COMPREHENSIVE FORMULARY - RxAmerica

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Drug Name Drug Tier Notes warfarin sodium tab 6 mg warfarin sodium tab 7.5 mg Cardiovascular Drugs ACCUPRIL TAB 10MG(Quinapril HCl) ACCUPRIL TAB 20MG(Quinapril HCl) ACCUPRIL TAB 40MG(Quinapril HCl) ACCUPRIL TAB 5MG(Quinapril HCl) ACCURETIC TAB 10/12.5(Quinapril-Hydrochlorothiazide) ACCURETIC TAB 20-25MG(Quinapril-Hydrochlorothiazide) ACCURETIC TAB 20/12.5(Quinapril-Hydrochlorothiazide) acebutolol hcl cap 200 mg acebutolol hcl cap 400 mg ACEON TAB 2MG(Perindopril Erbumine) ACEON TAB 4MG(Perindopril Erbumine) ACEON TAB 8MG(Perindopril Erbumine) acetazolamide tab 125 mg acetazolamide tab 250 mg ADALAT CC TAB 30MG ER(Nifedipine) ADALAT CC TAB 60MG ER(Nifedipine) ADALAT CC TAB 90MG ER(Nifedipine) ADVICOR TAB 1000-20(Niacin-Lovastatin) ADVICOR TAB 1000-40(Niacin-Lovastatin) ADVICOR TAB 500-20MG(Niacin-Lovastatin) ADVICOR TAB 750-20MG(Niacin-Lovastatin) ALDACTAZIDE TAB 25/25(Spironolactone & Hydrochlorothiazide) ALDACTAZIDE TAB 50/50(Spironolactone & Hydrochlorothiazide) ALDACTONE TAB 100MG(Spironolactone) ALDACTONE TAB 25MG(Spironolactone) ALDACTONE TAB 50MG(Spironolactone) ALTACE CAP 1.25MG(Ramipril) ALTACE CAP 10MG(Ramipril) ALTACE CAP 2.5MG(Ramipril) ALTACE CAP 5MG(Ramipril) ALTOPREV TAB 20MG ER(Lovastatin) ALTOPREV TAB 40MG ER(Lovastatin) ALTOPREV TAB 60MG ER(Lovastatin) amiodarone hcl inj 50 mg/ml amiodarone hcl tab 100 mg amiodarone hcl tab 200 mg amiodarone hcl tab 300 mg amiodarone hcl tab 400 mg amlodipine besylate tab 10 mg amlodipine besylate tab 2.5 mg amlodipine besylate tab 5 mg amlodipine besylate-benazepril hcl cap 10-20 mg amlodipine besylate-benazepril hcl cap 2.5-10 mg amlodipine besylate-benazepril hcl cap 5-10 mg amlodipine besylate-benazepril hcl cap 5-20 mg ANTARA CAP 130MG(Fenofibrate Micronized) 01 01 04 04 04 04 04 04 04 01 01 04 04 04 01 01 04 04 04 04 04 04 04 04 02 04 04 04 04 04 04 04 04 04 04 01 01 01 01 01 01 01 01 01 01 01 01 02 37
Drug Name Drug Tier Notes ANTARA CAP 43MG(Fenofibrate Micronized) ATACAND TAB 16MG(Candesartan Cilexetil) ATACAND TAB 32MG(Candesartan Cilexetil) ATACAND TAB 4MG(Candesartan Cilexetil) ATACAND TAB 8MG(Candesartan Cilexetil) ATACAND HCT TAB 16-12.5(Candesartan Cilexetil-Hydrochlorothiazide) ATACAND HCT TAB 32-12.5(Candesartan Cilexetil-Hydrochlorothiazide) atenolol & chlorthalidone tab 100-25 mg atenolol & chlorthalidone tab 50-25 mg atenolol tab 100 mg atenolol tab 25 mg atenolol tab 50 mg AVALIDE TAB 150-12.5(Irbesartan-Hydrochlorothiazide) AVALIDE TAB 300-12.5(Irbesartan-Hydrochlorothiazide) AVALIDE TAB 300-25MG(Irbesartan-Hydrochlorothiazide) AVAPRO TAB 150MG(Irbesartan) AVAPRO TAB 300MG(Irbesartan) AVAPRO TAB 75MG(Irbesartan) benazepril & hydrochlorothiazide tab 10-12.5 mg benazepril & hydrochlorothiazide tab 20-12.5 mg benazepril & hydrochlorothiazide tab 20-25 mg benazepril & hydrochlorothiazide tab 5-6.25 mg benazepril hcl tab 10 mg benazepril hcl tab 20 mg benazepril hcl tab 40 mg benazepril hcl tab 5 mg bendroflumethiazide & rauwolfia tab 4-50 mg BENICAR TAB 20MG(Olmesartan Medoxomil) BENICAR TAB 40MG(Olmesartan Medoxomil) BENICAR TAB 5MG(Olmesartan Medoxomil) BENICAR HCT TAB 20-12.5(Olmesartan Medoxomil-Hydrochlorothiazide) BENICAR HCT TAB 40-12.5(Olmesartan Medoxomil-Hydrochlorothiazide) BENICAR HCT TAB 40-25MG(Olmesartan Medoxomil-Hydrochlorothiazide) BETAPACE TAB 120MG(Sotalol HCl) BETAPACE TAB 160MG(Sotalol HCl) BETAPACE TAB 240MG(Sotalol HCl) BETAPACE TAB 80MG(Sotalol HCl) BETAPACE AF TAB 120MG(Sotalol HCl (AFIB/AFL)) BETAPACE AF TAB 160MG(Sotalol HCl (AFIB/AFL)) BETAPACE AF TAB 80MG(Sotalol HCl (AFIB/AFL)) betaxolol hcl tab 10 mg betaxolol hcl tab 20 mg BIDIL TAB(Isosorbide Dinitrate-Hydralazine HCl) bisoprolol & hydrochlorothiazide tab 10-6.25 mg bisoprolol & hydrochlorothiazide tab 2.5-6.25 mg bisoprolol & hydrochlorothiazide tab 5-6.25 mg bisoprolol fumarate tab 10 mg bisoprolol fumarate tab 5 mg CADUET TAB 10/10MG(Amlodipine Besylate-Atorvastatin Calcium) CADUET TAB 10/20MG(Amlodipine Besylate-Atorvastatin Calcium) 02 04 04 04 04 04 04 01 01 01 01 01 04 04 04 04 04 04 01 01 01 01 01 01 01 01 01 02 02 02 02 02 02 04 04 04 04 04 04 04 01 01 02 01 01 01 01 01 04 04 38
Page 1 and 2: www.Meds4Medicare.com COMPREHENSIVE
Page 3 and 4: If we remove drugs from our formula
Page 5 and 6: condition. For example, if Drug A a
Page 7 and 8: RxAmerica’s Formulary The formula
Page 9 and 10: Drug Name Drug Tier Notes Antihista
Page 11 and 12: Drug Name Drug Tier Notes AMOXIL SU
Page 13 and 14: Drug Name Drug Tier Notes cefazolin
Page 15 and 16: Drug Name Drug Tier Notes CLEOCIN C
Page 17 and 18: Drug Name Drug Tier Notes ethambuto
Page 19 and 20: Drug Name Drug Tier Notes MANDELAMI
Page 21: Drug Name Drug Tier Notes PEG-INTRO
Page 24 and 25: Drug Name Drug Tier Notes URISYM CA
Page 26 and 27: Drug Name Drug Tier Notes ARIMIDEX
Page 28 and 29: Drug Name Drug Tier Notes IDAMYCIN
Page 30 and 31: Drug Name Drug Tier Notes TESLAC TA
Page 32 and 33: Drug Name Drug Tier Notes COGNEX CA
Page 34 and 35: Drug Name Drug Tier Notes PROSTIGMI
Page 36 and 37: Drug Name Drug Tier Notes cilostazo
Page 40 and 41: Drug Name Drug Tier Notes CADUET TA
Page 42 and 43: Drug Name Drug Tier Notes COZAAR TA
Page 44 and 45: Drug Name Drug Tier Notes HYPERTENS
Page 46 and 47: Drug Name Drug Tier Notes LOTREL CA
Page 48 and 49: Drug Name Drug Tier Notes NITROSTAT
Page 50 and 51: Drug Name Drug Tier Notes sotalol h
Page 52 and 53: Drug Name Drug Tier Notes WELCHOL T
Page 54 and 55: Drug Name Drug Tier Notes AZILECT T
Page 56 and 57: Drug Name Drug Tier Notes CYMBALTA
Page 58 and 59: Drug Name Drug Tier Notes EMSAM DIS
Page 60 and 61: Drug Name Drug Tier Notes GEODON IN
Page 62 and 63: Drug Name Drug Tier Notes ketoprofe
Page 64 and 65: Drug Name Drug Tier Notes METADATE
Page 66 and 67: Drug Name Drug Tier Notes naproxen
Page 68 and 69: Drug Name Drug Tier Notes PAXIL TAB
Page 70 and 71: Drug Name Drug Tier Notes RITALIN T
Page 72 and 73: Drug Name Drug Tier Notes thiothixe
Page 74 and 75: Drug Name Drug Tier Notes ZYDONE TA
Page 76 and 77: Drug Name Drug Tier Notes CLINIMIX
Page 78 and 79: Drug Name Drug Tier Notes LITHOSTAT
Page 80 and 81: Drug Name Drug Tier Notes Enzymes A
Page 82 and 83: Drug Name Drug Tier Notes BLEPH-10
Page 84 and 85: Drug Name Drug Tier Notes OPTIPRANO
Page 86 and 87: Drug Name Drug Tier Notes amylase-l
Page 88 and 89:
Drug Name Drug Tier Notes opium tin
Page 90 and 91:
Drug Name Drug Tier Notes sodium th
Page 92 and 93:
Drug Name Drug Tier Notes CYTOMEL T
Page 94 and 95:
Drug Name Drug Tier Notes FEMCON FE
Page 96 and 97:
Drug Name Drug Tier Notes JANUMET T
Page 98 and 99:
Drug Name Drug Tier Notes NORDITROP
Page 100 and 101:
Drug Name Drug Tier Notes PREMPRO T
Page 102 and 103:
Drug Name Drug Tier Notes tolbutami
Page 104 and 105:
Drug Name Drug Tier Notes PANGLOBUL
Page 106 and 107:
Drug Name Drug Tier Notes benzoyl p
Page 108 and 109:
Drug Name Drug Tier Notes DIPROLENE
Page 110 and 111:
Drug Name Drug Tier Notes lidocaine
Page 112 and 113:
Drug Name Drug Tier Notes ROZEX EMU
Page 114 and 115:
Drug Name Drug Tier Notes XYRALID L
Page 116 and 117:
Drug Name Drug Tier Notes NASCOBAL
Page 118 and 119:
Drug Name Drug Tier Notes IMURAN TA
Page 120 and 121:
Drug Name Drug Tier Notes THALOMID
Page 122 and 123:
Drug Name Drug Tier Notes insulin s
Page 124 and 125:
Drug Name Drug Tier Notes BENZOIC A
Page 126 and 127:
Drug Name Drug Tier Notes HYOSCYAMI
Page 128 and 129:
INDEX A ABBOKINASE 34 ABELCET 9 ABI
Page 130 and 131:
BD PEN MINI 119 BD PEN 119 BD ULTRA
Page 132 and 133:
clobetasol propionate emollient bas
Page 134 and 135:
EDECRIN 75 edetate calcium disodium
Page 136 and 137:
HALDOL DECAN 59 HALDOL 59 HALFLYTEL
Page 138 and 139:
LEXAPRO 61 LEXIVA 17 LEXXEL 44 LIAL
Page 140 and 141:
naloxone hcl 64 naltrexone hcl 64 N
Page 142 and 143:
peritoneal dialysis solutions 73 PE
Page 144 and 145:
S SAIZEN 99 SAL-TROPINE 33 SALAGEN
Page 146 and 147:
TRAVASOL 2.75%/DEXTROSE 5 78 TRAVAS
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COMPREHENSIVE FORMULARY - RxAmerica

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