REACHOUT 2018 FORMULARY - daytonreachout.org · REACHOUT 2018 FORMULARY - Alpha List DRUG NAME...
Transcript of REACHOUT 2018 FORMULARY - daytonreachout.org · REACHOUT 2018 FORMULARY - Alpha List DRUG NAME...
REACHOUT 2018 FORMULARY - Alpha List
DRUG NAME
DOSAGE
FORM DRUG TYPE ALT NAME
Acetaminophen 325 mg (MaPap, Q-Pap) Tablet Analgesic Tylenol
Acyclovir 400 mg Tablet Antiviral Zovirax
Advair Diskus 500mcg/50mcg *sample* Inhaler Respiratory
Fluticasone/
salmeterol
Alcaine 0.5% ophthalmic *sample* Solution Ophthalmic, anestheticProparacaine
Albuterol Soln for Nebulizer 0.083% Solution Respiratory
Allopurinol 300 mg Tablet Anti-Gout Zyloprim
Amitriptyline 10mg Tablet Antidepressant Elavil
Amitriptyline 25 mg Tablet Antidepressant Elavil
Amitriptyline 50mg Tablet Antidepressant Elavil
Amitriptyline 150 mg Tablet Antidepressant Elavil
Amlodipine 2.5 mg Tablet Antihypertensive Norvasc
Amlodipine 5 mg Tablet Antihypertensive Norvasc
Amlodipine 10 mg Tablet Antihypertensive Norvasc
Amitiza 8mcg *sample* Capsule GI Agents Lubiprostone
Amitiza 24mcg *sample* Capsule GI Agents Lubiprostone
Amoxicillin 125 mg/5mL Suspension Anti-Infective Amoxil
Amoxicillin 250 mg Capsules Anti-infective Amoxil
Amoxicillin 250 mg/5mL Suspension Anti-Infective Amoxil
Amoxicillin 400mg/5mL Suspension Anti-infective Amoxil
Amoxicillin 500 mg Capsules Anti-Infective Amoxil
Amoxicillin 875 mg Tablet Anti-Infective Amoxil
Amoxicillin/Clavulanate 400mg/57mg /5ml Suspension Anti-Infective Augmentin
Amoxicillin/Clavulanate 500mg/125mg Tablet Anti-Infective Augmentin
Amoxicilin/Clavulanate 600mg/42.9mg/5ml Suspension Anti-infective Augmentin
Amoxicillin/Clavulanate 875mg/125mg Tablet Anti-Infective Augmentin
Anoro Ellipta *sample* Inhaler Respiratory
umeclindimium
/vilanterol
Antibiotic Ointment (Bacitracin) Ointment Anti-Infective, Topical (Bacitracin)
Antifungal Cream (Clotrimazole 1%) Cream Antifungal, topical Lotrimin
Apidra *sample* Vials Insulin Glulisine
Aricept 10 mg *sample* Tablet Anti-dementia Donepezil
Aripiprazole 2mg *sample* Tablet Antipsychotic Abilify
rev 2/20/2018Page 1
REACHOUT 2018 FORMULARY - Alpha List
DRUG NAME
DOSAGE
FORM DRUG TYPE ALT NAME
Aripiprazole 5mg *sample* Tablet Antipsychotic Abilify
Artificial Tears ophth ointment Ointment OTC
Artificial Tears solution Solution OTC
Asmanex HFA 100 mcg *sample* Inhaler Respiratory Mometasone
Asmanex HFA 200mcg *sample* Inhaler Respiratory Mometasone
Aspirin 325mg Tablet Analgesic
Aspirin 81mg chewable - clinic use only Tablet Analgesic
Aspirin 81mg Tablet Analgesic
Atenolol 25 mg Tablet Antihypertensive Tenormin
Atorvastatin 20 mg *sample* Tablet Cholesterol inhibitorLipitor
Atorvastatin 80mg Tablet Cholesterol inhibitorLipitor
Ayr saline nasal gel *sample* Gel Respiratory
Ayr saline nasal mist *sample* Mist Respiratory
Ayr saline nasal rinse kit *sample* Rinse Respiratory
Azithromycin 100mg/5ml Suspension Anti-infective Zithromax
Azithromycin 200mg/5ml Suspension Anti-infective Zithromax
Azithromycin 250mg Zpack Dose pack Anti-infective Zithromax
Azithromycin 250mg Tablet Anti-infective Zithromax
Azithromycin 500mg Tablet Anti-infective Zithromax
Baclofen 10mg *sample* Tablet Muscle relaxant Lioresal
Benzonatate 100 mg Capsules Cough Suppressants Tessalon Perles
Betamethasone valerate 0.1% *sample* Ointment Steroid, Topical Diprolene
Bisacodyl 5mg Tablet Laxative Ducolax
Boniva 150 mg *sample* Tablet Osteoporosis Ibandronate
Brilinta 60mg *sample* Tablet Antiplatelet agent Ticagrelor
Brilinta 90mg *sample* Tablet Antiplatelet agent Ticagrelor
Bumetanide 1mg Tablet Anti-infective Bumex
Bumetanide 2 mg Tablet Anti-infective Bumex
Bupropion SR 150mg *sample* Tablet Antidepressant Wellbutrin SR
Buspirone 10 mg Tablet Anxiolytics Buspar
Bydureon 2mg pen Pens Antidiabetic, GLP-1 agonistExenatide
Bystolic 20 mg *sample* Tablet Beta Blocker Nebivolol
Bystolic 10 mg *sample* Tablet Beta Blocker Nebivolol
rev 2/20/2018Page 2
REACHOUT 2018 FORMULARY - Alpha List
DRUG NAME
DOSAGE
FORM DRUG TYPE ALT NAME
Bystolic 5 mg *sample* Tablet Beta Blocker Nebivolol
Calamine Lotion Lotion Topical
Carbamazeprine 200 mg Tablet Anticonvulsant Tegretol
Carvedilol 3.125mg *sample* Tablet Beta Blocker Coreg
Carvedilol 6.25 mg Tablet Beta Blocker Coreg
Carvedilol 12.5 mg Tablet Beta Blocker Coreg
Carvedilol 25 mg Tablet Beta Blocker Coreg
Cefdinir 125mg/5ml Suspension Anti-infective Omnicef
Cefdinir 250mg/5ml Suspension Anti-infective Omnicef
Ceftriaxone 250mg injectable Injectable Anti-infective Rocephin
Ceftriaxone 500mg injectable Injectable Anti-infective Rocephin
Celebrex 100mg Capsule NSAID Celecoxib
Celecoxib 200mg Capsule NSAID Celebrex
Cephalexin 250 mg Capsules Anti-infective Keflex
Cephalexin 500 mg Capsules Anti-infective Keflex
Cetirizine 10mg (All Day Allergy) Tablet Antihistimane Zyrtec
Chlorthalidone 25 mg Tablet Diuretic Hygroton
Ciprofloxacin 0.3% opth solution Solution Anti-Infective, TopicalCiloxan
Ciprofloxacin 250 mg Tablet Anti-infective Cipro
Ciprofloxacin 500 mg Tablet Anti-infective Cipro
Citalopram 20 mg Tablet Anti-depressant Celexa
Citalopram 40 mg Tablet Anti-depressant Celexa
Clindamycin 150 mg Capsules Anti-infective Cleocin
Clindamycin/tretinoin 1.2%/0.025% *sample* Gel Topical Ziana
Clonidine 0.1 mg Tablet Antihypertensive Catapres
Clonidine 0.2 mg Tablet Antihypertensive Catapres
Clopidogrel 75mg Tablet Antiplatelet Plavix
Clotrimazole 1% Cream Antifungal, Topical Lotrimin
Clotrimazole & Betamethasone *samp* Cream Antifungal, Topical Lotrisone
Combivent Respimat *sample* Inhaler Respiratory Iprat/Alb
Cyclobenzaprine 5 mg Tablet Muscle relaxant Flexeril
Cyclobenzaprine 10 mg Tablet Muscle relaxant Flexeril
Crestor 40 mg *sample* Tablet Cholesterol inhibitorRosuvastatin
rev 2/20/2018Page 3
REACHOUT 2018 FORMULARY - Alpha List
DRUG NAME
DOSAGE
FORM DRUG TYPE ALT NAME
Depo-Medrol 80mg/mL *sample* Injectable Steroid
Methylprednisol
one
Depo-Provera Injectable Contraceptive
Medroxy-
progesterone
Diclofenac Gel 1% Gel Nsaid, Topical Voltaren
Dicyclomine 10 mg Capsules GI Agents Bentyl
Dicyclomine 20 mg Capsules GI Agents Bentyl
Digoxin 0.125 mg Tablet Cardiovascular Digox
Diltiazem 180 mg Capsules Calcium Channel BlockerCardizem
Diphenhydramine (Banophen) 12.5mg/5mL Syrup Antihistamine
Benadryl/
Banophen
Diphenhydramine (Banophen) 25 mg Tablet Antihistamine Benadryl
Dipyridamole 50 mg Tablet Antiplatelet Persantine
Divalproex DR 250mg Capsules Anti-Convulsant Depakote
Divalproex DR 500mg Capsules Anti-Convulsant Depakote
Docusate Sodium 100 mg Capsules Stool Softener Colace
Dulera 100mcg/5mcg *sample* Inhaler Respiratory
Mometasone/
formoterol
Dulera 200mcg/5mcg *sample* Inhaler Respiratory
Mometasone/
formoterol
Doxycycline 100 mg Capsules Anti-Infective Vibramycin
Duloxetine 30mg Capsules Anti-Depressant Cymbalta
Duloxetine 60mg Capsules Anti-Depressant Cymbalta
Dutasteride 0.5mg *sample* Capsules BPH Avodart
Earwax Drops (Debrox) Solution OTC Debrox
Edarbi 80 mg *sample* Tablet Antihypertensive Azilsartan
Eliquis 2.5mg *sample* Tablet Anticoagulant Apixaban
Eliquis 5mg *sample* Tablet Anticoagulant Apixaban
Enalapril 10 mg Tablet Ace Inhibitor Vasotec
Enoxaparin 40mg/0.4 ml Injectable Anticoagulant Lovenox
Enoxaparin 80 mg/0.8 ml Injectable Anticoagulant Lovenox
Enoxaparin 100mg/1 ml Injectable Anticoagulant Lovenox
Enoxaparin 150mg/1 ml Injectable Anticoagulant Lovenox
rev 2/20/2018Page 4
REACHOUT 2018 FORMULARY - Alpha List
DRUG NAME
DOSAGE
FORM DRUG TYPE ALT NAME
Epi-Pen 0.15mg (pediatric) - clinic use only Syringe Antidote Epinephrine
Epi-Pen 0.3mg - clinic use only Syringe Antidote Epinephrine
Erythromycin Ophth 0.5% Ointment Anti-Infective, TopicalIlotycin
Escitalopram 10 mg *sample* Tablet Anti-depressant Lexapro
Escitalopram 20mg *sample* Tablet Anti-depressant Lexapro
Famotidine 20 mg Tablet GI Agents Pepcid
Farxiga 5mg *sample* Tablet Oral diabetic Agent Dapagliflozin
Farxiga 10mg *sample* Tablet Oral diabetic Agent Dapagliflozin
Fenofibrate 160mg Tablet Lipid Lowering AgentsTricor
Ferrous Sulfate 325 mg Tablet Vitamins/Minerals Iron
Flovent HFA 110mcg Inhaler Respiratory Fluticasone
Fluconazole 150 mg Tablet Antifungal Diflucan
Fluconazole 200 mg Tablet Antifungal Diflucan
Fluoxetine 10mg Capsules Anti-Depressant Prozac
Fluoxetine 20 mg Capsules Anti-Depressant Prozac
Fluticasone Propionate 50 mcg Nasal Spray Respiratory Flonase
Folic Acid 1 mg Tablet Vitamins/Minerals Vitamin B
Furosemide 20 mg Tablet Diuretic Lasix
Furosemide 40 mg Tablet Diuretic Lasix
Gemfibrozil 600 mg Tablet Lipid Lowering AgentsLopid
Gentamicin Sulfate Ophth 0.3% Solution Anti-Infective, TopicalGentak
Glimepiride 4mg Tablet Oral Diabetic AgentsAmaryl
Glipizide 10 mg Tablet Oral Diabetic AgentsGlucotrol
Glipizide 5 mg Tablet Oral Diabetic AgentsGlucotrol
Glyburide 5 mg Tablet Oral Diabetic AgentsMicronase
Griseofulvin 125mg/5ml Suspension Anti-Infective Gris-Peg
Hemorrhoidal Ointment Ointment OTC Prep-H
Humalog Vials Insulin Lispro
Humalog KwikPens 100units/ml Pens Insulin Lispro
Humalog KwikPens 200units/ml *samp* Pens Insulin Lispro
Humalog Mix 75/25 Vials Insulin Lispro
Humulin 70/30 Vials Insulin NPH/Regular
Humulin N Vials Insulin Insulin NPH
rev 2/20/2018Page 5
REACHOUT 2018 FORMULARY - Alpha List
DRUG NAME
DOSAGE
FORM DRUG TYPE ALT NAME
Humulin R Vials Insulin Insulin Regular
Hydralazine 10 mg Tablet Cardiovascular Apresoline
Hydralazine 25 mg Tablet Cardiovascular Apresoline
Hydralazine 50 mg Tablet Cardiovascular Apresoline
Hydralazine 100 mg Tablet Cardiovascular Apresoline
Hydrochlorothiazide 12.5 mg Tablet Diuretic Microzide
Hydrochlorothiazide 25 mg Tablet Diuretic Microzide
Hydrocortisone 1% Ointment Ointment Steroid, Topical Cortizone
Hydrocortisone 1% Cream Cream Steroid, Topical Cortizone
Hydrocortisone 1% Lotion Lotion Steroid, Topical Cortizone
Hydrocortisone 2.5 % Ointment Ointment Steroid, Topical Cortizone
Hydrocortisone 2.5% Cream Cream Steroid, Topical Cortizone
Hydrocortisone 2.5% Lotion Lotion Steroid, Topical Cortizone
Hydroxychloroquine 200mg Tablet Anti-malaria Plaquenil
Hydroxyzine HCL 25 mg Tablet Antihistamine Atarax
Hydroxyzine Pamoate 25 mg Capsules Antihistamine Vistaril
Hydroxyzine Pamoate 50 mg Capsules Antihistamine Vistaril
Ibuprofen Children's Oral Susp 100/5 *sam Suspension NSAID Motrin
Ibuprofen 200 mg Tablet NSAID Motrin
Ibuprofen 400 mg Tablet NSAID Motrin
Ibuprofen 600 mg Tablet NSAID Motrin
Ibuprofen 800 mg Tablet NSAID Motrin
Indomethacin 25 mg Capsules Anti-Gout Indocin
Indomethacin 50mg Capsules Anti-Gout Indocin
Invokamet XR 50/500 mg *sample* Tablet Oral-Diabetic AgentsCana+Met
Invokamet XR 50/1000 mg *sample* Tablet Oral-Diabetic AgentsCana+Met
Invokamet XR 150/500 mg *sample* Tablet Oral-Diabetic AgentsCana+Met
Invokamet XR 150/1000 mg *sample* Tablet Oral-Diabetic AgentsCana+Met
Ipratropium & Albuterol Soln Nebulizer Vials Respiratory Duo-Neb
Ipratropium 0.02% Soln Nebulizer Vials Respiratory
Isoniazid 300mg Tablets Anti-Tubercular AgentLaniazid
Isosorbide Mononitrate ER 30 mg Tablet Cardiovascular Imdur
rev 2/20/2018Page 6
REACHOUT 2018 FORMULARY - Alpha List
DRUG NAME
DOSAGE
FORM DRUG TYPE ALT NAME
Janumet 50/500 *sample* Tablet Oral Diabetic AgentsSit+ Metformin
Janumet 50/1000 *sample* Tablet Oral Diabetic AgentsSit+ Metformin
Janumet XR 50/1000 *sample* Tablet Oral Diabetic AgentsSit+ Metformin
Janumet XR 100/1000 *sample* Tablet Oral Diabetic AgentsSit+ Metformin
Januvia 100 mg *sample* Tablet Oral Diabetic AgentsSitagliptin
Jentadueto 2.5/1000 mg *sample* Tablet Oral-Diabetic AgentsLin+Metformin
Jentadueto 5/1000 XR mg tab *sample* Tablet Oral-Diabetic AgentsLin+Metformin
Ketoconazole 2% Cream Cream Antifungal, Topical Xolegel
Ketoconazole 2% Shampoo Solution Antifungal, Topical
Ketotifen 2% ophthalmic (Eye itch relief) Solution Topical Zaditor
Lactulose Soln Syrup GI Agents Enulose
Lamotrigine 25mg *sample* Tablet Anti-Convulsant Lamictal
Lamotrigine 100mg *sample* Tablet Anti-Convulsant Lamictal
Lamotrigine 150mg *sample* Tablet Anti-Convulsant Lamictal
Lantus Vials Insulin Glargine
Lantus Solostar Pens Insulin Glargine
Latuda 20mg *sample* Tablet Antipsychotic
Levemir *sample* Vials Insulin
Levemir Flextouch *sample* Pens Insulin
Levetiracetam 500mg (Keppra) Tablets Anti-Convulsant Keppra
Levofloxacin 500 Tablet Anti-infective Levaquin
Levofloxacin 750 Tablet Anti-infective Levaquin
Levothyroxine 100 mcg Tablet Thyroid Synthroid
Lice Killing Shampoo Kit Solution Anti-parasitic
Lidocaine Patches 5% Patches Analgesic Lidoderm
Lidocaine 20mg/2 mL inj Injectable Analgesic
Lidocaine/prilocaine 2.5%/2.5% - clinic use only Cream Analgesic
Linezolid 600mg Tablet Anti-infective Zyvox
Linzess 72mcg *sample* Capsule GI Agents
Linzess 145mcg *sample* Capsule GI Agents
Linzess 290mcg *sample* Capsule GI Agents
Lisinopril 2.5 mg Tablet ACE Inhibitor Zestril
Lisinopril 5 mg Tablet ACE Inhibitor Zestril
rev 2/20/2018Page 7
REACHOUT 2018 FORMULARY - Alpha List
DRUG NAME
DOSAGE
FORM DRUG TYPE ALT NAME
Lisinopril 10 mg Tablet ACE Inhibitor Zestril
Lisinopril 20 mg Tablet ACE Inhibitor Zestril
Lisinopril 40 mg Tablet ACE Inhibitor Zestril
Loperamide 2mg Tablet AntiDiarrheal Imodium
Loratadine 10 mg Tablet Antihistamine Claritin
Loratadine Children's Liquid Syrup Antihistamine Claritin
Losartan K 50 mg Tablet Antihypertensive Cozaar
Losartan K 100 mg Tablet Antihypertensive Cozaar
Lovastatin 20 mg Tablet Cholesterol inhibitorMevacor
Lovastatin 40 mg Tablet Cholesterol inhibitorMevacor
Magnesium Citrate 296 Ml Solution Laxative
Maztim LA 420mg *sample* Tablet Calcium Channel BlockerDiltiazem ER
Meclizine 12.5 mg Tablet Antihistamine Antivert
Meclizine 25mg tablet Antihistamine Antivert
Medroxyprogesterone 10 mg Tablet Hormone Provera
Meloxicam 7.5mg Tablet Nsaid Mobic
Metformin 500 mg Tablet Oral Diabetic AgentsGlucophage
Metformin 850 mg *sample* Tablet Oral Diabetic AgentsGlucophage
Metformin 1000 mg Tablet Oral Diabetic AgentsGlucophage
Methimazole 10mg Tablet Thyroid Tapazole
Methocarbamol 500mg Tablet muscle relaxant Robaxin
Methylprednisolone 4 mg Dose Pak Steroid Medrol
Metoclopramide 10 mg Tablet GI Agents Reglan
Metoprolol succinate 50mg*sample* Tablet Beta Blocker Toprol XL
Metoprolol succinate 100mg *sample* Tablet Beta Blocker Toprol XL
Metoprolol Tartrate 25 mg Tablet Beta Blocker Lopressor
Metoprolol Tartrate 50 mg Tablet Beta Blocker Lopressor
Metoprolol Tartrate 100mg Tablet Beta Blocker Lopressor
Metronidazole 250 mg Tablet Anti-Infective Flagyl
Metronidazole 500 mg Tablet Anti-Infective Flagyl
Minocycline 50mg Tablet Anti-Infective Solodyn
Minocycline 100mg Tablet Anti-Infective Solodyn
Minoxidil 10 mg Tablet Antihypertensive
rev 2/20/2018Page 8
REACHOUT 2018 FORMULARY - Alpha List
DRUG NAME
DOSAGE
FORM DRUG TYPE ALT NAME
Mobisyl pain relieving cream Cream OTC Trolamine
Montelukast 10mg Tablet Respiratory Singulair
Mucinex ER 600mg Tablet OTC Guaifenesin
Mucus Relief DM Tablet OTC
Guaifenesin/
dextromethorph
an
Thera M multivitamin Tablet Vitamins/Minerals Multivitamins
Mupirocin 2% topical Ointment Anti-Infective, TopicalBactroban
Naproxen 500 mg Tablet NSAID Naprosyn
Narcan 4mg - clinic use only Nasal Spray Opioid antagonist
Neomycin & Polymyxin B Sulfate Otic Solution Anti-Infective, TopicalCortisporin
Neomycin & Polymyxin B Sulfate Otic Suspension Anti-Infective, TopicalCortisporin
Nesina 25mg *sample* Tablet Oral Diabetic AgentsAlogliptin
Nifedipine XL 30 mg Tablet Calcium Channel BlockerProcardia
Nitrofurantoin 100 mg (Macrobid) Capsules Anti-Infective Macrobid
Nitroglycerin 0.4 mg SL Tablet Cardiovascular Nitroglycerin
Nix Lice Killing Crème Rinse Suspension Anti-parasitic Permethrin
Norethindrone (Heather) Tablet Contraceptive Nora-Be
Novolin N -see Humulin N Vials Insulin NPH
Novolog * sample* or see Humalog Insulin Aspart
Nystatin Cream 100,000 units Cream Antifungal, topical Nyamyc
Nystatin Ointment 100,000 units Ointment Antifungal, topical Nyamyc
Nystatin Oral Susp Suspension Antifungal, oral Mycostatin
Nystatin Powder 100,000 units Powder Antifungal, topical Nyamyc
Omeprazole 20mg Capsules GI Agents Prilosec
Ondansetron 4mg Tablet anti-emetic Zofran
Ondansetron 4mg odt Tablet anti-emetic Zofran
Oxybutynin CL 5 mg Tablet Urinary Tract DisorderDitropan
Pantoprazole 20mg Tablet GI Agents Protonix
Pantoprazole 40mg Tablet GI Agents Protonix
Penicillin VK 250 mg Tablet Anti-infective
Penicillin VK 500 mg Tablet Anti-infective
Penicillin VK 125mg/5mL Solution Anti-infective
rev 2/20/2018Page 9
REACHOUT 2018 FORMULARY - Alpha List
DRUG NAME
DOSAGE
FORM DRUG TYPE ALT NAME
Penicillin VK 250mg/5mL Solution Anti-infective
Permethrin 5% Cream Anti-parasitic Elimite
Phenazopyridine 100 mg Tablet Urinary Tract DisorderPyridium
Phenazopyridine 200 mg Tablet Urinary Tract DisorderPyridium
Phenytoin Sodium ER 100 mg Capsules Anti-Convulsant Dilantin
Polymixin B & Trimethoprim Ophth Solution Anti-Infective, Topical
Polyethylene Glycol 3350 Powder Powder Laxative Miralax
Potassium Chloride ER 10 mEQ Tablet Cardiovascular
Potassium Chloride ER 20 mEQ Tablet Cardiovascular
Prazosin 1mg *sample* Capsule Antihypertensive Minipress
Prednisolone Oral Solution 15 mg / 5 ml Suspension Steroid Prelone
Prednisone Oral Solution 5mg/5ML Suspension Steroid
Prednisone
Intensol
Prednisone 5 mg Tablet Steroid Deltasone
Prednisone 10 mg Tablet Steroid Deltasone
Prednisone 20 mg Tablet Steroid Deltasone
Proctozone HC Rectal Cream Cream Steroid, Topical Hydrocortisone
Promethazine 25 mg Tablet anti-emetic Phenergan
Promethazine 6.25 Syrup Syrup anti-emetic Phenergan
Propranolol 10 mg Tablet Beta Blocker Inderal
Propranolol 20 mg Tablet Beta Blocker Inderal
Propranolol 80mg Tablet Beta Blocker Inderal
Propranolol ER 60 mg Capsules Beta Blocker Inderal
Quetiapine Fumarate 25mg *sample* Tablet Antipsychotic Seroquel
Quetiapine Fumarate 100mg *sample* Tablet Antipsychotic Seroquel
Quetiapine Fumarate 300mg *sample* Tablet Antipsychotic Seroquel
Ranitidine 150 mg Tablet GI Agents Zantac
Ranitidine 300 mg Tablet GI Agents Zantac
Rhinocort Allergy Spray *sample* Nasal Spray Respiratory Budesonide
Risendronate 150 mg *sample* Tablet Osteoporosis Actonel
Risperidone 1 mg *sample* Tablet Antipsychotic Risperdal
Risperidone 2 mg *sample* Tablet Antipsychotic Risperdal
Risperidone 4 mg *sample* Tablet Antispychotic Risperdal
rev 2/20/2018Page 10
REACHOUT 2018 FORMULARY - Alpha List
DRUG NAME
DOSAGE
FORM DRUG TYPE ALT NAME
Robitussin DM Syrup Syrup Cough Suppressants Robafen DM
Robitussin Plain Syrup Syrup Cough Suppressants Robafen
Rosuvastatin 10mg Tablet Cholesterol inhibitorCrestor
Saxenda Injectable Antidiabetic, GLP-1 agonistLiraglutide
Senexon-S tablet Laxative Senokot-S
Senna Laxative Tabs tablet Laxative Senokot
Seroquel XR 50mg *sample* Tablet Antipsychotic
Quetiapine
fumarate
Sertraline 100mg Tablet Anti-Depressant Zoloft
Sertraline 50 mg Tablet Anti-Depressant Zoloft
Silver Sulfadiazine 1% cream Cream Topical Agent
Simvastatin 10 mg Tablet Cholesterol inhibitorZocar
Simvastatin 20 mg Tablet Cholesterol inhibitorZocar
Simvastatin 40mg Tablet Cholesterol inhibitorZocar
Soliqua 100/33 *sample* Injectable Insulin/GLP-1
Glargine/
lixisenatide
Solu Medrol 40mg/mL Injectable Steroid
Methylprednisol
one
Solu Medrol 125mg/mL Injectable Steroid
Methylprednisol
one
Spiriva Respimat 1.25mcg Inhaler Respiratory
Tiotropium
bromide
Spironolactone 25 mg Tablet Diuretic Aldactone
Spironolactone 100 mg Tablet Diuretic Aldactone
Sprintec Tablet Oral Contraceptive
Ethinyl estradiol/
norgestimate
Stiolto Respimat 2.5mcg *sample* Inhaler Respiratory
Tiotropium/
olodaterol
Sucralfate 1gm Tablet GI Agents Carafate
Sulfacetamide Sodium Ophth Solution Anti-Infective, TopicalKlaron
Sulfamethoxazole & Trimeth 200/40/5ml Suspension Anti-infective Bactrim
Sulfamethoxazole/Trimeth DS 800/160 Tablet Anti-Infective Bactrim
rev 2/20/2018Page 11
REACHOUT 2018 FORMULARY - Alpha List
DRUG NAME
DOSAGE
FORM DRUG TYPE ALT NAME
Sulfasalazine DR 500mg *sample* Tablet GI Agents Azulfidine
Sumatriptan 25mg Tablet Antimigraine Imitrex
Sumatriptan 100mg Tablet Antimigraine Imitrex
Symbicort 80mcg/4.5mcg Inhaler Respiratory
Budesonide/
formoterol
Symbicort 160mcg/4.5mcg Inhaler Respiratory
Budesonide/
formoterol
Synjardy XR 5/1000mg *sample* Tablet Antidiabetic, SGLT2
Empagliflozin/m
etformin
Synjardy XR 10/1000mg *sample* Tablet Antidiabetic, SGLT2
Empagliflozin/m
etformin
Synjardy XR 12.5/1000mg *sample* Tablet Antidiabetic, SGLT2
Empagliflozin/m
etformin
Synjardy XR 25/1000mg Tablet Antidiabetic, SGLT2
Empagliflozin/m
etformin
Tamsulosin 0.4 mg Tablet Urinary Tract DisorderFlomax
Taztia XT 120mg *sample* Capsule Calcium Channel BlockerDiltiazem ER
Taztia XT 240mg *sample* Capsule Calcium Channel BlockerDiltiazem ER
Taztia XT 300mg *sample* Capsule Calcium Channel BlockerDiltiazem ER
Telmisartan 40mg Tablet Antihypertensive Micardis
Telmisartan 80mg Tablet Antihypertensive Micardis
Terazosin 2 mg Capsules Alpha 1 Blocker Hytrin
Terazosin 5 mg Capsules Alpha 1 Blocker Hytrin
Terbinafine 250 mg Tablet Antifungal Lamisil
Topiramate 25mg *sample* Tablet Anticonvulsant Topamax
Topiramate 50mg *sample* Tablet Anticonvulsant Topamax
Topiramate 100mg *sample* Tablet Anticonvulsant Topamax
Toprol XL 50mg *sample* Tablet Antihypertensive
Metoprolol
Succinate
Toujeo (glargine) *sample* Pens Insulin Glargine
Tradjenta 5 mg *sample* Tablet Oral Diabetic AgentsLinagliptin
Trazodone 50 mg Tablet Anti-Depressant Oleptro
Trazodone 100mg Tablet Anti-Depressant Oleptro
rev 2/20/2018Page 12
REACHOUT 2018 FORMULARY - Alpha List
DRUG NAME
DOSAGE
FORM DRUG TYPE ALT NAME
Trazodone 150 mg Tablet Anti-Depressant Oleptro
Tresiba Flextouch *sample* Pens Insulin Degludec
Triamcinolone Acetonide 0.025% Cream Steroid, Topical Kenalog
Triamcinolone Acetonide 0.1% Cream Steroid, Topical Kenalog
Triamcinolone Acetonide 0.1% Ointment Steroid, Topical Kenalog
Triamcinolone Acetonide 0.5% Cream Steroid, Topical Kenalog
Triamterene/HCTZ 37.5 mg - 25 mg Tablet Diuretic Maxzide
Triamterene/HCTZ 75 mg/ 50 mg Tablet Diuretic Maxzide
Tri- Sprintec Tablet Oral Contraceptive
Ethinyl estradiol/
norgestimate
Triple Antibiotic Ointment 28grams Ointment Anti-Infective, Topical
Bacitracin,
Neomycin,
Polymxin B
Trulicity 0.75mg/0.5mL *sample* Injectable Antidiabetic, GLP-1 agonistDulaglutide
Trulicity 1.5mg/0.5mL *sample* Injectable Antidiabetic, GLP-1 agonistDulaglutide
Uloric 40 mg *sample* Tablet Anti-gout Febuxostat
Uloric 80 mg *sample* Tablet Anti-gout Febuxostat
Valacyclovir 500mg Tablet Antiviral Valtrex
Valacyclovir 1000mg Tablet Antiviral Valtrex
Venlafaxine 75mg Tablet Antidepressant Effexor
Venlafaxine 100mg Tablet Antidepressant Effexor
Venlafaxine ER 37.5mg *sample* Tablet Antidepressant Effexor XR
Venlafaxine ER 75mg *sample* Tablet Antidepressant Effexor XR
Venlafaxine ER 150mg *sample* Tablet Antidepressant Effexor XR
Ventolin HFA Inhaler Respiratory Albuterol
Verapamil ER 240 mg Tablet Calcium Channel BlockerCalan
Vitamin B 100 Capsules Vitamins/Minerals Thiamine
Vitamin D (ergocalciferol) 50,000 units Tablet Vitamins/Minerals
Warfarin Sodium 1 mg Tablet Anticoagulants Coumadin
Warfarin Sodium 5 mg Tablet Anticoagulants Coumadin
Xarelto 15mg *sample* Tablet Anticoagulants Rivaroxaban
Xarelto 20mg Tablet Anticoagulants Rivaroxaban
rev 2/20/2018Page 13