2019 STANDARD ALTERNATIVE DRUG LIST (January - …

1 12019 STANDARD ALTERNATIVE drug LIST(October - December 2019)Product NameALTERNATIVE DRUG7 TOPIC EMUE piceram, PrumyxABILIFY MYCI TABaripiprazole tabABSORICA CAP Claravis, Myorisan, ZenataneACANYA GEL adapalene, clindamycin, tretinoinACTOPLUS MET TAB XR metformin/ER, pioglitazoneACUVAIL SOL ketorolac ophthalmicACZONE GEL adapalene, clindamycin, tretinoinADAZIN CRE lidocaine, lidocaine-tetracaine, lidocaine-prilocaineADLYXIN INJ Byetta, Bydureon, Ozempic, Trulicity, VictozaADVANCED MIS AM/PM BP Vit 3 PlusADVICOR TAB niacin / simvastatinAEMCOLO TAB XifaxanAEROSPAN AER Asmanex, Flovent, QVAR RediHalerAFREZZA POW Humulin/Humalog ProductsALA-QUIN CRE econazole, mupirocin, hydrocortisone valerateALBUTEROL AER HFAV entolin HFA, ProAir HFAALCORTIN A GEL oxiconazole cream, ketoconazole, hydrocortisone valerateALDACTAZIDE TAB spironolactone-HCTZ, amlodipine-valsartan-HCTZ, atenolol-chlorthalidone, benazepril-HCTZThe alternatives listed are suggestions based on how the drug works and the condition it treats.

2 You should discuss your therapy with your doctor of health care provider. Some alternatives may require prior authorization or have quantity NameALTERNATIVE DRUGALEVICYN SOL DERMAL doxepin cream, triamcinolone cream, mometasone creamALLZITAL TAB butalbital/acetaminophen tablet 50-325MG ALOCRIL SOL cromolyn, ketotifenALOG/PIOGLIP TAB Janumet, Janumet XR, JentaduetoALOG/PIOGLIT TAB Janumet, Janumet XR, JentaduetoALOGLIPTIN TAB Januvia, TradjentaALOGLIPTIN/ TAB METFORM Janumet, Janumet XR, JentaduetoALOQUIN GEL oxiconazole cream, ketoconazole, econzaoleALORA DIS estradiol once weekly patch, estradiol twice-weekly patch.

3 Estradiol tabletsALREX SUS dexamethasone ophthalmic, prednisolone ophthalmic, triamcinolone ophthalmicALTABAX OIN mupirocinALTOPREV TAB ER lovastatinALVESCO AER Asmanex, Flovent, QVAR RediHalerAMICAR SOL aminocaproic acid, tranexamic acidAMICAR TAB aminocaproic acid, tranexamic acidAMRIX CAP cyclobenzaprine tablet ANACAINE OIN lidocaine, lidocaine-tetracaineANADROL-50 TAB Procrit, EpogenANALPRAM E KIT hydrocortisone/pramoxine, hydrocortisone aloeANALPRAM KIT ADVANCED hydrocortisone/pramoxine, hydrocortisone aloeANALPRAM-HC LOT hydrocortisone/pramoxine, hydrocortisone aloeANGELIQ TAB estradiol-norethindrone acetate tablets, Jinteli tabletsANTARA CAP fenofibrate, gemfibrozilAPADAZ TABhydrocodone/APAP, oxycodone, oxycodone/APAP, morphine sulfate ERAPAP/CAFFEIN TAB DIHYDROC butalbital-APAP-caffeine-codeine, APAP-codeine3 Product NameALTERNATIVE DRUGAPIDRA INJ SOLOSTAR Humulin/Humalog ProductsAPIDRA INJ U-100 Humulin/Humalog ProductsAQUORAL AER Magic Mouthwash, Lidocaine 2%, Mouth KoteAQUORAL SPR Magic Mouthwash, Lidocaine 2%, Mouth KoteARCAPTA CAP SereventARIKAYCE SUSamikacin sulfate solutionARNUITY ELPT INH Asmanex, Flovent.

4 QVAR RediHalerARYMO ER TAB hydrocodone/APAP, oxycodone, oxycodone/APAP, morphine sulfate ERASTAGRAF XL CAP tacrolimus, PrografATENDIA PAD lidocaine, lidocaine-tetracaine, lidocaine-prilocaineATOPADERM CREH ylatopic Plus, HPR Plus, NeosalusAUVI-Q INJ EpiPen, epinephrine solution auto-injectorAVAILNEX CHW Nortuss-Ex liquidAVANDIA TAB pioglitazoneAVAR AER sulfacetamide sodium w/ sulfur foam 10-5%AVAR LS AER sulfacetamide sodium w/ sulfur foam 10-5%AVAR LS PAD sulfacetamide sodium w/ sulfur pad 10-4%AVAR PAD sulfacetamide sodium w/ sulfur pad 10-4%AZASAN TAB azathioprine, cyclosporine, mycophenolate, tacrolimusAZASAN TAB MG azathioprine, cyclosporine, mycophenolate, tacrolimusAZASITE SOL bacitracin ointment ophthalmic, ciprofloxacin ophthalmicAZELEX CRE adapalene, clindamycin, tretinoinAZENASE PAK MIS azelastine nasal spray, fluticasone nasal spray, budesonide nasal sprayAZESCO TAB 13-1 MGPrenatal Plus, Protect PlusBASAGLAR INJ Lantus, Toujeo4 Product NameALTERNATIVE DRUGBECONASE AQ SUS fluticasone nasal sprayBELSOMRA TAB zolpidem, zaleplon, eszopicloneBENSAL HP OIN ketoconazole, econzaole, topical corticosteroidsBENZHY/ACETA TAB hydrocodone/APAP, oxycodone, oxycodone/APAP.

5 Morphine sulfate ERBENZIQ GEL benzoyl peroxide gel (4%, 8%)BENZIQ LS GEL benzoyl peroxide gel (4%, 8%)BEPREVE DRO azelastine, ketotifen, olopatadineBESIVANCE SUS ciprfloxacin ophthalmic, ofloxacin ophthalmic BIDIL TAB isosorbide, hydralazineBIFERARX TAB iron asp gly/polysacch compl/ascorb CAL/b12/fa/cBIONECT AER hyaluronate sodium cream/gelBIO-STATIN CAP nystatin tabBP VIT CAP PLUS folbicBRINTELLIX TAB paroxetine, fluoxetine, escitalopramBROVANA NEB SereventB-SERENE PAD folbic, ondansetronBUNAVAIL MIS buprenorphine/naloxoneBUPAP TAB butalbital/acetaminophen tablet 50-325MG BUTISOL SOD TAB zolpidem, zaleplon, eszopicloneBUTRANS DIS morphine sulfate ERBYSTOLIC TAB atenolol.

6 Betaxolol, bisoprolol, carvedilol, metoprolol, timololBYVALSON TAB amlodipine/valsartan, telmisartan/amlodipine, trandolapril, verapamilCAMPHOMEX SPR diclofenac topicalCAPEX SHA fluocinolone oil/solutionCAPITAL/COD SUS acetaminophen/codeine sol 120-12/55 Product NameALTERNATIVE DRUGCARAFATE SUS sucralfateCARDIZEM LA TAB diltiazem SRCARDURA XL TAB alfuzosin, tamsulosin, doxazosin, terazosinCENFOL TAB folbicCEQUA SOLR estasis, XiidraCETACAINE AER lidocaine, lidocaine-tetracaine, lidocaine-prilocaineCIALIS TAB Sildenafil 25mg, 50mg, 100mg, tadalafil , 5mgCIFEREX CAP Vitamin D 50,000 units and FolbicCLIMARA PRO DIS WEEKLY estradiol once weekly patch, estradiol twice-weekly patch, estradiol tabletsCLINDAGEL GEL adapalene, clindamycin, tretinoinCLINDESSE CRE clindamycin vaginal cream, metronidazole vaginal gelCODAR AR LIQ hydrocodone-chlorpheniramine suspensionCOLY-MYCIN S SUS OTIC Cipro HC OticCOLYTE/FLAVR SOL PACKS Gavilyte-G, Gavilyte-C, PEG-3350 COMBIGAN SOL dorzolamide/timolol ophthalmicCONDYLOX GEL podofilox solutionCONZIP CAPtramadolCORDRAN TAP mometasone, triamcinolone, fluocinoloneCORDRAN CRE betamethasone dipropionate, mometasone.

7 Hydrocortisone valerateCORDRAN LOT betamethasone dipropionate, mometasone, hydrocortisone valerateCORDRAN OIN betamethasone dipropionate, mometasone, hydrocortisone valerateCOREMINO TABdoxycycline, minocyclineCORTANE-B LOT pramoxine-HC cream AER hydrocortisone, hemril-30, hydrocortisone/lidocaine, hydrocortisone/pramoxine, proctosol HCCORTISPORIN CRE mupirocin, fluocinolone acetate6 Product NameALTERNATIVE DRUGCYCLOMYDRIL SOL OP tropicamide, atropineDEBACTEROL SOL Episil, triamcinolone oral pasteDENAVIR CRE acyclovir ointment, famciclovir, valacyclovirDEPLIN CAP l-methylfolate tab 15mg, folbicDERMACINRX PAK DUOPATCH lidocaine, lidocaine-tetracaine, lidocaine-prilocaineDERMASORB HC KIT hydrocortisone cream, lotionDERMASORB TA KIT triamcinoloneDESONATE GEL mometasone, hydrocortisone valerate, fluocinoloneDEXAMETHASON TAB PAKprednisone, methylprednisolone, dexamethasoneDEXILANT CAP DR omeprazole 40mg, lansoprazole 30mg pantoprazole 20, 40mg, rabeprazole 20mgDEXPAK PAKprednisone, methylprednisolone, dexamethasoneDIALYVITE TAB 3000 Dialyvite tablets, Dialyvite Supreme D, Nephronex, Triphrocaps, Virt-CapsDIALYVITE TAB 5000 Dialyvite tablets, Dialyvite Supreme D, Nephronex.

8 Triphrocaps, Virt-CapsDIALYVITE/ TAB ZINC Dialyvite tablets, Dialyvite Supreme D, Nephronex, Triphrocaps, Virt-CapsDICLEGIS TAB ondansetron, prochlorperzine, metoclopramide, promethazineDICLOVIX KITdiclofenac topicalDIVIGEL GEL estradiol once weekly patch, estradiol twice-weekly patch, estradiol tabletsDORYX MPC TAB DOXYCYCLINE HYCLATE TAB DOXYCYCLINE TAB HYCL ERdoxycycline hyclate, doxycycline monohydrateDUEXIS TAB etodolac, diclofenac, ibuprofen, omeprazole 40mg, lansoprazole 30mg pantoprazole 20mgDUOPA SUS carbidopa/levodopaDUREZOL EMU fluorometholone susp DURLAZA CAP clopidogrel, prasugrelDUTOPROL TAB atenolol/HCTZDVORAH TABbutalbital-APAP-caffeine-codeine, APAP-codeine7 Product NameALTERNATIVE DRUGDXEVO PAKdexamethasone, prednisoneDYMISTA SPR azelastine nasal spray, fluticasone nasal spray, budesonide nasal sprayECOZA AER ketoconazole, econazoleEDLUAR SUB zolpidem, zaleplon, eszopicloneELESTRIN GEL estradiol once weekly patch, estradiol twice-weekly patch, estradiol tabletsELFOLATE TAB PLUS l-methylfolate tab 15mg, folbicELIDEL CRE tacrolimusELIGEN B12 TAB folbicELMIRON CAP amitriptyline, cimetidine.

9 Hydroxyzine EMBEDA CAP morphine sulfate EREMEND SUS aprepitant oral capsule/therapy packEMSAM DIS sertraline, escitalopram, venlafaxine ERENDOMETRIN SUP progesterone capsules, CrinoneENSTILAR AER mometasone, hydrocortisone valerate, fluocinoloneENTTY EMU SPRAYE piceram, PrumyxEPIDUO FORTE GEL adapalene, clindamycin, tretinoinEPIDUO GEL adapalene, clindamycin, tretinoinEPIFOAM AER pramoxine-HC cream CAP risperidone, quetiapine, carbamazepine ER tabletERTACZO CRE oxiconazole cream, ketoconazole, econzaoleESCAVITE D CHW TRI-VIT/FL DRO , MVC-Fluoride CHW, Floriva Plus, Vitamax PediatricESCAVITE LQ DRO TRI-VIT/FL DRO , MVC-Fluoride CHW, Floriva Plus, Vitamax PediatricESOMEPRAZOLE CAP omeprazole 40mg, lansoprazole 30mg pantoprazole 20, 40mg, rabeprazole 20mgESTRACE VAG CRE estradiol tablets, Premarin vaginal creamE