Brand Name Generic Name Tier Form ANALGESICSanalgesics, narcotic agonist and nsaid combination...

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Brand Name Generic Name Tier Form ANALGESICS ANALGESICS, NARCOTICS SUBUTEX BUPRENORPHINE HCL 3 Tablet SL SUBOXONE BUPRENORPHINE HCL/NALOXONE HCL 3 Tablet SL CODEINE PHOSPHATE CODEINE PHOS 3 Tablet Soluble ACETAMINOPHEN W/CODEINE CODEINE PHOS/ACETAMINOPHEN 1 Elixir CAPITAL W-CODEINE CODEINE PHOS/ACETAMINOPHEN 3 Suspension ACETAMINOPHEN W/CODEINE CODEINE PHOS/ACETAMINOPHEN 1 Tablet TYLENOL W/CODEINE NO.3 CODEINE PHOS/ACETAMINOPHEN 3 Tablet TYLENOL W/CODEINE NO.4 CODEINE PHOS/ACETAMINOPHEN 3 Tablet VOPAC CODEINE PHOS/ACETAMINOPHEN 3 Tablet ASPIRIN W/CODEINE CODEINE PHOS/ASPIRIN 1 Tablet SOMA COMPOUND W/CODEINE CODEINE PHOS/CARISOPRODOL/ASA 3 Tablet CODEINE SULFATE CODEINE SULF 3 Tablet BUTALBITAL/CAFF/APAP/CODEINE CODEINE/APAP/CAFFEIN/BUTALB 1 Capsule FIORICET W/CODEINE CODEINE/APAP/CAFFEIN/BUTALB 3 Capsule PHRENILIN W/CAFFEINE & CODEINE CODEINE/APAP/CAFFEIN/BUTALB 1 Capsule ASA-BUTALB-CAFF-COD CODEINE/ASA/CAFFEINE/BUTALB 1 Capsule ASCOMP W/CODEINE CODEINE/ASA/CAFFEINE/BUTALB 1 Capsule BUTALBITAL COMPOUND W/CODEINE CODEINE/ASA/CAFFEINE/BUTALB 1 Capsule FIORINAL W/CODEINE #3 CODEINE/ASA/CAFFEINE/BUTALB 3 Capsule PANLOR DC DHCODEINE BT/ACETAMINOPHN/CAFF 3 Capsule PANLOR SS DHCODEINE BT/ACETAMINOPHN/CAFF 3 Tablet SYNALGOS-DC DIHYDROCODEINE/ASPIRIN/CAFFEIN 3 Capsule DURAGESIC FENTANYL 3 Patch 72hr FENTANYL FENTANYL 1 Patch 72hr ACTIQ FENTANYL CITRATE 2 Lozenge DOLACET HYDROCODONE BIT/ACETAMINOPHEN 1 Capsule DOLOREX FORTE HYDROCODONE BIT/ACETAMINOPHEN 1 Capsule HYDROCET HYDROCODONE BIT/ACETAMINOPHEN 1 Capsule HYDROCODONE W/ACETAMINOPHEN HYDROCODONE BIT/ACETAMINOPHEN 1 Capsule MARGESIC H HYDROCODONE BIT/ACETAMINOPHEN 1 Capsule STAGESIC HYDROCODONE BIT/ACETAMINOPHEN 1 Capsule HYCET HYDROCODONE BIT/ACETAMINOPHEN 3 Solution HYDROCODONE-ACETAMINOPHEN HYDROCODONE BIT/ACETAMINOPHEN 1 Solution LORTAB HYDROCODONE BIT/ACETAMINOPHEN 3 Solution ANEXSIA HYDROCODONE BIT/ACETAMINOPHEN 1 Tablet CO-GESIC HYDROCODONE BIT/ACETAMINOPHEN 1 Tablet HYDROCODONE W/ACETAMINOPHEN HYDROCODONE BIT/ACETAMINOPHEN 1 Tablet HYDROCODONE W/ACETAMINOPHEN HS HYDROCODONE BIT/ACETAMINOPHEN 1 Tablet LORCET 10/650 HYDROCODONE BIT/ACETAMINOPHEN 3 Tablet LORCET PLUS HYDROCODONE BIT/ACETAMINOPHEN 3 Tablet LORTAB HYDROCODONE BIT/ACETAMINOPHEN 3 Tablet MAXIDONE HYDROCODONE BIT/ACETAMINOPHEN 3 Tablet NORCO HYDROCODONE BIT/ACETAMINOPHEN 3 Tablet STAGESIC-10 HYDROCODONE BIT/ACETAMINOPHEN 2 Tablet VANACET HYDROCODONE BIT/ACETAMINOPHEN 1 Tablet VICODIN HYDROCODONE BIT/ACETAMINOPHEN 3 Tablet VICODIN ES HYDROCODONE BIT/ACETAMINOPHEN 3 Tablet VICODIN HP HYDROCODONE BIT/ACETAMINOPHEN 3 Tablet XODOL HYDROCODONE BIT/ACETAMINOPHEN 3 Tablet ZYDONE HYDROCODONE BIT/ACETAMINOPHEN 3 Tablet DILAUDID-5 HYDROMORPHONE HCL 3 Liquid DILAUDID HYDROMORPHONE HCL 3 Suppository HYDROMORPHONE HCL HYDROMORPHONE HCL 1 Suppository DILAUDID HYDROMORPHONE HCL 3 Tablet HYDROMORPHONE HCL HYDROMORPHONE HCL 1 Tablet LEVO-DROMORAN LEVORPHANOL TARTRATE 3 Tablet DEMEROL MEPERIDINE HCL 3 Solution DEMEROL MEPERIDINE HCL 3 Tablet MEPERIDINE HCL MEPERIDINE HCL 1 Tablet MEPERITAB MEPERIDINE HCL 1 Tablet Trustmark/Starmark Clinical Formulary - January 2006 Page 1

Transcript of Brand Name Generic Name Tier Form ANALGESICSanalgesics, narcotic agonist and nsaid combination...

Page 1: Brand Name Generic Name Tier Form ANALGESICSanalgesics, narcotic agonist and nsaid combination reprexain ibuprofen/hydrocodone bit 3 tablet vicoprofen ibuprofen/hydrocodone bit 3 tablet

Brand Name Generic Name Tier Form

ANALGESICSANALGESICS, NARCOTICSSUBUTEX BUPRENORPHINE HCL 3 Tablet SLSUBOXONE BUPRENORPHINE HCL/NALOXONE HCL 3 Tablet SLCODEINE PHOSPHATE CODEINE PHOS 3 Tablet SolubleACETAMINOPHEN W/CODEINE CODEINE PHOS/ACETAMINOPHEN 1 ElixirCAPITAL W-CODEINE CODEINE PHOS/ACETAMINOPHEN 3 SuspensionACETAMINOPHEN W/CODEINE CODEINE PHOS/ACETAMINOPHEN 1 TabletTYLENOL W/CODEINE NO.3 CODEINE PHOS/ACETAMINOPHEN 3 TabletTYLENOL W/CODEINE NO.4 CODEINE PHOS/ACETAMINOPHEN 3 TabletVOPAC CODEINE PHOS/ACETAMINOPHEN 3 TabletASPIRIN W/CODEINE CODEINE PHOS/ASPIRIN 1 TabletSOMA COMPOUND W/CODEINE CODEINE PHOS/CARISOPRODOL/ASA 3 TabletCODEINE SULFATE CODEINE SULF 3 TabletBUTALBITAL/CAFF/APAP/CODEINE CODEINE/APAP/CAFFEIN/BUTALB 1 CapsuleFIORICET W/CODEINE CODEINE/APAP/CAFFEIN/BUTALB 3 CapsulePHRENILIN W/CAFFEINE & CODEINE CODEINE/APAP/CAFFEIN/BUTALB 1 CapsuleASA-BUTALB-CAFF-COD CODEINE/ASA/CAFFEINE/BUTALB 1 CapsuleASCOMP W/CODEINE CODEINE/ASA/CAFFEINE/BUTALB 1 CapsuleBUTALBITAL COMPOUND W/CODEINE CODEINE/ASA/CAFFEINE/BUTALB 1 CapsuleFIORINAL W/CODEINE #3 CODEINE/ASA/CAFFEINE/BUTALB 3 CapsulePANLOR DC DHCODEINE BT/ACETAMINOPHN/CAFF 3 CapsulePANLOR SS DHCODEINE BT/ACETAMINOPHN/CAFF 3 TabletSYNALGOS-DC DIHYDROCODEINE/ASPIRIN/CAFFEIN 3 CapsuleDURAGESIC FENTANYL 3 Patch 72hrFENTANYL FENTANYL 1 Patch 72hrACTIQ FENTANYL CITRATE 2 LozengeDOLACET HYDROCODONE BIT/ACETAMINOPHEN 1 CapsuleDOLOREX FORTE HYDROCODONE BIT/ACETAMINOPHEN 1 CapsuleHYDROCET HYDROCODONE BIT/ACETAMINOPHEN 1 CapsuleHYDROCODONE W/ACETAMINOPHEN HYDROCODONE BIT/ACETAMINOPHEN 1 CapsuleMARGESIC H HYDROCODONE BIT/ACETAMINOPHEN 1 CapsuleSTAGESIC HYDROCODONE BIT/ACETAMINOPHEN 1 CapsuleHYCET HYDROCODONE BIT/ACETAMINOPHEN 3 SolutionHYDROCODONE-ACETAMINOPHEN HYDROCODONE BIT/ACETAMINOPHEN 1 SolutionLORTAB HYDROCODONE BIT/ACETAMINOPHEN 3 SolutionANEXSIA HYDROCODONE BIT/ACETAMINOPHEN 1 TabletCO-GESIC HYDROCODONE BIT/ACETAMINOPHEN 1 TabletHYDROCODONE W/ACETAMINOPHEN HYDROCODONE BIT/ACETAMINOPHEN 1 TabletHYDROCODONE W/ACETAMINOPHEN HS HYDROCODONE BIT/ACETAMINOPHEN 1 TabletLORCET 10/650 HYDROCODONE BIT/ACETAMINOPHEN 3 TabletLORCET PLUS HYDROCODONE BIT/ACETAMINOPHEN 3 TabletLORTAB HYDROCODONE BIT/ACETAMINOPHEN 3 TabletMAXIDONE HYDROCODONE BIT/ACETAMINOPHEN 3 TabletNORCO HYDROCODONE BIT/ACETAMINOPHEN 3 TabletSTAGESIC-10 HYDROCODONE BIT/ACETAMINOPHEN 2 TabletVANACET HYDROCODONE BIT/ACETAMINOPHEN 1 TabletVICODIN HYDROCODONE BIT/ACETAMINOPHEN 3 TabletVICODIN ES HYDROCODONE BIT/ACETAMINOPHEN 3 TabletVICODIN HP HYDROCODONE BIT/ACETAMINOPHEN 3 TabletXODOL HYDROCODONE BIT/ACETAMINOPHEN 3 TabletZYDONE HYDROCODONE BIT/ACETAMINOPHEN 3 TabletDILAUDID-5 HYDROMORPHONE HCL 3 LiquidDILAUDID HYDROMORPHONE HCL 3 SuppositoryHYDROMORPHONE HCL HYDROMORPHONE HCL 1 SuppositoryDILAUDID HYDROMORPHONE HCL 3 TabletHYDROMORPHONE HCL HYDROMORPHONE HCL 1 TabletLEVO-DROMORAN LEVORPHANOL TARTRATE 3 TabletDEMEROL MEPERIDINE HCL 3 SolutionDEMEROL MEPERIDINE HCL 3 TabletMEPERIDINE HCL MEPERIDINE HCL 1 TabletMEPERITAB MEPERIDINE HCL 1 Tablet

Trustmark/Starmark Clinical Formulary - January 2006

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

METHADONE METHADONE HCL 2 ConcentrateMETHADONE INTENSOL METHADONE HCL 1 ConcentrateMETHADOSE METHADONE HCL 2 ConcentrateMETHADONE HCL METHADONE HCL 2 SolutionDOLOPHINE HCL METHADONE HCL 1 TabletDOLOPHINE HCL METHADONE HCL 2 TabletMETHADONE HCL METHADONE HCL 2 TabletMETHADOSE METHADONE HCL 1 TabletMETHADONE HCL METHADONE HCL 2 Tablet SolubleMETHADOSE METHADONE HCL 1 Tablet SolubleAVINZA MORPHINE SULFATE 3 CapsuleKADIAN MORPHINE SULFATE 2 Capsule 24hr SRMORPHINE SULFATE MORPHINE SULFATE 1 SolutionMSIR MORPHINE SULFATE 3 SolutionROXANOL MORPHINE SULFATE 1 SolutionROXANOL 100 MORPHINE SULFATE 1 SolutionMORPHINE SULFATE MORPHINE SULFATE 1 SuppositoryRMS-SUPPOSITORY MORPHINE SULFATE 1 SuppositoryMORPHINE SULFATE MORPHINE SULFATE 1 TabletMORPHINE SULFATE IR MORPHINE SULFATE 1 TabletMORPHINE SULFATE MORPHINE SULFATE 2 Tablet HypodermicMORPHINE SULFATE MORPHINE SULFATE 1 Tablet SAMS CONTIN MORPHINE SULFATE 3 Tablet SAORAMORPH SR MORPHINE SULFATE 1 Tablet SAOPIUM OPIUM 3 TinctureB & O SUPPRETTES NO.15-A OPIUM/BELLADONNA ALKALOIDS 3 SuppositoryB & O SUPPRETTES NO.16-A OPIUM/BELLADONNA ALKALOIDS 3 SuppositoryOXYIR OXYCODONE HCL 3 CapsuleOXYFAST OXYCODONE HCL 3 ConcentrateOXYCODONE HCL OXYCODONE HCL 1 SolutionROXICODONE OXYCODONE HCL 3 SolutionOXYCODONE HCL OXYCODONE HCL 1 TabletPERCOLONE OXYCODONE HCL 3 TabletROXICODONE OXYCODONE HCL 1 TabletOXYCODONE HCL OXYCODONE HCL 1 Tablet 12hr SROXYCONTIN OXYCODONE HCL 3 Tablet 12hr SROXYCODONE W/ACETAMINOPHEN OXYCODONE HCL/ACETAMINOPHEN 1 CapsuleTYLOX OXYCODONE HCL/ACETAMINOPHEN 3 CapsuleROXICET OXYCODONE HCL/ACETAMINOPHEN 3 SolutionENDOCET OXYCODONE HCL/ACETAMINOPHEN 1 TabletOXYCODONE W/ACETAMINOPHEN OXYCODONE HCL/ACETAMINOPHEN 1 TabletPERCOCET OXYCODONE HCL/ACETAMINOPHEN 3 TabletROXICET OXYCODONE HCL/ACETAMINOPHEN 3 TabletENDODAN OXYCODONE/ASPIRIN 1 TabletOXYCODONE W/ASPIRIN OXYCODONE/ASPIRIN 1 TabletPERCODAN OXYCODONE/ASPIRIN 3 TabletNUMORPHAN OXYMORPHONE HCL 3 SuppositoryTALACEN PENTAZOCINE HCL/ACETAMINOPHEN 3 TabletTALWIN NX PENTAZOCINE HCL/NALOXONE HCL 3 TabletDARVON PROPOXYPHENE HCL 3 CapsulePROPOXYPHENE HCL PROPOXYPHENE HCL 1 CapsulePROPOXYPHENE HCL W/APAP PROPOXYPHENE HCL/ACETAMINOPHEN 1 TabletDARVON-N PROPOXYPHENE NAPSYL 3 TabletBALACET 325 PROPOXYPHENE/ACETAMINOPHEN 1 TabletDARVOCET A500 PROPOXYPHENE/ACETAMINOPHEN 3 TabletDARVOCET-N 100 PROPOXYPHENE/ACETAMINOPHEN 3 TabletDARVOCET-N 50 PROPOXYPHENE/ACETAMINOPHEN 3 TabletPROPOXYPHENE NAPSYLATE W/APAP PROPOXYPHENE/ACETAMINOPHEN 1 TabletTRYCET PROPOXYPHENE/ACETAMINOPHEN 3 TabletULTRAM TRAMADOL HCL 3 TabletULTRACET TRAMADOL HCL/ACETAMINOPHEN 3 Tablet

ANALGESIC/ANTIPYRETICS, SALICYLATESEASPRIN ASPIRIN 3 Tablet EC

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

ZORPRIN ASPIRIN 3 Tablet SABUTALBITAL COMPOUND ASPIRIN/CAFFEINE/BUTALBITAL 1 CapsuleBUTALBITAL-ASP-CAFFEINE ASPIRIN/CAFFEINE/BUTALBITAL 1 CapsuleFARBITAL ASPIRIN/CAFFEINE/BUTALBITAL 1 CapsuleFIORINAL ASPIRIN/CAFFEINE/BUTALBITAL 3 CapsuleBUTALBITAL COMPOUND ASPIRIN/CAFFEINE/BUTALBITAL 1 TabletFARBITAL ASPIRIN/CAFFEINE/BUTALBITAL 1 TabletFORTABS ASPIRIN/CAFFEINE/BUTALBITAL 1 TabletEQUAGESIC ASPIRIN/MEPROBAMATE 3 TabletCHOLINE MAG TRISALICYLATE CHOL SAL/MAGNESIUM SALICYLATE 1 TabletTRICOSAL CHOL SAL/MAGNESIUM SALICYLATE 1 TabletDIFLUNISAL DIFLUNISAL 1 TabletDOLOBID DIFLUNISAL 3 TabletMAGAN MAGNESIUM SALICYLATE 3 TabletNOVASAL MAGNESIUM SALICYLATE 3 TabletDURAXIN SAL-AMIDE/ACETAMINOPHN/P-TLOX 3 CapsuleDURABAC SAL-AMIDE/APAP/P-TLOX/CAFFEIN 3 CapsuleFRENADOL SALICYLAMIDE/ACETAMINOPHEN 3 Tablet

ANALGESIC/ANTIPYRETICS,NON-SALICYLATEPHRENILIN FORTE ACETAMINOPHEN/BUTALBITAL 3 CapsuleAXOCET ACETAMINOPHEN/BUTALBITAL 3 TabletPHRENILIN ACETAMINOPHEN/BUTALBITAL 3 TabletANOLOR-300 ACETAMINOPHEN/CAFFEINE/BUTALB 1 CapsuleBUTALBITAL/APAP/CAFFEINE ACETAMINOPHEN/CAFFEINE/BUTALB 1 CapsuleESGIC ACETAMINOPHEN/CAFFEINE/BUTALB 3 CapsuleESGIC PLUS ACETAMINOPHEN/CAFFEINE/BUTALB 3 CapsuleGEONE ACETAMINOPHEN/CAFFEINE/BUTALB 1 CapsuleMARGESIC ACETAMINOPHEN/CAFFEINE/BUTALB 1 CapsuleMEDIGESIC ACETAMINOPHEN/CAFFEINE/BUTALB 1 CapsuleTENCET ACETAMINOPHEN/CAFFEINE/BUTALB 1 CapsuleTRIAD ACETAMINOPHEN/CAFFEINE/BUTALB 1 CapsuleDOLGIC LQ ACETAMINOPHEN/CAFFEINE/BUTALB 3 ElixirAMERICET ACETAMINOPHEN/CAFFEINE/BUTALB 1 TabletBUTALBITAL/APAP/CAFFEINE ACETAMINOPHEN/CAFFEINE/BUTALB 1 TabletDOLGIC PLUS ACETAMINOPHEN/CAFFEINE/BUTALB 3 TabletESGIC ACETAMINOPHEN/CAFFEINE/BUTALB 3 TabletESGIC-PLUS ACETAMINOPHEN/CAFFEINE/BUTALB 3 TabletFIORICET ACETAMINOPHEN/CAFFEINE/BUTALB 3 TabletQUALA-CET ACETAMINOPHEN/CAFFEINE/BUTALB 1 TabletREPAN ACETAMINOPHEN/CAFFEINE/BUTALB 1 TabletDOLOREX ACETAMINOPHEN/PHENYLTOLX CIT 3 CapsuleDOLOGESIC ACETAMINOPHEN/PHENYLTOLX CIT 3 LiquidACUFLEX ACETAMINOPHEN/PHENYLTOLX CIT 3 TabletDOLOGESIC ACETAMINOPHEN/PHENYLTOLX CIT 3 TabletFLEXTRA-650 ACETAMINOPHEN/PHENYLTOLX CIT 3 TabletFLEXTRA-DS ACETAMINOPHEN/PHENYLTOLX CIT 3 TabletRELAGESIC ACETAMINOPHEN/PHENYLTOLX CIT 3 TabletSTAFLEX ACETAMINOPHEN/PHENYLTOLX CIT 3 TabletLAGESIC ACETAMINOPHEN/PHENYLTOLX CIT 3 Tablet SAFLEXTRA ACETAMINOPHN/P-TLOX CI/CAFFEIN 3 Capsule

ANTIMIGRAINE PREPARATIONSAXERT ALMOTRIPTAN MALATE 3 TabletMIGRANAL DIHYDROERGOTAMINE MESYLATE 2 AerosolRELPAX ELETRIPTAN HYDROBROMIDE 3 TabletERGOCAFF-PB ERGOT TT/CAFF/BELL ALK/P-BARB 3 SuppositoryERGOMAR ERGOTAMINE TARTRATE 2 Tablet SLCAFERGOT ERGOTAMINE TARTRATE/CAFFEINE 2 SuppositoryMIGERGOT ERGOTAMINE TARTRATE/CAFFEINE 1 SuppositoryCAFERGOT ERGOTAMINE TARTRATE/CAFFEINE 2 TabletERGOTAMINE-CAFFEINE ERGOTAMINE TARTRATE/CAFFEINE 1 TabletFROVA FROVATRIPTAN SUCCINATE 3 TabletMIGRAL ISOMETHEPTENE MUCATE 3 Tablet

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

MIGRALAM ISOMETHEPTENE/APAP/CAFFEIN 3 CapsuleAMIDRINE ISOMETHEPTENE/APAP/DICHLPHEN 1 CapsuleAPAP/DICHLPHEN/ISOMETHEPTENE ISOMETHEPTENE/APAP/DICHLPHEN 1 CapsuleDURADRIN ISOMETHEPTENE/APAP/DICHLPHEN 1 CapsuleEPIDRIN ISOMETHEPTENE/APAP/DICHLPHEN 1 CapsuleISOMETH-D-CHLORALPHENAZ-APAP ISOMETHEPTENE/APAP/DICHLPHEN 1 CapsuleMIDRIN ISOMETHEPTENE/APAP/DICHLPHEN 2 CapsuleMIGQUIN ISOMETHEPTENE/APAP/DICHLPHEN 1 CapsuleMIGRATINE ISOMETHEPTENE/APAP/DICHLPHEN 1 CapsuleMIGRAZONE ISOMETHEPTENE/APAP/DICHLPHEN 1 CapsuleMIGRIN-A ISOMETHEPTENE/APAP/DICHLPHEN 1 CapsuleAMERGE NARATRIPTAN HCL 3 TabletMAXALT RIZATRIPTAN BENZOATE 2 TabletMAXALT MLT RIZATRIPTAN BENZOATE 2 Tablet, Disper. LingualIMITREX SUMATRIPTAN 2 Spray, Non-Aerosol (Ea)IMITREX SUMATRIPTAN SUCCINATE 2 CartridgeIMITREX SUMATRIPTAN SUCCINATE 2 TabletIMITREX SUMATRIPTAN SUCCINATE 2 VialZOMIG ZOLMITRIPTAN 2 Spray, Non-Aerosol (Ea)ZOMIG ZOLMITRIPTAN 2 TabletZOMIG ZMT ZOLMITRIPTAN 2 Tablet, Disper. Lingual

NARCOTIC ANTAGONISTSREVIA NALTREXONE HCL 3 Tablet

NSAIDS, CYCLOOXYGENASE INHIBITOR - TYPECATAFLAM DICLOFENAC POTASSIUM 3 TabletKETOROLAC TROMETHAMINE KETOROLAC TROMETHAMINE 1 TabletTORADOL KETOROLAC TROMETHAMINE 3 TabletPONSTEL MEFENAMIC ACID 3 Capsule

URINARY TRACT ANALGESIC AGENTSELMIRON PENTOSAN POLYSULFATE SODIUM 3 Capsule

ANALGESICS, NARCOTIC AGONIST AND NSAID COMBINATIONREPREXAIN IBUPROFEN/HYDROCODONE BIT 3 TabletVICOPROFEN IBUPROFEN/HYDROCODONE BIT 3 TabletCOMBUNOX IBUPROFEN/OXYCODONE HCL 3 Tablet

ANESTHETICSLOCAL ANESTHETICSORASEP B-CAINE/TAN AC/MENTH/CPYRD 3 AerosolORASEP B-CAINE/TAN AC/MENTH/CPYRD 3 SolutionBUCALSEP B-CAINE/ZINC CL/PINE/CPYRD 3 AerosolBUCALSEP B-CAINE/ZINC CL/PINE/CPYRD 3 SolutionANESTACON LIDOCAINE HCL 3 JelXYLOCAINE LIDOCAINE HCL 3 JelLIDOCAINE HCL LIDOCAINE HCL 1 SolutionXYLOCAINE LIDOCAINE HCL 3 SolutionXYLOCAINE VISCOUS LIDOCAINE HCL 3 SolutionGARYLIN PYRIL MAL/ETOH/B-CAINE/ME-BENZ 3 Spray

GENERAL ANESTHETICS, INHALANTSUPRANE DESFLURANE 3 LiquidISOFLURANE ISOFLURANE 3 LiquidULTANE SEVOFLURANE 3 Liquid

URINARY TRACT ANESTHETIC/ANALGESIC AGNT (AZO-DYE)PYRIDIUM PLUS PHENAZOPY HCL/HYOSCY/BUTABARB 3 TabletPHENAZOPYRIDINE HCL PHENAZOPYRIDINE HCL 1 TabletPYRIDIUM PHENAZOPYRIDINE HCL 2 TabletURODOL PHENAZOPYRIDINE HCL 1 Tablet

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Page 5: Brand Name Generic Name Tier Form ANALGESICSanalgesics, narcotic agonist and nsaid combination reprexain ibuprofen/hydrocodone bit 3 tablet vicoprofen ibuprofen/hydrocodone bit 3 tablet

Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

ANTI-OBESITY DRUGSANOREXIC AGENTSDIDREX BENZPHETAMINE HCL 3 TabletTENUATE DIETHYLPROPION HCL 3 TabletTENUATE DIETHYLPROPION HCL 3 Tablet SAADIPEX-P PHENTERMINE HCL 3 CapsulePHENTERMINE HCL PHENTERMINE HCL 3 CapsulePRO-FAST HS PHENTERMINE HCL 3 CapsuleADIPEX-P PHENTERMINE HCL 3 TabletPRO-FAST SA PHENTERMINE HCL 3 TabletIONAMIN PHENTERMINE RESIN 3 Capsule SAMERIDIA SIBUTRAMINE HCL M-HYDRATE 3 Capsule

FAT ABSORPTION DECREASING AGENTSXENICAL ORLISTAT 2 Capsule

ANTIARTHRITICSHYPERURICEMIA TX - PURINE INHIBITORSALLOPURINOL ALLOPURINOL 1 TabletZYLOPRIM ALLOPURINOL 3 Tablet

ANALGESIC/ANTIPYRETICS, SALICYLATESAMIGESIC SALSALATE 1 TabletSALFLEX SALSALATE 3 Tablet

URICOSURIC AGENTSPROBENECID PROBENECID 1 TabletSULFINPYRAZONE SULFINPYRAZONE 3 Tablet

COLCHICINECOLCHICINE COLCHICINE 2 Tablet

NSAIDS, CYCLOOXYGENASE INHIBITOR - TYPECELEBREX CELECOXIB 3 CapsuleVOLTAREN-XR DICLOFENAC SODIUM 3 Tablet 24hr SRDICLOFENAC SODIUM DICLOFENAC SODIUM 1 Tablet ECVOLTAREN DICLOFENAC SODIUM 3 Tablet ECARTHROTEC 50 DICLOFENAC SODIUM/MISOPROSTOL 3 Tablet ECARTHROTEC 75 DICLOFENAC SODIUM/MISOPROSTOL 3 Tablet ECETODOLAC ETODOLAC 1 CapsuleETODOLAC ETODOLAC 1 TabletNALFON FENOPROFEN CALCIUM 3 CapsuleANSAID FLURBIPROFEN 3 TabletFLURBIPROFEN FLURBIPROFEN 1 TabletIBUPROFEN IBUPROFEN 2 SuspensionMOTRIN IBUPROFEN 3 Suspension DropsIBUPROFEN IBUPROFEN 1 TabletIBUPROHM IBUPROFEN 1 TabletMOTRIN IBUPROFEN 3 TabletINDOMETHACIN INDOMETHACIN 1 CapsuleINDOCIN SR INDOMETHACIN 3 Capsule SAINDOMETHACIN INDOMETHACIN 1 Capsule SAINDOCIN INDOMETHACIN 2 SuppositoryINDOCIN INDOMETHACIN 2 SuspensionMOBIC MELOXICAM 3 SuspensionMOBIC MELOXICAM 3 TabletNABUMETONE NABUMETONE 1 TabletRELAFEN NABUMETONE 3 TabletNAPROSYN NAPROXEN 2 SuspensionNAPROXEN NAPROXEN 1 SuspensionNAPROSYN NAPROXEN 3 TabletNAPROXEN NAPROXEN 1 TabletEC-NAPROSYN NAPROXEN 3 Tablet ECNAPROXEN NAPROXEN 1 Tablet EC

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Page 6: Brand Name Generic Name Tier Form ANALGESICSanalgesics, narcotic agonist and nsaid combination reprexain ibuprofen/hydrocodone bit 3 tablet vicoprofen ibuprofen/hydrocodone bit 3 tablet

Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

ANAPROX NAPROXEN SODIUM 3 TabletANAPROX DS NAPROXEN SODIUM 3 TabletNAPROXEN SODIUM NAPROXEN SODIUM 1 TabletNAPRELAN NAPROXEN SODIUM 3 Tablet SANAPRELAN NAPROXEN SODIUM 3 Tablet SADAYPRO OXAPROZIN 3 TabletOXAPROZIN OXAPROZIN 1 TabletFELDENE PIROXICAM 3 CapsulePIROXICAM PIROXICAM 1 CapsuleCLINORIL SULINDAC 3 TabletSULINDAC SULINDAC 1 TabletTOLMETIN SODIUM TOLMETIN SODIUM 3 Tablet

GOLD SALTSRIDAURA AURANOFIN 2 Capsule

NSAID, COX INHIBITOR-TYPE & PROTON PUMP INHIB COMBPREVACID NAPRAPAC LANSOPRAZOLE/NAPROXEN 2 Combo. Pack.

ANTI-INFLAMMATORY TUMOR NECROSIS FACTOR INHIBITORHUMIRA ADALIMUMAB 3 KitENBREL ETANERCEPT 3 KitENBREL ETANERCEPT 3 Syringe

ANTI-INFLAMMATORY, PYRIMIDINE SYNTHESIS INHIBITORARAVA LEFLUNOMIDE 2 TabletLEFLUNOMIDE LEFLUNOMIDE 1 Tablet

ANTI-ARTHRITIC, FOLATE ANTAGONIST AGENTSRHEUMATREX METHOTREXATE SODIUM 2 Tablet

ANTI-ARTHRITIC AND CHELATING AGENTSCUPRIMINE PENICILLAMINE 2 CapsuleDEPEN PENICILLAMINE 2 Tablet

ANTI-FLAM. INTERLEUKIN-1 RECEPTOR ANTAGONISTKINERET ANAKINRA 3 Syringe

ANTIASTHMATICSXANTHINESAMINOPHYLLINE AMINOPHYLLINE 1 LiquidAMINOPHYLLINE AMINOPHYLLINE 1 TabletLUFYLLIN DYPHYLLINE 3 ElixirLUFYLLIN DYPHYLLINE 3 TabletLUFYLLIN-400 DYPHYLLINE 3 TabletTHEOCAP THEOPHYLLINE ANHYDROUS 2 Capsule 12hr SRTHEOPHYLLINE ANHYDROUS THEOPHYLLINE ANHYDROUS 1 Capsule 12hr SRTHEO-24 THEOPHYLLINE ANHYDROUS 2 Capsule 24hr SRELIXOPHYLLIN THEOPHYLLINE ANHYDROUS 2 ElixirTHEOPHYLLINE THEOPHYLLINE ANHYDROUS 1 ElixirTHEOPHYLLINE THEOPHYLLINE ANHYDROUS 2 SolutionQUIBRON-T THEOPHYLLINE ANHYDROUS 2 TabletQUIBRON-T/SR THEOPHYLLINE ANHYDROUS 2 Tablet 12hr SRTHEOCHRON THEOPHYLLINE ANHYDROUS 1 Tablet 12hr SRTHEOCHRON THEOPHYLLINE ANHYDROUS 2 Tablet 12hr SRTHEOPHYLLINE ANHYDROUS THEOPHYLLINE ANHYDROUS 1 Tablet 12hr SRUNIPHYL THEOPHYLLINE ANHYDROUS 2 Tablet SA

GENERAL BRONCHODILATOR AGENTSKIE EPHEDRINE/POTASSIUM IODIDE 3 SyrupBRONCOMAR-1 GUAIFEN/THEOP ANHYD/P-EPHED 3 ElixirPANFIL G GUAIFENESIN/DYPHYLLINE 3 CapsuleBRONKOPHYLLINE GG GUAIFENESIN/DYPHYLLINE 3 ElixirLUFYLLIN-GG GUAIFENESIN/DYPHYLLINE 3 ElixirBRONDIL GUAIFENESIN/DYPHYLLINE 3 LiquidDILEX-G 200 GUAIFENESIN/DYPHYLLINE 3 SyrupDIFIL-G GUAIFENESIN/DYPHYLLINE 3 Tablet

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

DILEX-G 400 GUAIFENESIN/DYPHYLLINE 3 TabletLUFYLLIN-GG GUAIFENESIN/DYPHYLLINE 3 TabletQUIBRON GUAIFENESIN/THEOPHYLLINE 3 CapsuleQUIBRON-300 GUAIFENESIN/THEOPHYLLINE 3 CapsuleBRONCOMAR GG GUAIFENESIN/THEOPHYLLINE 3 ElixirELIXOPHYLLIN GG GUAIFENESIN/THEOPHYLLINE 3 LiquidMYCI BRON-G GUAIFENESIN/THEOPHYLLINE 3 LiquidTHEOMAR GG GUAIFENESIN/THEOPHYLLINE 3 LiquidBRONCODUR GUAIFENESIN/THEOPHYLLINE 3 SolutionBRONCAP GUAIFENESIN/THEOPHYLLINE 3 TabletATROVENT HFA IPRATROPIUM BROMIDE 2 AerosolIPRATROPIUM BROMIDE IPRATROPIUM BROMIDE 1 SolutionSPIRIVA TIOTROPIUM BROMIDE 2 Capsule

ADRENERGIC AGENTS, CATECHOLAMINESISOETHARINE HCL ISOETHARINE HCL 3 Solution

BETA-ADRENERGIC AGENTSALBUTEROL ALBUTEROL 1 AerosolPROVENTIL ALBUTEROL 3 AerosolALBUTEROL ALBUTEROL 1 Aerosol RefillPROVENTIL ALBUTEROL 3 Aerosol RefillALBUTEROL SULFATE HFA ALBUTEROL SULFATE 1 AerosolPROVENTIL HFA ALBUTEROL SULFATE 2 AerosolVENTOLIN HFA ALBUTEROL SULFATE 2 AerosolACCUNEB ALBUTEROL SULFATE 2 SolutionAIRET ALBUTEROL SULFATE 3 SolutionALBUTEROL SULFATE ALBUTEROL SULFATE 1 SolutionPROVENTIL ALBUTEROL SULFATE 3 SolutionALBUTEROL SULFATE ALBUTEROL SULFATE 1 SyrupALBUTEROL SULFATE ALBUTEROL SULFATE 1 TabletVOSPIRE ER ALBUTEROL SULFATE 3 Tablet 12hr SRCOMBIVENT ALBUTEROL SULFATE/IPRATROPIUM 2 AerosolDUONEB ALBUTEROL SULFATE/IPRATROPIUM 2 SolutionFORADIL FORMOTEROL FUMARATE 2 CapsuleXOPENEX LEVALBUTEROL HCL 3 SolutionXOPENEX HFA LEVALBUTEROL TARTRATE 3 AerosolALUPENT METAPROTERENOL SULFATE 2 AerosolMETAPROTERENOL SULFATE METAPROTERENOL SULFATE 2 SolutionMETAPROTERENOL SULFATE METAPROTERENOL SULFATE 1 SyrupMETAPROTERENOL SULFATE METAPROTERENOL SULFATE 2 TabletMAXAIR AUTOHALER PIRBUTEROL ACETATE 3 AerosolSEREVENT DISKUS SALMETEROL XINAFOATE 2 Disk, w/ Inhal. Dev.BRETHINE TERBUTALINE SULFATE 3 AmpulBRETHINE TERBUTALINE SULFATE 2 TabletTERBUTALINE SULFATE TERBUTALINE SULFATE 1 Tablet

MAST CELL STABILIZERSINTAL CROMOLYN SODIUM 2 AerosolCROMOLYN SODIUM CROMOLYN SODIUM 1 AmpulINTAL CROMOLYN SODIUM 3 AmpulGASTROCROM CROMOLYN SODIUM 3 SolutionTILADE NEDOCROMIL SODIUM 3 Aerosol

LEUKOTRIENE RECEPTOR ANTAGONISTSSINGULAIR MONTELUKAST SODIUM 3 Chew TabSINGULAIR MONTELUKAST SODIUM 3 TabletACCOLATE ZAFIRLUKAST 2 Tablet

BETA-ADRENERGICS AND GLUCOCORTICOIDS COMBINATIONADVAIR DISKUS FLUTICASONE/SALMETEROL 2 Disk, w/ Inhal. Dev.

5-LIPOXYGENASE INHIBITORSZYFLO ZILEUTON 3 Tablet

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

ANTIHISTAMINESANTIHISTAMINESED-A-HIST DM D-METHORPHAN HB/PE/CHLORPHENIR 3 Solution

ANTIHISTAMINES - 1ST GENERATIONLODRANE 24 BROMPHENIRAMINE MALEATE 3 Capsule 24hr SRVAZOL BROMPHENIRAMINE MALEATE 3 LiquidLODRANE BROMPHENIRAMINE MALEATE 3 Tablet 12hr SRBROVEX CT BROMPHENIRAMINE TANNATE 3 Chew TabBROVEX BROMPHENIRAMINE TANNATE 3 SuspensionCONEX BROMPHENIRAMINE TANNATE 3 SuspensionJ-TAN BROMPHENIRAMINE TANNATE 3 SuspensionLODRANE XR BROMPHENIRAMINE TANNATE 3 SuspensionHISTEX PD 12 CARBINOX MAL/CARBINOX TANN 3 SuspensionHISTEX IE CARBINOXAMINE MALEATE 3 CapsuleCARBOXINE CARBINOXAMINE MALEATE 3 LiquidHISTEX PD CARBINOXAMINE MALEATE 3 LiquidPEDIATEX CARBINOXAMINE MALEATE 3 LiquidPALGIC CARBINOXAMINE MALEATE 3 TabletHISTEX CT CARBINOXAMINE MALEATE 3 Tablet 12hr SRPEDIATEX 12 CARBINOXAMINE TANNATE 3 SuspensionQDALL AR CHLORPHENIRAMINE MALEATE 3 CapsuleMYCI CHLORPED CHLORPHENIRAMINE TANNATE 3 DropsRICOBID-H CHLORPHENIRAMINE TANNATE 3 SuspensionAHIST CHLORPHENIRAMINE TANNATE 3 TabletMYCI CHLOR-TAN CHLORPHENIRAMINE TANNATE 3 TabletCYPROHEPTADINE HCL CYPROHEPTADINE HCL 1 SyrupCYPROHEPTADINE HCL CYPROHEPTADINE HCL 1 TabletDEXCHLORPHENIRAMINE MALEATE DEXCHLORPHENIRAMINE MALEATE 3 SyrupDEXCHLORPHENIRAMINE MALEATE DEXCHLORPHENIRAMINE MALEATE 3 Tablet SADYTAN DIPHENHYDRAMINE TANNATE 3 Chew TabDYTAN DIPHENHYDRAMINE TANNATE 3 SuspensionHYDROXYZINE HCL HYDROXYZINE HCL 1 SyrupHYDROXYZINE HCL HYDROXYZINE HCL 1 TabletHYDROXYZINE PAMOATE HYDROXYZINE PAMOATE 1 CapsuleVISTARIL HYDROXYZINE PAMOATE 3 CapsuleVISTARIL HYDROXYZINE PAMOATE 3 SuspensionPROMETHAZINE HCL PROMETHAZINE HCL 1 SyrupPROMETHAZINE HCL PROMETHAZINE HCL 2 TabletPOLY-HISTINE PYRIL MAL/PHENYLTOLOX/PHENIR 3 ElixirZYMINE TRIPROLIDINE HCL 3 Syrup

EYE ANTIHISTAMINESOPTIVAR AZELASTINE HCL 3 DropsEMADINE EMEDASTINE DIFUMARATE 3 DropsELESTAT EPINASTINE HCL 3 DropsZADITOR KETOTIFEN FUMARATE 2 DropsPATANOL OLOPATADINE HCL 2 Drops

ANTIHISTAMINES - 2ND GENERATIONZYRTEC CETIRIZINE HCL 3 Chew TabZYRTEC CETIRIZINE HCL 3 SyrupZYRTEC CETIRIZINE HCL 3 TabletCLARINEX DESLORATADINE 3 SyrupCLARINEX DESLORATADINE 3 TabletCLARINEX DESLORATADINE 3 Tablet, Disper. LingualALLEGRA FEXOFENADINE HCL 3 Tablet

ANTIHISTAMINE AND DECONGESTANT COMBINATION1ST GEN ANTIHISTAMINE & DECONGESTANT COMBINATIONSLODRANE D P-EPD TAN/BROMPHENIRAMIN 3 SuspensionPEDIATEX 12 D P-EPD TAN/CARBINOX TANN 3 SuspensionTANAFED DP P-EPD TAN/DEXCHLORPHEN 3 Suspension

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

BROVEX SR P-EPHED HCL/BROMPHENIRAMIN 3 Capsule 12hr SRHISTEX SR P-EPHED HCL/BROMPHENIRAMIN 3 Capsule 12hr SRTOURO ALLERGY P-EPHED HCL/BROMPHENIRAMIN 3 Capsule SAULTRABROM P-EPHED HCL/BROMPHENIRAMIN 3 Capsule SAULTRABROM PD P-EPHED HCL/BROMPHENIRAMIN 3 Capsule SAACCUHIST P-EPHED HCL/BROMPHENIRAMIN 3 DropsLODRANE P-EPHED HCL/BROMPHENIRAMIN 3 LiquidANDEHIST P-EPHED HCL/BROMPHENIRAMIN 3 SyrupBROFED P-EPHED HCL/BROMPHENIRAMIN 3 SyrupLODRANE P-EPHED HCL/BROMPHENIRAMIN 3 Tablet 12hr SRANDEHIST P-EPHED HCL/CARBINOX MAL 1 DropsANDEHIST P-EPHED HCL/CARBINOX MAL 3 DropsBIODEC P-EPHED HCL/CARBINOX MAL 1 DropsBROMDEC P-EPHED HCL/CARBINOX MAL 1 DropsCARBAXEFED RF P-EPHED HCL/CARBINOX MAL 1 DropsSILDEC P-EPHED HCL/CARBINOX MAL 1 DropsPEDIATEX-D P-EPHED HCL/CARBINOX MAL 3 LiquidCARBIC DS P-EPHED HCL/CARBINOX MAL 1 SyrupCARBINOXAMINE P-EPHED HCL/CARBINOX MAL 1 SyrupCARBINOXAMINE PSE P-EPHED HCL/CARBINOX MAL 1 SyrupHYDRO-TUSSIN CBX P-EPHED HCL/CARBINOX MAL 1 SyrupPALGIC DS P-EPHED HCL/CARBINOX MAL 2 SyrupCOLDEC P-EPHED HCL/CARBINOX MAL 1 TabletRONDAMINE P-EPHED HCL/CARBINOX MAL 1 TabletRONDEC P-EPHED HCL/CARBINOX MAL 2 TabletCOLDEC TR P-EPHED HCL/CARBINOX MAL 1 Tablet 12hr SRPALGIC D P-EPHED HCL/CARBINOX MAL 3 Tablet 12hr SRRONDEC-TR P-EPHED HCL/CARBINOX MAL 2 Tablet 12hr SRDISOPHROL P-EPHED HCL/D-BROMP MAL 3 TabletHEXAFED P-EPHED HCL/DEXCHLORPHEN 3 Tablet 12hr SRZYMINE-D P-EPHED HCL/TRIPROLIDINE HCL 3 LiquidHISTAMAX D PHENYLEPHRINE HCL/CARBINOX MAL 3 DropsXIRAHIST PHENYLEPHRINE HCL/CARBINOX MAL 3 DropsNOREL LA PHENYLEPHRINE HCL/CARBINOX MAL 3 Tablet 12hr SRDALLERGY-JR PHENYLEPHRINE HCL/CHLOR-MAL 3 Capsule 12hr SRPREHIST PHENYLEPHRINE HCL/CHLOR-MAL 3 Capsule SADALLERGY PHENYLEPHRINE HCL/CHLOR-MAL 3 DropsRONDEC PHENYLEPHRINE HCL/CHLOR-MAL 3 DropsHISTOR-D PHENYLEPHRINE HCL/CHLOR-MAL 3 ElixirRONDEC PHENYLEPHRINE HCL/CHLOR-MAL 3 SyrupHISTATAB PLUS PHENYLEPHRINE HCL/CHLOR-MAL 3 TabletPHENABID PHENYLEPHRINE HCL/CHLOR-MAL 3 Tablet SARESCON-JR PHENYLEPHRINE HCL/CHLOR-MAL 3 Tablet SAPROMETHAZINE VC PHENYLEPHRINE HCL/PROMETH HCL 1 SyrupBROMFED PHENYLEPHRINE/BROMPHENIRAMIN 3 Capsule 12hr SRBROMFED-PD PHENYLEPHRINE/BROMPHENIRAMIN 3 Capsule 12hr SRVAZOL-D PHENYLEPHRINE/BROMPHENIRAMIN 3 LiquidBROVEX-D PHENYLEPHRINE/BROMPHENIRAMIN 3 SuspensionJ-TAN D PHENYLEPHRINE/BROMPHENIRAMIN 3 SuspensionALACOL PHENYLEPHRINE/BROMPHENIRAMIN 3 SyrupRYNATAN PEDIATRIC PHENYLEPHRINE/CHLOR-TAN 3 Chew TabALLERX PHENYLEPHRINE/CHLOR-TAN 3 SuspensionDALLERGY-JR PHENYLEPHRINE/CHLOR-TAN 3 SuspensionRICOBID PHENYLEPHRINE/CHLOR-TAN 3 SuspensionRYNATAN PHENYLEPHRINE/CHLOR-TAN 3 SuspensionRYNATAN PHENYLEPHRINE/CHLOR-TAN 3 TabletRICOBID PHENYLEPHRINE/CHLOR-TAN 3 Tablet SADYTAN-D PHENYLEPHRINE/DP-HYDRAM TAN 3 SuspensionNALEX-A PHENYLEPHRINE/P-TLOX CI/CP 3 LiquidCOMHIST PHENYLEPHRINE/P-TLOX CI/CP 3 TabletNALEX-A PHENYLEPHRINE/P-TLOX CI/CP 3 TabletPHENA-S PHENYLEPHRINE/PYRIL MAL/CP 3 LiquidPOLY HIST PD PHENYLEPHRINE/PYRIL MAL/CP 3 LiquidPHENA-PLUS PHENYLEPHRINE/PYRIL MAL/CP 3 Tablet

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

POLY HIST FORTE PHENYLEPHRINE/PYRIL MAL/CP 3 Tablet SAVIRAVAN-T PHENYLEPHRINE/PYRIL TAN 3 Chew TabRYNA-12 S PHENYLEPHRINE/PYRIL TAN 3 SuspensionVIRAVAN-S PHENYLEPHRINE/PYRIL TAN 3 SuspensionRYNA-12 PHENYLEPHRINE/PYRIL TAN 3 TabletSUDAL-12 PSEUDOEPHED PL/CHLORPHEN POLAC 3 Chew TabDECONAMINE SR PSEUDOEPHEDRINE HCL/CHLOR-MAL 3 Capsule 12hr SRQDALL PSEUDOEPHEDRINE HCL/CHLOR-MAL 3 Capsule 24hr SRDECONAMINE PSEUDOEPHEDRINE HCL/CHLOR-MAL 3 Chew TabAMERIFED PSEUDOEPHEDRINE HCL/CHLOR-MAL 3 LiquidHISTEX PSEUDOEPHEDRINE HCL/CHLOR-MAL 3 LiquidDECONAMINE PSEUDOEPHEDRINE HCL/CHLOR-MAL 3 SyrupHISTALET PSEUDOEPHEDRINE HCL/CHLOR-MAL 3 SyrupDECONAMINE PSEUDOEPHEDRINE HCL/CHLOR-MAL 3 TabletBIOHIST-LA PSEUDOEPHEDRINE HCL/CHLOR-MAL 3 Tablet 12hr SR

2ND GEN ANTIHISTAMINE & DECONGESTANT COMBINATIONSZYRTEC-D P-EPHED HCL/CETIRIZINE HCL 3 Tablet 12hr SRALLEGRA-D P-EPHED HCL/FEXOFENADINE HCL 3 Tablet 12hr SRALLEGRA-D 24 HOUR P-EPHED HCL/FEXOFENADINE HCL 3 Tablet 24hr SRCLARINEX-D 24 HOUR P-EPHED SUL/DESLORATADINE 3 Tablet 24hr SRSEMPREX-D PSEUDOEPHEDRINE HCL/ACRIVAS 3 Capsule

ANTIINFECTIVESVAGINAL ANTIFUNGALSGYNAZOLE-1 BUTOCONAZOLE NITRATE 2 CreamMONISTAT 3 MICONAZOLE NITRATE 3 SuppositoryNYSTATIN NYSTATIN 1 TabletTERAZOL 3 TERCONAZOLE 2 CreamTERAZOL 7 TERCONAZOLE 2 CreamTERCONAZOLE TERCONAZOLE 1 CreamZAZOLE TERCONAZOLE 1 CreamTERAZOL 3 TERCONAZOLE 2 Suppository

VAGINAL SULFONAMIDESAVC SULFANILAMIDE 3 CreamDAYTO-SULF SULFATHIAZ/SULFACET/S-BENZ/URE 3 Cream

VAGINAL ANTIBIOTICSCLINDESSE CLINDAMYCIN PHOSPHATE 3 Vaginal CreamCLEOCIN CLINDAMYCIN PHOSPHATE 2 CreamCLINDAMAX CLINDAMYCIN PHOSPHATE 1 CreamCLEOCIN CLINDAMYCIN PHOSPHATE 2 SuppositoryMETROGEL-VAGINAL METRONIDAZOLE 2 GelVANDAZOLE METRONIDAZOLE 1 Gel

PENICILLINSAMOX TR/POTASSIUM CLAVULANATE AMOX TR/POTASSIUM CLAVULANATE 1 Chew TabAUGMENTIN AMOX TR/POTASSIUM CLAVULANATE 2 Chew TabAUGMENTIN AMOX TR/POTASSIUM CLAVULANATE 2 Chew TabAMOCLAN AMOX TR/POTASSIUM CLAVULANATE 1 SuspensionAMOX TR-POTASSIUM CLAVULANATE AMOX TR/POTASSIUM CLAVULANATE 1 SuspensionAUGMENTIN AMOX TR/POTASSIUM CLAVULANATE 2 SuspensionAUGMENTIN ES-600 AMOX TR/POTASSIUM CLAVULANATE 2 SuspensionAMOX TR-POTASSIUM CLAVULANATE AMOX TR/POTASSIUM CLAVULANATE 1 TabletAUGMENTIN AMOX TR/POTASSIUM CLAVULANATE 2 TabletAUGMENTIN XR AMOX TR/POTASSIUM CLAVULANATE 2 Tablet 12hr SRAMOXICILLIN AMOXICILLIN TRIHYDRATE 1 CapsuleAMOXIL AMOXICILLIN TRIHYDRATE 1 CapsuleAMOXICILLIN AMOXICILLIN TRIHYDRATE 1 Chew TabAMOXIL AMOXICILLIN TRIHYDRATE 2 Chew TabAMOXIL AMOXICILLIN TRIHYDRATE 2 DropsAMOXICILLIN AMOXICILLIN TRIHYDRATE 1 SuspensionAMOXICILLIN TRIHYDRATE AMOXICILLIN TRIHYDRATE 1 SuspensionAMOXIL AMOXICILLIN TRIHYDRATE 2 Suspension

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

TRIMOX 125 AMOXICILLIN TRIHYDRATE 1 SuspensionAMOXICILLIN AMOXICILLIN TRIHYDRATE 1 TabletAMOXIL AMOXICILLIN TRIHYDRATE 2 TabletDISPERMOX AMOXICILLIN TRIHYDRATE 3 Tablet Disper.AMPICILLIN TRIHYDRATE AMPICILLIN TRIHYDRATE 1 CapsuleAMPICILLIN TRIHYDRATE AMPICILLIN TRIHYDRATE 1 SuspensionGEOCILLIN CARBENICILLIN INDANYL SODIUM 3 TabletDICLOXACILLIN SODIUM DICLOXACILLIN SODIUM 1 CapsuleBACTOCILL OXACILLIN SODIUM 3 CapsulePENICILLIN V POTASSIUM PENICILLIN V POTASSIUM 1 SuspensionVEETIDS 125 PENICILLIN V POTASSIUM 1 SuspensionPENICILLIN V POTASSIUM PENICILLIN V POTASSIUM 1 Tablet

TETRACYCLINESDECLOMYCIN DEMECLOCYCLINE HCL 3 TabletVIBRAMYCIN DOXYCYCLINE CALCIUM 2 SyrupDOXYCYCLINE HYCLATE DOXYCYCLINE HYCLATE 1 CapsuleDOXY-LEMMON DOXYCYCLINE HYCLATE 1 CapsuleED DOXY-CAPS DOXYCYCLINE HYCLATE 1 CapsuleVIBRAMYCIN DOXYCYCLINE HYCLATE 3 CapsuleDOXYCYCLINE HYCLATE DOXYCYCLINE HYCLATE 1 TabletDOXY-LEMMON DOXYCYCLINE HYCLATE 1 TabletVIBRA-TABS DOXYCYCLINE HYCLATE 2 TabletDORYX DOXYCYCLINE HYCLATE 2 Tablet ECMONODOX DOXYCYCLINE MONOHYDRATE 3 CapsuleVIBRAMYCIN DOXYCYCLINE MONOHYDRATE 2 SuspensionADOXA DOXYCYCLINE MONOHYDRATE 3 TabletADOXA PAK DOXYCYCLINE MONOHYDRATE 3 TabletDYNACIN MINOCYCLINE HCL 3 CapsuleMINOCIN MINOCYCLINE HCL 3 CapsuleMINOCYCLINE HCL MINOCYCLINE HCL 1 CapsuleDYNACIN MINOCYCLINE HCL 3 TabletALA-TET TETRACYCLINE HCL 2 CapsuleTETRACYCLINE HCL TETRACYCLINE HCL 1 CapsuleSUMYCIN TETRACYCLINE HCL 2 SuspensionSUMYCIN 250 TETRACYCLINE HCL 2 TabletSUMYCIN 500 TETRACYCLINE HCL 2 Tablet

MACROLIDESZMAX AZITHROMYCIN 3 SuspensionZITHROMAX AZITHROMYCIN 2 PacketZITHROMAX AZITHROMYCIN 2 SuspensionAZITHROMYCIN AZITHROMYCIN 1 TabletZITHROMAX AZITHROMYCIN 2 TabletZITHROMAX TRI-PAK AZITHROMYCIN 2 TabletBIAXIN CLARITHROMYCIN 2 SuspensionCLARITHROMYCIN CLARITHROMYCIN 1 SuspensionBIAXIN CLARITHROMYCIN 2 TabletCLARITHROMYCIN CLARITHROMYCIN 1 TabletBIAXIN XL CLARITHROMYCIN 2 Tablet 24hr SRERYTHROMYCIN W/SULFISOXAZOLE ERY E-SUCC/SULFISOXAZOLE 1 SuspensionPEDIAZOLE ERY E-SUCC/SULFISOXAZOLE 3 SuspensionERYC ERYTHROMYCIN BASE 3 Capsule ECERYTHROMYCIN BASE ERYTHROMYCIN BASE 1 Capsule ECERYTHROMYCIN BASE ERYTHROMYCIN BASE 1 TabletERY-TAB ERYTHROMYCIN BASE 3 Tablet ECPCE ERYTHROMYCIN BASE 3 Tablet Particles/CrystalsERYPED ERYTHROMYCIN ETHYLSUCCINATE 2 DropsE.E.S. 200 ERYTHROMYCIN ETHYLSUCCINATE 2 SuspensionE.E.S. 400 ERYTHROMYCIN ETHYLSUCCINATE 1 SuspensionERYPED 200 ERYTHROMYCIN ETHYLSUCCINATE 2 SuspensionERYPED 400 ERYTHROMYCIN ETHYLSUCCINATE 2 SuspensionERYTHROMYCIN ETHYLSUCCINATE ERYTHROMYCIN ETHYLSUCCINATE 1 SuspensionE.E.S. 400 ERYTHROMYCIN ETHYLSUCCINATE 1 Tablet

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

ERYTHROMYCIN ETHYLSUCCINATE ERYTHROMYCIN ETHYLSUCCINATE 1 TabletERYTHROCIN STEARATE ERYTHROMYCIN STEARATE 1 Tablet

AMINOGLYCOSIDESNEO-FRADIN NEOMYCIN SULFATE 3 SolutionTOBI TOBRAMYCIN/0.25 NORMAL SALINE 3 Ampul

ANTITUBERCULAR ANTIBIOTICSSEROMYCIN CYCLOSERINE 3 CapsuleRIFADIN RIFAMPIN 3 CapsuleRIFAMPIN RIFAMPIN 1 CapsuleRIFATER RIFAMPIN/INH/PYRAZINAMIDE 2 TabletRIFAMATE RIFAMPIN/ISONIAZID 3 CapsulePRIFTIN RIFAPENTINE 3 Tablet

VANCOMYCIN AND DERIVATIVESVANCOCIN HCL VANCOMYCIN HCL 3 Capsule

LINCOSAMIDESCLEOCIN HCL CLINDAMYCIN HCL 2 CapsuleCLEOCIN HCL CLINDAMYCIN HCL 3 CapsuleCLINDAMYCIN HCL CLINDAMYCIN HCL 1 CapsuleCLEOCIN PALMITATE CLINDAMYCIN PALMITATE 2 Solution

ABSORBABLE SULFONAMIDESRENOQUID SULFACYTINE 3 TabletSEPTRA SULFAMETHOXAZOLE/TRIMETHOPRIM 3 SuspensionSULFAMETHOXAZOLE/TRIMETHOPRIM SULFAMETHOXAZOLE/TRIMETHOPRIM 1 SuspensionSULFATRIM SULFAMETHOXAZOLE/TRIMETHOPRIM 1 SuspensionSULTREX SULFAMETHOXAZOLE/TRIMETHOPRIM 1 SuspensionBACTRIM SULFAMETHOXAZOLE/TRIMETHOPRIM 3 TabletBACTRIM DS SULFAMETHOXAZOLE/TRIMETHOPRIM 3 TabletBETHAPRIM DS SULFAMETHOXAZOLE/TRIMETHOPRIM 1 TabletSEPTRA SULFAMETHOXAZOLE/TRIMETHOPRIM 3 TabletSEPTRA DS SULFAMETHOXAZOLE/TRIMETHOPRIM 3 TabletSULFAMETHOXAZOLE-TRIMETHOPRIM SULFAMETHOXAZOLE/TRIMETHOPRIM 1 TabletAZULFIDINE SULFASALAZINE 2 TabletSULFASALAZINE SULFASALAZINE 1 TabletSULFAZINE SULFASALAZINE 1 TabletAZULFIDINE SULFASALAZINE 2 Tablet ECSULFASALAZINE SULFASALAZINE 1 Tablet ECSULFAZINE EC SULFASALAZINE 1 Tablet ECSULFISOXAZOLE SULFISOXAZOLE 2 TabletGANTRISIN SULFISOXAZOLE ACETYL 2 Suspension

NITROFURAN DERIVATIVESFUROXONE FURAZOLIDONE 3 SuspensionFUROXONE FURAZOLIDONE 3 TabletFURADANTIN NITROFURANTOIN 2 SuspensionMACRODANTIN NITROFURANTOIN MACROCRYSTAL 2 CapsuleNITROFURANTOIN MACROCRYSTAL NITROFURANTOIN MACROCRYSTAL 1 CapsuleMACROBID NITROFURANTOIN/NITROFURAN MAC 3 Capsule

ANTI-INFECTIVES, MISC. (ANTIBACTERIALS)RIMSO-50 DIMETHYL SULFOXIDE 3 Solution

ISONIAZIDZYVOX LINEZOLID 2 SuspensionZYVOX LINEZOLID 2 Tablet

CEPHALOSPORINS - 1ST GENERATIONDURICEF CEFADROXIL HYDRATE 3 CapsuleDURICEF CEFADROXIL HYDRATE 3 SuspensionDURICEF CEFADROXIL HYDRATE 3 TabletCEPHALEXIN CEPHALEXIN MONOHYDRATE 1 CapsuleKEFLEX CEPHALEXIN MONOHYDRATE 3 CapsuleCEPHALEXIN CEPHALEXIN MONOHYDRATE 1 Suspension

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

KEFLEX CEPHALEXIN MONOHYDRATE 3 SuspensionCEPHALEXIN CEPHALEXIN MONOHYDRATE 1 TabletPANIXINE CEPHALEXIN MONOHYDRATE 3 Tablet Disper.VELOSEF CEPHRADINE 2 Capsule

CEPHALOSPORINS - 2ND GENERATIONCECLOR CEFACLOR 3 CapsuleCECLOR CEFACLOR 3 SuspensionCEFPROZIL CEFPROZIL 1 SuspensionCEFZIL CEFPROZIL 3 SuspensionCEFPROZIL CEFPROZIL 1 TabletCEFZIL CEFPROZIL 3 TabletCEFTIN CEFUROXIME AXETIL 2 SuspensionCEFTIN CEFUROXIME AXETIL 3 TabletCEFUROXIME CEFUROXIME AXETIL 1 TabletCEFUROXIME AXETIL CEFUROXIME AXETIL 1 TabletLORABID LORACARBEF 3 CapsuleLORABID LORACARBEF 3 Suspension

CEPHALOSPORINS - 3RD GENERATIONOMNICEF CEFDINIR 2 CapsuleOMNICEF CEFDINIR 2 SuspensionSPECTRACEF CEFDITOREN PIVOXIL 3 TabletSUPRAX CEFIXIME 2 SuspensionVANTIN CEFPODOXIME PROXETIL 2 SuspensionCEFPODOXIME PROXETIL CEFPODOXIME PROXETIL 1 TabletVANTIN CEFPODOXIME PROXETIL 2 TabletCEDAX CEFTIBUTEN DIHYDRATE 3 CapsuleCEDAX CEFTIBUTEN DIHYDRATE 3 Suspension

KETOLIDESKETEK TELITHROMYCIN 3 TabletKETEK PAK TELITHROMYCIN 3 Tablet

ANTIINFECTIVES/MISCELLANEOUSVAGINAL ANTISEPTICSACID JELLY ACETIC AC/RICINOLEIC/OXYQUINOL 3 JellyRELAGARD ACETIC ACID/OXYQUIN SO4 3 Jelly

ANTI-MYCOBACTERIUM AGENTSPASER AMINOSALICYLIC ACID 3 PacketETHAMBUTOL HYDROCHLORIDE ETHAMBUTOL HCL 1 TabletMYAMBUTOL ETHAMBUTOL HCL 2 TabletTRECATOR ETHIONAMIDE 3 TabletISONIAZID ISONIAZID 2 SyrupISONIAZID ISONIAZID 1 TabletPYRAZINAMIDE PYRAZINAMIDE 2 TabletMYCOBUTIN RIFABUTIN 2 Capsule

CHEMOTHERAPEUTICS, ANTIBACTERIAL, MISC.MONUROL FOSFOMYCIN TROMETHAMINE 3 PacketHIPREX METHENAMINE HIPPURATE 3 TabletMANDELAMINE METHENAMINE MANDELATE 2 TabletMANDELAMINE HAFGRAMS METHENAMINE MANDELATE 2 TabletMETHENAMINE MANDELATE METHENAMINE MANDELATE 1 TabletUROLENE BLUE METHYLENE BLUE 3 TabletPROSED/DS MTH/ME BLUE/BA/SALICY/ATP/HYOS 3 TabletTRAC 2X MTH/ME BLUE/BA/SALICY/ATP/HYOS 3 TabletURISED MTH/ME BLUE/BA/SALICY/ATP/HYOS 3 TabletPROSED EC MTH/ME BLUE/BA/SALICY/ATP/HYOS 3 Tablet ECURISYM MTH/ME BLUE/SALICY/NA PHOS/HYO 3 CapsuleUTA MTH/ME BLUE/SALICY/NA PHOS/HYO 3 CapsuleURELLE MTH/ME BLUE/SALICY/NA PHOS/HYO 3 TabletURETRON D/S MTH/ME BLUE/SALICY/NA PHOS/HYO 3 TabletURO BLUE MTH/ME BLUE/SALICY/NA PHOS/HYO 3 Tablet

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

UTRONA MTH/ME BLUE/SALICY/NA PHOS/HYO 3 TabletPRIMSOL TRIMETHOPRIM 3 SolutionPROLOPRIM TRIMETHOPRIM 3 TabletTRIMPEX TRIMETHOPRIM 3 Tablet

ANTIFUNGAL ANTIBIOTICSGRIS-PEG GRISEOFULVIN ULTRAMICROSIZE 2 TabletGRIFULVIN V GRISEOFULVIN,MICROSIZE 3 SuspensionGRISEOFULVIN GRISEOFULVIN,MICROSIZE 1 SuspensionFULVICIN U/F GRISEOFULVIN,MICROSIZE 3 TabletGRIFULVIN V GRISEOFULVIN,MICROSIZE 3 TabletNYSTATIN NYSTATIN 2 PowderNYSTATIN NYSTATIN 1 SuspensionMYCOSTATIN NYSTATIN 1 TabletNYSTATIN NYSTATIN 1 Tablet

ANTIFUNGAL AGENTSCLOTRIMAZOLE CLOTRIMAZOLE 1 TrocheMYCELEX CLOTRIMAZOLE 2 TrocheDIFLUCAN FLUCONAZOLE 2 SuspensionFLUCONAZOLE FLUCONAZOLE 1 SuspensionDIFLUCAN FLUCONAZOLE 2 TabletFLUCONAZOLE FLUCONAZOLE 1 TabletANCOBON FLUCYTOSINE 3 CapsuleITRACONAZOLE ITRACONAZOLE 1 CapsuleSPORANOX ITRACONAZOLE 2 CapsuleSPORANOX ITRACONAZOLE 2 SolutionKETOCONAZOLE KETOCONAZOLE 1 TabletNIZORAL KETOCONAZOLE 3 TabletLAMISIL TERBINAFINE HCL 2 TabletVFEND VORICONAZOLE 2 SuspensionVFEND VORICONAZOLE 2 Tablet

ANTIMALARIAL DRUGSMALARONE ATOVAQUONE/PROGUANIL HCL 3 TabletARALEN PHOSPHATE CHLOROQUINE PHOSPHATE 2 TabletCHLOROQUINE PHOSPHATE CHLOROQUINE PHOSPHATE 2 TabletHALFAN HALOFANTRINE HCL 3 TabletHYDROXYCHLOROQUINE SULFATE HYDROXYCHLOROQUINE SULFATE 1 TabletPLAQUENIL HYDROXYCHLOROQUINE SULFATE 3 TabletLARIAM MEFLOQUINE HCL 3 TabletPRIMAQUINE PRIMAQUINE PHOSPHATE 2 TabletDARAPRIM PYRIMETHAMINE 2 TabletFANSIDAR PYRIMETHAMINE/SULFADOXINE 2 TabletQUININE SULFATE QUININE SULFATE 2 CapsuleQUININE SULFATE QUININE SULFATE 1 Tablet

AMEBACIDESYODOXIN IODOQUINOL 2 TabletHUMATIN PAROMOMYCIN SULFATE 3 Capsule

ANAEROBIC ANTIPROTOZOAL-ANTIBACTERIAL AGENTSFLAGYL 375 METRONIDAZOLE 2 CapsuleMETRONIDAZOLE METRONIDAZOLE 1 CapsuleFLAGYL METRONIDAZOLE 3 TabletMETRONIDAZOLE METRONIDAZOLE 1 TabletMETRYL METRONIDAZOLE 1 TabletFLAGYL ER METRONIDAZOLE 3 Tablet SA

ANTIPROTOZOAL DRUGS,MISCELLANEOUSMEPRON ATOVAQUONE 2 Suspension

ANTHELMINTICSALBENZA ALBENDAZOLE 3 TabletSTROMECTOL IVERMECTIN 3 TabletMEBENDAZOLE MEBENDAZOLE 1 Chew Tab

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

BILTRICIDE PRAZIQUANTEL 3 TabletMINTEZOL THIABENDAZOLE 2 Chew TabMINTEZOL THIABENDAZOLE 2 Suspension

ANTIPARASITICSALINIA NITAZOXANIDE 3 SuspensionALINIA NITAZOXANIDE 3 Tablet

ANTILEPROTICSDAPSONE DAPSONE 3 Tablet

ANTIVIRALS, GENERALACYCLOVIR ACYCLOVIR 1 CapsuleZOVIRAX ACYCLOVIR 3 CapsuleACYCLOVIR ACYCLOVIR 1 SuspensionZOVIRAX ACYCLOVIR 3 SuspensionACYCLOVIR ACYCLOVIR 1 TabletZOVIRAX ACYCLOVIR 3 TabletFAMVIR FAMCICLOVIR 3 TabletCYTOVENE GANCICLOVIR 3 CapsuleGANCICLOVIR GANCICLOVIR 1 CapsuleTAMIFLU OSELTAMIVIR PHOSPHATE 2 CapsuleTAMIFLU OSELTAMIVIR PHOSPHATE 2 SuspensionFLUMADINE RIMANTADINE HCL 3 SyrupFLUMADINE RIMANTADINE HCL 3 TabletVALTREX VALACYCLOVIR HCL 2 TabletVALCYTE VALGANCICLOVIR HYDROCHLORIDE 3 TabletRELENZA ZANAMIVIR 3 Disk, w/ Inhal. Dev.

QUINOLONESCIPRO CIPROFLOXACIN 2 Suspension, MicrocapsuleCIPRO CIPROFLOXACIN HCL 3 TabletCIPROFLOXACIN HCL CIPROFLOXACIN HCL 1 TabletPROQUIN XR CIPROFLOXACIN HCL 3 Tablet 24hr SRCIPRO XR CIPROFLOXACIN HCL-BETAINE COMB 3 Tablet 24hr SRTEQUIN GATIFLOXACIN 3 TabletFACTIVE GEMIFLOXACIN MESYLATE 3 TabletLEVAQUIN LEVOFLOXACIN 3 SolutionLEVAQUIN LEVOFLOXACIN 2 TabletMAXAQUIN LOMEFLOXACIN HCL 3 TabletAVELOX MOXIFLOXACIN HCL 3 TabletAVELOX ABC PACK MOXIFLOXACIN HCL 3 TabletNEGGRAM NALIDIXIC ACID 3 TabletNOROXIN NORFLOXACIN 3 TabletFLOXIN OFLOXACIN 3 Tablet

ANTIVIRALS, HIV-SPECIFIC, PROTEASE INHIBITORSAGENERASE AMPRENAVIR/VITAMIN E 3 CapsuleAGENERASE AMPRENAVIR/VITAMIN E/PROP GLY 3 SolutionREYATAZ ATAZANAVIR SULFATE 3 CapsuleLEXIVA FOSAMPRENAVIR CALCIUM 3 TabletCRIXIVAN INDINAVIR SULFATE 3 CapsuleVIRACEPT NELFINAVIR MESYLATE 3 PowderVIRACEPT NELFINAVIR MESYLATE 3 TabletNORVIR RITONAVIR 3 CapsuleNORVIR RITONAVIR 3 SolutionFORTOVASE SAQUINAVIR 3 CapsuleINVIRASE SAQUINAVIR MESYLATE 3 CapsuleINVIRASE SAQUINAVIR MESYLATE 3 Tablet

HEPATITIS B TREATMENT AGENTSHEPSERA ADEFOVIR DIPIVOXIL 3 TabletBARACLUDE ENTECAVIR 3 SolutionBARACLUDE ENTECAVIR 3 TabletEPIVIR HBV LAMIVUDINE 3 SolutionEPIVIR HBV LAMIVUDINE 3 Tablet

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

HEPATITIS C TREATMENT AGENTSINFERGEN INTERFERON ALFACON-1 3 VialPEGASYS PEGINTERFERON ALFA-2A 3 KitPEGASYS PEGINTERFERON ALFA-2A 3 VialPEG-INTRON REDIPEN PEGINTERFERON ALFA-2B 3 PenPEG-INTRON PEGINTERFERON ALFA-2B 3 KitRIBATAB RIBAVIRIN 3 TabletREBETOL RIBAVIRIN 3 CapsuleREBETOL RIBAVIRIN 3 SolutionCOPEGUS RIBAVIRIN 3 TabletRIBATAB RIBAVIRIN 3 TabletREBETRON 1000 RIBAVIRIN/INTERFERON A-2B 3 KitREBETRON 1200 RIBAVIRIN/INTERFERON A-2B 3 KitREBETRON 600 RIBAVIRIN/INTERFERON A-2B 3 Kit

RIFAMYCINS AND RELATED DERIVATIVE ANTIBIOTICSXIFAXAN RIFAXIMIN 3 Tablet

ANTIVIRALS, HIV-SPEC, NUCLEOSIDE-NUCLEOTIDE ANALOGTRUVADA EMTRICITABINE/TENOFOVIR 3 Tablet

ANTIVIRALS, HIV-SPECIFIC, NUCLEOTIDE ANALOG, RTIVIREAD TENOFOVIR DISOPROXIL FUMARATE 3 Tablet

ANTIVIRALS, HIV-SPECIFIC, NUCLEOSIDE ANALOG, RTIZIAGEN ABACAVIR SULFATE 3 SolutionZIAGEN ABACAVIR SULFATE 3 TabletVIDEX EC DIDANOSINE 3 Capsule ECVIDEX DIDANOSINE 3 SolutionVIDEX DIDANOSINE/CALCIUM CARB/MAG 3 Chew TabEMTRIVA EMTRICITABINE 3 CapsuleEMTRIVA EMTRICITABINE 3 SolutionEPIVIR LAMIVUDINE 3 SolutionEPIVIR LAMIVUDINE 3 TabletZERIT STAVUDINE 3 CapsuleZERIT STAVUDINE 3 SolutionHIVID ZALCITABINE 3 TabletRETROVIR ZIDOVUDINE 3 CapsuleRETROVIR ZIDOVUDINE 3 SyrupRETROVIR ZIDOVUDINE 3 Tablet

ANTIVIRALS, HIV-SPECIFIC, NON-NUCLEOSIDE, RTIRESCRIPTOR DELAVIRDINE MESYLATE 3 TabletRESCRIPTOR DELAVIRDINE MESYLATE 3 Tablet Disper.SUSTIVA EFAVIRENZ 3 CapsuleSUSTIVA EFAVIRENZ 3 TabletVIRAMUNE NEVIRAPINE 3 SuspensionVIRAMUNE NEVIRAPINE 3 Tablet

ANTIVIRALS, HIV-SPEC., NUCLEOSIDE ANALOG, RTI COMBEPZICOM ABACAVIR SULFATE/LAMIVUDINE 3 TabletTRIZIVIR ABACAVIR/LAMIVUDINE/ZIDOVUDINE 3 TabletCOMBIVIR LAMIVUDINE/ZIDOVUDINE 3 Tablet

ANTIVIRALS, HIV-SPECIFIC, PROTEASE INHIBITOR COMBKALETRA RITONAVIR/LOPINAVIR 3 CapsuleKALETRA RITONAVIR/LOPINAVIR 3 SolutionKALETRA RITONAVIR/LOPINAVIR 3 Tablet

ANTIVIRALS, HIV-SPECIFIC, FUSION INHIBITORSFUZEON ENFUVIRTIDE 3 Kit

2ND GEN. ANAEROBIC ANTIPROTOZOAL-ANTIBACTERIALTINDAMAX TINIDAZOLE 3 Tablet

ANTIVIRALS, HIV-SPEC, NON-PEPTIDIC PROTEASE INHIBAPTIVUS TIPRANAVIR 3 Capsule

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

ANTINEOPLASTICSTOPICAL ANTINEOPLASTIC & PREMALIGNANT LESION AGNTSPANRETIN ALITRETINOIN 3 GelTARGRETIN BEXAROTENE 3 GelSOLARAZE DICLOFENAC SODIUM 3 GelCARAC FLUOROURACIL 2 CreamEFUDEX FLUOROURACIL 2 CreamFLUOROPLEX FLUOROURACIL 2 CreamEFUDEX FLUOROURACIL 2 SolutionFLUOROURACIL FLUOROURACIL 1 SolutionEFUDEX FLUOROURACIL/ADHESIVE BANDAGE 3 Kit

ALKYLATING AGENTSHEXALEN ALTRETAMINE 3 CapsuleMYLERAN BUSULFAN 3 TabletLEUKERAN CHLORAMBUCIL 3 TabletCYTOXAN CYCLOPHOSPHAMIDE 3 TabletDROXIA HYDROXYUREA 3 CapsuleHYDREA HYDROXYUREA 3 CapsuleMYLOCEL HYDROXYUREA 3 TabletCEENU LOMUSTINE 3 CapsuleALKERAN MELPHALAN 3 TabletTEMODAR TEMOZOLOMIDE 3 Capsule

ANTIMETABOLITESXELODA CAPECITABINE 3 TabletPURINETHOL MERCAPTOPURINE 3 TabletMETHOTREXATE METHOTREXATE SODIUM 1 TabletTREXALL METHOTREXATE SODIUM 2 TabletTHIOGUANINE THIOGUANINE 3 Tablet

STEROID ANTINEOPLASTICSEMCYT ESTRAMUSTINE PHOSPHATE SODIUM 3 CapsuleTESLAC TESTOLACTONE 3 Tablet

ANTINEOPLASTICS, MISCELLANEOUSARIMIDEX ANASTROZOLE 3 TabletVEPESID ETOPOSIDE 3 CapsuleAROMASIN EXEMESTANE 3 TabletFEMARA LETROZOLE 3 TabletLYSODREN MITOTANE 3 TabletMATULANE PROCARBAZINE HCL 3 CapsuleVESANOID TRETINOIN 3 Capsule

IMMUNOMODULATORSROFERON-A INTERFERON ALFA-2A,RECOMB. 3 KitINTRON A INTERFERON ALFA-2B,RECOMB. 3 KitINTRON A INTERFERON ALFA-2B,RECOMB. 3 SyringeINTRON A INTERFERON ALFA-2B,RECOMB. 3 VialACTIMMUNE INTERFERON GAMMA-1B,RECOMB. 3 Vial

ANTIANDROGENIC AGENTSCASODEX BICALUTAMIDE 3 TabletEULEXIN FLUTAMIDE 3 CapsuleNILANDRON NILUTAMIDE 3 Tablet

SELECTIVE RETINOID X RECEPTOR AGONISTS (RXR)TARGRETIN BEXAROTENE 3 Capsule

ANTINEOPLASTIC LHRH (GNRH) AGONIST, PITUITARY SUPPR.LUPRON LEUPROLIDE ACETATE 3 KitLUPRON DEPOT LEUPROLIDE ACETATE 3 KitLUPRON DEPOT LEUPROLIDE ACETATE 3 SyringeLUPRON LEUPROLIDE ACETATE 3 VialVIADUR LEUPROLIDE/LIDOCAINE HCL 3 Kit

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Trustmark/Starmark Clinical Formulary - January 2006

PHOTOACTIVATED, ANTINEOPLS. & PREMALIGNANT LESIONSLEVULAN AMINOLEVULINIC ACID HCL 3 Solution

ANTINEOPLASTIC SYSTEMIC ENZYME INHIBITORSTARCEVA ERLOTINIB HCL 3 TabletIRESSA GEFITINIB 3 TabletGLEEVEC IMATINIB MESYLATE 3 TabletNEXAVAR SORAFENIB TOSYLATE 3 Tablet

SELECTIVE ESTROGEN RECEPTOR MODULATORS (SERM)NOLVADEX TAMOXIFEN CITRATE 3 TabletFARESTON TOREMIFENE CITRATE 3 Tablet

ANTIPARKINSON DRUGSDECARBOXYLASE INHIBITORSLODOSYN CARBIDOPA 3 Tablet

ANTIPARKINSONISM DRUGS,OTHERAMANTADINE AMANTADINE HCL 1 CapsuleAMANTADINE HCL AMANTADINE HCL 1 CapsuleAMANTADINE HCL AMANTADINE HCL 1 SyrupAMANTADINE HCL AMANTADINE HCL 1 TabletSYMMETREL AMANTADINE HCL 2 TabletAPOKYN APOMORPHINE HCL 3 CartridgeCARBIDOPA-LEVODOPA CARBIDOPA/LEVODOPA 1 TabletSINEMET-10/100 CARBIDOPA/LEVODOPA 3 TabletSINEMET-25/100 CARBIDOPA/LEVODOPA 3 TabletSINEMET-25/250 CARBIDOPA/LEVODOPA 3 TabletCARBIDOPA/LEVODOPA CARBIDOPA/LEVODOPA 1 Tablet SACARBIDOPA-LEVODOPA CARBIDOPA/LEVODOPA 1 Tablet SASINEMET CR CARBIDOPA/LEVODOPA 3 Tablet SAPARCOPA CARBIDOPA/LEVODOPA 3 Tablet, Disper. LingualSTALEVO 100 CARBIDOPA/LEVODOPA/ENTACAPONE 2 TabletSTALEVO 150 CARBIDOPA/LEVODOPA/ENTACAPONE 2 TabletSTALEVO 50 CARBIDOPA/LEVODOPA/ENTACAPONE 2 TabletCOMTAN ENTACAPONE 2 TabletPERMAX PERGOLIDE MESYLATE 3 TabletMIRAPEX PRAMIPEXOLE DI-HCL 2 TabletREQUIP ROPINIROLE HCL 2 TabletELDEPRYL SELEGILINE HCL 3 CapsuleSELEGILINE HCL SELEGILINE HCL 1 CapsuleSELEGILINE HCL SELEGILINE HCL 2 TabletTASMAR TOLCAPONE 3 Tablet

ANTIPARKINSONISM DRUGS,ANTICHOLINERGICBENZTROPINE MESYLATE BENZTROPINE MESYLATE 1 TabletAKINETON BIPERIDEN HCL 3 TabletKEMADRIN PROCYCLIDINE HCL 3 TabletTRIHEXYPHENIDYL HCL TRIHEXYPHENIDYL HCL 2 ElixirTRIHEXYPHENIDYL HCL TRIHEXYPHENIDYL HCL 1 Tablet

AUTONOMIC DRUGSPARASYMPATHETIC AGENTSBETHANECHOL CHLORIDE BETHANECHOL CHLORIDE 1 TabletURECHOLINE BETHANECHOL CHLORIDE 2 TabletEVOXAC CEVIMELINE HCL 2 CapsuleGUANIDINE HCL GUANIDINE HCL 3 TabletPILOCARPINE HCL PILOCARPINE HCL 1 TabletSALAGEN PILOCARPINE HCL 2 Tablet

CHOLINESTERASE INHIBITORSMYTELASE AMBENONIUM CHLORIDE 3 TabletARICEPT DONEPEZIL HCL 2 TabletARICEPT ODT DONEPEZIL HCL 2 Tablet, Disper. Lingual

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Trustmark/Starmark Clinical Formulary - January 2006

RAZADYNE ER GALANTAMINE HYDROBROMIDE 2 Capsule 24hr SRRAZADYNE GALANTAMINE HYDROBROMIDE 2 SolutionRAZADYNE GALANTAMINE HYDROBROMIDE 2 TabletPROSTIGMIN NEOSTIGMINE BROMIDE 3 TabletMESTINON PYRIDOSTIGMINE BROMIDE 3 SyrupMESTINON PYRIDOSTIGMINE BROMIDE 3 TabletMESTINON PYRIDOSTIGMINE BROMIDE 3 Tablet SAEXELON RIVASTIGMINE TARTRATE 2 CapsuleEXELON RIVASTIGMINE TARTRATE 3 SolutionCOGNEX TACRINE HCL 3 Capsule

ADRENERGICS, AROMATIC, NON-CATECHOLAMINEADDERALL XR AMPHET ASP/AMPHET/D-AMPHET 2 Capsule 24hr SRADDERALL AMPHET ASP/AMPHET/D-AMPHET 3 TabletAMPHETAMINE SALT COMBO AMPHET ASP/AMPHET/D-AMPHET 1 TabletDEXEDRINE D-AMPHETAMINE SULFATE 3 Capsule SADEXEDRINE D-AMPHETAMINE SULFATE 3 TabletDESOXYN METHAMPHETAMINE HCL 3 Tablet

ALPHA-ADRENERGIC BLOCKING AGENTSDIBENZYLINE PHENOXYBENZAMINE HCL 3 Capsule

BETA-ADRENERGIC BLOCKING AGENTSSECTRAL ACEBUTOLOL HCL 3 CapsuleATENOLOL ATENOLOL 1 TabletTENORMIN ATENOLOL 3 TabletKERLONE BETAXOLOL HCL 3 TabletZEBETA BISOPROLOL FUMARATE 3 TabletTOPROL XL METOPROLOL SUCCINATE 2 Tablet 24hr SRLOPRESSOR METOPROLOL TARTRATE 3 TabletMETOPROLOL TARTRATE METOPROLOL TARTRATE 3 TabletCORGARD NADOLOL 3 TabletLEVATOL PENBUTOLOL SULFATE 3 TabletPINDOLOL PINDOLOL 1 TabletINDERAL LA PROPRANOLOL HCL 3 CapsuleINNOPRAN XL PROPRANOLOL HCL 3 Capsule 24hr SRPROPRANOLOL HCL PROPRANOLOL HCL 3 SolutionINDERAL PROPRANOLOL HCL 3 TabletPROPRANOLOL HCL PROPRANOLOL HCL 1 TabletBETAPACE SOTALOL HCL 3 TabletBETAPACE AF SOTALOL HCL 2 TabletSORINE SOTALOL HCL 1 TabletSOTALOL SOTALOL HCL 1 TabletSOTALOL AF SOTALOL HCL 1 TabletSOTALOL HCL SOTALOL HCL 1 TabletBLOCADREN TIMOLOL MALEATE 3 Tablet

ANAPHYLAXIS THERAPY AGENTSEPIPEN EPINEPHRINE 2 Pen InjEPIPEN JR. EPINEPHRINE 2 Pen Inj

ADRENERGIC VASOPRESSOR AGENTSPROAMATINE MIDODRINE HCL 3 Tablet

ALPHA-ADRENERGIC BLOCKING AGENT/THIAZIDE COMBMINIZIDE 1 PRAZOSIN HCL/POLYTHIAZIDE 3 CapsuleMINIZIDE 2 PRAZOSIN HCL/POLYTHIAZIDE 3 CapsuleMINIZIDE 5 PRAZOSIN HCL/POLYTHIAZIDE 3 Capsule

BLOODTOPICAL HEMOSTATICSASTRINGYN FERRIC SUBSULFATE 3 Solution

ANTIFIBRINOLYTIC AGENTSAMICAR AMINOCAPROIC ACID 3 SyrupAMICAR AMINOCAPROIC ACID 3 Tablet

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Trustmark/Starmark Clinical Formulary - January 2006

CITRATES AS ANTICOAGULANTSACD-A CITRATE DEXTROSE SOLUTION 3 SolutionCITRATE PHOSPHATE DEXTROSE CITRATE-PHOS-DEX SOLUTION 3 Solution

HEPARIN AND RELATED PREPARATIONSFRAGMIN DALTEPARIN SODIUM,PORCINE 3 SyringeFRAGMIN DALTEPARIN SODIUM,PORCINE 3 VialLOVENOX ENOXAPARIN SODIUM 3 SyringeLOVENOX ENOXAPARIN SODIUM 3 VialARIXTRA FONDAPARINUX SODIUM 3 SyringeINNOHEP TINZAPARIN SODIUM,PORCINE 3 Vial

ORAL ANTICOAGULANTS,COUMARIN TYPECOUMADIN WARFARIN SODIUM 3 TabletJANTOVEN WARFARIN SODIUM 1 TabletWARFARIN SODIUM WARFARIN SODIUM 1 Tablet

HEMORRHEOLOGIC AGENTSPENTOPAK PENTOXIFYLLINE 3 Tablet SAPENTOXIFYLLINE PENTOXIFYLLINE 1 Tablet SAPENTOXIL PENTOXIFYLLINE 1 Tablet SATRENTAL PENTOXIFYLLINE 3 Tablet SA

HEMATINICS, OTHERARANESP DARBEPOETIN ALFA IN ALBUMN SOL 3 SyringeARANESP DARBEPOETIN ALFA IN ALBUMN SOL 3 VialEPOGEN EPOETIN ALFA 3 VialPROCRIT EPOETIN ALFA 3 Vial

LEUKOCYTE (WBC) STIMULANTSNEUPOGEN FILGRASTIM 3 SyringeNEUPOGEN FILGRASTIM 3 VialLEUKINE SARGRAMOSTIM 3 Vial

PLATELET AGGREGATION INHIBITORSAGGRENOX ASPIRIN/DIPYRIDAMOLE 2 CapsulePLETAL CILOSTAZOL 3 TabletPLAVIX CLOPIDOGREL BISULFATE 3 TabletDIPYRIDAMOLE DIPYRIDAMOLE 1 TabletPERSANTINE DIPYRIDAMOLE 3 TabletTICLID TICLOPIDINE HCL 3 TabletTICLOPIDINE HCL TICLOPIDINE HCL 1 Tablet

PLATELET REDUCING AGENTSAGRYLIN ANAGRELIDE HCL 2 CapsuleANAGRELIDE HCL ANAGRELIDE HCL 1 Capsule

CARDIAC DRUGSDIGITALIS GLYCOSIDESLANOXICAPS DIGOXIN 2 CapsuleDIGOXIN DIGOXIN 1 SolutionDIGITEK DIGOXIN 3 TabletDIGOXIN DIGOXIN 3 TabletLANOXIN DIGOXIN 3 Tablet

ANTIARRHYTHMICSAMIODARONE HCL AMIODARONE HCL 1 TabletCORDARONE AMIODARONE HCL 2 TabletPACERONE AMIODARONE HCL 2 TabletDISOPYRAMIDE PHOSPHATE DISOPYRAMIDE PHOSPHATE 1 CapsuleNORPACE DISOPYRAMIDE PHOSPHATE 2 CapsuleDISOPYRAMIDE PHOSPHATE DISOPYRAMIDE PHOSPHATE 1 Capsule SANORPACE CR DISOPYRAMIDE PHOSPHATE 2 Capsule SATIKOSYN DOFETILIDE 3 CapsuleFLECAINIDE ACETATE FLECAINIDE ACETATE 1 TabletTAMBOCOR FLECAINIDE ACETATE 3 Tablet

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Trustmark/Starmark Clinical Formulary - January 2006

MEXILETINE HCL MEXILETINE HCL 1 CapsuleETHMOZINE MORICIZINE HCL 3 TabletPROCAINAMIDE HCL PROCAINAMIDE HCL 2 CapsulePRONESTYL PROCAINAMIDE HCL 2 CapsulePRONESTYL PROCAINAMIDE HCL 2 TabletPROCANBID PROCAINAMIDE HCL 2 Tablet 12hr SRPROCAINAMIDE HCL PROCAINAMIDE HCL 1 Tablet SAPRONESTYL-SR PROCAINAMIDE HCL 2 Tablet SARYTHMOL SR PROPAFENONE HCL 3 Capsule 12hr SRPROPAFENONE HCL PROPAFENONE HCL 1 TabletRYTHMOL PROPAFENONE HCL 3 TabletQUINIDINE GLUCONATE QUINIDINE GLUCONATE 1 Tablet SAQUINIDINE SULFATE QUINIDINE SULFATE 1 TabletQUINIDINE SULFATE QUINIDINE SULFATE 1 Tablet SA

VASODILATORS, CORONARYDILATRATE-SR ISOSORBIDE DINITRATE 2 Capsule SAISORDIL ISOSORBIDE DINITRATE 3 TabletISOSORBIDE DINITRATE ISOSORBIDE DINITRATE 1 TabletISOCHRON ISOSORBIDE DINITRATE 2 Tablet SAISOSORBIDE DINITRATE ISOSORBIDE DINITRATE 1 Tablet SAISOSORBIDE DINITRATE ISOSORBIDE DINITRATE 1 Tablet SLISMO ISOSORBIDE MONONITRATE 3 TabletMONOKET ISOSORBIDE MONONITRATE 3 TabletIMDUR ISOSORBIDE MONONITRATE 3 Tablet 24hr SRNITROLINGUAL NITROGLYCERIN 2 SprayNITROGLYCERIN NITROGLYCERIN 2 Capsule SANITROGLYN NITROGLYCERIN 1 Capsule SANITRO-TIME NITROGLYCERIN 1 Capsule SANITRO-BID NITROGLYCERIN 2 OintmentMINITRAN NITROGLYCERIN 2 Patch 24hrNITREK NITROGLYCERIN 1 Patch 24hrNITRO-DUR NITROGLYCERIN 2 Patch 24hrNITROGLYCERIN NITROGLYCERIN 1 Patch 24hrNITROGLYCERIN TRANSDERMAL NITROGLYCERIN 1 Patch 24hrNITROGLYCERIN NITROGLYCERIN 1 Tablet SLNITROQUICK NITROGLYCERIN 1 Tablet SLNITROSTAT NITROGLYCERIN 2 Tablet SL

CALCIUM CHANNEL BLOCKING AGENTSNORVASC AMLODIPINE BESYLATE 2 TabletDILTIAZEM HCL DILTIAZEM HCL 1 Capsule 12hr SRCARDIZEM CD DILTIAZEM HCL 3 Capsule 24hr SRCARTIA XT DILTIAZEM HCL 1 Capsule 24hr SRDILTIAZEM HCL DILTIAZEM HCL 1 Capsule 24hr SRDILACOR XR DILTIAZEM HCL 3 Capsule CRDILTIA XT DILTIAZEM HCL 1 Capsule CRDILTIAZEM ER DILTIAZEM HCL 1 Capsule CRDILTIAZEM HCL DILTIAZEM HCL 1 Capsule CRDILTIAZEM XR DILTIAZEM HCL 1 Capsule CRDILT-XR DILTIAZEM HCL 1 Capsule CRTIAZAC DILTIAZEM HCL 3 Capsule SACARDIZEM DILTIAZEM HCL 3 TabletDILTIAZEM HCL DILTIAZEM HCL 1 TabletCARDIZEM LA DILTIAZEM HCL 3 Tablet 24hr SRFELODIPINE ER FELODIPINE 1 Tablet 24hr SRPLENDIL FELODIPINE 3 Tablet 24hr SRDYNACIRC CR ISRADIPINE 3 Tablet Osmotic Laser-DrilledCARDENE NICARDIPINE HCL 3 CapsuleCARDENE SR NICARDIPINE HCL 3 Capsule SAPROCARDIA NIFEDIPINE 3 CapsuleNIFEDICAL XL NIFEDIPINE 1 Tablet Osmotic Laser-DrilledNIFEDIPINE ER NIFEDIPINE 1 Tablet Osmotic Laser-DrilledPROCARDIA XL NIFEDIPINE 3 Tablet Osmotic Laser-Drilled

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

ADALAT CC NIFEDIPINE 3 Tablet SAAFEDITAB CR NIFEDIPINE 1 Tablet SANIFEDIAC CC NIFEDIPINE 1 Tablet SANIFEDIPINE NIFEDIPINE 1 Tablet SANIMOTOP NIMODIPINE 3 CapsuleSULAR NISOLDIPINE 2 Tablet 24hr SRVERAPAMIL HCL VERAPAMIL HCL 1 Capsule 24hr SRVERELAN VERAPAMIL HCL 3 Capsule 24hr SRVERELAN PM VERAPAMIL HCL 3 Capsule 24hr SRCALAN VERAPAMIL HCL 3 TabletVERAPAMIL HCL VERAPAMIL HCL 1 TabletCOVERA-HS VERAPAMIL HCL 3 Tablet Osmotic Laser-DrilledCALAN SR VERAPAMIL HCL 3 Tablet SAISOPTIN SR VERAPAMIL HCL 3 Tablet SAVERAPAMIL HCL VERAPAMIL HCL 1 Tablet SA

CARDIOVASCULARHYPOTENSIVES, VASODILATORSHYDRALAZINE HCL HYDRALAZINE HCL 1 TabletHYDRA-ZIDE HYDRALAZINE/HYDROCHLOROTHIAZID 3 CapsuleUNI-SERP HYDRALAZINE/RESERPIN/HCTZ 3 TabletMINOXIDIL MINOXIDIL 1 Tablet

HYPOTENSIVES, SYMPATHOLYTICCATAPRES-TTS 1 CLONIDINE HCL 2 Patch WeeklyCATAPRES-TTS 2 CLONIDINE HCL 2 Patch WeeklyCATAPRES-TTS 3 CLONIDINE HCL 2 Patch WeeklyCATAPRES CLONIDINE HCL 3 TabletCLONIDINE HCL CLONIDINE HCL 1 TabletCLORPRES CLONIDINE HCL/CHLORTHALIDONE 3 TabletENDURONYL FORTE DESERPIDINE/METHYCLOTHIAZIDE 3 TabletTENEX GUANFACINE HCL 3 TabletALDOMET METHYLDOPA 2 TabletMETHYLDOPA METHYLDOPA 1 TabletALDOCLOR-250 METHYLDOPA/CHLOROTHIAZIDE 3 TabletALDORIL-25 METHYLDOPA/HYDROCHLOROTHIAZIDE 3 TabletALDORIL-D50 METHYLDOPA/HYDROCHLOROTHIAZIDE 3 TabletRESERPINE RESERPINE 3 Tablet

HYPOTENSIVES, GANGLIONIC BLOCKERSINVERSINE MECAMYLAMINE HCL 3 Tablet

HYPOTENSIVES, ACE INHIBITORSBENAZEPRIL HCL BENAZEPRIL HCL 1 TabletLOTENSIN BENAZEPRIL HCL 3 TabletBENAZEPRIL HCL-HCTZ BENAZEPRIL/HYDROCHLOROTHIAZIDE 1 TabletLOTENSIN HCT BENAZEPRIL/HYDROCHLOROTHIAZIDE 3 TabletCAPOTEN CAPTOPRIL 3 TabletCAPTOPRIL CAPTOPRIL 1 TabletCAPOZIDE CAPTOPRIL/HYDROCHLOROTHIAZIDE 3 TabletCAPTOPRIL/HYDROCHLOROTHIAZIDE CAPTOPRIL/HYDROCHLOROTHIAZIDE 1 TabletENALAPRIL MALEATE ENALAPRIL MALEATE 1 TabletVASOTEC ENALAPRIL MALEATE 3 TabletENALAPRIL MALEATE-HCTZ ENALAPRIL/HYDROCHLOROTHIAZIDE 1 TabletVASERETIC ENALAPRIL/HYDROCHLOROTHIAZIDE 3 TabletMONOPRIL FOSINOPRIL SODIUM 3 TabletMONOPRIL HCT FOSINOPRIL/HYDROCHLOROTHIAZIDE 3 TabletLISINOPRIL LISINOPRIL 1 TabletPRINIVIL LISINOPRIL 3 TabletZESTRIL LISINOPRIL 3 TabletLISINOPRIL-HCTZ LISINOPRIL/HYDROCHLOROTHIAZIDE 1 TabletLISINOPRIL-HYDROCHLOROTHIAZIDE LISINOPRIL/HYDROCHLOROTHIAZIDE 1 TabletPRINZIDE LISINOPRIL/HYDROCHLOROTHIAZIDE 3 TabletZESTORETIC LISINOPRIL/HYDROCHLOROTHIAZIDE 3 Tablet

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

UNIVASC MOEXIPRIL HCL 3 TabletUNIRETIC MOEXIPRIL/HYDROCHLOROTHIAZIDE 3 TabletACEON PERINDOPRIL ERBUMINE 3 TabletACCUPRIL QUINAPRIL HCL 2 TabletQUINAPRIL QUINAPRIL HCL 1 TabletQUINAPRIL HCL QUINAPRIL HCL 1 TabletACCURETIC QUINAPRIL/HYDROCHLOROTHIAZIDE 2 TabletQUINARETIC QUINAPRIL/HYDROCHLOROTHIAZIDE 1 TabletALTACE RAMIPRIL 2 CapsuleMAVIK TRANDOLAPRIL 3 Tablet

HYPOTENSIVES, MISCELLANEOUSTENORETIC 100 ATENOLOL/CHLORTHALIDONE 3 TabletTENORETIC 50 ATENOLOL/CHLORTHALIDONE 3 TabletBISOPROLOL FUMARATE-HCTZ BISOPROL/HYDROCHLOROTHIAZIDE 1 TabletZIAC BISOPROL/HYDROCHLOROTHIAZIDE 3 TabletLOPRESSOR HCT METOPROL/HYDROCHLOROTHIAZIDE 3 TabletDEMSER METYROSINE 3 CapsuleCORZIDE NADOLOL/BENDROFLUMETHIAZIDE 3 TabletINDERIDE-40/25 PROPRANOLOL/HYDROCHLOROTHIAZID 3 TabletTIMOLIDE TIMOLOL/HYDROCHLOROTHIAZIDE 3 Tablet

VASODILATORS, PERIPHERALISOVEX ETHAVERINE HCL 3 CapsuleVASODILAN ISOXSUPRINE HCL 3 TabletPAPAVERINE HCL PAPAVERINE HCL 3 Capsule SA

BILE SALT SEQUESTRANTSCHOLESTYRAMINE LIGHT CHOLESTYRAMINE/ASPARTAME 1 PacketPREVALITE CHOLESTYRAMINE/ASPARTAME 1 PacketQUESTRAN LIGHT CHOLESTYRAMINE/ASPARTAME 3 PacketCHOLESTYRAMINE LIGHT CHOLESTYRAMINE/ASPARTAME 1 PowderPREVALITE CHOLESTYRAMINE/ASPARTAME 1 PowderCHOLESTYRAMINE CHOLESTYRAMINE/SUCROSE 1 PacketQUESTRAN CHOLESTYRAMINE/SUCROSE 3 PacketCHOLESTYRAMINE CHOLESTYRAMINE/SUCROSE 1 PowderWELCHOL COLESEVELAM HCL 3 TabletCOLESTID COLESTIPOL HCL 2 GranulesCOLESTID COLESTIPOL HCL 2 PacketCOLESTID COLESTIPOL HCL 2 Tablet

ALPHA/BETA-ADRENERGIC BLOCKING AGENTSCOREG CARVEDILOL 2 TabletLABETALOL HCL LABETALOL HCL 1 TabletTRANDATE LABETALOL HCL 3 Tablet

ALPHA-ADRENERGIC BLOCKING AGENTSCARDURA DOXAZOSIN MESYLATE 3 TabletDOXAZOSIN MESYLATE DOXAZOSIN MESYLATE 1 TabletMINIPRESS PRAZOSIN HCL 3 CapsulePRAZOSIN HCL PRAZOSIN HCL 1 CapsuleHYTRIN TERAZOSIN HCL 3 CapsuleTERAZOSIN TERAZOSIN HCL 1 CapsuleTERAZOSIN HCL TERAZOSIN HCL 1 Capsule

LIPOTROPICSLIPITOR ATORVASTATIN CALCIUM 2 TabletCLOFIBRATE CLOFIBRATE 3 CapsuleZETIA EZETIMIBE 3 TabletVYTORIN EZETIMIBE/SIMVASTATIN 2 TabletTRIGLIDE FENOFIBRATE 3 TabletANTARA FENOFIBRATE,MICRONIZED 2 CapsuleLOFIBRA FENOFIBRATE,MICRONIZED 2 CapsuleLOFIBRA FENOFIBRATE,MICRONIZED 2 TabletTRICOR FENOFIBRATE,MICRONIZED 2 TabletLESCOL FLUVASTATIN SODIUM 3 Capsule

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

LESCOL XL FLUVASTATIN SODIUM 3 Tablet 24hr SRGEMFIBROZIL GEMFIBROZIL 1 TabletLOPID GEMFIBROZIL 3 TabletLOVASTATIN LOVASTATIN 1 TabletMEVACOR LOVASTATIN 3 TabletALTOPREV LOVASTATIN 3 Tablet 24hr SRLIPOCHOL PLUS METHIONINE/INOSITOL/CHOLINE/FA 3 TabletNIACOR NIACIN 3 TabletNIASPAN NIACIN 2 Tablet SAADVICOR NIACIN/LOVASTATIN 2 TabletLIPEX POLICOSANOL 3 TabletPRAVACHOL PRAVASTATIN SODIUM 3 TabletCRESTOR ROSUVASTATIN CALCIUM 3 TabletZOCOR SIMVASTATIN 3 Tablet

HYPOTENSIVES, ANGIOTENSIN RECEPTOR ANTAGONISTATACAND CANDESARTAN CILEXETIL 3 TabletATACAND HCT CANDESARTAN/HYDROCHLOROTHIAZID 3 TabletTEVETEN EPROSARTAN MESYLATE 3 TabletTEVETEN HCT EPROSARTAN/HYDROCHLOROTHIAZIDE 3 TabletAVAPRO IRBESARTAN 2 TabletAVALIDE IRBESARTAN/HYDROCHLOROTHIAZIDE 2 TabletCOZAAR LOSARTAN POTASSIUM 2 TabletHYZAAR LOSARTAN/HYDROCHLOROTHIAZIDE 2 TabletBENICAR OLMESARTAN MEDOXOMIL 3 TabletBENICAR HCT OLMESARTN/HYDROCHLOROTHIAZIDE 3 TabletMICARDIS TELMISARTAN 3 TabletMICARDIS HCT TELMISARTAN/HYDROCHLOROTHIAZID 3 TabletDIOVAN VALSARTAN 3 TabletDIOVAN HCT VALSARTAN/HYDROCHLOROTHIAZIDE 3 Tablet

ANTIHYPERLIP(HMGCOA) & CALCIUM CHANNEL BLOCKER CMBCADUET AMLODIPINE/ATORVAST CAL 2 Tablet

ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONLOTREL AMLODIPINE BESYLATE/BENAZEPRIL 2 CapsuleLEXXEL ENALAPRIL MALEATE/FELODIPINE 3 Tablet SATARKA TRANDOLAPRIL/VERAPAMIL HCL 3 Tablet

PULMONARY ANTIHYPERTENSIVES, PROSTACYCLIN-TYPEVENTAVIS ILOPROST 3 Ampul

PULM.ANTI-HTN, SEL.C-GMP PHOSPHODIESTERASE T5 INHIBREVATIO SILDENAFIL CITRATE 3 Tablet

VASODILATORS, COMBINATIONBIDIL ISOSORB DINIT/HYDRALAZINE HCL 3 Tablet

CNS DRUGSXANTHINESCAFCIT CAFFEINE CITRATED 3 Solution

ANTICONVULSANTSCARBATROL CARBAMAZEPINE 3 CapsuleEQUETRO CARBAMAZEPINE 3 CapsuleCARBAMAZEPINE CARBAMAZEPINE 1 Chew TabTEGRETOL CARBAMAZEPINE 2 Chew TabCARBAMAZEPINE CARBAMAZEPINE 1 SuspensionTEGRETOL CARBAMAZEPINE 2 SuspensionCARBAMAZEPINE CARBAMAZEPINE 1 TabletEPITOL CARBAMAZEPINE 1 TabletTEGRETOL CARBAMAZEPINE 2 TabletTEGRETOL XR CARBAMAZEPINE 2 Tablet 12hr SRCEBERCLON CLONAZEPAM 1 TabletCLONAZEPAM CLONAZEPAM 1 TabletKLONOPIN CLONAZEPAM 3 Tablet

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

KLONOPIN CLONAZEPAM 3 Tablet, Disper. LingualDIASTAT DIAZEPAM 2 KitDIASTAT ACUDIAL DIAZEPAM 2 KitDEPAKOTE SPRINKLE DIVALPROEX SODIUM 3 Capsule SprinkleDEPAKOTE ER DIVALPROEX SODIUM 3 Tablet 24hr SRDEPAKOTE DIVALPROEX SODIUM 3 Tablet ECETHOSUXIMIDE ETHOSUXIMIDE 1 CapsuleZARONTIN ETHOSUXIMIDE 2 CapsuleETHOSUXIMIDE ETHOSUXIMIDE 1 SyrupZARONTIN ETHOSUXIMIDE 2 SyrupPEGANONE ETHOTOIN 3 TabletFELBATOL FELBAMATE 3 SuspensionFELBATOL FELBAMATE 3 TabletGABAPENTIN GABAPENTIN 1 CapsuleNEURONTIN GABAPENTIN 3 CapsuleNEURONTIN GABAPENTIN 3 SolutionGABAPENTIN GABAPENTIN 1 TabletGABARONE GABAPENTIN 3 TabletNEURONTIN GABAPENTIN 3 TabletLAMICTAL LAMOTRIGINE 3 TabletLAMICTAL LAMOTRIGINE 3 Tablet Disper.KEPPRA LEVETIRACETAM 2 SolutionKEPPRA LEVETIRACETAM 2 TabletMEBARAL MEPHOBARBITAL 3 TabletCELONTIN METHSUXIMIDE 3 CapsuleTRILEPTAL OXCARBAZEPINE 2 SuspensionTRILEPTAL OXCARBAZEPINE 2 TabletDILANTIN PHENYTOIN 3 Chew TabDILANTIN-125 PHENYTOIN 3 SuspensionPHENYTOIN PHENYTOIN 1 SuspensionPHENYTOIN SODIUM PHENYTOIN SODIUM 2 CapsuleDILANTIN PHENYTOIN SODIUM EXTENDED 3 CapsuleDILANTIN PHENYTOIN SODIUM EXTENDED 3 CapsulePHENYTEK PHENYTOIN SODIUM EXTENDED 3 CapsulePHENYTOIN SODIUM PHENYTOIN SODIUM EXTENDED 1 CapsulePHENYTOIN SODIUM, EXTENDED PHENYTOIN SODIUM EXTENDED 1 CapsuleLYRICA PREGABALIN 3 CapsuleMYSOLINE PRIMIDONE 2 TabletPRIMIDONE PRIMIDONE 1 TabletGABITRIL TIAGABINE HCL 2 TabletTOPAMAX TOPIRAMATE 3 Capsule SprinkleTOPAMAX TOPIRAMATE 3 TabletDEPAKENE VALPROATE SODIUM 2 SyrupVALPROIC ACID VALPROATE SODIUM 1 SyrupDEPAKENE VALPROIC ACID 2 CapsuleVALPROIC ACID VALPROIC ACID 1 CapsuleZONEGRAN ZONISAMIDE 2 CapsuleZONISAMIDE ZONISAMIDE 1 Capsule

AMYOTROPHIC LATERAL SCLEROSIS AGENTSRILUTEK RILUZOLE 3 Tablet

ALZHEIMER'S THERAPY, NMDA RECEPTOR ANTAGONISTSNAMENDA MEMANTINE HCL 3 SolutionNAMENDA MEMANTINE HCL 2 Tablet

CONTRACEPTIVESCONTRACEPTIVES, ORALAPRI DESOGESTREL-ETHINYL ESTRADIOL 1 TabletCESIA DESOGESTREL-ETHINYL ESTRADIOL 1 TabletCYCLESSA DESOGESTREL-ETHINYL ESTRADIOL 2 TabletDESOGEN DESOGESTREL-ETHINYL ESTRADIOL 3 TabletORTHO-CEPT DESOGESTREL-ETHINYL ESTRADIOL 3 TabletRECLIPSEN DESOGESTREL-ETHINYL ESTRADIOL 1 Tablet

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

SOLIA DESOGESTREL-ETHINYL ESTRADIOL 1 TabletVELIVET DESOGESTREL-ETHINYL ESTRADIOL 1 TabletKARIVA DESOG-ET ESTRA/ETHIN ESTRA 1 TabletMIRCETTE DESOG-ET ESTRA/ETHIN ESTRA 3 TabletYASMIN 28 ETHINYL ESTRADIOL/DROSPIRENONE 2 TabletDEMULEN 1/35-28 ETHYNODIOL D-ETHINYL ESTRADIOL 3 TabletDEMULEN 1/50-21 ETHYNODIOL D-ETHINYL ESTRADIOL 3 TabletDEMULEN 1/50-28 ETHYNODIOL D-ETHINYL ESTRADIOL 3 TabletKELNOR 1/35 ETHYNODIOL D-ETHINYL ESTRADIOL 1 TabletZOVIA 1/35E ETHYNODIOL D-ETHINYL ESTRADIOL 1 TabletZOVIA 1/50E ETHYNODIOL D-ETHINYL ESTRADIOL 1 TabletPLAN B LEVONORGESTREL 2 TabletSEASONALE LEVONORGESTREL-ETH ESTRA 2 TabletALESSE-28 LEVONORGESTREL-ETH ESTRA 3 TabletAVIANE LEVONORGESTREL-ETH ESTRA 1 TabletENPRESSE LEVONORGESTREL-ETH ESTRA 1 TabletLESSINA LEVONORGESTREL-ETH ESTRA 1 TabletLEVLEN 28 LEVONORGESTREL-ETH ESTRA 1 TabletLEVLITE-28 LEVONORGESTREL-ETH ESTRA 1 TabletLEVORA-28 LEVONORGESTREL-ETH ESTRA 1 TabletLUTERA LEVONORGESTREL-ETH ESTRA 1 TabletNORDETTE-28 LEVONORGESTREL-ETH ESTRA 3 TabletPORTIA LEVONORGESTREL-ETH ESTRA 1 TabletTRI-LEVLEN 28 LEVONORGESTREL-ETH ESTRA 3 TabletTRIPHASIL-28 LEVONORGESTREL-ETH ESTRA 3 TabletTRIVORA-28 LEVONORGESTREL-ETH ESTRA 1 TabletESTROSTEP FE NORETH A-ET ESTRA/FE FUMARATE 2 TabletJUNEL FE NORETH A-ET ESTRA/FE FUMARATE 1 TabletLOESTRIN FE NORETH A-ET ESTRA/FE FUMARATE 3 TabletMICROGESTIN FE NORETH A-ET ESTRA/FE FUMARATE 1 TabletCAMILA NORETHINDRONE 1 TabletERRIN NORETHINDRONE 1 TabletJOLIVETTE NORETHINDRONE 1 TabletNORA-BE NORETHINDRONE 1 TabletNOR-Q-D NORETHINDRONE 3 TabletORTHO MICRONOR NORETHINDRONE 3 TabletJUNEL NORETHINDRONE A-E ESTRADIOL 1 TabletLOESTRIN NORETHINDRONE A-E ESTRADIOL 3 TabletMICROGESTIN NORETHINDRONE A-E ESTRADIOL 1 TabletOVCON-35 NORETHINDRONE-ETHINYL ESTRAD 3 Chew TabARANELLE NORETHINDRONE-ETHINYL ESTRAD 1 TabletBREVICON NORETHINDRONE-ETHINYL ESTRAD 3 TabletLEENA NORETHINDRONE-ETHINYL ESTRAD 1 TabletMODICON NORETHINDRONE-ETHINYL ESTRAD 3 TabletNECON NORETHINDRONE-ETHINYL ESTRAD 1 TabletNORINYL 1+35 NORETHINDRONE-ETHINYL ESTRAD 3 TabletNORTREL NORETHINDRONE-ETHINYL ESTRAD 1 TabletORTHO-NOVUM NORETHINDRONE-ETHINYL ESTRAD 3 TabletOVCON-35 NORETHINDRONE-ETHINYL ESTRAD 3 TabletOVCON-50 NORETHINDRONE-ETHINYL ESTRAD 3 TabletTRI-NORINYL NORETHINDRONE-ETHINYL ESTRAD 3 TabletNECON NORETHINDRONE-MESTRANOL 1 TabletNORINYL 1+50 NORETHINDRONE-MESTRANOL 3 TabletORTHO-NOVUM NORETHINDRONE-MESTRANOL 3 TabletMONONESSA NORGESTIMATE-ETHINYL ESTRADIOL 1 TabletORTHO TRI-CYCLEN NORGESTIMATE-ETHINYL ESTRADIOL 3 TabletORTHO TRI-CYCLEN LO NORGESTIMATE-ETHINYL ESTRADIOL 3 TabletORTHO-CYCLEN NORGESTIMATE-ETHINYL ESTRADIOL 3 TabletPREVIFEM NORGESTIMATE-ETHINYL ESTRADIOL 1 TabletSPRINTEC NORGESTIMATE-ETHINYL ESTRADIOL 1 TabletTRINESSA NORGESTIMATE-ETHINYL ESTRADIOL 1 TabletTRI-PREVIFEM NORGESTIMATE-ETHINYL ESTRADIOL 1 TabletTRI-SPRINTEC NORGESTIMATE-ETHINYL ESTRADIOL 1 TabletOVRETTE NORGESTREL 3 Tablet

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

CRYSELLE NORGESTREL-ETHINYL ESTRADIOL 1 TabletLO/OVRAL-28 NORGESTREL-ETHINYL ESTRADIOL 3 TabletLOW-OGESTREL NORGESTREL-ETHINYL ESTRADIOL 1 TabletOGESTREL NORGESTREL-ETHINYL ESTRADIOL 1 TabletOVRAL-28 NORGESTREL-ETHINYL ESTRADIOL 3 Tablet

INTRA-UTERINE DEVICES (IUD'S)MIRENA LEVONORGESTREL 3 Intrauerine Device

CONTRACEPTIVES,TRANSDERMALORTHO EVRA ETHINYL ESTRADIOL/NORELGEST 2 Patch Weekly

CONTRACEPTIVES, INTRAVAGINAL, SYSTEMICNUVARING ETONOGESTREL/ETHINYL ESTRADIOL 2 Ring, Vaginal

COUGH/COLD PREPARATIONSEXPECTORANTSPHENYDEX GUAIFEN/D-METHORPHAN HB/PE/PYR 3 LiquidPHANASIN GUAIFENESIN 3 DropsORGANIDIN NR GUAIFENESIN 3 LiquidVITA-NUMONYL EX GUAIFENESIN 3 SolutionORGANIDIN NR GUAIFENESIN 3 TabletALLFEN GUAIFENESIN 3 Tablet 12hr SRNUMOBID GUAIFENESIN 3 Tablet SAZOTEX-GP GUAIFENESIN/PHENYLEPHRINE HCL 3 TabletYODEFAN-NF POTASSIUM GUAIACOLSULFONATE 3 Liquid

COUGH AND/OR COLD PREPARATIONSTRIONATE CAR-B-PEN TA/CHLOR-TAN 3 SuspensionQUADTANN CAR-B-PEN TA/EPHED TAN/PE/CP 3 SuspensionDUONATE-12 PHENYLEPHRINE/PYRIL TAN 3 SuspensionDURA-TAP/PD PSEUDOEPHEDRINE HCL/CHLOR-MAL 3 CapsuleHISTAFED-LA PSEUDOEPHEDRINE HCL/CHLOR-MAL 3 Capsule SA

ANTITUSSIVES, NON-NARCOTICTESSALON BENZONATATE 3 CapsuleTESSALON PERLE BENZONATATE 3 Capsule

SYMPATHOMIMETIC AGENTSAH-CHEW D PHENYLEPHRINE HCL 3 Chew TabGILCHEW IR PHENYLEPHRINE HCL 3 Chew TabNASOP PHENYLEPHRINE HCL 3 Tablet, Disper. LingualAH-CHEW D PHENYLEPHRINE TANNATE 3 SuspensionNASOP PHENYLEPHRINE TANNATE 3 SuspensionSLOFED 60 PSEUDOEPHEDRINE HCL 3 Capsule SA

DECONGESTANT-ANALGESIC-EXPECTORANT COMBINATIONLUSONEX PLUS GUAIFEN/PHENYLEPHRINE/APAP 3 Tablet 12hr SR

1ST GEN ANTIHISTAMINE-DECONGESTANT-ANALGESIC COMBHEXAFLU P-EPHED HCL/ACETAMINOPHN/D-CP 3 TabletPROTID PHENYLEPHRINE/ACETAMINOPHN/CP 3 Tablet SANOREL SR PHENYLEPHRINE/APAP/P-TLOX/CP 3 Tablet 12hr SRND-GESIC PHENYLEPHRINE/APAP/PYRIL/CP 3 Tablet

NARCOTIC ANTITUSS-1ST GEN. ANTIHISTAMINE-DECONGESTSTATUSS GREEN PE/P-EPHEDRINE/HCOD/PYRIL/CP 3 LiquidPANCOF P-EPHED HCL/DHCODEINE BT/CP 3 SyrupHISTEX HC P-EPHED HCL/HCOD BT/CARBINOX 3 LiquidHPR END P-EPHED HCL/HYDROCODONE/BPM 3 LiquidANAPLEX HD P-EPHED HCL/HYDROCODONE/BPM 3 SolutionBROVEX HC P-EPHED HCL/HYDROCODONE/BPM 3 SyrupATUSS HD P-EPHED HCL/HYDROCODONE/CP 3 CapsuleGENECOF-HC P-EPHED HCL/HYDROCODONE/CP 3 LiquidJAYCOF-HC P-EPHED HCL/HYDROCODONE/CP 3 LiquidNOTUSS P-EPHED HCL/HYDROCODONE/CP 3 LiquidTUSSEND P-EPHED HCL/HYDROCODONE/CP 3 Syrup

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

TUSSEND P-EPHED HCL/HYDROCODONE/CP 3 TabletZYMINE HC P-EPHED HCL/HYDROCODONE/TRIPRO 3 LiquidPROMETHAZINE VC W/CODEINE PHENYLEPHRINE HCL/COD/PROMETH 1 SyrupBALTUSSIN PHENYLEPHRINE/DHCODEINE BT/CP 3 SyrupDONATUSSIN MAX PHENYLEPHRINE/HCOD BT/CARBINOX 3 LiquidEXCOF PHENYLEPHRINE/HCOD BT/CARBINOX 3 LiquidEXCOF-SF PHENYLEPHRINE/HCOD BT/CARBINOX 3 LiquidPHENA-HC PHENYLEPHRINE/HCOD BT/PYRIL/CP 3 LiquidDYTAN-HC PHENYLEPHRINE/HCOD TAN/DPHA 3 SuspensionHPB MAX PHENYLEPHRINE/HYDROCODONE/BPM 3 LiquidFLUTUSS HC PHENYLEPHRINE/HYDROCODONE/BPM 3 SolutionB-TUSS PHENYLEPHRINE/HYDROCODONE/CP 3 LiquidMAXI-TUSS HCX PHENYLEPHRINE/HYDROCODONE/CP 3 LiquidTRIANT-HC PHENYLEPHRINE/HYDROCODONE/CP 3 LiquidZ-COF HC PHENYLEPHRINE/HYDROCODONE/CP 3 SolutionENDAL-HD PLUS PHENYLEPHRINE/HYDROCODONE/CP 3 SyrupHISTUSSIN HC PHENYLEPHRINE/HYDROCODONE/CP 3 SyrupMAXI-TUSS HC PHENYLEPHRINE/HYDROCODONE/CP 3 SyrupVANEX HD PHENYLEPHRINE/HYDROCODONE/CP 3 SyrupZ-COF HC PHENYLEPHRINE/HYDROCODONE/CP 3 SyrupNOTUSS PD PHENYLEPHRINE/HYDROCODONE/D-CP 3 LiquidTUSSINATE PHENYLEPHRINE/HYDROCODONE/DPHA 3 SyrupPOLY-TUSSIN PHENYLEPHRINE/HYDROCODONE/PYR 3 LiquidCODIMAL DH PHENYLEPHRINE/HYDROCODONE/PYR 3 SyrupPRO-RED PHENYLEPHRINE/HYDROCODONE/PYR 3 Syrup

NON-NARC ANTITUSS-1ST GEN. ANTIHISTAMINE-DECONGESTRYNATUSS CAR-B-PEN TA/EPHED TAN/PE/CP 3 SuspensionRYNATUSS CAR-B-PEN TA/EPHED TAN/PE/CP 3 TabletDYTAN-CS CAR-B-PEN TA/PE/DP-HYDRAMINE 3 SuspensionDYTAN-CS CAR-B-PEN TA/PE/DP-HYDRAMINE 3 TabletBETATAN CAR-B-PEN TA/PHENYLEPHRINE/BPM 3 SuspensionCARBAPHEN 12 CAR-B-PEN TA/PHENYLEPHRINE/CP 3 SuspensionCARBAPHEN 12 PED CAR-B-PEN TA/PHENYLEPHRINE/CP 3 SuspensionRICOTUSS CAR-B-PEN TA/PHENYLEPHRINE/CP 3 SuspensionRICOTUSS CAR-B-PEN TA/PHENYLEPHRINE/CP 3 SuspensionTANNATE-12 CAR-B-PEN TA/PHENYLEPHRINE/CP 3 SuspensionXIRATUSS CAR-B-PEN TA/PHENYLEPHRINE/CP 3 SuspensionTUSSI-12D S CAR-B-PEN TA/PHENYLEPHRINE/PYR 3 SuspensionTUSSI-12D CAR-B-PEN TA/PHENYLEPHRINE/PYR 3 TabletANDEHIST-DM DM HB/P-EPHED HCL/CARBINOX 1 DropsBALAMINE DM DM HB/P-EPHED HCL/CARBINOX 2 DropsBIODEC-DM DM HB/P-EPHED HCL/CARBINOX 1 DropsBROMDEC DM DM HB/P-EPHED HCL/CARBINOX 1 DropsCARBAXEFED DM RF DM HB/P-EPHED HCL/CARBINOX 1 DropsCARBODEX DM DM HB/P-EPHED HCL/CARBINOX 1 DropsCARBOFED DM DM HB/P-EPHED HCL/CARBINOX 1 DropsPRODEC-DM DM HB/P-EPHED HCL/CARBINOX 1 DropsSILDEC-DM DM HB/P-EPHED HCL/CARBINOX 1 DropsPEDIATEX DM DM HB/P-EPHED HCL/CARBINOX 3 LiquidPEDIATEX DM DM HB/P-EPHED HCL/CARBINOX 3 SolutionBALAMINE DM DM HB/P-EPHED HCL/CARBINOX 3 SyrupTUSSAFED DM HB/P-EPHED HCL/CARBINOX 3 SyrupPEDIATEX 12 DM DM TAN/P-EPD TAN/CARBINOX 3 SuspensionDURATAN DM D-METHORP TAN/PE/BR-PHENIR 3 SuspensionVIRAVAN DM D-METHORP TAN/PE/PYRIL 3 Chew TabSINADEX 12 D-METHORP TAN/PE/PYRIL 3 SuspensionVIRAVAN DM D-METHORP TAN/PE/PYRIL 3 SuspensionANAPLEX DMX D-METHORP TAN/P-EPD TAN/BPM 3 SuspensionTANAFED DMX D-METHORP TAN/P-EPD TAN/D-CP 3 SuspensionMAXIPHEN ADT D-METHORP TAN/PHENYLEPHRINE/CP 3 TabletLORTUSS DM D-METHORPHAN HB/PE/BR-PHENIR 3 LiquidALACOL D-METHORPHAN HB/PE/BR-PHENIR 3 SyrupDMAX D-METHORPHAN HB/PE/CARBINOX 3 Drops

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

TRITUSS-A D-METHORPHAN HB/PE/CARBINOX 3 DropsXIRAHISTDM D-METHORPHAN HB/PE/CARBINOX 3 DropsDMAX D-METHORPHAN HB/PE/CARBINOX 3 SyrupED-DM D-METHORPHAN HB/PE/CHLORPHENIR 3 Chew TabDONATUSSIN DM D-METHORPHAN HB/PE/CHLORPHENIR 3 DropsRONDEC-DM D-METHORPHAN HB/PE/CHLORPHENIR 3 DropsAMERITUSS AD D-METHORPHAN HB/PE/CHLORPHENIR 3 LiquidRICOTUSS D-METHORPHAN HB/PE/CHLORPHENIR 3 SuspensionPOLY-TUSSIN DM D-METHORPHAN HB/PE/CHLORPHENIR 3 SyrupRONDEC-DM D-METHORPHAN HB/PE/CHLORPHENIR 3 SyrupPHENABID DM D-METHORPHAN HB/PE/CHLORPHENIR 3 Tablet 12hr SRTUSSALL D-METHORPHAN HB/PE/D-BP 3 SyrupTUSSALL-ER D-METHORPHAN HB/PE/D-BP 3 Tablet 12hr SRPOLY HIST DM D-METHORPHAN HB/PE/PYRIL 3 LiquidACCUHIST PDX D-METHORPHAN HB/P-EPD HCL/BPM 3 DropsDELTUSS DMX D-METHORPHAN HB/P-EPD HCL/BPM 3 LiquidANAPLEX DM D-METHORPHAN HB/P-EPD HCL/BPM 3 SyrupBROMFED-DM D-METHORPHAN HB/P-EPD HCL/BPM 3 SyrupAMERIFED DM D-METHORPHAN HB/P-EPHED HCL/CP 3 SyrupHDC DM D-METHORPHAN HB/P-EPHED HCL/CP 3 Syrup

NON-NARCOTIC ANTITUSSIVE AND EXPECTORANT COMB.SORBUTUSS GUAIFEN/D-METHORPHAN HB/K CIT 3 LiquidHUMIBID DM GUAIFEN/POT GUAIACO/DM 3 Capsule 12hr SRCERTUSS GUAIFENESIN/CARBETAPENTANE CIT 3 TabletCARBA-XP GUAIFENESIN/CARBETAPENTANE CIT 3 LiquidORATUSS GUAIFENESIN/CARBETAPENTANE CIT 3 LiquidALLFEN C GUAIFENESIN/CARBETAPENTANE CIT 3 Tablet 12hr SRXPECT-AT GUAIFENESIN/CARBETAPENTANE CIT 3 Tablet 12hr SRALBATUSSIN DM GUAIFENESIN/D-METHORPHAN HB 3 DropsTRISPEC DMX GUAIFENESIN/D-METHORPHAN HB 3 DropsDOMETUSS DM GUAIFENESIN/D-METHORPHAN HB 3 LiquidMAXI-TUSS DM GUAIFENESIN/D-METHORPHAN HB 3 LiquidTRISPEC DMX GUAIFENESIN/D-METHORPHAN HB 3 LiquidTUSSI-ORGANIDIN DM NR GUAIFENESIN/D-METHORPHAN HB 3 LiquidDURATUSS DM GUAIFENESIN/D-METHORPHAN HB 3 SolutionVITA-NUMONYL DM GUAIFENESIN/D-METHORPHAN HB 3 SolutionAQUATAB DM GUAIFENESIN/D-METHORPHAN HB 3 SyrupALLFEN-DM GUAIFENESIN/D-METHORPHAN HB 3 Tablet 12hr SRAQUATAB DM GUAIFENESIN/D-METHORPHAN HB 3 Tablet 12hr SRBIDEX DM GUAIFENESIN/D-METHORPHAN HB 3 Tablet 12hr SRDURADEX GUAIFENESIN/D-METHORPHAN HB 3 Tablet 12hr SRMUCO-FEN DM GUAIFENESIN/D-METHORPHAN HB 3 Tablet 12hr SRNUMOBID DX GUAIFENESIN/D-METHORPHAN HB 3 Tablet 12hr SRRESPA-DM GUAIFENESIN/D-METHORPHAN HB 3 Tablet 12hr SRRU-TUSS 800 DM GUAIFENESIN/D-METHORPHAN HB 3 Tablet 12hr SRTOURO DM GUAIFENESIN/D-METHORPHAN HB 3 Tablet 12hr SRZ-COF LA GUAIFENESIN/D-METHORPHAN HB 3 Tablet 12hr SRZ-COF LAX GUAIFENESIN/D-METHORPHAN HB 3 Tablet 12hr SRPROLEX DM POT GUAIACO/D-METHORPHAN HB 3 Liquid

NON-NARC ANTITUS-1ST GEN ANTIHIST-DECONGEST-EXPECTNEOTUSS-D GUAIFEN/DM HB/P-EPHEDRINE/CP 3 LiquidDEKA GUAIFEN/DM HB/P-EPHEDRINE/D-BP 3 LiquidPANATUSS DXP GUAIFEN/DM HB/PHENYLEPH/D-BP 3 DropsPANATUSS DXP GUAIFEN/DM HB/PHENYLEPH/D-BP 3 LiquidACCUHIST PDX GUAIFEN/D-METHORPHAN HB/PE/BPM 3 SyrupGENELAN GUAIFEN/D-METHORPHAN HB/PE/CP 3 LiquidLANZATUSS-N.F GUAIFEN/D-METHORPHAN HB/PE/CP 3 LiquidLARTUS GUAIFEN/D-METHORPHAN HB/PE/CP 3 LiquidTUSSILAN N.F. GUAIFEN/D-METHORPHAN HB/PE/CP 3 LiquidBRONCOPECTOL GUAIFEN/D-METHORPHAN HB/PE/CP 3 SyrupDONATUSSIN GUAIFEN/D-METHORPHAN HB/PE/CP 3 SyrupQUAL-TUSSIN GUAIFEN/D-METHORPHAN HB/PE/CP 3 Syrup

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

ZOTEX-DM GUAIFEN/D-METHORPHAN HB/PE/CP 3 SyrupLEMOTUSSIN-DM GUAIFEN/KG/DM/P-EPHEDRINE/CP 3 LiquidALBATUSSIN SR SENIOR POT GUAIACO/DM HB/PE/PYRIL 3 CapsuleALBATUSSIN-NN POT GUAIACO/DM HB/PE/PYRIL 3 LiquidALBATUSSIN NN POT GUAIACO-SOD CIT/DM/PE/PYR 3 Expectorant

1ST GEN ANTIHIST-DECONGEST-ANTICHOLINERGIC COMBPANNAZ S P-EPHED HCL/CARBINOX MAL/SCOP 3 SyrupPANNAZ P-EPHED HCL/CARBINOX MAL/SCOP 3 Tablet 12hr SRRESPA A.R. P-EPHED HCL/CHLOR-MAL/BELL ALK 3 Tablet 12hr SRDURAHIST P-EPHED HCL/CHLOR-MAL/SCOP 3 Tablet 12hr SRALLERX P-EPHED HCL/CHLOR-MAL/SCOP 3 Tablet, 12hr SRSTAHIST P-EPHED HCL/CPMM/ATP/SCOP/HYOS 3 Tablet 12hr SRDURAHIST D P-EPHED HCL/DEXCHLORPHEN/SCOP 3 Tablet 12hr SREXTENDRYL JR PHENYLEPHRINE/CHLOR-MAL/SCOP 3 Capsule SAAH-CHEW II PHENYLEPHRINE/CHLOR-MAL/SCOP 3 Chew TabAEROKID PHENYLEPHRINE/CHLOR-MAL/SCOP 3 SyrupEXTENDRYL PHENYLEPHRINE/CHLOR-MAL/SCOP 3 SyrupNOREL SD PHENYLEPHRINE/CHLOR-MAL/SCOP 3 SyrupDALLERGY PHENYLEPHRINE/CHLOR-MAL/SCOP 3 TabletDALLERGY PHENYLEPHRINE/CHLOR-MAL/SCOP 3 Tablet 12hr SRDRIZE-R PHENYLEPHRINE/CHLOR-MAL/SCOP 3 Tablet 12hr SRDURAHIST PE PHENYLEPHRINE/CHLOR-MAL/SCOP 3 Tablet 12hr SROMNIHIST II LA PHENYLEPHRINE/CHLOR-MAL/SCOP 3 Tablet 12hr SRRESCON-MX PHENYLEPHRINE/CHLOR-MAL/SCOP 3 Tablet 12hr SRAH-CHEW PHENYLEPHRINE/CHLOR-TAN/SCOP 3 Suspension

1ST GEN ANTIHISTAMINE-DECONGESTANT-EXPECTORANT CMBLEMOHIST PLUS GUAIFEN/P-EPHED HCL/CP 3 CapsuleDECON-G GUAIFEN/PHENYLEPHRINE/BPM 3 DropsSANTUSS GUAIFEN/PHENYLEPHRINE/CP 3 DropsRYNA-12X GUAIFEN/PHENYLEPHRINE/PYRIL 3 SuspensionRYNA-12X GUAIFEN/PHENYLEPHRINE/PYRIL 3 Tablet

NARCOTIC ANTITUSSIVE-ANTICHOLINERGIC COMB.HYCODAN HYDROCODONE BIT/HOMATROPINE 3 SyrupHYDROCODONE COMPOUND HYDROCODONE BIT/HOMATROPINE 1 SyrupHYDROMET HYDROCODONE BIT/HOMATROPINE 1 SyrupHYCODAN HYDROCODONE BIT/HOMATROPINE 3 TabletHYDROCODONE BT/HOMATROPINE MBR HYDROCODONE BIT/HOMATROPINE 1 TabletTUSSIGON HYDROCODONE BIT/HOMATROPINE 1 Tablet

NARCOTIC ANTITUSSIVE-1ST GENERATION ANTIHISTAMINEPROMETHAZINE W/CODEINE CODEINE/PROMETHAZINE HCL 1 SyrupS-T FORTE 2 HYDROCODONE BIT/CHLOR-MAL 3 LiquidHYTAN HYDROCODONE TANNATE/CHLOR-TAN 3 SuspensionTUSSIONEX HYDROCODONE/CHLORPHEN POLIS 3 Suspension 12hr SR

NON-NARC ANTITUSSIVE-1ST GEN ANTIHISTAMINE COMB.TUSSI-12 S CAR-B-PEN TA/CHLOR-TAN 3 SuspensionTUSSI-12 CAR-B-PEN TA/CHLOR-TAN 3 TabletPROMETHAZINE DM D-METHORPHAN HB/PROMETH HCL 1 Syrup

NARCOTIC ANTITUSS-1ST GEN ANTIHIST-EXPECT COMB.TUSNEL-HC GUAIFEN/HYDROCODONE/BR-PHENIR 3 Liquid

NON-NARC ANTITUSSIVE-1ST GEN ANTIHIST-EXPECT COMB.TUSNEL GUAIFEN/D-METHORPHAN HB/BPM 3 CapsuleTRISPEC SFX GUAIFEN/D-METHORPHAN HB/BPM 3 LiquidTUSNEL GUAIFEN/D-METHORPHAN HB/BPM 3 Liquid

NARCOTIC ANTITUSS-1ST GEN ANTIHIST-DECONGST-EXPECTZTUSS GUAIFEN/P-EPHED HCL/HCOD/CP 3 LiquidTUSSIREX PE/CODEINE/PHENIR/SODIUM CIT 3 LiquidTUSSIREX PE/CODEINE/PHENIR/SODIUM CIT 3 Syrup

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

NARCOTIC ANTITUSSIVE-DECONGESTANT COMBINATIONSSYMTAN P-EPD TAN/HYDROCODONE TANNATE 3 SuspensionHISTUSSIN D P-EPHED HCL/HYDROCODONE BIT 3 SolutionPANCOF HC P-EPHED HCL/HYDROCODONE BIT 3 SyrupP-V-TUSSIN P-EPHED HCL/HYDROCODONE BIT 3 TabletLORTUSS HC PHENYLEPHRINE HCL/HYDROCODONE 3 LiquidNALEX DH PHENYLEPHRINE HCL/HYDROCODONE 3 LiquidNALEX DH PHENYLEPHRINE HCL/HYDROCODONE 3 SyrupNUCOFED PSEUDOEPHEDRINE HCL/CODEINE 3 CapsuleNUCOFED PSEUDOEPHEDRINE HCL/CODEINE 3 Syrup

NON-NARCOTIC ANTITUSSIVE-DECONGESTANT COMBINATIONSRESPI-TANN CAR-B-PEN TA/P-EPD TAN 3 Chew TabRESPI-TANN CAR-B-PEN TA/P-EPD TAN 3 SuspensionRESPI-TANN PD CAR-B-PEN TA/P-EPD TAN 3 SuspensionLEVALL-12 CAR-B-PEN TA/PHENYLEPHRINE 3 SuspensionALBATUSSIN PEDIATRIC D-METHORPHAN HB/PHENYLEPHRINE 3 DropsALBATUSSIN PEDIATRIC D-METHORPHAN HB/PHENYLEPHRINE 3 Syrup

NARC ANTITUSS-1ST GEN ANTIHIST-DECONGEST-ANALGESICCOLREX COMPOUND PHENYLEPHRINE/COD/APAP/CP 3 Capsule

NON-NARC ANTITUSS-DECONGESTANT-ANALGESIC-EXPECT CBDURAFLU GUAIFEN/DM HB/P-EPHEDRINE/APAP 3 Tablet

NARCOTIC ANTITUSS-DECONGESTANT-EXPECTORANT COMBPANCOF EXP GUAIFEN/P-EPHED HCL/DIHY-COD 3 SyrupNUCOFED GUAIFENESIN/P-EPHED HCL/COD 3 SyrupTUSNEL PED-C GUAIFENESIN/P-EPHED HCL/COD 3 SyrupDECONAMINE CX GUAIFENESIN/P-EPHED HCL/HCOD 3 ExpectorantGENECOF-XP GUAIFENESIN/P-EPHED HCL/HCOD 3 LiquidJAYCOF-XP GUAIFENESIN/P-EPHED HCL/HCOD 3 LiquidTUSSEND GUAIFENESIN/P-EPHED HCL/HCOD 3 SolutionDYNEX HD GUAIFENESIN/P-EPHED HCL/HCOD 3 SyrupZTUSS GUAIFENESIN/P-EPHED HCL/HCOD 3 TabletGILTUSS PED-C GUAIFENESIN/PHENYLEPHRINE/COD 3 LiquidAMBI 5/15/100 GUAIFENESIN/PHENYLEPHRINE/HCOD 3 LiquidPOLY-TUSSIN XP GUAIFENESIN/PHENYLEPHRINE/HCOD 3 LiquidDURATUSS HD GUAIFENESIN/PHENYLEPHRINE/HCOD 3 SolutionATUSS G GUAIFENESIN/PHENYLEPHRINE/HCOD 3 SyrupENTEX HC GUAIFENESIN/PHENYLEPHRINE/HCOD 3 SyrupGILTUSS HC GUAIFENESIN/PHENYLEPHRINE/HCOD 3 SyrupLEVALL GUAIFENESIN/PHENYLEPHRINE/HCOD 3 SyrupTUSSAFED-HC GUAIFENESIN/PHENYLEPHRINE/HCOD 3 SyrupTUSSAFED-HCG GUAIFENESIN/PHENYLEPHRINE/HCOD 3 Syrup

NON-NARCOTIC ANTITUSS-DECONGESTANT-EXPECTORANT CMBALBATUSSIN CF D-METHORPHAN HB/PE/SODIUM CIT 3 DropsGENTEX LQ GUAIFEN/CAR-B-PENTANE/PE 3 SyrupLEVALL GUAIFEN/CAR-B-PENTANE/PE 3 SyrupORATUSS GUAIFEN/CAR-B-PENTANE/PE 3 Tablet 12hr SRDESPEC GUAIFEN/DM HB/P-EPHEDRINE 3 DropsTRISPEC PSE GUAIFEN/DM HB/P-EPHEDRINE 3 DropsTUSNEL-DM GUAIFEN/DM HB/P-EPHEDRINE 3 DropsSANTUSS GUAIFEN/DM HB/P-EPHEDRINE 3 LiquidTRISPEC PSE GUAIFEN/DM HB/P-EPHEDRINE 3 LiquidTUSNEL PEDIATRIC GUAIFEN/DM HB/P-EPHEDRINE 3 LiquidZ-COF DM GUAIFEN/DM HB/P-EPHEDRINE 3 LiquidZ-COF DMX GUAIFEN/DM HB/P-EPHEDRINE 3 LiquidZ-COF DM GUAIFEN/DM HB/P-EPHEDRINE 3 SolutionBRONCOTRON-D GUAIFEN/DM HB/P-EPHEDRINE 3 SuspensionAMBIFED-G DM GUAIFEN/DM HB/P-EPHEDRINE 3 Tablet 12hr SRAQUATAB C GUAIFEN/DM HB/P-EPHEDRINE 3 Tablet 12hr SRDESPEC DM GUAIFEN/DM HB/P-EPHEDRINE 3 Tablet 12hr SRMAXIFED DM GUAIFEN/DM HB/P-EPHEDRINE 3 Tablet 12hr SR

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

MAXIFED DMX GUAIFEN/DM HB/P-EPHEDRINE 3 Tablet 12hr SRMEDENT DM GUAIFEN/DM HB/P-EPHEDRINE 3 Tablet 12hr SRPROFEN FORTE DM GUAIFEN/DM HB/P-EPHEDRINE 3 Tablet 12hr SRPROFEN II DM GUAIFEN/DM HB/P-EPHEDRINE 3 Tablet 12hr SRTOURO CC GUAIFEN/DM HB/P-EPHEDRINE 3 Tablet 12hr SRTOURO CC-LD GUAIFEN/DM HB/P-EPHEDRINE 3 Tablet 12hr SRTRIKOF-D GUAIFEN/DM HB/P-EPHEDRINE 3 Tablet 12hr SRNUMONYL DX GUAIFEN/D-METHORPHAN HB/PE 3 DropsZOTEX GUAIFEN/D-METHORPHAN HB/PE 3 DropsGILTUSS GUAIFEN/D-METHORPHAN HB/PE 3 LiquidPHENYDEX GUAIFEN/D-METHORPHAN HB/PE 3 LiquidTUSSAFED EX GUAIFEN/D-METHORPHAN HB/PE 3 LiquidTUSSIDEX GUAIFEN/D-METHORPHAN HB/PE 3 LiquidTUSSI-PRES GUAIFEN/D-METHORPHAN HB/PE 3 LiquidTUSSI-PRES PEDIATRIC GUAIFEN/D-METHORPHAN HB/PE 3 LiquidNUMONYL DX GUAIFEN/D-METHORPHAN HB/PE 3 SolutionBRONTUSS SF GUAIFEN/D-METHORPHAN HB/PE 3 SyrupDESPEC DM GUAIFEN/D-METHORPHAN HB/PE 3 SyrupTRITUSS GUAIFEN/D-METHORPHAN HB/PE 3 SyrupZOTEX GUAIFEN/D-METHORPHAN HB/PE 3 SyrupZOTEX-G GUAIFEN/D-METHORPHAN HB/PE 3 SyrupCERTUSS-D GUAIFEN/D-METHORPHAN HB/PE 3 Tablet 12hr SRDURAPHEN DM GUAIFEN/D-METHORPHAN HB/PE 3 Tablet 12hr SRDURAPHEN FORTE GUAIFEN/D-METHORPHAN HB/PE 3 Tablet 12hr SRDURAPHEN II DM GUAIFEN/D-METHORPHAN HB/PE 3 Tablet 12hr SRGILTUSS TR GUAIFEN/D-METHORPHAN HB/PE 3 Tablet 12hr SRMAXIPHEN DM GUAIFEN/D-METHORPHAN HB/PE 3 Tablet 12hr SRMAXIPHEN-G DM GUAIFEN/D-METHORPHAN HB/PE 3 Tablet 12hr SRTRITUSS-ER GUAIFEN/D-METHORPHAN HB/PE 3 Tablet 12hr SRZOTEX LAX GUAIFEN/D-METHORPHAN HB/PE 3 Tablet 12hr SRZOTEX-LA GUAIFEN/D-METHORPHAN HB/PE 3 Tablet 12hr SRALBATUSSIN GUAIFEN/D-METHORPHAN HB/PE 3 Tablet SAALBATUSSIN SR GUAIFEN/D-METHORPHAN HB/PE 3 Tablet SACARBATUSS-CL POT GUAIACO/CAR-B-PENTANE/PE 3 LiquidALBATUSSIN CF POT GUAIACO/D-METHORPHAN HB/PE 3 DropsALBATUSSIN SR POT GUAIACO/D-METHORPHAN HB/PE 3 Tablet 12hr SRALBATUSSIN SR F POT GUAIACO/D-METHORPHAN HB/PE 3 Tablet 12hr SR

NARCOTIC ANTITUSSIVE-EXPECTORANT COMBINATIONDIABETIC TUSSIN C GUAIFENESIN/CODEINE PHOS 2 LiquidGANI-TUSS NR GUAIFENESIN/CODEINE PHOS 1 LiquidGUAIFENESIN NR GUAIFENESIN/CODEINE PHOS 1 LiquidGUAIFENESIN W/CODEINE GUAIFENESIN/CODEINE PHOS 1 LiquidGUAITUSSIN AC GUAIFENESIN/CODEINE PHOS 1 LiquidGUAL-CO GUAIFENESIN/CODEINE PHOS 1 LiquidIOPHEN-C NR GUAIFENESIN/CODEINE PHOS 1 LiquidROMILAR AC GUAIFENESIN/CODEINE PHOS 1 LiquidTUSSI-ORGANIDIN NR GUAIFENESIN/CODEINE PHOS 2 LiquidBIOTUSSIN AC GUAIFENESIN/CODEINE PHOS 1 SyrupROBAFEN AC GUAIFENESIN/CODEINE PHOS 1 SyrupBRONTEX GUAIFENESIN/CODEINE PHOS 3 TabletGUAIFENESIN/CODEINE PHOSPHATE GUAIFENESIN/CODEINE PHOS 1 TabletATUSS HX GUAIFENESIN/HYDROCODONE BIT 3 CapsuleFLUTUSS XP GUAIFENESIN/HYDROCODONE BIT 3 LiquidPHANATUSS HC GUAIFENESIN/HYDROCODONE BIT 3 LiquidCODICLEAR DH GUAIFENESIN/HYDROCODONE BIT 3 SyrupHYCOTUSS GUAIFENESIN/HYDROCODONE BIT 3 SyrupMAXI-TUSS HCG GUAIFENESIN/HYDROCODONE BIT 3 SyrupPANCOF XP GUAIFENESIN/HYDROCODONE BIT 3 SyrupPNEUMOTUSSIN GUAIFENESIN/HYDROCODONE BIT 3 SyrupTUSSO-DF GUAIFENESIN/HYDROCODONE BIT 3 SyrupPNEUMOTUSSIN GUAIFENESIN/HYDROCODONE BIT 3 TabletZTUSS ZT GUAIFENESIN/HYDROCODONE BIT 3 TabletTOURO HC GUAIFENESIN/HYDROCODONE BIT 3 Tablet 12hr SR

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

TUSSO-HC GUAIFENESIN/HYDROCODONE BIT 3 Tablet 12hr SRXPECT-HC GUAIFENESIN/HYDROCODONE BIT 3 Tablet 12hr SRJAYCOF POT GUAIACO/HYDROCODONE BIT 3 SyrupMC COUGH POT GUAIACO/HYDROCODONE BIT 3 SyrupMC JR COUGH POT GUAIACO/HYDROCODONE BIT 3 SyrupPRO-CLEAR POT GUAIACO/HYDROCODONE BIT 3 SyrupPROLEX DH POT GUAIACO/HYDROCODONE BIT 3 Syrup

DECONGESTANT-ANTICHOLINERGIC COMBINATIONSSTA-D PE/P-EPHED HCL/BELLAD ALK 3 Tablet 12hr SRALLERX-D P-EPHED HCL/METHSCOPOLAMN 3 Tablet 12hr SR

DECONGESTANT-EXPECTORANT COMBINATIONSVITA-NUMONYL GUAIFEN/PHENYLEPHRINE/K CIT 3 SolutionBRONCHOLATE GUAIFENESIN/EPHEDRINE HCL 3 SyrupEPHEX SR GUAIFENESIN/EPHEDRINE HCL 3 Tablet SAENTEX PSE GUAIFENESIN/P-EPHED HCL 3 Capsule 12hr SRLEVALL G GUAIFENESIN/P-EPHED HCL 3 Capsule 12hr SRRESPAIRE-60 GUAIFENESIN/P-EPHED HCL 3 Capsule SAPHENYDEX GUAIFENESIN/P-EPHED HCL 3 DropsMAXIFED-G GUAIFENESIN/P-EPHED HCL 3 TabletZEPHREX GUAIFENESIN/P-EPHED HCL 3 TabletABER-FED GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRALTEX-PSE GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRAMBI 45/800 GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRAMBI 80/700 GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRAMBI 80/780 GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRAMBIFED-G GUAIFENESIN/P-EPHED HCL 3 Tablet 12hr SRAMI-TEX PSE GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRAQUATAB D GUAIFENESIN/P-EPHED HCL 3 Tablet 12hr SRCOLDMIST JR GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRCOLDMIST LA GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRCONPEC L.A. GUAIFENESIN/P-EPHED HCL 3 Tablet 12hr SRDECONGESTANT II GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRDESPEC SR GUAIFENESIN/P-EPHED HCL 3 Tablet 12hr SRD-FEDA II GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRDURASAL II GUAIFENESIN/P-EPHED HCL 3 Tablet 12hr SRDYNEX GUAIFENESIN/P-EPHED HCL 3 Tablet 12hr SREUDAL-SR GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRG/P 1200/60 GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRGFN 1200/PSE 50 GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRGFN 550/PSE 60 GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRGFN 595/PSE 48 TAB GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRGFN 795/PSE 85 TAB GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRGFN 800/PSE 60 GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRG-P GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRGP-500 GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRGUAIFENESIN 600/PSE 120 GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRGUAIFENESIN PSE GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRGUAIFENESIN W/PSEUDOEPHEDRINE GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRGUAIFENEX GP GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRGUAIFENEX PSE GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRGUAIFENEX PSE 80 GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRGUAIMAX-D GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRH 9600 SR GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRHISTALET X GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRIOSAL II GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRIOTEX PSE GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRMAXIFED GUAIFENESIN/P-EPHED HCL 3 Tablet 12hr SRMEDENT LD GUAIFENESIN/P-EPHED HCL 3 Tablet 12hr SRMIRAPHEN PSE GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRNASATAB LA GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRPANMIST JR GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRPANMIST LA GUAIFENESIN/P-EPHED HCL 3 Tablet 12hr SR

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

P-EHEDRINE-GUAIFENESIN SR GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRP-EPHEDRINE-GUAFENESIN LA GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRPOLY-VENT GUAIFENESIN/P-EPHED HCL 3 Tablet 12hr SRPROFED GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRPROFEN FORTE GUAIFENESIN/P-EPHED HCL 3 Tablet 12hr SRPROFEN II GUAIFENESIN/P-EPHED HCL 3 Tablet 12hr SRPSEUDATEX GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRPSEUDO GG TR GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRPSEUDO MAX GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRPSEUDOEPHEDRINE W/GUAIFENESIN GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRRESPA-1ST GUAIFENESIN/P-EPHED HCL 3 Tablet 12hr SRRU-TUSS JR. GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRSTAMOIST E GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRTOURO LA GUAIFENESIN/P-EPHED HCL 3 Tablet 12hr SRTOURO LA-LD GUAIFENESIN/P-EPHED HCL 3 Tablet 12hr SRWE MIST II GUAIFENESIN/P-EPHED HCL 1 Tablet 12hr SRZEPHREX-LA GUAIFENESIN/P-EPHED HCL 3 Tablet 12hr SRSINA-12X GUAIFENESIN/PHENYLEPHRINE 3 SuspensionSINA-12X GUAIFENESIN/PHENYLEPHRINE 3 TabletDECONSAL II GUAIFENESIN/PHENYLEPHRINE HCL 3 Capsule 12hr SRENTEX ER GUAIFENESIN/PHENYLEPHRINE HCL 3 Capsule 12hr SRENTEX LA GUAIFENESIN/PHENYLEPHRINE HCL 3 Capsule 12hr SRGUAIFED GUAIFENESIN/PHENYLEPHRINE HCL 3 Capsule 12hr SRGUAIFED-PD GUAIFENESIN/PHENYLEPHRINE HCL 3 Capsule 12hr SRNUMONYL PEDIATRIC GUAIFENESIN/PHENYLEPHRINE HCL 3 DropsNUMONYL GUAIFENESIN/PHENYLEPHRINE HCL 3 LiquidCONPEC GUAIFENESIN/PHENYLEPHRINE HCL 3 SolutionENTEX GUAIFENESIN/PHENYLEPHRINE HCL 3 SyrupJ-MAX GUAIFENESIN/PHENYLEPHRINE HCL 3 SyrupZOTEX-GP GUAIFENESIN/PHENYLEPHRINE HCL 3 TabletALDEX GUAIFENESIN/PHENYLEPHRINE HCL 3 Tablet 12hr SRALDEX G GUAIFENESIN/PHENYLEPHRINE HCL 3 Tablet 12hr SRDECONEX GUAIFENESIN/PHENYLEPHRINE HCL 3 Tablet 12hr SRDURAPHEN II GUAIFENESIN/PHENYLEPHRINE HCL 3 Tablet 12hr SRDURATUSS GUAIFENESIN/PHENYLEPHRINE HCL 3 Tablet 12hr SRDURATUSS GP GUAIFENESIN/PHENYLEPHRINE HCL 3 Tablet 12hr SRGENTEX LA GUAIFENESIN/PHENYLEPHRINE HCL 3 Tablet 12hr SRJ-MAX GUAIFENESIN/PHENYLEPHRINE HCL 3 Tablet 12hr SRLIQUIBID-D GUAIFENESIN/PHENYLEPHRINE HCL 3 Tablet 12hr SRLIQUIBID-D 1200 GUAIFENESIN/PHENYLEPHRINE HCL 3 Tablet 12hr SRLIQUIBID-PD GUAIFENESIN/PHENYLEPHRINE HCL 3 Tablet 12hr SRLUSONEX GUAIFENESIN/PHENYLEPHRINE HCL 3 Tablet 12hr SRMAXIPHEN GUAIFENESIN/PHENYLEPHRINE HCL 3 Tablet 12hr SRMAXIPHEN G GUAIFENESIN/PHENYLEPHRINE HCL 3 Tablet 12hr SRMONTEPHEN GUAIFENESIN/PHENYLEPHRINE HCL 3 Tablet 12hr SRPROLEX D GUAIFENESIN/PHENYLEPHRINE HCL 3 Tablet 12hr SRPROLEX PD GUAIFENESIN/PHENYLEPHRINE HCL 3 Tablet 12hr SRRESPA-PE GUAIFENESIN/PHENYLEPHRINE HCL 3 Tablet 12hr SRSITREX GUAIFENESIN/PHENYLEPHRINE HCL 3 Tablet 12hr SRZOTEX GPX GUAIFENESIN/PHENYLEPHRINE HCL 3 Tablet 12hr SRCONPEC LA GUAIFENESIN/PHENYLEPHRINE HCL 3 Tablet SANUMONYL SR GUAIFENESIN/PHENYLEPHRINE HCL 3 Tablet SALUSONAL POT GUAIACO/PHENYLEPHRINE HCL 3 Liquid

EXPECTORANT COMBINATIONS OTHERALLFEN GUAIFENESIN/POT GUAIACO 3 Tablet 12hr SRHUMIBID L.A. GUAIFENESIN/POT GUAIACO 3 Tablet 12hr SR

DIAGNOSTICGASTROINTESTINAL RADIOPAQUE DIAGNOSTICSE-Z-CAT BARIUM SULFATE 3 SuspensionREADI-CAT BARIUM SULFATE 3 SuspensionREADI-CAT 2 BARIUM SULFATE 3 SuspensionTAGITOL BARIUM SULFATE 3 Suspension

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

BAR-TEST BARIUM SULFATE 3 TabletENTERO VU BARIUM SULFATE/METHYLCELLULOSE 3 LiquidENTERO VU BARIUM SULFATE/METHYLCELLULOSE 3 PacketGASTROMARK FERUMOXSIL 3 Suspension

BILIARY DIAGNOSTICS,RADIOPAQUETELEPAQUE IOPANOIC ACID 3 TabletORAGRAFIN SODIUM IPODATE SODIUM 3 CapsuleBILOPAQUE TYROPANOATE SODIUM 3 Capsule

EYE DIAGNOSTIC AGENTSFLUORESCEIN SODIUM FLUORESCEIN SODIUM 3 DropsFLUORETS FLUORESCEIN SODIUM 3 StripFLUOR-I-STRIP FLUORESCEIN SODIUM 3 StripFLUOR-I-STRIP AT FLUORESCEIN SODIUM 3 StripFUL-GLO FLUORESCEIN SODIUM 3 Strip

URINARY TRACT RADIOPAQUE DIAGNOSTICSGASTROGRAFIN DIATR MEGLU/DIATRIZOATE SODIUM 3 SolutionHYPAQUE SODIUM DIATRIZOATE SODIUM 3 Liquid

G.I. ULTRASOUND IMAGE-ENHANCING ADJNCT,DIAGNOSTICSONORX SIMETH/XANTH GUM/SLS 3 Suspension

DIURETICSOSMOTIC DIURETICSINTROL GLYCERIN 3 SolutionOSMOGLYN GLYCERIN 3 Solution

CARBONIC ANHYDRASE INHIBITORSDIAMOX SEQUELS ACETAZOLAMIDE 2 Capsule SAACETAZOLAMIDE ACETAZOLAMIDE 1 TabletMETHAZOLAMIDE METHAZOLAMIDE 1 Tablet

THIAZIDE AND RELATED DIURETICSNATURETIN-5 BENDROFLUMETHIAZIDE 3 TabletDIURIL CHLOROTHIAZIDE 3 SuspensionTHALITONE CHLORTHALIDONE 3 TabletHYDROCHLOROTHIAZIDE HYDROCHLOROTHIAZIDE 1 CapsuleMICROZIDE HYDROCHLOROTHIAZIDE 3 CapsuleHYDROCHLOROTHIAZIDE HYDROCHLOROTHIAZIDE 2 SolutionHYDROCHLOROTHIAZIDE HYDROCHLOROTHIAZIDE 1 TabletSALURON HYDROFLUMETHIAZIDE 3 TabletINDAPAMIDE INDAPAMIDE 1 TabletLOZOL INDAPAMIDE 3 TabletMETOLAZONE METOLAZONE 1 TabletZAROXOLYN METOLAZONE 2 Tablet

POTASSIUM SPARING DIURETICSINSPRA EPLERENONE 2 TabletALDACTONE SPIRONOLACTONE 3 TabletSPIRONOLACTONE SPIRONOLACTONE 1 TabletDYRENIUM TRIAMTERENE 3 Capsule

DIURETICS, MISCELLANEOUSISMOTIC ISOSORBIDE 3 Solution

POTASSIUM SPARING DIURETICS IN COMBINATIONMODURETIC AMILORIDE/HYDROCHLOROTHIAZIDE 3 TabletALDACTAZIDE SPIRONOLACT/HYDROCHLOROTHIAZID 3 TabletSPIRONOLACTONE W/HCTZ SPIRONOLACT/HYDROCHLOROTHIAZID 1 TabletTRIAMTERENE W/HCTZ TRIAMTERENE/HCTZ 1 TabletDYAZIDE TRIAMTERENE/HYDROCHLOROTHIAZID 3 CapsuleTRIAMTERENE W/HCTZ TRIAMTERENE/HYDROCHLOROTHIAZID 1 CapsuleMAXZIDE TRIAMTERENE/HYDROCHLOROTHIAZID 3 TabletMAXZIDE-25MG TRIAMTERENE/HYDROCHLOROTHIAZID 3 TabletTRIAMTERENE W/HCTZ TRIAMTERENE/HYDROCHLOROTHIAZID 1 Tablet

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

LOOP DIURETICSBUMEX BUMETANIDE 3 TabletEDECRIN ETHACRYNIC ACID 3 TabletFUROSEMIDE FUROSEMIDE 2 SolutionFUROSEMIDE FUROSEMIDE 1 TabletLASIX FUROSEMIDE 3 TabletDEMADEX TORSEMIDE 3 TabletTORSEMIDE TORSEMIDE 1 Tablet

ELECT/CALORIC/H2OELECTROLYTE DEPLETERSPHOSLO CALCIUM ACETATE 2 CapsulePHOSLO CALCIUM ACETATE 2 TabletMAGNEBIND 400 RX CALCIUM CARBONATE/MAG CARB/FA 3 TabletFOSRENOL LANTHANUM CARBONATE 3 Chew TabRENAGEL SEVELAMER HCL 2 TabletSODIUM POLYSTYRENE SULFONATE SODIUM POLYSTYRENE SULFONATE 3 Enema

POTASSIUM REPLACEMENTK-LYTE DS POT BICARB/POTASSIUM CIT/CA 3 Tablet Effer.K-LYTE/CL POT CHLORIDE/POT BICARB/CIT AC 3 Tablet Effer.QUICK-K POTASSIUM BICARBONATE 3 Tablet Effer.K-LYTE POTASSIUM BICARBONATE/CIT AC 3 Tablet Effer.MICRO-K POTASSIUM CHLORIDE 2 Capsule SAMICRO-K 10 POTASSIUM CHLORIDE 2 Capsule SAPOTASSIUM CHLORIDE POTASSIUM CHLORIDE 1 Capsule SACENA-K POTASSIUM CHLORIDE 1 LiquidKAOCHLOR POTASSIUM CHLORIDE 2 LiquidKAON-CL POTASSIUM CHLORIDE 2 LiquidKAY CIEL POTASSIUM CHLORIDE 2 LiquidPOTASSIUM CHLORIDE POTASSIUM CHLORIDE 1 LiquidRUM-K POTASSIUM CHLORIDE 2 LiquidK+ POTASSIUM POTASSIUM CHLORIDE 1 PacketKAY CIEL POTASSIUM CHLORIDE 2 PacketK-LOR POTASSIUM CHLORIDE 2 PacketKLOR-CON POTASSIUM CHLORIDE 1 PacketKLOR-CON/25 POTASSIUM CHLORIDE 2 PacketPOTASSIUM CHLORIDE POTASSIUM CHLORIDE 3 PacketED K+10 POTASSIUM CHLORIDE 1 Tablet SAKAON-CL 10 POTASSIUM CHLORIDE 1 Tablet SAKLOR-CON 10 POTASSIUM CHLORIDE 1 Tablet SAKLOR-CON 8 POTASSIUM CHLORIDE 1 Tablet SAKLOTRIX POTASSIUM CHLORIDE 2 Tablet SAK-TAB POTASSIUM CHLORIDE 2 Tablet SAPOTASSIUM CHLORIDE POTASSIUM CHLORIDE 1 Tablet SAK-DUR POTASSIUM CHLORIDE 2 Tablet SRKLOR-CON M10 POTASSIUM CHLORIDE 1 Tablet SRKLOR-CON M15 POTASSIUM CHLORIDE 1 Tablet SRKLOR-CON M20 POTASSIUM CHLORIDE 1 Tablet SRPOTASSIUM CHLORIDE POTASSIUM CHLORIDE 2 Tablet SRKAOCHLOR-EFF POTASSIUM CHLORIDE/POT BICARB 3 Tablet Effer.KAON POTASSIUM GLUCONATE 3 ElixirTRI-K POTASSIUM TRIPLATES 3 Liquid

CALCIUM REPLACEMENTCALCI-MAX CA CARBONATE/MGOX/VIT D2/BIOFL 3 CapsuleFOLGARD OS CACO3/MGOX/D3/B12/FA/B6/BORON 3 Tablet

IRON REPLACEMENTCHROMAGEN FE BG/VIT C/B12/STOMC/CA-THR 3 CapsuleNIFEREX-150 FORTE FE BISGLY/FE P/C/B12/FA/CA-THR 3 CapsuleNIFEREX GOLD FE BISGLY/FE P/DOSS/C/FA/MV 14 3 TabletCHROMAGEN FA FE BISGLY/VIT C/B12/FA/CA-THR 3 CapsuleFERRO-PLEX HEMATINIC FE FUM/DOSS NA/C/E/B12-IF/FA 3 Tablet

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

CHROMAGEN FORTE FE FUM/FE BG/C/B12/FA/CA-THR 3 CapsuleVITAFOL FE FUMARATE/CAL/E/FA/MULTIVIT 2 TabletNEPHRON FA FE FUMARATE/DOSS/FA/BCOMP&C 3 TabletHEMOCYTE PLUS FE FUMARATE/FA/VIT BCOMP&C/MIN 3 CapsuleCONISON FE FUMARATE/VIT C/B12-IF/FA 2 CapsuleFEROCON FE FUMARATE/VIT C/B12-IF/FA 1 CapsuleFEROTRINSIC FE FUMARATE/VIT C/B12-IF/FA 1 CapsuleFOLTRIN FE FUMARATE/VIT C/B12-IF/FA 1 CapsuleTRICON FE FUMARATE/VIT C/B12-IF/FA 1 CapsuleTRINSICON FE FUMARATE/VIT C/B12-IF/FA 2 CapsulePROFERRIN-FORTE FE HEME POLYPEPTIDE/FOLIC ACID 3 TabletHEMOCYTE-F FE PS CMPLX/CYANOCOBALAMIN/FA 3 ElixirVITAFOL FE PYROPHOS/VIT B COMP/FA 3 SyrupREPLIVA 21/7 FE/FE BG/C/FA/MV CMB11/CA-THR 3 TabletFEOCYTE FA FE/VIT C/VIT B12/FA/VIT B6/CU 3 Tablet SAHEMATRON FERRIC AMCIT/CYANOCOBALAMIN/FA 3 DropsHEMATRON FERRIC AMCIT/LYS/VIT B COMP/FA 3 LiquidFERROMAR FERROUS FUMARATE 3 Capsule SAHEMOCYTE-F FERROUS FUMARATE/FOLIC ACID 3 TabletIRCON-FA FERROUS FUMARATE/FOLIC ACID 3 TabletFETRIN FERROUS FUMARATE/VIT C/B12-IF 3 Capsule SAFUMATINIC FERROUS FUMARATE/VIT C/B12-IF 3 Capsule SAIRON-C FERROUS GLUCONATE/VIT C/FA 3 LiquidIBERET-FOLIC 500 FERROUS SULFATE/FA/VIT BCOMP&C 3 Tablet SAFERO-FOLIC-500 FERROUS SULFATE/VIT C/FA 3 Tablet SAERITROGEN FESO4EX/C/B12/LV-STM/IF/FA 3 TabletALBAFORT FESO4EX/DSS/C/B12IF/STOMC/FA 3 TabletHEMATRON-AF IRON,CARB/DSS/B12IF/FA/MV-MN 3 Tablet 24hr SRHEMAX IRON,CARB/DSS/B12IF/FA/MV-MN 3 Tablet 24hr SRIRO-PLEX IRON,CARB/DSS/C/E/B12IF/FA/B6 3 TabletSIDEROL IRON/FA/VITAMIN B COMP W-C/MIN 3 LiquidHEMOCYTE PLUS IRON/FA/VITAMIN B COMP W-C/MIN 3 TabletIROFOL IRON/FOLIC ACID 3 LiquidIROFOL IRON/FOLIC ACID 3 TabletSIDEROL IRON/LIVER EXT/VIT BCOMP&C/MIN 3 TabletV G TONIC IRON/VITAMIN B COMPLEX/FA/MIN 3 Elixir

IODINE CONTAINING AGENTSYODEFAN POTASSIUM IODIDE 3 LiquidSSKI POTASSIUM IODIDE 2 SolutionTHYROSHIELD POTASSIUM IODIDE 2 SolutionPIMA POTASSIUM IODIDE 3 Syrup

MINERAL REPLACEMENT,MISCELLANEOUSGLUTOFAC-MX DOCUSATE NA/FA/M-VITS-FE/MIN 3 Tablet

PROTEIN REPLACEMENTALBALYBE LYSINE/CALCIUM/VIT B COMP 3 SyrupLYSIPLEX LYSINE/VIT E/FA/VIT BCOMP&C/ZN 3 TabletFOLYSINE LYSINE/VITAMIN B COMPLEX/FA 3 Liquid

FLUORIDE PREPARATIONSFLUORIDE SODIUM FLUORIDE 3 Chew TabLURIDE SODIUM FLUORIDE 3 Chew TabSODIUM FLUORIDE SODIUM FLUORIDE 3 Chew TabCONTROL RX SODIUM FLUORIDE 3 CreamPREVIDENT 5000 PLUS SODIUM FLUORIDE 3 CreamFLUORABON SODIUM FLUORIDE 3 DropsFLUOR-A-DAY SODIUM FLUORIDE 3 DropsSODIUM FLUORIDE SODIUM FLUORIDE 3 DropsTHERA-FLUR-N SODIUM FLUORIDE 3 DropsPHOS-FLUR SODIUM FLUORIDE 3 GelPREVIDENT SODIUM FLUORIDE 3 GelSODIUM FLUORIDE SODIUM FLUORIDE 3 GelFLUOR-A-DAY SODIUM FLUORIDE 3 Lozenge

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

CAVIRINSE SODIUM FLUORIDE 3 SolutionSODIUM FLUORIDE SODIUM FLUORIDE 3 TabletJUST FOR KIDS STANNOUS FLUORIDE 3 GelOMNII GEL STANNOUS FLUORIDE 3 GelGEL-KAM STANNOUS FLUORIDE 3 Solution

HYPERGLYCEMICSPROGLYCEM DIAZOXIDE 2 SuspensionGLUCAGON GLUCAGON,HUMAN RECOMBINANT 2 KitGLUCAGON EMERGENCY KIT GLUCAGON,HUMAN RECOMBINANT 2 Kit

URINARY PH MODIFIERSPOLYCITRA-K CITRIC ACID/POTASSIUM CITRATE 3 PacketPOLYCITRA-K CITRIC ACID/POTASSIUM CITRATE 3 SolutionBICITRA CITRIC ACID/SODIUM CITRATE 3 SolutionORACIT CITRIC ACID/SODIUM CITRATE 3 SolutionSHOHL'S MODIFIED CITRIC ACID/SODIUM CITRATE 3 SolutionUROQID-ACID NO.2 METHEN MAND/NAPHOS M-B M-H 3 TabletK-PHOS M.F. NA PHOS,M-B/K PHOS,MONOB 3 TabletK-PHOS NO.2 NA PHOS,M-B/K PHOS,MONOB 3 TabletURO-KP-NEUTRAL PHOSPHORUS 3 TabletUROCIT-K POTASSIUM CITRATE 3 Tablet SACITROLITH POTASSIUM CITRATE/SODIUM CIT 3 TabletK-PHOS ORIGINAL POTASSIUM PHOSPHATE,MONOBASIC 2 TabletPEDAMETH RACEMETHIONINE 3 CapsulePEDAMETH RACEMETHIONINE 3 LiquidPOLYCITRA-LC SOD/POTASS/K CIT/SODIUM CIT/CA 3 SolutionPOLYCITRA SOD/POTASS/K CIT/SODIUM CIT/CA 3 Syrup

NUTRITIONAL THERAPY, MED COND SPECIAL FORMULATIONPREKUNIL NUT.TX. METABOLIC DISORDER,REG 3 Tablet

EENT PREPSOPHTHALMIC PREPARATIONS, MISCELLANEOUSDUOVISC CHONDRO SU A/HYALUR SOD 3 KitREV-EYES DAPIPRAZOLE HCL 3 DropsGONIOSOL HYPROMELLOSE 3 DropsFML-S NA SULFACETM/FLUOROMETHOLONE 3 Suspension Drops

EYE ANTI-INFECTIVES (RX ONLY)BETADINE POVIDONE-IODINE 3 Solution

EYE VASOCONSTRICTORS (RX ONLY)AK-CON NAPHAZOLINE HCL 1 DropsALBALON NAPHAZOLINE HCL 3 DropsALLERSOL NAPHAZOLINE HCL 1 DropsNAPHAZOLE NAPHAZOLINE HCL 1 DropsNAPHAZOLINE HCL NAPHAZOLINE HCL 1 DropsMYDFRIN PHENYLEPHRINE HCL 3 Drops

EYE IRRIGATIONSIOCARE BALANCED SALT SODIUM/CAL/MG SLT(REP)/POTASS 3 Solution

MIOTICS/OTHER INTRAOC. PRESSURE REDUCERSIOPIDINE APRACLONIDINE HCL 3 DropperetteIOPIDINE APRACLONIDINE HCL 3 DropsBETAXOLOL HCL BETAXOLOL HCL 2 DropsBETOPTIC S BETAXOLOL HCL 2 Suspension DropsLUMIGAN BIMATOPROST 2 DropsALPHAGAN P BRIMONIDINE TARTRATE 2 DropsBRIMONIDINE TARTRATE BRIMONIDINE TARTRATE 1 DropsAZOPT BRINZOLAMIDE 2 Suspension DropsCARBOPTIC CARBACHOL 1 DropsISOPTO CARBACHOL CARBACHOL 2 DropsHUMORSOL DEMECARIUM BROMIDE 3 DropsTRUSOPT DORZOLAMIDE HCL 3 Drops

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

PHOSPHOLINE IODIDE ECHOTHIOPHATE IODIDE 3 DropsXALATAN LATANOPROST 2 DropsBETAGAN LEVOBUNOLOL HCL 3 DropsLEVOBUNOLOL HCL LEVOBUNOLOL HCL 1 DropsOPTIPRANOLOL METIPRANOLOL 3 DropsISOPTO CARPINE PILOCARPINE HCL 2 DropsPILOCAR PILOCARPINE HCL 2 DropsPILOCARPINE HCL PILOCARPINE HCL 2 DropsPILOPTIC-1 PILOCARPINE HCL 1 DropsPILOPTIC-2 PILOCARPINE HCL 1 DropsPILOPTIC-3 PILOCARPINE HCL 1 DropsPILOPTIC-4 PILOCARPINE HCL 1 DropsPILOPTIC-6 PILOCARPINE HCL 1 DropsPILOPINE HS PILOCARPINE HCL 2 GelBETIMOL TIMOLOL 3 DropsISTALOL TIMOLOL MALEATE 3 DropsTIMOPTIC TIMOLOL MALEATE 2 DropperetteTIMOLOL MALEATE TIMOLOL MALEATE 1 DropsTIMOPTIC TIMOLOL MALEATE 3 DropsTIMOPTIC-XE TIMOLOL MALEATE 3 Gel-Forming Soln.COSOPT TIMOLOL MALEATE/DORZOLAM HCL 3 DropsTRAVATAN TRAVOPROST 3 Drops

EYE LOCAL ANESTHETICSALTAFLUOR BENOXINATE HCL/FLUORESCEIN NA 3 DropsFLURATE BENOXINATE HCL/FLUORESCEIN NA 3 DropsFLUORACAINE PROPARAC HCL/FLUORESCEIN NA 3 DropsALCAINE PROPARACAINE HCL 3 DropsTETRACAINE HCL TETRACAINE HCL 3 DropperetteTETRACAINE HCL TETRACAINE HCL 3 Drops

MYDRIATICSATROPINE CARE ATROPINE SULFATE 1 DropsATROPINE SULFATE ATROPINE SULFATE 1 DropsISOPTO ATROPINE ATROPINE SULFATE 2 DropsATROPINE SULFATE ATROPINE SULFATE 1 OintmentCYCLOGYL CYCLOPENTOLATE HCL 3 DropsDIPIVEFRIN HCL DIPIVEFRIN HCL 1 DropsPROPINE DIPIVEFRIN HCL 3 DropsEPINAL EPINEPHRYL BORATE 3 DropsISOPTO HOMATROPINE HOMATROPINE HBR 3 DropsPAREMYD HYDROXYAMPHETAMINE/TROPICAMIDE 3 DropsMUROCOLL-2 PHENYLEPHRINE HCL/SCOPOL HB 3 DropsCYCLOMYDRIL PHENYLEPHRINE/CYCLOPENT HCL 3 DropsISOPTO HYOSCINE SCOPOLAMINE HYDROBROMIDE 3 DropsMYDRIACYL TROPICAMIDE 3 Drops

EYE ANTIINFLAMMATORY AGENTSXIBROM BROMFENAC SODIUM 3 DropsMAXIDEX DEXAMETHASONE 2 Suspension DropsDEXAMETHASONE SODIUM PHOSPHATE DEXAMETHASONE SOD PHOSPHATE 1 DropsDEXASOL DEXAMETHASONE SOD PHOSPHATE 1 DropsDECADRON DEXAMETHASONE SOD PHOSPHATE 2 OintmentVOLTAREN DICLOFENAC SODIUM 3 DropsFML S.O.P. FLUOROMETHOLONE 2 OintmentFLUOROMETHOLONE FLUOROMETHOLONE 1 Suspension DropsFLUOR-OP FLUOROMETHOLONE 1 Suspension DropsFML FLUOROMETHOLONE 3 Suspension DropsFML FORTE FLUOROMETHOLONE 2 Suspension DropsFLAREX FLUOROMETHOLONE ACETATE 3 Suspension DropsOCUFEN FLURBIPROFEN SODIUM 3 DropsACULAR PF KETOROLAC TROMETHAMINE 3 DropperetteACULAR KETOROLAC TROMETHAMINE 3 DropsACULAR LS KETOROLAC TROMETHAMINE 3 DropsALREX LOTEPREDNOL ETABONATE 3 Suspension Drops

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

LOTEMAX LOTEPREDNOL ETABONATE 3 Suspension DropsNEVANAC NEPAFENAC 3 Suspension DropsECONOPRED PLUS PREDNISOLONE ACETATE 3 Suspension DropsPRED FORTE PREDNISOLONE ACETATE 3 Suspension DropsPRED MILD PREDNISOLONE ACETATE 2 Suspension DropsPREDNISOLONE ACETATE PREDNISOLONE ACETATE 1 Suspension DropsAK-PRED PREDNISOLONE SOD PHOSPHATE 1 DropsINFLAMASE FORTE PREDNISOLONE SOD PHOSPHATE 3 DropsINFLAMASE MILD PREDNISOLONE SOD PHOSPHATE 2 DropsPREDNISOL PREDNISOLONE SOD PHOSPHATE 1 DropsPREDNISOLONE SODIUM PHOSPHATE PREDNISOLONE SOD PHOSPHATE 1 DropsVEXOL RIMEXOLONE 3 Suspension Drops

EYE SULFONAMIDESOPTIMYD NA SULFACETM/PREDNIS SP 3 DropsSULFACETAMIDE W-PREDNISOLONE NA SULFACETM/PREDNIS SP 1 DropsVASOCIDIN NA SULFACETM/PREDNIS SP 3 DropsBLEPHAMIDE S.O.P. NA SULFACETM/PREDNISOL AC 2 OintmentBLEPHAMIDE NA SULFACETM/PREDNISOL AC 2 Suspension DropsBLEPH-10 SULFACETAMIDE SODIUM 3 DropsOCUSULF-10 SULFACETAMIDE SODIUM 1 DropsSULFAC SULFACETAMIDE SODIUM 1 DropsSULFACETAMIDE SODIUM SULFACETAMIDE SODIUM 1 DropsSULFAMIDE SULFACETAMIDE SODIUM 1 DropsSULFACETAMIDE SODIUM SULFACETAMIDE SODIUM 1 Ointment

EYE ANTIVIRALSTRIFLURIDINE TRIFLURIDINE 1 DropsVIROPTIC TRIFLURIDINE 2 Drops

OPHTHALMIC ANTIBIOTICSAK-POLY-BAC BACITRACIN/POLYMYXIN B SULFATE 1 OintmentBACITRACIN/POLYMYXIN B BACITRACIN/POLYMYXIN B SULFATE 1 OintmentPOLYCIN-B BACITRACIN/POLYMYXIN B SULFATE 1 OintmentCHLORAMPHENICOL CHLORAMPHENICOL 3 OintmentCILOXAN CIPROFLOXACIN HCL 3 DropsCILOXAN CIPROFLOXACIN HCL 3 OintmentERYTHROMYCIN ERYTHROMYCIN BASE 1 OintmentROMYCIN ERYTHROMYCIN BASE 1 OintmentZYMAR GATIFLOXACIN 3 DropsGENTAK GENTAMICIN SULFATE 1 DropsGENTAMICIN SULFATE GENTAMICIN SULFATE 1 DropsGENTASOL GENTAMICIN SULFATE 1 DropsGENTAK GENTAMICIN SULFATE 3 OintmentGENTAMICIN SULFATE GENTAMICIN SULFATE 1 OintmentQUIXIN LEVOFLOXACIN 3 DropsVIGAMOX MOXIFLOXACIN HCL 2 DropsNATACYN NATAMYCIN 3 Suspension DropsNEOSPORIN NEOMY SULF/GRAMICID D/POLY 3 DropsOCUFLOX OFLOXACIN 3 DropsOFLOXACIN OFLOXACIN 1 DropsTERAK OXY-TCN HCL/POLYMYX B SULF 3 OintmentPOLYMYXIN B SUL/TRIMETHOPRIM POLYMYXIN B SULFATE/TMP 1 DropsPOLYTRIM POLYMYXIN B SULFATE/TMP 3 DropsAKTOB TOBRAMYCIN SULFATE 1 DropsTOBRAMYCIN SULFATE TOBRAMYCIN SULFATE 1 DropsTOBRASOL TOBRAMYCIN SULFATE 1 DropsTOBREX TOBRAMYCIN SULFATE 3 DropsTOBREX TOBRAMYCIN SULFATE 3 Ointment

NOSE PREPARATIONS, MISCELLANEOUS (RX)ATROVENT IPRATROPIUM BROMIDE 3 AerosolIPRATROPIUM BROMIDE IPRATROPIUM BROMIDE 1 Aerosol

NOSE PREPARATIONS, VASOCONSTRICTORS (RX)TYZINE TETRAHYDROZOLINE HCL 3 Aerosol

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Trustmark/Starmark Clinical Formulary - January 2006

TYZINE TETRAHYDROZOLINE HCL 3 Drops

NOSE PREPARATIONS, VASOCONSTRICTORS(OTC)ADRENALIN CHLORIDE NASAL EPINEPHRINE 3 Solution

NASAL ANTI-INFLAMMATORY STEROIDSBECONASE AQ BECLOMETHASONE DIPROPIONATE 3 AerosolRHINOCORT AQUA BUDESONIDE 3 SprayNASAREL FLUNISOLIDE 3 AerosolFLONASE FLUTICASONE PROPIONATE 2 AerosolNASONEX MOMETASONE FUROATE 2 SparyNASACORT AQ TRIAMCINOLONE ACETONIDE 3 Aerosol

NOSE PREPARATIONS ANTIBIOTICSBACTROBAN NASAL MUPIROCIN CALCIUM 3 Ointment

EAR PREPARATIONS, MISC. ANTI-INFECTIVESDOMEBORO ACETIC ACID/ALUMINUM ACETATE 3 DropsACETASOL HC ACETIC ACID/HYDROCORTISONE 1 DropsACETIC ACID-HYDROCORTISONE ACETIC ACID/HYDROCORTISONE 2 DropsOTOMYCET-HC ACETIC ACID/HYDROCORTISONE 1 DropsCRESYLATE CRESYL ACE/BEN ALC/BUTANOL/IPA 3 DropsZOTO-HC HC/PRAMOXINE HCL/CHLOROXYLENOL 3 DropsCORTANE-B HC/PRAMOXINE HCL/CHLOROXYLENOL 3 Lotion

EAR PREPARATIONS, LOCAL ANESTHETICSOTILAM ANTIPYRINE/BENZOCAINE/GLY/UREA 3 DropsA/B OTIC ANTIPYRINE/BENZOCAINE/GLYCERIN 1 DropsALLERGEN ANTIPYRINE/BENZOCAINE/GLYCERIN 1 DropsANTIBEN ANTIPYRINE/BENZOCAINE/GLYCERIN 1 DropsANTIPYRINE W/BENZOCAINE ANTIPYRINE/BENZOCAINE/GLYCERIN 1 DropsAURODEX EAR DROPS ANTIPYRINE/BENZOCAINE/GLYCERIN 1 DropsAUROGUARD ANTIPYRINE/BENZOCAINE/GLYCERIN 1 DropsBALAGAN ANTIPYRINE/BENZOCAINE/GLYCERIN 1 DropsBENZOTIC ANTIPYRINE/BENZOCAINE/GLYCERIN 1 DropsDOLOTIC ANTIPYRINE/BENZOCAINE/GLYCERIN 1 DropsOTOGESIC ANTIPYRINE/BENZOCAINE/GLYCERIN 2 DropsOTRA NR ANTIPYRINE/BENZOCAINE/GLYCERIN 1 DropsPRO-OTIC ANTIPYRINE/BENZOCAINE/GLYCERIN 1 DropsOTOCAIN BENZOCAINE 3 DropsTYMPAGESIC PHENYLEPHRINE/ANTIPY/B-CAINE 3 DropsPRAMOTIC PRAMOXINE HCL/CHLOROXYLENOL 3 DropsALBA-3 PRAMOXINE/CHLOROXYLENOL/BAK 3 Drops

EAR PREPARATIONS ANTI-INFLAMMATORYDERMOTIC FLUOCINOLONE ACETONIDE OIL 3 DropsOTICIN HC HC/PRAMOXINE/CHLOROXYLENOL/BAK 3 Drops

EAR PREPARATIONS, ANTIBIOTICSPEDIOTIC NEO SUL/PLYMX B SU/BUFFERS/HC 2 Suspension DropsCORTISPORIN-TC NEOMY SULF/COLIST SUL/HC/THONZ 3 Suspension DropsANTIBIOTIC EAR SOLUTION NEOMY SULF/POLYMYX B SULF/HC 1 SolutionCORTISPORIN NEOMY SULF/POLYMYX B SULF/HC 3 SolutionCORTOMYCIN NEOMY SULF/POLYMYX B SULF/HC 1 SolutionNEOMYCIN/POLYMYXIN/HC NEOMY SULF/POLYMYX B SULF/HC 1 SolutionOTICIN HC NEOMY SULF/POLYMYX B SULF/HC 1 SolutionOTIMAR NEOMY SULF/POLYMYX B SULF/HC 1 SolutionOTOCIDIN NEOMY SULF/POLYMYX B SULF/HC 1 SolutionANTIBIOTIC EAR SUSPENSION NEOMY SULF/POLYMYX B SULF/HC 1 Suspension DropsCORT-BIOTIC NEOMY SULF/POLYMYX B SULF/HC 1 Suspension DropsCORTISPORIN NEOMY SULF/POLYMYX B SULF/HC 3 Suspension DropsCORTOMYCIN NEOMY SULF/POLYMYX B SULF/HC 1 Suspension DropsNEOMYCIN/POLYMYXIN/HC NEOMY SULF/POLYMYX B SULF/HC 1 Suspension DropsOTICIN HC NEOMY SULF/POLYMYX B SULF/HC 1 Suspension DropsOTIMAR NEOMY SULF/POLYMYX B SULF/HC 1 Suspension DropsCOLY-MYCIN S NEOMYCIN SULFATE/COLIST SUL/HC 3 Suspension Drops

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

FLOXIN OFLOXACIN 2 DropperetteFLOXIN OFLOXACIN 2 Drops

MOUTHWASHESFIRST-MOUTHWASH BLM MAG HYDROX/ALH/SMC/DPHA/LIDO 3 Mouthwash

NASAL ANTIHISTAMINEASTELIN AZELASTINE HCL 2 Aerosol

EYE ANTIBIOTIC-CORTICOID COMBINATIONSPRED-G GENTAMICIN/PREDNISOL AC 3 OintmentPRED-G GENTAMICIN/PREDNISOL AC 3 Suspension DropsMAXITROL NEO/POLYMYX B SULF/DEXAMETH 3 OintmentMAXITROL NEO/POLYMYX B SULF/DEXAMETH 3 Suspension DropsNEOMYCIN/POLYMYXIN/DEXAMETH NEO/POLYMYX B SULF/DEXAMETH 1 Suspension DropsPOLY-DEX NEO/POLYMYX B SULF/DEXAMETH 1 Suspension DropsCORTOMYCIN NEOMY SULF/BACITRAC ZN/POLY/HC 1 OintmentNEOMYCIN/BACITRACIN/POLY/HC NEOMY SULF/BACITRAC ZN/POLY/HC 1 OintmentCORTISPORIN NEOMY SULF/POLYMYX B SULF/HC 3 Suspension DropsPOLY-PRED NEOMY SULF/POLYMYX B SULF/PRED 3 Suspension DropsTOBRADEX TOBRAMYCIN SULFATE/DEXAMETH 2 OintmentTOBRADEX TOBRAMYCIN SULFATE/DEXAMETH 2 Suspension DropsZYLET TOBRAMYCIN/LOTEPRED ETAB 3 Suspension Drops

OTIC PREPARATIONS, ANTI-INFLAMMATORY-ANTIBIOTICSCIPRODEX CIPROFLOXACIN HCL/DEXAMETH 2 Suspension DropsCIPRO HC CIPROFLOXACIN HCL/HC 3 Suspension Drops

OPHTHALMIC MAST CELL STABILIZERSCROLOM CROMOLYN SODIUM 3 DropsALOMIDE LODOXAMIDE TROMETHAMINE 2 DropsALOCRIL NEDOCROMIL SODIUM 3 DropsALAMAST PEMIROLAST POTASSIUM 3 Drops

OPHTHALMIC ANTI-INFLAMMATORY IMMUNOMODULATOR-TYPERESTASIS CYCLOSPORINE 2 Dropperette

GASTROINTESTINALANTI-ULCER PREPARATIONSCYTOTEC MISOPROSTOL 3 TabletMISOPROSTOL MISOPROSTOL 1 TabletCARAFATE SUCRALFATE 2 SuspensionSUCRALFATE SUCRALFATE 2 SuspensionCARAFATE SUCRALFATE 3 TabletSUCRALFATE SUCRALFATE 1 Tablet

GASTRIC ENZYMESDIGEX CELL/AMY/LIP/PROTE/P-TLOX/HYOS 3 CapsuleGASTRINEX CELL/AMY/LIP/PROTE/P-TLOX/HYOS 3 CapsuleDIGESPLEN PLUS PEP/CELL/SIMETH/BILE/PANCREAT 3 Tablet ECDIGEPEPSIN PEPSIN/DHCAAC/PANCREATIN 3 TabletSUCRAID SACROSIDASE 3 Solution

ANTIDIARRHEALSMOTOFEN DIFENOXIN HCL/ATROPINE SULFATE 3 TabletDIPHENOXYLATE W/ATROPINE DIPHENOXYLATE HCL/ATROP SULF 1 LiquidLOMOTIL DIPHENOXYLATE HCL/ATROP SULF 3 LiquidDIPHENOXYLATE W/ATROPINE DIPHENOXYLATE HCL/ATROP SULF 1 TabletLOMOTIL DIPHENOXYLATE HCL/ATROP SULF 3 TabletLONOX DIPHENOXYLATE HCL/ATROP SULF 1 Tablet

LAXATIVES AND CATHARTICSHALFLYTELY BISAC/NACL/NAHCO3/KCL/PEG 3350 3 Combo. Pack.HALFLYTELY WITH FLAVOR PACKS BISAC/NACL/NAHCO3/KCL/PEG 3350 3 Combo. Pack.KRISTALOSE LACTULOSE 3 PacketCONSTULOSE LACTULOSE 1 SolutionLACTULOSE LACTULOSE 1 Solution

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

VISICOL NAPHOS M-B M-H/NA PHOS,DI-BA 3 TabletMIRALAX POLYETHYLENE GLYCOL 3350 3 PacketNULYTELY SOD CHLORIDE/NAHCO3/KCL/PEG'S 3 SolutionNULYTELY WITH FLAVOR PACKS SOD CHLORIDE/NAHCO3/KCL/PEG'S 1 SolutionTRILYTE WITH FLAVOR PACKETS SOD CHLORIDE/NAHCO3/KCL/PEG'S 3 SolutionGOLYTELY SOD SULF/SOD/NAHCO3/KCL/PEG'S 2 PacketCOLYTE SOD SULF/SOD/NAHCO3/KCL/PEG'S 3 SolutionCOLYTE WITH FLAVOR PACKETS SOD SULF/SOD/NAHCO3/KCL/PEG'S 3 SolutionGOLYTELY SOD SULF/SOD/NAHCO3/KCL/PEG'S 3 SolutionOCL SOD SULF/SOD/NAHCO3/KCL/PEG'S 2 SolutionPEG 3350/ELECTROLYTE SOD SULF/SOD/NAHCO3/KCL/PEG'S 1 Solution

BILE SALTSACTIGALL URSODIOL 3 CapsuleURSODIOL URSODIOL 1 CapsuleURSO URSODIOL 2 TabletURSO FORTE URSODIOL 2 Tablet

PANCREATIC ENZYMESDYGASE AMYLASE/LIPASE/PROTEASE 1 CapsuleENZYCAP AMYLASE/LIPASE/PROTEASE 1 CapsuleKUTRASE AMYLASE/LIPASE/PROTEASE 2 CapsuleKU-ZYME AMYLASE/LIPASE/PROTEASE 2 CapsuleKU-ZYME HP AMYLASE/LIPASE/PROTEASE 2 CapsuleLAPASE AMYLASE/LIPASE/PROTEASE 1 CapsuleCREON 10 AMYLASE/LIPASE/PROTEASE 2 Capsule ECCREON 20 AMYLASE/LIPASE/PROTEASE 2 Capsule ECCREON 5 AMYLASE/LIPASE/PROTEASE 2 Capsule ECLIPRAM AMYLASE/LIPASE/PROTEASE 1 Capsule ECLIPRAM-CR 10 AMYLASE/LIPASE/PROTEASE 1 Capsule ECLIPRAM-CR20 AMYLASE/LIPASE/PROTEASE 1 Capsule ECLIPRAM-CR5 AMYLASE/LIPASE/PROTEASE 1 Capsule ECLIPRAM-PN10 AMYLASE/LIPASE/PROTEASE 1 Capsule ECLIPRAM-PN16 AMYLASE/LIPASE/PROTEASE 1 Capsule ECLIPRAM-PN20 AMYLASE/LIPASE/PROTEASE 1 Capsule ECLIPRAM-UL12 AMYLASE/LIPASE/PROTEASE 1 Capsule ECLIPRAM-UL18 AMYLASE/LIPASE/PROTEASE 1 Capsule ECLIPRAM-UL20 AMYLASE/LIPASE/PROTEASE 1 Capsule ECPALCAPS 10 AMYLASE/LIPASE/PROTEASE 1 Capsule ECPALCAPS 20 AMYLASE/LIPASE/PROTEASE 1 Capsule ECPANCREASE AMYLASE/LIPASE/PROTEASE 2 Capsule ECPANCREASE MT 10 AMYLASE/LIPASE/PROTEASE 2 Capsule ECPANCREASE MT 16 AMYLASE/LIPASE/PROTEASE 2 Capsule ECPANCREASE MT 20 AMYLASE/LIPASE/PROTEASE 2 Capsule ECPANCREASE MT 4 AMYLASE/LIPASE/PROTEASE 2 Capsule ECPANCRECARB MS-16 AMYLASE/LIPASE/PROTEASE 2 Capsule ECPANCRECARB MS-4 AMYLASE/LIPASE/PROTEASE 2 Capsule ECPANCRECARB MS-8 AMYLASE/LIPASE/PROTEASE 2 Capsule ECPANCRELIPASE AMYLASE/LIPASE/PROTEASE 1 Capsule ECPANCRELIPASE MT-16 AMYLASE/LIPASE/PROTEASE 1 Capsule ECPANCRON 10 AMYLASE/LIPASE/PROTEASE 1 Capsule ECPANCRON 20 AMYLASE/LIPASE/PROTEASE 1 Capsule ECPANGESTYME CN 10 AMYLASE/LIPASE/PROTEASE 1 Capsule ECPANGESTYME CN 20 AMYLASE/LIPASE/PROTEASE 1 Capsule ECPANGESTYME EC AMYLASE/LIPASE/PROTEASE 1 Capsule ECPANGESTYME MT 16 AMYLASE/LIPASE/PROTEASE 1 Capsule ECPANGESTYME UL 12 AMYLASE/LIPASE/PROTEASE 1 Capsule ECPANGESTYME UL 18 AMYLASE/LIPASE/PROTEASE 1 Capsule ECPANGESTYME UL 20 AMYLASE/LIPASE/PROTEASE 1 Capsule ECPANOCAPS AMYLASE/LIPASE/PROTEASE 1 Capsule ECPANOCAPS MT 16 AMYLASE/LIPASE/PROTEASE 1 Capsule ECPANOCAPS MT 20 AMYLASE/LIPASE/PROTEASE 1 Capsule ECULTRACAPS MT 20 AMYLASE/LIPASE/PROTEASE 1 Capsule ECULTRASE AMYLASE/LIPASE/PROTEASE 1 Capsule EC

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

ULTRASE MT 12 AMYLASE/LIPASE/PROTEASE 2 Capsule ECULTRASE MT 18 AMYLASE/LIPASE/PROTEASE 2 Capsule ECULTRASE MT 20 AMYLASE/LIPASE/PROTEASE 2 Capsule ECULTRASE MT 6 AMYLASE/LIPASE/PROTEASE 2 Capsule ECVIOKASE AMYLASE/LIPASE/PROTEASE 2 PowderPANCRELIPASE AMYLASE/LIPASE/PROTEASE 1 TabletPANCRELIPASE 8,000 AMYLASE/LIPASE/PROTEASE 1 TabletPANOKASE AMYLASE/LIPASE/PROTEASE 1 TabletPANOKASE-16 AMYLASE/LIPASE/PROTEASE 1 TabletPLARETASE 8000 AMYLASE/LIPASE/PROTEASE 1 TabletVIOKASE AMYLASE/LIPASE/PROTEASE 2 TabletENZYMAX PANCREATIN 3 Tablet

AMMONIA INHIBITORSLITHOSTAT ACETOHYDROXAMIC ACID 3 TabletENULOSE LACTULOSE 1 SolutionGENERLAC LACTULOSE 1 SolutionLACTULOSE LACTULOSE 1 SolutionUCEPHAN SODIUM BENZOATE/NA PH-ACETATE 3 SolutionBUPHENYL SODIUM PHENYLBUTYRATE 3 Tablet

ANTIEMETIC/ANTIVERTIGO AGENTSEMEND APREPITANT 2 CapsuleANZEMET DOLASETRON MESYLATE 3 TabletMARINOL DRONABINOL 3 CapsuleKYTRIL GRANISETRON HCL 3 SolutionKYTRIL GRANISETRON HCL 3 TabletVERTIN-32 MECLIZINE HCL 2 Chew TabANTIVERT MECLIZINE HCL 2 TabletANTIVERT/25 MECLIZINE HCL 2 TabletMECLIZINE HCL MECLIZINE HCL 1 TabletUNIVERT MECLIZINE HCL 1 TabletVERTIN-32 MECLIZINE HCL 2 TabletZOFRAN ODT ONDANSETRON 2 Tablet, Disper. LingualZOFRAN ONDANSETRON HCL 2 SolutionZOFRAN ONDANSETRON HCL 2 TabletCOMPAZINE PROCHLORPERAZINE EDISYLATE 2 SyrupCOMPRO PROCHLORPERAZINE MALEATE 1 SuppositoryPROCHLORPERAZINE MALEATE PROCHLORPERAZINE MALEATE 1 SuppositoryPROCHLORPERAZINE MALEATE PROCHLORPERAZINE MALEATE 1 TabletPHENADOZ PROMETHAZINE HCL 1 SuppositoryPROMETHAZINE HCL PROMETHAZINE HCL 1 SuppositoryPROMETHEGAN PROMETHAZINE HCL 1 SuppositoryTRANSDERM-SCOP SCOPOLAMINE HYDROBROMIDE 2 Patch 72hrMALDEMAR SCOPOLAMINE HYDROBROMIDE 3 TabletSCOPACE SCOPOLAMINE HYDROBROMIDE 3 TabletTIGAN TRIMETHOBENZAMIDE HCL 2 CapsuleTRIMETHOBENZAMIDE HCL TRIMETHOBENZAMIDE HCL 1 CapsuleTEBAMIDE TRIMETHOBENZAMIDE HCL/B-CAINE 1 SuppositoryTRIMETHOBENZAMIDE HCL TRIMETHOBENZAMIDE HCL/B-CAINE 1 Suppository

BELLADONNA ALKALOIDSCOLYTROL ATROP SULF/SCOPOL HB/HYOSCY 3 SuspensionSIMETYL ATROP SULF/SCOPOL HB/HYOSCY 3 TabletSAL-TROPINE ATROPINE SULFATE 3 TabletCOLYTROL BELLADONNA ALKALOIDS 3 ElixirCOLYTROL BELLADONNA ALKALOIDS 3 TabletSPACOL BELLADONNA ALKALOIDS 3 TabletANTISPASMODIC BELLADONNA ALKALOIDS/PHENOBARB 1 ElixirBELLADONNA W/PHENOBARBITAL BELLADONNA ALKALOIDS/PHENOBARB 1 ElixirCOLIDROPS BELLADONNA ALKALOIDS/PHENOBARB 1 ElixirDONNATAL BELLADONNA ALKALOIDS/PHENOBARB 2 ElixirLAHEY MIXTURE #3 BELLADONNA ALKALOIDS/PHENOBARB 1 ElixirANTISPAS BELLADONNA ALKALOIDS/PHENOBARB 1 TabletBARBIDONNA BELLADONNA ALKALOIDS/PHENOBARB 2 Tablet

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

BELLADONNA W/PHENOBARBITAL BELLADONNA ALKALOIDS/PHENOBARB 1 TabletDONNATAL BELLADONNA ALKALOIDS/PHENOBARB 2 TabletHAPONAL BELLADONNA ALKALOIDS/PHENOBARB 1 TabletALKABEL-SR BELLADONNA ALKALOIDS/PHENOBARB 1 Tablet SABELLATAL ER BELLADONNA ALKALOIDS/PHENOBARB 1 Tablet SADONNATAL BELLADONNA ALKALOIDS/PHENOBARB 2 Tablet SAPAINFUL MENSTRUATION NO.31 BELLADONNA ALKALOIDS/YELW JAS 3 TabletCYSTOSPAZ HYOSCYAMINE 3 TabletHYOSCYAMINE HYOSCYAMINE 1 TabletHYOSPAZ HYOSCYAMINE 1 TabletCYSTOSPAZ-M HYOSCYAMINE SULFATE 1 Capsule 12hr SRHYOSCYAMINE SULFATE HYOSCYAMINE SULFATE 1 Capsule 12hr SRLEVSINEX HYOSCYAMINE SULFATE 3 Capsule 12hr SRCOLIDROPS HYOSCYAMINE SULFATE 1 DropsCOLYTROL HYOSCYAMINE SULFATE 3 DropsGASTROSED HYOSCYAMINE SULFATE 1 DropsHYCO HYOSCYAMINE SULFATE 1 DropsHYOSCYAMINE SULFATE HYOSCYAMINE SULFATE 1 DropsHYOSYNE HYOSCYAMINE SULFATE 1 DropsLEVSIN HYOSCYAMINE SULFATE 3 DropsSPACOL I.D. HYOSCYAMINE SULFATE 1 DropsSPASDEL HYOSCYAMINE SULFATE 1 DropsHYOSCYAMINE SULFATE HYOSCYAMINE SULFATE 1 ElixirHYOSYNE HYOSCYAMINE SULFATE 1 ElixirLEVSIN HYOSCYAMINE SULFATE 3 ElixirSPASDEL HYOSCYAMINE SULFATE 1 ElixirIB-STAT HYOSCYAMINE SULFATE 3 SprayANASPAZ HYOSCYAMINE SULFATE 1 TabletDONNAMAR HYOSCYAMINE SULFATE 3 TabletGASTROSED HYOSCYAMINE SULFATE 1 TabletHYOSCYAMINE SULFATE HYOSCYAMINE SULFATE 1 TabletHYOSCYAMINE SULFATE HYOSCYAMINE SULFATE 3 TabletLEVSIN HYOSCYAMINE SULFATE 3 TabletSPASDEL HYOSCYAMINE SULFATE 1 TabletHYOSCYAMINE SULFATE HYOSCYAMINE SULFATE 1 Tablet 12hr SRLEVBID HYOSCYAMINE SULFATE 3 Tablet 12hr SRSPACOL T/S HYOSCYAMINE SULFATE 1 Tablet 12hr SRSYMAX-SR HYOSCYAMINE SULFATE 1 Tablet 12hr SRA-SPAS-S/L HYOSCYAMINE SULFATE 1 Tablet SLHYOSCYAMINE SULFATE HYOSCYAMINE SULFATE 1 Tablet SLLEVSIN/SL HYOSCYAMINE SULFATE 3 Tablet SLSYMAX-SL HYOSCYAMINE SULFATE 1 Tablet SLHYOSCYAMINE SULFATE HYOSCYAMINE SULFATE 1 Tablet, Disper. LingualMAR-SPAS HYOSCYAMINE SULFATE 3 Tablet, Disper. LingualNULEV HYOSCYAMINE SULFATE 3 Tablet, Disper. LingualSYMAX HYOSCYAMINE SULFATE 1 Tablet, Disper. LingualSYMAX DUOTAB HYOSCYAMINE SULFATE 3 Tablet, Multiphasic ReleasePAMINE SCOPOLAMINE METHYLBROMIDE 3 TabletPAMINE FORTE SCOPOLAMINE METHYLBROMIDE 3 TabletSIMETYL SIMETHICONE/BELLAD ALK 3 Elixir

ANTICHOLINERGICS, QUATERNARY AMMONIUMCLIDINIUM W/CHLORDIAZEPOXIDE CLIDINIUM BR/CHLORDIAZEPOXIDE 1 CapsuleLIBRAX CLIDINIUM BR/CHLORDIAZEPOXIDE 3 CapsuleLIDOX CLIDINIUM BR/CHLORDIAZEPOXIDE 1 CapsuleQUARZAN CLIDINIUM BROMIDE 3 CapsuleROBINUL GLYCOPYRROLATE 3 TabletROBINUL FORTE GLYCOPYRROLATE 3 TabletCANTIL MEPENZOLATE BROMIDE 3 TabletPRO-BANTHINE PROPANTHELINE BROMIDE 2 TabletPROPANTHELINE BROMIDE PROPANTHELINE BROMIDE 1 Tablet

ANTICHOLINERGICS/ANTISPASMODICSBENTYL DICYCLOMINE HCL 2 Capsule

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

DICYCLOMINE HCL DICYCLOMINE HCL 1 CapsuleBENTYL DICYCLOMINE HCL 3 SyrupDICYCLOMINE HCL DICYCLOMINE HCL 1 SyrupBENTYL DICYCLOMINE HCL 3 TabletDICYCLOMINE HCL DICYCLOMINE HCL 1 Tablet

INTESTINAL MOTILITY STIMULANTSMETOCLOPRAMIDE HCL INTENSOL METOCLOPRAMIDE HCL 2 ConcentrateMETOCLOPRAMIDE HCL METOCLOPRAMIDE HCL 1 SolutionMETOCLOPRAMIDE HCL METOCLOPRAMIDE HCL 1 TabletREGLAN METOCLOPRAMIDE HCL 3 Tablet

LIPOTROPICSOMACOR OMEGA-3 ACID ETHYL ESTERS 3 Capsule

RECTAL PREPARATIONSPROCTOFOAM-HC HC ACETATE/PRAMOXINE HCL 2 FoamANUSOL-HC HYDROCORTISONE 3 CreamPROCTOCORT HYDROCORTISONE 3 CreamPROCTOCREAM-HC HYDROCORTISONE 3 CreamPROCTO-KIT HYDROCORTISONE 3 CreamHYDROCORTISONEACETATE HYDROCORTISONE ACETATE 3 CreamANUCORT-HC HYDROCORTISONE ACETATE 1 SuppositoryANUDIL HC HYDROCORTISONE ACETATE 1 SuppositoryANUMED-HC HYDROCORTISONE ACETATE 1 SuppositoryANUSOL-HC HYDROCORTISONE ACETATE 2 SuppositoryENCORT HYDROCORTISONE ACETATE 1 SuppositoryHEMORRHOIDAL HC HYDROCORTISONE ACETATE 1 SuppositoryHEMRIL HYDROCORTISONE ACETATE 2 SuppositoryHEMRIL-HC HYDROCORTISONE ACETATE 1 SuppositoryHYDROCORTISONE ACETATE HYDROCORTISONE ACETATE 1 SuppositoryPROCTOCORT HYDROCORTISONE ACETATE 1 SuppositoryPROCTOSERT HC HYDROCORTISONE ACETATE 1 SuppositoryPROCTOSOL-HC HYDROCORTISONE ACETATE 1 SuppositoryRECTASOL-HC HYDROCORTISONE ACETATE 1 Suppository

HEMORRHOIDAL PREPARATIONSANALPRAM HC HC ACETATE/PRAMOXINE HCL 3 CreamANALPRAM-HC HC ACETATE/PRAMOXINE HCL 3 Lotion

HEMORRHOIDALS, LOCAL RECTAL ANESTHETICSANAMANTLE HC HC ACETATE/LIDOCAINE HCL 3 CreamANAMANTLE HC HC ACETATE/LIDOCAINE HCL 3 KitANAMANTLE HC FORTE HC ACETATE/LIDOCAINE HCL 3 Kit

ANTI-ULCER-H.PYLORI AGENTSPREVPAC LANSOPRAZOLE/AMOX TR/CLARITH 2 Combo. Pack.

DRUGS TO TX CHRONIC INFLAMM. DISEASE OF COLONREMICADE INFLIXIMAB 3 Vial

GASTRIC ACID SECRETION REDUCERSCIMETIDINE CIMETIDINE 1 TabletTAGAMET CIMETIDINE 3 TabletCIMETIDINE HCL CIMETIDINE HCL 1 LiquidNEXIUM ESOMEPRAZOLE MAG TRIHYDRATE 2 Capsule ECPEPCID FAMOTIDINE 3 SuspensionPEPCID FAMOTIDINE 3 TabletPEPCID RPD FAMOTIDINE 3 Tablet, Disper. LingualPREVACID LANSOPRAZOLE 2 Capsule ECAXID NIZATIDINE 3 CapsuleAXID NIZATIDINE 3 SolutionOMEPRAZOLE OMEPRAZOLE 1 Capsule ECPRILOSEC OMEPRAZOLE 3 Capsule ECZEGERID OMEPRAZOLE 3 PacketPROTONIX PANTOPRAZOLE SODIUM 3 Tablet ECACIPHEX RABEPRAZOLE SODIUM 3 Tablet EC

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

RANITIDINE HCL RANITIDINE HCL 1 CapsuleTALADINE RANITIDINE HCL 3 CapsuleZANTAC RANITIDINE HCL 3 SyrupRANITIDINE HCL RANITIDINE HCL 1 TabletZANTAC RANITIDINE HCL 3 TabletZANTAC RANITIDINE HCL 3 Tablet Effer.ZANTAC 25 RANITIDINE HCL 3 Tablet Effer.

IRRITABLE BOWEL SYND. AGENT, 5HT-4 PARTIAL AGONISTZELNORM TEGASEROD HYDROGEN MALEATE 3 Tablet

IRRITABLE BOWEL SYND. AGENT, 5HT-3 ANTAGONIST-TYPELOTRONEX ALOSETRON HCL 3 Tablet

DRUG TX-CHRONIC INFLAM. COLON DX, 5-AMINOSALICYLATCOLAZAL BALSALAZIDE DISODIUM 2 CapsulePENTASA MESALAMINE 2 Capsule SAASACOL MESALAMINE 2 Tablet ECDIPENTUM OLSALAZINE SODIUM 2 Capsule

CHRONIC INFLAM. COLON DX, 5-A-SALICYLAT,RECTAL TXMESALAMINE MESALAMINE 1 EnemaROWASA MESALAMINE 2 EnemaCANASA MESALAMINE 2 Suppository

HORMONESANDROGENIC AGENTSANDROXY FLUOXYMESTERONE 3 TabletANDROID METHYLTESTOSTERONE 3 CapsuleTESTRED METHYLTESTOSTERONE 3 CapsuleMETHITEST METHYLTESTOSTERONE 3 TabletOXANDRIN OXANDROLONE 3 TabletANADROL-50 OXYMETHOLONE 3 TabletANDROGEL TESTOSTERONE 2 GelTESTIM TESTOSTERONE 2 GelANDRODERM TESTOSTERONE 2 Patch 24hrFIRST-TESTOSTERONE MC TESTOSTERONE PROPIONATE 3 CreamFIRST-TESTOSTERONE TESTOSTERONE PROPIONATE 3 Ointment

ESTROGENIC AGENTSESTRASORB ESTRADIOL 3 EmulsionESTROGEL ESTRADIOL 3 GelALORA ESTRADIOL 1 Patch BiweeklyALORA ESTRADIOL 2 Patch BiweeklyESTRADERM ESTRADIOL 2 Patch BiweeklyVIVELLE ESTRADIOL 2 Patch BiweeklyVIVELLE-DOT ESTRADIOL 2 Patch BiweeklyCLIMARA ESTRADIOL 2 Patch WeeklyESTRADIOL TDS ESTRADIOL 1 Patch WeeklyESTRADIOL TRANSDERMAL PATCH ESTRADIOL 1 Patch WeeklyMENOSTAR ESTRADIOL 3 Patch WeeklyESTRACE ESTRADIOL 3 TabletESTRADIOL ESTRADIOL 1 TabletGYNODIOL ESTRADIOL 3 TabletFEMTRACE ESTRADIOL ACETATE 3 TabletCLIMARA PRO ESTRADIOL/LEVONORGESTREL 2 Patch WeeklyCOMBIPATCH ESTRADIOL/NORETH AC 2 Patch BiweeklyACTIVELLA ESTRADIOL/NORETH AC 3 TabletPREFEST ESTRADIOL/NORGESTIMATE 2 TabletPREMPHASE ESTROGEN,CON/M-PROGEST ACET 2 TabletPREMPRO ESTROGEN,CON/M-PROGEST ACET 2 TabletCENESTIN ESTROGENS,CONJ.,SYNTHETIC A 3 TabletPREMARIN ESTROGENS,CONJUGATED 2 TabletMENEST ESTROGENS,ESTERIFIED 2 TabletESTROPIPATE ESTROPIPATE 1 Tablet

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

OGEN ESTROPIPATE 3 TabletORTHO-EST ESTROPIPATE 3 TabletFEMHRT ETHINYL ESTRADIOL/NORETH AC 3 Tablet

ESTROGEN/ANDROGEN COMBINATIONSEEMT ME-TESTOSTERONE/ESTROGEN,ESTER 1 TabletEEMT HS ME-TESTOSTERONE/ESTROGEN,ESTER 1 TabletESTRATEST ME-TESTOSTERONE/ESTROGEN,ESTER 2 TabletESTRATEST H.S. ME-TESTOSTERONE/ESTROGEN,ESTER 2 TabletESTROGEN & METHYLTESTOSTERONE ME-TESTOSTERONE/ESTROGEN,ESTER 1 TabletSYNTEST D.S. ME-TESTOSTERONE/ESTROGEN,ESTER 1 TabletSYNTEST H.S. ME-TESTOSTERONE/ESTROGEN,ESTER 1 Tablet

PROGESTATIONAL AGENTSMEDROXYPROGESTERONE ACETATE MEDROXYPROGESTERONE ACET 1 TabletPROVERA MEDROXYPROGESTERONE ACET 3 TabletAYGESTIN NORETHINDRONE ACETATE 3 TabletPROMETRIUM PROGESTERONE,MICRONIZED 2 CapsuleFIRST-PROGESTERONE MC 10 PROGESTERONE,MICRONIZED 3 CreamFIRST-PROGESTERONE MC 5 PROGESTERONE,MICRONIZED 3 CreamPROCHIEVE 4% PROGESTERONE,MICRONIZED 2 GelPROCHIEVE 8% PROGESTERONE,MICRONIZED 3 Gel

OXYTOCICSPREPIDIL DINOPROSTONE 3 GelCERVIDIL DINOPROSTONE 3 SuppositoryPROSTIN E2 VAGINAL SUPPOSITORY DINOPROSTONE 3 SuppositoryMETHERGINE METHYLERGONOVINE MALEATE 3 Tablet

FERTILITY STIMULATING PREPARATIONS, NON-FSHCLOMID CLOMIPHENE CITRATE 3 TabletCLOMIPHENE CITRATE CLOMIPHENE CITRATE 1 TabletSEROPHENE CLOMIPHENE CITRATE 1 Tablet

FOLLICLE STIM./LUTEINIZING HORMONESGONAL-F RFF FOLLITROPIN ALPHA,RECOMB 3 PenGONAL-F FOLLITROPIN ALPHA,RECOMB 3 KitFOLLISTIM AQ FOLLITROPIN BETA,RECOMB 3 Cartridge

GROWTH HORMONESNORDITROPIN NORDIFLEX SOMATROPIN 3 PenGENOTROPIN SOMATROPIN 3 CartridgeHUMATROPE SOMATROPIN 3 CartridgeNORDITROPIN SOMATROPIN 3 CartridgeNUTROPIN AQ SOMATROPIN 3 CartridgeSAIZEN SOMATROPIN 3 CartridgeNUTROPIN DEPOT SOMATROPIN 3 KitHUMATROPE SOMATROPIN 3 VialNORDITROPIN SOMATROPIN 3 VialNUTROPIN SOMATROPIN 3 VialNUTROPIN AQ SOMATROPIN 3 VialSAIZEN SOMATROPIN 3 VialSEROSTIM SOMATROPIN 3 Vial

SOMATOSTATIC AGENTSSANDOSTATIN OCTREOTIDE ACETATE 3 AmpulSANDOSTATIN LAR OCTREOTIDE ACETATE 3 KitSANDOSTATIN OCTREOTIDE ACETATE 3 Vial

PITUITARY SUPPRESSIVE AGENTSBROMOCRIPTINE MESYLATE BROMOCRIPTINE MESYLATE 1 CapsulePARLODEL BROMOCRIPTINE MESYLATE 2 CapsuleBROMOCRIPTINE MESYLATE BROMOCRIPTINE MESYLATE 1 TabletPARLODEL BROMOCRIPTINE MESYLATE 3 TabletDOSTINEX CABERGOLINE 3 TabletDANAZOL DANAZOL 2 Capsule

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

ANTIDIURETIC AND VASOPRESSOR HORMONESDESMOPRESSIN ACETATE DESMOPRESSIN ACETATE 1 AerosolMINIRIN DESMOPRESSIN ACETATE 2 AerosolSTIMATE DESMOPRESSIN ACETATE 2 AerosolDDAVP DESMOPRESSIN ACETATE 2 AmpulDESMOPRESSIN ACETATE DESMOPRESSIN ACETATE 1 AmpulDDAVP DESMOPRESSIN ACETATE 2 SolutionDESMOPRESSIN ACETATE DESMOPRESSIN ACETATE 1 SolutionDDAVP DESMOPRESSIN ACETATE 2 TabletDESMOPRESSIN ACETATE DESMOPRESSIN ACETATE 1 TabletDDAVP DESMOPRESSIN ACETATE 2 VialDESMOPRESSIN ACETATE DESMOPRESSIN ACETATE 1 VialDDAVP DESMOPRESSIN/NA PHOS,DI-BA/CA 2 AerosolDESMOPRESSIN ACETATE DESMOPRESSIN/NA PHOS,DI-BA/CA 1 Aerosol

BONE RESORPTION INHIBITORSFORTICAL CALCITONIN,SALMON,SYNTHETIC 1 AerosolMIACALCIN CALCITONIN,SALMON,SYNTHETIC 2 AerosolMIACALCIN CALCITONIN,SALMON,SYNTHETIC 2 Vial

GLUCOCORTICOIDSQVAR BECLOMETHASONE DIPROPIONATE 2 AerosolCELESTONE BETAMETHASONE 3 SolutionPULMICORT BUDESONIDE 2 Aerosol PowderPULMICORT BUDESONIDE 2 AmpulENTOCORT EC BUDESONIDE 3 Capsule 24hr SRDECADRON DEXAMETHASONE 2 TabletDEXAMETHASONE DEXAMETHASONE 1 TabletDEXPAK DEXAMETHASONE 2 TabletDEXAMETHASONE INTENSOL DEXAMETHASONE 2 DropsDEXAMETHASONE DEXAMETHASONE 1 ElixirDEXAMETHASONE DEXAMETHASONE 2 SolutionDECADRON DEXAMETHASONE 2 TabletDEXAMETHASONE DEXAMETHASONE 2 TabletAEROBID FLUNISOLIDE 3 AerosolAEROBID-M FLUNISOLIDE/MENTHOL 3 AerosolFLOVENT HFA FLUTICASONE PROPIONATE 2 AerosolCORTEF HYDROCORTISONE 3 TabletMEDROL METHYLPREDNISOLONE 2 TabletMEPROLONE UNIPAK METHYLPREDNISOLONE 1 TabletMETHYLPREDNISOLONE METHYLPREDNISOLONE 1 TabletMEDROL METHYLPREDNISOLONE 2 TabletMETHYLPREDNISOLONE METHYLPREDNISOLONE 1 TabletASMANEX MOMETASONE FUROATE 3 AerosolPREDNISOLONE PREDNISOLONE 1 SyrupPRELONE PREDNISOLONE 3 SyrupPREDNISOLONE PREDNISOLONE 2 TabletBUBBLI-PRED PREDNISOLONE SOD PHOSPHATE 1 SolutionORAPRED PREDNISOLONE SOD PHOSPHATE 2 SolutionPEDIAPRED PREDNISOLONE SOD PHOSPHATE 3 SolutionPREDNISOLONE SODIUM PHOSPHATE PREDNISOLONE SOD PHOSPHATE 1 SolutionPREDNISONE PREDNISONE 1 TabletSTERAPRED PREDNISONE 2 TabletSTERAPRED DS PREDNISONE 2 TabletPREDNISONE INTENSOL PREDNISONE 2 ConcentratePREDNISONE PREDNISONE 2 SolutionPREDNISONE PREDNISONE 1 TabletARISTOCORT TRIAMCINOLONE 3 TabletAZMACORT TRIAMCINOLONE ACETONIDE 2 Aerosol

MINERALOCORTICOIDSFLORINEF ACETATE FLUDROCORTISONE ACETATE 3 TabletFLUDROCORTISONE ACETATE FLUDROCORTISONE ACETATE 1 Tablet

VAGINAL ESTROGEN PREPARATIONS

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

ESTRACE ESTRADIOL 3 CreamESTRING ESTRADIOL 2 Ring, VaginalVAGIFEM ESTRADIOL 2 TabletFEMRING ESTRADIOL ACETATE 2 Ring, VaginalPREMARIN ESTROGENS,CONJUGATED 2 Cream

PREGNANCY FACILITATING/MAINTAINING AGENT, HORMONALFIRST-PROGESTERONE VGS 100 PROGESTERONE 3 SuppositoryFIRST-PROGESTERONE VGS 200 PROGESTERONE 3 SuppositoryFIRST-PROGESTERONE VGS 50 PROGESTERONE 3 SuppositoryCRINONE PROGESTERONE,MICRONIZED 3 GelPROCHIEVE PROGESTERONE,MICRONIZED 3 Gel

RECTAL/LOWER BOWEL PREP., GLUCOCORT. (NON-HEMORR)COLOCORT HYDROCORTISONE 2 EnemaHYDROCORTISONE HYDROCORTISONE 1 EnemaCORTIFOAM HYDROCORTISONE ACETATE 2 Aerosol

GROWTH HORMONE RELEASING HORMONE (GHRH) & ANALOGSGEREF SERMORELIN ACETATE 3 Vial

LHRH(GNRH) AGONIST ANALOG PITUITARY SUPPRESSANTSLUPRON DEPOT LEUPROLIDE ACETATE 3 KitSYNAREL NAFARELIN ACETATE 2 Aerosol

LHRH(GNRH)AGNST PIT.SUP-CENTRAL PRECOCIOUS PUBERTYLUPRON DEPOT-PED LEUPROLIDE ACETATE 3 Kit

HYPOGLYCEMICSINSULINSRELION 70/30 INNOLET HUM INSULIN NPH/REG INSULIN HM 3 PenNOVOLIN 70/30 HUM INSULIN NPH/REG INSULIN HM 2 CartridgeHUMULIN 50/50 HUM INSULIN NPH/REG INSULIN HM 2 VialHUMULIN 70/30 HUM INSULIN NPH/REG INSULIN HM 2 VialNOVOLIN 70/30 HUM INSULIN NPH/REG INSULIN HM 2 VialRELION 70/30 HUM INSULIN NPH/REG INSULIN HM 3 VialNOVOLOG INSULIN ASPART 2 CartridgeNOVOLOG INSULIN ASPART 2 VialLANTUS INSULIN GLARGINE,HUM.REC.ANLOG 2 CartridgeLANTUS INSULIN GLARGINE,HUM.REC.ANLOG 2 VialILETIN II NPH(PORK) INSULIN ISOPHANE,PORK PURE 2 VialHUMALOG INSULIN LISPRO,HUMAN REC.ANLOG 2 CartridgeHUMALOG INSULIN LISPRO,HUMAN REC.ANLOG 2 VialRELION N INNOLET INSULIN NPH HUMAN RECOM 3 PenNOVOLIN N INSULIN NPH HUMAN RECOM 2 CartridgeHUMULIN N INSULIN NPH HUMAN RECOM 2 VialNOVOLIN N INSULIN NPH HUMAN RECOM 2 VialRELION N INSULIN NPH HUMAN RECOM 3 VialHUMALOG MIX 75/25 INSULIN NPL/INSULIN LISPRO 2 PenHUMALOG MIX 75/25 INSULIN NPL/INSULIN LISPRO 2 VialNOVOLIN R INSULIN REGULAR HUMAN REC 2 CartridgeHUMULIN R INSULIN REGULAR HUMAN REC 2 VialNOVOLIN R INSULIN REGULAR HUMAN REC 2 VialRELION R INSULIN REGULAR HUMAN REC 3 VialHUMULIN U INSULIN ZINC EXTEND HUMAN REC 2 VialHUMULIN L INSULIN ZINC HUMAN REC 2 VialILETIN II REGULAR(PORK) INSULIN,PORK PURIFIED 2 VialNOVOLOG MIX 70/30 INSULN ASP PRT/INSULIN ASPART 2 CartridgeNOVOLOG MIX 70/30 INSULN ASP PRT/INSULIN ASPART 2 Vial

HYPOGLYCEMICS, INSULIN-RELEASE STIMULANT TYPEACETOHEXAMIDE ACETOHEXAMIDE 3 TabletDIABINESE CHLORPROPAMIDE 3 TabletAMARYL GLIMEPIRIDE 2 TabletGLIMEPIRIDE GLIMEPIRIDE 1 TabletGLIPIZIDE GLIPIZIDE 1 Tablet

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

GLUCOTROL GLIPIZIDE 3 TabletGLIPIZIDE ER GLIPIZIDE 1 Tablet Osmotic Laser-DrilledGLIPIZIDE XL GLIPIZIDE 1 Tablet Osmotic Laser-DrilledGLUCOTROL XL GLIPIZIDE 2 Tablet Osmotic Laser-DrilledMETAGLIP GLIPIZIDE/METFORMIN HCL 3 TabletDIABETA GLYBURIDE 3 TabletGLYBURIDE GLYBURIDE 1 TabletMICRONASE GLYBURIDE 3 TabletGLYBURIDE MICRONIZED GLYBURIDE,MICRONIZED 1 TabletGLYCRON GLYBURIDE,MICRONIZED 2 TabletGLYNASE GLYBURIDE,MICRONIZED 3 TabletGLUCOVANCE GLYBURIDE/METFORMIN HCL 2 TabletGLYBURIDE-METFORMIN HCL GLYBURIDE/METFORMIN HCL 1 TabletSTARLIX NATEGLINIDE 3 TabletPRANDIN REPAGLINIDE 2 TabletTOLBUTAMIDE TOLBUTAMIDE 3 Tablet

HYPOGLYCEMICS, BIGUANIDE TYPE (NON-SULFONYLUREAS)FORTAMET METFORMIN HCL 3 TabletRIOMET METFORMIN HCL 2 SolutionGLUCOPHAGE METFORMIN HCL 3 TabletMETFORMIN HCL METFORMIN HCL 1 TabletGLUCOPHAGE XR METFORMIN HCL 3 Tablet 24hr SRMETFORMIN HCL METFORMIN HCL 1 Tablet 24hr SRMETFORMIN HCL ER METFORMIN HCL 1 Tablet 24hr SR

HYPOGLYCEMICS, ALPHA-GLUCOSIDASE INHIB TYPE (N-S)PRECOSE ACARBOSE 2 TabletGLYSET MIGLITOL 3 Tablet

HYPOGLYCEMICS, INSULIN-RESPONSE ENHANCER (N-S)ACTOS PIOGLITAZONE HCL 2 TabletACTOPLUS MET PIOGLITAZONE HCL/METFORMIN HCL 3 TabletAVANDIA ROSIGLITAZONE MALEATE 2 TabletAVANDAMET ROSIGLITAZONE/METFORMIN HCL 2 Tablet

ANTIHYPERGLY, INCRETIN MIMETIC(GLP-1 RECEP. AGONIST)BYETTA EXENATIDE 3 Pen

IMMUNOSUPPRESSANTSIMMUNOSUPPRESSIVESAZASAN AZATHIOPRINE 2 TabletIMURAN AZATHIOPRINE 3 TabletCYCLOSPORINE CYCLOSPORINE 1 CapsuleSANDIMMUNE CYCLOSPORINE 2 CapsuleCYCLOSPORINE CYCLOSPORINE 1 SolutionSANDIMMUNE CYCLOSPORINE 2 SolutionCYCLOSPORINE CYCLOSPORINE, MODIFIED 2 CapsuleGENGRAF CYCLOSPORINE, MODIFIED 1 CapsuleNEORAL CYCLOSPORINE, MODIFIED 2 CapsuleCYCLOSPORINE CYCLOSPORINE, MODIFIED 1 SolutionGENGRAF CYCLOSPORINE, MODIFIED 1 SolutionNEORAL CYCLOSPORINE, MODIFIED 2 SolutionCELLCEPT MYCOPHENOLATE MOFETIL 3 CapsuleCELLCEPT MYCOPHENOLATE MOFETIL 3 SuspensionCELLCEPT MYCOPHENOLATE MOFETIL 3 TabletMYFORTIC MYCOPHENOLATE SODIUM 3 Tablet ECRAPAMUNE SIROLIMUS 3 SolutionRAPAMUNE SIROLIMUS 3 TabletPROGRAF TACROLIMUS ANHYDROUS 3 Capsule

TOPICAL IMMUNOSUPPRESSIVE AGENTSELIDEL PIMECROLIMUS 2 CreamPROTOPIC TACROLIMUS 2 Ointment

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

MUSCLE RELAXANTSSKELETAL MUSCLE RELAXANTSBACLOFEN BACLOFEN 1 TabletCARISOPRODOL CARISOPRODOL 1 TabletSOMA CARISOPRODOL 3 TabletVANADOM CARISOPRODOL 3 TabletCARISOPRODOL COMPOUND CARISOPRODOL/ASPIRIN 1 TabletSOMA COMPOUND CARISOPRODOL/ASPIRIN 3 TabletPARAFON FORTE DSC CHLORZOXAZONE 3 TabletCYCLOBENZAPRINE HCL CYCLOBENZAPRINE HCL 1 TabletFLEXERIL CYCLOBENZAPRINE HCL 3 TabletDANTRIUM DANTROLENE SODIUM 2 CapsuleDANTROLENE SODIUM DANTROLENE SODIUM 1 CapsuleSKELAXIN METAXALONE 3 TabletMETHOCARBAMOL METHOCARBAMOL 1 TabletROBAXIN METHOCARBAMOL 3 TabletROBAXIN-750 METHOCARBAMOL 3 TabletMETHOCARBAMOL W/ASPIRIN METHOCARBAMOL/ASPIRIN 1 TabletZANAFLEX TIZANIDINE HCL 3 CapsuleTIZANIDINE HCL TIZANIDINE HCL 1 TabletZANAFLEX TIZANIDINE HCL 3 Tablet

PSYCHOTHERAPEUTIC DRUGSANTI-ANXIETY DRUGSALPRAZOLAM INTENSOL ALPRAZOLAM 2 ConcentrateALPRAZOLAM ALPRAZOLAM 1 TabletXANAX ALPRAZOLAM 3 TabletXANAX XR ALPRAZOLAM 3 Tablet 24hr SRNIRAVAM ALPRAZOLAM 3 Tablet, Disper. LingualBUSPAR BUSPIRONE HCL 3 TabletBUSPIRONE HCL BUSPIRONE HCL 1 TabletVANSPAR BUSPIRONE HCL 3 TabletCHLORDIAZEPOXIDE HCL CHLORDIAZEPOXIDE HCL 1 CapsuleLIBRIUM CHLORDIAZEPOXIDE HCL 3 CapsuleCLORAZEPATE DIPOTASSIUM CLORAZEPATE DIPOTASSIUM 1 TabletTRANXENE T-TAB CLORAZEPATE DIPOTASSIUM 3 TabletTRANXENE SD CLORAZEPATE DIPOTASSIUM 2 Tablet SADIAZEPAM DIAZEPAM 2 ConcentrateDIAZEPAM DIAZEPAM 2 SolutionDIAZEPAM DIAZEPAM 1 TabletVALIUM DIAZEPAM 3 TabletPAXIPAM HALAZEPAM 3 TabletLORAZEPAM INTENSOL LORAZEPAM 2 ConcentrateATIVAN LORAZEPAM 3 TabletLORAZEPAM LORAZEPAM 1 TabletMEPROBAMATE MEPROBAMATE 1 TabletMILTOWN MEPROBAMATE 3 TabletSERAX OXAZEPAM 3 CapsuleSERAX OXAZEPAM 3 Tablet

ANTI-PSYCHOTICS,PHENOTHIAZINESCHLORPROMAZINE HCL CHLORPROMAZINE HCL 1 ConcentrateCHLORPROMAZINE HCL CHLORPROMAZINE HCL 1 TabletCHLORPROMAZINE HCL CHLORPROMAZINE HCL 2 TabletFLUPHENAZINE HCL FLUPHENAZINE HCL 1 ConcentrateFLUPHENAZINE HCL FLUPHENAZINE HCL 1 ElixirFLUPHENAZINE HCL FLUPHENAZINE HCL 1 TabletPROLIXIN FLUPHENAZINE HCL 3 TabletPERPHENAZINE PERPHENAZINE 2 ConcentratePERPHENAZINE PERPHENAZINE 1 TabletTHIORIDAZINE HCL THIORIDAZINE HCL 1 ConcentrateTHIORIDAZINE HCL THIORIDAZINE HCL 1 Tablet

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

TRIFLUOPERAZINE HCL TRIFLUOPERAZINE HCL 1 Tablet

ANTI-MANIA DRUGSESKALITH LITHIUM CARBONATE 2 CapsuleLITHIUM CARBONATE LITHIUM CARBONATE 2 CapsuleLITHIUM CARBONATE LITHIUM CARBONATE 1 TabletESKALITH CR LITHIUM CARBONATE 2 Tablet SALITHIUM CARBONATE LITHIUM CARBONATE 1 Tablet SALITHOBID LITHIUM CARBONATE 2 Tablet SALITHIUM CITRATE LITHIUM CITRATE 2 Solution

TX FOR ATTENTION DEFICIT-HYPERACT(ADHD)/NARCOLEPSYFOCALIN XR DEXMETHYLPHENIDATE HCL 3 CapsuleFOCALIN DEXMETHYLPHENIDATE HCL 3 TabletMETADATE CD METHYLPHENIDATE HCL 2 CapsuleRITALIN LA METHYLPHENIDATE HCL 2 CapsuleMETHYLIN METHYLPHENIDATE HCL 2 Chew TabMETHYLIN METHYLPHENIDATE HCL 2 SolutionMETHYLIN METHYLPHENIDATE HCL 1 TabletMETHYLPHENIDATE HCL METHYLPHENIDATE HCL 1 TabletRITALIN METHYLPHENIDATE HCL 3 TabletCONCERTA METHYLPHENIDATE HCL 3 Tablet Osmotic Laser-DrilledMETADATE ER METHYLPHENIDATE HCL 1 Tablet SAMETHYLIN ER METHYLPHENIDATE HCL 1 Tablet SAMETHYLPHENIDATE ER METHYLPHENIDATE HCL 1 Tablet SAMETHYLPHENIDATE HCL METHYLPHENIDATE HCL 1 Tablet SARITALIN-SR METHYLPHENIDATE HCL 3 Tablet SAPROVIGIL MODAFINIL 2 Tablet

SSRI &ANTIPSYCH,ATYP,DOPAMINE&SEROTONIN ANTAG COMBSYMBYAX OLANZAPINE/FLUOXETINE HCL 3 Capsule

ANTI-ANXIETY (ANXIOLYTIC) AND ANTISPASMODIC COMB.LIBRAX CHLORDIAZEPOXIDE/METHSCOPOLAMN 3 Capsule

SELECTIVE SEROTONIN REUPTAKE INHIBITOR (SSRIS)CELEXA CITALOPRAM HYDROBROMIDE 2 SolutionCITALOPRAM CITALOPRAM HYDROBROMIDE 1 SolutionCELEXA CITALOPRAM HYDROBROMIDE 2 TabletCITALOPRAM HBR CITALOPRAM HYDROBROMIDE 1 TabletLEXAPRO ESCITALOPRAM OXALATE 2 SolutionLEXAPRO ESCITALOPRAM OXALATE 2 TabletFLUOXETINE HCL FLUOXETINE HCL 1 CapsulePROZAC FLUOXETINE HCL 3 CapsuleSARAFEM FLUOXETINE HCL 3 CapsulePROZAC WEEKLY FLUOXETINE HCL 3 Capsule ECFLUOXETINE HCL FLUOXETINE HCL 1 SolutionPROZAC FLUOXETINE HCL 3 SolutionFLUOXETINE HCL FLUOXETINE HCL 1 TabletPROZAC FLUOXETINE HCL 3 TabletRAPIFLUX FLUOXETINE HCL 3 TabletFLUVOXAMINE MALEATE FLUVOXAMINE MALEATE 1 TabletPAXIL PAROXETINE HCL 2 SuspensionPAROXETINE HCL PAROXETINE HCL 1 TabletPAXIL PAROXETINE HCL 3 TabletPAXIL CR PAROXETINE HCL 2 Tablet 24hr SRPEXEVA PAROXETINE MESYLATE 3 TabletZOLOFT SERTRALINE HCL 2 ConcentrateZOLOFT SERTRALINE HCL 2 Tablet

TRICYCLIC ANTIDEPRESSANTS & REL. NON-SEL. RU-INHIBAMITRIPTYLINE HCL AMITRIPTYLINE HCL 1 TabletENDEP AMITRIPTYLINE HCL 1 TabletVANATRIP AMITRIPTYLINE HCL 1 TabletAMOXAPINE AMOXAPINE 3 TabletANAFRANIL CLOMIPRAMINE HCL 3 Capsule

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

DESIPRAMINE HCL DESIPRAMINE HCL 1 TabletNORPRAMIN DESIPRAMINE HCL 3 TabletDOXEPIN HCL DOXEPIN HCL 1 CapsuleSINEQUAN DOXEPIN HCL 3 CapsuleDOXEPIN HCL DOXEPIN HCL 1 ConcentrateIMIPRAMINE HCL IMIPRAMINE HCL 1 TabletTOFRANIL IMIPRAMINE HCL 3 TabletTOFRANIL-PM IMIPRAMINE PAMOATE 3 CapsuleNORTRIPTYLINE HCL NORTRIPTYLINE HCL 1 CapsulePAMELOR NORTRIPTYLINE HCL 3 CapsuleNORTRIPTYLINE HCL NORTRIPTYLINE HCL 1 SolutionPAMELOR NORTRIPTYLINE HCL 3 SolutionVIVACTIL PROTRIPTYLINE HCL 3 TabletSURMONTIL TRIMIPRAMINE MALEATE 3 Capsule

TRICYCLIC ANTIDEPRESSANT/BENZODIAZEPINE COMBINATNSLIMBITROL AMITRIP HCL/CHLORDIAZEPOXIDE 3 TabletLIMBITROL DS AMITRIP HCL/CHLORDIAZEPOXIDE 3 Tablet

ALPHA-2 RECEPTOR ANTAGONIST ANTIDEPRESSANTSMIRTAZAPINE MIRTAZAPINE 3 TabletREMERON MIRTAZAPINE 3 TabletMIRTAZAPINE MIRTAZAPINE 1 Tablet, Disper. LingualREMERON MIRTAZAPINE 3 Tablet, Disper. Lingual

SEROTONIN-NOREPINEPHRINE REUPTAKE-INHIB (SNRIS)CYMBALTA DULOXETINE HCL 3 Capsule ECEFFEXOR XR VENLAFAXINE HCL 2 Capsule 24hr SREFFEXOR VENLAFAXINE HCL 2 Tablet

NOREPINEPHRINE AND DOPAMINE REUPTAKE INHIB (NDRIS)BUPROPION HCL BUPROPION HCL 1 TabletWELLBUTRIN BUPROPION HCL 3 TabletWELLBUTRIN XL BUPROPION HCL 2 Tablet 24hr SRBUDEPRION SR BUPROPION HCL 1 Tablet SABUPROPION HCL BUPROPION HCL 1 Tablet SAWELLBUTRIN SR BUPROPION HCL 3 Tablet SA

SEROTONIN-2 ANTAGONIST/REUPTAKE INHIBITORS (SARIS)NEFAZODONE HCL NEFAZODONE HCL 3 TabletDESYREL TRAZODONE HCL 3 TabletTRAZODONE HCL TRAZODONE HCL 1 Tablet

MAOIS - NON-SELECTIVE & IRREVERSIBLEMARPLAN ISOCARBOXAZID 3 TabletNARDIL PHENELZINE SULFATE 3 TabletPARNATE TRANYLCYPROMINE SULFATE 3 Tablet

ANTIPSYCHOTICS, DOPAMINE ANTAGONISTS, BUTYROPHENONESHALOPERIDOL HALOPERIDOL 1 TabletHALOPERIDOL LACTATE HALOPERIDOL LACTATE 1 Concentrate

ANTIPSYCHOTICS, DOPAMINE ANTAGONISTS, THIOXANTHENESNAVANE THIOTHIXENE 3 CapsuleTHIOTHIXENE THIOTHIXENE 1 Capsule

ANTIPSYCH, DOPAMINE ANTAG., DIPHENYLBUTYLPIPERIDINESORAP PIMOZIDE 3 Tablet

ANTIPSYCHOTICS, DOPAMINE ANTAGONST, DIHYDROINDOLONESMOBAN MOLINDONE HCL 3 Tablet

ANTIPSYCHOTICS, ATYPICAL, DOPAMINE, & SEROTONIN ANTAGCLOZAPINE CLOZAPINE 2 TabletCLOZARIL CLOZAPINE 2 TabletFAZACLO CLOZAPINE 2 Tablet, Disper. LingualZYPREXA OLANZAPINE 2 TabletZYPREXA ZYDIS OLANZAPINE 3 Tablet, Disper. Lingual

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

SEROQUEL QUETIAPINE FUMARATE 2 TabletRISPERDAL RISPERIDONE 3 SolutionRISPERDAL RISPERIDONE 3 TabletRISPERDAL RISPERIDONE 3 Tablet, Disper. LingualGEODON ZIPRASIDONE HCL 3 Capsule

ANTIPSYCHOTICS, DOPAMINE & SEROTONIN ANTAGONISTSLOXITANE LOXAPINE SUCCINATE 3 Capsule

ANTIPSYCHOTICS, ATYP, D2 PARTIAL AGONIST/5HT MIXEDABILIFY ARIPIPRAZOLE 2 SolutionABILIFY ARIPIPRAZOLE 2 Tablet

TX FOR ATTENTION DEFICIT-HYPERACT.(ADHD), NRI-TYPESTRATTERA ATOMOXETINE HCL 3 Capsule

SEDATIVE/HYPNOTICSBARBITURATESBUTISOL SODIUM BUTABARBITAL SODIUM 3 ElixirBUTISOL SODIUM BUTABARBITAL SODIUM 3 TabletPHENOBARBITAL PHENOBARBITAL 1 ElixirPHENOBARBITAL PHENOBARBITAL 1 TabletSECONAL SODIUM SECOBARBITAL SODIUM 3 Capsule

SEDATIVE-HYPNOTICS, NON-BARBITURATESOMNOTE CHLORAL HYDRATE 3 CapsuleAQUACHLORAL CHLORAL HYDRATE 3 SuppositoryCHLORAL HYDRATE CHLORAL HYDRATE 3 SuppositoryCHLORAL HYDRATE CHLORAL HYDRATE 3 SyrupPROSOM ESTAZOLAM 3 TabletLUNESTA ESZOPICLONE 3 TabletDALMANE FLURAZEPAM HCL 3 CapsuleMIDAZOLAM HCL MIDAZOLAM HCL 3 SyrupPARALDEHYDE PARALDEHYDE 3 LiquidDORAL QUAZEPAM 3 TabletRESTORIL TEMAZEPAM 3 CapsuleRESTORIL TEMAZEPAM 3 CapsuleTEMAZEPAM TEMAZEPAM 1 CapsuleHALCION TRIAZOLAM 3 TabletTRIAZOLAM TRIAZOLAM 1 TabletSONATA ZALEPLON 3 CapsuleAMBIEN ZOLPIDEM TARTRATE 3 TabletAMBIEN PAK ZOLPIDEM TARTRATE 3 TabletAMBIEN CR ZOLPIDEM TARTRATE 3 Tablet, Multiphasic Release

ANTI-NARCOLEPSY & ANTI-CATAPLEXY,SEDATIVE-TYPE AGTXYREM SODIUM OXYBATE 2 Solution

HYPNOTICS, MELATONIN MT1/MT2 RECEPTOR AGONISTSROZEREM RAMELTEON 3 Tablet

SKIN PREPSTOPICAL/MUCOUS MEMBR./SUBCUT. ENZYMESANANA BROMELAINS 3 TabletANANA FORTE BROMELAINS 3 TabletSANTYL COLLAGENASE 3 OintmentACCUZYME PAPAIN/UREA 3 OintmentETHEZYME PAPAIN/UREA 3 OintmentPANAFIL-WHITE PAPAIN/UREA 3 OintmentACCUZYME PAPAIN/UREA 3 SprayPANAFIL PAPAIN/UREA/CHLOROPHYLLIN 3 OintmentPANAFIL PAPAIN/UREA/CHLOROPHYLLIN 3 SprayGRANULEX TRYPSIN/BALSAM PERU/CASTOR OIL 3 AerosolXENADERM TRYPSIN/BALSAM PERU/CASTOR OIL 3 Ointment

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

EMOLLIENTSAMMONIUM LACTATE AMMONIUM LACTATE 1 CreamLAC-HYDRIN AMMONIUM LACTATE 3 CreamAMMONIUM LACTATE AMMONIUM LACTATE 1 LotionLAC-HYDRIN AMMONIUM LACTATE 3 LotionLACLOTION AMMONIUM LACTATE 1 LotionATOPICLAIR DL-E AC/GRAPE/HYALURONIC ACID 3 CreamMIMYX EMOLLIENT COMBINATION NO. 3 3 CreamLACTINOL-E LACTIC ACID 3 CreamLACTINOL LACTIC ACID 3 Lotion

PROTECTIVESBIONECT HYALURONATE SODIUM 3 CreamBIONECT HYALURONATE SODIUM 3 GelBIONECT HYALURONATE SODIUM 3 SprayCONSTANT CLENS NAPH,MB-DB/K PH,MBDB/ZINC/UREA 3 AerosolRADIAPLEXRX VIT E/ALLANT/MANN PS/HYALUR AC 3 Gel

ANTIPRURITICS, TOPICALPRUDOXIN DOXEPIN HCL 3 CreamZONALON DOXEPIN HCL 3 Cream

ASTRINGENTSALUMINUM ACETATE ALUMINUM ACETATE 3 Solution

KERATOLYTICSULTRALYTIC 2 AMMONIUM LACTATE/UREA 3 CreamULTRALYTIC 2 AMMONIUM LACTATE/UREA 3 FoamBREVOXYL-4 BENZOYL PEROXIDE 3 GelBREVOXYL-8 BENZOYL PEROXIDE 3 GelDESQUAM-X BENZOYL PEROXIDE 3 BarTRIAZ BENZOYL PEROXIDE 3 CleanserBENZASHAVE BENZOYL PEROXIDE 3 CreamBENZAGEL WASH BENZOYL PEROXIDE 3 GelBENZAGEL-10 BENZOYL PEROXIDE 3 GelBENZAGEL-5 BENZOYL PEROXIDE 3 GelBREVOXYL BENZOYL PEROXIDE 3 GelCLINAC BPO BENZOYL PEROXIDE 3 GelPANOXYL 5 BENZOYL PEROXIDE 3 GelPANOXYL AQ 2.5 BENZOYL PEROXIDE 3 GelPANOXYL AQ 5 BENZOYL PEROXIDE 3 GelTRIAZ BENZOYL PEROXIDE 3 GelBENZAC AC BENZOYL PEROXIDE 3 LiquidBENZAC W WASH BENZOYL PEROXIDE 3 LiquidZACLIR BENZOYL PEROXIDE 3 LotionZACLIR BENZOYL PEROXIDE 3 LotionTRIAZ BENZOYL PEROXIDE 3 PadsNEOBENZ MICRO BENZOYL PEROXIDE MICROSPHERES 3 CreamBENZIQ BENZOYL PEROXIDE/ALOE VERA 3 GelBENZIQ LS BENZOYL PEROXIDE/ALOE VERA 3 GelNUOX BENZOYL PEROXIDE/SULFUR 3 GelSULFOXYL REGULAR BENZOYL PEROXIDE/SULFUR 3 LotionSULFOXYL STRONG BENZOYL PEROXIDE/SULFUR 3 LotionZODERM BENZOYL PEROXIDE/UREA 3 CleanserZODERM BENZOYL PEROXIDE/UREA 3 CreamZODERM BENZOYL PEROXIDE/UREA 3 GelZODERM BENZOYL PEROXIDE/UREA 3 PadsCONDYLOX PODOFILOX 2 GelCONDYLOX PODOFILOX 2 SolutionPODOFILOX PODOFILOX 1 SolutionPODOCON-25 PODOPHYLLUM RESIN 3 LiquidPOTASSIUM HYDROXIDE POTASSIUM HYDROXIDE 3 SolutionDERMA-CAS RESORCINOL/PHENOL LIQUID 3 GelSALEX SALICYLIC ACID 3 CreamKERALYT SALICYLIC ACID 3 Gel

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

EMERSAL SALICYLIC ACID/AMMONIATED HG 3 LotionGORDOFILM SALICYLIC ACID/LA/COLLODION 3 SolutionKERALAC UREA 3 CreamUMECTA UREA 3 EmulsionCARMOL 40 UREA 3 CreamKERALAC UREA 3 CreamCARMOL 40 UREA 3 GelKERALAC UREA 3 GelKERALAC UREA 3 LotionGORDO-UREA UREA 3 OintmentKERALAC UREA 3 Ointment

IRRITANTS/COUNTER-IRRITANTSDOAK TAR DISTILLATE COAL TAR 3 LiquidOXALIS OXALIC ACID 3 Ointment

SHAMPOOS/LOTIONCAPITROL CHLOROXINE 3 Shampoo

TOPICAL AGENTS, MISCELLANEOUSPYROGALLIC ACID PYROGALLOL 3 OintmentTRI-CHLOR TRICHLOROACETIC ACID 3 SolutionCARMOL 40 UREA 3 LotionGORDO-UREA UREA 3 Ointment

HYPOPIGMENTATION AGENTSNUQUIN HP DIOXYBENZONE/HYDROQUINONE 3 GelSOLAQUIN FORTE DIOXYBENZONE/PDO/HYDROQUINONE 3 CreamSOLAQUIN FORTE DIOXYBENZONE/PDO/HYDROQUINONE 3 GelTRI-LUMA FLUOCIN ACET/TRETINOIN/H-QUIN 3 CreamELDOQUIN FORTE HYDROQUINONE 3 CreamLUSTRA HYDROQUINONE 3 CreamAGE SPOT AND SKIN LIGHTENING HYDROQUINONE 3 GelMELANEX HYDROQUINONE 3 SolutionEPIQUIN MICRO HYDROQUINONE MICROSPHERES 3 CreamEPIQUIN MICRO XD HYDROQUINONE MICROSPHERES 3 PacketELDOPAQUE FORTE HYDROQUINONE/FERRIC OXIDE 3 CreamGLYQUIN XM KERA1/OXBN/AVOBNZ/O-CRL/H-QUIN 3 CreamBENOQUIN MONOBENZONE 3 CreamLUSTRA-AF OCTINOXATE/HYDROQUINONE 3 CreamCLARIPEL OXYBEN/AVOBENZ/OCTINOX/H-QUIN 3 CreamGLYQUIN OXYBEN/PDO/OCTINOX/H-QUINONE 3 CreamSKIN BLEACHING WITH SUNSCREEN SUNSCREEN/HYDROQUINONE 3 CreamSOLAGE TRETINOIN/MEQUINOL 3 SolutionALUSTRA VITAMIN A/HYDROQUINONE 3 Cream

TOPICAL PREPARATIONS, MISCELLANEOUSALLCLENZ POLOXAMER 3 CleanserSILVER NITRATE SILVER NITRATE 3 Ointment

TOPICAL PREPARATIONS, ANTIBACTERIALSIODOSORB CADEXOMER IODINE 3 GelIODOFLEX CADEXOMER IODINE 3 PadsALA-QUIN CLIOQUINOL/HYDROCORTISONE 3 CreamPHISOHEX HEXACHLOROPHENE 3 LiquidVYTONE HYDROCORTISONE/IODOQUINOL 3 CreamUNGUENTUM BOSSI METHEN SFS/C-T/AMMONIATED HG 3 OintmentFURACIN NITROFURAZONE 3 CreamFURACIN NITROFURAZONE 3 OintmentSILVER NITRATE SILVER NITRATE 3 Solution

TOPICAL ANTIFUNGALSBENSAL HP BENZOIC ACID/SALICYLIC ACID 3 OintmentMENTAX BUTENAFINE HCL 3 CreamCICLOPIROX CICLOPIROX 1 CreamLOPROX CICLOPIROX 2 Cream

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

LOPROX CICLOPIROX 2 GelCICLOPIROX CICLOPIROX 1 LotionLOPROX CICLOPIROX 2 LotionLOPROX CICLOPIROX 2 ShampooPENLAC CICLOPIROX 3 SolutionCLOTRIMAZOLE/BETAMETHASONE CLOTRIMAZOLE/BETAMET DIPROP 1 CreamCLOTRIMAZOLE-BETAMETHASONE CLOTRIMAZOLE/BETAMET DIPROP 1 LotionLOTRISONE CLOTRIMAZOLE/BETAMET DIPROP 2 LotionECONAZOLE NITRATE ECONAZOLE NITRATE 1 CreamSPECTAZOLE ECONAZOLE NITRATE 3 CreamFORMALYDE-10 FORMALDEHYDE 3 AerosolKETOCONAZOLE KETOCONAZOLE 2 CreamKETOCONAZOLE KETOCONAZOLE 1 ShampooNIZORAL KETOCONAZOLE 2 ShampooMONISTAT-DERM MICONAZOLE NITRATE 3 CreamNAFTIN NAFTIFINE HCL 3 CreamNAFTIN NAFTIFINE HCL 3 GelMYCOSTATIN NYSTATIN 3 CreamNYSTATIN NYSTATIN 1 CreamNYSTATIN NYSTATIN 1 OintmentMYCOSTATIN NYSTATIN 3 PowderNYAMYC NYSTATIN 1 PowderNYSTATIN NYSTATIN 1 PowderNYSTOP NYSTATIN 1 PowderPEDI-DRI NYSTATIN 1 PowderMYCONEL NYSTATIN/TRIAMCIN 1 CreamMYTREX NYSTATIN/TRIAMCIN 3 CreamNYSTATIN W/TRIAMCINOLONE NYSTATIN/TRIAMCIN 1 CreamNYSTATIN W/TRIAMCINOLONE NYSTATIN/TRIAMCIN 1 OintmentOXISTAT OXICONAZOLE NITRATE 2 CreamOXISTAT OXICONAZOLE NITRATE 2 LotionERTACZO SERTACONAZOLE NITRATE 3 CreamEXODERM SODIUM THIOSULFATE/SAL ACID 3 LotionVERSICLEAR SODIUM THIOSULFATE/SAL ACID 3 LotionEXELDERM SULCONAZOLE NITRATE 3 CreamEXELDERM SULCONAZOLE NITRATE 3 SolutionLAMISIL TERBINAFINE HCL 3 Spray

TOPICAL LOCAL ANESTHETICSANACAINE BENZOCAINE 3 OintmentFLUORI-METHANE CCL3F/DICHLORODIFLUOROMETHANE 3 AerosolCOCAINE HCL COCAINE HCL 3 SolutionETHYL CHLORIDE ETHYL CHLORIDE 3 AerosolFLURO-ETHYL ETHYL CHLORIDE/C2CL2F4 3 AerosolLIDAMANTLE HC HC ACETATE/LIDOCAINE HCL 3 CreamLIDAMANTLE HC HC ACETATE/LIDOCAINE HCL 3 LotionNOVACORT HC ACETATE/PRAMOX HCL/ALOE PS 3 GelPRAMOSONE HC ACETATE/PRAMOXINE HCL 3 CreamEPIFOAM HC ACETATE/PRAMOXINE HCL 3 FoamPRAMOSONE HC ACETATE/PRAMOXINE HCL 3 LotionLIDODERM LIDOCAINE 3 PatchLIDAMANTLE LIDOCAINE HCL 3 CreamLIDAMANTLE LIDOCAINE HCL 3 LotionLIDOCAINE HCL LIDOCAINE HCL 3 OintmentEMLA LIDOCAINE/PRILOCAINE 3 CreamPAIN EASE NORFLURANE/HFC 245FA 3 AerosolSPRAY AND STRETCH NORFLURANE/HFC 245FA 3 AerosolPONTOCAINE TETRACAINE HCL 3 SolutionCETACAINE TETRACAINE/BENZOCAINE/BUTAMBEN 3 AerosolEXACTACAIN TETRACAINE/BENZOCAINE/BUTAMBEN 3 AerosolCETACAINE TETRACAINE/BENZOCAINE/BUTAMBEN 3 GelCETACAINE TETRACAINE/BENZOCAINE/BUTAMBEN 3 LiquidCETACAINE TETRACAINE/BENZOCAINE/BUTAMBEN 3 OintmentREGENECARE VIT E/LIDOCAIN/ALO VER/COLAGN 3 Gel

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

TOPICAL ANTI-INFLAMMATORY STEROIDALACLOVATE ALCLOMETASONE DIPROPIONATE 2 CreamALCLOMETASONE DIPROPIONATE ALCLOMETASONE DIPROPIONATE 1 CreamACLOVATE ALCLOMETASONE DIPROPIONATE 2 OintmentALCLOMETASONE DIPROPIONATE ALCLOMETASONE DIPROPIONATE 1 OintmentCYCLOCORT AMCINONIDE 3 CreamCYCLOCORT AMCINONIDE 3 LotionCYCLOCORT AMCINONIDE 3 OintmentBETAMETHASONE DIPROPIONATE BETAMET DIPROP/PROP GLY 1 CreamBETAMETHASONE DP AUGMENTED BETAMET DIPROP/PROP GLY 1 CreamDIPROLENE AF BETAMET DIPROP/PROP GLY 2 CreamDIPROLENE BETAMET DIPROP/PROP GLY 2 LotionBETAMETHASONE DP AUGMENTED BETAMET DIPROP/PROP GLY 1 OintmentDIPROLENE BETAMET DIPROP/PROP GLY 2 OintmentBETAMETHASONE DIPROPIONATE BETAMETHASONE DIPROPIONATE 1 CreamBETANATE BETAMETHASONE DIPROPIONATE 1 CreamDEL-BETA BETAMETHASONE DIPROPIONATE 1 CreamDIPROSONE BETAMETHASONE DIPROPIONATE 3 CreamALPHATREX BETAMETHASONE DIPROPIONATE 1 GelBETAMETHASONE DIPROPIONATE BETAMETHASONE DIPROPIONATE 1 GelBETAMETHASONE DIPROPIONATE BETAMETHASONE DIPROPIONATE 1 LotionDEL-BETA BETAMETHASONE DIPROPIONATE 1 LotionBETAMETHASONE DIPROPIONATE BETAMETHASONE DIPROPIONATE 1 OintmentBETAMETHASONE VALERATE BETAMETHASONE VALERATE 1 CreamBETA-VAL BETAMETHASONE VALERATE 1 CreamLUXIQ BETAMETHASONE VALERATE 2 FoamBETAMETHASONE VALERATE BETAMETHASONE VALERATE 1 LotionBETAMETHASONE VALERATE BETAMETHASONE VALERATE 1 OintmentCLOBETASOL PROPIONATE CLOBETASOL PROPIONATE 1 CreamCORMAX CLOBETASOL PROPIONATE 2 CreamEMBELINE CLOBETASOL PROPIONATE 1 CreamTEMOVATE CLOBETASOL PROPIONATE 3 CreamOLUX CLOBETASOL PROPIONATE 2 FoamCLOBETASOL PROPIONATE CLOBETASOL PROPIONATE 1 GelCLOBEVATE CLOBETASOL PROPIONATE 3 GelEMBELINE CLOBETASOL PROPIONATE 1 GelTEMOVATE CLOBETASOL PROPIONATE 3 GelCLOBEX CLOBETASOL PROPIONATE 3 LotionCLOBETASOL PROPIONATE CLOBETASOL PROPIONATE 1 OintmentCORMAX CLOBETASOL PROPIONATE 2 OintmentEMBELINE CLOBETASOL PROPIONATE 1 OintmentTEMOVATE CLOBETASOL PROPIONATE 3 OintmentCLOBEX CLOBETASOL PROPIONATE 3 ShampooCLOBETASOL PROPIONATE CLOBETASOL PROPIONATE 1 SolutionCORMAX CLOBETASOL PROPIONATE 3 SolutionEMBELINE CLOBETASOL PROPIONATE 1 SolutionTEMOVATE CLOBETASOL PROPIONATE 3 SolutionCLOBEX CLOBETASOL PROPIONATE 3 SprayCLOBETASOL E CLOBETASOL PROPIONATE/EMOLL 1 CreamCLOBETASOL PROPIONATE CLOBETASOL PROPIONATE/EMOLL 1 CreamEMBELINE E CLOBETASOL PROPIONATE/EMOLL 1 CreamTEMOVATE EMOLLIENT CLOBETASOL PROPIONATE/EMOLL 3 CreamCLODERM CLOCORTOLONE PIVALATE 3 CreamDELONIDE DESONIDE 1 CreamDESONIDE DESONIDE 1 CreamDESOWEN DESONIDE 3 CreamTRIDESILON DESONIDE 3 CreamDESONIDE DESONIDE 1 LotionDESOWEN DESONIDE 3 LotionLOKARA DESONIDE 1 LotionDESONIDE DESONIDE 1 OintmentDESOWEN DESONIDE 3 OintmentTRIDESILON DESONIDE 1 Ointment

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

TOPICORT DESOXIMETASONE 3 CreamTOPICORT LP DESOXIMETASONE 3 CreamTOPICORT DESOXIMETASONE 3 GelTOPICORT DESOXIMETASONE 3 OintmentPSORCON E DIFLORASONE DIACETATE/EMOLL 3 CreamPSORCON E DIFLORASONE DIACETATE/EMOLL 3 OintmentFLUOCINOLONE ACETONIDE FLUOCINOLONE ACETONIDE 1 CreamSYNALAR FLUOCINOLONE ACETONIDE 3 CreamDERMA-SMOOTHE/FS FLUOCINOLONE ACETONIDE 2 OilFLUOCINOLONE ACETONIDE FLUOCINOLONE ACETONIDE 1 OintmentSYNALAR FLUOCINOLONE ACETONIDE 3 OintmentCAPEX SHAMPOO FLUOCINOLONE ACETONIDE 2 ShampooFLUOCINOLONE ACETONIDE FLUOCINOLONE ACETONIDE 1 SolutionSYNALAR FLUOCINOLONE ACETONIDE 3 SolutionDERMA-SMOOTHE/FS FLUOCINOLONE/SHOWER CAP 2 OilFLUOCINONIDE FLUOCINONIDE 1 CreamLIDEX FLUOCINONIDE 3 CreamVANOS FLUOCINONIDE 3 CreamFLUOCINONIDE FLUOCINONIDE 1 GelLIDEX FLUOCINONIDE 3 GelFLUOCINONIDE FLUOCINONIDE 1 OintmentLIDEX FLUOCINONIDE 3 OintmentFLUOCINONIDE FLUOCINONIDE 1 SolutionLIDEX FLUOCINONIDE 3 SolutionFLUOCINONIDE FLUOCINONIDE/EMOLLIENT 1 CreamFLUOCINONIDE-E FLUOCINONIDE/EMOLLIENT 1 CreamLIDEX-E FLUOCINONIDE/EMOLLIENT 2 CreamCORDRAN SP FLURANDRENOLIDE 3 CreamCORDRAN FLURANDRENOLIDE 3 LotionCORDRAN FLURANDRENOLIDE 3 OintmentCORDRAN FLURANDRENOLIDE 3 TapeCUTIVATE FLUTICASONE PROPIONATE 3 CreamCUTIVATE FLUTICASONE PROPIONATE 3 LotionCUTIVATE FLUTICASONE PROPIONATE 3 OintmentHALOG HALCINONIDE 3 CreamHALOG HALCINONIDE 3 OintmentHALOG HALCINONIDE 3 SolutionHALOBETASOL PROPIONATE HALOBETASOL PROPIONATE 1 CreamULTRAVATE HALOBETASOL PROPIONATE 2 CreamHALOBETASOL PROPIONATE HALOBETASOL PROPIONATE 1 OintmentULTRAVATE HALOBETASOL PROPIONATE 2 OintmentHYDROCORTISONE HC/MINERAL OIL/PETROLAT,WHT 3 OintmentALA-CORT HYDROCORTISONE 3 CreamHYTONE HYDROCORTISONE 3 CreamFIRST-HYDROCORTISONE HYDROCORTISONE 3 GelALA-SCALP HP HYDROCORTISONE 3 LotionCETACORT HYDROCORTISONE 3 LotionHYTONE HYDROCORTISONE 3 LotionLACTICARE-HC HYDROCORTISONE 3 LotionNUTRACORT HYDROCORTISONE 3 LotionTEXACORT HYDROCORTISONE 3 SolutionNUZON HYDROCORTISONE ACETATE/ALO VER 3 GelCARMOL HC HYDROCORTISONE ACETATE/UREA 3 CreamHYDROCORTISONE BUTYRATE HYDROCORTISONE BUTYRATE 3 OintmentLOCOID HYDROCORTISONE BUTYRATE/EMOLL 3 CreamPANDEL HYDROCORTISONE PROBUTATE 3 CreamHYDROCORTISONE VALERATE HYDROCORTISONE VALERATE 1 CreamWESTCORT HYDROCORTISONE VALERATE 3 CreamHYDROCORTISONE VALERATE HYDROCORTISONE VALERATE 1 OintmentWESTCORT HYDROCORTISONE VALERATE 3 OintmentVANOXIDE-HC HYDROCORTISONE/BENZ PER 3 LotionELOCON MOMETASONE FUROATE 2 CreamMOMETASONE FUROATE MOMETASONE FUROATE 1 CreamELOCON MOMETASONE FUROATE 2 Lotion

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

MOMETASONE FUROATE MOMETASONE FUROATE 1 LotionELOCON MOMETASONE FUROATE 2 OintmentMOMETASONE FUROATE MOMETASONE FUROATE 1 OintmentDERMATOP PREDNICARBATE 3 CreamDERMATOP PREDNICARBATE 3 OintmentAQUAPHILIC W/TRIAMCINOLONE TRIAMCIN/HYDROPHILIC OINTMENT 3 OintmentAQUAPHILIC W/TAC + CARBAMIDE TRIAMCIN/UREA/HYDRO OINT 3 OintmentKENALOG TRIAMCINOLONE ACETONIDE 2 AerosolKENALOG TRIAMCINOLONE ACETONIDE 3 CreamTRIAMCINOLONE ACETONIDE TRIAMCINOLONE ACETONIDE 1 CreamTRIDERM TRIAMCINOLONE ACETONIDE 1 CreamKENALOG TRIAMCINOLONE ACETONIDE 3 LotionTRIAMCINOLONE ACETONIDE TRIAMCINOLONE ACETONIDE 1 LotionARISTOCORT HP TRIAMCINOLONE ACETONIDE 3 OintmentKENALOG TRIAMCINOLONE ACETONIDE 3 OintmentTRIAMCINOLONE ACETONIDE TRIAMCINOLONE ACETONIDE 1 OintmentTRIAMCINOLONE ACETONIDE TRIAMCINOLONE ACETONIDE 2 OintmentTRIDERM TRIAMCINOLONE ACETONIDE 1 OintmentARISTOCORT A TRIAMCINOLONE ACETONIDE/L.S.B. 3 Cream

TOPICAL ANTIPARASITICSEURAX CROTAMITON 3 CreamEURAX CROTAMITON 3 LotionLINDANE LINDANE 3 LotionLINDANE LINDANE 3 ShampooOVIDE MALATHION 3 LotionELIMITE PERMETHRIN 3 Cream

TOPICAL SULFONAMIDESSULFAMYLON MAFENIDE ACETATE 3 CreamSULFAMYLON MAFENIDE ACETATE 3 PacketROSAC NA SULFACETM/AVOBENZONE/SULFUR 3 CreamSILVADENE SILVER SULFADIAZINE 3 CreamSILVER SULFADIAZINE SILVER SULFADIAZINE 1 CreamSSD SILVER SULFADIAZINE 1 CreamSSD AF SILVER SULFADIAZINE 1 CreamTHERMAZENE SILVER SULFADIAZINE 1 CreamPLEXION TS SULFACETAMIDE SODIUM/SULFUR 3 SuspensionSODIUM SULFACETAMIDE-SULFUR SULFACETAMIDE SODIUM/SULFUR 1 CreamZETACET SULFACETAMIDE SODIUM/SULFUR 1 CleanserAVAR SULFACETAMIDE SODIUM/SULFUR 1 CleanserCLENIA SULFACETAMIDE SODIUM/SULFUR 1 CleanserPLEXION SULFACETAMIDE SODIUM/SULFUR 3 CleanserPRASCION SULFACETAMIDE SODIUM/SULFUR 1 CleanserPRASCION AV SULFACETAMIDE SODIUM/SULFUR 1 CleanserROSADERM SULFACETAMIDE SODIUM/SULFUR 1 CleanserROSANIL SULFACETAMIDE SODIUM/SULFUR 3 CleanserROSULA SULFACETAMIDE SODIUM/SULFUR 1 CleanserSODIUM SULFACETAMIDE-SULFUR SULFACETAMIDE SODIUM/SULFUR 1 CleanserSULFATOL SULFACETAMIDE SODIUM/SULFUR 1 CleanserZETACET SULFACETAMIDE SODIUM/SULFUR 1 CleanserAVAR-E SULFACETAMIDE SODIUM/SULFUR 3 CreamCLENIA SULFACETAMIDE SODIUM/SULFUR 3 CreamPLEXION SCT SULFACETAMIDE SODIUM/SULFUR 3 CreamSUPHERA SULFACETAMIDE SODIUM/SULFUR 3 CreamAVAR SULFACETAMIDE SODIUM/SULFUR 3 GelSOD.SULFACETAMIDE/SULFUR TF SULFACETAMIDE SODIUM/SULFUR 1 LotionSODIUM SULFACETAMIDE/SULFUR SULFACETAMIDE SODIUM/SULFUR 1 LotionSULFACET-R SULFACETAMIDE SODIUM/SULFUR 1 LotionZETACET SULFACETAMIDE SODIUM/SULFUR 3 LotionPLEXION SULFACETAMIDE SODIUM/SULFUR 3 Pads

TOPICAL ANTIVIRALSZOVIRAX ACYCLOVIR 3 CreamZOVIRAX ACYCLOVIR 3 Ointment

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

DENAVIR PENCICLOVIR 3 Cream

TOPICAL ANTIBIOTICSEVOCLIN CLINDAMYCIN PHOSPHATE 3 FoamCLEOCIN T CLINDAMYCIN PHOSPHATE 3 GelCLINDAGEL CLINDAMYCIN PHOSPHATE 3 GelCLINDAMAX CLINDAMYCIN PHOSPHATE 1 GelCLINDAMYCIN PHOSPHATE CLINDAMYCIN PHOSPHATE 1 GelCLEOCIN T CLINDAMYCIN PHOSPHATE 3 LotionCLINDAMAX CLINDAMYCIN PHOSPHATE 1 LotionCLINDAMYCIN PHOSPHATE CLINDAMYCIN PHOSPHATE 1 LotionCLEOCIN T CLINDAMYCIN PHOSPHATE 3 SolutionCLINDA-DERM CLINDAMYCIN PHOSPHATE 1 SolutionCLINDAMYCIN PHOSPHATE CLINDAMYCIN PHOSPHATE 1 SolutionCLEOCIN T CLINDAMYCIN PHOSPHATE 3 SwabCLINDAMYCIN PHOSPHATE CLINDAMYCIN PHOSPHATE 1 SwabCLINDETS CLINDAMYCIN PHOSPHATE 3 SwabAKNE-MYCIN ERYTHROMYCIN BASE 2 OintmentDEL-MYCIN ERYTHROMYCIN BASE 2 SolutionBENZAMYCIN ERYTHROMYCIN BASE/BENZ PER 3 GelERYTHROMYCIN-BENZOYL PEROXIDE ERYTHROMYCIN BASE/BENZ PER 1 GelBENZAMYCINPAK ERYTHROMYCIN BASE/BENZ PER 3 Gel (Ea)EMGEL ERYTHROMYCIN BASE/ETHANOL 3 GelERYGEL ERYTHROMYCIN BASE/ETHANOL 3 GelERYTHROMYCIN BASE ERYTHROMYCIN BASE/ETHANOL 1 GelERYDERM ERYTHROMYCIN BASE/ETHANOL 1 SolutionERYTHROMYCIN ERYTHROMYCIN BASE/ETHANOL 1 SolutionTHERAMYCIN Z ERYTHROMYCIN BASE/ETHANOL 1 SolutionEMCIN CLEAR ERYTHROMYCIN BASE/ETHANOL 3 SwabERY ERYTHROMYCIN BASE/ETHANOL 1 SwabBACTROBAN MUPIROCIN 3 OintmentCENTANY MUPIROCIN 3 OintmentBACTROBAN MUPIROCIN CALCIUM 3 Cream

ANTISEPTICS, MISCELLANEOUSCHLORHEXIDINE GLUCONATE CHLORHEXIDINE GLUCONATE 3 Liquid

IMMUNOMODULATORSALDARA IMIQUIMOD 2 Packet

ANTIPERSPIRANTSDRYSOL ALUMINUM CHLORIDE 3 SolutionDRYSOL DAB-O-MATIC ALUMINUM CHLORIDE 3 SolutionXERAC AC ALUMINUM CHLORIDE 3 Solution

VITAMIN A DERIVATIVESDIFFERIN ADAPALENE 2 CreamDIFFERIN ADAPALENE 2 GelDIFFERIN ADAPALENE 2 SwabAVITA TRETINOIN 2 CreamRETIN-A TRETINOIN 3 CreamTRETINOIN TRETINOIN 1 CreamAVITA TRETINOIN 1 GelRETIN-A TRETINOIN 3 GelTRETINOIN TRETINOIN 1 GelRETIN-A TRETINOIN 2 LiquidRETIN-A MICRO TRETINOIN MICROSPHERES 2 GelTRETIN-X TRETINOIN/EMOL 9/SKIN CLN1/GEL 3 Combo. Pack.TRETIN-X TRETINOIN/EMOL CMB9/SKIN CLN1 3 Combo. Pack.

ANTISEBORRHEIC AGENTSSELENIUM SULFIDE SELENIUM SULFIDE 1 ShampooSEL-PEN SELENIUM SULFIDE 1 ShampooSELSEB SELENIUM SULFIDE 3 ShampooSELSUN RX SELENIUM SULFIDE 3 ShampooOVACE SULFACETAMIDE SODIUM 3 Cream

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

OVACE SULFACETAMIDE SODIUM 3 FoamOVACE SULFACETAMIDE SODIUM 3 GelSEB-PREV SULFACETAMIDE SODIUM 3 LotionCARMOL SCALP SULFACETAMIDE SODIUM/UREA 3 KitCARMOL SULFACETAMIDE SODIUM/UREA 3 LotionROSULA NS SULFACETAMIDE SODIUM/UREA 3 Pads

ANTIPSORIATICS AGENTSANTHRALIN ANTHRALIN 1 CreamDRITHO-SCALP ANTHRALIN 3 CreamPSORIATEC ANTHRALIN 3 CreamDOVONEX CALCIPOTRIENE 2 CreamDOVONEX CALCIPOTRIENE 2 OintmentDOVONEX CALCIPOTRIENE 2 SolutionTAZORAC TAZAROTENE 2 CreamTAZORAC TAZAROTENE 2 Gel

ANTIPSORIATIC AGENTS, SYSTEMICSORIATANE ACITRETIN 2 CapsuleRAPTIVA EFALIZUMAB 3 Kit8-MOP METHOXSALEN 2 CapsuleOXSORALEN-ULTRA METHOXSALEN, RAPID 2 Capsule

ACNE AGENTS, TOPICALAZELEX AZELAIC ACID 3 CreamZ-CLINZ 10 CLINDAMYCIN PHOSPHATE/BENZ PER 2 Combo. Pack.Z-CLINZ 5 CLINDAMYCIN PHOSPHATE/BENZ PER 2 Combo. Pack.BENZACLIN CLINDAMYCIN PHOSPHATE/BENZ PER 2 GelDUAC CLINDAMYCIN PHOSPHATE/BENZ PER 2 GelKLARON SULFACETAMIDE SODIUM 3 Lotion

ACNE AGENTS, SYSTEMICACCUTANE ISOTRETINOIN 3 CapsuleAMNESTEEM ISOTRETINOIN 1 CapsuleCLARAVIS ISOTRETINOIN 1 CapsuleSOTRET ISOTRETINOIN 3 Capsule

TOPICAL HYPERPIGMENTATION AGENTSOXSORALEN METHOXSALEN 2 Lotion

DIABETIC ULCER PREPARATIONS, TOPICALREGRANEX BECAPLERMIN 2 Gel

VITAMIN A DERIVATIVES, TOPICAL COSMETIC AGENTSAVAGE TAZAROTENE 3 CreamRENOVA TRETINOIN/EMOLLIENT 3 CreamRENOVA TRETINOIN/EMOLLIENT 3 CreamTRETINOIN TRETINOIN/EMOLLIENT 1 Cream

HAIR GROWTH REDUCTION AGENTSVANIQA EFLORNITHINE HCL 3 Cream

ROSACEA AGENTS, TOPICALFINACEA AZELAIC ACID 2 GelMETROCREAM METRONIDAZOLE 2 CreamMETRONIDAZOLE METRONIDAZOLE 1 CreamNORITATE METRONIDAZOLE 2 CreamMETROGEL METRONIDAZOLE 2 GelMETROLOTION METRONIDAZOLE 2 Lotion

THYROID PREPSTHYROID HORMONESLEVOTHROID LEVOTHYROXINE SODIUM 1 TabletLEVOTHYROXINE SODIUM LEVOTHYROXINE SODIUM 1 TabletLEVOXYL LEVOTHYROXINE SODIUM 1 TabletL-THYROXINE LEVOTHYROXINE SODIUM 1 TabletSYNTHROID LEVOTHYROXINE SODIUM 2 Tablet

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

UNITHROID LEVOTHYROXINE SODIUM 1 TabletCYTOMEL LIOTHYRONINE SODIUM 3 TabletTHYROLAR-1 LIOTRIX 3 TabletTHYROLAR-1/2 LIOTRIX 3 TabletTHYROLAR-1/4 LIOTRIX 3 TabletTHYROLAR-2 LIOTRIX 3 TabletTHYROLAR-3 LIOTRIX 3 TabletARMOUR THYROID THYROID 3 TabletNATURE-THROID THYROID 1 TabletTHYROID THYROID 1 TabletWESTHROID THYROID 1 Tablet

ANTITHYROID PREPARATIONSMETHIMAZOLE METHIMAZOLE 1 TabletMETHIMAZOLE METHIMAZOLE 2 TabletTAPAZOLE METHIMAZOLE 3 TabletPROPYLTHIOURACIL PROPYLTHIOURACIL 1 Tablet

BIOLOGICALSINFLUENZA VIRUS VACCINESFLUMIST INFLUENZA VACC,TRI 2005(LIVE) 3 Spray, Non-Aerosol (Ea)

GRAM (-) BACILLI (NON-ENTERIC) VACCINESVIVOTIF BERNA TYPHOID VACC,LIVE,ATTENUATED 3 Capsule EC

ANTIGENIC SKIN TESTST.R.U.E. TEST DERMATITIS ANTIGENS 3 Patch

PRENATAL VITAMINSPRENATAL VITAMIN PREPARATIONSPREMESIS RX CA CARBONATE/VIT B12/FA/VIT B6 3 TabletDUET STUARTNATAL IRON B-G SUC-P/PNV COMB.NO2/FA 3 TabletDUET DHA STUARTNATAL IRON B-G SUC-P/PNV2/OMEGA-3/FA 3 Combo. Pack.OB COMPLETE IRON,CARBONYL/FA/MULTIVITS-MIN 3 TabletICAR-C PLUS IRON,CARBONYL/VIT C/VIT B12/FA 3 TabletPRIMACARE P-NAT VIT/FE FUM/OM-3/FA/FAT 1 3 Combo. Pack.MARNATAL-F PLUS P-NAT VIT/FE P/DHA/EPA/OM-3/FA 3 Combo. Pack.MAXINATE PNV COMB.NO3/FE FM-FE GLU/FA 3 TabletNATELLE C PNV W-O CA.1/FE BISGLY/FA 3 TabletPRENATE ELITE PNV/FE,CARBO/DOSS/FA/LM-FOLATE 3 TabletDUET STUART NATAL PNV/IRON FUM&BIS-GLY/FA/ASP 3 Chew TabOPTINATE PNV/IRON,CARB/DOSS/DHA/FA #1 3 Combo. Pack.PRIMACARE ONE PNV/IRON,CARB/OM-3/FA/FAT 1 3 CapsuleICAR PRENATAL PNV/IRON,CARB/OM-3/FA/MIN AA 3 Combo. Pack.STRONGSTART PRENATAL VIT/FE FUM/DOSS/FA 3 TabletVITA-PREN PRENATAL VIT/FE FUM/DOSS/FA 3 TabletAMINATE W/90MG IRON PRENATAL VIT/FE FUM/DOSS/FA 1 Tablet SAMYNATE 90 PLUS PRENATAL VIT/FE FUM/DOSS/FA 1 Tablet SAPRENATAL MR 90 FE PRENATAL VIT/FE FUM/DOSS/FA 1 Tablet SAMYNATAL PRENATAL VIT/FE FUMARATE/FA 2 CapsulePRENATAL 19 PRENATAL VIT/FE FUMARATE/FA 1 Chew TabSTRONGSTART PRENATAL VIT/FE FUMARATE/FA 3 Chew TabCO-NATAL FA PRENATAL VIT/FE FUMARATE/FA 1 TabletLACTOCAL-F PRENATAL VIT/FE FUMARATE/FA 2 TabletMYNATAL PLUS PRENATAL VIT/FE FUMARATE/FA 1 TabletMYNATAL-Z PRENATAL VIT/FE FUMARATE/FA 1 TabletNATAFOLIC-PN PRENATAL VIT/FE FUMARATE/FA 1 TabletNATALCARE PIC PRENATAL VIT/FE FUMARATE/FA 1 TabletNATALCARE PLUS PRENATAL VIT/FE FUMARATE/FA 1 TabletNATALCARE RX PRENATAL VIT/FE FUMARATE/FA 1 TabletNATALCARE THREE PRENATAL VIT/FE FUMARATE/FA 1 TabletNATALVIT PRENATAL VIT/FE FUMARATE/FA 2 TabletNATATAB FA PRENATAL VIT/FE FUMARATE/FA 1 TabletNESTABS FA PRENATAL VIT/FE FUMARATE/FA 2 Tablet

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

NOVASTART PRENATAL VIT/FE FUMARATE/FA 2 TabletO-CAL FA PRENATAL VIT/FE FUMARATE/FA 2 TabletO-CAL PRENATAL PRENATAL VIT/FE FUMARATE/FA 2 TabletPRENAFIRST PRENATAL VIT/FE FUMARATE/FA 1 TabletPRENATABS FA PRENATAL VIT/FE FUMARATE/FA 1 TabletPRENATAL 1 PLUS 1 PRENATAL VIT/FE FUMARATE/FA 1 TabletPRENATAL 1+1 PRENATAL VIT/FE FUMARATE/FA 1 TabletPRENATAL FORMULA PRENATAL VIT/FE FUMARATE/FA 1 TabletPRENATAL FORMULA 3 PRENATAL VIT/FE FUMARATE/FA 1 TabletPRENATAL LOW IRON PRENATAL VIT/FE FUMARATE/FA 1 TabletPRENATAL PLUS PRENATAL VIT/FE FUMARATE/FA 1 TabletPRENATAL PLUS NF PRENATAL VIT/FE FUMARATE/FA 1 TabletPRENATAL RX PRENATAL VIT/FE FUMARATE/FA 1 TabletPRENATAL RX 1 PRENATAL VIT/FE FUMARATE/FA 1 TabletPRENATAL Z PRENATAL VIT/FE FUMARATE/FA 2 TabletSTUARTNATAL PLUS 3 PRENATAL VIT/FE FUMARATE/FA 2 TabletTRICARE PRENATAL VIT/FE FUMARATE/FA 2 TabletTRINATE PRENATAL VIT/FE FUMARATE/FA 1 TabletVITAFOL-OB PRENATAL VIT/FE FUMARATE/FA 2 TabletVITAFOL-PN PRENATAL VIT/FE FUMARATE/FA 2 TabletVYNATAL-FA PRENATAL VIT/FE FUMARATE/FA 1 TabletMATERNITY PRENATAL VIT/FE FUMARATE/FA/SE 1 TabletPRENATAL MTR PRENATAL VIT/FE FUMARATE/FA/SE 1 TabletVINATE-M PRENATAL VIT/FE FUMARATE/FA/SE 1 TabletNATALCARE PIC PRENATAL VIT/FE PS CMPLX/FA 1 TabletNATALCARE PIC FORTE PRENATAL VIT/FE PS CMPLX/FA 1 TabletPOLY IRON PN PRENATAL VIT/FE PS CMPLX/FA 1 TabletPOLY IRON PN FORTE PRENATAL VIT/FE PS CMPLX/FA 1 TabletCITRACAL PRENATAL RX PRENATAL VIT/FECBNGL/DOSS/FA 3 TabletPRENA-CAP PRENATAL VIT/IRON,CARB/DOSS/FA 2 CapsuleOBSTETRIX-100 PRENATAL VIT/IRON,CARB/DOSS/FA 3 TabletATABEX PRENATAL VIT/IRON,CARBONYL/FA 3 TabletNESTABS CBF PRENATAL VIT/IRON,CARBONYL/FA 3 TabletNESTABS RX PRENATAL VIT/IRON,CARBONYL/FA 3 TabletNATELLE PRENATAL VITAMINS/FE BISGLY/FA 3 TabletNATELLE-EZ PRENATAL VITAMINS/FE BISGLY/FA 3 TabletLIQUID PRENATAL VITAMIN PRENATAL VITAMINS/FE SULF/FA 3 LiquidNUTRACARE PRENATAL VITAMINS/IRON/FA 3 Chew TabPERRY PRENATAL TABLET PRENATAL VITS W-CA,FE,FA(<1MG) 1 TabletNATELLE PREFER PV W-O CAL/FE BISGLY/FA 3 TabletNATAFORT PV W-O CAL/FE CARB-FESO4/FA 3 TabletSELECT-OB PV W-O CAL/FE PS CMPLX/FA 3 Chew TabOBTREX PV W-O CAL/FE,CARBONYL/DOSS/FA 3 TabletOBSTETRIX EC PV W-O CAL/FE,CARBONYL/DOSS/FA 3 Tablet ECNATACHEW PV W-O CAL/FERROUS FUMARATE/FA 3 Chew TabM-VIT PV W-O CAL/FERROUS FUMARATE/FA 2 TabletCENOGEN ULTRA PV W-O VIT A/FE FUMARATE/FA 3 CapsulePRECARE PV W-O VIT A/FE FUMARATE/FA 3 Chew TabPRECARE PRENATAL PV W-O VIT A/FE FUMARATE/FA 3 TabletPRECARE CONCEIVE PV W-O VIT A/FECBN-FEFM/FA 3 TabletNOVANATAL PV W-O VIT A/IRON,CARBONYL/FA 3 Tablet

VITAMINSVITAMIN B PREPARATIONSNERVIDOX-6 NR BIOT/VIT B12/FA/VIT B6/VIT B1 3 Tablet SANEURODEP NR BIOT/VIT B12/FA/VIT B6/VIT B1 3 Tablet SACALAFOL RX CA CARB/VIT D3/B-12/FA/B6 3 TabletFOLGARD RX CYANOCOBALAMIN/FA/PYRIDOXINE 3 TabletFOLTX CYANOCOBALAMIN/FA/PYRIDOXINE 3 TabletMYO VYT CYANOCOBALAMIN/FA/PYRIDOXINE 3 Tablet 24hr SRDIALYVITE 3000 FA/VIT BCOMP&C/SE/MIN AA/ZN 3 TabletDIATX ZN FOLIC ACID/VIT BCOMP&C/CU/ZNOX 3 TabletNEPHPLEX RX FOLIC ACID/VIT BCOMP&C/ZINC 3 Tablet

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

NEPHROCAPS FOLIC ACID/VITAMIN B COMP W-C 3 CapsuleNEPHRO-VITE RX FOLIC ACID/VITAMIN B COMP W-C 3 TabletVG LYSIN HC/VIT E AC/FA/B&C/MN 3 CapsuleSUPERVITE LYSINE HCL/VIT B COMP/FA/ZINC 3 LiquidALBA-LYBE LYSINE HCL/VITAMIN B COMPLEX 3 DropsLYSIPLEX LYSINE/VITAMIN B COMPLEX/FA/ZN 3 SyrupVITALAN F.A. LYSINE/VITAMIN B COMPLEX/FA/ZN 3 SyrupMETANX ME-COBALAM/LM-FOLATE/PYRIDOXAL 3 TabletFOLPACE RX MGOX/E AC SUCC/B-12/FA/B6 3 TabletPOTABA POTASSIUM AMINOBENZOATE 3 CapsulePOTABA ENVULE POTASSIUM AMINOBENZOATE 3 PacketPOTABA POTASSIUM AMINOBENZOATE 3 TabletBTREX VIT B12/INTRINS FACT/FA/VIT B6 3 TabletCEREFOLIN VIT B12/LM-FOLATE CA/VIT B6/B2 3 TabletVARIDIN VITAMIN B COMPLEX 3 TabletNERVO B-12 VITAMIN B COMPLEX/FOLIC ACID 3 Lozenge

VITAMIN D PREPARATIONSROCALTROL CALCITRIOL 3 CapsuleROCALTROL CALCITRIOL 3 SolutionDHT DIHYDROTACHYSTEROL 2 SolutionDHT DIHYDROTACHYSTEROL 2 TabletDRISDOL ERGOCALCIFEROL 2 CapsuleVITAMIN D ERGOCALCIFEROL 1 Capsule

GERIATRIC VITAMIN PREPARATIONSSENILEZOL IRON/VITAMIN B COMPLEX 3 ElixirELDERCAPS MULTIVITAMINS W-MINERALS 3 CapsuleSTROVITE PLUS MULTIVITS W-FE,OTHER MIN 3 Tablet

PEDIATRIC VITAMIN PREPARATIONSTRI-VI-FLOR W/IRON FLUORIDE ION/IRON/VIT A,C&D 1 DropsTRI-VIT W/FLUORIDE & IRON FLUORIDE ION/IRON/VIT A,C&D 1 DropsVI-DAYLIN/F ADC PLUS IRON FLUORIDE ION/IRON/VIT A,C&D 2 DropsMULTI VIT W/FLUORIDE FLUORIDE ION/MULTIVITAMINS 1 Chew TabMULTIVITAMINS W/FLUORIDE FLUORIDE ION/MULTIVITAMINS 1 Chew TabMULTIVITAMINS W/FLUORIDE FLUORIDE ION/MULTIVITAMINS 1 DropsPOLY-VI-FLOR FLUORIDE ION/MULTIVITAMINS 2 DropsPOLY-VITAMINS W/FLUORIDE FLUORIDE ION/MULTIVITAMINS 1 DropsMULTIVITA BETS W/FLUORIDE/IRON FLUORIDE ION/MULTIVITS W-FE 1 Chew TabMULTI-VIT W/FLUORIDE & IRON FLUORIDE ION/MULTIVITS W-FE 1 DropsPOLY-VI-FLOR W/IRON FLUORIDE ION/MULTIVITS W-FE 2 DropsPOLY-VITAMIN W/IRON & FLUORIDE FLUORIDE ION/MULTIVITS W-FE 1 DropsFLOR-DAC FLUORIDE ION/VIT A,C&D 1 Chew TabTRI-A-VITE W/FLUORIDE FLUORIDE ION/VIT A,C&D 1 Chew TabFLUORABON BASIC FLUORIDE ION/VIT A,C&D 2 DropsTRI-VI-FLOR FLUORIDE ION/VIT A,C&D 2 DropsTRI-VITAMIN W/FLUORIDE FLUORIDE ION/VIT A,C&D 1 DropsTRI-VITAMINS W/FLUORIDE FLUORIDE ION/VIT A,C&D 1 DropsADEFLOR M FLUORIDE/CAL/MULTIVITS W-FE 3 Tablet

VITAMIN K PREPARATIONSMEPHYTON PHYTONADIONE 2 Tablet

VITAMIN B12 PREPARATIONSNASCOBAL CYANOCOBALAMIN 3 GelFOLTRATE CYANOCOBALAMIN/FOLIC ACID 3 TabletNEURIN-SL CYANOCOBALAMIN/METHYLCOBALAMIN 3 Tablet SLMARTINIC VITAMIN B12-INTRINSIC FACTOR 3 Capsule

FOLIC ACID PREPARATIONSPRE-FOLIC ASCORBIC ACID/FOLIC ACID 3 TabletUROSEX FA/MULTIVITS-MIN/YHBK/GIN/DAM 3 TabletFOLIC ACID FOLIC ACID 1 TabletSUPERVITE FOLIC ACID/MULTIVITS-MIN 3 TabletTHERAPEUTIC VITAMIN W/MINERALS FOLIC ACID/MU-VITS-MIN TH 1 Capsule

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

V-C FORTE FOLIC ACID/MU-VITS-MIN TH 1 CapsuleVI-C FORTE FOLIC ACID/MU-VITS-MIN TH 1 CapsuleVICA-FORTE FOLIC ACID/MU-VITS-MIN TH 1 CapsuleVIC-FORTE FOLIC ACID/MU-VITS-MIN TH 2 CapsuleVICON FORTE FOLIC ACID/MU-VITS-MIN TH 2 CapsuleVITACON FORTE FOLIC ACID/MU-VITS-MIN TH 1 Capsule

NIACIN PREPARATIONSNIACIN NIACIN 1 Capsule SA

MULTIVITAMIN PREPARATIONSPROTECT PLUS NR AMINO AC/FA/MV-MN/DIETARY 2 3 CapsulePROTECT PLUS AMINO ACIDS/MV,FE,OTHER MIN 3 CapsulePROTECT PLUS AMINO ACIDS/MV,TH W-FE,MN 3 LiquidCARDIOTEK RX ARGININE HCL/VIT B12/FA/VIT B6 3 TabletRENAX E AC SUCC/FA/VIT BCOMP&C/ZN/SE 3 TabletGLUTOFAC-ZX FA/MULTIVITS-MIN/LYCOPENE/LUT 3 TabletUDAMIN FA/MULTIVITS-MIN/MIN AA CHEL 3 Tablet SACORVITE FA/MU-VITS-MIN TH/LYCOPENE/LUT 3 TabletUDAMIN SP FA/MV-MN/MIN AA CHEL/SAW PAL 3 Tablet SABACMIN FE FUMARATE/FA/MV-MN/SE 3 TabletDIALYVITE 800 WITH IRON FE FUMARATE/FA/VIT BCOMP&C 3 TabletGLUTOFAC-ZX FOLIC ACID/MULTIVITS-MIN 3 TabletSTROVITE FORTE FOLIC ACID/MV,FE,OTHER MIN 3 SyrupNUTRICAP FOLIC ACID/MV,FE,OTHER MIN 3 TabletSTROVITE FORTE FOLIC ACID/MV,FE,OTHER MIN 3 TabletNICOMIDE FOLIC ACID/NIACINAMIDE/CU/ZNOX 3 Tablet, Multiphasic ReleaseNUTRIVIT IRON/LYSINE/VIT B COMP/FA 3 LiquidVG MULTIVITAMINS 3 CapsuleCAROMEGA MULTIVITAMINS 3 TabletSTROVITE MULTIVITAMINS 3 TabletHEMOCYTE MULTIVITS W-FE,OTHER MIN 3 ElixirPROMAR MULTIVITS W-IRON,HEMATINIC 3 CapsuleCEFOL MULTIVITS,STRESS FORMULA 3 TabletB-COMPLEX PLUS VITAMIN MULTIVITS,THERAP W-FE,HEMATIN 3 TabletBEROCCA PLUS MULTIVITS,THERAP W-FE,HEMATIN 3 TabletFORTAVIT MV/DIETARY 4/DNA/RNA 3 CapsuleENCORA OM-3/CA CARB/D3/FA/MV CMB 13 3 Combo. Pack.STROVITE ADVANCE THIOCT AC/FA/MULTIVITS-MIN/LUT 3 TabletSUPPORT-500 VITAMIN B COMP W-C 3 CapsuleBEROCCA VITAMIN B COMP W-C 3 Tablet

SMOKING DETERRENTSSMOKING DETERRENT AGENTS (GANGLIONIC STIM,OTHERS)NICOTROL NICOTINE 3 CartridgeNICOTINE NICOTINE 3 Patch 24hrNICOTROL NS NICOTINE 3 Spray

SMOKING DETERRENTS, OTHERZYBAN BUPROPION HCL 3 Tablet SA

UNCLASSIFIED DRUG PRODUCTSMUCOLYTICSPULMOZYME DORNASE ALFA 3 Solution

ANTI-ALCOHOLIC PREPARATIONSCAMPRAL ACAMPROSATE CALCIUM 3 Tablet ECANTABUSE DISULFIRAM 2 Tablet

DIETARY SUPPLEMENT, MISCELLANEOUSLIMBREL BAICALIN/CATECHIN 3 CapsuleVANACHOL DHA/EPA/POLICOS/VIT B12/FA/B6 3 CapsuleANIMI-3 OMEGA-3/VIT B12/FA/PYRIDOXINE 3 Capsule

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

METALLIC POISON, AGENTS TO TREATEXJADE DEFERASIROX 3 Tablet Disper.CHEMET SUCCIMER 3 CapsuleSYPRINE TRIENTINE HCL 3 CapsuleGALZIN ZINC ACETATE 3 Capsule

DENTAL AIDS AND PREPARATIONSPERIDEX CHLORHEXIDINE GLUCONATE 3 MouthwashARESTIN MINOCYCLINE HCL MICROSPHERES 3 CartridgeACTISITE TETRACYCLINE HCL 3 KitBUCALCIDE ZINC CL/B-CAINE/CETYLPYRD CL 3 Spray

ADRENAL STEROID INHIBITORSCYTADREN AMINOGLUTETHIMIDE 3 Tablet

BONE RESORPTION INHIBITORSFOSAMAX ALENDRONATE SODIUM 2 SolutionFOSAMAX ALENDRONATE SODIUM 2 TabletDIDRONEL ETIDRONATE DISODIUM 3 TabletBONIVA IBANDRONATE SODIUM 3 TabletEVISTA RALOXIFENE HCL 2 TabletACTONEL RISEDRONATE SODIUM 2 TabletSKELID TILUDRONATE DISODIUM 3 Tablet

VAGINAL PREPARATIONSAMINO-CERV SODIUM PROPIONATE/AMINO AC/URE 3 CreamAMINO-CERV SODIUM PROPIONATE/AMINO AC/URE 3 Cream

KIDNEY STONE AGENTSCALCIBIND CELLULOSE SODIUM PHOSPHATE 3 KitCYSTAGON CYSTEAMINE BITARTRATE 3 CapsuleSTONEX EUC/BORN/FENC/PINENE A-B/CAM 3 CapsuleTHIOLA TIOPRONIN 3 Tablet

BULK CHEMICALSNYSTAT-RX NYSTATIN 1 Powder

ANTILEPROTICSTHALOMID THALIDOMIDE 3 Capsule

HOMEOPATHIC DRUGSSPEED TRAUMA FORMULA BEL/ARN/MAR/AC/ST.JHNWT/HRB63 3 GelPSORIZIDE FORTE NICK SULF/POT BROMIDE/FUM AC 3 Chew TabECZEMOL NICK SULF/POT BROMIDE/SULFUR 3 TabletACUNOL ZN BROM/NICK SULF/BROMIDE/SULF 3 Chew Tab

CHEMOTHERAPY RESCUE/ANTIDOTE AGENTSLEUCOVORIN CALCIUM LEUCOVORIN CALCIUM 2 TabletMESNEX MESNA 3 Tablet

METABOLIC DEFICIENCY AGENTSCYSTADANE BETAINE 3 PowderCARNITOR LEVOCARNITINE 3 LiquidCARNITOR LEVOCARNITINE 3 Tablet

DRUGS TO TREAT IMPOTENCYMUSE ALPROSTADIL 3 SuppositoryCAVERJECT ALPROSTADIL 2 AmpulCAVERJECT ALPROSTADIL 2 KitEDEX ALPROSTADIL 2 KitCAVERJECT ALPROSTADIL 2 VialVIAGRA SILDENAFIL CITRATE 2 TabletCIALIS TADALAFIL 3 TabletLEVITRA VARDENAFIL HCL 3 TabletYOCON YOHIMBINE HCL 3 TabletYOHIMAR YOHIMBINE HCL/ZINC SULFATE 3 Tablet

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

AGENTS TO TREAT MULTIPLE SCLEROSISCOPAXONE GLATIRAMER ACETATE 3 KitAVONEX INTERFERON BETA-1A 3 KitAVONEX ADMINISTRATION PACK INTERFERON BETA-1A/ALBUMIN 3 KitREBIF INTERFERON BETA-1A/ALBUMIN 3 SyringeBETASERON INTERFERON BETA-1B 3 Vial

BENIGN PROSTATIC HYPERTROPHY/MICTURITION AGENTSUROXATRAL ALFUZOSIN HCL 3 Tablet 24hr SRAVODART DUTASTERIDE 2 CapsulePROSCAR FINASTERIDE 2 TabletFLOMAX TAMSULOSIN HCL 2 Capsule 24hr SR

ANTIOXIDANT AGENTSOXIPLEN VITAMIN E/FOLIC ACID/ZINC/SE 3 Tablet

ORAL MUCOSITIS/STOMATITIS AGENTSSALICEPT ACEMANNAN 3 SuspensionSALICEPT ACEMANNAN/ASPARTAME 3 SolutionGELCLAIR K SORBATE/HE-CEL/PVP/HYALUR AC 3 PacketORAMAGICRX K SORBATE/MALTO/ALO V/MANN PS 3 Mouthwash

ORAL MUCOSITIS/STOMATITIS ANTI-INFLAMMATORY AGENTAPHTHASOL AMLEXANOX 3 Paste

URINARY TRACT ANTISPASMODIC/ANTIINCONTINENCE AGENTURISPAS FLAVOXATE HCL 3 TabletOXYTROL OXYBUTYNIN 2 Patch BiweeklyDITROPAN OXYBUTYNIN CHLORIDE 3 SyrupOXYBUTYNIN CHLORIDE OXYBUTYNIN CHLORIDE 1 SyrupDITROPAN OXYBUTYNIN CHLORIDE 3 TabletOXYBUTYNIN CHLORIDE OXYBUTYNIN CHLORIDE 1 TabletDITROPAN XL OXYBUTYNIN CHLORIDE 3 Tablet Osmotic Laser-DrilledDETROL LA TOLTERODINE TARTRATE 2 Capsule 24hr SRDETROL TOLTERODINE TARTRATE 2 TabletSANCTURA TROSPIUM CHLORIDE 3 Tablet

TOPICAL ANTIBIOTICS/ANTIINFLAMMATORY,STEROIDALCORTISPORIN NEOMY SULF/POLYMYX B SULF/HC 3 CreamCORTISPORIN NEOMYCIN/BACITRA/POLYMYXIN/HC 3 Ointment

HYPERTRICHOTIC AGENTS, SYSTEMIC/INCL. COMBINATIONSPROPECIA FINASTERIDE 3 Tablet

SALIVA SUBSTITUTE AGENTSCAPHOSOL SALIVA SUBSTITUTION COMBO NO.2 3 Solution

PERIODONTAL COLLAGENASE INHIBITORSDOXYCYCLINE HYCLATE DOXYCYCLINE HYCLATE 1 TabletPERIOSTAT DOXYCYCLINE HYCLATE 2 Tablet

CALCIMIMETIC, PARATHYROID CALCIUM ENHANCERSENSIPAR CINACALCET HCL 2 Tablet

URINARY TRACT ANTISPASMODIC, M(3) SELECTIVE ANTAG.ENABLEX DARIFENACIN HYDROBROMIDE 3 Tablet 24hr SRVESICARE SOLIFENACIN SUCCINATE 3 Tablet

ABORTIFACIENT, PROGESTERONE RECEPTOR ANTAGONIST-TYPMIFEPREX MIFEPRISTONE 3 Tablet

INTRAPLEURAL SCLEROSING AGENTS, ANTINEOPLAST. ADJ.SCLEROSOL TALC 3 AerosolPULMONARY ANTI-HTN, ENDOTHELIN RECEPTOR ANTAGONISTTRACLEER BOSENTAN 2 TabletDRUGS TO TREAT HEREDITARY TYROSINEMIAORFADIN NITISINONE 3 Tablet

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Brand Name Generic Name Tier Form

Trustmark/Starmark Clinical Formulary - January 2006

BONE FORMATION STIM. AGENTS - PARATHYROID HORMONEFORTEO TERIPARATIDE 3 SyringeGROWTH HORMONE RECEPTOR ANTAGONISTSSOMAVERT PEGVISOMANT 3 VialDRUGS TO TX GAUCHER DX-TYPE 1, SUBSTRATE REDUCINGZAVESCA MIGLUSTAT 2 CapsuleBONE RESORPTION INHIBITOR & VITAMIN D COMBINATIONSFOSAMAX PLUS D ALENDRONATE SODIUM/VITAMIN D3 2 TabletBONE RESORPTION INHIBITOR & CALCIUM COMBINATIONSACTONEL WITH CALCIUM RISEDRON SOD/CALCIUM CARBONATE 3 TabletHYPERPARATHYROID TX AGENTS - VITAMIN D ANALOG-TYPEHECTOROL DOXERCALCIFEROL 3 CapsuleZEMPLAR PARICALCITOL 3 CapsuleAPPETITE STIM. FOR ANOREXIA,CACHEXIA,WASTING SYND.MEGACE MEGESTROL ACETATE 3 SuspensionMEGACE ES MEGESTROL ACETATE 3 Suspension

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