| Name Brand Medication |
Formulary Status |
General Pharmacy Index 4 Category |
|
| Aciphex |
B tier brand |
Proton pump inhibitors |
| Actonel |
B tier brandmaintenance benefit |
Calcium regulators |
| Allegra |
B tier brand |
Antihistamine-non-sedating |
| Amaryl |
B tier brandmaintenance benefit |
Sulfonylureas |
| Augmentin |
B tier brand |
Penicillin combinations |
| Avandia |
C tier non-preferred |
Insulin-sensitizing agents |
| Avelox |
C tier non-preferred |
Fluoroquinolones |
| Clarinex |
Not listed |
Antihistamine-non-sedating |
| Cozaar |
B tier brandmaintenance benefit |
Angiotensin II receptor antagonists |
| Detrol La |
C tier non-preferred |
Urinary antispasmodics |
| Ditropan Xl |
Not listed |
Urinary antispasmodics |
| Elidel |
Not listed |
Immunomodulating agentsdermatitis |
| Imitrex |
B tier brand |
Serotonin agonists |
| Lexapro |
Unlisted |
Selective serotonin reuptake inhibitors |
| Maxalt |
B tier brand |
Serotonin agonists |
| Nasacort |
B tier brand |
Nasal steroids |
| Nexium |
Not listed |
Proton pump inhibitors |
| Oxytrol |
Not listed |
Urinary antispasmodics |
| Paxil |
B tier brand |
Selective serotonin reuptake inhibitors |
| Protonix |
B tier brand |
Proton pump inhibitors |
| Toprol Xl |
B tier brandmaintenance benefit |
Beta blockers cardioselective |
| Valtrex |
C tier non-preferred |
Herpes agents |
| Vioxx |
C tier non-preferred |
Nonsteroidal anti-inflammatory drugs |
| Wellbutrin |
Unlisted (SR is listed) |
Miscellaneous antidepressants |
| Zocor |
B tier brandmaintenance benefit |
HMG CoA reductase inhibitors |