The following is a list of the most commonly prescribed drugs. It represents an abbreviatedversion of the drug list (formulary) that is at the core of your prescription-drug benefit plan. The list is not all-inclusive and does not guarantee coverage. In addition to using this list,you are encouraged to ask your doctor to prescribe generic drugs whenever appropriate. PLEASE NOTE: The symbol * next to a drug signifies that it is subject to nonformulary status 2011 Express Scripts when a generic is available throughout the year. Not all the drugs listed are covered by all prescription-drug benefit programs; check your benefit materials for the specific drugs National Preferred Formulary covered and the copayments for your prescription-drug benefit program. For specific questions about your coverage, please call the phone number printed on your ID card. ANTIINFECTIVES Drugs to Treat Multiple Proton Pump Inhibitors Sclerosis Antivirals Psychotherapeutic Combinations Drugs Affecting The Nose Other GI Drugs Angiotensin II Receptor Antagonists + HCT Combos levetiracetam Sedative/Hypnotics Anti-Arrhythmic Drugs Antidementia Drugs Selective Serotonin ENDOCRINE MEDICATIONS Beta-Adrenergic Reuptake Inhibitors Cephalosporins Antagonists Amylin Analogues Dipeptidyl Peptidase-IV Inhibitors & Combos Antidepressants Macrolides Tertiary Amines Glucocorticoids IMMUNOLOGICALS Oral Antifungals Calcium Antagonists Other Autonomic/CNS Drugs Antiparkinson Drugs Growth Hormones Other Drugs For ADHD Glucose Elevating Drugs Penicillins DERMATOLOGICAL Incretin Mimetics MEDICATIONS Erythroid Stimulants Endothelin Receptor Antipsychotic Drugs Antagonists Insulins Antiacne Drugs Interferons Quinolones HMG-CoA Reductase Inhibitors Pegylated Interferons/ Antivertigo & Antiemetics Insulin Sensitizers Oral Ribavirin Agents Topical Antibacterials Topical Antifungals HMG-CoA Combinations MUSCULOSKELETAL MEDICATIONS Hypolipoproteinemics Urinary Antiinfectives Class II Narcotics Oral Hypoglycemics CNS Muscle Relaxants
nitrofurantoin macrocrystal cholestyramine
ANTINEOPLASTIC/IMMUNO- fenofibrate Antipsoriasis & Antieczema glimepiride SUPPRESSANT DRUGS Drugs Drugs to Prevent & Treat Gout Corticosteroid Drugs Injectable Drugs For Arthritis Nitrates Class III Narcotics Non-Steroidal Anti- Thiazide & Related Drugs Thyroid Supplements Inflammatory Agents Miscellaneous Dermatologicals Other Antihypertensives CNS Stimulants Other Endocrine Drugs NUTRITION & BLOOD MODIFIERS Other Cardiovascular Topical Anti-Inflammatory Drugs Drugs GASTROINTESTINAL Antiplatelet Drugs CARDIOVASCULAR Drugs to Prevent & Treat MEDICATIONS MEDICATIONS Headaches Antispasmodics/Drugs EAR-NOSE MEDICATIONS ACE Inhibitors + HCT Affecting GI Motility Combos AUTONOMIC & CNS Blood Detoxicants MEDICATIONS Drugs Affecting The Ear H. Pylori Drugs Anticonvulsants THIS DOCUMENT LIST IS EFFECTIVE JANUARY 1, 2011 THROUGH DECEMBER 31, 2011. THIS LIST IS SUBJECT TO CHANGE. You can get more information and updates to this document at our website at www.express-scripts.com. 2011 Express Scripts, Inc. PRMT22037-11 (09/15/10) All Rights Reserved Oral and Inj. Anticoagulants PATANOL* Examples of Nonformulary Medications With Selected Formulary Alternatives
The following is a list of some nonformulary brand-name medications with examples of selected alternatives that are on the formulary.
warfarin Therapeutic Vitamins & RESPIRATORY MEDICATIONS
Column 1 lists examples of nonformulary medications. Minerals
Column 2 lists some alternatives that can be prescribed. Antihistamines
XYZAL Antihistamine/ Nonformulary Formulary Alternative Nonformulary Formulary Alternative OBSTETRICAL & Decongestants GYNECOLOGICAL MEDICATIONS Androgen Drugs Antitussive & Expectorants Contraceptives Beta-2 Adrenergics considered formulary, unless FORADIL
lovastatin, simvastatin, Crestor, Lipitor*
lovastatin, simvastatin, Crestor, Lipitor*
Estrogen Drugs Leukotriene Modifiers Methyl Xanthines Other Drugs For Asthma Estrogen/Progestin Combinations Ovulatory Stimulants UROLOGICAL MEDICATIONS Prenatal Vitamins Anticholinergic Antispasmodics Progestin Drugs Drugs Used For BPH
amlodipine, felodipine er, nifedipine er,
Erectile Dysfunction Agents Specialized OB/GYN Drugs OPHTHALMIC MEDICATIONS WEIGHT MANAGEMENT Antibacterial Drugs Appetite Suppressants DIABETIC SUPPLIES Antiglaucoma Drugs Meters & Strips Corticosteroid Drugs Miscellaneous Supplies
The symbol [INJ] next to a drug name indicates that the drug is available in injectable form only. Other Ophthalmic Drugs For the member: Generic medications contain the same active ingredients as their corresponding brand-name medications, although
they may look different in color or shape. They have been FDA-approved under strict standards. For the physician: Please prescribe preferred products and allow generic substitutions when medically appropriate. Thank you.
Brand-name drugs are listed in CAPITAL letters.
Generic drugs are listed in lower case letters. THIS DOCUMENT LIST IS EFFECTIVE JANUARY 1, 2011 THROUGH DECEMBER 31, 2011. THIS LIST IS SUBJECT TO CHANGE. You can get more information and updates to this document at our website at www.express-scripts.com. 2011 Express Scripts, Inc. PRMT22037-11 (09/15/10) All Rights Reserved
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