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GENERIC BRAND GENERIC BRAND Minocycline generics only Tetracycline generics only / Other Anti-Infectives...... Atovaquone Mepron / generic/Rondec Clindamycin generics only Ethambutol generic/Myambutol Zyrtec Iodoquinol Yodoxin Cetirizine/Pseudoephedrine Zyrtec-D Isoniazid Isoniazid generics only Isoniazid/Rifampin Rifamate generics only Isoniazid/Rifampin/ Rifater Fexofenadine/ Allegra-D Pyrazinamide Pseudoephedrine Methenamine generic/Hiprex Formulary HCl generics only Metronidazole generic/Flagyl Hydroxyzine HCl 100mg Atarax 375mg Tablets Nitrofurantoin generic/Macrodantin OCT 2009 Pyrazinamide Pyrazinamide Hydroxyzine Pamoate generics only generics only Rifabutin Mycobutin INTRODUCTION EXPECTORANT AND COUGH PRODUCTS------Rifampin generics only Carbinoxamine/ generic/Rondec- Tobramycin, inhaled TOBI This condensed formulary is designed to serve as Pseudoephedrine/DM DM Drops Antifungal Agents...... a reference guide and assist in the selection of Guaifenesin/Codeine generic/Tussi- Fluconazole generics only Griseofulvin Microsize Susp generics only cost-effective pharmaceutical products. The Organidin-S Griseofulvin Ultramicrosize generics only formulary is not intended to be a substitute for Guiafenesin/ generic/Deconsal/ Pseudoephedrine Duratuss GP Itraconazole generics only your clinical knowledge and judgment. In all Ketoconazole oral generics only cases, the prescriber is expected to select Hydrocodone/Homatropine generics only Promethazine/Codeine or DM generics only Nystatin oral generic/Mycostatin appropriate drug therapy for the individual patient Terbinafine generics only and provide high quality healthcare. Promethazine/ generics only Promethazine/Phenylephrine/ generics only ANTIVIRALS ------

Codeine Acyclovir generics only The APS National Pharmacy and Therapeutics /Pseudoephedrine/ generics only Acyclovir 250mg/5ml Susp Zovirax Committee will regularly review the formulary to Codeine Amantadine generics only ensure it meets the needs of both patients and NASAL ------Emtricitabine Emtriva providers. Thank you in advance for your generics only Ganciclovir Cytovene cooperation. Nasonex Indinavir Crixivan NASAL ------Lamivudine Epivir HBV GENERIC BRAND Astelin Oseltamivir Tamiflu ANTIDIABETIC AGENTS OTHER NASAL AGENTS ------Ribavirin generic/Copegus Ritonavir/Lopinavir Kaletra Ipratropium generics only Valacyclovir Valtrex ------Valganciclovir Valcyte ANTI-INFECTIVE AGENTS (ORAL) Rapid-Acting Insulins ...... Zidovudine Retrovir Aspart Novolog Apidra ANTHELMINTICS ------All self-administered drugs specifically indicated for Humalog Mebendazole generic/Vermox the treatment of HIV and its opportunistic infections Regular (Pork) Iletin II Reg/Insulin R Thiabendazole Mintezol are on formulary. Pork/Velosulin ANTIBIOTICS------Human BR Cephalosporins...... ANTINEOPLASTIC AND IMMUNOSUPPRESSIVE Regular Human Humulin R/Novolin R Cefadroxil generics only AGENTS Intermediate-Acting Insulins ...... Cefdinir generic/Omnicef Human Humulin,Novolin N, Cefpodoxime generics only L, 70/30,Humulin Cefprozil generics only All self-administered FDA-approved antineoplastic 50/50 Cefuroxime generics only and immunosuppressive agents are on formulary. Novolog Mix 70/30 Cephalexin generics only Insulin Lispro Humalog Mix 75/25 Cephradine generics only AUTONOMIC & CENTRAL NERVOUS SYSTEM Lente (Pork) Iletin II Lente Ketolides ...... NPH (Pork) Iletin II NPH/ Telithromycin Ketek ALZHEIMER’S AGENTS ------Long-Acting Insulins ...... Macrolides ...... Donepezil Aricept Levemir Azithromycin generics only Memantine Namenda Lantus Clarithromycin, SR generics only Rivastigmine Exelon Ultralente Human Humulin U Erythromycin Base generics only ANALGESICS, NARCOTIC ------ORAL ------Erythromycin Estolate generics only APAP/Caffeine/Butalbital generics only Acarbose Precose Erythromycin Ethylsuccinate generics only APAP or ASA/Codeine generics only Glimepiride generics only Erythromycin ES/ generics only APAP/Hydrocodone generics only Glipizide, XL generics only Sulfisoxazole ASA/Caffeine/Butalbital generics only Glyburide generics only Erythromycin Stearate generics only Buprenorphine Suboxone, Subutex Metformin, XR generics only Penicillins ...... Codeine/APAP or ASA/ generics only Metformin/Glyburide generics only Amoxicillin generic/Amoxil Caffeine/Butalbital Miglitol Glyset Ampicillin generic/Principen Fentanyl Transdermal generics only Nateglinide Starlix Amoxicillin/Clavulanate generic/ Fentanyl Transmucosal Actiq Pioglitazone Actos Augmentin/ES/XR Hydromorphone generics only Pioglitazone/Glimepiride Duetact Dicloxacillin generics only Meperidine generics only Pioglitazone/Metformin Actoplus Met Penicillin V Potassium generics only Methadone generics only Repaglinide Prandin Quinolones ...... Morphine Sulfate/SR generics only Rosiglitazone Avandia Ciprofloxacin generics only Oxycodone OxyContin Rosiglitazone/Glimepiride Avandaryl Levofloxacin Levaquin Oxycodone/APAP generics only Rosiglitazone/Metformin Avandamet Ofloxacin generics only Oxycodone/ASA generics only Sitagliptin Januvia Sulfonamides ...... Oxycodone/SA generics only Sitagliptin/Metformin Janumet Erythromycin ES/ generics only Propoxyphene HCl generics only OTHER ANTIDIABETIC AGENTS ------Sulfisoxazole Propoxyphene/APAP 650mg generics only Byetta Sulfisoxazole generic/Gantrisin Propoxyphene/APAP 325mg generics only Glucagon TMP-SMX/DS generics only ANALGESICS, NONSTEROIDAL ANTI- Symlin Tetracyclines ...... INFLAMMATORY ------Doxycycline hyclate generics only Diclofenac generics only GENERIC BRAND GENERIC BRAND GENERIC BRAND Etodolac generics only Flecainide generics only Flurbiprofen generics only Mexiletine generics only Ibuprofen generics only PSYCHOTHERAPEUTIC AGENTS ------Procainamide/SR generic/Pronestyl Indomethacin/SR generics only ...... Propafenone generics only Ketorolac generics only generics only Quinidine Gluconate SR generics only Nabumetone generics only Bupropion/SR generics only Quinidine Sulfate/SR generics only Naproxen/EC gen/Naprosyn Susp Bupropion XL Wellbutrin XL Sotalol gen/Betapace AF Oxaprozin generics only Citalopram generics only Tocainide Tonocard Piroxicam generics only generics only ANTICOAGULANTS/ANTITHROMBOTICS ------Sulindac generics only generics only ASA/Dipyridamole ER Aggrenox ANALGESICS, SALICYLATES ------Duloxetine Cymbalta Clopidogrel Plavix Choline Mg Trisalicylate generics only Escitalopram Lexapro Enoxaparin Lovenox Diflunisal 250mg Tablet gen/Dolobid 250mg Fluoxetine generics only Fondaparinux Arixtra Salsalate generics only generics only Ticlopidine generics only ANTICONVULSANTS ------ generics only Warfarin generic/Coumadin Carbamazepine/SR generic/Carbatrol/ Mirtazapine Remeron 45mg ANTILIPEMICS ------Tegretol/Tegretol XR SolTab Atorvastatin Lipitor Clonazepam generics only generics only Cholestyramine generics only Diazepam Rectal Gel Diastat Paroxetine/CR generic/Paxil susp/ Colestipol Colestid Divalproex Sodium Depakote/ER/Spr Paxil CR Ezetimibe Zetia Ethosuximide Tab/Liq generic/Zarontin Sertraline generics only Fenofibrate generic/Antara/ Felbamate Felbatol generics only Lofibra/Tricor Gabapentin gen/Neurontin soln Venlafaxine generics/Effexor XR Gemfibrozil generics only Lamotrigine generic/Lamictal Antimanic Agent ...... Lovastatin generics only Levetiracetam Keppra Lithium Carbonate/CR generic/Eskalith/CR/ Niacin ER Niaspan Oxcarbazepine generic/Trileptal Lithobid Niacin/Lovastatin Advicor Phenobarbital generics only Lithium Citrate generics only Omega-3 Acid Ethyl Esters Lovaza Phenytoin generic/Dilantin/ Antipsychotic Agents ...... Pravastatin generics only Phenytek Abilify Simvastatin generics only Primidone generics only generics only CALCIUM CHANNEL BLOCKERS ------Tiagabine Gabitril generic/Clozaril, Amlodipine generics only Topiramate Topamax Fazaclo Diltiazem/SR/XR generics only Valproic Acid generic/Depakene generic only Felodipine generics only Zonisamide generic/Zonegran generics only Nifedipine XL/SR generics only ANTIPARKINSON AGENTS ------ Zyprexa/Zydis Nisoldipine ER Sular Apomorphine subcutaneous Apokyn Invega Verapamil/SR generics only Benztropine Mesylate generics only generics only COMBINATION ANTIHYPERTENSIVES ------ generics only Seroquel/XR Amlodipine/atorvastatin Caduet Carbidopa/Levodopa,CR generic only Risperdal/M Benazepril/Amlodipine generics only Carbidopa/Levodopa/ Stalevo generics only Benazepril/HCTZ generics only Entacapone Thiothixene gen/ Navane 20mg Bisoprolol/HCTZ generics only Entacapone COMTan generics only Captopril/HCTZ generics only Pramipexole Mirapex Geodon Enalapril/HCTZ generics only Ropinirole Requip Lisinopril/HCTZ generics only Selegiline generics only CARDIOVASCULAR AGENTS Losartan/HCTZ Hyzaar Trihexyphenidyl generics only Moexipril/HCTZ Uniretic ANXIOLYTICS, SEDATIVES, AND HYPNOTICS ----- ALDOSTERONE ANTAGONISTS ------Quinapril/HCTZ Quinaretic Alprazolam generics only Spironolactone generics only Valsartan/HCTZ Diovan HCT Buspirone generics only ANGIOTENSIN II ANTAGONISTS ------DIURETICS ------Chlordiazepoxide generics only Losartan Cozaar Acetazolamide/SR generics only Clorazepate/SD gen/Tranxene SD Valsartan Diovan Chlorthalidone Thalitone Diazepam generics only ANGIOTENSIN CONVERTING ENZYME INHIBITORS Furosemide generics only Lorazepam generics only Benazepril generics only HCTZ/Triamterene generics only Meprobamate generics only Captopril generics only Hydrochlorothiazide generics only Temazepam generics only Enalapril generics only Indapamide generic/Lozol Triazolam generics only Fosinopril generics only Methazolamide generics only Zolpidem generic/Ambien CR Lisinopril generics only Metolazone generic/Zaroxolyn CEREBRAL STIMULANTS ------Quinapril generics only Spironolactone/HCTZ generics only Amphetamine/ generic/Adderall XR Ramipril Altace Torsemide generics only D-amphetamine/XR ANTI-ADRENERGIC AGENTS – BETA-BLOCKERS -- VASODILATORS ------Methylphenidate/SR generics only Atenolol generics only Dipyridamole generics only Methylphenidate ER Concerta Carvedilol generic/Coreg/CR Hydralazine generics only DMARDS ------Labetalol generics only Isosorbide Dinitrate/SR generic/Isordil/ Adalimumab Humira Metoprolol/XL generics/ Toprol XL Dilatrate-SR Anakinra Kineret Pindolol generics only Isosorbide Dinitrate/ BiDil Auranofin Ridaura Propranolol/LA/XL generic/Inderal LA/ Hydralazine Etanercept Enbrel Innopran XL Minoxidil generics only Infliximab Remicade ANTI-ADRENERGIC BLOCKERS – CENTRALLY Nitroglycerin Sublingual generic/Nitrostat Leflunomide generics only ACTING ------Nitroglycerin SR generics only Methotrexate generic/ Clonidine generics only Nitroglycerin Patch gen/Minitran/Nitrek Rheumatrex/Trexall Methyldopa generic/Aldomet Nitro-Dur MIGRAINE AGENTS------ANTI-ADRENERGIC BLOCKERS – PERIPHERALLY Nitroglycerin Spray Nitrolingual Dihydroergotamine Mesylate Migranal ACTING------Nitroglycerin Topical generics only Ergotamine/Caffeine generic/Cafergot Doxazosin generics only Isometheptene/APAP/ generic/Midrin Prazosin generics only CONTRACEPTIVES Dichloralphenazone Tamsulosin Flomax Rizatriptan Maxalt/MLT Terazosin generics only MONOPHASIC ------Sumatriptan Imitrex ANTIARRHYTHMICS ------EE/Desogestrel generics only Zomitriptan Zomig/ZMT Amiodarone generic/Cordarone (e.g.,Apri) OBSESSIVE COMPULSIVE DISORDER AGENTS--- Digoxin generic/Lanoxin EE/Drospirenone Yasmin/ Yaz Fluvoxamine generics only Digoxin Lanoxicaps EE/Ethynodiol generics only Disopyramide/CR generic/Norpace/CR (e.g., Zovia) GENERIC BRAND GENERIC BRAND GENERIC BRAND EE/Levonorgestrel generics only (e.g., Sucralfate generics only Levora/Nordette) EE/Levonorgestrel Lybrel TOPICAL ANTI-INFLAMMATORY AGENTS ------BOWEL EVACUANTS ------EE/Levonorgestrel Seasonale Low Potency ...... Polyethylene Glycol generics only EE/Levonorgestrel Seasonique Valerate generics only DIGESTANTS ------EE/Norethindrone generics only Desonide generics only Pancrelipase generic/Creon/ (e.g.,Junel/ Fluocinolone Acetonide generics only Pancrecarb-16/ Microgestin/Necon) Hydrocortisone Butyrate Locoid Pancrease/ EE/Norethindrone/Fe generics only Hydrocortisone Probutate Pandel Ultrase/Viokase (e.g.,Microgestin Fe) Intermediate Potency ...... OTHER GI PRODUCTS ------EE/Norgestimate generics only Alclometasone Dipropionate Aclovate Balsalazide Colazal (e.g., Mononessa/ Betamethasone Diprosone Aerosol Entocort EC Previfem/Sprintec) Diproprionate Spray Hydrocortisone Rectal generic/Cortifoam/ EE/Norgestrel generics only Betamethasone Valerate generic/Luxiq Proctocort HC (e.g., Cryselle/ Hydrocortisone Valerate generics only Hydrocortisone/Pramoxine Proctofoam-HC Low/Ogestrel) Mometasone Furoate generic/Elocon Lactulose generics only Mestranol/Norethindrone generics only Acetonide generics only Misoprostol generics only (e.g.,Necon) High Potency ...... Mesalamine generic/Rowasa BI-PHASIC ------Betamethasone generics only Mesalamine Asacol/Canasa/ EE/Desogestrel generics only Diproprionate Pentasa (e.g.,Kariva) Fluocinonide generic/Lidex-E Olsalazine Dipentum EE/Norethindrone generics only Fluocinolone Acetonide generics only Sulfasalazine gen/Azulfidine/ENtab (e.g.,Necon /NEE) generics only Ursodiol generic/Urso TRI-PHASIC ------Highest Potency ...... EE/Desogestrel Cesia/Cyclessa/ Aug Betamethasone generics only GOUT AGENTS Velivet Dipropionate EE/Levonorgestrel generics only (e.g., Clobetasol Propionate generic/Clobex/Olux Allopurinol generics only Enpresse/Trivora) Halobetasol Propionate generic/Ultravate Colchicine Colchicine EE/Norethindrone generics only OTHER DERMATOLOGICALS ------Probenecid Probenecid (e.g.,Necon/Nortrel) Ammonium lactate generics only EE/Norethindrone/Fe generic/Estrostep Fe Anthralin generics only HORMONES EE/Norgestimate generics only (e.g., Becaplermin Regranex Trinessa, Tri-Cyclen Bexarotene Targretin Lo, Tri-Previfem, Calcipotriene Dovonex ANDROGENS ------Tri-Sprintec) Fluorouracil gen/ Carac/Efudex/ Danocrine generic/Danazol PROGESTIN ONLY ------Fluoroplex Testolactone Teslac Norethindrone generics only (e.g., Imiquimod Aldara Testosterone Androderm/ Nor-Q-D/Nora-Be) Lindane Lotion/Shampoo generics only Androgel/Testim EMERGENCY CONTRACEPTION ------Pimecrolimus Elidel ANTIESTROGENS/ANTIANDROGENS ------EE/Levonorgestrel Preven Podofilox Soln/Gel generics only Dutasteride Avodart Levonorgestrel Plan B Selenium Sulfide Shampoo generics only Finasteride generics only CONTRACEPTIVE DEVICES ------Tacrolimus Protopic Tamoxifen generic/Nolvadex EE/Etonogestrel NuvaRing ------ generics only EE/Norelgestromin Ortho-Evra Patch DIAGNOSTICS Estradiol Transdermal Alora/Climara/ Climara Pro/ CORTICOSTEROIDS Glucose test strips on formulary include Accu-Chek Estraderm/ and Accu-Chek Active, Advantage, Compact, Easy, Vivelle/DOT generics only Instant, and Simplicity products/ Aviva/ Chemstrip Estradiol Vag. Ring Estring Fludrocortisone generics only BG/ Comfort Curve/ Fast Take/ One Touch/ One Estradiol Vag. Tablets Vagifem Methylprednisolone generic/Medrol Touch Ultra/ Surestep Estrogens, Conjugated Premarin/Vag Crm Tablets/Liquid generic/Orapred Estrogens, Conj Synthetic Cenestin Prednisone Tablets/Liquid generics only GASTROINTESTINAL AGENTS Estrogens, Esterified Menest Estropipate generics only DERMATOLOGICALS ANTIEMETIC/ ANTIVERTIGO ------ AND ANDROGEN COMBINATIONS ----- Dronabinol Marinol Estrogens, Esterified/ generics only ACNE ------Granisetron Kytril Methyltestosterone Adapalene Differin generic/Antivert ESTROGEN AND Isotretinoin Capsule generics only Ondansetron Oral generics only COMBINATIONS ------Sodium sulfacetamide/ generics only generics only Estradiol/Norethindrone/ Activella Sulfur lotion Prochlorperazine CompazineSyrup Transdermal Sodium sulfacetamide/Sulfur generics only Promethazine generic/Phenergan Estradiol/Norgestimate Prefest Tretinoin generics only Scopolamine Transdermal Transderm-Scop Estrogens, Conj./ Premphase/ ANTIBIOTICS ------Thiethylperazine Oral Torecan Medroxyprogesterone Prempro/Low Dose Clindamycin generics only Trimethobenzamide generic/Tigan Ethinyl Estradiol/ Femhrt Clindamycin/Benzoyl Duac ANTISPASMODIC/ GI MOTILITY ------Norethindrone peroxide Belladonna Alkaloids/ Pb generic/Donnatal FERTILITY REGULATORS ------Erythromycin generics only Clidinium/Chlordiazepoxide generics only Cetrorelix Cetrotide Erythromycin/Benzoyl generics only Dicyclomine generics only Chorionic Gonadotropins generics/Ovidrel peroxide Diphenoxylate/Atropine generics only Clomiphene generics only Metronidazole generic/MetroGel Hyoscyamine generics only Follitropin-alfa/beta Gonal-F/ RFF Silver Sulfadiazine generics only generics only Leuprolide generics only ANTIVIRALS ------Propantheline generic/Pro-Banthine ------Acyclovir Ointment Zovirax ANTIULCER ------Somatropin Genotropin/Humatrope/ FUNGICIDES ------Amoxicillin/Clarithromycin/ PrevPac Nutropin/ Nutropin AQ/ Ciclopirox generic/ Loprox Gel, Lansoprazole Nutropin Depot Shampoo generics only PROGESTINS ------Clotrimazole/ generic/ Esomeprazole Nexium Medroxyprogesterone generics only Betamethasone Lotrisone lotion Lansoprazole Prevacid Megestrol Acetate generics only Econazole Nitrate generics only Lansoprazole/Naproxen Prevacid Naprapac Norethindrone Acetate generics only Ketoconazole generics only Omeprazole generic only Progesterone, Micronized Prometrium Nystatin generics only generic only SELECTIVE RECEPTOR MODULATORS ------Nystatin/Triamcinolone generics only Ranitidine Zantac granules, Syr Raloxifene Evista GENERIC BRAND GENERIC BRAND GENERIC BRAND

URINARY AGENTS IMMUNOLOGIC AGENTS OSTEOPOROSIS AGENTS Bethanechol Urecholine Glatiramer Copaxone * Alendronate Fosamax Oxybutynin generics only Interferon Avonex * Alendronate/Cholecalciferol Fosamax Plus D Phenazopyridine generic/Pyridium Betaseron* Ibandronate Boniva Potassium Phosphate K-Phos Original Rebif * Solifenacin VESIcare Peginterferon Pegasys/Peg- OTICS Tolterodine Detrol/Detrol LA Intron/Redipen Antipyrine/Benzocaine/ generic/AB Otic VAGINAL PREPARATIONS * All of the following are available at the highest Glycerin brand copay: Avonex, Betaseron, Copaxone, Triethanolamine Cerumenex Butoconazole Gynazole-1 and Rebif. ANTI-INFECTIVE AND ANTI-INFLAMMATORY Clindamycin Cleocin Vaginal COMBINATIONS ------Cream/Ovule IMPOTENCE AGENTS Acetic Acid/HC generics only Metronidazole Gel generics only Ciprofloxacin/ Ciprodex Nystatin generic/Mycostatin Alprostadil gen/Caverject Dexamethasone Terconazole Cream/Supps generic/Terazol Sildenafil Viagra Ofloxacin generic/Floxin Otic Triple Sulfa Cream Triple Sulfa Vag Crm Polymyxin-B//HC generics only

OPHTHALMICS MISCELLANEOUS AGENTS RESPIRATORY/ASTHMA

ANTI-ALLERGIC AGENTS ------Aminoglutethimide Cytadren Azelastine Optivar ANTI-ASTHMATIC AGENTS ------Anagrelide Agrylin Levocabastine Livostin Antileukotrienes ...... Calcium Acetate PhosLo HCl Patanol Montelukast Singulair Cevimeline Evoxac Alamast Corticosteroids ...... Darbepoetin Alfa Aranesp ANTI-GLAUCOMA AGENTS------Beclomethasone Qvar Desmopressin generic/DDAVP Betaxolol generic solution Budesonide Inhaler/Soln Pulmicort Disulfiram Antabuse Betoptic-S Fluticasone Inhaler/Rotadisk Flovent/HFA Epinephrine Epipen/Epipen Jr/ Bimatoprost Lumigan Mometasone Asmanex Twinject Brimonidine generic/Alphagan-P Triamcinolone Acetonide Azmacort Erythropoetin Alfa Epogen/Procrit Brinzolamide Azopt Sympathomimetics ...... Filgrastim Neupogen * Carbachol generic/Isopto Albuterol generics only Hydroxyurea generics only Carbachol Albuterol Inhaler, CFC-free ProAir HFA/Proventil Lanthanum carbonate Fosrenol Dipivefrin generics only HFA Mycophenolate Mofetil Cellcept Dorzolamide Trusopt Albuterol Solution generic/AccuNeb Nicotine Transdermal Nicotine TD Dorzolamide/Timolol Cosopt Albuterol SR Tablets Proventil Repetabs Orlistat Xenical Latanoprost Xalatan Formoterol Foradil Pegfilgrastim Neulasta * Pilocarpine gen/Isopto Carpine/ Levalbuterol Xopenex HFA Pentoxifylline generics only Pilocar Metaproterenol generics only Pilocarpine Tablet generic/Salagen Timolol Betimol Salmeterol Serevent/Diskus Pyridostigmine generics only ANTI-INFECTIVE/ANTIVIRAL AGENTS ------Terbutaline generics only Pyridostigmine Mestinon 180mg Erythromycin generics only Xanthine Derivatives ...... Timespan Ganciclovir Capsules generic/Cytovene Aminophylline Aminophylline Sargramostim Leukine * Gentamicin generics only Guaifenesin/Diphylline Panfil G Sevelamer Renagel Moxifloxacin Vigamox Theophylline IR/SR gen/Uniphyl/Theo-24 Sodium Oxybate/Gamma Xyrem Ofloxacin generics only OTHER RESPIRATORY/ASTHMA AGENTS ------Hydroxybutyrate Polymyxin-B/Bacitracin generics only Albuterol/Ipratropium MDI Combivent Polymyxin-B/Gramicidin/ generics only Albuterol/Ipratropium Soln generic/DuoNeb * All of the following are available at the highest Neomycin Budesonide/Formoterol Symbicort brand copay: Leukine, Neulasta, and Polymyxin-B/Trimethoprim generics only Cromolyn Sodium generics only Neupogen. Sulfacetamide generics only Cromolyn Sodium Intal Inhaler Tobramycin generics only generics only Trifluridine generic/Viroptic Ipratropium Bromide Atrovent Inhaler ANTI-INFECTIVE AND ANTI-INFLAMMATORY Omalizumab Xolair COMBINATIONS ------Pentamidine Nebupent Polymyxin-B/Neomycin/ generics only Potassium Iodide generics only Bacitracin/HC Salmeterol/Fluticasone Advair Diskus Polymyxin-B/Neomycin/ generics only Tiotropium Spiriva Dexamethasone Sulfacetamide/Prednisolone generic/ SKELETAL MUSCLE RELAXANTS Blephamide/S.O.P. Tobramycin/Dexamethasone Tobradex Baclofen generics only ANTI-INFLAMMATORY AGENTS ------Carisoprodol, ASA/Caffeine generics only Dexamethasone generic/Decadron generics only Fluorometholone generic/FML Forte/ Dantrolene generic/Dantrium S.O.P. Diazepam generics only Prednisolone Acetate generics only Methocarbamol, ASA generics only Prednisolone Phosphate generic/Inflamase Tizanidine generics only Mild BETA-BLOCKERS ------THYROID AND ANTITHYROID AGENTS Levobunolol generics only Timolol generics only Levothyroxine generic/Levoxyl/ Timolol Timoptic Ocudose Synthroid/Unithroid VASOCONSTRICTORS ------Methimazole generic only generics only Propylthiouracil Propylthiouracil MISCELLANEOUS OPHTHALMIC AGENTS ------Thyroid, Dessicated Armour Thyroid Cyclosporine Restasis