FF41245K - BCBSM_MEDCO_v2W by yaoyufang


									Preferred Prescriptions® Formulary File Sheet                                      Blue Cross
for the State of Michigan                                                          Blue Shield
                                                                                   of Michigan
Key Therapeutic Drug Categories                                        ®       ®

The following is a list of the most commonly prescribed drugs. It represents an abbreviated version of the formulary
that is at the core of your benefit plan.The list is not all-inclusive and does not guarantee coverage.This list is subject
to change.
                     KEY:                           Oral Erythromycins               BRANDS
                                          GENERICS                                    Ancobon (Flucytosine)                   F
 G = Formulary generic drug.                                                          Lamisil Oral Granules (Terbinafine HCl) F
                                           Azithromycin (Zithromax)               G
 F = Formulary brand-name drug.            Clarithromycin (Biaxin)                G   Noxafil (Posaconazole)                  F
     = Weigh risk of birth defects or      Clarithromycin ER (Biaxin XL)          G   Sporanox Oral Solution (Itraconazole) F
                                           Erythromycin Base (E-Mycin)            G   Vfend Tablet (Voriconazole)             F
         other adverse outcomes.
                                           Erythromycin Ethylsuccinate (Eryped)   G      Oral Miscellaneous Agents
     = Do not use in pregnancy.            Erythromycin Ethylsuccinate/           G
                                             Sulfisoxazole Acetyl (Pediazole)        GENERICS
              Anti-Infectives                                                         Clindamycin HCl (Cleocin HCl)           G
         (Antibiotics/Antifungals)         Erythromycin Stearate                  G
                                             (Erythrocin Stearate)                    Neomycin Sulfate (Neomycin Sulfate)     G
             Oral Penicillins                                                        BRANDS
GENERICS                                              Oral Quinolones                 Dapsone (Dapsone)                       F
  Amoxicillin Trihydrate (Amoxil)     G GENERICS                                      Tobi Ampul for Nebulization             F
  Amoxicillin Trihydrate/Potassium    G    Ciprofloxacin ER (Cipro XR)            G     (Tobramycin/0.25 Normal Saline)
   Clavulanate (Augmentin)                 Ciprofloxacin HCl (Cipro)              G   Xifaxan 550mg (Rifaximin)               F
  Amoxicillin Trihydrate/Potassium    G    Ofloxacin (Floxin)                     G   Zyvox (Linezolid)                       F
   Clavulanate (Augmentin XR)             BRANDS
  Ampicillin Trihydrate (Principen)   G                                                      Vaginal Antifungals
                                           Cipro Suspension (Ciprofloxacin)       F
  Dicloxacillin Sodium (Dynapen)      G    Levaquin (Levofloxacin)                F GENERICS
  Penicillin V Potassium (Pen-Vee K)  G    Noroxin (Norfloxacin)                  F   Fluconazole (Diflucan 150mg)            G
BRANDS                                                                                Miconazole Nitrate Vaginal Suppository G
  Augmentin Chewable Tablets 250mg F                      Oral Sulfas                   (Monistat 3)                          G
   (Amoxicillin Trihydrate/Potassium      GENERICS                                    Nystatin (Nystatin)                     G
   Clavulanate)                            Erythromycin Ethylsuccinate/           G   Terconazole (Terazol)                   G
  Augmentin Suspension 125mg          F      Sulfisoxazole Acetyl (Pediazole)        BRANDS
   (Amoxicillin Trihydrate/Potassium       Sulfadiazine (Sulfadiazine)            G   Gynazole-1 (Butoconazole Nitrate)       F
   Clavulanate)                            Sulfamethoxazole/Trimethoprim          G
                                             (Bactrim DS, Septra DS)                           Psychotherapeutics
           Oral Tetracyclines              Sulfisoxazole (Sulfisoxazole)          G           (Anxiety/Depression)
GENERICS                                                                                        Hypnotic Agents
  Doxycycline Hyclate Capsule         G        Oral Urinary Tract Agents
   (Vibramycin Capsule)                   GENERICS                                    Chloral Hydrate (Somnote)               G
  Doxycycline Hyclate Tablet          G    Methenamine Hippurate (Hiprex)         G   Estazolam (ProSom)                      G
   (Vibra-Tabs Tablet)                     Methenamine Mandelate (Mandelamine) G      Flurazepam HCl (Dalmane)                G
  Doxycycline Monohydrate             G    Nitrofurantoin Macrocrystal            G
                                             (Macrodantin)                            Temazepam (Restoril)                    G
   (Monodox, Vibramycin Suspension)                                                   Triazolam (Halcion)                     G
  Minocycline HCl (Dynacin, Minocin) G     Nitrofurantoin/Nitrofurantoin          G
                                             Macrocrystal (Macrobid)                  Zaleplon (Sonata)                       G
  Tetracycline HCl (Achromycin V)     G                                               Zolpidem Tartrate (Ambien)              G
                                           Phenazopyridine HCl (Pyridium)         G
BRANDS                                     Trimethoprim (Proloprim)               G
  Adoxa (Doxycycline Monohydrate)     F BRANDS                                            Tricyclic Antidepressants
  Adoxa Pak (Doxycycline Monohydrate) F                                              GENERICS
                                           Furadantin (Nitrofurantoin)            F   Amitriptyline HCl (Elavil)              G
  Oracea (Doxycycline Monohydrate)    F
                                                 Oral Antifungal Agents               Amoxapine (Asendin)                     G
         Oral Cephalosporins              GENERICS                                    Clomipramine HCl (Anafranil)            G
GENERICS                                   Clotrimazole (Mycelex Troche)          G   Desipramine HCl (Norpramin)             G
  Cefaclor (Ceclor)                   G    Fluconazole (Diflucan)                 G   Doxepin HCl (Sinequan)                  G
  Cefadroxil Hydrate (Duricef)        G    Griseofulvin (Grifulvin V)             G   Imipramine HCl (Tofranil)               G
  Cefdinir (Omnicef)                  G    Griseofulvin Ultramicrosize (Gris-Peg) G   Imipramine Pamoate (Tofranil-PM)        G
  Cefpodoxime Proxetil (Vantin)       G    Itraconazole (Sporanox)                G   Nortriptyline HCl (Pamelor)             G
  Cefuroxime Axetil (Ceftin)          G    Ketoconazole (Nizoral)                 G   Protriptyline HCl (Vivactil)            G
  Cephalexin Monohydrate (Keflex)     G    Nystatin (Mycostatin)                  G   Trimipramine Maleate                    G
  Cephradine (Velosef)                G    Terbinafine HCl (Lamisil)              G     (Surmontil 25mg, 50mg)                G
                                                                                                                     FORM #FF41245K
                                                                                                                            (Ed. 2/11)
BRANDS                                           MAOI Antidepressants                    Nifedipine (Adalat, Procardia)          G
 Surmontil (Trimipramine Maleate)      F   GENERICS                                      Nifedipine (Adalat CC)                  G
                                            Tranylcypromine Sulfate (Parnate)      G     Nifedipine (Procardia XL)               G
 Miscellaneous Antidepressants             BRANDS                                        Nisoldipine (Sular)                     G
GENERICS                                    Nardil (Phenelzine Sulfate)            F          Nitroglycerin Patches
 Bupropion HCl (Wellbutrin )           G         SSRI Antidepressants                  GENERICS
 Bupropion HCl (Wellbutrin SR)         G GENERICS                                       Nitroglycerin Patch (Nitroglycerin Patch) G
 Bupropion HCl (Wellbutrin XL)         G  Citalopram HBr (Celexa)                  G   BRANDS
                                          Fluoxetine HCl (Prozac)                  G    Minitran (Nitroglycerin)                  F
 Maprotiline HCl (Ludiomil)            G
                                          Fluvoxamine Maleate (Luvox)              G         Adrenergic Antagonists
 Mirtazapine Tablet (Remeron Tablet)   G  Paroxetine HCl (Paxil)                   G
 Mirtazapine Tablet, Rapid Dissolve    G                                                          & Related Drugs
                                          Sertraline HCl (Zoloft)                  G
  (Remeron SolTab)                                                                     GENERICS
                                                      Cardiovascular                    Clonidine HCl (Catapres, Catapres-TTS) G
 Trazodone HCl (Desyrel)               G                                                Doxazosin Mesylate (Cardura)           G
 Venlafaxine HCl (Effexor)             G (Blood Pressure/Heart/Cholesterol)             Guanfacine HCl (Tenex)                 G
 Venlafaxine HCl (Effexor XR)          G              Beta Blockers                     Methyldopa (Aldomet)                   G
BRANDS                                   GENERICS                                       Prazosin HCl (Minipress)               G
                                          Acebutolol HCl (Sectral)                 G    Reserpine (Reserpine)                  G
 Cymbalta (Duloxetine)                 F  Atenolol (Tenormin)                      G    Terazosin HCl (Hytrin)                 G
 Pristiq (Desvenlafaxine Succinate)    F  Betaxolol HCl (Kerlone)                  G
                                          Bisoprolol Fumarate (Zebeta)             G         Angiotensin II Blockers
            Antipsychotics                Carvedilol (Coreg)                       G             & Renin Inhibitors
GENERICS                                  Labetalol HCl (Normodyne, Trandate) G        GENERICS
                                          Metoprolol Succinate (Toprol XL)         G    Losartan Potassium (Cozaar)              G
 Clozapine (Clozaril)                  G                                                Losartan Potassium/Hydrochlorothiazide   G
                                          Metoprolol Tartrate (Lopressor)          G
 Chlorpromazine HCl (Thorazine)        G  Nadolol (Corgard)                        G     (Hyzaar)
 Fluphenazine HCl (Prolixin)           G  Pindolol (Visken)                        G   BRANDS
 Haloperidol (Haldol)                  G  Propranolol HCl (Inderal)                G    Atacand (Candesartan Cilexetil)          F
 Haloperidol Lactate Concentrate, Oral G  Propranolol HCl (Inderal LA)             G    Atacand HCT (Candesartan Cilexetil/      F
  (Haldol)                                Timolol Maleate (Blocadren)              G     Hydrochlorothiazide)
                                         BRANDS                                         Benicar (Olmesartan Medoxomil)           F
 Loxapine Succinate (Loxitane)         G
                                          Bystolic (Nebivolol HCl)                 F    Benicar HCT (Olmesartan Medoxomil/       F
 Perphenazine (Trilafon)               G  Coreg CR (Carvedilol)                    F     Hydrochlorothiazide)
 Risperidone (Risperdal)               G                                                Diovan (Valsartan)                       F
 Thiothixene (Navane)                  G            Calcium Blockers
                                                                                        Diovan HCT                               F
 Trifluoperazine HCl (Stelazine)       G GENERICS                                        (Valsartan/Hydrochlorothiazide)
                                          Diltiazem HCl (Cardizem)                 G    Micardis (Telmisartan)                   F
BRANDS                                    Diltiazem HCl (Cardizem LA)              G
                                          Diltiazem HCl Capsule, Sustained Action G     Micardis HCT                             F
 Clozaril (Clozapine)                  F
                                            (Tiazac)                                     (Telmisartan/Hydrochlorothiazide)
 Geodon (Ziprasidone HCl)              F                                                Tekturna (Aliskiren Hemifumarate)        F
 Moban (Molindone HCl)                 F  Diltiazem HCl Capsule, Sustained Release G
                                            12 hr (Cardizem SR)                         Tekturna HCT                             F
 Orap (Pimozide)                       F  Diltiazem HCl Capsule, Sustained Release G     (Aliskiren/Hydrochlorothiazide)
 Seroquel (Quetiapine Fumarate)        F    24 hr (Cardizem CD)                         Valturna (Aliskiren/Valsartan)           F
 Seroquel XR (Quetiapine Fumarate)     F  Nimodipine (Nimotop)                     G               Antilipidemics
 Zyprexa, Zyprexa Zydis (Olanzapine)   F  Verapamil HCl (Calan)                    G   GENERICS
                                          Verapamil HCl Capsule, 24 hr Sustained G      Cholestyramine/Aspartame                 G
              Anxiolytics                   Release Pellets (Verelan, Verelan PM)        (Questran Light)
                                          Verapamil HCl Tablet, Sustained Action G      Cholestyramine/Sucrose (Questran)        G
GENERICS                                    (Calan SR, Isoptin S.R.)
 Alprazolam (Xanax)                    G                                                Fenofibrate, Micronized (Lofibra)        G
                                          Verapamil HCl Tablet, Sustained Release G     Gemfibrozil (Lopid)                      G
 Buspirone HCl (Buspar)                G    Osmotic Push 24 hr (Covera-HS)              Lovastatin (Mevacor)                     G
 Chlordiazepoxide HCl (Librium)        G BRANDS                                         Pravastatin (Pravachol)                  G
 Clorazepate Dipotassium               G  Cardizem LA 120mg (Diltiazem HCl) F           Simvastatin (Zocor)                      G
  (Tranxene T-Tab)                                  Dihydropyridines                   BRANDS
 Diazepam (Valium)                     G GENERICS                                       Antara (Fenofibrate, Micronized)         F
                                          Amlodipine Besylate (Norvasc)            G    Altoprev (Lovastatin)                    F
 Lorazepam (Ativan)                    G                                                Crestor (Rosuvastatin Calcium)           F
                                          Felodipine (Plendil)                     G
 Oxazepam (Serax)                      G  Isradipine (DynaCirc)                    G    Lipitor (Atorvastatin Calcium)           F
  Lovaza (Omega-3 Acid Ethyl Esters)       F                   Endocrine                  One Touch Test Strips                        F
  Niaspan (Niacin Tablet,                  F (Diabetes/Hormones/Contraceptives)
                                                           Insulin Therapy                 (Blood Sugar Diagnostic)
   Sustained Action Sequential)               BRANDS                                      One Touch Ultra Test Strips                  F
  Simcor (Niacin/Simvastatin)              F   Apidra, Apidra Solostar                 F   (Blood Sugar Diagnostic)
  Tricor (Fenofibrate, Nanocrystallized)   F     (Insulin Glulisine)                      Surestep Pro Test Strips                     F
  Triglide (Fenofibrate)                   F   Humalog, Humalog Mix                    F   (Blood Sugar Diagnostic)
  Trilipix (Fenofibric Acid)               F     (Insulin Lispro, Human Rec. Anlog)
  Vytorin (Ezetimibe/Simvastatin)          F                                              Surestep Test Strips                         F
                                               Humulin (Insulin Human Recombinant) F
  Welchol (Colesevelam HCl)                F   Lantus, Lantus Solostar                 F   (Blood Sugar Diagnostic)
  Zetia (Ezetimibe)                        F     (Insulin Glargine, Human                       Contraceptive Agents
                                                 Recombinant Analog)
              ACE Inhibitors                   Levemir (Insulin Detemir)               F GENERICS
GENERICS                                       Novolog, Novolog Mix (Insulin Aspart) F    Desogestrel-Ethinyl Estradiol (Cyclessa) G
  Benazepril HCl (Lotensin)                G                                              Desogestrel-Ethinyl Estradiol (Desogen) G
  Captopril (Capoten)                      G Non-Insulin Hypoglycemic Agents              Desogestrel-Ethinyl Estradiol (Ortho-Cept)G
  Enalapril Maleate (Vasotec)              G GENERICS                                     Desogestrel-Ethinyl Estradiol/               G
  Fosinopril Sodium (Monopril)             G   Acarbose (Precose)                      G
                                               Chlorpropamide (Diabinese)              G   Ethinyl Estradiol (Mircette)
  Lisinopril (Prinivil, Zestril)           G                                              Ethinyl Estradiol/Drospirenone (Yasmin) G
                                               Glimepiride (Amaryl)                    G
  Moexipril HCl (Univasc)                  G   Glipizide (Glucotrol, Glucotrol XL)     G  Ethinyl Estradiol/Drospirenone (Yaz)         G
  Perindopril Erbumine (Aceon)             G   Glipizide/Metformin HCl (Metaglip)      G  Ethynodiol D-Ethinyl Estradiol (Demulen)G
  Quinapril HCl (Accupril)                 G   Glyburide (DiaBeta, Micronase)          G
  Ramipril (Altace)                        G                                              Levonorgestrel (Plan B)                      G
                                               Glyburide, Micronized (Glynase)         G
  Trandolapril (Mavik)                     G   Glyburide/Metformin HCl (Glucovance) G     Levonorgestrel-Ethinyl Estradiol (Alesse) G
                                               Metformin HCl                           G  Levonorgestrel-Ethinyl Estradiol (Nordette)G
 Combination Antihypertensives                   (Glucophage, Glucophage XR)              Levonorgestrel-Ethinyl Estradiol             G
GENERICS                                       Nateglinide (Starlix)                   G   (Seasonale)
  Amlodipine Besylate/Benazepril HCl       G   Tolazamide (Tolinase)                   G
   (Lotrel)                                                                               Levonorgestrel-Ethinyl Estradiol             G
                                               Tolbutamide (Orinase)                   G
  Atenolol/Chlorthalidone (Tenoretic)      G BRANDS                                        (Tri-Levlen)
  Benazepril HCl/Hydrochlorothiazide       G   Actoplus Met                            F  Levonorgestrel-Ethinyl Estradiol (Triphasil) G
   (Lotensin HCT)                                (Pioglitazone HCl/Metformin HCl)         Norethindrone (Ortho Micronor)               G
  Bisoprolol Fumarate/Hydrochlorothiazide G    Actos (Pioglitazone HCl)                F  Norethindrone A-E Estradiol (Loestrin) G
   (Ziac)                                      Avandamet                               F  Norethindrone A-E Estradiol/Ferrous          G
  Captopril/Hydrochlorothiazide (Capozide) G     (Rosiglitazone Maleate/Metformin HCl)     Fumarate (Estrostep Fe)
  Enalapril Maleate/Hydrochlorothiazide G      Avandaryl                               F
                                                 (Rosiglitazone Maleate/Glimepiride)      Norethindrone A-E Estradiol/Ferrous          G
  Fosinopril/Hydrochlorothiazide           G   Avandia (Rosiglitazone Maleate)         F   Fumarate (Loestrin Fe)
   (Monopril HCT)                              Byetta (Exenatide)                      F  Norethindrone-Ethinyl Estradiol              G
  Hydralazine HCl/Hydrochlorothiazide      G   Duetact (Pioglitazone/Glimepiride)      F   (Brevicon)
   (Apresazide)                                Janumet                                 F  Norethindrone-Ethinyl Estradiol              G
  Lisinopril/Hydrochlorothiazide           G     (Sitagliptin Phos/Metformin HCl)          (Modicon)
   (Prinzide, Zestoretic)                      Januvia (Sitagliptin Phosphate)         F  Norethindrone-Ethinyl Estradiol (Norinyl) G
  Methyldopa/Hydrochlorothiazide (Aldoril) G   Onglyza (Saxagliptin HCl)               F  Norethindrone-Ethinyl Estradiol              G
  Metoprolol/Hydrochlorothiazide           G   Prandin (Repaglinide)                   F
                                               Symlin (Pramlintide)                    F   (Ortho-Novum)
   (Lopressor HCT)                                                                        Norethindrone-Mestranol (Norinyl)            G
  Moexipril/Hydrochlorothiazide (Uniretic) G       Blood Glucose Test Strips
  Propranolol HCl/Hydrochlorothiazide      G GENERICS                                     Norethindrone-Mestranol (Ortho-Novum) G
   (Inderide)                                                                             Norgestimate-Ethinyl Estradiol               G
                                               Alcohol Antiseptic Pads (Alcohol Prep) G    (Ortho-Cyclen, Ortho Tri-Cyclen)
  Quinapril HCl/Hydrochlorothiazide        G
   (Accuretic)                                BRANDS                                      Norgestrel-Ethinyl Estradiol (Lo/Ovral) G
  Trandolapril HCl/Verapamil (Tarka)       G   Accu-Chek Active Test Strips            F
                                                 (Blood Sugar Diagnostic)                 Norgestrel-Ethinyl Estradiol (Ovral)         G
BRANDS                                         Accu-Chek Aviva Test Strips             F BRANDS
  Azor (Amlodipine Bes/Olmesartan Med) F         (Blood Sugar Diagnostic)                 Lybrel (Levonorgestrel-Ethinyl Estradiol) F
  Exforge (Amlodipine/Valsartan)           F   Accu-Chek Comfort Curve Test Strips F      NuvaRing (Etonogestrel/Ethinyl Estradiol) F
  Exforge HCT                              F     (Blood Sugar Diagnostic)                 Plan B One-Step (Levonorgestrel)             F
   (Amlodipine/Valsartan/HCTZ)                 Accu-Chek Compact Test Strips           F
  Lotrel 5-40mg, 10-40mg                   F     (Blood Sugar Diagnostic)                 Seasonique (Levonorgestrel-Ethinyl           F
   (Amlodipine Besylate/Benazepril HCl)        Fast Take Test Strips                   F   Estradiol/Ethinyl Estradiol)
  Twynsta (Telmisartan/Amlodipine)         F     (Blood Sugar Diagnostic)                 Yaz (Ethinyl Estradiol/Drospirenone)         F
Estrogens/Estrogen Combinations                Ibuprofen (Motrin)                        G         Nasal Corticosteroids
GENERICS                                       Indomethacin (Indocin)                    G GENERICS
  Estradiol Patch (Estradiol)               G  Indomethacin (Indocin SR)                 G  Flunisolide (Nasalide)                  G
  Estradiol Tablet (Estrace)                G  Ketoprofen (Orudis)                       G  Fluticasone Propionate (Flonase)        G
  Estradiol/Norethindrone (Activella)       G  Ketoprofen (Oruvail)                      G BRANDS
  Estropipate (Ogen)                        G  Meclofenamate Sodium                      G  Nasacort AQ (Triamcinolone Acetonide) F
  Methyltestosterone/Estrogens, Esterified  G    (Meclofenamate Sodium)                     Nasonex (Mometasone Furoate)            F
   (Estratest, Estratest H.S.)                 Meloxicam (Mobic)                         G  Rhinocort Aqua (Budesonide)             F
BRANDS                                         Nabumetone (Relafen)                      G  Veramyst (Fluticasone Furoate)          F
  Cenestin (Estrogens, Conjugated Synthetic)F  Naproxen (Naprosyn)                       G Miscellaneous Pulmonary Agents
  Climara (Estradiol)                       F  Naproxen Sodium                           G GENERICS
  Combipatch                                F    (Anaprox, Anaprox DS)                      Acetylcysteine (Mucomyst)               G
   (Estradiol/Norethindrone Acetate)           Naproxen Sodium (Naprelan)                G  Cromolyn Sodium Ampul for               G
  Divigel (Estradiol)                       F  Oxaprozin (Daypro)                        G    Nebulization (Intal)
  Enjuvia (Estrogens, Conjugated Synthetic) F  Piroxicam (Feldene)                       G  Ipratropium Bromide Solution (Atrovent) G
  Estrace Vaginal Cream (Estradiol)         F  Sulindac (Clinoril)                       G  Ipratropium/Albuterol Sulfate (Duoneb) G
  Estraderm (Estradiol)                     F  Tolmetin Sodium (Tolectin)                G BRANDS
  Estring Vaginal Ring (Estradiol)          F BRANDS                                        Advair Diskus (Fluticasone Propionate/ F
  Evamist (Estradiol)                       F  Vimovo (Naproxen/Esomeprazole Mag)        F    Salmeterol Xinafoate)
  Premarin Tablets (Estrogens, Conjugated) F                                                Advair HFA (Fluticasone/Salmeterol)     F
                                                    NSAID COX-2 Inhibitors                  Atrovent HFA (Ipratropium Bromide) F
  Premphase (Estrogens, Conjugated/         F
                                              BRANDS                                        Berinert (C1 Esterase Inhibitor)        F
   Medroxyprogesterone Acet)                   Celebrex (Celecoxib)                      F  Cinryze (C1 Esterase Inhibitor)         F
  Prempro (Estrogens, Conjugated/           F                                               Combivent (Albuterol Sulfate/           F
   Medroxyprogesterone Acet)                     Respiratory (Allergy/Asthma)                 Ipratropium Bromide)
  Vagifem (Estradiol)                       F          Beta Agonists Oral                   Intal Inhaler (Cromolyn Sodium)         F
  Vivelle, Vivelle-Dot (Estradiol)          F GENERICS                                      Letairis (Ambrisentan)                  F
                                               Albuterol Sulfate (Proventil)             G  Pulmozyme (Dornase Alfa)                F
                G. I. (Ulcer)                  Metaproterenol Sulfate (Alupent)          G  Revatio (Sildenafil Citrate)            F
               Ulcer Drugs                     Terbutaline Sulfate (Brethine)            G  Singulair (Montelukast Sodium)          F
GENERICS                                                                                    Spiriva (Tiotropium Bromide)            F
  Cimetidine HCl Liquid (Tagamet Liquid) G           Beta Agonist Inhalers                  Symbicort (Budesonide/Formoterol        F
  Cimetidine Tablet (Tagamet Tablet)        G GENERICS                                        Fumarate)
  Famotidine (Pepcid)                       G  Albuterol (Proventil)                     G  Tilade (Nedocromil Sodium)              F
  Lansoprazole (Prevacid)                   G  Albuterol Sulfate (Accuneb)               G  Tracleer (Bosentan)                     F
  Misoprostol (Cytotec)                     G  Albuterol Sulfate Solution                G  Tyvaso (Treprostinil)                   F
  Nizatidine (Axid)                         G    (Proventil Solution)                       Ventavis (Iloprost)                     F
  Omeprazole (Prilosec Rx)                  G  Isoetharine HCl Solution                  G
                                                 (Bronkosol Solution)                        Antihistamine/Decongestant
  Omeprazole/Sodium Bicarbonate             G                                                            Combinations
   (Zegerid Rx)                                Levalbuterol HCl (Xopenex 1.25mg/0.5)     G
  Pantoprazole Sodium (Protonix)            G  Metaproterenol Sulfate (Alupent )         G GENERICS
  Ranitidine HCl (Zantac)                   G BRANDS                                        Carbetapentane Tannate/                 G
                                               Foradil (Formoterol Fumarate)             F    Chlorpheniramine Tannate (Tussi-12)
BRANDS                                                                                      Carbetapentane Tannate/Ephedrine        G
  Axid Oral Solution (Nizatidine)           F  Maxair Autohaler (Pirbuterol Acetate)     F
                                               Perforomist (Formoterol Fumarate)         F    Tannate/Phenylephrine/
  Nexium                                    F                                                Chlorpheniramine Suspension
   (Esomeprazole Magnesium Trihydrate)         ProAir HFA (Albuterol Sulfate)            F
                                               Serevent Diskus (Salmeterol Xinafoate)    F   (Rynatuss)
            Other G.I. Drugs                   Xopenex HFA (Levalbuterol Tartrate)       F  Carbetapentane Tannate/Phenylephrine G
GENERICS                                       Xopenex Solution (Levalbuterol HCl)       F    Tannate/Chlorpheniramine
  Sucralfate Tablet (Carafate Tablet)       G                                                 Suspension (Tussi-12)
                                                         Inhaled Steroids                   Phenylephrine HCl/Phenyltoloxamine      G
  Carafate Suspension (Sucralfate)          F GENERICS                                        Citrate/Chlorpheniramine (Nalex-A)
  Pylera (Bismuth/Metronid/Tetracycline) F     Budesonide (Pulmicort 0.25mg/2mL)         G  Phenylephrine HCl/Promethazine HCl G
                                               Budesonide (Pulmicort 0.5mg/2mL)          G    (Phenergan VC)
       NSAIDs (Pain Relievers)                BRANDS                                        Phenylephrine Tannate/Chlorpheniramine G
                                               Asmanex (Mometasone Furoate)              F    Tannate (Rynatan)
                   NSAIDs                      Flovent HFA (Fluticasone Propionate)      F  Phenylephrine Tannate/Diphenhydramine G
GENERICS                                       Flovent Diskus (Fluticasone Propionate)   F    Tannate Suspension
  Etodolac (Lodine)                         G  Pulmicort 1mg/2mL (Budesonide)            F   (Dytan-D Suspension)
  Etodolac (Lodine XL)                      G  Pulmicort Flexhaler (Budesonide)          F  Phenylephrine Tannate/Pyrilamine        G
  Flurbiprofen (Ansaid)                     G  QVAR (Beclomethasone Dipropionate)        F    Tannate (Ryna-12 S)
 Phenylephrine Tannate/Pyrilamine       G     Clarinex-D 24 Hour                    F                Miscellaneous
  Tannate/Chlorpheniramine (Rynatan)           (P-ephed/Desloratadine)                  GENERICS
 Pseudoephedrine HCl/Brompheniramine    G     Deconamine, Deconamine SR             F    Alendronate Sodium (Fosamax)                G
  Maleate (Bromfed)                            (Pseudoephedrine HCl/                     Calcitonin, Salmon, Synthetic (Miacalcin)   G
 Pseudoephedrine HCl/Chlorpheniramine   G      Chlorpheniramine Maleate)
  Maleate (Biohist-LA)                                                                  BRANDS
 Pseudoephedrine HCl/Fexofenadine HCl   G            Antihistamines                      Boniva (Ibandronate Sodium)                 F
  (Allegra-D 12 HR)                       GENERICS                                       Evista (Raloxifene HCl)                     F
 Pseudoephedrine Tannate/               G  Clemastine Fumarate (Tavist)             G    Forteo (Teriparatide)                       F
  Chlorpheniramine Tannate (Tanafed)       Cyproheptadine HCl (Periactin)           G    Fosamax Oral Solution                       F
 Pseudoephedrine Tannate/               G  Diphenhydramine HCl 50mg (Benadryl)      G     (Alendronate Sodium)
  Dexchlorpheniramine Tannate                                                            Fosamax Plus D                              F
                                           Fexofenadine HCl (Allegra)               G
  (Tanafed DP)                                                                            (Alendronate/Vitamin D3)
                                           Hydroxyzine HCl (Atarax)                 G
BRANDS                                     Hydroxyzine Pamoate (Vistaril)           G
 Allegra-D 24 HR                        F
  (Pseudoephedrine HCl/                    Promethazine HCl (Phenergan)             G
  Fexofenadine HCl)                       BRANDS
 Clarinex-D 12 Hour                     F  Allegra Oral Suspension (Fexofenadine)   F
  (P-ephed/Desloratadine)                  Clarinex (Desloratadine)                 F

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