TABLE OF CONTENTS



TABLE OF CONTENTS

ANTI-INFECTIVES 5

PENICILLINS 5

TETRACYCLINES 5

CEPHALOSPORINS 5

FIRST GENERATION CEPHALOSPORINS 5

SECOND GENERATION CEPHALOSPORINS 5

THIRD GENERATION CEPHALOSPORINS 5

ERYTHROMYCINS & OTHER MACROLIDES 5

FLOUROQUINOLONES 5

SULFA'S & RELATED AGENTS 6

URINARY TRACT AGENTS 6

ANTIVIRALS 6

HIV/AIDS THERAPY 6

ANTIFUNGAL AGENTS 6

VANCOMYCIN 7

MISC. ANTI-INFECTIVES 7

ANTIPARASITICS 7

ANTIMALARIALS 7

ANTIMYCOBACTERIALS 7

ANTINEOPLASTIC & IMMUNOSUPPRESANT DRUGS 8

ALKYLATING AGENTS 8

ANTIMETABOLITIES 8

HORMONES 8

ANTIESTROGENS 8

ANTIANDROGENS 8

RADIOPHARMACEUTICALS 8

IMMUNOSUPPRESSANT DRUGS 8

MISC. ANTINEOPLASTIC DRUGS 9

ADJUNCTIVE AGENTS 10

Autonomic & CNS Drugs, Neurology & Psych 10

NARCOTIC ANALGESICS 10

COMBINATION NARCOTIC/ANALGESICS 10

NSAIDS 10

NSAIDS-SPECIFIC COX II INHIBITORS 11

SALICYLATES 11

MISC. ANALGESICS 11

NARCOTIC ANTAGONISTS 11

HEADACHE THERAPY 11

ANTIPARKINSONISM AGENTS 11

ANTICONVULSANTS 11

MISC. NEUROLOGICAL THERAPY 12

MUSCLE RELAXANTS & ANTISPASMODIC AGENTS 12

HYPNOTIC AGENTS 12

TRICYCLICS 13

MISC. ANTIDEPRESSANTS 13

MAO INHIBITORS 13

SELECTIVE SEROTONIN REUPTAKE INHIBITORS 13

PHENOTHIAZINES 13

BUTYROPHENONES 13

MISC. ANTIPSYCHOTICS 13

MISCELLANEOUS PSYCHOTHERAPEUTIC AGENTS 14

ANXIOLYTICS 14

Cardiovascular, Hypertension & Lipids 14

ANTIARRHYTHMIC AGENTS 14

CARDIAC GLYCOSIDES 14

RAPID ACTING NITRATES 14

LONG ACTING NITRATES 14

ANTICOAGULANTS 14

ANTIPLATELET DRUGS 14

HEPARIN 15

VITAMIN K 15

HEMOSTATICS 15

MISC. COAGULATION AGENTS 15

THIAZIDE & RELATED DIURETICS 15

BETA BLOCKERS 15

CALCIUM CHANNEL BLOCKERS/ NON-DIHYDROPYRIDINES 16

CALCIUM CHANNEL BLOCKERS/DIHYDROPYRIDINES 16

ACE INHIBITORS 16

ADRENERGIC ANTAGONISTS & RELATED DRUGS 16

AGENTS FOR PHEOCHROMOCYTOMA 16

VASODILATORS 16

OTHER ANTIHYPERTENSIVE COMBINATIONS 16

ANGIOTENSION II RECEPTOR BLOCKERS & RENIN INHIBITOR 17

LIPID/CHOLESTEROL LOWERING AGENTS 17

MISC. CARDIOVASCULAR AGENTS 17

Dermatological/Topical Therapy 17

TOPICAL CORTICOSTEROIDS VERY HIGH POTENCY 17

TOPICAL CORTICOSTEROIDS HIGH POTENCY 17

TOPICAL CORTICOSTEROIDS MEDIUM POTENCY 17

TOPICAL CORTICOSTEROIDS LOW POTENCY 18

TOPICAL ANESTHETICS 18

THERAPY FOR ACNE 18

TOPICAL ANTIBACTERIALS 18

TOPICAL ANTIFUNGALS 18

TOPICAL ANTIVARALS 18

BURN THERAPY 19

TOPICAL ENZYMES 19

KERATOLYTICS 19

ANTIPSORIATICS/ANTISEBORRHEIC 19

TOPICAL SCABICIDES/PEDICULICIDES 19

MISC. DERMATOLOGICALS 19

EAR, NOSE & THROAT MEDICATIONS 19

MISCELLANEOUS OTIC PREPARATIONS 19

OTIC STEROID / ANTIBIOTIC 19

MISCELLANEOUS AGENTS 20

ENDOCRINE/DIABETES 20

ANTITHYROID AGENTS 20

THYROID HORMONES 20

ADRENAL HORMONES 20

ANDROGENS 20

OVULATORY STIMULANTS 20

MISCELLANEOUS AGENTS 20

GONADOTROPIN & RELATED AGENTS 21

INSULIN THERAPY 21

NON-INSULIN HYPOGLYCEMIC AGENTS 21

GLUCOSE ELEVATING AGENTS 21

INSULIN SYRINGES/MISCELLANEOUS DME 21

BLOOD GLUCOSE MONITORING DEVICES & SUPPLIES 22

GASTROENTEROLOGY 22

H2 ANTAGONISTS 22

PROSTAGLANDINS 22

OTHER ULCER THERAPY 22

PROTON PUMP INHIBITORS 22

ANTIDIARRHEALS 22

ANTISPASMODICS 22

BILE ACIDS 22

DIGESTIVE ENZYMES 22

MISC. GASTROINTESTINAL AGENTS 23

ANTIVERTIGO & ANTIEMETIC AGENTS 23

BOWEL EVACUANTS 23

IMMUNOLOGY, VACCINES & BIOTECHNOLOGY 23

ERYTHROID STIMULANTS 23

MYELOID STIMULANTS 23

INTERFERONS 23

GROWTH HORMONES 23

INTERLEUKINS 24

VACCINES & MISCELLANEOUS IMMUNOLOGICALS 24

MUSCULOSKELETAL & RHEUMATOLOGY 25

GOUT THERAPY 25

OTHER RHEUMATOLOGICALS 25

OSTEOPOROSIS THERAPY 25

OBSTETRICS & GYNECOLOGY 25

MONOPHASIC /BIPHASIC /TRIPHASIC AGENTS 25

OXYTOCICS 26

PROGESTINS 26

ESTROGENS 26

ESTROGEN COMBINATIONS 26

VAGINAL CLEANSER /ANTIINFECTIVES 26

VAGINAL ANTIFUNGALS 26

SPECIALIZED OB/GYN DRUGS 26

DIAPHRAGMS AND OTHER NON-ORAL CONTRACEPTIVES 26

OPHTHALMOLOGY 26

BETA-BLOCKERS 26

CHOLINESTERASE INHIBITOR MIOTICS 26

DIRECT ACTING MIOTICS 27

OTHER GLAUCOMA DRUGS 27

ORAL DRUGS FOR GLAUCOMA 27

CYCLOPLEGIC MYDRIATICS 27

NON-STEROIDAL ANTI-INFLAMMATORY AGENTS 27

VASOCONSTRICTOR DECONGESTANTS 27

ANTIBIOTICS 27

SULFONAMIDES 27

STEROIDS 27

STEROID-ANTIBIOTIC COMBINATIONS 27

STEROID-SULFONAMIDE COMBINATIONS 28

SYMPATHOMIMETICS 28

MISCELLANEOUS OPHTHALMOLOGICS 28

ANTIVIRALS 28

RESPIRATORY, ALLERGY, COUGH & COLD 28

ANTIHISTAMINES 28

ADRENERGICS 28

ANTITUSSIVE COMBINATIONS 28

DECONGESTANT / ANTIHISTAMINES 28

XANTHINES 29

BETA AGONISTS ORAL 29

BETA AGONISTS INHALERS 29

INHALED CORTICOSTEROIDS 29

INTRANASAL STEROIDS 29

MISCELLANEOUS PULMONARY AGENTS 29

UROLOGICALS 29

CHOLINERGIC STIMULANTS 29

ANTICHOLINERGICS & ANTISPASMODICS 29

URINARY ANESTHETICS 30

MISCELLANEOUS UROLOGICALS 30

BENIGN PROSTATIC HYPERPLASIA (BPH) THERAPY 30

VITAMINS, HEMATINICS & ELECTROLYTES 30

VITAMINS & HEMATINICS 30

POTASSIUM 32

OTHER ELECTROLYTES 32

MISCELLANEOUS NUTRITION PRODUCTS 32

BLOOD DERIVATIVES 32

DIAGNOSTICS & MISCELLANEOUS AGENTS 33

MISCELLANEOUS AGENTS 33

SMOKING DETERRENTS 33

ANOREXIANTS 33

NEUTRACEUTICALS 33

IRRIGATING SOLUTIONS 33

ANTIDOTES 33

ANTI-INFECTIVES

PENICILLINS

GENERIC

amoxicillin

amoxicillin/clavulanate er

ampicillin

ampicillin/sulbactam

dicloxacillin sodium

nafcill in dextrose

nafcillin sodium

oxacillin sodium

penicillin g potassium

penicillin g procaine

penicillin g sodium

penicillin v potassium

piperacillin-tazobactam

PREFERRED

AMOXICILLIN POWDER

AUGMENTIN 125-31.25 MG/5ML

BICILLIN C-R

BICILLIN L-A

PENICILLIN GK-ISO-OSM DEXTROSE

TIMENTIN

ZOSYN IV SOLUTION

NON PREFERRED

AUGMENTIN

ZOSYN VIAL

TETRACYCLINES

GENERIC

demeclocycline hcl

doxycycline hyclate

doxycycline monohydrate

minocycline hcl

minocycline hcl er

ocudox

PREFERRED

DEMECLOCYCLINE HCL POWDER

DOXYCYCLINE HYCLATE POWDER

MINOCIN 100MG VIAL

MINOCYCLINE HCL POWDER

ORACEA

SOLODYN ER

TETRACYCLINE

NON PREFERRED

DOXYCYCLINE MONOHYDRATE POWDER

MINOCIN

CEPHALOSPORINS

FIRST GENERATION CEPHALOSPORINS

GENERIC

cefazolin

cephalexin

NON PREFERRED

CEFAZOLIN/DEXTROSE

SECOND GENERATION CEPHALOSPORINS

GENERIC

cefaclor

cefoxitin

cefoxitin/dextrose

cefpodoxime proxetil

cefprozil

cefuroxime axetil

cefuroxime sodium

PREFERRED

CEFUROXIME 75G BULK BAG

THIRD GENERATION CEPHALOSPORINS

GENERIC

cefdinir

cefepime

cefotaxime

cefotetan

ceftazidime

ceftibuten

ceftriaxone

PREFERRED

AVYCAZ

CEFTAZIDIME IV PIGGYBACK

FORTAZ IN ISO-OSMOTIC DEXTROSE

TEFLARO

ZERBAXA

NON PREFERRED

CEFEPIME/DEXTROSE

CEFTRIAXONE 100G BULK BAG

ERYTHROMYCINS & OTHER MACROLIDES

GENERIC

azithromycin

clarithromycin

clarithromycin er

erythromycin

erythromycin del rel

erythromycin ethylsuccinate

erythromycin stearate

erythromycin/sulfisoxazole

PREFERRED

AZITHROMYCIN POWDER

CLARITHROMYCIN POWDER

ERYTHROCIN LACTOBIONATE

ERYTHROMYCIN ETHYLSUCCINATE POWDER

ERYTHROMYCIN POWDER

FLOUROQUINOLONES

GENERIC

ciprofloxacin

ciprofloxacin er

ciprofloxacin suspension

ciprofloxacin/dextrose

levofloxacin/d5w

moxifloxacin hcl

ofloxacin tablets

PREFERRED

AVELOX IV

LEVOFLOXACIN HEMIHYDRATE POWDER

MOXIFLOXACIN HCL IV PIGGYBACK

NON PREFERRED

LEVOFLOXACIN HEMIHYDRATE SOLUTION

MOXIFLOXACIN HCL POWDER

SULFA'S & RELATED AGENTS

GENERIC

sulfadiazine

sulfamethoxazole/trimethoprim

PREFERRED

SULFADIAZINE POWDER

URINARY TRACT AGENTS

GENERIC

methenamine hippurate

methenamine mandelate

methylene blue

nitrofurantoin

nitrofurantoin macrocrystal

trimethoprim

PREFERRED

METHENAMINE MANDELATE POWDER

NITROFURANTOIN POWDER

TRIMETHOPRIM POWDER

ANTIVIRALS

GENERIC

acyclovir

adefovir dipivoxil

amantadine hcl

cidofovir

entecavir

famciclovir

foscarnet sodium

ganciclovir

ribavirin

rimantadine hcl

valacyclovir

valganciclovir hcl

PREFERRED

AMANTADINE HCL POWDER

DAKLINZA

RAPIVAB

RELENZA

RIBAVIRIN POWDER

SOVALDI

TECHNIVIE

TYZEKA

VALACYCLOVIR POWDER

VICTRELIS

NON PREFERRED

CIDOFOVIR

HIV/AIDS THERAPY

GENERIC

abacavir

abacavir/lamivudine/zidovudine

didanosine

lamivudine

lamivudine hbv

lamivudine/zidovudine

nevirapine er

stavudine

zidovudine

PREFERRED

APTIVUS

ATRIPLA

COMPLERA

CRIXIVAN

DESCOVY

EDURANT

EMTRIVA

EPZICOM

FUZEON

GENVOYA

INTELENCE

INVIRASE

ISENTRESS

KALETRA

LEXIVA

NORVIR

ODEFSEY

PREZISTA

RESCRIPTOR

RETROVIR VIAL

REYATAZ

SELZENTRY

STRIBILD

SUSTIVA

TIVICAY

TRIUMEQ

TRUVADA

VIDEX

VIRACEPT

VIREAD

ZIAGEN SOLUTION

NON PREFERRED

RETROVIR

VIRAMUNE

ZIAGEN TABLET

ANTIFUNGAL AGENTS

GENERIC

amphotericin

fluconazole

fluconazole in dextrose

fluconazole in saline

flucytosine

griseofulvin

griseofulvin ultramicrosize

itraconazole

ketoconazole

nystatin

terbinafine

voriconazole

PREFERRED

AMBISOME

AMPHOTERICIN POWDER

CANCIDAS

CRESEMBA

FLUCONAZOLE POWDER

FLUCYTOSINE POWDER

GRISEOFULVIN POWDER

ITRACONAZOLE POWDER

KETOCONAZOLE POWDER

LAMISIL

MYCAMINE

NOXAFIL

NYSTATIN

SPORANOX SOLUTION

TERBINAFINE

VIBATIV

VORICONAZOLE POWDER

NON PREFERRED

FLUCONAZOLE 100MG/50ML PIGGYBACK

ITRACONAZOLE 1GM POWDER

KETOCONAZOLE CRYSTALS

LAMISIL 250MG TABLET

NYSTATIN 100MM POWDER

SPORANOX CAPSULE

VANCOMYCIN

GENERIC

vancomycin hcl

PREFERRED

VANCOMYCIN HCL

NON PREFERRED

VANCOMYCIN HCL 750 VIAL W/THREADPORT

MISC. ANTI-INFECTIVES

GENERIC

aztreonam

bacitracin

clindamycin hcl

clindamycin palmitate hcl

clindamycin phosphate

clindamycin phosphate/dextrose

colistimethate

dapsone

gentamicin sulfate

gentamicin sulfate in ns

imipenem-cilastatin

kanamycin sulfate

linezolid

neomycin sulfate

polymyxin b sulfate

tobramycin sulfate

tobramycin sulfate in ns

PREFERRED

AMIKACIN

AMIKACIN POWDER

AZACTAM-ISO-OSMOTIC DEXTROSE

BACITRACIN POWDER

BETHKIS

CAYSTON

CHLORAMPHENICOL

CLINDAMYCIN HCL POWDER

CLINDAMYCIN PHOSPHATE

COLISTIMETHATE POWDER

CUBICIN

DALVANCE

DAPSONE POWDER

DORIBAX

GENTAMICIN SULFATE IN NS 100MG/50ML

INVANZ

KANAMYCIN SULFATE POWDER

MEROPENEM - 0.9% NACL

NEOMYCIN SULFATE POWDER

POLYMYXIN B SULFATE POWDER

SIVEXTRO VIAL

SYNERCID

TOBI PODHALER

TOBRAMYCIN SULFATE POWDER

TYGACIL

XIFAXAN

NON PREFERRED

ACZONE

GENTAMICIN SULFATE 60MG/ML VIAL

GENTAMICIN SULFATE IN NS 120MG/0.1L

ORABACTIV

SIVEXTRO TABLET

TOBRAMYCIN SULFATE 300MG/5ML AMPUL

ANTIPARASITICS

GENERIC

atovaquone

ivermectin

metronidazole

paromomycin sulfate

tinidazole

PREFERRED

ALBENZA

ALINIA

BILTRICIDE

EMVERM

IMPAVIDO

IVERMECTIN POWDER

METRONIDAZOLE POWDER

NEBUPENT

PAROMOMYCIN SULFATE POWDER

TINIDAZOLE POWDER

ANTIMALARIALS

GENERIC

atovaquone/proguanil hcl

chloroquine phosphate

hydroxychloroquine sulfate

mefloquine hcl

quinine sulfate

PREFERRED

CHLOROQUINE PHOSPHATE POWDER

COARTEM

DARAPRIM

HYDROXYCHLOROQUINE SULFATE POWDER

PRIMAQUINE

QUININE SULFATE POWDER

ANTIMYCOBACTERIALS

GENERIC

ethambutol hcl

isoniazid

pyrazinamide

rifabutin

PREFERRED

CAPASTAT SULFATE

ISONIAZID POWDER

PRIFTIN

SIRTURO

STREPTOMYCIN SULFATE

NON PREFERRED

PYRAZINAMIDE POWDER

RIFADIN

ANTINEOPLASTIC & IMMUNOSUPPRESANT DRUGS

ALKYLATING AGENTS

GENERIC

carboplatin

cisplatin

cyclophosphamide

ifosfamide

ifosfamide-mesna

melphalan hcl

oxaliplatin

temozolomide

thiotepa

PREFERRED

ALKERAN 2MG

BENDEKA

BICNU

BUSULFEX

CEENU

CISPLATIN POWDER

CYCLOPHOSPHAMIDE

GLEOSTINE

LEUKERAN

LOMUSTINE

MUSTARGEN

MYLERAN

TEMODAR 100MG VIAL

THIOTEPA POWDER

TREANDA

VALCHLOR

ZANOSAR

NON PREFERRED

ALKERAN 50MG

TEMODAR CAPSULES

ANTIMETABOLITIES

GENERIC

azacitidine

capecitabine

cytarabine

decitabine

floxuridine

fludarabine phosphate

gemcitabine hcl

mercaptopurine

methotrexate

PREFERRED

ALIMTA

ARRANON

CLOLAR

DEPOCYT

FLOXURIDINE POWDER

FOLOTYN

MERCAPTOPURINE POWDER

METHOTREXATE POWDER

TABLOID

TREXALL

NON PREFERRED

FLUOROURACIL 0.005 CREAM

HORMONES

GENERIC

megestrol acetate

PREFERRED

MEGESTROL ACETATE POWDER

ANTIESTROGENS

GENERIC

anastrozole

exemestane

letrozole

tamoxifen citrate

PREFERRED

ANASTROZOLE POWDER

FARESTON

FASLODEX

LETROZOLE POWDER

TAMOXIFEN CITRATE POWDER

ANTIANDROGENS

GENERIC

bicalutamide

flutamide

PREFERRED

NILANDRON

XTANDI

ZYTIGA

RADIOPHARMACEUTICALS

PREFERRED

IODOPEN

XOFIGO

IMMUNOSUPPRESSANT DRUGS

GENERIC

azathioprine

azathioprine sodium

cyclosporine

mycophenolate acid del rel

mycophenolate mofetil

mycophenolic acid del rel

sirolimus

tacrolimus

PREFERRED

AZASAN

AZATHIOPRINE POWDER

CELLCEPT 500MG VIAL

CYCLOSPORINE POWDER

NULOJIX

PROGRAF 5MG/ML AMPUL

RAPAMUNE SOLUTION

SANDIMMUNE SOLUTION 100MG/ML SOLUTION

SIMULECT

SIROLIMUS POWDER

TACROLIMUS POWDER

ZORTRESS

NON PREFERRED

CELLCEPT

PROGRAF CAPSULES

RAPAMUNE

SANDIMMUNE SOLUTION

MISC. ANTINEOPLASTIC DRUGS

GENERIC

bleomycin

cladribine

dacarbazine

dactinomycin

daunorubicin

docetaxel

doxorubicin hcl

doxorubicin hcl liposomal

epirubicin hcl

etoposide

hydroxyurea

idarubicin hcl

imatinib mesylate

irinotecan hcl

leuprolide acetate

mitomycin

mitoxantrone

octreotide acetate

paclitaxel

topotecan hcl

tretinoin

vinblastine sulfate

PREFERRED

ABRAXANE

ADCETRIS

AFINITOR

AFINITOR DISPERZ

ARZERRA

AVASTIN

BEXXAR 14MG/ML

BLINCYTO

BOSULIF

CAPRELSA

CYRAMZA

DARZALEX

DAUNOXOME

DOCEFREZ

DROXIA

ELIGARD

ELSPAR

EMCYT

ERBITUX

ERIVEDGE

ETOPOPHOS

ETOPOSIDE POWDER

FIRMAGON

GAZYVA

GILOTRIF

HALAVEN

HERCEPTIN

HEXALEN

HYCAMTIN CAPSULES

HYDROXYUREA POWDER

IBRANCE

ICLUSIG

IMBRUVICA

INLYTA

ISTODAX

IXEMPRA

JAKAFI

JEVTANA

KADCYLA

KEYTRUDA

KYPROLIS

LENVIMA

LEUPROLIDE ACETATE POWDER

LONSURF

LUPRON DEPOT

LUPRON DEPOT 11.25MG

LUPRON DEPOT-PED

LYNPARZA

LYSODREN

MARQIBO

MATULANE

MEKINIST

MITOMYCIN POWDER

NEXAVAR

NINLARO

ONCASPAR

ONIVYDE

ONTAK

OPDIVO

PERJETA

PHOTOFRIN

POMALYST

PROVENGE

PURIXAN

REVLIMID

RITUXAN

SANDOSTATIN KIT

SANDOSTATIN LAR DEPOT

SIGNIFOR

SOMATULINE DEPOT

SPRYCEL

STIVARGA

SUTENT

SYLVANT

SYNRIBO

TAFINLAR

TAGRISSO

TARCEVA

TARGRETIN GEL

TASIGNA

TENIPOSIDE

THALOMID

TORISEL

TRELSTAR

TRELSTAR DEPOT

TRELSTAR LA

TRETINOIN POWDER

TRISENOX

TYKERB

UNITUXIN

VALSTAR

VANTAS

VECTIBIX

VELCADE

VENCLEXTA

VENCLEXTA STARTER PACK

VOTRIENT

VUMON

XALKORI

YERVOY

YONDELIS

ZALTRAP

ZELBORAF

ZEVALIN

ZOLADEX

ZOLINZA

ZYDELIG

ZYKADIA

NON PREFERRED

BEXXAR

HYCAMTIN 4MG VIAL

SANDOSTATIN

TARGRETIN 75 CAPSULE

ADJUNCTIVE AGENTS

GENERIC

amifostine

calcium folinate

dexrazoxane

leucovorin calcium

levoleucovorin calcium

mesna

PREFERRED

CALCIUM FOLINATE POWDER

ELITEK

KEPIVANCE

LEUCOVORIN CALCIUM POWDER

MESNEX 400MG TABLET

VISTOGARD

VORAXAZE

XGEVA

NON PREFERRED

MESNEX 100MG/ML VIAL

Autonomic & CNS Drugs, Neurology & Psych

NARCOTIC ANALGESICS

GENERIC

alfentanil hcl

buprenorphine

codeine sulfate

fentanyl

fentanyl citrate

hydromorphone hcl

levorphanol tartrate

methadone hcl

morphine sulfate

morphine sulfate cr

morphine sulfate er

oxycodone hcl

oxymorphone hcl

oxymorphone hcl er

sufentil 50mcg/ml ampul

PREFERRED

BUPRENORPHINE POWDER

BUTRANS

DILAUDID-HP 250 MG

FENTANYL CITRATE POWDER

HYDROMORPHONE HCL 1GM POWDER

INFUMORPH

LEVORPHANOL TARTRATE POWDER

MEPERIDINE HCL POWDER

METHADONE HCL POWDER

MORPHINE SULFATE TABLET POWDER

OPANA ER

OXYCODONE HCL POWDER

OXYCONTIN ER

SUFENTIL POWDER

ULTIVA

NON PREFERRED

CODEINE SULFATE SOLUTION

DILAUDID-HP

FENTANYL

FENTANYL CITRATE 100MCG/2ML

HYDROMORPHONE HCL 0.5MG/0.5ML SYRINGE

meperidine hcl

MORPHINE SULFATE

SUFENTIL 50MCG/ML VIAL

COMBINATION NARCOTIC/ANALGESICS

GENERIC

acetaminophen/codeine

butalbital compound

butalbital compound/codeine

butalbital/apap/caffeine

butalbital/aspirin/caffeine

butalbital/caff/apap/codeine

hydrocodone bit/ibuprofen

hydrocodone w/acetaminophen

oxycodone hcl/ibuprofen

oxycodone w/acetaminophen

oxycodone w/aspirin

NON PREFERRED

HYDROCODONE W/ACETAMINOPHEN

NSAIDS

GENERIC

diclofenac potassium

diclofenac sodium

diclofenac sodium/misoprostol del rel

etodolac

etodolac er

fenoprofen calcium

flurbiprofen

ibuprofen

indomethacin

indomethacin er

ketoprofen er

ketorolac tromethamine

meclofenamate sodium

mefenamic acid

meloxicam

nabumetone

naproxen

naproxen sodium

oxaprozin

piroxicam

sulindac

tolmetin sodium

PREFERRED

DICLOFENAC SODIUM POWDER

ETODOLAC POWDER

FLURBIPROFEN POWDER

IBUPROFEN POWDER

INDOMETHACIN POWDER

KETOPROFEN ER POWDER

KETOROLAC TROMETHAMINE POWDER

MECLOFENAMATE SODIUM POWDER

MEFENAMIC ACID POWDER

MELOXICAM POWDER

MITIGARE

NAPROXEN POWDER

NAPROXEN SODIUM POWDER

NEOPROFEN

PIROXICAM POWDER

SULINDAC POWDER

ZORVOLEX

NON PREFERRED

FENOPROFEN CALCIUM

NABUMETONE POWDER

NSAIDS-SPECIFIC COX II INHIBITORS

GENERIC

celecoxib

PREFERRED

CELECOXIB POWDER

SALICYLATES

GENERIC

choline mag trisalicylate

diflunisal

SALICYLAMIDE

salsalate

PREFERRED

CHOLINE MAG TRISALICYLATE POWDER

SALSALATE POWDER

MISC. ANALGESICS

GENERIC

acetaminophen-diphenhydramine

butorphanol

clonidine

nalbuphine hcl

pentazocine lactate

tramadol hcl

tramadol hcl er

tramadol/acetaminophen

PREFERRED

BUTORPHANOL POWDER

MONOVISC

NALBUPHINE HCL POWDER

NUCYNTA

NUCYNTA ER

OFIRMEV

ORTHOVISC

PRIALT

QUADRAMET

SYNVISC

SYNVISC-ONE

TRAMADOL HCL POWDER

NON PREFERRED

TRAMADOL HCL ER

NARCOTIC ANTAGONISTS

GENERIC

buprenorphine/naloxone

naloxone hcl

naltrexone hydrochloride

PREFERRED

MOVANTIK

NALOXONE HCL POWDER

NALTREXONE HYDROCHLORIDE POWDER

NARCAN

SUBOXONE

ZUBSOLV

NON PREFERRED

SUBOXONE TABLET

HEADACHE THERAPY

GENERIC

dihydroergotamine mesylate

ergotamine-caffeine

naratriptan hcl

rizatriptan

rizatriptan disintegrating tablets

sumatriptan succinate

zolmitriptan

zolmitriptan ODT

PREFERRED

DIHYDROERGOTAMINE MESYLATE

ISOMETHEPTENE MUCATE

RELPAX

SUMATRIPTAN SUCCINATE POWDER

SUMAVEL DOSEPRO

VIVITROL

ZOMIG SPRAY

NON PREFERRED

TREXIMET

ZOLMITRIPTAN

ZOMIG TABLET

ANTIPARKINSONISM AGENTS

GENERIC

benztropine

benztropine mesylate

carbidopa/levodopa

carbidopa/levodopa er

carbidopa/levodopa ODT

carbidopa/levodopa/entacapone

entacapone

pramipexole er

ropinirole hcl

ropinirole hcl er

selegiline hcl

trihexyphenidyl hcl

PREFERRED

APOKYN

AZILECT

SELEGILINE HCL POWDER

ANTICONVULSANTS

GENERIC

carbamazepine

carbamazepine er

clonazepam

clonazepam ODT

diazepam

diazepam rectal gel

divalproex sodium

divalproex sodium er

ethosuximide

felbamate

fosphenytoin sodium

gabapentin

lamotrigine

lamotrigine er

levetiracetam

levetiracetam er

oxcarbazepine

phenobarbital

phenobarbital sodium

phenytoin

phenytoin sodium

primidone

tiagabine hcl

topiramate

valproate sodium

valproic acid

zonisamide

PREFERRED

BANZEL

CARBAMAZEPINE POWDER

CELONTIN

CLONAZEPAM POWDER

DIAZEPAM POWDER

DILANTIN 30MG

ETHOSUXIMIDE POWDER

FYCOMPA

GABAPENTIN POWDER

GABITRIL 12MG, 16 MG

GRALISE

LAMICTAL XR

LAMOTRIGINE POWDER

LEVETIRACETAM POWDER

LYRICA

ONFI

OXTELLAR XR

PEGANONE

PHENOBARBITAL POWDER

PHENOBARBITAL SODIUM POWDER

PHENYTOIN POWDER

PHENYTOIN SODIUM POWDER

POTIGA

PRIMIDONE POWDER

SABRIL

TOPIRAMATE POWDER

VALPROATE SODIUM POWDER

VALPROIC ACID

VIMPAT

NON PREFERRED

DILANTIN

FYCOMPA 0.5MG/ML SUSPENSION

GABITRIL 2MG, 4MG

LAMICTAL XR

ZONISAMIDE

MISC. NEUROLOGICAL THERAPY

GENERIC

donepezil hcl

galantamine

glatimer acetate

memantine

rivastigmine

PREFERRED

AMPYRA

COPAXONE 40MG/ML

GILENYA

LEMTRADA

NAMENDA XR

NAMZARIC

NUEDEXTA

TECFIDERA

TYSABRI

NON PREFERRED

ANALPRAM 2.5% LOTION

COPAXONE 20MG/ML

MEMANTINE DOSE PACK

XENAZINE

MUSCLE RELAXANTS & ANTISPASMODIC AGENTS

GENERIC

anectine

baclofen

chlorzoxazone

cyclobenzaprine hcl

dantrolene sodium

methocarbamol

neostigmine methylsulfate

orphenadrine citrate

orphenadrine compound

pyridostigmine bromide

tizanidine hcl

PREFERRED

BACLOFEN POWDER

CYCLOBENZAPRINE HCL

DANTROLENE SODIUM POWDER

EDROPHONIUM CHLORIDE

GABLOFEN

LIORESAL

MESTINON SYRUP

METHOCARBAMOL POWDER

NEOSTIGMINE METHYLSULFATE POWDER

ORPHENADRINE CITRATE POWDER

PYRIDOSTIGMINE BROMIDE POWDER

ROBAXIN VIAL

TIZANIDINE HCL POWDER

NON PREFERRED

MESTINON

MESTINON ER

NEOSTIGMINE METHYLSULFATE

ROBAXIN

HYPNOTIC AGENTS

GENERIC

diphenhydramine hcl

flurazepam hcl

seconal sodium

temazepam

triazolam

zaleplon

zolpidem tartrate

zolpidem tartrate er

PREFERRED

AMYTAL

DOXYLAMINE SUCCINATE

NEMBUTAL SODIUM

ROZEREM

TRICYCLICS

GENERIC

amitriptyline hcl

amoxapine 150mg

amoxapine 25mg

clomipramine hcl

desipramine hcl

doxepin hcl

imipramine hcl

imipramine pamoate

nortriptyline hcl

trimipramine maleate

PREFERRED

AMITRIPTYLINE HCL POWDER

CLOMIPRAMINE HCL POWDER

DESIPRAMINE HCL POWDER

DOXEPIN HCL POWDER

IMIPRAMINE HCL POWDER

NORTRIPTYLINE HCL POWDER

MISC. ANTIDEPRESSANTS

GENERIC

amitriptyline/chlordiazepoxide

bupropion er (12 hour)

bupropion hcl

bupropion hcl xl er

bupropion sr

duloxetine

mirtazapine

mirtazapine disintegrating

perphenazine/amitriptyline

trazodone hcl

venlafaxine hcl

venlafaxine hcl er

PREFERRED

BUPROPION HCL POWDER

FETZIMA

MIRTAZAPINE POWDER

PRISTIQ ER

TRAZODONE HCL POWDER

NON PREFERRED

DULOXETINE POWDER

MAO INHIBITORS

GENERIC

phenelzine sulfate

tranylcypromine sulfate

PREFERRED

PHENELZINE SULFATE POWDER

SELECTIVE SEROTONIN REUPTAKE INHIBITORS

GENERIC

citalopram hbr

escitalopram oxalate

fluoxetine

fluvoxamine maleate er

paroxetine hcl

paroxetine hcl er

PREFERRED

BRISDELLE

FLUOXETINE POWDER

VIIBRYD

NON PREFERRED

FLUOXETINE 60MG

PHENOTHIAZINES

GENERIC

chlorpromazine

fluphenazine decanoate

fluphenazine hcl

perphenazine

thioridazine hcl

trifluoperazine hcl

PREFERRED

CHLORPROMAZINE POWDER

FLUPHENAZINE DECANOATE 2.5%

THIORIDAZINE HCL POWDER

NON PREFERRED

FLUPHENAZINE DECANOATE 1GM LIQUID

PERPHENAZINE

BUTYROPHENONES

GENERIC

haloperidol

haloperidol decanoate

haloperidol lactate

PREFERRED

HALOPERIDOL DECANOATE POWDER

HALOPERIDOL POWDER

MISC. ANTIPSYCHOTICS

GENERIC

aripiprazole ODT

aripiprazole tablets

clozapine

clozapine ODT

loxapine succinate

olanzapine

olanzapine ODT

olanzapine/fluoxetine hcl

quetiapine fumarate

thiothixene

ziprasidone hcl

PREFERRED

ABILIFY MAINTENA, ER

ARISTADA

LATUDA

LOXAPINE SUCCINATE POWDER

RISPERDAL CONSTA

SEROQUEL XR

VIMIZIM

NON PREFERRED

CLOZAPINE ODT

RISPERDAL

RISPERDAL M-TAB DISINTEGRATING

MISCELLANEOUS PSYCHOTHERAPEUTIC AGENTS

GENERIC

amphetamine salt combo,er

armodafinil

clonidine hcl er

dexmethylphenidate er

dextroamphetamine sulfate

dextroamphetamine sulfate er

ergoloid mesylates

flumazenil

guanfacine er

guanidine hcl

lithium carbonate

lithium carbonate er

methamphetamine hcl

methylphenidate er

methylphenidate hcl

modafinil

PREFERRED

DAYTRANA

ERGOLOID MESYLATES POWDER

EVEKEO

LITHIUM CARBONATE POWDER

METHYLPHENIDATE HCL POWDER

QUILLICHEW ER

QUILLIVANT XR

VYVANSE

XYREM

NON PREFERRED

FLUMAZENIL POWDER

ANXIOLYTICS

GENERIC

alprazolam

alprazolam er

alprazolam ODT

buspirone hcl

chlordiazepoxide hcl

clorazepate dipotassium

lorazepam

midazolam hcl

oxazepam

PREFERRED

ALPRAZOLAM POWDER

BUSPIRONE HCL POWDER

LORAZEPAM POWDER

MIDAZOLAM HCL POWDER

NON PREFERRED

midazolam hcl

Cardiovascular, Hypertension & Lipids

ANTIARRHYTHMIC AGENTS

GENERIC

adenosine

amiodarone hcl

dofetilide

flecainide acetate

ibutilide fumarate

lidocaine hcl in 7.5% dextrose

mexiletine hcl

procainamide hcl

propafenone hcl

propafenone hcl er

quinidine gluconate

quinidine gluconate er

quinidine sulfate

sotalol

PREFERRED

ADENOSINE POWDER

AMIODARONE HCL POWDER

MEXILETINE HCL POWDER

NEXTERONE

PROCAINAMIDE HCL POWDER

QUINIDINE SULFATE

SOTALOL HCL

SOTYLIZE

CARDIAC GLYCOSIDES

GENERIC

digoxin

PREFERRED

DIGOXIN POWDER

LANOXIN PEDIATRIC

RAPID ACTING NITRATES

GENERIC

nitroglycerin

nitroglycerin in d5w

nitroglycerin spray

nitroglycerin tablets

PREFERRED

NITROSTAT

LONG ACTING NITRATES

GENERIC

isosorbide dinitrate

isosorbide mononitrate

isosorbide mononitrate er

nitroglycerin er

PREFERRED

DILATRATE-SR

ANTICOAGULANTS

GENERIC

warfarin sodium

PREFERRED

ARGATROBAN

COUMADIN 5MG VIAL

ELIQUIS

PRADAXA

REFLUDAN

WARFARIN SODIUM POWDER

XARELTO

NON PREFERRED

COUMADIN

ANTIPLATELET DRUGS

GENERIC

aspirin / dipyridamole er

cilostazol

clopidogrel

dipyridamole

PREFERRED

AGGRASTAT 5 MG/100ML

BRILINTA

DIPYRIDAMOLE POWDER

EFFIENT

INTEGRILIN

REOPRO

ZONTIVITY

NON PREFERRED

AGGRASTAT 12.5MG/250

HEPARIN

GENERIC

enoxaparin sodium

fondaparinux sodium

heparin lock flush

heparin sodium in 0.45% nacl

heparin sodium in 5% dextrose

PREFERRED

FRAGMIN

NON PREFERRED

HEPARIN SODIUM IN 0.45% NACL 12500/500

VITAMIN K

PREFERRED

MEPHYTON

PHYTONADIONE

HEMOSTATICS

GENERIC

tranexamic acid

PREFERRED

HUMATE-P

NOVOSEVEN RT

NPLATE

PROMACTA

TRANEXAMIC ACID POWDER

WILATE

MISC. COAGULATION AGENTS

GENERIC

pentoxifylline

protamine sulfate

PREFERRED

ADVATE

ADVATE H

ADVATE L

ADVATE N

ADVATE SH

ADVATE UH

ADYNOVATE

ALPHANATE

ALPHANINE SD

ALPROLIX

ANGIOMAX

BEBULIN

BEBULIN VH IMMUNO

BENEFIX

CEPROTIN

COAGADEX

CORIFACT

ELOCTATE

FEIBA NF

HELIXATE FS

HEMOFIL

IXINITY

KOATE-DVI

KOGENATE FS

MONOCLATE-P

MONONINE

OBIZUR

PENTOXIFYLLINE POWDER

PROFILNINE SD

PROTAMINE SULFATE POWDER

RECOMBINATE

RIASTAP

THROMBATE III

TRETTEN

XYNTHA

NON PREFERRED

ATRYN

THIAZIDE & RELATED DIURETICS

GENERIC

amiloride hcl

amiloride hcl w/hctz

bumetanide

chlorothiazide

chlorothiazide sodium

chlorthalidone

eplerenone

furosemide

hydrochlorothiazide

indapamide

mannitol

methyclothiazide

metolazone

spironolactone

spironolactone/hctz

torsemide

PREFERRED

AMILORIDE HCL POWDER

FUROSEMIDE POWDER

HYDROCHLOROTHIAZIDE POWDER

MANNITOL POWDER

RESECTISOL

SPIRONOLACTONE POWDER

NON PREFERRED

EDECRIN

FUROSEMIDE 40MG/4ML SOLUTION

TORSEMIDE

BETA BLOCKERS

GENERIC

acebutolol hcl

atenolol

betaxolol hcl

bisoprolol fumarate

labetalol hcl

metoprolol succinate er

metoprolol tartrate

nadolol

pindolol

propranolol hcl

propranolol hcl er

timolol maleate

PREFERRED

ACEBUTOLOL HCL POWDER

ATENOLOL POWDER

BYSTOLIC

COREG CR

LABETALOL HCL POWDER

METOPROLOL TARTRATE POWDER

NADOLOL POWDER

PROPRANOLOL HCL POWDER

TIMOLOL MALEATE POWDER

CALCIUM CHANNEL BLOCKERS/ NON-DIHYDROPYRIDINES

GENERIC

diltiazem

diltiazem 24hr cd

diltiazem er

diltiazem er 24 hour

diltiazem hcl

nimodipine

verapamil er

verapamil er pm

verapamil hcl

PREFERRED

DILTIAZEM HCL POWDER

VERAPAMIL HCL POWDER

NON PREFERRED

NIMODIPINE POWDER

CALCIUM CHANNEL BLOCKERS/DIHYDROPYRIDINES

GENERIC

amlodipine besylate

felodipine er

isradipine

nicardipine hcl

PREFERRED

AMLODIPINE BESYLATE POWDER

CLEVIPREX 25MG/50ML

NON PREFERRED

CLEVIPREX 50MG/100ML

ACE INHIBITORS

GENERIC

benazepril hcl

captopril

enalapril maleate

enalaprilat

fosinopril sodium

lisinopril

moexipril hcl

perindopril erbumine

quinapril

ramipril

trandolapril

trandolapril/verapamil er

PREFERRED

BENAZEPRIL HCL POWDER

CAPTOPRIL POWDER

ENALAPRIL MALEATE POWDER

LISINOPRIL POWDER

ADRENERGIC ANTAGONISTS & RELATED DRUGS

GENERIC

clonidine hcl

clonidine/chlorthalidone

doxazosin mesylate

guanfacine hcl

methyldopa

methyldopate hcl

prazosin hcl

reserpine

terazosin hcl

PREFERRED

CLONIDINE HCL POWDER

RESERPINE POWDER

NON PREFERRED

PRAZOSIN HCL POWDER

AGENTS FOR PHEOCHROMOCYTOMA

GENERIC

phentolamine mesylate

PREFERRED

DEMSER

PHENTOLAMINE MESYLATE POWDER

NON PREFERRED

PHENTOLAMINE MESYLATE VIAL

VASODILATORS

GENERIC

epoprostenol

epoprostenol diluent

hydralazine hcl

minoxidil

papaverine hcl

papaverine hcl er

PREFERRED

FLOLAN

HYDRALAZINE HCL POWDER

MINOXIDIL POWDER

PAPAVERINE HCL POWDER

REMODULIN

UPTRAVI

OTHER ANTIHYPERTENSIVE COMBINATIONS

GENERIC

amlodipine/valsartan

amlodipine/valsartan/hctz

atenolol/chlorthalidone

benazepril/hctz

bisoprolol fumarate/hctz

captopril/hydrochlorothiazide

enalapril maleate/hctz

fosinopril/hydrochlorothiazide

lisinopril/hctz

methyldopa/hydrochlorothiazide

metoprolol/hydrochlorothiazide

moexipril/hydrochlorothiazide

nadolol-bendroflumethiazide

propranolol/hctz

quinapril/hydrochlorothiazide

PREFERRED

AZOR

TRIBENZOR

ANGIOTENSION II RECEPTOR BLOCKERS & RENIN INHIBITOR

GENERIC

candesartan cilexetil

candesartan/hydrochlorothiazide

irbesartan

irbesartan/hydrochlorothiazide

losartan potassium

losartan/hydrochlorothiazide

valsartan

valsartan/hydrochlorothiazide

PREFERRED

BENICAR

BENICAR HCT

EDARBI

EDARBYCLOR

TEKAMLO

TEKTURNA

TEKTURNA HCT

LIPID/CHOLESTEROL LOWERING AGENTS

GENERIC

amlodipine-atorvastatin

atorvastatin calcium

cholestyramine

cholestyramine light

colestipol hcl

fenofibrate

fenofibric acid

fenofibric acid del rel

fluvastatin sodium

gemfibrozil

lovastatin

niacin er

omega-3-acid ethyl esters

pravastatin sodium

rosuvastatin

simvastatin

PREFERRED

CHOLESTYRAMINE POWDER

GEMFIBROZIL POWDER

JUXTAPID

LIPOFEN

LIPTRUZET

LIVALO

PRALUENT PEN

PRALUENT SYRINGE

REPATHA SURECLICK

REPATHA SYRINGE

SIMCOR ER

SIMVASTATIN POWDER

VASCEPA

VYTORIN

WELCHOL

ZETIA

NON PREFERRED

FENOFIBRATE

MISC. CARDIOVASCULAR AGENTS

GENERIC

dobutamine

dobutamine/dextrose

dopamine hcl

dopamine hcl in 5% dextrose

milrinone in 5% dextrose

milrinone lactate

norepinephrine bitartrate

phenylephrine hcl

PREFERRED

ACTIVASE

CATHFLO ACTIVASE

CORLANOR

DOPAMINE HCL POWDER

ENTRESTO

NATRECOR

PHENYLEPHRINE HCL POWDER

RANEXA

RETAVASE

Dermatological/Topical Therapy

TOPICAL CORTICOSTEROIDS VERY HIGH POTENCY

GENERIC

clobetasol e

clobetasol propionate

diflorason diacetate/emollient

diflorasone diacetate

halobetasol propionate

PREFERRED

CLOBETASOL PROPIONATE POWDER

TOPICAL CORTICOSTEROIDS HIGH POTENCY

GENERIC

amcinonide

betamethasone dipropionate augment

betamethasone valerate

desoximetasone

fluocinonide

PREFERRED

BETAMETHASONE DIPROPIONATE AUGMENT POWDER

BETAMETHASONE VALERATE POWDER

DESOXIMETASONE POWDER

FLUOCINONIDE POWDER

TOPICAL CORTICOSTEROIDS MEDIUM POTENCY

GENERIC

fluocinolone acetonide

fluticasone propionate

hydrocortisone butyrate

hydrocortisone butyrate/emoll

hydrocortisone valerate

mometasone furoate

PREFERRED

FLUOCINOLONE ACETONIDE POWDER

FLUTICASONE PROPIONATE POWDER

MOMETASONE FUROATE POWDER

TRIAMCINOLONE ACETONIDE POWDER

NON PREFERRED

FLUOCINOLONE ACETONIDE POWDER

FLUTICASONE PROPIONATE 50MCG SPRAY

TOPICAL CORTICOSTEROIDS LOW POTENCY

GENERIC

alclometasone dipropionate

desonide

hydrocortisone

hydrocortisone acetate

PREFERRED

DESONIDE POWDER

HYDROCORTISONE ACETATE POWDER

TOPICAL ANESTHETICS

GENERIC

bupivacaine hcl

bupivacaine/epinephrine

carbocaine

chloroprocaine

cocaine hcl

ethyl chloride

lidocaine

lidocaine hcl

lidocaine hcl w/epinephrine

lidocaine/prilocaine

lidocaine-hc

ropivacaine

sensorcaine 5MG/ML VIAL

PREFERRED

BENZOCAINE

BUPIVACAINE HCL POWDER

CARBOCAINE 20MG/ML

COCAINE HCL

LIDOCAINE HCL POWDER

LIDOCAINE POWDER

MEPIVACAINE HCL POWDER

NESACAINE 10MG/ML

ROPIVACAINE POWDER

NON PREFERRED

BUPIVACAINE/EPINEPHRINE CARTRIDGE

CARBOCAINE 10MG/ML

LIDOCAINE

LIDOCAINE HCL

LIDOCAINE HCL W/EPINEPHRINE

LIDOCAINE-HC

MEPIVACAINE HCL 30MG/ML CARTRIDGE

NESACAINE 20MG/ML

SENSORCAINE 2.5MG/ML VIAL

THERAPY FOR ACNE

GENERIC

adapalene

benprox

benzoyl peroxide

clindamycin phos/benzoyl peroxide

clindamycin phosphate topical

clindamycin-benzoyl peroxide

erythromycin solution

erythromycin-benzoyl peroxide

sodium sulfacetamide/sulfur

tretinoin microsphere

PREFERRED

ABSORICA

BENZOYL PEROXIDE POWDER

DIFFERIN 0.1% LOTION

EPIDUO

EPIDUO FORTE

FINACEA

FINACEA PLUS

MIRVASO

ONEXTON

TAZORAC

ZIANA

NON PREFERRED

ADAPALENE LOTION

DIFFERIN

ISOTRETINOIN

SODIUM SULFACETAMIDE/SULFUR GEL

TRETIN-X

TOPICAL ANTIBACTERIALS

GENERIC

bacitracin

bacitracin/polymyxin ophth oint

gentamicin sulfate

mafenide acetate

mupirocin

sulfacetamide sodium

PREFERRED

GENTAMICIN SULFATE POWDER

MAFENIDE ACETATE POWDER

MUPIROCIN POWDER

SULFAMYLON CREAM

NON PREFERRED

SULFACETAMIDE SODIUM

SULFAMYLON PACKET

TOPICAL ANTIFUNGALS

GENERIC

ciclopirox

clotrimazole

clotrimazole/betamethasone

econazole nitrate

nystatin

nystatin w/triamcinolone

PREFERRED

CLOTRIMAZOLE POWDER

ECONAZOLE NITRATE POWDER

NYSTATIN

TOPICAL ANTIVARALS

PREFERRED

ACYCLOVIR POWDER

ZOVIRAX 0.05 CREAm

NON PREFERRED

ZOVIRAX

BURN THERAPY

GENERIC

silver sulfadiazine

PREFERRED

SILVER SULFADIAZINE POWDER

TOPICAL ENZYMES

PREFERRED

SANTYL

KERATOLYTICS

GENERIC

salicylic acid

PREFERRED

SALICYLIC ACID

ANTIPSORIATICS/ANTISEBORRHEIC

GENERIC

acitretin

calcipotriene

selenium sulfide

PREFERRED

ANTHRALIN

CALCIPOTRIENE POWDER

ENSTILAR

SELENIUM SULFIDE POWDER

STELARA

TACLONEX SUSPENSION

NON PREFERRED

CALCITRIOL

COSENTYX

TACLONEX OINTMENT

TOPICAL SCABICIDES/PEDICULICIDES

GENERIC

lindane

malathion

permethrin

spinosad

PREFERRED

PERMETHRIN

MISC. DERMATOLOGICALS

GENERIC

alphaquin hp

aluminum chloride topical

ammonium lactate

avo cream

chlorhexidine gluconate

dexpanthenol

eletone

emulsion sb

fluorouracil

hpr

hpr plus

hydroquinone cream

hydroquinone er cream

imiquimod

lactic acid

lustra-ultra

mb hydrogel

nuquin hp

podofilox

pruclair

prumyx

prutect

sonafine

tl-cermide

urea

PREFERRED

ALUMINUM CHLORIDE POWDER

AMMONIUM LACTATE

CARAC

CHLORHEXIDINE GLUCONATE 0.2 SOLUTION

CONDYLOX GEL

DEXPANTHENOL

ELIDEL

ETHYL ALCOHOL

FLUOROURACIL POWDER

HYDROQUINONE POWDER

IMIQUIMOD POWDER

LACTIC ACID 88 TO 92 %

OXSORALEN 1% LOTION

REGRANEX

UREAM POWDER, BEADS

NON PREFERRED

CHLORHEXIDINE GLUCONATE

CONDYLOX SOLUTION

ETHYL ALCOHOL 1 LIQUID

PODOFILOX POWDER

UREA LOTION

EAR, NOSE & THROAT MEDICATIONS

MISCELLANEOUS OTIC PREPARATIONS

GENERIC

acetic acid otic solution

acetic acid/aluminum otic sol

acetic acid/hydrocortisone otic sol

antipyrine/benzocaine otic sol

antipyrine/benzocaine/poly otic sol

chloroxylenol/benzocaine/hc acetate otic susp

ciprofloxacin hcl

ofloxacin otic drops

PREFERRED

CIPROFLOXACIN HCL

OTIC STEROID / ANTIBIOTIC

GENERIC

neomycin/polymyxin/hc

neomycin/polymyxin/hc drops

PREFERRED

CIPRODEX

MISCELLANEOUS AGENTS

GENERIC

azelastine hcl

ipratropium bromide spray

oxymetazoline hcl 12 hour

sodium chloride

sodium fluoride

PREFERRED

FIRST-BXN

FIRST-MOUTHWASH BLM

MYALEPT

OXYMETAZOLINE HCL POWDER

SODIUM FLUORIDE

SODIUM FLUORIDE POWDER

NON PREFERRED

ATROVENT SPRAY

AZELASTINE HCL POWDER

ENDOCRINE/DIABETES

ANTITHYROID AGENTS

GENERIC

methimazole

propylthiouracil

PREFERRED

METHIMAZOLE POWDER

PROPYLTHIOURACIL POWDER

THYROID HORMONES

GENERIC

levothroid

levothyroxine sodium

liothyronine sodium

PREFERRED

ARMOUR THYROID

LEVOTHYROXINE SODIUM

LIOTHYRONINE SODIUM POWDER

THYROID

ADRENAL HORMONES

GENERIC

a-hydrocort

cortisone acetate

cosyntropin

dexamethasone

dexamethasone sodium phosphate

fludrocortisone acetate

methylprednisolone

methylprednisolone acetate

methylprednisolone sod succ

prednisolone

prednisolone sodium phosphate

prednisone

veripred 20

PREFERRED

ARISTOSPAN

BETAMETHASONE

BETAMETHASONE ACETATE

BETAMETHASONE SODIUM PHOSPHATE

CORTISONE ACETATE POWDER

DEPO-MEDROL 20 MG/ML

DEXAMETHASONE POWDER

DEXAMETHASONE SODIUM PHOSPHATE POWDER

FLUDROCORTISONE ACETATE POWDER

KENALOG 10MG/ML VIAL

METHYLPREDNISOLONE POWDER

METHYLPREDNISOLONE SOD SUCC POWDER

PREDNISOLONE POWDER

PREDNISONE POWDER

SOLU-CORTEF

SOLU-MEDROL 2G VIAL

NON PREFERRED

COSYNTROPIN

DEPO-MEDROL

KENALOG

MEDROL

SOLU-MEDROL

ANDROGENS

GENERIC

danazol

oxandrolone

testosterone cypionate

testosterone enanthate

testosterone gel

PREFERRED

AXIRON

DANAZOL POWDER

FLUOXYMESTERONE

METHITEST

OXANDROLONE POWDER

TESTOSTERONE CYPIONATE POWDER

TESTOSTERONE ENANTHATE POWDER

TESTOSTERONE POWDER

NON PREFERRED

TESTOSTERONE GEL

OVULATORY STIMULANTS

GENERIC

clomiphene citrate

PREFERRED

CLOMIPHENE CITRATE POWDER

FOLLISTIM AQ

GONAL-F

GONAL-F RFF

GONAL-F RFF REDI-JECT

MENOPUR

REPRONEX

NON PREFERRED

BRAVELLE

MISCELLANEOUS AGENTS

GENERIC

cabergoline

calcitonin salmon nasal

calcitriol

desmopressin acetate

doxercalciferol

pamidronate disodium

paricalcitol

vasopressin

zoledronic acid

PREFERRED

ACTHREL

ALDURAZYME

CERDELGA

CEREZYME

DESMOPRESSIN ACETATE POWDER

ELAPRASE

ELELYSO

FABRAZYME

KALYDECO

KUVAN

LUMIZYME

MIACALCIN VIAL

MYOZYME

NAGLAZYME

SAMSCA

SENSIPAR

SOMAVERT

STIMATE SPRAY

SYNAREL

VPRIV

ZAVESCA

ZEMPLAR VIAL

ZOMETA INFUSION BOTTLE

NON PREFERRED

MIACALCIN AEROSOL

PARICALCITOL

ZEMPLAR CAPSULE

ZOLEDRONIC ACID

ZOMETA VIAL

GONADOTROPIN & RELATED AGENTS

GENERIC

chorionic gonadotropin

PREFERRED

CHORIONIC GONADOTROPIN POWDER

INSULIN THERAPY

PREFERRED

HUMALOG

HUMULIN 70/30, KWIKPEN

HUMULIN KWIKPEN

HUMULIN R 500 UNITS

HUMULIN R U-500 KWIKPEN

LANTUS

LANTUS SOLOSTAR

LEVEMIR

LEVEMIR, FLEXTOUCH

NOVOLOG

NOVOLOG FLEXPEN

NOVOLOG MIX 70-30

TOUJEO SOLOSTAR

TRESIBA FLEXTOUCH U-100

TRESIBA FLEXTOUCH U-200

NON-INSULIN HYPOGLYCEMIC AGENTS

GENERIC

acarbose

glimepiride

glipizide

glipizide er

glyburide

glyburide micronized

glyburide/metformin hcl

metformin hcl

metformin hcl er

nateglinide

pioglitazone hcl

pioglitazone/glimepiride

pioglitazone/metformin

repaglinide/metformin

tolazamide

tolbutamide

PREFERRED

ACTOPLUS MET XR

BYDUREON

BYDUREON PEN

BYETTA

GLIPIZIDE POWDER

GLYBURIDE POWDER

GLYXAMBI

INVOKAMET

INVOKANA

JANUMET

JANUMET XR

JANUVIA

JENTADUETO

JUVISYNC

KOMBIGLYZE XR

METFORMIN HCL POWDER

ONGLYZA

RIOMET

SYMLINPEN 60

SYNJARDY

TRADJENTA

VICTOZA

XIGDUO XR

GLUCOSE ELEVATING AGENTS

PREFERRED

GLUCAGEN

PROGLYCEM

NON PREFERRED

GLUCAGON

INSULIN SYRINGES/MISCELLANEOUS DME

PREFERRED

1ST CHOICE LANCETS

ACCU-CHEK FASTCLIX, MULTICLIX, SOFTCLIX, LANCETS

ACCU-CHEK SOFTCLIX LANCETS DEVICE

DEXCOM G4 SENSOR

FEMCAP

FORA LANCING DEVICE

FREESTYLE CONTROL SOLUTION

FREESTYLE FREEDOM LITE

MEDISENSE

MEDISENSE GLUCOSE KETONE CONTR

MINIMED

MINIMED RESERVOIR

NOVOFINE

NOVOFINE AUTOCOVER

ONE TOUCH ULTRA 2

ONE TOUCH ULTRA SMART

ONE TOUCH ULTRA SYSTEM

ONE TOUCH ULTRAMINI

ONE TOUCH VERIO

ONE TOUCH VERIO FLEX

ONE TOUCH VERIO IQ

ONE TOUCH VERIO SYNC

ORTHO-DIAPHRAGM

PARADIGM INFUSION

PARADIGM INSULIN PUMP

PARADIGM SILHOUETTE

POLYFIN QR

PRODIGY INSULIN SYRINGE

PRODIGY PEN NEEDLE

QUICK RELEASE SOFT TEFLON

SILHOUETTE

SOF-SET

SOF-SET MICRO

SOFT TOUCH

SOLOSITE

SURE-T PARADIGM

VGO 20

VGO 30

VGO 40

NON PREFERRED

DEXCOM G4 SENSOR

BLOOD GLUCOSE MONITORING DEVICES & SUPPLIES

PREFERRED

FREESTYLE FREEDOM KIT

FREESTYLE FREEDOM LITE METER

FREESTYLE INSULINX

FREESTYLE INSULINX GLUCOSE SYSTEM

FREESTYLE INSULINX TEST STRIPS

FREESTYLE LITE METER

FREESTYLE LITE TEST STRIPS

FREESTYLE TEST STRIPS

ONE TOUCH ULTRA TEST STRIPS

OPTIUM

OPTIUM EZ

PRECISION PCX, PCX PLUS, POINT OF CARE, Q-I-D

PRECISION XTRA B-KETONE STRIPS

PRECISION XTRA MONITOR

PRECISION XTRA TEST STRIPS

GASTROENTEROLOGY

H2 ANTAGONISTS

GENERIC

cimetidine

famotidine

nizatidine

ranitidine hcl

PREFERRED

CIMETIDINE POWDER

FAMOTIDINE POWDER

RANITIDINE HCL POWDER

PROSTAGLANDINS

GENERIC

misoprostol

PREFERRED

MISOPROSTOL POWDER

OTHER ULCER THERAPY

GENERIC

carafate

lansoprazole/amoxicillin/clarithromycin

sucralfate

PREFERRED

SUCRALFATE POWDER

NON PREFERRED

CARAFATE

PROTON PUMP INHIBITORS

GENERIC

esomeprazole

lansoprazole del rel

omeprazole del rel

omeprazole sodium bicarbonate

pantoprazole sodium

PREFERRED

LANSOPRAZOLE POWDER

OMEPRAZOLE POWDER

NON PREFERRED

NEXIUM

OMEPRAZOLE SODIUM BICARBONATE

ANTIDIARRHEALS

GENERIC

diphenoxylate/atropine

loperamide hcl

opium

paregoric

PREFERRED

LOPERAMIDE HCL

ANTISPASMODICS

GENERIC

dicyclomine hcl

glycopyrrolate

hyoscyamine sulfate

hyoscyamine sulfate disinegrating tablets

hyoscyamine sulfate er

PREFERRED

DICYCLOMINE HCL POWDER

GLYCOPYRROLATE POWDER

HYOSCYAMINE SULFATE POWDER

LEVSIN 0.5MG/ML AMPUL

NON PREFERRED

LEVSIN 0.125MG TABLET

BILE ACIDS

GENERIC

ursodiol

PREFERRED

CHENODAL

CHOLBAM

KINEVAC

URSODIOL POWDER

DIGESTIVE ENZYMES

GENERIC

pancrelipase

PREFERRED

CREON

SUCRAID

VIOKACE

ZENPEP DEL-REL

MISC. GASTROINTESTINAL AGENTS

GENERIC

balsalazide disodium

budesonide

budesonide ec

CITRA PH

hydrocortisone

hydrocortisone/pramoxine

lactulose

mesalamine

metoclopramide hcl

sodium bicarbonate

sulfasalazine

sulfasalazine dr

PREFERRED

AMITIZA

ASACOL HD

CANASA

CORTIFOAM

CYSTADANE

ENTYVIO

HYDROCORTISONE POWDER

LIALDA

LINZESS

MESALAMINE POWDER

METOCLOPRAMIDE HCL POWDER

PENTASA

PROCTOFOAM-HC

RECTIV

RELISTOR

REMICADE

SODIUM BICARBONATE POWDER

SULFASALAZINE POWDER

UCERIS EXTENDED RELEASE

VIBERZI

NON PREFERRED

LOTRONEX

SODIUM BICARBONATE POWDER

sodium chloride/sodium bicarb

UCERIS FOAM

ANTIVERTIGO & ANTIEMETIC AGENTS

GENERIC

dimenhydrinate

dronabinol

droperidol

granisetron hcl

granisol

meclizine hcl

ondansetron hcl

ondansetron ODT

prochlorperazine edisylate

prochlorperazine maleate

trimethobenzamide hcl

PREFERRED

AKYNZEO

ALOXI

DIMENHYDRINATE POWDER

DROPERIDOL POWDER

EMEND

MECLIZINE HCL POWDER

ONDANSETRON HCL POWDER

PROCHLORPERAZINE EDISYLATE POWDER

PROCHLORPERAZINE MALEATE POWDER

SANCUSO

SCOPOLAMINE HYDROBROMIDE

TRIMETHOBENZAMIDE HCL POWDER

BOWEL EVACUANTS

GENERIC

peg 3350-electrolyte

polyethylene glycol

PREFERRED

POLYETHYLENE GLYCOL

PREPOPIK

SUCLEAR

SUPREP

NON PREFERRED

POLYETHYLENE GLYCOL

IMMUNOLOGY, VACCINES & BIOTECHNOLOGY

ERYTHROID STIMULANTS

PREFERRED

ARANESP

PROCRIT

MYELOID STIMULANTS

PREFERRED

GRANIX

LEUKINE

MOZOBIL

NEULASTA

NEUPOGEN

ZARXIO

INTERFERONS

PREFERRED

ACTIMMUNE

ALFERON N

AVONEX

BETASERON

INFERGEN

INTRON A

PEGASYS

PEGASYS PROCLICK

PLEGRIDY

REBIF

REBIF REBIDOSE

SYLATRON

GROWTH HORMONES

PREFERRED

EGRIFTA

GENOTROPIN

HUMATROPE

NORDITROPIN

SEROSTIM

NON PREFERRED

OMNITROPE

INTERLEUKINS

PREFERRED

ARCALYST

ILARIS

NEUMEGA

PROLEUKIN

VACCINES & MISCELLANEOUS IMMUNOLOGICALS

GENERIC

candin

fomepizole

tetanus toxoid

PREFERRED

ACTHIB

ADACEL

AFLURIA

APLISOL

ATGAM

BEXSERO

BIOTHRAX

BOOSTRIX

BOTOX

CERVARIX

COMVAX

CROFAB

CYTOGAM

ENGERIX-B

FLUARIX

FLULAVAL

FLULAVAL QUAD

FLUMIST

FLUVIRIN

FLUZONE

FLUZONE INTRADERM QUAD

GAMASTAN S-D

GAMMAGARD LIQUID

GAMMAGARD S-D

GAMUNEX

GAMUNEX-C

GARDASIL 9

GRASTEK

HAVRIX

HEPAGAM B

HIZENTRA

HYPERHEP B S-D

HYPERRAB S-D

HYPERRHO S-D

HYPERTET S-D

IMOGAM RABIES-HT

IMOVAX RABIES VACCINE

INFANRIX

IPOL

IXIARO

MENACTRA

MENOMUNE-A-C-Y-W-135

M-M-R II VACCINE W/DILUENT

MYOBLOC

PEDIARIX

PEDVAXHIB

PNEUMOVAX 23

PREVNAR 13

PRIVIGEN

PROQUAD

QUADRACEL DTAP-IPV

RABAVERT

RAGWITEK

RECOMBIVAX HB

ROTATEQ

SYNAGIS

TETANUS DIPHTHERIA TOXOIDS

TETANUS DIPHTHERIA TOXOIDS - PED

THERACYS

THYMOGLOBULIN

TICE BCG

TRUMENBA

TUBERSOL

TWINRIX

TYPHIM VI

VAQTA VIAL

VARIVAX VACCINE

VARIZIG

VIVOTIF BERNA DEL REL

YF-VAX

NON PREFERRED

VAQTA SYRINGES

MUSCULOSKELETAL & RHEUMATOLOGY

GOUT THERAPY

GENERIC

allopurinol

allopurinol sodium

probenecid

PREFERRED

ALLOPURINOL POWDER

COLCHICINE POWDER

COLCRYS

KRYSTEXXA

ULORIC

NON PREFERRED

COLCHICINE

OTHER RHEUMATOLOGICALS

GENERIC

leflunomide

PREFERRED

ACTEMRA

BENLYSTA

CUPRIMINE

DEPEN

ENBREL

HUMIRA

ORENCIA

OTREXUP

RIDAURA

SAVELLA

SIMPONI 100MG/ML

NON PREFERRED

SIMPONI 50MG/0.5ML

OSTEOPOROSIS THERAPY

GENERIC

alendronate sodium

ibandronate

ibandronate sodium

risedronate dr

risedronate, sodium

PREFERRED

FORTEO

OBSTETRICS & GYNECOLOGY

MONOPHASIC /BIPHASIC /TRIPHASIC AGENTS

GENERIC

altavera

alyacen

amethia

amethia lo

amethyst

apri

aranelle

aubra

aviane

azurette

balziva

briellyn

camrese

camrese lo

caziant

chateal

cryselle

cyclafem

dasetta

daysee

elinest

emoquette

enpresse

enskyce

estarylla

falmina

gianvi

gildagia

gildess

gildess fe

introvale

jolessa

junel

junel fe

kariva

kelnor 1-35

kurvelo

leena

lessina

levonorgestrel

levora

loryna

low-ogestrel

lutera

marlissa

microgestin

microgestin fe

mono-linyah

mononessa

myzilra

necon

norethindrone/ethinyl estradiol

norethindrone/ethinyl estradiol iron

nortrel

ocella

ogestrel

orsythia

philith

pirmella

portia

quasense

reclipsen

sprintec

sronyx

syeda

tilia fe

tri-estarylla

tri-legest fe

tri-linyah

trinessa

trivora

velivet

vestura

viorele

wera

wymzya fe

zarah

zenchent

zenchent fe

zeosa

zovia

PREFERRED

BEYAZ

LO LOESTRIN FE

NATAZIA

SAFYRAL

OXYTOCICS

GENERIC

methylergonovine maleate

oxytocin

PREFERRED

ERGONOVINE MALEATE

HEMABATE

OXYTOCIN POWDER

NON PREFERRED

METHYLERGONOVINE MALEATE

PROGESTINS

GENERIC

errin

heather

jencycla

jolivette

lyza

medroxyprogesterone acetate

nora-be

norethindrone acetate

progesterone in oil

progesterone micronized

PREFERRED

CALDOLOR

CRINONE

DEPO-PROVERA 400 MG/ML

ENDOMETRIN

MAKENA

NORETHINDRONE ACETATE POWDER

PROGESTERONE MICRONIZED POWDER

NON PREFERRED

DEPO-PROVERA

MEDROXYPROGESTERONE ACETATE POWDER

ESTROGENS

GENERIC

estradiol

estradiol patch

estradiol valerate

estropipate

PREFERRED

CENESTIN

DEPO-ESTRADIOL

DIVIGEL

ENJUVIA

ESTRACE CREAM

ESTRADIOL VALERATE POWDER

MINIVELLE

PREMARIN

PREMARIN CREAM

VAGIFEM

NON PREFERRED

ESTRACE TABLET

ESTROGEN COMBINATIONS

GENERIC

estradiol/norethindrone acetate

estrogen/methyltestosterone

PREFERRED

COMBIPATCH

DUAVEE

PREMPHASE

PREMPRO

VAGINAL CLEANSER /ANTIINFECTIVES

GENERIC

clindamycin phosphate vaginal

VAGINAL ANTIFUNGALS

GENERIC

miconazole 1

terconazole

PREFERRED

MICONAZOLE 1

SPECIALIZED OB/GYN DRUGS

GENERIC

isoxsuprine hcl

PREFERRED

ISOXSUPRINE HCL POWDER

OSPHENA

DIAPHRAGMS AND OTHER NON-ORAL CONTRACEPTIVES

PREFERRED

IMPLANON

MIRENA

NEXPLANON

NUVARING

OPHTHALMOLOGY

BETA-BLOCKERS

GENERIC

betaxolol ophth solution

carteolol hcl

levobunolol hcl drops

metipranolol drops

CHOLINESTERASE INHIBITOR MIOTICS

PREFERRED

PHOSPHOLINE IODIDE DROPS

DIRECT ACTING MIOTICS

GENERIC

pilocarpine hcl

PREFERRED

PILOCARPINE HCL POWDER

PILOPINE HS

OTHER GLAUCOMA DRUGS

GENERIC

bimatoprost

dorzolamide hcl

dorzolamide/timolol

latanoprost drops

physostigmine salicylate

travoprost

PREFERRED

CARBACHOL

COMBIGAN

ISOPTO CARBACHOL 0.015

PHYSOSTIGMINE SALICYLATE

TRAVATAN Z

NON PREFERRED

ISOPTO CARBACHOL 0.03

LATANOPROST DROPS 1GM OIL

ORAL DRUGS FOR GLAUCOMA

GENERIC

acetazolamide

acetazolamide er

methazolamide

PREFERRED

ACETAZOLAMIDE POWDER

METHAZOLAMIDE POWDER

CYCLOPLEGIC MYDRIATICS

GENERIC

atropine sulfate

cyclopentolate ophth solution

homatropine hydrobromide

tropicamide

PREFERRED

ATROPINE SULFATE POWDER

CYCLOPENTOLATE POWDER

HOMATROPINE HYDROBROMIDE

TROPICAMIDE POWDER

NON-STEROIDAL ANTI-INFLAMMATORY AGENTS

GENERIC

bromfenac ophth

flurbiprofen sodium

ketorolac tromethamine drops

PREFERRED

ILEVRO

NEVANAC

PROLENSA

NON PREFERRED

BROMFENAC POWDER

VASOCONSTRICTOR DECONGESTANTS

GENERIC

naphazoline hcl

PREFERRED

NAPHAZOLINE HCL POWDER

ANTIBIOTICS

GENERIC

ciprofloxacin ophth solution

erythromycin ointment

gatifloxacin

gentasol

levofloxacin hemihydrate

neomycin/polymyxin/gramicidin

ofloxacin

tobramycin sulfate drops

PREFERRED

AZASITE

BESIVANCE

MOXEZA

NATACYN

TOBRAMYCIN SULFATE POWDER

VIGAMOX

SULFONAMIDES

GENERIC

sulfacetamide sodium

STEROIDS

GENERIC

fluorometholone

prednisolone acetate

prednisolone sodium phosphate drops

PREFERRED

ALREX

FLUOROMETHOLONE POWDER

FML S.O.P.

LOTEMAX

PRED MILD

PREDNISOLONE ACETATE POWDER

PREDNISOLONE SODIUM PHOSPHATE DROPS POWDER

STEROID-ANTIBIOTIC COMBINATIONS

GENERIC

neomycin/bacitracin/poly/hc

tobramycin/dexamethasone

PREFERRED

TOBRADEX OINTMENT

TOBRADEX ST

ZYLET

NON PREFERRED

TOBRADEX SUSPENSION

STEROID-SULFONAMIDE COMBINATIONS

GENERIC

sulfacetamide w/prednisolone

SYMPATHOMIMETICS

GENERIC

apraclonidine ophth solution

brimonidine ophth solution

PREFERRED

ALPHAGAN P 0.001%

BRIMONIDINE POWDER

NON PREFERRED

ALPHAGAN P 0.0015%

MISCELLANEOUS OPHTHALMOLOGICS

GENERIC

azelastine hcl ophth solution

balanced salt ophth irrigation

cromolyn sodium

epinastine hcl

olopatindine

proparacaine hcl

proparacaine/fluorescein

sodium chloride drops

tetcaine drops

PREFERRED

BEPREVE

CYSTARAN

EYLEA

FLUORESCEIN SODIUM

JETREA

LUCENTIS

PATADAY

PAZEO

PROPARACAINE HCL POWDER

RESTASIS

VISUDYNE

ANTIVIRALS

GENERIC

trifluridine

PREFERRED

TRIFLURIDINE POWDER

RESPIRATORY, ALLERGY, COUGH & COLD

ANTIHISTAMINES

GENERIC

arbinoxa

carbinoxamine

cetirizine syrup

clemastine fumarate

cyproheptadine hcl

desloratadine

desloratadine disintegrating tablets

dexchlorpheniramine maleate er

diphenhydramine

hydroxyzine hcl

hydroxyzine pamoate

levocetirizine dihydrochloride

promethazine hcl

promethegan

PREFERRED

CLEMASTINE FUMARATE POWDER

CYPROHEPTADINE HCL POWDER

DIPHENHYDRAMINE POWDER

HYDROXYZINE HCL POWDER

HYDROXYZINE PAMOATE POWDER

LEVOCETIRIZINE DIHYDROCHLORIDE POWDER

PROMETHAZINE HCL POWDER

PROMETHAZINE HCL TABLETS POWDER

NON PREFERRED

CYPROHEPTADINE HCL 4MG/10ML SYRUP

HYDROXYZINE HCL 50MG/25ML SOLUTION

ADRENERGICS

GENERIC

epinephrine

PREFERRED

EPINEPHRINE POWDER

EPIPEN

EPIPEN JR.

NON PREFERRED

EPINEPHRINE 1MG/ML AMPUL

ANTITUSSIVE COMBINATIONS

GENERIC

benzonatate

chlorphen/pse/dm tannate

D-CHLORPHENIRA/PSE/CHLOPHEDIAN 12.5CPD-1DCPM-30PSE

dihydrocodeine/aspirin/caffeine

dihydrocodeine/bpm/pe

DM/PHENYLEPH/CHLORPHENIRAMINE 10PEH-4CPM-20DM

guaifenesin/codeine

hydrocodone/chlorpheniramine er

hydrocodone/homatropin

promethazine vc/codeine

promethazine/dextromethorphan

PREFERRED

DEXTROMETHORPHAN HBR

TUSSICAPS

NON PREFERRED

GUAIFENESIN/CODEINE

HYDROCODONE/HOMATROPIN

PSEUDOEPH/CHLOPHEDIANOL/GG 12.5CPD-100GFN-30PSE

DECONGESTANT / ANTIHISTAMINES

GENERIC

brompheniramine/pseudoephedrine

phenylephrine/chlorpheniramine 10peh-4cpm

pseudoephedrine hcl

pseudoephedrine hcl er

PREFERRED

PSEUDOEPHEDRINE HCL

NON PREFERRED

pseudoephedrine sulfate er

XANTHINES

GENERIC

aminophylline

caffeine/sodium benzoate

difil-g

theophylline anhydrous drops er 12 hr

theophylline anhydrous er

PREFERRED

AMINOPHYLLINE POWDER

THEOPHYLLINE ANHYDROUS POWDER

NON PREFERRED

AMINOPHYLLINE 500MG/20ML AMPUL

BETA AGONISTS ORAL

GENERIC

albuterol sulfate

ephedrine sulfate

metaproterenol sulfate

terbutaline sulfate

PREFERRED

ALBUTEROL

ALBUTEROL SULFATE POWDER

EPHEDRINE SULFATE POWDER

METAPROTERENOL SULFATE POWDER

TERBUTALINE SULFATE POWDER

BETA AGONISTS INHALERS

GENERIC

levalbuterol hcl

PREFERRED

ARCAPTA NEOHALER

FORADIL

LEVALBUTEROL HCL POWDER

PERFOROMIST

PROAIR HFA

PROAIR RESPICLICK

SEREVENT DISKUS

VENTOLIN HFA

INHALED CORTICOSTEROIDS

GENERIC

budesonide

PREFERRED

ASMANEX, HFA

BUDESONIDE POWDER

FLOVENT DISKUS

FLOVENT HFA

PULMICORT FLEXHALER

QVAR

INTRANASAL STEROIDS

GENERIC

flunisolide

triamcinolone acetonide

PREFERRED

DYMISTA

FLUNISOLIDE POWDER

VERAMYST

MISCELLANEOUS PULMONARY AGENTS

GENERIC

acetylcysteine

cromolyn sodium

ipratropium bromide

ipratropium/albuterol nebulization

montelukast sodium

sildenafil citrate

sodium chloride

zafirlukast

PREFERRED

ACETYLCYSTEINE POWDER

ADCIRCA

ADEMPAS

ADVAIR DISKUS

ADVAIR HFA

ANORO ELLIPTA

ARNUITY ELLIPTA

BERINERT

BREO ELLIPTA

CINRYZE

COMBIVENT RESPIMAT

CROMOLYN SODIUM POWDER

DALIRESP

DULERA

FIRAZYR

IPRATROPIUM BROMIDE POWDER

KALBITOR

LETAIRIS

MONTELUKAST SODIUM POWDER

NUCALA

OPSUMIT

ORKAMBI

PULMOZYME

SILDENAFIL CITRATE POWDER

SPIRIVA RESPIMAT

STIOLTO RESPIMAT

SYMBICORT

TRACLEER

TUDORZA PRESSAIR

TYVASO

VENTAVIS

XOLAIR

UROLOGICALS

CHOLINERGIC STIMULANTS

GENERIC

bethanechol chloride

PREFERRED

BETHANECHOL CHLORIDE POWDER

ANTICHOLINERGICS & ANTISPASMODICS

GENERIC

darifenacin er

flavoxate hcl

oxybutynin chloride

oxybutynin chloride er

tolterodine tartrate

trospium chloride er

PREFERRED

GELNIQUE

MYRBETRIQ ER 24 HR

OXYBUTYNIN CHLORIDE POWDER

TOVIAZ

VESICARE

URINARY ANESTHETICS

GENERIC

phenazopyridine hcl

phenazopyridine plus

PREFERRED

PHENAZOPYRIDINE HCL POWDER

MISCELLANEOUS UROLOGICALS

GENERIC

alprostadil

glycine

hyophen

phosphasal

potassium citrate er

tricitrates

uretron d-s

urimar-t

urin d.s.

urogesic

ustell

PREFERRED

ALPROSTADIL POWDER

AMINOACETIC ACID

AMMONIUM CHLORIDE

CAVERJECT

CIALIS

CYSTAGON

ELMIRON

GLYCINE POWDER

K-PHOS ORIGINAL

MUSE

RENACIDIN

VIAGRA

NON PREFERRED

AMINOACETIC ACID POWDER

BENIGN PROSTATIC HYPERPLASIA (BPH) THERAPY

GENERIC

alfuzosin hcl er

finasteride

tamsulosin hcl er 24 hr

PREFERRED

FINASTERIDE POWDER

RAPAFLO

VITAMINS, HEMATINICS & ELECTROLYTES

VITAMINS & HEMATINICS

GENERIC

advanced am/pm

ascorbic acid

bal-care dha

b-complex

cavan-alpha kit

cavan-ec sod dha

centratex

choice-ob + dha

choice-tabs

complete natal dha

corvita

dailyvite

dexferrum

dialyvite 800

elite ob

elite-ob

elite-ob 400

fabb

fe 90 plus

fe c

ferocon

ferotrinsic

ferraplus 90

ferrex 150 forte

ferrex 150 forte plus

ferrex 28

ferrocite plus

ferrogels forte

folbecal

folbee

folbee plus

folbic

folcaps

folcaps omega-3

folic acid

folic acid/cyancobal/pyridoxine

folivane-f

folivane-ob

folivane-plus

folivane-prx dha nf

folplex 2.2

foltanx

hematinic plus

hematinic with folic acid

hematogen

hematogen fa

hematogen forte

hemenatal ob

hemenatal ob + dha

hemetab

hydroxocobalamin

iferex 150 forte

inatal advance

inatal gt

inatal ultra

infed

l-mefolate-pyridox-mecobalamin

l-methyl-b6-b12

l-methylfolate calcium

m.v.i. adult

macnatal cn dha

mefolate-pyridox-mecobalamin

metafolbic

methyl-b6-b12

multigen

multigen folic

multigen plus

multivitamin w/fluoride & iron

multivitamin with fluoride

mynatal

mynatal advance

mynatal caps

mynatal plus

mynatal-z

mynate 90 plus er

mynephrocaps

natal-v rx

natalvirt 90 dha

natalvirt ca

natalvirt flt

nephplex rx

nephro-vite rx

nutri-tab ob

obstetrix dha

pnv ob+dha

pnv-dha

pnv-first

pnv-omega

pnv-select

pnv-total

poly-iron 150 forte

polysaccharide iron forte

pr natal 400

pr natal 400 ec

pr natal 430

pr natal 430 ec

prefol-dha

prena1

prena1 chew

prena1 plus

prenaissance

prenaissance 90 dha

prenaissance balance

prenaissance dha

prenaissance harmony dha

prenaissance next

prenaissance plus

prenaplus

prenatabs fa

prenatabs rx

prenatal ad

prenatal low iron

prenatal plus

prenatal-u

pyridoxine hcl

relnate dha

renal caps

renalpren

rena-vite rx

reno caps

se-natal 19

se-tan dha prenatal

se-tan plus

setonet

setonet ec

strovite

taron forte

taron prenatal

taron-bc

taron-c dha

taron-duo ec

therapeutic hematinic

therapeutic vitamin/minerals

thiamine hcl

tl gard rx

tl g-fol os

tl icon

tl-care dha

tl-fol 500 er

tl-hem 150 er 24 hr

tl-select

tri rx

triadvance

tricon

trigels-f forte

trinatal gt

trinatal rx 1

trinatal ultra

trinate

triphrocaps

triveen-duo dha

triveen-one

triveen-prx rnf

triveen-ten

triveen-u

trust natal dha

ultimate ob dha

ultimatecare one

ultimatecare one nf

v-c forte

vemavite-prx 2

vena-bal dha

venatal complete dha

venatal-fa

vinacal

vinate az

vinate c

vinate calcium

vinate dha

vinate gt

vinate ic

vinate ii

vinate one

vinate ultra

vinate-m

virt-bal dha

virt-bal dha plus

virt-pn

virt-pn dha

virt-pn plus

virt-select

virt-vite

virt-vite forte

vitacirc-b

vitafol-ob

vitafol-pn

vitamin a

v-natal

vol-care rx

vol-nate

vol-plus

vol-tab rx

vp-ch plus

vp-ch-pnv

vp-era ob plus

vp-ggr-b6

vp-heme one

zatean-ch

zatean-pn

zatean-pn dha

zatean-pn plus

zingiber

PREFERRED

AQUASOL A

ASCORBIC ACID

FERAHEME

FOLIC ACID POWDER

HYDROXOCOBALAMIN POWDER

INFUVITE

L-METHYLFOLATE CALCIUM POWEDER

M.V.I. PEDIATRIC

M.V.I.-12

NASCOBAL

PYRIDOXINE HCL

THIAMINE HCL POWDER

TROPHAMINE

VENOFER

VITAMIN A

NON PREFERRED

B-COMPLEX

CENOLATE

CONCEPTION XR MOTILITY

DIALYVITE 800

DULEEK-MET NEW

folbic rf

FOLIC ACID 20MG CAP

FOLIC ACID-VIT B12

PYRIDOXINE HCL 500MG TABLETS

STUART ONE

THIAMINE HCL

VITAMIN A

vitaspire

vynatal-fa

POTASSIUM

GENERIC

pot chloride/dextrose/ns

potassium acetate

potassium bicarbonate

potassium chloride

potassium chloride/dextrose

PREFERRED

POTASSIUM ACETATE

POTASSIUM BICARBONATE

POTASSIUM CHLORIDE

OTHER ELECTROLYTES

GENERIC

calcium acetate

calcium chloride

calcium gluconate

chromium chloride

copper chloride

eliphos

k-phos neutral

magnesium chloride

magnesium sulfate

manganese

manganese sulfate

multitrace-4

nutrilyte

nutrilyte ii

potassium chl-normal saline

ringers

selenium

sodium acetate

sodium chloride

sodium lactate

zinc chloride

zinc sulfate

PREFERRED

ADDAMEL N

CALCIUM ACETATE POWDER

CALCIUM CHLORIDE

CALCIUM GLUCONATE 61MG

CALCIUM GLUCONATE POWDER

CUPRIC SULFATE

GLYCOPHOS

MAGNESIUM CHLORIDE

MAGNESIUM SULFATE

MAGNESIUM SULFATE IN DEXTROSE

MANGANESE SULFATE POWDER

MULTITRACE-4

MULTITRACE-5

NEUT

NORMOSOL-R AND DEXTROSE

PEDITRACE

SODIUM ACETATE POWDER

SODIUM LACTATE

TPN ELECTROLYTES 18-18-5MEQ

TRACE ELEMENTS

ZINC CHLORIDE

ZINC SULFATE

NON PREFERRED

CALCIUM ACETATE

CALCIUM GLUCONATE 50MG

CUPRIC SULFATE

MAGNESIUM SULFATE 100MG CAPSULE

SELENIUM

TPN ELECTROLYTES 35-20-5MEQ

MISCELLANEOUS NUTRITION PRODUCTS

GENERIC

alz-nac

amino acid

freamine iii

hetastarch w/sodium chloride

intralipid

l-methylfolate-mecobalamin-nac

metafolbic plus

premasol

travasol

vp-zel

PREFERRED

AMINOSYN

BAL IN OIL

CLINIMIX

CLINIMIX E

FREAMINE HBC

FREAMINE III

HEPATAMINE

HEPATASOL

IONOSOL B WITH DEXTROSE 5%

ISOLYTE S

NEPHRAMINE

NORMOSOL-M AND DEXTROSE

NORMOSOL-R PH 7.4

PLASMA-LYTE 148

PREMASOL

PROCALAMINE

PROSOL

NON PREFERRED

AMINO ACID 700MG TABLETS

INTRALIPID

METHYLFOLATE MECOBALAMIN-NAC 6-600-2MG

BLOOD DERIVATIVES

GENERIC

albumin

NON PREFERRED

ALBUMIN

DIAGNOSTICS & MISCELLANEOUS AGENTS

MISCELLANEOUS AGENTS

GENERIC

acamprosate calcium

acetic acid irrigation

anagrelide hydrochloride

bupivacaine/dextrose

caffeine citrated

cevimeline hcl

citric acid

deferoxamine

delflex w/dextrose

dextrose in lactated ringers

dextrose in water

dextrose with sodium chloride

disulfiram

etidronate disodium

etomidate

ketamine hcl

levocarnitine

md-gastroview

midodrine hcl

pilocarpine hcl

propofol

riluzole

sodium chloride

sodium phosphate 3mmol/ml vial

sodium polystyrene sulfonate

sodium thiosulfate

water

water intravenous solution

water solution; irrigation

PREFERRED

ACETIC ACID

ADAGEN

AMMONUL

ARALAST NP

BREVITAL

BROMHEXINE HYDROCHLORIDE

BUPHENYL

CAFFEINE CITRATED POWDER

CARBAGLU

CHEMET

CITRIC ACID POWDER

DISULFIRAM POWDER

EOVIST

ETHAMOLIN

ETOMIDATE POWDER

EXJADE

EXTRANEAL ICODEXTRIN DIALYSIS

FERRIPROX

FOSRENOL

HEXTEND LACTATED ELECTROLYTE

INCRELEX

ISOVUE 0.61ML VIAL

ISOVUE-M 0.61ML VIAL

JADENU

KANUMA

KETAMINE HCL POWDER

LEVOCARNITINE POWDER

LEXISCAN

MAGNEVIST VIAL

NATPARA

OMNIPAQUE

ORFADIN

PANHEMATIN

PROHANCE VIAL

PROLASTIN C

RAVICTI

RENVELA

SEROTONIN HCL

SODIUM PHOSPHATE

SODIUM THIOSULFATE

SOLIRIS

SOTRADECOL

STRENSIQ

THALLOUS CHLORIDE TL-201

THYROGEN

TRYPSIN

VELTASSA

VISIPAQUE 270 MG/ML INFUSION

WATER

XIAFLEX

XURIDEN

ZEMAIRA

NON PREFERRED

BUPHENYL POWDER

DELFLEX W/DEXTROSE

ISOVUE

ISOVUE-M 0.41ML VIAL

KETAMINE HCL 50MG/ML SYRINGE

MAGNEVIST SYRINGE

ORFADIN 4MG/ML SUSPENSION

PROHANCE SYRINGE

PROSTAMEN

SODIUM POLYSTYRENE SULFONATE

VISIPAQUE

SMOKING DETERRENTS

PREFERRED

CHANTIX

ANOREXIANTS

GENERIC

benzphetamine hcl

diethylpropion hcl

phendimetrazine tartrate

phendimetrazine tartrate er

phentermine hcl

PREFERRED

DIETHYLPROPION HCL POWDER

PHENTERMINE HCL POWDER

NEUTRACEUTICALS

PREFERRED

UVA URSI LEAF FLUID EXTRACT

IRRIGATING SOLUTIONS

GENERIC

neomycin-polymyxin b

ringers irrigation

ANTIDOTES

PREFERRED

PROTOPAM CHLORIDE

NON PREFERRED

ATROPEN

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