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Schc formulary 2005

Table of Contents
Analgesics
Antipyretics 4
Skeletal
Relaxants
Inhibitors
Rheumatoid
Arthritis
Anesthetics
Triptans
Analgesics 7
Anti-Infectives
Antihelmintics
Miscellaneous
Antifungals
Penicillins
Antivirals
Quinolones
Cephalosporins
Sulfonamides
Macrolides
Tetracyclines
Cardiovascular
Inhibitors
Glycosides
Antianginals 16
Diuretics
Modifiers
ACE/Diuretic
Statins 18
Blockers
Fibrates
Blockers
Miscellaneous
Blockers
ACE/Statin Combinations
Dermatology
Antivirals
Antibiotics
Anorectal
Preparations
Emollients
Antifungals
Keratolytics 23
Anti-Inflammatory 22
Scabicides/Pediculicides
Antiseborrheics
Diabetes
Antidiabetics 24
Supplies
Insulin 25
Table of Contents
Endocrine
Antigout
Corticosteroids
Vitamins/Electrolytes
Osteoporosis Agents
Antihistamines
OticsCough
Antihist/Decongest
Preparations 30
Antacids
Cathartics
Antidiarrheals
Antagonists
Antiemetics
ProtonPump
Inhibitors
Appetite
Stimulants
Protease
Inhibitors
Neurology
Anticonvulsants
Migraine
AntiParkinson Agents
Contraceptives
Progestins
Estrogens
Opthamology
Psychiatry
Antidepressants
Sedatives/Hypnotics 41
Psychotherapeutics 40
Pulmonary

Antiasthmatics
Inhalants
Enuresis/Incontinence
43 Erectile
Dysfunction 43
ANALGESICS
ANALGESICS
ANTIPYRETICS
Formulary 1) acetaminophen (Tylenol)
COX II INHIBITOR
LOCAL ANESTHETICS
ANALGESICS
ANALGESICS
TO PATIENT
NSAIDS (NONSTEROIDAL ANTI-
Formulary
INFLAMMATORY DRUGS)
Analgesics
ANALGESICS
TO PATIENT
Formulary (Vicodin)
Analgesics
ANALGESICS
TO PATIENT
RHEUMATOID
ARTHRITIS
Formulary
SKELETAL MUSCLE
RELAXANTS
TRIPTANS
URINARY ANALGESICS
Antibiotics
ANTI-INFECTIVES
TO PATIENT
ANTIFUNGALS
Formulary 100,000
ANTIHELMENTIC
Antibiotics
ANTI-INFECTIVES
TO PATIENT
ANTIVIRALS
Formulary
CEPHALOSPORINS
1st Generation
2nd Generation
Antibiotics
ANTI-INFECTIVES
TO PATIENT
MACROLIDES
Formulary
MISCELLANEOUS
Antibiotics
ANTI-INFECTIVES
TO PATIENT
PENICILLINS
Formulary
500mg 20 – 12.00 875mg 20 – 14.19 Augmentin Antibiotics
ANTI-INFECTIVES
TO PATIENT
QUINOLONES
Formulary 500mg 20 – 5.95
SULFONAMIDES
TETRACYCLINES
Cardiovascular
ANTIHYPERLIPIDEMIC AGENTS
TO PATIENT
ACE INHIBITORS
Formulary
Cardiovascular
BLOOD MODIFIERS
TO PATIENT
DIURETICS
Formulary
COMBINATION
ACE/DIURETIC
Cardiovascular
ANTIHYPERTENSIVES
Centrally Acting
FORMULARY
Antiadrenergic Agents
ANTIADRENERGIC AGENTS
- ALPHA 1 BLOCKERS
BETA BLOCKERS
- NONSPECIFIC
BETA AND ALPHA 1
BLOCKERS
BETA BLOCKERS -
CARDIOSELECTIVE
Cardiovascular
ANTIHYPERTENSIVES
CALCIUM CHANNEL BLOCKERS
Formulary
CARDIAC GLYCOSIDES
ANTIANGINAL AGENTS
Cardiovascular
ANTIHYPERTENSIVES
BLOOD MODIFIERS
Formulary
Cardiovascular
ANTIHYPERTENSIVES
TO PATIENT
Formulary 10mg
FIBRATES
MISCELLANEOUS
COMBINATION
CALCIUM CHANNEL BLOCKER/
5/10mg 30 – 101.39/$6.00 5/20mg 30 – 104.35/$6.00 5/40mg 30 – 104.35/$6.00 5/80mg 30 – 104.35/$6.00 DENTAL PRODUCTS
TO PATIENT
1) chlorhexidine gluconate (Peridex) 16oz – 7.79 Formulary
DERMATOLOGY
ACNE PREPARATIONS
TO PATIENT
TOPICALS
FORMULARY 1) benzoyl peroxide Gel
ANTIBIOTICS
Dermatology
DERMATOLOGY
TO PATIENT
ANORECTAL
PREPARATIONS
Formulary
ANTIFUNGALS
Dermatology
DERMATOLOGY
TO PATIENT
ANTI-INFLAMMATORY
Formulary
ANTISEBORRHEICS
ANTIVIRAL
DIAPER RASH
EMOLLIENTS/VEHICLS
Dermatology
DERMATOLOGY
TO PATIENT
KERATOLYTICS
Formulary
SCABICIDES/PEDICULICIDES
VAGINAL PREPARATIONS
Diabetes
ANTIDIABETIC AGENTS
TO PATIENT
BIGUANIDES
Formulary
SULFONYLUREAS
GLITAZONES
COMBINATIONS
1) glyburide/metformin (Glucovance) 2.5/500mg Diabetes
DIABETES
TO PATIENT
Formulary
DIABETIC SUPPLIES
7) NovoFine- 30 disposable needles 100 – 40.59 Endocrine
ENDOCRINE
TO PATIENT
ANTIGOUT
Formulary
CORTICOSTEROIDS
OSTEOPOROSIS
Endocrine
VITAMINS/ELECTROLYTES
TO PATIENT
Formulary
ANTIHISTAMINES
TO PATIENT
Formulary
3) meclizine (Antivert) 12.5, 25mg 30 – 6.59 ANTIHISTAMINE/
DECONGESTANT
COMBINATIONS
TO PATIENT
Formulary
1) A/B Otic Drops (Allergen) soln 15ml – 6.85 COUGH PREPARATIONS
TO PATIENT
Formulary
TO PATIENT
ANTACIDS
Formulary
ANTIDIARRHEALS
TO PATIENT
ANTIEMETICS
Formulary 12.5,
CATHARTICS
4) Vegetable Laxative Powder (psyllium 283g – 6.55 hydrophilic mucilloid) TO PATIENT
H2 ANTAGONISTS
Formulary
MISCELLANEOUS
PROTON PUMP INHIBITORS
HIV MEDICATIONS
TO PATIENT
APPETITE STIMULANTS
FORMULARY 1) Marinol (dronabinol) 5mg
NUCLEOSIDE REVERSE
TRANSCRIPTASE INHIBITORS
NON-NUCLEOSIDE
REVERSE TRANSCRIPTASE
INHIBITORS
PROTEASE INHIBITORS
625mg 60 – 357.69 3) Lexiva (fosamprenavir) Neur ology
ANTICONVULSANTS
COST
TO PATIENT

Formulary
30mg 90 – 28.25 100mg 90 – 20.95 50mg 300mg 90 – 14.55 400mg 90 – 12.95 9) Lyrica (Pregabalin) NEUROLOGY
NEUROLOGY
TO PATIENT
ANTIPARKINSONIAN AGENTS
Formulary
MIGRAINE MEDICATIONS
CONTRACEPTIVES
TO PATIENT
Formulary
ESTROGENS
PROGESTINS
OPHTHALMOLOGY
OPHTHALMICS
TO PATIENT
Formulary
6) sulfacetamide opth (Sodium Sula- myd) Psychiatry
ANTIDEPRESSANTS
TO PATIENT
Formulary
10mg 30 – 10.05 20mg 30 – 7.95 40mg 25mg 30 – 6.19 50mg 30 – 6.55 75mg 30 – 6.85 100mg 30 – 6.88 75mg 30 – 71.95 150mg 30 – 78.29 2) Cymbalta (Duloxetine) Psychiatry
ANTIPSYCHOTICS
TO PATIENT
Formulary
PSYCHOTHERAPEUTICS
15mg 30 – 79.95 20mg 30 – 77.75 25mg 30 – 78.59 30mg 30 – 77.75 PSYCHIATRY
SEDATIVE/HYPNOTIC
TO PATIENT
BENZODIAZEPINES
Formulary
MISCELLANEOUS
NONBENZODIAZEPINE
HYPNOTICS
PULMONARY
COST
TO PATIENT

ANTIASTHMATICS
Formulary
RESPIRATORY AGENTS
INHALANTS
4) Combivent (ipratropium/albuterol) MDI 6) ipratropium bromide 2.5ml vial 25 vials – 15.75 UROGENITAL
TO PATIENT
Incontinence/Enuresis
Formulary
Erectile Dysfunction
Advair 42 BuSpar 41 Aerochamber 42 Buspirone Amitriptyline 39 Carisoprodol 7 Amoxicillin Imitrex 7 Lyrica 35 Indomethacin 5 Imdur

Source: http://www.midwestclinicians.org/sharedchcpolicies/Pharmacy/340B/SCHC%20Formulary%202005.pdf

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