| Anti-infectives |
| Antifungals |
griseofulvin
ketoconazole
terbinafine (PA) |
Antivirals |
Step 1:
acyclovir
famciclovir
Step 2:
VALTREX
(requires use of famciclovir)
TAMILFLU (QL) |
| Cephalosporins |
cefdinir
cefprozil
cefuroxime
cephradine |
Erythromycins/macrolides |
azithromycin
clarithromycin
clindamycin
erythromycin |
| Fluoroquinolones |
ciprofloxacin
ofloxacin
AVELOX
LEVAQUIN |
Penicillins |
amoxicillin
amoxicillin/clavulannate
ampicillin
dicloxacillin
penicillin VK |
Tetracyclines
|
doxycycline
minocycline
tetracycline
|
|
|
| Cardiovascular agents |
| ACE inhibitors/ARBS |
Step therapy requires step 1 drug before step 2 drug
1st line:
captopril and captopril/HCTZ
enalapril and enalapril/HCTZ
lisinopril and lisinopril /HCTZ
2nd line:
COZAAR/HYZAAR
DIOVAN/DIOVAN HCT
AVAPRO/AVALIDE |
Beta blockers |
atenolol
metoprolol/metoprolol ER
propranolol |
| Calcium channel blockers |
amlodipine/ amlodipine-benazepril
diltiazem
felodipine
nifedipine ER
verapamil |
Cholesterol-lowering (statins) |
Step therapy requires two step-1 drugs before step 2 drug
Step 1:
lovastatin
pravastatin
simvastatin
Step 2 (available by PA; 1st line if >40% reduction in LDL required):
CRESTOR
VYTORIN |
| Diuretics |
furosemide
hydrochlorothiazide
triamterene/HCTZ |
|
|
| Central nervous system agents |
| Antidepressants (SSRI/SNRI) |
Step therapy requires step 1 drug before step 2 drug
Step 1:
citalopram
fluoxetine
paroxetine
sertraline
Step 2:
EFFEXOR XR
CYMBALTA
LEXAPRO
|
Antidepressants, misc. |
bupropion
mirtazapine
venlafaxine |
| ADD/ADHD |
amphetamine salts
methylphenidate
ADDERALL XR
CONCERTA |
Migraine |
IMITREX (QL)
MAXALT/MAXALT MLT (QL)
(Step therapy requires IMITREX before MAXALT/MAXALT MLT) |
| NSAIDS |
diclofenac
ibuprofen
meloxicam
nabumetone
naproxen
CELEBREX (PA) |
Sedative hypnotics |
temazepam
Step therapy requires 1st line drug before 2nd
line drug
Step 1:
zolpidem
Step 2:
AMBIEN CR
LUNESTA
SONATA |
| Dermatologic agents |
| Acne |
benzoyl peroxide
clindamycin
tretinoin
DIFFERIN |
Misc. topicals |
DOVONEX
ELIDEL
PROTOPIC |
| Endocrine/metabolic agents |
Diabetic (oral)
|
glipizide
glyburide
metformin
ACTOS
AVANDIA
BYETTA (requires also using 2 oral diabetes drugs)
JANUVIA (requires concurrent use of metformin, 1500mg daily)
|
Diabetic (insulin) |
HUMULIN/HUMALOG
LANTUS
LEVEMIR
NOVOLIN/NOVOLOG |
| Diabetic test strips |
ACCU-CHEK
ONE TOUCH |
Estrogens (oral) |
estradiol
PREMARIN
PREMPRO |
| Estrogens (patch) |
estradiol
CLIMARA
ESTRADERM
VIVELLE/VIVELLE-DOT |
|
|
| Gastrointestinal agents |
H2 receptor antagonist
|
ranitidine
cimetidine |
Proton pump inhibitors (PPIs) |
Step therapy requires steps 1 and 2 drugs before step 3 and step 3 before step 4 drug
Step 1 and 2:
pantoprazole
Prilosec OTC/omeprazole
Step 3:
ACIPHEX
Step 4:
PREVACID SOLUTAB |
Misc. GI/GU
|
oxybutynin/oxybutynin ER
ENABLEX
VESICARE
PEG 3350 (generic MIRALAX)
AMITIZA (PA)
ondansetron (QL: 20 tabs per 30 days)
granisetron (QL: 20 tabs per 30 days) |
|
|
| Ophthalmic agents |
| Allergy |
cromolyn
Step therapy requires step 1 drug before step 2 drug
Step 1:
Zaditor OTC
Step 2:
PATANOL
OPTIVAR |
Glaucoma |
timolol/timolol XE
AZOPT
BETIMOL
TRUSOPT
XALATAN |
| Miscellaneous |
ciprofloxacin
ofloxacin
tobramycin |
|
|
Respiratory agents
|
| Antihistimines |
cetirizine
fexofenadine
loratadine
|
Steroids (inhaled) |
FLOVENT
PULMICORT
QVAR |
| Steroids (nasal) |
Step 1:
fluticasone
flunisolide
ASTELIN
TILADE
Step 2 (requires a trial of fluticasone or flunisolide):
NASACORT |
Miscellaneous |
ADVAIR
SEREVENT |
