Indiana DOC Formulary.docx
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- RFP DOC Correctional Health ServicesBid Documents State and local contract opportunity
- Solicitation number
- 27-87787
- Issued by
- Hendricks County, Indiana
About this file
This document is a Formulary Drug List for the Indiana Department of Corrections (IDOC) applicable to both adult and juvenile facilities, effective February 27, 2025. The formulary comprises an extensive catalog of pharmaceuticals organized by therapeutic class, including analgesics, anti-inflammatories, anti-infectives, cardiovascular agents, psychotropic agents, dermatological agents, gastrointestinal agents, respiratory agents, vaccines, vitamins, and miscellaneous medications. The document specifies approved medications with their strengths, dosage forms, brand names, and therapeutic classifications. Notable restrictions and limitations are documented throughout, including maximum dosage frequencies (e.g., acetaminophen limited to 60 doses per 30 days), duration restrictions on certain medications (e.g., cyclobenzaprine limited to 7 days use per 180 days), and patient population restrictions (e.g., clonidine for dialysis or juvenile patients only, nitrofurantoin restricted to female patients). The formulary identifies 23 preferred agents still requiring formulary exception requests, including Teriflunomide, Gilenya, Briumvi, Suboxone, and various inhaler medications.
The formulary does not contain pricing information, set-asides, incumbent details, or funding sources, as it functions as a reference document establishing approved medications and usage parameters rather than a procurement contract. Notably, several combination HIV medications are listed as brand name only with instructions to order component medications separately at specified dosages. The document includes detailed listings for HIV agents across multiple categories (fusion inhibitors, integrase inhibitors, protease inhibitors, and supportive agents) and specifies restrictions on emergency medications, psychotropic agents for juvenile-only use, and duration limitations on medications such as ondansetron and anti-emetics to prevent abuse or overutilization within the correctional setting.
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Text version
Formulary Drug List - Indiana Department of Corrections
- Index - Product Name Equivalent Brand Name Therapy Section Formulary Drug List - Indiana Department of Corrections
- Index - Product Name Equivalent Brand Name Therapy Section Formulary Drug List ‐ Indiana Department of Corrections- Index Product Name Equivalent Brand Name Therapy Section
Formulary Drug List Indiana Department of Correction Adult/Juvenile Grouped by Therapy Class February 27, 2025
Table of Contents
| 1. | Analgesics and Anti-Inflammatories | 7 |
| Acetaminophen Agents (01.01) | 7 | |
| Anti-Gout Agents (01.02) | 7 | |
| Anti-Migraine Agents (01.03) | 7 | |
| Narcotic Analgesics/Antagonists (01.04) | 7 | |
| Neuropathic Pain Agents (01.05) | 7 | |
| Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) (01.06) | 7 | |
| Skeletal Muscle Relaxants (01.08) | 8 | |
| Other Analgesics and Anti-Inflammatories (01.09) | 8 | |
| 23. | Antihistamines/Decongestants/Antitussives/ Expectorants | 8 |
| 1st Generation Antihistamines (02.01) | 8 | |
| 2nd Generation Antihistamines (02.02) | 8 | |
| Antitussives (02.03) | 8 | |
| Expectorants (02.04) | 8 | |
| Decongestants (02.05) | 8 | |
| Combination Products (02.06) | 8 | |
| 3. | Anti-Infectives | 8 |
| Aminoglycosides (03.01) | 8 | |
| Antifungals (03.02) | 8 | |
| Antihelmintics (03.03) | 8 | |
| Antimalarials (03.04) | 8 | |
| Antituberculars (03.05) | 8 | |
| Antivirals (non-HIV) (03.06) | 9 | |
| Cephalosporins (03.07) | 9 | |
| Fluoroquinolones (03.08) | 9 | |
| Hepatitis Medications – Hepatitis B Agents (03.08.01) | 9 | |
| Hepatitis Medications – Hepatitis C Agents (03.08.02) | 9 | |
| HIV Agents-Fusion Inhibitors (03.09.01) | 9 | |
| HIV Agents - Integrase Inhibitors (03.09.02) | 9 | |
| HIV Agents - Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) (03.09.03) | 9 | |
| HIV Agents - Nucleos(t)ide Reverse Transcriptase Inhibitors (NRTIs) (03.09.04) | 10 | |
| HIV Agents - Protease Inhibitors (03.09.05) | 10 | |
| HIV Agents - Combination Products (03.09.06) Listed as Brand Name ONLY | 10 | |
| *HIV Combination Drugs Preferred Ordering: | 11 | |
| HIV Agents - Supportive Agents (03.09.07) | 11 | |
| Macrolides/Azalides/Lincosamides/Oxazolidinones (03.10) | 11 | |
| Penicillins (03.11) | 12 | |
| Sulfonamides (03.12) | 12 | |
| Tetracyclines (03.13) | 12 | |
| Other Anti-Infectives (03.14) | 12 | |
| 4. | Cancer-Related Agents | 13 |
| Antineoplastics (04.01) | 13 | |
| 5. | Cardiovascular Agents | 13 |
| Alpha-adrenergic Blockers (05.01) | 13 | |
| Angiotensin-Converting Enzyme Inhibitors (ACE) (05.02) | 13 | |
| Angiotensin Receptor Blockers (ARBs) (05.03) | 13 | |
| Antidysrhythmics - Type 1a (05.04.01) | 13 | |
| Antidysrhythmics - Type 1b (05.04.02) | 14 | |
| Antidysrhythmics - Type 1c (05.04.03) | 14 | |
| Antidysrhythmics - Type III (05.04.04) | 14 | |
| Antilipidemics - HMG-Coenzyme A Reductase Inhibitors (05.05.01) | 14 | |
| Antilipidemics - Other Antilipidemics (05.05.02) | 14 | |
| Beta-Adrenergic Blockers - Selective Agents (05.06.01) | 14 | |
| Beta-Adrenergic Blockers-Non-Selective Agents (05.06.02) | 14 | |
| Beta-Adrenergic Blockers - a,ß Antagonists (05.06.03) | 15 | |
| Calcium Channel Blockers - Dihydropyridine (05.07.01) | 15 | |
| Calcium Channel Blockers - Non-Dihydropyridine (05.07.02) | 15 | |
| Cardiac Glycosides (05.08) | 15 | |
| Centrally-Acting Antihypertensives (05.09) | 15 | |
| Diuretics (05.10) | 15 | |
| Hemorrheologic Agents (05.11) | 16 | |
| Vasodilators - Nitrates (05.12.01) | 16 | |
| Vasodilators - Non-Nitrates (05.12.02) | 17 | |
| Combination Agents (05.13) | 17 | |
| Other CV Agents (05.14) | 17 | |
| 6. | Psychotropic Agents | 17 |
| Antidepressants (06.01) | 17 | |
| Antidepressants - Tricyclic Antidepressants (06.01.01) | 17 | |
| Antidepressants - Serotonin +/- Norepinephrine Reuptake Inhibitors (SSRI / SNRI) (06.01.02) | 17 | |
| Antidepressants - Other Antidepressants (06.01.03) | 17 | |
| Antipsychotic Agents (06.02) | 18 | |
| Antipsychotic Agents - 1st Generation Agents (06.02.01) | 18 | |
| Antipsychotic Agents - 2nd Generation Agents (06.02.02) | 18 | |
| Barbiturates (06.03) | 19 | |
| Cerebral Stimulants (06.04) | 19 | |
| Mood Stabilizers (06.05) | 19 | |
| Sedatives / Hypnotics (06.06) | 19 | |
| Benzodiazepine (06.06.01) | 19 | |
| Other Agents (06.06.02) | 19 | |
| Anxiolytic (06.07) | 19 | |
| Other CNS Agents (6.08) | 19 | |
| 7. | Dental Agents | 20 |
| Dental Agents (07.01) | 20 | |
| 8. | Dermatological Agents | 20 |
| Anti-Acne Products (08.01) | 20 | |
| Antifungals (08.02) | 20 | |
| Anti-Infectives (08.03) | 20 | |
| Antipsoriatics (08.04) | 20 | |
| Antipruritics & Local Anesthetics (08.05) | 20 | |
| Moisturizing and Barrier Agents (08.06) | 20 | |
| Scabicides (08.07) | 20 | |
| Steroid Anti-Inflammatories - Very High Potency (08.08.01) | 20 | |
| Steroid Anti-Inflammatories - High Potency (08.08.02) | 20 | |
| Steroid Anti-Inflammatories - Medium Potency (08.08.03) | 21 | |
| Steroid Anti-Inflammatories - Low Potency (08.08.04) | 21 | |
| Other Derm Agents (08.09) | 21 | |
| 9. | Diagnostics and Supplies | 21 |
| Diagnostics and Supplies (09.01) | 21 | |
| 10. | Emergency Medications | 21 |
| Emergency Medications (10.01) | 21 | |
| 11. | Endocrine – Metabolic Agents | 22 |
| Androgens (11.01) | 22 | |
| Estrogens – Progestins (11.02) | 22 | |
| Insulins (11.03) | 23 | |
| Hypoglycemics - Sulfonylureas (11.04.01) | 23 | |
| Hypoglycemics - Biguanides (11.04.02) | 23 | |
| Hypoglycemics - Thiazolidinediones (11.04.03) | 23 | |
| Hypoglycemics - Incretin Mimetics (11.04.04) | 23 | |
| Hypoglycemics - Combination Agents (11.04.05) | 23 | |
| Hypoglycemics - Other Agents (11.04.06) | 23 | |
| Thyroid Agents (11.05) | 23 | |
| Adrenal Corticosteroids (11.06) | 24 | |
| Osteoporosis Agents (11.07) | 24 | |
| Other Endocrine - Metabolic Agents (11.08) | 24 | |
| 12. | Gastrointestinal Agents | 24 |
| Aminosalicylates (12.01) | 24 | |
| Antacids (12.02) | 25 | |
| Anti-Diarrheals (12.03) | 25 | |
| Anti-Emetics (12.04) | 25 | |
| Cathartics / Laxatives (12.05) | 25 | |
| Digestive Enzymes (12.06) | 25 | |
| GI Motility Agents (12.07) | 25 | |
| Histamine – 2 Receptor Antagonists (H2RAs) (12.09) | 25 | |
| Proton Pump Inhibitors (PPIs) (12.10) | 26 | |
| Other GI Agents (12.11) | 26 | |
| Hemorrhoidal Agents (12.12) | 26 | |
| 13. | Genitourinary Agents | 26 |
| Benign Prostatic Hypertrophy Agents (13.01) | 26 | |
| Other GU Agents (13.02) | 26 | |
| 14. | Hematological Agents | 27 |
| Hematological Agents (14.01) | 27 | |
| Sickle Cell Agents (14.02) | 27 | |
| 15. | Immunosuppressants | 27 |
| Immunosuppressants (15.01) | 27 | |
| Antirheumatic Agents (15.02) | 27 | |
| 16. | Neurological Agents | 27 |
| Alzheimer’s Agents (16.01) | 27 | |
| Anticonvulsants (16.02) | 27 | |
| Anti-Parkinsons Agents (16.03) | 28 |
Myasthenia Gravis Agents (16.04)….……………………………………………………………………………………………………………28
| Multiple Sclerosis Agents (16.04) | 28 | |
| 16. | Neurological Agents | 28 |
| Other Neuro Agents (16.05) | 28 | |
| 17. | Obstetric – Gynecologic Agents | 28 |
| Contraceptives (17.01) | 28 | |
| Anti-Infectives (17.02) | 28 | |
| 18. Ophthalmic – Otic Preparations | 28 | |
| Anti-Glaucoma Agents (18.01) | 28 | |
| Antihistamines / Decongestants (18.02) | 29 | |
| Anti-Infective Agents (18.03) | 29 | |
| Anti-Inflammatory Agents (18.04) | 29 | |
| Otic Preparations (18.05) | 29 | |
| Other Otic-Ophthalmic Agents (18.06) | 29 | |
| 19. | Respiratory Agents | 30 |
| Anticholinergics (19.01) | 30 | |
| Beta Agonists (19.02) | 30 | |
| Inhaled Oral Steroids (19.03) | 30 | |
| Nasal Sprays (19.04) | 30 | |
| Combination Products (19.05) | 30 | |
| Other Respiratory Agents (19.06) | 30 | |
| 20. Vaccines | 30 | |
| Vaccines - (20.01) | 30 | |
| 21. | Vitamins – Minerals – Dietary Supplements | 31 |
| Vitamins – Minerals – Dietary Supplements (21.01) | 31 | |
| 22. | Miscellaneous and Unclassified Agents | 32 |
| Miscellaneous and Unclassified Agents (22.01) | 32 |
23. Preferred Agents Still Needing Formulary Exception Request………………………………………32 Teriflunomide(Aubagio) or Gilenya / injection Briumvi – For Multiple Sclerosis Fluphilia – Pegfilgrastim-jmdb used once per chemo cycle Granix – daily filgrastim agent Suboxone – dissolve tablets preferred product Tudorza – anticholinergic inhaler Duaklir – LAMA/LABA inhaler Alvesco – steroid inhaler Farxiga – SGLP2 Inhibitor
1. Analgesics and Anti-Inflammatories Acetaminophen Agents (01.01)
| Apap - box /24 protocol 325 mg tablet | Tylenol |
| Acetaminophen 325 mg tablet (limit 60 doses per 30 days) | Tylenol |
| Acetaminophen 500 mg tablet (limit 60 doses per 30 days) | Tylenol |
| Acetaminophen 325 mg rectal suppository | Tylenol supp |
| Acetaminophen 650 mg rectal suppository | Tylenol supp |
Anti-Gout Agents (01.02)
| Allopurinol 100 mg and 300mg tablet | Zyloprim |
| Probenecid 500 mg tablet | Benemid |
Anti-Migraine Agents (01.03) Sumatriptan all Strengths (Max dose 9 tabs per month) Imitrex Narcotic Analgesics/Antagonists (01.04)
| Acetaminophen/Codeine 120-12 mg/5 ml elixir | Tylenol/cod elix |
| Acetaminophen/Codeine/ 300-30 mg tablet 7 day max every 180 days | Tylenol #3 |
| Nalbuphine 10 mg/ml injection | Nubain |
| Nalbuphine 20 mg/ml injection | Nubain |
Tramadol 50mg 7 day max every 180 days Ultram Neuropathic Pain Agents (01.05) Duloxetine capsule all strengths Cymbalta Nortriptyline capsule all strengths Pamelor Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) (01.06) Diclofenac gel 1% Voltaren Ibuprofen max 1200mg/day max 7-day order/30 days Motrin Ketorolac Trometh 15 mg and 30mg/ml injection Toradol Inj.
Meloxicam 7.5mg and 15mg Mobic Naproxen 500mg/2 daily max 7-day order/30 days Aleve/anaprox Salicylates (01.07)
| Asa 325mg ec 325 mg tab ec | Ecotrin |
| Aspirin - film coat 325 mg tablet | Asa fc |
| Aspirin ec 81 mg tab ec | Ecotrin |
| Aspirin fc box/24 protocol 325 mg tablet | Aspirin |
Skeletal Muscle Relaxants (01.08)
| Cyclobenzaprine 5 mg tablet (7 days use per 180 days) | Flexeril |
| Cyclobenzaprine 10 mg tablet (7 days use per 180 days) | Flexeril |
Other Analgesics and Anti-Inflammatories (01.09)
2. Antihistamines/Decongestants/Antitussives/ Expectorants 1st Generation Antihistamines (02.01) Diphenhydramine vial 50 mg/ml injection for mental health emergent use Benadryl Diphenhydramine oral/liquid for emergent use (mild allergic reactions) Benadryl (oral diphenhydramine max 30 count card stock only) 2nd Generation Antihistamines (02.02) Loratidine 10mg tablet Juvenile only Claritin Antitussives (02.03) Expectorants (02.04) Decongestants (02.05) Combination Products (02.06)
3. Anti-Infectives Aminoglycosides (03.01) Antifungals (03.02)
| Clotrimazole 10 mg mucous membrane troche | Mycelex |
| Fluconazole 50mg tablet (limit to 30 day treatment/180 day) | Diflucan |
| Fluconazole 100 mg tablet (limit to 30-day treatment/180 day) | Diflucan |
| Fluconazole 150 mg tablet (limit to 30-day treatment/180 day) | Diflucan |
| Fluconazole 200 mg tablet (limit to 30-day treatment/180 day) | Diflucan |
| Nystatin 100,000 u/ml oral suspension | Mycostatin |
| Terbinafine HCL 250 mg tablet | Lamisil |
Antihelmintics (03.03) Antimalarials (03.04)
| Hydroxychloroquine 200 mg | Plaquenil |
| Pyrimethamine 25 mg tablet | Daraprim |
Antituberculars (03.05)
| Ethambutol HCL 100 mg tablet | Myambutol |
| Ethambutol HCL 400 mg tablet | Myambutol |
| Isoniazid 100 mg tablet | Inh |
| Isoniazid 300 mg tablet | Inh |
| Pyrazinamide 500 mg tablet | Pyrazinamide |
| Rifampin 150 mg capsule | Rifadin |
| Rifampin 300 mg capsule | Rifadin |
| Rifapentine 150mg tablet limited to 84 days every 365 days | Priftin |
| Streptomycin 1gm injection | Streptomycin |
Antivirals (non-HIV) (03.06)
| Acyclovir 200 mg capsule | Zovirax |
| Acyclovir 400 mg tablet | Zovirax |
| Acyclovir 800 mg tablet | Zovirax |
| Amantadine HCL 100 mg capsule | Symmetrel |
| Amantadine HCL 50 mg/5 ml oral solution | Symmetrel |
| Ganciclovir 500 mg/250ml iv | Cytovene inj. |
Cephalosporins (03.07)
| Cefazolin 500 mg injection | Kefzol |
| Cefazolin 1 gm injection | Ancef |
| Ceftriaxone 250 mg injection | Rocephin inj. |
| Ceftriaxone 500 mg injection | Rocephin inj. |
Ceftriaxone 1g injection Rocephin inj.
| Ceftriaxone 2g injection | Rocephin inj. |
| Cephalexin 250 mg capsule | Keflex |
| Cephalexin 500 mg capsule | Keflex |
| Cephalexin susp 250 mg/5 ml suspension | Keflex susp |
Fluoroquinolones (03.08) Hepatitis Medications – Hepatitis B Agents (03.08.01) Tenofovir 300mg Viread Entecavir 0.5 and 1mg Baraclude Hepatitis Medications – Hepatitis C Agents (03.08.02) HIV Agents-Fusion Inhibitors (03.09.01)
| Maraviroc 150 mg tablet | Selzentry |
| Maraviroc 300 mg tablet | Selzentry |
HIV Agents - Integrase Inhibitors (03.09.02)
| Dolutegravir 10 mg tablet | Tivicay |
| Dolutegravir 25 mg tablet | Tivicay |
| Dolutegravir 50 mg tablet | Tivicay |
| Raltegravir 400 mg tablet | Isentress |
HIV Agents - Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) (03.09.03)
| Efavirenz 200 mg capsule | Sustiva | |
| Efavirenz 600 mg tablet | Sustiva | |
| Etravirine 100 mg tablet | Intelence | |
| Etravirine 200 mg tablet | Intelence | |
| Nevirapine 200 mg tablet | Viramune | |
| Rilpivirine 25mg tablet | Endurant |
HIV Agents - Nucleos(t)ide Reverse Transcriptase Inhibitors (NRTIs) (03.09.04)
| Abacavir 300 mg tablet (and combo products) | Ziagen |
| Didanosine 125 mg cap delay-rel | Videx ec |
| Didanosine 200 mg cap delay-rel | Videx ec |
| Didanosine 250 mg cap delay-rel | Videx ec |
| Didanosine 400 mg cap delay-rel | Videx ec |
| Emtricitabine 200 mg capsule | Emtriva |
| Lamivudine 300 mg tablet (and combo products) | Epivir |
| Lamivudine- 10 mg/ml oral solution | Epivir |
| Stavudine 15 mg capsule | Zerit |
| Stavudine 20 mg capsule | Zerit |
| Stavudine 30 mg capsule | Zerit |
| Stavudine 40 mg capsule | Zerit |
| Tenofovir Disoproxil 300 mg tablet | Viread |
| Zidovudine 10 mg/ml oral syrup | Retrovir |
| Zidovudine 100 mg capsule | Retrovir |
| Zidovudine 300 mg tablet | Retrovir |
HIV Agents - Protease Inhibitors (03.09.05)
| Atazanavir sulfate 150 mg cpsule | Reyataz |
| Atazanavir sulfate 200 mg capsule | Reyataz |
| Atazanavir sulfate 300 mg capsule | Reyataz |
| Darunavir Ethanolate 600 mg tablet | Prezista |
| Darunavir Ethanolate 800 mg tablet | Prezista |
| Fosamprenavir ca 700 mg tablet | Lexiva |
| Indinavir 400 mg capsule | Crixivan |
| Lopinavir/ritonavir tab 200/50 mg tablet | Kaletra tab |
| Lopinavir\Riton 400-100/5 ml oral solution | Kaletra sol |
| Nelfinavir 250 mg tablet | Viracept |
| Nelfinavir 625 mg tablet | Viracept |
| Ritonavir 100 mg tablet | Norvir |
| Ritonavir 80 mg/ml solution | Norvir |
| Saquinavir Mesylate 200 mg capsule | Invirase |
| Saquinavir Mesylate 500 mg tablet | Invirase |
| Tipranavir 250 mg capsule | Aptivus |
HIV Agents - Combination Products (03.09.06) Listed as Brand Name ONLY
| Biktarvy* Brand off formulary - use two med combo | See preferred ordering below |
| Complera* | See preferred ordering below |
Delstrigo Descovy Evotaz Genvoya Juluca Odefsey Prezcobix Stribild
| Symtuza* | See preferred ordering below |
| Triumeq* | See preferred ordering below |
Trizivir *HIV Combination Drugs Preferred Ordering:
*Biktarvy Order as: Tivicay 50mg and Emtricitabine 200mg/ Tenofovir disoproxil Fumarate 300mg *Complera Order as: Lamivudine 300mg & Endurant 25mg & Tenofovir Disoproxil Fumarate 300mg
| *Symtuza | Order as: Prezcobix 800/150 & |
| Lamivudine 300mg& |
Tenofovir disoproxil Fumarate 300mg *Triumeq Order as: Abacavir 600mg/ Lamivudine 300 & Tivicay 50mg HIV Agents - Supportive Agents (03.09.07) Azithromycin 600 mg tablet Zithromax Macrolides/Azalides/Lincosamides/Oxazolidinones (03.10)
| Azithromycin 250 mg tablet | Zithromax |
| Azithromycin 600 mg tablet | Zithromax |
| Azithromycin z-pak 250 mg tablet | Zithromax |
Clarithromycin 500mg tablet Biaxin
| Clindamycin HCL 150 mg capsule | Cleocin |
| Clindamycin HCL 300 mg capsule | Cleocin |
| Clindamycin phosphate 150mg/ml injection | Cleocin |
| Clindamycin phosphate 300 mg/2ml injection | Cleocin |
| Clindamycin phosphate 600 mg/4ml injection | Cleocin |
| Clindamycin phos 900 mg/8ml injection | Cleocin |
Penicillins (03.11)
| Amoxicillin 250 mg capsule | Amoxil |
| Amoxicillin 250 mg/5 ml suspension | Amoxil |
| Amoxicillin 500 mg capsule | Amoxil |
| Amoxicillin/clav 875-125 mg tablet | Augmentin |
| Dicloxacillin 250 mg capsule | Dynapen |
| Dicloxacillin 500 mg capsule | Dynapen |
| Nafcillin 1gm injection | Nafcil |
| Nafcillin 2gm injection | Nafcil |
| Penic g procaine 600,000 units injection | Wycillin |
| Penicillin v Potassium 250 mg tablet | Pen-VK |
| Penicillin v Potassium 500 mg tablet | Pen-VK |
| Penicillin v Potassium 250mg/5 ml oral reconst sol | Pen-VK oral |
| Penicillin-g Potassium 5mu injection | Penicillin Inj. |
| Penicillin-g Benzathine | Bicillin LA inj |
Piperacillin/Tazobactam Injection all doses Zosyn Sulfonamides (03.12)
| Sulfameth-Trimeth 800-160 mg tablet | Bactrim DS / Septra |
| Sulfameth/Trimeth 400/80 mg tablet | Bactrim/Septra |
| Sulfameth/Trimeth 400/80 mg/5ml injection | Bactrim Inj. |
| Sulfameth\Tri 200-40 mg/5 ml oral suspension | Bactrim/Septra |
Tetracyclines (03.13)
| Doxycycline Hyclate 50 mg | Vibramycin |
| Doxycycline Hyclate 100 mg capsule | Vibramycin |
Other Anti-Infectives (03.14)
| Dapsone 25 and 100 mg | Dapsone | |
| Metronidazole 250 and 500mg | Flagyl | |
| Metronidazole/nacl 500 mg/100 ml IVPB | Flagyl IVPB | |
| Nitrofurantoin monohydrate 100mg capsule | Macrobid | |
| (Restricted to use in female patients) | ||
| Linezolid 600mg | Zyvox | |
| Linezolid injection | Zyvox | |
| Vancomycin HCL 500 mg injection | Vancocin | |
| Vancomycin HCL 750 mg injection | Vancocin | |
| Vancomycin HCL 1000 mg injection | Vancocin | |
| 4. | Cancer-Related Agents |
Antineoplastics (04.01)
| Hydroxyurea 500 mg capsule | Hydrea |
| Tamoxifen Citrate 10 mg tablet | Nolvadex |
| Tamoxifen Citrate 20 mg tablet | Nolvadex |
| 5. | Cardiovascular Agents |
Alpha-adrenergic Blockers (05.01)
| Doxazosin 1 mg tablet | Cardura | |
| Doxazosin 2 mg tablet | Cardura | |
| Doxazosin 4 mg tablet | Cardura | |
| Doxazosin 8mg tablet | Cardura | |
| Terazosin 1 mg capsule | Hytrin | |
| Terazosin 2 mg capsule | Hytrin | |
| Terazosin 5 mg capsule | Hytrin | |
| Terazosin 10 mg capsule | Hytrin |
Angiotensin-Converting Enzyme Inhibitors (ACE) (05.02)
| Benazepril 5 mg tablet | Lotensin |
| Benazepril 10 mg tablet | Lotensin |
| Benazepril 20 mg tablet | Lotensin |
| Benazepril 40 mg tablet | Lotensin |
| Lisinopril 2.5 mg tablet | Zestril/Prinivil |
| Lisinopril 5 mg tablet | Zestril/Prinivil |
| Lisinopril 10 mg tablet | Zestril/Prinivil |
| Lisinopril 20 mg tablet | Zestril |
| Lisinopril 30 mg tablet | Zestril/Prinivil |
| Lisinopril 40 mg tablet | Zestril/Prinivil |
Angiotensin Receptor Blockers (ARBs) (05.03)
| Losartan 25 mg tablet | Cozaar |
| Losartan 50 mg tablet | Cozaar |
| Losartan 100 mg tablet | Cozaar |
Olmesartan all strengths Benzicar Antidysrhythmics - Type 1a (05.04.01)
| Disopyramide Phos 100 mg capsule | Norpace |
| Disopyramide Phos 150 mg capsule | Norpace |
| Disopyramide Phos 150 mg cap extended release | Norpace CR |
Quinidine Sulfate 200 mg tablet Antidysrhythmics - Type 1b (05.04.02) Antidysrhythmics - Type 1c (05.04.03) Antidysrhythmics - Type III (05.04.04) Amiodarone HCL 100 And 200mg Tablet Cordarone Antilipidemics - HMG-Coenzyme A Reductase Inhibitors (05.05.01)
| Atorvastatin 10 mg tablet | Lipitor |
| Atorvastatin 20 mg tablet | Lipitor |
| Atorvastatin 40 mg tablet | Lipitor |
| Atorvastatin 80 mg tablet | Lipitor |
| Rosuvastatin 5 mg tablet | Crestor |
| Rosuvastatin 10 mg tablet | Crestor |
| Rosuvastatin 20 mg tablet | Crestor |
| Rosuvastatin 40 mg tablet | Crestor |
| Simvastatin 5 mg tablet | Zocor |
| Simvastatin 10 mg tablet | Zocor |
| Simvastatin 20 mg tablet | Zocor |
| Simvastatin 40 mg tablet | Zocor |
Antilipidemics - Other Antilipidemics (05.05.02)
| Cholestyramine/Aspar powder | Questran light | |
| Cholestyramine/Aspartame pack | Questran light | |
| Ezetimibe tablet | Zetia | |
| Gemfibrozil 600 mg tablet | Lopid | |
| Niacin- 250 mg extended release tablet | Slo-Niacin | |
| Niacin- 500 mg extended release tablet | Slo-Niacin | |
| Niacin 750 mg extended release | Slo-Niacin |
Beta-Adrenergic Blockers - Selective Agents (05.06.01)
| Atenolol 25 mg tablet | Tenormin |
| Atenolol 50 mg tablet | Tenormin |
| Atenolol 100 mg tablet | Tenormin |
| Metoprolol Tart 25/50/75/100mg tablet | Lopressor |
| Metoprolol Succ 25/50/100/200mg tablet | Toprol XL |
Beta-Adrenergic Blockers-Non-Selective Agents (05.06.02)
| Propranolol 10 mg tablet | Inderal |
| Propranolol 20 mg tablet | Inderal |
| Propranolol 40 mg tablet | Inderal |
| Propranolol 60 mg tablet | Inderal |
| Propranolol 80 mg tablet | Inderal |
Beta-Adrenergic Blockers - a,ß Antagonists (05.06.03)
| Carvedilol 3.125 mg tablet | Coreg |
| Carvedilol 6.25 mg tablet | Coreg |
| Carvedilol 12.5 mg tablet | Coreg |
| Carvedilol 25 mg tablet | Coreg |
| Labetalol 100 mg tablet | Trandate |
| Labetalol 200 mg tablet | Trandate |
| Labetalol 300 mg tablet | Trandate |
Calcium Channel Blockers - Dihydropyridine (05.07.01)
| Amlodipine 2.5 mg tablet | Norvasc |
| Amlodipine 5 mg tablet | Norvasc |
| Amlodipine 10mg tablet | Norvasc |
Calcium Channel Blockers - Non-Dihydropyridine (05.07.02)
| Diltiazem HCL120 mg cap extended release 24 hr controlled | Dilacor XR |
| Diltiazem HCL 180 mg cap extended release 24 hr controlled | Dilacor XR |
| Diltiazem HCL 240 mg cap extended release 24 hr controlled | Dilacor XR |
| Diltiazem HCL 300 mg cap extended release 24 hr controlled | Cardizem cd |
| Diltiazem HCL 360 mg cap extended release 24 hr controlled | Cardizem cd |
| Diltiazem HCL 30 mg tablet | Cardizem |
| Diltiazem HCL 60 mg tablet | Cardizem |
| Diltiazem HCL 90 mg tablet | Cardizem |
| Diltiazem HCL 120 mg tablet | Cardizem |
| Verapamil 40 mg tablet | Calan |
| Verapamil 80 mg tablet | Calan |
| Verapamil 120 mg tablet | Calan |
| Verapamil120 mg tab extended release | Calan SR |
| Verapamil180 mg tab extended release | Calan SR |
| Verapamil 240 mg tab extended release | Calan SR |
Cardiac Glycosides (05.08)
| Digoxin 125 mcg tablet | Lanoxin |
| Digoxin 250 mcg tablet | Lanoxin |
| Digoxin 250 mcg/ml injection | Lanoxin Inj.. |
Centrally Acting Antihypertensives (05.09)
| Clonidine all strengths for dialysis/juvenile patients only | Catapress |
| Methyldopa 250 and 500mg tablet | Aldomet |
Diuretics (05.10)
| Acetazolamide 250 mg tablet | Diamox |
| Acetazolamide 500 mg cap extended-release | Diamox Sequel |
Eplerenone all strengths Inspra
| Furosemide 20 mg tablet | Lasix |
| Furosemide 40 mg tablet | Lasix |
| Furosemide 80 mg tablet | Lasix |
| Furosemide 10mg/ml injection | Lasix |
| Hydrochlorothiazide 12.5mg cap/tab | HCTZ |
| Hydrochlorothiazide 25 mg tablet | HCTZ |
| Hydrochlorothiazide 50 mg tablet | Hydrodiuril |
| Spironolactone 12.5mg | Aldactone |
| Spironolactone 25 mg tablet | Aldactone |
| Spironolactone 50 mg tablet | Aldactone |
| Spironolactone 100mg tablet | Aldactone |
| Triamterene/Hydrochlorothiazide 37.5-25 mg tablet | Maxzide 25 |
| Triamterene/Hydrochlorothiazide 75-50 mg tablet | Maxzide |
Hemorrheologic Agents (05.11)
| Clopidogrel 75 mg | Plavix |
| Dipyridamole 25 mg tablet | Persantine |
| Dipyridamole 50 mg tablet | Persantine |
| Dipyridamole 75 mg tablet | Persantine |
| Enoxparin injections - all strengths | Lovenox |
| Heparin sodium 1,000 u/ml injection | Heparin |
| Heparin sodium 5,000 u/ml injection | Heparin |
| Heparin sodium mdv 10,000 u/ml injection | Heparin |
| Heparin lock flush 10 u/ml iv sol | Hep lock |
| Heparin lock flush 100 u/ml iv sol | Hep lock |
| Heparin lock flush pf syringe 10 u/ml | Heparin lock |
| Warfarin sod 1 mg tablet | Jantoven |
| Warfarin sod 2 mg tablet | Jantoven |
| Warfarin sod 2.5 mg tablet | Jantoven |
| Warfarin sod 3 mg tablet | Jantoven |
| Warfarin sod 4 mg tablet | Jantoven |
| Warfarin sod 5 mg tablet | Jantoven |
| Warfarin sod 6 mg tablet | Jantoven |
| Warfarin sod 7.5mg tablet | Jantoven |
| Warfarin sod 10 mg tablet | Jantoven |
Vasodilators - Nitrates (05.12.01)
| Isosorbide-Mononit 10 mg tablet | Monoket |
| Isosorbide-Mononit 20 mg tablet | Monoket |
| Isosorbide-Mononit 30 mg tab sr 24 hr | Imdur |
| Isosorbide-Mononit 60 mg tab sr 24 hr | Imdur |
| Isosorbide-Mononit 120 mg tab sr 24 hr | Imdur |
| Nitroglycerin SL 1/150 (0.4mg) tab subl | Nitrostat |
Vasodilators - non-nitrates (05.12.02) Guanfacine 1 and 2mg tablets juvenile only Tenex
| Hydralazine HCL 10 mg tablet | Apresoline |
| Hydralazine HCL 25 mg tablet | Apresoline |
| Hydralazine HCL 50 mg tablet | Apresoline |
| Hydralazine HCL 100 mg tablet | Apresoline |
| Minoxidil 2.5 mg tablet | Loniten |
| Minoxidil 10 mg tablet | Loniten |
Combination Agents (05.13) Other CV Agents (05.14)
6. Central Nervous System Agents Antidepressants (06.01) Antidepressants - Tricyclic Antidepressants (06.01.01) Antidepressants - Serotonin +/- Norepinephrine Reuptake Inhibitors (SSRI / SNRI) (06.01.02)
| Citalopram 10 mg tablet | Celexa |
| Citalopram 20 mg tablet | Celexa |
| Citalopram 40 mg tablet | Celexa |
| Citalopram oral 10 mg/5 ml solution | Celexa Oral Soln |
| Duloxetine 20 mg capsule, delayed release | Cymbalta |
| Duloxetine 30 mg capsule, delayed release | Cymbalta |
| Duloxetine 40 mg capsule, delayed release | Cymbalta |
| Duloxetine 60 mg capsule, delayed release | Cymbalta |
Escitalopram 5mg, 10mg, 20mg tablets Lexapro
| Fluoxetine 10 mg capsule | Prozac |
| Fluoxetine 20 mg capsule | Prozac |
| Fluoxetine 40 mg capsule | Prozac |
| Fluoxetine soln 20 mg/5 ml oral solution | Prozac |
| Paroxetine all strengths regular release | Paxil |
| Sertraline HCL 25 mg tablet | Zoloft |
| Sertraline HCL 50 mg tablet | Zoloft |
| Sertraline HCL 100 mg tablet | Zoloft |
| Sertraline oral conc 20 mg/ ml concentrate | Zoloft Oral Conc |
Antidepressants - Other Antidepressants (06.01.03) Antipsychotic Agents (06.02) Antipsychotic Agents - 1st Generation Agents (06.02.01) Fluphenazine tablets 1mg,2.5mg,5mg,10mg Prolixin
| Fluphenazine Decon vl 25 mg/ml injection | Prolixin Decanoate |
| Fluphenazine HCL vl 2.5 mg/ml injection sol | Prolixin Inj.. |
| Haloperidol 0.5 mg tablet | Haldol |
| Haloperidol 1 mg tablet | Haldol |
| Haloperidol 2 mg tablet | Haldol |
| Haloperidol 5 mg tablet | Haldol |
| Haloperidol 10 mg tablet | Haldol |
| Haloperidol 20mg tablet | Haldol |
| Haloperidol Dec 50 mg/ml im injection | Haldol Decanoate |
| Haloperidol Dec 100 mg/ml im injection | Haldol Decanoate |
| Haloperidol Lact 5 mg/ml injection | Haldol |
| Haloperidol lactate 2 mg/ml oral concentrate | Haldol |
| Loxapine succinate 5 mg capsule | Loxitane |
| Loxapine succinate 10 mg capsule | Loxitane |
| Loxapine succinate 25 mg capsule | Loxitane |
| Loxapine succinate 50 mg capsule | Loxitane |
| Perphenazine 2 mg tablet | Trilafon |
| Perphenazine 4 mg tablet | Trilafon |
| Perphenazine 16 mg tablet | Trilafon |
| Perphenazine 8 mg tablet | Trilafon |
| Thiothixene 1 mg capsule | Navane |
| Thiothixene 2 mg capsule | Navane |
| Thiothixene 5 mg capsule | Navane |
| Thiothixene 10 mg capsule | Navane |
| Trifluoperazine HCL 1 mg tablet | Stelazine |
| Trifluoperazine HCL 2 mg tablet | Stelazine |
| Trifluoperazine HCL 5 mg tablet | Stelazine |
| Trifluoperazine HCL 10 mg tablet | Stelazine |
Antipsychotic Agents - 2nd Generation Agents (06.02.02)
| Aripiprazole 2 mg tablet | Abilify |
| Aripiprazole 5 mg tablet | Abilify |
| Aripiprazole 10 mg tablet | Abilify |
| Aripiprazole 15 mg tablet | Abilify |
| Aripiprazole 20 mg tablet | Abilify |
| Aripiprazole 30 mg tablet | Abilify |
Lurisidone 20mg, 40mg, 60mg, 80mg, 120mg tabs Latuda
| Olanzapine 2.5 mg tablet | Zyprexa |
| Olanzapine 5 mg tablet | Zyprexa |
| Olanzapine 7.5 mg tablet | Zyprexa |
| Olanzapine 10 mg tablet | Zyprexa |
| Olanzapine 15 mg tablet | Zyprexa |
| Olanzapine 20 mg tablet | Zyprexa |
| Risperidone 0.25 mg tablet | Risperdal |
| Risperidone 0.5 mg tablet | Risperdal |
| Risperidone 1mg tablet | Risperdal |
| Risperidone 2 mg tablet | Risperdal |
| Risperidone 3 mg tablet | Risperdal |
| Risperidone 4 mg tablet | Risperdal |
| Risperidone 1 mg / ml solution | Risperdal Soln |
| Ziprasidone HCL 20 mg capsule | Geodon |
| Ziprasidone HCL 40 mg capsule | Geodon |
| Ziprasidone HCL 60 mg capsule | Geodon |
| Ziprasidone HCL 80 mg capsule | Geodon |
Barbiturates (06.03) Cerebral Stimulants (06.04) Amphetamine all strengths Juvenile only Adderall Methylphenidate all strength Juvenile only Ritalin Mood Stabilizers (06.05)
| Divalproex Sodium 125 mg tab | Depakote |
| Divalproex Sodium 250 mg tab | Depakote |
| Divalproex Sodium 500 mg tab | Depakote |
| Lamotrigine 25 mg tablet | Lamictal |
| Lamotrigine 100 mg tablet | Lamictal |
| Lamotrigine 150 mg tablet | Lamictal |
| Lamotrigine 200 mg tablet | Lamictal |
| Lithium Carbonate 150 mg capsule | Eskalith |
| Lithium Carbonate 300 mg capsule | Eskalith |
| Lithium Citrate 300mg (8meq)/5ml syrup | Lithium Citrate |
| Valproic Acid 250 mg capsule | Depakene |
Sedatives / Hypnotics (06.06) Benzodiazepine (06.06.01) Other Agents (06.06.02) Anxiolytic (06.07) Other CNS Agents (6.08) Naltrexone 50 mg tablet Depade/Revia (Use limited to addiction recovery treatment)
| Prazosin 1 mg capsules | Minipress |
| Prazosin 2 mg capsules | Minipress |
| Prazosin 5 mg capsules | Minipress |
(Prazosin limited to treatment of ptsd related nightmares and sleep disturbances)
7. Dental Agents Dental Agents (07.01)
| Benzocaine 20 % mucous membrane liquid | Anbesol max strength |
| Chlorhexidine Gluc 0.12% mucous membrane mwash | Peridex |
| Sore Throat lozenge (mucous membrane lozenge) | Cepacol |
| 8. | Dermatological Agents |
Anti-Acne Products (08.01) Benzoyl Peroxide 5 and10% Topical Gel Persagel Antifungals (08.02)
| Miconazole Nitrate Topical 2% Cream | Micatin Cream |
| Clotrimazole 1% Topical Cream | Lotrimin AF |
| Nystatin 100,000 u/gm topical cream | Mycostatin |
| Nystatin 100,000u/gm topical ointment | Mycostatin |
Anti-Infectives (08.03) Bacitracin Ointment Bacitracin
| Bacitracin/Polymyxin B 500-10,000u/G Topical Ointment | Polysporin |
| Silver Sulfadiazine 1% Topical Cream | Silvadene |
Antipsoriatics (08.04) Yusimry biosimilar to Humira Antipruritic & Local Anesthetics (08.05)
Moisturizing and Barrier Agents (08.06)
| Minerin Cream | Minerin |
| Zinc Oxide Ointment 20% Ointment | Zinc Oxide |
Scabicides (08.07)
| Ivermectin 3 mg Tablet | Stromectal |
| Permethrin 5% Cream | Elimite |
| Permethrin 1% Topical Liquid | Nix Cream Rinse |
Steroid Anti-Inflammatories - Very High Potency (08.08.01) Steroid Anti-Inflammatories - High Potency (08.08.02)
| Betamethasone Dipropionate 0.05% aug. Cream | Diprolene AF |
| Triamcinolone Acetonide 0.5% Topical Cream | Kenalog |
| Triamcinolone Acetonide 0.5% Topical Ointment | Kenalog |
Steroid Anti-Inflammatories - Medium Potency (08.08.03) Triamcinolone 0.1% Topical Cream and Ointment Kenalog Steroid Anti-Inflammatories - Low Potency (08.08.04) Hemorrhoidal Hc 1% Cream Preparation H w/Hydrocortisone Hydrocortisone 1% Topical Cream and Ointment Hytone Other Derm Agents (08.09)
| Calcium Acet/Alum So4 Pack | Domeboro |
| Ferric Subsulf Solution 259mg/G Topical Solution | Monsels Solution |
Imiquimod 5% Cream Aldara
| Salicylic Acid 17% Topical Liquid | Duofilm |
| Salicylic Acid 40% Topical Plaster | Mediplast Patch |
| Silver Nitrate Appl 75-25% Topical Stick | Silver Nitrate |
| 9. | Diagnostics and Supplies |
Diagnostics and Supplies (09.01) Candida Albicans Skin Test
| Dextrose 5% in Water (D5w) | D5-W |
| Dextrose 50% in Water Iv Syringe | D-50w |
| D5%-0.45% Sodium Chloride Intravenous Parenteral Solution | D5-1/2ns 1000ml |
| Lactated Ringers Intravenous Parenteral Solution | Lactated Ringers |
| Potassium Chloride 20meq/L--O.45% Nacl IV Parenter Soln | Sodium Chloride 0.45% + KCL |
| Potassium Chlorid-D5-0.45%Nacl+20meq/L IV Parenter Soln | D5-1/2ns + KCL |
| Sod Chloride 0.9% Inj. | Normal Saline |
| Tuberculin Ppd Vl 5tu/0.1 ml Inj. | Aplisol |
| Water for Inj. Sterile | Water for Inj. |
| 10. | Emergency Medications |
Emergency Medications (10.01)
| Atropine 0.1 mg/ml Inj. Syringe | Atropine Sulfate |
| Atropine 0.4 mg/ml Inj. Solution | Atropine Inj.. |
| Calcium Gluconate 100mg/ml 10% Intravenous Sol | Ca Gluconate |
| Charcoal + Sorbitol 50 Gm/240 ml Suspension | Charcoal |
| Charcoal 25gm Liquid | Charcoal |
| Charcoal 50gm Liquid | Charcoal |
| Dexamethasone 4 mg/ml Inj. Solution | Decadron Inj.. |
| Diphenhydramine Inj for emergent mental health use | Benadryl |
Diphenhydramine oral for emergent use (mild allergic reactions) Benadryl (oral diphenhydramine max 30 count card stock only)
| Epinephrine 1mg/ml (1:1000) Inj. Solution (1ml) | Adrenalin |
| Epinephrine 1mg/ml (1:1000) Inj. Solution Vial | Adrenalin |
| Fluphenazine HCL 2.5 mg/5ml Elixir | Prolixin Elixir |
| Fluphenazine HCL 5 mg/ml Oral Concentrate | Prolixin Oral |
| Fluphenazine HCL 2.5 mg/ml Inj. Solution | Prolixin Inj.. |
| Furosemide Vial 10 mg/ ml Inj. | Lasix |
| Haloperidol Lact 5 mg/ml Inj. Solution | Haldol |
| Ketorolac 15 mg/ml Inj. Solution | Toradol Inj.. |
| Ketorolac 30 mg/ml Inj. Solution | Toradol Inj.. |
| Labetalol 100 mg Tablet | Trandate |
| Labetalol 200 mg Tablet | Trandate |
| Labetalol 300 mg Tablet | Trandate |
| Lidocaine 10mg/ml (1%) Inj. Solution | Xylocaine |
| Methylpred Acetate 40 mg/ml Inj. Susp | Depo-Medrol |
| Methylpred Acetate 80 mg/ml Inj. Susp | Depo-Medrol |
| Methylpred Sod Succ 40mg Inj. | Solu-Medrol |
| Methylpred Sod Succ 125 mg Inj. | Solu-Medrol |
| Methylpred Sod Succ 500 mg Inj. | Solu-Medrol |
| Naloxone 0.4 mg/ml Inj. | Narcan |
| Naloxone Syringe 2 mg/2 ml Inj. | Narcan |
| Naloxone Nasal Spray | Nasal Narcan |
| Nitroglycerin 1/150 (0.4mg) Tab Subl | Nitrostat |
| Phenytoin Sod Vial 50 mg/ ml Inj. | Dilantin |
| Phytonadione Amp 10 mg/ml Inj. | Aqua-Mephyton |
| Potassium Cl 40meq/15 ml Oral Liquid | Kaon-Cl |
| Potassium Cl 10 Meq/100 ml IVPB Inj. | Potassium Chloride |
| Potassium Cl 20 Meq/100 ml IVPB Inj. | Potassium Chloride |
| SOD Bicarbonate (1meq/ml) 8.4 % IV Soln | Sodium Bicarbonate |
| SOD Polysty Sulf Oral Powder | Kayexalate Powder |
| SOD Polysty Sulf 15gm/60 ml Oral Suspension | Kayexalate Susp |
| Thiamine HCL 50 mg Tablet | Vitamin B-1 |
| Thiamine HCL 100 mg Tablet | Vitamin B-1 |
| Thiamine HCL 100 mg/ml Inj. Soln | Vitamin B-1 |
| 11. | Endocrine – Metabolic Agents |
Androgens (11.01) Estrogens – Progestins (11.02)
| Estradiol 0.5 mg Tablet | Estrace |
| Estradiol 1 And 2mg Tablet | Estrace |
Insulins (11.03)
| Insulin Hum NPH Vl 100 U/ml Inj. | Novolin NPH |
| Insulin Hum Reg Vl 100 U/ml Inj. | Novolin Reg |
| Insulin Glargine 100 Units/ml | Semglee/Lantus |
Hypoglycemics - Sulfonylureas (11.04.01)
| Glimepiride 1 mg Tablet | Amaryl |
| Glimepiride 2 mg Tablet | Amaryl |
| Glimepiride 4 mg Tablet | Amaryl |
| Glipizide 5 mg Tablet | Glucotrol |
| Glipizide 10 mg Tablet | Glucotrol |
Hypoglycemics - Biguanides (11.04.02)
| Metformin 500mg tablet | Glucophage |
| Metformin 850 mg tablet | Glucophage |
| Metformin 1000 mg tablet | Glucophage |
| Metformin 500 mg tab extended release 24 hr | Glucophage XR |
| Metformin 750 mg tab extended release 24 hr | Glucophage XR |
Hypoglycemics – DPP-4 Inhibitor (11.04.03) Saxagliptin all strengths Onglyza Hypoglycemics - Incretin Mimetics (11.04.04) Hypoglycemics - Combination Agents (11.04.05) Hypoglycemics - Other Agents (11.04.06) Thyroid Agents (11.05)
| Levothyroxine 25 Mcg Tablet | Synthroid |
| Levothyroxine 50 Mcg Tablet | Synthroid |
| Levothyroxine 75 Mcg Tablet | Synthroid |
| Levothyroxine 88 Mcg Tablet | Synthroid |
| Levothyroxine 100 Mcg Tablet | Synthroid |
| Levothyroxine 112 Mcg Tablet | Synthroid |
| Levothyroxine 125 Mcg Tablet | Synthroid |
| Levothyroxine 137 Mcg Tablet | Synthroid |
| Levothyroxine 150 Mcg Tablet | Synthroid |
| Levothyroxine 175 Mcg Tablet | Synthroid |
| Levothyroxine 200 Mcg Tablet | Synthroid |
| Levothyroxine 300 Mcg Tablet | Synthroid |
| Methimazole 5 mg Tablet | Tapazole |
| Methimazole 10 mg Tablet | Tapazole |
Adrenal Corticosteroids (11.06)
| Dexamethasone 0.5 mg Tablet | Decadron |
| Dexamethasone 0.5 mg/5 ml Oral Elixir | Decadron |
| Dexamethasone 0.75 mg Tablet | Decadron |
| Dexamethasone 1 mg Tablet | Decadron |
| Dexamethasone 1.5 mg Tablet | Decadron |
| Dexamethasone 2 mg Tablet | Decadron |
| Dexamethasone 4 mg Tablet | Decadron |
| Dexamethasone 6 mg Tablet | Decadron |
| Hydrocortisone 5 mg Tablet | Cortef |
| Hydrocortisone 10 mg Tablet | Cortef |
| Hydrocortisone 20 mg Tablet | Cortef |
| Methylprednisolone 2 mg Tablet | Medrol |
| Methylprednisolone 4 mg Tablet | Medrol |
| Methylprednisolone 4 mg Tablets, Dose Pack | Medrol Dosepak |
| Prednisone 1 mg Tablet | Deltasone |
| Prednisone 2.5 mg Tablet | Deltasone |
| Prednisone 5 mg Tablet | Deltasone |
| Prednisone 10 mg Tablet | Deltasone |
| Prednisone 20 mg Tablet | Deltasone |
| Prednisone 50 mg Tablet | Deltasone |
| Prednisone 5 mg Tablets, Dose Pack | Prednisone |
| Prednisone 10 mg Tablet Tablets, Dose Pack | Prednisone |
| Triamcinolone Acet 40 mg/ml Inj. Suspension | Kenalog |
Osteoporosis Agents (11.07)
| Alendronate 35 mg Tablet | Fosamax |
| Alendronate 70 mg Tablet | Fosamax |
Other Endocrine - Metabolic Agents (11.08)
| Calcitriol 0.25 Mcg Capsule | Rocaltrol |
| Calcitriol 0.5 Mcg Capsule | Rocaltrol |
| Cinacalcet 30 mg Tablet | Sensipar |
| Cinacalcet 60 mg Tablet | Sensipar |
| Cinacalcet 90 mg Tablet | Sensipar |
| Glucose 40% Oral Gel | Glutose |
| Paricalcitol Vial 2 Mcg/ml Inj. | Zemplar |
| Paricalcitol Vial 5 Mcg/ml Inj. | Zemplar |
12. Gastrointestinal Agents Aminosalicylates (12.01)
| Balsalazide 750 mg Capsule | Colazal |
| Sulfasalazine 500 mg Tablet | Azulfidine |
Tumor Necrosis Factor (12.02) Yusmiry SQ Injectable biosimilar to Humira Anti-Diarrheals (12.03)
| Loperamide 2 mg Tablet (24 doses/30-day limit) | Imodium |
| Pink Bismuth 262 mg Tab Chew | Pepto-Bismol |
Anti-Emetics (12.04)
| Ondansetron 4 mg Tablet (7 days max every 180 days) | Zofran |
| Ondansetron 8 mg Tablet (7 days max every 180 days) | Zofran |
| Ondansetron HCL Vial 2 mg/ml Inj. (7 days max every 180 days) | Zofran Sdv 4mg |
| Ondansetron 4 mg, Tablet Disintegrating (7 days max every 180 days) | Zofran ODT |
| Ondansetron 8 mg Tablet Disintegrating (7 days max every 180 days) | Zofran ODT |
| Prochlorperazine Maleate 5 mg Tablet (3 days max every 180 days) | Compazine |
| Prochlorperazine Maleate 10 mg Tablet (3 days max every 180 days) | Compazine |
| Prochlorperazine 25 mg Rectal Suppository (3 days max every 180 days) | Compazine |
| Promethazine HCL 25 mg/ml Inj. Soln (3 days max every 180 days) | Phenergan |
| Promethazine HCL 50 mg/ml Inj. Soln (3 days max every 180 days) | Phenergan |
| Promethazine- 25 mg Rectal Suppository (3 days max every 180 days) | Phenergan |
| Promethazine- 50 mg Rectal Suppository (3 days max every 180 days) | Phenergan |
Cathartics / Laxatives (12.05)
| Bisacodyl 10 mg Rectal Suppository (7 days max every 180 days) | Dulcolax Supp |
| Bisacodyl 5 mg Tab, Delayed Release (Dr/Ec) (7 days max every 180 days) | Dulcolax |
| Bisacodyl 5 mg Tablet (7 days max every 180 days) | Dulcolax |
| Calcium Polycarbophil 625mg Tablets | Fibercon |
| Docusate Sodium-100mg (Limited pre and post-partum patients) | Colace |
| Glycerin Adult Rectal Suppository | Glycerin Supp |
| Lactulose 10gm/15 ml Oral Solution | Chronulac |
| Magnesium Citrate Solution | Citrate of Mag |
| Milk of Mag Susp 80meq/30 ml Suspension Limited to Clinic Stock Only | MOM |
| Peg 3350/Electrolytes 227.1-21.5-6.36g Oral Powder | Golytely |
| Sodium Phosphate 19.7g/119ml Rectal Enema | Fleet Enema |
Digestive Enzymes (12.06) Lactase 3000 Units Tablets Lactaid GI Motility Agents (12.07) Polyethylene Glycol Miralax Histamine – 2 Receptor Antagonists (H2RAs) (12.09)
| Famotidine 10 mg tablet | Pepcid |
| Famotidine 20 mg tablet | Pepcid |
| Famotidine 40 mg Tablet | Pepcid |
Proton Pump Inhibitors (PPIs) (12.10) Omeprazole 20 mg capsule Prilosec (8-week duration including taper every 365 days) Omeprazole 40 mg capsule Prilosec (8-week duration including taper every 365 days) Other GI Agents (12.11)
| Lactobacillus Acidophilus (Restricted to use in female patients) | Lactinex |
| Sevelamer Carbonate 800 mg tablet | Renvela |
| Sucralfate 1gm tablet | Carafate |
Hemorrhoidal Agents (12.12)
| Dibucaine 1% rectal ointment | Nupercainal | |
| Hemorrhoidal hc 1% cream | Preparation H w/Hydrocort | |
| Hemorrhoidal supp (phenylephrine) 0.25% rectal | Preparation H | |
| Hydrocortisone CR 1% | Hytone | |
| Hydrocortisone enema 100mg/60ml enema | Cortenema | |
| Search as brand in NextGen | ||
| Hydrocortisone ointment 1% | Hytone | |
| 13. | Genitourinary Agents |
Benign Prostatic Hypertrophy Agents (13.01)
| Doxazosin 1 mg Tablet | Cardura |
| Doxazosin 2 mg Tablet | Cardura |
| Doxazosin 4 mg Tablet | Cardura |
| Doxazosin 8mg Tablet | Cardura |
Finasteride 1 and 5mg Proscar
| Tamsulosin 0.4 mg Cap Extended Release 24 Hr | Flomax |
| Terazosin 1 mg Capsule | Hytrin |
| Terazosin 2 mg Capsule | Hytrin |
| Terazosin 5 mg Capsule | Hytrin |
Terazosin 10 mg Capsule Other GU Agents (13.02)
| Bethanechol 50 mg Tablet | Urecholine |
| Sod Bicarbonate 325 mg Tablet | Sodium Bicarb |
| Sod Bicarbonate 650 mg Tablet | Sodium Bicarb |
| 14. | Hematological Agents |
Hematological Agents (14.01)
| Epoetin Beta (Preferred) | Mircera |
| Epoetin Alfa | Retacrit |
| Immune Globulin D (Limited to Iwp) | Rhogam |
Sickle Cell Agents (14.02)
| Hydroxyurea 500 mg Capsule | Hydrea |
| 15. | Immunosuppressants |
Immunosuppressants (15.01)
| Azathioprine 50 mg Tablet | Imuran |
| Cyclosporine 25 mg Capsule | Sandimmune |
| Cyclosporine 100 mg Capsule | Sandimmune |
| Cyclosporine Modified 25 mg Capsule | Neoral/Gengraf |
| Cyclosporine Modified 100 mg Capsule | Neoral/Gengraf |
| Cyclosporine Modified 100 mg/ml Solution | Neoral Solution |
| Tacrolimus 0.5 mg Capsule | Prograf |
| Tacrolimus 1 mg Capsule | Prograf |
| Tacrolimus 5 mg Capsule | Prograf |
Antirheumatic Agents (15.02)
| Hydroxychloroquine Sulfate 200 mg | Plaquenil |
| Methotrexate 2.5 mg Tablet | Trexall |
| Methotrexate 25mg/ml Inj. | Trexall |
Yusimry biosimilar to Humira
16. Neurological Agents Alzheimer’s Agents (16.01) Anticonvulsants (16.02)
| Divalproex 125 mg Tab | Depakote |
| Divalproex 250 mg Tab | Depakote |
| Divalproex 500 mg Tab | Depakote |
| Lamotrigine 25 mg Tablet | Lamictal |
| Lamotrigine 100 mg Tablet | Lamictal |
| Lamotrigine 150 mg tablet | Lamictal |
| Lamotrigine 200 mg tablet | Lamictal |
| Levetiracetam 250 mg IR/ER Tablet | Keppra |
| Levetiracetam 500 mg IR/ER Tablet | Keppra |
| Levetiracetam 750 mg IR/ER Tablet | Keppra |
| Levetiracetam 1000 mg IR/ER Tablet | Keppra |
Oxcarbazepine all IR strengths Trileptal
| Phenytoin 125 mg/5 ml Oral Suspension | Dilantin-125 |
| Phenytoin 50 mg Tablet Chewable | Dilantin Infatab |
| Phenytoin Sod *Ext* 30 mg Capsule | Dilantin |
| Phenytoin Sod *Ext* 100 mg Capsule | Dilantin |
| Valproic Acid 250 mg Capsule | Depakene |
| Valproic Acid 250 mg/5 ml Oral Solution | Depakene Syrup |
Anti-Parkinsons Agents (16.03)
| Amantadine HCL 100 mg Capsule | Symmetrel |
| Amantadine HCL 50 mg/5 ml Oral Solution | Symmetrel |
| Benztropine 0.5 mg Tablet | Cogentin |
| Benztropine 1 mg Tablet | Cogentin |
| Benztropine 2 mg Tablet | Cogentin |
| Benztropine 2mg/2ml Inj. | Cogentin Inj. |
| Bromocriptine 2.5 mg Tablet | Parlodel |
| Bromocriptine 5 mg Capsule | Parlodel |
| Carbidopa/Levodopa 10-100 mg Tablet | Sinemet |
| Carbidopa/Levodopa 25-100 mg Tablet | Sinemet |
| Carbidopa/Levodopa 25-250 mg Tablet | Sinemet |
Myasthenia Gravis (16.04) (Cholinesterase inhibitor) Pyridostigmine all strengths Mestinon Multiple Sclerosis Agents (16.041) Other Neuro Agents (16.05)
| Meclizine 12.5 mg Tablet | Antivert |
| Meclizine 25 mg Tablet | Antivert |
| Valproic Acid 250 mg/5 ml Oral Soln | Depakene Syrup |
| 17. | Obstetric – Gynecologic Agents |
Contraceptives (17.01)
| Noreth/Estrad 1-0.035 mg Tablet | Ortho-Novum 1/35 |
| Norgest/Estradiol 0.3/0.03 mg Tablet | Lo-Ovral |
Anti-Infectives (17.02) Miconazole 2% Vaginal Cream Monistat-7 Other OB Agents (17.03)
| Medroxyprogesterone 2.5 mg Tablet | Provera |
| Medroxyprogesterone 5 mg Tablet | Provera |
| Medroxyprogesterone 10 mg Tablet | Provera |
| Medroxyprogesterone Acetate 150mg/ml Im Susp (Depo) | Depo-Provera |
18. Ophthalmic – Otic Preparations Anti-Glaucoma Agents (18.01)
| Betaxolol HCL 0.25% Ophthalmic Drops, Susp | Betoptic S |
| Betaxolol HCL 0.5% Ophthalmic Drops | Betoptic Ophth |
| Brimonidine Soln 0.2% Ophthalmic Drops | Alphagan |
| Dorzolamide 2% Ophthalmic Drops | Trusopt Ophth |
| Latanoprost 0.005% Ophthalmic Drops | Xalatan |
| Levobunolol 0.5% Ophthalmic Drops | Betagan Ophth |
| Pilocarpine HCL 1% Ophthalmic Drops | Isopto Carpine |
| Pilocarpine HCL 2% Ophthalmic Drops | Isopto Carpine |
| Pilocarpine HCL 4% Ophthalmic Drops | Isopto Carpine |
| Timolol 0.25% Ophthalmic Drops | Timoptic |
| Timolol 0.5% Ophthalmic Drops | Timoptic |
Antihistamines / Decongestants (18.02) Anti-Infective Agents (18.03)
| Bacitracin/Polymyxin B Ophthalmic Ointment | Polysporin Ophth |
| Ciprofloxacin 0.3% Ophthalmic Drops | Ciloxan Ophth |
Moxifloxacin 0.5% Opthalmic Drops Vigamox
| Neomy/Bac/Poly 3.5-400-10,000 mg/Unit/Unit/G Eye Ointment | Neosporin Ophth |
| Neomy/Poly B/Gram 1.75mg-10,000u-0.025mg/ml Ophthalmic Drops | Neosporin |
| Neomy/Polymyx/Dex Ophthalmic Oint 3.5mg/G-10,000u/G--0.1% | Maxitrol |
| Neomy/Polymyx/Dex Ophthalmic Susp 3.5mg/ml -10,000unit/ml-0.1% | Maxitrol |
| Neomy/Bac/ Polymx/Hc Ointment 3.5-400-10,000u/G--0.1% | Cortisporin Ophth |
| Sulfacet/Pred 10%-0.25% Ophthalmic Drops | Vasocidin |
| Sulfacet/Pred 10%/0.2% Ophthalmic Susp | Blephamide Ophth |
| Tobramycin Eye Drops 0.3% Ophthalmic Drops | Tobrex Ophth |
| Tobramycin Oint 0.3% Ophthalmic Ointment | Tobrex |
| Trifluridine 1% Ophthalmic Drops | Viroptic Ophth |
Anti-Inflammatory Agents (18.04) Dexamethasone 0.1% Ophthalmic Susp Decadron Ophth Diclofenac 0.1% Opthalmic Drops Voltaren
| Prednisolone Acet 0.12% Ophthalmic Susp | Pred Mild Eye Drops |
| Prednisolone Acet 1% Ophthalmic Susp | Pred Forte Susp |
Otic Preparations (18.05)
| Acetic Acid 2% Otic Solution | Vosol |
| Acetic Acid/Al Acet Otic 2% Otic | Domeboro Otic |
| Neomy/Polymx/Hc 3.5-10,000, 1mg/ml Otic Susp | Cortisporin Otic |
| Carbamide Peroxide 6.5% Otic (4 Day max every 30 days) | Debrox |
Other Ophthalmic-Otic Agents (18.06)
| Artificial Tears (Polyvin Alc) 1.4% Ophthalmic Drops | Liquifilm Tears |
| Atropine Sulfate 1% Ophthalmic Drops | Isopto Atropine |
| Atropine Sulfate 1% Ophthalmic Ointment | Atropine Ophth |
| Cyclopentolate 0.5% Ophthalmic Drops | Cyclogyl |
| Cyclopentolate 1% Ophthalmic Drops | Cyclogyl |
| Cyclopentolate 2% Ophthalmic Drops | Cyclogyl |
| Eye Wash Irrg Ophthalmic | Dacriose |
| Fluorescein/Benoxinate 0.25%-0.4% Ophthalmic Drops | Fluress |
Meningococcal ACWY Menquadfi Meningococcal B Bexsero
| Fluorescein 1 mg Strip | Ful-Glo |
| Homatropine Hbr 5% Ophthalmic Drops | Isopto Homatropine |
| Proparacaine HCL 0.5% Ophthalmic Drops | Ophthetic |
| Sod Chloride Eye Drops 2% Ophthalmic | Muro-128 Ophth |
| Sod Chloride Eye Drops 5% Ophthalmic | Muro-128 Ophth |
| Sod Chloride Eye Oint 5% Ointment | Muro-128 Ophth |
| Tropicamide 0.5% Ophthalmic Drops | Mydriacyl |
| Tropicamide 1% Ophthalmic Drops | Mydriacyl |
| 19. | Respiratory Agents |
Anticholinergics (19.01) Ipratropium 0.02% Nebulization Solution Atrovent Soln Beta Agonists (19.02)
| Albuterol 90 Mcg/Actuation Inhalation Hfa Aerosol | Proair |
| Albuterol 2.5mg/3ml (0.083%) Inhalation Sol For Neb | Proventil |
| Albuterol 2 mg/5ml Syrup | Proventil |
Inhaled Oral Steroids (19.03)
Nasal Steroid Sprays (19.04) Triamcinolone Nasal Inhaler Nasalcort Combination Products (19.05)
| Ipratropium-Albuterol 0.5-3 mg/3ml Nebulization Solution | Duoneb |
| Fluticasone/Salmeterol Inhaler (Laba) (All Strengths) | Airduo |
Other Respiratory Agents (19.06)
| Acetylcysteine Vial 100 mg/ml (Misc Soln) | Mucomyst 10% |
| Acetylcysteine Vial 200 mg/ml (Misc Soln) | Mucomyst 20% |
| Aminophylline 250 mg/10 ml Inj. | Aminophylline |
| Montelukast 10mg (Leukotriene Antagonists) | Singulair |
20. Vaccines Vaccines - (20.01)
| Hepatitis B Vacc Pf 10 mcg/ml Inj. | Recombivax Hb Ped |
| Hepatitis-A Vacc 50 U/ml Im Inj. Syringe | Vaqta |
| Hepatitis-A Vacc 50 U/ml Inj. | Vaqta |
| Influenza Vaccine | Fluvirin-AFluria |
| Measles, Mumps, Rubella Vl Inj. | MMR Vaccine |
Papillomavirus HPV Pneumococcal 20 Valent Conj Vaccine Prevnar 20
| Pneumococcal 23 Valent Conj Vaccine | Pneumovax 23 |
| Shingrix Inj. | Shingrix |
| Tetanus Tox Conjugate 10/25 mcg Inj. | Hiberix |
| Tetanus-Diphtheria Tox Inj. | Decavac/Tenivac Syg |
| Tetanus-Diphtheria Vial Inj. | Decavac/Tenivac Vial |
| 21. | Vitamins – Minerals – Dietary Supplements |
Vitamins – Minerals – Dietary Supplements (21.01)
| Calcium Acetate 667 mg Tablet | Phoslo/ Eliphos | |
| Calcium Carbonate / Vitamin D Tablet | Various Brand Names | |
| Calcium Gluconate 100mg/ml (10%) Iv Soln | CA Gluconate | |
| Cyanocobalamin 1000 Mcg Tablet | Vitamin B12 | |
| Cyanocobalamin 1000 Mcg/ml Inj. | Vitamin B12 | |
| Ferrous Sulfate 325 mg (65mg Iron) Tab, Delayed Rel Dr/Ec | Feso4 (65mg Fe} | |
| Folic Acid 1 mg Tablet | Folic Acid | |
| Iron Dextran Comp 50 mg/ml Inj. Soln | Infed | |
| Lanthanum Carb 500 mg Tab Chewable | Fosrenol | |
| Lanthanum Carb 1000 mg Tab Chewable | Fosrenol | |
| Phytonadione Amp 10 mg/ml Inj. | Aqua-Mephyton | |
| Pot IOD/Iodine Sol 10%-5% Solution | Lugol's Solution | |
| Potassium Cl 8meq Tab Extended Release | Slow-K | |
| Potassium Cl 10 Meq Tab/Cap | K-DUR/KLOR-Con | |
| Potassium Cl 20meq Oral Packet | K-LOR Powd Pkt | |
| Potassium Cl 20meq Tab Extended Release | KLOR-Con M20 | |
| Potassium Cl 40meq/15 ml Liquid | Kaon-Cl | |
| Potassium Cl 10 Meq/100 ml IVPB Inj. | Potassium Chloride | |
| Potassium Cl 20 Meq/100 ml IVPB Njection | Potassium Chloride | |
| Prenatal Vit Tablet | Prenatal Vit | |
| Pyridoxine Tablet | Vitamin B-6 | |
| Sod Ferric Gluc Sucrose 62.5 mg/5 ml Iv Sol | Ferrlecit Inj. | |
| Thiamine HCL 50 mg Tablet | Vitamin B-1 | |
| Thiamine HCL 100 mg Tablet | Vitamin B-1 | |
| Thiamine HCL100 mg/ml Inj. Sol | Vitamin B-1 | |
| Vitamin B Comp W-C/Fa Tablet | Rena-Vite Rx | |
| 22. | Miscellaneous and Unclassified Agents |
Miscellaneous and Unclassified Agents (22.01)
| Alteplase | Cathflo |
| Bupivacaine HCL 0.25% (2.5mg/ml) Inj. Soln | Marcaine |
| Bupivacaine HCL 0.5% (5mg/ml) Inj. Soln | Marcaine |
| Bupivacaine HCL/Epi Vl 0.5% (1:200,000) Inj. | Marcaine Epi |
| Lidocaine 10mg/ml (1%) Inj. | Xylocaine |
| Lidocaine Epinephrine 1% (1:100,000) Inj. Soln | Xylocaine W/Epi |
| Lidocaine 20 mg/ml (2%) Inj. | Xylocaine |
| Lidocaine Epinephrine 2% (1:200,000) Inj. Soln | Xylocaine W/Ep |
23. Preferred Agents Still Needing Formulary Exception Request
Teriflunomide(Aubagio) or Gilenya injection Briumvi – For Multiple Sclerosis Fluphilia – Pegfilgrastim-jmdb used once per chemo cycle Granix – daily filgrastim agent Suboxone – dissolve tablets preferred product Tudorza – anticholinergic inhaler Duaklir – LAMA/LABA inhaler Alvesco – steroid inhaler Farxiga – SGLP2 Inhibitor
Formulary Drug List - Indiana Department of Corrections
Rev. 02/27/2025 Adult/Juvenile
| 1/2ns + KCL 20 Meq Inj. | Sodium Chloride 0.45% + KCL | 09.01 |
| Abacavir 300 mg Tablet | Ziagen | 03.09.04 |
| Acetaminophen 325 mg Tablet | Tylenol | 01.01 |
| Acetaminophen 500 mg Tablet | Tylenol | 01.01 |
| Acetazolamide 250 mg Tablet | Diamox | 05.10 |
| Acetazolamide 500 mg Cap Cr | Diamox Sequel | 05.10 |
| Acetic Acid Soln 2% Otic | Vosol | 18.05 |
| Acetic Acid/Al Acet Otic 2% Otic | Domeboro Otic | 18.05 |
| Acetylcysteine Vial 100 mg/ml (For Nebulization) | Mucomyst 10% | 19.06 |
| Acetylcysteine Vial 200 mg/ml (For Nebulization) | Mucomyst 20% | 19.06 |
| Acyclovir 200 mg Capsule | Zovirax | 03.06 |
| Acyclovir 400 mg Tablet | Zovirax | 03.06 |
| Acyclovir 800 mg Tablet | Zovirax | 03.06 |
| Albuterol HFA Proair 90 mcg Inhaler | Proair | 19.02 |
| Albuterol 0.083% Nebulization Solution | Proventil | 19.02 |
| Albuterol Syrup 2 mg/5mi Syrup | Proventil | 19.02 |
| Alendronate Sodium 35/70mg Tablet | Fosamax | 11.07 |
| Allopurinol 100 mg Tablet | Zyloprim | 01.02 |
| Allopurinol 300 mg Tablet | Zyloprim | 01.02 |
| Alteplase | Cathflo | 22.01 |
| Amantadine HCL 100 mg Capsule | Symmetrel | 03.06 |
| Amantadine HCL 100 mg Capsule | Symmetrel | 16.03 |
| Amantadine HCL 50 mg/5 ml Syrup | Symmetrel | 03.06 |
| Amantadine HCL 50 mg/5 ml Syrup | Symmetrel | 16.03 |
| Aminophylline Vl 250 mg/10 ml Inj. | Aminophylline | 19.06 |
| Amiodarone HCL 100 mg Tablet | Cordarone | 05.04.04 |
| Amiodarone HCL 200 mg Tablet | Cordarone | 05.04.04 |
| Amlodipine Besylate 10 mg Tablet | Norvasc | 05.07.01 |
| Amlodipine Besylate 2.5 mg Tablet | Norvasc | 05.07.01 |
| Amlodipine Besylate 5 mg Tablet | Norvasc | 05.07.01 |
| Amoxicillin 250 mg Capsule | Amoxil | 03.11 |
| Amoxicillin 250 mg/5 ml Suspension | Amoxil | 03.11 |
| Amoxicillin 500 mg Capsule | Amoxil | 03.11 |
| Amoxicillin/Clav 875-125 mg Tablet | Augmentin | 03.11 |
Amphetamine tablet Juvenile Only Adderall 06.04
| Apap - Box /24 Protocol 325 mg Tablet | Tylenol | 01.01 |
| Apap Suppository 325 mg Suppository | Tylenol Supp | 01.01 |
| Apap Suppository 650 MG Suppository | Tylenol Supp | 01.01 |
| Aripiprazole 2 mg Tablet | Abilify | 06.02.02 |
| Aripiprazole 5 mg Tablet | Abilify | 06.02.02 |
| Aripiprazole 10 mg Tablet | Abilify | 06.02.02 |
| Aripiprazole 15 mg Tablet | Abilify | 06.02.02 |
| Aripiprazole 20 mg Tablet | Abilify | 06.02.02 |
| Aripiprazole 30 mg Tablet | ABILIFY | 06.02.02 |
| Artificial Tears 1.4% Ophthalmic | Liquifilm Tears | 18.06 |
| Asa 325mg Ec 325 mg Tab Ec | Ecotrin | 01.07 |
| Aspirin - Film Coat 325 mg Tablet | Asa FC | 01.07 |
| Aspirin Ec 81 mg Tab Ec | Ecotrin | 01.07 |
| Aspirin FC Box/24 Protocol 325 mg Tablet | Aspirin | 01.07 |
| Atazanavir Sulfate 150 mg Capsule | Reyataz | 03.09.05 |
| Atazanavir Sulfate 200 mg Capsule | Reyataz | 03.09.05 |
| Atazanavir Sulfate 300 mg Capsule | Reyataz | 03.09.05 |
| Atenolol 100 mg Tablet | Tenormin | 05.06.01 |
| Atenolol 25 mg Tablet | Tenormin | 05.06.01 |
| Atenolol 50 mg Tablet | Tenormin | 05.06.01 |
Atomoxetine all strengths Juvenile Only Strattera 06.08
| Atorvastatin 10 mg Tablet | Lipitor | 05.05.01 |
| Atorvastatin 20 mg Tablet | Lipitor | 05.05.01 |
| Atorvastatin 40 mg Tablet | Lipitor | 05.05.01 |
| Atorvastatin 80 mg Tablet | Lipitor | 05.05.01 |
| Atripla* | 03.09.06 | |
| Atropine Sulfate O/S 1% Ophthalmic | Isopto Atropine | 18.06 |
| Atropine Sulfate Oint 1% Ophthalmic | Atropine Ophth | 18.06 |
| Atropine Syringe 0.1 mg/ml Inj. | Atropine Sulfate | 10.01 |
| Atropine Vial 0.4 mg/ml Inj. | Atropine Inj. | 10.01 |
| Azathioprine 50 mg Tablet | Imuran | 15.01 |
| Azithromycin 250 mg Tablet | Zithromax | 03.10 |
| Azithromycin 600 mg tablet | Zithromax | 03.09.07 |
| Azithromycin 600 mg Tablet | Zithromax | 03.10 |
| Azithromycin Z-Pak 250 mg Tablet | Zithromax Z-Pak | 03.10 |
Bacitracin Ointment Bacitracin 18.03
| Bacitracin/Polymyxin B Ointment | Polysporin | 18.03 |
| Balsalazide Disodium 750 mg Capsule | Colazal | 12.01 |
| Benazepril HCL 10 mg Tablet | Lotensin | 05.02 |
| Benazepril HCL 20 mg Tablet | Lotensin | 05.02 |
| Benazepril HCL 40 mg Tablet | Lotensin | 05.02 |
| Benazepril HCL 5 mg Tablet | Lotensin | 05.02 |
| Benzocaine 20% 20 % Liquid | Anbesol Liquid Max | 07.01 |
| Benzoyl Peroxide 10% Gel (Jelly) | Persagel | 08.01 |
| Benztropine Mes 0.5 mg Tablet | Cogentin | 06.99 |
| Benztropine Mes 0.5 mg Tablet | Cogentin | 16.03 |
| Benztropine Mes 1 mg Tablet | Cogentin | 06.99 |
| Benztropine Mes 1 mg Tablet | Cogentin | 16.03 |
| Benztropine Mes 2 mg Tablet | Cogentin | 06.99 |
| Benztropine Mes 2 mg Tablet | Cogentin | 16.03 |
| Benztropine Mes Vl/Amp 1 mg/ml Inj. | Cogentin Inj. | 06.99 |
| Benztropine Mes Vl/Amp 1 mg/ml Inj. | Cogentin Inj. | 16.03 |
| Betamethasone- 0.05% Aug Cream | Diprolene AF | 08.08.02 |
| Betaxolol HCL O/S 0.25% Ophthalmic | Betoptic S | 18.01 |
| Betaxolol HCL O/S 0.5% Ophthalmic | Betoptic Ophth | 18.01 |
| Bethanechol 50 mg Tablet | Urecholine | 13.02 |
| Biktarvy (two med combo only no brand name) | 03.09.06 | |
| Bisacodyl 10 mg Suppository | Dulcolax Supp | 12.05 |
| Bisacodyl 5 mg Tab Ec | Dulcolax | 12.05 |
| Brimonidine Soln 0.2% Ophthalmic | Alphagan | 18.01 |
| Bromocriptine Mesy 2.5 mg Tablet | Parlodel | 16.03 |
| Bromocriptine Mesylate 5 mg Capsule | Parlodel | 16.03 |
| Bupivacaine HCL Vl 0.25% Inj. | Marcaine | 22.01 |
| Bupivacaine HCL Vl 0.5% Inj. | Marcaine | 22.01 |
| Bupivacaine HCL/Epi Vl 0.5% Inj. | Marcaine Epi | 22.01 |
| Calcitriol 0.25 Mcg Capsule | Rocaltrol | 11.08 |
| Calcitriol 0.5 Mcg Capsule | Rocaltrol | 11.08 |
| Calcium Acet/Alum So4 Pack | Domeboro | 08.09 |
| Calcium Acetate 667 mg Tablet | Phoslo/ Eliphos | 21.01 |
| Calcium Carbonate / Vitamin D Tablet | Various Brand Names | 21.01 |
| Calcium Gluconate Vl 10% Inj. | Ca Gluconate | 10.01 |
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 .