district of columbia - dc.fhsc.com of columbia department of health care finance pharmacy preferred...

District of Columbia Department of Health Care Finance

Pharmacy Preferred Drug List (PDL)

Effective March 19, 2018

Non-preferred medications require prior authorization of 19

ANALGESICS

Drug Class Preferred Requires Prior Authorization

Long-Acting Narcotics*

* Clinical criteria apply to this entire therapeutic class

fentanyl 12, 25, 50, 75, 100 mcg/hr (transdermal)

Embeda®

Hysingla® ER

morphine ER tablet (gen MSContin/Oramorph SR

Kadian®

Arymo® ER

Avinza®

Belbuca®

buprenorphine patch

Butrans®

Duragesic®

Exalgo®

fentanyl 37.5, 62.5, 87.5 mcg/hr (transdermal)

hydromorphone ER

morphine ER (gen for Avinza)

morphine ER cap (gen for Kadian & Avinza)

Morphabond® ER

MS Contin®

Opana ER®

oxycodone ER

OxyContin®

oxymorphone ER

Xtampza® ER

Zohydro® ER

NSAIDS: Oral and Topical diclofenac sodium

ibuprofen (tab & susp)

indomethacin IR cap

ketoprofen IR

ketorolac

meloxicam tab

naproxen tab piroxicam

sulindac

Voltaren® gel

Anaprox®

Ansaid

Arthrotec

Capxib®

Cataflam® tab

Celebrex®

celecoxib

Daypro®

Dermacinrx Lexitral®

diclofenac (topical)

diclofenac/capsicum

diclofenac potassium

diclofenac SR

diclofenac/misoprostol

diflunisal

Duexis®

etodolac IR and SR

feldene

fenoprofen

Flector® patch

flurbiprofen

Indocin®

indomethacin ER cap

Inflamma-K®

ketoprofen Ercap

Lidoxib®

meclofenamate

mefenamic acid

meloxicam susp

Mobic® nabumetone Nalfon® Naprelan® Naprosyn® naproxen EC naproxen susp oxaprozin

Pennsaid®

Ponstel® Sprix® Tivorbex® Tolmetin Vimovo® Vivlodex® Voltaren® XR Vopac® MDS Xrylix® Zipsor® Zorvolex®

Opiate Dependance Treatment Agents

naloxone syringe & vial

naltrexone

Narcan® nasal spray

Suboxone® Film

Bunavail®

buprenorphine

buprenorphine/naloxone

Evzio®

Zubsolv®

Tramadol and Tramadol Like Agents tramadol HCl tramadol HCl-acetaminophen

Conzip®

Nucynta ER®

Nucynta®

Rybix ODT®

Ryzolt ER®

tramadol ER

Ultracet®

Ultram®

Ultram ER®





ANTI-INFECTIVES


Antibiotics: Fluoroquinolones ciprofloxacin tablet

levofloxacin tablets

Cipro® susp Avelox®

ciprofloxacin ER

Cipro®

Cipro XR®

Levaquin®

levofloxacin soln

moxifloxacin

Noroxin®

ofloxacin

Antibiotics: GI metronidazole tabs Alinia®

Dificid®

Flagyl®

Flagyl ER®

metronidazole caps neomycin

paromomycin

Solosec®

Tindamax®

tinidazole

Vancocin®

vancomycin

Xifaxan®

Antibiotics: Macrolides & Ketolides

azithromycin

clarithromycin

erythromycin base DR cap Biaxin®

E.E.S. 200 Susp®

E.E.S. 400 Tab®

Eryped®susp

Erythrocin®

erythromycin base tab erythromycin susp

Ketek®

PCE Zithromax®

ZMAX®

Antibiotics: Vaginal Cleocin® Ovules

Clindesse®

metronidazole vaginal gel

Vandazole®

Cleocin® crm

clindamycin vaginal crm

Metrogel-Vaginal®

Nuvessa®

Antifungals fluconazole

griseofulvin susp

griseofulvin ultra-microsize tabs

nystatin susp

terbinafine

Ancobon®

clotrimazole

Cresemba®

Diflucan®

fluconazole susp

flucytosine

Grifulvin V® tabs

Gris-Peg®

griseofulvin tabs

itraconazole

ketoconazole

Lamisil®

Noxafil®

nystatin tabs and powder

Onmel®

Oravig®

Sporanox capsule®

Sporanox solution®

Terbinex®

Vfend®

voriconazole





ANTI-INFECTIVES


Antifungals, Topical ciclopirox (cream & soln)

clotrimazole crm (OTC & RX)

clotrimazole-betamethasone crm

ketoconazole shampoo

miconazole OTC (crm, oint, powder)

nystatin (crm, oint, powder)

terbinafine OTC cream

tolnaftate OTC (crm & powder)

Alevazol® OTC Bensal® HP ciclopirox ( gel, kit,

susp.,shampoo ) clotrimazole soln. (OTC &

RX) clotrimazole-

betamethasone lotion CNL 8 kit Dermacinrx Therazole®

PAK Desenex Aero® powder

OTC econazole topical Ertaczo® (topical) Exelderm® Extina® Fungoid® OTC Jublia® Kerydin

ketoconazole (crm, foam)

Lamisil® OTC (topical) Loprox® Lotrimin AF® OTC Lotrisone® crm Luzu® Mentax® miconazole OTC spray naftifine crm Naftin® Nizoral® shampoo nystatin-triamcinolone

topical oxiconazole cream Oxistat® Pediaderm® AF Penlac® Tinactin® OTC powder tolnaftate OTC (soln, pwdr

& spray)

Vusion®

Xolegel®

Antivirals: Herpes acyclovir cap, tab & susp

famciclovir

valacyclovir

Famvir®

Sitavig®

Valtrex®

Zovirax®

Hepatitis B: Oral Agents Baraclude® solution

entecavir

Epivir® HBV soln

lamivudine (HBV) tab

Hepsera®

Viread®

adefovir

Baraclude® tablet

Epivir® HBV tab

Tyzeka®

Vemlidy®

Hepatitis C Agents*

* Clinical criteria, genotype consideration and review apply to this entire therapeutic class

Mavyret®

Pegasys Proclick®

Pegasys® syringe / vial

Ribapak®

ribavirvin tabs & caps

Vosevi®

Copegus®

Daklinza®

Epclusa®

Harvoni®

Olysio®

Pegasys Conv Pack/ Kit®

PEG-Intron®

PEG-Intron Redipen®

Rebatol®

Ribasphere®

ribavirin dose pack

Sovaldi®

Technivie®

VieKira® Pak

VieKira® XR

Zepatier®





ANTI-INFECTIVES


HIV / AIDS abacavir

abacavir/lamivudine

abacavir/lamivudine/

zidovudine

Aptivus

atazanavir

Atripla

Biktarvy

Combivir

Complera

Crixivan

Descovy

didanosine DR

Edurant

efavirenz

Emtriva

Epivir

Epzicom

Evotaz

fosamprenavir

Fuzeon

Genvoya

Intelence

Invirase

Isentress

Isentress HD

Juluca

Kalentra

lamivudine

lamivudine / zidovudine

Lexiva lopinavir/ritonavir

nevirapine

nevirapine ER

Norvir

Odefsky

Prezcobix

Prezista

Rescriptor

Retrovir

ritonavir

Reyataz

Selzentry

stavudine

Stribild

Sustiva

Symfi Lo

Tivicay

Triumeq

Trizivir

Truvada

Tybost

Viread

Videx

Videx EC DR cap

Viracept

Viramune

Vitekta

Zerit

Ziagen zidovudine

N/A

Influenza Agents Relenza®

rimantadine

Tamiflu® Flumadine® oseltamivir

Topical Antibiotics bacitracin OTC

bacitracin/polymyxin OTC

gentamicin ointment

mupirocin ointment

neomycin / polymyxin / pramoxine topical

triple antibiotic oint OTC

Altabax®

bacitracin packet OTC

Bactroban®

Centany®

Centany AT®

double antibiotic oint OTC

gentamicin crm

mupirocin cream

Neosporin ®

Polysporin®

triple antibiotic oint PLUS

Topical Antivirals Zovirax® cream acyclovir ointment

Denavir®

Xerese®

Zovirax® ointment





CARDIOVASCULAR


ACE Inhibitors benazepril

enalapril

lisinopril Accupril®

Altace®

captopril

Epaned®

fosinopril

Lotensin®

Mavik®

moexipril

perindopril

Prinivil®

quinapril

ramipril

trandolapril

Vasotec®

Zestril®

ACE Inhibitor/Diuretic Combinations

benazepril w/HCTZ lisinopril w/HCTZ Accuretic®

captopril w/HCTZ

enalapril w/HCTZ

fosinopril w/HCTZ

Lotensin HCT®

moexipril w/HCTZ

quinapril w/HCTZ

quinaretic

Uniretic®

Vaseretic®

Zestoretic®

Angiotensin Receptor Blockers losartan

Micardis®

valsartan Atacand®

Avapro®

Benicar®

candesartan

Cozaar®

Diovan®

Edarbi®

Entresto®

eprosartan

irbesartan

olmesartan

telmisartan

Teveten®

Angiotensin Receptor Blockers/Diuretic

losartan w/HCTZ

Micardis® HCT

valsartan-HCTZ Atacand HCT®

Avalide®

Benicar HCT®

Diovan HCT®

Edarbyclor®

Hyzaar®

irbesartan /HCTZ

telmisartan/HCTZ

Teveten HCT®

Angiotensin Receptor Modulators Combinations

amlodipine / benazepril

amlodipine / valsartan

Exforge®HCT amlodipine/olmesartan

amlodipine/olmesartan/ HCTZ

amlodipine / valsartan / HCTZ

Azor®

Byvalson®

Exforge®

Lotrel®

Prestalia®

Tarka®

telmisartan / amlodipine

trandolapril / verapamil

Tribenzor®

Twynsta®

Antihypertensives, Sympatholytics Catapres-TTS® patches

clonidine

guanfacine

methyldopa

Catapres®

clonidine patches

Clorpres®

methyldopa HTZ

reserpine

Beta Blockers atenolol

bisoprolol

Bystolic®

carvedilol

metoprolol succinate ER

metoprolol tartrate

propranolol tabs / soln

acebutolol

Betapace®

Betapace AF®

betaxolol

Coreg®

Coreg CR®

Corgard®

Hemangeol®

Inderal LA®

Lopressor®

nadolol

pindolol

propranolol ER / SA

Sectral®

Sorine®

sotalol

Sotylize®

Tenormin®





CARDIOVASCULAR


Inderal XL®

Innopran XL®

labetalol

Levatol®

Toprol XL®

timolol

Trandate®

Zebeta®

Beta Blockers/Diuretic Combinations

atenolol / chlorthalidone bisoprolol / HCTZ

Corzide®

Dutoprol®

Lopressor HCT®

metoprolol / HCTZ

nadolol / bendroflumethiazide

propranolol / HCTZ

Tenoretic®

Ziac®

Bidil Bidil® N/A

Calcium Channel Blockers (DHP) Afeditab CR®

amlodipine

nifediac CC

nifedical XL

nifedipine IR

nifedipine ER/SA/XL

Adalat CC®

Cardene SR®

felodipine ER

isradipine

nicardipine HCl

nisoldipine

Norvasc®

Nymalize®

Procardia®

Procardia XL®

Sular®

Calcium Channel Blockers (NonDHP) diltiazem ER cap

diltiazem tab

verapamil tab

verapamil ER tab

Calan SR®

Cardizem CD®

Cardizem LA®

diltiazem LA®

Matzim LA®

Tiazac

Tiazac 420 mg

verapamil 360 mg cap

verapamil ER cap

verapamil ER PM

Verelan

Verelan PM

Direct Renin Inhibitors N/A Tekturna® Tekturna HCT®

Lipotropics: Bile Acid Sequestrants cholestyramine

cholestyramine light packet

cholestyramine light powder

colestipol tablet

Prevalite® packet

Prevalite® powder

Colestid® granules

Colestid® packets

Colestid® tablet

colestipol granules

Questran® packet

Questran® powder

Questran Light® packet

Questran Light® powder

Welchol®

Lipotropics: Cholesterol Absorption Inhibitors and Others

Zetia® ezetimibe

Juxtapid®

Kynamro®

Praluent®

Repatha®

Lipotropics: HMG-CoA Reductase Inhibitors (Statins)

atorvastatin

lovastatin

pravastatin

rosuvastatin

simvastatin

Advicor®

amlodipine/atorvastatin

Altoprev®

Caduet®

Crestor®

fluvastatin SR and ER

Lescol®

Lescol XL®

Lipitor®

Liptruzet®

Livalo®

Mevacor®

Pravachol®

Simcor®

simvastatin/ezetimibe

Vytorin®

Zocor®

Lipotropics: Niacin Derivatives Niaspan® niacin ER Niacor®





CARDIOVASCULAR


Lipotropics: Triglyceride Lowering Agents

fenofibrate (for Tricor®)

gemfibrozil

Trilipix® Antara®

Fenofibrate (Lofibra, Lipofen)

fenofibric acid

Fibricor®

Lofibra®

Lipofen®

Lopid®

Lovaza®

omega-3 acid ethyl esters (Rx)

Tricor

Triglide®

Vascepa®

Platelet Aggregation Inhibitors Aggrenox®

Brilinta®

clopidogrel

dipyridamole

aspirin / dipyridamole

Durlaza®

Effient®

Persantine®

prasugrel

Plavix®

ticlopidine

Zontivity®

Ranexa like Agents

Anti-Angina/Anti-Ischemic

Ranexa®

CENTRAL NERVOUS SYSTEM


Alzheimer's Agents: Cholinesterase Inhibitors

donepezil ODT

donepezil tabs

Exelon® patch

rivastigmine caps

Aricept®

Aricept ODT®

donepezil 23 mg

Exelon® caps/solution

galantamine IR/ER/soln

Razadyne® ER

Razadyne® tabs and soln

rivastigmine patch

Alzheimer's Agents: NMDA Receptor Antagonist and combinations

memantine tablets memantine ER

memantine solution

Namenda®

Namenda® XR

Namzaric®

Anti-Convulsants: Carbamazepine Derivatives

carbamazepine ER caps

carbamazepine chew tabs

Tegretol® susp

Tegretol® tablets

Tegretol® XR

Trileptal® oral susp

Aptiom®

carbamazepine oral susp

carbamazepine tablets

carbamazepine XR tablets

Carbatrol®

Equetro®

oxcarbazepine susp

Oxtellar®

Tegretol® chew tabs

Trileptal® tablets

Anti-Convulsants: First Generation clonazepam tablets

Diastat®

divalproex ER

divalproex sodium

divalproex sodium sprinkle

ethosuximide susp

phenobarbital elixir

phenobarbital tablets

phenytoin chewtab

phenytoin oral susp

phenytoin sodium extended

primidone

valproic acid capsule

valproic acid syrup

Celontin®

clonazepam ODT

Depakene® capsule

Depakene® syrup

Depakote®

Depakote® ER

Depakote® sprinkle

diazepam rectal

Dilantin® capsule

Dilantin-125® oral susp

Dilantin® chew tab

divalproex sodium sprinkle

ethosuximide capsule

felbamate

Felbatol®

Klonopin®

Mysoline® tablet

Peganone®

Phenytek®

Stavzor®

Vigabatrin®

Zarontin® capsule

Zarontin® syrup







Anti-Convulsants: Second Generation and Others

lamotrigine tab

lamotrigine tab DS PK

levetiracetam solution

levetiracetam tablet

topiramate tablet

topiramate sprinkle cap

zonisamide

Banzel®

Briviact®

Fycompa®

Gabarone®

Gabitril®

Keppra® / Keppra® XR

Lamictal® / Chew / XR / ODT

lamotrigine ER / ODT

levetiracetam ER

Onfi®

Potiga®

Qudexy XR®

Sabril®

Spritam®

tiagabine

Topamax® tablet

Topamax® sprinkle cap

topiramate ER (generic for Qudexy XR)

Trokendi XR®

Vimpat®

Zonegran®

Anti-Depressants: SSRIs citalopram tablet

escitalopram tabs

fluoxetine caps

fluoxetine solution

paroxetine

sertraline tablet Brisdelle®

Celexa® tablet

citalopram solution

escitalopram soln

fluoxetine DR / weekly

fluoxetine 60 mg

fluoxetine tabs

fluvoxamine

Lexapro®

Luvox CR®

paroxetine CR

Paxil®

Paxil CR®

Pexeva®

Prozac®

Prozac® weekly

Sarafem®

sertraline solution

Zoloft® solution

Zoloft® tablet

Anti-Depressants: Others bupropion IR/SR/XL

mirtazapine IR

trazodone

venlafaxine IR

venlafaxine ER caps (OSM 24)

Aplenzin

Brintellix®

desvenlafaxine ER

Effexor®

Effexor XR®

Fetzima®

Forfivo XL®

Khedezla®

mirtazapine ODT

Nefazadone

Pristiq®

Remeron®

Trintellix®

venlafaxine ER tabs

Viibryd®

Wellbutrin ® IR / SR / XL

Anti-Hyperkinesis Agents*


Adderall XR®

amphetamine salt combo IR

dextroamphetamine IR tab

dextroamphetamine soln

Focalin® IR

Focalin XR®

guanfacine ER

Metadate ER®

methylphenidate

methylphenidate ER 18, 27, 36, 54 mg

methylphenidate ER/SR/SA 10 & 20mg

Ritalin LA®

Strattera®

Vyvanse® caps

Adderall®

Armodafinil

Adzenys® XR ODT

amphetamine salt combo XR

Aptensio® XR

armodafini

atomoxetine hcl

clonidine ER

Cotempla® XR-ODT

Concerta®

Daytrana®

Desoxyn®

Dexedrine® Spansule

dexmethylphenidate XR

dextroampheta mine ER

Intuniv®

Kapvay®

methamphetamine

Methylin®

Metadate® CD

methylphenidate CD

methylphenidate ER cap (gen Ritalin LA)

methylphenidate Liquid

modafinil

Mydayis®

Nuvigil®

Procentra®

Provigil®

Quillichew® ER

Quillivant®







dextroamphetamine soln (generic for Procentra)

Dyanavel® XR

Evekeo®

Ritalin® IR and SR

Vyvanse® chewable tabs Zenzedi®

Anti-Migraine: 5-HT1 Receptor Agonists and others

rizatriptan tablet

sumatriptan injection

sumatriptan nasal

sumatriptan tablet

almotriptan

Alsuma®

Amerge®

Axert®

Cambia®

Frova®

frovatriptan

Imitrex®

Maxalt® / Maxalt MLT®

Migranow®

naratriptan

Onzetra Xsail®

Relpax®

rizatriptan ODT

sumatriptan-naproxen

Sumavel®

Treximet®

Zecuity®

zolmitriptan

Zembrance Symtouch®

Zomig®

Atypical Antipsychotics Abilify discmelt®

Abilify® solution

aripiprazole tablet

clozapine

Latuda®

olanzapine

paliperidone

quetiapine (IR &ER)

risperidone solution

risperidone tablet

Saphris®

ziprasidone

Abilify® tablet

aripiprazole ODT

aripiprazole solution

clozapine ODT

Clozaril®

Fanapt®

Fazaclo®

Geodon®

Invega®

Nuplazid®

olanzapine / fluoxetine

Rexulti®

Risperdal®

risperidone ODT

Seroquel®

Seroquel XR®

Symbyax®

Versacloz®

Vraylar®

Zyprexa®

Atypical Antipsychotics Long Acting Injectables

* Clinical criteria may apply

Abilify® Maintena

Invega® Sustenna

Invega® Trinza

Risperdal® Consta

Aristada® Zyprexa® Relprevv

Multiple Sclerosis Agents

* Clinical criteria may apply

Avonex®

Avonex® pen

Betaseron®

Copaxone® 20mg Kit

Gilenya®

Rebif®

Rebif® Rebidose

Ampyra®

Aubagio®

Copaxone® 40mg syringe

Extavia®

glatiramer syringe

Glatopa®

Plegridy®

Tecfidera

Zinbryta®

Neuropathic Pain duloxetine

gabapentin caps & soln

Lyrica® capsules

Cymbalta®

Dermacinrx® PHN PAK

gabapentin tabs

Gralise® Horizant®

Irenka® (dulo\xetine 40mg)

lidocaine patch

Lidoderm®

Lyrica® CR

Lyrica® solution Neurontin®

Qutenza®

Smartrx Gaba® Kit

Savella®

Parkinson's Agents: Non-Ergot Dopamine Receptor Agonists

pramipexole

amantadine (caps & syrup)

ropinirole amantadine tabs

Mirapex®

Mirapex ER®

Neupro®

pramipexole ER

Requip®

Requip XL®

ropinirole ER

Sedative Hypnotic Agents flurazepam triazolam Ambien® / Ambien CR® Restoril®







temazepam 15 & 30 mg zolpidem tartrate IR Belsomra®

Doral®

Edluar®

eszopiclone

estazolam

Halcion®

Hetlioz®

Intermezzo®

Lunesta®

Rozerem®

Silenor®

Sonata®

temazepam 7.5 & 22.5mg

zaleplon

zolpidem (generic for Intermezzo)

zolpidem ER

Zolpimist®

Skeletal Muscle Relaxants baclofen

chlorzoxazone

cyclobenzaprine HCl

methocarbamol

tizanidine HCl tablet

Amrix®

carisoprodol

carisoprodol compound

Dantrium®

dantrolene sodium

Fexmid®

Lorzone®

metaxolone

Parafon Forte DSC®

orphenadrine

orphenadrine compound

Robaxin®

Skelaxin®

Soma®

tizanidine HCl capsule

Zanaflex®

ENDOCRINE AND METABOLIC AGENTS


Agents for Gout allopurinol

colchicines caps

probenecid

probenecid-colchicine

colchicine tabs

Colcrys®

Mitigare®

Uloric®

Zurampic®

Zyloprim®

Androgenic Agents Androgel® Androderm®

Axiron®

Fortesta®

Natesto® (nasal)

Testim®

testosterone (topical)

Vogelxo®

Bone: Bisphosphonates alendronate tablet Actonel®

alendronate soln

Atelvia®

Binosto®

Boniva®

Fosamax®

Fosamax® Plus D

ibandronate

risedronate

Bone: Nasal Calcitonins calcitonin, salmon Fortical® Miacalcin®

Bone: Others raloxifene Evista®

Forteo®

Prolia®

Tymlos®

Diabetes: Amylin Analogs N/A Symlin® Pens

Diabetes: DPP-IV Inhibitors Janumet®

Janumet® XR

Januvia®

Jentadueto®

Tradjenta®

alogliptin

alogliptin / metformin

alogliptin / pioglitazone

Glyxambi®

Jentadueto® XR

Kazano®

Kombiglyze XR®

Nesina®

Onglyza®

Oseni®

Ozempic®

Qtern®







Diabetes: GLP-1 Receptor Agonists Bydureon®

Byetta®

Victoza®

Adlyxin®

Bydureon® BCISE

Soliqua®

Steglujan®

Tanzeum®

Trulicity®

Xultophy®

Diabetes: Insulin Long Acting Lantus Solostar® Pen

Lantus® vial

Levemir® FlexPens

Levemir® vial

Basaglar®

Toujeo® Solostar

Tresiba®

Diabetes: Insulin Mixes 70/30 Humulin® 70/30 vial NovoLog® Mix 70/30 vial

NovoLog® Mix 70/30 flexpen syr

Humulin® 70/30 pen

Novolin® 70/30 vial

Relion Novolin 70/30 vial

Diabetes: Insulin Mixes - Other Humalog® Mix 50/50 vial

Humalog® Mix 75/25 vial

Novolog® Mix 50/50 pen

Novolog® Mix 50/50 vial

Humalog® Mix 50/50 kwikpen

Humalog® Mix 50/50 pen

Humalog® Mix 75/25 kwikpen

Humalog® Mix 75/25 pen

Diabetes: Insulin NPH Humulin® N 100 u/ml vial Humulin® N 100 u/ml pen

Novolin® N

Relion Novolin N 100 u/ml

Diabetes: Insulin Rapid Acting NovoLog® cartridge

Novolog® flexpen syr

Novolog® vial

Humalog® 100 u/ml vial

Admelog®

Apidra®

Apidra Solostar®

Fiasp®

Humalog® 100 u/ml cartridge

Humalog® 100 u/ml kwikpen

Humalog Junior Kwikpen®

Humalog® 100 u/ml pen

Humalog® 200 u/ml pen

Diabetes: Insulin Regular Humulin® R 100 u/ml vial Humulin® R 500 u/ml vial Afrezza® (Inhalation)

Humulin® R 100 u/ml Pen

Humulin® R 500 u/ml Pen

Novolin® R

Relion Novolin R 100 u/ml

Diabetes: Meglitinides nateglinide repaglinide Prandin® Starlix®

Diabetes: Meglitinide Combinations N/A PrandiMet® repaglinide / metformin

Diabetes: Metformins and Metformin-Sulfonylurea Combinations

metformin

metformin-glyburide

metformin ER (generic for Glucophage XR)

Fortamet®

Glucophage®

Glucophage XR®

Glucovance®

Glumetza®

metformin ER (generic for Fortamet and Glumetza)

metformin / glipizide

Riomet®

Diabetes: SGLT2 Inhibitors Farxiga®

Invokana®

Jardiance®

Xigduo XR®

Invokamet®

Invokamet® XR

Segluromet®

Steglatro®

Synjardy®

Diabetes: Thiazolidinediones pioglitazone Acotplus Met®

ActoPlus Met XR®

Actos®

Avandia®

DuetAct®

pioglitazone / glimepiride

pioglitazone / metformin







Growth Hormones*


Genotropin® cartridge

Genotropin® syringe

Nutropin®

Nutropin AQ Cartridge®

Nutropin AQ Vial®

Nutropin NuSpin®

Humatrope® Cartridge

Humatrope® Vial

Norditropin® Flexpro

Norditropin® Nordiflex

Omnitrope®

Saizen® Cartridge

Saizen® Vial

Serostim®

Tev-Tropin®

Zomacton®

Zorbtive®

Progestins Used for Cachexia megestrol acetate oral susp

Megace® oral susp Megace® ES oral susp

megestrol ES oral susp

Vaginal Estrogen Preparations

(Intravaginal and Topical)

Premarin® Vagifem® Estrace®

estradiol vaginal tablet

Estring®

Femring®

Intrarosa®

GASTROINTESTINAL


Antiemetics – Oral metoclopramide solution and tablet

ondansetron ODT

ondansetron tablet Akynzeo®

Anzemet®

aprepitant

Bonjesta®

Diclegis®

Emend®

granisetron

metoclopramide ODT

Metozolv ODT®

ondansetron solution

Reglan®

Sancuso®

Varubi®

Zofran® ODT

Zofran® Solution

Zofran® Tablet

Zuplenz®

Histamine-2-Receptor Antagonists famotidine tabs ranitidine tabs/syrup cimetidine tabs and soln

famotidine susp

nizatidine

Pepcid® tablets

Pepcid® oral susp

ranitidine caps

Zantac® tablets

Zantac® syrup

H. Pylori Combinations Pylera® Lansoprazole / amoxicillin / clarithromycin (pack)

Omeclamox-pak®

Prevpac®

Irritable Bowel Syndrome &

Chronic GI Motility

Amitiza®

Linzess®

Movantik® alosetron

Lotronex®

Relistor® oral and subQ.

Symproic®

Viberzi®

Pancreatic Enzymes Creon® Zenpep® Pancreaze®

Pertzye®

Ultresa®

Viokace®





GASTROINTESTINAL


Proton Pump Inhibitors omeprazole (Rx)

pantoprazole Aciphex®

Dexilant (Kapidex)®

esomeprazole (generic for Nexium)

esomeprazole strontium

lansoprazole (all)

Nexium®

Nexium® OTC

omeprazole OTC

omeprazole / sodium bicarbonate (all)

Prevacid® capsules

Prevacid® 15mg OTC

Prevacid SoluTab®

Prilosec® OTC

Prilosec® (Rx)

Prilosec® susp (Rx)

Protonix®

rabeprazole

Zegerid®

Ulcerative Colitis – Oral Apriso®

Delzicol®

sulfasalazine DR

sulfasalazine IR

Asacol-HD®

Azulfidine®

Azulfidine EN-tabs®

balsalazide

Colazal®

Dipentum®

Giazo®

Lialda®

mesalamine (IR & ER)

Pentasa®

Uceris®

Ulcerative Colitis – Rectal Canasa® rectal suppositories

mesalamine enema mesalamine kit

Rowasa® enema kit

Rowasa® enema

sfRowasa® enema

Uceris® rectal

GENITOURINARY AND RENAL


Alpha Blockers for BPH alfuzosin tamsulosin Flomax® Rapaflo®

Uroxatral®

Androgen Hormone Inhibitors dutasteride finasteride Avodart®

dutasteride / tamsulosin

Jalyn®

Proscar®

Electrolyte Depleters calcium acetate caps and tabs

Renagel®

Renvela® tablets

Auryxia®

Eliphos®

Fosrenol®

lanthanum carbonate

Phoslyra®

PhosLo®

Renvela® packets

sevelamer carbonate

Velphoro®

Urinary Tract Antispasmodics oxybutynin IR and ER tab

oxybutynin syrup

Toviaz®

Vesicare®

darifenacin

Detrol®

Detrol LA®

Ditropan XL®

Enablex®

flavoxate

Gelnique®

Myrbetriq ER®

Oxytrol®

tolterodine IR and ER

trospium IR and ER





HEMATOLOGICAL AGENTS


Anticoagulants Eliquis® tabs

enoxaparin syringe& vial

Pradaxa®

warfarin

Xarelto® tablet

Arixtra®

Coumadin®

Eliquis® dose pak

Fragmin®

Fondaparinux

Lovenox® syringe & vial

Savaysa®

Xarelto® dose pack

Hematopoietic Agents Aranesp® Procrit® Epogen®

IMMUNOLOGIC AGENTS


Immunomodulators Enbrel® Humira® Actemra® (subcutaneous)

Cimzia®

CimziaKit®

Cosentyx®

Ilaris ® (subcutane.)

Kevzara®

Kineret®

Orencia® SQ

Otezla®

Siliq®

Simponi®

Stelara®

Taltz®

Tremfya®

Xeljanz®

Immunomodulators, Topical imiquimod Aldara® Zyclara®

Immunomodulators Topical, Atopic Dermatitis

Elidel® Eucrisa®

Protopic®

tacrolimus oint.

Immunosuppressants azathioprine

Cellcept® susp

cyclosporine

cyclosporine, modified

Gengraf®

Hecoria®

mycophenolate mofetil

Myfortic®

sirolimus

tacrolimus

Astagraf XL®

Azasan®

Cellcept®

Envarsus® XR

Imuran®

mycophenolic acid

Neoral®

Prograf®

Rapamune®

Sandimmune®

Zortress®

Methotrexate Agents methotrexate tab

methotrexate vial

methotrexate vial pf Otrexup® auto inject

Rasuvo® auto injector

Rheumatrex® dose pack

Trexall®

Xatmep® soln

OPHTHALMICS


Allergic Conjunctivitis Agents:

Antihistamines

ketotifen OTC Pataday®

Pazeo®

Alrex®

azelastine ophth drops

Bepreve®

Elestat®

Emadine®

epinastine

Lastacaft®

olopatadine

Optivar®

Patanol®

Zaditor® OTC





OPHTHALMICS


Allergic Conjunctivitis Agents:

Mast Cell Stabilizers

cromolyn Alocril® Alomide®

Glaucoma Agents:

Alpha2 Adrenergic Agents

Alphagan P 0.1%®

Alphagan P 0.15%®

brimonidine 0.2% apraclonidine

brimonidine P 0.15%

Iopidine®

Glaucoma Agents:

Beta Blockers

Betimol®

carteolol

Combigan®

levobunolol

metipranolol

timolol maleate timolol maleate gel-forming soln

Betagan®

betaxolol

Betoptic S®

Istalol®

Timoptic®

Timoptic-XE®

Glaucoma Agents:

Carbonic Anhydrase Inhibitors

Azopt®

dorzolamide

dorzolamide / timolol

Simbrinza®

Cosopt®

Cosopt® PF

Trusopt®

Glaucoma Agents:

Prostaglandin Agonists

latanoprost Travatan Z® bimatoprost

Lumigan®

Travoprost

Xalatan®

Zioptan®

OPHTHALMICS


Ophthalmic Antiinflammatories: Corticosteroids

dexamethasone

Durezol®

Lotemax drops®

prednisolone acetate

Flarex®

FML®

FML Forte®

FML S.O.P.®

fluorometholone

Lotemax gel®

Lotemax oint®

Maxidex®

Omnipred®

Pred Forte®

Pred Mild®

prednisolone sodium

phosphate

Vexol®

Ophthalmic Antiinflammatories: NSAIDs

diclofenac sodium

flurbiprofen

ketorolac ophth 0.4 (LS)

ketorolac ophth 0.5

Acular®

Acular LS®

Acuvail®

Bromfenac®

Bromsite®

Ilevro®

Nevanac®

Ocufen®

Prolensa®

Ophthalmic Antibiotics: Macrolides erythromycin Azasite® Ilotycin®





OPHTHALMICS


Ophthalmic Antibiotics: Quinolones ciprofloxacin drops

Moxeza®

ofloxacin drops

Vigamox®

Zymar®

Besivance®

Ciloxan Drops®

Ciloxan ointment®

Gatifloxacin

levofloxacin ophth

Ocuflox®

Zymaxid®

Ophthalmic Antibiotic-Steroid Combinations

neomycin / polymyxin / dexamethasone

Tobradex® oint

Tobradex® susp

Blephamide®

Blephamide® S.O.P.

Maxitrol® drops

Maxitrol® oint

neomycin/bacitracin/ polymyxin/HC

neomycin/polymyxin/HC

Preg-G® drops

Pred-G® oint

sulfacetamide / prednisolone

Tobradex® ST

tobramycin / dexamethasone susp

Zylet®

OTICS


Otic Antibiotics Ciprodex®

ciprofloxacin otic

neomycin/polymyxin/HC soln and susp

Cipro HC®

Coly-Mycin S®

Cortisporin® soln

Cortisporin-TC®

ofloxacin drops

PAH AGENTS


Endothelin Receptor Antagonists and Other PAH agents

Tracleer®

Letairis®

Adempas®

Opsumit®

Orenitram® ER

Uptravi®

PAH, Inhalation Tyvaso® Ventavis® N/A

PDE Inhibitors for PPH/PAH


Adcirca® sildenafil Revatio®

RESPIRATORY


Inhaled Antibiotics Bethkis® Kitabis® Pak Cayston®

Tobi®

Tobi podhaler®

tobramycin inhaled soln

COPD Agents Atrovent HFA®

Combivent Respimat®

ipratropium / albuterol nebs

ipratropium bromide

Spiriva®

Airduo Respiclick®

Anoro Ellipta®

Bevespi Aerosphere

Daliresp®

DuoNeb®

fluticasone/salmeterol

Incruse Ellipta®

Lonhala Magnair®

Seebri Neohaler®

Spiriva Respimat®

Stiolto Respimat®

Tudorza Pressair®

Utibron Neohaler®





RESPIRATORY


Antihistamines, Non-Sedating cetirizine solution

cetirizine solution (OTC)

cetirizine tablets (OTC)

loratadine / pseudoephedrine (OTC)

loratadine solution (OTC)

loratadine tablet

Allegra®

Allegra® ODT

Allegra-D®

cetirizine 5 mg/5 ml OTC solution

cetirizine chewable (OTC)

cetirizine-D (Rx and OTC)

Clarinex®

Clarinex-D®

Claritin®

Claritin-D®

desloratadine

fexofenadine

fexofenadine-D

levocetirizine

loratidine ODT (OTC)

Semprex-D®

Xyzal®

Zyrtec®

Beta Agonists: Oral Agents albuterol syrup metaproterenol syrup albuterol ER

albuterol tablet

metaproterenol tablet

terbutaline

Vospire ER®

Beta Agonists: Short-Acting MDI ProAir® HFA Proventil HFA® Maxair Autohaler®

Ventolin HFA®

Xopenex HFA®

Beta Agonists: Long-Acting MDI*

*COPD only

Foradil® Arcapta®

Serevent Diskus®

Striverdi Respimat®

Beta Agonists: Nebulizer albuterol sulfate albuterol (gen for AccuNeb®)

AccuNeb®

Brovana®

levalbuterol inh soln

Perforomist®

Xopenex®

Beta Agonists: Combination Products

Advair Diskus®

Advair HFA®

Dulera®

Symbicort®

Breo Ellipta® Trelegy Ellipta®

Corticosteroids Inhaled Asmanex®

Flovent Diskus®

Flovent HFA®

QVAR®

Pulmicort® 0.25, 0.5 mg & 1 mg respules

Aerospan®

Alvesco®

Armonair Respiclick®

Arnuity Ellipta®

Asmanex HFA®

budesonide 0.25, 0.5 mg & 1 mg respules Pulmicort Flexhaler® QVAR® Redihaler

Intranasal Corticosteroids fluticasone propionate Beconase AQ®

budesonide nasal spray

Dymista®

Flonase®

Flunisolide

mometasone

Nasacort AQ®

Nasonex®

Omnaris®

Qnasl®

Rhinocort Aqua®

Ticanase®

Ticalast®

triamcinolone Nasal Spray

Veramyst®

Zetonna®

Intranasal Rhinitis Agents azelastine ( generic for Astepro only)

ipratropium

Patanase® Astelin®

Astepro®

Atrovent®

azelastine

olopatadine

Leukotriene Receptor Antagonists montelukast zafirlukast Accolate®

Singulair®

zileuton ER

Zyflo® CR

Self-Injectable Epinephrine Adrenaclick® 0.15mg & 3mg

epinephrine 0.15mg, 3mg injector

epinephrine 0.15mg, 3mg injector (generic for EpiPen)

Auvi-Q®

EpiPen®

EpiPen® Jr.

Smoking Cessation Agents bupropion SR

Chantix®

Chantix®dose pack

nicotine gum OTC

nicotine lozenge OTC

nicotine patch OTC

Nicoderm®CQ patch

Nicorette®gum OTC

Nicorette® lozenge OTC

Nicotrol® inhaler

Nicotrol® NS nasal spray

Zyban®





TOPICAL AGENTS FOR ACNE


Benzoyl Peroxide Combination, Antibiotic and other Products

Benzaclin® with pump Aczone®

Acanya Gel and pump®

Benzaclin® topical

Benzamycin® topical

benzoyl peroxide / clindamycin

dapsone

Duac® CS

erythromycin gel

erythromycin-benzoyl peroxide topical

Neuac®

Onexton®

Topical Retinoids Epiduo®

Retin-A® cream and gel

Tazorac® Cream & Gel adapalene

adapalene/benzoyl peroxide

Atralin®

Avita®

clindamycin/tretinoin

Dermapak® Plus

Differin®

Epiduo® Forte

Fabior®

Retin-A® micro

Retin-A® micro pump

tazarotene

tretinoin

tretinoin micro

Tretin-X®

Veltin®

Ziana®

TOPICAL AND ORAL AGENTS FOR PSORIASIS


Oral Agents for Psoriasis acitretin Soriatane®

Topical Agents for Psoriasis calcipotriene crm

calcipotriene oint

calcipotriene scalp soln

calcipotriene / betamethasone

calcitrene

calcitriol oint

Dovonex® cream

Enstilar®

Sorilux®

Taclonex®

Vectical®

TOPICAL AGENTS FOR ROSACEA


Rosacea Agents Finacea® gel

Metrocream®

Metrogel® Finacea® foam

Metrolotion®

metronidazole crm, gel & lotion

Mirvaso®

Noritate®

Rhofade®

Rosadan®

Soolantra®





TOPICAL STEROIDS


Low Potency Topical Steroids desonide (crm & oint) hydrocortisone (crm & oint)

alclometasone dipropionate (crm, oint)

Aqua Glycolic HC®

Capex Shampoo®

Derma-Smoothe-FS®

Desonate gel®

desonide lotion

Desowen®

fluocinolone 0.01% oil

hydrocortisone lotion

hydrocortisone/min oil/ pet oint

hydrocortisone acetate / urea

hydrocortisone / aloe gel

Micort-HC®

Pediaderm HC®

Pediaderm TA®

Texacort®

Tridesilon®

U-Cort®

Verdeso®

Medium Potency Topical Steroids hydrocortisone butyrate soln

hydrocortisone valerate (crm & oint)

mometasone furoate (crm & oint)

betamethasone valerate foam

clocortolone crm

Cloderm®

Cordran® Lotion

Cordran® SP oint

Cordran Tape®

Cutivate® (crm & lot)

Dermatop® (crm & oint)

Elocon®(crm, oint & soln)

fluocinolone acetonide (crm, oint & soln)

flurandrenolide (crm, lot)

fluticasone propionate (crm, lot &oint)

hydrocortisone butyrate (crm, emol & oint)

Luxiq®

mometasone furoate soln

Momexin®

Noxipak®

Pandel®

Prednicarbate (crm & oint)

Synalar® kit (crm & oint)

Synalar® soln

Synalar® TS kit

High Potency Topical Steroids betamethasone dipropionate (crm & lot)

betamethasone valerate (crm, lot & oint)

fluocinonide (crm, emollient, gel & soln)

triamcinolone acetonide (crm & oint)

amcinonide (crm, lot, oint)

betamethasone dipropionate (gel & oint)

betamethasone dipropionate / prop gly (crm, lot & oint)

Dermacin®

Dermacin Silazone®

desoximetasone (crm, gel & oint)

diflorasone diacetate (crm & oint)

Diprolene® (lot & oint)

Diprolene AF® cream

Ellzia® Pak

fluocinonide oint

Halog® (crm & oint)

Kenalog Aerosol®

Sernivo®

Topicort LP®

triamcinolone acetonide (aerosol & lotion)

triamcinolone/dimethicone

Trianex®

Vanos®

Very High Potency Topical Steroids clobetasol emollient cream

clobetasol propionate (crm, gel, oint & soln)

halobetasol propionate (crm & oint)

Apexicon E®

clobetasol lotion & shampoo

clobetasol propionate (foam & spray)

Clobex®

Clodan®

Halonate®

Olux®

Olux-E®

Temovate®

Ultravate®

district of columbia - dc.fhsc.com of columbia department of health care finance pharmacy preferred...

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