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

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DRUG NAMETIER1 2 3 415.1.4 LEUKOTRIENE MODIFIERSmontelukast sodium Xzafirlukast XACCOLATE ST X zafirlukastSINGULAIR ST X montelukast15.2.1 ANTIHISTAMINESarbinoxa Xcetirizine Xcyproheptadine hcl Xdiphenhydramine hcl Xfexofenadine hcl Xlevocetirizine dihydrochloride Xloratadine Xpromethazine hcl XCLARINEX X desloratadineXYZAL X levocetirizineZYRTEC X15.2.3 ANTIHISTAMINE/DECONGESTANT COMBINATIONSpromethazine vc XALLEGRA‐D 24 HOUR XCLARINEX‐D 12 HOUR X desloratadineCLARINEX‐D 24 HOUR X desloratadineZYRTEC‐D XSUGGESTED PREFFERED ALTERNATIVES15.3 ANTITUSSIVE AND EXPECTORANT DRUGSbenzonatate Xguaifenesin/codiene Xguaifenesin‐codeine Xpromethazine vc‐codeine Xpromethazine‐codeine Xpromethazine‐dm XREZIRA X promethazine vc <strong>with</strong> codeineTUSSICAPS XTUSSIONEX X hydrocodone/chlorphen polisZUTRIPRO X promethazine vc <strong>with</strong> codeine15.4 OTHER RESPIRATORY DRUGSDALIRESP XPULMOZYME XCHAPTER 16: UROLOGICAL MEDICATIONS16.1.1 ANTICHOLINERGIC ANTISPASMODICSoxybutynin chloride Xoxybutynin chloride er Xtolterodine tartrate XDETROL ST X tolterodineDETROL LA ST X
DRUG NAME1 2 3 4 SUGGESTED PREFFERED ALTERNATIVESENABLEX ST XGELNIQUE ST XOXYTROL ST XSANCTURA XR ST X trospium erTOVIAZ ST XVESICARE ST X16.1.2 CHOLINERGIC STIMULANTSbethanechol chloride X16.1.3 URINARY ANESTHETICSphenazopyridine hcl X16.1.4 OTHER GENITOURINARY PRODUCTSalfuzosin hcl Xfinasteride Xpotassium citrate Xtamsulosin hcl XAVODART X finasterideCIALIS XELMIRON XFLOMAX X tamsulosin hclJALYN X alfuzosn, finasterid, tamsulosLEVITRA X CIALIS, VIAGRAMUSE XMYRBETRIQ XRAPAFLO XSTAXYN X CIALIS, VIAGRAVIAGRA XCHAPTER 17: DIAGNOSTIC & MISCELLANEOUS MEDICATIONS17.1 DIAGNOSTIC PRODUCTSMINILINK REAL‐TIME TRANSMITTER XPARADIGM REAL‐TIME XPRECISION XTRA XSOF‐SENSOR X ACCU‐CHEK, ONE TOUCH17.2 MISCELLANEOUS DRUGSTHALOMID X17.3.1 APPETITE SUPPRESSANTSphentermine hcl XQSYMIA X benzphet,diethylprop,phentermCHAPTER 18: MEDICAL (MISCELLANEOUS) SUPPLIES18.0 MEDICAL (MISCELLANEOUS) SUPPLIESAEROCHAMBER XCONCEPTION XMINIMED XMINIMED RESERVOIR XOPTICHAMBER XTIER
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 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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