affordable + rxboost formulary drug list

Table of Contents

Affordable PlanRxValue Formulary pg. 2-11

RxBoost Formulary pg. 12-17

Formulary Drug ListAffordable + RxBoost

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© PRAM INSURANCE SERVICES, INC.PG 1 OF 10

2020 RxVALUE FORMULARYThe following list by drug category contains generic drugs that are available to members

of the RxValue prescription Plan. The generic drugs (listed in lowercase) are available at a copay up to the monthly maximum benefit of the plan. All drugs not contained on this list

are not eligible for the copay benefit, however, are eligible at PRAM’s discounted rate. Please refer to your benefit materials for Limitations and Exclusions. Quantity limits per copay may

apply to certain medicaitons. This list is continually evaluated and changes can occur at any time. Please contact PRAM to confirm the most current drug list. We encourage you to share this list with

your physician at the time of your treatment.

*NO BRAND NAME DRUGS ARE COVERED ON THIS FORMULARY, ALL BRAND NAMES ARE PROVIDED STRICTLY FOR CROSS REFERENCE TO THE APPLICABLE COVERED GENERIC.

Category Covered Generic Name Brand Name*Anti-Infective Antibiotics Cephalosporins cefaclor Ceclor

cefadroxil Duricefcefdinir Omnicefcefprozil Cefzilcephalexin Keflex

Erythromycins & Other Macrolides

azithromycin Zithromax / Z-PAKclarithromycin Biaxin, Biaxin XLerythromycin ethylsuccinate EES, EryPederythromycin stearate Erythrocin

Penicilins amoxicillin Amoxilamoxicillin / pot. Clav Augmentindicloxacillin Dicloxacillinpenicillin VK Pen-Vee K

Quinolones ciprofloxacin Ciprolevofloxacin Levaquinofloxacin Floxin

Tetracyclines doxycycline Vibramycinminocycline Minocintetracycline Achromycin V

Antifungals clotrimazole / betamethasone Lotrisoneeconazole Spectazolefluconazole Diflucangriseofulvin Gris-PEG / Grifulvinketoconazole Nizoralmetronidazole Flagylnystatin oral Mycostatinterbinafine Lamisiltolnaftate

Antifungals - (Vaginal) clotrimazole Mycelex-7fluconazole Diflucanmiconazole Monistat

Anti-Infective Specialized Indications

ethambutol HCI Myambutolhydroxychloroquine Plaquenilmebendazole Vermoxneomycin

Antineoplastic/ Immunosupressants

azathioprine Imurancyclophosphamide Cytoxanflutamide Eulexinhydroxyurea Hydrealeucovorin Wellcorovin



Category Covered Generic Name Brand Name*Anti-Infective (cont.)

Antineoplastic/ Immunosuppressants (cont.)

megestrol Megacemethotrexatetamoxifen Nolvadex

Anti-Tubercular ethambutol MyambutolAntivirals acyclovir Zovirax

amantadine Symmetrelnevirapine Viramumerimantadine Flumadinezidovudine Retrovir

OtherAnti-Infectives

clindamycin HCI Cleocinisoniazid Nydrazidmethenamine Urexmethanamine/ sod bis/ phenyl salicyl/ methylene blue / hyos

Urimax

nitrofurantoin Macrodantin/ Macrobidrifampin Rifadintrimethoprim Trimpex

Topical Antibacterial silver sulfadiazine SilvadeneTopical Antifungals ciclopirox Loprox

ketoconazole cream/ shampoo Nizoral nystatin ointment

nystatin / triaminolone MycologAutonomicand CentralNervousSystem

Analgesics, Antimigrainal

pentazocine / naloxone Talacen / Talwin NXsumatriptan Imitrextramadol Ultram

Analgesics, Narcotics APAP / codeine Tylenol w/ CodeineAPAP / hydrocodone Vicodin / NorcoASA / codeine Empirin w/ Codeinebuprenorphine HCL/ Naloxone HCL Suboxonebuprenorphine HCI Subutexbutalbital/ acetaminophen Phrenlin, Sedapapbutalbital/ acetaminophen/ caffeine Floricethydrocodone/ ibuprofen Vicoprofenmeperidine Demerolmepiridine/ promethazine Meperganmorphine sulfate MSIR, MSContinoxycodone OxyIRoxycodone/ APAP Percocetoxycodone/ ASA Percodan

Analgesics, Non-SteroidalAnti-Inflammatory

colchicine HCL Mitgarediclofenac sodium Voltaren XRdiflunisal Dolobidibuprofen Motrinketorolac Toradolmeloxicam Mobicnaproxen Naprosynoxaprozin Daypropiroxicam Feldene

2020 RxVALUE FORMULARY*NO BRAND NAME DRUGS ARE COVERED ON THIS FORMULARY, ALL BRAND

NAMES ARE PROVIDED STRICTLY FOR CROSS REFERENCE TO THE APPLICABLE COVERED GENERIC.



Category Covered Generic Name Brand Name*Autonomicand CentralNervousSystem (cont.)

Anticonvulsants carbamezepine Tegretolclorazepate Tranxenedivalproex NA Depakote Sprinkle/ Depakote ERethosuximide Zarontingabapentin Neurontinlithium carbonatephenobarbitalphenytoin/ pheyntoin extended Dilantinprimidone Mysoline

topiramate Topamaxvolproic acid/ valproate sodium Depakene/ Depakote

Antiparkinsons amantadine Symmetrelbenzatropine mesylate Cogentinbromocriptine Parlodelcarbidopa/ levodopa Sinemet/ Sinemet CRropinirole HCI Requipselegiline Eldepryltrihexyphenidyl Artane

Antipsychotics chlorpromazine Thorazineclozapine Clozarilfluphenazine Prolixinhaloperidol Haldolloxapine Loxitaneperphenazinequetiapine fumarate Seroquelrisperidone Risperdalthioridazine Mellarilthiothixene Navanetrifluoperazine Stelazine

Antivertigo/ Antiemetics hydroxyzine Ataraxmeclizine HCI Antivertondansetron Zofranolanzapine Zyprexaprochlorperazine Compazinepromethazine HCI Phenergan

promethazine HCI suppository, rectal Phenergantrimethobenzamide Tigan

Anxiolytics, Sedatives and Hypnotics alprazolam Xanaxaquachloral supprettes Noctecbuspirone Busparchlordiazepoxide HCI Libriumclonazepam Klonopindiazepam Valiumestazolam Prosomfluzapam Dalmanelorazepam Ativan





Category Covered Generic Name Brand Name*Autonomicand CentralNervousSystem(cont.)

Anxiolytics, Sedatives and Hypnotics(cont.)

oxazepam Seraxtemapzepam Restoriltriazolam Halcionzolpidem tartrate Ambien

CNS Stimulants amphetamine / dextroamphetamine

Adderall

destroamphetamine Dexedrine / Destrostatmethylphenidate Ritalin / Methylinmemantine Namenda

Drugs to Prevent and Treat Gout allopurinol Zyloprimprobenecid

Muscle Relaxants/ Antispasmodics baclofen Lioresalcarisoprodol Somacarisoprodol and aspirin Soma Compoundcarisoprodol, aspirin, codeine Soma Compound with Codeinechlorazoxazone Parafon Forte DSCcyclobenzaprine Flexerilmetaxalone Skelaxin

methocarbamol Robaxintizanidine Zanaflex

Psychotherapeutics Antidepressants amitriphtyline Elavilamitriptyline / chlordiazepoxide Limbitrolamitriptyline / perphenazine Triavilamoxapine Asendinbupropion Wellbutrin & Wellbutrin SR,

Wellbutrin XLcitalopram Celexaclomipramine Anafrildesirpramine Norpramindoxepin Sinequanduloxetine Cymbalta

fluoxetine Prozacfluvoxamine Luvoximipramine Tofranilmaprotiline Ludiomilmirtazapine Remeronnortriptyline Pamelorparoxetine Paxilsertraline Zolofttrazodone Desyrelvenlafaxine HCI Effexor XR

Cardiovascular ACE Inhibitors captopril Capotenenalapril Vasoteclisinopril Zestrilquinapril Accupril





Category Covered Generic Name Brand Name*Cardiovascular(cont.)

Alpha Blockers doxazosin Carduraprazosin Minipressterazosin Hytrin

AngiotensinReceptor Blockers

irbesartan Avaprolosartan Cozaarolmesartan medoxomil Benicarvalsartan Diovan

Antiarrhythmics amiodarone Cordaronedisopyramide Norpacemexiletine Mexitilnitroglycerinprocainamide Procainamidepropafenone Rythmolquinidine

Beta-Adrenergic Antagonists

acebutolol Sectralatenolol Tenorminbetaxolol Kerlonebisoprolol Zebetacarvedilol Coreglabetolol Normodynemetoprolol Lopressormetoprolol succinate Toprol XLnadolol Corgardpindolol Viskenpropranolol Inderalsotalol Betapacetimolol Blocadren

Calcium Channel Blockers amlopidine Norvascdiltiazem Cardizem/ SR / Dilacor XRmatzim LA Cardizem LAnicardipine Cardenenifedipine Procardia XLverapamil Calan SR / Isoptin SR

Cardiac Glycosides digoxin LanoxinCholesterol - Lowering atorvastatin Lipitor

cholestyramineezetimibe Zetiagemfibrozil Lopidlovastatin Mevacorniacinpravastatin Pravacholrosuvastatin Crestorsimvastatin Zocor

Diuretics amiloride / HCTZ Modureticbumetanide Bumexchlorthalidone Hygroton





Category Covered Generic Name Brand Name*Cardiovascular (cont.)

Diuretics (cont.) furosemide Lasixhydrochlorothiazideindapamide Lozolmethazolamidemetolazone Zaroxolynspironolactone Aldactonetorsemide Demadex

Diuretic Combinations atenolol / chlorthalidone Tenoreticbisoprolol / hydrochlorthiazide Ziaccaptopril / hydrochlorthiazide Capozidechlorothiazide Diurilenalapril / hydrochlorthiazide Vasoreticlisinopril / hydrochlorthiazide Zestoreticmethyldopa / hydrochlorthiazide Aldorilpropranolol / hydrochlorthiazide Inderidespironolactone / hydrochlorthiazide Aldactazidetriamterene / hydrochlorthiazide Dyazide

Other Antihypertensives clonidine Catapresguanfacine Tenexhydralazine Apresolinemethyldopa Aldometminoxidil Lonitenquinine sulfate Qualaquin

Other Cardiovascular Drugs pentoxifylline TrentalVasodilating isosorbide dinitrate Isordil

isosorbide mononitrate Imdurisoxsuprine Vasodilannitroglycerin Nitrolingual

Dermatologicals Anti-Acne clindamycin Celocin-T / Clindets Pledgetssulfacetamide Novacet / Sulfacet-R

Antipsoriasis selenium sulfide Exsel / SelsunOther Dermatological aluminum chloride DrysolTopical Corticosteroids alclometasone Aclovate

amcinonide Cyclocortaugmented betamethasone diproprionate

Diprosone, Maxivate

betamethasone valerate Valisoneclobetasol propionate Temovate/ Edesonide DesOwendesoximetasone Topicortfluocinaide Lidex-Efluocinolone acetonide Synalar / Derma SmootheFSmometasone furoate Eloconprednicarbate Dermatop

Ear, Nose & ThroatMedications

Drugs Affecting the Ear acetic acid VoSolacetic acid / aluminum acetate Domeboro Oticantipyrine / benzocaine Auralgan/ AB Otic Solution





Category Covered Generic Name Brand Name*Ear, Nose & Throat Medications(cont.)

Drugs Affecting the Ear (cont.) hydrocortisone / acetic acid Acetasol HCneomycin / polymyxin / hc Cortisporin

ofloxacin Floxin Otic

Drugs Affecting the Throat and Mouth

chlorhexidine Peridexlidocaine HCI viscous solution Xylocaine Viscous Gelsodium fluoride Gel-Kamtriamcinolone acetonide Kenalog in Orabase

EndocrineMedications

Adrenal Corticosteroid dexamethasone Hexadrolfludricortisone Florinefhydrocortisone Cortefmethylprednisolone Medrol / Medrol Pakprednisolone Orapred / Pediapredprednisone Deltasone

Antidiabetic Agents chlorpropamide Diabineseglimepiride Amarylglipizide Glucotrolglyburide Diabeta/ Glynaseglyburide / metformin Glucovancemetformin Glucophagemiglitol Glysetnateglinide Starlixpioglitazone Actosrepaglinide Prandin

Drugs to Treat Osteoporosis

alendronate Fosamaxrisedronate sodium Actonel

Thyroid and Anti-Thyroid levothyroxine Synthroid / Levoxylmethimazolepropylthiouracilthyroid

Gastrointestinal Antispasmodics belladonna alkaloids Anti-Spas

belladonna alkaloids/ phenobarbital Donnataldiphenoxylate / atropine Lomotilclidinium / chlordiazepoxide Libraxdicyclomine Bentylhyoscyamine Levsinmetoclopramide Reglan

Other Gastrointestinal electrolyte solution/ PEG’s Golytelyhydrocortisone suppositories Anusol HCmagnesium oxide Mag-Oxmisoprostol CytotecPEG 3350 / electrolytes solution Colytepramoxine / hydrocortisone / chloroxylenol

Cortane B

sulfasalizine AzulfidineProton Pump Inhibitors omeprazole Prilosec

lasoprazole Prevacidpantoprazole Protonix





Category Covered Generic Name Brand Name*Nutrition,BloodModifiers and Electrolytes

Drugs and VitaminsAffecting Coagulation

clopidogrel Plavixdipyridamole Persantineticlopidine Ticlidwarfarin Coumadin

Fluoride Products sodium fluoride Karidium/ LuridePotassium Supplements potassium chloride K-DUR/ Micro-KVitamins / Minerals ergocalciferol Calciferol

folic acid Folatepyridoxinezinc sulfate

Ophthalmic Glaucoma acetazolamide Diamoxapraclonidine Lopidinebetaxolol Betoptic / Sbrimonidine tartrate Alphagancarteolol Ocupressdipivefrin AKProdorzolamide Trusoptlatanoprost Xalatanlevobunolol Betaganmetipranolol Optipranololpilocarpine Pilocartimolol Timoptic/ XE

Ophthalmic Topical Antibacterial

bacitracin Ak-Tracinciprofloxacin Ciloxan ofloxacin Ocufloxoxytetracycline/ polymyxin B Terramycin and Polymyxin B

Ophthalmicsulfacetamide Bleph-10tobramycin Tobrex

Ophthalmic Antihistamines azelastine HCL OptivarOphthalmic Anti-Infectives/ Corticosteroids

gentamicin Garamycinneomycin / bacitracin / polymyxin Neosporinneomycin / bacitracin / polysporin / hydrocortisone

Cortisporin

neomycin / dexamethasone / polymyxin Dexacidin/ MaxitrolOphthalmic Anti-Infectives/ Corticosteroids(cont.)

polymyxin B / trimethoprim Polytrimsulfacetamide / prednisolone Blephamidesulfacetamide / prednisone Vasocidin

Ophthalmic Corticosteroids dexamethasone Decadronfluroromethalone FML Liquifilmprednisolone Econopred Plus / Pred Forteprednisolone Forte

Ophthalmic Topical Antivirals trifluridine ViropticOther Ophthalmic cyclopentolate Cyclogyl





Category Covered Generic Name Brand Name*Obstetrical and Gynecological

Androgens danazol DanocrineContraceptives drosprienone/ehtinyl estradiol Yaz, Yazmin

ethinyl estradiol and desogestrel Ortho-Cept/ Desogenethinyl estradiol and ethynodiol diacetate Zoviaethinyl estradiol and levonorgesterel Triphasil/ Levlennorethindrone NorQD/ Ortho Micronornorethindrone / estradiol / fe fumarate Loestrin-fenorethindrone / ethinyl estradiol Mircettenorethindrone / ethinyl estradiol Modiconnorethindrone / mestranol Ortho-Novumnorgestrimate / ethinyl estradiol Ortho Cyclennorgestrimate / ethinyl estradiol Ortho Tri-Cyclennorelgestromin/ ethinyl estradiol patch Xulane/ Ortho Evra

Estrogen Patches estradiol Vivelle/DotOral Estrogens estradiol Estrace

estropipate Ortho-Est/ OgenPrenatal Vitamins All vitamins are preferred on formularyProgestins medroxyprogesterone Provera

norethindrone Aygestinprogesterone Prometrium

Respiratory, Allergy, Coughand Cold

Antihistamines/ Anti-Allergenics

cyproheptadine Cyproheptaddexchlorpheniramine tablet SA Polaramine Repetabfexofenadine Allegrahydroxyzine pamoate Vistarilmontelukast sodium Singulair

Anti-Tussive Combinations guaifenesin / codeine Robitussin A-Cguaifenesin / PSE / hydrocodone Deconamine CXguaifenesin / hydrocodone Codiclearhydrocodone / homatropine Hydromethydrocodone / potassium guiaco CoTussphenylephrine / hydrocodone / GG Levall 5.0phenylephrine / pyrilamine / DM PolyHist DMphenylephrine / pyrilamine / hydrocodone

Codimal DH

promethazine / codeinephenylephrine / chlorphen / hydrocodone

HC Tussive & Histinex HC

promethazine / DM

pseudoephedrine / brompheniramine / hydrocodone

Brovex HC

pseudoephedrine w/ codeine / GG Codafedpseudoephedrine-CPM / hydrocodone Genecof-HCpseudoephedrine / hydrocodone Pancofpseudoephedrine / hydro / GG Hydrotussin





Category Covered Generic Name Brand Name*Beta AgonistInhalers

metaproterenol Alupent

Inhaled CorticosteroidsIntranasal Steroids

flunisolide Nasalidefluticasone Flonasemometasone furoate Nasonex

Beta Agonist Oral albuterol Proventilalbuterol, multiphasic release Proventilmetaproterenol sulfate

Decongestants/ Antihistamines benzonatate Tessalon Perlecyproheptadine Periactinpseudoephedrine / chlorpheniramine tab / syrup / cap SA

Deconamine SR/ Deconamine

pseudoephedrine / methscopolamine Allerx-DExpectorant CombinationsLeukotriene ModifiersMiscellaneous Pulmonary Agents

guaifenesin / PSE / hydrocodone Guaifed/ Deconsal/ Entex PSEmontelkast sodium Singulairacetylcysteine Mucomyst

cromolyn sodium ampul Intalipratropium Atrovent Inhaler/ Nasal Spray

Pulmonary Agents Xanthines aminophyllinedyphyllinetheophylline Theo-Dur/ Slo-Phyllin/ Theolair-SR

UrologicalMedications

Anticholinergics/ Antispasmodics

flavoxate Urispas

Benign Prostatic Hypertrophy tamsulosin HCL FlomaxMiscellaneous Urologicals oxybutynin Ditropan

phenazopyridine Pyridiumtamsulosin HCL Flomaxterazosin Hytrin

Other Genitourinary Products potassium citrate Urocit-Kpotassium phosphate K-Phos



DRUG NAME DRUG NAME DRUG NAMEAbilify Aristada Breo ElliptaAbilify M Armour Thyroid Breo ElliptaAbrilada (Biosimilar Remicade) Arnuity Ellipta Breo Ellipta 200Absorica Arranon Breo Ellipta 100Accutane (isotretinoin) Arzerra Breo Ellipta 200achtar Asacol BrilintaActemra SC Asacol 800mg Brineuraactimmune Asmanex Twisthaler BrukinsaAcuvail Asmanex/Asmanex HFA BydureonAdakevo Asragraf XL BydureonAdcentris Atripla Bydureon 2/0.85 mlAdcirca Atrovent HFA BystolicAdhansia XR Aubagio Bystolic 10AdvairHFA /Advair Diskus auryxia Bystolic 5Advate Austedo CabometyxAdynovate Avandia CalquenceAerochamber Plus Avastin CanasaAfinitor Avonex CapecitabineAimovig Avsola (remicaid biosim) CapecitabineAiromir Avycaz CaplytaAjovy Azopt CarbagluAkynzeo Bagsimi CaystonAldurazyme Balversa Cerdelga Aliqopa Baraclude CerezymeAlphagan P barhemsys CetrotideAlprolix Basaglar KwikPen (5 x 3ml) ChantixAlunbrig Basalgar CholbamAmitiza Bebulin VH CialisAmlodipine Benefix Cialis 10mgAmpyra Benicar/Olmetec Cialis 20mgAmzeeq Benlysta Cialis 5mgAnjeso Beovu CimduoAnnovera Betaseron-Betaplus CimziaAnoro Ellipta Bethkis CimziaApidra Biorphen CiprodexApligraf Bktarvy CoagadexAptivus Blincyto CoartemAralast Bosulif ColchicineAranesp Botox CombiganArikayce Braftovi Combivent Respimat

2020 Rx Boost Formulary

PRAM Insurance Services, Inc. 2020 Rx Boost Formulary

DRUG NAME DRUG NAME DRUG NAMECometriq Dysport FarydakComplera Edarbi FasenraConcerta Edarbi/Edarbychlor FeibaCopaxone 40mg (shared solution) Edurant FerrinproxCopiktra Effexor XR FetrojaCopiktra Effient FetzimaCorifact Egrifta Fiasp VialCortef Elaprase Flovent HFACosentyx Elelyso Focalin XRCotellic Eliquis FollistimCozaar Elmiron FolotynCozaar 25mg Eloctate Forteo Cozaar 50mg Elreada GablofenCreon Elzonrus GamunexCrestor Emflaza Ganirellix Crinone Emgality GattexCryvista Emtriva GelniqueCuprimine Enbrel GenosylCuprimine Enbrel Genotropin Cuprimine Endometrin GenvoyaCyclophosamide 50mg Enhertu Gilenya Cymbalta Enstilar GilotrifCystadane Enstilar GivlaariDaklinza Entresto Glatopa (20 or 40mg/ml)Dalvance Entyvio GleevecDarzolex Envarasus XR Glucagon InjectionDaurasmo Epclusa Glucagon InjectionDaurismo Epidiolex GluconormDDAVP Rhinyle EpiPen Auto-Injector GlumetzaDelzicol Epivir GlyxambiDemser Epogen Gonal- FDescovy Epzicom GvokeDexilant Erivedge Haldol D InjDificid Erleada Haldol InjDovato Esbriet HarvoniDuaklir Pressair Esperoct HepseraDuexis Estrace Cr HerceptinDulera Evenity HerzumaDulera/Zenhale 100 Evista HetliozDulera/Zenhale200 evotaz HizentraDuobrii Exjade Humalog Duopa Extavia Humalog KwikpenDupixent Eylea Humalog KwikPen (5 x 3ml)Duragesic Fabrazyme Humalog U-200 ONLYDurizol Farseton HumatropeDurysta Farxiga Humira


DRUG NAME DRUG NAME DRUG NAMEHumulin 30/70 Kitabis PK Mesalamine 800mgHumulin R U-500 ONLY Kogenate FS Mesalamine SuppositoriesHymactin Korlym ModeribaIbrance Koselugo MonoviscIclusig Krystexxa MonuralIdelvion Kuvan MotegreityIdhifa Kynamro MugardIlaris Lamictal MulpletaIlevro Lamictal MultaqIlumya Lamictal 200 MydayisImatinib (Gleevec) Lamictal 100 MyforticImbruvica Lamictal 200 MyobolocInbrija Lantus MyrbetriqIncruse Ellipta Lantus Solostar MyxredinInfed Latuda NaglazymeInlyta Lemtrada Namenda/Namenda XRInrebic Lenvima NamzaricIntelence Letaris NayzilamInvega Sustina Levemir FlexTouch (5 x 3mL) NeoralInvega T lexiva NerlynxInvega Trinza Libtayo NeulastaInvokana Linzess NeupogenInvokana 100mg Lipitor NexavarInvokana 300 Lipitor 10mg NexletolIressa Lipitor 80mg Ninlaroisentress Lixiana NorditropinIvokamet/XR Lokelma NortheraIxinity Lonsurf NorvascJadenu Lorbrena NorvirJanumet/Janumet XR Lotemax NouressJanuvia Lotemax NourianzJardiance Lucemyra NovoeightJatenzo Lumigan NovologJelmyto Lumizyme NovologJentadueto Lumoxiti Novolog FlextouchJuluca Lupaneta Pack Novolog Penfills (5 x 3mL)Juxtapid Lupron NoxafilJynarque Lupron Depot NplateJynneso Lupron Depot Ped NubeqaKaletra Lynparza Nucala Kalydeco Lyrica NuplazidKaterzia Mavelclad NurtecKeveyis Mekinist Nurtec ODTKevzara Mektovi Nutropin Keytruda Mesalamine OcalivaKisqali, XL Mesalamine 1.2 OCREVUS


DRUG NAME DRUG NAME DRUG NAMEOdefsey Prograf Rosuvastatin 40Odomzo Prolia RozlytrekOfev Promacta RubracaOlmetec Prozac RuxienceOlumiant Pulmicort RuzurgiOmegaven Pulmicort flexhaler RybelsusOmnitrope Pulmozyme RydaptOnpattro Purixan SaizenOpsumit Pylera SamscaOrencia Qutenza SancusoOrfadin Qvar Easi-Breathe Inhaler SandimmuneOrkambi Ranexa SandostatinOrlissa Rapaflo Sandostatin LAROrthovisc Syringe Rasilez/Tekturna Santyl OintOtezla Rasuvo SaphrisOthovisc Ravciti SarclisaOvidrel Reblozyl SaxendaOxbryta Reclast Saxenda (5 Pens)Oxtrexup Rectiv ScarlisaOzempic Regranex SceneesePadcev Relistor ScenessePalynzig Relvar/Breo Ellipta selzentryPataday Remicade SensiparPazeo 0.7% Reopro SevenfactPemazyre Repatha SigniforPemfexy rescriptor SildenafilPentasa Restasis Eye Drop Sildenafil 100mgPiqray Retisert SiliqPlegridy retrovir SimbrinzaPlenity Revatio SimponiPomolyst Revcovi Simponi AriaPoteligeo Revlimid SingulairPradaxa Rexulti Singulair 10Praluent Rexulti 2mg SkyriziPrandin Rexulti 3mg SlyndPred Forte Reyataz Somatuline Depot Premarin tabs Reyvow SomavertPremarin Vaginal Cr (ONLY - not Tabs) Rhopressa Soolantra Cream 1%Prevymis Ribasphere Ribapak SovaldiPrezcoxib Ribavirin Spiriva Prezista Rinvoq SporanoxPrialt Rinvoq SpravatoPristiq Risperdal Consta SprycelProair Rituxan StelaraProcrit Rocklatan StendraProcysbi Rosuvastatin Stiolto Respimat


DRUG NAME DRUG NAME DRUG NAMEStrattera Tobi ViagraStribild Tobi Podhaler Viagra 100mgStriverdi Respimat Torgarzo ViberziSunosi Tosmyra Victozasustiva Toujeo VigamoxSutent Toviaz ViibyrdSymbicort Inhaler Tracleer VimpatSymdeko Trajenta ViokaseSymfi Lo Travatan Z viraceptSymlin Trelegy Ellipta Viramune XRSymtuza Tremfya VireadSynagis Tresiba Flextouch Pens VistogardSynjardy/XR Tretten VitektaSynthroid Trikafta VitrakviSynvisc One Trilepta VivitrolSyprine Trimeq VizimproTaclonex Trintellix Voltaren EmulgelTadalafil TRIUMEQ VoseviTadalafil 10 trizivir VotrientTagrisso Trodelvy VprivTakhzyro Trokendi VraylarTalfinar Trulicity VumerityTalicia Truvada VyeptiTaltz Tudorza Genuair VyeptiTalzenna Turalio WakixTarceva Tybost WelcholTargretin Tykerb Wixela Inhub (Geq Advair)Targrisso Tymlos XalkoriTasigna Tysabri XareltoTavalisse Tyvaso XeljanzTazverik Ubrelvy Xeljanz XRTecentriq Ubrelvy XelodaTecfidera Uceris XenazineTeflaro Uloric XenletaTegretol Uloric XeominTegsedi Ultomeris XeravaTekturna Uptravi XermeloTestosterone Gel, Valchlor XgevaThalomid Varubi XiaflexThiola EC Vemlidy XidraThyroid Hormone Venclexta XifaxinThyroid Hormone Ventavis XolairThyroid Hormone 60mg Ventolin HFA XolairTibsovo Verzenio XospataTikosyn Vesicare XuridenTivicay Vesicare Xyntha


DRUG NAMEXyremYervoyYondeusYonsaYuperliZarxioZejulaZelborafZemairaZemdriZenpepZepatierZeposiziagenZiextenzoZirabev (Biosim - Avastin)ZolinzazortressZulressoZydeligZykadiaZyprexaZyprexa RelZyprexa ZydisZytiga


affordable + rxboost formulary drug list

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