Attachment G - December 2024 Alphabetical State Drug Formulary.pdf

OFFICE OF HEALTH SERVICES, PHARMACY DEPARTMENT (December 2024)

It is DC policy that prescribing be limited to the FORMULARY unless an DRUG EXCEPTION REQUEST is approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent available.

Revised as of December 19, 2024

DRUG NAME ALTERNATE NAME

ABACAVIR ZIAGEN

ABACAVIR/DOLUTEGRAVIR/LAMIVUDINE TRIUMEQ

ABILIFY TAB ONLY ARIPIPRAZOLE TAB

ABILIFY MAINTENA ARIPIPRAZOLE

ACACTAM AZTREONAM

ACCUZYME ENZYME COMBINATIONS, TOPICAL

ACETAMINOPHEN 325MG TYLENOL 325MG

ACETAMINOPHEN SUPPOSITORIES TYLENOL SUPPOSITORIES

ACETAMINOPHEN/ASPRIN/CAFFEINE EXCEDRINE MIGRAINE

ACETAMINOPHEN/CODEINE LIQ CV TYLENOL/COD LIQ

ACETAMINOPHEN/CODEINE TAB CIII TYLENOL/COD #3

ACETAMINOPHEN/HYDROCODONE CIII VICODIN, GENERIC

ACETIC ACID

ACETIC ACID 2% OTIC DOMEBORO OTIC

ACETIC ACID 2%/HC 1% OTIC VOSOL-HC OTIC, GENERIC ONLY

ACETIC ACID OTIC VOSOL OTIC

ACETYLCYSTEINE MUCOMYST

ACHROMYCIN TETRACYCLINE

ACTA-CHAR CHARCOAL, ACTIVATED U.S.P.

ACTH INJECTION CORTICOTROPIN INJECTION

ACTHAR CORTICOTROPIN INJECTION

ACTHAR ACTH

ACTHAR GEL ACTH, REPOSITORY

ACULAR KETOROLAC OPHTH

ACYCLOVIR IV / ORAL ONLY ZOVIRAX IV / ORAL ONLY

ACYCLOVIR IV/ORAL ONLY ZOVIRAX ORAL / IV ONLY

ADAKVEO (RMC ONLY/DER) CRIZANLIZUMAB

ADALIMUMAB (DER REQUIRED) HADLIMA PREFEERED (DER REQUIRED)

ADENOCARD (RMC ONLY) ADENOSINE (RMC ONLY)

ADENOSINE (RMC ONLY) ADENOCARD (RMC ONLY)

ADRENALIN INJ EPINEPHRINE HCL INJ

ADRENALIN, EPPY-N EPINEPHRINE

ADRIAMYCIN DOXORUBICIN HCL

ADRUCIL FLUOROURACIL

ADSORBONAC SODIUM CHLORIDE 5% OPHTH

AEROSPORIN POLYMYXIN B SULFATE

AIRDUO (DOT ONLY) Fluticasone Propionate/Salmeterol Xinafoate

AK-PENTOLATE CYCLOPENTOLATE HCL

ALAMAG PLUS (DORM/SICK CALL) AL/MAG HYDROXIDE/SIMETHICONE

ALBUMIN, NORMAL SERUM ALBUMINAR-25

ALBUMINAR-25 ALBUMIN, NORMAL SERUM

ALBUTEROL ORAL AND NEBULIZER

FDC-ITN-25-068

Operation and Management of Contractor-Operated Correctional Facilities

ATTACHMENT G

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent available.

Revised as of December 19, 2024

ALBUTEROL/IPRATROPIUM INHAL. SOL DUONEB

ALDACTONE, GENERIC SPIRONOLACTONE

ALDOMET METHYLDOPA

ALENDRONATE FOSAMAX

ALIMTA PEMETREXED DISODIUM

ALKERAN MELPHALAN

ALLOPURINOL ZYLOPRIM, GENERIC ONLY

ALOGLIPTIN NESINA

ALPHA1-PROTEINASE INHIBITOR [HUMAN] PROLASTIN, GLASSIA (REQUIRES APPROVED DER)

(REQUIRES APPROVED DER)

ALPHAGAN 0.2% BRIMONIDINE TARTRATE 0.2%

ALTEPLASE RECOMBINANT (RMC ONLY) CATHFLO ACTIVASE (RMC ONLY)

AL/MAG HYDROXIDE/SIMETHICONE ALAMAG PLUS (DORM/SICK CALL)

ALUMINUM ACETATE BUROW’S SOLN, DOMEBORO POWDER

ALVESCO HFA INHALER CICLESONIDE HFA INHALER

AMANTADINE SYMMETREL

AMCILL AMPICILLIN

AMETHOPTERIN METHOTREXATE

AMIKACIN (RMC ONLY)

AMINO ACID SOLUTION FREAMINE III, AMINOSYN

AMINOPHYLLINE

AMINOSYN AMINO ACID SOLUTION

AMJEVITA ADALIMUMAB (DER REQUIRED)

AMIODARONE CORDARONE

AMLODIPINE NORVASC

AMMONIA, AROMATIC

AMMONIUM LACTATE CR AND LOT (DER) AMLACTIN CREAM AND LOTION

AMOXICILLIN TRIMOX, AMOXIL

AMOXICILLIN/CLAVULANATE IR AUGMENTIN IR

AMOXIL AMOXICILLIN

AMPHOTERICIN B IV FUNGIZONE IV

AMPICILLIN POLYCILLIN, AMCILL

AMPICILLIN NA/ SULBACTAM NA UNASYN

AMYLASE/LIPASE/PROTEASE ZENPEP

ANALGESIC BALM, GENERIC MENTH/METHYLSALICYLAT CRM

ANAPROX, GENERIC NAPROXEN SODIUM

ANASTROZOLE ARIMIDEX

ANCEF CEFAZOLIN

ANECTINE SUCCINYLCHOLINE CHLORIDE

ANTIHEMOPHILIC FACTOR FACTOR VIII COMPLEX (HUMAN)

ANTIHEMOPHILIC FACTOR FACTOR IX

ANTIHEMOPHILIC FACTOR (HUM) MONOCLATE-P, FACTOR VIII COMPLEX

ANTILIRIUM PHYSOSTIGMINE SALICYLATE

ANTISPASMODIC BELLADONNA ALKA/PB

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent available.

Revised as of December 19, 2024

ANTIVERT MECLIZINE HCL

ANUSOL OINTMENT HEMORRHOID ANESTHETIC OINTMENT

ANUSOL SUPP HEMORRHOIDAL SUPP

ANUSOL-HC CREAM HYDROCORT/HEMORRHOID CREAM

APAP W CODEINE ELIXIR CV TYLENOL C CODEINE, GENERIC

APIXABAN (DER REQUIRED) ELIQUIS (DER REQUIRED)

APREMILAST OTEZLA

APRESOLINE HYDRALAZINE

APTIVUS TIPRANAVIR

AQUA MEPHYTON, MEPHYTON PHYTONADIONE

AQUAPHOR – Post Radiation only HYDROPHILIC PETROLATUM

AQUASOL A VITAMIN A

AQUASOL E TOCOPHEROL

ARAMINE METARAMINOL BITARTRATE

AREDIA PAMIDRONATE DISODIUM

ARICEPT DONEPEZIL

ARIMIDEX ANASTROZOLE

ARIPIPRAZOLE TAB ONLY ABILIFY TAB ONLY

ARISTOCORT INJ TRIAMCINOLONE ACETONIDE INJ

ARTIFICIAL TEAR POLYVINYL ALCOHOL

ARTIFICIAL TEAR METHYLCELLULOSE

ASA ASPIRIN

ASACOL HD MESALAMINE

ASCORBIC ACID TABLET (RMC ONLY AND COVID) VITAMIN C TABLET (RMC ONLY AND COVID)

ASPIRIN ASA

ATARAX, VISTARIL HYDROXYZINE PAMOATE

Prescription for Atarax & Vistaril will be therapeutically substituted per P & T 10/02/02

ATENOLOL TENORMIN, GENERIC ONLY

ATAZANAVIR SULFATE REYATAZ

ATAZANAVIR/COBICISTAT EVOTAZ

ATIVAN LORAZEPAM CIV

ATORVASTATIN LIPITOR

ATOVAQUONE MEPRON

ATRACURIUM TRACRIUM

ATRIPLA EFAVIRENZ, EMTRICITABINE,TENOFOVIR

ATROPINE SULFATE INJ

ATROPINE SULFATE OPHTH ISOPTOATROPINE

AUGMENTIN IR AMOXICILLIN/CLAVULANATE IR

AURALGAN SOLN BENZOCAINE/ANTIPYRINE OTIC

AURTO, GENERIC ONLY BENZOCAINE/ANTIPYRINE OTIC

AURYXIA (DER) FERRIC CITRATE (DER)

AVASTIN BEVACIZUMAD

AVONEX (DER REQUIRED) INTERFERON BETA-1A (DER REQUIRED)

AZACITIDINE VIDAZA

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

AZATHIOPRINE IMURAN

AZITHROMYCIN ZITHROMAX ORAL AND INJECTABLE

AZT ZIDOVUDINE

AZTREONAM AZACTAM

AZULFIDINE SULFASALAZINE

B.S.S. BALANCED SALT OPHTH SOLN

BACID LACTOBACILLUS ACIDOPHILUS

BACIGUENT BACITRACIN OINTMENT

BACITRACIN OINTMENT BACIGUENT

BACITRACIN OPHTHALMIC

BACLOFEN LIORESAL

BACTRIM ORAL, INJ COTRIMOXAZOLE ORAL, INJ (TMP-SMX)

BACTROBAN OINTMENT MUPIROCIN OINTMENT ONLY

BALANCED SALT OPHTH SOLN B.S.S.

BALSAM PERU/TRYPSIN SPRAY GRANULEX

BAMLANIVIMAB (DER)

BARACLUDE (DER REQUIRED) ENTECAVIR (DER REQUIRED)

BARICITINIB (DER) OLUMIAN DER

BCG INTRAVESICAL PACIS, TICE BCG, THERA CYS

BCNU CARMUSTINE

BELLADONNA/METHYLENE BLUE

BENADRYL (PHYSICAL HEALTH) DIPHENHYDRAMINE HCL (PHYSICAL HEALTH)

BENTYL (DOT ONLY) DICYCLOMINE HCL (DOT ONLY)

BENZAGEL BENZOYL PEROXIDE

BENZALKONIUM CHLORIDE SOL ZEPHIRAN SOLN

BENZOCAINE LOZENGES IND-PAK

BENZOCAINE/ANTIPYRINE OTIC AURALGAN SOLN, AURTO, GENERIC

BENZOIN TINCTURE

BENZONATATE TESSALON PERLES

BENZOYL PEROXIDE TOPICAL (EXCLUDES WASH)

BENZTROPINE MESYLATE COGENTIN

BETADINE POVIDONE-IODINE TOPICAL

BETAGAN LEVOBUNOLOL OPHTHALMIC

BETAMETHASONE DIP. AUG 0.05% CR 50GM DIPROLENE AF 0.05% CR 50MG

BETAMETHASONE DIP 0.05% OINT 45 GM

BETASERON (DER REQUIRED) INTERFERON BETA-1B (DER REQUIRED)

BETAXOLOL 0.5% OPHTHALMIC BETOPTIC 0.5%

BETHANECHOL CHLORIDE URECHOLINE, GENERIC ONLY

BETOPTIC 0.5% BETAXOLOL OPHTHALMIC 0.5%

BEVACIZUMAD AVASTIN

BH WETTING SOLN POLYVINYL ALCOHOL

BIAXIN IR CLARITHROMYCIN IR

BICALUTAMIDE CASODEX

BICILLIN LA PENICILLIN G BENZATHINE LA

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

BICITRA SOLN SOD CITRATE/CITRIC ACID

BICNU CARMUSTINE

BICTEGRAVIR/EMTRICITABINE/TENOFOVIR BIKTARVY

BIKTARVY BICTEGRAVIR/EMTRICITABINE/TENOFOVIR

BIOZYME-C CREAM COLLAGENASE TOPICAL

BISACODYL DULCOLAX

BISMUTH SUBSALICYLATE PINK BISMUTH, PEPTO BISMOL

BLENOXANE BLEOMYCIN

BLEOMYCIN BLENOXANE

BLEPH-10 SULFACETAMIDE SODIUM

BONINE MECLIZINE HCL

BOOSTRIX DIPHTHERIA/TETANUS/PERTUSSIN

BORTEZOMID VELCADE

BOSTON CLEANER DAILY RIGID GAS PERMEABLE

BOSTON CONDITIONING SOLUTION RIGID GAS PERMEABLE

BRETHINE TERBUTALINE SULFATE

BRETYLIUM TOSYLATE BRETYLOL

BRETYLOL BRETYLIUM TOSYLATE

BRICANYL TERBUTALINE SULFATE

BRILINTA (DER REQUIRED) TECAGRELOR (DER REQUIRED)

BRIMATOPROST (DER) LUMIGAN (DER)

BRIMONIDINE TARTRATE 0.2% ALPHAGAN 0.2%

BROMOCRIPTINE PARLODEL

BUDESONIDE ORAL

BUFFERED OPHTH IRRIGATION DACRIOSE

BUPIVACAINE HCL MARCAINE, SENSORCAINE

BUPIVICAINE/EPINEPHRINE MARCAINE/EPINEPHRINE

BUPRENORPHINE SL TABLETS ONLY (DER)

BUPRENORPHINE/NALOXONE SL TABS ONLY (DER)

BUROW’S SOLN ALUMINUM ACETATE

BUSPAR BUSPIRONE

BUSPIRONE BUSPAR

CAFERGOT ERGOTAMINE/CAFFEINE

CALAMINE LOTION

CALAN SR VERAPAMIL ER

CALAN VERAPAMIL HCL

CALCIFEROL ERGOCALCIFEROL

CALCITONIN MIACALCIN

CALCITRIOL ROCALTROL, VITAMIN D

CALCIUM ACETATE PHOSLO

CALCIUM CARBONATE OS-CAL 500, OS-CAL

CALCIUM CHLORIDE

CALCIUM GLUCONATE

CALCIUM LEUCOVORIN WELLCOVORIN, FOLINIC ACID

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

CALCIUM WITH VIT D (ALL) CALCIUM WITH VIT D (ALL)

CAMPTOSAR IRINOTECAN HCI

CAPECITABINE XELODA

CAPLYTA (DER) LUMATEPERONE (DER)

CAPVAXIVE PNEUMOCOCCAL-21 VACCINE

CARAFATE SUCRALFATE

CARBAMAZEPINE (DOT ONLY) DER REQUIRED TEGRETOL (DOT ONLY) DER REQUIRED

CARBAMIDE PEROXIDE OTIC DEBROX

CARBIDOPA/LEVODOPA SINEMET

CARBOCAINE MEPIVACAINE

CARBOPLATIN CARBOPLATIN

CARDIZEM ALL FORMS DILTIAZEM ALL FORMS

CARVEDILOL IR COREG IR

CASODEX BICALUTAMIDE

CARMUSTINE BCNU, BICNU

CASIRIVAMAB/IMDEVIMAB (DER)

CATHFLO ACIVASE (RMC ONLY) ALTEPLASE RECOMBINANT (RMC ONLY)

CCNU LOMUSTINE

CECLOR CEFACLOR

CEE NU LOMUSTINE

CEFACLOR CECLOR

CEFAPIME () MAXIPIME

CEFAZOLIN ANCEF, KEFZOL

CEFDINIR OMNICEF

CEFOXITIN SODIUM MEFOXIN

CEFPODOXIME VANTIN

CEFTAROLINE (DER REQUIRED) TEFLARO (DER REQUIRED)

CEFTAZIDIME (RMC HOSPITAL ONLY) FORTAZ/TAZICEF (RMC HOSPITAL ONLY)

CEFTRIAXONE ROCEPHIN

CELEXA (MAXIMUM 40MG/DAY) CITALOPRAM (MAXIMUM 40MG/DAY)

CELLCEPT MYCOPHENOLATE MOFETIL

CEPHALEXIN KEFLEX, GENERIC

CEPHULAC LACTULOSE

CERTOLIZUMAB PEGOL (DER REQUIRED) CIMZIA (DER REQUIRED)

CERUBIDINE DAUNORUBICIN HCL

CETACAINE BENZOCAINE 14%

CETUXIMAB ERBITUX

CHARCOAID CHARCOAL, ACTIVATED U.S.P.

CHARCOAL, ACTIVATED U.S.P. CHARCOAID, ACTA-CHAR

CHLOR-TRIMETON CHLORPHENIRAMINE MALEATE

CHLORAMBUCIL LEUKERAN

CHLORHEXIDINE GLUCONATE HIBICLENS

CHLORHEXIDINE GLUCONATE PERIDEX ORAL RINSE

CHLOROPROCAINE NESACAINE

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

CHLORPHENIRAMINE MALEATE CHLOR-TRIMETON

CHLORPROMAZINE THORAZINE

CHLORTHALIDONE HYGROTON, GENERIC

CHLORZOXAZONE PARAFON FORTE DSC

CHOLECALCIFEROL (COVID-19) VITAMIN D3 (COVID-19)

CHOLOGRAFIN MEGLUMINE IODIPAMIDE MEGLUMINE

CHRONULAC LACTULOSE

CICLESONIDE HFA INHALER ALVESCO HFA INHALER

CILOXAN CIPROFLOXACIN

CINACALCET SENSIPAR

CIMZIA (DER REQUIRED) CERTOLIZUMAB PEGOL (DER REQUIRED)

CIPRO CIPROFLOXACIN

CIPROFLOXACIN HCL CILOXAN, CIPRO

CISPLATIN CISPLATINUM, PLATINOL

CISPLATINUM CISPLATIN

CITALOPRAM (MAXIMUM 40MG/DAY) CELEXA (MAXIMUM 40MG/DAY)

CITROMA, CITRATE OF MAGNESIA MAGNESIUM CITRATE

CITROVORUM FACTOR LEUCOVORIN CALCIUM

CITRUCEL FIBER LAXATIVE

CLARITHROMYCIN IR BIAXIN IR

CLARITIN LORATADINE

CLARITIN-D (DER) LORATADINE/PSEUDOEPHEDRINE (DER)

CLEAN-N-SOAK CLEANING & SOAKING SOLUTION

CLEANING & SOAKING SOLUTION HARD CONTACT LENS, CLEAN-N-SOAK

CLEANING SOLUTION CONTACT LENS SOLN (HARD LENS)

CLEOCIN IV CLINDAMYCIN IV

CLEOCIN (ORAL PRODUCT) CLINDAMYCIN

CLEOCIN VAGINAL CREAM CLINDAMYCIN PHOSPHATE

CLERZ 2 LUBRICATING EYE DROPS

CLINDAMYCIN IV CLEOCIN IV

CLINDAMYCIN (ORAL PRODUCT) CLEOCIN

CLINDAMYCIN PHOSPHATE VAGINAL CLEOCIN VAGINAL

CLINORIL SULINDAC

CLOBETASOL 0.05% OINT 60GM

CLOPIDOGREL PLAVIX

CLOTRIMAZOLE MYCELEX, LOTRIMIN

CODEINE PHOSPHATE/SULFATE CII

COGENTIN BENZTROPINE MESYLATE

COLACE DOCUSATE SODIUM

COLCHICINE

COLLAGENASE TOPICAL SANTYL

COLYTE ORAL COLON LAVAGE SOLN

COMBIVENT IPRATROPIUM BROMIDE AND ALBUTEROL

SULFATE

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

For moderate to severe Asthma only.

COMFORT EYE DROPS EYE DROPS FOR GAS PERMEABLE

CONDYLOX SOL (FOR SINGLE DOSE ONLY) PODOFLIOX SOLUTION

COMPLERA EMTRICITABINE/RILPIVIRINE/TENOFOVIR

CONRAY IOTHALAMATE MEGLUMINE

CONTACT LENS SOLN (HARD LENS) WETTING SOLUTION, CLEANING SOLUTION

CONTACT LENS SOLUTION SENSITIVE EYES, FLEXCARE

COPAXONE (DER REQUIRED) GLATIRAMER (DER REQUIRED)

CORDARONE AMIODARONE

CORLANOR (DER REQUIRED) IVABRADINE (DER REQUIRED)

COREG IR CARVEDILOL IR

CORTEF HYDROCORTISONE TABLET

CORTICOTROPIN INJECTION ACTH INJECTION, ACTHAR

CORTISPORIN OTIC NEOMYCIN / POLYMYXIN / HC OTIC

CORTROSYN COSYNTROPIN

COSMEGEN COSMEGEN

COSOPT OPHTH DORZOLAMIDE/TIMOLOL OPHTH

COSYNTROPIN CORTROSYN

COTRIMOXAZOLE INJ BACTRIM INJ, SEPTRA INJ

COTRIMOXAZOLE ORAL (TMP-SMX) BACTRIM ORAL, SEPTRA ORAL

COUMADIN (DOT ONLY) WARFARIN SODIUM (DOT ONLY)

COZAAR LOSARTAN

CREON

CRIXIVAN INDINAVIR

CRIZANLIZUMAB ADAKVEO (RMC ONLY/DER)

CUBICIN (DER REQUIRED) DAPTOMYCIN (DER REQUIRED)

CYANOCOBALAMIN VITAMIN B-12

CYCLOBENZAPRINE FLEXERIL

CYCLOGYL CYCLOPENTOLATE HCL

CYCLOPENTOLATE HCL CYCLOGYL, AK-PENTOLATE

CYCLOPHOSPHAMIDE CYTOXAN, NEOSAR

CYCLOSPORINE SANDIMMUNE, NEORAL

CYMBALTA DULOXETINE

CYPROHEPTADINE PERIACTIN

CYSTO-CONRAY IOTHALAMATE MEGLUMINE

CYSTOGRAFIN DIATRIZOATE MEGLUMINE

CYTARABINE HCL CYTOSAR

CYTOSAR CYTARABINE HCL

CYTOTEC MISOPROSTOL

CYTOVENE GANCICLOVIR SODIUM

CYTOXAN CYCLOPHOSPHAMIDE

D-GLUCOSE DEXTROSE

DABRAFENIB MESYLATE TAFINLAR

DACARBAZINE DTIC-DOME

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

DACRIOSE BUFFERED OPHTH IRRIGATION

DAILY CLEANER (HARD LENSES) TITAN LIQUID CL

DAILY CLEANER (SOFT LENSES) LENS PLUS

DAKIN’S SOLUTION SODIUM HYPOCHLORITE

DANAZOL DANOCRINE

DANOCRINE DANAZOL

DAPSONE DDS

DAPTOMYCIN (DER REQUIRED) CUBICIN (DER REQUIRED)

DARAPRIM PYRIMETHAMINE

DARUNAVIR PREZISTA

DARUNAVIR AND COBICISTAT PREZCOBIX

DASATINIB SPRYCEL

DAUNOMYCIN HCL DAUNORUBICIN HCL

DAUNORUBICIN HCL CERUBIDINE, DAUNOMYCIN HCL

DDAVP DESMOPRESSIN ACETATE

DDI DIDANOSINE

DDS DAPSONE

DEBRISAN DEXTRANOMER

DEBROX CARBAMIDE PEROXIDE OTIC

DECADRON OPHTH DEXAMETHASONE OPHTHALMIC

DECADRON DEXAMETHASONE INJECTIBLE/ORAL

DELESTROGEN ESTRADIOL VALERATE INJ

DELTASONE PREDNISONE

DEMEROL MEPERIDINE HCL CII

DENTAL AGENTS

DENTU CREAM PASTE DENTURE CLEANER

DENTURE CLEANER DENTU CREAM PASTE

DEPAKENE VALPROIC ACID

DEPAKOTE DR AND ER DIVALPROEX SODIUM DR AND ER

DEPO PROVERA MEDROXYPROGESTERONE ACETATE

DEPO-ESTRADIOL ESTRADIOL CYPIONATE INJ

DEPO-MEDROL METHYLPREDNISOLONE

DERMOPLAST BENZOCAINE TOPICAL SPRAY

DESCOVY EMTRICITABINE, TENOFOVIR

DESENSITIZING TOOTHPASTE SENSODYNE

DESMOPRESSIN ACETATE DDAVP, STIMATE

DEXAMETHASONE OPHTHALMIC DECADRON OPHTH, MAXIDEX

DEXAMETHASONE INJECTIBLE/ORAL DECADRON

DEXTRANOMER DEBRISAN

DEXTROSE D-GLUCOSE, GLUCOSE

DEXTROSE AND SODIUM CHLORIDE

DEXTROSE/LEVULOSE/PHOSPHORIC ACID EMETROL, GENERIC ONLY

DHS TAR SHAMPOO TAR SHAMPOO

DIAGNOSTIC AGENTS

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

DIATRIZOATE MEGLUMINE RENO-M-30, RENO-M-60, CYSTOGRAFIN

DIATRIZOATE SODIUM HYPAQUE

DIAZEPAM (ANTIANXIETY) CIV VALIUM

DIAZEPAM (ANTICONVULSANT) CIV VALIUM

DIAZEPAM (SEDATIVE) CIV VALIUM

DIBUCAINE TOPICAL GENERIC ONLY

DICLOFENAC OPHTH SOLUTION

DICLOXACILLIN DYNAPEN

DICYCLOMINE HCL (DOT ONLY) BENTYL (DOT ONLY)

DIDANOSINE EC VIDEX EC

DIDRONEL ETIDRONATE

DIFICID (RMC ONLY) FIDAXOMICIN (RMC ONLY)

DIFLUCAN FLUCONAZOLE

DIGOXIN LANOXIN

DILACOR XR DILTIAZEM ER

DILANTIN PHENYTOIN

DILAUDID (RMC ONLY) HYDROMORPHONE (RMC ONLY)

DILTIAZEM (ONCE DAILY DOSING) CARDIZEM CD

(Therapeutic substitution approved)

DILTIAZEM-ALL FORMS CARDIZEM ALL FORMS

DINOPROST TROMETHAMINE PROSTIN F2 ALPHA

DINOPROSTONE PROSTIN E2

DIPHENHYDRAMINE (PHYSICAL HEALTH) BENADRYL, BENYLIN (PHYSICAL HEALTH)

DIPHTHERIA/TETANUS TOXOID DT, TD

DIPHTHERIA/TETANUS/PERTUSSIN BOOSTRIX

DIPIVEFRIN HCL OPHTH PROPINE

DIPROLENE AF 0.05% CR 50GM BETAMETHASONE DIP. AUG 0.05% CR 50GM

DISALCID, GENERIC SALSALATE

DISINFECTION SOLN (SOFT LEN)

DITROPAN (DOT ONLY) OXYBUTYNIN (DOT ONLY)

DIULO METOLAZONE

DIVALPROEX SODIUM DR AND ER DEPAKOTE DR AND ER

DOBUTAMINE DOBUTREX

DOBUTREX DOBUTAMINE

DOCETAXEL TAXOTERE

DOCUSATE SODIUM COLACE, DSS

DOLUTEGRAVIR TIVICAY

DOMEBORO OTIC ACETIC ACID 2% OTIC

DOMEBORO POWDER ALUMINUM ACETATE

DONEPEZIL ARICEPT

DOPAMINE HCL INTROPIN

DORZOLAMIDE TRUSOPT

DORZOLAMIDE/TIMOLOL OPHTH COSOPT OPHTH

DOXORUBICIN HCL ADRIAMYCIN

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

DOXYCYCLINE VIBRAMYCIN

DRISDOL ERGOCALCIFEROL

DT DIPHTHERIA/TETANUS TOXOID

DTIC-DOME DACARBAZINE

DULAGLUTIDE INJECTION TRULICITY (DER)

DULCOLAX BISACODYL

DULOXETINE CYMBALTA

DUODERM FLEXIBLE HYDROACTIVE DRESSING

DUOFILM SALICYLIC ACID

DUONEB INHALANT SOL ALBUTEROL/IPRATROPIUM

DUPILUMAB (DER) DUPIXENT (DER)

DUPIXENT (DER) DUPILUMAB (DER)

DYAZIDE, MAXZIDE-25 TRIAMTERENE/HCTZ

DYNAPEN DICLOXACILLIN

E-MYCIN ERYTHROMYCIN BASE

ECULIZUMAB (DER REQUIRED) SOLIRIS (DER REQUIRED)

EDARAVONE (DER REQUIRED) RADICAVA (DER REQUIRED)

E.E.S. ERYTHROMYCIN ETHYLSUCCINATE

EDROPHONIUM CHLORIDE TENSILON, ENLON

EDURANT RILPIVIRINE

EFAVIRENZ SUSTIVA

EFAVIRENZ, EMTRICITABINE,TENOFOVIR ATRIPLA

EFFEXOR XR VENLAFAXINE ER ONLY

EFODINE POVIDONE-IODINE TOPICAL

EFUDEX FLUOROURACIL

ELBASVIR / GRAZOPREVIR (PT MUST BE ON APPROVED PT. LIST) ZEPATIER (PT MUST BE ON APPROVED PT. LIST)

ELIGARD LEUPROLIDE ACETATE

ELIMITE CREAM PERMETHRIN

ELIQUIS (DER REQUIRED) APIXABAN (DER REQUIRED)

ELLENCE EPIRUBICIN

ELOXATIN OXALIPLATIN

ELTROMBOPAG PROMACTA

ELVITEGRAVIR/COBISTAT/EMTRICITABINE/TENOFOVIR GENVOYA, STRIBILD

EMERGEN-C IMMUNE (COVID-19 ONLY)

EMETROL DEXTROSE/LEVULOSE/PHOSPHORIC ACID

EMICIZUMAB HEMLIBRA

EMPAGLIFLOZIN JARDIANCE

EMTRICITABINE EMTRIVA

EMTRICITABINE / TENOFOVIR DESCOVY, TRUVADA

EMTRICITABINE,TENOFOVIR, EFAVIRENZ ATRIPLA

EMTRICITABINE/RILPIVIRINE/TENOFOVIR COMPLERA, ODEFSEY

EMTRIVA EMTRICITABINE

ENBREL (DER REQUIRED) ETANERCEPT (DER REQUIRED)

ENFUVIRTIDE FUZEON

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

ENGERIX-B ADULT HEPATITIS B VACCINE(RECOMBINANT)

ENLON EDROPHONIUM CHLORIDE

ENOXAPARIN SODIUM INJECTION LOVENOX

ENSURE PLUS ENTERAL DIET, COMPLETE

ENSURE ENTERAL DIET, SUPPLEMENT

ENTECAVIR (DER REQUIRED) BARACLUDE (DER REQUIRED)

ENTERAL DIET, CLEAR LIQUID, NOT COMPLETE FORTA DRINK

ENTERAL DIET, COMPLETE SUSTACAL PLUS, ENSURE PLUS

ENTERAL DIET, COMPLETE DIABETIC GLUCERNA

ENTERAL DIET, COMPLETE HIGH CALORIE TWOCAL

ENTERAL DIET, COMPLETE PULM/DIABET PULMOCARE

ENTERAL DIET, COMPLETE RENAL SUPLENA

ENTERAL DIET, ISOTONIC ISOCAL, OSMOLITE HN

ENTERAL DIET, SUPPLEMENT SUSTACAL, ENSURE

ENTRAVIRINE INTELENCE

ENTRESTO (DER REQUIRED) SACUBITRIL/VALSARTAN (DER REQUIRED)

ENZYMATIC CLEANER KIT FOR SOFT, GAS PERMEABLE

ENZYME COMBINATIONS, TOPICAL ACCUZYME

EPCLUSA (PT MUST BE ON APPROVED PT. LIST) SOFOSBUVIR / VELPATASVIR

(SOFOSBUVIR / VELPATASVIR (ASEGUA THERAPEUTICS) IS THE PREFERRED DAA AS LONG AS IT IS CONSISTENT WITH THE CLINICAL BEST

INTERESTS OF THE APPLICABLE PATIENT)

EPIFRIN EPINEPHRINE OPHTH SOLN

EPINAL EPINEPHRINE OPHTH SOLN

EPINEPHRINE ADRENALIN, EPPY

EPINEPHRINE HCL INJ ADRENALIN INJ

EPINEPHRINE INJ SUSP SUS-PHRINE

EPINEPHRINE OPHTH SOLN EPINAL, EPIFRIN

EPIRUBICIN ELLENCE

EPIVIR LAMIVUDINE (3TC)

EPIVIR / ZIAGEN EPIZCOM

EPIZCOM EPIVIR / ZIAGEN

EPOETIN ALFA (DER REQUIRED) EPOGEN, PROCRIT, RETACRIT

EPOGEN (DER REQUIRED) EPOETIN ALFA (DER REQUIRED)

ERBITUX CETUXIMAB

ERGOCALCIFEROL DRISDOL, CALCIFEROL

ERGONOVINE MALEATE INJ ERGOTRATE

ERGOTAMINE/CAFFEINE CAFERGOT

ERGOTRATE ERGONOVINE MALEATE INJ

ERLOTINIB HYDROCHLORIDE TARCEVA

ERTAPENEM (DER REQUIRED) INVANZ (DER REQUIRED)

ERYC ERYTHROMYCIN BASE

ERYTHROCIN ERYTHROMYCIN STEARATE

ERYTHROMYCIN ILOTYCIN

ERYTHROMYCIN BASE ERYC, E-MYCIN

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

ERYTHROMYCIN ETHYLSUCCINATE E.E.S., PEDIAMYCIN

ERYTHROMYCIN OPHTHALMIC ILOTYCIN

ERYTHROMYCIN STEARATE ERYTHROCIN, GENERIC

ESCITALOPRAM LEXAPRO

ESTINYL ETHINYL ESTRADIOL

ESTRACE VAGINAL CREAM ESTRADIOL VAGINAL CREAM

ESTRADERM ESTRADIOL

ESTRADIOL ESTRADERM

ESTRADIOL VAGINAL CREAM ESTRACE VAGINAL CREAM

ESTRADIOL CYPIONATE INJ DEPO-ESTRADIOL

ESTRADIOL VALERATE INJ DELESTROGEN

ESTROGENIC SUBST CONJ CRM PREMARIN CREAM

ESTRONE SUSPENSION INJ

ESTROPIPATE OGEN

ETANERCEPT (DER REQUIRED) ENBREL (DER REQUIRED)

ETHAMBUTOL HCL MYAMBUTOL

ETHINYL ESTRADIOL ESTINYL, FEMINONE

30 MCG ETHINYL ESTRADIOL AND 0.3 MG LO OVRAL NORGESTREL

35 MCG ETHINYL ESTRADIOL AND 1 MG ORTHO-NOVUM 1/35 NORGESTREL

PHASE 1 - 35 MCG ETHINYL ESTRADIOL AND ORTHO-NOVUM 7/7/7

0.5 MG NORENTHINDRONE//PHASE 2 - 35 MCG

ETHINYL ESTRADIOL AND 0.75 MG

NORETHINDRONE// PHASE 3 - 35 MCG

30 MCG ETHINYL ESTRADIOL AND 1.5 MG LOESTRIN 1.5/30

NORETHINDRONE

ETHINYL ESTRADIOL AND NORGESTIMATE ORTHO TRI-CYCLEN

ETIDRONATE DIDRONEL

ETOPOSIDE VEPESID / TOPOSAR

EVOTAZ ATAZANAVIR/COBICISTAT

EXCEDRINE MIGRAINE ACETAMINOPHEN/ASPRIN/CAFFEINE

EXELON RIVASTIGMINE

EYE DROPS FOR GAS PERMEABLE COMFORT EYE DROPS

EYE DROPS FOR SOFT LENSES LUBRICANT EYE DROPS, MOISTURE DROPS

EYE STREAM SODIUM CHLORIDE (ISOTONIC)

EZETIMBE ZETIA

FACTOR COMPLEX VIII ANTIHEMOPHILIC FACTOR (HUMAN)

FACTOR VIII COMPLEX (HUMAN) ANTIHEMOPHILIC, MONOCLATE-P

FACTOR IX ANTIHEMOPHILIC FACTOR

FAMOTIDINE PEPCID

FAT EMULSION LIPOSYN II

FEMINONE ETHINYL ESTRADIOL

FEOSOL FERROUS SULFATE

FER-IN-SOL FERROUS SULFATE

FERRIC CITRATE (DER) AURYXIA (DER)

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

FERRLECIT SODIUM FERRIC GLUCONATE COMPLEX

FERROUS SULFATE FEOSOL, FER-IN-SOL

FIBER-LAX TABLETS POLYCAROBPHIL

FIDAXOMICIN (RMC ONLY) DIFICID (RMC ONLY)

FILGRASTIM (DER REQUIRED) NEUPOGEN, NIVESTYM (DER REQUIRED)

FINASTERIDE PROSCAR

FINGOLIMOD (DER REQUIRED) GILENYA (DER REQUIRED)

FLAGYL IV / TABLETS(250MG AND 500MG) METRONIDAZOLE IV / TABLETS

FLAVOXATE HCL URISPAS

FLEET ENEMA SOD PHOSPHATE/BIPHOSPHATE

FLEET ENEMA PHOSPHATE INORGANIC ENEMA

FLEXCARE CONTACT LENS SOLUTION

FLEXERIL CYCLOBENZAPRINE

FLEXIBLE HYDROACTIVE DRESSING DUODERM

FLOMAX TAMSULOSIN

FLORINEF FLUDROCORTISONE ACETATE

FLOXIN OFLOXACIN

FLOXURIDINE FUDR

FLUCONAZOLE DIFLUCAN

FLUDARABINE FLUDURA

FLUDURA FLUDARABINE

FLUDROCORTISONE ACETATE FLORINEF

FLUMAZENIL ROMAZICON

FLUOR I STRIP FLUORESCEIN TX-STRIP

FLUORESCEIN SODIUM FLURESS

FLUORESCEIN TX-STRIP FLUOR I STRIP

FLUOROMETHOLONE FML OPHTH SUSP, FML FORTE

FLUOROURACIL 5-FLUOROURACIL, 5-FU

FLUOTHANE HALOTHANE

FLUOXETINE 10 MG 20MG ONLY GENERIC ONLY

FLUOXYMESTERONE CIII HALOTESTIN

FLUPHENAZINE DECANOATE PROLIXIN DECANOATE

FLUPHENAZINE HCL PROLIXIN

FLURESS FLUORESCEIN SODIUM

FLUTAMIDE FLUTAMIDE

FLUTICASONE NASAL SPRAY GENERIC ONLY

Fluticasone Propionate/Salmeterol Xinafoate AIRDUO (DOT ONLY)

FLUZONE INFLUENZA VIRUS VACCINE

FML FORTE FLUOROMETHOLONE

FML OPHTH SUSP FLUOROMETHOLONE

FOLIC ACID FOLVITE

FOLINIC ACID CALCIUM LEUCOVORIN

FOLVITE FOLIC ACID

FOR SOFT, GAS PERM. ENZYMATIC CLEANER KIT

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

FORTAZ (RMC HOSPITAL ONLY) CEFTAZIDIME (RMC HOSPITAL ONLY)

FORTOVASE SAQUINAVIR MESYLATE

FOSAMAX ALENDRONATE

FOSAMPRENAVIR CALCIUM LEXIVA

TERFREAMINE III AMINO ACID SOLUTION

FUDR FLOXURIDINE

FUNGIZONE IV AMPHOTERICIN B IV

FUROSEMIDE LASIX, GENERIC

FUSILEV LEVOLEUCOVORIN CALCIUM

FUZEON ENFUVIRTIDE

GADODIAMIDE OMNISCAN

GALANTAMINE RAZADYNE

GAMMULIN RH RH-O (D) IMMUNOGLOBULIN

GANCICLOVIR SODIUM CYTOVENE

GANTRISIN SULFISOXAZOLE

GARAMYCIN CREAM GENTAMICIN TOPICAL

GARAMYCIN INJ GENTAMICIN SULFATE INJ

GARAMYCIN OPHTH GENTAMICIN OPHTHALMIC

GASTRODRAFIN MG GASTROVIEW

GEMCITABINE HCI GEMZAR

GEMFIBROZIL (APPROVED DER REQUIRED) LOPID (APPROVED DER REQUIRED)

GEMZAR GEMCITABINE HCI

GENTACIDIN GENTAMICIN OPHTHALMIC

GENTAMICIN OPHTHALMIC GARAMYCIN OPHTH, GENTACIDIN

GENTAMICIN SULFATE INJ GARAMYCIN INJ

GENTAMICIN TOPICAL GARAMYCIN CREAM

GENVOYA ELVITEGRAVIR/COBISTAT/EMTRICITABINE/TENOFOVIR

GEODON INJECTION ZIPRASIDONE (SIII FACILITIES ONLY)

GILENYA (DER REQUIRED) FINGOLIMOD (DER REQUIRED)

GLASSIA (DER REQUIRED) ALPHA1-PROTEINASE INHIBITOR

GLATIRAMER (DER REQUIRED) COPAXONE, GLATOPA (DER REQUIRED)

GLATOPA (DER REQUIRED) GLATIRAMER (DER REQUIRED)

GLECAPREVIR / PIBRENTASVIR MAVYRET (PT MUST BE ON APPROVED PT. LIST)

GLEEVEC IMATINIB

GLIPIZIDE IR AND XL GLUCOTROL, GLUCOTROL XL

GLUCAGON HCL

GLUCERNA ENTERAL DIET,COMPLETE DIABETIC

GLUCOPHAGE METFORMIN HCL

GLUCOPHAGE XR METFORMIN HYDROCHLORIDE

GLUCOSE DEXTROSE

GLUCOTROL GLIPIZIDE

GLUCOTROL XL GLIPIZIDE XL

GOLYTELY ORAL COLON LAVAGE SOLN

GRANEX TBO-FILGRASTIM

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

GRANULEX SPRAY TRYPSIN-BALSAM PE

GUAIFENESIN ROBITUSSIN, MUCINEX

H-BIG HEPATITIS B IMMUNE GLOBULIN

HADLIMA ADALIMUMAB

HALDOL HALOPERIDOL

HALDOL DECANOATE HALOPERIDOL DECANOATE

HALOPERIDOL HALDOL

HALOPERIDOL DECANOATE HALDOL DECANOATE

HALOTESTIN FLUOXYMESTERONE CIII

HALOTHANE FLUOTHANE

HARD CONTACT LENS CLEANING & SOAKING SOLUTION

HARVONI (PT MUST BE ON APPROVED PT. LIST) LEDIPASVIR / SOFOSBUVIR

HAVRIX HEPATITIS A VACCINE

HEMLIBRA EMICIZUMAB

HEMORRHOID ANESTHETIC OINT ANUSOL OINTMENT

HEMORRHOID EMOLLIENT OINT PREPARATION H

HEMORRHOIDAL SUPP ANUSOL SUPP

HEPARIN INFUSION

HEPARIN SODIUM INJ

HEPATITIS A VACCINE HAVRIX

HEPATITIS B IMMUNE GLOBULIN H-BIG

HEPATITIS B VACCINE (RECOMB) ENGERIX-B ADULT

HIBICLENS CHLORHEXIDINE GLUCONATE

HOMATROPINE HBR OPHTHALM

HOMATROPINE HYDROBROMIDE ISOPTO HOMATROPINE

HUMIBID GUAIFENESIN

HUMIRA (DER REQUIRED) ADALIMUMAB (DER REQUIRED)

HYALURONATE SOD SODIUM HYALURONATE

HYCAMTIN TOPOTECAN HCI

HYDRALAZINE APRESOLINE

HYDREA HYDROXYUREA

HYDROCHLOROTHIAZIDE HYDRODIURIL, ORETIC

HYDROCORT/HEMORRHOID CREAM ANUSOL-HC CREAM

HYDROCORTISONE 1% 28GM OR 30GM CREAM

HYDROCORTISONE TABLET

HYDROCORTISONE ENEMA CORTENEMA

HYDRODIURIL HYDROCHLOROTHIAZIDE

HYDROGEN PEROXIDE PEROXIDE

HYDROMORPHONE (RMC ONLY) DILAUDID (RMC ONLY)

HYDROPHILIC PETROLATUM- Post Radiation only AQUAPHOR

HYDROXYCHLOROQUINE PLAQUENIL

HYDROXYUREA HYDREA

HYDROXYZINE PAMOATE VISTARIL

Prescription for Atarax & Vistaril will be therapeutically substituted per P & T 10/02/02 approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

HYGROTON, GENERIC CHLORTHALIDONE

HYOSCYAMINE SULFATE LEVSIN

HYPAQUE DIATRIZOATE SODIUM

HYPERTET TETANUS IMMUNE GLOBULIN

HYTRIN (DOT) TERAZOSIN

HYZAAR LOSARTAN/HCTZ

IBRUTINIB IMBRUVICA

IBUPROFEN MOTRIN

(10 DAY LIMIT ON RX OVER 1,200MG/DAY : P&T AUGUST 2010)

(SIX MONTH PRESCRIPTION LIMIT ; P&T NOVEMBER 2008)

IDOXURIDINE HERPLEX, STOXIL

IFEX IFOSFAMIDE

IFOSFAMIDE IFEX

ILOTYCIN OPHTH ERYTHROMYCIN OPHTHALMIC

IMATINIB GLEEVEC

IMITREX SUMATRIPTAN

IMBRUVICA IBRUTINIB

IMDUR ISOSORBIDE MONONITRATE

IMIPENEM/CILASTATIN (DER REQUIRED) PRIMAXIN (DER REQUIRED)

IMMUNE GLOBULIN SANDOGLOBULIN

IMODIUM LOPERAMIDE

IMODIUM AD LOPERAMIDE

IMURAN AZATHIOPRINE

INCRUSE ELLIPTA UMECLIDINIUM

INDAPAMIDE LOZOL

INDERAL, GENERIC PROPRANOLOL HCL

INDERAL LA, GENERIC PROPRANOLOL EXTENDED RELEASE

INDINAVIR CRIXIVAN

INDOCIN (RESTRICTED TO 7 DAYS) INDOMETHACIN

INDOCIN-SR (RESTRICTED TO 7 DAYS) INDOMETHACIN SR

INDOMETHACIN (RESTRICTED TO 7 DAYS) INDOCIN/INDOCIN SR

INFLECTRA (DER REQUIRED) INFLIXIMAB (DER REQUIRED)

INFLIXIMAB (DER REQUIRED) RANFLEXIS, INFLECTRA, REMICADE (DER REQUIRED)

INFLUENZA VIRUS VACCINE FLUZONE

INH ISONIAZID

INSULIN ASPART (DER REQUIRED) NOVOLOG (DER REQUIRED)

INSULIN GLARGINE SEMGLEE

INSULIN, NPH HUMAN

INSULIN, REGULAR HUMAN

INSULIN,HUMAN COMB 70/30

INTAL, CROLOM CROMOLYN SODIUM

INTELENCE ENTRAVIRINE

INTERFERON ALFA-2A REFERON-A

INTERFERON ALFA-2B RECOMBINANT INTRON A

Only approved for Hepatitis C and AIDS related Kaposi’s Sarcoma approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

INTERFERON BETA-1A (DER REQUIRED) AVONEX (DER REQUIRED)

INTERFERON BETA-1B (DER REQUIRED) BETASERON (DER REQUIRED)

INTRALIPID INTRAVENOUS FAT EMULSION

INTRAVENOUS FAT EMULSION NTRALIPID, LIPOSYN

INTRON A INTERFERON ALFA-2B RECOMBINANT

Only approved for Hepatitis C and AIDS related Kaposi’s Sarcoma

INTROPIN DOPAMINE HCL

INVANZ (DER REQUIRED) ERTAPENEM (DER REQUIRED)

INVEGA SUSTENNA (DER)

INVIRASE SAQUINAVIR MESYLATE

IODINE TINCTURE 2%, USP

IODIPAMIDE MEGLUMINE CHOLOGRAFIN MEG

IOHEXOL OMNIPAQUE 240, 300, 350

IOPANOIC ACID TELEPAQUE

IOTHALAMATE MEGLUMINE CYSTO-CONRAY, CONRAY

IPRATROPIUM/ALBUTEROL INHAL. SOL DUONEB

IPRATROPIUM BROMIDE/ALBUTEROL SULF. COMBIVENT

For moderate to severe Asthma only.

IRINOTECAN HCI CAMPTOSAR

IRRIGATION STERILE STERILE WATER FOR IRRIGATION

ISENTRESS RALTEGRAVIR

ISOCAL ENTERAL DIET, ISOTONIC

ISONIAZID INH, NYDRAZID

ISOPROTERENOL ISUPREL

ISOPTO HOMATROPINE HOMATROPINE HYDROBROMIDE

ISOPTOATROPINE ATROPINE SULFATE OPHTH

ISOPTOCARPINE PILOCARPINE HCL (0.5-3%)

ISOPTOCARPINE PILOCARPINE HCL (4-10%)

ISOPTOHYOSCINE SCOPOLAMINE HBR OPHTH

ISORDIL ISOSORBIDE DINITRATE ORAL

ISOSORBIDE DINITRATE ORAL ISORDIL, SORBITRATE

ISOSORBIDE MONONITRATE IMDUR

ISOTONIC NACL SODIUM CHLORIDE INJECTION

ISOVUE-300 IOPAMIDOL

ISUPREL ISOPROTERENOL

IVABRADINE (DER REQUIRED) CORLANOR (DER REQUIRED)

IVERMECTIN STROMECTOL

JARDIANCE EMPAGLIFLOZIN

K-LYTE CL POTASSIUM CHLORIDE

KALETRA LOPINAVIR/RITANAVIR

KAOLIN/PECTIN KAOPECTATE

KAOPECTATE KAOLIN/PECTIN

KAYEXALATE SOD POLYSTYRENE SULFONATE

KEFLEX, GENERIC CEPHALEXIN

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

KEFZOL CEFAZOLIN

KENALOG INJECT TRIAMCINOLONE ACETONIDE INJ

KENALOG PLASIBASE

KEPPRA IR AND XR LEVETIRACETAM IR AND XR

KERALYT SALICYLIC ACID TOPICAL

KETO-STIX

KETOCONAZOLE TOPICAL NIZORAL TOPICAL

KETOROLAC OPHTH ACULAR

KETOROLAC TROMETHAMINE TORADOL IM

Five day maximum duration per prescription.

KONAKION PHYTONADIONE

LACOSAMIDE (DER REQUIRED) VIMPAT (DER REQUIRED)

LACRI-LUBE OCULAR LUBRICANT, STERILE

LACRILUBE PETROLATUM STERILE OPHTH

LACTATED RINGER'S

LACTINEX LACTOBACILLUS ACIDOPHILUS

LACTOBACILLUS ACIDOPHILUS LACTINEX, BACID

LACTULOSE CEPHULAC, CHRONULAC

LAMICTAL LAMOTRIGINE

LAMIVUDINE EPIVIR

LAMOTRIGINE LAMICTAL

LEDIPASVIR / SOFOSBUVIR HARVONI (PT MUST BE ON APPROVED PT. LIST)

LEXAPRO ESCITALOPRAM

LANOXIN DIGOXIN

LANTUS (DER REQUIRED) INSULIN GLARGINE

LASIX, GENERIC FUROSEMIDE

LATANOPROST XALATAN

LENALIDOMIDE REVLIMID

LENS PLUS DAILY CLEANER (SOFT LENSES)

LEUCOVORIN CALCIUM WELLCOVORIN, CITROVORUM FACTOR

LEUKERAN CHLORAMBUCIL

LEUPROLIDE ACETATE ELIGARD ONLY

LEVALBUTEROL HFA INHALER XOPENEX HFA INHALER

(MAXIMUM OF ONE EVERY 90 DAYS UNLESS APPROVED DER) (MAXIMUM OF ONE EVERY 90 DAYS UNLESS APPROVED DER)

LEVAQUIN LEVOFLOXACIN

LEVARTERENOL NOREPINEPHRINE BITARTRATE

LEVETIRACETAM IR AND XR KEPPRA IR AND XR

LEVO-DROMORAN LEVORPHANOL TARTRATE CII

LEVOBUNOLOL OPHTHALMIC BETAGAN

LEVOFLOXACIN LEVAQUIN

LEVOLEUCOVORIN CALCIUM FUSILEV

LEVONORGESTREL PLAN B ONE STEP

LEVOPHED NOREPINEPHRINE BITARTRATE

LEVORPHANOL TARTRATE CII LEVO-DROMORAN

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

LEVOTHROID, LEVOXYL LEVOTHYROXINE

LEVOTHYROXINE SYNTHROID, LEVOTHROID, LEVOXYL

LEVSIN HYOSCYAMINE SULFATE

LEXISCAN REGADENOSON

LEXIVA FOSAMPRENAVIR CALCIUM

LIDOCAINE, CARDIAC INJECTION XYLOCAINE

LIDOCAINE, ORAL XYLOCAINE VISCO, VISCOUS XYLOCAINE

LIDOCAINE, TOPICAL XYLOCAINE JELLY, XYLOCAINE OINT

LIDOCAINE, UNPRESERVED XYLOCAINE

LIDOCAINE, W/EPINEPHRINE XYLOCAINE / EPI

LIDOCAINE, W/PRESERVATIVE XYLOCAINE

LINEZOLID (DER REQUIRED) ZYVOX (DER REQUIRED)

LIORESAL BACLOFEN

LIPASE/AMYLASE/PROTEASE

LIPITOR ATORVASTATIN

LIPOSYN INTRAVENOUS FAT EMULSION

LIPOSYN II FAT EMULSION

LISINOPRIL ZESTRIL

LITHANE LITHIUM CARBONATE

LITHIUM CARBONATE IR AND ER LITHANE, LITHOBID

LITHOBID LITHIUM CARBONATE ER

LOESTRIN 1.5/30 30 MCG ETHINYL ESTRADIOL AND 1.5 MG

NORETHINDRONE

LOMUSTINE CCNU, CEE NU

LONITEN MINOXIDIL

LO OVRAL 30 MCG ETHINYL ESTRADIOL AND 0.3 MG

NORGESTREL

LOPERAMIDE IMODIUM, IMODIUM AD

LOPID (APPROVED DER REQUIRED) GEMFIBROZIL (APPROVED DER REQUIRED)

LOPINAVIR/RITANAVIR KALETRA

LOPRESSOR METOPROLOL TARTRATE

LORATADINE CLARITIN

LORATADINE/PSEUDOEPHEDRINE (DER) CLARTITIN-D (DER)

LORAZEPAM CIV ATIVAN

LOSARTAN COZAAR

LOSARTAN/HCTZ HYZAAR

LOTRIMIN CLOTRIMAZOLE TOPICAL

LOVENOX ENOXAPARIN SODIUM INJECTION

LOZOL INDAPAMIDE

LUBRICANT EYE DROPS EYE DROPS FOR SOFT LENSES

LUBRICATING EYE DROPS CLERZ 2

LUBRIDERM/LUBRISOFT (DER)

LUMATEPERONE (DER) CAPLYTA (DER)

LUMIGAN (DER) BRIMATOPROST (DER)

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

LUMINAL, GENERIC PHENOBARBITAL CIV

MACROBID NITROFLANTOIN MONO/MACRO

MACRODANTIN NITROFURANTOIN MACROCRYSTALS

MAGIC MOUTHWASH DIPHEN/VISCOUS LID/MAALOX

MAGNESIUM CITRATE CITROMA, CITRATE OF MAGNESIA

MAGNESIUM GLUCONATE GENERIC

MAGNESIUM HYDROXIDE SUSP MILK OF MAG, MOM

MAGNESIUM OXIDE GENERIC

MAGNESIUM SULFATE GENERIC

MANDELAMINE METHENAMINE MANDELATE

MARAVIROC SELZENTRY

MARCAINE BUPIVACAINE HCL

MARCAINE/EPINEPHRINE BUPIVICAINE/EPINEPHRINE

MATERNA VITAMINS, PRENATAL

MATULANE PORCARBAZINE HCL

MAVYRET (PT MUST BE ON APPROVED PT. LIST) GLECAPREVIR / PIBRENTASVIR

MAXIDEX DEXAMETHASONE OPHTHALMIC

MAXIPIME () CEFIPIME HCL

MAXZIDE, GENERIC TRIAMTERENE/HCTZ

MD GASTROVIEW GASTROGRAFIN

MECLIZINE HCL BONINE, ANTIVERT

MEDIPLAST SALICYLIC ACID

MEDROXYPROGESTERONE ACETATE PROVERA, DEPO PROVERA

MEFOXIN CEFOXITIN SODIUM

MEGACE MEGESTROL ACETATE

MEGESTROL ACETATE MEGACE

MEKINIST TRAMETINIB DIMETHYL SULFOXIDE

MELATONIN 3MG TABLET MELATONIN 3MG

MELOXICAM MOBIC

MELPHALAN ALKERAN

MEMANTINE NAMENDA

MENADIOL SOD DIPHOSPHATE SYNKAVITE

MENTH/METHYLSALICYLAT CRM ANALGESIC BALM

MENTHOL

MEPERIDINE HCL CII DEMEROL, GENERIC

MEPHYTON PHYTONADIONE

MEPIVACAINE CARBOCAINE

MEPRON ATOVAQUONE

MERCAPTOPURINE PURINETHOL

METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA MIRCERA

MIRCERA METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA

MEROPENEM (DER REQUIRED) MERREM (DER REQUIRED)

MERREM (DER REQUIRED) MEROPENEM (DER REQUIRED)

MESALAMINE ROWASA, ASACOL, PENTASA, DELZICOL

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

MESNA MESNEX

MESNEX MESNA

MESTINON PYRIDOSTIGMINE BROMIDE

METARAMINOL BITARTRATE ARAMINE

METFORMIN HCL GLUCOPHAGE

METFORMIN HYDROCHLORIDE XR GLUCOPHAGE XR

METHENAMINE MANDELATE MANDELAMINE

METHERGINE METHYLERGONOVINE MALEATE

METHIMAZOLE TAPAZOLE

METHOCARBAMOL ROBAXIN

METHOTREXATE AMETHOPTERIN, MEXATE

METHYLCELLULOSE ULTRA TEARS, ARTIFICIAL TEAR

METHYLDOPA ALDOMET

METHYLERGONOVINE MALEATE METHERGINE

METHYLPREDNISOLONE DEPO-MEDROL, SOLU-MEDROL

METICORTEN PREDNISONE

METOCLOPRAMIDE REGLAN

METOPROLOL SUCCINATE TOPROL XL

METOPROLOL TARTRATE LOPRESSOR

METROGEL METRONIDAZOLE VAGINAL

METRONIDAZOLE ORAL 250MG AND 500MG FLAGYL 250MG AND 500MG TABLETS

MEXATE METHOTREXATE

MIACALCIN CALCITONIN

MICAFUNGIN SODIUM (DER REQUIRED) MYCAMINE (DER REQUIRED)

MICONAZOLE-1 COMBO PACK MONISTAT-1 COMBO PACK

MICONAZOLE TOPICAL MONISTAT, GENERIC ONLY

MICRONOR PROGESTERONE ONLY ORAL CONTRACEPTIVE

MIDAZOLAM VERSED

MILK OF MAG MAGNESIUM HYDROXIDE SUSP

MINIPRESS* PRAZOSIN*

*ADDITIONAL APPROVAL FOR MENTAL HEALTH USAGE

MINOXIDIL LONITEN

MIOSTAT CARBACHOL

MIRALAX POLYETHYLENE GLYCOL 3350

MISOPROSTOL CYTOTEC

MITOMYCIN MUTAMYCIN

MMR MUMPS,MEASELS,RUBELLA

MOBIC MELOXICAM

MOISTURE DROPS EYE DROPS FOR SOFT LENSES

MOM MAGNESIUM HYDROXIDE SUSP

MONISTAT, GENERIC MICONAZOLE TOPICAL

MONISTAT-1 COMBO PACK MICONAZOLE-1 COMBO PACK

MONOCLATE-P ANTIHEMOPHILLIC FACTOR (HUMAN)

MONTELUKAST SINGULAIR

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

MORPHINE ORAL S.R. CII ORAMORPH SR ,MS CONTIN

MORPHINE SULFATE CII GENERIC

MOTRIN IBUPROFEN

(10 DAY LIMIT ON RX OVER 1,200MG/DAY : P&T AUGUST 2010)

(SIX MONTH PRESCRIPTION LIMIT ; P&T NOVEMBER 2008)

MS CONTIN MORPHINE ORAL S.R. CII

MSTA MUMPS SKIN TEST ANTIGEN

MUCINEX GUAIFENSIN

MUCOMYST ACETYLCYSTEINE

MULTI-PURPOSE CONTACT LENS SOFT LENSES (RENU)

MULTIVITAMINS IV

MULTIVITAMINS TABLETS (DIALYSIS PT ONLY)

MUMPS, MEASLES, RUBELLA MMR

MUMPS SKIN TEST ANTIGEN MSTA

MUPIROCIN OINTMENT BACTROBAN OINTMENT

MURO 128 SODIUM CHLORIDE 5% OPHTH

MUTAMYCIN MITOMYCIN

MYAMBUTOL ETHAMBUTOL HCL

MYCAMINE (DER REQUIRED) MICAFUNGIN SODIUM (DER REQUIRED)

MYCELEX CLOTRIMAZOLE TOPICAL & TROCHES

MYCIFRADIN NEOMYCIN SULFATE

MYCOBUTIN RIFABUTIN

MYCOPHENOLATE MOFETIL CELLCEPT

MYCOPHENOLIC ACID MYFORTIC

MYCOSTATIN NYSTATIN ORAL

MYCOSTATIN TOP NYSTATIN TOPICAL

MYCOSTATIN VAG NYSTATIN VAGINAL TABLETS

MYDFRIN PHENYLEPHRINE OPHTH SOLN

MYDRIACYL TROPICAMIDE

MYFORTIC MYCOPHENOLIC ACID

MYLICON SIMETHICONE

MYSOLINE PRIMIDONE

NACL FOR IRRIGATION SODIUM CHLORIDE IRRIGATION

NAFCIL NAFCILLIN

NAFCILLIN UNIPEN, NAFCIL

NALOXONE NARCAN

NAMENDA MEMANTINE

NAPROSYN NAPROXEN

NAPROXEN NAPROSYN

NAPROXEN SODIUM ANAPROX, GENERIC ONLY

NARCAN NALOXONE

NATURAL FIBER TABLETS FIBER LAXATIVE TABLETS

NATURAL RUBBER ADHESIVE SKIN BOND CEMENT

NAVANE THIOTHIXENE

NAVELBINE VINORELBINE

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

NEBCIN TOBRAMYCIN

NELFINAVIR VIRACEPT

NEO-SYNEPHRINE PHENYLEPHRINE HCL NASAL

NEO-SYNEPHRINE PHENYLEPHRINE INJECTION

NEOMYCIN / POLYMYXIN / HC OTIC CORTISPORIN OTIC

NEOMYCIN SULFATE MYCIFRADIN

NEORAL CYCLOSPORINE

NEOSAR CYCLOPHOSPHAMIDE

NEOSTIGMINE METHYLSULFATE PROSTIGMIN

NEPHROCAPS (RESTRICTED TO DIALYSIS PATIENTS) VITAMIN B AND C

NESACAINE CHLOROPROCAINE

NESINA ALOGLIPTIN

NETARSUDIL (DER) RHOPRESSA (DER)

NEUPOGEN (DER REQUIRED) FILGRASTIM (DER REQUIRED)

NEUTRA-PHOS

NEVIRAPINE IR VIRAMUNE IR

NEXAVAR SORAFENIB

NIACIN (DER REQUIRED) NICOTINIC ACID, (DER REQUIRED)

NIACIN SUSTAINED RELEASE (DER REQUIRED) NICOBID, GENERIC (DER REQUIRED)

NICOBID (DER REQUIRED) NIACIN SUSTAINED RELEASE (DER REQUIRED)

NICOTINIC ACID, (DER REQUIRED) NIACIN (DER REQUIRED)

NIFEDIPINE NIFEDIPINE

NILSTAT NYSTATIN ORAL

NILSTAT TOPICAL NYSTATIN TOPICAL

NIPRIDE NITROPRUSSIDE SODIUM

NITRO-BID NITROGLYCERIN ORAL

NITRO-DUR NITROGLYCERIN PATCHES

NITROFURANTOIN MACROCRYSTALS MACRODANTIN

NITROFLANTOIN MONO/MACRO MACROBID

NITROGARD NITROGLYCERIN ORAL

NITROGLYCERIN ORAL NITROGARD, NITRO-BID

NITROGLYCERIN PATCHES NITRO-DUR

NITROGLYCERIN SUBLINGUAL NITROSTAT

NITROPRUSSIDE SODIUM NIPRIDE

NITROSTAT NITROGLYCERIN SUBLINGUAL

NIVESTYM FILGRASTIM

NIZORAL TOPICAL KETOCONAZOLE TOPICAL

NOLVADEX TAMOXIFEN CITRATE

NORCURON VECURONIUM BROMIDE

NOREPINEPHRINE BITARTRATE LEVOPHED, LEVARTERENOL

NORMAL SALINE SODIUM CHLORIDE INJECTION

NORVASC AMLODIPINE

NORVIR RITONAVIR

NOVOCAIN PROCAINE HCL

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

NOVOLIN INSULIN HUMAN

NOVOLOG (DER REQUIRED) INSULIN ASPART (DER REQUIRED)

NPLATE ROMIPLOSTIM

NUPERCAINAL DIBUCAINE

NYDRAZID ISONIAZID

NYSTATIN ORAL MYCOSTATIN, NILSTAT

NYSTATIN TOPICAL MYCOSTATIN TOP, NILSTAT TOPICAL

NYSTATIN VAGINAL TABLETS MYCOSTATIN VAG

OCEAN SPRAY SODIUM CHLORIDE (ISOTONIC)

OCTREOTIDE (DER REQURIED) SANDOSTATIN, SANDOSTATIN LAR (DER REQUIRED)

OCUFLOX OFLOXACIN

OCULAR LUBRICANT, STERILE LACRI-LUBE

OCUTRICIN OPHT SOL POLYM/NEOMYCIN/GRAMICIDIN

ODEFSEY EMTRICITABINE/RILPIVIRINE/TENOFOVIR

OFLOXACIN FLOXIN, OCUFLOX

OGEN ESTROPIPATE

OINTMENT BASE-POST RADIATION ONLY AQUAPHOR

OLANZAPINE TABLETS AND ODT ZYPREXA TABLETS

OLUMIAN (DER) BARICITINIB (DER)

OMEPRAZOLE (H. PYLORI TX ONLY) PRILOSEC

OMNICEF CEFDINIR

OMNIPAQUE 300 IOHEXOL

OMNIPAQUE 350 IOHEXOL

OMNISCAN GADODIAMIDE

ONCOVIN VINCRISTINE SULFATE

ONDANSETRON ZOFRAN

ORABASE WITH BENZOCAINE PECTIN/GELATIN/BENZOCAINE ORAL OINT

ORAL COLON LAVAGE SOLN GOLYTELY, COLYTE

ORAMORPH SR MORPHINE SR CII

ORETIC, GENERIC HYDROCHLOROTHIAZIDE

ORTHO-NOVUM 1/35 35 MCG ETHINYL ESTRADIOL AND 1 MG

NORETHINDRONE

ORTHO-NOVUM 7/7/7 PHASE 1 - 35 MCG ETHINYL ESTRADIOL

AND

0.5 MG NORENTHINDRONE//PHASE 2 - 35 MCG

ETHINYL ESTRADIOL AND 0.75 MG

NORETHINDRONE// PHASE 3 - 35 MCG

ETHINYL ESTRADIOL AND 1 MG

NORETHINDRONE

ORTHO TRI-CYCLEN ETHINYL ESTRADIOL AND NORGESTIMATE

OS-CAL CALCIUM CARBONATE

OS-CAL 500 CALCIUM CARBONATE 500

OSMITOL MANNITOL

OSMOLITE HN ENTERAL DIET, ISOTONIC

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

OTEZLA APREMILAST

OTICAIR OTIC SUSP POLYMYXIN/NEOMYCIN/HYDROCOR

OXALIPLATIN ELOXATIN

OXCARBAMAZEPINE (APPROVED FOR MH USEAGE) TRILEPTAL

OXYBUTYNIN (DOT ONLY) DITROPAN (DOT ONLY)

OXYCODONE CII ROXICODONE

OXYMETAZOLINE NASAL

OXYTOCIN PITOCIN

PACE, TICE BCG, THERA CYS BCG INTRAVESICAL

PACLITAXEL TAXOL

P.Z.A. PYRAZINAMIDE U.S.P.

PAMABROM 25 MG & TYLENOL 325 MG CRAMP TABLETS

PAMIDRONATE DISODIUM AREDIA

PANCRELIPASE

PANCURONIUM BR PAVULON

PANTOPRAZOLE PROTONIX

PARAFON FORTE DSC CHLORZOXAZONE

PARICALCITOL ZEMPLAR

PARLODEL BROMOCRIPTINE

PAROXETINE PAXIL

PAXIL PAROXETINE

PECTIN/GELATIN/BENZOCAINE ORAL OINT ORABASE WIT BENZOCAINE

PEDIAMYCIN ERYTHROMYCIN ETHYLSUCCINATE

PEGASYS (REQUIRES RMD APPROVAL) PEGYLATED INTERFERON ALPHA-2A

(REQUIRED RMD APPROVAL)

PEG INTRON (REQUIRES RMD APPROVAL) PEGYLATED INTERFERON ALPHA-2B

(REQUIRED RMD APPROVAL)

PEGYLATED INTERFERON PEGINTERFERON ALPHA 2 A AND ALPHA 2B

(REQUIRED RMD APPROVAL) (REQUIRED RMD APPROVAL)

PEMETREXED DISODIUM ALIMTA

PENICILLIN G, BENZATHINE LA BICILLIN LA

PENICILLIN G, POTASSIUM

PENICILLIN G POTASSIUM PARENTERAL PFIZERPEN

PENICILLIN VK PENICILLIN, V POTASSIUM

PENICILLIN, V POTASSIUM PENICILLIN VK, V-CILLIN K

PENTASA MESALAMINE

PENTOTHAL SODIUM THIOPENTAL SODIUM CIII

PENTOXIFYLLINE TRENTAL

PEPCID FAMOTIDINE

PEPTO BISMOL, PINK BISMUTH BISMUTH SUBSALICYLATE

PERIACTIN CYPROHEPTADINE

PERIDEX ORAL RINSE CHLORHEXIDINE GLUCONATE

PERMETHRIN ELIMITE CREAM/NIX CREAM RINSE

PEROXIDE HYDROGEN PEROXIDE

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

PERPHENAZINE TRILAFON

PETROLATUM STERILE OPHTH LACRILUBE

PFIZERPEN PENICILLIN G POTASSIUM PARENTERAL

PHENAZOPYRIDINE PYRIDIUM

PHENERGAN (DOT ONLY) PROMETHAZINE HCL (DOT ONLY)

PHENOBARBITAL CIV LUMINAL, GENERIC

PHENOL CARBOLIC ACID

PHENYLEPHRINE HCL NASAL NEO-SYNEPHRINE

PHENYLEPHRINE INJECTION NEO-SYNEPHRINE

PHENYTOIN DILANTIN

PHOSLO CALCIUM ACETATE

PHOSPHATE INORGANIC ENEMA FLEET ENEMA

PHYSOSTIGMINE SALICYLATE ESERINE, ANTILIRIUM

PHYTONADIONE MEPHYTON

PILOCAR PILOCARPINE HCL (0.5-3%)

PILOCAR PILOCARPINE HCL (4-10%)

PILOCARPINE HCL SALAGEN

PILOCARPINE HCL (0.5-3%) ISOPTOCARPINE, PILOCAR

PILOCARPINE HCL (4-10%) ISOPTOCARPINE, PILOCAR

PINK BISMUTH, PEPTO BISMOL, BISMUTH SUBSALICYLATE

PIPERACILLIN/TAZOBACTAM() ZOSYN

PITOCIN OXYTOCIN

PITRESSIN VASOPRESSIN

PLAN B ONE STEP LEVONORGESTREL

PLAQUENIL HYDROXYCHLOROQUINE

PLASMA PROTEIN FRACTION 5% PLASMA-PLEX, PLASMANATE

PLASMA-PLEX PLASMA PROTEIN FRACTION 5%

PLASMANATE PLASMA PROTEIN FRACTION 5%

PLATINOL CISPLATIN

PLAVIX CLOPIDOGREL

PLICAMYCIN MITHRAMYCIN

PNEUMOCOCCAL VACCINE PNU-IMUNE 23, PNEUMOVAX 23,PREVNAR 20,CAPVAXIVE

PNEUMOVAX 23 PNEUMOCOCCAL VACCINE

PNU-IMUNE 23 PNEUMOCOCCAL VACCINE

PODOFILOX SOLUTION CONDYLOX TOPICAL SOLUTION

POLYCILLIN AMPICILLIN

POLYCARBOPHIL FIBER LAX TABLETS

POLYETHYLENE GLYCOL 3350 MIRALAX

POLYMYXIN B SULFATE AEROSPORIN

POLYMYXIN/BACITRACIN OINT POLYSPORIN OINT

POLYMYXIN/BACITRACIN OPHT POLYSPORIN OPHT OINT

POLYSPORIN OINT POLYMYXIN/BACITRACIN OINT

POLYSPORIN OPHT OINT POLYMYXIN/BACITRACIN OPHT

POLYTAR TAR SHAMPOO

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

POLYVINYL ALCOHOL ARTIFICIAL TEAR, BH WETTING SOLN

PONTOCAINE TETRACAINE

PONTOCAINE OPHTH TETRACAINE HCL 0.5% OPHTH

POTASSIUM CHLORIDE K-LYTE/CL, SLOW-K

POTASSIUM NITRATE/SODIUM MONOFLUORO- SENSODYNE, DESENSITIZING TOOTHPASTE

PHOSPHATE

POTASSIUM PHOSPHATE INJ

POVIDONE-IODINE TOPICAL BETADINE, EFODINE

PPD TUBERCULIN INJECTION

PRAMOXINE PROCTOFOAM

PRAMOXINE HCL 1% W/HYDROCOR GENERIC ONLY, PROCTOFOAM HC

PRAVACHOL PRAVASTATIN

PRAVASTATIN PRAVACHOL

PRAZOSIN* MINIPRESS*

*ADDITIONAL APPROVAL FOR MENTAL HEALTH USAGE

PRED FORTE PREDNISOLONE ACETATE OPHT

PRED MILD PREDNISOLONE ACETATE OPHT

PRED/NEOMYCIN/POLYMYXIN POLY PRED

PREDNISOLONE ACETATE OPHT PRED MILD, PRED FORTE

PREDNISONE METICORTEN, DELTASONE

PREMARIN CREAM ESTROGENIC SUBST CONJ CRM

PREPARATION H HEMORRHOID EMOLLIENT OINT

PRESERVISION ARED 2 CAPSULE

PREVNAR 13 PNEUMOCOCCAL VACCINE

PREZCOBIX DARUNAVIR AND COBICISTAT

PRIFTIN RIFAPENTIN

PRILOSEC (H.PYLORI TX ONLY) OMEPRAZOLE (H. PYLORI TX ONLY)

PRIMAXIN (DER REQUIRED) IMIPENEM/CILASTATIN (DER REQUIRED)

PRIMIDONE MYSOLINE

PREZISTA DARUNAVIR

PROCAINAMIDE HCL PRONESTYL, PROCAN SR

PROCAINE HCL NOVOCAIN

PROCAN SR PROCAINAMIDE HCL

PROCRIT EPOETIN ALFA

PROCTOFOAM PRAMOXINE

PROCTOFOAM HC PRAMOXINE W/ HC

PROGESTERONE INJECTION

PROGRAF (DER REQUIRED) TACROLIMUS (DER REQUIRED)

PROLASTIN (REQUIRES APPROVED DER) ALPHA1-PROTEINASE INHIBITOR [HUMAN]

(REQUIRES APPROVED DER)

PROLIXIN DECANOATE FLUPHENAZINE DECANOATE

PROLIXIN FLUPHENAZINE HCL

PROLOPRIM TRIMETHOPRIM

PROMACTA ELTROMBOPAG

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

PROMETHAZINE HCL (DOT ONLY) PHENERGAN (DOT ONLY)

PRONESTYL PROCAINAMIDE HCL

PROPINE DIPIVEFRIN HCL OPHTH

PROPRANOLOL EXTENDED RELEASE INDERAL LA, GENERIC

PROPRANOLOL HCL INDERAL, GENERIC

PROPYLTHIOURACIL PTU

PROSCAR FINASTERIDE

PROSTIGMIN NEOSTIGMINE METHYLSULFATE

PROSTIN E2 DINOPROSTONE

PROSTIN F2 ALPHA DINOPROST TROMETHAMINE

PROTAMINE SULFATE

PROTONIX PANTOPRAZOLE

PROTOSTAT METRONIDAZOLE ORAL

PROVERA MEDROXYPROGESTERONE ACETATE

PSYLLIUM FIBER LAX TABLETS

PULMOCARE ENTERAL DIET, COMPLETE PULM/DIABET

PURINETHOL MERCAPTOPURINE

PYRAZINAMIDE U.S.P. P.Z.A.

PYRETHRINS RID SHAMPOO

PYRIDIUM PHENAZOPYRIDINE

PYRIDOSTIGMINE BROMIDE MESTINON

PYRIDOXINE (WITH INH) (MENTHAL HEALTH) VITAMIN B-6 (WITH INH) (MENTAL HEALTH)

PYRIMETHAMINE DARAPRIM

QUELICIN SUCCINYLCHOLINE CHLORIDE

RABIES VACCINE RABIES VACCINE

RADICAVA (DER REQUIRED) EDARAVONE (DER REQUIRED)

RANOLAZINE RANEXA

RAPAMUNE (DER REQUIRED) SIROLIMUS (DER REQUIRED)

RAZADYNE GALANTAMINE

REGLAN METOCLOPRAMIDE

RALTEGRAVIR ISENTRESS

REMDESIVIR (RMC ONLY) VEKLURY (RMC ONLY)

RANEXA RANOLAZINE

RANFLEXIS (DER REQUIRED) INFLIXIMAB (DER REQUIRED)

REGADENOSON LEXISCAN

REMICADE (DER REQUIRED) INFLIXIMAB (DER REQUIRED)

RENO-M-30 DIATRIZOATE MEGLUMINE

RENO-M-60 DIATRIZOATE MEGLUMINE

RENU (BAUSCH & LOMB) SOFT LENS REWETTING DROPS

RENVELA SEVELAMER CARBONATE

RETACRIT EPOETIN ALFA-EPBX

RETROVIR ZIDOVUDINE

REVLIMID LENALIDOMIDE

REYATAZ ATAZANAVIR SULFATE

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

RH-O (D) IMMUNOGLOBULIN RHOGAM, GAMMULIN RH

RHOGAM RH-O (D) IMMUNOGLOBULIN

RHOPRESSA (DER) NETARSUDIL (DER)

RIBAVIRIN (DER REQUIRED) VIRAZOLE (DER REQUIRED)

RIFABUTIN MYCOBUTIN

RIFADIN (TB TREATMENT ONLY) RIFAMPIN (TB TREATMENT ONLY)

RIFAMPIN (TB TREATMENT ONLY) RIFADIN, RIMACTANE (TB TX ONLY)

RIFAPENTIN PRIFTIN

RIFAXIMIN (DER REQUIRED) XIFAXAN (DER REQUIRED)

RIGID GAS PERMEABLE BOSTON CLEANER DAILY

RIGID GAS PERMEABLE BOSTON CONDITIONING SOLUTION

RILPIVIRINE EDURANT

RILPIVIRINE/EMTRICITABINE/TENOFOVIR COMPLERA

RIMACTANE (TB TREATMENT ONLY) RIFAMPIN (TB TREATMENT ONLY)

RISPERDAL CONSTA RISPERIDONE INJECTION

RISPERDAL ORAL RISPERIDONE ORAL

RISPERIDONE ORAL RISPERDAL ORAL

RISPERIDONE INJECTION RISPERDAL CONSTA

RITONAVIR NORVIR

RITUXAN (DER REQUIRED) RITUXIMAB (DER REQUIRED)

RITUXIMAB (DER REQUIRED) RITUXAN (DER REQUIRED)

RIVASTIGMINE EXELON

ROBAXIN METHOCARBAMOL

ROBITUSSIN, GUAIFENESIN

ROCALTROL CALCITRIOL

ROCEPHIN CEFTRIAXONE

ROFERON-A INTERFERON ALFA-2A

ROMAZICON FLUMAZENIL

ROMIPLOSTIM NPLATE

(ONLY WITH APPROVAL OF THE DC OHS DIRECTOR OF MEDICAL SERVICES OR DESIGNEE)

ROWASA MESALAMINE

ROXICODONE OXYCODONE CII

S.A.S.-500 SULFASALAZINE

SACUBITRIL/VALSARTAN (DER REQUIRED) ENTRESTO (DER REQUIRED)

SALAGEN PILOCARPINE HCL

SALICYLIC ACID DUOFILM, MEDIPLAST

SALICYLIC ACID TOPICAL KERALYT

SALSALATE DISALCID, GENERIC

SANDIMMUNE CYCLOSPORINE

SANDOGLOBULIN IMMUNE GLOBULIN

SANDOSTATIN, SANDOSTATIN LAR (DER REQUIRED) OCTREOTIDE (DER REQURIED)

SANTYL COLLAGENASE

SAQUINAVIR FORTOVASE

SAQUINAVIR MESYLATE INVIRASE

approved by the RMED (Medical) or RMHC (Mental Health) or designee and filed with the designated FDC Pharmacy. It is DC policy that Brand name drugs are considered non-formulary when there is a generic equivalent

SCOPOLAMINE HBR OPHTH ISOPTOHYOSCINE

SEASONIQUE ETHINYL ESTRADIOL AND LEVONORGESTREL

SELENIUM SULFIDE, GENERIC ONLY SELSUN LOTION,/SHAMPOO GENERIC ONLY

SELSUN LOTION/ SHAMPOO SELENIUM SULFIDE

SELZENTRY MARAVIROC

SEMGLEE INSULIN GLARGINE

SENNA CONCENTRATE SENOKOT

SENOKOT SENNA CONCENTRATE

SENSIPAR CINACALCET

SENSITIVE EYES CONTACT LENS SOLUTION

SENSODYNE POTASSIUM NITRATE/ SODIUM

MONOFLUOROPHOSPHATE

SENSORCAINE BUPIVACAINE HCL

SEPTRA INJ COTRIMOXAZOLE INJ

SEPTRA ORAL COTRIMOXAZOLE ORAL (TMP-SMX)

SERTRALINE HCL ZOLOFT

SEVELAMER CARBONATE RENVELA

SHINGRIX ZOSTER VACCINE (RECOMBINANT)

SHOHL’S SOLN SOD CITRATE/CITRIC ACID

SILVADENE CREAM SILVER SULFADIAZINE 1% CR

SILVER SULFADIAZINE 1% CR SILVADENE CREAM, SSD CREAM

SIMETHICONE MYLICON

SINEMET…