prescription drug formulary optima … · optima health prescription drug formulary optima family...

Revised: 6/28/2018

OPTIMA HEALTH PRESCRIPTION DRUG FORMULARY

OPTIMA FAMILY CARE (FAMIS) (July September 2018)

Effective: July 1, 2018

Table of Contents

ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

PENICILLINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

CEPHALOSPORIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

FIRST GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

SECOND GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

THIRD GENERATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

MACROLIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

TETRACYCLINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

QUINOLONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

AMINOGLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

SULFONAMIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

ANTIMYCOBACTERIAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

ANTIFUNGALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

ANTIVIRALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

ANTIMALARIALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

ANTHELMINTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

MISC. ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

ANTINEOPLASTICS, ETC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

ALKYLATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

ANTIMETABOLITES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

HORMONAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

MITOTIC INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

ENZYME INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

TOPOISOMERASE I INHIBITOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

ANTINEOPLASTICS MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

CHEMOTHERAPY RESCUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

ANTINEOPLASTIC COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

CARDIOVASCULAR DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

CARDIAC GLYCOSIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

ANTIANGINAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

BETA BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

CALCIUM CHANNEL BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

ANTIARRHYTHMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

ACE INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

ANGIOTENSIN RCPTR BLOCKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

ANTIHYPERTENSIVES MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

ANTIHYPERTENSIVE COMBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

DIURETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

VASOPRESSORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

ANTIHYPERLIPIDEMICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

CARDIOVASCULAR - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

DERMATOLOGICALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

ACNE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

ROSACEA AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

ANTIBIOTICS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

ANTIFUNGALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

ANTIVIRALS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

ANTI-INFLAMMATORY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

ANTIPSORIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

ANTISEBORRHEIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

CORTICOSTEROIDS - TOPICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

IMMUNOMODULATING AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

DERMATOLOGICALS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

ENDOCRINE AND METABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

CORTICOSTEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

ANDROGENS-ANABOLIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

ESTROGENS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

CONTRACEPTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

PROGESTINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

ANTIDIABETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

INSULIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

INCRETIN MIMETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

SULFONYLUREAS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

BIGUANIDES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

MEGLITINIDE ANALOGUES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

DIABETIC OTHER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

ALPHA-GLUCOSIDASE INHIBIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

DPP-4 INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

INSULIN SENSITIZING AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

ANTIDIABETIC COMBINATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

BISPHOSPHONATES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

CALCITONINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

PARATHYROID HORMONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

HORMONE RECEPTOR MDLTR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

FERTILITY REGULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

LHRH/GNRH AGONIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

GROWTH HORMONES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

SOMATOSTATIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

POSTERIOR PITUITARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

PROLACTIN INHIBITORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

METABOLIC MODIFIERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

THYROID AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

GASTROINTESTINAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

LAXATIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

ANTIDIARRHEALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

ANTACIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

ULCER DRUGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

ANTIEMETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

DIGESTIVE AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

GASTROINTESTINAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

GENITOURINARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

URINARY ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

URINARY ANTISPASMODICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

VAGINAL PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

GENITOURINARY - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

HEMATOLOGICAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

HEMATOPOIETIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

ANTICOAGULANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

HEMOSTATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

HEMATOLOGICAL - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

MOUTH/THROAT/DENTAL AGENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

NEUROLOGY, CNS, PSYCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

ANTIANXIETY AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

ANTIDEPRESSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

ANTIPSYCHOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

HYPNOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

ADHD, NARCOLEPSY, ETC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

ANTICONVULSANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

ANTIPARKINSON AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

NEUROLOGY, PSYCH - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

NEUROMUSCULAR AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

MUSCULOSKELETAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

ANTIMYASTHENIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

OPHTHALMOLOGY AND OTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

ANTI-INFECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

BETA-BLOCKERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

OPHTHALMIC STEROIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

PROSTAGLANDINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

CYCLOPLEGIC MYDRIATICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

DECONGESTANTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

MIOTICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

ADRENERGIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

IMMUNOMODULATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

LOCAL ANESTHETICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

OPHTHALMICS - MISC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

OTIC AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

OXYTOCICS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

PAIN MANAGEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

ANALGESICS - NONNARCOTIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

ANALGESICS - OPIOID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

ANTI-INFLAMMATORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

MIGRAINE PRODUCTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

GOUT AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

RESPIRATORY, ALLERGY, ETC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

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

NASAL AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

COUGH/COLD/ALLERGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

ANTIASTHMATIC/COPD AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

RESPIRATORY AGENTS - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

VACCINES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

VITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

MULTIVITAMINS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

MEDICAL DEVICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

DIABETIC SUPPLIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

MEDICAL DEVICES - MISC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

MISCELLANEOUS AGENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

doxycycline

doxycycline hyclate

doxycycline hyclate DRST

doxycycline monohydrate

July 2018

minocycline hydrochloride

minocycline hydrochlorideerST

ANTI-INFECTIVES

minocycline HCL

minocycline HCL ERST

PENICILLINS

mondoxyne nl

FORMULARY FORMULARY

morgidox 1X100MG

amoxicillin

morgidox 1X50MG

amoxicillin/clavulanate potassium

morgidox 2X100MG

amoxicillin/clavulanate potassium ER

okebo

ampicillin

soloxideST

dicloxacillin sodium

tetracycline hydrochloride

penicillin v potassium

tetracycline HCL

Amoxicillin

Tetracycline HCL

Amoxicillin ER

Vibramycin

Amoxicillin/Clavulanate Potassium

Ampicillin

Augmentin

QUINOLONES

Penicillin V Potassium

FORMULARY FORMULARY

ciprofloxacin

CEPHALOSPORIN

ciprofloxacin ER

FIRST GENERATION

ciprofloxacin HCL

FORMULARY FORMULARY

levofloxacin

cefadroxil

moxifloxacin HCL

cephalexin

Ciprofloxacin HCL

Cephalexin

Levofloxacin

SECOND GENERATION

FORMULARY FORMULARY

AMINOGLYCOSIDES

cefaclor

FORMULARY FORMULARY

cefprozil

neomycin sulfate

cefuroxime axetil

paromomycin sulfate

Cefaclor

tobramycinQL

Ceftin

QL

THIRD GENERATION

FORMULARY FORMULARY

SULFONAMIDES

cefdinir

FORMULARY FORMULARY

cefixime

Sulfadiazine

cefpodoxime proxetil

Suprax

ANTIMYCOBACTERIAL AGENTS

FORMULARY FORMULARY

MACROLIDES

ethambutol HCL

isoniazid

FORMULARY FORMULARY

pyrazinamide

azithromycin

rifabutin

clarithromycin

rifampin

clarithromycin ER

Cycloserine

erythromycin

Isoniazid

erythromycin base

Rifamate

erythromycin ethylsuccinate

Azithromycin

ANTIFUNGALS

Clarithromycin

E.e.s. 400

FORMULARY FORMULARY

Ery-TAB

bio-statin

Eryped 400

fluconazole

Erythrocin Stearate

flucytosine

Erythromycin Ethylsuccinate

griseofulvin microsize

PCE

griseofulvin ultramicrosize

itraconazole

ketoconazole

TETRACYCLINES

nystatin

terbinafine HCL

FORMULARY FORMULARY

voriconazole

avidoxy

coreminoST

demeclocycline hydrochloride

ANTIVIRALS

demeclocycline HCL

FORMULARY FORMULARY

abacavir

Effective July 1, 2018

PA=Prior Auth Required; ST=Step Therapy; QL=Quantity Limits; AL=Age Limit; 1

abacavir sulfate/lamivudine/zidovudine

Truvada

abacavir/lamivudine

Tybost

acyclovir

Vemlidy

atazanavir

Videx Pediatric

atazanavir sulfate

Viekira PAKPA

didanosine

Viekira XRPA

efavirenz

Viracept

efavirnez

Viread

entecavir

Vitekta

famciclovir

VoseviPA

fosamprenavir calcium

ZepatierPA

lamivudine

lamivudine/zidovudine

lopinavir/ritonavir

ANTIMALARIALS

moderiba

FORMULARY FORMULARY

nevirapine

atovaquone/proguanil HCL

nevirapine ER

chloroquine phosphate

oseltamivir phosphateQL

hydroxychloroquine sulfate

ribasphere

mefloquine HCL

ribavirin

quinine sulfate

rimantadine HCL

Chloroquine Phosphate

ritonavir

DaraprimPA

stavudine

Mefloquine HCL

tenofovir disoproxil fumarate

Primaquine Phosphate

valacyclovir HCL

valganciclovir

valganciclovir hydrochlordeAL

ANTHELMINTICS

zidovudine

FORMULARY FORMULARY

Aptivus

ivermectin

Atripla

pinworm medicine

Biktarvy

reeses pinworm medicine

Complera

EmvermST

Crixivan

Reeses Pinworm Medicine

Descovy

Edurant

Emtriva

MISC. ANTI-INFECTIVES

EpclusaPA

FORMULARY FORMULARY

Evotaz

atovaquone

Fuzeon

clindamycin palmitate HCL

Genvoya

clindamycin HCL

HarvoniPA

dapsone

Intelence

linezolid

Invirase

metronidazole

Isentress

sulfamethoxazole/trimethoprim

Isentress HD

sulfamethoxazole/trimethoprim DS

Juluca

sulfatrim pediatric

Kaletra

tinidazole

Lexiva

trimethoprim

MavyretPA

vancomycin

Norvir

vancomycin HCL

Odefsey

Alinia

Peg-intron Redipen

Cayston

Peg-intron Redipen PAK 4

First-vancomycin 25

Pegasys

First-vancomycin 50

Pegasys Proclick

Firvanq

Pegintron

Linezolid

Prezcobix

Nebupent

Prezista

Rebetol

Relenza DiskhalerQL

ANTINEOPLASTICS, ETC.

Rescriptor

ALKYLATING AGENTS

Reyataz

FORMULARY FORMULARY

Ribasphere

cyclophosphamide

Ribasphere Ribapak

melphalanQL

Selzentry

temozolomide

SovaldiPA

Cyclophosphamide

Stribild

Gleostine

TamifluQL

Hexalen

Tivicay

Leukeran

Triumeq



Myleran

Alecensa

Valchlor

Bosulif

Yondelis

CabometyxQL

Caprelsa

Cometriq

ANTIMETABOLITES

Cotellic

Farydak

FORMULARY FORMULARY

Gilotrif

capecitabine

Ibrance

mercaptopurine

Iclusig

methotrexate

Idhifa

methotrexate sodium

Imbruvica

Methotrexate Sodium

Inlyta

Purixan

IressaPA

Tabloid

Jakafi

Trexall

KisqaliPA

Xatmep

Lenvima 10 MG Daily Dose


HORMONAL AGENTS


FORMULARY FORMULARY


anastrozole


bicalutamide


exemestane

Lynparza

flutamide

Mekinist

letrozole

Nerlynx

leuprolide acetate

Nexavar

megestrol acetate

Ninlaro

nilutamide

RubracaQL,PA

tamoxifen citrate

Rydapt

Eligard

Sprycel

Emcyt

Stivarga

Fareston

Sutent

Firmagon

Tafinlar

Lupron Depot (1-month)

Tagrisso


Tarceva


Tasigna


Tykerb

Lysodren

VerzenioPA

Soltamox

Votrient

Vantas

XalkoriPA

Xtandi

ZejulaPA

Zoladex

ZelborafPA

Zytiga

Zolinza

Zydelig

Zykadia

IMMUNOMODULATORS

FORMULARY FORMULARY

TOPOISOMERASE I INHIBITOR

azathioprine

FORMULARY FORMULARY

cyclosporine

Hycamtin

cyclosporine modified

Onivyde

gengraf

mycophenolate mofetil

ANTINEOPLASTICS MISC.

mycophenolic acid DR

FORMULARY FORMULARY

sirolimus

bexarotene

tacrolimus

hydroxyurea

Cyclosporine Modified

tretinoin

Pomalyst

ActimmunePA

Revlimid

Alferon N

Sandimmune

Intron A

Thalomid

Intron A W/Diluent

Matulane

MITOTIC INHIBITORS

Sylatron

FORMULARY FORMULARY

Etoposide

CHEMOTHERAPY RESCUE

FORMULARY FORMULARY

ENZYME INHIBITORS

leucovorin calcium

FORMULARY FORMULARY

Leucovorin Calcium

imatinib mesylate

Mesnex

Afinitor

Afinitor Disperz



ANTINEOPLASTIC COMBO

isradipine

nicardipine HCL

FORMULARY FORMULARY

nifedical XL

Kisqali Femara 200 Dose

nifedipine


nifedipine ER


nimodipine

Lonsurf

taztia XT

verapamil HCL

CARDIOVASCULAR DRUGS

verapamil HCL ER

CARDIAC GLYCOSIDES

verapamil HCL SR

FORMULARY FORMULARY

Cardizem LA

digitek

digox

ANTIARRHYTHMICS

digoxin

FORMULARY FORMULARY

Digoxin

amiodarone hydrochloride

amiodarone hydrocloride

ANTIANGINAL AGENTS

amiodarone HCL

FORMULARY FORMULARY

disopyramide phosphate

isosorbide dinitrate

dofetilide

isosorbide mononitrate

flecainide acetate

isosorbide mononitrate ER

mexiletine HCL

minitran

propafenone hydrochloride ER

nitro-time

propafenone hydrochlorideer

nitroglycerin

propafenone HCL

nitroglycerin lingual

propafenone HCL ER

nitroglycerin transdermal

quinidine gluconate CR

nitroglycerin ER

quinidine gluconate ER

Dilatrate SR

Multaq

Isosorbide Dinitrate ER

Norpace CR

Nitro-bid

Quinidine Sulfate

Nitro-dur

Nitroglycerin Lingual

ACE INHIBITORS

FORMULARY FORMULARY

BETA BLOCKERS

benazepril HCL

FORMULARY FORMULARY

captopril

acebutolol hydrochloride

enalapril maleate

acebutolol HCL

fosinopril sodium

atenolol

lisinopril

betaxolol HCL

quinapril hydrochloride

bisoprolol fumarate

quinapril HCL

carvedilol

ramipril

labetalol hydrochloride

trandolapril

labetalol HCL

Epaned

metoprolol succinate ER

metoprolol tartrate

ANGIOTENSIN RCPTR BLOCKER

nadolol

FORMULARY FORMULARY

pindolol

candesartan cilexetil

propranolol hydrochloride

irbesartan

propranolol HCL

losartan potassium

propranolol HCL ER

olmesartan medoxomil

sotalol hydrochloride

telmisartan

sotalol hydrochloride (AF)

valsartan

sotalol hydrocholride

Eprosartan Mesylate

sotalol HCL

sotalol HCL (AF)

ANTIHYPERTENSIVES MISC.

Metoprolol Tartrate

FORMULARY FORMULARY

Propranolol HCL

clonidine HCL

doxazosin

doxazosin mesylate

CALCIUM CHANNEL BLOCKERS

eplerenone

FORMULARY FORMULARY

guanfacine HCL

afeditab CR

hydralazine hydrochloride

amlodipine besylate

hydralazine HCL

cartia XT

methyldopa

dilt-XR

minoxidil

diltiazem CD

phenoxybenzamine hydrochloride

diltiazem HCL

prazosin HCL

diltiazem HCL CD

terazosin HCL

diltiazem HCL ER

felodipine ER



ANTIHYPERTENSIVE COMBO

ANTIHYPERLIPIDEMICS

FORMULARY FORMULARY

FORMULARY FORMULARY

amlodipine besylate/benazepril hydrochloride

atorvastatin calcium

amlodipine besylate/benazepril HCL

cholestyramine

amlodipine besylate/valsartan

cholestyramine light

amlodipine/olmesartan medoxomil

colestipol HCL

amlodipine/valsartan/hctz

fenofibrate

atenolol/chlorthalidone

fenofibrate micronized

benazepril HCL/hydrochlorothiazide

fenofibric acid DR

bisoprolol fumarate/hydrochlorothiazide

fluvastatin

candesartan cilexetil/hydrochlorothiazide

fluvastatin sodium ERST

enalapril maleate/hydrochlorothiazide

gemfibrozil

fosinopril sodium/hydrochlorothiazide

lovastatin

irbesartan/hydrochlorothiazide

niacin ER

lisinopril/hydrochlorothiazide

omega-3-acid ethyl estersPA

losartan potassium/hydrochlorothiazide

pravastatin sodium

metoprolol/hydrochlorothiazide

prevalite

moexipril/hydrochlorothiazide

rosuvastatin calcium

nadolol/bendroflumethiazide

simvastatin

olmesartan medoxomil/hydrochlorothiazide

trikloPA

quinapril/hydrochlorothiazide

Fenofibrate

telmisartan/amlodipine

Fenofibric Acid

telmisartan/hydrochlorothiazide

Niacor

trandolapril/verapamil HCL ER

RepathaQL,PA

valsartan/hydrochlorothiazide

Repatha Pushtronex SystemQL,PA

Captopril/Hydrochlorothiazide

Repatha SureclickQL,PA

Clorpres

Welchol

Methyldopa/Hydrochlorothiazide

Metoprolol/Hydrochlorothiazide

Propranolol/Hydrochlorothiazide

CARDIOVASCULAR - MISC.

Trandolapril/Verapamil HCL ER

FORMULARY FORMULARY

amlodipine besylate/atorvastatin calcium

sildenafilQL,PA

DIURETICS

sildenafil citrateQL,PA

FORMULARY FORMULARY

AdcircaPA

acetazolamide

Adempas

acetazolamide ER

Letairis

amiloride HCL

Opsumit

amiloride/hydrochlorothiazide

RevatioPA

bumetanide

Tracleer

chlorothiazide

Tyvaso

chlorthalidone

Tyvaso Refill

furosemide

Tyvaso Starter

hydrochlorothiazide

UptraviPA

indapamide

Ventavis

methazolamide

metolazone

DERMATOLOGICALS

spironolactone

ACNE PRODUCTS

spironolactone/hydrochlorothiazide

FORMULARY FORMULARY

torsemide

acne medication 5

triamterene/hydrochlorothiazide

adapalene

Aldactazide

adapalene P.M.

Chlorothiazide

amnesteem

Diuril

avar cleanser

Furosemide

avita

Methyclothiazide

benzoyl peroxide

Triamterene/Hydrochlorothiazide

bp gel

claravis

clearplex v

VASOPRESSORS

clindacin etz pledgets

FORMULARY FORMULARY

clindacin-p

midodrine HCL

clindamycin phosphate

AdrenaclickQL

clindamycin/benzoyl peroxide

Auvi-qQL

ery

EpinephrineQL

erythromycin

Epipen 2-PAKQL

erythromycin/benzoyl peroxide

Epipen-JR 2-PAKQL

isotretinoin

kp benzoyl peroxide

myorisan



neuac

HM bacitracin

rosanil cleanser

HM triple antibiotic

sodium sulfacetamide

HM triple antibiotic plus maximum strength

sodium sulfacetamide/sulfur

SB bacitracin

sodium sulfacetamide/sulfur cleanser

SB triple antibiotic

sulfacetamide sodium

sulfacetamide sodium/sulfur cleanser

tretinoin

ANTIFUNGALS - TOPICAL

tretinoin microsphereST

FORMULARY FORMULARY

tretinoin microsphere P.M.ST

anti-fungal

zenatane

antifungal

Clindacin Etz

antifungal foot

Clindacin PAC

athletes foot

CVS creamy acne face wash

athletes foot AF cream

DifferinAL

baza antifungal

Panoxyl-4 Creamy Wash

carrington antifungal

Sodium Sulfacetamide/Sulfur

cavilon

ciclodan

ciclopirox

ROSACEA AGENTS

ciclopirox nail lacquer

FORMULARY FORMULARY

ciclopirox olamine

metronidazole

clotrimazole

rosadan

clotrimazole anti-fungal

DoxycyclineST

clotrimazole antifungal

Metronidazole

clotrimazole grx

Mirvaso

clotrimazole AF

Rhofade

clotrimazole/betamethasone dipropionate

desenex

ANTIBIOTICS - TOPICAL

econazole nitrate

eq antifungal

FORMULARY FORMULARY

eq athletes foot

bacitracin

eq jock itch

bacitracin/neomycin/polymyxin

eql antifungal

bacitraycin plus

eql athletes foot

bactericin

fungicure intensive with nailguard

curad triple antibiotic

gnp athletes foot

eq triple antibiotic

gnp terbinafine hydrochloride

eql first aid antibiotic

jock itch

eql first aid antibiotic + pain relief maximum strength

jock itch relief

first aid antibiotic

ketoconazole

gentamicin sulfate

kp clotrimazole

gnp first aid antibiotic

kp miconazole nitrate

gnp triple antibiotic

kp terbinafine hydrochloride

gnp triple antibiotic plus

micaderm

lanabiotic

miconazole antifungal

medi-first triple antibiotic

miconazole nitrate

meijer triple antibiotic

nyamyc

mupirocin

nyata

neoporacin

nystatin

neosporin + pain relief maximum strength

nystatin/triamcinolone

neosporin pain/itch/scar

nystatin/triamcinolone acetonide

px triple ointment

nystop

qc bacitracin

podactin

ra antibiotic/pain relief maximum strength

pro-EX antifungal

ra triple antibiotic

px athletic foot

ra triple antibiotic plus

qc athletes foot

sm first aid antibiotic

qc clotrimazole

sm triple antibiotic

ra antifungal

sm triple antibiotic original strength

ra antifungal foot care

sm triple antibiotic plus maximum strength

ra athletes foot

tgt antibiotic

ra clotrimazole

tgt bacitracin

ra foot care antifungal

tri-biozene

ra jock itch

triple antibiotic

remedy antifungal

triple antibiotic plus

secura antifungal

triple antibiotic plus maximum strength

secura antifungal extra thick

triple antibiotic with pain relief maximum strength

shopko athletes foot

CVS antibiotic

sm antifungal clotrimazole

CVS triple antibiotic

sm antifungal miconazole

CVS triple antibiotic maximum strength



sm athletes foot

eql anti-itch maximum strength plus 10 healing moisturizers

soothe & cool inzo antifungal cream

fluocinolone acetonide

terbinafine HCL

fluocinolone acetonide body

tgt athletes foot

fluocinolone acetonide scalp

tgt clotrimazole

fluocinonide

tineacide

fluocinonide emulsified base

CVS athletes foot

fluticasone propionate

CVS clotrimazole

gnp hydrocortisone

CVS itch relief antifungal

gnp hydrocortisone maximum strength

CVS jock itch

gnp hydrocortisone plus

CVS ringworm

halobetasol propionate

Exoderm

hydrocortisone

SB clotrimazole foot

hydrocortisone butyrate

hydrocortisone butyrate (lipid)

hydrocortisone butyrate (lipophilic)

ANTIVIRALS - TOPICAL

hydrocortisone intensive healing

FORMULARY FORMULARY

hydrocortisone maximum strength

acyclovir

hydrocortisone maximum strength plus 10 moisturizers

hydrocortisone maximum strength plus 12 moisturizers

ANTI-INFLAMMATORY AGENTS

hydrocortisone plus

FORMULARY FORMULARY

hydrocortisone valerate

diclofenac sodium

hydrocortisone IN absorbase

hydrocortisone 1% IN absorbase

ANTIPSORIATICS

hydroskin

FORMULARY FORMULARY

instacort 5

acitretin

kericort 10

calcipotriene

kp hydrocortisone

calcitrene

kp hydrocortisone maximum strength

methoxsalen

lokara

Dritho-creme HP

meijer hydrocortisone

SiliqPA

mometasone furoate

TremfyaPA

neosporin eczema essentials maximum strength

8-mop

noble formula HC

prednicarbate

ANTISEBORRHEIC AGENTS

preparation h hydrocortisone

FORMULARY FORMULARY

px hydrocream

seb-prev wash

qc hydrocortisone

selenium sulfide

qc hydrocortisone maximumstrength

selenium sulfide shampoo

ra anti-itch maximum strength

sodium sulfacetamide

ra anti-itch/maximum strength

sodium sulfacetamide wash

ra hydrocortisone maximumstrength

ra hydrocortisone plus 12

CORTICOSTEROIDS - TOPICAL

recort plus

FORMULARY FORMULARY

scalacort

ala-cort

sm hydrocortisone

alclometasone dipropionate

sm hydrocortisone maximum strength

alphatrex

tgt anti-itch maximum strength

anti-itch maximum strength

tgt anti-itch plus oatmeal

augmented betamethasone dipropionate

tgt anti-itch/aloe/vitamin e

aveeno anti-itch maximum strength

triamcinolone acetonide

betamethasone dipropionate

triderm

betamethasone valerate

Amcinonide

calcipotriene/betamethasone dipropionateST

Augmented Betamethasone Dipropionate

clobetasol propionate

Clocortolone Pivalate

clobetasol propionate e

Clocortolone Pivalate P.M.

clobetasol propionate emollient

CVS anti-itch maximum strength

clodan

CVS cortisone intense healing anti-itch

cormax scalp application

CVS cortisone maximum strength

cortaid maximum strength

CVS eczema anti-itch maximum strength

cortizone-10

CVS hydrocortisone anti-itch

desonide

CVS hydrocortisone maximum strength

desoximetasone

Diflorasone Diacetate

eq anti-itch maximum strength

Lidosol-HC

eq hydrocortisone maximu m strength

MED-derm hydrocortisone

eq hydrocortisone plus

Pramosone

eq 1% hydrocortisone

Prednicarbate

eql anti-itch intensive healing formula

Synalar

eql anti-itch maximum strength

SB hydrocortisone

SB hydrocortisone maximum strength

SB hydrocortisone plus



podofilox

premium lidocaine

IMMUNOMODULATING AGENTS

ra calming daily moisturizing

ra capsicum hot patch

FORMULARY FORMULARY

ra diaper rash

imiquimod

ra hydrating healing

tacrolimus

ra lice maximum strength

Elidel

ra lice treatment

ra moisturizing therapy

ra renewal moisturizing

DERMATOLOGICALS - MISC.

rea LO 40

FORMULARY FORMULARY

rid lice killing shampoo

a-200 maximum strength

salacyn

advanced healing ointment/baby

salicylic acid

al12

salicylic acid wart remover

amlactin

salicylic acid ER

ammonium lactate

salimez

anecream

salisol forte

aspercreme w/lidocaine

salitech forte

boudreauxs butt paste maximum strength

saratoga

caprex

sm lice killing

caprex +

sm lice killing maximum strength

capsaicin

sm lice treatment

capsaicin hot patch

sodium hyaluronate

cerovel

stop lice maximum strength

cocoa butter skin cream

sure result SR relief

collagen

tgt lice killing maximum strength

cottontails diaper rash

tippy toes diaper rash

dermaphor

trixaicin HP

diaper rash

urea

dry skin treatment

urea hydrating

dry skin treatment advanced therapy

urea 40% nail film

e-ointment

urea-c40

eq diaper rash

uremez-40

eq lice killing maximum strength

zinc oxide

eql advanced healing ointment

Atopaderm

eql baby basics diaper rash

Atopiclair

eql lice killing maximum strength

Capsagel

ethyl chloride

Cerave

flanders buttocks

Cerave AM SPF 30

geri-hydrolac 12

Cerave PM

geri-hydrolac 5

Cerave Renewing SA

glydo

Cerave SA Renewing

gnp lice treatment

Cetaphil

hydrolatum

Cetaphil Daily Advance Ultra Hydrating

hydrophor

Cetaphil Daily Facial Moisturizer

lac-hydrin five

Cetaphil Dermacontrol Moisturizer/SPF 30

lactic acid

Cetaphil Moisturizing

lactic acid e

Cetaphil Restoraderm

lactic acid w/vitamin e

Cetaphil Therapeutic Hand

latrix

Cocaine HCL

lice killing maximum strength

CVS advanced healing ointment

lice killing shampoo

CVS diaper rash

lice treatment

CVS hydrating skin treatment

lice treatment creme rinse

CVS lice killing

licide

CVS lice treatment

licide maximum strength

CVS medicated heat patch

lido-k

CVS moisturizing cream

lidocaine

CVS moisturizing extra dry

lidocaine hydrochloride

CVS permethrin

lidocaine HCL

CVS skin treatment

lidocaine HCL jelly

CVS skin treatment body lotion

lidocaine PAK

Dexeryl

lidocaine-prilocaine-cream base

Dmae

lidocaine/prilocaine

Drysol

lidocream

DHEA

lindaneST

Eletone

malathion

Eletone Twinpack

moisturizing cream

Ethyl Chloride

permethrin

Ethyl Chloride/Fine Pinpoint



Ethyl Chloride/Fine Stream

ANDROGENS-ANABOLIC

Ethyl Chloride/Medium Jet Stream

FORMULARY FORMULARY

Ethyl Chloride/Medium Stream

danazol

Ethyl Chloride/Mist

methyltestosterone

Eucerin

oxandrolone

Eucerin Calming Daily Moisturizer

testosteronePA

Eucerin Daily Protection/SPF 30

testosterone cypionatePA

Eucerin Intensive Repair

testosterone enanthatePA

Eucerin Intensive Repair Hand

testosterone topical solutionPA

Eucerin Original Healing Soothing Repair

testosterone P.M.PA

Eucerin Plus

AndrodermPA

Eucerin Plus Intensive Repair

AndrogelPA

Eucerin Skin Calming Daily Moisturizing

Androgel P.M.PA

Eucerin Smoothing Repair Advanced Formula

Testosterone

Hylatopic Plus

Testosterone P.M.PA

Hylira

PA

Hypercare

HM lice killing maximum strength

ESTROGENS

HM lice treatment

FORMULARY FORMULARY

HPR Plus

amabelz

Latrix XM

estradiol

LindaneST

estradiol/norethindrone acetate

LC-4 lidocaine

jevantique LO

Neocera

jinteli

Neosalus

lopreeza

Neosalus CP

mimvey

Nivatopic Plus

mimvey LO

Ointment Base

norethindrone acetate/ethinyl estradiol

Oxsoralen

Combipatch

Podocon 25 IN Benzoin Tincture

Estropipate

Pruclair

Menest

Prumyx

Prefest

Pyrogallic Acid

Premarin

Salrix

Premphase

Salvax

Prempro

Spinosad

Sulfurated Lime

CONTRACEPTIVES

SB lice killing maximum strength

FORMULARY FORMULARY

SB lice treatment

aftera

Tetrix

altavera

Urea

alyacen 1/35

Urea Topical

alyacen 7/7/7

Vitamin E With Panthenol

amethia

Xeralux

amethia LO

amethyst

apri

ENDOCRINE AND METABOLIC

aranelle

CORTICOSTEROIDS

aubra

FORMULARY FORMULARY

aviane

budesonide

azurette

decadron

balziva

dexamethasone

bekyree

fludrocortisone acetate

blisovi FE 1.5/30

hydrocortisone

blisovi FE 1/20

methylprednisolone

blisovi 24 FE

methylprednisolone dose pack

briellyn

prednisolone

camila

prednisolone sodium phosphate

camrese

prednisolone sodium phosphate odt

camrese LO

prednisone

caziant

Cortisone Acetate

chateal

Dexamethasone

cryselle-28

Dexamethasone Intensol

cyclafem 1/35

Prednisolone Sodium Phosphate

cyclafem 7/7/7

Prednisone

cyred

Prednisone Intensol

dasetta 1/35

Solu-cortef

dasetta 7/7/7

deblitane

delyla



desogestrel/ethinyl estradiol

necon 1/35

drospirenone/ethinyl estradiol

necon 10/11-28

econtra one-step

necon 7/7/7

econtra EZ

next choice one dose

elinest

nikki

emoquette

nora-be

enpresse-28

norethindrone

enskyce

norethindrone & ethinyl estradiol ferrous fumarate

errin

norethindrone acetate/ethinyl estradiol

estarylla

norethindrone acetate/ethinyl estradiol/ferrous fumarate

ethynodiol diacetate/ethinyl estradiol

norethindrone/ethinyl estradiol/ferrous fumarate

fallback solo

norgestimate/ethinyl estradiol

falmina

norlyda

femynor

norlyroc

gianvi

nortrel 0.5/35 (28)

gildagia

nortrel 1/35

gildess FE 1.5/30

nortrel 7/7/7

gildess FE 1/20

ocella

gildess 1.5/30

opcicon one-step

gildess 1/20

option 2

heather

orsythia

introvale

philith

isibloom

pimtrea

jencycla

pirmella 1/35

jolessa

pirmella 7/7/7

jolivette

portia-28

juleber

previfem

junel FE 1.5/30

quasense

junel FE 1/20

react

junel FE 24

reclipsen

junel 1.5/30

setlakin

junel 1/20

sharobel

kaitlib FE

sprintec 28

kariva

sronyx

kelnor 1/35

syeda

kelnor 1/50

take action

kimidess

tarina FE 1/20

kurvelo

tilia FE

larin FE 1.5/30

tri femynor

larin FE 1/20

tri-estarylla

larin 1.5/30

tri-legest FE

larin 1/20

tri-linyah

larissia

tri-previfem

leena

tri-sprintec

lessina

tri-vylibra

levonest

tri-LO-estarylla

levonorgestrel

trinessa

levonorgestrel and ethinyl estradiol

trinessa LO

levonorgestrel/ethinyl estradiol

trivora-28

levora 0.15/30-28

velivet

lillow

vestura

loryna

vienva

low-ogestrel

viorele

lutera

vyfemla

lyza

vylibra

marlissa

wera

medroxyprogesterone acetate

wymzya FE

melodetta 24 FE

zarah

mibelas 24 FE

zenchent

microgestin FE

zenchent FE

microgestin FE 1.5/30

zovia 1/35e

microgestin 1.5/30

zovia 1/50e

microgestin 1/20

Ella

microgestin 24 FE

Necon 1/50-28

mono-linyah

Norinyl 1+50

mononessa

Nuvaring

my choice

Ogestrel

my way

Xulane

myzilra

necon 0.5/35-28



PROGESTINS

FORMULARY

pioglitazone HCL

FORMULARY FORMULARY

Avandia

medroxyprogesterone acetate

ANTIDIABETIC COMBINATIONS

megestrol acetate

FORMULARY FORMULARY

norethindrone acetate

glipizide/metformin HCL

progesterone

glyburide/metformin HCL

Janumet

ANTIDIABETIC AGENTS

Janumet XR

INSULIN

Jentadueto

FORMULARY FORMULARY

Jentadueto XR

Admelog

Soliqua 100/33QL,ST

Humalog

Humalog Junior Kwikpen

BISPHOSPHONATES

Humalog Kwikpen

FORMULARY FORMULARY

Humalog Mix 50/50

alendronate sodium

Humalog Mix 50/50 Kwikpen

ibandronate sodium

Humalog Mix 75/25

risedronate sodium

Humalog Mix 75/25 Kwikpen

risedronate sodium DR

Humulin N

Alendronate Sodium

Humulin N Kwikpen

Binosto

Humulin R

Etidronate Disodium

Humulin R U-500 (concentrated)

Fosamax Plus D

Humulin R U-500 Kwikpen

Humulin 70/30

Humulin 70/30 Kwikpen

CALCITONINS

Lantus

Lantus Solostar

FORMULARY FORMULARY

Toujeo Max Solostar

calcitonin salmon

Toujeo Solostar

calcitonin-salmon

INCRETIN MIMETIC AGENTS

FORMULARY FORMULARY

PARATHYROID HORMONE

AdlyxinST

FORMULARY FORMULARY

Adlyxin Starter PackST

ForteoQL

TanzeumST

Natpara

TrulicityST

TymlosQL

SULFONYLUREAS

FORMULARY FORMULARY

HORMONE RECEPTOR MDLTR

glimepiride

FORMULARY FORMULARY

glipizide

raloxifene hydrochloride

glipizide ER

Osphena

glipizide XL

glyburide

FERTILITY REGULATORS

glyburide micronized

FORMULARY FORMULARY

Chlorpropamide

Chorionic GonadotropinPA

Tolazamide

NovarelPA

Tolbutamide

Pregnyl W/Diluent Benzyl Alcohol/NACLPA

BIGUANIDES

FORMULARY FORMULARY

LHRH/GNRH AGONIST

metformin hydrochloride

FORMULARY FORMULARY

metformin HCL

Lupron Depot-PED (1-month)

metformin HCL ER

SynarelPA

MEGLITINIDE ANALOGUES

FORMULARY FORMULARY

GROWTH HORMONES

nateglinide

FORMULARY FORMULARY

repaglinide

Norditropin CartridgePA

DIABETIC OTHER

Norditropin FlexproPA

FORMULARY FORMULARY

Glucagen Hypokit

SOMATOSTATIC AGENTS

Glucagon Emergency Kit

FORMULARY FORMULARY

Proglycem

octreotide acetate

ALPHA-GLUCOSIDASE INHIBIT

Sandostatin Lar Depot

FORMULARY FORMULARY

acarbose

POSTERIOR PITUITARY

miglitol

FORMULARY FORMULARY

DPP-4 INHIBITORS

desmopressin acetate

FORMULARY FORMULARY

Stimate

Januvia

Tradjenta

INSULIN SENSITIZING AGENT

FORMULARY



PROLACTIN INHIBITORS

eq fiber laxative

eq fiber therapy

FORMULARY FORMULARY

eq gentle laxative

cabergoline

eq laxative maximum strength

eq magnesium citrate

METABOLIC MODIFIERS

eq milk of magnesia

FORMULARY FORMULARY

eq natural fiber laxative

calcitriol

eq natural laxative

doxercalciferol

eq natural vegetable laxative

levocarnitine

eq senna-s

paricalcitol

eq stool softener

Sensipar

eq stool softener/stimulant laxative

eq vegetable laxative

eq womans laxative

THYROID AGENTS

eq womens laxative

FORMULARY FORMULARY

eql clearlax

levo-t

eql fiber laxative

levothyroxine sodium

eql fiber therapy

levothyroxine sodium TAB 0.075MG

eql gentle laxative

levothyroxine/liothyronine

eql laxative

levoxyl

eql laxative maximum strength

liothyronine sodium

eql magnesium citrate

methimazole

eql milk of magnesia

propylthiouracil

eql natural fiber

Armour Thyroid

eql senna laxative

Cytomel

eql senna-s

NP thyroid 120

eql stool softener

Synthroid

eql stool softener/stimulant laxative

eql stool softener/stimulant laxative overnight relief

GASTROINTESTINAL

evac-u-gen

LAXATIVES

feenamint

FORMULARY FORMULARY

fiber

alophen

fiber laxative

bisac-evac

fiber therapy

bisacodyl

fiber TABS

bisacodyl laxative

fiber-CAPS

bisacodyl EC

fiber-LAX

biscolax

fibergen

calcium polycarbophil

fleet laxative

carters little pills

gavilax

citrate of magnesia

gavilyte-c

citrate of megnesia

gavilyte-h

citroma

gavilyte-n/flavor pack

clearlax

gavilyte-G

colace 2-IN-1

gentle laxative

constulose

gentle laxative for women

correct

gentle laxative overnightrelief

correctol

gentlelax

correctol extra gentle

geri-kot

diocto

glycerin children

doc-q-LAX

glycerin infants & children

docqlace

glycerin pediatric

docu

glycolax

docu soft

gnp bisa-LAX

docusate calcium

gnp clearlax

docusate sodium

gnp docusate calcium

docusate sodium & senna stimulant laxative/stool softener

gnp fiber-CAPS

docusate sodium/senna

gnp glycerin child

docusil

gnp glycerin infant

dok

gnp laxative

dok plus

gnp laxative pills

dss

gnp magnesium citrate

ducodyl

gnp milk of magnesia

dulcolax balance

gnp natural fiber

dulcolax milk of magnesia

gnp senna plus

dulcolax pink stool softener

gnp senna LAX

dulcolax stool softener

gnp senna-LAX

easy-LAX

gnp stool softener

easy-LAX plus

gnp stool softener/stimulant laxative

eq clearlax

gnp womens gentle laxative



gnp womens laxative

qc stool softener plus laxative

goodsense magnesium citrate

qc stool softener plus stimulant laxative

goodsense natural fiber

ra col-rite

goodsense senna laxative

ra fast relief laxative

goodsense stimulant laxative plus

ra fiber

kao-tin

ra fiber laxative

kls fiber-TABS

ra fiber supplement

kls laxaclear

ra fiber therapy

kls natural psyllium fiber

ra fiber-CAP

kls stool softener

ra fiber-TAB

konsyl

ra laxative

konsyl fiber

ra laxative & stool softener

kp bisacodyl

ra laxative extra strength

kp senna

ra laxative maximum strength

ks stool softener

ra magnesium citrate

lactulose

ra milk of magnesia

laxa basic

ra multihealth fiber supplement

laxacin

ra p col-rite

laxative

ra senna

laxative feminine

ra senna plus

laxative pills maximum strength

ra stimulant laxative

laxative pills regular strength

ra stool softener

laxative with senna

ra womens laxative

magnesium citrate

reguloid

medi-natural

sani-supp pediatric

medi-natural plus

senexon

medi-LAX

senexon-s

metamucil

senna

metamucil multihealth fiber

senna laxative

metamucil original texture

senna plus

metamucil smooth texture

senna s

metamucil smooth texture sugar free

senna smooth

milk of magnesia

senna LAX

natrul colon care

senna-grx

natural fiber

senna-plus

natural fiber laxative

senna-s

natural fiber therapy

senna-time

natural psyllium seed indian husks

senna-time s

natural senna laxative

senna-LAX

natural vegetable fiber

senna-TABS

peg 3350

senna/docusate sodium

peg 3350/electrolytes

sennacon

peg-prep

sennalax-s

peg-3350/electrolytes

sennazon

peg-3350/NACL/NA bicarbonate/KCL

senno

pegylax

sennosides/docusate sodium

peg3350

senokot extra strength

perdiem overnight relief

silace

peri-colace

sm clearlax

phillips milk of magnesia

sm docusate calcium

phillips stool softener

sm fiber

polyethylene glycol 3350

sm fiber laxative

psyldex

sm gentle laxative

psyllium H.S.

sm glycerin laxative pediatric

px docusate sodium

sm laxative

px fiber

sm laxative maximum strength

px laxative

sm magnesium citrate

px milk of magnesia

sm milk of magnesia

px vegetable laxative

sm natural laxative plus stool softener

qc docusate calcium

sm senna laxative

qc gentle laxative

sm senna laxative maximum strength

qc laxative

sm senna-s

qc magnesium citrate

sm stool softener

qc milk of magnesia

sm stool softener plus laxative

qc natura-LAX

sm womans laxative

qc natural vegetable

smooth LAX

qc natural vegetable laxative

sof-LAX

qc senna

sorbulax

qc senna-s

stimulant laxative

qc stool softener

stool softener



stool softener & stimulannt laxative

SB FIB LAX orange

stool softener extra strength

stool softener laxative

stool softener plus laxative

ANTIDIARRHEALS

stool softener plus stimulant laxative

FORMULARY FORMULARY

stool softener/laxative

anti-diarrheal

surfak

diamode

sw clearlax

diphenoxylate/atropine

tgt fiber laxative

eq anti-diarrheal

tgt fiber therapy

eq loperamide HCL

tgt gentle laxative

eql anti-diarrheal

tgt laxative pills maximum strength

eql loperamide HCL

tgt natural laxative pills maximum strength

flora assist

tgt powderlax

floranex

tgt senna

gnp anti-diarrheal

tgt senna laxative

gnp loperamide HCL

tgt senna laxative/stool softener

imperim

tgt stool softener

kls anti-diarrheal

tgt stool softener & stimulant laxative

lactinex

tgt womens laxative

lactobacillus

the magic bullet

loperamide a-d

trilyte

loperamide hydrochloride

veracolate

loperamide HCL

wal-mucil

meijer anti-diarrheal

womans laxative

probiotic chewable childrens

womens laxative

probiotic packets childrens

Cascara Sagrada

px anti-diarrheal

CVS bisacodyl

qc anti-diarrheal

CVS c-LAX laxative

ra anti-diarrheal

CVS citrate of magnesia

ra loperamide HCL

CVS fiber laxative

sm anti-diarrheal

CVS gentle laxative

sm loperamide HCL

CVS gentle laxative womens

tgt anti-diarrheal

CVS laxative pills

tgt loperamide HCL

CVS magnesium citrate

CVS anti-diarrheal

CVS milk of magnesia

CVS loperamide HCL

CVS natural daily fiber

Diphenoxylate/Atropine

CVS purelax

HM anti-diarrheal

CVS senna

HM loperamide HCL

CVS senna plus

Lactinex

CVS senna-extra

Paregoric

CVS stool softener

SB anti-diarrhea

CVS stool softener plus stimulant laxative

SR anti-diarrheal

DR edwards olive laxative

EX-LAX ultra

Golytely

ANTACIDS

HM clearlax

FORMULARY FORMULARY

HM fiber

almacone

HM laxative

antacid

HM magnesium citrate

antacid & antigas

HM milk of magnesia

antacid anti-gas

HM senna

antacid anti-gas regular strength

HM senna-s

antacid calcium extra ST rength

HM stool softener

antacid calcium regular strength

HM stool softener maximum strength

antacid extra strength

HM stool softener/laxative

antacid fast acting

Metamucil Multihealth Fiber

antacid fast relief

SB bisacodyl laxative EC

antacid flavor chews

SB docusate sodium

antacid i

SB docusate sodium/senna

antacid liquid

SB fiber laxative

antacid m

SB gentle laxative womens

antacid plus anti-gas fast acting

SB gentle LAX-women

antacid plus anti-gas relief

SB glycerin pediatric

antacid regular strength

SB laxative

antacid regular strength fast acting

SB magnesium citrate

calcium antacid

SB milk of magnesia

calcium antacid extra strength

SB polyethylene glycol 3 350

calcium carbonate

SB senna-LAX

calcium carbonate extra strength

SB stool softener



chewable antacid

SB antacid anti-gas

comfort gel

SB antacid extra strength

comfort gel antacid anti-gas

SB antacid/antigas

comfort gel antacid& anti-gas

Tums Lasting Effects

eq antacid

eq antacid extra strength

ULCER DRUGS

eq antacid/anti-gas

FORMULARY FORMULARY

eql antacid

acid control maximum strength

eql antacid extra strength

acid controller maximum strength

eql antacid/anti-gas

acid reducer

flanax heartburn relief

acid reducer maximum strength

geri-lanta

cimetidine

gnp antacid

cimetidine acid reducer

gnp antacid & anti-gas/regular strength

cimetidine 200

gnp antacid anti-gas

dicyclomine HCL

gnp antacid extra strength

ed-spaz

gnp antacid/regular strength

eq acid reducer

gnp masanti regular strength

eq acid reducer maximum strength

healthy mama tame the flame

eq heartburn relief

kls antacid

eq omeprazole magnesium

long lasting antacid

eq ranitidine

magnesium oxide

eql acid reducer

meijer antacid anti-gas

eql acid reducer maximum strength

mi-acid

eql heartburn prevention/maximum strength

milantex

eql heartburn relief maximum strength

mintox

esomeprazole magnesium

px antacid extra strength

famotidine

px antacid regular strength

glycopyrrolate

px calcium antacid regular strength

gnp acid control 150 maximum strength

qc antacid

gnp acid control 75

qc antacid extra strength

gnp acid reducer

qc antacid/anti-gas

gnp acid reducer maximum strength

ra antacid

gnp heartburn relief

ra antacid extra strength

gnp heartburn relief 200

ra antacid/anti-gas

gnp omeprazole

ra liquid antacid

goodsense acid reducer

ra smooth antacid extra strength

heartburn relief

rulox

heartburn relief maximum strength

sm antacid

heartburn relief 150 maximum strength

sm antacid advanced

hyoscyamine sulfate

sm antacid anti-gas

hyoscyamine sulfate odt

sm antacid/antigas

hyoscyamine sulfate ER

sm calcium antacid

hyoscyamine sulfate SR

sm calcium antacid extra strength

kls acid controller maximum strength

sm smooth antacid extra strength

kls acid reducer

sodium bicarbonate

kls acid reducer maximum strength

tgt antacid anti-gas regular strength

kp omeprazole magnesium

tgt antacid extra strength

lansoprazole

tums freshers

lansoprazole/amoxicillin/clarithromycin

tums smoothies

methscopolamine bromide

CAL-gest antacid

misoprostol

CVS antacid extra

nizatidine

CVS antacid extra strength

nulev

CVS antacid kids

omeprazole

CVS antacid liquid fast relief

omeprazole magnesium

CVS antacid/anti-gas

omeprazole DR

CVS antacid/anti-gas liq uid

oscimin

CVS antacid/simethicone

oscimin SR

CVS chewy not chalky flavor chews

pantoprazole sodium

CVS smooth antacid extra strength

pantoprazole sodium DR

Di-gel

pepcid ac maximum strength

HM antacid

phenobarbital/belladonna alkaloids

HM antacid/antigas

px acid reducer

HM calcium antacid

px acid reducer maximum strength

HM calcium antacid extra strength

px ranitidine

HM calcium antacid smoothdissolve

qc acid controller maximum strength

HM calcium antacid smoothdissolve extra strength

qc omeprazole magnesium

HM magnesium

ra acid reducer

MAG-al plus

ra acid reducer maximum strength

SB antacid



rabeprazole sodium

sm motion sickness

ranitidine acid reducer

travel-ease

ranitidine maximum strength

trimethobenzamide HCL

ranitidine HCL

wal-dram II

ranitidine 150 maximum strength

CVS motion sickness II

ranitidine 75

Granisetron HCL

sm acid reducer

HM motion relief

sm acid reducer maximum strength

HM motion sickness relief

sucralfate

SyndrosPA

sw acid reducer 150 maximum strength

Transderm-scop

symax-SR

tgt acid reducer

wal-zan 150 maximum strength

DIGESTIVE AIDS

wal-zan 75

FORMULARY FORMULARY

Belladonna & Opium

Creon

Belladonna Alkaloids & Opium

Zenpep

Carafate

Cimetidine HCL

CVS acid controller maximum strength

GASTROINTESTINAL - MISC.

CVS acid reducer maximum strength

FORMULARY FORMULARY

CVS heartburn relief

CVS omeprazole magnesium

alosetron hydrochloride

CVS ranitidine

ana-lex

CVS Omeprazole

balsalazide disodium

Eq Omeprazole

calcium acetateQL

Eql Omeprazole

colocort

First-lansoprazole

cromolyn sodium

First-omeprazole

drx choice gas relief

Gnp Omeprazole

enulose

HM acid reducer

eq gas relief

HM acid reducer maximum strength

eq infants gas relief

HM famotidine

eql gas relief

HM Omeprazole

eql gas relief extra strength

Kls Omeprazole

eql infants gas relief

Nizatidine

gas relief

Omeprazole

gas relief extra strength

Omeprazole + Syrspend SF Alka

gas relief infants

Pepcid Ac Maximum Strength

gas-x extra strength

Prilosec

gas-x infant drops

Prilosec OTC

generlac

Propantheline Bromide

gnp gas relief

Px Omeprazole

gnp gas relief extra strength

Ra Omeprazole

gnp infants gas relief

Sm Omeprazole

hydrocortisone

Sw Omeprazole

hydrocortisone acetate/pramoxine

Symax Duotab

infants gas relief

SB acid controller maximum strength

infants simethicone

SB acid reducer

lactulose

SB acid reducer ranitidine 75

lidocaine HCL/hydrocortisone acetate

SB cimetidine

little remedies for tummys gas relief

SB Omeprazole

little tummys gas relief

Tgt Omeprazole

mesalamine

mesalamine DR

metoclopramide HCL

ANTIEMETICS

mi-acid gas relief

FORMULARY FORMULARY

mommys bliss gas relief drops

dramamine less drowsy

mytab gas

dronabinol

pediacare gas relief drops infants

eq motion sickness relief

pediacare infants gas relief

eql motion sickness relief

pramcort

gnp motion sickness relief

procto-MED HC

granisetron hydrochloride

procto-PAK

granisetron HCLQL

proctosol HC

meclizine HCL

proctozone-HC

meclizine 25

px gas relief extra strength

ondansetron odt

px gas relief infants

ondansetron HCL

qc gas relief

ra motion sickness relief

ra gas relief

scopolamine

ra gas relief extra strength



ra gas relief/infants

trospium chloride

sevelamer carbonateQL

trospium chloride ER

simeped

Oxytrol For Women

simethicone

simethicone extra strength

VAGINAL PRODUCTS

sm gas relief

FORMULARY FORMULARY

sm gas relief drops infants

clindamycin phosphate

sm gas relief extra strength

clotrimazole

sm gas relief infants drops

clotrimazole-7

sulfasalazine

eq miconazole 1

tgt gas relief extra strength

eq miconazole 3 combo pack

tgt gas relief infants drops

eq miconazole 7

ursodiol

eq miconazole 7 day treatment

Apriso

eql miconazole 1

Canasa

eql miconazole 3

Cortifoam

eql miconazole 7

CVS gas relief

estradiol

CVS gas relief drops extra strength

gnp miconazole 1

CVS gas relief infants

gnp miconazole 3

CVS infants gas relief

gnp miconazole 3 combination pack

Gas-x

gnp miconazole 7

HM gas relief

goodsense miconazole 1

HM gas relief extra strengh

metronidazole vaginal

HM gas relief extra strength

miconazole

HM gas relief infants

miconazole nitrate

HM gas relief infants drops

miconazole 1

Lidocaine HCL-hydrocortisone Acetate With Aloe

miconazole 3 combination pack

Mesalamine DR

miconazole 3 combo pack

Metoclopramide Odt

miconazole 7

Pentasa

px miconazole 3-day combo pack

Proctofoam HC

qc miconazole 7

RenagelQL

ra clotrimazole 7

SB gas relief

ra miconazole 3 combination pack

QL

ra miconazole 7

sm clotrimazole vaginal

GENITOURINARY

sm miconazole 3

sm miconazole 7

URINARY ANTI-INFECTIVES

terconazole

FORMULARY FORMULARY

tgt miconazole 1

azuphen mb

tgt miconazole 3 combination pack

me/naphos/mb/hyo 1

tgt miconazole 7

methenamine hippurate

vagistat-3

methenamine mandelate

vandazole

nitrofurantoin

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