Preferred drug quick reference list

These drugs are generally approved for all PriorityHMO^SM, PriorityEPO^SM, PriorityPOS^SM, PriorityPPO^SM plans when the employer has purchased the prescription drug benefit. Listing on this chart does not guarantee coverage.

Jump down the page to:
Anti-infectives
Cardiovascular agents
Central nervous system agents
Dermatologic agents
Endocrine/metabolic agents
Gastrointestinal agents
Ophthalmic agents
Respiratory agents

Key
UPPERCASE names = brand name drugs
lower case names = generic drugs
Initial capitals = OTC drugs (Prilosec OTC, for example)
QL = Quantity limit applies (see notes)
PA = Prior authorization is required; form is available in the Drug PA forms section

Anti-infectives
Therapeutic class	Drug name	Therapeutic class	Drug name
Antifungals:	griseofulvin ketoconazole terbinafine	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
Therapeutic class	Drug name	Therapeutic class	Drug name
ACE inhibitors/ARBS:	Step 1: captopril and captopril/HCTZ enalapril and enalapril/HCTZ lisinopril and lisinopril /HCTZ ramipril  Step 2: COZAAR/HYZAAR DIOVAN/DIOVAN HCT AVAPRO/AVALIDE Step therapy requires step 1 drug before step 2 drug	Beta blockers:	atenolol metoprolol/metoprolol ER propranolol
Calcium channel blockers:	amlodipine/ amlodipine-benazepril diltiazem felodipine nifedipine ER verapamil	Cholesterol-lowering (statins):	lovastatin pravastatin simvastatin CRESTOR
Diuretics:	furosemide hydrochlorothiazide triamterene/HCTZ
Central nervous system agents
Therapeutic class	Drug name	Therapeutic class	Drug name
Antidepressants (SSRI/SNRI):	Step 1: citalopram fluoxetine paroxetine sertraline Step 2: EFFEXOR XR CYMBALTA LEXAPRO Step therapy requires step 1 drug before step 2 drug	Antidepressants, misc.:	bupropion mirtazapine venlafaxine
ADD/ADHD:	amphetamine salts methylphenidate ADDERALL XR CONCERTA	Migraine:	sumatripan (QL) MAXALT/MAXALT MLT (QL) ZOMIG (QL) Step Therapy requires sumatripan before MAXALT/MAXALT MLT or ZOMIG
NSAIDS:	diclofenac ibuprofen meloxicam nabumetone naproxen CELEBREX (PA)	Sedative hypnotics:	temazepam Step 1: zolpidem zaleplon Step 2: AMBIEN CR LUNESTA Step therapy requires step 1 drug before step 2 drug
Dermatologic agents
Therapeutic class	Drug name	Therapeutic class	Drug name
Acne:	benzoyl peroxide clindamycin tretinoin DIFFERIN	Misc. topicals:	DOVONEX ELIDEL PROTOPIC
Endocrine/metabolic agents
Therapeutic class	Drug name	Therapeutic class	Drug name
Diabetic (oral):	glipizide glyburide metformin ACTOS AVANDIA BYETTA (requires concurrent use of metformin) JANUVIA (requires concurrent use of metformin)	Diabetic (insulin):	HUMULIN/HUMALOG LANTUS LEVEMIR NOVOLIN/NOVOLOG
Diabetic test strips:	ACCU-CHEK (tier 1 copay) ONE TOUCH (tier 1 copay)	Estrogens (oral):	estradiol PREMARIN PREMPRO
Estrogens (patch):	estradiol CLIMARA ESTRADERM VIVELLE/VIVELLE-DOT
Gastrointestinal agents
Therapeutic class	Drug name	Therapeutic class	Drug name
H2 receptor antagonist:	ranitidine cimetidine famotidine	Proton pump inhibitors (PPIs):	Step 1: pantoprazole Prilosec OTC/omeprazole Prevacid OTC/lansoprazole Step 2: ACIPHEX Step therapy requires all three step 1 drugs before step 2 drug
Misc. GI/GU:	oxybutynin/oxybutynin ER ENABLEX VESICARE ondansetron granisetron (QL: 20 tabs per 30 days)
Ophthalmic agents
Therapeutic class	Drug name	Therapeutic class	Drug name
Allergy:	cromolyn Step 1: Zaditor OTC Step 2: PATANOL OPTIVAR Step therapy requires step 1 drug before step 2 drug	Glaucoma:	dorzolamide timolol/timolol XE AZOPT XALATAN
Miscellaneous:	ciprofloxacin ofloxacin tobramycin VIGAMOX ZYMAR
Respiratory agents
Therapeutic class	Drug name	Therapeutic class	Drug name
Antihistimines:	cetirizine fexofenadine loratadine	Steroids (inhaled):	PULMICORT (tier 1 copay) QVAR (tier 1 copay) FLOVENT (tier 2 copay)
Steroids (nasal):	Step 1: fluticasone flunisolide ASTELIN TILADE Step 2: NASACORT RHINOCORT Step 2 drug requires a trial of fluticasone or flunisolide	Miscellaneous:	ADVAIR SEREVENT SYMBICORT