Preferred Prescriptions®
Member GuidePlease bring this guide with you on your next doctor visit.
Improving health while lowering costs keeps Medco at the heart of health.™
Medco manages your prescription drug benefit for your health plan.
Preferred Prescriptions® is a formulary list of medications thatmay be covered under your prescription drug plan.This list wasreviewed by an independent group of practicing doctors and pharmacists, and it contains medications made by most pharma-ceutical manufacturers. It includes medications for many coveredconditions.
SAVING MONEY ON PRESCRIPTIONSYour plan may prefer some medications over others. These arecalled preferred drugs.
You may pay:• Lowest co-payment/co-insurance for generic drugs• Higher co-payment/co-insurance for preferred brand-name
drugs• Highest co-payment/co-insurance for nonpreferred
brand-name drugs
Your doctor may be able to help you save money by prescribinggeneric and preferred brand-name drugs if appropriate. So be sureto bring this guide with you on every visit to your doctor. Somecommonly prescribed nonpreferred drugs are also listed in thisguide for your reference.
Please note: This guide does not contain a complete list of preferred and nonpreferred drugs. It only lists the mostcommonly prescribed drugs. For an updated and complete listing of your prescription benefit, you can visit the “BenefitHighlights” section of our website—www.medco.com—andclick on the View your preferred drug list link. Not all medica-tions listed here are covered by every prescription drug plan.
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FINDING MEDICATIONS WITH LOWERCO-PAYMENTS/CO-INSURANCEThis guide lists medications two ways to help you find somegeneric, preferred, and nonpreferred brand-name drugs.
SECTION I - ALPHABETICALLY BY DRUG CATEGORY (SUCH AS RESPIRATORY)Within each category, medications are listed in alphabetical order, with generic, preferred brand-name, and nonpreferredbrand-name drugs sorted separately:
G Means a preferred generic medicationP Means a preferred brand-name medicationNP Means a nonpreferred brand-name medication
SECTION II - ALPHABETICALLY BY BRAND NAMEAfter each nonpreferred brand-name drug, you will find possible generic and preferred brand-name alternatives.
SAFETY CONSIDERATION SYMBOLSHere is a quick guide for you and your doctor, which explains our safety symbols. These symbols appear next to certain medications.
Means weigh risk of birth defects or other adverse outcomes.
Means do not use in pregnancy.
The information in this guide was in effect at the time of printing and maybe subject to change.
Key:G = Means a preferred generic medication.P = Means a preferred brand-name medication.NP = Means a nonpreferred brand-name medication.
= Means weigh risk of birth defects or other adverse outcomes.= Means do not use in pregnancy.
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SECTION I:THERAPEUTIC DRUG CATEGORIES
Oral PenicillinsG amoxicillin trihydrateG amoxicillin trihydrate/
potassium clavulanateG ampicillin trihydrateG dicloxacillin sodiumG penicillin v
potassiumP Augmentin Chewable
Tablet 125 - 31.25mg,250 - 62.5mg
P AugmentinSuspension 125 - 31.25mg/5,250 - 62.5mg/5
P Augmentin Tablet250-125mg
P Augmentin XRNP Augmentin Chewable
Tablet 200 - 28.5mg,400 - 57mg
NP Augmentin ESNP Augmentin
Suspension 200 - 28.5mg/5,400 - 57mg/5
NP Augmentin Tablet500 - 125mg,875 - 125mg
NP DispermoxNP Geocillin
Oral TetracyclinesG doxycycline hyclate
capsuleG doxycycline hyclate
tabletG doxycycline
monohydrateG minocycline HClG tetracycline HClP AdoxaP OraceaNP DoryxNP DynacinNP MinocinNP MonodoxNP PeriostatNP SolodynNP Vibramycin
SuspensionNP Vibramycin Syrup
Oral CephalosporinsG cefaclorG cefadroxil hydrateG cefdinirG cefpodoxime proxetilG cefprozilG cefuroxime axetilG cephalexin
monohydrateG cephradineP Ceftin Tablet 125mgNP Ceclor CD
ANTI-INFECTIVES (Antibiotics/Antifungals)
Key:G = Means a preferred generic medication.P = Means a preferred brand-name medication.NP = Means a nonpreferred brand-name medication.
= Means weigh risk of birth defects or other adverse outcomes.= Means do not use in pregnancy.
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NP CedaxNP Ceftin SuspensionNP Ceftin Tablet 250mg,
500mgNP CefzilNP DuricefNP KeflexNP OmnicefNP SpectracefNP SupraxNP VantinNP Velosef
Oral ErythromycinsG azithromycinG clarithromycinG clarithromycin ERG erythromycin base
tablet, enteric coatedG erythromycin
ethylsuccinateG erythromycin
ethylsuccinate/sulfisoxazole acetyl
G erythromycin stearateNP BiaxinNP Biaxin XLNP EryPedNP PCENP ZithromaxNP Zmax
Oral QuinolonesG ciprofloxacin HClG ofloxacinP Cipro SuspensionP LevaquinP NoroxinNP AveloxNP Cipro Tablet
NP Cipro XRNP FactiveNP FloxinNP MaxaquinNP Proquin XRNP Tequin
Oral SulfasG erythromycin
ethylsuccinate/sulfisoxazole acetyl
G sulfadiazineG sulfamethoxazole/
trimethoprimG sulfisoxazoleNP Bactrim DSNP GantrisinNP Septra DS
Oral Urinary TractAgentsG methenamine
hippurateG methenamine
mandelateG nitrofurantoinG nitrofurantoin
macrocrystalG phenazopyridine HClG trimethoprimP FuradantinNP HiprexNP MacrobidNP MacrodantinNP MonurolNP Primsol
Key:G = Means a preferred generic medication.P = Means a preferred brand-name medication.NP = Means a nonpreferred brand-name medication.
= Means weigh risk of birth defects or other adverse outcomes.= Means do not use in pregnancy.
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Oral AntifungalAgentsG clotrimazoleG fluconazoleG griseofulvin G griseofulvin
ultramicrosizeG itraconazoleG ketoconazoleG nystatinG terbinafine HClP AncobonP Lamisil Oral GranulesP NoxafilP Sporanox Oral
SolutionP Vfend TabletNP DiflucanNP Grifulvin VNP Gris-PegNP Lamisil TabletNP MycostatinNP Mycelex Troche NP NizoralNP Sporanox CapsuleNP Vfend Suspension
Oral MiscellaneousAgentsG clindamycin HClG neomycin sulfateP DapsoneP Tobi Ampul for
NebulizationP ZyvoxNP Cleocin HClNP KetekNP Xifaxan
Vaginal AntifungalsG fluconazoleG miconazole nitrate
vaginal suppositoryG nystatinG terconazoleP Gynazole-1NP Terazol
Key:G = Means a preferred generic medication.P = Means a preferred brand-name medication.NP = Means a nonpreferred brand-name medication.
= Means weigh risk of birth defects or other adverse outcomes.= Means do not use in pregnancy.
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Hypnotic AgentsG chloral hydrateG estazolamG flurazepam HClG temazepamG triazolamG zaleplonG zolpidem tartrateP Ambien CRP Restoril 7.5mg,
22.5mgNP AmbienNP DalmaneNP DoralNP HalcionNP LunestaNP ProSomNP Restoril 15mg, 30mgNP RozeremNP Sonata
TricyclicAntidepressantsG amitriptyline HClG amoxapineG clomipramine HClG desipramine HClG doxepin HClG imipramine HClG nortriptyline HClG protriptyline HClG trimipramine maleateP Surmontil 100mgP Tofranil-PMNP Anafranil
NP AsendinNP Aventyl HClNP ElavilNP NorpraminNP PamelorNP SinequanNP Surmontil 25mg,
50mgNP TofranilNP Vivactil
MiscellaneousAntidepressantsG bupropion HCl tabletG bupropion HCl tablet,
sustained actionG maprotiline HClG mirtazapineG trazodone HClG venlafaxine HClP CymbaltaP Effexor XRP PristiqNP DesyrelNP EffexorNP LudiomilNP Remeron SolTabNP Remeron TabletNP SerzoneNP WellbutrinNP Wellbutrin SRNP Wellbutrin XL
AntipsychoticsG chlorpromazine HClG clozapineG fluphenazine HCl
PSYCHOTHERAPEUTICS (Anxiety/Depression)
Key:G = Means a preferred generic medication.P = Means a preferred brand-name medication.NP = Means a nonpreferred brand-name medication.
= Means weigh risk of birth defects or other adverse outcomes.= Means do not use in pregnancy.
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G haloperidolG haloperidol lactate
concentrate, oralG loxapine succinateG perphenazineG risperidoneG thiothixeneG trifluoperazine HClP ClozarilP GeodonP MobanP OrapP Risperdal M-TabP SeroquelP Seroquel XRP ZyprexaP Zyprexa ZydisNP AbilifyNP InvegaNP RisperdalNP Symbyax
AnxiolyticsG alprazolamG alprazolam XRG buspirone HClG chlordiazepoxide
HClG clorazepate
dipotassiumG diazepamG lorazepamG oxazepamNP AtivanNP BusparNP LibriumNP NiravamNP PaxipamNP Serax
NP Tranxene SDNP Tranxene T-TabNP ValiumNP XanaxNP Xanax XR
MAOIAntidepressantsG tranylcypromine
sulfateP NardilNP EmsamNP Parnate
SSRI AntidepressantsG citalopram HBrG fluoxetine HClG fluvoxamine maleateG paroxetine HClG sertraline HClNP CelexaNP LexaproNP LuvoxNP Luvox CRNP PaxilNP Paxil CRNP PexevaNP ProzacNP Prozac WeeklyNP SarafemNP Zoloft
Key:G = Means a preferred generic medication.P = Means a preferred brand-name medication.NP = Means a nonpreferred brand-name medication.
= Means weigh risk of birth defects or other adverse outcomes.= Means do not use in pregnancy.
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Beta BlockersG acebutolol HClG atenololG betaxolol HClG bisoprolol fumarateG carvedilolG labetalol HClG metoprolol succinateG metoprolol tartrateG nadololG pindololG propranolol HClG propranolol HCl
capsule, sustainedaction 24 hr
G timolol maleateP Coreg CRNP BystolicNP CoregNP CorgardNP InderalNP Inderal LANP Innopran XLNP KerloneNP LevatolNP LopressorNP NormodyneNP SectralNP TenorminNP Toprol XLNP TrandateNP Zebeta
Calcium BlockersG diltiazem HClG diltiazem HCl capsule,
sustained release 12 hr
G diltiazem HCl capsule,sustained release 24 hr
G nimodipineG verapamil HClG verapamil HCl
capsule, 24 hr sustained release pellets
G verapamil HCl tablet,sustained action
P Cardizem LAP Covera-HSNP Calan SRNP CardizemNP Cardizem CDNP Cardizem SRNP Isoptin S.R.NP NimotopNP TiazacNP VerelanNP Verelan PM
DihydropyridinesG amlodipine besylateG felodipine ERG isradipineG nifedipineG nifedipine tablet,
sustained actionG nifedipine tablet,
sustained releaseosmotic push
G nisoldipineP SularNP Adalat CCNP Cardene SRNP DynaCirc
CARDIOVASCULAR(Blood Pressure/Heart/Cholesterol)
Key:G = Means a preferred generic medication.P = Means a preferred brand-name medication.NP = Means a nonpreferred brand-name medication.
= Means weigh risk of birth defects or other adverse outcomes.= Means do not use in pregnancy.
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NP DynaCirc CRNP NorvascNP PlendilNP Procardia XL
Nitroglycerin PatchesG nitroglycerin patchP Minitran PatchNP Nitro-Dur Patch
AdrenergicAntagonists &Related DrugsG clonidine HClG doxazosin mesylateG guanfacine HClG methyldopaG prazosin HClG reserpineG terazosin HClP Catapres-TTS PatchNP CarduraNP Cardura XLNP CatapresNP HytrinNP MinipressNP Tenex
Angiotensin IIBlockers & ReninInhibitorsP AtacandP Atacand HCTP BenicarP Benicar HCTP CozaarP DiovanP Diovan HCTP HyzaarP Micardis
P Micardis HCTP TekturnaP Tekturna HCTNP AvalideNP AvaproNP TevetenNP Teveten HCT
AntilipidemicsG cholestyramine/
aspartameG cholestyramine/
sucroseG colestipol HClG fenofibrate,
micronizedG gemfibrozilG lovastatinG niacinG pravastatinG simvastatinP AdvicorP AltoprevP CrestorP FenoglideP LipitorP LovazaP NiaspanP SimcorP TricorP TriglideP VytorinP WelcholP ZetiaNP AntaraNP CaduetNP ColestidNP LescolNP Lescol XLNP LofibraNP Lopid
Key:G = Means a preferred generic medication.P = Means a preferred brand-name medication.NP = Means a nonpreferred brand-name medication.
= Means weigh risk of birth defects or other adverse outcomes.= Means do not use in pregnancy.
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NP MevacorNP PravacholNP QuestranNP Questran LightNP Zocor
ACE InhibitorsG benazepril HClG captoprilG enalapril maleateG fosinopril sodiumG lisinoprilG moexiprilG quinaprilG ramiprilG trandolaprilP AceonP AltaceNP AccuprilNP CapotenNP LotensinNP MavikNP MonoprilNP PrinivilNP UnivascNP VasotecNP Zestril
CombinationAntihypertensivesG amlodipine
besylate/benazeprilG atenolol/
chlorthalidoneG benazepril HCl/
hydrochlorothiazideG bisoprolol fumarate/
hydrochlorothiazideG captopril/
hydrochlorothiazide
G enalapril maleate/hydrochlorothiazide
G fosinopril/hydrochlorothiazide
G hydralazine HCl/hydrochlorothiazide
G lisinopril/hydrochlorothiazide
G methyldopa/hydrochlorothiazide
G metoprolol/hydrochlorothiazide
G moexipril/hydrochlorothiazide
G propranolol HCl/hydrochlorothiazide
G quinapril/hydrochlorothiazide
P ExforgeP Lotrel 5-40mg,
10-40mgNP AzorNP AccureticNP CapozideNP ClorpresNP CorzideNP LexxelNP Lopressor HCTNP Lotensin HCTNP Lotrel 2.5-10mg,
5-10mg, 5-20mg,10-20mg
NP Monopril HCTNP PrinzideNP TarkaNP TenoreticNP UnireticNP VasereticNP ZestoreticNP Ziac
Key:G = Means a preferred generic medication.P = Means a preferred brand-name medication.NP = Means a nonpreferred brand-name medication.
= Means weigh risk of birth defects or other adverse outcomes.= Means do not use in pregnancy.
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Insulin TherapyP ApidraP HumalogP Humalog Mix 50/50P Humalog Mix 75/25P HumulinP LantusP Lantus SoloStarP LevemirP NovoLogP NovoLog Mix 70/30NP Novolin
Non-InsulinHypoglycemic AgentsG acarboseG chlorpropamideG glimepirideG glipizideG glipizide/
metformin HClG glipizide tablet,
sustained releaseosmotic push
G glyburideG glyburide/
metformin HClG glyburide, micronizedG metformin HClG metformin HCl tablet,
sustained release 24 hr
G tolazamideG tolbutamideP Actoplus MetP Actos
P AvandametP AvandarylP AvandiaP ByettaP DuetactP JanumetP JanuviaP PrandinP StarlixP SymlinNP AmarylNP DiaBetaNP GlucophageNP Glucophage XRNP GlucotrolNP Glucotrol XLNP GlucovanceNP GlynaseNP GlysetNP MetaglipNP MicronaseNP Precose
Blood Glucose TestStripsG alcohol antiseptic
padsP Accu-Chek Active Test
StripsP Accu-Chek Aviva Test
StripsP Accu-Chek Comfort
Curve Test StripsP Accu-Chek Compact
Test StripsP Fast Take Test StripsP One Touch Test Strips
ENDOCRINE (Diabetes/Hormones/Contraceptives)
Key:G = Means a preferred generic medication.P = Means a preferred brand-name medication.NP = Means a nonpreferred brand-name medication.
= Means weigh risk of birth defects or other adverse outcomes.= Means do not use in pregnancy.
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P One Touch Ultra TestStrips
P Surestep Pro TestStrips
P Surestep Test Strips
Contraceptive AgentsG desogestrel-ethinyl
estradiolG desogestrel-ethinyl
estradiol/ethinylestradiol
G ethinyl estradiol/drospirenone
G ethynodiol d-ethinylestradiol
G levonorgestrel-ethinyl estradiol
G norethindroneG norethindrone a-e
estradiolG norethindrone a-e
estradiol/ferrousfumarate
G norethindrone-ethinyl estradiol
G norethindrone-mestranol
G norgestimate-ethinyl estradiol
G norgestrel-ethinylestradiol
P CyclessaP LybrelP NuvaRingP Ortho Tri-Cyclen LoP Plan BP SeasoniqueP YazNP Alesse
NP BreviconNP DemulenNP DesogenNP Estrostep FeNP LevlenNP LevliteNP LoestrinNP Loestrin FeNP Loestrin 24 FeNP Lo/OvralNP MircetteNP ModiconNP NordetteNP NorinylNP Ortho-CeptNP Ortho-CyclenNP Ortho EvraNP Ortho MicronorNP Ortho-NovumNP Ortho Tri-CyclenNP OvconNP OvralNP SeasonaleNP Tri-LevlenNP Tri-NorinylNP TriphasilNP Yasmin
Estrogens/EstrogenCombinationsG estradiol patchG estradiol tabletG estradiol/
norethindroneacetate
G estropipateG methyl-
testosterone/estrogens, esterified
P Activella 0.5-0.1mg
Key:G = Means a preferred generic medication.P = Means a preferred brand-name medication.NP = Means a nonpreferred brand-name medication.
= Means weigh risk of birth defects or other adverse outcomes.= Means do not use in pregnancy.
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P CenestinP Climara PatchP CombipatchP EnjuviaP Estraderm PatchP EstratestP Estratest H.S.P Estring Vaginal RingP EvamistP Premarin TabletP Premarin Vaginal
CreamP PremphaseP PremproP VagifemP VivelleP Vivelle-Dot
NP Activella 1-0.5mgNP AloraNP AngeliqNP Climara Pro PatchNP DivigelNP ElestrinNP EstraceNP EstrasorbNP FemhrtNP FemringNP FemtraceNP MenestNP OgenNP Ortho-Prefest
Ulcer DrugsG cimetidine HCl liquidG cimetidine tabletG famotidineG misoprostolG nizatidineG omeprazoleG pantoprazole sodiumG ranitidine HClP Axid Oral SolutionP Nexium CapsuleP Nexium SuspensionNP AciphexNP Axid CapsuleNP CytotecNP Pepcid
NP PrevacidNP Prilosec RxNP ProtonixNP TagametNP Zantac Rx Syrup NP Zantac Rx TabletNP Zegerid
Other G I DrugsG sucralfate tabletP Carafate Suspension P PyleraNP Carafate Tablet
G I (Ulcer)
Key:G = Means a preferred generic medication.P = Means a preferred brand-name medication.NP = Means a nonpreferred brand-name medication.
= Means weigh risk of birth defects or other adverse outcomes.= Means do not use in pregnancy.
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NSAIDsG etodolacG etodolac tablet,
sustained release 24 hr
G flurbiprofenG ibuprofenG indomethacinG indomethacin
capsule, sustainedaction
G ketoprofenG ketoprofen capsule,
24 hr sustainedrelease pellets
G meclofenamatesodium
G meloxicamG nabumetoneG naproxenG naproxen sodiumG naproxen sodium
tablet, sustainedaction
G oxaprozinG piroxicamG sulindacG tolmetin sodiumNP ClinorilNP DayproNP diclofenac
potassiumNP diclofenac sodium
NP IndocinNP LodineNP Lodine XLNP MobicNP MotrinNP NaprelanNP NaprosynNP OruvailNP RelafenNP Voltaren
NSAID COX-2InhibitorsP Celebrex
NSAIDS (Pain Relievers)
Key:G = Means a preferred generic medication.P = Means a preferred brand-name medication.NP = Means a nonpreferred brand-name medication.
= Means weigh risk of birth defects or other adverse outcomes.= Means do not use in pregnancy.
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G acetaminophen/butalbital
G acetaminophen/caffeine/butalbital
G aspirin/caffeine/butalbital
G dihydroergotaminemesylate
G ergotamine/caffeinetablet
G ergotamine tartrate/caffeinesuppository, rectal
G isometheptenemucate/acetaminophen/dichloralphenazone
P AmergeP ErgomarP FrovaP ImitrexP MaxaltP Maxalt MLTP PhrenilinP Phrenilin ForteP RelpaxP ZomigP Zomig ZMTNP AxertNP Cafergot tabletNP MidrinNP MigranalNP Treximet
MIGRAINE/HEADACHE THERAPY
G galantamine HBrP AriceptP Aricept ODTP ExelonP Razadyne Oral
Solution
P Razadyne ERNP CognexNP NamendaNP Razadyne Tablet
DRUGS TO TREAT ALZHEIMER’S DISEASE
G flavoxateG oxybutynin chloride P DetrolP Detrol LAP Enablex
P OxytrolP VesicareNP Ditropan XLNP SancturaNP Sanctura XR
DRUGS TO TREAT OVERACTIVE BLADDER
Key:G = Means a preferred generic medication.P = Means a preferred brand-name medication.NP = Means a nonpreferred brand-name medication.
= Means weigh risk of birth defects or other adverse outcomes.= Means do not use in pregnancy.
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Beta Agonists OralG albuterol sulfateG albuterol sulfate SRG metaproterenol
sulfateG terbutaline sulfateNP AlupentNP BrethineNP VentolinNP Volmax
Beta Agonist InhalersG albuterol aerosolG albuterol sulfate
solutionG isoetharine HCl
solutionG metaproterenol
sulfate solutionP ForadilP Maxair AutohalerP PerforomistP Proair HFAP Serevent DiskusP XopenexP Xopenex HFANP AccunebNP AlupentNP BrovanaNP ProventilNP Proventil HFANP Ventolin HFANP Ventolin
Inhaled SteroidsP AsmanexP Flovent DiskusP Flovent HFAP Flovent InhalerP Flovent RotadiskP Pulmicort FlexhalerP Pulmicort InhalerP Pulmicort RespulesP QVARNP AerobidNP Aerobid-MNP AlvescoNP Azmacort
Nasal CorticosteroidsG flunisolideG fluticasone propionateP Nasacort AQP NasonexP Rhinocort AquaP VeramystNP Beconase AQNP FlonaseNP NasacortNP NasalideNP NasarelNP Omnaris
MiscellaneousPulmonary AgentsG acetylcysteine vialG cromolyn sodium
ampul for nebulization
RESPIRATORY (Allergy/Asthma)
Key:G = Means a preferred generic medication.P = Means a preferred brand-name medication.NP = Means a nonpreferred brand-name medication.
= Means weigh risk of birth defects or other adverse outcomes.= Means do not use in pregnancy.
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G ipratropium/albuterolsulfate
G ipratropium bromidesolution
P Advair DiskusP Advair HFAP Atrovent HFAP Atrovent InhalerP Combivent InhalerP Intal InhalerP LetairisP PulmozymeP RevatioP SingulairP SpirivaP SymbicortP Tilade InhalerP TracleerP VentavisNP AccolateNP Atrovent Inhalation
SolutionNP DuonebNP XolairNP ZyfloNP Zyflo CR
Antihistamine/DecongestantCombinationsG carbetapentane
tannate/chlorpheniramine tannate
G carbetapentane tannate/ephedrinetannate/phenylephrine/chlorpheniramine suspension
G carbetapentane tannate/phenylephrine tannate/chlorpheniramine suspension
G phenylephrine HCl/phenyltoloxamine citrate/chlorpheniramine
G phenylephrine HCl/promethazine HCl
G phenylephrine tannate/chlorpheniramine tannate
G phenylephrine tannate/diphenhydramine tannate suspension
G phenylephrine tannate/pyrilamine tannate/chlorpheniraminetablet
G pseudoephedrine HCl/brompheniraminemaleate
G pseudoephedrine HCl/brompheniraminemaleate capsule,sustained release 12 hr
G pseudoephedrine HCl/chlorpheniraminemaleate
Key:G = Means a preferred generic medication.P = Means a preferred brand-name medication.NP = Means a nonpreferred brand-name medication.
= Means weigh risk of birth defects or other adverse outcomes.= Means do not use in pregnancy.
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G pseudoephedrine HCl/chlorpheniraminemaleate capsule,sustained release 12 hr
G pseudoephedrine tannate/chlorpheniramine tannate
G pseudoephedrine tannate/dexchlorpheniraminetannate
P Allegra-D 12 HourP Allegra-D 24 HourP Deconamine LiquidP Deconamine SRP Histex LiquidP Histex SRNP Clarinex-D 12 hrNP Clarinex-D 24 hrNP Deconamine TabletNP RynatanNP RynatussNP Semprex-D
AntihistaminesG clemastine fumarateG cyproheptadine HClG dexchlorpheniramine
maleate syrupG diphenhydramine HClG fexofenadine HClG hydroxyzine HClG hydroxyzine pamoateP Allegra Oral
SuspensionP Astelin Nasal SprayP Clarinex RediTabsP Clarinex TabletNP Allegra ODTNP Allegra TabletNP AtaraxNP Clarinex SyrupNP VistarilNP Xyzal
Key:G = Means a preferred generic medication.P = Means a preferred brand-name medication.NP = Means a nonpreferred brand-name medication.
= Means weigh risk of birth defects or other adverse outcomes.= Means do not use in pregnancy.
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G alendronate sodiumP Actonel 30mgP BonivaP EvistaP ForteoP Fosamax Plus DP Fosamax SolutionP Miacalcin Nasal SprayNP Actonel 5mgNP Actonel 35mgNP Actonel 75mgNP Actonel 150mgNP Actonel with CalciumNP Fosamax Tablet
OSTEOPOROSIS/PAGET’S DISEASE
Nonpreferred Possible Preferred ProductsProduct
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SECTION II:NONPREFERRED DRUGS AND THEIR POSSIBLE PREFERRED
ALTERNATIVES
Abilify® clozapine (generic), risperidone (generic), Geodon®
(Pfizer), Seroquel® (AstraZeneca), Seroquel XR®
(AstraZeneca), Zyprexa® (Eli Lilly)Accolate® Singulair® (Merck)
Accuneb® albuterol sulfate (generic)
Accupril® quinapril (generic)Accuretic® quinapril/hydrochlorothiazide (generic)Aciphex® omeprazole (generic), Nexium® (AstraZeneca)Activella® 1-0.5mg estradiol/norethindrone acetate (generic)Actonel® 5mg alendronate sodium 5mg (generic), alendronate
sodium 10mg (generic), Boniva® (Roche)Actonel® 35mg alendronate sodium 35mg (generic), alendronate
75mg, 150mg sodium 70mg (generic), Boniva® (Roche)Actonel® alendronate sodium (generic), Boniva® (Roche)
with CalciumAdalat CC® nifedipine ER (generic), amlodipine besylate (generic),
Sular® (First-Horizon)Aerobid® Asmanex® (Schering), Flovent Inhaler®
(GlaxoSmithKline), Pulmicort Inhaler® (AstraZeneca),QVAR® (Ivax)
Aerobid-M® Asmanex® (Schering), Flovent Inhaler®
(GlaxoSmithKline), Pulmicort Inhaler® (AstraZeneca),QVAR® (Ivax)
Allegra® ODT fexofenadine HCl (generic)Allegra® Tablet fexofenadine HCl (generic), Clarinex® (Schering)Alesse® Aviane® (Barr-branded generic*), Lessina® (Barr-
branded generic*), Lutera® (Watson-branded generic*),Lybrel® (Wyeth)
Alora® estradiol patch (generic), Climara® (Berlex), Estraderm®
(Novartis), Vivelle® (Novartis)Alupent® metaproterenol sulfate (generic), Maxair Autohaler®
(3M), Proair HFA® (Teva), Xopenex HFA® (Sepracor)Alvesco® Asmanex® (Schering), Flovent HFA® (GlaxoSmithKline),
Pulmicort Flexhaler® (AstraZeneca)Amaryl® glimepiride (generic)Ambien® zolpidem tartrate (generic)
*Branded generics have the same co-payment as regular generics.
Nonpreferred Possible Preferred ProductsProduct
21*Branded generics have the same co-payment as regular generics.
Amoxil® amoxicillin trihydrate (generic)Anafranil® clomipramine HCl (generic)Anaprox DS® naproxen sodium (generic)Angeliq® estradiol/norethindrone acetate (generic),
Activella® 0.5-0.1mg (Novo Nordisk), Premphase®
(Wyeth), Prempro® (Wyeth)Ansaid® flurbiprofen (generic)Antara® fenofibrate (generic), gemfibrozil (generic), Tricor®
(Abbott), Triglide® (Sciele)Arthrotec® ibuprofen (generic), naproxen (generic), Celebrex®
(Pfizer)Asendin® amoxapine (generic)
50mg, 100mgAtarax® hydroxyzine HCl (generic)Ativan® lorazepam (generic)Atrovent® ipratropium bromide (generic)
solutionAugmentin® amoxicillin trihydrate/potassium clavulanate (generic)chewable tablet200-28.5mg,400-57mg
Augmentin® amoxicillin trihydrate/potassium clavulanate (generic)suspension200-28.5mg/5,400-57mg/5
Augmentin® amoxicillin trihydrate/potassium clavulanate (generic)tablet500-125mg,875-125mg
Augmentin ES® amoxicillin trihydrate/potassium clavulanate (generic)Avalide® Atacand HCT® (AstraZeneca), Benicar HCT® (Daiichi
Sankyo), Diovan HCT® (Novartis), Hyzaar® (Merck),Micardis HCT® (BIPI)
Avapro® Atacand® (AstraZeneca), Benicar® (Daiichi Sankyo),Cozaar® (Merck), Diovan® (Novartis), Micardis® (BIPI)
Avelox® Levaquin® (J&J)Aventyl HCl® nortriptyline HCl (generic)Axert® Amerge® (GlaxoSmithKline), Frova® (Endo), Imitrex®
(GlaxoSmithKline), Maxalt® (Merck), Relpax® (Pfizer),Zomig® (AstraZeneca)
Axid® Capsule nizatidine (generic)
Nonpreferred Possible Preferred ProductsProduct
22
Azmacort® Asmanex® (Schering), Flovent Inhaler®
(GlaxoSmithKline), Pulmicort Inhaler® (AstraZeneca),QVAR® (Ivax)
Azor® amlodipine besylate (generic), Benicar® (DaiichiSankyo)
Bactrim DS® sulfamethoxazole/trimethoprim (generic)Beconase AQ® flunisolide (generic), fluticasone propionate (generic),
Nasacort AQ® (Aventis), Nasonex® (Schering), RhinocortAqua® (AstraZeneca)
Biaxin® clarithromycin (generic)Biaxin XL® clarithromycin ER (generic)Biohist-LA® pseudoephedrine HCl/chlorpheniramine maleate
(generic)Brethine® terbutaline sulfate (generic)Brevicon® Necon® (Watson-branded generic*), Nortrel®
(Barr-branded generic*)Brovana® Foradil® (Schering), Proair HFA® (Teva), Serevent Diskus®
(GlaxoSmithKline)
Buspar® buspirone HCl (generic)Butisol Sodium® chloral hydrate (generic), temazepam (generic),
triazolam (generic)Bystolic® atenolol (generic), metoprolol tartrate (generic)Caduet® amlodipine besylate (generic), Lipitor® (Pfizer)Calan SR® verapamil HCl tablet, sustained action (generic)Capoten® captopril (generic)Capozide® captopril/hydrochlorothiazide (generic)Carafate Tablet® sucralfate (generic)Cardene SR® amlodipine besylate (generic), nifedipine ER (generic),
Sular® (First-Horizon)Cardizem® diltiazem HCl (generic)Cardizem CD® diltiazem HCl capsule, sustained release 24 hr
(generic)Cardizem SR® diltiazem HCl capsule, sustained release 12 hr
(generic)Cardura® doxazosin mesylate (generic)Cataflam® etodolac (generic), ibuprofen (generic), naproxen
(generic)Catapres® clonidine HCl (generic)Ceclor CD® cefaclor (generic), cefdinir (generic),
cefuroxime axetil (generic)
*Branded generics have the same co-payment as regular generics.
23
Cedax® cefaclor (generic), cefdinir (generic),cefuroxime axetil (generic)
Ceftin cefuroxime axetil (generic)Suspension®
Ceftin Tablet® cefuroxime axetil (generic)250mg, 500mg
Cefzil® cefaclor (generic), cefdinir (generic),cefuroxime axetil (generic)
Celexa® citalopram (generic)Cipro Tablet® ciprofloxacin HCl tablet (generic)Clarinex-D Allegra-D® (Aventis)
12 Hour®
Clarinex-D Allegra-D® (Aventis)24 Hour®
Cleocin HCl® clindamycin HCl (generic)Climara Pro® Combipatch® (Novartis)Clinoril® sulindac (generic)Clorpres® clonidine HCl (generic), chlorthalidone (generic)Cognex® Aricept® (Eisai), Exelon® (Novartis), Razadyne®
(Janssen Pharmaceuticals)Colestid® cholestyramine (generic), Welchol® (Sankyo)Coreg® carvedilol (generic)
Corgard® nadolol (generic)Corzide® bisoprolol fumarate/hydrochlorothiazide (generic),
metoprolol/hydrochlorothiazide (generic), propranololHCl/hydrochlorothiazide (generic)
Cytotec® misoprostol (generic)Dallergy® syrup pseudoephedrine HCl/brompheniramine maleate
(generic)Dalmane® flurazepam HCl (generic)Daypro® oxaprozin (generic)Deconamine® pseudoephedrine w/chlorpheniramine (generic)
tabletDemulen® Zovia® (Watson-branded generic*)Desogen® Apri® (Barr-branded generic*),
Solia® (Prasco Labs-branded generic*)Desyrel® trazodone HCl (generic)DiaBeta® glyburide (generic)Diclofenac etodolac (generic), ibuprofen (generic), naproxen
Potassium (generic)
*Branded generics have the same co-payment as regular generics.
Nonpreferred Possible Preferred ProductsProduct
Nonpreferred Possible Preferred ProductsProduct
24
Diclofenac etodolac (generic), ibuprofen (generic), naproxen Sodium (generic)
Diflucan® fluconazole (generic)Dilacor XR® diltiazem XR (generic)Dispermox® amoxicillin trihydrate suspension (generic),
amoxicillin trihydrate chewable tablet (generic)Ditropan XL® oxybutynin chloride ER (generic)
Divigel® estradiol patch (generic)Doral® temazepam (generic), triazolam (generic), zaleplon
(generic), zolpidem tartrate (generic), Restoril®
(Mallinckrodt)Doryx® doxycycline hyclate (generic)Duoneb® ipratropium/albuterol sulfate (generic)Duricef® cefadroxil hydrate (generic)Dynacin® minocycline HCl (generic), myrac (generic)DynaCirc® isradipine (generic), amlodipine besylate (generic),
nifedipine ER (generic), Sular® (First-Horizon)DynaCirc CR® amlodipine besylate (generic), nifedipine ER (generic),
Sular® (First-Horizon)EC-Naprosyn® naproxen (generic)Effexor® venlafaxine HCl (generic)Elavil® amitriptyline HCl (generic)Elestrin® estradiol patch (generic), Climara® (Berlex), Estraderm®
(Novartis), Vivelle® (Novogyne)
Emsam® tranylcypromine sulfate (generic), Nardil® (Parke-Davis)Enduronyl Forte® hydrochlorothiazide (generic), methyldopa/HCTZ
(generic)EryPed Chewable erythromycin ethylsuccinate (generic)Tablet® 200mg
EryPed erythromycin ethylsuccinate (generic)Suspension®
400mg/5mlEstrace Tablet® estradiol (generic)Estrace Vaginal Premarin Vaginal Cream® (Wyeth)
Cream®
Estrasorb® estradiol patch (generic)Estrogel® estradiol patch (generic), Climara Patch® (Berlex),
Estraderm Patch® (Novartis), Vivelle Patch® (Novartis)Estrostep Fe® Apri® (Barr-branded generic*), Kariva® (Barr-branded
generic*), Microgestin Fe® (Watson-branded generic*),Cyclessa® (Organon)
*Branded generics have the same co-payment as regular generics.
25
Factive® ciprofloxacin (generic), Levaquin® (J&J)Feldene® piroxicam (generic)Femhrt® estradiol/norethindrone acetate (generic),
Activella® 0.5-0.1mg (Novo Nordisk), Premphase®
(Wyeth), Prempro® (Wyeth)Femring® Estring® (Pfizer), Premarin Vaginal Cream® (Wyeth)Femtrace® estradiol (generic)Flonase® fluticasone propionate (generic)Floxin® ofloxacin (generic)Fortamet® metformin HCl ER (generic), metformin HCl tablet
(generic)Fosamax® Tablets alendronate sodium (generic)Gantrisin® sulfisoxazole (generic)Geocillin® ciprofloxacin HCl (generic)Glucophage® metformin HCl (generic)Glucophage XR® metformin HCl ER (generic), metformin HCl tablet
(generic)Glucotrol® glipizide (generic)Glucotrol XL® glipizide ER (generic)Glucovance® glyburide/metformin HCl (generic)Glynase® glyburide, micronized (generic)Glyset® acarbose (generic)Grifulvin V® griseofulvin ultramicrosize (generic), itraconazole
(generic), ketoconazole (generic), terbinafine HCl(generic)
Gris-Peg® griseofulvin ultramicrosize (generic), itraconazole(generic), ketoconazole (generic), terbinafine HCl(generic)
Guanabenz clonidine HCl (generic), methyldopa (generic)Acetate®
Halcion® triazolam (generic)Hiprex® methenamine hippurate (generic)Hytrin® terazosin (generic)Inderal® propranolol HCl (generic)Inderal LA® propranolol capsule, sustained action (generic)Indocin® indomethacin (generic)Innopran XL® propranolol capsule, sustained action (generic)Invega® risperidone (generic), Geodon® (Pfizer), Seroquel®
(AstraZeneca), Seroquel XR® (AstraZeneca),Zyprexa® (Eli Lilly)
*Branded generics have the same co-payment as regular generics.
Nonpreferred Possible Preferred ProductsProduct
Nonpreferred Possible Preferred ProductsProduct
26
Isoptin S.R.® verapamil HCl tablet, sustained action (generic)Keflex® cephalexin monohydrate (generic)Kerlone® betaxolol HCl (generic)Ketek® amoxicillin trihydrate/potassium clavulanate (generic),
azithromycin (generic), Levaquin® (J&J)Lamisil® terbinafine HCl (generic)
Lescol® lovastatin (generic), simvastatin (generic), Altoprev®
(Andrx), Crestor® (AstraZeneca), Lipitor® (Pfizer),VytorinTM (Merck/Schering)
Lescol XL® lovastatin (generic), simvastatin (generic), Altoprev®
(Andrx), Crestor® (AstraZeneca), Lipitor® (Pfizer),VytorinTM (Merck/Schering)
Levatol® acebutolol HCl (generic), atenolol (generic),metoprolol tartrate (generic)
Levlen® Levora® (Watson-branded generic*), Portia®
(Barr-branded generic*)Levlite® Aviane® (Barr-branded generic*), Lessina®
(Barr-branded generic*), Lybrel® (Wyeth) Lexapro® citalopram (generic), fluoxetine HCl (generic),
paroxetine HCl (generic), sertraline HCl (generic),Effexor XR® (Wyeth), Pristiq® (Wyeth)
Lexapro Solution® citalopram solution (generic), fluoxetine HCl solution(generic), paroxetine HCl suspension (generic)
Lexxel® amlodipine besylate/benazepril (generic)Librium® chlordiazepoxide HCl (generic)Lodine® etodolac (generic)Lodine XL® etodolac (generic)Loestrin® Junel® (Barr-branded generic*), Microgestin®
(Watson-branded generic*)Loestrin Fe® Junel Fe® (Barr-branded generic*), Microgestin Fe®
(Watson-branded generic*)Loestrin 24 Fe® Junel Fe® (Barr-branded generic*), Microgestin Fe®
(Watson-branded generic*)Lofibra® fenofibrate (generic), Triglide® (First Horizon)Lo/Ovral® Low-Ogestrel® (Watson-branded generic*)Lopid® gemfibrozil (generic)Lopressor® metoprolol tartrate (generic)Lopressor HCT® metoprolol/hydrochlorothiazide (generic)Lotensin® benazepril HCl (generic)Lotensin HCT® benazepril HCl/hydrochlorothiazide (generic)
*Branded generics have the same co-payment as regular generics.
27
Lotrel® 2.5-10mg, amlodipine besylate/benazepril (generic)5-10mg, 5-20mg,10-20mg
Ludiomil® maprotiline HCl (generic)Lunesta® temazepam (generic), zolpidem tartrate (generic),
Ambien CR® (Sanofi-Aventis)Luvox® fluvoxamine maleate (generic)Luvox CR® fluvoxamine maleate (generic)Macrobid® nitrofurantoin macrocrystal (generic)Macrodantin® nitrofurantoin (generic)Mandelamine® methenamine mandelate (generic)Mavik® trandolapril HCl (generic)Maxaquin® ciprofloxacin HCl (generic), Levaquin® (J&J)Menest® estradiol (generic), estropipate (generic), Cenestin®
(Duramed/Barr), Enjuvia® (Duramed/Barr),Premarin® (Wyeth)
Menostar Patch® Climara Patch® (Berlex), Vivelle Patch® (Novartis)Metaglip® glipizide/metformin (generic)Mevacor® lovastatin (generic)Micronase® glyburide (generic)Midrin® isometheptene/apap/dichloralphenazone (generic)Migranal® Imitrex® Nasal Spray (GlaxoSmithKline), Zomig® Nasal
Spray (AstraZeneca), Amerge® (GlaxoSmithKline), Frova®
(Endo), Maxalt® (Merck), Relpax® (Pfizer)Minipress® prazosin HCl (generic)Minocin® minocycline HCl (generic)Mircette® Kariva® (Barr-branded generic*)Mobic® meloxicam (generic)Modicon® Necon® (Watson-branded generic*), Nortrel®
(Barr-branded generic*)Monistat 3 Vaginal miconazole 3 vaginal suppository (generic)
Suppository®
Monodox® doxycycline monohydrate (generic)Monopril® fosinopril sodium (generic)Monopril HCT® fosinopril/hydrochlorothiazide (generic)Monurol® ciprofloxacin HCl (generic), sulfamethoxazole/
trimethoprim (generic), trimethoprim (generic),Noroxin® (Merck)
Motrin® ibuprofen (generic)
*Branded generics have the same co-payment as regular generics.
Nonpreferred Possible Preferred ProductsProduct
Nonpreferred Possible Preferred ProductsProduct
28
Nalfon® etodolac (generic), ibuprofen (generic), indomethacin(generic), meclofenamate sodium (generic),naproxen (generic), sulindac (generic)
Namenda Aricept® (Eisai), Exelon® (Novartis), Razadyne®
Dose Pack® (Janssen Pharmaceuticals)Namenda Oral Exelon Oral Solution® (Novartis), Razadyne Oral
Solution® Solution® (Janssen Pharmaceuticals)Namenda Tablet® Aricept® (Eisai), Exelon® (Novartis), Razadyne® (Janssen
Pharmaceuticals)Naprelan® naproxen sodium (generic)Naprosyn® naproxen (generic)Nasacort® Nasacort AQ® (Aventis)Nasalide® flunisolide (generic)Nasarel® flunisolide (generic), fluticasone propionate (generic),
Nasacort AQ® (Aventis), Nasonex® (Schering), RhinocortAqua® (AstraZeneca)
Nembutal chloral hydrate (generic), temazepam (generic),Sodium® triazolam (generic)
Nimotop® nimodipine (generic)Niravam® alprazolam (generic)Nitro-Dur® nitroglycerin patch (generic), Minitran® (3M)Nizoral® ketoconazole (generic)Nordette® Levora® (Watson-branded generic*), Portia®
(Barr-branded generic*)Norinyl® Necon® (Watson-branded generic*), Nortrel®
(Barr-branded generic*)Normodyne® labetalol HCl (generic)Norpramin® desipramine HCl (generic)Norvasc® amlodipine besylate (generic)Novolin® Humulin® (Eli Lilly)Ogen® estropipate (generic)Omnaris® flunisolide (generic), fluticasone propionate (generic),
Nasacort AQ® (Aventis), Nasonex® (Schering), RhinocortAqua® (AstraZeneca)
Omnicef® cefdinir (generic)Orinase® tolbutamide (generic)Ortho-Cept® Apri®(Barr-branded generic*), Solia®
(Prasco Labs-branded generic*)Ortho-Cyclen® MonoNessa® (Watson-branded generic*), Previfem®
(Teva-branded generic*), Sprintec® (Barr-branded generic*)
*Branded generics have the same co-payment as regular generics.
29
Ortho Evra® MonoNessa® (Watson-branded generic*), TriNessa®
(Watson-branded generic*)Ortho Micronor® norethindrone acetate (generic)Ortho-Novum® Necon® (Watson-branded generic*), Nortrel®
1/35, 7/7/7 (Barr-branded generic*)Ortho-Novum® Necon® (Watson-branded generic*)
1/50Ortho-Prefest® estradiol/norethindrone acetate (generic),
Activella® 0.5-0.1mg (Novo Nordisk), Premphase®
(Wyeth), Prempro® (Wyeth)Ortho Tri-Cyclen® TriNessa® (Watson-branded generic*), Tri-Previfem®
(Teva-branded generic*), Tri-Sprintec® (Barr-brandedgeneric*)
Oruvail® ketoprofen (generic)Ovcon® Necon® (Watson-branded generic*)Ovral® Ogestrel® (Watson-branded generic*)Pamelor® nortriptyline HCl (generic)Parnate® tranylcypromine sulfate (generic)Paxil® paroxetine HCl (generic)Paxil CR® paroxetine HCl sustained release tab (generic)Paxipam® clorazepate dipotassium (generic), diazepam (generic),
lorazepam (generic), oxazepam (generic)PCE® erythromycin (generic)Pepcid famotidine (generic), cimetidine HCl liquid (generic),
Suspension® Axid Oral Solution® (Braintree)Pepcid Tablet® famotidine (generic)Periostat® doxycycline hyclate (generic)Pexeva® paroxetine HCl (generic)Phenergan® promethazine HCl (generic)Plendil® felodipine ER (generic)Ponstel® etodolac (generic), ibuprofen (generic), indomethacin
(generic), meclofenamate sodium (generic),naproxen (generic), sulindac (generic)
Pravachol® pravastatin (generic)Precose® acarbose (generic)Prevacid® omeprazole (generic), Nexium® (AstraZeneca)Prilosec Rx® omeprazole (generic), Nexium® (AstraZeneca)Primsol® trimethoprim (generic)Prinivil® lisinopril (generic)Prinzide® lisinopril/hydrochlorothiazide (generic)
*Branded generics have the same co-payment as regular generics.
Nonpreferred Possible Preferred ProductsProduct
Nonpreferred Possible Preferred ProductsProduct
30
Procardia XL® nifedipine ER tablet, sustained release osmotic push(generic)
Proquin XR® ciprofloxacin HCl (generic)ProSom® estazolam (generic)Protonix® Nexium® Suspension (AstraZeneca)
SuspensionProtonix® Tablet pantoprazole sodium (generic), omeprazole (generic),
Nexium® (AstraZeneca)Proventil® albuterol (generic)Proventil HFA® Proair HFA® (Teva), Xopenex HFA® (Sepracor)Prozac® fluoxetine HCl (generic)Prozac Weekly® fluoxetine HCl (generic)Questran® cholestyramine (generic), prevalite (generic)Questran Light® cholestyramine/aspartame (generic), prevalite (generic)Raniclor® tablet, cefaclor suspension (generic), cefaclor capsule
chewable (generic)Razadyne® tablet galantamine (generic)Relafen® nabumetone (generic)Remeron® mirtazapine soltabs (generic), mirtazapine tabs
(generic)Restoril® temazepam (generic)
15mg, 30mgRiomet Solution® metformin HCl (generic)Risperdal risperidone (generic)
Oral Solution®
Risperdal Tablet® risperidone (generic)
Rozerem® estazolam (generic), temazepam (generic), triazolam(generic), zolpidem tartrate (generic), Ambien CR®
(Sanofi-Aventis)Rynatan® phenclor tannate pediatric (generic),
brompheniramine/pseudoephedrine (generic),pseudoephedrine HCl/chlorpheniramine maleate(generic)
Rynatuss® carbetapentane/ephed/phenyleph/CP (generic)Sanctura® oxybutynin chloride (generic), oxybutynin chloride ER
(generic), Detrol® (Pharmacia/Upjohn), Detrol LA®
(Pharmacia/Upjohn), Enablex® (Novartis), Vesicare®
(GlaxoSmithKline)Sanctura XR® oxybutynin chloride ER (generic), Detrol LA®
(Pharmacia/Upjohn), Enablex® (Novartis), Vesicare®
(GlaxoSmithKline)
*Branded generics have the same co-payment as regular generics.
31
Sarafem® fluoxetine HCl (generic)Seasonale® Jolessa® (Barr-branded generic*), Quasense®
(Watson-branded generic*), Lybrel® (Wyeth),Seasonique® (Duramed/Barr)
Seconal Sodium® chloral hydrate (generic), temazepam (generic),triazolam (generic)
Sectral® acebutolol HCl (generic)Semprex-D® pseudoephedrine HCl/brompheniramine (generic),
pseudoephedrine HCl/chlorpheniramine (generic)Septra DS® sulfamethoxazole/trimethoprim (generic)Serax® oxazepam (generic)Serzone® fluoxetine HCl (generic), paroxetine HCl (generic)Sinequan® doxepin HCl (generic)Solodyn® minocycline HCl (generic), doxycycline monohydrate
(generic)Sonata® zaleplon (generic)Spectracef® cefaclor (generic), cefdinir (generic), cefuroxime axetil
(generic)Sporanox® itraconazole (generic)
capsuleSuprax® cefdinir (generic), cefuroxime axetil (generic)Surmontil® trimipramine maleate (generic)
25mg, 50mgSymbyax® fluoxetine HCl (generic), risperidone (generic),
Seroquel® (AstraZeneca), Seroquel XR® (AstraZeneca),Zyprexa® (Eli Lilly)
Tagamet® cimetidine (generic)Tarka® amlodipine besylate/benazepril (generic)Tenex® guanfacine HCl (generic)Tenoretic® atenolol/chlorthalidone (generic)Tenormin® atenolol (generic)Tequin® Levaquin® (J&J)Terazol® terconazole (generic)Teveten® Atacand® (AstraZeneca), Benicar® (Daiichi Sankyo),
Cozaar® (Merck), Diovan® (Novartis), Micardis® (BIPI)Teveten HCT® Atacand HCT® (AstraZeneca), Benicar HCT® (Daiichi
Sankyo), Diovan HCT® (Novartis), Hyzaar® (Merck),Micardis HCT® (BIPI)
Thioridazine HCl® chlorpromazine HCl (generic), haloperidol (generic),risperidone (generic), Seroquel® (AstraZeneca)
*Branded generics have the same co-payment as regular generics.
Nonpreferred Possible Preferred ProductsProduct
Nonpreferred Possible Preferred ProductsProduct
32
Tiazac® 120mg, diltiazem HCl capsule, sustained release 24 hr 180mg, 240mg, (generic)300mg, 360mg
Tiazac® 420mg Cardizem LA® (Biovail)Tofranil® imipramine HCl (generic)Toprol XL® metoprolol succinate (generic)Toradol® etodolac (generic), ibuprofen (generic), indomethacin
(generic), meclofenamate sodium (generic),naproxen (generic), sulindac (generic)
Trandate® labetalol HCl (generic)Tranxene SD® clorazepate dipotassium (generic)Tranxene T-Tab® clorazepate dipotassium (generic)Treximet® naproxen (generic), Imitrex® (GlaxoSmithKline)Tri-Levlen® Enpresse® (Barr-branded generic*), Trivora®
(Watson-branded generic*)Tri-Norinyl® Necon® (Watson-branded generic*), Nortrel®
(Barr-branded generic*)Triphasil® Enpresse® (Barr-branded generic*), Trivora®
(Watson-branded generic*)Uniretic® moexipril/hydrochlorothiazide (generic)Univasc® benazepril (generic), enalapril maleate (generic),
lisinopril (generic), Aceon® (Solvay Pharmaceuticals),Altace® (Monarch)
Valium® diazepam (generic)Vantin cefaclor suspension (generic), cefdinir suspension
Suspension® (generic)Vantin Tablet® cefpodoxime proxetil tablet (generic)Vaseretic® enalapril maleate/hydrochlorothiazide (generic)Vasotec® enalapril maleate (generic)Velosef® cephradine (generic)Ventolin® albuterol (generic)Ventolin HFA® albuterol (generic), Proair HFA® (Teva), Xopenex HFA®
(Sepracor)Verelan® verapamil ER (generic)Verelan PM® verapamil ER PM (generic)Vfend Suspension® Vfend Tablet® (Pfizer)Vibramycin Syrup® doxycycline monohydrate suspension (generic)Vistaril® hydroxyzine pamoate (generic)Vivactil® protriptyline HCl (generic)Volmax® albuterol sulfate (generic)
*Branded generics have the same co-payment as regular generics.
33
Voltaren® etodolac (generic), ibuprofen (generic), naproxen(generic)
Voltaren-XR® etodolac (generic), ibuprofen (generic), naproxen(generic)
Wellbutrin® bupropion HCl (generic)Wellbutrin SR® bupropion HCl tablet, sustained release (generic)Wellbutrin XL® bupropion tablet, sustained release (generic)Wytensin® clonidine HCl (generic), methyldopa (generic)Xanax® alprazolam (generic)Xanax XR® alprazolam XR (generic)Xifaxan® azithromycin (generic), ciprofloxacin HCl (generic)Xolair® Asmanex® (Schering), Flovent HFA® (GlaxoSmithKline),
Pulmicort® (AstraZeneca), QVAR® (Ivax)Xyzal Solution® fexofenadine HCl (generic), Allegra Suspension®
(Aventis), Clarinex® Rapid Dissolve Tabs (Schering)Xyzal Tablet® fexofenadine HCl (generic), Clarinex® Tablet (Schering)Yasmin® Ocella® (Barr-branded generic*)Zantac Rx Syrup® ranitidine HCl tablet (generic), Axid Oral Solution®
(Braintree)Zantac Rx Tablet® ranitidine HCl tablet (generic)Zebeta® bisoprolol fumarate (generic)Zegerid® omeprazole (generic), Nexium® (AstraZeneca)Zestoretic® lisinopril/hydrochlorothiazide (generic)Zestril® lisinopril (generic)Ziac® bisoprolol fumarate/hydrochlorothiazide (generic)Zithromax® azithromycin (generic)Zmax® azithromycin (generic)Zocor® simvastatin (generic)Zoloft® sertraline HCl (generic)Zyflo® Singulair® (Merck)Zyflo CR® Singulair® (Merck)
*Branded generics have the same co-payment as regular generics.
Nonpreferred Possible Preferred ProductsProduct
This guide does not contain a complete list of formulary and nonformulary drugs. It only liststhe most commonly prescribed drugs. For anupdated and complete listing of your prescriptionbenefit, you can visit the “Benefit highlights”section of our website, www.medco.com, and click on “Learn about formularies” or by callingcustomer service at the phone number on theback of your prescription card.
www.medco.com
Medco and Preferred Prescriptions are trademarks of Medco Health Solutions, Inc.© 2008 Medco Health Solutions, Inc.All rights reserved.MG924590 MEIPG
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