Rhode Island ADAP Drug Assistance Program Formulary
The formulary for RI ADAP consists of all currently FDA approved antiretroviral medications, Hepatitis C medications, as well as other drugs deemed necessary for the treatment and quality of life of the patient. Brand Name Generic Name Brand Name Generic Name Reverse Transcriptase Inhibitors (RTI's) Antibiotics Atripla Efavirenz/Emtricitabine/Tenofovir Bactrim/Septra Sulfamethoxazole/Trimethoprim Combivir Lamivudine/Zidovudine Biaxin Clarithomycin Cipro Ciprofloxacin Emtriva Emtrictiabine Dapsone Dapsone Epivir Lamivudine Daraprim Pyrimethamine Epzicom Abacavir Sulfate/Lamivudine Isonaizid Isonaizid Retrovir Zidovudine, AZT Myambutol Ethambutol Trizivir Abacavir/Lamivudine/Zidovudine Nebupent Pentamidine Truvada Emtricitabine/Tenofovir Primaquine Primaquine Phosphate Videx Didanosine Sulfadiazine Sulfadiazine Viread Tenofovir Zithromax Azithromycin Zerit Stavudine Mycobutin Rifabutin Ziagen Abacavir
Non‐Nucleoside RTI's Anti‐Anxiety Complera Emtrictiabine/Rilpivirine/Tenofovir Intelence Etravirine Ativan Lorazepam Rescriptor Delavirdine Klonopin Clonazepam Sustiva Efavirenz Viramune Nevirapine Edurant Efavirenz Viramune Nevirapine Edurant Rilpivirine Anti‐Depressants Odefsey Celexa Citalopram Descovy emtricitabine/tenofovir alafenamide or F/TAF Desyrel Trazodone Protease Inhibitors (PI) Elavil Amitriptyline Agenerase Amprenavir/Vitamin E Paxil Paroxetine Apitvus Tipranavir Prozac Fluoxetine Crixivan Indinavir Zoloft Sertraline Invirase Saquinavir Kaletra Lopinavir/Ritonavir Lexiva Fosamprenavir Anti‐Virals Norvir Ritonavir Cytovene IV only Ganciclovir Prezista Darunavir Cytovene Oral Ganciclovir Reyataz Atazanavir Relenza Zanamivir Viracept Nelfinavir Tamiflu Oseltamivir Evotaz Valcyte Valganciclovir Prezcobix Valtrex Valacyclovir Zovirax Acyclovir
Anti‐Retrovirals Fusion Inhibitors** Anti‐Virals Hepatitis Fuzeon Enfuvirtide Copegus** Ribavirin Selzentry Maraviroc Intron A Inteferon Alfa 2b Integrase Inhibitors Pegasys Peginterferon Alfa 2a Isentress Raltegravir PEG‐Intron** Peginterferon Alfa 2b Tivicay Dolutegravir Rebetol** Ribavirin Triumeq Dolutegravir/Lamivudine/Abacavir Genvoya Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Anti‐Psychotics Stribild Elevitegravir/Cobicistat/Emtricitabine/Tenofovir Risperdal Risperidone Zyprexa Olanzapine Integrase Inhibitors & Non‐Nucleoside RTI's Juluca Analgesics/Pain Duragesic Fentanyl Anti‐Fungals Morphine Sulfate Morphine Sulfate Diflucan Fluzonazole IR/MS Contin Mepron Atovaquone Roxicodone, Oxycodone HCL Sporanox Itraconazole OxyContin
Miscellaneous Folinic Acid Leucovorin Hydrea Hydroxyurea Neurontin Gabapentin
Updated 01/10/2018 ppb **Prior Authorization Required