COMPREHENSIVE FORMULARY - RxAmerica

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Drug Name Drug Tier Notes COZAAR TAB 25MG(Losartan Potassium) COZAAR TAB 50MG(Losartan Potassium) CRESTOR TAB 10MG(Rosuvastatin Calcium) CRESTOR TAB 20MG(Rosuvastatin Calcium) CRESTOR TAB 40MG(Rosuvastatin Calcium) CRESTOR TAB 5MG(Rosuvastatin Calcium) DIAMOX CAP 500MG CR(Acetazolamide) digoxin inj 0.1 mg/ml digoxin inj 0.25 mg/ml digoxin oral soln 0.05 mg/ml digoxin tab 0.125 mg digoxin tab 0.25 mg DILACOR XR CAP 120MG/24(Diltiazem HCl) DILACOR XR CAP 180MG/24(Diltiazem HCl) DILACOR XR CAP 240MG/24(Diltiazem HCl) DILATRATE SR CAP 40MG(Isosorbide Dinitrate) diltiazem hcl cap sr 12hr 120 mg diltiazem hcl cap sr 12hr 60 mg diltiazem hcl cap sr 12hr 90 mg diltiazem hcl cap sr 24hr 120 mg diltiazem hcl cap sr 24hr 180 mg diltiazem hcl cap sr 24hr 240 mg diltiazem hcl coated beads cap sr 24hr 120 mg diltiazem hcl coated beads cap sr 24hr 180 mg diltiazem hcl coated beads cap sr 24hr 240 mg diltiazem hcl coated beads cap sr 24hr 300 mg diltiazem hcl extended release beads cap sr 24hr 120 mg diltiazem hcl extended release beads cap sr 24hr 180 mg diltiazem hcl extended release beads cap sr 24hr 240 mg diltiazem hcl extended release beads cap sr 24hr 300 mg diltiazem hcl extended release beads cap sr 24hr 360 mg diltiazem hcl extended release beads cap sr 24hr 420 mg diltiazem hcl iv soln 5 mg/ml diltiazem hcl tab 120 mg diltiazem hcl tab 30 mg diltiazem hcl tab 60 mg diltiazem hcl tab 90 mg DIOVAN TAB 160MG(Valsartan) DIOVAN TAB 320MG(Valsartan) DIOVAN TAB 40MG(Valsartan) DIOVAN TAB 80MG(Valsartan) DIOVAN HCT TAB 160/12.5(Valsartan-Hydrochlorothiazide) DIOVAN HCT TAB 160/25MG(Valsartan-Hydrochlorothiazide) DIOVAN HCT TAB 320/12.5(Valsartan-Hydrochlorothiazide) DIOVAN HCT TAB 320/25MG(Valsartan-Hydrochlorothiazide) DIOVAN HCT TAB 80/12.5(Valsartan-Hydrochlorothiazide) dipyridamole tab 25 mg dipyridamole tab 50 mg dipyridamole tab 75 mg disopyramide phosphate cap 100 mg 04 04 04 04 04 04 02 01 01 01 01 01 04 04 04 02 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 02 02 02 02 02 02 02 02 02 01 01 01 01 41
Drug Name Drug Tier Notes disopyramide phosphate cap 150 mg disopyramide phosphate cap sr 12hr 150 mg doxazosin mesylate tab 1 mg doxazosin mesylate tab 2 mg doxazosin mesylate tab 4 mg doxazosin mesylate tab 8 mg DYNACIRC CR TAB 10MG(Isradipine) DYNACIRC CR TAB 5MG(Isradipine) enalapril maleate & hydrochlorothiazide tab 10-25 mg enalapril maleate & hydrochlorothiazide tab 5-12.5 mg enalapril maleate tab 10 mg enalapril maleate tab 2.5 mg enalapril maleate tab 20 mg enalapril maleate tab 5 mg ETHMOZINE TAB 200MG(Moricizine HCl) ETHMOZINE TAB 250MG(Moricizine HCl) ETHMOZINE TAB 300MG(Moricizine HCl) EXFORGE TAB 10-160MG(Amlodipine Besylate-Valsartan) EXFORGE TAB 10-320MG(Amlodipine Besylate-Valsartan) EXFORGE TAB 5-160MG(Amlodipine Besylate-Valsartan) EXFORGE TAB 5-320MG(Amlodipine Besylate-Valsartan) felodipine tab sr 24hr 10 mg felodipine tab sr 24hr 2.5 mg felodipine tab sr 24hr 5 mg fenofibrate micronized cap 134 mg fenofibrate micronized cap 200 mg fenofibrate micronized cap 67 mg fenofibrate tab 160 mg fenofibrate tab 54 mg flecainide acetate tab 100 mg flecainide acetate tab 150 mg flecainide acetate tab 50 mg fosinopril sodium & hydrochlorothiazide tab 10-12.5 mg fosinopril sodium & hydrochlorothiazide tab 20-12.5 mg fosinopril sodium tab 10 mg fosinopril sodium tab 20 mg fosinopril sodium tab 40 mg gemfibrozil tab 600 mg guanabenz acetate tab 4 mg guanabenz acetate tab 8 mg guanfacine hcl tab 1 mg guanfacine hcl tab 2 mg hydralazine & hydrochlorothiazide cap 100-50 mg hydralazine & hydrochlorothiazide cap 25-25 mg hydralazine & hydrochlorothiazide cap 50-50 mg hydralazine hcl inj 20 mg/ml hydralazine hcl tab 10 mg hydralazine hcl tab 100 mg hydralazine hcl tab 25 mg hydralazine hcl tab 50 mg 01 01 01 01 01 01 02 02 01 01 01 01 01 01 04 04 04 04 04 04 04 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 42
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 38 and 39: Drug Name Drug Tier Notes warfarin
Page 40 and 41: Drug Name Drug Tier Notes CADUET 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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