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ZOOM+Performance - Medication List

  CB = Covered Benefit   Prescription required. A 100% Covered Benefit without cost sharing if all coverage criteria required under the Affordable Care Act are met.
  T1 (Tier 1) = Preferred Generics  
  T2 (Tier 2) = Preferred Brand Name Drugs   May also include single source generic medications. (i.e. generic medications that are only available from one manufacuturer)
  T3 (Tier 3) = Non-preferred Brand Name Drugs   Contains high cost brand name medications. These drugs have therapeutic alternatives in Tier 1 or 2 or can include brand medications where a generic equivalent is available.
  T4 (Tier 4) = Specialty Medications   These medications are typically self injected, used to treat complex medical conditions, require special handling or have other unique requirements. They may also require more involvement with your physician &/or pharmacy.
  PA = Prior Authorization Required   Requires extra steps or information and approval before coverage.
 

*This list is subject to change at any time and coverage is based on your specific benefit plan.

Medication Tier / PA
Reviewed on September 23, 2016
8-MOP (Methoxsalen)T2
A
ABACAVIR SULFATE TAB T1
ABACAVIR/LAMIVUDINE/ZIDOVUDINE T1
ABILIFY MAINTENA T2
ABRAXANE (Paclitaxel, albumin bound) T4
ABSORICA T2
ACAMPROSATE CALCIUM T1
ACARBOSE T1
ACEBUTOLOL HCL T1
ACETAMINOPHEN-CODEINE T1
ACETAMINOPHEN, DICHLORALPHENAZONE; ISOMETHEPTENE (MIDRIN®) T1
ACETAZOLAMIDE T1
ACETIC ACID T1
ACETIC ACID-ALUMINUM T1
ACETYLCYSTEINE T1
ACITRETIN T4
ACTEMRA (Tocilizumab) T4, PA
ACTIMMUNE (Interferon Gamma-1b) T4
ACYCLOVIR T1
ACZONE (Dapsone) T3
ADAGEN (Pegademase Bovine) T4
ADAPALENE T1, PA
ADEFOVIR DIPIVOXIL T4
ADEMPAS (Riociguat) T4
ADVAIR (Fluticasone; Salmeterol) T2
AFINITOR (Everolimus) T4, PA
AKYNZEO T2, PA
ALBENZA (Albendazole) T2
ALBUTEROL NEBULES T1
ALCLOMETASONE DIPROPIONATE T1
ALDURAZYME (Laronidase) T4
ALENDRONATE T1
ALFUZOSIN HCL ER T1
ALIMTA (Pemetrexed) T4, PA
ALINIA (Nitazoxanide) T2
ALKERAN (Melphalan) T2
ALLOPURINOL T1
ALOXI (Palonosetron) T3, PA
ALPHANATE (Antihemophilic Factor VIII) T4
ALPHANINE SD (Factor IX) T4
ALPRAZOLAM T1
ALPROLIX (Factor IX) T4
ALREX (Loteprednol) T2
ALUMINUM CHLORIDE- TOPICAL T1
AMANTADINE T1
AMCINONIDE T1
AMILORIDE HCL T1
AMILORIDE-HYDROCHLOROTHIAZIDE T1
AMIODARONE HCL T1
AMITIZA (Lubiprostone) T3
AMITRIPTYLINE HCL T1
AMLODIPINE BESYLATE T1
AMLODIPINE BESYLATE-BENAZEPRIL T1
AMLODIPINE-VALSARTAN T1
AMLODIPINE/VALSARTAN/HCTHIAZID T1
AMOXAPINE T1
AMOXICILLIN-CLAVULANATE T1
AMPICILLIN T1
AMPICILLIN-SULBACTAM T1
ANAGRELIDE HCL T1
ANASTROZOLE T1
ANDRODERM (Testosterone) T2, PA
ANDROGEL T2
ANDROGEL PACKET (Testosterone) T2, PA
ANORO ELLIPTA T2
ANTIPYRINE-BENZOCAINE T1
APOKYN (apomorphine) T4
APRACLONIDINE HCL T1
APTIVUS T2
ARANESP (Darbepoetin Alpha) T4, PA
ARCALYST (Rilonacept) T4, PA
ARGATROBAN T2, PA
ARIPIPRAZOLE T1
ARMODAFINIL T1
ARMOUR THYROID T2
ARNUITY ELLIPTA T2
ARRANON (Nelarabine) T4
ARZERRA (Ofatumumab) T4, PA
ASACOL HD (Mesalamine, 5-ASA) T2
ASMANEX Twisthaler T2
ASMANEX HFA T2
ASPIRIN CB
ASPIRIN/DIPYRIDAMOLE T1
ATENOLOL T1
ATENOLOL-CHLORTHALIDONE T1
ATORVASTATIN T1
ATOVAQUONE T1
ATOVAQUONE ORAL SUSP T1
ATOVAQUONE-PROGUANIL HCL T1
ATRIPLA T2
ATROPINE SULFATE T1
ATROVENT HFA (Ipratropium) T2
AUGMENTIN SUSPENSION (Amoxicillin; Clavulanic Acid) T2
AUVI-Q T2, PA
AVASTIN (Bevacizumab) T4, PA
AVONEX (Interferon Beta-1a) T4, PA
AVYCAZ T2, PA
AXIRON T2
AZACITIDINE T4
AZASAN (AzaTHIOprine) T3
AZASITE (Azithromycin) T3
AZATHIOPRINE T1
AZELASTINE HCL DROPS/SPRAY T1
AZILECT (Rasagiline) T2
AZITHROMYCIN T1
B
BACITRACIN T1
BACITRACIN-POLYMYXIN B TOPICAL T1
BACLOFEN T1
BALSALAZIDE DISODIUM T1
BANZEL (Rufinamide) T4, PA
BARACLUDE SOLUTION (Entecavir) T4
BEBULIN VH IMMUNO (FACTOR IX) T4
BELLADONNA-OPIUM SUPPOSITORY T1
BELLADONNA-PHENOBARBITAL T1
BENAZEPRIL HCL T1
BENAZEPRIL-HYDROCHLOROTHIAZIDE T1
BENEFIX (Factor IX) T4
BENLYSTA (Belimumab) T4
BENZONATATE T1
BENZOYL PEROXIDE T1
BENZTROPINE MESYLATE T1
BESIVANCE (Besifloxacin) T3
BETAMETHASONE T1
BETAXOLOL HCL T1
BETHANECHOL CHLORIDE T1
BETHKIS T4,PA
BETOPTIC S (Betaxolol) T2
BEXSERO T2
BEYAZ (Drospirenone, Ethinyl Estradiol, Levomefolate) T2
BICALUTAMIDE T1
BICNU (Carmustine) T2
BIMATOPROST T1
BISOPROLOL FUMARATE T1
BISOPROLOL-HYDROCHLOROTHIAZIDE T1
BLINCYTO T2, PA
BLOOD SUGAR TEST STRIPS T2
BOSULIF (Bosutinib) T4, PA
BRILINTA (Ticagrelor) T3
BRIMONIDINE TARTRATE T1
BROMFENAC SODIUM T1
BROMOCRIPTINE MESYLATE T1
BUDESONIDE T1
BUMETANIDE T1
BUPHENYL (Sodium Phenylbutyrate) T2
BUPRENORPHINE HCL T1, PA
BUPRENORPHINE-NALOXONE T1, PA
BUPROPION IR/SR/XL T1
BUSPIRONE HCL T1
BUSULFEX (Busulfan) T2
BUTALB-CAFF-ACETAMINOPH-CODEINE (FIORICET W/ CODEINE®) T1
BUTALBITAL-ACETAMINOPHEN T1
BUTALBITAL-ACETAMINOPHEN-CAFFEINE (FIORICET®) T1
BUTALBITAL-ASPIRIN-CAFFEINE (FIORINAL®) T1
BUTORPHANOL T1, PA
BUTRANS (Buprenorphine) T3, PA
BYDUREON (Exenatide) T2, PA
BYDUREON PEN T2, PA
BYETTA (Exenatide) T2, PA
BYSTOLIC (Nebivolol) T3
C
CABERGOLINE T1
CALCIPOTRIENE T1
CALCIPOTRIENE-BETAMETHASONE T1
CALCIUM ACETATE T1
CANAGLIFLOZIN/METFORMIN T1
CANASA (Mesalamine) T2
CANDESARTAN CILEXETIL T1
CANDESARTAN-HYDROCHLOROTHIAZIDE T1
CAPASTAT SULFATE (Capreomycin) T4
CAPECITABINE T4
CAPTOPRIL T1
CAPTOPRIL-HYDROCHLOROTHIAZIDE T1
CARAC (Fluorouracil) T2
CARAFATE (Sucralfate) T3
CARBAMAZEPINE T1
CARBIDOPA T1
CARBIDOPA-LEVODOPA (SINEMET®) T1
CARBIDOPA-LEVODOPA-ENTACAPONE (STALEVO®) T1
CARBINOXAMINE MALEATE T1
CARBOPLATIN T2
CARTEOLOL HCL T1
CARVEDILOL T1
CAYSTON (Aztreonam) T4, PA
CEFACLOR T1
CEFADROXIL T1
CEFAZOLIN T1
CEFDINIR T1
CEFEPIME T3
CEFOTAXIME T1
CEFOTETAN T1
CEFOXITIN T1
CEFPODOXIME PROXETIL T1
CEFPROZIL T1
CEFTAZIDIME T3
CEFTIBUTEN T3
CEFTRIAXONE T2
CEFUROXIME T1
CELECOXIB T1
CELONTIN (Methsuximide) T2
CEPHALEXIN T1
CERDELGA T2, PA
CEREZYME (Imiglucerase) T4,PA
CEVIMELINE HCL T1
CHANTIX (Varenicline) CB
CHEMET (Succimer) T2
CHLORAL HYDRATE T1
CHLORDIAZEPOXIDE HCL T1
CHLORDIAZEPOXIDE-AMITRIPTYLINE T1
CHLORDIAZEPOXIDE-CLIDINIUM T1
CHLORHEXIDINE GLUCONATE T1
CHLOROQUINE PHOSPHATE T1
CHLOROTHIAZIDE T1
CHLOROXYLENOL; HYDROCORTISONE; PRAMOXINE T1
CHLORPROMAZINE T1
CHLORTHALIDONE T1
CHLORZOXAZONE T1
CHOLESTYRAMINE T1
CICLOPIROX T1
CIDOFOVIR T4
CILASTATIN T4, PA
CILOSTAZOL T1
CIPRODEX (Ciprofloxacin - Dexamethasone ) T2
CIPROFLOXACIN T1
CISPLATIN T1
CITALOPRAM HBR T1
CLARITHROMYCIN T1
CLAVULANATE T3
CLINDAMYCIN T1
CLINDAMYCIN PHOS 1%/BENZOYL PEROXIDE 5% T1
CLINDAMYCIN-BENZOYL PEROXIDE T1
CLOBETASOL T1
CLOLAR (Clofarabine) T4
CLOMIPRAMINE HCL T1
CLONAZEPAM T1
CLONIDINE T1
CLONIDINE-CHLORTHALIDONE T1
CLOPIDOGREL T1
CLORAZEPATE DIPOTASSIUM T1
CLOTRIMAZOLE T1
CLOTRIMAZOLE-BETAMETHASONE T1
CLOZAPINE T1
COARTEM (Artemether; Lumefantrine) T2
CODEINE SULFATE T1
COLCRYS (Colchicine) T2
COLESTIPOL HCL T1
COMBIGAN (Brimonidine; Timolol) T3
COMBIPATCH (Estradiol; Norethindrone) T2
COMBIVENT RESPIMAT (Albuterol; Ipratropium) T2
COMPLERA T2
CONDYLOX (Condylox) T3
CONTRACEPTIVES, DEVICES & IMPLANTS CB-T2
CONTRACEPTIVES, INJECTABLES CB-T2
CONTRACEPTIVES, ORAL, BRAND T2
CONTRACEPTIVES, ORAL, GENERIC CB
CONTRACEPTIVES, OVER THE COUNTER CB
COREG CR (Carvedilol - multiphasic release) T3
CORIFACT (Factor XII)) T4
CORTIFOAM (Hydrocortisone) T3
CORTISONE ACETATE T1
COSENTYX T2, PA
CREON (Pancrelipase) T2
CRESEMBA T2, PA
CRESTOR (Rosuvastatin) T3, PA
CRINONE (Progesterone) T3
CRIXIVAN T2
CROMOLYN SODIUM T1
CYCLOBENZAPRINE HCL T1
CYCLOPENTOLATE HCL T1
CYCLOPHOSPHAMIDE T1
CYCLOSPORINE T1
CYPROHEPTADINE HCL T1
CYRAMZA (Ramucirumab) T3
CYSTADANE (Betaine) T2
CYSTAGON (Cysteamine) T4
D
DALIRESP (Roflumilast) T3, PA
DALVANCE (Dalbavancin) T4
DANAZOL T1
DANTROLENE SODIUM T1
DAPSONE T1
DARAPRIM (Pyrimethamine) T2
DAYTRANA PATCH (Methylphenidate) T3
DECITABINE T4
DELZICOL (Mesalamine, 5-ASA) T2
DEMECLOCYCLINE HCL T1
DEMSER (Metyrosine) T3
DENAVIR (Penciclovir) T3
DEPO-ESTRADIOL (Estradiol cypionate) T2
DEPO-MEDROL (Methylprednisolone acetate) T2
DEPO-PROVERA (Medroxyprogesterone acetate) T2
DEPOCYT (Cytarabine) T2
DESCOVYT2, PA
DESMOPRESSIN ACETATE T1
DESONIDE T1
DESOXIMETASONE T1
DEXAMETHASONE T1
DEXCOM G4 T2
DEXMEDETOMIDINE HCL T1
DEXMETHYLPHENIDATE HCL (FOCALIN®) T1
DEXMETHYLPHENIDATE HCL XR T1
DEXTROAMPHETAMINE-AMPHET (ADDERALL®) T1
DIABETIC TESTING STRIPS (BLOOD & URINE) T2
DIAPHRAGM T3
DIAZEPAM T1
DIBENZYLINE (Phenoxybenzamine) T3
DICLOFENAC T1
DICLOFENAC SODIUM-MISOPROSTOL T1
DICLOXACILLIN SODIUM T1
DICYCLOMINE HCL T1
DIDANOSINE T1
DIFFERIN (Adapalene) T2, PA
DIFLORASONE DIACETATE T1
DIFLUNISAL T1
DIGOXIN T1
DILTIAZEM T1
DIMENHYDRINATE T1
DIPHENOXYLATE-ATROPINE T1
DIPYRIDAMOLE T1
DISULFIRAM T1
DIVALPROEX T1
DIVIGEL (Estrodiol) T2
DONEPEZIL HCL T1
DORIPENEM T4, PA
DORZOLAMIDE HCL T1
DORZOLAMIDE-TIMOLOL T1
DOXAZOSIN MESYLATE T1
DOXEPIN HCL T1
DOXERCALCIFEROL T1
DOXYCYCLINE T1
DUAVEE T2
DULERA (Formoterol-Mometasone) T2
DULOXETINE HCL T1
DUREZOL (Difluprednate) T3
E
ECONAZOLE NITRATE T1
EDARBI T2, PA
EDARBYCLOR T2
EDURANT T2
EGRIFTA (Tesamorelin) T4, PA
ELETONE (Emollient, miscellaneous) T3
ELIDEL (Pimecrolimus) T3
ELIQUIS (Apixaban) T3, PA
ELITEK (Rasburicase) T4
ELMIRON (Pentosan Polysulfate Sodium) T2
ELOCTATE (Antihemophilic Factor, Fc Fusion Protein) T4
EMCYT (Estramustine) T2
EMTRIVA T2
ENALAPRIL MALEATE T1
ENALAPRIL-HYDROCHLOROTHIAZIDE T1
ENBREL (Etanercept) T4, PA
ENDOMETRIN (Progesterone) T2
ENJUVIA (Conjugated Estrogens) T2
ENOXAPARIN SODIUM (LOVENOX) T4
ENTACAPONE T1
ENTECAVIR T1
EPIDUO (Adapalene; Benzoyl Peroxide) T3
EPINASTINE HCL T1
EPINEPHRINE AUTOJECT T1
EPIPEN (Epinephrine) T2
EPLERENONE T1
EPROSARTAN MESYLATE T1
EPZICOM T2
ERBITUX (Cetuximab) T4, PA
ERGOLOID MESYLATES T1
ERIVEDGE (Vismodegib) T4, PA
ERTAPENEM T4, PA
ERYTHROMYCIN T1
ESCITALOPRAM T1
ESOMEPRAZOLE MAGNESIUM T1
ESTAZOLAM T1
ESTRACE VAGINAL (Estradiol) T2
ESTRADIOL T1
ESTRADIOL-NORETHINDRONE ACE T1
ESTROGEN-METHYLTESTOSTERONE T1
ESTROPIPATE T1
ESZOPICLONE T1
ETHAMBUTOL HCL T1
ETHOSUXIMIDE T1
ETIDRONATE DISODIUM T1
ETODOLAC T1
ETOPOSIDE T1
EVAMIST (Estradiol) T2
EXEMESTANE T1
EXJADE (Deferasirox) T4
EXTAVIA (Interferon Beta-1b) T4, PA
F
FABRAZYME (Agalsidase Beta) T4
FAMCICLOVIR T1
FARESTON (Toremifene) T2
FASLODEX (Fulvestrant) T4
FE C PLUS (Cyanocobalamin, Folic Acid, Iron, and Vitamin C) T2
FEIBA NF (Anti-inhibitor Coagulant Complex) T4
FELBAMATE T1
FELODIPINE ER T1
FEM PH (Glacial acetic acid & Oxyquinoline) T2
FENOFIBRATE T1
FENOFIBRIC ACID T2
FENOPROFEN CALCIUM T1
FENTANYL CITRATE LOZENGE T1, T4, PA
FENTANYL LOZENGE T1
FENTANYL PATCH T1
FEROCON (Iron w/ Vitamin B12 & intrinsic factor) T2
FERREX 150 FORTE PLUS (Multivitamins w/ minerals- including iron) T2
FERREX 28 (Iron, Succinic Acid, Vitamin C, Folic Acid, and Vitamin B12) T2
FERROCITE PLUS (Ferrous Fumarate ) T2
FIDAXOMICIN T3
FINACEA (Azelaic Acid) T3
FINASTERIDE T1
FLAVOXATE HCL T1
FLECAINIDE ACETATE T1
FLOVENT T2
FLUCAINE T1
FLUCONAZOLE T1
FLUCYTOSINE T1
FLUDROCORTISONE ACETATE T1
FLUMIST T2
FLUNISOLIDE T1
FLUOCINOLONE T1
FLUOCINONIDE T1
FLUORIDE CB-T1
FLUORIDE W/ MULTIVITAMINS T1
FLUOROMETHOLONE T1
FLUOROURACIL T1
FLUOXETINE T1
FLUPHENAZINE T1
FLURAZEPAM HCL T1
FLURBIPROFEN T1
FLUTAMIDE T1
FLUTICASONE PROPIONATE T1
FLUVASTATIN SODIUM T1
FLUVOXAMINE T1
FLUZONE T2
FML S.O.P. (Fluorometholone) T2
FOLBECAL (Prenatal Multivitamins and Minerals) T2
FOLIC ACID CB-T1
FOLOTYN (PRALAtrexate) T4, PA
FONDAPARINUX SODIUM T4
FORADIL (Formoterol) T2
FORTEO (Teriparatide) T4, PA
FOSCARNET SODIUM T4
FOSINOPRIL SODIUM T1
FOSRENOL T2
FRAGMIN (Dalteparin) T4
FUROSEMIDE T1
FUZEON T2
FYCOMPA (Perampanel) T3, PA
G
GABAPENTIN T1
GABITRIL (TiaGABine) T2
GALANTAMINE HBR T1
GARDASIL T2
GATIFLOXACIN T1
GELNIQUE (Oxybutynin) T3
GEMFIBROZIL T1
GENOTROPIN (Somatropin, rh-GH) T4, PA
GENTAMICIN SULFATE T1
GILOTRIF (Afatinib) T4, PA
GLATIRAMER ACETATE T1
GLIMEPIRIDE T1
GLIPIZIDE T1
GLIPIZIDE-METFORMIN T1
GLUCAGON T2
GLYBURIDE T1
GLYBURIDE-METFORMIN T1
GLYCOPYRROLATE T1
GRANISETRON HCL T1
GRISEOFULVIN T1
GUAIFENESIN-CODEINE T1
GUANFACINE HCL T1
GUANIDINE HCL T1
H
HALAVEN (EriBULin) T4, PA
HALFLYTELY-BISACODYL (Polyethylene Glycol; Electrolytes; Bisacodyl) T3
HALOBETASOL PROPIONATE T1
HALOPERIDOL T1
HELIXATE FS (Antihemophilic Factor VIII) T4
HEMABATE (Carboprost Tromethamine ) T2
HEMETAB (Polysaccharide-Iron Complex, Vitamin B12, and Folic Acid) T2
HEPARIN SODIUM T1
HERCEPTIN (Trastuzumab) T4, PA
HEXALEN (Altretamine) T2
HUMALOG (Insulin Lispro) T2
HUMALOG MIX 50-50 (Insulin:Lispro-Lispro Protamine) T2
HUMALOG MIX 75-25 (Insulin:Lispro-Lispro Protamine) T2
HUMATE-P (Antihemophilic Factor VIII) T4
HUMATROPE (Somatropin) T4, PA
HUMIRA (Adalimumab) T4, PA
HUMULIN R (Regular Insulin) T2
HYDRALAZINE HCL T1
HYDROCHLOROTHIAZIDE T1
HYDROCOD-CPM-PSEUDOEPHEDRIN T1
HYDROCODONE-ACETAMINOPHEN T1
HYDROCODONE-CHLORPHENIRAMIN T1
HYDROCODONE-HOMATROPINE T1
HYDROCODONE-IBUPROFEN T1
HYDROCORTISONE T1
HYDROCORTISONE-ACETIC ACID (ACETASOL HC) T1
HYDROCORTISONE-IODOQUINOL T1
HYDROCORTISONE-PRAMOXINE TOPICAL T1
HYDROGEL (Topical combination, miscellaneous) T2
HYDROMORPHONE T1
HYDROXYCHLOROQUINE T1
HYDROXYUREA T1
HYDROXYZINE T1
HYOSCYAMINE SULFATE T1
I
IBANDRONATE SODIUM T1
IBRANCE T2, PA
IBUPROFEN T1
IFOSFAMIDE-MESNA T1
IMATINIB MESYLATE T4, PA
IMBRUVICA (Ibrutinib) T4, PA
IMIPENEM T4, PA
IMIPRAMINE T1
IMIQUIMOD T1
IMMUNIZATION VACCINES CB
INDAPAMIDE T1
INDOMETHACIN T1
INFERGEN (Interferon Alfacon-1) T4
INLYTA (Axitinib) T4, PA
INSULIN SYRINGES T2
INTELENCE T2
INTRON A (Interferon Alfa-2b) T4
INVIRASE T2
IPRATROPIUM BROMIDE T1
IPRATROPIUM-ALBUTEROL T1
IRBESARTAN T1
IRBESARTAN-HYDROCHLOROTHIAZIDE T1
IRESSA (Gefitinib) T4
IRINOTECAN HCL T1
IRON CB
ISENTRESS T2
ISONIAZID T1
ISOSORBIDE DINITRATE T1
ISOSORBIDE MONONITRATE T1
ISOTRETINOIN ORAL T3
ISOXSUPRINE HCL T1
ISTODAX (RomiDEPsin) T4, PA
ITRACONAZOLE T1
IVERMECTIN T1
IXEMPRA (Ixabepilone) T4
J
JAKAFI (Ruxolitinib) T4, PA
JANUMET XR (Metformin; Sitagliptin) T2, PA
JANUVIA (SitaGLIPtin) T2, PA
JENTADUETO T2, PA
JEVTANA (Cabazitaxel) T4, PA
JINTELI (FEMHRT®) T1
K
KADCYLA (Ado-Trastuzumab emtansine) T4, PA
KALBITOR (Ecallantide) T4
KALETRA T2
KALYDECO (Ivacaftor) T4, PA
KEPIVANCE (Palifermin) T3
KETOCONAZOLE T1
KETOPROFEN T1
KETOROLAC TROMETHAMINE T1
KEYTRUDA T2
KLOR-CON T1
KUVAN (Sapropterin) T4
L
L-METHYLFOLATE CALCIUM T1
LABETALOL HCL T1
LACTIC ACID T1
LACTULOSE T1
LAMIVUDINE T1
LAMIVUDINE-ZIDOVUDINE T1
LAMOTRIGINE T1
LAMOTRIGINE ODT T1
LANCETS T2
LANSOPRAZOL-AMOXICIL-CLARIT T1
LANSOPRAZOLE T1
LANTUS (Insulin Glargine ) T2
LATANOPROST T1
LAZANDA T2, PA
LEFLUNOMIDE T1
LEMTRADA T2
LENVIMA T2, PA
LETAIRIS (Ambrisentan) T4, PA
LETROZOLE T1
LEUCOVORIN CALCIUM T1
LEUKERAN (Chlorambucil) T2
LEUKINE (Sargramostim) T4
LEUPROLIDE ACETATE (2 week kit) T1
LEVALBUTEROL HCL T1
LEVEMIR (Insulin Detemir) T2
LEVETIRACETAM T1
LEVOBUNOLOL HCL T1
LEVOCARNITINE T1
LEVOFLOXACIN T1
LEVONORGESTREL (PLAN B®) CB
LEVORPHANOL TARTRATE T1
LEVOTHROID® T3
LEVOTHYROXINE T1
LEVOXYL® T3
LEXIVA T2
LIDOCAINE HCL T1
LIDOCAINE HCL-EPINEPHRINE T1
LIDOCAINE-HYDROCORTISONE T1
LIDOCAINE-PRILOCAINE T1
LINDANE T1
LIOTHYRONINE SODIUM T1
LISINOPRIL T1
LISINOPRIL-HYDROCHLOROTHIAZIDE T1
LITHIUM CARBONATE T1
LO LOESTRIN FE (Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate) T2
LOMUSTINE T1
LORAZEPAM T1
LOSARTAN POTASSIUM T1
LOSARTAN-HYDROCHLOROTHIAZIDE T1
LOTEMAX (Loteprednol) T2
LOTRONEX (Alosetron) T3
LOVASTATIN T1
LOXAPINE T1
LYNPARZA T2, PA
LYRICA (Pregabalin) T3, PA
LYSODREN (Mitotane) T2
M
MAGNESIUM CHLORIDE T2
MALATHION T1
MAPROTILINE HCL T1
MARQIBO (VinCRIStine) T3
MATULANE (Procarbazine) T2
MEBENDAZOLE T1
MECLOFENAMATE SODIUM T1
MEDROXYPROGESTERONE ACETATE T1
MEFENAMIC ACID T1
MEFLOQUINE HCL T1
MEGESTROL ACETATE T1
MEKINIST (Trametinib) T4, PA
MELOXICAM T1
MELPHALAN HCL T4
MEPERIDINE HCL (solution for injection) T1
MEPHYTON (Phytonadione) T2
MERCAPTOPURINE T1
MEROPENEM T4
MESALAMINE (Rectal Susp) T1
METAPROTERENOL SULFATE T1
METAXALONE T1
METFORMIN HCL T1
METFORMIN HCL ER (GLUCOPHAGE XR®) T1
METHADONE HCL T1, PA
METHAZOLAMIDE T1
METHENAMINE T1
METHIMAZOLE T1
METHOCARBAMOL T1
METHOTREXATE T1
METHOXSALEN T1
METHYCLOTHIAZIDE T1
METHYLDOPA T1
METHYLDOPA-HYDROCHLOROTHIAZIDE T1
METHYLDOPATE T1
METHYLERGONOVINE MALEATE T1
METHYLPHENIDATE (CONCERTA®, RITALIN®, METADATE®) T1
METHYLPREDNISOLONE T1
METIPRANOLOL T1
METOCLOPRAMIDE HCL T1
METOLAZONE T1
METOPROLOL T1
METOPROLOL-HYDROCHLOROTHIAZIDE T1
METRONIDAZOLE T1
MEXILETINE HCL T1
MIACALCIN INJECTABLE (Calcitonin) T2
MIDAZOLAM HCL T1
MIDODRINE HCL T1
MIGERGOT (Caffeine; Ergotamine) T1
MINASTRIN 24 FE (Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate) T2
MINOCYCLINE HCL T1
MINOXIDIL T1
MIRAPEX ER (Pramipexole) T2, PA
MIRENA (Levonorgestrel) T2
MIRTAZAPINE T1
MISOPROSTOL T1
MODAFINIL T1, PA
MOEXIPRIL HCL T1
MOMETASONE FUROATE T1
MONOBASIC POTASSIUM PHOSPHATE T2
MONONINE (Factor IX Concentrate) T4
MONTELUKAST SODIUM T1
MORPHINE SULFATE (MS CONTIN®, AVINZA®, KADIAN®) T1
MOVANTIK T2, PA
MOVIPREP (Polyethylene Glycol; Electrolytes) T3
MOXIFLOXACIN HCL T1
MOZOBIL (Plerixafor) T4
MULTIGEN (Iron supplement w/ Vit C) T2
MUPIROCIN T1
MYALEPT (Metreleptin) T4, PA
MYCOPHENOLATE MOFETIL T1
MYCOPHENOLIC T1
MYLERAN (Busulfan) T2
MYOCHRYSINE (Gold Sodium Thiomalate ) T2
MYRBETRIQ (Mirabegron) T2
N
NABUMETONE T1
NADOLOL T1
NADOLOL-BENDROFLUMETHIAZIDE T1
NAFCILLIN T1
NAGLAZYME (Galsulfase) T4
NALOXONE HCL T1, PA
NALTREXONE HCL (DEPADE) T1, PA
NAMENDA (Memantine) T2
NAPHAZOLINE HCL T1
NAPROXEN T1
NARATRIPTAN HCL T1
NASCOBAL (Cyanocobalamin) T2
NATACYN (Natamycin) T2
NATEGLINIDE T1
NATPARA T2, PA
NATURE-THROID (WESTHROID®) T1
NEBUPENT (Pentamidine) T2
NEOMYCIN SULFATE T1
NEOMYCIN-BACITRACIN-POLY-HC T1
NEOMYCIN-BACITRACIN-POLYMYX T1
NEOMYCIN-POLYMYXIN-DEXAMETHASONE T1
NEOMYCIN-POLYMYXIN-GRAMICIDIN T1
NEOMYCIN-POLYMYXIN-HYDROCORTISONE T1
NEULASTA (Pegfilgrastim) T4, PA
NEUPOGEN (Filgrastim) T4
NEVANAC T1
NEVIRAPINE T1
NEVIRAPINE XR T1
NEXAVAR (SORAfenib) T4, PA
NIACIN ER (NIASPAN®) T1
NICARDIPINE HCL T1
NICOTROL, NICOTROL NS CB
NIFEDIPINE ER T1
NILUTAMIDE T1, PA
NIMODIPINE T1
NISOLDIPINE T1
NITRO-BID (Nitroglycerin) T2
NITROFURANTOIN T1
NITROGLYCERIN T1
NITROGLYCERIN SPRAY T1
NIVATOPIC PLUS (Emollient combination) T2
NORDITROPIN (Somatropin) T4, PA
NORETH ACETATE 1MG/ETHINYL ESTRADIOL 0.02MG T1
NORETHINDRONE ACETATE T1
NORTRIPTYLINE T1
NORVIR T2
NOVOLOG (Insulin Aspart) T2
NOVOLOG MIX 70-30 (Insulin Aspart-Aspart protamine ) T2
NOVOSEVEN (Factor VIIa) T4
NOXAFIL (Posaconazole) T4
NUEDEXTA (Dextromethorphan; Quinidine) T3
NUVARING (Ethinyl Estradiol; Etonogestrel) CB-T2,PA
NUVIGIL T2, PA
NYSTATIN T1
NYSTATIN-TRIAMCINOLONE T1
O
OBIZUR T2
OCTREOTIDE ACETATE T4
OFLOXACIN T1
OLANZAPINE T1
OLOPATADINE HCL T1
OLYSIO (Simeprevir) T4, PA
OMEGA-3 ACID ETHYL ESTERS (LOVAZA®) T1
OMEPRAZOLE T1
ONCASPAR (Pegaspargase) T4
ONDANSETRON HCL T1
ONEXTON T2, PA
ONFI (Clobazam) T3, PA
OPDIVO T2, PA
OPIUM TINCTURE T1
ORENCIA (Abatacept) T4, PA
ORFADIN (Nitisinone) T4
ORPHENADRINE CITRATE T1
OXACILLIN T1
OXANDROLONE T1, PA
OXAPROZIN T1
OXAZEPAM T1
OXCARBAZEPINE T1
OXSORALEN (Methoxsalen) T2
OXTELLAR XR T2, PA
OXYBUTYNIN T1
OXYCODONE HCL T1
OXYCODONE HCL-IBUPROFEN T1
OXYCODONE-ACETAMINOPHEN T1
OXYCODONE-ASPIRIN T1
OXYCONTIN (Oxycodone) T3, PA
OXYMORPHONE T1
OXYTROL (Oxybutynin) T3
P
PANCRELIPASE T2
PANTOPRAZOLE SODIUM T1
PARICALCITOL T1, PA
PAROMOMYCIN SULFATE T1
PAROXETINE HCL T1
PATADAY (Olopatadine) T3
PEG 3350-ELECTROLYTE (GAVILYTE-C) T1
PEG-3350 W/ FLAVOR PACKS (GAVILYTE-N, TRILYTE WITH FLAVOR PACKET) T1
PEGANONE (Ethotoin) T4
PEGASYS (Peginterferon Alfa-2a) T4, PA
PEMIROLAST POTASSIUM T3
PENICILLIN G POTASSIUM T1
PENICILLIN V POTASSIUM T1
PENTASA (Mesalamine, 5-ASA) T2
PENTOSTATIN T4
PENTOXIFYLLINE T1
PERFOROMIST (Formoterol) T3
PERINDOPRIL ERBUMINE T1
PERJETA (Pertuzumab) T4, PA
PERMETHRIN T1
PERPHENAZINE T1
PERPHENAZINE-AMITRIPTYLINE T1
PHENAZOPYRIDINE HCL T1
PHENELZINE SULFATE T1
PHENOBARBITAL T1
PHENYLEPHRINE HCL T1
PHENYTOIN T1
PHOSPHOLINE IODIDE T1
PILOCARPINE HCL T1
PILOPINE HS (Pilocarpine) T2
PIOGLITAZONE HCL T1
PIOGLITAZONE-GLIMEPIRIDE T1
PIOGLITAZONE-METFORMIN T1
PIPERACILLIN T1
PIROXICAM T1
PLEGRIDY T2, PA
PODOFILOX T1
POLYMYXIN B-TRIMETHOPRIM T1
POLYSACCHARIDE IRON FORTE T1
POLYVITAMIN WITH IRON-FLUOR T1
POMALYST (Pomalidomide) T4, PA
POTASSIUM CHLORIDE T1
POTASSIUM CITRATE ER T1
POTIGA (Ezogabine) T3
PRADAXA (Dabigatran Etexilate ) T2
PRAMIPEXOLE DIHYDROCHLORIDE T1
PRAMOSONE (Hydrocortisone; Pramoxine) T2
PRAMOXINE-HYDROCORTISONE T1
PRAVASTATIN SODIUM T1
PRAZOSIN HCL T1
PRED MILD (Prednisolone) T2
PREDNICARBATE T1
PREDNISOLONE T1
PREDNISONE T1
PREMARIN (Conjugated Estrogens) T2
PREMPHASE (Conjugated Estrogens; Medroxyprogesterone) T2
PREMPRO (Conjugated Estrogens; Medroxyprogesterone) T2
PRENATAL MULTIVITAMINS T1-T2
PREZISTA T2
PRIFTIN (Rifapentine) T3
PRIMAQUINE T1
PRIMIDONE T1
PRISTIQ (Desvenlafaxine) T2
PROAIR HFA (Albuterol) T2
PROBENECID T1
PROBENECID-COLCHICINE T1
PROCAINAMIDE HCL T1
PROCHLORPERAZINE T1
PROCRIT (Epoetin Alfa) T4, PA
PROCTOSOL-HC T1
PROFILNINE (Factor IX Complex) T4
PROGESTERONE T1
PROGLYCEM (Diazoxide) T2
PROLEUKIN (Aldesleukin) T4
PROMACTA (Eltrombopag) T4,PA
PROMETHAZINE HCL T1
PROMETHAZINE-CODEINE T1
PROMETHAZINE-DEXTROMETHORPHAN T1
PROMETHAZINE-PHENYLEPHRINE-CODEINE T1
PROPAFENONE HCL T1
PROPARACAINE HCL (PARCAINE) T1
PROPRANOLOL T1
PROPRANOLOL-HYDROCHLOROTHIAZIDE T1
PROPYLTHIOURACIL T1
PROSTIGMIN (Neostigmine) T2
PROTRIPTYLINE HCL T1
PROVENTIL HFA (albuterol) T3
PRUCLAIR (Topical combination, miscellaneous) T2
PRUDOXIN (Doxepin) T3
PRUMYX (zenieva) T2
PRUTECT TOPICAL (Topical combination, miscellaneous) T2
PULMOZYME (Dornase Alfa) T4
PYLERA (Bismuth Subcitrate Potassium; Metronidazole; Tetracycline) T3
PYRAZINAMIDE T1
PYRIDOSTIGMINE BROMIDE T1
Q
QUAZEPAM T1
QUETIAPINE IR T1
QUINAPRIL HCL T1
QUINAPRIL-HYDROCHLOROTHIAZIDE T1
QUINIDINE T1
QUININE T1, PA
QVAR (Beclomethasone) T2
R
RALOXIFENE HCL CB-T1
RAMIPRIL T1
RANEXA (Ranolazine) T3
RAPIVAB T2, PA
REBIF (Interferon Beta-1A) T4, PA
RECTIV (Nitroglycerin) T2
RELENZA (Zanamivir) T3
RELISTOR (Methylnaltrexone) T4, PA
REMICADE (Infliximab) T4, PA
REMODULIN (Treprostinil) T4, PA
RENVELA POWDER PACKET (Sevelamer) T3
REPAGLINIDE T1
REPAGLINIDE/METFORMIN HCL T1
RESCRIPTOR T2
RESERPINE T1
RESTASIS (CycloSPORINE) T3
RETAVASE (Reteplase) T2
REVLIMID (Lenalidomide) T4, PA
REYATAZ T2
REYATAZ (Powder) T2, PA
RIBAPAK (Ribavirin) T4
RIBASPHERE (Ribavirin) T4
RIBAVIRIN T4
RIDAURA (Auranofin) T2
RIFABUTIN T1
RIFAMPIN T1
RILUZOLE T1
RIMANTADINE HCL T1
RISEDRONATE SODIUM T1
RISPERIDONE T1
RITUXAN (Rituximab) T4, PA
RIVASTIGMINE T1
RIVASTIGMINE 24HR PATCH T1
RIZATRIPTAN T1
ROPINIROLE HCL T1
ROPIVACAINE HCL T1
ROZEREM (Ramelteon) T3, PA
S
SABRIL (Vigabatrin) T4
SAFYRAL (Drospirenone; Ethinyl Estradiol; Levomefolate) T2
SALSALATE T1
SAMSCA (Tolvaptan) T4
SANDIMMUNE T2
SANDOSTATIN LAR DEPOT T2, PA
SANTYL (Collagenase) T3
SELEGILINE HCL T1
SELENIUM SULFIDE T1
SELZENTRY T2
SENSIPAR (Cinacalcet) T4
SEREVENT DISKUS (Salmeterol) T2
SEROQUEL XR T3, PA
SEROSTIM (Somatropin) T4, PA
SERTRALINE HCL T1
SEVELAMER CARBONATE T1
SIGNIFOR (Pasireotide) T3
SILDENAFIL 20mg (Revatio) T1, PA
SILVER NITRATE T1
SILVER SULFADIAZINE T1
SIMULECT (Basiliximab) T4
SIMVASTATIN T1
SIROLIMUS T1
SIRTURO (Bedaquiline) T4
SMOKING CESSATION (OTC); NICOTINE: GUM, LOZENGE, PATCH CB
SMOKING CESSATION (RX); BUPROPION, CHANTIX, NICOTROL CB
SODIUM ACETATE T2
SODIUM CHLORIDE T1
SODIUM GLUCONATE T2
SODIUM PHENYLBUTYRATE T1
SODIUM POLYSTYRENE SULFONATE T1
SODIUM SULFACETAMIDE T1
SODIUM SULFACETAMIDE-SULFUR T1
SOLU-CORTEF (Hydrocortisone) T2
SOLU-MEDROL (Methylprednisolone) T3
SOMAVERT (Pegvisomant) T4,PA
SOTALOL T1
SOTYLIZE T2
SOVALDI (Sofosbuvir) T4,PA
SPIRIVA (Tiotropium) T2
SPIRIVA RESPIMAT T2
SPIRONOLACTONE T1
SPIRONOLACTONE-HCTZ T1
SPORANOX (Itraconazole) T2
SPRYCEL (Dasatinib) T4, PA
STAVUDINE T1
STIMATE (Desmopressin) T4
STIVARGA (Regorafenib) T4, PA
STRATTERA (AtoMOXetine) T2
STREPTOZOCIN T3
STRIBILD T2
SUCRAID (Sacrosidase) T3
SUCRALFATE T1
SULFACETAMIDE-PREDNISOLONE T1
SULFADIAZINE T1
SULFAMETHOXAZOLE-TRIMETHOPRIM T1
SULFAMYLON (Mafenide ) T3
SULFASALAZINE T1
SULINDAC T1
SUMATRIPTAN T1
SUPREP (Sodium Sulfate, Potassium Sulfate, Magnesium Sulfate) T3
SUSTIVA T2
SUTENT (SUNItinib) T4, PA
SYLATRON 4-PACK (Peginterferon Alfa-2b) T4, PA
SYLVANT (Siltuximab) T4, PA
SYMBICORT (Budesonide; Formoterol) T2
SYMLIN (Pramlintide) T3, PA
SYNAGIS (Palivizumab) T4, PA
SYNAREL (Nafarelin) T4
SYNERCID (Dalfopristin; Quinupristin) T2
SYNTHROID® T3
T
TABLOID (Thioguanine) T2
TACROLIMUS T1
TAFINLAR (Dabrafenib) T4, PA
TAMIFLU (Oseltamivir) T2
TAMOXIFEN CITRATE CB-T1
TAMSULOSIN HCL T1
TARCEVA (Erlotinib) T4, PA
TARGRETIN ORAL (Bexarotene) T3
TARGRETIN TOPICAL (Bexarotene) T4
TASIGNA (Nilotinib) T4, PA
TAZORAC (Tazarotene) T2
TELMISARTAN T1
TELMISARTAN-AMLODIPINE T1
TELMISARTAN-HYDROCHLOROTHIAZIDE T1
TEMAZEPAM T1
TEMOZOLOMIDE T1
TERAZOSIN HCL T1
TERBINAFINE HCL T1
TERBUTALINE SULFATE T1
TERCONAZOLE T1
TESTOSTERONE -INJECTABLE T1
TESTOSTERONE TOPICAL GEL T1, PA
TETRACAINE HCL T1
TETRACYCLINE HCL T1
THALOMID (Thalidomide) T4
THEOPHYLLINE T1
THIORIDAZINE HCL T1
THIOTHIXENE T1
TIAGABINE HCL T1
TICARCILLIN T3
TIKOSYN (Dofetilide) T4
TIMOLOL T1
TINIDAZOLE T1
TIVICAY T2
TIZANIDINE HCL T1
TOBI PODHALER (Tobramycin) T4,PA
TOBRADEX (Dexamethasone; Tobramycin) T2
TOBRAMYCIN T1
TOBRAMYCIN-DEXAMETHASONE T1
TOLMETIN SODIUM T1
TOLTERODINE T1
TOPIRAMATE T1
TORISEL (Temsirolimus) T4
TORSEMIDE T1
TOVIAZ (Fesoterodine) T2
TRACLEER (Bosentan) T4, PA
TRADJENTA T2, PA
TRAMADOL HCL T1
TRAMADOL HCL-ACETAMINOPHEN T1
TRANDOLAPRIL T1
TRANDOLAPRIL/VERAPAMIL HCL T1
TRANEXAMIC ACID T3
TRANSDERM-SCOP (Scopolamine) T2
TRANYLCYPROMINE SULFATE T1
TRAVATAN Z (Travoprost) T2
TRAVOPROST T1
TRAZODONE HCL T1
TRETINOIN ORAL T1
TRETINOIN TOPICAL T1, PA
TREXALL (Methotrexate) T3
TRIAMCINOLONE T1
TRIAMTERENE-HCTZ T1
TRIAZOLAM T1
TRIFLUOPERAZINE HCL T1
TRIFLURIDINE T1
TRIHEXYPHENIDYL HCL T1
TRIMETHOBENZAMIDE HCL T1
TRIMETHOPRIM T1
TRIMIPRAMINE MALEATE T1
TROPICAMIDE T1
TROSPIUM T1
TRUMENBA T2
TRUVADA T2
TUDORZA PRESSAIR (Aclidinium) T2
TYGACIL (Tigecycline) T3
TYKERB (Lapatinib) T4, PA
TYSABRI (Natalizumab) T4, PA
TYZEKA (Telbivudine) T4
U
UNITHROID® T3
URSODIOL T1
V
VAGIFEM (Estradiol) T2
VALACYCLOVIR T1
VALGANCICLOVIR T1
VALPROATE T1
VALSARTAN T1
VALSARTAN-HYDROCHLOROTHIAZIDE T1
VALSARTAN/HCTZ T1
VANCOMYCIN HCL T1
VANDETANIB (CAPRELSA®) T4, PA
VECTIBIX (Panitumumab) T4
VECTICAL OINTMENT (Calcitriol) T3
VELTIN / ZIANA (Clindamycin-Tretinoin) T3
VENLAFAXINE T1
VENTAVIS (Iloprost) T4, PA
VENTOLIN HFA (Albuterol) T2
VERAPAMIL T1
VERIPRED 20 (Prednisolone) T3
VIBATIV (Telavancin) T4
VICTOZA (Liraglutide) T2, PA
VICTRELIS (Boceprevir) T4, PA
VIIBRYD (Vilazodone) T3, PA
VIMIZIM (Elosulfase Alfa ) T4
VIMPAT (Lacosamide) T3, PA
VIRACEPT T2
VIREAD T2
VIVELLE-DOT (estradiol) T2
VOLTAREN GEL (Diclofenac) T2
VORICONAZOLE T4
VOTRIENT (PAZOPanib) T4
VYVANSE (Lisdexamfetamine) T2
W
WARFARIN SODIUM T1
WELCHOL (Colesevelam) T3
WILATE (Factor VIII) T4
X
XALKORI (Crizotinib) T4, PA
XARELTO (Rivaroxaban) T2
XENAZINE (Tetrabenazine) T4, PA
XGEVA (Denosumab) T4, PA
XIAFLEX (Collagenase) T3, T4
XIFAXAN (Rifaximin) T4
XIGDUO XR T2, PA
XOLAIR (Omalizumab) T4, PA
XTANDI (Enzalutamide) T4, PA
XULANE (Ethinyl Estradiol; Norelgestromine) CB
XYNTHA (Antihemophilic Factor- Recombinate) T4
XYREM (Sodium Oxybate) T3, PA
Y
YERVOY (Ipilimumab) T4, PA
Z
ZAFIRLUKAST T1
ZALEPLON T1
ZALTRAP (Ziv-Aflibercept ) T4, PA
ZAVESCA (Miglustat) T4, PA
ZELBORAF (Vemurafenib) T4, PA
ZEMAIRA (Alpha1-Proteinase Inhibitor) T4
ZEMPLAR (Paricalcitol) T3
ZENPEP (Pancrelipase) T2
ZERBAXA T2
ZETIA (Ezetimibe) T3
ZIDOVUDINE T1
ZIPRASIDONE HCL T1
ZOLEDRONIC ACID T4, PA
ZOLINZA (Vorinostat) T4, PA
ZOLMITRIPTAN T1
ZOLPIDEM T1
ZOMETA (Zoledronic Acid) T4, PA
ZONISAMIDE T1
ZONTIVITY T2, PA
ZORTRESS (Everolimus) T4
ZORVOLEX T2, PA
ZOVIRAX CREAM (Acyclovir) T3
ZUBSOLV T2, PA
ZYKADIA (Ceritinib) T4, PA
ZYLET (Loteprednol; Tobramycin) T2
ZYTIGA (Abiraterone Acetate) T4, PA
ZYVOX (Linezolid) T2
Drug Description ST / PA Preferred Alternatives
PA - prior approval may be required.
ST - step therapy may be required.
(g) - generic equivalent required. Brand not covered or may require higher copay. Brand names are listed for reference purposes only.
ABSORICASTAmnesteem, Claravis, Myorisan, Zenatane
ACIPHEX SPRINKLESSTAciphex(g), Prilosec(g), Prevacid(g), Protonixg), Zegerid(g), Zantac(g)
ACTICLATESTMinocin(g), Monodox(g), tetracycline, Vibramycin(g)
ADVICORSTLescol(g), Lipitor(g), Mevacor(g), Pravachol(g), Zocor(g),Niaspan(g)
ALTOPREVSTLescol(g), Lipitor(g), Mevacor(g), Pravachol(g), Zocor(g)
APLENZINSTCelexa(g) Prozac(g), Zoloft(g), Effexor & XR(g), Wellbutrin & SR,XL(g)
APTIOMSTDilantin(g), Keppra(g), Tegretol(g), Topamax(g), Trileptal(g)
ATELVIASTFosamax(g)
AVODARTSTProscar(g), Flomax(g), Uroxatral(g)
AXERTSTAmerge(g), Imitrex(g), Maxalt & MLT(g), Zomig & ZMT(g)
BENICARSTgeneric ARB or generic ARB combo
BETASERONPA, STExtavia
BINOSTOSTFosamax(g)
BRINTELLIXSTCelexa(g) Prozac(g), Zoloft(g), Effexor & XR(g), Wellbutrin & SR,XL(g)
BRISDELLESTparoxetine(g), venlafaxine(g)
CAMBIASTVoltaren(g), generic NSAIDs-Lodine & XL (g), Mobic(g), Motrin(g), Naprosyn(g)
CRESTORSTLescol(g), Lipitor(g), Mevacor(g), Pravachol(g), Zocor(g)
DAYTRANASTAdderall(g), Focalcin(g), Concerta(g), Metadate(g), Ritalin(g)
DEXILANTSTAciphex(g), Prilosec(g), Prevacid(g), Protonixg), Zegerid(g)
DIFICIDSTmetronidazole, vancomycin
DORYXSTMinocin(g), Monodox(g), Vibramycin(g)
EDARBISTgeneric ARB or generic ARB combo
EDULARSTAmbien(g), Lunesta(g), Sonata(g)
ELIDELSTgeneric corticosteroids of medium or higher potency
ENABLEXSTDetrol(g), Urecholine(g), flavoxate, oxybutinin, trospium
EPIDUOSTbenzoyl peroxide product & adapaline or tretinoin product
FABIORSTRetin-A(g), Differin(g), Tazorac
FANAPTSTClozaril(g), Risperdal(g), Geodon(g), Seroquel(g), Zyprexa(g)
FETZIMASTCelexa(g) Prozac(g), Zoloft(g), Effexor & XR(g), Wellbutrin & SR,XL(g)
FORFIVO XLSTCelexa(g) Prozac(g), Zoloft(g), Effexor & XR(g), Wellbutrin & SR,XL(g)
FOSAMAX PLUS DSTFosamax(g)
FRAGMINSTLovenox(g)
FROVASTAmerge(g), Imitrex(g), Maxalt & MLT(g), Zomig & ZMT(g)
GELNIQUESTDetrol(g), Urecholine(g), flavoxate, oxybutinin, trospium
GRALISESTNeurontin(g), generic TCAs-Adapin(g), Elavil(g), Sinequan(g), Tofranil(g), Ultram(g)
HORIZANTSTMirapex(g), Neurontin(g), generic TCAs-Elavil(g), Sinequan(g), Tofranil(g), Requip(g)
INTERMEZZOSTAmbien(g), Lunesta(g), Sonata(g), Restoril(g)
INVEGASTClozaril(g), Risperdal(g), Geodon(g), Seroquel(g), Zyprexa(g)
JALYNSTProscar(g), Flomax(g), Uroxatral(g)
JENTADUETOSTGlucophage(g), Insulin, Glucotrol & XL(g), Glynase(g), Amaryl(g), Actos(g), ActoPlus Met(g), Janumet & XR, Kombiglyze SR
KAZANOSTGlucophage(g), Insulin, Glucotrol & XL(g), Glynase(g), Amaryl(g), Actos(g), ActoPlus Met(g), Januvia, Janumet & XR, Onglyza, Kombiglyze SR
KHEDEZLASTCelexa(g) Prozac(g), Zoloft(g), Effexor & XR(g)
LATUDASTClozaril(g), Risperdal(g), Geodon(g), Seroquel(g), Zyprexa(g)
LESCOL XLSTLescol(g), Lipitor(g), Mevacor(g), Pravachol(g), Zocor(g)
LIPTRUZETSTLescol(g), Lipitor(g), Mevacor(g), Pravachol(g), Zocor(g)
LIVALOSTLescol(g), Lipitor(g), Mevacor(g), Pravachol(g), Zocor(g)
LUNESTASTSonata(g), Ambien(g)
NAMENDA XRSTNamenda, Aricept & ODT(g)
NESINASTGlucophage(g), Insulin, Glucotrol & XL(g), Glynase(g), Amaryl(g), Actos(g), Januvia, Janumet & XR, Onglyza, Kombiglyze SR
NEXIUMSTAciphex(g), Prilosec(g), Prevacid(g), Protonix(g)
NUCYNTA ERSTmorphine sulfate ER
NUVIGILSTProvigil(g)
ORACEASTMinocin(g), Monodox(g), Vibramycin(g), tetracycline
OSENISTGlucophage(g), Insulin, Glucotrol & XL(g), Glynase(g), Amaryl(g), Actos(g), ActoPlus Met(g), Januvia, Janumet & XR, Onglyza, Kombiglyze SR
PEXEVASTCelexa(g) Prozac(g), Paxilg), Zoloft(g)
PRISTIQSTCelexa(g) Prozac(g), Zoloft(g), Effexor & XR(g)
QUILLIVANT XRSTAdderall(g), Focalcin(g), Concerta(g), Metadate(g), Ritalin(g)
RANEXASTnitrate plus a beta blocker or calcium channel blocker
RAPAFLOSTProscar(g), Flomax(g), Uroxatral(g)
RELPAXSTAmerge(g), Imitrex(g), Maxalt & MLT(g), Zomig & ZMT(g)
ROZEREMSTSonata(g), Ambien(g)
SAPHRISSTClozaril(g), Risperdal(g), Geodon(g), Seroquel(g), Zyprexa(g)
SEROQUEL XRSTClozaril(g), Risperdal(g), Geodon(g), Seroquel(g), Zyprexa(g)
SILENORSTAdapin(g), Ambien(g), Desyrel(g), Lunesta(g), Sinequan(g), Sonata(g)
SIMCORSTindividual agents Zocor(g) PLUS Niaspan(g)
SOLODYNSTMinocin(g), Monodox(g), Vibramycin(g), tetracycline
STRATTERASTAdderall(g), Focalcin(g), Concerta(g), Metadate(g), Ritalin(g)
SUMAVEL DOSEPROSTAmerge(g), Imitrex(g), Maxalt & MLT(g), Zomig & ZMT(g)
TACLONEX SUSPSTgeneric corticosteroids of medium or higher potency
TAZORACSTgeneric retinoid products
TEKTURNASTgeneric ARB or generic ARB combo
TEVETENgeneric ARB or generic ARB combo
TOVIAZSTgeneric anticholinergic/antispasmodic
TRADJENTASTGlucophage(g), Insulin, Glucotrol & XL(g), Glynase(g), Amaryl(g), Actos(g), Januvia, Janumet & XR, Onglyza, Kombiglyze SR
VELTINSTtopical clindamycin or erythromycin pdoduct & tretinoin product
VERSACLOZSTClozaril(g), Fazaclo(g)
VESICARESTgeneric anticholinergic/antispasmodic
VIIBRYDSTCymbalta(g), Celexa(g) Prozac(g), Zoloft(g), Effexor & XR(g), Wellbutrin & SR,XL(g)
VYTORINSTLescol(g), Lipitor(g), Mevacor(g), Pravachol(g), Zocor(g)
VYVANSESTAdderall & XR(g), Ritalin & LA,SR(g), Concerta(g), Metadate CD(g)
ZEGERID PACKETSTPrilosec(g), Prevacid(g), Protonix(g), Zegerid(g)
ZETIASTLescol(g), Lipitor(g), Mevacor(g), Pravachol(g), Zocor(g)
ZIPSORSTMobic(g), Motrin(g), Naprosyn & EC(g), Voltaren(g)
ZOLPIMISTSTAmbien(g), Lunesta(g), Sonata(g)
ZOMIG NASAL SPRAYSTAmerge(g), Imitrex(g), Maxalt & MLT(g), Zomig & ZMT(g)
ZYMARSTciprofloxacin or ofloxacin ophth