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Freescale Generic 15427-1-0409 Layout 4 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) ketoconazole (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 acetate (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) megestrol acetate (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) desogestrel-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
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