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Maintenance Medication Drug List - Express Scripts...MYKIDZ IRON FL MYNATAL MYNATAL ADVANCE MYNATAL...

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1 | Page Maintenance Medication Drug List Drug Level_231267_Updated February 2017 A ACARBOSE ACCOLATE ACCUPRIL ACCURETIC ACEBUTOLOL HCL ACEON ACETAZOLAMIDE ACIPHEX ACIPHEX SPRINKLE ACTIGALL ACTIVE OB ACTIVELLA ACTONEL ACTOPLUS MET ACTOPLUS MET XR ACTOS ADALAT CC ADLYXIN ADVAIR DISKUS ADVAIR HFA ADVANCED AM/PM ADVICOR ADYNOVATE AEROSPAN AFEDITAB CR AFREZZA AGGRENOX AGRYLIN ALBUTEROL SULFATE ALDACTAZIDE ALDACTONE ALENDRONATE SODIUM ALFUZOSIN HCL ER ALLOPURINOL ALOGLIPTIN ALOGLIPTIN-METFORMIN ALOGLIPTIN-PIOGLITAZONE ALORA ALPHAGAN P ALTACE ALTAVERA ALTOPREV ALVESCO ALYACEN AMABELZ AMARYL AMETHIA AMETHIA LO AMETHYST AMILORIDE HCL AMILORIDE HCL W/HCTZ AMIODARONE HCL AMITIZA AMLODIPINE BESYLATE AMLODIPINE BESYLATE-BENAZEPRIL AMLODIPINE-ATORVASTATIN AMLODIPINE-OLMESARTAN AMLODIPINE-VALSARTAN AMLODIPINE-VALSARTAN-HCTZ AMTURNIDE ANAGRELIDE HYDROCHLORIDE ANAPROX ANAPROX DS ANASTROZOLE ANGELIQ ANIMI-3 ANSAID ANTARA APIDRA APIDRA SOLOSTAR APLENZIN APRI APRISO ARANELLE ARAVA ARCAPTA NEOHALER ARICEPT ARICEPT ODT ARIMIDEX ARMOUR THYROID ARNUITY ELLIPTA AROMASIN ARTHROTEC ASACOL HD ASHLYNA ASMANEX ASMANEX HFA ASPIRIN E.C. ASPIRIN-DIPYRIDAMOLE ER ATABEX EC ATACAND ATACAND HCT ATELVIA ATENOLOL ATENOLOL W/CHLORTHALIDONE ATORVASTATIN CALCIUM ATROVENT ATROVENT HFA AUBRA AVALIDE AVANDAMET AVANDARYL AVANDIA AVAPRO AVIANE AVODART AV-VITE FB AV-VITE FB FORTE AYGESTIN AZILECT AZOPT AZOR AZULFIDINE AZURETTE B BACLOFEN BACMIN BAL-CARE DHA BAL-CARE DHA ESSENTIAL BALZIVA BASAGLAR KWIKPEN U-100 BECONASE AQ BEKYREE BENAZEPRIL HCL
Transcript
Page 1: Maintenance Medication Drug List - Express Scripts...MYKIDZ IRON FL MYNATAL MYNATAL ADVANCE MYNATAL PLUS MYNATAL -Z MYNATE 90 PLUS MYNEPHROCAPS MYRBETRIQ MYZILRA N NABUMETONE NADOLOL

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Maintenance Medication Drug List Drug Level_231267_Updated February 2017

A ACARBOSE

ACCOLATE

ACCUPRIL

ACCURETIC

ACEBUTOLOL HCL

ACEON

ACETAZOLAMIDE

ACIPHEX

ACIPHEX SPRINKLE

ACTIGALL

ACTIVE OB

ACTIVELLA

ACTONEL

ACTOPLUS MET

ACTOPLUS MET XR

ACTOS

ADALAT CC

ADLYXIN

ADVAIR DISKUS

ADVAIR HFA

ADVANCED AM/PM

ADVICOR

ADYNOVATE

AEROSPAN

AFEDITAB CR

AFREZZA

AGGRENOX

AGRYLIN

ALBUTEROL SULFATE

ALDACTAZIDE

ALDACTONE

ALENDRONATE SODIUM

ALFUZOSIN HCL ER

ALLOPURINOL

ALOGLIPTIN

ALOGLIPTIN-METFORMIN

ALOGLIPTIN-PIOGLITAZONE

ALORA

ALPHAGAN P

ALTACE

ALTAVERA

ALTOPREV

ALVESCO

ALYACEN

AMABELZ

AMARYL

AMETHIA

AMETHIA LO

AMETHYST

AMILORIDE HCL

AMILORIDE HCL W/HCTZ

AMIODARONE HCL

AMITIZA

AMLODIPINE BESYLATE

AMLODIPINE BESYLATE-BENAZEPRIL

AMLODIPINE-ATORVASTATIN

AMLODIPINE-OLMESARTAN

AMLODIPINE-VALSARTAN

AMLODIPINE-VALSARTAN-HCTZ

AMTURNIDE

ANAGRELIDE HYDROCHLORIDE

ANAPROX

ANAPROX DS

ANASTROZOLE

ANGELIQ

ANIMI-3

ANSAID

ANTARA

APIDRA

APIDRA SOLOSTAR

APLENZIN

APRI

APRISO

ARANELLE

ARAVA

ARCAPTA NEOHALER

ARICEPT

ARICEPT ODT

ARIMIDEX

ARMOUR THYROID

ARNUITY ELLIPTA

AROMASIN

ARTHROTEC

ASACOL HD

ASHLYNA

ASMANEX

ASMANEX HFA

ASPIRIN E.C.

ASPIRIN-DIPYRIDAMOLE ER

ATABEX EC

ATACAND

ATACAND HCT

ATELVIA

ATENOLOL

ATENOLOL W/CHLORTHALIDONE

ATORVASTATIN CALCIUM

ATROVENT

ATROVENT HFA

AUBRA

AVALIDE

AVANDAMET

AVANDARYL

AVANDIA

AVAPRO

AVIANE

AVODART

AV-VITE FB

AV-VITE FB FORTE

AYGESTIN

AZILECT

AZOPT

AZOR

AZULFIDINE

AZURETTE B BACLOFEN

BACMIN

BAL-CARE DHA

BAL-CARE DHA ESSENTIAL

BALZIVA

BASAGLAR KWIKPEN U-100

BECONASE AQ

BEKYREE

BENAZEPRIL HCL

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Maintenance Medication Drug List Drug Level_231267_Updated February 2017

BENAZEPRIL HCL-HCTZ

BENICAR

BENICAR HCT

BETAGAN

BETAPACE

BETAPACE AF

BETAXOLOL HCL

BETIMOL

BETOPTIC S

BEYAZ

BICALUTAMIDE

BIDIL

BIMATOPROST

BINOSTO

BISOPROLOL FUMARATE

BISOPROLOL FUMARATE/HCTZ

BLISOVI 24 FE

BLISOVI FE

BONIVA

BP VIT 3 PLUS

BREO ELLIPTA

BREVICON

BRIELLYN

BRILINTA

BRIMONIDINE TARTRATE

BRINTELLIX

BROMOCRIPTINE MESYLATE

BROVANA

BUDEPRION SR

BUDESONIDE

BUMETANIDE

BUPHENYL

BUPROPION HCL

BUPROPION HCL ER

BUPROPION HCL XL

BUPROPION SR

BUSPIRONE HCL

BYDUREON

BYDUREON PEN

BYETTA

BYSTOLIC

BYVALSON

C CABERGOLINE

CADEAU DHA

CADUET

CALAN

CALAN SR

CALCITONIN-SALMON

CALCITRIOL

CALCIUM PNV

CALCIUM-FOLIC ACID PLUS D

CAMILA

CAMRESE

CAMRESE LO

CANDESARTAN CILEXETIL

CANDESARTAN-HYDROCHLOROTHIAZID

CAPTOPRIL

CAPTOPRIL/HYDROCHLOROTHIAZIDE

CARAFATE

CARBIDOPA

CARBIDOPA/LEVODOPA

CARBIDOPA-LEVODOPA ER

CARBIDOPA-LEVODOPA-ENTACAPONE

CARDENE SR

CARDIZEM

CARDIZEM CD

CARDIZEM LA

CARDURA

CARDURA XL

CARNITOR

CARNITOR SF

CARTEOLOL HCL

CARTIA XT

CARVEDILOL

CASODEX

CATAFLAM

CATAPRES

CATAPRES-TTS

CAVAN-EC SOD DHA

CAVERJECT

CAZIANT

CELEBREX

CELECOXIB

CELEXA

CENESTIN

CEVIMELINE HCL

CHATEAL

CHLOROTHIAZIDE

CHLORPROPAMIDE

CHLORTHALIDONE

CHOICE-OB + DHA

CHOICE-TABS

CHOLESTYRAMINE

CHOLESTYRAMINE LIGHT

CHOLINE MAG TRISALICYLATE

CIALIS

CILOSTAZOL

CIMETIDINE

CITALOPRAM HBR

CITRANATAL 90 DHA

CITRANATAL ASSURE

CITRANATAL B-CALM

CITRANATAL DHA

CITRANATAL HARMONY

CITRANATAL RX

CLIMARA

CLIMARA PRO

CLINPRO 5000

CLONIDINE HCL

CLONIDINE HCL ER

CLOPIDOGREL

CLORPRES

C-NATE DHA

COLCHICINE

COLCRYS

COLESTID

COLESTIPOL HCL

COMBIGAN

COMBIPATCH

COMPLETE NATAL DHA

COMPLETENATE

COMTAN

CONCEPT DHA

CONCEPT OB

CONSTULOSE

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Maintenance Medication Drug List Drug Level_231267_Updated February 2017

CONTRAVE ER

CORDARONE

COREG

COREG CR

CORGARD

CORLANOR

CORVITA

CORVITE

CORZIDE

COSOPT

COSOPT PF

COZAAR

CRESTOR

CROMOLYN SODIUM

CRYSELLE

CUPRIMINE

CYANOCOBALAMIN

CYCLAFEM

CYCLESSA

CYCLOSET

CYMBALTA

CYRED

CYTOMEL

CYTOTEC D DALIRESP

DANTRIUM

DANTROLENE SODIUM

DARIFENACIN ER

DASETTA

DAYPRO

DAYSEE

DEBLITANE

DELYLA

DELZICOL

DEMADEX

DENTA 5000 PLUS

DENTAGEL

DEPEN

DEPO-PROVERA

DEPO-SUBQ PROVERA

DESMOPRESSIN ACETATE

DESOGEN

DESOGESTREL-ETHINYL ESTRADIOL

DESOGESTR-ETH ESTRAD ETH ESTRA

DESVENLAFAXINE ER

DESVENLAFAXINE FUMARATE ER

DETROL

DETROL LA

DEXILANT

DIABETA

DIALYVITE

DIALYVITE 800 WITH IRON

DIAMOX SEQUELS

DICLOFENAC POTASSIUM

DICLOFENAC SODIUM

DICLOFENAC SODIUM-MISOPROSTOL

DIFIL-G

DIFLUNISAL

DIGITEK

DIGOX

DIGOXIN

DILACOR XR

DILATRATE-SR

DILT-CD

DILTIAZEM 24HR CD

DILTIAZEM ER

DILTIAZEM HCL

DILT-XR

DILTZAC ER

DIOVAN

DIOVAN HCT

DIPENTUM

DIPYRIDAMOLE

DISALCID

DISOPYRAMIDE PHOSPHATE

DITROPAN XL

DIURIL

DIVIGEL

DONEPEZIL HCL

DORZOLAMIDE HCL

DORZOLAMIDE-TIMOLOL

DOTHELLE DHA

DOXAZOSIN MESYLATE

DOXERCALCIFEROL

DRISDOL

DROSPIRENONE-ETH ESTRA-LEVOMEF

DROSPIRENONE-ETHINYL ESTRADIOL

DUAVEE

DUET DHA

DUET DHA BALANCED

DUET DHA EC

DUETACT

DUEXIS

DULERA

DULOXETINE HCL

DURLAZA

DUTASTERIDE

DUTASTERIDE-TAMSULOSIN

DUTOPROL

DYAZIDE

DYRENIUM E EC-NAPROSYN

EDARBI

EDARBYCLOR

EDECRIN

EDEX

EFFER-K

EFFEXOR XR

EFFIENT

ELDEPRYL

ELDERCAPS

ELESTRIN

ELINEST

ELIQUIS

ELITE OB

ELITE-OB

ELITE-OB 400

ELIXOPHYLLIN

EMOQUETTE

ENABLEX

ENALAPRIL MALEATE

ENALAPRIL MALEATE/HCTZ

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Maintenance Medication Drug List Drug Level_231267_Updated February 2017

ENBRACE HR

ENJUVIA

ENPRESSE

ENSKYCE

ENTACAPONE

ENTRESTO

ENULOSE

EPANED

EPLERENONE

EPROSARTAN MESYLATE

ERGOCALCIFEROL

ERGOLOID MESYLATES

ERRIN

ESCAVITE

ESCAVITE D

ESCAVITE LQ

ESCITALOPRAM OXALATE

ESOMEPRAZOLE MAGNESIUM

ESOMEPRAZOLE STRONTIUM

ESTARYLLA

ESTRACE

ESTRADIOL

ESTRADIOL-NORETHINDRONE ACETAT

ESTRASORB

ESTRING

ESTROGEL

ESTROPIPATE

ESTROSTEP FE

ETHACRYNIC ACID

ETHYNODIOL-ETHINYL ESTRADIOL

ETIDRONATE DISODIUM

ETODOLAC

ETODOLAC ER

EVAMIST

EVISTA

EVOXAC

EXELON

EXEMESTANE

EXFORGE

EXFORGE HCT

EXTRA-VIRT PLUS DHA

EZETIMIBE

F FABB

FALMINA

FAMOTIDINE

FARESTON

FARXIGA

FASLODEX

FELDENE

FELODIPINE ER

FEMARA

FEMCON FE

FEMHRT

FEMRING

FEMYNOR

FENOFIBRATE

FENOFIBRIC ACID

FENOGLIDE

FENOPROFEN CALCIUM

FENORTHO

FETZIMA

FIBRICOR

FINASTERIDE

FLAVOXATE HCL

FLECAINIDE ACETATE

FLOMAX

FLONASE

FLORIVA

FLORIVA PLUS

FLOVENT DISKUS

FLOVENT HFA

FLUDROCORTISONE ACETATE

FLUNISOLIDE

FLUORABON

FLUOR-A-DAY

FLUORIDE

FLUORIDEX DAILY DEFENSE

FLUORIDEX SENSITIVITY RELIEF

FLUORITAB

FLUOXETINE DR

FLUOXETINE HCL

FLURA-DROPS

FLURBIPROFEN

FLUTAMIDE

FLUTICASONE PROPIONATE

FLUVASTATIN ER

FLUVASTATIN SODIUM

FLUVOXAMINE MALEATE

FOCALGIN 90 DHA

FOCALGIN CA

FOCALGIN-B

FOLBECAL

FOLBEE

FOLBEE PLUS

FOLBIC

FOLCAL DHA

FOLCAPS OMEGA-3

FOLET DHA

FOLET ONE

FOLGARD OS

FOLGARD RX

FOLIC ACID

FOLIC ACID-CYANCOBAL-PYRIDOXIN

FOLINATAL PLUS B

FOLIVANE-OB

FOLIVANE-PRX DHA NF

FOLPLEX 2.2

FORADIL

FORFIVO XL

FORTAMET

FORTAVIT

FORTICAL

FOSAMAX

FOSAMAX PLUS D

FOSINOPRIL SODIUM

FOSINOPRIL-HYDROCHLOROTHIAZIDE

FUROSEMIDE

FYAVOLV G GABAPENTIN

GABLOFEN

GALANTAMINE

GASTROCROM

GELNIQUE

Page 5: Maintenance Medication Drug List - Express Scripts...MYKIDZ IRON FL MYNATAL MYNATAL ADVANCE MYNATAL PLUS MYNATAL -Z MYNATE 90 PLUS MYNEPHROCAPS MYRBETRIQ MYZILRA N NABUMETONE NADOLOL

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Maintenance Medication Drug List Drug Level_231267_Updated February 2017

GEMFIBROZIL

GENERESS FE

GENERLAC

GESTICARE DHA

GIANVI

GILDAGIA

GILDESS

GILDESS 24 FE

GILDESS FE

GLIMEPIRIDE

GLIPIZIDE

GLIPIZIDE ER

GLIPIZIDE XL

GLIPIZIDE-METFORMIN

GLUCOPHAGE

GLUCOPHAGE XR

GLUCOTROL

GLUCOTROL XL

GLUCOVANCE

GLUMETZA

GLYBURIDE

GLYBURIDE MICRONIZED

GLYBURIDE-METFORMIN HCL

GLYCATE

GLYCOPYRROLATE

GLYNASE

GLYSET

GLYXAMBI

GUANFACINE HCL

GUANFACINE HCL ER H HEATHER

HECTOROL

HEMENATAL OB

HEMENATAL OB + DHA

HONEY BEE VENOM PROTEIN

HORIZANT

HUMALOG

HUMALOG MIX 50-50

HUMALOG MIX 75-25

HUMULIN 70/30 KWIKPEN

HUMULIN 70-30

HUMULIN N

HUMULIN N KWIKPEN

HUMULIN R

HUMULIN R U-500 KWIKPEN

HYDRALAZINE HCL

HYDROCHLOROTHIAZIDE

HYDROXYCHLOROQUINE SULFATE

HYZAAR I IBANDRONATE SODIUM

IBUPROFEN

IMDUR

INATAL ADVANCE

INATAL ULTRA

INCRUSE ELLIPTA

INDAPAMIDE

INDERAL LA

INDERAL XL

INDOCIN

INDOMETHACIN

INFANATE BALANCE

INFANATE PLUS

INNOPRAN XL

INSPRA

INTROVALE

INTUNIV

INVOKAMET

INVOKAMET XR

INVOKANA

IPRATROPIUM BROMIDE

IRBESARTAN

IRBESARTAN-HYDROCHLOROTHIAZIDE

IRENKA

ISOCHRON

ISOPTO CARBACHOL

ISOPTO CARPINE

ISORDIL

ISOSORBIDE DINITRATE

ISOSORBIDE MONONITRATE

ISOXSUPRINE HCL

ISRADIPINE

ISTALOL J JALYN

JANUMET

JANUMET XR

JANUVIA

JARDIANCE

JENCYCLA

JENTADUETO

JENTADUETO XR

JEVANTIQUE LO

JINTELI

JOLESSA

JOLIVETTE

JULEBER

JUNEL

JUNEL FE K K EFFERVESCENT

KAITLIB FE

KAPVAY

KARIVA

KAZANO

KELNOR 1-35

KETOPROFEN

KHEDEZLA

KIMIDESS

KLOR-CON

KLOR-CON M

KLOR-CON SPRINKLE

KLOR-CON-EF

KOMBIGLYZE XR

KOSHER PRENATAL PLUS IRON

KRISTALOSE

K-SOL

K-TAB KURVELO L LABETALOL HCL

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Maintenance Medication Drug List Drug Level_231267_Updated February 2017

LACTULOSE

LANOXIN

LANSOPRAZOLE

LANTUS

LANTUS SOLOSTAR

LARIN

LARIN FE

LARISSIA

LASIX

LATANOPROST

LAYOLIS FE

LEENA

LEFLUNOMIDE

LESCOL

LESCOL XL

LESSINA

LETROZOLE

LEVATOL

LEVEMIR

LEVEMIR FLEXTOUCH

LEVITRA

LEVOBUNOLOL HCL

LEVOCARNITINE

LEVOMEFOLATE DHA

LEVONEST

LEVONORGESTREL-ETH ESTRADIOL

LEVONORG-ETH ESTRAD ETH ESTRAD

LEVORA

LEVO-T

LEVOTHYROXINE SODIUM

LEVOXYL

LEXAPRO

LIALDA

LINZESS

LIORESAL

LIOTHYRONINE SODIUM

LIPITOR

LIPOFEN

LIPTRUZET

LISINOPRIL

LISINOPRIL-HCTZ

LIVALO

LO LOESTRIN FE

LO MINASTRIN FE

LODINE

LODOSYN

LOESTRIN

LOESTRIN FE

LOFIBRA

LOMEDIA 24 FE

LOPID

LOPREEZA

LOPRESSOR

LOPRESSOR HCT

LORYNA

LOSARTAN POTASSIUM

LOSARTAN-HYDROCHLOROTHIAZIDE

LOSEASONIQUE

LOTENSIN

LOTENSIN HCT

LOTREL

LOVASTATIN

LOVAZA

LOW-OGESTREL

LOZI-FLUR

LUDENT FLUORIDE

LUFYLLIN

LUMIGAN

LUTERA

LUVOX CR

LYZA M MACNATAL CN DHA

MACUVEX

MACUZIN

MARLISSA

MARNATAL-F

MATZIM LA

MAVIK

MAXINATE

MAXZIDE

MEBOLIC

MECLOFENAMATE SODIUM

MEDROXYPROGESTERONE ACETATE

MELOXICAM

MEMANTINE HCL

MENEST

MENOSTAR

MESALAMINE

METAPROTERENOL SULFATE

METFORMIN HCL

METFORMIN HCL ER

METHAZOLAMIDE

METHIMAZOLE

METHYCLOTHIAZIDE

METHYLDOPA

METHYLDOPA/HYDROCHLOROTHIAZIDE

METIPRANOLOL

METOLAZONE

METOPROLOL SUCCINATE

METOPROLOL SUCCINATE-HCTZ ER

METOPROLOL TARTRATE

METOPROLOL-HYDROCHLOROTHIAZIDE

MEVACOR

MEXILETINE HCL

MIACALCIN

MICARDIS

MICARDIS HCT

MICROGESTIN

MICROGESTIN 24 FE

MICROGESTIN FE

MICROZIDE

MIGLITOL

MIMVEY

MIMVEY LO

MINASTRIN 24 FE

MINIPRESS

MINITRAN

MINIVELLE

MINOXIDIL

MIRAPEX

MIRAPEX ER

MIRCETTE

MIRTAZAPINE

MISOPROSTOL

Page 7: Maintenance Medication Drug List - Express Scripts...MYKIDZ IRON FL MYNATAL MYNATAL ADVANCE MYNATAL PLUS MYNATAL -Z MYNATE 90 PLUS MYNEPHROCAPS MYRBETRIQ MYZILRA N NABUMETONE NADOLOL

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Maintenance Medication Drug List Drug Level_231267_Updated February 2017

MITIGARE

MIXED VESPID VENOM PROTEIN

MOBIC

MODICON

MOEXIPRIL HCL

MOEXIPRIL-HYDROCHLOROTHIAZIDE

MOMETASONE FUROATE

MONO-LINYAH

MONONESSA

MONTELUKAST SODIUM

MULTAQ

MULTICHEW

MULTIVITAMIN W/FLUORIDE & IRON

MULTIVITAMIN WITH FLUORIDE

MULTIVITAMINS

MULTIVITAMINS-A,B,D,E,K,ZN

MUSE

MVC-FLUORIDE

M-VIT

MYKIDZ IRON FL

MYNATAL

MYNATAL ADVANCE

MYNATAL PLUS

MYNATAL-Z

MYNATE 90 PLUS

MYNEPHROCAPS

MYRBETRIQ

MYZILRA N NABUMETONE

NADOLOL

NADOLOL-BENDROFLUMETHIAZIDE

NALFON

NAMENDA

NAMENDA XR

NAMZARIC

NAPRELAN

NAPROSYN

NAPROXEN

NAPROXEN SODIUM

NAPROXEN SODIUM DS

NAPROXEN SODIUM ER

NASACORT AQ

NASCOBAL

NASONEX

NATACHEW

NATAFORT

NATAL-V RX

NATALVIRT 90 DHA

NATALVIRT CA

NATALVIT

NATAZIA

NATEGLINIDE

NATELLE ONE

NATURE-THROID

NECON

NEEVO DHA

NEFAZODONE HCL

NEPHPLEX RX

NEPHROCAPS

NEPHRO-VITE RX

NEPTAZANE

NESINA

NESTABS

NESTABS ABC

NESTABS DHA

NEUPRO

NEURONTIN

NEWGEN

NEXA PLUS

NEXIUM RX

NIACIN ER

NIACOR

NIASPAN

NICARDIPINE HCL

NICOMIDE

NIFEDICAL XL

NIFEDIPINE

NIFEDIPINE ER

NIKKI

NILANDRON

NILUTAMIDE

NISOLDIPINE

NITRO-BID

NITRO-DUR

NITROGLYCERIN

NITRO-TIME

NIVA-FOL

NIVA-PLUS

NIZATIDINE

NORA-BE

NORETHINDRONE ACETATE

NORETHINDRONE-ETHIN ESTRADIOL

NORETHIN-ETH ESTRA FERROUS FUM

NORGESTIMATE-ETHINYL ESTRADIOL

NORGESTREL-ETHINY ESTRA

NORINYL

NORLYROC

NORPACE

NORPACE CR

NOR-Q-D

NORTREL

NORVASC

NOVOLIN 70-30

NOVOLIN N

NOVOLIN R

NOVOLOG

NOVOLOG FLEXPEN

NOVOLOG MIX 70-30

NP THYROID

NUTRICAP

NUVARING O OB COMPLETE

OB COMPLETE DHA

OB COMPLETE GOLD

OB COMPLETE ONE

OB COMPLETE PETITE

OB COMPLETE PREMIER

OBSTETRIX DHA

OBSTETRIX EC

OBSTETRIX ONE

OBTREX

OBTREX DHA

Page 8: Maintenance Medication Drug List - Express Scripts...MYKIDZ IRON FL MYNATAL MYNATAL ADVANCE MYNATAL PLUS MYNATAL -Z MYNATE 90 PLUS MYNEPHROCAPS MYRBETRIQ MYZILRA N NABUMETONE NADOLOL

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Maintenance Medication Drug List Drug Level_231267_Updated February 2017

O-CAL FA

O-CAL PRENATAL

OCELLA

OGESTREL

OLEPTRO ER

OLMESARTAN MEDOXOMIL

OLMESARTAN-AMLODIPINE-HCTZ

OLMESARTAN-HYDROCHLOROTHIAZIDE

OMEGA-3 ACID ETHYL ESTERS

OMEPRAZOLE

OMEPRAZOLE+SYRSPEND SF ALKA

OMEPRAZOLE-SODIUM BICARBONATE

OMNARIS

ONGLYZA

ORSYTHIA

ORTHO EVRA

ORTHO MICRONOR

ORTHO TRI-CYCLEN

ORTHO TRI-CYCLEN LO

ORTHO-CEPT

ORTHO-CYCLEN

ORTHO-NOVUM

OSENI

OTREXUP

OVCON

OXAPROZIN

OXYBUTYNIN CHLORIDE

OXYBUTYNIN CHLORIDE ER

OXYTROL P PACERONE

PAIRE OB PLUS DHA

PANTOPRAZOLE SODIUM

PAPAVERINE HCL

PARCOPA

PARICALCITOL

PARLODEL

PAROXETINE ER

PAROXETINE HCL

PAXIL

PAXIL CR

PENTASA

PENTOXIFYLLINE

PEPCID

PERFOROMIST

PERINDOPRIL ERBUMINE

PERSANTINE

PEXEVA

PHILITH

PHOSPHOLINE IODIDE

PILOCARPINE HCL

PIMTREA

PINDOLOL

PIOGLITAZONE HCL

PIOGLITAZONE-GLIMEPIRIDE

PIOGLITAZONE-METFORMIN

PIRMELLA

PIROXICAM

PLAQUENIL

PLAVIX

PLETAL

PNV 29-1

PNV FOLIC ACID + IRON

PNV OB+DHA

PNV-DHA

PNV-DHA + DOCUSATE

PNV-FERROUS FUMARATE-DOCU-FA

PNV-FIRST

PNV-OMEGA

PNV-SELECT

PNV-TOTAL

PNV-VP-U

POLY-VI-FLOR

POLY-VI-FLOR FS

POLY-VI-FLOR W/IRON

POLY-VITAMIN WITH FLUORIDE

PORTIA

POTABA

POTASSIUM BICARBONATE

POTASSIUM CHLORIDE

POTASSIUM CITRATE ER

PR NATAL 400

PR NATAL 400 EC

PR NATAL 430

PR NATAL 430 EC

PRADAXA

PRAMIPEXOLE DI-HCL

PRAMIPEXOLE ER

PRANDIMET

PRANDIN

PRAVACHOL

PRAVASTATIN SODIUM

PRAZOSIN HCL

PRECOSE

PREFERA-OB

PREFERA-OB ONE

PREFERA-OB PLUS DHA

PREFEST

PREFOL-DHA

PREMARIN

PREMPHASE

PREMPRO

PRENA1

PRENA1 CHEW

PRENA1 PEARL

PRENA1 PLUS

PRENA1 TRUE

PRENAISSANCE

PRENAISSANCE 90 DHA

PRENAISSANCE BALANCE

PRENAISSANCE DHA

PRENAISSANCE HARMONY DHA

PRENAISSANCE NEXT

PRENAISSANCE NEXT-B

PRENAISSANCE PLUS

PRENAISSANCE PROMISE

PRENAPLUS

PRENATA

PRENATABS FA

PRENATABS RX

PRENATAL 19

PRENATAL AD

PRENATAL LOW IRON

PRENATAL PLUS

PRENATAL PLUS-DHA

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Maintenance Medication Drug List Drug Level_231267_Updated February 2017

PRENATAL VITAMIN PLUS LOW IRON

PRENATAL-U

PRENATE

PRENATE AM

PRENATE DHA

PRENATE ELITE

PRENATE ENHANCE

PRENATE ESSENTIAL

PRENATE MINI

PRENATE PIXIE

PRENATE RESTORE

PRENATE STAR

PREPLUS

PREQUE 10

PRESTALIA

PRETAB

PREVACID RX

PREVALITE

PREVIDENT

PREVIDENT 5000 ENAMEL PROTECT

PREVIDENT 5000 SENSITIVE

PREVIFEM

PRILOSEC RX

PRIMACARE

PRINIVIL

PRISTIQ

PROBENECID

PROBENECID W/COLCHICINE

PROCARDIA

PROCARDIA XL

PROGESTERONE

PROGLYCEM

PROMETRIUM

PROPAFENONE HCL

PROPECIA

PROPRANOLOL HCL

PROPRANOLOL HCL ER

PROPRANOLOL HCL-HCTZ

PROPYLTHIOURACIL

PROSCAR

PROTECT IRON

PROTONIX

PROVERA

PROVIDA DHA

PROVIDA OB

PROZAC

PROZAC WEEKLY

PULMICORT

PULMICORT FLEXHALER

PUREFE OB PLUS

PUREFE PLUS Q QBRELIS

QNASL

QUARTETTE

QUASENSE

QUESTRAN

QUESTRAN LIGHT

QUFLORA

QUFLORA FE

QUINAPRIL

QUINAPRIL-HYDROCHLOROTHIAZIDE

QUINIDINE GLUCONATE

QUINIDINE SULFATE

QVAR R RABEPRAZOLE SODIUM

RAJANI

RALOXIFENE HCL

RAMIPRIL

RANEXA

RANITIDINE HCL

RAPAFLO

RASAGILINE MESYLATE

RASUVO

RAYALDEE

RAZADYNE

RAZADYNE ER

RECLIPSEN

RELNATE DHA

REMERON

RENAL CAPS

RENA-VITE RX

RENO CAPS

REPAGLINIDE

REPAGLINIDE-METFORMIN HCL

REQ49+

REQUIP

REQUIP XL

RESCULA

RESERPINE

RESTASIS

RESTASIS MULTIDOSE

RHINOCORT AQUA

RIDAURA

RIOMET

RISEDRONATE SODIUM

RISEDRONATE SODIUM DR

RIVASTIGMINE

R-NATAL OB

ROBINUL

ROBINUL FORTE

ROCALTROL

ROPINIROLE HCL

ROSUVASTATIN CALCIUM

RULAVITE DHA

RYTARY

RYTHMOL

RYTHMOL SR S SAFYRAL

SALAGEN

SALSALATE

SANCTURA

SANCTURA XR

SARAFEM

SAVAYSA

SAVELLA

SAXENDA

SEASONIQUE

SECTRAL

SEEBRI NEOHALER

SELECT-OB

SELECT-OB + DHA

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Maintenance Medication Drug List Drug Level_231267_Updated February 2017

SELEGILINE HCL

SE-NATAL 19

SEREVENT DISKUS

SERTRALINE HCL

SE-TAN DHA

SETLAKIN

SETONET

SETONET-EC

SF

SF 5000 PLUS

SHAROBEL

SIMBRINZA

SIMCOR

SIMVASTATIN

SINEMET

SINEMET CR

SINGULAIR

SODIUM FLUORIDE

SODIUM PHENYLBUTYRATE

SOLIQUA 100-33

SOLTAMOX

SORINE

SOTALOL

SOTALOL AF

SOTYLIZE

SPIRIVA

SPIRIVA RESPIMAT

SPIRONOLACTONE

SPIRONOLACTONE W/HCTZ

SPRINTEC

SRONYX

STALEVO

STANNOUS FLUORIDE

STARLIX

STAXYN

STENDRA

STRATTERA

STRIVERDI RESPIMAT

STROVITE FORTE

STROVITE ONE

STROVITE PLUS

SUCRALFATE

SULAR

SULFASALAZINE

SULFASALAZINE DR

SULFAZINE

SULINDAC

SUPERVITE

SYEDA

SYMBICORT

SYMLINPEN 120

SYMLINPEN 60

SYNJARDY

SYNTHROID T TAMOXIFEN CITRATE

TAMSULOSIN HCL

TANZEUM

TAPAZOLE

TARINA FE

TARKA

TARON PRENATAL

TARON-BC

TARON-C DHA

TASMAR

TAYTULLA

TAZTIA XT

TEKAMLO

TEKTURNA

TEKTURNA HCT

TELMISARTAN

TELMISARTAN-AMLODIPINE

TELMISARTAN-HYDROCHLOROTHIAZID

TENEX

TENORETIC

TENORMIN

TERAZOSIN HCL

TERBUTALINE SULFATE

TEVETEN

TEVETEN HCT

TEXAVITE LQ

THEO-24

THEOCHRON

THEOPHYLLINE ANHYDROUS

THERAPEUTIC HEMATINIC

THRIVITE 19

THRIVITE RX

THYROLAR

TIAZAC

TICANASE

TICASPRAY

TICLOPIDINE HCL

TILIA FE

TIMOLOL MALEATE

TIMOPTIC

TIMOPTIC-XE

TIROSINT

TL FOLATE

TL GARD RX

TL G-FOL OS

TL-CARE DHA

TL-FLUORIVITE

TL-SELECT

TL-SELECT DHA

TOLAZAMIDE

TOLBUTAMIDE

TOLCAPONE

TOLMETIN SODIUM

TOLTERODINE TARTRATE

TOLTERODINE TARTRATE ER

TOPROL XL

TORSEMIDE

TOUJEO SOLOSTAR

TOVIAZ

TRADJENTA

TRANDATE

TRANDOLAPRIL

TRANDOLAPRIL-VERAPAMIL

TRAVATAN Z

TRAVOPROST

TRAZODONE HCL

TRESIBA FLEXTOUCH U-100

TRESIBA FLEXTOUCH U-200

TRIADVANCE

TRIAMCINOLONE ACETONIDE

Page 11: Maintenance Medication Drug List - Express Scripts...MYKIDZ IRON FL MYNATAL MYNATAL ADVANCE MYNATAL PLUS MYNATAL -Z MYNATE 90 PLUS MYNEPHROCAPS MYRBETRIQ MYZILRA N NABUMETONE NADOLOL

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TRIAMTERENE W/HCTZ

TRIBENZOR

TRICARE

TRICARE PRENATAL

TRICARE PRENATAL COMPLEAT

TRICARE PRENATAL DHA ONE

TRICARE PRENATAL WITH DHA

TRICOR

TRI-ESTARYLLA

TRIFERIC

TRIGLIDE

TRI-LEGEST FE

TRI-LINYAH

TRILIPIX

TRI-LO-ESTARYLLA

TRI-LO-MARZIA

TRI-LO-SPRINTEC

TRINATAL GT

TRINATAL RX 1

TRINATAL ULTRA

TRINATE

TRINESSA

TRINESSA LO

TRI-NORINYL

TRINTELLIX

TRIPHROCAPS

TRIPLE-VITAMIN W-FLUORIDE

TRI-PREVIFEM

TRI-SPRINTEC

TRISTART DHA

TRI-TABS DHA

TRIVEEN-DUO DHA

TRIVEEN-ONE

TRIVEEN-PRX RNF

TRI-VI-FLOR

TRI-VI-FLORO

TRI-VITAMIN WITH FLUORIDE

TRI-VITAMIN WITH IRON-FLUORIDE

TRIVORA

TROSPIUM CHLORIDE

TRULANCE

TRULICITY

TRUSOPT

TRUST NATAL DHA

TUDORZA PRESSAIR

TWYNSTA U UDAMIN SP

ULORIC

ULTIMATE OB DHA

ULTIMATECARE ONE

ULTIMATECARE ONE NF

UNIRETIC

UNITHROID

UNIVASC

UROCIT-K

UROXATRAL

URSO

URSO FORTE

URSODIOL V VAGIFEM

VALSARTAN

VALSARTAN-HYDROCHLOROTHIAZIDE

VASCEPA

VASERETIC

VASOTEC

V-C FORTE

VELIVET

VEMAVITE-PRX 2

VENA-BAL DHA

VENATAL-FA

VENLAFAXINE HCL

VENLAFAXINE HCL ER

VENLAFAXINE HCL ER BRAND

VERAMYST

VERAPAMIL ER

VERAPAMIL ER PM

VERAPAMIL HCL

VERELAN

VERELAN PM

VESICARE

VESTURA

VIAGRA

VI-C FORTE

VICTOZA

VIENVA

VIIBRYD

VIMOVO

VINACAL

VINATE

VINATE DHA

VINATE DHA RF

VINATE GT

VINATE II

VINATE ONE

VINATE ULTRA

VINATE-M

VIORELE

VIRT NATE

VIRT-ADVANCE

VIRT-BAL DHA

VIRT-BAL DHA PLUS

VIRT-C DHA

VIRT-CAPS

VIRT-CARE ONE

VIRT-GARD

VIRT-NATE DHA

VIRT-PN

VIRT-PN DHA

VIRT-PN PLUS

VIRTPREX

VIRT-SELECT

VIRT-VITE

VIRT-VITE FORTE

VIRT-VITE GT

VIT 3

VITAFOL

VITAFOL FE+

VITAFOL NANO

VITAFOL ULTRA

VITAFOL-OB

VITAFOL-OB+DHA

VITAFOL-ONE

VITAFOL-PN

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VITAMAX

VITAMED MD ONE RX

VITAMED MD PLUS RX

VITAMEDMD REDICHEW RX

VITAMIN D2

VITAMINS A,C,D & FLUORIDE

VITAPEARL

VITATRUE

VIVA DHA

VIVELLE- DOT

VIVLODEX

VOL-CARE RX

VOL-NATE

VOL-PLUS

VOL-TAB RX

VOLTAREN-XR

VOSPIRE ER

VP CH ULTRA

VP-CH PLUS

VP-CH-PNV

VP-ERA OB PLUS

VP-GGR-B6

VP-HEME OB

VP-HEME OB + DHA

VP-HEME ONE

VP-PNV-DHA

VP-VITE RX

VYFEMLA

VYTORIN W WASP VENOM PROTEIN

WELCHOL

WELLBUTRIN

WELLBUTRIN SR

WELLBUTRIN XL

WERA

WESTHROID

WHITE FACED HORNET VENOM

WP THYROID

WYMZYA FE

X XALATAN

XARELTO

XENICAL

XIFAXAN

XIGDUO XR

XIIDRA

XULANE

XYZBAC Y YASMIN

YAZ

YELLOW HORNET VENOM PROTEIN

YELLOW JACKET VENOM PROTEIN

YOSPRALA

YUVAFEM Z ZAFIRLUKAST

ZANTAC RX

ZARAH

ZAROXOLYN

ZATEAN-CH

ZATEAN-PN

ZATEAN-PN DHA

ZATEAN-PN PLUS

ZEBETA

ZEGERID RX

ZELAPAR

ZEMPLAR

ZENCHENT

ZENCHENT FE

ZEOSA

ZESTORETIC

ZESTRIL

ZETIA

ZETONNA

ZIAC

ZINBRYTA

ZINGIBER

ZIOPTAN

ZOCOR

ZOLOFT

ZONTIVITY

ZORVOLEX

ZOVIA

ZURAMPIC

ZYFLO

ZYFLO CR

ZYLOPRIM


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