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Effective
January 1, 2008
2008 EMPIRE PLAN PREFERRED DRUG LIST
Administered by UnitedHealthcare
The following is a list of the most commonly prescribed generic and brand-name drugs included on the 2008 Empire Plan Preferred Drug List.
This is not a complete list of all prescription drugs on the preferred drug list or covered under the Empire Plan. This list is subject to
change due to FDA approval of new brand and generic drugs and product availability. For specific questions about your prescriptions, coverage and
copayments, please call The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and select The Empire Plan Prescription Drug Program.
For the enrollee: Enrollees are encouraged to ask their doctors to prescribe generic versions of brand-name drugs whenever
appropriate, as this will result in a lower copayment. 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 generic and preferred products when medically appropriate for your patients.
Biaxin XL*
Actonel*
Allegra-D (g)*
Avonex (PA)
Concerta*
Cardizem LA*
Condylox (g)*
Copaxone (PA)
Betaseron (PA)
Depakote*
KEY
Generic Drugs are listed in lower case letters. Brand-name drugs are listed with the first letter of the name capitalized.
The symbol * next to a brand-name drug signifies that this drug may be available as a generic in 2007 or 2008. When a generic version is available, mandatory generic substitution
will apply. Use of a non-preferred brand-name prescription drug when the generic is available will result in the enrollee paying the applicable non-preferred copayment plus the
difference in cost between the brand-name drug and the generic, not to exceed the full cost of the drug. The symbol (g) next to a brand-name drug indicates that a generic is
currently available for at least one or more strengths of the brand medication. When a generic is available for a particular strength of the brand-name drug, that strength of the
brand-name drug is non-preferred. For the drug Dilantin, enrollees will not be charged the difference in cost between the brand-name drug and the generic version when the brand-
name drug is dispensed instead of the generic. The symbol (PA) next to a drug name indicates that prior authorization is required.
You can get more information about your prescription drug benefits by calling The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and selecting The Empire PlanPrescription Drug Program. From the homepage, http://www.cs.state.ny.us, select either Employees or Retirees and follow the links to Health Benefits. Select your group andbenefit plan if prompted. On the resulting NYS Online health benefits page, select “Using Your Benefits” and scroll down to the 2008 Empire Plan Preferred Drug List. Depakote ER*
Imitrex*
Meridia (PA)
Dilantin (g)
Infergen (PA)
Intal (g)*
Intron-A (PA)
Dovonex*
Forteo (PA)
itraconazole (PA)
Fosamax*
Fosamax Plus D*
Enbrel (PA)
Lamictal (g)*
Hepsera*
Humatrope (PA)
Humira (PA)
Norditropin (PA)
KEY
Generic Drugs are listed in lower case letters. Brand-name drugs are listed with the first letter of the name capitalized.
The symbol * next to a brand-name drug signifies that this drug may be available as a generic in 2007 or 2008. When a generic version is available, mandatory generic substitution
will apply. Use of a non-preferred brand-name prescription drug when the generic is available will result in the enrollee paying the applicable non-preferred copayment plus the
difference in cost between the brand-name drug and the generic, not to exceed the full cost of the drug. The symbol (g) next to a brand-name drug indicates that a generic is
currently available for at least one or more strengths of the brand medication. When a generic is available for a particular strength of the brand-name drug, that strength of the
brand-name drug is non-preferred. For the drug Dilantin, enrollees will not be charged the difference in cost between the brand-name drug and the generic version when the brand-
name drug is dispensed instead of the generic. The symbol (PA) next to a drug name indicates that prior authorization is required.
You can get more information about your prescription drug benefits by calling The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and selecting The Empire PlanPrescription Drug Program. From the homepage, http://www.cs.state.ny.us, select either Employees or Retirees and follow the links to Health Benefits. Select your group andbenefit plan if prompted. On the resulting NYS Online health benefits page, select “Using Your Benefits” and scroll down to the 2008 Empire Plan Preferred Drug List. Nutropin (PA)
Ventavis (PA)
Pulmicort Flexhaler*
Tazorac (PA)
Tegretol XR*
Wellbutrin XL (g)*
terbinafine (generic Lamisil) (PA)
Oxycontin (g)*
Tev-Tropin (PA)
Pancrease MT (g)*
Peg-Intron (PA)
Rebif (PA)
Pegasys (PA)
Retin-A Micro Gel (PA)
Tracleer (PA)
phentermine (PA)
Revatio (PA)
Zyrtec-D*
Risperdal (except for M-Tab)*
Roferon A (PA)
tretinoin (PA)
Serevent*
Serostim (PA)
Precose*
Trusopt*
KEY
Generic Drugs are listed in lower case letters. Brand-name drugs are listed with the first letter of the name capitalized.
The symbol * next to a brand-name drug signifies that this drug may be available as a generic in 2007 or 2008. When a generic version is available, mandatory generic substitution
will apply. Use of a non-preferred brand-name prescription drug when the generic is available will result in the enrollee paying the applicable non-preferred copayment plus the
difference in cost between the brand-name drug and the generic, not to exceed the full cost of the drug. The symbol (g) next to a brand-name drug indicates that a generic is
currently available for at least one or more strengths of the brand medication. When a generic is available for a particular strength of the brand-name drug, that strength of the
brand-name drug is non-preferred. For the drug Dilantin, enrollees will not be charged the difference in cost between the brand-name drug and the generic version when the brand-
name drug is dispensed instead of the generic. The symbol (PA) next to a drug name indicates that prior authorization is required.
You can get more information about your prescription drug benefits by calling The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and selecting The Empire PlanPrescription Drug Program. From the homepage, http://www.cs.state.ny.us, select either Employees or Retirees and follow the links to Health Benefits. Select your group andbenefit plan if prompted. On the resulting NYS Online health benefits page, select “Using Your Benefits” and scroll down to the 2008 Empire Plan Preferred Drug List. Examples of Non-Preferred Brand-Name Drugs with 2008 Empire Plan Preferred Drug List Alternatives
Non-Preferred Drugs
Empire Plan Preferred Drug List Alternatives
Geodon*, Risperdal (except for M-Tab)*,Seroquel (except for XR), Zyprexa (except for Zydis)
omeprazole (generic Prilosec), Nexium, Prevacid estradiol patch, Esclim, Estraderm, Vivelle, Vivelle-Dot zolpidem (generic Ambien), temazepam, flurazepam, triazolam, Sonata*
zolpidem (generic Ambien), temazepam, flurazepam, triazolam, Sonata*
Benicar HCT, Diovan HCT, Hyzaar, Micardis HCT Atrovent Inhaler*,Spiriva
Benicar HCT, Diovan HCT, Hyzaar, Micardis HCT Asmanex, Flovent, Pulmicort Flexhaler*, QVAR
clindamycin, benzoyl peroxide/erythromycin, Duac azithromycin (generic Zithromax), clarithromycin (generic Biaxin) amlodipine (generic Norvasc) plus Lipitor fexofenadine (generic Allegra), Zyrtec*
pseudoephedrine/chlorpheniramine, Allegra-D (g)*, Zyrtec-D*
venlafaxine (generic Effexor), Effexor XR Differin (PA)
tretinoin (PA), Retin-A Micro Gel (PA), Tazorac (PA)
Genotropin (PA)
Humatrope (PA), Norditropin (PA), Nutropin (PA), Tev-Tropin (PA)
econazole, ketoconazole, nystatin, Naftin zolpidem (generic Ambien), temazepam, flurazepam, triazolam, Sonata*
citalopram (generic Celexa), fluoxetine (generic Prozac), sertraline (generic Zoloft),paroxetine (generic Paxil), Lexapro omeprazole (generic Prilosec), Nexium, Prevacid Provigil (PA)
amphetamine with dextroamphetamine salt combination,dextroamphetamine, methylphenidate, Adderall XR, Concerta fluticasone (generic Flonase), flunisolide, Nasacort AQ, Nasonex levonorgestrel-ethinyl estradiol tablet, dosepack, 3 month (generic Seasonale) KEY
Generic Drugs are listed in lower case letters. Brand-name drugs are listed with the first letter of the name capitalized.
The symbol * next to a brand-name drug signifies that this drug may be available as a generic in 2007 or 2008. When a generic version is available, mandatory generic substitution
will apply. Use of a non-preferred brand-name prescription drug when the generic is available will result in the enrollee paying the applicable non-preferred copayment plus the
difference in cost between the brand-name drug and the generic, not to exceed the full cost of the drug. The symbol (g) next to a brand-name drug indicates that a generic is
currently available for at least one or more strengths of the brand medication. When a generic is available for a particular strength of the brand-name drug, that strength of the
brand-name drug is non-preferred. For the drug Dilantin, enrollees will not be charged the difference in cost between the brand-name drug and the generic version when the brand-
name drug is dispensed instead of the generic. The symbol (PA) next to a drug name indicates that prior authorization is required.
You can get more information about your prescription drug benefits by calling The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and selecting The Empire PlanPrescription Drug Program. From the homepage, http://www.cs.state.ny.us, select either Employees or Retirees and follow the links to Health Benefits. Select your group andbenefit plan if prompted. On the resulting NYS Online health benefits page, select “Using Your Benefits” and scroll down to the 2008 Empire Plan Preferred Drug List.

Source: http://www.nysomce.org/pdf/Empire%202008%20preferred%20drug%20list-alpha.pdf