Connecticut Medicaid Preferred Drug List (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.)

2 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. 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).

3 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. ALFUZOSIN ER (ORAL) UROXATRAL BUPROPION SR, BUPROPION XL (ORAL) WELLBUTRIN XR.

4 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.

5 AMITIZA (ORAL) CALCIUM ACETATE CAPSULE, TABLET (ORAL) PHOSLO, CALPHRON. AMLODIPINE (ORAL) NORVASC CAMILA (ORAL). AMLODIPINE / BENAZEPRIL (ORAL) LOTREL CANASA (RECTAL). 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.

6 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). 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.

7 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).

8 ATROVENT HFA (INHALATION) CEPHALEXIN CAPSULE, SUSPENSION (ORAL) KEFLEX. 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.

9 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. 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).

10 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.