RegenceRx Preferred Medication List/Formulary

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Non-Preferred/Non-Formulary Brands: Generic and Preferred Brand Alternatives Effective February 1, 2008 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. 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. 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 (Asmanex ® /Azmacort ® /Flovent ® Diskus ® / Flovent ® HFA/Pulmicort ® /QVAR ® ) + Serevent ® Diskus ® /Foradil ® *May not be a covered benefit under some plans. 23 Non-Preferred/ Non-Formulary Brand Name Advicor ® Aerobid ® / M Aggrenox ® Alamast ® Generic and Preferred Brand 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 ® ) Effective February 1, 2008 ©2008. RegenceRx. All Rights Reserved.
Non-Preferred/ Non-Formulary Brand Name Ambien CR Generic and Preferred Brand 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 (Vasotec ® ), fosinopril (Monopril ® ), 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 (Vasotec ® ), fosinopril (Monopril ® ), lisinopril (Zestril ® , Prinivil ® ), Micardis ® , moexipril (Univasc ® ), quinapril (Accupril ® ), trandolapril (Mavik ® ) 24 Non-Preferred/ Non-Formulary Brand Name Avinza ® Avodart ® Generic and Preferred Brand 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 (Benzamycin ® ) 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 (Pravachol ® ), lovastatin (Mevacor ® ), Crestor ® , Vytorin ® diclofenac (Voltaren ® XR), etodolac (Lodine ® XL), naproxen (Naprosyn ® ), salsalate (Disalcid ® ), choline magnesium 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 ® Effective February 1, 2008 ©2008. RegenceRx. All Rights Reserved.
Page 1 and 2: RegenceRx Preferred Medication List
Page 3 and 4: RegenceRx is dedicated to provide t
Page 5 and 6: Preferred/Formulary Medications: By
Page 7 and 8: CARDIOVASCULAR (cont.) amlodipine b
Page 9 and 10: IMMUNOSUPPRESSANTS azathioprine tab
Page 11 and 12: RESPIRATORY (cont.) Flovent ® Disk
Page 13 and 14: A to Z Listing: Generics Effective
Page 15 and 16: Generic Non-Preferred/Non- Formular
Page 17 and 18: Generic Non-Preferred/Non- Formular
Page 19 and 20: A to Z Listing: Preferred/Formulary
Page 21 and 22: Invirase ® capsule, tablet Isopto
Page 23: Visicol ® tablet Vivelle ® patch
Page 27 and 28: Non-Preferred/ Non-Formulary Brand
Page 29: P.O. Box 1271, Portland, OR 97207-1

RegenceRx Preferred Medication List/Formulary

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