Drug Lookup Tool

List of Drugs That Require Prior Authorization

PDF Download: List of Drugs That Require Prior Authorization
Submit Drug PAs Online: Express Path
Drug Name Generic Name PA Program Disease State Submit PA or Call
Abraxane Paclitaxel Protein-Bound Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Abstral fentanyl transmucosal drug Pharmacy PA Pain For Real-Time Response, Submit PA
OR Call (800) 753-2851
Actemra Tocilizumab Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Acthar Gel Repository Corticotropin Injection Medical Management/PA Metabolic, Immune Disorders or Inherited Rare Disease For Real-Time Response, Submit PA
OR Call (866) 877-7042
Actimmune Interferon Gamma-1b,Recomb. Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Actiq fentanyl transmucosal drug Pharmacy PA Pain For Real-Time Response, Submit PA
OR Call (800) 753-2851
Adcetris Brentuximab Vedotin Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Adcirca Tadalafil Pharmacy PA Pulmonary Hypertension For Real-Time Response, Submit PA
OR Call (800) 753-2851
Adempas Riociguat Pharmacy PA Pulmonary Hypertension For Real-Time Response, Submit PA
OR Call (800) 753-2851
Adrucil Fluorouracil Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Advair Diskus Fluticasone Propionate and Salmeterol Pharmacy PA Asthma/COPD For Real-Time Response, Submit PA
OR Call (800) 753-2851
Advair HFA Fluticasone Propionate and Salmeterol Pharmacy PA Asthma/COPD For Real-Time Response, Submit PA
OR Call (800) 753-2851
Advate Antihemoph.FVIII, Full Length UHA Internal Clinical PA Hemophilia
Adynovate Antihemophilic Factor VIII UHA Internal Clinical PA Hemophilia
Afinitor (o) Everolimus Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Afstyla antihem.fviii,sin-chn,b-dm tru UHA Internal Clinical PA Hemophilia
Aimovig erenumab Pharmacy PA Migraine Headaches For Real-Time Response, Submit PA
OR Call (800) 753-2851
Ajovy fremanezumab-vfrm Pharmacy PA Migraine Headaches For Real-Time Response, Submit PA
OR Call (800) 753-2851
Alecensa (o) Alectinib Hydrochloride Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Alimta Pemetrexed Disodium Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Alkeran Melphalan HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Alphanate Antihemophilic Factor/vWF UHA Internal Clinical PA Hemophilia
AlphaNine SD Factor IX UHA Internal Clinical PA Hemophilia
Alprolix Factor IX Rec, Fc Fusion Protn UHA Internal Clinical PA Hemophilia
Alunbrig Brigatinib Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Amifostine Amifostine Crystalline Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Ampyra Dalfampridine Pharmacy PA Multiple Sclerosis For Real-Time Response, Submit PA
OR Call (800) 753-2851
Androderm topical testosterone Pharmacy PA Endocrine Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
AndroGel topical testosterone Pharmacy PA Endocrine Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
Aralast NP Alpha-1-Proteinase Inhibitor Medical Management/PA Alpha 1 Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Aranesp Darbepoetin Alfa In Polysorbat Medical Management/PA Blood Cell Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Arcalyst Rilonacept Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Arranon Nelarabine Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Arzerra Ofatumumab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Atralin topical tretinoin products Pharmacy PA Skin Conditions For Real-Time Response, Submit PA
OR Call (800) 753-2851
Aubagio Teriflunomide Pharmacy PA Multiple Sclerosis For Real-Time Response, Submit PA
OR Call (800) 753-2851
Austedo Deutetrabenazine Pharmacy PA Huntington's Disease For Real-Time Response, Submit PA
OR Call (800) 753-2851
Avastin Bevacizumab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Aveed injectable testosterone Medical Management/PA Endocrine Disorders For Real-Time Response, Submit PA
OR Call (866) 877-7042
Avinza class II narcotic Pharmacy PA Pain For Real-Time Response, Submit PA
OR Call (800) 753-2851
Avita topical tretinoin products Pharmacy PA Skin Conditions For Real-Time Response, Submit PA
OR Call (800) 753-2851
Avonex Interferon Beta-1a Medical Management/PA Multiple Sclerosis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Axiron topical testosterone Pharmacy PA Endocrine Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
Azacitidine Azacitidine Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Azedra Iobenguane I 131 Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Bavencio avelumab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Bebulin Factor IX Cplx(Pcc)#6, 3factor UHA Internal Clinical PA Hemophilia
Beleodaq Belinostat Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Bendeka Bendamustine HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
BeneFIX Factor IX Human Recombinant UHA Internal Clinical PA Hemophilia
Benlysta IV Belimumab Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Benlysta SC Belimumab Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Berinert C1 Esterase Inhibitor Medical Management/PA Hereditary Angioedema For Real-Time Response, Submit PA
OR Call (866) 877-7042
Besponsa inotuzumab ozogamicin Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Betaseron Interferon Beta-1b Medical Management/PA Multiple Sclerosis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Bicnu Carmustine Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Bivigam Immun Glob G (IgG)/Gly/IgA 50+ Medical Management/PA Immune Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Bleomycin Sulfate Bleomycin Sulfate Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Blincyto Blinatumomab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Boniva Ibandronate Sodium Medical Management/PA Osteoporosis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Bosulif (o) Bosutinib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Botox Onabotulinumtoxina Medical Management/PA Neuromuscular Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Braftovi encorafenib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Breo Ellipta Fluticasone and Vilanterol Pharmacy PA Asthma/COPD For Real-Time Response, Submit PA
OR Call (800) 753-2851
Brineura Cerliponase alfa Medical Management/PA Enzyme Deficiencies For Real-Time Response, Submit PA
OR Call (866) 877-7042
Bunavail Buprenorphine HCl/Naloxone HCl Pharmacy PA Chemical Dependence For Real-Time Response, Submit PA
OR Call (800) 753-2851
Buprenorphine-Naloxone Buprenorphine HCl/Naloxone HCl Pharmacy PA Chemical Dependence For Real-Time Response, Submit PA
OR Call (800) 753-2851
Busulfex Busulfan Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Bydureon GLP-1 agonist Pharmacy PA Diabetes For Real-Time Response, Submit PA
OR Call (800) 753-2851
Byetta GLP-1 agonist Pharmacy PA Diabetes For Real-Time Response, Submit PA
OR Call (800) 753-2851
Cabometyx Cabozantinib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Calcium Folinate Leucovorin Calcium Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Calquence Acalabrutinib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Camptosar Irinotecan HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Capecitabine Capecitabine Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Caprelsa Vandetanib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Carboplatin Carboplatin Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Carimune NF Immun Glob G(IgG)/Sucr/IgA 50+ Medical Management/PA Immune Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Chemet Succimer Pharmacy PA Chelating Agents For Real-Time Response, Submit PA
OR Call (800) 753-2851
Chenodal chenodiol Pharmacy PA Gallstones For Real-Time Response, Submit PA
OR Call (800) 753-2851
Cholbam Cholic Acid Pharmacy PA Gi Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
Cimzia Certolizumab Pegol Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Cinqair reslizumab Pharmacy PA Respiratory Conditions For Real-Time Response, Submit PA
OR Call (800) 753-2851
Cinryze C1 Esterase Inhibitor Medical Management/PA Hereditary Angioedema For Real-Time Response, Submit PA
OR Call (866) 877-7042
Cisplatin Cisplatin Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Cladribine Cladribine Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Clindamycin/Tretinoin Gel Clindamycin and Tretinoin Pharmacy PA Skin Conditions For Real-Time Response, Submit PA
OR Call (800) 753-2851
Clolar Clofarabine Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Cometriq Cabozantinib S-Malate Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Copaxone Glatiramer Acetate Medical Management/PA Multiple Sclerosis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Copegus, Rebetol, Ribasphere Ribavirin Pharmacy PA Hepatitis C For Real-Time Response, Submit PA
OR Call (800) 753-2851
Copiktra Duvelisib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Corifact Factor XIII UHA Internal Clinical PA Hemophilia
Corlanor ivabradine Pharmacy PA Heart Failure For Real-Time Response, Submit PA
OR Call (800) 753-2851
Cosentyx Secukinumab Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Cosmegen Dactinomycin Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Cotellic Cobimetinib Fumarate Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Crysvita burosumab Medical Management/PA X Linked Hypophosphatemia For Real-Time Response, Submit PA
OR Call (866) 877-7042
Cuvitru Immune Globulin Medical Management/PA Immune Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Cyclophosphamide Cyclophosphamide Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Cyramza Ramucirumab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Cytarabine Cytarabine Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Dacarbazine Dacarbazine Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Dacogen Decitabine Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Daklinza daclatasvir Pharmacy PA Hepatitis C For Real-Time Response, Submit PA
OR Call (800) 753-2851
Daliresp roflumilast Pharmacy PA Respiratory Conditions For Real-Time Response, Submit PA
OR Call (800) 753-2851
Daraprim Pyrimethamine Pharmacy PA Toxoplasmosis For Real-Time Response, Submit PA
OR Call (800) 753-2851
Darzalex Daratumumab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Daunorubicin HCl Daunorubicin HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
DDAVP Desmopressin Acetate UHA Internal Clinical PA Hemophilia
Decitabine Decitabine Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Delatestryl injectable testosterone Medical Management/PA Endocrine Disorders For Real-Time Response, Submit PA
OR Call (866) 877-7042
Depo - Testosterone injectable testosterone Medical Management/PA Endocrine Disorders For Real-Time Response, Submit PA
OR Call (866) 877-7042
Depocyt Cytarabine Liposome/PF Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Desmopressin Acetate Desmopressin Acetate UHA Internal Clinical PA Hemophilia
Dexrazoxane Dexrazoxane HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Diclegis Doxylamine Succinate Pharmacy PA Nausea/Vomiting For Real-Time Response, Submit PA
OR Call (800) 753-2851
Docefrez Docetaxel Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Docetaxel Docetaxel Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Doptelet avatrombopag Pharmacy PA Thrombocytopenia For Real-Time Response, Submit PA
OR Call (800) 753-2851
Doxil Doxorubicin HCl Peg-Liposomal Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Doxorubicin HCl Doxorubicin HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Dulera Formoterol and Mometasone Pharmacy PA Asthma/COPD For Real-Time Response, Submit PA
OR Call (800) 753-2851
Dupixent Dupilumab Medical Management/PA Atopic Dermatitis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Durolane hyaluronate sodium, stabilized Medical Management/PA Osteoarthritis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Dysport Abobotulinumtoxina Medical Management/PA Neuromuscular Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Egrifta Tesamorelin Acetate Medical Management/PA Endocrine Disorders For Real-Time Response, Submit PA
OR Call (866) 877-7042
Eligard Leuprolide Acetate Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Eliquis Apixaban Pharmacy PA Cardiovascular Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
Elitek Rasburicase Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Ellence Epirubicin HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Eloctate Antihemoph.FVIII Rec, Fc Fusion UHA Internal Clinical PA Hemophilia
Emflaza Deflazacort Pharmacy PA Duchenne Muscular Dystrophy For Real-Time Response, Submit PA
OR Call (800) 753-2851
Emgality galcanezumab-gnlm Pharmacy PA Migraine Headaches For Real-Time Response, Submit PA
OR Call (800) 753-2851
Empliciti Elotuzumab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Enbrel Etanercept Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Endari L-glutamine oral powder Pharmacy PA Sickle Cell Disease For Real-Time Response, Submit PA
OR Call (800) 753-2851
Entresto sacubitril/valsartan Pharmacy PA Heart Failure For Real-Time Response, Submit PA
OR Call (800) 753-2851
Entyvio Vedolizumab Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Epclusa Sofosubuvir/velpatasvir Pharmacy PA Hepatitis C For Real-Time Response, Submit PA
OR Call (800) 753-2851
Epidiolex Cannabidiol oral solution Pharmacy PA Seizures For Real-Time Response, Submit PA
OR Call (800) 753-2851
Epirubicin HCl Epirubicin HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Epogen Epoetin Alfa Medical Management/PA Blood Cell Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Epoprostenol Sodium Epoprostenol Sodium (Glycine) Medical Management/PA Pulmonary Hypertension For Real-Time Response, Submit PA
OR Call (866) 877-7042
Erbitux Cetuximab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Erivedge Vismodegib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Erleada apalutamide Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Erwinaze Asparaginase (Erwinia Chrysan) Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Esbriet Pirfenidone Pharmacy PA Idiopathic Pulmonary Fibrosis For Real-Time Response, Submit PA
OR Call (800) 753-2851
Etopophos Etoposide Phosphate Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Etoposide Etoposide Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Euflexxa Hyaluronate Sodium Medical Management/PA Osteoarthritis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Exalgo class II narcotic Pharmacy PA Pain For Real-Time Response, Submit PA
OR Call (800) 753-2851
Exjade Deferasirox Pharmacy PA Iron Chelator For Real-Time Response, Submit PA
OR Call (800) 753-2851
Exondys 51 Eteplirsen Medical Management/PA Duchenne Muscular Dystrophy For Real-Time Response, Submit PA
OR Call (866) 877-7042
Extavia Interferon Beta-1b Medical Management/PA Multiple Sclerosis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Eylea Aflibercept Medical Management/PA Ophthalmic Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Fabior topical tazarotene products Pharmacy PA Skin Conditions For Real-Time Response, Submit PA
OR Call (800) 753-2851
Farydak Panobinostat Lactate Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Fasenra Benralizumab Medical Management/PA Asthma For Real-Time Response, Submit PA
OR Call (866) 877-7042
Faslodex Fulvestrant Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Feiba NF Anti-Inhibitor Coagulant Comp. UHA Internal Clinical PA Hemophilia
Fentora fentanyl transmucosal drug Pharmacy PA Pain For Real-Time Response, Submit PA
OR Call (800) 753-2851
Ferriprox Deferiprone Pharmacy PA Iron Chelator For Real-Time Response, Submit PA
OR Call (800) 753-2851
Firazyr Icatibant Acetate Medical Management/PA Hereditary Angioedema For Real-Time Response, Submit PA
OR Call (866) 877-7042
Firmagon Degarelix Acetate Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
First Testosterone topical testosterone Pharmacy PA Endocrine Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
Flebogamma DIF Immun Glob G(IgG)/Sorb/IgA 50+ Medical Management/PA Immune Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Flolan Epoprostenol Sodium (Glycine) Medical Management/PA Pulmonary Hypertension For Real-Time Response, Submit PA
OR Call (866) 877-7042
Floxuridine Floxuridine Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Fludarabine Phosphate Fludarabine Phosphate Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Fluorouracil Fluorouracil Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Folotyn Pralatrexate Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Fortesta topical testosterone Pharmacy PA Endocrine Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
Fulphila Pegfilgrastim-jmdb Medical Management/PA Blood Cell Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Fusilev Levoleucovorin Calcium Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Galafold Migalastat Pharmacy PA Fabry Disease For Real-Time Response, Submit PA
OR Call (800) 753-2851
Gammagard Liquid Immun Glob G/Gly/Gluc/IgA 0-50 Medical Management/PA Immune Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Gammagard S/D Immun Glob G/Gly/Gluc/IgA 0-50 Medical Management/PA Immune Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Gammaked Immun Glob G (IgG)/Gly/IgA 50+ Medical Management/PA Immune Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Gammaplex Immun Glob G/Sorb/Gly/IgA 0-50 Medical Management/PA Immune Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Gamunex-C Immun Glob G (IgG)/Gly/IgA 50+ Medical Management/PA Immune Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Gazyva Obinutuzumab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Gel-One Hyaluronate Sod, Cross-Linked Medical Management/PA Osteoarthritis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Gelsyn-3 Hyaluronic Acid 0.8% Medical Management/PA Osteoarthritis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Gemcitabine HCl Gemcitabine HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Gemzar Gemcitabine HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Genotropin Somatropin Medical Management/PA Growth Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
GenVisc 850 Hyaluronate Sodium Medical Management/PA Osteoarthritis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Gilenya Fingolimod HCl Pharmacy PA Multiple Sclerosis For Real-Time Response, Submit PA
OR Call (800) 753-2851
Gilotrif (o) Afatinib Dimaleate Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Glassia Alpha-1-Proteinase Inhibitor Medical Management/PA Alpha 1 Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Glatopa Glatiramer Acetate Medical Management/PA Multiple Sclerosis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Gleevec (o) Imatinib Mesylate Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Gocovri XR Amantadine ER Pharmacy PA Parkinson's Disease For Real-Time Response, Submit PA
OR Call (800) 753-2851
Granix Tbo-Filgrastim Medical Management/PA Blood Cell Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Grastek Grass Pollen-Timothy, Standard Pharmacy PA Allergies For Real-Time Response, Submit PA
OR Call (800) 753-2851
Haegarda C1 Esterase Inhibitor Medical Management/PA Hereditary Angioedema For Real-Time Response, Submit PA
OR Call (866) 877-7042
Halaven Eribulin Mesylate Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Harvoni Ledipasvir/Sofosbuvir Pharmacy PA Hepatitis C For Real-Time Response, Submit PA
OR Call (800) 753-2851
Helixate FS Antihemoph.FVIII, Full Length UHA Internal Clinical PA Hemophilia
Hemlibra Emicizumab UHA Internal Clinical PA Hemophilia
Hemofil M Antihemophilic Factor, Human UHA Internal Clinical PA Hemophilia
Herceptin Trastuzumab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Hetlioz tasimelteon Pharmacy PA Sleep Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
Hizentra Immun Glob G(IgG)/Pro/IgA 0-50 Medical Management/PA Immune Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
HP Acthar Corticotropin Medical Management/PA CNS/Autonomic Disorders For Real-Time Response, Submit PA
OR Call (866) 877-7042
Humate-P Antihemophilic Factor/vWF UHA Internal Clinical PA Hemophilia
Humatrope Somatropin Medical Management/PA Growth Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Humira Adalimumab Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Hyalgan Hyaluronate Sodium Medical Management/PA Osteoarthritis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Hycamtin Topotecan HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Hymovis Hyaluronic Acid injection Medical Management/PA Osteoarthritis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Ibrance (o) Palbociclib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Iclusig Ponatinib Hcl Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Idamycin PFS Idarubicin HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Idarubicin HCl Idarubicin HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Idelvion factor ix recom,albumin fusion UHA Internal Clinical PA Hemophilia
Idhifa enasidenib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Ifex Ifosfamide Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Ifosfamide Ifosfamide Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Ilaris Canakinumab Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Ilumya tildrakizumab Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
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Imatinib Mesylate Imatinib Mesylate Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Imbruvica Ibrutinib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Imfinzi durvalumab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Imlygic Talimogene Laherparepvec Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Increlex Mecasermin Medical Management/PA Growth Deficiency For Real-Time Response, Submit PA
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Inflectra Infliximab-dyyb Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
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Ingrezza Valbenazine Pharmacy PA Mental/Neuro Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
Inlyta Axitinib Pharmacy PA Cancer For Real-Time Response, Submit PA
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Intron A Interferon Alfa-2b, Recomb. Medical Management/PA Cancer For Real-Time Response, Submit PA
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OR Call (800) 753-2851
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Istodax Romidepsin Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Ixempra Ixabepilone Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Ixinity Factor IX Human Recomb, Thr 148 UHA Internal Clinical PA Hemophilia
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Jadenu Sprinkles Deferasirox Pharmacy PA Iron Chelator For Real-Time Response, Submit PA
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Jakafi Ruxolitinib Phosphate Pharmacy PA Cancer For Real-Time Response, Submit PA
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Jevtana Cabazitaxel Medical Management/PA Cancer For Real-Time Response, Submit PA
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Jynarque tolvaptan Pharmacy PA Kidney Disease For Real-Time Response, Submit PA
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Kadcyla Ado-Trastuzumab Emtansine Medical Management/PA Cancer For Real-Time Response, Submit PA
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Kalydeco Ivacaftor Pharmacy PA Cystic Fibrosis For Real-Time Response, Submit PA
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Kcentra Hum Prothrombin Cplx(Pcc)4fact UHA Internal Clinical PA Hemophilia
Kepivance Palifermin Medical Management/PA Cancer For Real-Time Response, Submit PA
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Keveyis dichlorphenamide Pharmacy PA Electrolyte Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
Kevzara Sarilumab Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
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Keytruda Pembrolizumab Medical Management/PA Cancer For Real-Time Response, Submit PA
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Kineret Anakinra Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
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Kisqali Ribociclib Pharmacy PA Cancer For Real-Time Response, Submit PA
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Koate-DVI Antihemophilic Factor, Human UHA Internal Clinical PA Hemophilia
Kogenate FS Antihemoph.FVIII, Full Length UHA Internal Clinical PA Hemophilia
Korlym Mifepristone Pharmacy PA Endocrine Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
Kovaltry antihemoph.fviii,full length UHA Internal Clinical PA Hemophilia
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Kuvan Sapropterin Dihydrochloride Pharmacy PA Endocrine Disorders For Real-Time Response, Submit PA
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Kyprolis Carfilzomib Medical Management/PA Cancer For Real-Time Response, Submit PA
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latanoprost ophthalmic prostaglandin Pharmacy PA Ophthalmic Conditions For Real-Time Response, Submit PA
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Lazanda fentanyl transmucosal drug Pharmacy PA Pain For Real-Time Response, Submit PA
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Lemtrada Alemtuzumab Medical Management/PA Multiple Sclerosis For Real-Time Response, Submit PA
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Lenvima Lenvatinib Mesylate Pharmacy PA Cancer For Real-Time Response, Submit PA
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Letairis Ambrisentan Pharmacy PA Pulmonary Hypertension For Real-Time Response, Submit PA
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Leukine Sargramostim Medical Management/PA Blood Cell Deficiency For Real-Time Response, Submit PA
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OR Call (866) 877-7042
Lonsurf Trifluridine/Tipiracil Hcl Pharmacy PA Cancer For Real-Time Response, Submit PA
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Lovaza omega- 3 fatty acids Pharmacy PA High Blood Cholesterol For Real-Time Response, Submit PA
OR Call (800) 753-2851
Lucemyra Lofexidine Pharmacy PA Opioid Withdrawal For Real-Time Response, Submit PA
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Lucentis Ranibizumab Medical Management/PA Ophthalmic Conditions For Real-Time Response, Submit PA
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Lumigan ophthalmic prostaglandin Pharmacy PA Ophthalmic Conditions For Real-Time Response, Submit PA
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Lupron Depot Leuprolide Acetate Medical Management/PA Endocrine Disorders For Real-Time Response, Submit PA
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Lupron Depot-Ped Leuprolide Acetate Medical Management/PA Endocrine Disorders For Real-Time Response, Submit PA
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Lynparza Olaparib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
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OR Call (866) 877-7042
Makena Hydroxyprogesterone Caproate Medical Management/PA Hormonal Supplementation For Real-Time Response, Submit PA
OR Call (866) 877-7042
Marqibo Vincristine Sulfate Liposomal Medical Management/PA Cancer For Real-Time Response, Submit PA
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Mekinist Trametinib Dimethyl Sulfoxide Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Mektovi binimetinib Pharmacy PA Cancer For Real-Time Response, Submit PA
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Melphalan HCl Melphalan HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
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Mesna Mesna Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Mesnex Mesna Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Methadone class II narcotic Pharmacy PA Pain For Real-Time Response, Submit PA
OR Call (800) 753-2851
Methotrexate Methotrexate Sodium Medical Management/PA Cancer For Real-Time Response, Submit PA
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Mircera Methoxy Peg-Epoetin Beta Medical Management/PA Blood Cell Deficiency For Real-Time Response, Submit PA
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Mirvaso Topical Gel Brimonidine Pharmacy PA Skin Conditions For Real-Time Response, Submit PA
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Monoclate-P Antihemophilic Factor, Human UHA Internal Clinical PA Hemophilia
Mononine Factor IX UHA Internal Clinical PA Hemophilia
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MS Contin class II narcotic Pharmacy PA Pain For Real-Time Response, Submit PA
OR Call (800) 753-2851
Mulpleta Lusutrombopag Pharmacy PA Thrombocytopenia For Real-Time Response, Submit PA
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Mustargen Mechlorethamine HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Myalept Metreleptin Medical Management/PA Endocrine Disorders For Real-Time Response, Submit PA
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Myleran Busulfan Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Mylotarg Gemtuzumab Ozogamicin Medical Management/PA Cancer For Real-Time Response, Submit PA
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Myobloc Rimabotulinumtoxinb Medical Management/PA Neuromuscular Conditions For Real-Time Response, Submit PA
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Natpara Parathyroid Hormone Medical Management/PA Endocrine Disorders For Real-Time Response, Submit PA
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Navelbine Vinorelbine Tartrate Medical Management/PA Cancer For Real-Time Response, Submit PA
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Nerlynx Neratinib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Neulasta Pegfilgrastim Medical Management/PA Blood Cell Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Neupogen Filgrastim Medical Management/PA Blood Cell Deficiency For Real-Time Response, Submit PA
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OR Call (800) 753-2851
Ninlaro Ixazomib Citrate Pharmacy PA Cancer For Real-Time Response, Submit PA
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OR Call (866) 877-7042
Nivestym filgrastim-aafi Medical Management/PA Blood Cell Deficiency For Real-Time Response, Submit PA
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Novoeight Antihemoph.FVIII, B-Dom Truncat UHA Internal Clinical PA Hemophilia
NovoSeven RT Coagulation Factor Viia,Recomb UHA Internal Clinical PA Hemophilia
Nplate Romiplostim Medical Management/PA Blood Cell Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Nucala Mepolizumab (Recombinant) Medical Management/PA Asthma For Real-Time Response, Submit PA
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Nucynta class II narcotic Pharmacy PA Pain For Real-Time Response, Submit PA
OR Call (800) 753-2851
Nuedexta dextromethorphan/quinidine sulfate Pharmacy PA Neurological Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
Nulojix Belatacept Medical Management/PA Transplant For Real-Time Response, Submit PA
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Nuplazid pimavanserin Pharmacy PA Parkinson's Disease Psychosis For Real-Time Response, Submit PA
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Nutropin Somatropin Medical Management/PA Growth Deficiency For Real-Time Response, Submit PA
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OR Call (800) 753-2851
Nuwiq Antihemoph.FVIII, Hek B-Delete UHA Internal Clinical PA Hemophilia
Obizur Antihemophilic Factor VIII, Recomb Porcine UHA Internal Clinical PA Hemophilia
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OR Call (800) 753-2851
Ocrevus Ocrelizumab Medical Management/PA Multiple Sclerosis For Real-Time Response, Submit PA
OR Call (866) 877-7042
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OR Call (866) 877-7042
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OR Call (800) 753-2851
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OR Call (800) 753-2851
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OR Call (800) 753-2851
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OR Call (800) 753-2851
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OR Call (800) 753-2851
Omnitrope Somatropin Medical Management/PA Growth Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Oncaspar Pegaspargase Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Onivyde Irinotecan Liposomal Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Onpattro Patisiran Medical Management/PA Misc Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
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OR Call (800) 753-2851
Opana ER class II narcotic Pharmacy PA Pain For Real-Time Response, Submit PA
OR Call (800) 753-2851
Opdivo Nivolumab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
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OR Call (800) 753-2851
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OR Call (866) 877-7042
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OR Call (800) 753-2851
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OR Call (800) 753-2851
Orthovisc Hyaluronate Sodium Medical Management/PA Osteoarthritis For Real-Time Response, Submit PA
OR Call (866) 877-7042
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OR Call (800) 753-2851
Otezla Apremilast Pharmacy PA Pain/Inflammation For Real-Time Response, Submit PA
OR Call (800) 753-2851
Oxaliplatin Oxaliplatin Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
OxyContin class II narcotic Pharmacy PA Pain For Real-Time Response, Submit PA
OR Call (800) 753-2851
Paclitaxel Paclitaxel Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Palynziq pegvaliase Medical Management/PA Phenylketonuria For Real-Time Response, Submit PA
OR Call (866) 877-7042
Pegasys Peginterferon Alfa-2a Medical Management/PA Hepatitis C For Real-Time Response, Submit PA
OR Call (866) 877-7042
PEG-Intron Peginterferon Alfa-2b Medical Management/PA Hepatitis C For Real-Time Response, Submit PA
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Perjeta Pertuzumab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Photofrin Porfimer Sodium Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Plegridy Peginterferon Beta-1a Medical Management/PA Multiple Sclerosis For Real-Time Response, Submit PA
OR Call (866) 877-7042
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OR Call (800) 753-2851
Portrazza Necitumumab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Poteligeo Mogamulizumab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Pradaxa Dabigatran Etexilate Pharmacy PA Cardiovascular Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
Praluent Alirocumab Medical Management/PA High Blood Cholesterol For Real-Time Response, Submit PA
OR Call (866) 877-7042
Privigen Immun Glob G(IgG)/Pro/IgA 0-50 Medical Management/PA Immune Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Procrit Epoetin Alfa Medical Management/PA Blood Cell Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Profilnine Factor IX Cplx(Pcc)#4, 3factor UHA Internal Clinical PA Hemophilia
Profilnine SD Factor IX Cplx(Pcc)#4, 3factor UHA Internal Clinical PA Hemophilia
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Proleukin Aldesleukin Medical Management/PA Cancer For Real-Time Response, Submit PA
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Prolia Denosumab Medical Management/PA Osteoporosis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Promacta Eltrombopag Olamine Pharmacy PA Blood Cell Deficiency For Real-Time Response, Submit PA
OR Call (800) 753-2851
Provenge Sipuleucel-T/Lactated Ringers Medical Management/PA Cancer For Real-Time Response, Submit PA
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Purixan Mercaptopurine Medical Management/PA Cancer For Real-Time Response, Submit PA
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OR Call (866) 877-7042
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OR Call (800) 753-2851
Rebif Interferon Beta-1a/Albumin Medical Management/PA Multiple Sclerosis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Reclast Zoledronic Acid/Mannitol&Water Medical Management/PA Osteoporosis For Real-Time Response, Submit PA
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RECOMBINATE Antihemophilic Factor, Hum Rec UHA Internal Clinical PA Hemophilia
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Remodulin Treprostinil Sodium Medical Management/PA Pulmonary Hypertension For Real-Time Response, Submit PA
OR Call (866) 877-7042
Renflexis Infliximab-abda Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
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Repatha Evolocumab Medical Management/PA High Blood Cholesterol For Real-Time Response, Submit PA
OR Call (866) 877-7042
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OR Call (800) 753-2851
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OR Call (800) 753-2851
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OR Call (800) 753-2851
RiaSTAP Fibrinogen UHA Internal Clinical PA Hemophilia
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Ribavirin Ribavirin Pharmacy PA Hepatitis C For Real-Time Response, Submit PA
OR Call (800) 753-2851
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Rituxan Hycela Rituximab/hyaluronidase,human Medical Management/PA Cancer For Real-Time Response, Submit PA
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OR Call (800) 753-2851
Ruconest C1 Esterase Inhibitor, Recomb Medical Management/PA Hereditary Angioedema For Real-Time Response, Submit PA
OR Call (866) 877-7042
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OR Call (800) 753-2851
Saizen Somatropin Medical Management/PA Growth Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
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OR Call (800) 753-2851
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OR Call (800) 753-2851
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OR Call (800) 753-2851
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OR Call (800) 753-2851
Serostim Somatropin Medical Management/PA Growth Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Signifor Pasireotide Diaspartate Medical Management/PA Endocrine Disorders For Real-Time Response, Submit PA
OR Call (866) 877-7042
Signifor LAR Pasireotide Medical Management/PA Endocrine Disorders For Real-Time Response, Submit PA
OR Call (866) 877-7042
Siliq Brodalumab Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Simponi Golimumab Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Simponi Aria Golimumab Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
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OR Call (800) 753-2851
Somatuline Depot Lanreotide Acetate Medical Management/PA Endocrine Disorders For Real-Time Response, Submit PA
OR Call (866) 877-7042
Sovaldi Sofosbuvir Pharmacy PA Hepatitis C For Real-Time Response, Submit PA
OR Call (800) 753-2851
Spinraza Nusinersen Medical Management/PA Metabolic Disorders For Real-Time Response, Submit PA
OR Call (866) 877-7042
Sprycel Dasatinib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Stelara Ustekinumab Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Stivarga Regorafenib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
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OR Call (866) 877-7042
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OR Call (800) 753-2851
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OR Call (800) 753-2851
Subsys fentanyl transmucosal drug Pharmacy PA Pain For Real-Time Response, Submit PA
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Supartz FX Hyaluronate Sodium Medical Management/PA Osteoarthritis For Real-Time Response, Submit PA
OR Call (866) 877-7042
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OR Call (800) 753-2851
Sylatron Peginterferon Alfa-2b Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Sylvant Siltuximab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Symbicort Budenoside/Formoterol Fumarate Dihydrate Pharmacy PA Asthma/COPD For Real-Time Response, Submit PA
OR Call (800) 753-2851
Symdeko tezacaftor / ivacaftor Pharmacy PA Cystic Fibrosis For Real-Time Response, Submit PA
OR Call (800) 753-2851
Symlin pramlintide Pharmacy PA Diabetes For Real-Time Response, Submit PA
OR Call (800) 753-2851
Synagis Palivizumab Medical Management/PA Respiratory Syncytial Virus For Real-Time Response, Submit PA
OR Call (866) 877-7042
Synribo Omacetaxine Mepesuccinate Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Synvisc Hylan G-F 20 Medical Management/PA Osteoarthritis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Synvisc One Hylan G-F 20 Medical Management/PA Osteoarthritis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Syprine Trientine Hydrochloride Pharmacy PA Wilson's Disease For Real-Time Response, Submit PA
OR Call (800) 753-2851
Tafinlar Dabrafenib Mesylate Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Tagrisso Osimertinib Mesylate Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Takhzyro lanadelumab Medical Management/PA Hereditary Angioedema For Real-Time Response, Submit PA
OR Call (866) 877-7042
Taltz Ixekizumab Medical Management/PA Skin Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Tanzeum GLP-1 agonist Pharmacy PA Diabetes For Real-Time Response, Submit PA
OR Call (800) 753-2851
Tarceva Erlotinib Hcl Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Targretin Bexarotene Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Tasigna Nilotinib Hcl Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Tavalisse fostamatinib disodium hexahydrate Pharmacy PA Thrombocytopenia For Real-Time Response, Submit PA
OR Call (800) 753-2851
Taxotere Docetaxel Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Tazorac topical tazarotene products Pharmacy PA Skin Conditions For Real-Time Response, Submit PA
OR Call (800) 753-2851
Tecentriq Atezolizumab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Tecfidera Dimethyl Fumarate Pharmacy PA Multiple Sclerosis For Real-Time Response, Submit PA
OR Call (800) 753-2851
Technivie ombitasvir, paritaprevir and ritonavir Pharmacy PA Hepatitis C For Real-Time Response, Submit PA
OR Call (800) 753-2851
Temodar Temozolomide Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Temozolomide INJ Temozolomide Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Teniposide Teniposide Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Testim topical testosterone Pharmacy PA Endocrine Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
Testopel Testosterone Medical Management/PA Endocrine Disorders For Real-Time Response, Submit PA
OR Call (866) 877-7042
testosterone cypionate injectable testosterone Medical Management/PA Endocrine Disorders For Real-Time Response, Submit PA
OR Call (866) 877-7042
testosterone enanthate injectable testosterone Medical Management/PA Endocrine Disorders For Real-Time Response, Submit PA
OR Call (866) 877-7042
Thalomid Thalidomide Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Theracys BCG Live Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Thiotepa Thiotepa Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Tibsovo Ivosidenib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Toposar Etoposide Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Topotecan HCl Topotecan HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Torisel Temsirolimus Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Totect Dexrazoxane HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Tracleer Bosentan Pharmacy PA Pulmonary Hypertension For Real-Time Response, Submit PA
OR Call (800) 753-2851
Travatan/Z ophthalmic prostaglandin Pharmacy PA Ophthalmic Conditions For Real-Time Response, Submit PA
OR Call (800) 753-2851
Treanda Bendamustine HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Trelstar Triptorelin Pamoate Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Tremfya Guselkumab Medical Management/PA Inflammatory Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
tretinoin topical tretinoin products Pharmacy PA Skin Conditions For Real-Time Response, Submit PA
OR Call (800) 753-2851
Tretin-X topical tretinoin products Pharmacy PA Skin Conditions For Real-Time Response, Submit PA
OR Call (800) 753-2851
Tretten Factor XIII A-Subunit, Recomb UHA Internal Clinical PA Hemophilia
Trexall Methotrexate Sodium Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Trisenox Arsenic Trioxide Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Trogarzo ibalizumab Medical Management/PA HIV For Real-Time Response, Submit PA
OR Call (866) 877-7042
Trulicity GLP-1 agonist Pharmacy PA Diabetes For Real-Time Response, Submit PA
OR Call (800) 753-2851
Tykerb Lapatinib Ditosylate Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Tymlos Abaloparatide Medical Management/PA Bone Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Tysabri Natalizumab Medical Management/PA Multiple Sclerosis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Tyvaso Treprostinil Pharmacy PA Pulmonary Hypertension For Real-Time Response, Submit PA
OR Call (800) 753-2851
Unituxin Dinutuximab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Uptravi Selexipag Pharmacy PA Circulation Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
Valchlor Mechlorethamine HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Valstar Valrubicin Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Vantas Histrelin Ac Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Vascepa Cosapent Pharmacy PA High Blood Cholesterol For Real-Time Response, Submit PA
OR Call (800) 753-2851
Vectibix Panitumumab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Velcade Bortezomib Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Veletri Epoprostenol Sodium (Arginine) Medical Management/PA Pulmonary Hypertension For Real-Time Response, Submit PA
OR Call (866) 877-7042
Veltin topical tretinoin products Pharmacy PA Skin Conditions For Real-Time Response, Submit PA
OR Call (800) 753-2851
Venclexta Venetoclax Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Ventavis Iloprost Tromethamine Pharmacy PA Pulmonary Hypertension For Real-Time Response, Submit PA
OR Call (800) 753-2851
Verzenio abemaciclib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Victoza GLP-1 agonist Pharmacy PA Diabetes For Real-Time Response, Submit PA
OR Call (800) 753-2851
Vidaza Azacitidine Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Viekira Pak Ombita/Paritap/Riton/Dasabuvir Pharmacy PA Hepatitis C For Real-Time Response, Submit PA
OR Call (800) 753-2851
Vimizim Elosulfase Alfa Pharmacy PA Enzyme Deficiencies For Real-Time Response, Submit PA
OR Call (800) 753-2851
Vinblastine Sulfate Vinblastine Sulfate Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Vincasar PFS Vincristine Sulfate Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Vincristine Sulfate Vincristine Sulfate Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Vinorelbine Tartrate Vinorelbine Tartrate Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Visco-3 Hyaluronate Sodium Medical Management/PA Osteoarthritis For Real-Time Response, Submit PA
OR Call (866) 877-7042
Vizimpro Dacomitinib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Vogelxo Testosterone Gel Pharmacy PA Endocrine Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
Vosevi Sofosbuvir/Velpatasvir Pharmacy PA Hepatitis C For Real-Time Response, Submit PA
OR Call (800) 753-2851
Votrient Pazopanib Hcl Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Wilate Antihemophilic Factor/Vwf UHA Internal Clinical PA Hemophilia
Xalatan ophthalmic prostaglandin Pharmacy PA Ophthalmic Conditions For Real-Time Response, Submit PA
OR Call (800) 753-2851
Xalkori Crizotinib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Xarelto Rivaroxaban Pharmacy PA Cardiovascular Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
Xeljanz Tofacitinib Citrate Pharmacy PA Inflammatory Conditions For Real-Time Response, Submit PA
OR Call (800) 753-2851
Xeloda Capecitabine Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Xenazine Tetrabenazine Pharmacy PA Mental/Neuro Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
Xeomin Incobotulinumtoxina Medical Management/PA Neuromuscular Conditions For Real-Time Response, Submit PA
OR Call (866) 877-7042
Xermelo Telotristat Ethyl Pharmacy PA Gastrointestinal Conditions For Real-Time Response, Submit PA
OR Call (800) 753-2851
Xgeva Denosumab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Xiaflex Collagenase Clostridium Hist. UHA Internal Clinical PA Misc Conditions
Xiidra Lifitegrast Pharmacy PA Ophthalmic Conditions For Real-Time Response, Submit PA
OR Call (800) 753-2851
Xofigo Radium-223 Dichloride Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Xolair Omalizumab Medical Management/PA Asthma For Real-Time Response, Submit PA
OR Call (866) 877-7042
Xtandi Enzalutamide Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Xyntha Antihemoph.FVIII, B-Domain Del UHA Internal Clinical PA Hemophilia
Xyntha Solofuse Antihemoph.FVIII, B-Domain Del UHA Internal Clinical PA Hemophilia
Xyrem Sodium Oxybate Pharmacy PA Sleep Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
Yervoy Ipilimumab Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Yescarta axicabtagene ciloleucel Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Yondelis Trabectedin Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Yonsa abiraterone acetate Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Zaltrap Ziv-Aflibercept Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Zanosar Streptozocin Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Zarxio Filgrastim-Sndz Medical Management/PA Blood Cell Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Zavesca miglustat Pharmacy PA Gaucher's Disease For Real-Time Response, Submit PA
OR Call (800) 753-2851
Zejula Niraparib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Zelboraf Vemurafenib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Zemaira Alpha-1-Proteinase Inhibitor Medical Management/PA Alpha 1 Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Zevalin Kit For Y-90/Ibritumomab/Album Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Ziana topical tretinoin products Pharmacy PA Skin Conditions For Real-Time Response, Submit PA
OR Call (800) 753-2851
Zinecard Dexrazoxane HCl Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Zioptan ophthalmic prostaglandin Pharmacy PA Ophthalmic Conditions For Real-Time Response, Submit PA
OR Call (800) 753-2851
Zoladex Goserelin Acetate Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Zoledronic Acid Zoledronic Acid Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Zolinza Vorinostat Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Zomacton Somatropin Medical Management/PA Growth Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Zometa Zoledronic Acid Medical Management/PA Cancer For Real-Time Response, Submit PA
OR Call (866) 877-7042
Zontivity Vorapaxar Pharmacy PA Cardiovascular Disorders For Real-Time Response, Submit PA
OR Call (800) 753-2851
Zorbtive Somatropin Medical Management/PA Growth Deficiency For Real-Time Response, Submit PA
OR Call (866) 877-7042
Zovirax Acyclovir Pharmacy PA Skin Conditions For Real-Time Response, Submit PA
OR Call (800) 753-2851
Zubsolv Buprenorphine HCl/Naloxone HCl Pharmacy PA Chemical Dependence For Real-Time Response, Submit PA
OR Call (800) 753-2851
Zydelig Idelalisib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Zykadia Ceritinib Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Zytiga Abiraterone Acetate Pharmacy PA Cancer For Real-Time Response, Submit PA
OR Call (800) 753-2851
Zyvox Linezolid Pharmacy PA Infections For Real-Time Response, Submit PA
OR Call (800) 753-2851

List of Step Therapy Drugs

PDF Download: List of Step Therapy Drugs
Submit Drug PAs Online: Express Path
Medication Therapeutic Category First Line Alternative
ACANYA SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
ACIPHEX ULCER RULE 1: ESOMEPRAZOLE, LANSOPRAZOLE (RX AND OTC), OMEPRAZOLE (RX OR OTC), PANTOPRAZOLE, RABEPRAZOLE
ACIPHEX SPRINKLE ULCER RULE 1: ESOMEPRAZOLE, LANSOPRAZOLE (RX AND OTC), OMEPRAZOLE (RX OR OTC), PANTOPRAZOLE, RABEPRAZOLE
ACTEMRA SC INFLAMMATORY CONDITIONS JUVENILE IDIOPATHIC ARTHRITIS: HUMIRA
ACTICLATE ANTI-INFECTIVE GENERIC SOLID DOSAGE FORMS: AVIDOXY, DEMECLOCYCLINE, DOXYCYCLINE IR, DOXYCYCLINE DR, MINOCYCLINE IR, MONDOXYNE NL, MORGIDOX, OCUDOX CONVENIENCE KIT, TETRACYCLINE
ACTONEL BONE CONDITIONS STEP 1: ALENDRONATE, IBANDRONATE, RISEDRONATE
STEP 2: ATELVIA
ACTONEL PLUS CALCIUM BONE CONDITIONS STEP 1: ALENDRONATE, IBANDRONATE, RISEDRONATE
STEP 2: ATELVIA
ACTOPLUS MET DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
ACTOPLUS MET XR DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
ACTOS DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
ACZONE SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
ADALAT CC HIGH BLOOD PRESSURE RULE 1: GENERIC DHP CCBS: AFEDITAB CR, AMLODIPINE, AMLODIPINE/ATORVASTATIN, AMLODIPINE/BENAZEPRIL, FELODIPINE ER, ISRADIPINE IR, NICARDIPINE IR, NIFEDIPINE, NIFEDIPINE ER, NIFEDIPINE XL, NIFEDIAC CC, NIFEDICAL XL, NISOLDIPINE ER
ADAPALENE SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
ADCIRCA PULMONARY HYPERTENSION SILDENAFIL 20MG TABLETS, TADALAFIL 20MG TABLETS
ADDERALL XR ATTENTION DISORDERS GENERIC STIMULANT MEDICATIONS
FOR EXAMPLE: AMPHETAMINE/DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, DEXMETHYLPHENIDATE EXTENDED-RELEASE CAPSULES, DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, METHYLPHENIDATE EXTENDED-RELEASE CAPSULES, METADATE ER, METHYLPHENIDATE SUSTAINED-RELEASE TABLETS, METHYLPHENIDATE EXTENDED-RELEASE TABLETS
ADOXA ANTI-INFECTIVE GENERIC SOLID DOSAGE FORMS: AVIDOXY, DEMECLOCYCLINE, DOXYCYCLINE IR, DOXYCYCLINE DR, MINOCYCLINE IR, MONDOXYNE NL, MORGIDOX, OCUDOX CONVENIENCE KIT, TETRACYCLINE
ADZENXS XR ODT ATTENTION DISORDERS GENERIC STIMULANT MEDICATIONS
FOR EXAMPLE: AMPHETAMINE/DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, DEXMETHYLPHENIDATE EXTENDED-RELEASE CAPSULES, DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, METHYLPHENIDATE EXTENDED-RELEASE CAPSULES, METADATE ER, METHYLPHENIDATE SUSTAINED-RELEASE TABLETS, METHYLPHENIDATE EXTENDED-RELEASE TABLETS
AEROSPAN ASTHMA/COPD ARNUITY ELLIPTA, ASMANEX HFA, ASMANEX TWISTHALER, FLOVENT DISKUS, FLOVENT HFA, PULMICORT FLEXHALER, QVAR
AKTIPAK SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
ALA-SCALP HP SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
ALCORTIN A SKIN INFECTIONS RULE 1: TOPICAL STEROID+MUPIROCIN
ALLZITAL PAIN RULE 6: GENERIC PRODUCT WITH BUTALBITAL
ALOCRIL EYE CONDITIONS CROMOLYN
ALOGLIPTIN DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
ALOGLIPTIN/METFORMIN DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
ALOGLIPTIN/PIOGLITAZONE DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
ALOMIDE EYE CONDITIONS CROMOLYN
ALREX EYE CONDITIONS AZELASTINE, EPINASTINE, OLOPATADINE
ALSUMA INJECTION MIGRAINE HEADACHES ALMOTRIPTAN, ELETRIPTAN, FROVATRIPTAN, NARATRIPTAN, RIZATRIPTAN, SUMATRIPTAN, SUMATRIPTAN INJECTION, SUMATRIPTAN NASAL SPRAY, ZOLMITRIPTAN
ALTOPREV HIGH BLOOD CHOLESTEROL STEP 1: ATORVASTATIN, LOVASTATIN, PRAVASTATIN, SIMVASTATIN, FLUVASTATIN, FLUVASTATIN EXTENDED-RELEASE, ROSUVASTATIN, ATORVASTATIN/AMLODIPINE, EZETIMIBE/SIMVASTATIN
STEP 2: LIVALO
ALVESCO ASTHMA/COPD ARNUITY ELLIPTA, ASMANEX HFA, ASMANEX TWISTHALER, FLOVENT DISKUS, FLOVENT HFA, PULMICORT FLEXHALER, QVAR
AMBIEN SLEEP DISORDER ESZOPICLONE, ZALEPLON, ZOLPIDEM, ZOLPIDEM ER
AMBIEN CR SLEEP DISORDER ESZOPICLONE, ZALEPLON, ZOLPIDEM, ZOLPIDEM ER
AMERGE MIGRAINE HEADACHES ALMOTRIPTAN, ELETRIPTAN, FROVATRIPTAN, NARATRIPTAN, RIZATRIPTAN, SUMATRIPTAN, SUMATRIPTAN INJECTION, SUMATRIPTAN NASAL SPRAY, ZOLMITRIPTAN
AMPYRA MULTIPLE SCLEROSIS RULE 2: DALFAMPRIDINE
AMRIX ER MUSCLE RELAXANT RULE 3: GENERIC CYCLOBENZAPRINE
ANAPROX PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
ANAPROX DS PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
ANDROID HORMONAL SUPPLEMENTATION RULE 4: GENERIC OR METHITEST
ANSAID PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
ANTARA HIGH BLOOD CHOLESTEROL FENOFIBRATE, FENOFIBRIC ACID
ANUSOL HC SUPPOSITORY INFLAMMATORY CONDITIONS GENERIC HYDROCORTISONE ACETATE SUPPOSITORY (25 MG OR 30 MG), ANUCORT-HC (25 MG), GRX HICORT (25 MG), HEMMOREX-HC (25 MG OR 30 MG), RECTACORT-HC (25 MG)
APLENZIN DEPRESSION BUPROPION SR, BUPROPION ER
APTENSIO XR ATTENTION DISORDERS GENERIC STIMULANT MEDICATIONS
FOR EXAMPLE: AMPHETAMINE/DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, DEXMETHYLPHENIDATE EXTENDED-RELEASE CAPSULES, DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, METHYLPHENIDATE EXTENDED-RELEASE CAPSULES, METADATE ER, METHYLPHENIDATE SUSTAINED-RELEASE TABLETS, METHYLPHENIDATE EXTENDED-RELEASE TABLETS
AQUA GLYCOLIC HC SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
ARANESP BLOOD DISORDERS PROCRIT
ARBINOXA 4 MG TABLET ALLERGY CARBINOXAMINE 4 MG TABLET, CARBINOXAMINE 4 MG/5 ML LIQUID
ARBINOXA 4 MG/5 ML LIQUID ALLERGY CARBINOXAMINE 4 MG TABLET, CARBINOXAMINE 4 MG/5 ML LIQUID
ARCALYST METABOLIC, IMMUNE DISORDERS OR INHERITED RARE DISEASE ILARIS
ARICEPT 10MG TABLET MENTAL/NEUROLOGICAL DISORDERS RULE 1: GALANTAMINE, GALANTAMINE ER, RIVASTIGMINE, DONEPEZIL (DOES NOT INCLUDE DONEPEZIL 23 MG TABLETS)
ARICEPT 23MG TABLET (BRAND OR GENERIC) MENTAL/NEUROLOGICAL DISORDERS RULE 2: ARICEPT 10 MG TABLETS (BRAND OR GENERIC) OR ARICEPT ODT 10 MG (BRAND OR GENERIC)
ARICEPT 5MG TABLET MENTAL/NEUROLOGICAL DISORDERS RULE 1: GALANTAMINE, GALANTAMINE ER, RIVASTIGMINE, DONEPEZIL (DOES NOT INCLUDE DONEPEZIL 23 MG TABLETS)
ARICEPT ODT MENTAL/NEUROLOGICAL DISORDERS RULE 1: GALANTAMINE, GALANTAMINE ER, RIVASTIGMINE, DONEPEZIL (DOES NOT INCLUDE DONEPEZIL 23 MG TABLETS)
ARTHROTEC PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
ASTAGRAF XL TRANSPLANT RULE 5: GENERIC TACROLIMUS
ATACAND HIGH BLOOD PRESSURE CANDESARTAN, CANDESARTAN/HCTZ, EPROSARTAN, IRBESARTAN, IRBESARTAN/HCTZ, LOSARTAN, LOSARTAN/HCTZ, OLMESARTAN TABLETS, OLMESARTAN/HCTZ TABLETS, OLMESARTAN/AMLODIPINE TABLETS, OLMESARTAN/AMLODIPINE/HCTZ TABLETS, TELMISARTAN, TELMISARTAN/AMLODIPINE, TELMISARTAN/HCTZ, VALSARTAN, VALSARTAN/HCTZ, VALSARTAN/AMLODIPINE, VALSARTAN/AMLODIPINE/HYDROCHLOROTHIAZIDE
ATACAND HCT HIGH BLOOD PRESSURE CANDESARTAN, CANDESARTAN/HCTZ, EPROSARTAN, IRBESARTAN, IRBESARTAN/HCTZ, LOSARTAN, LOSARTAN/HCTZ, OLMESARTAN TABLETS, OLMESARTAN/HCTZ TABLETS, OLMESARTAN/AMLODIPINE TABLETS, OLMESARTAN/AMLODIPINE/HCTZ TABLETS, TELMISARTAN, TELMISARTAN/AMLODIPINE, TELMISARTAN/HCTZ, VALSARTAN, VALSARTAN/HCTZ, VALSARTAN/AMLODIPINE, VALSARTAN/AMLODIPINE/HYDROCHLOROTHIAZIDE
ATELVIA BONE CONDITIONS STEP 1: ALENDRONATE, IBANDRONATE, RISEDRONATE
STEP 2: ATELVIA
AUBAGIO MULTIPLE SCLEROSIS RULE 1: GENERIC GLATIRAMER 20MG OR 40 MG
AVALIDE HIGH BLOOD PRESSURE CANDESARTAN, CANDESARTAN/HCTZ, EPROSARTAN, IRBESARTAN, IRBESARTAN/HCTZ, LOSARTAN, LOSARTAN/HCTZ, OLMESARTAN TABLETS, OLMESARTAN/HCTZ TABLETS, OLMESARTAN/AMLODIPINE TABLETS, OLMESARTAN/AMLODIPINE/HCTZ TABLETS, TELMISARTAN, TELMISARTAN/AMLODIPINE, TELMISARTAN/HCTZ, VALSARTAN, VALSARTAN/HCTZ, VALSARTAN/AMLODIPINE, VALSARTAN/AMLODIPINE/HYDROCHLOROTHIAZIDE
AVANDAMET DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
AVANDARYL DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
AVANDIA DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
AVAPRO HIGH BLOOD PRESSURE CANDESARTAN, CANDESARTAN/HCTZ, EPROSARTAN, IRBESARTAN, IRBESARTAN/HCTZ, LOSARTAN, LOSARTAN/HCTZ, OLMESARTAN TABLETS, OLMESARTAN/HCTZ TABLETS, OLMESARTAN/AMLODIPINE TABLETS, OLMESARTAN/AMLODIPINE/HCTZ TABLETS, TELMISARTAN, TELMISARTAN/AMLODIPINE, TELMISARTAN/HCTZ, VALSARTAN, VALSARTAN/HCTZ, VALSARTAN/AMLODIPINE, VALSARTAN/AMLODIPINE/HYDROCHLOROTHIAZIDE
AVAR CLEANSER SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ACNE CLEANSERS CONTAINING BENZOYL PEROXIDE OR SULFACETAMIDE/SULFUR
AVAR LS CLEANSER SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ACNE CLEANSERS CONTAINING BENZOYL PEROXIDE OR SULFACETAMIDE/SULFUR
AVAR-E CREAM SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
AVAR-E LS CREAM SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
AVIDOXY DK KIT ANTI-INFECTIVE GENERIC SOLID DOSAGE FORMS: AVIDOXY, DEMECLOCYCLINE, DOXYCYCLINE IR, DOXYCYCLINE DR, MINOCYCLINE IR, MONDOXYNE NL, MORGIDOX, OCUDOX CONVENIENCE KIT, TETRACYCLINE
AVINZA PAIN - NARCOTIC N/A
AVODART BPH FINASTERIDE 5 MG
AVONEX MULTIPLE SCLEROSIS RULE 1: GENERIC GLATIRAMER 20MG OR 40 MG
AXERT MIGRAINE HEADACHES ALMOTRIPTAN, ELETRIPTAN, FROVATRIPTAN, NARATRIPTAN, RIZATRIPTAN, SUMATRIPTAN, SUMATRIPTAN INJECTION, SUMATRIPTAN NASAL SPRAY, ZOLMITRIPTAN
AZELEX SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
AZILECT MENTAL/NEUROLOGICAL DISORDERS RASAGILINE, SELEGILINE
AZOR HIGH BLOOD PRESSURE CANDESARTAN, CANDESARTAN/HCTZ, EPROSARTAN, IRBESARTAN, IRBESARTAN/HCTZ, LOSARTAN, LOSARTAN/HCTZ, OLMESARTAN TABLETS, OLMESARTAN/HCTZ TABLETS, OLMESARTAN/AMLODIPINE TABLETS, OLMESARTAN/AMLODIPINE/HCTZ TABLETS, TELMISARTAN, TELMISARTAN/AMLODIPINE, TELMISARTAN/HCTZ, VALSARTAN, VALSARTAN/HCTZ, VALSARTAN/AMLODIPINE, VALSARTAN/AMLODIPINE/HYDROCHLOROTHIAZIDE
BECONASE AQ ALLERGIES BUDESONIDE NASAL SPRAY, BUDESONIDE NASAL SPRAY (OTC), FLUTICASONE PROPIONATE NASAL SPRAY, FLUNISOLIDE NASAL SPRAY, MOMETASONE FUROATE NASAL SPRAY, TRIAMCINOLONE NASAL SPRAY (OTC), TRIAMCINOLONE ACETONIDE NASAL SPRAY
BELBUCA PAIN - NARCOTIC N/A
BELSOMRA SLEEP DISORDER ESZOPICLONE, ZALEPLON, ZOLPIDEM, ZOLPIDEM ER
BENICAR HIGH BLOOD PRESSURE CANDESARTAN, CANDESARTAN/HCTZ, EPROSARTAN, IRBESARTAN, IRBESARTAN/HCTZ, LOSARTAN, LOSARTAN/HCTZ, OLMESARTAN TABLETS, OLMESARTAN/HCTZ TABLETS, OLMESARTAN/AMLODIPINE TABLETS, OLMESARTAN/AMLODIPINE/HCTZ TABLETS, TELMISARTAN, TELMISARTAN/AMLODIPINE, TELMISARTAN/HCTZ, VALSARTAN, VALSARTAN/HCTZ, VALSARTAN/AMLODIPINE, VALSARTAN/AMLODIPINE/HYDROCHLOROTHIAZIDE
BENICAR HCT HIGH BLOOD PRESSURE CANDESARTAN, CANDESARTAN/HCTZ, EPROSARTAN, IRBESARTAN, IRBESARTAN/HCTZ, LOSARTAN, LOSARTAN/HCTZ, OLMESARTAN TABLETS, OLMESARTAN/HCTZ TABLETS, OLMESARTAN/AMLODIPINE TABLETS, OLMESARTAN/AMLODIPINE/HCTZ TABLETS, TELMISARTAN, TELMISARTAN/AMLODIPINE, TELMISARTAN/HCTZ, VALSARTAN, VALSARTAN/HCTZ, VALSARTAN/AMLODIPINE, VALSARTAN/AMLODIPINE/HYDROCHLOROTHIAZIDE
BENZAC AC SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ACNE CLEANSERS CONTAINING BENZOYL PEROXIDE OR SULFACETAMIDE/SULFUR
BENZAC W SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ACNE CLEANSERS CONTAINING BENZOYL PEROXIDE OR SULFACETAMIDE/SULFUR
BENZACLIN SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
BENZAMYCIN SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
BENZAMYCIN PAK SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
BENZEFOAM SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
BENZEFOAM ULTRA SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
BEPREVE EYE CONDITIONS AZELASTINE, EPINASTINE, OLOPATADINE
BERINERT HEREDITARY ANGIOEDEMA RUCONEST
BETAPACE HIGH BLOOD PRESSURE RULE 2: GENERIC ORAL SOTALOL
BETAPACE AF HIGH BLOOD PRESSURE RULE 2: GENERIC ORAL SOTALOL
BETASERON MULTIPLE SCLEROSIS RULE 1: GENERIC GLATIRAMER 20MG OR 40 MG
BINOSTO BONE CONDITIONS STEP 1: ALENDRONATE, IBANDRONATE, RISEDRONATE
STEP 2: ATELVIA
BONIVA BONE CONDITIONS STEP 1: ALENDRONATE, IBANDRONATE, RISEDRONATE
STEP 2: ATELVIA
BRINTELLIX DEPRESSION REQUIRES USE OF ANY ONE GENERIC SSRI:
CITALOPRAM, ESCITALOPRAM, FLUOXETINE, FLUOXETINE DR, FLUVOXAMINE, FLUVOXAMINE ER, PAROXETINE, PAROXETINE CR, SERTRALINE
BRISDELLE DEPRESSION REQUIRES USE OF ANY ONE GENERIC SSRI:
CITALOPRAM, ESCITALOPRAM, FLUOXETINE, FLUOXETINE DR, FLUVOXAMINE, FLUVOXAMINE ER, PAROXETINE, PAROXETINE CR, SERTRALINE
BRIVIACT MENTAL/NEUROLOGICAL DISORDERS RULE 3: LEVETIRACETAM , LEVETIRACETAM XR, ROWEEPRA
BUPAP PAIN RULE 6: GENERIC PRODUCT WITH BUTALBITAL
BUTRANS PAIN - NARCOTIC N/A
BYSTOLIC HIGH BLOOD PRESSURE RULE 1: GENERIC BETA-BLOCKERS (I.E., ACEBUTOLOL, ATENOLOL, BETAXOLOL, BISOPROLOL, CARVEDILOL, LABETALOL, METOPROLOL SUCCINATE ER, METOPROLOL TARTRATE, NADOLOL, PINDOLOL, PROPRANOLOL, PROPRANOLOL ER, TIMOLOL) AND GENERIC BETA-BLOCKER COMBINATION PRODUCTS (I.E., ATENOLOL/CHLORTHALIDONE, BISOPROLOL/HCTZ, METOPROLOL/HCTZ, NADOLOL/BENDROFLUMETHIAZIDE, PROPRANOLOL/HCTZ)
BYVALSON HIGH BLOOD PRESSURE RULE 1: GENERIC BETA-BLOCKERS (I.E., ACEBUTOLOL, ATENOLOL, BETAXOLOL, BISOPROLOL, CARVEDILOL, LABETALOL, METOPROLOL SUCCINATE ER, METOPROLOL TARTRATE, NADOLOL, PINDOLOL, PROPRANOLOL, PROPRANOLOL ER, TIMOLOL) AND GENERIC BETA-BLOCKER COMBINATION PRODUCTS (I.E., ATENOLOL/CHLORTHALIDONE, BISOPROLOL/HCTZ, METOPROLOL/HCTZ, NADOLOL/BENDROFLUMETHIAZIDE, PROPRANOLOL/HCTZ)
CADUET HIGH BLOOD CHOLESTEROL STEP 1: ATORVASTATIN, LOVASTATIN, PRAVASTATIN, SIMVASTATIN, FLUVASTATIN, FLUVASTATIN EXTENDED-RELEASE, ROSUVASTATIN, ATORVASTATIN/AMLODIPINE, EZETIMIBE/SIMVASTATIN
STEP 2: LIVALO
CALAN HIGH BLOOD PRESSURE RULE 3: VERAPAMIL SR, VERAPAMIL IR, VERAPAMIL ER
CALAN SR HIGH BLOOD PRESSURE RULE 3: VERAPAMIL SR, VERAPAMIL IR, VERAPAMIL ER
CAMBIA PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
CAPEX SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
CARBINOXAMINE MALEATE 6 MG TABLET ALLERGY CARBINOXAMINE 4 MG TABLET, CARBINOXAMINE 4 MG/5 ML LIQUID
CARDENE SR HIGH BLOOD PRESSURE RULE 1: GENERIC DHP CCBS: AFEDITAB CR, AMLODIPINE, AMLODIPINE/ATORVASTATIN, AMLODIPINE/BENAZEPRIL, FELODIPINE ER, ISRADIPINE IR, NICARDIPINE IR, NIFEDIPINE, NIFEDIPINE ER, NIFEDIPINE XL, NIFEDIAC CC, NIFEDICAL XL, NISOLDIPINE ER
CARDURA BPH ALFUZOSIN ER, DOXAZOSIN, TAMSULOSIN, TERAZOSIN
CARDURA XL BPH ALFUZOSIN ER, DOXAZOSIN, TAMSULOSIN, TERAZOSIN
CAROSPIR HIGH BLOOD PRESSURE RULE 22: SPIRONOLACTONE
CATAFLAM PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
CELEBREX PAIN STEP 1: BRAND OR GENERIC ORAL NSAIDS (MUST USE 2)
FOR EXAMPLE: DICLOFENAC (IR AND ER), ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC, MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
STEP 2: CELECOXIB
CELECOXIB PAIN BRAND OR GENERIC ORAL NSAIDS (MUST USE 2)
FOR EXAMPLE: DICLOFENAC (IR AND ER), ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC, MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
CELEXA DEPRESSION REQUIRES USE OF ANY ONE GENERIC SSRI:
CITALOPRAM, ESCITALOPRAM, FLUOXETINE, FLUOXETINE DR, FLUVOXAMINE, FLUVOXAMINE ER, PAROXETINE, PAROXETINE CR, SERTRALINE
CICLODAN 8% KIT ANTI-FUNGAL GENERIC CICLODAN 8% TOPICAL SOLUTION , CICLOPIROX TOPICAL SOLUTION 8%, CICLOPIROX 8% TREATMENT KIT
CIMZIA INFLAMMATORY CONDITIONS RHEUMATOID ARTHRITIS: ACTEMRA SC, ENBREL, HUMIRA, XELJANZ/XR (TRY 2)
ANKYLOSING SPONDYLITIS: COSENTYX, ENBREL, HUMIRA (TRY 2)
PSORIATIC ARTHRITIS: COSENTYX, ENBREL, HUMIRA, STELARA SC, XELJANZ/XR (TRY 2)
PSORIASIS: COSENTYX, HUMIRA, OTEZLA, STELARA SC (TRY 2)
CROHN'S DISEASE: HUMIRA, STELARA SC (TRY 1)
CINQAIR ASTHMA SPECIALTY FASENRA, NUCALA
CLARIFOAM EF SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
CLEOCIN T SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
CLINDACIN ETZ 1% KIT SKIN CONDITIONS ONE BRAND OR GENERIC PRESCRIPTION TOPICAL ACNE PRODUCT AND ONE BRAND OR GENERIC PRESCRIPTION TOPICAL ACNE CLEANSER
CLINDACIN PAC SKIN CONDITIONS ONE BRAND OR GENERIC PRESCRIPTION TOPICAL ACNE PRODUCT AND ONE BRAND OR GENERIC PRESCRIPTION TOPICAL ACNE CLEANSER
CLINDAGEL SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
CLOBEX SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
CLODAN SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
CLODERM SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
CNL 8 NAIL KIT ANTI-FUNGAL GENERIC CICLODAN 8% TOPICAL SOLUTION , CICLOPIROX TOPICAL SOLUTION 8%, CICLOPIROX 8% TREATMENT KIT
COLCHICINE CAPSULES GOUT COLCRYS, MITIGARE
COLCHICINE TABLETS GOUT COLCRYS, MITIGARE
COLESTID HIGH BLOOD CHOLESTEROL CHOLESTYRAMINE, COLESTIPOL, PREVALITE
CONCERTA ATTENTION DISORDERS GENERIC STIMULANT MEDICATIONS
FOR EXAMPLE: AMPHETAMINE/DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, DEXMETHYLPHENIDATE EXTENDED-RELEASE CAPSULES, DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, METHYLPHENIDATE EXTENDED-RELEASE CAPSULES, METADATE ER, METHYLPHENIDATE SUSTAINED-RELEASE TABLETS, METHYLPHENIDATE EXTENDED-RELEASE TABLETS
CONZIP PAIN TRAMADOL, TRAMADOL ER, TRAMADOL/ACETAMINOPHEN
CORDRAN SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
COREG HIGH BLOOD PRESSURE RULE 1: GENERIC BETA-BLOCKERS (I.E., ACEBUTOLOL, ATENOLOL, BETAXOLOL, BISOPROLOL, CARVEDILOL, LABETALOL, METOPROLOL SUCCINATE ER, METOPROLOL TARTRATE, NADOLOL, PINDOLOL, PROPRANOLOL, PROPRANOLOL ER, TIMOLOL) AND GENERIC BETA-BLOCKER COMBINATION PRODUCTS (I.E., ATENOLOL/CHLORTHALIDONE, BISOPROLOL/HCTZ, METOPROLOL/HCTZ, NADOLOL/BENDROFLUMETHIAZIDE, PROPRANOLOL/HCTZ)
COREG CR HIGH BLOOD PRESSURE RULE 1: GENERIC BETA-BLOCKERS (I.E., ACEBUTOLOL, ATENOLOL, BETAXOLOL, BISOPROLOL, CARVEDILOL, LABETALOL, METOPROLOL SUCCINATE ER, METOPROLOL TARTRATE, NADOLOL, PINDOLOL, PROPRANOLOL, PROPRANOLOL ER, TIMOLOL) AND GENERIC BETA-BLOCKER COMBINATION PRODUCTS (I.E., ATENOLOL/CHLORTHALIDONE, BISOPROLOL/HCTZ, METOPROLOL/HCTZ, NADOLOL/BENDROFLUMETHIAZIDE, PROPRANOLOL/HCTZ)
CORGARD HIGH BLOOD PRESSURE RULE 1: GENERIC BETA-BLOCKERS (I.E., ACEBUTOLOL, ATENOLOL, BETAXOLOL, BISOPROLOL, CARVEDILOL, LABETALOL, METOPROLOL SUCCINATE ER, METOPROLOL TARTRATE, NADOLOL, PINDOLOL, PROPRANOLOL, PROPRANOLOL ER, TIMOLOL) AND GENERIC BETA-BLOCKER COMBINATION PRODUCTS (I.E., ATENOLOL/CHLORTHALIDONE, BISOPROLOL/HCTZ, METOPROLOL/HCTZ, NADOLOL/BENDROFLUMETHIAZIDE, PROPRANOLOL/HCTZ)
CORZIDE HIGH BLOOD PRESSURE RULE 1: GENERIC BETA-BLOCKERS (I.E., ACEBUTOLOL, ATENOLOL, BETAXOLOL, BISOPROLOL, CARVEDILOL, LABETALOL, METOPROLOL SUCCINATE ER, METOPROLOL TARTRATE, NADOLOL, PINDOLOL, PROPRANOLOL, PROPRANOLOL ER, TIMOLOL) AND GENERIC BETA-BLOCKER COMBINATION PRODUCTS (I.E., ATENOLOL/CHLORTHALIDONE, BISOPROLOL/HCTZ, METOPROLOL/HCTZ, NADOLOL/BENDROFLUMETHIAZIDE, PROPRANOLOL/HCTZ)
COZAAR HIGH BLOOD PRESSURE CANDESARTAN, CANDESARTAN/HCTZ, EPROSARTAN, IRBESARTAN, IRBESARTAN/HCTZ, LOSARTAN, LOSARTAN/HCTZ, OLMESARTAN TABLETS, OLMESARTAN/HCTZ TABLETS, OLMESARTAN/AMLODIPINE TABLETS, OLMESARTAN/AMLODIPINE/HCTZ TABLETS, TELMISARTAN, TELMISARTAN/AMLODIPINE, TELMISARTAN/HCTZ, VALSARTAN, VALSARTAN/HCTZ, VALSARTAN/AMLODIPINE, VALSARTAN/AMLODIPINE/HYDROCHLOROTHIAZIDE
CRESTOR HIGH BLOOD CHOLESTEROL STEP 1: ATORVASTATIN, LOVASTATIN, PRAVASTATIN, SIMVASTATIN, FLUVASTATIN, FLUVASTATIN EXTENDED-RELEASE, ROSUVASTATIN, ATORVASTATIN/AMLODIPINE, EZETIMIBE/SIMVASTATIN
STEP 2: LIVALO
CUPRIMINE WILSON'S DISEASE STEP 1: GALZIN (WITH EXCEPTIONS)
STEP 2: DEPEN
CUTIVATE SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
CYMBALTA DEPRESSION REQUIRES USE OF ANY ONE (BRAND OR GENERIC SSRI) OR (GENERIC SNRI)
SSRIS: CITALOPRAM (CELEXA), DULOXETINE (CYMBALTA), ESCITALOPRAM (LEXAPRO), FLUOXETINE (PROZAC, SARAFEM), FLUVOXAMINE IR OR ER (LUVOX CR), PAROXETINE IR OR ER (PAXIL, PAXIL CR), PEXEVA, SERTRALINE (ZOLOFT), TRINTELLIX (FORMERLY KNOWN AS BRINTELLIX), VIIBRYD
SNRIS: VENLAFAXINE IR OR ER, VENLAFAXINE IMMEDIATE-RELEASE TABLETS
DAKLINZA HEPATITIS C HARVONI, EPCLUSA, VIEKIRA PAK, VIEKIRA XR, VOSEVI, ZEPATIER
DAYPRO PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
DAYTRANA ATTENTION DISORDERS GENERIC STIMULANT MEDICATIONS
FOR EXAMPLE: AMPHETAMINE/DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, DEXMETHYLPHENIDATE EXTENDED-RELEASE CAPSULES, DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, METHYLPHENIDATE EXTENDED-RELEASE CAPSULES, METADATE ER, METHYLPHENIDATE SUSTAINED-RELEASE TABLETS, METHYLPHENIDATE EXTENDED-RELEASE TABLETS
DEMSER PHEOCHROMOCYTOMA STEP 1: ALPHA BLOCKERS (DOXAZOSIN, PRAZOSIN, TERAZOSIN)
STEP 2: DIBENZYLINE
DEPAKENE MENTAL/NEUROLOGICAL DISORDERS RULE 1: DIVALPROEX SODIUM, DIVALPROEX SODIUM ER/EC/DR, VALPROIC ACID
DEPAKOTE MENTAL/NEUROLOGICAL DISORDERS RULE 1: DIVALPROEX SODIUM, DIVALPROEX SODIUM ER/EC/DR, VALPROIC ACID
DEPAKOTE ER/EC/DR MENTAL/NEUROLOGICAL DISORDERS RULE 1: DIVALPROEX SODIUM, DIVALPROEX SODIUM ER/EC/DR, VALPROIC ACID
DEPAKOTE SPRINKLE MENTAL/NEUROLOGICAL DISORDERS RULE 1: DIVALPROEX SODIUM, DIVALPROEX SODIUM ER/EC/DR, VALPROIC ACID
DEPEN WILSON'S DISEASE STEP 1: GALZIN (WITH EXCEPTIONS)
STEP 2: DEPEN
DERMA-SMOOTH FS SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
DERMASORB HC SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
DERMASORB TA SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
DERMATOP SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
DESONATE SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
DESOWEN SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
DESVENLAFAXINE ER (BRAND) DEPRESSION REQUIRES USE OF ANY ONE (BRAND OR GENERIC SSRI) OR (GENERIC SNRI)
SSRIS: CITALOPRAM (CELEXA), DULOXETINE (CYMBALTA), ESCITALOPRAM (LEXAPRO), FLUOXETINE (PROZAC, SARAFEM), FLUVOXAMINE IR OR ER (LUVOX CR), PAROXETINE IR OR ER (PAXIL, PAXIL CR), PEXEVA, SERTRALINE (ZOLOFT), TRINTELLIX (FORMERLY KNOWN AS BRINTELLIX), VIIBRYD
SNRIS: VENLAFAXINE IR OR ER, VENLAFAXINE IMMEDIATE-RELEASE TABLETS
DESVENLAFAXINE FUMARATE ER (BRAND) DEPRESSION REQUIRES USE OF ANY ONE (BRAND OR GENERIC SSRI) OR (GENERIC SNRI)
SSRIS: CITALOPRAM (CELEXA), DULOXETINE (CYMBALTA), ESCITALOPRAM (LEXAPRO), FLUOXETINE (PROZAC, SARAFEM), FLUVOXAMINE IR OR ER (LUVOX CR), PAROXETINE IR OR ER (PAXIL, PAXIL CR), PEXEVA, SERTRALINE (ZOLOFT), TRINTELLIX (FORMERLY KNOWN AS BRINTELLIX), VIIBRYD
SNRIS: VENLAFAXINE IR OR ER, VENLAFAXINE IMMEDIATE-RELEASE TABLETS
DETROL OVERACTIVE BLADDER DARIFENACIN ER, OXYBUTYNIN IR, OXYBUTYNIN ER, TOLTERODINE, TOLTERODINE ER, TROSPIUM, TROSPIUM ER
DETROL LA OVERACTIVE BLADDER DARIFENACIN ER, OXYBUTYNIN IR, OXYBUTYNIN ER, TOLTERODINE, TOLTERODINE ER, TROSPIUM, TROSPIUM ER
DEXAMETHASONE 1.5 MG TABLET (6 DAY/10 DAY/13 DAY DOSE PACKS) INFLAMMATORY CONDITIONS RULE 19: GENERIC DEXAMETHASON TABLETS
DEXEDRINE ATTENTION DISORDERS GENERIC STIMULANT MEDICATIONS
FOR EXAMPLE: AMPHETAMINE/DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, DEXMETHYLPHENIDATE EXTENDED-RELEASE CAPSULES, DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, METHYLPHENIDATE EXTENDED-RELEASE CAPSULES, METADATE ER, METHYLPHENIDATE SUSTAINED-RELEASE TABLETS, METHYLPHENIDATE EXTENDED-RELEASE TABLETS
DEXILANT ULCER RULE 1: ESOMEPRAZOLE, LANSOPRAZOLE (RX AND OTC), OMEPRAZOLE (RX OR OTC), PANTOPRAZOLE, RABEPRAZOLE
DEXPAK 6 DAY/10 DAY/13 DAY INFLAMMATORY CONDITIONS RULE 19: GENERIC DEXAMETHASON TABLETS
DIBENZYLINE PHEOCHROMOCYTOMA STEP 1: ALPHA BLOCKERS (DOXAZOSIN, PRAZOSIN, TERAZOSIN)
STEP 2: DIBENZYLINE
DICLOFENAC SODIUM 1% GEL PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
DIFFERIN SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
DIOVAN HIGH BLOOD PRESSURE CANDESARTAN, CANDESARTAN/HCTZ, EPROSARTAN, IRBESARTAN, IRBESARTAN/HCTZ, LOSARTAN, LOSARTAN/HCTZ, OLMESARTAN TABLETS, OLMESARTAN/HCTZ TABLETS, OLMESARTAN/AMLODIPINE TABLETS, OLMESARTAN/AMLODIPINE/HCTZ TABLETS, TELMISARTAN, TELMISARTAN/AMLODIPINE, TELMISARTAN/HCTZ, VALSARTAN, VALSARTAN/HCTZ, VALSARTAN/AMLODIPINE, VALSARTAN/AMLODIPINE/HYDROCHLOROTHIAZIDE
DIOVAN HCT HIGH BLOOD PRESSURE CANDESARTAN, CANDESARTAN/HCTZ, EPROSARTAN, IRBESARTAN, IRBESARTAN/HCTZ, LOSARTAN, LOSARTAN/HCTZ, OLMESARTAN TABLETS, OLMESARTAN/HCTZ TABLETS, OLMESARTAN/AMLODIPINE TABLETS, OLMESARTAN/AMLODIPINE/HCTZ TABLETS, TELMISARTAN, TELMISARTAN/AMLODIPINE, TELMISARTAN/HCTZ, VALSARTAN, VALSARTAN/HCTZ, VALSARTAN/AMLODIPINE, VALSARTAN/AMLODIPINE/HYDROCHLOROTHIAZIDE
DIPROLENE SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
DIPROLENE/AF SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
DISKETS PAIN - NARCOTIC N/A
DITROPAN XL OVERACTIVE BLADDER DARIFENACIN ER, OXYBUTYNIN IR, OXYBUTYNIN ER, TOLTERODINE, TOLTERODINE ER, TROSPIUM, TROSPIUM ER
DOLOPHINE PAIN - NARCOTIC N/A
DORYX ANTI-INFECTIVE GENERIC SOLID DOSAGE FORMS: AVIDOXY, DEMECLOCYCLINE, DOXYCYCLINE IR, DOXYCYCLINE DR, MINOCYCLINE IR, MONDOXYNE NL, MORGIDOX, OCUDOX CONVENIENCE KIT, TETRACYCLINE
DORYX MPC ANTI-INFECTIVE GENERIC SOLID DOSAGE FORMS: AVIDOXY, DEMECLOCYCLINE, DOXYCYCLINE IR, DOXYCYCLINE DR, MINOCYCLINE IR, MONDOXYNE NL, MORGIDOX, OCUDOX CONVENIENCE KIT, TETRACYCLINE
DOXEPIN SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL CORTICOSTEROIDS (MUST TRY 2)
DOXYCYCLINE 40MG CAPSULES (IR/DR) (BRAND) ANTI-INFECTIVE GENERIC SOLID DOSAGE FORMS: AVIDOXY, DEMECLOCYCLINE, DOXYCYCLINE IR, DOXYCYCLINE DR, MINOCYCLINE IR, MONDOXYNE NL, MORGIDOX, OCUDOX CONVENIENCE KIT, TETRACYCLINE
DUAC SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
DUETACT DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
DURAGESIC PAIN - NARCOTIC N/A
DURLAZA BLOOD MODIFYING RULE 7: TWO OTHER ASPIRIN PRODUCTS
DUTASTERIDE BPH FINASTERIDE 5 MG
DUTASTERIDE/TAMSULOSIN BPH FINASTERIDE 5 MG
DUTOPROL HIGH BLOOD PRESSURE RULE 1: GENERIC BETA-BLOCKERS (I.E., ACEBUTOLOL, ATENOLOL, BETAXOLOL, BISOPROLOL, CARVEDILOL, LABETALOL, METOPROLOL SUCCINATE ER, METOPROLOL TARTRATE, NADOLOL, PINDOLOL, PROPRANOLOL, PROPRANOLOL ER, TIMOLOL) AND GENERIC BETA-BLOCKER COMBINATION PRODUCTS (I.E., ATENOLOL/CHLORTHALIDONE, BISOPROLOL/HCTZ, METOPROLOL/HCTZ, NADOLOL/BENDROFLUMETHIAZIDE, PROPRANOLOL/HCTZ)
DUZALLO GOUT ALLOPURINOL
DYMISTA ALLERGIES BUDESONIDE NASAL SPRAY, BUDESONIDE NASAL SPRAY (OTC), FLUTICASONE PROPIONATE NASAL SPRAY, FLUNISOLIDE NASAL SPRAY, MOMETASONE FUROATE NASAL SPRAY, TRIAMCINOLONE NASAL SPRAY (OTC), TRIAMCINOLONE ACETONIDE NASAL SPRAY
DYNAVEL XR ATTENTION DISORDERS GENERIC STIMULANT MEDICATIONS
FOR EXAMPLE: AMPHETAMINE/DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, DEXMETHYLPHENIDATE EXTENDED-RELEASE CAPSULES, DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, METHYLPHENIDATE EXTENDED-RELEASE CAPSULES, METADATE ER, METHYLPHENIDATE SUSTAINED-RELEASE TABLETS, METHYLPHENIDATE EXTENDED-RELEASE TABLETS
EC-NAPROSYN PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
EDARBI HIGH BLOOD PRESSURE CANDESARTAN, CANDESARTAN/HCTZ, EPROSARTAN, IRBESARTAN, IRBESARTAN/HCTZ, LOSARTAN, LOSARTAN/HCTZ, OLMESARTAN TABLETS, OLMESARTAN/HCTZ TABLETS, OLMESARTAN/AMLODIPINE TABLETS, OLMESARTAN/AMLODIPINE/HCTZ TABLETS, TELMISARTAN, TELMISARTAN/AMLODIPINE, TELMISARTAN/HCTZ, VALSARTAN, VALSARTAN/HCTZ, VALSARTAN/AMLODIPINE, VALSARTAN/AMLODIPINE/HYDROCHLOROTHIAZIDE
EDARBYCLOR HIGH BLOOD PRESSURE CANDESARTAN, CANDESARTAN/HCTZ, EPROSARTAN, IRBESARTAN, IRBESARTAN/HCTZ, LOSARTAN, LOSARTAN/HCTZ, OLMESARTAN TABLETS, OLMESARTAN/HCTZ TABLETS, OLMESARTAN/AMLODIPINE TABLETS, OLMESARTAN/AMLODIPINE/HCTZ TABLETS, TELMISARTAN, TELMISARTAN/AMLODIPINE, TELMISARTAN/HCTZ, VALSARTAN, VALSARTAN/HCTZ, VALSARTAN/AMLODIPINE, VALSARTAN/AMLODIPINE/HYDROCHLOROTHIAZIDE
EDLUAR SLEEP DISORDER ESZOPICLONE, ZALEPLON, ZOLPIDEM, ZOLPIDEM ER
EFFEXOR DEPRESSION REQUIRES USE OF ANY ONE (BRAND OR GENERIC SSRI) OR (GENERIC SNRI)
SSRIS: CITALOPRAM (CELEXA), DULOXETINE (CYMBALTA), ESCITALOPRAM (LEXAPRO), FLUOXETINE (PROZAC, SARAFEM), FLUVOXAMINE IR OR ER (LUVOX CR), PAROXETINE IR OR ER (PAXIL, PAXIL CR), PEXEVA, SERTRALINE (ZOLOFT), TRINTELLIX (FORMERLY KNOWN AS BRINTELLIX), VIIBRYD
SNRIS: VENLAFAXINE IR OR ER, VENLAFAXINE IMMEDIATE-RELEASE TABLETS
EFFEXOR XR DEPRESSION REQUIRES USE OF ANY ONE (BRAND OR GENERIC SSRI) OR (GENERIC SNRI)
SSRIS: CITALOPRAM (CELEXA), DULOXETINE (CYMBALTA), ESCITALOPRAM (LEXAPRO), FLUOXETINE (PROZAC, SARAFEM), FLUVOXAMINE IR OR ER (LUVOX CR), PAROXETINE IR OR ER (PAXIL, PAXIL CR), PEXEVA, SERTRALINE (ZOLOFT), TRINTELLIX (FORMERLY KNOWN AS BRINTELLIX), VIIBRYD
SNRIS: VENLAFAXINE IR OR ER, VENLAFAXINE IMMEDIATE-RELEASE TABLETS
ELDEPRYL MENTAL/NEUROLOGICAL DISORDERS RASAGILINE, SELEGILINE
ELELYSO METABOLIC, IMMUNE DISORDERS OR INHERITED RARE DISEASE RULE 1: CEREZYME
ELESTAT EYE CONDITIONS AZELASTINE, EPINASTINE, OLOPATADINE
ELIDEL SKIN CONDITIONS REQUIRES USE OF ONE PRESCRIPTION TOPICAL CORTICOSTEROID FIRST (BRAND OR GENERIC):
FOR EXAMPLE:
ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
ELOCON SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
EMADINE EYE CONDITIONS AZELASTINE, EPINASTINE, OLOPATADINE
EMBEDA PAIN - NARCOTIC N/A
ENABLEX OVERACTIVE BLADDER DARIFENACIN ER, OXYBUTYNIN IR, OXYBUTYNIN ER, TOLTERODINE, TOLTERODINE ER, TROSPIUM, TROSPIUM ER
ENVARSUS XR TRANSPLANT RULE 5: GENERIC TACROLIMUS
EPIDUO SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
EPIDUO FORTE SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
EPOGEN BLOOD DISORDERS PROCRIT
ESGIC PAIN RULE 6: GENERIC PRODUCT WITH BUTALBITAL
ESOMEPRAZOLE STRONTIUM ULCER RULE 1: ESOMEPRAZOLE, LANSOPRAZOLE (RX AND OTC), OMEPRAZOLE (RX OR OTC), PANTOPRAZOLE, RABEPRAZOLE
EUCRISA SKIN CONDITIONS REQUIRES USE OF ONE PRESCRIPTION TOPICAL CORTICOSTEROID FIRST (BRAND OR GENERIC):
FOR EXAMPLE:
ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
EVOCLIN SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
EVZIO PAIN - NARCOTIC NALOXONE 0.4 MG/ML VIAL, NALOXONE 0.4 MG/ML SYRINGE, NALOXONE 2 MG/2 ML SYRINGE
EXALGO PAIN - NARCOTIC N/A
EXELON PATCH MENTAL/NEUROLOGICAL DISORDERS RULE 1: GALANTAMINE, GALANTAMINE ER, RIVASTIGMINE, DONEPEZIL (DOES NOT INCLUDE DONEPEZIL 23 MG TABLETS)
EXELON TABLET MENTAL/NEUROLOGICAL DISORDERS RULE 1: GALANTAMINE, GALANTAMINE ER, RIVASTIGMINE, DONEPEZIL (DOES NOT INCLUDE DONEPEZIL 23 MG TABLETS)
EXFORGE HIGH BLOOD PRESSURE CANDESARTAN, CANDESARTAN/HCTZ, EPROSARTAN, IRBESARTAN, IRBESARTAN/HCTZ, LOSARTAN, LOSARTAN/HCTZ, OLMESARTAN TABLETS, OLMESARTAN/HCTZ TABLETS, OLMESARTAN/AMLODIPINE TABLETS, OLMESARTAN/AMLODIPINE/HCTZ TABLETS, TELMISARTAN, TELMISARTAN/AMLODIPINE, TELMISARTAN/HCTZ, VALSARTAN, VALSARTAN/HCTZ, VALSARTAN/AMLODIPINE, VALSARTAN/AMLODIPINE/HYDROCHLOROTHIAZIDE
EXFORGE HCT HIGH BLOOD PRESSURE CANDESARTAN, CANDESARTAN/HCTZ, EPROSARTAN, IRBESARTAN, IRBESARTAN/HCTZ, LOSARTAN, LOSARTAN/HCTZ, OLMESARTAN TABLETS, OLMESARTAN/HCTZ TABLETS, OLMESARTAN/AMLODIPINE TABLETS, OLMESARTAN/AMLODIPINE/HCTZ TABLETS, TELMISARTAN, TELMISARTAN/AMLODIPINE, TELMISARTAN/HCTZ, VALSARTAN, VALSARTAN/HCTZ, VALSARTAN/AMLODIPINE, VALSARTAN/AMLODIPINE/HYDROCHLOROTHIAZIDE
EXTAVIA MULTIPLE SCLEROSIS RULE 1: GENERIC GLATIRAMER 20MG OR 40 MG
FARXIGA DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
FELDENE PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
FENOFIBRATE CAPSULES (BRAND) HIGH BLOOD CHOLESTEROL FENOFIBRATE, FENOFIBRIC ACID
FENOGLIDE HIGH BLOOD CHOLESTEROL FENOFIBRATE, FENOFIBRIC ACID
FENOPROFEN (BRAND) PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
FETZIMA DEPRESSION REQUIRES USE OF ANY ONE (BRAND OR GENERIC SSRI) OR (GENERIC SNRI)
SSRIS: CITALOPRAM (CELEXA), DULOXETINE (CYMBALTA), ESCITALOPRAM (LEXAPRO), FLUOXETINE (PROZAC, SARAFEM), FLUVOXAMINE IR OR ER (LUVOX CR), PAROXETINE IR OR ER (PAXIL, PAXIL CR), PEXEVA, SERTRALINE (ZOLOFT), TRINTELLIX (FORMERLY KNOWN AS BRINTELLIX), VIIBRYD
SNRIS: VENLAFAXINE IR OR ER, VENLAFAXINE IMMEDIATE-RELEASE TABLETS
FEXMID MUSCLE RELAXANT RULE 3: GENERIC CYCLOBENZAPRINE
FIBRICOR HIGH BLOOD CHOLESTEROL FENOFIBRATE, FENOFIBRIC ACID
FINACEA FOAM SKIN CONDITIONS METRONIDAZOLE CREAM 0.75%, METRONIDAZOLE GEL 0.75% AND 1%, METRONIDAZOLE LOTION 0.75%, ROSADAN CREAM, ROSADAN GEL
FINACEA GEL SKIN CONDITIONS METRONIDAZOLE CREAM 0.75%, METRONIDAZOLE GEL 0.75% AND 1%, METRONIDAZOLE LOTION 0.75%, ROSADAN CREAM, ROSADAN GEL
FIORICET PAIN RULE 6: GENERIC PRODUCT WITH BUTALBITAL
FIORINAL PAIN RULE 6: GENERIC PRODUCT WITH BUTALBITAL
FIRMAGON ONCOLOGY ELIGARD
FLECTOR PATCH PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
FLOMAX BPH ALFUZOSIN ER, DOXAZOSIN, TAMSULOSIN, TERAZOSIN
FLONASE ALLERGIES BUDESONIDE NASAL SPRAY, BUDESONIDE NASAL SPRAY (OTC), FLUTICASONE PROPIONATE NASAL SPRAY, FLUNISOLIDE NASAL SPRAY, MOMETASONE FUROATE NASAL SPRAY, TRIAMCINOLONE NASAL SPRAY (OTC), TRIAMCINOLONE ACETONIDE NASAL SPRAY
FLOWTUSS COUGH AND COLD RULE 8: GENERIC COUGH/COLD LIQUID
FLUOXETINE 60MG TABLETS DEPRESSION REQUIRES USE OF ANY ONE GENERIC SSRI:
CITALOPRAM, ESCITALOPRAM, FLUOXETINE, FLUOXETINE DR, FLUVOXAMINE, FLUVOXAMINE ER, PAROXETINE, PAROXETINE CR, SERTRALINE
FOCALIN XR ATTENTION DISORDERS GENERIC STIMULANT MEDICATIONS
FOR EXAMPLE: AMPHETAMINE/DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, DEXMETHYLPHENIDATE EXTENDED-RELEASE CAPSULES, DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, METHYLPHENIDATE EXTENDED-RELEASE CAPSULES, METADATE ER, METHYLPHENIDATE SUSTAINED-RELEASE TABLETS, METHYLPHENIDATE EXTENDED-RELEASE TABLETS
FORFIVO XL DEPRESSION BUPROPION SR, BUPROPION ER
FORTAMET (BRAND AND GENERIC) DIABETES METFORMIN ER (GENERIC TO GLUCOPHAGE XR ONLY
FOSAMAX PLUS D BONE CONDITIONS STEP 1: ALENDRONATE, IBANDRONATE, RISEDRONATE
STEP 2: ATELVIA
FOSAMAX TABLETS BONE CONDITIONS STEP 1: ALENDRONATE, IBANDRONATE, RISEDRONATE
STEP 2: ATELVIA
FROVA MIGRAINE HEADACHES ALMOTRIPTAN, ELETRIPTAN, FROVATRIPTAN, NARATRIPTAN, RIZATRIPTAN, SUMATRIPTAN, SUMATRIPTAN INJECTION, SUMATRIPTAN NASAL SPRAY, ZOLMITRIPTAN
GELNIQUE OVERACTIVE BLADDER DARIFENACIN ER, OXYBUTYNIN IR, OXYBUTYNIN ER, TOLTERODINE, TOLTERODINE ER, TROSPIUM, TROSPIUM ER
GILENYA MULTIPLE SCLEROSIS RULE 1: GENERIC GLATIRAMER 20MG OR 40 MG
GLATOPA 20 MG MULTIPLE SCLEROSIS RULE 1: GENERIC GLATIRAMER 20MG OR 40 MG
GLUCOPHAGE DIABETES METFORMIN IR
GLUCOPHAGE XR (BRAND) DIABETES METFORMIN ER (GENERIC TO GLUCOPHAGE XR ONLY
GLUMETZA (BRAND AND GENERIC) DIABETES STEP 1: METFORMIN ER (GENERIC TO GLUCOPHAGE XR ONLY)
STEP 2: GLUCOPHAGE XR (BRAND), FORTAMET (BRAND AND GENERIC)
GLYXAMBI DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
GRALISE MENTAL/NEUROLOGICAL DISORDERS GABAPENTIN
HALOG SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
HECTOROL CAPSULES VITAMIN D DEFICIENCY CALCITRIOL CAPSULES, CALCITRIOL ORAL SOLUTION
HORIZANT MENTAL/NEUROLOGICAL DISORDERS GABAPENTIN
HYCOFENIX COUGH AND COLD RULE 8: GENERIC COUGH/COLD LIQUID
HYDROMORPHONE ER PAIN - NARCOTIC N/A
HYSINGLA ER PAIN - NARCOTIC N/A
HYTRIN BPH ALFUZOSIN ER, DOXAZOSIN, TAMSULOSIN, TERAZOSIN
HYZAAR HIGH BLOOD PRESSURE CANDESARTAN, CANDESARTAN/HCTZ, EPROSARTAN, IRBESARTAN, IRBESARTAN/HCTZ, LOSARTAN, LOSARTAN/HCTZ, OLMESARTAN TABLETS, OLMESARTAN/HCTZ TABLETS, OLMESARTAN/AMLODIPINE TABLETS, OLMESARTAN/AMLODIPINE/HCTZ TABLETS, TELMISARTAN, TELMISARTAN/AMLODIPINE, TELMISARTAN/HCTZ, VALSARTAN, VALSARTAN/HCTZ, VALSARTAN/AMLODIPINE, VALSARTAN/AMLODIPINE/HYDROCHLOROTHIAZIDE
IMITREX (ORAL) MIGRAINE HEADACHES ALMOTRIPTAN, ELETRIPTAN, FROVATRIPTAN, NARATRIPTAN, RIZATRIPTAN, SUMATRIPTAN, SUMATRIPTAN INJECTION, SUMATRIPTAN NASAL SPRAY, ZOLMITRIPTAN
IMITREX INJECTION MIGRAINE HEADACHES ALMOTRIPTAN, ELETRIPTAN, FROVATRIPTAN, NARATRIPTAN, RIZATRIPTAN, SUMATRIPTAN, SUMATRIPTAN INJECTION, SUMATRIPTAN NASAL SPRAY, ZOLMITRIPTAN
IMITREX NASAL SPRAY MIGRAINE HEADACHES ALMOTRIPTAN, ELETRIPTAN, FROVATRIPTAN, NARATRIPTAN, RIZATRIPTAN, SUMATRIPTAN, SUMATRIPTAN INJECTION, SUMATRIPTAN NASAL SPRAY, ZOLMITRIPTAN
INDERAL LA HIGH BLOOD PRESSURE RULE 1: GENERIC BETA-BLOCKERS (I.E., ACEBUTOLOL, ATENOLOL, BETAXOLOL, BISOPROLOL, CARVEDILOL, LABETALOL, METOPROLOL SUCCINATE ER, METOPROLOL TARTRATE, NADOLOL, PINDOLOL, PROPRANOLOL, PROPRANOLOL ER, TIMOLOL) AND GENERIC BETA-BLOCKER COMBINATION PRODUCTS (I.E., ATENOLOL/CHLORTHALIDONE, BISOPROLOL/HCTZ, METOPROLOL/HCTZ, NADOLOL/BENDROFLUMETHIAZIDE, PROPRANOLOL/HCTZ)
INDERAL XL HIGH BLOOD PRESSURE RULE 1: GENERIC BETA-BLOCKERS (I.E., ACEBUTOLOL, ATENOLOL, BETAXOLOL, BISOPROLOL, CARVEDILOL, LABETALOL, METOPROLOL SUCCINATE ER, METOPROLOL TARTRATE, NADOLOL, PINDOLOL, PROPRANOLOL, PROPRANOLOL ER, TIMOLOL) AND GENERIC BETA-BLOCKER COMBINATION PRODUCTS (I.E., ATENOLOL/CHLORTHALIDONE, BISOPROLOL/HCTZ, METOPROLOL/HCTZ, NADOLOL/BENDROFLUMETHIAZIDE, PROPRANOLOL/HCTZ)
INDOCIN PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
INGREZZA MENTAL/NEUROLOGICAL DISORDERS TETRABENAZINE
INNOPRAN XL HIGH BLOOD PRESSURE RULE 1: GENERIC BETA-BLOCKERS (I.E., ACEBUTOLOL, ATENOLOL, BETAXOLOL, BISOPROLOL, CARVEDILOL, LABETALOL, METOPROLOL SUCCINATE ER, METOPROLOL TARTRATE, NADOLOL, PINDOLOL, PROPRANOLOL, PROPRANOLOL ER, TIMOLOL) AND GENERIC BETA-BLOCKER COMBINATION PRODUCTS (I.E., ATENOLOL/CHLORTHALIDONE, BISOPROLOL/HCTZ, METOPROLOL/HCTZ, NADOLOL/BENDROFLUMETHIAZIDE, PROPRANOLOL/HCTZ)
INOVA 4-1 EASY PAD SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
INOVA 8-2 EASY PAD SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
INOVA EASY PAD SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
INTERMEZZO SLEEP DISORDER ESZOPICLONE, ZALEPLON, ZOLPIDEM, ZOLPIDEM ER
INTUNIV ATTENTION DISORDERS BRAND AND GENERIC STIMULANT MEDICATIONS
FOR EXAMPLE: ADDERALL, ADDERALL XR, ADZENYS XR ODT, APTENSIO XR, ATOMOXETINE, CONCERTA, DAYTRANA, DESOXYN, DEXEDRINE, DEXEDRINE SPANSULES, DEXTROAMPHETAMINE, DEXTROAMPHETAMINE SR, DEXMETHYLPHENIDATE IR, DYNAVEL XR, FOCALIN, FOCALIN XR, METADATE CD, METADATE ER, METHAMPHETAMINE, METHYLIN, METHYLIN ER, METHYLPHENIDATE ER, METHYLPHENIDATE IMMEDIATE RELEASE, MIXED AMPHETAMINE SALTS IR, QUILLICHEW ER, RITALIN LA, RITALIN SR, VYVANSE
INVOKAMET DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
INVOKAMET XR DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
INVOKANA DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
IRENKA DEPRESSION REQUIRES USE OF ANY ONE (BRAND OR GENERIC SSRI) OR (GENERIC SNRI)
SSRIS: CITALOPRAM (CELEXA), DULOXETINE (CYMBALTA), ESCITALOPRAM (LEXAPRO), FLUOXETINE (PROZAC, SARAFEM), FLUVOXAMINE IR OR ER (LUVOX CR), PAROXETINE IR OR ER (PAXIL, PAXIL CR), PEXEVA, SERTRALINE (ZOLOFT), TRINTELLIX (FORMERLY KNOWN AS BRINTELLIX), VIIBRYD
SNRIS: VENLAFAXINE IR OR ER, VENLAFAXINE IMMEDIATE-RELEASE TABLETS
JALYN BPH FINASTERIDE 5 MG
JANUMET DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
JANUMET XR DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
JANUVIA DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
JARDIANCE DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
JENTADUETO DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
JENTADUETO XR DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
JUBLIA ANTI-FUNGAL GENERIC CICLODAN 8% TOPICAL SOLUTION , CICLOPIROX TOPICAL SOLUTION 8%, CICLOPIROX 8% TREATMENT KIT
JUVISYNC DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
KADIAN PAIN - NARCOTIC N/A
KAPVAY ATTENTION DISORDERS BRAND AND GENERIC STIMULANT MEDICATIONS
FOR EXAMPLE: ADDERALL, ADDERALL XR, ADZENYS XR ODT, APTENSIO XR, ATOMOXETINE, CONCERTA, DAYTRANA, DESOXYN, DEXEDRINE, DEXEDRINE SPANSULES, DEXTROAMPHETAMINE, DEXTROAMPHETAMINE SR, DEXMETHYLPHENIDATE IR, DYNAVEL XR, FOCALIN, FOCALIN XR, METADATE CD, METADATE ER, METHAMPHETAMINE, METHYLIN, METHYLIN ER, METHYLPHENIDATE ER, METHYLPHENIDATE IMMEDIATE RELEASE, MIXED AMPHETAMINE SALTS IR, QUILLICHEW ER, RITALIN LA, RITALIN SR, VYVANSE
KARBINAL ER 4 MG/5 ML SUSPENSION ALLERGY CARBINOXAMINE 4 MG TABLET, CARBINOXAMINE 4 MG/5 ML LIQUID
KAZANO DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
KENALOG SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
KEPPRA MENTAL/NEUROLOGICAL DISORDERS RULE 3: LEVETIRACETAM , LEVETIRACETAM XR, ROWEEPRA
KEPPRA XR MENTAL/NEUROLOGICAL DISORDERS RULE 3: LEVETIRACETAM , LEVETIRACETAM XR, ROWEEPRA
KERYDIN ANTI-FUNGAL GENERIC CICLODAN 8% TOPICAL SOLUTION , CICLOPIROX TOPICAL SOLUTION 8%, CICLOPIROX 8% TREATMENT KIT
KHEDEZLA DEPRESSION REQUIRES USE OF ANY ONE (BRAND OR GENERIC SSRI) OR (GENERIC SNRI)
SSRIS: CITALOPRAM (CELEXA), DULOXETINE (CYMBALTA), ESCITALOPRAM (LEXAPRO), FLUOXETINE (PROZAC, SARAFEM), FLUVOXAMINE IR OR ER (LUVOX CR), PAROXETINE IR OR ER (PAXIL, PAXIL CR), PEXEVA, SERTRALINE (ZOLOFT), TRINTELLIX (FORMERLY KNOWN AS BRINTELLIX), VIIBRYD
SNRIS: VENLAFAXINE IR OR ER, VENLAFAXINE IMMEDIATE-RELEASE TABLETS
KLARON SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
KLOFENSAID II PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
KOMBIGLYZE XR DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
LAMICTAL MENTAL/NEUROLOGICAL DISORDERS RULE 2: LAMOTRIGINE, LAMOTRIGINE XR
LAMICTAL XR MENTAL/NEUROLOGICAL DISORDERS RULE 2: LAMOTRIGINE, LAMOTRIGINE XR
LASTACAFT EYE CONDITIONS AZELASTINE, EPINASTINE, OLOPATADINE
LESCOL HIGH BLOOD CHOLESTEROL STEP 1: ATORVASTATIN, LOVASTATIN, PRAVASTATIN, SIMVASTATIN, FLUVASTATIN, FLUVASTATIN EXTENDED-RELEASE, ROSUVASTATIN, ATORVASTATIN/AMLODIPINE, EZETIMIBE/SIMVASTATIN
STEP 2: LIVALO
LESCOL XL HIGH BLOOD CHOLESTEROL STEP 1: ATORVASTATIN, LOVASTATIN, PRAVASTATIN, SIMVASTATIN, FLUVASTATIN, FLUVASTATIN EXTENDED-RELEASE, ROSUVASTATIN, ATORVASTATIN/AMLODIPINE, EZETIMIBE/SIMVASTATIN
STEP 2: LIVALO
LETAIRIS PULMONARY HYPERTENSION TRACLEER, OPSUMIT
LEVATOL HIGH BLOOD PRESSURE RULE 1: GENERIC BETA-BLOCKERS (I.E., ACEBUTOLOL, ATENOLOL, BETAXOLOL, BISOPROLOL, CARVEDILOL, LABETALOL, METOPROLOL SUCCINATE ER, METOPROLOL TARTRATE, NADOLOL, PINDOLOL, PROPRANOLOL, PROPRANOLOL ER, TIMOLOL) AND GENERIC BETA-BLOCKER COMBINATION PRODUCTS (I.E., ATENOLOL/CHLORTHALIDONE, BISOPROLOL/HCTZ, METOPROLOL/HCTZ, NADOLOL/BENDROFLUMETHIAZIDE, PROPRANOLOL/HCTZ)
LEXAPRO DEPRESSION REQUIRES USE OF ANY ONE GENERIC SSRI:
CITALOPRAM, ESCITALOPRAM, FLUOXETINE, FLUOXETINE DR, FLUVOXAMINE, FLUVOXAMINE ER, PAROXETINE, PAROXETINE CR, SERTRALINE
LIDOCAINE-TETRACAINE 7%-7% CREAM SKIN CONDITIONS RULE 9: LIDOCAINE/PRILOCAINE CREAM
LIPITOR HIGH BLOOD CHOLESTEROL STEP 1: ATORVASTATIN, LOVASTATIN, PRAVASTATIN, SIMVASTATIN, FLUVASTATIN, FLUVASTATIN EXTENDED-RELEASE, ROSUVASTATIN, ATORVASTATIN/AMLODIPINE, EZETIMIBE/SIMVASTATIN
STEP 2: LIVALO
LIPOFEN HIGH BLOOD CHOLESTEROL FENOFIBRATE, FENOFIBRIC ACID
LIVALO HIGH BLOOD CHOLESTEROL STEP 1: ATORVASTATIN, LOVASTATIN, PRAVASTATIN, SIMVASTATIN, FLUVASTATIN, FLUVASTATIN EXTENDED-RELEASE, ROSUVASTATIN, ATORVASTATIN/AMLODIPINE, EZETIMIBE/SIMVASTATIN
STEP 2: LIVALO
LOCOID SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
LOCORT 7 DAY/11 DAY INFLAMMATORY CONDITIONS RULE 19: GENERIC DEXAMETHASON TABLETS
LOFIBRA HIGH BLOOD CHOLESTEROL FENOFIBRATE, FENOFIBRIC ACID
LOPRESSOR HIGH BLOOD PRESSURE RULE 1: GENERIC BETA-BLOCKERS (I.E., ACEBUTOLOL, ATENOLOL, BETAXOLOL, BISOPROLOL, CARVEDILOL, LABETALOL, METOPROLOL SUCCINATE ER, METOPROLOL TARTRATE, NADOLOL, PINDOLOL, PROPRANOLOL, PROPRANOLOL ER, TIMOLOL) AND GENERIC BETA-BLOCKER COMBINATION PRODUCTS (I.E., ATENOLOL/CHLORTHALIDONE, BISOPROLOL/HCTZ, METOPROLOL/HCTZ, NADOLOL/BENDROFLUMETHIAZIDE, PROPRANOLOL/HCTZ)
LOPRESSOR HCT HIGH BLOOD PRESSURE RULE 1: GENERIC BETA-BLOCKERS (I.E., ACEBUTOLOL, ATENOLOL, BETAXOLOL, BISOPROLOL, CARVEDILOL, LABETALOL, METOPROLOL SUCCINATE ER, METOPROLOL TARTRATE, NADOLOL, PINDOLOL, PROPRANOLOL, PROPRANOLOL ER, TIMOLOL) AND GENERIC BETA-BLOCKER COMBINATION PRODUCTS (I.E., ATENOLOL/CHLORTHALIDONE, BISOPROLOL/HCTZ, METOPROLOL/HCTZ, NADOLOL/BENDROFLUMETHIAZIDE, PROPRANOLOL/HCTZ)
LORZONE MUSCLE RELAXANT RULE 10: GENERIC CHLORZOXAZONE
LUNESTA SLEEP DISORDER ESZOPICLONE, ZALEPLON, ZOLPIDEM, ZOLPIDEM ER
LUVOX CR DEPRESSION REQUIRES USE OF ANY ONE GENERIC SSRI:
CITALOPRAM, ESCITALOPRAM, FLUOXETINE, FLUOXETINE DR, FLUVOXAMINE, FLUVOXAMINE ER, PAROXETINE, PAROXETINE CR, SERTRALINE
LUXIQ SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
LYRICA CR MENTAL/NEUROLOGICAL DISORDERS N/A (PA RULE WILL STOP ALL CLAIMS)
MARINOL NAUSEA/VOMITING AT LEAST 2 CONVENTIONAL ANTIEMETIC TREATMENT (FOR N/V ASSOCIATED WITH CANCER CHEMOTHERAPY) OR GENERIC DRONABINOL CAPSULES
MAVYRET HEPATITIS C HARVONI, EPCLUSA, VIEKIRA PAK, VIEKIRA XR, VOSEVI, ZEPATIER
MAXALT MIGRAINE HEADACHES ALMOTRIPTAN, ELETRIPTAN, FROVATRIPTAN, NARATRIPTAN, RIZATRIPTAN, SUMATRIPTAN, SUMATRIPTAN INJECTION, SUMATRIPTAN NASAL SPRAY, ZOLMITRIPTAN
MAXALT MLT MIGRAINE HEADACHES ALMOTRIPTAN, ELETRIPTAN, FROVATRIPTAN, NARATRIPTAN, RIZATRIPTAN, SUMATRIPTAN, SUMATRIPTAN INJECTION, SUMATRIPTAN NASAL SPRAY, ZOLMITRIPTAN
METADATE CD ATTENTION DISORDERS GENERIC STIMULANT MEDICATIONS
FOR EXAMPLE: AMPHETAMINE/DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, DEXMETHYLPHENIDATE EXTENDED-RELEASE CAPSULES, DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, METHYLPHENIDATE EXTENDED-RELEASE CAPSULES, METADATE ER, METHYLPHENIDATE SUSTAINED-RELEASE TABLETS, METHYLPHENIDATE EXTENDED-RELEASE TABLETS
METHADOSE PAIN - NARCOTIC N/A
METHERGINE MIGRAINE HEADACHES TRIAL OF OTHER SPECIFIC HEADACHE THERAPIES (PRIOR AUTH WITH STEP THERAPY)
METROCREAM SKIN CONDITIONS METRONIDAZOLE CREAM 0.75%, METRONIDAZOLE GEL 0.75% AND 1%, METRONIDAZOLE LOTION 0.75%, ROSADAN CREAM, ROSADAN GEL
METROGEL SKIN CONDITIONS METRONIDAZOLE CREAM 0.75%, METRONIDAZOLE GEL 0.75% AND 1%, METRONIDAZOLE LOTION 0.75%, ROSADAN CREAM, ROSADAN GEL
METROLOTION SKIN CONDITIONS METRONIDAZOLE CREAM 0.75%, METRONIDAZOLE GEL 0.75% AND 1%, METRONIDAZOLE LOTION 0.75%, ROSADAN CREAM, ROSADAN GEL
MEVACOR HIGH BLOOD CHOLESTEROL STEP 1: ATORVASTATIN, LOVASTATIN, PRAVASTATIN, SIMVASTATIN, FLUVASTATIN, FLUVASTATIN EXTENDED-RELEASE, ROSUVASTATIN, ATORVASTATIN/AMLODIPINE, EZETIMIBE/SIMVASTATIN
STEP 2: LIVALO
MICARDIS HIGH BLOOD PRESSURE CANDESARTAN, CANDESARTAN/HCTZ, EPROSARTAN, IRBESARTAN, IRBESARTAN/HCTZ, LOSARTAN, LOSARTAN/HCTZ, OLMESARTAN TABLETS, OLMESARTAN/HCTZ TABLETS, OLMESARTAN/AMLODIPINE TABLETS, OLMESARTAN/AMLODIPINE/HCTZ TABLETS, TELMISARTAN, TELMISARTAN/AMLODIPINE, TELMISARTAN/HCTZ, VALSARTAN, VALSARTAN/HCTZ, VALSARTAN/AMLODIPINE, VALSARTAN/AMLODIPINE/HYDROCHLOROTHIAZIDE
MICARDIS HCT HIGH BLOOD PRESSURE CANDESARTAN, CANDESARTAN/HCTZ, EPROSARTAN, IRBESARTAN, IRBESARTAN/HCTZ, LOSARTAN, LOSARTAN/HCTZ, OLMESARTAN TABLETS, OLMESARTAN/HCTZ TABLETS, OLMESARTAN/AMLODIPINE TABLETS, OLMESARTAN/AMLODIPINE/HCTZ TABLETS, TELMISARTAN, TELMISARTAN/AMLODIPINE, TELMISARTAN/HCTZ, VALSARTAN, VALSARTAN/HCTZ, VALSARTAN/AMLODIPINE, VALSARTAN/AMLODIPINE/HYDROCHLOROTHIAZIDE
MIGRANAL MIGRAINE HEADACHES ALMOTRIPTAN, ELETRIPTAN, FROVATRIPTAN, NARATRIPTAN, RIZATRIPTAN, SUMATRIPTAN, SUMATRIPTAN INJECTION, SUMATRIPTAN NASAL SPRAY, ZOLMITRIPTAN
MINOCIN ANTI-INFECTIVE GENERIC SOLID DOSAGE FORMS: AVIDOXY, DEMECLOCYCLINE, DOXYCYCLINE IR, DOXYCYCLINE DR, MINOCYCLINE IR, MONDOXYNE NL, MORGIDOX, OCUDOX CONVENIENCE KIT, TETRACYCLINE
MINOCIN KIT ANTI-INFECTIVE GENERIC SOLID DOSAGE FORMS: AVIDOXY, DEMECLOCYCLINE, DOXYCYCLINE IR, DOXYCYCLINE DR, MINOCYCLINE IR, MONDOXYNE NL, MORGIDOX, OCUDOX CONVENIENCE KIT, TETRACYCLINE
MINOCYCLINE ER ANTI-INFECTIVE GENERIC SOLID DOSAGE FORMS: AVIDOXY, DEMECLOCYCLINE, DOXYCYCLINE IR, DOXYCYCLINE DR, MINOCYCLINE IR, MONDOXYNE NL, MORGIDOX, OCUDOX CONVENIENCE KIT, TETRACYCLINE
MIRCERA BLOOD DISORDERS PROCRIT
MOBIC PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
MONODOX ANTI-INFECTIVE GENERIC SOLID DOSAGE FORMS: AVIDOXY, DEMECLOCYCLINE, DOXYCYCLINE IR, DOXYCYCLINE DR, MINOCYCLINE IR, MONDOXYNE NL, MORGIDOX, OCUDOX CONVENIENCE KIT, TETRACYCLINE
MORGIDOX KIT ANTI-INFECTIVE GENERIC SOLID DOSAGE FORMS: AVIDOXY, DEMECLOCYCLINE, DOXYCYCLINE IR, DOXYCYCLINE DR, MINOCYCLINE IR, MONDOXYNE NL, MORGIDOX, OCUDOX CONVENIENCE KIT, TETRACYCLINE
MORPHINE SULFATE CR/ER PAIN - NARCOTIC N/A
MOTRIN PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
MS CONTIN PAIN - NARCOTIC N/A
MYRBETRIQ OVERACTIVE BLADDER DARIFENACIN ER, OXYBUTYNIN IR, OXYBUTYNIN ER, TOLTERODINE, TOLTERODINE ER, TROSPIUM, TROSPIUM ER
NALFON PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
NAMENDA ORAL SOLUTION MENTAL/NEUROLOGICAL DISORDERS RULE 3: MEMANTINE TABLETS, MEMANTINE ORAL SOLUTION
NAMENDA TABLETS MENTAL/NEUROLOGICAL DISORDERS RULE 3: MEMANTINE TABLETS, MEMANTINE ORAL SOLUTION
NAMENDA XR MENTAL/NEUROLOGICAL DISORDERS RULE 3: MEMANTINE TABLETS, MEMANTINE ORAL SOLUTION
NAMZARIC MENTAL/NEUROLOGICAL DISORDERS RULE 1: GALANTAMINE, GALANTAMINE ER, RIVASTIGMINE, DONEPEZIL (DOES NOT INCLUDE DONEPEZIL 23 MG TABLETS)
NAPRELAN PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
NAPROSYN PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
NASACORT ALLERGIES BUDESONIDE NASAL SPRAY, BUDESONIDE NASAL SPRAY (OTC), FLUTICASONE PROPIONATE NASAL SPRAY, FLUNISOLIDE NASAL SPRAY, MOMETASONE FUROATE NASAL SPRAY, TRIAMCINOLONE NASAL SPRAY (OTC), TRIAMCINOLONE ACETONIDE NASAL SPRAY
NASACORT AQ ALLERGIES BUDESONIDE NASAL SPRAY, BUDESONIDE NASAL SPRAY (OTC), FLUTICASONE PROPIONATE NASAL SPRAY, FLUNISOLIDE NASAL SPRAY, MOMETASONE FUROATE NASAL SPRAY, TRIAMCINOLONE NASAL SPRAY (OTC), TRIAMCINOLONE ACETONIDE NASAL SPRAY
NASONEX ALLERGIES BUDESONIDE NASAL SPRAY, BUDESONIDE NASAL SPRAY (OTC), FLUTICASONE PROPIONATE NASAL SPRAY, FLUNISOLIDE NASAL SPRAY, MOMETASONE FUROATE NASAL SPRAY, TRIAMCINOLONE NASAL SPRAY (OTC), TRIAMCINOLONE ACETONIDE NASAL SPRAY
NESINA DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
NEUAC SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
NEURONTIN MENTAL/NEUROLOGICAL DISORDERS GABAPENTIN
NEXIUM ULCER RULE 1: ESOMEPRAZOLE, LANSOPRAZOLE (RX AND OTC), OMEPRAZOLE (RX OR OTC), PANTOPRAZOLE, RABEPRAZOLE
NOCTIVA OVERACTIVE BLADDER DESMOPRESSIN
NORITATE CREAM SKIN CONDITIONS METRONIDAZOLE CREAM 0.75%, METRONIDAZOLE GEL 0.75% AND 1%, METRONIDAZOLE LOTION 0.75%, ROSADAN CREAM, ROSADAN GEL
NORVASC HIGH BLOOD PRESSURE RULE 1: GENERIC DHP CCBS: AFEDITAB CR, AMLODIPINE, AMLODIPINE/ATORVASTATIN, AMLODIPINE/BENAZEPRIL, FELODIPINE ER, ISRADIPINE IR, NICARDIPINE IR, NIFEDIPINE, NIFEDIPINE ER, NIFEDIPINE XL, NIFEDIAC CC, NIFEDICAL XL, NISOLDIPINE ER
NOVACORT 2%-1% GEL SKIN CONDITIONS RULE 11: HYDROCORTISONE-PRAMOXINE CREAM
NUCYNTA ER PAIN - NARCOTIC N/A
NUOX SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
OBERDON COUGH AND COLD RULE 8: GENERIC COUGH/COLD LIQUID
OLEPTRO ER SLEEP DISORDERS RULE 12: GENERIC TRAZODONE
OLUMIANT INFLAMMATORY CONDITIONS RHEUMATOID ARTHRITIS: ACTEMRA SC, ENBREL, HUMIRA, XELJANZ/XR (TRY 2)
OLUX SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
OLUX-E SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
OLYSIO HEPATITIS C HARVONI, EPCLUSA, VIEKIRA PAK, VIEKIRA XR, VOSEVI, ZEPATIER
OMNARIS ALLERGIES BUDESONIDE NASAL SPRAY, BUDESONIDE NASAL SPRAY (OTC), FLUTICASONE PROPIONATE NASAL SPRAY, FLUNISOLIDE NASAL SPRAY, MOMETASONE FUROATE NASAL SPRAY, TRIAMCINOLONE NASAL SPRAY (OTC), TRIAMCINOLONE ACETONIDE NASAL SPRAY
ONEXTON SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
ONGLYZA DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
ONZETRA XSAIL MIGRAINE HEADACHES ALMOTRIPTAN, ELETRIPTAN, FROVATRIPTAN, NARATRIPTAN, RIZATRIPTAN, SUMATRIPTAN, SUMATRIPTAN INJECTION, SUMATRIPTAN NASAL SPRAY, ZOLMITRIPTAN
OPANA ER PAIN - NARCOTIC N/A
OPTIVAR EYE CONDITIONS AZELASTINE, EPINASTINE, OLOPATADINE
ORACEA ANTI-INFECTIVE GENERIC SOLID DOSAGE FORMS: AVIDOXY, DEMECLOCYCLINE, DOXYCYCLINE IR, DOXYCYCLINE DR, MINOCYCLINE IR, MONDOXYNE NL, MORGIDOX, OCUDOX CONVENIENCE KIT, TETRACYCLINE
ORENCIA SC INFLAMMATORY CONDITIONS RHEUMATOID ARTHRITIS: ACTEMRA SC, ENBREL, HUMIRA, XELJANZ/XR (TRY 2)
JUVENILE IDIOPATHIC ARTHRITIS: ENBREL, HUMIRA, ACTEMRA SC (TRY 2)
PSORIATIC ARTHRITIS: COSENTYX, ENBREL, HUMIRA, STELARA SC, XELJANZ/XR (TRY 2)
ORTHO EVRA AND BRAND ORAL CONTRACEPTIVES CONTRACEPTIVES XULANE AND GENERIC ORAL CONTRACEPTIVES
OSENI DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
OTEZLA INFLAMMATORY CONDITIONS PSORIATIC ARTHRITIS: COSENTYX, ENBREL, HUMIRA, STELARA SC, XELJANZ/XR (TRY 1)
OTREXUP INFLAMMATORY CONDITIONS METHOTREXATE INJECTION
OVACE PLUS CREAM & LOTION SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
OXTELLAR XR MENTAL/NEUROLOGICAL DISORDERS RULE 4: OXCARBAZEPINE
OXYCODONE ER (BRAND) PAIN - NARCOTIC N/A
OXYCONTIN PAIN - NARCOTIC N/A
OXYMORPHONE ER PAIN - NARCOTIC N/A
OXYTROL OVERACTIVE BLADDER DARIFENACIN ER, OXYBUTYNIN IR, OXYBUTYNIN ER, TOLTERODINE, TOLTERODINE ER, TROSPIUM, TROSPIUM ER
PACNEX 7% SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ACNE CLEANSERS CONTAINING BENZOYL PEROXIDE OR SULFACETAMIDE/SULFUR
PACNEX HP SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ACNE CLEANSERS CONTAINING BENZOYL PEROXIDE OR SULFACETAMIDE/SULFUR
PACNEX LP SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ACNE CLEANSERS CONTAINING BENZOYL PEROXIDE OR SULFACETAMIDE/SULFUR
PACNEX MX SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ACNE CLEANSERS CONTAINING BENZOYL PEROXIDE OR SULFACETAMIDE/SULFUR
PANDEL SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
PATADAY EYE CONDITIONS AZELASTINE, EPINASTINE, OLOPATADINE
PATANOL EYE CONDITIONS AZELASTINE, EPINASTINE, OLOPATADINE
PAXIL DEPRESSION REQUIRES USE OF ANY ONE GENERIC SSRI:
CITALOPRAM, ESCITALOPRAM, FLUOXETINE, FLUOXETINE DR, FLUVOXAMINE, FLUVOXAMINE ER, PAROXETINE, PAROXETINE CR, SERTRALINE
PAXIL CR DEPRESSION REQUIRES USE OF ANY ONE GENERIC SSRI:
CITALOPRAM, ESCITALOPRAM, FLUOXETINE, FLUOXETINE DR, FLUVOXAMINE, FLUVOXAMINE ER, PAROXETINE, PAROXETINE CR, SERTRALINE
PAZEO EYE CONDITIONS AZELASTINE, EPINASTINE, OLOPATADINE
PEDIADERM SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
PEDIADERM TA SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
PEDIPIROX-4 NAIL KIT ANTI-FUNGAL GENERIC CICLODAN 8% TOPICAL SOLUTION , CICLOPIROX TOPICAL SOLUTION 8%, CICLOPIROX 8% TREATMENT KIT
PENLAC ANTI-FUNGAL GENERIC CICLODAN 8% TOPICAL SOLUTION , CICLOPIROX TOPICAL SOLUTION 8%, CICLOPIROX 8% TREATMENT KIT
PENNSAID PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
PEXEVA DEPRESSION REQUIRES USE OF ANY ONE GENERIC SSRI:
CITALOPRAM, ESCITALOPRAM, FLUOXETINE, FLUOXETINE DR, FLUVOXAMINE, FLUVOXAMINE ER, PAROXETINE, PAROXETINE CR, SERTRALINE
PLEXION CLEANSER & CLOTHS SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ACNE CLEANSERS CONTAINING BENZOYL PEROXIDE OR SULFACETAMIDE/SULFUR
PLEXION CREAM & LOTION SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
PLIAGLIS SKIN CONDITIONS RULE 9: LIDOCAINE/PRILOCAINE CREAM
PONSTEL PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
PRAVACHOL HIGH BLOOD CHOLESTEROL STEP 1: ATORVASTATIN, LOVASTATIN, PRAVASTATIN, SIMVASTATIN, FLUVASTATIN, FLUVASTATIN EXTENDED-RELEASE, ROSUVASTATIN, ATORVASTATIN/AMLODIPINE, EZETIMIBE/SIMVASTATIN
STEP 2: LIVALO
PRESTALIA HIGH BLOOD PRESSURE RULE 2: MUST USE ONE GENERIC DHP CCB AND ONE ACE-INHIBITOR (BRAND OR GENERIC)
PREVACID ULCER RULE 1: ESOMEPRAZOLE, LANSOPRAZOLE (RX AND OTC), OMEPRAZOLE (RX OR OTC), PANTOPRAZOLE, RABEPRAZOLE
PREVACID SOLUTAB ULCER RULE 1: ESOMEPRAZOLE, LANSOPRAZOLE (RX AND OTC), OMEPRAZOLE (RX OR OTC), PANTOPRAZOLE, RABEPRAZOLE
PRILOSEC ULCER RULE 1: ESOMEPRAZOLE, LANSOPRAZOLE (RX AND OTC), OMEPRAZOLE (RX OR OTC), PANTOPRAZOLE, RABEPRAZOLE
PRISTIQ DEPRESSION REQUIRES USE OF ANY ONE (BRAND OR GENERIC SSRI) OR (GENERIC SNRI)
SSRIS: CITALOPRAM (CELEXA), DULOXETINE (CYMBALTA), ESCITALOPRAM (LEXAPRO), FLUOXETINE (PROZAC, SARAFEM), FLUVOXAMINE IR OR ER (LUVOX CR), PAROXETINE IR OR ER (PAXIL, PAXIL CR), PEXEVA, SERTRALINE (ZOLOFT), TRINTELLIX (FORMERLY KNOWN AS BRINTELLIX), VIIBRYD
SNRIS: VENLAFAXINE IR OR ER, VENLAFAXINE IMMEDIATE-RELEASE TABLETS
PROCARDIA HIGH BLOOD PRESSURE RULE 1: GENERIC DHP CCBS: AFEDITAB CR, AMLODIPINE, AMLODIPINE/ATORVASTATIN, AMLODIPINE/BENAZEPRIL, FELODIPINE ER, ISRADIPINE IR, NICARDIPINE IR, NIFEDIPINE, NIFEDIPINE ER, NIFEDIPINE XL, NIFEDIAC CC, NIFEDICAL XL, NISOLDIPINE ER
PROCARDIA XL HIGH BLOOD PRESSURE RULE 1: GENERIC DHP CCBS: AFEDITAB CR, AMLODIPINE, AMLODIPINE/ATORVASTATIN, AMLODIPINE/BENAZEPRIL, FELODIPINE ER, ISRADIPINE IR, NICARDIPINE IR, NIFEDIPINE, NIFEDIPINE ER, NIFEDIPINE XL, NIFEDIAC CC, NIFEDICAL XL, NISOLDIPINE ER
PROCYSBI DR URINARY DISORDERS RULE 13: CYSTAGON
PROSCAR BPH FINASTERIDE 5 MG
PROTOCORT SUPPOSITORY INFLAMMATORY CONDITIONS GENERIC HYDROCORTISONE ACETATE SUPPOSITORY (25 MG OR 30 MG), ANUCORT-HC (25 MG), GRX HICORT (25 MG), HEMMOREX-HC (25 MG OR 30 MG), RECTACORT-HC (25 MG)
PROTONIX ULCER RULE 1: ESOMEPRAZOLE, LANSOPRAZOLE (RX AND OTC), OMEPRAZOLE (RX OR OTC), PANTOPRAZOLE, RABEPRAZOLE
PROTOPIC SKIN CONDITIONS REQUIRES USE OF ONE PRESCRIPTION TOPICAL CORTICOSTEROID FIRST (BRAND OR GENERIC):
FOR EXAMPLE:
ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
PROZAC DEPRESSION REQUIRES USE OF ANY ONE GENERIC SSRI:
CITALOPRAM, ESCITALOPRAM, FLUOXETINE, FLUOXETINE DR, FLUVOXAMINE, FLUVOXAMINE ER, PAROXETINE, PAROXETINE CR, SERTRALINE
PROZAC WEEKLY DEPRESSION REQUIRES USE OF ANY ONE GENERIC SSRI:
CITALOPRAM, ESCITALOPRAM, FLUOXETINE, FLUOXETINE DR, FLUVOXAMINE, FLUVOXAMINE ER, PAROXETINE, PAROXETINE CR, SERTRALINE
PRUDOXIN SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL CORTICOSTEROIDS (MUST TRY 2)
PSORCON SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
QDEXY XR MENTAL/NEUROLOGICAL DISORDERS TOPIRAMATE, TOPIRAGEN
QNASAL ALLERGIES BUDESONIDE NASAL SPRAY, BUDESONIDE NASAL SPRAY (OTC), FLUTICASONE PROPIONATE NASAL SPRAY, FLUNISOLIDE NASAL SPRAY, MOMETASONE FUROATE NASAL SPRAY, TRIAMCINOLONE NASAL SPRAY (OTC), TRIAMCINOLONE ACETONIDE NASAL SPRAY
QTERN DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
QUESTRAN HIGH BLOOD CHOLESTEROL CHOLESTYRAMINE, COLESTIPOL, PREVALITE
QUESTRAN LIGHT HIGH BLOOD CHOLESTEROL CHOLESTYRAMINE, COLESTIPOL, PREVALITE
QUILLICHEW ER ATTENTION DISORDERS GENERIC STIMULANT MEDICATIONS
FOR EXAMPLE: AMPHETAMINE/DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, DEXMETHYLPHENIDATE EXTENDED-RELEASE CAPSULES, DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, METHYLPHENIDATE EXTENDED-RELEASE CAPSULES, METADATE ER, METHYLPHENIDATE SUSTAINED-RELEASE TABLETS, METHYLPHENIDATE EXTENDED-RELEASE TABLETS
QUILLIVANT XR ATTENTION DISORDERS GENERIC STIMULANT MEDICATIONS
FOR EXAMPLE: AMPHETAMINE/DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, DEXMETHYLPHENIDATE EXTENDED-RELEASE CAPSULES, DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, METHYLPHENIDATE EXTENDED-RELEASE CAPSULES, METADATE ER, METHYLPHENIDATE SUSTAINED-RELEASE TABLETS, METHYLPHENIDATE EXTENDED-RELEASE TABLETS
RAPAFLO BPH ALFUZOSIN ER, DOXAZOSIN, TAMSULOSIN, TERAZOSIN
RASUVO INFLAMMATORY CONDITIONS METHOTREXATE INJECTION
RAYALDEE CAPSULES VITAMIN D DEFICIENCY CALCITRIOL CAPSULES, CALCITRIOL ORAL SOLUTION
RAYOS DR INFLAMMATION/IMMUNE DISORDERS RULE 14: GENERIC PREDNISONE
RAZADYNE MENTAL/NEUROLOGICAL DISORDERS RULE 1: GALANTAMINE, GALANTAMINE ER, RIVASTIGMINE, DONEPEZIL (DOES NOT INCLUDE DONEPEZIL 23 MG TABLETS)
RAZADYNE ER MENTAL/NEUROLOGICAL DISORDERS RULE 1: GALANTAMINE, GALANTAMINE ER, RIVASTIGMINE, DONEPEZIL (DOES NOT INCLUDE DONEPEZIL 23 MG TABLETS)
RECOMBINATE HEMOPHILIA ADVATE, ADYNOVATE, AFSTYLA, HELIXATE, KOGENATE, KOVALTRY, NOVOEIGHT, NUWIQ
RELISTOR CONSTIPATION AMITIZA, MOVANTIK, SYMPROIC (MUST TRY TWO)
RELPAX MIGRAINE HEADACHES ALMOTRIPTAN, ELETRIPTAN, FROVATRIPTAN, NARATRIPTAN, RIZATRIPTAN, SUMATRIPTAN, SUMATRIPTAN INJECTION, SUMATRIPTAN NASAL SPRAY, ZOLMITRIPTAN
REVATIO ORAL SUSPENSION PULMONARY HYPERTENSION SILDENAFIL 20MG TABLETS, TADALAFIL 20MG TABLETS
REVATIO TABLETS PULMONARY HYPERTENSION SILDENAFIL 20MG TABLETS, TADALAFIL 20MG TABLETS
RHINOCORT ALLERGIES BUDESONIDE NASAL SPRAY, BUDESONIDE NASAL SPRAY (OTC), FLUTICASONE PROPIONATE NASAL SPRAY, FLUNISOLIDE NASAL SPRAY, MOMETASONE FUROATE NASAL SPRAY, TRIAMCINOLONE NASAL SPRAY (OTC), TRIAMCINOLONE ACETONIDE NASAL SPRAY
RHINOCORT AQUA ALLERGIES BUDESONIDE NASAL SPRAY, BUDESONIDE NASAL SPRAY (OTC), FLUTICASONE PROPIONATE NASAL SPRAY, FLUNISOLIDE NASAL SPRAY, MOMETASONE FUROATE NASAL SPRAY, TRIAMCINOLONE NASAL SPRAY (OTC), TRIAMCINOLONE ACETONIDE NASAL SPRAY
RIOMET DIABETES METFORMIN IR
RITALIN LA ATTENTION DISORDERS GENERIC STIMULANT MEDICATIONS
FOR EXAMPLE: AMPHETAMINE/DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, DEXMETHYLPHENIDATE EXTENDED-RELEASE CAPSULES, DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, METHYLPHENIDATE EXTENDED-RELEASE CAPSULES, METADATE ER, METHYLPHENIDATE SUSTAINED-RELEASE TABLETS, METHYLPHENIDATE EXTENDED-RELEASE TABLETS
RITALIN SR ATTENTION DISORDERS GENERIC STIMULANT MEDICATIONS
FOR EXAMPLE: AMPHETAMINE/DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, DEXMETHYLPHENIDATE EXTENDED-RELEASE CAPSULES, DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, METHYLPHENIDATE EXTENDED-RELEASE CAPSULES, METADATE ER, METHYLPHENIDATE SUSTAINED-RELEASE TABLETS, METHYLPHENIDATE EXTENDED-RELEASE TABLETS
ROCALTROL CAPSULES VITAMIN D DEFICIENCY CALCITRIOL CAPSULES, CALCITRIOL ORAL SOLUTION
ROCALTROL ORAL SOLUTION VITAMIN D DEFICIENCY CALCITRIOL CAPSULES, CALCITRIOL ORAL SOLUTION
ROSADAN CREAM KIT SKIN CONDITIONS METRONIDAZOLE CREAM 0.75%, METRONIDAZOLE GEL 0.75% AND 1%, METRONIDAZOLE LOTION 0.75%, ROSADAN CREAM, ROSADAN GEL
ROSADAN GEL KIT SKIN CONDITIONS METRONIDAZOLE CREAM 0.75%, METRONIDAZOLE GEL 0.75% AND 1%, METRONIDAZOLE LOTION 0.75%, ROSADAN CREAM, ROSADAN GEL
ROSANIL SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ACNE CLEANSERS CONTAINING BENZOYL PEROXIDE OR SULFACETAMIDE/SULFUR
ROSULA SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ACNE CLEANSERS CONTAINING BENZOYL PEROXIDE OR SULFACETAMIDE/SULFUR
ROZEREM SLEEP DISORDER ESZOPICLONE, ZALEPLON, ZOLPIDEM, ZOLPIDEM ER
RYVENT 6 MG TABLET ALLERGY CARBINOXAMINE 4 MG TABLET, CARBINOXAMINE 4 MG/5 ML LIQUID
SANCTURA OVERACTIVE BLADDER DARIFENACIN ER, OXYBUTYNIN IR, OXYBUTYNIN ER, TOLTERODINE, TOLTERODINE ER, TROSPIUM, TROSPIUM ER
SANCTURA XR OVERACTIVE BLADDER DARIFENACIN ER, OXYBUTYNIN IR, OXYBUTYNIN ER, TOLTERODINE, TOLTERODINE ER, TROSPIUM, TROSPIUM ER
SARAFEM DEPRESSION REQUIRES USE OF ANY ONE GENERIC SSRI:
CITALOPRAM, ESCITALOPRAM, FLUOXETINE, FLUOXETINE DR, FLUVOXAMINE, FLUVOXAMINE ER, PAROXETINE, PAROXETINE CR, SERTRALINE
SAVELLA PAIN/INFLAMMATION REQUIRES USE OF ANY TWO (BRAND OR GENERIC SSRIS) OR (BRAND OR GENERIC SNRIS)
SSRIS: CITALOPRAM (CELEXA), DULOXETINE (CYMBALTA), ESCITALOPRAM (LEXAPRO), FLUOXETINE (PROZAC, SARAFEM), FLUVOXAMINE IR OR ER (LUVOX CR), PAROXETINE IR OR ER (PAXIL, PAXIL CR), PEXEVA, SERTRALINE (ZOLOFT), TRINTELLIX (FORMERLY KNOWN AS BRINTELLIX), VIIBRYD
SNRIS: DESVENLAFAXINE ER (BRAND), DESVENLAFAXINE FUMARATE ER (BRAND), FETZIMA, IRENKA, KHEDEZLA, PRISTIQ, VENLAFAXINE IR OR ER (EFFEXOR, EFFEXOR XR), VENLAFAXINE ER (BRAND PRODUCT)
SCALACORT SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
SECTRAL HIGH BLOOD PRESSURE RULE 1: GENERIC BETA-BLOCKERS (I.E., ACEBUTOLOL, ATENOLOL, BETAXOLOL, BISOPROLOL, CARVEDILOL, LABETALOL, METOPROLOL SUCCINATE ER, METOPROLOL TARTRATE, NADOLOL, PINDOLOL, PROPRANOLOL, PROPRANOLOL ER, TIMOLOL) AND GENERIC BETA-BLOCKER COMBINATION PRODUCTS (I.E., ATENOLOL/CHLORTHALIDONE, BISOPROLOL/HCTZ, METOPROLOL/HCTZ, NADOLOL/BENDROFLUMETHIAZIDE, PROPRANOLOL/HCTZ)
SERNIVO SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
SIKLOS SICKLE CELL DISEASE DROXIA
SILENOR SLEEP DISORDER ESZOPICLONE, ZALEPLON, ZOLPIDEM, ZOLPIDEM ER
SITAVIG BUCCAL TABLETS VIRAL INFECTIONS RULE 15: GENERIC ACYCLOVIR
SOLODYN ANTI-INFECTIVE GENERIC SOLID DOSAGE FORMS: AVIDOXY, DEMECLOCYCLINE, DOXYCYCLINE IR, DOXYCYCLINE DR, MINOCYCLINE IR, MONDOXYNE NL, MORGIDOX, OCUDOX CONVENIENCE KIT, TETRACYCLINE
SONATA SLEEP DISORDER ESZOPICLONE, ZALEPLON, ZOLPIDEM, ZOLPIDEM ER
SOOLANTRA SKIN CONDITIONS METRONIDAZOLE CREAM 0.75%, METRONIDAZOLE GEL 0.75% AND 1%, METRONIDAZOLE LOTION 0.75%, ROSADAN CREAM, ROSADAN GEL
SOVALDI HEPATITIS C HARVONI, EPCLUSA, VIEKIRA PAK, VIEKIRA XR, VOSEVI, ZEPATIER
SPIRITAM MENTAL/NEUROLOGICAL DISORDERS RULE 3: LEVETIRACETAM , LEVETIRACETAM XR, ROWEEPRA
SPRIX PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
STAVZOR MENTAL/NEUROLOGICAL DISORDERS RULE 1: DIVALPROEX SODIUM, DIVALPROEX SODIUM ER/EC/DR, VALPROIC ACID
STEGLATRO DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
STRATTERA ATTENTION DISORDERS BRAND AND GENERIC STIMULANT MEDICATIONS
FOR EXAMPLE: ADDERALL, ADDERALL XR, ADZENYS XR ODT, APTENSIO XR, ATOMOXETINE, CONCERTA, DAYTRANA, DESOXYN, DEXEDRINE, DEXEDRINE SPANSULES, DEXTROAMPHETAMINE, DEXTROAMPHETAMINE SR, DEXMETHYLPHENIDATE IR, DYNAVEL XR, FOCALIN, FOCALIN XR, METADATE CD, METADATE ER, METHAMPHETAMINE, METHYLIN, METHYLIN ER, METHYLPHENIDATE ER, METHYLPHENIDATE IMMEDIATE RELEASE, MIXED AMPHETAMINE SALTS IR, QUILLICHEW ER, RITALIN LA, RITALIN SR, VYVANSE
SULAR HIGH BLOOD PRESSURE RULE 1: GENERIC DHP CCBS: AFEDITAB CR, AMLODIPINE, AMLODIPINE/ATORVASTATIN, AMLODIPINE/BENAZEPRIL, FELODIPINE ER, ISRADIPINE IR, NICARDIPINE IR, NIFEDIPINE, NIFEDIPINE ER, NIFEDIPINE XL, NIFEDIAC CC, NIFEDICAL XL, NISOLDIPINE ER
SUMADAN SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ACNE CLEANSERS CONTAINING BENZOYL PEROXIDE OR SULFACETAMIDE/SULFUR
SUMADAN XLT SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ACNE CLEANSERS CONTAINING BENZOYL PEROXIDE OR SULFACETAMIDE/SULFUR
SUMAVEL DOSEPRO MIGRAINE HEADACHES ALMOTRIPTAN, ELETRIPTAN, FROVATRIPTAN, NARATRIPTAN, RIZATRIPTAN, SUMATRIPTAN, SUMATRIPTAN INJECTION, SUMATRIPTAN NASAL SPRAY, ZOLMITRIPTAN
SUMAXIN SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ACNE CLEANSERS CONTAINING BENZOYL PEROXIDE OR SULFACETAMIDE/SULFUR
SUMAXIN CP SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ACNE CLEANSERS CONTAINING BENZOYL PEROXIDE OR SULFACETAMIDE/SULFUR
SYNALAR SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
SYNALAR TS KIT SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
SYNDROS NAUSEA/VOMITING AT LEAST 2 CONVENTIONAL ANTIEMETIC TREATMENT (FOR N/V ASSOCIATED WITH CANCER CHEMOTHERAPY) OR GENERIC DRONABINOL CAPSULES
SYNJARDY DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
TACROLIMUS OINTMENT(GENERIC) SKIN CONDITIONS REQUIRES USE OF ONE PRESCRIPTION TOPICAL CORTICOSTEROID FIRST (BRAND OR GENERIC):
FOR EXAMPLE:
ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
TALTZ INFLAMMATORY CONDITIONS PSORIATIC ARTHRITIS: COSENTYX, ENBREL, HUMIRA, STELARA SC, XELJANZ/XR (TRY 2)
PSORIASIS: COSENTYX, HUMIRA, OTEZLA, STELARA SC (TRY 2)
TARGADOX ANTI-INFECTIVE GENERIC SOLID DOSAGE FORMS: AVIDOXY, DEMECLOCYCLINE, DOXYCYCLINE IR, DOXYCYCLINE DR, MINOCYCLINE IR, MONDOXYNE NL, MORGIDOX, OCUDOX CONVENIENCE KIT, TETRACYCLINE
TECFIDERA MULTIPLE SCLEROSIS RULE 1: GENERIC GLATIRAMER 20MG OR 40 MG
TEMOVATE SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
TENORETIC HIGH BLOOD PRESSURE RULE 1: GENERIC BETA-BLOCKERS (I.E., ACEBUTOLOL, ATENOLOL, BETAXOLOL, BISOPROLOL, CARVEDILOL, LABETALOL, METOPROLOL SUCCINATE ER, METOPROLOL TARTRATE, NADOLOL, PINDOLOL, PROPRANOLOL, PROPRANOLOL ER, TIMOLOL) AND GENERIC BETA-BLOCKER COMBINATION PRODUCTS (I.E., ATENOLOL/CHLORTHALIDONE, BISOPROLOL/HCTZ, METOPROLOL/HCTZ, NADOLOL/BENDROFLUMETHIAZIDE, PROPRANOLOL/HCTZ)
TENORMIN HIGH BLOOD PRESSURE RULE 1: GENERIC BETA-BLOCKERS (I.E., ACEBUTOLOL, ATENOLOL, BETAXOLOL, BISOPROLOL, CARVEDILOL, LABETALOL, METOPROLOL SUCCINATE ER, METOPROLOL TARTRATE, NADOLOL, PINDOLOL, PROPRANOLOL, PROPRANOLOL ER, TIMOLOL) AND GENERIC BETA-BLOCKER COMBINATION PRODUCTS (I.E., ATENOLOL/CHLORTHALIDONE, BISOPROLOL/HCTZ, METOPROLOL/HCTZ, NADOLOL/BENDROFLUMETHIAZIDE, PROPRANOLOL/HCTZ)
TESTRED HORMONAL SUPPLEMENTATION RULE 4: GENERIC OR METHITEST
TEVETEN HIGH BLOOD PRESSURE CANDESARTAN, CANDESARTAN/HCTZ, EPROSARTAN, IRBESARTAN, IRBESARTAN/HCTZ, LOSARTAN, LOSARTAN/HCTZ, OLMESARTAN TABLETS, OLMESARTAN/HCTZ TABLETS, OLMESARTAN/AMLODIPINE TABLETS, OLMESARTAN/AMLODIPINE/HCTZ TABLETS, TELMISARTAN, TELMISARTAN/AMLODIPINE, TELMISARTAN/HCTZ, VALSARTAN, VALSARTAN/HCTZ, VALSARTAN/AMLODIPINE, VALSARTAN/AMLODIPINE/HYDROCHLOROTHIAZIDE
TEVETEN HCT HIGH BLOOD PRESSURE CANDESARTAN, CANDESARTAN/HCTZ, EPROSARTAN, IRBESARTAN, IRBESARTAN/HCTZ, LOSARTAN, LOSARTAN/HCTZ, OLMESARTAN TABLETS, OLMESARTAN/HCTZ TABLETS, OLMESARTAN/AMLODIPINE TABLETS, OLMESARTAN/AMLODIPINE/HCTZ TABLETS, TELMISARTAN, TELMISARTAN/AMLODIPINE, TELMISARTAN/HCTZ, VALSARTAN, VALSARTAN/HCTZ, VALSARTAN/AMLODIPINE, VALSARTAN/AMLODIPINE/HYDROCHLOROTHIAZIDE
TEXACORT SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
TIVORBEX PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
TOPAMAX MENTAL/NEUROLOGICAL DISORDERS TOPIRAMATE, TOPIRAGEN
TOPAMAX SPRINKLE MENTAL/NEUROLOGICAL DISORDERS TOPIRAMATE, TOPIRAGEN
TOPICORT SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
TOPICORT SPRAY SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
TOPIRAMATE ER MENTAL/NEUROLOGICAL DISORDERS TOPIRAMATE, TOPIRAGEN
TOPROL XL HIGH BLOOD PRESSURE RULE 1: GENERIC BETA-BLOCKERS (I.E., ACEBUTOLOL, ATENOLOL, BETAXOLOL, BISOPROLOL, CARVEDILOL, LABETALOL, METOPROLOL SUCCINATE ER, METOPROLOL TARTRATE, NADOLOL, PINDOLOL, PROPRANOLOL, PROPRANOLOL ER, TIMOLOL) AND GENERIC BETA-BLOCKER COMBINATION PRODUCTS (I.E., ATENOLOL/CHLORTHALIDONE, BISOPROLOL/HCTZ, METOPROLOL/HCTZ, NADOLOL/BENDROFLUMETHIAZIDE, PROPRANOLOL/HCTZ)
TOVIAZ OVERACTIVE BLADDER DARIFENACIN ER, OXYBUTYNIN IR, OXYBUTYNIN ER, TOLTERODINE, TOLTERODINE ER, TROSPIUM, TROSPIUM ER
TRADJENTA DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
TRAMADOL EXTENDED RELEASE PAIN TRAMADOL, TRAMADOL ER, TRAMADOL/ACETAMINOPHEN
TRANDATE HIGH BLOOD PRESSURE RULE 1: GENERIC BETA-BLOCKERS (I.E., ACEBUTOLOL, ATENOLOL, BETAXOLOL, BISOPROLOL, CARVEDILOL, LABETALOL, METOPROLOL SUCCINATE ER, METOPROLOL TARTRATE, NADOLOL, PINDOLOL, PROPRANOLOL, PROPRANOLOL ER, TIMOLOL) AND GENERIC BETA-BLOCKER COMBINATION PRODUCTS (I.E., ATENOLOL/CHLORTHALIDONE, BISOPROLOL/HCTZ, METOPROLOL/HCTZ, NADOLOL/BENDROFLUMETHIAZIDE, PROPRANOLOL/HCTZ)
TRELSTAR DEPOT ONCOLOGY ELIGARD
TRELSTAR LA ONCOLOGY ELIGARD
TREMFYA INFLAMMATORY CONDITIONS PSORIASIS: HUMIRA
TREXIMET MIGRAINE HEADACHES ALMOTRIPTAN, ELETRIPTAN, FROVATRIPTAN, NARATRIPTAN, RIZATRIPTAN, SUMATRIPTAN, SUMATRIPTAN INJECTION, SUMATRIPTAN NASAL SPRAY, ZOLMITRIPTAN
TRIBENZOR HIGH BLOOD PRESSURE CANDESARTAN, CANDESARTAN/HCTZ, EPROSARTAN, IRBESARTAN, IRBESARTAN/HCTZ, LOSARTAN, LOSARTAN/HCTZ, OLMESARTAN TABLETS, OLMESARTAN/HCTZ TABLETS, OLMESARTAN/AMLODIPINE TABLETS, OLMESARTAN/AMLODIPINE/HCTZ TABLETS, TELMISARTAN, TELMISARTAN/AMLODIPINE, TELMISARTAN/HCTZ, VALSARTAN, VALSARTAN/HCTZ, VALSARTAN/AMLODIPINE, VALSARTAN/AMLODIPINE/HYDROCHLOROTHIAZIDE
TRICOR HIGH BLOOD CHOLESTEROL FENOFIBRATE, FENOFIBRIC ACID
TRIGLIDE HIGH BLOOD CHOLESTEROL FENOFIBRATE, FENOFIBRIC ACID
TRILEPTAL MENTAL/NEUROLOGICAL DISORDERS RULE 4: OXCARBAZEPINE
TRILIPIX HIGH BLOOD CHOLESTEROL FENOFIBRATE, FENOFIBRIC ACID
TROKENDI XR MENTAL/NEUROLOGICAL DISORDERS TOPIRAMATE, TOPIRAGEN
TUSSICAPS COUGH AND COLD RULE 16: GENERIC COUGH/COLD LIQUID
TUZISTRA XR COUGH AND COLD RULE 17: GENERIC COUGH/COLD LIQUID
TWYNSTA HIGH BLOOD PRESSURE CANDESARTAN, CANDESARTAN/HCTZ, EPROSARTAN, IRBESARTAN, IRBESARTAN/HCTZ, LOSARTAN, LOSARTAN/HCTZ, OLMESARTAN TABLETS, OLMESARTAN/HCTZ TABLETS, OLMESARTAN/AMLODIPINE TABLETS, OLMESARTAN/AMLODIPINE/HCTZ TABLETS, TELMISARTAN, TELMISARTAN/AMLODIPINE, TELMISARTAN/HCTZ, VALSARTAN, VALSARTAN/HCTZ, VALSARTAN/AMLODIPINE, VALSARTAN/AMLODIPINE/HYDROCHLOROTHIAZIDE
ULORIC GOUT ALLOPURINOL
ULTRACET PAIN TRAMADOL, TRAMADOL ER, TRAMADOL/ACETAMINOPHEN
ULTRAM PAIN TRAMADOL, TRAMADOL ER, TRAMADOL/ACETAMINOPHEN
ULTRAM ER PAIN TRAMADOL, TRAMADOL ER, TRAMADOL/ACETAMINOPHEN
ULTRAVATE SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
ULTRAVATE X SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
UROXATRAL BPH ALFUZOSIN ER, DOXAZOSIN, TAMSULOSIN, TERAZOSIN
VANATOL LQ PAIN RULE 6: GENERIC PRODUCT WITH BUTALBITAL
VANATOL S PAIN RULE 6: GENERIC PRODUCT WITH BUTALBITAL
VANOS SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
VELTIN SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
VENLAFAXINE EXTENDED-RELEASE (BRAND) DEPRESSION REQUIRES USE OF ANY ONE (BRAND OR GENERIC SSRI) OR (GENERIC SNRI)
SSRIS: CITALOPRAM (CELEXA), DULOXETINE (CYMBALTA), ESCITALOPRAM (LEXAPRO), FLUOXETINE (PROZAC, SARAFEM), FLUVOXAMINE IR OR ER (LUVOX CR), PAROXETINE IR OR ER (PAXIL, PAXIL CR), PEXEVA, SERTRALINE (ZOLOFT), TRINTELLIX (FORMERLY KNOWN AS BRINTELLIX), VIIBRYD
SNRIS: VENLAFAXINE IR OR ER, VENLAFAXINE IMMEDIATE-RELEASE TABLETS
VENTAVIS PULMONARY HYPERTENSION TYVASO
VERAMYST ALLERGIES BUDESONIDE NASAL SPRAY, BUDESONIDE NASAL SPRAY (OTC), FLUTICASONE PROPIONATE NASAL SPRAY, FLUNISOLIDE NASAL SPRAY, MOMETASONE FUROATE NASAL SPRAY, TRIAMCINOLONE NASAL SPRAY (OTC), TRIAMCINOLONE ACETONIDE NASAL SPRAY
VERDESO SKIN CONDITIONS REQUIRES USE OF TWO PRESCRIPTION GENERIC TOPICAL CORTICOSTEROIDS FIRST
FOR EXAMPLE: ALCLOMETASONE, AMCINONIDE, BETAMETHASONE DIPROPIONATE (AUGMENTED), BETAMETHASONE DIPROPIONATE, BETAMETHASONE VALERATE, CLOBETASOL, DESONIDE, DESOXIMETASONE, DIFLORASONE, FLUOCINOLONE, FLUOCINONIDE, FLURANDRENOLIDE, FLUTICASONE, HALOBETASOL, HYDROCORTISONE, MOMETASONE, PREDNICARBATE, TRIAMCINOLONE
VERELAN HIGH BLOOD PRESSURE RULE 3: VERAPAMIL SR, VERAPAMIL IR, VERAPAMIL ER
VERELAN PM HIGH BLOOD PRESSURE RULE 3: VERAPAMIL SR, VERAPAMIL IR, VERAPAMIL ER
VESICARE OVERACTIVE BLADDER DARIFENACIN ER, OXYBUTYNIN IR, OXYBUTYNIN ER, TOLTERODINE, TOLTERODINE ER, TROSPIUM, TROSPIUM ER
VIBRAMYCIN ANTI-INFECTIVE GENERIC SOLID DOSAGE FORMS: AVIDOXY, DEMECLOCYCLINE, DOXYCYCLINE IR, DOXYCYCLINE DR, MINOCYCLINE IR, MONDOXYNE NL, MORGIDOX, OCUDOX CONVENIENCE KIT, TETRACYCLINE
VIIBRYD DEPRESSION REQUIRES USE OF ANY ONE GENERIC SSRI:
CITALOPRAM, ESCITALOPRAM, FLUOXETINE, FLUOXETINE DR, FLUVOXAMINE, FLUVOXAMINE ER, PAROXETINE, PAROXETINE CR, SERTRALINE
VITUZ COUGH AND COLD RULE 17: GENERIC COUGH/COLD LIQUID
VIVLODEX PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
VOLTAREN GEL PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
VOLTAREN XR PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
VYTORIN HIGH BLOOD CHOLESTEROL STEP 1: ATORVASTATIN, LOVASTATIN, PRAVASTATIN, SIMVASTATIN, FLUVASTATIN, FLUVASTATIN EXTENDED-RELEASE, ROSUVASTATIN, ATORVASTATIN/AMLODIPINE, EZETIMIBE/SIMVASTATIN
STEP 2: LIVALO
VYVANSE ATTENTION DISORDERS GENERIC STIMULANT MEDICATIONS
FOR EXAMPLE: AMPHETAMINE/DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, DEXMETHYLPHENIDATE EXTENDED-RELEASE CAPSULES, DEXTROAMPHETAMINE EXTENDED-RELEASE CAPSULES, METHYLPHENIDATE EXTENDED-RELEASE CAPSULES, METADATE ER, METHYLPHENIDATE SUSTAINED-RELEASE TABLETS, METHYLPHENIDATE EXTENDED-RELEASE TABLETS
WELCHOL HIGH BLOOD CHOLESTEROL CHOLESTYRAMINE, COLESTIPOL, PREVALITE
WELLBUTRIN SR DEPRESSION BUPROPION SR, BUPROPION ER
WELLBUTRIN XL DEPRESSION BUPROPION SR, BUPROPION ER
XADAGO MENTAL/NEUROLOGICAL DISORDERS RASAGILINE, SELEGILINE
XATMEP ONCOLOGY/INFLAMMATORY CONDITIONS RULE 21: METHOTREXATE TABLETS, TREXALL
XENAZINE MENTAL/NEUROLOGICAL DISORDERS TETRABENAZINE
XIGDUO XR DIABETES REQUIRES USE OF ANY ONE METFORMIN OR METFORMIN-CONTAINING PRODUCT (BRAND OR GENERIC)
XTAMPZA ER PAIN - NARCOTIC N/A
XYNTHA HEMOPHILIA ADVATE, ADYNOVATE, AFSTYLA, HELIXATE, KOGENATE, KOVALTRY, NOVOEIGHT, NUWIQ
YOSPRALA ULCER RULE 18: ASPIRIN + RX PPI
ZAVESCA METABOLIC, IMMUNE DISORDERS OR INHERITED RARE DISEASE RULE 2: CERDELGA, GENERIC MIGLUSTAT
ZEBETA HIGH BLOOD PRESSURE RULE 1: GENERIC BETA-BLOCKERS (I.E., ACEBUTOLOL, ATENOLOL, BETAXOLOL, BISOPROLOL, CARVEDILOL, LABETALOL, METOPROLOL SUCCINATE ER, METOPROLOL TARTRATE, NADOLOL, PINDOLOL, PROPRANOLOL, PROPRANOLOL ER, TIMOLOL) AND GENERIC BETA-BLOCKER COMBINATION PRODUCTS (I.E., ATENOLOL/CHLORTHALIDONE, BISOPROLOL/HCTZ, METOPROLOL/HCTZ, NADOLOL/BENDROFLUMETHIAZIDE, PROPRANOLOL/HCTZ)
ZEGERID (BRAND AND SELECT GENERICS) ULCER RULE 2: ALL CLAIMS ARE STOPPED AND GIVEN THE POS MESSAGING TO TRY 5 OTHER GENERICS. IF A PATIENT HAS TRIED THE FIRST LINE ALTERNATIVES, A COVERAGE REVIEW MUST BE COMPLETED IN ORDER TO GAIN ACCESS TO A STEP 2 DRUG.
ZELAPAR MENTAL/NEUROLOGICAL DISORDERS RASAGILINE, SELEGILINE
ZEMAIRA METABOLIC, IMMUNE DISORDERS OR INHERITED RARE DISEASE ARALAST NP, GLASSIA
ZEMBRACE SYMTOUCH MIGRAINE HEADACHES ALMOTRIPTAN, ELETRIPTAN, FROVATRIPTAN, NARATRIPTAN, RIZATRIPTAN, SUMATRIPTAN, SUMATRIPTAN INJECTION, SUMATRIPTAN NASAL SPRAY, ZOLMITRIPTAN
ZEMPLAR CAPSULES VITAMIN D DEFICIENCY CALCITRIOL CAPSULES, CALCITRIOL ORAL SOLUTION
ZETIA HIGH BLOOD CHOLESTEROL STEP 1: GENERIC OR BRAND HMG/HMG COMBINATION PRODUCTS (I.E.: ATORVASTATIN, ATORVASTATIN PLUS AMLODIPINE, EZETIMIBE PLUS SIMVASTATIN, FLUVASTATIN, FLUVASTATIN ER, LOVASTATIN, PRAVASTATIN, ROSUVASTATIN, SIMVASTATIN, ALTOPREV, CADUET, CRESTOR, LESCOL, LESCOL XL, LIPITOR, LIVALO, MEVACOR, PRAVACHOL, VYTORIN, ZOCOR, ZYPITAMAG)
STEP 2: GENERIC EZETIMIBE TABLETS
ZETONNA ALLERGIES BUDESONIDE NASAL SPRAY, BUDESONIDE NASAL SPRAY (OTC), FLUTICASONE PROPIONATE NASAL SPRAY, FLUNISOLIDE NASAL SPRAY, MOMETASONE FUROATE NASAL SPRAY, TRIAMCINOLONE NASAL SPRAY (OTC), TRIAMCINOLONE ACETONIDE NASAL SPRAY
ZIAC HIGH BLOOD PRESSURE RULE 1: GENERIC BETA-BLOCKERS (I.E., ACEBUTOLOL, ATENOLOL, BETAXOLOL, BISOPROLOL, CARVEDILOL, LABETALOL, METOPROLOL SUCCINATE ER, METOPROLOL TARTRATE, NADOLOL, PINDOLOL, PROPRANOLOL, PROPRANOLOL ER, TIMOLOL) AND GENERIC BETA-BLOCKER COMBINATION PRODUCTS (I.E., ATENOLOL/CHLORTHALIDONE, BISOPROLOL/HCTZ, METOPROLOL/HCTZ, NADOLOL/BENDROFLUMETHIAZIDE, PROPRANOLOL/HCTZ)
ZIANA SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL ADAPALENE, BENZOYL PEROXIDE, CLINDAMYCIN, ERYTHROMYCIN, SODIUM SULFACETAMIDE, OR SODIUM SULFACETAMIDE/SULFUR-CONTAINING PRODUCTS
ZILEUTON ER ASTHMA/COPD RULE 20: GENERIC MONTELUKAST
ZIPSOR PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
ZOHYDRO ER PAIN - NARCOTIC N/A
ZOCOR HIGH BLOOD CHOLESTEROL STEP 1: ATORVASTATIN, LOVASTATIN, PRAVASTATIN, SIMVASTATIN, FLUVASTATIN, FLUVASTATIN EXTENDED-RELEASE, ROSUVASTATIN, ATORVASTATIN/AMLODIPINE, EZETIMIBE/SIMVASTATIN
STEP 2: LIVALO
ZOLOFT DEPRESSION REQUIRES USE OF ANY ONE GENERIC SSRI:
CITALOPRAM, ESCITALOPRAM, FLUOXETINE, FLUOXETINE DR, FLUVOXAMINE, FLUVOXAMINE ER, PAROXETINE, PAROXETINE CR, SERTRALINE
ZOLPIMIST SLEEP DISORDER ESZOPICLONE, ZALEPLON, ZOLPIDEM, ZOLPIDEM ER
ZOMIG MIGRAINE HEADACHES ALMOTRIPTAN, ELETRIPTAN, FROVATRIPTAN, NARATRIPTAN, RIZATRIPTAN, SUMATRIPTAN, SUMATRIPTAN INJECTION, SUMATRIPTAN NASAL SPRAY, ZOLMITRIPTAN
ZOMIG NASAL SPRAY MIGRAINE HEADACHES ALMOTRIPTAN, ELETRIPTAN, FROVATRIPTAN, NARATRIPTAN, RIZATRIPTAN, SUMATRIPTAN, SUMATRIPTAN INJECTION, SUMATRIPTAN NASAL SPRAY, ZOLMITRIPTAN
ZOMIG ZMT MIGRAINE HEADACHES ALMOTRIPTAN, ELETRIPTAN, FROVATRIPTAN, NARATRIPTAN, RIZATRIPTAN, SUMATRIPTAN, SUMATRIPTAN INJECTION, SUMATRIPTAN NASAL SPRAY, ZOLMITRIPTAN
ZONACORT 7 DAY/11 DAY INFLAMMATORY CONDITIONS RULE 19: GENERIC DEXAMETHASON TABLETS
ZONALON SKIN CONDITIONS GENERIC PRESCRIPTION TOPICAL CORTICOSTEROIDS (MUST TRY 2)
ZORVOLEX PAIN GENERIC NSAIDS (MUST USE TWO)
FOR EXAMPLE: DICLOFENAC (IR AND ER), DICLOFENAC TOPICAL SOLUTION 1.5%, ETODOLAC (IR AND ER), FENOPROFEN, FLURBIPROFEN, IBUPROFEN, INDOMETHACIN (IR AND ER), KETOPROFEN (IR AND ER), KETOROLAC (ORAL), MECLOFENAMATE, MEFENAMIC ACID, MELOXICAM, NABUMETONE, NAPROXEN (IR AND ER), OXAPROZIN, PIROXICAM, SULINDAC, TOLMETIN, DICLOFENAC SODIUM/MISOPROSTOL
ZURAMPIC GOUT PROBENECID, PROBENECID/COLCHICHINE
ZYFLO ASTHMA/COPD RULE 20: GENERIC MONTELUKAST
ZYFLO CR ASTHMA/COPD RULE 20: GENERIC MONTELUKAST