The following Preferred Drug List is an abbreviated version of commonly prescribed medications. This list is intended to be a guide and prescribers should still use generics when possible. Drugs listed in CAPS and Italics are Brand Drugs and generic products are listed in lowercase letters. (SP) indicates a specialty medication. A ARCAPTA NEOHALER bupropion clomiphene citrate ABSORICA aripiprazole bupropion ext-release clonazepam ACANYA ARISTADA [INJ] (SP) buspirone clonidine acetaminophen/codeine ACTEMRA [INJ] (SP) acyclovir ADEMPAS (SP) ADVAIR DISKUS ADVAIR HFA AFSTYLA [INJ] (SP) AIMOVIG [INJ (SP) AKYNZEO albuterol nebulization solution alendronate allopurinol ALPHAGAN P 0.1% alprazolam ALREX amiodarone AMITIZA amitriptyline amlodipine amlodipine/benazepril amlodipine/valsartan amoxicillin amoxicillin/potassium clavulanate anastrozole ANDRODERM ANORO ELLIPTA apri APRISO ARANESP [INJ] (SP) ARNUITY ELLIPTA ASMANEX HFA ASMANEX TWISTHALER atenolol atenolol/chlorthalidone atorvastatin AUBAGIO (SP) AVONEX [INJ] (SP) AZASITE azelastine nasal spray azithromycin AZOPT B BD AUTOSHIELD DUO NEEDLES BD ULTRAFINE INSULIN SYRINGES BD ULTRAFINE PEN NEEDLES BELBUCA BELSOMRA BELVIQ, BELVIQ XR benazepril benzonatate BEPREVE BETASERON [INJ] (SP) BETHKIS (SP) BEVESPI AEROSPHERE bisoprolol/hctz BOSULIF (SP) BREO ELLIPTA BRILINTA budesonide nebulization suspension butalbital/ acetaminophen/ caffeine BUTRANS BYSTOLIC BYVALSON C CABOMETYX (SP) CANASA CARAC carbidopa/levodopa carvedilol/er cefdinir cefuroxime axetil celecoxib cephalexin CERDELGA (SP) CEREZYME [INJ] (SP) CETROTIDE [INJ] (SP) chlorhexidine gluconate chlorthalidone CIMDUO (SP) CIPRODEX ciprofloxacin citalopram clarithromycin CLENPIQ clindamycin hcl clindamycin phosphate clindamycin phosphate/benzoyl peroxide clobetasol propionate clopidogrel clotrimazole/ betamethasone dipropionate COLCRYS COMBIGAN COMBIPATCH COMBIVENT RESPIMAT COPAXONE [INJ] 40MG (SP) CORLANOR COSENTYX [INJ] (SP) CREON CRESEMBA cyanocobalamin [INJ] cyclobenzaprine D DALIRESP DAYTRANA DELZICOL DESCOVY (SP) desloratadine desonide desvenlafaxine succinate ER dexamethasone DEXCOM G4/G5/G6 DEXILANT dexmethylphenidate extrelease dextroamphetamine/ amphetamine dextroamphetamine/ amphetamine ext-release diazepam 2019 all rights reserved. Effective 1/1/19. CE 1
diclofenac sodium delayed-release dicyclomine digoxin diltiazem ext-release diphenoxylate/atropine divalproex delayed-release divalproex ext-release DIVIGEL donepezil doxazosin doxycycline hyclate doxycycline monohydrate DUAVEE DULERA duloxetine delayed-release DYMISTA E EDARBI EDARBYCLOR ELIDEL ELIGARD (SP) ELIQUIS enalapril ENBREL [INJ] (SP) ENDOMETRIN enoxaparin [INJ] ENSTILAR ENTRESTO EPCLUSA (SP) EPIDUO FORTE EPIPEN, EPIPEN JR [INJ] ergocalciferol ERLEADA (SP) erythromycin eye ointment ESBRIET (SP) escitalopram esomeprazole magnesium delayed-release estradiol estradiol patch ESTRING eszopiclone EUFLEXXA [INJ] (SP) ezetimibe F famotidine FARXIGA fenofibrate fenofibrate micronized fenofibric acid delayedrelease fentanyl patch FETZIMA FIASP FINACEA finasteride FLECTOR FLOVENT DISKUS FLOVENT HFA fluconazole fluocinonide fluoxetine 60 mg tab fluticasone nasal spray MG folic acid FORTEO [INJ] (SP) FRAGMIN [INJ] (SP) FREESTYLE KITS/METERS; FREESTYLE FREEDOM, FREESTYLE FREEDOM LITE, FREESTYLE INSULINX FREESTYLE LITE FREESTYLE TEST STRIPS; FREESTYLE, FREESTYLE INSULINX, FREESTYLE LITE, furosemide FYCOMPA G gabapentin gemfibrozil GENVOYA (SP) gildess fe GILENYA (SP) GILOTRIF (SP) glimepiride glipizide glipizide ext-release GLUCAGEN [INJ] GLUCAGON [INJ] glyburide GLYXAMBI GONAL-F, GONAL-F RFF, GONAL-F RFF REDI-JECT [INJ] (SP) GRALISE GRANIX [INJ] (SP) GRASTEK guanfacine ext-release H HARVONI (SP) HUMALOG [INJ] HUMATROPE [INJ] (SP) HUMIRA [INJ] (SP) HUMULIN [INJ] hydralazine hydrochlorothiazide hydrocodone/ acetaminophen hydrocodone/ chlorpheniramine polistirex ext-release hydrocodone/homatropine hydrocortisone topical hydromorphone hydroxychloroquine hydroxyzine hcl hydroxyzine pamoate HYSINGLA ER I ibandronate IBRANCE (SP) ibuprofen ILEVRO INCRUSE ELLIPTA indomethacin INLYTA (SP) INVOKAMET INVOKAMET XR INVOKANA irbesartan IRESSA (SP) isosorbide mononitrate extrelease J JANUMET, JANUMET XR JANUVIA JARDIANCE JENTADUETO, JENTADUETO XR JUBLIA junel fe 2019 all rights reserved. Effective 1/1/19. CE 2
K ketoconazole topical KISQALI (SP) KITABIS PAK (SP) KOVALTRY [INJ] (SP) L labetalol lamotrigine lansoprazole delayedrelease LANTUS [INJ] latanoprost eye solution LATUDA LETAIRIS (SP) LEVEMIR [INJ] levetiracetam LUPRON DEPOT [INJ] (SP) LUZU LYRICA M MAKENA MULTIDOSE VIAL [INJ] (SP) MAVYRET (SP) meclizine medroxyprogesterone meloxicam mesalamine MESTINON SYRUP metaxalone metformin metformin ext-release methimazole moderiba mometasone mononessa MONOVISC [INJ] (SP) montelukast morphine sulfate extrelease MOVANTIK MOXEZA MULTAQ multivitamins/fluoride mupirocin MUSE MYRBETRIQ N nabumetone NOVOFINE AUTOSHIELD NEEDLES NOVOFINE NEEDLES NOVOLIN [INJ] NOVOLOG [INJ] NOVOTWIST NEEDLES NUCYNTA, NUCYNTA ER NUEDEXTA NUVARING NUWIQ [INJ] (SP) nystatin oral suspension nystatin topical O ODEFSEY (SP) OFEV (SP) olanzapine levocetirizine methocarbamol NAMZARIC olmesartan levofloxacin levothyroxine sodium lidocaine patches LINZESS liothyronine LIPOFEN lisinopril lisinopril/hctz LIVALO LOESTRIN FE LOKELMA LO LOESTRIN FE lorazepam losartan losartan/hctz LOTEMAX lovastatin methotrexate methylphenidate methylphenidate extrelease methylprednisolone metoclopramide hcl metoprolol succinate extrelease metoprolol tartrate metronidazole metronidazole topical metronidazole vaginal gel microgestin fe MINIVELLE minocycline MIRENA (SP) mirtazapine MIRVASO naproxen, naproxen sodium NARCAN NASCOBAL neomycin/polymyxin/ hydrocortisone ear drops NEUPOGEN [INJ] (SP) NEUPRO NEVANAC NEXIUM 24HR niacin ext-release nifedipine ext-release nitrofurantoin monohydrate/ macrocrystal NITYR (SP) NORDITROPIN [INJ] (SP) nortriptyline NOVOEIGHT [INJ] (SP) olmesartan/hctz olmesartan/amlodipine/hct olopatadine omeprazole delayedrelease ODACTRA ondansetron ondansetron orally disintegrating tablets ONETOUCH KITS/METERS; ULTRAMINI, VERIO, VERIO FLEX, VERIO IQ, VERIO SYNC ONETOUCH TEST STRIPS; ULTRA, VERIO ONEXTON OPSUMIT (SP) ORACEA ORENITRAM ER (SP) ORTHOVISC [INJ] (SP) 2019 all rights reserved. Effective 1/1/19. CE 3
OTEZLA (SP) OTREXUP [INJ] (SP) OVIDREL [INJ] (SP) oxcarbazepine oxybutynin ext-release oxycodone oxycodone/ acetaminophen OXTELLAR XR OXYCONTIN OZEMPIC [INJ] P pantoprazole delayedrelease paroxetine PAZEO penicillin v potassium PENTASA PERFOROMIST PHOSLYRA PICATO pioglitazone PLEGRIDY [INJ] (SP) polymyxin/trimethoprim eye solution PREMARIN CREAM PREMARIN TABS PREMPHASE PREMPRO PREPOPIK PROAIR HFA PROAIR RESPICLICK PROCRIT [INJ] (SP) PROCTOFOAM-HC progesterone micronized PROLASTIN C [INJ] (SP) PROLENSA promethazine promethazine/ dextromethorphan propranolol propranolol ext-release PULMICORT FLEXHALER PYLERA Q QNASL QSYMIA QUDEXY quetiapine ranitidine RAPAFLO RASUVO [INJ] (SP) REBIF [INJ] (SP) RECTIV RELISTOR [INJ] (SP) REMICADE [INJ] (SP) RENFLEXIS [INJ] (SP) REPATHA [INJ] (SP) RESTASIS risperidone rizatriptan ropinirole rosuvastatin RUCONEST [INJ] (SP) RYTARY S SANCUSO SAPHRIS SAVELLA SAXENDA SEREVENT DISKUS sertraline SPIRIVA RESPIMAT spironolactone sprintec SPRYCEL (SP) STELARA [INJ] (SP) STIOLTO RESPIMAT STRIVERDI RESPIMAT SUBOXONE SL FILM sulfamethoxazole/ trimethoprim sumatriptan SUPREP SYMBICORT SYMLINPEN [INJ] SYMPROIC SYMFI (SP) SYMFI LO (SP) SYNJARDY, SYNJARDY XR T TACLONEX SUSPENSION TALTZ (SP) tamoxifen tamsulosin ext-release TARCEVA (SP) potassium chloride extrelease PRALUENT [INJ] (SP) pramipexole pravastatin pred mild prednisolone acetate eye suspension prednisolone sodium phosphate prednisone QUILLICHEW ER QUILLIVANT XR QVAR R rabeprazole delayedrelease RAGWITEK raloxifene ramipril RANEXA SILENOR SIMPONI 100 MG [INJ] (SP) simvastatin SOLIQUA [INJ] SOLODYN SOMATULINE DEPOT [INJ] (SP) SOOLANTRA SOVALDI (SP) SPIRIVA HANDIHALER TASIGNA (SP) TAZORAC (gel and 0.05% cream) TECFIDERA (SP) TEKTURNA TEKTURNA HCT temazepam terazosin terconazole vaginal testosterone cypionate [INJ] testsoterone gel 1% 2019 all rights reserved. Effective 1/1/19. CE 4
timolol maleate eye solution tizanidine TOBI PODHALER (SP) TOBRADEX OINTMENT TOBRADEX ST tobramycin eye solution tobramycin/ dexamethasone eye suspension topiramate TOUJEO SOLOSTAR [INJ] TOVIAZ TRACLEER (SP) TRADJENTA tramadol TRAVATAN Z trazodone TREMFYA [[INJ] (SP) U ULORIC UPTRAVI (SP) UTIBRON NEOHALER V valacyclovir valsartan valsartan/hctz VASCEPA VELPHORO (SP) VELTASSA venlafaxine venlafaxine ext-release VENTOLIN HFA verapamil ext-release VESICARE VIBERZI VICTOZA [INJ] XTANDI (SP) XULTOPHY [INJ] Y YONSA (SP) Z ZARXIO [INJ] (SP) ZELAPAR ZENPEP ZOHYDRO ER zolpidem zolpidem ext-release ZOMIG NASAL ZONTIVITY ZOVIRAX CREAM ZUBSOLV ZYLET ZYTIGA (SP) TRESIBA [INJ] VIIBRYD TREXIMET VIMPAT triamcinolone topical VIOKACE triamterene/hctz VOSEVI (SP) trinessa VYVANSE TRINTELLIX W tri-sprintec warfarin TROKENDI XR X TRULICITY [INJ] XARELTO TRUSOPT XELJANZ, XELJANZ XR (SP) TYMLOS [INJ] (SP) XIFAXAN TYSABRI [INJ] (SP) XIGDUO XR XIIDRA 2019 all rights reserved. Effective 1/1/19. CE 5
Examples of Nonformulary Medications With Selected Formulary Alternatives The following is a list of some nonformulary brand-name medications with examples of selected alternatives that are on the formulary. Column 1 lists examples of nonformulary medications. Column 2 lists some alternatives that can be prescribed. Nonformulary Medications ACCU-CHEK METERS STRIPS ACZONE ADDYI AEROSPAN ALVESCO AMPYRA (SP) ANDROGEL 1.62% APIDRA ATRALIN AURYXIA BECONASE AQ BESIVANCE BETIMOL BRAVELLE (SP) BREEZE, CONTOUR METERS/STRIPS BUNAVAIL BYETTA, BYDUREON, BYDUREON BCise CIALIS CIMZIA (SP) CLINDESSE CLOBEX CONTRAVE COSOPT PF CRINONE EPIDUO DIFFERIN DIFICID DIPENTUM ELESTRIN EPIDUO EPOGEN (SP) EVEKEO FLUOROPLEX FOCALIN XR 25 MG, 35MG FOLLISTIM AQ (SP) FORTESTA FORFIVO XL GELNIQUE GEL-ONE (SP) GENOTROPIN (SP) GENVISC 850 (SP) HYALGAN (SP) INTRAROSA KADIAN KAZANO KERYDIN KOMBIGLYZE XR LEVITRA LIALDA LORZONE LUCEMYRA METROGEL MIGRANAL MIRCERA (SP) MITIGARE MOVIPREP NATESTO Formulary Alternative (s) FREESTYLE METERS/STRIPS, ONETOUCH METERS/STRIPS ARNUITY ELLIPTA, ASMANEX HFA/TWISTHALER, FLOVENT DISKUS/HFA, PULMICORT FLEXHALER, QVAR dimethyl fumarate, glatiramer HUMALOG, NOVOLOG, FIASP budesonide, flunisolide, fluticasone, mometasone, QNASL GONAL-F, GONAL-F RFF, GONAL-F RFF REDI-JECT FREESTYLE METERS/STRIPS, ONETOUCH METERS/STRIPS TRULICITY, VICTOZA, OZEMPIC, tadalafil ACTEMRA, COSENTYX, ENBREL, HUMIRA, OTEZLA, REMICADE, STELARA, XELJANZ, XELJANZ XR BELVIQ, BELVIQ XR, QSYMIA, SAXENDA ENDOMETRIN ARANESP, PROCRIT amphetamine salts methylphenidate ER GONAL-F, GONAL-F RFF, GONAL-F RFF REDI-JECT MYRBETRIQ, TOVIAZ, VESICARE hydromorphone ext-release, morphine sulfate ext-release, oxymorphone ext-release, HYSINGLA ER, NUCYNTA ER, OXYCONTIN JANUMET, JANUMET XR, JENTADUETO, JENTADUETO XR JANUMET, JANUMET XR, JENTADUETO, JENTADUETO XR clonidine ARANESP, PROCRIT COLCRYS allopurinol, COLCRYS, ULORIC 2019 all rights reserved. Effective 1/1/19. CE 7
NESINA NUTROPIN AQ (SP) OMNARIS OMNITROPE ONGLYZA OSPHENA QBREXZA PANCREAZE PERTZYE PRADAXA PROVENTIL HFA RAYALDEE RENVELA Tablets REXULTI SAIZEN (SP) SAVAYSA SEEBRI NEOHALER SEGLUROMET SIMPONI 50 MG (SP) STAXYN STEGLATRO STENDRA SUPARTZ, SUPARTZ FX (SP) TACLONEX OINTMENT TANZEUM TAZORAC 0.1% Cr TESTIM TIROSINT TRUETEST, TRUETRACK METERS/STRIPS UCERIS RECTAL FOAM ULTRESA VELTIN VIVLODEX VOGELXO XIMINO XOPENEX HFA ZETONNA ZIOPTAN ZORVOLEX ZURAMPIC JANUVIA, TRADJENTA budesonide, flunisolide, fluticasone, mometasone, QNASL JANUVIA, TRADJENTA N/A CREON, ZENPEP CREON, ZENPEP ELIQUIS, XARELTO PROAIR HFA/RESPICLICK, VENTOLIN HFA sevelamer ELIQUIS, XARELTO SPIRIVA HANDIHALER, SPIRIVA RESPIMAT, INCRUSE ELLIPTA INVOKAMET/XR, SYNJARDY/XR, XIGDUO XR ACTEMRA, COSENTYX, ENBREL, HUMIRA, OTEZLA, REMICADE FARXIGA, INVOKANA, JARDIANCE TRULICITY, VICTOZA, OZEMPIC FREESTYLE METERS/STRIPS, ONETOUCH METERS/STRIPS ANUCORT, ANUSOL, CANASA CREON, ZENPEP clindamycin/benzoyl peroxide, clindamycin/tretinoin, ACANYA, ONEXTON PROAIR HFA/RESPICLICK, VENTOLIN HFA budesonide, flunisolide, fluticasone, mometasone, QNASL bimatoprost, latanoprost, travoprost, TRAVATAN Z 2019 all rights reserved. Effective 1/1/19. CE 7