Connecticut Medicaid Alphabetized Preferred Drug (PDL ...

1 Connecticut Medicaid Alphabetized Preferred Drug List (PDL). ** Available on **. (Navigate to Pharmacy Information > Preferred Drug List > PDL Alphabetical List ). Preferred Drug Brand Equivalent Preferred Drug Brand Equivalent ABILIFY DISCMELT, SOLUTION (ORAL) BENZTROPINE (ORAL) COGENTIN. ABILIFY MAINTENA ER (INTRAMUSC.) BETAMETHASONE DIPROPIONATE CREAM, LOTION (TOPICAL) DIPROSONE. ACARBOSE (ORAL) PRECOSE BETAMETHASONE VALERATE CREAM, OINT, LOTION (TOPICAL) VALISONE. ACETIC ACID (OTIC) VOSOL BETASERON KIT (SUBCUTANE.). ACITRETIN (ORAL) BETHKIS (INHALATION). ACYCLOVIR CAPSULE, TABLET (ORAL) ZOVIRAX BETOPTIC S (OPHTHALMIC). ACYCLOVIR SUSPENSION (ORAL) BEVESPI AEROSPHERE (INHALATION)*. ADASUVE (INHALATION) BEYAZ (ORAL). ADDERALL (ORAL) BICALUTAMIDE (ORAL) CASODEX.

2 ADDERALL XR (ORAL) BIFERA TABLET OTC (ORAL). ADVAIR DISKUS (INHALATION) BILTRICIDE (ORAL)*. AFINITOR (ORAL) (not DISPERZ) BLEPHAMIDE EYE DROPS (OPHTHALMIC). AGGRENOX (ORAL) BLISOVI FE 1/20, BLISOVI FE (ORAL). ALBENZA (ORAL)* BOSULIF (ORAL). ALBUTEROL NEB SOLN , , MG/3 ML (INHALATION) BOTOX (INTRAMUSC). ALBUTEROL NEB SOLN ML (INHALATION) BREO ELLIPTA (INHALATION)*. ALBUTEROL NEB SOLN 100 MG/20 ML (INHALATION) BRILINTA (ORAL). ALBUTEROL SOLUTION, SYRUP (ORAL) BRIMONIDINE (OPHTHALMIC) ALPHAGAN. ALBUTEROL SULFATE / IPRATROPIUM INHALATION SOLUTION DUONEB BROMOCRIPTINE (ORAL) PARLODEL. ALDARA (TOPICAL)* BUDESONIDE EC (ORAL) ENTOCORT EC. ALECENSA (ORAL) BUPRENORPHINE HCL TABLET (SUBLINGUAL). ALENDRONATE TABLETS (ORAL) FOSAMAX BUPROPION (ORAL) WELLBUTRIN.

3 ALFUZOSIN ER (ORAL) UROXATRAL BUPROPION SR, BUPROPION XL (ORAL) WELLBUTRIN XR. ALKERAN (ORAL) BUSPIRONE (ORAL) VANSPAR. ALLOPURINOL (ORAL) ZYLOPRIM BUTALBITAL / CAFFEINE / APAP W/CODEINE (ORAL) FIORICET W/CODEINE. ALPHAGAN P (OPHTHALMIC) BUTALBITAL / CAFFEINE / ASA W/CODEINE (ORAL) FIORINAL W/CODEINE. ALPRAZOLAM TABLET (IR) (ORAL) XANAX BYDUREON PEN, VIAL (SUBCUTANE.). ALREX (OPHTHALMIC) BYETTA DOSE PEN (SUBCUTANE.). ALTAVERA (ORAL) CABOMETYX (ORAL). ALYACEN 1/35 (ORAL) CALCIPOTRIENE OINTMENT, SOLUTION (TOPICAL) DOVONOX. AMANTADINE CAPSULE, SOLUTION (ORAL) SYMMETREL CALCITONIN-SALMON SPRAY (NASAL) FORTICAL. AMITIZA (ORAL) CALCIUM ACETATE CAPSULE, TABLET (ORAL) PHOSLO, CALPHRON. AMLODIPINE (ORAL) NORVASC CAMILA (ORAL). AMLODIPINE / BENAZEPRIL (ORAL) LOTREL CANASA (RECTAL).

4 AMLODIPINE / OLMESARTAN (ORAL) AZOR (ORAL) CAPEX SHAMPOO (TOPICAL). AMLODIPINE / VALSARTAN (ORAL) EXFORGE CAPRELSA (ORAL). AMLODAPINE / VALSARTAN / HCTZ (ORAL) EXFORGE HCT CAPSAICIN OTC (TOPICAL). AMMONIUM LACTATE CREAM/LOTION (TOPICAL) LAC-HYDRIN CARBAMAZEPINE ER CAPSULE, ER TABLET (ORAL) CARBATROL. AMOXICILLIN/CLAV CHEW TAB, SUSPENSION, TABLET (ORAL) AUGMENTIN CARBAMAZEPINE SUSPENSION, TAB CHEW, TABLET (ORAL) TEGRETOL. AMPHETAMINE SALT COMBO (IR) (ORAL) ADDERALL CARBIDOPA / LEVODOPA ER TABLET (ORAL). ANASTROZOLE (ORAL) CARBIDOPA / LEVODOPA TABLET, ODT (ORAL). ANDROGEL GEL PACKET, PUMP (TRANSDERM.) CARTEOLOL (OPHTHALMIC) OCUPRESS. ANORO ELLIPTA (INHALATION) CARVEDILOL (ORAL) COREG. APAP / CODEINE ELIXIR, TABLET (ORAL) TYLENOL W/ CODEINE CATAPRES-TTS (TRANSDERM).

5 APRI-28 (ORAL) CAYSTON (INHALATION). APRISO (ORAL) CAZIANT (ORAL). APTENSIO XR (ORAL)* CEFACLOR CAPSULE, SUSPENSION (ORAL) CECLOR. ARANELLE (ORAL) CEFADROXIL CAPSULE, SUSPENSION, TABLET (ORAL) DURICEF. ARANESP DISP SYRIN, VIAL (INJECTION) CEFDINIR CAPSULE, SUSPENSION (ORAL) OMNICEF. ARIPIPRAZOLE SOLUTION, TABLET (ORAL) ABILIFY CEFIXIME SUSPENSION (ORAL). ARISTADA (INTRAMUSC)* CEFPODOXIME SUSPENSION, TABLET (ORAL) VANTIN. ASMANEX TWISTHALER (INHALATION) CEFPROZIL SUSPENSION, TABLET (ORAL) CEFZIL. ATENOLOL (ORAL) TENORMIN CEFTIN SUSPENSION (ORAL). ATENOLOL / CHLORTHALIDONE (ORAL) TENORETIC CEFUROXIME TABLET (ORAL) CEFTIN. ATOMOXETINE (ORAL) STRATTERA CELONTIN (ORAL). ATORVASTATIN (ORAL) LIPITOR CENTRATEX (ORAL). ATROVENT HFA (INHALATION) CEPHALEXIN CAPSULE, SUSPENSION (ORAL) KEFLEX.

6 AUBAGIO (ORAL) CEPHALEXIN TABLET (ORAL). AVIANE-28 (ORAL) CETIRIZINE SOLUTION (ORAL) ZYRTEC. AVONEX ADMIN PACK, PEN, PREFILLED SYRINGE (INTRAMUSC.) CHANTIX TAB DS PK, TABLET (ORAL). AZATHIOPRINE (ORAL) IMURAN CHATEAL-28 (ORAL). AZELASTINE (generic ASTELIN) (NASAL)* ASTELIN CHLORDIAZEPOXIDE (ORAL). AZELEX (TOPICAL) CHLORPROMAZINE (ORAL) THORAZINE. AZITHROMYCIN PACKET, SUSPENSION (ORAL) ZITHROMAX CHLORZOXAZONE (ORAL) PARAFLEX. AZITHROMYCIN TABLET (ORAL) ZITHROMAX CHOLESTYRAMINE/ASPARTAME (ORAL) PREVALITE. AZOPT (OPHTHALMIC) CHOLESTYRAMINE/SUCROSE (ORAL) QUESTRAN. BACITRACIN-POLYMYXIN B SULFATE OINTMENT (OPTHALMIC) CIMETIDINE TABLET OTC (ORAL). BACLOFEN (ORAL) LIORESAL CIPRO SUSPENSION (ORAL). Page 1 of 6 Preferred brand-name medications with non- Preferred generic equivalents are listed in bold Updated: 4/4/2018.

7 Connecticut Medicaid Alphabetized Preferred Drug List (PDL). ** Available on **. (Navigate to Pharmacy Information > Preferred Drug List > PDL Alphabetical List ). Preferred Drug Brand Equivalent Preferred Drug Brand Equivalent CIPRODEX (OTIC) DILTIAZEM CAPSULE ER (ORAL). CIPROFLOXACIN (OTIC) DILTIAZEM TABLET (ORAL) CARDIZEM. CIPROFLOXACIN SOLUTION (OPHTHALMIC)* DIOVAN (ORAL). CIPROFLOXACIN TABLET (IR) (ORAL) CIPRO DIPYRIDAMOLE (ORAL) PERSANTINE. CITALOPRAM TABLET, SOLUTION (ORAL) CELEXA DIVALPROEX ER, DIVALPROEX SPRINKLE (ORAL) DEPAKOTE. CITRANATAL 90 DHA (ORAL) DIVALPROEX TABLET (ORAL). CITRANATAL ASSURE (ORAL) DONEPEZIL ODT (ORAL) ARICEPT ODT. CITRANATAL B-CALM (ORAL) DONEPEZIL TABLET (5MG &10MG) (ORAL) ARICEPT. CITRANATAL DHA (ORAL) DORZOLAMIDE (OPHTHALMIC) TRUSOPT.

8 CITRANATAL HARMONY CAPSULE (ORAL) DORZOLAMIDE / TIMOLOL (OPHTHALMIC) COSOPT. CLARITHROMYCIN ER (ORAL) DOTHELLE DHA (ORAL). CLARITHROMYCIN TABLET (ORAL) BIAXIN DOVONEX CREAM (TOPICAL). CLEOCIN OVULES (VAGINAL) DOXAZOSIN (ORAL) CARDURA. CLINDAMYCIN PHOSPHATE PLEGET (TOPICAL) DOXYCYCLINE HYCLATE CAPSULE, TABLET (ORAL) VIBRAMYCIN. CLINDAMYCIN PHOSPHATE SOLUTION (TOPICAL) CLEOCIN-T DOXYCYCLINE MONOHYDRATE 100 MG & 50 MG (ORAL) MONODOX. CLINDAMYCIN-BENZOYL PEROXIDE 1-5% PUMP (TOPICAL) BENZACLIN GEL PUMP DRONABINOL (ORAL) MARINOL. CLINDESSE (VAGINAL) DROSPIRENONE/ETHINYL ESTRADIOL MONOPHASIC (ORAL) YASMIN. CLOBETASOL EMOLLIENT (TOPICAL) TEMOVATE EMOLLIENT DULERA (INHALATION). CLOBETASOL PROPIONATE CREAM, GEL, OINT, DULOXETINE 20MG, 30MG, 60MG CAPSULES (ORAL) CYMBALTA.

9 SOLUTION (TOPICAL) TEMOVATE DUREZOL (OPHTHALMIC). CLOBEX SHAMPOO (TOPICAL) DUTASTERIDE (ORAL). CLONAZEPAM (not ER) (ORAL) KLONOPIN 200 SUSP (ORAL). CLONIDINE TABLET (ORAL) EGRIFTA (SUB-Q). CLOPIDOGREL (ORAL) PLAVIX ELIDEL (TOPICAL). CLOTRIMAZOLE CREAM OTC (TOPICAL) ELIGARD (SUB-Q). CLOTRIMAZOLE SOLUTION RX (TOPICAL) ELINEST-28 (ORAL). CLOTRIMAZOLE CREAM RX (TOPICAL) LOTRIMIN AF, MYCELEX ELIQUIS (ORAL). CLOTRIMAZOLE TROCHE (MUCOUS MEM) MYCELEX TROCHE EMCYT (ORAL). CLOTRIMAZOLE-BETAMETHASONE CREAM (TOPICAL) LOTRISONE EMEND, EMEND TRIFOLD PACK (ORAL). CLOTRIMAZOLE-BETAMETHASONE LOTION (TOPICAL) EMOQUETTE-28 (ORAL). CLOZAPINE (ORAL) CLOZARIL EMSAM (TRANSDERMAL)*. CODEINE (ORAL) ENALAPRIL, ENALAPRIL HCTZ (ORAL) VASOTEC, VASORETIC. COLCHICINE CAPSULE (ORAL)* ENBREL DISP SYRINGE, KIT, PEN (INJECTION).

10 COLESTIPOL TABLET (ORAL) COLESTID ENOXAPARIN SYRINGE (SUBCUTAN.) LOVENOX SYRINGE. COMBIGAN (OPTHALMIC) ENPRESSE-28 (ORAL). COMETRIQ (ORAL) ENTRESTO (ORAL). COMPLETE NATAL DHA (ORAL) EPCLUSA (ORAL). COMPLETENATE TABLET CHEW (ORAL) EPIDUO GEL PUMP (TOPICAL). CONCEPT DHA (ORAL) EPINEPHRINE MG, MG (INJECTION) EPIPEN JR, EPIPEN. CONCERTA (ORAL)* ERIVEDGE (ORAL). COPAXONE SYRINGE (SUBCUTANE) ERY-TAB EC (ORAL). COTELLIC (ORAL) ERYTHROCIN (ORAL) E-MYCIN. CREON (ORAL) ERYTHROMYCIN (OPHTHALMIC) ILOTYCIN. CRESTOR (ORAL) ERYTHROMYCIN BASE TABLET (ORAL) ERY-TAB. CROMOLYN SODIUM (OPHTHALMIC) OPTICROM ERYTHROMYCIN SOLUTION (TOPICAL) A/T/S. CRYSELLE-28 (ORAL) ESCITALOPRAM SOLUTION, TABLET (ORAL) LEXAPRO. CYCLAFEM 1/35 (ORAL) ESOMEPRAZOLE CAPSULES (ORAL) NEXIUM CAPSULES.