RegenceRx Preferred Medication List/Formulary
RegenceRx Preferred Medication List/Formulary
RegenceRx Preferred Medication List/Formulary
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DIABETES (cont.)<br />
Lantus ® SoloSTAR ® insulin<br />
Novolin ® insulins<br />
Novolog ® insulins<br />
Prandin ® tablet<br />
Precose ® tablet<br />
Proglycem ® capsule, oral suspension<br />
DIABETIC SUPPLIES<br />
- Please check if these are covered by your prescription benefit:<br />
Ascensia ® test strips*<br />
Ascensia Breeze ® 2 test strips*<br />
Ascensia Contour ® test strips*<br />
Novofine ® needles*<br />
Lancets, needles, syringes (all products)*<br />
EAR/NOSE/THROAT<br />
acetic acid otic (Acetasol ® )<br />
acetic acid/hydrocortisone otic (Acetasol ® -HC)<br />
benzocaine/antipyrine otic (Aurodex ® )<br />
benzonatate capsule (Tessalon ® )<br />
clemastine tablet (Tavist ® )<br />
fexofenadine tablet (Allegra ® )<br />
flunisolide nasal spray (Nasalide ® )<br />
fluticasone propionate nasal spray (Flonase ® )<br />
hydrocodone/homatropine tablet, syrup (Hycodan ® )<br />
hydrocort/polymyx/neomycin otic<br />
(Cortisporin ® Otic)<br />
ipratropium nasal spray (Atrovent ® )<br />
Astelin ® nasal spray<br />
BromHist ® oral solution<br />
Carboxine-PSE ® liquid<br />
Cerumenex ® otic solution<br />
Ciprodex ® otic suspension<br />
Cipro ® HC otic suspension<br />
Nasacort ® AQ nasal spray<br />
Nasonex ® nasal spray<br />
Relacon-HC ® syrup<br />
Rescon JR ® capsule<br />
Rhinocort ® Aqua ® nasal spray<br />
GASTROINTESTINAL<br />
cimetidine tablet, liquid (Tagamet ® )<br />
dicyclomine capsule, tablet (Bentyl ® )<br />
diphenoxylate/atropine tablet (Lomotil ® )<br />
famotidine tablet (Pepcid ® )<br />
hyoscyamine capsule (Levsin ® )<br />
lactulose syrup (Enulose ® )<br />
loperamide capsule, liquid (Imodium ® )<br />
meclizine tablet (Antivert ® )<br />
mesalamine enema (Rowasa ® )<br />
metoclopramide tablet, syrup (Reglan ® )<br />
misoprostil tablet (Cytotec ® )<br />
omeprazole capsule (Prilosec ® )<br />
ondansetron tablet (Zofran ODT ® )<br />
ondansetron HCL tablet, oral solution (Zofran ® )<br />
pantoprazole sodium tablet (Protonix ® )<br />
polyethylene glycol/electrolyte solution<br />
prochlorperazine tablet (Compazine ® )<br />
promethazine tablet, suppository (Phenergan ® )<br />
ranitidine tablet, syrup (Zantac ® )<br />
sucralfate tablet (Carafate ® )<br />
sulfasalazine tablet (Azulfidine ® EN-tabs ® )<br />
trimethobenzamide capsule, suppository<br />
(Tigan ® )<br />
ursodiol capsule (Actigall ® )<br />
Analpram HC ® rectal cream, rectal lotion<br />
*May not be a covered benefit under some plans.<br />
7<br />
GASTROINTESTINAL (cont.)<br />
Anzemet ® tablet<br />
Asacol ® tablet, oral solution<br />
Canasa ® rectal suppository<br />
Colyte ® powder for reconstitution<br />
Compro ® rectal suppository<br />
Cortifoam ® rectal foam<br />
Creon ® capsule<br />
Dipentum ® capsule<br />
Epifoam ® topical foam<br />
Golytely ® powder for reconstitution, packets<br />
Helidac ® combopak<br />
Kristalose ® packet<br />
Kutrase ® capsule<br />
Ku-zyme ® capsule<br />
Ku-zyme ® HP capsule<br />
Kytril ® tablet, solution<br />
NuLytely ® powder for reconstitution<br />
Pancrease ® capsule<br />
Pancrease ® MT capsule<br />
Pancrecarb MS ® capsule<br />
Pentasa ® capsule<br />
Prevacid ® capsule, suspension, tablet<br />
PrevPac ®<br />
Prilosec OTC - Available at the generic copay.<br />
ProctoFoam ® -HC rectal foam<br />
Ultrase ® capsule<br />
Ultrase ® MT capsule<br />
URSO ® tablet<br />
Viokase ® tablet, powder<br />
Visicol ® tablet<br />
HORMONE/ENDOCRINE (ALSO SEE WOMEN’S HEALTH)<br />
calcitriol capsule (Rocaltrol ® )<br />
cortisone acetate tablet (Cortone ® )<br />
desmopressin tablet, nasal spray, nasal solution (DDAVP ® )<br />
dexamethasone tablet, elixir (Decadron ® )<br />
fludrocortisone tablet (Florinef ® )<br />
folic acid tablet (Folvite ® )<br />
levothyroxine sodium tablet<br />
methimazole tablet (Tapazole ® )<br />
methylprednisolone tablet (Medrol ® )<br />
prednisolone 15mg/5ml syrup (Prelone ® )<br />
prednisolone sod phosphate oral solution (Orapred ® )<br />
prednisone tablet, solution (Deltasone ® )<br />
propylthiouracil tablet<br />
thyroid dessicated tablet<br />
triamcinolone tablet (Aristocort ® )<br />
unithroid tablet<br />
Armour ® Thyroid tablet<br />
Cytomel ® tablet<br />
DDAVP ® nasal spray, nasal solution<br />
Dexamethasone Intensol ® oral solution<br />
Levothroid ® tablet<br />
Levoxyl ® tablet<br />
Methitest ® tablet<br />
Nilandron ® tablet<br />
Pediapred ® oral solution<br />
Prednisone Intensol ® oral concentrate<br />
Stimate ® nasal spray<br />
Synthroid ® tablet<br />
Teslac ® tablet<br />
Testred ® tablet<br />
Thyrolar ® tablet<br />
Westhroid ® tablet<br />
Winstrol ® tablet<br />
Effective February 1, 2008<br />
©2008. <strong>RegenceRx</strong>. All Rights Reserved.
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