Member Guide
PHARMAVAILBENEFIT MANAGEMENT
Custom RxFormulary
Please bring this guide with you on your next doctor visit.
The PHARMAVAIL’S EVIDENCE-BASED Rx Formulary is a formulary list of medications that may be covered under your prescription drug plan. This list was reviewed by an independent group of practicing doctors and pharmacists, and it contains medications made by most pharmaceutical manufacturers. It includes medications for many covered conditions.
BE SURE TO BRING THIS GUIDE WITH YOU ON EVERY VISIT TO YOUR DOCTOR
Please note: This guide does not contain a complete list of preferred drugs. It only lists the most commonly prescribed drugs.
KEEPING COSTS DOWN SO YOUR COVERAGE CONTINUES
Often, your doctor can choose among several drugs to treat a condition, and your plan may prefer some medications over others. These are called preferred drugs, and using them helps keep costs down for your plan sponsor. This in turn helps ensure that your plan will provide coverage for the medications you need in the years ahead.
In many cases, using these preferred drugs can also save you money now. For example, brand-name drugs may have generic versions that may have a lower co-payment/co-insurance.
FINDING MEDICATIONS WITH
LOWERCO-PAYMENTS/CO-INSURANCE
This guide lists medications two ways to help you find somegeneric, preferred, and nonpreferred brand-name drugs.
SECTION I - ALPHABETICALLY BY DRUG CATEGORY (SUCH AS RESPIRATORY)
Within each category, medications are listed in alphabetical order,with generic, preferred brand-name drugs, and nonpreferred brand-name drugs sorted separately:
G Means a preferred generic medication
P Means a preferred brand-name medication
NP Means a nonpreferred brand-name medication
NC Means Not Covered
SECTION II - ALPHABETICALLY BY BRAND NAME
After each nonpreferred brand-name drug, you will find possiblegeneric and preferred brand-name alternatives.
SAFETY CONSIDERATION SYMBOLS
Here is a quick guide for you and your doctor.
/ Means weigh risk of birth defects or other adverse outcomes./ Means do not use in pregnancy.
The information in this guide was in effect at the time of printing and maybe subject to change.
Page 1 of 16
SECTION I:THERAPEUTIC DRUG CATEGORIES
Page 1 of 16
ANTI-INFECTIVES (Antibiotics/Antifungals)
Page 1 of 16
Oral Penicillins
G amoxicillin trihydrate
G amoxicillin trihydrate/
potassium clavulanate
G ampicillin trihydrate
G dicloxacillin sodium
G penicillin v
potassium
P Augmentin Chewable
Tablet 250 - 62.5mg
P Augmentin
Suspension
125 - 31.25mg/5
NP Amoxil
NP Augmentin Chewable
Tablet 200 - 28.5mg,
400 - 57mg
NP Augmentin ES
NP Augmentin
Suspension
200 - 28.5mg/5,
250 - 62.5mg/5,
400 - 57mg/5
NP Augmentin Tablet
NP Augmentin XR
NP Moxatag
Oral Tetracyclines
G doxycycline hyclate
G doxycycline
monohydrate
G minocycline HCl
G tetracycline HCl
NCAdoxa
NCAdoxa Pak
NCOracea
NCDoryx
NP Dynacin
NP Minocin
NCMonodox
NP Periostat
NCSolodyn
NP Vibramycin
Oral Cephalosporins
G cefaclor
G cefadroxil hydrate
G cefdinir
G cefpodoxime proxetil
G cefprozil
G cefuroxime axetil
G cephalexin
monohydrate
G cephradine
NP Ceclor CD
NP Cedax
NP Ceftin
NP Cefzil
NP Duricef
NP Keflex
NP Omnicef
NP Raniclor
NP Spectracef
NP Suprax
NP Vantin
Oral Erythromycins
G azithromycin
G clarithromycin
G clarithromycin ER
G erythromycin base
G erythromycin
ethylsuccinate
G erythromycin
ethylsuccinate/
sulfisoxazole acetyl
G erythromycin stearate
NP Biaxin
NPBiaxin XL
NP EryPed
NP PCE
NP Zithromax
NP Zmax
Oral Quinolones
G ciprofloxacin HCl
G ofloxacin
P Cipro Suspension
P Levaquin
P Noroxin
NP Avelox
NP Cipro Tablet
NP Cipro XR
NP Factive
NP Floxin
NP Proquin XR
Oral Sulfas
G erythromycin
ethylsuccinate/
sulfisoxazole acetyl
G sulfadiazine
G sulfamethoxazole/
trimethoprim
G sulfisoxazole
NP Bactrim DS
NP Gantrisin
NP Septra DS
Oral Urinary TractAgents
G methenamine
hippurate
G methenamine
mandelate
G nitrofurantoin
Gnitrofurantoin
macrocrystal
G phenazopyridine HCl
G trimethoprim
P Furadantin
NP Hiprex
NP Macrobid
NP Macrodantin
NP Monurol
NP Primsol
AntifungalAgents
G clotrimazole
G fluconazole
G griseofulvin
G griseofulvin
ultramicrosize
G itraconazole
G ketoconazole
G nystatin
G terbinafine HCl
G voriconazole
P Ancobon
P Lamisil Oral Granules
P Noxafil
P Sporanox Oral
Solution
NP Diflucan
NCJublia
NP Grifulvin V
NP Gris-Peg
NP Lamisil Tablet
NP Mycostatin
NP Mycelex Troche
NP Nizoral
NP Oravig
NP Sporanox Capsule
NP Vfend
Page 1 of 16
PSYCHOTHERAPEUTICS (Anxiety/Depression)
Page 1 of 16
Hypnotic Agents
G chloral hydrate
G estazolam
G flurazepam HCl
G temazepam
G triazolam
G zaleplon
G zolpidem tartrate
NP Ambien
NP Ambien CR
NP Dalmane
NP Doral
NP Edluar
NP Halcion
NP Lunesta
NP ProSom
NP Restoril
NP Rozerem
NCSilenor
NP Sonata
NCZolpimist
TricyclicAntidepressants
G amitriptyline HCl
G amoxapine
G clomipramine HCl
G desipramine HCl
G doxepin HCl
G imipramine HCl
G imipramine
pamoate
G nortriptyline HCl
G protriptyline HCl
G trimipramine maleate
P Surmontil
NP Anafranil
NP Asendin
NP Elavil
NP Norpramin
NP Pamelor
NP Sinequan
NP Tofranil
NP Tofranil-PM
NP Vivactil
MiscellaneousAntidepressants
G bupropion HCl tablet
G bupropion HCl tablet,
sustained action
G maprotiline HCl
G mirtazapine
G trazodone HCl
G venlafaxine HCl
P Cymbalta
NCPristiq
NP Desyrel
NP Effexor
NCEffexor XR
NP Ludiomil
NP Oleptro ER
NPVibryd
NPFetzima
NPTrintellix
NP Remeron
NP Serzone
NP Wellbutrin
NP Wellbutrin SR
NCWellbutrin XL
Antipsychotics
G chlorpromazine HCl
G clozapine
G fluphenazine HCl
G haloperidol
G haloperidol lactate
concentrate, oral
G loxapine succinate
G perphenazine
G risperidone
G thiothixene
G trifluoperazine HCl
NPClozaril
P Geodon
P Moban
P Orap
NPSeroquel
NPSeroquel XR
NPZyprexa
NPZyprexa Zydis
NP Abilify
NP Fanapt
NP Invega
NP Risperdal
Anxiolytics
G alprazolam
G alprazolam XR
G buspirone HCl
G chlordiazepoxide
HCl
G clorazepate
dipotassium
G diazepam
G lorazepam
G oxazepam
NP Ativan
NP Buspar
NP Librium
NP Niravam
NP Serax
NP Tranxene SD
NP Tranxene T-Tab
NP Valium
NP Xanax
NP Xanax XR
MAOIAntidepressants
G phenelzine sulfate
G tranylcypromine
sulfate
NP Emsam
NP Nardil
NP Parnate
SSRI Antidepressants
G citalopram HBr
G fluoxetine HCl
G fluvoxamine maleate
G paroxetine HCl
G sertraline HCl
NP Celexa
NP Lexapro
NP Luvox
NP Luvox CR
NP Paxil
NP Paxil CR
NP Pexeva
NP Prozac
NP Prozac Weekly
NP Sarafem
NP Zoloft
MiscellaneousPsychotherapeuticAgents
G amphetamine
aspartate/
amphetamine
sulfate/
dextroamphetamine
G dextroamphetamine
sulfate
G lithium carbonate
G lithium citrate
G methamphetamine
HCl
G methylphenidate HCl
NPConcerta
NPDaytrana
NPIntuniv
P Metadate CD
P Metadate ER 20mg
NPProvigil
P Strattera
NPVyvanse
NPXyrem
NP Adderall
NP Adderall XR
NP Desoxyn
NP Dexedrine
NP Eskalith
NP Eskalith CR
NP Focalin
NP Focalin XR
NP Kapvay
NP Liquadd
NP Lithobid
NP Metadate ER 10mg
NP Methylin Oral
Solution
NP Methylin Chewable
Tablet
NP Nuvigil
NP Ritalin
NP Ritalin LA
NP Ritalin SR
Page 1 of 16
CARDIOVASCULAR (Blood Pressure/Heart/Cholesterol)
Page 1 of 16
Beta Blockers
G acebutolol HCl
G atenolol
G betaxolol HCl
G bisoprolol fumarate
G carvedilol
G labetalol HCl
G metoprolol succinate
G metoprolol tartrate
G nadolol
G pindolol
G propranolol HCl
G propranolol HCl
capsule, sustained
action 24 hr
G timolol maleate
P Bystolic
NPCoreg CR
NP Coreg
NP Corgard
NP Inderal
NP Inderal LA
NP Innopran XL
NP Kerlone
NP Levatol
NP Lopressor
NP Normodyne
NP Sectral
NP Tenormin
NP Toprol XL
NP Trandate
NP Zebeta
Calcium Blockers
G diltiazem HCl
G diltiazem HCl capsule,
sustained release 12 hr
G diltiazem HCl capsule,
sustained release24 hr
G diltiazem HCl tablet,
sustained release
G nimodipine
G verapamil HCl
G verapamil HCl
capsule, 24 hr
sustained release
G verapamil HCl tablet,
sustained action
P Cardizem LA 120mg
NP Calan SR
NP Cardizem
NP Cardizem CD
NP Cardizem LA 180mg,
240mg, 300mg,
360mg, 420mg
NP Cardizem SR
NP Covera-HS
NP Isoptin S.R.
NP Nimotop
NP Tiazac
NP Verelan
NP Verelan PM
Dihydropyridines
G amlodipine besylate
G felodipine
G isradipine
G nifedipine
G nifedipine tablet,
sustained release
G nisoldipine
NP Adalat CC
NP Cardene SR
NP DynaCirc
NP DynaCirc CR
NP Norvasc
NP Plendil
NP Procardia XL
NP Sular
Nitroglycerin Patches
G nitroglycerin patch
P Minitran Patch
NP Nitro-Dur Patch
AdrenergicAntagonists &Related Drugs
G clonidine HCl
G doxazosin mesylate
G guanfacine HCl
G methyldopa
G prazosin HCl
G reserpine
G terazosin HCl
NP Cardura
NP Cardura XL
NP Catapres
NP Catapres-TTS
NP Hytrin
NP Minipress
NP Nexiclon XR
NP Tenex
Angiotensin II Blockers
& ReninInhibitors
G losartan potassium
G olmesartan medoxomil
G olmesartan/HCTZ
G candesartan cilexetil
G candesartan/HCTZ
G telmisartan
G telmisartan/HCTZ
G losartan/
hydrochlorothiazide
NP Atacand
NP Atacand HCT
NP Benicar
NP Benicar HCT
NP Diovan
NP Diovan HCT
NPMicardis
NP Micardis HCT
NPTekamlo
NPTekturna
NPTekturna HCT
NPValturna
NP Avalide
NP Avapro
NP Cozaar
NP Hyzaar
NP Teveten
NP Teveten HCT
Antilipidemics
G cholestyramine/
aspartame
G cholestyramine/
sucrose
G colestipol HCl
G fenofibrate,
micronized
G gemfibrozil
G lovastatin
G pravastatin
G simvastatin
G atorvastatin
G rouvastatin
NPAltoprev
NPAntara
NCCrestor
NCLipitor
NCLipofen
NCLivalo
NCNiaspan
NPSimcor
NPTricor
NPTriglide
NPTrilipix
NCVytorin
NPWelchol
NCZetia
NP Advicor
NP Caduet
NP Colestid
NP Fenoglide
NP Fibricor
NP Lescol
NP Lescol XL
NCLivalo
NP Lofibra
NP Lopid
NP Mevacor
NP Pravachol
NP Questran
NP Questran Light
NP Zocor
ACE Inhibitors
G benazepril HCl
G captopril
G enalapril maleate
G fosinopril sodium
G lisinopril
G moexipril
G perindopril erbumine
G quinapril
G ramipril
G trandolapril
NP Accupril
NP Aceon
NP Altace
NP Capoten
NP Lotensin
NP Mavik
NP Monopril
NP Prinivil
NP Univasc
NP Vasotec
NP Zestril
Combination Antihypertensives
G Amlodipine
besylate/benazepril
G atenolol/chlorthalidone
G benazepril
HCl/hydrochlorothiazide
G bisoprolol fumarate/
hydrochlorothiazide
G captopril/
hydrochlorothiazide
G enalapril maleate/
hydrochlorothiazide
G fosinopril/
hydrochlorothiazide
G hydralazine HCl/
hydrochlorothiazide
G lisinopril/hydrochlorothiazide
G methyldopa/
hydrochlorothiazide
G metoprolol/hydrochlorothiazide
G moexipril/
hydrochlorothiazide
G propranolol
HCl/hydrochlorothiazide
G quinapril/
hydrochlorothiazide
G trandolapril/verapamil
P Azor
P Exforge
P Exforge HCT
NP Tribenzor
NP Twynsta
NP Accuretic
NP Capozide
NP Clorpres
NP Corzide
NP Lexxel
NP Lopressor HCT
NP Lotensin HCT
NP Lotrel
NP Monopril HCT
NP Prinzide
NP Tarka
NP Tenoretic
NP Uniretic
NP Vaseretic
NP Zestoretic
NP Ziac
Page 1 of 16
ENDOCRINE (Diabetes/Hormones/Contraceptives)
Page 1 of 16
Insulin Therapy
P Apidra
P Apidra Solostar
NPHumalog
NPHumalog Mix 50/50
NHumalog Mix 75/25
P Humulin
P Lantus
P Lantus SoloStar
NP Levemir
P NovoLog
P NovoLog Mix 70/30
NP Novolin
Non-Insulin Hypoglycemic Agents
G acarbose
G chlorpropamide
G glimepiride
G glipizide
G glipizide/metformin HCl
G glyburide
G glyburide/metformin HCl
G glyburide, micronized
G metformin HCl
G nateglinide
G tolazamide
G tolbutamide
NPActoplus Met
NPActos
P Avandamet
P Avandaryl
P Avandia
NPByetta
P Duetact
NPJanumet
NPJanuvia
NPKombiglyze XR
NPOnglyza
NPPrandin
NPSymlin
NP Actoplus Met XR
NP Amaryl
NP Cycloset
NP Diabinese
NP DiaBeta
NP Fortamet
NP Glucophage
NP Glucophage XR
NP Glucotrol
NP Glucotrol XL
NP Glucovance
NCGlumetza
NP Glynase
NP Glyset
NP Metaglip
NP Micronase
NP Orinase
NP Prandimet
NP Precose
NP Riomet
NP Starlix
NP Tolinase
NP Victoza
NPTradjenta
NPTanzeum
NPTresiba Flex
NPTrulicity
NPJentadueto XR
NPFarxiga
Blood Glucose Test Strips
G alcohol antisepticpads
P Accu-Chek Active TestStrips
P Accu-Chek Aviva TestStrips
P Accu-Chek ComfortCurve Test Strips
P Accu-Chek CompactTest Strips
P Fast Take Test Strips
P One Touch Test Strips
P One Touch Ultra TestStrips
P Surestep Pro TestStrips
P Surestep Test Strips
Contraceptive Agents
G desogestrel-ethinylestradiol
G desogestrel-ethinyl
estradiol/ethinylestradiol
G ethinyl estradiol/
drospirenone
G ethynodiol d-ethinyl
estradiol
G levonorgestrel
G levonorgestrelethinyl
estradiol
G norethindrone
G norethindrone a-eestradiol
G norethindrone a-e
estradiol/ferrousfumarate
G norethindroneethinyl
estradiol
G norethindroneethinyl
estradiol/ferrous fumarate
G norethindronemestranol
G norgestimateethinyl estradiol
G norgestrel-ethinylestradiol
NPBeyaz
NPElla
NPLoSeasonique
NPLybrel
NPNatazia
NPNuvaRing
NPPlan B One-Step
NPSeasonique
NPYaz
NP Alesse
NP Brevicon
NP Cyclessa
NP Demulen
NP Desogen
NP Estrostep Fe
NP Femcon Fe
NP Levlen
NP Levlite
NP Loestrin
NP Loestrin Fe
NP Loestrin 24 Fe
NP Lo Loestrin Fe
NP Lo/Ovral
NP Mircette
NP Modicon
NP Nordette
NP Norinyl
NP Ortho-Cept
NP Ortho-Cyclen
NP Ortho Evra
NP Ortho Micronor
NP Ortho-Novum
NP Ortho Tri-Cyclen
NP Ortho Tri-Cyclen Lo
NP Ovcon
NP Ovral
NP Seasonale
NP Tri-Levlen
NP Tri-Norinyl
NP Triphasil
NP Yasmin
Estrogens/Estrogen Combinations
G estradiol patch
G estradiol tablet
G estradiol/norethindrone
acetate
G estropipate
G methyltestosterone/
estrogens, esterified
G norethindrone/ethinyl
estradiol
P Cenestin
P Climara
P Combipatch
P Divigel
P Enjuvia
P Estrace VaginalCream
P Estraderm
P Estring
P Evamist
P Premarin Tablet
P Premphase
P Prempro
P Vagifem
P Vivelle
P Vivelle-Dot
NP Activella
NP Alora
NP Climara Pro
NP Elestrin
NP Estrace Tablet
NP Estrasorb
NP Estratest
NP Estratest H.S.
NP Estrogel
NP Femhrt
NP Femring
NP Femtrace
NP Menest
NP Menostar
NP Ortho-Prefest
NP Premarin VaginalCream
Page 1 of 16
G I (Ulcer)
Ulcer Drugs
Page 1 of 16
G cimetidine HCl liquid
G cimetidine tablet
G famotidine
NClansoprazole
G misoprostol
G nizatidine
NComeprazole
NComeprazole/sodium
bicarbonate
NCpantoprazole sodium
NCesomeprazole
G ranitidine HCl
P Axid Oral Solution
NCNexium -24 OTC
NCNexium RX
NCAciphex
NP Axid Capsule
NP Cytotec
NCDexilant
NPPepcid
NCPrevacid
NCPrilosec Rx
NCProtonix
NP Tagamet
NP Zantac Rx
NCZegerid Rx
Page 1 of 16
NSAIDS (Pain Relievers)
Page 1 of 16
NSAIDs
G etodolac
G flurbiprofen
G ibuprofen
G indomethacin
G ketoprofen
G meclofenamatesodium
G meloxicam
G nabumetone
G naproxen
G naproxen sodium
G oxaprozin
G piroxicam
G sulindac
G tolmetin sodium
NCVimovo
NP Anaprox DS
NP Ansaid
NP Arthrotec
NP Cambia
NP Clinoril
NP Daypro
NP diclofenacpotassium
NP diclofenac sodium
NP EC-Naprosyn
NP Feldene
NP Flector
NP Indocin
NCDuexis®
NP Lodine
NP Lodine XL
NP Mobic
NP Motrin
NP Naprelan
NP Naprosyn
NCPennsaid
NP Relafen
NP Toradol
NP Voltaren
NP Voltaren-XR
NSAID COX-2 Inhibitors
Gcelecoxib
NCCelebrex
Page 1 of 16
DRUGS TO TREAT OVERACTIVE BLADDER
Page 1 of 16
Gflavoxate
G oxybutynin chloride
G trospium chloride
NPDetrol
NPDetrol LA
NP Enablex
NPGelnique
NPOxytrol
NPSanctura XR
NPVesicare
NP Ditropan
NP Ditropan XL
NP Sanctura
NP Toviaz
Page 1 of 16
RESPIRATORY (Allergy/Asthma)
Page 1 of 16
Beta Agonists Oral
G albuterol sulfate
G metaproterenolsulfate
G terbutaline sulfate
NP Alupent
NP Brethine
NP Proventil
NP Ventolin
Beta Agonist Inhalers
G albuterol
G albuterol sulfate
G levalbuterol HCl
G metaproterenolsulfate
P Foradil
P Maxair Autohaler
NPPerforomist
P Proair HFA
NPSerevent Diskus
NPXopenex 0.31mg/3mL,
0.63mg/3mL,
1.25mg/3mL
NPXopenex HFA
NP Accuneb
NP Alupent
NP Brovana
NP Proventil
NP Proventil HFA
NP Ventolin
NP Ventolin HFA
NP Xopenex 1.25mg/0.5
Inhaled Steroids
G budesonide
P Asmanex
P Flovent Diskus
P Flovent HFA
P Pulmicort Flexhaler
NPPulmicort 1mg/2mLRespules
NP QVAR
NP Aerobid
NP Aerobid-M
NP Alvesco
NP Azmacort
NP Pulmicort 0.25mg/2mL
NP Pulmicort 0.5mg/2mL
Nasal Corticosteroids
G flunisolide
G fluticasone propionate
NCNasacort AQ
P Nasonex-OTC only
NCRhinocort Aqua
NCVeramyst
NP Beconas
P Flonase-OTC only
NCNasalide
NCNasarel
NCOmnaris
Miscellaneous
Pulmonary Agents
G acetylcysteine
G cromolyn sodium
ampul fornebulization
G ipratropium/albuterolsulfate
G ipratropium bromidesolution
G zafirlukast
NPAdvair Diskus
NPAdvair HFA
P AtroventHFA
NPBerinert
NPCinryze
P Combivent
NPDulera
P Intal Inhaler
P Letairis
NPPulmozyme
NPRevatio
NPSingulair
NPSpiriva
NPSymbicort
NPTilade
NPTracleer
NPTyvaso
NPVentavis
NP Accolate
NP Adcirca
NP Atrovent InhalationSolution
NP Duoneb
NP Kalbitor
NP Xolair
NP Zyflo
NP Zyflo CR
Page 1 of 16
OSTEOPOROSIS/PAGET’S DISEASE
Page 1 of 16
G alendronate sodium
G calcitonin, salmon,synthetic
P Actonel 30mg
P Boniva
P Evista
P Forteo
P Fosamax Plus D
P Fosamax Solution
NP Actonel 5mg
NP Actonel 35mg
NP Actonel 75mg
NP Actonel 150mg
NP Actonel with Calcium
NP Atelvia
NP Fosamax Tablet
NP Miacalcin Nasal Spray
NP Prolia
Page 1 of 16
NEUROLOGICALS
Page 1 of 16
Anticonvulsants/Anti-Seizure
G carbamazepine
G clonazepam
G diazepam
G divalproex sodium
G ethosuximide
G gabapentin
G lamotrigine
G levetiracetam
G mephobarbital
G oxcarbazepine
G phenobarbital
G phenytoin
G phenytoin sodiumextended
G primidone
G topiramate
G valproic acid
P Banzel
P Carbatrol
P Celontin
P Diastat
P Dilantin ChewableTablet
P Dilantin 30mg
NPFelbatol
NPGabitril
NPKeppra XR
NPLamictal ODT
NPLamictal XR
NPLyrica
P Peganone
P Tegretol XR 100mg
P Vimpat
NP Depakote
NP Depakote ER
NP Depakote Sprinkle
NP Dilantin 100mgCapsule
NP Dilantin OralSuspension
NP Equetro
NP Keppra
NP Klonopin
NP Lamictal
NP Mebaral
NP Mysoline
NP Neurontin
NP Phenytek
NP Sabril
NP Tegretol
NP Tegretol XR 200mg,400mg
NP Topamax
NP Trileptal
NP Zarontin
NP Zonegran
Migraine/Headache Therapy
G acetaminophen/butalbital
G acetaminophen/
caffeine/butalbital
G aspirin/caffeine/
butalbital
G dihydroergotaminemesylate
G ergotamine/caffeine
G isometheptenemucate/
acetaminophen/ dichloralphenazone
G naratriptan HCl
G sumatriptan succinate
P Ergomar
NPFrova
NPMaxalt
NPMaxalt MLT
NPRelpax
NPTreximet
NPZomig
NPZomig ZMT
NP Amerge
NP Axert
NP Cafergot tablet
NP Imitrex
NP Midrin
NP Migranal
NP Phrenilin
NP Phrenilin Forte
Drugs to treat
Alzheimers Disease
G donepezil HCl
G galantamine HBr
G rivastigmine tartrate
P Aricept 23mg
P Exelon Patch
P Exelon Solution
P Namenda
NP Aricept 5mg, 10mg
NP Aricept ODT
NP Cognex
NP Exelon Capsules
NP Razadyne
NP Razadyne ER
Page 1 of 16
SECTION II:
NONPREFERRED DRUGS AND THEIR POSSIBLE PREFERRED
ALTERNATIVES
Page 1 of 16
Page 1 of 16
Nonpreferred Product / Possible Preferred ProductsAbilify® / clozapine (generic), risperidone (generic), Geodon® (Pfizer), Seroquel® (AstraZeneca), Seroquel XR® (AstraZeneca), Zyprexa® (Eli Lilly)
Acanya® / Clindamycin/benzoyl peroxide generics
Accolate® / zafirlukast (various)
Accuneb® / albuterol sulfate (generic)
Accupril® / quinapril (generic)
Accuretic® / quinapril/hydrochlorothiazide (generic)
Aceon® / perindopril erbumine (generic)
Aciphex® / omeprazole (generic), Nexium® (AstraZeneca)
Activella® 1-0.5mg / estradiol/norethindrone acetate (generic)
Activella® 0.5-0.1mg / estradiol/norethindrone acetate (generic), Premphase® (Wyeth), Prempro® (Wyeth)
Actonel® 5mg / alendronate sodium 5mg (generic), alendronate sodium 10mg (generic), Boniva® (Roche)
Actonel® 35mg
75mg, 150mg / alendronate sodium 35mg (generic), alendronate sodium 70mg (generic), Boniva® (Roche)
Actonel® with Calcium / alendronate sodium (generic), Boniva® (Roche)
Actoplus Met XR® / metformin HCl ER (generic), Actos® (Takeda)
Aczone® / Dapsone gel
Adalat CC® / nifedipine ER (generic), amlodipine besylate (generic),
nisoldipine (generic)
Adcirca® / Revatio® (Pfizer)
Adderall® / amphetamine salt combo (generic)
Adderall XR® / dextroamphetamine-amphetamine ER (generic)
Advicor® / lovastatin (generic), pravastatin (generic), simvastatin (generic), Crestor® (AstraZeneca), Lipitor® (Pfizer), Niaspan® (Abbott),VytorinTM (Merck/Schering)
Aerobid® / Asmanex® (Schering), Flovent HFA® (GlaxoSmithKline),Pulmicort Flexhaler® (AstraZeneca), QVAR® (Ivax)
Aerobid-M® / Asmanex® (Schering), Flovent HFA® (GlaxoSmithKline), Pulmicort Flexhaler® (AstraZeneca), QVAR® (Ivax)
Aggrenox® / Dipyridamole/Aspirin
Alesse® / Aviane® (Barr-branded generic*), Lessina® (Barr-branded generic*), Lutera® (Watson-branded generic*), Lybrel® (Wyeth)
Alora® / estradiol patch (generic), Climara® (Berlex), Estraderm® (Novartis),Vivelle® (Novartis)
Altace® / ramipril (generic)
Alupent® / Maxair Autohaler® (Graceway), Proair HFA® (Teva), Xopenex HFA® (Sepracor)
Alvesco® / Asmanex® (Schering), Flovent HFA® (GlaxoSmithKline), Pulmicort Flexhaler® (AstraZeneca)
Amaryl® / glimepiride (generic)
Ambien® / zolpidem tartrate (generic)
Ambien CR® / zolpidem tartrate (generic)
Amerge® / naratriptan HCl (generic)
Amoxil® / amoxicillin trihydrate (generic)
Amrix® / cyclobenzaprine
Anafranil® / clomipramine HCl (generic)
Anaprox DS® / naproxen sodium (generic)
Angeliq® / estradiol/norethindrone acetate (generic), Premphase® (Wyeth), Prempro® (Wyeth)
Ansaid®® / flurbiprofen (generic)
Aplenzin® / Buproprion generic
Aricept® 5mg,10mg / donepezil HCl (generic)
Aricept ODT® / donepezil HCl (generic)
Arthrotec® / ibuprofen (generic), naproxen (generic), Celebrex® (Pfizer)
Asendin® / amoxapine (generic)
Atelvia® / alendronate sodium (generic), Boniva® (Roche)
Ativan® / lorazepam (generic)
Atrovent® solution / ipratropium bromide (generic)
Augmentin®
chewable tablet
200-28.5mg,
400-57mg / amoxicillin trihydrate/potassium clavulanate (generic)
Augmentin®
Suspension
200-28.5mg/5,
250-62.5mg/5,
400-57mg/5 / amoxicillin trihydrate/potassium clavulanate (generic)
Augmentin®
tablet / amoxicillin trihydrate/potassium clavulanate (generic)
Augmentin ES® / amoxicillin trihydrate/potassium clavulanate (generic)
Augmentin XR® / amoxicillin trihydrate/potassium clavulanate (generic)
Avalide® / losartan/hydrochlorothiazide (generic), Atacand HCT® (AstraZeneca), Benicar HCT® (Daiichi Sankyo), Diovan HCT® (Novartis), Micardis HCT® (BIPI)
Avapro® / losartan potassium (generic), Atacand® (AstraZeneca), Benicar® (Daiichi Sankyo), Diovan® (Novartis),Micardis® (BIPI)
Avar-LS® / Sodium sulfacetamide lotion
Avelox® / Levaquin® (J&J)
Axert® / naratriptan HCl (generic), sumatriptan succinate (generic), Frova® (Endo),Maxalt® (Merck), Relpax® (Pfizer), Zomig® (AstraZeneca)
Axid® Capsule / nizatidine (generic)
Azmacort® / Asmanex® (Schering), Flovent HFA® (GlaxoSmithKline), Pulmicort Flexhaler® (AstraZeneca), QVAR® (Ivax)
Bactrim DS® / sulfamethoxazole/trimethoprim (generic)
Beconase AQ® / flunisolide (generic), fluticasone propionate (generic), Nasacort AQ® (Aventis), Nasonex® (Schering), Rhinocort Aqua® (AstraZeneca),Veramyst® (GlaxoSmithKline)
Biaxin® / clarithromycin (generic)
Biaxin XL® / clarithromycin ER (generic)
Brethine® / terbutaline sulfate (generic)
Brevicon® / Necon® (Watson-branded generic*), Nortrel® (Barr-branded generic*)
Brisdelle® / Various generic SSRIs
Brovana® / Foradil® (Schering), Perforomist® (Dey Labs), Proair HFA® (Teva), Serevent Diskus® (GlaxoSmithKline)
Buspar® / buspirone HCl (generic)
Butisol Sodium® / chloral hydrate (generic), temazepam (generic),triazolam (generic)
Caduet® / amlodipine besylate (generic), Lipitor® (Pfizer)
Calan SR® / verapamil HCl tablet, sustained action (generic)
Cambia® / etodolac (generic), ibuprofen (generic), naproxen (generic)
Capoten® / captopril (generic)
Capozide® / captopril/hydrochlorothiazide (generic)
Cardene SR® / amlodipine besylate (generic), nifedipine ER (generic)
Cardizem® / diltiazem HCl (generic)
Cardizem CD® / diltiazem HCl capsule, sustained release 24 hr (generic)
Cardizem LA®
180mg, 240mg,
300mg, 360mg,
420mg / diltiazem ER (generic)
Cardizem SR® / diltiazem HCl capsule, sustained release 12 hr (generic)
Cardura® / doxazosin mesylate (generic)
Cataflam® / etodolac (generic), ibuprofen (generic), naproxen (generic)
Catapres® / clonidine HCl tablet (generic)
Catapres-TTS® / clonidine HCl patch (generic)