COMPREHENSIVE FORMULARY - RxAmerica

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Drug Name Drug Tier Notes HYPERTENSOLO PAK(Metoprolol Tartrate-Nutritional Supplement) HYTRIN CAP 10MG(Terazosin HCl) HYTRIN CAP 1MG(Terazosin HCl) HYTRIN CAP 2MG(Terazosin HCl) HYTRIN CAP 5MG(Terazosin HCl) HYZAAR TAB 100-12.5(Losartan Potassium & Hydrochlorothiazide) HYZAAR TAB 100-25(Losartan Potassium & Hydrochlorothiazide) HYZAAR TAB 50-12.5(Losartan Potassium & Hydrochlorothiazide) IMDUR TAB 120MG ER(Isosorbide Mononitrate) IMDUR TAB 30MG ER(Isosorbide Mononitrate) IMDUR TAB 60MG ER(Isosorbide Mononitrate) INDERAL TAB 60MG(Propranolol HCl) INDERAL LA CAP 120MG(Propranolol HCl) INDERAL LA CAP 160MG(Propranolol HCl) INDERAL LA CAP 60MG(Propranolol HCl) INDERAL LA CAP 80MG(Propranolol HCl) INDERIDE TAB 40/25(Propranolol & Hydrochlorothiazide) INNOPRAN XL CAP 120MG(Propranolol HCl Sustained-Release Beads) INNOPRAN XL CAP 80MG(Propranolol HCl Sustained-Release Beads) INSPRA TAB 25MG(Eplerenone) INSPRA TAB 50MG(Eplerenone) INVERSINE TAB 2.5MG(Mecamylamine HCl) ISMO TAB 20MG(Isosorbide Mononitrate) ISOPTIN SR TAB 120MG(Verapamil HCl) ISOPTIN SR TAB 180MG(Verapamil HCl) ISOPTIN SR TAB 240MG(Verapamil HCl) ISORDIL TAB 40MG(Isosorbide Dinitrate) ISORDIL TAB 5MG(Isosorbide Dinitrate) isosorbide dinitrate sl tab 2.5 mg isosorbide dinitrate sl tab 5 mg isosorbide dinitrate tab 10 mg isosorbide dinitrate tab 20 mg isosorbide dinitrate tab 30 mg isosorbide dinitrate tab 5 mg isosorbide dinitrate tab cr 40 mg isosorbide mononitrate tab 10 mg isosorbide mononitrate tab 20 mg isosorbide mononitrate tab sr 24hr 120 mg isosorbide mononitrate tab sr 24hr 30 mg isosorbide mononitrate tab sr 24hr 60 mg isradipine cap 2.5 mg isradipine cap 5 mg KERLONE TAB 10MG(Betaxolol HCl) KERLONE TAB 20MG(Betaxolol HCl) labetalol hcl iv soln 5 mg/ml labetalol hcl tab 100 mg labetalol hcl tab 200 mg labetalol hcl tab 300 mg LANOXICAPS CAP 0.1MG(Digoxin) LANOXICAPS CAP 0.2MG(Digoxin) 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 02 02 04 04 04 04 04 04 04 02 04 01 01 01 01 01 01 01 01 01 01 01 01 01 01 04 04 01 01 01 01 02 02 43
Drug Name Drug Tier Notes LANOXIN INJ 0.25MG/1(Digoxin) LANOXIN TAB 0.125MG(Digoxin) LANOXIN TAB 0.125MG(Digoxin) LANOXIN TAB 0.25MG(Digoxin) LANOXIN TAB 0.25MG(Digoxin) LESCOL CAP 20MG(Fluvastatin Sodium) LESCOL CAP 40MG(Fluvastatin Sodium) LESCOL XL TAB 80MG(Fluvastatin Sodium) LETAIRIS TAB 10MG(Ambrisentan) LETAIRIS TAB 5MG(Ambrisentan) LEVATOL TAB 20MG(Penbutolol Sulfate) LEXXEL TAB 5-5MG(Enalapril Maleate-Felodipine) lidocaine hcl iv inj 10 mg/ml lidocaine hcl iv inj 20 mg/ml LIPITOR TAB 10MG(Atorvastatin Calcium) LIPITOR TAB 20MG(Atorvastatin Calcium) LIPITOR TAB 40MG(Atorvastatin Calcium) LIPITOR TAB 80MG(Atorvastatin Calcium) lisinopril & hydrochlorothiazide tab 10-12.5 mg lisinopril & hydrochlorothiazide tab 20-12.5 mg lisinopril & hydrochlorothiazide tab 20-25 mg lisinopril tab 10 mg lisinopril tab 2.5 mg lisinopril tab 20 mg lisinopril tab 30 mg lisinopril tab 40 mg lisinopril tab 5 mg LOFIBRA CAP 134MG(Fenofibrate Micronized) LOFIBRA CAP 200MG(Fenofibrate Micronized) LOFIBRA CAP 67MG(Fenofibrate Micronized) LOFIBRA TAB 160MG(Fenofibrate) LOFIBRA TAB 54MG(Fenofibrate) LOPID TAB 600MG(Gemfibrozil) LOPRESS HCT TAB 100/25MG(Metoprolol & Hydrochlorothiazide) LOPRESS HCT TAB 100/50MG(Metoprolol & Hydrochlorothiazide) LOPRESS HCT TAB 50-25MG(Metoprolol & Hydrochlorothiazide) LOPRESSOR INJ 5MG/5ML(Metoprolol Tartrate) LOPRESSOR TAB 100MG(Metoprolol Tartrate) LOPRESSOR TAB 50MG(Metoprolol Tartrate) LOTENSIN TAB 10MG(Benazepril HCl) LOTENSIN TAB 20MG(Benazepril HCl) LOTENSIN TAB 40MG(Benazepril HCl) LOTENSIN TAB 5MG(Benazepril HCl) LOTENSIN HCT TAB 10-12.5(Benazepril & Hydrochlorothiazide) LOTENSIN HCT TAB 20-12.5(Benazepril & Hydrochlorothiazide) LOTENSIN HCT TAB 20-25MG(Benazepril & Hydrochlorothiazide) LOTENSIN HCT TAB 5-6.25MG(Benazepril & Hydrochlorothiazide) LOTREL CAP 10-20MG(Amlodipine Besylate-Benazepril HCl) LOTREL CAP 10-40MG(Amlodipine Besylate-Benazepril HCl) LOTREL CAP 2.5-10MG(Amlodipine Besylate-Benazepril HCl) 04 02 04 02 04 04 04 04 04 04 02 04 01 01 02 02 02 02 01 01 01 01 01 01 01 01 01 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 02 02 02 44
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 42 and 43: Drug Name Drug Tier Notes COZAAR TA
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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