7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg...

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7/17/2012 Kaiser Permanente Northwest Region Preferred Product Formulary List Page 1 of 44 Product Brand or Generic? A/B Otic Sol Generic Abilify Tab 10 mg Brand Abilify Tab 15 mg Brand Abilify Tab 20 mg Brand Abilify Tab 30 mg Brand Abilify Tab 5 mg Brand Acarbose Tab 100 mg Generic Acarbose Tab 50 mg Generic Acebutolol HCL Cap 200 mg Generic Acebutolol HCL Cap 400 mg Generic Acetaminophen / codeine #2 Tab 300-15 mg Generic Acetaminophen / codeine #3 Tab 300-30 mg Generic Acetaminophen / codeine Sol 120-12 / 5 Generic Acetazolamide ER Cap 500 mg ER Generic Acetazolamide Tab 125 mg Generic Acetazolamide Tab 250 mg Generic Acetic Acid Sol 2% Otic Generic Acetic Acid / aluminum Acetate Sol 2% Otic Generic Acetylcysteine Sol 10% Generic Acetylcysteine Sol 20% Generic Acyclovir Cap 200 mg Generic Acyclovir Sus 200 / 5 ml Generic Acyclovir Tab 400 mg Generic Acyclovir Tab 800 mg Generic Adcirca Tab 20 mg Brand Adderall XR Cap 10 mg Brand Adderall XR Cap 15 mg Brand Adderall XR Cap 20 mg Brand Adderall XR Cap 25 mg Brand Adderall XR Cap 30 mg Brand Adderall XR Cap 5 mg Brand Advair Diskus Aer 100 / 50 Brand Advair Diskus Aer 250 / 50 Brand Advair Diskus Aer 500 / 50 Brand Aerochamber Z-stat Plus / flowsignal Mis Stat Pls Brand

Transcript of 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg...

Page 1: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 1 of 44

Product Brand or Generic?

A/B Otic Sol GenericAbilify Tab 10 mg BrandAbilify Tab 15 mg BrandAbilify Tab 20 mg BrandAbilify Tab 30 mg BrandAbilify Tab 5 mg BrandAcarbose Tab 100 mg GenericAcarbose Tab 50 mg GenericAcebutolol HCL Cap 200 mg GenericAcebutolol HCL Cap 400 mg GenericAcetaminophen / codeine #2 Tab 300-15 mg GenericAcetaminophen / codeine #3 Tab 300-30 mg GenericAcetaminophen / codeine Sol 120-12 / 5 GenericAcetazolamide ER Cap 500 mg ER GenericAcetazolamide Tab 125 mg GenericAcetazolamide Tab 250 mg GenericAcetic Acid Sol 2% Otic GenericAcetic Acid / aluminum Acetate Sol 2% Otic GenericAcetylcysteine Sol 10% GenericAcetylcysteine Sol 20% GenericAcyclovir Cap 200 mg GenericAcyclovir Sus 200 / 5 ml GenericAcyclovir Tab 400 mg GenericAcyclovir Tab 800 mg GenericAdcirca Tab 20 mg BrandAdderall XR Cap 10 mg BrandAdderall XR Cap 15 mg BrandAdderall XR Cap 20 mg BrandAdderall XR Cap 25 mg BrandAdderall XR Cap 30 mg BrandAdderall XR Cap 5 mg BrandAdvair Diskus Aer 100 / 50 BrandAdvair Diskus Aer 250 / 50 BrandAdvair Diskus Aer 500 / 50 BrandAerochamber Z-stat Plus / flowsignal Mis Stat Pls Brand

Page 2: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

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Product Brand or Generic?

Aerochamber Z-stat Plus / medium Mask Mis Stat Pls BrandAggrenox Cap 25-200 mg BrandAkne-mycin Oin 2% BrandAlbenza Tab 200 mg BrandAlbuterol Sulfate Neb 0.083% GenericAlbuterol Sulfate Neb 0.5% GenericAlendronate Sodium Tab 10 mg GenericAlendronate Sodium Tab 40 mg GenericAlendronate Sodium Tab 70 mg GenericAlinia Sus 100 mg / 5 ml BrandAlkeran Tab 2 mg BrandAllopurinol Tab 100 mg GenericAllopurinol Tab 300 mg GenericAlprazolam Tab 0.25 mg GenericAlprazolam Tab 0.5 mg GenericAlprazolam Tab 1 mg GenericAlprazolam Tab 2 mg GenericAmantadine HCL Cap 100 mg GenericAmantadine HCL Syp 50 mg / 5 ml GenericAminocaproic Acid Tab 500 mg GenericAmiodarone HCL Tab 200 mg GenericAmitriptyline HCL Tab 10 mg GenericAmitriptyline HCL Tab 25 mg GenericAmitriptyline HCL Tab 50 mg GenericAmlodipine Besylate Tab 10 mg GenericAmlodipine Besylate Tab 2.5 mg GenericAmlodipine Besylate Tab 5 mg GenericAmoxicillin Cap 250 mg GenericAmoxicillin Cap 500 mg GenericAmoxicillin Sus 125 / 5 ml GenericAmoxicillin Sus 250 / 5 ml GenericAmoxicillin Sus 400 / 5 ml GenericAmoxicillin Sus 400 / 5 ml GenericAmoxicillin Sus 400 / 5 ml GenericAmoxicillin / clavulanate Potassium Chw 200 mg Generic

Page 3: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

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Product Brand or Generic?

Amoxicillin / clavulanate Potassium Chw 400 mg GenericAmoxicillin / clavulanate Potassium Sus 600 / 5 ml GenericAmoxicillin / potassium Clavulanate Sus 200 / 5 ml GenericAmoxicillin / potassium Clavulanate Sus 400 / 5 ml GenericAmoxicillin / potassium Clavulanate Tab 500 mg GenericAmoxicillin / potassium Clavulanate Tab 875 mg GenericAmphetamine / dextroamphetamine Tab 10 mg GenericAmphetamine / dextroamphetamine Tab 20 mg GenericAmphetamine / dextroamphetamine Tab 30 mg GenericAmphetamine / dextroamphetamine Tab 5 mg GenericAnagrelide Hydrochloride Cap 0.5 mg GenericAncobon Cap 250 mg BrandAncobon Cap 500 mg BrandAntabuse Tab 250 mg BrandAptivus Cap 250 mg BrandAricept Tab 10 mg BrandArimidex Tab 1 mg BrandArixtra Sol 10 / 0.8 BrandArixtra Sol 2.5 / 0.5 BrandArixtra Sol 5.0 / 0.4 BrandArixtra Sol 7.5 / 0.6 BrandAsacol Tab 400 mg DR BrandAsacol Tab 400 mg DR BrandAsmanex 120 Metered Doses Aer 220 mcg BrandAsmanex 30 Metered Doses Aer 110 mcg BrandAsmanex 60 Metered Doses Aer 220 mcg BrandAtenolol Tab 100 mg GenericAtenolol Tab 25 mg GenericAtenolol Tab 50 mg GenericAtenolol / chlorthalidone Tab 100-25 mg GenericAtenolol / chlorthalidone Tab 50-25 mg GenericAtripla Tab BrandAtropine Sulfate Oin 1% Op GenericAtropine Sulfate Sol 1% Op GenericAtrovent HFA Aer 17 mcg Brand

Page 4: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

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Product Brand or Generic?

Augmented Betamethasone Dipropionate Cre 0.05% GenericAugmented Betamethasone Dipropionate Gel 0.05% GenericAugmented Betamethasone Dipropionate Lot 0.05% GenericAugmented Betamethasone Dipropionate Oin 0.05% GenericAugmentin Sus 125 / 5 ml BrandAvc Cre 15% BrandAvc Cre 15% BrandAvelox Tab 400 mg BrandAvonex Kit 30 mcg BrandAvonex Kit 30 mcg BrandAvonex Pen Kit 30 mcg BrandAzathioprine Tab 50 mg GenericAzelex Cre 20% BrandAzithromycin Sus 100 / 5 ml GenericAzithromycin Sus 200 / 5 ml GenericAzithromycin Tab 250 mg GenericAzithromycin Tab 600 mg GenericBacitracin Oin Op BrandBacitracin / neomycin / polymyxin Oin Op GenericBacitracin / polymyxin B Oin Op GenericBaclofen Tab 10 mg GenericBaclofen Tab 20 mg GenericBacteriostatic Water For Injection / benzyl Alcohol Inj Benz Alc BrandBactroban Nasal Oin Nasal 2% BrandBaraclude Tab 0.5 mg BrandBaraclude Tab 1 mg BrandBD Insulin Syringe Ultraf Ine / 0.3 ml / 30g X 1 / 2" Mis 0.3 / 30g BrandBD Insulin Syringe Ultraf Ine / 1 ml / 30g X 1 / 2" Mis 1 ml / 30g BrandBD Insulin Syringe / U-100 / 0.5 ml / 30g X 1 / 2" Mis 0.5 / 30g BrandBelladonna Alkaloids / phenobarbital Elx GenericBelladonna Alkaloids / phenobarbital Tab 16.2 mg GenericBenazepril HCL Tab 10 mg GenericBenazepril HCL Tab 20 mg GenericBenazepril HCL Tab 40 mg GenericBenazepril HCL Tab 5 mg Generic

Page 5: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

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Product Brand or Generic?

Benefix Inj 1000 unit BrandBenefix Inj 2000 unit BrandBenefix Inj 250 unit BrandBenefix Inj 500 unit BrandBenzonatate Cap 100 mg GenericBenztropine Mesylate Tab 0.5 mg GenericBenztropine Mesylate Tab 1 mg GenericBenztropine Mesylate Tab 2 mg GenericBetamethasone Dipropionate Cre 0.05% GenericBetamethasone Dipropionate Oin 0.05% GenericBetamethasone Valerate Cre 0.1% GenericBetamethasone Valerate Lot 0.1% GenericBetamethasone Valerate Oin 0.1% BrandBetaseron Inj 0.3 mg BrandBetaxolol HCL Sol 0.5% Op GenericBethanechol Chloride Tab 25 mg GenericBicalutamide Tab 50 mg GenericBiltricide Tab 600 mg BrandBlephamide S.o.p. Oin S.o.p. BrandBrimonidine Tartrate Sol 0.2% Op GenericBromfenex Pd Cap 6-60 mgcr GenericBromocriptine Mesylate Tab 2.5 mg GenericBumetanide Tab 0.5 mg GenericBumetanide Tab 1 mg GenericBumetanide Tab 2 mg GenericBupropion HCL SR Tab 100 mg SR GenericBupropion HCL SR Tab 150 mg SR GenericBupropion HCL SR Tab 200 mg SR GenericBupropion HCL Tab 100 mg GenericBupropion HCL Tab 75 mg GenericBupropion HCL XL Tab 150 mg XL GenericBupropion HCL XL Tab 150 mg XL GenericBupropion HCL XL Tab 300 mg XL GenericBuspirone HCL Tab 10 mg GenericBuspirone HCL Tab 15 mg Generic

Page 6: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

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Product Brand or Generic?

Buspirone HCL Tab 5 mg GenericButalbital / acetaminophen / caffeine Tab GenericButalbital / aspirin / caffeine Tab GenericCabergoline Tab 0.5 mg GenericCafergot Tab 1-100 mg BrandCalcipotriene Sol 0.005% GenericCalcitriol Cap 0.25 mcg GenericCalcitriol Cap 0.5 mcg GenericCampral Tab 333 mg BrandCanasa Sup 1000 mg BrandCaptopril Tab 100 mg GenericCaptopril Tab 12.5 mg GenericCaptopril Tab 25 mg GenericCaptopril Tab 50 mg GenericCarbamazepine Chw 100 mg GenericCarbamazepine ER Tab 200 mg ER GenericCarbamazepine ER Tab 400 mg ER GenericCarbamazepine Sus 100 / 5 ml GenericCarbamazepine Tab 200 mg GenericCarbatrol Cap 300 mg BrandCarbidopa / levodopa ER Tab 25-100 mg GenericCarbidopa / levodopa ER Tab 50-200 mg GenericCarbidopa / levodopa Tab 10-100 mg GenericCarbidopa / levodopa Tab 25-100 mg GenericCarbidopa / levodopa Tab 25-250 mg GenericCarvedilol Tab 12.5 mg GenericCarvedilol Tab 25 mg GenericCarvedilol Tab 3.125 mg GenericCarvedilol Tab 6.25 mg GenericCayston Inh 75 mg BrandCeenu Cap 100 mg BrandCeenu Cap 10 mg BrandCeenu Cap 40 mg BrandCefpodoxime Proxetil Sus 100 / 5 ml GenericCefpodoxime Proxetil Sus 50 mg / 5 ml Generic

Page 7: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

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Product Brand or Generic?

Cefpodoxime Proxetil Tab 200 mg GenericCelontin Cap 300 mg BrandCephalexin Cap 250 mg GenericCephalexin Cap 500 mg GenericCephalexin Sus 125 / 5 ml GenericCephalexin Sus 250 / 5 ml GenericChemstrip Ugk Tes Ugk BrandCheratussin AC Syp AC GenericChloral Hydrate Syp 500 / 5 ml GenericChlordiazepoxide HCL Cap 10 mg GenericChlordiazepoxide HCL Cap 25 mg GenericChlordiazepoxide HCL Cap 5 mg GenericChlorhexidine Gluconate Oral Rinse Sol 0.12% GenericChloroquine Phosphate Tab 500 mg GenericChlorpromazine HCL Tab 100 mg GenericChlorpromazine HCL Tab 10 mg GenericChlorpromazine HCL Tab 200 mg GenericChlorpromazine HCL Tab 25 mg GenericChlorpromazine HCL Tab 50 mg GenericChlorthalidone Tab 25 mg GenericChlorthalidone Tab 50 mg GenericCholestyramine Light Pow 4 gram Lite GenericCholestyramine Pow 4 gram GenericCholestyramine Pow 4 gram GenericChorionic Gonadotropin Inj 10000 unit GenericCilostazol Tab 100 mg GenericCilostazol Tab 50 mg GenericCimetidine HCL Sol 300 / 5 ml GenericCiprofloxacin HCL Tab 250 mg GenericCiprofloxacin HCL Tab 500 mg GenericCiprofloxacin HCL Tab 750 mg GenericCitalopram Hydrobromide Sol 10 mg / 5 ml GenericCitalopram Hydrobromide Tab 10 mg GenericCitalopram Hydrobromide Tab 20 mg GenericCitalopram Hydrobromide Tab 40 mg Generic

Page 8: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

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Product Brand or Generic?

Citric Acid / sodium Citrate Sol Sod Citr GenericClarithromycin Tab 500 mg GenericCleocin Pediatric Granules Sol 75 mg / 5 ml BrandClimara Dis 0.025 mg BrandClimara Dis 0.0375 mg BrandClimara Dis 0.05 mg BrandClimara Dis 0.06 mg BrandClimara Dis 0.075 mg BrandClimara Dis 0.1 mg BrandClindamycin HCL Cap 150 mg GenericClindamycin HCL Cap 300 mg GenericClindamycin Phosphate Gel 1% GenericClindamycin Phosphate Lot 10 mg / ml GenericClindamycin Phosphate Sol 1% GenericClobetasol Propionate Aer 0.05% GenericClobetasol Propionate Emollient Cre 0.05% GenericClobetasol Propionate Gel 0.05% GenericClobetasol Propionate Oin 0.05% GenericClomipramine HCL Cap 25 mg GenericClomipramine HCL Cap 50 mg GenericClomipramine HCL Cap 75 mg GenericClonazepam Tab 0.5 mg GenericClonazepam Tab 1 mg GenericClonazepam Tab 2 mg GenericClonidine HCL Tab 0.1 mg GenericClonidine HCL Tab 0.2 mg GenericClonidine HCL Tab 0.3 mg GenericClorazepate Dipotassium Tab 15 mg GenericClorazepate Dipotassium Tab 3.75 mg GenericClorazepate Dipotassium Tab 7.5 mg GenericClotrimazole Tro 10 mg GenericClozapine Tab 100 mg GenericClozapine Tab 200 mg GenericClozapine Tab 25 mg GenericClozapine Tab 50 mg Generic

Page 9: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

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Product Brand or Generic?

Codeine Sulfate Tab 30 mg GenericCodeine Sulfate Tab 60 mg GenericColazal Cap 750 mg BrandColchicine Tab 0.6 mg GenericColcrys Tab 0.6 mg BrandColestipol HCL Tab 1 gram GenericCombivir Tab 150-300 BrandComplera Tab BrandComtan Tab 200 mg BrandConcerta Tab 18 mg BrandConcerta Tab 27 mg BrandConcerta Tab 36 mg BrandConcerta Tab 54 mg BrandCondylox Gel 0.5% BrandCopaxone Kit 20 mg / ml BrandCordran Tape Tap 4 mcg / cm BrandCozaar Tab 100 mg BrandCozaar Tab 25 mg BrandCrixivan Cap 200 mg BrandCrixivan Cap 333 mg BrandCrixivan Cap 400 mg BrandCromolyn Sodium Neb 20 mg / 2 ml GenericCromolyn Sodium Sol 4% Op GenericCuprimine Cap 250 mg BrandCyanocobalamin Inj 1000 mcg GenericCyclobenzaprine HCL Tab 10 mg GenericCyclobenzaprine HCL Tab 5 mg GenericCyclogyl Sol 0.5% Op BrandCyclogyl Sol 2% Op BrandCyclopentolate HCL Sol 1% Op GenericCyclopentolate HCL Sol 1% Op GenericCyclophosphamide Tab 25 mg BrandCyclophosphamide Tab 50 mg BrandCyproheptadine HCL Syp 2 mg / 5 ml GenericCyproheptadine HCL Tab 4 mg Generic

Page 10: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

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Product Brand or Generic?

Danazol Cap 100 mg GenericDanazol Cap 200 mg GenericDanazol Cap 50 mg GenericDantrolene Sodium Cap 100 mg GenericDantrolene Sodium Cap 25 mg GenericDantrolene Sodium Cap 50 mg GenericDapsone Tab 100 mg BrandDapsone Tab 25 mg BrandDaraprim Tab 25 mg BrandDepo-estradiol Inj 5 mg / ml BrandDesipramine HCL Tab 10 mg GenericDesipramine HCL Tab 25 mg GenericDesipramine HCL Tab 50 mg GenericDesmopressin Acetate Sol 0.01% GenericDesmopressin Acetate Spr 0.01% GenericDesmopressin Acetate Spr 0.01% GenericDesmopressin Acetate Tab 0.1 mg GenericDesmopressin Acetate Tab 0.2 mg GenericDesonide Cre 0.05% GenericDesonide Oin 0.05% GenericDexamethasone Elx 0.5 / 5 ml GenericDexamethasone Intensol Con 1 mg / ml BrandDexamethasone Sodium Phosphate Sol 0.1% Op GenericDexamethasone Sol 0.5 / 5 ml BrandDexamethasone Tab 0.5 mg GenericDexamethasone Tab 0.75 mg GenericDexamethasone Tab 4 mg GenericDextroamphetamine Sulfate ER Cap 10 mg ER GenericDextroamphetamine Sulfate ER Cap 15 mg ER GenericDextroamphetamine Sulfate ER Cap 5 mg ER GenericDextroamphetamine Sulfate Tab 10 mg GenericDextroamphetamine Sulfate Tab 5 mg GenericDiamox Cap 500 mg CR BrandDiastat Acudial Gel 12.5-20 BrandDiastat Acudial Gel 5-10 mg Brand

Page 11: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

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Product Brand or Generic?

Diastat Pediatric Gel 2.5m Gel BrandDiazepam Intensol Con 5 mg / ml BrandDiazepam Tab 10 mg GenericDiazepam Tab 2 mg GenericDiazepam Tab 5 mg GenericDibenzyline Cap 10 mg BrandDiclofenac Sodium Sol 0.1% Op GenericDicloxacillin Sodium Cap 250 mg GenericDicloxacillin Sodium Cap 500 mg GenericDicyclomine HCL Cap 10 mg GenericDicyclomine HCL Sol 10 mg / 5 ml GenericDicyclomine HCL Tab 20 mg GenericDidanosine Cap 200 mg GenericDidanosine Cap 250 mg GenericDidanosine Cap 400 mg GenericDifferin Cre 0.1% BrandDifferin Gel 0.1% BrandDigoxin Sol 50 mcg / ml BrandDigoxin Tab 0.125 mg GenericDigoxin Tab 0.25 mg GenericDihydroergotamine Mesylate Inj 1 mg / ml GenericDilantin Cap 30 mg BrandDilantin Infatabs Chw 50 mg BrandDilaudid Sup 3 mg BrandDiltiazem HCL ER Cap 120 mg ER GenericDiltiazem HCL ER Cap 180 mg ER GenericDiltiazem HCL ER Cap 240 mg ER GenericDiltiazem HCL Tab 120 mg GenericDiltiazem HCL Tab 30 mg GenericDiltiazem HCL Tab 60 mg GenericDiltiazem HCL Tab 90 mg GenericDiphenoxylate / atropine Liq 2.5 / 5 BrandDiphenoxylate / atropine Tab 2.5 mg GenericDipivefrin HCL Sol 0.1% Op GenericDipyridamole Tab 25 mg Generic

Page 12: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

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Product Brand or Generic?

Dipyridamole Tab 50 mg GenericDipyridamole Tab 75 mg GenericDisopyramide Phosphate Cap 100 mg GenericDisopyramide Phosphate Cap 150 mg GenericDisopyramide Phosphate ER Cap 150 mg ER GenericDiuril Sus 250 / 5 ml BrandDivalproex Sodium Cap 125 mg GenericDivalproex Sodium DR Tab 125 mg DR GenericDivalproex Sodium DR Tab 250 mg DR GenericDivalproex Sodium DR Tab 500 mg DR GenericDonepezil HCL Tab 5 mg GenericDorzolamide HCL Sol 2% Op GenericDorzolamide HCL / timolol Maleate Sol 2-0.5%op GenericDoxazosin Mesylate Tab 1 mg GenericDoxazosin Mesylate Tab 2 mg GenericDoxazosin Mesylate Tab 4 mg GenericDoxazosin Mesylate Tab 8 mg GenericDoxepin HCL Cap 10 mg GenericDoxepin HCL Cap 25 mg GenericDoxepin HCL Cap 50 mg GenericDoxycycline Hyclate Cap 100 mg GenericDoxycycline Hyclate Cap 50 mg GenericDulera Aer 100-5 mcg BrandDulera Aer 200-5 mcg BrandDyrenium Cap 100 mg BrandE.E.S. Granules Sus 200 / 5 ml BrandEdecrin Tab 25 mg BrandEdurant Tab 25 mg BrandEffient Tab 10 mg BrandEffient Tab 5 mg BrandEfudex Cre 5% BrandElidel Cre 1% BrandEliphos Tab 667 mg BrandElla Tab 30 mg BrandElmiron Cap 100 mg Brand

Page 13: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

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Product Brand or Generic?

Enalapril Maleate Tab 10 mg GenericEnalapril Maleate Tab 20 mg GenericEnalapril Maleate Tab 5 mg GenericEnbrel Inj 25 mg BrandEnbrel Inj 50 mg / ml BrandEnbrel Sureclick Inj 50 mg / ml BrandEpinephrine Inj 0.15 mg BrandEpinephrine Inj 0.3 mg BrandEpipen 2-pak Inj 0.3 mg BrandEpipen Inj 0.3 mg BrandEpipen Inj 0.3 mg BrandEpipen Inj 0.3 mg BrandEpipen-jr Inj 0.15 mg BrandEpipen-jr Inj 0.15 mg BrandEpivir Hbv Tab 100 mg BrandEpivir Sol 10 mg / ml BrandEpivir Tab 150 mg BrandEpivir Tab 300 mg BrandEpzicom Tab BrandErgotamine Tartrate / caffeine Tab 1 / 100 GenericEry-tab Tab 250 mg EC BrandErythromycin Oin Op GenericErythromycin Sol 2% GenericErythromycin / sulfisoxazole Sus 200-600 GenericEsterified Estrogens / methyltestosterone DS Tab Mtest DS GenericEsterified Estrogens / methyltestosterone HS Tab Mtest HS GenericEstradiol Tab 0.5 mg GenericEstradiol Tab 1 mg GenericEstradiol Tab 2 mg GenericEstradiol Valerate Inj 20 mg / ml GenericEstradiol Valerate Inj 40 mg / ml GenericEstring Mis 2 mg BrandEthambutol HCL Tab 100 mg GenericEthambutol HCL Tab 400 mg GenericEthosuximide Cap 250 mg Generic

Page 14: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

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Product Brand or Generic?

Ethosuximide Sol 250 / 5 ml GenericEtidronate Disodium Tab 200 mg BrandEtidronate Disodium Tab 400 mg GenericEtodolac Cap 300 mg GenericEtodolac Tab 400 mg GenericEtoposide Cap 50 mg GenericExelon Cap 1.5 mg BrandExelon Cap 3 mg BrandExelon Cap 4.5 mg BrandExelon Cap 6 mg BrandExtavia Inj 0.3 mg BrandFamotidine Tab 20 mg GenericFamotidine Tab 40 mg GenericFemara Tab 2.5 mg BrandFenofibrate Tab 160 mg GenericFenofibrate Tab 54 mg GenericFentanyl Dis 100 mcg / h GenericFentanyl Dis 12 mcg / hour GenericFentanyl Dis 25 mcg / hour GenericFentanyl Dis 50 mcg / hour GenericFentanyl Dis 75 mcg / hour GenericFinacea Gel 15% BrandFinasteride Tab 5 mg GenericFlecainide Acetate Tab 100 mg GenericFlecainide Acetate Tab 50 mg GenericFluconazole Tab 100 mg GenericFluconazole Tab 150 mg GenericFluconazole Tab 200 mg GenericFluconazole Tab 50 mg GenericFludrocortisone Acetate Tab 0.1 mg GenericFlunisolide Spr 0.025% GenericFluocinolone Acetonide Cre 0.01% GenericFluocinolone Acetonide Cre 0.025% GenericFluocinolone Acetonide Oin 0.025% GenericFluocinolone Acetonide Sol 0.01% Brand

Page 15: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

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Product Brand or Generic?

Fluocinonide Cre 0.05% GenericFluocinonide Gel 0.05% GenericFluocinonide Oin 0.05% GenericFluocinonide-e Cre -e 0.05% GenericFluorabon Dro BrandFluoridex Daily Defense Gel 1.1% GenericFluorometholone Sus 0.1% Op GenericFluorouracil Cre 5% GenericFluorouracil Sol 2% GenericFluoxetine HCL Cap 10 mg GenericFluoxetine HCL Cap 20 mg GenericFluoxetine HCL Sol 20 mg / 5 ml GenericFluphenazine HCL Tab 10 mg GenericFluphenazine HCL Tab 1 mg GenericFluphenazine HCL Tab 2.5 mg GenericFluphenazine HCL Tab 5 mg GenericFlurbiprofen Sodium Sol 0.03% Op GenericFlutamide Cap 125 mg GenericFluticasone Propionate Spr 50 mcg GenericFluvoxamine Maleate Tab 100 mg GenericFluvoxamine Maleate Tab 25 mg GenericFluvoxamine Maleate Tab 50 mg GenericFml Oin 0.1% Op BrandFolic Acid Tab 1 mg GenericFortical Spr 200 / act BrandFuradantin Sus 25 mg / 5 ml BrandFurosemide Sol 10 mg / ml GenericFurosemide Tab 20 mg GenericFurosemide Tab 40 mg GenericFurosemide Tab 80 mg GenericFuzeon Kit BrandGabapentin Cap 100 mg GenericGabapentin Cap 300 mg GenericGabapentin Cap 400 mg GenericGabapentin Tab 600 mg Generic

Page 16: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

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Product Brand or Generic?

Gabapentin Tab 800 mg GenericGabitril Tab 12 mg BrandGabitril Tab 16 mg BrandGabitril Tab 2 mg BrandGabitril Tab 4 mg BrandGalantamine Hydrobromide Cap 16 mg ER GenericGalantamine Hydrobromide Cap 24 mg ER GenericGalantamine Hydrobromide Cap 8 mg ER GenericGalantamine Hydrobromide Tab 12 mg GenericGalantamine Hydrobromide Tab 4 mg GenericGalantamine Hydrobromide Tab 8 mg GenericGanciclovir Cap 250 mg BrandGanciclovir Cap 500 mg BrandGemfibrozil Tab 600 mg GenericGengraf Cap 100 mg GenericGengraf Cap 25 mg GenericGentak Oin 0.3% Op GenericGentak Sol 0.3% Op GenericGentamicin Sulfate Cre 0.1% GenericGentamicin Sulfate Oin 0.1% GenericGeodon Cap 20 mg BrandGeodon Cap 40 mg BrandGeodon Cap 60 mg BrandGeodon Cap 80 mg BrandGleevec Tab 100 mg BrandGlipizide Tab 10 mg GenericGlipizide Tab 5 mg GenericGlucagen Hypokit Inj Hypokit BrandGriseofulvin Microsize Sus 125 / 5 ml GenericGris-peg Tab 125 mg BrandGris-peg Tab 250 mg BrandGuaifenesin / phenylephrine HCL ER Tab 600-30 mg GenericGuanfacine HCL Tab 1 mg GenericGuanfacine HCL Tab 2 mg GenericHaloperidol Con 2 mg / ml Generic

Page 17: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

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Product Brand or Generic?

Haloperidol Tab 0.5 mg GenericHaloperidol Tab 10 mg GenericHaloperidol Tab 1 mg GenericHaloperidol Tab 2 mg GenericHaloperidol Tab 5 mg GenericHepsera Tab 10 mg BrandHerceptin Inj 440 mg BrandHexalen Cap 50 mg BrandHumate-p Inj 1000 unit BrandHumate-p Inj 2000 unit BrandHumate-p Inj 500 unit BrandHumira Kit 40 mg / 0.8 BrandHumira Pen Kit 40 mg / 0.8 BrandHydralazine HCL Tab 100 mg GenericHydralazine HCL Tab 10 mg GenericHydralazine HCL Tab 25 mg GenericHydralazine HCL Tab 50 mg GenericHydrochlorothiazide Tab 25 mg GenericHydrochlorothiazide Tab 50 mg GenericHydrocodone Bitartrate / homatropine Methylbromide Tab Homatrop GenericHydrocodone / acetaminophen Sol 7.5-500 GenericHydrocodone / acetaminophen Tab 10-325 mg GenericHydrocodone / acetaminophen Tab 5-325 mg GenericHydrocodone / acetaminophen Tab 5-500 mg GenericHydrocortisone Butyrate Cre 0.1% GenericHydrocortisone Butyrate Oin 0.1% GenericHydrocortisone Cre 2.5% GenericHydrocortisone Ene 100 mg GenericHydrocortisone Oin 2.5% GenericHydrocortisone Tab 20 mg GenericHydrocortisone Tab 5 mg GenericHydromet Syp 5-1.5 / 5 GenericHydromorphone HCL Sup 3 mg BrandHydromorphone HCL Tab 2 mg GenericHydromorphone HCL Tab 4 mg Generic

Page 18: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 18 of 44

Product Brand or Generic?

Hydroxychloroquine Sulfate Tab 200 mg GenericHydroxyurea Cap 500 mg GenericHydroxyzine HCL Inj 50 mg / ml GenericHydroxyzine HCL Syp 10 mg / 5 ml GenericHydroxyzine HCL Tab 10 mg GenericHydroxyzine HCL Tab 25 mg GenericHydroxyzine HCL Tab 50 mg GenericHydroxyzine Pamoate Cap 25 mg GenericHydroxyzine Pamoate Cap 50 mg GenericHypercare Sol 20% GenericIbuprofen Tab 400 mg GenericIbuprofen Tab 600 mg GenericIbuprofen Tab 800 mg GenericImipramine HCL Tab 10 mg GenericImipramine HCL Tab 25 mg GenericImipramine HCL Tab 50 mg GenericImplanon Imp 68 mg BrandIndomethacin Cap 25 mg GenericIndomethacin Cap 50 mg GenericIndomethacin ER Cap 75 mg ER GenericIntal Inhaler Aer 800 mcg BrandIntelence Tab 100 mg BrandIntelence Tab 200 mg BrandIntron-A Kit 10 million units / ml BrandIntron-A Inj 10 million units Pen BrandIntron-A Inj 25 million units BrandInvirase Cap 200 mg BrandInvirase Tab 500 mg BrandIpratropium Bromide Sol 0.02%inh GenericIpratropium Bromide Spr 0.03% GenericIpratropium Bromide Spr 0.06% GenericIpratropium Bromide / albut Erol Sulfate Sol Albuter GenericIpratropium Bromide / albut Erol Sulfate Sol Albuter GenericIsentress Tab 400 mg BrandIsoniazid Syp 50 mg / 5 ml Brand

Page 19: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 19 of 44

Product Brand or Generic?

Isoniazid Tab 100 mg GenericIsoniazid Tab 300 mg GenericIsopto Carbachol Sol 1.5% Op BrandIsopto Carbachol Sol 3% Op BrandIsopto Homatropine Sol 2% Op BrandIsopto Homatropine Sol 5% Op BrandIsopto Hyoscine Sol 0.25% Op BrandIsordil Titradose Tab 40 mg BrandIsosorbide Dinitrate ER Tab 40 mg ER GenericIsosorbide Dinitrate Sub 2.5 mg BrandIsosorbide Dinitrate Sub 5 mg BrandIsosorbide Dinitrate Tab 10 mg GenericIsosorbide Dinitrate Tab 20 mg GenericIsosorbide Dinitrate Tab 5 mg GenericIsosorbide Mononitrate ER Tab 120 mg ER GenericIsosorbide Mononitrate ER Tab 30 mg ER GenericIsosorbide Mononitrate ER Tab 60 mg ER GenericKaletra Sol BrandKaletra Tab 200-50 mg BrandKenalog Aer Spray BrandKeppra Tab 250 mg BrandKeppra Tab 500 mg BrandKeppra Tab 750 mg BrandKetoconazole Cre 2% GenericKetoconazole Sha 2% GenericKetoconazole Tab 200 mg GenericKetostix Tes BrandKlor-con Pow 20 mEq GenericK-phos Tab BrandK-tabs Tab 10 mEq CR BrandLabetalol HCL Tab 100 mg GenericLabetalol HCL Tab 200 mg GenericLabetalol HCL Tab 300 mg GenericLactulose Sol 10 gram / 15 GenericLamotrigine Chw 25 mg Generic

Page 20: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 20 of 44

Product Brand or Generic?

Lamotrigine Chw 5 mg GenericLamotrigine Tab 100 mg GenericLamotrigine Tab 150 mg GenericLamotrigine Tab 200 mg GenericLamotrigine Tab 25 mg GenericLantus Inj 100 / ml BrandLatanoprost Sol 0.005% GenericLatanoprost Sol 0.005% GenericLeena Tab GenericLeflunomide Tab 10 mg GenericLeflunomide Tab 20 mg GenericLetairis Tab 10 mg BrandLetairis Tab 5 mg BrandLetrozole Tab 2.5 mg GenericLeucovorin Calcium Tab 5 mg GenericLeukeran Tab 2 mg BrandLeuprolide Acetate Inj 1 mg / 0.2 GenericLevetiracetam Sol 100 mg / ml GenericLevetiracetam Tab 1000 mg GenericLevetiracetam Tab 250 mg GenericLevetiracetam Tab 500 mg GenericLevetiracetam Tab 750 mg GenericLevobunolol HCL Sol 0.25% Op BrandLevobunolol HCL Sol 0.5% Op GenericLevofloxacin Tab 500 mg GenericLevora 0.15 / 30-28 Tab 0.15 / 30 GenericLevothroid Tab 100 mcg GenericLevothroid Tab 112 mcg GenericLevothroid Tab 125 mcg GenericLevothroid Tab 137 mcg GenericLevothroid Tab 150 mcg GenericLevothroid Tab 175 mcg GenericLevothroid Tab 200 mcg GenericLevothroid Tab 25 mcg GenericLevothroid Tab 300 mcg Generic

Page 21: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 21 of 44

Product Brand or Generic?

Levothroid Tab 50 mcg GenericLevothroid Tab 75 mcg GenericLevothroid Tab 88 mcg GenericLexiva Tab 700 mg BrandLidocaine HCL Jelly Gel 2% Jelly GenericLidocaine HCL Sol 4% GenericLidocaine Oin 5% GenericLidocaine Oin 5% GenericLidocaine Viscous Sol 2% Visc GenericLiothyronine Sodium Tab 25 mcg GenericLiothyronine Sodium Tab 50 mcg GenericLiothyronine Sodium Tab 5 mcg GenericLipitor Tab 80 mg BrandLisinopril Tab 10 mg GenericLisinopril Tab 2.5 mg GenericLisinopril Tab 20 mg GenericLisinopril Tab 40 mg GenericLisinopril Tab 5 mg GenericLisinopril / hydrochlorothiazide Tab 10-12.5 GenericLisinopril / hydrochlorothiazide Tab 20-12.5 GenericLisinopril / hydrochlorothiazide Tab 20-25 mg GenericLithium Carbonate Cap 150 mg GenericLithium Carbonate Cap 300 mg GenericLithium Carbonate ER Tab 300 mg ER GenericLithium Carbonate ER Tab 450 mg ER GenericLocoid Lipocream Cre 0.1% BrandLodosyn Tab 25 mg BrandLorazepam Intensol Con 2 mg / ml BrandLorazepam Tab 0.5 mg GenericLorazepam Tab 1 mg GenericLorazepam Tab 2 mg GenericLosartan Potassium Tab 100 mg GenericLosartan Potassium Tab 25 mg GenericLosartan Potassium Tab 50 mg GenericLosartan Potassium / hydrochlorothiazide Tab 100-12.5 Generic

Page 22: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 22 of 44

Product Brand or Generic?

Losartan Potassium / hydrochlorothiazide Tab 100-12.5 GenericLosartan Potassium / hydrochlorothiazide Tab 100-12.5 GenericLosartan Potassium / hydrochlorothiazide Tab 100-25 GenericLosartan Potassium / hydrochlorothiazide Tab 50-12.5 GenericLovastatin Tab 10 mg GenericLovastatin Tab 20 mg GenericLovastatin Tab 40 mg GenericLovenox Inj 100 mg / ml BrandLovenox Inj 120 / 0.8 BrandLovenox Inj 150 mg / ml BrandLovenox Inj 30 / 0.3 ml BrandLovenox Inj 300 / 3 ml BrandLovenox Inj 40 / 0.4 ml BrandLovenox Inj 60 / 0.6 ml BrandLovenox Inj 80 / 0.8 ml BrandLoxapine Succinate Cap 10 mg GenericLoxapine Succinate Cap 25 mg GenericLoxapine Succinate Cap 50 mg GenericLoxapine Succinate Cap 5 mg GenericLumigan Sol 0.03% BrandLysodren Tab 500 mg BrandMacrodantin Cap 25 mg BrandMalarone Tab 250-100 BrandMalarone Tab 62.5-25 BrandMatulane Cap 50 mg BrandMaxalt-MLT Tab 10 mg BrandMaxalt-MLT Tab 5 mg BrandMebendazole Chw 100 mg BrandMedroxyprogesterone Acetate Inj 150 mg / ml GenericMedroxyprogesterone Acetate Tab 10 mg GenericMedroxyprogesterone Acetate Tab 2.5 mg GenericMedroxyprogesterone Acetate Tab 5 mg GenericMefloquine HCL Tab 250 mg GenericMegestrol Acetate Sus 40 mg / ml GenericMegestrol Acetate Tab 20 mg Generic

Page 23: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 23 of 44

Product Brand or Generic?

Megestrol Acetate Tab 40 mg GenericMeloxicam Tab 15 mg GenericMeloxicam Tab 7.5 mg GenericMephyton Tab 5 mg BrandMepron Sus BrandMercaptopurine Tab 50 mg GenericMesalamine Ene 4 gram GenericMesnex Tab 400 mg BrandMestinon Timespan Tab Timespan BrandMetadate CD Cap 10 mg BrandMetadate CD Cap 20 mg BrandMetadate CD Cap 30 mg BrandMetadate CD Cap 40 mg BrandMetadate CD Cap 50 mg BrandMetadate CD Cap 60 mg BrandMetformin HCL Tab 1000 mg GenericMetformin HCL Tab 500 mg GenericMetformin HCL Tab 850 mg GenericMethadone HCL Tab 10 mg GenericMethadone HCL Tab 5 mg GenericMethadose Con 10 mg / ml GenericMethazolamide Tab 50 mg GenericMethergine Tab 0.2 mg BrandMethimazole Tab 10 mg GenericMethimazole Tab 5 mg GenericMethitest Tab 10 mg BrandMethocarbamol Tab 500 mg GenericMethocarbamol Tab 750 mg GenericMethotrexate Sodium Inj 25 mg / ml GenericMethotrexate Sodium Inj 25 mg / ml GenericMethotrexate Tab 2.5 mg GenericMethyldopa Tab 250 mg GenericMethyldopa Tab 500 mg GenericMethylin ER Tab 10 mg ER GenericMethylin ER Tab 20 mg ER Generic

Page 24: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 24 of 44

Product Brand or Generic?

Methylin Tab 10 mg GenericMethylin Tab 20 mg GenericMethylin Tab 5 mg GenericMetoclopramide HCL Sol 5 mg / 5 ml GenericMetoclopramide HCL Tab 10 mg GenericMetoclopramide HCL Tab 5 mg GenericMetolazone Tab 10 mg GenericMetolazone Tab 2.5 mg GenericMetolazone Tab 5 mg GenericMetoprolol Tartrate Tab 100 mg GenericMetoprolol Tartrate Tab 25 mg GenericMetoprolol Tartrate Tab 50 mg GenericMetrocream Cre 0.75% BrandMetrogel Gel 0.75% BrandMetrolotion Lot 0.75% BrandMetronidazole Cre 0.75% GenericMetronidazole Gel 0.75% GenericMetronidazole Lot 0.75% GenericMetronidazole Tab 250 mg GenericMetronidazole Tab 500 mg GenericMexiletine HCL Cap 150 mg BrandMexiletine HCL Cap 200 mg BrandMexiletine HCL Cap 250 mg BrandMiacalcin Inj 200 / ml BrandMicrogestin Fe 1.5 / 30 Tab Fe1.5 / 30 GenericMicrogestin Fe Tab Fe 1 / 20 GenericMidazolam HCL Syp 2 mg / ml GenericMidodrine HCL Tab 2.5 mg GenericMidodrine HCL Tab 5 mg GenericMidrin Cap BrandMigergot Sup 2 / 100 BrandMigranal Spr 4 mg / ml BrandMinitran Dis 0.1 mg / hour GenericMinitran Dis 0.2 mg / hour GenericMinitran Dis 0.4 mg / hour Generic

Page 25: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 25 of 44

Product Brand or Generic?

Minitran Dis 0.6 mg / hour GenericMinocycline HCL Cap 100 mg GenericMinocycline HCL Cap 50 mg GenericMirapex Tab 0.25 mg BrandMirapex Tab 1.5 mg BrandMirapex Tab 1 mg BrandMirena IUD System BrandMirtazapine Tab 15 mg GenericMirtazapine Tab 30 mg GenericMirtazapine Tab 45 mg GenericMisoprostol Tab 200 mcg GenericMometasone Furoate Cre 0.1% GenericMometasone Furoate Oin 0.1% GenericMonarc-m Inj 250-1100 BrandMorphine Sulfate ER Tab 100 mg ER GenericMorphine Sulfate ER Tab 15 mg ER GenericMorphine Sulfate ER Tab 200 mg ER GenericMorphine Sulfate ER Tab 30 mg ER GenericMorphine Sulfate ER Tab 60 mg ER GenericMorphine Sulfate Sol 20 mg / ml GenericMorphine Sulfate Sup 10 mg BrandMorphine Sulfate Sup 20 mg BrandMorphine Sulfate Sup 30 mg BrandMorphine Sulfate Tab 15 mg BrandMorphine Sulfate Tab 15 mg GenericMorphine Sulfate Tab 30 mg BrandMulti Vit / fl Chw 0.25 mg GenericMulti-vit / fluoride Chw 1 mg GenericMulti-vit / iron / fluoride Dro / fl 0.25 GenericMulti-vitamin / fluoride Chw 0.25 mg GenericMulti-vitamin / fluoride Chw 0.5 mg GenericMulti-vitamin / fluoride Chw 0.5 mg GenericMulti-vitamin / fluoride Chw 1 mg GenericMupirocin Oin 2% GenericMycobutin Cap 150 mg Brand

Page 26: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 26 of 44

Product Brand or Generic?

Mycophenolate Mofetil Cap 250 mg GenericMycophenolate Mofetil Tab 500 mg GenericMyleran Tab 2 mg BrandNabumetone Tab 500 mg GenericNabumetone Tab 750 mg GenericNadolol Tab 20 mg GenericNadolol Tab 40 mg GenericNadolol Tab 80 mg GenericNaltrexone HCL Tab 50 mg GenericNamenda Tab 10 mg BrandNamenda Tab 5 mg BrandNamenda Titration Pak Tab 5-10 mg BrandNaproxen Sodium Tab 550 mg GenericNaproxen Tab 250 mg GenericNaproxen Tab 375 mg GenericNaproxen Tab 500 mg GenericNaratriptan HCL Tab 2.5 mg GenericNardil Tab 15 mg BrandNardil Tab 15 mg BrandNatacyn Sus 5% Op BrandNecon 0.5 / 35-28 Tab 0.5 / 35 GenericNeo-fradin Sol 125 / 5 ml BrandNeomycin Sulfate Tab 500 mg GenericNeomycin / polymyxin B Sulfates Sol 40 / ml Ir GenericNeomycin / polymyxin / bacitracin / hydrocortisone Oin / HC 1%op GenericNeomycin / polymyxin / dexamethasone Oin 0.1% Op GenericNeomycin / polymyxin / dexamethasone Sus 0.1% Op GenericNeomycin / polymyxin / HC Sol 1% Otic GenericNeomycin / polymyxin / hydrocortisone Sus 1% Otic GenericNeoral Sol 100 mg / ml BrandNeumega Inj 5 mg BrandNeumega Inj 5 mg BrandNeupogen Inj 300 / 0.5 BrandNeupogen Inj 300 mcg BrandNeupogen Inj 480 / 0.8 Brand

Page 27: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 27 of 44

Product Brand or Generic?

Neupogen Inj 480 mcg BrandNexavar Tab 200 mg BrandNexplanon Imp 68 mg BrandNiacin SR Tab 250 mg SR GenericNiacin Tab 100 mg GenericNiacin Tab 500 mg GenericNiacin Tab 50 mg GenericNiacin TR Tab 500 mg TR GenericNicotine Dis 14 mg / 24 hours GenericNicotine Dis 21 mg / 24 hours GenericNicotine Dis 7 mg / 24 hours GenericNicotine Polacrilex Gum 2 mg GenericNicotine Polacrilex Gum 4 mg Reg GenericNicotine Transdermal System Kit Transder BrandNifedical XL Tab 30 mg GenericNifedical XL Tab 60 mg GenericNifedipine ER Tab 90 mg ER GenericNimodipine Cap 30 mg GenericNitro-bid Oin 2% BrandNitro-bid Oin 2% BrandNitrofurantoin Macrocrystalline Cap 100 mg GenericNitrofurantoin Macrocrystalline Cap 50 mg GenericNitrofurantoin Monohydrate Cap 100 mg GenericNitroglycerin Sub 0.3 mg GenericNitroglycerin Sub 0.4 mg GenericNitroglycerin Sub 0.6 mg GenericNitroglycerin Transdermal Dis 0.1 mg / hour GenericNitrolingual Pumpspray Spr Pumpspra BrandNitrostat Sub 0.3 mg BrandNitrostat Sub 0.4 mg BrandNitrostat Sub 0.6 mg BrandNora-be Tab 0.35 mg GenericNorditropin Nordiflex Pen Inj 15 / 1.5 ml BrandNorethindrone Acetate Tab 5 mg GenericNorinyl 1+35 Tab 1+35-28 Brand

Page 28: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 28 of 44

Product Brand or Generic?

Norpace CR Cap 100 mg CR BrandNorpace CR Cap 150 mg CR BrandNortriptyline HCL Cap 10 mg GenericNortriptyline HCL Cap 25 mg GenericNortriptyline HCL Cap 50 mg GenericNortriptyline HCL Cap 75 mg GenericNorvir Cap 100 mg BrandNorvir Tab 100 mg BrandNovolin 70 / 30 Inj 70 / 30 BrandNovolin N Inj U-100 BrandNovolin R Inj U-100 BrandNystatin Cre 100000 GenericNystatin Oin 100000 GenericNystatin Sus 100000 GenericNystatin / triamcinolone Cre BrandNystatin / triamcinolone Oin GenericNystop Pow 100000 GenericOctreotide Acetate Inj 1000 mcg GenericOctreotide Acetate Inj 100 mcg GenericOctreotide Acetate Inj 200 mcg GenericOfloxacin Dro 0.3% Op GenericOfloxacin Dro 0.3%otic GenericOmeprazole Cap 10 mg GenericOmeprazole Cap 20 mg GenericOmnitrope Inj 10 / 1.5 ml BrandOmnitrope Inj 5.8 mg BrandOmnitrope Inj 5 / 1.5 ml BrandOndansetron HCL Tab 4 mg GenericOndansetron HCL Tab 8 mg GenericOndansetron ODT Tab 4 mg ODT GenericOndansetron ODT Tab 8 mg ODT GenericOnetouch Ultra Blue Tes Ultra Bl BrandOrtho Diaphragm All-flex Kit 60 DPR 60 mm BrandOrtho Diaphragm All-flex Kit 65 DPR 65 mm BrandOrtho Diaphragm All-flex Kit 70 DPR 70 mm Brand

Page 29: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 29 of 44

Product Brand or Generic?

Ortho Diaphragm All-flex Kit 75 DPR 75 mm BrandOrtho Diaphragm All-flex Kit 80 DPR 80 mm BrandOrtho Diaphragm All-flex Kit 85 DPR 85 mm BrandOrtho Diaphragm All-flex Kit 90 DPR 90 mm BrandOxazepam Cap 10 mg GenericOxazepam Cap 15 mg GenericOxazepam Cap 30 mg GenericOxcarbazepine Sus 300 mg / 5 ml GenericOxcarbazepine Tab 150 mg GenericOxcarbazepine Tab 300 mg GenericOxcarbazepine Tab 600 mg GenericOxsoralen Ultra Cap 10 mg BrandOxybutynin Chloride ER Tab 10 mg ER GenericOxybutynin Chloride ER Tab 15 mg ER GenericOxybutynin Chloride ER Tab 5 mg ER GenericOxybutynin Chloride Syp 5 mg / 5 ml GenericOxybutynin Chloride Syp 5 mg / 5 ml GenericOxybutynin Chloride Tab 5 mg GenericOxybutynin Chloride Tab 5 mg GenericOxycodone HCL Con 20 mg / ml GenericOxycodone HCL Tab 5 mg GenericOxycodone / acetaminophen Tab 5-325 mg GenericOxytrol Dis 3.9 mg / 24 BrandPancrease MT 4 Cap 4 BrandPancrelipase 10000 Cap 10000 BrandPancrelipase 16000 Cap 16000 BrandPancrelipase 20000 Cap 20000 BrandPancrelipase 4500 Cap 4500 BrandPancrelipase Cap 5000 unit BrandPangestyme EC Cap BrandPangestyme Ul 12 Cap BrandPangestyme Ul 18 Cap BrandPangestyme Ul 20 Cap BrandPantoprazole Sodium Tab 20 mg GenericPantoprazole Sodium Tab 40 mg Generic

Page 30: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 30 of 44

Product Brand or Generic?

Papaverine HCL CR Cap 150 mg CR GenericParagard Intrauterine Copper Contraceptive T380a IUD T380a BrandParegoric Tin 2 mg / 5 ml GenericParomomycin Sulfate Cap 250 mg GenericParoxetine HCL Tab 10 mg GenericParoxetine HCL Tab 20 mg GenericParoxetine HCL Tab 30 mg GenericParoxetine HCL Tab 40 mg GenericPeg 3350 / electrolytes Sol Electrol GenericPegasys Inj BrandPegasys Kit BrandPeg-intron Kit 120 mcg BrandPeg-intron Kit 150 mcg BrandPeg-intron Kit 80 mcg BrandPeg-intron Redipen Pak 4 Kit 120 Rp BrandPeg-intron Redipen Pak 4 Kit 150 Rp BrandPeg-intron Redipen Pak 4 Kit 50 mcg Rp BrandPeg-intron Redipen Pak 4 Kit 80 mcg Rp BrandPenicillin V Potassium Sol 125 / 5 ml GenericPenicillin V Potassium Sol 250 / 5 ml GenericPenicillin V Potassium Tab 250 mg GenericPenicillin V Potassium Tab 500 mg GenericPenicilln VK Sol 125 / 5 ml GenericPentoxifylline ER Tab 400 mg ER GenericPermethrin Cre 5% GenericPerphenazine Tab 2 mg GenericPerphenazine Tab 4 mg GenericPerphenazine Tab 8 mg GenericPhenobarbital Elx 20 mg / 5 ml GenericPhenobarbital Tab 16.2 mg GenericPhenobarbital Tab 32.4 mg GenericPhenobarbital Tab 64.8 mg BrandPhenobarbital Tab 97.2 mg BrandPhenylephrine HCL Sol 10% Op GenericPhenylephrine HCL Sol 2.5% Op Generic

Page 31: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 31 of 44

Product Brand or Generic?

Phenylhistine Expectorant Sol Expect GenericPhenytoin Sodium Extended Cap 100 mg GenericPhenytoin Sus 125 / 5 ml GenericPhenytoin Sus 125 / 5 ml GenericPhisohex Liq 3% BrandPhoslo Cap 667 mg BrandPhoslyra Sol BrandPhospha 250 Neutral Tab Neutral GenericPhospholine Iodide Sol 0.125%op BrandPilocarpine HCL Sol 0.5% Op GenericPilocarpine HCL Sol 1% Op GenericPilocarpine HCL Sol 2% Op GenericPilocarpine HCL Sol 3% Op GenericPilocarpine HCL Sol 4% Op GenericPilocarpine Hydrochloride Tab 5 mg GenericPilopine HS Gel 4% Op BrandPlan B One-step Tab 1.5 mg BrandPlan B One-step Tab 1.5 mg BrandPlan B Tab 0.75 mg BrandPlavix Tab 75 mg BrandPlavix Tab 75 mg BrandPoly-vitamin / fluoride Dro 0.25 mg GenericPolyvitamin / fluoride Dro 0.5 mg / ml GenericPotassium Chloride Liq 10% GenericPotassium Citrate ER Tab 1080 mg GenericPotassium Citrate ER Tab 540 mg GenericPotassium Citrate / citric Acid Sol Citr Acd GenericPramipexole Dihydrochloride Tab 0.125 mg GenericPramipexole Dihydrochloride Tab 0.5 mg GenericPramipexole Dihydrochloride Tab 0.75 mg GenericPramosone Cre 1% BrandPramosone Cre 1-2.5% BrandPramosone Lot 1% BrandPramosone Lot 2.5% BrandPramosone Oin 1% Brand

Page 32: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 32 of 44

Product Brand or Generic?

Pramosone Oin 2.5% BrandPravastatin Sodium Tab 10 mg GenericPravastatin Sodium Tab 20 mg GenericPravastatin Sodium Tab 40 mg GenericPravastatin Sodium Tab 80 mg GenericPrazosin HCL Cap 1 mg GenericPrazosin HCL Cap 2 mg GenericPrazosin HCL Cap 5 mg GenericPred Mild Sus 0.12% Op BrandPred-g Sus Op BrandPrednicarbate Cre 0.1% GenericPrednisolone Acetate Sus 1% Op GenericPrednisolone Sodium Phosphate Sol 15 mg / 5 ml GenericPrednisone Pak 5 mg GenericPrednisone Tab 10 mg GenericPrednisone Tab 1 mg GenericPrednisone Tab 2.5 mg GenericPrednisone Tab 20 mg GenericPrednisone Tab 50 mg BrandPrednisone Tab 5 mg GenericPremarin Cre 0.625 mg BrandPrentif Cavity-rim Cervical Cap Mis 31 mm BrandPrezista Tab 150 mg BrandPrezista Tab 400 mg BrandPrezista Tab 600 mg BrandPrezista Tab 75 mg BrandPrimaquine Phosphate Tab 26.3 mg BrandPrimidone Tab 250 mg GenericPrimidone Tab 50 mg GenericProair HFA Aer BrandProbenecid Tab 500 mg GenericProbenecid / colchicine Tab 500-0.5 GenericProchlorperazine Maleate Tab 10 mg GenericProchlorperazine Maleate Tab 5 mg GenericProchlorperazine Sup 25 mg Generic

Page 33: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 33 of 44

Product Brand or Generic?

Procrit Inj 10000 / ml BrandProcrit Inj 2000 / ml BrandProcrit Inj 20000 / ml BrandProcrit Inj 3000 / ml BrandProcrit Inj 4000 / ml BrandProcrit Inj 40000 / ml BrandProctosol HC Cre 2.5% GenericPrograf Cap 0.5 mg BrandPrograf Cap 1 mg BrandPrograf Cap 5 mg BrandPromacta Tab 25 mg BrandPromacta Tab 50 mg BrandPromacta Tab 75 mg BrandPromethazine HCL Plain Syp 6.25 / 5 ml GenericPromethazine HCL Tab 25 mg GenericPromethazine VC Plain Syp Plain GenericPromethazine VC / codeine Syp Codeine GenericPromethazine / codeine Syp 6.25-10 GenericPromethazine / dextromethorphan Syp DM GenericPromethegan Sup 12.5 mg GenericPromethegan Sup 25 mg GenericPropafenone HCL Tab 150 mg GenericPropafenone HCL Tab 225 mg GenericPropafenone HCL Tab 300 mg GenericPropantheline Bromide Tab 15 mg BrandPropranolol HCL Sol 40 mg / 5 ml BrandPropranolol HCL Tab 10 mg GenericPropranolol HCL Tab 20 mg GenericPropranolol HCL Tab 40 mg GenericPropranolol HCL Tab 80 mg GenericPropylthiouracil Tab 50 mg GenericProstigmin Tab 15 mg BrandProtonix Pak BrandProtriptyline HCL Tab 10 mg GenericProtriptyline HCL Tab 5 mg Generic

Page 34: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 34 of 44

Product Brand or Generic?

Psoriatec Cre 1% GenericPulmicort Flexhaler Inh 180 mcg BrandPulmozyme Sol 1 mg / ml BrandPyrazinamide Tab 500 mg GenericPyridostigmine Bromide Tab 60 mg GenericQuinidine Gluconate CR Tab 324 mg CR GenericQuinidine Sulfate Tab 200 mg GenericQvar Aer 40 mcg BrandQvar Aer 80 mcg BrandRanitidine HCL Syp 75 mg / 5 ml GenericRanitidine HCL Tab 150 mg GenericRanitidine HCL Tab 300 mg GenericRapamune Sol 1 mg / ml BrandRapamune Tab 0.5 mg BrandRapamune Tab 1 mg BrandRebif Inj 22 / 0.5 BrandRebif Inj 44 / 0.5 BrandRebif Titration Pack Sol Pack BrandRecombinate Inj 220-400 BrandRecombinate Inj 401-800 BrandRecombinate Inj 801-1240 BrandRelenza Diskhaler Mis Diskhale BrandRenvela Tab 800 mg BrandRescriptor Tab 100 Mg BrandRescriptor Tab 200 mg BrandRetin-A Cre 0.025% BrandRetin-A Cre 0.05% BrandRetin-A Cre 0.1% BrandRetin-A Gel 0.01% BrandRetin-A Gel 0.025% BrandRetin-A Micro Gel 0.1% BrandRetrovir Syp 50 mg / 5 ml BrandRevlimid Cap 10 mg BrandRevlimid Cap 15 mg BrandRevlimid Cap 25 mg Brand

Page 35: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 35 of 44

Product Brand or Generic?

Revlimid Cap 5 mg BrandReyataz Cap 200 mg BrandReyataz Cap 300 mg BrandRibavirin Cap 200 mg GenericRidaura Cap 3 mg BrandRifamate Cap BrandRifampin Cap 300 mg GenericRilutek Tab 50 mg BrandRimantadine HCL Tab 100 mg GenericRimso-50 Sol 50% BrandRimso-50 Sol 50% BrandRisperidone Sol 1 mg / ml GenericRisperidone Tab 0.25 mg GenericRisperidone Tab 0.5 mg GenericRisperidone Tab 1 mg GenericRisperidone Tab 2 mg GenericRisperidone Tab 3 mg GenericRisperidone Tab 4 mg GenericRms Sup 5 mg BrandRocaltrol Cap 0.25 mcg BrandRocaltrol Cap 0.5 mcg BrandRopinirole HCL Tab 0.25 mg GenericRopinirole HCL Tab 0.5 mg GenericRopinirole HCL Tab 1 mg GenericRopinirole HCL Tab 2 mg GenericRopinirole HCL Tab 3 mg GenericRopinirole HCL Tab 4 mg GenericRopinirole HCL Tab 5 mg GenericRosaderm Emu Cleanser GenericRoxicet Sol 5-325 / 5 BrandSalsalate Tab 500 mg GenericSalsalate Tab 750 mg GenericSandimmune Cap 100 mg BrandSandimmune Cap 25 mg BrandSandostatin Inj 100 mcg Brand

Page 36: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 36 of 44

Product Brand or Generic?

Sandostatin Inj 500 mcg BrandScopace Tab 0.4 mg BrandSelegiline HCL Cap 5 mg GenericSelegiline HCL Tab 5 mg GenericSelenium Sulfide Sha 2.5% GenericSelzentry Tab 150 mg BrandSelzentry Tab 300 mg BrandSerevent Diskus Aer 50 mcg BrandSeroquel Tab 100 mg BrandSeroquel Tab 200 mg BrandSeroquel Tab 25 mg BrandSeroquel Tab 300 mg BrandSeroquel Tab 400 mg BrandSeroquel Tab 50 mg BrandSertraline HCL Tab 100 mg GenericSertraline HCL Tab 25 mg GenericSertraline HCL Tab 50 mg GenericSimvastatin Tab 20 mg GenericSimvastatin Tab 40 mg GenericSimvastatin Tab 80 mg GenericSodium Chloride Dey-pak Neb 10% GenericSodium Fluoride Chw 1.1 mg GenericSodium Fluoride Chw 2.2 mg GenericSodium Polystyrene Sulfonate Sus 15 gram / 60 GenericSodium Sulfacetamide Sol 10% Op GenericSodium Sulfacetamide / sulfur Lot 10-5% GenericSodium Sulfacetamide / sulfur Lot 10-5% GenericSolu-cortef Inj 100 mg BrandSolu-cortef Inj 250 mg BrandSoriatane Cap 10 mg BrandSoriatane Cap 25 mg BrandSoriatane CK Kit 10 mg BrandSoriatane CK Kit 25 mg BrandSotalol HCL Tab 120 mg GenericSotalol HCL Tab 160 mg Generic

Page 37: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 37 of 44

Product Brand or Generic?

Sotalol HCL Tab 240 mg GenericSotalol HCL Tab 80 mg GenericSotret Cap 10 mg GenericSotret Cap 20 mg GenericSotret Cap 30 mg GenericSotret Cap 40 mg GenericSpiriva Handihaler Cap Handihlr BrandSpironolactone Tab 100 mg GenericSpironolactone Tab 25 mg GenericSpironolactone Tab 50 mg GenericSpironolactone / hydrochlorothiazide Tab 25 / 25 GenericSprintec 28 Tab 28 Day GenericSprycel Tab 20 mg BrandSprycel Tab 50 mg BrandSprycel Tab 70 mg BrandSSD Cre 1% GenericSSKI Sol 1 gram / ml BrandStalevo 100 Tab BrandStalevo 125 Tab BrandStalevo 150 Tab BrandStalevo 200 Tab BrandStalevo 50 Tab BrandStalevo 75 Tab BrandStavudine Cap 15 mg GenericStavudine Cap 20 mg GenericStavudine Cap 30 mg GenericStavudine Cap 40 mg GenericSterile Water For Injection Inj GenericSuboxone Sub 2-0.5 mg BrandSuboxone Sub 8-2 mg BrandSuclor Cap 8-120 CR GenericSucralfate Tab 1 gram GenericSulfacetamide Sodium / prednisolone Sodium Phosphate Sol Op GenericSulfadiazine Tab 500 mg BrandSulfamethoxazole / trimethoprim DS Tab 800-160 Generic

Page 38: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 38 of 44

Product Brand or Generic?

Sulfamethoxazole / trimethoprim Tab 400-80 mg GenericSulfasalazine Tab 500 mg DR GenericSulfatrim Sus 200-40 / 5 GenericSulfazine Tab 500 mg GenericSulindac Tab 150 mg GenericSulindac Tab 200 mg GenericSumatriptan Spr 20 mg / act BrandSumatriptan Succinate Inj 6 mg / 0.5 GenericSumatriptan Succinate Inj 6 mg / 0.5 GenericSumatriptan Succinate Refill Inj 6 mg / 0.5 GenericSumatriptan Succinate Tab 100 mg GenericSumatriptan Succinate Tab 25 mg GenericSumatriptan Succinate Tab 50 mg GenericSuprax Tab 400 mg BrandSustiva Cap 200 mg BrandSustiva Tab 600 mg BrandSutent Cap 12.5 mg BrandSutent Cap 12.5 mg BrandSutent Cap 25 mg BrandSutent Cap 50 mg BrandSynarel Sol 2 mg / ml BrandTabloid Tab 40 mg BrandTacrolimus Cap 0.5 mg GenericTacrolimus Cap 1 mg GenericTacrolimus Cap 5 mg GenericTamiflu Cap 75 mg BrandTamiflu Sus 12 mg / ml BrandTamiflu Sus 6 mg / ml BrandTamoxifen Citrate Tab 10 mg GenericTamoxifen Citrate Tab 20 mg GenericTamsulosin HCL Cap 0.4 mg GenericTannate Pediatric Sus GenericTarceva Tab 100 mg BrandTarceva Tab 150 mg BrandTarceva Tab 25 mg Brand

Page 39: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 39 of 44

Product Brand or Generic?

Tazorac Cre 0.05% BrandTazorac Cre 0.1% BrandTazorac Gel 0.05% BrandTazorac Gel 0.1% BrandTegretol-XR Tab 100 mg BrandTemazepam Cap 15 mg GenericTemazepam Cap 30 mg GenericTemazepam Cap 30 mg GenericTemodar Cap 100 mg BrandTemodar Cap 100 mg BrandTemodar Cap 140 mg BrandTemodar Cap 140 mg BrandTemodar Cap 180 mg BrandTemodar Cap 180 mg BrandTemodar Cap 20 mg BrandTemodar Cap 20 mg BrandTemodar Cap 250 mg BrandTemodar Cap 5 mg BrandTemodar Cap 5 mg BrandTerazosin HCL Cap 10 mg GenericTerazosin HCL Cap 1 mg GenericTerazosin HCL Cap 2 mg GenericTerazosin HCL Cap 5 mg GenericTerbutaline Sulfate Tab 2.5 mg GenericTerbutaline Sulfate Tab 5 mg GenericTestosterone Cypionate Inj 100 mg / ml GenericTestosterone Cypionate Inj 200 mg / ml GenericTestosterone Enanthate Inj 200 mg / ml GenericTetracycline HCL Cap 250 mg GenericTetracycline HCL Cap 500 mg GenericTheophylline ER Tab 100 mg ER GenericTheophylline ER Tab 200 mg ER GenericTheophylline ER Tab 300 mg ER GenericThiothixene Cap 10 mg GenericThiothixene Cap 1 mg Generic

Page 40: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 40 of 44

Product Brand or Generic?

Thiothixene Cap 2 mg GenericThiothixene Cap 5 mg GenericTikosyn Cap 125 mcg BrandTikosyn Cap 250 mcg BrandTikosyn Cap 500 mcg BrandTimolol Maleate Sol 0.25% Op GenericTimolol Maleate Sol 0.5% Op GenericTizanidine HCL Tab 4 mg GenericTobi Neb 300 / 5 ml BrandTobramycin Sulfate Sol 0.3% Op GenericTolbutamide Tab 500 mg BrandTopiramate Cap 15 mg GenericTopiramate Cap 25 mg GenericTopiramate Tab 100 mg GenericTopiramate Tab 200 mg GenericTopiramate Tab 25 mg GenericTopiramate Tab 50 mg GenericTracleer Tab 125 mg BrandTracleer Tab 62.5 mg BrandTramadol HCL Tab 50 mg GenericTransderm-scop Dis 1.5 mg BrandTranylcypromine Sulfate Tab 10 mg GenericTrazodone HCL Tab 100 mg GenericTrazodone HCL Tab 50 mg GenericTrecator Tab 250 mg BrandTretinoin Cap 10 mg BrandTriamcinolon Cre 0.025% GenericTriamcinolone Acetonide Cre 0.025% GenericTriamcinolone Acetonide Cre 0.1% GenericTriamcinolone Acetonide Oin 0.025% GenericTriamcinolone Acetonide Oin 0.025% GenericTriamcinolone Acetonide Oin 0.1% GenericTriamcinolone In Orabase Pst 0.1% GenericTriamterene / hydrochlorothiazide Tab 37.5-25 GenericTriamterene / hydrochlorothiazide Tab 75-50 mg Generic

Page 41: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 41 of 44

Product Brand or Generic?

Trifluoperazine HCL Tab 10 mg GenericTrifluoperazine HCL Tab 1 mg GenericTrifluoperazine HCL Tab 2 mg GenericTrifluoperazine HCL Tab 5 mg GenericTrifluridine Sol 1% Op GenericTrihexyphenidyl HCL Tab 2 mg GenericTrihexyphenidyl HCL Tab 5 mg GenericTrileptal Sus 300 mg / 5 ml BrandTrimethobenzamide HCL Cap 300 mg GenericTrimethoprim Sulfate / polymyxin B Sulfate Sol Polymyxn GenericTrimethoprim Tab 100 mg GenericTri-sprintec Tab GenericTri-vitamin / fluoride Dro 0.25 mg GenericTri-vitamin / fluoride Dro 0.25 mg GenericTri-vitamin / fluoride Dro 0.5 mg GenericTri-vitamin / fluoride Dro 0.5 mg GenericTri-vitamin / iron / fluoride Dro / fl 0.25 GenericTrivora-28 Tab GenericTrizivir Tab BrandTrospium Chloride Tab 20 mg GenericTruvada Tab BrandTykerb Tab 250 mg BrandUltrase MT 12 Cap BrandUltrase MT 18 Cap BrandUltrase MT 20 Cap BrandUrsodiol Cap 300 mg GenericValcyte Sol 50 mg / ml BrandValcyte Tab 450 mg BrandValproic Acid Cap 250 mg GenericValproic Acid Syp 250 / 5 ml GenericVancocin HCL Cap 125 mg BrandVancomycin HCL Cap 125 mg GenericVancomycin HCL Cap 250 mg GenericVectical Oin 3 mcg / gram BrandVelcade Inj 3.5 mg Brand

Page 42: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 42 of 44

Product Brand or Generic?

Venlafaxine HCL ER Cap 150 mg ER GenericVenlafaxine HCL ER Cap 37.5 mg GenericVenlafaxine HCL ER Cap 75 mg ER GenericVenlafaxine HCL Tab 100 mg GenericVenlafaxine HCL Tab 25 mg GenericVenlafaxine HCL Tab 37.5 mg GenericVenlafaxine HCL Tab 50 mg GenericVenlafaxine HCL Tab 75 mg GenericVenofer Inj 20 mg / ml BrandVerapamil HCL ER Tab 180 mg ER GenericVerapamil HCL ER Tab 240 mg ER GenericVerapamil HCL Tab 120 mg GenericVerapamil HCL Tab 80 mg GenericVfend Tab 200 mg BrandVfend Tab 50 mg BrandVidex EC Cap 125 mg BrandViracept Pow 50 mg / gram BrandViracept Tab 250 mg BrandViracept Tab 625 mg BrandViramune Tab 200 mg BrandViramune XR Tab BrandViread Tab 300 mg BrandVisudyne Inj 15 mg BrandVitamin D Cap 50000 unit GenericVivotif Berna Cap EC BrandVotrient Tab 200 mg BrandWarfarin Sodium Tab 10 mg GenericWarfarin Sodium Tab 1 mg GenericWarfarin Sodium Tab 2.5 mg GenericWarfarin Sodium Tab 2.5 mg GenericWarfarin Sodium Tab 2 mg GenericWarfarin Sodium Tab 3 mg GenericWarfarin Sodium Tab 4 mg GenericWarfarin Sodium Tab 5 mg GenericWarfarin Sodium Tab 6 mg Generic

Page 43: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 43 of 44

Product Brand or Generic?

Warfarin Sodium Tab 7.5 mg GenericXalkori Cap 200 mg BrandXalkori Cap 250 mg BrandXarelto Tab 10 mg BrandXeloda Tab 150 mg BrandXeloda Tab 500 mg BrandXenaderm Oin BrandXerac AC Sol 6.25% BrandYasmin 28 Tab 3-0.03 mg BrandYodoxin Tab 650 mg BrandZelboraf Tab 240 mg BrandZenpep Cap 10000 unit BrandZenpep Cap 15000 unit BrandZenpep Cap 20000 unit BrandZiagen Sol 20 mg / ml BrandZiagen Tab 300 mg BrandZidovudine Cap 100 mg GenericZidovudine Tab 300 mg GenericZolpidem Tartrate Tab 10 mg GenericZolpidem Tartrate Tab 5 mg GenericZonisamide Cap 100 mg GenericZonisamide Cap 25 mg GenericZonisamide Cap 50 mg GenericZortress Tab 0.25 mg BrandZortress Tab 0.5 mg BrandZortress Tab 0.75 mg BrandZovia 1 / 35e Tab GenericZovia 1 / 50e Tab BrandZymar Dro 0.3% BrandZymaxid Sol 0.5% BrandZyprexa Tab 10 mg BrandZyprexa Tab 15 mg BrandZyprexa Tab 2.5 mg BrandZyprexa Tab 20 mg BrandZyprexa Tab 5 mg Brand

Page 44: 7/17/2012 Kaiser Permanente Northwest Region … Mesylate Tab 2.5 mg Generic. Bumetanide Tab 0.5 mg Generic. Bumetanide Tab 1 mg Generic. Bumetanide Tab 2 mg Generic. Bupropion ...

7/17/2012 Kaiser Permanente Northwest RegionPreferred Product Formulary List

Page 44 of 44

Product Brand or Generic?

Zyprexa Tab 7.5 mg BrandZytiga Tab 250 mg BrandZyvox Sus 100 mg / 5 ml BrandZyvox Tab 600 mg Brand