUZONE HIGH-DOSE FLUZONE QUAD GARDASIL 9 HAVRIX IMOVAX RABIES VACCINE IPOL IXIARO RABAVERT RECOMBIVAX HB ROTATEQ SHINGRIX STAMARIL VAQTA VIAL VARIVAX VACCINE


YF-VAX

NON PREFERRED VAQTA SYRINGES

VAGINAL PRODUCTS

Imidazole-Related AntifungalsGENERIC miconazole 1 terconazole

PREFERRED MICONAZOLE 1

Vaginal Anti-infectivesGENERIC clindamycin phosphate vaginal

Vaginal EstrogensPREFERRED ESTRING PREMARIN CREAM

Vaginal ProgestinsPREFERRED CRINONE FEMRING

NON PREFERRED ENDOMETRIN ESTRACE CREAM

VASOPRESSORS

Anaphylaxis Therapy AgentsGENERIC epinephrine ampule/vial epinephrine auto-injector

NON PREFERRED EPINEPHRINE 1MG/ML AMPUL EPIPEN EPIPEN JR.

VasopressorsGENERIC dobutamine dobutamine/dextrose dopamine hcl dopamine hcl in 5% dextrose norepinephrine bitartrate phenylephrine hcl phenylephrine hcl-ns

PREFERRED PHENYLEPHRINE HCL-NS

NON PREFERRED LEVOPHED AMPULE/VIAL PHENYLEPHRINE HCL-NS 200MCG/5ML SYRINGE

PHENYLEPHRINE HCL-NS 40MG/5ML SYRINGE

VITAMINS

Vitamin AGENERIC vitamin a

PREFERRED AQUASOL A VITAMIN A

NON PREFERRED VITAMIN A

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 cavan-alpha kit cavan-ec sod dha choice-ob + dha choice-tabs elite-ob 400 folbecal folivane-f folplex 2.2 hematinic plus hematinic with folic acid hematogen hematogen fa hematogen forte hemetab iferex 150 forte


mefolate-pyridox-mecobalamin multigen multigen folic multigen plus multivitamin w/fluoride & iron multivitamin with fluoride poly-iron 150 forte polysaccharide iron forte setonet setonet ec thiamine hcl tl gard rx tl icon tl-care dha tricon trigels-f forte trinatal ultra triveen-one triveen-ten triveen-u trust natal dha ultimatecare one ultimatecare one nf vinacal vinate az vinate c vinate calcium virt-bal dha plus virt-pn vitacirc-b vp-era ob plus vp-ggr-b6 zingiber

PREFERRED FERAHEME

NON PREFERRED CENOLATE CONCEPTION XR MOTILITY DULEEK-MET NEW THIAMINE HCL VITASPIRE VYNATAL-FA

X-Linked Hypophosphatemia (XLH) Treatment - Agents

X-Linked Hypophosphatemia (XLH) Treatment - AgentsPREFERRED CRYSVITA


adhd/anti-narcolepsy/anti … · web viewestrogen & androgen generic...

Documents