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IHS National Pharmacy & Therapeutics Committee National IHS National Pharmacy & Therapeutics Committee National Core Formulary; Last Updated: 09/23/2021 **Note: Medications in GREY indicate removed items.** Generic Medication Name Pharmacological Category (up-to-date) Formulary Brief (if Notes / Similar NCF Active? available) Miscellaneous Medications Acetaminophen Analgesic, Miscellaneous Yes Albuterol nebulized solution Beta2 Agonist Yes Albuterol, metered dose inhaler Beta2 Agonist NPTC Meeting Update *Any product* Yes (MDI) (Nov 2017) Alendronate Bisphosphonate Derivative Osteoporosis (2016) Yes Allopurinol Antigout Agent; Xanthine Oxidase Inhibitor Gout (2016) Yes Alogliptin Antidiabetic Agent, Dipeptidyl Peptidase 4 (DPP-4) Inhibitor DPP-IV Inhibitors (2019) Yes Anastrozole Antineoplastic Agent, Aromatase Inhibitor Yes Aspirin Antiplatelet Agent; Nonsteroidal Anti-Inflammatory Drug; Salicylate Yes Azithromycin Antibiotic, Macrolide STIs - PART 1 (2021) Yes Calcium Electrolyte supplement *Any formulation* Yes Carbidopa-Levodopa (immediate Anti-Parkinson Agent; Decarboxylase Inhibitor-Dopamine Precursor Parkinson's Disease Yes release) (2019) Clindamycin, topical ===REMOVED from NCF=== (See Benzoyl Peroxide AND Removed January No Clindamycin, topical combination) 2020 Corticosteroid, intranasal Intranasal Corticosteroid *Any product* Yes Cyanocobalamin (Vitamin B12), Vitamin, Water Soluble Hematologic Supplements Yes oral (2016) Printed on 09/25/2021 Page 1 of 18 National Core Formulary; Last Updated: 09/23/2021 Generic Medication Name Pharmacological Category (up-to-date) Formulary Brief (if available) Notes / Miscellaneous Similar NCF Active? Medications Dicyclomine Anticholinergic Agent Irritable Bowel Syndrome Yes (2018) Digoxin Antiarrhythmic Agent, Miscellaneous; Cardiac Digoxin Use (2016) Yes Glycoside Donepezil Acetylcholinesterase Inhibitor (Central) 5mg and 10mg strengths Yes Doxycycline Antibiotic, Tetracycline STIs - PART 1 (2021) Yes Dulaglutide ===REMOVED from NCF=== NPTC Meeting Update (2020) Removed Nov 2020 No Empagliflozin Antidiabetic Agent, Sodium-Glucose SGLT-2 Inhibitors (2019) Yes Cotransporter 2 (SGLT2) Inhibitor Epinephrine Injection Devices (both Alpha-/Beta- Agonist Epinephrine Injection Devices Any device, auto-injector or Yes 0.15mg and 0.3mg) (2020 pre-filled syringe Estradiol tablets Estrogen Derivative Menopausal Hormone Therapy Yes (2016) Ethinyl estradiol / Etonogestrel Contraceptive; Estrogen and Progestin Contraception (2016) Yes vaginal ring Combination Ethinyl estradiol / Norelgestromin, Contraceptive; Estrogen and Progestin Contraception (2016) Yes transdermal Combination Ezetimibe Antilipemic Agent, 2-Azetidinone 2018 ACC/AHA Cholesterol Yes Guidelines (2019) Fibric Acid Derivative ===REMOVED from NCF=== Hyperlipidemia (2017) Removed Feb 2017 No Finasteride 5 Alpha-Reductase Inhibitor Benign Prostatic Hypertrophy Yes (2016) Fluoride, oral Nutritional Supplement Supplements in Oral Health *Any oral formulation* Yes (2016) Printed on 09/25/2021 Page 2 of 18 National Core Formulary; Last Updated: 09/23/2021 Generic Medication Name Pharmacological Category Formulary Brief (if available) Notes / Miscellaneous Similar NCF Active? (up-to-date) Medications Folic Acid Vitamin, Water Soluble Supplements in Womens Any product containing >400 mcg / Yes Health (2016) daily dose Furosemide Antihypertensive; Loop Diuretic Heart Failure Overview (2017) Yes Gabapentin Anticonvulsant, Miscellaneous; Gabapentin & Pregabalin in Yes GABA Analog Pain (2014) Gemfibrozil ===REMOVED from NCF=== Dyslipidemia Guidelines Removed Feb 2014 No Review (2014) Glipizide Antidiabetic Agent; Sulfonylurea Sulfonylureas (2015) Yes Glucagon Antidote; Hypoglycemia For outpatient use Yes H1 Antagonist (2nd generation), long-acting Histamine H1 Antagonist, Second *Any product* Yes Generation Hydroxyzine Histamine H1 Antagonist, First Anxiety Disorders (2021) Yes Generation Insulin / Regular human (NovoLIN® R) Insulin, Short-Acting Insulins (2015) *Branded product* Yes Insulin aspart (NovoLog®) Insulin, Rapid-Acting Insulins (2015) *Branded product*; Pen Device Yes Insulin aspart / Insulin aspart protamine Insulin, Combination (70/30 Mix) Insulins (2015) *Branded product*; Pen Device Yes (NovoLog® Mix 70/30) Insulin NPH (NovoLIN® N) Insulin, Intermediate-Acting Insulins (2015) *Branded product* Yes Insulin NPH / Regular human insulin Insulin, Combination (70/30 Mix) Insulins (2015) *Branded product* Yes (NovoLIN® 70/30) Iron, oral Iron Salt Hematologic Supplements *Any oral formulation* Yes (2016) Printed on 09/25/2021 Page 3 of 18 National Core Formulary; Last Updated: 09/23/2021 Generic Medication Pharmacological Category (up-to-date) Formulary Brief (if Notes / Miscellaneous Similar NCF Active? Name available) Medications Laxative, bulk-forming Bulk-forming Laxative *Any product* Yes Laxative, stimulant Stimulant Laxative *Any product* Yes Letrozole Antineoplastic Agent, Aromatase Inhibitor Yes Levothyroxine Thyroid Agent Yes Liraglutide or Antidiabetic Agent, Glucagon-Like Peptide-1 GLP-1 Receptor Agonists Select either of these subcutaneous agents, Yes semaglutide (GLP-1) Receptor Agonist (2019) no preference given Lisinopril Antihypertensive, Angiotensin-Converting Enzyme ACEIs & ARBs in Heart Yes Inhibitor Failure (2017) Lithium Antimanic Agent ER Lithium & Divalproex Yes (2012) Loperamide Antidiarrheal Irritable Bowel Syndrome Yes (2018) Lopinavir / Ritonavir ===REMOVED from NCF=== (see HIV PrEP (2018) Removed August 2013 No (Kaletra®) Emtricitabine/tenofovir) Losartan Antihypertensive, Angiotensin II Receptor Blocker ACEIs & ARBs in Heart Yes Failure (2017) Low-molecular weight Low-molecular Weight Heparin VTE Prophylaxis (2011) *Any product* Yes heparin Memantine N-Methyl-D-Aspartate (NMDA) Receptor Antagonist Yes Metformin Antidiabetic Agent; Biguanide Yes Mometasone Corticosteroid, Inhalant *Branded product* Yes (Asmanex®) Printed on 09/25/2021 Page 4 of 18 National Core Formulary; Last Updated: 09/23/2021 Generic Medication Name Pharmacological Category (up-to-date) Formulary Brief (if available) Notes / Similar NCF Active? Miscellaneous Medications Montelukast Leukotriene Receptor Antagonist Yes Naloxone Antidote; Opioid Antagonist Treatment of Opioid Overdose Yes (2014) Naltrexone, extended-release for injection Antidote; Opioid Antagonist Opioid Use Disorder (2018) **See REMS here** Yes (**REMS drug**) Niacin extended release (Niaspan®) ===REMOVED from NCF=== Hyperlipidemia (2017) Removed Feb 2017 No Ondansetron Antiemetic; Selective 5-HT3 Receptor Antiemetic Agents (2021) Yes Antagonist Ophthalmic Prostaglandin Analog Ophthalmic Prostaglandin Analog Ophth Prostaglandin Analogs *Any product* Yes (2018) Oral contraceptive pill, extended cycle Contraceptive Contraception (2016) *Any product* Yes Oseltamivir Antiviral Agent; Neuraminidase Inhibitor Treatment of Influenza (2019) Yes Penicillin G benzathine Antibiotic, Penicillin STIs - PART 1 (2021) Yes Phentermine Central Nervous System Stimulant Obesity Treatment (2018) Yes Phosphodiesterase 5 (PDE5) Inhibitor Phosphodiesterase-5 Enzyme Inhibitor Phosphodiesterase 5 Inhibitors *Any product* Yes (2018) Pioglitazone Antidiabetic Agent, Thiazolidinedione Thiazolidinediones (2017) Yes Pramipexole Anti-Parkinson Agent, Dopamine Agonist Insomnia/Sleep Medications Yes (2021) Prednisone Corticosteroid, Systemic Yes Printed on 09/25/2021 Page 5 of 18 National Core Formulary; Last Updated: 09/23/2021 Generic Medication Pharmacological Category (up-to-date) Formulary Brief (if available) Notes / Miscellaneous Similar NCF Active? Name Medications Prenatal Multivitamin Vitamin Pregnancy & Prenatal Care Must contain >400 mcg of folic acid/dose Yes (2021) Proton Pump Inhibitor Proton Pump Inhibitor GERD & PUD (2018) *Any product* Yes Pyridoxine (Vitamin B6) Vitamin, Water Soluble Supplements in Obstetrics Yes (2016) Salmeterol (Serevent®) ===REMOVED from NCF=== Inhaled Anticholinergics (2011) Removed Sept 2011 No Salsalate Salicylate Yes Semaglutide or liraglutide Antidiabetic Agent, Glucagon-Like Peptide-1 GLP-1 Receptor Agonists Select either of these subcutaneous Yes (GLP-1) Receptor Agonist (2019) agents, no preference given Semaglutide, dulaglutide ===REMOVED from NCF=== Dulaglutide removed from NCF; liraglutide No or liraglutide and semaglutide remain on NCF Spironolactone Antihypertensive; Mineralocorticoid Receptor Mineralocorticoid Receptor Yes Antagonists; Potassium Sparing Diuretic Antagonist in HF (2017) Sumatriptan Antimigraine Agent; Serotonin 5-HT 1B/1D Triptans (2016) Any two (2) triptan medications are Yes Receptor Agonist required, one must be sumatriptan Tamoxifen Antineoplastic Agent, Estrogen Receptor Yes Antagonist; Selective Estrogen Receptor Modulator Tiotropium (Spiriva®) Long-Acting Anticholinergic Agent Inhaled Anticholinergics (2011) *Branded product* Yes Trazodone ===REMOVED from NCF=== Insomnia (2015) Removed Oct 2015 No Tretinoin, topical Topical Skin Product, Acne Acne (2013) *Any product* Yes Vaccines, All Vaccines Vaccine (2011) All ACIP recommended vaccines for Yes ACIP-recommended routine use in accordance with ACIP guidelines Printed on 09/25/2021 Page 6 of 18 National Core Formulary; Last Updated: 09/23/2021 Generic Medication Name Pharmacological Category (up-to-date) Formulary Brief (if Notes / Miscellaneous Similar NCF Medications Active? available) Vitamin D Vitamin D Analog Vitamin D (2010) *Any product* Yes Vitamin D Analog (Topical) Vitamin D Analog Psoriasis (2018) *Any product* Yes Etanercept -OR- Adalimumab Antirheumatic, Disease Modifying; Tumor TNF Inhibitors (2016) ONLY In
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