Durham County Indigent Pharmacy Program (DCIPP) Formulary

A N T I D E P R E S S A N T S amitriptyline 10 mg 25 mg 50 mg 75 mg 100 mg

bupropion SR 100 mg 150 mg 200 mg

bupropion XL 150mg 300mg

citalopram 10 mg 20 mg 40 mg

doxepin 25 mg 50 mg 100 mg

duloxetine 20 mg 30 mg 60mg

escitalopram 10mg 20 mg

fluoxetine 10 mg 20 mg 40 mg

imipramine 25 mg 50 mg

mirtazapine 15 mg 30 mg

nortriptyline 10 mg 25 mg 75 mg

paroxetine 10 mg 20 mg

sertraline 25 mg 50 mg 100 mg

venlafaxine XR (capsule) 37.5 mg 75 mg 150 mg

M O O D S T A B I L I Z E R S

carbamazepine 200 mg

lithium carbonate 300 mg

divalproex sodium DR 250 mg 500 mg

divalproex ER 250mg 500mg

lamotrigine tablets 25 mg 100 mg 150 mg 200 mg

oxcarbazepine 300 mg 600 mg

A N T I P S Y C H O T I C S aripiprazole 2 mg 5 mg 10 mg 15 mg 20 mg 30 mg

clozapine (bridge to patient assistance) 25mg 50mg 100mg 200mg

fluphenazine* 1 mg 2.5 mg 5 mg 10 mg

haloperidol 0.5 mg 1 mg 2 mg 5 mg

olanzapine 2.5 mg 5 mg 7.5 mg 10 mg 15 mg 20 mg

perphenazine* 2 mg 4 mg 8 mg

quetiapine 25 mg 50 mg 100 mg 200 mg 300 mg 400 mg

quetiapine ER 150mg 200mg 300mg

risperidone 0.25 mg .50 mg 1 mg 2 mg 3 mg 4 mg

thiothixene 2 mg 5 mg 10 mg

trifluoperazine* 2 mg 5 mg 10 mg

fluphenazine (inj) 5 ml 25 ml

fluphenazine decanoate 25 mg/cc 5 cc

haloperidol decanoate 50 mg 100 mg

S L E E P A I D S , A N T I A N X I E T Y , M I S C E L L A N E O U S

amlodipine 2.5mg 5mg 10mg

atenolol 25 mg 50 mg 100 mg

benztropine .5 mg 1 mg 2 mg

buspirone 5 mg 10 mg 15 mg

diphenhydramine 25 mg 50 mg

hydrochlorothiazide 25mg

hydoxyzine 25mg 50mg

levothyroxine 25µg 50µg 75 µg 100 µg 112 µg 125 µg 137 µg 150 µg 175µg 200 µg 300 µg

metformin 500 mg 750 mg 1000 mg

metoprolol 25 mg 50 mg 100 mg

prazosin 1 mg 2 mg 5 mg

propranolol 10 mg 20 mg 40 mg 80 mg

trazodone 50 mg 100 mg 150 mg

trihexyphenidyl 2 mg 5 mg

S U B S T A N C E U S E D I S O R D E R S

naltrexone oral tablets 50mg

buprenorphine /naloxone SL tablets 8mg/2mg

*No new starts; current DCIP users as of 7/1/16 (fluphenazine) or 2/20/17 (perphenazine, trifluoperazine) are grandfathered in.

1/15/2020

Durham County* Medication Assistance Program (MAP) Formulary

ORAL MEDICATIONS

Clozapine 25mg, 50mg, 100 mg, 200mg

Latuda 20 mg, 40mg, 60 mg, 80mg ,120mg

Saphris 2.5mg, 5mg and10mg

Rexulti 2mg, 4mg

Trintellix 10mg, 20mg

Vibryd 10mg, 20mg, 40mg

LAI MEDICATIONS

Aristada 441mg , 662mg, 882mg, 1064mg

Aristada Initio 675mg

Abilify Maintena 300mg, 400mg

Invega Sustenna 39mg, 78mg, 117mg, 156mg, 234mg,

Invega Trinza 273mg, 410mg, 546mg, 819mg

Risperdal Consta 12.5mg, 25mg, 37.5mg, 50mg

Zyprexxa Relprevv 210mg, 300mg and 405mg

*The Durham County MAP site is Gurleys Pharmacy. For other North Carolina counties’ MAP sites, please visit https://files.nc.gov/ncdhhs/documents/Medication%20Assistance%20Program%20Sites%203.docx

MEDICATION RESOURCES

Patient Advocacy Foundation (PAF) Co-Pay Relief Program (CPF) : Provides direct financial assistance to qualified individuals, assisting them with prescription drug co-payments, coinsurances and deductibles. PHARMACIES (Non-Profit)

NC Med Assist : Non-profit pharmacy program for North Carolina (NC) residents that provides FREE access to lifesaving prescription medications, patient support, advocacy and related services to poor, vulnerable, and uninsured NC residents. The pharmacy mails the prescriptions to non-Mecklenberg County NC residents..

Rx Outreach: Non-profit mail order pharmacy in St Louis that ships directly to individuals’ homes. It is available to qualifying individuals and families. Patients can be on Medicaid, Medicare or other health insurance and still receive medications from Rx Outreach. There are no enrollment or membership fees.

PHARMACY DISCOUNT PROGRAMS :

FamilyWize: A huge consumer group buying service for the uninsured and underinsured. The discounts and savings on medications are provided voluntarily by the more than 61,000 participating pharmacies that have agreed to provide prices similar to what they give large insurance companies and employers.

NCMS Discount Prescription Drug Card : Touts savings of up to 75% (discounts average roughly 30%) at more than 68,000 national and regional pharmacies. This card can be used as the primary plan and/or it can be used on prescriptions not covered by an insurance plan.

Needy Meds : Non-profit clearinghouse that provides information on all medical needs, including medications. It collects data on patient assistance programs, drug coupons and rebates, and offers its own drug discount card.

For profit programs (these mostly exclude independent pharmacies which may match chain pharmacies’ discount prices)

o Blink Health offers a free app that finds the cheapest price for a drug and locks it in for individuals who can then pay on-line and fill their prescriptions at one of 60,000 pharmacies in the United States.

o Good Rx : collects and compares prices and then offers consumers a coupon to get the best rate. The company has information on every FDA approved medication at more than 70,000 US pharmacies (mostly chains). Once the individual finds the best price at a local pharmacy, they can either print a coupon or show it on their smart phone.

To see more information about patient assistance programs described above, please visit

https://www.alliancehealthplan.org/consumers-families/help-paying-medications/