2014 Express Scripts Basic Formulary List
The 2014 Basic Formulary drug list is shown below. The formulary is the list of drugs included in your prescription drug benefit plan. Inclusion on the list does notguarantee coverage.
The following list is not a complete list of over-the-counter [OTC] products and prescription medical supplies that are on the formulary. The only OTC products andprescription medical supplies that appear on the list are in contracted classes. PLEASE NOTE: Brand-name drugs may move to nonformulary status if a generic version becomes available during the year. Not all the drugs listed are covered by all prescription drug benefit programs; check your benefit materials for the specific drugs covered and the copayments for your prescription drug benefit program. For specific questions about your coverage, please call the phone number printed on your member ID card. For the member: Generic medications contain the same active ingredients as
their corresponding brand-name medications, although they may look different in
color or shape. They have been FDA-approved under strict standards. For the physician: Please prescribe preferred products and allow generic
Brand-name drugs are listed in CAPITAL letters. Example: CELEBREX
substitutions when medically appropriate.
Generic drugs are listed in lower-case letters. Example: ibuprofen
A Created 11/1/2013. Please note that this document is subject to change. Any changes/updates to this document can be viewed at Express-Scripts.com. 2014 Express Scripts #2053 BASIC-A All Rights Reserved COMP2053A-14 (11/01/13) B C Created 11/1/2013. Please note that this document is subject to change. Any changes/updates to this document can be viewed at Express-Scripts.com. 2014 Express Scripts #2053 BASIC-A All Rights Reserved COMP2053A-14 (11/01/13)
clotrimazole/betamethasone dipropionate DAUNOXOME [INJ]
desloratadine orally disintegrating tablets donepezil
E D Created 11/1/2013. Please note that this document is subject to change. Any changes/updates to this document can be viewed at Express-Scripts.com. 2014 Express Scripts #2053 BASIC-A All Rights Reserved COMP2053A-14 (11/01/13) G F H Created 11/1/2013. Please note that this document is subject to change. Any changes/updates to this document can be viewed at Express-Scripts.com. 2014 Express Scripts #2053 BASIC-A All Rights Reserved COMP2053A-14 (11/01/13)
hyoscyamine orally disintegrating tablets isotretinoin
I J M K
medroxyprogesterone (contraceptive) [INJ]
ipratropium bromide nebulization solution
ipratropium/albuterol sulfate nebulization L Created 11/1/2013. Please note that this document is subject to change. Any changes/updates to this document can be viewed at Express-Scripts.com. 2014 Express Scripts #2053 BASIC-A All Rights Reserved COMP2053A-14 (11/01/13) O
ondansetron orally disintegrating tablets
N
mirtazapine orally disintegrating tablets
Created 11/1/2013. Please note that this document is subject to change. Any changes/updates to this document can be viewed at Express-Scripts.com. 2014 Express Scripts #2053 BASIC-A All Rights Reserved COMP2053A-14 (11/01/13)
PRECISION XTRA B-KETONE STRIPS [OTC] promethazine/phenylephrine
P Q
peg 3350/electrolytes powder for 4000 mL polysaccharide iron forte
R Created 11/1/2013. Please note that this document is subject to change. Any changes/updates to this document can be viewed at Express-Scripts.com. 2014 Express Scripts #2053 BASIC-A All Rights Reserved COMP2053A-14 (11/01/13) T
risperidone orally disintegrating tablets
rizatriptan orally disintegrating tablets
S Created 11/1/2013. Please note that this document is subject to change. Any changes/updates to this document can be viewed at Express-Scripts.com. 2014 Express Scripts #2053 BASIC-A All Rights Reserved COMP2053A-14 (11/01/13) Y Z V
zolmitriptan orally disintegrating tablets
W
water for injection, bacteriostatic [INJ]
X # U Created 11/1/2013. Please note that this document is subject to change. Any changes/updates to this document can be viewed at Express-Scripts.com. 2014 Express Scripts #2053 BASIC-A All Rights Reserved COMP2053A-14 (11/01/13)
AUCTION CATALOGUE Description Reserve £ ALBUMS, LEAVES & MIXED LOTS - S/book with sel'n of QE2 com'wlth m. inc 1977 S/book with sel'n of mainly u QE2 comm'wlth many commoner but no duplication (600+)S/cards duplicated m/u KG6/QE2 comm'wlth KUT-Zambia modest condition (580+)British Commonwealth, g-fu, over 60 countries (1000)British Commonwealth, g-fu, over 60 countries (1000)
Review Week 3 According to the federal Controlled Substances Act, a prescription for Tylenol no. 3 would be filed in which schedule? a. anxiety b. hyperkinesis isorder c. depression d. insomnia Which of the following names are correctly matched? A patient presents the following prescriptions from a primary physician: K-dur 20 mEQ qd, Nitro-Dur 0.2mglhr patch 1 qd for 12 hr, Nitrostat 0.4