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ABILIFY 2MG COMBIGAN 0.2-0.5% INLYTA 1MG OLYSIO 150MG TASIGNA 150MG
ABILIFY DISCMELT 10MG COMBIVENT RESPIMAT INLYTA 5MG OMNARIS NASAL SPRAY 50MCG TASIGNA 200MG
ABILIFY DISCMELT 15MG 20MCG/100MCG INTELENCE 100MG ONGLYZA 2.5MG TASMAR 100MG
ACCOLATE (G) 20MG COMPLERA 200/25/300MG INTELENCE 200MG ONGLYZA 5MG TAZORAC CREAM 0.05%
ACIPHEX (G) 20MG COSOPT PF DROPS 2%/0.5% INVEGA 3MG ORACEA 40MG TAZORAC CREAM 0.1%
ACTONEL 5MG CRESTOR 5MG INVEGA 6MG OTEZLA 30MG TAZORAC GEL 0.05%
ACTONEL 30MG CRESTOR 10MG INVEGA 9MG PATADAY 0.2% TAZORAC GEL 0.1%
ACTONEL 150MG CRESTOR 20MG INVIRASE 500MG PATANOL OPHTH SOL 0.1% TECFIDERA 120MG
ACZONE 5% CRESTOR 40MG INVOKANA 100MG PENNSAID 1.5% TECFIDERA 240MG
ADCIRCA 20MG CRINONE GEL 8% INVOKANA 300MG PENTASA 500MG TEGRETOL (G) 200MG
ADVAIR DISKUS 100MCG CRIXIVAN 200MG ISENTRESS 400MG PRADAXA 75MG TEGRETOL XR (G) 200MG
ADVAIR DISKUS 250MCG CRIXIVAN 400MG ISOPTO CARPINE 1% PRADAXA 150MG TEGRETOL XR (G) 400MG
ADVAIR DISKUS 500MCG CUTIVATE OINT (G) 0.005% ISOPTO CARPINE 2% PRED FORTE (G) 1% TEKTURNA 150MG
ADVAIR HFA 45/21MCG DALIRESP 500MCG ISOPTO CARPINE 4% PREMARIN 0.3MG TEKTURNA 300MG
ADVAIR HFA 115/21MCG DERMOTIC OIL 0.01% JADENU 90MG PREMARIN 0.625MG TEKTURNA HCT 150-12.5MG
ADVAIR HFA 230/21MCG DESCOVY 200MG/25MG JADENU 180MG PREMARIN 1.25MG TEKTURNA HCT 300-12.5MG
AFINITOR 2.5MG DETROL LA 2MG JADENU 360MG PREMARIN VAG 0.625MG/GM TEKTURNA HCT 300-25MG
AFINITOR 5MG DETROL LA 4MG JAKAFI 5MG PREMPRO 0.3MG/1.5MG TEVETEN HCT 600/12.5MG
AFINITOR 10MG DEXILANT DR 30MG JAKAFI 10MG PREMPRO 0.625MG/2.5MG TIVICAY 50MG
AGGRENOX 200/25MG DEXILANT DR 60MG JAKAFI 15MG PREMPRO 0.625MG/5MG TOBREX OINT 0.3%
ALOCRIL OPHTH 2% DIFFERIN CREAM (G) 0.1% JAKAFI 20MG PREVACID SOLUTAB 15MG TOVIAZ 4MG
ALOMIDE 0.1% DIFFERIN GEL (G) 0.1% JALYN 0.5MG/0.4MG PREVACID SOLUTAB 30MG TOVIAZ 8MG
ALPHAGAN-P OPHTH SOL (G) DIFFERIN GEL 0.3% JANUMET 50/500MG PREZCOBIX 800MG/150MG TRACLEER 62.5MG
0.15% DIPENTUM 250MG JANUMET 50/1000MG PREZISTA 600MG TRACLEER 125MG
ALREX 0.2% DIPROLENE LOTION (G) 0.05% JANUMET XR 50MG/500MG PREZISTA 800MG TRADJENTA 5MG
ALVESCO 80MCG 100MCG DIPROLENE OINT (G) 0.05% JANUMET XR 50MG/1000MG PRISTIQ 50MG TRAVATAN Z OPHTH SOL
ALVESCO 160MCG 200MCG DIVIGEL 0.5MG JANUMET XR 100MG/1000MG PRISTIQ 100MG 0.004%
AMITIZA 24MCG DIVIGEL 1MG JANUVIA 25MG PROMETRIUM (G) 100MG TRIBENZOR 20/5/12.5MG
ANORO ELLIPTA 62.5/25MCG DOVONEX CREAM (G) 50MCG JANUVIA 50MG PROTOPIC OINT 0.03% TRIBENZOR 40/5/12.5MG
ANZEMET 100MG DUAVEE 0.45-20MG JANUVIA 100MG PROTOPIC OINT 0.1% TRIBENZOR 40/5/25MG
ARCAPTA NEOHALER 75MCG DULERA 100MCG/5MCG JARDIANCE 10MG QVAR 40MCG 50MCG TRIBENZOR 40/10/12.5MG
ARNUITY ELLIPTA 100MCG DULERA 200MCG/5MCG JARDIANCE 25MG QVAR 80MCG 100MCG TRIBENZOR 40/10/25MG
ARNUITY ELLIPTA 200MCG DYMISTA NASAL SPRAY JUBLIA 10% RANEXA 500MG TRINTELLIX 5MG
ARTHROTEC (G) 50MG 137/50MCG KALETRA 200MG/50MG RAPAFLO 4MG TRINTELLIX 10MG
ARTHROTEC (G) 75MG EDARBI 40MG KAZANO 12.5/1000MG RAPAFLO 8MG TRINTELLIX 20MG
ASACOL HD 800MG EDARBI 80MG KOMBIGLYZE XR 2.5MG/1000MG RAPAMUNE (G) 0.5MG TRIUMEQ TABLET
ASMANEX TWISTHALER 110MCG EDARBYCLOR 40MG/25MG KOMBIGLYZE XR 5MG/500MG RAPAMUNE (G) 1MG TRUVADA 200-300MG
ASMANEX TWISTHALER 220MCG EDECRIN 25MG KOMBIGLYZE XR 5MG/1000MG RAPAMUNE (G) 2MG TUDORZA PRESSAIR 400MCG
ATACAND (G) 4MG EDURANT 25MG LATUDA 20MG RELPAX 20MG TWYNSTA 40/5MG
ATACAND (G) 8MG EFFIENT 5MG LATUDA 40MG RELPAX 40MG TWYNSTA 40/10MG
ATACAND (G) 16MG EFFIENT 10MG LATUDA 60MG RENAGEL 800MG TWYNSTA 80/5MG
ATACAND (G) 32MG ELIDEL 1% LATUDA 80MG RENVELA 800MG TWYNSTA 80/10MG
ATACAND HCT (G) 16MG/12.5MG ELIQUIS 2.5MG LATUDA 120MG RESTASIS VIALS 0.05% TYZEKA 600MG
ATACAND HCT (G) 32MG/12.5MG ELIQUIS 5MG LESCOL (G) 20MG RETIN A CREAM (G) 0.05% ULORIC 80MG
ATELVIA DR 35MG ELMIRON 100MG LESCOL (G) 40MG RETIN A MICRO GEL (G) 0.04% UROCIT-K (G) 10MEQ
ATRIPLA 600-200-300MG EMADINE 0.05% LESCOL XL 80MG RETIN-A MICRO GEL PUMP (G) VAGIFEM 10MCG
ATROVENT HFA 20UG ENABLEX 7.5MG LEXIVA 700MG 0.1% VALCYTE 450MG
AUBAGIO 14MG ENABLEX 15MG LIALDA 1.2GM REYATAZ 150MG VECTICAL (G) 3MCG/GM
AVANDAMET 2MG/500MG ENTOCORT (G) 3MG LINZESS 145MCG REYATAZ 200MG VENTOLIN HFA 90MCG
AVANDAMET 2MG/1000MG ENTRESTO 24MG-26MG LINZESS 290MCG REYATAZ 300MG VESICARE 5MG
AVANDAMET 4MG/500MG ENTRESTO 49MG-51MG LOCOID LIPOCREAM 0.1% SAPHRIS 5MG VESICARE 10MG
AVANDAMET 4MG/1000MG ENTRESTO 97MG-103MG LIPITOR (G) 10MG SAPHRIS 10MG VIMOVO 375/20MG
AVANDIA 2MG EPIDUO GEL PUMP 0.1%/2.5% LIPITOR (G) 20MG SELZENTRY 150MG VIMOVO 500/20MG
AVANDIA 4MG EPIPEN 0.3MG LIPITOR (G) 40MG SELZENTRY 300MG VIRAMUNE XR 400MG
AVANDIA 8MG EPIPEN JR 0.15MG LIPITOR (G) 80MG SENSIPAR 30MG VIREAD 300MG
AXERT 6.25MG EPZICOM LOTEMAX SUSPENSION 0.5% SENSIPAR 60MG VIVELLE-DOT 25MCG
AXERT 12.5MG ESTROGEL 0.06% LOVENOX (G) 40MG SENSIPAR 90MG VIVELLE-DOT 37.5MCG
AZILECT 0.5MG EVISTA 60MG LOVENOX (G) 60MG SEREVENT DISKUS 50MCG VIVELLE-DOT 50MCG
AZILECT 1MG EXELON 9.5MG/24HR LOVENOX (G) 80MG SEROQUEL XR 50MG VIVELLE-DOT 75MCG
AZOPT OPHTH DROPS 1% EXELON 13.3MG/24HR LOVENOX (G) 100MG SEROQUEL XR 150MG VIVELLE-DOT 100MCG
AZOR 20/5MG EXJADE 125MG LUMIGAN OPHTH 0.01% SEROQUEL XR 200MG VOLTAREN GEL
AZOR 40/5MG EXJADE 250MG MESNEX 400MG SEROQUEL XR 300MG VYTORIN 10/10MG
AZOR 40/10MG EXJADE 500MG MESTINON TS 180MG SEROQUEL XR 400MG VYTORIN 10/20MG
BACTROBAN NASAL OINT 2% FARESTON 60MG METRO CREAM (G) 0.75% SIMBRINZA 1%/0.2% VYTORIN 10/40MG
BANZEL 200MG FARXIGA 5MG METROGEL PUMP 1% SOLARAZE (G) 3% VYTORIN 10/80MG
BANZEL 400MG FARXIGA 10MG MICARDIS HCT (G) 40/12.5MG SOOLANTRA 1% WELLBUTRIN XL (G) 150MG
BARACLUDE 0.5MG FELDENE 10MG MICARDIS HCT (G) 80/12.5MG SORIATANE (G) 10MG WELLBUTRIN XL (G) 300MG
BARACLUDE 1MG FELDENE 20MG MICARDIS HCT (G) 80/25MG SORIATANE (G) 25MG WELCHOL 625MG
BECONASE AQ 42MCG FINACEA 15% MIGRANAL NASAL SPRAY SPIRIVA 18MCG XALKORI 200MG
BENICAR 20MG FLAREX 0.1% 4MG/ML SPIRIVA RESPIMAT 2.5MCG XALKORI 250MG
BENICAR 40MG FLOVENT 44MCG 50MCG MIRAPEX ER 0.375MG SPRYCEL 20MG XARELTO 10MG
BENICAR HCT 20MG/12.5MG FLOVENT 110MCG 125MCG MIRAPEX ER 0.75MG SPRYCEL 50MG XARELTO 15MG
BENICAR HCT 40MG/12.5MG FLOVENT 220MCG 250MCG MIRAPEX ER 1.5MG SPRYCEL 70MG XARELTO 20MG
BENICAR HCT 40MG/25MG FLOVENT DISKUS 100MCG MIRAPEX ER 2.25MG SPRYCEL 100MG XELJANZ 5MG
BENZACLIN PUMP FLOVENT DISKUS 250MCG MIRAPEX ER 3MG STIOLTO RESPIMAT 2.5/2.5MCG XELODA (G) 150MG
BETIMOL 0.25% FORADIL + AEROLIZER 12MCG MIRAPEX ER 3.75MG STIVARGA 40MG XELODA (G) 500MG
BETIMOL 0.5% FOSRENOL CHEW 500MG MIRAPEX ER 4.5MG STRATTERA 10MG XENICAL 120MG
BETOPTIC S OPHTH 0.25% FOSRENOL CHEW 750MG MIRVASO 0.33% STRATTERA 18MG XIGDUO XR 5/1000MG
BREO ELLIPTA 100/25MCG FOSRENOL CHEW 1000MG MULTAQ 400MG STRATTERA 25MG XIGDUO XR 10/500MG
BREO ELLIPTA 200/25MCG FOSRENOL POWDER 750MG MYFORTIC 360MG STRATTERA 40MG XIGDUO XR 10/1000MG
BRILINTA 60MG FOSRENOL POWDER 1000MG MYRBETRIQ 25MG STRATTERA 60MG XTANDI 40MG
BRILINTA 90MG FROVA 2.5MG MYRBETRIQ 50MG STRATTERA 80MG ZELAPAR 1.25MG
BYSTOLIC 2.5MG GELNIQUE 10% NASONEX 50MCG STRATTERA 100MG ZELBORAF 240MG
BYSTOLIC 5MG GILENYA 0.5MG NESINA 6.25MG STRIBILD ZETIA 10MG
BYSTOLIC 10MG GILOTRIF 20MG NESINA 12.5MG SUSTIVA 50MG ZIAGEN 300MG
BYSTOLIC 20MG GILOTRIF 30MG NESINA 25MG SUSTIVA 200MG ZOMIG NASAL SPRAY 5MG
CADUET (G) 5/10MG GILOTRIF 40MG NEUPRO 1MG SUSTIVA 600MG ZORTRESS 0.25MG
CADUET (G) 5/20MG GLEEVEC 100MG NEUPRO 2MG SUTENT 12.5MG ZORTRESS 0.5MG
CADUET (G) 5/40MG GLEEVEC 400MG NEUPRO 3MG SUTENT 25MG ZORTRESS 0.75MG
CADUET (G) 10/10MG GLUCAGEN HYPOKIT 1MG NEUPRO 4MG SUTENT 50MG ZOVIRAX CREAM 5%
CADUET (G) 10/20MG GLUMETZA ER 1000MG NEUPRO 6MG SYNAREL NASAL ZYCLARA 3.75%
CAMBIA 50MG IMITREX AUTOINJECTOR NEUPRO 8MG SYNJARDY 5MG/500MG ZYTIGA 250MG
CARDURA XL 4MG STATDOSE (G) 6MG/0.5ML NEXAVAR 200MG SYNJARDY 5MG/1000MG
CARDURA XL 8MG IMITREX NASAL SPRAY (G) NEXIUM 20MG SYNJARDY 12.5MG/500MG
CLIMARA PATCH (G) 25MCG 5MG-2DOSE NEXIUM 40MG SYNJARDY 12.5MG/1000MG
CLIMARA PATCH (G) 50MCG IMITREX NASAL SPRAY (G) NEXIUM DR 10MG TABLOID 40MG
CLIMARA PATCH (G) 75MCG 20MG-2DOSE NORITATE CREAM 1% TARKA 2/180MG
CLIMARA PRO 0.045/0.015MG INCRUSE ELLIPTA 62.5MCG NORVIR TABLET 100MG TARKA 4/240MG

NOTE: Medication names appearing with (G) are available in a Generic version from your local or U.S. mail order pharmacy. For a greater
savings to your healthcare plan, ask your physician about taking a Generic equivalent of your medication.
This list is subject to change. Please call 1-866-488-7874 toll free to verify the availability of your medication through this program. September 2017