Preferred Drug List 2013 Standard Formulary with ... - Express Scripts
Preferred Drug List 2013 Standard Formulary with ... - Express Scripts Preferred Drug List 2013 Standard Formulary with ... - Express Scripts
LEXIVA 2.5.1LIALDA 9.6lidocaine hcl 1.2lidocaine‐prilocaine 1.2LIDODERM 1.2LINZESS 9.7LIPITOR 4.8.2LIPOFEN 4.8.1lisinopril 4.5.4.1lisinoprilhydrochlorothiazide4.5.6lithium carbonate 5.3LIVALO 4.8.2LO LOESTRIN FE 13.7LOCOID 6.1LOCOID LIPOCREAM 6.1LOESTRIN 24 FE 13.7loperamide 9.2loratadine 15.2.1lorazepam 5.2.1loryna 13.7losartan potassium 4.5.4.2losartanhydrochlorothiazide4.5.6LOSEASONIQUE 13.7LOTEMAX 14.2LOTREL 4.5.6lovastatin 4.8.2LOVAZA 4.8.1LOVENOX 12.3.2low‐ogestrel 13.7LUMIGAN 14.5LUNESTA 5.2.2LUNESTA 5.2.2LUPRON DEPOT 13.1.2lutera 13.7LUVOX CR 5.5.1.3LYRICA 5.4.7LYSTEDA 12.5MAKENA 13.5MALARONE 2.7.3MAXAIR AUTOHALER 15.1.1MAXALT/MLT 5.1.2meclizine hcl 5.6medroxyprogesterone 13.5acetatemefloquine hcl 2.7.3MEGACE ES 3megestrol acetate 3meloxicam 11.1.2MENEST 13.4MENOSTAR 13.4mercaptopurine 3METADATE CD 5.9.1metaproterenol sulfate 15.1.1metaxalone 11.3.2metformin hcl 8.1.2metformin hcl er 8.1.2methadone hcl 5.1.1.1methimazole 8.4.2methocarbamol 11.3.2methotrexate inj 3methotrexate tab, pwd 3methyldopa 4.5.2methylphenidate er 5.9.1methylphenidate hcl 5.9.1methylphenidate sr 5.9.1methylprednisolone 8.3.1metoclopramide hcl 9.3metolazone 4.3.2metoprolol succinate 4.4metoprolol tartrate 4.4metoprololhydrochlorothiazide4.5.6METROGEL 6.3metronidazole 6.3metronidazole 13.1.3metronidazole 2.7.5MICARDIS 4.5.4.2MICARDIS HCT 4.5.4.2microgestin 13.7microgestin fe 13.7MIGRANAL 5.1.2MINILINK REAL‐TIME 17.1TRANSMITTERMINIMED 18MINIMED RESERVOIR 18minocycline hcl 2.1.7minoxidil 4.5.1MIRAPEX 5.7.2MIRAPEX ER 5.7.2mirtazapine 5.5.1.4misoprostol 9.4.1modafinil 5.9.1moexipril hcl 4.5.4.1moexiprilhydrochlorothiazide4.5.6mometasone furoate 6.1mononessa 13.7montelukast sodium 15.1.4morphine sulfate/er 5.1.1.1MOVIPREP 9.6MOXEZA 14.1.1MULTAQ 4.7.5mupirocin 2.2MUSE 16.1.4mycophenolate mofetil 3MYFORTIC 3MYRBETRIQ 16.1.4nabumetone 11.1.2nadolol 4.4naltrexone hcl 5.9.2
NAMENDA 5.9.3NAPRELAN 11.1.2naproxen 11.1.2naproxen sodium 11.1.2naratriptan hcl 5.1.2NASACORT AQ 7.2NASCOBAL 12.1.3NASONEX 7.2NATAZIA 13.7nateglinide 8.1.2necon 13.7NEEVO DHA 13.1.1neomycin‐bacitracinpolymyxin14.1.1neomycin‐polymyxindexameth14.3neomycin‐polymyxin‐hc 7.1neomycin‐polymyxin‐hc 14.3neomycin‐polymyxinhydrocort7.1NEULASTA 10.2.1NEUPOGEN 10.2.1NEUPRO 5.7.2NEVANAC 14.6nevirapine 2.5.1NEXIUM 9.4.2NIASPAN 4.8.1nifediac cc 4.2nifedical xl 4.2nifedipine er 4.2nisoldipine 4.2nitrofurantoin 2.1.8nitrofurantoin mono‐macro 2.1.8nitroglycerin 4.6.1nitroglycerin patch 4.6.1NITROSTAT 4.6.1nizatidine 9.4nora‐be 13.5NORDITROPIN FLEXPRO 10.2.4NORDITROPIN NORDIFLEX 10.2.4norethindrone 13.5norethindrone acetate 13.5NOROXIN 2.1.9nortrel 13.7nortriptyline hcl 5.5.1.2NORVIR 2.5.1novarel 13.1.2NOVOFINE 18.1NOVOFINE 32 18.1NOVOFINE AUTOCOVER 18.1NOVOLIN products 8.1.1NOVOLOG products 8.1.1NUCYNTA/ER 5.1.1.1NUEDEXTA 5.9.2NULYTELY WITH FLAVOR 9.6PACKSNUTROPIN/AQ/AQ NUSPIN 10.2.4NUVARING 13.7NUVIGIL 5.9.1nystatin 2.3nystatin 2.4.2nystatin‐triamcinolone 2.4.3ocella 13.7ofloxacin 7.1ofloxacin 14.1.1ofloxacin 2.1.9ogestrel 13.7olanzapine 5.8olanzapine odt 5.8olanzapine‐fluoxetine hcl 5.8.1.1OLUX 6.1OLUX‐E 6.1OMECLAMOX‐PAK 9.4.3omeprazole 9.4.2omeprazole 9.4.2.1omeprazole‐sodium 9.4.2bicarbonateOMNARIS 7.2OMNITROPE 10.2.4ondansetron hcl 5.6ondansetron odt 5.6ONE TOUCH LANCETS 18.1ONE TOUCH TEST STRIPS 18.1ONE TOUCH ULTRA 2 18.1ONE TOUCH ULTRA SMART 18.1ONE TOUCH ULTRA SYSTEM 18.1ONE TOUCH ULTRA TEST 18.1STRIPSONE TOUCH ULTRAMINI 18.1ONE TOUCH VERIO 18.1ONE TOUCH VERIO IQ 18.1ONGLYZA 8.1.5.2ONSOLIS 5.1.1.1OPANA 5.1.1.1OPANA ER 5.1.1.1OPTICHAMBER 18ORACEA 2.1.7ORAVIG 2.3ORENCIA 3orphenadrine citrate 11.3.2ORTHO EVRA 13.7ORTHO TRI‐CYCLEN 13.7ORTHO TRI‐CYCLEN LO 13.7OSMOPREP 9.5OVIDREL 13.1.2oxaprozin 11.1.2oxazepam 5.2.1oxcarbazepine 5.4.1OXISTAT 2.4.2oxybutynin chloride 16.1.1oxybutynin chloride er 16.1.1oxycodone hcl 5.1.1.1
- 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 18 and 19: DRUG NAME1 2 3 4 SUGGESTED PREFFERE
- Page 20 and 21: DRUG NAME1 2 3 4 SUGGESTED PREFFERE
- Page 22 and 23: DRUG NAME1 2 3 4 SUGGESTED PREFFERE
- Page 24 and 25: DRUG NAME1 2 3 4 SUGGESTED PREFFERE
- Page 26 and 27: DRUG NAME1 2 3 4salsalate XTIERSUGG
- Page 28 and 29: DRUG NAME1 2 3 4 SUGGESTED PREFFERE
- Page 30 and 31: DRUG NAME1 2 3 4 SUGGESTED PREFFERE
- Page 32 and 33: DRUG NAME1 2 3 4 SUGGESTED PREFFERE
- 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 46 and 47: oxycodone‐acetaminophen 5.1.1.1OX
- Page 48 and 49: SUMAVEL DOSEPRO 5.1.2SUPRAX 2.1.1SU
NAMENDA 5.9.3NAPRELAN 11.1.2naproxen 11.1.2naproxen sodium 11.1.2naratriptan hcl 5.1.2NASACORT AQ 7.2NASCOBAL 12.1.3NASONEX 7.2NATAZIA 13.7nateglinide 8.1.2necon 13.7NEEVO DHA 13.1.1neomycin‐bacitracinpolymyxin14.1.1neomycin‐polymyxindexameth14.3neomycin‐polymyxin‐hc 7.1neomycin‐polymyxin‐hc 14.3neomycin‐polymyxinhydrocort7.1NEULASTA 10.2.1NEUPOGEN 10.2.1NEUPRO 5.7.2NEVANAC 14.6nevirapine 2.5.1NEXIUM 9.4.2NIASPAN 4.8.1nifediac cc 4.2nifedical xl 4.2nifedipine er 4.2nisoldipine 4.2nitrofurantoin 2.1.8nitrofurantoin mono‐macro 2.1.8nitroglycerin 4.6.1nitroglycerin patch 4.6.1NITROSTAT 4.6.1nizatidine 9.4nora‐be 13.5NORDITROPIN FLEXPRO 10.2.4NORDITROPIN NORDIFLEX 10.2.4norethindrone 13.5norethindrone acetate 13.5NOROXIN 2.1.9nortrel 13.7nortriptyline hcl 5.5.1.2NORVIR 2.5.1novarel 13.1.2NOVOFINE 18.1NOVOFINE 32 18.1NOVOFINE AUTOCOVER 18.1NOVOLIN products 8.1.1NOVOLOG products 8.1.1NUCYNTA/ER 5.1.1.1NUEDEXTA 5.9.2NULYTELY WITH FLAVOR 9.6PACKSNUTROPIN/AQ/AQ NUSPIN 10.2.4NUVARING 13.7NUVIGIL 5.9.1nystatin 2.3nystatin 2.4.2nystatin‐triamcinolone 2.4.3ocella 13.7ofloxacin 7.1ofloxacin 14.1.1ofloxacin 2.1.9ogestrel 13.7olanzapine 5.8olanzapine odt 5.8olanzapine‐fluoxetine hcl 5.8.1.1OLUX 6.1OLUX‐E 6.1OMECLAMOX‐PAK 9.4.3omeprazole 9.4.2omeprazole 9.4.2.1omeprazole‐sodium 9.4.2bicarbonateOMNARIS 7.2OMNITROPE 10.2.4ondansetron hcl 5.6ondansetron odt 5.6ONE TOUCH LANCETS 18.1ONE TOUCH TEST STRIPS 18.1ONE TOUCH ULTRA 2 18.1ONE TOUCH ULTRA SMART 18.1ONE TOUCH ULTRA SYSTEM 18.1ONE TOUCH ULTRA TEST 18.1STRIPSONE TOUCH ULTRAMINI 18.1ONE TOUCH VERIO 18.1ONE TOUCH VERIO IQ 18.1ONGLYZA 8.1.5.2ONSOLIS 5.1.1.1OPANA 5.1.1.1OPANA ER 5.1.1.1OPTICHAMBER 18ORACEA 2.1.7ORAVIG 2.3ORENCIA 3orphenadrine citrate 11.3.2ORTHO EVRA 13.7ORTHO TRI‐CYCLEN 13.7ORTHO TRI‐CYCLEN LO 13.7OSMOPREP 9.5OVIDREL 13.1.2oxaprozin 11.1.2oxazepam 5.2.1oxcarbazepine 5.4.1OXISTAT 2.4.2oxybutynin chloride 16.1.1oxybutynin chloride er 16.1.1oxycodone hcl 5.1.1.1
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