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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DRUG NAME<br />
1 2 3 SUGGESTED PREFFERED ALTERNATIVES<br />
ORTHO EVRA X generics, BEYAZ, LOESTRIN 24/LO LOESTRIN,<br />
NATAZIA, NUVARING, SAFYRAL<br />
ORTHO TRI‐CYCLEN X trinesa, tri‐previ, tri‐sprint<br />
ORTHO TRI‐CYCLEN LO X generics, BEYAZ, LOESTRIN 24/LO LOESTRIN,<br />
NATAZIA, NUVARING, SAFYRAL<br />
SAFYRAL X<br />
SEASONIQUE X amethia, camrese<br />
YASMIN 28 X ocella,syeda,zarah<br />
YAZ X gianvi, loryna, vestura<br />
CHAPTER 14: OPHTHALMIC MEDICATIONS<br />
14.1.1 OPHTHALMIC TOPICAL ANTIBACTERIAL DRUGS<br />
bacitracin X<br />
bacitracin‐polymyxin X<br />
ciprofloxacin hcl X<br />
erythromycin X<br />
gentamicin sulfate X<br />
neomycin‐bacitracin‐polymyxin X<br />
ofloxacin X<br />
polymyxin b sul‐trimethoprim X<br />
sulfacetamide sodium X<br />
AZASITE X<br />
BESIVANCE X generic, MOXEZA, VIGAMOX, ZYMAXID<br />
MOXEZA X<br />
VIGAMOX X<br />
ZYMAXID X<br />
14.1.2 OPHTHALMIC TOPICAL ANTIVIRAL DRUGS<br />
trifluridine X<br />
14.2 OPHTHALMIC CORTICOSTEROID DRUGS<br />
fluorometholone X<br />
prednisolone acetate X<br />
ALREX X azelastine, PATADAY, PATANOL<br />
DUREZOL X<br />
FML FORTE X generics, DUREZOL, LOTEMAX SOLN<br />
LOTEMAX X<br />
VEXOL X generics, DUREZOL, LOTEMAX SOLN<br />
14.3 OPHTHALMIC ANTIINFECTIVE/CORTICOSTEROIDS<br />
neomycin‐polymyxin‐dexameth X<br />
neomycin‐polymyxin‐hc X<br />
tobramycin‐dexamethasone X<br />
TOBRADEX X tobramycin sulfate/dexameth<br />
TOBRADEX ST X<br />
ZYLET X<br />
14.5 ANTIGLAUCOMA DRUGS<br />
acetazolamide X<br />
TIER
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