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Latest_fomulary.pdf

*Most Brand Name drugs with generic alternatives are designated as cefaclor, cefadroxil, cephadrine, cephalexin Non-Preferred drugs. Below is a list of commonly prescribed Brand Name drugs that have generic alternatives. Please note that this list is not all inclusive. 2 0 0 3 N O N - P R E F E R R E D a n d P R E F E R R E D D R U G L I S T This preferred drug list has been reviewed by physicians and pharmacists to ensure that you carbamazepine, phenytoin, DILANTIN, TEGRETOL receive therapeutically sound and cost-effective care.
Please show this list to your doctor each time a prescription is written. This list serves as a guide to your physician for prescribing not only therapeutically sound medications, but cost Brand drugs with generic alternatives are considered non-preferred and may not be ibuprofen, naproxen, piroxicam, salsalate, sulindac, listed here. The non-preferred brand drugs on this list may be subject to a higher copayment if so required by your plan. If there is any difference between this list and your benefit plan, your benefit plan’s provisions will take precedence. This list may not be all Generic drugs are listed in lowercase.
cefaclor, cefadroxil, cephadrine, cephalexin acetaminophen with codeine, ibuprofen, hydrocodone diclofenac, ibuprofen, nabumetone, naproxen, cromolyn sodium ophthalmic, ALAMAST, LIVOSTIN, carbamazepine, phenytoin, DEPAKOTE, DILANTIN, enalapril maleate,lisinopril, ACCUPRIL, ACEON, Preferred Diabetic Supplies: ACCU-CHEK, GLUCOMETER IMITREX, MIGRANAL, RELPAX, ZOMIG, ZOMIG ZMT Preferred Thyroid Replacement Products: LEVOXYL, UNITHROID Preferred Hepatitis Products: COPEGUS, PEG-INTRON, PEGASYS, REBETOL diclofenac potassium, ibuprofen, nabumetone, In an effort to stay current with new developments in the pharmaceutical industry, this list amoxicillin/clavulanate, amoxicillin (trihydrate), is reviewed continuously. Any brand name drug for which a generic product becomes cefadroxil, cephadrine, cephalexin, erythromycin, available may be designated a non-preferred product. Updates and changes to this list may be found on PhamaCare’s web site at www.pharmacareGSD.com.
enalapril/hctz, lisinopril/hctz, ACCURETIC, diclofenac potassium, ibuprofen, nabumetone,naproxen, salsalate IMITREX, MIGRANAL, RELPAX, ZOMIG, ZOMIG-ZMT diclofenac potassium, ibuprofen, nabumetone, flunisolide, FLONASE, NASONEX, RHINOCORT AQUA amphetamine/dextroamphetamine, methylphenidate diclofenac, ibuprofen, nabumetone, naproxen, IMITREX, MIGRANAL, RELPAX, ZOMIG, ZOMIG ZMT cefaclor, cefadroxil, cephadrine, cephalexin cromolyn sodium ophthalmic, ALAMAST, LIVOSTIN, cefaclor, cefadroxil, cephadrine, cephalexin microgestin, necon, zovia, MICRONOR, MODICON cefaclor, cefadroxil, cephadrine, cephalexin microgestin, necon, zovia, MICRONOR, MODICON cefaclor, cefadroxil, cephadrine, cephalexin cefaclor, cefadroxil, cephadrine, cephalexin diclofenac, ibuprofen, nabumetone, naproxen, cimetidine, famotidine, nizatidine, ranitidine ibuprofen, naproxen, piroxicam, salsalate, sulindac amphetamine/dextroamphetamine, methylphenidate microgestin, necon, zovia, MICRONOR, MODICON cefaclor, cefadroxil, cephadrine, cephalexin enalapril maleate, lisinopril, ACCUPRIL, ACEON, enalapril/hctz, lisinopril/hctz, ACCURETIC, bupropion, EFFEXOR, EFFEXOR XR, WELLBUTRIN SR IMITREX, MIGRANAL, RELPAX, ZOMIG, ZOMIG-ZMT amphetamine/dextroamphetamine, methylphenidate amphetamine/dextroamphetamine, methylphenidate

Source: http://www.edh.com/products/UPS%20Current%20Formulary.pdf

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