FOX ARMY HEALTH CENTER

PHARMACY FORMULARY REFERENCE

HOURS OF OPERATION:

Monday thru Friday 7:30am – 4:30pm

Peak times are between 11:30 – 13:30 and all day Fridays

Please check our website’s Live Wait-Time Tracker for current

wait times: www.redstone.amedd.army.mil

FY19 Holiday and Training Closure Schedule on last page

**Please check our monthly training closure schedule as it varies!**

ORDER REFILLS AHEAD OF TIME BY:

Phone: 256-842-7337or 800-223-9531 or

Online: www.redstone.amedd.army.mil

This FORMULARY can also be found on line at

www.redstone.amedd.army.mil

Click on .pdf (paper form)

Suzette Baker, RPh, BS, Pharm CHIEF, PHARMACY SERVICE

REDSTONE ARSENAL, AL 35809-7000

JANUARY 2019

2

FOREWARD This guide is published for the use of the customers of Fox Army Health Center. It is intended as an

aid to understanding the services available at Fox Army Health Center’s Pharmacy and is not an official publication of this organization of the Department of the Army. While we have attempted

to provide information representative of the questions most often asked by our customers, this guide does not portend to be all inclusive or exclusive to services offered. Specific questions should

be directed to the pharmacy staff.

GENERAL INFORMATION

AR 40-3 requires that medical care and services be provided only to eligible beneficiaries. The military I.D. card is a tool that helps us meet this requirement. Medication will not be issued for a patient who is over the age of 10 years unless a valid military I.D. card (or a paper photocopy of the front and back of the ID Card) for that patient is presented to pharmacy services. (Electronic devices with picture of ID Cards are not accepted.)

TELEPHONE NUMBERS:

Outpatient pharmacy: (256) 955-8888 ext. # 1701 (allow 24 business hours for return call)

Automated phone-in refill system: (256) 842-7337 or 1-800-223-9531 On-line refill requests: www.redstone.amedd.army.mil

GENERAL DISPENSING POLICIES

Maintenance medications:

Maintenance Medication (NON-controlled) Physicians may write for up to a 90 day supply with 3 refills

Narcotics and Scheduled III-V Controlled Substances: Physicians may write for a maximum of a 30 day supply with 5 refills (for a total of six months)

Schedule II Substances: drugs may be written for a maximum of a one month supply and are NOT refillable. Schedule II narcotic (controlled substance) prescriptions must be hand-carried with

original signature of prescriber (electronic or verbal submissions are not accepted). Narcotic prescription refills may be filled no sooner than two (2) days prior to actual due

date of refill prescription (28 days from the date it was last picked up).

Exception: Ritalin, Adderall, Concerta (or equivalents) may be given up to a 90-day supply for Attention Deficit Disorder and No Refills. Testosterone and seizure products may be given up to a 90-day supply with one refill.

Electronically transmitted prescriptions from providers are not filled until the patient presents to pharmacy, pulls appropriate category service ticket and requests the prescription.

Prescriptions expire after ONE year from the original date it was written for most medications

Controlled substances prescriptions expire SIX months from the original date written.

FAHC follows dispensing policy outlined by the Dept. of the Army; Health Affairs and TRICARE which include quantity limits and formulary/Non-formulary designations.

FORMULARY INDEX

Therapeutic Category – page # Therapeutic Category – page#

Alzheimers/Dementia - 4

Analgesics/Anti-Inflammatory/Opioids - 4

Anti-Anxiety - 4

Anti-Coagulants/Blood Thinner (Circulation) - 4

Anti-Convulsants (Epilepsy,Parkinsons) - 5

Anti-Depressants / Bipolar - 5

Anti-Emetics (Nausea/Vomiting) - 5

Anti-Histamine/Decongestant/Cough/Allergy - 5, 6

Anti-Microbials(Antibiotics/Bacteria/ Fungal/ Parasitic/Viral) -6,7

Anti-Psychotics (Psychiatrics) - 7

Anti-Rheumatics (Arthritis/RheumatoidArthritis) -7

Attention Deficit/Narcolepsy - 7

Attention Deficit/Non-Stimulants - 7

Cholesterol/Lipid Lowering - 7

Contraceptives (Birth Control) – 8, 9

Corticosteroids- Oral - 9

Dental Agents - 9

Diabetic Agents & Supplies - 9

Diuretic (Fluid Retention) - 10

Dry Mouth - 10

Electrolyte Replacement - 9 Emergency Meds (Insect Sting/Substance Abuse)- 10

Erectile Dysfunction - 10

Fertility Medication - 10

Gastro-IntestinalAgents (Acid Reflux/Heartburn)- 10

G-I Agents Other (GI Prep kits/IBS/Gall Bladder/etc)- 10,11

Genito-Urinary Agents (Bladder/Prostate) -11

Gout Agents - 11

Hormones (Estrogen/Progestin/Testosterone) - 11

Hypertensive/Cardiac(Blood Pressure/Heart)- 12,13

Immunologic/Biologic(RA/Psoriasis/Crohn’s) - 13

Migraine Agents - 13

Multiple Sclerosis Agent -13

Muscle Relaxants - 13

Myesthenia Gravis - 13

Nasal Sprays/Rinses – 14 Neurological Agent (Nerve Pain/Restless Leg) - 14

Oncology/Cancer - 14 Ophthalmics (Eye Care) - Antibiotics/Antivirals - 14

Ophthalmics (Eye Care)- (Glaucoma/allergy/etc) -14, 15

Osteoporosis/Bone Loss - 15

Otic (Ear Care) Preparations - 15

Prostate Medication - 15

Respiratory- 16

Sedative Hypnotics (Sleep Aids) - 16

Smoking Cessation - 16

Thyroid/Anti-Thyroid Agents - 16

Topical Agents - 16, 17

Vaginal Preparations - 17

Vitamins and Minerals – 18

*Dye-free products are not stocked and are not available for order at this pharmacy*

4

Alzheimers / Dementia

Donepezil (Aricept equiv) 5mg; 10mg tabs

Memantine (Namenda equiv) immediate release tablets only – 5mg & 10mg (excludes Namenda XR)

Rivastigmine patch (Exelon equiv) 4.6mg/24 hrs; 9.5mg/24 hrs; 13.3mg/24 hrs patch

ANALGESICS / ANTI-INFLAMMATORY / OPIOIDS

Acetaminophen (Tylenol equiv) 325mg tabs

Acetaminophen elixir for Children (Tylenol Elixir equiv) 160mg/5ml

Acetaminophen w/ Codeine elixir (Tylenol w/Codeine Elixir equiv) 120mg/12mg per 5mls *controlled substance**

Acetaminophen w/ Codeine #3 (Tylenol#3 equiv) 300mg/30mg tabs *controlled substance*

Analpram HC (pramoxine/ 1%/HC 2.5%) cream

Arthrotec equiv (diclofenac/misoprostol) 75/200mg tabs

Aspirin (enteric coated and chewable) 81mg tabs; 325mg enteric-coated tabs

Celecoxib (Celebrex equiv) 100mg; 200mg caps

Diclofenac (Voltaren, Voltaren DR equiv) 75mg delayed-release tabs, 50mg immediate release tabs

Etodolac (Lodine, Lodine XL equiv) 400mg; 500mg; 500mg XL tabs

Fentanyl transdermal system (Duragesic equiv) 25; 50; 75; 100 mcg/hour patch *controlled substance*

Ibuprofen (Motrin equiv) 400; 600; 800mg tabs

Indomethacin (Indocin, Indocin SR equiv) 25mg; 50mg; 75mg SR caps

Ketorolac Tromethamine (Toradol equiv) 10mg tabs *maximum qty of #24 tabs*

Lidocaine (Lidoderm) Adhesive Patch 5% (700mg/patch) maximum 3 boxes/30 days

Meloxicam (Mobic equiv) 7.5mg; 15mg tabs

Mefenamic acid (Ponstel equiv) 250mg caps

Meperidine (Demerol equiv) – 50mg tabs only *controlled substance*

Morphine immediate release oral (MSIR equiv) 15mg; 30mg tabs *controlled substance*

Morphine sustained-release (Ms Contin equiv) 15mg; 30mg; 60mg; 100mg; 200mg tabs *controlled substance*

Nabumetone (Relafen equiv) 500mg; 750mg tabs

Naproxen immediate-release (Naprosyn; Anaprox DS equiv) 250mg; 375mg; 500mg; 550mg tabs

Hydrocodone/Acetaminophen (Norco tabs equiv) 5/325mg; 7.5/325mg; 10/325mg tabs *controlled substance*

Hydrocodone /Acetaminophen (Norco liquid equiv) 7.5/325mg per 15ml (tablespoonful) *controlled substance*

Oxycodone immediate-release (Roxicodone, Oxy IR equiv) 5mg; 10mg; 15mg;, 20mg; 30mg tabs *controlled substance*

Oxycodone sustained-release (Oxycontin equiv) 10mg; 15mg; 20mg; 30mg; 40mg; 60mg; 80mg tabs *controlled substance*

Oxycodone/Acetaminophen (Percocet equiv) 5/325mg; 7.5/325mg; 10/325mg tabs *controlled substance*

Piroxicam (Feldene equiv) 10mg; 20mg caps

Salsalate (Disalcid equiv) 500mg tabs

Sulindac 200mg tabs

Tramadol (Ultram equiv) Immediate-Release only 50mg; QTY LIMIT: 30-day limit for controlled substances; Excludes Tramadol ER

Ultracet equiv (Tramadol/Acetaminophen) 37.5mg/325mg; QTY LIMIT: 30-day limit/controlled substance; maximum of 240 tabs/30 days

Anti-Anxiety

Buspirone (Buspar equiv) 5mg; 10mg 15mg tabs

Clonazepam oral (Klonopin) 0.5mg; 1mg; 2mg tabs *controlled substance*

Clorazepate oral (Tranxene) 7.5mg tabs only *controlled substance*

Diazepam (Valium) 2mg; 5mg tabs *controlled substance*

Hydroxyzine HCL oral (Atarax) 10mg; 25mg tabs

Hydroxyzine Pamoate (Vistaril equiv) 25mg caps

Chlordiazepoxide/Clidinium (Librax equiv) 5mg/2.5mg caps

Lorazepam (Ativan) 0.5mg, 1mg, 2mg tabs *controlled substance*

Anti-Coagulants - (Circulation/Blood Thinners)

Apixaban (Eliquis) 2.5mg; 5mg tabs

Cilostazole (Pletal equiv) 50mg; 100mg tabs

Clopidogrel (Plavix) 75mg tabs

Dipyridamole (Persantine equiv) 25mg tabs

Enoxaparin (Lovenox equiv) 30mg; 40mg; 60mg; 80mg; 100mg; 120mg; 150mg injection

Pentoxifylline (Trental) 400mg tabs Prasugrel (Effient) 10mg tabs

Rivaroxaban (Xarelto) 10mg; 15mg; 20mg tabs

Ticagrelor (Brilinta) 60 mg, 90 mg tabs

Warfarin sodium (GENERIC only) all strengths

5

Anti-Convulsants/ Epilepsy/Parkinson

Amantadine (Symmetrel equiv) 100mg caps

Benztropine (Cogentin equiv) 0.5mg; 2mg tabs

Carbamazepine (Tegretol equiv) 100mg; 200mg tabs

Carbamezapine XR (Tegretol XR equiv) 100mg; 200mg; 400mg tabs

Carbamezapine Suspension (Tegretol Suspension equiv) 100mg/5ml

Clonazepam (Klonopin equiv) 0.5mg; 1mg; 2mg tabs *controlled substance*

Clorazepate (Tranxene equiv) 7.5mg tabs only *controlled substance*

Diazepam (Valium equiv) 2mg; 5mg tabs *controlled substance*

Divalproex (Depakote, Depakote ER, Depakote Sprinkles equiv) 250mg SR; 250mg ER and 500mg ER; 125mg sprinkles

Lacosamide (Vimpat) tablets all strengths – QTY limit – controlled substance

Lamotrigine (Lamictal equiv) 25mg; 50mg; 150mg; 200mg tabs and 5mg; 25mg Chewtabs

Leviteracetam (Keppra equiv) 250mg; 500mg; 750mg; 1000mg; 500mg XR; 750mg XR tabs

Oxcarbazepine (Trileptal) 150mg; 300mg; 600mg tabs

Phenobarbital 32.4 mg tabs *controlled substance*

Phenytoin (Dilantin brand only) 30mg; 100mg caps; 50mg chew tabs; 125mg/5ml suspension

Primidone (Mysoline) 50mg; 250mg tabs

Rasagiline (Azilect) 0.5mg, 1mg tabs

Sinemet equiv (Carbidopa/Levodopa) – Immediate-release 10/100, 25/100, 25/250mg tabs

Sinemet ER equiv (Carbidopa/Levodopa ER) 25/100mg; 50/200mg tablet

Stalevo equiv (Carbidopa-Levodopa-Entacapone) all strengths tabs

Topiramate (Topamax equiv) 25mg; 50mg; 100mg; 200mg tabs; and 15mg & 25mg sprinkle capsules

Trihexyphenidyl (Artane equiv) 2mg tabs

Zonisamide (Zonegran equiv) 25mg; 100mg caps **allergy alert - this is a SULFA drug**

Anti-Depressants / Bipolar

Amitriptyline (Elavil) 10mg; 25mg; 50mg; 100mg tabs Bupropion SR (Wellbutrin SR equiv) 100mg; 150mg tabs

Bupropion XL (Wellbutrin XL equiv) 150mg; 300mg tabs

Citalopram (Celexa equiv) 10mg; 20mg; 40mg tabs

Doxepin (Sinequan equiv) 10mg; 25mg; 50mg caps

Duloxetine (Cymbalta equiv) 20mg; 30mg; 60mg caps

Escitalopram (Lexapro equiv) 10mg; 20mg tabs

Fluoxetine (Prozac equiv) 10mg; 20mg caps

Fluvoxamine (Luvox equiv) 50mg; 100mg caps (Excludes Luvox CR)

Imipramine (Tofranil equiv) 10mg; 25mg tabs

Lurasidone (Latuda) 20mg; 40mg; 60mg; 80mg tabs

Mirtazapine (Remeron equiv) 15mg, 30mg tabs

Nefazodone (Serzone equiv) 150mg; 200mg; 250mg tabs

Nortriptyline (Pamelor equiv) 10mg; 25mg caps

Paroxetine (Paxil equiv) 10mg, 20mg; 30mg tabs

Paroxetine CR (Paxil CR equiv) 25mg caps

Sertraline (Zoloft equiv) 25mg; 50mg; 100mg tabs

Trazodone (Desyrel equiv) 50mg; 100mg tabs

Venlafaxine Immediate-release (Effexor equiv) 25mg; 75mg tabs

Venlafaxine XR (Effexor XR equiv) 37.5mg; 75mg; 150mg caps

Anti-Emetics (Nausea/Vomiting)

Ondansetron liquid (Zofran equiv) 4mg/5ml

Ondansetron tablets (Zofran equiv) – 8mg oral tabs; 4mg ODT and 8mg ODT (Oral Disintegrating Tabs)

Prochlorperazine (Compazine equiv) – 5mg; 10mg tabs

Promethazine (Phenergan equiv) 25mg tabs

Promethazine liquid (Phenergan equiv) 6.25mg/5ml

Promethazine (Phenergan equiv) 12.5mg; 25mg suppositories

Scopolamine Base (Transderm Scop patch) 1.5mg/72hr (Motion sickness prevention only)

Anti-Histamines / Decongestants / Cough Suppressants / Allergy

Benzonatate Perles (Tessalon equiv) 100mg

Brompheniramine/Pseudoephedrine (Bromfed DM liquid equiv) 2/30/10mg per 5ml **Limit 1 mo. w/refills**

Cetirizine liquid (Zyrtec liquid for Children) 5mg/5ml

Cetirizine (Zyrtec equiv) 10mg tabs only

Cetirizine-D (Zyrtec-D equiv) 12-hour *Available only in 12 count boxes*Limit 1 mo. w/refills**

6

Anti-Histamines / Decongestants / Cough Suppressants / Allergy cont.

Brompheniramine/Pseudephedrine (Lodrane –D equiv) 12/120mg tabs **Only available in 60 count btl***Limit 1 mo. w/refills**

Chlorpheniramine (Chlortrimeton equiv) 4mg tabs

Cyproheptadine liquid (Periactin equiv) 4mg tabs and 2mg/5ml oral solution

Diphenhydramine liquid (Benadryl equiv) – 25mg caps and 12.5ml/5ml

Fexofenadine (Allegra equiv) 60mg 180mg tabs

Fexofenadine liquid (Children’s Allegra equiv) 30mg/5ml suspension

Fexofenadine/Pseudoephedrine (Allegra-D 12-hr equiv ) 60/120mg tab**Only available in 30 count boxes**Limit 1 mo. w/refills**

Hydrocodone/Chlorpheniramine (Tussionex equiv ) 10/8mg suspension –**Max qty of 4 ounces (115ml) dispensed**controlled substance

Hydroxyzine (Atarax) 10mg; 25mg tabs and 10mg/5ml liquid

Guaifenesin sustained release (Mucinex equiv) 600mg tabs only

Guaifenesin (Robitussin-generic) 100mg/5ml syrup

Guaifenesin/Dextromethorphan (Robitussin DM-generic) 100mg/5mg per 5ml syrup

Guaifenesin/Codeine (Cheratussin AC) syrup *controlled substance*

Guaifenesin/Codeine/pseudoephedrine (Cheratussin DAC) syrup *controlled substance*

Guaifenesin/Pseudoephedrine (Mucinex-D 12 hour equiv) 600mg/60mg tabs **Only available in 36 count boxes***Limit 1 mo. w/refills*

Loratadine (Claritin equiv) 10mg Swallow tablets and Children’s Oral solution 5mg/5ml

Loratadine/Pseudoephedrine (Claritin-D equiv) 10/240mg tabs 24-hr **Only available in 15 count boxes** Limit 1 mo. w/refills**

Meclizine (Antivert) 25mg tabs

Montelukast (Singular equiv) – 4mg granules; 4mg & 5mg chewtabs; 10mg tabs

Phenylephrine (Sudafed PE) 10mg tabs

Phenylephrine/Chlorpheniramine/Acetaminophen/ (Norel AD equiv) 10/4/325mg tabs

Phenylephrine, Dextromethorphan, Acetaminophen (DayQuil) 5/10/325mg caps

Phenylephrine, Dextromethorphan, Acetaminophen, Doxylamine (NyQuil Severe Cold and Flu) 5/10/325/6.25mg caplets

Promethazine w/DM syrup (Phenergan DM Syrup generic)

Pseudoephedrine (Sudafed) 60mg tablets only (by prescription only)

Anti-Microbials (Antibiotics, Anti-Virals, Antifungals, Antiparasitic)

Acyclovir (Zovirax equiv) 200mg tabs and 400mg caps

Albendazole (Albenza eqiuv) 200mg tabs

Amantadine (Symmetrel equiv) 100mg caps

Amoxicillin (Amoxil) 250mg; 500mg; 875mg tabs/caps

Amoxicillin (Amoxil) 250mg/5ml; 400mg/5ml suspension

Amoxicillin/clavulanate (Augmentin equiv) 250mg; 500mg; 875mg tabs and 1000mg XR tabs

Amoxicillin/clavulanate (Augmentin equiv) 200mg/5ml; 250mg/5ml; 400mg/5ml; 600mg/5ml suspension

Azithromycin (Zithromax, Zpack equiv) 250mg tabs and 100mg/5ml; 200mg/5ml suspension

Cefprozil (Cefzil) 250mg tabs or 250mg/5ml suspension

Cefuroxime (Ceftin) tablets only

Cephadroxil (Duricef equiv) 500mg caps

Cephalexin (Keflex equiv) 250mg; 500mg caps

Cephalexin (Keflex equiv) 250mg/5ml suspension

Cefdinir (Omnicef equiv) 300mg caps only

Cefdinir (Omnicef equiv) 125mg/5ml; 250mg/5ml suspension

Ciprofloxan (Cipro equiv) 250mg; 500mg tabs

Clarithromycin (Biaxin & Biaxin XL equiv) 500mg tabs and 250mg/5ml suspension

Clindamycin (Cleocin equib) 150mg; 300mg caps and 75mg/5ml oral suspension

Dapsone 25mg; 100mg tabs

Dicloxacillin oral (Dynapen equiv) 250mg caps

Doxycycline Hyclate (Vibramycin equib) 20mg; 100mg oral tabs/cap (excludes Doryx extended release)

Doxycycline Monohydrate (Monodox equiv) 50mg; 100mg caps

Doxycycline, USP (ORACEA equiv) 40mg caps for ACNE

Erythromycin (Erythrocin equiv) and ERYC delayed release 250mg caps/tabs

Ethanbutol (Myambutol) 400mg tabs

Famcyclovir (Famvir equiv) 250mg; 500mg tabs

Fluconazole (Diflucan equiv) 100mg; 150mg; 200mg tabs

Griseofulvin oral (Gris-peg equiv) 250mg ultramicrosize tabs; 125mg/5ml microsize oral suspension.

Isoniazid oral (INH) 100mg; 300mg tabs

Ivermectin 3mg tabs

Ivermectin (Sklice equiv) 0.5% Lotion

Itraconazole (Sporonox eqiuv) 200mg caps

Levofloxacin (Levaquin equiv) 250mg; 500mg; 750mg tabs

Methenamine (Hiprex, Urex) 1gm tabs

Metronidazole (Flagyl) 250mg; 500mg tabs

Minocycline (Minocin) 50mg; 100mg caps

Naftifine (Naftin equiv) 2% cream

Nitrofurantoin USP (Macrodantin equiv) 50mg caps and Nitrofurantoin Monohydrate/Macrocyrstals (Macrobid equiv) 100mg caps

7

Anti-Microbials (Antibiotics, Anti-Virals, Antifungals, Antiparasitic) cont.

Nystatin 500,000U oral tabs (does not include Mycostatin Pastilles)

Penicillin VK (Pen VK) 250mg; 500mg tabs and 250mg/5ml suspension

PrevPac (H.pylori) equiv

Rifampin (Rifadin equiv) 300mg caps

Sulfamethoxazole/trimethoprim (Bactrim DS/Septra DS equiv) 160mg/800mg tabs and 200mg/40mg per 5ml pediatric suspension

Terbinafine (Lamisil equiv) 250mg tabs and cream

Tetracycline 250mg caps

Trimethoprim (Proloprim) 100 mg tabs

Valacyclovir (Valtrex equiv) 500mg; 1gm tabs

Antipsychotics (Psychiatrics) Aripiprazole (Ability) all strengths

Chlorpromazine (Thorazine equiv) 25mg; 50mg tabs

Lithium (Lithobid equiv) 300mg tabs/caps and 300mg XR, 450mg XR tabs

Lurasidone (Latuda equiv) 40mg; 60mg tabs

Olanzapine (Zyprexa equiv) 2.5mg; 5mg; 10mg tabs

Quetiapine (Seroquel and Seroquel XR equiv) all strengths for both

Risperidone (Risperdal equiv) 0.25mg; 0.5mg; 1mg; 2mg; 4mg tabs

Ziprasidone (Geodon equiv) 20mg; 40mg; 60mg; 80mg tabs

Anti-rheumatics (Arthritis/Rheumatoid Arthritis)

Azathioprine (Imuran equiv) 50mg tabs

Hydroxychloroquine (Plaquenil equiv) 200mg tabs

Humira (Adalimumab) 40mg injection (2 injections per box)

Leflunomide (Arava equiv) 20mg tabs

Attention Deficit/Narcolepsy/STIMULANT

**Per AR 40-3 Adderal (amphetamine) will not be dispensed to prevent drowsiness**

Adderall (mixed amphetamine salts equiv) 5mg; 10mg; 20mg; 30mg tabs *controlled substance*

Adderall XR (mixed amphetamine equiv) 5mg; 10mg; 20mg; 25mg; 30mg tabs *controlled substance*

Armodafinil (Nuvigil) 50mg; 150mg; 200mg; and 250mg tabs *controlled substance*

Dexmethylphenidate IR (Focalin IR) 5mg; 10mg tabs *controlled substance*

Dextroamphetamine (Dexedrine equiv) 5mg caps and 5mg; 10mg; 15mg spansules *controlled substance*

Methylphenidate (Ritalin, Concerta equiv) 5mg; 10mg; 20mg tabs *controlled substance*

Methylphenidate LA (Ritalin LA equiv) GENERIC ONLY 20mg; 30mg; 40mg caps *controlled substance*

Methylphenidate XR (Quillivent XR Reconstitute equiv) 5mg/ml suspension *ordered upon request only-requires 3 business days)

Modafinil (Provigil) 100mg & 200mg tabs *controlled substance*

Attention Deficit/NON-STIMULANT

Atomoxetine (Strattera equiv) all strengths caps

Clonidine ER (Kapvay ER) 0.1mg

Guanfacine ER (Intuniv equiv) 1mg; 2mg; 3mg 4mg tabs

Cholesterol / Lipid Lowering

Atorvastatin (Lipitor) 10mg; 20mg; 40mg; 80mg tabs

Cholestyramine (Questran equiv) powder cans

Colestipol (Colestid equiv) 1gm tabs

Ezetimibe (Zetia equiv) 10mg tabs

Fenofibrate (Triglide equiv) 160mg tabs (only)

Fenofibrate Nanocrystallized (Tricor equiv) 48mg; 54mg; 145mg tabs (excludes Trilipix delayed release)

Fish Oil (Omega 3 Fatty Acid) 1000mg caps {NOT equiv. to Lovaza}

Gemfibozil (Lopid equiv) 600mg tabs

Niacin SR (Niaspan equiv) 500mg; 750mg; 1000mg extended-release tabs

Pravastatin (Pravachol equiv) 10mg; 20mg; 40mg; 80mg tabs

Rosuvastatin (Crestor equiv) 10mg; 20mg; 40mg tabs

Simvastatin (Zocor equiv) 5mg; 10mg; 20mg; 40mg; 80mg tabs

8

Contraceptives (Birth control)

LOW-DOSE MONOPHASIC

Product Estrogen Progestin

Orsythia Lutera Sronyx

Ethinyl Estradiol 20 mcg Levonorgestrel 0.1 mg

Gildess FE 1/20 Junel FE 1/20

Microgestin FE 1/20 Trina FE 1/20

Ethinyl Estradiol 20 mcg Norethindrone 1 mg

Levora Ethinyl Estradiol 30 mcg Levonorgestrel 0.15 mg

Cryselle-28 Elinest – 28

Low-Orgestrel-28 Ethinyl Estradiol 30 mcg Norgestrel 0.3 mg

Junel FE 1.5/30 Ethinyl Estradiol 30 mcg Norethindrone 1.5 mg

Apri Ethinyl Estradiol 30 mcg Desogestrel 0.15 mg

Ocella; Safyral; Syeda; Yasmin; Zarah Ethinyl Estradiol 30 mcg Drospirenone 3 mg

Zovia 1/35E Ethinyl Estradiol 35 mcg Ethynodiol Diacetate 1 mg

Estarylla; Mono-Linyah; MonoNessa; Ortho-Cyclen; Preifem, Sprintec

Ethinyl Estradiol 35 mcg Norgestimate 0.25 mg

Alyacen 1/35; Cyclafem 1/35; Dasetta 1/35; Necon 1/35-28;

Norinyl 1/35; Nortrel 1/35; Pirmella 1/35

Ethinyl Estradiol 35 mcg Norethindrone 1 mg

HIGH-DOSE MONOPHASIC

Product Estrogen Progestin

Ogestrel 0.5/50-28 Ethinyl Estradiol 50 mcg Norgestrel 0.5 mg

Kelnor; Zovia 1/50E-28 Ethinyl Estradiol 50 mcg Ethynodiol Diacetate 1 mg

TRIPHASIC

Product Estrogen Progestin

Trinessa Lo Ortho Tri-Cyclen Lo

Ethinyl Estradiol 25 mcg

Norgestimate:

0.18 mg x 7 days

0.215 mg x 7 days

0.25 mg x 7 days

Caziant; Cyclessa Velivant

Ethinyl Estradiol 25 mcg

Desogestrel:

0.1 mg x 7 days

0.125 mg x 7 days

0.15 mg x 7 days

Trivora Myzilra

Levonest Enpresse

Ethinyl Estradiol:

30 mcg x 6 days

40 mcg x 5 days

30 mcg x 10 days

Levonorgestrel:

0.05 mg x 6 days

0.075 mg x 5 days

0.125 mg x 10 days

TriNessa Ethinyl Estradiol 35 mcg

Norgestimate:

0.18 mg x 7 days

0.215 mg x 7 days

0.25 mg x 7 days

Aranelle; Leena; Tri-Norinyl

Ethinyl Estradiol 35 mcg

Norethindrone:

0.5 mg x 7 days

1 mg x 9 days

0.5 mg x 5 days

Alyacen 7/7/7; Cyclafem 7/7/7; Dasetta 7/7/7; Necon 7/7/7; Nortrel 7/7/7; Pirmella 7/7/7

Ethinyl Estradiol 35 mcg

Norethindrone:

0.5 mg x 7 days

0.75 mg x 7 days

1 mg x 7 days

EXTENDED CYCLE

Product Estrogen Progestin

Jolessa Introvale; Quasense

Ethinyl Estradiol 30 mcg x 84 days Levonorgestrel 0.15 mg x 84 days

Gianvi; Loryna; Nikki; Vestura; Yaz

Ethinyl Estradiol 20 mg x 24 days Drosperidone 3 mg x 24 days

9

Contraceptives (Birth control) cont.

PROGESTIN ONLY PILLS

Product Progestin

Nora-BE (Camila, Errin, Heather, Jencycla, Jolivetta, Lyza,

Ortho Micronor)

Norethindrone 0.35 mg

Contraceptive Alternatives

Nuvaring (estonogestrel/Ethinyl Estradiol) vaginal ring

Xulane Patch (equiv to Ortho Evra)

Contraceptive (Emergency)

Ella (Ulipristal Acetate) 30mg *dispensing limitations*

Plan – B (Levonorgestrel 1.5mg) *dispensing limitations*

Corticosteroids – Oral

Budesonide (Entocort equiv) 3mg caps (Crohn’s Disease) Dexamethasone (Decadron equiv) 0.5mg, 0.75mg; 1.5mg, 4mg tabs and DexPak 1.5mg tabs (6-day, 10-day, 13-day pack)

Fludrocortisone (Florinef equiv) 0.1mg tabs

Methylprednisolone (Medrol, Medrol Dose Pack equiv) 4mg tabs

Prednisone (Deltasone equiv) 5; 10; 20mg tabs

Prednisolone (Pediapred, Prelone equiv) 5mg/5ml; 15mg/5ml liquid

Dental Agents

Chlorhexidine oral rinse (Peridex, PerioGard)

Sodium Fluoride (PreviDent 5000 Plus) 1.1% paste Spearmint

Triamcinolone (Kenalog-in-Orabase) paste

Viscous Lidocaine (Xylocaine) 2% oral gel 100ml

Diabetic Agents/Supplies Alcohol pads Box of 100

Acarbose (Precose) 50mg tabs

Exenatide (Bydureon) 2mg SQ pen (4 injections per box) REQUIRES PRIOR AUTHORIZATION FORM

Exenatide ER (Bydureon BCise 2mg SQ pen (4 injections per box) REQUIRES PRIOR AUTHORIZATION FORM

Empagliflozin (Jardiance) 10mg; 25mg tab

Glucometer Free Style Lite (only one type of meter on formulary)

Glucometer Strips Free Style Lite test strips

Lancets (generic)

Glimepiride (Amaryl equiv) 2mg; 4mg tabs

Glipizide IR (Glucotrol immediate-release equiv) 5mg; 10mg tabs

Glipizide XL (Glucotrol XL equiv) 5mg; 10mg XL tabs

Glucogon Emergency Injectable Kit #1

Glyburide (Micronase) 0.25mg; 5mg tabs

Insulin aspart (Novolog & Novolog mix) vials and Flexpens

Insulin detemir (rDNA origin) (Levemir) vials only

Insulin glargine (rDNA origin) Lantus Vials and Solostar pens

Insulin human 70/30 NPH and Regular vials

Insulin Lispro (HUMALOG) vials, Kwikpen,

Insulin Lispro MIX 75/25 (Humalog Mix) Kwikpen

Insulin PEN Needles Short – 1/4” (6mm) length, 32 gauge

Metformin (Glucophage equiv) 500mg; 850mg; 1000mg tabs

Metformin XR (Glucophage XR equiv) 500mg and 750mg XR tabs (Excludes 1000mg XR)

Metformin/Glyburide (Glucovance) 1.25mg/250mg; 2.5mg/500mg; 5mg/500mg tabs

Nateglinide (Starlix) 60mg; 120mg tabs

Pioglitazone (Actos equiv) 15mg; 30mg; 45mg tabs

Sitagliptin (Januvia) 25mg; 50mg; 100mg tabs

Sitagliptin/Metformin (Janumet) 50/500mg; 50/1000mg tabs

Sitagliptin/Metformin XR (Janumet XR) 50/500mg; 50/1000mg; 100/1000mg tabs (once daily dosing)

Syringes, Insulin - Available in 1/2cc and 1cc, ½” 30G

10

Diuretics (Fluid Retention)

Bumetanide (Bumex) 1mg tabs

Chlorthalidone (Hygroton) 25mg; 50mg tabs

Furosemide (Lasix equiv) 20mg; 40mg tabs

Hydrochlorothiazide (HCTZ) 12.5mg tabs; 25mg tabs; 50mg tabs

Hydrochlorothiazide/triamterene (Maxzide equiv) 25mg/37.5mg; 50mg/75mg tabs

Indapamide (Lozol equiv) 1.25mg; 2.5mg tabs

Metolazone (Zaroxolyn equiv) 2.5mg; 5mg tabs

Spironolactone (Aldactone equiv) 25mg; 50mg tabs

Torsemide (Demadex equiv) 5mg; 20mg tabs

Dry Mouth

Biotene Dry Mouth Oral Rinse 1 liter bottles

Cevimeline (Evoxac) 30mg caps

Electolyte Replacement

Magnesium Oxide (MagOx) 400mg tabs

Potassium chloride (KDur, Klor) 8 mEq;, 10mEq; 20mEq tabs

Potassium chloride powder for solution (KLor 20mEq packets) 100 packets/box

Emergency Kit (Insect Sting / Substance Abuse)

Glucagon Emergency Kit

Insect sting kit (Epi-Pen and Epi-pen Jr.) **Pharmacy needs to annotate allergy on file** (Manufacture shortage check with pharmacy)

Naloxone (Narcan equiv) Nasal Spray

Naltrexone (Naltrexone) 50mg tabs

Erectile Dysfunction

Sildenafil (Viagra equiv) 25mg; 50mg; 100mg tabs (Limit 6 tabs/month –Maximum 3 months/18 tabs)

Fertility Drugs

Clomiphene (Clomid equiv) 50mg tabs

Gastrointestinal Reflux Disease (GERD) Agents/Acid Reflux/Heartburn/Gas

Cimetidine (Tagamet equiv) 300mg; 400mg tabs

Famotidine (Pepcid equiv) 20mg; 40mg tabs

Omeprazole (Prilosec equiv) 20mg; 40mg caps

Omeprazole (FIRST-Omeprazole KIT) 2mg/ml suspension

Pantoprazole (Protonix equiv) 20mg; 40mg tabs

Rabeprazole (Aciphex equiv) 20mg tabs

Simethicone 80mg chew tabs

Gastrointestinal Agents (GI Prep Kits/ Diarrhea/Constipation/IBS/Crohn’s/Gallbladder)

Budesonide (Entocort equiv) 3mg caps (for Crohn’s disease)

Chlordiazepoxide/clidinium (Librax equiv)

Colyte / Golytely Bowel Prep **See other Bowel Prep kits below*

Dicyclomine (Bentyl equiv) 10mg caps; 20mg tabs

Docusate sodium (Colace equiv) 100mg caps

Flavoxate (Urispas equiv) 100mg tabs

Hyoscyamine (Levsin, LevBid equiv) 0.125mg SL; 0.375 tabs

Lactulose (Cephulac equiv) Syrup 10gm/15ml

Linaclotide (Linzess equiv) 145mcg; 290mcg tabs

Lomotil (diphenoxylate/atropine) 2.5mg/0.025mg tabs *controlled substance*

Loperamide (Imodium equiv) 2mg caps

Lubiprostone (Amitiza equiv) 8mcg, 24mcg tabs

Mesalamine (Lialda equiv) 1.2G delayed release

Miralax equiv (propylene glycol 3350) powder for suspension (Max Qty Limit = 1 x 527gm bottle per 30 days) 17gm/dose

11

Gastrointestinal Agents (GI Prep Kits/ Diarrhea/Constipation/IBS/Crohn’s/Gallbladder)

Metoclopramide (Reglan equiv) 10mg tablets

Misoprostol (Cytotec equiv) 200mg tabs

Moviprep Bowel Prep kit

Naldemidine (Symproic) 0.2mg tabs (opioid induced constipation)

Pancrelipase (Creon equiv) delayed release capsules 3000mg; 6000mg; 12,000mg; 24,000mg; 36,000mg caps

Prochlorperazine (Compazine equiv) – 5mg tabs

Prepopik Bowel Prep kit

Ranitidine (Zantac equiv) 300mg; 400mg (Excludes EFFERdos or GELdose)

SuPrep Bowel Prep Kit

Sucralfate (Carafate equiv) 1gm tabs and 1gm/10ml suspension

Ursodiol (Actigal equiv) 300mg; 500mg caps

Gastrointestinal Agents (Other)

Probiotic (Culturelle) (Lactobacillus Rhamnosus GG) one tab daily max – no refrigeration required; contains 15 Billion Units CFUs. >12yo

Genitourinary Agents (Bladder/Prostate)

Alfuzosin (Uroxatral equiv) 10mg tabs

Doxazosin (Cardura equiv) 2mg; 4mg; 8mg tabs

Desmopressin (DDAVP equiv) Nasal spray

Desmopressin (DDAVP equiv) 0.1mg; 0.2mg tabs

Oxybutynin (Ditropan equiv) 5mg Immediate-Release tabs

Oxybutynin XL (Ditropan XL equiv) 5mg; 10mg XL tabs

Prazosin (Minipres equiv) 1mg; 2mg; 5mg caps

Phenazopyridine (Pyridium equiv) 100mg; 200mg tabs

Potassium Citrate (Urocit-K) 5 mEq; 10 mEq; 15 mEq tabs

Solifenacin (Vesicare equiv) 5mg; 10mg tabs

Tamsulosin (Flomax equiv) 0.4mg caps

Terazosin (Hytrin equiv) 1mg; 2mg; 5mg; 10mg caps

Tolterodine LA (Detrol LA equiv) 2mg; 4mg caps (Excludes immediate-release tabs)

Urogesic Blue equiv (hyoscyamine/methenamine/methylene blue/NaPhosphate) tabs

Ustell equiv (methanamine/NaPhosphate/phenylsalicylate/methylene blue/hyoscyamine) caps

Gout Agents

Allopurinol (Zyloprim equiv) 100mg; 300mg tabs

Colbenemid equiv (colchicine/probenecid) 0.5mg/500mg tabs

Colchicine 0.6mg only

Probenecid (Benemid equiv) 500mg tabs

Hormones – Estrogen/ Progestin/Testosterone

Activella equiv (estradiol & norethindrone) 0.5mg/0.1mg; 1mg/0.5mg tabs

Prempro equiv (conjugate estrogens/medroxyprogesterone acetate) 0.3/1.5; 0.45/1.5; 0.625/2.5; 0.625/5mg tabs

Combipatch equiv (estradiol/norenthindrone) 50/140mcg (0.05/0.14mg) ; 50/250mcg (0.05/0.25mg) patch

Conjugated estrogens (Premarin equiv) 0.3mg; 0.45mg; 0.625mg; 0.9mg;1.25mg tabs

Conjugated estrogens (Premarin Vaginal Cream equiv) vaginal cream

Estradiol (Estrace Vaginal Cream equiv) vaginal cream

Estradiol (Vagifem equiv) 10mcg vaginal tab

Estradiol 2mg Ring (ESTRING equiv)

Estradiol patch equiv (Alora Patch: 0.05mg; 0.1mg) Twice-a-week dosing

Estradiol patch equiv (Climara Patch) Once-a-week dosing

Estradiol (Estrace equiv) 0.5mg; 1mg; 2mg tabs

Estradiol (Minivelle; Vivelle Dot- transdermal equiv) 0.1mg/24hr patch

Estratest equiv (Estradiol/Methyltestosterone) tablets *controlled substance*

Medroxyprogesterone (Provera equiv) 5mg; 10mg tabs

Progesterone (Prometrium equiv) 100mg; 200mg caps

Testosterone Cypionate (Depo-Testosterone) 200mg/ml injectable (Enanthate is EXCLUDED) *controlled substance*

Testosterone Gel (Fortesta equiv) 60gm canister *controlled substance* 120 pumps/can

12

HYPERTENSIVE/CARDIAC MEDICATIONS (Blood Pressure/Heart)

Ace Inhibitors/Angiotensin II Blocker – all generic only

Benazepril (Lotensin equiv) 5mg; 10mg; 20mg; 40mg tabs

Captopril (Capoten) 25mg tabs

Enalapril (Vasotec equiv) 5mg; 10mg tabs

Fosinopril (Monopril equiv) 10mg; 20mg tabs

Irbesartan (Avapro) 150mg; 300mg

Irbesartan/HCTZ (Avalide) 150mg/12.5mg; 300mg/12.5mg

Lisinopril (Zestril, Prinivil equiv) 2.5mgl 5mgl 10mg; 20mg tabs

Lisinopril-HCTZ (Zestoretic equiv) 10/12.5; 20/12.5; 20/25mg tabs

Losartan (Cozaar equiv) 25mg; 50mg; 100mg tabs

Losartin-HCTZ (Hyzaar equiv) 50/12.5; 100/12.5; 100/25mg tabs

Ramipril (Altace equiv) 1.25mg; 2.5mg; 5mg; 10mg caps

Telmisartan (Micardis equiv) 20mg; 40mg; 80mg tabs

Telmisartan-HCT (Micardis/HCT equiv) 40/12.5; 80/12.5; 80/25mg tabs

Aldosterone Antagonists

Eplerenone (Inspra) 25mg; 50mg tabs

Spironolactone (Aldactone) 25mg; 50mg tabs

Alpha-1-Adrenergic Blocker

Doxazosin oral (Cardura equiv) 2mg; 4mg; 8mg tabs

Prazosin (Minipres equiv) 1mg; 2mg; 5mg caps

Terazosin (Hytrin equiv) 1mg; 2mg; 5mg; 10mg caps

Alpha/Beta-Adrenergic Blocker

Carvedilol (Coreg equiv) 3.125mg; 6.25mg; 12.5mg; 25mg tabs

Carvedilol CR (Coreg equiv) 10mg; 20mg; 40mg; 80mg caps

Antiadrenergic – Centrally Acting

Clonidine (Catapres) 0.1mg; 0.2mg; 0.3mg tabs

Clonidine (Catapress TTS) patches 0.1mg; 0.2mg; 0.3mg

Beta-Adrenergic Blockers – all generic only

Atenolol (Tenormin equiv) 25mg; 50mg tabs

Bisoprolol (Zebeta equiv) 5mg; 10mg tabs

Bisoprolol/ Hydrochlorothiazide (Ziac equiv) 5/6.25mg tabs

Labetalol (Normodyne) 100mg; 200mg tabs

Metoprolol (Lopressor equiv) 25mg; 50mg; 100mg tabs

Metoprolol Succinate (Toprol XL equiv) 25mg; 50mg; 100mg tabs

Nadolol (Corgard equiv) 40mg; 80mg tabs

Propranolol (Inderal, Inderal LA equiv) 10mg; 20mg; 40mg; 80mg tabs and 60mg; 80mg; 120mg; 160mg LA caps

Calcium Channel Blockers

Amlodipine (Norvasc equiv) tablets 2.5mg; 5mg; 10mg tabs

Amlodipine/Benazepril (Lotrel equiv) 2.5/10mg; 5/10mg; 5/20mg; 10/20mg, 5/40mg; 10/40mg caps

Diltiazem (Cardizem equiv) 30mg; 60mg; 90mg tabs

Diltiazem Sustained Release (Tiazac equiv) 120mg; 180mg; 240mg; 300mg; 360mg; 420mg SR caps

Felodipine (Plendil equiv) 2.5mg; 5mg; 10mg tabs

Nifedipine Sustained Release (Adalat CC equiv) 30mg; 60mg; 90mg SR tabs

Verapamil (Calan, Calan SR) 80mg; 180mg; 240 SR tabs (Excludes Verelan extended-release)

13

HYPERTENSIVE/CARDIAC MEDICATIONS (Blood Pressure/Heart)

Cardiac Agents

Amiodarone (Pacerone equiv) 200mg tabs

Digoxin (Lanoxin equiv) 0.125mg, 0.25 tabs

Dipyridamole (Persantine equiv) 0.25 tabs

Dronedarone (Multaq) 400mg tabs

Flecainide (Tambocor equiv) 50mg; 100mg; 150mg tabs

Magnesium Oxide (MagOx) 400mg tabs

Propafenone (Rythmol) 150mg, 225mg, 325mg caps

Ranolazine (Ranexa equiv) 500mg; 1,000mg tabs

Sotalol (Betapace equiv) 80mg; 120mg; 160mg; 240mg tabs

Combination

Amlodipine/Valsartan (Exforge equiv) 5/160mg; 5/320mg; 10/160mg; 10/320mg tabs

Amlodipine/Valsartan/HCTZ (Exforge HCT equiv) 5/12.5/160mg; 5/25/160mg; 10/12.5/160mg; 10/25/160mg; 10/25/320mg tabs

Vasodilators

Hydralazine oral (Apresoline equiv) 10mg; 25mg; 50mg tabs

Isosorbide dinitrate oral (Isordil equiv) 10mg tabs only

Isosorbide mononitrate (Imdur,Ismo equiv) 30mg; 60mg tabs

Minoxidil (Loniten) 2.5mg; 10 mg tabs

Nitroglycerin patches (Nitro-Dur equiv) 0.2mg; 0.4mg patches

Nitroglycerin sublingual (Nitrostat equiv tabs and sublingual spray)

Immunologics / Biologic Agent (Rheumatoid Arthritis/Psoriasis/Crohn’s)

Adalimumab (Humira) 40mg/0.8ml Pen Inj Kit & 40mg/0.8ml Syringe Kit *(limited to these two only)

Leflunomide (Arava equiv) 10mg; 20mg tabs

Mycophenolate (Cellcept equiv) 250mg caps and 500mg tabs

Tacrolimus (Prograf) 1mg caps

Migraine Agents

Acetaminophen/Butalbital/Caffeine (Fioricet equiv) 325/50/40mg tabs (only) *controlled substance*

Aspirin/Butalbital/Caffeine (Fiorinal equiv) 325/50/40mg caps/tabs *controlled substance*

Eletriptan (Relpax equiv) 20mg; 40mg tabs *Quantity limit: 12 tabs per 30 days*

Imitrex *generic only* Quantity limits : 25mg & 50mg tabs limited to 18 tabs/30 days ; 100mg tabs limited to 9 tabs/30 days

Imitrex Stat Dose equiv syringes Quantity limits : 8 syringes/30 days

Imitrex *generic only* Nasal spray 20mg per unit Quantity limits: 6 units per 30 days; 18 units per 90 days

Rizatriptan (Maxalt and Maxalt MLT equiv) 5mg; 10mg tabs Quantity limits: 12 tabs/30 days

Topiramate (Topamax equiv) tabs all strengths (excludes extended release tables)

Zolmitriptan (Zomig equiv) 5mg tabs only Quantity limits: 12 tabs/30days

Zolmitriptan (Zomig-ZMT equiv) 2.5mg; 5mg orally disintegrating tabs Quantity limit: 12 tabs/30 days

Multiple Sclerosis Agent

Interferon Beta-1b (Betaseron) 0.3mg *(vial or kit only on BCF)*

Muscle Relaxants

Baclofen (Lioresal equiv) 10mg tabs

Cyclobenzaprine (Flexeril equiv) 5mg; 10mg tabs

Metaxalone (Skelaxin equiv) 400mg; 800mg tabs

Methocarbamol (Robaxin equiv) 500mg; 750mg tabs

Tizanidine (Zanaflex equiv) 4mg tabs only

Myesthenia Gravis

Pyridostigmine (Mestinon equiv) 60mg caps

14

Nasal Sprays and Rinses

Azelastine (Astelin equiv) Nasal Spray (Excludes Astepro)

Budesonide (Rhinocort AQ equiv) Nasal Spray

Flunisolide (Nasalide equiv) nasal spray

Fluticasone (Flonase equiv) nasal spray

Ipratropium Bromide (Atrovent equiv) 0.03% and 0.06% nasal spray Saline (Ocean spray equiv) nasal spray

Saline Rinse (Neil-Med) Starter Kit contains reusable bottle and 50 prefilled packets

Saline Rinse (Neil-Med) Refill Kit contains 100 prefilled packets

Triamcinolone Acetonide (Nasacort) nasal spray- Alcohol free

Neurological Agents (Nerve Pain/Restless Leg Syndrome)

Gabapentin (Neurontin equiv) 100mg; 300mg; 400mg 600mg; 800mg caps

Pramipexole (Mirapex equiv) 0.125mg; 0.25mg; 0.5mg tabs (immediate release) only (for Restless Legs Syndrome)

Ropinirole (Requip equiv) (immediate release only) 0.25mg; 0.5mg; 1mg; 2mg; 3mg; 4mg; 5mg tabs

Oncology/Cancer

Antiandrogen

Bicalutamide (Casodex equiv) 50mg tab

Antiestrogen

Anastrazole (Arimidex equiv) 1mg tabs

Exemestane (Aromasin equiv) 25mg tabs

Letrozole (Femara equiv) 2.5mg tabs

Tamoxifen (Nolvadex equiv) 10mg; 20mg tabs

Antimetabolite/Folic Acid Antagonist

Methotrexate (Trexall equiv) 2.5mg tablets only (excludes injectable)

Eye Care: Ophthalmics – Antibiotics/Antivirals

Azasite (azithromycin equiv) 1% solution

Bacitracin ointment

Besifloxacin (Besivance) 0.6% Ophthalmic suspension (5ml)

Ciprofloxacin (Ciloxan equiv) ophthalmic drops and ointment

Erythromycin (Ilotycin equiv) ointment

Ganciclovir (Zirgan equiv) 0.15% GEL

Gentamycin (Garamycin equiv) drops and ointment

Moxifloxacin (Vigamox equiv) drops 0.5%

Neomycin/Polymyxin B sulfates/Gramicidin (Neosporin equiv) solution

Neomycin/Polymyxin B sulfates/Hydrocortisone (Cortisporin equiv) drops and ointment

Ofloxacin (Ocuflox equiv) 0.3% solution

Sulfacetamide (Sulamyd equiv) solution

Tobramycin (Tobrex equiv) drops and ointment

Tobramycin/Dexamethasone (Tobradex equiv) drops and ointment

Trimethoprim/Polymixin B (Polytrim equiv) drops

15

Eye Care: Ophthalmics – other (glaucoma, moisturizing, allergy, anti-inflammatory, other)

Atropine 1% solution 5ml bottle

Azelastine (Optivar) 0.05% solution

Betaxolol (Betoptic-S equiv) 0.25%; 0.5% drops

Bimatoprost (Lumigan equiv) 0.01% solution

Brimonidine (Alphagan-P) 0.1%; 0.15% and 0.2% drops

Brinzolamide/Brimonidine (Simbrinza equiv) 1%/0.2% drops

Carboxymethylcellullose (Refresh Celluvisc PF equiv) 30ct/box- Preservative Free

Diclofenac (Voltaren equiv) drops

Difluprednate (Durezol equiv) 0.05% drops

Dorzolamide (Trusopt equiv) drops

Fluorometholone (FML equiv) 0.1% suspension

Isopto Hyoscine (Scopolamine) drops

Ketorolac Tromethamine (Acular) 0.5% drops; no refills

Ketotifen (Zaditor equiv) 0.025% solution 5ml bottle

Latanoprost (Xalatan equiv) solution *Generic only* <must be refrigerated>

Levobunolol (Betagan equiv) 0.5% solution ONLY

Loteprednol etabonate (Alrex equiv) suspension

Loteprednol etabonate (Lotemax equiv) 0.5% gel only

LiquifilmTears equiv (1.4% polyvinyl alcohol / 0.5% chlorobutanol, NaCl) with preservatives only (drops)

Nepafenac (Ilevro equiv) 0.3% suspension (once daily dosage)

Nepafenac (Nevanac equiv) 0.1% suspension

Olopatadine HCL (Patanol equiv) 0.1% solution

Olopatadine HCL (Pazeo equiv) 0.7% solution

Pilocarpine 1%; 2%; 4% SOLUTION only

Prednisolone (Pred-Forte equiv) 1% solution 5ml bottle

Prednisolone (Pred-Mild equiv) 0.25% solution 5ml bottle

Sodium Chloride (Muro-128 equiv) 5% drops and 5% ointment

Timolol, Timolol GFS (Timoptic, Timoptic XE equiv) 0.25%; 0.5% solution

Timolol/Brimonidine (Combigan equiv) 0.2%/0.5% drops

Timolol/Dorzolamide (Cosopt Plus equiv) solution

Osteoporosis / Bone Loss

Alendronate (Fosamax equiv) 10mg; 35mg; 70mg tabs (Excludes Fosamax-D)

Calcitrol (Rocaltrol equiv) 0.25mcg; 0.5mcg caps

Calcitonin-salmon (Miacalcin Nasal spray equiv) - Store unopened bottle in fridge; open bottles at room temp & discard after 30 days

Ibandronate (Boniva equiv) 150mg tabs (once monthly)

Raloxifene (Evista equiv) 60mg tabs

Ear Care: Otic Preparations

Acetic Acid 2% Otic Solution

Carbamide peroxide (Debrox equiv) drops

Ciprofloxacin/Dexamethasone (Ciprodex equiv) drops

Fluocinolone (Dermotic) 0.1% solution

Neomycin/Polymixin B/Hydrocortisone (Cortisporin equiv) solution and suspension

Prostate Medication

Alfuzosin (Uroxatral equiv) 10mg tabs

Bicalutamide (Casodex equiv) 50mg tabs

Doxazosin (Cardura equiv) 2mg; 4mg; 8mg tabs

Finasteride (Proscar equiv) 5mg tabs

Tamsulosin (Flomax equiv) 0.4mg caps

Terazosin (Hytrin equiv) 1mg; 2mg; 5mg; 10mg caps

16

Respiratory (COPD, Asthma, Bronchodilator)-oral inhalers provided as HFA when available

Advair (Salmeterol/fluticasone) HFA and discus

Albuterol MDI (ProAir) HFA inhaler

Albuterol oral liquid

Albuterol nebulizer solution for inhalation 1.25mg/3ml; 2.5mg/3ml – 30 per box

Umeclidinium/Vilanterol (Anora Ellipta inhaler) 62.5mcg/25mcg MDI

Budesonide nebulizer solution for inhalation (Pulmicort Respules) 0.25mg; 0.5mg; 1mg vials **30 per box

Albuterol/Ipratropium (Combivent Respimat) inhaler *dosed 1 puff four times daily*

Albuterol/Ipratropium (Duoneb equiv) 3mg nebulizer solution for inhalation – 30 per box

Fluticasone oral inhaler (Flovent) HFA and diskus

Glycopyrrolate (Robinul) 1 mg tab

Ipatropium oral inhaler (Atrovent) MDI

Ipatropium (Atrovent) nebulizer solution for inhalation **30 per box**

Levalbuterol (Xopenex equiv) MDI inhaler

Levalbuterol (Xopenex equiv) 0.31mg/3ml, 0.63mg/3ml, 1.25mg/3ml nebulizer solution

Montelukast (Singulair) 10mg tabs and 4mg; 5mg chewable tabs and 4mg granules

Roflumilast (Daliresp) 500 mg tabs

Spacer (Aerochamber) and also Aerochamber w/mask (S, M, L)

Salmeterol (Serevent) discus

Terbutaline (Brethine) 2.5mg; 5mg tabs

Theophylline SR 200mg; 400mg; 600mg

Tiotropium (Spiriva) HandiHaler

Tiotropium (Spirivia) RESPIMAT *ONE inhaler per 30 DAYS* 1.25mg/actuation and 2.5mcg/actuation

Trelegy Ellipta (fluticasone furoate, umeclidinium & vilanterol) inhaler *dosed 1 puff daily*

Umeclidinium (Incruse Ellipta) 62/5mg MDI inhaler

Sedative Hypnotic Agents / Insomnia (Sleep Aids)

Eszopiclone (Lunesta equiv) 1mg; 2mg; 3mg tabs (30 day qty limit) *controlled substance*

Melatonin 1mg, 3mg tabs

Temazepam (Restoril equiv) 7.5mg; 15mg; 30mg caps (30 day qty limit) *controlled substance*

Trazodone (Desyrel equiv) 50mg; 100mg tabs

Zolpidem (Ambien equiv) 5mg; 10mg tabs *controlled substance-30 day supply w/refills* *Max 5mg for females*

Zolpidem (Ambien CR equiv) 6.25mg and 12.5mg *controlled substance-30 day supply w/refills*

Smoking Cessation Agents

Nicoderm Patches 7mg; 14mg; 21mg

Nicorette gum 50 pieces/box

Thyroid/Antithyroid Agents

Armour Thyroid 15mg; 30mg; 60mg; 90mg; 120mg (1/4gr, 1/2gr, 1gr, 1.5gr, 2 grain) tabs

Levothyroxine (Synthroid brand only) all strengths tabs (excludes: Tirosint capsules)

Liothyronine (Cytomel equiv) 5mcg; 25mcg; 50mcg tabs

Methimazole (Tapazole equiv) 5mg; 10mg tabs – for Hyperthyroidism

Propylthiouracil (PTU) 50mg tabs

Topical Agents

Acyclovir (Zovirax) 5% ointment

Adapalene (Differin) 0.1% gel

Adapalene/Benzoyl Peroxide (Epiduo gel equiv) 0.1/2.5% gel

Aluminum chloride hexahydrate (Drysol equiv)

Augmented Betamethasone Dipropionate (Diprolene AF equiv) cream 15 gram and 50 gram

Bacitracin topical ointment 30 gram

Betamethasone Valerate (Valisone equiv) 0.1% cream 15gm tube

Betamethasone (Topicort) 0.25% spray

Calcipotriene (Dovonex) cream and ointment

Calcipotriene/betamethasone (Taclonex) ointment

CeraVe Cream

Ciclopirox (Penlac equiv) 8% solution only

Clindamycin (Cleocin-T equiv) solution only 60 ml

Clindamycin gel, cream, lotion

Clindamycin/Benzoyl Peroxide (Duac gel equiv) 1.2/5% gel

17

Topical Agents cont.

Clobetasol cream (Temovate equiv) 0.05% cream/ointment/gel 15 gram; shampoo 118ml

Clobetasol Foam (Olux equiv)

Clotrimazole/Betamethasone dipropionate cream (Lotrisone equiv)

Colloidal Sulfur/Salicylic Acid (Sebex equiv) 2% Shampoo

Desonide (DesOwen equiv) cream

Diclofenac (Voltaren GEL equiv) 1% gel (only) –100gram

Diclofenac (PENNSAID equiv) 1.5% solution (**excluding 2% solution)

Erythromycin 1.5% solution *excludes pads*

Fluocinolone (Synalar equiv) 0.01% cream and solution

Fluocinolone (Synalar equiv) 0.025% cream and ointment

Fluocinonide (Lidex equiv) 0.05% cream; ointment; solution

Fluocinonide (Lidex equiv) 0.1% cream

Fluorouracil (Efudex equiv) 5% cream

Fluticasone (Cutivate ) cream and ointment

Gentamycin 0.1% (Garamycin equiv) cream

Halobetasol (Ultravate equiv) cream/ointment

Hydrocortisone 0.5%; 1%; 2.5% cream 2.5% lotion

Hydrocortisone Valerate (Westcort equiv) cream

Hydrocortisone (Anusol-HC equiv) rectal cream and suppositories

Hydrocortisone/Pramoxine (Proctofoam HC equiv) foam

Hydroquinone (Eldoquin equiv) 4% cream

Imiquimond (Aldara equiv) 5% cream Box of 24 single use packets

Ivermectin (Sklice equiv) 0.5% Lotion

Ketaconazole (Nizoral equiv) 2% Shampoo

Lidocaine 2% JELLY 30gram

Lidocaine 4% CREAM 30gram

Lidocaine 5% OINT 35gram

Lidocaine (Lidoderm) Adhesive Patch 5% (700mg/patch) maximum 3 boxes/30 days

Metronidazole (Metrocream equiv) 0.75% cream

Metronidazole (Metrogel equiv) gel

Mometasone (Elocon equiv) 0.1% cream

Mupirocin (Bactroban equiv) ointment and cream

Nystatin ointment & powder

Permethrin (Elimite equiv) cream

Pimecrolimus (Elidel equiv) cream

Pramoxine/Hydrocortisone (Analpram HC equiv) 1/2.5% cream

Prilocaine/Lidocaine (EMLA equiv) 2.5/2.5% cream 30gram

Selenium sulfide (Selsun equiv) 2.5% lotion (**excludes 1% Selsun Blue which is OTC)

Silver sulfadiazine (Silvadene equiv) cream

Sulfacetamide (Klaron equiv) 10% lotion

Tacrolimus (Protoptic equiv) 0.3% (<16yrs) and 0.1% (>15yrs) ointment

Tazarotene (Tazorac equiv) 0.1% gel

Terbinafine (Lamisil Equiv) 1% cream

Tretinoin (Retin-A equiv) CREAM only *NOT FOR COSMETIC USE* (excludes gel, ointment, and 0.1% MICRO)

Triamcinolone acetonide (Kenalog equiv) 0.1% cream, ointment, spray

Triamcinolone/Nystatin (Mycolog equiv) cream

Urea 20%; 40% cream

Vaginal Preparations

Clindamycin phosphate (Cleocin equiv) cream

Clotrimazole (Gyne-Lotrimin-7 equiv) cream

Conjugated Estrogens (Premarin equiv) cream

Estradiol (Vagifem equiv) 10mcg tabs

Estradiol (Estrace equiv) cream

Metronidazole (Metrogel equiv) cream

Miconazole (Monistat-7 equiv) 2% cream

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Vitamins and Minerals

B12 1000mcg tabs

B12 (Cyanocobalamine) 1000mcg/ml injection (note: prescription is needed for syringes)

Calcium Carbonate & Vitamin D3 600mg tabs

Cyanocobalamine (Nascobal) spray 500mcg/spray (once per week dosing)

Cardiotex Rx (Bioperine/Folic acid/B12/B6/L-Arginine) 5mg/2mg/500mcg/50mg/500mg tabs

Cerefolin NAC (Methylfolate/N-acetyl-L-cysteine/Methylcobalamine/Algae-S powder) 6/600/2/90.314mg tabs

Ferrous Citrate (Auryxia) 210 mg tabs

Ferrous Sulfate (Iron) 325mg immediate-release tabs

Ferrous sulfate (Slow-Fe) slow release 42mg

Fish oil (Omega-3 Fatty Acid) 1000mg {NOT equiv. to Lovaza}

Folic Acid 1mg tabs

Cyanocobalamine/Pyridoxine/L-methylfolate (Foltx) 2/25/1.13mg tabs

ICAR-C equiv (Carbonyl iron/Vit C) 100/250mg tabs

ICAR-C Plus equiv (Carbonyl iron/Folic acid/Cyanocobalamine/Vit C) 100mg/1mg/25mcg/250mg tabs

Magnesium Oxide (MagOx) 400mg tabs

Prenatal vitamins with folic acid tabs *Limited to women of child bearing age

Prenatal Multi + DHA 200mg tabs

Prenatal + low iron 27mg tabs

Calcitrol (Rocaltrol equiv) 0.25mcg; 0.5mcg caps

Vitamin D daily 1,000U and 5,000U

Vitamin D2 50,000 IU (ergocalciferol) gel caps only

Vitamin D3 50,000 IU (cholecalciferol) oral capsules (once weekly)

**** Note: In the event of a medication recall, if your medication

is affected, a FAHC Pharmacy staff member will contact you.

Otherwise, continue to take your medication as directed.***

19

Fox has no emergency room or emergency

medical services (EMS).

Dial 911 to activate EMS.

Advice Nurses are available 24 hours a day, at (256) 955-8888 or

1-800-223-9531, to provide care advice.

Pharmacy business hours: 07:30am – 4:30pm MON-FRI

CLOSURES

**Varying days of each Month for training check schedule for updates

**Saturdays and Sundays

**All noted Federal and Training Holidays – See schedule next page

Check out the Live Wait-Time Tracker on the website:

www.redstone.amedd.army.mil

New patient information packets are available on our webpage

Information on how to transfer prescriptions TO our facility is available on our web page

Electronic prescriptions can be sent to: DOD REDSTONE

Electronic prescriptions sent by your doctor are not processed until you pull a ticket and request the prescription.

20

FOX ARMY HEALTH CENTER HOLIDAY and TRAINING SCHEDULE

Calendar Year 2019 (Subject to mission requirement changes)

Federal /Training Holiday observed (Full Day Closures):

Monday 21 JAN 2019 Thursday 11 NOV 2019 Monday 18 FEB 2019 Thursday 28 NOV 2019 Monday 27 MAY 2019 Friday 29 NOV 2019 Thursday 4 JUL 2019 Tuesday 24 DEC 2019 Monday 2 SEP 2019 Wednesday 25 DEC 2019 Monday 14 OCT 2019 Routine/Individual Training, and Organizational Activity Days (Partial day closure):

Wednesday 30 JAN 2019 Closed from 0730 – 1300 Wednesday 24 APR 2019 Closed from 0730 – 1300 Wednesday 24 JUL 2019 Closed from 0730 – 1300 Thursday 03 OCT 2019 Closed from 1130 – 1630 Wednesday 23 OCT 2019 Closed from 0730 - 1300

Nurse Advice Lines (NALs) are available during non-duty hours at (256) 955-8888 or 1-800-223-9531 to provide care advice. Fox Army Health Center is an ambulatory care clinic, and does not have an emergency room. In case of emergency, dial 911.