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Exhibit A
MERCER COUNTY
MH/MR DRUG FORMULARY
Effective July 1, 2012
All forms of a drug listed on this formulary will be covered with the exception of injectables. Generic drugs must be substituted, if available. In order for a brand name to be dispensed, the prescriber must hand-write “brand necessary” or “brand medically necessary.” BRAND NAME ABILIFY ……………………………………………. ARIPIPRAZOLE ADAPIN, SINEQUAN……………………………… DOXEPIN ADDERALL………………………………………….AMPHETAMINE & DEXTROAMPHETAMINE MIXTURE ADDERALL XR……………………………………. AMPHETAMINE & DEXTROAMPHETAMINE MIXTURE AKINETON…………………………………………. BIPERIDEN AMBIEN………………………………………………ZOLPIDEM TARTRATE ANAFRANIL…………………………………………CLOMIPRAMINE ARTANE…………………………………………….TRIHEXYPHENIDYL ASENDIN……………………………………………AMOXAPINE ATARAX……………………………………………. HYDROXYZINE HYDROCHLORIDE ATIVAN………………………………………………LORAZEPAM BENADRYL………………………………………….DIPHENHYDRAMINE BUSPAR…………………………………………….BUSPIRONE CAMPRAL………………………………………….ACAMPROSATE CELEXA…………………………………………….CITALOPRAM HYDROROMIDE COGENTIN…………………………………………. BENZTROPINE CONCERTA…………………………………………METHYLPHENIDATE HYDROCHLORIDE CYLERT, ORAP…………………………………….PEMOLINE CYLERT…………………………………………….PEMOLINE CYMBALTA………………………………………….DULOXETINE HCI DAYTRANA (Patch) ……………………………….METHYLPHENIDATE DEPAKOTE …………………………………………DIVALPROEX DEPAKOTE ER…………………………………….DIVALPROEX DESYREL……………………………………………TRAZODONE DEXEDRINE………………………………………. DEXTRO AMPHETAMINE EFFEXOR…………………………………………. VENLAFAXINE HYDROCHLORIDE EFFEXOR XR……………………………………….VENLAFAXINE HYDROCHLORIDE * Denotes the addition of a new drug to the formulary list. ELAVIL, ENDEP…………………………………….AMITRIPTYLINE FOCALIN XR……………………………………… .DEXMETHYPHENIDATE *FOCALIN…………………………………………….DEXMETHYPHENIDATE GABITRIL……………………………………………TIAGABINE HCL GEODON…………………………………………. ZIPRASIDONE HALDOL……………………………………………. HALOPERIDOL HALDOL DECANOATE……………………………HALOPERIDOL DECANOATE INDERAL…………………………………………….PROPRANOLOL INVEGA……………………………………………. PALIPERIDONE KLONOPIN…………………………………………. CLONAZEPAM KLONOPIN WAFERS…………………………… CLONAZEPAM LAMICTAL………………………………………….LAMOTRIGINE LEXAPRO……………………………………………ESCITALOPRAM OXALATE LIBRIUM…………………………………………….CHLORDIAZEPOXIDE LIMBITROL…………………………………………. CHLORDIAZEPOXIDE W/AMITRIPTYLINE LITHOBID, ESKALITH……………………………. LITHIUM CARBONATE LOXITANE…………………………………………. LOXAPINE LUDIOMIL…………………………………………. MAPROTILINE LUNESTA……………………………………………ESZOPICIONE LUVOX……………………………………………….FLUVOXAMINE MALEATE LUVOX CR………………………………………….FLUVOXAMINE MELLARIL………………………………………….THIORIDAZINE METADATE ER…………………………………….METHYLPHENIDATE HYDROCHLORIDE METHYLIN ER…………………………………….METHYLPHENIDATE HYDROCHLORIDE MOBAN………………………………………………MOLINDONE MYSOLINE………………………………………….PRIMIDONE NARDIL………………………………………………PHENELZINE NAVANE…………………………………………….THIOTHIXENE NEURONTIN……………………………………….GABAPENTIN NORPRAMIN, PERTOFRANE…………………… DESIPRAMINE ORAP………………………………………………. PIMOZIDE PAMELOR, AVENTYL……………………………. NORTRIPTYLINE PARLODEL………………………………………….BROMOCRIPTINE PARNATE……………………………………………TRANYLCYPROMINE PAXIL…………………………………………………PAROXETINE HYDROCHLORIDE PAXIL CR ……………………………………………PAROXETINE PEXEVA…………………………………… ……….PAROXETINE PROLIXIN, PERMITIL…………………………….FLUPHENAZINE * Denotes the addition of a new drug to the formulary list. PROLIXIN DECANOATE………………………….FLUPHENAZINE DECANOATE PROVIGIL ………………………………………….MODAFINIL PROZAC…………………………………………….FLUOXETINE PROZAC WEEKLY…………………………….….FLUOXETINE REMERON………………………………………….MIRTAZAPINE REMERON SOL TAB………………………………MIRTAZAPINE RESTORIL…………………………………………. TEMAZEPAM RISPERDAL………………………………………. RISPERIDONE RISPERIDAL M TAB……………………………….RISPERIDONE RITALIN………………………………………………METHYLPHENIDATE SERAX……………………………………………….OXAZEPAM SERZONE………………………………………… NEFAZODONE HYDROCHLORIDE SEROQUEL…………………………………………QUETIAPINE SONATA…………………………………………… ZALEPLON STELAZINE………………………………………….TRIFLUOPERAZINE STRATTERA…………………………………………ATOMOXETINE HCL SURMONTIL……………………………………….TRIMIPRAMINE MALEATE SYMMETREL……………………………………….AMANTADINE TEGRETOL………………………………………….CARBAMAZEPINE TEGRETOL XR…………………………………….CARBAMAZEPINE THORAZINE…………………………………………CHLORPROMAZINE HYDROCHLORIDE TOFRANIL……………………………………………IMIPRAMINE TOPAMAX……………………………………………TOPIRAMATE TRANXENE………………………………………….CLORAZEPATE DIPOTASSIUM TRIAVIL, ETRAFON……………………………….AMITRIPTYLINE/PERPHENAZINE TRILAFON…………………………………………. PERPHENAZINE TRILEPTAL………………………………………….OXCARBAZEPINE VALIUM……………………………………………. DIAZEPAM VISTARIL…………………………………………….HYDROXYZINE PAMOATE VIVACTIL…………………………………………….PROTRIPTYLINE WELLBUTRIN……………………………………….BUPROPION HYDROCHLORIDE WELLBUTRIN SR………………………………….BUPROPION HYDROCHLORIDE WELLBUTRIN XL…………………………………. BUPROPION HYDROCHLORIDE XANAX……………………………………………….ALPRAZOLAM XANAX XR……………………………….………. ALPRAZOLAM XR ZOLOFT……………………………………………. SERTRALINE HC1 ZYPREXA…………………………………………. OLANZAPINE * Denotes the addition of a new drug to the formulary list.

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