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 cyproheptadine hcl X diphenhydramine hcl X fexofenadine hcl X levocetirizine dihydrochloride X loratadine X promethazine hcl X CLARINEX X desloratadine XYZAL X levocetirizine ZYRTEC X 15.2.3 ANTIHISTAMINE/DECONGESTANT COMBINATIONS promethazine vc X ALLEGRA‐D 24 HOUR X CLARINEX‐D 12 HOUR X desloratadine CLARINEX‐D 24 HOUR X desloratadine ZYRTEC‐D X 15.3 ANTITUSSIVE AND EXPECTORANT DRUGS benzonatate X guaifenesin/codiene X guaifenesin‐codeine X promethazine vc‐codeine X promethazine‐codeine X promethazine‐dm X REZIRA X promethazine vc with codeine TUSSICAPS X TUSSIONEX X hydrocodone/chlorphen polis ZUTRIPRO X promethazine vc with codeine 15.4 OTHER RESPIRATORY DRUGS DALIRESP X PULMOZYME X CHAPTER 16: UROLOGICAL MEDICATIONS 16.1.1 ANTICHOLINERGIC ANTISPASMODICS oxybutynin chloride X oxybutynin chloride er X tolterodine tartrate X DETROL ST X tolterodine DETROL LA ST X ENABLEX ST X GELNIQUE ST X OXYTROL ST X SANCTURA XR ST X trospium er TOVIAZ ST X VESICARE ST X 16.1.2 CHOLINERGIC STIMULANTS bethanechol chloride X TIER
DRUG NAME 16.1.3 URINARY ANESTHETICS phenazopyridine hcl X TIER 1 2 3 SUGGESTED PREFFERED ALTERNATIVES 16.1.4 OTHER GENITOURINARY PRODUCTS alfuzosin hcl X finasteride X potassium citrate X tamsulosin hcl X AVODART X finasteride CIALIS X ELMIRON X FLOMAX X tamsulosin hcl JALYN X alfuzosn, finasterid, tamsulos LEVITRA X CIALIS, VIAGRA MUSE X MYRBETRIQ X RAPAFLO X STAXYN X CIALIS, VIAGRA VIAGRA X CHAPTER 17: DIAGNOSTIC & MISCELLANEOUS MEDICATIONS 17.1 DIAGNOSTIC PRODUCTS MINILINK REAL‐TIME TRANSMITTER X PARADIGM REAL‐TIME X PRECISION XTRA X SOF‐SENSOR X ACCU‐CHEK, ONE TOUCH 17.2 MISCELLANEOUS DRUGS THALOMID X 17.3.1 APPETITE SUPPRESSANTS phentermine hcl X QSYMIA X benzphet,diethylprop,phenterm CHAPTER 18: MEDICAL (MISCELLANEOUS) SUPPLIES 18.0 MEDICAL (MISCELLANEOUS) SUPPLIES AEROCHAMBER X CONCEPTION X MINIMED X MINIMED RESERVOIR X OPTICHAMBER X PARADIGM X PARADIGM INFUSION X PARADIGM SILHOUETTE X POLYFIN X POLYFIN QR X PRIMABELLA X QUICK RELEASE SOFT TEFLON X SILHOUETTE X
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DRUG NAME<br />
16.1.3 URINARY ANESTHETICS<br />
phenazopyridine hcl X<br />
TIER<br />
1 2 3<br />
SUGGESTED PREFFERED ALTERNATIVES<br />
16.1.4 OTHER GENITOURINARY PRODUCTS<br />
alfuzosin hcl X<br />
finasteride X<br />
potassium citrate X<br />
tamsulosin hcl X<br />
AVODART X finasteride<br />
CIALIS X<br />
ELMIRON X<br />
FLOMAX X tamsulosin hcl<br />
JALYN X alfuzosn, finasterid, tamsulos<br />
LEVITRA X CIALIS, VIAGRA<br />
MUSE X<br />
MYRBETRIQ X<br />
RAPAFLO X<br />
STAXYN X CIALIS, VIAGRA<br />
VIAGRA X<br />
CHAPTER 17: DIAGNOSTIC & MISCELLANEOUS MEDICATIONS<br />
17.1 DIAGNOSTIC PRODUCTS<br />
MINILINK REAL‐TIME TRANSMITTER X<br />
PARADIGM REAL‐TIME X<br />
PRECISION XTRA X<br />
SOF‐SENSOR X ACCU‐CHEK, ONE TOUCH<br />
17.2 MISCELLANEOUS DRUGS<br />
THALOMID X<br />
17.3.1 APPETITE SUPPRESSANTS<br />
phentermine hcl X<br />
QSYMIA X benzphet,diethylprop,phenterm<br />
CHAPTER 18: MEDICAL (MISCELLANEOUS) SUPPLIES<br />
18.0 MEDICAL (MISCELLANEOUS) SUPPLIES<br />
AEROCHAMBER X<br />
CONCEPTION X<br />
MINIMED X<br />
MINIMED RESERVOIR X<br />
OPTICHAMBER X<br />
PARADIGM X<br />
PARADIGM INFUSION X<br />
PARADIGM SILHOUETTE X<br />
POLYFIN X<br />
POLYFIN QR X<br />
PRIMABELLA X<br />
QUICK RELEASE SOFT TEFLON X<br />
SILHOUETTE X
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