A
Acarbose (PRECOSE)
Acrivastine/pseudoephedrine (SEMPREX-D)
Alosetron (LOTRONEX)
Appetite suppressants
APRI
Ardeparin (NORMIFLO)
AVIANE
Azelastine HCl ophthalmic solution (OPTIVAR)
B
Bepridil (VASCOR)
BIAXIN XL
Bitolterol inhaler (TORNALATE)
BRONTEX (Guaifenesin/codeine)
Butorphanol nasal spray (STADOL NS)
C
Candesartan (ATACAND)
Cefaclor
Cefixime tablets (SUPRAX)
Cefprozil tablets (CEFZIL)
Ceftibuten (CEDAX)
Celecoxib (CELEBREX)
CENESTIN (synthetic conjugated estrogens)
Cephradine
Cerivastatin (BAYCOL)
Clindamycin/benzoyl peroxide gel 1-5% (BENZACLIN) 50 mg
COVERA-HS
CYCLESSA
D
D.A. II
Dalteparin (FRAGMIN)
Desogestrel Ethinyl Estradiol (ORTHO-CEPT)
Dexamethasone inhaler (DECADRON TURBINAIRE)
Diclofenac/Misoprostol (ARTHROTEC)
Diclofenac potassium (CATAFLAM)
Diflunisol
Diltiazem HCI (CARDIZEM CD)
Diltiazem SR (DILACOR XR)
Dipyridamole/Aspirin (AGGRENOX)
Dirithromycin (DYNABAC)
DYAZIDE
E
EC-NAPROSYN or NAPRELAN
Eflornithine (VANIQA)
Emadastine diflumarate (EMADINE)
Enalapril/felodipine (LEXXEL)
Enoxacin (PENETREX)
Estradiol/norethindrone transdermal system (COMBIPATCH)
Ethinyl estradiol/norethindrone AC (FemHRT)
Ethynodiol-mestranol (OVULEN)
Etodolac
F
Famciclovir (FAMVIR)
Famotidine (PEPCID) except generic 20 mg and 40 mg tablets and oral suspension
Fenofibrate (LIPIDIL)
Fenoprofen
Fexofenadine HCl (ALLEGRA)
Fexofenadine/pseudoephedrine (ALLEGRA D)
Flunisolide nasal inhaler (NASALIDE, NASAREL)
Flunisolide oral inhaler (AEROBID, AEROBID-M)
Fluoxetine HCl (tablets)
Flurbiprofen
Fosfomycin (MONUROL)
Fosinopril (MONOPRIL)
G
Gatifloxacin (TEQUIN)
H
HELIDAC
Human growth hormone brands other than Humatrope (Humatrope requires prior authorization)
Hydroquinone products
I
Ibuprofen/hydrocodone (VICOPROFEN)
Irbesartan (AVAPRO)
Isoproterenol inhaler (MEDIHALER-ISO or ISUPREL)
Isosorbide mononitrate (ISMO)
Isradipine (DYNACIRC CR)
J
JENSET-28
K
Ketoprofen
Ketotifen fumarate ophthalmic solution (ZADITOR)
|
L
Levafloxacin (LEVAQUIN)
Levalbuterol (XOPENEX)
LEVLITE
Levonorgestrel ethinyl estradiol (NORDETTE)
LEVORA
LODINE XL
Lomefloxacin (MAXAQUIN)
Loracarbef capsules (LORABID)
Loratadine melting tablets (CLARITIN REDITABS) (Ages > 6)
M
Mefenamic acid (PONSTEL)
Metaproterenol Inhaler (ALUPENT INHALER)
MICROGESTIN FE
Minoxidil topical solution (ROGAINE)
MODICON
N
Naphazoline/antazoline ophthalmic solution
Naphazoline HCl/pheniramine maleate ophthalmic solution
NAPROSYN EC
NECON
Nicardipine (CARDENE and CARDENE SR)
Nifedipine (PROCARDIA XL)
Nisoldipine (SULAR)
Nizatidine (AXID)
Norethindrone ethinyl estradiol (MODICON)
NOVOLIN 70/30
NOVOLIN L
NOVOLIN N
NOVOLIN R
O
Ogestrel
Omeprazole (PRILOSEC)
Over-the-counter drugs
Oxaprozin (DAYPRO)
P
Pemirolast potassium ophthalmic solution (ALAMAST)
Phenylpropanolamine containing products
Phenytoin (all generics)
Pravastatin (PRAVACHOL)
Progesterone oral (other than PROMETRIUM, which requires prior authorization)
PROPECIA
Q
Quinapril (ACCUPRIL)
R
Rabeprazole (ACIPHEX)
Ramipril (ALTACE)
Ranitidine capsules
S
Sildenafil (VIAGRA)
Smoking cessation products
Sparfloxacin (ZAGAM)
T
Tacrine (COGNEX)
Telmisartan (MICARDIS)
Terbutaline inhaler (BRETHAIRE)
Tiludronate (SKELID)
Tinzaparin (INNOHEP)
Tolmetin
Toremifene (FARESTON)
Torsemide (DEMADEX)
Tramadol
Trandolapril (MAVIK)
Trandolapril/verapamil (TARKA)
Triamcinolone nasal inhaler (NASACORT)
TRILEVLEN
TRITEC
Troglitazone (REZULIN)
Trovafloxacin (TROVAN)
U
Unoprostone isopropyl (RESCULA)
V
Valdecoxib (BEXTRA)
VERELAN
VOLTAREN XR
Y
YASMIN
Z
Zaleplon (SONATA)
Zanamivir (RELENZA)
Zileuton (ZYFLO)
ZOVIA |
