The following is a list of the most commonly prescribed drugs. It represents an abbreviatedversion of the drug list (formulary) that is at the core of your prescription-drug benefit plan. The list is not all-inclusive and does not guarantee coverage. In addition to using this list,you are encouraged to ask your doctor to prescribe generic drugs whenever appropriate. PLEASE NOTE: Brand-name drugs may move to nonformulary status if a generic version becomes available during the year. Not all the drugs listed are covered by all 2014 Express Scripts prescription-drug benefit programs; check your benefit materials for the specific drugs covered and the copayments for your prescription-drug benefit program. For specific Basic Formulary questions about your coverage, please call the phone number printed on your ID card. ANTIINFECTIVES Glucose Elevating Drugs Antivirals Angiotensin II Receptor Class III Narcotics Antagonists + HCT Combos Growth Hormones
hydrocodone/acetaminophen FINACEA, FINACEA PLUS
losartan/hydrochlorothiazide Other Cardiovascular Drugs CNS Stimulants Cephalosporins Antipsoriasis & Antieczema Incretin Mimetics Anti-Arrhythmic Drugs Drugs AUTONOMIC & CNS MEDICATIONS Macrolides Beta-Adrenergic Insulins Antagonists Corticosteroid Drugs Anticonvulsants Oral Antifungals Drugs to Prevent & Treat Headaches Penicillins Miscellaneous Insulin Sensitizers Dermatologicals Oral Hypoglycemics Quinolones Tetracyclines Calcium Antagonists Antidementia Drugs
PRAMOSONE, PRAMOSONE E metformin ext-release
Sodium-Glucose Co- Antidepressants Drugs to Treat Multiple Transporter 2 Inhibitors Sclerosis Topical Anti-Inflammatory Topical Antibacterials Diuretics Drugs Thyroid Supplements Topical Antifungals EAR-NOSE MEDICATIONS Other Endocrine Drugs
REBIF, REBIF REBIDOSE [INJ] Drugs Affecting The Ear Endothelin Receptor Non-Narcotic Analgesics Urinary Antiinfectives Antagonists Antiparkinson Drugs Other Antiinfective Drugs Sedative/Hypnotics Drugs Affecting The Nose HMG-CoA Reductase GASTROINTESTINAL Inhibitors MEDICATIONS Antipsychotic Drugs Selective Serotonin Antispasmodics/Drugs Reuptake Inhibitors Affecting GI Motility ANTINEOPLASTIC/IMMUNO- ENDOCRINE MEDICATIONS HMG-CoA Combinations SUPPRESSANT DRUGS H. Pylori Drugs Amylin Analogues Proton Pump Inhibitors Antivertigo & Antiemetics Hypolipoproteinemics Androgen Drugs Tertiary Amines Other GI Drugs Other Autonomic/CNS Drugs Dipeptidyl Peptidase-IV Anxiolytics Inhibitors & Combos CARDIOVASCULAR Other Drugs For ADHD MEDICATIONS Nitrates Class II Narcotics ACE Inhibitors + DERMATOLOGICAL Glucocorticoids HCT Combos MEDICATIONS Other Antihypertensives
morphine sulfate ext-release Antiacne Drugs 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 website at www.express-scripts.com. 2014 Express Scripts Holding Company #2053 BASIC-T All Rights Reserved PRMT2053T-14 (09/04/13) RESPIRATORY MEDICATIONS Examples of Nonformulary Medications With Selected Formulary Alternatives
The following is a list of some nonformulary brand-name medications with examples of selected
Antihistamines
alternatives that are on the formulary. Column 1 lists examples of nonformulary medications.
Column 2 lists some alternatives that can be prescribed. Estrogen Drugs Nonformulary Medications Formulary Alternative(s) IMMUNOLOGICALS
Freestyle meters/strips, OneTouch meters/strips
Antihistamine/Antitussives Erythroid Stimulants Interferons Estrogen/Progestin Antitussive & Expectorants
morphine sulfate ext-release, oxymorphone ext-release, Nucynta ER,
Combinations
flunisolide, fluticasone, triamcinolone acetonide, Nasonex, Qnasl
MUSCULOSKELETAL Beta-2 Adrenergics MEDICATIONS CNS Muscle Relaxants Ovulatory Stimulants
Freestyle meters/strips, OneTouch meters/strips
candesartan/hydrochlorothiazide, irbesartan/hydrochlorothiazide,
Prenatal Vitamins Leukotriene Modifiers Drugs to Prevent & Treat
losartan/hydrochlorothiazide, valsartan/hydrochlorothiazide,
Gout Other Drugs For Asthma
morphine sulfate ext-release, oxymorphone ext-release, Nucynta ER,
Progestin Drugs Injectable Drugs For Arthritis Non-Steroidal Anti- Inflammatory Agents Specialized OB/GYN Drugs
morphine sulfate ext-release, oxymorphone ext-release, Nucynta ER,
Vaginal Antiinfectives UROLOGICAL MEDICATIONS Anticholinergic
candesartan/hydrochlorothiazide, irbesartan/hydrochlorothiazide,
Other OB/GYN Products Antispasmodics
losartan/hydrochlorothiazide, valsartan/hydrochlorothiazide,
OPHTHALMIC MEDICATIONS NUTRITION & BLOOD Antibacterial Drugs MODIFIERS Antiplatelet Drugs Drugs Used For BPH
flunisolide, fluticasone, triamcinolone acetonide, Nasonex, Qnasl
Erectile Dysfunction Agents Blood Detoxicants
flunisolide, fluticasone, triamcinolone acetonide, Nasonex, Qnasl
Oral and Inj. Anticoagulants Antiglaucoma Drugs DIABETIC SUPPLIES
candesartan/hydrochlorothiazide, irbesartan/hydrochlorothiazide,
Therapeutic Vitamins &
losartan/hydrochlorothiazide, valsartan/hydrochlorothiazide,
Minerals Meters & Strips Corticosteroid Drugs
Freestyle meters/strips, OneTouch meters/strips
flunisolide, fluticasone, triamcinolone acetonide, Nasonex, Qnasl
Other Ophthalmic Drugs Thrombin Inhibitors
flunisolide, fluticasone, triamcinolone acetonide, Nasonex, Qnasl
latanoprost, travoprost, Lumigan, Travatan Z
OBSTETRICAL & GYNECOLOGICAL MEDICATIONS
The symbol [INJ] next to a drug name indicates that the drug is available in injectable form only. For the member: Generic medications contain the same active ingredients as their corresponding Contraceptives Miscellaneous Supplies
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 preferred products and allow generic substitutions when
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 website at www.express-scripts.com. 2014 Express Scripts Holding Company #2053 BASIC-T All Rights Reserved PRMT2053T-14 (09/04/13)
74 Prince, A.M. et al. (1992) J. Infect. Dis. 165, 438–443 78 Laskus, T. et al. (1996) Virology 220, 171–176 75 Farci, P. et al. (1992) Science 258, 135–140 79 Cane, E.J. et al. (1996) New Engl. J. Med. 334, 815–820 76 Martell, M. et al. (1994) J. Virol. 68, 3425–3436 80 Okamoto, H. et al. (1994) Hepatology 20, 1131–1136 77 Gretch, D.R. et a
Martin Ross, M.D. Tara Nelson, N.D. The Healing Arts Partnership 4744 41st Ave. S.W., Ste. 102; Seattle, WA 98116 Name _______________________________________________________ Date _______________________ E-mail __________________________________ Home Phone (____)_______________________________ Cell Phone (____) _________________________Work Phone (____) ______________________________