Preferred Drug List 2013 Standard Formulary with ... - Express Scripts

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DRUG NAME1 2 3 4 SUGGESTED PREFFERED ALTERNATIVESPROTONIX ST X pantoprazole sodiumZEGERID ST X generics, NEXIUM9.4.2.1 PROTON PUMP INHIBITORS ‐ OTComeprazole X9.4.3 HELICOBACTER PYLORI DRUGSHELIDAC X bismuth+metroni+tetracy, PYLERAOMECLAMOX‐PAK X omepraz+clarithro+amox, PYLERAPREVPAC X amox+clarith+lansoprazo, PYLERAPYLERA X9.5 LAXATIVES AND CATHARTICSOSMOPREP X generic, HALFLYT, MOVIPRP,SUPREP9.6 OTHER GI DRUGSanucort‐hc Xbalsalazide disodium Xbudesonide ec Xhydrocortisone Xhydrocortisone acetate Xpancrelipase 5,000 Xpeg 3350‐electrolyte Xproctosol‐hc Xproctozone‐hc Xsulfasalazine Xtrilyte <strong>with</strong> flavor packets Xursodiol XANALPRAM ADVANCED X hydrocortisone/pramoxine creamANALPRAM E X hydrocortisone/pramoxine creamANALPRAM HC X hydrocortisone/pramoxine creamAPRISO X balsalazide, ASACOL/HD, LIALDA, PENTASAASACOL XASACOL HD XCANASA XCREON XDIPENTUM X balsalazide, ASACOL/HD, LIALDA, PENTASAGOLYTELY X generics, HALFLYTELY, MOVIPREP, SUPREPHALFLYTELY‐BISACODYL XLIALDA XMOVIPREP XNULYTELY WITH FLAVOR PACKS X peg‐3350 w/flavor packs solnPANCREAZE X generics, CREON, ZENPEPPENTASA XPERTZYE X generics, CREON, ZENPEPPREPOPIK X generics, HALFLYTELY, MOVIPREP, SUPREPRELISTOR XSFROWASA X mesalamine 4 gm/60 ml enemaTIER
DRUG NAME1 2 3 4SUPREP XZENPEP X9.7 IRRITABLE BOWEL DRUGSAMITIZA XLINZESS XCHAPTER 10: IMMUNOLOGICALS AND VACCINES10.0 IMMUNOLOGICALS AND VACCINESSYNAGIS XZOSTAVAX X10.2.1 MYELOID STIMULANTSNEULASTA XNEUPOGEN X10.2.2 ERYTHROID STIMULANTSARANESP XPROCRIT XTIERSUGGESTED PREFFERED ALTERNATIVES10.2.3 INTERFERONSAVONEX PA XAVONEX ADMINISTRATION PACK PA XAVONEX PEN PA XBETASERON PA XCOPAXONE XEXTAVIA PA X AVONEX, BETASERON, REBIFPEGASYS/PROCLICK XPEGINTRON/REDIPEN XREBIF PA X10.2.4 GROWTH HORMONES AND RELATED DRUGSGENOTROPIN PA XHUMATROPE PA XNORDITROPIN FLEXPRO PA X GENOTROP,HUMATROP,NUTROPIN/AQNORDITROPIN NORDIFLEX PA X GENOTROP,HUMATROP,NUTROPIN/AQNUTROPIN/AQ/AQ NUSPIN PA XOMNITROPE PA X GENOTROP,HUMATROP,NUTROPIN/AQSAIZEN PA X GENOTROP,HUMATROP,NUTROPIN/AQTEV‐TROPIN PA X GENOTROP,HUMATROP,NUTROPIN/AQ10.2.6 INTERLEUKIN RECEPTOR ANTAGONISTKINERET PA X ORENCIA10.2.7 IMMUNOGLOBULIN ANTIBODIESXOLAIR XCHAPTER 11: MUSCULOSKELETAL MEDICATIONS11.1.1 SALICYLATES AND RELATED DRUGSaspirin Xaspirin ec Xcholine mag trisalicylate Xdiflunisal X
Page 4: TABLE OF CONTENTSChapterChapter 1Ch
Page 8 and 9: DRUG NAME1 2 3 4 SUGGESTED PREFFERE
Page 10 and 11: DRUG NAMETIER1 2 3 4SUGGESTED PREFF
Page 12 and 13: DRUG NAME1 2 3 4TIKOSYN XTIERSUGGES
Page 14 and 15: DRUG NAME1 2 3 4MIGRANAL XRELPAX ST
Page 16 and 17: DRUG NAMETIER1 2 3 4SUGGESTED PREFF
Page 26 and 27: DRUG NAME1 2 3 4salsalate XTIERSUGG
Page 34 and 35: DRUG NAMETIER1 2 3 415.1.4 LEUKOTRI
Page 36 and 37: DRUG NAME1 2 3 4PARADIGM XPARADIGM
Page 38 and 39: IndexABILIFY 5.8ABILIFY DISCMELT 5.
Page 40 and 41: carbidopa‐levodopaentacapone5.7.2
Page 42 and 43: EVISTA 13.4.3EXALGO 5.1.1.1EXELDERM
Page 44 and 45: LEXIVA 2.5.1LIALDA 9.6lidocaine hcl
Page 46 and 47: oxycodone‐acetaminophen 5.1.1.1OX
Page 48 and 49: SUMAVEL DOSEPRO 5.1.2SUPRAX 2.1.1SU

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