2009 Preferred Drug List
This is a condensed version of the TAkE ThIS LIST wITh YOU
Catalyst Rx Incentive Formulary. Please EACh TIME YOU VISIT A DOCTOR.
be aware that this is not an all-inclusive
list. Changes may occur throughout the ASk YOUR DOCTOR FOR GENERIC
year and plan exclusions may override DRUGS whENEVER POSSIBLE.
this list. Benefit designs may vary with
respect to drug coverage, quantity limits, • Brand Drugs = CAPitAl lEttERs
step therapy, days supply and prior • Generic Drugs = lower case
authorization. 14983stOH1008
ANTI-INFECTIVE ACE inHiBitORs (cont.) BEtA BlOCKERs
AGENTS fosinopril acebutolol
AntifungAls lisinopril atenolol
clotrimazole moexipril betaxolol
fluconazole quinapril bisoprolol
griseofulvin suspension ramipril capsules carvedilol
itraconazole trandolapril labetalol
ketoconazole AngiOtEnsin ii metoprolol/ extended-release
nystatin BlOCKERs nadolol
terbinafine BENICAR® pindolol
GRIS-PEG® DIOVAN® propranolol/
VFEND® extended-release
AntiHYPERliPiDEMiCs timolol
CEPHAlOsPORins cholestyramine COREG CR™
cefaclor/ extended-release colestipol
cefadroxil gemfibrozil CAlCiuM BlOCKERs
cefdinir lovastatin amlodipine
cefpodoxime pravastatin diltiazem/ extended-release
cefprozil simvastatin felodipine
cefuroxime ADVICOR® nicardipine
cephalexin CADUET® nifedipine/ extended-release
CRESTOR® verapamil/ extended-release
fluOROQuinOlOnEs
LIPITOR® CARDIZEM LA®
ciprofloxacin
LOVAZA® SULAR®
ofloxacin
AVELOX® NIASPAN®
SIMCOR® CENTRAL NERVOUS
MACROliDE AntiBiOtiCs SYSTEM AGENTS
TRICOR®
azithromycin AntiDEPREssAnts
WELCHOL®
clarithromycin/ amitriptyline
ZETIA®
extended-release bupropion/ extended-release
erythromycin AntiHYPERtEnsiVEs & citalopram
COMBinAtiOns clomipramine
PEniCillins
amlodipine/ benazepril desipramine
amoxicillin
atenolol/ chlorthalidone doxepin
amoxicillin/ clavulanate
benazepril/ HCTZ fluoxetine
ampicillin
bisoprolol/ HCTZ fluvoxamine
dicloxacillin
captopril/ HCTZ imipramine
penicillin
clonidine maprotiline
MisC. Anti-infECtiVEs doxazosin
doxycycline mirtazapine
enalapril/ HCTZ nortriptyline
erythromycin/ sulfisoxazole fosinopril/ HCTZ
metronidazole paroxetine/
guanfacine extended-release
minocycline hydralazine/ HCTZ
nitrofurantoin sertraline
lisinopril/ HCTZ trazodone
tetracycline methyldopa/ HCTZ
trimethoprim trimipramine
metoprolol/ HCTZ venlafaxine
trimethoprim/ minoxidil
sulfamethoxazole CYMBALTA®
moexipril/ HCTZ EFFEXOR XR®
FURADANTIN® nadolol/ bendroflumethiazide
ZYVOX® LEXAPRO®
prazosin PRISTIQ®
propranolol/ HCTZ VIVACTIL®
CARDIOVASCULAR terazosin
AGENTS BENICAR HCT® AntiPsYCHOtiCs
ACE inHiBitORs DIOVAN HCT® chlorpromazine
benazepril clozapine
captopril fluphenazine
enalapril haloperidol
loxapine
2009 Preferred Drug List (cont.)
AntiPsYCHOtiCs (cont.) DiABEtiC tEsting nsAiDs (cont.)
perphenazine suPPliEs ketorolac
risperidone ACCU-CHEK® METERS/ meclofenamate
thioridazine STRIPS meloxicam
thiothixene BAYER METERS/ STRIPS nabumetone
trifluoperazine EstROgEns & naproxen
ABILIFY®/ DISCMELT® PROgEstEROnEs/ oxaprozin
GEODON® COMBinAtiOns piroxicam
MOBAN® estradiol/ norethindrone sulindac
ORAP® estradiol transdermal system tolmetin
RISPERDAL M-TAB® estropipate
SEROQUEL®/ XR™ ENJUVIA® RESPIRATORY AGENTS
ZYPREXA®/ ZYDIS® ESTRATEST/ HS® AllERgY-nAsAl
Cns stiMulAnts PREMARIN/ LOW-DOSE® PRODuCts
amphetamine- PREMPHASE® flunisolide
dextroamphetamine PREMPRO™ fluticasone
dexmethylphenidate VIVELLE/ DOT® ipratropium
dextroamphetamine ASTELIN®
insulins NASACORT AQ®
methylphenidate LANTUS®
CONCERTA® NASONEX®
LEVEMIR®
STRATTERA® NOVOLIN® AntiAstHMAtiCs
HYPnOtiCs/ AnXiOlYtiCs NOVOLOG® albuterol extended-release
alprazolam tablets
OtHER EnDOCRinE albuterol/ ipratropium
buspirone DRugs
chloral hydrate nebulization
alendronate albuterol nebulization
chlordiazepoxide ACTONEL®
clorazepate cromolyn nebulization
ACTONEL® WITH CALCIUM metaproterenol nebulization
diazepam MIACALCIN® NASAL SPRAY
estazolam terbutaline
flurazepam theophylline
GASTROINTESTINAL ADVAIR®
lorazepam AGENTS
oxazepam ALUPENT®
H-2 AntAgOnists ASMANEX®
temazepam cimetidine
triazolam ATROVENT® HFA
famotidine COMBIVENT®
zaleplon nizatidine
zolpidem FLOVENT® HFA/
ranitidine DISKUS®
MigRAinE AgEnts Note: Consider over-the-counter
FORADIL®
alternatives such as Axid, Pepcid,
(QTY. LIMITS APPLY) INTAL®
Tagamet or Zantac (may not be
IMITREX® covered by your plan). PROAIR® HFA
MAXALT® PULMICORT®
RELPAX® PROtOn PuMP
inHiBitORs SEREVENT® DISKUS®
omeprazole OTC* SINGULAIR®
ENDOCRINE AND SPIRIVA®
METABOLIC AGENTS pantoprazole
PRILOSEC OTC®* SYMBICORT®
AntiDiABEtiCs TILADE®
*Over-the-counter medications
acarbose (OTCs) require a written prescription. XOPENEX®/ HFA®
glimepiride First retail fill of OTCs are free and
glipizide/ extended-release each retail fill thereafter has a $5
UROLOGICAL
glipizide/ metformin copayment ($12.50 through mail
service). MEDICATIONS
glyburide AntiCHOlinERgiCs/
glyburide/ metformin MisC. ulCER
AntisPAsMODiCs
metformin/ extended-release methscopolamine
flavoxate
ACTOplus MET® misoprostol
hyoscyamine subl
ACTOS® sucralfate
oxybutynin/
AVANDAMET® CARAFATE® (suspension only)
extended-release
AVANDARYL® PREVACID® NapraPAC™
DETROL/ LA®
AVANDIA® PREVPAC®
ENABLEX®
BYETTA® PYLERA®
VESICARE®
DUETACT®
GLYSET® MUSCULOSkELETAL BEnign PROstAtiC
JANUMET™ AGENTS HYPERtROPHY DRugs
JANUVIA™ nsAiDs doxazosin
PRANDIN® diclofenac finasteride
STARLIX® etodolac/ extended-release terazosin
SYMLIN® fenoprofen AVODART®
flurbiprofen FLOMAX®
ibuprofen
indomethacin
ketoprofen DL 01 694 1008
Catalyst Rx Customer service: 1-866-854-8850
For a complete drug list, please visit www.catalystrx.com.