Your 2012 Prescription Drug List Quick-Reference Guide
Your 2012 Prescription Drug List Quick-Reference Guide
Your 2012 Prescription Drug List Quick-Reference Guide
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<strong>Your</strong> <strong>2012</strong> <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong><br />
<strong>Quick</strong>-<strong>Reference</strong> <strong>Guide</strong><br />
Traditional Three-Tier<br />
Student Resources<br />
Table of Contents<br />
1 <strong>Your</strong> <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong><br />
2 Introduction<br />
<strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong> - <strong>2012</strong><br />
Anti-Infectives<br />
5 Antibiotics<br />
5 Antifungals<br />
5 Antivirals<br />
Cardiovascular/<br />
Heart Disease<br />
5 Coagulation Therapy<br />
6 High Blood Pressure<br />
6 High Cholesterol<br />
7 Other<br />
Central Nervous System<br />
7 Attention Deficit Disorder<br />
7 Depression<br />
7 Migraine<br />
8 Multiple Sclerosis<br />
8 Sedatives/Hypnotics<br />
8 Seizure Disorders<br />
8 Other<br />
9 Dermatology<br />
Diabetes/Endocrine<br />
9 Blood Glucose Monitoring<br />
10 Insulin<br />
10 Non-Insulin<br />
Endocrine<br />
10 Growth Hormone<br />
10 Other<br />
Eye Conditions<br />
11 Anti-Allergy<br />
11 Antibiotics<br />
11 Glaucoma<br />
Gastrointestinal<br />
11 Acid Suppression<br />
11 Nausea/Vomiting<br />
12 Other<br />
Men’s Health<br />
12 Erectile Dysfunction<br />
12 Prostate<br />
Miscellaneous<br />
12 Miscellaneous<br />
12 Overactive Bladder<br />
Musculoskeletal<br />
13 Osteoporosis<br />
13 Pain Relief<br />
13 Rheumatoid Arthritis<br />
13 Other<br />
Respiratory<br />
14 Asthma/COPD<br />
14 Nasal Allergy<br />
14 Oral Allergy<br />
Women’s Health<br />
14 Contraceptives<br />
15 Estrogen/Progesterone<br />
15 Prenatal Vitamins<br />
16 Additional Tier 3 <strong>Drug</strong>s with<br />
a generic equivalent in Tier 1<br />
17 Index<br />
For the most current PDL updates, visit www.uhcsr.com or call the toll-free member phone number on the<br />
back of your health plan ID card.<br />
Created October, 2011. <strong>2012</strong> <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong> – Student Resources Traditional Three-Tier 1/12
<strong>Your</strong> <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong>:<br />
Helping you get the most out of your pharmacy benefit.<br />
This <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong> (PDL) outlines the most commonly prescribed medications for certain conditions<br />
and divides them into tiers. <strong>Your</strong> costs may change depending on a medication’s tier placement.<br />
To help you better use your pharmacy benefit, this guide answers commonly asked questions about your PDL.<br />
Go to www.uhcsr.com for complete and up-to-date PDL<br />
information<br />
Since the PDL may change, we encourage you to click on “Login To My Account” at our website,<br />
www.uhcsr.com. This website is the best source for up-to-date information about the medications your<br />
pharmacy benefit covers, possible lower-cost options, and how the costs of medications compare.<br />
Visit www.uhcsr.com for updates<br />
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<strong>2012</strong> <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong> – Student Resources Traditional Three-Tier
Welcome to your <strong>2012</strong> Three-Tier <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong><br />
We want to help you better understand your medication choices. <strong>Your</strong> pharmacy benefit<br />
offers flexibility and choice in finding the right medication for you. To help you get the most<br />
out of your pharmacy benefit, we’ve included some of the most commonly asked questions<br />
about the PDL.<br />
What is a PDL?<br />
A PDL is a list of commonly prescribed medications<br />
placed into tiers. The PDL includes both brand and generic<br />
prescription medications approved by the U.S. Food<br />
and <strong>Drug</strong> Administration (FDA). The PDL is reviewed<br />
periodically and may change. It is created at a point in<br />
time, it is not a complete list of medications and not all<br />
medications listed may be covered under your plan. If you<br />
have pharmacy benefit coverage with UnitedHealthcare<br />
Student Resources, please look at your benefit plan<br />
documents provided by your university or school to see<br />
what medications are covered under your plan. Where<br />
differences are noted between this PDL quick-reference<br />
guide and your benefit plan documents, the benefit plan<br />
documents will govern. You may also click on “Login To My<br />
Account” at www.uhcsr.com or call the toll-free member<br />
phone number on the back of your health plan ID card for<br />
more information.<br />
How do I use my PDL?<br />
When choosing a medication, you and your doctor should<br />
consult the PDL. This guide is organized by common<br />
medical conditions. Then, within each medical condition<br />
section, medications are listed by tier.<br />
If your medication is not located in the PDL please click on<br />
“Login To My Account” at www.uhcsr.com or call the<br />
toll-free member phone number on the back of your<br />
health plan ID card.<br />
What are Tiers?<br />
Tiers are the different cost levels you pay for a medication.<br />
Each tier is assigned a cost, which is determined by your<br />
university or school. This is how much you will pay when you<br />
fill a prescription. Tier 1 medications are your lowest-cost<br />
options. If your medication is placed in Tier 2 or 3 look to<br />
see if there is a Tier 1 alternative. Discuss your options with<br />
your doctor.<br />
Check your benefit plan documents to find out your<br />
pharmacy plan costs.<br />
Tier 1 Tier 2 Tier 3<br />
<strong>Your</strong> <strong>Your</strong> <strong>Your</strong><br />
lowest-cost midrange-cost highest-cost<br />
medications medications medications<br />
Who determines medication tier placements?<br />
The UnitedHealthcare PDL Management Committee<br />
makes tier placement decisions. The PDL Management<br />
Committee is comprised of senior level UnitedHealth<br />
Group physicians and business leaders. The Committee’s<br />
goal is to help ensure access to a wide range of medications,<br />
while helping to control health care costs for you and your<br />
university or school.<br />
Visit www.uhcsr.com for updates<br />
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<strong>2012</strong> <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong> – Student Resources Traditional Three-Tier
What factors impact tier placement decisions?<br />
The PDL Management Committee decides tier placement<br />
based on several factors including:<br />
u Clinical information from the UnitedHealthcare<br />
Pharmacy and Therapeutics Committee about the safety<br />
and effectiveness of different medications.<br />
u The medication’s costs and other economic factors.<br />
When do medications change tiers?<br />
Medications may change tiers once per calendar year<br />
( January 1). When a generic medication becomes available,<br />
the tier placement of both the brand and generic medication<br />
are evaluated. Medications may change tiers with this<br />
evaluation.<br />
When a medication changes tiers, you may have to pay a<br />
different amount for that medication. These changes may<br />
occur without prior notice to you. For the most current<br />
information on your pharmacy coverage, please call the<br />
toll-free member phone number on the back of your<br />
health plan ID card or click on “Login To My Account”<br />
at www.uhcsr.com.<br />
Why are there notations (SL, N, etc.) next<br />
to certain medications in the PDL, and<br />
what do they mean?<br />
As you go through this list, you might notice some<br />
medications are noted with symbols next to them. The<br />
notations refer to our pharmacy programs. <strong>Your</strong> benefit<br />
plan determines how these medications may be covered for<br />
you but the symbols are guidelines to help you check what<br />
medications may be impacted.<br />
To learn more about a pharmacy program or to find<br />
out if it applies to you, please click on “Login To My<br />
Account” at www.uhcsr.com or call the toll-free member<br />
phone number on the back of your health plan ID card.<br />
Here is a quick symbol overview:<br />
PDL Symbols<br />
Why is the medication that I am currently<br />
taking no longer covered?<br />
Medications may be excluded from coverage under your<br />
pharmacy benefit. For example, a medication may be<br />
excluded from coverage when it is therapeutically equivalent<br />
to another prescription medication or an over-the-counter<br />
(OTC) medication. There may be alternatives on the PDL or<br />
OTC medications that are right for your treatment.<br />
Should I talk to my doctor about<br />
OTC medications?<br />
An OTC medication may be the right treatment for some<br />
conditions. Talk to your doctor about OTC options. These<br />
medications are not covered under your pharmacy benefit,<br />
but they may cost less than your out-of-pocket expense for<br />
prescription medications.<br />
What is the difference between<br />
brand-name and generic medications?<br />
Generic medications contain the same active ingredients<br />
as brand-name medications, but they often cost less.<br />
After the patent on a brand-name medication expires,<br />
other companies can manufacture an FDA-approved and<br />
chemically-equivalent version of the medication. These types<br />
of medications are called generic medications. Many times,<br />
the same company that makes a brand-name medication also<br />
makes the generic version.<br />
What if my doctor writes a brand-name<br />
prescription?<br />
The next time your doctor gives you a prescription for a<br />
brand-name medication, ask if a generic equivalent or<br />
lower-tier alternative is available and if it might be<br />
right for you. Generic medications are usually your<br />
lowest-cost option, but not always. Click on “Login To My<br />
Account” at www.uhcsr.com to make sure.<br />
1<br />
/2T Eligible for Half Tablet Program<br />
N Notification or Prior Authorization required*<br />
SL Supply limit<br />
*Depending on your benefit you may have notification or prior authorization<br />
requirements for select medications.<br />
Visit www.uhcsr.com for updates<br />
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<strong>2012</strong> <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong> – Student Resources Traditional Three-Tier
Are you taking a specialty medication?<br />
Specialty medications are managed through our Specialty<br />
Pharmacy Program which offers personalized member<br />
support. The program also offers access to on-call<br />
pharmacists available 24 hours a day, robust clinical and<br />
adherence programs and support coaching on lower-cost<br />
medication options. Please note your specialty medication<br />
may not be listed in this guide. Please click on “Login To<br />
My Account” at www.uhcsr.com for more information.<br />
How do I access updated information<br />
about my pharmacy benefit?<br />
Since the PDL may change, we encourage you to click on<br />
“Login To My Account” at www.uhcsr.com or call the<br />
toll-free member phone number on the back of your health<br />
plan ID card for more current information.<br />
What if I still have questions?<br />
Please call the toll-free member phone number on the back<br />
of your health plan ID card. Representatives are available<br />
24 hours a day (except Thanksgiving and Christmas).<br />
Medications are categorized by common therapeutic conditions in this PDL for ease of reference only. These categories do not determine coverage for the medication for your<br />
condition. <strong>Your</strong> benefit plan determines how these medications may be covered for you.<br />
In certain documents, the <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong> (PDL) was referred to as the “Preferred <strong>Drug</strong> <strong>List</strong> (PDL).” This change in descriptive terms does not affect your benefit coverage.<br />
Where differences are noted between this PDL reference guide and your benefit plan documents, the benefit plan documents will govern. For the most current PDL information, log on<br />
to www.uhcsr.com.<br />
Visit www.uhcsr.com for updates<br />
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<strong>2012</strong> <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong> – Student Resources Traditional Three-Tier
Anti-Infectives Antibiotics (Oral, inhaled and ear antibiotics are listed)<br />
Tier 1<br />
A-B Otic<br />
Amoxicillin<br />
Amoxicillin/Potassium Clavulanate<br />
Amoxicillin-Clavulanate ER<br />
Ampicillin<br />
Azithromycin<br />
Cefadroxil<br />
Cefdinir<br />
Cefprozil<br />
Cefuroxime<br />
Cephalexin<br />
Ciprofloxacin Sustained-Release 24 Hour Tablet<br />
Ciprofloxacin Tablet<br />
Tier 2<br />
Augmentin<br />
Cipro Suspension<br />
Ciprodex Otic<br />
Cleocin HCl 75 mg<br />
Tier 3<br />
Adoxa<br />
Augmentin XR<br />
Avelox<br />
Clarithromycin Suspension<br />
Clarithromycin Sustained-Release Tablet<br />
Clarithromycin Tablet<br />
Clindamycin HCl<br />
Clindamycin Palmitate<br />
Dicloxacillin Sodium<br />
Doxycycline Hyclate Enteric-Coated Tablet<br />
Doxycycline Monohydrate<br />
Doxycycline Monohydrate Capsule 150 mg<br />
Erythromycin<br />
Erythromycin Base Enteric-Coated Tablet<br />
250, 333 mg<br />
Levofloxacin<br />
Dapsone<br />
Ery-Tab 500 mg<br />
Macrodantin 25 mg<br />
Tobi<br />
Cetraxal<br />
Cipro HC<br />
Doryx<br />
Metronidazole<br />
Minocycline HCl<br />
Neomycin/Polymyxin/HC Otic<br />
Nitrofurantoin Macrocrystal<br />
Nitrofurantoin Suspension<br />
Nitrofurantoin/Nitrofurantoin Macrocrystal<br />
Ofloxacin Otic<br />
Penicillin V Potassium<br />
Sulfamethoxazole/Trimethoprim<br />
Tetracycline<br />
Vancocin HCl SL<br />
Velosef Suspension 250 mg<br />
Zyvox SL<br />
Oracea<br />
Solodyn<br />
Suprax<br />
Anti-Infectives Antifungals (Oral and topical antifungals are listed)<br />
Tier 1<br />
Clotrimazole<br />
Fluconazole<br />
Itraconazole Capsule SL<br />
Ketoconazole<br />
Metronidazole Vaginal<br />
Nystatin<br />
Terbinafine Tablet SL<br />
Terconazole Vaginal<br />
Voriconazole SL<br />
Tier 2<br />
Clindesse Vaginal<br />
Mycostatin<br />
Noxafil<br />
Sporanox Oral Solution<br />
Tier 3<br />
Extina SL Gynazole-1 Vaginal Lamisil Granules SL<br />
Anti-Infectives Antivirals<br />
Tier 1<br />
Acyclovir<br />
Amantadine<br />
Tier 2<br />
Baraclude<br />
Epivir HBV<br />
Famciclovir SL<br />
Ribavirin<br />
Hepsera<br />
Rebetol Solution<br />
Valacyclovir SL<br />
Valcyte SL<br />
Tier 3<br />
Relenza SL Tamiflu SL Valtrex SL<br />
Cardiovascular/Heart Disease Coagulation Therapy<br />
Tier 1<br />
Cilostazol<br />
Enoxaparin SL<br />
Tier 2<br />
Coumadin<br />
Tier 3<br />
Aggrenox<br />
Arixtra SL<br />
Fondaparinux SL<br />
Pentoxifylline<br />
Plavix<br />
Effient<br />
Fragmin SL<br />
Warfarin Sodium<br />
Innohep SL<br />
Lovenox SL<br />
Please refer to page 3 for a definition of notations/symbols.<br />
Visit www.uhcsr.com for updates<br />
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<strong>2012</strong> <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong> – Student Resources Traditional Three-Tier
Cardiovascular/Heart Disease High Blood Pressure<br />
Tier 1<br />
Amlodipine<br />
Amlodipine/Benazepril SL<br />
Atenolol<br />
Atenolol/Chlorthalidone<br />
Benazepril<br />
Benazepril/Hydrochlorothiazide<br />
Bisoprolol<br />
Bisoprolol/Hydrochlorothiazide<br />
Bumetanide<br />
Captopril<br />
Captopril/Hydrochlorothiazide<br />
Carvedilol<br />
Chlorthalidone<br />
Clonidine<br />
Clonidine Transdermal Weekly Patch SL<br />
Diltiazem<br />
Diltiazem Controlled-Release Capsule<br />
Diltiazem Sustained-Action Capsule<br />
Diltiazem Sustained-Release 12 Hour Capsule<br />
Diltiazem Sustained-Release 24 Hour Capsule<br />
Diltiazem Sustained-Release 24 Hour Tablet<br />
Doxazosin<br />
Tier 2<br />
Aldactazide 50-50 mg<br />
Benicar 1 /2T SL<br />
Benicar HCT SL<br />
BiDil<br />
Bystolic<br />
Tier 3<br />
Aceon 1 /2T<br />
Amturnide SL<br />
Atacand 1 /2T SL<br />
Atacand HCT SL<br />
Avalide SL<br />
Avapro 1 /2T SL<br />
Azor SL<br />
Cardizem LA 180, 240, 300, 360, 420 mg<br />
Catapres-TTS SL<br />
Enalapril<br />
Enalapril/Hydrochlorothiazide<br />
Eplerenone<br />
Felodipine<br />
Fosinopril<br />
Fosinopril/Hydrochlorothiazide<br />
Furosemide<br />
Guanfacine<br />
Hydralazine<br />
Hydrochlorothiazide<br />
Indapamide<br />
Labetalol<br />
Lisinopril<br />
Lisinopril/Hydrochlorothiazide<br />
Losartan 1 /2T<br />
Losartan/Hydrochlorothiazide SL<br />
Methyldopa<br />
Methyldopa/Hydrochlorothiazide<br />
Metolazone<br />
Metoprolol Succinate Sustained-Release Tablet<br />
Metoprolol Tartrate<br />
Metoprolol/Hydrochlorothiazide<br />
Cardizem CD 360 mg<br />
Cardizem LA 120 mg<br />
Clorpres<br />
Dibenzyline<br />
Diuril Suspension 250 mg/5 ml<br />
Coreg CR SL<br />
Diovan 1 /2T SL<br />
Diovan HCT SL<br />
Exforge SL<br />
Exforge HCT SL<br />
Lotrel SL<br />
Sular<br />
Tarka<br />
Tekamlo SL<br />
Minoxidil<br />
Moexipril 1 /2T<br />
Nadolol<br />
Nifedipine<br />
Nisoldipine<br />
Perindopril Erbumine 1 /2T<br />
Propranolol<br />
Propranolol Sustained-Action Capsule<br />
Propranolol/Hydrochlorothiazide<br />
Quinapril<br />
Quinapril/Hydrochlorothiazide<br />
Ramipril<br />
Spironolactone<br />
Spironolactone/Hydrochlorothiazide<br />
Terazosin<br />
Timolol Maleate<br />
Torsemide<br />
Trandolapril 1 /2T<br />
Trandolapril/Verapamil<br />
Triamterene/Hydrochlorothiazide<br />
Verapamil<br />
Verapamil Sustained-Release 24 Hour Pellets<br />
Micardis SL<br />
Micardis HCT SL<br />
Thalitone<br />
Tekturna SL<br />
Tekturna HCT SL<br />
Teveten SL<br />
Teveten HCT SL<br />
Tribenzor SL<br />
Twynsta SL<br />
Valturna SL<br />
Cardiovascular/Heart Disease High Cholesterol<br />
Tier 1<br />
Cholestyramine<br />
Colestipol<br />
Fenofibrate<br />
Tier 2<br />
Altoprev SL<br />
Antara<br />
Tier 3<br />
Advicor SL<br />
Atorvastatin 1 /2T SL<br />
Caduet SL<br />
Fenoglide<br />
Lescol SL<br />
Fenofibric Acid<br />
Gemfibrozil<br />
Lipitor 1 /2T SL<br />
Crestor 1 /2T SL<br />
Lipofen<br />
Lescol XL SL<br />
Livalo SL<br />
Lovaza<br />
Niaspan<br />
Simcor SL<br />
Lovastatin<br />
Pravastatin 1 /2T<br />
Simvastatin 1 /2T<br />
Welchol<br />
Tricor<br />
Triglide<br />
Trilipix<br />
Vytorin SL<br />
Zetia SL<br />
Please refer to page 3 for a definition of notations/symbols.<br />
Visit www.uhcsr.com for updates<br />
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<strong>2012</strong> <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong> – Student Resources Traditional Three-Tier
Cardiovascular/Heart Disease Other<br />
Tier 1<br />
Amiodarone<br />
Digoxin<br />
Flecainide Acetate<br />
Isosorbide Dinitrate<br />
Tier 2<br />
Lanoxin<br />
Multaq<br />
Tier 3<br />
Nitrolingual SL<br />
Isosorbide Mononitrate<br />
Mexiletine<br />
Nitroglycerin<br />
Nitroglycerin Transdermal Patch<br />
Nitrostat<br />
Ranexa<br />
Nitromist SL<br />
Nitroglycerin Spray SL<br />
Propafenone Sustained-Release<br />
12 Hour Capsule<br />
Sotalol<br />
Central Nervous System Attention Deficit Disorder<br />
Tier 1<br />
Amphetamine Aspartate/Amphetamine Sulfate/<br />
Dextroamphetamine Sustained-Release<br />
24 Hour Capsule SL<br />
Amphetamine Salt Combo<br />
Dextroamphetamine Sulfate<br />
Methamphetamine<br />
Methylphenidate<br />
Methylphenidate Extended-Release<br />
24 Hour Tablet SL<br />
Tier 2<br />
Intuniv SL<br />
Tier 3<br />
Adderall XR SL<br />
Concerta SL<br />
Daytrana SL<br />
Vyvanse SL<br />
Focalin XR SL<br />
Metadate CD SL<br />
Methylin<br />
Ritalin LA SL<br />
Strattera SL<br />
Central Nervous System Depression<br />
Tier 1<br />
Amitriptyline<br />
Amitriptyline/Perphenazine<br />
Bupropion<br />
Bupropion XL<br />
Citalopram Hydrobromide<br />
Doxepin<br />
Fluoxetine<br />
Tier 3<br />
Aplenzin SL<br />
Cymbalta SL<br />
Lexapro 1 /2T SL<br />
Fluoxetine Delayed-Release Capsule SL<br />
Fluvoxamine Maleate<br />
Imipramine<br />
Mirtazapine<br />
Nefazodone<br />
Nortriptyline<br />
Paroxetine Sustained-Release 24 Hour Tablet SL<br />
Luvox CR SL<br />
Oleptro SL<br />
Pexeva 1 /2T SL<br />
Paroxetine Tablet<br />
Phenelzine<br />
Sertraline 1 /2T<br />
Trazodone<br />
Venlafaxine Extended-Release Tablet SL<br />
Venlafaxine Sustained-Release Capsule SL<br />
Venlafaxine Tablet<br />
Pristiq SL<br />
Central Nervous System Migraine<br />
Tier 1<br />
Acetaminophen/Butalbital/Caffeine SL<br />
Acetaminophen/Dichloralphenazone/<br />
Isometheptene Mucate<br />
Tier 2<br />
Cafergot<br />
Tier 3<br />
Alsuma SL<br />
Axert SL<br />
Cambia SL<br />
Frova SL<br />
Aspirin/Butalbital/Caffeine<br />
Naratriptan SL<br />
Relpax SL<br />
Ergomar<br />
Maxalt SL<br />
Maxalt MLT SL<br />
Migranal<br />
Sumavel DosePro SL<br />
Sumatriptan Succinate Injection, Tablet SL<br />
Sumatriptan Succinate Nasal Spray SL<br />
Treximet SL<br />
Zomig SL<br />
Zomig Nasal Spray SL<br />
Zomig ZMT SL<br />
Please refer to page 3 for a definition of notations/symbols.<br />
Visit www.uhcsr.com for updates<br />
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<strong>2012</strong> <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong> – Student Resources Traditional Three-Tier
Central Nervous System Multiple Sclerosis<br />
Tier 2<br />
Ampyra SL<br />
Avonex SL<br />
Copaxone SL<br />
Rebif SL<br />
Tier 3<br />
Betaseron SL Extavia SL Gilenya SL<br />
Central Nervous System Sedatives/Hypnotics<br />
Tier 1<br />
Temazepam<br />
Triazolam<br />
Tier 3<br />
Ambien SL<br />
Ambien CR SL<br />
Edluar SL<br />
Zaleplon SL<br />
Zolpidem Multiphasic-Release Tablet SL<br />
Lunesta SL<br />
Rozerem SL<br />
Silenor SL<br />
Zolpidem Tablet SL<br />
Sonata SL<br />
Central Nervous System Seizure Disorders<br />
Tier 1<br />
Carbamazepine<br />
Carbamazepine Extended-Release<br />
12 Hour Capsule<br />
Carbamazepine Sustained-Release<br />
12 Hour Tablet<br />
Clonazepam<br />
Diazepam Rectal Gel SL<br />
Tier 2<br />
Celontin<br />
Dilantin<br />
Felbatol<br />
Tier 3<br />
Carbatrol<br />
Depakote ER<br />
Keppra<br />
Keppra XR<br />
Divalproex Sodium Sprinkle Capsule<br />
Divalproex Sodium Sustained-Release Tablet<br />
Divalproex Sodium Tablet<br />
Gabapentin<br />
Lamotrigine<br />
Levetiracetam<br />
Levetiracetam Extended-Release 24 Hour Tablet<br />
Gabitril<br />
Mysoline<br />
Peganone<br />
Lamictal<br />
Lamictal Dose Pack SL<br />
Lamictal ODT<br />
Lamictal XR<br />
Oxcarbazepine<br />
Phenobarbital<br />
Phenytoin Sodium<br />
Primidone<br />
Topiramate<br />
Zonisamide<br />
Sabril<br />
Tegretol<br />
Lyrica SL<br />
Stavzor<br />
Topamax<br />
Central Nervous System Other<br />
Tier 1<br />
Alprazolam<br />
Benztropine Mesylate<br />
Buspirone<br />
Carbidopa/Levodopa<br />
Clorazepate Dipotassium<br />
Tier 2<br />
Akineton<br />
Apokyn<br />
Comtan<br />
FazaClo<br />
Tier 3<br />
Abilify 1 /2T SL<br />
Aricept 23 mg<br />
Exelon Solution<br />
Fanapt SL<br />
Clozapine<br />
Diazepam<br />
Donepezil 5, 10 mg<br />
Galantamine<br />
Lithium Carbonate<br />
Geodon SL<br />
Navane 20 mg<br />
Seroquel SL<br />
Symbyax SL<br />
Invega SL<br />
Mirapex ER<br />
Namenda<br />
Nuvigil SL<br />
Lorazepam<br />
Pramipexole<br />
Risperidone<br />
Rivastigmine<br />
Ropinirole<br />
Tasmar<br />
Xyrem SL<br />
Zyprexa SL<br />
Provigil SL<br />
Requip XL<br />
Seroquel XR SL<br />
Zyprexa Zydis SL<br />
Please refer to page 3 for a definition of notations/symbols.<br />
Visit www.uhcsr.com for updates<br />
8<br />
<strong>2012</strong> <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong> – Student Resources Traditional Three-Tier
Dermatology<br />
Tier 1<br />
Adapalene N SL<br />
Alclometasone Dipropionate<br />
Betamethasone Dipropionate<br />
Betamethasone Valerate<br />
Ciclopirox Cream, Gel, Lotion<br />
Ciclopirox Non-Oral Solution<br />
Ciclopirox Shampoo 1%<br />
Clindamycin Foam 1% SL<br />
Clindamycin Gel, Lotion, Solution, Swabs<br />
Clindamycin Phosphate/Benzoyl Peroxide Gel<br />
1%-5% SL<br />
Clobetasol Propionate<br />
Clobetasol Propionate Foam SL<br />
Tier 2<br />
Azelex SL<br />
Benzamycin<br />
Condylox Gel<br />
Tier 3<br />
Acanya<br />
Aczone<br />
Aldara SL<br />
Altabax SL<br />
Atralin N SL<br />
Avita Gel N SL<br />
Bactroban SL<br />
Benzaclin Gel 1%-5% SL<br />
Clindagel SL<br />
Clobex SL<br />
Clobex Shampoo SL<br />
Cutivate Lotion<br />
Denavir<br />
Derma-Smoothe/FS<br />
Desonate SL<br />
Differin Cream, Gel 0.1% N SL<br />
Clotrimazole/Betamethasone<br />
Desonide<br />
Desoximetasone<br />
Econazole Nitrate<br />
Erythromycin<br />
Erythromycin/Benzoyl Peroxide<br />
Fluocinonide<br />
Fluticasone Propionate<br />
Halobetasol Propionate<br />
Hydrocortisone<br />
Hydrocortisone Valerate<br />
Imiquimod SL<br />
Isotretinoin<br />
Dovonex Cream SL<br />
Oxsoralen-Ultra<br />
Protopic SL<br />
Differin Gel 0.3% N SL<br />
Differin Lotion N SL<br />
Duac SL<br />
Elidel SL<br />
Epiduo SL<br />
Evoclin SL<br />
Finacea<br />
Finacea Plus<br />
Locoid Lipocream SL<br />
Locoid Lotion SL<br />
Loprox Shampoo<br />
Metrogel 1%<br />
Metrolotion<br />
Naftin<br />
Noritate<br />
Olux-E SL<br />
Ketoconazole<br />
Lidocaine<br />
Metronidazole<br />
Mometasone Furoate<br />
Mupirocin<br />
Nystatin<br />
Nystatin/Triamcinolone Acetonide<br />
Permethrin<br />
Silver Sulfadiazine<br />
Sulfacetamide Sodium/Sulfur<br />
Tretinoin N<br />
Triamcinolone Acetonide<br />
Urea<br />
Regranex<br />
Stelara SL<br />
Oxistat<br />
Retin-A Micro N SL<br />
Taclonex SL<br />
Taclonex Scalp SL<br />
Tazorac N SL<br />
Tretin-X N SL<br />
Vanos SL<br />
Vectical SL<br />
Veltin SL<br />
Verdeso SL<br />
Vusion<br />
Xerese<br />
Xolegel<br />
Ziana SL<br />
Zovirax SL<br />
Zyclara SL<br />
Diabetes/Endocrine Blood Glucose Monitoring<br />
Tier 1<br />
Accu-Chek Active Test Strips SL<br />
Accu-Chek Aviva Care Kit<br />
Accu-Chek Aviva Test Strips SL<br />
Accu-Chek Comfort Curve Test Strips SL<br />
Tier 3<br />
Ascensia Autodisc Test Strips SL<br />
Ascensia Breeze 2 Test Strips SL<br />
Ascensia Elite Test Strips SL<br />
Accu-Chek Compact Care Kit<br />
Accu-Chek Compact Test Strips SL<br />
One Touch Test Strips SL<br />
One Touch Ultra 2 System<br />
Contour Test Strips SL<br />
Freestyle Lite Test Strips SL<br />
Freestyle Test Strips SL<br />
One Touch Ultra Mini System<br />
One Touch Ultra Test Strips SL<br />
Precision Xtra Test Strips SL<br />
Please refer to page 3 for a definition of notations/symbols.<br />
Visit www.uhcsr.com for updates<br />
9<br />
<strong>2012</strong> <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong> – Student Resources Traditional Three-Tier
Diabetes/Endocrine Insulin<br />
Tier 1<br />
Humalog Vials<br />
Humalog-Mix Vials<br />
Tier 2<br />
Humalog KwikPen<br />
Humalog-Mix KwikPen<br />
Tier 3<br />
Apidra<br />
Lantus Solostar Pens/Cartridges<br />
Diabetes/Endocrine Non-Insulin<br />
Tier 1<br />
Acarbose<br />
Glimepiride<br />
Glipizide<br />
Tier 2<br />
Actoplus Met SL<br />
Actos 1 /2T SL<br />
Byetta SL<br />
Tier 3<br />
Avandamet SL<br />
Avandaryl SL<br />
Avandia SL<br />
Humulin 70-30 Vials<br />
Humulin Vials<br />
Humulin KwikPen<br />
Lantus Vials<br />
Levemir Flexpen<br />
Novolin Vials<br />
Glipizide/Metformin<br />
Glyburide<br />
Glyburide/Metformin<br />
Duetact SL<br />
Glyset<br />
Janumet SL<br />
Fortamet<br />
Glumetza<br />
Onglyza SL<br />
Levemir Vials<br />
NovoLog<br />
Metformin<br />
Nateglinide SL<br />
Januvia SL<br />
Prandin SL<br />
Starlix SL<br />
Symlin SL<br />
Victoza SL<br />
Endocrine Growth Hormone<br />
Tier 2<br />
Nutropin, AQ, NuSpin SL<br />
Saizen SL<br />
Tier 3<br />
Genotropin SL<br />
Humatrope SL<br />
Serostim SL<br />
Tev-Tropin SL<br />
Norditropin SL<br />
Omnitrope SL<br />
Zorbtive SL<br />
Endocrine Other<br />
Tier 1<br />
Cabergoline<br />
Calcitriol<br />
Desmopressin<br />
Dexamethasone<br />
Fludrocortisone<br />
Hydrocortisone Tablet<br />
Tier 2<br />
Androderm SL<br />
Android<br />
Hectorol<br />
Kuvan SL<br />
Levothyroxine Sodium<br />
Liothyronine Sodium<br />
Methimazole<br />
Methylprednisolone Dosepak Tablet 4 mg<br />
Octreotide Acetate<br />
Orapred<br />
Medrol 2, 8, 24, 32 mg<br />
Pediapred<br />
Sandostatin Vial<br />
Synarel<br />
Oxandrolone<br />
Prednisolone<br />
Prednisone<br />
Testosterone<br />
Synthroid<br />
Testim SL<br />
Tirosint<br />
Zemplar<br />
Tier 3<br />
Androgel SL Armour Thyroid Orapred ODT<br />
Please refer to page 3 for a definition of notations/symbols.<br />
Visit www.uhcsr.com for updates<br />
10<br />
<strong>2012</strong> <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong> – Student Resources Traditional Three-Tier
Eye Conditions Anti-Allergy<br />
Tier 1<br />
Azelastine HCl SL Epinastine SL Ketorolac Tromethamine<br />
Tier 3<br />
Bepreve SL<br />
Elestat SL<br />
Emadine SL<br />
Lastacaft SL<br />
Optivar SL<br />
Pataday SL<br />
Patanol SL<br />
Eye Conditions Antibiotics<br />
Tier 1<br />
Ciprofloxacin<br />
Erythromycin<br />
Gentamicin Sulfate<br />
Levofloxacin<br />
Tier 2<br />
Blephamide S.O.P.<br />
Tier 3<br />
Azasite SL<br />
Tobradex ST SL<br />
Neomycin/Polymyxin B Sulfate/Dexamethasone<br />
Ofloxacin<br />
Polymyxin B Sulfate/Trimethoprim<br />
Sulfacetamide Sodium<br />
Vigamox<br />
Zylet<br />
Tobramycin Sulfate Drops<br />
Tobramycin/Dexamethasone<br />
Zymaxid SL<br />
Eye Conditions Glaucoma<br />
Tier 1<br />
Acetazolamide<br />
Apraclonidine<br />
Brimonidine Tartrate<br />
Tier 2<br />
Alphagan P 0.1% SL<br />
Azopt SL<br />
Betimol SL<br />
Tier 3<br />
Iopidine 1%<br />
Brimonidine Tartrate 0.15% SL<br />
Dorzolamide HCl<br />
Dorzolamide HCl/Timolol Maleate<br />
Combigan SL<br />
Lumigan SL<br />
Phospholine Iodide<br />
Latanoprost SL<br />
Timolol Maleate<br />
Pilopine HS<br />
Travatan Z SL<br />
Gastrointestinal Acid Suppression<br />
Tier 1<br />
Cimetidine<br />
Lansoprazole SL<br />
Misoprostol<br />
Nizatidine Oral Solution<br />
Omeprazole<br />
Omeprazole/Sodium Bicarbonate Capsule SL<br />
Pantoprazole<br />
Ranitidine Syrup<br />
Tier 2<br />
Helidac Prevpac SL Pylera<br />
Tier 3<br />
Aciphex SL<br />
Carafate Oral Suspension<br />
Dexilant SL<br />
Nexium Capsule SL<br />
Gastrointestinal Nausea/Vomiting<br />
Nexium Suspension SL<br />
Prevacid Delayed-Release Enteric-Coated<br />
Capsule SL<br />
Prevacid Solutab SL<br />
Sucralfate Tablet<br />
Zegerid Capsule SL<br />
Prilosec Rx 10, 20 mg<br />
Prilosec Rx 40 mg<br />
Zegerid Packet SL<br />
Tier 1<br />
Granisetron Tablet SL Ondansetron Prochlorperazine Maleate<br />
Tier 2<br />
Emend SL<br />
Tier 3<br />
Anzemet SL<br />
Cesamet<br />
Sancuso SL<br />
Transderm-Scop<br />
Zuplenz SL<br />
Please refer to page 3 for a definition of notations/symbols.<br />
Visit www.uhcsr.com for updates<br />
11<br />
<strong>2012</strong> <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong> – Student Resources Traditional Three-Tier
Gastrointestinal Other<br />
Tier 1<br />
Balsalazide<br />
Belladona/Phenobarbital<br />
Budesonide Extended-Release<br />
24 Hour Capsule<br />
Chlordiazepoxide/Clidinium<br />
Tier 2<br />
Apriso<br />
Canasa<br />
Creon<br />
Tier 3<br />
Amitiza SL<br />
Asacol<br />
Asacol HD<br />
Dipentum<br />
Men’s Health Erectile Dysfunction<br />
Tier 3<br />
Caverject SL<br />
Cialis N SL<br />
Men’s Health Prostate<br />
Tier 1<br />
Alfuzosin<br />
Doxazosin<br />
Tier 3<br />
Avodart N<br />
Jalyn<br />
Diphenoxylate/Atropine<br />
Lactulose<br />
Mesalamine<br />
Metoclopramide<br />
Polyethylene Glycol<br />
GoLYTELY Packet<br />
Lialda<br />
Lotronex SL<br />
Entocort EC<br />
Halflytely-Bisacodyl<br />
Metozolv ODT<br />
Moviprep<br />
Edex SL<br />
Levitra N SL<br />
Finasteride<br />
Tamsulosin<br />
Rapaflo<br />
Uroxatral<br />
Sulfasalazine<br />
Trilyte with Flavor Packets<br />
Ursodiol<br />
Relistor<br />
Zenpep<br />
Pancreaze<br />
Pentasa<br />
Muse SL<br />
Viagra N SL<br />
Terazosin<br />
Miscellaneous<br />
Tier 1<br />
Anastrozole<br />
Antipyrine/Benzocaine<br />
Azathioprine<br />
Benzonatate<br />
Chlorhexidine Gluconate<br />
Tier 2<br />
Cellcept Suspension<br />
Epipen SL<br />
Epipen Jr SL<br />
Tier 3<br />
Acuvail SL<br />
Aromasin<br />
Infergen SL<br />
Epinephrine Pen Injector SL<br />
Exemestane<br />
Hydrocodone/Chlorpheniramine Suspension SL<br />
Letrozole<br />
Megestrol Acetate<br />
Fareston<br />
Lidoderm SL<br />
Myfortic<br />
Intron A<br />
Restasis SL<br />
Tussionex SL<br />
Mycophenolate Capsule, Tablet<br />
Phenazopyridine<br />
Tacrolimus<br />
Tamoxifen<br />
Neoral<br />
Rapamune<br />
Sandimmune<br />
Twinject SL<br />
Miscellaneous Overactive Bladder<br />
Tier 1<br />
Dicyclomine Tablet<br />
Hyoscyamine Sulfate<br />
Tier 2<br />
Enablex<br />
Gelnique<br />
Oxybutynin<br />
Trospium<br />
Oxytrol<br />
Sanctura XR<br />
Vesicare<br />
Tier 3<br />
Detrol Detrol LA Toviaz<br />
Please refer to page 3 for a definition of notations/symbols.<br />
Visit www.uhcsr.com for updates<br />
12<br />
<strong>2012</strong> <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong> – Student Resources Traditional Three-Tier
Musculoskeletal Osteoporosis<br />
Tier 1<br />
Alendronate SL Calcitonin Salmon Nasal Spray Fortical<br />
Tier 2<br />
Actonel SL<br />
Boniva Tablet SL<br />
Tier 3<br />
Fosamax Plus D SL<br />
Musculoskeletal Pain Relief<br />
Tier 1<br />
Acetaminophen/Butalbital/Caffeine/Codeine SL<br />
Acetaminophen/Codeine SL<br />
Acetaminophen/Hydrocodone Bit SL<br />
Acetaminophen/Oxycodone SL<br />
Aspirin/Butalbital/Caffeine/Codeine<br />
Aspirin/Oxycodone<br />
Butorphanol Nasal Spray SL<br />
Diclofenac Potassium<br />
Diclofenac Sodium<br />
Etodolac<br />
Fentanyl Citrate Lollipop SL<br />
Fentanyl Transdermal SL<br />
Hydromorphone<br />
Tier 2<br />
Codeine Phosphate<br />
MSIR Capsule<br />
Tier 3<br />
Arthrotec<br />
Avinza SL<br />
Celebrex SL<br />
Duragesic SL<br />
Embeda SL<br />
Exalgo SL<br />
Evista<br />
Forteo<br />
Ibuprofen<br />
Ibuprofen/Hydrocodone<br />
Ibuprofen/Oxycodone<br />
Indomethacin<br />
Ketorolac Tromethamine<br />
Mefenamic Acid<br />
Meloxicam<br />
Meperidine<br />
Methadone<br />
Morphine Sulfate<br />
Morphine Sulfate Sustained-Action Tablet SL<br />
Nabumetone<br />
Naproxen<br />
Opana ER SL<br />
OxyContin SL<br />
Fentora SL<br />
Flector<br />
Kadian SL<br />
Naprelan<br />
Onsolis SL<br />
Opana SL<br />
Naproxen Sodium<br />
Oxaprozin<br />
Oxycodone<br />
Oxymorphone SL<br />
Oxymorphone Extended-Release<br />
12 Hour Tablet SL<br />
Piroxicam<br />
Sulindac<br />
Tolmetin Sodium<br />
Tramadol<br />
Tramadol Sustained-Release<br />
24 Hour Tablet SL<br />
Tramadol/Acetaminophen SL<br />
Voltaren Gel<br />
Pennsaid<br />
Rybix ODT SL<br />
Ryzolt SL<br />
Vimovo SL<br />
Zipsor<br />
Musculoskeletal Rheumatoid Arthritis<br />
Tier 1<br />
Azathioprine<br />
Hydroxychloroquine Sulfate<br />
Tier 2<br />
Cimzia SL<br />
Cuprimine<br />
Tier 3<br />
Humira SL<br />
Leflunomide<br />
Methotrexate<br />
Enbrel SL<br />
Simponi SL<br />
Kineret SL<br />
Sulfasalazine<br />
Trexall<br />
Musculoskeletal Other<br />
Tier 1<br />
Allopurinol<br />
Baclofen<br />
Carisoprodol 250 mg<br />
Carisoprodol 350 mg<br />
Tier 2<br />
Colcrys<br />
Tier 3<br />
Amrix<br />
Savella SL<br />
Cyclobenzaprine<br />
Cyclobenzaprine Extended-Release<br />
24 Hour Capsule<br />
Metaxalone<br />
Skelaxin<br />
Soma 250 mg<br />
Methocarbamol<br />
Orphenadrine<br />
Orphenadrine Compound<br />
Tizanidine<br />
Uloric SL<br />
Please refer to page 3 for a definition of notations/symbols.<br />
Visit www.uhcsr.com for updates<br />
13<br />
<strong>2012</strong> <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong> – Student Resources Traditional Three-Tier
Respiratory Asthma/COPD<br />
Tier 1<br />
Albuterol Sulfate<br />
Albuterol Sulfate/Ipratropium Non-Oral Solution<br />
Alvesco SL<br />
Asmanex SL<br />
Tier 2<br />
Foradil SL<br />
Pulmicort Respules 1 mg/2 ml SL<br />
Tier 3<br />
Advair Diskus SL<br />
Advair HFA SL<br />
Atrovent HFA SL<br />
Combivent SL<br />
Dulera SL<br />
Flovent Diskus SL<br />
Budesonide Inhalation Suspension 0.25 mg/<br />
2 ml, 0.5 mg/2 ml SL<br />
Ipratropium Bromide<br />
QVAR SL<br />
Singulair SL<br />
Spiriva SL<br />
Flovent HFA SL<br />
Maxair Autohaler SL<br />
Perforomist SL<br />
Proair HFA SL<br />
Proventil HFA SL<br />
Pulmicort Flexhaler SL<br />
Theophylline<br />
Ventolin HFA SL<br />
Zafirlukast SL<br />
Serevent Diskus SL<br />
Symbicort SL<br />
Xopenex HFA SL<br />
Xopenex Vial, Nebulizer SL<br />
Respiratory Nasal Allergy<br />
Tier 1<br />
Azelastine HCl SL<br />
Flunisolide<br />
Tier 2<br />
Nasonex SL<br />
Tier 3<br />
Astelin SL<br />
Astepro<br />
Beconase AQ SL<br />
Fluticasone Propionate SL<br />
Triamcinolone Acetonide SL<br />
Nasacort AQ SL<br />
Omnaris SL<br />
Patanase<br />
Rhinocort Aqua SL<br />
Veramyst<br />
Respiratory Oral Allergy<br />
Tier 1<br />
Cyproheptadine<br />
Hydroxyzine<br />
Tier 3<br />
Clarinex SL<br />
Levocetirizine SL<br />
Promethazine<br />
Clarinex-D SL<br />
Women’s Health Contraceptives<br />
Tier 1<br />
Amethia<br />
Amethyst<br />
Apri<br />
Aviane<br />
Azurette<br />
Balziva<br />
Camila<br />
Camrese<br />
Enpresse<br />
Errin<br />
Gianvi<br />
Heather<br />
Introvale<br />
Jolessa<br />
Jolivette<br />
Junel<br />
Junel Fe<br />
Kariva<br />
Levora<br />
Low-Ogestrel<br />
Lutera<br />
Medroxyprogesterone 150 mg/ml<br />
Microgestin<br />
Microgestin Fe<br />
Mononessa<br />
Necon 7/7/7<br />
Nora-Be<br />
Norethindrone<br />
Nortrel 7/7/7<br />
Ocella<br />
Portia<br />
Previfem<br />
Quasense<br />
Reclipsen<br />
Sprintec<br />
Tilia Fe<br />
Tri-Legest Fe<br />
Tri-Previfem<br />
Tri-Sprintec<br />
Trinessa<br />
Trivora<br />
Zarah<br />
Zenchent<br />
Zeosa<br />
Zovia<br />
Tier 2<br />
Depo-SubQ Provera NuvaRing Ovrette<br />
Tier 3<br />
Beyaz<br />
Femcon Fe<br />
Lo Loestrin Fe<br />
Loestrin 24 Fe<br />
LoSeasonique<br />
Lybrel<br />
Ortho Evra<br />
Ortho Micronor<br />
Ortho Tri-Cyclen<br />
Ortho Tri-Cyclen Lo<br />
Ortho-Cyclen<br />
Ortho-Novum 7/7/7<br />
Safyral<br />
Seasonique<br />
Yasmin<br />
Yaz<br />
Please refer to page 3 for a definition of notations/symbols.<br />
Visit www.uhcsr.com for updates<br />
14<br />
<strong>2012</strong> <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong> – Student Resources Traditional Three-Tier
Women’s Health Estrogen/Progesterone<br />
Tier 1<br />
Estradiol<br />
Estradiol/Norethindrone Acetate<br />
Estradiol Transdermal Weekly Patch SL<br />
Tier 2<br />
Cenestin<br />
Climara SL<br />
Crinone<br />
Divigel<br />
Enjuvia<br />
Tier 3<br />
Activella<br />
Alora SL<br />
Climara Pro SL<br />
Combipatch SL<br />
Estrasorb SL<br />
Estropipate<br />
Medroxyprogesterone<br />
Norethindrone Acetate<br />
Estrace Cream with Applicator<br />
Estraderm SL<br />
Estring SL<br />
Evamist<br />
Prefest<br />
Estrogel SL<br />
Femhrt<br />
Femring SL<br />
First-Progesterone<br />
Menostar Transdermal Weekly Patch SL<br />
Norethindrone Acetate/Ethinyl Estradiol<br />
Tablet 1 mg/5 mcg<br />
Prometrium<br />
Vagifem<br />
Vivelle SL<br />
Vivelle-Dot SL<br />
Premarin<br />
Premphase<br />
Prempro<br />
Prochieve<br />
Women’s Health Prenatal Vitamins<br />
Tier 1<br />
Advanced Care Plus<br />
Cavan-EC Sod DHA<br />
Folcal DHA<br />
Folic Acid<br />
Multi-Nate 30<br />
Multinatal Plus<br />
Natalcare Plus<br />
PR Natal 430<br />
Tier 3<br />
Brand Prenatal Vitamins<br />
PR Natal 430 EC<br />
PR Natal 440 EC<br />
Prenatal 19<br />
Prenatal Advantage<br />
Prenatal Plus<br />
Pruet DHA 29-1-430 mg<br />
Pruet DHA EC 29-1-430 mg<br />
Setonet<br />
Setonet-EC<br />
Taron A Prenatal<br />
Vemavite-PRX 2<br />
Vinate III<br />
Vitanatal OB+DHA<br />
Zatean-PN<br />
Zatean-PN DHA<br />
Zatean-PN Plus<br />
Please refer to page 3 for a definition of notations/symbols.<br />
Visit www.uhcsr.com for updates<br />
15<br />
<strong>2012</strong> <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong> – Student Resources Traditional Three-Tier
Additional Tier 3 <strong>Drug</strong>s with a generic equivalent in Tier 1<br />
Accolate SL (Zafirlukast SL)<br />
Accupril (Quinapril)<br />
Acular (Ketorolac Tromethamine)<br />
Adderall (Amphetamine/Dextroamphetamine Salt<br />
Combination)<br />
Aldactone (Spironolactone)<br />
Altace (Ramipril)<br />
Amaryl (Glimepiride)<br />
Ambien SL (Zolpidem SL)<br />
Amerge SL (Naratriptan SL)<br />
Anaprox (Naproxen)<br />
Aricept (Donepezil)<br />
Arimidex (Anastrozole)<br />
Ativan (Lorazepam)<br />
Augmentin ES (Amoxicillin/Potassium<br />
Clavulanate)<br />
Biaxin Tablet (Clarithromycin Tablet)<br />
Buspar (Buspirone)<br />
Calan, Calan SR (Verapamil)<br />
Capoten (Captopril)<br />
Cardizem CD except for 360 mg strength<br />
(Diltiazem Capsule, Sustained-Release<br />
24 Hour)<br />
Cardura (Doxazosin)<br />
Ceftin (Cefuroxime)<br />
Cefzil (Cefprozil)<br />
Celexa (Citalopram)<br />
Ciloxan Eye Drops (Ciprofloxacin)<br />
Cipro (Ciprofloxacin)<br />
Cleocin T (Clindamycin Gel, Lotion, Solution,<br />
Swabs)<br />
Clozaril (Clozapine)<br />
Colazal (Balsalazide)<br />
Colestid (Colestipol)<br />
Coreg (Carvedilol)<br />
Cozaar 1 /2T (Losartan 1 /2T)<br />
DDAVP (Desmopressin)<br />
Depakote (Divalproex Sodium Tablet)<br />
Depakote ER (Divalproex Sodium<br />
Sustained-Release 24 Hour Tablet)<br />
Depo-Provera (Medroxyprogesterone<br />
150 mg/ml)<br />
DiaBeta, Micronase, Glynase (Glyburide)<br />
Diastat Acudial SL (Diazepam Rectal Gel SL)<br />
Didronel (Etidronate Disodium)<br />
Diflucan (Fluconazole)<br />
Ditropan XL (Oxybutynin Sustained-Release<br />
Tablet)<br />
Duricef (Cefadroxil)<br />
Dyazide (Triamterene/Hydrochlorothiazide)<br />
Dynacirc (Isradipine)<br />
Effexor (Venlafaxine)<br />
Effexor XR SL (Venlafaxine Sustained-Release<br />
Capsule SL)<br />
Eskalith CR (Lithium Carbonate<br />
Controlled-Release Tablet)<br />
Femara (Letrozole)<br />
Fioricet SL (Acetaminophen/Butalbital/<br />
Caffeine SL)<br />
Flomax (Tamsulosin)<br />
Flonase SL (Fluticasone Nasal Spray SL)<br />
Floxin Otic (Ofloxacin Otic Drops)<br />
Fosamax SL (Alendronate SL)<br />
Glucophage, XR (Metformin)<br />
Glucotrol, XL (Glipizide)<br />
Glucovance (Glyburide/Metformin)<br />
Hytrin (Terazosin)<br />
Hyzaar SL (Losartan/Hydrochlorothiazide SL)<br />
Imitrex SL (Sumatriptan Succinate Injection,<br />
Tablet SL)<br />
Inderal (Propranolol)<br />
Keflex (Cephalexin)<br />
Keppra (Levetiracetam)<br />
Klonopin (Clonazepam)<br />
Lamictal (Lamotrigine)<br />
Lamisil SL (Terbinafine Tablet SL)<br />
Lasix (Furosemide)<br />
Levaquin (Levofloxacin)<br />
Lopid (Gemfibrozil)<br />
Lopressor (Metoprolol)<br />
Mavik 1 /2T (Trandolapril 1 /2T)<br />
Medrol (Methylprednisolone Dosepak<br />
Tablet 4 mg)<br />
Mevacor (Lovastatin)<br />
Mobic (Meloxicam)<br />
Monopril (Fosinopril)<br />
Monopril HCT (Fosinopril/Hydrochlorothiazide)<br />
Motrin (Ibuprofen) - <strong>Prescription</strong> strengths only<br />
Naprosyn (Naproxen) - <strong>Prescription</strong><br />
strengths only<br />
Nardil (Phenelzine)<br />
Nasarel SL (Flunisolide Nasal Spray SL)<br />
Neurontin (Gabapentin)<br />
Norvasc (Amlodipine)<br />
Ocuflox Eye Drops (Ofloxacin)<br />
Paxil (Paroxetine)<br />
Penlac (Ciclopirox Solution, Non-Oral)<br />
Percocet 5-325, 7.5-500, 10-650 SL<br />
(Acetaminophen/Oxycodone SL)<br />
Plan B (Levonorgestrel)<br />
Pletal (Cilostazol)<br />
Pravachol 1 /2T (Pravastatin 1 /2T)<br />
Precose (Acarbose)<br />
Prilosec (Omeprazole)<br />
Prinivil, Zestril (Lisinopril)<br />
Prinzide, Zestoretic (Lisinopril/<br />
Hydrochlorothiazide)<br />
Procardia XL (Nifedipine Extended-Release<br />
Tablet)<br />
Proscar (Finasteride)<br />
Protonix (Pantoprazole)<br />
Provera (Medroxyprogesterone)<br />
Prozac (Fluoxetine Capsule)<br />
Prozac Weekly SL (Fluoxetine Delayed-Release<br />
Capsule SL)<br />
Remeron (Mirtazapine)<br />
Remeron SolTab (Mirtazapine Dispersible Tablet)<br />
Requip (Ropinirole)<br />
Restoril (Temazepam)<br />
Risperdal (Risperidone)<br />
Ritalin (Methylphenidate)<br />
Ritalin SR (Methylphenidate Extended-Release<br />
Tablet)<br />
Sonata SL (Zaleplon SL)<br />
Surmontil (Trimipramine Maleate)<br />
Tenoretic (Atenolol/Chlorthalidone)<br />
Tenormin (Atenolol)<br />
Tiazac (Diltiazem)<br />
Topamax (Topiramate)<br />
Toprol XL 25 mg (Metoprolol Succinate<br />
Sustained-Release Tablet)<br />
Trileptal (Oxcarbazepine)<br />
Trusopt (Dorzolamide Eye Drops)<br />
Tylenol #3 SL (Acetaminophen/Codeine SL)<br />
Ultracet SL (Tramadol/Acetaminophen SL)<br />
Ultram (Tramadol)<br />
Valium (Diazepam)<br />
Vaseretic (Enalapril/Hydrochlorothiazide)<br />
Vasotec (Enalapril)<br />
Vfend SL (Voriconazole SL)<br />
Vicodin SL, Vicodin ES SL (Acetaminophen/<br />
Hydrocodone SL)<br />
Vicoprofen (Ibuprofen/Hydrocodone)<br />
Voltaren Tablet (Diclofenac)<br />
Wellbutrin (Bupropion HCl)<br />
Wellbutrin SR (Bupropion HCl Sustained-Action<br />
Tablet)<br />
Wellbutrin XL (Bupropion HCl Sustained-Release<br />
24 Hour Tablet)<br />
Xalatan SL (Latanoprost SL)<br />
Xanax, Xanax XR (Alprazolam)<br />
Zantac Syrup (Ranitidine Syrup)<br />
Ziac (Bisoprolol/Hydrochlorothiazide)<br />
Zithromax (Azithromycin)<br />
Zocor 1 /2T (Simvastatin 1 /2T)<br />
Zofran (Ondansetron)<br />
Zoloft 1 /2T (Sertraline 1 /2T)<br />
Zonegran (Zonisamide)<br />
Zovirax (Acyclovir Capsule, Suspension, Tablet)<br />
Please refer to page 3 for a definition of notations/symbols.<br />
Visit www.uhcsr.com for updates<br />
16<br />
<strong>2012</strong> <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong> – Student Resources Traditional Three-Tier
Index<br />
A<br />
A-B Otic 5<br />
Abilify 8<br />
Acanya 9<br />
Acarbose 10, 16<br />
Accolate 16<br />
Accu-Chek Active Test Strips 9<br />
Accu-Chek Aviva Care Kit 9<br />
Accu-Chek Aviva Test Strips 9<br />
Accu-Chek Comfort Curve Test Strips 9<br />
Accu-Chek Compact Care Kit 9<br />
Accu-Chek Compact Test Strips 9<br />
Accupril 16<br />
Aceon 6<br />
Acetaminophen/Butalbital/Caffeine 7, 13, 16<br />
Acetaminophen/Butalbital/Caffeine/Codeine 13<br />
Acetaminophen/Codeine 13, 16<br />
Acetaminophen/Dichloralphenazone/<br />
Isometheptene Mucate 7<br />
Acetaminophen/Hydrocodone 13, 16<br />
Acetaminophen/Hydrocodone Bit 13<br />
Acetaminophen/Oxycodone 13, 16<br />
Acetazolamide 11<br />
Aciphex 11<br />
Activella 15<br />
Actonel 13<br />
Actoplus Met 10<br />
Actos 10<br />
Acular 16<br />
Acuvail 12<br />
Acyclovir 5, 16<br />
Acyclovir Capsule, Suspension, Tablet 16<br />
Aczone 9<br />
Adapalene 9<br />
Adderall 7, 16<br />
Adderall XR 7<br />
Adoxa 5<br />
Advair Diskus 14<br />
Advair HFA 14<br />
Advanced Care Plus 15<br />
Advicor 6<br />
Aggrenox 5<br />
Akineton 8<br />
Albuterol Sulfate 14<br />
Albuterol Sulfate/Ipratropium<br />
Non-Oral Solution 14<br />
Alclometasone Dipropionate 9<br />
Aldactazide 50-50 mg 6<br />
Aldactone 16<br />
Aldara 9<br />
Alendronate 13, 16<br />
Alfuzosin 12<br />
Allopurinol 13<br />
Alora 15<br />
Alphagan P 0.1% 11<br />
Alprazolam 8, 16<br />
Alsuma 7<br />
Altabax 9<br />
Altace 16<br />
Altoprev 6<br />
Alvesco 14<br />
Amantadine 5<br />
Amaryl 16<br />
Ambien 8, 16<br />
Ambien CR 8<br />
Amerge 16<br />
Amethia 14<br />
Amethyst 14<br />
Amiodarone 7<br />
Amitiza 12<br />
Amitriptyline 7<br />
Amitriptyline/Perphenazine 7<br />
Amlodipine 6, 16<br />
Amlodipine/Benazepril 6<br />
Amoxicillin 5, 16<br />
Amoxicillin-Clavulanate ER 5<br />
Amoxicillin/Potassium Clavulanate 5, 16<br />
Amphetamine/Dextroamphetamine<br />
Salt Combination 16<br />
Amphetamine Aspartate/Amphetamine Sulfate/<br />
Dextroamphetamine Sustained-Release<br />
24 Hour Capsule 7<br />
Amphetamine Salt Combo 7<br />
Ampicillin 5<br />
Ampyra 8<br />
Amrix 13<br />
Amturnide 6<br />
Anaprox 16<br />
Anastrozole 12, 16<br />
Androderm 10<br />
Androgel 10<br />
Android 10<br />
Antara 6<br />
Antipyrine/Benzocaine 12<br />
Anzemet 11<br />
Apidra 10<br />
Aplenzin 7<br />
Apokyn 8<br />
Apraclonidine 11<br />
Apri 14<br />
Apriso 12<br />
Aricept 8, 16<br />
Aricept 23 mg 8<br />
Arimidex 16<br />
Arixtra 5<br />
Armour Thyroid 10<br />
Aromasin 12<br />
Arthrotec 13<br />
Asacol 12<br />
Asacol HD 12<br />
Ascensia Autodisc Test Strips 9<br />
Ascensia Breeze 2 Test Strips 9<br />
Ascensia Elite Test Strips 9<br />
Asmanex 14<br />
Aspirin/Butalbital/Caffeine 7, 13<br />
Aspirin/Butalbital/Caffeine/Codeine 13<br />
Aspirin/Oxycodone 13<br />
Astelin 14<br />
Astepro 14<br />
Atacand 6<br />
Atacand HCT 6<br />
Atenolol 6, 16<br />
Atenolol/Chlorthalidone 6, 16<br />
Ativan 16<br />
Atorvastatin 6<br />
Atralin 9<br />
Atrovent HFA 14<br />
Augmentin 5, 16<br />
Augmentin ES 16<br />
Augmentin XR 5<br />
Avalide 6<br />
Avandamet 10<br />
Avandaryl 10<br />
Avandia 10<br />
Avapro 6<br />
Avelox 5<br />
Aviane 14<br />
Avinza 13<br />
Avita Gel 9<br />
Avodart 12<br />
Avonex 8<br />
Axert 7<br />
Azasite 11<br />
Azathioprine 12-13<br />
Azelastine HCl 11, 14<br />
Azelex 9<br />
Azithromycin 5, 16<br />
Azopt 11<br />
Azor 6<br />
Azurette 14<br />
B<br />
Baclofen 13<br />
Bactroban 9<br />
Balsalazide 12, 16<br />
Balziva 14<br />
Baraclude 5<br />
Beconase AQ 14<br />
Belladona/Phenobarbital 12<br />
Benazepril 6<br />
Benazepril/Hydrochlorothiazide 6<br />
Benicar 6<br />
Benicar HCT 6<br />
Benzaclin Gel 1%-5% 9<br />
Benzamycin 9<br />
Benzonatate 12<br />
Benztropine Mesylate 8<br />
Bepreve 11<br />
Betamethasone Dipropionate 9<br />
Betamethasone Valerate 9<br />
Betaseron 8<br />
Betimol 11<br />
Beyaz 14<br />
Biaxin Tablet 16<br />
BiDil 6<br />
Bisoprolol 6, 16<br />
Bisoprolol/Hydrochlorothiazide 6, 16<br />
Blephamide S.O.P. 11<br />
Boniva Tablet 13<br />
Brand Prenatal Vitamins 15<br />
Brimonidine Tartrate 11<br />
Brimonidine Tartrate 0.15% 11<br />
Budesonide Extended-Release<br />
24 Hour Capsule 12<br />
Budesonide Inhalation Suspension<br />
0.25 mg/2 ml, 0.5 mg/2 ml 14<br />
Bumetanide 6<br />
Bupropion 7, 16<br />
Bupropion HCl 16<br />
Bupropion HCl Sustained-Action Tablet 16<br />
Bupropion HCl Sustained-Release<br />
24 Hour Tablet 16<br />
Bupropion XL 7<br />
Buspar 16<br />
Buspirone 8, 16<br />
Butorphanol Nasal Spray 13<br />
Byetta 10<br />
Bystolic 6<br />
C<br />
Cabergoline 10<br />
Caduet 6<br />
Cafergot 7<br />
Calan, Calan SR 16<br />
Calcitonin Salmon Nasal Spray 13<br />
Calcitriol 10<br />
Cambia 7<br />
Camila 14<br />
Camrese 14<br />
Canasa 12<br />
Capoten 16<br />
Captopril 6, 16<br />
Captopril/Hydrochlorothiazide 6<br />
Carafate Oral Suspension 11<br />
Carbamazepine 8<br />
Carbamazepine Extended-Release<br />
12 Hour Capsule 8<br />
Carbamazepine Sustained-Release<br />
12 Hour Tablet 8<br />
Carbatrol 8<br />
Carbidopa/Levodopa 8<br />
Cardizem CD 360 mg 6<br />
Cardizem CD except for 360 mg strength 16<br />
Cardizem LA 120 mg 6<br />
Cardizem LA 180, 240, 300, 360, 420 mg 6<br />
Cardura 16<br />
Carisoprodol 250 mg 13<br />
Carisoprodol 350 mg 13<br />
Carvedilol 6, 16<br />
Catapres-TTS 6<br />
Visit www.uhcsr.com for updates<br />
17<br />
<strong>2012</strong> <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong> – Student Resources Traditional Three-Tier
Cavan-EC Sod DHA 15<br />
Caverject 12<br />
Cefadroxil 5, 16<br />
Cefdinir 5<br />
Cefprozil 5, 16<br />
Ceftin 16<br />
Cefuroxime 5, 16<br />
Cefzil 16<br />
Celebrex 13<br />
Celexa 16<br />
Cellcept Suspension 12<br />
Celontin 8<br />
Cenestin 15<br />
Cephalexin 5, 16<br />
Cesamet 11<br />
Cetraxal 5<br />
Chlordiazepoxide/Clidinium 12<br />
Chlorhexidine Gluconate 12<br />
Chlorthalidone 6, 16<br />
Cholestyramine 6<br />
Cialis 12<br />
Ciclopirox Cream, Gel, Lotion 9<br />
Ciclopirox Non-Oral Solution 9<br />
Ciclopirox Shampoo 1% 9<br />
Ciclopirox Solution, Non-Oral 16<br />
Cilostazol 5, 16<br />
Ciloxan Eye Drops 16<br />
Cimetidine 11<br />
Cimzia 13<br />
Cipro 5, 16<br />
Cipro HC 5<br />
Cipro Suspension 5<br />
Ciprodex Otic 5<br />
Ciprofloxacin 5, 11, 16<br />
Ciprofloxacin Sustained-Release 24 Hour Tablet 5<br />
Ciprofloxacin Tablet 5<br />
Citalopram 7, 16<br />
Citalopram Hydrobromide 7<br />
Clarinex 14<br />
Clarinex-D 14<br />
Clarithromycin Suspension 5<br />
Clarithromycin Sustained-Release Tablet 5<br />
Clarithromycin Tablet 5, 16<br />
Cleocin HCl 75 mg 5<br />
Cleocin T 16<br />
Climara 15<br />
Climara Pro 15<br />
Clindagel 9<br />
Clindamycin Foam 1% 9<br />
Clindamycin Gel, Lotion, Solution, Swabs 9, 16<br />
Clindamycin HCl 5<br />
Clindamycin Palmitate 5<br />
Clindamycin Phosphate/Benzoyl Peroxide<br />
Gel 1%-5% 9<br />
Clindesse Vaginal 5<br />
Clobetasol Propionate 9<br />
Clobetasol Propionate Foam 9<br />
Clobex 9<br />
Clobex Shampoo 9<br />
Clonazepam 8, 16<br />
Clonidine 6<br />
Clonidine Transdermal Weekly Patch 6<br />
Clorazepate Dipotassium 8<br />
Clorpres 6<br />
Clotrimazole 5, 9<br />
Clotrimazole/Betamethasone 9<br />
Clozapine 8, 16<br />
Clozaril 16<br />
Codeine Phosphate 13<br />
Colazal 16<br />
Colcrys 13<br />
Colestid 16<br />
Colestipol 6, 16<br />
Combigan 11<br />
Combipatch 15<br />
Combivent 14<br />
Comtan 8<br />
Concerta 7<br />
Condylox Gel 9<br />
Contour Test Strips 9<br />
Copaxone 8<br />
Coreg 6, 16<br />
Coreg CR 6<br />
Coumadin 5<br />
Cozaar 16<br />
Creon 12<br />
Crestor 6<br />
Crinone 15<br />
Cuprimine 13<br />
Cutivate Lotion 9<br />
Cyclobenzaprine 13<br />
Cyclobenzaprine Extended-Release<br />
24 Hour Capsule 13<br />
Cymbalta 7<br />
Cyproheptadine 14<br />
D<br />
Dapsone 5<br />
Daytrana 7<br />
DDAVP 16<br />
Denavir 9<br />
Depakote 8, 16<br />
Depakote ER 8, 16<br />
Depo-Provera 16<br />
Depo-SubQ Provera 14<br />
Derma-Smoothe/FS 9<br />
Desmopressin 10, 16<br />
Desonate 9<br />
Desonide 9<br />
Desoximetasone 9<br />
Detrol 12<br />
Detrol LA 12<br />
Dexamethasone 10-11<br />
Dexilant 11<br />
Dextroamphetamine Sulfate 7<br />
DiaBeta 16<br />
Diastat Acudial 16<br />
Diazepam 8, 16<br />
Diazepam Rectal Gel 8, 16<br />
Dibenzyline 6<br />
Diclofenac 13, 16<br />
Diclofenac Potassium 13<br />
Diclofenac Sodium 13<br />
Dicloxacillin Sodium 5<br />
Dicyclomine Tablet 12<br />
Didronel 16<br />
Differin Cream, Gel 0.1% 9<br />
Differin Gel 0.3% 9<br />
Differin Lotion 9<br />
Diflucan 16<br />
Digoxin 7<br />
Dilantin 8<br />
Diltiazem 6, 16<br />
Diltiazem Capsule, Sustained-Release 24 Hour 16<br />
Diltiazem Controlled-Release Capsule 6<br />
Diltiazem Sustained-Action Capsule 6<br />
Diltiazem Sustained-Release 12 Hour Capsule 6<br />
Diltiazem Sustained-Release 24 Hour Capsule 6<br />
Diltiazem Sustained-Release 24 Hour Tablet 6<br />
Diovan 6<br />
Diovan HCT 6<br />
Dipentum 12<br />
Diphenoxylate/Atropine 12<br />
Ditropan XL 16<br />
Diuril Suspension 250 mg/5 ml 6<br />
Divalproex Sodium Sprinkle Capsule 8<br />
Divalproex Sodium Sustained-Release<br />
24 Hour Tablet 16<br />
Divalproex Sodium Sustained-Release Tablet 8<br />
Divalproex Sodium Tablet 8, 16<br />
Divigel 15<br />
Donepezil 8, 16<br />
Donepezil 5, 10 mg 8<br />
Doryx 5<br />
Dorzolamide Eye Drops 16<br />
Dorzolamide HCl 11<br />
Dorzolamide HCl/Timolol Maleate 11<br />
Dovonex Cream 9<br />
Doxazosin 6, 12, 16<br />
Doxepin 7<br />
Doxycycline Hyclate Enteric-Coated Tablet 5<br />
Doxycycline Monohydrate 5<br />
Doxycycline Monohydrate Capsule 150 mg 5<br />
Duac 9<br />
Duetact 10<br />
Dulera 14<br />
Duragesic 13<br />
Duricef 16<br />
Dyazide 16<br />
Dynacirc 16<br />
E<br />
Econazole Nitrate 9<br />
Edex 12<br />
Edluar 8<br />
Effexor 16<br />
Effexor XR 16<br />
Effient 5<br />
Elestat 11<br />
Elidel 9<br />
Emadine 11<br />
Embeda 13<br />
Emend 11<br />
Enablex 12<br />
Enalapril 6, 16<br />
Enalapril/Hydrochlorothiazide 6, 16<br />
Enbrel 13<br />
Enjuvia 15<br />
Enoxaparin 5<br />
Enpresse 14<br />
Entocort EC 12<br />
Epiduo 9<br />
Epinastine 11<br />
Epinephrine Pen Injector 12<br />
Epipen 12<br />
Epipen Jr 12<br />
Epivir HBV 5<br />
Eplerenone 6<br />
Ergomar 7<br />
Errin 14<br />
Ery-Tab 500 mg 5<br />
Erythromycin 5, 9, 11<br />
Erythromycin/Benzoyl Peroxide 9<br />
Erythromycin Base Enteric-Coated<br />
Tablet 250, 333 mg 5<br />
Eskalith CR 16<br />
Estrace Cream with Applicator 15<br />
Estraderm 15<br />
Estradiol 15<br />
Estradiol/Norethindrone Acetate 15<br />
Estradiol Transdermal Weekly Patch 15<br />
Estrasorb 15<br />
Estring 15<br />
Estrogel 15<br />
Estropipate 15<br />
Etidronate Disodium 16<br />
Etodolac 13<br />
Evamist 15<br />
Evista 13<br />
Evoclin 9<br />
Exalgo 13<br />
Exelon Solution 8<br />
Exemestane 12<br />
Exforge 6<br />
Exforge HCT 6<br />
Extavia 8<br />
Extina 5<br />
F<br />
Famciclovir 5<br />
Fanapt 8<br />
Fareston 12<br />
FazaClo 8<br />
Felbatol 8<br />
Felodipine 6<br />
Femara 16<br />
Femcon Fe 14<br />
Visit www.uhcsr.com for updates<br />
18<br />
<strong>2012</strong> <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong> – Student Resources Traditional Three-Tier
Femhrt 15<br />
Femring 15<br />
Fenofibrate 6<br />
Fenofibric Acid 6<br />
Fenoglide 6<br />
Fentanyl Citrate Lollipop 13<br />
Fentanyl Transdermal 13<br />
Fentora 13<br />
Finacea 9<br />
Finacea Plus 9<br />
Finasteride 12, 16<br />
Fioricet 16<br />
First-Progesterone 15<br />
Flecainide Acetate 7<br />
Flector 13<br />
Flomax 16<br />
Flonase 16<br />
Flovent Diskus 14<br />
Flovent HFA 14<br />
Floxin Otic 16<br />
Fluconazole 5, 16<br />
Fludrocortisone 10<br />
Flunisolide 14, 16<br />
Flunisolide Nasal Spray 16<br />
Fluocinonide 9<br />
Fluoxetine 7, 16<br />
Fluoxetine Capsule 16<br />
Fluoxetine Delayed-Release Capsule 7, 16<br />
Fluticasone Nasal Spray 16<br />
Fluticasone Propionate 9, 14<br />
Fluvoxamine Maleate 7<br />
Focalin XR 7<br />
Folcal DHA 15<br />
Folic Acid 15<br />
Fondaparinux 5<br />
Foradil 14<br />
Fortamet 10<br />
Forteo 13<br />
Fortical 13<br />
Fosamax 13, 16<br />
Fosamax Plus D 13<br />
Fosinopril 6, 16<br />
Fosinopril/Hydrochlorothiazide 6, 16<br />
Fragmin 5<br />
Freestyle Lite Test Strips 9<br />
Freestyle Test Strips 9<br />
Frova 7<br />
Furosemide 6, 16<br />
G<br />
Gabapentin 8, 16<br />
Gabitril 8<br />
Galantamine 8<br />
Gelnique 12<br />
Gemfibrozil 6, 16<br />
Genotropin 10<br />
Gentamicin Sulfate 11<br />
Geodon 8<br />
Gianvi 14<br />
Gilenya 8<br />
Glimepiride 10, 16<br />
Glipizide 10, 16<br />
Glipizide/Metformin 10<br />
Glucophage, XR 16<br />
Glucotrol, XL 16<br />
Glucovance 16<br />
Glumetza 10<br />
Glyburide 10, 16<br />
Glyburide/Metformin 10, 16<br />
Glynase 16<br />
Glyset 10<br />
GoLYTELY Packet 12<br />
Granisetron Tablet 11<br />
Guanfacine 6<br />
Gynazole-1 Vaginal 5<br />
H<br />
Halflytely-Bisacodyl 12<br />
Halobetasol Propionate 9<br />
Heather 14<br />
Hectorol 10<br />
Helidac 11<br />
Hepsera 5<br />
Humalog-Mix KwikPen 10<br />
Humalog-Mix Vials 10<br />
Humalog KwikPen 10<br />
Humalog Vials 10<br />
Humatrope 10<br />
Humira 13<br />
Humulin 70-30 Vials 10<br />
Humulin KwikPen 10<br />
Humulin Vials 10<br />
Hydralazine 6<br />
Hydrochlorothiazide 6, 16<br />
Hydrocodone/Chlorpheniramine Suspension 12<br />
Hydrocortisone 9-10<br />
Hydrocortisone Tablet 10<br />
Hydrocortisone Valerate 9<br />
Hydromorphone 13<br />
Hydroxychloroquine Sulfate 13<br />
Hydroxyzine 14<br />
Hyoscyamine Sulfate 12<br />
Hytrin 16<br />
Hyzaar 16<br />
I<br />
Ibuprofen 13, 16<br />
Ibuprofen/Hydrocodone 13, 16<br />
Ibuprofen/Oxycodone 13<br />
Ibuprofen - <strong>Prescription</strong> strengths only 16<br />
Imipramine 7<br />
Imiquimod 9<br />
Imitrex 16<br />
Indapamide 6<br />
Inderal 16<br />
Indomethacin 13<br />
Infergen 12<br />
Innohep 5<br />
Intron A 12<br />
Introvale 14<br />
Intuniv 7<br />
Invega 8<br />
Iopidine 1% 11<br />
Ipratropium Bromide 14<br />
Isosorbide Dinitrate 7<br />
Isosorbide Mononitrate 7<br />
Isotretinoin 9<br />
Isradipine 16<br />
Itraconazole Capsule 5<br />
J<br />
Jalyn 12<br />
Janumet 10<br />
Januvia 10<br />
Jolessa 14<br />
Jolivette 14<br />
Junel 14<br />
Junel Fe 14<br />
K<br />
Kadian 13<br />
Kariva 14<br />
Keflex 16<br />
Keppra 8, 16<br />
Keppra XR 8<br />
Ketoconazole 5, 9<br />
Ketorolac Tromethamine 11, 13, 16<br />
Kineret 13<br />
Klonopin 16<br />
Kuvan 10<br />
L<br />
Labetalol 6<br />
Lactulose 12<br />
Lamictal 8, 16<br />
Lamictal Dose Pack 8<br />
Lamictal ODT 8<br />
Lamictal XR 8<br />
Lamisil 5, 16<br />
Lamisil Granules 5<br />
Lamotrigine 8, 16<br />
Lanoxin 7<br />
Lansoprazole 11<br />
Lantus Solostar Pens/Cartridges 10<br />
Lantus Vials 10<br />
Lasix 16<br />
Lastacaft 11<br />
Latanoprost 11, 16<br />
Leflunomide 13<br />
Lescol 6<br />
Lescol XL 6<br />
Letrozole 12, 16<br />
Levaquin 16<br />
Levemir Flexpen 10<br />
Levemir Vials 10<br />
Levetiracetam 8, 16<br />
Levetiracetam Extended-Release 24 Hour Tablet 8<br />
Levitra 12<br />
Levocetirizine 14<br />
Levofloxacin 5, 11, 16<br />
Levonorgestrel 16<br />
Levora 14<br />
Levothyroxine Sodium 10<br />
Lexapro 7<br />
Lialda 12<br />
Lidocaine 9<br />
Lidoderm 12<br />
Liothyronine Sodium 10<br />
Lipitor 6<br />
Lipofen 6<br />
Lisinopril 6, 16<br />
Lisinopril/Hydrochlorothiazide 6, 16<br />
Lithium Carbonate 8, 16<br />
Lithium Carbonate Controlled-Release Tablet 16<br />
Livalo 6<br />
Lo Loestrin Fe 14<br />
Locoid Lipocream 9<br />
Locoid Lotion 9<br />
Loestrin 24 Fe 14<br />
Lopid 16<br />
Lopressor 16<br />
Loprox Shampoo 9<br />
Lorazepam 8, 16<br />
Losartan 6, 16<br />
Losartan/Hydrochlorothiazide 6, 16<br />
LoSeasonique 14<br />
Lotrel 6<br />
Lotronex 12<br />
Lovastatin 6, 16<br />
Lovaza 6<br />
Lovenox 5<br />
Low-Ogestrel 14<br />
Lumigan 11<br />
Lunesta 8<br />
Lutera 14<br />
Luvox CR 7<br />
Lybrel 14<br />
Lyrica 8<br />
M<br />
Macrodantin 25 mg 5<br />
Mavik 16<br />
Maxair Autohaler 14<br />
Maxalt 7<br />
Maxalt MLT 7<br />
Medrol 10, 16<br />
Medrol 2, 8, 24, 32 mg 10<br />
Medroxyprogesterone 14-16<br />
Medroxyprogesterone 150 mg/ml 14, 16<br />
Mefenamic Acid 13<br />
Megestrol Acetate 12<br />
Meloxicam 13, 16<br />
Menostar Transdermal Weekly Patch 15<br />
Meperidine 13<br />
Mesalamine 12<br />
Metadate CD 7<br />
Metaxalone 13<br />
Metformin 10, 16<br />
Methadone 13<br />
Methamphetamine 7<br />
Methimazole 10<br />
Visit www.uhcsr.com for updates<br />
19<br />
<strong>2012</strong> <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong> – Student Resources Traditional Three-Tier
Methocarbamol 13<br />
Methotrexate 13<br />
Methyldopa 6<br />
Methyldopa/Hydrochlorothiazide 6<br />
Methylin 7<br />
Methylphenidate 7, 16<br />
Methylphenidate Extended-Release<br />
24 Hour Tablet 7<br />
Methylphenidate Extended-Release Tablet 16<br />
Methylprednisolone Dosepak Tablet 4 mg 10, 16<br />
Metoclopramide 12<br />
Metolazone 6<br />
Metoprolol 6, 16<br />
Metoprolol/Hydrochlorothiazide 6<br />
Metoprolol Succinate Sustained-Release<br />
Tablet 6, 16<br />
Metoprolol Tartrate 6<br />
Metozolv ODT 12<br />
Metrogel 1% 9<br />
Metrolotion 9<br />
Metronidazole 5, 9<br />
Metronidazole Vaginal 5<br />
Mevacor 16<br />
Mexiletine 7<br />
Micardis 6<br />
Micardis HCT 6<br />
Microgestin 14<br />
Microgestin Fe 14<br />
Micronase 16<br />
Migranal 7<br />
Minocycline HCl 5<br />
Minoxidil 6<br />
Mirapex ER 8<br />
Mirtazapine 7, 16<br />
Mirtazapine Dispersible Tablet 16<br />
Misoprostol 11<br />
Mobic 16<br />
Moexipril 6<br />
Mometasone Furoate 9<br />
Mononessa 14<br />
Monopril 16<br />
Monopril HCT 16<br />
Morphine Sulfate 13<br />
Morphine Sulfate Sustained-Action Tablet 13<br />
Motrin - <strong>Prescription</strong> strengths only 16<br />
Moviprep 12<br />
MSIR Capsule 13<br />
Multaq 7<br />
Multi-Nate 30 15<br />
Multinatal Plus 15<br />
Mupirocin 9<br />
Muse 12<br />
Mycophenolate Capsule, Tablet 12<br />
Mycostatin 5<br />
Myfortic 12<br />
Mysoline 8<br />
N<br />
Nabumetone 13<br />
Nadolol 6<br />
Naftin 9<br />
Namenda 8<br />
Naprelan 13<br />
Naprosyn - <strong>Prescription</strong> strengths only 16<br />
Naproxen 13, 16<br />
Naproxen - <strong>Prescription</strong> strengths only 16<br />
Naproxen Sodium 13<br />
Naratriptan 7, 16<br />
Nardil 16<br />
Nasacort AQ 14<br />
Nasarel 16<br />
Nasonex 14<br />
Natalcare Plus 15<br />
Nateglinide 10<br />
Navane 20 mg 8<br />
Necon 7/7/7 14<br />
Nefazodone 7<br />
Neomycin/Polymyxin/HC Otic 5<br />
Neomycin/Polymyxin B Sulfate/<br />
Dexamethasone 11<br />
Neoral 12<br />
Neurontin 16<br />
Nexium Capsule 11<br />
Nexium Suspension 11<br />
Niaspan 6<br />
Nifedipine 6, 16<br />
Nifedipine Extended-Release Tablet 16<br />
Nisoldipine 6<br />
Nitrofurantoin/Nitrofurantoin Macrocrystal 5<br />
Nitrofurantoin Macrocrystal 5<br />
Nitrofurantoin Suspension 5<br />
Nitroglycerin 7<br />
Nitroglycerin Spray 7<br />
Nitroglycerin Transdermal Patch 7<br />
Nitrolingual 7<br />
Nitromist 7<br />
Nitrostat 7<br />
Nizatidine Oral Solution 11<br />
Nora-Be 14<br />
Norditropin 10<br />
Norethindrone 14-15<br />
Norethindrone Acetate 15<br />
Norethindrone Acetate/Ethinyl Estradiol<br />
Tablet 1 mg/5 mcg 15<br />
Noritate 9<br />
Nortrel 7/7/7 14<br />
Nortriptyline 7<br />
Norvasc 16<br />
Novolin Vials 10<br />
NovoLog 10<br />
Noxafil 5<br />
Nutropin, AQ, NuSpin 10<br />
NuvaRing 14<br />
Nuvigil 8<br />
Nystatin 5, 9<br />
Nystatin/Triamcinolone Acetonide 9<br />
O<br />
Ocella 14<br />
Octreotide Acetate 10<br />
Ocuflox Eye Drops 16<br />
Ofloxacin 5, 11, 16<br />
Ofloxacin Otic 5, 16<br />
Ofloxacin Otic Drops 16<br />
Oleptro 7<br />
Olux-E 9<br />
Omeprazole 11, 16<br />
Omeprazole/Sodium Bicarbonate Capsule 11<br />
Omnaris 14<br />
Omnitrope 10<br />
Ondansetron 11, 16<br />
One Touch Test Strips 9<br />
One Touch Ultra 2 System 9<br />
One Touch Ultra Mini System 9<br />
One Touch Ultra Test Strips 9<br />
Onglyza 10<br />
Onsolis 13<br />
Opana 13<br />
Opana ER 13<br />
Optivar 11<br />
Oracea 5<br />
Orapred 10<br />
Orapred ODT 10<br />
Orphenadrine 13<br />
Orphenadrine Compound 13<br />
Ortho-Cyclen 14<br />
Ortho-Novum 7/7/7 14<br />
Ortho Evra 14<br />
Ortho Micronor 14<br />
Ortho Tri-Cyclen 14<br />
Ortho Tri-Cyclen Lo 14<br />
Ovrette 14<br />
Oxandrolone 10<br />
Oxaprozin 13<br />
Oxcarbazepine 8, 16<br />
Oxistat 9<br />
Oxsoralen-Ultra 9<br />
Oxybutynin 12, 16<br />
Oxybutynin Sustained-Release Tablet 16<br />
Oxycodone 13, 16<br />
OxyContin 13<br />
Oxymorphone 13<br />
Oxymorphone Extended-Release<br />
12 Hour Tablet 13<br />
Oxytrol 12<br />
P<br />
Pancreaze 12<br />
Pantoprazole 11, 16<br />
Paroxetine 7, 16<br />
Paroxetine Sustained-Release 24 Hour Tablet 7<br />
Paroxetine Tablet 7<br />
Pataday 11<br />
Patanase 14<br />
Patanol 11<br />
Paxil 16<br />
Pediapred 10<br />
Peganone 8<br />
Penicillin V Potassium 5<br />
Penlac 16<br />
Pennsaid 13<br />
Pentasa 12<br />
Pentoxifylline 5<br />
Percocet 5-325, 7.5-500, 10-650 16<br />
Perforomist 14<br />
Perindopril Erbumine 6<br />
Permethrin 9<br />
Pexeva 7<br />
Phenazopyridine 12<br />
Phenelzine 7, 16<br />
Phenobarbital 8, 12<br />
Phenytoin Sodium 8<br />
Phospholine Iodide 11<br />
Pilopine HS 11<br />
Piroxicam 13<br />
Plan B 16<br />
Plavix 5<br />
Pletal 16<br />
Polyethylene Glycol 12<br />
Polymyxin B Sulfate/Trimethoprim 11<br />
Portia 14<br />
PR Natal 430 15<br />
PR Natal 430 EC 15<br />
PR Natal 440 EC 15<br />
Pramipexole 8<br />
Prandin 10<br />
Pravachol 16<br />
Pravastatin 6, 16<br />
Precision Xtra Test Strips 9<br />
Precose 16<br />
Prednisolone 10<br />
Prednisone 10<br />
Prefest 15<br />
Premarin 15<br />
Premphase 15<br />
Prempro 15<br />
Prenatal 19 15<br />
Prenatal Advantage 15<br />
Prenatal Plus 15<br />
Prevacid Delayed-Release<br />
Enteric-Coated Capsule 11<br />
Prevacid Solutab 11<br />
Previfem 14<br />
Prevpac 11<br />
Prilosec 11, 16<br />
Prilosec Rx 10, 20 mg 11<br />
Prilosec Rx 40 mg 11<br />
Primidone 8<br />
Prinivil 16<br />
Prinzide 16<br />
Pristiq 7<br />
Proair HFA 14<br />
Procardia XL 16<br />
Prochieve 15<br />
Prochlorperazine Maleate 11<br />
Promethazine 14<br />
Visit www.uhcsr.com for updates<br />
20<br />
<strong>2012</strong> <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong> – Student Resources Traditional Three-Tier
Prometrium 15<br />
Propafenone Sustained-Release<br />
12 Hour Capsule 7<br />
Propranolol 6, 16<br />
Propranolol/Hydrochlorothiazide 6<br />
Propranolol Sustained-Action Capsule 6<br />
Proscar 16<br />
Protonix 16<br />
Protopic 9<br />
Proventil HFA 14<br />
Provera 14, 16<br />
Provigil 8<br />
Prozac 16<br />
Prozac Weekly 16<br />
Pruet DHA 29-1-430 mg 15<br />
Pruet DHA EC 29-1-430 mg 15<br />
Pulmicort Flexhaler 14<br />
Pulmicort Respules 1 mg/2 ml 14<br />
Pylera 11<br />
Q<br />
Quasense 14<br />
Quinapril 6, 16<br />
Quinapril/Hydrochlorothiazide 6<br />
QVAR 14<br />
R<br />
Ramipril 6, 16<br />
Ranexa 7<br />
Ranitidine Syrup 11, 16<br />
Rapaflo 12<br />
Rapamune 12<br />
Rebetol Solution 5<br />
Rebif 8<br />
Reclipsen 14<br />
Regranex 9<br />
Relenza 5<br />
Relistor 12<br />
Relpax 7<br />
Remeron 16<br />
Remeron SolTab 16<br />
Requip 8, 16<br />
Requip XL 8<br />
Restasis 12<br />
Restoril 16<br />
Retin-A Micro 9<br />
Rhinocort Aqua 14<br />
Ribavirin 5<br />
Risperdal 16<br />
Risperidone 8, 16<br />
Ritalin 7, 16<br />
Ritalin LA 7<br />
Ritalin SR 16<br />
Rivastigmine 8<br />
Ropinirole 8, 16<br />
Rozerem 8<br />
Rybix ODT 13<br />
Ryzolt 13<br />
S<br />
Sabril 8<br />
Safyral 14<br />
Saizen 10<br />
Sanctura XR 12<br />
Sancuso 11<br />
Sandimmune 12<br />
Sandostatin Vial 10<br />
Savella 13<br />
Seasonique 14<br />
Serevent Diskus 14<br />
Seroquel 8<br />
Seroquel XR 8<br />
Serostim 10<br />
Sertraline 7, 16<br />
Setonet 15<br />
Setonet-EC 15<br />
Silenor 8<br />
Silver Sulfadiazine 9<br />
Simcor 6<br />
Simponi 13<br />
Simvastatin 6, 16<br />
Singulair 14<br />
Skelaxin 13<br />
Solodyn 5<br />
Soma 250 mg 13<br />
Sonata 8, 16<br />
Sotalol 7<br />
Spiriva 14<br />
Spironolactone 6, 16<br />
Spironolactone/Hydrochlorothiazide 6<br />
Sporanox Oral Solution 5<br />
Sprintec 14<br />
Starlix 10<br />
Stavzor 8<br />
Stelara 9<br />
Strattera 7<br />
Sucralfate Tablet 11<br />
Sular 6<br />
Sulfacetamide Sodium 9, 11<br />
Sulfacetamide Sodium/Sulfur 9<br />
Sulfamethoxazole/Trimethoprim 5<br />
Sulfasalazine 12-13<br />
Sulindac 13<br />
Sumatriptan Succinate Injection, Tablet 7, 16<br />
Sumatriptan Succinate Nasal Spray 7<br />
Sumavel DosePro 7<br />
Suprax 5<br />
Surmontil 16<br />
Symbicort 14<br />
Symbyax 8<br />
Symlin 10<br />
Synarel 10<br />
Synthroid 10<br />
T<br />
Taclonex 9<br />
Taclonex Scalp 9<br />
Tacrolimus 12<br />
Tamiflu 5<br />
Tamoxifen 12<br />
Tamsulosin 12, 16<br />
Tarka 6<br />
Taron A Prenatal 15<br />
Tasmar 8<br />
Tazorac 9<br />
Tegretol 8<br />
Tekamlo 6<br />
Tekturna 6<br />
Tekturna HCT 6<br />
Temazepam 8, 16<br />
Tenoretic 16<br />
Tenormin 16<br />
Terazosin 6, 12, 16<br />
Terbinafine Tablet 5, 16<br />
Terconazole Vaginal 5<br />
Testim 10<br />
Testosterone 10<br />
Tetracycline 5<br />
Tev-Tropin 10<br />
Teveten 6<br />
Teveten HCT 6<br />
Thalitone 6<br />
Theophylline 14<br />
Tiazac 16<br />
Tilia Fe 14<br />
Timolol Maleate 6, 11<br />
Tirosint 10<br />
Tizanidine 13<br />
Tobi 5<br />
Tobradex ST 11<br />
Tobramycin/Dexamethasone 11<br />
Tobramycin Sulfate Drops 11<br />
Tolmetin Sodium 13<br />
Topamax 8, 16<br />
Topiramate 8, 16<br />
Toprol XL 25 mg 16<br />
Torsemide 6<br />
Toviaz 12<br />
Tramadol 13, 16<br />
Tramadol/Acetaminophen 13, 16<br />
Tramadol Sustained-Release 24 Hour Tablet 13<br />
Trandolapril 6, 16<br />
Trandolapril/Verapamil 6<br />
Transderm-Scop 11<br />
Travatan Z 11<br />
Trazodone 7<br />
Tretin-X 9<br />
Tretinoin 9<br />
Trexall 13<br />
Treximet 7<br />
Tri-Legest Fe 14<br />
Tri-Previfem 14<br />
Tri-Sprintec 14<br />
Triamcinolone Acetonide 9, 14<br />
Triamterene/Hydrochlorothiazide 6, 16<br />
Triazolam 8<br />
Tribenzor 6<br />
Tricor 6<br />
Triglide 6<br />
Trileptal 16<br />
Trilipix 6<br />
Trilyte with Flavor Packets 12<br />
Trimipramine Maleate 16<br />
Trinessa 14<br />
Trivora 14<br />
Trospium 12<br />
Trusopt 16<br />
Tussionex 12<br />
Twinject 12<br />
Twynsta 6<br />
Tylenol #3 16<br />
U<br />
Uloric 13<br />
Ultracet 16<br />
Ultram 16<br />
Urea 9<br />
Uroxatral 12<br />
Ursodiol 12<br />
V<br />
Vagifem 15<br />
Valacyclovir 5<br />
Valcyte 5<br />
Valium 16<br />
Valtrex 5<br />
Valturna 6<br />
Vancocin HCl 5<br />
Vanos 9<br />
Vaseretic 16<br />
Vasotec 16<br />
Vectical 9<br />
Velosef Suspension 250 mg 5<br />
Veltin 9<br />
Vemavite-PRX 2 15<br />
Venlafaxine 7, 16<br />
Venlafaxine Extended-Release Tablet 7<br />
Venlafaxine Sustained-Release Capsule 7, 16<br />
Venlafaxine Tablet 7<br />
Ventolin HFA 14<br />
Veramyst 14<br />
Verapamil 6, 16<br />
Verapamil Sustained-Release 24 Hour Pellets 6<br />
Verdeso 9<br />
Vesicare 12<br />
Vfend 16<br />
Viagra 12<br />
Vicodin 16<br />
Vicodin ES 16<br />
Vicoprofen 16<br />
Victoza 10<br />
Vigamox 11<br />
Vimovo 13<br />
Vinate III 15<br />
Vitanatal OB+DHA 15<br />
Vivelle 15<br />
Vivelle-Dot 15<br />
Voltaren Gel 13<br />
Voltaren Tablet 16<br />
Voriconazole 5, 16<br />
Visit www.uhcsr.com for updates<br />
21<br />
<strong>2012</strong> <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong> – Student Resources Traditional Three-Tier
Vusion 9<br />
Vytorin 6<br />
Vyvanse 7<br />
W<br />
Warfarin Sodium 5<br />
Welchol 6<br />
Wellbutrin 16<br />
Wellbutrin SR 16<br />
Wellbutrin XL 16<br />
X<br />
Xalatan 16<br />
Xanax, Xanax XR 16<br />
Xerese 9<br />
Xolegel 9<br />
Xopenex HFA 14<br />
Xopenex Vial, Nebulizer 14<br />
Xyrem 8<br />
Y<br />
Yasmin 14<br />
Yaz 14<br />
Z<br />
Zafirlukast 14, 16<br />
Zaleplon 8, 16<br />
Zantac Syrup 16<br />
Zarah 14<br />
Zatean-PN 15<br />
Zatean-PN DHA 15<br />
Zatean-PN Plus 15<br />
Zegerid Capsule 11<br />
Zegerid Packet 11<br />
Zemplar 10<br />
Zenchent 14<br />
Zenpep 12<br />
Zeosa 14<br />
Zestoretic 16<br />
Zestril 16<br />
Zetia 6<br />
Ziac 16<br />
Ziana 9<br />
Zipsor 13<br />
Zithromax 16<br />
Zocor 16<br />
Zofran 16<br />
Zoloft 16<br />
Zolpidem 8, 16<br />
Zolpidem Multiphasic-Release Tablet 8<br />
Zolpidem Tablet 8<br />
Zomig 7<br />
Zomig Nasal Spray 7<br />
Zomig ZMT 7<br />
Zonegran 16<br />
Zonisamide 8, 16<br />
Zorbtive 10<br />
Zovia 14<br />
Zovirax 9, 16<br />
Zuplenz 11<br />
Zyclara 9<br />
Zylet 11<br />
Zymaxid 11<br />
Zyprexa 8<br />
Zyprexa Zydis 8<br />
Zyvox 5<br />
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22<br />
<strong>2012</strong> <strong>Prescription</strong> <strong>Drug</strong> <strong>List</strong> – Student Resources Traditional Three-Tier
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