BLUE - Formulary
RED - Non Formulary

Table of Contents Index Policy Information

Formulary Index

Numbers A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

a-b otic (DRUGS AFFECTING THE EAR)

A-METHAPRED (GLUCOCORTICOID DRUGS)

A-TAN 12X (ANTITUSSIVE AND EXPECTORANT DRUGS)

aa 3%/electrolyte-tpn/glycerin (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

abacavir sulfate (ANTIRETROVIRALS & PROTEASE INH)

abatacept/maltose (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

ABILIFY (ANTIPSYCHOTIC DRUGS)

ABILIFY DISCMELT (ANTIPSYCHOTIC DRUGS)

acamprosate calcium (OTHER CNS/AUTONOMIC DRUGS)

ACAPELLA (MEDICAL (MISCELLANEOUS) SUPPLIES)

acarbose (ORAL HYPOGLYCEMICS & COMBOS)

ACCOLATE (LEUKOTRIENE MODIFIERS)

ACCU-CHEK (DIABETIC SUPPLIES)

ACCU-CHEK ADVANTAGE (DIABETIC SUPPLIES)

ACCU-CHEK III (DIABETIC SUPPLIES)

ACCU-CHEK SPIRIT (DIABETIC SUPPLIES)

ACCU-CHEK TENDER (DIABETIC SUPPLIES)

ACCU-CHEK ULTRAFLEX (DIABETIC SUPPLIES)

ACCUHIST (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

ACCUHIST DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

ACCUHIST PDX (ANTITUSSIVE AND EXPECTORANT DRUGS)

ACCUNEB (BETA-2 ADRENERGIC DRUGS)

ACCUPRIL (ANGIOTENSIN CONVERTING ENZYME INHIBITORS)

ACCURETIC (OTHER ANTIHYPERTENSIVES)

ACCUTANE (PA) (dermatologist consultation suggested) (ACCUTANES)

ACCUZYME (TOPICAL DERMATOLOGICAL DRUGS)

ACD-A (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

ACE AEROSOL CLOUD ENHANCER (BETA-2 ADRENERGIC DRUGS)

acebutolol (BETA-ADRENERGIC ANTAGONIST DRUGS)

acebutolol hcl (BETA-ADRENERGIC ANTAGONIST DRUGS)

ACEON (ANGIOTENSIN CONVERTING ENZYME INHIBITORS)

acetaminophen-butalbital (DRUGS TO PREVENT AND TREAT HEADACHES)

acetaminophen-codeine (CLASS III NARCOTICS)

acetaminophen/butalbital (DRUGS TO PREVENT AND TREAT HEADACHES)

acetaminophen/caffeine/butalb (DRUGS TO PREVENT AND TREAT HEADACHES)

acetaminophen/caffeine/isometh (DRUGS TO PREVENT AND TREAT HEADACHES)

acetasol hc (DRUGS AFFECTING THE EAR)

acetazolamide (ANTIGLAUCOMA DRUGS)

acetic acid (DRUGS AFFECTING THE EAR)

ACETIC ACID (OTHER GENITOURINARY PRODUCTS)

acetic acid-aluminum (DRUGS AFFECTING THE EAR)

acetic acid-hydrocortisone (DRUGS AFFECTING THE EAR)

acetic acid/aluminum acetate (DRUGS AFFECTING THE EAR)

acetic acid/hydrocortisone (DRUGS AFFECTING THE EAR)

acetylcysteine (OTHER DRUGS FOR ASTHMA)

ACID JELLY (OB/GYN TOPICAL ANTIINFECTIVES)

ACIPHEX (Requires trial of H2 and OTC omeprazole) (PROTON PUMP INHIBITORS)

acitretin/emollient comb (ANTIPSORIASIS AND ANTIECZEMA DRUGS)

ACLARO (TOPICAL DERMATOLOGICAL DRUGS)

ACLARO PD (TOPICAL DERMATOLOGICAL DRUGS)

ACLOVATE (TOPICAL CORTICOSTEROID DRUGS)

ACTHAR H.P. (OTHER ENDOCRINE DRUGS)

ACTHIB (IMMUNOLOGICALS AND VACCINES)

acticin (SCABICIDES)

ACTIGALL (OTHER GI DRUGS)

ACTIMMUNE (INTERFERONS)

ACTIQ (CLASS II NARCOTICS)

ACTIS (MEDICAL (MISCELLANEOUS) SUPPLIES)

ACTIVASE (OTHER CARDIOVASCULAR DRUGS)

ACTIVELLA (ESTROGEN/PROGESTIN COMBINATIONS)

ACTONEL (Step Therapy-requires trial of alendronate prior to use) (OTHER ENDOCRINE DRUGS)

ACTONEL WITH CALCIUM (Step Therapy-Requires trial of alendronate prior to use) (OTHER ENDOCRINE DRUGS)

ACTOPLUS MET (INSULIN SENSITIZERS & COMBOS)

ACTOS (INSULIN SENSITIZERS & COMBOS)

ACUFLEX (ANALGESICS)

ACULAR (OTHER OPHTHALMIC DRUGS)

ACULAR LS (OTHER OPHTHALMIC DRUGS)

ACULAR PF (OTHER OPHTHALMIC DRUGS)

ACUNOL (HOMEOPATHIC DRUGS)

acyclovir (OTHER ANTIVIRAL DRUGS)

acyclovir (TOPICAL ANTIVIRAL DRUGS)

acyclovir sodium (OTHER ANTIVIRAL DRUGS)

ADAGEN (MISCELLANEOUS DRUGS)

ADALAT CC (CALCIUM ANTAGONISTS)

adalimumab (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

adapalene (ANTIACNE DRUGS)

ADDERALL (PAR) (CNS STIMULANT DRUGS)

ADDERALL XR (CNS STIMULANT DRUGS)

adefovir dipivoxil (OTHER ANTIVIRAL DRUGS)

ADIPEX-P (APPETITE SUPPRESSANTS)

ADOXA (TETRACYCLINES)

ADOXA CK (TETRACYCLINES)

ADOXA PAK (TETRACYCLINES)

ADOXA TT (TETRACYCLINES)

ADRENALIN CHLORIDE (OTHER DRUGS FOR ASTHMA)

adriamycin (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

adrucil (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

ADVAIR DISKUS (OTHER DRUGS FOR ASTHMA)

ADVAIR HFA (OTHER DRUGS FOR ASTHMA)

advanced natalcare (PRENATAL VITAMINS)

advanced-rf natalcare (PRENATAL VITAMINS)

ADVATE (HEMOSTATICS)

ADVATE H (HEMOSTATICS)

ADVATE L (HEMOSTATICS)

ADVATE M (HEMOSTATICS)

ADVATE SH (HEMOSTATICS)

ADVATE UH (HEMOSTATICS)

ADVICOR (HMG-COA COMBINATIONS)

AERO OTIC HC (DRUGS AFFECTING THE EAR)

AEROBID (OTHER DRUGS FOR ASTHMA)

AEROBID-M (OTHER DRUGS FOR ASTHMA)

AEROCHAMBER (MEDICAL (MISCELLANEOUS) SUPPLIES)

AEROCHAMBER MAX (MEDICAL (MISCELLANEOUS) SUPPLIES)

AEROCHAMBER MV (MEDICAL (MISCELLANEOUS) SUPPLIES)

AEROCHAMBER WITH FLOWSIGNAL (MEDICAL (MISCELLANEOUS) SUPPLIES)

AEROCHAMBER Z-STAT PLUS (MEDICAL (MISCELLANEOUS) SUPPLIES)

AEROHIST (ANTIHISTAMINES)

AEROHIST PLUS (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

AEROKID (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

AEROTRACH PLUS (MEDICAL (MISCELLANEOUS) SUPPLIES)

afeditab cr (CALCIUM ANTAGONISTS)

AFLURIA (IMMUNOLOGICALS AND VACCINES)

AGGRENOX (ANTIPLATELET DRUGS)

AGRYLIN (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

AH-CHEW (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

AH-CHEW D (DECONGESTANTS)

AH-CHEW D (ANTITUSSIVE AND EXPECTORANT DRUGS)

AH-CHEW II (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

AH-CHEW ULTRA (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

AHIST (ANTIHISTAMINES)

AIRET (BETA-2 ADRENERGIC DRUGS)

AK-CON (OTHER OPHTHALMIC DRUGS)

ak-dilate (OTHER OPHTHALMIC DRUGS)

ak-pentolate (OTHER OPHTHALMIC DRUGS)

ak-poly-bac (OPHTHALMIC TOPICAL ANTIBACTERIAL DRUGS)

AKNE-MYCIN (ANTIACNE DRUGS)

AKORN BALANCED SALT (OTHER OPHTHALMIC DRUGS)

aktob (OPHTHALMIC TOPICAL ANTIBACTERIAL DRUGS)

AKURZA (ANTIPSORIASIS AND ANTIECZEMA DRUGS)

ALA-CORT (TOPICAL CORTICOSTEROID DRUGS)

ALA-HIST (ANTIHISTAMINES)

ALA-HIST AC (ANTITUSSIVE AND EXPECTORANT DRUGS)

ALA-HIST D (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

ALA-HIST DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

ALA-QUIN (TOPICAL CORTICOSTEROID DRUGS)

ALA-SCALP HP (TOPICAL CORTICOSTEROID DRUGS)

ALA-TET (TETRACYCLINES)

ALACOL (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

ALACOL DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

ALAGESIC (DRUGS TO PREVENT AND TREAT HEADACHES)

ALAHIST DHC (ANTITUSSIVE AND EXPECTORANT DRUGS)

ALAHIST LQ (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

ALAMAST (OTHER OPHTHALMIC DRUGS)

ALBA-3 (DRUGS AFFECTING THE EAR)

ALBAFORT (INJECTABLE VITAMINS)

ALBAFORT (THERAPEUTIC VITAMINS & MINERALS)

ALBAFORT S (INJECTABLE VITAMINS)

ALBALON (OTHER OPHTHALMIC DRUGS)

ALBALYBE (VITAMINS & MINERALS & RELATED PRODUCTS)

ALBATUSSIN CF (ANTITUSSIVE AND EXPECTORANT DRUGS)

ALBATUSSIN DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

ALBATUSSIN NN (ANTITUSSIVE AND EXPECTORANT DRUGS)

ALBATUSSIN PEDIATRIC (ANTITUSSIVE AND EXPECTORANT DRUGS)

ALBATUSSIN SR (ANTITUSSIVE AND EXPECTORANT DRUGS)

ALBATUSSIN SR F (ANTITUSSIVE AND EXPECTORANT DRUGS)

ALBATUSSIN SR SENIOR (ANTITUSSIVE AND EXPECTORANT DRUGS)

albendazole (ANTHELMINTICS)

ALBENZA (ANTHELMINTICS)

albumin human (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

ALBUMINAR-25 (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

alburx (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

albutein (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

albuterol (BETA-2 ADRENERGIC DRUGS)

albuterol sulfate (BETA-2 ADRENERGIC DRUGS)

ALBUTEROL SULFATE (BETA-2 ADRENERGIC DRUGS)

albuterol sulfate/ipratropium (OTHER DRUGS FOR ASTHMA)

ALCAINE (OTHER OPHTHALMIC DRUGS)

ALCET (CLASS II NARCOTICS)

alclometasone (TOPICAL CORTICOSTEROID DRUGS)

alclometasone dipropionate (TOPICAL CORTICOSTEROID DRUGS)

ALCORTIN A (TOPICAL CORTICOSTEROID DRUGS)

ALDACTAZIDE (POTASSIUM SPARING DIURETICS)

ALDACTONE (POTASSIUM SPARING DIURETICS)

ALDARA (TOPICAL DERMATOLOGICAL DRUGS)

aldesleukin (INTERLEUKINS)

ALDEX AN (ANTIHISTAMINES)

ALDEX D (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

ALDEX DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

ALDEX-CT (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

alendronate (OTHER ENDOCRINE DRUGS)

alendronate sodium (OTHER ENDOCRINE DRUGS)

ALERSULE (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

ALFERON N (INTERFERONS)

alfuzosin hcl (OTHER GENITOURINARY PRODUCTS)

alglucerase (OTHER ENDOCRINE DRUGS)

ALI-FLEX (ANALGESICS)

ALICLEN (ANTIPSORIASIS AND ANTIECZEMA DRUGS)

ALINIA (OTHER ANTIINFECTIVE DRUGS)

aliskiren hemifumarate (OTHER ANTIHYPERTENSIVES)

ALKERAN (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

ALLANDERM-T (TOPICAL DERMATOLOGICAL DRUGS)

ALLANENZYME (TOPICAL DERMATOLOGICAL DRUGS)

ALLANFILLENZYME (TOPICAL DERMATOLOGICAL DRUGS)

allanfol rx (VITAMINS & MINERALS & RELATED PRODUCTS)

ALLANHIST PDX (ANTITUSSIVE AND EXPECTORANT DRUGS)

ALLANTAN (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

allantex (VITAMINS & MINERALS & RELATED PRODUCTS)

ALLANVAN-DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

ALLANVAN-S (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

ALLEGRA (ANTIHISTAMINES)

ALLEGRA ODT (ANTIHISTAMINES)

ALLEGRA-D 12 HOUR (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

ALLEGRA-D 24 HOUR (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

ALLERDUR (ANTITUSSIVE AND EXPECTORANT DRUGS)

ALLERGIST SYRINGE (MEDICAL (MISCELLANEOUS) SUPPLIES)

ALLERGIST TRAY (MEDICAL (MISCELLANEOUS) SUPPLIES)

allergy syringes (MEDICAL (MISCELLANEOUS) SUPPLIES)

ALLERSOL (OTHER OPHTHALMIC DRUGS)

ALLERTAN (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

ALLERX (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

ALLERX 10 (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

ALLERX 30 (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

ALLERX DF (ANTIHISTAMINES)

ALLERX DF 30 (ANTIHISTAMINES)

ALLERX PE (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

ALLERX-D (DECONGESTANTS)

ALLFEN CD (ANTITUSSIVE AND EXPECTORANT DRUGS)

ALLFEN CDX (ANTITUSSIVE AND EXPECTORANT DRUGS)

ALLFEN DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

allopurinol (DRUGS TO PREVENT AND TREAT GOUT)

ALLRES D (ANTITUSSIVE AND EXPECTORANT DRUGS)

ALLRES G (ANTITUSSIVE AND EXPECTORANT DRUGS)

ALLRES PD (ANTITUSSIVE AND EXPECTORANT DRUGS)

ALOCRIL (OTHER OPHTHALMIC DRUGS)

ALODOX (TETRACYCLINES)

ALOMIDE (OTHER OPHTHALMIC DRUGS)

ALORA (ESTROGEN DRUGS)

alosetron (IRRITABLE BOWEL DRUGS)

ALPHAGAN P (ANTIGLAUCOMA DRUGS)

ALPHANATE (HEMOSTATICS)

ALPHANINE SD (HEMOSTATICS)

ALPHAQUIN HP (TOPICAL DERMATOLOGICAL DRUGS)

alprazolam (ANXIOLYTICS)

ALPRAZOLAM ER (ANXIOLYTICS)

ALPRAZOLAM INTENSOL (ANXIOLYTICS)

ALPRAZOLAM XR (ANXIOLYTICS)

alprostadil (OTHER CARDIOVASCULAR DRUGS)

alprostadil (OTHER GENITOURINARY PRODUCTS)

ALREX (OPHTHALMIC CORTICOSTEROID DRUGS)

ALTABAX (TOPICAL ANTIBACTERIAL DRUGS)

ALTACE (ANGIOTENSIN CONVERTING ENZYME INHIBITORS)

ALTAFLUOR (OTHER OPHTHALMIC DRUGS)

altafrin (OTHER OPHTHALMIC DRUGS)

alteplase (OTHER CARDIOVASCULAR DRUGS)

ALTOPREV (HMG-COA REDUCTASE INHIBITORS)

altretamine (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

aluminum acetate (ANTIPRURITIC DRUGS)

aluminum chloride hexahydrate (TOPICAL DERMATOLOGICAL DRUGS)

ALUPENT (BETA-2 ADRENERGIC DRUGS)

ALVESCO (OTHER DRUGS FOR ASTHMA)

amantadine (OTHER ANTIVIRAL DRUGS)

AMANTADINE (OTHER ANTIVIRAL DRUGS)

AMARYL (ORAL HYPOGLYCEMICS & COMBOS)

ambenonium chloride (OTHER CNS/AUTONOMIC DRUGS)

AMBIEN (For members under the age of 60 requires trail of generic benzodiazepine) (SEDATIVE/HYPNOTIC DRUGS)

AMBIEN CR (SEDATIVE/HYPNOTIC DRUGS)

amcinonide (TOPICAL CORTICOSTEROID DRUGS)

AMCINONIDE (TOPICAL CORTICOSTEROID DRUGS)

AMDRY-C (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

AMDRY-D (DECONGESTANTS)

AMERGE (QL=9 tabs/Rx) (DRUGS TO PREVENT AND TREAT HEADACHES)

AMERICAINE (TOPICAL ANESTHETICS)

AMICAR (HEMOSTATICS)

amifostine (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

amikacin (AMINOGLYCOSIDES)

amikacin sulfate (AMINOGLYCOSIDES)

amiloride hcl (POTASSIUM SPARING DIURETICS)

amiloride hcl-hctz (POTASSIUM SPARING DIURETICS)

amiloride hydrochloride (POTASSIUM SPARING DIURETICS)

AMINO ACID CERVICAL (OB/GYN TOPICAL ANTIINFECTIVES)

amino acids (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

amino acids/mv,fe,other min (VITAMINS & MINERALS & RELATED PRODUCTS)

AMINOBENZOATE POTASSIUM (VITAMINS & MINERALS & RELATED PRODUCTS)

aminocaproic acid (HEMOSTATICS)

aminophylline (METHYL XANTHINE DRUGS)

AMINOSYN (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

AMINOSYN II (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

AMINOSYN-PF (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

amiodarone (AMIODARONES)

amiodarone hcl (AMIODARONES)

AMITIZA (IRRITABLE BOWEL DRUGS)

amitriptyline (TERTIARY AMINES)

amitriptyline hcl (TERTIARY AMINES)

amitriptyline hcl/perphenazine (OTHER ANTIDEPRESSANTS)

AMITRIPTYLINE-CHLORDIAZEPOXIDE (OTHER ANTIDEPRESSANTS)

amlodipine (CALCIUM ANTAGONISTS)

amlodipine besylate (CALCIUM ANTAGONISTS)

amlodipine besylate-benazepril (OTHER ANTIHYPERTENSIVES)

AMMONIUM CHLORIDE (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

ammonium chloride (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

ammonium lactate (TOPICAL DERMATOLOGICAL DRUGS)

AMMONIUM LACTATE (TOPICAL DERMATOLOGICAL DRUGS)

amnesteem (ACCUTANES)

amobarbital (SEDATIVE/HYPNOTIC DRUGS)

amoclan (PENICILLINS)

amox tr-potassium clavulanate (PENICILLINS)

amoxapine (SECONDARY AMINES)

amoxicillin (PENICILLINS)

AMOXICILLIN (PENICILLINS)

amoxicillin clavulanate (PENICILLINS)

AMOXIL (PENICILLINS)

amphetamine salt combo (CNS STIMULANT DRUGS)

amphetamine/dextroamphetamine (CNS STIMULANT DRUGS)

ampho b c-s (PARENTERAL ANTIFUNGALS)

AMPHOTEC (PARENTERAL ANTIFUNGALS)

amphotericin b (PARENTERAL ANTIFUNGALS)

ampicillin sodium (PENICILLINS)

ampicillin sodium/sulbactam na (PENICILLINS)

ampicillin trihydrate (PENICILLINS)

ampicillin-sulbactam (PENICILLINS)

AMRIX (CNS MUSCLE RELAXANTS)

AMVISC (OTHER OPHTHALMIC DRUGS)

AMVISC PLUS (OTHER OPHTHALMIC DRUGS)

AMYL NITRITE (NITRATES)

amylase/lipase/protease (OTHER GI DRUGS)

AMYTAL SODIUM (SEDATIVE/HYPNOTIC DRUGS)

ANA-LEX HC (OTHER GI DRUGS)

ANABAR (CNS MUSCLE RELAXANTS)

ANACAINE (TOPICAL ANESTHETICS)

ANADROL-50 (ANDROGEN DRUGS)

ANAFRANIL (TERTIARY AMINES)

anagrelide (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

anagrelide hcl (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

anakinra (INTERLEUKIN RECPTR ANTAGONIST)

ANALPRAM HC (OTHER GI DRUGS)

ANAMANTLE HC (TOPICAL CORTICOSTEROID DRUGS)

ANAMANTLE HC (OTHER GI DRUGS)

ANAMANTLE HC FORTE (TOPICAL CORTICOSTEROID DRUGS)

ANANA FORTE (TOPICAL DERMATOLOGICAL DRUGS)

ANAPLEX DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

ANAPLEX DMX (ANTITUSSIVE AND EXPECTORANT DRUGS)

ANAPROX (requires trial of OTC NSAID) (NON-STEROIDAL ANTIINFLAMMATORY AGENTS)

ANAPROX DS (requires trial of OTC NSAID) (NON-STEROIDAL ANTIINFLAMMATORY AGENTS)

ANASPAZ (ANTISPASMODICS/DRUGS AFFECT GI MOTILITY)

anastrozole (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

ANCOBON (ORAL ANTIFUNGAL DRUGS)

andehist (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

ANDEHIST-DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

ANDRODERM (ANDROGEN DRUGS)

ANDROGEL (ANDROGEN DRUGS)

ANDROID (ANDROGEN DRUGS)

ANDROXY (ANDROGEN DRUGS)

ANECTINE (DIRECT MUSCLE RELAXANTS)

ANEMAGEN (VITAMINS & MINERALS & RELATED PRODUCTS)

ANEMAGEN FORTE (VITAMINS & MINERALS & RELATED PRODUCTS)

ANESTACON (TOPICAL ANESTHETICS)

ANGELIQ (ESTROGEN/PROGESTIN COMBINATIONS)

ANIMI-3 (VITAMINS & MINERALS & RELATED PRODUCTS)

ANOLOR-300 (DRUGS TO PREVENT AND TREAT HEADACHES)

ANSAID (requires trial of OTC NSAID) (NON-STEROIDAL ANTIINFLAMMATORY AGENTS)

ANTABUSE (ALCOHOL ANTAGONIST)

ANTARA (HYPOLIPOPROTEINEMICS)

anthralin (ANTIPSORIASIS AND ANTIECZEMA DRUGS)

anti-inhibitor coagulant comp. (HEMOSTATICS)

antipyrine-benzocaine (DRUGS AFFECTING THE EAR)

antipyrine/benzocaine (DRUGS AFFECTING THE EAR)

antivenin, crotalidae (IMMUNOLOGICALS AND VACCINES)

ANTIVERT (ANTIVERTIGO AND ANTIEMETIC DRUGS)

anucort-hc (OTHER GI DRUGS)

anudil hc (OTHER GI DRUGS)

anumed-hc (OTHER GI DRUGS)

ANUSOL-HC (OTHER GI DRUGS)

ANZEMET (Q) (PA) (ANTIVERTIGO AND ANTIEMETIC DRUGS)

APAP-CAFFEINE-DIHYDROCODEINE (CLASS III NARCOTICS)

apap/isometheptene/dichlphen (DRUGS TO PREVENT AND TREAT HEADACHES)

APEXICON (TOPICAL CORTICOSTEROID DRUGS)

APEXICON E (TOPICAL CORTICOSTEROID DRUGS)

APHTHASOL (DRUGS AFFECTING THE THROAT AND MOUTH)

APIDRA (INSULIN)

APLIGRAF (MEDICAL (MISCELLANEOUS) SUPPLIES)

APLISOL (IMMUNOLOGICALS AND VACCINES)

APOKYN (OTHER ANTIPARKINSON DRUGS)

apomorphine hcl (OTHER ANTIPARKINSON DRUGS)

aprepitant (ANTIVERTIGO AND ANTIEMETIC DRUGS)

apri (CONTRACEPTIVES)

APTIVUS (ANTIRETROVIRALS & PROTEASE INH)

AQUASOL A (ORAL DERMATOLOGICAL DRUGS)

AQUORAL (DRUGS AFFECTING THE THROAT AND MOUTH)

ARALEN PHOSPHATE (PLASMODICIDES)

aranelle (CONTRACEPTIVES)

ARANESP (ERYTHROID STIMULANTS)

ARAVA (covered only if prescribed by rheumatologist) (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

AREDIA (OTHER ENDOCRINE DRUGS)

ARESTIN (DRUGS AFFECTING THE THROAT AND MOUTH)

arformoterol tartrate (BETA-2 ADRENERGIC DRUGS)

ARICEPT (ANTIDEMENTIA DRUGS)

ARICEPT ODT (ANTIDEMENTIA DRUGS)

ARIMIDEX (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

ARISTOSPAN (GLUCOCORTICOID DRUGS)

ARIXTRA (INJECTABLE ANTICOAGULANTS)

ARMOUR THYROID (THYROID SUPPLEMENTS)

AROMASIN (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

ARTHROTEC 50 (requires trial of OTC NSAID) (NON-STEROIDAL ANTIINFLAMMATORY AGENTS)

ARTHROTEC 75 (requires trial of OTC NSAID) (NON-STEROIDAL ANTIINFLAMMATORY AGENTS)

ASACOL (OTHER GI DRUGS)

ASCENSIA AUTODISC (DIABETIC SUPPLIES)

ASCENSIA BREEZE 2 (DIABETIC SUPPLIES)

ASCENSIA CONTOUR (DIABETIC SUPPLIES)

ASCENSIA ELITE (DIABETIC SUPPLIES)

ascomp with codeine (DRUGS TO PREVENT AND TREAT HEADACHES)

ascor l 500 (INJECTABLE VITAMINS)

ascorbic acid (INJECTABLE VITAMINS)

ASCORBIC ACID (VITAMINS & MINERALS & RELATED PRODUCTS)

ASMANEX (OTHER DRUGS FOR ASTHMA)

ASP (CNS MUSCLE RELAXANTS)

asparaginase (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

aspirin (SALICYLATES AND RELATED DRUGS)

ASPIRIN EC (SALICYLATES AND RELATED DRUGS)

aspirin with codeine (CLASS III NARCOTICS)

aspirin/caffeine/butalbital (DRUGS TO PREVENT AND TREAT HEADACHES)

aspirin/dipyridamole (ANTIPLATELET DRUGS)

ASTELIN 68ml (2pk=4btls) (DRUGS AFFECTING THE NOSE)

ASTHMAPACK II (DIAGNOSTIC PRODUCTS)

ASTRAMORPH-PF (CLASS II NARCOTICS)

ASTRINGYN (HEMOSTATICS)

ATABEX (PRENATAL VITAMINS)

ATACAND (ANGIOTENSIN II RECEPTOR ANTAGONISTS)

ATACAND HCT (OTHER ANTIHYPERTENSIVES)

ATACAND HCT (requires trial of ACE inhibitor) (OTHER ANTIHYPERTENSIVES)

atazanavir sulfate (ANTIRETROVIRALS & PROTEASE INH)

atenolol (BETA-ADRENERGIC ANTAGONIST DRUGS)

atenolol-chlorthalidone (OTHER ANTIHYPERTENSIVES)

ATGAM (IMMUNOLOGICALS AND VACCINES)

ATIVAN (ANXIOLYTICS)

atomoxetine (OTHER DRUGS FOR ADHD)

ATOPICLAIR (TOPICAL DERMATOLOGICAL DRUGS)

atovaquone (OTHER ANTIINFECTIVE DRUGS)

atovaquone/proguanil hcl (PLASMODICIDES)

ATRALIN (ANTIACNE DRUGS)

ATRIDOX (DRUGS AFFECTING THE THROAT AND MOUTH)

ATRIPLA (ANTIRETROVIRALS & PROTEASE INH)

atropine care (OTHER OPHTHALMIC DRUGS)

atropine sulfate (OTHER CNS/AUTONOMIC DRUGS)

atropine sulfate (OTHER OPHTHALMIC DRUGS)

ATROVENT (DRUGS AFFECTING THE NOSE)

ATROVENT HFA (OTHER DRUGS FOR ASTHMA)

ATTENUVAX VACCINE WITH DILUENT (IMMUNOLOGICALS AND VACCINES)

ATUSS DS (ANTITUSSIVE AND EXPECTORANT DRUGS)

AUGMENTIN (PENICILLINS)

AUGMENTIN ES-600 (PENICILLINS)

AUGMENTIN XR (PENICILLINS)

AURALGAN (DRUGS AFFECTING THE EAR)

auranofin (OTHER DRUGS FOR ARTHRITIS)

aurodex ear drops (DRUGS AFFECTING THE EAR)

auroguard (DRUGS AFFECTING THE EAR)

AURUM 12X (HOMEOPATHIC DRUGS)

AVAGE (TOPICAL DERMATOLOGICAL DRUGS)

AVALIDE (OTHER ANTIHYPERTENSIVES)

AVANDAMET (INSULIN SENSITIZERS & COMBOS)

AVANDARYL (INSULIN SENSITIZERS & COMBOS)

AVANDIA (INSULIN SENSITIZERS & COMBOS)

AVAPRO (ANGIOTENSIN II RECEPTOR ANTAGONISTS)

AVAR (ANTIACNE DRUGS)

AVAR-E (ANTIACNE DRUGS)

AVC (OB/GYN TOPICAL ANTIINFECTIVES)

AVELOX (QUINOLONES)

AVELOX ABC PACK (QUINOLONES)

aviane (CONTRACEPTIVES)

AVINZA (CLASS II NARCOTICS)

AVITA (ANTIACNE DRUGS)

AVITENE (HEMOSTATICS)

avobenz/octinox/h-quinone (TOPICAL DERMATOLOGICAL DRUGS)

AVODART (OTHER GENITOURINARY PRODUCTS)

AVONEX (INTERFERONS)

AVONEX ADMINISTRATION PACK (PAR) (covered if prescribed by neurologist) (INTERFERONS)

AXERT (DRUGS TO PREVENT AND TREAT HEADACHES)

AXID (ANTIULCER DRUGS)

AYGESTIN (PROGESTIN DRUGS)

AZACTAM (OTHER ANTIINFECTIVE DRUGS)

AZASAN (use generic Azathioprine) (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

AZASITE (OPHTHALMIC TOPICAL ANTIBACTERIAL DRUGS)

azathioprine (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

azelaic acid (ANTIACNE DRUGS)

azelastine hcl (DRUGS AFFECTING THE NOSE)

AZELEX (ANTIACNE DRUGS)

AZILECT (OTHER ANTIPARKINSON DRUGS)

azithromycin (OTHER MACROLIDES)

AZITHROMYCIN (QL = 1 bottle/Rx; 6x250mg; 5x500mg; 10x600mg) (OTHER MACROLIDES)

AZMACORT (OTHER DRUGS FOR ASTHMA)

AZOPT (ANTIGLAUCOMA DRUGS)

AZOR (OTHER ANTIHYPERTENSIVES)

aztreonam (OTHER ANTIINFECTIVE DRUGS)

AZULFIDINE (OTHER GI DRUGS)

Formulary Date: 10/07/2008 Update Date: 10/09/2008 V1.3.0