STATE OF TENNESSEE DEPARTMENT OF HEALTH Ryan White Part B Program HIV DRUG ASSISTANCE PROGRAM (HDAP) FORMULARY November 13, 2020 Nucleoside Reverse Transcriptase Inhibitors Non-Nucleoside Reverse Transcriptase Inhibitors Protease Inhibitors Generic Name Brand Name Generic Name Brand Name Generic Name Brand Name Abacavir Ziagen Efavirenz Sustiva Atazanavir Reyataz Abacavir/Lamivudine Epzicom Etravirine Intelence Atazanavir/Cobicistat Evotaz Emtricitabine Emtriva Nevirapine Viramune Darunavir Prezista Emtricitabine/Tenofovir Truvada Rilpivirine Edurant Darunavir/Cobicistat Prezcobix Emtricitabine/Tenofovir Alafenamide Descovy Doravirine Pifelto Fosamprenavir Lexiva Lamivudine Epivir Cross Class Combinations Lopinavir/Ritonavir Kaletra Lamivudine/Zidovudine Combivir Bictegravir/Emtricitabine/Tenofovir Alafenamide Biktarvy Ritonavir Norvir Stavudine Zerit Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Symtuza Entry Inhibitors Tenofovir Viread Doravirine/lamivudine/tenofovir disoproxilfumarate Delstrigo Fostemsavir Rukobia Zidovudine Retrovir Dolutegravir/Abacavir/Lamivudine Triumeq CCR5 Inhibitor CD4 Post-Attachment Inhibitors Dolutegravir/Rilpivirine Juluca Generic Name Brand Name Ibalizumab-uiyk Trogarzo Efavirenz/Emtricitabine/Tenofovir Atripla Maraviroc Selzentry* Fusion Inhibitor Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Stribild Generic Name Brand Name Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Genvoya Enfuvirtide Fuzeon* Rilpivirine/Emtricitabine/Tenofovir Complera Hepatitis C Medications Rilpivirine/Emtricitabine/Tenofovir Alafenamide Odefsey Generic Name Brand Name Dolutegravir/Lamivudine Dovato Glecaprevir/Pibrentasvir Mavyret Integrase Inhibitors Sofosbuvir/Ledipasvir Harvoni Generic Name Brand Name Sofosbuvir/Velpatasvir Epclusa Dolutegravir Tivicay Sofosbuvir/Velpatasvir/Voxilaprevir Vosevi Raltegravir Isentress Modified November 13, 2020 Anti-Infectives Cardiovascular Adefovir Doxycycline Paromomycin Atorvastatin Albendazole Entecavir Pentamidine Amlodpine Amoxicillin Ethambutal Permethrine Cream Carvedilol Amoxicillin/clavulanate Fluconazole Primaquine Enalapril Azithromycin Itraconazole Pyrimethamine Fenofibrate Atovaquone Ivermectin Rifabutin Gemfibrozil Clarithromycin Levofloxacin Sulfadiazine Hydrochlorothiazide Clindamycin Metronidizole Sulfamethoxazole/Trimethoprim Losartan Ciprofloxacin Nitrofurantoin Valacyclovir Metoprolol Dapsone Nystatin Valganciclovir Pioglitazone CNS Endocrine GI Aripiprazole Nortriptyline Alogliptin Famotidine Bupropion Olanzapine Dulaglutide Omeprazole Buspirone Oxcarbazepine Exenatide Mytesi Citalopram Phenytoin Glimepiride Respiratory Duloxetine Quetiapine Metformin Albuterol Inhaler Escitalopram Risperidone Insulin - short acting Beclomethasone Inhaler Lamotrigine Sertraline Insulin - Intermediate acting Smoking Cessation Levetiracetam Trazadone Insulin - long acting Varenicline Lithium carbonate Valproic acid Novolin 70/30 Nicotine Gum Mirtazapine Venlafaxine Statins Nicotine Losenges Naltrexone Zypitamag Nicotine Patches MISC Available through the Medical Services Fee Schedule Alendronate Potassium Chloride Amphotericin Foscarnet Cyproheptadine (Peri-Actin) Promethazine Ceftriaxone Ganciclovir Ergocalciferol Mytesi Cosyntropin Vancomycin Furosemide Narcan Nasal Spray Diabetic supplies* Hydroxyzine Nitroglycerin Imiquimod Triamcinolone cream Leucovorin *Diabetic meters,lancets,test strips, alcohol pads, syringes Modified November 13, 2020