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
DRUG NAME 1 2 3 SUGGESTED PREFFERED ALTERNATIVES PREFERA‐OB ONE X prenatal mv & min capsule PREFERA‐OB PLUS DHA X hemenatal ob+dha combo pk PRENATE DHA X generic Rx prenatal vitamans PRENATE ELITE X generic Rx prenatal vitamans PRENATE ESSENTIAL X generic Rx prenatal vitamans 13.1.2 SPECIALIZED OB/GYN DRUGS leuprolide acetate PA X novarel X CETROTIDE X GANIRELIX ACETATE X LUPRON DEPOT PA X ELIGARD, TRELSTAR OVIDREL X ch.gonadotrpin,novarel 13.1.3 OB/GYN TOPICAL ANTIINFECTIVES clindamycin phosphate X metronidazole X vandazole X 13.2 OVULATORY STIMULANTS clomiphene citrate X BRAVELLE X GONAL‐F/RFF FOLLISTIM AQ X GONAL‐F/RFF GONAL‐F/RFF X 13.3 ANDROGEN DRUGS testosterone cypionate X ANDRODERM X ANDROGEL X AXIRON X FORTESTA X ANDRODERM, ANDROGEL, AXIRON STRIANT X ANDRODERM, ANDROGEL, AXIRON TESTIM X ANDRODERM, ANDROGEL, AXIRON 13.4 ESTROGEN DRUGS estradiol X estrogen & methyltestosterone X estrogen‐methyltestosterone X estropipate X CENESTIN X DIVIGEL X ELESTRIN X estradiol ptch, DIVIGEL, EVAMIST ENJUVIA X ESTRACE X VAGIFEM ESTRASORB X estradiol ptch, DIVIGEL, EVAMIST ESTRING X VAGIFEM ESTROGEL X estradiol ptch, DIVIGEL, EVAMIST EVAMIST X MENEST X estradiol, CENESTIN, ENJUVIA, PREMARN TIER
DRUG NAME 1 2 3 SUGGESTED PREFFERED ALTERNATIVES MENOSTAR X gen estradiol ptch, VIVELLE‐DOT PREMARIN X VAGIFEM X VIVELLE‐DOT X 13.4.1 ESTROGEN/PROGESTIN COMBINATIONS jinteli X ACTIVELLA X estradiol/noreth acetate ANGELIQ X ee/noreth ac, PREMPHASE/PREMPRO CLIMARA PRO X COMBIPATCH X FEMHRT X ee/noreth ac, PREMPHASE/PREMPRO PREFEST X ee/noreth ac, PREMPHASE/PREMPRO PREMPHASE X PREMPRO X 13.4.3 SELECTIVE ESTROGEN RECEPTOR MODULATOR EVISTA X 13.5 PROGESTIN DRUGS camila X errin X jolivette X medroxyprogesterone acetate X nora‐be X norethindrone X norethindrone acetate X progesterone in oil X CRINONE X ENDOMETRIN X MAKENA X PROMETRIUM X progesterone 13.7 CONTRACEPTIVES altavera X apri X aranelle X aviane X azurette X balziva X camrese X cesia X cryselle X cyclafem X enpresse X gildess fe X jolessa X junel X TIER
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DRUG NAME<br />
1 2 3 SUGGESTED PREFFERED ALTERNATIVES<br />
MENOSTAR X gen estradiol ptch, VIVELLE‐DOT<br />
PREMARIN X<br />
VAGIFEM X<br />
VIVELLE‐DOT X<br />
13.4.1 ESTROGEN/PROGESTIN COMBINATIONS<br />
jinteli X<br />
ACTIVELLA X estradiol/noreth acetate<br />
ANGELIQ X ee/noreth ac, PREMPHASE/PREMPRO<br />
CLIMARA PRO X<br />
COMBIPATCH X<br />
FEMHRT X ee/noreth ac, PREMPHASE/PREMPRO<br />
PREFEST X ee/noreth ac, PREMPHASE/PREMPRO<br />
PREMPHASE X<br />
PREMPRO X<br />
13.4.3 SELECTIVE ESTROGEN RECEPTOR MODULATOR<br />
EVISTA X<br />
13.5 PROGESTIN DRUGS<br />
camila X<br />
errin X<br />
jolivette X<br />
medroxyprogesterone acetate X<br />
nora‐be X<br />
norethindrone X<br />
norethindrone acetate X<br />
progesterone in oil X<br />
CRINONE X<br />
ENDOMETRIN X<br />
MAKENA X<br />
PROMETRIUM X progesterone<br />
13.7 CONTRACEPTIVES<br />
altavera X<br />
apri X<br />
aranelle X<br />
aviane X<br />
azurette X<br />
balziva X<br />
camrese X<br />
cesia X<br />
cryselle X<br />
cyclafem X<br />
enpresse X<br />
gildess fe X<br />
jolessa X<br />
junel X<br />
TIER
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