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FLORIDA MEDICAID BRAND DRUG PREFERRED LIST*

Brand Name Generic Name

Adderall XR dextroamphetamine/amphetamine

Advair Diskus for inhalation fluticasone/salmeterol diskus

Aggrenox capsules /dipyridamole

Alkeran tablets melphalan

Amicar tablets and solution aminocaproic acid

Androgel gel pack/pump**

Apriso capsules mesalamine

Aptensio XR methylphenidate ER

Avita cream 0.025% cream

Azactam vials aztreonam

Bicnu vials carmustine

Biltricide tablets praziquantel

Butrans patch** buprenorphine transdermal

Cellcept suspension mycophenolate mofetil Cipro suspension (250mg/5ml & 500mg/5ml) ciprofloxacin

Concerta methylphenidate

Copaxone syringes 20mg glatiramer accetate/Glatopa

Derma-Smoothe-FS oil fluocinolone 0.01% oil

Dermotic ear drops fluocinolone 0.01% otic

Diclegis tablets doxylamine - pyridoxine

Differin cream and lotion

ethylsuccinate E.E.S. 200mg/5ml suspension suspension

Elidel 1% cream pimecrolimus

Exelon patch rivastigmine transdermal

Firazyr syringes* icatibant

Firvanq solution 50mg/ml vancomycin solution 50mg/ml

Finacea GEL 15% azelaic acid

Focalin XR capsules dexmethylphenidate hcl

Glyset tablets miglitol

Humalog vial insulin lispro vial

Humalog Mix Pen insulin lispro protamine mix Kitabis Pak* tobramycin pak

Lamictal Dose Pak and Lamictal ODT tabs lamotrigine dose pak and ODT tabs

Lescol capsules / Lescol XL tablets** fluvastatin ER

Letairis tablets** ambrisentan

Lialda 1.2g tablets** mesalamine 1.2 g

Lotemax 0.5% drops loteprednol 0.5% drops

Mephyton tablets phytonadione tablets

Micardis and Micardis HCT tablets** telmisartan and telmisartan HCT

Natroba suspension spinosad

Nexium packets esomeprazole packets

Norvir tablets ritonavir tablets

Novolog/Novolog Mix insulin insulin aspart

Prevacid ODT lansoprazole ODT

Proair and Proventil HFA Inhalers albuterol sulfate HFA inhalers

Protopic ointment tacrolimus

Ranexa ER tablets ranolazine ER

Rapamune solution sirolimus solution Relpax tablets** eletriptan

Renvela Powder Packet sevelamer carbonate powder pack

Retin-A cream tretinoin cream

Rozerem tablets ramelteon tablets

Suboxone Film** buprenorphine/naloxone film

Symbicort HFA budesonide/formoterol

Symbyax capsules** olanzapine/fluoxetine

Tasmar tablets** tolcapone

Tobradex drops suspension tobramycin/dexamethasone

Tracleer tablets** bosentan

Transderm Scop patches** scopolamine

Travatan Z eye drops travoprost

Tribenzor tablets** olmesasartan-amlodipine-HCTZ

Trizivir tablets* abacavir/zidovudine/lamivudine

Vagifem tablets

Valstar vials valrubicin

Xeloda tablets capecitabine Xopenex HFA** levalbuterol HFA

Zavesca capsules miglustat

Ziagen solution* abacavir

Zovirax ointment and cream acyclovir ointment and cream

Zytiga tablets

*Drugs on the list have both, brand and generic formulations. When prescribed to Florida Medicaid recipients, the brand name formulation must be dispensed. ** Brand and generic formulations are NON-Preferred – Prior authorization required. If criteria is met, brand formulation will be approved. Drugs without ** do not require prior authorization.