High Cost Generics (HCG) Drug List GlobalHealth, in partnership with MagellanRx, continually monitors generic medications to offer the best overall health care value at the lowest possible tier. A Generic Drug is equivalent to its brand name counterpart. While generic medications are usually less expensive than brand name medications, certain generics are not always the lowest cost option. There are times where a generic alternative can be more expensive than other generic medications within the same therapeutic class. We have identified options for members to reduce out-of-pocket costs, while offering the same clinical benefit. The following is the 2021 list of High Cost Generics. For additional questions on lower cost options please consult your primary care physician or contact Magellan at 1-800-424-1789. Please Note: High Cost Generics will process at Tier 3 copays. Drug Name Alternatives ACETAMN-CAF- ACETAMIN-CAF-DIHYDROCODEIN DIHYDRCODEIN 320.5 325 CAPSULE ALCLOMETASONE DIPR ALCLOMETASONE DIPRO 0.05% CRM 0.05% OINT BUTALBITAL- ALLZITAL 25-325 MG TABLET ACETAMINOPHN 50-325 ALMOTRIPTAN MALATE TAB NARATRIPTAN HCL sumatriptan zolmitriptan AMCINONIDE 0.1% CREAM aclometasone desonide AMCINONIDE 0.1% LOTION aclometasone desonide APREPITANT 125-80-80 MG PACK ondansetron Aprepitant capsule AVAR-E GREEN EMOLLIENT CREAM AVAR-E EMOLLIENT CREAM NEO-POLYCIN EYE BACITRACIN 500 UNIT/GM OPHTH GENTAMICIN 0.3% EYE DROP OINTMENT NEO-POLYCIN EYE BACITRACIN-POLYMYXIN EYE OINT GENTAMICIN 0.3% EYE DROP OINTMENT BENAZEPRIL-HCTZ TAB lisinopril/hydrochlorothiazide BENZONATATE CAPSULE OTC robitussin BENZTROPINE 2 MG/2 ML AMPULE trihexyphenidyl hcl Benztropine Vial BETAMETHASONE VALER 0.12% aclometasone desonide FOAM magellanrx.com 1 │ 2020. Magellan Rx Management, LLC. All rights reserved. MRX1305_1219 Drug Name Alternatives BIMATOPROST 0.03% EYE DROPS Latanoprost BIMATOPROST 0.03% EYELASH SOLN n/a BP 10-1 WASH AVAR-E EMOLLIENT CREAM BRIMONIDINE 0.2% EYE BRIMONIDINE TARTRATE 0.15% DRP DROP BROMFENAC SODIUM 0.09% EYE diclofenac flurbiprofen ketorolac DRP BROMOCRIPTINE 2.5 MG TABLET Carbidopa/Levodopa Benztropine BROMOCRIPTINE 5 MG CAPSULE Carbidopa/Levodopa Benztropine BUDESONIDE 0.25 MG/2 ML BUDESONIDE 0.5 MG/2 ML BUDESONIDE 1 MG/2 ML INH SUSP SUSP SUSP BUDESONIDE EC 3 MG CAPSULE prednisone BUMETANIDE TABLET torsemide furosemide Bumetanide 0.5mg BUTALBITAL- BUTALBITAL-ACETAMINOPHN 50-300 ACETAMINOPHEN 50-325 TABLET CAFFEINE CIT 60 MG/3 ML ORAL Butalbital/Caffiene/APAP CALCIPOTRIENE 0.005% CREAM CALCIPOTRIENE OINTMENT CALCIPOTRIENE SOLUTION TRIAMCINOLONE 0.025% CALCITRENE 0.005% OINTMENT OINT CALCIPOTRIENE 0.005% CALCIPOTRIENE 0.005% CALCITRIOL 3 MCG/G OINTMENT OINTMENT CREAM CAPTOPRIL TABLET Lisinopril CARBINOXAMINE MALEATE 6 MG CARBINOXAMINE MALEATE TAB 4 MG TAB CARISOPRODOL 250 MG TABLET Carisoprodol 350mg CARVEDILOL ER CAPSULE Carvedilol CERAMAX SKIN BARRIER CREAM OTC emollient CHLORZOXAZONE 500 MG CHLORZOXAZONE 250 MG TABLET TABLET CLINDAMYCIN PH 1% CLINDACIN ETZ 1% PLEDGET SOLUTION CLINDAMYCIN PH 1% CLINDACIN P 1% PLEDGETS SOLUTION CLINDAMYCIN PHOSPHATE 1% CLINDAMYCIN PH 1% FOAM SOLUTION CLINDA-TRETINOIN 1.2%-0.025% Clinda-Benzoyl Peroxide CLOBETASOL 0.05% TOPICAL LOTN aclometasone desonide CLOBETASOL EMOLLNT 0.05% FOAM aclometasone desonide CLOBETASOL EMULSION 0.05% aclometasone desonide FOAM CLOBETASOL PROP 0.05% FOAM aclometasone desonide CLOBETASOL PROP 0.05% SPRAY aclometasone desonide 2 │ 2020. Magellan Rx Management, LLC. All rights reserved. MRX1305_1219 Drug Name Alternatives CLOCORTOLONE 0.1% CREAM PUMP aclometasone desonide CLOCORTOLONE PIVALATE 0.1% CRM aclometasone desonide CLOBETASOL 0.05% CLODAN 0.05% SHAMPOO SHAMPOO CLONIDINE HCL ER 0.1 MG TABLET Clonidine CLONIDINE PATCH Clonidine Tablet CLOTRIMAZOLE-BETAMETHASONE CLOTRIMAZOLE- LOT BETAMETHASONE CREAM COLESTIPOL HCL 1 GM TABLET FENOFIBRATE 54 MG TABLET COLESTIPOL HCL GRANULES FENOFIBRATE 54 MG TABLET COLESTIPOL HCL GRANULES PACKET FENOFIBRATE 54 MG TABLET COLESTIPOL MICRONIZED 1 GM TAB FENOFIBRATE 54 MG TABLET CORTISONE 25 MG TABLET Hydrocortisone CVS OMEPRAZOLE-BICARB 20-1,100 Omeprazole CYCLOBENZAPRINE 10 MG CYCLOBENZAPRINE 7.5 MG TABLET TABLET CYCLOBENZAPRINE 10 MG CYCLOBENZAPRINE ER TABLET CARISOPRODOL 350 mg CYCLOBENZAPRINE 10 MG DANTROLENE SODIUM CAP tablet TABLET SODIUM SULFACETAMIDE CLINDAMYCIN-BENZOYL DAPSONE 5% GEL LOTION PEROXIDE GEL DESLORATADINE ODT FEXOFENADINE FEXOFENADINE OTC DESMOPRESSIN AC 4 MCG/ML VIAL Desmopressin Tablet DESOXIMETASONE 0.05% CREAM aclometasone desonide DESOXIMETASONE 0.05% OINTMENT aclometasone desonide DESVENLAFAXINE ER TAB desvenlafaxine fumarate DEXAMETHASONE 1.5 MG DEXAMETHASONE 10 DAY 1.5 MG TB TABLET DEXAMETHASONE 1.5 MG DEXAMETHASONE 13 DAY 1.5 MG TB TABLET DEXAMETHASONE 1.5 MG DEXAMETHASONE 6 DAY 1.5 MG TAB TABLET DEXCHLORPHENIRAMINE 2 MG/5 ML DICLOFENAC 1.5% TOPICAL SOLN Diclofenac 1% DICLOFENAC EPOLAMINE 1.3% PTCH ACETAMINOPHEN (OTC) THERMACARE (OTC) IBUPROFEN (OTC) DICLOFENAC SOD DR 50 MG DICLOFENAC SOD DR 25 MG TAB TAB FLUOROURACIL 5% TOPICAL DICLOFENAC SODIUM 3% GEL SOLN DIFLORASONE 0.05% CREAM aclometasone desonide DIFLORASONE 0.05% OINTMENT aclometasone desonide 3 │ 2020. Magellan Rx Management, LLC. All rights reserved. MRX1305_1219 Drug Name Alternatives DIGOXIN 0.05 MG/ML SOLUTION Digoxin Tablet DOXEPIN 5% CREAM OTC Anti-Itch cream Doxycycline Hyclate DOXYCYCLINE HYC DR TAB Doxycycline Hyclate 50mg 100mg Doxycycline Hyclate DOXYCYCLINE HYCLATE TAB Doxycycline Hyclate 50mg 100mg Doxycycline Monohydrate DOXYCYCLINE IR-DR 40 MG CAP Doxycycline Monohydrate 50mg 100mg Doxycycline Monohydrate DOXYCYCLINE MONO CAP Doxycycline Monohydrate 50mg 100mg Doxycycline Monohydrate DOXYCYCLINE MONO TABLET Doxycycline Monohydrate 50mg 100mg DROSP-EE-LEVOMEF 3-0.03- DROSP-EE-LEVOMEF 3-0.02-0.451 0.451 ENDOCET TABLET Oxycodone/APAP 5-325mg ENTACAPONE 200 MG TABLET Carbidopa/Levodopa/Entacapone EPLERENONE TABLET Spironolactone BUTALB-ACETAMIN-CAFF 50-325- ESGIC CAPSULE 40 ESOMEPRAZOLE DR 49.3 MG CAP LANSOPRAZOLE OMEPRAZOLE ESOMEPRAZOLE DR PACKET LANSOPRAZOLE OMEPRAZOLE ESTRADIOL TDS 0.075 MG/DAY Estradiol tablet Estradiol patches ESTRADIOL VALERATE VL Estradiol tablet Estradiol patches ETHACRYNIC ACID 25 MG TABLET torsemide furosemide ETODOLAC ER 500 MG TABLET ibuprofen naproxen FAMOTIDINE 20 MG/5 ML-NS FAMOTIDINE 20 MG PIGGYBACK SYR FAMOTIDINE 40 MG/5 ML SUSP Famotidine Tablet FENOFIBRATE 48 MG FENOFIBRATE 50 MG CAPSULE FENOFIBRATE 54 MG TABLET TABLET FENOFIBRATE CAPSULE Fenofibrate 134mg FENOFIBRATE TABLET Fenofibrate 134mg FENOPROFEN CAPSULE Ibuprofen FENTANYL 100 MCG/HR FENTANYL 25 MCG/HR FENTANYL 37.5 MCG/HR PATCH FENTANYL 12 MCG/HR PATCH PATCH PATCH FENTANYL 100 MCG/HR FENTANYL 25 MCG/HR FENTANYL 62.5 MCG/HR PATCH FENTANYL 12 MCG/HR PATCH PATCH PATCH FENTANYL CIT OTFC Morphine Oxycodone ER FLUOCINOLONE 0.01% SCALP OIL aclometasone desonide FLUOCINOLONE 0.01% SOLUTION aclometasone desonide FLUOCINOLONE 0.025% CREAM aclometasone desonide FLUOCINOLONE 0.025% OINTMENT aclometasone desonide FLUOCINOLONE OIL 0.01% EAR FLAC OTIC OIL 0.01% EAR DROP DRP FLUOCINONIDE 0.1% CREAM aclometasone desonide 4 │ 2020. Magellan Rx Management, LLC. All rights reserved. MRX1305_1219 Drug Name Alternatives FLUOXETINE DR 90 MG CAPSULE Fluoxetine Capsule FLUOXETINE HCL TABLET Fluoxetine Capsule FLURANDRENOLIDE 0.05% CREAM aclometasone desonide FLURANDRENOLIDE 0.05% LOTION aclometasone desonide FLURANDRENOLIDE 0.05% aclometasone desonide OINTMENT FLUTICASONE PROP 0.05% LOTION aclometasone desonide FLUVASTATIN ER 80 MG TABLET atorvastatin lovastatin pravastatin FLUVASTATIN SODIUM CAP atorvastatin lovastatin pravastatin FROVATRIPTAN SUCC 2.5 MG TAB naratriptan sumatriptan zolmitriptan GATIFLOXACIN 0.5% EYE DROPS Moxifloxacin GAVILYTE-N SOLUTION GAVILYTE-C SOLUTION LIDOCAINE HCL 2% JEL GLYDO 2% JELLY SYRINGE UROJET AC GRISEOFULVIN MICRO 500 MG TAB Terbinafine GRISEOFULVIN ULTRA TAB Terbinafine DEXAMETHASONE 1.5 MG HIDEX 6 DAY 1.5 MG TABLET TABLET HYDROCOD-CPM-PSEUDOEP 5-4- Hydrocodone OTC PSEUDOEPHEDRINE 60/5 HYDROCODONE-ACETAMIN 10-300 Hydrocodone/APAP 10-325 MG HYDROCODONE-ACETAMIN 5-300 Hydrocodone/APAP 5-325 MG HYDROCODONE-ACETAMIN 7.5-300 Hydrocodone/APAP 7.5-325 HYDROCODONE-ACETAMN 7.5- Hydrocodone/APAP 5-325mg 325/15 HYDROCODONE-HOMATROPINE 5- HYDROCODONE- 1.5 HOMATROPINE SOLN HYDROCODONE-IBUPROFEN 10-200 Hydrocodone/APAP HYDROCODONE-IBUPROFEN 5-200 Hydrocodone/APAP MG HYDROCORT BUTY 0.1% LIPID CRM Hydrocortisone Buty Lotion HYDROCORT BUTY 0.1% LIPO CREAM Hydrocortisone Buty Lotion HYDROCORTISONE 1% HYDROCORTISONE 1% ABSORBASE CREAM HYDROMORPHONE 1 MG/ML MORPHINE SULF 10 MG/5 SOLUTION ML SOLN MORPHINE SULF 10 MG/5 HYDROMORPHONE 5 MG/5 ML SOLN ML SOLN HYDROMORPHONE HCL ER TAB Morphine Oxycodone ER IMIQUIMOD 5% CREAM IMIQUIMOD 3.75% CREAM PUMP PACKET IODOQUINOL-HYDROCORT-ALOE GEL n/a KETOCONAZOLE 2% FOAM Ketoconazole Cream KETOPROFEN 50 MG CAPSULE ibuprofen naproxen KETOPROFEN ER 200 MG CAPSULE ibuprofen naproxen 5 │ 2020. Magellan Rx Management, LLC. All rights reserved. MRX1305_1219 Drug Name Alternatives LACTULOSE 10 GM PACKET lactulose solution LANTHANUM CARB 1,000 MG TB SEVELAMER CARBONATE CHW 800 MG TABLET LEVORPHANOL TABLET morphine LIDOCAINE HCL 2% JEL LIDOCAINE HCL 2% JELLY URO-JET UROJET AC LIDOCAINE HCL 3% LOTION LIDOCAINE 4% CREAM LIDOCAINE HCL 4% SOLUTION LIDOCAINE 4% CREAM LIDOCAINE-PRILOCAINE CREAM LIDOCAINE 4% CREAM LIDOCAINE-PRILOCAINE LIDOCAINE-TETRACAINE 7%-7% CRM CREAM LINDANE 1% SHAMPOO NIX Permethrin MALATHION 0.5% LOTION Permethrin NIX MECLOFENAMATE CAPSULE Allopurinol MEFENAMIC ACID 250 MG CAPSULE ibuprofen naproxen MELODETTA 24