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
oxycodone‐acetaminophen 5.1.1.1OXYCONTIN 5.1.1.1oxymorphone hcl 5.1.1.1OXYTROL 16.1.1PANCREAZE 9.6pancrelipase 5,000 9.6pantoprazole sodium 9.4.2PARADIGM 18PARADIGM INFUSION 18PARADIGM REAL‐TIME 17.1PARADIGM SILHOUETTE 18paroxetine hcl 5.5.1.3PATADAY 14.6PATANASE 7.2PATANOL 14.6peg 3350‐electrolyte 9.6PEGASYS/PROCLICK 10.2.3PEGINTRON/REDIPEN 10.2.3penicillin v potassium 2.1.5PENNSAID 6.9.5PENTASA 9.6pentoxifylline 4.9PERFOROMIST 15.1.1permethrin 6.9.3perphenazine 5.8PERTZYE 9.6phenazopyridine hcl 16.1.3phenobarbital 5.4.6phentermine hcl 17.3.1PHENYTEK 5.4.3phenytoin sodium extended 5.4.3PHOSLYRA 12.1.3PICATO 6.9.2pilocarpine hcl 7.3pilocarpine hcl 14.5pindolol 4.4piroxicam 11.1.2PLAVIX 12.4POLYFIN 18POLYFIN QR 18polymyxin b sultrimethoprim14.1.1portia 13.7potassium chloride 12.2potassium citrate 16.1.4POTIGA 5.4.7PRADAXA 12.3.5pramipexole5.7.2dihydrochloridePRAMOSONE 6.1PRAMOSONE E 6.1PRANDIMET 8.1.2PRANDIN 8.1.2pravastatin sodium 4.8.2prazosin hcl 4.5.1PRECISION 18.1PRECISION XTRA 17.1PRECISION XTRA 18.1prednisolone 8.3.1prednisolone acetate 14.2prednisolone sodium 8.3.1phosphateprednisone 8.3.1PREFERA OB 13.1.1PREFERA‐OB ONE 13.1.1PREFERA‐OB PLUS DHA 13.1.1PREFEST 13.4.1PREMARIN 13.4PREMPHASE 13.4.1PREMPRO 13.4.1PRENATE DHA 13.1.1PRENATE ELITE 13.1.1PRENATE ESSENTIAL 13.1.1PREPOPIK 9.6PREVACID 9.4.2previfem 13.7PREVPAC 9.4.3PREZISTA 2.5.1PRIMABELLA 18primidone 5.4.6PRISTIQ ER 5.5.1.4PROAIR HFA 15.1.1probenecid 11.2prochlorperazine maleate 5.6PROCRIT 10.2.2proctosol‐hc 9.6proctozone‐hc 9.6PRODIGY 18.1PRODIGY INSULIN SYRINGE 18.1PRODIGY NO CODING 18.1PRODIGY PEN NEEDLE 18.1PRODIGY POCKET 18.1PRODIGY VOICE 18.1progesterone in oil 13.5PROGRAF cap, susp 3PROGRAF inj 3promethazine hcl 5.6promethazine hcl 15.2.1promethazine vc 15.2.3promethazine vc‐codeine 15.3promethazine‐codeine 15.3promethazine‐dm 15.3promethegan 5.6PROMETRIUM 13.5PROMISEB 6.9.2propafenone hcl 4.7.1.3propranolol hcl 4.4propylthiouracil 8.4.2PROTONIX 9.4.2PROTOPIC 6.9.2PROVENTIL HFA 15.1.1PROVIGIL 5.9.1
PULMICORT 15.1.3PULMICORT FLEXHALER 15.1.3PULMOZYME 15.4PYLERA 9.4.3pyridostigmine bromide 5.9.2QNASL 7.2QSYMIA 17.3.1QUALAQUIN 2.7.3quasense 13.7quetiapine fumarate 5.8QUICK RELEASE SOFT 18TEFLONquinapril hcl 4.5.4.1quinaprilhydrochlorothiazide4.5.6QVAR 15.1.3ramipril 4.5.4.1RANEXA 4.9ranitidine hcl 9.4RAPAFLO 16.1.4RAPAMUNE 3RAYOS 8.3.1REBIF 10.2.3reclipsen 13.7RELENZA 2.5.2RELISTOR 9.6RELPAX 5.1.2RENAGEL 12.7RENVELA 12.7reprexain 5.1.1.2REQUIP XL 5.7.2RESTASIS 14.6RETIN‐A MICRO 6.3RETIN‐A MICRO PUMP 6.3REVATIO 4.6.2REVLIMID 3REYATAZ 2.5.1REZIRA 15.3RHINOCORT AQUA 7.2ribapak 2.5.2ribavirin 2.5.2rifampin 2.7.2RIOMET 8.1.2RISPERDAL CONSTA 5.8risperidone 5.8RITALIN LA 5.9.1rivastigmine 5.9.3ropinirole hcl 5.7.2roxicet 5.1.1.1ROZEREM 5.2.2RYTHMOL SR 4.7.1.3SAFYRAL 13.7SAIZEN 10.2.4salsalate 11.1.1SANCTURA XR 16.1.1SANCUSO 5.6SANDOSTATIN LAR 3SANTYL 6.9.2SAPHRIS 5.8SAVELLA 5.5.1.4SEASONIQUE 13.7selenium sulfide 6.8SENSIPAR 8.6SEREVENT DISKUS 15.1.1SEROQUEL 5.8SEROQUEL XR 5.8sertraline hcl 5.5.1.3SFROWASA 9.6SILENOR 5.2.2SILHOUETTE 18silver sulfadiazine 2.2SIMCOR 4.8.2.1SIMPONI 3simvastatin 4.8.2SINGULAIR 15.1.4SKELAXIN 11.3.2sodium fluoride 12.1.4sodium sulfacetamidesulfur6.3SOF‐SENSOR 17.1SOF‐SET 18SOF‐SET MICRO 18SOFT TOUCH 18.1SOFTCLIX 18.1SOLARAZE 6.9.2solia 13.7SOLODYN 2.1.7SOMA 11.3.2SOMATULINE DEPOT 3SORILUX 6.8sotalol 4.7.5SPIRIVA 15.1.3spironolactone 4.3.3spironolactone‐hctz 4.3.3sprintec 13.7sronyx 13.7STALEVO 100 5.7.2STAXYN 16.1.4STELARA 3STRATTERA 5.9.6STRIANT 13.3SUBOXONE 5.1.1.2SUBSYS 5.1.1.1sucralfate 9.4.1SULAR 4.2sulfacetamide sodium 6.8sulfacetamide sodium 14.1.1sulfamethoxazoletrimethoprim2.1.6sulfasalazine 9.6sulindac 11.1.2sumatriptan 5.1.2
- 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 44 and 45: LEXIVA 2.5.1LIALDA 9.6lidocaine hcl
- Page 48 and 49: SUMAVEL DOSEPRO 5.1.2SUPRAX 2.1.1SU
PULMICORT 15.1.3PULMICORT FLEXHALER 15.1.3PULMOZYME 15.4PYLERA 9.4.3pyridostigmine bromide 5.9.2QNASL 7.2QSYMIA 17.3.1QUALAQUIN 2.7.3quasense 13.7quetiapine fumarate 5.8QUICK RELEASE SOFT 18TEFLONquinapril hcl 4.5.4.1quinaprilhydrochlorothiazide4.5.6QVAR 15.1.3ramipril 4.5.4.1RANEXA 4.9ranitidine hcl 9.4RAPAFLO 16.1.4RAPAMUNE 3RAYOS 8.3.1REBIF 10.2.3reclipsen 13.7RELENZA 2.5.2RELISTOR 9.6RELPAX 5.1.2RENAGEL 12.7RENVELA 12.7reprexain 5.1.1.2REQUIP XL 5.7.2RESTASIS 14.6RETIN‐A MICRO 6.3RETIN‐A MICRO PUMP 6.3REVATIO 4.6.2REVLIMID 3REYATAZ 2.5.1REZIRA 15.3RHINOCORT AQUA 7.2ribapak 2.5.2ribavirin 2.5.2rifampin 2.7.2RIOMET 8.1.2RISPERDAL CONSTA 5.8risperidone 5.8RITALIN LA 5.9.1rivastigmine 5.9.3ropinirole hcl 5.7.2roxicet 5.1.1.1ROZEREM 5.2.2RYTHMOL SR 4.7.1.3SAFYRAL 13.7SAIZEN 10.2.4salsalate 11.1.1SANCTURA XR 16.1.1SANCUSO 5.6SANDOSTATIN LAR 3SANTYL 6.9.2SAPHRIS 5.8SAVELLA 5.5.1.4SEASONIQUE 13.7selenium sulfide 6.8SENSIPAR 8.6SEREVENT DISKUS 15.1.1SEROQUEL 5.8SEROQUEL XR 5.8sertraline hcl 5.5.1.3SFROWASA 9.6SILENOR 5.2.2SILHOUETTE 18silver sulfadiazine 2.2SIMCOR 4.8.2.1SIMPONI 3simvastatin 4.8.2SINGULAIR 15.1.4SKELAXIN 11.3.2sodium fluoride 12.1.4sodium sulfacetamidesulfur6.3SOF‐SENSOR 17.1SOF‐SET 18SOF‐SET MICRO 18SOFT TOUCH 18.1SOFTCLIX 18.1SOLARAZE 6.9.2solia 13.7SOLODYN 2.1.7SOMA 11.3.2SOMATULINE DEPOT 3SORILUX 6.8sotalol 4.7.5SPIRIVA 15.1.3spironolactone 4.3.3spironolactone‐hctz 4.3.3sprintec 13.7sronyx 13.7STALEVO 100 5.7.2STAXYN 16.1.4STELARA 3STRATTERA 5.9.6STRIANT 13.3SUBOXONE 5.1.1.2SUBSYS 5.1.1.1sucralfate 9.4.1SULAR 4.2sulfacetamide sodium 6.8sulfacetamide sodium 14.1.1sulfamethoxazoletrimethoprim2.1.6sulfasalazine 9.6sulindac 11.1.2sumatriptan 5.1.2
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