2019 STANDARD ALTERNATIVE DRUG LIST (October - December …

2020 STANDARD ALTERNATIVE DRUG LIST (January - March 2020)

The alternatives listed are suggestions based on how the drug works and the condition it treats. You should discuss your therapy with your doctor of health care provider. Some alternatives may require prior authorization or have quantity limits.

Product Name 7TOPIC EMU ABILIFY MYCI TAB ABSORICA CAP ACANYA GEL ACTOPLUS MET TAB XR ACUVAIL SOL ACZONE GEL ADAZIN CRE ADLYXIN INJ ADVANCED MIS AM/PM AEMCOLO TAB AEROSPAN AER AFREZZA POW ALA-QUIN CRE ALBUTEROL AER HFA ALCORTIN A GEL ALDACTAZIDE TAB ALEVICYN SOL DERMAL

ALTERNATIVE DRUG Epiceram, Prumyx aripiprazole tab Claravis, Myorisan, Zenatane adapalene, clindamycin, tretinoin metformin/ER, pioglitazone ketorolac ophthalmic adapalene, clindamycin, tretinoin lidocaine, lidocaine-tetracaine, lidocaine-prilocaine Byetta, Bydureon, Ozempic, Trulicity, Victoza BP Vit 3 Plus Xifaxan Asmanex, Flovent, QVAR RediHaler Humulin/Humalog Products econazole, mupirocin, hydrocortisone valerate Ventolin HFA, ProAir HFA oxiconazole cream, ketoconazole, hydrocortisone valerate spironolactone-HCTZ, amlodipine-valsartan-HCTZ, atenolol-chlorthalidone, benazepril-HCTZ doxepin cream, triamcinolone cream, mometasone cream

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Product Name ALLZITAL TAB ALOCRIL SOL ALOG/PIOGLIP TAB ALOG/PIOGLIT TAB ALOGLIPTIN TAB ALOGLIPTIN/ TAB METFORM ALOQUIN GEL ALORA DIS ALREX SUS ALTABAX OIN ALTOPREV TAB ER ALVESCO AER AMICAR SOL AMICAR TAB AMRIX CAP ANACAINE OIN ANADROL-50 TAB ANALPRAM E KIT ANALPRAM KIT ADVANCED ANALPRAM-HC LOT ANGELIQ TAB ANIMI-3 CAP ANIMI-3 CAP VIT D ANTARA CAP APADAZ TAB

ALTERNATIVE DRUG butalbital/acetaminophen tablet 50-325MG cromolyn, ketotifen Janumet, Janumet XR, Jentadueto Janumet, Janumet XR, Jentadueto Januvia, Tradjenta Janumet, Janumet XR, Jentadueto oxiconazole cream, ketoconazole, econzaole estradiol once weekly patch, estradiol twice-weekly patch, estradiol tablets dexamethasone ophthalmic, prednisolone ophthalmic, triamcinolone ophthalmic mupirocin lovastatin Asmanex, Flovent, QVAR RediHaler aminocaproic acid, tranexamic acid aminocaproic acid, tranexamic acid cyclobenzaprine tablet lidocaine, lidocaine-tetracaine Procrit, Epogen hydrocortisone/pramoxine, hydrocortisone aloe hydrocortisone/pramoxine, hydrocortisone aloe hydrocortisone/pramoxine, hydrocortisone aloe estradiol-norethindrone acetate tablets, Jinteli tablets folbic folbic fenofibrate, gemfibrozil hydrocodone/APAP, oxycodone, oxycodone/APAP, morphine sulfate ER

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Product Name APAP/CAFFEIN TAB DIHYDROC APIDRA INJ SOLOSTAR APIDRA INJ U-100 AQUORAL AER AQUORAL SPR ARCAPTA CAP ARIKAYCE SUS ARNUITY ELPT INH ARYMO ER TAB ASTAGRAF XL CAP ASTERO GEL ATENDIA PAD ATOPADERM CRE AUVI-Q INJ AVAILNEX CHW AVANDIA TAB AVAR AER AVAR LS AER AVAR LS PAD AVAR PAD AZASAN TAB AZASAN TAB MG AZASITE SOL AZELEX CRE AZENASE PAK MIS

ALTERNATIVE DRUG butalbital-APAP-caffeine-codeine, APAP-codeine Humulin/Humalog Products Humulin/Humalog Products Magic Mouthwash, Lidocaine 2%, Mouth Kote Magic Mouthwash, Lidocaine 2%, Mouth Kote Serevent amikacin sulfate solution Asmanex, Flovent, QVAR RediHaler hydrocodone/APAP, oxycodone, oxycodone/APAP, morphine sulfate ER tacrolimus, Prograf lidocaine 3% gel/cream/lotion lidocaine, lidocaine-tetracaine, lidocaine-prilocaine Hylatopic Plus, HPR Plus, Neosalus epinephrine solution auto-injector Nortuss-Ex liquid pioglitazone sulfacetamide sodium w/ sulfur foam 10-5% sulfacetamide sodium w/ sulfur foam 10-5% sulfacetamide sodium w/ sulfur pad 10-4% sulfacetamide sodium w/ sulfur pad 10-4% azathioprine, cyclosporine, mycophenolate, tacrolimus azathioprine, cyclosporine, mycophenolate, tacrolimus bacitracin ointment ophthalmic, ciprofloxacin ophthalmic adapalene, clindamycin, tretinoin azelastine nasal spray, fluticasone nasal spray, budesonide nasal spray

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Product Name AZESCO TAB 13-1MG BASAGLAR INJ BECONASE AQ SUS BELSOMRA TAB BENSAL HP OIN BENZHY/ACETA TAB BENZIQ GEL BENZIQ LS GEL BEPREVE DRO BESIVANCE SUS BIDIL TAB BIFERARX TAB BIONECT AER BIO-STATIN CAP BP VIT CAP PLUS BRINTELLIX TAB BROVANA NEB B-SERENE PAD BUNAVAIL MIS BUPAP TAB BUTISOL SOD TAB BUTRANS DIS BYSTOLIC TAB BYVALSON TAB CAMPHOMEX SPR

ALTERNATIVE DRUG Prenatal Plus, Protect Plus Lantus, Toujeo fluticasone nasal spray zolpidem, zaleplon, eszopiclone ketoconazole, econzaole, topical corticosteroids hydrocodone/APAP, oxycodone, oxycodone/APAP, morphine sulfate ER benzoyl peroxide gel (4%, 8%) benzoyl peroxide gel (4%, 8%) azelastine, ketotifen, olopatadine ciprfloxacin ophthalmic, ofloxacin ophthalmic isosorbide, hydralazine iron asp gly/polysacch compl/ascorb CAL/b12/fa/c hyaluronate sodium 0.2% cream/gel nystatin tab folbic paroxetine, fluoxetine, escitalopram Serevent folbic, ondansetron buprenorphine/naloxone butalbital/acetaminophen tablet 50-325MG zolpidem, zaleplon, eszopiclone morphine sulfate ER atenolol, betaxolol, bisoprolol, carvedilol, metoprolol amlodipine/valsartan, telmisartan/amlodipine, trandolapril, verapamil diclofenac topical

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Product Name CAPEX SHA CAPHOSOL SOL CAPITAL/COD SUS CARAFATE SUS CARDIZEM LA TAB CARDURA XL TAB CENFOL TAB CEQUA SOL CETACAINE AER CIALIS TAB CIFEREX CAP CLIMARA PRO DIS WEEKLY CLINDAGEL GEL CLINDESSE CRE CODAR AR LIQ COLY-MYCIN S SUS OTIC COLYTE/FLAVR SOL PACKS COMBIGAN SOL CONDYLOX GEL CONZIP CAP CORDRAN TAP CORDRAN CRE CORDRAN LOT CORDRAN OIN COREMINO TAB

ALTERNATIVE DRUG fluocinolone oil/solution Magic Mouthwash, Lidocaine 2%, Mouth Kote acetaminophen/codeine sol 120-12/5 sucralfate diltiazem ER, Taztia XT, Cartia XT, Matzim LA, verapamil ER alfuzosin, tamsulosin, doxazosin, terazosin folbic Restasis, Xiidra lidocaine, lidocaine-tetracaine, lidocaine-prilocaine Sildenafil 25mg, 50mg, 100mg, tadalafil 2.5mg, 5mg Vitamin D 50,000 units and Folbic estradiol once weekly patch, estradiol twice-weekly patch, estradiol tablets adapalene, clindamycin, tretinoin clindamycin vaginal cream, metronidazole vaginal gel hydrocodone-chlorpheniramine suspension Cipro HC Otic Gavilyte-G, Gavilyte-C, PEG-3350 dorzolamide/timolol ophthalmic podofilox 0.5% solution tramadol mometasone, triamcinolone, fluocinolone betamethasone dipropionate, mometasone, hydrocortisone valerate mometasone, triamcinolone, fluocinolone mometasone, triamcinolone, fluocinolone doxycycline, minocycline

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Product Name CORTANE-B LOT CORTIFOAM AER CORTISPORIN CRE CYCLOMYDRIL SOL OP DEBACTEROL SOL DENAVIR CRE DEPLIN CAP DERMACINRX PAK DUOPATCH DERMASORB HC KIT DERMASORB TA KIT DESONATE GEL DEXAMETHASON TAB PAK DEXILANT CAP DR DEXPAK PAK DIALYVITE TAB 3000 DIALYVITE TAB 5000 DIALYVITE/ TAB ZINC DICLEGIS TAB DICLOVIX KIT DIVIGEL GEL DORYX MPC TAB DOXYCYCLINE TAB HYCL ER DUEXIS TAB DUOPA SUS DURACHOL CAP 1-3775IU

ALTERNATIVE DRUG pramoxine-HC cream 1-2.5% hydrocortisone, hemril-30, hydrocortisone/lidocaine, hydrocortisone/pramoxine, proctosol HC mupirocin, fluocinolone acetate tropicamide, atropine Episil, triamcinolone oral paste acyclovir ointment, famciclovir, valacyclovir l-methylfolate tab 15mg, folbic lidocaine, lidocaine-tetracaine, lidocaine-prilocaine hydrocortisone 2.5% cream, lotion triamcinolone mometasone, hydrocortisone valerate, fluocinolone prednisone, methylprednisolone, dexamethasone omeprazole 40mg, lansoprazole 30mg pantoprazole 20, 40mg, rabeprazole 20mg prednisone, methylprednisolone, dexamethasone Dialyvite tablets, Dialyvite Supreme D, Nephronex, Triphrocaps, Virt-Caps Dialyvite tablets, Dialyvite Supreme D, Nephronex, Triphrocaps, Virt-Caps Dialyvite tablets, Dialyvite Supreme D, Nephronex, Triphrocaps, Virt-Caps ondansetron, prochlorperzine, metoclopramide, promethazine diclofenac topical estradiol once weekly patch, estradiol twice-weekly patch, estradiol tablets DOXYCYCLINE HYCLATE TAB doxycycline hyclate, doxycycline monohydrate etodolac, diclofenac, ibuprofen, omeprazole 40mg, lansoprazole 30mg pantoprazole 20mg carbidopa/levodopa Vitamin D 50,000 units and Folbic

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Product Name DUREZOL EMU DURLAZA CAP DUTOPROL TAB DVORAH TAB DXEVO PAK DYMISTA SPR ECOZA AER EDLUAR SUB ELESTRIN GEL ELFOLATE TAB PLUS ELIDEL CRE ELIGEN B12 TAB ELMIRON CAP EMBEDA CAP EMEND SUS EMSAM DIS ENDOMETRIN SUP ENSTILAR AER ENTTY EMU SPRAY EPIDUO FORTE GEL EPIDUO GEL EPIFOAM AER EQUETRO CAP ERTACZO CRE ESCAVITE D CHW

ALTERNATIVE DRUG fluorometholone susp clopidogrel, prasugrel atenolol/Chlorthalidone, bisoprolol/HCTZ, metoprolol/HCTZ butalbital-APAP-caffeine-codeine, APAP-codeine dexamethasone, prednisone azelastine nasal spray, fluticasone nasal spray, budesonide nasal spray ketoconazole, econazole zolpidem, zaleplon, eszopiclone estradiol once weekly patch, estradiol twice-weekly patch, estradiol tablets l-methylfolate tab 15mg, folbic tacrolimus folbic amitriptyline, cimetidine, hydroxyzine morphine sulfate ER aprepitant oral capsule/therapy pack sertraline, escitalopram, venlafaxine ER progesterone capsules, Crinone mometasone, hydrocortisone valerate, fluocinolone Epiceram, Prumyx adapalene, clindamycin, tretinoin adapalene, clindamycin, tretinoin pramoxine-HC cream 1-2.5% carbamazepine ER tab, risperidone, quetiapine oxiconazole cream, ketoconazole, econzaole TRI-VIT/FL DRO 0.25MG, MVC-Fluoride CHW, Floriva Plus, Vitamax Pediatric

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Product Name ESCAVITE LQ DRO ESOMEPRAZOLE CAP ESTRACE VAG CRE ESTRING MIS ESTROGEL GEL EURAX CRE EURAX LOT EVAMIST SPR EXELDERM CRE EXELDERM SOL EZALLOR SPR CAP FABIOR AER FACTIVE TAB FANAPT PAK FANAPT TAB FE 90 PLUS TAB FEMRING MIS FENORTHO CAP FERIVA TAB FERIVAFA CAP FERRALET TAB FERRO-PLEX TAB FERROTRIN CAP FETZIMA CAP FETZIMA CAP TITRATIO

ALTERNATIVE DRUG TRI-VIT/FL DRO 0.25MG, MVC-Fluoride CHW, Floriva Plus, Vitamax Pediatric omeprazole 40mg, lansoprazole 30mg pantoprazole 20, 40mg, rabeprazole 20mg estradiol tablets, Premarin vaginal cream estradiol tablets, Premarin vaginal cream estradiol once weekly patch, estradiol twice-weekly patch, estradiol tablets permethrin permethrin estradiol once weekly patch, estradiol twice-weekly patch, estradiol tablets oxiconazole cream, ketoconazole, econzaole oxiconazole cream, ketoconazole, econzaole rosuvastatin tablets, atorvastatin tablets Claravis, Myorisan, Zenatane levofloxaxin, ciprofloxacin, moxifloxacin risperidone, quetiapine, olanzapine, ziprasidone risperidone, quetiapine, olanzapine, ziprasidone multi-vit/iron/fluoride, vinate care estradiol tablets, Premarin vaginal cream naproxen, etodolac multi-vit/iron/fluoride, vinate care multi-vit/iron/fluoride, vinate care multi-vit/iron/fluoride, vinate care Ferrex 150 Forte Plus Ferrex 150 Forte Plus paroxetine, fluoxetine, escitalopram paroxetine, fluoxetine, escitalopram

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