Currentformulary

VICTRELIS
ANTI-AMEBIC, ANTIHELMINTHIC & ANTIPROTOZOAL STROMECTOL
NEBUPENT
BILTRICIDE
TINDAMAX
DIFLUCAN
SPORANOX
SPORANOX
SPORANOX SOLUTION
NOXAFIL SUSPENSION
LAMISIL ORAL GRANULES
SYMMETREL
FLUMADINE
PRIMAQUINE
MALARONE
DARAPRIM
QUALAQUIN
COMBINATION
EPZICOM
TRIZIVIR
Generics should be considered first line of prescribing. In the event a generic becomes available for any brand, the brand will no longer be considered preferred. This drug list is not inclusive nor does it guarantee coverage, but represents a summary of prescription drug coverage. The participant's specific drug benefit plan may have a different co-pay for specific products on this list. Products and specific dosage forms may or may not be covered depending on your plan. Changes to the formulary can occur at any time.
COMPLERA
COMBIVIR
OTHER
SELZENTRY
ISENTRESS
PROTEASE INHIBITOR
REYATAZ
PREZISTA
CRIXIVAN
VIRACEPT
INVIRASE
REVERSE TRANSCRIPTASE INHIBITOR
VIDEX DELAYED RELEASE
RESCRIPTOR
VIDEX SOLUTION
INTELENCE
EPIVIR SOLN
EPIVIR-HBV
VIRAMUNE
SEROMYCIN
TRECATOR
TRECATOR
MYCOBUTIN
RIFAMATE
VIRAZOLE
BARACLUDE
Generics should be considered first line of prescribing. In the event a generic becomes available for any brand, the brand will no longer be considered preferred. This drug list is not inclusive nor does it guarantee coverage, but represents a summary of prescription drug coverage. The participant's specific drug benefit plan may have a different co-pay for specific products on this list. Products and specific dosage forms may or may not be covered depending on your plan. Changes to the formulary can occur at any time.
REBETOL ORAL SOLUTION
SYLATRON
INTRON-A
INFERGEN
PEG-INTRON
ZITHROMAX
ERYTHROCIN
EES GRANULES, ERYPED
ERYTHROMYCIN FILMTAB
FURADANTIN, MACROBID, MARC
LINCOCIN
XIFAXAN 550MG
VANCOCIN CAPSULES
AUGMENTIN
AUGMENTIN SUSP 125/5
BICILLIN LA
BICILLIN CR
LEVAQUIN
Generics should be considered first line of prescribing. In the event a generic becomes available for any brand, the brand will no longer be considered preferred. This drug list is not inclusive nor does it guarantee coverage, but represents a summary of prescription drug coverage. The participant's specific drug benefit plan may have a different co-pay for specific products on this list. Products and specific dosage forms may or may not be covered depending on your plan. Changes to the formulary can occur at any time.
CIPRO SUSP
CEFTIN SUSP 250/5
VIBRAMYCIN
FURADANTIN SUSP
VIVAGLOBIN
ARCALYST
ACTIMMUNE
COUMADIN
COUMADIN
LOVENOX 300MG/3ML
Generics should be considered first line of prescribing. In the event a generic becomes available for any brand, the brand will no longer be considered preferred. This drug list is not inclusive nor does it guarantee coverage, but represents a summary of prescription drug coverage. The participant's specific drug benefit plan may have a different co-pay for specific products on this list. Products and specific dosage forms may or may not be covered depending on your plan. Changes to the formulary can occur at any time.
AGGRENOX
BRILINTA
IPRIVASK
AMICAR 1000MG
PRINVIL, ZESTRIL
PRINZIDE, ZESTORETIC
ACCUPRIL
ACCURETIC
LOTREL 5/40, 10/40
ANGIOTENSIN II RECEPTOR BLOCKER & COMBINATION VALTURNA
EXFORGE HCT
EDARBI, EDARBYCLOR
ATACAND HCT
TEVETEN HCT
BENICAR HCT
MICARDIS
MICARDIS HCT
DIOVAN HCT
HMG-COA REDUCTASE INHIBITOR
LIPITOR
PRAVACHOL
Generics should be considered first line of prescribing. In the event a generic becomes available for any brand, the brand will no longer be considered preferred. This drug list is not inclusive nor does it guarantee coverage, but represents a summary of prescription drug coverage. The participant's specific drug benefit plan may have a different co-pay for specific products on this list. Products and specific dosage forms may or may not be covered depending on your plan. Changes to the formulary can occur at any time.
LESCOL XL
ALTOPREV
OTHER
QUESTRAN
FENOGLIDE
TRIGLIDE
TRILIPIX
PACERONE 100MG
BETA-ADRENERGIC BLOCKER & COMBINATION TENORMIN
LOPRESSOR
TOPROL XL
BYSTOLIC
CALCIUM CHANNEL BLOCKER & COMBINATIONS CARDIZEM, DILACOR, TIAZAC
ADALAT, PROCARDIA
CALAN SR, COVERA HS
CARDIZEM LA
MICROZIDE
ZAROXOLYN
ALDACTONE
ALDACTAZIDE
Generics should be considered first line of prescribing. In the event a generic becomes available for any brand, the brand will no longer be considered preferred. This drug list is not inclusive nor does it guarantee coverage, but represents a summary of prescription drug coverage. The participant's specific drug benefit plan may have a different co-pay for specific products on this list. Products and specific dosage forms may or may not be covered depending on your plan. Changes to the formulary can occur at any time.
TEKTURNA
AMTURNIDE
TEKTURNA HCT
CLORPRES
TRIBENZOR
RESERPINE
DIBENZYLINE
DILATRATE-SR
NITRO-BID OINT
NITROLINGUAL SPRAY
VENTAVIS
EXELON SUSP/PATCH
ONSOLIS BUCCAL TAB
DILAUDID LIQUID
DEMEROL SOLN
MORPHINE SOLN
MORPHINE SUPP
OXYCONTIN
Generics should be considered first line of prescribing. In the event a generic becomes available for any brand, the brand will no longer be considered preferred. This drug list is not inclusive nor does it guarantee coverage, but represents a summary of prescription drug coverage. The participant's specific drug benefit plan may have a different co-pay for specific products on this list. Products and specific dosage forms may or may not be covered depending on your plan. Changes to the formulary can occur at any time.
TEGRETOL/XR
DEPAKOTE/ER/SPRINKLE
PEGANONE
FELBATOL
LAMICTAL CHEWABLE 2MG
LAMICTAL ODT
LAMICTAL XR/STARTER KIT
CELONTIN
TRILEPTAL
DILANTIN/CHEWABLE/SUSP
GABITRIL
DEPAKENE
OTHER
WELLBUTRIN
WELLBUTRIN SR
CYMBALTA
VENLAFAXINE ER
SELECTIVE SEROTONIN REUPTAKE INHIBITOR (SSRI)
CELEXA
PAXIL SUSP
SEROTONIN NOREPIHEPHRINE REUPTAKE INHIBITOR (SNRI)
DESYREL
EFFEXOR XR
EFFEXOR XR
TRICYCLIC
ELAVIL
SURMONTIL
MIRAPEX ER
REQUIP XL
Generics should be considered first line of prescribing. In the event a generic becomes available for any brand, the brand will no longer be considered preferred. This drug list is not inclusive nor does it guarantee coverage, but represents a summary of prescription drug coverage. The participant's specific drug benefit plan may have a different co-pay for specific products on this list. Products and specific dosage forms may or may not be covered depending on your plan. Changes to the formulary can occur at any time.
SEROQUEL
CLOZARIL 200MG
ZYPREXA ZYDIS
SEROQUEL XR
TRANSDERM SCOP
FOCALIN XR
STRATERRA
CONCERTA
DAYTRANA
METADATE CD
AMBIEN CR
COPAXONE
BETASERON
SUBOXONE TAB/FILM
Generics should be considered first line of prescribing. In the event a generic becomes available for any brand, the brand will no longer be considered preferred. This drug list is not inclusive nor does it guarantee coverage, but represents a summary of prescription drug coverage. The participant's specific drug benefit plan may have a different co-pay for specific products on this list. Products and specific dosage forms may or may not be covered depending on your plan. Changes to the formulary can occur at any time.
NUEDEXTA
PROVIGIL
PROSTIGMIN
MESTINON SYRUP
MESTINON TIMESPAN
XENAZINE
METHERGINE
ERGOMAR SUBL
MIGERGOT SUPP
TREXIMET
MAXALT, MAXALT MLT
IMITREX INJ KIT
IMITREX NASAL SPRAY
ZOMIG, ZOMIG ZMT
SORIATANE CK KIT
PANRETIN
FINACEA PLUS
REGRANEX
CARAC, FLUOROPLEX
FLUOROPLEX
LIDODERM
LIDAMANTLE HC PADS
BENZACLIN, DUAC
BENZAMYCIN
DIFFERIN
Generics should be considered first line of prescribing. In the event a generic becomes available for any brand, the brand will no longer be considered preferred. This drug list is not inclusive nor does it guarantee coverage, but represents a summary of prescription drug coverage. The participant's specific drug benefit plan may have a different co-pay for specific products on this list. Products and specific dosage forms may or may not be covered depending on your plan. Changes to the formulary can occur at any time.
ZODERM 4.5% CREAM
ROSULA NS
BACTROBAN OINT
BACTROBAN CRM
OVACE PLUS CREAM
OVACE PLUS SHAMPOO
DRITHOSCALP, PSORIATEC
DOVONEX CREAM
VECTICAL
OXSORALEN
SEB-PREV
CARMOL SCALP
ZOVIRAX CRM, OINT
CAPEX SHAMPOO
CORDRAN TAPE
LOCOID LIPOCREAM/LOTION
PROTOPIC
Generics should be considered first line of prescribing. In the event a generic becomes available for any brand, the brand will no longer be considered preferred. This drug list is not inclusive nor does it guarantee coverage, but represents a summary of prescription drug coverage. The participant's specific drug benefit plan may have a different co-pay for specific products on this list. Products and specific dosage forms may or may not be covered depending on your plan. Changes to the formulary can occur at any time.
CONDYLOX GEL
SOLARAZE GEL 3%
ANALPRAM-HC
CORTIFOAM
PROCTOFOAM-HC
NYSTATIN VAGINAL TABLETS
CLINDESSE
VANDAZOLE
ACCU-CHEK
ONE TOUCH
ACCU-CHEK LANCETS
BD ALCOHOL SWABS
BD LANCETS/DEVICE
BD PEN NEEDLES
BD SYRINGES
NOVOFINE SYRINGES
ONE TOUCH LANCETS
ACCU-CHEK
ONE TOUCH
CIPRODEX
ANTIHISTAMINE
Generics should be considered first line of prescribing. In the event a generic becomes available for any brand, the brand will no longer be considered preferred. This drug list is not inclusive nor does it guarantee coverage, but represents a summary of prescription drug coverage. The participant's specific drug benefit plan may have a different co-pay for specific products on this list. Products and specific dosage forms may or may not be covered depending on your plan. Changes to the formulary can occur at any time.
CORTICOSTEROID
RHINOCORT AQUA
VERAMYST
COMBINATION
METAGLIP
ACTOPLUS MET XR
PRANDIMET
ACTOPLUS MET
AVANDARYL
AVANDAMET
KOMBIGLYZE XR
JUVISYNC
DPP-4 INHIBITOR
ONGLYZA
TRADJENTA
INSULIN
LANTUS
NOVOLOG/PENFILL
NOVOLOG MIX/PENFILL
HUMALOG/PEN
HUMALOG MIX/PEN
HUMULIN/PEN
OTHER
AMARYL
GLUCOTROL
GLUCOTROL XL
GLUCOPHAGE
GLUCOPHAGE
GLUCAGON/GLUCAGEN
SYMLINPEN
THIAZOLIDINEDIONE
ACTOS
FORTICAL, MIACALCIN
ACTONEL 30MG
FOSAMAX SOLUTION
Generics should be considered first line of prescribing. In the event a generic becomes available for any brand, the brand will no longer be considered preferred. This drug list is not inclusive nor does it guarantee coverage, but represents a summary of prescription drug coverage. The participant's specific drug benefit plan may have a different co-pay for specific products on this list. Products and specific dosage forms may or may not be covered depending on your plan. Changes to the formulary can occur at any time.
FOSAMAX PLUS D
MIACALCIN INJ
INCRELEX
SOMAVERT
PROTROPIN
GENOTROPIN
HUMATROPE
NORDITROPIN
NUTROPIN
NUTROPIN AQ
OMNITROPE
SEROSTIM
TEV-TROPIN
FABRAZYME
NAGLAZYME
ELAPRASE
CEREZYME
ALDURAZYME
TESTRED, ANDROID
SENSIPAR
SYNTHROID
SYNTHROID
ARMOUR THYROID
THYROLAR
PROPANTHELINE
LOTRONEX
LEVBID, LEVSINEX
LEVSIN, LEVSIN SL
Generics should be considered first line of prescribing. In the event a generic becomes available for any brand, the brand will no longer be considered preferred. This drug list is not inclusive nor does it guarantee coverage, but represents a summary of prescription drug coverage. The participant's specific drug benefit plan may have a different co-pay for specific products on this list. Products and specific dosage forms may or may not be covered depending on your plan. Changes to the formulary can occur at any time.
RELISTOR
HALFLYTELY
AZULFIDINE EN
PANCREAZE
ULTRASE MT, VIOKASE
GASTROCROM
KRISTALOSE PACKET
CARAFATE SUSP
PREVACID
PRILOSEC
PROTONIX
DEXILANT
NEXIUM, NEXIUM GRANULES
PROMACTA
NEUPOGEN
NEULASTA
Generics should be considered first line of prescribing. In the event a generic becomes available for any brand, the brand will no longer be considered preferred. This drug list is not inclusive nor does it guarantee coverage, but represents a summary of prescription drug coverage. The participant's specific drug benefit plan may have a different co-pay for specific products on this list. Products and specific dosage forms may or may not be covered depending on your plan. Changes to the formulary can occur at any time.
FIRMAGON
ZORTRESS
FASLODEX
SUPPRELIN LA
REMICADE
LYSODREN
NILANDRON
VOTRIENT
FARESTON
CAPRESLA
ZELBORAF
ARIMIDEX
TARGRETIN
LEUKERAN
AROMASIN
REVLIMID
MATULANE
THALOMID
HYCAMTIN
Generics should be considered first line of prescribing. In the event a generic becomes available for any brand, the brand will no longer be considered preferred. This drug list is not inclusive nor does it guarantee coverage, but represents a summary of prescription drug coverage. The participant's specific drug benefit plan may have a different co-pay for specific products on this list. Products and specific dosage forms may or may not be covered depending on your plan. Changes to the formulary can occur at any time.
SANDIMMUNE ORAL
AFINITOR
CUPRIMINE, DEPEN
CYCLOSPORINE
CELLCEPT SUSP
MYFORTIC
RAPAMUNE
PROLASTIN
CARBAGLU
HIZENTRA
SOMATULINE
BUPHENYL
SANDOSTATIN LAR DEPOT
NICOTROL INHALER
NICOTROL NASAL SPRAY
ZYLOPRIM
KRYSTEXXA
Generics should be considered first line of prescribing. In the event a generic becomes available for any brand, the brand will no longer be considered preferred. This drug list is not inclusive nor does it guarantee coverage, but represents a summary of prescription drug coverage. The participant's specific drug benefit plan may have a different co-pay for specific products on this list. Products and specific dosage forms may or may not be covered depending on your plan. Changes to the formulary can occur at any time.
NAPROSYN
CELEBREX
FLEXERIL
ZANAFLEX
SKELAXIN
FOSRENOL
CEREFOLIN
HECTOROL
DEXFERRUM
MEPHYTON
REPLIVA 21/7
ANDRODERM
ANDROGEL
SPRINTEC, ORTHO-CYCLEN
LOSEASONIQUE
SEASONIQUE, NORDETTE, AVIAN
GIANVI, OCELLA, YASMIN, YAZ
YASMIN 28
ORTHO EVRA
FEMCON FE, FEMHRT
ORTHO TRI-CYCLEN LO
NUVARING
LOESTRIN/FE
LO LOESTRIN FE
Generics should be considered first line of prescribing. In the event a generic becomes available for any brand, the brand will no longer be considered preferred. This drug list is not inclusive nor does it guarantee coverage, but represents a summary of prescription drug coverage. The participant's specific drug benefit plan may have a different co-pay for specific products on this list. Products and specific dosage forms may or may not be covered depending on your plan. Changes to the formulary can occur at any time.
DEPO-PROVERA 400MG/ML
ORAL
ESTRACE
CENESTIN
PREMARIN
TOPICAL
FEMRING
PREMARIN VAGINAL CRM
TRANSDERMAL
CLIMARA
ESTRADERM
VIVELLE-DOT
ACTIVELLA
COMBIPATCH
PREMPHASE
CETROTIDE
FOLLISTIM AQ
REPRONEX
BRAVELLE
MYTELASE
CLEOCINVAGINAL CRM/SUPP
ALL PRENATAL VITAMINS
PROVERA, DEPO-PROVERA
CRINONE, PROCHIEVE
PROMETRIUM
Generics should be considered first line of prescribing. In the event a generic becomes available for any brand, the brand will no longer be considered preferred. This drug list is not inclusive nor does it guarantee coverage, but represents a summary of prescription drug coverage. The participant's specific drug benefit plan may have a different co-pay for specific products on this list. Products and specific dosage forms may or may not be covered depending on your plan. Changes to the formulary can occur at any time.
ALPHAGAN P 0.1%
ALPHAGAN P
LASTACAFT
MAXITROL
BESIVANCE
CILOXAN OINT
TOBREX OINTMENT
ANTI-INFECTIVE & CORTICOSTEROID COMBO BLEPHAMIDE
TOBRADEX ST EYE DROP
TOBRADEX OINT
RETISERT
FML S.O.P 0.1% OINT
PRED MILD
ALPHAGAN P
BETOPTIC S
ISOPTO CARBACHOL
PHOSPHOLINE IODIDE
PILOPINE H.S.
TRAVATAN, TRAVATAN Z
Generics should be considered first line of prescribing. In the event a generic becomes available for any brand, the brand will no longer be considered preferred. This drug list is not inclusive nor does it guarantee coverage, but represents a summary of prescription drug coverage. The participant's specific drug benefit plan may have a different co-pay for specific products on this list. Products and specific dosage forms may or may not be covered depending on your plan. Changes to the formulary can occur at any time.
CYCLOGYL 0.5%, 2%
RESTASIS
LACRISERT
LUCENTIS
ASTELIN, ASTEPRO
CLARINEX
ALLEGRA SUSP
ANTIHISTAMINE & DECONGESTANT COMBINATION CLARINEX-D
LONG ACTING
FORADIL
PERFOROMIST
SEREVENT
SHORT ACTING
VENTOLIN HFA
PROAIR HFA
XOPENEX / HFA
MAXAIR AUTOHALER
SYMBICORT
COMBIVENT
PULMICORT
NASALIDE
NASACORT AQ
PULMICORT 1MG/2ML
PULMICORT FLEXHALER
NASACORT AQ
Generics should be considered first line of prescribing. In the event a generic becomes available for any brand, the brand will no longer be considered preferred. This drug list is not inclusive nor does it guarantee coverage, but represents a summary of prescription drug coverage. The participant's specific drug benefit plan may have a different co-pay for specific products on this list. Products and specific dosage forms may or may not be covered depending on your plan. Changes to the formulary can occur at any time.
TUSSICAPS
ACCOLATE
SINGULAIR
EPIPEN, EPIPEN JR
BERINERT
LUFYLLIN
EPHEDRINE SULFATE
ATROVENT HFA
DALIRESP
ELIXOPHYLLIN ELIXIR
SPIRIVA HANDIHALER
PULMOZYME
REMODULIN
LETAIRIS
TRACLEER
VENTAVIS
STAXYN, LEVITRA
CAVERJECT
Generics should be considered first line of prescribing. In the event a generic becomes available for any brand, the brand will no longer be considered preferred. This drug list is not inclusive nor does it guarantee coverage, but represents a summary of prescription drug coverage. The participant's specific drug benefit plan may have a different co-pay for specific products on this list. Products and specific dosage forms may or may not be covered depending on your plan. Changes to the formulary can occur at any time.
LITHOSTAT
CYSTADANE
RENACIDIN
citric acid/sodium citratre/potassium citr CYSTAGON
URIBEL, PHOSPHASAL
K-PHOS M.F., K-PHOS NO. 2
K-PHOS NEUTRAL
DITROPAN
DITROPAN XL
SANCTURA
GELNIQUE
VESICARE
DETROL LA
SANCTURA XR
Generics should be considered first line of prescribing. In the event a generic becomes available for any brand, the brand will no longer be considered preferred. This drug list is not inclusive nor does it guarantee coverage, but represents a summary of prescription drug coverage. The participant's specific drug benefit plan may have a different co-pay for specific products on this list. Products and specific dosage forms may or may not be covered depending on your plan. Changes to the formulary can occur at any time.

Source: http://www.southernscripts.net/SS_Formulary042012.pdf

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