Preferred Prescriptions®/ RX Selections™ Member Guide Please bring this guide with you on your next doctor visit.
Express Scripts manages your prescription drug benefit for your employer, plan sponsor, or health plan. Medco is now a part of the Express Scripts family of pharmacies. Preferred Prescriptions®/RX Selections™ is a formulary list of medications that may be covered under your prescription drug plan.This list was reviewed by an independent group of practicing doctors and pharmacists, and it contains medications made by most pharmaceutical manufacturers. It includes medications for many covered conditions. SAVING MONEY ON PRESCRIPTIONS Your plan may prefer some medications over others. These are called preferred drugs. You may pay:• Lowest co-payment/co-insurance for generic drugs• Higher co-payment/co-insurance for preferred brand-name
• Highest co-payment/co-insurance for nonpreferred
Your doctor may be able to help you save money by prescribing generic and preferred brand-name drugs if appropriate. So be sure to bring this guide with you on every visit to your doctor. Some commonly prescribed nonpreferred drugs are also listed in this guide for your reference. Please note: This guide does not contain a complete list of formulary and nonformulary drugs. It only lists the most commonly prescribed drugs. Visit Express-Scripts.com anytime to check the price and coverage of medications under your plan. Simply select “Price a medication” from the left hand menu and search for your medication to see pricing. Click “View coverage notes” on the pricing results page to see any coverage details. If you are a first-time visitor to Express-Scripts.com, please take a moment to register. (Be sure to have your member ID number and a recent prescription number handy.) Not all medications listed here are covered by every prescription drug plan. FINDING MEDICATIONS WITH LOWER CO-PAYMENTS/CO-INSURANCE This guide lists medications two ways to help you find some generic, preferred, and nonpreferred brand-name drugs.
SECTION I - ALPHABETICALLY BY DRUG CATEGORY (SUCH AS RESPIRATORY)Within each category, medications are listed in alphabetical order, with generic, preferred brand-name, and nonpreferredbrand-name drugs sorted separately:
Means a nonpreferred brand-name medication
SECTION II - ALPHABETICALLY BY BRAND NAMEAfter each nonpreferred brand-name drug, you will find possible generic and preferred brand-name alternatives. SAFETY CONSIDERATION SYMBOLS Here is a quick guide for you and your doctor, which explains our safety symbols. These symbols appear next to certain medications.
Means weigh risk of birth defects or other adverse outcomes.
The information in this guide was in effect at the time of printing and may be subject to change. SECTION I: THERAPEUTIC DRUG CATEGORIES ANTI-INFECTIVES (Antibiotics/Antifungals) Oral Penicillins Oral Cephalosporins Oral Tetracyclines
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes. Oral Erythromycins Oral Urinary Tract Oral Quinolones Oral Antifungal Oral Sulfas
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes. PSYCHOTHERAPEUTICS (Anxiety/Depression) Hypnotic Agents Tricyclic Antidepressants
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes. Miscellaneous Antidepressants Anxiolytics Antipsychotics
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes. Antidepressants SSRI Antidepressants Miscellaneous Psychotherapeutic
amphetamine aspartate/amphetamine sulfate/dextroamphetamine
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes. CARDIOVASCULAR (Blood Pressure/Heart/Cholesterol) Beta Blockers Dihydropyridines Nitroglycerin Patches Calcium Blockers Adrenergic Antagonists & Related
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes. Antilipidemics Angiotensin II Blockers & Renin Inhibitors
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes. Combination Antihypertensives ACE Inhibitors
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes. ENDOCRINE (Diabetes/Hormones/Contraceptives) Insulin Therapy Non-Insulin Hypoglycemic Agents
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes. Contraceptive Agents Blood Glucose Test
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes. Estrogens/Estrogen Combinations
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes. G I (Ulcer) Ulcer Drugs NSAIDS (Pain Relievers)
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes. NSAID COX- Inhibitors DRUGS TO TREAT OVERACTIVE BLADDER RESPIRATORY (Allergy/Asthma) Beta Agonists Oral Beta Agonist Inhalers Inhaled Steroids
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes. Nasal Corticosteroids Miscellaneous Pulmonary Agents
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes. OSTEOPOROSIS/PAGET’S DISEASE NEUROLOGICALS Anticonvulsants/ Anti-Seizure
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes. Drugs to treat Alzheimers Disease Migraine/Headache
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes. SECTION II: NONPREFERRED DRUGS AND THEIR POSSIBLE PREFERRED ALTERNATIVES Nonpreferred Possible Preferred Products
omeprazole (generic), Nexium® (AstraZeneca)
estradiol/norethindrone acetate (generic)
alendronate sodium (generic), ibandronate sodium
nifedipine ER (generic), amlodipine besylate (generic),nisoldipine (generic)
dextroamphetamine-amphetamine ER (generic)
atorvastatin calcium (generic), lovastatin (generic),pravastatin (generic), simvastatin (generic), Crestor®(AstraZeneca), Niaspan® (Abbott), VytorinTM(Merck/Schering)
Asmanex® (Schering), Pulmicort Flexhaler®(AstraZeneca), QVAR® (Ivax)
Asmanex® (Schering), Pulmicort Flexhaler®(AstraZeneca), QVAR® (Ivax)
Aviane® (Barr-branded generic*), Lessina® (Barr-branded generic*), Lutera® (Watson-branded generic*),Lybrel® (Wyeth)
estradiol patch (generic), Climara® (Berlex), Estraderm®(Novartis), Vivelle® (Novartis)
*Branded generics have the same co-payment as regular generics. Nonpreferred Possible Preferred Products
estradiol/norethindrone acetate (generic), Premphase® (Wyeth), Prempro® (Wyeth)
Arcapta Neohaler® Foradil® (Schering), Serevent Diskus® (GlaxoSmithKline)
Aricept® 5mg,10mg donepezil HCl (generic)
ibuprofen (generic), naproxen (generic), Celebrex®(Pfizer)
candesartan/hydrochlorothiazide (generic)
amoxicillin trihydrate/potassium clavulanate (generic)
amoxicillin trihydrate/potassium clavulanate (generic)
suspension200-28.5mg/5, 250-62.5mg/5,400-57mg/5
amoxicillin trihydrate/potassium clavulanate (generic)
amoxicillin trihydrate/potassium clavulanate (generic)
amoxicillin trihydrate/potassium clavulanate (generic)
metformin HCl (generic), pioglitazone (generic)
glimepiride (generic), pioglitazone (generic)
naratriptan HCl (generic), rizatriptan (generic), sumatriptan succinate (generic), Relpax® (Pfizer), Zomig®(AstraZeneca)
*Branded generics have the same co-payment as regular generics. Nonpreferred Possible Preferred Products
flunisolide (generic), fluticasone propionate (generic),triamcinolone acetonide (generic), Nasonex®(Schering), Rhinocort Aqua® (AstraZeneca), Veramyst®(GlaxoSmithKline)
Necon® (Watson-branded generic*), Nortrel®(Barr-branded generic*)
Foradil® (Schering), Perforomist® (Dey Labs), Proair HFA®(Teva), Serevent Diskus® (GlaxoSmithKline)
chloral hydrate (generic), temazepam (generic), triazolam (generic)
amlodipine besylate (generic), atorvastatin calcium(generic)
verapamil HCl tablet, sustained action (generic)
etodolac (generic), ibuprofen (generic), naproxen(generic)
amlodipine besylate (generic), nifedipine ER (generic)
diltiazem HCl capsule, sustained release 24 hr (generic)
diltiazem HCl capsule, sustained release 12 hr (generic)
etodolac (generic), ibuprofen (generic), naproxen(generic)
cefaclor (generic), cefdinir (generic), cefuroxime axetil (generic)
cefaclor (generic), cefdinir (generic), cefuroxime axetil (generic)
*Branded generics have the same co-payment as regular generics. Nonpreferred Possible Preferred Products
chlorthalidone (generic), clonidine HCl (generic)
cholestyramine (generic), Welchol® (Sankyo)
bisoprolol fumarate/hydrochlorothiazide (generic),metoprolol/hydrochlorothiazide (generic), propranololHCl/hydrochlorothiazide (generic)
verapamil HCl capsule, 24 hr sustained release (generic)
Caziant® (Watson-branded generic*), Cesia® (PrascoLabs-branded generic*), Velivet® (Barr-branded generic*)
metformin HCl (generic), Byetta® (Amylin Pharma),Janumet® (Merck), Januvia® (Merck), Onglyza®(Bristol-Myers Squibb)
Depakote® Sprinkle divalproex sodium (generic)Desogen®
Apri® (Barr-branded generic*), Solia® (Prasco Labs-branded generic*)
omeprazole (generic), Nexium® (AstraZeneca)
etodolac (generic), ibuprofen (generic), naproxen
etodolac (generic), ibuprofen (generic), naproxen
*Branded generics have the same co-payment as regular generics. Nonpreferred Possible Preferred Products
temazepam (generic), triazolam (generic), zaleplon(generic), zolpidem tartrate (generic)
famotidine (generic), ibuprofen (generic), naproxen(generic), omeprazole (generic)
hydrochlorothiazide (generic), metoprolol succinate(generic)
amlodipine besylate (generic), nifedipine ER (generic),nisoldipine (generic)
losartan potassium (generic), Atacand® (AstraZeneca),Benicar® (Daiichi Sankyo), Diovan® (Novartis), Micardis®(BIPI)
candesartan/hydrochlorothiazide (generic),irbesartan/hydrochlorothiazide (generic),losartan/hydrochlorothiazide (generic),valsartan/hydrochlorothiazide (generic), Benicar HCT®(Daiichi Sankyo), Micardis HCT® (Boehringer Ingelheim)
estradiol patch (generic), Climara® (Berlex), Divigel®(Upsher Smith), Estraderm® (Novartis), Vivelle®(Novogyne)
phenelzine sulfate (generic), tranylcypromine sulfate(generic)
carbamazepine (generic), divalproex sodium (generic),lithium carbonate (generic)
estradiol patch (generic), Divigel® (Upsher Smith)
estradiol patch (generic), Climara® (Berlex), Divigel®(Upsher Smith), Estraderm® (Novartis), Vivelle®(Novartis)
*Branded generics have the same co-payment as regular generics. Nonpreferred Possible Preferred Products
Apri® (Barr-branded generic*), Kariva® (Barr-brandedgeneric*), Microgestin Fe® (Watson-branded generic*)
Exelon® Capsules rivastigmine tartrate (generic)Factive®
ciprofloxacin (generic), levofloxacin (generic)
clozapine (generic), olanzapine (generic), quetiapinefumarate (generic), risperidone (generic), ziprasidoneHCl (generic), Seroquel XR® (AstraZeneca)
Estrace Vaginal Cream® (Warner Chilcott), Estring®(Pfizer)
fenofibrate (generic), Triglide® (Sciele), Trilipix® (Abbott)
Alvesco® (Sunovion), Asmanex® (Schering), PulmicortFlexhaler® (AstraZeneca), QVAR® (Ivax)
Alvesco® (Sunovion), Asmanex® (Schering), PulmicortFlexhaler® (AstraZeneca), QVAR® (Ivax)
dextroamphetamine-amphetamine ER (generic),methylphenidate CD (generic), methylphenidate ER(generic), Daytrana® (Shire US Inc.), Methylin ER®(Mallinckrodt Pharmaceuticals)
metformin HCl ER (generic), metformin HCl tablet(generic)
alendronate sodium (generic), Actonel® (WarnerChilcott), Atelvia® (Warner Chilcott),
alendronate sodium (generic), ibandronate sodium(generic)
naratriptan HCl (generic), rizatriptan (generic), sumatriptan succinate (generic), Relpax® (Pfizer), Zomig® (AstraZeneca), Zomig ZMT® (AstraZeneca)
metformin HCl ER (generic), metformin HCl tablet(generic)
*Branded generics have the same co-payment as regular generics. Nonpreferred Possible Preferred Products
griseofulvin ultramicrosize (generic), itraconazole(generic), ketoconazole (generic), terbinafine HCl(generic)
griseofulvin ultramicrosize (generic), itraconazole(generic), ketoconazole (generic), terbinafine HCl(generic)
clonidine HCl (generic), methyldopa (generic)
propranolol capsule, sustained action (generic)
propranolol capsule, sustained action (generic)
olanzapine (generic), quetiapine fumarate (generic),risperidone (generic), ziprasidone HCl (generic),Seroquel XR® (AstraZeneca)
verapamil HCl tablet, sustained action (generic)
clonidine HCl (generic), Intuniv® (Shire US Inc.)
*Branded generics have the same co-payment as regular generics. Nonpreferred Possible Preferred Products
atorvastatin calcium (generic), lovastatin (generic),simvastatin (generic), Altoprev® (Andrx), Crestor®(AstraZeneca), VytorinTM (Merck/Schering)
acebutolol HCl (generic), atenolol (generic), metoprolol tartrate (generic)
Aviane® (Barr-branded generic*), Lessina®(Barr-branded generic*), Lybrel® (Wyeth)
lithium carbonate tablet, sustained action (generic)
atorvastatin calcium (generic), lovastatin (generic),pravastatin (generic), simvastatin (generic), Crestor®(AstraZeneca)
Junel® (Barr-branded generic*), Microgestin®(Watson-branded generic*)
Junel Fe® (Barr-branded generic*), Microgestin Fe®(Watson-branded generic*)
fenofibrate (generic), Triglide® (First Horizon), Trilipix®(Abbott)
Amethia Lo® (Watson-branded generic*), Camrese Lo®(Teva-branded generic*)
benazepril HCl/hydrochlorothiazide (generic)
Maxair Autohaler® Proair HFA® (Teva), Ventolin HFA® (GlaxoSmithKline)
*Branded generics have the same co-payment as regular generics. Nonpreferred Possible Preferred Products
estradiol (generic), estropipate (generic), Cenestin®(Duramed/Barr), Enjuvia® (Duramed/Barr),Premarin® (Wyeth)
Climara Patch® (Berlex), Vivelle Patch® (Novartis)
isometheptene/apap/dichloralphenazone (generic)
naratriptan HCl (generic), rizatriptan (generic), sumatriptan nasal spray (generic), Relpax® (Pfizer),Zomig® Nasal Spray (AstraZeneca)
nitroglycerin patch (generic), Nitro-Dur® (Schering)
Necon® (Watson-branded generic*), Nortrel®(Barr-branded generic*)
Monistat 3 Vaginal miconazole 3 vaginal suppository (generic)
ciprofloxacin HCl (generic), sulfamethoxazole/trimethoprim (generic), trimethoprim (generic)
etodolac (generic), ibuprofen (generic), indomethacin(generic), meclofenamate sodium (generic), naproxen (generic), sulindac (generic)
chloral hydrate (generic), temazepam (generic),
*Branded generics have the same co-payment as regular generics. Nonpreferred Possible Preferred Products
Levora® (Watson-branded generic*), Portia®(Barr-branded generic*)
Necon® (Watson-branded generic*), Nortrel®(Barr-branded generic*)
ciprofloxacin HCl (generic), levofloxacin (generic),Avelox® (Merck)
flunisolide (generic), fluticasone propionate (generic),triamcinolone acetonide (generic), Nasonex®(Schering), Rhinocort Aqua® (AstraZeneca), Veramyst®(GlaxoSmithKline)
clotrimazole (generic), fluconazole (generic), nystatinsuspension (generic)
Apri®(Barr-branded generic*), Solia®(Prasco Labs-branded generic*)
MonoNessa® (Watson-branded generic*), Previfem®(Teva-branded generic*), Sprintec® (Barr-branded generic*)
MonoNessa® (Watson-branded generic*), TriNessa®(Watson-branded generic*)
Necon® (Watson-branded generic*), Nortrel®
estradiol/norethindrone acetate (generic), Premphase® (Wyeth), Prempro® (Wyeth)
TriNessa® (Watson-branded generic*), Tri-Previfem®(Teva-branded generic*), Tri-Sprintec® (Barr-brandedgeneric*)
TriNessa® (Watson-branded generic*), Tri-Previfem®
(Teva-branded generic*), Tri-Sprintec® (Barr-brandedgeneric*)
*Branded generics have the same co-payment as regular generics. Nonpreferred Possible Preferred Products
paroxetine HCl sustained release tab (generic)
etodolac (generic), ibuprofen (generic), naproxen(generic)
Plan B One-Step® Next Choice One Dose® (Watson-branded generic*)Ponstel®
etodolac (generic), ibuprofen (generic), indomethacin(generic), meclofenamate sodium (generic), naproxen (generic), sulindac (generic)
estradiol/norethindrone acetate (generic), Premphase® (Wyeth), Prempro® (Wyeth)
Estrace® Vaginal Cream (Warner Chilcott)
lansoprazole (generic), omeprazole (generic), Nexium®(AstraZeneca)
omeprazole (generic), Nexium® (AstraZeneca)
alendronate sodium (generic), ibandronate sodium(generic), Evista® (Eli Lilly), Forteo® (Eli Lilly)
pantoprazole sodium (generic), omeprazole (generic),Nexium® (AstraZeneca)
Proair HFA® (Teva), Ventolin HFA® (GlaxoSmithKline)
*Branded generics have the same co-payment as regular generics. Nonpreferred Possible Preferred Products
cholestyramine (generic), prevalite (generic)
cholestyramine/aspartame (generic), prevalite (generic)
mirtazapine soltabs (generic), mirtazapine tabs (generic)
methylphenidate ER (generic), dextroamphetamine sulfate (generic), dextroamphetamine-amphetamineER (generic), methylphenidate CD (generic), Daytrana®(Shire US Inc.)
clozapine (generic), olanzapine (generic), quetiapinefumarate (generic), risperidone (generic), ziprasidoneHCl (generic), Seroquel XR® (AstraZeneca)
Amethyst® (Watson-branded generic*), Jolessa®(Barr-branded generic*), Quasense® (Watson-brandedgeneric*),
Amethia® (Watson-branded generic*), Camrese®(Teva-branded generic*)
chloral hydrate (generic), temazepam (generic), triazolam (generic)
minocycline HCl (generic), doxycycline monohydrate(generic)
cefaclor (generic), cefdinir (generic), cefuroxime axetil(generic)
*Branded generics have the same co-payment as regular generics. Nonpreferred Possible Preferred Products
etodolac (generic), ibuprofen (generic), naproxen(generic)
nisoldipine (generic), amlodipine besylate (generic),isradipine (generic), nifedipine ER (generic)
cefdinir (generic), cefuroxime axetil (generic)
fluoxetine HCl (generic), olanzapine (generic), quetiapine fumarate (generic), risperidone (generic),Seroquel XR® (AstraZeneca)
eprosartan mesylate (generic), losartan potassium(generic), Atacand® (AstraZeneca), Benicar® (DaiichiSankyo), Diovan® (Novartis), Micardis® (BIPI)
candesartan/hydrochlorothiazide (generic),losartan/hydrochlorothiazide (generic),valsartan/hydrochlorothiazide (generic), Benicar HCT®(Daiichi Sankyo), Micardis HCT® (BIPI)
Thioridazine HCl® chlorpromazine HCl (generic), haloperidol (generic),
quetiapine fumarate (generic), risperidone (generic)
diltiazem HCl capsule, sustained release 24 hr (generic)
etodolac (generic), ibuprofen (generic), indomethacin(generic), meclofenamate sodium (generic), naproxen (generic), sulindac (generic)
*Branded generics have the same co-payment as regular generics. Nonpreferred Possible Preferred Products
Necon® (Watson-branded generic*), Nortrel®(Barr-branded generic*)
enalapril maleate/hydrochlorothiazide (generic)
Vibramycin® Syrup Vibramycin® Suspension (Pfizer)Vivactil®
Voltaren® Tablets etodolac (generic), ibuprofen (generic), naproxen
etodolac (generic), ibuprofen (generic), naproxen(generic)
bupropion HCl tablet, sustained release (generic)
bupropion HCl tablet, extended release (generic)
clonidine HCl (generic), methyldopa (generic)
Proair HFA® (Teva), Ventolin HFA® (GlaxoSmithKline)
omeprazole/sodium bicarbonate (generic), omeprazole(generic), Nexium® (AstraZeneca)
bisoprolol fumarate/hydrochlorothiazide (generic)
*Branded generics have the same co-payment as regular generics. Nonpreferred Possible Preferred Products
carbamazepine (generic), clonazepam (generic) ethosuximide (generic,) phenobarbital (generic), phenytoin sodium (generic), Lyrica® (Pfizer)
*Branded generics have the same co-payment as regular generics.
This guide does not contain a complete list of formulary and nonformulary drugs. It only liststhe most commonly prescribed drugs. Visit Express-Scripts.com anytime to check the priceand coverage of medications under your plan. Simply select “Price a medication” from the left-hand menu and search for your medication to seepricing. Click “View coverage notes” on the pricingresults page to see any coverage details. If you area first-time visitor to Express-Scripts.com, pleasetake a moment to register. (Be sure to have yourmember ID number and a recent prescriptionnumber handy.) Or, for an updated and completelisting of your prescription benefit, call customerservice at the phone number on the back of yourprescription card.
Express Scripts and Medco have come together as one company, soMedco is now a part of the Express Scripts family of pharmacies.
2013 Express Scripts Holding Company. All rights reserved.
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