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

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DRUG NAME1 2 3 4 SUGGESTED PREFFERED ALTERNATIVESACTOPLUS MET XR XACTOS X pioglitazoneAVANDAMET X pioglit+metfor, ACTOPLUS MET XRAVANDARYL X pioglitzone/glimepirideAVANDIA X pioglitazoneDUETACT X pioglitazone/glimepiride8.1.4 AMYLIN ANALOGUESSYMLINPEN X8.1.5.1 INCRETIN MIMETICSBYDUREON XBYETTA XVICTOZA X8.1.5.2 DIPEPTIDYL PEPTIDASE‐IV INHIBITORSJANUMET/XR XJANUVIA XJENTADUETO XJUVISYNC XKOMBIGLYZE XR XONGLYZA XTRADJENTA X8.2 GLUCOSE ELEVATING DRUGSGLUCAGEN XGLUCAGON EMERGENCY KIT X8.3.1 GLUCOCORTICOID DRUGSdexamethasone Xdexamethasone sodium phosphate Xhydrocortisone Xmethylprednisolone Xprednisolone Xprednisolone sodium phosphate Xprednisone Xveripred 20 XRAYOS X immediate‐release prednisone8.3.2 MINERALOCORTICOID DRUGSfludrocortisone acetate X8.4.1 THYROID SUPPLEMENTSlevothyroxine sodium Xlevoxyl XARMOUR THYROID XCYTOMEL X liothyronineSYNTHROID X levothyroxine sodium8.4.2 ANTITHYROID DRUGSmethimazole Xpropylthiouracil XTIER
DRUG NAMETIER1 2 3 48.6 OTHER ENDOCRINE DRUGSalendronate sodium Xcalcitonin nasal spray Xdesmopressin acetate inj Xdesmopressin acetate other doseforms Xetidronate disodium Xibandronate sodium XACTONEL ST XATELVIA ST XBINOSTO ST XFORTEO PA XSUGGESTED PREFFERED ALTERNATIVESalendronate, ibandronate, ACTONEL,ATELVIAFOSAMAX PLUS D ST Xalendronate, ibandronate, ACTONEL,ATELVIASENSIPAR XCHAPTER 9: GASTROINTESTINAL MEDICATIONS9.1.2 OTC H2 ANTAGONISTSfamotidine X9.2 ANTIDIARRHEAL DRUGSdiphenoxylate‐atropine Xloperamide X9.3 ANTISPASMODICS/DRUGS AFFECT GI MOTILITYchlordiazepoxide‐clidinium Xdicyclomine hcl Xhyoscyamine sulfate Xmetoclopramide hcl X9.4 ANTIULCER DRUGScimetidine Xfamotidine Xnizatidine Xranitidine hcl X9.4.1 OTHER ANTIULCER DRUGSmisoprostol Xsucralfate XCARAFATE X sucralfate9.4.2 PROTON PUMP INHIBITORSlansoprazole Xomeprazole Xomeprazole‐sodium bicarbonate ST Xpantoprazole sodium XACIPHEX ST X generics, NEXIUMDEXILANT ST X generics, NEXIUMNEXIUM ST XPREVACID ST X lansoprazole
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 16 and 17: DRUG NAMETIER1 2 3 4SUGGESTED PREFF
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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