Preferred Drug List 2013 Standard Formulary (3 ... - Express Scripts
Preferred Drug List 2013 Standard Formulary (3 ... - Express Scripts
Preferred Drug List 2013 Standard Formulary (3 ... - Express Scripts
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TIER<br />
DRUG NAME<br />
1 2 3<br />
primidone X<br />
SUGGESTED PREFFERED ALTERNATIVES<br />
5.4.7 OTHER ANTICONVULSANTS<br />
gabapentin X<br />
lamotrigine X<br />
levetiracetam X<br />
topiramate X<br />
zonisamide X<br />
GRALISE ST X gabapentin<br />
HORIZANT ST X gabapentin<br />
KEPPRA X levetiracetam<br />
KEPPRA XR X levetiracetam er<br />
LAMICTAL X lamotrigine<br />
LAMICTAL ODT X<br />
LAMICTAL XR X<br />
LYRICA ST X<br />
POTIGA X<br />
TOPAMAX X topiramate sprinkle caps<br />
VIMPAT PA X<br />
5.5.1.1 TERTIARY AMINES<br />
amitriptyline hcl X<br />
clomipramine hcl X<br />
doxepin hcl X<br />
imipramine hcl X<br />
5.5.1.2 SECONDARY AMINES<br />
desipramine hcl X<br />
nortriptyline hcl X<br />
5.5.1.3 SELECTIVE SEROTONIN REUPTAKE INHIBITORS<br />
citalopram X<br />
citalopram hbr X<br />
escitalopram oxalate X<br />
fluoxetine hcl X<br />
fluvoxamine maleate X<br />
paroxetine hcl X<br />
sertraline hcl X<br />
LEXAPRO X escitalopram<br />
LUVOX CR X generic SSRIs, VIIBRYD<br />
VIIBRYD ST X<br />
5.5.1.4 OTHER ANTIDEPRESSANTS<br />
bupropion hcl X<br />
bupropion hcl sr X<br />
bupropion xl X<br />
mirtazapine X<br />
trazodone hcl X<br />
venlafaxine hcl X