Nebraska Mental Health Board Prescription Assistance Program - Formulary 2019 Antidepressants Antipsychotics Mood Stabilizers Amitriptyline Aripiprazole Carbamazepine Bupropion Aripiprazole injection- Aristada and Initio** Carbamazepine XR Bupropion SR Aripiprazole injection- Abilify Maintena** Divalproex Bupropion XL Asenapine** Divalproex DR Citalopram Brexpiprazole**^ Divalproex ER Clomipramine Cariprazine** Gabapentin Desvenlafaxine Chlorpromazine Lamotrigine Doxepin Clozapine Levetiracetam Duloxetine Fluphenazine Lithium Escitalopram Fluphenazine decanoate injection Lithium ER Fluoxetine Haloperidol Oxcarbazepine Fluvoxamine Haloperidol decanoate injection Phenytoin ER Imipramine Iloperidone** Topiramate Mirtazapine Loxapine Valproic Acid Nortriptyline Luradisone** Paroxetine Olanzapine Selegiline Olanzapine ODT Sertraline Paliperidone Trazodone Paliperidone injection - Invega Sustenna** Vilazodone Perphenazine Venlafaxine Quetiapine Venlafaxine XR Quetiapine XR Vortioxetine** Risperidone Risperidone injection- Risperdal Consta** Risperidone ODT Thiothixene Trifluoperazine Ziprasidone

Side Effect Treatment Anti-Anxiety/Sedatives/Hypnotics Stimulants and similar Amantadine Alprazolam Amphetamine salts, mixed Atenolol Buspirone Amphetamine salts, mixed XR Benztropine Clonazepam Atomoxetine Clonidine Diazepam Lisdexamfetamine** Cyproheptadine Eszopiclone Methylphenidate Diphenhydramine Lorazepam Methylphenidate ER Docusate sodium Melatonin Modafinil Guanfacine Temazepam Hydroxyzine HCl Zaleplon Metformin Zolpidem Metformin ER Zolpidem CR Metoprolol Metoprolol XL Propranolol Propranolol LA Trihexyphenidyl

Substance Abuse/Other Miscellaneous Long Acting Injectables Acamprosate Carbidopa/Levodopa Aripiprazole - Abilify Maintena** Disulfiram Levothyroxine Aripiprazole - Aristada** Naltrexone Liothyronine Aripiprazole - Initio** Naltrexone Injection** Prazosin Fluphenazine decanoate Ropinirole Haloperidol decanoate Vitamin E Paliperidone - Invega Sustenna** Paliperidone - Invega Trinza**

**As of 1/2019, these products are only available as BRAND, and will be dispensed as such. Generic products will be dispensed and utilized as they become available. ^Temporary-under current review Listed Alphabetically

Covered medications (A-Z) Covered medications (A-Z) Covered medications (A-Z) Acamprosate Fluvoxamine Quetiapine Alprazolam Gabapentin Quetiapine XR Amantadine Guanfacine Risperidone Amitriptyline Haloperidol Risperidone Consta Amphetamine salts, mixed Haloperidol decanoate Risperidone ODT Amphetamine salts, mixed XR Hydroxyzine HCl Ropinirole Aripiprazole Iloperidone Selegiline Aripiprazole Aristada** Imipramine Sertraline Aripiprazole Maintena Lamotrigine Temazepam Asenapine Levetiracetam Thiothixene Atenolol Levothyroxine Topiramate Atomoxetine Liothyronine Trazodone Benztropine Lisdexamfetamine Trifluoperazine Brexpiprazole** Lithium Trihexyphenidyl Bupropion Lithium ER Valproic Acid Bupropion SR Lorazepam Venlafaxine Bupropion XL Loxapine Venlafaxine XR Buspirone Luradisone Vilazodone Carbamazepine Melatonin Vitamin E Carbamazepine XR Metformin Zaleplon Carbidopa/Levodopa Metformin ER Ziprasidone Chlorpromazine Methylphenidate Zolpidem Citalopram Methylphenidate ER Zolpidem CR Clomipramine Metoprolol Clonazepam Metoprolol XL Clonidine Mirtazapine Clozapine Modafinil Cyproheptadine Naltrexone Diazepam Naltrexone Injection** Diphenhydramine Nortriptyline Disulfiram Olanzapine Divalproex Olanzapine ODT Divalproex DR Oxcarbazepine Divalproex ER Paliperidone **Temporary-- Docusate sodium Paliperidone Sustenna under current review Doxepin Paliperidone Trinza Duloxetine Paroxetine Escitalopram Perphenazine Eszopiclone Phenytoin ER Fluoxetine Prazosin Fluphenazine Propranolol Fluphenazine decanoate Propranolol LA