Name Brand Medication | Formulary Status | General Pharmacy Index 4 Category |
---|---|---|
Aciphex | B tier brand | Proton pump inhibitors |
Actonel | B tier brand—maintenance benefit | Calcium regulators |
Allegra | B tier brand | Antihistamine-non-sedating |
Amaryl | B tier brand—maintenance 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 brand—maintenance benefit | Angiotensin II receptor antagonists |
Detrol La | C tier non-preferred | Urinary antispasmodics |
Ditropan Xl | Not listed | Urinary antispasmodics |
Elidel | Not listed | Immunomodulating agents—dermatitis |
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 brand—maintenance 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 brand—maintenance benefit | HMG CoA reductase inhibitors |
* Formulary Scott & White Health Plan (SWHP) preference in descending order: (1) A tier = non-name brand generic; (2) B tier—maintenance benefit = specific name brand with quantity discounts for SWHP pharmacies; (3) B tier = specific name brand; (4) C tier = non-preferred name brand; (5) unlisted.