NVIH Formulary
This document defines the medications included on the Northern Valley Indian Health (NVIH) CHS formulary. The formulary lists the medications which are covered for those Native American patients who have no other payment source and obtain their medications at the expense of NVIH. Coverage of specific medications on this formulary will change over time with some medications being added and others excluded. The decisions regarding which medications are covered will be made by the Pharmacy and Therapeutics Committee.
If a patient or a provider wishes to request that a medication be paid for by NVIH CHS funds and that medication is not included on the formulary, the request should be made to the CHS committee. The CHS committee has the authority to grant exceptions to the limitations of the formulary. Requests that medications be added to the formulary should be made to the Pharmacy and Therapeutics Committee.
You can sort the table by clicking on the column headings.
| Generic Name | Brand Name | Category | Sub Category | Comments |
|---|---|---|---|---|
| colchicine 0.6mg. tablets | - None | renal | - none | |
| desmopressin acetate 0.1mg tablets | DDAVP | renal | - none | |
| dicyclomine 20mg tablets | Bentyl | gi | - none | |
| guaifenex LA 600mg tablets | - None | ent | - none | |
| diphenoxylate/atropine tablets | Lomotil | gi | - none | |
| ibuprofen 600mg tablets | Motrin | nsaid | - none | |
| finasteride 5mg | Proscar | urol | - none | |
| benztropine 1mg tablet | Cogentin | neuro | - none | |
| bismuth subsalicylate chewable tablets | Pepto Bismal | gi | - none | |
| bupropion 150mg extended tablets | Wellbutrin, Zyban | psych | - none | |
| acetaminophen Children's Drops 160mg/ml | Children’s Tylenol | pain | - none | |
| buspirone 7.5mg tablets | Buspar | psych | - none | |
| capsaicin 0.25% cream | Zostrix Cream | derm | - none | |
| allopurinol 300mg | - None | endo | - none | |
| carbidopa/levodopa 25/250 tablets | Sinemet | neuro | - none | |
| trazodone 150mg tablets | - None | psych | - none | |
| piroxicam 20mg capsules | Feldene | nsaid | - none | |
| mirtazapine 45mg | Remeron | psych | - none | |
| ipratropium 0.02% Soln | Atrovert | pulm | - none | |
| multivitamin | - None | vit | - none | |
| niacin 100mg tablets | - None | lipid | - none | |
| prenatal vitamin tablets | - None | vit | - none | |
| levothyroxine 112mcg tablets | Synthroid | endo | - none | |
| promethazine 50mg suppositories | Phenergan | gi | - none | |
| levothyroxine 175mcg tablets | Synthroid | endo | - none | |
| levothyroxine 75mcg tablets | Synthroid | endo | - none | |
| pyridoxine 50mg tablets | Vitamin B6 | vit | - none | |
| lithium 300mg tablets | Lithobid | psych | - none | |
| oxybutynin 5mg tablets short acting | Ditropan | urol | - none | |
| salsalate 500mg tablets | - None | - none | - none | |
| loperimide 2mg capsules | Immodium | gi | - none | |
| simethicone 80mg chew tablets | Gas-EX | gi | - none | |
| meclizine 25mg tablets | Antivert | neuro | - none | |
| sodium fluoride 0.5mg drops | - None | vit | - none | |
| medroxyprogesterone acetate 150mg/ml injection | Depo-Provera | endo | - none | |
| metformin 850mg tablets | Glucophage | dm | - none | |
| sulfamethoxazole/trimethoprim DS | Bactrim, Septra | abx | - none | |
| methotrexate 2.5mg tablets | Trexall | rheum | - none | |
| diclofenac Sodium 50mg EC tablets | Voltaren | nsaid | - none | |
| guaifenesin 100mg/5ml syrup | - None | ent | - none | |
| ibuprofen 800mg tablets | Motrin | nsaid | - none | |
| epinephrine 0.15mg syringe | EpiPen Jr. | allergy | - none | |
| fish oil | - None | card | - none | |
| carbidopa/levodopa CR 25/250 tablets | Sinemet | neuro | - none | |
| alum/Mag/Simth 400/400/40mg | Mylanta II | gi | - none | |
| baclofen 10mg tablets | - None | pain | - none | |
| benztropine 2mg tablet | Cogentin | neuro | - none | |
| acetaminophen 120mg suppositories | Tylenol | pain | - none | |
| buspirone 10mg tablets | Buspar | psych | - none | |
| acetaminophen Infant Drops 100mg/ml | Infant Tylenol | pain | - none | |
| metoclopramide 10mg tablets | Reglan | gi | - none | |
| trazodone 50mg tablets | - None | psych | - none | |
| naproxen 500mg tablets | Naprosyn | nsaid | - none | |
| niacin 500mg tablets | - None | lipid | - none | |
| promethazine 12.5mg suppositories | Phenergan | gi | - none | |
| levothyroxine 125mcg tablets | Synthroid | endo | - none | |
| promethazine/codeine syrup | - None | gi | - none | |
| levothyroxine 200mcg tablets | Synthroid | endo | - none | |
| levothyroxine 88mcg tablets | Synthroid | endo | - none | |
| lithium 300mg controlled release tablets | Lithobid | psych | - none | |
| selenium sulfide shampoo 2.5% | Selsun | derm | - none | |
| sodium Cl 0.04% nasal spray | - None | ent | - none | |
| medroxyprogesterone 10mg | Provera | endo | - none | |
| sodium phosphate enema | Fleets | gi | - none | |
| mesalamine 400mg tablets | Asacol | gi | - none | |
| sucralfate 1gm tablets | Carafate | gi | - none | |
| methimazole 10mg | Tapazole | endo | - none | |
| sulfamethoxazole/trimethoprim susp | Bactrim, Septra | abx | - none | |
| guaifenesin DM cough syrup | - None | ent | - none | |
| hydroxychloroquine 200mg tablets | Plaquenil | rheum | - none | |
| hyoscyamine Sulfate 0.125mg tablets | Anaspaz, Levbid, Levbid | gi | - none | |
| docusate sodium 100mg capsules | Colace | gi | - none | |
| ibuprofen suspension 100mg/5ml | Motrin | nsaid | - none | |
| epinephrine 0.3mg syringe | EpiPen | allergy | - none | |
| ferrous sulfate 325mg tablets | - None | heme | - none | |
| folic acid 1mg tablets | - None | vit | - none | |
| gabapentin 300 capsules | Neurontin | pain | - none | |
| carisoprodol 350mg tablets | Soma | pain | - none | |
| baclofen 20mg tablets | - None | pain | - none | |
| bisacodyl 5mg EC tablets | - None | gi | - none | |
| acetaminophen 325mg tablets | Tylenol | pain | - none | |
| buspirone 30mg tablets | Buspar | psych | - none | |
| alendronate 70mg tablets | Fosamox | endo | - none | |
| carbidopa/levodopa 10/100 tablets | Sinemet | neuro | - none | |
| metoclopramide 5mg/5ml syrup | Reglan | gi | - none | |
| phenazopyridine 100mg | Pyridium | urol | - none | |
| tramadol 50mg tablets | Ultram | pain | - none | |
| mirtazapine 15mg | Remeron | psych | - none | |
| potassium chloride 20mEq | Micro-K | renal | - none | |
| tri-vit/fluor 0.25mg/cc | - None | vit | - none | |
| promethazine 25mg tablet | Phenergan | gi | - none | |
| levothyroxine 137mcg tablets | Synthroid | endo | - none | |
| levothyroxine 25mcg tablets | Synthroid | endo | - none | |
| pseudoephedrine 60mg tablets | - None | ent | - none | |
| lithium 450mg controlled release tablets | Lithobid | psych | - none | |
| sodium fluoride 0.5mg chewable tablets | - None | vit | - none | |
| medroxyprogesterone 5mg | Provera | endo | - none | |
| metformin 1000mg tablets | Glucophage | dm | - none | |
| methimazole 5mg | Tapazole | endo | - none | |
| tamsulosin 0.4mg | Flomax | urol | - none | |
| desmopressin acetate 10mcg/spray nasal | DDAVP | renal | - none | |
| guaifenesin/codeine expectorant | - None | ent | - none | |
| ibuprofen 400mg tablets | Motrin | nsaid | - none | |
| docusate sodium 50mg/5ml liquid | Colace | gi | - none | |
| ferrous sulfate elixir 220mg/5ml | - None | heme | - none | |
| benztropine 0.5mg tablet | Cogentin | neuro | - none | |
| bisacodyl 10mg suppositories | - None | gi | - none | |
| bupropion 150mg extended tablets | Wellbutrin, Zyban | psych | - none | |
| acetaminophen 500mg tablets | ES Tylenol | pain | - none | |
| buspirone 5mg tablets | Buspar | psych | - none | |
| calcium 600mg w/ vit D tabs | - None | vit | - none | |
| allopurinol 100mg | - None | endo | - none | |
| carbidopa/levodopa 25/100 tablets | Sinemet | neuro | - none | |
| pentoxifylline 400mg SA tablets | Trental | heme | - none | |
| trazodone 100mg tablets | - None | psych | - none | |
| mirtazapine 30mg | Remeron | psych | - none | |
| ipatropium MDI | Atrovert | pulm | - none | |
| levothyroxine 100mcg tablets | Synthroid | endo | - none | |
| promethazine 50mg tablet | Phenergan | gi | - none | |
| levothyroxine 150mcg tablets | Synthroid | endo | - none | |
| levothyroxine 50mcg tablets | Synthroid | endo | - none | |
| pseudoephedrine syrup 30mg/5ml | - None | ent | - none | |
| lithium 150mg tablets | Lithobid | psych | - none | |
| lithium 600mg controlled release tablets | Lithobid | psych | - none | |
| simethicone 40mg/0.6ml drops | Mylicon Drops | gi | - none | |
| sodium fluoride 1mg chewable tablets | - None | vit | - none | |
| medroxyprogesterone 2.5mg | Provera | endo | - none | |
| metformin 500mg tablets | Glucophage | dm | - none | |
| methocarbamol 500mg tablets | Robaxin | pain | - none | |
| doxazosin 1mg | Cardura | card | a-blocker | |
| terazosin 1mg capsules | Hytrin | card | a-blocker | |
| prazosin 5mg capsules | Minipress | card | a-blocker | |
| doxazosin 2mg | Cardura | card | a-blocker | |
| clonidine HCl 0.1mg tablets | Catapress | card | a-blocker | |
| terazosin 2mg capsules | Hytrin | card | a-blocker | |
| doxazosin 4mg | Cardura | card | a-blocker | |
| clonidine HCl 0.2mg tablets | Catapress | card | a-blocker | |
| terazosin 5mg capsules | Hytrin | card | a-blocker | |
| prazosin 1mg capsules | Minipress | card | a-blocker | |
| doxazosin 8mg | Cardura | card | a-blocker | |
| clonidine HCl 0.3mg tablets | Catapress | card | a-blocker | |
| terazosin 10mg capsules | Hytrin | card | a-blocker | |
| prazosin 2mg capsules | Minipress | card | a-blocker | |
| gentamicin 0.3% Ophth solution | - None | ophtho | abx | |
| gentamicin ophtho ointment | - None | ophtho | abx | |
| polymixin b/trimethoprim ophthal | Polytrim | ophtho | abx | |
| triple antibiotic ointment | - None | derm | abx | |
| ofloxacin 0.3% ophtho solution | Ocuflox | ophtho | abx | |
| silver sulfadiazine 1% cream 400gm | - None | derm | abx | |
| erythromycin ophtho ointment | - None | ophtho | abx | |
| silver sulfadiazine 1% cream 50gm | - None | derm | abx | |
| sulfacetamide 10% ophth oint | - None | ophtho | abx | |
| neosporin ointment | - None | derm | abx | |
| sulfacetamide 10% ophth soln | - None | ophtho | abx | |
| enalapril 20mg tablets | Vasotec | card | ace | |
| benazepril 10mg tablets | Lotensin | card | ace | |
| lisinopril 30mg tablets | Zestril/Prinivil | card | ace | |
| enalapril 2.5mg tablets | Vasotec | card | ace | |
| benazepril 20mg tablets | Lotensin | card | ace | |
| captopril 25mg tablets | Capoten | card | ace | |
| lisinopril 40mg tablets | Zestril/Prinivil | card | ace | |
| enalapril 5mg tablets | Vasotec | card | ace | |
| benazepril 40mg tablets | Lotensin | card | ace | |
| captopril 50mg tablets | Capoten | card | ace | |
| lisinopril 10mg tablets | Zestril/Prinivil | card | ace | |
| lisinopril 5mg tablets | Zestril/Prinivil | card | ace | |
| enalapril 10mg tablets | Vasotec | card | ace | |
| benazepril 5mg tablets | Lotensin | card | ace | |
| lisinopril 20mg tablets | Zestril/Prinivil | card | ace | |
| benzoyl peroxide topical 10% 45gm | - None | derm | acne | |
| benzoyl peroxide topical 5% 60gm | - None | derm | acne | |
| benzoyl peroxide topical 10% 60gm | - None | derm | acne | |
| benzoyl peroxide topical 5% 90gm | - None | derm | acne | |
| benzoyl peroxide topical 10% 90gm | - None | derm | acne | |
| benzoyl peroxide topical 5% 45gm | - None | derm | acne | |
| clindamycin 1% Topical Solution | Cleocin | derm | acne | |
| benzoyl peroxide topical 2.5% 60gm | - None | derm | acne | |
| digoxin 125mcg tablets | Lanoxin | card | anti-arrhythmics | |
| digoxin 250mcg tablets | Lanoxin | card | anti-arrhythmics | |
| amiodarone 200 tablet | Cordarone, Pacerone | card | anti-arrhythmics | |
| permethrin 1% rinse | Nix | derm | anti-parasitic | |
| permethrin 5% rinse | Elimite | derm | anti-parasitic | |
| mebendazole 100 chewable tablet | - None | abx | anti-parasitic | |
| rifampin 300mg | - None | abx | anti-TB | |
| isoniazid 300mg tablets | - None | abx | anti-TB | |
| dapsone 100mg tablets | - None | abx | anti-TB | |
| clopidogrel 75mg tablet | Plavix | heme | anticoag | |
| aspirin 325mg tablets | - None | heme | anticoag | |
| warfarin 10mg tablets | Coumadin | heme | anticoag | |
| warfarin 3mg tablets | Coumadin | heme | anticoag | |
| warfarin 7.5mg tablets | Coumadin | heme | anticoag | |
| aspirin 81mg enteric coated tablets | - None | heme | anticoag | |
| warfarin 1mg tablets | Coumadin | heme | anticoag | |
| warfarin 4mg tablets | Coumadin | heme | anticoag | |
| warfarin 2mg tablets | Coumadin | heme | anticoag | |
| warfarin 5mg tablets | Coumadin | heme | anticoag | |
| aspirin 325mg enteric coated tablets | - None | heme | anticoag | |
| warfarin 2.5mg tablets | Coumadin | heme | anticoag | |
| warfarin 6mg tablets | Coumadin | heme | anticoag | |
| fluconazole 150mg tablets | Diflucan | abx | antifungal | |
| telmisartan 80mg | Micardis | card | arb | step therapy |
| losartan 100mg | Cozaar | card | arb | |
| losartan 25mg | Cozaar | card | arb | |
| telmisartan 40mg | Micardis | card | arb | step therapy |
| losartan 50mg | Cozaar | card | arb | |
| carvedilol 25mg | Coreg | card | b-blocker | |
| atenolol 50mg tablets | Tenormin | card | b-blocker | |
| metoprolol 25mg tablets | Lopressor, Toprol | card | b-blocker | |
| propranolol 40mg tablets | Inderal | card | b-blocker | |
| carvedilol 3.125mg | Coreg | card | b-blocker | |
| timolol 0.5% ophth Soln | Betimol, Timoptic | ophtho | b-blocker | |
| propranolol 80mg tablets | Inderal | card | b-blocker | |
| carvedilol 6.25mg | Coreg | card | b-blocker | |
| atenolol 100mg tablets | Tenormin | card | b-blocker | |
| metoprolol 100mg tablets | Lopressor, Toprol | card | b-blocker | |
| propranolol 10mg tablets | Inderal | card | b-blocker | |
| carvedilol 12.5mg | Coreg | card | b-blocker | |
| atenolol 25mg tablets | Tenormin | card | b-blocker | |
| metoprolol 50mg tablets | Lopressor, Toprol | card | b-blocker | |
| propranolol 20mg tablets | Inderal | card | b-blocker | |
| diazepam 5mg tablets | Valium | psych | benzo | |
| alprazolam 2mg | Xanax | psych | benzo | |
| clonazepam 0.5mg tablets | Klonopin | psych | benzo | |
| lorazepam 1mg tablets | Ativan | psych | benzo | |
| clonazepam 1mg tablets | Klonopin | psych | benzo | |
| alprazolam 0.25mg | Xanax | psych | benzo | |
| temazepam 15mg capsules | Restoril | psych | benzo | |
| diazepam 10mg tablets | Valium | psych | benzo | |
| clonazepam 2mg tablets | Klonopin | psych | benzo | |
| alprazolam 0.50mg | Xanax | psych | benzo | |
| temazepam 30mg capsules | Restoril | psych | benzo | |
| diazepam 2mg tablets | Valium | psych | benzo | |
| alprazolam 1mg | Xanax | psych | benzo | |
| lorazepam 0.5mg tablets | Ativan | psych | benzo | |
| albuterol 5mg/ml solution | AccuNeb, Proventil, Ventolin, ProAir | pulm | beta-agonist | |
| albuterol 90mcg/spray MDI | AccuNeb, Proventil, Ventolin, ProAir | pulm | beta-agonist | |
| albuterol 2mg/5ml syrup | AccuNeb, Proventil, Ventolin, ProAir | pulm | beta-agonist | |
| diltiazem 180mg SR capsules | Tiazac, Cardizem | card | ccb | |
| diltiazem 60mg tablets | Tiazac, Cardizem | card | ccb | |
| verapamil 120mg CR tablets | Calan | card | ccb | |
| diltiazem 240mg SR capsules | Tiazac, Cardizem | card | ccb | |
| diltiazem 90mg SR capsules | Tiazac, Cardizem | card | ccb | |
| amlodipine 10mg tablets | Norvasc | card | ccb | |
| verapamil 180mg CR tablets | Calan | card | ccb | |
| diltiazem 300mg SR capsules | Tiazac, Cardizem | card | ccb | |
| amlodipine 2.5mg tablets | Norvasc | card | ccb | |
| verapamil 240mg CR tablets | Calan | card | ccb | |
| nifedipine SR 30mg tablets | Procardia, Adalat | card | ccb | |
| diltiazem 120mg SR capsules | Tiazac, Cardizem | card | ccb | |
| diltiazem 360mg SR capsules | Tiazac, Cardizem | card | ccb | |
| amlodipine 5mg tablets | Norvasc | card | ccb | |
| verapamil 80mg tablets | Calan | card | ccb | |
| nifedipine SR 60mg tablets | Procardia, Adalat | card | ccb | |
| cephalexin 500mg capsules | Keflex | abx | ceph1 | |
| cephalexin 250mg/5ml suspension | Keflex | abx | ceph1 | |
| cephalexin 250mg capsules | Keflex | abx | ceph1 | |
| cefaclor 250mg capsule | - None | abx | ceph2 | |
| cefaclor 500mg capsule | - None | abx | ceph2 | |
| cefaclor 250mg capsule | Chlor-Trimetron | abx | ceph2 | |
| ceftriaxone 1Gm. Vial | Rocephin | abx | ceph3 | in-house severe infection |
| furosemide 40mg tablets | Lasix | renal | diuretic | |
| metolazone 2.5mg | Zaroxylin | renal | diuretic | |
| triamterene/HCTZ 75/50 capsules | Diazide, Maxide | renal | diuretic | |
| spironolactone 50mg | Aldactone | renal | diuretic | |
| hydrochlorothiazide 25mg tablets | - None | renal | diuretic | |
| furosemide 80mg tablets | Lasix | renal | diuretic | |
| metolazone 5mg | Zaroxylin | renal | diuretic | |
| hydrochlorothiazide 50mg tablets | - None | renal | diuretic | |
| bumetanide 1mg tablets | Bumex | renal | diuretic | |
| spironolactone 100mg | Aldactone | renal | diuretic | |
| furosemide 20mg tablets | Lasix | renal | diuretic | |
| metolazone 10mg | Zaroxylin | renal | diuretic | |
| triamterene/HCTZ 37.5/25 capsules | Diazide, Maxide | renal | diuretic | |
| spironolactone 25mg | Aldactone | renal | diuretic | |
| bromocriptine 2.5mg tablets | Parlodel | endo | endo | |
| gemfibrozil 600mg tablets | Lopid | lipid | fibrate | |
| ciprofloxacin 500mg tablets | Cipro | abx | fluroq | |
| levofloxacin 500mg tablets | Levaquin | abx | fluroq | restricted to pneumonia |
| ketoconazole 2% cream 60gm | Nizoral | derm | fungal | |
| nystatin ointment 100,000U/gm | Mycostatin | derm | fungal | |
| nystatin/triamcinolone cream 45gm | Mycolog | derm | fungal | |
| clotrimazole 1% topical cream | Lotrimin, Mycelex | derm | fungal | |
| ketoconazole 2% shampoo | Nizoral | derm | fungal | |
| nystatin oral suspension 100,000U/gm | Mycostatin | derm | fungal | |
| clotrimazole 1% topical solution | Lotrimin, Mycelex | derm | fungal | |
| ketoconazole 2% cream 15gm | Nizoral | derm | fungal | |
| nystatin/triamcinolone cream 15gm | Mycolog | derm | fungal | |
| clotrimazole 1% vaginal cream | Gyne-Lotrimin | gyn | fungal | |
| miconazole topical 2% cream | - None | derm | fungal | |
| ketoconazole 2% cream 30gm | Nizoral | derm | fungal | |
| nystatin cream 100,000U/gm | Mycostatin | derm | fungal | |
| nystatin/triamcinolone cream 30gm | Mycolog | derm | fungal | |
| hydroxyzine HCl 10mg tablets | Atarax, Vistaril | allergy | h1-blocker | |
| chlorpheniramine 4mg tablets | Chlor-Trimetron | allergy | h1-blocker | |
| hydroxyzine HCl 25mg tablets | Atarax, Vistaril | allergy | h1-blocker | |
| chlorpheniramine 8mg SA capsuless | Chlor-Trimetron | allergy | h1-blocker | |
| loratidine 1mg/ml | Claritin | allergy | h1-blocker | |
| diphenhydramine 12.5mg/5ml Elixir | Benadryl | allergy | h1-blocker | |
| cetirizine 10mg tablets | Zyrtec | allergy | h1-blocker | |
| loratidine 10mg tablets | Claritin | allergy | h1-blocker | |
| hydroxyzine 10mg/5ml Syrup | Atarax, Vistaril | allergy | h1-blocker | |
| diphenhydramine 25mg capsules | Benadryl | allergy | h1-blocker | |
| cetirizine 1mg/1ml syrup | Zyrtec | allergy | h1-blocker | |
| famotidine 20mg | Pepcid | gi | h2-blocker | |
| ranitidine 150mg | Zantac | gi | h2-blocker | |
| ranitidine 15mg/ml syrup | Zantac | gi | h2-blocker | |
| ranitidine 300mg | Zantac | gi | h2-blocker | |
| butalbital/APAP/Caffeine 50/325/40mg tablet | Fioricet | neuro | ha | |
| butalbital/APAP/Caffeine 50/500/40mg tablet | Fioricet | neuro | ha | |
| estradiol 1mg tablets | Estrace | endo | hrt | |
| estradiol 2mg tablets | Estrace | endo | hrt | |
| estrogen, conjugated 0.625mg | Premarin | endo | hrt | |
| estrogen, conjugated 1.25mg | Premarin | endo | hrt | |
| insulin aspart protamine/aspart 70/30 3ml cartridge | Novalog 70/30 | dm | insulin | |
| insulin glargine 100units/ml 3ml cartridge | Lantus | dm | insulin | |
| insulin human NPH 100units/ml 3ml cart | Novolin N, Humulin N | dm | insulin | |
| insulin lispro 100units/ml 3ml cart | Humalog | dm | insulin | |
| insulin aspart protamine/aspart 70/30 vial | Novalog 70/30 | dm | insulin | |
| insulin human 70/30 100units/ml 10ml vial | Novolin 70/30, Humulin 70/30 | dm | insulin | |
| insulin human regular 100units/ml 10ml vial | Novolin R, Humulin R | dm | insulin | |
| insulin lispro protamine/lispro 75/25 10ml vial | Humalog 75/25 | dm | insulin | |
| insulin aspart 100unit/ml 10ml vial | Novalog | dm | insulin | |
| insulin detemir 100units/ml 10ml | Levamir | dm | insulin | |
| insulin human 70/30 100units/ml 3ml cart | Novolin 70/30, Humulin 70/30 | dm | insulin | |
| insulin human regular 100units/ml 3ml cart | Novolin R, Humulin R | dm | insulin | |
| insulin lispro protamine/lispro 75/25 3ml syringes | Humalog 75/25 | dm | insulin | |
| insulin aspart 100unit/ml 3ml cartridge | Novalog | dm | insulin | |
| insulin glargine 100units/ml 10ml vial | Lantus | dm | insulin | |
| insulin human NPH 100units/ml 10ml vial | Novolin N, Humulin N | dm | insulin | |
| insulin lispro 100units/ml 10ml vial | Humalog | dm | insulin | |
| montelukast 10mg tablet | Singular | allergy | leukotriene | Step therapy required |
| montelukast 5mg chewable tablet | Singular | allergy | leukotriene | Step therapy required |
| montelukast 4mg chewable tablet | Singular | allergy | leukotriene | Step therapy required |
| erythromycin base 250mg tablets EC | Ery-Tab | abx | macrolides | |
| erythromycin base 500mg tablets | Ery-Tab | abx | macrolides | |
| azithromycin 200mg/5ml. Susp. | Zithromax | abx | macrolides | |
| azithromycin 250mg tablets | Zithromax | abx | macrolides | |
| erythromycin 200mg/5ml suspension | - None | abx | macrolides | |
| erythromycin/sulfisoxazole 200/600 susp | Pediazole | abx | macrolides | |
| azithromycin 500mg tablets | Zithromax | abx | macrolides | |
| acetaminophen/hydrocodone 325/10 | - None | pain | narc | |
| acetaminophen/hydrocodone 750/7.5 | Vicodin | pain | narc | |
| acetaminophen/Codeine 30mg | - None | pain | narc | |
| hydrocodone/APAP 5/500 tablets | Vicodin | pain | narc | |
| acetaminophen/Codeine Elixir 12.5mg/5ml | - None | pain | narc | |
| acetaminophen/hydrocodone 325/5 | - None | pain | narc | |
| isosorbide mononitrate 30mg ER tablets | Imdur | card | nitrate | |
| isosorbide mononitrate 60mg ER tablets | Imdur | card | nitrate | |
| isosorbide dinitrate 10mg tablets | Isordil | card | nitrate | |
| isosorbide mononitrate 120mg ER tablets | Imdur | card | nitrate | |
| ethinyl estradiol/norethindrone - 28 tablets | Ortho-Novum | endo | ocp | |
| ethinyl estradiol/norgestrel tablets | Lo/Ovral | endo | ocp | |
| artificial tears ophthalmic soln | - None | ophtho | ophtho | |
| exenatide 5mcg/0.02ml | Byetta | derm | other | |
| clindamycin HCl 150mg capsules | Cleocin | abx | other | |
| nitrofurantoin 50mg caps | Macrobid | abx | other | |
| nitroglycerin 0.4mg Sublingual tablets | Nitrostat, Nitroquick | card | other | |
| cyclobenzaprine 10mg tablets | Flexeril | pain | other | |
| glucagon 1mg Emergency Kit | - None | dm | other | |
| metronidazole 250mg tablets | Flagyl | abx | other | |
| nitrofurantoin 50mg caps | Macrobid | abx | other | |
| nitroglycerin 0.4mg/hr patches | - None | card | other | |
| clarithromycin 500mg tablet | Biaxin | abx | other | only for H. pylori treatment |
| metronidazole 500mg tablets | Flagyl | abx | other | |
| neomycin/Polymyxin/HC otic suspension | Cortisporin Otic | abx | other | |
| nitrofurantoin 100mg caps | Macrobid | abx | other | |
| nitroglycerin 0.6mg/hr patches | - None | card | other | |
| exenatide 10mcg/0.04ml | Byetta | derm | other | |
| nitroglycerin 0.2mg/hr patches | - None | card | other | |
| amoxicillin 125mg/5ml Susp | Trimox | abx | pcn | |
| penicillin VK 250mg tablets | - None | abx | pcn | |
| amoxicillin 250mg capsules | Trimox | abx | pcn | |
| penicillin VK 500mg tablets | - None | abx | pcn | |
| dicloxacillin 250mg capsules | - None | abx | pcn | |
| amoxicillin 250mg/5ml Susp | Trimox | abx | pcn | |
| penicillin VK 250mg/5ml suspension | - None | abx | pcn | |
| dicloxacillin 500mg capsules | - None | abx | pcn | |
| amoxicillin 500mg capsules | Trimox | abx | pcn | |
| amoxicillin/clavulanate 200mg/5ml Suspension | Augmentin | abx | pcn/lactam | |
| amoxicillin/clavulanate 400/57mg chewable tablet | Augmentin | abx | pcn/lactam | |
| amoxicillin/clavulanate 875/125mg tablets | Augmentin | abx | pcn/lactam | |
| omeprazole 10mg capsules | Prilosec | gi | ppi | |
| omeprazole 20mg capsules | Prilosec | gi | ppi | |
| carbamazepine 100mg/5ml suspension | Tegretol | neuro | seizure | |
| phenobarbital 30mg tablets | - None | neuro | seizure | |
| phenytoin 125mg/5ml suspension | Dilantin | neuro | seizure | |
| divalproex sodium 250mg EC tablets | Depakote | neuro | seizure | |
| carbamazepine 200mg tablets | Tegretol | neuro | seizure | |
| phenobarbital 60mg tablets | - None | neuro | seizure | |
| ethosuximide 250mg | - None | neuro | seizure | |
| phenobarbital 20mg/5ml elixir | - None | neuro | seizure | |
| carbamazepine 100mg Chewable tablets | Tegretol | neuro | seizure | |
| phenobarbital 100mg tablets | - None | neuro | seizure | |
| phenytoin 100mg capsules | Dilantin | neuro | seizure | |
| valproic acid 250mg capsule | Depakote | neuro | seizure | |
| zolpidem 10mg | Ambien | psych | sleep | |
| zolpidem 5mg | Ambien | psych | sleep | |
| citalopram 20mg | Celexa | psych | ssri | |
| paroxetine 40mg tablets | Paxil | psych | ssri | |
| sertaline 50mg tablets | Zoloft | psych | ssri | |
| citalopram 40mg | Celexa | psych | ssri | |
| paroxetine 10mg tablets | Paxil | psych | ssri | |
| paroxetine 20mg tablets | Paxil | psych | ssri | |
| sertaline 100mg tablets | Zoloft | psych | ssri | |
| citalopram 10mg | Celexa | psych | ssri | |
| paroxetine 30mg tablets | Paxil | psych | ssri | |
| sertaline 25mg tablets | Zoloft | psych | ssri | |
| pravastatin 20mg tablets | Pravachol | lipid | statin | |
| lovastatin 10mg tablets | Mevacor | lipid | statin | |
| simvastatin 80mg tablets | Zocor | lipid | statin | |
| pravastatin 40mg tablets | Pravachol | lipid | statin | |
| simvastatin 10mg tablets | Zocor | lipid | statin | |
| lovastatin 20mg tablets | Mevacor | lipid | statin | |
| simvastatin 20mg tablets | Zocor | lipid | statin | |
| lovastatin 40mg tablets | Mevacor | lipid | statin | |
| pravastatin 10mg tablets | Pravachol | lipid | statin | |
| simvastatin 40mg tablets | Zocor | lipid | statin | |
| hydrocortisone 1% cream | - None | derm | steriod | |
| prednisone 20mg tablets | - None | endo | steriod | |
| hydrocortisone rectal 25mg suppositories | Proctosol, Cortiform | gi | steriod | |
| fluticasone 50mcg nasal spray | Flonase | allergy | steriod | |
| prednisolone 15mg/5ml soln | PediaPred | endo | steriod | |
| prednisone 50mg tablets | - None | endo | steriod | |
| triamcinolone 0.1% cream | Kenalog | derm | steriod | |
| prednisone 10mg tablets | - None | endo | steriod | |
| prednisone 5mg tablets | - None | endo | steriod | |
| flunisolide inhaled | Aerobid | pulm | steriod | |
| beclomethazone MDI | Vanceril, Beclovent | pulm | steriod | |
| prednisone 1mg tablets | - None | endo | steriod | |
| prednisone 5mg/5ml solution | - None | endo | steriod | |
| fluocinonide 0.05% cream | Lidex, Vanos | derm | steroid | |
| fluocinonide 0.05% ointment | Lidex, Vanos | derm | steroid | |
| fluocinonide 0.05% solution | Lidex, Vanos | derm | steroid | |
| clobetasol 0.05% cream 15gm | Clobex | derm | steroid high | |
| clobetasol 0.05% cream 30gm | Clobex | derm | steroid high | |
| clobetasol 0.05% cream 60gm | Clobex | derm | steroid high | |
| dextroamphetamine 15mg extended release | Dexedrine | psych | stim | |
| amphetamine/dextroamphetamine 12.5mg | Adderall | neuro | stim | |
| amphetamine/dextroamphetamine 5mg | Adderall | neuro | stim | |
| methylphenidate 20mg CR tablet | Ritalin | rheum | stim | |
| dextroamphetamine 10mg | Dexedrine | psych | stim | |
| dextroamphetamine 15mg extended release | Dexedrine | psych | stim | |
| amphetamine/dextroamphetamine 15mg | Adderall | neuro | stim | |
| amphetamine/dextroamphetamine 7.5mg | Adderall | neuro | stim | |
| methylphenidate 10mg tablet | Ritalin | rheum | stim | |
| dextroamphetamine 5mg | Dexedrine | psych | stim | |
| amphetamine/dextroamphetamine 20mg | Adderall | neuro | stim | |
| methylphenidate 20mg tablet | Ritalin | rheum | stim | |
| dextroamphetamine 10mg extended release | Dexedrine | psych | stim | |
| amphetamine/dextroamphetamine 10mg | Adderall | neuro | stim | |
| amphetamine/dextroamphetamine 30mg | Adderall | neuro | stim | |
| methylphenidate 5mg tablet | Ritalin | rheum | stim | |
| glipizide 10mg | Glucotrol | dm | sulfonourea | |
| glipizide XL 10mg | Glucotrol | dm | sulfonourea | |
| glyburide 5mg tablets | Diabeta, Micronase | dm | sulfonourea | |
| glipizide 5mg | Glucotrol | dm | sulfonourea | |
| glimeprimide 2mg | Amaryl | derm | sulfonourea | |
| glipizide XL 2.5mg | Glucotrol | dm | sulfonourea | |
| glyburide 1.25mg tablets | Diabeta, Micronase | dm | sulfonourea | |
| glimeprimide 4mg | Amaryl | derm | sulfonourea | |
| glipizide XL 5mg | Glucotrol | dm | sulfonourea | |
| glyburide 2.5mg tablets | Diabeta, Micronase | dm | sulfonourea | |
| imipramine HCl 25mg tablets | Tofranil | psych | tca | |
| doxepin 100mg capsules | - None | psych | tca | |
| fluoxetine 20mg tablet | Prozac | psych | tca | |
| amitriptyline HCl 100mg | Elavil | psych | tca | |
| amitriptyline HCl 75mg | Elavil | psych | tca | |
| nortriptyline HCl 25mg capsules | Pamelor | psych | tca | |
| imipramine HCl 50mg tablets | Tofranil | psych | tca | |
| doxepin 25mg capsules | - None | psych | tca | |
| amitriptyline HCl 150mg | Elavil | psych | tca | |
| nortriptyline HCl 50mg capsules | Pamelor | psych | tca | |
| doxepin 50mg capsules | - None | psych | tca | |
| amitriptyline HCl 25mg | Elavil | psych | tca | |
| nortriptyline HCl 75mg capsules | Pamelor | psych | tca | |
| imipramine HCl 10mg tablets | Tofranil | psych | tca | |
| doxepin 75mg capsules | - None | psych | tca | |
| fluoxetine 10mg tablet | Prozac | psych | tca | |
| amitriptyline HCl 50mg | Elavil | psych | tca | |
| nortriptyline HCl 10mg capsules | Pamelor | psych | tca | |
| doxycycline 100mg tablets | Vibramycin | abx | tetracyclines | |
| tetracycline 500mg capsules | - None | abx | tetracyclines | |
| minocycline 100mg capsules | Minocin, Solodyn | abx | tetracyclines | |
| minocycline 50mg capsules | Minocin, Solodyn | abx | tetracyclines | |
| tetracycline 250mg capsules | - None | abx | tetracyclines | |
| pioglitazone 45mg | Actos | dm | tgz | |
| rosiglitazone 2mg tablets | Avandia | dm | tgz | |
| pioglitazone 30mg | Actos | dm | tgz | |
| rosiglitazone 4mg tablets | Avandia | dm | tgz | |
| pioglitazone 15mg | Actos | dm | tgz | |
| rosiglitazone 8mg tablets | Avandia | dm | tgz | |
| bacitracin Topical Ointment | - None | abx | topical | |
| acyclovir 200mg | Zovirax | abx | viral | |
| acyclovir 400mg | Zovirax | abx | viral | |
| amantadine 100mg capsules | Symmetrel | abx | viral | |
| acyclovir 800mg | Zovirax | abx | viral |
