PDL Drug Class Review Announcement July 13, 2021
Drug Classes to be reviewed: Anticonvulsants, Oral; Stimulants and other ADHD Agents; Bone Resorption Suppression & Related Agents; Contraceptives (Oral & Topical); Estrogen Agents (Injectable, Oral/Transdermal); Diabetes Management Agents (Amylin, Biguanides, DPP-4 Inhibitors, GLP-1 Analogues, Hypoglycemic Combinations, Insulins, Meglitinides, SGLT-2 Inhibitors, Thiazolidinediones); Glucagon, Self-Administered; GI Motility (Chronic); Anticoagulants (Oral & Parenteral); Antiplatelet Agents; Colony Stimulating Factors; Erythropoiesis Stimulating Agents; Newer Hereditary Angioedema Agents; Ophthalmic Immunomodulators; Overactive Bladder Agents, and Prenatal Vitamins.
These drug classes will be reviewed at the July 13th, 2021 P&T Committee meeting from 1‐5pm. The meeting will be held virtually. Dossiers and Supplemental Rebate offers are due to Magellan by June 15, 2021.
Interested parties who want to present at the meeting shall give advanced notice and provide a one-page summary of the clinical information that will be presented for P&T Committee dissemination. Please contact Jessica Czechowski, Pharmacist Account Executive, [email protected] and carbon copy Brittany Schock, PDL & Clinical Strategy Pharmacist, at 303-866-6371 or by email at [email protected] to give advance notice to present at the meeting. Advance notice requests to present and/or written public comments can be submitted to and will be distributed to P&T Committee Members, once approved. Please provide public comments no later than July 6, 2021 by 5pm MT to ensure they are reviewed for inclusion in the information supplied to the P&T Committee members. Policies surrounding stakeholder comment can be found at: https://www.colorado.gov/pacific/hcpf/pharmacy-and- therapeutics-committee
ANTICONVULSANTS: Oral Brand Name Generic Name
Phenobarbital elixir, solution, tablet
Valproic Acid capsule, solution
Zonisamide capsule
Aptiom Eslicarbazepine tablet
Banzel Rufinamide suspension, tablet
Rufinamide suspension Briviact Brivaracetam solution, tablet
Carbatrol ER Carbamazepine ER capsule
Carbamazepine ER capsule
Celontin Methsuximide Kapseal
Depakote Divalproex Sodium capsule, sprinkle capsule, DR tablet, ER tablet Divalproex Sodium capsule, sprinkle capsule, DR tablet, ER tablet Diacomit Stiripentol capsule, powder packet
Dilantin Phenytoin ER capsule, Infatab, suspension
Phenytoin ER capsule, chewable tablet, suspension
Elepsia XR Levetiracetam ER tablet
Epidiolex Cannabidiol (CBD) solution
Epitol Carbamazepine tablet
Equetro Carbamazepine capsule
Felbatol Felbamate suspension, tablet
Felbamate suspension, tablet
Fintepla Fenfluramine solution
Fycompa Perampanel tablet, suspension
Gabitril Tiagabine tablet
Tiagabine tablet
Keppra, Keppra XR Levetiracetam solution, tablet, ER tablet
Levetiracetam solution, tablet, ER tablet
Klonopin Clonazepam tablet
Clonazepam tablet, ODT/Dispersable tablet
Lamictal, Lamictal XR Lamotrigine tablet, dispersable tablet, starter kit, ODT, ODT kit, ER tablet, ER kit Lamotrigine tablet, dispersable tablet, starter kit, ODT, ODT kit, ER tablet, ER kit Mysoline Primidone tablet
Primidone tablet
Onfi Clobazam suspension, tablet
Clobazam suspension, tablet
Oxtellar XR Oxcarbazepine ER tablet
Peganone Ethotoin tablet
Phenytek Phenytoin ER capsule
Qudexy XR Topiramate ER capsule
Topiramate ER capsule
Roweepra/Roweepra XR Levetiracetam tablet, ER tablet
Sabril Vigabatrin powder packet, tablet
Vigabatrin powder packet, tablet
Spritam Levetiracetam tablet
Subvenite Lamotrigine tablet
Sympazan Clobazam film
Tegretol, Tegretol XR Carbamazepine suspension, tablet
Carbamazepine chewable tablet, suspension, tablet, ER tablet Topamax Topiramate tablet, sprinkle capsule
Topiramate tablet, sprinkle capsule
Trileptal Oxcarbazepine suspension, tablet
Oxcarbazepine suspension, tablet
Trokendi XR Topiramate ER capsule
Vimpat Lacosamide solution, starter kit, tablet Xcopri Cenobamate tablet, titration pack, daily dose pack
Zarontin Ethosuximide capsule, solution
Ethosuximide capsule, solution
STIMULANTS and other ADHD Agents Brand Name Generic Name
Clonidine ER tablet
Dextroamphetamine tablet
Methylphenidate chewable tablet
Methylphenidate CD/ER capsule
Methylphenidate ER 72mg tablet
Adderall/Adderall XR Dextroamphetamine/amphetamine tablet, ER capsule Dextroamphetamine/amphetamine tablet, ER capsule Adhansia XR Methylphenidate ER capsule
Adzenys ER Amphetamine ER suspension
Amphetamine ER suspension
Adzenys XR-ODT Amphetamine ER ODT
Aptensio XR Methylphenidate ER capsule
Methylphenidate ER capsule
Concerta Methylphenidate ER tablet
Methylphenidate ER tablet
Cotempla XR-ODT Methylphenidate ODT
Daytrana Methylphenidate patch
Desoxyn Methamphetamine tablet Methamphetamine tablet
Dexedrine Dextroamphetamine spansule
Dextroamphetamine ER capsule
Dyanavel XR Amphetamine ER suspension
Evekeo Amphetamine tablet, ODT
Amphetamine tablet
Focalin/Focalin XR Dexmethylphenidate tablet, ER capsule
Dexmethylphenidate tablet, ER capsule
Intuniv ER Guanfacine ER tablet
Guanfacine ER tablet
Jornay PM Methylphenidate ER capsule
Methylin Methylphenidate solution
Methylphenidate solution
Mydayis ER Dextroamphetamine/Amphetamine capsule
Nuvigil Armodafinil tablet
Armodafinil tablet
Procentra Dextroamphetamine solution
Dextroamphetamine solution
Provigil Modafinil tablet
Modafinil tablet
Qelbree Viloxazine capsule
Quillichew ER Methylphenidate ER chewable tablet
Quillivant XR Methylphenidate ER suspension
Relexxi ER Methylphenidate ER tablet Methylphenidate ER tablet
Ritalin/Ritalin LA/Ritalin SR Methylphenidate tablet, ER tablet, LA capsule
Methylphenidate tablet, ER tablet, ER/LA capsule
Strattera Atomoxetine capsule
Atomoxetine capsule
Sunosi Solriamfetol tablet
Vyvanse Lisdexamfetamine capsule, chewable tablet
Wakix Pitolisant tablet
Zenzedi Dextroamphetamine tablet
Dextroamphetamine tablet
BONE RESORPTION SUPPRESSION & RELATED AGENTS Brand Name Generic Name
Bisphosphonates
Actonel Risedronate tablet
Risedronate tablet
Atelvia Risedronate DR tablet
Risedronate DR tablet
Boniva Ibandronate tablet
Ibandronate tablet
Fosamax Alendronate tablet
Alendronate solution, tablet
Fosamax Plus D Alendronate with Vitamin D tablet
Non-Bisphosphonates
Calcitonin-Salmon, Synthetic nasal spray Teriparatide pen injector
Evista Raloxifene tablet
Raloxifene tablet
Forteo Teriparatide pen injector
Tymlos Abaloparatide pen injector
CONTRACEPTIVES Brand Name Generic Name
Oral
Desogestrel/Ethinyl Estradiol tablet
Desogestrel-Ethinyl Estradiol/Ethinyl Estradiol tablet
Drospirenone/Ethinyl Estradiol tablet
Drospirenone/Ethinyl Estradiol/Levomethofolate tablet Ethynodiol/Ethinyl Estradiol tablet
Levonorgestrel/Ethinyl Estradiol tablet
Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol tablet Norethindrone tablet
Norethindrone/Ethinyl Estradiol tablet
Norethindrone/Ethinyl Estradiol/Iron capsule, tablet, chewable tablet Norgestimate/Ethinyl Estradiol tablet
Afirmelle Levonorgestrel/Ethinyl Estradiol tablet
Altavera Levonorgestrel/Ethinyl Estradiol tablet
Alyacen Norethindrone/Ethinyl Estradiol tablet
Amethia/Amethia Lo Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol tablet Amethyst Levonorgestrel/Ethinyl Estradiol tablet
Apri Desogestrel/Ethinyl Estradiol tablet
Aranelle Norethindrone/Ethinyl Estradiol tablet
Ashlyna Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol tablet Aubra/Aubra EQ Levonorgestrel/Ethinyl Estradiol tablet
Aurovela/Aurovela Fe/Aurovela 24 Fe Norethindrone/Ethinyl Estradiol tablet
Aviane Levonorgestrel/Ethinyl Estradiol tablet
Ayuna Levonorgestrel/Ethinyl Estradiol tablet
Azurette Desogestrel-Ethinyl Estradiol/Ethinyl Estradiol tablet
Balcoltra Levonorgestrel/Ethinyl Estradiol/Iron tablet
Balziva Norethindrone/Ethinyl Estradiol tablet
Bekyree Desogestrel-Ethinyl Estradiol/Ethinyl Estradiol tablet
Beyaz Dropirenone/Ethinyl Estradiol/Levonorgestrel tablet
Blisovi Fe/Blisovi 24 Fe Norethindrone/Ethinyl Estradiol/Iron tablet
Briellyn Norethindrone/Ethinyl Estradiol tablet
Camila Norethindrone tablet
Camrese/Camrese Lo Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol tablet Caziant Desogestrel/Ethinyl Estradiol tablet
Charlotte 24 Fe Norethindrone/Ethinyl Estradiol/Iron chewable tablet
Chateal/Chateal EQ Levonorgestrel/Ethinyl Estradiol tablet
Cryselle Norgestrel/Ethinyl Estradiol tablet
Cyclafem Norethindrone/Ethinyl Estradiol tablet
Cyred/Cyred EQ Desogestrel/Ethinyl Estradiol tablet
Dasetta Norethindrone/Ethinyl Estradiol tablet Daysee Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol tablet Deblitane Norethindrone tablet
Dolishale Levonorgestrel/Ethinyl Estradiol tablet
Elinest Norgestrel/Ethinyl Estradiol tablet
Emoquette Desogestrel/Ethinyl Estradiol tablet
Enpresse Levonorgestrel/Ethinyl Estradiol tablet
Enskyce Desogestrel/Ethinyl Estradiol tablet
Errin Norethindrone tablet
Estarylla/Tri-Estarylla/Tri-Lo-Estarylla Norgestimate/Ethinyl Estradiol tablet
Estrostep Fe Norethindrone/Ethinyl Estradiol/Iron tablet
Falmina Levonorgestrel/Ethinyl Estradiol tablet
Fayosim Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol tablet Femynor/Tri Femynor Norgestimate/Ethinyl Estradiol tablet
Gemmily Norethindrone/Ethinyl Estradiol/Iron capsule
Generess Fe Norethindrone/Ethinyl Estradiol/Iron chewable tablet
Gianvi Drospirenone/Ethinyl Estradiol tablet
Hailey/Hailey 24 Fe/Hailey Fe Norethindrone/Ethinyl Estradiol/Iron tablet
Heather Norethindrone tablet
Iclevia Levonorgestrel/Ethinyl Estradiol tablet
Incassia Norethindrone tablet
Introvale Levonorgestrel/Ethinyl Estradiol tablet
Isibloom Desogestrel/Ethinyl Estradiol tablet
Jaimiess/LoJaimiess Levonorgest/Ethinyl Estradiol/Ethinyl Estradiol tablet
Jasmiel Drospirenone/Ethinyl Estradiol tablet Jencycla Norethindrone tablet
Jolessa Levonorgestrel/Ethinyl Estradiol tablet
Jolivette Norethindrone tablet
Juleber Desogestrel/Ethinyl Estradiol tablet
Junel/Junel Fe/Junel Fe 24 Norethindrone/Ethinyl Estradiol tablet
Kaitlib Fe Norethidrone/Ethinyl Estradiol chewable tablet
Kalliga Desogestrel/Ethinyl Estradiol tablet
Kariva Desogestrel-Ethinyl Estradiol/Ethinyl Estradiol tablet
Kelnor Ethynodiol/Ethinyl Estradiol tablet
Kurvelo Levonorgestrel/Ethinyl Estradiol tablet
Larin/Larin 21/Larin Fe/Larin 24 Fe Norethindrone/Ethinyl Estradiol tablet
Larissia Levonorgestrel/Ethinyl Estradiol tablet
Layolis Fe Norethindrone/Ethinyl Estradiol/Iron chewable tablet
Leena Norethindrone/Ethinyl Estradiol tablet
Lessina Levonorgestrel/Ethinyl Estradiol tablet
Levonest Levonorgestrel/Ethinyl Estradiol tablet
Levora Levonorgestrel/Ethinyl Estradiol tablet
Lillow Levonorgestrel/Ethinyl Estradiol tablet
Loestrin/Loestrin Fe/Lo Loestrin Fe Norethindrone/Ethinyl Estradiol tablet
Loryna Drospirenone/Ethinyl Estradiol tablet
Low-Ogestrel Norgestrel/Ethinyl Estradiol tablet
Lutera Levonorgestrel/Ethinyl Estradiol tablet
Lyleq Norethindrone tablet
Lyza Norethindrone tablet Marlissa Levonorgestrel/Ethinyl Estradiol tablet
Melodetta Fe Norethindrone/Ethinyl Estradiol/Iron chewable tablet
Merzee Norethindrone/Ethinyl Estradiol capsule
Mibelas 24 Fe Norethindrone/Ethinyl Estradiol/Iron chewable tablet
Microgestin 21/Microgestin 24 Fe/ Norethindrone/Ethinyl Estradiol/Iron tablet Microgestin Fe Mili/Tri-Lo-Mili/Tri-Mili Norgestimate/Ethinyl Estradiol tablet
Minastrin 24 Fe Norethindrone/Ethinyl Estradiol/Iron chewable tablet
Mircette Desogestrel/Ethinyl Estradiol/Ethinyl Estradiol tablet
Mono-Linyah Norgestimate/Ethinyl Estradiol tablet
Natazia Dienogestrel/Estradiol Valerate tablet
Necon Norethindrone/Ethinyl Estradiol tablet
Nextstellis Drospirenone/Estetrol tablet
Nikki Drospirenone/Ethinyl Estradiol tablet
Nora-Be Norethindrone tablet
Norlyda Norethindrone tablet
Nortrel Norethindrone/Ethinyl Estradiol tablet
Nylia Norethindrone/Ethinyl Estradiol tablet
Nymyo/Tri-Nymyo Norgestimate/Ethinyl Estradiol tablet
Ocella Drospirenone/Ethinyl Estradiol tablet
Orsythia Levonorgestrel/Ethinyl Estradiol tablet
Ortho-Novum Norethindrone/Ethinyl Estradiol tablet
Ortho Tri-Cyclen Norgestimate/Ethinyl Estradiol tablet
Philith Norethindrone/Ethinyl Estradiol tablet
Pimtrea Desogestrel/Ethinyl Estradiol/Ethinyl Estradiol tablet Pirmella Norethindrone/Ethinyl Estradiol tablet
Portia Levonorgestrel/Ethinyl Estradiol tablet
Previfem/Tri-Previfem Norgestimate/Ethinyl Estradiol tablet
Quartette Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol tablet Reclipsen Desogestrel/Ethinyl Estradiol tablet
Rivelsa Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol tablet Safyral Drospirenone/Ethinyl Estradiol/Levomethofolate tablet Seasonique/LoSeasonique Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol tablet Setlakin Levonorgestrel/Ethinyl Estradiol tablet
Sharobel Norethindrone tablet
Simliya Desogestrel/Ethinyl Estradiol/Ethinyl Estradiol tablet
Simpesse Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol tablet Slynd Drospirenone tablet
Sprintec/Tri-Sprintec/Tri-Lo-Sprintec Norgestimate/Ethinyl Estradiol tablet
Sronyx Levonorgestrel/Ethinyl Estradiol tablet
Syeda Drospirenone/Ethinyl Estradiol tablet
Tarina Fe/Tarina 24 Fe Norethindrone/Ethinyl Estradiol/Iron tablet
Taytulla Norethindrone/Ethinyl Estradiol/Iron capsule
Tilia Fe Norethindrone/Ethinyl Estradiol/Iron tablet
Tri-Legest Fe Norethindrone/Ethinyl Estradiol/Iron tablet
Tri-Linyah Norgestimate/Ethinyl Estradiol tablet
Tri-Lo-Marzia Norgestimate/Ethinyl Estradiol tablet
Trivora Levonorgestrel/Ethinyl Estradiol tablet Tulana Norethindrone tablet
Tyblume Levonorgestrel/Ethinyl Estradiol chewable tablet
Tydemy Drospirenone/Ethinyl Estradiol/Levomethofolate tablet Velivet Desogestrel/Ethinyl Estradiol tablet
Vestura Drospirenone/Ethinyl Estradiol tablet
Vienva Levonorgestrel/Ethinyl Estradiol tablet
Viorele Desogestrel-Ethinyl Estradiol/Ethinyl Estradiol tablet
Volnea Desogestrel/Ethinyl Estradiol/Ethinyl Estradiol tablet
Vyfemla Norethindrone/Ethinyl Estradiol tablet
Vylibra/Tri-Vylibra Norgestimate/Ethinyl Estradiol tablet
Wera Norethindrone/Ethinyl Estradiol tablet
Wymzya Fe Norethindrone/Ethinyl Estradiol/Iron chewable tablet
Yasmin/Yaz Drospirenone/Ethinyl Estradiol tablet
Zarah Drospirenone/Ethinyl Estradiol tablet
Zovia Ethynodiol/Ethinyl Estradiol tablet
Zumandimine/Lo-Zumandimine Drospirenone/Ethinyl Estradiol tablet
Topical
Annovera Segesterone acetate/Ethinyl Estradiol vaginal ring
Eluryng Etonorgestrel/Ethinyl Estradiol vaginal ring
Nuvaring Etonorgestrel/Ethinyl Estradiol vaginal ring
Etonorgestrel/Ethinyl Estradiol vaginal ring
Phexxi Lactic Acid/Citric Acid/Potassium vaginal gel
Twirla Levonorgestrel/Ethinyl Estradiol patch
Xulane Norelgestromin/Ethinyl Estradiol patch Zafemy Norelgestromin/Ethinyl Estradiol patch
ESTROGEN AGENTS Brand Name Generic Name
Oral
Estrace Estradiol tablet
Estradiol tablet
Transdermal
Alora Estradiol patch
Climara Estradiol patch
Estradiol patch
Dotti Estradiol patch
Estradiol patch
Lyllana Estradiol patch
Menostar Estradiol patch
Minivelle Estradiol patch
Vivelle-Dot Estradiol patch
Estradiol patch
ESTROGEN AGENTS: Parenteral Brand Name Generic Name
Depo-Estradiol Estradiol cypionate vial
Delestrogen Estradiol valerate vial
Estradiol valerate vial
DIABETES MANAGEMENT CLASSES: Amylin Brand Name Generic Name
Symlin Pramlintide pen injector
DIABETES MANAGEMENT CLASSES: Biguanides Brand Name Generic Name
Metformin tablet
Fortamet ER Metformin ER Osm-Tab
Metformin ER Osm-Tab
Glumetza ER Metformin ER tablet
Metformin ER tablet
Riomet/Riomet ER Metformin solution, ER solution
Metformin solution
DIABETES MANAGEMENT CLASSES: DPP-4 Inhibitors & Combinations Brand Name Generic Name
Single-Ingredient Products
Januvia Sitagliptin tablet
Nesina Alogliptin tablet
Alogliptin tablet
Onglyza Saxagliptin tablet
Tradjenta Linagliptin tablet
Combinations
Janumet/Janumet XR Sitagliptin/Metformin tablet, Sitagliptin/Metformin ER tablet Jentadueto/Jentadueto XR Linagliptin/Metformin tablet, Linagliptin/Metformin ER tablet Kazano Alogliptin/Metformin tablet
Alogliptin/Metformin tablet
Kombiglyze XR Saxagliptin/Metformin ER tablet
DIABETES MANAGEMENT CLASSES: GLP-1 Analogues Brand Name Generic Name
Adlyxin Lixisenatide injector pack
Bydureon/Bydureon BCISE Exenatide pen injector, autoinjector
Byetta Exenatide pen injector
Ozempic Semaglutide pen
Rybelsus Semaglutide oral tablet
Trulicity Dulaglutide pen
Victoza Liraglutide pen
DIABETES MANAGEMENT CLASSES: Hypoglycemic Combinations Brand Name Generic Name
Glipizide/Metformin tablet
Glyburide/Metformin tablet
Duetact Pioglitazone/Glimepiride tablet
Pioglitazone/Glimepiride tablet
Glyxambi Empagliflozin/Linagliptin tablet
Oseni Alogliptin/Pioglitazone tablet
Alogliptin/Pioglitazone tablet
Qtern Dapagliflozin/Saxagliptin tablet
Soliqua Lixisenatide/insulin glargine subcutaneous injection Steglujan Ertugliflozin/Sitagliptin tablet
Trijardy XR Empagliflozin/Linagliptin/Metformin tablet
Xultophy Liraglutide/insulin degludec subcutaneous injection
DIABETES MANAGEMENT CLASSES: Insulin & Related Agents
Brand Name Generic Name
Rapid-acting Admelog Insulin lispro Solostar, vial
Afrezza Insulin regular cartridge, unit
Apidra Insulin glulisine Solostar, vial
Fiasp Insulin aspart FlexTouch, penfill, vial
Humalog/Humalog Jr. Insulin lispro cartridge, Kwikpen, vial
Insulin lispro pen/Jr. pen, vial
Lyumjev Insulin lispro-aabc Kwikpen, vial
Novolog Insulin aspart cartridge, Flexpen, vial
Insulin aspart cartridge, pen, vial
Short-acting Humulin R Regular insulin Kwikpen, vial
Novolin R Regular insulin Kwikpen, vial
Intermediate-acting Humulin N Insulin NPH Kiwkpen, vial
Novolin N Insulin NPH Flexpen, vial
Long-acting Basaglar Insulin glargine Kwikpen
Lantus Insulin glargine Solostar, vial
Levemir Insulin detemir Flextouch, vial Semglee Insulin glargine pen, vial
Toujeo/Toujeo Max Insulin glargine Solostar
Tresiba Insulin degludec Flextouch, vial
Insulin Mixtures Humalog Mix 50/50 50% insulin lispro protamine/50% insulin lispro Kwikpen, vial
Humalog Mix 75/25 75% insulin lispro protamine/25% insulin lispro Kwikpen, vial 75% insulin lispro protamine/25% insulin lispro Kwikpen, vial Humulin 70/30 70% insulin NPH/30% insulin regular Kwikpen, vial
Novolin 70/30 70% insulin NPH/30% insulin regular Flexpen, vial
Novolog Mix 70/30 70% insulin aspart protamine/30% insulin aspart Flexpen, vial
70% insulin aspart protamine/30% insulin aspart Flexpen, vial
DIABETES MANAGEMENT CLASSES: Meglitinides & Combinations Brand Name Generic Name
Single-Ingredient Products
Prandin Repaglinide tablet
Repaglinide tablet
Starlix Nateglinide tablet
Nateglinide tablet
Combinations
Repaglinide/Metformin tablet
DIABETES MANAGEMENT CLASSES: SGLT-2 Inhibitors & Combinations Brand Name Generic Name Single-Ingredient Products
Farxiga Dapagliflozin tablet
Invokana Canagliflozin tablet
Jardiance Empagliflozin tablet
Steglatro Ertugliflozin tablet
Combinations
Invokamet/Invokamet XR Canagliflozin/Metformin tablet
Segluromet Ertugliflozin/Metformin tablet
Synjardy/Synjardy XR Empagliflozin/Metformin tablet
Xigduo XR Dapagliflozin/Metformin tablet
DIABETES MANAGEMENT CLASSES: Thiazolidinediones & Combinations Brand Name Generic Name
Single-Ingredient Products
Actos Pioglitazone tablet
Pioglitazone tablet
Avandia Rosiglitazone tablet
Combinations
Actoplus Met Pioglitazone/Metformin tablet
Pioglitazone/Metformin tablet
GLUCAGON, SELF-ADMINISTERED Brand Name Generic Name Baqsimi Glucagon spray
Glucagen Hypokit Glucagon kit
Glucagon Emergency Kit Glucagon kit
Gvoke Glucagon Hypopen, syringe
Zegalogue Dasiglucagon autoinjector, syringe
GI MOTILITY, CHRONIC Brand Name Generic Name
Amitiza Lubiprostone capsule
Lubiprostone capsule
Linzess Linaclotide capsule
Lotronex Alosetron tablet
Alosetron tablet
Motegrity Prucalopride tablet
Movantik Naloxegol tablet
Relistor Methylnaltrexone syringe, tablet
Symproic Naldemedine tablet
Trulance Plecanatide tablet
Viberzi Eluxadoline tablet
ANTICOAGULANTS: Oral Brand Name Generic Name
Bevyxxa Betrixaban capsule
Jantoven Warfarin tablet Warfarin tablet
Eliquis Apixaban tablet, starter pack
Pradaxa Dabigatran capsule
Savaysa Edoxaban tablet
Xarelto Rivaroxaban tablet, starter pack
ANTICOAGULANTS: Parenteral Brand Name Generic Name
Arixtra Fondaparinux syringe
Fondaparinux syringe
Fragmin Dalteparin syringe, vial
Lovenox Enoxaparin syringe
Enoxaparin syringe
ANTIPLATELET AGENTS Brand Name Generic Name
Aspirin/dipyridamole capsule
Cilostazol tablet
Dipyridamole tablet
Pentoxifylline ER tablet
Brilinta Tigacrelor tablet
Effient Prasugrel tablet
Prasugrel tablet
Plavix Clopidogrel tablet
Clopidogrel tablet Yosprala Aspirin/Omeprazole DR tablet
Zontivity Vorapaxar tablet
COLONY STIMULATING FACTORS Brand Name Generic Name
Granix tbo-Flilgrastim syringe, vial
Fulphila** Pegfilgrastim-jmdb syringe
Leukine Sargramostim vial
Neulasta/Neulasta Onpro Pegfilgrastim syringe, kit
Neupogen Filgrastim syringe, vial
Nyvepria** Pegfilgrastim-apgf syringe
Nivestym* Filgrastim-aafi syringe, vial
Udenyca** Pegfilgrastim-cbqv syringe
Zarxio* Filgrastim-sndz syringe
Ziextenzo** Pegfilgrastim-bmez syringe
*biosimilar to Neupogen **biosimilar to Neulasta
ERYTHROPOIESIS STIMULATING AGENTS Brand Name Generic Name
Aranesp Darbepoetin alfa syring, vial
Epogen Epoetin alfa vial
Mircera Methoxy peg- epoetin beta syringe
Procrit Epoetin alfa vial
Retacrit* Epoetin alfa-epbx vial
*biosimilar to Procrit
NEWER HAE – HEREDITARY ANGIOEDEMA AGENTS Brand Name Generic Name
Berinert C1 Esterase Inhibitor kit, vial
Cinryze C1 Esterase Inhibitor vial
Firazyr Icatibant syringe
Icatibant syringe
Haegarda C1 Esterase Inhibitor vial
Orladeyo Berotralstat capsule
Ruconest C1 Esterase Inhibitor, recombinant vial
Takhzyro Lanadelumab-flyo vial
OPHTHALMIC, IMMUNOMODULATORS Brand Name Generic Name
Cequa Cyclosporine solution
Restasis Cyclosporine emulsion
Restasis Multidose Cyclosporine emulsion
Xiidra Lifitegrast drops
OVERACTIVE BLADDER AGENTS Brand Name Generic Name
Flavoxate tablet
Oxybutynin syrup, tablet
Trospium tablet, ER capsule
Detrol/Detrol LA Tolterodine tablet, ER capsule
Tolterodine tablet, ER capsule Ditropan XL Oxybutynin ER tablet
Oxybutynin ER tablet
Enablex Darifenacin ER tablet
Darifenacin ER tablet
Gelnique Oxybutynin gel sachet
Gemtesa Vibegron tablet
Myrbetriq ER Mirabegron ER tablet
Oxytrol Oxybutynin (Rx) patch
Toviaz ER Fesoterodine ER tablet
Vesicare Solifenacin tablet
Solifenacin tablet
Vesicare LS Solifenacin suspension
PRENATAL VITAMINS Brand Name Generic Name
Citranatal/Citranatal Assure/Citranatal B- Various formulations Calm/Citranatal 90/ Citranatal DHA/Citranatal Harmony/ Citranatal Rx C-Nate DHA PNV/FeF/FA/Omega 3
Complete Natal DHA PNV/Fe/FA
Completenate PNV/FeF/FA chewable tablet
Elite-OB PNV/Fe/FA caplet
Enbrace HR PNV/Fe/Folate/DHA softgel
Folivane-OB PNV/FeF/FA capsule
M-Natal Plus PNV/Ca/Fe/FA tablet Marnatal-F PNV/Ca/Fe/FA capsule
Nestabs/Nestabs ABC/Nestabs Various Formulations DHA/Nestabs One OB Complete/OB Complete One/OB Various Formulations Complete Petite/OB Complete Premier/OB Complete DHA O-Cal FA PNV/Fe/FA tablet
PNV/PNV-Select/PNV-DHA/PNV-Omega Various Formulations
Prenatal Vitamin Plus Low Iron PNV/Ca/Fe/FA tablet
Prenate/Prenate AM/Prenate DHA/Prenate Various Formulations Elite/Prenate Enhance/Prenate Essential/ Prenate Mini/Prenate Pixie/Prenate Restore/Prenate Star Preplus PNV/Ca/Fe/FA tablet
Pretab PNV/Ca/Fe/FA tablet
Primacare PNV/Fe/Folate/DHA softgel
PureFe Plus/PureFe OB Plus PNV/Fe/FA capsule
Select-OB Various Formulations
SE-Natal 19 Various Formulations
Taron-C DHA PNV/Fe/Omega 3/DHA capsule
Thrivite PNV/Ca/Fe/FA tablet
Tricare Prenatal PNV/Fe/FA tablet
Trinatal Rx 1 PNV/Ca/Fe/FA tablet
Tristart DHA PNV/Fe/Folate/DHA softgel
Triveen-Duo DHA PNV/Fe/FA/Omega 3 combo pack
Vinate DHA PNV/Fe/LMF
Virt-C DHA/Virt-Nate/Virt-PN DHA/Virt-PN Various Formulations Plus/Virt-PN Vitafol/Vitafol-Fe/Vitafol Nano/Vitafol-OB/ Various Formulations Vitafol-One/ Vitafol-Ultra VP-PNV DHA PNV/Fe/FA/DHA softgel
Westab Plus PNV/Ca/Fe/FA tablet
Westgel DHA PNV/Fe/FA/DHA softgel
Zatean-PN DHA/Zatean-PN Plus Various Formulations
Note: Ca – Calcium, FA – Folic Acid Fe – Iron, FeF – Iron fumarate, FeG – Iron Gluconate, LMF – L-methylfolate, PNV – prenatal vitamin