Comprehensive Listing of Drugs in the USP Model Guidelinesprovider.indianamedicaid.com/ihcp/ProviderServices/pdf/... · 2012. 10. 16. · Comprehensive Listing of Drugs in the USP

Comprehensive Listing of Drugs in the USP Model Guidelines for Drugs Approved Through October 2004

This document provides a comprehensive listing of drugs categorized according to the USP Model Guidelines categories and classes. Although every effort has been made to include all eligible Part D, Food and Drug Administration (FDA)-approved dugs approved through October 2004 within each Therapeutic Category and Pharmacologic Class, the absence of a drug from this list does not specifically imply an intended exclusion. USP intends to modify and revise this comprehensive listing as part of its ongoing activity related to updating the Model Guidelines. This listing appears in an excel formatted table that includes five columns. The first two columns – Therapeutic Category and Pharmacologic Class – comprise the USP Model Guidelines. The third column lists the Formulary Key Drug Types, which were provided to CMS separately in USP’s comments on the CMS Draft Guidance regarding the formulary review process. The remaining two columns comprise the comprehensive listing of drugs requested by CMS and are entitled Pharmaceutical Preparations and Salts/Esters. Each drug, drawn from the FDA’s Orange Book, has been listed according to its generic name. USP understands that CMS intends to use the Formulary Key Drug Types as a check, assessing whether a formulary includes at least one drug from each item in the listing – or request justification for any exclusions. Because this will apply to all formularies, USP has included this listing here to facilitate CMS’ evaluation of formularies – regardless of the classification system that is used. Individual drugs are listed in the table based upon the most specifically listed Therapeutic Category, Pharmacologic Class or Formulary Key Drug Type. The enclosed table offers a foundation for a more comprehensive database that could be of great benefit to CMS, Plans, and to the overall administration of the Medicare Prescription Drug Benefit. As part of its ongoing work to revise the Model Guidelines, USP proposes to enhance this table over time to include valuable clinical and economic data such as:

• International Classification of Diseases, Ninth Revision Codes (ICD-9 Codes) • Off-label indications • Dosage forms • Route of administration • Pharmacokinetics • Patient population-based preferred drugs lists • The National Drug Code Directory Codes (NDC Codes) • Average pricing guides • And more.

This information could be utilized for individual plan and formulary analysis as well as for data collection and analysis for the overall benefit.

COMPREHENSIVE LISTING OF DRUGS IN THE USP MODEL GUIDELINESTherapeutic

CategoryPharmacologic

ClassFormulary Key

Drug TypesPharmaceutical

PreparationsSalts/Esters

Analgesics Opioid Analgesics Opioid Analgesics, Long-acting

Levomethadyl Acetate Hydrochloride

Levorphanol Tartrate

Methadone Hydrochloride

Morphine Sulfate

Opioid Analgesics, Short-acting

Alfentanil Hydrochloride

Buprenorphine

Butorphanol Tartrate

Codeine Phosphate

Sulfate

Fentanyl

Citrate

Hydromorphone Hydrochloride

Meperidine HydrochlorideNalbuphine Hydrochloride

Opium

Oxycodone Hydrochloride

Oxymorphone Hydrochloride

Pentazocine Lactate

Propoxyphene Hydrochloride

Napsylate

Remifentanil

Sufentanil Citrate

Tramadol Hydrochloride

Non-opioid Analgesics Cyclooxygenase-2 (COX-2) Inhibitors

Celecoxib

Valdecoxib

Nonsteroidal Anti-inflammatory Drugs, Nonspecific

Duloxetine Hydrochloride

Choline and Magnesium SalicylatesDiclofenac Potassium

Sodium

Diflunisal

Etodolac

Fenoprofen Calcium

Flurbiprofen

Ibuprofen

Indomethacin

Ketoprofen

Ketorolac Tromethamine

Magnesium Salicylate

Meclofenamate Sodium

Mefenamic Acid

Comprehensive Listing of Drugs in the USP Model Guidelinesfor Drugs Approved Through October 2004

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Therapeutic Category

Pharmacologic Class

Formulary Key Drug Types

Pharmaceutical Preparations

Salts/Esters

Meloxicam

Nabumetone

Naproxen

Sodium

Oxaprozin

Piroxicam

Salsalate

Sodium Thiosalicylate

Sulindac

Tolmetin Sodium

Anesthetics Local Anesthetics

Articaine Hydrochloride

Bupivicaine Hydrochloride

Chloroprocaine Hydrochloride

Levobupivicaine

Lidocaine Hydrochloride

Mepivacaine Hydrochloride

Procaine Hydrochloride

Tetracaine Hydrochloride

Antibacterials Beta-lactam, Cephalosporins

Cephalosporin Antibacterials, 1st Generation

Cefadroxil

Cefazolin

Cephalexin

Hydrochloride

Cephapirin

Cephradine

Cephalosporin Antibacterials, 2nd Generation

Cefaclor

Cefamandole Nafate

Cefonicid

Cefotetan

Cefoxitin

Cefprozil

Cefuroxime Axetil

Cephalosporin Antibacterials, 3rd Generation

Cefdinir

Cefditoren

Cefixime

Cefoperazone

Cefotaxime

Cefpodoxime Proxetil

Ceftazidime

Ceftibuten

Ceftizoxime

Ceftriaxone

Beta-lactam, Penicillins Amino Derivative Penicillins

Amoxicillin

Amoxicillin and Clavulanate Potassium






Pharmacologic Class



Salts/Esters

Ampicillin

Sodium

Ampicillin and Sulbactam Sodium

Bacampicillin Hydrochloride

Extended Spectrum Penicillins

Carbenicillin Indanyl Sodium

Disodium

Mezlocillin Sodium

Piperacillin Sodium

Piperacillin and Tazobactam Sodium

Ticarcillin Disodium

Ticarcillin and Clavulanic Acid

Penicillinase-resistant Penicillins

Cloxacillin Sodium

Dicloxacillin Sodium

Flucloxacillin Sodium

Methicillin Sodium

Nafcillin Sodium

Oxacillin Sodium

Beta-lactam, Other Carbacephem Antibacterials

Loracarbef

Macrolides Erythromycins

Erythromycin

Estolate

Ethylsuccinate

Lactobionate

Stearate

Ketolides

Telithromycin

Macrolides (Non-erythromycins, Non-ketolides)

Azithromycin

Clarithromycin

Dirithromycin

Troleandomycin

Quinolones Quinolones, Fluorinated

Ciprofloxacin

Gatifloxacin

Gemifloxacin

Levofloxacin

Lomefloxacin

Moxifloxacin Hydrochloride

Norfloxacin

Ofloxacin

Quinolones, Non-fluorinated

Nalidixic Acid

Sulfonamides

Sulfadiazine






Pharmacologic Class



Salts/Esters

Sulfadiazine and TrimethoprimSulfamethizole

Sulfanilamide

Sulfisoxazole

Acetyl

Sulfamethoxazole and Trimethoprim

Tetracyclines

Demeclocycline Hydrochloride

Doxycycline

Calcium

Hyclate

Minocycline Hydrochloride

Oxytetracycline Hydrochloride

Tetracycline

Hydrochloride

Antibacterials, Other Antifolate Antibacterials

Trimethoprim

Glycopeptide Antibacterials

Vancomycin Hydrochloride

Lincomycin Antibacterials

Clindamycin Hydrochloride

Palmitate HydrochloridePhosphate

Lincomycin Hydrochloride

Nitrofuran Antibacterials

Furazolidone

Nitrofurantoin

Oxazolidinone Antibacterials

Linezolid

Miscellaneous Antibacterials

Bacitracin

Chloramphenicol

Palmitate

Daptomycin

Fosfomycin Tromethamine

Methenamine Hippurate

Mandelate

Metronidazole

Hydrochloride

Calcium

Neomycin Sulfate

Rifaximin

Spectinomycin Hydrochloride

Anticonvulsants Calcium Channel Modifying Agents

Ethosuximide

Methsuximide

Trimethadione






Pharmacologic Class



Salts/Esters

Zonisamide

Gamma-aminobutyric Acid (GABA) Augmenting Agents

Divalproex Sodium

Gabapentin

Primidone

Tiagabine Hydrochloride

Valproate Sodium

Valproic Acid

Glutamate Reducing Agents

Felbamate

Lamotrigine

Topiramate

Sodium Channel Inhibitors

Carbamazepine

Ethotoin

Fosphenytoin Sodium

Oxcarbazepine

Phenytoin Sodium

Anticonvulsants (Other)

Levetiracetam

Antidementia Agents Cholinesterase Inhibitors

Donepezil Hydrochloride

Galantamine

Rivastigmine Tartrate

Tacrine Hydrochloride

Glutamate Pathway Modifiers

Memantine

Antidementia Agents, Other

Ergoloid Mesylates

Antidepressants Monoamine Oxidase (Type A) Inhibitors

Phenelzine Sulfate

Tranylcypromine Sulfate

Reuptake Inhibitors Selective Serotonin Reuptake Inhibitors (SSRIs)

Citalopram Hydrobromide

Escitalopram Oxalate

Fluoxetine Hydrochloride

Fluvoxamine Maleate

Paroxetine Hydrochloride

Sertraline Hydrochloride

Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

Duloxetine Hydrochloride

Nefazodone Hydrochloride

Venlafaxine Hydrochloride

Tricyclics

Amitriptyline Hydrochloride






Pharmacologic Class



Salts/Esters

Amoxapine

Clomipramine Hydrochloride

Desipramine Hydrochloride

Doxepin Hydrochloride

Imipramine Hydrochloride

Pamoate

Nortriptyline Hydrochloride

Protriptyline Hydrochloride

Trimipramine Maleate

Antidepressants, Other

Bupropion Hydrochloride

Maprotiline Hydrochloride

Mirtazapine

Trazodone Hydrochloride

Antiemetics 5-Hydroxytryptamine 3 (5-HT3) Antagonists

Dolasetron Mesylate

Granisetron Hydrochloride

Ondansetron Hydrochloride

Palonosetron Hydrochloride

Antiemetics (Non-5-HT3 Antagonists)

Aprepitant

Chlorpromazine Hydrochloride

Dimenhydrinate

Diphenhydramine Hydrochloride

Dronabinol

Droperidol

Hydroxyzine Pamoate

Meclizine Hydrochloride

Metoclopramide

Perphenazine

Prochlorperazine Edisylate

Maleate

Promethazine Hydrochloride

Scopolamine

Thiethylperazine Maleate

Trimethobenzamide Hydrochloride

Antifungals Allylamine Antifungals

Terbinafine Hydrochloride

Azole Antifungals

Butoconazole Nitrate

Clotrimazole

Fluconazole

Itraconazole

Ketoconazole

Miconazole Nitrate

Terconazole

Voriconazole

Polyene Antifungals

Amphotericin B






Pharmacologic Class



Salts/Esters

Amphotericin B Cholesteryl Complex

Sulfate

Amphotericin B Lipid ComplexAmphotericin B Liposomal ComplexNystatin

Pyrimidine Antifungals

Flucytosine

Antifungals (Other)

Griseofulvin

Antigout Agents Renal Tubular Blocking Agents

Probenecid

Sulfinpyrazone

Xanthine Oxidase Inhibitors

Allopurinol

Antigout Agents (Non-renal Tubular Blocking Agents and Non-xanthine Inhibitors)

Colchicine

Anti-inflammatories Glucocorticoids

Nonsteroidal Anti-inflammatory Drugs

Cyclooxygenase-2 (COX-2) Inhibitors

Celecoxib

Valdecoxib

Nonsteroidal Anti-inflammatory Drugs, Non-specific

Choline and Magnesium SalicylatesDiclofenac Potassium

Sodium

Diflunisal

Etodolac

Fenoprofen Calcium

Flurbiprofen

Ibuprofen

Indomethacin

Ketoprofen


Magnesium Salicylate

Meclofenamate Sodium

Mefenamic Acid

Meloxicam

Nabumetone

Naproxen

Sodium

Oxaprozin

Piroxicam

Salsalate

Sodium Thiosalicylate

Sulindac

Tolmetin Sodium

Antimigraine Agents Abortive Ergot Alkaloids






Pharmacologic Class



Salts/Esters

Dihydroergotamine Mesylate

Ergotamine Tartrate

Triptans

Almotriptan

Frovatriptan Succinate

Naratriptan HydrochlorideRizatriptan Benzoate

Sumatriptan

ZolmitriptanProphylactic Beta-adrenergic Blocking

AgentsPropranolol Hydrochloride

Timolol Maleate

Antimigraine Agents, Prophylactic (Non–beta-adrenergic Blocking Agents)

Divalproex Sodium

Topiramate

Antimycobacterials Antituberculars

Aminosalicylate Sodium

Capreomycin Sulfate

Cycloserine

Ethambutol Hydrochloride

Ethionamide

Isoniazid

Pyrazinamide

Rifampin

Rifampin and Isoniazid

Rifampin, Isoniazid, and PyrazinamideRifapentine

Antimycobacterials, Other

Clofazimine

Dapsone

Rifabutin

Antineoplastics Alkylating Agents

Altretamine

Busulfan

Carmustine

Chlorambucil

Cyclophosphamide

Dacarbazine

Ifosfamide

Lomustine

Mechlorethamine Hydrochloride

Melphalan

Hydrochloride

Procarbazine Hydrochloride

Temozolomide

Thiotepa

Uracil Mustard

Antimetabolites

Azacitidine






Pharmacologic Class



Salts/Esters

Capecitabine

Cytarabine

Floxuridine

Fluorouracil

Gemcitabine

Hydroxyurea

Mercaptopurine

Methotrexate

Sodium

Pemetrexed Disodium

Pentostatin

Thioguanine

Immune Modulators and Vaccines

Aldesleukin

BCG Vaccine (Live)

Molecular Target Inhibitors

Bortezomib

Erlotinib

Gefitinib

Imatinib Mesylate

Tretinoin

Nucleoside Analogs

Cladribine

Fludarabine Phosphate

Protective Agents

Amifostine

Dexrazoxane

Leucovorin Calcium

Mesna

Rasburicase

Topoisomerase Inhibitors

Etoposide

Phosphate

Irinotecan Hydrochloride

Teniposide

Topotecan

Antineoplastics, Other

Arsenic Trioxide

Asparaginase

Bexarotene

Carboplatin

Cisplatin

Denileukin Diftitox

Oxaliplatin

Pegaspargase

Porfimer Sodium

Antiparasitics Anthelmintics

Albendazole

Ivermectin

Mebendazole






Pharmacologic Class



Salts/Esters

Praziquantel

Pyrantel Pamoate

Thiabendazole

Antiprotozoals Antimalarials

Atovaquone and Proguanil Hydrochloride

Chloroquine Phosphate

Hydrochloride

Hydroxychloroquine Sulfate

Iodoquinol

Mefloquine Hydrochloride

Primaquine Phosphate

Pyrimethamine

Quinine Sulfate

Sulfadoxine and Pyrimethamine

Antiprotozoals (Non-antimalarials)

Atovaquone

Nitazoxanide

Pentamidine Isethionate

Tinidazole

Trimetrexate Glucuronate

Pediculicides/Scabicides

Lindane

Malathion

Permethrin

Antiparkinson Agents Catechol O-methyltransferase (COMT) Inhibitors

Entacapone

Tolcapone

Dopamine AgonistsAmantadine Hydrochloride

Carbidopa

Carbidopa and Levodopa

Levodopa

Pergolide Mesylate

Pramipexole Dihydrochloride Monohydrate

Ropinirole Hydrochloride

Antiparkinson Agents, Other

Benztropine

Biperiden Hydrochloride

Bromocriptine


Procyclidine Hydrochloride

Selegiline Hydrochloride

Trihexyphenidyl Hydrochloride

Antipsychotics Non-phenothiazines

Haloperidol Decanoate

Lactate

Loxapine Succinate

Molindone Hydrochloride






Pharmacologic Class



Salts/Esters

Pimozide

Thiothixene Hydrochloride

Ziprasidone Hydrochloride

Mesylate

Non-phenothiazines/ Atypicals

Aripiprazole

Clozapine

Olanzapine

Quetiapine Fumarate

Risperidone

Phenothiazines

Chlorpromazine Hydrochloride

Fluphenazine Hydrochloride

Decanoate

Enanthate

Hydrochloride

Mesoridazine Besylate

Perphenazine

Prochlorperazine

Edisylate

Maleate

Thioridazine Hydrochloride

Trifluoperazine Hydrochloride

Antivirals Anti-cytomegalovirus (CMV) Agents

Cidofovir

Foscarnet Sodium

Ganciclovir

Sodium

Valganciclovir Hydrochloride

Antiherpetic Agents

Acyclovir

Famciclovir

Foscarnet Sodium

Valacyclovir Hydrochloride

Anti-human Immunodeficiency Virus (HIV) Agents, Fusion Inhibitors

Enfuvirtide

Anti-HIV Agents, Non-nucleoside Reverse Transcriptase Inhibitors

Delavirdine Mesylate

Efavirenz

Nevirapine

Anti-HIV Agents, Nucleoside and Nucleotide Reverse Transcriptase Inhibitors

Abacavir Sulfate






Pharmacologic Class



Salts/Esters

Abacavir, Lamivudine, and ZidovudineDidanosine

Emtricitabine

Emtricitabine and Tenofovir Disoproxil Fumarate

Lamivudine

Lamivudine and Zidovudine

Stavudine

Tenofovir Disoproxil Fumarate

Zalcitabine

Zidovudine

Anti-HIV Agents, Protease Inhibitors

Amprenavir

Atazanavir Sulfate

Fosamprenavir Calcium

Indinavir Sulfate

Lopinavir and Ritonavir

Nelfinavir Mesylate

Ritonavir

Saquinavir

Mesylate

Anti-influenza Agents

Amantadine Hydrochloride

Oseltamivir Phosphate

Rimantadine Hydrochloride

Zanamivir

Antivirals, Other

Adefovir Dipivoxil

Ribavirin

Anxiolytics Antidepressants


Escitalopram Oxalate

Paroxetine Hydrochloride

Sertraline Hydrochloride

Anxiolytics, Other

Buspirone Hydrochloride

Meprobamate

Autonomic Agents Parasympatholytics

Atropine Sulfate

Belladonna

Dicyclomine Hydrochloride

Glycopyrrolate

Hyoscyamine

Sulfate

Mepenzolate Bromide

Methscopolamine Bromide

Orphenadrine Citrate

Propantheline Bromide

Scopolamine

Tolterodine Tartrate






Pharmacologic Class



Salts/Esters

Parasympathomimetics

Ambenonium Chloride

Edrophonium Chloride

Guanidine Hydrochloride

Neostigmine Methylsulfate

Pyridostigmine Bromide

Sympatholytics Alpha-adrenergic Blocking Agents

Alfuzosin Hydrochloride

Doxazosin Mesylate

Hydrochloride

Phenoxybenzamine Hydrochloride

Phentolamine Mesylate

Prazosin Hydrochloride

Tamsulosin Hydrochloride

Terazosin Hydrochloride

Beta-adrenergic Blocking Agents

Acebutolol Hydrochloride

Atenolol

Betaxolol Hydrochloride

Bisoprolol Fumarate

Carteolol Hydrochloride

Carvedilol

Esmolol Hydrochloride

Labetalol Hydrochloride

Hydrochloride

Metoprolol Tartrate

Succinate

Tartrate

Nadolol

Penbutolol Sulfate

Pindolol

Propranolol Hydrochloride

Sotalol Hydrochloride

Timolol Maleate

Sympathomimetics Alpha-adrenergic Agonists

Clonidine Hydrochloride

Guanabenz Acetate

Guanfacine Hydrochloride

Mephentermine Sulfate

Metaraminol Bitartrate

Methoxamine Hydrochloride

Methyldopa

Methyldopate Hydrochloride

Midodrine Hydrochloride

Phenylephrine Hydrochloride

Alpha-beta–adrenergic Agonists

Ephedrine Sulfate

Epinephrine Hydrochloride

Norepinephrine Bitartrate

Beta-adrenergic Agonists

Dobutamine Hydrochloride






Pharmacologic Class



Salts/Esters

Dopamine Hydrochloride

Dopamine/Dextrose Hydrochloride

Isoproterenol Hydrochloride

Bipolar Agents

Divalproex Sodium

Lithium Carbonate

Citrate

Ziprasidone Hydrochloride

Mesylate

Blood Glucose Regulators

Antihypoglycemics

Diazoxide

Glucagon Hydrochloride

Hypoglycemics, Oral Alpha Glucosidase Inhibitors

Acarbose

Miglitol

Biguanides

Metformin Hydrochloride

Meglitinides

Nateglinide

Repaglinide

Sulfonylureas

Acetohexamide

Chlorpropamide

Glimepiride

Glipizide

Glyburide

Tolazamide

Tolbutamide

Thiazolidinediones

Pioglitazone

Rosiglitazone Maleate

Insulins

Insulin, Rapid-acting

Insulin Aspart

Insulin Lispro

Insulin, Short-acting

Insulin (Purified pork)

Insulin Human

Insulin, Intermediate-acting

Insulin (Purified pork) Zinc

Insulin Human Zinc

Isophane Insulin (Beef/pork)

Isophane Insulin (Purified pork)Isophane Insulin Human

Insulin, Long-acting

Insulin Glargine

Insulin Human (Extended) Zinc

Blood Products/Modifiers/ Volume Expanders

Anticoagulants Anticoagulants, Oral

Anisindione






Pharmacologic Class



Salts/Esters

Warfarin Sodium

Blood Formation Products

Darbepoetin Alfa

Epoetin Alfa

Coagulants

Aminocaproic Acid

Antihemophilic Factor (Cryoprecipitated)Antihemophilic Factor (Human)Antihemophilic Factor (Porcine)Antihemophilic Factor (Recombinant)

Anti-inhibitor Coagulant ComplexAprotinin

Factor VIIa

Factor IX (Human)

Factor IX Complex (Human)

Phytonadione

Tranexamic Acid

Platelet Aggregation Inhibitors

Abciximab

Aspirin

Cilostazol

Clopidogrel Bisulfate

Dipyridamole

Eptifibatide

Ticlopidine Hydrochloride

Tirofiban Hydrochloride

Cardiovascular Agents

Alpha-adrenergic Agonists

Clonidine Hydrochloride

Guanabenz Acetate

Guanfacine Hydrochloride

Mephentermine Sulfate

Metaraminol Bitartrate

Methoxamine Hydrochloride

Methyldopa

Methyldopate Hydrochloride

Midodrine Hydrochloride

Phenylephrine Hydrochloride

Alpha-adrenergic Blocking Agents

Doxazosin Mesylate

Phenoxybenzamine Hydrochloride

Phentolamine Mesylate

Prazosin Hydrochloride


Antiarrhythmics Antiarrhythmics - Classes IA, B, and C

Disopyramide Phosphate

Flecainide Acetate






Pharmacologic Class



Salts/Esters

Lidocaine Hydrochloride

Mexiletine Hydrochloride

Moricizine Hydrochloride

Procainamide Hydrochloride

Propafenone Hydrochloride

Quinidine Bisulfate

Gluconate

Polygalacturonate

Sulfate

Tocainide Hydrochloride

Antiarrhythmics - Class II




Antiarrhythmics - Class III

Amiodarone Hydrochloride

Bretylium Tosylate

Dofetilide

Ibutilide Fumarate


Antiarrhythmics - Class IV

Bepridil Hydrochloride

Diltiazem Hydrochloride

Verapamil Hydrochloride

Antiarrhythmics (Other)

Adenosine Phosphate

Beta-adrenergic Blocking Agents

Alpha-beta–adrenergic Blocking Agents

Labetalol Hydrochloride

Carvedilol

Cardioselective Beta-adrenergic Blocking Agents


Atenolol


Bisoprolol Fumarate


Metoprolol Succinate

Tartrate

Nonselective Beta-adrenergic Blocking Agents


Nadolol

Penbutolol Sulfate

Pindolol



Timolol Maleate

Calcium Channel Blocking Agents

Dihydropyridines






Pharmacologic Class



Salts/Esters

Amlodipine

Felodipine

Isradipine

Nicardipine Hydrochloride

Nifedipine

Nimodipine

Nisoldipine

Calcium Channel Blocking Agents (Non-dihydropyridines)

Bepridil Hydrochloride

Diltiazem Hydrochloride

Verapamil Hydrochloride

Direct Cardiac Inotropics

Digoxin

Inamrinone Lactate

Milrinone Lactate

Diuretics Carbonic Anhydrase Inhibitors

Acetazolamide

Sodium

Methazolamide

Loop Diuretics

BumetanideEthacrynic Acid

Ethacrynate Sodium

Furosemide

TorsemideOsmotic Diuretics

Glycerin

Mannitol

Urea

Potassium-sparing Diuretics

Amiloride Hydrochloride

Triamterene

Thiazide Diuretics

Bendroflumethiazide

ChlorothiazideSodium

Chlorthalidone

HydrochlorothiazideHydroflumethiazide

Indapamide

MethyclothiazideMetolazone

Polythiazide

TrichlormethiazideDyslipidemics Bile Acid Sequestrants

Cholestyramine Resin

Colesevelam Hydrochloride

Colestipol Hydrochloride

Fibrates

Clofibrate






Pharmacologic Class



Salts/Esters

Fenofibrate

Gemfibrozil

3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) Reductase Inhibitors

Atorvastatin Calcium

Fluvastatin Sodium

Lovastatin

Pravastatin SodiumRosuvastatin Calcium

SimvastatinLipid Absorption Inhibitors

Ezetimibe

Nicotinic Acid

Niacin

Renin-angiotensin-aldosterone System Inhibitors

Aldosterone Receptor Antagonists

Eplerenone

SpironolactoneAngiotensin-converting Enzyme (ACE) Inhibitors

Benazepril Hydrochloride

Captopril

Enalapril Maleate

Enalaprilat

Fosinopril Sodium

Lisinopril

Moexipril Hydrochloride

Perindopril Erbumine

Quinapril Hydrochloride

Ramipril

Trandolapril

Angiotensin II Receptor Antagonists

Candesartan Cilexetil

Eprosartan Mesylate

Irbesartan

Losartan Potassium

Olmesartan Medoxomil

Telmisartan

Valsartan

Vasodilators

Amyl Nitrite

Bosentan

Diazoxide

Epoprostenol Sodium

Ethaverine Hydrochloride

Fenoldopam Mesylate

Hydralazine Hydrochloride

Isosorbide Dinitrate

Mononitrate






Pharmacologic Class



Salts/Esters

Isoxsuprine Hydrochloride

Minoxidil

Papaverine Hydrochloride

Nesiritide

Nitroglycerin

Nitroprusside Sodium

Treprostinil Sodium

Central Nervous System Agents

Amphetamines

Dextroamphetamine Sulfate

Dextroamphetamine and Amphetamine

(Mixed salts)

Methamphetamine Hydrochloride

Non-amphetamines

Atomoxetine Hydrochloride

Dexmethylphenidate Hydrochloride

Doxapram Hydrochloride

Methylphenidate Hydrochloride

Modafinil

Pemoline

Riluzole

Dental and Oral Agents

Amlexanox

Cevimeline Hydrochloride

Chlorhexidine Gluconate

Doxycycline Hyclate

Minocycline

Palifermin

Pilocarpine Hydrochloride

Prilocaine Hydrochloride

Triamcinolone Acetonide

Dermatological Agents

Dermatological Anesthetics

Cocaine Hydrochloride

Lidocaine

Hydrochloride

Tetracaine Hydrochloride

Dermatological Antibacterials

Gentamicin Sulfate

Mafenide Acetate

Metronidazole

Mupirocin

Calcium

Silver Sulfadiazine

Dermatological Antifungals

Amphotericin B

Butenafine

Ciclopirox

Clotrimazole

Econazole Nitrate

Ketoconazole

Miconazole Nitrate






Pharmacologic Class



Salts/Esters

Naftifine Hydrochloride

Nystatin

Oxiconazole Nitrate

Sertaconazole Nitrate

Sulconazole Nitrate

Terbinafine Hydrochloride

Dermatological Anti-inflammatories

Diclofenac Sodium

Dermatological Antipruritic Agents


Pramoxine and Hydrocortisone

Hydrochloride and Acetate

Dermatological Antivirals

Acyclovir

Penciclovir Sodium

Dermatological Keratolytics

Dermatological Mitotic Inhibitors

Chloroxine

Podofilox

Podophyllum Resin

Selenium Sulfide

Dermatological Photochemotherapy Agents

Porphyrin Derivative Photochemotherapy

Aminolevulinic Acid Hydrochloride

Psoralen Photochemotherapy

Methoxsalen

Trioxsalen

Dermatological Retinoids

Acitretin

Alitretinoin

Tazarotene

Tretinoin

Dermatological Tar Derivatives

Anthralin

Dermatological Vitamin D Analogs

Calcipotriene

Dermatological Wound Care Agents

Becaplermin

Wound Debriding Agents

CollagenaseDeterrents/ Replacements

Alcohol Deterrents

Acamprosate Calcium

Disulfiram

Enzyme Replacements/ Modifiers

Agalsidase Beta

Alglucerase






Pharmacologic Class



Salts/Esters

Betaine Anhydrous

Cysteamine Bitartrate

Imiglucerase

Laronidase

Miglustat

Nitisinone

Pancrelipase

Pegademase Bovine

Sacrosidase

Sodium PhenylbutyrateGastrointestinal Agents

Antispasmodics, Gastrointestinal

Atropine Sulfate

Belladonna

Dicyclomine Hydrochloride

Glycopyrrolate

Hyoscyamine

Sulfate

Mepenzolate Bromide

Methscopolamine Bromide

Propantheline Bromide

Scopolamine

Histamine2 (H2) Blocking Agents

Cimetidine

Hydrochloride

Famotidine

Nizatidine

Ranitidine Hydrochloride

Irritable Bowel Syndrome Agents

Alosetron

Tegaserod Maleate

Protectants

Misoprostol

Sucralfate

Proton Pump Inhibitors

Esomeprazole Magnesium

Lansoprazole

Omeprazole

Pantoprazole Sodium

Sodium Sesquihydrate

Rabeprazole

Gastrointestinal Agents, Other

Cisapride

Dehydrocholic Acid

Difenoxin and Atropine Hydrochloride and Sulfate

Diphenoxylate and Atropine Hydrochloride and Sulfate

Lactulose

Lanthanum Carbonate

Loperamide Hydrochloride






Pharmacologic Class



Salts/Esters

Octreotide

Polyethylene Glycol 3350 NF

Sevelamer Hydrochloride

Ursodiol

Genitourinary Agents Antispasmodics, Urinary

Darifenacin

Flavoxate Hydrochloride

Hyoscyamine

Sulfate

Oxybutynin

Chloride

Solifenacin Succinate

Tolterodine Tartrate

Trospium Chloride

Benign Prostatic Hypertrophy Agents

Alpha1-adrenergic Blocking Agents

Alfuzosin Hydrochloride

Doxazosin Mesylate

Tamsulosin Hydrochloride


5 Alpha-reductase Inhibitors

Dutasteride

Finasteride

Impotence Agents Phosphodiesterase Inhibitors

Sildenafil CitrateTadalafil

Vardenafil HydrochlorideProstaglandins

Alprostadil

Hormonal Agents, Stimulant/ Replacement/ Modifying

Adrenal Glucocorticoids

Betamethasone

Sodium Phosphate

Sodium Phosphate and Acetate

Budesonide

Cortisone Acetate

Dexamethasone

Acetate

Sodium Phosphate

Hydrocortisone

Acetate

Sodium Phosphate

Sodium Succinate

Methylprednisolone

Acetate

Sodium Succinate

Prednisolone

Acetate






Pharmacologic Class



Salts/Esters

Acetate and Sodium PhosphateSodium Phosphate

Prednisone

Triamcinolone

Acetonide

Diacetate

Hexacetonide

Glucocorticoids-Topical-Low Potency

Alclometasone Dipropionate

Cloclortolone Pivalate

Desonide

Dexamethasone

Sodium Phosphate

Flumethasone Pivalate

Hydrocortisone

Acetate

Glucocorticoids-Topical-Medium Potency

Betamethasone Benzoate

Valerate

Desoximetasone

Fluocinolone Acetonide

Flurandrenolide

Fluticasone Propionate

Hydrocortisone Butyrate

Probutate

Valerate

Mometasone Furoate

Prednicarbate


Glucocorticoids-Topical-High Potency

Amcinonide

Betamethasone

Dipropionate

Desoximetasone

Diflorasone Diacetate

Fluocinolone Acetonide

Fluocinonide

Halcinonide


Glucocorticoids-Topical-Very High Potency

Betamethasone Dipropionate

Clobetasol Propionate

Diflorasone Diacetate

Halobetasol Propionate

Mineralocorticoids

Fludrocortisone Acetate

Parathyroid/Metabolic Bone Disease Agents

Bisphosphonates

Alendronate Sodium

Etidronate Disodium






Pharmacologic Class



Salts/Esters

Pamidronate Disodium

Risedronate Sodium

Tiludronate Disodium

Zoledronic Acid

Calcium Regulating Hormones

Calcitonin, Salmon

Teriparatide

Vitamin D–related Agents/Metabolic Bone Disease Agents

Doxercalciferol

Paricalcitol

Parathyroid/Metabolic Bone Disease Agents (Other)

Gallium Nitrate

Pituitary

Chorionic Gonadotropin

Desmopressin Acetate

Oxytocin

Somatrem

Somatropin, Recombinant

Vasopressin

Prostaglandins

Alprostadil

Carboprost Tromethamine

Dinoprostone

Misoprostol

Sex Hormones/Modifiers Androgens/Anabolic Steroids

Danazol

Fluoxymesterone

Methyltestosterone

Nandrolone Decanoate

Phenpropionate

Oxandrolone

Oxymetholone

Testosterone

Cypionate

Enanthate

Propionate

EstrogensDienestrol

Estradiol

Acetate

Cypionate

Hemihydrate

Valerate

Estrogens, Conjugated

Estrogens, Conjugated SyntheticEstrogens, Esterified

Estrone

Estropipate






Pharmacologic Class



Salts/Esters

Ethinyl Estradiol

Progestins

Hydroxyprogesterone Caproate

Levonogestrel

Medroxyprogesterone Acetate

Megestrol Acetate

Norethindrone

Acetate

Norgestrel

Progesterone

Selective Estrogen Receptor Modifying Agents

Raloxifene Hydrochloride

Thyroid

Levothyroxine Sodium

Liothyronine Sodium

Liotrix

Thyroid

Hormonal Agents, Suppressant

Adrenal

Aminoglutethimide

Mitotane

Pituitary

Abarelix

Bromocriptine Mesylate

Cabergoline

Goserelin Acetate

Histrelin Acetate

Leuprolide Acetate

Nafarelin Acetate

Octreotide Acetate

Pegvisomant

Triptorelin Pamoate

Sex Hormones/Modifiers Antiandrogens

Bicalutamide

Dutasteride

Finasteride

Flutamide

Nilutamide

Antiestrogens/Modifiers

Anastrozole

Estramustine Phosphate Sodium

Exemestane

Fulvestrant

Letrozole

Tamoxifen Citrate

Testolactone

Toremifene Citrate

Thyroid

Methimazole

PropylthiouracilParathyroid






Pharmacologic Class



Salts/Esters

Cinacalcet Hydrochloride

Immunological Agents Immune Stimulants Vaccines

Anthrax Vaccine Adsorbed

Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine Adsorbed

Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine Adsorbed, Hepatitis B (Recombinant) and Inactivated Poliovirus Vaccine

Haemophilus B Conjugate VaccineHaemophilus B Conjugate Vaccine and Hepatitis B Vaccine (Recombinant)

Hepatitis A Vaccine Inactivated

Hepatitis A Virus Vaccine Inactivated and Hepatitis B Virus Vaccine Recombinant

Hepatitis B Virus Vaccine Inactivated

Hepatitis B Virus Vaccine Recombinant

Influenza Virus Vaccine

Japanese Encephalitis Virus Vaccine Inactivated

Lyme Disease Vaccine

Measles Virus Vaccine Live

Measles, Mumps, and Rubella Virus Vaccine Live

Meningococcal Polysaccharide Vaccine

Mumps Virus Vaccine Live

Pneumococcal Conjugate Vaccine

Pneumococcal Vaccine Polyvalent






Pharmacologic Class



Salts/Esters

Poliovirus Vaccine Inactivated

Poliovirus Vaccine Live Oral

Rabies Vaccine

Rubella Virus Vaccine

Typhoid Vaccine Live Oral

Typhoid Vi Polysaccharide VaccineVaricella Virus Vaccine

Yellow Fever Vaccine

Immune Stimulants (Non-vaccines)

Interferon Alfa-2a, RecombinantInterferon Alfa-2b, RecombinantInterferon Alfa-n3

Interferon Alfacon-1

Interferon Beta-1a

Interferon Beta-1b

Interferon Gamma-1b, RecombinantPeginterferon Alfa-2b

Peginterferon Alfa-2a

Ribavirin and Interferon Alfa-2b

Immune Suppressants Tumor Necrosis Factor (TNF) Inhibitors

Adalimumab

Etanercept

Infliximab

Immune Suppressants (Non-TNF Inhibitors)

Alefacept

Anakinra

Azathioprine

Sodium

Basilixumab

Cyclosporine

Daclizumab

Efalizumab

Muromonab-CD3

Mycophenolate Mofetil

Mofetil Hydrochloride

Natalizumab

Penicillamine

Sirolimus

Tacrolimus

Immunomodulators

Auranofin

Glatiramer Acetate

Gold Sodium thiomalate

Imiquimod

Leflunomide

Omalizumab






Pharmacologic Class



Salts/Esters

Pimecrolimus

Tacrolimus

ThalidomideInflammatory Bowel Disease Agents

Glucocorticoids

Betamethasone

Sodium Phosphate and Acetate

Budesonide

Cortisone Acetate

Dexamethasone

Acetate

Sodium Phosphate

Hydrocortisone

Acetate

Sodium Succinate

Sodium Phosphate

Methylprednisolone

Acetate

Sodium Succinate

Prednisolone

Acetate

Acetate and Sodium PhosphateSodium Phosphate

Prednisone

Triamcinolone

Acetonide

Diacetate

SalicylatesBalsalazide Disodium

Mesalamine

Olsalazine Sodium

SulfonamidesSulfasalazine

Ophthalmic Agents Ophthalmic Anti-allergy Agents

Azelastine Hydrochloride

Cromolyn Sodium

Emedastine Difumarate

Ketotifen Fumarate

Levocabastine Hydrochloride

Lodoxamide Tromethamine

Naphazoline Hydrochloride

Nedocromil Sodium

Olopatadine Hydrochloride

Pemirolast Potassium

Ophthalmic Antibacterials

Bacitracin

Chloramphenicol

Ciprofloxacin Hydrochloride

Gentamicin Sulfate

Erythromycin






Pharmacologic Class



Salts/Esters

Gatifloxacin

Levofloxacin

Moxifloxacin Hydrochloride

Natamycin

Ofloxacin

Sulfacetamide Sodium

Tobramycin

Ophthalmic Antifungals

Natamycin

Ophthalmic Antiglaucoma Agents

Alpha-adrenergic Agonists, Ophthalmic

Apraclonidine Hydrochloride

Brimonidine

Dipivefrin Hydrochloride

Beta-adrenergic Blocking Agents, Ophthalmic



Levobetaxolol Hydrochloride

Levobunolol Hydrochloride

Metipranolol Hydrochloride

Timolol Hemihydrate

Maleate

Carbonic Anhydrase Inhibitors, Ophthalmic

Acetazolamide

Sodium

Brinzolamide

Dorzolamide Hydrochloride

Methazolamide

Miotics, Ophthalmic

Carbachol

Demecarium Bromide

Echothiophate Iodide

Physostigmine Salicylate

Sulfate

Pilocarpine

Hydrochloride

Nitrate

Osmotic Agents, Ophthalmic

Glycerin

Mannitol

Urea

Prostaglandins, Ophthalmic

Bimatoprost

Latanoprost

Travoprost

Unoprostone Isopropyl

Ophthalmic Anti-inflammatories

Dexamethasone

Sodium Phosphate

Diclofenac Sodium






Pharmacologic Class



Salts/Esters

Fluorometholone

Acetate

Flurbiprofen Sodium


Loteprednol

Medrysone

Prednisolone Acetate

Sodium Phosphate

Rimexolone

Ophthalmic Antivirals

Ganciclovir

Idoxuridine

Trifluridine

Ophthalmic Agents, Other

Botulinum Toxin Type A

Cyclosporine

Dapiprazole HydrochlorideFomiversen Sodium

Hydroxypropyl Cellulose

Pegaptanib Sodium

Verteporfin

Otic Agents Otic Antibacterials

Ofloxacin

Otic Anti-inflammatories

Dexamethasone Sodium Phosphate

Respiratory Tract Agents

Antihistamines Histamine1 (H1) Blocking Agents, Mildly/Non-sedating

Azelastine

Cetirizine Hydrochloride

Desloratadine

Fexofenadine Hydrochloride

H1 Blocking Agents, Sedating

Brompheniramine Maleate

Chlorpheniramine Maleate

Clemastine Fumarate

Dexchlorpheniramine Maleate

Dimenhydrinate


Promethazine Hydrochloride

Hydroxyzine Hydrochloride

Pamoate

Azatadine Maleate

Cyproheptadine Hydrochloride

Antileukotrienes

Montelukast Sodium

Zafirlukast

Zileuton

Bronchodilators, Anticholinergic

Ipratropium Bromide






Pharmacologic Class



Salts/Esters

Tiotropium Bromide Monohydrate

Bronchodilators, Anti-inflammatories

Beclomethasone Dipropionate

Dipropionate Monohydrate

Budesonide

Dexamethasone Sodium PhosphateFlunisolide

Fluticasone Propionate

Mometasone Furoate Monohydrate


Bronchodilators, Phosphodiesterase 2 Inhibitors (Xanthines)

Aminophylline

Dyphylline

Oxytriphylline

Theophylline

Bronchodilators, Sympathomimetic

Albuterol Sulfate

Ephedrine Sulfate

Epinephrine

Bitartrate

Formoterol Fumarate Dihydrate

Isoetharine

Isoproterenol Hydrochloride

Levalbuterol Hydrochloride

Metaproterenol Sulfate

Pirbuterol Acetate

Salmeterol Xinafoate

Terbutaline Sulfate

Mast Cell Stabilizers

Cromolyn Sodium

Nedrocromil

Mucolytics

N-Acetylcysteine

Dornase Alfa

Respiratory Tract Agents, Other

Alpha 1-proteinase Inhibitor, HumanBenzonatate

Bosentan

Guaifenesin

Iodinated Glycerol

Oxygen

Potassium Iodide

Tetrahydrozoline Hydrochloride

Sedatives/ Hypnotics

Chloral Hydrate

Eszopiclone

Zaleplon






Pharmacologic Class



Salts/Esters

Zolpidem Tartrate

Skeletal Muscle Relaxants

Atracurium Besylate

Baclofen

Botulinum Toxin Type A

Botulinum Toxin Type B

Carisoprodol

Chlorphenesin Carbamate

Chlorzoxazone

Cisatracurium

Cyclobenzaprine Hydrochloride

Dantrolene Sodium

Doxacurium Chloride

Metaxalone

Methocarbamol

Orphenadrine Citrate

Hydrochloride

Pancuronium Bromide

Rocuronium Bromide

Succinylcholine Chloride

Tizanidine Hydrochloride

Vecuronium Bromide

Therapeutic Nutrients/Minerals/Electrolytes

Electrolytes/Minerals

Ammonium ChlorideCalcium Acetate

Chloride

Gluceptate

Gluconate

Chromic Chloride

Cupric Chloride

Sulfate

Fluoride

Sodium

Stannous

Strong Iodine

Iron Dextran

PolysaccharideSucrose

Magnesium Chloride

Sulfate

Manganese Chloride

Molybdate Ammonium

Potassium AcetateBicarbonate

Bicarbonate and CitrateChloride

Citrate

Citrate and Citric AcidGluconate






Pharmacologic Class



Salts/Esters

Gluconate and ChlorideGluconate and CitratePhosphates

Potassium, Monobasic Phosphates

Potassium and Sodium Citrates

Phosphates

Selenium

Sodium Acetate

Bicarbonate

Lactate

Chloride

Ferric Gluconate Complex

Phosphates

Tricitrates

Trikates

Zinc Chloride

Sulfate

Vitamins Prenatal Vitamins

Toxicologic Agents Opioid Antagonists

Nalmefene Hydrochloride

Naloxone Hydrochloride

Naltrexone Hydrochloride





Documents

Comprehensive Listing of Drugs in the USP Model Guidelinesprovider.indianamedicaid.com/ihcp/ProviderServices/pdf/... · 2012. 10. 16. · Comprehensive Listing of Drugs in the USP