2019 STANDARD ALTERNATIVE DRUG LIST (July - …

1 2019 STANDARD ALTERNATIVE drug LIST. (October - December 2019). (50 or Less Employees). The alternatives listed are suggestions based on how the drug works and the condition it treats. You should discuss your therapy with you doctor or health care provider. Some alternatives may require prior authorization or have quantity limits. Product Name ALTERNATIVE drug . 7 TOPIC EMU Epiceram, Prumyx ABILIFY MYCI TAB aripiprazole tab ABSORICA CAP Claravis, Myorisan, Zenatane ACTOPLUS MET TAB XR metformin/ER, pioglitazone ACUVAIL SOL ketorolac ophthalmic ADLYXIN INJ Byetta, Bydureon, Victoza, Trulicity, Ozempic ADVANCED MIS AM/PM Dialyvite tablets, Dialyvite Supreme D, Triphrocaps, Virt-Caps ADVICOR TAB niacin / simvastatin AEMCOLO TAB Xifaxan AFREZZA POW Humulin/Humalog Products ALBUTEROL AER HFA Ventolin HFA, Proair HFA.

2 ALCORTIN A GEL oxiconazole cream, ketoconazole, hydrocortisone valerate ALDACTAZIDE TAB spironolactone-HCTZ, amlodipine-valsartan-HCTZ, atenolol-chlorthalidone, benazepril-HCTZ. ALEVICYN SOL DERMAL doxepin cream, triamcinolone cream, mometasone cream ALOG/PIOGLIP TAB Januvia, pioglitazone, Janumet XR, Jentadueto ALOGLIPTIN/ TAB METFORM Janumet, Janumet XR, Jentadueto ALOQUIN GEL oxiconazole cream, ketoconazole, econzaole ALPHAGAN P SOL apraclonidine, brimonidine 1. Product Name ALTERNATIVE drug . ALREX SUS dexamethasone ophthalmic, prednisolone ophthalmic, triamcinolone ophthalmic AMICAR SOL aminocaproic acid, tranexamic acid AMRIX CAP cyclobenzaprine tablet ANALPRAM KIT ADVANCED hydrocortisone/pramoxine, hydrocortisone aloe ANALPRAM-HC LOT hydrocortisone/pramoxine, hydrocortisone aloe ANGELIQ TAB estradiol-norethindrone acetate tablets, Jinteli tablets ANTARA CAP fenofibrate, gemfibrozil APADAZ TAB hydrocodone/APAP, oxycodone, oxycodone/APAP.

3 APAP/CAFFEIN TAB DIHYDROC butalbital-APAP-caffeine-codeine, APAP-codeine AQUORAL AER Magic Mouthwash, Lidocaine 2%, Mouth Kote AQUORAL SPR Magic Mouthwash, Lidocaine 2%, Mouth Kote ARIKAYCE SUS amikacin sulfate solution ARNUITY ELPT INH Asmanex, Flovent, QVAR Redihaler ARYMO ER TAB morphine ER tab, morphine ER cap, oxymorphone ER. ASTAGRAF XL CAP tacrolimus, Prograf ATOPADERM CRE Hylatopic Plus, HPR Plus, Neosalus ATROVENT HFA AER Ipratropium AUVI-Q INJ EpiPen, epinephrine solution auto-injector AVAILNEX CHW Nortuss-Ex liquid AVAR LS PAD sulfacetamide sodium w/ sulfur pad 10-4%.

4 AZASAN TAB azathioprine, cyclosporine, mycophenolate, tacrolimus AZELEX CRE adapalene, clindamycin, tretinoin AZENASE PAK MIS azelastine nasal spray, fluticasone nasal spray, budesonide nasal spray AZESCO TAB 13-1MG Prenatal Plus, Protect Plus 2. Product Name ALTERNATIVE drug . BASAGLAR INJ Lantus, Toujeo BECONASE AQ SUS fluticasone nasal spray BENSAL HP OIN ketoconazole, econzaole, topical corticosteroids BENZHY/ACETA TAB hydrocodone/APAP, oxycodone, oxycodone/APAP. BENZIQ GEL benzoyl peroxide gel (4%, 8%).

5 BENZIQ LS GEL benzoyl peroxide gel (4%, 8%). BEVESPI AER Anoro Ellipta BIDIL TAB isosorbide, hydralazine BIFERARX TAB iron asp gly/polysacch compl/ascorb CAL/b12/fa/c B-SERENE PAD folbic, ondansetron BUNAVAIL MIS buprenorphine/naloxone BUPAP TAB butalbital-acetaminophen 50-325mg BUTISOL SOD TAB zolpidem, zaleplon BUTRANS DIS buprenorphine TD patch BYVALSON TAB amlodipine/valsartan, telmisartan/amlodipine, trandolapril, verapamil CAMPHOMEX SPR diclofenac topical CARDIZEM LA TAB diltiazem SR. CARDURA XL TAB alfuzosin, tamsulosin, doxazosin CEQUA SOL Restasis, Xiidra CETACAINE AER lidocaine, lidocaine-tetracaine, lidocaine-prilocaine CHLORZOXAZON 250MG TAB CHLORZOXAZONE TAB 500 MG.

6 CLARINEX SYP levocetirizine, desloratadine CLIMARA PRO DIS WEEKLY estradiol once weekly patch, estradiol twice-weekly patch, estradiol tablets CLINDAGEL GEL adapalene, clindamycin, tretinoin 3. Product Name ALTERNATIVE drug . CLINDESSE CRE clindamycin vaginal cream, metronidazole vaginal gel COLYTE/FLAVR SOL PACKS Gavilyte-G, Gavilyte-C, PEG-3350. CONDYLOX GEL podofilox solution CONZIP CAP tramadol, tramadol ER tabs CORDRAN CRE betamethasone dipropionate, mometasone, hydrocortisone valerate CORDRAN TAP mometasone, triamcinolone, fluocinolone COREMINO TAB doxycycline, minocycline CORTIFOAM AER hydrocortisone, hydrocortisone/lidocaine, hydrocortisone/pramoxine, proctosol HC.

7 CORTISPORIN CRE mupirocin, fluocinolone acetate CYCLOMYDRIL SOL OP tropicamide, atropine DEPLIN CAP l-methylfolate tab 15mg, folbic DERMACINRX PAK DUOPATCH lidocaine, lidocaine-tetracaine, lidocaine-prilocaine DESONATE GEL mometasone, hydrocortisone valerate, fluocinolone DEXAMETHASON TAB prednisone, methylprednisolone, dexamethasone DEXPAK PAK prednisone, methylprednisolone, dexamethasone DIALYVITE TAB Dialyvite Supereme D, Nephron FA, Triphrocaps, Virt-caps DIALYVITE/ TAB ZINC Dialyvite Supereme D, Nephron FA, Triphrocaps, Virt-caps DICLEGIS TAB ondansetron, prochlorperzine, metoclopramide, promethazine DICLOVIX KIT diclofenac topical DIVIGEL GEL estradiol once weekly patch, estradiol twice-weekly patch, estradiol tablets DORYX MPC TAB DOXYCYCLINE HYCLATE TAB.

8 DOXYCYCL HYC TAB DR DOXYCYCLINE HYCLATE TAB. DOXYCYCLINE TAB HYCL ER doxycycline hyclate, doxycycline monohydrate DUEXIS TAB etodolac, diclofenac, ibuprofen, omeprazole 40mg, lansoprazole 30mg pantoprazole 20mg 4. Product Name ALTERNATIVE drug . DUOPA SUS carbidopa/levodopa DUTOPROL TAB atenolol/HCTZ. DVORAH TAB butalbital-APAP-caffeine-codeine, APAP-codeine DXEVO dexamethasone, prednisone DYMISTA SPR azelastine nasal spray, fluticasone nasal spray, budesonide nasal spray ECOZA AER ketoconazole, econazole EDLUAR SUB zolpidem, zaleplon, eszopiclone ELESTRIN GEL estradiol once weekly patch, estradiol twice-weekly patch, estradiol tablets ELFOLATE TAB PLUS l-methylfolate tab 15mg, folbic ELIGEN B12 TAB folbic EMEND SUS aprepitant oral capsule/therapy pack ENDOMETRIN SUP progesterone capsules.

9 Crinone ENTTY EMU SPRAY Epiceram, Prumyx EQUETRO CAP carbamazepine ER tab, risperidone, quetiapine ESCAVITE D CHW TRI-VIT/FL DRO , MVC-Fluoride CHW, Floriva Plus, Vitamax Pediatric ESCAVITE LQ DRO TRI-VIT/FL DRO , MVC-Fluoride CHW, Floriva Plus, Vitamax Pediatric ESTRING MIS estradiol tablets, Premarin vaginal cream ESTROGEL GEL estradiol once weekly patch, estradiol twice-weekly patch, estradiol tablets EVAMIST SPR estradiol once weekly patch, estradiol twice-weekly patch, estradiol tablets FABIOR AER Claravis, Myorisan, Zenatane FE PLUS TAB multi-vit/iron/fluoride, vinate care FEMRING MIS estradiol tablets, Premarin vaginal cream FENORTHO CAP naproxen, etodolac FERIVA TAB multi-vit/iron/fluoride, vinate care 5.

10 Product Name ALTERNATIVE drug . FERIVAFA CAP multi-vit/iron/fluoride, vinate care FLECTOR DIS meloxicam, ibuprofen, naproxen FLORIVA CHW TRI-VIT/FL DRO , MVC-Fluoride CHW, Floriva Plus, Vitamax Pediatric FLORIVA DRO TRI-VIT/FL DRO , MVC-Fluoride CHW, Floriva Plus, Vitamax Pediatric FOLGARD OS TAB multi-vit/iron/fluoride, Virt-Gard, Folbee, Folplex, CalciFol FOLIVANE-F CAP tri-vit/fluoride/iron, vitamins a/c/d/fluoride FOLVITE-D TAB Folbic, Vitamin D 50,000 units FOLTRATE TAB folbic FORFIVO XL TAB bupriopion, bupropion SR/XL.