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April 2009

2009 Freescale Generic Drug List

The medications included on this 2009 Freescale Generic Drug List are considered Generic Drugs (Tier 1) under the Freescale Prescription Drug Program. Generics should be considered the first line of prescribing. This program is available to participants in the Freescale Medical Plan.

PLAN PARTICIPANT HEALTH CARE PROVIDER Your benefit plan provides you with a prescription benefit program. Your patient is covered under a prescription benefit plan. As a way to Ask your doctor to consider prescribing, when medically appropriate, help manage health care costs, authorize generic substitution whenever a preferred medicine from this list. Take this list along when you or a possible. If you believe a brand-name product is necessary, consider covered family member sees a doctor. prescribing a brand name on this list. Please note: Please note: ● Listed products are for informational purposes only and are not intended ● Generics should be considered the first line of prescribing. to replace the clinical judgment of the prescriber. ● This drug list represents a summary of prescription coverage. It is not inclusive and does not guarantee coverage. ● Unless specifically indicated, drug list products will include all dosage forms.

TETRACYCLINES ANALGESICS NON-NARCOTIC ANALGESICS INFLUENZA AGENTS CARDIOVASCULAR doxycycline hyclate amantadine butalbital-acetaminophen- NSAIDs (PERIOSTAT, VIBRAMYCIN) rimantadine (FLUMADINE) ACE INHIBITORS caffeine (FIORICET) diclofenac sodium minocycline (MINOCIN) benazepril (LOTENSIN) butalbital-aspirin-caffeine delayed-rel (VOLTAREN) tetracycline MISCELLANEOUS captopril (CAPOTEN) (FIORINAL) diflunisal clindamycin (CLEOCIN) enalapril (VASOTEC) tramadol (ULTRAM) ANTIFUNGALS etodolac mebendazole fosinopril (MONOPRIL) ibuprofen (MOTRIN) clotrimazole troches (MYCELEX) metronidazole (FLAGYL) lisinopril (ZESTRIL) ANTI-INFECTIVES indomethacin fluconazole (DIFLUCAN) nitrofurantoin ext-rel quinapril (ACCUPRIL) itraconazole (SPORANOX) indomethacin ext-rel ANTIBACTERIALS (MACROBID) ramipril (ALTACE) (INDOCIN SR) (NIZORAL) nitrofurantoin macrocrystals trandolapril (MAVIK) CEPHALOSPORINS meloxicam (MOBIC) nystatin (MYCOSTATIN) (MACRODANTIN) cefaclor nabumetone terbinafine tabs (LAMISIL) sulfamethoxazole- ACE INHIBITOR/CALCIUM cefadroxil (DURICEF) naproxen (NAPROSYN) trimethoprim (SEPTRA) CHANNEL BLOCKER cefdinir (OMNICEF) ANTIMALARIALS naproxen sodium (ANAPROX) trimethoprim COMBINATIONS cefprozil (CEFZIL) chloroquine (ARALEN) oxaprozin (DAYPRO) amlodipine-benazepril (LOTREL) cefuroxime axetil (CEFTIN) mefloquine (LARIAM) ANTINEOPLASTIC salsalate ACE INHIBITOR/DIURETIC cephalexin (KEFLEX) AGENTS sulindac (CLINORIL) ANTIRETROVIRAL AGENTS COMBINATIONS ERYTHROMYCINS/ ALKYLATING AGENTS GOUT MACROLIDES NUCLEOSIDE REVERSE benazepril- allopurinol (ZYLOPRIM) azithromycin (ZITHROMAX) TRANSCRIPTASE INHIBITORS cyclophosphamide hydrochlorothiazide didanosine delayed-rel (LOTENSIN HCT) colchicine tabs clarithromycin (BIAXIN) ANTIMETABOLITES probenecid clarithromycin ext-rel (VIDEX EC) captopril-hydrochlorothiazide mercaptopurine (PURINETHOL) (BIAXIN XL) stavudine (ZERIT) (CAPOZIDE) NARCOTIC ANALGESICS zidovudine (RETROVIR) erythromycin delayed-rel HORMONAL ANTINEOPLASTIC enalapril-hydrochlorothiazide codeine-acetaminophen (VASERETIC) erythromycin ANTITUBERCULAR AGENTS AGENTS (TYLENOL w/CODEINE) ethylsuccinate (E.E.S.) fosinopril-hydrochlorothiazide ethambutol (MYAMBUTOL) ANTIANDROGENS hydrocodone-acetaminophen erythromycin stearate (MONOPRIL-HCT) (LORCET, LORTAB, MAXIDONE, isoniazid flutamide lisinopril-hydrochlorothiazide erythromycin-sulfisoxazole pyrazinamide NORCO, VICODIN ES) ANTIESTROGENS (ZESTORETIC) (PEDIAZOLE) rifampin (RIFADIN) tamoxifen quinapril-hydrochlorothiazide NARCOTIC ANALGESICS, CII FLUOROQUINOLONES ANTIVIRALS (ACCURETIC) fentanyl transdermal ciprofloxacin ext-rel (CIPRO XR) LUTEINIZING HORMONE- (DURAGESIC) ciprofloxacin tabs (CIPRO tabs) CYTOMEGALOVIRUS AGENTS RELEASING HORMONE (LHRH) ADRENOLYTICS, CENTRAL hydromorphone (DILAUDID) PENICILLINS ganciclovir AGONISTS clonidine (CATAPRES) leuprolide (LUPRON) morphine amoxicillin (AMOXIL) HEPATITIS AGENTS guanfacine (TENEX) morphine ext-rel (MS CONTIN) amoxicillin-clavulanate PROGESTINS ribavirin caps (REBETOL) ALDOSTERONE RECEPTOR morphine supp (AUGMENTIN, ribavirin tabs (COPEGUS) (MEGACE) oxycodone (OXYIR, AUGMENTIN ES-600) ANTAGONISTS HERPES AGENTS MISCELLANEOUS ROXICODONE) ampicillin eplerenone (INSPRA) acyclovir (ZOVIRAX) oxycodone soln dicloxacillin etoposide spironolactone (ALDACTONE) famciclovir (FAMVIR) oxycodone-acetaminophen penicillin VK hydroxyurea (HYDREA) 5/325 (PERCOCET) tretinoin caps (VESANOID) POTASSIUM-SPARING ANTIARRHYTHMICS ANTIDEMENTIA HYPNOTICS CONTRACEPTIVES DIURETICS amiodarone (CORDARONE) amiloride galantamine (RAZADYNE) BENZODIAZEPINES MONOPHASIC disopyramide (NORPACE) galantamine ext-rel 20 mcg ESTROGEN THIAZIDES AND temazepam (RESTORIL) disopyramide ext-rel (RAZADYNE ER) levonorgestrel-EE 0.1/20 THIAZIDE-LIKE DIURETICS triazolam (HALCION) (NORPACE CR) (LEVLITE) chlorthalidone ANTIDEPRESSANTS NONBENZODIAZEPINES flecainide (TAMBOCOR) norethindrone acetate-EE hydrochlorothiazide zolpidem (AMBIEN) mexiletine MONOAMINE OXIDASE 1/20 (LOESTRIN 1/20) indapamide propafenone (RYTHMOL) INHIBITORS (MAOIs) MIGRAINE norethindrone acetate-EE-iron metolazone (ZAROXOLYN) sotalol (BETAPACE, tranylcypromine (PARNATE) 1/20 (LOESTRIN FE 1/20) ERGOTAMINE DERIVATIVES BETAPACE AF) DIURETIC COMBINATIONS SELECTIVE SEROTONIN 30 mcg ESTROGEN amiloride-hydrochlorothiazide dihydroergotamine inj ANTILIPEMICS REUPTAKE INHIBITORS (SSRIs) (D.H.E. 45) -EE 0.15/30 spironolactone- citalopram (CELEXA) (ORTHO-CEPT) BILE ACID RESINS hydrochlorothiazide ergotamine-caffeine fluoxetine (PROZAC) (CAFERGOT) drospirenone/EE 3/30 (YASMIN) cholestyramine (ALDACTAZIDE) paroxetine HCl (PAXIL) levonorgestrel-EE 0.15/30 SELECTIVE SEROTONIN (QUESTRAN, triamterene- paroxetine HCl ext-rel (PAXIL CR) (LEVLEN, Levora) AGONISTS QUESTRAN LIGHT) hydrochlorothiazide sertraline (ZOLOFT) norethindrone acetate-EE colestipol (COLESTID) (DYAZIDE, MAXZIDE) sumatriptan (IMITREX) SEROTONIN NOREPINEPHRINE 1.5/30 (LOESTRIN 1.5/30) FIBRATES NITRATES REUPTAKE INHIBITORS MOOD STABILIZERS norethindrone acetate-EE-iron fenofibrate (LOFIBRA) 1 1.5/30 (LOESTRIN FE 1.5/30) ORAL (SNRIs) lithium carbonate gemfibrozil (LOPID) venlafaxine (EFFEXOR) lithium carbonate ext-rel norgestrel-EE 0.3/30 isosorbide dinitrate (ISORDIL) (Low-Ogestrel) HMG-CoA REDUCTASE isosorbide dinitrate ext-rel tabs TRICYCLIC ANTIDEPRESSANTS tabs 300 mg (LITHOBID) 35 mcg ESTROGEN INHIBITORS isosorbide mononitrate (ISMO) (TCAs) lithium carbonate ext-rel ethynodiol diacetate-EE 1/35 lovastatin (MEVACOR) isosorbide mononitrate ext-rel amitriptyline tabs 450 mg (DEMULEN, Zovia 1/35) pravastatin (PRAVACHOL) (IMDUR) desipramine (NORPRAMIN) MUSCULOSKELETAL THERAPY norethindrone-EE 0.5/35 simvastatin (ZOCOR) doxepin SUBLINGUAL AGENTS (BREVICON, MODICON) imipramine HCl (TOFRANIL) BETA-BLOCKERS nitroglycerin sublingual baclofen norethindrone-EE 1/35 nortriptyline (PAMELOR) atenolol (TENORMIN) (NITROSTAT) carisoprodol (SOMA) (NORINYL 1+35, bisoprolol (ZEBETA) TRANSDERMAL MISCELLANEOUS AGENTS chlorzoxazone ORTHO-NOVUM 1/35) carvedilol (COREG) nitroglycerin transdermal bupropion (WELLBUTRIN) (PARAFON FORTE DSC) norgestimate-EE 0.25/35 labetalol (TRANDATE) (NITRO-DUR) bupropion ext-rel cyclobenzaprine (FLEXERIL) (ORTHO-CYCLEN) metoprolol (LOPRESSOR) (WELLBUTRIN SR, dantrolene (DANTRIUM) 50 mcg ESTROGEN PULMONARY ARTERIAL WELLBUTRIN XL) nadolol (CORGARD) methocarbamol (ROBAXIN) ethynodiol diacetate-EE 1/50 HYPERTENSION mirtazapine (REMERON) pindolol orphenadrine-aspirin-caffeine (DEMULEN, Zovia 1/50) trazodone propranolol PROSTAGLANDIN tizanidine (ZANAFLEX) norethindrone-ME 1/50 propranolol ext-rel VASODILATORS ANTIPARKINSONIAN AGENTS MYASTHENIA GRAVIS (NORINYL 1+50, (INDERAL LA) epoprostenol sodium (FLOLAN) ORTHO-NOVUM 1/50) amantadine pyridostigmine (MESTINON) BETA-BLOCKER/DIURETIC MISCELLANEOUS benztropine BIPHASIC COMBINATIONS bromocriptine (PARLODEL) PSYCHOTHERAPEUTIC- desogestrel-EE (MIRCETTE) hydralazine carbidopa-levodopa MISCELLANEOUS atenolol-chlorthalidone methyldopa TRIPHASIC (PARCOPA, SINEMET) (TENORETIC) midodrine (PROAMATINE) NARCOTIC ANTAGONISTS desogestrel-EE (CYCLESSA) bisoprolol- carbidopa-levodopa ext-rel naltrexone (REVIA) levonorgestrel-EE (SINEMET CR) hydrochlorothiazide (ZIAC) CENTRAL NERVOUS SMOKING DETERRENTS (TRI-LEVLEN, Trivora) ropinirole (REQUIP) metoprolol- SYSTEM bupropion ext-rel (ZYBAN) norethindrone-EE selegiline (ELDEPRYL) hydrochlorothiazide nicotine transdermal (ORTHO-NOVUM 7/7/7, (LOPRESSOR HCT) ANTIANXIETY trihexyphenidyl TRI-NORINYL) norgestimate-EE CALCIUM CHANNEL BENZODIAZEPINES ANTIPSYCHOTICS ENDOCRINE AND alprazolam (XANAX) (ORTHO TRI-CYCLEN) BLOCKERS ATYPICALS METABOLIC clonazepam tabs (KLONOPIN) EXTENDED CYCLE clozapine (CLOZARIL) ANTIDIABETICS DIHYDROPYRIDINES diazepam (VALIUM) levonorgestrel-EE 0.15/30 risperidone (RISPERDAL) amlodipine (NORVASC) lorazepam (ATIVAN) ALPHA-GLUCOSIDASE (SEASONALE) felodipine ext-rel (PLENDIL) MISCELLANEOUS oxazepam (SERAX) INHIBITORS PROGESTIN ONLY nifedipine ext-rel chlorpromazine MISCELLANEOUS acarbose (PRECOSE) norethindrone (ADALAT CC, PROCARDIA XL) fluphenazine buspirone (BUSPAR) BIGUANIDES (NOR-QD, ORTHO MICRONOR) haloperidol NONDIHYDROPYRIDINES clomipramine (ANAFRANIL) metformin (GLUCOPHAGE) perphenazine INJECTABLE diltiazem ext-rel fluvoxamine metformin ext-rel thioridazine medroxyprogesterone (CARDIZEM CD, TIAZAC) (GLUCOPHAGE XR) verapamil ext-rel (CALAN SR) ANTICONVULSANTS thiothixene (NAVANE) acetate 150 mg/mL carbamazepine (TEGRETOL) trifluoperazine BIGUANIDE/SULFONYLUREA (DEPO-PROVERA) DIGITALIS GLYCOSIDES divalproex sodium delayed-rel COMBINATIONS ATTENTION DEFICIT ENDOMETRIOSIS digoxin (LANOXIN) (DEPAKOTE) glipizide-metformin (METAGLIP) HYPERACTIVITY DISORDER digoxin ped elixir divalproex sodium ext-rel SULFONYLUREAS dexmethylphenidate (FOCALIN) (DEPAKOTE ER) glimepiride (AMARYL) ESTROGENS DIURETICS dextroamphetamine ethosuximide (ZARONTIN) glipizide (GLUCOTROL) (DEXEDRINE) ORAL CARBONIC ANHYDRASE gabapentin (NEURONTIN) glipizide ext-rel (GLUCOTROL XL) dextroamphetamine ext-rel estradiol (ESTRACE) INHIBITORS lamotrigine (LAMICTAL) (DEXEDRINE SPANSULE) CALCIUM REGULATORS estropipate (OGEN) acetazolamide levetiracetam (KEPPRA) methylphenidate (RITALIN) acetazolamide ext-rel oxcarbazepine (TRILEPTAL) BISPHOSPHONATES TRANSDERMAL methylphenidate ext-rel (DIAMOX SEQUELS) phenobarbital alendronate (FOSAMAX) estradiol (CLIMARA) methazolamide (METADATE ER) phenytoin sodium extended CALCITONINS ESTROGENS/PROGESTINS LOOP DIURETICS (DILANTIN) calcitonin-salmon (Fortical, estradiol/norethindrone 1/0.5 bumetanide (BUMEX) primidone (MYSOLINE) MIACALCIN) (ACTIVELLA) furosemide (LASIX) valproic acid (DEPAKENE) torsemide (DEMADEX) zonisamide (ZONEGRAN) 2 TOPICAL FERTILITY REGULATORS INFLAMMATORY BOWEL MISCELLANEOUS ANTIHISTAMINE/ benzoyl peroxide (BENZAC AC) DISEASE DECONGESTANT chorionic gonadotropin cilostazol (PLETAL) clindamycin gel, lotion, soln COMBINATIONS (Novarel) ORAL AGENTS (CLEOCIN T) clomiphene (CLOMID) sulfasalazine (AZULFIDINE) IMMUNOLOGIC AGENTS brompheniramine- erythromycin gel 2% (ERYGEL) pseudoephedrine sulfasalazine delayed-rel DISEASE-MODIFYING erythromycin soln 4 mg/45 mg per 5 mL (AZULFIDINE EN-TABS) ANTIRHEUMATIC DRUGS erythromycin-benzoyl peroxide brompheniramine- RECTAL AGENTS (DMARDs) (BENZAMYCIN) pseudoephedrine ext-rel sulfacetamide lotion 10% (CORTEF) hydrocortisone enema hydroxychloroquine 12 mg/120 mg (MEDROL) mesalamine rectal susp (PLAQUENIL) (KLARON) brompheniramine- sulfacetamide-sulfur crm, gel, sodium phosphate (ROWASA) leflunomide (ARAVA) pseudoephedrine ext-rel (ORAPRED, PEDIAPRED) methotrexate lotion, pads LAXATIVES 6 mg/60 mg prednisolone syrup (PRELONE) tretinoin (Avita, RETIN-A) lactulose IMMUNOSUPPRESSANTS chlorpheniramine- pseudoephedrine ext-rel ANTIBIOTICS peg 3350-electrolytes ANTIMETABOLITES gentamicin PHOSPHATE BINDER AGENTS (NULYTELY) 8 mg/120 mg azathioprine (IMURAN) (DECONAMINE SR) mupirocin (BACTROBAN) calcium acetate (PHOSLO) polyethylene glycol 3350 CALCINEURIN INHIBITORS silver sulfadiazine (SILVADENE) (MIRALAX) ANTITUSSIVES PROGESTINS cyclosporine (SANDIMMUNE) ANTIFUNGALS benzonatate (TESSALON) medroxyprogesterone acetate PROSTAGLANDINS cyclosporine, modified (NEORAL) ciclopirox (LOPROX) (PROVERA) misoprostol (CYTOTEC) ANTITUSSIVE COMBINATIONS clotrimazole norethindrone acetate NUTRITIONAL/ econazole PROTON PUMP INHIBITORS NARCOTIC (AYGESTIN) SUPPLEMENTS ketoconazole (NIZORAL) omeprazole delayed-rel codeine-chlorpheniramine- nystatin (MYCOSTATIN) THYROID AGENTS (PRILOSEC) ELECTROLYTES pseudoephedrine ANTIPSORIATICS pantoprazole delayed-rel codeine-guaifenesin liquid ANTITHYROID AGENTS POTASSIUM calcipotriene (DOVONEX) (PROTONIX) potassium chloride ext-rel codeine-guaifenesin- methimazole (TAPAZOLE) ANTISEBORRHEICS (K-DUR, MICRO-K) pseudoephedrine propylthiouracil SALIVA STIMULANTS ketoconazole shampoo 2% potassium chloride liquid codeine-promethazine THYROID SUPPLEMENTS pilocarpine (SALAGEN) codeine-promethazine- (NIZORAL SHAMPOO) levothyroxine VITAMINS AND MINERALS selenium sulfide shampoo 2.5% , RECTAL phenylephrine (Levoxyl, SYNTHROID) (PROMETHAZINE VC (SELSUN) hydrocortisone crm FOLIC ACID AGENTS w/CODEINE) VASOPRESSINS (ProctoCream-HC 2.5%) folic acid hydrocodone-homatropine desmopressin spray, tabs folic acid-vitamin B6-vitamin B12 LOW POTENCY (HYCODAN) (DDAVP) MISCELLANEOUS (FOLTX) crm, oint 0.05% sucralfate (CARAFATE) PRENATAL VITAMINS NON-NARCOTIC (ACLOVATE) MISCELLANEOUS prenatal vitamins/docusate/ dextromethorphan- crm, lotion, oint 0.05% cabergoline (DOSTINEX) GENITOURINARY folic acid (CITRANATAL RX) brompheniramine- (DESOWEN) levocarnitine (CARNITOR) pseudoephedrine acetonide soln 0.01% BENIGN PROSTATIC prenatal vitamins/folic acid dextromethorphan- hydrocortisone crm 2.5% HYPERPLASIA (VITAFOL-OB, VITAFOL-PN) GASTROINTESTINAL promethazine (HYTONE) doxazosin (CARDURA) MISCELLANEOUS hydrocortisone lotion 1% ANTIDIARRHEALS finasteride (PROSCAR) calcitriol (1,25-D3) (ROCALTROL) BETA AGONISTS MEDIUM POTENCY diphenoxylate-atropine terazosin (HYTRIN) cyanocobalamin inj INHALANTS valerate crm, (LOMOTIL) ergocalciferol (D2) (DRISDOL) albuterol (PROVENTIL) lotion, oint 0.1% loperamide URINARY ANTISPASMODICS fluoride drops (LURIDE) albuterol soln (ACCUNEB, crm 0.05% oxybutynin (DITROPAN) fluoride tabs (LURIDE LOZI-TABS) PROVENTIL) crm, ANTIEMETICS oxybutynin ext-rel multivitamins-fluoride drops, oint 0.025% dronabinol (MARINOL) (DITROPAN XL) tabs (POLY-VI-FLOR) ORAL AGENTS crm 0.05%, granisetron (KYTRIL) multivitamins-fluoride-iron albuterol VAGINAL ANTI-INFECTIVES oint 0.005% (CUTIVATE) meclizine (ANTIVERT) drops, tabs (POLY-VI-FLOR) albuterol ext-rel (VOSPIRE ER) clindamycin crm (CLEOCIN) hydrocortisone butyrate crm, metoclopramide (REGLAN) vitamin ADC-fluoride drops terbutaline (BRETHINE) ondansetron (ZOFRAN) metronidazole oint, soln 0.1% (LOCOID) vitamin ADC-fluoride-iron drops MAST CELL STABILIZERS prochlorperazine (METROGEL-VAGINAL) hydrocortisone valerate crm, promethazine terconazole RESPIRATORY cromolyn soln (INTAL) oint 0.2% (WESTCORT) trimethobenzamide caps (TERAZOL 3, TERAZOL 7) crm, lotion, oint 0.1% ANTICHOLINERGICS NASAL STEROIDS (ELOCON) (TIGAN caps) MISCELLANEOUS ipratropium soln spray (NASAREL) acetonide crm, ANTISPASMODICS bethanechol (URECHOLINE) fluticasone spray (FLONASE) lotion 0.025% (KENALOG) phenazopyridine (PYRIDIUM) ANTICHOLINERGIC/BETA chlordiazepoxide-clidinium XANTHINES crm, dicyclomine (BENTYL) potassium citrate (UROCIT-K) AGONIST COMBINATIONS lotion, oint 0.1% (KENALOG) theophylline ext-rel tabs hyoscyamine sulfate (LEVSIN) ipratropium-albuterol soln hyoscyamine sulfate ext-rel HEMATOLOGIC (DUONEB) MISCELLANEOUS (LEVBID, LEVSINEX) ANTICOAGULANTS ANTIHISTAMINES, ipratropium spray CHOLELITHOLYTICS warfarin (COUMADIN) NONSEDATING (ATROVENT spray) fexofenadine (ALLEGRA) ursodiol (ACTIGALL) PLATELET AGGREGATION TOPICAL INHIBITORS ANTIHISTAMINES, SEDATING H2-RECEPTOR ANTAGONISTS DERMATOLOGY dipyridamole (PERSANTINE) clemastine 2.68 mg cimetidine (TAGAMET) cyproheptadine ACNE famotidine (PEPCID) PLATELET SYNTHESIS ORAL hydroxyzine HCl ranitidine (ZANTAC) INHIBITORS isotretinoin (ACCUTANE) anagrelide (AGRYLIN)

3 HIGH POTENCY EMOLLIENTS ANTI-INFLAMMATORIES, CARBONIC ANHYDRASE OPHTHALMIC betamethasone dipropionate ammonium lactate 12% NONSTEROIDAL INHIBITOR/BETA-BLOCKER augmented crm 0.05% (LAC-HYDRIN) ANTIALLERGICS diclofenac sodium (VOLTAREN) COMBINATIONS (DIPROLENE AF) LOCAL ANESTHETIC cromolyn sodium (CROLOM) ANTI-INFLAMMATORIES, dorzolamide-timolol maleate betamethasone dipropionate lidocaine-prilocaine (EMLA) ANTI-INFECTIVES STEROIDAL (COSOPT) augmented lotion 0.05% ROSACEA bacitracin dexamethasone sodium PARASYMPATHOMIMETICS (DIPROLENE) metronidazole crm, gel, ciprofloxacin (CILOXAN) phosphate pilocarpine (ISOPTO CARPINE) betamethasone dipropionate lotion 0.75% (METROCREAM, erythromycin (FML) SYMPATHOMIMETICS crm, lotion, oint 0.05% METROLOTION) gentamicin prednisolone acetate 1% brimonidine 0.2% desoximetasone crm, oint 0.25%, sulfacetamide-sulfur (PLEXION) neomycin-polymyxin B- (PRED FORTE) gel 0.05% (TOPICORT) gramicidin (NEOSPORIN) prednisolone phosphate 1% OTIC diacetate crm 0.05% SCABICIDES AND ofloxacin (OCUFLOX) ANTIVIRALS ANTI-INFECTIVES emollient PEDICULICIDES polymyxin B-bacitracin trifluridine (VIROPTIC) acetic acid crm 0.05% (PSORCON E) permethrin 5% (ELIMITE) polymyxin B-trimethoprim acetic acid-aluminum acetate crm, gel, oint, MISCELLANEOUS SKIN AND (POLYTRIM) BETA-BLOCKERS, (DOMEBORO OTIC) soln 0.05% (LIDEX) MUCOUS MEMBRANE sulfacetamide 10% (BLEPH-10) NONSELECTIVE ofloxacin otic (FLOXIN OTIC) triamcinolone acetonide podofilox (CONDYLOX) tobramycin (TOBREX) levobunolol (BETAGAN) crm, 0.5% (KENALOG) metipranolol ANTI-INFECTIVE/ ANTI-INFECTIVE/ MOUTH/THROAT/DENTAL (OPTIPRANOLOL) ANTI-INFLAMMATORY VERY HIGH POTENCY ANTI-INFLAMMATORY AGENTS timolol maleate (TIMOPTIC) COMBINATIONS betamethasone dipropionate COMBINATIONS timolol maleate gel acetic acid-hydrocortisone augmented gel, oint 0.05% ANESTHETICS-TOPICAL ORAL neomycin-polymyxin B- (TIMOPTIC-XE) neomycin-polymyxin B- (DIPROLENE) lidocaine viscous bacitracin-hydrocortisone oint hydrocortisone propionate crm, gel, (XYLOCAINE VISCOUS) (CORTISPORIN) CARBONIC ANHYDRASE (CORTISPORIN OTIC) lotion, oint 0.05% (TEMOVATE) STEROIDS-MOUTH/THROAT neomycin-polymyxin B- INHIBITORS, TOPICAL triamcinolone paste dexamethasone (MAXITROL) dorzolamide (TRUSOPT) foam 0.05% (OLUX) (Kenalog in Orabase) neomycin-polymyxin B- diflorasone diacetate oint 0.05% hydrocortisone susp halobetasol propionate crm, (CORTISPORIN) oint 0.05% (ULTRAVATE) sulfacetamide-prednisolone phosphate 10%/0.25%

QUICK REFERENCE DRUG LIST

A benazepril C clarithromycin D benazepril-hydrochlorothiazide clarithromycin ext-rel cabergoline danazol acarbose benzonatate clemastine 2.68 mg calcipotriene dantrolene acetazolamide benzoyl peroxide clindamycin calcitonin-salmon desipramine acetazolamide ext-rel benztropine clindamycin crm calcitriol (1,25-D3) desmopressin spray, tabs acetic acid betamethasone dipropionate clindamycin gel, lotion, soln calcium acetate desogestrel-EE acetic acid-aluminum acetate augmented crm 0.05% clobetasol propionate crm, gel, captopril desogestrel-EE 0.15/30 acetic acid-hydrocortisone betamethasone dipropionate lotion, oint 0.05% captopril-hydrochlorothiazide desonide crm, lotion, oint 0.05% acyclovir augmented gel, oint 0.05% clobetasol propionate carbamazepine desoximetasone crm 0.05% albuterol betamethasone dipropionate foam 0.05% carbidopa-levodopa desoximetasone crm, albuterol ext-rel augmented lotion 0.05% clomiphene carbidopa-levodopa ext-rel oint 0.25%, gel 0.05% albuterol soln betamethasone dipropionate clomipramine carisoprodol dexamethasone alclometasone crm, oint 0.05% crm, lotion, oint 0.05% clonazepam tabs carvedilol dexamethasone sodium alendronate betamethasone valerate crm, clonidine cefaclor phosphate allopurinol lotion, oint 0.1% clotrimazole cefadroxil dexmethylphenidate alprazolam bethanechol clotrimazole troches cefdinir dextroamphetamine amantadine bisoprolol clozapine cefprozil dextroamphetamine ext-rel amiloride bisoprolol-hydrochlorothiazide codeine-acetaminophen cefuroxime axetil dextromethorphan- amiloride-hydrochlorothiazide brimonidine 0.2% codeine-chlorpheniramine- cephalexin brompheniramine- amiodarone bromocriptine pseudoephedrine chlordiazepoxide-clidinium pseudoephedrine amitriptyline brompheniramine- codeine-guaifenesin liquid chloroquine dextromethorphan- amlodipine pseudoephedrine codeine-guaifenesin- chlorpheniramine- promethazine amlodipine-benazepril 4 mg/45 mg per 5 mL pseudoephedrine pseudoephedrine ext-rel diazepam ammonium lactate 12% brompheniramine- codeine-promethazine 8 mg/120 mg diclofenac sodium delayed-rel amoxicillin pseudoephedrine ext-rel codeine-promethazine chlorpromazine diclofenac sodium ophthalmic amoxicillin-clavulanate 12 mg/120 mg phenylephrine chlorthalidone dicloxacillin ampicillin brompheniramine- colchicine tabs chlorzoxazone dicyclomine anagrelide pseudoephedrine ext-rel colestipol cholestyramine didanosine delayed-rel atenolol 6 mg/60 mg cromolyn sodium chorionic gonadotropin diflorasone diacetate crm 0.05% atenolol-chlorthalidone bumetanide cromolyn soln ciclopirox diflorasone diacetate emollient Avita bupropion cyanocobalamin inj cilostazol crm 0.05% azathioprine bupropion ext-rel cyclobenzaprine cimetidine diflorasone diacetate oint 0.05% azithromycin buspirone cyclophosphamide ciprofloxacin diflunisal butalbital-acetaminophen- cyclosporine B ciprofloxacin ext-rel digoxin caffeine cyclosporine, modified ciprofloxacin tabs digoxin ped elixir bacitracin butalbital-aspirin-caffeine cyproheptadine baclofen citalopram dihydroergotamine inj

4 diltiazem ext-rel fosinopril levobunolol naproxen potassium chloride liquid diphenoxylate-atropine fosinopril-hydrochlorothiazide levocarnitine naproxen sodium potassium citrate dipyridamole furosemide levonorgestrel-EE neomycin-polymyxin B- pravastatin disopyramide levonorgestrel-EE 0.1/20 bacitracin-hydrocortisone oint prednisolone acetate 1% disopyramide ext-rel G levonorgestrel-EE 0.15/30 neomycin-polymyxin B- prednisolone phosphate 1% divalproex sodium delayed-rel gabapentin Levora dexamethasone prednisolone sodium phosphate divalproex sodium ext-rel galantamine levothyroxine neomycin-polymyxin B- prednisolone syrup dorzolamide galantamine ext-rel Levoxyl gramicidin prednisone dorzolamide-timolol maleate ganciclovir lidocaine-prilocaine neomycin-polymyxin B- prenatal vitamins/docusate/ doxazosin gemfibrozil lidocaine viscous hydrocortisone folic acid doxepin gentamicin lisinopril neomycin-polymyxin B- prenatal vitamins/folic acid doxycycline hyclate glimepiride lisinopril-hydrochlorothiazide hydrocortisone susp primidone dronabinol glipizide lithium carbonate nicotine transdermal probenecid drospirenone/EE 3/30 glipizide ext-rel lithium carbonate ext-rel nifedipine ext-rel prochlorperazine glipizide-metformin tabs 300 mg nitrofurantoin ext-rel ProctoCream-HC 2.5% E granisetron lithium carbonate ext-rel nitrofurantoin macrocrystals promethazine econazole guanfacine tabs 450 mg nitroglycerin sublingual propafenone enalapril loperamide nitroglycerin transdermal propranolol enalapril-hydrochlorothiazide H lorazepam norethindrone propranolol ext-rel eplerenone halobetasol propionate crm, lovastatin norethindrone acetate propylthiouracil epoprostenol sodium oint 0.05% Low-Ogestrel norethindrone acetate-EE 1.5/30 pyrazinamide ergocalciferol (D2) haloperidol norethindrone acetate-EE 1/20 pyridostigmine ergotamine-caffeine M norethindrone acetate-EE-iron hydralazine Q erythromycin hydrochlorothiazide mebendazole 1.5/30 erythromycin delayed-rel hydrocodone-acetaminophen meclizine norethindrone acetate-EE-iron quinapril erythromycin ethylsuccinate hydrocodone-homatropine medroxyprogesterone acetate 1/20 quinapril-hydrochlorothiazide erythromycin gel 2% hydrocortisone medroxyprogesterone acetate norethindrone-EE erythromycin soln hydrocortisone butyrate crm, 150 mg/mL norethindrone-EE 0.5/35 R erythromycin stearate oint, soln 0.1% mefloquine norethindrone-EE 1/35 ramipril erythromycin-benzoyl peroxide hydrocortisone crm megestrol acetate norethindrone-ME 1/50 ranitidine erythromycin-sulfisoxazole hydrocortisone crm 2.5% meloxicam norgestimate-EE ribavirin caps estradiol hydrocortisone enema mercaptopurine norgestimate-EE 0.25/35 ribavirin tabs estradiol-norethindrone 1/0.5 hydrocortisone lotion 1% mesalamine rectal susp norgestrel-EE 0.3/30 rifampin estropipate hydrocortisone valerate crm, metformin nortriptyline rimantadine ethambutol oint 0.2% metformin ext-rel Novarel risperidone ethosuximide hydromorphone methazolamide nystatin ropinirole ethynodiol diacetate-EE 1/35 methimazole hydroxychloroquine O ethynodiol diacetate-EE 1/50 hydroxyurea methocarbamol S etodolac hydroxyzine HCl methotrexate ofloxacin salsalate etoposide hyoscyamine sulfate methyldopa ofloxacin otic selegiline hyoscyamine sulfate ext-rel methylphenidate omeprazole delayed-rel F selenium sulfide shampoo 2.5% methylphenidate ext-rel ondansetron sertraline famciclovir I methylprednisolone orphenadrine-aspirin-caffeine silver sulfadiazine famotidine ibuprofen metipranolol oxaprozin simvastatin felodipine ext-rel imipramine HCl metoclopramide oxazepam sotalol fenofibrate indapamide metolazone oxcarbazepine spironolactone fentanyl transdermal indomethacin metoprolol oxybutynin spironolactone- fexofenadine indomethacin ext-rel metoprolol-hydrochlorothiazide oxybutynin ext-rel hydrochlorothiazide finasteride ipratropium soln metronidazole oxycodone stavudine flecainide ipratropium spray metronidazole crm, gel, oxycodone soln sucralfate fluconazole ipratropium-albuterol soln lotion 0.75% oxycodone-acetaminophen sulfacetamide 10% fludrocortisone isoniazid mexiletine 5/325 sulfacetamide lotion 10% flunisolide spray midodrine isosorbide dinitrate P sulfacetamide- fluocinolone acetonide crm, isosorbide dinitrate ext-rel tabs minocycline prednisolone phosphate oint 0.025% isosorbide mononitrate mirtazapine pantoprazole delayed-rel 10%/0.25% fluocinolone acetonide isosorbide mononitrate ext-rel misoprostol paroxetine HCl sulfacetamide-sulfur soln 0.01% isotretinoin mometasone crm, lotion, paroxetine HCl ext-rel sulfacetamide-sulfur crm, gel, fluocinonide crm, gel, oint, itraconazole oint 0.1% peg 3350-electrolytes lotion, pads soln 0.05% morphine penicillin VK sulfamethoxazole-trimethoprim fluoride drops K morphine ext-rel permethrin 5% sulfasalazine morphine supp fluoride tabs Kenalog in Orabase perphenazine sulfasalazine delayed-rel multivitamins-fluoride drops, fluorometholone ketoconazole phenazopyridine sulindac tabs fluoxetine ketoconazole shampoo 2% phenobarbital sumatriptan fluphenazine multivitamins-fluoride-iron phenytoin sodium extended flutamide L drops, tabs pilocarpine T fluticasone propionate mupirocin pindolol labetalol tamoxifen crm 0.05%, oint 0.005% podofilox lactulose temazepam fluticasone spray N polyethylene glycol 3350 lamotrigine terazosin fluvoxamine nabumetone polymyxin B-bacitracin leflunomide terbinafine tabs folic acid nadolol polymyxin B-trimethoprim leuprolide acetate terbutaline folic acid-vitamin B6-vitamin B12 naltrexone potassium chloride ext-rel levetiracetam terconazole Fortical

5 tetracycline trandolapril triamcinolone paste U W theophylline ext-rel tabs tranylcypromine triamterene- thioridazine trazodone hydrochlorothiazide ursodiol warfarin thiothixene tretinoin triazolam V Z timolol maleate tretinoin caps trifluoperazine timolol maleate gel triamcinolone acetonide crm, trifluridine valproic acid zidovudine tizanidine lotion 0.025% trihexyphenidyl venlafaxine zolpidem tobramycin triamcinolone acetonide crm, trimethobenzamide caps verapamil ext-rel zonisamide torsemide lotion, oint 0.1% trimethoprim vitamin ADC-fluoride drops Zovia 1/35 tramadol triamcinolone acetonide Trivora vitamin ADC-fluoride-iron drops Zovia 1/50 crm 0.5%

FOR YOUR INFORMATION: Generics should be considered the first line of prescribing. This 2009 Freescale Generic Drug List represents a summary of prescription coverage. It is not inclusive and does not guarantee coverage. The plan participant's prescription benefit plan may have a different coinsurance for specific products on the list. Unless specifically indicated, drug list products will include all dosage forms. This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics. Generics listed in therapeutic categories are for representational purposes only. This is not an all-inclusive list. Listed products may be available generically in certain strengths or dosage forms.

1 Indicates the proposed mechanism of action, based on the American Psychiatric Association Summary of Treatment Recommendations.

This 2009 Freescale Generic Drug List contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers. Listed products are for informational purposes only and are not intended to replace the clinical judgment of the prescriber.

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