Maintenance Drug List - Valley Health Plan · labetalol hcl lactulose lamictal lamictal chewable...

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Medi-Span drug data contains a field indicating whether it is a maintenance medication, signifying it is generally used chronically (greater than 30 days) to treat or prevent a condition. This code is used as part of some benefit setups chosen by clients including:

• Mandatory Mail Order or 90-day Retail (medications on maintenance list required to be filled at 90-day retail or mail order)

• Optional Mail Order (only medications on maintenance list allowed to be filled at 90-day retail or mail order)

Maintenance Drug ListUpdated October 2019

N4042-1019

8-MOPABACAVIRABACAVIR SULFATE/LAMIVUDINEABILIFYABILIFY DISCMELTABILIFY MAINTENA

ACAMPROSATE CALCIUM DRACARBOSEACCUPRILACCURETICACEBUTOLOL HCLACEONACETAZOLAMIDEACETAZOLAMIDE ERACIPHEXACIPHEX SPRINKLEACITRETINACTIGALLACTIVELLAACTIVE-PAC/GABAPENTINACTONELACTOPLUS METACTOPLUS MET XR

ACTOSADALAT CCADVICORADVILAFEDITAB CRAFREZZAAGGRENOXAGRYLINALBUTEROL SULFATEALBUTEROL SULFATE ERALDACTAZIDEALDACTONEALENDRONATE SODIUMALEVEALFUZOSIN HCL ERALLEGRAALLEGRA ODTALLOPURINOLALORAALPHAGAN PALTACEALTAVERAALTOPREVALYACEN 1/35ALYACEN 7/7/7

AMANTADINE HCLAMARYLAMETHIAAMETHIA LOAMETHYSTAMILORIDE HCLAMILORIDE/HYDROCHLOROTHIAZIDEAMIODARONE HCLAMITIZAAMITRIPTYLINE HCLAMLODIPINE BESYLATEAMLODIPINE BESYLATE/ATORVASTATINAMLODIPINE BESYLATE/BENAZAPRILAMLODIPINE BESYLATE/VALSARTANAMLODIPINE/VALSARTAN/HYDROCHLOROTHIAZIDEAMOXAPINEAMTURNIDEANAFRANIL

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• Note: Not all medications may be covered on your formulary. Always refer to your formulary for a list of current covered drugs.

ANAGRELIDE HYDROCHLORIDEANAPROXANAPROX DSANASPAZANASTROZOLEANDRODERMANDROGELANDROGEL PUMPANGELIQANTABUSEANTARAAPLENZINAPRIAPRISOAPTIOMAPTIVUSARALENARANELLEARAVAARICEPTARICEPT ODTARIMIDEXARMOUR THYROIDAROMASINARTHROTEC 50ARTHROTEC 75ASTAGRAF XLATACANDATACAND HCTATELVIAATENOLOLATENOLOL/CHLORTHALIDONE

ATORVASTATIN CALCIUMATRIPLAATROPINE SULFATEAUBRAAURYXIAAVAILNEXAVALIDEAVANDAMETAVANDARYLAVANDIAAVAPROAVIANEAVODARTAXIDAXID ARAXIRONAYGESTINAZASANAZATADINEAZATHIOPRINEAZILECTAZOPTAZORAZULFIDINEAZULFIDINE EN-TABSAZURETTEBACLOFENBALZIVABANZELBARACLUDEBENAZEPRIL HCLBENAZEPRIL HCL/HYDROCHLOROTHIAZIDEBENICARBENICAR HCT

BENZTROPINE MESYLATEBETAGANBETAGAN C CAP QDBETAPACE

BETAPACE AFBETAXOLOL HCLBETIMOLBETOPTIC-SBEYAZBICALUTAMIDEBIDILBINOSTOBISOPROLOL FUMARATEBISOPROLOL FUMARATE/HYDROCHLOROTHIAZIDEBONIVABREVICON-28BRIELLYNBRILINTABRIMONIDINE TARTRATEBRINTELLIXBRISDELLEBROMOCRIPTINE MESYLATEBUDEPRION SRBUMETANIDEBUPHENYLBUPROPION HCLBUPROPION HCL XLBYDUREONBYETTABYSTOLICCADUETCALAN

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CALAN SRCALCITRIOLCALCIUM ACETATECALPHRONCAMILACAMRESECAMRESE LOCANDESARTAN CILEXETILCANDESARTAN CILEXETIL/HYDROCHLOROTHIAZIDECAPTOPRILCAPTOPRIL/HYDROCHLOROTHIAZIDECARAFATECARBAMAZEPINECARBAMAZEPINE ERCARBATROLCARBIDOPACARBIDOPA/LEVODOPACARBIDOPA/LEVODOPA ODTCARBIDOPA/LEVODOPA/ENTACAPONECARDIZEMCARDIZEM CDCARDIZEM LACARDIZEM SRCARDURACARDURA XLCARNITORCARNITOR SFCARTEOLOL HCLCARTIA XT

CARVEDILOLCASODEXCATAPRESCATAPRES-TTSCAZIANTCELEBREXCELECOXIBCELEXACELONTINCESIACETIRIZINE HCLCHATEALCHEMETCHLOROQUINE PHOSPHATECHLOROTHIAZIDECHLORPROMAZINE HCLCHLORPROPAMIDECHLORTHALIDONECHOLESTYRAMINECHOLESTYRAMINE LIGHTCIALISCILOSTAZOLCIMETIDINECIMETIDINE HCLCITALOPRAM HYDROBROMIDECLARINEXCLARINEX REDITABSCLARITINCLIMARACLIMARA PROCLOMIPRAMINE HCLCLONIDINE HCL

CLONIDINE HCL ERCLOPIDOGRELCLORPRES

COLESTIDCOLESTID FLAVOREDCOLESTIPOL HCLCOMBIGANCOMBIPATCHCOMBIVIRCOMPAZINECOMPLERACOMTANCO-NATAL FACONSTULOSECORDARONECOREGCOREG CRCORGARDCORZIDECOSOPTCOSOPT PFCOVARYXCOVARYX HSCOZAARCREONCRESTORCRIXIVANCROMOLYN SODIUMCRYSELLE-28CUVPOSACYCLAFEM 1/35CYCLAFEM 7/7/7CYCLESSACYCLOGYL

• Note: Not all medications may be covered on your formulary. Always refer to your formulary for a list of current covered drugs.

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CYCLOMYDRILCYCLOPENTOLATE HCLCYCLOSETCYCLOSPORINECYCLOSPORINE MODIFIEDCYMBALTACYPROHEPTADINE HCLCYSTADANECYTOMELCYTOTECDALIRESPDAPSONEDASETTA 1/35DASETTA 7/7/7DAYPRODAYSEEDDAVPDEBLITANEDELYLADELZICOLDEMADEXDEPAKENEDEPAKOTEDEPAKOTE ERDEPAKOTE SPRINKLESDEPRIZINE FUSEPAQDESIPRAMINE HCLDESLORATADINEDESLORATADINE ODTDESMOPRESSIN ACETATEDESOGENDESOGESTREL/ETHINYL ESTRADIOLDESVENLAFAXINE ER

DETROLDETROL LADEXILANTDEXMEDETOMIDINE HCLDIABETADIAMOXDICLOFENAC SODIUM ERDICLOFENAC SODIUM/MISOPROLOLDIDANOSINEDIFLUNISALDIGITEKDIGOXDIGOXINDILACOR XRDILANTINDILANTIN INFATABSDILANTIN-125DILATRATE SRDILT-CDDILTIA XTDILTIAZEM HCLDILTIAZEM HCL ERDILTIAZEM SRDILTIAZEM XRDILT-XRDILTZACDIOVANDIOVAN HCTDIPENTUMDIPYRIDAMOLEDISALCIDDISOPYRAMIDE PHOSPHATEDISULFIRAM

DITROPANDITROPAN XLDIURILDIVALPROEX SODIUMDIVALPROEX SODIUM DRDIVALPROEX SODIUM ERDIVIGELDONEPEZIL HCLDORZOLAMIDE HCLDORZOLAMIDE HCL/TIMOLOL MALEATEDOXAZOSIN MESYLATEDOXEPIN HCLDOXERCALCIFEROLDRISDOLDROSPIRENONE/ETHINYL ESTRADIOLDROXIADUAVEEDUETACTDUEXISDULOXETINE HCLDUTOPROLDYAZIDEDYRENIUMEC-NAPROSYNEDARBIEDARBYCLOREDECRINEDURANTEFFER-KEFFERVESCENT POTASSIUM CHLORIDEEFFEXOR XREFFIENT

• Note: Not all medications may be covered on your formulary. Always refer to your formulary for a list of current covered drugs.

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ELDEPRYLELESTRINELINESTELIPHOSELIQUISELIXOPHYLLINEMCYTEMOQUETTEEMSAMEMTRIVAENABLEXENALAPRIL MALEATEENALAPRIL MALEATE/HYDROCHLOROTHIAZIDEENJUVIAENPRESSEENSKYCEENTACAPONEENTECAVIRENTERAGAMENULOSEEPANEDEPITOLEPIVIREPIVIR HBVEPLERENONEEPROSARTAN MESYLATEEPZICOMEQUETROERGOCALCIFEROLERGOLOID MESYLATESERRINESBRIETESCITALOPRAM OXALATEESOMEPRAZOLE STRONTIUM

ESTARYLLAESTERIFIED ESTROGENS/METHYLTESTOSTERONEESTRACEESTRADIOLESTRADIOL/NORETHINDRONE ACETATEESTRINGESTROGELESTROPIPATEESTROSTEP FEETHOSUXIMIDEETODOLACETODOLAC EREULEXINEVAMISTEVISTAEXELONEXEMESTANEEXFORGEEXFORGE HCTFALESSAFALMINAFAMOTIDINEFANAPTFANAPT TITRATION PACKFARESTONFARXIGAFELBAMATEFELBATOLFELDENEFELODIPINE ERFEMARAFEMCON FEFEMHRT LOW DOSE

FEMRINGFENOFIBRATEFENOFIBRATE MICRONIZEDFENOFIBRIC ACIDFENOFIBRIC ACID DRFENOGLIDEFENOPROFEN CALCIUMFETZIMAFEXOFENADINE HCLFIBRICORFINASTERIDEFIRST-LANSOPRAZOLEFIRST-OMEPRAZOLEFIRST-TESTOSTERONEFLAVOXATE HCLFLECAINIDE ACETATEFLOMAXFLORICALFLUDROCORTISONE ACETATEFLUORABONFLUOR-A-DAYFLUORIDEFLUORITABFLUOXETINEFLUOXETINE DRFLUOXETINE HCLFLUPHENAZINE HCLFLURA-DROPSFLURBIPROFENFLUTAMIDEFLUVASTATINFLUVOXAMINE MALEATEFLUVOXAMINE MALEATE ER

• Note: Not all medications may be covered on your formulary. Always refer to your formulary for a list of current covered drugs.

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FORFIVO XLFORTAMETFORTESTAFOSAMAXFOSAMAX PLUS DFOSINOPRIL SODIUMFOSINOPRIL SODIUM/HYDROCHLOROTHIAZIDEFOSRENOLFUROSEMIDEFYCOMPAGABAPENTINGABITIDINEGABITRILGALANTAMINE HYDROBROMIDEGASTROCROMGELNIQUEGEMFIBROZILGENERESS FEGENERLACGENGRAFGEODONGIANVIGILDAGIAGILDESS 1.5/30GILDESS 1/20GILDESS FE 1.5/30GILDESS FE 1/20GLIMEPIRIDEGLIPIZIDEGLIPIZIDE/METFORMIN HCLGLUCOPHAGEGLUCOPHAGE XR

GLUCOTROLGLUCOTROL XLGLUCOVANCEGLUMETZAGLYBURIDEGLYBURIDE MICRONIZEDGLYBURIDE/METFORMIN HCLGLYNASEGLYSETGRALISEGRASTEKGUANFACINE ERGUANFACINE HCLGUANIDINE HCLHALOPERIDOLHEATHERHECTOROLHEMANGEOLHOMATROPAIREHORIZANTHUMALOGHUMALOG KWIKPENHUMALOG MIX 50/50 KWIKPENHUMALOG MIX 75/25HUMALOG MIX 75/25 KWIKPENHUMULIN 70/30HUMULIN 70/30 KWIKPENHUMULIN NHUMULIN N KWIKPENHYDRALAZINE/HYDROCHLOROTHIAZIDE

HYDREAHYDROCHLOROTHIAZIDEHYDROCHLOROTHIAZIDE /TRIAMTERENEHYDROXYCHLOROQUINE SULFATEHYDROXYUREAHYOMAX-SLHYOSCYAMINE SULFATEHYOSCYAMINE SULFATE ODTHYOSYNE

HYPERTENEVIDE-12.5

HYPERTENIPINE-2.5HYPERTENSOLOLHYZAARIBANDRONATE SODIUMIBUPROFENIMDURIMIPRAMINE HCLIMIPRAMINE PAMOATEIMURANINDAPAMIDEINDERAL LAINDERAL XLINDOCININDOMETHACININNOPRAN XLINSPRAINTELENCEINTROVALEINTUNIVINVEGAINVIRASE

• Note: Not all medications may be covered on your formulary. Always refer to your formulary for a list of current covered drugs.

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INVOKAMETINVOKANAIRBESARTANIRBESARTAN/HYDROCHLOROTHIAZIDEISENTRESSISODITRATE ERISONIAZIDISOPTIN SRISOPTO ATROPINEISOPTO CARBACHOLISOPTO CARPINEISOPTO HOMATROPINEISOPTO HYOSCINEISORDIL TITRADOSEISOSORBIDE DINITRATEISOSORBIDE MONONITRATEISOSORBIDE MONONITRATE ERISOXSUPRINE HCLISRADIPINEISTALOLJALYNJANUMETJANUMET XRJANUVIA

JARDIANCEJENCYCLAJENTADUETOJINTELIJOLESSAJOLIVETTEJUNEL 1.5/30JUNEL 1/20

JUNEL FE 1.5/30JUNEL FE 1/20KALETRAKAPIDEXKARIDIUMKARIVAKAZANOK-BICARBK-EFFERVESCENTKELNOR 1/35KEPPRAKEPPRA XRKERLONEKETOPROFENKETOPROFEN ERKHEDEZLAKOMBIGLYZE XRK-PHOSK-PHOS NEUTRALK-PRIMEKRISTALOSEK-SOLK-TABKURVELOK-VESCENTLABETALOL HCLLACTULOSELAMICTALLAMICTAL CHEWABLE DISPERSLAMICTAL ODTLAMICTAL XRLAMIVUDINELAMIVUDINE/ZIDOVUDINE

LAMOTRIGINELAMOTRIGINE ERLANOXINLANSOPRAZOLELANTUSLANTUS SOLOSTARLARIN 1.5/30LARIN 1/20LARIN FE 1.5/30LARIN FE 1/20LASIXLATANOPROSTLATUDALEENALEFLUNOMIDELESCOLLESCOL XLLESSINALETROZOLELEVATOLLEVBIDLEVEMIRLEVEMIR FLEXPENLEVEMIR FLEXTOUCHLEVETIRACETAMLEVETIRACETAM ERLEVOBUNOLOL HCLLEVOCARNITINELEVOCETIRIZINELEVONESTLEVONORGESTREL/ETHINYL ESTRADIOLLEVORA 0.15/30LEVOTHYROXINE SODIUMLEVOXYL

• Note: Not all medications may be covered on your formulary. Always refer to your formulary for a list of current covered drugs.

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LEVSINLEVSIN/SLLEXAPROLEXIVALINZESSLIOTHYRONINE SODIUMLIPITORLIPOFENLIPTRUZETLISINOPRILLISINOPRIL/HYDROCHLOROTHIAZIDELITHIUMLITHIUM CARBONATELITHIUM CARBONATE ERLITHOBIDLIVALOLO LOESTRIN FELODOSYNLOESTRIN 1.5/30LOESTRIN 1/20LOESTRIN FE 1.5/30LOESTRIN FE 1/20LOFIBRALOMEDIA 24 FELOPIDLOPREEZALOPRESSORLOPRESSOR HCTLORATADINELORYNALOSARTAN POTASSIUMLOSARTAN POTASSIUM/HYDROCHLOROTHIAZIDELOSEASONIQUELOTENSIN

LOTENSIN HCTLOTRELLOTRONEXLOVASTATINLOVAZALOW-OGESTRELLOXAPINELOXAPINE SUCCINATELOZI-FLURLUDENTLUFYLLINLUMIGANLURIDELUTERALYRICALYZAMAGNEBIND 200MAPROTILINE HCLMARLISSAMARPLANMATULANEMATZIM LAMAVIKMECLOFENAMATE SODIUMMEDIPROXENMEDROXY PROGESTERONE ACETATEMEFENAMIC ACIDMEFLOQUINE HCLMEGACE ESMEGACE ORALMEGESTROL ACETATEMELOXICAMMENESTMENOSTAR

MESTINONMESTINON TIMESPANMETAPROTERENOL SULFATEMETFORMIN HCLMETFORMIN HCL ERMETHAZOLAMIDEMETHIMAZOLEMETHOTREXATEMETHOTREXATE SODIUMMETHOXSALENMETHYCLOTHIAZIDEMETHYLDOPAMETHYLDOPA/HYDROCHLOROTHIAZIDEMETIPRANOLOLMETOLAZONEMETOPROLOL SUCCINATE ERMETOPROLOL TARTRATEMETOPROLOL/HYDROCHLOROTHIAZIDEMEVACORMEXILETINE HCLMICARDISMICARDIS HCTMICROGESTIN 1.5/30MICROGESTIN 1/20MICROGESTIN FEMICROGESTIN FE 1.5/30MICRO-KMICRONIZED COLESTIPOL HCLMICROZIDEMINASTRIN 24 FE

• Note: Not all medications may be covered on your formulary. Always refer to your formulary for a list of current covered drugs.

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MINIPRESSMINITRANMINIVELLEMINOXIDILMIRAPEXMIRAPEX ERMIRCETTEMIRTAZAPINEMIRTAZAPINE ODTMISOPROSTOLMOBICMODICONMOEXIPRIL HCLMOEXIPRIL/HYDROCHLOROTHIAZIDEMONOCALMONO-LINYAHMONONESSAMONTELUKAST SODIUMMOTRINMULTAQMYDRALMYDRIACYLMYRBETRIQMYSOLINEMYTELASEMYZILRANABUMETONENADOLOLNADOLOL/ HYDROCHLOROTHIAZIDE FLUMETHIAZIDENAFRINSENAFRINSE DROPSNALFON

NAMENDANAMENDA XRNAPRELANNAPROSYNNAPROXENNAPROXEN DRNAPROXEN ECNAPROXEN SODIUMNARDILNASCOBALNATAZIANATEGLINIDENECON 0.5/35NECON 1/35NECON 1/50NECON 10/11NECON 7/7/7NEFAZODONE HCLNEORALNEPTAZANENESINANEUPRONEURONTINNEVIRAPINENEVIRAPINE ERNEXICLON XRNEXIUMNEXIUM 24HRNIACIN ERNIASPANNICARDIPINE HCLNIFEDIAC CCNIFEDICAL XLNIFEDIPINENIFEDIPINE ER

NIKKINIMODIPINENISOLDIPINENISOLDIPINE ERNITRO-BIDNITRO-DURNITROGLYCERIN TRANSDERMALNITROMISTNITROSTATNITRO-TIMENIZATIDINENOLAHISTNORA-BENORETHINDRONE ACETATENORETHINDRONE ACETATE/ETHINYL ESTRADIOLNORGESTIMATE/ETHINYL ESTRADIOLNORINYL 1+35NORINYL 1+50NORLYROCNORPACENORPACE CRNORPRAMINNOR-QDNORTREL 0.5/35NORTREL 1/35NORTREL 7/7/7NORTRIPTYLINE HCLNORVASCNORVIR

• Note: Not all medications may be covered on your formulary. Always refer to your formulary for a list of current covered drugs.

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NOVOLIN 70/30NOVOLIN 70/30 RELIONNOVOLIN NNOVOLIN N RELIONNOVOLIN N U-100NOVOLOGNOVOLOG FLEXPENNOVOLOG MIX 70/30NOVOLOG MIX 70/30 PREFILLNOVOLOG PENFILLNOXAFILNUEDEXTANULEVNUVARINGOCELLAOFEVOGESTRELOLANZAPINEOLANZAPINE ODTOLANZAPINE/FLUOXETINEOLEPTROOMEGA-3-ACID ETHYL ESTERSOMEPRAZOLEOMEPRAZOLE + SYRSPEND SFOMEPRAZOLE/SODIUM BICARBONATEONFIONGLYZAOPSUMITORALAIRORAP

ORSYTHIAORTHO EVRAORTHO MICRONORORTHO TRI-CYCLENORTHO TRI-CYCLEN LOORTHO-CEPTORTHO-CYCLENORTHO-ESTORTHO-NOVUM 1/35ORTHO-NOVUM 7/7/7OSCIMINOSCIMIN SROSENIOSPHENAOTREXUPOVCON-35OXAPROZINOXCARBAZEPINEOXSORALEN ULTRAOXTELLAR XROXYBUTYNIN CHLORIDEOXYBUTYNIN CHLORIDE EROXYTROLOXYTROL FOR WOMENPACERONEPAMELORPANCREAZEPANCRELIPASEPANTOPRAZOLE SODIUMPARICALCITOLPARLODELPARNATEPAROXETINE HCLPAROXETINE HCL ERPAXIL

PAXIL CRPEGANONEPENTASAPEPCIDPERINDOPRIL ERBUMINEPERPHENAZINEPERPHENAZINE/AMITRIPTYLINEPERSANTINEPERTZYEPEXEVAPHENELZINE SULFATEPHENOBARBITALPHENYTEKPHENYTOINPHENYTOIN INFATABSPHENYTOIN SODIUM EXTENDEDPHILITHPHOSLOPHOSLYRAPHOSPHA 250 NEUTRALPHOSPHOLINE IODIDEPILOCARPINE HCLPILOCARPINE HYDROCHLORIDEPIMTREAPINDOLOLPIOGLITAZONE HCLPIOGLITAZONE HCL/GLIMEPIRIDEPIOGLITAZONE HCL/METFORMINPIRMELLA 1/35PIRMELLA 7/7/7

• Note: Not all medications may be covered on your formulary. Always refer to your formulary for a list of current covered drugs.

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PIROXICAMPLAQUENILPLAVIXPLETALPOLICOSANOLPONSTELPORTIAPOTABAPOTASSIUM BICARBONATEPOTASSIUM CHLORIDEPOTASSIUM CHLORIDE SRPOTASSIUM GLUCONATEPOTIGAPRADAXAPRAMIPEXOLE DIHYDROCHLORIDEPRANDIMETPRANDINPRAVACHOLPRAVASTATIN SODIUMPRAZOSIN HCLPRECEDEXPRECOSEPREFESTPREMARINPREMPHASEPREMPROPREVACIDPREVACID 24HRPREVACID SOLUTABPREVALITEPREVIDENTPREVIFEMPREZISTA

PRILOSECPRIMIDONEPRINIVILPRISTIQPROBENECIDPROBENECID/COLCHICINEPROCARDIAPROCARDIA XLPROCHLORPERAZINE MALEATEPROGESTERONEPROGLYCEMPROMACTAPROMETRIUMPROPAFENONE HCLPROPAFENONE HCL ERPROPRANOLOL HCLPROPRANOLOL HCL ERPROPRANOLOL/HYDROCHLOROTHIAZIDEPROPYLTHIOURACILPROSCARPROSTIGMINPROTONIXPROTRIPTYLINE HCLPROVERAPROZACPROZAC WEEKLYPYRIDOSTIGMINE BROMIDEQUARTETTEQUASENSEQUDEXY XRQUESTRANQUESTRAN LIGHT

QUETIAPINE FUMARATEQUINAPRIL HCLQUINAPRIL/HYDROCHLOROTHIAZIDEQUINARETICQUINIDINE SULFATEQUINIDINE SULFATE ERRABEPRAZOLE SODIUMRAGWITEKRALOXIFENE HYDROCHLORIDERAMIPRILRANEXARANITIDINE 150RANITIDINE HCLRAPAFLORASUVORAZADYNERAZADYNE ERRECLIPSENREGONOLREMERONREMERON SOLTABRENAGELRENVELAREPAGLINIDEREQUIPREQUIP XLRESCRIPTORRESCULARESERPINERESTASISRETROVIRREVATIOREYATAZRHEUMATREX

• Note: Not all medications may be covered on your formulary. Always refer to your formulary for a list of current covered drugs.

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RIDAURARILUTEKRILUZOLERIOMETRISEDRONATE SODIUMRISPERDALRISPERDAL M-TABRISPERIDONERISPERIDONE M-TABRISPERIDONE ODTRIVASTIGMINE TARTRATEROCALTROLROPINIROLE ERROPINIROLE HCLROZEREMRYTHMOLRYTHMOL SRSAFYRALSALAGENSALSALATESANDIMMUNESAPHRISSARAFEMSAVELLASAVELLA TITRATION PACKSEASONIQUESECTRALSELEGILINE HCLSELZENTRYSENTRADINESEROQUELSEROQUEL XRSERTRALINE HCLSHAROBELSILDENAFIL

SILDENAFIL CITRATESILENORSIMBRINZASIMCORSIMPONI ARIASIMVASTATINSINEMETSINEMET CRSINGULAIRSODIUM FLUORIDESODIUM PHENYLBUTYRATESOLIASOLTAMOXSORIATANESORIATANE CKSORINESOTALOL HCLSOTALOL HCL (AF)SPIRONOLACTONESPIRONOLACTONE/HYDROCHLOROTHIAZIDESPRINTECSRONYXSSKISTALEVOSTARLIXSTAVUDINESTAVZORSTIMATESTRATTERASTRIBILDSUCRALFATESULARSULFASALAZINE

SULFAZINESULFAZINE ECSULINDACSURMONTILSUSTIVASYEDASYMAX DUOTABSYMAX FASTABSSYMAX-SLSYMAX-SRSYMBYAXSYMLINPENSYNTHROIDTAMOXIFEN CITRATETAMSULOSIN HCLTANZEUMTAPAZOLETARINA FE 1/20TARKATASMARTAZTIA XTTEGRETOLTEGRETOL-XRTEKAMLOTEKTURNATEKTURNA HCTTELMISARTANTELMISARTAN/AMLODIPINETELMISARTAN/HYDROCHLOROTHIAZIDETENEXTENORETICTENORMINTENSILON

• Note: Not all medications may be covered on your formulary. Always refer to your formulary for a list of current covered drugs.

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TERAZOSIN HCLTERBUTALINE SULFATETERFENADINETESLACTESTIMTESTOSTERONETESTOSTERONE PUMPTEVETENTEVETEN HCTTHEO-24THEOCHRONTHEOPHYLLINETHIORIDAZINE HCLTHIOTHIXENETHYROIDTIAGABINE HYDROCHLORIDETIAZACTICLOPIDINE HCLTIKOSYNTILIA FETIMOLOL MALEATETIMOLOL MALEATE OPHTHALMICTIMOPTICTIMOPTIC OCUDOSETIMOPTIC-XETIROSINTTIVICAYTIZANIDINE HCLTOFRANILTOFRANIL-PMTOLAZAMIDETOLBUTAMIDETOLMETIN SODIUM

TOLTERODINE TARTRATETOLTERODINE TARTRATE ERTOPAMAXTOPAMAX SPRINKLETOPIRAGENTOPIRAMATETOPIRAMATE ERTOPROL XLTORSEMIDETOVIAZTRADJENTATRANDATETRANDOLAPRILTRANYLCYPROMINE SULFATETRAVATAN ZTRAVOPROSTTRAZODONE HCLTREPOXICAM-7.5TREXALLTRIAMTERENE/HYDROCHLOROTHIAZIDETRIBENZORTRICORTRI-ESTARYLLATRIFLUOPERAZINE HCLTRIGLIDETRIHEXYPHENIDYL HCLTRI-LEGEST FETRILEPTALTRI-LINYAHTRILIPIXTRINESSATRI-NORINYL

TRI-PREVIFEMTRI-SPRINTECTRIUMEQTRIVORATRIZIVIRTROKENDI XRTROPICAMIDETROSPIUM CHLORIDETROSPIUM CHLORIDE ERTRULICITYTRUSOPTTRUVADATWYNSTATYBOSTTYZEKAULORICULTRESAUROXATRALURSO 250URSO FORTEURSODIOLVAGIFEMVALCYTEVALGANCICLOVIRVALPROIC ACIDVALSARTANVALSARTAN/HYDROCHLOROTHIAZIDEVALTURNAVASCAZENVASCEPAVASERETICVASOTECVECAMYLVELIVET

• Note: Not all medications may be covered on your formulary. Always refer to your formulary for a list of current covered drugs.

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VELPHOROVENLAFAXINE HCLVENLAFAXINE HCL ERVERAPAMIL HCLVERAPAMIL HCL ERVERELANVERELAN PMVESICAREVESTURAVICTOZAVIDEXVIDEX ECVIIBRYDVIMOVOVIMPATVIOKACEVIORELEVIRACEPTVIRAMUNEVIRAMUNE XRVIREADVIRT-PHOS 250 NEUTRALVITAMIN DVITAMIN D2VIVELLE-DOTVOGELXOVOGELXO PUMPVOLTAREN-XRVOSPIRE ERVYFEMLAVYTORINWELCHOLWELLBUTRINWELLBUTRIN SRWELLBUTRIN XL

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• Note: Not all medications may be covered on your formulary. Always refer to your formulary for a list of current covered drugs.