Microsoft word - january 2011 detailed formulary.docx

2011 Detailed Formulary
January 2011
INTRODUCTION
This Member Formulary is a useful aid to understanding your drug benefit program. The formulary is a list of drugs reviewed and
approved by an independent committee of physicians and pharmacists. The formulary includes drugs that are commonly prescribed by
physicians, clinically useful, and cost-effective.
Bring this Member Formulary to your doctor appointments. Your doctor can review the formulary and determine if a drug listed is
appropriate for you. When you have a prescription filled, your copayment will be at one of three levels or "tiers." Tier 1 and tier 2 drugs
will be the lower copayments. However, a tier 1 or tier 2 drug may not always be available or the best choice for your medical condition.
Tier 1 (lowest copayment) includes only generic versions of brand-name drugs. Generic drugs are noted in lowercase type. A brand-
name drug that is bolded indicates that a generic is available. All generic drugs, whether listed in this formulary or not, are the lowest
copayment.
Tier 2 (intermediate copayment) includes selected brand-name drugs. Brand-name drugs are noted in all capital letters.
Tier 3 (highest copayment) includes all brand-name drugs not listed in tier 2 and includes all brands not listed in this formulary.
Brand-name drugs are shown in capital letters. Those with generic versions available are identified with a bolded brand name.
Generic versions of brand-name drugs are always in tier 1 (lowest copayment.)

The drug names listed here are the registered and/or unregistered trademarks of third-party pharmaceutical companies unrelated to
and unaffiliated with Script Care. These trademarked brand names are included here for informational purposes only and are not
intended to imply or suggest any affiliation between Script Care and such third-party pharmaceutical companies.
LEARNING MORE ABOUT GENERIC DRUGS
One way you can reduce your out-of-pocket cost is by requesting a generic drug. A generic drug is a copy of the original brand-name
drug, whether prescription or over-the-counter. Generic drugs are usually priced lower than their brand-name equivalents.
Generic drugs are:
Approved by the U.S. Food and Drug Administration for safety and effectiveness, and are manufactured under the same strict standards which apply to brand-name drugs. Tested in humans to assure the generic is absorbed in the bloodstream in a similar manner as the brand-name drug. Generics may be different from the brand in size, color, and inactive ingredients, but this does not alter the effectiveness or the ability to be absorbed just like the brand-name drug. Manufactured in the same strength and dosage form as the brand-name drug.
When a generic drug is substituted for a brand-name drug, you can expect the generic to produce the same clinical effect and
safety profile as the brand-name drug.
HELPFUL HINTS FOR TAKING DRUGS PROPERLY
Consult your pharmacist when you have questions about prescription and over-the-counter drugs. Take your medication exactly as prescribed. Store your medication at room temperature unless advised differently on the label. Display the telephone number of your local Poison Control Center on your phone. Keep an up-to-date list of your prescription and over-the-counter drugs, including the dosage schedule and the name of the prescribing physician, in your purse or wallet. Every time you have an appointment, show the list to your doctor.
IMPORTANT
Your benefit coverage may not be limited to this list. There may be drugs listed here that are not covered by your specific plan. Some
strengths/dosage forms of drugs listed may not be on the formulary. Using this list is voluntary. This list is subject to change at any time.
Refer to your benefit materials or call your prescription benefit member services telephone number for specific coverage information.

LEGEND
#
Only the dosage forms/strengths of the brand-name product noted are on the Member Formulary
Only the brand-name product noted is on the Member Formulary
boldface
Indicates generic availability; boldface may not apply to every strength or dosage form under the listed generic name delayed-rel Delayed-release (also known as enteric-coated), refer to the reference brand listed for clarification
ext-rel
Extended-release (also known as sustained-release), refer to the reference brand listed for clarification ANALGESICS
Practice guidelines of pain management are available at: http://www.asahq.org
probenecid
diflunisal
etodolac
indomethacin
ZYLOPRIM
DILAUDID
nabumetone
DURAGESIC
salsalate
NARCOTIC ANALGESICS
PERCOCET
Management (includes WHO analgesic ladder) CLINORIL
are available at: http://www.asahq.org
ROXICODONE tabs 15 mg, soln 5 mg/5
http://www.nccn.org
Opioid guidelines in the management of chronic http://www.asipp.org/Guidelines.htm
NON-NARCOTIC ANALGESICS
NAPROSYN
VOLTAREN
FIORICET
LORTAB
MAXIDONE
FIORINAL
NSAIDs, TOPICAL
w/CODEINE
VISCOSUPPLEMENTS
COX-2 INHIBITORS
NARCOTIC ANALGESICS, CII
morphine
morphine
oxycodone tabs 5 mg
ANTI-INFECTIVES
Hepatitis: CDC recommendations on the
ANTIBACTERIALS
Penicillins
treatment of hepatitis are available at: Cephalosporins
http://www.cdc.gov/ncidod/diseases/hepatiti
First Generation
ampicillin
s/index.htm
dicloxacillin
Guidelines for the management of chronic penicillin
hepatitis by the American Association for the cefadroxil
Study of Liver Disease are available at: http://www.aasld.org
AUGMENTIN
HIV/AIDS: Guidelines for the treatment of HIV
Second Generation
AUGMENTIN
patients by the U.S. Department of Health and cefaclor
Sulfonamides
http://www.aidsinfo.nih.gov
cefprozil
Infective Endocarditis: American Heart
prevention of bacterial endocarditis are Tetracyclines
Third Generation
available at: http://www.americanheart.org
Influenza: Recommendations of the Advisory
tetracycline
http://www.cdc.gov/ncidod/diseases/flu/fluvi
PERIOSTAT
VIBRAMYCIN
Erythromycins/Macrolides
International Travel: CDC recommendations
for international travel are available at: ANTIFUNGALS
http://www.cdc.gov/travel
erythromycin
delayed-rel
Sexually Transmitted Diseases: CDC
erythromycin
stearate
Sexually Transmitted Diseases Guidelines are erythromycin/sulfisoxazole
http://www.cdc.gov/std/treatment/default.ht
DIFLUCAN
LAMISIL #
Respiratory Tract Infection/Antibiotic
Use/Community Acquired Pneumonia/Other:
ZITHROMAX
Principles of appropriate antibiotic use for Fluoroquinolones
MYCOSTATIN
treatment of nonspecific upper respiratory tract SPORANOX
http://www.cdc.gov/ncidod/guidelines/guidel
ines_topic_ar.htm
ANTIMALARIALS
Practice guidelines and statements developed CIPRO tabs
http://www.idsociety.org
ARALEN
LARIAM
Nucleotide Reverse Transcriptase
ANTIRETROVIRAL AGENTS
Inhibitors
Antiretroviral Combinations
Protease Inhibitors
Herpes Agents
Chemokine Receptor Antagonists
Influenza Agents
amantadine
Fusion Inhibitors
Integrase Inhibitors
ANTITUBERCULAR AGENTS
FLUMADINE
Non-nucleoside Reverse Transcriptase
isoniazid
MISCELLANEOUS
Inhibitors
pyrazinamide
mebendazole
MYAMBUTOL
trimethoprim
ANTIVIRALS
Nucleoside Reverse Transcriptase
Cytomegalovirus Agents
Inhibitors
ganciclovir
MACROBID
MACRODANTIN
RETROVIR
Hepatitis Agents
ANTINEOPLASTIC AGENTS
Clinical practice guidelines in oncology are Antiestrogens
KINASE INHIBITORS
available at: http://www.nccn.org
http://www.asco.org
tamoxifen
ALKYLATING AGENTS
cyclophosphamide
Aromatase Inhibitors
Luteinizing Hormone-releasing
Hormone (LHRH) Agonists
TOPOISOMERASE INHIBITORS
ANTIMETABOLITES
leuprolide
MISCELLANEOUS
etoposide
Progestins
PURINETHOL
HORMONAL ANTINEOPLASTIC
VESANOID
ZOLINZA
TIER
Antiandrogens
IMMUNOMODULATORS
flutamide
CARDIOVASCULAR
The Seventh Report of the Joint National Cholesterol Absorption Inhibitors
ANGIOTENSIN II RECEPTOR
ANTAGONIST/CALCIUM CHANNEL
Fibrates
http://www.nhlbi.nih.gov/guidelines/hyperten
BLOCKER/DIURETIC
Guidelines for the evaluation and management COMBINATIONS
of cardiovascular diseases in adults are available at: http://www.acc.org
http://www.americanheart.org
http://www.heartfailureguideline.org
ANGIOTENSIN II RECEPTOR
ACE INHIBITORS
ANTAGONIST / DIRECT RENIN
Guidelines for the use of ACE inhibitors are available at: INHIBITOR COMBINATIONS
HMG-CoA Reductase Inhibitors
http://professional.diabetes.org
http://www.acc.org
http://www.americanheart.org
http://www.nhlbi.nih.gov/guidelines/hyperten
ANGIOTENSIN II RECEPTOR
ANTAGONISTS/DIURETIC
ACCUPRIL
PRAVACHOL
COMBINATIONS
Guidelines for the use of angiotensin II receptor Niacins/Combinations
antagonists in various patient populations are LOTENSIN
http://professional.diabetes.org
http://www.nhlbi.nih.gov/guidelines/hyperten
MONOPRIL
Omega-3 Fatty Acids
ACE INHIBITOR/CALCIUM
BETA-BLOCKERS
CHANNEL BLOCKER
Guidelines for the use of beta-blockers and COMBINATIONS
beta-blocker combinations in various patient populations are available at: http://www.acc.org
http://www.nhlbi.nih.gov/guidelines/hyperten
sion
TIER
ACE INHIBITOR/DIURETIC
pindolol
COMBINATIONS
* Atacand should be reserved for patients who
meet CHARM (Candesartan in Heart Failure -
propranolol
Assessment of Reduction in Mortality and ACCURETIC
CAPOZIDE
LOTENSIN
MONOPRIL-HCT
ANTIARRHYTHMICS
VASERETIC
Guidelines for the use of antiarrhythmics and ZESTORETIC
LOPRESSOR
ADRENOLYTICS, CENTRAL
http://www.acc.org
TENORMIN
TOPROL-XL
CATAPRES
TRANDATE
CATAPRES-TTS
BETAPACE
BETA-BLOCKER/DIURETIC
ALDOSTERONE RECEPTOR
BETAPACE AF
COMBINATIONS
CORDARONE
ANTAGONISTS
Guidelines for the use of beta-blockers and diuretic combinations in various patient ALDACTONE
http://www.acc.org
TAMBOCOR
http://www.nhlbi.nih.gov/guidelines/hyperten
ALPHA BLOCKERS
Guidelines for the use of alpha blockers in ANTILIPEMICS
various patient populations are available at: LOPRESSOR
http://www.nhlbi.nih.gov/guidelines/hyperten
Detection, Evaluation, and Treatment of High TENORETIC
Blood Cholesterol in Adults (Adult Treatment http://www.nhlbi.nih.gov/guidelines/
CALCIUM CHANNEL BLOCKERS
cholesterol/index.htm
Dihydropyridines
Bile Acid Resins
ANGIOTENSIN II RECEPTOR
felodipine
ANTAGONIST/CALCIUM CHANNEL
BLOCKER COMBINATIONS
COLESTID
PROCARDIA XL
QUESTRAN/QUESTRAN
Nondihydropyridines
Transdermal
Loop Diuretics
nitroglycerin
transdermal
CARDIZEM CD
NITRO-DUR
NITRATE/VASODILATOR
CALCIUM CHANNEL
Potassium-sparing Diuretics
COMBINATIONS
BLOCKER/ANTILIPEMIC
COMBINATIONS
amiloride
Thiazide and Thiazide-like Diuretics
PULMONARY ARTERIAL
chlorthalidone
HYPERTENSION
DIGITALIS GLYCOSIDES
hydrochlorothiazide
indapamide
Endothelin Receptor Antagonists
ZAROXOLYN
Diuretic Combinations
Phosphodiesterase Inhibitors
amiloride/hydrochlorothiazide
DIRECT RENIN INHIBITORS
ALDACTAZIDE
Prostaglandin Vasodilators
DIRECT RENIN INHIBITOR
COMBINATIONS
NITRATES
isosorbide
dinitrate
MISCELLANEOUS
DIURETICS
Carbonic Anhydrase Inhibitors
hydralazine
methyldopa
TIER
acetazolamide
Sublingual
methazolamide
NITROSTAT
PROAMATINE
CENTRAL NERVOUS SYSTEM
Practice guidelines for psychiatric disorders are disorder, obsessive-compulsive disorder, panic available at: http://www.psych.org
disorder, and premenstrual dysphoric disorder. ANTIANXIETY
NEURONTIN
Guidelines for the evaluation and management Benzodiazepines
of bipolar and depressive disorders are available at: http://www.psych.org
TRILEPTAL
Monoamine Oxidase Inhibitors (MAOIs)
oxazepam
KLONOPIN
DEPAKENE
DILANTIN
Selective Serotonin Reuptake Inhibitors
Miscellaneous
MYSOLINE
TEGRETOL
fluvoxamine
TEGRETOL-XR
ZARONTIN
ANAFRANIL
ZONEGRAN
ANTIDEMENTIA
ANTICONVULSANTS
Practice guidelines for the management of Practice guidelines for the treatment of epilepsy dementia are available at: http://www.aan.com
are available at: http://www.aan.com
Serotonin Norepinephrine Reuptake
Inhibitors (SNRIs)*
phenobarbital
* Indicates the proposed mechanism of action,
based on the American Psychiatric Association DEPAKOTE
RAZADYNE
DEPAKOTE ER
RAZADYNE ER
venlafaxine
ANTIDEPRESSANTS
Although these agents are primarily indicated LAMICTAL
approved for other indications, including bipolar Tricyclic Antidepressants (TCAs)
ATTENTION DEFICIT
Selective Serotonin
HYPERACTIVITY DISORDER
Agonist/Nonsteroidal Antiinflammatory
amitriptyline
Guidelines for the evaluation and management Drug (NSAID) Combinations
of attention deficit disorder are available at: http://www.aacap.org
NORPRAMIN
http://www.aap.org
MOOD STABILIZERS
TOFRANIL
ADDERALL
Miscellaneous Agents
carbonate
lithium carbonate ext-rel tabs 450 mg
trazodone
LITHOBID
WELLBUTRIN
WELLBUTRIN
MULTIPLE SCLEROSIS AGENTS
WELLBUTRIN
Practice guidelines for multiple sclerosis are available at: http://www.aan.com
ANTIPARKINSONIAN AGENTS
DEXEDRINE
Practice guidelines for the diagnosis and DEXEDRINE
SPANSULE
treatment of Parkinson's disease are available METADATE ER
http://www.aan.com
amantadine
benztropine
FIBROMYALGIA
trihexyphenidyl
MUSCULOSKELETAL THERAPY
HUNTINGTON'S DISEASE AGENTS
baclofen
orphenadrine/aspirin/caffeine
DANTRIUM
HYPNOTICS
FLEXERIL
Practice parameters for the treatment of sleep disorders and clinical guidelines for the ELDEPRYL
PARLODEL
http://www.aasmnet.org
ZANAFLEX
Benzodiazepines
MYASTHENIA GRAVIS
ANTIPSYCHOTICS
RESTORIL
MESTINON
Atypicals
Nonbenzodiazepines
NARCOLEPSY/CATAPLEXY
RISPERDAL
MIGRAINE
PSYCHOTHERAPEUTICMISCELLA
Guidelines for prevention and management of http://www.aan.com
Alcohol Deterrents
Ergotamine Derivatives
CLOZARIL
CAFERGOT
Miscellaneous
Narcotic Antagonists
chlorpromazine
fluphenazine
Selective Serotonin Agonists
Partial Narcotic Agonist/Narcotic
haloperidol
Antagonist Combinations
perphenazine
thioridazine
trifluoperazine
Smoking Deterrents
nicotine
transdermal
ENDOCRINE AND METABOLIC
ANDROGENS
Meglitinides
ORTHO-CEPT
Clinical practice guidelines for the treatment of 35 mcg Estrogen
http://www.aace.com
Sulfonylureas
ethynodiol diacetate/EE 1/35 - Zovia
GLUCOTROL
GLUCOTROL
BREVICON
Supplies
ANTIDIABETICS
ACCU-CHEK kits and test strips OTC
ORTHO-CYCLEN
Guidelines of treatment and management of BD insulin syringes and needles OTC
ORTHO-NOVUM
50 mcg Estrogen
http://professional.diabetes.org
ONETOUCH kits and test strips OTC
Alpha-glucosidase Inhibitors
ethynodiol diacetate/EE 1/50 - Zovia
ANTIOBESITY
Guidelines of treatment and management of Amylin Analogs
http://www.aace.com
ORTHO-NOVUM
http://www.nhlbi.nih.gov/guidelines/obesity/
Biphasic
ob_home.htm
Biguanides
Monoamine Reuptake Inhibitors
MIRCETTE
Triphasic
Fat Absorption Decreasing Agents
levonorgestrel/EE
GLUCOPHAGE
GLUCOPHAGE
TRI-CYCLEN
Biguanide/Sulfonylurea Combinations
CALCIUM RECEPTOR
CYCLESSA
ANTAGONISTS
METAGLIP
TRI-CYCLEN
Dipeptidyl Peptidase-4 (DPP-4)
ORTHO-NOVUM
TRI-NORINYL
Inhibitors
Four Phase
CALCIUM REGULATORS
Bisphosphonates
Guidelines of treatment and management of Extended Cycle
Dipeptidyl Peptidase-4 (DPP-4)
Inhibitor/Biguanide Combinations
http://www.aace.com
http://www.nof.org
Incretin Mimetic Agents
SEASONALE
Progestin Only
Insulins
Calcitonins
MICRONOR
Emergency Contraception
calcitonin-salmon
Fortical
MIACALCIN
Injectable
Parathyroid Hormones
DEPO-PROVERA
Progestin Intrauterine Device
CONTRACEPTIVES
Transdermal
Monophasic
Insulin Sensitizers
20 mcg Estrogen
levonorgestrel/EE
Insulin Sensitizer/Biguanide
ENDOMETRIOSIS
Combinations
LOESTRIN
LOESTRIN
30 mcg Estrogen
Insulin Sensitizer/Sulfonylurea
Combinations
levonorgestrel/EE
ESTROGENS
norgestrel/EE 0.3/30 - Low-Ogestrel
Guidelines of treatment and management of hormone therapy and menopause are available LOESTRIN
at: http://www.menopause.org
LOESTRIN
PHOSPHATE BINDER AGENTS
GLUCOCORTICOIDS
PROGESTINS
Transdermal
dexamethasone
fludrocortisone
prednisone
AYGESTIN
PEDIAPRED
GLUCOSE ELEVATING AGENTS
SELECTIVE ESTROGEN
RECEPTOR MODULATORS
ESTROGEN/PROGESTINS
HUMAN GROWTH HORMONES
Guidelines for use of growth hormone are THYROID AGENTS
available at: http://www.aace.com
Antithyroid Agents
estradiol/norethindrone
propylthiouracil
TAPAZOLE
Thyroid Supplements
levothyroxine
Transdermal
HYPERPARATHYROID
levothyroxine
TREATMENT, VITAMIN D
SYNTHROID
VASOPRESSINS
FERTILITY REGULATORS
PHENYLKETONURIA TREATMENT
chorionic
gonadotropin
MISCELLANEOUS
CARNITOR
DOSTINEX
GASTROINTESTINAL
Guidelines for the treatment and management H2 RECEPTOR ANTAGONISTS
of various gastrointestinal diseases/conditions are available at: http://www.acg.gi.org
http://www.gastro.org
ANTIDIARRHEALS
ANTISPASMODICS
loperamide
chlordiazepoxide/clidinium
INFLAMMATORY BOWEL DISEASE
hyoscyamine sulfate orally
Injectable Agents
disintegrating tabs
ANTIEMETICS
Oral Agents
prochlorperazine
balsalazide
promethazine
LEVSINEX
CHOLELITHOLYTICS
ANTIVERT
ACTIGALL
AZULFIDINE
AZULFIDINE
Program for Lotronex, call 1-888-423-5227 or PROTON PUMP INHIBITORS
Rectal Agents
lansoprazole
delayed-rel
hydrocortisone
pantoprazole
delayed-rel
LAXATIVES
lactulose
PRILOSEC
SALIVA STIMULANTS
IRRITABLE BOWEL SYNDROME
IRRITABLE BOWEL SYNDROME WITH
NULYTELY
CONSTIPATION
STEROIDS, RECTAL
IRRITABLE BOWEL SYNDROME WITH
DIARRHEA
PANCREATIC ENZYMES
PROCTOCREAM-HC
* For safety reasons, to prescribe Lotronex, the
ULCER THERAPY COMBINATIONS
physician must be enrolled in the Prescribing understand the benefits and risks of treatment with Lotronex for severe diarrhea-predominant IBS, including the information in the Prescribing PROSTAGLANDINS
MISCELLANEOUS
Information, Medication Guide and Patient- Physician Agreement for Lotronex. To enroll or GENITOURINARY
BENIGN PROSTATIC
Phosphodiesterase Inhibitors
HYPERPLASIA
VAGINAL ANTI-INFECTIVES
Guidelines for the management of BPH are available at: http://www.auanet.org/guidelines
METROGEL-VAGINAL
URINARY ANTISPASMODICS
oxybutynin
ERECTILE DYSFUNCTION
MISCELLANEOUS
Guidelines for the management of erectile http://www.auanet.org/guidelines
UROCIT-K
Alprostadil Agents
PYRIDIUM
URECHOLINE
DITROPAN XL
HEMATOLOGIC
Guidelines of treatment and management of HEMATOPOIETIC GROWTH
PAROXYSMAL NOCTURNAL
http://www.hemophilia.org
Guidelines for the management of neutropenia HEMOGLOBINURIA (PNH) AGENTS
ANTICOAGULANTS
are available at: http://www.asco.org
Injectable
associated with chronic kidney disease are PLATELET AGGREGATION
http://www.kidney.org/professionals/kdoqi/g
INHIBITORS
uidelines_commentaries.cfm#guidelines
COUMADIN
Synthetic Heparinoid-like Agents
PERSANTINE
IDIOPATHIC THROMBOCYTOPENIC
PURPURA AGENTS
PLATELET SYNTHESIS
INHIBITORS
STEM CELL MOBILIZERS
MISCELLANEOUS
IMMUNOLOGIC AGENTS
DISEASE-MODIFYING
IMMUNOMODULATORS
ANTIRHEUMATIC DRUGS
AZASAN
CELLCEPT
(DMARDs)
Guidelines for the management of rheumatic http://www.cdc.gov/hepatitis/index.htm
Guidelines for the management of hepatitis are
available at: http://www.aasld.org
http://www.rheumatology.org
Interferons
Calcineurin Inhibitors
methotrexate
SANDIMMUNE
Miscellaneous
Rapamycin Derivatives
IMMUNOSUPPRESSANTS
PLAQUENIL
Antimetabolites
NUTRITIONAL/SUPPLEMENTS
ELECTROLYTES
Miscellaneous
Potassium
Prenatal Vitamins
cyanocobalamin
potassium
chloride
multivitamins/fluoride
multivitamins/fluoride/iron
ADC/fluoride
ADC/fluoride/iron
VITAMINS AND MINERALS
Folic Acid Agents
LOZI-TABS
RESPIRATORY
Guidelines to the management, prevention, or ANTIHISTAMINES, LOW SEDATING
treatment of COPD and asthma are available at: ANTITUSSIVES
http://www.aaaai.org
http://www.ginasthma.com
ZYRTEC OTC
TESSALON
http://www.goldcopd.com
http://www.nhlbi.nih.gov
The Allergy Report and guidelines for allergy
ANTIHISTAMINES, NONSEDATING
ANTITUSSIVE COMBINATIONS
Narcotic
http://www.aaaai.org
ANAPHYLAXIS TREATMENT
codeine/chlorpheniramine/
pseudoephedrine
ANTIHISTAMINES, SEDATING
TIER
codeine/guaifenesin
codeine/guaifenesin/pseudoephedrine
clemastine
codeine/promethazine
cyproheptadine
hydroxyzine
ANTICHOLINERGICS
PROMETHAZINE
w/CODEINE
ANTIHISTAMINE/DECONGESTANT
ipratropium
COMBINATIONS
Non-narcotic
brompheniramine/pseudoephedrine
dextromethorphan/brompheniramine/
mg/45 mg per 5 mL
brompheniramine/pseudoephedrine
pseudoephedrine
ANTICHOLINERGIC/BETA
rel 12 mg/120 mg
dextromethorphan/chlorpheniramine/
AGONIST COMBINATIONS
brompheniramine/pseudoephedrine
phenylephrine drops, syrup
rel 6 mg/60 mg
dextromethorphan/promethazine
DECONAMINE
ZYRTEC-D
BETA AGONISTS
LEUKOTRIENE RECEPTOR
STEROID/BETA AGONIST
Inhalants
ANTAGONISTS
COMBINATIONS
Short Acting
albuterol
MAST CELL STABILIZERS
cromolyn
STEROID INHALANTS
NASAL ANTIHISTAMINES
Long Acting
Oral Agents
NASAL STEROIDS
XANTHINES
albuterol
theophylline
flunisolide
BRETHINE
CYSTIC FIBROSIS
MISCELLANEOUS
ATROVENT
DERMATOLOGY
Antifungals
Medium Potency
Guidelines for the care and treatment of acne clotrimazole
vulgaris are available at: http://www.aad.org
econazole
betamethasone
valerate
Oral
oint 0.1%
desoximetasone
ACCUTANE
fluocinolone acetonide crm, oint 0.025%
triamcinolone acetonide crm, lotion
Topical
triamcinolone acetonide crm, lotion,
erythromycin
MYCOSTATIN
oint 0.1%
erythromycin
NIZORAL
OXISTAT
sulfacetamide/sulfur crm, gel, lotion,
Antipsoriatics
CUTIVATE
tretinoin
(generic of AVITA)
Guidelines of care for the management and treatment of psoriasis with topical therapies are available at: http://www.aad.org
Injectable
WESTCORT
High Potency
Oral
betamethasone dipropionate crm, lotion,
oint 0.05%
diflorasone diacetate crm 0.05%
BENZACLIN
Topical
triamcinolone acetonide crm 0.5%
BENZAMYCIN
DIPROLENE
Antiseborrheics
Actinic Keratosis
DIPROLENE
NIZORAL SHAMPOO
TOPICORT
Very High Potency
Antibiotics
Corticosteroids
Low Potency
diflorasone
diacetate
gentamicin
fluocinolone acetonide soln 0.01%
hydrocortisone
DIPROLENE
BACTROBAN
hydrocortisone
TEMOVATE
SILVADENE
ACLOVATE
ULTRAVATE
Emollients
LAC-HYDRIN
OPTIPRANOLOL
Immunomodulators
Antifungals
TIMOPTIC
Guidelines for the treatment of atopic dermatitis TIMOPTIC-XE
are available at: http://www.aad.org
Selective
Anti-infectives
bacitracin
Carbonic Anhydrase Inhibitors
Local Analgesics
erythromycin
Topical
gentamicin
polymyxin
B/bacitracin
Local Anesthetic
Carbonic Anhydrase Inhibitor/Beta-
blocker Combinations
BLEPH-10
metronidazole
Immunomodulators
NEOSPORIN
POLYTRIM
Prostaglandins
METROCREAM
Anti-infective/Anti-inflammatory
Combinations
METROLOTION
Scabicides and Pediculicides
sulfacetamide/prednisolone
phosphate
10%/0.25%
Sympathomimetics
brimonidine
ALPHAGAN
Miscellaneous Skin and Mucous
CORTISPORIN
Sympathomimetic/Beta-blocker
Membrane
MAXITROL
Combinations
Anti-inflammatories
CONDYLOX
Nonsteroidal
Clinical practice guidelines for the treatment of MOUTH/THROAT/DENTAL AGENTS
Anesthetics - Topical Oral
VOLTAREN
http://www.aap.org
Steroidal
Anti-infectives
XYLOCAINE
Steroids - Mouth/Throat
dexamethasone
phosphate
prednisolone
phosphate
triamcinolone
OPHTHALMIC
DOMEBORO
Preferred Practice Pattern Guidelines for the Anti-infective/Anti-inflammatory
treatment of various ophthalmic conditions are Combinations
available at: http://one.aao.org
Antiallergics
Antivirals
VIROPTIC
Beta-blockers
CORTISPORIN
Nonselective

Source: http://www.tpsd.org/home/files/prescription_drug_list.pdf