The following is a list of commonly prescribed drugs. It represents an abbreviatedversion of the drug list (formulary) that is the core of your prescription drugbenefit plan. This list does not guarantee coverage and is subject to change withor without notice. Check your benefit materials for coverage information,including the co-payments/co-insurances and any requirements associated withyour prescription drug benefit program. For specific questions about your
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coverage, please call the phone number printed on your ID card. Formulary Drug List by Therapeutic Class PLEASE NOTE: Brand name drugs may move to non-formulary status if a generic version becomes available during the year. ANTIINFECTIVES Class II Narcotics Other Autonomic/CNS Drugs Androgen Drugs Antivirals Other Cholesterol Lowering Other Drugs For ADHD Drugs Dipeptidyl Peptidase-IV Inhibitors & Combos Angiotensin II Receptor DERMATOLOGICAL Antagonists + HCT Combos MEDICATIONS Cephalosporins Class III Narcotics Antiacne Drugs Glucocorticoids Macrolides Anti-Arrhythmic Drugs AUTONOMIC & CNS CNS Stimulants Oral Antifungals MEDICATIONS Beta Blockers Anticonvulsants Glucose Elevating Drugs Penicillins Growth Hormones Antipsoriasis & Antieczema GENOTROPIN [INJ] Drugs Quinolones Incretin Mimetics Drugs to Prevent & Treat Headaches Corticosteroid Drugs Tetracyclines Insulins Antidementia Drugs Calcium Channel Blockers Topical Antibacterials Miscellaneous Dermatologicals Insulin Sensitizers Topical Antifungals Antidepressants Oral Hypoglycemics Diuretics Drugs to Treat Multiple Sclerosis Urinary Antiinfectives Other Antiinfective Drugs HMG-CoA Reductase Inhibitors Antiparkinson Drugs Sodium-Glucose Co-
REBIF, REBIF REBIDOSE [INJ] Topical Anti-Inflammatory Transporter 2 Inhibitors Drugs Non-Narcotic Analgesics Thyroid Supplements EAR-NOSE MEDICATIONS Antipsychotic Drugs ANTINEOPLASTIC/IMMUNO- Other Blood Pressure Drugs ABILIFY, ABILIFY DISCMELT Sedative/Hypnotics Other Endocrine Drugs SUPPRESSANT DRUGS Drugs Affecting The Ear Selective Serotonin Reuptake Inhibitors Drugs Affecting The Nose Antivertigo & Antiemetics EYE MEDICATIONS Antibacterial Drugs CARDIOVASCULAR Other Cardiovascular Drugs Tertiary Amines MEDICATIONS Anxiolytics ENDOCRINE MEDICATIONS ACE Inhibitors + Amylin Analogues HCT Combos THIS DOCUMENT LIST IS EFFECTIVE JANUARY 1, 2014 THROUGH DECEMBER 31, 2014. THIS LIST IS SUBJECT TO CHANGE. You can get more information and updates to this document at our web site at http://hr.osu.edu/benefits/hb_prescription.aspx. 2014 Express Scripts Holding Company All Rights Reserved PRMTA8WB-14 (09/04/13) Progestin Drugs Examples of Non-Formulary Medications with Selected Formulary Alternatives
The following is a list of selected non-formulary brand name medications with examples of
alternatives that are on the formulary. This list does not dictate nor control decisions regarding
Drugs to Prevent & Treat Gout
appropriate care. As always, you and your health care provider make the final decision on which
Antiglaucoma Drugs Specialized OB/GYN Drugs Non-Formulary Medications Formulary Alternative(s) Injectable Drugs For Arthritis Vaginal Antiinfectives Non-Steroidal Anti- Inflammatory Agents RESPIRATORY
morphine sulfate ext-release, oxymorphone ext-release, Nucynta ER,
MEDICATIONS Corticosteroid Drugs
flunisolide, fluticasone, triamcinolone acetonide, Nasonex, Qnasl
Antihistamines Other Eye Drugs Antihistamine/Antitussives NUTRITION & BLOOD MODIFIERS
candesartan/hydrochlorothiazide, irbesartan/hydrochlorothiazide,
losartan/hydrochlorothiazide, valsartan/hydrochlorothiazide,
Antiplatelet Drugs Antitussive & Expectorants
morphine sulfate ext-release, oxymorphone ext-release, Nucynta ER,
Beta-2 Adrenergics Blood Detoxicants GASTROINTESTINAL Oral and Inj. Anticoagulants levalbuterol MEDICATIONS
morphine sulfate ext-release, oxymorphone ext-release, Nucynta ER,
Antispasmodics/Drugs Affecting GI Motility Leukotriene Modifiers Therapeutic Vitamins & H. Pylori Drugs Minerals Other Drugs For Asthma
candesartan/hydrochlorothiazide, irbesartan/hydrochlorothiazide,
losartan/hydrochlorothiazide, valsartan/hydrochlorothiazide,
Proton Pump Inhibitors Thrombin Inhibitors Other GI Drugs
flunisolide, fluticasone, triamcinolone acetonide, Nasonex, Qnasl
OBSTETRICAL & GYNECOLOGICAL MEDICATIONS UROLOGICAL MEDICATIONS
flunisolide, fluticasone, triamcinolone acetonide, Nasonex, Qnasl
Contraceptives Anticholinergic Antispasmodics
candesartan/hydrochlorothiazide, irbesartan/hydrochlorothiazide,
losartan/hydrochlorothiazide, valsartan/hydrochlorothiazide,
Estrogen Drugs Drugs Used For BPH
flunisolide, fluticasone, triamcinolone acetonide, Nasonex, Qnasl
IMMUNOLOGICALS DIABETIC SUPPLIES Erythroid Stimulants Meters & Strips Estrogen/Progestin
flunisolide, fluticasone, triamcinolone acetonide, Nasonex, Qnasl
Combinations
latanoprost, travoprost, Lumigan, Travatan Z
Interferons
The symbol [INJ] next to a drug name indicates that the drug is available in injectable form only. MUSCULOSKELETAL For the member: Generic medications contain the same active ingredients as their corresponding MEDICATIONS Ovulatory Stimulants
brand name medications, although they may look different in color or shape. They have been
FDA-approved under strict standards. For the physician: Please prescribe formulary products and allow generic substitutions when CNS Muscle Relaxants Prenatal Vitamins
Brand name drugs are listed in CAPITAL letters.
Generic drugs are listed in lower case letters. THIS DOCUMENT LIST IS EFFECTIVE JANUARY 1, 2014 THROUGH DECEMBER 31, 2014. THIS LIST IS SUBJECT TO CHANGE. You can get more information and updates to this document at our web site at http://hr.osu.edu/benefits/hb_prescription.aspx. 2014 Express Scripts Holding Company All Rights Reserved PRMTA8WB-14 (09/04/13)
Botox ® is a protein that is natural and has been purified. It is registered and is available via prescription only. Botox ® improves skin appearance by relaxing muscles that can cause wrinkles. It's derived from bacteria (under sterile laboratory conditions) in a similar way that penicillin is derived from mould. The active ingredient is called botulinum toxin. A lot of wrinkles in the
Shanah tovah u‘metukah – a sweet and good year. My friend, Marisa1 has been married for three years. All of a sudden people she works with started to approach her and make statements like, ―Mazal tov. When are you due?‖ or ―How are you feeling? You look really great‖ or ―We‘ve been waiting for this. We‘re so happy for you and your husband.‖ Marisa is not pregnant. These painfu
The following is a list of commonly prescribed drugs. It represents an abbreviatedversion of the drug list (formulary) that is the core of your prescription drugbenefit plan. This list does not guarantee coverage and is subject to change withor without notice. Check your benefit materials for coverage information,including the co-payments/co-insurances and any requirements associated withyour prescription drug benefit program. For specific questions about your
2014 The Ohio State University