Section 7 Preferred Drug List Kansas State Group Health Insurance Program Member Preferred Drug List 2007 The drug representation on the Preferred Drug List is subject to continuing review by the Caremark National Pharmacy and Therapeutics Committee solely as it relates to safety and efficacy. If you have questions or need additional information, contact Kansas State Employees Prescription Drug Program toll-free at 1-800-294-6324 or access the Web site at:: http://khpa.ks.gov/subject/benelink The Preferred Drug List is subject to change. You may access the most current drug list at the State of Kansas Web site at: http://khpa.ks.gov/subject/benelink to locate covered prescriptions on-line. What is a Preferred Drug List? A Preferred Drug List is a list of safe and cost effective drugs, chosen by a committee of physicians and pharmacists. Drug lists have been used in hospitals for many years to help ensure quality drug use. The Kansas State Employees Preferred Drug List will be continually revised to reflect the changing drug market. Should I ask my physician to switch my current medications to a medication that is on the Preferred Drug List? Many of your medications will already be on the Preferred Drug List. However, if you have a medication that is not, ask your physician to choose a similar Preferred Drug List product for you to use. Should I use generics? There are many medications on the market that do not come in generic form. For those drugs that do, your pharmacist should suggest safe and effective generic alternatives. The following drug categories contain medications your doctor may prescribe. You should present this member Preferred Drug List to your physician at each office visit. KSE-CDL-0107 Your Kansas State Employees Preferred Drug List As Of January 2007 ANALGESICS Second Generation NSAIDs cefaclor * $$ ibuprofen * $ cefuroxime axetil * $$$ naproxen * $ Third Generation naproxen sodium * $$ cefdinir (OMNICEF) $$$$ indomethacin * $$ * salsalate $$$$ Erythromycins/Macrolides * etodolac $$$$ erythromycin stearate * $ * oxaprozin $$$$ erythromycin/sulfisoxazole * $ * sulindac $$$$ erythromycin ethylsuccinate * $ * diflunisal $$$$$ erythromycin delayed-rel * $ * diclofenac sodium delayed-rel $$$$$ azithromycin susp * $$ * nabumetone $$ $$$$$ azithromycin tabs * $$ * indomethacin ext-rel $$$ $$$$$ clarithromycin * $$$ clarithromycin ext-rel (BIAXIN XL) $$$ COX-2 INHIBITORS celecoxib (CELEBREX) $ $$$$$ Fluoroquinolones ciprofloxacin ext-rel (CIPRO XR) $$ GOUT ciprofloxacin susp (CIPRO susp) $$$$ allopurinol * $ moxifloxacin (AVELOX) $$$$$ colchicine * $$$$ ciprofloxacin tabs * $$$$$ probenecid * $ $$$$$ levofloxacin (LEVAQUIN) $$$$$ NARCOTIC ANALGESICS Penicillins hydrocodone/acetaminophen * $$ amoxicillin * $ codeine/acetaminophen * $$ ampicillin * $ NARCOTIC ANALGESICS, CII penicillin VK * $ oxycodone/acetaminophen 5/325 * $ dicloxacillin * $ oxycodone soln * $$$$ amoxicillin/clavulanate * $$$ oxycodone * $$$$$ hydromorphone * $ $$$$$ Sulfonamides morphine * $$ $$$$$ acetyl sulfisoxazole susp (GANTRISIN) $ morphine ext-rel (AVINZA) $$$ $$$$$ Tetracyclines oxycodone ext-rel * $$$ $$$$$ doxycycline hyclate * $ fentanyl transdermal * $$$ $$$$$ tetracycline * $ morphine supp * $$$$$ $$$$$ minocycline * $$ NON-NARCOTIC ANALGESICS ANTIFUNGALS tramadol * $$ nystatin * $$$ butalbital/acetaminophen/caffeine * $$$ ketoconazole * $$$$ butalbital/aspirin/caffeine * $$$ clotrimazole troches * $$$$$ griseofulvin ultramicrosize $$$$$ ANTI-INFECTIVES (GRIS-PEG) ANTIBACTERIALS fluconazole * $$$$$ Cephalosporins terbinafine tabs (LAMISIL) $ $$$$$ First Generation itraconazole * $$ $$$$$ cephalexin * $ voriconazole (VFEND) $$$$$ $$$$$ cefadroxil * $$ * = Generic available Please note this may affect your coinsurance. Your Kansas State Employees Preferred Drug List As Of January 2007 ANTIMALARIALS ANTITUBERCULAR AGENTS chloroquine * $$ isoniazid * $ mefloquine * $$ pyrazinamide * $$$$ atovaquone/proguanil (MALARONE) $$$$$ rifampin * $$$$$ ethambutol * $$$$$ ANTIRETROVIRAL AGENTS Non-Nucleoside Reverse- ANTIVIRALS Transcriptase Inhibitors Cytomegalovirus Agents delavirdine (RESCRIPTOR) $ $$$$$ valganciclovir (VALCYTE) $$ nevirapine (VIRAMUNE) $$ $$$$$ ganciclovir * $$$$ $$$$$ efavirenz (SUSTIVA) $$ $$$$$ Hepatitis Agents Nucleoside Reverse-Transcriptase Inhibitors lamivudine (EPIVIR-HBV) $$$$$ zalcitabine (HIVID) $ $$$$$ adefovir dipivoxil (HEPSERA) $$ $$$$$ didanosine (VIDEX) $ $$$$$ ribavirin * $$ $$$$$ emtricitabine (EMTRIVA) $ $$$$$ entecavir (BARACLUDE) $$$ $$$$$ lamivudine (EPIVIR) $ $$$$$ ribavirin oral soln (REBETOL) $$$ $$$$$ didanosine delayed-rel * $ $$$$$ stavudine (ZERIT) $ $$$$$ Herpes Agents zidovudine (RETROVIR) $$ $$$$$ acyclovir * $ abacavir (ZIAGEN) $$ $$$$$ valacyclovir (VALTREX) $$ Nucleoside Reverse-Transcriptase Influenza Agents Inhibitor Combinations amantadine * $ lamivudine/zidovudine $$$ $$$$$ rimantadine * $$$ (COMBIVIR) oseltamivir (TAMIFLU) $$$$$ emtricitabine/tenofovir $$$ $$$$$ (TRUVADA) MISCELLANEOUS abacavir/lamivudine $$$ $$$$$ metronidazole * $ (EPZICOM) sulfamethoxazole/trimethoprim * $ abacavir/lamivudine/ $$$ $$$$$ mebendazole * $ zidovudine (TRIZIVIR) dapsone $ trimethoprim * $ Nucleotide Reverse- nitrofurantoin ext-rel * $$ Transcriptase Inhibitors clindamycin * $$ tenofovir (VIREAD) $$ $$$$$ nitrofurantoin macrocrystals * $$ Protease Inhibitors ANTINEOPLASTIC AGENTS fosamprenavir (LEXIVA) $ $$$$$ HORMONAL ANTINEOPLASTIC AGENTS indinavir (CRIXIVAN) $$ $$$$$ Antiandrogens nelfinavir (VIRACEPT) $$$ $$$$$ bicalutamide (CASODEX) lopinavir/ritonavir (KALETRA) $$$ $$$$$ flutamide * amprenavir (AGENERASE) $$$ $$$$$ saquinavir mesylate (INVIRASE) $$$ $$$$$ Antiestrogens atazanavir (REYATAZ) $$$ $$$$$ fulvestrant (FASLODEX) darunavir (PREZISTA) $$$$ $$$$$ tamoxifen * tipranavir (APTIVUS) $$$$$ $$$$$ toremifene (FARESTON) ritonavir (NORVIR) $$$$$ $$$$$ * = Generic available Please note this may affect your coinsurance. Your Kansas State Employees Preferred Drug List As Of January 2007 Aromatase Inhibitors ACE INHIBITOR/CALCIUM CHANNEL anastrozole (ARIMIDEX) BLOCKER COMBINATIONS exemestane (AROMASIN) trandolapril/verapamil ext-rel $ $$$$$ letrozole (FEMARA) (TARKA) amlodipine/benazepril (LOTREL) $$ $$$$$ Luteinizing Hormone-Releasing Hormone (LHRH) Agonists ACE INHIBITOR/ goserelin acetate (ZOLADEX) DIURETIC COMBINATIONS leuprolide acetate * benazepril/hydrochlorothiazide * $$ triptorelin pamoate (TRELSTAR) captopril/hydrochlorothiazide * $$ lisinopril/hydrochlorothiazide * $$ Progestins enalapril/hydrochlorothiazide * $$$ megestrol acetate * fosinopril/hydrochlorothiazide * $$$$ quinapril/hydrochlorothiazide * $$$$ ORAL AGENTS Alkylating Agents ADRENOLYTICS, CENTRAL busulfan (MYLERAN) clonidine * $ chlorambucil (LEUKERAN) guanfacine * $$ cyclophosphamide * lomustine (CEENU) ALPHA BLOCKERS melphalan (ALKERAN) doxazosin * $ temozolomide (TEMODAR) terazosin * $ Antimetabolites ANGIOTENSIN II RECEPTOR ANTAGONISTS capecitabine (XELODA) candesartan (ATACAND†) $$$$ mercaptopurine * irbesartan (AVAPRO) $$$$$ thioguanine losartan (COZAAR) $$$$$ † Atacand should be reserved for participants who meet Multi Kinase Inhibitors CHARM (Candesartan in Heart Failure - Assessment of sorafenib (NEXAVAR) Reduction in Mortality and Morbidity) trial criteria. sunitinib (SUTENT) ANGIOTENSIN II RECEPTOR Tyrosine Kinase Inhibitors ANTAGONIST COMBINATIONS erlotinib (TARCEVA) candesartan/hydrochlorothiazide $$$$$ imatinib mesylate (GLEEVEC) (ATACAND HCT) irbesartan/hydrochlorothiazide $ $$$$$ Miscellaneous (AVALIDE) altretamine (HEXALEN) losartan/hydrochlorothiazide $$ $$$$$ bexarotene (TARGRETIN) (HYZAAR) etoposide * hydroxyurea * ANTIARRHYTHMICS mitotane (LYSODREN) mexiletine * $$$$ procarbazine (MATULANE) disopyramide ext-rel * $ $$$$$ tretinoin caps (VESANOID) amiodarone * $$ $$$$$ flecainide * $$ $$$$$ CARDIOVASCULAR propafenone * $$$ $$$$$ ACE INHIBITORS disopyramide * $$$ $$$$$ lisinopril * $ dofetilide (TIKOSYN) $$$ $$$$$ benazepril * $$ sotalol * $$$$ $$$$$ fosinopril * $$$ quinapril * $$$$$ ramipril (ALTACE) $$$$$ * = Generic available Please note this may affect your coinsurance. Your Kansas State Employees Preferred Drug List As Of January 2007 ANTILIPEMICS CALCIUM CHANNEL BLOCKER/ Antilipemic Combinations ANTILIPEMIC COMBINATIONS ezetimibe/simvastatin (VYTORIN) $$ $$$$$ amlodipine/atorvastatin $$$ $$$$$ (CADUET) Bile Acid Resins cholestyramine $ $$$$$ DIGITALIS GLYCOSIDES (cans cost preferred) * digoxin ped elixir * $ colesevelam (WELCHOL) $$$$ $$$$$ digoxin * $ Cholesterol Absorption Inhibitors DIURETICS ezetimibe (ZETIA) $$ $$$$$ hydrochlorothiazide * $ amiloride/hydrochlorothiazide * $ Fibrates chlorthalidone * $ gemfibrozil * $$$ triamterene/hydrochlorothiazide * $ fenofibrate * $$$ $$$$$ indapamide * $ fenofibrate (TRICOR) $$$ $$$$$ furosemide * $ bumetanide * $ HMG-CoA Reductase Inhibitors amiloride * $$ lovastatin * $$$ spironolactone/hydrochlorothiazide * $$$ pravastatin * $$ $$$$$ torsemide * $$$ atorvastatin (LIPITOR) $$$ $$$$$ spironolactone * $$$ metolazone * $$$$$ Niacins niacin ext-rel (NIASPAN) $$ $$$$$ NITRATES Oral BETA-BLOCKERS isosorbide dinitrate oral * $ atenolol * $ isosorbide mononitrate ext-rel * $ metoprolol * $ isosorbide dinitrate ext-rel tabs * $$ pindolol * $ isosorbide mononitrate * $$$ propranolol * $$ nadolol * $$ Sublingual bisoprolol * $$$ nitroglycerin sublingual * $$ labetalol * $$$$ metoprolol ext-rel (TOPROL-XL) $$$$$ Transdermal carvedilol (COREG) $$$ $$$$$ nitroglycerin transdermal * $ $$$$$ BETA-BLOCKER/DIURETIC COMBINATIONS NITRATE/VASODILATOR COMBINATIONS atenolol/chlorthalidone