General InformationThe drugs listed below represent the most commonly used medications (names in lower case letters are generic names). The list is not all inclusive nor does it guarantee coverage. Drugs may be subject to quantity, age, or gender limitations.
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Tier 1 - Generic Drugs on the FormularyCurrent as of 7/1/2007
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| acetaminophen/codeine |
acetaminophen/hydrocodone |
| acyclovir |
albuterol HFA inhaler |
| alclometasone topical |
allopurinol |
| alprazolam |
amantadine |
| amiloride/hydrochlorothiazide |
amitriptyline |
| amlodipine |
amoxicillin |
| amoxicillin/clavulanate |
Apri |
| atenolol |
Aviane |
| azathioprine |
baclofen |
| benazepril |
benztropine |
| betamethasone topical |
bisoprolol |
| bromocriptine |
bumetanide |
| bupropion |
buspirone |
| calcitriol |
captopril |
| carbidopa/levodopa |
cefaclor |
| cefadroxil |
cefpodoxime |
| cefuroxime |
cephalexin |
| ciclopirox topical |
cilostazol |
| ciprofloxacin |
citalopram |
| clarithromycin |
clindamycin |
| clobetasol topical |
clonazepam |
| clonidine |
clopidogrel |
| clotrimazole |
clozapine |
| colchicine |
Cryselle |
| cyclobenzaprine |
desipramine |
| dexamethasone |
diazepam |
| diclofenac |
diflunisal |
| digoxin |
diltiazem |
| dipyridamole |
doxazosin |
| doxepine |
doxycycline |
| enalapril |
Enpresse |
| erythromycin |
erythromycin/sulfisoxazole |
| estradiol |
estropipate |
| etodolac |
felodipine |
| finasteride |
flecainide |
| fluconazole* |
fludrocortisone |
| fluocinonide topical |
fluoxetine |
| flurazepam |
fluticasone nasal |
| fluticasone topical |
fluvoxamine |
| fosinopril |
furosemide |
| gabapentin |
gemfibrozil |
| glipizide |
glyburide |
| glyburide/metformin |
guanfacine |
| haloperidol |
hydralazine |
| hydrochlorothiazide |
hydroxychloroquine |
| hydroxyzine |
imipramine |
| indapamide |
indomethacin |
| ipratropium nasal |
isosorbide |
| itraconazole* |
Kariva |
| ketoconazole |
ketoprofen |
| labetalol |
Lessina |
| levobunolol |
Levora |
| levothyroxine |
lisinopril |
| lorazepam |
lovastatin |
| Low-Ogestrel |
medroxyprogesterone oral |
| metformin |
methotrexate |
| methyldopa |
methylprednisolone |
| metoclopramide |
metolazone |
| metoprolol |
metronidazole |
| Microgestin |
minocycline |
| mirtazapine |
misoprostol |
| mometasone topical |
Mononessa |
| nabumetone |
nadolol |
| naproxen |
Necon |
| nefazodone |
nicardipine |
| nifedipine |
nitrofurantoin |
| nitroglycerin |
norethindrone |
| Nortrel |
nortriptyline |
| ofloxacin |
oxaprozin |
| oxybutynin |
paroxetine |
| penicillin |
phenobarbital |
| phenytoin |
pilocarpine |
| piroxicam |
potassium chloride |
| pravastatin |
prazosin |
| prednisolone |
prednisone |
| prenatal vitamins |
primidone |
| Pro-Air HFA |
probenecid |
| prochlorperazine |
promethazine/codeine |
| propafenone |
propranolol |
| quinapril |
quinidine |
| risperidone |
salsalate |
| sertraline |
simvastatin |
| sotalol |
spironolactone |
| Sprintec |
sucralfate |
| sulfamethoxazole/trimethoprim |
sulindac |
| tamoxifen |
temazepam |
| terazosin |
tetracycline |
| theophylline |
thioridazine |
| ticlopidine |
timolol |
| tizanidine |
tobramycin |
| torsemide |
trazodone |
| tretinoin topical* |
Tri-Sprintec |
| triamcinolone topical |
triamterene/hydrochlorothiazide |
| Trinessa |
Trivora |
| verapamil |
warfarin |
| zolpidem |
Zovia |
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Tier 2 - Brand Name Drugs on the FormularyCurrent as of 7/1/2007
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| Abilify |
Accu-Chek |
| Actonel |
Actos |
| Adderall XR |
Advair |
| Aggrenox |
Aldara* |
| Alrex |
Altace |
| Amaryl |
Anzemet |
| Aricept |
Asacol |
| Asmanex |
Astelin |
| Avandia |
Avandmet |
| Avonex |
Azilect |
| Azopt |
Bactroban |
| Benicar |
Benicar HCT |
| Betaseron |
Betimol |
| Betoptic S |
Byetta |
| Canasa |
Carbatrol |
| Cefzil |
Chantix |
| Chemstrip |
Ciloxan |
| CombiPatch |
Combivent |
| Concerta |
Copaxone |
| Coreg |
Cosopt |
| Covera-HS |
Cymbalta* |
| Cytomel |
Depakote |
| Detrol LA |
Differin* |
| Diovan |
Diovan HCT |
| Dovonex |
DuoNeb |
| Effexor* |
Elidel |
| Enbrel* |
Epipen |
| Evista |
Exelon |
| Famvir |
Femara |
| FemHRT |
Flomax |
| Flovent HFA |
FML Forte |
| Foradil |
Fosamax |
| Foteo* |
Fragmin |
| Glyset |
Humalog |
| Humira* |
Humulin |
| Imitrex |
Increlex* |
| Iplex* |
Januvia |
| Keppra |
Kytril |
| Lamictal |
Lantus |
| Levemir |
Lexapro |
| Lotemax |
Lotrel |
| Lovenox |
Lumigan |
| Lyrica* |
Maxalt |
| Metadate CD |
Miacalcin |
| Namenda |
Nasonex |
| Niaspan |
Nitrolingual |
| Novalog |
Novolin |
| Nuvaring |
Omnicef |
| One Touch |
Ortho Evra |
| Patanol |
Pentasa |
| PhosLo |
Plavix |
| Prandin |
Precose |
| Premarin |
Premphase |
| Prempro |
Prometrium |
| Protopic |
Pulmicort |
| Relenza |
Requip |
| Restasis |
Serevent |
| Seroquel |
Singulair* |
| Strattera |
Surestep |
| Symlin |
Synthroid |
| Tamiflu |
Tazorac* |
| Tegretol XR |
Tilade |
| Tobradex |
Topamax |
| Trileptal |
Trusopt |
| Uniphyl |
Uroxatral |
| Vexol |
Vigamox |
| Vytorin |
Xalatan |
| Zetia |
Zofran |
| Zonegran |
Zymar |
| Zyprexa |
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Tier 3 - Brand Name Drugs Not on the FormularyCurrent as of 7/1/2007
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| Accolate* |
Aciphex |
| Activella |
Advicor* |
| Aerobid |
Allegra |
| Allegra-D |
Altocor* |
| Ambien CR* |
Amerge |
| Amitiza |
Angeliq |
| Antara |
Ascensia |
| Atacand |
Atacand HCT |
| Augmentin XR |
Avalide |
| Avapro |
Avelox |
| Avodart |
Axert |
| Azmacort |
Beconase AQ |
| BiDil |
Boniva |
| Caduet* |
Cardizem LA |
| Cedax |
Celebrex |
| Cenestin |
Cesamet |
| Cipro XR |
Clarinex |
| Colazal |
Cozaar |
| Crestor* |
Daytrana |
| Dipentum |
Dynabac |
| Enablex |
Estrogel |
| Estrostep FE |
Exforge |
| Exubera |
Focalin XR |
| Freestyle |
Frova |
| Gantrisin |
Glucometer |
| Glucovance |
Hyzaar |
| Innopran XL |
Inspra |
| Lescol* |
Lexxel |
| Lipitor* |
Lofibra |
| Lorabid |
Lunesta* |
| Lybrel |
Mavik |
| Maxair |
Maxaquin |
| Menest |
Metaglip |
| Micadis HCT |
Micardis |
| Nasacort AQ |
Nasalide |
| Nexium |
Noroxin |
| Nuvigil* |
Opana |
| Ortho Prefest |
Ortho Tri-Cyclen Lo |
| Ovcon |
Oxytrol |
| Paxil CR |
PCE |
| Precision |
Prevacid |
| Protonix |
Provigil* |
| Prozac Weekly |
QVAR |
| Relpax |
Rhinocort Aqua |
| Rozerem* |
Rynatan |
| Sanctura |
Seasonale |
| Sensipar |
Skelid |
| Sonata* |
Starlix |
| Sular |
Suprax |
| Tarka |
Teveten |
| Teveten HCT |
Tricor |
| Uniretic |
Vantin |
| Ventolin HFA |
Verelan PM |
| Vesicare |
Welchol |
| Wellbutrin XL* |
Xopenex HFA* |
| Xyzal |
Yasmin |
| Zomig |
Zyflo CR* |
| Zyrtec |
Zyrtec-D |