Drug Formulary (Appendix A)

Complimentary State Formulary Access

Drug ClassGeneric NameInnovator brandNoteGeneric (GE)Status
Drug ClassGeneric NameInnovator brandNoteGeneric (GE)Status
AnticoagulantsApixabanEliquisNo
Y
AnticoagulantsDabigatranPradaxaNo
Y
AnticoagulantsEnoxaparinLovenoxYes
Y
AnticoagulantsRivaroxabanXareltoNo
Y
AntidepressantsAmitriptylineElavilFor mental health conditionsYes
Y
AntidepressantsBupropionWellbutrin For mental health conditionsYes
Y
AntidepressantsBupropionWellbutrinFor pain treatmentYes
N
AntidepressantsCitalopramCelexa For mental health conditionsYes
N
AntidepressantsDesvenlafaxinePristiq For mental health conditionsYes
Y
AntidepressantsDuloxetineCymbaltaFor mental disordersYes
Y
AntidepressantsEscitalopramLexaproFor mental disordersYes
Y
AntidepressantsEscitalopramLexaproFor pain treatmentYes
N
AntidepressantsFluoxetineProzacFor mental disordersYes
Y
AntidepressantsFluoxetineProzacFor pain treatmentYes
N
AntidepressantsFluvoxamineLuvoxFor mental disordersYes
N
AntidepressantsMilnacipranSavella/IxelFor mental disordersYes
N
AntidepressantsMirtazapineRemeronFor pain treatmentYes
N
AntidepressantsMirtazapineRemeronFor mental disordersYes
Y
AntidepressantsNortriptylinePamelorFor mental disordersYes
Y
AntidepressantsParoxetinePaxilFor mental disordersYes
Y
AntidepressantsParoxetinePaxilFor pain treatmentYes
N
AntidepressantsSertralineZoloftFor mental disordersYes
Y
AntidepressantsSertralineZoloftFor pain treatmentYes
N
AntidepressantsVenlafaxineEffexorFor mental disordersYes
Y
AntidiabeticsAcarbosePrecoseYes
N
AntidiabeticsExenatideByettaNo
N
AntidiabeticsGlimepirideAmarylYes
N
AntidiabeticsGlipizideGlucotrolYes
N
AntidiabeticsGlyburideGlynaseYes
N
AntidiabeticsInsulin lisproHumalogNo
Y
AntidiabeticsInsulin humanHumulinNo
N
AntidiabeticsHuman insulinNovolinNo
N
AntidiabeticsInsulin aspartNovoLogNo
Y
AntidiabeticsMetforminGlucophageYes
Y
AntidiabeticsMiglitolGlysetYes
N
AntidiabeticsNateglinideStarlixYes
N
AntidiabeticsPioglitazoneActosYes
N
AntidiabeticsRepaglinidePrandinYes
N
AntidiabeticsRosiglitazoneAvandiaYes
N
AntidiabeticsSaxagliptinOnglyzaNo
N
AntidiabeticsSitagliptinJanuviaNo
N
AntiemeticsOndansetronZofranOral dissolving tabletYes
N
AntiemeticsOndansetronZuplenzOral soluble filmNo
N
Anti-epilepsy drugs (AEDs)CarbamazepineTegretolYes
Y
Anti-epilepsy drugs (AEDs)GabapentinNeurontin, GabaroneYes
Y
Anti-epilepsy drugs (AEDs)Gabapentin ERGraliseNo
N
Anti-epilepsy drugs (AEDs)Gabapentin ERHorizantNo
N
Anti-epilepsy drugs (AEDs)LacosamideVimpatYes
N
Anti-epilepsy drugs (AEDs)LamotrigineLamictalYes
N
Anti-epilepsy drugs (AEDs)LevetiracetamKeppraYes
N
Anti-epilepsy drugs (AEDs)OxcarbazepineTrileptalYes
Y
Anti-epilepsy drugs (AEDs)PhenytoinDilantinYes
N
Anti-epilepsy drugs (AEDs)PregabalinLyrica IRYes
Y
Anti-epilepsy drugs (AEDs)TiagabineGabitrilYes
N
Anti-epilepsy drugs (AEDs)TopiramateTopamaxYes
N
Anti-epilepsy drugs (AEDs)ZonisamideZonegranYes
N
AntihypertensivesAliskirenTekturnaNo
N
AntihypertensivesAmlodipineNorvascYes
Y
AntihypertensivesAtenololTenorminYes
Y
AntihypertensivesBenazeprilLotensinYes
Y
AntihypertensivesCaptoprilCapotenYes
Y
AntihypertensivesClonidineCatapresYes
N
AntihypertensivesDoxazosinCarduraYes
N
AntihypertensivesEnalaprilVasotecYes
Y
AntihypertensivesHydralazineApresolineYes
N
AntihypertensivesHydrochlorothiazideHCTZYes
Y
AntihypertensivesLisinoprilZestrilYes
Y
AntihypertensivesLosartanCozaarYes
Y
AntihypertensivesMetoprololLopressorYes
Y
AntihypertensivesMinoxidilLonitenYes
N
AntihypertensivesNadololCorgardYes
Y
AntihypertensivesNicardipineCardeneYes
Y
AntihypertensivesNifedipineProcardiaYes
Y
AntihypertensivesOlmesartanBenicarYes
Y
AntihypertensivesPrazosinMinipressFor HypertensionYes
N
AntihypertensivesPropranololInderalYes
Y
AntihypertensivesRamiprilAltaceYes
Y
AntihypertensivesSpironolactoneAldactoneYes
N
AntihypertensivesTerazosinHytrinYes
N
AntihypertensivesValsartanDiovanYes
Y
Anti-infectivesAmoxicillinAmoxilYes
Y
Anti-infectivesAmoxicillin-ClavulanateAugmentinYes
Y
Anti-infectivesAzithromycinZithromaxYes
Y
Anti-infectivesCefadroxilDuricefYes
Y
Anti-infectivesCefdinirOmnicefYes
Y
Anti-infectivesCefprozilCefzilYes
Y
Anti-infectivesCefuroximeCeftinYes
Y
Anti-infectivesCephalexinKeflexYes
Y
Anti-infectivesCiprofloxacinCiproYes
Y
Anti-infectivesClarithromycinBiaxinYes
Y
Anti-infectivesClindamycinCleocinYes
Y
Anti-infectivesDicloxacillinDynapenYes
Y
Anti-infectivesDoxycyclineVibramycin, DoryxYes
Y
Anti-infectivesLevofloxacinLevaquinYes
Y
Anti-infectivesLinezolidZyvoxYes
Y
Anti-infectivesMetronidazoleFlagylYes
Y
Anti-infectivesMinocyclineMinocin, DynacinYes
Y
Anti-infectivesMoxifloxacinAveloxYes
Y
Anti-infectivesPenicillinVeetidsYes
Y
Anti-infectivesSulfamethoxazole-TrimethoprimBactrim, SeptraYes
Y
Asthma medicationsAlbuterol oral tabletAlbuterolYes
N
Asthma medicationsBeclomethasoneQvarNo
Y
Asthma medicationsCiclesonideAlvescoNo
Y
Asthma medicationsCromolynCromolynYes
N
Asthma medicationsFluticasone inhalationFloventNo
Y
Asthma medicationsFormoterolForadilNo
N
Asthma medicationsBudesonideSymbicortNo
Y
Asthma medicationsMometasone Furoate/ Formoterol FumarateDuleraNo
Y
Asthma medicationsMometasone FuroateAsmanexNo
Y
Asthma medicationsMontelukastSingulairYes
N
Asthma medicationsOmalizumabXolairNo
N
Asthma medicationsPirbuterolMaxairNo
Y
Asthma medicationsSalmeterolSereventNo
N
Asthma medicationsSalmeterol/FluticasoneAdvairNo
Y
Asthma medicationsTheophyllineSlo-Bid, Elixophyllin, Quibron-T, Theo-24, Theochron, Theolair, UniphylYes
N
Asthma medicationsZafirlukastAccolateYes
N
Asthma medicationsZileutonZyfloNo
N
Atypical antipsychoticsAripiprazoleAbilifyYes
N
Atypical antipsychoticsQuetiapineSeroquelYes
N
Atypical antipsychoticsOlanzapineZyprexaYes
N
Atypical antipsychoticsRisperidoneRisperdalYes
N
BenzodiazepinesAlprazolamXanaxYes
N
BenzodiazepinesChlordiazepoxideLibriumYes
N
BenzodiazepinesClonazepamKlonopinYes
N
BenzodiazepinesClorazepateTranxeneYes
N
BenzodiazepinesDiazepamValiumYes
N
BenzodiazepinesEstazolamProSomYes
N
BenzodiazepinesFlurazepamDalmaneYes
N
BenzodiazepinesLorazepamAtivanYes
N
BenzodiazepinesMidazolamVersedYes
N
BenzodiazepinesOxazepamSeraxYes
N
BenzodiazepinesQuazepamDoralNo
N
BenzodiazepinesTemazepamRestorilYes
N
BenzodiazepinesTriazolamHalcion Yes
N
BisphosphonatesAlendronateFosamaxYes
Y
BisphosphonatesIbandronateBonivaYes
Y
BisphosphonatesRisedronateActonel, AtelviaYes
Y
Botulinum toxinOnabotulinumtoxinABotoxNo
N
Botulinum toxinBotulinum toxin type ADysportNo
N
Botulinum toxinRimabotulinumtoxinBMyoblocNo
N
Botulinum toxinIncobotulinumtoxinAXeominNo
N
CannabinoidsMarijuana/dronabinolMarinolYes
N
CannabinoidsNabiloneCesametNo
N
CannabinoidsTetrahydrocannabinolTHC dronabinol MarinolYes
N
Central adrenergic agonistsClonidine, intrathecalDuraclonYes
N
Dopamine agonistsAmantadineSymmetrelYes
Y
Dopamine agonistsCarbidopa/LevodopaSinemetYes
Y
Gout medicationsColchicineColchicineYes
N
H2-receptor antagonistsCimetidineTagametY-OTC
Y
H2-receptor antagonistsFamotidinePepcidY-OTC
Y
NSAIDs Ibuprofen and famotidineDuexisYes
N
H2-receptor antagonistsRanitidineZantacY-OTC
N
LaxativesLubiprostoneAmitizaNo
N
LaxativesMethylnaltrexoneRelistorNo
N
LaxativesNaloxegolMovantikNo
N
LaxativesOTC LaxativesvariousY-OTC
Y
Muscle relaxantsBaclofenLioresalOral tabletsYes
Y
Muscle relaxantsCarisoprodolSomaYes
N
Muscle relaxantsChlorzoxazoneParafon ForteYes
N
Muscle relaxantsChlorzoxazoneLorzoneNo
N
Muscle relaxantsCyclobenzaprineFlexeril, FexmidYes
Y
Muscle relaxantsCyclobenzaprine ERAmrixNo
N
Muscle relaxantsDantroleneDantriumYes
N
Muscle relaxantsMeprobamateMiltownYes
N
Muscle relaxantsMetaxaloneSkelaxinYes
N
Muscle relaxantsMethocarbamolRobaxin, RelaxinYes
Y
Muscle relaxantsOrphenadrineNorflex, Banflex, Antiflex, Mio-Rel, OrphenateYes
N
Muscle relaxantsTizanidineZanaflexYes
Y
Nonprescription analgesicsAcetaminophenTylenolY-OTC
Y
Nonprescription analgesicsAspirinBayerY-OTC
Y
NSAIDsCelecoxibCelebrexYes
Y
NSAIDsDiclofenac sodiumVoltarenYes
Y
NSAIDsDiclofenacZorvolexNo
Y
NSAIDsDiclofenac sodium and misoprostolArthrotecYes
N
NSAIDsDiclofenac epolamineFlectorTopical patchNo
N
NSAIDsDiclofenac PotassiumCataflamYes
Y
NSAIDsDiclofenac PotassiumZipsorYes
N
NSAIDsDiclofenac sodium ERVoltaren-XRYes
Y
NSAIDsDiclofenac sodium Voltaren gelTopicalY-OTC
Y
NSAIDsDiclofenac sodiumPennsaidTopicalYes
Y
NSAIDsDiflunisalDolobidYes
Y
NSAIDsEtodolacLodineYes
Y
NSAIDsEtodolac ERLodine XLYes
Y
NSAIDsFenoprofenNalfonYes
Y
NSAIDsFlurbiprofenAnsaidYes
Y
NSAIDsIbuprofenAdvilY-OTC
Y
NSAIDsIbuprofenMotrinY-OTC
Y
NSAIDsIndomethacinIndocinYes
N
NSAIDsIndomethacinTivorbexNo
N
NSAIDsIndomethacin ERIndocin SRYes
N
NSAIDsKetoprofenKetoprofenYes
Y
NSAIDsKetoprofen ERKetoprofenYes
Y
NSAIDsKetorolac tromethamineToradolOralYes
N
NSAIDsKetorolac tromethamineToradol InjectionYes
Y
NSAIDsKetorolac tromethamineSprixNasal spray, meteredNo
N
NSAIDsMefenamic AcidPonstelYes
Y
NSAIDsMeloxicamMobicYes
Y
NSAIDsNabumetoneRelafenYes
Y
NSAIDsNaproxenAleveY-OTC
Y
NSAIDsNaproxenNaprosyn, Anaprox, Anaprox DSYes
Y
NSAIDsNaproxen EREC-NaprosynYes
Y
NSAIDsNaproxen ERNaprelanYes
Y
NSAIDsOxaprozinDayproYes
Y
NSAIDsPiroxicamFeldeneYes
Y
NSAIDsSulindacClinorilYes
Y
OpioidsBuprenorphine hydrochlorideBelbucaBuccal filmNo
N
OpioidsBuprenorphine hydrochlorideSubutexSublingual tablet for opioid use disorderYes
N
OpioidsBuprenorphine hydrochlorideSubutexSublingual tablet for pain treatmentYes
N
OpioidsBuprenorphineButransTransdermalYes
N
OpioidsBuprenorphine hydrochloride/naloxone hydrochlorideSuboxoneBuccal, sublingual film for opioid use disorderYes
N
OpioidsBuprenorphine hydrochloride/naloxone hydrochlorideSuboxoneBuccal, sublingual film for pain treatmentYes
N
OpioidsBuprenorphine hydrochloride/naloxone hydrochlorideZubsolv Sublingual tablet for opioid use orderNo
N
OpioidsBuprenorphine hydrochloride/naloxone hydrochlorideZubsolv Sublingual tablet for pain treatmentNo
N
OpioidsCodeine sulfateCodeineYes
Y
OpioidsAcetaminophen/codeine phosphateTylenol with CodeineYes
Y
OpioidsAcetaminophen/caffeine/dihydrocodeine bitartrateTrezixNo
N
OpioidsFentanyl citrateFentoraTransmucosalYes
N
OpioidsFentanyl citrateActiqLozengeYes
N
OpioidsFentanyl citrateLazandaNasal sprayNo
N
OpioidsFentanylSubsys Sublingual sprayNo
N
OpioidsFentanylFentanylTransdermalYes
N
OpioidsHydrocodone bitartrate ERHysingla ER Yes
N
OpioidsHydrocodone bitartrate/ibuprofenHydrocodone and IbuprofenYes
Y
OpioidsHydromorphone hydrochlorideDilaudidYes
N
OpioidsHydromorphone hydrochloride ERHydromorphone ERYes
N
OpioidsLevorphanol tartrateLevorphanol Yes
N
OpioidsMeperidine hydrochlorideDemerolYes
N
OpioidsMethadone hydrochlorideMethadoseYes
N
OpioidsMorphine sulfateMorphine Yes
N
OpioidsMorphine ERAvinzaYes
N
OpioidsMorphine sulfate ERMorphine ERYes
N
OpioidsMorphine sulfate ERMS-Contin Extended release tabletYes
N
OpioidsNaloxoneNarcanIntranasalYes
Y
OpioidsNaloxoneNaloxoneInjectableYes
Y
OpioidsOxycodone hydrochlorideOxaydoNo
Y
OpioidsOxycodone hydrochloride EROxyContinYes
N
OpioidsOxycodone hydrochloride/acetaminophenPercocetYes
Y
OpioidsOxycodone hydrochlorideOxycodoneYes
Y
OpioidsOxymorphone hydrochloride IROxymorphone Yes
N
OpioidsOxymorphone hydrochloride EROxymorphone ERYes
N
OpioidsPentazocine hydrochloride/naloxone hydrochloridePentazocine and NaloxoneYes
N
OpioidsTapentadol hydrochlorideNucyntaNo
N
OpioidsTramadol hydrochlorideUltramYes
N
OpioidsTramadol hydrochloride ERUltram ERYes
N
OpioidsTramadol hydrochloride ERConZipYes
N
OpioidsTramadol hydrochloride/acetaminophenUltracetYes
N
Oral corticosteroidsMethylprednisoloneMedrolYes
Y
Oral corticosteroidsPrednisonePrednisoneYes
Y
PPI (Proton Pump Inhibitor)DexlansoprazoleDexilantNo
N
PPI (Proton Pump Inhibitor)EsomeprazoleNexiumY-OTC
Y
NSAIDsEsomeprazole/NaproxenVimovoYes
N
PPI (Proton Pump Inhibitor)LansoprazolePrevacidY-OTC
Y
PPI (Proton Pump Inhibitor)OmeprazolePrilosecY-OTC
Y
PPI (Proton Pump Inhibitor)PantoprazoleProtonixYes
Y
PPI (Proton Pump Inhibitor)RabeprazoleAciphexYes
N
ProstaglandinsMisoprostolCytotecYes
Y
Sedative-hypnoticsEszopicloneLunestaYes
Y
Sedative-hypnoticsPromethazinePhenerganYes
N
Sedative-hypnoticsRamelteonRozeremYes
Y
Sedative-hypnoticsTrazodoneDesyrelYes
N
Sedative-hypnoticsZaleplonSonataYes
Y
Sedative-hypnoticsZolpidemAmbienYes
Y
Sedative-hypnoticsZolpidem ERAmbien CRYes
N
Sedative-hypnoticsZolpidemEdluar SLYes
N
StimulantsArmodafinilNuvigilYes
N
StimulantsModafinilProvigilYes
N
StimulantsSodium oxybateXyremYes
N
Topical analgesicsCapsaicinQutenzaNo
N
Topical analgesicsLidocaineLidodermYes
N
Topical analgesicsMentholBengay Ultra StrengthY-OTC
Y
TriptansRizatriptanMaxaltYes
Y
TriptansSumatriptanImitrexYes
Y
Tumor necrosis factor (TNF) modifiersAdalimumabHumiraYes
N
Tumor necrosis factor (TNF) modifiersEtanerceptEnbrelYes
N
Tumor necrosis factor (TNF) modifiersInfliximabRemicadeYes
N
Asthma medicationsAlbuterol inhalationProventil/VentolinNot meteredYes
Y
Asthma medicationsAlbuterol/IpratropiumCombiventNot meteredYes
Y
Asthma medicationsBudesonide inhalationPulmicortNot meteredYes
Y
Asthma medicationsIpratropiumAtroventNot meteredYes
N
Asthma medicationsLevalbuterolXopenexNot meteredYes
Y
Dopamine agonistsPramipexoleMirapexNot ERYes
N
Dopamine agonistsRopiniroleRequipNot ERYes
N
AntidepressantsVenlafaxine EREffexor XRYes
Y
Sedative-hypnoticsDiphenhydramineBenadrylFor insomniaY-OTC
N
OpioidsHydrocodone bitartrate/acetaminophenHydrocodone and AcetaminophenYes
Y
HIV AntiretroviralsAtazanavirReyatazYes
Y
HIV AntiretroviralsDarunavirPrezistaNo
Y
HIV AntiretroviralsDidanosine ERVidex ECYes
N
HIV AntiretroviralsEmtricitabineEmtrivaNo
Y
HIV AntiretroviralsEmtricitabine/TenofovirTruvadaYes
Y
HIV AntiretroviralsEtravirineIntelenceNo
Y
HIV AntiretroviralsLamivudineEpivirYes
Y
HIV AntiretroviralsLamivudine/ZidovudineCombivirYes
Y
HIV AntiretroviralsLopinavir/RitonavirKaletraFor HIVYes
Y
HIV AntiretroviralsNelfinavirViraceptNo
N
HIV AntiretroviralsNevirapineViramuneYes
N
HIV AntiretroviralsNevirapine ERViramune XRYes
N
HIV AntiretroviralsRaltegravirIsentressNo
Y
HIV AntiretroviralsRilpivirineEdurantNo
Y
HIV AntiretroviralsRitonavirNorvirYes
Y
HIV AntiretroviralsTenofovirVireadYes
Y
HIV AntiretroviralsTipranavirAptivusNo
N
HIV AntiretroviralsZidovudineRetrovirYes
Y
Human Immune globulinsHepatitis B Immune GlobulinHepaGam BNo
Y
Human Immune globulinsHepatitis B Immune GlobulinHyperhep BNo
Y
Human Immune globulinsHepatitis B Immune GlobulinNabi-HBNo
Y
Human Immune globulinsHepatitis B Immune GlobulinHepaGamB NovaPlussNo
Y
HIV AntiretroviralsDidanosineVidexNo
N
Anti-epilepsy drugs (AEDs)Pregabalin ERLyrica CRYes
N
Compound drugsN/AN/ANo
N
OpioidsOxycodone ERXtampza ERNo
N
Topical analgesicsMentholBiofreeze gelY-OTC
Y
CGRP InhibitorsErenumab-aooeAimovigPrefilled injectableNo
N
AntidepressantsEsketamineSpravatoNasal sprayNo
N
AntidepressantsDuloxetineCymbaltaFor pain treatmentYes
Y
CGRP InhibitorsFremanezumabAjovyPrefilled injectableNo
N
CGRP InhibitorsGalcanezumab-gnlmEmgalityPrefilled injectableNo
N
HIV AntiretroviralsLopinavir/RitonavirKaletra For COVID-19Yes
N
AntihypertensivesPrazosinMinipressFor PTSD, nightmaresYes
Y
Disease-modifying antirheumatic drug (DMARD)Hydroxychloroquine sulfatePlaquenilFor COVID-19Yes
N
Muscle relaxantsBaclofenOzobax Oral solutionYes
N
AnthelminticsIvermectinStromectolOralYes
N
PPI (Proton Pump Inhibitor)Omeprazole/Sodium BicarbonateZegeridFor pain treatmentY-OTC
N
BisphosphonatesPamidronate Disodium Aredia Intravenous infusionYes
Y
CGRP InhibitorsEptinezumab-jjmrVyepti Intravenous infusionNo
N
CGRP InhibitorsRimegepant SulfateNurtecNo
N
CGRP InhibitorsUbrogepantUbrelvyNo
N
CGRP InhibitorsAtogepantQuliptaNo
N
TriptansAlmotriptan MalateN/AYes
Y
TriptansEletriptan Hydrobromide RelpaxYes
Y
TriptansFrovatriptan SuccinateFrovaYes
Y
TriptansNaratriptan HydrochlorideAmergeYes
Y
TriptansSumatriptan/Naproxen SodiumTreximetYes
N
TriptansZolmitriptanZomigYes
Y
OpioidsNaloxoneZIMHIPrefilled injectableNo
Y
Topical analgesicsLidocaineZtlidoTopical patchNo
Y
Topical analgesicsTrolamine salicylateAspercreme Pain RelievingY-OTC
Y
Topical analgesicsTrolamine salicylateSportscremeY-OTC
Y
NSAIDsIbuprofenMotrinYes
Y
Misc analgesicsAcetaminophen/butalbital/caffeineFioricetYes
N
OpioidsAcetaminophen/butalbital/caffeine/codeineFioricet with CodeineYes
N
Misc analgesicsAspirin/butalbital/caffeineAspirin, Butalbital, and CaffeineAspirin 500mgYes
N
Misc analgesicsAspirin/butalbital/caffeineFiorinalAspirin 325mgYes
N
OpioidsBuprenorphine hydrochloride/naloxone hydrochlorideSuboxoneSublingual tablet for opioid use disorderYes
Y
OpioidsBuprenorphine hydrochloride/naloxone hydrochlorideSuboxoneSublingual tablet for pain treatmentYes
N
OpioidsHydrocodone bitartrate ERZohydro ER Yes
N
OpioidsMethadone hydrochlorideDisketsYes
N
OpioidsNaloxoneKloxxadoIntranasalNo
Y
OpioidsNaltrexone hydrochlorideReviaYes
Y
OpioidsOxycodone hydrochlorideRoxicodoneYes
Y
OpioidsTapentadol hydrochloride ERNucynta ERNo
N
OpioidsTramadol hydrochloride ERTramadol ERYes
N
OpioidsTramadol hydrochloride ERRyzoltYes
N

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