Kansas AIDS Drug Assistance Program Formulary

HIV Anti-Retroviral

Entry Inhibitors-CCR5 Co-Receptor Antagonists, including Fusion Inhibitors Generic Name Brand Name enfuvirtide/T-20 Fuzeon maraviroc Selzentry1 1 Requires Trofile Assay Test

Integrase Inhibitors Generic Name Brand Name dolutegravir Tivicay elvitegravir Vitekta raltegravir Isentress

Multi-Class Combination Drugs Generic Name Brand Name abacavir sulfate/dolutegravir sodium/lamivudine Triumeq bictegravir, emtricitabine, and tenofovir alafenamide Biktarvy cobicistat/elvitegravir/emtricitabine/tenofovir Stribild cobicistat/elvitegravir/emtricitabine/tenofovir alafenamide Genvoya darunavir, cobicistat, emtricitabine, and tenofovir alafenamide Symtuza dolutegravir sodium/lamivudine Dovato dolutegravir sod/rilpivirine HCl Juluca doravirine/lamivudine/tenofovir disoproxil fumarate Delstrigo efavirenz, lamivudine and tenofovir disoproxil fumarate Symfi Lo efavirenz/emtricitabine/tenofovir disoproxil fumarate Atripla emtricitabine/rilpivirine/tenofovir alafenamide Odefsey emtricitabine/tenofovir alafenamide Descovy lamivudine and tenofovir disoproxil fumarate Cimduo

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI) Generic Name Brand Name delavirdine mesylate Rescriptor doravirine Pifeltro efavirenz Sustiva etravirine Intelence nevirapine Viramune rilpivirine Edurant

Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTI) Generic Name Brand Name abacavir sulfate Ziagen abacavir/lamivudine Epzicom abacavir/lamivudine/zidovudine Trizivir didanosine/ddI/dideoxyinosine Videx and Videx EC 1 of 4 Revised October 2018 emtricitabine/FTC Emtriva emtricitabine/tenofovir disoproxil Truvada lamivudine/3TC Epivir lamivudine/zidovudine Combivir stavudine/d4T Zerit tenofovir alafenamide fumarate Vemlidy

HIV Anti-Retroviral

Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTI) - continued Generic Name Brand Name tenofovir disoproxil fumarate Viread zidovudine/AZT/azidothymidine/ZDV Retrovir

CD4 Post-Attachment HIV-1 Inhibitor Generic Name Brand Name ibalizumab-uiyk Trogarzo*

*Trogarzo requires a Prior Authorization.

Pharmacokinetic Enhancers Generic Name Brand Name cobicistat Tybost

Protease Inhibitors (PI) Generic Name Brand Name amprenavir/vitamin E Agenerase atazanavir sulfate Reyataz atazanavir/cobicistat Evotaz cobicistat/darunavir Prezcobix darunavir Prezista fosamprenavir calcium Lexiva indinavir, IDV, MK‐639 Crixivan lopinavir/ritonavir Kaletra nelfinavir mesylate/NFV Viracept ritonavir/ABT-538 Norvir saquinavir mesylate/SQV Invirase tipranavir Aptivus

Non-HIV Medications

Antibiotics Generic Name Brand Name Azithromycin Zithromax Ceftriaxone Rocephin Cephalexin HCl Keftab 2 of 4 Revised October 2018 Cephalexin Monohydrate Keflex Clarithromycin Biaxin Clindamycin HCl Cleocin Clindamycin Palmitate Cleocin Palmatate (pediatric) Clindamycin Phosphate Cleocin T Dapsone Dapsone Doxycycline Calcium Vibramycin Doxycycline Hyclate Vibramycin Doxycycline Monohydrate Monodox Fidaxomicin Dificid Metronidazole Flagyl

Non-HIV Medications

Antibiotics - continued Generic Name Brand Name Metronidazole Metro-Gel (topical) Metronidazole Benzoate Metro-Gel (topical) Paromomycin Sulfate Humatin Rifabutin* Mycobutin Sulfadiazine Sulfadiazine Sulfamethoxazole/Trimethoprim Bactrim/Septra Sulfamethoxazole/Trimethoprim DS Bactrim DS/Septra DS

*Rifabutin is not permitted for treatment of Tuberculosis, as such treatment is provided by KDHE's TB Section.

Antidepressants Generic Name Brand Name Amitriptyline HCl Elavil Trazodone HCl Desyrel

Antifungals Generic Name Brand Name Atovaquone Mepron Clotrimazole Mycelex Fluconazole Diflucan Itraconazole Sporanox, Onmel Ketoconazole Nizoral Nystatin Mycostatin Nystatin/Triamcinolone Nystatin-Triamcinolone Pentamidine Isethionate Nebupent

Antivirals (Non-HIV) Generic Name Brand Name Acyclovir Zovirax Famciclovir Famvir Ganciclovir Cytovene-IV

3 of 4 Revised October 2018 Valacyclovir HCl Valtrex Valganciclovir HCl Valcyte

Appetite Stimulants Generic Name Brand Name Dronabinol Marinol* Megestrol Acetate Megace Oxandrolone Oxandrin

*Marinol requires a Prior Authorization.

Benzodiazepines Generic Name Brand Name Clonazepam Klonopin

Non-HIV Medications

Influenza Agents Generic Name Brand Name Baloxavir marvoxil Xofluza Oseltamivir phosphate Tamiflu Zanamivir Relenza

Miscellaneous Preventive/Treatment Agents Generic Name Brand Name Benznidazole Benznidazole Crofelemer Mytesi Atovaquone Mepron Ethambutol HCl Myambutol Hydroxyurea Hydrea, Droxia Leucovorin Calcium Leucovorin Calcium Miltefosine Impavido Nitazoxanide Alinia Primaquine Phosphate Primaquine Pyrimethamine Daraprim

4 of 4 Revised October 2018