| Generic |
Non-Preferred/Non-Formulary Brand
Name |
A |
| acebutolol capsule |
Sectral® |
| acetazolamide tablet |
Diamox® |
| acetic acid otic |
Acetasol® |
| acetic acid/hydrocortisone otic |
Acetasol®-HC |
| acetohexamide tablet |
Dymelor® |
| acetylcysteine solution |
Mucomyst® |
| acyclovir tablet, capsule, suspension |
Zovirax® |
albuterol oral inhaler,
inhalation solution, tablet, syrup
|
Proventil® |
| alendronate sodium tablet |
Fosamax® |
| allopurinol tablet |
Zyloprim® |
| alprazolam tablet |
Xanax® |
| amantadine capsule, syrup |
Symmetrel® |
| amcinonide cream, ointment,
lotion |
Cyclocort® |
| amiloride tablet |
Midamor® |
| amiloride/HCTZ tablet |
Moduretic® |
| aminocaproic acid tablet |
Amicar® |
| aminophylline tablet, liquid |
|
| amiodarone tablet |
Cordarone®** |
| amitriptyline tablet |
Elavil® |
| amlodipine besylate/benazepril |
Lotrel® |
| amlodipine besylate tablet |
Norvasc® |
| amoxapine tablet |
Asendin® |
| amoxicillin capsule, tablet, suspension,
chews, drops |
Amoxil® |
| amoxicillin/pot. clavulanate tabs, chews,
suspension |
Augmentin® |
| amphetamine/ dextroamphetamine
tablet |
Adderall® |
| anagrelide capsule |
Agrylin® |
| atenolol tablet |
Tenormin® |
| atenolol/chlorthalidone tablet |
Tenoretic® |
| atropine ophthalmic solution |
Atropair® |
| azathioprine tablet |
Imuran® |
| azithromycin tablet, packet, suspension |
Zithromax® |
| « Back to
top » |
B |
| bacitracin ophthalmic solution |
|
| bacitracin/polymyxin ointment |
Polysporin® |
| baclofen tablet |
Lioresal® |
| benazepril tablet |
Lotensin® |
| benazepril HCL tablet |
Lotensin® |
| benzocaine/antipyrine otic |
Aurodex® |
| benzonatate capsule |
Tessalon® |
| benztropine tablet |
Cogentin® |
| betamethasone dipropionate
cream, gel, lotion, ointment |
Diprolene® |
| betamethasone valerate liquid,
lotion |
Beta-val® |
| betamethasone/clotrimazole cream |
Lotrisone® |
| betamethasone dipropionate augmented cream |
Diprolene® AF |
| betaxolol ophthalmic solution |
|
| betaxolol tablet |
Kerlone® |
| bethanechol tablet |
Urecholine® |
| brimonidine ophthalmic solution |
Alphagan® |
| bromocriptine tablet |
Parlodel® |
| bumetanide tablet |
Bumex® |
| bupropion SR tablet |
Wellbutrin SR® |
| buspirone tablet |
BuSpar® |
| « Back to
top » |
C |
| cabergoline tablet |
Dostinex® |
| calcitriol capsule |
Rocaltrol® |
| captopril tablet |
Capoten® |
| captopril/HCTZ tablet |
Capozide® |
| carbamazepine tablet, chews, suspension |
Tegretol® |
| carbidopa/levodopa tablet |
Sinemet® |
| carisoprodol tablet |
Soma® |
| carisoprodol/ASA tablet |
Soma® Compound |
| carteolol ophthalmic solution |
|
| carvedilol tablet |
Coreg® |
| cefaclor capsule, suspension |
Ceclor® |
| cefadroxil capsule, tablet, suspension |
Duricef® |
| cefdinir capsule, suspension |
Omnicef® |
| cefprozil tablet, suspension |
Cefzil® |
| cefuroxime tablet |
Ceftin® |
| cephalexin capsule |
Keflex® |
| cephradine capsule |
Velosef® |
| chloral hydrate capsule |
|
| chlordiazepoxide capsule |
Librium® |
| chlorhexidine gluconate
oral rinse |
Peridex® |
| chloroquine tablet |
Aralen® |
| chlorothiazide tablet |
Diuril® |
| chlorpromazine tablet, drops, syrup |
Thorazine® |
| chlorpropamide tablet |
Diabinese® |
| chlorthalidone tablet |
Hygroton® |
| cholestyramine/sucrose powder |
Questran® |
| choline mag trisalicylate
tablet |
Trilisate® |
| ciclopirox cream, gel, topical suspension |
Loprox® |
| ciclopirox topical solution |
Penlac® |
| cilostazol tablet |
Pletal® |
| cimetidine tablet, liquid |
Tagamet® |
| ciprofloxacin tablet, suspension |
Cipro® |
| citalopram tablet |
Celexa®** |
| citric acid/sodium citrate solution |
Bicitra® |
| clarithromycin tablet |
Biaxin® |
| clemastine tablet |
Tavist® |
| clindamycin capsule |
Cleocin® |
| clindamycin topical gel,
lotion, solution |
Cleocin® |
| clobetasol propionate cream,
lotion, ointment |
Temovate® |
| clomiphene citrate tablet* |
Clomid®* |
| clomipramine capsule |
Anafranil® |
| clonazepam tablet |
Klonopin® |
| clonidine tablet |
Catapres® |
| clorazepate tablet |
Tranxene® |
| clozapine tablet |
Clozaril® |
| codeine/APAP tablet |
Tylenol® #3 |
| colchicine tablet |
|
| colestipol HCL granules, tablet |
Colestid® |
| cortisone acetate tablet |
Cortone® |
| cromolyn ophthalmic solution |
Crolom® |
| cromolyn neb sodium solution |
Intal® |
| cryselle™ tablet |
|
| cyanocobalamin injection |
|
| cyclobenzaprine tablet |
Flexeril® |
| cyclophosphamide tablet |
Cytoxan® |
| cyclosporine capsule, solution |
Sandimmune®** |
| cyclosporine, modified capsule, solution |
Neoral® |
| « Back to
top » |
D |
| dantrolene capsule |
Dantrium ® |
| danazol capsule |
Danocrine® |
| desipramine tablet |
Norpramin® |
| desmopressin tablet, nasal spray, nasal solution |
DDAVP®** |
| desonide/petrolatum cream |
Desonide® |
| desoximetasone gel, ointment,
cream |
Topicort® |
| dexamethasone sod phos ophthalmic
suspension |
|
| dexamethasone tablet, elixir |
Decadron® |
| dextroamphetamine tablet |
Dexedrine® |
| dextroamphetamine SR capsule |
Dexedrine Spansule® |
| diazepam tablet, solution |
Valium® |
| diclofenac sod ophthalmic
solution |
|
| diclofenac tablet |
Voltaren® |
| dicloxacillin capsule |
Dynapen® |
| dicyclomine capsule, tablet |
Bentyl® |
| didanosine capsule |
Videx EC® |
| diflorasone ointment, cream |
Psorcon® |
| diflunisal tablet |
Dolobid® |
| digoxin tablet, elixir |
Lanoxin®** |
| diltiazem SR capsule |
Cardizem® CD |
| diltiazem SR capsule |
Cardizem® SR |
| diltiazem SR capsule |
Dilacor® XR |
| diltiazem tablet |
Cardizem® |
| diphenoxylate/atropine tablet |
Lomotil® |
| dipivefrin ophthalmic solution |
Propine® |
| dipyridamole tablet |
Persantine® |
| disopyramide & ER capsule |
Norpace®, Norpace CR®** |
| doxazosin tablet |
Cardura® |
| doxepin capsule |
Sinequan® |
| doxycycline capsule, tablet |
Vibramycin® |
| dyphylline tablet |
Lufyllin® |
| « Back to
top » |
E |
| enalapril tablet |
Vasotec® |
| enalapril/HCTZ tablet |
Vaseretic® |
| ergotamine/caffeine tablet, suppository |
Cafergot® |
| erythromycin base EC tablet |
Emycin® |
| erythromycin base ophthalmic ointment |
|
| erythromycin base/benzoyl peroxide gel |
Benzamycin® |
| erythromycin ethylsuc tablet, suspension |
EES® |
| erythromycin/sulfisoxazole suspension |
Pediazole® |
| estazolam tablet |
Prosom® |
| estradiol tablet |
Estrace® |
| estradiol transdermal patch |
|
| estropipate tablet |
Ogen® |
| ethambutol tablet |
Myambutol® |
| ethosuximide syrup |
Zarontin®** |
| etidronate disodium |
Didronel® |
| etodolac capsule |
Lodine® |
| etoposide capsule |
Toposar®, Vepesid® |
| « Back to
top » |
F |
| famciclovir tablet |
Famvir® |
| famotidine tablet |
Pepcid® |
| felodipine tablet |
Plendil® |
| fenoprofen tablet, capsule |
Nalfon® |
| fexofenadine |
Allegra® |
| fenofibrate microsphere capsule, tablet |
LoFibra® |
| fentanyl patch |
Duragesic® |
| finasteride tablet |
Proscar® |
| flecainide tablet |
Tambocor® |
| fluconazole tablet, oral suspension |
Diflucan® |
| fludrocortisone tablet |
Florinef® |
| flunisolide nasal spray |
Nasalide® |
| fluocinolone acetonide cream,
ointment |
Synalar® |
| fluocinonide cream, ointment,
solution, gel |
Lidex® |
| fluoride drops |
|
| fluorometholone ophthalmic
suspension |
Fluor-Op® |
| fluoxetine capsule |
Prozac® |
| fluphenazine tablet, concentrate, elixir |
Prolixin® |
| flurazepam capsule |
Dalmane® |
| flurbiprofen ophthalmic
solution |
Ocufen® |
| flurbiprofen tablet |
Ansaid® |
| flutamide capsule |
Eulexin® |
| fluticasone propionate nasal spray |
Flonase® |
| fluvoxamine tablet |
Luvox® |
| folic acid tablet |
Folvite® |
| fosinopril tablet |
Monopril® |
| fosinopril/HCTZ tablet |
Monopril HCT ® |
| furosemide tablet |
Lasix® |
| « Back to
top » |
G |
| gabapentin capsule, tablet |
Neurontin® |
| ganciclovir capsule |
Cytovene® |
| gemfibrozil capsule |
Lopid® |
| gentamicin cream, ointment |
Garamycin® |
| gentamicin ophthalmic solution |
Genoptic® |
| glimepiride tablet |
Amaryl® |
| glipizide tablet |
Glucotrol® |
| glipizide ER tablet |
Glucotrol® XL |
| glipizide-metformin tablet |
Metaglip™ |
| glyburide tablet |
Diabeta® |
| glyburide, micronized tablet |
Glynase® |
| granisetron HCL tablet, solution |
Kytril® |
| griseofulvin ultramicronized
tablet |
Fulvicin® P/G |
| guanfacine tablet |
Tenex® |
| « Back to
top » |
H |
| haloperidol tablet, solution |
Haldol® |
| heparin sodium injection |
|
| homatropine ophthalmic solution |
Isopto® Homatropine** |
| hydralazine tablet |
Apresoline® |
| hydralazine/HCTZ tablet |
Apresazide® |
| hydrochlorothiazide tablet |
Oretic® |
| hydrocodone/APAP tablet |
Vicodin® |
| hydrocodone/homatropine tablet, syrup |
Hycodan® |
| hydrocodone/ibuprofen tablet |
Vicoprofen® |
| hydrocort/polymyx/neomycin otic |
Cortisporin® Otic |
| hydrocortisone butyrate cream, ointment,
solution |
Locoid® |
| hydrocortisone cream, ointment, lotion |
Ala-cort® |
| hydromorphone tablet |
Dilaudid® |
| hydroxychloroquine tablet |
Plaquenil® |
| hydroxyurea capsule |
Hydrea® |
| hydroxyzine HCL tablet |
Atarax® |
| hydroxyzine pamoate capsule |
Vistaril® |
| hyoscyamine capsule |
Cystospaz-M® |
| « Back to
top » |
I |
| ibuprofen tablet |
Motrin® |
| imipramine tablet |
Tofranil® |
| indapamide tablet |
Lozol® |
| indomethacin capsule |
Indocin® |
| ipratropium bromide solution |
Atrovent® |
| ipratropium nasal spray |
Atrovent® |
| ipratropium-albuterol inhalation solution |
Duoneb® |
| isoniazid tablet |
|
| isosorbide dinitrate & ER tablet |
Isordil® & Dilatrate® SR |
| isosorbide mononitrate & ER tablet |
Ismo® & Imdur® |
| isotretinoin (claravis, sotret, amnesteem) capsule |
Accutane® |
| itraconazole capsule, solution |
Sporanox®* |
| « Back to
top » |
K |
| ketoconazole shampoo |
Nizoral®** |
| ketoconazole tablet |
Nizoral® |
| ketoprofen capsule |
Orudis® |
| ketoprofen ER capsule |
Oruvail® SR |
| ketotifen fumarate ophthalmic solution |
Zaditor® |
| « Back to
top » |
L |
| labetalol tablet |
Trandate® |
| lactulose syrup |
Enulose® |
| lamotrigine tablet (5mg, 25mg strengths) |
Lamictal® (5mg, 25mg strengths) |
| leena tablet* |
|
| leflunomide tablet |
Arava® |
| leucovorin tablet |
Wellcovorin® |
| leuprolide non-depot injection |
|
| levobunolol ophthalmic solution |
Betagan® |
| levothyroxine sodium tablet |
|
| lidocaine viscous solution |
Xylocaine® |
| lindane lotion, shampoo |
Kwell® |
| lisinopril tablet |
Zestril®, Prinivil® |
| lisinopril/HCTZ tablet |
Zestoretic® |
| lithium carbonate capsule |
Eskalith® |
| lithium citrate syrup |
|
| loperamide capsule, liquid |
Imodium® |
| lorazepam tablet |
Ativan® |
| lovastatin tablet |
Mevacor® |
| loxapine succinate capsule |
Loxitane® |
| « Back to
top » |
M |
| maprotiline tablet |
Ludiomil® |
| mebendazole chewtabs |
Vermox® |
| meclizine tablet |
Antivert® |
| meclofenamate capsule |
Meclomen® |
| medroxyprogesterone acetate tablet |
|
| megestrol tablet, syrup |
Megace® |
| menest tablet |
|
| meperidine tablet, syrup |
Demerol® |
| mesalamine enema |
Rowasa® |
| metaproterenol tablet, syrup, inhalation
solution |
Alupent® |
| metformin ER tablet |
Glucophage® XR |
| metformin tablet |
Glucophage® |
| methadone tablet, solution, concentrate |
Dolophine® |
| methazolamide tablet |
Neptazane® |
| methenamine hippurate tablet |
Hiprex® |
| methenamine mandelate tablet |
Mandelamine® |
| methimazole tablet |
Tapazole® |
| methocarbamol tablet |
Robaxin® |
| methocarbamol/ASA tablet |
Robaxisal® |
| methotrexate tablet |
Rheumatrex® |
| methyclothiazide tablet |
Enduron® |
| methyldopa tablet |
Aldomet® |
| methylphenidate ER tablet |
Ritalin® SR |
| methylphenidate tablet |
Ritalin® |
| methylprednisolone tablet |
Medrol® |
| metoclopramide tablet, syrup |
Reglan® |
| metolazone tablet |
Zaroxolyn®** |
| metoprolol tablet |
Lopressor® |
| metoprolol succinate tablet |
Toprol XL® |
| metronidazole tablet |
Flagyl® |
| metronidazole vaginal gel |
MetroGel-Vaginal® |
| mexiletine capsule |
Mexitil® |
| midodrine tablet |
Proamatine® |
| minocycline capsule |
Minocin® |
| minoxidil tablet |
Loniten® |
| mirtazapine tablet |
Remeron® |
| misoprostil tablet |
Cytotec® |
| mometasone cream, ointment |
Elocon® |
| moexipril/HCTZ tablet |
Uniretic® |
| moexipril HCL tablet |
Univasc® |
| morphine SR tablet |
MS Contin® |
| mupirocin ointment |
Bactroban® |
| « Back to
top » |
N |
| nabumetone tablet |
Relafen® |
| nadolol tablet |
Corgard® |
| naphazoline ophthalmic solution |
Vasocon® |
| naproxen tablet |
Naprosyn® |
| nefazodone tablet |
Serzone® |
| neo/polymyx/dexamethasone ophthalmic suspension,
ointment |
|
| nicardipine capsule |
Cardene® |
| nifedipine capsule |
Procardia® |
| nifedipine SA tablet |
Adalat® CC |
| nimodipine capsule |
Nimotop® |
| nitrofurantoin capsule |
Macrodantin®, Macrobid® |
| nitroglycerin capsule |
NitroTime® |
| nitroglycerin patch |
Minitran®, Nitro-Dur® |
| nora-BE tablet |
|
| nortriptyline capsule |
Pamelor® |
| nystatin suspension, tablet |
Mycostatin® |
| « Back to
top » |
O |
| octreotide acetate injection |
Sandostatin® |
| ofloxacin tablet |
Floxin® |
| omeprazole capsule |
Prilosec® |
| ondansetron HCL tablet, oral solution |
Zofran® |
| ondansetron tablet |
Zofran ODT® |
| oxaprozin tablet |
Daypro® |
| oxazepam capsule |
Serax® |
| oxcarbazepine tablet |
Trileptal® |
| oxybutynin tablet |
Ditropan® |
| oxybutynin chloride ER |
Ditropan XL® |
| oxycodone capsule |
OxyIR® |
| oxycodone/APAP tablet |
Percocet® |
| oxycodone/ASA tablet |
Percodan® |
| « Back to
top » |
P |
| pantoprazole sodium tablet |
Protonix® |
| paroxetine tablet |
Paxil® |
| pemoline tab, chewtab |
Cylert® |
| penicillin V potassium tablet, suspension |
Veetids® |
| pentoxifylline tablet |
Trental® |
| permethrin 5% cream |
Elimite® |
| perphenazine tablet |
Trilafon® |
| phenazopyridine tablet |
Pyridium® |
| phenobarbital tablet, elixir |
|
| phenylephrine ophthalmic
solution |
|
| phenytoin sodium capsule |
Dilantin®** |
| pilocarpine ophthalmic solution |
Adsorbocarpine® |
| pilocarpine tablet |
Salagen® |
| pindolol tablet |
Visken® |
| piroxicam capsule |
Feldene® |
| polyethylene glycol/electrolyte solution |
|
| potassium chloride tablet |
K-Dur®** |
| pravastatin tablet |
Pravachol® |
| prazosin capsule |
Minipress® |
| prednisolone 15mg/5ml syrup |
Prelone® |
| prednisolone acetate ophthalmic
suspension |
Pred Forte® |
| prednisolone sod phosphate
ophthalmic solution |
Inflamase Forte® |
| prednisolone sod phosphate oral solution |
Orapred® |
| prednisone tablet, solution |
Deltasone® |
| previfem™ tablet |
|
| primaquine phosphate tablet |
|
| primidone tablet |
Mysoline®** |
| probenecid tablet |
|
| procainamide capsule |
Pronestyl® |
| procainamide SA tablet |
Pronestyl SR® |
| prochlorperazine tablet |
Compazine® |
| promethazine tablet, suppository |
Phenergan® |
| propafenone tablet |
Rythmol® |
| propoxyphene/APAP tablet |
Darvocet N®-100 |
| propranolol tablet |
Inderal® |
| propranolol HCL SA capsule |
Inderal® LA |
| propranolol/HCTZ tablet |
Inderide® |
| propylthiouracil tablet |
|
| protriptyline tablet |
Vivactil® |
| pyrazinamide tablet |
|
| « Back to
top » |
Q |
| quinapril tablet |
Accupril® |
| quinapril/HCTZ tablet |
Accuretic® |
| quinidine gluconate tablet |
Quinaglute® |
| quinidine sulfate tablet |
Quinidex® |
| « Back to
top » |
R |
| ramipril capsule |
Altace® |
| ranitidine tablet, syrup |
Zantac® |
| ribavirin capsule |
Rebetol®** |
| ribavirin tablet |
Copegus® |
| rifampin capsule |
Rifadin® |
| rimantadine tablet |
Flumadine® |
| « Back to
top » |
S |
| salsalate tablet |
Disalcid® |
| selegiline tablet, capsule |
Eldepryl® |
| sertraline tablet |
Zoloft® |
| silver sulfadiazine cream |
Silvadene® |
| simvastatin tablet |
Zocor® |
| sotalol tablet |
Betapace® |
| spironolactone tablet |
Aldactone® |
| spironolactone/HCTZ tablet |
Aldactazide® |
| sucralfate tablet |
Carafate® |
| sulfacetamide ophthalmic solution |
Bleph®-10 |
| sulfadiazine tablet |
Microsulfon® |
| sulfamethoxazole/trimethoprim tablet, suspension |
Bactrim®, Septra® |
| sulfasalazine tablet |
Azulfidine® EN-tabs® |
| sulfisoxazole tablet, suspension |
Gantrisin® |
| sulindac tablet |
Clinoril® |
| « Back to
top » |
T |
| tamoxifen tablet |
Nolvadex®** |
| temazepam capsule |
Restoril® |
| terbinafine HCL tablet |
Lamisil® |
| terazosin capsule |
Hytrin® |
| tetracycline capsule |
Achromycin® |
| theophylline tablet, capsule, elixir |
|
| thioridazine tablet, solution |
Mellaril® |
| thiothixene capsule |
Navane® |
| thyroid dessicated tablet |
|
| ticlopidine tablet |
Ticlid® |
| tilia FE tablet |
Estrostep® FE |
| timolol maleate ophthalmic
solution |
Betimol®** |
| timolol maleate tablet |
Blocadren® |
| tizanidine tablet |
Zanaflex® |
| tobramycin ophthalmic solution |
Tobrex® |
| tolazamide tablet |
Tolinase® |
| tolbutamide tablet |
Orinase® |
| tolmetin tablet |
Tolectin® |
| tramadol tablet |
Ultram® |
| tramadol/APAP tablet |
Ultracet® |
| trandolapril tablet |
Mavik® |
| tranylcypromine sulfate tablet |
Parnate® |
| trazadone tablet |
Desyrel® |
| tretinoin capsule |
Vesanoid® |
| tretinoin cream, gel, lotion* |
Retin A®* |
| triamcinolone acetonide
cream, ointment |
Aristocort® |
| triamcinolone tablet |
Aristocort® |
| triamterene/HCTZ tablet |
Maxzide® |
| triazolam tablet |
Halcion® |
| trifluoperazine tablet |
Stelazine® |
| trifluridine ophthalmic
solution |
Viroptic® |
| trihexyphenidyl tablet |
Artane® |
| tri-legest FE tablet |
Estrostep® FE |
| trimethobenzamide capsule,
suppository |
Tigan® |
| trimethoprim tablet |
Proloprim® |
| « Back to
top » |
U |
| unithroid tablet |
|
| urea cream, gel, lotion |
Keralac® |
| ursodiol capsule |
Actigall® |
| « Back to
top » |
V |
| valproic acid capsule, syrup |
Depakene® |
| valproate sodium syrup |
Depakene® |
| venlafaxine HCL tablet |
Effexor® |
| verapamil tablet |
Calan® |
| verapamil SR tablet |
Calan SR® |
| « Back to
top » |
W |
| warfarin tablet |
Coumadin®** |
| « Back to
top » |
Z |
| zidovudine capsule, tablet, syrup |
Retrovir® |
| zolpidem tartrate tablet |
Ambien® |
| zonisamide capsule |
Zonegran® |
| « Back to
top » |
* May not be a covered benefit under some plans.
** This brand is preferred/formulary.