Covered Drug List 2013 - Effective July 15, 2013 Managed by:
Allergies Asthma/Respiratory Eye Care & Glaucoma (cont.) Heart Health & Blood Pressure Mental Health (cont.) Women's Health Fluticasone Nasal Spray Albuterol Tablets Homatropine HBr (cont.) Imipramine Camila Hydroxyzine HCL Ipratropium-albuterol Levobunolol HCl Felodipine ER Lithium Estradiol ProAir HFA Pilocarpine Fosinopril Loxapine Estradiol transdermal patch Antibiotics Terbutaline Sulfate Polymixin B / Trimethoprim Fosinopril / HCTZ Maprotiline Estropipate Amoxicillin Theophylline, Anhydrous, ER Prednisolone Acetate Furosemide Mirtazapine Medroxyprogesterone (not injection) Amoxicillin / Clavulanate Sulfacetamide Sodium Hydralazine Nefazodone Nora-be Ampicillin Blood Modifiers Timolol Maleate Hydrochlorothiazide Nortriptyline Oral Contraceptives - All generics Azithromycin Dipyridamole Tobramycin Sulfate Indapamide Paroxetine tablets Tamoxifen Cefaclor Ticlopidine Tropicamide Isosorbide Dinitrate Perphenazine Cefadroxil Warfarin Sodium Isosorbide Mononitrate Phenytoin Other Medical Conditions Cefpodoxime Fungal Infections Labetalol Sertraline Tablets Hydroxychloroquine Sulf Cefuroxime Cholesterol Clotrimazole Lisinopril Thioridazine Lactulose Cephalexin Fenofribate Clotrimazole Troche Lisinopril / HCTZ Thiothixene Megestrol Acetate Ciprofloxacin Gemfibrozil Clotrimazole/Betameth Losartan Trazodone Promethazine Clindamycin Lovastatin Fluconazole Losartan / HCTZ Trifluoperazine Dicloxacillin Pravastatin Itraconazole Metolazone Trihexyphenidyl Flu/Pneumonia Vaccines Doxycycline Simvastatin Ketoconazole Metoprolol / HCTZ Valproic Acid Afluria Erythromycin / Sulfasox Nystatin Metoprolol, ER Venlafaxine Agriflu Metronidazole Dermatology Nystatin / Triamcinolone Mexiletine Fluarix Minocycline Clobetasol Propionate Cream Nadolol Osteoporosis Flulaval Neomycin Sulfate Triamcinolone Acetonide Cream Gastrointestinal Health Nifedipine, ER Alendronate Fluvirin Nitrofurantoin Macrocrystals Cimetidine Nitroglycerin Flumist Ofloxacin Diabetes Dicyclomine NitroStat Thyroid Conditions Fluzone Paromomycin Sulfate Alcohol Swabs Famotidine Propafenone Levothyroxine Influenza A (H1N1) Penicillin V Potassium Ascensia Autodisc strips Hyoscyamine drops Propranolol, ER / SA Methimazole Pneumovax Sulfamethoxazole/Trimeth Ascensia Elite strips Hyoscyamine sulfate / ER tabs Quinapril Tetracycline Bayer Breeze2 meter / strips Metoclopramide Quinidine Gluconate Tuberculosis Trimethoprim Bayer Contour meter / strips Nizatidine Sotalol Ethambutol Glimepiride Omeprazole (10mg, 20mg) Spironolactone Isoniazid Arthritis and Pain Glipizide, ER / XL Ranitidine Terazosin Pyrazinamide Allopurinol Glyburide Sulfasalazine Triamterene / HCTZ Rifampin Dexamethasone Glyburide/Metformin Ursodiol Verapamil, ER / PM / SR Diclofenac Sodium Insulin Syringes Urology Diflunisal Lancet Devices Heart Health & Blood Pressure Mental Health Bethanechol Chloride Etodolac Lancets Amiodarone Amitriptyline Flavoxate Fenoprofen Lantus Amlodipine Amoxapine Oxybutynin HCl Flurbiprofen Metformin, ER Amlodipine / Benazepril Benztropine Phenazopyridine HCl Hydroxychloroquine Sulf Novolin R, N, 70/30 Atenolol Bupropion, SR / XL 300mg Ibuprofen NovoLog Atenolol / Chlorthalidone Buspirone Viruses Indomethacin Benazepril Carbamazepine Acyclovir Ketoprofen Ear Health Benazepril / HCTZ Chlorpromazine Amantadine Ketorolac Antipyrine/Benzocaine Otic Bisoprolol / HCTZ Citalopram tablets Rimantadine Meloxicam Neomycin/Polymixin/HC Otic Bisoprolol Fumarate Clomipramine Methotrexate Bumetanide Clozapine Vitamins & Minerals Methylprednisolone Eye Care & Glaucoma Captopril Desipramine Calcitriol Nabumetone Acetazolamide Carvedilol Divalproex, ER Folic acid Naproxen Atropine Sulfate Chlorthalidone Doxepin Potassium Chloride Piroxicam Bacitracin Clonidine Fluoxetine capsules/tablets Prenatal Vitamins - All generics Prednisolone Sod-Phos Brimonidine Tartrate Digoxin Fluphenazine Prednisone Carteolol HCl Diltiazem, ER / XR Fluphenazine Decanoate Salsalate Cyclopentolate HCl Disopyramide Phosphate Fluvoxamine tablets Sulindac Dexamethasone Sod-Phos Doxazosin Gabapentin Erythromycin Enalapril Haloperidol Gentamicin Sulfate Enalapril / HCTZ Haloperidol Decanoate Hydroxyzine Pamoate