anti-infectives - ascellahealth hcl meropenem [inj] methenamine hippurate methenamine mandelate...
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2016 Enhanced Formulary
The 2016 AscellaHealth Enhanced Formulary list is listed below. Last updated October 2015 and subject to change at any time. Inclusion on this list does not guarantee coverage. Coverage is based on your specific benefit plan.
KEY: [INJ], [inj] - Injectable Drug [OTC], [otc] - Over the Counter [SP], [sp] - Specialty Drug Brand name drugs are listed in CAPITAL letters. Example: ABILIFY. Generic drugs are listed in lower-case letters. Example: altavera
Generic medications contain the same active ingredients as their corresponding brand-name medications, though they may appear different in shape and color. They have been FDA-approved under strict standards.
Anti-Infectives
abacavir [sp]
ACETIC
ACID/OXYQUINOLINE
acyclovir
acyclovir [inj]
adefovir dipivoxil
ALBENZA
ALINIA
amantadine hcl
AMBISOME [INJ]
amikacin [inj]
amoxicillin
amoxicillin-clavulanate er
amphotericin [inj]
ampicillin [inj]
ampicillin/sulbactam [inj]
APTIVUS [SP]
atovaquone
atovaquone-proguanil hcl
ATRIPLA [INJ]
AUGMENTIN 125-31.25
MG/5ML
AVELOX
AVELOX IV [INJ]
AVYCAZ
AZACTAM-ISO-OSMOTIC
DEXTROSE [INJ]
azithromycin [inj]
azithromycin [sp]
aztreonam [inj]
bacitracin [inj]
BETHKIS
BICILLIN C-R [INJ]
BICILLIN L-A [INJ]
CANCIDAS [INJ]
CAPASTAT SULFATE [INJ]
CAYSTON [SP]
cefaclor
cefazolin [inj]
cefazolin/dextrose [inj]
cefdinir
cefepime [inj]
cefepime/dextrose [inj]
cefotaxime [inj]
cefotetan [inj]
cefoxitin [inj]
cefoxitin/dextrose [inj]
cefpodoxime proxetil
cefprozil
CEFTAZIDIME
ceftazidime [inj]
ceftibuten
ceftriaxone [inj]
ceftriaxone/dextrose [inj]
cefuroxime axetil
cefuroxime sodium
cefuroxime sodium [inj]
CEFUROXIME SODIUM 75
G [INJ]
cephalexin
chloramphenicol [inj]
chloroquine phosphate
cidofovir [inj]
ciprofloxacin
ciprofloxacin er
ciprofloxacin/dextrose [inj]
ciprofloxacin suspension
clarithromycin
clarithromycin er
clindamycin hcl
clindamycin palmitate hcl
clindamycin phosphate
[inj]
clindamycin
phosphate/dextrose [inj]
clotrimazole
COARTEM
colistimethate [inj]
COMPLERA [SP]
CRESEMBA
CRIXIVAN [SP]
CUBICIN [INJ]
DALVANCE [INJ]
DAPSONE
DARAPRIM
2016 Enhanced Formulary
demeclocycline hcl
dicloxacillin sodium
didanosine
DORIBAX
doxycycline hyclate
doxycycline hyclate [inj]
doxycycline monohydrate
EDURANT
EMTRIVA
entecavir
EPIVIR HBV SOLUTION
EPIVIR SOLUTION
ERYTHROCIN
LACTOBIONATE [INJ]
erythromycin
erythromycin del-rel
erythromycin
ethylsuccinate
erythromycin stearate
erythromycin
w/sulfisoxazole
ethambutol hcl
famciclovir
fluconazole, in dextrose,
saline
flucytosine
FORTAZ IN ISO-OSMOTIC
DEXTROSE [INJ]
foscarnet sodium
FUZEON [INJ]
ganciclovir
gentamicin sulfate [inj]
gentamicin sulfate in ns
GENTAMICIN SULFATE IN
NS 100 MG/0.1l [INJ]
griseofulvin
griseofulvin ultramicrosize
HARVONI
hydroxychloroquine
sulfate
imipenem-cilastatin [inj]
INTELENCE
INVANZ [INJ]
INVIRASE
ISENTRESS
isoniazid
isoniazid [inj]
itraconazole
KALETRA
kanamycin sulfate [inj]
ketoconazole
LAMISIL
lamivudine
lamivudine-zidovudine
levofloxacin hemihydrate
levofloxacin hemihydrate
[inj]
levofloxacin-d5w [inj]
LEXIVA
mefloquine hcl
meropenem [inj]
methenamine hippurate
methenamine mandelate
methylene blue [inj]
metronidazole
metronidazole [inj]
MINOCIN
minocycline hcl, er
moxifloxacin hcl
MYCAMINE [INJ]
nafcillin dextrose [inj]
nafcillin sodium [inj]
NEBUPENT [INJ]
neomycin sulfate
nevirapine, er
nitrofurantoin
nitrofurantoin
macrocrystal
NORVIR
NOXAFIL
nystatin tablet
ocudox
ofloxacin tablets
ORACEA
ORABACTIV [INJ]
oxacillin sodium [inj]
1g/50ml
oxacillin sodium [inj]
paromomycin sulfate
penicillin g potassium [inj]
penicillin g procaine
penicillin g sodium [inj]
PENICILLIN GK-ISO-OSM
DEXTROSE
penicillin v potassium
piperacillin-tazobactam
[inj]
polymyxin b sulfate [inj]
PREZISTA
PRIFTIN
PRIMAQUINE
pyrazinamide
quinine sulfate
RAPIVAB
RELENZA
RESCRIPTOR
RETROVIR [INJ]
REYATAZ
ribavirin
rifabutin
RIFADIN
RIFADIN[INJ]
rimantadine hcl
SELZENTRY
SIRTURO
SIVEXTRO [INJ]
SYLVANT [INJ]
SOLODYN 55, 65, 80, 105,
115MG ER
SOVALDI
SPORANOX
stavudine
2016 Enhanced Formulary
STREPTOMYCIN SULFATE
[INJ]
STRIBILD
STROMECTOL
sulfadiazine
sulfamethoxazole/trimeth
oprim
sulfamethoxazole/trimeth
oprim [inj]
SUSTIVA
SYNERCID [INJ]
TEFLARO [INJ]
terbinafine
TETRACYCLINE
TIMENTIN [INJ]
tinidazole
TIVICAY
TOBI PODHALER
tobramycin sulfate [inj]
trimethoprim
TRIUMEQ
TRUVADA
TYGACIL [INJ]
TYZEKA
valacyclovir
valganciclovir hcl
vancomycin hcl [inj]
VIBATIV [INJ]
VICTRELIS
VIDEX
VIRACEPT
VIREAD
voriconazole
voriconazole [inj]
XIFAXAN
ZERBAXA
ZIAGEN
zidovudine
ZOSYN [INJ]
ZYVOX
ZYVOX [INJ]
Antineoplastic &
Immunosuppresants
ABRAXANE [INJ] [SP]
ADCETRIS [INJ] [SP]
AFINITOR [SP]
AFINITOR DISPERZ [SP]
ALIMTA [INJ]
ALKERAN
amifostine [inj]
anastrozole
ARRANON [INJ] [SP]
ARZERRA [INJ] [SP]
AVASTIN [INJ] [SP]
azacitidine [inj] [sp]
AZASAN
azathioprine [sp]
azathioprine sodium [inj]
[sp]
BEXXAR [INJ]
bicalutamide
BICNU [INJ]
bleomycin [inj]
BLINCYTO
BOSULIF [SP]
BUSULFEX [INJ]
calcium folinate [inj]
CAPRELSA [SP]
carboplatin [inj]
CEENU
CELLCEPT [INJ] [SP]
CELLCEPT SUSPENSION
[SP]
cisplatin [inj]
cladribine [inj]
CLOLAR [INJ]
cyclophosphamide [inj]
cyclophosphamide tablets,
capsules
cyclosporine [inj] [sp]
cyclosporine [sp]
cyclosporine modified [sp]
CYRAMZA
cytarabine [inj]
dacarbazine [inj]
dactinomycin [inj]
daunorubicin [inj]
DAUNOXOME [INJ]
decitabine [inj] [sp]
DEPOCYT [INJ]
dexrazoxane [inj]
DOCEFREZ [INJ]
docetaxel [inj]
doxorubicin hcl [inj]
doxorubicin hcl liposomal
[inj]
DROXIA
ELIGARD
ELITEK [INJ]
ELSPAR
EMCYT
epirubicin hcl [inj]
ERIVEDGE
ETOPOPHOS [INJ]
etoposide
etoposide [inj]
exemestane
FARESTON
FASLODEX
floxuridine [inj]
fludarabine phosphate
[inj]
fluorouracil [inj]
flutamide
FOLOTYN [INJ]
FUSILEV [INJ]
GAZYVA [INJ]
gemcitabine hcl [inj]
GILOTRIF
GLEEVEC
HALAVEN [INJ]
2016 Enhanced Formulary
HERCEPTIN [INJ]
HEXALEN
HYCAMTIN CAPSULES [SP]
hydroxyurea
IBRANCE
ICLUSIG
idarubicin hcl [inj]
ifosfamide [inj]
ifosfamide-mesna
IMBRUVICA
INLYTA
IODOPEN [INJ]
irinotecan hcl [inj]
ISTODAX [INJ]
IXEMPRA
JAKAFI
JEVTANA [INJ]
KADCYLA [INJ]
KEPIVANCE [INJ]
KEYTRUDA
KYPROLIS [INJ]
LEMTRADA
LENVIMA
letrozole
leucovorin calcium
leucovorin calcium [inj]
LEUKERAN
leuprolide acetate
levoleucovorin calcium
lomustine
LUPRON DEPOT
LUPRON DEPOT 11.25MG
LUPRON DEPOT-PED
LYNPARZA
LYSODREN
MARQIBO
MATULANE
megestrol acetate
MEKINIST
melphalan hcl [inj]
mercaptopurine
mesna [inj]
MESNEX
methotrexate
methotrexate [inj]
mitomycin [inj]
mitoxantrone [inj]
MUSTARGEN [INJ]
mycophenolate mofetil
mycophenolate acid
delayed-release
MYLERAN
NEXAVAR
NILANDRON
NULOJIX [INJ]
octreotide acetate[inj]
ONCASPAR
ONTAK [INJ]
OPDIVO
oxaliplatin
paclitaxel [inj]
PERJETA [INJ]
PHOTOFRIN [INJ]
POMALYST
PROGRAF
PROVENGE [INJ]
PURIXAN
REVLIMID
RITUXAN [INJ]
SANDIMMUNE SOLUTION
SANDOSTATIN [INJ]
SANDOSTATIN LAR DEPOT
SIGNIFOR [INJ]
SIMULECT [INJ]
SOMATULINE DEPOT [INJ]
SPRYCEL
STIVARGA
SUTENT
SYNRIBO [INJ]
SYLVANT [INJ]
TABLOID
tacrolimus
TAFINLAR
tamoxifen citrate
TARCEVA
TASIGNA
TEMODAR [INJ]
temozolomide
TENIPOSIDE [INJ]
THALOMID
thiotepa [inj]
topotecan hcl [inj]
TORISEL [INJ]
TREANDA [INJ]
TRELSTAR, DEPOT [INJ], LA
tretinoin caps
TREXALL
TRISENOX [INJ]
TYKERB
UNITUXIN
VANTAS
VECTIBIX [INJ]
VELCADE [INJ]
vinblastine sulfate
VORAXAZE [INJ]
VOTRIENT
VUMON [INJ]
XALKORI
XGEVA [INJ]
XOFIGO [INJ]
XTANDI
YERVOY [INJ]
ZALTRAP [INJ]
ZANOSAR [INJ]
ZELBORAF
ZEVALIN
ZOLADEX
ZOLINZA
ZORTRESS
ZYDELIG
ZYKADIA
ZYTIGA
2016 Enhanced Formulary
Autonomic, Neurology
and Psych
ABILIFY DISCMELT
ABILIFY MAINTENA, ER
acetaminophen w/codeine
acetaminophen-
diphenhydra-alfentanil
[inj]
alprazolam
alprazolam er
alprazolam orally
disintegrating tablet
amitriptyline hcl
amitriptyline/chlordiazepo
xide
amoxapine
amphetamine salt combo,
er
AMPYRA [SP]
AMYTAL [INJ]
anectine [inj]
APOKYN [INJ] [SP]
aripiprazole
AZILECT
baclofen
BANZEL
benztropine [inj]
benztropine mesylate
BRISDELLE
buprenorphine [inj]
buprenorphine
hydrochloride
buprenorphine-naloxone
bupropion ext-release (12
hour)
bupropion hcl
bupropion hcl xl er
bupropion sr er
buspirone hcl
butalbital compound
butalbital compound
w/codeine
butalbital-aspirin-caffeine
butalbital/apap/caffeine
butalbital/caff/apap/codei
ne
butorphanol [inj]
butorphanol nasal
BUTRANS
calcium-folic acid plus d
carbamazepine
carbamazepine ext-release
carbidopa-levodopa er
carbidopa-levodopa-
entacapone
carbidopa/levodopa
carbidopa/levodopa orally
disintegrating tablets
celecoxib
CELONTIN
chlordiazepoxide hcl
chlorpromazine [inj]
chlorpromazine hcl
chlorzoxazone
choline mag trisalicylate
citalopram hbr
clomipramine hcl
clonazepam
clonazepam orally
disintegrating tablets
clonidine [inj]
clonidine hcl er
clorazepate dipotassium
clozapine
clozapine odt
codeine sulfate
COPAXONE [INJ] [SP]
cyclobenzaprine hcl
dantrolene sodium
DAYTRANA
desipramine hcl
dexmethylphenidate, er
dextroamphetamine
sulfate
dextroamphetamine
sulfate er
diazepam
diazepam rectal gel
diclofenac potassium
diclofenac sodium
diclofenac sodium-
misoprostol delayed
release
diflunisal
dihydroergotamine
mesylate
DILANTIN
DILAUDID-HP 250 MG [INJ]
diltiazem [inj]
diphenhydramine hcl
divalproex sodium
divalproex sodium er
donepezil hcl
doxepin hcl
DOXYLAMINE SUCCINATE
duloxetine
EDROPHONIUM CHLORIDE
entacapone
ERGOLOID MESYLATES
ergotamine-caffeine
escitalopram oxalate
estrazolam
ethosuximide
etodolac
etodolac er
EXELON PATCHES
felbamate
fenoprofen calcium
fentanyl [inj]
fentanyl citrate, [inj],
lozenge
FETZIMA
2016 Enhanced Formulary
flumazenil [inj]
fluoxetine dr
fluoxetine hcl
fluphenazine decanoate
[inj]
fluphenazine hcl
flurazepam hcl
flurbiprofen
fluvoxamine maleate er 24
hr
fosphenytoin sodium
FYCOMPA
gabapentin
GABITRIL 12MG, 16MG
GABLOFEN [INJ]
galantamine
GILENYA
GRALISE
guanidine hcl
haloperidol
haloperidol [inj]
haloperidol decanoate [inj]
haloperidol lactate [inj]
HYCAMTIN CAPSULES [SP]
hydrocodone bit-
ibuprofen
hydrocodone
w/acetaminophen
hydromorphone hcl,
rectal, [inj]
HYSINGLA ER
ibuprofen
imipramine hcl
imipramine pamoate
indomethacin
indomethacin [inj]
indomethacin er
INFUMORPH
INTUNIV
ISOMETHEPTENE MUCATE
ketoprofen er
ketorolac tromethamine
ketorolac tromethamine
[inj]
lamotrigine
lamotrigine er
LATUDA
levetiracetam, [inj], er
levorphanol tartrate
LIORESAL [INJ]
lithium carbonate tab, er,
caps
lorazepam
lorazepam [inj]
loxapine succinate
LYRICA
maprotiline hcl
meclofenamate sodium
mefenamic acid
meloxicam
memantine
meperidine hcl [inj]
MESTINON
MESTINON ER
methamphetamine hcl
methocarbamol
methadone hcl
methadone hcl [inj]
methylphenidate er
methylphenidate hcl
midazolam
mirtazapine
mirtazapine disintegrating
tablets
modafinil
morphine sulfate [inj]
morphine sulfate cr, er
morphine sulfate tablet
MOVANTIK
nalbuphine hcl [inj]
naloxone hcl [inj]
naltrexone hydrochloride
nabumetone
NAMENDA XR
NAMZARIC
NAPROSYN
naproxen
naproxen sodium
naratriptan hcl
NEMBUTAL SODIUM [INJ]
NEOPROFEN [INJ]
neostigmine methylsulfate
[inj]
nortriptyline hcl
NUCYNTA
NUCYNTA ER
NUEDEXTA
NUVIGIL
OFIRMEV [INJ]
olanzapine
olanzapine [inj]
olanzapine odt
olanzapine-fluoxetine hcl
ONFI
OPANA ER
oxaprozin
OXTELLAR ER
oxycodone hcl
oxycodone hcl-ibuprofen
oxycodone
w/acetaminophen
oxycodone w/aspirin
OXYCONTIN ER
oxymorphone hcl
oxymorphone hcl er
orphenadrine citrate [inj]
orphenadrine citrate er
orphenadrine compound
ORTHOVISC [INJ]
oxazepam
oxcarbazepine
paroxetine hcl
paroxetine hcl er
2016 Enhanced Formulary
PEGANONE
pentazocine lactate
perphenazine
perphenazine/amitriptylin
e
phenelzine sulfate
phenobarbital
phenobarbital sodium [inj]
phenytoin
phenytoin sodium
phenytoin sodium [inj]
piroxicam
POTIGA
pramipexol
pramipexol er
PRIALT [INJ]
primidone
PRISTIQ ER
pyridostigmine bromide
QUADRAMET [INJ]
quetiapine fumarate
QUILLIVANT XR
RELPAX
RISPERDAL
RISPERDAL CONSTA [INJ]
RISPERDAL M-TAB
DISINTEGRATING
rivastigmine
rizatriptan
rizatriptan disintegrating
tablets
ROBAXIN [INJ]
ropinirole hcl
ropinirole hcl er
ROZEREM
SABRIL
SALICYLAMIDE
salsalate
seconal sodium
selegiline hcl
SEROQUEL XR
SUBOXONE
sulindac
sumatriptan succinate
sumatriptan succinate
spray non-aerosol
sumatriptan succinate [inj]
SUMAVEL DOSEPRO [INJ]
SYNVISC [INJ]
SYNVISC-ONE [INJ]
TECFIDERA DELAYED
RELEASE
TEGRETOL XR
temazepam
thioridazine hcl
thiothixene
tiagabine hcl
tizanidine hcl
tolmetin sodium
topiramate
tramadol hcl
tramadol hcl er
tramadol hcl-
acetaminophen
tranylcypromine sulfate
trazodone hcl
triazolam
trifluoperazine hcl
trihexyphenidyl hcl
trimipramine maleate
TYSABRI [INJ]
ULTIVA [INJ]
VALPROATE SODIUM
valproate sodium [inj]
valproic acid
venlafaxine hcl
venlafaxine hcl er
VIIBRYD
VIMPAT [INJ]
VIVITROL [INJ]
VOLTAREN
VYVANSE
XENAZINE
XYREM
zaleplon
ziprasidone hcl
zolmitriptan
zolmitriptan odt
zolpidem tartrate
zolpidem tartrate er
ZOMIG
zonisamide
ZORVOLEX
ZUBSOLV
Cardiovascular,
Hypertension & Lipids
acebutolol hcl
ACTIVASE [INJ]
adenosine [inj]
ADVATE [INJ] [SP]
ADVATE H [INJ] [SP]
ADVATE L [INJ] [SP]
ADVATE N [INJ] [SP]
ADVATE SH [INJ] [SP]
ADVATE UH [INJ] [SP]
AGGRASTAT [INJ]
AGGRENOX ER
ALPHANATE [INJ] [SP]
ALPHANINE SD [INJ] [SP]
ALPROLIX
amiloride hcl
amiloride hcl w/hctz
amiodarone hcl
amiodarone hcl [inj]
amlodipine besylate
amlodipine-atorvastatin
ANGIOMAX [INJ] [SP]
ARGATROBAN [INJ]
atenolol
atenolol w/chlorthalidone
atorvastatin calcium
2016 Enhanced Formulary
ATRYN
AZOR
BEBULIN [INJ] [SP]
BEBULIN VH IMMUNO
[INJ] [SP]
benazepril hcl
benazepril hcl-hctz
BENEFIX [INJ] [SP]
BENICAR
BENICAR HCT
betaxolol hcl
bisoprolol fumarate
bisoprolol fumarate/hctz
BRILINTA
bumetanide
bumetanide [inj]
BYSTOLIC
candesartan cilexetil
candesartan-
hydrochlorothiazid
captopril
captopril/hydrochlorothiaz
ide
CATHFLO ACTIVASE [INJ]
CEPROTIN [INJ] [SP]
chlorothiazide
chlorothiazide
chlorothiazide sodium [inj]
chlorthalidone
cholestyramine
cholestyramine light
cilostazol
CLEVIPREX [INJ]
clonidine hcl
clopidogrel
colestipol hcl
COREG CR ER
CORIFACT [INJ] [SP]
CORLANOR
COUMADIN [INJ]
CRESTOR
DEMSER
digoxin
DILATRATE-SR EXT-REL
diltiazem [inj]
diltiazem 24hr cd
diltiazem er
diltiazem er 24 hour
diltiazem hcl
dipyridamole [inj]
dobutamine [inj]
dobutamine/dextrose [inj]
dopamine hcl [inj]
dopamine hcl in 5%
dextrose
doxazosin mesylate
EDARBI
EDARBYCHLOR
EDECRIN[INJ]
EFFIENT
ELIQUIS
ELOCTATE [INJ]
enalapril maleate
enalapril maleate/hctz
enalaprilat [inj]
enoxaparin sodium
ENTRESTO
eplerenone
epoprostenol [inj]
EXFORGE
EXFORGE HCT
FEIBA NF [INJ]
felodipine er
fenofibrate
fenofibrate caps
fenofibric acid
fenofibric acid delayed
release
flecainide acetate
fluvastatin sodium
fondaparinux sodium
fosinopril sodium
fosinopril/hydrochlorothia
zide
FRAGMIN
furosemide
furosemide [inj]
gemfibrozil
guanfacine hcl
HELIXATE FS [INJ]
HEMOFIL [INJ]
heparin lock flush [inj]
heparin sodium in 0.45%
nacl [inj]
heparin sodium in 5%
dextrose [inj]
HUMATE-P [INJ] [SP]
hydralazine hcl
hydrochlorothiazide
ibutilide fumarate [inj]
indapamide
INTEGRILIN [INJ]
irbesartan
irbesartan/hydrochlorothi
azide
isosorbide dinitrate
isosorbide mononitrate
isosorbide mononitrate er
isradipine
IXINITY
JUXTAPID
KOATE-DVI [INJ]
labetalol hcl
labetalol hcl [inj]
LANOXIN PEDIATRIC
lidocaine hcl in 7.5%
dextrose [inj]
LIPOFEN
LIPTRUZET
lisinopril
lisinopril-hctz
losartan potassium
2016 Enhanced Formulary
losartan-
hydrochlorothiazide
lovastatin
mannitol
MEPHYTON
methyclothiazide
methyldopa
methyldopa/hydrochlorot
hiazide
methyldopate hcl [inj]
metolazone
metoprolol succinate er
metoprolol tartrate
metoprolol tartrate [inj]
metoprolol-
hydrochlorothiazide
mexiletine hcl
milrinone in 5% dextrose
milrinone lactate [inj]
minoxidil
moexipril hcl
moexipril/hydrochlorothia
zide
MONOCLATE-P [INJ]
MONONINE
MONONINE [INJ]
MONOVISC [INJ]
nadolol
nadolol/bendroflumethiazi
de
NATRECOR [INJ]
NEXTERONE
niacin er
nicardipine hcl
nicardipine hcl [inj]
nifedipine er
nimodipine
nitroglycerin
nitroglycerin tablets
nitroglycerin [inj]
nitroglycerin er
nitroglycerin in d5w [inj]
nitroglycerin spray
NITROLINGUAL
NITROSTAT
norepinephrine bitartrate
[inj]
NOVOSEVEN [INJ]
NPLATE [INJ]
OBIZUR
omega-3-acid ethyl esters
papaverine hcl [inj]
papaverine hcl er
pentoxifylline er
perindopril erbumine
PHENTOLAMINE
MESYLATE [INJ]
phenylephrine hcl [inj]
PHYTONADIONE
pindolol
PRADAXA
PRALUENT PEN
PRALUENT SYRINGE
pravastatin sodium
prazosin hcl
procainamide hcl [inj]
PROFILNINE SD [INJ]
PROMACTA
propafenone hcl
propafenone hcl er
propranolol hcl
propranolol hcl er
propranolol hcl-hctz
protamine sulfate [inj]
quinapril
quinapril/hydrochlorothiaz
ide
quinidine gluconate [inj]
quinidine gluconate er
quinidine sulfate
quinidine sulfate er
ramipril
RANEXA
RECOMBINATE [INJ]
REFLUDAN [INJ]
REMODULIN [INJ]
REOPRO [INJ]
REPATHA SYRINGE
REPATHA SURECLICK
RESECTISOL
reserpine
RETAVASE
RIASTAP
SIMCOR ER
simvastatin
sotalol
SOTALOL HCL [INJ]
SOTYLIZE
spironolactone
spironolactone/hydrochlor
othiazide
TARKA
TEKAMLO
TEKTURNA
TEKTURNA HCT
terazosin hcl
THROMBATE III [INJ]
TIKOSYN
timolol maleate
torsemide
torsemide [inj]
trandolapril
TRANEXAMIC ACID
tranexamic acid [inj]
TRETTEN
TRIBENZOR
valsartan
valsartan/hydrochlorothia
zide
VASCEPA
verapamil er
verapamil er pm
verapamil hcl [inj]
2016 Enhanced Formulary
VYTORIN
warfarin sodium
WELCHOL
WILATE
XARELTO
XYNTHA
XYNTHA SOLOFUSE
ZETIA
ZONTIVITY
Dermatological &
Topical Therapy
ABSORICA
acitretin
acyclovir ointment
adapalene
alclometasone
dipropionate
alphaquin hp
aluminum chloride 20%
topical
amcinonide
ammonium lactate 12%
topical
ABSORICA
ANTHRALIN
ATRALIN
avo cream
bacitracin eye ointment
bacitracin/polymyxin eye
ointment
benprox
BENZOCAINE
benzoyl peroxide
betamethasone
dipropionate augmented
betamethasone valerate
bupivacaine hcl
bupivacaine/epinephrine
[inj]
calcipotriene
calcitriol
CARAC
CARBOCAINE 2% [INJ]
CHLORHEXIDINE
GLUCONATE
chloroprocaine [inj]
ciclopirox
clindamycin phosphate
topical
clindamycin-benzoyl
peroxide
clobetasol e
clobetasol propionate
clotrimazole
clotrimazole/betamethaso
ne
cocaine hcl topical solution
CONDYLOX GEL
COSENTYX
desonide
desoximetasone
DEXPANTHENOL
diclofenac sodium gel
DIFFERIN 0.1% LOTION
diflorasone diacetate
diflorason
diacetate/emollient
econazole nitrate
eletone
ELIDEL
emulsion sb
EPIDUO
EPIDUO FORTE
erythromycin solution
erythromycin-benzoyl
peroxide
ETHYL ALCOHOL
ethyl chloride
FINACEA
FINACEA PLUS
fluocinolone acetonide
cream
fluocinolone acetonide
ointment
fluocinonide
fluorouracil
fluticasone propionate
gentamicin sulfate cream
gentamicin sulfate
ointment
halobetasol propionate
hpr foam
hpr plus
hydrocortisone
hydrocortisone butyrate
hydrocortisone
butyrate/emoll
hydrocortisone
acetate/lidocaine
hydrocortisone
acetate/pramoxine
hydrocortisone valerate
hydroquinone cream
hydroquinone ER
imiquimod
isotretinoin
ketoconazole cream
lactic acid
lidocaine hcl, jelly,
ointment
lidocaine hcl
w/epinephrine [inj]
lidocaine-prilocaine
lindane
lustra-ultra
mafenide acetate
malathion
mb hydrogel
mepivacaine hcl
metronidazole cream
MIRVASO
2016 Enhanced Formulary
mometasone furoate
mupirocin
NESACAINE
nuquin hp
nystatin ointment
nystatin w/triamcinolone
ONEXTON
OXSORALEN 1% LOTION
permethrin
podofilox
prednicarbate
pruclair
prumyx
prutect
REGRANEX
ropivacaine hcl [INJ]
salicylic acid
SANTYL
selenium sulfide
sensorcaine [inj]
silver sulfadiazine
sodium
sulfacetamide/sulfur
sonafine
spinosad
STELARA [INJ] [SP]
sulfacetamide sodium
topical
sulfacetamide sodium-
sulfur
SULFAMYLON
TACLONEX SUSPENSION
tacrolimus ointment
TAZORAC
tl-cermide
TRETIN-X
tretinoin cream
tretinoin microsphere
triamcinolone acetonide
0.1% cream
urea
ZIANA
ZOVIRAX CREAM
Ear, Nose & Throat
acetic acid ear solution
acetic acid/aluminum ear
solution
acetic acid/hydrocortisone
ear solution
antipyrine w/benzocaine
ear solution
antipyrine
w/benzocaine/poly ear
solution
ASTEPRO
ATROVENT SPRAY
azelastine hcl nasal spray
chloroxylenol/benzocaine/
hc acet ear susp
CIPRODEX
ciprofloxacin hcl
FIRST-BXN
FIRST-MOUTHWASH BLM
hydrocortisone/pramoxine
ear solution
hydrocortisone/pramoxine
/chloroxylenol
ipratropium bromide spray
MYALEPT
neomycin/polymyxin/hc
ofloxacin otic drops
oxymetazoline hcl 12 hour
sodium fluoride
sodium fluoride cream
Endocrine/Diabetes
1ST CHOICE LANCETS
A-HYDROCORT [INJ]
acarbose
ACCU-CHEK FASTCLIX,
MULTICLIX, SOFTCLIX
LANCETS [OTC]
ACCU-CHEK SOFTCLIX
LANCETS DEVICE [OTC]
ACTHAR H.P. [INJ] [SP]
ACTHREL [INJ]
ACTOPLUS MET XR
ALDURAZYME [INJ] [SP]
ANDROGEL
ARISTOSPAN [INJ]
ARMOUR THYROID
AXIRON
BETAMETHASONE
BETAMETHASONE
ACETATE
betamethasone
acetate/betamethasone
sodium phosphate [inj]
BETAMETHASONE
SODIUM PHOSPHATE
BRAVELLE [INJ]
BYDUREON [INJ]
BYDUREON PEN
BYETTA [INJ]
cabergoline
calcitonin salmon nasal
calcitriol [inj]
CERDELGA [SP]
CEREZYME [INJ] [SP]
chorionic gonadotropin
[inj] [sp]
clomiphene citrate
cortisone acetate
cosyntropin [INJ]
danazol
DEPO-MEDROL 20 MG/ML
[INJ]
desmopressin acetate
desmopressin acetate [inj]
DEXCOM G4, SENSOR
2016 Enhanced Formulary
dexamethasone
dexamethasone sodium
phosphate
doxercalciferol
ELAPRASE [INJ]
ELELYSO [INJ]
FABRAZYME [INJ]
FARXIGA
FEMCAP
fludrocortisone acetate
FLUOXYMESTERONE
FOLLISTIM AQ [INJ]
FORA LANCING DEVICE
FREESTYLE FREEDOM KIT
[OTC]
FREESTYLE FREEDOM LITE
METER [OTC]
FREESTYLE INSULINX
GLUCOSE SYSTEM [OTC]
FREESTYLE INSULINX TEST
STRIPS [OTC]
FREESTYLE LITE METER
[OTC]
FREESTYLE LITE TEST
STRIPS [OTC]
FREESTYLE TEST STRIPS
[OTC]
glimepiride
glipizide
glipizide er
GLUCAGEN [INJ]
GLUCAGON
glyburide
glyburide micronized
glyburide-metformin hcl
GLYXAMBI
HUMALOG [INJ]
HUMULIN [INJ] [OTC]
HUMULIN R 500 UNITS
[INJ]
hyoscyamine/phenyltoloxa
mine
INVOKANA
INVOKAMET
JANUMET
JANUMET XR
JANUVIA
JENTADUETO
JUVISYNC
KENALOG [INJ]
KOMBIGLYZE XR
KUVAN
LANTUS [INJ]
LANTUS SOLOSTAR [INJ]
LEVEMIR [INJ]
LEVOTHROID
levothyroxine sodium
levothyroxine sodium [inj]
liothyronine [inj]
liothyronine tablet
LUMIZYME [INJ]
MEDROL
MENOPUR [INJ]
metformin hcl
metformin hcl er
methimazole
METHITEST
methylprednisolone
methylprednisolone
acetate [inj]
methylprednisolone sod
succ [inj]
MIACALCIN [INJ]
MINIMED
MINIMED RESERVOIR
MYOZYME [INJ]
NAGLAZYME [INJ]
nateglinide [INJ]
NOVOFINE
NOVOFINE AUTOCOVER
NOVOLOG [INJ]
NOVOLOG FLEXPEN
NOVOLOG MIX 70-30
ONE TOUCH ULTRA 2
ONE TOUCH ULTRA
SMART
ONE TOUCH ULTRA
SYSTEM
ONE TOUCH ULTRA TEST
STRIPS
ONE TOUCH ULTRAMINI
ONE TOUCH VERIO
ONE TOUCH VERIO IQ
ONE TOUCH VERIO SYNC
ONGLYZA
OPTIUM
OPTIUM EZ
ORTHO-DIAPHRAGM
oxandrolone
pamidronate disodium
[inj]
PARADIGM INFUSION
PARADIGM INSULIN PUMP
PARADIGM SILHOUETTE
paricalcitol
pioglitazone hcl
pioglitazone-glimepiride
pioglitazone-metformin
POLYFIN QR
PRANDIMET
PRECISION PCX, PCX PLUS,
POINT OF CARE,Q-I-D
PRECISION XTRA B-
KETONE STRIPS [OTC]
PRECISION XTRA
MONITOR [OTC]
PRECISION XTRA TEST
STRIPS [OTC]
prednisolone
prednisolone sodium
phosphate [inj]
prednisone
2016 Enhanced Formulary
PRODIGY INSULIN SYRINGE
PRODIGY PEN NEEDLE
PROGLYCEM
propylthiouracil
QUICK RELEASE SOFT
TEFLON
repaglinide
RIOMET
SAMSCA
SENSIPAR
SILHOUETTE
SILHOUETTE [INJ]
SOF-SET
SOF-SET MICRO
SOFT TOUCH
SOLOSITE
SOLU-CORTEF [INJ]
SOLU-MEDROL [INJ]
SOMAVERT [INJ]
STIMATE SPRAY
SURE-T PARADIGM
SYMLINPEN 60 [INJ]
SYNAREL
SYNJARDY
testosterone cypionate
[inj]
testosterone enanthate
[inj]
testosterone gel pump
THYROID
tolazamide
tolbutamide
TOUJEO SOLOSTAR
TRADJENTA
vasopressin [inj]
veripred 20
VGO 20
VGO 30
VGO 40
VICTOZA [INJ]
VIMIZIM [INJ] [SP]
VPRIV [INJ]
XIGDUO XR
ZAVESCA
ZEMPLAR [INJ]
ZOLEDRONIC ACID [INJ]
ZOMETA [INJ]
Gastroenterology
AKYNZEO
ALOXI [INJ]
AMITIZA
ANALPRAM ADVANCED
CREAM KIT
ANALPRAM 2.5% LOTION
ANALPRAM-HC 1% CREAM
SINGLES
ASACOL HD
balsalazide disodium
budesonide ec
CANASA
carafate
CHOLBAM
CHENODAL [SP]
cimetidine
CITRA PH
CORTIFOAM
CREON
cromolyn sodium oral
solution
CYSTADANE [SP]
DELZICOL
dicyclomine hcl
dimenhydrinate [inj]
diphenoxylate w/atropine
dronabinol
droperidol [inj]
EMEND [INJ]
ENTYVIO
ENTYVIO [INJ]
famotidine
famotidine [inj]
glycopyrrolate
glycopyrrolate [inj]
granisetron hcl
granisetron hcl [inj]
GRANISOL
hydrocortisone
hydrocortisone acetate
hyoscyamine sulfate, odt,
er
KINEVAC [INJ]
lactulose
lansoprazol-amoxicil-
clarithromycin
lansoprazole delayed
release
LEVSIN
LIALDA
LINZESS
loperamide hcl
LOTRONEX
meclizine hcl
mesalamine
metoclopramide hcl
metoclopramide hcl [inj]
misoprostol
NEXIUM
NEXIUM [INJ]
nizatidine
omeprazole delayed
release
omeprazole/sodium
bicarbonate
ondansetron hcl
ondansetron hcl [inj]
ondansetron hcl in
dextrose [inj]
ondansetron in sodium
chloride[inj]
ondansetron odt
opium
2016 Enhanced Formulary
pancrelipase
pantoprazole sodium
paregoric
peg 3350-electrolyte
PENTASA
phenobarb/hyoscyamine/
atropine/scoplamine
polyethylene glycol
PREPOPIK
prochlorperazine edisylate
[inj]
prochlorperazine maleate
PROCTOFOAM-HC
ranitidine
ranitidine hcl [inj]
RECTIV
RELISTOR [INJ]
REMICADE [INJ]
SANCUSO
SCOPOLAMINE
HYDROBROMIDE
sodium bicarbonate
sodium chloride/sodium
bicarb
SUCLEAR
SUCRAID
sucralfate
sulfasalazine
sulfasalazine del rel
SUPREP
trimethobenzamide hcl
trimethobenzamide hcl
[inj]
UCERIS
ursodiol
VIOKACE
ZENPEP DEL-REL
Immunology, Vaccines
& Biotechnology
ACTHIB [INJ]
ACTIMMUNE [INJ] [SP]
ADACEL [INJ]
AFLURIA [INJ]
ALFERON N [INJ]
APLISOL [INJ]
ARANESP [INJ] [SP]
ARCALYST [INJ] [SP]
ATGAM [INJ]
AVONEX [INJ] [SP]
BETASERON
BEXSERO
BIOTHRAX [INJ]
BOOSTRIX [INJ]
BOTOX [INJ] [SP]
candin
CERVARIX [INJ]
COMVAX [INJ]
CROFAB [INJ]
CYTOGAM [INJ] [SP]
DIPHTHERIA-TETANUS
TOXOIDS-PED
EGRIFTA [INJ] [SP]
ENGERIX-B [INJ]
FLUARIX [INJ]
FLULAVAL [INJ]
FLULAVAL QUAD [INJ]
FLUMIST
FLUVIRIN [INJ]
FLUZONE [INJ]
FLUZONE INTRADERM
QUAD [INJ]
fomepizole
GAMASTAN S-D [INJ]
GAMMAGARD LIQUID
[INJ]
GAMMAGARD S-D [INJ]
GAMUNEX [INJ]
GAMUNEX-C [INJ]
GARDASIL 9 [INJ]
GENOTROPIN [INJ] [SP]
GRASTEK
HAVRIX
HEPAGAM B [INJ]
HIZENTRA [INJ]
HUMATROPE [INJ] [SP]
HYPERHEP B S-D [INJ]
HYPERRAB S-D [INJ]
HYPERRHO S-D
HYPERTET S-D
ILARIS [INJ]
IMOGAM RABIES-HT [INJ]
IMOVAX RABIES VACCINE
[INJ]
INFANRIX [INJ]
INFERGEN [INJ] [SP]
INTRON A [INJ] [SP]
IPOL [INJ]
IXIARO
LEUKINE [INJ]
M-M-R II VACCINE
W/DILUENT [INJ]
MENACTRA [INJ]
MENOMUNE-A-C-Y-W-135
[INJ]
MOZOBIL [INJ]
MYOBLOC [INJ]
OMNITROPE [INJ] [SP]
NEULASTA [INJ]
NEUMEGA [INJ]
NEUPOGEN [INJ]
NORDITROPIN [INJ] [SP]
PEDIARIX [INJ]
PEDVAXHIB [INJ]
PEGASYS [INJ] [SP]
PEGASYS PROCLICK [INJ]
[SP]
PLEGRIDY [SP]
PNEUMOVAX 23 [INJ]
PREVNAR 13
PRIVIGEN [INJ]
PROCRIT [INJ]
2016 Enhanced Formulary
PROLEUKIN [INJ]
PROQUAD [INJ]
QUADRACEL DTAP-IPV
RABAVERT
RAGWITEK
REBIF [INJ] [SP]
REBIF REBIDOSE [INJ] [SP]
RECOMBIVAX HB
ROTATEQ
SEROSTIM [INJ] [SP]
SYLATRON [INJ] [SP]
TETANUS DIPHTHERIA
TOXOIDS [INJ]
tetanus toxoid
THERACYS [INJ]
THYMOGLOBULIN [INJ]
TICE BCG [INJ]
TRUMENBA
TUBERSOL [INJ]
TWINRIX [INJ]
TYPHIM VI [INJ]
VAQTA
VARIVAX VACCINE [INJ]
VARIZIG [INJ]
VIVOTIF BERNA DEL-REL
YF-VAX [INJ]
Musculoskeletal &
Rheumatology
ACTEMRA [INJ] [SP]
alendronate sodium
allopurinol
ATELVIA
BENLYSTA [INJ] [SP]
colchicine
COLCRYS
CUPRIMINE
dihydrocodeine/aspirin/ca
ffeine
ENBREL [INJ] [SP]
FORTEO [INJ] [SP]
HUMIRA [INJ] [SP]
ibandronate[inj]
ibandronate sodium
KRYSTEXXA [INJ] [SP]
leflunomide
ORENCIA [INJ] [SP]
OTREXUP
naproxen delayed release
probenecid
RIDAURA
risedronate
risedronate sodium
SAVELLA
SIMPONI 100MG
ULORIC
Obstetrics &
Gynecology
altavera
alyacen
amethia
amethia lo
amethyst
apri
aranelle
aubra [inj]
aviane
azurette
balziva
BEYAZ
briellyn
caldolor [inj]
camrese
camrese lo
caziant
CENESTIN
chateal
clindamycin phosphate
vaginal
COMBIPATCH
CRINONE
cryselle
cyclafem
dasetta
daysee
DEPO-ESTRADIOL [INJ]
DEPO-PROVERA 400
MG/ML [INJ]
DIVIGEL
DUAVEE
elinest
emoquette
ENDOMETRIN
ENJUVIA
enpresse
enskyce
ERGONOVINE MALEATE
errin
estarylla
ESTRACE CREAM
ESTRACE TABLET
estradiol
estradiol patch
0.05mg/day
estradiol valerate [inj]
estradiol-norethindrone
acetate
estrogen &
methyltestosterone
estropipate
falmina
gianvi
gildagia
gildess
gildess fe
heather
HEMABATE [INJ]
IMPLANON
introvale
isoxsuprine hcl
2016 Enhanced Formulary
jencycla
jolessa
jolivette
junel
junel fe
kariva
kelnor 1-35
kurvelo
leena
lessina
levonorgestrel
levora
LO LOESTRIN FE
LO MINASTRIN FE
loryna
low-ogestrel
lutera
lyza
MAKENA [INJ]
marlissa
medroxyprogesterone
acetate [inj]
methylergonovine maleate
METHYLERGONOVINE
MALEATE [INJ]
metronidazole gel
MICONAZOLE 1
microgestin
microgestin fe
MINIVELLE
MIRENA
mono-linyah
mononessa
myzilra
NATAZIA
necon
NEXPLANON
nora-be
norethindrone acetate
norethindrone/ethinyl
estradiol
norethindrone/ethinyl
estradiol-iron
NUVARING
ocella
ogestrel
orsythia
OSPHENA
oxytocin [inj]
philith
pirmella
portia
PREMARIN
PREMARIN [INJ]
PREMARIN CREAM
PREMPHASE
PREMPRO
progesterone
quasense
reclipsen
SAFYRAL
sprintec
sronyx
syeda
terconazole
tilia fe
tri-estarylla
tri-legest fe
tri-linyah
trinessa
trivora
VAGIFEM
velivet
vestura
viorele
wera
wymzya fe
zarah
zenchent
zenchent fe
zeosa
zovia
Ophthalmology
acetazolamide, er, [inj]
ALPHAGAN P 0.1%
ALREX
apraclonidine eye solution
atropine sulfate eye
solution
atropine sulfate eye
ointment
azelastine hcl eye solution
balanced salt eye irrigation
BEPREVE
BESIVANCE
betaxolol eye solution
brimonidine eye solution
bromfenac eye solution
carbachol [INJ]
carteolol hcl
ciprofloxacin eye solution
COMBIGAN
cromolyn sodium eye
solution
cyclopentolate eye
solution
CYSTARAN [SP]
dexamethasone sodium
phosphate
diclofenac sodium gel
dorzolamide hcl
dorzolamide-timolol
epinastine hcl
erythromycin ointment
EYLEA [INJ]
FLUORESCEIN SODIUM
fluorometholone
flurbiprofen sodium
FML S.O.P.
gatifloxacin
gentasol
2016 Enhanced Formulary
homatropine
hydrobromide
ILEVRO
ISOPTO CARBACHOL
JETREA [INJ]
ketorolac eye solution
latanoprost drops
levobunolol hcl drops
levofloxacin hemihydrate
rops
LOTEMAX
LUCENTIS [INJ]
LUMIGAN
methazolamide
metipranolol drops
MOXEZA
naphazoline hcl
NATACYN
neomycin/polymyxin/dexa
methasone
neomycin/bacitracin/poly
myxin/hc
neomycin/polymyxin/gra
micidin
NEVANAC
ofloxacin
PATADAY
PATANOL
PAZEO
phenylephrine hcl
PHOSPHOLINE IODIDE
drops
physostigmine salicylate
[inj]
pilocarpine hcl drops
PILOPINE HS
polymyxin/trimethoprim
eye solution
PRED MILD
prednisolone acetate
prednisolone sodium
phosphate drops
PROLENSA
proparacaine hcl
proparacaine-fluorescein
RESTASIS
sodium chloride drops
sulfacetamide sodium
ointment
sulfacetamide sodium
drops
sulfacetamide/prednisolon
e
tetracaine drops
timolol maleate drops
TOBRADEX
TOBRADEX ST
tobramycin
tobramycin sulfate drops
tobramycin-
dexamethasone
TRAVATAN Z
travoprost
TRIFLURIDINE
tropicamide
VIGAMOX
VISUDYNE [INJ]
ZYLET
Respiratory, Allergy,
Cough & Cold
acetylcysteine
ADCIRCA [SP]
ADVAIR DISKUS
ADVAIR HFA
albuterol sulfate
aminophylline [inj]
ANORO ELLIPTA
arbinoxa
ARCAPTA NEOHALER
ARNUITY ELLIPTA
ASMANEX, HFA
AUVI-Q
benzonatate
BREO ELLIPTA
brompheniramine/pseudo
ephedrine
budesonide
caffeine/sodium benzoate
[inj]
carbinoxamine
cetirizine syrup
chlorphen-pse-dm tannate
CINRYZE [INJ] [SP]
clemastine fumarate
COMBIVENT RESPIMAT
cromolyn sodium
nebulization solution
cyproheptadine hcl
D-
CHLORPHENIRA/PSE/CHLO
PHEDIAN 12.5CPD-
1DCPM-30PSE
DALIRESP
desloratadine, odt
dexchlorpheniramine
maleate er
DEXTROMETHORPHAN
HBR
difil-g
dihydrocodeine-bpm-pe
diphenhydramine [inj]
DM/PHENYLEPH/CHLORPH
ENIRAMINE 10PEH-4CPM-
20DM
DULERA
DYMISTA
ephedrine sulfate
epinephrine [inj]
EPIPEN
EPIPEN JR.
2016 Enhanced Formulary
epoprostenol diluent [inj]
[sp]
FIRAZYR
FLOVENT
FLOVENT DISKUS
FLOVENT HFA
flunisolide
fluticasone propionate
FORADIL
guaifenesin/codeine
hydrocodone/chlorphenira
mine er
hydrocodone/homatropin
e
hydroxyzine hcl
hydroxyzine pamoate
ipratropium bromide
ipratropium-albuterol
nebulization
KALBITOR [INJ]
KALYDECO
LETAIRIS
levalbuterol hcl
levocetirizine
dihydrochloride
metaproterenol sulfate
montelukast sodium
NASONEX
OPSUMIT
ORKAMBI
PERFOROMIST [INJ]
phenylephrine/chlorphenir
amine 10peh-4cpm
phenylephrine/chlorphenir
amine
phenylephrine/dihydrocod
eine/chlorphenir
PROAIR HFA
PROAIR RESPICLICK
promethazine hcl, sup,
tablets, [inj]
promethazine vc
w/codeine
promethazine w/dm
promethegan
PSEUDOEPH/CHLOPHEDIA
NOL/GG 12.5CPD-100GFN-
30PSE
pseudoephedrine hcl 12
hour ER
pseudoephedrine hcl-d 12
hour
pseudoephedrine sulfate
ER
PULMICORT
PULMICORT FLEXHALER
PULMOZYME
QVAR
REVATIO [INJ]
SEREVENT DISKUS
sildenafil citrate
sodium chloride nebulizer
SPIRIVA, RESPIMAT
STIOLTO RESPIMAT
SYMBICORT
terbutaline sulfate
terbutaline sulfate [inj]
theophylline anhydrous
elixir
theophylline anhydrous
drops er 12 hr
TRACLEER
triamcinolone acetonide
spray
TUDORZA PRESSAIR
TUSSICAPS
TYVASO
VENTAVIS
VENTOLIN HFA
VERAMYST
XOLAIR [INJ]
zafirlukast
Urologicals
alfuzosin hcl er
alprostadil [inj]
AMINOACETIC ACID
aminoacetic acid [inj]
AMMONIUM CHLORIDE
[INJ]
bethanechol chloride
CAVERJECT [INJ]
CIALIS
CYSTAGON [SP]
ELMIRON
finasteride
flavoxate hcl
GELNIQUE
glycine
hyophen
k-phos neutral
K-PHOS ORIGINAL
MUSE
MYRBETRIQ ER 24 HR
oxybutynin chloride
oxybutynin chloride er
phenazopyridine hcl
phenazopyridine plus
phosphasal
potassium citrate er
RAPAFLO
RENACIDIN
tamsulosin er
tolterodine tartrate
TOVIAZ
tricitrates
trospium chloride er
uretron d-s
urimar-t
urin d.s.
urogesic
ustell
2016 Enhanced Formulary
VESICARE
VIAGRA
Vitamins, Hematinics
& Electrolytes
ADDAMEL N [INJ]
advanced am/pm
albumin human [inj]
ALZ-NAC
amino acid [inj]
AMINOSYN [INJ]
AQUASOL A [INJ] [SP]
ascorbic acid [inj]
b-complex
BAL IN OIL [INJ]
bal-care dha
calcium acetate
calcium chloride [inj]
calcium gluconate [inj]
cavan-alpha kit
cavan-ec sod dha
CENOLATE [INJ]
centratex
choice-ob + dha
choice-tabs
chromium chloride [inj]
CLINIMIX [INJ]
complete natal dha
CONCEPTION XR MOTILITY
copper chloride [inj]
corvita
CUPRIC SULFATE [INJ]
cyanocobalamin [inj]
DAILYVITE
dexferrum
DIALYVITE 800
DULEEK-MET NEW
eliphos
elite ob
elite-ob 400
fabb
fe 90 plus
fe c
FERAHEME
ferocon
ferotrinsic
ferraplus 90
ferrex 150 forte
ferrex 150 forte plus
ferrex 28
ferrocite plus
ferrogels forte
folbecal
folbee
folbee plus
folbic
folbic rf
folcaps
folcaps omega-3
folic acid
folic acid [inj]
folic acid-cyancobal-
pyridoxine
folivane-f
folivane-ob
folivane-plus
folivane-prx dha nf
folplex 2.2
foltanx
FREAMINE HBC
FREAMINE III
GLYCOPHOS [INJ]
hematinic plus
hematinic with folic acid
hematogen
hematogen fa
hematogen forte
hemenatal ob
hemenatal ob + dha
hemetab
HEPATAMINE [INJ]
HEPATASOL [INJ]
hetastarch w/sodium
chloride [inj]
hydroxocobalamin
iferex 150 forte
inatal advance
inatal gt
inatal ultra
infed [inj]
INFUVITE [INJ]
intralipid
IONOSOL B WITH
DEXTROSE 5%
ISOLYTE S [INJ]
k-phos neutral
L-MEFOLATE-PYRIDOX-
MECOBALAMIN-NAC
L-METHYLFOLATE
CALCIUM
m.v.i. adult [inj]
M.V.I. PEDIATRIC [INJ]
M.V.I.-12 [INJ]
macnatal cn dha
magnesium chloride [inj]
magnesium sulfate [inj]
MAGNESIUM SULFATE IN
DEXTROSE [INJ]
manganese [inj]
manganese sulfate [inj]
metafolbic
metafolbic plus
multigen
multigen folic
multigen plus
MULTITRACE-4 [INJ]
MULTITRACE-5 [INJ]
multivitamin w/fluoride &
iron
multivitamin with fluoride
mynatal
mynatal caps
2016 Enhanced Formulary
mynatal advance
mynatal plus
mynatal-z
mynate 90 plus er
mynephrocaps
NASCOBAL
NATAL-V RX
natalvirt 90 dha
natalvirt ca
natalvirt flt
nephplex rx
NEPHRAMINE [INJ]
nephro-vite rx
NEUT [INJ]
NORMOSOL-M AND
DEXTROSE [INJ]
NORMOSOL-R AND
DEXTROSE [INJ]
NORMOSOL-R PH 7.4 [INJ]
nutri-tab ob
nutrilyte [inj]
nutrilyte ii [inj]
obstetrix dha
PEDITRACE [INJ]
PLASMA-LYTE 148 [INJ]
pnv ob+dha
pnv-dha
pnv-first
pnv-omega
pnv-select
pnv-total
polysaccharide iron forte
poly-iron 150 forte
pot chloride/dextrose/ns
[inj]
potassium acetate [inj]
potassium bicarbonate
potassium chl-normal
saline [inj]
potassium chloride
potassium
chloride/dextrose [inj]
pr natal 400
pr natal 400 ec
pr natal 430
pr natal 430 ec
prefol-dha
premasol [inj]
prena1
prena1 chew
prena1 plus
prenaissance
prenaissance 90 dha
prenaissance balance
prenaissance dha
prenaissance harmony dha
prenaissance next
prenaissance plus
prenaplus
prenatabs fa
prenatabs rx
prenatal ad
prenatal low iron
prenatal plus
prenatal-u
PROCALAMINE
PROSOL
pyridoxine hcl
relnate dha
RENA-VITE RX
renal caps
renalpren
reno caps
ringers [inj]
se-tan dha pernatal
se-tan plus
se-natal 19
selenium [inj]
setonet
setonet-ec
sodium acetate [inj]
sodium chloride 3%
sodium chloride0.45%
sodium lactate [inj]
strovite
STUART ONE
taron forte
taron prenatal
taron-bc
taron-c dha
taron-duo ec
therapeutic hematinic
therapeutic
vitamin/minerals
thiamine hcl
tl g-fol os
tl gard rx
tl icon
tl-care dha
tl-fol 500 er
tl-hem 150 er 24 hr
tl-select
TPN ELECTROLYTES [INJ]
TRACE ELEMENTS [INJ]
travasol [inj]
tri rx
triadvance
tricon
trigels-f forte
trinatal gt
trinatal rx 1
trinatal ultra
trinate
triphrocaps
triveen-duo dha
triveen-one
triveen-prx rnf
triveen-ten
triveen-u
trust natal dha
ultimate ob dha
ultimatecare one
2016 Enhanced Formulary
ultimatecare one nf
v-c forte
v-natal
vemavite-prx 2
vena-bal dha
venatal complete dha
venatal-fa
VENOFER [INJ]
vinacal
vinate az
vinate c
vinate calcium
vinate dha
vinate gt
vinate ic
vinate ii
vinate one
vinate ultra
vinate-m
virt-bal dha
virt-bal dha plus
virt-pn
virt-pn dha
virt-pn plus
virt-select
virt-vite
virt-vite forte
vitafol-ob
vitafol-pn
vitamin a
vitaspire
vol-care rx
vol-nate
vol-plus
vol-tab rx
vp-ch plus
vp-ch-pnv
vp-era ob plus
vp-ggr-b6
vp-heme one
vp-zel
vynatal-fa
zatean-ch
zatean-pn
zatean-pn dha
zatean-pn plus
zinc chloride
zinc sulfate
Miscellaneous &
Diagnostic Agents
acamprosate calcium
acetic acid irrigation
ADAGEN [INJ] [SP]
AMMONUL [INJ]
anagrelide hydrochloride
ARALAST NP [INJ] [SP]
atropen [inj]
benzphetamine hcl
BREVITAL [INJ]
bromhexine hydrochloride
BUPHENYL TABLETS
bupivacaine/dextrose [inj]
caffeine citrated
caffeine citrated [inj]
CARBAGLU [SP]
cevimeline hcl
CHANTIX
CHEMET
citric acid
CLINIMIX E [INJ]
deferoxamine [inj]
DELFLEX/DEXTROSE
dextrose in lactated
ringers
dextrose in water
dextrose/sodium chloride
diethylpropion hcl
EDARBYCLOR
EOVIST [INJ]
ETHAMOLIN
etidronate disodium
etomidate [inj]
EXJADE
EXTRANEAL ICODEXTRIN
DIALYSIS
FERRIPROX
FOSRENOL
HEXTEND LACTATED
ELECTROLYTE
INCRELEX [INJ]
ISOVUE [INJ]
ISOVUE-M [INJ]
JADENU
ketamine hcl [inj]
levocarnitine
levocarnitine [inj]
LEXISCAN
MAGNEVIST [INJ]
md-gastroview
midodrine hcl
NATPARA [INJ]
neomycin-polymyxin b
[inj]
OMNIPAQUE
ORFADIN
PANHEMATIN [INJ]
phendimetrazine tartrate
phendimetrazine tartrate
er
phentermine hcl
pilocarpine hcl
PROHANCE [INJ]
PROLASTIN [INJ]
PROLASTIN C [INJ]
propofol
PROSTAMEN
PROTOPAM CHLORIDE
[INJ]
RAVICTI
RENVELA
riluzole
2016 Enhanced Formulary
ringers irrigation
serotonin hcl
sodium chloride
sodium chloride [inj]
sodium chloride irrigation
SODIUM PHOSPHATE
sodium polystyrene
sulfonate
sodium thiosulfate [inj]
SOLIRIS [INJ]
SOTRADECOL [INJ]
THALLOUS CHLORIDE TL-
201
THYROGEN [INJ]
TRYPSIN
UVA URSI LEAF FLUID
EXTRACT
VISIPAQUE [INJ]
water [inj]
water intravenous solution
water solution irrigation
XIAFLEX [INJ]
ZEMAIRA [INJ]
The 2016 AscellaHealth Enhanced Formulary list is listed below. Last updated October 2015 and subject to change at any time. Inclusion on this list does not guarantee coverage. Coverage is based on your specific benefit plan.
KEY: [INJ], [inj] - Injectable Drug [OTC], [otc] - Over the Counter [SP], [sp] - Specialty Drug Brand name drugs are listed in CAPITAL letters. Example: ABILIFY Generic drugs are listed in lower-case letters. Example: altavera
Generic medications contain the same active ingredients as their corresponding brand-name medications, though they may appear different in shape and color. They have been FDA-approved under strict standards.