Pdl_2010_rev 20100101.xlsx

2010 Preferred Drug List
(Standard Formulary)
DEPRESSION
INFECTION (cont.)
OPHTHALMICS (cont.)
RESPIRATORY (cont.)
WOMEN'S HEALTH
amphetamine salts / ER
SSRI's
Antimicrobials (cont.)
Beta-2 Agonists
Osteoporosis/HRT
methylphenidate / ER
citalopram
cefadroxil
metipranolol
alendronate
fluoxetine
cephalexin
ofloxacin
albuterol
ciprofloxacin
paroxetine
clarithromycin
pilocarpine
ALZHEIMER'S DISEASE
sertraline
clindamycin
polymixin B/trimethoprim
galantamine / ER
Other Antidepressants
dicloxacillin
prednisolone
Corticosteriod Inhalers
estradiol
amitriptyline
doxycycline
estropipate
CARDIOVASCULAR
bupropion / SR / XL
erythromycin
tobramycin
Renin Angiotensin
desipramine
minocycline
Miscellaneous Agents
Aldosterone System
ofloxacin
cromolyn sodium
imipramine
penicillin
ipratropium bromide
fortical
benazepril / HCTZ
mirtazapine
trazodone
tetracycline
theophylline
enalapril / HCTZ
venlafaxine
trimethoprim
NSAIDs
Contraceptives
fosinopril / HCTZ
Antivirals
SEDATIVE/HYPNOTICS
all oral generics
lisinopril / HCTZ
DIABETES
acyclovir
diclofenac
chloral hydrate
quinapril / quinaretic
valacyclovir
etodolac/ext-rel
estazolam
ramipril
flurazepam
MIGRAINE
ibuprofen
temazepam
Alpha Blockers/BPH
glimepiride
butalbital/caffeine/acetaminophen
indomethacin
Anti-infectives
doxazosin
glipizide / ext-rel
butalbital/caffeine/aspirin
meloxicam
finasteride
glipizide/metformin
isometheptene/apap/dichlphenazone
naproxen
zolpidem
prazosin
glyburide
oxaprozin
terconazole
terazosin
glyburide/metformin
sumatriptan
piroxicam
salsalate
REPLACEMENT
Prescription Vitamins
Beta Blockers
MISCELLANEOUS
sulindac
levothyroxine sodium
all generics
atenolol
Other Agents
labetalol
metformin / ext-rel
acetaminophen/codeine
metoprolol / metoprolol XL
carisoprodol
TOPICAL PRODUCTS
fentanyl
amcinonide
pindolol
hydrocodone/acetaminophen
betamethasone
propranolol
GASTROINTESTINAL Enbrel (Tier 3) / **
hydrocodone/ibuprofen
clobetasol
morphine / ext-rel
desonide
Calcium Channel Blockers
cimetidine
oxycodone / ext-rel
desoximetasone
Boldface denotes generic
diltiazem/ext-rel
famotidine
propoxyphene/acetaminophen
diflorasone
felodipine
tizanidine
fluocinonide
nicardipine
lansoprazole
tramadol / tramadol-APAP
fluticasone
nifedipine/ext-rel
nizatidine
halobetasol
(Tier 3) - 3rd tier copay if applicable omeprazole
RESPIRATORY
hydrocortisone
verapamil/ext-rel ranitidine
Nasal Antihistamines
mometasone
OPHTHALMICS
nystatin
Cholesterol Lowering Agents
HEPATITIS C
betaxolol
triamcinolone
PLEASE NOTE: When a generic
fenofibrate
carteolol
Nasal Corticosteriods
ribavirin
cromolyn sodium
flunisolide
URINARY INCONTINENCE will automatically move to the 3rd tier or
lovastatin
dexamethasone
fluticasone
flavoxate
INFECTION
dorzolamide
Tier placement is subject to change. pravastatin
Antimicrobials
dorzolamide / timolol
oxybutynin
amoxicillin
erythromycin
simvastatin
amoxicillin/clavulanate
gentamicin sulfate
ampicillin
levobunolol
cefaclor

Source: http://www.arkansasbcbs.com/doclib/forms/pharmacy/2010_pdl_bchaba_1.12.10.pdf