2-Tier Closed Preferred List - Sierra Health and Life
2-Tier Closed Preferred List - Sierra Health and Life
2-Tier Closed Preferred List - Sierra Health and Life
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<strong>Preferred</strong> Alternatives<br />
The following table identifies the preferred alternatives for some commonly prescribed non-preferred drugs.<br />
Copayments are lower when preferred drugs are prescribed.<br />
Non-<strong>Preferred</strong> Drug<br />
ACEON<br />
ACIPHEX<br />
ACTIVELLA<br />
ADVAIR<br />
AEROBID<br />
AEROBID-M<br />
AGGRENOX<br />
ALESSE<br />
ALORA<br />
ALTOCOR<br />
AMERGE<br />
ATACAND<br />
ATACAND HCT<br />
AVALIDE<br />
AVAPRO<br />
AXERT<br />
AZMACORT<br />
AZOPT<br />
BECONASE AQ<br />
BETAPACE AF<br />
BREVICON<br />
CELEBREX<br />
CLIMARA<br />
COGNEX<br />
CONCERTA<br />
COREG CR<br />
COVERA HS<br />
CYCLESSA<br />
DEMULEN<br />
DESOGEN<br />
DESOXYN<br />
DETROL<br />
DETROL LA<br />
DIOVAN<br />
DIOVAN HCT<br />
DUONEB<br />
<strong>Preferred</strong> Alternative(s)<br />
benazepril, fosinopril, lisinopril, quinapril, tr<strong>and</strong>olapril UNIVASC<br />
omeprazole, pantoprazole<br />
ORTHO-PREFEST, PREMPRO, PREMPHASE<br />
SYMBICORT (see section 12-D)<br />
ASMANEX, QVAR<br />
ASMANEX, QVAR<br />
dipyridamole <strong>and</strong> aspirin<br />
LEVLITE<br />
VIVELLE, VIVELLE DOT<br />
simvastatin, lovastatin, LIPITOR<br />
sumatriptan, RELPAX<br />
BENICAR, losartan<br />
BENICAR HCT, losartan-HCTZ<br />
BENICAR HCT, losartan-HCTZ<br />
BENICAR, losartan<br />
sumatriptan, RELPAX<br />
ASMANEX, QVAR<br />
TRUSOPT<br />
sotalol (BETAPACE)<br />
MODICON<br />
ibuprofen, naproxen, others (see section 9-C)<br />
VIVELLE, VIVELLE DOT<br />
donepezil, galantamine<br />
methylphenidate, dextroamphetamine, ADDERALL XR<br />
carvedilol, metoprolol succinate SR<br />
verapamil<br />
another oral contraceptive (see section 6-D)<br />
another oral contraceptive (see section 6-D)<br />
ORTHO-CEPT<br />
methylphenidate, dextroamphetamine, ADDERALL XR<br />
oxybutynin, URECHOLINE, URISPAS<br />
oxybutynin XL, URECHOLINE, URISPAS<br />
BENICAR, losartan<br />
BENICAR HCT, losartan-HCTZ<br />
COMBIVENT<br />
31<br />
2-<strong>Tier</strong> (closed) Drug Benefit Guide 01/04/12
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