PrimeChoice™ Essential Formulary, July 2013 - Prime Therapeutics

GENERICBRANDtheophylline ERzafirlukastRESPIRATORY AGENTS – MISC.FIRAZYRKALYDECOPULMOZYMEGASTROINTESTINAL AGENTSLAXATIVESlactulosePEG-electrolytes for soln, generics of Colyte,Golytely, NulytelyANTIDIARRHEALSdiphenoxylate/atropine tabsloperamideULCER DRUGScimetidineSYMAX DUOTABdicyclomine caps, tabsfamotidineglycopyrrolatehyoscyaminelansoprazole DRmethscopolaminemisoprostolomeprazole DRpantoprazole DRranitidinesucralfateANTIEMETICSgranisetronEMENDmeclizineondansetrontrimethobenzamideDIGESTIVE AIDSZENPEPGASTROINTESTINAL AGENTS – MISC.balsalazideCANASAcalcium acetateCHENODALlactuloseREMICADEmesalaminemetoclopramidesulfasalazinesulfasalazine DRursodiolGENITOURINARY AGENTSURINARY ANTI-INFECTIVESnitrofurantoinnitrofurantoin macrocrystallinenitrofurantoin monohydrate/macrocrystallineURINARY ANTISPASMODICSoxybutynin IR, ERtolterodineVAGINAL PRODUCTSclindamycin crmESTRACE crmmetronidazole gelVAGIFEMterconazoleGENITOURINARY AGENTS – MISC.alfuzosin ERCYSTAGONfinasterideTRICITRATESpotassium citrate/citric acidsodium citrate/citric acidtamsulosinCENTRAL NERVOUS SYSTEM DRUGSANTIANXIETY AGENTSalprazolam IR, ER, ODTbuspirone 5 mg, 10 mg, 15 mg, 30 mgdiazepam tabsGENERICBRANDhydroxyzine hclhydroxyzine pamoate 25 mg, 50 mglorazepamANTIDEPRESSANTSamitriptylinebupropion IR, ERcitalopramclomipraminedesipraminedoxepin, NF = caps, 75 mgescitalopramfluoxetine IR; DR, NF = 60 mgfluvoxamine IR, ERimipramine hclmirtazapine IR, ODTnortriptyline capsparoxetine hcl IR, ERphenelzinesertralinetranylcyprominetrazodonevenlafaxine IR, ER; NF = 225 mgANTIPSYCHOTICSchlorpromazine hclclozapinefluphenazine hcl tabshaloperidolhaloperidol decanoatehaloperidol lactate conclithium carbonate IR, ERloxapineolanzapine IR, ODTperphenazineprochlorperazinequetiapinerisperidone IR, ODTthiothixenetrifluoperazineziprasidoneHYPNOTICSestazolamphenobarbital, NF = 64.8 mg, 97.2 mgtemazepamzaleplonzolpidemADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTSamphetamine/dextroamphetamine IR, ERcaffeine citratedextroamphetamine IR, ERmethylphenidate IR, ER – generics of Ritalin/SRmodafinilPSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS – MISC.bupropion ER – smoking deterrentCHANTIXdisulfiramCOPAXONEdonepezil IR, ODTNICOTROL INHALERgalantamine IR, ERNICOTROL NSnaltrexoneREBIFrivastigmineANALGESICS AND ANESTHETICSANALGESICS – NON-NARCOTICbutalbital/acetaminophenbutalbital/acetaminophen/caffeinebutalbital/aspirin/caffeine capssalsalateGENERICANALGESICS – NARCOTICacetaminophen/codeinebuprenorphinebuprenorphine/naloxonebutalbital/aspirin/caffeine/codeinefentanylfentanyl citratehydrocodone/acetaminophen, NF = tabs,2.5-325 mghydrocodone/ibuprofenhydromorphone soln, tabsmethadone conc, soln, tabsmorphine sulfate conc, solnmorphine sulfate ERoxycodone caps; tabs 5 mg, 15 mg, 30 mgoxycodone/acetaminophenoxycodone/aspirintramadoltramadol/acetaminophenANALGESICS – ANTI-INFLAMMATORYdiclofenac potassiumdiclofenac sodium DR, ERetodolac IR, ERflurbiprofenibuprofenindomethacin IR, ERketoprofen NF = ERleflunomidemeloxicamnabumetonenaproxen IR, DRnaproxen sodium IR, ERoxaprozinpiroxicamsulindacMIGRAINE PRODUCTSacetaminophen/isometheptene/dichloralphenazonenaratriptanrizatriptan IR, ODTsumatriptan inj, tabsGOUT AGENTSallopurinolprobenecidprobenecid/colchicineNEUROMUSCULAR DRUGSANTICONVULSANTScarbamazepine IR, ERclonazepam IR, ODTdivalproex DR, ERethosuximidegabapentinlamotrigine IR, ERlevetiracetamoxcarbazepinephenytoinphenytoin sodium ERprimidonetopiramatevalproic acidzonisamideBRANDHYDROMORPHONE suppMORPHINE SULFATE supp, tabsSUBOXONE filmHUMIRAIMITREX nasalDIASTATSABRIL{continued}4622 © Prime Therapeutics LLC 05/13 PrimeChoice Essential Page 3 of 4

GENERICANTIPARKINSON AGENTSamantadine, NF = tabsbenztropinebromocriptinecarbidopa/levodopa IR, ER, ODTentacaponepramipexoleropinirole IR, ERselegilinetrihexyphenidylNEUROMUSCULAR AGENTSMUSCULOSKELETAL THERAPY AGENTSbaclofenchlorzoxazonecyclobenzaprinedantrolenemetaxalonemethocarbamolorphenadrine ERorphenadrine/aspirin/caffeine 25-385-30 mgtizanidineANTIMYASTHENIC AGENTSpyridostigmineNUTRITIONAL PRODUCTSVITAMINSergocalciferolMULTIVITAMINSpediatric multivitaminspediatric vitamins ADCMINERALS AND ELECTROLYTESpotassium bicarbonate/chloride effervescent25 mEqpotassium chloride IR, ER; NF = granules;soln, 20%potassium chloride microencapsulated ERpotassium phosphate/sodium phosphatessodium fluoride chew tabs; soln,0.275 mg/drop, 1.1 mg/mLHEMATOLOGICAL AGENTSHEMATOPOIETIC AGENTScyanocobalamin injfolic acid tabsANTICOAGULANTSenoxaparinwarfarinHEMATOLOGICAL AGENTS – MISC.anagrelidecilostazolclopidogreldipyridamolepentoxifylline ERTOPICAL PRODUCTSOPHTHALMIC AGENTSatropine sulfate solnazelastine solnbacitracin/polymyxin B ointbrimonidine solnBRANDGENERICcarteolol solnAPOKYNciprofloxacin solncromolyn sodium solncyclopentolate solndexamethasone sodium phosphate solndiclofenac solndorzolamide solndorzolamide/timolol maleate solnerythromycin ointfluorometholone suspflurbiprofen solnRILUTEKgentamicin oint, solnhomatropine solnketorolac solnlatanoprost solnlevobunolol soln, 0.5%metipranolol solnneomycin/polymyxin B/bacitracin ointneomycin/polymyxin B/bacitracin/hydrocortisone ointneomycin/polymyxin B/dexamethasone oint, suspneomycin/polymyxin B/gramicidin solnMESTINON syrupofloxacin solnpilocarpine solnpolymyxin B/trimethoprim solnMEPHYTONprednisolone acetate suspsulfacetamide sodium solnPRENATAL PLUS, PLUS/IRON, VITAMINS PLUS sulfacetamide sodium/prednisolone solntimolol maleate solntobramycin solntobramycin/dexamethasone susptrifluridine solntropicamide solnOTIC AGENTSacetic acidbenzocaine/antipyrinehydrocortisone/acetic acidneomycin/polymyxin B/hydrocortisoneofloxacinMOUTH/THROAT/DENTAL AGENTSNEUPOGENcevimelinePROCRITchlorhexidineclotrimazole trochelidocaine viscousnystatin susppilocarpine tabssodium fluoridetriamcinolone dental pasteANORECTAL AGENTShydrocortisone crm, 2.5%; enemahydrocortisone acetate supp, 25 mgDERMATOLOGICALSadapalene crm, gel, 0.1%ADVATEBENEFIXFEIBA NF/VH IMMUNOHELIXATE FSHEMOFIL MKOGENATE FSMONOCLATE-PRECOMBINATEXYNTHAXYNTHA SOLOFUSEBACITRACIN ointNATACYNalclometasonealuminum chlorideamcinonide crmbetamethasone dipropionatebetamethasone dipropionate, augmentedbetamethasone valeratecalcipotriene crm, solnciclopirox, NF = topical kitclindamycin topicalBRANDCORTIFOAMFINACEAPANRETINTARGRETIN gelTAZORACXERAC ACGENERICBRANDclindamycin/benzoyl peroxideclobetasoldesonidedesoximetasone crm, 0.25%; gel; oint, 0.25%diflorasone ointeconazoleerythromycin pads, solnerythromycin/benzoyl peroxidefluocinolonefluocinonidefluorouracilfluticasone propionatehalobetasolhydrocortisonehydrocortisone valerateimiquimodisotretinoin caps, 10 mg, 20 mg, 40 mgketoconazole crm, shampoo, 2%lidocaine jelly, 2%; oint, 5%; soln, 4%lidocaine/prilocaine crmlindanemalathionmetronidazole topicalmometasonemupirocinnystatin topicalnystatin/triamcinolone crmpermethrin crm, 5%podofiloxselenium sulfide 2.5%silver sulfadiazinesulfacetamide sodium/sulfur NF = susp10%-5%tretinoin, NF = emollient crm; microsphere geltriamcinolone, NF = oint, 0.5%MISCELLANEOUS PRODUCTSANTIDOTESCHEMETDIABETIC SUPPLIESINSULIN PEN NEEDLES – VARIOUSINSULIN SYRINGES – VARIOUSLANCET DEVICE – VARIOUSLANCETS – VARIOUSTEST STRIPS – ASCENSIA AUTODISC,BAYER BREEZE 2, CONTOUR, CONTOUR NEXTMEDICAL DEVICESINHALER ASSIST DEVICES – AEROCHAMBERASSORTED CLASSESazathioprineCELLCEPT oral suspcyclosporineCUPRIMINEcyclosporine modified caps, 25 mg, CYCLOSPORINE MODIFIED 50 mg100 mg; solnREVLIMIDmycophenolate mofetilTHALOMIDsodium polystyrene sulfonatetacrolimus caps4622 © Prime Therapeutics LLC 05/13 PrimeChoice EssentialPage 4 of 4