RegenceRx Preferred Medication List/Formulary

RegenceRx Preferred Medication List/Formulary 

Help to stretch your prescription dollar 

February1, 2008 

Effective February 1, 2008 

©2008. RegenceRx. All Rights Reserved.

Table of Contents 

2 

3 

4-11 

12-17 

18-22 

23-27 

Your Preferred 

Medication List/Formulary 

Common Questions and Answers 

Preferred/Formulary Medications 

• By Category 

• A to Z Listing 

– Generics 

– Preferred/Formulary Brands 

Non-Preferred/Non-Formulary Brands 

• Generic and Preferred 

Brand Alternatives 



RegenceRx is dedicated to provide the tools you need to 

understand your options and be a more informed consumer. 

This preferred medication list/formulary will help—with the 

answers you need to access affordable prescription benefits. 

Determining Cost 

How much you pay for a prescription 

depends on whether it’s a: 

• Generic 

• Preferred/formulary brand name 

• Non-preferred/non-formulary 

brand name (brand name 

medication not on the list) 

Your cost is lowest for generic 

medications and highest for nonpreferred/non-formulary 

brand name 

medications. You can find specific 

coverage and copay information in 

your summary of benefits. 

Generic medications 

Generics provide the same 

therapeutic benefits of their brand 

name counterparts, without the 

brand name price. In fact, generic 

medications are generally 20-60% 

less expensive. The U.S. Food and 

Drug Administration assures both 

generic and brand name medications 

meet the same high standards for 

strength, quality, and purity. 

Newly-introduced 

generic medications 

When a generic is introduced to the 

marketplace, it immediately becomes 

available at the lowest copay. After a 

generic is available, the brand name 

medication will only be available at the 

non-preferred/non-formulary copay. 

Preferred/formulary 

brand name medications 

Brand name medications on the 

preferred medication list (PML) 

have been chosen because our 

professional review has shown each 

of them to be high-quality, effective, 

and affordable. Preferred/formulary 

brand name medications are either 

more effective or equally effective—at 

a lower cost—than other brand name 

medications not listed. 

Non-preferred/non-formulary 

brand name medications 

Non-preferred/non-formulary brand 

name medications are those that do 

not appear on the PML due to side 

effects, therapeutic performance, 

or higher cost. You may still opt 

for these medications, but your 

copay will be higher than any other 

prescription type. 



Q and A 

How can I use the PML/formulary 

to get the best benefit? 

Ask your doctor to prescribe 

generic medications whenever 

possible. If a generic is not available, 

ask your doctor to choose a 

preferred/formulary brand name 

medication. Take this list when you 

go to the doctor so you can discuss 

your options. 

How can I tell if a listed medication 

is a generic? 

Generic medications are listed 

in lower case bold, like this: 

fluconazole. 

How can I tell if a listed medication 

is a brand? 

Brand name medications start with 

a capital letter and are followed by 

a registered trademark symbol like 

this: ®. 

Brand name medications listed in 

parentheses after a generic are: 

• non-preferred/non-formulary 

• only listed as a reference for a 

generically available medication 

Please remember that not all brands 

are preferred/formulary. 

What if my medication is not on 

the PML/formulary? 

First, check with your doctor. There 

are preferred/formulary alternatives 

in most cases, and your doctor 

can determine an acceptable 

alternative for your medical 

condition. If you remain on a 

non-preferred/non-formulary brand 

name medication, your benefit will 

depend on your coverage. 

What if my medication needs 

prior authorization? 

Certain medications may need prior 

authorization. This means that we 

will need to review information from 

your doctor before the medication 

can be approved for coverage. For a 

list of medications that need prior 

authorization, please visit our Web 

site at www.regencerx.com or 

contact our Customer Service 

Department at the phone number 

listed on your member card. 

If you decide to purchase the 

medication without authorization, you 

will be responsible for the total cost of 

the prescription. 

What resources were used to 

determine what medications would 

be on the PML/formulary? 

Information from the US Food and 

Drug Administration (FDA), medical 

literature (including scientific studies), 

and national treatment guidelines 

were reviewed by the RegenceRx 

Pharmacy and Therapeutics (P&T) 

Committee. This committee includes 

practicing doctors and pharmacists. 

When there are choices, medications 

with the best value were included on 

the PML/formulary. 

If you have questions, please 

contact our Customer Service 

Department at the phone number 

listed on your member card. Or 

visit us at www.regencerx.com. 



Preferred/Formulary Medications: By Category 


This list can be used to assist you and your doctor in choosing a generic or preferred/formulary medication. 

• Generic medications are listed in lower case bold. Example: fluconazole. 

• Brand name medications start with a capital letter and are followed by a registered trademark symbol like this ® . 

Example: Ancobon ® . 

• Brand name medications listed in parenthesis after a generic are: 

- Non-preferred/non-formulary. 

- Only listed as a reference for a generically available medication. Example: fluconazole (Diflucan ® ) 

Additional Information: 

- Preferred/formulary medications are limited to the dosage form and strength listed; if no strength is listed, 

all strengths for the listed dosage form are preferred/formulary. 

- Sustained action/release (SA/SR), extended release (ER/XR), long-acting (LA), and enteric coated (EC) medications 

are only preferred/formulary if listed. 

- Occasionally, preferred/formulary medications may be contract exclusions and, therefore, are not covered. 

- Some medications may require prior authorization or have quantity limits. 

Please note that the PML/formulary list may change. To view the most current list, visit our Web site at www.regencerx.com. 

For more detailed prescription benefit information, please refer to your benefits booklet. 

ANTIFUNGALS (Systemic) 

fluconazole tablet, oral suspension (Diflucan ® ) 

griseofulvin microsize oral suspension (Grifulvin V ® ) 

griseofulvin microsize tablet (Fulvicin ® U/F) 

griseofulvin ultramicrosize tablet (Fulvicin ® P/G) 

itraconazole capsule (Sporanox ® )* 

ketoconazole tablet (Nizoral ® ) 

nystatin suspension, tablet (Mycostatin ® ) 

terbinafine HCL tablet (Lamisil ® )* 

Ancobon ® capsule 

Mycelex ® Troche 

Sporanox solution* 

Vfend ® tablet, oral suspension 

ANTI-INFECTIVES 

amoxicillin capsule, suspension, tablet, 

chews, drops (Amoxil ® ) 

amoxicillin/pot. clavulanate tabs, chews, 

suspension (Augmentin ® ) 

azithromycin tablet, packet, suspension (Zithromax ® ) 

cefaclor capsule, suspension (Ceclor ® ) 

cefadroxil capsule, tablet, suspension (Duricef ® ) 

cefdinir capsule, suspension (Omnicef ® ) 

cefprozil tablet, suspension (Cefzil ® ) 

cefuroxime tablet (Ceftin ® ) 

cephalexin capsule (Keflex ® ) 

cephradine capsule (Velosef ® ) 

chloroquine tablet (Aralen ® ) 

ciprofloxacin tablet, suspension (Cipro ® ) 

clarithromycin tablet (Biaxin ® ) 

clindamycin capsule (Cleocin ® ) 

dicloxacillin capsule (Dynapen ® ) 

doxycycline capsule, tablet (Vibramycin ® ) 

doxycycline hyclate tablet (Periostat ® ) 

erythromycin base EC tablet (Emycin ® ) 

*May not be a covered benefit under some plans. 

4 

ANTI-INFECTIVES (cont.) 

erythromycin ethyl suc tablet, suspension (EES ® ) 

erythromycin/sulfisox suspension (Pediazole ® ) 

ethambutol tablet (Myambutol ® ) 

hydroxychloroquine tablet (Plaquenil ® ) 

isoniazid tablet 

mebendazole chewtabs (Vermox ® ) 

metronidazole tablet (Flagyl ® ) 

minocycline capsule (Minocin ® ) 

nitrofurantoin capsule (Macrodantin ® , Macrobid ® ) 

ofloxacin tablet (Floxin ® ) 

penicillin V potassium tablet, suspension (Veetids ® ) 

pyrazinamide tablet 

rifampin capsule (Rifadin ® ) 

rifampin/isoniazid capsule (Rifamate ® ) 

sulfamethoxazole/trimethoprim tablet, suspension 

(Bactrim ® , Septra ® ) 

sulfadiazine tablet (Microsulfon ® ) 

sulfisoxazole tablet, suspension (Gantrisin ® ) 

tetracycline capsule (Achromycin ® ) 

trimethoprim tablet (Proloprim ® ) 

Albenza ® tablet 

Alinia ® tablet, suspension 

Augmentin ES-600 ® oral suspension 

Avelox ® tablet 

Biltricide ® tablet 

Dapsone ® tablet 

Daraprim ® tablet 

Fansidar ® tablet 

Furadantin ® oral suspension 

Furoxone ® tablet, oral suspension 

Humatin ® capsule 

Lamprene ® capsule 

Lariam ® tablet 

Mepron ® oral suspension 



ANTI-INFECTIVES (cont.) 

Mintezol ® oral suspension, chewable 

Mycobutin ® capsule 

Primaquine ® tablet 

Seromycin ® capsule 

Stromectal ® tablet 

Yodoxin ® tablet 

Zyvox ® tablet, oral suspension 

ANTINEOPLASTICS 

cyclophosphamide tablet (Cytoxan ® ) 

etoposide capsule (Toposar ® , Vepesid ® ) 

flutamide capsule (Eulexin ® ) 

hydroxyurea capsule (Hydrea ® ) 

leucovorin tablet (Wellcovorin ® ) 

megestrol tablet, syrup (Megace ® ) 

tamoxifen tablet (Nolvadex ® ) 

tretinoin capsule (Vesanoid ® ) 

Alkeran ® tablet 

Arimidex ® tablet 

Aromasin ® tablet 

Casodex ® tablet 

CeeNu ® capsule 

Droxia ® capsule 

Emcyt ® capsule 

Fareston ® tablet 

Femara ® tablet 

Gleevec ® tablet, capsule 

Hexalen ® capsule 

Leukeran ® tablet 

Lysodren ® tablet 

Matulane ® capsule 

Mesnex ® tablet 

Myleran ® tablet 

Nolvadex ® tablet 

Purinethol ® tablet 

Tarceva ® tablet 

Temodar ® capsule 

Thioguanine ® tablet 

Xeloda ® tablet 

ANTI-VIRALS/HIV/AIDS 

acyclovir tablet, capsule, suspension (Zovirax ® ) 

amantadine capsule, syrup (Symmetrel ® ) 

didanosine capsule (Videx EC ® ) 

famciclovir tablet (Famvir ® ) 

ganciclovir capsule (Cytovene ® ) 

ribavirin capsule (Rebetol ® ) 

ribavirin tablet (Copegus ® ) 

rimantadine tablet (Flumadine ® ) 

zidovudine capsule, tablet, syrup (Retrovir ® ) 

Agenerase ® capsule, oral solution 

Atripla tablet 

Baraclude ® tablet, oral solution 

Combivir ® tablet 

Crixivan ® capsule 

Emtriva ® capsule 

Epivir ® tablet, oral solution 

Epivir HBV ® tablet, oral solution 

Epzicom ® tablet 

Fortovase ® capsule 

Hepsera ® tablet 

Hivid ® tablet 

Invirase ® capsule, tablet 

5 

ANTI-VIRALS/HIV/AIDS (cont.) 

Kaletra ® capsule, oral solution 

Lexiva ® tablet 

Norvir ® capsule, oral solution 

Prezista tablet 

Rebetol ® oral solution 

Rescriptor ® tablet 

Reyataz ® capsule 

Sustiva ® capsule, tablet 

Tamiflu ® capsule, suspension for reconstitution 

Trizivir ® tablet 

Valtrex ® tablet 

Videx ® chew tab, solution, packet 

Viracept ® tablet, powder for oral solution 

Viramune ® tablet, oral suspension 

Viread ® tablet 

Zerit ® capsule, oral solution 

Ziagen ® tablet, oral solution 

BEHAVIOR MODIFICATION 

amphetamine/dextroamphetamine tablet (Adderall ® ) 

dextroamphetamine SR capsule 

(Dexedrine Spansule ® ) 

dextroamphetamine tablet (Dexedrine ® ) 

methylphenidate tablet (Ritalin ® ) 

methylphenidate ER tablet (Ritalin ® SR) 

Adderall XR capsule 

Antabuse ® tablet 

Metadate ® CD capsule 

BLOOD MODIFIERS 

aminocaproic acid tablet (Amicar ® ) 

anagrelide capsule (Agrylin ® ) 

cilostazol tablet (Pletal ® ) 

dipyridamole tablet (Persantine ® ) 

pentoxifylline tablet (Trental ® ) 

ticlopidine tablet (Ticlid ® ) 

warfarin tablet (Coumadin ® ) 

Coumadin ® tablet 

Mephyton ® tablet 

Plavix ® tablet 

BONE & JOINT 

allopurinol tablet (Zyloprim ® ) 

colchicine tablet 

leflunomide tablet (Arava ® ) 

methotrexate tablet (Rheumatrex ® ) 

probenecid tablet 

sulfasalazine tablet (Azulfidine ® EN-tabs ® ) 

Actonel ® tablet 

Actonel ® with Calcium tablet 

Cuprimine ® capsule 

Depen ® tablet 

Didronel ® tablet 

Evista ® tablet 

Fosamax ® tablet, oral solution 

Fosamax Plus D tablet 

Ridaura ® capsule 

Miacalcin ® nasal spray 

CARDIOVASCULAR 

acebutolol capsule (Sectral ® ) 

amiloride tablet (Midamor ® ) 

amiloride/HCTZ tablet (Moduretic ® ) 

amiodarone tablet (Cordarone ® ) 

amlodipine besylate (Norvasc ® ) 



CARDIOVASCULAR (cont.) 

amlodipine besylate/benazepril capsule (Lotrel ® ) 

atenolol tablet (Tenormin ® ) 

atenolol/chlorthalidone tablet (Tenoretic ® ) 

benazepril HCL tablet (Lotensin ® ) 

benazepril HCL/HCTZ tablet (Lotensin ® HCT) 

betaxolol tablet (Kerlone ® ) 

bumetanide tablet (Bumex ® ) 

captopril tablet (Capoten ® ) 

captopril/HCTZ tablet (Capozide ® ) 

carvedilol tablet (Coreg ® ) 

chlorothiazide tablet (Diuril ® ) 

chlorthalidone tablet (Thalitone ® ) 

clonidine tablet (Catapres ® ) 

digoxin tablet, elixir (Lanoxin ® ) 

diltiazem tablet (Cardizem ® ) 

diltiazem SR capsule (Cardizem ® SR) 

diltiazem SR capsule (Cardizem ® CD) 

diltiazem SR capsule (Dilacor ® XR) 

disopyramide & ER capsule (Norpace ® , Norpace CR ® ) 

doxazosin tablet (Cardura ® ) 

enalapril tablet (Vasotec ® ) 

enalapril/HCTZ tablet (Vaseretic ® ) 

felodipine tablet (Plendil ® ) 

flecainide tablet (Tambocor ® ) 

fosinopril tablet (Monopril ® ) 

fosinopril/HCTZ tablet (Monopril HCT ® ) 

furosemide tablet (Lasix ® ) 

guanfacine tablet (Tenex ® ) 

hydralazine tablet (Apresoline ® ) 

hydralazine/HCTZ tablet (Apresazide ® ) 

hydrochlorothiazide tablet (Oretic ® ) 

indapamide tablet (Lozol ® ) 

isosorbide dinitrate & ER tablet 

(Isordil ® & Dilatrate ® SR) 

isosorbide mononitrate & ER tablet 

(Ismo ® & Imdur ® ) 

labetalol tablet (Trandate ® ) 

lisinopril tablet (Zestril ® , Prinivil ® ) 

lisinopril/HCTZ tablet (Zestoretic ® ) 

methyclothiazide tablet (Enduron ® ) 

methyldopa tablet (Aldomet ® ) 

metolazone tablet (Zaroxolyn ® ) 

metoprolol tablet (Lopressor ® ) 

metoprolol succinate tablet (Toprol XL ® ) 

mexiletine capsule (Mexitil ® ) 

midodrine tablet (Proamatine ® ) 

minoxidil tablet (Loniten ® ) 

moexipril/HCTZ tablet (Uniretic ® ) 

moexipril HCL tablet (Univasc ® ) 

nadolol tablet (Corgard ® ) 

nicardipine capsule (Cardene ® ) 

nifedipine capsule (Procardia ® ) 

nifedipine SA tablet (Adalat ® CC) 

nimodipine capsule (Nimotop ® ) 

nitroglycerin patch (Minitran ® , Nitro-Dur ® ) 

nitroglycerin capsule (NitroTime ® ) 

pindolol tablet (Visken ® ) 

potassium chloride tablet (K-Dur ® ) 

prazosin capsule (Minipress ® ) 

procainamide capsule (Pronestyl ® ) 

procainamide SA tablet (Pronestyl SR ® ) 

propafenone tablet (Rythmol ® ) 

propranolol tablet (Inderal ® ) 

propranolol/HCTZ tablet (Inderide ® ) 

quinapril tablet (Accupril ® ) 

quinapril/HCTZ tablet (Accuretic ® ) 

6 

CARDIOVASCULAR (cont.) 

quinidine gluconate tablet (Quinaglute ® ) 

quinidine sulfate tablet (Quinidex ® ) 

ramipril capsule (Altace ® ) 

sotalol tablet (Betapace ® ) 

spironolactone tablet (Aldactone ® ) 

spironolactone/HCTZ tablet (Aldactazide ® ) 

terazosin capsule (Hytrin ® ) 

timolol maleate tablet (Blocadren ® ) 

trandolapril tablet (Mavik ® ) 

triamterene/HCTZ tablet (Maxzide ® ) 

verapamil tablet (Calan ® ) 

verapamil SR tablet (Calan SR ® ) 

Benicar tablet 

Benicar HCT tablet 

Catapres-TTS ® patch 

Cordarone ® tablet 

Inderal ® LA capsule 

Innopran XL capsule 

Kaon-CL-10 ® tablet 

K-Dur ® tablet 

K-Lyte ® DS tablet 

Lanoxicaps ® 

Lanoxin ® tablet, elixir 

Micardis ® tablet 

Micardis HCT ® tablet 

Micro-K ® capsule 

Norpace ® CR capsule 

Procanbid ® tablet 

Revatio tablet 

Sular ® tablet 

Tikosyn ® capsule 

Tracleer ® tablet 

CHOLESTEROL LOWERING 

cholestyramine/sucrose powder (Questran ® ) 

colestipol HCL granules, tablet (Colestid ® ) 

fenofibrate microsphere capsule, tablet (Lofibra ® ) 

gemfibrozil capsule (Lopid ® ) 

lovastatin tablet (Mevacor ® ) 

pravastatin tablet (Pravachol ® ) 

simvastatin tablet (Zocor ® ) 

Colestid ® packet 

Crestor ® tablet 

Niaspan ® tablet 

Vytorin ® tablet 

DIABETES 

acetohexamide tablet (Dymelor ® ) 

chlorpropamide tablet (Diabinese ® ) 

glimepiride tablet (Amaryl ® ) 

glipizide tablet (Glucotrol ® ) 

glipizide ER tablet (Glucotrol ® XL) 

glipizide-metformin (Metaglip) 

glyburide tablet (Diabeta ® ) 

glyburide, micronized tablet (Glynase ® ) 

metformin tablet (Glucophage ® ) 

metformin ER tablet (Glucophage ® XR) 

tolazamide tablet (Tolinase ® ) 

tolbutamide tablet (Orinase ® ) 

Actos ® tablet 

Avandia ® tablet 

GlucaGen ® injection 

Glucagon ® injection 

Humalog ® insulins 

Humulin ® insulins 

Lantus ® insulin 



DIABETES (cont.) 

Lantus ® SoloSTAR ® insulin 

Novolin ® insulins 

Novolog ® insulins 

Prandin ® tablet 

Precose ® tablet 

Proglycem ® capsule, oral suspension 

DIABETIC SUPPLIES 

- Please check if these are covered by your prescription benefit: 

Ascensia ® test strips* 

Ascensia Breeze ® 2 test strips* 

Ascensia Contour ® test strips* 

Novofine ® needles* 

Lancets, needles, syringes (all products)* 

EAR/NOSE/THROAT 

acetic acid otic (Acetasol ® ) 

acetic acid/hydrocortisone otic (Acetasol ® -HC) 

benzocaine/antipyrine otic (Aurodex ® ) 

benzonatate capsule (Tessalon ® ) 

clemastine tablet (Tavist ® ) 

fexofenadine tablet (Allegra ® ) 

flunisolide nasal spray (Nasalide ® ) 

fluticasone propionate nasal spray (Flonase ® ) 

hydrocodone/homatropine tablet, syrup (Hycodan ® ) 

hydrocort/polymyx/neomycin otic 

(Cortisporin ® Otic) 

ipratropium nasal spray (Atrovent ® ) 

Astelin ® nasal spray 

BromHist ® oral solution 

Carboxine-PSE ® liquid 

Cerumenex ® otic solution 

Ciprodex ® otic suspension 

Cipro ® HC otic suspension 

Nasacort ® AQ nasal spray 

Nasonex ® nasal spray 

Relacon-HC ® syrup 

Rescon JR ® capsule 

Rhinocort ® Aqua ® nasal spray 

GASTROINTESTINAL 

cimetidine tablet, liquid (Tagamet ® ) 

dicyclomine capsule, tablet (Bentyl ® ) 

diphenoxylate/atropine tablet (Lomotil ® ) 

famotidine tablet (Pepcid ® ) 

hyoscyamine capsule (Levsin ® ) 

lactulose syrup (Enulose ® ) 

loperamide capsule, liquid (Imodium ® ) 

meclizine tablet (Antivert ® ) 

mesalamine enema (Rowasa ® ) 

metoclopramide tablet, syrup (Reglan ® ) 

misoprostil tablet (Cytotec ® ) 

omeprazole capsule (Prilosec ® ) 

ondansetron tablet (Zofran ODT ® ) 

ondansetron HCL tablet, oral solution (Zofran ® ) 

pantoprazole sodium tablet (Protonix ® ) 

polyethylene glycol/electrolyte solution 

prochlorperazine tablet (Compazine ® ) 

promethazine tablet, suppository (Phenergan ® ) 

ranitidine tablet, syrup (Zantac ® ) 

sucralfate tablet (Carafate ® ) 

sulfasalazine tablet (Azulfidine ® EN-tabs ® ) 

trimethobenzamide capsule, suppository 

(Tigan ® ) 

ursodiol capsule (Actigall ® ) 

Analpram HC ® rectal cream, rectal lotion 


7 

GASTROINTESTINAL (cont.) 

Anzemet ® tablet 

Asacol ® tablet, oral solution 

Canasa ® rectal suppository 

Colyte ® powder for reconstitution 

Compro ® rectal suppository 

Cortifoam ® rectal foam 

Creon ® capsule 

Dipentum ® capsule 

Epifoam ® topical foam 

Golytely ® powder for reconstitution, packets 

Helidac ® combopak 

Kristalose ® packet 

Kutrase ® capsule 

Ku-zyme ® capsule 

Ku-zyme ® HP capsule 

Kytril ® tablet, solution 

NuLytely ® powder for reconstitution 

Pancrease ® capsule 

Pancrease ® MT capsule 

Pancrecarb MS ® capsule 

Pentasa ® capsule 

Prevacid ® capsule, suspension, tablet 

PrevPac ® 

Prilosec OTC - Available at the generic copay. 

ProctoFoam ® -HC rectal foam 

Ultrase ® capsule 

Ultrase ® MT capsule 

URSO ® tablet 

Viokase ® tablet, powder 

Visicol ® tablet 

HORMONE/ENDOCRINE (ALSO SEE WOMEN’S HEALTH) 

calcitriol capsule (Rocaltrol ® ) 

cortisone acetate tablet (Cortone ® ) 

desmopressin tablet, nasal spray, nasal solution (DDAVP ® ) 

dexamethasone tablet, elixir (Decadron ® ) 

fludrocortisone tablet (Florinef ® ) 

folic acid tablet (Folvite ® ) 

levothyroxine sodium tablet 

methimazole tablet (Tapazole ® ) 

methylprednisolone tablet (Medrol ® ) 

prednisolone 15mg/5ml syrup (Prelone ® ) 

prednisolone sod phosphate oral solution (Orapred ® ) 

prednisone tablet, solution (Deltasone ® ) 

propylthiouracil tablet 

thyroid dessicated tablet 

triamcinolone tablet (Aristocort ® ) 

unithroid tablet 

Armour ® Thyroid tablet 

Cytomel ® tablet 

DDAVP ® nasal spray, nasal solution 

Dexamethasone Intensol ® oral solution 

Levothroid ® tablet 

Levoxyl ® tablet 

Methitest ® tablet 

Nilandron ® tablet 

Pediapred ® oral solution 

Prednisone Intensol ® oral concentrate 

Stimate ® nasal spray 

Synthroid ® tablet 

Teslac ® tablet 

Testred ® tablet 

Thyrolar ® tablet 

Westhroid ® tablet 

Winstrol ® tablet 



IMMUNOSUPPRESSANTS 

azathioprine tablet (Imuran ® ) 

cyclosporine, modified capsule, solution (Neoral ® ) 

cyclosporine capsule, solution (Sandimmune ® ) 

CellCept ® tablet, capsule, suspension 

Myfortic ® ER tablet 

Prograf ® capsule 

Rapamune ® tablet, solution 

Sandimmune ® capsule, solution 

MENTAL HEALTH 

alprazolam tablet (Xanax ® ) 

amitriptyline tablet (Elavil ® ) 

amoxapine tablet (Asendin ® ) 

bupropion SR tablet (Wellbutrin SR ® ) 

buspirone tablet (BuSpar ® ) 

chloral hydrate capsule 

chlordiazepoxide capsule (Librium ® ) 

chlorpromazine tablet, drops, syrup 

(Thorazine ® ) 

citalopram tablet (Celexa ® ) 

clomipramine capsule (Anafranil ® ) 

clonazepam tablet (Klonopin ® ) 

clorazepate tablet (Tranxene ® ) 

clozapine tablet (Clozaril ® ) 

desipramine tablet (Norpramin ® ) 

diazepam tablet, solution (Valium ® ) 

doxepin capsule (Sinequan ® ) 

estazolam tablet (Prosom ® ) 

fluoxetine capsule (Prozac ® ) 

fluphenazine tablet, concentrate, elixir 

(Prolixin ® ) 

flurazepam capsule (Dalmane ® ) 

fluvoxamine tablet (Luvox ® ) 

haloperidol tablet, solution (Haldol ® ) 

hydroxyzine HCL tablet (Atarax ® ) 

hydroxyzine pamoate capsule (Vistaril ® ) 

imipramine tablet (Tofranil ® ) 

lithium carbonate capsule (Eskalith ® ) 

lithium citrate syrup 

lorazepam tablet (Ativan ® ) 

loxapine succinate capsule (Loxitane ® ) 

maprotiline tablet (Ludiomil ® ) 

mirtazapine tablet (Remeron ® ) 

nefazodone tablet (Serzone ® ) 

nortriptyline capsule (Pamelor ® ) 

oxazepam capsule (Serax ® ) 

paroxetine tablet (Paxil ® ) 

perphenazine tablet (Trilafon ® ) 

protriptyline tablet (Vivactil ® ) 

sertraline tablet (Zoloft ® ) 

temazepam capsule (Restoril ® ) 

thioridazine tablet, solution (Mellaril ® ) 

thiothixene capsule (Navane ® ) 

tranylcypromine sulfate tablet (Parnate ® ) 

trazodone tablet (Desyrel ® ) 

triazolam tablet (Halcion ® ) 

trifluoperazine tablet (Stelazine ® ) 

venlafaxine HCL tablet (Effexor ® ) 

zolpidem tartrate tablet (Ambien ® ) 

Effexor XR ® capsule 

Eskalith ® capsule, tablet 

Eskalith CR ® tablet 

Lithobid ® tablet 

Lorazepam Intensol ® oral concentrate 

Moban ® tablet, oral concentrate 

8 

MENTAL HEALTH (cont.) 

Nardil ® tablet 

Orap ® tablet 

Risperdal ® tablet, solution 

Seroquel ® tablet 

Zyprexa ® tablet 

Zyprexa Zydis ® tablet 

MUSCLE RELAXANTS 

baclofen tablet (Lioresal ® ) 

carisoprodol tablet (Soma ® ) 

carisoprodol/ASA tablet (Soma ® Compound) 

cyclobenzaprine tablet (Flexeril ® ) 

dantrolene capsule (Dantrium ® ) 

methocarbamol tablet (Robaxin ® ) 

methocarbamol/ASA tablet (Robaxisal ® ) 

tizanidine tablet (Zanaflex ® ) 

NEUROLOGICAL 

benztropine tablet (Cogentin ® ) 

bromocriptine capsule, tablet (Parlodel ® ) 

cabergoline tablet (Dostinex ® ) 

carbamazepine tablet, chews, suspension (Tegretol ® ) 

carbidopa/levodopa tablet (Sinemet ® ) 

ethosuximide syrup (Zarontin ® ) 

gabapentin tablet, capsule (Neurontin ® ) 

lamotrigine tablet (Lamictal ® ) 

oxcarbazepine tablet (Trileptal ® ) 

phenobarbital tablet, elixir 

phenytoin sodium capsule (Dilantin ® ) 

primidone tablet (Mysoline ® ) 

selegiline tablet, capsule (Eldepryl ® ) 

trihexyphenidyl tablet (Artane ® ) 

valproic acid capsule, syrup (Depakene ® ) 

valproate sodium syrup (Depakene ® ) 

zonisamide capsule (Zonegran ® ) 

Aricept ® tablet 

Aricept ODT ® tablet 

Carbatrol ® capsule 

Celontin ® tablet, capsule 

Cognex ® capsule 

Comtan ® tablet 

Depakote ® tablet 

Depakote ® ER tablet 

Depakote Sprinkle ® capsule 

Diastat ® rectal gel 

Diastat ® AcuDial rectal gel 

Dilantin ® capsule, chews, suspension 

Epitol ® tablet 

Exelon ® capsule, solution 

Felbatol ® tablet, oral suspension 

Gabitril ® tablet 

Kemadrin ® tablet 

Keppra ® tablet, solution 

Lamictal ® tablet 

Mebaral ® tablet 

Mestinon ® tablet, syrup 

Mirapex ® tablet 

Mysoline ® tablet, oral suspension 

Phenytek ® capsule 

Razadyne tablet, solution 

Requip ® tablet 

Rilutek ® tablet 

Stalevo ® tablet 

Tegretol ® XR tablet 

Topamax ® tablet, sprinkle 

Zarontin ® capsule, syrup 



OPHTHALMIC 

acetazolamide tablet (Diamox ® ) 

atropine ophthalmic solution (Atropair ® ) 

bacitracin ophthalmic solution 

betaxolol ophthalmic solution 

brimonidine ophthalmic solution (Alphagan ® ) 

carteolol ophthalmic solution 

cromolyn ophthalmic solution (Crolom ® ) 

dexamethasone sod phos ophthalmic suspension 

diclofenac sod ophthalmic solution 

dipivefrin ophthalmic solution (Propine ® ) 

erythromycin base ophthalmic ointment 

fluorometholone ophthalmic suspension (Fluor-Op ® ) 

flurbiprofen ophthalmic solution (Ocufen ® ) 

gentamicin ophthalmic solution (Genoptic ® ) 

homatropine ophthalmic solution 

(Isopto ® Homatropine) 

ketotifen fumarate ophthalmic solution (Zaditor ® ) 

levobunolol ophthalmic solution (Betagan ® ) 

methazolamide tablet (Neptazane ® ) 

naphazoline ophthalmic solution (Vasocon ® ) 

neo/polymyx/dexamethasone ophthalmic suspension, 

ointment 

phenylephrine ophthalmic solution 

pilocarpine ophthalmic solution (Adsorbocarpine ® ) 

prednisolone acetate ophthalmic suspension 

(Pred Forte ® ) 

prednisolone sod phosphate ophthalmic solution 

(Inflamase Forte ® ) 

sulfacetamide ophthalmic solution (Bleph ® -10) 

timolol maleate ophthalmic solution (Timoptic ® ) 

tobramycin ophthalmic solution (Tobrex ® ) 

trifluridine ophthalmic solution (Viroptic ® ) 

Acular ® ophthalmic solution 

Acular LS ophthalmic solution 

Acular ® PF ophthalmic droperette 

Alocril ® ophthalmic solution 

Alphagan ® P ophthalmic solution 

Alrex ® ophthalmic suspension 

Azopt ® ophthalmic suspension 

Betimol ® ophthalmic solution 

Betoptic S ® ophthalmic suspension 

Blephamide ® S.O.P. ophthalmic ointment 

Ciloxan ® ophthalmic solution, ointment 

Cosopt ® ophthalmic solution 

Cyclogyl ® ophthalmic solution 

Diamox Sequels ® capsule 

FML ® S.O.P. ophthalmic ointment 

Isopto ® Atropine ophthalmic solution 

Isopto ® Homatropine ophthalmic solution 

Lotemax ® ophthalmic suspension 

Lumigan ® ophthalmic solution 

Ocuflox ® ophthalmic solution 

Patanol ® ophthalmic solution 

Pilopine HS ® ophthalmic gel 

Pred-Mild ® ophthalmic suspension 

Timoptic-XE ® ophthalmic sol-gel 

TobraDex ® ophthalmic suspension, ointment 

Travatan ® ophthalmic solution 

Travatan Z ® ophthalmic solution 

Trusopt ® ophthalmic solution 

PAIN & INFLAMMATORY DISEASE 

choline mag trisalicylate tablet (Trilisate ® ) 

codeine/APAP tablet (Tylenol ® #3) 

diclofenac tablet (Voltaren ® ) 

diflunisal tablet (Dolobid ® ) 

9 

PAIN & INFLAMMATORY DISEASE (cont.) 

ergotamine/caffeine tablet, suppository (Cafergot ® ) 

etodolac capsule (Lodine ® ) 

fenoprofen tablet, capsule (Nalfon ® ) 

fentanyl citrate lollipop (Actiq ® ) 

fentanyl patch (Duragesic ® ) 

flurbiprofen tablet (Ansaid ® ) 

hydrocodone/APAP tablet (Vicodin ® ) 

hydrocodone/ibuprofen tablet (Vicoprofen ® ) 

hydromorphone tablet (Dilaudid ® ) 

ibuprofen tablet (Motrin ® ) 

indomethacin capsule (Indocin ® ) 

ketoprofen capsule (Orudis ® ) 

ketoprofen ER capsule (Oruvail ® SR) 

meclofenamate capsule (Meclomen ® ) 

meloxicam tablet (Mobic ® ) 

meperidine tablet, syrup (Demerol ® ) 

methadone tablet, solution, concentrate 

(Dolophine ® ) 

morphine sulfate tablet, capsule, solution 

morphine SR tablet (MS Contin ® ) 

nabumetone tablet (Relafen ® ) 

naproxen tablet (Naprosyn ® ) 

oxaprozin tablet (Daypro ® ) 

oxycodone capsule (OxyIR ® ) 

oxycodone SR tablets (OxyContin ® ) 

oxycodone/APAP tablet (Percocet ® ) 

oxycodone/ASA tablet (Percodan ® ) 

piroxicam capsule (Feldene ® ) 

propoxyphene/APAP tablet (Darvocet N ® -100) 

salsalate tablet (Disalcid ® ) 

sulindac tablet (Clinoril ® ) 

tolmetin tablet (Tolectin ® ) 

tramadol tablet (Ultram ® ) 

tramadol/APAP tablet (Ultracet ® ) 

Ergomar ® tablet 

Imitrex ® tablet, nasal spray, injection 

Kadian ® capsule 

Maxalt ® tablet 

Maxalt ® -MLT tablet 

Migranal ® nasal spray 

Phrenalin ® with caffeine/codeine capsule 

Relpax ® tablet 

Zomig ® tablet, nasal spray 

Zomig-ZMT tablet 

RESPIRATORY 

acetylcysteine solution (Mucomyst ® ) 

albuterol oral inhaler, inhalation solution, 

tablet, syrup (Proventil ® ) 

aminophylline tablet, liquid 

cromolyn sodium solution (Intal ® ) 

dyphylline tablet (Lufyllin ® ) 

ipratropium bromide solution (Atrovent ® ) 

ipratropium/albuterol inhalation solution (Duoneb ® ) 

metaproterenol tablet, syrup, inhalation solution 

(Alupent ® ) 

theophylline tablet, capsule, elixir 

Accolate ® tablet 

Asmanex ® twisthaler 

Atrovent ® oral inhaler 

Atrovent HFA ® oral inhaler 

Azmacort ® oral inhaler 

Beclovent ® oral inhaler 

Combivent ® oral inhaler 



RESPIRATORY (cont.) 

Flovent ® Diskus ® oral inhaler 

Flovent HFA ® oral inhaler 

Foradil ® oral inhaler 

Intal ® oral inhaler 

Nebupent ® powder for inhalation 

Peak Flow Meters 

ProAir ® HFA oral inhaler 

Proventil HFA ® oral inhaler 

Pulmicort Respules ® 

Pulmicort ® oral inhaler 

Pulmozyme ® inhalation solution 

QVAR ® oral inhaler 

Serevent Diskus ® oral inhaler 

Singulair ® tablet, granules, chews 

Spacer devices 

Spiriva ® oral inhaler 

Tilade ® oral inhaler 

Tobi ® oral inhalation solution 

Uniphyl ® tablet 

SKIN/TOPICAL 

amcinonide cream, ointment, lotion (Cyclocort ® ) 

bacitracin/polymyxin ointment (Polysporin ® ) 

betamethasone dipropionate cream, gel, lotion, ointment 

(Diprolene ® ) 

betamethasone dipropionate augmented cream 

(Diprolene AF ® ) 

betamethasone valerate liquid, lotion (Beta-val ® ) 

betamethasone/clotrimazole cream (Lotrisone ® ) 

ciclopirox cream, gel, topical suspension (Loprox ® ) 

ciclopirox topical solution (Penlac ® )* 

clindamycin topical gel, lotion, solution (Cleocin ® ) 

clobetasol propionate cream, lotion, ointment 

(Temovate ® ) 

desonide/petrolatum cream (Desonide ® ) 

desoximetasone gel, ointment, cream (Topicort ® ) 

diflorasone diacetate ointment, cream (Psorcon ® ) 

erythromycin base/benzoyl peroxide gel 

(Benzamycin ® ) 

fluocinolone acetonide cream, ointment 

(Synalar ® ) 

fluocinonide cream, ointment, solution, gel 

(Lidex ® ) 

fluorouracil cream, solution (Efudex ® ) 

gentamicin cream, ointment (Garamycin ® ) 

hydrocortisone cream, ointment, lotion 

(Ala-cort ® ) 

hydrocortisone butyrate cream, ointment, solution (Locoid ® ) 

isotretinoin (amnesteem, claravis, sotret) capsule (Accutane ® ) 

ketoconazole shampoo (Nizoral ® ) 

lidocaine viscous solution (Xylocaine ® ) 

lindane lotion, shampoo (Kwell ® ) 

mometasone cream, lotion, ointment (Elocon ® ) 

mupirocin ointment (Bactroban ® ) 

permethrin 5% cream (Elimite ® ) 

podofilox solution (Condylox ® ) 

silver sulfadiazine cream (Silvadene ® ) 

sulfacetamide sodium/sulfur emulsion, medicated pad 

(Plexion ® ) 

tretinoin cream, gel, lotion (Retin A ® )* 

triamcinolone acetonide cream, ointment (Aristocort ® ) 

urea cream, gel, lotion (Keralac ® ) 

Aclovate ® cream, ointment 

Azelex ® cream 

Bactroban ® cream 

Bactroban ® nasal ointment 


10 

SKIN/TOPICAL (cont.) 

Benzac W ® gel 

Capex ® shampoo 

Carac ® cream 

Centany ® ointment 

Cloderm ® cream 

Condylox ® gel, solution 

Cordran ® lotion, tape, ointment, cream 

Cutivate ® cream, lotion, ointment 

Derma-Smooth/FS ® oil 

Differin ® gel, cream, solution, swab 

Dovonex ® ointment, cream, solution 

Eurax ® cream, lotion 

Fluoroplex ® cream, solution 

Loprox ® shampoo 

Luxiq ® foam 

MetroCream ® 

MetroGel ® 

Phisohex ® liquid 

MetroLotion ® 

Noritate ® cream 

Ovide ® lotion 

Retin A Micro ® gel* 

Soriatane ® capsule 

Soriatane ® CK kit 

Tazorac ® cream, gel 

Topicort LP ® cream 

Ultravate ® cream, ointment 

UROLOGY 

citric acid/sodium citrate solution (Bicitra ® ) 

bethanechol tablet (Urecholine ® ) 

finasteride tablet (Proscar ® ) 

methenamine hippurate tablet (Hiprex ® ) 

methenamine mandelate tablet (Mandelamine ® ) 

oxybutynin tablet (Ditropan ® ) 

oxybutynin chloride ER tablet (Ditropan ® XL) 

phenazopyridine tablet (Pyridium ® ) 

potassium citrate tablet (Urocit-K ® ) 

Detrol ® LA capsule 

Elmiron ® capsule 

Uroxatral ® tablet 

WOMEN’S HEALTH 

clomiphene citrate tablet (Clomid ® )* 

cryselle tablet* 

danazol capsule (Danocrine ® ) 

estradiol tablet (Estrace ® ) 

estradiol transdermal patch 

estropipate tablet (Ogen ® ) 

medroxyprogesterone acetate tablet 

menest tablet 

metronidazole vaginal gel (MetroGel-Vaginal ® ) 

nora-BE tablet* 

previfem tablet* 

tilia FE tablet* (Estrostep ® FE) 

tri-legest FE tablet* (Estrostep ® FE) 

Alesse ® tablet* 

Anemagen ® capsule 

Cenestin ® tablet 

Demulen ® tablet* 

Desogen ® tablet* 

Diaphragms* 

Esclim ® patch 

Estraderm ® patch 

FemHRT ® tablet 

Gynazole ® -1 vaginal cream 

Loestrin ® tablet* 



WOMEN’S HEALTH (cont.) 

Loestrin ® FE tablet* 

Loestrin ® 24 FE tablet* 

LoOvral ® tablet* 

Methergine ® tablet 

Micronor ® tablet* 

Modicon ® tablet* 

Nestab FA ® tablet 

Nordette ® tablet* 

Norinyl ® tablet* 

Nor-QD ® tablet* 

Ortho Cept ® tablet* 

Ortho Cyclen ® tablet* 

Ortho Evra ® patch* 

Ortho Novum ® tablet* 

Ortho Prefest ® tablet 

Ortho Tri-Cyclen ® tablet* 

Ortho Tri-Cyclen ® Lo tablet* 

Ovral ® tablet* 

Ovrette ® tablet* 

Plan B ® tablet* 

Premarin ® tablet 

Premarin ® vaginal cream 

Premphase ® tablet 

Prempro ® tablet 

Serophene ® tablet* 

Terazol ® vaginal cream 

Tri-Levlen ® tablet* 

Tri-Norinyl ® tablet* 

Triphasil ® tablet* 

Vagifem ® vaginal tablet 

Vivelle ® patch 

Vivelle-DOT ® patch 

SELF-INJECTED 

cyanocobalamin injection 

heparin sodium injection 

leuprolide non-depot injection 

octreotide acetate injection (Sandostatin ® ) 

Apokyn ® injection 

Aranesp ® injection 

Avonex ® injection 

Copaxone ® injection 

Enbrel ® injection 

Epipen ® injection 

Epipen ® Jr injection 

Epogen ® injection 

Fragmin ® injection 

Fuzeon ® injection 

Increlex injection 

Innohep ® injection 

Intron ® A injection 

Leukine ® injection 

Lovenox ® injection 

Miacalcin ® injection 

Neupogen ® injection 

Nutropin AQ ® injection* ▼ 

Nutropin Depot ® injection* ▼ 

Nutropin ® injection* ▼ 

Pegasys ® injection 

Peg-Intron ® injection 

Peg-Intron ® Redipen injection 

Procrit ® injection 

Rebetron ® injection 

Rebif ® injection 

Saizen ® injection* ▼ 


▼ Obtain from a designated Specialty Pharmacy. 

11 

OTHER 

chlorhexidine gluconate oral rinse (Peridex ® ) 

fluoride drops 

pilocarpine tablet (Salagen ® ) 

Buphenyl ® tablet, powder 

Carnitor ® tablet, liquid 

Chemet ® capsule 

Cystadane ® oral powder 

Dialyvite ® tablet 

Evoxac ® tablet 

Galzin ® capsule 

PerioGard ® oral liquid 

PhosLo ® capsule, tablet 

Radiogardase ® capsule 

Sensipar ® tablet 

Syprine ® capsule 



A to Z Listing: Generics 


This list can be used to assist you and your doctor in choosing a generic. 

• Generic medications are listed in lower case bold. 

• Non-preferred/non-formulary brands are listed only as a reference for generically available medications. 

• Not all generics are listed. Those listed are examples of some of the generic medications available. 


- Occasionally, generic medications may be contract exclusions and, therefore, are not covered. 




Generic 

Non-Preferred/Non- 

Formulary Brand Name 

A 

acebutolol capsule Sectral ® 

acetazolamide tablet Diamox ® 

acetic acid otic Acetasol ® 

acetic acid/hydrocortisone otic Acetasol ® -HC 

acetohexamide tablet Dymelor ® 

acetylcysteine solution Mucomyst ® 

acyclovir tablet, capsule, 

suspension 

albuterol oral inhaler, 

inhalation solution, tablet, 

syrup 

Zovirax ® 

Proventil ® 

allopurinol tablet Zyloprim ® 

alprazolam tablet Xanax ® 

amantadine capsule, syrup Symmetrel ® 

amcinonide cream, ointment, 

lotion 

Cyclocort ® 

amiloride tablet Midamor ® 

amiloride/HCTZ tablet Moduretic ® 

aminocaproic acid tablet Amicar ® 

aminophylline tablet, liquid 

amiodarone tablet Cordarone ® ** 

amitriptyline tablet Elavil ® 

amlodipine besylate tablet Norvasc ® 

amlodipine besylate/benazepril 

capsule 

Lotrel ® 

amoxapine tablet Asendin ® 

amoxicillin capsule, tablet, 

suspension, chews, drops 

Amoxil ® 

amoxicillin/pot. clavulanate 

tabs, chews, suspension 

Augmentin ® 

amphetamine/ 

dextroamphetamine tablet 

Adderall ® 

anagrelide capsule Agrylin ® 

atenolol tablet Tenormin ® 

atenolol/chlorthalidone tablet Tenoretic ® 

atropine ophthalmic solution Atropair ® 

**This brand is preferred/formulary. 

12 

Generic 

azathioprine tablet Imuran ® 



azithromycin tablet, packet, 

suspension 

Zithromax ® 

B 

bacitracin ophthalmic solution 

bacitracin/polymyxin ointment Polysporin ® 

baclofen tablet Lioresal ® 

benazepril tablet Lotensin ® 

benzocaine/antipyrine otic Aurodex ® 

benzonatate capsule Tessalon ® 

benztropine tablet Cogentin ® 

betamethasone dipropionate 

cream, gel, lotion, ointment 

Diprolene ® 


augmented cream 

Diprolene AF ® 

betamethasone valerate liquid, 

lotion 

Beta-val ® 

betamethasone/clotrimazole 

cream 

Lotrisone ® 

betaxolol ophthalmic solution 

betaxolol tablet Kerlone ® 

bethanechol tablet Urecholine ® 

brimonidine ophthalmic 

solution 

Alphagan ® 

bromocriptine capsule, tablet Parlodel ® 

bumetanide tablet Bumex ® 

bupropion SR tablet Wellbutrin SR ® 

buspirone tablet BuSpar ® 

C 

cabergoline tablet Dostinex ® 

calcitriol capsule Rocaltrol ® 

captopril tablet Capoten ® 

captopril/HCTZ tablet Capozide ® 

carbamazepine tablet, chews, 

suspension 

Tegretol ® 

carbidopa/levodopa tablet Sinemet ® 



Generic 



carisoprodol tablet Soma ® 

carisoprodol/ASA tablet Soma ® carteolol ophthalmic solution 

Compound 

carvedilol tablet Coreg ® 

cefaclor capsule, suspension Ceclor ® 

cefadroxil capsule, tablet, 

suspension 

Duricef ® 

cefdinir capsule, suspension Omnicef ® 

cefprozil tablet, suspension Cefzil ® 

cefuroxime tablet Ceftin ® 

cephalexin capsule Keflex ® 

cephradine capsule Velosef ® 

chloral hydrate capsule 

chlordiazepoxide capsule Librium ® 

chlorhexidine gluconate oral 

rinse 

Peridex ® 

chloroquine tablet Aralen ® 

chlorothiazide tablet Diuril ® 

chlorpromazine tablet, drops, 

syrup 

Thorazine ® 

chlorpropamide tablet Diabinese ® 

chlorthalidone tablet Hygroton ® 

cholestyramine/sucrose 

powder 

Questran ® 

choline mag trisalicylate tablet Trilisate ® 

ciclopirox cream, gel, topical 

suspension 

Loprox ® 

ciclopirox topical solution* Penlac ® 

cilostazol tab Pletal ® 

cimetidine tablet, liquid Tagamet ® 

ciprofloxacin tablet, 

suspension 

Cipro ® 

citalopram tablet Celexa ® 

citric acid/sodium citrate 

solution 

Bicitra ® 

clarithromycin tablet Biaxin ® 

clemastine tablet Tavist ® 

clindamycin capsule Cleocin ® 

clindamycin topical gel, lotion, 

solution 

Cleocin ® 

clobetasol propionate cream, 

lotion, ointment 

Temovate ® 

clomiphene citrate tablet* Clomid ® * 

clomipramine capsule Anafranil ® 

clonazepam tablet Klonopin ® 

clonidine tablet Catapres ® 

clozapine tablet Clozaril ® 

clorazepate tablet Tranxene ® 

codeine/APAP tablet Tylenol ® #3 

colchicine tablet 

colestipol HCL granules, tablet Colestid ® 

cortisone acetate tablet Cortone ® 

cromolyn ophthalmic solution Crolom ® 

cromolyn neb sodium solution Intal ® 

cryselle tablet* Lo/Ovral ® ** 

cyanocobalamin injection 



13 

Generic 

cyclobenzaprine tablet Flexeril ® 

cyclophosphamide tablet Cytoxan ® 


Formulary Brand 

cyclosporine capsule, solution Sandimmune ® ** 

cyclosporine, modified capsule, 

solution 

Neoral ® 

D 

danazol capsule Danocrine ® 

dantrolene capsule Dantrium ® 

desipramine tablet Norpramin ® 

desmopressin tablet, nasal 

spray, nasal solution 

DDAVP ® ** 

desonide/petrolatum cream Desonide ® 

desoximetasone gel, ointment, 

cream 

Topicort ® 

dexamethasone sod phos 

ophthalmic suspension 

dexamethasone tablet, elixir Decadron ® 

dextroamphetamine tablet Dexedrine ® 

dextroamphetamine SR 

capsule 

Dexedrine Spansule ® 

diazepam tablet, solution Valium ® 

diclofenac sod ophthalmic 

solution 

diclofenac tablet Voltaren ® 

dicloxacillin capsule Dynapen ® 

dicyclomine capsule, tablet Bentyl ® 

didanosine capsule Videx EC ® 

diflorasone diacetate ointment, 

cream 

Psorcon ® 

diflunisal tablet Dolobid ® 

digoxin tablet, elixir Lanoxin ® ** 

diltiazem SR capsule Cardizem ® CD 

diltiazem SR capsule Cardizem ® SR 

diltiazem SR capsule Dilacor ® XR 

diltiazem tablet Cardizem ® 

diphenoxylate/atropine tablet Lomotil ® 

dipivefrin ophthalmic solution Propine ® 

dipyridamole tablet Persantine ® 

disopyramide & ER capsule Norpace ® , Norpace CR ® ** 

doxazosin tablet Cardura ® 

doxepin capsule Sinequan ® 

doxycycline capsule, tablet Vibramycin ® 

doxycycline hyclate tablet Periostat ® 

dyphylline tablet Lufyllin ® 

E 

enalapril tablet Vasotec ® 

enalapril/HCTZ tablet Vaseretic ® 

ergotamine/caffeine tablet, 

suppository 

Cafergot ® 

erythromycin base EC tablet Emycin ® 

erythromycin base ophthalmic 

ointment 

erythromycin base/benzoyl 

peroxide gel 

Benzamycin ® 

erythromycin ethylsuc tablet, 

suspension 

EES ® 



Generic 



erythromycin/sulfisoxazole 

suspension 

Pediazole ® 

estazolam tablet Prosom ® 

estradiol tablet Estrace ® 

estradiol transdermal patch 

estropipate tablet Ogen ® 

ethambutol tablet Myambutol ® 

ethosuximide syrup Zarontin ® ** 

etodolac capsule Lodine ® 

etoposide capsule Toposar ® , Vepesid ® 

F 

famciclovir tablet Famvir ® 

famotidine tablet Pepcid ® 

felodipine tablet Plendil ® 

fenofibrate microsphere 

capsule, tablet 

fenoprofen tablet, capsule Nalfon ® 

fentanyl citrate lollipop Actiq ® 

fentanyl patch Duragesic ® 

fexofenadine tablet Allegra ® 

finasteride tablet Proscar ® 

flecainide tablet Tambocor ® 

fluconazole tablet, oral 

suspension 

Diflucan ® 

fludrocortisone tablet Florinef ® 

flunisolide nasal spray Nasalide ® 

fluticasone propionate nasal 

spray 

Flonase ® 

fluocinolone acetonide cream, 

ointment 

Synalar ® 

fluocinonide cream, ointment, 

solution, gel 

Lidex ® 

fluoride drops 

fluorometholone ophthalmic 

suspension 

Fluor-Op ® 

fluorouracil cream, solution Efudex ® 

fluoxetine capsule Prozac ® 

fluphenazine tablet, 

concentrate, elixir 

Prolixin ® 

flurazepam capsule Dalmane ® 

flurbiprofen ophthalmic 

solution 

Ocufen ® 

flurbiprofen tablet Ansaid ® 

flutamide capsule Eulexin ® 

fluvoxamine tablet Luvox ® 

folic acid tablet Folvite ® 

fosinopril tablet Monopril ® 

fosinopril/HCTZ tablet Monopril HCT ® 

furosemide tablet Lasix ® 

G 

gabapentin capsule, tablet Neurontin ® 

ganciclovir capsule Cytovene ® 

gemfibrozil capsule Lopid ® 

gentamicin cream, ointment Garamycin ® 

gentamicin ophthalmic 

solution 

Genoptic ® 

glimepiride tablet Amaryl ® 



14 

Generic 



glipizide tablet Glucotrol ® 

glipizide ER tablet Glucotrol ® XL 

glipizide-metformin tablet Metaglip 

glyburide tablet Diabeta ® 

glyburide, micronized tablet Glynase ® 

griseofulvin microsize oral 

suspension 

Grifulvin ® V 

griseofulvin microsize tablet Fulvicin ® U/F 

griseofulvin ultramicrosize 

tablet 

Fulvicin ® P/G 

guanfacine tablet Tenex ® 

H 

haloperidol tablet, solution Haldol ® 

heparin sodium injection 

homatropine ophthalmic 

Isopto ® Homatropine** 

solution 

hydralazine tablet Apresoline ® 

hydralazine/HCTZ tablet Apresazide ® 

hydrochlorothiazide tablet Oretic ® 

hydrocodone/APAP tablet Vicodin ® 

hydrocodone/homatropine 

tablet, syrup 

Hycodan ® 

hydrocodone/ibuprofen tablet Vicoprofen ® 

hydrocort/polymyx/neomycin otic Cortisporin ® Otic 

hydrocortisone cream, 

ointment, lotion 

Ala-cort ® 

hydrocortisone butyrate 

cream, ointment, solution 

Locoid ® 

hydromorphone tablet Dilaudid ® 

hydroxychloroquine tablet Plaquenil ® 

hydroxyurea capsule Hydrea ® 

hydroxyzine HCL tablet Atarax ® 

hydroxyzine pamoate capsule Vistaril ® 

hyoscyamine capsule Cystospaz-M ® 

I 

ibuprofen tablet Motrin ® 

imipramine tablet Tofranil ® 

indapamide tablet Lozol ® 

indomethacin capsule Indocin ® 

ipratropium bromide solution Atrovent ® 

ipratropium nasal spray Atrovent ® 

ipratropium/albuterol 

inhalation solution 

isoniazid tablet 

isosorbide dinitrate & ER 

tablet 

isosorbide mononitrate & ER 

tablet 

isotretinoin (amnesteem, 

claravis, sotret) capsule 

Duoneb ® 

Isordil ® & Dilatrate ® SR 

Ismo ® & Imdur ® 

Accutane ® 

itraconazole capsule* Sporanox ® 

K 

ketoconazole shampoo, tablet Nizoral ® 

ketoprofen capsule Orudis ® 

ketoprofen ER capsule Oruvail 


©2008. RegenceRx. All Rights Reserved. 

® SR 

ketotifen fumarate ophthalmic 

Zaditor 

solution 

®

Generic 



L 

labetalol tablet Trandate ® 

lactulose syrup Enulose ® 

lamotrigine tablet Lamictal ® ** 

leflunomide tablet Arava ® 

leucovorin tablet Wellcovorin ® 

leuprolide non-depot injection 

levobunolol ophthalmic 

solution 

Betagan ® 

levothyroxine sodium tablet 

lidocaine viscous solution Xylocaine ® 

lindane lotion, shampoo Kwell ® 

lisinopril tablet Zestril ® , Prinivil ® 

lisinopril/HCTZ tablet Zestoretic ® 

lithium carbonate capsule Eskalith ® 

lithium citrate syrup 

loperamide capsule, liquid Imodium ® 

lorazepam tablet Ativan ® 

lovastatin tablet Mevacor ® 

loxapine succinate capsule Loxitane ® 

M 

maprotiline tablet Ludiomil ® 

mebendazole chewtabs Vermox ® 

meclizine tablet Antivert ® 

meclofenamate capsule Meclomen ® 

medroxyprogesterone acetate 

tablet 

megestrol tablet, syrup Megace ® 

meloxicam tablet Mobic ® 

menest tablet 

meperidine tablet, syrup Demerol ® 

mesalamine enema Rowasa ® 

metaproterenol tablet, syrup, 

inhalation solution 

Alupent ® 

metformin ER tablet Glucophage ® XR 

metformin tablet Glucophage ® 

methadone tablet, solution, 

concentrate 

Dolophine ® 

methazolamide tablet Neptazane ® 

methenamine hippurate tablet Hiprex ® 

methenamine mandelate tablet Mandelamine ® 

methimazole tablet Tapazole ® 

methocarbamol tablet Robaxin ® 

methocarbamol/ASA tablet Robaxisal ® 

methotrexate tablet Rheumatrex ® 

methyclothiazide tablet Enduron ® 

methyldopa tablet Aldomet ® 

methylphenidate ER tablet Ritalin ® SR 

methylphenidate tablet Ritalin ® 

methylprednisolone tablet Medrol ® 

metoclopramide tablet, syrup Reglan ® 

metolazone tablet Zaroxolyn ® 

metoprolol tablet Lopressor ® 

metoprolol succinate tablet Toprol XL ® 

metronidazole tablet Flagyl ® 



15 

Generic 



metronidazole vaginal gel MetroGel-Vaginal ® 

mexiletine capsule Mexitil ® 

midodrine tablet Proamatine ® 

minocycline capsule Minocin ® 

minoxidil tablet Loniten ® 

mirtazapine tablet Remeron ® 

misoprostil tablet Cytotec ® 

moexipril HCL tablet Univasc ® 

moexipril/HCTZ tablet Uniretic ® 

mometasone cream, lotion, 

ointment 

Elocon ® 

morphine SR tablet MS Contin ® 

mupirocin ointment Bactroban ® 

N 

nabumetone tablet Relafen ® 

nadolol tablet Corgard ® 

naphazoline ophthalmic 

solution 

Vasocon ® 

naproxen tablet Naprosyn ® 

nefazodone tablet Serzone ® 

neo/polymyx/dexamethasone 

ophthalmic suspension, 

ointment 

nicardipine capsule Cardene ® 

nifedipine capsule Procardia ® 

nifedipine SA tablet Adalat ® CC 

nimodipine capsule Nimotop ® 

nitrofurantoin capsule Macrodantin ® , Macrobid ® 

nitroglycerin capsule NitroTime ® 

nitroglycerin patch Minitran ® , Nitro-Dur ® 

nora-BE tablet* Nor-Q-D ® *,** 

nortriptyline capsule Pamelor ® 

nystatin suspension, tablet Mycostatin ® 

O 

octreotide injection Sandostatin ® 

ofloxacin tablet Floxin ® 

omeprazole capsule Prilosec ® 

ondansetron Zofran ODT ® 

ondansetron HCL Zofran ® 

oxaprozin tablet Daypro ® 

oxazepam capsule Serax ® 

oxcarbazepine tablet Trileptal ® 

oxybutynin tablet Ditropan ® 

oxybutynin chloride ER tablet Ditropan ® XL 

oxycodone capsule OxyIR ® 

oxycodone SR tablet OxyContin ® 

oxycodone/APAP tablet Percocet ® 

oxycodone/ASA tablet Percodan ® 

P 

pantoprazole sodium tablet Protonix ® 

paroxetine tablet Paxil ® 

penicillin V potassium tablet, 

suspension 

Veetids ® 

pentoxifylline tablet Trental ® 

permethrin 5% cream Elimite ® 



Generic 



perphenazine tablet Trilafon ® 

phenazopyridine tablet Pyridium ® 

phenobarbital tablet, elixir 

phenylephrine ophthalmic 

solution 

phenytoin sodium capsule Dilantin ® ** 

pilocarpine ophthalmic solution Adsorbocarpine ® 

pilocarpine tablet Salagen ® 

pindolol tablet Visken ® 

piroxicam capsule Feldene ® 

polyethylene glycol/electrolyte 

solution 

potassium chloride tablet K-Dur ® ** 

potassium citrate tablet Urocit-K ® 

pravastatin Pravachol ® 

prazosin capsule Minipress ® 

prednisolone 15mg/5ml syrup Prelone ® 

prednisolone acetate ophthalmic 

suspension 

Pred Forte ® 

prednisolone sod phosphate 

ophthalmic solution 

Inflamase Forte ® 

prednisolone sod phosphate 

oral solution 

Orapred ® 

prednisone tablet, solution Deltasone ® 

previfem tablet 

primaquine phosphate tablet 

primidone tablet Mysoline ® ** 

probenecid tablet 

procainamide capsule Pronestyl ® 

procainamide SA tablet Pronestyl SR ® 

prochlorperazine tablet Compazine ® 

promethazine tablet, 

suppository 

Phenergan ® 

propafenone tablet Rythmol ® 

propoxyphene/APAP tablet Darvocet N ® -100 

propranolol tablet Inderal ® 

propranolol/HCTZ tablet Inderide ® 

propylthiouracil tablet 

protriptyline tablet Vivactil ® 

pyrazinamide tablet 

Q 

quinapril tablet Accupril ® 

quinapril/ HCTZ tablet Accuretic ® 

quinidine gluconate tablet Quinaglute ® 

quinidine sulfate tablet Quinidex ® 

R 

ramipril capsule Altace ® 

ranitidine tablet, syrup Zantac ® 

ribavirin capsule Rebetol ® 

ribavirin tablet Copegus ® 

rifampin capsule Rifadin ® 

rifampin/isoniazid capsule Rifamate ® 

rimantadine tablet Flumadine ® 

S 

salsalate tablet Disalcid ® 



16 

Generic 



selegiline tablet, capsule Eldepryl ® 

sertraline tablet Zoloft ® 

silver sulfadiazine cream Silvadene ® 

simvastatin tablet Zocor ® 

sotalol tablet Betapace ® 

spironolactone tablet Aldactone ® 

spironolactone/HCTZ tablet Aldactazide ® 

sucralfate tablet Carafate ® 

sulfacetamide ophthalmic 

solution 

Bleph ® -10 

sulfacetamide sodium/sulfur 

emulsion, medicated pad 

Plexion ® 

sulfadiazine tablet Microsulfon ® 

sulfamethoxazole/trimethoprim 

tablet, suspension 

Bactrim ® , Septra ® 

sulfasalazine tablet Azulfidine ® EN-tabs ® 

sulfisoxazole tablet, suspension Gantrisin ® 

sulindac tablet Clinoril ® 

T 

tamoxifen tablet Nolvadex ® ** 

temazepam capsule Restoril ® 

terazosin capsule Hytrin ® 

terbinafine HCL tablet* Lamisil ® 

tetracycline capsule Achromycin ® 

theophylline tablet, capsule, 

elixir 

thioridazine tablet, solution Mellaril ® 

thiothixene capsule Navane ® 

thyroid dessicated tablet 

ticlopidine tablet Ticlid ® 

tilia FE tablet Estrostep ® FE 

timolol maleate ophthalmic 

solution 

Betimol ® ** 

timolol maleate tablet Blocadren ® 

tizanidine tablet Zanaflex ® 

tobramycin ophthalmic 

solution 

Tobrex ® 

tolazamide tablet Tolinase ® 

tolbutamide tablet Orinase ® 

tolmetin tablet Tolectin ® 

tramadol tablet Ultram ® 

tramadol/APAP tablet Ultracet ® 

trandolapril tablet Mavik ® 

tranylcypromine sulfate tablet Parnate ® 

trazodone tablet Desyrel ® 

tretinoin capsule Vesanoid ® 

tretinoin cream, gel, lotion* Retin A ® * 

triamcinolone acetonide 

cream, ointment 

Aristocort ® 

triamcinolone tablet Aristocort ® 

triamterene/HCTZ tablet Maxzide ® 

triazolam tablet Halcion ® 

trifluoperazine tablet Stelazine ® 



Generic 



trifluridine ophthalmic 

solution 

Viroptic ® 

trihexyphenidyl tablet Artane ® 

tri-legest FE tablet Estrostep ® FE 

trimethobenzamide capsule, 

suppository 

Tigan ® 

trimethoprim tablet Proloprim ® 

U 

unithroid tablet 

urea cream, gel, lotion Keralac ® 

ursodiol capsule Actigall ® 

V 

valproic acid capsule, syrup Depakene ® 

valproate sodium syrup Depakene ® 

venlafaxine HCL tablet Effexor ® 

verapamil tablet Calan ® 

verapamil SR Calan SR ® 

W 

warfarin tablet Coumadin ® ** 

Z 

zidovudine capsule, tablet, 

syrup 

Retrovir ® 

zolpidem tartrate tablet Ambien ® 

zonisamide capsule Zonegran ® 


17 



A to Z Listing: Preferred/Formulary Brands 


This list can be used to assist you and your doctor in choosing a preferred/formulary brand. 










A 

Accolate ® tablet 

Aclovate ® cream, ointment 

Actonel ® tablet 

Actonel ® with Calcium tablet 

Actos ® tablet 

Acular ® ophthalmic solution 

Acular LS ophthalmic solution 

Acular ® PF ophthalmic droperette 

Adderall XR capsule 

Agenerase ® capsule, solution 

Albenza ® tablet 

Alesse ® tablet* 

Alinia ® tablet, suspension 

Alkeran ® tablet 

Alocril ® ophthalmic solution 

Alphagan ® P ophthalmic solution 

Alrex ® ophthalmic suspension 

Analpram HC ® rectal cream, rectal lotion 

Ancobon ® capsule 

Anemagen ® capsule 

Antabuse ® tablet 

Anzemet ® tablet 

Apokyn ® injection 

Aranesp ® injection 

Aricept ® tablet 

Aricept ODT ® tablet 

Arimidex ® tablet 

Armour ® Thyroid tablet 

Aromasin ® tablet 

Asacol ® tablet, oral solution 


- Please check if these are covered by your prescription benefit. 

Ascensia Contour ® test strips* 


Ascensia Breeze ® 2 test strips* 


Asmanex ® twisthaler 

Astelin ® nasal spray 


18 

Atripla tablet 

Atrovent ® oral inhaler 

Atrovent HFA ® oral inhaler 

Augmentin ES-600 ® suspension 

Avandia ® tablet 

Avelox ® tablet 

Avonex ® injection 

Azelex ® cream 

Azmacort ® oral inhaler 

Azopt ® ophthalmic suspension 

B 

Bactroban Nasal ® ointment 

Bactroban ® cream 

Baraclude ® tablet, oral solution 

Beclovent ® oral inhaler 

Benicar ® tablet 

Benicar HCT ® tablet 

Benzac W ® gel 

Betimol ® ophthalmic solution 

Betoptic S ® ophthalmic suspension 

Biltricide ® tablet 

Blephamide ® S.O.P. ophthalmic ointment 

Bromhist ® oral solution 

Buphenyl ® oral powder, tablet 

C 

Canasa ® rectal suppository 

Capex ® shampoo 

Carac ® cream 

Carbatrol ® capsule 

Carboxine-PSE ® liquid 

Carnitor ® tablet, liquid 

Casodex ® tablet 

Catapres-TTS ® patch 

Ceenu ® capsule 

Cellcept capsule, tablet, suspension 

Celontin ® tablet, capsule 

Cenestin ® tablet 

Centany ® ointment 

Cerumenex ® otic solution 



Chemet ® capsule 

Ciloxan ® ophthalmic solution, ophthalmic ointment 

Ciprodex ® otic suspension 

Cipro HC ® otic suspension 

Cloderm ® cream 

Cognex ® capsule 

Colestid ® packets 

Colyte ® powder for reconstitution 

Combivent ® oral inhaler 

Combivir ® tablet 

Compro ® rectal suppository 

Comtan ® tablet 

Condylox ® gel, solution 

Copaxone ® injection 

Cordarone ® tablet 

Cordran ® lotion, tape, ointment, cream 

Cortifoam ® rectal foam 

Cosopt ® ophthalmic solution 

Coumadin ® tablet 

Creon ® capsule 

Crestor ® tablet 

Crixivan ® capsule 

Cuprimine ® capsule 

Cutivate ® cream, lotion, ointment 

Cyclogyl ® ophthalmic solution 

Cystadane ® oral powder 

Cytomel ® tablet 

D 

Dapsone ® tablet 

Daraprim ® tablet 

DDAVP ® nasal solution, nasal spray 

Demulen ® tablet* 

Depakote Sprinkle ® capsule 

Depakote ® ER tablet 

Depakote ® tablet 

Depen ® tablet 

Derma-Smoothe/FS ® oil 

Desogen ® tablet* 

Detrol ® LA capsule 

Dexamethasone Intensol ® oral solution 

Diabetic supplies: lancets, needles, syringes* 


Dialyvite ® tablet 

Diamox Sequels ® capsule 

Diaphragms* 

Diastat ® rectal gel 

Diastat ® AcuDial rectal gel 

Didronel ® tablet 

Differin ® cream, gel, solution, swab 

Dilantin ® capsule, chews, suspension 

Dipentum ® capsule 

Dovonex ® cream, ointment, solution 

Droxia ® capsule 

E 

Effexor XR ® capsule 

Elmiron ® capsule 

Emcyt ® capsule 

Emtriva ® capsule 

Enbrel ® injection 


19 

Epifoam ® topical foam 

Epipen ® injection 

Epipen ® Jr injection 

Epitol ® tablet 

Epivir ® tablet, solution 

Epivir HBV ® tablet, solution 

Epogen ® injection 

Epzicom ® tablet 

Ergomar ® tablet 

Esclim ® patch 

Eskalith ® capsule, tablet 

Eskalith CR ® tablet 

Estraderm ® patch 

Eurax ® cream, lotion 

Evista ® tablet 

Evoxac ® capsule 

Exelon ® capsule, solution 

F 

Fansidar ® tablet 

Fareston ® tablet 

Felbatol ® tablet, oral suspension 

Femara ® tablet 

FemHRT ® tablet 

Flovent ® Diskus ® oral inhaler 

Flovent HFA ® oral inhaler 

Fluoroplex ® cream, solution 

FML ® S.O.P. ointment 

Foradil ® oral inhaler 

Fortovase ® capsule 

Fosamax ® tablet, oral solution 

Fosamax Plus D tablet 

Fragmin ® injection 

Furadantin ® oral suspension 

Furoxone ® tablet, oral suspension 

Fuzeon ® injection 

G 

Gabitril ® tablet 

Galzin ® capsule 

Gleevec ® tablet, capsule 

GlucaGen ® injection 

Glucagon ® injection 

Golytely ® powder for reconstitution, packets 

Gynazole-1 ® vaginal cream 

H 

Helidac ® combo pak 

Hepsera ® tablet 

Hexalen ® capsule 

Hivid ® tablet 

Humalog ® insulins 

Humatin ® capsule 

Humulin ® insulins 

I 

Imitrex ® tablet, nasal spray, injection 

Increlex injection 

Inderal ® LA capsule 

Innohep ® injection 

Innopran XL capsule 

Intal ® oral inhaler 

Intron ® A injection 



Invirase ® capsule, tablet 

Isopto ® Atropine ophthalmic solution 

Isopto ® Homatropine ophthalmic solution 

K 

Kadian ® capsule 

Kaletra ® capsule, solution 

Kaon-CL-10 ® tablet 

K-Dur ® tablet 

Kemadrin ® tablet 

Keppra ® tablet, solution. 

K-Lyte ® DS tablet 

Kristalose ® packet 

Kutrase ® capsule 

Ku-Zyme ® capsule 

Ku-Zyme ® HP capsule 

Kytril ® solution, tablet 

L 

Lamictal ® tablet 

Lamprene ® capsule 

Lanoxicaps ® capsule 

Lanoxin ® tablet, elixir 

Lantus ® insulin 

Lantus ® SoloSTAR ® insulin 

Lariam ® tablet 

Leukeran ® tablet 

Leukine ® injection 

Levothroid ® tablet 

Levoxyl ® tablet 

Lexiva ® tablet 

Lithobid ® tablet 

Loestrin ® tablet* 

Loestrin ® FE tablet* 

Loestrin ® 24 FE tablet* 

LoOvral ® tablet* 

Loprox ® shampoo 

Lorazepam Intensol ® oral concentrate 

Lotemax ® ophthalmic suspension 

Lovenox ® injection 

Lumigan ® ophthalmic solution 

Luxiq ® topical foam 

Lysodren ® tablet 

M 

Matulane ® capsule 

Maxalt ® tablet 

Maxalt MLT ® tablet 

Mebaral ® tablet 

Mephyton ® tablet 

Mepron ® oral suspension 

Mesnex ® tablet 

Mestinon ® tablet, syrup 

Metadate ® CD capsule 

Methergine ® tablet 

Methitest ® tablet 

MetroCream ® 

MetroGel ® 

MetroLotion ® 

Miacalcin ® injection, nasal spray 

Micardis ® tablet 

Micardis HCT ® tablet 



20 

Micro-K ® capsule 

Micronor ® tablet* 

Migranal ® nasal spray 

Mintezol ® oral suspension, chews 

Mirapex ® tablet 

Moban ® oral concentrate, tablet 

Modicon ® tablet* 

Mycelex ® troche 

Mycobutin ® capsule 

Myfortic ® ER tablet 

Myleran ® tablet 

Mysoline ® tablet, oral suspension 

N 

Nardil ® tablet 

Nasacort ® AQ nasal spray 

Nasonex ® nasal spray 

Nebupent ® aerosol powder for inhalation 

Nestabs FA ® tablet 

Neupogen ® injection 

Niaspan ® tablet 

Nilandron ® tablet 

Nolvadex ® tablet 

Novofine ® needles* 


Nordette ® tablet* 

Norinyl ® tablet* 

Noritate ® cream 

Norpace ® CR capsule 

Nor-QD ® tablet* 

Norvir ® capsule, solution 

Novolin ® insulins 

Novolog ® insulins 

Nulytely ® powder for reconstitution 

Nutropin ® injection* ▼ 

Nutropin AQ ® injection* ▼ 

Nutropin Depot ® injection* ▼ 

O 

Ocuflox ® ophthalmic solution 

Orap ® tablet 

Ortho Cept ® tablet* 

Ortho Cyclen ® tablet* 

Ortho Evra ® patch* 

Ortho Novum ® tablet* 

Ortho Prefest ® tablet 

Ortho Tri-Cyclen ® tablet* 

Ortho Tri-Cyclen ® Lo tablet* 

Ovide ® lotion 

Ovral ® tablet* 

Ovrette ® tablet* 

P 

Pancrease ® capsule 

Pancrease ® MT capsule 

Pancrecarb MS ® capsule 

Patanol ® ophthalmic solution 

Peak Flow Meters 

Pediapred ® solution 

Pegasys ® injection 

Peg-Intron ® injection 

Peg-Intron ® Redipen injection 



Pentasa ® capsule 

PerioGard ® oral liquid 

Phenytek ® capsule 

Phisohex ® liquid 

Phoslo ® capsule, tablet 

Phrenilin w/Caffeine & Codeine ® capsule 

Pilopine HS ® ophthalmic gel 

Plan B ® tablet* 

Plavix ® tablet 

Prandin ® tablet 

Precose ® tablet 

Pred Mild ® ophthalmic suspension 

Prednisone Intensol ® oral concentrate 

Premarin ® tablet 

Premarin ® vaginal cream 

Premphase ® tablet 

Prempro ® tablet 

Prevacid ® capsule, suspension, tablet 

Prevpac ® 

Prezista tablet 

Prilosec OTC tablet - Available at generic copay. 

Primaquine ® tablet 

Procanbid ® tablet 

Procrit ® injection 

ProctoFoam ® -HC rectal foam 

Proglycem ® capsule, oral suspension 

Prograf ® capsule 

ProAir ® HFA oral inhaler 

Proventil HFA ® oral inhaler 

Pulmicort ® oral inhaler 

Pulmicort ® respules 

Pulmozyme ® inhalation solution 

Purinethol ® tablet 

Q 

QVAR ® oral inhaler 

R 

Radiogardase ® capsule 

Rapamune ® tablet, solution 

Rebetol ® oral solution 

Rebetron ® injection 

Rebif ® injection 

Relacon-HC ® syrup 

Relpax ® tablet 

Remicade ® - Covered only under the medical benefit. 

Razadyne tablet, solution 

Requip ® tablet 

Rescon JR ® capsule 

Rescriptor ® tablet 

Retin-A Micro ® gel* 

Revatio tablet 

Reyataz ® capsule 

Rhinocort Aqua ® nasal spray 

Ridaura ® capsule 

Rilutek ® tablet 

Risperdal ® tablet, solution 

S 

Saizen ® injection* ▼ 

Sandimmune ® capsule, solution 

Sensipar ® tablet 



21 

Serevent Diskus ® oral inhaler 

Seromycin ® capsule 

Serophene ® tablet* 

Seroquel ® tablet 

Singulair ® tablet, chews, granules 

Soriatane ® capsule 

Soriatane ® CK kit 

Spacer Device 

Spiriva ® oral inhaler 

Sporanox ® solution* 

Stalevo ® tablet 

Stimate ® nasal spray 

Stromectol ® tablet 

Sular ® tablet 

Sustiva ® capsule, tablet 

Synthroid ® tablet 

Syprine ® capsule 

T 

Tamiflu ® capsule, suspension for reconstitution 

Tarceva ® tablet 

Tazorac ® cream, gel 

Tegretol ® XR tablet 

Temodar ® capsule 

Terazol ® vaginal cream 

Teslac ® tablet 

Testred ® capsule 

Thioguanine ® tablet 

Thyrolar ® tablet 

Tikosyn ® capsule 

Tilade ® oral inhaler 

Timoptic-XE ® ophthalmic sol-gel 

Tobi ® oral inhalation solution 

TobraDex ® ophthalmic suspension, ointment 

Topamax ® tablet, sprinkle 

Topicort LP ® cream 

Tracleer ® tablet 

Travatan ® ophthalmic solution 

Travatan Z ® ophthalmic solution 

Tri-Levlen ® tablet* 

Tri-Norinyl ® tablet* 

Triphasil ® tablet* 

Trizivir ® tablet 

Trusopt ® ophthalmic solution 

U 

Ultrase ® capsule 

Ultrase ® MT capsule 

Ultravate ® cream, ointment 

Uniphyl ® tablet 

Uroxatral ® tablet 

URSO ® tablet 

V 

Vagifem ® vaginal tablet 

Valtrex ® tablet 

Vfend ® tablet, oral suspension 

Videx ® chew tablets, solution, packets 

Viokase ® tablet, powder for oral solution 

Viracept ® tablet, powder for oral solution 

Viramune ® tablet, oral suspension 

Viread ® tablet 



Visicol ® tablet 

Vivelle ® patch 

Vivelle-DOT ® patch 

Vytorin ® tablet 

W 

Westhroid ® tablet 

Winstrol ® tablet 

X 

Xeloda ® tablet 

Y 

Yodoxin ® tablet 

Z 

Zarontin ® capsule, syrup 

Zerit ® capsule, oral solution 

Ziagen ® tablet, oral solution 

Zomig ® tablet, nasal spray 

Zomig-ZMT tablet 

Zyprexa ® tablet 

Zyprexa ® Zydis ® tablet 

Zyvox ® tablet, oral suspension 

22 



Non-Preferred/Non-Formulary Brands: 

Generic and Preferred Brand Alternatives 


This list can be used to assist you and your doctor in choosing a generic or preferred/formulary alternative. 

• Generic medications are listed in lower case bold. Example: fluconazole. 

• Non-preferred/non-formulary brands are listed in parenthesis only as a reference for generically available medications. 

• This is a partial list. New or rarely used medications may not be listed. 

• Other, less-expensive options may be available over the counter (OTC) without a prescription. 

OTC products generally are not a covered prescription benefit. 










Non-Preferred/ 

Non-Formulary 

Brand Name 

A 

Abilify ® 

Accu-Chek ® 

Aceon ® 

Aciphex ® 

Generic and Preferred Brand 

Alternatives 

clozapine (Clozaril ® ), haloperidol 

(Haldol ® ), Risperdal ® , Zyprexa ® , Seroquel ® 

Ascensia Breeze ® 2 test strips*, Ascensia 

Contour ® test strips* 

benazepril (Lotensin ® ), enalapril 

(Vasotec ® ), fosinopril (Monopril ® ), 

lisinopril (Zestril ® , Prinivil ® ), moexipril 

(Univasc ® ), quinapril (Accupril ® ), 

trandolapril (Mavik ® ) 

cimetidine (Tagamet ® ), famotidine 

(Pepcid ® ), omeprazole (Prilosec ® ), 

pantoprazole (Protonix ® ), ranitidine 

(Zantac ® ), Prevacid ® , Prilosec OTC 

Activella ® 

estradiol (Estrace ® ) + 

medroxyprogesterone (Provera ® ), 

estradiol (Estrace ® ) + norethindrone 

(Aygestin ® ), FemHRT ® , Prempro ® , 

Premphase ® 

Adoxa ® doxycycline (Vibramycin ® ) 

Advair Diskus ® 

(Asmanex ® /Azmacort ® /Flovent ® Diskus ® / 

Flovent ® HFA/Pulmicort ® /QVAR ® ) + 

Serevent ® Diskus ® /Foradil ® 

Advair ® HFA 


Flovent ® HFA/Pulmicort ® /QVAR ® ) + 

Serevent ® Diskus ® /Foradil ® 


23 



Brand Name 

Advicor ® 

Aerobid ® / M 

Aggrenox ® 

Alamast ® 


Alternatives 

simvastatin (Zocor ® ), pravastatin 

(Pravachol ® ), lovastatin (Mevacor ® ), 

Crestor ® , Vytorin ® + Niaspan ® 

Asmanex ® , Azmacort ® , Flovent ® Diskus ® , 

Flovent ® HFA, Pulmicort ® , QVAR ® 

cilostazol (Pletal ® ), dipyridamole 

(Persantine ® ) + aspirin (OTC), ticlopidine 

(Ticlid ® ), Plavix ® 

Acular ® , Alocril ® , cromolyn ophthalmic 

(Crolom ® ), ketotifen fumarate 

ophthalmic solution (Zaditor ® ), Patanol ® 

Aldara ® podofilox (Condylox ® ) 

Allegra-D ® 

Alomide ® 

Altace ® 

OTC loratadine*, OTC Claritin-D ® *, 

OTC Alavert-D*, fexodenadine 

(Allegra ® ) + decongestant* 

cromolyn ophthalmic (Crolom ® ), 

ketotifen fumarate ophthalmic solution 

(Zaditor ® ), Alocril ® , Patanol ® 

benazepril (Lotensin ® ), captopril 

(Capoten ® ), enalapril (Vasotec ® ), 

fosinopril (Monopril ® ), lisinopril 

(Zestril ® , Prinivil ® ), moexipril (Univasc ® ), 

quinapril (Accupril ® ), trandolapril 

(Mavik ® ) 





Brand Name 

Ambien CR 


Alternatives 

flurazepam (Dalmane ® ), temazepam 

(Restoril ® ), triazolam (Halcion ® ), 

zolpidem tartrate (Ambien ® ) 

Amerge ® Imitrex ® , Maxalt ® , Zomig ® , Relpax ® 

Amitiza ® 

Androderm ® 

Androgel ® 

lactulose, polyethylene glycol/electrolyte 

solution 

testosterone cypionate (Depo- 

Testosterone ® ), testosterone enanthate 

(Delatestryl ® ) 

testosterone cypionate (Depo- 

Testosterone ® ), testosterone enanthate 

(Delatestryl ® ) 

Angeliq ® FemHrt ® , Premphase ® , Prempro ® 

Apidra ® Humalog ® , Novolog ® 

Aptivus ® 

Arthrotec ® 

Atacand ® 

Atacand HCT ® 

Invirase ® , Agenerase ® , Reyataz ® , Lexiva ® , 

Crixivan ® , Viracept ® , Norvir ® 

diclofenac (Voltaren ® ), etodolac 

(Lodine ® ), naproxen (Naprosyn ® ), 

salsalate (Disalcid ® ), choline magnesium 

trisalicylate (Trilisate ® ), meloxicam 

(Mobic ® ) 

benazapril (Lotensin ® ), Benicar , 

captopril (Capoten ® ), enalapril 


lisinopril (Zestril ® , Prinivil ® ), Micardis ® , 

moexipril (Univasc ® ), quinapril 

(Accupril ® ), trandolapril (Mavik ® ) 

lisinopril/HCTZ (Zestoretic ® ), captopril/ 

HCTZ (Capozide ® ), enalapril/HCTZ 

(Vaseretic ® ), fosinopril/HCTZ (Monopril 

HCT ® ), Benicar HCT , Micardis HCT ® 

Augmentin XR ® amoxicillin/clavulanate (Augmentin ® ) 

Avalide ® 

Avandamet ® 

Avapro ® 

benazepril/HCTZ (Lotensin HCT ® ), 

Benicar HCT , captopril/HCTZ 

(Capozide ® ), enalapril/HCTZ 

(Vasoretic ® ), fosinopril/HCTZ (Monopril 

HCT ® ), lisinopril/HCTZ (Zestoretic ® , 

Prinzide ® ), Micardis HCT ® , moexipril/ 

HCTZ (Uniretic ® ), quinapril/HCTZ 

(Accuretic ® ) 

glyburide (Diabeta ® ), glipizide 

(Glucotrol ® ), metformin (Glucophage ® ) 

benazapril (Lotensin ® ), Benicar , 

captopril (Capoten ® ), enalapril 


lisinopril (Zestril ® , Prinivil ® ), Micardis ® , 

moexipril (Univasc ® ), quinapril 

(Accupril ® ), trandolapril (Mavik ® ) 

24 



Brand Name 

Avinza ® 

Avodart ® 


Alternatives 

fentanyl transdermal (Duragesic ® ), 

hydromorphone (Dilaudid ® ), morphine 

SR (MS Contin ® ), morphine sulfate, 

oxycodone SR (Oxycontin ® ), oxycodone, 

codeine sulfate, Kadian ® 

terazosin (Hytrin ® ), doxazosin (Cardura ® ), 

finasteride (Proscar ® ), prazosin 

(Minipress ® ), Uroxatral ® 

Axert ® Imitrex ® , Maxalt ® , Zomig ® , Relpax ® 

Azilect ® 

bromocriptine (Parlodel ® ), pergolide 

(Permax ® ), selegiline (Eldepryl ® ), 

Comtan ® , Mirapex ® , Requip ® 

B 

Bacitracin ® neomycin/polymyxin/bacitracin, 

neomycin/polymyxin/gramacidin 

ophthalmic 

(Neosporin ® ) 

Beconase AQ ® 

flunisolide (Nasalide ® ), fluticasone 

propionate (Flonase ® ), Nasacort AQ ® , 

Nasonex, Rhinocort Aqua ® 

BenzaClin ® erythromycin base/benzoyl peroxide 


Betaseron ® Avonex ® , Copaxone ® , Rebif ® 

B-D ® test strips Ascensia ® test strips* 

Biaxin XL ® 

clarithromycin, erythromycin (E-mycin ® , 

EES ® ), doxycycline (Vibramycin ® ), 

azithromycin (Zithromax ® ) 

Boniva ® Fosamax ® , Actonel ® 

Brevoxyl ® benzoyl peroxide (Desquam ® , Benzac ® ) 

C 

Caduet ® 

Celebrex ® 

diltiazem SR (Cardizem SR ® ), 

verapamil SR (Calan SR ® ), nifedipine 

SA (Adalat CC ® ), felodipine (Plendil ® ) 

+ simvastatin (Zocor ® ), pravastatin 


Crestor ® , Vytorin ® 

diclofenac (Voltaren ® XR), etodolac 

(Lodine ® XL), naproxen (Naprosyn ® ), 


trisalicylate (Trilisate ® ) 

Cipro XR ® ciprofloxacin (Cipro ® ) 

Clarinex ® 

Climara ® 

OTC loratadine*, OTC Claritin ® *, OTC 

Alavert* 

estradiol, estropipate, Esclim ® , 

Estraderm ® , Vivelle ® , Vivelle DOT ® 

Climara Pro ® FemHRT ® , Prempro ® , Premphase ® 

Clobex ® 

Colazal ® 

clobetasol propionate (Temovate ® ), 

betamethasone dipropionate (Diprolene ® ) 

sulfasalazine (Azulfidine Entabs ® ), 

Asacol ® , Dipentum ® , Pentasa ® 

Combipatch ® FemHRT ® , Prempro ® , Premphase ® 





Brand Name 

Concerta ® 

Cortef ® 


Alternatives 

methylphenidate ER (Ritalin SR ® ), 

Metadate CD ® , Adderall XR ® 

prednisone (Deltasone ® ), dexamethasone 

(Decadron ® ), methylprednisolone 

(Medrol ® ) 

Cozaar ® Benicar , Micardis ® 

Cyclessa ® velivet, cesia 

Cymbalta ® 

bupropion SR (Wellbutrin SR ® ), 

citalopram (Celexa ® ), fluoxetine 

(Prozac ® ), paroxetine (Paxil ® ), sertraline 

(Zoloft ® ) 

D 

Denavir ® acyclovir capsule (Zovirax ® ) 

Dermatop ® 

betamethasone valerate (Betaval ® ), 


(Diprolene ® ), flunisolone acetonide 

(Synalar ® ), triamcinolone acetonide 

(Aristocort ® ) 

Detrol ® 

Detrol LA ® , oxybutynin (Ditropan ® ), 

oxybutynin chloride ER (Ditropan ® XL) 

Diovan ® Benicar , Micardis ® 

Diovan HCT ® Benicar HCT , Micardis HCT ® 

Doryx ® doxycycline hyclate (Vibramycin ® ) 

Duac ® 

erythromycin/benzoyl peroxide 


Duetact ® glimepiride (Amaryl ® ) + Avandia ® /Actos ® 

DynaCirc CR ® 

E 

Elidel ® 

Emend ® 

diltiazem SR (Cardizem SR ® ) , 

verapamil SR (Calan SR ® ), nifedipine SA 

(Adalat CC ® ), felodipine (Plendil ® ) 

triamcinolone (Aristocort ® ), 


(Diprolene ® ), fluocinolone (Synalar ® ) 

Anzemet ® , Kytril ® , metoclopramide 

(Reglan ® ), ondansetron HCL (Zofran ®, 

Zofran ODT ® ), prochlorperazine 

(Compazine ® ) 

Enablex ® oxybutynin (Ditropan ® ), oxybutynin 

chloride ER (Ditropan XL ® ), Detrol LA ® 

Entocort EC ® prednisone, methylprednisolone 

Estrace ® 

vaginal cream 

Estratest ® / H.S. 

Estring ® 

Exelderm ® 

estradiol, Premarin ® vaginal cream, 

Vagifem ® 

estradiol (Estrace ® ), estropipate (Ogen ® ), 

Premarin ® , Cenestin ® 

estradiol, Premarin ® vaginal cream, 

Vagifem ® 



clotrimazole (Lotrimin ® ), econazole 

(Spectazole ® ), ketoconazole (Nizoral ® ), 

nystatin (Mycostatin ® ), terbinafine 

(Lamisil ® ) 

25 



Brand Name 


Alternatives 

Exforge ® amlodipine (Norvasc ® ) + Micardis ® /Benicar ® 

F 

Femring ® estradiol (Estrace ® ), Premarin ® vaginal 

cream 

Finacea ® Azelex ® 

Flarex ® 

Flomax ® 

Focalin ® 

fluorometholone (Fluor-Op ® ), 

prednisolone sodium acetate (Pred 

Forte ® ), Alrex ® , FML S.O.P. ® 

terazosin (Hytrin ® ), prazosin 

(Minipress ® ), doxazosin (Cardura ® ), 

Uroxatral ® 


Metadate CD ® 

Foltx ® folic acid + Vitamin B12 + Vitamin B6 

Fortamet ® metformin (Glucophage ® ) 

Freestyle ® test strips Ascensia ® test strips* 

Frova ® Imitrex ® , Maxalt ® , Zomig ® , Relpax ® 

G 

Genotropin ® * ▼ Nutropin ® * ▼ , Nutropin AQ ® * ▼ , Saizen ® * ▼ 

Geodon ® Risperdal ® , Zyprexa ® , Seroquel 

Glyset ® 

H 



Half-Lytely ® polyethylene glycol/electrolyte solution 

Hectorol ® calcitriol (Rocaltrol ® ) 

Humatrope ® * ▼ Nutropin ® * ▼ , Nutropin AQ ® * ▼ , Saizen ® * ▼ 

Humira ® 

methotrexate (Rheumatrex ® ), leflunomide 

(Arava ® ), Enbrel ® 

Hyzaar ® Benicar HCT , Micardis HCT ® 

I 

Innopran XL ® 

Ivega 

J 

Januvia ® 

K 

Ketek ® 

Kineret ® 

Klaron ® 

propranolol (Inderal ® ), atenolol 

(Tenormin ® ), Inderal LA ® 

Risperdal ® , Seroquel ® , Zyprexa ® , 

Zyprexa ® Zydis ® 

glipizide (Glucotrol ® ), glyburide (Micronase ® ), 

metformin (Glucophage ® ), insulin 

amoxicillin/clavulanate (Augmentin ® ), 

clarithromycin (Biaxin ® ), doxycycline 

(Vibramycin ® ), azithromycin 

(Zithromax ® ) 

methotrexate (Rheumatrex ® ), leflunomide 

(Arava ® ), Enbrel ® 

benzoyl peroxide (Desquam ® ), Azelex ® , 

erythromycin/benzoyl peroxide 






Brand Name 

L 

Lescol ® 

Lescol XL ® 

Levaquin ® 

Levemir ® 


Alternatives 







ofloxacin (Floxin ® ), ciprofloxacin 

(Cipro ® ), Avelox ® 

Lantus ® , Humulin N ® , Novolin N ® , 

Humalog 75/25 ® , Novolog 70/30 ® 

Levlen ® aviane*, lessina*, levora*, portia* 

Lexapro ® 

Lidoderm ® 

Lipitor ® 

Livostin ® 

Lovaza ® 

Lunesta ® 

M 

Malarone ® 



(Zoloft ® ) 

amitriptyline (Elavil ® ), nortriptyline 

(Pamelor ® ), gabapentin (Neurontin ® ) 




cromolyn ophthalmic (Crolom ® ), 

ketotifen fumarate ophthalmic solution 

(Zaditor ® ), Alocril ® , Patanol ® 

fenofibrate, gemfibrozil (Lopid ® ), lofibra, 

lovastatin (Mevacor ® ), pravastatin 

(Pravachol ® ), simvastatin (Zocor ® ) 




hydroxychloroquine (Plaquenil ® ), 

mefloquine (Lariam ® ), chloroquine 

(Aralen ® ) 

Maxair ® ProAir ® HFA, Proventil HFA ® 

Mircette ® Kariva* 

N 

Namenda ® Aricept ® , Exelon ® , Razadyne 

Nasarel ® 

Natelle ® 

Nexium ® 

flunisolide (Nasalide ® ), Rhinocort Aqua ® , 

fluticasone propionate (Flonase ® ), 

Nasacort AQ ® , Nasonex 

generic prenatal vitamins with 

folic acid 





Norditropin ® * ▼ Nutropin ® * ▼ , Nutropin AQ ® * ▼ , Saizen ® * ▼ 

Norditropin 

Nordiflex ® * ▼ 

Nutropin ® * ▼ , Nutropin AQ ® * ▼ , Saizen ® * ▼ 

NuvaRing ® generic oral contraceptives* 



26 



Brand Name 


Alternatives 

O 

O-Cal FA 

generic prenatal vitamins with 

folic acid 

Olux ® clobetasol (Temovate ® ) 

Omnitrope* ▼ Nutropin ® * ▼ , Nutropin AQ ® * ▼ , Saizen ® * ▼ 

One-Touch ® test 

strips 

One-Touch ® Ultra ® 

test strips 

Opana ® 

Opana ® ER 





codeine sulfate, hydromorphone 

(Dilaudid ® ), morphine sulfate, 

oxycodone 

codeine sulfate, fentanyl transdermal 

(Duragesic ® ), hydromorphone 

(Dilaudid ® ), Kadian ® , morphine SR (MS 

Contin ® ), morphine sulfate, oxycodone, 

oxycodone SR (Oxycontin ® ), 

Ovcon ® generic oral contraceptives * 

Oxytrol ® 

Oxistat ® 

P 

Paxil CR ® 

Ponstel ® 



miconazole (Monistat ® ), clotrimazole 

(Lotrimin ® ), ketoconazole (Nizoral ® ), 

nystatin (Mycostatin ® ) 



(Zoloft ® ) 

diclofenac (Voltaren ® ), etodolac 

(Lodine ® ), naproxen (Naprosyn ® ), 


trisalicylate (trilisate ® ) 

Precare Prenatal ® generic prenatal vitamins 

Precision QID ® Ascensia ® test strips* 

Precision Xtra ® 

teststrips 


Prenate Elite ® generic prenatal vitamins 

with folic acid 

Prevident 5000 Plus sodium fluoride gel 

Prilosec ® 





® generic prenatal vitamins 

Primacare prenatal 

with folic acid 

Prometrium ® medroxyprogesterone (Provera ® ) 

Protonix ® 

omeprazole (Prilosec ® ), pantoprazole 

(Protonix ® ), Prilosec OTC 





Brand Name 

Protopic ® 


Alternatives 

triamcinolone (Aristocort ® ), 


(Diprolene ® ), fluocinolone (Synalar ® ) 

Provigil ® 


dextroamphetamine (Dexedrine ® ), 

amphetamine/dextroamphetamine 

(Adderall ® ) 

Prozac Weekly ® fluoxetine (Prozac ® ) 

Pylera ® Helidac ® , PrevPac ® 

R 

Renagel ® PhosLo ® 

Ritalin LA ® methylphenidate ER, Metadate CD ® 

Rosac ® 

Rozerem 

S 

Sanctura ® 

sulfacetamide sodium/sulfur (Plexion ® ), 

benzoyl peroxide 






Sarafem ® fluoxetine (Prozac ® ) 

Seasonale ® levora,* portia,* Nordette ® * 

Serostim* ▼ Nutropin ® * ▼ , Nutropin AQ ® * ▼ , Saizen ® * ▼ 

Skelaxin ® carisoprodol (Soma ® ), cyclobenzaprine 

(Flexeril ® ), methocarbamol (Robaxin ® ) 

Sonata ® 




Spectracef ® cefuroxime (Ceftin ® ), cefaclor (Ceclor ® ) 

Starlix ® 

Strattera ® 

Symbicort ® 



methylphenidate ER, Metadate CD ® , 

Adderall XR ® 


Flovent ® HFA/Pulmicort ® /Qvar ® ) + 

Foradil ® /Sereven ® Diskus ® 

Symbyax ® fluoxetine (Prozac) ® + Zyprexa ® 

T 

Tarka ® 

trandolapril (Mavik ® )+ verapamil 

(Calan ® ) 

Tequin ® 

ofloxacin (Floxin ® ), ciprofloxacin 

(Cipro ® ), Avelox ® 

Teveten ® Benicar , Micardis ® 

Tev-Tropin* ▼ Nutropin ® * ▼ , Nutropin AQ ® * ▼ , Saizen ® * ▼ 

Tiazac ® diltiazem SR (Dilacor XR ® ) 

Trans-Derm Scop ® meclizine (Antivert ® ) 

Triaz ® benzoyl peroxide (Desquam ® ) 

Tricor ® 

gemfibrozil (Lopid ® ), fenofibrate 

(LoFibra) 



27 



Brand Name 


Alternatives 

Tri-Levlen ® trivora*, enpresse*, Triphasil ® * 

Truvada ® Emtriva ® + Viread ® 

Tussionex ® 

Pennkinetic 

Suspension 

hydrocodone bitartrate/homatropine 

(Hycodan ® ), hydrocodone bitartrate/ 

guaifenesin (Hycotuss ® ) 

Tyzeka ® 

Baraclude, Epivir ® HBV, Hepsera ® , 

Intron A ® , Pegasys ® 

V 

Valcyte ® ganciclovir (Cytovene ® ) 

Vantin ® cefuroxime (Ceftin ® ), cefaclor (Ceclor ® ) 

Ventolin HFA ® ProAir ® HFA,Proventil HFA ® 

Veramyst ® 

flunisolide (Nasarel ® , Nasalide ® ), 

fluticasone (Flonase ® ), Nasacort AQ ® , 

Nasonex ® , Rhinocort ® Aqua ® 

Vesicare ® oxybutynin (Ditropan ® ), oxybutynin 

chloride ER (Ditropan ® XL), Detrol LA ® 

Vigamox ® ciprofloxacin (Ciloxan ® ), ofloxacin (Ocuflox ® ) 

W 

Welchol ® cholestyramine (Questran ® ), 

colestipol HCL (Colestid ® ) 

Wellbutrin XL ® bupropion SR (Wellbutrin SR ® X 

) 

Xalatan ® Travatan ® , Travatan Z ® , Lumigan ® 

Xanax XR ® alprazolam (Xanax ® ) 

flurbiprofen (Ocufen ® ), Acular ® , 

Xibrom ® 

Acular LS, Acular ® PF 

Xifaxan ® azithromycin (Zithromax ® ), ciprofloxacin 

(Cipro ® ), ofloxacin (Floxin ® Xopenex 

) 

® albuterol 

Xopenex HFA ® ProAir HFA ® , Proventil HFA ® 

Xyzal ® 

fexofenadine (Allegra ® ), OTC Alavert*, 

OTC Claritin ® Y 

*, OTC loratadine* 

Yasmin ® generic oral contraceptives* 

Z 

Zegerid ® 

Zetia ® 

Ziana 





simvastatin (Zocor ® ), pravastatin (Pravachol ® ), 

lovastatin (Mevacor ® ), Crestor ® , Vytorin ® 

clindamycin (Cleocin ® ), erythromycin 

base/ethanol (Erygel ® ), sulfacetamide 

sodium (Klaron ® ), erythromycin 

base/benzoyl peroxide (Benzamycin ® ), 

tretinoin (Retin A ® ), Differin ® , Tazorac ® 

Zorbtive ® * ▼ Nutropin ® * ▼ , Nutropin AQ ® * ▼ , Saizen ® * ▼ 

Zovirax ® ointment 

acyclovir (Zovirax) tablets, capsules or 

suspension, Valtrex ® tablet 

Zylet ® TobraDex ® ophthalmic suspension, ointment 

OTC loratadine*, OTC Claritin ® *, OTC 

Zyrtec ® 

Zyrtec-D ® 

Alavert*, fexofenadine(Allegra ® ) 

OTC loratadine* + decongestant* 

OTC Claritin-D ® *, OTC Alavert-D*, 

fexodenadine (Allegra ® ) + decongestant 



P.O. Box 1271, Portland, OR 97207-1271 

www.regencerx.com 

Effective February 00260-or 1, / 2008 2-08

RegenceRx Preferred Medication List/Formulary

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