RegenceRx Preferred Medication List/Formulary
RegenceRx Preferred Medication List/Formulary
RegenceRx Preferred Medication List/Formulary
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Non-<strong>Preferred</strong>/<br />
Non-<strong>Formulary</strong><br />
Brand Name<br />
Protopic ®<br />
Generic and <strong>Preferred</strong> Brand<br />
Alternatives<br />
triamcinolone (Aristocort ® ),<br />
betamethasone dipropionate<br />
(Diprolene ® ), fluocinolone (Synalar ® )<br />
Provigil ®<br />
methylphenidate ER (Ritalin SR ® ),<br />
dextroamphetamine (Dexedrine ® ),<br />
amphetamine/dextroamphetamine<br />
(Adderall ® )<br />
Prozac Weekly ® fluoxetine (Prozac ® )<br />
Pylera ® Helidac ® , PrevPac ®<br />
R<br />
Renagel ® PhosLo ®<br />
Ritalin LA ® methylphenidate ER, Metadate CD ®<br />
Rosac ®<br />
Rozerem<br />
S<br />
Sanctura ®<br />
sulfacetamide sodium/sulfur (Plexion ® ),<br />
benzoyl peroxide<br />
flurazepam (Dalmane ® ), temazepam<br />
(Restoril ® ), triazolam (Halcion ® ),<br />
zolpidem tartrate (Ambien ® )<br />
Detrol LA ® , oxybutynin (Ditropan ® ),<br />
oxybutynin chloride ER (Ditropan ® XL)<br />
Sarafem ® fluoxetine (Prozac ® )<br />
Seasonale ® levora,* portia,* Nordette ® *<br />
Serostim* ▼ Nutropin ® * ▼ , Nutropin AQ ® * ▼ , Saizen ® * ▼<br />
Skelaxin ® carisoprodol (Soma ® ), cyclobenzaprine<br />
(Flexeril ® ), methocarbamol (Robaxin ® )<br />
Sonata ®<br />
flurazepam (Dalmane ® ), temazepam<br />
(Restoril ® ), triazolam (Halcion ® ),<br />
zolpidem tartrate (Ambien ® )<br />
Spectracef ® cefuroxime (Ceftin ® ), cefaclor (Ceclor ® )<br />
Starlix ®<br />
Strattera ®<br />
Symbicort ®<br />
glyburide (Diabeta ® ), glipizide<br />
(Glucotrol ® ), metformin (Glucophage ® )<br />
methylphenidate ER, Metadate CD ® ,<br />
Adderall XR ®<br />
(Asmanex ® /Azmacort ® /Flovent ® Diskus ® /<br />
Flovent ® HFA/Pulmicort ® /Qvar ® ) +<br />
Foradil ® /Sereven ® Diskus ®<br />
Symbyax ® fluoxetine (Prozac) ® + Zyprexa ®<br />
T<br />
Tarka ®<br />
trandolapril (Mavik ® )+ verapamil<br />
(Calan ® )<br />
Tequin ®<br />
ofloxacin (Floxin ® ), ciprofloxacin<br />
(Cipro ® ), Avelox ®<br />
Teveten ® Benicar , Micardis ®<br />
Tev-Tropin* ▼ Nutropin ® * ▼ , Nutropin AQ ® * ▼ , Saizen ® * ▼<br />
Tiazac ® diltiazem SR (Dilacor XR ® )<br />
Trans-Derm Scop ® meclizine (Antivert ® )<br />
Triaz ® benzoyl peroxide (Desquam ® )<br />
Tricor ®<br />
gemfibrozil (Lopid ® ), fenofibrate<br />
(LoFibra)<br />
*May not be a covered benefit under some plans.<br />
▼ Obtain from a designated Specialty Pharmacy.<br />
27<br />
Non-<strong>Preferred</strong>/<br />
Non-<strong>Formulary</strong><br />
Brand Name<br />
Generic and <strong>Preferred</strong> Brand<br />
Alternatives<br />
Tri-Levlen ® trivora*, enpresse*, Triphasil ® *<br />
Truvada ® Emtriva ® + Viread ®<br />
Tussionex ®<br />
Pennkinetic<br />
Suspension<br />
hydrocodone bitartrate/homatropine<br />
(Hycodan ® ), hydrocodone bitartrate/<br />
guaifenesin (Hycotuss ® )<br />
Tyzeka ®<br />
Baraclude, Epivir ® HBV, Hepsera ® ,<br />
Intron A ® , Pegasys ®<br />
V<br />
Valcyte ® ganciclovir (Cytovene ® )<br />
Vantin ® cefuroxime (Ceftin ® ), cefaclor (Ceclor ® )<br />
Ventolin HFA ® ProAir ® HFA,Proventil HFA ®<br />
Veramyst ®<br />
flunisolide (Nasarel ® , Nasalide ® ),<br />
fluticasone (Flonase ® ), Nasacort AQ ® ,<br />
Nasonex ® , Rhinocort ® Aqua ®<br />
Vesicare ® oxybutynin (Ditropan ® ), oxybutynin<br />
chloride ER (Ditropan ® XL), Detrol LA ®<br />
Vigamox ® ciprofloxacin (Ciloxan ® ), ofloxacin (Ocuflox ® )<br />
W<br />
Welchol ® cholestyramine (Questran ® ),<br />
colestipol HCL (Colestid ® )<br />
Wellbutrin XL ® bupropion SR (Wellbutrin SR ® X<br />
)<br />
Xalatan ® Travatan ® , Travatan Z ® , Lumigan ®<br />
Xanax XR ® alprazolam (Xanax ® )<br />
flurbiprofen (Ocufen ® ), Acular ® ,<br />
Xibrom ®<br />
Acular LS, Acular ® PF<br />
Xifaxan ® azithromycin (Zithromax ® ), ciprofloxacin<br />
(Cipro ® ), ofloxacin (Floxin ® Xopenex<br />
)<br />
® albuterol<br />
Xopenex HFA ® ProAir HFA ® , Proventil HFA ®<br />
Xyzal ®<br />
fexofenadine (Allegra ® ), OTC Alavert*,<br />
OTC Claritin ® Y<br />
*, OTC loratadine*<br />
Yasmin ® generic oral contraceptives*<br />
Z<br />
Zegerid ®<br />
Zetia ®<br />
Ziana<br />
cimetidine (Tagamet ® ), famotidine<br />
(Pepcid ® ), omeprazole (Prilosec ® ),<br />
pantoprazole (Protonix ® ), ranitidine<br />
(Zantac ® ), Prevacid ® , Prilosec OTC<br />
simvastatin (Zocor ® ), pravastatin (Pravachol ® ),<br />
lovastatin (Mevacor ® ), Crestor ® , Vytorin ®<br />
clindamycin (Cleocin ® ), erythromycin<br />
base/ethanol (Erygel ® ), sulfacetamide<br />
sodium (Klaron ® ), erythromycin<br />
base/benzoyl peroxide (Benzamycin ® ),<br />
tretinoin (Retin A ® ), Differin ® , Tazorac ®<br />
Zorbtive ® * ▼ Nutropin ® * ▼ , Nutropin AQ ® * ▼ , Saizen ® * ▼<br />
Zovirax ® ointment<br />
acyclovir (Zovirax) tablets, capsules or<br />
suspension, Valtrex ® tablet<br />
Zylet ® TobraDex ® ophthalmic suspension, ointment<br />
OTC loratadine*, OTC Claritin ® *, OTC<br />
Zyrtec ®<br />
Zyrtec-D ®<br />
Alavert*, fexofenadine(Allegra ® )<br />
OTC loratadine* + decongestant*<br />
OTC Claritin-D ® *, OTC Alavert-D*,<br />
fexodenadine (Allegra ® ) + decongestant<br />
Effective February 1, 2008<br />
©2008. <strong>RegenceRx</strong>. All Rights Reserved.
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