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Preferred Medication List/Formulary (PML)

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Generics Alphabetical List
Effective January 15, 2010
Updated January 21, 2010

This list can be used to assist you and your doctor in choosing a generic.
  • Generic medications are listed in lower case bold.
  • Non-preferred/non-formulary brands are listed only as a reference for generically available medications.
  • Not all generics are listed. Those listed are examples of some of the generic medications available.

Additional Information:

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A   B   C   D   E   F   G   H   I   J   K   L   M   N   O   P   Q   R   S   T   U   V   W   X   Y   Z  

Generic Non-Preferred/Non-Formulary Brand Name
A
acarbose tablet Precose®
acebutolol capsule Sectral®
acetazolamide tablet Diamox®
acetazolamide SR capsule Diamox Sequels®
acetic acid otic Acetasol®
acetic acid/hydrocortisone otic Acetasol®-HC
acetohexamide tablet Dymelor®  
acetylcysteine solution Mucomyst®
acyclovir tablet, capsule, suspension Zovirax®
albuterol 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®
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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®
bicalutamide tablet++ Casodex®
brimonidine ophthalmic solution Alphagan®
bromocriptine tablet Parlodel®
budeprion SR tablet Wellbutrin SR®
budeprion XL tablet Wellbutrin XL®
bumetanide tablet Bumex®
bupropion SR tablet Wellbutrin SR®
bupropion XL tablet Wellbutrin XL®
buspirone tablet BuSpar®
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C
cabergoline tablet Dostinex®
calcipotriene solution Dovonex®
calcitonin-salmon nasal spray Fortical®, Miacalcin®
calcitriol capsule Rocaltrol®
calcium acetate capsule PhosLo®
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, shampoo, topical suspension Loprox®
ciclopirox topical solution Penlac®
cilostazol tablet Pletal®
cimetidine tablet, liquid Tagamet®
ciprofloxacin tablet, suspension Cipro®
ciprofloxacin HCL ophthalmic solution Ciloxan®
citalopram tablet Celexa®**
citric acid/sodium citrate solution Bicitra®
clarithromycin tablet Biaxin®
clemastine tablet Tavist®
clindamycin capsule Cleocin®
clindamycin topical gel, lotion, solution Cleocin®
clindamycin/benzoyl peroxide BenzaClin®
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®
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D
dantrolene capsule Dantrium ®
danazol capsule Danocrine®
dapsone tablet  
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®
dipyridamole tablet Persantine®
disopyramide & ER capsule Norpace®, Norpace CR®**
divalproex sodium tablet Depakote®
divalproex sodium ER tablet Depakote® ER
divalproex sodium sprinkle capsule Depakote Sprinkle® capsule
dorzolamide HCL ophthalmic solution Trusopt®
dorzolamide-timolol ophthalmic solution Cosopt®
doxazosin tablet Cardura®
doxepin capsule Sinequan®
doxycycline capsule, tablet Vibramycin®
dyphylline tablet Lufyllin®
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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®++
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F
famciclovir tablet Famvir®
famotidine tablet Pepcid®
felodipine tablet Plendil®
fenofibrate capsule, tablet  
fenoprofen tablet, capsule Nalfon®
fexofenadine Allegra®
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®
folbic Foltx®
folic acid tablet Folvite®
fosinopril tablet Monopril®
fosinopril/HCTZ tablet Monopril HCT ®
furosemide tablet Lasix®
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G
gabapentin capsule, tablet Neurontin®
galantamine HBR tablet, oral solution Razadyne™
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®
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H
halobetasol propionate cream, ointment Ultravate®
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®
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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®*
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J
jolessa tablet* Seasonale®*
K
ketoconazole shampoo Nizoral®**
ketoconazole tablet Nizoral®
ketoprofen capsule Orudis®
ketoprofen ER capsule Oruvail® SR
ketorolac 0.4% ophthalmic solution Acular LS®
ketorolac 0.5% ophthalmic solution Acular®
ketotifen fumarate ophthalmic solution Zaditor®
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L
labetalol tablet Trandate®
lactulose syrup Enulose®
lamotrigine Lamictal®
leena tablet*  
leflunomide tablet Arava®
leucovorin tablet++ Wellcovorin®++
leuprolide non-depot injection  
levetiracetam tablet, solution Keppra®
levobunolol ophthalmic solution Betagan®
levothyroxine sodium tablet  
lidocaine viscous solution Xylocaine®
lindane lotion, shampoo Kwell®
liothyronine sodium tablet Cytomel®
lisinopril tablet Zestril®, Prinivil®
lisinopril/HCTZ tablet Zestoretic®
lithium carbonate capsule Eskalith®
lithium citrate syrup  
lofibra capsule, tablet  
loperamide capsule, liquid Imodium®
lorazepam tablet Ativan®
lovastatin tablet Mevacor®
loxapine succinate capsule Loxitane®
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M
malathion lotion Ovide®
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®
metipranolol ophthalmic solution OptiPranolol®
metoclopramide tablet, syrup Reglan®
metolazone tablet Zaroxolyn®**
metoprolol tablet Lopressor®
metoprolol succinate tablet Toprol XL®
metronidazole cream MetroCream®
metronidazole lotion MetroLotion®
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®
mycophenolate mofetil capsule, tablet Cellcept®
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N
nabumetone tablet Relafen®
nadolol tablet Corgard®
naphazoline ophthalmic solution Vasocon®
naproxen tablet Naprosyn®
nefazodone tablet Serzone®
neo/polymyx/dexamethasone ophthalmic suspension, ointment  
next choice tablet* Plan B®
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®
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O
ocella tablet* Yasmin®*
octreotide acetate injection Sandostatin®
ofloxacin ophthalmic solution Ocuflox®
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®
oxycodone HCL SR tablet Oxycontin®
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P
pantoprazole sodium tablet Protonix®
paroxetine tablet Paxil®
peg-3350/kcl sol/sodium Nulytely®
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 Isopto Carpine®
pilocarpine tablet Salagen®
pindolol tablet Visken®
piroxicam capsule Feldene®
polyethylene glycol/electrolyte solution  
potassium chloride tablet K-Dur®**
potassium chloride CR capsule Micro-K®
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  
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Q
quasense tablet* Seasonale®*
quinapril tablet Accupril®
quinapril/HCTZ tablet Accuretic®
quinidine gluconate tablet Quinaglute®
quinidine sulfate tablet Quinidex®
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R
ramipril capsule Altace®
ranitidine tablet, syrup Zantac®
ribavirin capsule Rebetol®**
ribavirin tablet Copegus®
rifampin capsule Rifadin®
rimantadine tablet Flumadine®
risperidone tablet, solution Risperdal®
risperidone M-Tab Risperdal® M-Tab™
ropinirole HCL tablet Requip®
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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®
stavudine capsule, oral solution Zerit®
sucralfate tablet  Carafate®
sulfacetamide ophthalmic solution Bleph®-10
sulfacetamide sodium topical suspension Klaron®
sulfadiazine tablet Microsulfon®
sulfamethoxazole/trimethoprim tablet, suspension Bactrim®, Septra®
sulfasalazine tablet Azulfidine® EN-tabs®
sulfisoxazole tablet, suspension Gantrisin®
sulindac tablet Clinoril®
sumatriptan succinate injection, tablet Imitrex® injection, tablet
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T
tacrolimus capsule Prograf®
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 Timoptic®
timolol maleate ophthalmic gel solution Timoptic-XE®
timolol maleate tablet Blocadren®
tizanidine tablet Zanaflex®
tobramycin ophthalmic solution Tobrex®
tolazamide tablet Tolinase®
tolbutamide tablet Orinase®
tolmetin tablet Tolectin®
topiramate capsule Topamax® Sprinkle
topiramate tablet Topamax®
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®
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U
unithroid tablet  
urea cream, gel, lotion Keralac®
ursodiol capsule Actigall®
ursodiol tablet Urso®
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V
valacyclovir HCL tablet Valtrex®
valproic acid capsule, syrup Depakene®
valproate sodium syrup Depakene®
venlafaxine HCL tablet Effexor®
venlafaxine XR tablet Effexor XR® capsule
verapamil tablet Calan®
verapamil SR tablet Calan SR®
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W
warfarin tablet Coumadin®**
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Z
zaleplon capsule Sonata®
zidovudine capsule, tablet, syrup Retrovir®
zolpidem tartrate tablet Ambien®
zonisamide capsule Zonegran®
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* May not be a covered benefit under some plans.
** This brand is preferred/formulary.
++ Regence BlueCross BlueShield of Oregon members may have a different copay/coinsurance amount for cancer related medications. Please check your prescription benefit.

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Preferred/Formulary Brands Alphabetical List
Effective January 1, 2010
Updated January 1, 2010

This list can assist you in choosing a preferred/formulary brand medication.
  • Preferred/formulary products are limited to the dosage form and strength listed; if no strength is listed, all strengths for the listed dosage form are preferred/formulary.
  • Sustained action/release (SA/SR), extended release (ER/XR), long-acting (LA), and enteric coated (EC) medications are only preferred or formulary if listed.
  • Occasionally, preferred/formulary medications may be contract exclusions and therefore are not covered.
  • Some medications may require prior authorization or have quantity limits.
  • If you can't find the medication you are looking for here, try the Rx Price guide or Alternatives to Non-Formulary Medications.
  • Please note that this list may change.

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A   B   C   D   E   F   G   H   I   J   K   L   M   N   O   P   Q   R   S   T   U   V   W   X   Y   Z  

A
Abilify® tablet, solution
Abilify Discmelt® tablet
Accolate® tablet
Aclovate® cream, ointment
Actonel® tablet
Actonel® with Calcium tablet
ACTOplus met® tablet
Actos® tablet
Acular® PF ophthalmic droperette
Adderall XR™ capsule
Advair Diskus® oral inhaler
Advair® HFA oral inhaler
Agenerase® capsule, solution
Albenza® tablet
Alesse® tablet*
Alinia® tablet, suspension
Alkeran® tablet++
Alocril® ophthalmic solution
Alora® patch
Alphagan® P ophthalmic solution
Alrex®ophthalmic suspension
Analpram-HC® rectal cream, lotion
Ancobon® capsule
Anemagen® capsule
Antabuse® tablet
Apokyn® injection
Aranesp® injection
Aricept® tablet
Aricept ODT® tablet
Arimidex® tablet++
Arixtra® injection
Armour® Thyroid tablet
Aromasin® tablet++
Asacol® tablet, oral solution
Asacol® HD tablet
Asmanex® twisthaler
Astepro® nasal spray
Astelin® nasal spray
Atripla® tablet
Atrovent® oral inhaler
Atrovent HFA® oral inhaler
Augmentin ES-600® suspension
Avandia® tablet
Avelox® tablet
Avonex® injection
Azelex® cream
Azmacort® oral inhaler
Azopt® ophthalmic suspension

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B
Bactroban Nasal® ointment
Bactroban® cream
Baraclude® tablet
Bayer® test strips*
   - Please check if these are covered by your prescription benefit.
Bayer Breeze® 2 test strips*
Bayer Contour® test strips*
Beclovent® oral inhaler
Benicar® tablet
Benicar HCT® tablet
Benzac W® gel
Betimol® ophthalmic solution
Betoptic S® ophthalmic suspension
Biltricide® tablet
Blephamide® S.O.P. ophthalmic ointment
Bromhist® oral solution
Buphenyl®oral powder, tablet

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C
Canasa® rectal suppository
Capex® shampoo
Carac®cream++
Carbatrol® capsule
Carboxine-PSE® liquid
Carnitor® tablet, liquid
Catapres-TTS® patch
CeeNu® capsule++
Cellcept® suspension
Celontin® tablet, capsule
Cenestin® tablet
Centany® ointment
Cerumenex® otic solution
Chemet® capsule
Ciloxan® ophthalmic ointment
Ciprodex® otic suspension
Cipro HC® otic suspension
Cloderm® cream
Colyte® powder for reconstitution
Combivent® oral inhaler
Combivir® tablet
Compro® rectal suppository
Comtan® tablet
Condylox® gel, solution
Copaxone® injection
Cordran® lotion, tape, ointment, cream
Cortifoam® rectal foam
Coumadin® tablet
Creon® capsule
Crestor® tablet
Crixivan® capsule
Cuprimine® capsule
Cutivate® cream, ointment
Cyclogyl® ophthalmic solution
Cystadane® oral powder

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D
Daraprim® tablet
DDAVP® nasal solution, nasal spray
Demulen® tablet*
Depen® tablet
Derma-Smoothe/FS® oil
Desogen® tablet*
Detrol® LA capsule
Dexamethasone Intensol® oral solution
Diabetic supplies: lancets, needles, syringes
   - Please check if these are covered by your prescription benefit.
Dialyvite® tablet
Diaphragms*
Diastat® rectal gel
Diastat® AcuDial™ rectal gel
Differin®cream, gel, solution, swab
Dilantin® capsule, chews, suspension
Dipentum® capsule
Droxia®capsule++
Duetact® tablet

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E
Efudex®cream, solution
Elmiron®capsule
Elocon®lotion
Emcyt®capsule++
Emend® capsule
Emtriva® capsule
Enbrel® injection
Epifoam® topical foam
Epipen® injection
Epipen® Jr injection
Epitol® tablet
Epivir®tablet, solution
Epivir HBV®tablet, solution
Epogen® injection
Epzicom ® tablet
Ergomar® tablet
Esclim® patch
Eskalith® capsule, tablet
Eskalith CR® tablet
Estraderm® patch
Eurax® cream, lotion
Evista® tablet
Evoxac® capsule
Exelon® capsule, solution, patch

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F
Fansidar® tablet
Fareston® tablet++
Felbatol® tablet, oral suspension
Femara® tablet++
FemHRT® tablet
Flovent® Diskus® oral inhaler
Flovent® HFA oral inhaler
Fluoroplex® cream, solution++
FML® S.O.P. ointment
Foradil® oral inhaler
Fortovase® capsule
Fosamax® oral solution
Fragmin® injection
Furadantin® oral suspension
Furoxone® tablet, oral suspension
Fuzeon® injection

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G
Gabitril® tablet
Galzin® capsule
Geodon® capsule
Gleevec® tablet, capsule++
GlucaGen® injection
Glucagon® injection
Golytely® powder for reconstitution, packets
Grifulvin V® oral suspension
Gynazole-1® vaginal cream

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H
Helidac® combo pak
Hepsera® tablet
Hexalen® capsule++
Hivid® tablet
Humalog® insulins
Humatin® capsule
Humira® injection
Humulin® insulins

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I
Imitrex® nasal spray
Increlex™ injection
Innohep® injection
Innopran XL™ capsule
Intal® oral inhaler
Intron® A injection
Invirase® capsule
Isentress™ tablet
Isopto® Atropine ophthalmic solution
Isopto® Homatropine ophthalmic solution

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K
Kadian® capsule
Kaletra® capsule, solution
Kaon-CL-10® tablet
Kapidex™ capsule
K-Dur® tablet
Kemadrin® tablet
K-Lyte® DS tablet
Kristalose® packet
K-Tab® tablet
Kutrase® capsule
Ku-Zyme® capsule
Ku-Zyme® HP capsule

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L
Lamprene® capsule
Lanoxicaps® capsule
Lanoxin®tablet, elixir
Lantus® insulin
Lantus® SoloSTAR® insulin
Lariam® tablet
Leena® tablet*
Letairis® tablet
Leukeran® tablet++
Leukine® injection
Levothroid® tablet
Levoxyl® tablet
Lexiva® tablet, oral suspension
Lithobid® tablet
Loestrin® tablet*
Loestrin® Fe tablet*
LoOvral® tablet*
Lorazepam Intensol® oral concentrate
Lotemax® ophthalmic suspension
Lovenox® injection
Lumigan® ophthalmic solution
Luxiq® topical foam
Lysodren® tablet++

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M
Matulane® capsule++
Maxalt® tablet
Maxalt MLT® tablet
Mebaral® tablet
Mephyton® tablet
Mepron® oral suspension
Mesnex® tablet++
Mestinon® tablet, syrup
Metadate® CD capsule
Methergine® tablet
Methitest® tablet
MetroGel®
Miacalcin® injection
Micardis® tablet
Micardis HCT® tablet
Micronor® tablet*
Migranal® nasal spray
Mintezol® oral suspension, chews
Mirapex® tablet
Moban® oral concentrate, tablet
Modicon® tablet*
Mycelex® troche
Mycobutin® capsule
Myfortic® ER tablet
Myleran® tablet++
Mysoline® tablet, oral suspension

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N
Nardil® tablet
Nasacort® AQ nasal spray
Nebupent® aerosol powder for inhalation
Nestabs FA® tablet
Neupogen® injection
Nexavar® tablet++
Niaspan® tablet
Nilandron® tablet++
Nizoral® shampoo
Nolvadex® tablet++
Nordette® tablet*
Norinyl® tablet*
Noritate® cream
Norpace® CR capsule
Nor-QD® tablet*
Norvir® capsule, solution
Novolin® insulins
Novolog® insulins
Nutropin® injection*•
Nutropin AQ® injection*•
Nutropin Depot® injection*•

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O
Orap® tablet
Ortho Cept® tablet*
Ortho Cyclen® tablet*
Ortho Evra® patch*
Ortho Novum® tablet*
Ortho Prefest® tablet
Ortho Tri-Cyclen® tablet*
Ortho Tri-Cyclen® Lo tablet*
Ovral® tablet*
Ovrette® tablet*

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P
Pancrease® capsule
Pancrease® MT capsule
Pancrecarb MS® capsule
Patanol® ophthalmic solution
Peak Flow Meters
Pediapred® solution
Pegasys® injection
Peg-Intron® injection
Peg-Intron® Redipen injection
Pentasa® capsule
PerioGard® oral liquid
Periostat® tablet
Phenytek® capsule
Phisohex® liquid
Phrenilin w/ Caffeine & Codeine® capsule
Pilopine HS® ophthalmic gel
Plavix® tablet
Plexion® emulsion, medicated pads
Prandin® tablet
Pred Mild® ophthalmic suspension
Prednisone Intensol® oral concentrate
Premarin® tablet
Premarin® vaginal cream
Premphase® tablet
Prempro® tablet
Prevacid® capsule, suspension, solutab
Prevpac®
Prezista® tablet
Primaquine® tablet
ProAir® HFA oral inhaler
Procanbid® tablet
Procrit® injection
ProctoFoam®-HC rectal foam
Proglycem® capsule, oral suspension
Propine® ophthalmic solution
Pulmicort® oral inhaler
Pulmicort® respules
Pulmozyme® inhalation solution
Purinethol® tablet++

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Q
QVAR® oral inhaler

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R
Radiogardase® capsule
Rapamune® tablet, solution
Rebetol® capsule, oral solution
Rebetron® injection
Rebif® injection
Relacon-HC® syrup
Relpax® tablet
Remicade® - Covered only under the medical benefit.
Rescon JR® capsule
Rescriptor® tablet
Retin-A Micro® gel*
Revatio™ tablet
Revlimid® capsule
Reyataz® capsule
Ridaura® capsule
Rilutek® tablet

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S
Saizen® injection*•
Sandimmune® capsule, solution
Selzentry™ tablet
Sensipar® tablet
Serevent Diskus® oral inhaler
Seromycin® capsule
Serophene® tablet*
Seroquel® tablet
Seroquel XR™ tablet
Singulair® tablet, chews, granules
Soriatane® capsule
Soriatane® CK kit
Spacer Devices
Spiriva® oral inhaler
Sporanox® capsule, solution*
Stalevo® tablet
Stimate® nasal spray
Stromectol® tablet
Sular® tablet
Sustiva® capsule, tablet
Synthroid® tablet
Syprine® capsule

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T
Tabloid® tablet++
Tamiflu® capsule, suspension
Tarceva® tablet
Tazorac® cream, gel
Tegretol® XR tablet
Temodar® capsule++
Terazol® vaginal cream
Teslac® tablet
Testred® capsule
Thioguanine® tablet++
Thyrolar® tablet
Tikosyn® capsule
Tobi® oral inhalation solution
TobraDex® ophthalmic suspension, ointment
Topicort LP® cream
Tracleer® tablet
Travatan® ophthalmic solution
Travatan Z® ophthalmic solution
Tri-Levlen® tablet*
Tri-Norinyl® tablet*
Triphasil® tablet*
Trizivir® tablet
Truvada® tablet

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U
Ultrase® capsule
Ultrase® MT capsule
Uniphyl® tablet
Uroxatral® tablet

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V
Vagifem® vaginal tablet
Ventolin® HFA oral inhaler
Vfend® tablet, oral suspension
Videx® chew tablets, solution, packets
Viokase® tablet, powder for oral solution
Viracept® tablet, powder for oral solution
Viramune® tablet, oral suspension
Viread® tablet
Visicol® tablet
Vivelle® patch
Vivelle-DOT® patch
Vyvanse® capsule

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W
Westhroid® tablet
Winstrol® tablet

X
Xeloda® tablet++

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Y
Yodoxin® tablet

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Z
Zarontin® capsule, syrup
Zaroxolyn® tablet
Ziagen® tablet, oral solution
Zyprexa® tablet
Zyprexa Zydis® tablet
Zyvox® tablet, oral suspension

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* May not be a covered benefit under some plans.
• Obtain from designated Specialty Pharmacy.
++ Regence BlueCross BlueShield of Oregon members may have a different copay/coinsurance amount for cancer related medications. Please check your prescription benefit.

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