Spreadsheet: 64b5d032-0edf-4340-b68c-d0043209d916
Sheet: Sheet1

Washtenaw Health Plan Formulary | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4
Brand Name | Generic Name | Drug Class | Specific Therapeutic Description | Notes
Anaprox 275 mg tablet | Naproxen Sodium | Analgesic | Non Steroidal
Anaprox DS 550 mg tablet | Naprozen Sodium | Analgesic | Non Steroidal
Ansaid  50 mg tablet | [NAME] | Analgesic | Non Steroidal
Ansaid 100 mg tablet | [NAME] | Analgesic | Non Steroidal
Anturane 200MG capsule | Sulfinpyrazone | Analgesic | Antiarthritic
Aspirin w/codeine #4 tablet | Codeine | Analgesic | Narcotic | QL narcotic cumulative total 180 tabs/month
Aspirin w/codeine  #3 tablet | Codeine | Analgesic | Narcotic | QL narcotic cumulative total 180 tabs/month
Clinoril 150 mg tablet | Sulindac | Analgesic | Non Steroidal
Clinoril 200 mg tablet | Sulindac | Analgesic | Non Steroidal
Demerol 50 mg tablet | Meperidine HCL | Analgesic | Narcotic | QL narcotic cumulative total 180 tabs/month
Demerol 50 mg/ 5 ml syrup | Meperidine HCL | Analgesic | Narcotic | QL narcotic cumulative total 180 tabs/month
Demerol 100 mg tablet | Meperidine HCL | Analgesic | Narcotic | QL narcotic cumulative total 180 tabs/month
Dilaudid 2 mg tablet | Hydromorphone | Analgesic | Narcotic | QL narcotic cumulative total 180 tabs/month
Dilaudid 3 mg suppository | Hydromorphone | Analgesic | Narcotic | QL narcotic cumulative total 180 tabs/month
Dilaudid  4 mg tablet | Hydromorphone | Analgesic | Narcotic | QL narcotic cumulative total 180 tabs/month
Dilaudid  5 mg/5 ml liquid | Hydromorphone | Analgesic | Narcotic | QL narcotic cumulative total 180 tabs/month
Dilaudid  8 mg tablet | Hydromorphone | Analgesic | Narcotic | QL narcotic cumulative total 180 tabs/month
Disalcid 500 mg tablet | Salsalate | Analgesic | Salicylate
Disalcid 750 mg tablet | Salsalate | Analgesic | Salicylate
Dolobid 250 mg tablet | Diflunisal | Analgesic | Analgesic
Dolobid  500 mg tablet | Diflunisal | Analgesic | Analgesic
[NAME] mg tablet | Methadone | Analgesic | Narcotic | QL (30 mg daily)
Dolophine 10 mg tablet | Methadone | Analgesic | Narcotic | QL (30 mg daily)
Feldene 10 mg capsule | Piroxicam | Analgesic | Non Steroidal | Not covered; available at $4 program
Feldene  20 Feldene | Piroxicam | Analgesic | Non Steroidal | Not covered; available at $4 program
[NAME]  50-325-40 mg tablet | Acetomin/Caffeine/Butalbital | Analgesic | Analgesic
Fiorinal  50-325-40 mg capsule | ASA/Caffeine/Butalbital | Analgesic | Analgesic
Fiorinal  50-325-40 mg tablet | ASA/Caffeine/Butalbital | Analgesic | Analgesic
Fiorinal/Codeine #3 capsule | Codeine/ASA/Caffein/Butalbital | Analgesic | Narcotic | QL narcotic cumulative 180 tabs/month
Flexeril 10 mg tablet | [NAME] | Analgesic | Muscle Relaxants | Not covered; available at $4 program
Imitrex 25 mg tablet | sumatriptan | Analgesic | Migraine | QL (9/month)
Imitrex 50 mg tablet | sumatriptan | Analgesic | Migraine | QL (9/month)
Imitrex 100 mg tablet | sumatriptan | Analgesic | Migraine | QL (9/month)
Indocin 25 mg capsule | Indomethacin | Analgesic | Non Steroidal
Indocin 50 mg capsule | Indomethacin | Analgesic | Non Steroidal
[NAME] 10 mg tablet | Baclofen | Analgesic | Muscle Relaxants | Not covered; available at $4 program
[NAME] 20 mg tablet | Baclofen | Analgesic | Muscle Relaxants | Not covered; available at $4 program
Lorcet 10/650 TABLET | Hydrocodone/Acetaminophin | Analgesic | Narcotic | QL narcotic cumulative total 180 tabs/month
Lorcet HD capsule | Hydrocodone | Analgesic | Narcotic | QL narcotic cumulative total 180 tabs/month
Lorcet Plus 7.5/650 tablet | Hydrocodone/Acetaminophin | Analgesic | Narcotic | QL narcotic cumulative total 180 tabs/month
Lortab 10/500 tablet | Hydrocodone/Acetaminophin | Analgesic | Narcotic | QL narcotic cumulative total 180 tabs/month
Lortab 7.5/500 tablet | Hydrocodone/Acetaminophin | Analgesic | Narcotic | QL narcotic cumulative total 180 tabs/month
Lortab elixer | Hydrocodone/APAP elixer | Analgesic | Narcotic | QL narcotic cumulative total 960 ml/month
Meclomen 50 mg capsule | Meclofenamate Sodium | Analgesic | Non Steroidal
Meclomen 100 mg capsule | Meclofenamate Sodium | Analgesic | Non Steroidal
Methotrexate 2.5 mg tablet | Methotrexate Sodium | Analgesic | Antiarthritic
Methotrexate 25 mg tablet | Methotrexate Sodium | Analgesic | Antiarthritic
Methotrexate 25 mg/ml vial | Methotrexate Sodium | Analgesic | Antiarthritic
Motrin 400 mg tablet | Ibuprofen | Analgesic | Non Steroidal | Not covered; available at $4 program
Motrin 600 mg tablet | Ibuprofen | Analgesic | Non Steroidal | Not covered; available at $4 program
Motrin 800 mg tablet | Ibuprofen | Analgesic | Non Steroidal | Not covered; available at $4 program
[NAME] 15 mg tablet | [NAME] | Analgesic | Narcotic | PA Req'd > 60 mg daily
[NAME] 30 mg tablet | [NAME] | Analgesic | Narcotic | PA Req'd > 60 mg daily
[NAME] 60 mg tablet | [NAME] | Analgesic | Narcotic | PA Req'd > 60 mg daily
[NAME] 100 mg tablet | [NAME] | Analgesic | Narcotic | PA Req'd > 60 mg daily
MSIR 15 mt talet | Morphine sulfate IR | Analgesic | Narcotic | QL narcotic cumulative 180 tabs/month
MSIR 30 mg tablet | Morphine sulfate IR | Analgesic | Narcotic | QL narcotic cumulative 180 tabs/month
MSIR 10 mg/5 ml solution | Morphine sulfate IR | Analgesic | Narcotic | QL  narcotic cumulative total 960 ml/month
MSIR 20 mg/5 ml solution | Morphine sulfate IR | Analgesic | Narcotic | QL  narcotic cumulative total 960 ml/month
Nalfon 600 mg tablet | Fenoprofen Calcium | Analgesic | Non Steroidal
Naprosyn 250 mg tablet | Naproxen | Analgesic | Non Steroidal | Not covered,available at $4 program
Naprosyn 375 mg tablet | Naproxen | Analgesic | Non Steroidal | Not covered,available at $4 program
Naprosyn 500 mg tablet | Naproxen | Analgesic | Non Steroidal | Not covered,available at $4 program
Norco 5/325 mg tablet | Hydrocodone/Acetominophin | Analgesic | Narcotic | QL narcotic cumulative total 180 tabs/month
Norco 7.5/325 mg tablet | Hydrocodone/Acetominophin | Analgesic | Narcotic | QL narcotic cumulative total 180 tabs/month
[NAME] 10/325 mg tablet | Hydrocodone/Acetominophin | Analgesic | Narcotic | QL narcotic cumulative total 180 tabs/month
Orudis 25 mg capsule | Ketoprofen | Analgesic | Non Steroidal
Orudis 50 mg capsule | Ketoprofen | Analgesic | Non Steroidal
Orudis 75 mg capsule | Ketoprofen | Analgesic | Non Steroidal
Oxycodone | Oxycodone HCL | Analgesic | Narcotic | QL narcotic cumulative total180 tabs/month
Paraflex 250 mg tablet | Chlorzoxazone | Analgesic | Muscle Relaxants
Parafon forte DSC 500 mg cpt | Chlorzoxazone | Analgesic | Muscle Relaxants
Percocet 2.5/325 tablet | Oxycodone/Acetominophin | Analgesic | Narcotic | QL narcotic cumulative total180 tabs/month
Percocet 5/325 tablet | Oxycodone/Acetominophin | Analgesic | Narcotic | QL narcotic cumulative total180 tabs/month
Percocet 7.5/325 tablet | Oxycodone/Acetominophin | Analgesic | Narcotic | QL narcotic cumulative total180 tabs/month
Percocet 7.5/500 tablet | Oxycodone/Acetominophin | Analgesic | Narcotic | QL narcotic cumulative total180 tabs/month
Percocet 10/325 tablet | Oxycodone/Acetominophin | Analgesic | Narcotic | QL narcotic cumulative total180 tabs/month
Percocet 10/650 tablet | Oxycodone/Acetominophin | Analgesic | Narcotic | QL narcotic cumulative total180 tabs/month
Percodan tablet | Oxycodone/Acetominophin | Analgesic | Narcotic | QL narcotic cumulative total180 tabs/month
Roxicodone HCL 5 mg cap/tablet | Oxycodone HCL | Analgesic | Narcotic | QL narcotic cumulative total180 tabs/month
Tolectin 200 mg tablet | [NAME] | Analgesic | Non Steroidal
Tolectin DS 400 mg capsule | [NAME] | Analgesic | Non Steroidal
Trilisate 500 mg tablet | Choline/Magnesium/Trisalic | Analgesic | Salicylate
Trilisate 750 mg tablet | Choline/Magnesium/Trisalic | Analgesic | Salicylate
Trilisate 1000 mg talbet | Choline/Magnesium/Trisalic | Analgesic | Salicylate
Tylenol w/Codeine #2 tablet | Acetaminophin/Codeine | Analgesic | Narcotic | QL narcotic cumulative total180 tabs/month
Tylenol w/Codeine #3 tablet | Acetaminophin/Codeine | Analgesic | Narcotic | QL narcotic cumulative total180 tabs/month
Tylenol w/Codeine #4 tablet | Acetaminophin/Codeine | Analgesic | Narcotic | QL narcotic cumulative total180 tabs/month
Tylenol w/Codeine elixer | Acetaminophin/Codeine | Analgesic | Narcotic | QL narcotic cumulative total180 tabs/month
Tylox 5/500 capsule | Oxycodone/APAP | Analgesic | Narcotic | QL narcotic cumulative total180 tabs/month
Ultram 50 mg tablet | [NAME] | Analgesic | Analgesic
Vicodin 5/500 mg tablet | Hydrocodone/Acetamin | Analgesic | Narcotic | QL narcotic cumulative total180 tabs/month
Vicodin ES 7.5/750 mg tablet | Hydrocodone/Acetamin | Analgesic | Narcotic | QL narcotic cumulative total180 tabs/month
Vicoprofen 7.5/200 mg tablet | Hydrocodone/Ibuprofen | Analgesic | Narcotic | QL narcotic cumulative total180 tabs/month
Voltaren 25 mg tablet EC | Diclofenac Sodium | Analgesic | Non Steroidal | Not covered; available at $4 program
[NAME] 50 mg tablet EC | Diclofenac Sodium | Analgesic | Non Steroidal | Not covered; available at $4 program
[NAME] 75 mg tablet EC | Diclofenac Sodium | Analgesic | Non Steroidal | Not covered; available at $4 program
Zyloprim 100 mg tablet | Allopurinol | Analgesic | Antiarthritic | Not covered; available at $4 program
Zyloprim 300 mg tablet | Allopurinol | Analgesic | Antiarthritic | Not covered; available at $4 program
[NAME] mg tablet | [NAME] | Analgesics | Muscle Relaxants
[NAME] 750 mg tablet | [NAME] | Analgesics | Muscle Relaxants
Soma 350 mg tablet | Carisoprodol | Analgesics | Muscle Relaxants
Soma Compound tablet | Carisoprodol/Aspirin | Analgesics | Muscle Relaxants
Amoxil 250 mg capsule | Amoxicillin | Anti-Infective | Penicillin | Not covered; available at $4 program
Amoxil 250 mg tablet chew | Amoxicillin | Anti-Infective | Penicillin | Not covered; available at $4 program
Amoxil 250 mg/5ml suspension | Amoxicillin | Anti-Infective | Penicillin | Not covered; available at $4 program
Amoxil 400 mg/5 ml suspension | Amoxicillin | Anti-Infective | Penicillin | Not covered; available at $4 program
Amoxil 500 mg capsule/tablet | Amoxicillin | Anti-Infective | Penicillin | Not covered; available at $4 program
Amoxil 875 mg tablet | Amoxicillin | Anti-Infective | Penicillin | Not covered; available at $4 program
Augmentin 125 mg chewable tablets | Amos/Potassium Clavulanate | Anti-Infective | Penicillin
Augmentin  125mg/5 ml suspension | Amos/Potassium Clavulanate | Anti-Infective | Penicillin
Augmentin  200mg chewable tablet | Amos/Potassium Clavulanate | Anti-Infective | Penicillin
Augmentin  200 mg/5 ml suspension | Amos/Potassium Clavulanate | Anti-Infective | Penicillin
Augmentin 250 mg chewable tablet | Amos/Potassium Clavulanate | Anti-Infective | Penicillin
Augmentin  250 mg tablet | Amos/Potassium Clavulanate | Anti-Infective | Penicillin
Augmentin  250 mg/5 ml suspension | Amos/Potassium Clavulanate | Anti-Infective | Penicillin
Augmentin  400 mg chewable tablet | Amos/Potassium Clavulanate | Anti-Infective | Penicillin
Augmentin  400 mg/5 ml suspension | Amos/Potassium Clavulanate | Anti-Infective | Penicillin
Augmentin 500 mg tablet | Amos/Potassium Clavulanate | Anti-Infective | Penicillin
Augmentin  875 mg tablet | Amos/Potassium Clavulanate | Anti-Infective | Penicillin
Azulfadine 500 mg tablet | Sulasalaxine | Anti-Infective | Sulfonamide
Bactrim 400-800 mg tablet | Sulfamethoxazole//Tri | Anti-Infective | Sulfonamide | Not covered; available at $4 program
[NAME] tablet | Sulfamethoxazole//Tri | Anti-Infective | Sulfonamide | Not covered; available at $4 program
Bactrim Pediatric Oral Susp | Sulfamethoxazole//Tri | Anti-Infective | Sulfonamide | Not covered; available at $4 program
Biaxin 250 mg tablet | Chlarithromycin | Anti-Infective | Macrolides
Biaxin 500 mg tablet | Chlarithromycin | Anti-Infective | Macrolides
Ceclor 250 mg pulvule | Ceflacor | Anti-Infective | Cephalosporin
Ceclor 250 mg/5 ml suspension | Ceflacor | Anti-Infective | Cephalosporin
Ceclor 375 mg/5 ml suspension | Ceflacor | Anti-Infective | Cephalosporin
Ceclor 500 mg pulvule | Ceflacor | Anti-Infective | Cephalosporin
Cipro 250 mg tablet | Ciprofloxacin | Anti-Infective | Quinolone | Not covered; available at $4 program
Cipro 250 mg/5 ml suspension | Ciprofloxacin | Anti-Infective | Quinolone | Not covered; available at $4 program
Cipro 500 mg tablet | Ciprofloxacin | Anti-Infective | Quinolone | Not covered; available at $4 program
Cipro 500 mg/5 ml suspension | Ciprofloxacin | Anti-Infective | Quinolone | Not covered; available at $4 program
Cipro 750 mg tablet | Ciprofloxacin | Anti-Infective | Quinolone | Not covered; available at $4 program
Ciprodex 0.3% otic suspension | Ciprofloxacin/Dexamethasone | Anti-Infective | Quinolone
[NAME] 150 mg capsule | Clindamycin | Anti-Infective | Miscellaneous
Diflucan 150 mg tablet | Fluconazole | Anti-Infective | [NAME] | Not covered; available at $4 program
Duricef 500 mg capsule | Cefadroxil | Anti-Infective | Cephalosporin
Dynapen 250 mg capsule | [NAME] | Anti-Infective | Penicillin
Dynapen 500 mg capsule | [NAME] | Anti-Infective | Penicillin
EES 400 mg film tab | Erythromycin | Anti-Infective | Macrolides
EES 400 mg/5 ml suspension | Erythromycin | Anti-Infective | Macrolides
E-Mycin 333 mg tablet EC | [NAME] | Anti-Infective | Macrolides
Eryc 250 mg capsule | [NAME] | Anti-Infective | Macrolides
Eryped 400mg/5 ml granulse | Erythromycin | Anti-Infective | Macrolides
Erythrocin 250 mg filmtab | Erythromycin | Anti-Infective | Macrolides
Erythrocin 500 mg filmtab | Erythromycin | Anti-Infective | Macrolides
Erythromycin 2% solution | [NAME] | Anti-Infective | Macrolides
Flagyl 250 mg tablet | Metronidazole | Anti-Infective | Antibacterial
Flagyl 500 mg tablet | Metronidazole | Anti-Infective | Antibacterial
Gantrisin 500 mg tablet | Sulisoxazole | Anti-Infective | Sulfonamide
Grifulvin V 125 mg/5 ml  oral susp | Griseofulvin  Microsize | Anti-Infective | [NAME]
Isoniazid 100 mg tablet | Isoniazid | Anti-Infective | TB | Not covered; available at $4 program
Isoniazid 300 mg tablet | Isoniazid | Anti-Infective | TB | Not covered; available at $4 program
Keflex 250 mg pulvule | Cephalexin | Anti-Infective | Cephalosporin | Not covered; available at $4 program
Keflex 250 mg/5ml oral susp | Cephalexin | Anti-Infective | Cephalosporin | Not covered; available at $4 program
Keflex 500 mg pulvule | Cephalexin | Anti-Infective | Cephalosporin | Not covered; available at $4 program
[NAME] 250 mg tablet | [NAME] | Anti-Infective | Fluoroquinolone
Levaquin 500 mg tablet | [NAME] | Anti-Infective | Fluoroquinolone
[NAME] 750 mg tablet | [NAME] | Anti-Infective | Fluoroquinolone
Macrodantin 25 mg capsule | Nitrofurantoin macrocrystals | Anti-infective | Urinary Tract Anti-infective
Macrodantin 50 mg capsule | Nitrofurantoin macrocrystals | Anti-infective | Urinary Tract Anti-infective
Macrodantin 100  mg capsule | Nitrofurantoin macrocrystals | Anti-infective | Urinary Tract Anti-infective
Metro-vaginal 0.75% gel | Metronidazole | Anti-Infective | Vaginal | Not covered; available at $4 program
Minocin  50 mg pelletized cap | Minocycline | Anti-Infective | Tetracycline
Minocin 100 mg pelletized cap | Minocycline | Anti-Infective | Tetracycline
Monodox  50 mg capsule | Doxycycline Monohydrate | Anti-Infective | Tetracycline
Monodox 100 mg capsule | Doxycycline Monohydrate | Anti-Infective | Tetracycline
Penicillin VK 250 mg tablet | Penicillin V | Anti-Infective | Penicillin
Penicliin VK 250 mg/5 ml liquid | Penicillin V | Anti-Infective | Penicillin
Peniclllin VK 500 mg tablet | Penicillin V | Anti-Infective | Penicillin
Peridex 0.12% liquid | Chlorhexidene | Anti-Infective | Miscellaneous
Plaquenil 200 mg tablet | Hydroxychloroquine | Anti-Infective | [NAME]
Principen 250 mg capsule | Ampicillin | Anti-Infective | Penicillin
Principen 250 mg/5 ml susp | Ampicillin | Anti-Infective | Penicillin
Principen 500 mg capsule | Ampicillin | Anti-Infective | Penicillin
Proloprim 100 mg tablet | Trimethoprim | Anti-Infective | Miscellaneous
Proloprim 200 mg tablet | Trimethoprim | Anti-Infective | Miscellaneous
Sumycin 500 mg capsule | Tetracycline | Anti-Infective | Tetracycline | Not covered; available at $4 program
Sumycin V 250 mg capsule | Tetracycline | Anti-Infective | Tetracycline | Not covered; available at $4 program
Trimpex 100 mg tablet | Trimethoprem | Anti-Infective | Urinary Tract Agents
Zithromax 200 mg/5 ml susp | [NAME] | Anti-Infective | Macrolides
Zithromax 250 mg tablets | [NAME] | Anti-Infective | Macrolides | QL (6 pills)
[NAME] 200 mg capsule | Acyclovir | Anti-Infective | Antiviral | Not covered,available at $4 program
[NAME] 400 mg tablet | Acyclovir | Anti-Infective | Antiviral
[NAME] 800 mg tablet | Acyclovir | Anti-Infective | Antiviral
Cardec-DM drops | D-Methorpan/P-Ephedrine | Bronchal | Cough & Cold
[NAME] | Spacer | Bronchial | Asthma/COPD | QL (1/year)
Alupent 0.6% solution | Metaproterenol | Bronchial | Asthma/COPD
Alupent 10 mg tablet | Metaproterenol | Bronchial | Asthma/COPD
Alupent 10 mg/5 ml syrup | Metaproterenol | Bronchial | Asthma/COPD
Alupent 20 mg tablet | Metaproterenol | Bronchial | Asthma/COPD
Alupent 5% Solution | Metaproterenol | Bronchial | Asthma/COPD
[NAME] syrup | Codeine | Bronchial | Antihist/Antitussive
Aminophylline  100 mg tablet | Aminophylline | Bronchial | Asthma/COPD
Aminophylline 5 mg/5 ml liquid | Aminophylline | Bronchial | Asthma/COPD
Aminophylline 200 mg tablet | Aminophylline | Bronchial | Asthma/COPD
Atarax 10 mg tablet | Hydroxyzine | Bronchial | Antihistamine
Atarax 25 mg tablet | Hydroxyzine | Bronchial | Antihistamine
Atarax  50 mg tablet | Hydroxyzine | Bronchial | Antihistamine
Atrovent 0.02% Solution | Ipatropium Bromide | Bronchial | Asthma/COPD | Not covered;available at $4 program
Atrovent  HFA [NAME] | Ipratropium Bromide | Bronchial | Asthma/COPD
[NAME] elixer | Guaifen/Cod/Phenylep | Bronchial | Cough & Cold
Elixophyllin 80 mg/15 ml elixer | Theophylline | Bronchial | Asthma/COPD
Entex PSE 400-120 mg SR cap | Guaifenesin/P-Ephedring | Bronchial | Cough & Cold
Entex PSE 600-60 mg SR cap | Guaifenesin/P-Ephedring | Bronchial | Cough & Cold
Epipen 0.3 mg injection | Epinephrine | Bronchial | Anaphylaxis Therapy | QL (2 injections/rx)
[NAME] mg injection | Epinephrine | Bronchial | Anaphylaxis Therapy | QL (2 injections/rx)
Flonase Nasal Spray | Fluticasone Proprionate | Bronchial | Nasal Corticosteroid
Flovent HFA  110 mcg inhaler | Fluticasone Proprionate | Bronchial | Inhaled Glucocorticoid
Flovent HFA 220 [NAME] | Fluticasone Proprionate | Bronchial | Inhaled Glucocorticoid | PA Req'd
Histussin HD solution | Guaifenesin/Phenyephrine/Hcon | Bronchial | Cough & Cold
Hycodan syrup | Hydrocodone/Homatrop | Bronchial | Cough & Cold
Intal Nebulizer solution | [NAME] | Bronchial | Asthma/COPD
Lufyllin 100 mg/15 ml elixer | Dyphylline | Bronchial | Asthma/COPD
Lufyllin 200 mg tablet | Dyphylline | Bronchial | Asthma/COPD
[NAME] mg tablet | Guaifenesin | Bronchial | Cough & Cold
Periactin 2mg/5 ml syrup | Cyproheptadine | Bronchial | Antihistamine
Periactin 4 mg tablet | Cyproheptadine | Bronchial | Antihistamine
Phenergan 6.25 mg/5 ml syrup | [NAME] | Bronchial | Antihistamine | Not covered,available at $4 program
Phenergan 25 mg tablet | [NAME] | Bronchial | Antihistamine | Not covered,available at $4 program
[NAME] ml syrup | Dexchlorpheniramine | Bronchial | Antihistamine
Polarmine 6 mg repetab | Dexchlorpheniramine | Bronchial | Antihistamine
ProAir HFA inhaler 90 mcg | Albuterol HFA | Bronchial | Asthma/COPD | QL (2/month)
QVAR 40 [NAME] | Beclomethasone Dipropionate | Bronchial | Asthma/COPD
QVAR 80 [NAME] | Beclomethasone Dipropionate | Bronchial | Asthma/COPD
Robitussin AC syrup | Codeine/Guaifenesin | Bronchial | Cough & Cold
Robitussin DAC syrup | Codeine/P-ephedrine/Guaif | Bronchial | Cough & Cold
Rynatan tablet | Phenylephrine/Pyrila | Bronchial | Cough & Cold
Singulair 10 mg tablet | Montelukast | Bronchial | Antiasthmatic
Singulair 4 mg chew tab | Montelukast | Bronchial | Antiasthmatic
Singulair 5 mg chew tab | Montelukast | Bronchial | Antiasthmatic
Tavist 1.34 mg tablet | Clemastine Fumarate | Bronchial | Antihistamine
Tavist 2.68 mg tablet | Clemastine Fumarate | Bronchial | Antihistamine
Tessalon Perle 100 mg cap | Benzonatate | Bronchial | Cough & Cold
[NAME] 100 mg tablet SA | Theophylline | Bronchial | Asthma/COPD
[NAME] 200 mg tablet SA | Theophylline | Bronchial | Asthma/COPD
[NAME] 300 mg tablet SA | Theophylline | Bronchial | Asthma/COPD
[NAME] mg/ml solution | Albuterol | Bronchial | Asthma/COPD | Not covered; available at $4 program
[NAME] mg tablet | Albuterol | Bronchial | Asthma/COPD | Not covered; available at $4 program
[NAME] ml solution | Albuterol | Bronchial | Asthma/COPD | Not covered; available at $4 program
Vistaril 25 mg capsule | Hydroxyzine Pamoate | Bronchial | Antihistamine
Vistaril 50 mg capsule | Hydroxyzine Pamoate | Bronchial | Antihistamine
Vistaril 100 mg capsule | Hydroxyzine Pamoate | Bronchial | Antihistamine
Adalat 10 mg capsule | Nifedipine | Cardiovascular | Calcium Channel Blocker
Adalat 20 mg capsule | Nifedipine | Cardiovascular | Calcium Channel Blocker
[NAME] 30 mg tablet SA | Nifedipine | Cardiovascular | Calcium Channel Blocker
[NAME] 60 mg tablet SA | Nifedipine | Cardiovascular | Calcium Channel Blocker
[NAME] 90 mg tablet SA | Nifedipine | Cardiovascular | Calcium Channel Blocker
Aldactazide 25/25 mg tablet | Spironolactone/HCTZ | Cardiovascular | Diuretics, K+ sparing
Aldactone 25 mg tablet | Spironolactone | Cardiovascular | Diuretics, K+ sparing
Aldactone 50 mg tablet | Spironolactone | Cardiovascular | Diuretics, K+ sparing
Aldactone 75 mg tablet | Spironolactone | Cardiovascular | Diuretics, K+ sparing
Aldactone 100 mg tablet | Spironolactone | Cardiovascular | Diuretics, K+ sparing
Aldomet 125 mg tablet | Methyldopa | Cardiovascular | Antihypertensives, [NAME] | Not covered; available at $4 program
Aldomet 250 mg tablet | Methyldopa | Cardiovascular | Antihypertensives, [NAME] | Not covered; available at $4 program
Aldomet 500 mg tablet | Methyldopa | Cardiovascular | Antihypertensives, [NAME] | Not covered; available at $4 program
Aldoril-15  mg tablet | Methyldopa/Hydrochlorothiazide | Cardiovascular | [NAME]/diuretic
Aldoril-25 mg tablet | Methyldopa/Hydrochlorothiazide | Cardiovascular | [NAME]/diuretic
Apresoline  10 mg tablet | [NAME] | Cardiovascular | Antihypertensives, [NAME] | Not covered; available at $4 program
Apresoline  25 mg tablet | [NAME] | Cardiovascular | Antihypertensives, [NAME] | Not covered; available at $4 program
Apresoline 50 mg tablet | [NAME] | Cardiovascular | Antihypertensives, [NAME]
Apresoline 100 mg tablet | [NAME] | Cardiovascular | Antihypertensives, [NAME]
[NAME]  5 mg tablet | Timolol Maleate | Cardiovascular | Cardiovascular
[NAME] 10 mg tablet | Timolol Maleate | Cardiovascular | Cardiovascular
[NAME] 20 mg tablet | Timolol Maleate | Cardiovascular | Cardiovascular
Bumex 0.5 mg tablet | Bumetanide | Cardiovascular | Diuretics/Loop | Not covered; available at $4 program
Bumex 1 mg tablet | Bumetanide | Cardiovascular | Diuretics/Loop | Not covered; available at $4 program
Bumex 2 mg tablet | Bumetanide | Cardiovascular | Diuretics/Loop | Not covered; available at $4 program
Calan  40 mg tablet | [NAME] | Cardiovascular | Calcium Channel Blocker
Calan  80 mg tablet | [NAME] | Cardiovascular | Calcium Channel Blocker
Calan 120 mg tablet | [NAME] | Cardiovascular | Calcium Channel Blocker
Calan SR 120 mg caplet | [NAME] | Cardiovascular | Calcium Channel Blocker
Calan SR 180 mg caplet | [NAME] | Cardiovascular | Calcium Channel Blocker
Calan SR 240MG caplet SA | [NAME] | Cardiovascular | Calcium Channel Blocker
Capoten  12.5 mg tablet | Captopril | Cardiovascular | ACE Inhibitor | Not covered; available at $4 program
Capoten  25 mg tablet | Captopril | Cardiovascular | ACE Inhibitor | Not covered; available at $4 program
Capoten 50 mg tablet | Captopril | Cardiovascular | ACE Inhibitor | Not covered; available at $4 program
Capoten 100 mg tablet | Captopril | Cardiovascular | ACE Inhibitor | Not covered; available at $4 program
Cardene 20 mg capsule | Nicardipine | Cardiovascular | Calcium Channel Blocker
[NAME] mg capsule | Nicardipine | Cardiovascular | Calcium Channel Blocker
Cardizem 30 mg tablet | Diltiazem | Cardiovascular | Calcium Channel Blocker | Not covered; available at $4 program
Cardizem 60 mg tablet | Diltiazem | Cardiovascular | Calcium Channel Blocker | Not covered; available at $4 program
Cardizem 90 mg tablet | Diltiazem | Cardiovascular | Calcium Channel Blocker | Not covered; available at $4 program
Cardizem 120 mg tablet | Diltiazem | Cardiovascular | Calcium Channel Blocker | Not covered; available at $4 program
Cardizem  CD 120 mg cap SR 24 hour | Diltiazem | Cardiovascular | Calcium Channel Blocker
Cardizem  CD 180 mg cap SR 24 hour | Diltiazem | Cardiovascular | Calcium Channel Blocker
Cardizem  CD 240 mg cap SR 24 hour | Diltiazem | Cardiovascular | Calcium Channel Blocker
Cardizem  CD 300 mg cap SR 24 hour | Diltiazem | Cardiovascular | Calcium Channel Blocker
Cardizem  SR   60 mg capsule | Diltiazem | Cardiovascular | Calcium Channel Blocker
Cardizem SR   90 mg capsule | Diltiazem | Cardiovascular | Calcium Channel Blocker
Cardizem  SR 120 mg capsule | Diltiazem | Cardiovascular | Calcium Channel Blocker
Cardura 1 mg tablet | Doxazosin | Cardiovascular | [NAME] | Not covered; available at $4 program
[NAME] mg tablet | Doxazosin | Cardiovascular | [NAME] | Not covered; available at $4 program
[NAME] 4 mg tablet | Doxazosin | Cardiovascular | [NAME] | Not covered; available at $4 program
[NAME] 8 mg tablet | Doxazosin | Cardiovascular | [NAME] | Not covered; available at $4 program
Catapres 0.1 mg tablet | Clonidine | Cardiovascular | Antihypertensives, [NAME] | Not covered; available at $4 program
Catapres 0.2 mg tablet | Clonidine | Cardiovascular | Antihypertensives, [NAME] | Not covered; available at $4 program
Catapres 0.3 mg tablet | Clonidine | Cardiovascular | Antihypertensives, [NAME] | Not covered; available at $4 program
Cordarone 200 mg tablet | Amiodarone | Cardiovascular | Anti-Arrhythmics
Coreg 3.125 mg tablet | Carvedilol | Cardiovascular | Beta Blocker | Not covered; available at $4 program
Coreg 6.25 mg tablet | Carvedilol | Cardiovascular | Beta Blocker | Not covered; available at $4 program
Coreg 12.5 mg tablet | Carvedilol | Cardiovascular | Beta Blocker | Not covered; available at $4 program
[NAME] mg tablet | Carvedilol | Cardiovascular | Beta Blocker | Not covered; available at $4 program
Corgard 20 mg tablet | Nadolol | Cardiovascular | Beta Blocker | Not covered; available at $4 program
Corgard 40 mg tablet | Nadolol | Cardiovascular | Beta Blocker | Not covered; available at $4 program
Corgard 80 mg tablet | Nadolol | Cardiovascular | Beta Blocker | Not covered; available at $4 program
Corgard 120 mg tablet | Nadolol | Cardiovascular | Beta Blocker | Not covered; available at $4 program
Corgard 160 mg tablet | Nadolol | Cardiovascular | Beta Blocker | Not covered; available at $4 program
[NAME] | Warfarin Sodium | Cardiovascular | Anticoagulant | Not covered; available at $4 program
[NAME] mg tablet | Warfarin Sodium | Cardiovascular | Anticoagulant | Not covered; available at $4 program
[NAME]  2.5 mg tablet | Warfarin Sodium | Cardiovascular | Anticoagulant | Not covered; available at $4 program
[NAME]mg tablet | Warfarin Sodium | Cardiovascular | Anticoagulant | Not covered; available at $4 program
[NAME]  5 mg tablet | Warfarin Sodium | Cardiovascular | Anticoagulant | Not covered; available at $4 program
[NAME] 6 mg tablet | Warfarin Sodium | Cardiovascular | Anticoagulant | Not covered; available at $4 program
[NAME]  7.5mg tablet | Warfarin Sodium | Cardiovascular | Anticoagulant | Not covered; available at $4 program
[NAME] 10 mg tablet | Warfarin Sodium | Cardiovascular | Anticoagulant | Not covered; available at $4 program
Cozaar 25 mg tablet | Losartan | Cardiovascular | [NAME] receptor blocker
Cozaar 50 mg tablet | Losartan | Cardiovascular | [NAME] receptor blocker
Cozaar 100 mg tablet | Losartan | Cardiovascular | [NAME] receptor blocker
Diamox 125 mg tablet | Acetazolamide | Cardiovascular | Diuretic,Carbonic Anhydrase
Diamox 250 mg tablet | Acetazolamide | Cardiovascular | Diuretic,Carbonic Anhydrase
Diuril 250 mg tablet | Chlorothiazide | Cardiovascular | Diuretic, thiazide
Diuril 500 mg tablet | Chlorothiazide | Cardiovascular | Diuretic, thiazide
Dyazide 37.5/25 capsule | HCTZ/Triameterene | Cardiovascular | Diretics, K+ sparing | Not covered; available at $4 program
Dyazide 50/25 capsule | HCTZ/Triameterene | Cardiovascular | Diretics, K+ sparing | Not covered; available at $4 program
Enduron 2.5 mg tablet | Methyclothiazide | Cardiovascular | Diuretic/Thiazide
Enduron 5 mg tablet | Methyclothiazide | Cardiovascular | Diuretic/Thiazide
Flomax 0.4 mg capsule | [NAME] | Cardiovascular | [NAME]
Hydergine 1 mg tablet | Ergoloid mesylates | Cardiovascular | Vasodilator
Hydrodiuril 25 mg tablet | Hydrochlorothiazide | Cardiovascular | Diuretic, thiazide | Not covered; available at $4 program
Hydrodiuril 50 mg tablet | Hydrochlorothiazide | Cardiovascular | Diuretic, thiazide | Not covered; available at $4 program
Hygroton 25 mg tablet | Chlorthalidone | Cardiovascular | Diuretic, thiazide
Hygroton 50 mg tablet | Chlorthalidone | Cardiovascular | Diuretic, thiazide
Hytrin 1 mg capsule | Terazosin | Cardiovascular | [NAME] | Not covered; available at $4 program
Hytrin10 mg capsule | Terazosin | Cardiovascular | [NAME] | Not covered; available at $4 program
Hytrin 2 mg capsule | Terazosin | Cardiovascular | [NAME] | Not covered; available at $4 program
Hytrin 5 mg capsule | Terazosin | Cardiovascular | [NAME] | Not covered; available at $4 program
Hyzaar 50-12.5 mg capsules | Losartan/HCTZ | Cardiovascular | ARB/Diuretic
Hyzaar 100-12.5 mg capsules | Losartan/HCTZ | Cardiovascular | ARB/Diuretic
Hyzaar 100-25 mg capsules | Losartan/HCTZ | Cardiovascular | ARB/Diuretic
Imdur 120 mg tablet | [NAME] | Cardiovascular | Coronary Vasodilator | Not covered; available at $4 program
Imdur 30 mg tablet | [NAME] | Cardiovascular | Coronary Vasodilator | Not covered; available at $4 program
Imdur 60 mg tablet | [NAME] | Cardiovascular | Coronary Vasodilator | Not covered; available at $4 program
Inderal 10 mg tablet | Propranolol | Cardiovascular | Beta Blocker | Not covered; available at $4 program
Inderal  20 mg tablet | Propranolol | Cardiovascular | Beta Blocker | Not covered; available at $4 program
Inderal 40 mg tablet | Propranolol | Cardiovascular | Beta Blocker | Not covered; available at $4 program
Inderal 80 mg tablet | Propranolol | Cardiovascular | Beta Blocker | Not covered; available at $4 program
Inderal LA   80 mg capsule | Propranolol | Cardiovascular | Beta Blocker
Inderal LA 120 mg capsule SA | Propranolol | Cardiovascular | Beta Blocker
IsordilL  2.5 mg tablet SL | Isosorbide Dinitrate | Cardiovascular | Coronary Vasodilator
IsordilL 5 mg tablet | Isosorbide Dinitrate | Cardiovascular | Coronary Vasodilator
IsordilL  5 mg tablet SL | Isosorbide Dinitrate | Cardiovascular | Coronary Vasodilator
Isordil10 mg tablet | Isosorbide Dinitrate | Cardiovascular | Coronary Vasodilator
Isordil 20 mg tablet | Isosorbide Dinitrate | Cardiovascular | Coronary Vasodilator
IsordilL 30 mg tablet | Isosorbide Dinitrate | Cardiovascular | Coronary Vasodilator
Isordil 40 mg tablet SA | Isosorbide Dinitrate | Cardiovascular | Coronary Vasodilator
KCL 20 meq/15 ml liquid | Potassium Chloride | Cardiovascular | Potassium Supplements
K-Dur 20 meq tab SR | Potassium Chloride | Cardiovascular | Potassium Supplements
Klor-con 8 meq tablet SA | Potassium Chloride | Cardiovascular | Potassium Supplements
K-Tab 10 meq tablet SA | Potassium Chloride | Cardiovascular | Potassium Supplements
K-Lyte 25 meq tablet eff | Potassium Bicarbonate/Cit AC | Cardiovascular | Potassium Supplements
Lanoxin 0.05 mg/ml elixer | Digoxin | Cardiovascular | Digitalis Glycoside
Lanoxin 0.125 mg tablet | Digoxin | Cardiovascular | Digitalis Glycoside
Lanoxin 0.25 mg tablet | Digoxin | Cardiovascular | Digitalis Glycoside
[NAME] | Digoxin | Cardiovascular | Digitalis Glycoside
[NAME] mg/ml  solution | Furosemide | Cardiovascular | Diuretic, thiazide
[NAME] 20 mg tablet | Furosemide | Cardiovascular | Diuretic, thiazide | Not covered; available at $4 program
[NAME] mg tablet | Furosemide | Cardiovascular | Diuretic, thiazide | Not covered; available at $4 program
[NAME] mg tablet | Furosemide | Cardiovascular | Diuretic, thiazide | Not covered; available at $4 program
Lipitor 10 mg tablet | Atorvastatin | Cardiovascular | Cholesterol lowering
Lipitor 20 mg tablet | Atorvastatin | Cardiovascular | Cholesterol lowering
Lipitor 40 mg tablet | Atorvastatin | Cardiovascular | Cholesterol lowering
Lipitor 80 mg tablet | Atorvastatin | Cardiovascular | Cholesterol lowering
Loniten 2.5  mg tablet | Minoxidil | Cardiovascular | Antihypertensives, [NAME]
Loniten 10 mg tablet | Minoxidil | Cardiovascular | Antihypertensives, [NAME]
Lopid 600 mg tablet | Gemfibrozil | Cardiovascular | Lipotropic
Lopressor  25 mg tablet | Metoprolol Tartrate | Cardiovascular | Beta Blocker | Not covered; available at $4 program
Lopressor 50 mg tablet | Metoprolol Tartrate | Cardiovascular | Beta Blocker | Not covered; available at $4 program
Lopressor 100 mg tablet | Metoprolol Tartrate | Cardiovascular | Beta Blocker | Not covered; available at $4 program
Lozol 1.25 mg tablet | Indapamide | Cardiovascular | Diuretic, thiazide | Not covered; available at $4 program
Lozol 2.5 mg tablet | Indapamide | Cardiovascular | Diuretic, thiazide | Not covered; available at $4 program
Maxzide 25 mg tablet | HCTZ/Triameterene | Cardiovascular | Diretics, K+ sparing | Not covered; available at $4 program
Maxzide 50/75 mg tablet | HCTZ/Triameterene | Cardiovascular | Diretics, K+ sparing | Not covered; available at $4 program
Mevacor 10 mg tablet | [NAME] | Cardiovascular | Cholesterol lowering
Mevacor20 mg tablet | [NAME] | Cardiovascular | Cholesterol lowering
Mevacor 40 mg tablet | [NAME] | Cardiovascular | Cholesterol lowering
Mexitil 150 mg capsule | Mexiletine | Cardiovascular | Antiarrhythmic
Mexitil 200 mg capsule | Mexiletine | Cardiovascular | Antiarrhythmic
Mexitil 250 mg capsule | Mexiletine | Cardiovascular | Antiarrhythmic
Micro-K 10 meq extencaps | Potassium Chloride | Cardiovascular | Potassium Supplements
Minipress 1 mg capsule | [NAME] HCL | Cardiovascular | Antihypertensives, [NAME] | not covered; available at $4 program
Minipress 2 mg capsule | [NAME] HCL | Cardiovascular | Antihypertensives, [NAME] | not covered; available at $4 program
Minipress 5 mg capsule | [NAME] HCL | Cardiovascular | Antihypertensives, [NAME] | not covered; available at $4 program
Moduretic 5/50 tablet | HCTZ/Amiloride | Cardiovascular | Diuretics, K= Sparing
Neptazane 25 mg tablet | Methazolamide | Cardiovascular | Diuretic, Carbonic Anhydrase
Neptazane 50 mg tablet | Methazolamide | Cardiovascular | Diuretic, Carbonic Anhydrase
[NAME]% ointment | Nitroglycerin | Cardiovascular | Coronary Vasodilator
Nitroglycerine 2.5 mg caps SA | Nitroglycerin | Cardiovascular | Coronary Vasodilator
Nitroglycerine 6.5 mg caps SA | Nitroglycerin | Cardiovascular | Coronary Vasodilator
Nitroglycerine 9 mg caps SA | Nitroglycerin | Cardiovascular | Coronary Vasodilator
Nitrostat 0.3 mg tablet SL | Nitroglycerin | Cardiovascular | Coronary Vasodilator
Nitrostat 0.4 mg tablet SL | Nitroglycerin | Cardiovascular | Coronary Vasodilator
Nitrostat 0.6 mg tablet SL | Nitroglycerin | Cardiovascular | Coronary Vasodilator
Norpace 100 mg capsule | Disopyramide | Cardiovascular | Antiarrhythmic
Norpace 150 mg capsule | Disopyramide | Cardiovascular | Antiarrhythmic
Norvasc 2.5 mg tablet | Amlodipine | Cardiovascular | Antihypertensives, [NAME] | Not covered,available at $4 program
Norvasc 5 mg tablet | Amlodipine | Cardiovascular | Antihypertensives, [NAME] | Not covered,available at $4 program
Norvasc 10 mg tablet | Amlodipine | Cardiovascular | Antihypertensives, [NAME] | Not covered,available at $4 program
Pavabid 150 mg capsule SA | Papaverne | Cardiovascular | Peripheral Vasodilator
Plavix 75 mg tablet | Clopidogrel | Cardiovascular | Antiplatelet
Pravachol 10 mg tablet | [NAME] | Cardiovascular | Cholesterol lowering
Pravachol 20 mg tablet | [NAME] | Cardiovascular | Cholesterol lowering
Pravachol 40 mg tablet | [NAME] | Cardiovascular | Cholesterol lowering
Pravachol 80 mg tablet | [NAME] | Cardiovascular | Cholesterol lowering
Procainamide 750 mg tablet | Procainamide HCL | Cardiovascular | Antiarrhythmic
Procardia 10 mg capsule | Nifedipine | Cardiovascular | Calcium Channel Blocker
Procardia 20 mg capsule | Nifedipine | Cardiovascular | Calcium Channel Blocker
Procardia XL 30 mg tablet | Nifedipine | Cardiovascular | Calcium Channel Blocker
Procardia XL 60 mg tablet | Nifedipine | Cardiovascular | Calcium Channel Blocker
Procardia XL 90 mg tablet | Nifedipine | Cardiovascular | Calcium Channel Blocker
Questran Light powder | Cholestyramine/Aspar | Cardiovascular | Lipotropic
Questran powder | Cholestyramine/Aspar | Cardiovascular | Lipotropic
Quinaglute 324 mg tablet | Quinidine Gluconate | Cardiovascular | Antiarrhythmic
Quinidex  300 mg tablet | Quinidine Sulfate | Cardiovascular | Antiarrhythmic
Quinidine 200 mg tablet | Quinidine Sulfate | Cardiovascular | Antiarrhythmic
Quinidine 300 mg tablet | Quinidine Sulfate | Cardiovascular | Antiarrhythmic
Sectral 200 mg capsule | Acebutolol | Cardiovascular | Beta Blocker
Sectral 400 mg capsule | Acebutolol | Cardiovascular | Beta Blocker
Slow-K 8 meq tablet | Potassium Chloride | Cardiovascular | Potassium Supplements
Tenex 1 mg tablet | Guanfacine HCL | Cardiovascular | Antihypertensives, [NAME] | Not covered; available at $4 program
Tenex 2 mg tablet | Guanfacine HCL | Cardiovascular | Antihypertensives, [NAME] | Not covered; available at $4 program
Tenoretic 50/25 mg tablet | Atenolol/Chlorthalicone | Cardiovascular | Beta Blocker + Diuretic | Not covered; available at $4 program
Tenoretic 100/25 mg tablet | Atenolol/Chlorthalicone | Cardiovascular | Beta Blocker + Diuretic | Not covered; available at $4 program
[NAME] mg tablet | Atenolol | Cardiovascular | Beta Blocker | Not covered; available at $4 program
Tenormin 50 mg tablet | Atenolol | Cardiovascular | Beta Blocker | Not covered; available at $4 program
Tenormin 100 mg tablet | Atenolol | Cardiovascular | Beta Blocker | Not covered; available at $4 program
Transderm-Nitro Patch .1 mg/hr | Nitroglycerin | Cardiovascular | Coronary Vasodilator
Transderm-Nitro Patch .2 mg/hr | Nitroglycerin | Cardiovascular | Coronary Vasodilator
Transderm-Nitro Patch .4 mg/hr | Nitroglycerin | Cardiovascular | Coronary Vasodilator
[NAME] 10 mg tablet | Isoxsuprine | Cardiovascular | Peripheral Vasodilator
Vasodilan 20 mg tablet | Isoxsuprine | Cardiovascular | Peripheral Vasodilator
Vasotec 2.5 mg tablet | Enalapril Maleate | Cardiovascular | ACE Inhibitor | Not covered; available at $4 program
Vasotec 5 mg tablet | Enalapril Maleate | Cardiovascular | ACE Inhibitor | Not covered; available at $4 program
Vasotec  10 mg tablet | Enalapril Maleate | Cardiovascular | ACE Inhibitor | Not covered; available at $4 program
Vasotec 20 mg tablet | Enalapril Maleate | Cardiovascular | ACE Inhibitor | Not covered; available at $4 program
Visken 5 mg tablet | Pindolol | Cardiovascular | Beta Blocker | Not covered; available at $4 program
Visken 10 mg tablet | Pindolol | Cardiovascular | Beta Blocker | Not covered; available at $4 program
Wytensin 4 mg tablet | [NAME] | Cardiovascular | Antihypertensives, [NAME]
Wytensin 8 ng tablet | [NAME] | Cardiovascular | Antihypertensives, [NAME]
Zestoretic 10-12.5  mg tablet | Lisinopril/HCTZ | Cardiovascular | ACE Inhibitor/Diuretic | Not covered; available at $4 program
Zestoretic 20-12.5 mg tablet | Lisinopril/HCTZ | Cardiovascular | ACE Inhibitor/Diuretic | Not covered; available at $4 program
Zestoretic 20-25 mg tablet | Lisinopril/HCTZ | Cardiovascular | ACE Inhibitor/Diuretic | Not covered; available at $4 program
Zestril 2.5 mg tablet | Lisinopril | Cardiovascular | Ace Inhibitor | Not covered,available at $4 program
Zestril 5 mg tablet | Lisinopril | Cardiovascular | Ace Inhibitor | Not covered; available at $4 program
Zestril 10 mg tablet | Lisinopril | Cardiovascular | Ace Inhibitor | Not covered; available at $4 program
Zestril 20 mg tablet | Lisinopril | Cardiovascular | Ace Inhibitor | Not covered; available at $4 program
Zestril 30 mg tablet | Lisinopril | Cardiovascular | Ace Inhibitor | Not covered; available at $4 program
Zocor 5 mg tablet | Simvastatin | Cardiovascular | Cholesterol lowering
Zocor 10 mg tablet | Simvastatin | Cardiovascular | Cholesterol lowering
Zocor 20 mg tablet | Simvastatin | Cardiovascular | Cholesterol lowering
Zocor 40 mg tablet | Simvastatin | Cardiovascular | Cholesterol lowering
Zocor 80 mg tablet | Simvastatin | Cardiovascular | Cholesterol lowering
A/T/S 2% gel | [NAME] | Dermatologic | Anti-Infective
A/T/S 2% topical solution | [NAME] | Dermatologic | Anti-Infective
[NAME] solution | Clindamycin | Dermatologic | Anti-Infective
Aristocort A 0.025% cream/oint/lotion | Triamcinolone/Acetonide/L.S.B. | Dermatological | Corticosteroid
Aristocort  A 0.5% cream | Triamcinolone/Acetonide/L.S.B. | Dermatological | Corticosteroid
Aristocort A 0.1% cream/ointment | Triamcinolone/Acetonide/L.S.B. | Dermatological | Corticosteroid
Condylox 0.5% solution | Podofilox | Dermatological | Miscellaneous
Diprosone 0.05% cream | Betamethasone | Dermatological | Corticosteroid | Not covered; available at $4 program
Diprosone 0.05 pc lotion | Betamethasone | Dermatological | Corticosteroid | Not covered; available at $4 program
Diprosone 0.05 pc ointment | Betamethasone | Dermatological | Corticosteroid | Not covered; available at $4 program
Elimite 5% cream | Permethrin | Dermatological | Antiparasitic
Hytone 1% cream/ ointment | Hydrocortisone | Dermatological | Corticosteroid
Hytone 2.5 pc cream/oint/lotion | Hydrocortisone | Dermatological | Corticosteroid
Kenalog-Orabase 0.1% paste | Triamcinolone | Dermatological | Corticosteroid
[NAME] mg tablet | Terbinafine | Dermatological | [NAME] | Not covered; available at $4 program
Lidex 0.05% cream | Fluocinonide | Dermatological | Corticosteroid | Not covered; available at $4 program
Lidex  0.05% gel | Fluocinonide | Dermatological | Corticosteroid | Not covered; available at $4 program
Lidex 0.05% ointment | Fluocinonide | Dermatological | Corticosteroid | Not covered; available at $4 program
Lidex 0.05% solution | Fluocinonide | Dermatological | Corticosteroid | Not covered; available at $4 program
Lidex -E 0.05% cream | Fluocinonide/Emollient | Dermatological | Corticosteroid
Lotrisone cream | Betamethasone/Clotrimazole | Dermatological | Anti-fungal
Lotrisone lotion | Betamethasone/Clotrimazole | Dermatological | Anti-fungal
Metro gel/lotion/cream 0.75% | Metronidazole | Dermatological | Rosacea agent
Mycolog II cream | Nystatin/Triamcinolone | Dermatological | [NAME]
Mycolog II ointment | Nystatin/Triamcinolone | Dermatological | [NAME]
[NAME] 100.000 u/gm cream | [NAME] | Dermatological | [NAME] | Not covered,available at $4 program
Mycostatin 100,000 u/ml susp | [NAME] | Dermatological | [NAME]
Mycostatin 500,000 oral tab | [NAME] | Dermatological | [NAME]
Selsun 2.5% shampoo | Selenium Sulfide | Dermatological | Miscellaneous
Silvadene 1% cream | Silver Sulfadizaine | Dermatological | Anti-infective | Not covered; available at $4 program
Synalar 0.01% solution | Fluocinolone | Dermatological | Corticosteroid
Synalar 0.025% cream | Fluocinolone | Dermatological | Corticosteroid
Synalar 0.025% ointment | Fluocinolone | Dermatological | Corticosteroid
Topicort 0.25% cream | Desoximetasone | Dermatological | Corticosteroid
[NAME] 0.25 PC ointment | Desoximetasone | Dermatological | Corticosteroid
Topicort LP 0.05% PC cream | Desoximetasone | Dermatological | Corticosteroid
Valisone 0.1 PC cream | Betamethasone | Dermatological | Corticosteroid
Valisone 0.1 PC lotion | Betamethasone | Dermatological | Corticosteroid
Valisone 0.1 PC ointment | Betamethasone | Dermatological | Corticosteroid
Bacitracin ointment | Bacitracin | Dermatology | Anti-Infective
[NAME] blood glucose strips | Blood glucose strips | Diabetes | Supplies | QL (100/month)
[NAME] lancets | Lancets | Diabetes | Supplies
[NAME] | Glucometer | Diabetes | Supplies | [NAME]  [PHONE] for a free meter
Bayer Contour blood glucose strips | Blood glucose strips | Diabetes | Supplies | QL (100/month)
Bayer Contour Lancets | Lancets | Diabetes | Supplies
[NAME] | Glucometer | Diabetes | Supplies | [NAME]  [PHONE] for a free meter
[NAME] blood glucose strips | Blood glucose strips | Diabetes | Supplies | QL (100/month)
Bayer Contour Next Lancets | Lancets | Diabetes | Supplies
B-D Insulin syringes  .5 cc | [NAME] | Diabetes | Supplies
B-D Insulin Syringes 1 cc | [NAME] | Diabetes | Supplies
Diabenese 100 mg tablet | Chlorpropamide | Diabetes | Sulfonylureas | Not covered; available at $4 program
Diabenese 250 mg tablet | Chlorpropamide | Diabetes | Sulfonylureas | Not covered; available at $4 program
Diabeta 1.25 mg tablet | Glyburide | Diabetes | Sulfonylureas
Diabeta 2.5 mg tablet | Glyburide | Diabetes | Sulfonylureas
Diabeta 5 mg tablet | Glyburide | Diabetes | Sulfonylureas
[NAME] | Glucagon | Diabetes | Hyperglycemic | QL (1 kit/rx)
Glucophage 1000 mg tablet | Metformin | Diabetes | Biguanide | Not covered; available at $4 program
Glucophage 500 mg tablet | Metformin | Diabetes | Biguanide | Not covered; available at $4 program
Glucophage 850 mg tablet | Metformin | Diabetes | Biguanide | Not covered; available at $4 program
Glucophage ER 500 mg tablet | Metformin ER | Diabetes | Biguanide | Not covered; available at $4 program
Glucophage ER 750 mg tablet | Metformin ER | Diabetes | Biguanide | Not covered; available at $4 program
Glucotrol 5 mg tablet | Glipizide | Diabetes | Sulfonylureas | Not covered; available at $4 program
Glucotrol 10 mg tablet | Glipizide | Diabetes | Sulfonylureas | Not covered; available at $4 program
Glynase 1.5 mg prestab | Glyburide | Diabetes | Sulfonylureas
Glynase 3 mg prestab | Glyburide Micronized | Diabetes | Sulfonylureas
Glynase 6 mg prestab | Glyburide | Diabetes | Sulfonylureas
Humalin 50/50 100 u/ml vial | Insulin/Human Regular | Diabetes | Insulin | QL (3 vials/month)
Humalog U-100  ml vial | [NAME] | Diabetes | Insulin | QL (3 vials/month)
Humalog Mix  75/25 ml vial | [NAME] | Diabetes | Insulin | QL (3 vials/month)
Humulin 70/30 ml vial | [NAME] | Diabetes | Insulin | QL (3 vials/month)
Humulin L 100 u/ml vial | Insulin ZN Human | Diabetes | Insulin | QL (3 vials/month)
Humulin N  U-100 ml vial | [NAME] | Diabetes | Insulin | QL (3 vials/month)
Humulin R 100  U-100 vial | [NAME]. Human | Diabetes | Insulin | QL (3 vials/month)
Lantus Insulin 100 IU/ml vial | [NAME] | Diabetes | Insulin
Micronase 1.25 mg tablet | Glyburide | Diabetes | Sulfonylureas
Micronase 2.5 mg tablet | Glyburide | Diabetes | Sulfonylureas
Micronase 5 mg tablet | Glyburide | Diabetes | Sulfonylureas
Novolin 70/30 | NPH/Regular | Diabetes | Insulin | QL (3 vials/month)
Novolin N 100 u/ml vial | NPH Human | Diabetes | Insulin | QL (3 vials/month)
Novolog 100 u/ml vial | [NAME] | Diabetes | Insulin | QL (3 vials/month)
Antivert 12.5 mg tablet | Meclizine | Gastrointestinal | Anti-Nausea
Antivert 25 mg tablet | Meclizine | Gastrointestinal | Anti-Nausea
Anucort-HC 25MG Suppository | Hydrocortisone | Gastrointestinal | Rectal Prep
Bentyl 10 mg capsule | Dicyclomine | Gastrointestinal | Antispasmotic/Anticholinergics | Not covered; available at $4 program
Bentyl 20 mg tablet | Dicyclomine | Gastrointestinal | Antispasmotic/Anticholinergics | Not covered; available at $4 program
Carafate 1gm tablet | Sucralfate | Gastrointestinal | anti-Ulcer
[NAME] 10 gm/15 ml syrup | Lactulose | Gastrointestinal | laxative
[NAME] | [NAME] | Gastrointestinal | laxative
Compazine  5 mg tablet | Prochlorperazine | Gastrointestinal | Anti-Nausea | Not covered; available at $4 program
Compazine 10 mg tablet | Prochlorperazine | Gastrointestinal | Anti-Nausea | Not covered; available at $4 program
Donnatal Elixer | [NAME] | Gastrointestinal | Antispasmotic/Anticholinergics
Levsin 0.125 mg tablet SL | [NAME] | Gastrointestinal | Antispasmotic/Anticholinergics
Levsin 0.375 MG capsule SA | [NAME] | Gastrointestinal | Antispasmotic/Anticholinergics
Levsin 0.375 mg tablet SA | [NAME] | Gastrointestinal | Antispasmotic/Anticholinergics
[NAME] 0.375 mg capsule SA | [NAME] | Gastrointestinal | Antispasmotic/Anticholinergics
Librax capsule | Clidinium/CL-Br/CDP | Gastrointestinal | Antispasmotic/Anticholinergics
Lomotil Liquid | Diphenoxylate | Gastrointestinal | Antidiarrheal
Lomotil tablet | Diphenoxylate | Gastrointestinal | Antidiarrheal
Pepcid 20 mg tablet | Famotidine | Gastrointestinal | H-2 Antagonist | Not covered,available at $4 program
Prilosec 20 mg capsule | Omeprazole | Gastrointestinal | Proton Pump Inhibitor
[NAME] capsule | Omeprazole | Gastrointestinal | Proton Pump Inhibitor
Probanthine 15 mg tablet | [NAME] | Gastrointestinal | Antispasmotic/Anticholinergics
[NAME] mg tablet | Metoclopramide | Gastrointestinal | Anti-nausea | Not covered; available at $4 program
[NAME] mg tablet | Metoclopramide | Gastrointestinal | Anti-nausea | Not covered; available at $4 program
Tagamet 300 mg tablet | Cimetadine | Gastrointestinal | H-2 Antagonist
Tagamet 300 mg/5 ml liquid | Cimetadine | Gastrointestinal | H-2 Antagonist
Tagamet 400 mg tablet | Cimetadine | Gastrointestinal | H-2 Antagonist
Zantac 75 mg tablet | Ranitidine | Gastrointestinal | H-2 Antagonist | Not covered; available at $4 program
Zantac  150 mg tablet | Ranitidine | Gastrointestinal | H-2 Antagonist | Not covered; available at $4 program
Zantac  300  mg tablet | Ranitidine | Gastrointestinal | H-2 Antagonist | Not covered; available at $4 program
[NAME] 30 mg tablet | thyroid | Miscellaneous | Thyroid
[NAME] 60 mg tablet | thyroid | Miscellaneous | Thyroid
[NAME] 120 mg tablet | thyroid | Miscellaneous | Thyroid
Decadron  0.5 mg tablet | Dexamethasone | Miscellaneous | Corticosteroid
Decadron  0.5 mg/5 ml elixer | Dexamethasone | Miscellaneous | Corticosteroid
Decadron   0.75 mg tablet | Dexamethasone | Miscellaneous | Corticosteroid
Decadron  1 mg tablet | Dexamethasone | Miscellaneous | Corticosteroid
Decadron  1.5 mg tablet | Dexamethasone | Miscellaneous | Corticosteroid
Decadron  2 mg tablet | Dexamethasone | Miscellaneous | Corticosteroid
Decadron  4 mg tablet | Dexamethasone | Miscellaneous | Corticosteroid
Decadron 6 mg tablet | Dexamethasone | Miscellaneous | Corticosteroid
[NAME] mg tablet | Oxybutynin Cl | Miscellaneous | Urinary Tract Agents | Not covered; available at $4 program
Flu vaccine injection | Flu vaccine injection | Miscellaneous | Prevention | zero copay at  pharmacy only
Flu vaccine nasal spray | Flu vaccine nasal spray | Miscellaneous | Prevention | zero copay at  pharmacy only
Fosamax 70 mg tablet | Alendronate sodium | Miscellaneous | CNS Stimulant | QL (4/month)
Imuran 50 mg tablet | Azathiprine | Miscellaneous | Immunosuppresive
[NAME] mg dosepak | Methylprednisone | Miscellaneous | Corticosteroid
Orapred 15 mg/5 ml | Prednisolone | Miscellaneous | Corticosteroid
Prednisone 1mg tablet | Prednisone | Miscellaneous | Corticosteroid
Prednisone  2.5 mg tablet | Prednisone | Miscellaneous | Corticosteroid
Prednisone  5 mg tablet | Prednisone | Miscellaneous | Corticosteroid | Not covered,available at $4 program
Prednisone 10 mg tablet | Prednisone | Miscellaneous | Corticosteroid | Not covered,available at $4 program
Prednisone 20 mg tablet | Prednisone | Miscellaneous | Corticosteroid | Not covered,available at $4 program
Propylthioracil | Propylthioracil | Miscellaneous | Anti-Thyroid
Pyridium 100 mg tablet | Phenazopyridine | Miscellaneous | Urinary Tract Agents | Not covered; available at $4 program
Pyridium 200 mg tablet | Phenazopyridine | Miscellaneous | Urinary Tract Agents | Not covered; available at $4 program
[NAME] mg tablet | Levothyroxine Sodium | Miscellaneous | Thyroid | Not covered; available at $4 program
[NAME] mg tablet | Levothyroxine Sodium | Miscellaneous | Thyroid | Not covered; available at $4 program
[NAME] 0.075 mg tablet | Levothyroxine Sodium | Miscellaneous | Thyroid | Not covered; available at $4 program
[NAME] 0.088 mg tablet | Levothyroxine Sodium | Miscellaneous | Thyroid | Not covered; available at $4 program
[NAME] | Levothyroxine Sodium | Miscellaneous | Thyroid | Not covered; available at $4 program
[NAME] mg tablet | Levothyroxine Sodium | Miscellaneous | Thyroid | Not covered; available at $4 program
[NAME] 0.125 mg tablet | Levothyroxine Sodium | Miscellaneous | Thyroid | Not covered; available at $4 program
[NAME] mg tablet | Levothyroxine Sodium | Miscellaneous | Thyroid | Not covered; available at $4 program
[NAME] mg tablet | Levothyroxine Sodium | Miscellaneous | Thyroid | Not covered; available at $4 program
[NAME] 0.175mg tablet | Levothyroxine Sodium | Miscellaneous | Thyroid | Not covered; available at $4 program
[NAME] mg tablet | Levothyroxine Sodium | Miscellaneous | Thyroid | Not covered; available at $4 program
[NAME] mg tablet | Levothyroxine Sodium | Miscellaneous | Thyroid | Not covered; available at $4 program
Tapazole 5 mg tablet | Methimazole | Miscellaneous | Anti-Thyroid
Tapazole 10 mg tablet | Methimazole | Miscellaneous | Anti-Thyroid
Atropine 1% eye drops | Atropine | Opthalmic Agents | Miscellaneous | Not covered;available at $4 program
[NAME]/gm eye ointment | Bacitracin | Opthalmic Agents | Anti-Infective | Not covered; available at $4 program
Betagan 0.25% opth drops | Levobunolol | Opthalmic Agents | Glaucoma
Betagan 0.5% opth drops | Levobunolol | Opthalmic Agents | Glaucoma
Cortisporin  eye drops | Neomycin | Opthalmic Agents | Anti-Infective
Cortisporin  eye ointment | Neomycin/Bacitracin/Polymixin B | Opthalmic Agents | Anti-Infective
Decadron  0.1 PC opth drops | Dexamethasone | Opthalmic Agents | Corticosteroid
FML Liquifilm 0.1% eye drop | Fluromethalone | Opthalmic Agents | Corticosteroid
Garamycin 3 mg/gm opth ointment | Gentamicin Sulfate | Opthalmic Agents | Anti-Infective
Garamycin 3 mg/ml eye drops | Gentamicin Sulfate | Opthalmic Agents | Anti-Infective | Not covered; available at $4 program
Garamycin 0.1 % cream | Gentamicin Sulfate | Opthalmic Agents | Anti-Infective | Not covered; available at $4 program
Garamycin 0.1% ointment | Gentamicin Sulfate | Opthalmic Agents | Anti-Infective | Not covered; available at $4 program
Ilotycin 5 mg/gm ointment | [NAME] | Opthalmic Agents | Anti-Infective
[NAME] eye drops | Atropine | Opthalmic Agents | Miscellaneous | Not covered; available at $4 program
Maxitrol eye drops | Neomycin/Polymixin/Dexameth | Opthalmic Agents | Anti-Infective/Cortico
Maxitrol eye ointment | Neomycin/Polymixin/Dexameth | Opthalmic Agents | Anti-Infective/Cortico
Mydriacyl 1% drops | Nystatin/Triamcin | Opthalmic Agents | Dilator
Neosporin eye drops | Neomycin/Gramcidin/Polymixin B | Opthalmic Agents | Anti-Infective
Neosporin Opthalmic ointment | Neomycin/Gramcidin/Polymixin B | Opthalmic Agents | Anti-Infective
Ocufen 0.03% eye drops | [NAME] | Opthalmic Agents | Non Steroidal
Ocuflox 0.3% eye drops | Ofloxacin | Opthalmic Agents | Anti-Infective
Pilocarpine  0.5% eye drops | Pilocarpine HCL | Opthalmic Agents | Glaucoma | Not covered,available at $4 program
Pilocarpine 1% eye drops | Pilocarpine HCL | Opthalmic Agents | Glaucoma | Not covered,available at $4 program
Pilocarpine 2% eye drops | Pilocarpine HCL | Opthalmic Agents | Glaucoma | Not covered,available at $4 program
Pilocarpine 3% eye drops | Pilocarpine HCL | Opthalmic Agents | Glaucoma | Not covered,available at $4 program
Pilocarpine 4% eye drops | Pilocarpine HCL | Opthalmic Agents | Glaucoma | Not covered,available at $4 program
Pilocarpine 6% eye drops | Pilocarpine HCL | Opthalmic Agents | Glaucoma | Not covered,available at $4 program
Pred forte 1% eye drops | Prednislone Acetate | Opthalmic Agents | Corticosteroid
Propine 0.1% eye drops | Dipivefrin | Opthalmic Agents | Glaucoma
Sod Sulamyd 10 PC Opth drops | Sulfacetamide sodium | Opthalmic Agents | Anti-Infective
Sod Sulamyd 10 PC Opth oint | Sulfacetamide sodium | Opthalmic Agents | Anti-Infective
Timoptic 0.25%  eye drops | Timolol Maleate | Opthalmic Agents | Glaucoma | Not covered; available at $4 program
Timoptic 0.5% eye drops | Timolol Maleate | Opthalmic Agents | Glaucoma | Not covered; available at $4 program
Timoptic Opth ocudose 0.25% | Timolol Maleate | Opthalmic Agents | Glaucoma | Not covered; available at $4 program
Timoptic Opth ocudose 0.5% | Timolol Maleate | Opthalmic Agents | Glaucoma | Not covered; available at $4 program
Tobrex  0.3% eye drops | [NAME] | Opthalmic Agents | Anti-Infective | Not covered; available at $4 program
Xalatan 0.005% eye drops | Lantanoprost | Opthalmic Agents | Glaucoma
Cortisporin ear suspension | Neomycin/HC/Polymix B | Otic Agent | Anti-Infective
Cortisporin  Otic solution drops | Neomycin | Otic Agent | Anti-Infective
Domeboro Otic drops | Acetic Acid/Aluminum | Otic Agent | Miscellaneous
[NAME] drops | Acetic Acid | Otic Agents | Anti-Infective/Cortico
Artane 2 mg tablet | [NAME] | Paychotherapeutic | Antiparkinson's
Artane  2 mg/5 ml elixer | [NAME] | Paychotherapeutic | Antiparkinson's
Artane  5 mg tablet | [NAME] | Paychotherapeutic | Antiparkinson's
Ambien 5 mg tablet | [NAME] | Psychotherapeutic | Sedative/Hypnotic | QL (10/month)
Ambien 10 mg tablet | [NAME] | Psychotherapeutic | Sedative/Hypnotic | QL (10/month)
Antabuse 250 mg tablet | Disulfiram | Psychotherapeutic | Substance Abuse
Antabuse 500 mg tablet | Disulfiram | Psychotherapeutic | Substance Abuse
[NAME] mg tablet | Lorazepam | Psychotherapeutic | Anti-Anxiety
[NAME] | Lorazepam | Psychotherapeutic | Anti-Anxiety
[NAME] mg tablet | Lorazepam | Psychotherapeutic | Anti-Anxiety
[NAME] mg tablet | [NAME] | Psychotherapeutic | Anti-Anxiety | Not covered; available at $4 program
[NAME] mg tablet | [NAME] | Psychotherapeutic | Anti-Anxiety | Not covered; available at $4 program
[NAME] 15 mg tablet | [NAME] | Psychotherapeutic | Anti-Anxiety | Not covered; available at $4 program
[NAME] 30 mg tablet | [NAME] | Psychotherapeutic | Anti-Anxiety | Not covered; available at $4 program
Celexa 10 mg tablet | Citalopram | Psychotherapeutic | Antidepressant | Not covered; available at $4 program
Celexa 20 mg tablet | Citalopram | Psychotherapeutic | Antidepressant | Not covered; available at $4 program
Celexa 40 mg tablet | Citalopram | Psychotherapeutic | Antidepressant | Not covered; available at $4 program
Celexa Solution 10mg/5ml | Citalopram | Psychotherapeutic | Antidepressant | Not covered; available at $4 program
Cogentin 0.5 mg tablet | Benztropine Mesylate | Psychotherapeutic | Antiparkinson's | Not covered; available at $4 program
Cogentin 1  mg tablet | Benztropine Mesylate | Psychotherapeutic | Antiparkinson's | Not covered; available at $4 program
Cogentin 2 mg tablet | Benztropine Mesylate | Psychotherapeutic | Antiparkinson's | Not covered; available at $4 program
Cogentin Ampule 2mg/2ml | Benztropine Mesylate | Psychotherapeutic | Antiparkinson's | Not covered; available at $4 program
Dalmane 15 mg capsule | Flurazepam HCL | Psychotherapeutic | Sedative/Hypnotic
Dalmane 30 mg capsule | Flurazepam HCL | Psychotherapeutic | Sedative/Hypnotic
[NAME] 250mg/cup | Valproate sodium | Psychotherapeutic | Anticonvulsant
Depakene 250 mg capsule | Valproic Acid | Psychotherapeutic | Anticonvulsant
Depakene solution 500mg/10ml | Valproate sodium | Psychotherapeutic | Anticonvulsant
Depakene Syringe 250mg/5ml | Valproate sodium | Psychotherapeutic | Anticonvulsant
Depakote125 mg tablet EC | Divalproex Sodium | Psychotherapeutic | Anticonvulsant
Depakote 250 mg tablet EC | Divalproex Sodium | Psychotherapeutic | Anticonvulsant
Depakote 500 mg tablet EC | Divalproex Sodium | Psychotherapeutic | Anticonvulsant
Desyrel  50 mg tablet | Trazadone | Psychotherapeutic | Antidepressant | Not covered; available at $4 program
[NAME] 100 mg tablet | Trazadone | Psychotherapeutic | Antidepressant | Not covered; available at $4 program
Desyrel 150 mg tablet | Trazadone | Psychotherapeutic | Antidepressant | Not covered; available at $4 program
Desyrel 300mg tablet | Trazadone | Psychotherapeutic | Antidepressant | Not covered; available at $4 program
[NAME] 50 mg infatab | [NAME] | Psychotherapeutic | Anticonvulsant
[NAME] 100 mg kapseal | [NAME] | Psychotherapeutic | Anticonvulsant
[NAME]  125 mg/5 ml susp | [NAME] | Psychotherapeutic | Anticonvulsant
[NAME] 30mg capsule | [NAME] | Psychotherapeutic | Anticonvulsant
[NAME] 50mg/ml ampule | [NAME] | Psychotherapeutic | Anticonvulsant
[NAME] 50mg/ml syringe | [NAME] | Psychotherapeutic | Anticonvulsant
[NAME] 50mg/ml vial | [NAME] | Psychotherapeutic | Anticonvulsant
[NAME] 100mg/4ml suspension | [NAME] | Psychotherapeutic | Anticonvulsant
Elavil  10 mg tablet | Amitriptyline | Psychotherapeutic | Antidepressant | Not covered; available at $4 program
Elavil  25 mg tablet | Amitriptyline | Psychotherapeutic | Antidepressant | Not covered; available at $4 program
Elavil  50 mg tablet | Amitriptyline | Psychotherapeutic | Antidepressant | Not covered; available at $4 program
Elavil  75 mg tablet | Amitriptyline | Psychotherapeutic | Antidepressant | Not covered; available at $4 program
Elavil 100 mg tablet | Amitriptyline | Psychotherapeutic | Antidepressant | Not covered; available at $4 program
Elavil 150 mg tablet | Amitriptyline | Psychotherapeutic | Antidepressant | Not covered; available at $4 program
[NAME] 300 mg cap/tab | Lithium Carbonate | Psychotherapeutic | Antipsychotic
Halcion 0.125 mg tablet | Triazolam | Psychotherapeutic | Sedative/Hypnotic
Halcion 0.25 mg tablet | Triazolam | Psychotherapeutic | Sedative/Hypnotic
Haldol 2 mg/ml oral conc | [NAME] | Psychotherapeutic | Antipsychotic | Not covered; available at $4 program
Haldol 0.5 mg tablet | [NAME] | Psychotherapeutic | Antipsychotic | Not covered; available at $4 program
Haldol  1 mg tablet | [NAME] | Psychotherapeutic | Antipsychotic | Not covered; available at $4 program
Haldol  2mg tablet | [NAME] | Psychotherapeutic | Antipsychotic | Not covered; available at $4 program
Haldol  50 mg/ml vial | [NAME] | Psychotherapeutic | Antipsychotic | Not covered; available at $4 program
Haldol  5MG TABLET | [NAME] | Psychotherapeutic | Antipsychotic | Not covered; available at $4 program
Haldol  20 mg tablet | [NAME] | Psychotherapeutic | Antipsychotic | Not covered; available at $4 program
Keppra 250mg tablet | [NAME] | Psychotherapeutic | Anticonvulsant
Keppra 500mg tablet | [NAME] | Psychotherapeutic | Anticonvulsant | [NAME] 3000 mg/day
Keppra 750mg tablet | [NAME] | Psychotherapeutic | Anticonvulsant | [NAME] 3000 mg/day
Keppra 1000mg tablet | [NAME] | Psychotherapeutic | Anticonvulsant | [NAME] 3000 mg/day
[NAME] | Clonazepam | Psychotherapeutic | Anticonvulsant
[NAME] | Clonazepam | Psychotherapeutic | Anticonvulsant
[NAME] mg tablet | Clonazepam | Psychotherapeutic | Anticonvulsant
[NAME] 0.125mg tab disper | Clonazepam | Psychotherapeutic | Anticonvulsant
Klonopin 0.25mg tab disper | Clonazepam | Psychotherapeutic | Anticonvulsant
[NAME]mg tab disper | Clonazepam | Psychotherapeutic | Anticonvulsant
[NAME]mg tab disper | Clonazepam | Psychotherapeutic | Anticonvulsant
[NAME]mg tab disper | Clonazepam | Psychotherapeutic | Anticonvulsant
Lamictal 25mg tablet | [NAME] | Psychotherapeutic | Anticonvulsant | [NAME] 500 mg/day
Lamictal 100 mg tablet | [NAME] | Psychotherapeutic | Anticonvulsant | [NAME] 500 mg/day
Lamictal 150mg tablet | [NAME] | Psychotherapeutic | Anticonvulsant | [NAME] 500 mg/day
Lamictal 200mg tablet | [NAME] | Psychotherapeutic | Anticonvulsant | [NAME] 500 mg/day
Librium  5 mg capsule | Chlordiazepoxide HCL | Psychotherapeutic | Anti-Anxiety
Librium 10 mg capsule | Chlordiazepoxide HCL | Psychotherapeutic | Anti-Anxiety
Librium 25 mg capsule | Chlordiazepoxide HCL | Psychotherapeutic | Anti-Anxiety
Limbitrol 12.5/5 mg tablet | Chlordiazepoxide/Amitriptyline | Psychotherapeutic | Antidepressant
[NAME] mg tablet | Chlordiazepoxide/Amitriptyline | Psychotherapeutic | Antidepressant
Lithotabs 150 mg capsule | Lithium Carbonate | Psychotherapeutic | Antipsychotic
Lithotabs 300 mg tablet | Lithium Carbonate | Psychotherapeutic | Antipsychotic
Lithotabs 450 mg tablet | Lithium Carbonate | Psychotherapeutic | Antipsychotic
Loxitane  5 mg capsule | Loxapine Succinate | Psychotherapeutic | Antipsychotic
Loxitane 10 mg capsule | Loxapine Succinate | Psychotherapeutic | Antipsychotic
Loxitane 25 mg capsule | Loxapine Succinate | Psychotherapeutic | Antipsychotic
Loxitane 50 mg capsule | Loxapine Succinate | Psychotherapeutic | Antipsychotic
Mysoline 50 mg tablet | Primidone | Psychotherapeutic | Anticonvulsant
Mysoline 250 mg tablet | Primidone | Psychotherapeutic | Anticonvulsant
[NAME] capsule | [NAME] | Psychotherapeutic | Antipsychotic
[NAME] mg capsule | [NAME] | Psychotherapeutic | Antipsychotic
[NAME] mg capsule | [NAME] | Psychotherapeutic | Antipsychotic
[NAME] oral conc | [NAME] | Psychotherapeutic | Antipsychotic
Navane 20 mg capsule | [NAME] | Psychotherapeutic | Antipsychotic
[NAME] 10 mg capsule | [NAME] | Psychotherapeutic | Antipsychotic
Neurontin 100 mg capsule | Gabapentin | Psychotherapeutic | Anticonvulsant | [NAME] 3600 mg/day
Neurontin 300 mg capsule | Gabapentin | Psychotherapeutic | Anticonvulsant | [NAME] 3600 mg/day
Neurontin 400 mg capsule | Gabapentin | Psychotherapeutic | Anticonvulsant | [NAME] 3600 mg/day
Neurontin 250mg/5ml soln | Gabapentin | Psychotherapeutic | Anticonvulsant | [NAME] 3600 mg/day
Norpramin 10mg tablet | Desipramine HCL | Psychotherapeutic | Antidepressant
Norpramin 100mg tablet | Desipramine HCL | Psychotherapeutic | Antidepressant
Norpramin 150mg tablet | Desipramine HCL | Psychotherapeutic | Antidepressant
Norpramin 25mg tablet | Desipramine HCL | Psychotherapeutic | Antidepressant
Norpramin 50mg tablet | Desipramine HCL | Psychotherapeutic | Antidepressant
Norpramin 75mg tablet | Desipramine HCL | Psychotherapeutic | Antidepressant
Norpramin 10 mg tablet | Desipramine | Psychotherapeutic | Antidepressant
Norpramin 25 mg tablet | Desipramine | Psychotherapeutic | Antidepressant
Norpramin 50 mg tablet | Desipramine | Psychotherapeutic | Antidepressant
Norpramin 75 mg tablet | Desipramine | Psychotherapeutic | Antidepressant
Norpramin 100 mg tablet | Desipramine | Psychotherapeutic | Antidepressant
Pamelor 10 mg capsule | [NAME] | Psychotherapeutic | Antidepressant | Not covered,available at $4 program
Pamelor 25 mg capsule | [NAME] | Psychotherapeutic | Antidepressant | Not covered,available at $4 program
Pamelor 50 mg capsule | [NAME] | Psychotherapeutic | Antidepressant | Not covered,available at $4 program
Pamelor 75 mg capsule | [NAME] | Psychotherapeutic | Antidepressant | Not covered,available at $4 program
Pamelor 10mg/5ml soln | [NAME] | Psychotherapeutic | Antidepressant | Not covered,available at $4 program
Paxil 10 mg tablet | Paroxetine HCL | Psychotherapeutic | Antidepressant | Not covered,available at $4 program
Paxil 20 mg tablet | Paroxetine HCL | Psychotherapeutic | Antidepressant | Not covered,available at $4 program
Paxil 30 mg tablet | Paroxetine HCL | Psychotherapeutic | Antidepressant | Not covered,available at $4 program
Paxil 40 mg tablet | Paroxetine HCL | Psychotherapeutic | Antidepressant | Not covered,available at $4 program
Phenobarbital 15 mg tablet | Phenobarbital | Psychotherapeutic | Anticonvulsant
Phenobarbital 30 mg tablet | Phenobarbital | Psychotherapeutic | Anticonvulsant
Phenobarbital 60 mg tablet | Phenobarbital | Psychotherapeutic | Anticonvulsant
Phenobarbital 100 mg tablet | Phenobarbital | Psychotherapeutic | Anticonvulsant
Prolixin 1 mg tablet | Fluphenazine HCL | Psychotherapeutic | Antipsychotic | Not covered,available at $4 program
Prolixin 2.5 mg tablet | Fluphenazine HCL | Psychotherapeutic | Antipsychotic | Not covered,available at $4 program
Prolixin 5 mg tablet | Fluphenazine HCL | Psychotherapeutic | Antipsychotic | Not covered,available at $4 program
[NAME] 10 mg capsule | [NAME] | Psychotherapeutic | Antidepressant | Not covered; available at $4 program
[NAME] 15 mg tablet | Mirtazapine | Psychotherapeutic | Antidepressant
[NAME] 30 mg tablet | Mirtazapine | Psychotherapeutic | Antidepressant
[NAME] 45 mg tablet | Mirtazapine | Psychotherapeutic | Antidepressant
Restoril 15 mg capsule | Temazepam | Psychotherapeutic | Sedative/Hypnotic
Restoril 30 mg capsule | Temazepam | Psychotherapeutic | Sedative/Hypnotic
Risperdal 0.25mg tablet | Risperidone | Psychotherapeutic | Antipsychotic
Risperdal 0.5 mg tablet | Risperidone | Psychotherapeutic | Antipsychotic
Risperdal 1mg tablet | Risperidone | Psychotherapeutic | Antipsychotic
[NAME]mg tablet | Risperidone | Psychotherapeutic | Antipsychotic
Risperdal 3mg tablet | Risperidone | Psychotherapeutic | Antipsychotic
Risperdal 4mg tablet | Risperidone | Psychotherapeutic | Antipsychotic
Risperdal 1mg/ml soln | Risperidone | Psychotherapeutic | Antipsychotic
Ritalin 5 mg tablet | Methylphenidate | Psychotherapeutic | CNS Stimulants
Ritalin 10 mg tablet | Methylphenidate | Psychotherapeutic | CNS Stimulants
Ritalin 20 mg tablet | Methylphenidate | Psychotherapeutic | CNS Stimulants
Ritalin-SR 20 mg tablet SA | Methylphenidate | Psychotherapeutic | CNS Stimulants
Serax 10 mg capsule | Oxazepam | Psychotherapeutic | Anti-Anxiety
Serax 15 mg capsule | Oxazepam | Psychotherapeutic | Anti-Anxiety
[NAME] 30 mg capsule | Oxazepam | Psychotherapeutic | Anti-Anxiety
Sinemet 10/100 tablet | Carbidopa/Levadopa | Psychotherapeutic | Antiparkinson's
Sinemet 25/100 tablet | Carbidopa/Levadopa | Psychotherapeutic | Antiparkinson's
Sinemet 25/250 tablet | Carbidopa/Levadopa | Psychotherapeutic | Antiparkinson's
Sinequan 10 mg capsule | [NAME] | Psychotherapeutic | Antidepressant
Sinequan 10 mg/ml oral conc | [NAME] | Psychotherapeutic | Antidepressant
Sinequan 25 mg capsule | [NAME] | Psychotherapeutic | Antidepressant
Sinequan 50 mg capsule | [NAME] | Psychotherapeutic | Antidepressant
Sinequan 75 mg capsule | [NAME] | Psychotherapeutic | Antidepressant
Sinequan 100 mg capsule | [NAME] | Psychotherapeutic | Antidepressant
Sinequan 150 mg capsule | [NAME] | Psychotherapeutic | Antidepressant
Stelazine 1 mg tablet | Trifluoperazine HCL | Psychotherapeutic | Antipsychotic
[NAME] | Trifluoperazine HCL | Psychotherapeutic | Antipsychotic
Stelazine 5 mg tablet | Trifluoperazine HCL | Psychotherapeutic | Antipsychotic
Stelazine 10 mg tablet | Trifluoperazine HCL | Psychotherapeutic | Antipsychotic
Symmetrel 100 mg tablet | Amantadine | Psychotherapeutic | Antiparkinson's
Symmetrel 50 mg/5 ml syrup | Amantadine | Psychotherapeutic | Antiparkinson's
Tegretol 100 mg tab chew | [NAME] | Psychotherapeutic | Anticonvulsant | Not covered; available at $4 program
Tegretol 200 mg tablet | [NAME] | Psychotherapeutic | Anticonvulsant | Not covered; available at $4 program
Tegretol 100 mg/5 ml | [NAME] | Psychotherapeutic | Anticonvulsant
Tegretol 200 mg/10 ml | [NAME] | Psychotherapeutic | Anticonvulsant
Tofranil 10 mg tablet | Imipramine | Psychotherapeutic | Antidepressant
Tofranil 25 mg tablet | Imipramine | Psychotherapeutic | Antidepressant
Tofranil 50 mg tablet | Imipramine | Psychotherapeutic | Antidepressant
Tranxene 3.75 mg tablet | Clorazepate | Psychotherapeutic | Anti-Anxiety
[NAME] 7.5 mg tablet | Clorazepate | Psychotherapeutic | Anti-Anxiety
[NAME] 15 mg tablet | Clorazepate | Psychotherapeutic | Anti-Anxiety
Triavil/Etrafon 2-10 mg tablet | Perphenazine/Amitriptyline | Psychotherapeutic | Antidepressant
Triavil/Etrafon 2-25 mg tablet | Perphenazine/Amitriptyline | Psychotherapeutic | Antidepressant
Triavil/Etrafon 4-10 mg tablet | Perphenazine/Amitriptyline | Psychotherapeutic | Antidepressant
Triavil/Etrafon 4-25 mg tablet | Perphenazine/Amitriptyline | Psychotherapeutic | Antidepressant
Triavil/Etrafon 4-50 mg tablet | Perphenazine/Amitriptyline | Psychotherapeutic | Antidepressant
Trilafon 2 mg tablet | Perphenazine | Psychotherapeutic | Antidepressant
[NAME] mg tablet | Perphenazine | Psychotherapeutic | Antidepressant
Trilafon 8 mg tablet | Perphenazine | Psychotherapeutic | Antidepressant
Trilafon 16 mg tablet | Perphenazine | Psychotherapeutic | Antidepressant
Valium 2 mg tablet | Diazepam | Psychotherapeutic | Anti-Anxiety
Valium 5 mg tablet | Diazepam | Psychotherapeutic | Anti-Anxiety
Valium 5 mg/ml vial | Diazepam | Psychotherapeutic | Anti-Anxiety
Valium 5 mg/ml Disp syringe | Diazepam | Psychotherapeutic | Anti-Anxiety
Valium 10 mg tablet | Diazepam | Psychotherapeutic | Anti-Anxiety
Vanspar 7.5 mg tablet | Buspirone | Psychotherapeutic | Anti-Anxiety
Vivactil 5 mg tablet | Protriptyline HCL | Psychotherapeutic | Antidepressant
Vivactil 10 mg tablet | Proptriptyline HCL | Psychotherapeutic | Antidepressant
Wellbutrin 75 mg tablet | Bupropion | Psychotherapeutic | Antidepressant
Wellbutrin 100 mg tablet | Bupropion | Psychotherapeutic | Antidepressant
Wellbutrin SR 100 mg tablet | Bupropion | Psychotherapeutic | Antidepressant
Wellbutrin SR 150 mg tablet | Bupropion | Psychotherapeutic | Antidepressant
Xanax 0.25 mg tablet | Alprazolam | Psychotherapeutic | Anti-Anxiety
Xanax 0.5 mg tablet | Alprazolam | Psychotherapeutic | Anti-Anxiety
Xanax 1 mg tablet | Alprazolam | Psychotherapeutic | Anti-Anxiety
Xanax 2 mg tablet | Alprazolam | Psychotherapeutic | Anti-Anxiety
Zoloft 25 mg tablet | Sertraline | Psychotherapeutic | Antidepressant
[NAME] 50 mg tablet | Sertraline | Psychotherapeutic | Antidepressant
Zoloft 100 mg tablet | Sertraline | Psychotherapeutic | Antidepressant
B-Complex Vitamin [NAME] | Iron/Multiv/Min | Vitamin Supplements | Miscellaneous
Folic Acid 1 mg tablet | Folic Acid | Vitamin Supplements | CNS Stimulant | Not covered; available at $4 program
Natal Care | Prenatal Vitamins W/Fe Fumarate,FA | Vitamin Supplements | Prenatal Vitamins | Not covered,available at $4 program
Prenatal Vitamins | Prenatal Vit w/ Fe Fumarate, FA | Vitamin Supplements | Prenatal | Not covered,available at $4 program
Vitamin D 50000 iu capsule | Ergocalciferol | Vitamin Supplements | Vitamin D
Monistat-3 vaginal suppository | Miconazole nitrate | Women' health | [NAME]
Ogen 0.625 mg tablet | Estropipate | Women' health | Estrogen
Ogen 1.25 mg tablet | Estropipate | Women' health | Estrogen
Ogen 3 mg tablet | Estropipate | Women' health | Estrogen
Estrace 0.5 mg tablet | [NAME] | Women's Health | Estrogen | Not covered; available at $4 program
Estrace 1 mg tablet | [NAME] | Women's Health | Estrogen | Not covered; available at $4 program
Estrace 2 mg tablet | [NAME] | Women's Health | Estrogen | Not covered; available at $4 program
Provera 2.5 mg tablet | Medroxyprogesterone | Women's Health | Progesterone | Not covered,available at $4 program
Provera   5 mg tablet | Medroxyprogesterone | Women's Health | Progesterone | Not covered,available at $4 program
Provera 10 mg tablet | Medroxyprogesterone | Women's Health | Progesterone | Not covered,available at $4 program