Avoid High Medication Costs

Ask your doctor to choose a drug from this covered list.

Drug Formulary Alphabetical (pdf)
Special 90-Day Drug Formulary (pdf)

 

$5

30-day supply of generic drugs

$12

90-day supply of certain generic drugs*

$15

30-day supply of brand-name drugs that are not available generically

*90-day formulations and dosages may vary and are at the discretion of the pharmacy.

Search the Formulary

Search Tips
Search on terms that appear in any column. Examples: “diabetes generic”, “cardio 90 day” or “cholestyramine”.
To sort by multiple columns, sort the first column then hold the shift key as you sort the second column.

Drug NameTrade NameBrand NameSupplyCategoryAgent ClassKeywords
30 days#Error#Error
acarbosePRECOSEGeneric30 days or 90 days#Error#Error
acebutololSECTRALGeneric30 days#Error#Errorheart
acetaminophen/butalbital/caffeineGeneric30 days#Error#Error
acetaminophen/codeineTYLENOL #3, TYLENOL #4Generic30 days#Error#Error
acetaminophen/hydrocodoneVICODIN, LORTAB, LORCET, LORTAB, NORCOGeneric30 days#Error#Error
acetaminophen/oxycodonePERCOCET, ENDOCETGeneric30 days#Error#Error
acetazolamideDIAMOXGeneric30 days#Error#Error
acetic acid/HC oticACETASOL HCGeneric30 days#Error#Error
acyclovir 200mg caps, 400mgZOVIRAXGeneric30 days or 90 days#Error#Errorinfection; virus
acyclovir 800mgZOVIRAXGeneric30 days#Error#Errorinfection; virus
acyclovir (susp.)ZOVIRAXGeneric30 days#Error#Errorinfection; virus
acyclovir oint 5% (Limit: 15gm)ZOVIRAXGeneric30 days#Error#Error
ADVAIR (Diskus, HFA)ADVAIR DISKUS, ADVAIR HFABrand Name30 days#Error#Error
AEROCHAMBER or equivalent (spacer)Brand Name30 days#Error#Error
albuterol (inhaler, inhalation solution)PROVENTILGeneric30 days#Error#Error
albuterol (nebul. Sol, syrup, tablet)PROVENTILGeneric30 days#Error#ErrorAsthma
alclometasoneACLOVATEGeneric30 days#Error#ErrorSkin
alendronateFOSAMAXGeneric30 days or 90 days#Error#Error
allopurinol (tab)ZYLOPRIMGeneric30 days or 90 days#Error#Error
ALPHAGAN-PBrand Name30 days#Error#Error
alprazolamXANAX, NIRAVAM, XANAX, XANAX XRGeneric30 days#Error#ErrorAnxiety, Panic Disorders
Alprazoplam ER (tabs)XANAX XRGeneric30 days#Error#Error
ALREXBrand Name30 days#Error#Error
amantadineSYMMETRELGeneric30 days#Error#Error
amilorideMIDAMORGeneric30 days#Error#Errorheart
amiloride/hctzGeneric30 days or 90 days#Error#Errorheart
amiodaroneCORDARONE, PACERONEGeneric30 days#Error#Errorheart
amitriptylineELAVILGeneric30 days#Error#Error
amlodipineNORVASCGeneric30 days or 90 days#Error#Error
amoxicillin/clavunate (All dosage forms except XR)AUGMENTINGeneric30 days#Error#Errorinfection
amphetamine saltsADDERALLGeneric30 days#Error#ErrorADHD
amphetamine salts combo-XR (cap)ADDERALL-XRGeneric30 days#Error#Error
ampicillinPRINCIPENGeneric30 days#Error#Errorinfection
anastrozoleARIMIDEXGeneric30 days or 90 days#Error#Error
ANORO (inhalation powder)ANORO ELLIPTABrand Name30 days#Error#ErrorCOPD
apraclonidine ophth.IOPIDINEGeneric30 days#Error#Error
aripiprazole (tab)ABILIFYGeneric30 days#Error#Error
ARNUITYARNUITYBrand Name30 days#Error#Error
ASACOLBrand Name30 days#Error#Error
ASMANEXBrand Name30 days#Error#Error
atenololTENORMINGeneric30 days or 90 days#Error#ErrorHeart, Angina, Hypertension
atenolol/chlorthalidoneTENORETICGeneric30 days or 90 days#Error#Errorheart
atomoxetine (caps)STRATTERAGeneric30 days#Error#Error
atorvastatin (tab)LIPITORGeneric30 days or 90 days#Error#Errorheart, cholesterol
atropine ophth.Generic30 days#Error#Error
ATROVENT HFABrand Name30 days#Error#Error
azathioprine (tab)AZASAN, IMURANGeneric30 days#Error#Error
azithromycin (powder, susp, tab)ZITHROMAX, ZPAKGeneric30 days#Error#Errorinfection
AZOPTBrand Name30 days#Error#Error
bacitracin (ophth.)Generic30 days#Error#Error
bacitracin/neomycin /polymyxin/HC ophth.Generic30 days#Error#Error
baclofenLIORESAL, GABLOFENGeneric30 days or 90 days#Error#Error
balsalazide disodiumGeneric30 days#Error#Error
balziva 0.04/0.035mgGeneric30 days#Error#Error
Bayer Contour Next (Glucose test strips - provided at cost)Brand Name30 days#Error#Error
Bayer Contour Next EZ (Glucometer)Brand Name30 days#Error#Error
Bayer MicroLancets (Lancets)Brand Name30 days#Error#Error
benazeprilLOTENSINGeneric30 days or 90 days#Error#Errorheart
benzonatateTESSALONGeneric30 days#Error#Error
benzoyl peroxide (gel, liq)Generic30 days#Error#ErrorSkin
benzoyl peroxide w/ erythromycin (gel)BENZAMYCIN, BENZAMYCIN PAKGeneric30 days#Error#ErrorSkin
benztropineCOGENTINGeneric30 days or 90 days#Error#Error
betamethasone (augmented) (crm, oint)Generic30 days#Error#ErrorSkin
betamethasone (crm, oint)Generic30 days#Error#ErrorSkin
betamethasone (lotion)Generic30 days#Error#Error
betamethasone/clotrimazole (crm, oint)LOTRISONEGeneric30 days#Error#ErrorSkin
bethanecholURECHOLINEGeneric30 days#Error#Error
BETIMOLBrand Name30 days#Error#Error
bisoprololZEBETAGeneric30 days or 90 days#Error#Errorheart
bisoprolol/hctzZIACGeneric30 days or 90 days#Error#Errorheart
BLEPHAMIDEBrand Name30 days#Error#Error
BREOBREOBrand Name30 days#Error#Error
brimonidineGeneric30 days#Error#Error
bromocriptinePARLODELGeneric30 days#Error#Error
budesonide (nebul sol)PULMICORT, RHINOCORT, ENTOCORT ECGeneric30 days#Error#ErrorAllergies
bumetanideBUMEXGeneric30 days#Error#Errorheart
bupropionWELLBUTRINGeneric30 days#Error#Error
bupropion-SRWELLBUTRIN-SRGeneric30 days#Error#Error
bupropion-XLWELLBUTRIN-XLGeneric30 days#Error#Error
buspironeBUSPARGeneric30 days#Error#Error
cabergolineDOSTINEXGeneric30 days#Error#Error
calcipotriene (crm, ointm, soln)CALCITRENE, DOVONEX, SORILUXGeneric30 days#Error#ErrorSkin
calcitonin sprayMIACALCIN, FORTICALGeneric30 days#Error#Error
calcium acetatePHOSLO, ELIPHOS, PHOSLYRAGeneric30 days#Error#Error
camila 0.35mgERRIN, JOLIVETTE, LYZA, NOR-QD, NORA-BE, ORTHO MICRONORGeneric30 days or 90 days#Error#Errornor-q-d, errin, jolivette, heather
CAPEX 0.01% (shampoo)Brand Name30 days#Error#ErrorSkin
captoprilCAPOTENGeneric30 days#Error#Errorheart
captopril/hctzCAPOZIDEGeneric30 days#Error#Errorheart
carbamazepineTEGRETOLGeneric30 days#Error#Error
carbamazepine-srTEGRETOL-XRGeneric30 days#Error#Error
carbidopa/levodopaSINEMET, PARCOPAGeneric30 days#Error#Error
carbidopa/levodopa-srSINEMET-CRGeneric30 days#Error#Error
carisoprodolSOMAGeneric30 days#Error#ErrorMuscle Injuries
carisoprodol/aspirinSOMA COMPOUNDGeneric30 days#Error#Error
carteolol ophthalmicOCUPRESSGeneric30 days#Error#Error
carvedilol (tablet)COREGGeneric30 days or 90 days#Error#ErrorHeart, Hypertension, Heart Failure
cefaclorCECLOR, RANICLORGeneric30 days#Error#Errorinfection
cefadroxilDURICEFGeneric30 days#Error#Errorinfection
cefdinirOMNICEFGeneric30 days#Error#Errorinfection,
cefpodoximeVANTINGeneric30 days#Error#Errorinfection
cefuroximeCEFTIN, KEFUROX, ZINACEFGeneric30 days#Error#Errorinfection
celecoxibCELEBREXGeneric30 days#Error#Error
cephalexinKEFLEXGeneric30 days#Error#Errorinfection
CHANTIXBrand Name30 days#Error#Error
chlorhexidine gluconatePERIDEXGeneric30 days#Error#Error
chloroquineARALEN PHOSPHATEGeneric30 days#Error#Errorinfection
chlorpromazineTHORAZINEGeneric30 days#Error#Error
chlorthalidoneTHALITONE, HYGROTONGeneric30 days#Error#Errorheart
cholestyramineQUESTRAN, PREVALITEGeneric30 days#Error#Errorheart
cholestyramine liteQUESTRAN LIGHTGeneric30 days#Error#Errorheart
ciclopirox (crm, gel, lotion)PENLAC, LOPROXGeneric30 days#Error#ErrorSkin
cilostazol (tab)PLETALGeneric30 days or 90 days#Error#Error
cimetidine 300mg, 400mg, 800mgTAGAMETGeneric30 days#Error#Error
ciprofloxacinCIPRO, CIPRO XR, PROQUIN XR, CIPRO I.V., CIPRO CYSTITIS PACKGeneric30 days#Error#Errorinfection
citalopram 20, 40mgCELEXAGeneric30 days or 90 days#Error#ErrorDepression
clarithromycin (susp, tab)BIAXINGeneric30 days#Error#Errorinfection
CLEOCIN 100mg (vaginal suppos.)Brand Name30 days#Error#Error
clindamycin (cap, cream, gel, lotion, solution)CLEOCINGeneric30 days#Error#Errorinfection
clobetasol 0.05% 0.05%TEMOVATEGeneric30 days#Error#Error
clomipheneCLOMIDGeneric30 days#Error#Error
clomipramineANAFRANILGeneric30 days#Error#Error
clonazepamKLONOPIN, KLONOPIN WAFERGeneric30 days#Error#ErrorSeizure, Panic Attack
clonidine (patch)CATAPRESGeneric30 days#Error#ErrorHeart, Hypertension
clonidine (tab)CATAPRESGeneric30 days or 90 days#Error#ErrorHeart, Hypertension
clopidogrel 75mg (tab)PLAVIXGeneric30 days or 90 days#Error#Errorheart
clotrimazoleLOTRIMINE, DESENEXGeneric30 days#Error#ErrorSkin
colchicine (12 tabs/month) 0.6mg (tab)Generic30 days#Error#Error
colestipolCOLESTIDGeneric30 days#Error#Errorheart
COMBIPATCH 0.05, 0.14Brand Name30 days#Error#Error
COMBIVENTCOMBIVENT, DUONEBBrand Name30 days#Error#Error
CREONBrand Name30 days#Error#Error
CRINONE (gel)CRINONE, PROMETRIUM, ENDOMETRINBrand Name30 days#Error#Error
cromolyn (nebul soln)INTALGeneric30 days#Error#Error
cromolyn 4% (Opth drops)Generic30 days#Error#Error
cyclobenzaprineFLEXERILGeneric30 days or 90 days#Error#ErrorMuscle Pain, Spasms
cyclopentolate ophth.AK-PENTOLATE, CYCLOGYL, CYLATE, OCU-PENTOLATE, PENTOLAIRGeneric30 days#Error#Error
cyclosporine (cap)NEORAL, GENGRAF, SANDIMMUNEGeneric30 days#Error#Error
cyproheptadinePERIACTINGeneric30 days#Error#Error
danazolDANOCRINEGeneric30 days#Error#Error
DELZICOL (cap)Brand Name30 days#Error#Error
dermotic ear (drops)Generic30 days#Error#Error
desipramineNORPRAMINGeneric30 days#Error#Error
desmopressinDDAVPGeneric30 days#Error#Error
desonideDESONATEGeneric30 days#Error#ErrorSkin
desoximetasoneTOPICORTGeneric30 days#Error#ErrorSkin
dexamethasoneDECADRONGeneric30 days#Error#Error
diazepam (tab, gel)VALIUMGeneric30 days#Error#Error
diclofenac (tab)VOLTAREN, ZORVOLEXGeneric30 days#Error#Error
diclofenac gel 1%Generic30 days#Error#Error
dicloxacillinGeneric30 days#Error#Errorinfection
dicyclomine 10, 20mgBENTYLGeneric30 days or 90 days#Error#Error
diflorasoneAPEXICON, MAXIFLOR, PSORCONGeneric30 days#Error#ErrorSkin
diflunisalDOLOBIDGeneric30 days#Error#Error
digoxin (tab)LANOXINGeneric30 days#Error#Errorheart
diltiazem 30, 60, 90, 120mg (tab)CARDIZEMGeneric30 days#Error#Error
diltiazem-CDCARDIZEM-CDGeneric30 days#Error#Errorheart
dipyridamolePERSANTINEGeneric30 days#Error#Errorheart
disopyramideNORPACEGeneric30 days#Error#Errorheart
divalproex sodiumDEPAKOTEGeneric30 days#Error#Error
divalproex-ERDEPAKOTE-ERGeneric30 days#Error#Error
donepezil (tab)ARICEPTGeneric30 days or 90 days#Error#Error
dorzolamideTRUSOPTGeneric30 days#Error#Error
dorzolamide/timololCOSOPTGeneric30 days#Error#Error
doxazosinCARDURAGeneric30 days or 90 days#Error#Errorheart
doxepin (caps & liquid)SINEQUANGeneric30 days#Error#Error
doxycyclineDORYX, MONODOX, ORACEAGeneric30 days#Error#Errorinfection
DULERABrand Name30 days#Error#Error
duloxetineCYMBALTAGeneric30 days#Error#Error
econazole 1% (cream)Generic30 days#Error#Error
eletriptan 20mg and 40mg (pk of 6) (tabs)REPLAXGeneric30 days#Error#Error
ELIQUIS (tab)Brand Name30 days#Error#Error
Emgality (injectable) (Limit: restricted to Neuroologits)Brand Name30 days#Error#Error
emoquette 0.15/0.03mgORTHO-CEPT
APRI, AZURETTE, CAZIANT, CESIA, CYCLESSA, DESOGEN, EMOQUETTE, KARIVA, MIRCETTE, ORTHO-CEPT, RECLIPSEN, SOLIA, VELIVET, VIORELE
Generic30 days or 90 days#Error#Error
enalaprilVASOTECGeneric30 days or 90 days#Error#Errorheart
enalapril/hctzVASERETICGeneric30 days or 90 days#Error#Errorheart
ENBREL PFS/MINI/SURECLICK (injectable)Brand Name30 days#Error#Error
enoxaparin (injectable) (Limit: up to 10 days)LOVENOXGeneric30 days#Error#Error
enpresse-28TRIPHASIL-28, TRI-LEVLEN-28Generic30 days or 90 days#Error#Errortriphasic,trivora-28
entecavir (tabs)BARACLUDEGeneric30 days#Error#Error
epinephrine auto-injectorEPIPENGeneric30 days#Error#Error
epinephrine auto-injector jr.EPIPEN-JRGeneric30 days#Error#Error
erythromycin (caps, gel, ophth ointm, susp, tab)E.E.S. GRANULES, E.E.S.-200, E.E.S.-400, E.E.S.-400 FILMTAB, ERY-TAB, ERYC, ERYPED, ERYPED 200, ERYPED 400Generic30 days#Error#ErrorSkin
erythromycin/sulfisoxazolePEDIAZOLE, ERYZOLE, SULFIMYCINGeneric30 days#Error#Errorinfection
escitalopram (tab)LEXAPROGeneric30 days or 90 days#Error#Error
estradiol (crm, patch)CLIMARA, VIVELLE, ESTRACE, ESTRADERM, FEMTRACE, GYNODIOLGeneric30 days#Error#Error
estradiol (tab)ESTRACEGeneric30 days or 90 days#Error#Error
estrogen/methyltestosteroneGeneric30 days#Error#Error
estropipate 0.75, 1.5mg (tab)OGEN 0.625, OGEN 1.25, OGEN 2.5, ORTHO-ESTGeneric30 days#Error#Error
ethambutolMYAMBUTOLGeneric30 days#Error#Errorinfection
ethosuximideZARONTINGeneric30 days#Error#Error
etodolacLODINEGeneric30 days#Error#Error
ezetimibeZETIAGeneric30 days or 90 days#Error#Error
famciclovirFAMVIRGeneric30 days#Error#Errorinfection; virus
famotidine 40mgPEPCIDGeneric30 days or 90 days#Error#Error
fenofibrate (tab)TRICOR, LIPOFEN, FENOGLIDEGeneric30 days#Error#ErrorHeart, Cholesterol
fentanylDURAGESIC, FENTORA, ONSOLISGeneric30 days#Error#Error
finasteridePROSCAR, PROPECIA, PROSCARGeneric30 days or 90 days#Error#ErrorBenign Prostatic Hyperplasia (BPH)
flavoxateURISPASGeneric30 days#Error#Error
flecainideTAMBOCORGeneric30 days#Error#Errorheart
FLOVENT (Diskus, HFA)Brand Name30 days#Error#Error
fluconazole (oral suspension, tab)DIFLUCANGeneric30 days#Error#Errorinfection
fludrocortisoneFLORINEF ACETATEGeneric30 days#Error#Error
flunisolide (nasal spray)NASARELGeneric30 days#Error#Error
fluocinonide 0.05%LIDEXGeneric30 days#Error#Error
fluocinonide 0.05% (crm, ointm, soln)LIDEX, VANOSGeneric30 days#Error#ErrorSkin
fluoride oral supplementsGeneric30 days#Error#Error
fluoride oral supplements (chewables, drops)Generic30 days or 90 days#Error#Error
fluorometholone (ophth. ointm & susp.)FMLGeneric30 days#Error#Error
fluorouracil (crm, top. soln)Generic30 days#Error#ErrorSkin
fluoxetine (capsule)PROZACGeneric30 days or 90 days#Error#ErrorDepression
fluphenazineGeneric30 days#Error#Error
flurazepamDALMANEGeneric30 days#Error#Error
flurbiprofenANSAIDGeneric30 days#Error#Error
fluticasone (inhaler, nasal spray, cream, ointment)FLONASE, FLOVENT, CUTIVATEGeneric30 days#Error#ErrorRhinitis, Skin
fluvoxamineLUVOXGeneric30 days#Error#Error
folic acid 1mgFA-8, FOLACIN-800Generic30 days or 90 days#Error#Error
furosemideLASIX, LASIX, DIAQUA-2, LO-AQUAGeneric30 days or 90 days#Error#ErrorHeart, Hypertension
gabapentinNEURONTINGeneric30 days or 90 days#Error#ErrorSeizures
ganciclovirGeneric30 days#Error#Errorinfection; virus
gemfibrozilLOPIDGeneric30 days or 90 days#Error#Errorheart, cholesterol
gentamicin (crm, ophth, oint, soln)GENTAK, GARAMYCINGeneric30 days#Error#ErrorEyes, Skin
glimepirideAMARYLGeneric30 days or 90 days#Error#Error
glipizideGLIPIZIDEGeneric30 days or 90 days#Error#Error
glipizide-XLGLUCOTROL-XLGeneric30 days or 90 days#Error#Error
GLUCAGON KITGeneric30 days#Error#Error
glyburideGeneric30 days or 90 days#Error#Error
glyburide micronizedGeneric30 days or 90 days#Error#Error
griseofulvin v (susp, tab)GRIFULVINGeneric30 days#Error#Errorinfection
guaifenesin/codeineGeneric30 days#Error#Error
guanfacine (tab)TENEXGeneric30 days#Error#Errorblood pressure; ADHD; hypertension
Guanfacine ER (tabs)INTUNIV ERGeneric30 days#Error#Error
H.Pylori 14-day Triple Therapy Amox/Clarithomycin/LansoprazoleGeneric30 days#Error#Error
haloperidol (tab)HALDOLGeneric30 days#Error#Error
heparinGeneric30 days#Error#Error
homatropineGeneric30 days#Error#Error
homatropine/hydrocodone (syr)TUSSIGONGeneric30 days#Error#Error
HUMIRA PFS/PEN (injectable)Brand Name30 days#Error#Error
hydralazineAPRESOLINEGeneric30 days or 90 days#Error#Errorheart
hydrochlorothiazideDIURILGeneric30 days or 90 days#Error#ErrorHeart, Hypertension
hydrocortisone 2.5% (lotion)Generic30 days#Error#Error
hydrocortisone (tab, suppository)Generic30 days#Error#ErrorSkin
hydrocortisone/iodoquinol 1%-1% (cream)DERMAZENEGeneric30 days#Error#ErrorSkin
hydrocortisone/pramoxineANALPRAM, HC PRAMOXINE, NOVACORT, PRAMOSONE, PROCTOFOAM HC, RECTOCORT HC, PRAMCORTGeneric30 days#Error#ErrorSkin
hydromorphoneDILAUDIDGeneric30 days#Error#Error
hydroquinone (crm)Generic30 days#Error#ErrorSkin
hydroxychloroquinePLAQUENILGeneric30 days#Error#Errorinfection
hydroxyurea (cap)DROXIAGeneric30 days#Error#Error
hydroxyzineATARAX, VISTARIL, HYZINEGeneric30 days#Error#Error
hyoscyamineGeneric30 days#Error#Error
hyoscyamine-erGeneric30 days#Error#Error
ibuprofen 400mg, 600mg, 800mg (tab)MOTRINGeneric30 days or 90 days#Error#ErrorInflammation
imipramineTOFRANILGeneric30 days#Error#Error
imiquimod (Limit: 12 packets/30 days)ALDARA, ZYCLARAGeneric30 days#Error#ErrorSkin Growths
INCRUSE Ellipta (inhalation powder)INCRUSEBrand Name30 days#Error#ErrorCOPD
indapamideLOZOLGeneric30 days or 90 days#Error#Errorheart
indomethacin, indomethacin-er 25mg, 50mg, 75mgINDOCINGeneric30 days#Error#Error
ipratropium (neb. sol)ATROVENTGeneric30 days#Error#Error
isoniazidNYDRAZIDGeneric30 days#Error#Errorinfection
isosorbide dinitrateDILATRATE-SRGeneric30 days#Error#Errorheart
isosorbide mononitrate 30mg, 60mg, 120mgIMDURGeneric30 days or 90 days#Error#Errorheart
JANUMETBrand Name30 days#Error#Error
JANUMET-XRBrand Name30 days#Error#Error
JANUVIABrand Name30 days#Error#Error
jinteli 1/0.005mgGeneric30 days#Error#Error
jolivette 0.35mgORTHO-MICRONOR,
AYGESTIN, CAMILA, ERRI, NOR-QD, NORA-BE, ORTHO MICRONOR
Generic30 days or 90 days#Error#Errorortho-micronor, nor-q-d, errin, camila, heather
junel 1/0.02mg or 1.5/.03mgLOESTRINGeneric30 days or 90 days#Error#Error
junel-fe 1.5/0.03mgLOESTRIN-FEGeneric30 days or 90 days#Error#Error
karivaMIRCETTE, APRI, AZURETTE, CAZIANT, CESIA, CYCLESSA, DESOGEN, EMOQUETTE, KARIVA, MIRCETTE, ORTHO-CEPT, RECLIPSEN, SOLIA, VELIVET, VIORELEGeneric30 days or 90 days#Error#Error
kelnor 1/0.035mgDEMULEN 1/35-28, KELNOR, ZOVIA 1/35, ZOVIA 1/50Generic30 days or 90 days#Error#Errorzovia 1/35
ketoconazole 2% (cream)Generic30 days#Error#Error
ketoconazole (shampoo only)NIZORALGeneric30 days#Error#ErrorSkin
ketoprofenACTRON, ORUDISGeneric30 days#Error#Error
ketorolacTORADOLGeneric30 days#Error#ErrorEyes
labetololGeneric30 days or 90 days#Error#Errorheart
lactulose (syrup)Generic30 days or 90 days#Error#Error
lamotrigineLAMICTALGeneric30 days#Error#ErrorSeizures
LANTUSBrand Name30 days#Error#Error
latanoprost ophth.XALATANGeneric30 days or 90 days#Error#Errorglaucoma
leenaTRI-NORINYLGeneric30 days#Error#Errortriphasic
leflunomide (tab)Generic30 days#Error#Error
letrozoleFEMARAGeneric30 days or 90 days#Error#Error
leuprolide injectionGeneric30 days#Error#Error
levetiracetamKEPPRAGeneric30 days#Error#ErrorSeizures
levobunolol ophth.BETAGANGeneric30 days#Error#Error
levofloxacinLEVAQUINGeneric30 days#Error#Errorinfection
levothyroxine (tablet)Generic30 days or 90 days#Error#Error
levoxylSYNTHROIDBrand Name30 days#Error#Error
LIALDA (tab)Brand Name30 days#Error#Error
lidocaine (crm, gel, ointm, viscous liq)Generic30 days#Error#ErrorSkin
lidocaine/prilocaine (top.)EMLAGeneric30 days#Error#ErrorSkin
lindaneGeneric30 days#Error#ErrorSkin
liothyronineCYTOMEL, TRIOSTATGeneric30 days#Error#Error
lisinoprilPRINIVIL, ZESTRILGeneric30 days or 90 days#Error#Error
lisinopril/hctzPRINZIDE, ZESTORETICGeneric30 days or 90 days#Error#Errorheart
lithium carbonateLITHOBIDGeneric30 days or 90 days#Error#Errorpsychiatry
lorazepamATIVANGeneric30 days#Error#ErrorAnxiety
losartanCOZAARGeneric30 days or 90 days#Error#Error
losartan/hctzHYZAARGeneric30 days or 90 days#Error#Errorheart
LOTEMAXBrand Name30 days#Error#Error
lovastatinMEVACOR, ALTOCORGeneric30 days or 90 days#Error#ErrorHeart, High Cholesterol
low-ogestrel 0.3/0.03mgLO/OVRAL-21, CRYSELLE 28, LO/OVRAL-28, LOW-OGESTREL, OGESTREL-28Generic30 days or 90 days#Error#Errorcryselle-28
loxapineLOXITANE, LOXITANE, LOXITANE C, LOXITANE IMGeneric30 days#Error#Errorpsychiatry
mebendazoleVERMOXGeneric30 days#Error#Errorinfection
medroxyprogesterone (injectable (90-d), tab(30-d))DEPO-PROVERA, PROVERAGeneric30 days or 90 days#Error#Error
mefloquineLARIAMGeneric30 days#Error#Errorinfection
megestrol (tab)MEGACEGeneric30 days or 90 days#Error#Error
meloxicamMOBICGeneric30 days or 90 days#Error#ErrorArthritis
memantine (tab)NAMENDAGeneric30 days#Error#Error
meprobamateEQUANIL, MB-TABGeneric30 days#Error#Error
MEPRONBrand Name30 days#Error#Errorinfection
mesalamineCANASAGeneric30 days#Error#Error
metaproterenol (syr)ALUPENT, METAPRELGeneric30 days#Error#Error
metforminFORTAMET, GLUCOPHAGE, GLUCOPHAGE XR, GLUMETZA, RIOMETGeneric30 days or 90 days#Error#ErrorDiabetes
methazolamideGLAUCTABS, MZM, NEPTAZANEGeneric30 days#Error#Error
methergine 0.2mg (tabs) (Limit: 12 tabs)Generic30 days#Error#Error
methimazoleNORTHYX, TAPAZOLEGeneric30 days or 90 days#Error#Error
methocarbamolROBAXIN, ROBAXIN-750, CARBACOT, SKELEXGeneric30 days#Error#Error
methotrexate (tab)RHEUMATREX DOSE PACK, TREXALLGeneric30 days#Error#Error
methyldopaALDOMETGeneric30 days or 90 days#Error#Errorheart
methylphenidate (IR tabs only)RITALIN, METADATE, METHYLINGeneric30 days#Error#ErrorADHD
methylprednisoloneMEDROLGeneric30 days#Error#Error
metoclopramide (syr, tab)METOZOLV ODT, REGLANGeneric30 days or 90 days#Error#Error
metolazoneZAROXOLYN, MYKROXGeneric30 days#Error#Errorheart
metoprololLOPRESSORGeneric30 days or 90 days#Error#Error
metoprolol/hctzLOPRESSOR HCTGeneric30 days#Error#Errorheart
metoprolol-xlTOPROL-XLGeneric30 days or 90 days#Error#Errorheart
metronidazole (crm, vag. gel, tab)FLAGYL, METROGELGeneric30 days#Error#ErrorSkin
mexiletineMEXITILGeneric30 days#Error#Error
MicrochamberMICROCHAMBER30 days#Error#Error
microgestin 1/0.02mg or 1.5/0.03mgLOESTRINGeneric30 days or 90 days#Error#Error
microgestin-fe 1/0.02mg or 1.5/0.03mgLOESTRIN-FEGeneric30 days or 90 days#Error#Error
minocyclineDYNACIN, MINOCIN, MINOCIN PAC, MYRAC, SOLODYN, VECTRINGeneric30 days#Error#Errorinfection
minoxidilLONITENGeneric30 days#Error#Errorheart
mirtazapine (tab)REMERONGeneric30 days#Error#Error
misoprostolCYTOTECGeneric30 days#Error#Error
mometasone (crm, lotion, ointment)ELOCONGeneric30 days#Error#ErrorSkin
montelukast (chew, tab)SINGULAIRGeneric30 days or 90 days#Error#Error
morphine (IR or ER Tabs only)MS CONTINGeneric30 days#Error#Error
mupirocin (ointment only)BACTROBANGeneric30 days#Error#ErrorSkin
MYCOBUTINBrand Name30 days#Error#Errorinfection
mycophenolate mofetilCELLCEPTGeneric30 days#Error#Error
nabumetoneRELAFENGeneric30 days#Error#Error
nadololCORGARDGeneric30 days#Error#Errorheart
naltrexoneREVIAGeneric30 days#Error#Error
naproxenNAPROSYN, ALEVEGeneric30 days or 90 days#Error#ErrorInflammation
naproxen-ecEC-NAPROSYNGeneric30 days#Error#Error
naratriptanAMERGEGeneric30 days#Error#Error
neomycinGeneric30 days#Error#Errorinfection
Neomycin/Polymixin/Dexameth 0.1% (Ophth drops)MAXITROLGeneric30 days#Error#Error
Neomycin/Polymixin/Dexameth 0.1% (Ophth Oint)MAXITROLGeneric30 days#Error#Error
neomycin/polymyxin/ HC ophth. (crm, ointm, susp )Generic30 days#Error#Error
neomycin/polymyxin/gramicidin ophth.Generic30 days#Error#Error
nicotine (gum, lozenges, patches)NICODERM, NICORETTE, NICOTROLGeneric30 days#Error#Error
nifedipinePROCARDIA, NIFEDICALGeneric30 days or 90 days#Error#Error
nitrofurantoinMACROBID, MACRODANTINGeneric30 days#Error#Errorinfection
nitroglycerin (ointm, patch, SL, spray)Generic30 days#Error#Errorheart
norethindroneAYGESTIN, CAMILA, ERRIN, JOLIVETTE, NOR-QD, NORA-BE, ORTHO MICRONOR, HEATHERGeneric30 days or 90 days#Error#Error
nortrel 7/7/7 (0.5/0.035mg)ORTHO-NOVUM 7/7/7Generic30 days or 90 days#Error#Errortriphasic
nortriptylinePAMELOR, AVENTYL HCLGeneric30 days or 90 days#Error#Error
NOVOLIN 70/30Brand Name30 days#Error#Error
NOVOLIN NBrand Name30 days#Error#Error
NOVOLIN RBrand Name30 days#Error#Error
NOVOLOGBrand Name30 days#Error#Error
NUVARINGBrand Name30 days#Error#Error
nystatin (crm, ointm, powd, susp)MYCOSTATIN TOPICAL, NYSTOPGeneric30 days#Error#ErrorSkin
nystatin/triamcinoloneMYCOLOGGeneric30 days#Error#Error
ocella 3-0.03mgYASMIN, GIANVI, LORYNA, OCELLA, SYEDA, VESTURA, YASMIN, YAZ, ZARAHGeneric30 days or 90 days#Error#Errorsyeda, zarah
ofloxacin (ophth, otic)FLOXIN, OCUFLOXGeneric30 days#Error#Error
orphenadrineNORFLEX, ORPHENATEGeneric30 days#Error#Error
orphenadrine compoundGeneric30 days#Error#Error
ORTHO EVRABrand Name30 days#Error#Error
oxcarbazepine (tab)Generic30 days#Error#Error
OXSORALEN-ULTRABrand Name30 days#Error#ErrorSkin
oxybutyninDITROPANGeneric30 days#Error#Error
oxybutynin-XLDITROPAN-XLGeneric30 days#Error#Error
oxycodoneOXYCONTINGeneric30 days#Error#Error
oxycodone/acetaminophenENDOCET, PERCOCETGeneric30 days#Error#Error
oxycodone-ERGeneric30 days#Error#Error
PANCREAZEBrand Name30 days#Error#Error
pantoprazolePROTONIXGeneric30 days or 90 days#Error#ErrorGERD
paroxetinePAXILGeneric30 days or 90 days#Error#ErrorDepression
peg 3350/electrolytesGeneric30 days#Error#Error
penicilln vkGeneric30 days#Error#Errorinfection
pentoxifylline-erGeneric30 days#Error#Errorheart
permethrinGeneric30 days#Error#ErrorSkin
perphenazineTRILAFONGeneric30 days#Error#Error
perphenazine/amitriptylineETRAFON, TRIAVILGeneric30 days#Error#Error
phenazopyridineGeneric30 days#Error#Error
phenobarbitalGeneric30 days#Error#Error
phenytoinDILANTINGeneric30 days#Error#Error
phytonadione 5mg (tabs) (Limit: 30 tabs)MEPHYTONGeneric30 days#Error#Error
pilocarpine (ophth.)ISOPTO CARPINE, PILOPINE HSGeneric30 days#Error#Error
pindololVISKENGeneric30 days#Error#Errorheart
piroxicamFELDENEGeneric30 days#Error#Error
podofiloxCONDYLOXGeneric30 days#Error#ErrorSkin
polymyxin-b & trimethoprimGeneric30 days#Error#Error
portia-28 0.15/0.03mgNORDETTE-28Generic30 days or 90 days#Error#Erroraltavera, levora-28
potassium chlorideKLOR-CON, K-DURGeneric30 days or 90 days#Error#Error
potassium chloride-erGeneric30 days or 90 days#Error#Error
potassium citrate (tabs)UROCIT-KGeneric30 days#Error#Error
pramipexoleMIRAPEX, MIRAPEX ERGeneric30 days#Error#Error
PRANDINBrand Name30 days#Error#Error
pravastatinPREVACHOL, PRAVACHOLGeneric30 days or 90 days#Error#ErrorHeart, High Cholesterol
prazosinMINIPRESSGeneric30 days#Error#Errorheart
prednicarbateDERMATOPGeneric30 days#Error#ErrorSkin
prednisolone (oral liquid, ophth. Drop)ORAPRED, PEDIAPRED, PRELONE, PRED FORTEGeneric30 days#Error#Error
prednisone (tab)DELTASONEGeneric30 days or 90 days#Error#ErrorSwelling, Allergic Reactions
Pregabalin (caps)LYRICAGeneric30 days#Error#Error
PREMARIN (tab, vag crm)Brand Name30 days#Error#Error
PREMPHASEBrand Name30 days#Error#Error
PREMPROBrand Name30 days#Error#Error
prenatal plus vitaminsGeneric30 days or 90 days#Error#Error
primidoneMYSOLINEGeneric30 days#Error#Error
probenecidBENEMIDGeneric30 days#Error#Error
procainamideGeneric30 days#Error#Errorheart
prochlorperazineCOMPAZINEGeneric30 days or 90 days#Error#Error
PROCTOZONE-HC 2.5% (crm)Brand Name30 days#Error#Error
progesterone 50mg/ml (injection)PROMETRIUMGeneric30 days#Error#Error
promethazine (syr, tab)PHENERGANGeneric30 days#Error#Error
promethazine/codeinePHENERGAN W/ CODEINEGeneric30 days#Error#Error
promethazine-dmGeneric30 days#Error#Error
propranololINDERALGeneric30 days#Error#Errorheart
propranolol-ERGeneric30 days#Error#Errorheart
propranolol-LAGeneric30 days#Error#Errorheart
propylthiouracilGeneric30 days#Error#Error
PROVENTIL HFABrand Name30 days#Error#Error
PULMICORT FLEXHALERBrand Name30 days#Error#Error
PULMOZYMEBrand Name30 days#Error#Error
pyrazinamideGeneric30 days#Error#Errorinfection
pyridostigmineGeneric30 days#Error#Error
Quetiapine Fum ER (tabs)SEROQUEL XRGeneric30 days#Error#Error
quetiapine fumarateSEROQUELGeneric30 days#Error#Errorpsychiatry
quinidine sulfateGeneric30 days#Error#Errorheart
quinidine sulfate-erGeneric30 days#Error#Errorheart
QVARBrand Name30 days#Error#Error
ramiprilALTACEGeneric30 days or 90 days#Error#Errorblood pressure
ranitidine 150, 300mgZANTACGeneric30 days or 90 days#Error#ErrorUlcers, GERD
REGRANEXBrand Name30 days#Error#ErrorSkin
RENAGELBrand Name30 days#Error#Error
repaglinide (tab)Generic30 days or 90 days#Error#Error
ribavirin (caps, tabs)COPEGUS, REBETOL, RIBAPAK, RIBASPHERE, RIBATAB, VIRAZOLEGeneric30 days#Error#Errorinfection; virus
rifampinRIFADIN, RIMACTANEGeneric30 days#Error#Errorinfection
risperidone (tab)RISPERDALGeneric30 days#Error#Error
rizatriptanMAXALTGeneric30 days#Error#Errormigraine; headache
ropiniroleREQUIPGeneric30 days#Error#Error
rosuvastatinCRESTORGeneric30 days or 90 days#Error#Error
salsalate 500mgSALFLEX, AMIGESICGeneric30 days#Error#Error
SANTYLBrand Name30 days#Error#ErrorSkin
selegilineELDEPRYL, ZELAPARGeneric30 days#Error#Error
selenium sulfide (lotion)Generic30 days#Error#ErrorSkin
sertralineZOLOFTGeneric30 days or 90 days#Error#Error
sevelamer carbonate 800mg tabs 800mg (tab)RENVELAGeneric30 days#Error#Error
silver sulfadiazineSILVADENEGeneric30 days#Error#ErrorSkin
simvastatinZOCORGeneric30 days or 90 days#Error#ErrorHeart, High Cholesterol
sodium citrate/citric acid (liq)BICITRA, CYTRA-2, LIQUI-DUAL CITRA, ORACITGeneric30 days or 90 days#Error#Error
sodium polystyrene sulfonateKAYEXALATEGeneric30 days#Error#Error
solifenacin (tab)VESICAREGeneric30 days#Error#Error
SOLU-CORTEFBrand Name30 days#Error#Error
sotalol 80mgBETAPACE, SORINEGeneric30 days or 90 days#Error#Errorheart
spironolactone 25mgALDACTONEGeneric30 days or 90 days#Error#ErrorHeart, Hypertension
spironolactone/hctzALDACTAZIDEGeneric30 days#Error#Errorheart
sprintec 0.25/0.035mgMONONESSA, ORTHO TRI-CYCLEN, ORTHO TRI-CYCLEN LO, ORTHO-CYCLEN, PREVIFEM, SPRINTEC, TRI-LO-SPRINTEC, TRI-PREVIFEM, TRI-SPRINTEC, TRINESSAGeneric30 days or 90 days#Error#Error
sucralfateCARAFATEGeneric30 days#Error#Error
sulfacetamide sodium 10% ophth.Generic30 days#Error#Error
sulfacetamide/prednisoloneGeneric30 days#Error#Error
sulfacetamide/sulfur 10%/5% (topical cleanser)Generic30 days#Error#Error
sulfamethoxazole-trimethoprimGeneric30 days#Error#Errorinfection
sulfasalazineAZULFIDINE, SULFAZINEGeneric30 days#Error#Error
sulfasalazine-ecGeneric30 days#Error#Error
sulindacCLINORILGeneric30 days#Error#Error
sumatriptan 9 tabs per 30 days (tabs)IMITREXGeneric30 days#Error#ErrorMigraines
sumatriptan succ 6mg/0.5ml (injectable)IMITREXGeneric30 days#Error#Error
SUPREP (liq)Brand Name30 days#Error#Error
SYNTHROIDBrand Name30 days#Error#Error
tacrolimus (cap & ointment)PROTOPIC, PROGRAFGeneric30 days#Error#ErrorTransplant Organ Rejection
TAMIFLUBrand Name30 days#Error#Errorinfection; virus
tamoxifenSOLTAMOXGeneric30 days or 90 days#Error#Error
tamsulosinFLOMAXGeneric30 days or 90 days#Error#Error
temazepamRESTORILGeneric30 days#Error#ErrorInsomnia
tenofovir 300mg (tab)VIREADGeneric30 days#Error#Error
teraconazole vaginalGeneric30 days#Error#Error
terazosinHYTRINGeneric30 days or 90 days#Error#Errorheart
terbinafine (tab)LAMISILGeneric30 days or 90 days#Error#Errorinfection
testosterone depotDEPO-TESTOSTERONEGeneric30 days#Error#Error
tetracyclineALA-TET, PANMYCIN, SUMYCINGeneric30 days#Error#Errorinfection
theophyllineGeneric30 days#Error#Error
thioridazineMELLARIL, MELLARIL-SGeneric30 days#Error#Error
timolol (sol)BLOCADRENGeneric30 days or 90 days#Error#Error
timolol-xe (ophth.)Generic30 days#Error#Error
tobramycin ophth.Generic30 days#Error#Error
tobramycin/dexamethasone ophth. 0.3-0.1%TOBRADEXGeneric30 days#Error#Error
TOBREX (ophth. ointment)Brand Name30 days#Error#Error
tolterodineDETROLGeneric30 days#Error#Errorbladder, urinary incontinence
topiramateTOPAMAXGeneric30 days#Error#ErrorSeizures
topiramate ER 25mg, 50mg 100mg (caps) (Limit: restricted to neurologists)TOPAMAXGeneric30 days#Error#Error
torsemideDEMADEXGeneric30 days#Error#Errorheart
tramadolULTRAMGeneric30 days#Error#ErrorModerate Pain
Tranexamic Acid (tabs) (Limit: 30 tabs)LYSTEDAGeneric30 days#Error#Error
TRANSDERM-SCOPBrand Name30 days#Error#Error
trazodoneDESYRELGeneric30 days or 90 days#Error#Error
TRELEGY Ellipta (Inhaler)TRELEGYBrand Name30 days#Error#Error
tretinoin 0.1%, 0.05%, 0.01% & 0.025% (cream or gel 15-20 gm max) (Limit: acne vulgaris)RETIN AGeneric30 days#Error#Error
triamcinolone (crm)KENALOGGeneric30 days#Error#ErrorSkin
triamcinolone (ointm)ARISTOCORTGeneric30 days#Error#ErrorSkin
triamcinolone/orabaseGeneric30 days#Error#Error
triamterene/hctzDYAZIDE, MAXZIDEGeneric30 days or 90 days#Error#Errorheart
triazolamHALCIONGeneric30 days#Error#Error
trifluoperazineSTELAZINEGeneric30 days#Error#Error
trifluridine ophth.TRIFLURIDINE, VIROPTICGeneric30 days#Error#Error
trihexyphenidylARTANE, TRIHEXANEGeneric30 days or 90 days#Error#Error
tri-lo-sprintecORTHO TRICYCLEN-LOGeneric30 days or 90 days#Error#Error
trimethobenzamideTIGAN, TICON, BENZACOTGeneric30 days#Error#Error
trimethoprim/polymyxinGeneric30 days#Error#Error
tri-sprintecMONONESSA, ORTHO TRI-CYCLEN, ORTHO TRI-CYCLEN LO, ORTHO-CYCLEN, PREVIFEM, SPRINTEC, TRI-LO-SPRINTEC, TRI-PREVIFEM, TRI-SPRINTEC, TRINESSAGeneric30 days or 90 days#Error#Error
urea 40% (crm, gel)URAMAXIN GTGeneric30 days#Error#ErrorSkin
ursodiolACTIGALL, URSOGeneric30 days#Error#Error
VAGIFEMBrand Name30 days#Error#Error
valacyclovirVALTREXGeneric30 days#Error#Errorinfection; virus
valproic acidDEPAKENE, STAVZOR, DEPACONGeneric30 days#Error#Error
valsartanDIOVANGeneric30 days#Error#Error
Valsartan/hctz (tab)DIOVAN/HCTZGeneric30 days#Error#Error
vancomycin 125mg or 250mg (caps) (Limit: 50 caps)Generic30 days#Error#Error
vancomycin injectableGeneric30 days#Error#Errorinfection
VANOXIDE-HCBrand Name30 days#Error#ErrorSkin
venlafaxine (cap)EFFEXORGeneric30 days#Error#Error
venlafaxine-ER (cap)EFFEXOR-XRGeneric30 days#Error#Error
VENTOLIN HFAVENTOLIN HFABrand Name30 days#Error#Error
verapamilCALAN, VERELANGeneric30 days#Error#Error
verapamil-erCALAN-SRGeneric30 days#Error#Errorheart
VYVANSEBrand Name30 days#Error#Error
warfarinCOUMADINGeneric30 days or 90 days#Error#ErrorHeart, Thrombosis
zafirlukastACCOLATEGeneric30 days#Error#Error
ZENPEPBrand Name30 days#Error#Error
Ziprasidone (caps)GEODONGeneric30 days#Error#Error
zolpidemAMBIENGeneric30 days#Error#Errorsleep, insomnia
zonisamideZONEGRANGeneric30 days#Error#Error