July 1, 2013 Changes to the Connecticut Medicaid Preferred Drug List

Connecticut Medicaid Alphabetized Preferred Drug List (PDL)
*** Available on www.ctdssmap.com ***
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Preferred Drug Brand Equivalent Preferred Drug Brand Equivalent
CHOLESTYRAMINE/ASPARTAME (ORAL) PREVALITE DIOVAN, DIOVAN HCT (ORAL)
CHOLESTYRAMINE/SUCROSE (ORAL) QUESTRAN DIPYRIDAMOLE (ORAL) PERSANTINE
CIPRO SUSPENSION (ORAL) * DIVALPROEX SPRINKLE (ORAL) DEPAKOTE
CIPRODEX (OTIC) DIVALPROEX TABLET, DIVALPROEX ER (ORAL) DEPAKOTE
CIPROFLOXACIN SOLUTION (OPTHALMIC) DONEPEZIL TABLET, ODT (ORAL) ARICEPT
CIPROFLOXACIN TABLET (ORAL) CIPRO DORZOLAMIDE (OPHTHALMIC) TRUSOPT
CITALOPRAM TABLET, SOLUTION (ORAL) CELEXA DORZOLAMIDE / TIMOLOL (OPHTHALMIC) COSOPT
CITRANATAL 90 DHA, CITRANATAL ASSURE, *
DOVONEX CREAM (TOPICAL)
CITRANATAL B-CALM, CITRANATAL HARMONY, * DOXAZOSIN (ORAL) CARDURA
CITRANATAL RX (ORAL) DOXYCYCLINE HYCLATE CAPSULE, TABLET (ORAL) VIBRAMYCIN
CLARITHROMYCIN TABLET (ORAL) BIAXIN DOXYCYCLINE MONOHYDRATE 100 MG & 50 MG CAPSULE (ORAL) MONODOX
CLEOCIN OVULES (VAGINAL) DUAC (TOPICAL) *
CLINDAMYCIN (VAGINAL) CLINDAMAX DULERA (INHALATION)
CLINDAMYCIN PHOSPHATE GEL, MEDICATED SWAB, CLEOCIN-T DUONEB (INHALATION)
SOLUTION (TOPICAL)
DYSPORT (INTRAMUSC)
CLOBETASOL EMOLLIENT (TOPICAL) TEMOVATE EMOLLIENT E.E.S. 400 TABLET (ORAL)
CLOBETASOL PROPIONATE CREAM, GEL, OINT, SOLUTION (TOPICAL) TEMOVATE ECONAZOLE (TOPICAL) SPECTAZOLE
CLONAZEPAM (ORAL) KLONOPIN EGRIFTA (SUB-Q)
CLONIDINE (ORAL) CATAPRES ELIDEL (TOPICAL)
CLOPIDOGREL (ORAL) PLAVIX ELINEST (ORAL) *
CLOTRIMAZOLE (MUCOUS MEM) MYCELEX TROCHE ELIPHOS (ORAL)
CLOTRIMAZOLE CREAM RX, SOLUTION RX (TOPICAL) LOTRIMIN AF, MYCELEX ELIQUIS (ORAL)
CLOTRIMAZOLE-BETAMETHASONE CREAM, LOTION (TOPICAL) LOTRISONE EMEND, EMEND PACK (ORAL)
CLOZAPINE (ORAL) CLOZARIL / FAZACLO ENALAPRIL, ENALAPRIL HCTZ (ORAL) VASOTEC, VASORETIC
CLOZARIL (ORAL)
ENBREL DISP SYRINGE, KIT, PEN (INJECTION)
CODEINE (ORAL)
ENPRESSE (ORAL)
COMBIGAN (OPHTHALMIC)
EPI-PEN, EPI-PEN JR. (INJECTION)
COMBIVENT (INHALATION)
ERIVEDGE (ORAL)
COMBIVENT RESPIMAT (INHALATION)
ERY-TAB (ORAL)
COMPLETE NATAL DHA (ORAL) ERYTHROCIN (ORAL) E-MYCIN
COMPLETENATE (ORAL) ERYTHROMYCIN (OPHTHALMIC) ILOTYCIN
CONCEPT DHA, CONCEPT OB (ORAL) ERYTHROMYCIN BASE TABLET (ORAL) ERY-TAB
COPAXONE (SUBCUTANE.) ERYTHROMYCIN GEL, SOLUTION (TOPICAL) A/T/S
CREON (ORAL) ESCITALOPRAM TABLET (ORAL) LEXAPRO
CRESTOR (ORAL) * ETHOSUXIMIDE SYRUP (ORAL) ZARONTIN
CROMOLYN SODIUM (OPHTHALMIC) OPTICROM ETODOLAC TAB SR (ORAL) LODINE, LODINE XL
CRYSELLE (ORAL)
EURAX CREAM (TOPICAL)
CYCLAFEM (ORAL)
EXELON (TRANSDERMAL)
CYCLOBENZAPRINE (ORAL) FLEXERIL EXELON CAPSULES (ORAL)
CYCLOSPORINE CAPSULE, SOFTGEL (ORAL) SANDIMMUNE EXEMESTANE (ORAL) AROMASIN
CYCLOSPORINE MODIFIED CAPSULE, MODIFIED SOLUTION (ORAL) NEORAL EXFORGE, EXFORGE HCT (ORAL)
CYMBALTA (ORAL)
EZFE FORTE (ORAL)
DAILY PRENATAL (ORAL) FALMINA (ORAL) *
DASETTA (ORAL) *
FANAPT TABLET, TITRATION PACK (ORAL)
DAYTRANA (TRANSDERMAL)
FAZACLO (ORAL)
DENAVIR (TOPICAL)
FE C (ORAL)
DERMA-SMOOTHE-FS (TOPICAL) FELBAMATE SUSPENSION (ORAL) FELBATOL
DESONIDE CREAM, OINTMENT (TOPICAL) DESOWEN FEMCON FE (ORAL)
DESOWEN LOTION (TOPICAL) FENTANYL (TRANSDERM) DURAGESIC
DEXAMETHASONE (OPHTHALMIC) DEXASOL FEXOFENADINE 60 MG OTC, 180 MG OTC (ORAL) ALLEGRA
DEXMETHYLPHENIDATE (ORAL) FOCALIN FEXOFENADINE-D 12-HOUR OTC, 24-HOUR OTC (ORAL) ALLEGRA-D
DEXTROAMPHETAMINE TABLET (ORAL) DEXEDRINE FINASTERIDE (ORAL) PROSCAR
DIAZEPAM (RECTAL) DIASTAT ACUDIAL FLAREX (OPHTHALMIC)
DICLOFENAC (OPHTHALMIC) VOLTAREN FLECTOR (TOPICAL)
DIFFERIN CREAM, GEL, LOTION (TOPICAL) *
FLOVENT DISKUS, FLOVENT HFA (INHALATION)
DIHYDROCODEINE / APAP / CAFFEINE (ORAL) PANLOR FLUCONAZOLE SUSPENSION, TABLET (ORAL) DIFLUCAN
DILANTIN INFATAB (ORAL)
FLUNISOLIDE (NASAL)
DILTIAZEM TABLET, DILTIAZEM CAPSULE ER (ORAL) CARDIZEM FLUOCINOLONE ACETONIDE CREAM, OINT, SOLUTION (TOPICAL) DERMA-SMOOTH
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Preferred brand-name medications with non-preferred generic equivalents are listed in bold
Updated: 7/1/2013