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

M-END DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

M-END WC (ANTITUSSIVE AND EXPECTORANT DRUGS)

M-M-R II VACCINE (IMMUNOLOGICALS AND VACCINES)

M-VIT (PRENATAL VITAMINS)

M.V.I. PEDIATRIC (INJECTABLE VITAMINS)

M.V.I.-12 (INJECTABLE VITAMINS)

MACROBID (URINARY ANTIINFECTIVES)

MACRODANTIN (URINARY ANTIINFECTIVES)

MAGAN (SALICYLATES AND RELATED DRUGS)

MAGNACET (CLASS II NARCOTICS)

MAGNEBIND 400 RX (BLOOD DETOXICANTS)

magnesium chloride (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

magnesium sulfate (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

MALARONE (PLASMODICIDES)

MALDEMAR (ANTISPASMODICS/DRUGS AFFECT GI MOTILITY)

mannitol (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

maprotiline (OTHER ANTIDEPRESSANTS)

maprotiline hcl (OTHER ANTIDEPRESSANTS)

MAR-SPAS (ANTISPASMODICS/DRUGS AFFECT GI MOTILITY)

MARCAINE (LOCAL ANESTHETICS)

MARCAINE WITH EPINEPHRINE (LOCAL ANESTHETICS)

MARCAINE-EPINEPHRINE (LOCAL ANESTHETICS)

MARGESIC (DRUGS TO PREVENT AND TREAT HEADACHES)

margesic h (CLASS III NARCOTICS)

MARINOL (ANTIVERTIGO AND ANTIEMETIC DRUGS)

marlexate (POTASSIUM REMOVING RESINS)

MARNATAL-F PLUS (PRENATAL VITAMINS)

MARPLAN (MAO INHIBITORS)

marten-tab (DRUGS TO PREVENT AND TREAT HEADACHES)

MARTINIC (THERAPEUTIC VITAMINS & MINERALS)

MASK SET (MEDICAL (MISCELLANEOUS) SUPPLIES)

MASK SET WITH Y-PIECE (MEDICAL (MISCELLANEOUS) SUPPLIES)

MASK, PEDIATRIC (MEDICAL (MISCELLANEOUS) SUPPLIES)

maternity (PRENATAL VITAMINS)

MATULANE (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

MAVIK (ANGIOTENSIN CONVERTING ENZYME INHIBITORS)

MAXAIR AUTOHALER (BETA-2 ADRENERGIC DRUGS)

MAXALT (QLL = 6 tabs/Rx) (DRUGS TO PREVENT AND TREAT HEADACHES)

MAXALT MLT (DRUGS TO PREVENT AND TREAT HEADACHES)

MAXALT MLT (QLL = 6 tabs/Rx) (DRUGS TO PREVENT AND TREAT HEADACHES)

MAXARON FORTE (VITAMINS & MINERALS & RELATED PRODUCTS)

MAXIDEX (OPHTHALMIC CORTICOSTEROID DRUGS)

MAXIDONE (CLASS III NARCOTICS)

MAXIFED (ANTITUSSIVE AND EXPECTORANT DRUGS)

MAXIFED CD (ANTITUSSIVE AND EXPECTORANT DRUGS)

MAXIFED DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

MAXIFED DMX (ANTITUSSIVE AND EXPECTORANT DRUGS)

MAXIFED-G (ANTITUSSIVE AND EXPECTORANT DRUGS)

MAXIFED-G CD (ANTITUSSIVE AND EXPECTORANT DRUGS)

MAXIFLU CD (ANTITUSSIVE AND EXPECTORANT DRUGS)

MAXIFLU DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

MAXINATE (PRENATAL VITAMINS)

MAXIPHEN (ANTITUSSIVE AND EXPECTORANT DRUGS)

MAXIPHEN DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

MAXIPIME (CEPHALOSPORINS)

MAXITROL (OPHTHALMIC ANTIINFECTIVE/CORTICOSTEROIDS)

MAXZIDE (POTASSIUM SPARING DIURETICS)

MAXZIDE-25MG (POTASSIUM SPARING DIURETICS)

me-testosterone/estrogen,ester (ESTROGEN DRUGS)

measles vaccine,atten (IMMUNOLOGICALS AND VACCINES)

measles,mumps&rubella vaccine (IMMUNOLOGICALS AND VACCINES)

MEBARAL (ANTICONVULSANT BARBITURATES)

mebendazole (ANTHELMINTICS)

mechlorethamine (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

meclizine hcl (ANTIVERTIGO AND ANTIEMETIC DRUGS)

MECLIZINE HCL (50mg Only) (ANTIVERTIGO AND ANTIEMETIC DRUGS)

meclofenamate (NON-STEROIDAL ANTIINFLAMMATORY AGENTS)

MECLOFENAMATE SODIUM (Requires trial of OTC NSAID) (NON-STEROIDAL ANTIINFLAMMATORY AGENTS)

MEDROL (GLUCOCORTICOID DRUGS)

medroxyprogesterone (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

medroxyprogesterone (PROGESTIN DRUGS)

medroxyprogesterone acetate (PROGESTIN DRUGS)

mefenamic acid (NON-STEROIDAL ANTIINFLAMMATORY AGENTS)

mefloquine (PLASMODICIDES)

mefloquine hcl (PLASMODICIDES)

MEFOXIN (CEPHALOSPORINS)

mega c-a plus (INJECTABLE VITAMINS)

MEGACE (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

MEGACE ES (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

megestrol (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

megestrol acetate (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

MELANEX (TOPICAL DERMATOLOGICAL DRUGS)

MELISSENGEIST (HOMEOPATHIC DRUGS)

MELOXICAM (NON-STEROIDAL ANTIINFLAMMATORY AGENTS)

melpaque hp (TOPICAL DERMATOLOGICAL DRUGS)

melphalan (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

melquin hp (TOPICAL DERMATOLOGICAL DRUGS)

MELQUIN-3 (TOPICAL DERMATOLOGICAL DRUGS)

memantine hcl (ANTIDEMENTIA DRUGS)

MENEST (ESTROGEN DRUGS)

meningococcal vac a,c,y,w-135 (IMMUNOLOGICALS AND VACCINES)

MENOMUNE-A-C-Y-W-135 (IMMUNOLOGICALS AND VACCINES)

MENOPUR (OVULATORY STIMULANTS)

MENOSTAR (ESTROGEN DRUGS)

menotropins (OVULATORY STIMULANTS)

MENTAX (OTHER TOPICAL ANTIFUNGALS)

meperidine (CLASS II NARCOTICS)

meperidine hcl (CLASS II NARCOTICS)

meperitab (CLASS II NARCOTICS)

mephobarbital (ANTICONVULSANT BARBITURATES)

MEPHYTON (ORAL ANTICOAGULANTS, VITAMIN K)

mepivacaine (LOCAL ANESTHETICS)

MEPROBAMATE (ANXIOLYTICS)

meprolone unipak (GLUCOCORTICOID DRUGS)

MEPRON (PAR) (OTHER ANTIINFECTIVE DRUGS)

MEPROZINE (CLASS II NARCOTICS)

mercaptopurine (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

MERIDIA (APPETITE SUPPRESSANTS)

MERUVAX II VACCINE W-DILUENT (IMMUNOLOGICALS AND VACCINES)

mesalamine (OTHER GI DRUGS)

MESNA (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

mesna (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

MESNEX (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

MESTINON (OTHER CNS/AUTONOMIC DRUGS)

METADATE CD (CNS STIMULANT DRUGS)

METAGLIP (ORAL HYPOGLYCEMICS & COMBOS)

METANX (VITAMINS & MINERALS & RELATED PRODUCTS)

metaproterenol (BETA-2 ADRENERGIC DRUGS)

metaproterenol sulfate (BETA-2 ADRENERGIC DRUGS)

metformin (ORAL HYPOGLYCEMICS & COMBOS)

metformin hcl (ORAL HYPOGLYCEMICS & COMBOS)

metformin hcl er (ORAL HYPOGLYCEMICS & COMBOS)

meth/me blue/ba/salol/atp/hyos (OTHER GENITOURINARY PRODUCTS)

meth/meth blue/ba/salicy/hyos (OTHER GENITOURINARY PRODUCTS)

meth/meth blue/salol/sod/hyos (URINARY ANTIINFECTIVES)

methacholine (DIAGNOSTIC PRODUCTS)

methadex (OPHTHALMIC ANTIINFECTIVE/CORTICOSTEROIDS)

methadone (CLASS II NARCOTICS)

methadone hcl (CLASS II NARCOTICS)

METHADONE HCL (CLASS II NARCOTICS)

methadone intensol (CLASS II NARCOTICS)

methadose (CLASS II NARCOTICS)

METHADOSE (CLASS II NARCOTICS)

methamphetamine (CNS STIMULANT DRUGS)

methazolamide (ANTIGLAUCOMA DRUGS)

METHENAMINE HIPPURATE (URINARY ANTIINFECTIVES)

METHERGINE (OXYTOCICS)

methimazole (ANTITHYROID DRUGS)

METHITEST (ANDROGEN DRUGS)

methocarbamol (CNS MUSCLE RELAXANTS)

methotrexate (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

methotrexate sodium (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

methoxsalen (ORAL DERMATOLOGICAL DRUGS)

methoxsalen (TOPICAL DERMATOLOGICAL DRUGS)

METHSCOPOLAMINE BROMIDE (ANTISPASMODICS/DRUGS AFFECT GI MOTILITY)

methsuximide (SUCCINIMIDES)

methyclothiazide (THIAZIDE AND RELATED DRUGS)

methyldopa (CENTRALLY ACTING ANTIHYPERTENSIVES)

methyldopa-hydrochlorothiazide (OTHER ANTIHYPERTENSIVES)

methyldopa/hctz (OTHER ANTIHYPERTENSIVES)

methylene blue (DIAGNOSTIC PRODUCTS)

methylergonovine (OXYTOCICS)

METHYLIN (CNS STIMULANT DRUGS)

methylin er (CNS STIMULANT DRUGS)

methylphenidate (CNS STIMULANT DRUGS)

methylphenidate er (CNS STIMULANT DRUGS)

methylphenidate hcl (CNS STIMULANT DRUGS)

methylphenidate sr (CNS STIMULANT DRUGS)

methylprednisolone (GLUCOCORTICOID DRUGS)

methylprednisolone acetate (GLUCOCORTICOID DRUGS)

methylprednisolone sod succ (GLUCOCORTICOID DRUGS)

methyltestosterone (ANDROGEN DRUGS)

METIPRANOLOL (ANTIGLAUCOMA DRUGS)

metoclopramide (ANTISPASMODICS/DRUGS AFFECT GI MOTILITY)

metoclopramide hcl (ANTISPASMODICS/DRUGS AFFECT GI MOTILITY)

metolazone (THIAZIDE AND RELATED DRUGS)

metoprolol succinate (BETA-ADRENERGIC ANTAGONIST DRUGS)

metoprolol tartrate (BETA-ADRENERGIC ANTAGONIST DRUGS)

metoprolol-hydrochlorothiazide (OTHER ANTIHYPERTENSIVES)

METRO IV (TRICHOMONOCIDES)

METROCREAM (ANTIACNE DRUGS)

METROGEL (ANTIACNE DRUGS)

METROGEL-VAGINAL (OB/GYN TOPICAL ANTIINFECTIVES)

METROLOTION (ANTIACNE DRUGS)

metronidazole (TRICHOMONOCIDES)

METRONIDAZOLE (TRICHOMONOCIDES)

metronidazole (ANTIACNE DRUGS)

metronidazole (OB/GYN TOPICAL ANTIINFECTIVES)

metryl (TRICHOMONOCIDES)

MEVACOR (HMG-COA REDUCTASE INHIBITORS)

mexiletine (CLASS 1B)

mexiletine hcl (CLASS 1B)

MI-OMEGA (VITAMINS & MINERALS & RELATED PRODUCTS)

MIACALCIN (OTHER ENDOCRINE DRUGS)

MICARDIS (ANGIOTENSIN II RECEPTOR ANTAGONISTS)

MICARDIS HCT (OTHER ANTIHYPERTENSIVES)

miconazole 3 (VAGINAL ANTIFUNGALS)

miconazole nitrate (VAGINAL ANTIFUNGALS)

MICRHOGAM (IMMUNOLOGICALS AND VACCINES)

MICRO-K (POTASSIUM SUPPLEMENTS)

MICROCHAMBER (MEDICAL (MISCELLANEOUS) SUPPLIES)

microgestin (CONTRACEPTIVES)

microgestin fe (CONTRACEPTIVES)

MICRONASE (ORAL HYPOGLYCEMICS & COMBOS)

MICROSPACER (BETA-2 ADRENERGIC DRUGS)

MICROZIDE (THIAZIDE AND RELATED DRUGS)

midazolam hcl (LOCAL ANESTHETICS)

MIDAZOLAM HCL (SEDATIVE/HYPNOTIC DRUGS)

midodrine (OTHER CARDIOVASCULAR DRUGS)

midodrine hcl (OTHER CARDIOVASCULAR DRUGS)

MIDRIN (DRUGS TO PREVENT AND TREAT HEADACHES)

migergot (DRUGS TO PREVENT AND TREAT HEADACHES)

MIGRALAM (DRUGS TO PREVENT AND TREAT HEADACHES)

MIGRANAL (DRUGS TO PREVENT AND TREAT HEADACHES)

MIGRATEN (DRUGS TO PREVENT AND TREAT HEADACHES)

MILLIPRED (GLUCOCORTICOID DRUGS)

milrinone lactate (CARDIAC GLYCOSIDES)

MIMYX (TOPICAL DERMATOLOGICAL DRUGS)

MINILINK REAL-TIME TRANSMITTER (DIAGNOSTIC PRODUCTS)

MINIMED (MEDICAL (MISCELLANEOUS) SUPPLIES)

MINIMED INFUSION (DIABETIC SUPPLIES)

MINIMED RESERVOIR (MEDICAL (MISCELLANEOUS) SUPPLIES)

MINIPRESS (VASODILATOR ANTIHYPERTENSIVES)

MINITRAN (NITRATES)

MINOCIN (TETRACYCLINES)

minocycline (TETRACYCLINES)

minocycline hcl (TETRACYCLINES)

MINOCYCLINE HCL (TETRACYCLINES)

minoxidil (VASODILATOR ANTIHYPERTENSIVES)

MINTUSS DR (ANTITUSSIVE AND EXPECTORANT DRUGS)

MIRAPEX (OTHER ANTIPARKINSON DRUGS)

MIRCETTE (CONTRACEPTIVES)

MIRENA (PROGESTIN DRUGS)

mirtazapine (OTHER ANTIDEPRESSANTS)

MIRTAZAPINE (OTHER ANTIDEPRESSANTS)

misc supp (dress,tape,gauze) (MEDICAL (MISCELLANEOUS) SUPPLIES)

misc supplies (MEDICAL (MISCELLANEOUS) SUPPLIES)

misc supplies (DIABETIC SUPPLIES)

misoprostol (OTHER ANTIULCER DRUGS)

MISTERNEB COMPRESSOR (MEDICAL (MISCELLANEOUS) SUPPLIES)

mitomycin (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

mitotane (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

mitoxantrone (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

mitoxantrone hcl (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

MIXED VESPID VENOM PROTEIN (IMMUNOLOGICALS AND VACCINES)

MOBAN (ANTIPSYCHOTIC DRUGS)

MOBIC (Requires trial of 2 first line NSAIDs) (NON-STEROIDAL ANTIINFLAMMATORY AGENTS)

modafinil (CNS STIMULANT DRUGS)

MODICON (CONTRACEPTIVES)

moexipril (ANGIOTENSIN CONVERTING ENZYME INHIBITORS)

moexipril hcl (ANGIOTENSIN CONVERTING ENZYME INHIBITORS)

moexipril-hydrochlorothiazide (OTHER ANTIHYPERTENSIVES)

moexipril/hctz (OTHER ANTIHYPERTENSIVES)

mold extracts (IMMUNOLOGICALS AND VACCINES)

molindone (ANTIPSYCHOTIC DRUGS)

mometasone (TOPICAL CORTICOSTEROID DRUGS)

mometasone (DRUGS AFFECTING THE NOSE)

mometasone (OTHER DRUGS FOR ASTHMA)

mometasone furoate (TOPICAL CORTICOSTEROID DRUGS)

MONARC-M (HEMOSTATICS)

MONOCLATE-P (HEMOSTATICS)

MONODOX (TETRACYCLINES)

MONOJECT (DIABETIC SUPPLIES)

MONOJECT INSULIN SYRINGE (DIABETIC SUPPLIES)

MONOJECT MAGELLAN (MEDICAL (MISCELLANEOUS) SUPPLIES)

MONOJECT PREFILL (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

MONOJECT SYRINGE (MEDICAL (MISCELLANEOUS) SUPPLIES)

MONOKET (NITRATES)

mononessa (CONTRACEPTIVES)

MONONINE (HEMOSTATICS)

MONOPRIL (ANGIOTENSIN CONVERTING ENZYME INHIBITORS)

MONOPRIL HCT (OTHER ANTIHYPERTENSIVES)

montelukast sodium (LEUKOTRIENE MODIFIERS)

MONUROL (URINARY ANTIINFECTIVES)

morphine (CLASS II NARCOTICS)

morphine sulfate (CLASS II NARCOTICS)

MORPHINE SULFATE (CLASS II NARCOTICS)

morrhuate sodium (MISCELLANEOUS DRUGS)

MOTOFEN (ANTIDIARRHEAL DRUGS)

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

MOVIPREP (OTHER GI DRUGS)

moxifloxacin (QUINOLONES)

moxifloxacin (OPHTHALMIC TOPICAL ANTIBACTERIAL DRUGS)

MS CONTIN (CLASS II NARCOTICS)

MST 600 (SALICYLATES AND RELATED DRUGS)

MUCOTROL (DRUGS AFFECTING THE THROAT AND MOUTH)

multi vitamins with fluoride (VITAMINS & MINERALS & RELATED PRODUCTS)

MULTI-RET FOLIC 500 (VITAMINS & MINERALS & RELATED PRODUCTS)

multi-vita bets-fluoride (VITAMINS & MINERALS & RELATED PRODUCTS)

MULTICHEW (VITAMINS & MINERALS & RELATED PRODUCTS)

multifol plus (PRENATAL VITAMINS)

MULTIGEN (VITAMINS & MINERALS & RELATED PRODUCTS)

MULTIGEN PLUS (VITAMINS & MINERALS & RELATED PRODUCTS)

multitrace-5 (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

multivitamin with fluoride (VITAMINS & MINERALS & RELATED PRODUCTS)

MULTIVITAMIN WITH MINERALS (PRENATAL VITAMINS)

multivitamins (INJECTABLE VITAMINS)

multivitamins (VITAMINS & MINERALS & RELATED PRODUCTS)

MULTIVITAMINS W-FLUORIDE-IRON (VITAMINS & MINERALS & RELATED PRODUCTS)

multivitamins w-iron, hematini (VITAMINS & MINERALS & RELATED PRODUCTS)

multivitamins w/fluoride (VITAMINS & MINERALS & RELATED PRODUCTS)

multivitamins with fluoride (VITAMINS & MINERALS & RELATED PRODUCTS)

multivits w fe,ca,fa,minerals (VITAMINS & MINERALS & RELATED PRODUCTS)

mumps vaccine,live (IMMUNOLOGICALS AND VACCINES)

MUMPSVAX VACCINE W-DILUENT (IMMUNOLOGICALS AND VACCINES)

mupirocin (TOPICAL ANTIBACTERIAL DRUGS)

mupirocin calcium (TOPICAL ANTIBACTERIAL DRUGS)

MUROCOLL-2 (OTHER OPHTHALMIC DRUGS)

MUSE (PAR) (OTHER GENITOURINARY PRODUCTS)

MUSTARGEN (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

MYAMBUTOL (ANTITUBERCULOSIS DRUGS)

MYCELEX (ORAL ANTIFUNGAL DRUGS)

MYCOBUTIN (ANTITUBERCULOSIS DRUGS)

myconel (TOPICAL ANTIFUNGAL-CORTICOSTEROID COMB.)

mycophenolate mofetil (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

mycophenolate sodium (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

MYCOSTATIN (ORAL ANTIFUNGAL DRUGS)

MYCOSTATIN (OTHER TOPICAL ANTIFUNGALS)

MYDFRIN (OTHER OPHTHALMIC DRUGS)

mydral (OTHER OPHTHALMIC DRUGS)

MYDRIACYL (OTHER OPHTHALMIC DRUGS)

MYFERON-150 FORTE (VITAMINS & MINERALS & RELATED PRODUCTS)

MYFORTIC (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

MYHIST-DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

MYHIST-PD (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

MYKIDZ IRON FL (VITAMINS & MINERALS & RELATED PRODUCTS)

MYLERAN (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

mynatal (PRENATAL VITAMINS)

mynatal advance (PRENATAL VITAMINS)

mynatal plus (PRENATAL VITAMINS)

mynatal-z (PRENATAL VITAMINS)

mynate 90 plus (PRENATAL VITAMINS)

MYOBLOC (DIRECT MUSCLE RELAXANTS)

myochrysine (OTHER DRUGS FOR ARTHRITIS)

MYOPHEN (ANALGESICS)

MYRAC (TETRACYCLINES)

MYSOLINE (ANTICONVULSANT BARBITURATES)

MYTELASE (OTHER CNS/AUTONOMIC DRUGS)

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