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
SUMAVEL DOSEPRO 5.1.2SUPRAX 2.1.1SUPREP 9.6SURESTEP 18.1SURE‐T 18SUSTIVA 2.5.1syeda 13.7SYMBICORT 15.1.3SYMBYAX 5.8.1.1SYMBYAX 5.8.1.1SYMLINPEN 8.1.4SYNAGIS 10SYNTHROID 8.4.1TACLONEX 6.8tacrolimus 3TAMIFLU 2.5.2tamoxifen citrate 3tamsulosin hcl 16.1.4TARKA 4.5.6TAZORAC 6.8TEGRETOL XR 5.4.1TEGRETOL XR 5.4.1TEKAMLO 4.5.6TEKTURNA 4.5.6TEKTURNA HCT 4.5.6temazepam 5.2.2terazosin hcl 4.5.1terbinafine hcl 2.3terconazole 2.4.1TESTIM 13.3testosterone cypionate 13.3tetracycline hcl 2.1.7TEVETEN 4.5.4.2TEVETEN HCT 4.5.4.2TEV‐TROPIN 10.2.4THALOMID 17.2theophylline 15.1.2theophylline anhydrous 15.1.2thioridazine hcl 5.8thiothixene 5.8TIKOSYN 4.7.5tilia fe 13.7timolol maleate 4.4timolol maleate 14.5TIMOPTIC OCUDOSE 14.5tinidazole 2.7.5tizanidine hcl 11.3.1TOBI 2.8.2TOBRADEX 14.3TOBRADEX ST 14.3tobramycin sulfate 2.8.2tobramycin‐dexamethasone 14.3tolterodine tartrate 16.1.1TOPAMAX 5.4.7topiramate 5.4.7TOPROL XL 4.4torsemide 4.3.1TOVIAZ 16.1.1TRACLEER 4.6.3TRADJENTA 8.1.5.2tramadol hcl/er 5.1.1tramadol hclacetaminophen5.1.1trandolapril 4.5.4.1TRANSDERM‐SCOP 5.6tranylcypromine sulfate 5.5.2TRAVATAN Z 14.5trazodone hcl 5.5.1.4tretinoin 3tretinoin 6.3tretinoin 6.9.2TREXIMET 5.1.2triamcinolone acetonide 6.1triamcinolone acetonide 7.2triamcinolone acetonide 7.3triamterene‐hctz 4.3.3triamterenehydrochlorothiazid4.3.3triazolam 5.2.2TRIBENZOR 4.5.6TRICOR 4.8.1trifluoperazine hcl 5.8trifluridine 14.1.2TRIGLIDE 4.8.1trihexyphenidyl hcl 5.7.1tri‐legest fe 13.7TRILIPIX 4.8.1trilyte with flavor packets 9.6trimethoprim 2.1.8trinessa 13.7tri‐previfem 13.7tri‐sprintec 13.7trivora‐28 13.7TRUE2GO BLOOD GLUCOSE 18.1SYSTEMTRUERESULT BLOOD 18.1GLUCOSE SYSTMTRUETEST TEST STRIPS 18.1TRUETRACK SMART SYSTEM 18.1TRUETRACK TEST STRIP 18.1TRUVADA 2.5.1TUDORZA PRESSAIR 15.1.3TUSSICAPS 15.3TUSSIONEX 15.3TWYNSTA 4.5.6TYKERB 3ULESFIA 6.9.3ULORIC 11.2ULTRAVATE PAC 6.1ursodiol 9.6VAGIFEM 13.4valacyclovir 2.5.2
VALPROIC ACID 5.4.4VALTREX 2.5.2VANCOCIN HCL 2.8vancomycin hcl 2.8vandazole 13.1.3VECTICAL 6.8velivet 13.7VELTIN 6.3venlafaxine hcl 5.5.1.4venlafaxine hcl er 5.5.1.4VENLAFAXINE HCL ER 5.5.1.4VENTOLIN HFA 15.1.1VERAMYST 7.2verapamil 4.2verapamil er pm 4.2VEREGEN 6.9.2veripred 20 8.3.1VESICARE 16.1.1VEXOL 14.2VGO 20 18.1VGO 30 18.1VGO 40 18.1VIAGRA 16.1.4VICTOZA 8.1.5.1VICTRELIS 2.5.1VIGAMOX 14.1.1VIIBRYD 5.5.1.3VIMOVO 11.1.2VIMPAT 5.4.7VIRAMUNE 2.5.1VIRAMUNE XR 2.5.1VIREAD 2.5.1vitamin d 12.1.3VIVELLE‐DOT 13.4VOLTAREN 6.9.5voriconazole 2.3VYTORIN 4.8.2.1VYTORIN 4.8.2.1VYVANSE 5.9.1warfarin sodium 12.3.1WELCHOL 4.8.1WELLBUTRIN XL 5.5.1.4XALATAN 14.5XARELTO 12.3.3XELODA 3XERESE 2.6XIFAXAN 2.8XOLAIR 10.2.7XOPENEX 15.1.1XOPENEX CONCENTRATE 15.1.1XOPENEX HFA 15.1.1XYZAL 15.2.1YASMIN 28 13.7YAZ 13.7zafirlukast 15.1.4zaleplon 5.2.2zamicet 5.1.1.2zarah 13.7ZEGERID 9.4.2ZEMPLAR 12.1.3zenchent 13.7ZENPEP 9.6ZETIA 4.8.1ZETONNA 7.2ZIAGEN 2.5.1ZIANA 6.3ZIOPTAN 14.5ziprasidone hcl 5.8zolpidem tartrate/er 5.2.2ZOLPIMIST 5.2.2ZOMIG/ZMT 5.1.2zonisamide 5.4.7ZOSTAVAX 10zovia 1‐35e 13.7zovia 1‐50e 13.7ZOVIRAX 2.6ZUPLENZ 5.6ZUTRIPRO 15.3ZYCLARA 6.9.2ZYLET 14.3ZYMAXID 14.1.1ZYPREXA 5.8ZYPREXA ZYDIS 5.8ZYRTEC 15.2.1ZYRTEC‐D 15.2.3ZYVOX 2.8
- 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 46 and 47: oxycodone‐acetaminophen 5.1.1.1OX
VALPROIC ACID 5.4.4VALTREX 2.5.2VANCOCIN HCL 2.8vancomycin hcl 2.8vandazole 13.1.3VECTICAL 6.8velivet 13.7VELTIN 6.3venlafaxine hcl 5.5.1.4venlafaxine hcl er 5.5.1.4VENLAFAXINE HCL ER 5.5.1.4VENTOLIN HFA 15.1.1VERAMYST 7.2verapamil 4.2verapamil er pm 4.2VEREGEN 6.9.2veripred 20 8.3.1VESICARE 16.1.1VEXOL 14.2VGO 20 18.1VGO 30 18.1VGO 40 18.1VIAGRA 16.1.4VICTOZA 8.1.5.1VICTRELIS 2.5.1VIGAMOX 14.1.1VIIBRYD 5.5.1.3VIMOVO 11.1.2VIMPAT 5.4.7VIRAMUNE 2.5.1VIRAMUNE XR 2.5.1VIREAD 2.5.1vitamin d 12.1.3VIVELLE‐DOT 13.4VOLTAREN 6.9.5voriconazole 2.3VYTORIN 4.8.2.1VYTORIN 4.8.2.1VYVANSE 5.9.1warfarin sodium 12.3.1WELCHOL 4.8.1WELLBUTRIN XL 5.5.1.4XALATAN 14.5XARELTO 12.3.3XELODA 3XERESE 2.6XIFAXAN 2.8XOLAIR 10.2.7XOPENEX 15.1.1XOPENEX CONCENTRATE 15.1.1XOPENEX HFA 15.1.1XYZAL 15.2.1YASMIN 28 13.7YAZ 13.7zafirlukast 15.1.4zaleplon 5.2.2zamicet 5.1.1.2zarah 13.7ZEGERID 9.4.2ZEMPLAR 12.1.3zenchent 13.7ZENPEP 9.6ZETIA 4.8.1ZETONNA 7.2ZIAGEN 2.5.1ZIANA 6.3ZIOPTAN 14.5ziprasidone hcl 5.8zolpidem tartrate/er 5.2.2ZOLPIMIST 5.2.2ZOMIG/ZMT 5.1.2zonisamide 5.4.7ZOSTAVAX 10zovia 1‐35e 13.7zovia 1‐50e 13.7ZOVIRAX 2.6ZUPLENZ 5.6ZUTRIPRO 15.3ZYCLARA 6.9.2ZYLET 14.3ZYMAXID 14.1.1ZYPREXA 5.8ZYPREXA ZYDIS 5.8ZYRTEC 15.2.1ZYRTEC‐D 15.2.3ZYVOX 2.8
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