Preferred Drug List 2013 Standard Formulary with ... - Express Scripts

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DRUG NAMETIER1 2 3 4SUGGESTED PREFFERED ALTERNATIVES5.5.1.4 OTHER ANTIDEPRESSANTSbupropion hcl Xbupropion hcl sr Xbupropion xl Xmirtazapine Xtrazodone hcl Xvenlafaxine hcl Xvenlafaxine hcl er XVENLAFAXINE HCL ER ST X venlafax er(NOT UCB NDCS‐65580CYMBALTA PA XEFFEXOR XR ST X venlafax er(NOT UCB NDCS‐65580PRISTIQ ER ST XSAVELLA PA XWELLBUTRIN XL X bupropion xl5.5.2 MAO INHIBITORStranylcypromine sulfate X5.6 ANTIVERTIGO AND ANTIEMETIC DRUGSdronabinol Xgranisetron hcl Xmeclizine hcl Xondansetron hcl Xondansetron odt Xprochlorperazine maleate Xpromethazine hcl Xpromethegan XEMEND XSANCUSO XTRANSDERM‐SCOP X meclizineZUPLENZ X ondansetron odt5.7.1 ANTIPARKINSON ANTICHOLINERGIC DRUGSbenztropine mesylate Xtrihexyphenidyl hcl X5.7.2 OTHER ANTIPARKINSON DRUGSbromocriptine mesylate Xcarbidopa‐levodopa Xcarbidopa‐levodopa‐entacapone Xpramipexole dihydrochloride Xropinirole hcl XAZILECT XCOMTAN X entacaponeMIRAPEX X pramipexoleMIRAPEX ER XNEUPRO X pramipex,ropinir/er,MIRAPEX ERREQUIP XL X ropinirole er
DRUG NAME1 2 3 4 SUGGESTED PREFFERED ALTERNATIVESSTALEVO 100 X carbidopa/levodopa/entacapone5.8 ANTIPSYCHOTIC DRUGSclozapine Xfluphenazine hcl Xhaloperidol Xolanzapine Xolanzapine odt Xperphenazine Xquetiapine fumarate Xrisperidone Xthioridazine hcl Xthiothixene Xtrifluoperazine hcl Xziprasidone hcl XABILIFY XABILIFY DISCMELT XFANAPT Xgeneric, ABILIFY/DISC, LATUDA, SEROQUELXRGEODON X ziprasidoneINVEGA Xgeneric, ABILIFY/DISC, LATUDA, SEROQUELXRLATUDA XRISPERDAL CONSTA XSAPHRIS Xgeneric, ABILIFY/DISC, LATUDA, SEROQUELXRSEROQUEL X quetiapine fumarateSEROQUEL XR XZYPREXA X olanzapineZYPREXA ZYDIS X olanzapine odt5.8.1 ALIPHATIC PHENOTHIAZINESchlorpromazine hcl X5.8.1.1 PSYCHOTHERAPEUTIC COMBINATIONSolanzapine‐fluoxetine hcl XSYMBYAX XSYMBYAX X olanzapine/fluoxetine hcl5.9.1 CNS STIMULANT DRUGSamphetamine salt combo Xdexmethylphenidate hcl Xdextroamphetamine sulfate Xdextroamphetamine‐amphetamine Xmethylphenidate er Xmethylphenidate hcl Xmethylphenidate sr Xmodafinil PA XADDERALL XR ST X dextroamphetamne‐amphetamne erTIER
Page 4: TABLE OF CONTENTSChapterChapter 1Ch
Page 8 and 9: DRUG NAME1 2 3 4 SUGGESTED PREFFERE
Page 10 and 11: DRUG NAMETIER1 2 3 4SUGGESTED PREFF
Page 12 and 13: DRUG NAME1 2 3 4TIKOSYN XTIERSUGGES
Page 14 and 15: DRUG NAME1 2 3 4MIGRANAL XRELPAX ST
Page 26 and 27: DRUG NAME1 2 3 4salsalate XTIERSUGG
Page 34 and 35: DRUG NAMETIER1 2 3 415.1.4 LEUKOTRI
Page 36 and 37: DRUG NAME1 2 3 4PARADIGM XPARADIGM
Page 38 and 39: IndexABILIFY 5.8ABILIFY DISCMELT 5.
Page 40 and 41: carbidopa‐levodopaentacapone5.7.2
Page 42 and 43: EVISTA 13.4.3EXALGO 5.1.1.1EXELDERM
Page 44 and 45: LEXIVA 2.5.1LIALDA 9.6lidocaine hcl
Page 46 and 47: oxycodone‐acetaminophen 5.1.1.1OX
Page 48 and 49: SUMAVEL DOSEPRO 5.1.2SUPRAX 2.1.1SU

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