COMPREHENSIVE FORMULARY - RxAmerica

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Drug Name Drug Tier Notes NITROSTAT SUB 0.6MG(Nitroglycerin) NORPACE CAP 100MG(Disopyramide Phosphate) NORPACE CAP 100MG CR(Disopyramide Phosphate) NORPACE CAP 150MG(Disopyramide Phosphate) NORPACE CAP 150MG CR(Disopyramide Phosphate) NORVASC TAB 10MG(Amlodipine Besylate) NORVASC TAB 2.5MG(Amlodipine Besylate) NORVASC TAB 5MG(Amlodipine Besylate) PACERONE TAB 400MG(Amiodarone HCl) papaverine hcl cap cr 150 mg papaverine hcl inj 30 mg/ml PERSANTINE TAB 25MG(Dipyridamole) PERSANTINE TAB 50MG(Dipyridamole) PERSANTINE TAB 75MG(Dipyridamole) pindolol tab 10 mg pindolol tab 5 mg PLENDIL TAB 10MG CR(Felodipine) PLENDIL TAB 2.5MG CR(Felodipine) PLENDIL TAB 5MG CR(Felodipine) PRAVACHOL TAB 10MG(Pravastatin Sodium) PRAVACHOL TAB 20MG(Pravastatin Sodium) PRAVACHOL TAB 40MG(Pravastatin Sodium) PRAVACHOL TAB 80MG(Pravastatin Sodium) pravastatin sodium tab 10 mg pravastatin sodium tab 20 mg pravastatin sodium tab 40 mg pravastatin sodium tab 80 mg prazosin hcl cap 1 mg prazosin hcl cap 2 mg prazosin hcl cap 5 mg PRINIVIL TAB 10MG(Lisinopril) PRINIVIL TAB 20MG(Lisinopril) PRINIVIL TAB 5MG(Lisinopril) PRINZIDE TAB 10/12.5(Lisinopril & Hydrochlorothiazide) PRINZIDE TAB 20-12.5(Lisinopril & Hydrochlorothiazide) PRINZIDE TAB 20-25MG(Lisinopril & Hydrochlorothiazide) procainamide hcl cap 250 mg procainamide hcl cap 500 mg procainamide hcl inj 100 mg/ml procainamide hcl inj 500 mg/ml procainamide hcl tab cr 500 mg procainamide hcl tab cr 750 mg PROCANBID TAB 1000 MG(Procainamide HCl) PROCANBID TAB 500MG CR(Procainamide HCl) PROCARDIA CAP 10MG(Nifedipine) PROCARDIA XL TAB 30MG CR(Nifedipine) PROCARDIA XL TAB 60MG CR(Nifedipine) PROCARDIA XL TAB 90MG CR(Nifedipine) PRONESTYL CAP 250MG(Procainamide HCl) PRONESTYL CAP 375MG(Procainamide HCl) 02 04 02 04 04 04 04 04 04 01 01 04 04 04 01 01 04 04 04 04 04 04 04 01 01 01 01 01 01 01 04 04 04 04 04 04 01 01 01 01 01 01 02 02 04 04 04 04 04 02 47
Drug Name Drug Tier Notes PRONESTYL TAB 375MG(Procainamide HCl) PRONESTYL TAB 500MG(Procainamide HCl) propafenone hcl tab 150 mg propafenone hcl tab 225 mg propafenone hcl tab 300 mg propranolol & hydrochlorothiazide tab 40-25 mg propranolol & hydrochlorothiazide tab 80-25 mg propranolol hcl cap sr 24hr 120 mg propranolol hcl cap sr 24hr 160 mg propranolol hcl cap sr 24hr 60 mg propranolol hcl cap sr 24hr 80 mg propranolol hcl inj 1 mg/ml propranolol hcl tab 10 mg propranolol hcl tab 20 mg propranolol hcl tab 40 mg propranolol hcl tab 60 mg propranolol hcl tab 80 mg QUESTRAN POW 4GM(Cholestyramine) QUESTRAN POW 4GM LITE(Cholestyramine Light) quinapril hcl tab 10 mg quinapril hcl tab 20 mg quinapril hcl tab 40 mg quinapril hcl tab 5 mg quinapril-hydrochlorothiazide tab 10-12.5 mg quinapril-hydrochlorothiazide tab 20-12.5 mg quinapril-hydrochlorothiazide tab 20-25 mg quinidine gluconate inj 80 mg/ml quinidine gluconate tab cr 324 mg quinidine sulfate tab 200 mg quinidine sulfate tab 300 mg quinidine sulfate tab cr 300 mg RANEXA TAB 500MG(Ranolazine) reserpine tab 0.1 mg reserpine tab 0.25 mg REVATIO TAB 20MG(Sildenafil Citrate (Pulmonary Hypertension)) RYTHMOL TAB 150MG(Propafenone HCl) RYTHMOL TAB 225MG(Propafenone HCl) RYTHMOL TAB 300MG(Propafenone HCl) RYTHMOL SR CAP 225MG(Propafenone HCl) RYTHMOL SR CAP 325MG(Propafenone HCl) RYTHMOL SR CAP 425MG(Propafenone HCl) SECTRAL CAP 200MG(Acebutolol HCl) SECTRAL CAP 400MG(Acebutolol HCl) simvastatin tab 10 mg simvastatin tab 20 mg simvastatin tab 40 mg simvastatin tab 5 mg simvastatin tab 80 mg sotalol hcl (afib/afl) tab 120 mg sotalol hcl (afib/afl) tab 160 mg 02 02 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 04 04 01 01 01 01 01 01 01 01 01 01 01 01 02 01 01 02 04 04 04 02 02 02 04 04 01 01 01 01 01 01 01 (PA) (PA) 48
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 44 and 45: Drug Name Drug Tier Notes HYPERTENS
Page 46 and 47: Drug Name Drug Tier Notes LOTREL CA
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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