PrimeChoice Plus Formulary - Prime Therapeutics
PrimeChoice Plus Formulary - Prime Therapeutics
PrimeChoice Plus Formulary - Prime Therapeutics
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GENERIC<br />
BRAND<br />
CONTRACEPTIVES<br />
levonorgestrel<br />
ELLA<br />
medroxyprogesterone inj, 150 mg/mL LO LOESTRIN FE<br />
oral contraceptive generics, NF =<br />
LOESTRIN 24 FE<br />
Amethia Lo, Camrese, Camrese Lo, MIRENA<br />
levonorgestrel/ethinyl estradiol ( generics NECON 10/11, 1/50<br />
of Loseasonique), Tilia Fe, Tri-Legest Fe, NUVARING<br />
Wymzya Fe, Zenchent Fe, Zeosa<br />
OGESTREL<br />
ORTHO EVRA<br />
ORTHO TRI-CYCLEN LO<br />
ZOVIA 1/50E<br />
PROGESTINS<br />
medroxyprogesterone acetate tabs<br />
norethindrone acetate<br />
progesterone micronized<br />
ANTIDIABETICS<br />
acarbose<br />
BYDUREON<br />
glimepiride<br />
BYE T TA<br />
glipizide IR, ER<br />
GLUCAGON EMERGENCY KIT<br />
glipizide/metformin<br />
GLYBURIDE, distributor of Diabeta<br />
glyburide micronized<br />
JANUMET<br />
glyburide/metformin<br />
JANUMET XR<br />
glyburide, generics of Micronase<br />
JANUVIA<br />
metformin IR, ER<br />
JUVISYNC<br />
nateglinide<br />
KOMBIGLYZE XR<br />
pioglitazone<br />
ONGLYZA<br />
pioglitazone/metformin<br />
PRANDIN<br />
VICTOZA<br />
Rapid-Acting Insulins<br />
HUMALOG<br />
NOVOLOG<br />
Short-Acting Insulins<br />
HUMULIN R<br />
NOVOLIN R<br />
Intermediate-Acting Insulins<br />
HUMALOG MIX 50/50, 75/25<br />
HUMULIN N<br />
HUMULIN 70/30<br />
NOVOLIN N<br />
NOVOLIN 70/30<br />
NOVOLOG MIX 70/30<br />
Basal Insulins<br />
L ANTUS<br />
LEVEMIR<br />
THYROID AGENTS<br />
levothyroxine<br />
liothyronine<br />
methimazole<br />
propylthiouracil<br />
OXY TOCICS<br />
methylergonovine<br />
ENDOCRINE AND METABOLIC AGENTS – MISC.<br />
alendronate 5 mg, 10 mg, 35 mg, 70 mg AC TONEL<br />
cabergoline<br />
ALENDRONATE 40 mg<br />
calcitonin-salmon<br />
ATELVIA<br />
calcitriol<br />
CETROTIDE<br />
chorionic gonadotropin<br />
ETIDRONATE 200 mg<br />
clomiphene<br />
E VISTA<br />
desmopressin<br />
FOLLISTIM AQ<br />
etidronate 400 mg<br />
FORTEO<br />
ibandronate<br />
GONAL-F<br />
levocarnitine<br />
INCRELEX<br />
octreotide<br />
LUPRON DEPOT-PED<br />
NORDITROPIN<br />
NUTROPIN<br />
NUTROPIN AQ<br />
ORFADIN<br />
OVIDREL<br />
REPRONEX<br />
SANDOSTATIN LAR DEPOT<br />
SENSIPAR<br />
GENERIC<br />
CARDIOVASCULAR AGENTS<br />
CARDIOTONICS<br />
digoxin tabs<br />
ANTIANGINAL AGENTS<br />
isosorbide dinitrate IR; NF = ER, SL<br />
isosorbide mononitrate<br />
nitroglycerin patches<br />
BETA BLOCKERS<br />
acebutolol<br />
atenolol<br />
bisoprolol<br />
car vedilol<br />
labetalol<br />
metoprolol succinate ER<br />
metoprolol tartrate<br />
nadolol<br />
propranolol IR, ER<br />
sotalol<br />
sotalol AF<br />
CALCIUM CHANNEL BLOCKERS<br />
amlodipine<br />
diltiazem IR, ER caps – 24 hr dosing<br />
felodipine ER<br />
nifedipine ER<br />
verapamil 80 mg, 120 mg<br />
verapamil ER, NF = caps, 100, 200, 300 mg<br />
ANTIARRHYTHMICS<br />
amiodarone<br />
disopyramide<br />
flecainide<br />
propafenone IR, ER<br />
quinidine gluconate ER<br />
quinidine sulfate IR<br />
ANTIHYPERTENSIVES<br />
amlodipine/benazepril<br />
atenolol/chlorthalidone<br />
benazepril<br />
benazepril/hydrochlorothiazide<br />
bisoprolol/hydrochlorothiazide<br />
captopril<br />
clonidine<br />
doxazosin<br />
enalapril<br />
enalapril/hydrochlorothiazide<br />
eplerenone<br />
fosinopril<br />
fosinopril/hydrochlorothiazide<br />
guanfacine<br />
hydralazine<br />
irbesar tan<br />
irbesar tan/hydrochlorothiazide<br />
lisinopril<br />
lisinopril/hydrochlorothiazide<br />
losartan<br />
losartan/hydrochlorothiazide<br />
methyldopa<br />
minoxidil<br />
moexipril<br />
moexipril/hydrochlorothiazide<br />
perindopril<br />
prazosin<br />
quinapril<br />
quinapril/hydrochlorothiazide<br />
ramipril<br />
terazosin<br />
trandolapril<br />
valsartan/hydrochlorothiazide<br />
BRAND<br />
STIMATE<br />
SYNAREL<br />
ZEMPLAR<br />
DIGOXIN soln<br />
L ANOXIN tabs<br />
NITRO-BID<br />
NITROSTAT<br />
RANEXA<br />
BYSTOLIC<br />
PINDOLOL<br />
PROPRANOLOL soln<br />
TIMOLOL<br />
VERAPAMIL 40 mg<br />
MEXILETINE<br />
MULTAQ<br />
NORPACE CR 100 mg<br />
QUINIDINE SULFATE ER<br />
AZOR<br />
BENICAR<br />
BENICAR HCT<br />
CAPTOPRIL/HYDROCHLOROTHIAZIDE<br />
DIBENZYLINE<br />
DIOVAN<br />
EXFORGE<br />
EXFORGE HCT<br />
MICARDIS<br />
MICARDIS HCT<br />
PROPRANOLOL/HYDROCHLOROTHIAZIDE<br />
GENERIC<br />
DIURETICS<br />
acetazolamide IR, 250 mg; ER<br />
amiloride<br />
amiloride/hydrochlorothiazide<br />
bumetanide<br />
chlorothiazide<br />
chlorthalidone 25 mg<br />
furosemide, NF = soln, 8 mg/mL<br />
hydrochlorothiazide, NF = tabs, 12.5 mg<br />
indapamide<br />
methazolamide<br />
metolazone<br />
spironolactone<br />
spironolactone/hydrochlorothiazide<br />
torsemide<br />
triamterene/hydrochlorothiazide<br />
VASOPRESSORS<br />
midodrine<br />
ANTIHYPERLIPIDEMICS<br />
ator vastatin<br />
cholest yramine<br />
colestipol<br />
fenofibrate<br />
fenofibrate micronized<br />
gemfibrozil<br />
lovastatin<br />
pravastatin<br />
simvastatin<br />
CARDIOVASCULAR AGENTS – MISC.<br />
sildenafil 20 mg<br />
RESPIRATORY AGENTS<br />
ANTIHISTAMINES<br />
cetirizine syrup<br />
cyproheptadine<br />
promethazine supp, 12.5 mg, 25 mg; syrup;<br />
tabs<br />
PROMETHEGAN 50 mg<br />
NASAL AGENTS –SYSTEMIC AND TOPIC AL<br />
BRAND<br />
ACETAZOL AMIDE 125 mg<br />
CHLORTHALIDONE 50 mg<br />
EPIPEN<br />
EPIPEN-JR<br />
CRESTOR<br />
LOVAZA<br />
NIASPAN<br />
TRILIPIX<br />
WELCHOL<br />
ZETIA<br />
ADCIRC A<br />
CADUET<br />
CAVERJECT<br />
CIALIS<br />
LE TAIRIS<br />
MUSE<br />
TRACLEER<br />
azelastine<br />
fluticasone propionate<br />
ipratropium<br />
triamcinolone spray<br />
COUGH/COLD/ALLERGY<br />
acetylcysteine<br />
ANTIASTHMATIC AND BRONCHODIL ATOR AGENTS<br />
albuterol, NF = ER<br />
budesonide<br />
cromolyn sodium inhal soln<br />
ipratropium inhal soln<br />
ipratropium/albuterol<br />
montelukast<br />
terbutaline<br />
theophylline ER<br />
zafirlukast<br />
ASTEPRO<br />
BACTROBAN NASAL<br />
FLUNISOLIDE<br />
NASONEX<br />
ADVAIR DISKUS<br />
ADVAIR HFA<br />
ASMANEX<br />
ATROVENT HFA<br />
COMBIVENT<br />
COMBIVENT RESPIMAT<br />
DULERA<br />
FLOVENT DISKUS<br />
FLOVENT HFA<br />
FOR ADIL AEROLIZER<br />
PROAIR HFA<br />
PULMICORT RESPULES 1 mg/2 mL<br />
QVAR<br />
SEREVENT DISKUS<br />
SPIRIVA HANDIHALER<br />
SYMBICORT<br />
VENTOLIN HFA<br />
RESPIRATORY AGENTS – MISC.<br />
FIRAZYR<br />
K ALYDECO<br />
PULMOZYME<br />
{continued}<br />
4550 © <strong>Prime</strong> <strong>Therapeutics</strong> LLC 02/13 <strong><strong>Prime</strong>Choice</strong> <strong>Plus</strong> Page 2 of 4
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