Mca hsapharmacyformulary

Santa Cruz HSA Pharmacy Drug MCA Formulary
Updated on 9/23/13 9:51:15 AM
Allergy/Cough and Cold
Opioid Agents (These are restricted to
Anticonvulsants Agents
30 Day Supply)
Antihistamines
Cough Syrup (codeine)
Analgesics
Analgesic Comb Agents (Restricted to
Antialcoholic Agent
Antidepressant Agents
#60/month;up to #120with TAR)
Antialcoholic Agent
Antidepressants-Miscellaneous
hydrocodone/APAP 7.5/750 Vicodin ES Anti-Asthmatics
codeine/APAP 30mg 60mg Tylenol #3 #4 Miscellaneous
hydrocodone/APAP 7.5/500 Lortab all Antidepressants-SSRI
Migraine Agents
Antidepressants-Tetracyclic
Monday, September 23, 2013
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Antidepressants-Tricyclics
Miscellaneous Agents
Anti-Psychotics
sulfamethoxazole/trimethopr Septra Anti-Psychotics
nitrofurantoin/nitrofurantoin MacrobidMacro Antiemetic/Antivertigo
5-HT3 Receptor Antagonists
Anti-Infective Agents
Anti-Fungals
Phenothiazine Deriv
Penicillins
Anti-Virals
Cephalosporins
Quinolones
Macrolides
AntiRetrovirals
Celluar Chemokine Receptor Antag
Sulfone
Integrase Inhibitors
Tetracyclines
Non-nucleoside Reverse Trans inhib
Monday, September 23, 2013
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Non-Nucleotide RTI + Nucleoside
Cardiovascular Agents
Beta Blockers
RTI
ACE Inhibitors
efavirenz+tenofovir+emtricit Atripla rilpivirine+tenofovir+emtracit Complera Nucleoside Reverse Trans Inhibitors
Alpha/Beta Adrenergic Blockers
Angiotensin II Receptor Antagonists
Calcium Channel Blockers
Nucleotide Reverse Trans Inhib
Anti-Adrenergic-Centrally Acting
Protease Inhibitors
Cholesterol Lowering Agents
Anti-Anginals (vasodilators)
Antirheumatic
Anti-arrhythmic
Anxiolytic Agents
Hematinic
Benzodiazepines
Anticoagulants
Hemorrheologic
Antiplatelet-Aggregation Inhibitor
Inotropics
Miscellaneous
Vasodilators
Monday, September 23, 2013
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CNS Stimulants
Diagnostic Agents
Electrolytes
CNS Stimulants
Gastrointestinal Agents
Antidiarrheals
Corticosteroid Agents
Antiemetics
Insulin
Antispamodics(anticholinergics)
COX-2 Inhibitors
Detoxification Agent
Sulfonylureas
Detoxification Agent
Colonoscopy Preps
Diabetic Agents
Biguanides
Thiazolidinediones
H2 Blockers
Diabetic Supplies
Diuretic Agents
Laxatives
Loop agents
Miscellaneous
Potassium Sparing
Thiazide/Potassium Sparing
Proton Pump Inhibitors
triamterene/hydrochlorothiaz Dyazide Thiazides
Monday, September 23, 2013
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Genitourinary Agents
Narcotic Agonist-
Ophthalmic Beta Blockers
Antagonist Analgesics
Adrenolytics-Peripheral
Narcotic Agonist-Antagonist
Analgesics
Ophthalmic Carbonic Anhydrase
Inhibitors
NonSteroidal Anti-
Inflammatory Agents
Analgesics
Ophthalmic Prostaglandins
Antispamodics
Opthalmic AntiFungal
Hypnotic Agents
Opthalmic Antihistamine
Oncology
Opthalmic Antiinfective-Antiinflam.
Migraine Agents
Anti-Estrogen
Migraine Agents
Anti-Metabolite
Ophthalmic Agents
Ophthalmic Adrenergic Agents
Opthalmic AntiInflamatory
Muscle Relaxant Agents
Ophthalmic Antiinfective Agents
neomycin/polymixinB/grama Neosporin Monday, September 23, 2013
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Opthalmic Cycloplegic Mydriatic
Respiratory adrenergic Combinations
Thyroid Agents
Dessicated (T4 T3)
Miscellaneous
Respiratory anticholinergic
Respiratory beta-adrenergic
T4
Respiratory bronchodilator--Xanthine
Topical Agents
Respiratory Nasal Spray
Opthalmic Decongestant
Opthalmic Diagnostic
Respiratory steroid inhalant
Opthalmic Local Anesthetics
Opthalmic Sympathomimetic
Otic Agents
Scabicides/Pediculicides
Miscellaneous
Sex Hormones
Respiratory/Asthma
Androgen Hormone Inhibitor
Miscellaneous
Smoking Deterents
smoking deterents
Monday, September 23, 2013
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Uricosurics (Gout Agents)
Vitamin/Mineral
Miscelaneous
Womens' Health
Antifungal (Vaginal)
Bisphosphonates 35mg and 70mg
Estrogen (vaginal)
Estrogens (Oral)
Progestins
Monday, September 23, 2013
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HSA Pharmacy Drug/Brand Alpha MCA Report
Updated on 9/23/13 9:51:49 AM
belladonna Donnatal
Ciprofloxacin- Cipro HC
alkaloids/phenobarbital
Hydrocortisone
abacavir/lamivudine Epzicom
betamethasone (all Diprolene, etc
citalopram Celexa
acetazolamide Diamox
clarithromycin Biaxin
acetic acid VoSol
betaxalol Betoptic-S
clindamycin Cleocin
acetic VoSol HC
blood glucose strips True Track(#100/30d
acid/hydrocortisone
clindamycin 1% Lotion Cleocin 1% Lotion
acyclovir Zovirax
clindamycin soln. Cleocin 1% soln
blood glucose strips #100/90 days if NOT
afluzosin Uroxatral
clobetasol All Forms Olux, Temovate
albuterol Proventil
brimonidine tartrate Alphagan
clonazepam Klonopin
albuterol plus Duoneb
brinzolamide Azopt
clonidine Catapres
ipratropium
budesonide Pulmicort Flex and R
clopidrogel Plavix
alcohol swabs
budesonide Rhinocort Aqua
Clozapine Clozaril
Alendronate Fosamax
buprenorphine 2mg/8mg subutex
codeine/APAP 30mg Tylenol #3 #4
allopurinol Zyloprim
bupropion Wellbutrin, SR,XL
alprazolam Xanax
colchicine Colcrys
buspirone Buspar
alubuterol/ipratropium Duoneb
congugated estrogens Premarin Crm
amiodarone Cordarone/Pacerone
cyclobenzaprine Flexeril
candesartan cilextil Atacand
amitriptyline Elavil
Cyclomydril- Cyclomydril
candesartan cilextil Atacand HCT
phenylephrine
amlodipine Norvasc
captopril Capoten
Cyclopentolate Cyclogyl
amoxicillin Amoxil
Carbachol Isopto Carbachol
amoxicillin clavulanate Augmentin
carbamazepine Tegretol
antipyrine/benzocaine Auralgan
D, L-amphetamine IR;XR Adderall IR; XR
carvedilol Coreg
Apraclonidine Iopidine
D-amphetamine IR;XR Dexedrine IR; XR
ceftriaxone Rocephin
atazanavir Reyataz
dapsone dapsone
celecoxib Celebrex
atenolol Tenormin
darunavir Prezista
cephalexin Keflex
atorvastatin Lipitor
desimpramine Norpramin
chlordiazepoxide Librium.detox. max 5
Atropine Sulfate Isopto Atropine
Dexamethasone Maxidex
azelastine Astelin
dexamethasone Decadron
chlorhexidine Hibiclens
azithromycin Z-pak
diclofenac Voltaren
chlorpromazine Thorazine
azithromycin Zithromax
dicloxacillin Dynapen
chlorthalidone Hygroton
dicyclomine Bentyl
ciclopirox 1% Shampoo Loprox Shampoo
digoxin Lanoxin
bacitracin
ciprofloxacin Ciloxan
diltiazem Cardizem
baclofen Lioresal
ciprofloxacin Cipro
diphenhydramine Benadryl
beclomethasone Qvar 80mcg
ciprofloxacin/dexameth Ciprodex
diphenoxylate/atropine Lomotil
Monday, September 23, 2013
Page 1 of 4
disulfiram Antabuse
fluticasone 50mcg Flonase
divalproex sodium Depakote DR, ER
furosemide Lasix
Ibuprofen Motrin
D-methylphenidate Ratalin IR;SR
imipramine Tofranil
gabapentin Neurontin
indomethacin Indocin
doxazosin Cardura
gemfibrozil Lopid
inhaler/spacer Aerochamber
doxazosin Cardura XL
gentamycin Garamycin
Insulin Lantus
doxepin Sinequan
glimeperide Amaryl
Insulin Novolin
doxycycline Vibramycin
glipizide Glucotrol XL
Insulin Humalog
glipizide Glucotrol
Insulin Apidra
efavirenz Sustiva
glucometer True Track One
insulin needles/syringes
efavirenz+tenofovir+emt Atripla
ipratropium Atrovent
ricitabine
glyburide Micronase
ipratropium/albiterol Combivent Respimat
eletriptan Relpax
guaifenesin/codeine Robitussin AC
ipratropium/albuterol Combivent
Emedastine Emadine
isoniazid INH
enoxaparin Lovenox
Haloperidol Haldol
isosorbide mononitrate Imdur
epinephrine auto- Epi Pen
Homatropine Isopto Homatropine
injector
hydralazine Apresoline
ergocalciferol Drisdol
hydrochlorothiazide Hydrodiuril
ketoconazole Nizoral
erythromycin Ilotycin
hydrocodone/APAP Vicodin
erythromycins Ery Tab, EES
esomeprazole Nexium
labetalol Normodyne
hydrocodone/APAP
estradiol Estrace Crm
lactulose Cephulac
estradiol vaginal tabs Vagifem
lamivudine Epivir
hydrocodone/APAP Norco
ethambutol Myambutol
lamotrigine Lamictal
etravirine Intelence
hydrocodone/APAP Lortab
latanoprost Xalatan
hydrocodone/APAP
leflunomide Arava
ferrous sulfate Feosol
levetiracetam Keppra
fexofenadine Allegra, Allegra-D
hydrocodone/APAP Lortab all Forms
levoctetirizine Xyzal
finasteride Proscar
levofloxacin Levaquin…prior appr
Flecainide Tambocor
hydrocodone/APAP Vicodin ES
levothyroxine Levoxyl
fluconazole Diflucan
lidocaine viscous Xylocaine
fluocinolone Synalar
hydrocortisone 2.5%
liothyronine Cytomel
fluocinonide Lidex
hydromorphone Dilaudid
lisinopril Zestril
Fluorometholone Flarex
hydroxyzine HCl Atarax
Lithium Eskalith
fluoxetine Prozac
hydroxyzine pamoate Vistaril
loperamide Imodium
fluphenazine Prolixin
hyoscyamine Levsin, LevsinSL
lopinavir/ritonavir Kaletra
fluticasone Flovent
hyroxychloroquine Plaquenil
Monday, September 23, 2013
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lorazepam Ativan
naltrexone Revia
phenazopyridine Pyridium
losartan Cozaar
naproxen Naprosyn
phenobarbital
Lovastatin Mevacor
Natamycin Natacyn
Phenylephrine Mydfrin
Loxapine Loxitane
neomycin/polymixin/HC Cortisporin
phenytoin Dilantin
neomycin/polymixinB/gr Neosporin
Pilocarpine Isopto Carpine
amacidin
maraviroc Selzentry
pioglitazone Actos
Neomycin/Polymyxon/D Maxitrol
mebendazole Vermox
piroxicam Feldene
meclizine Antivert
polyethlyeneglycol soln GoLytely
nepafenac Nevanac
medroxyprogesterone Provera
polyethyleneglycol soln MoviPrep
nevirapine Viramune and XR
meloxicam Mobic
potassium chloride K-tabs
niacin Niaspan only
mesalamine Asacol
pravastatin Pravachol
nifedipine Procardia XL
metformin Glucophage
prazosin Minipress
nitrofurantoin/nitrofuran Macrobid
methadone 5mg 10mg Dolophine
Prednisolone Econopred
toin Macro
methimazole Tapazole
prednisone Deltasone
nitroglycerin Nitrostat
methocarbamol Robaxin
pregabalin Lyrica
nortriptyline Pamelor
methotrexate Trexall
primidone Mysoline
nystatin Mycostatin
methylprednisolone Medrol and Dosepak
probenecid Benemid
nystatin/triamcinolone Mycolog
metoclopramide Reglan
prochlorperazine Compazine
metoprolol Succ. Toprol;Toprol XL
promethazine Phenergan
Olanzapine Zyprexa
metoprolol Tart Lopressor
Proparacaine Alcaine
Olopatadine Patanol
metronidazole MetroGel Lotion/Crm
propranolol Inderal
omeprazole Prilosec
metronidazole Flagyl
pyrazinamide
ondansetron Zofran
metronidazole MetroGel 0.75% 1.0%
oxcarbazepine Trileptal
minocycline Minocin
quinapril Accupril
oxybutynin Ditropan
Mirtazapine Remeron
Quitiapine Seroquel all forms
oxycodone IR Roxicodone
mirtazapine Remeron
oxycodone/APAP 5/325 Percocet
montelukast Singulair
oxycodone/APAP
raltegravir Isentress
morphine S04 IR 15mg All Forms
10/325mg
ranitidine Zantac
oxycodone/APAP Percocet
rifampin Rifadin
morphine SO4 ER 15mg MS Contin
7.5/325mg
rilpivirine+tenofovir+emt Complera
30mg 60mg
racitabiine
Moxifloxacin Vigamox
paroxetine Paxil
Rimexolone Vexol
mupirocin Bactroban
penicillin VK Veetids,V-cillin K
Risperidone Risperdal
pentoxiphylline Trental
ritonavir Norvir
nabumetone Relafen
permethrin Elimite
rosuvastatin Crestor
nadolol Corgard
perphenazine Trilafon
Monday, September 23, 2013
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salsalate Disalcid
trazodone Desyrel
Scopolamine Isopto Hyoscine
triamcinolone Nasacorrt AQ
sertraline Zoloft
triamcinolone (all forms)
silver sulfadiazine Silvadene
triamterene/hydrochloro Dyazide
simvastatin Zocor
thiazide
Sodium Fluorescein` Fluorescite
trifluoperazine Stelazine
spironolactone Aldactone
Tropicamide Mydriacyl
sulcralfate Carafate
sulfacetamide sodium Sulamyd
varenicline Chantix 0.5mg; 1mg
venlafaxine XR Effexor XR
sulfamethoxazole/trimet Septra
verapamil Calan
sulfasalazine Azulfidine
warfarin Coumadin
sumatriptan Imitrex 1month,then
Sumatriptan Imitrex
zafirlukast Accolate
zidovudine/amivudine Combivir
tamoxifen Nolvadex
Ziprasidone Geodon
tamsulosin Flomax
zolmitriptan Zomig/Zomig ZMT
temazepam Restoril
zolpidem Ambien
tenofovir Viread
tenofovir/emtricitabine Truvada
terazosin Hytrin
tetracycline Sumycin
theophyline Theo Dur
Thioridazine Mellaril
Thiothixene Navane
Thyroid Dessicated Armour Thyroid
timolol maleate Timoptic
tobramycin Tobrex
Tobramycin/Dexamethas Tobradex
tolteradine Detrol LA
topiramate Topamax
torsemide Demadex
tramadol Ultram
travoprost Travatan
Monday, September 23, 2013
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Source: http://www.santacruzhealth.org/mca/pdfs/MCAFormulary.pdf