Attachment M - Census Data - KEHP Formulary Disruption Final.xlsx
XLSX spreadsheet 1 MB Posted
- Attached to
- Pharmacy Benefits Manager (PBM)
- Solicitation number
- RFP-758-2500000221-3
- Issued by
- Kentucky
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment F - Mandatory Requirements - PBM RFP 2025.xlsx | XLSX spreadsheet | |
| Attachment C - Prescriptions Filled from Nov 2023 through Oct 2024.pdf | ||
| Attahment K - BAA.pdf | ||
| Attachment O - Census Data - KEHP Rx Plan Designs 2024.xlsx | XLSX spreadsheet | |
| Attachment N - Census Data - KEHP Network Disruption Final.xlsx | XLSX spreadsheet | |
| Attachment B - Cost Form - PBM RFP 2025.xlsx | XLSX spreadsheet | |
| Final_RFP_758_2500000221_1_SO_FORM.PDF | ||
| Attachment J -DEI Billing Procedure Document.pdf | ||
| Final_RFP_758_2500000221_3_SO_FORM.PDF | ||
| Final_RFP_758_2500000221_2_SO_FORM.PDF | ||
| Attachment H - Technical Questionnaire - PBM RFP 2025.xlsx | XLSX spreadsheet | |
| Attachment L - KEHP Pharmacy Claims Invoicing Document - PBM RFP 2025.xlsx | XLSX spreadsheet | |
| Attachment I - KEHP Data Integration Chart - PBM RFP 2025.xlsx | XLSX spreadsheet | |
| Attachment P - Census Data - KEHP Rx Plan Designs 2025.xlsx | XLSX spreadsheet |
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Text version
Summary
| Client Name: | Commonwealth of Kentucky |
| Data Range: | November 1, 2023 - October 31, 2024 |
| Current Formulary: | Exclusions-Based |
| Formulary to Use: | Exclusions-Based |
Directions: Please summarize the results for ALL DRUGS.
Positive = Drugs that move from Non-Formulary to Formulary status Negative = Drugs that move from Formulary to Non-Formulary status Excluded = Drugs that move from Formulary or Non Formulary to a Proposed Excluded status No Change = Drugs that have the same Current and Proposed Status
| Formulary Without Exclusions | Formulary With Exclusions | |||||||
| (Proposed Formulary) | (Proposed Formulary) | |||||||
| No Change | Positive | Negative | No Change | Positive | Negative | Excluded | ||
| # Rxs | 0 | 0 | 0 | # Rxs | 0 | 0 | 0 | 0 |
| % | 0.00% | 0.00% | 0.00% | % | 0.00% | 0.00% | 0.00% | 0.00% |
Directions: Please summarize the results for SPECIALTY MEDICATIONS ONLY.
Positive = Drugs that move from Non-Formulary to Formulary status Negative = Drugs that move from Formulary to Non-Formulary status Excluded = Drugs that move from Formulary or Non Formulary to a Proposed Excluded status No Change = Drugs that have the same Current and Proposed Status
| Formulary Without Exclusions | Formulary With Exclusions | |||||||
| (Proposed Formulary) | (Proposed Formulary) | |||||||
| No Change | Positive | Negative | No Change | Positive | Negative | Excluded | ||
| # Rxs | 0 | 0 | 0 | # Rxs | 0 | 0 | 0 | 0 |
| % | 0.00% | 0.00% | 0.00% | % | 0.00% | 0.00% | 0.00% | 0.00% |
| Directions: Please summarize the results for NON-SPECIALTY MEDICATIONS ONLY. |
Positive = Drugs that move from Non-Formulary to Formulary status Negative = Drugs that move from Formulary to Non-Formulary status Excluded = Drugs that move from Formulary or Non Formulary to a Proposed Excluded status No Change = Drugs that have the same Current and Proposed Status
| Formulary Without Exclusions | Formulary With Exclusions | |||||||
| (Proposed Formulary) | (Proposed Formulary) | |||||||
| No Change | Positive | Negative | No Change | Positive | Negative | Excluded | ||
| # Rxs | 0 | 0 | 0 | # Rxs | 0 | 0 | 0 | 0 |
| % | 0.00% | 0.00% | 0.00% | % | 0.00% | 0.00% | 0.00% | 0.00% |
Formulary Disruption Client Name: Commonwealth of Kentucky Directions: Please complete the chart below with your proposed formulary using the data provided. Enter the name of your proposed formulary in cells G8 and/or L8.
Impact: Based on Current Formulary Status to Proposed Fromulary Status Positive = Drugs that move from Non-Formulary to Formulary status Negative = Drugs that move from Formulary to Non-Formulary status Excluded = Drugs that move from Formulary or Non Formulary to a Proposed Excluded status No Change = Drugs that have the same Current and Proposed Status
| Data Range: | November 1, 2023 - October 31, 2024 |
| Current Formulary: | Exclusions-Based |
| Formulary to Use: | Exclusions-Based |
| Formulary Without Exclusions | Formulary With Exclusions | |||||||||||||||
| *Do Not Copy Over Row 10 Example | (Proposed Formulary) | (Proposed Formulary) | ||||||||||||||
| NDC | Drug Name | Rxs | OTC (Y/N) | Acute / | ||||||||||||
| Maintenance | Current Formulary Status | Proposed Formulary Status (Formulary, Non-Formulary, or Excluded) | Proposed Tier (1,2,3) | Impact (Positive/Negative/ Excluded/No Change) | Specialty Indicator (Y/N) | List Alternatives if Negative | Proposed Formulary Status | Proposed Tier (1,2,3, Excluded) | Impact | |||||||
| (Positive/Negative/ Excluded/No Change) | Specialty Indicator (Y/N) | List Alternatives if Negative/Excluded | ||||||||||||||
| 0000000000 | Example | 5 | Y | Acute | Formulary | Non-Formulary | 3 | Negative | Y | OTC Available | Excluded | Excluded | Excluded | Y | OTC Available | |
| 60505082901 | FLUTICASONE PROPIONATE | 28483 | N | Acute | Formulary | |||||||||||
| 00169452414 | WEGOVY | 27888 | N | Maint | Excluded | |||||||||||
| 31722072610 | MONTELUKAST SODIUM | 26839 | N | Maint | Formulary | |||||||||||
| 42806040021 | METHYLPREDNISOLONE DOSE P | 22819 | N | Acute | Formulary | |||||||||||
| 00169413013 | OZEMPIC | 22775 | N | Maint | Formulary | |||||||||||
| 00169418113 | OZEMPIC | 20761 | N | Maint | Formulary | |||||||||||
| 00054327099 | FLUTICASONE PROPIONATE | 19667 | N | Acute | Formulary | |||||||||||
| 00169477212 | OZEMPIC | 19666 | N | Maint | Formulary | |||||||||||
| 69452015120 | VITAMIN D | 19333 | N | Maint | Formulary | |||||||||||
| 42806054701 | VITAMIN D | 19002 | N | Maint | Formulary | |||||||||||
| 68180096301 | ALBUTEROL SULFATE HFA | 16415 | N | Maint | Formulary | |||||||||||
| 70010049105 | METFORMIN HYDROCHLORIDE E | 15872 | N | Maint | Formulary | |||||||||||
| 68180098003 | LISINOPRIL | 15114 | N | Maint | Formulary | |||||||||||
| 65862050320 | AMOXICILLIN/CLAVULANATE P | 14494 | N | Acute | Formulary | |||||||||||
| 70954006020 | PREDNISONE | 13311 | N | Acute | Formulary | |||||||||||
| 68462015713 | ONDANSETRON ODT | 12919 | N | Acute | Formulary | |||||||||||
| 08627005303 | DEXCOM G6 SENSOR | 12908 | N | Maint | Formulary | |||||||||||
| 68382005105 | MELOXICAM | 12759 | N | Maint | Formulary | |||||||||||
| 00002149580 | MOUNJARO | 12626 | N | Maint | Formulary | |||||||||||
| 65862001501 | AMOXICILLIN | 12532 | N | Acute | Formulary | |||||||||||
| 68180098103 | LISINOPRIL | 12397 | N | Maint | Formulary | |||||||||||
| 00310621030 | FARXIGA | 11735 | N | Maint | Formulary | |||||||||||
| 00169451714 | WEGOVY | 11730 | N | Maint | Excluded | |||||||||||
| 42571012290 | LEVOCETIRIZINE DIHYDROCHL | 11629 | N | Maint | Formulary | |||||||||||
| 67877054360 | CEFDINIR | 11013 | N | Acute | Formulary | |||||||||||
| 00172208380 | HYDROCHLOROTHIAZIDE | 10781 | N | Maint | Formulary | |||||||||||
| 00597015330 | JARDIANCE | 10672 | N | Maint | Formulary | |||||||||||
| 00186037020 | SYMBICORT | 10544 | N | Maint | Formulary | |||||||||||
| 57237000511 | FLUCONAZOLE | 10446 | N | Acute | Formulary | |||||||||||
| 68180072003 | AMLODIPINE BESYLATE | 10319 | N | Maint | Formulary | |||||||||||
| 29300012810 | HYDROCHLOROTHIAZIDE | 10271 | N | Maint | Formulary | |||||||||||
| 68180072103 | AMLODIPINE BESYLATE | 9914 | N | Maint | Formulary | |||||||||||
| 00430042014 | LO LOESTRIN FE | 9785 | N | Maint | Formulary | |||||||||||
| 00002148480 | MOUNJARO | 9778 | N | Maint | Formulary | |||||||||||
| 69097014260 | ALBUTEROL SULFATE HFA | 9183 | N | Maint | Formulary | |||||||||||
| 08627007701 | DEXCOM G7 SENSOR | 9154 | N | Maint | Formulary | |||||||||||
| 69097083412 | SERTRALINE HCL | 9083 | N | Maint | Formulary | |||||||||||
| 00002150680 | MOUNJARO | 8924 | N | Maint | Formulary | |||||||||||
| 00093317431 | ALBUTEROL SULFATE HFA | 8895 | N | Maint | Excluded | |||||||||||
| 00003089421 | ELIQUIS | 8807 | N | Maint | Formulary | |||||||||||
| 65862057490 | MONTELUKAST SODIUM | 8777 | N | Maint | Formulary | |||||||||||
| 68180097903 | LISINOPRIL | 8625 | N | Maint | Formulary | |||||||||||
| 65862056099 | PANTOPRAZOLE SODIUM | 8557 | N | Maint | Formulary | |||||||||||
| 59746000103 | METHYLPREDNISOLONE DOSE P | 8538 | N | Acute | Formulary | |||||||||||
| 00054074287 | ALBUTEROL SULFATE HFA | 8375 | N | Maint | Formulary | |||||||||||
| 00088221905 | LANTUS SOLOSTAR | 8334 | N | Maint | Formulary | |||||||||||
| 31722070110 | LOSARTAN POTASSIUM | 8063 | N | Maint | Formulary | |||||||||||
| 00169450114 | WEGOVY | 7935 | N | Acute | Excluded | |||||||||||
| 65862042005 | SULFAMETHOXAZOLE/TRIMETHO | 7905 | N | Acute | Formulary | |||||||||||
| 00002143611 | EMGALITY | 7795 | N | Maint | Formulary | |||||||||||
| 64380073706 | VITAMIN D | 7730 | N | Maint | Formulary | |||||||||||
| 00002250680 | ZEPBOUND | 7533 | N | Acute | Excluded | |||||||||||
| 00781261305 | AMOXICILLIN | 7477 | N | Acute | Formulary | |||||||||||
| 68180035302 | SERTRALINE HYDROCHLORIDE | 7394 | N | Maint | Formulary | |||||||||||
| 31722070210 | LOSARTAN POTASSIUM | 7360 | N | Maint | Formulary | |||||||||||
| 00002147180 | MOUNJARO | 7357 | N | Maint | Formulary | |||||||||||
| 52817033200 | CYCLOBENZAPRINE HYDROCHLO | 7348 | N | Acute | Formulary | |||||||||||
| 68180035202 | SERTRALINE HCL | 7262 | N | Maint | Formulary | |||||||||||
| 13668001005 | CITALOPRAM HYDROBROMIDE | 7258 | N | Maint | Formulary | |||||||||||
| 00002249580 | ZEPBOUND | 7179 | N | Maint | Excluded | |||||||||||
| 43547028111 | ESCITALOPRAM OXALATE | 7133 | N | Maint | Formulary | |||||||||||
| 00406012305 | HYDROCODONE BITARTRATE/AC | 7132 | N | Acute | Formulary | |||||||||||
| 00093310905 | AMOXICILLIN | 6964 | N | Acute | Formulary | |||||||||||
| 65862064169 | AZITHROMYCIN | 6924 | N | Acute | Formulary | |||||||||||
| 00169750111 | NOVOLOG | 6906 | N | Maint | Formulary | |||||||||||
| 69097083512 | SERTRALINE HYDROCHLORIDE | 6881 | N | Maint | Formulary | |||||||||||
| 68462039710 | OMEPRAZOLE | 6802 | N | Maint | Formulary | |||||||||||
| 42192060716 | BROMPHEN/PSEUDOEPHEDRINE | 6635 | N | Acute | Formulary | |||||||||||
| 67877021905 | CEPHALEXIN | 6600 | N | Acute | Formulary | |||||||||||
| 08627001601 | DEXCOM G6 TRANSMITTER | 6583 | N | Maint | Formulary | |||||||||||
| 29300012510 | MELOXICAM | 6569 | N | Maint | Formulary | |||||||||||
| 55111014512 | FLUCONAZOLE | 6490 | N | Acute | Formulary | |||||||||||
| 23155000810 | HYDROCHLOROTHIAZIDE | 6479 | N | Maint | Formulary | |||||||||||
| 70436015542 | PROMETHAZINE DM | 6456 | N | Acute | Formulary | |||||||||||
| 29300024505 | BUSPIRONE HYDROCHLORIDE | 6452 | N | Maint | Formulary | |||||||||||
| 43547035311 | LISINOPRIL | 6452 | N | Maint | Formulary | |||||||||||
| 68001033408 | LISINOPRIL | 6393 | N | Maint | Formulary | |||||||||||
| 50458057930 | XARELTO | 6373 | N | Maint | Formulary | |||||||||||
| 59651036205 | IBUPROFEN | 6309 | N | Maint | Formulary | |||||||||||
| 29300039710 | AMLODIPINE BESYLATE | 6306 | N | Maint | Formulary | |||||||||||
| 00169450514 | WEGOVY | 6297 | N | Acute | Excluded | |||||||||||
| 68180051303 | LISINOPRIL | 6258 | N | Maint | Formulary | |||||||||||
| 43547028211 | ESCITALOPRAM OXALATE | 6237 | N | Maint | Formulary | |||||||||||
| 31722055190 | LEVOCETIRIZINE DIHYDROCHL | 6227 | N | Maint | Formulary | |||||||||||
| 00781808926 | AZITHROMYCIN | 6208 | N | Acute | Formulary | |||||||||||
| 13668013610 | ESCITALOPRAM OXALATE | 6195 | N | Maint | Formulary | |||||||||||
| 50111056003 | TRAZODONE HYDROCHLORIDE | 6160 | N | Maint | Formulary | |||||||||||
| 68382013210 | TAMSULOSIN HYDROCHLORIDE | 6156 | N | Maint | Formulary | |||||||||||
| 65862064163 | AZITHROMYCIN | 6131 | N | Acute | Formulary | |||||||||||
| 00574110416 | BROMPHEN/PSEUDOEPHEDRINE | 6097 | N | Acute | Formulary | |||||||||||
| 00169452514 | WEGOVY | 6091 | N | Acute | Excluded | |||||||||||
| 00555901658 | SPRINTEC 28 | 5967 | N | Maint | Formulary | |||||||||||
| 00169633910 | NOVOLOG FLEXPEN | 5861 | N | Maint | Formulary | |||||||||||
| 69238183107 | LEVOTHYROXINE SODIUM | 5859 | N | Maint | Formulary | |||||||||||
| 16571086350 | BUPROPION HYDROCHLORIDE E | 5848 | N | Maint | Formulary | |||||||||||
| 31722071310 | PANTOPRAZOLE SODIUM | 5838 | N | Maint | Formulary | |||||||||||
| 29300039810 | AMLODIPINE BESYLATE | 5727 | N | Maint | Formulary | |||||||||||
| 43547035411 | LISINOPRIL | 5622 | N | Maint | Formulary | |||||||||||
| 65862007101 | AMOXICILLIN | 5553 | N | Acute | Formulary | |||||||||||
| 00597015230 | JARDIANCE | 5550 | N | Maint | Formulary | |||||||||||
| 60505257908 | ATORVASTATIN CALCIUM | 5487 | N | Maint | Formulary | |||||||||||
| 70010006310 | METFORMIN HYDROCHLORIDE | 5465 | N | Maint | Formulary | |||||||||||
| 65862017760 | CEFDINIR | 5413 | N | Acute | Formulary | |||||||||||
| 27808023302 | DOXYCYCLINE HYCLATE | 5387 | N | Acute | Formulary | |||||||||||
| 68462039610 | OMEPRAZOLE | 5365 | N | Maint | Formulary | |||||||||||
| 65862001705 | AMOXICILLIN | 5334 | N | Acute | Formulary | |||||||||||
| 00093314705 | CEPHALEXIN | 5312 | N | Acute | Formulary | |||||||||||
| 00228282011 | HYDROCHLOROTHIAZIDE | 5293 | N | Maint | Formulary | |||||||||||
| 68001036103 | MONTELUKAST SODIUM | 5285 | N | Maint | Formulary | |||||||||||
| 72511076002 | REPATHA SURECLICK | 5277 | N | Maint | Formulary | |||||||||||
| 16571086250 | BUPROPION HYDROCHLORIDE E | 5276 | N | Maint | Formulary | |||||||||||
| 55111018010 | TIZANIDINE HYDROCHLORIDE | 5260 | N | Acute | Formulary | |||||||||||
| 29300024405 | BUSPIRONE HYDROCHLORIDE | 5224 | N | Maint | Formulary | |||||||||||
| 50111078751 | AZITHROMYCIN | 5190 | N | Acute | Formulary | |||||||||||
| 43547035611 | LISINOPRIL | 5177 | N | Maint | Formulary | |||||||||||
| 16571020150 | DICLOFENAC SODIUM DR | 5173 | N | Maint | Formulary | |||||||||||
| 65862001205 | SERTRALINE HCL | 5134 | N | Maint | Formulary | |||||||||||
| 69238183207 | LEVOTHYROXINE SODIUM | 5096 | N | Maint | Formulary | |||||||||||
| 65862001305 | SERTRALINE HYDROCHLORIDE | 5051 | N | Maint | Formulary | |||||||||||
| 08508300021 | OMNIPOD 5 DEXCOM G7G6 POD | 5048 | N | Maint | Formulary | |||||||||||
| 29300022019 | MONTELUKAST SODIUM | 5042 | N | Maint | Formulary | |||||||||||
| 55111015810 | OMEPRAZOLE | 5015 | N | Maint | Formulary | |||||||||||
| 13668001105 | CITALOPRAM HYDROBROMIDE | 5001 | N | Maint | Formulary | |||||||||||
| 27808005701 | PROMETHAZINE HYDROCHLORID | 4991 | N | Acute | Formulary | |||||||||||
| 68180086111 | AZITHROMYCIN | 4942 | N | Acute | Formulary | |||||||||||
| 00555901858 | TRI-SPRINTEC | 4935 | N | Maint | Formulary | |||||||||||
| 00143988701 | AMOXICILLIN | 4917 | N | Acute | Formulary | |||||||||||
| 68001033508 | LISINOPRIL | 4878 | N | Maint | Formulary | |||||||||||
| 59651021430 | AZELASTINE HYDROCHLORIDE | 4872 | N | Acute | Formulary | |||||||||||
| 00023650110 | UBRELVY | 4870 | N | Acute | Formulary | |||||||||||
| 68180031909 | BUPROPION HYDROCHLORIDE E | 4797 | N | Maint | Formulary | |||||||||||
| 65862020399 | LOSARTAN POTASSIUM | 4776 | N | Maint | Formulary | |||||||||||
| 50228013690 | LEVOCETIRIZINE DIHYDROCHL | 4740 | N | Maint | Formulary | |||||||||||
| 13668013710 | ESCITALOPRAM OXALATE | 4673 | N | Maint | Formulary | |||||||||||
| 00074709430 | QULIPTA | 4603 | N | Maint | Formulary | |||||||||||
| 31722070010 | LOSARTAN POTASSIUM | 4576 | N | Maint | Formulary | |||||||||||
| 68180047903 | SIMVASTATIN | 4573 | N | Maint | Formulary | |||||||||||
| 00186037220 | SYMBICORT | 4569 | N | Maint | Formulary | |||||||||||
| 65862050301 | AMOXICILLIN/CLAVULANATE P | 4535 | N | Acute | Formulary | |||||||||||
| 55111046605 | METOPROLOL SUCCINATE ER | 4533 | N | Maint | Formulary | |||||||||||
| 00002248480 | ZEPBOUND | 4509 | N | Maint | Excluded | |||||||||||
| 62332025130 | AZITHROMYCIN | 4509 | N | Acute | Formulary | |||||||||||
| 67877032105 | IBUPROFEN | 4498 | N | Maint | Formulary | |||||||||||
| 11534016503 | FOLIC ACID | 4445 | N | Maint | Formulary | |||||||||||
| 00143928501 | AMOXICILLIN | 4418 | N | Acute | Formulary | |||||||||||
| 70700016201 | PROGESTERONE | 4353 | N | Maint | Formulary | |||||||||||
| 65862000899 | METFORMIN HYDROCHLORIDE | 4335 | N | Maint | Formulary | |||||||||||
| 68180032002 | BUPROPION HYDROCHLORIDE E | 4334 | N | Maint | Formulary | |||||||||||
| 60505257808 | ATORVASTATIN CALCIUM | 4301 | N | Maint | Formulary | |||||||||||
| 43547036211 | LOSARTAN POTASSIUM | 4281 | N | Maint | Formulary | |||||||||||
| 68001000501 | METHYLPREDNISOLONE DOSE P | 4281 | N | Acute | Formulary | |||||||||||
| 55111046705 | METOPROLOL SUCCINATE ER | 4143 | N | Maint | Formulary | |||||||||||
| 65702071210 | ACCU-CHEK GUIDE TEST STRI | 4136 | Y | Maint | Formulary | |||||||||||
| 68180051902 | LISINOPRIL/HYDROCHLOROTHI | 4084 | N | Maint | Formulary | |||||||||||
| 68180096603 | LEVOTHYROXINE SODIUM | 4082 | N | Maint | Formulary | |||||||||||
| 57237007710 | ONDANSETRON ODT | 4058 | N | Acute | Formulary | |||||||||||
| 27241009990 | DULOXETINE HYDROCHLORIDE | 4035 | N | Maint | Formulary | |||||||||||
| 00002146080 | MOUNJARO | 4020 | N | Maint | Formulary | |||||||||||
| 00406012405 | HYDROCODONE/ACETAMINOPHEN | 4003 | N | Acute | Formulary | |||||||||||
| 69097015907 | MELOXICAM | 3997 | N | Maint | Formulary | |||||||||||
| 45802046564 | KETOCONAZOLE | 3983 | N | Acute | Formulary | |||||||||||
| 65862039010 | ONDANSETRON ODT | 3965 | N | Acute | Formulary | |||||||||||
| 31722071390 | PANTOPRAZOLE SODIUM | 3940 | N | Maint | Formulary | |||||||||||
| 51672131200 | MUPIROCIN | 3926 | N | Acute | Formulary | |||||||||||
| 43547036111 | LOSARTAN POTASSIUM | 3915 | N | Maint | Formulary | |||||||||||
| 00143924920 | AMOXICILLIN/CLAVULANATE P | 3912 | N | Acute | Formulary | |||||||||||
| 72205000399 | ROSUVASTATIN CALCIUM | 3906 | N | Maint | Formulary | |||||||||||
| 00116200116 | CHLORHEXIDINE GLUCONATE | 3885 | N | Acute | Formulary | |||||||||||
| 00574110404 | BROMPHEN/PSEUDOEPHEDRINE | 3880 | N | Acute | Formulary | |||||||||||
| 64980056210 | FUROSEMIDE | 3874 | N | Maint | Formulary | |||||||||||
| 65862020299 | LOSARTAN POTASSIUM | 3858 | N | Maint | Formulary | |||||||||||
| 47781030301 | NITROFURANTOIN MONOHYDRAT | 3847 | N | Acute | Formulary | |||||||||||
| 00378395105 | ATORVASTATIN CALCIUM | 3843 | N | Maint | Formulary | |||||||||||
| 65862007175 | AMOXICILLIN | 3829 | N | Acute | Formulary | |||||||||||
| 68382091634 | METHYLPREDNISOLONE DOSE P | 3768 | N | Acute | Formulary | |||||||||||
| 69315012710 | FOLIC ACID | 3764 | N | Maint | Formulary | |||||||||||
| 00406012301 | HYDROCODONE BITARTRATE/AC | 3762 | N | Acute | Formulary | |||||||||||
| 59746017509 | PREDNISONE | 3754 | N | Acute | Formulary | |||||||||||
| 50111056001 | TRAZODONE HYDROCHLORIDE | 3751 | N | Maint | Formulary | |||||||||||
| 70756040411 | NITROFURANTOIN MONOHYDRAT | 3724 | N | Acute | Formulary | |||||||||||
| 00002145780 | MOUNJARO | 3707 | N | Maint | Formulary | |||||||||||
| 29300022010 | MONTELUKAST SODIUM | 3694 | N | Maint | Formulary | |||||||||||
| 69238207707 | PROPRANOLOL HYDROCHLORIDE | 3671 | N | Maint | Formulary | |||||||||||
| 69097012715 | AMLODIPINE BESYLATE | 3639 | N | Maint | Formulary | |||||||||||
| 27241009903 | DULOXETINE HYDROCHLORIDE | 3623 | N | Maint | Formulary | |||||||||||
| 29300039705 | AMLODIPINE BESYLATE | 3606 | N | Maint | Formulary | |||||||||||
| 70377007813 | ATORVASTATIN CALCIUM | 3592 | N | Maint | Formulary | |||||||||||
| 00378395005 | ATORVASTATIN CALCIUM | 3577 | N | Maint | Formulary | |||||||||||
| 72205002399 | ATORVASTATIN CALCIUM | 3568 | N | Maint | Formulary | |||||||||||
| 68382056410 | METOPROLOL SUCCINATE ER | 3557 | N | Maint | Formulary | |||||||||||
| 68001048608 | LISINOPRIL | 3549 | N | Maint | Formulary | |||||||||||
| 68382009605 | HYDROXYCHLOROQUINE SULFAT | 3538 | N | Maint | Formulary | |||||||||||
| 00406012505 | HYDROCODONE BITARTRATE/AC | 3535 | N | Acute | Formulary | |||||||||||
| 70700011985 | ESTARYLLA | 3513 | N | Maint | Formulary | |||||||||||
| 69238183407 | LEVOTHYROXINE SODIUM | 3501 | N | Maint | Formulary | |||||||||||
| 70010049110 | METFORMIN HYDROCHLORIDE E | 3485 | N | Maint | Formulary | |||||||||||
| 70010006505 | METFORMIN HYDROCHLORIDE | 3481 | N | Maint | Formulary | |||||||||||
| 55111064505 | OMEPRAZOLE | 3463 | N | Maint | Formulary | |||||||||||
| 53885000810 | ONETOUCH DELICA PLUS LANC | 3458 | Y | Maint | Formulary | |||||||||||
| 23155002910 | FLUOXETINE HYDROCHLORIDE | 3443 | N | Maint | Formulary | |||||||||||
| 72205002499 | ATORVASTATIN CALCIUM | 3434 | N | Maint | Formulary | |||||||||||
| 70700015010 | OMEPRAZOLE | 3373 | N | Maint | Formulary | |||||||||||
| 08290320550 | BD PEN NEEDLE/NANO 2ND GE | 3362 | Y | Maint | Formulary | |||||||||||
| 42806071401 | BENZONATATE | 3361 | N | Acute | Formulary | |||||||||||
| 60505083305 | AZELASTINE HYDROCHLORIDE | 3361 | N | Acute | Formulary | |||||||||||
| 69680011225 | CYANOCOBALAMIN | 3352 | N | Acute | Formulary | |||||||||||
| 68180046403 | SIMVASTATIN | 3307 | N | Maint | Formulary | |||||||||||
| 00093101042 | MUPIROCIN | 3305 | N | Acute | Formulary | |||||||||||
| 65862007701 | CIPROFLOXACIN HYDROCHLORI | 3269 | N | Acute | Formulary | |||||||||||
| 00378395205 | ATORVASTATIN CALCIUM | 3268 | N | Maint | Formulary | |||||||||||
| 69238183007 | LEVOTHYROXINE SODIUM | 3264 | N | Maint | Formulary | |||||||||||
| 00143988775 | AMOXICILLIN | 3259 | N | Acute | Formulary | |||||||||||
| 65162046650 | IBUPROFEN | 3226 | N | Maint | Formulary | |||||||||||
| 60505258008 | ATORVASTATIN CALCIUM | 3221 | N | Maint | Formulary | |||||||||||
| 50924097110 | ACCU-CHEK SOFTCLIX LANCET | 3191 | Y | Maint | Formulary | |||||||||||
| 67877015905 | METFORMIN HYDROCHLORIDE E | 3173 | N | Maint | Formulary | |||||||||||
| 69315011610 | FUROSEMIDE | 3159 | N | Maint | Formulary | |||||||||||
| 00069532130 | PAXLOVID | 3147 | N | Acute | Formulary | |||||||||||
| 68180088673 | NIKKI | 3126 | N | Maint | Formulary | |||||||||||
| 69097012815 | AMLODIPINE BESYLATE | 3112 | N | Maint | Formulary | |||||||||||
| 65862059805 | TAMSULOSIN HYDROCHLORIDE | 3101 | N | Maint | Formulary | |||||||||||
| 31722095801 | BENZONATATE | 3100 | N | Acute | Formulary | |||||||||||
| 68180096703 | LEVOTHYROXINE SODIUM | 3098 | N | Maint | Formulary | |||||||||||
| 00642747001 | SLYND | 3081 | N | Maint | Excluded | |||||||||||
| 00024591502 | DUPIXENT | 3080 | N | Maint | Formulary | |||||||||||
| 68180012202 | CEPHALEXIN | 3078 | N | Acute | Formulary | |||||||||||
| 65862001005 | METFORMIN HYDROCHLORIDE | 3074 | N | Maint | Formulary | |||||||||||
| 65862052899 | VENLAFAXINE HYDROCHLORIDE | 3073 | N | Maint | Formulary | |||||||||||
| 55111019605 | CLOPIDOGREL | 3064 | N | Maint | Formulary | |||||||||||
| 68001035603 | METOPROLOL SUCCINATE ER | 3063 | N | Maint | Formulary | |||||||||||
| 00002223680 | TRULICITY | 3062 | N | Maint | Formulary | |||||||||||
| 65862018730 | ONDANSETRON HYDROCHLORIDE | 3060 | N | Acute | Formulary | |||||||||||
| 00121075908 | PREDNISOLONE SODIUM PHOSP | 3042 | N | Acute | Formulary | |||||||||||
| 00456120130 | LINZESS | 3038 | N | Maint | Formulary | |||||||||||
| 00378668910 | PANTOPRAZOLE SODIUM | 3020 | N | Maint | Formulary | |||||||||||
| 00115169449 | EPINEPHRINE | 3015 | N | Acute | Formulary | |||||||||||
| 69452017173 | AZITHROMYCIN | 3003 | N | Acute | Formulary | |||||||||||
| 65862035705 | CLOPIDOGREL | 2999 | N | Maint | Formulary | |||||||||||
| 00555088602 | ESTRADIOL | 2998 | N | Maint | Formulary | |||||||||||
| 53885024510 | ONETOUCH ULTRA | 2996 | Y | Maint | Formulary | |||||||||||
| 00169431430 | RYBELSUS | 2977 | N | Maint | Formulary | |||||||||||
| 65862029490 | ROSUVASTATIN CALCIUM | 2973 | N | Maint | Formulary | |||||||||||
| 27241009810 | DULOXETINE HCL | 2946 | N | Maint | Formulary | |||||||||||
| 51991074810 | DULOXETINE HYDROCHLORIDE | 2945 | N | Maint | Formulary | |||||||||||
| 68382004101 | PROMETHAZINE HYDROCHLORID | 2933 | N | Acute | Formulary | |||||||||||
| 68001040008 | FLUOXETINE HYDROCHLORIDE | 2928 | N | Maint | Formulary | |||||||||||
| 68180052002 | LISINOPRIL/HYDROCHLOROTHI | 2920 | N | Maint | Formulary | |||||||||||
| 65702071110 | ACCU-CHEK GUIDE | 2904 | Y | Maint | Formulary | |||||||||||
| 70710113908 | FLUCONAZOLE | 2897 | N | Acute | Formulary | |||||||||||
| 68180051802 | LISINOPRIL/HYDROCHLOROTHI | 2889 | N | Maint | Formulary | |||||||||||
| 50111064803 | FLUOXETINE HYDROCHLORIDE | 2887 | N | Maint | Formulary | |||||||||||
| 65862052890 | VENLAFAXINE HYDROCHLORIDE | 2874 | N | Maint | Formulary | |||||||||||
| 72888000400 | METOPROLOL TARTRATE | 2870 | N | Maint | Formulary | |||||||||||
| 00002143480 | TRULICITY | 2844 | N | Maint | Formulary | |||||||||||
| 65862019399 | FLUOXETINE HYDROCHLORIDE | 2833 | N | Maint | Formulary | |||||||||||
| 70377007713 | ATORVASTATIN CALCIUM | 2829 | N | Maint | Formulary | |||||||||||
| 00093100301 | BUSPIRONE HCL | 2826 | N | Maint | Formulary | |||||||||||
| 66993045730 | DAPAGLIFLOZIN PROPANEDIOL | 2822 | N | Maint | Excluded | |||||||||||
| 16571086850 | GABAPENTIN | 2815 | N | Maint | Formulary | |||||||||||
| 68180031902 | BUPROPION HYDROCHLORIDE E | 2802 | N | Maint | Formulary | |||||||||||
| 43547042150 | LISINOPRIL/HYDROCHLOROTHI | 2800 | N | Maint | Formulary | |||||||||||
| 00093342210 | CYCLOBENZAPRINE HYDROCHLO | 2799 | N | Acute | Formulary | |||||||||||
| 42806041605 | BUPROPION HYDROCHLORIDE E | 2795 | N | Maint | Formulary | |||||||||||
| 60219170705 | PREDNISONE | 2790 | N | Acute | Formulary | |||||||||||
| 42385094711 | METFORMIN HYDROCHLORIDE | 2789 | N | Maint | Formulary | |||||||||||
| 59746017310 | PREDNISONE | 2787 | N | Acute | Formulary | |||||||||||
| 69238183607 | LEVOTHYROXINE SODIUM | 2785 | N | Maint | Formulary | |||||||||||
| 68001036206 | CEFDINIR | 2781 | N | Acute | Formulary | |||||||||||
| 70010006305 | METFORMIN HYDROCHLORIDE | 2765 | N | Maint | Formulary | |||||||||||
| 00093720210 | PRAVASTATIN SODIUM | 2760 | N | Maint | Formulary | |||||||||||
| 61314062810 | POLYMYXIN B SULFATE/TRIME | 2760 | N | Acute | Formulary | |||||||||||
| 00406012401 | HYDROCODONE/ACETAMINOPHEN | 2756 | N | Acute | Formulary | |||||||||||
| 43547028210 | ESCITALOPRAM OXALATE | 2754 | N | Maint | Formulary | |||||||||||
| 00093005405 | BUSPIRONE HYDROCHLORIDE | 2751 | N | Maint | Formulary | |||||||||||
| 29300042010 | AMITRIPTYLINE HYDROCHLORI | 2747 | N | Maint | Formulary | |||||||||||
| 68382080610 | TRAZODONE HYDROCHLORIDE | 2747 | N | Maint | Formulary | |||||||||||
| 72205002299 | ATORVASTATIN CALCIUM | 2739 | N | Maint | Formulary | |||||||||||
| 00169430730 | RYBELSUS | 2724 | N | Maint | Formulary | |||||||||||
| 42571016242 | AMOXICILLIN/CLAVULANATE P | 2724 | N | Acute | Formulary | |||||||||||
| 31722070190 | LOSARTAN POTASSIUM | 2722 | N | Maint | Formulary | |||||||||||
| 00378727253 | NORETHINDRONE | 2721 | N | Maint | Formulary | |||||||||||
| 57237007530 | ONDANSETRON HYDROCHLORIDE | 2718 | N | Acute | Formulary | |||||||||||
| 16729044817 | LEVOTHYROXINE SODIUM | 2714 | N | Maint | Formulary | |||||||||||
| 65862021960 | CEFDINIR | 2712 | N | Acute | Formulary | |||||||||||
| 52937000120 | VASCEPA | 2710 | N | Maint | Excluded | |||||||||||
| 69238207807 | PROPRANOLOL HYDROCHLORIDE | 2709 | N | Maint | Formulary | |||||||||||
| 00555902658 | JUNEL FE 1/20 | 2695 | N | Maint | Formulary | |||||||||||
| 65862069790 | VENLAFAXINE HYDROCHLORIDE | 2693 | N | Maint | Formulary | |||||||||||
| 71288030302 | CYANOCOBALAMIN | 2693 | N | Acute | Formulary | |||||||||||
| 00378623205 | CITALOPRAM HYDROBROMIDE | 2688 | N | Maint | Formulary | |||||||||||
| 13668033005 | TRAZODONE HYDROCHLORIDE | 2683 | N | Maint | Formulary | |||||||||||
| 13811070810 | METHYLPHENIDATE HYDROCHLO | 2679 | N | Maint | Formulary | |||||||||||
| 68462018022 | MUPIROCIN | 2673 | N | Acute | Formulary | |||||||||||
| 65162027250 | SULFAMETHOXAZOLE/TRIMETHO | 2671 | N | Acute | Formulary | |||||||||||
| 00143965901 | TESTOSTERONE CYPIONATE | 2668 | N | Maint | Formulary | |||||||||||
| 68462010530 | ONDANSETRON HYDROCHLORIDE | 2665 | N | Acute | Formulary | |||||||||||
| 13668000905 | CITALOPRAM HYDROBROMIDE | 2659 | N | Maint | Formulary | |||||||||||
| 00093720110 | PRAVASTATIN SODIUM | 2648 | N | Maint | Formulary | |||||||||||
| 43547036011 | LOSARTAN POTASSIUM | 2643 | N | Maint | Formulary | |||||||||||
| 31722070290 | LOSARTAN POTASSIUM | 2638 | N | Maint | Formulary | |||||||||||
| 65862020199 | LOSARTAN POTASSIUM | 2638 | N | Maint | Formulary | |||||||||||
| 53746010901 | HYDROCODONE BITARTRATE/AC | 2631 | N | Acute | Formulary | |||||||||||
| 68382009810 | PAROXETINE HYDROCHLORIDE | 2616 | N | Maint | Formulary | |||||||||||
| 66685100100 | AMOXICILLIN/CLAVULANATE P | 2594 | N | Acute | Formulary | |||||||||||
| 27808015603 | ROSUVASTATIN CALCIUM | 2589 | N | Maint | Formulary | |||||||||||
| 68001033308 | LISINOPRIL | 2583 | N | Maint | Formulary | |||||||||||
| 70954005920 | PREDNISONE | 2575 | N | Acute | Formulary | |||||||||||
| 00006027731 | JANUVIA | 2567 | N | Maint | Excluded | |||||||||||
| 67877026218 | RIZATRIPTAN BENZOATE | 2562 | N | Acute | Formulary | |||||||||||
| 68382005005 | MELOXICAM | 2562 | N | Maint | Formulary | |||||||||||
| 70377000713 | ROSUVASTATIN CALCIUM | 2560 | N | Maint | Formulary | |||||||||||
| 53885027210 | ONETOUCH VERIO TEST STRIP | 2556 | Y | Maint | Formulary | |||||||||||
| 00093770198 | LEVOCETIRIZINE DIHYDROCHL | 2551 | N | Maint | Formulary | |||||||||||
| 00169266015 | TRESIBA FLEXTOUCH | 2547 | N | Maint | Formulary | |||||||||||
| 68382050010 | OMEPRAZOLE | 2544 | N | Maint | Formulary | |||||||||||
| 69097084805 | ESCITALOPRAM OXALATE | 2544 | N | Maint | Formulary | |||||||||||
| 00406012410 | HYDROCODONE/ACETAMINOPHEN | 2543 | N | Acute | Formulary | |||||||||||
| 31722070530 | VALACYCLOVIR HYDROCHLORID | 2541 | N | Acute | Formulary | |||||||||||
| 16571020106 | DICLOFENAC SODIUM DR | 2537 | N | Maint | Formulary | |||||||||||
| 69097042112 | CELECOXIB | 2533 | N | Maint | Formulary | |||||||||||
| 08290320119 | BD PEN NEEDLE/MINI/ULTRA- | 2532 | Y | Maint | Formulary | |||||||||||
| 00456120230 | LINZESS | 2527 | N | Maint | Formulary | |||||||||||
| 23155003005 | FLUOXETINE HYDROCHLORIDE | 2520 | N | Maint | Formulary | |||||||||||
| 68382056510 | METOPROLOL SUCCINATE ER | 2506 | N | Maint | Formulary | |||||||||||
| 13668013601 | ESCITALOPRAM OXALATE | 2493 | N | Maint | Formulary | |||||||||||
| 69097083305 | SERTRALINE HYDROCHLORIDE | 2493 | N | Maint | Formulary | |||||||||||
| 43598083105 | ATORVASTATIN CALCIUM | 2489 | N | Maint | Formulary | |||||||||||
| 43547035211 | LISINOPRIL | 2486 | N | Maint | Formulary | |||||||||||
| 00591292754 | LEVALBUTEROL TARTRATE HFA | 2475 | N | Maint | Formulary | |||||||||||
| 00002247180 | ZEPBOUND | 2473 | N | Maint | Excluded | |||||||||||
| 64980056310 | FUROSEMIDE | 2473 | N | Maint | Formulary | |||||||||||
| 29300035005 | ALLOPURINOL | 2470 | N | Maint | Formulary | |||||||||||
| 00169255013 | TRESIBA FLEXTOUCH | 2465 | N | Maint | Formulary | |||||||||||
| 45802009735 | ESTRADIOL | 2465 | N | Maint | Formulary | |||||||||||
| 69097015915 | MELOXICAM | 2447 | N | Maint | Formulary | |||||||||||
| 42571016201 | AMOXICILLIN/CLAVULANATE P | 2441 | N | Acute | Formulary | |||||||||||
| 65162010250 | GABAPENTIN | 2428 | N | Maint | Formulary | |||||||||||
| 31722001710 | FAMOTIDINE | 2425 | N | Maint | Formulary | |||||||||||
| 31722070590 | VALACYCLOVIR HYDROCHLORID | 2425 | N | Acute | Formulary | |||||||||||
| 59651005205 | EZETIMIBE | 2421 | N | Maint | Formulary | |||||||||||
| 50228014610 | HYDROCHLOROTHIAZIDE | 2416 | N | Maint | Formulary | |||||||||||
| 00555097302 | AMPHETAMINE/DEXTROAMPHETA | 2412 | N | Maint | Formulary | |||||||||||
| 43547028110 | ESCITALOPRAM OXALATE | 2412 | N | Maint | Formulary | |||||||||||
| 00115180301 | HYDROXYZINE PAMOATE | 2409 | N | Acute | Formulary | |||||||||||
| 16714069211 | FLUCONAZOLE | 2408 | N | Acute | Formulary | |||||||||||
| 72618300002 | NURTEC | 2394 | N | Acute | Excluded | |||||||||||
| 00093083205 | CLONAZEPAM | 2393 | N | Acute | Formulary | |||||||||||
| 57237002801 | AMOXICILLIN | 2393 | N | Acute | Formulary | |||||||||||
| 55111029398 | SUMATRIPTAN SUCCINATE | 2371 | N | Acute | Formulary | |||||||||||
| 65862016001 | ZOLPIDEM TARTRATE | 2367 | N | Acute | Formulary | |||||||||||
| 59651039001 | BUSPIRONE HYDROCHLORIDE | 2362 | N | Maint | Formulary | |||||||||||
| 65862069705 | VENLAFAXINE HYDROCHLORIDE | 2356 | N | Maint | Formulary | |||||||||||
| 00597010061 | SPIRIVA RESPIMAT | 2350 | N | Maint | Formulary | |||||||||||
| 00093005401 | BUSPIRONE HYDROCHLORIDE | 2345 | N | Maint | Formulary | |||||||||||
| 00172392670 | DIAZEPAM | 2344 | N | Acute | Formulary | |||||||||||
| 78206014603 | NUVARING | 2343 | N | Maint | Excluded | |||||||||||
| 13811071910 | NITROFURANTOIN MONOHYDRAT | 2337 | N | Acute | Formulary | |||||||||||
| 68645051054 | HYDROCHLOROTHIAZIDE | 2335 | N | Maint | Formulary | |||||||||||
| 00378668977 | PANTOPRAZOLE SODIUM | 2310 | N | Maint | Formulary | |||||||||||
| 42192060704 | BROMPHEN/PSEUDOEPHEDRINE | 2304 | N | Acute | Formulary | |||||||||||
| 70700016301 | PROGESTERONE | 2302 | N | Maint | Formulary | |||||||||||
| 70377007913 | ATORVASTATIN CALCIUM | 2300 | N | Maint | Formulary | |||||||||||
| 50111064801 | FLUOXETINE HYDROCHLORIDE | 2298 | N | Maint | Formulary | |||||||||||
| 16714061305 | SERTRALINE HYDROCHLORIDE | 2296 | N | Maint | Formulary | |||||||||||
| 68382013905 | TOPIRAMATE | 2296 | N | Maint | Formulary | |||||||||||
| 65862018601 | CLINDAMYCIN HYDROCHLORIDE | 2294 | N | Acute | Formulary | |||||||||||
| 65862019405 | FLUOXETINE HYDROCHLORIDE | 2284 | N | Maint | Formulary | |||||||||||
| 69238183307 | LEVOTHYROXINE SODIUM | 2281 | N | Maint | Formulary | |||||||||||
| 42571025201 | CLINDAMYCIN HYDROCHLORIDE | 2265 | N | Acute | Formulary | |||||||||||
| 00093227534 | AMOXICILLIN/CLAVULANATE P | 2261 | N | Acute | Formulary | |||||||||||
| 62332014231 | CELECOXIB | 2260 | N | Maint | Formulary | |||||||||||
| 64850050501 | AMPHETAMINE/DEXTROAMPHETA | 2259 | N | Maint | Formulary | |||||||||||
| 70010075401 | METHOCARBAMOL | 2253 | N | Acute | Formulary | |||||||||||
| 24208091055 | ERYTHROMYCIN | 2243 | N | Acute | Formulary | |||||||||||
| 68645061090 | LISINOPRIL | 2241 | N | Maint | Formulary | |||||||||||
| 69315011710 | FUROSEMIDE | 2236 | N | Maint | Formulary | |||||||||||
| 55111018015 | TIZANIDINE HYDROCHLORIDE | 2231 | N | Acute | Formulary | |||||||||||
| 68645052354 | SERTRALINE HYDROCHLORIDE | 2228 | N | Maint | Formulary | |||||||||||
| 68382066105 | SPIRONOLACTONE | 2226 | N | Maint | Formulary | |||||||||||
| 00054032756 | FLUTICASONE PROPIONATE/SA | 2224 | N | Maint | Formulary | |||||||||||
| 50228014605 | HYDROCHLOROTHIAZIDE | 2217 | N | Maint | Formulary | |||||||||||
| 68382080510 | TRAZODONE HYDROCHLORIDE | 2216 | N | Maint | Formulary | |||||||||||
| 00093416173 | AMOXICILLIN | 2215 | N | Acute | Formulary | |||||||||||
| 16714029904 | AMOXICILLIN | 2214 | N | Acute | Formulary | |||||||||||
| 68645052254 | SERTRALINE HCL | 2204 | N | Maint | Formulary | |||||||||||
| 00002143380 | TRULICITY | 2203 | N | Maint | Formulary | |||||||||||
| 64380080707 | IBUPROFEN | 2203 | N | Maint | Formulary | |||||||||||
| 51991074710 | DULOXETINE HCL | 2197 | N | Maint | Formulary | |||||||||||
| 00406051205 | OXYCODONE/ACETAMINOPHEN | 2193 | N | Acute | Formulary | |||||||||||
| 52817018000 | CLONIDINE HYDROCHLORIDE | 2188 | N | Maint | Formulary | |||||||||||
| 68645061190 | LISINOPRIL | 2186 | N | Maint | Formulary | |||||||||||
| 69315015501 | HYDROCHLOROTHIAZIDE | 2184 | N | Maint | Formulary | |||||||||||
| 29300039805 | AMLODIPINE BESYLATE | 2181 | N | Maint | Formulary | |||||||||||
| 00378623305 | CITALOPRAM HYDROBROMIDE | 2176 | N | Maint | Formulary | |||||||||||
| 16729044917 | LEVOTHYROXINE SODIUM | 2176 | N | Maint | Formulary | |||||||||||
| 29300041510 | CYCLOBENZAPRINE HYDROCHLO | 2174 | N | Acute | Formulary | |||||||||||
| 16714017403 | ATORVASTATIN CALCIUM | 2168 | N | Maint | Formulary | |||||||||||
| 00185067405 | HYDROXYZINE PAMOATE | 2164 | N | Acute | Formulary | |||||||||||
| 13668000805 | ZOLPIDEM TARTRATE | 2161 | N | Acute | Formulary | |||||||||||
| 00172572880 | FAMOTIDINE | 2160 | N | Maint | Formulary | |||||||||||
| 60219234805 | TRAMADOL HYDROCHLORIDE | 2145 | N | Acute | Formulary | |||||||||||
| 00378932132 | WIXELA INHUB | 2144 | N | Maint | Formulary | |||||||||||
| 65862001105 | SERTRALINE HYDROCHLORIDE | 2140 | N | Maint | Formulary | |||||||||||
| 68645058259 | METFORMIN HYDROCHLORIDE | 2138 | N | Maint | Formulary | |||||||||||
| 49483060450 | IBUPROFEN | 2134 | N | Maint | Formulary | |||||||||||
| 72205000499 | ROSUVASTATIN CALCIUM | 2132 | N | Maint | Formulary | |||||||||||
| 00143962125 | CYANOCOBALAMIN | 2131 | N | Acute | Formulary | |||||||||||
| 13668013701 | ESCITALOPRAM OXALATE | 2122 | N | Maint | Formulary | |||||||||||
| 68382070718 | DOXYCYCLINE MONOHYDRATE | 2122 | N | Acute | Formulary | |||||||||||
| 00093505998 | ATORVASTATIN CALCIUM | 2117 | N | Maint | Formulary | |||||||||||
| 65862039110 | ONDANSETRON ODT | 2117 | N | Acute | Formulary | |||||||||||
| 68382013805 | TOPIRAMATE | 2108 | N | Maint | Formulary | |||||||||||
| 00143980305 | DOXYCYCLINE HYCLATE | 2106 | N | Acute | Formulary | |||||||||||
| 67877056110 | METFORMIN HYDROCHLORIDE | 2105 | N | Maint | Formulary | |||||||||||
| 42806071501 | BENZONATATE | 2103 | N | Acute | Formulary | |||||||||||
| 68462019005 | NAPROXEN | 2100 | N | Maint | Formulary | |||||||||||
| 69315015510 | HYDROCHLOROTHIAZIDE | 2093 | N | Maint | Formulary | |||||||||||
| 68180096903 | LEVOTHYROXINE SODIUM | 2089 | N | Maint | Formulary | |||||||||||
| 64764075030 | TRINTELLIX | 2087 | N | Maint | Excluded | |||||||||||
| 65862056090 | PANTOPRAZOLE SODIUM | 2086 | N | Maint | Formulary | |||||||||||
| 68180096503 | LEVOTHYROXINE SODIUM | 2084 | N | Maint | Formulary | |||||||||||
| 64850050201 | AMPHETAMINE/DEXTROAMPHETA | 2079 | N | Maint | Formulary | |||||||||||
| 00406012310 | HYDROCODONE BITARTRATE/AC | 2073 | N | Acute | Formulary | |||||||||||
| 16571086203 | BUPROPION HYDROCHLORIDE E | 2071 | N | Maint | Formulary | |||||||||||
| 68001025317 | FLUCONAZOLE | 2065 | N | Acute | Formulary | |||||||||||
| 65162068090 | PROMETHAZINE HYDROCHLORID | 2064 | N | Acute | Formulary | |||||||||||
| 50111033401 | METRONIDAZOLE | 2059 | N | Acute | Formulary | |||||||||||
| 70954056510 | ESTRADIOL | 2047 | N | Maint | Formulary | |||||||||||
| 70954056520 | ESTRADIOL | 2047 | N | Maint | Formulary | |||||||||||
| 00169280015 | SAXENDA | 2035 | N | Maint | Excluded | |||||||||||
| 67877019805 | AMLODIPINE BESYLATE | 2035 | N | Maint | Formulary | |||||||||||
| 69097083312 | SERTRALINE HYDROCHLORIDE | 2035 | N | Maint | Formulary | |||||||||||
| 00310620530 | FARXIGA | 2034 | N | Maint | Formulary | |||||||||||
| 31722070090 | LOSARTAN POTASSIUM | 2026 | N | Maint | Formulary | |||||||||||
| 31722072250 | LEVOFLOXACIN | 2024 | N | Acute | Formulary | |||||||||||
| 65862067705 | ALPRAZOLAM | 2008 | N | Acute | Formulary | |||||||||||
| 24208046325 | LATANOPROST | 2001 | N | Maint | Formulary | |||||||||||
| 33342020010 | LEVOCETIRIZINE DIHYDROCHL | 1988 | N | Maint | Formulary | |||||||||||
| 50742061510 | METOPROLOL SUCCINATE ER | 1988 | N | Maint | Formulary | |||||||||||
| 29300047705 | BUSPIRONE HYDROCHLORIDE | 1987 | N | Maint | Formulary | |||||||||||
| 70700011885 | VIENVA | 1979 | N | Maint | Formulary | |||||||||||
| 68645056354 | IBUPROFEN | 1963 | N | Maint | Formulary | |||||||||||
| 70954005820 | PREDNISONE | 1962 | N | Acute | Formulary | |||||||||||
| 00002318280 | TRULICITY | 1956 | N | Maint | Formulary | |||||||||||
| 00093506110 | HYDROXYZINE HYDROCHLORIDE | 1952 | N | Acute | Formulary | |||||||||||
| 68001059308 | ESCITALOPRAM OXALATE | 1949 | N | Maint | Formulary | |||||||||||
| 68180086573 | BLISOVI FE 1/20 | 1949 | N | Maint | Formulary | |||||||||||
| 55111046805 | METOPROLOL SUCCINATE ER | 1946 | N | Maint | Formulary | |||||||||||
| 08290320109 | BD PEN NEEDLE/SHORT/ULTRA | 1935 | Y | Maint | Formulary | |||||||||||
| 43547042250 | LISINOPRIL/HYDROCHLOROTHI | 1931 | N | Maint | Formulary | |||||||||||
| 53746051401 | SPIRONOLACTONE | 1928 | N | Maint | Formulary | |||||||||||
| 65862052790 | VENLAFAXINE HYDROCHLORIDE | 1927 | N | Maint | Formulary | |||||||||||
| 00169517603 | VAGIFEM | 1926 | N | Maint | Formulary | |||||||||||
| 68462022605 | EZETIMIBE | 1923 | N | Maint | Formulary | |||||||||||
| 00406012510 | HYDROCODONE BITARTRATE/AC | 1921 | N | Acute | Formulary | |||||||||||
| 60219170805 | PREDNISONE | 1921 | N | Acute | Formulary | |||||||||||
| 68180035103 | SERTRALINE HYDROCHLORIDE | 1912 | N | Maint | Formulary | |||||||||||
| 68001024604 | ONDANSETRON ODT | 1908 | N | Acute | Formulary | |||||||||||
| 00406055201 | OXYCODONE HYDROCHLORIDE | 1906 | N | Acute | Formulary | |||||||||||
| 31722088390 | ROSUVASTATIN CALCIUM | 1903 | N | Maint | Formulary | |||||||||||
| 70377000712 | ROSUVASTATIN CALCIUM | 1903 | N | Maint | Formulary | |||||||||||
| 29300035505 | TRAMADOL HYDROCHLORIDE | 1900 | N | Acute | Formulary | |||||||||||
| 59651000305 | OMEPRAZOLE DR | 1891 | N | Maint | Formulary | |||||||||||
| 00378464226 | ESTRADIOL | 1890 | N | Maint | Formulary | |||||||||||
| 43598083205 | ATORVASTATIN CALCIUM | 1890 | N | Maint | Formulary | |||||||||||
| 68382066010 | SPIRONOLACTONE | 1890 | N | Maint | Formulary | |||||||||||
| 00093078710 | ATENOLOL | 1887 | N | Maint | Formulary | |||||||||||
| 42794001812 | LIOTHYRONINE SODIUM | 1884 | N | Maint | Formulary | |||||||||||
| 70010006510 | METFORMIN HYDROCHLORIDE | 1876 | N | Maint | Formulary | |||||||||||
| 51991074890 | DULOXETINE HYDROCHLORIDE | 1870 | N | Maint | Formulary | |||||||||||
| 45963055650 | GABAPENTIN | 1866 | N | Maint | Formulary | |||||||||||
| 70010077005 | METHOCARBAMOL | 1866 | N | Acute | Formulary | |||||||||||
| 70710122600 | AMITRIPTYLINE HYDROCHLORI | 1864 | N | Maint | Formulary | |||||||||||
| 08290320122 | BD PEN NEEDLE/NANO/ULTRA | 1862 | Y | Maint | Formulary | |||||||||||
| 43598083005 | ATORVASTATIN CALCIUM | 1862 | N | Maint | Formulary | |||||||||||
| 16714017303 | ATORVASTATIN CALCIUM | 1859 | N | Maint | Formulary | |||||||||||
| 68462041929 | HAILEY FE 1/20 | 1859 | N | Maint | Formulary | |||||||||||
| 69097084905 | ESCITALOPRAM OXALATE | 1858 | N | Maint | Formulary | |||||||||||
| 69238183507 | LEVOTHYROXINE SODIUM | 1854 | N | Maint | Formulary | |||||||||||
| 70512084025 | CYANOCOBALAMIN | 1853 | N | Acute | Formulary | |||||||||||
| 31722072690 | MONTELUKAST SODIUM | 1852 | N | Maint | Formulary | |||||||||||
| 69097007112 | BUPROPION HYDROCHLORIDE E | 1846 | N | Maint | Formulary | |||||||||||
| 00093321205 | CLONAZEPAM | 1841 | N | Acute | Formulary | |||||||||||
| 68180087673 | NORETHINDRONE | 1838 | N | Maint | Formulary | |||||||||||
| 64380078408 | PREDNISONE | 1836 | N | Acute | Formulary | |||||||||||
| 55111015330 | ONDANSETRON HYDROCHLORIDE | 1834 | N | Acute | Formulary | |||||||||||
| 00555089902 | ESTRADIOL | 1830 | N | Maint | Formulary | |||||||||||
| 65862029590 | ROSUVASTATIN CALCIUM | 1828 | N | Maint | Formulary | |||||||||||
| 00078065920 | ENTRESTO | 1827 | N | Maint | Formulary | |||||||||||
| 00456120330 | LINZESS | 1824 | N | Maint | Formulary | |||||||||||
| 00093005301 | BUSPIRONE HYDROCHLORIDE | 1823 | N | Maint | Formulary | |||||||||||
| 69584085250 | SPIRONOLACTONE | 1823 | N | Maint | Formulary | |||||||||||
| 00054040022 | DESVENLAFAXINE ER | 1797 | N | Maint | Formulary | |||||||||||
| 27808015503 | ROSUVASTATIN CALCIUM | 1797 | N | Maint | Formulary | |||||||||||
| 53885024450 | ONETOUCH ULTRA | 1794 | Y | Maint | Formulary | |||||||||||
| 69238207701 | PROPRANOLOL HYDROCHLORIDE | 1793 | N | Maint | Formulary | |||||||||||
| 13811070910 | METHYLPHENIDATE HYDROCHLO | 1788 | N | Maint | Formulary | |||||||||||
| 51991031133 | DESVENLAFAXINE ER | 1788 | N | Maint | Formulary | |||||||||||
| 72888001400 | CYCLOBENZAPRINE HYDROCHLO | 1786 | N | Acute | Formulary | |||||||||||
| 43386070083 | SODIUM SULFATE/POTASSIUM | 1779 | N | Acute | Formulary | |||||||||||
| 16729045117 | LEVOTHYROXINE SODIUM | 1777 | N | Maint | Formulary | |||||||||||
| 43547042050 | LISINOPRIL/HYDROCHLOROTHI | 1777 | N | Maint | Formulary | |||||||||||
| 50228018010 | GABAPENTIN | 1776 | N | Maint | Formulary | |||||||||||
| 70010077001 | METHOCARBAMOL | 1776 | N | Acute | Formulary | |||||||||||
| 52817036000 | METOPROLOL TARTRATE | 1775 | N | Maint | Formulary | |||||||||||
| 52817036100 | METOPROLOL TARTRATE | 1773 | N | Maint | Formulary | |||||||||||
| 00591544210 | PREDNISONE | 1766 | N | Acute | Formulary | |||||||||||
| 68382009405 | CARVEDILOL | 1766 | N | Maint | Formulary | |||||||||||
| 13107008405 | LORAZEPAM | 1762 | N | Acute | Formulary | |||||||||||
| 61874011530 | VRAYLAR | 1758 | N | Maint | Excluded | |||||||||||
| 67877069601 | CHLORTHALIDONE | 1756 | N | Maint | Formulary | |||||||||||
| 00173086910 | ANORO ELLIPTA | 1748 | N | Maint | Formulary | |||||||||||
| 16571020111 | DICLOFENAC SODIUM DR | 1748 | N | Maint | Formulary | |||||||||||
| 31722070490 | VALACYCLOVIR HYDROCHLORID | 1748 | N | Acute | Formulary | |||||||||||
| 27808023402 | DOXYCYCLINE HYCLATE | 1746 | N | Acute | Formulary | |||||||||||
| 50228017505 | BUPROPION HYDROCHLORIDE E | 1745 | N | Maint | Formulary | |||||||||||
| 64380071307 | BENZONATATE | 1739 | N | Acute | Formulary | |||||||||||
| 53885027150 | ONETOUCH VERIO TEST STRIP | 1736 | Y | Maint | Formulary | |||||||||||
| 00002771559 | BASAGLAR KWIKPEN | 1734 | N | Maint | Excluded | |||||||||||
| 65862047099 | LOSARTAN POTASSIUM/HYDROC | 1731 | N | Maint | Formulary | |||||||||||
| 57237002901 | AMOXICILLIN | 1726 | N | Acute | Formulary | |||||||||||
| 71930002643 | BROMPHEN/PSEUDOEPHEDRINE | 1719 | N | Acute | Formulary | |||||||||||
| 61314063705 | PREDNISOLONE ACETATE | 1718 | N | Acute | Formulary | |||||||||||
| 68462073129 | HAILEY 24 FE | 1718 | N | Maint | Formulary | |||||||||||
| 65862014836 | SUMATRIPTAN SUCCINATE | 1716 | N | Acute | Formulary | |||||||||||
| 65862029390 | ROSUVASTATIN CALCIUM | 1716 | N | Maint | Formulary | |||||||||||
| 42806031250 | DOXYCYCLINE HYCLATE | 1715 | N | Acute | Formulary | |||||||||||
| 57237010099 | METOPROLOL TARTRATE | 1713 | N | Maint | Formulary | |||||||||||
| 00228202950 | ALPRAZOLAM | 1712 | N | Acute | Formulary | |||||||||||
| 53746051101 | SPIRONOLACTONE | 1709 | N | Maint | Formulary | |||||||||||
| 68462034690 | LEVOCETIRIZINE DIHYDROCHL | 1708 | N | Maint | Formulary | |||||||||||
| 16729044717 | LEVOTHYROXINE SODIUM | 1702 | N | Maint | Formulary | |||||||||||
| 70377000812 | ROSUVASTATIN CALCIUM | 1700 | N | Maint | Formulary | |||||||||||
| 68462026290 | ROSUVASTATIN CALCIUM | 1699 | N | Maint | Formulary | |||||||||||
| 70954056410 | ESTRADIOL | 1698 | N | Maint | Formulary | |||||||||||
| 00078091112 | XIIDRA | 1693 | N | Maint | Formulary | |||||||||||
| 68645058459 | METFORMIN HYDROCHLORIDE | 1691 | N | Maint | Formulary | |||||||||||
| 00378001805 | METOPROLOL TARTRATE | 1689 | N | Maint | Formulary | |||||||||||
| 00024591401 | DUPIXENT | 1682 | N | Maint | Formulary | |||||||||||
| 62332041510 | OSELTAMIVIR PHOSPHATE | 1681 | N | Acute | Formulary | |||||||||||
| 42806071405 | BENZONATATE | 1674 | N | Acute | Formulary | |||||||||||
| 61442010310 | DICLOFENAC SODIUM DR | 1672 | N | Maint | Formulary | |||||||||||
| 00093505898 | ATORVASTATIN CALCIUM | 1668 | N | Maint | Formulary | |||||||||||
| 45802011222 | MUPIROCIN | 1664 | N | Acute | Formulary | |||||||||||
| 16714098901 | ROSUVASTATIN CALCIUM | 1662 | N | Maint | Formulary | |||||||||||
| 16714017503 | ATORVASTATIN CALCIUM | 1658 | N | Maint | Formulary | |||||||||||
| 16571020210 | DICLOFENAC SODIUM DR | 1657 | N | Maint | Formulary | |||||||||||
| 27241011703 | FENOFIBRATE | 1656 | N | Maint | Formulary | |||||||||||
| 00378718505 | METFORMIN HYDROCHLORIDE | 1652 | N | Maint | Formulary | |||||||||||
| 16714063403 | OMEPRAZOLE | 1648 | N | Maint | Formulary | |||||||||||
| 68180051202 | LISINOPRIL | 1648 | N | Maint | Formulary | |||||||||||
| 72205002799 | ROSUVASTATIN CALCIUM | 1646 | N | Maint | Formulary | |||||||||||
| 00781729685 | ALBUTEROL SULFATE HFA | 1645 | N | Maint | Formulary | |||||||||||
| 76204020025 | ALBUTEROL SULFATE | 1645 | N | Maint | Formulary | |||||||||||
| 13668013501 | ESCITALOPRAM OXALATE | 1641 | N | Maint | Formulary | |||||||||||
| 00378464026 | ESTRADIOL | 1639 | N | Maint | Formulary | |||||||||||
| 68001040103 | FLUOXETINE HYDROCHLORIDE | 1631 | N | Maint | Formulary | |||||||||||
| 68645058054 | AMLODIPINE BESYLATE | 1631 | N | Maint | Formulary | |||||||||||
| 13107008001 | TRAZODONE HYDROCHLORIDE | 1628 | N | Maint | Formulary | |||||||||||
| 69584085310 | SPIRONOLACTONE | 1627 | N | Maint | Formulary | |||||||||||
| 00093719801 | FLUOXETINE HYDROCHLORIDE | 1623 | N | Maint | Formulary | |||||||||||
| 29300024605 | BUSPIRONE HYDROCHLORIDE | 1617 | N | Maint | Formulary | |||||||||||
| 43598032675 | CIPROFLOXACIN/DEXAMETHASO | 1616 | N | Acute | Formulary | |||||||||||
| 69452014430 | BENZONATATE | 1613 | N | Acute | Formulary | |||||||||||
| 00093505698 | ATORVASTATIN CALCIUM | 1609 | N | Maint | Formulary | |||||||||||
| 70377000813 | ROSUVASTATIN CALCIUM | 1607 | N | Maint | Formulary | |||||||||||
| 65862006299 | METOPROLOL TARTRATE | 1606 | N | Maint | Formulary | |||||||||||
| 68180047803 | SIMVASTATIN | 1602 | N | Maint | Formulary | |||||||||||
| 29300012410 | MELOXICAM | 1600 | N | Maint | Formulary | |||||||||||
| 13811070710 | METHYLPHENIDATE HYDROCHLO | 1594 | N | Maint | Formulary | |||||||||||
| 16714072103 | FLUOXETINE HYDROCHLORIDE | 1594 | N | Maint | Formulary | |||||||||||
| 57237009960 | CEFDINIR | 1593 | N | Acute | Formulary | |||||||||||
| 68645059559 | METFORMIN HYDROCHLORIDE E | 1586 | N | Maint | Formulary | |||||||||||
| 00781107710 | ALPRAZOLAM | 1585 | N | Acute | Formulary | |||||||||||
| 68382077501 | METHOTREXATE SODIUM | 1582 | N | Acute | Formulary | |||||||||||
| 65862077885 | TRI-LO-MILI | 1580 | N | Maint | Formulary | |||||||||||
| 00555902858 | JUNEL FE 1.5/30 | 1575 | N | Maint | Formulary | |||||||||||
| 70010006599 | METFORMIN HYDROCHLORIDE | 1575 | N | Maint | Formulary | |||||||||||
| 00603459315 | METHYLPREDNISOLONE DOSE P | 1570 | N | Acute | Formulary | |||||||||||
| 69097081312 | GABAPENTIN | 1559 | N | Maint | Formulary | |||||||||||
| 70010013905 | NAPROXEN | 1558 | N | Maint | Formulary | |||||||||||
| 16714001402 | AMOXICILLIN/CLAVULANATE P | 1555 | N | Acute | Formulary | |||||||||||
| 49483070210 | FLUOXETINE HYDROCHLORIDE | 1555 | N | Maint | Formulary | |||||||||||
| 68462015813 | ONDANSETRON ODT | 1552 | N | Acute | Formulary | |||||||||||
| 68645061390 | LISINOPRIL | 1552 | N | Maint | Formulary | |||||||||||
| 64764073030 | TRINTELLIX | 1549 | N | Maint | Excluded | |||||||||||
| 13668001001 | CITALOPRAM HYDROBROMIDE | 1546 | N | Maint | Formulary | |||||||||||
| 57237001999 | DULOXETINE HYDROCHLORIDE | 1540 | N | Maint | Formulary | |||||||||||
| 00172572960 | FAMOTIDINE | 1538 | N | Maint | Formulary | |||||||||||
| 45963070911 | METOPROLOL SUCCINATE ER | 1538 | N | Maint | Formulary | |||||||||||
| 00597016061 | SPIRIVA RESPIMAT | 1536 | N | Maint | Formulary | |||||||||||
| 29300041519 | CYCLOBENZAPRINE HYDROCHLO | 1536 | N | Acute | Formulary | |||||||||||
| 55111032205 | GLIMEPIRIDE | 1536 | N | Maint | Formulary | |||||||||||
| 68382014005 | TOPIRAMATE | 1536 | N | Maint | Formulary | |||||||||||
| 13811070610 | METHYLPHENIDATE HYDROCHLO | 1532 | N | Maint | Formulary | |||||||||||
| 67877056310 | METFORMIN HYDROCHLORIDE | 1531 | N | Maint | Formulary | |||||||||||
| 60219126601 | OSELTAMIVIR PHOSPHATE | 1530 | N | Acute | Formulary | |||||||||||
| 65862016899 | ATENOLOL | 1529 | N | Maint | Formulary | |||||||||||
| 50111033402 | METRONIDAZOLE | 1526 | N | Acute | Formulary | |||||||||||
| 62332002891 | LOSARTAN POTASSIUM | 1522 | N | Maint | Formulary | |||||||||||
| 16714061205 | SERTRALINE HYDROCHLORIDE | 1521 | N | Maint | Formulary | |||||||||||
| 83457010001 | HYRIMOZ | 1521 | N | Maint | Formulary | |||||||||||
| 16714066202 | GABAPENTIN | 1510 | N | Maint | Formulary | |||||||||||
| 61314054701 | LATANOPROST | 1502 | N | Maint | Formulary | |||||||||||
| 67877019810 | AMLODIPINE BESYLATE | 1500 | N | Maint | Formulary | |||||||||||
| 42806055212 | OMEGA-3-ACID ETHYL ESTERS | 1496 | N | Maint | Formulary | |||||||||||
| 59651015201 | PROGESTERONE | 1495 | N | Maint | Formulary | |||||||||||
| 65862050220 | AMOXICILLIN/CLAVULANATE P | 1490 | N | Acute | Formulary | |||||||||||
| 00378180310 | LEVOTHYROXINE SODIUM | 1488 | N | Maint | Formulary | |||||||||||
| 51224002206 | AZITHROMYCIN | 1488 | N | Acute | Formulary | |||||||||||
| 53489011905 | DOXYCYCLINE HYCLATE | 1487 | N | Acute | Formulary | |||||||||||
| 27808015703 | ROSUVASTATIN CALCIUM | 1485 | N | Maint | Formulary | |||||||||||
| 67877019910 | AMLODIPINE BESYLATE | 1485 | N | Maint | Formulary | |||||||||||
| 57237001401 | TAMSULOSIN HYDROCHLORIDE | 1482 | N | Maint | Formulary | |||||||||||
| 57237007550 | ONDANSETRON HYDROCHLORIDE | 1481 | N | Acute | Formulary | |||||||||||
| 00597015390 | JARDIANCE | 1467 | N | Maint | Formulary | |||||||||||
| 68382009505 | CARVEDILOL | 1465 | N | Maint | Formulary | |||||||||||
| 31722072890 | MONTELUKAST SODIUM | 1457 | N | Maint | Formulary | |||||||||||
| 67877032005 | IBUPROFEN | 1457 | N | Maint | Formulary | |||||||||||
| 31722088490 | ROSUVASTATIN CALCIUM | 1456 | N | Maint | Formulary | |||||||||||
| 62332002991 | LOSARTAN POTASSIUM | 1456 | N | Maint | Formulary | |||||||||||
| 00781107905 | ALPRAZOLAM | 1454 | N | Acute | Formulary | |||||||||||
| 55513013760 | OTEZLA | 1454 | N | Maint | Formulary | |||||||||||
| 50111056002 | TRAZODONE HYDROCHLORIDE | 1453 | N | Maint | Formulary | |||||||||||
| 16571010009 | MONTELUKAST SODIUM | 1452 | N | Maint | Formulary | |||||||||||
| 64380071207 | BENZONATATE | 1442 | N | Acute | Formulary | |||||||||||
| 00074055402 | HUMIRA PEN | 1433 | N | Maint | Excluded | |||||||||||
| 00378180510 | LEVOTHYROXINE SODIUM | 1433 | N | Maint | Formulary | |||||||||||
| 60505017007 | PRAVASTATIN SODIUM | 1433 | N | Maint | Formulary | |||||||||||
| 69097007212 | BUPROPION HYDROCHLORIDE E | 1432 | N | Maint | Formulary | |||||||||||
| 64380018001 | DOXYCYCLINE MONOHYDRATE | 1424 | N | Acute | Formulary | |||||||||||
| 16571011450 | HYDROXYZINE HYDROCHLORIDE | 1421 | N | Acute | Formulary | |||||||||||
| 42806041405 | BUPROPION HYDROCHLORIDE E | 1420 | N | Maint | Formulary | |||||||||||
| 42858010201 | OXYCODONE/ACETAMINOPHEN | 1419 | N | Acute | Formulary | |||||||||||
| 00093506105 | HYDROXYZINE HYDROCHLORIDE | 1417 | N | Acute | Formulary | |||||||||||
| 16571011410 | HYDROXYZINE HYDROCHLORIDE | 1413 | N | Acute | Formulary | |||||||||||
| 61269050906 | PULMICORT FLEXHALER | 1409 | N | Maint | Formulary | |||||||||||
| 21922003601 | CLINDAMYCIN PHOSPHATE | 1402 | N | Acute | Formulary | |||||||||||
| 00093720298 | PRAVASTATIN SODIUM | 1398 | N | Maint | Formulary | |||||||||||
| 29300034905 | ALLOPURINOL | 1397 | N | Maint | Formulary | |||||||||||
| 64380078507 | PREDNISONE | 1395 | N | Acute | Formulary | |||||||||||
| 16714017202 | TIZANIDINE HYDROCHLORIDE | 1393 | N | Acute | Formulary | |||||||||||
| 43547042309 | LOSARTAN POTASSIUM/HYDROC | 1393 | N | Maint | Formulary | |||||||||||
| 67877041401 | METFORMIN HYDROCHLORIDE E | 1390 | N | Maint | Formulary | |||||||||||
| 00409656201 | TESTOSTERONE CYPIONATE | 1389 | N | Maint | Formulary | |||||||||||
| 69238183807 | LEVOTHYROXINE SODIUM | 1387 | N | Maint | Formulary | |||||||||||
| 69315090405 | LORAZEPAM | 1387 | N | Acute | Formulary | |||||||||||
| 68462012605 | GABAPENTIN | 1385 | N | Maint | Formulary | |||||||||||
| 65862044990 | VALACYCLOVIR HYDROCHLORID | 1384 | N | Acute | Formulary | |||||||||||
| 00555077902 | MEDROXYPROGESTERONE ACETA | 1382 | N | Maint | Formulary | |||||||||||
| 65862085901 | FAMOTIDINE | 1378 | N | Maint | Formulary | |||||||||||
| 13107007901 | TRAZODONE HYDROCHLORIDE | 1377 | N | Maint | Formulary | |||||||||||
| 68462072029 | DROSPIRENONE/ETHINYL ESTR | 1374 | N | Maint | Formulary | |||||||||||
| 31722070430 | VALACYCLOVIR HYDROCHLORID | 1373 | N | Acute | Formulary | |||||||||||
| 27241009803 | DULOXETINE HCL | 1372 | N | Maint | Formulary | |||||||||||
| 59651030030 | TAMOXIFEN CITRATE | 1369 | N | Maint | Formulary | |||||||||||
| 68001059608 | DULOXETINE HYDROCHLORIDE | 1367 | N | Maint | Formulary | |||||||||||
| 53746051501 | SPIRONOLACTONE | 1361 | N | Maint | Formulary | |||||||||||
| 00603533815 | PREDNISONE | 1359 | N | Acute | Formulary | |||||||||||
| 72578005518 | DOXYCYCLINE HYCLATE | 1359 | N | Acute | Formulary | |||||||||||
| 70710113803 | FLUCONAZOLE | 1356 | N | Acute | Formulary | |||||||||||
| 51991000633 | DESVENLAFAXINE ER | 1353 | N | Maint | Formulary | |||||||||||
| 00310908012 | AIRSUPRA | 1351 | N | Acute | Formulary | |||||||||||
| 55111068305 | IBU | 1350 | N | Maint | Formulary | |||||||||||
| 68001036105 | MONTELUKAST SODIUM | 1349 | N | Maint | Formulary | |||||||||||
| 65862046890 | LOSARTAN POTASSIUM/HYDROC | 1348 | N | Maint | Formulary | |||||||||||
| 68001059208 | ESCITALOPRAM OXALATE | 1340 | N | Maint | Formulary | |||||||||||
| 43547028010 | ESCITALOPRAM OXALATE | 1338 | N | Maint | Formulary | |||||||||||
| 16714008210 | HYDROXYZINE HYDROCHLORIDE | 1336 | N | Acute | Formulary | |||||||||||
| 57237016199 | OMEPRAZOLE | 1334 | N | Maint | Formulary | |||||||||||
| 31722063231 | OSELTAMIVIR PHOSPHATE | 1332 | N | Acute | Formulary | |||||||||||
| 31722014905 | GABAPENTIN | 1331 | N | Maint | Formulary | |||||||||||
| 66993000210 | ESTRADIOL | 1330 | N | Maint | Formulary | |||||||||||
| 55111072510 | MONTELUKAST SODIUM | 1328 | N | Maint | Formulary | |||||||||||
| 00378718705 | METFORMIN HYDROCHLORIDE | 1326 | N | Maint | Formulary | |||||||||||
| 00023650116 | UBRELVY | 1318 | N | Acute | Formulary | |||||||||||
| 65862067805 | ALPRAZOLAM | 1315 | N | Acute | Formulary | |||||||||||
| 68180096803 | LEVOTHYROXINE SODIUM | 1311 | N | Maint | Formulary | |||||||||||
| 68382000810 | LAMOTRIGINE | 1311 | N | Maint | Formulary | |||||||||||
| 68001039708 | FAMOTIDINE | 1310 | N | Maint | Formulary | |||||||||||
| 64980034214 | ALENDRONATE SODIUM | 1309 | N | Maint | Formulary | |||||||||||
| 72888000500 | METOPROLOL TARTRATE | 1308 | N | Maint | Formulary | |||||||||||
| 43547036909 | VALSARTAN | 1306 | N | Maint | Formulary | |||||||||||
| 16714068403 | SIMVASTATIN | 1303 | N | Maint | Formulary | |||||||||||
| 69584085410 | SPIRONOLACTONE | 1302 | N | Maint | Formulary | |||||||||||
| 00093354143 | ESTRADIOL | 1301 | N | Maint | Formulary | |||||||||||
| 65862007930 | TERBINAFINE HCL | 1301 | N | Acute | Formulary | |||||||||||
| 13668008190 | MONTELUKAST SODIUM | 1298 | N | Maint | Formulary | |||||||||||
| 00093100305 | BUSPIRONE HCL | 1297 | N | Maint | Formulary | |||||||||||
| 00406012501 | HYDROCODONE BITARTRATE/AC | 1295 | N | Acute | Formulary | |||||||||||
| 29300035501 | TRAMADOL HYDROCHLORIDE | 1293 | N | Acute | Formulary | |||||||||||
| 68382056610 | METOPROLOL SUCCINATE ER | 1292 | N | Maint | Formulary | |||||||||||
| 68382013201 | TAMSULOSIN HYDROCHLORIDE | 1286 | N | Maint | Formulary | |||||||||||
| 29300041910 | AMITRIPTYLINE HYDROCHLORI | 1284 | N | Maint | Formulary | |||||||||||
| 65862021901 | CEFDINIR | 1283 | N | Acute | Formulary | |||||||||||
| 50111056103 | TRAZODONE HYDROCHLORIDE | 1282 | N | Maint | Formulary | |||||||||||
| 29300024401 | BUSPIRONE HYDROCHLORIDE | 1280 | N | Maint | Formulary | |||||||||||
| 55111017915 | TIZANIDINE HCL | 1278 | N | Acute | Formulary | |||||||||||
| 29300042110 | AMITRIPTYLINE HYDROCHLORI | 1277 | N | Maint | Formulary | |||||||||||
| 31722088290 | ROSUVASTATIN CALCIUM | 1277 | N | Maint | Formulary | |||||||||||
| 59651036105 | IBUPROFEN | 1277 | N | Maint | Formulary | |||||||||||
| 68382066201 | SPIRONOLACTONE | 1276 | N | Maint | Formulary | |||||||||||
| 68180087773 | JENCYCLA | 1275 | N | Maint | Formulary | |||||||||||
| 68180097103 | LEVOTHYROXINE SODIUM | 1271 | N | Maint | Formulary | |||||||||||
| 45802026337 | CLINDAMYCIN PHOSPHATE | 1270 | N | Acute | Formulary | |||||||||||
| 45802011214 | MUPIROCIN | 1268 | N | Acute | Formulary | |||||||||||
| 00002246080 | ZEPBOUND | 1265 | N | Maint | Excluded | |||||||||||
| 68382080505 | TRAZODONE HYDROCHLORIDE | 1264 | N | Maint | Formulary | |||||||||||
| 68462026190 | ROSUVASTATIN CALCIUM | 1264 | N | Maint | Formulary | |||||||||||
| 60219170701 | PREDNISONE | 1263 | N | Acute | Formulary | |||||||||||
| 00555902542 | JUNEL 1/20 | 1262 | N | Maint | Formulary | |||||||||||
| 62332014271 | CELECOXIB | 1258 | N | Maint | Formulary | |||||||||||
| 70377002813 | ATORVASTATIN CALCIUM | 1257 | N | Maint | Formulary | |||||||||||
| 00074230630 | RINVOQ | 1256 | N | Maint | Formulary | |||||||||||
| 72888000405 | METOPROLOL TARTRATE | 1255 | N | Maint | Formulary | |||||||||||
| 65702040810 | ACCU-CHEK AVIVA PLUS | 1253 | Y | Maint | Formulary | |||||||||||
| 70377000612 | ROSUVASTATIN CALCIUM | 1253 | N | Maint | Formulary | |||||||||||
| 68180065208 | DOXYCYCLINE MONOHYDRATE | 1247 | N | Acute | Formulary | |||||||||||
| 69315090505 | LORAZEPAM | 1245 | N | Acute | Formulary | |||||||||||
| 68462013281 | NORETHINDRONE ACETATE/ETH | 1244 | N | Maint | Formulary | |||||||||||
| 70954005930 | PREDNISONE | 1243 | N | Acute | Formulary | |||||||||||
| 52817032000 | BACLOFEN | 1242 | N | Acute | Formulary | |||||||||||
| 65702028810 | ACCU-CHEK FASTCLIX LANCET | 1242 | Y | Maint | Formulary | |||||||||||
| 00378395305 | ATORVASTATIN CALCIUM | 1240 | N | Maint | Formulary | |||||||||||
| 42385094911 | METFORMIN HYDROCHLORIDE | 1240 | N | Maint | Formulary | |||||||||||
| 58406003204 | ENBREL SURECLICK | 1240 | N | Maint | Formulary | |||||||||||
| 70377000613 | ROSUVASTATIN CALCIUM | 1239 | N | Maint | Formulary | |||||||||||
| 52817033050 | CYCLOBENZAPRINE HYDROCHLO | 1237 | N | Acute | Formulary | |||||||||||
| 55566680001 | CLENPIQ | 1236 | N | Acute | Formulary | |||||||||||
| 68180083773 | TRI-LO-MARZIA | 1236 | N | Maint | Formulary | |||||||||||
| 00378427677 | VALACYCLOVIR HYDROCHLORID | 1235 | N | Acute | Formulary | |||||||||||
| 51991031290 | DESVENLAFAXINE ER | 1235 | N | Maint | Formulary | |||||||||||
| 00555904958 | CRYSELLE-28 | 1234 | N | Maint | Formulary | |||||||||||
| 69097040715 | METOPROLOL SUCCINATE ER | 1234 | N | Maint | Formulary | |||||||||||
| 65862077685 | MILI | 1233 | N | Maint | Formulary | |||||||||||
| 68382009305 | CARVEDILOL | 1228 | N | Maint | Formulary | |||||||||||
| 68645051954 | ESCITALOPRAM OXALATE | 1228 | N | Maint | Formulary | |||||||||||
| 00054040013 | DESVENLAFAXINE ER | 1225 | N | Maint | Formulary |
This is the start of the file's text. The full file is on GovTribe.
File details come from the government source that posted it. Updated .