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

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DRUG NAME1 2 3 4PARADIGM XPARADIGM INFUSION XPARADIGM SILHOUETTE XPOLYFIN XPOLYFIN QR XPRIMABELLA XQUICK RELEASE SOFT TEFLON XSILHOUETTE XSOF‐SET XSOF‐SET MICRO XSURE‐T XTIERSUGGESTED PREFFERED ALTERNATIVES18.1 DIABETIC SUPPLIESACCU‐CHEK XACCU‐CHEK ACTIVE XACCU‐CHEK AVIVA XACCU‐CHEK AVIVA PLUS XACCU‐CHEK COMFORT CURVE XACCU‐CHEK COMPACT XACCU‐CHEK COMPACT BLUE CONTROL XACCU‐CHEK FASTCLIX XACCU‐CHEK NANO SMARTVIEW XACCU‐CHEK SMARTVIEW XACCU‐CHEK SOFTCLIX XASCENSIA AUTODISC X ACCU‐CHEK, ONE TOUCHAUTODISC NORMAL X ACCU‐CHEK, ONE TOUCHBREEZE 2 X ACCU‐CHEK, ONE TOUCHCONTOUR X ACCU‐CHEK, ONE TOUCHCONTOUR NEXT X ACCU‐CHEK, ONE TOUCHCONTOUR NEXT EZ X ACCU‐CHEK, ONE TOUCHCONTOUR USB X ACCU‐CHEK, ONE TOUCHCONTROL SOLUTION X ACCU‐CHEK, ONE TOUCHFORA LANCETS XFORA LANCING DEVICE XFORA TEST STRIP X ACCU‐CHEK, ONE TOUCHFORA V30A X ACCU‐CHEK, ONE TOUCHFREESTYLE FREEDOM LITE X ACCU‐CHEK, ONE TOUCHFREESTYLE INSULINX X ACCU‐CHEK, ONE TOUCHFREESTYLE INSULINX TEST STRIPS X ACCU‐CHEK, ONE TOUCHFREESTYLE LITE METER X ACCU‐CHEK, ONE TOUCHFREESTYLE LITE STRIPS X ACCU‐CHEK, ONE TOUCHFREESTYLE TEST STRIPS X ACCU‐CHEK, ONE TOUCHGLUCOSE TEST STRIP X ACCU‐CHEK, ONE TOUCHGUARDIAN RT STARTER KIT XNOVOFINE X
DRUG NAME1 2 3 4 SUGGESTED PREFFERED ALTERNATIVESNOVOFINE 32 XNOVOFINE AUTOCOVER XONE TOUCH LANCETS XONE TOUCH TEST STRIPS XONE TOUCH ULTRA 2 XONE TOUCH ULTRA SMART XONE TOUCH ULTRA SYSTEM XONE TOUCH ULTRA TEST STRIPS XONE TOUCH ULTRAMINI XONE TOUCH VERIO XONE TOUCH VERIO IQ XPRECISION XPRECISION XTRA XPRODIGY X ACCU‐CHEK, ONE TOUCHPRODIGY INSULIN SYRINGE XPRODIGY NO CODING X ACCU‐CHEK, ONE TOUCHPRODIGY PEN NEEDLE XPRODIGY POCKET X ACCU‐CHEK, ONE TOUCHPRODIGY VOICE X ACCU‐CHEK, ONE TOUCHSOFT TOUCH XSOFTCLIX XSURESTEP XTRUE2GO BLOOD GLUCOSE SYSTEM X ACCU‐CHEK, ONE TOUCHTRUERESULT BLOOD GLUCOSE SYSTM X ACCU‐CHEK, ONE TOUCHTRUETEST TEST STRIPS X ACCU‐CHEK, ONE TOUCHTRUETRACK SMART SYSTEM X ACCU‐CHEK, ONE TOUCHTRUETRACK TEST STRIP X ACCU‐CHEK, ONE TOUCHVGO 20 XVGO 30 XVGO 40 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 34 and 35: DRUG NAMETIER1 2 3 415.1.4 LEUKOTRI
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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