List of Formulary Drugs

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List of Formulary Drugs
2014 Drug Formulary
GENERICS
BRANDS
Acyclovir
800 mg
Actoplus Met
15/500 mg
Acyclovir
400 mg
Actoplus Met
Advil (Infants)
15/850 mg
50mg/1.25ml
Advil(Children) Suspension
100 mg
Albuterol Sulfate Inhalation Solution 0.083%
Alendronate
70 mg
Allopurinol
300 mg
Aggrenox
25/200 mg
Allopurinol
100 mg
Amitiza
24 mcg
Amitriptyline HCL
25 mg
Amitiza
8 mcg
Amitriptyline HCL
Amlodipine
50 mg
5 mg
Antara
Apriso ER
130 mg
0.375g
Amlodipine
10 mg
Arthrotec 50
50 mg/200 mcg
Atenolol
25 mg
Arthrotec 75
75 mg/200 mcg
Atenolol
50 mg
Atacand HCT
16/12.5 mg
Bupropion HCL SR
100 mg
Avodart
0.5 mg
Bupropion HCL SR
150 mg
Azor
5/40 mg
Bupropion HCL XL
150 mg
Azor
10/40 mg
Captopril
12.5 mg
Azor
5/20 mg
Captopril
25 mg
Benicar
40 mg
Captopril
50 mg
Benicar HCT
40/12.5 mg
Carvedilol
3.125 mg
Bidil
20/37.5 mg
Carvedilol
6.25 mg
Binosto
70 mg
Carvedilol
12.5 mg
Brilinta
90 mg
Carvedilol
25 mg
Bystolic
10 mg
Ciprofloxacin
500 mg
Bystolic
20 mg
Citalopram
20 mg
Bystolic
5 mg
Clonidine
0.1 mg
Citracal
1200 mg Slow Release
Clonidine
0.2 mg
Crestor
20 mg
Clonidine
0.3 mg
Detrol LA
4 mg
Clopidogrel
75 mg
Dulera Inhalation Aerosol
100 mcg/5 mcg
Cyclobenzaprine
10 mg
Dulera Inhalation Aerosol
200 mcg/5 mcg
Diclofenac
50 mg
Evista
60 mg
Diclofenac
75 mg
Dicyclomine HCL
20 mg
Glumetza ER
Invokana
500 mg
100 mg
Digoxin
0.125 mcg
Janumet
50/500 mg
Digoxin
0.25 mcg
Janumet
50/1000 mg
Divalproex DR
500 mg
Janumet XR
50/1000 mg
Divalproex DR
250 mg
Kombiglyze XR
5/1000 mg
Divalproex ER
250 mg
Kombiglyze XR
2.5/1000 mg
Divalproex ER
500 mg
Lialda
1.2 g
Page 1 of 3
Updated 05/23/2014
2014 Drug Formulary
GENERICS
BRANDS
Doxepin
25 mg
Lialda
1.2 g
Doxepin
Effer-K
50 mg
10 mEq
Linzess
290 mcg
Linzess
145 mcg
Enalapril
20 mg
Lipofen
150 mg
Enalapril
2.5 mg
Livalo
2 mg
Enalapril
5 mg
Metamucil
.21 oz/5.85 g
Enalapril
10 mg
Micardis
40 mg
Estrace Vaginal Cream
0.1 mg
Micardis
80 mg
Famotidine
20 mg
Micardis HCT
80/12.5 mg
Famotidine
40 mg
Niaspan ER
500 mg
Flovent Diskus
100 mcg
Nicotrol Inhaler
10 mg
Furosemide Oral
40 mg
Onglyza
5 mg
Furosemide Oral
20 mg
Onglyza
2.5 mg
Furosemide Oral
80 mg
Pradaxa
150 mg
Glipizide
10 mg
Pradaxa
75 mg
Glipizide
5 mg
Pulmicort Flexhaler
180 mcg
Glyburide, micronized
3 mg
Glyburide, micronized
6 mg
Rapaflo
Saphris
8 mg
5mg
Hydroxyzine HCL
25 mg
Simcor
500/40 mg
Indapamide
1.25 mg
Indapamide
2.5 mg
Simcor
Similac Prenatal/Lutein&DHA
500/20 mg
200mg/6mg
Ipratropium Inhalation Solution
0.02%
Tribenzor
40-5-25 mg
Lamotrigine
100 mg
Tribenzor
20-5-12.5 mg
Lamotrigine
150 mg
Tribenzor
40-5-12.5 mg
Levetiracetam
500 mg
Tribenzor
40-10-25 mg
Levothyroxine
50 mcg
Uloric
40 mg
Levothyroxine
100 mcg
Levothyroxine
125 mcg
Uloric
Vagifem Vaginal
80 mg
10 mcg
Lisonopril
10 mg
Vesicare
5 mg
Lisonopril
20 mg
Vesicare
10 mg
Lovastatin
20 mg
Viibryd Kit
10-20-40 mg
Lovastatin
10 mg
Vytorin
10/20 mg
Lovastatin
40 mg
Vytorin
10/40 mg
Meloxicam
15 mg
WelChol
625 mg
Metformin
500 mg
Zetia
10 mg
Metformin
850 mg
Metformin
1000 mg
Metoprolol Tartrate
100 mg
Page 2 of 3
Updated 05/23/2014
2014 Drug Formulary
GENERICS
Metoprolol Tartrate
25 mg
Metoprolol Tartrate
50 mg
Mirtazapine
15 mg
Mirtazapine
30 mg
Nitrofurantoin
100 mg
Omeprazole
20 mg
Pantoprazole
40 mg
Prochlorperazine
10 mg
Prochlorperazine
5 mg
Propranolol HCL
10 mg
Propranolol HCL
20 mg
Propranolol HCL
80 mg
Propranolol HCL
Pulmicort Respules Inhalation
Suspension
Ranexa
40 mg
1 mg/ 2 ml
Risperidone
0.5 mg
Risperidone
1 mg
Risperidone
2 mg
Risperidone
3 mg
Ropinirole HCL
0.5 mg
Ropinirole HCL
1 mg
Ropinirole HCL
2 mg
Ropinirole HCL
3 mg
Tamsulosin
0.4 mg
Terazosin
1 mg
Terazosin
2 mg
Terazosin
5 mg
Terazosin
10 mg
Triamterene/HCTZ
37.5/25 mg
Triamterene/HCTZ
75/50 mg
Tudorza
400 mcg
Valacyclovir HCL
500 mg
Valacyclovir HCL
1000 mg
Verapamil HCL ER
120 mg
Verapamil HCL ER
240 mg
1000 mg
Page 3 of 3
Updated 05/23/2014

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