Effective Date: 2/15/2012
Community Health Plans
Barry Eaton Health Plan Formulary - Plan B Only
•
Recent updates to the formulary are noted as "NEW" in the Status column.
•
Effective 2/1/10 medications available from the Walmart $4 prescription program and narcotic analgesics were deleted.
•
Effective 3/1/10 all insulins and inhalers were deleted. Refer Plan B members to their primary care provider at the Healthy Connections Clinic
.
•
The website www.communityhealthplans.org provides a formulary "Complete List" and "Quick List", and also information on the "Free Blood Glucose Meter Program". Click on Barry Eaton Health Plan/Provider Tools/Pharmacy Benefit Services.
•
Exceptions to the formulary are not available through the Health Plan for Plan B members. See "Other Medication Resources" at the website for links to local pharmacy discount programs and drug company assistance programs.
•
Call Customer Service at 1-866-291-8691 for assistance regarding the medications provided by the Barry Eaton Health Plan.
Brand Name:
A/T/S
Adalat/Procardia
Aldactazide
Aldactone
Aldomet
Aldoril
Alphagan
Altace
Alupent
Ambien
Amoxil
Anaprox
Anaprox DS
Antabuse
Antivert
Anusol HC
Apresoline
Arava
Aristicort
Aristocort
Armour Thyroid
Artane
Atarax
Ativan
Atrovent
Atrovent HFA
Azmacort
Azulfadine
Bacitracin
Bactrim
Bactrim DS
Benadryl
Bentyl
Berocca
Berocca Plus
Betagan
Bleph-10
Breeze II
Bumex
Buspar
Calan
Calan SR
Capoten
Capozide
Carafate
Cardec DM
Cardizem
Cardizem CD
Cardura
Catapres
Ceclor
Celexa
Cephulac
Cipro
Citrical Prenatal Rx
Claritin
Claritin Reditab
Cleocin
Cleocin T
Clinoril
Cogentin
Colace
Colyte
Compazine
Condylox
Contour
Coreg
Corgard
Cortisporin
Coumadin
Dalmane
Daypro
Decadron
Demerol
Depakene
Depakote
Desyrel
Diabenese
Diabeta
Diamox
Diflucan
Dilacor XR
Dilantin
Dilaudid
Diprosone
Disalcid
Ditropan
Dolophine
Domeboro
Donnatal
Drisdol
Duricef
Dyazide
Dynapen
ED Cyte F
EES
Elavil
Elimite
Enduron
Eryc
Erygel
Eryped
Ery-Tab
Erythromycin
Esgic
Esgic Plus
Eskalith
Estrace
Fioricet
Fioricet w/Codeine
Fiorinal
Fiorinal w/Cod
Flagyl
Flexeril
Flonase
FML
Folic Acid
Gantrisin
Garamycin
Glucophage
Glucophage XR
Glucotrol
Glucovance
Golytely
Grifulvin V
Halcion
Haldol
Haldol Conc
Humalog
Humalog Mix
Humulin
Humulin N
Humulin R
Hydrodiuril
Hygroton
Hytone
Hytrin
Ilotycin
Imdur
Imitrex
Imodium AD
Imuran
Inderal
Insulin Syringes
Intal Neb
Isoniazid
Isordil
Isordil SL
Kaochlor S-F
K-DUR
Keflex
Kenalog in Orabase
Klonopin
K-Lyte
K-Tab
Lancets
Lanoxin
Lantus
Lasix
Levemir
Levothroid
Levoxyl
Levsin
Levsin SL
Levsinex
Librax
Librium
Lidex
Lidex E
Lioresal
Lomotil
Loniten
Lopid
Lopressor
Lorcet
Lorcet HD
Lorcet Plus
Lortab
Lotensin
Lotensin HCT
Lotrimin
Loxitane
Lozol
Maalox
Macrodantin
Materna
Maxitrol
Maxzide
Meclomen
Medrol DP
Metamucil
Methotrexate
Mevacor
Mexitil
Micro-K
Micronor
Microzide
Minocin
Mobic
Moduretic
Monistat-3
Motrin
Mycolog
Mycostatin
Mylanta
Mysoline
Naprosyn
Natacare Rx
Natafort
Natal Care Plus
Natalcare
Natalcare PIC Forte
Navane
Neevo
Neosporin
Neptazane
Nestabs CBF
Nestabs FA
Nestabs Rx
Nitro-Bid
Nitro-Dur
Nitrostat
Nix
Norco
Norpace
Norvasc
Novacet
Novolin
Novolin N
Novolin R
Novolog
Novolog Mix
O-Cal FA
O-Cal Prenatal
Ocupress
Ogen
Organidin NR
Ortho Tricyclen
Ortho-Cyclen
Orudis
Otogesic
Pamelor
Parafon DSC
Paxil
P-D Natalplus
Pen-VK
Pepcid
Percocet
Percodan
Peri-Colace
Persantine
Phenergan
Phenergan DM
Phenobarbital
Pilocarpine
Plaquenil
Poly-Vi-Flor
Precose
Pred Forte
Prednisone
Prenatal
Prenatal 1+1
Prenatal rx1
Prenatal S
Prental Plus
Principen
Proair HFA
Pro-Banthine
Probenecid
Procainamide
Prolixin
Proloprim
Pronestyl
Propylthiouracil
Proventil
Provera
Prozac
Pyridium
Questran
Questran Lt
Quinaglute
Quinidex
Quinidine
Qvar
Reglan
Restoril
Rheumatrex
Ritalin
Ritalin SR
Robaxin
Robitussin
Robitussin DM
Sectral
Selsun
Silvadene
Sinemet
Sinequan
Slow-K
Stelazine
Sumycin
Symmetrel
Synalar
Synthroid
Tagamet
Tagamet HB
Tapazole
Tegretol
Temovate
Tenex
Tenoretic
Tenormin
Tessalon Perles
Thorazine
Timoptic
Tinactin
Tobrex
Tofranil
Trandate
Tranxene
Trideselon
Trilafon
Trilisate
Tri-Norinyl
Trusopt
Tylenol w/Codeine
Tylox
Ultram
Unithroid
Valisone
Valium
Vaseretic
Vasotec
Ventolin HFA
Vermox
Vibramycin
Vibra-Tab
Vicodin
Vicodin ES
Vistaril
Voltaren
Vosol
Vosol HC
Wytensin
Xanax
Xylocaine Viscous
Zanaflex
Zantac
Zestoretic
Zestril
Ziac
Zocor
Zoloft
Zovirax
Zyloprim
Zyrtec
Drug Class:
Analgesic
Anti-Infective
Bronchial
Cardiovascular
Dermatologic
Diabetes
Endocrine
Gastrointestinal
Miscellaneous
Ophthalmic Agents
Otic Agents
Psychotherapeutic
Vitamin Supplements
Women's Health
Detailed Formulary - pdf
Generic Name:
Acebutolol
Acetazolamide
Acetic Acid
Acetic Acid/Alum Ace
Acetic Acid/HC
Acrabose
Acyclovir
Albuterol Sulfate
Allopurinol
Alprazolam
Amantadine
Amitriptyline
Amlodipine Besylate
Amoxicillin
Ampicillin
Anitpyrine/Benzocaine/Glycerin
APAP/Codeine
ASA/Caff/Butalbital
Atenolol
Atenolol/Chorthalidone
Azathiprine
Bacitracin
Baclofen
Beclomethasone Dip
Belladona Alk/Pb
Benazepril
Benazepril/HCTZ
Benzonatate
Benztropine Mes
Betamethasone Dip
Betamethasone Val
Bisoprol/HCTZ
Blood Glucose Strip
Brimonidine tartrate
Bulalb/APAP/Caff
Bumetanide
Buspirone
Captopril
Captopril/HCTZ
Carbamazepine
Carbidopa/Levadopa
Carteolol HCl
Carvedilol
Cefaclor
Cefadroxil
Cephalexin
Cetirizine
Chlordiazepoxide
Chlorpromazine
Chlorpropamide
Chlorthalidone
Chlorzoxazone
Choline Mag Trisalicylate
Cimetidine
Ciprofloxacin
Citalopram
Clindamycin
Clindinium Br/CDP
Clobetasol
Clonazepam
Clonidine
Clorazepate
Clotrimazole
Codeine/Butalbital/ASA/Caff
Colestyramine
Cromolyn Sodium
Cyclobenzaprine
Desonide
Dexamethasone
Diazepam
Diclofenac
Dicloxacillin
Dicyclomine
Digoxin
Diltiazem
Diltiazem CR
Diltiazem SR 24Hr
Diphenhydramine
Diphenoxylate/Atropine Su
Dipyridamole
Disopyramide Phos
Disulfiram
Divalproex Sod DR
D-Methor/Pe/Chlorphen
Docusate Sod
Dorzolamide HCl
Doxazosin
Doxepin
Doxycycline
Electrolyte Soln/PEG
Enalapril
Enalapril/HCTZ
Ergocalciferol
Erythromycin Base
Erythromycin Base/ROH
Erythromycin Ethylsuccinate
Estradiol
Estropipate
Famotidine
Fluconazole
Fluocinolone Ace
Fluocinonide
Fluoxetine
Fluphenazine
Flurazepam
Fluromethalone
Fluticasone
Folic Acid
Furosemide
Gemfibrozil
Gentamicin Sulf
Glipizide
Glyburide
Glyburide/Metformin
Griseofulvin
Guaifenesin
Guaifenesin/D-meth
Guanabenz acet
Guanfacine
Haloperidol
Haloperidol Lactate
HCTZ
HCTZ/Amiloride
HCTZ/Triamterene
Hydralazine
Hydrocodone Bit/APAP
Hydrocodone/APAP
Hydrocortisone
Hydromorphone
Hydroxychlorquine Sulf
Hydroxyzine
Hydroxyzine Pam
Hyoscyamine Sulf
Ibuprofen
Imipramine
Indapamide
Insulin Syringes
Ipratropium Br
Isoniazid
Isosorbide dinitrare
Isosorbide dinitrate
Isosorbide dinitrate SL
Isosorbide Mononitrate
Ketoprofen
Labetalol
Lactulose
Lancets
Leflunomide
Levobunolol
Levothyroxine Sodium
Lidocaine
Lisinopril
Lisinopril/HCTZ
Lithium Carbonate
Loperamide
Loratadine
Lorazepam
Lovastatin
Loxapine
Mag Hydrox/Al Hydrox
Mag Hydrox/Al Hydrox/Sim
Mebendazole
Meclizine
Meclofenamate Sod
Medroxyprogesterone
Meloxicam
Meperidine HCL
Metaproterenol Sulf
Metformin
Methadone
Methazolamide
Methclothiazide
Methimazole
Methocarbamol
Methotrexate
Methyldopa
Methyldopa/HCTZ
Methylphenidate
Methylprednisolone
Metoclopramide
Metoprolol Tar
Metronidazole
Mexiletine
Miconazole nitrate
Minocycline
Minoxidil
Multivit/Therap w-fe, Hematin
Multivitamin + Fl
Nadolol
Naproxen
Naproxen Sod
Neomy/Pmx/HC
Neomycin/Polymx/Dexamth
Neomycin/Polymx/Gram
Neomycin/Polymx/HC
Nifedepine
Nitrofurantoin macro
Nitroglycerin
Nitroglycerin SL
Nitroglyerin SA
Norethindrone
Norethindrone-ethyinyl estradiol
Norgestimate-ethyinyl estradiol
Nortriptyline
Nystatin
Nystatin/Triamcin
Oxaprosin
Oxprazin
Oxybutynin Cl
Oxycodone/APAP
Oxycodone/ASA
Paroxetine
Penicillin
Permethrin
Perphenazine
Phenazopyradine
Phenobarbital
Phenytoin
Pilocarpine
Podofilox
Potassium Chloride
Prednisolone Acet
Prednisone
Prenatal Vitamin
Primidone
Probenecid
Procainamide
Procainamide SA
Prochlorperazine Mal
Promethazine
Promthazine/D-meth
Propantheline Br
Propranolol
Propylthiouracil
Psyllium Seed
Psyllium Seed/Sucrose
Quinidine Gluconate
Quinidine Sulf
Ramipril
Ranitidine
Salsalate
Selenium Sulf
Sertraline
Silver Sulfasalazine
Simvastatin
SMZ/TMP
Sod Sulfacetamide/Sulfur
Spironolactone
Spironolactone/HCTZ
Sucralfate
Sulfacetamide Sodium
Sulfasalazine
Sulfasalazine DR
Sulfisoxazole
Sulindac
Sumatriptan
Temazepam
Terazosin
Tetracycline
Thiothixene
Thyroid
Timolol Mal
Tizanidine
Tobramycin
Tolnaftate
Tramadol
Trazadone
Triamcinolone Acetonide
Triazolam
Trifluoperazine
Trihexyphenidyl
Trimethoprim
Valproic Acid
Verapamil
Verapamil SA
Vitamin B Comp w/C
Warfarin
Zolpidem
Specific Therapeutic Desc:
ACE Inhibitor
ACE Inhibitor/Diuretic
Alpha Blocker
Alpha Glucosidase Inh
Alpha/Beta Blocker
Analgesic, Misc
Anesthetic
Antacid
Antiarrhythmic
Antiarthritic
Antibacterial
Anticoagulant
Antidiarrheal
Antifungal
Antihistamine
Antihistamine, non sed.
Antihypertensives, Misc
Anti-Infective
Anti-Infective/Corticosteroid
Antimalarial
Anti-nausea
Antiparasitic
Antiparkinson's
Antispasmotic/Anticholingergics
Anti-Thyroid
Anti-Ulcer
Antiviral
Asthma/COPD
Beta Blocker
Beta Blocker + Diuretic
Biguanide
Biguanide/Sulfonylurea
Calcium Channel Blocker
Cephalosporin
Cholesterol - Statin
Coronary Vasodilator
Corticosteroid
Cough & Cold
Digitalis Glycoside
Diuretic, Carbonic Anhydrase
Diuretic, Thiazide
Diuretics, K+ Sparing
Diuretics, Loop
Estrogen
Glaucoma
H-2 Antagonist
Immunosuppresive
Insulin
Laxative
Lipotropic
Macrolide
Mast Cell Stabilizer
Migraine
Miscellaneous
Muscle Relaxants
Narcotic
Nasal Corticosteroid
Non Steroidal
Oral Contraceptive
Penicillin
Potassium Supplements
Prenatal
Progesterone
Quinolone
Rectal Prep
Salicylate
Sulfonamide
Sulfonylureas
Supplies
TB
Tetracycline
Thyroid
Urinary Tract Agents
Womens Health - Antiinfective
Detailed Formulary - Excel
Quicklist Summary - pdf
* Click on column header to sort.
GEQ Only
OTC
Brand Name (Reference Only)
Generic Name
STRENGTH
Dosage Form
Drug Class
Specific Therapeutic Description
Prescribing Edits
Status
*
A/T/S
Erythromycin Base/ROH
soln
Dermatologic
Anti-Infective
*
Adalat/Procardia
Nifedepine
10mg
cap
Cardiovascular
Calcium Channel Blocker
*
Adalat/Procardia
Nifedepine
20mg
cap
Cardiovascular
Calcium Channel Blocker
*
Aldoril
Methyldopa/HCTZ
250-15
tab
Cardiovascular
Antihypertensives, Misc
*
Aldoril
Methyldopa/HCTZ
250-25
tab
Cardiovascular
Antihypertensives, Misc
*
Alphagan
Brimonidine tartrate
drops
Ophthalmic Agents
Glaucoma
*
Altace
Ramipril
2.5mg
cap
Cardiovascular
ACE Inhibitor
*
Altace
Ramipril
5mg
cap
Cardiovascular
ACE Inhibitor
*
Altace
Ramipril
10mg
cap
Cardiovascular
ACE Inhibitor
*
Alupent
Metaproterenol Sulf
6mg/ml
soln
Bronchial
Asthma/COPD
*
Alupent
Metaproterenol Sulf
4mg/ml
soln
Bronchial
Asthma/COPD
*
Alupent
Metaproterenol Sulf
10mg/5ml
syrup
Bronchial
Asthma/COPD
*
Alupent
Metaproterenol Sulf
10mg
tab
Bronchial
Asthma/COPD
*
Alupent
Metaproterenol Sulf
20mg
tab
Bronchial
Asthma/COPD
*
Ambien
Zolpidem
5mg
Tab
Psychotherapeutic
Sedative/Hypnotic
NEW
*
Ambien
Zolpidem
10mg
Tab
Psychotherapeutic
Sedative/Hypnotic
NEW
*
Anaprox
Naproxen Sod
275mg
tab
Analgesic
Non Steroidal
*
Anaprox DS
Naproxen Sod
550mg
tab
Analgesic
Non Steroidal
*
Antabuse
Disulfiram
250mg
tab
Psychotherapeutic
Substance Abuse
*
Antabuse
Disulfiram
500mg
tab
Psychotherapeutic
Substance Abuse
*
Antivert
Meclizine
12.5mg
tab
Gastrointestinal
Anti-nausea
*
Antivert
Meclizine
25mg
tab
Gastrointestinal
Anti-nausea
*
Apresoline
Hydralazine
10mg
tab
Cardiovascular
Antihypertensives, Misc
*
Apresoline
Hydralazine
100mg
tab
Cardiovascular
Antihypertensives, Misc
*
Apresoline
Hydralazine
25mg
tab
Cardiovascular
Antihypertensives, Misc
*
Apresoline
Hydralazine
50mg
tab
Cardiovascular
Antihypertensives, Misc
*
Arava
Leflunomide
10mg
tab
Miscellaneous
Antiarthritic
*
Arava
Leflunomide
20mg
tab
Miscellaneous
Antiarthritic
Armour Thyroid
Thyroid
60mg
tab
Miscellaneous
Thyroid
Armour Thyroid
Thyroid
15mg
tab
Miscellaneous
Thyroid
Armour Thyroid
Thyroid
30mg
tab
Miscellaneous
Thyroid
Armour Thyroid
Thyroid
90mg
tab
Miscellaneous
Thyroid
Armour Thyroid
Thyroid
120mg
tab
Miscellaneous
Thyroid
Armour Thyroid
Thyroid
180mg
tab
Miscellaneous
Thyroid
Armour Thyroid
Thyroid
240mg
tab
Miscellaneous
Thyroid
Armour Thyroid
Thyroid
300mg
tab
Miscellaneous
Thyroid
*
Atarax
Hydroxyzine
10/5
syrup
Bronchial
Antihistamine
*
Atarax
Hydroxyzine
10mg
tab
Bronchial
Antihistamine
*
Atarax
Hydroxyzine
25mg
tab
Bronchial
Antihistamine
*
Atarax
Hydroxyzine
50mg
tab
Bronchial
Antihistamine
*
Ativan
Lorazepam
0.5mg
tab
Psychotherapeutic
Anti-Anxiety
*
Ativan
Lorazepam
1mg
tab
Psychotherapeutic
Anti-Anxiety
*
Ativan
Lorazepam
2mg
tab
Psychotherapeutic
Anti-Anxiety
*
Atrovent
Ipratropium Br
21mcg
soln
Bronchial
Asthma/COPD
*
Azulfadine
Sulfasalazine
500mg
tab
Anti-Infective
Sulfonamide
*
Azulfadine
Sulfasalazine DR
500mg
tab
Anti-Infective
Sulfonamide
*
Bacitracin
Bacitracin
500u/g
Oint
Ophthalmic Agents
Anti-Infective
*
Benadryl
Diphenhydramine
25mg
cap
Bronchial
Antihistamine
*
Benadryl
Diphenhydramine
50mg
cap
Bronchial
Antihistamine
*
Berocca
Vitamin B Comp w/C
tab
Vitamin Supplements
Miscellaneous
*
Berocca Plus
Multivit/Therap w-fe, Hematin
tab
Vitamin Supplements
Miscellaneous
Blood Glucose Strips
Contour
strip
Diabetes
Supplies
QL - 102/month Free Meter-Call Bayer 877-229-3777
Blood Glucose Strips
Breeze II
strip
Diabetes
Supplies
QL - 102/month Free Meter-Call Bayer 877-229-3777
*
Carafate
Sucralfate
1gm
tab
Gastrointestinal
Anti-Ulcer
*
Cardec DM
D-Methor/Pe/Chlorphen
syrup
Bronchial
Cough & Cold
QL - 240ml
*
Ceclor
Cefaclor
250mg
cap
Anti-Infective
Cephalosporin
*
Ceclor
Cefaclor
500mg
cap
Anti-Infective
Cephalosporin
*
Ceclor
Cefaclor
125mg/5
susp
Anti-Infective
Cephalosporin
*
Ceclor
Cefaclor
187mg/5
susp
Anti-Infective
Cephalosporin
*
Ceclor
Cefaclor
250/5mg
susp
Anti-Infective
Cephalosporin
*
Ceclor
Cefaclor
375/5mg
susp
Anti-Infective
Cephalosporin
*
Cleocin
Clindamycin
150mg
cap
Anti-Infective
Miscellaneous
*
Cleocin T
Clindamycin
soln
Dermatologic
Anti-Infective
*
Clinoril
Sulindac
150mg
tab
Analgesic
Non Steroidal
*
Clinoril
Sulindac
200mg
tab
Analgesic
Non Steroidal
*
x
Colace
Docusate Sod
100mg
cap
Gastrointestinal
Laxative
*
Colyte
Electrolyte Soln/PEG
soln
Gastrointestinal
Laxative
*
Compazine
Prochlorperazine Mal
10mg
tab
Gastrointestinal
Anti-nausea
*
Compazine
Prochlorperazine Mal
5mg
tab
Gastrointestinal
Anti-nausea
*
Condylox
Podofilox
soln
Dermatologic
Miscellaneous
*
Cortisporin
Neomy/Pmx/HC
soln
Otic Agents
Anti-Infective/Corticosteroid
*
Cortisporin
Neomy/Pmx/HC
susp
Otic Agents
Anti-Infective/Corticosteroid
*
Cortisporin
Neomycin/Polymx/HC
Oint
Ophthalmic Agents
Anti-Infective
*
Cortisporin
Neomycin/Polymx/HC
susp
Ophthalmic Agents
Anti-Infective
*
Dalmane
Flurazepam
15mg
cap
Psychotherapeutic
Sedative/Hypnotic
*
Dalmane
Flurazepam
30mg
cap
Psychotherapeutic
Sedative/Hypnotic
*
Daypro
Oxprazin
600mg
tab
Analgesic
Non Steroidal
*
Decadron
Dexamethasone
0.5mg/5
soln
Miscellaneous
Corticosteroid
*
Decadron
Dexamethasone
1.5mg
tab
Miscellaneous
Corticosteroid
*
Depakene
Valproic Acid
250mg
cap
Psychotherapeutic
Anticonvulsant
*
Depakote
Divalproex Sod DR
250mg
tab
Psychotherapeutic
Anticonvulsant
*
Depakote
Divalproex Sod DR
500mg
tab
Psychotherapeutic
Anticonvulsant
*
Depakote
Divalproex Sod DR
125mg
tab
Psychotherapeutic
Anticonvulsant
*
Diamox
Acetazolamide
250mg
tab
Cardiovascular
Diuretic, Carbonic Anhydrase
*
Dilantin
Phenytoin
100/4
soln
Psychotherapeutic
Anticonvulsant
*
Dilantin
Phenytoin
50mg
tab chew
Psychotherapeutic
Anticonvulsant
*
Dilantin
Phenytoin
100mg
cap
Psychotherapeutic
Anticonvulsant
*
Dilantin
Phenytoin
30mg
cap
Psychotherapeutic
Anticonvulsant
*
Disalcid
Salsalate
500mg
tab
Analgesic
Salicylate
*
Disalcid
Salsalate
750mg
tab
Analgesic
Salicylate
*
Domeboro
Acetic Acid/Alum Ace
drops
Otic Agents
Miscellaneous
*
Drisdol
Ergocalciferol
50,000U
cap
Vitamin Supplements
Miscellaneous
*
Duricef
Cefadroxil
500mg
cap
Anti-Infective
Cephalosporin
*
Dynapen
Dicloxacillin
250mg
cap
Anti-Infective
Penicillin
*
Dynapen
Dicloxacillin
500mg
cap
Anti-Infective
Penicillin
*
EES
Erythromycin Ethylsuccinate
200/5
susp
Anti-Infective
Macrolide
*
EES
Erythromycin Ethylsuccinate
400/5
susp
Anti-Infective
Macrolide
*
EES
Erythromycin Ethylsuccinate
400mg
tab
Anti-Infective
Macrolide
*
Elavil
Amitriptyline
150mg
Tab
Psychotherapeutic
Antidepressant
NEW
*
Elimite
Permethrin
cr
Dermatologic
Antiparasitic
*
Enduron
Methclothiazide
5mg
tab
Cardiovascular
Diuretic, Thiazide
*
Erygel
Erythromycin Base/ROH
gel
Dermatologic
Anti-Infective
*
Eryped
Erythromycin Ethylsuccinate
200/5
susp
Anti-Infective
Macrolide
*
FML
Fluromethalone
susp
Ophthalmic Agents
Corticosteroid
Gantrisin
Sulfisoxazole
500/5
susp
Anti-Infective
Sulfonamide
*
Glucophage XR
Metformin
750mg SR
tab
Diabetes
Biguanide
*
Glucovance
Glyburide/Metformin
5/500mg
tab
Diabetes
Biguanide/Sulfonylurea
*
Glucovance
Glyburide/Metformin
2.5/500mg
tab
Diabetes
Biguanide/Sulfonylurea
*
Golytely
Electrolyte Soln/PEG
soln
Gastrointestinal
Laxative
Grifulvin V
Griseofulvin
125/5
susp
Anti-Infective
Antifungal
*
Halcion
Triazolam
0.25mg
tab
Psychotherapeutic
Sedative/Hypnotic
*
Halcion
Triazolam
0.125mg
tab
Psychotherapeutic
Sedative/Hypnotic
*
Imdur
Isosorbide Mononitrate
120mg
tab
Cardiovascular
Coronary Vasodilator
*
Imitrex
Sumatriptan
50mg
tab
Analgesic
Migraine
9 tabs/mo
*
Imitrex
Sumatriptan
100mg
tab
Analgesic
Migraine
9 tabs/mo
*
Imitrex
Sumatriptan
25mg
tab
Analgesic
Migraine
9 tabs/mo
*
Imuran
Azathiprine
50mg
tab
Miscellaneous
Immunosuppresive
*
Insulin Syringes
Insulin Syringes
Diabetes
Supplies
*
Intal Neb
Cromolyn Sodium
20mg/2ml
vial
Bronchial
Mast Cell Stabilizer
*
Isordil
Isosorbide dinitrate
10mg
tab
Cardiovascular
Coronary Vasodilator
*
Isordil
Isosorbide dinitrate
20mg
tab
Cardiovascular
Coronary Vasodilator
*
Isordil
Isosorbide dinitrate
5mg
tab
Cardiovascular
Coronary Vasodilator
*
Isordil SL
Isosorbide dinitrate SL
5mg
tab
Cardiovascular
Coronary Vasodilator
*
Isordil SL
Isosorbide dinitrate SL
2.5mg
tab
Cardiovascular
Coronary Vasodilator
*
Kenalog in Orabase
Triamcinolone Acetonide
paste
Dermatologic
Corticosteroid
*
Klonopin
Clonazepam
0.5mg
tab
Psychotherapeutic
Anticonvulsant
*
Klonopin
Clonazepam
1mg
tab
Psychotherapeutic
Anticonvulsant
*
Klonopin
Clonazepam
2mg
tab
Psychotherapeutic
Anticonvulsant
*
Lancets
Lancets
Diabetes
Supplies
*
Levsin
Hyoscyamine Sulf
0.125mg/ml
drops
Gastrointestinal
Antispasmotic/Anticholingergics
*
Levsin SL
Hyoscyamine Sulf
0.125mg/ml
tab
Gastrointestinal
Antispasmotic/Anticholingergics
*
Levsinex
Hyoscyamine Sulf
0.375mg
cap
Gastrointestinal
Antispasmotic/Anticholingergics
*
Librax
Clindinium Br/CDP
cap
Gastrointestinal
Antispasmotic/Anticholingergics
*
Librium
Chlordiazepoxide
10mg
cap
Psychotherapeutic
Anti-Anxiety
*
Librium
Chlordiazepoxide
25mg
cap
Psychotherapeutic
Anti-Anxiety
*
Librium
Chlordiazepoxide
5mg
cap
Psychotherapeutic
Anti-Anxiety
*
Lomotil
Diphenoxylate/Atropine Su
syrup
Gastrointestinal
Antidiarrheal
*
Lomotil
Diphenoxylate/Atropine Su
tab
Gastrointestinal
Antidiarrheal
*
Loniten
Minoxidil
10mg
tab
Cardiovascular
Antihypertensives, Misc
*
Loniten
Minoxidil
2.5mg
tab
Cardiovascular
Antihypertensives, Misc
*
Lopid
Gemfibrozil
600mg
tab
Cardiovascular
Lipotropic
*
Lotrimin
Clotrimazole
Cr
Dermatologic
Antifungal
*
Lotrimin
Clotrimazole
soln
Dermatologic
Antifungal
*
Loxitane
Loxapine
10mg
cap
Psychotherapeutic
Antipsychotic
*
Loxitane
Loxapine
25mg
cap
Psychotherapeutic
Antipsychotic
*
Loxitane
Loxapine
5mg
cap
Psychotherapeutic
Antipsychotic
*
Loxitane
Loxapine
50mg
cap
Psychotherapeutic
Antipsychotic
*
Macrodantin
Nitrofurantoin macro
100mg
cap
Anti-Infective
Miscellaneous
*
Macrodantin
Nitrofurantoin macro
25mg
cap
Anti-Infective
Miscellaneous
*
Macrodantin
Nitrofurantoin macro
50mg
cap
Anti-Infective
Miscellaneous
*
Meclomen
Meclofenamate Sod
100mg
cap
Analgesic
Non Steroidal
*
Meclomen
Meclofenamate Sod
50mg
cap
Analgesic
Non Steroidal
*
Methotrexate
Methotrexate
2.5mg
tab
Analgesic
Antiarthirtic
*
Mexitil
Mexiletine
150mg
cap
Cardiovascular
Antiarrhythmic
*
Mexitil
Mexiletine
200mg
cap
Cardiovascular
Antiarrhythmic
*
Mexitil
Mexiletine
250mg
cap
Cardiovascular
Antiarrhythmic
*
Microzide
HCTZ
12.5mg
tab
Cardiovascular
Diuretic, Thiazide
Not Covered
*
Minocin
Minocycline
100mg
cap
Anti-Infective
Tetracycline
*
Minocin
Minocycline
50mg
cap
Anti-Infective
Tetracycline
*
x
Monistat-3
Miconazole nitrate
200mg
supp
Women's Health
Antifungal
*
Mycostatin
Nystatin
100mu
tab
Women's Health
Women's Health - Antiinfective
*
Mycostatin
Nystatin
100mu/ml
susp
Anti-Infective
Miscellaneous
*
Mycostatin
Nystatin
500mu
tab
Anti-Infective
Miscellaneous
*
Mysoline
Primidone
250mg
tab
Psychotherapeutic
Anticonvulsant
*
Mysoline
Primidone
50mg
tab
Psychotherapeutic
Anticonvulsant
*
Neosporin
Neomycin/Polymx/Gram
drops
Ophthalmic Agents
Anti-Infective
*
Neptazane
Methazolamide
25mg
tab
Cardiovascular
Diuretic, Carbonic Anhydrase
*
Nitro-Bid
Nitroglyerin SA
2.5mg
cap
Cardiovascular
Coronary Vasodilator
*
Nitro-Bid
Nitroglyerin SA
6.5mg
cap
Cardiovascular
Coronary Vasodilator
*
Nitro-Bid
Nitroglyerin SA
9mg
cap
Cardiovascular
Coronary Vasodilator
*
Nitro-Bid
Nitroglycerin
Oint
Cardiovascular
Coronary Vasodilator
*
Nitro-Dur
Nitroglycerin
0.4mg
patch
Cardiovascular
Coronary Vasodilator
*
Nitro-Dur
Nitroglycerin
0.1mg
patch
Cardiovascular
Coronary Vasodilator
*
Nitro-Dur
Nitroglycerin
0.2mg
patch
Cardiovascular
Coronary Vasodilator
*
Nitro-Dur
Nitroglycerin
0.6mg
patch
Cardiovascular
Coronary Vasodilator
*
Nitrostat
Nitroglycerin SL
0.3mg
tab
Cardiovascular
Coronary Vasodilator
*
Nitrostat
Nitroglycerin SL
0.4mg
tab
Cardiovascular
Coronary Vasodilator
*
Nitrostat
Nitroglycerin SL
0.6mg
tab
Cardiovascular
Coronary Vasodilator
*
x
Nix
Permethrin
liquid
Dermatologic
Antiparasitic
*
Norpace
Disopyramide Phos
100mg
cap
Cardiovascular
Antiarrhythmic
*
Norpace
Disopyramide Phos
150mg
cap
Cardiovascular
Antiarrhythmic
*
Norvasc
Amlodipine Besylate
2.5mg
tab
Cardiovascular
Calcium Channel Blocker
*
Norvasc
Amlodipine Besylate
10mg
tab
Cardiovascular
Calcium Channel Blocker
*
Norvasc
Amlodipine Besylate
5mg
tab
Cardiovascular
Calcium Channel Blocker
*
Novacet
Sod Sulfacetamide/Sulfur
10/5%
lotion
Dermatologic
Anti-Infective
*
Ocupress
Carteolol HCl
drops
Ophthalmic Agents
Glaucoma
*
Organidin NR
Guaifenesin
200mg
tab
Bronchial
Cough & Cold
*
Orudis
Ketoprofen
75ng
cap
Analgesic
Non Steroidal
*
Parafon DSC
Chlorzoxazone
500mg
tab
Analgesic
Muscle Relaxants
*
Persantine
Dipyridamole
25mg
tab
Cardiovascular
Coronary Vasodilator
*
Persantine
Dipyridamole
50mg
tab
Cardiovascular
Coronary Vasodilator
*
Persantine
Dipyridamole
75mg
tab
Cardiovascular
Coronary Vasodilator
*
Phenobarbital
Phenobarbital
20/5
elixir
Psychotherapeutic
Anticonvulsant
*
Phenobarbital
Phenobarbital
15mg
tab
Psychotherapeutic
Anticonvulsant
*
Phenobarbital
Phenobarbital
60mg
tab
Psychotherapeutic
Anticonvulsant
*
Phenobarbital
Phenobarbital
30mg
tab
Psychotherapeutic
Anticonvulsant
*
Phenobarbital
Phenobarbital
100mg
tab
Psychotherapeutic
Anticonvulsant
*
Phenobarbital
Phenobarbital
16.2mg
tab
Psychotherapeutic
Anticonvulsant
*
Phenobarbital
Phenobarbital
32.4mg
tab
Psychotherapeutic
Anticonvulsant
*
Phenobarbital
Phenobarbital
64.8mg
tab
Psychotherapeutic
Anticonvulsant
*
Phenobarbital
Phenobarbital
97.2mg
tab
Psychotherapeutic
Anticonvulsant
*
Plaquenil
Hydroxychlorquine Sulf
200mg
tab
Anti-Infective
Antimalarial
*
Poly-Vi-Flor
Multivitamin + Fl
0.25mg
tab chew
Vitamin Supplements
Multivitamin Ped
*
Poly-Vi-Flor
Multivitamin + Fl
0.25mg
drops
Vitamin Supplements
Multivitamin Ped
*
Poly-Vi-Flor
Multivitamin + Fl
0.5mg
drops
Vitamin Supplements
Multivitamin Ped
*
Poly-Vi-Flor
Multivitamin + Fl
0.5mg
drops
Vitamin Supplements
Multivitamin Ped
*
Poly-Vi-Flor
Multivitamin + Fl
0.25mg
drops
Vitamin Supplements
Multivitamin Ped
*
Precose
Acrabose
100mg
tab
Diabetes
Alpha Glucosidase Inh
*
Precose
Acrabose
50mg
tab
Diabetes
Alpha Glucosidase Inh
*
Precose
Acrabose
25mg
tab
Diabetes
Alpha Glucosidase Inh
*
Pred Forte
Prednisolone Acet
drops
Ophthalmic Agents
Corticosteroid
*
Principen
Ampicillin
250mg
cap
Anti-Infective
Penicillin
*
Principen
Ampicillin
500mg
cap
Anti-Infective
Penicillin
*
Principen
Ampicillin
250/6
susp
Anti-Infective
Penicillin
*
Principen
Ampicillin
250/5
susp
Anti-Infective
Penicillin
*
Pro-Banthine
Propantheline Br
15mg
tab
Gastrointestinal
Antispasmotic/Anticholingergics
*
Probenecid
Probenecid
500mg
tab
Analgesic
Antiarthritic
*
Procainamide
Procainamide SA
750mg
tab
Cardiovascular
Antiarrhythmic
*
Proloprim
Trimethoprim
100mg
tab
Anti-Infective
Miscellaneous
*
Pronestyl
Procainamide
250mg
cap
Cardiovascular
Antiarrhythmic
*
Propylthiouracil
Propylthiouracil
50mg
tab
Miscellaneous
Anti-Thyroid
*
Questran
Colestyramine
4g
packet
Cardiovascular
Lipotropic
*
Questran
Colestyramine
4g
powder
Cardiovascular
Lipotropic
*
Questran Lt
Colestyramine
4g
packet
Cardiovascular
Lipotropic
*
Quinaglute
Quinidine Gluconate
324mg
tab
Cardiovascular
Antiarrhythmic
*
Quinidex
Quinidine Sulf
300mg
tab
Cardiovascular
Antiarrhythmic
*
Quinidine
Quinidine Sulf
200mg
tab
Cardiovascular
Antiarrhythmic
*
Restoril
Temazepam
15mg
cap
Psychotherapeutic
Sedative/Hypnotic
*
Restoril
Temazepam
30mg
cap
Psychotherapeutic
Sedative/Hypnotic
*
Rheumatrex
Methotrexate
2.5mg DP
tab
Analgesic
Antiarthritic
QL - 40 tabs
*
Ritalin
Methylphenidate
10mg
tab
Psychotherapeutic
CNS Stimulants
*
Ritalin
Methylphenidate
5mg
tab
Psychotherapeutic
CNS Stimulants
*
Ritalin
Methylphenidate
20mg
tab
Psychotherapeutic
CNS Stimulants
*
Ritalin SR
Methylphenidate
20mg
tab
Psychotherapeutic
CNS Stimulants
*
Robaxin
Methocarbamol
500mg
tab
Analgesic
Muscle Relaxants
*
Robaxin
Methocarbamol
750mg
tab
Analgesic
Muscle Relaxants
*
Sectral
Acebutolol
200mg
cap
Cardiovascular
Beta Blocker
*
Sectral
Acebutolol
400mg
cap
Cardiovascular
Beta Blocker
*
Silvadene
Silver Sulfasalazine
cream
Anti-Infective
Sulfonamide
*
Sinemet
Carbidopa/Levadopa
10/100
tab
Psychotherapeutic
Antiparkinson's
*
Sinemet
Carbidopa/Levadopa
25/100
tab
Psychotherapeutic
Antiparkinson's
*
Sinemet
Carbidopa/Levadopa
25/250
tab
Psychotherapeutic
Antiparkinson's
*
Stelazine
Trifluoperazine
1mg
tab
Psychotherapeutic
Antipsychotic
*
Stelazine
Trifluoperazine
10mg
tab
Psychotherapeutic
Antipsychotic
*
Stelazine
Trifluoperazine
2mg
tab
Psychotherapeutic
Antipsychotic
*
Stelazine
Trifluoperazine
5mg
tab
Psychotherapeutic
Antipsychotic
*
Symmetrel
Amantadine
100mg
cap
Anti-Infective
Miscellaneous
*
Symmetrel
Amantadine
100mg
tab
Anti-Infective
Miscellaneous
*
Symmetrel
Amantadine
50mg/5ml
syrup
Anti-Infective
Miscellaneous
*
Tapazole
Methimazole
10mg
tab
Miscellaneous
Anti-Thyroid
*
Tapazole
Methimazole
5mg
tab
Miscellaneous
Anti-Thyroid
*
Temovate
Clobetasol
soln
Dermatologic
Corticosteroid
*
Temovate
Clobetasol
Oint
Dermatologic
Corticosteroid
*
Temovate
Clobetasol
cr
Dermatologic
Corticosteroid
*
Tessalon Perles
Benzonatate
100mg
cap
Bronchial
Cough & Cold
QL - 240ml
*
Thorazine
Chlorpromazine
25mg
tab
Psychotherapeutic
Antipsychotic
*
Thorazine
Chlorpromazine
50mg
tab
Psychotherapeutic
Antipsychotic
*
Thorazine
Chlorpromazine
100mg
tab
Psychotherapeutic
Antipsychotic
*
Thorazine
Chlorpromazine
200mg
tab
Psychotherapeutic
Antipsychotic
*
Tofranil
Imipramine
10mg
tab
Psychotherapeutic
Antidepressant
*
Tofranil
Imipramine
25mg
tab
Psychotherapeutic
Antidepressant
*
Tofranil
Imipramine
50mg
tab
Psychotherapeutic
Antidepressant
*
Trandate
Labetalol
100mg
tab
Cardiovascular
Beta Blocker
*
Trandate
Labetalol
200mg
tab
Cardiovascular
Beta Blocker
*
Trandate
Labetalol
300mg
tab
Cardiovascular
Beta Blocker
*
Tranxene
Clorazepate
15mg
tab
Psychotherapeutic
Anti-Anxiety
*
Tranxene
Clorazepate
3.75mg
tab
Psychotherapeutic
Anti-Anxiety
*
Tranxene
Clorazepate
7.5mg
tab
Psychotherapeutic
Anti-Anxiety
*
Trideselon
Desonide
cr
Dermatologic
Corticosteroid
*
Trilafon
Perphenazine
16mg
tab
Psychotherapeutic
Antipsychotic
*
Trilafon
Perphenazine
2mg
tab
Psychotherapeutic
Antipsychotic
*
Trilafon
Perphenazine
4mg
tab
Psychotherapeutic
Antipsychotic
*
Trilafon
Perphenazine
8mg
tab
Psychotherapeutic
Antipsychotic
*
Trilisate
Choline Mag Trisalicylate
500mg
tab
Analgesic
Salicylate
*
Trilisate
Choline Mag Trisalicylate
750mg
tab
Analgesic
Salicylate
*
Trilisate
Choline Mag Trisalicylate
1000mg
tab
Analgesic
Salicylate
*
Trusopt
Dorzolamide HCl
drops
Ophthalmic Agents
Glaucoma
*
Unithroid
Levothyroxine Sodium
112 mcg
tab
Miscellaneous
Thyroid
*
Unithroid
Levothyroxine Sodium
25 mcg
tab
Miscellaneous
Thyroid
*
Unithroid
Levothyroxine Sodium
50 mcg
tab
Miscellaneous
Thyroid
*
Unithroid
Levothyroxine Sodium
100 mcg
tab
Miscellaneous
Thyroid
*
Unithroid
Levothyroxine Sodium
75 mcg
tab
Miscellaneous
Thyroid
*
Unithroid
Levothyroxine Sodium
200 mcg
tab
Miscellaneous
Thyroid
*
Unithroid
Levothyroxine Sodium
125 mcg
tab
Miscellaneous
Thyroid
*
Unithroid
Levothyroxine Sodium
150 mcg
tab
Miscellaneous
Thyroid
*
Unithroid
Levothyroxine Sodium
175 mcg
tab
Miscellaneous
Thyroid
*
Unithroid
Levothyroxine Sodium
300 mcg
tab
Miscellaneous
Thyroid
*
Unithroid
Levothyroxine Sodium
88 mcg
tab
Miscellaneous
Thyroid
*
Unithroid
Levothyroxine Sodium
137 mcg
tab
Miscellaneous
Thyroid
*
Valium
Diazepam
10mg
tab
Psychotherapeutic
Anti-Anxiety
*
Valium
Diazepam
2mg
tab
Psychotherapeutic
Anti-Anxiety
*
Valium
Diazepam
5mg
tab
Psychotherapeutic
Anti-Anxiety
*
Vermox
Mebendazole
100mg
tab
Anti-Infective
Miscellaneous
*
Vistaril
Hydroxyzine Pam
25mg
cap
Bronchial
Antihistamine
*
Vistaril
Hydroxyzine Pam
50mg
cap
Bronchial
Antihistamine
*
Vosol
Acetic Acid
drops
Otic Agents
Anti-Infective
*
Vosol HC
Acetic Acid/HC
drops
Otic Agents
Anti-Infective/Corticosteroid
*
Wytensin
Guanabenz acet
4mg
tab
Cardiovascular
Antihypertensives, Misc
*
Xanax
Alprazolam
0.25mg
tab
Psychotherapeutic
Anti-Anxiety
*
Xanax
Alprazolam
0.5mg
tab
Psychotherapeutic
Anti-Anxiety
*
Xanax
Alprazolam
1mg
tab
Psychotherapeutic
Anti-Anxiety
*
Xanax
Alprazolam
2mg
tab
Psychotherapeutic
Anti-Anxiety
*
Zanaflex
Tizanidine
2mg
tab
Analgesic
Muscle Relaxants
*
Zanaflex
Tizanidine
4mg
tab
Analgesic
Muscle Relaxants
*
Zocor
Simvastatin
5mg
tab
Cardiovascular
Lipotropic
*
Zocor
Simvastatin
10mg
tab
Cardiovascular
Lipotropic
*
Zocor
Simvastatin
20mg
tab
Cardiovascular
Lipotropic
*
Zocor
Simvastatin
40mg
tab
Cardiovascular
Lipotropic
*
Zocor
Simvastatin
80mg
tab
Cardiovascular
Lipotropic
*
Zoloft
Sertraline
25mg
Tab
Psychotherapeutic
Antidepressant
NEW
*
Zoloft
Sertraline
50mg
Tab
Psychotherapeutic
Antidepressant
NEW
*
Zoloft
Sertraline
100mg
Tab
Psychotherapeutic
Antidepressant
NEW
*
*
Zyrtec
Cetirizine
10mg
tab
Bronchial
Antihistamine, non sed.
*
*
Zyrtec
Cetirizine
5mg
tab
Bronchial