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2007 The Mutual of Omaha Drug Formulary lists preferred medications. The formulary
is developed and updated by the Mutual of Omaha Pharmacy and Therapeutics (P&T) Committee and is subject to change. Please note that when a generic
Mutual of Omaha equivalent becomes available for a brand name drug on formulary, the brand
name formulary drug becomes non-formulary. Certain drugs require prior
Drug Formulary authorization and/or have quantity limit requirements in some circumstances.
Al compounded medications, if covered under your plan, are non-formulary. Al drugs listed on the formulary are subject to your specific plan provisions. Al drugs may not be covered under your plan. To obtain the most current formulary listing, please go to mutualofomaha.com or call the customer service number on your ID card.
ANESTHETICS
Topical Anesthetics
ANTIINFECTIVES
Antibacterial Drugs
Topical Antiviral Drugs
CARDIOVASCULAR
MEDICATIONS
Antiinfectives Specialized
Indications
Antianxiety and Sedative-
Antilipidemic Medications
Hypnotic Drugs
Antivertigo and Antiemetic
AUTONOMIC AND CNS
Drugs
MEDICATIONS
Class II Narcotics
Antimania Drugs
Antiparkinson Drugs
Anticonvulsant Drugs
Cardiac Glycosides
Diuretics
Topical Antibacterial Drugs
Class III Narcotics
Oral Antifungal Drugs
Antipsychotic Drugs
Class IV Narcotics
Beta-Adrenergic Antagonist
Drugs
Topical Antifungal Drugs
Drugs to Prevent and Treat
Headaches
Antidepressant Drugs
Topical Antifungal-
Corticosteroid
Combinations
CNS Stimulant/Other CNS-
Autonomic Drugs
Oral Antiviral Drugs
(G) next to a drug name indicates that a generic is available for at least one or more strengths of the brand medication and the brand name product is
non-formulary; (PAR) stands for Prior Authorization Required; (QL) stands for Quantity Limit and OTC stands for over-the-counter medications.
Drug Formulary 
ACE Inhibitors
Drugs Affecting the Nose
Antiulcer Drugs
Other Drugs for Arthritis
ARBs
ENDOCRINE
MEDICATIONS
Drugs to Prevent and Treat
Gout
Hypoglycemic
Calcium Antagonists
Antipruritic Drugs
Antiacne Drugs
Skeletal Muscle Relaxants
Other GI Drugs
Other Antihypertensives
and Combinations:
NUTRITION, BLOOD
MODIFIERS,
Adrenal Corticosteroid
ELECTROLYTES
Drugs
Vitamins & Minerals &
Related Products
IMMUNOLOGICALS AND
VACCINES
Pulmonary Arterial
Hypertension
Keratolytic Drugs
Thyroid Drugs
MUSCULOSKELETAL
MEDICATIONS
Therapeutic Vitamins &
Vasodilating Drugs
Minerals
Antipsoriasis and
Drugs for Inflammatory
Antieczema Drugs
Diseases
Other Endocrine Drugs
Flouride Products
Osteoporosis Drugs
Non-Steroidal
Antiinflammatory Agents
DERMATOLOGICAL
Potassium Supplements
MEDICATIONS
Topical Immunomodulators
Topical Corticosteroid
Drugs
EAR-NOSE-THROAT
MEDICATIONS
GASTROINTESTINAL
Drugs Affecting the Ear
MEDICATIONS
Antidiarrheal Drugs
Antispasmodics/Drugs
Affect GI Motility
(G) next to a drug name indicates that a generic is available for at least one or more strengths of the brand medication and the brand name product is
non-formulary; (PAR) stands for Prior Authorization Required; (QL) stands for Quantity Limit and OTC stands for over-the-counter medications.
Drug Formulary 2
Estrogen/Progestin
UROLOGICAL
Combinations
MEDICATIONS
Drugs to Treat Urinary Tract
Disorders
Drugs and Vitamins
Affecting Coagulation
Antiglaucoma Drugs
Methyl Xanthine Drugs
Selective Estrogen Receptor
Modulator
Progestin Drugs
Other Genitourinary
Products
Oral Contraceptives
Other Drugs for Asthma
Pulmonary
Antiinflammatory Drugs
Drugs for BPH
Leukotriene Modifiers (QL)
Antihistamine and
MEDICAL
OBSTETRICAL &
Decongestant Drugs
(MISCELLANEOUS)
GYNECOLOGICAL
SUPPLIES
MEDICATIONS
OPHTHALMIC
MEDICATIONS
Diabetic Supplies
Prenatal Vitamins
Ophthalmic Antiinfective
Drugs
Antitussive and Expectorant
Other Ophthalmic Drugs
Drugs
Specialized OB/GYN Drugs
Meters
OB/GYN Topical
Antiinfective Drugs
Vaginal Antifungals
RESPIRATORY
Ophthalmic Corticosteroid
MEDICATIONS
Test Strips
Androgen Drugs
Drugs
Bronchodilators and
Related Drugs
Estrogen Drugs
Other Respiratory Drugs
Ophthalmic Antiinfective/
Corticosteroids
This list is subject to
(G) next to a drug name indicates that a generic is available for at least one or more strengths of the brand medication and the brand name product is
non-formulary; (PAR) stands for Prior Authorization Required; (QL) stands for Quantity Limit and OTC stands for over-the-counter medications.
Drug Formulary 
Examples of Non-Formulary Medications with Selected Formulary and Over-The-Counter Alternatives
The following is a list of the most commonly prescribed drugs. It represents an abbreviated version of the drug list (formulary) that is at the core of your
pharmacy benefit plan. The list is not all-inclusive and does not guarantee coverage. In addition to using this list, you are encouraged to ask your doctor to prescribe generic drugs whenever appropriate. Over-the-counter medications are not covered under the pharmacy benefit.
The following is a list of some non-formulary brand medications with examples of selected alternatives that are on the formulary.
Thank you for your compliance.
Non-Formulary
Formulary Alternative
Non-Formulary
Formulary Alternative
enalapril/hctz, lisinopril/HCTZ, Lotensin HCT (G) captopril, enalapril, lisinopril, Altace, Lotensin (G) omeprazole (10mg) (QL), Nexium (PAR) (QL), Avelox, ciprofloxacin, ofloxacin, Levaquin lovastatin, Pravachol (G), Zocor (G), Lipitor Omeprazole (10mg) (QL), Nexium (PAR) (QL), OTC Alavert, OTC Claritin, OTC loratadine fluoxetine (daily), Celexa (10mg and 40mg) (G), lovastatin, Pravachol (G), Zocar (G), Lipitor Amerge (QL), Imitrex (QL), Zomig/ZMT (QL) Amerge (QL), Imitrex (QL), Zomig/ZMT (QL) Flonase (QL) (G), Nasacort (QL), Nasonex (QL) Flonase (QL) (G), Nasacort (QL), Nasonex (QL) bupropion, Effexor (G), Effexor xr, mirtazapine, amox tr/potassium clavulanate, Augmentin ES (G) amox tr/potassium clavulanate, Augmentin ES (G), OTC Alavert, OTC Claritin, OTC loratadine Avelox, ciprofloxacin, ofloxacin, Levaquin erythromycin, Biaxin (G), Biaxin XL, Zithromax (G) Amerge (QL), Imitrex (QL), Zomig/ZMT (QL) enalapril/hctz, lisinopril/hctz, Lotensin HCT Flonase (QL) (G), Nasacort (QL), Nasonex (QL) lovastatin, Pravachol (G), Zocor (G), Lipitor amox tr/potassium clavulanate, Augmentin ES (G), Avelox, ciprofloxacin, ofloxacin, Levaquin captopril, enalapril, lisinopril, Altace, Lotensin (G) Amerge (QL), Imitrex (QL), Zomig/ZMT (QL) Avelox, ciprofloxacin, ofloxacin, Levaquin OTC Alavert, OTC Claritin, OTC loratadine enaplapril/hcyz, lisinopril/hctz, Lotensin HCT Flonase (QL) (G), Nasacort (QL), Nasonex (QL) KEY
■ (G) next to a drug name indicates that a generic is available for at least one or more strengths of the brand medication and the brand name product is
non-formulary.
■ PAR stands for Prior Authorization Required. ■ QL stands for Quantity Limit.
■ OTC stands for over-the-counter medications.
For the member: Generic medications contain the same active ingredients as their corresponding brand name medications, although they may look different in
color or shape. They have been FDA-approved under strict standards.
For the physician: Please prescribe preferred products and allow generic substititutions when medically appropriate. Thank You.
Drug Formulary 

Source: http://www.mutual-supplement.com/documents/mug6319_1006.pdf