WellDyneRx Formulary Member Guide Formulary062113.pdfWellDyneRx Formulary Member Guideis a formulary list of medications that may be covered under your prescription drug plan.This

WellDyneRx Formulary Member GuidePlease bring this guide with you on your next doctor visit.

WellDyneRx manages your prescription drug benefit for your health plan.

NOTES

WellDyneRx Formulary Member Guide is a formulary list of medications that may be covered under your prescription drugplan.This list was reviewed by an independent group of practicingdoctors and pharmacists, and it contains medications made bymost pharmaceutical manufacturers. It includes medications formany covered conditions.

SAVING MONEY ON PRESCRIPTIONSYour plan may prefer some medications over others. These arecalled preferred drugs.

You may pay:• Lowest co-payment/co-insurance for generic drugs• Higher co-payment/co-insurance for preferred brand-name

drugs• Highest co-payment/co-insurance for nonpreferred

brand-name drugs

Your doctor may be able to help you save money by prescribinggeneric and preferred brand-name drugs if appropriate. So be sureto bring this guide with you on every visit to your doctor. Somecommonly prescribed nonpreferred drugs are also listed in thisguide for your reference.

Please note: This guide does not contain a complete list of preferred and nonpreferred drugs. It only lists the most commonly prescribed drugs.

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FINDING MEDICATIONS WITH LOWERCO-PAYMENTS/CO-INSURANCEThis guide lists medications two ways to help you find somegeneric, preferred, and nonpreferred brand-name drugs.

SECTION I - ALPHABETICALLY BY DRUG CATEGORY (SUCH AS RESPIRATORY)Within each category, medications are listed in alphabetical order, with generic, preferred brand-name, and nonpreferredbrand-name drugs sorted separately:

G Means a preferred generic medicationP Means a preferred brand-name medicationNP Means a nonpreferred brand-name medication

SECTION II - ALPHABETICALLY BY BRAND NAMEAfter each nonpreferred brand-name drug, you will find possible generic and preferred brand-name alternatives.

SAFETY CONSIDERATION SYMBOLSHere is a quick guide for you and your doctor, which explains our safety symbols. These symbols appear next to certain medications.

Means weigh risk of birth defects or other adverse outcomes.

Means do not use in pregnancy.

The information in this guide was in effect at the time of printing and maybe subject to change.

Key:G = Means a preferred generic medication.P = Means a preferred brand-name medication.NP = Means a nonpreferred brand-name medication.

= Means weigh risk of birth defects or other adverse outcomes.= Means do not use in pregnancy.

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SECTION I: THERAPEUTIC DRUG CATEGORIES

Oral PenicillinsG amoxicillin trihydrateG amoxicillin trihydrate/

potassium clavulanateG ampicillin trihydrateG dicloxacillin sodiumG penicillin v

potassiumP Augmentin Chewable

Tablet 250 - 62.5mgP Augmentin

Suspension 125 - 31.25mg/5

NP AmoxilNP Augmentin Chewable

Tablet 200 - 28.5mg,400 - 57mg

NP Augmentin ESNP Augmentin

Suspension 200 - 28.5mg/5, 250 - 62.5mg/5,400 - 57mg/5

NP Augmentin TabletNP Augmentin XRNP Moxatag

Oral TetracyclinesG doxycycline hyclateG doxycycline

monohydrateG minocycline HClG tetracycline HCl

P OraceaNP AdoxaNP Adoxa PakNP DoryxNP DynacinNP MinocinNP MonodoxNP PeriostatNP SolodynNP Vibramycin

Oral CephalosporinsG cefaclorG cefadroxil hydrateG cefdinirG cefpodoxime proxetilG cefprozilG cefuroxime axetilG cephalexin

monohydrateNP Ceclor CDNP CedaxNP CeftinNP DuricefNP KeflexNP OmnicefNP SpectracefNP SupraxNP Vantin

ANTI-INFECTIVES (Antibiotics/Antifungals)



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Oral ErythromycinsG azithromycinG clarithromycinG clarithromycin ERG erythromycin baseG erythromycin

ethylsuccinateG erythromycin

ethylsuccinate/sulfisoxazole acetyl

G erythromycin stearateP DificidNP BiaxinNP Biaxin XLNP EryPedNP PCENP ZithromaxNP Zmax

Oral QuinolonesG ciprofloxacin HClG levofloxacinG ofloxacinP AveloxP Cipro SuspensionNP Cipro TabletNP Cipro XRNP FactiveNP FloxinNP LevaquinNP NoroxinNP Proquin XR

Oral SulfasG erythromycin

ethylsuccinate/sulfisoxazole acetyl

G sulfadiazine

G sulfamethoxazole/trimethoprim

G sulfisoxazoleNP Bactrim DSNP GantrisinNP Septra DS

Oral Urinary TractAgentsG methenamine

hippurateG methenamine

mandelateG nitrofurantoinG nitrofurantoin

macrocrystalG phenazopyridine HClG trimethoprimNP FuradantinNP HiprexNP MacrobidNP MacrodantinNP MonurolNP Primsol

Oral AntifungalAgentsG clotrimazoleG fluconazoleG flucytosineG griseofulvin G griseofulvin

ultramicrosizeG itraconazoleG ketoconazoleG nystatinG terbinafine HClG voriconazole

Hypnotic AgentsG chloral hydrateG estazolamG flurazepam HClG temazepamG triazolamG zaleplonG zolpidem tartrateP LunestaP SilenorNP AmbienNP Ambien CRNP DoralNP EdluarNP HalcionNP IntermezzoNP Restoril NP RozeremNP SonataNP Zolpimist

TricyclicAntidepressantsG amitriptyline HClG amoxapineG clomipramine HClG desipramine HClG doxepin HClG imipramine HClG imipramine

pamoate G nortriptyline HClG protriptyline HClG trimipramine maleateNP AnafranilNP NorpraminNP PamelorNP SurmontilNP TofranilNP Tofranil-PMNP Vivactil



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P Lamisil Oral GranulesP NoxafilP Sporanox Oral

SolutionNP AncobonNP DiflucanNP Grifulvin VNP Gris-PegNP Lamisil TabletNP MycostatinNP Mycelex Troche NP Nizoral

NP OravigNP Sporanox CapsuleNP Vfend

PSYCHOTHERAPEUTICS (Anxiety/Depression)



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MiscellaneousAntidepressantsG bupropion HCl G maprotiline HClG mirtazapineG trazodone HClG venlafaxine HClP CymbaltaP PristiqNP DesyrelNP EffexorNP Effexor XRNP Oleptro ERNP RemeronNP WellbutrinNP Wellbutrin SRNP Wellbutrin XL

AntipsychoticsG chlorpromazine HClG clozapineG fluphenazine HClG haloperidolG haloperidol lactate

concentrate, oralG loxapine succinateG olanzapineG perphenazineG quetiapine fumarateG risperidoneG thiothixeneG trifluoperazine HClG ziprasidone HCl

P AbilifyP ClozarilP LatudaP MobanP OrapP Seroquel XRNP FanaptNP GeodonNP InvegaNP RisperdalNP SaphrisNP SeroquelNP SymbyaxNP ZyprexaNP Zyprexa Zydis

AnxiolyticsG alprazolamG alprazolam XRG buspirone HClG chlordiazepoxide

HClG clorazepate

dipotassiumG diazepamG lorazepamG oxazepamNP AtivanNP BusparNP LibriumNP NiravamNP Tranxene T-TabNP ValiumNP XanaxNP Xanax XR



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MAOIAntidepressantsG phenelzine sulfateG tranylcypromine

sulfateNP EmsamNP NardilNP Parnate

SSRI AntidepressantsG citalopram HBrG escitalopram oxalateG fluoxetine HClG fluvoxamine maleateG paroxetine HClG sertraline HClP ViibrydNP CelexaNP LexaproNP Luvox CRNP PaxilNP Paxil CRNP PexevaNP ProzacNP Prozac WeeklyNP SarafemNP Zoloft

MiscellaneousPsychotherapeuticAgentsG amphetamine

aspartate/amphetamine sulfate/dextroamphetamine

G dextroamphetaminesulfate

G lithium carbonate

G lithium citrateG methamphetamine

HClG methylphenidate HClG modafinilP DaytranaP IntunivP Metadate CDP StratteraP Vyvanse P XyremNP AdderallNP Adderall XRNP ConcertaNP DesoxynNP DexedrineNP FocalinNP Focalin XRNP KapvayNP LiquaddNP LithobidNP Methylin Oral

SolutionNP Methylin Chewable

TabletNP NuvigilNP ProvigilNP RitalinNP Ritalin LANP Ritalin SR



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Beta BlockersG acebutolol HClG atenololG betaxolol HClG bisoprolol fumarateG carvedilolG labetalol HClG metoprolol succinateG metoprolol tartrateG nadololG pindololG propranolol HClG timolol maleateP BystolicP Coreg CRNP CoregNP CorgardNP InderalNP Inderal LANP Innopran XLNP KerloneNP LevatolNP LopressorNP SectralNP TenorminNP Toprol XLNP TrandateNP Zebeta

Calcium BlockersG diltiazem HClG nimodipineG verapamil HClP Cardizem LA 120mg

NP Calan SRNP CardizemNP Cardizem CDNP Cardizem LA 180mg,

240mg, 300mg,360mg, 420mg

NP Cardizem SRNP Covera-HSNP Dilacor XRNP Isoptin S.R.NP NimotopNP TiazacNP VerelanNP Verelan PM

DihydropyridinesG amlodipine besylateG felodipineG isradipineG nifedipineG nisoldipineNP Adalat CCNP Cardene SRNP DynaCirc CRNP NorvascNP Procardia XLNP Sular

Nitroglycerin PatchesG nitroglycerin patchP Nitro-Dur PatchNP Minitran Patch

CARDIOVASCULAR(Blood Pressure/Heart/Cholesterol)



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AdrenergicAntagonists &Related DrugsG clonidine HClG doxazosin mesylateG guanfacine HClG methyldopaG prazosin HClG reserpineG terazosin HClNP CarduraNP Cardura XLNP CatapresNP Catapres-TTSNP HytrinNP MinipressNP Nexiclon XRNP Tenex

Angiotensin IIBlockers & ReninInhibitorsG eprosartan

mesylateG irbesartanG irbesartan/

hydrochlorothiazideG losartan potassiumG losartan/

hydrochlorothiazideG valsartan/

hydrochlorothiazideP AmturnideP AtacandP Atacand HCTP BenicarP Benicar HCTP DiovanP MicardisP Micardis HCT

P TekamloP TekturnaP Tekturna HCTP ValturnaNP AvalideNP AvaproNP CozaarNP Diovan HCTNP EdarbiNP EdarbyclorNP HyzaarNP TevetenNP Teveten HCT

AntilipidemicsG atorvastatin calciumG cholestyramine/

aspartameG cholestyramine/

sucroseG colestipol HClG fenofibrate,

micronizedG fluvastatin sodiumG gemfibrozilG lovastatinG pravastatinG simvastatinP AltoprevP AntaraP CrestorP FenoglideP LipofenP LovazaP NiaspanP SimcorP TricorP TriglideP TrilipixP VytorinP Welchol



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P ZetiaNP AdvicorNP CaduetNP ColestidNP FibricorNP LescolNP Lescol XLNP LipitorNP LivaloNP LofibraNP LopidNP MevacorNP PravacholNP QuestranNP Questran LightNP Zocor

ACE InhibitorsG benazepril HClG captoprilG enalapril maleateG fosinopril sodiumG lisinoprilG moexiprilG perindopril erbumineG quinaprilG ramiprilG trandolaprilNP AccuprilNP AceonNP AltaceNP LotensinNP MavikNP MonoprilNP PrinivilNP UnivascNP VasotecNP Zestril

CombinationAntihypertensivesG amlodipine

besylate/benazeprilG atenolol/

chlorthalidoneG benazepril HCl/

hydrochlorothiazideG bisoprolol fumarate/

hydrochlorothiazideG captopril/

hydrochlorothiazideG enalapril maleate/

hydrochlorothiazideG fosinopril/

hydrochlorothiazideG hydralazine HCl/

hydrochlorothiazideG lisinopril/

hydrochlorothiazideG methyldopa/

hydrochlorothiazideG metoprolol/

hydrochlorothiazideG moexipril/

hydrochlorothiazideG propranolol HCl/

hydrochlorothiazideG quinapril/

hydrochlorothiazideG trandolapril/

verapamilP AzorP ExforgeP Exforge HCTP TarkaP TribenzorP TwynstaNP AccureticNP Clorpres



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Insulin TherapyP ApidraP Apidra SolostarP HumalogP Humalog Mix 50/50P Humalog Mix 75/25P HumulinP LantusP Lantus SoloStarP LevemirP NovoLogP NovoLog Mix 70/30NP Novolin

Non-InsulinHypoglycemic AgentsG acarboseG chlorpropamideG glimepirideG glipizideG glipizide/

metformin HClG glyburideG glyburide/

metformin HClG glyburide, micronizedG metformin HClG nateglinide

G pioglitizone HClG pioglitizone HCl/

metformin HClG tolazamideG tolbutamideP Actoplus Met XRP BydureonP ByettaP DuetactP JanumetP Janumet XRP JanuviaP JentaduetoP JuvisyncP Kombiglyze XRP OnglyzaP PrandimetP PrandinP RiometP SymlinP TradjentaP VictozaNP Actoplus MetNP ActosNP AmarylNP AvandametNP AvandarylNP Avandia

ENDOCRINE (Diabetes/Hormones/Contraceptives)

NP CorzideNP DutoprolNP Lopressor HCTNP Lotensin HCTNP LotrelNP Prinzide

NP TenoreticNP UnireticNP VasereticNP ZestoreticNP Ziac



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NP CyclosetNP DiaBetaNP FortametNP GlucophageNP Glucophage XRNP GlucotrolNP Glucotrol XLNP GlucovanceNP GlumetzaNP GlynaseNP GlysetNP MetaglipNP PrecoseNP Starlix

Blood Glucose TestStripsG alcohol antiseptic

padsP Accu-Chek Active Test

StripsP Accu-Chek Aviva Plus

Test StripsP Accu-Chek Aviva Test

StripsP Accu-Chek Comfort

Curve Test StripsP Accu-Chek Compact

Test StripsP Accu-Chek Smartview

Test StripsP Fast Take Test StripsP One Touch Test StripsP One Touch Ultra Test

Strips P One Touch Verio Test

Strips P Surestep Pro Test

StripsP Surestep Test Strips

Contraceptive AgentsG desogestrel-ethinyl

estradiolG desogestrel-ethinyl

estradiol/ethinylestradiol

G ethinyl estradiol/drospirenone

G ethynodiol d-ethinylestradiol

G levonorgestrelG levonorgestrel-

ethinyl estradiolG levonorgestrel-

ethinyl estradiol/ethinyl estradiol

G norethindroneG norethindrone a-e

estradiolG norethindrone a-e

estradiol/ferrousfumarate

G norethindrone-ethinyl estradiol

G norethindrone-ethinyl estradiol/ferrous fumarate

G norethindrone-mestranol

G norgestimate-ethinyl estradiol

G norgestrel-ethinylestradiol

P BeyazP EllaP Loestrin 24 FeP Lo Loestrin FeP NataziaP NuvaRingP Safyral



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P YazNP AlesseNP BreviconNP CyclessaNP DemulenNP DesogenNP Estrostep FeNP Femcon FeNP LevliteNP LoestrinNP Loestrin FeNP Lo/OvralNP LoSeasoniqueNP LybrelNP MircetteNP ModiconNP NordetteNP NorinylNP Ortho-CeptNP Ortho-CyclenNP Ortho EvraNP Ortho MicronorNP Ortho-NovumNP Ortho Tri-CyclenNP Ortho Tri-Cyclen LoNP OvconNP OvralNP Plan B One-StepNP SeasonaleNP SeasoniqueNP Tri-NorinylNP Yasmin

Estrogens/EstrogenCombinationsG estradiolG estradiol/

norethindroneacetate

G estropipate

G methyl-testosterone/estrogens, esterified

G norethindrone/ethinyl estradiol

P CenestinP ClimaraP CombipatchP DivigelP EnjuviaP Estrace Vaginal

CreamP EstradermP EstringP EvamistP Premarin Tablet P PremphaseP PremproP VagifemP VivelleP Vivelle-DotNP ActivellaNP AloraNP AngeliqNP Climara ProNP ElestrinNP Estrace TabletNP EstrasorbNP EstrogelNP FemhrtNP FemringNP FemtraceNP MenestNP MenostarNP OgenNP Ortho-PrefestNP PrefestNP Premarin Vaginal

Cream



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NSAIDsG etodolacG flurbiprofenG ibuprofenG indomethacinG ketoprofenG meclofenamate

sodiumG meloxicamG nabumetoneG naproxenG naproxen sodiumG oxaprozinG piroxicamG sulindacG tolmetin sodiumP Flector

P VimovoP Voltaren GelNP Anaprox DSNP AnsaidNP ArthrotecNP CambiaNP CataflamNP ClinorilNP DayproNP diclofenac

potassiumNP diclofenac sodiumNP DuexisNP EC-NaprosynNP FeldeneNP IndocinNP LodineNP Mobic

NSAIDS (Pain Relievers)

Ulcer DrugsG cimetidine HCl liquidG cimetidine tabletG famotidineG lansoprazoleG misoprostolG nizatidineG omeprazoleG omeprazole/sodium

bicarbonateG pantoprazole sodiumG ranitidine HCl

P Axid Oral SolutionP Nexium NP AciphexNP Axid CapsuleNP CytotecNP DexilantNP PepcidNP PrevacidNP Prilosec RxNP ProtonixNP TagametNP Zantac RxNP Zegerid Rx

G I (Ulcer)



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NP MotrinNP NalfonNP NaprelanNP NaprosynNP PennsaidNP RelafenNP Sprix

NP ToradolNP Voltaren TabletsNP Voltaren-XR

NSAID COX-2InhibitorsP Celebrex

G flavoxateG oxybutynin chloride G tolterodine tartrateG trospium chlorideP Detrol LAP EnablexP Gelnique

P OxytrolP Sanctura XRP ToviazP VesicareNP DetrolNP Ditropan XLNP Sanctura

DRUGS TO TREAT OVERACTIVE BLADDER

Beta Agonists OralG albuterol sulfateG metaproterenol

sulfateG terbutaline sulfateNP AlupentNP Proventil

Beta Agonist InhalersG albuterolG albuterol sulfateG levalbuterol HClG metaproterenol

sulfate

P ForadilP PerforomistP Proair HFAP Serevent DiskusP Ventolin HFANP AccunebNP Arcapta NeohalerNP BrovanaNP Maxair AutohalerNP Proventil HFANP XopenexNP Xopenex HFA

Inhaled SteroidsG budesonide

RESPIRATORY (Allergy/Asthma)



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P AlvescoP AsmanexP Pulmicort FlexhalerP Pulmicort 1mg/2mL

RespulesP QVARNP AerobidNP Aerobid-MNP AzmacortNP Flovent DiskusNP Flovent HFANP Pulmicort 0.25mg/2mLNP Pulmicort 0.5mg/2mL

Nasal CorticosteroidsG flunisolideG fluticasone propionateG triamcinolone

acetonide P NasonexP QnaslP Rhinocort AquaP VeramystNP Beconase AQNP FlonaseNP Nasacort AQNP Omnaris

MiscellaneousPulmonary AgentsG acetylcysteineG cromolyn sodium

ampul for nebulization

G ipratropium/albuterolsulfate

G ipratropium bromidesolution

G montelukast sodiumG zafirlukastP AdcircaP Advair DiskusP Advair HFAP Atrovent HFAP BerinertP CinryzeP CombiventP Combivent RespimatP DalirespP DuleraP Intal InhalerP KalydecoP LetairisP PulmozymeP RevatioP SpirivaP SymbicortP TracleerP TyvasoP VentavisNP AccolateNP DuonebNP FirazyrNP KalbitorNP SingulairNP XolairNP ZyfloNP Zyflo CR



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G alendronate sodiumG calcitonin, salmon,

syntheticG ibandronate sodiumP Actonel P AtelviaP EvistaP ForteoNP Actonel with CalciumNP Boniva

NP FosamaxNP Fosamax Plus DNP Miacalcin Nasal SprayNP Prolia

OSTEOPOROSIS/PAGET’S DISEASE

Anticonvulsants/Anti-SeizureG carbamazepineG clonazepamG diazepamG divalproex sodiumG ethosuximideG felbamateG gabapentinG lamotrigineG levetiracetamG mephobarbitalG oxcarbazepineG phenobarbitalG phenytoinG phenytoin sodium

extendedG primidoneG topiramateG valproic acid

P Banzel TabletP CelontinP DiastatP Dilantin Chewable

TabletP Dilantin 30mgP GabitrilP Lamictal ODTP Lamictal XRP LyricaP PeganoneP Tegretol XR 100mgP PotigaP VimpatNP Banzel SuspensionNP CarbatrolNP DepakoteNP Depakote ERNP Depakote SprinkleNP Dilantin 100mg

Capsule

NEUROLOGICALS



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NP Dilantin OralSuspension

NP EquetroNP Felbatol NP GraliseNP KeppraNP Keppra XRNP KlonopinNP LamictalNP MebaralNP MysolineNP NeurontinNP OnfiNP PhenytekNP SabrilNP TegretolNP Tegretol XR 200mg,

400mgNP TopamaxNP TrileptalNP ZarontinNP Zonegran

Migraine/HeadacheTherapyG acetaminophen/

butalbitalG acetaminophen/

caffeine/butalbital G aspirin/caffeine/

butalbitalG dihydroergotamine

mesylateG ergotamine/caffeineG isometheptene

mucate/acetaminophen/dichloralphenazone

G naratriptan HClG sumatriptan succinate

P ErgomarP MaxaltP Maxalt MLTP RelpaxP TreximetP ZomigP Zomig ZMTNP AlsumaNP AmergeNP AxertNP Cafergot tabletNP FrovaNP ImitrexNP MidrinNP MigranalNP PhrenilinNP Phrenilin ForteNP Sumavel

Drugs to treatAlzheimers DiseaseG donepezil HClG galantamine HBrG rivastigmine tartrateP Aricept 23mgP Exelon PatchP Exelon SolutionP NamendaNP Aricept 5mg, 10mgNP Aricept ODTNP CognexNP Exelon CapsulesNP RazadyneNP Razadyne ER

Nonpreferred Possible Preferred ProductsProduct

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SECTION II: NONPREFERRED DRUGS AND THEIR POSSIBLE PREFERRED

ALTERNATIVES

Accolate® zafirlukast (various)Accuneb® albuterol sulfate (generic)Accupril® quinapril (generic)Accuretic® quinapril/hydrochlorothiazide (generic)Aceon® perindopril erbumine (generic)Aciphex® omeprazole (generic), Nexium® (AstraZeneca)Activella® estradiol/norethindrone acetate (generic)Actonel® alendronate sodium (generic), ibandronate sodium

with Calcium (generic)Actoplus Met® pioglitazone/metformin (generic)Actos® pioglitazone HCl (generic)Adalat CC® nifedipine ER (generic), amlodipine besylate (generic),

nisoldipine (generic)Adderall® amphetamine salt combo (generic)Adderall XR® dextroamphetamine-amphetamine ER (generic)Adoxa® doxycycline monohydrate (generic)Adoxa Pak® doxycycline monohydrate (generic)Advicor® atorvastatin calcium (generic), lovastatin (generic),

pravastatin (generic), simvastatin (generic), Crestor®

(AstraZeneca), Niaspan® (Abbott), VytorinTM

(Merck/Schering)Aerobid® Asmanex® (Schering), Pulmicort Flexhaler®

(AstraZeneca), QVAR® (Ivax)Aerobid-M® Asmanex® (Schering), Pulmicort Flexhaler®

(AstraZeneca), QVAR® (Ivax)Alesse® Aviane® (Barr-branded generic*), Lessina® (Barr-

branded generic*), Lutera® (Watson-branded generic*),Lybrel® (Wyeth)

Alora® estradiol patch (generic), Climara® (Berlex), Estraderm®

(Novartis), Vivelle® (Novartis)Alsuma® sumatriptan succinate (generic)Altace® ramipril (generic)Amaryl® glimepiride (generic)Ambien® zolpidem tartrate (generic)Ambien CR® zolpidem tartrate ER (generic)

*Branded generics have the same co-payment as regular generics.


20*Branded generics have the same co-payment as regular generics.

Amerge® naratriptan HCl (generic)Amoxil® amoxicillin trihydrate (generic)Anafranil® clomipramine HCl (generic)Anaprox DS® naproxen sodium (generic)Ancobon® flucytosine (generic)Angeliq® estradiol/norethindrone acetate (generic),

Premphase® (Wyeth), Prempro® (Wyeth)Ansaid® flurbiprofen (generic)Arcapta Neohaler® Foradil® (Schering), Serevent Diskus® (GlaxoSmithKline)Aricept® 5mg,10mg donepezil HCl (generic)Aricept ODT® donepezil HCl (generic)Arthrotec® ibuprofen (generic), naproxen (generic), Celebrex®

(Pfizer)Ativan® lorazepam (generic)Augmentin® amoxicillin trihydrate/potassium clavulanate (generic)chewable tablet200-28.5mg,400-57mg

Augmentin® amoxicillin trihydrate/potassium clavulanate (generic)suspension200-28.5mg/5, 250-62.5mg/5,400-57mg/5

Augmentin® amoxicillin trihydrate/potassium clavulanate (generic)tablet

Augmentin ES® amoxicillin trihydrate/potassium clavulanate (generic)Augmentin XR® amoxicillin trihydrate/potassium clavulanate (generic)Avalide® irbesartan/hydrochlorothiazide (generic)Avapro® irbesartan (generic)Axert® naratriptan HCl (generic), sumatriptan succinate

(generic), Maxalt® (Merck), Relpax® (Pfizer), Zomig®

(AstraZeneca)Axid® Capsule nizatidine (generic)Azmacort® Asmanex® (Schering), Pulmicort Flexhaler®

(AstraZeneca), QVAR® (Ivax)Bactrim DS® sulfamethoxazole/trimethoprim (generic)Banzel® Banzel® Tablet (Eisai)Oral Suspension

Beconase AQ® flunisolide (generic), fluticasone propionate (generic),triamcinolone acetonide (generic), Nasonex®

(Schering), Rhinocort Aqua® (AstraZeneca), Veramyst®

(GlaxoSmithKline)


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Biaxin® clarithromycin (generic)Biaxin XL® clarithromycin ER (generic)Boniva® ibandronate sodium (generic)Brevicon® Necon® (Watson-branded generic*), Nortrel®

(Barr-branded generic*)Brovana® Foradil® (Schering), Perforomist® (Dey Labs), Proair HFA®

(Teva), Serevent Diskus® (GlaxoSmithKline)Buspar® buspirone HCl (generic)Butisol Sodium® chloral hydrate (generic), temazepam (generic),

triazolam (generic)Caduet® amlodipine besylate (generic), atorvastatin calcium

(generic)Calan SR® verapamil HCl tablet, sustained action (generic)Cambia® etodolac (generic), ibuprofen (generic), naproxen

(generic)Carbatrol® carbamazepine (generic)Cardene SR® amlodipine besylate (generic), nifedipine ER (generic)Cardizem® diltiazem HCl (generic)Cardizem CD® diltiazem HCl capsule, sustained release 24 hr

(generic)Cardizem LA® diltiazem ER (generic)180mg, 240mg,300mg, 360mg, 420mg

Cardizem SR® diltiazem HCl capsule, sustained release 12 hr (generic)

Cardura® doxazosin mesylate (generic)Cataflam® etodolac (generic), ibuprofen (generic), naproxen

(generic)Catapres® clonidine HCl tablet (generic)Catapres-TTS® clonidine HCl patch (generic)Ceclor CD® cefaclor (generic), cefdinir (generic),

cefuroxime axetil (generic)Cedax® cefaclor (generic), cefdinir (generic),

cefuroxime axetil (generic)Ceftin® cefuroxime axetil (generic)Celexa® citalopram (generic)Cipro Tablet® ciprofloxacin HCl tablet (generic)Climara Pro® Combipatch® (Novartis)Clinoril® sulindac (generic)Clorpres® chlorthalidone (generic), clonidine HCl (generic)


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Cognex® donepezil HCl (generic), galantamine (generic), rivastigmine tartrate (generic)

Colestid® cholestyramine (generic), Welchol® (Sankyo)Coreg® carvedilol (generic)Corgard® nadolol (generic)Corzide® bisoprolol fumarate/hydrochlorothiazide (generic),

metoprolol/hydrochlorothiazide (generic), propranololHCl/hydrochlorothiazide (generic)

Covera-HS® verapamil HCl capsule, 24 hr sustained release (generic)Cozaar® losartan potassium (generic)Cyclessa® Caziant® (Watson-branded generic*), Cesia® (Prasco

Labs-branded generic*), Velivet® (Barr-branded generic*)Cycloset® metformin HCl (generic), Byetta® (Amylin Pharma),

Janumet® (Merck), Januvia® (Merck), Onglyza®

(Bristol-Myers Squibb)Cytotec® misoprostol (generic)Daypro® oxaprozin (generic)Demulen® Zovia® (Watson-branded generic*)Depakote® divalproex sodium (generic)Depakote ER® divalproex sodium ER (generic)Depakote® Sprinkle divalproex sodium (generic)Desogen® Apri® (Barr-branded generic*),

Solia® (Prasco Labs-branded generic*)Desoxyn® methamphetamine HCl (generic)Desyrel® trazodone HCl (generic)Detrol® tolterodine tartrate (generic)Dexedrine® dextroamphetamine sulfate (generic)Dexilant® omeprazole (generic), Nexium® (AstraZeneca)DiaBeta® glyburide (generic)Diclofenac etodolac (generic), ibuprofen (generic), naproxen

Potassium (generic)Diclofenac etodolac (generic), ibuprofen (generic), naproxen

Sodium (generic)Diflucan® fluconazole (generic)Dilacor XR® diltiazem XR (generic)Dilantin® phenytoin sodium capsule (generic)

100mg CapsuleDilantin® Oral phenytoin (generic)

SuspensionDiovan HCT® valsartan/hydrochlorothiazide (generic)




23

Ditropan XL® oxybutynin chloride ER (generic)Doral® temazepam (generic), triazolam (generic), zaleplon

(generic), zolpidem tartrate (generic)Doryx® doxycycline hyclate (generic)Duexis® famotidine (generic), ibuprofen (generic), naproxen

(generic), omeprazole (generic)Duoneb® ipratropium/albuterol sulfate (generic)Duricef® cefadroxil hydrate (generic)Dutoprol® hydrochlorothiazide (generic), metoprolol succinate

(generic)Dynacin® minocycline HCl (generic)DynaCirc CR® amlodipine besylate (generic), nifedipine ER (generic),

nisoldipine (generic)EC-Naprosyn® naproxen (generic)Edarbi® losartan potassium (generic), Atacand® (AstraZeneca),

Benicar® (Daiichi Sankyo), Diovan® (Novartis), Micardis®

(BIPI)Edarbyclor® irbesartan/hydrochlorothiazide (generic),

losartan/hydrochlorothiazide (generic),valsartan/hydrochlorothiazide (generic), Atacand HCT®

(AstraZeneca), Benicar HCT® (Daiichi Sankyo), MicardisHCT® (Boehringer Ingelheim)

Edluar® zolpidem tartrate (generic)Effexor® venlafaxine HCl (generic)Effexor XR® venlafaxine HCl (generic)Elestrin® estradiol patch (generic), Climara® (Berlex), Divigel®

(Upsher Smith), Estraderm® (Novartis), Vivelle®

(Novogyne)Emsam® phenelzine sulfate (generic), tranylcypromine sulfate

(generic)Equetro® carbamazepine (generic), divalproex sodium (generic),

lithium carbonate (generic)EryPed erythromycin ethylsuccinate (generic)Suspension®

400mg/5mlEstrace® Tablet estradiol (generic)Estrasorb® estradiol patch (generic), Divigel® (Upsher Smith)Estrogel® estradiol patch (generic), Climara® (Berlex), Divigel®

(Upsher Smith), Estraderm® (Novartis), Vivelle®

(Novartis)Estrostep Fe® Apri® (Barr-branded generic*), Kariva® (Barr-branded

generic*), Microgestin Fe® (Watson-branded generic*)


24

Exelon® Capsules rivastigmine tartrate (generic)Factive® ciprofloxacin (generic), levofloxacin (generic)Fanapt® clozapine (generic), olanzapine (generic), quetiapine

fumarate (generic), risperidone (generic), ziprasidoneHCl (generic), Seroquel XR® (AstraZeneca)

Felbatol® felbamate (generic)Feldene® piroxicam (generic)Femhrt® Jinteli® (Teva-branded generic*)Femcon Fe® Zeosa® (Teva-branded generic*)Femring® Estrace Vaginal Cream® (Warner Chilcott), Estring®

(Pfizer)Femtrace® estradiol (generic)Fibricor® fenofibrate (generic), Tricor® (Abbott), Triglide® (Sciele),

Trilipix® (Abbott)Firazyr® Berinert® (CSL Behring), Cinryze® (Viropharma)Flonase® fluticasone propionate (generic)Floxin® ofloxacin (generic)Focalin® dexmethylphenidate HCl (generic)Focalin XR® dextroamphetamine-amphetamine ER (generic),

methylphenidate ER (generic), Daytrana® (Shire US Inc.),Metadate CD® (Celltech Pharm), Methylin ER®

(Mallinckrodt Pharmaceuticals)Fortamet® metformin HCl ER (generic), metformin HCl tablet

(generic)Fosamax® Tablets alendronate sodium (generic)Fosamax Plus D® alendronate sodium (generic), ibandronate sodium

(generic)Furadantin® nitrofurantoin (generic)Gantrisin® sulfisoxazole (generic)Geodon® ziprasidone HCl (generic)Glucophage® metformin HCl (generic)Glucophage XR® metformin HCl ER (generic), metformin HCl tablet

(generic)Glucotrol® glipizide (generic)Glucotrol XL® glipizide ER (generic)Glucovance® glyburide/metformin HCl (generic)Glynase® glyburide, micronized (generic)Glyset® acarbose (generic)Gralise® gabapentin (generic)




25

Grifulvin V® griseofulvin ultramicrosize (generic), itraconazole(generic), ketoconazole (generic), terbinafine HCl(generic)

Gris-Peg® griseofulvin ultramicrosize (generic), itraconazole(generic), ketoconazole (generic), terbinafine HCl(generic)

Guanabenz clonidine HCl (generic), methyldopa (generic)Acetate®

Halcion® triazolam (generic)Hiprex® methenamine hippurate (generic)Hytrin® terazosin (generic)Hyzaar® losartan/hydrochlorothiazide (generic)Imitrex® sumatriptan succinate (generic)Inderal® propranolol HCl (generic)Inderal LA® propranolol capsule, sustained action (generic)Indocin® indomethacin (generic)Innopran XL® propranolol capsule, sustained action (generic)Intermezzo® zaleplon (generic)Invega® olanzapine (generic), quetiapine fumarate (generic),

risperidone (generic), ziprasidone HCl (generic),Seroquel XR® (AstraZeneca)

Isoptin S.R.® verapamil HCl tablet, sustained action (generic)Kalbitor® Berinert® (CSL Behring)Kapvay® clonidine HCl (generic), Intuniv® (Shire US Inc.)Keflex® cephalexin monohydrate (generic)Keppra® levetiracetam (generic)Keppra XR® levetiracetam (generic)Kerlone® betaxolol HCl (generic)Klonopin® clonazepam (generic)Lamictal® lamotrigine (generic)Lamisil® tablet terbinafine HCl (generic)Lescol® fluvastatin sodium (generic)Lescol XL® atorvastatin calcium (generic), lovastatin (generic),

simvastatin (generic), Altoprev® (Andrx), Crestor®

(AstraZeneca), VytorinTM (Merck/Schering)Levaquin® levofloxacin (generic)Levatol® acebutolol HCl (generic), atenolol (generic),

metoprolol tartrate (generic)Levlite® Aviane® (Barr-branded generic*), Lessina®

(Barr-branded generic*), Lybrel® (Wyeth)


26

Lexapro® escitalopram oxalate (generic)Librium® chlordiazepoxide HCl (generic)Lipitor® atorvastatin calcium (generic)Liquadd® dextroamphetamine sulfate (generic)Lithobid® lithium carbonate tablet, sustained action (generic)Livalo® atorvastatin calcium (generic), lovastatin (generic),

pravastatin (generic), simvastatin (generic), Crestor®

(AstraZeneca)Lodine® etodolac (generic)Loestrin® Junel® (Barr-branded generic*), Microgestin®

(Watson-branded generic*)Loestrin Fe® Junel Fe® (Barr-branded generic*), Microgestin Fe®

(Watson-branded generic*)Lofibra® fenofibrate (generic), Tricor® (Abbott), Triglide® (First

Horizon), Trilipix® (Abbott)Lo/Ovral® Low-Ogestrel® (Watson-branded generic*)Lopid® gemfibrozil (generic)Lopressor® metoprolol tartrate (generic)Lopressor HCT® metoprolol/hydrochlorothiazide (generic)LoSeasonique® Amethia Lo® (Watson-branded generic*), Camrese Lo®

(Teva-branded generic*)Lotensin® benazepril HCl (generic)Lotensin HCT® benazepril HCl/hydrochlorothiazide (generic)Lotrel® amlodipine besylate/benazepril (generic)Luvox CR® fluvoxamine maleate (generic)Lybrel® Amethyst® (Watson-branded generic*)Macrobid® nitrofurantoin macrocrystal (generic)Macrodantin® nitrofurantoin (generic)Mavik® trandolapril HCl (generic)Maxair Autohaler® Proair HFA® (Teva)Mebaral® mephobarbital (generic)Menest® estradiol (generic), estropipate (generic), Cenestin®

(Duramed/Barr), Enjuvia® (Duramed/Barr),Premarin® (Wyeth)

Menostar Patch® Climara Patch® (Berlex), Vivelle Patch® (Novartis)Metaglip® glipizide/metformin (generic)Methylin® methylphenidate HCl (generic)

Oral SolutionMethylin® methylphenidate HCl (generic)

Chewable TabletMevacor® lovastatin (generic)




27

Miacalcin® calcitonin-salmon (generic)Midrin® isometheptene/apap/dichloralphenazone (generic)Migranal® naratriptan HCl (generic), sumatriptan nasal spray

(generic), Maxalt® (Merck), Relpax® (Pfizer), Zomig® NasalSpray (AstraZeneca)

Minipress® prazosin HCl (generic)Minitran® nitroglycerin patch (generic), Nitro-Dur® (Schering)Minocin® minocycline HCl (generic)Mircette® Kariva® (Barr-branded generic*)Mobic® meloxicam (generic)Modicon® Necon® (Watson-branded generic*), Nortrel®

(Barr-branded generic*)Monistat 3 Vaginal miconazole 3 vaginal suppository (generic)

Suppository®

Monodox® doxycycline monohydrate (generic)Monopril® fosinopril sodium (generic)Monurol® ciprofloxacin HCl (generic), sulfamethoxazole/

trimethoprim (generic), trimethoprim (generic)Motrin® ibuprofen (generic)Moxatag® amoxicillin (generic)Mysoline® primidone (generic)Nalfon® etodolac (generic), ibuprofen (generic), indomethacin

(generic), meclofenamate sodium (generic), naproxen (generic), sulindac (generic)

Naprelan® naproxen sodium (generic)Naprosyn® naproxen (generic)Nardil® phenelzine sulfate (generic)Nasacort AQ® triamcinolone acetonide (generic)Nembutal chloral hydrate (generic), temazepam (generic),

Sodium® triazolam (generic)Neurontin® gabapentin (generic)Nexiclon XR® clonidine HCl (generic)Nimotop® nimodipine (generic)Niravam® alprazolam (generic)Nizoral® ketoconazole (generic)Nordette® Levora® (Watson-branded generic*), Portia®

(Barr-branded generic*)Norinyl® Necon® (Watson-branded generic*), Nortrel®

(Barr-branded generic*)Norpramin® desipramine HCl (generic)


28

Norvasc® amlodipine besylate (generic)Novolin® Humulin® (Eli Lilly)Nuvigil® modafinil (generic)Ogen® estropipate (generic)Oleptro ER® trazodone HCl (generic)Omnaris® flunisolide (generic), fluticasone propionate (generic),

triamcinolone acetonide (generic), Nasonex®

(Schering), Rhinocort Aqua® (AstraZeneca), Veramyst®

(GlaxoSmithKline)Omnicef® cefdinir (generic)Onfi® felbamate (generic), lamotrigine (generic), topiramate

(generic), Banzel® Tablet (Eisai)Oravig® clotrimazole (generic), fluconazole (generic), nystatin

suspension (generic)Ortho-Cept® Apri®(Barr-branded generic*), Solia®

(Prasco Labs-branded generic*)Ortho-Cyclen® MonoNessa® (Watson-branded generic*), Previfem®

(Teva-branded generic*), Sprintec® (Barr-branded generic*)

Ortho Evra® MonoNessa® (Watson-branded generic*), TriNessa®

(Watson-branded generic*)Ortho Micronor® norethindrone acetate (generic)Ortho-Novum® Necon® (Watson-branded generic*), Nortrel®

1/35, 7/7/7 (Barr-branded generic*)Ortho-Novum® Necon® (Watson-branded generic*)

1/50Ortho-Prefest® estradiol/norethindrone acetate (generic),

Premphase® (Wyeth), Prempro® (Wyeth)Ortho Tri-Cyclen® TriNessa® (Watson-branded generic*), Tri-Previfem®

(Teva-branded generic*), Tri-Sprintec® (Barr-brandedgeneric*)

Ortho Tri-Cyclen TriNessa® (Watson-branded generic*), Tri-Previfem®

Lo® (Teva-branded generic*), Tri-Sprintec® (Barr-brandedgeneric*)

Ovcon® Necon® (Watson-branded generic*)Ovral® Ogestrel® (Watson-branded generic*)Pamelor® nortriptyline HCl (generic)Parnate® tranylcypromine sulfate (generic)Paxil® paroxetine HCl (generic)Paxil CR® paroxetine HCl sustained release tab (generic)PCE® erythromycin (generic)




29

Pennsaid® etodolac (generic), ibuprofen (generic), naproxen(generic)

Pepcid® famotidine (generic), cimetidine HCl liquid (generic),Suspension Axid Oral Solution® (Braintree)

Pepcid® Tablet famotidine (generic)Periostat® doxycycline hyclate (generic)Pexeva® paroxetine HCl (generic)Phenytek® phenytoin sodium (generic)Phrenilin® acetaminophen/butalbital (generic)Plan B One-Step® Next Choice One Dose® (Watson-branded generic*)Ponstel® etodolac (generic), ibuprofen (generic), indomethacin


Pravachol® pravastatin (generic)Precose® acarbose (generic)Prefest® estradiol/norethindrone acetate (generic),

Premphase® (Wyeth), Prempro® (Wyeth)Premarin® Estrace® Vaginal Cream (Warner Chilcott)Vaginal Cream

Prevacid® lansoprazole (generic), omeprazole (generic), Nexium®

(AstraZeneca)Prilosec Rx® omeprazole (generic), Nexium® (AstraZeneca)Primsol® trimethoprim (generic)Prinivil® lisinopril (generic)Prinzide® lisinopril/hydrochlorothiazide (generic)Procardia XL® nifedipine ER (generic)Prolia® alendronate sodium (generic), ibandronate sodium

(generic), Evista® (Eli Lilly), Forteo® (Eli Lilly)Proquin XR® ciprofloxacin HCl (generic)Protonix® Nexium® Suspension (AstraZeneca)

SuspensionProtonix® Tablet pantoprazole sodium (generic), omeprazole (generic),

Nexium® (AstraZeneca)Proventil HFA® Proair HFA® (Teva)Provigil® modafinil (generic)Prozac® fluoxetine HCl (generic)Prozac Weekly® fluoxetine HCl (generic)Pulmicort® budesonide (generic)0.25mg/2mL,0.5mg/2mL

Questran® cholestyramine (generic), prevalite (generic)


30

Questran Light® cholestyramine/aspartame (generic), prevalite (generic)Razadyne® galantamine (generic)Razadyne ER® galantamine ER (generic)Relafen® nabumetone (generic)Remeron® mirtazapine soltabs (generic), mirtazapine tabs

(generic)Restoril® temazepam (generic)Risperdal® risperidone (generic)

Oral SolutionRisperdal® Tablet risperidone (generic)Ritalin® methylphenidate HCl (generic)Ritalin LA® methylphenidate ER (generic), dextroamphetamine

sulfate (generic), dextroamphetamine-amphetamineER (generic), Daytrana® (Shire US Inc.), Metadate CD®

(Celltech Pharm)Ritalin SR® methylphenidate ER (generic)Rozerem® estazolam (generic), temazepam (generic), triazolam

(generic), zolpidem tartrate (generic)Sabril® divalproex sodium (generic), lamotrigine (generic),

levetiracetam (generic), topiramate (generic), Gabitril®

(Cephalon)Sanctura® trospium chloride (generic)Saphris® clozapine (generic), olanzapine (generic), quetiapine

fumarate (generic), risperidone (generic), ziprasidoneHCl (generic), Seroquel XR® (AstraZeneca)

Sarafem® fluoxetine HCl (generic)Seasonale® Amethyst® (Watson-branded generic*), Jolessa®

(Barr-branded generic*), Quasense® (Watson-brandedgeneric*),

Seasonique® Amethia® (Watson-branded generic*), Camrese®

(Teva-branded generic*)Seconal Sodium® chloral hydrate (generic), temazepam (generic),

triazolam (generic)Sectral® acebutolol HCl (generic)Septra DS® sulfamethoxazole/trimethoprim (generic)Seroquel® quetiapine fumarate (generic)Singulair® montelukast sodium (generic)Solodyn® minocycline HCl (generic), doxycycline monohydrate

(generic)Sonata® zaleplon (generic)Spectracef® cefaclor (generic), cefdinir (generic), cefuroxime axetil

(generic)




31

Sporanox® itraconazole (generic)Capsule

Sprix® etodolac (generic), ibuprofen (generic), naproxen(generic)

Starlix® nateglinide (generic)Sular® nisoldipine (generic), amlodipine besylate (generic),

isradipine (generic), nifedipine ER (generic)Suprax® cefdinir (generic), cefuroxime axetil (generic)Surmontil® trimipramine maleate (generic)Symbyax® fluoxetine HCl (generic), olanzapine (generic),

quetiapine fumarate (generic), risperidone (generic),Seroquel XR® (AstraZeneca)

Tagamet® cimetidine (generic)Tegretol® carbamazepine (generic)Tegretol XR® carbamazepine XR (generic)

200mg, 400mgTenex® guanfacine HCl (generic)Tenoretic® atenolol/chlorthalidone (generic)Tenormin® atenolol (generic)Teveten® eprosartan mesylate (generic), losartan potassium

(generic), Atacand® (AstraZeneca), Benicar® (DaiichiSankyo), Diovan® (Novartis), Micardis® (BIPI)

Teveten HCT® losartan/hydrochlorothiazide (generic),valsartan/hydrochlorothiazide (generic), Atacand HCT®

(AstraZeneca), Benicar HCT® (Daiichi Sankyo), MicardisHCT® (BIPI)

Thioridazine HCl® chlorpromazine HCl (generic), haloperidol (generic),quetiapine fumarate (generic), risperidone (generic)

Tiazac® diltiazem HCl capsule, sustained release 24 hr (generic)Tofranil® imipramine HCl (generic)Tofranil-PM® imipramine pamoate (generic)Topamax® topiramate (generic)Toprol XL® metoprolol succinate (generic)Toradol® etodolac (generic), ibuprofen (generic), indomethacin


Trandate® labetalol HCl (generic)Tranxene T-Tab® clorazepate dipotassium (generic)Trileptal® carbamazepine (generic)Tri-Norinyl® Necon® (Watson-branded generic*), Nortrel®

(Barr-branded generic*)Uniretic® moexipril/hydrochlorothiazide (generic)


32

Univasc® moexipril HCl (generic)Valium® diazepam (generic)Vantin® cefpodoxime proxetil (generic)Vaseretic® enalapril maleate/hydrochlorothiazide (generic)Vasotec® enalapril maleate (generic)Verelan® verapamil ER (generic)Verelan PM® verapamil ER PM (generic)Vfend® voriconazole (generic)Vibramycin® Syrup Vibramycin® Suspension (Pfizer)Vivactil® protriptyline HCl (generic)Voltaren® Tablets etodolac (generic), ibuprofen (generic), naproxen

(generic)Voltaren-XR® etodolac (generic), ibuprofen (generic), naproxen

(generic)Wellbutrin® bupropion HCl (generic)Wellbutrin SR® bupropion HCl tablet, sustained release (generic)Wellbutrin XL® bupropion HCl tablet, extended release (generic)Wytensin® clonidine HCl (generic), methyldopa (generic)Xanax® alprazolam (generic)Xanax XR® alprazolam XR (generic)Xolair® Asmanex® (Schering), Pulmicort Flexhaler®

(AstraZeneca), QVAR® (Ivax)Xopenex® levalbuterol HCl (generic)

1.25mg/0.5Yasmin® Ocella® (Barr-branded generic*)Zantac Rx Syrup® ranitidine HCl tablet (generic), Axid Oral Solution®

(Braintree)Zantac Rx Tablet® ranitidine HCl tablet (generic)Zarontin® ethosuximide (generic)Zebeta® bisoprolol fumarate (generic)Zegerid Rx® omeprazole/sodium bicarbonate (generic), omeprazole

(generic), Nexium® (AstraZeneca)Zestoretic® lisinopril/hydrochlorothiazide (generic)Zestril® lisinopril (generic)Ziac® bisoprolol fumarate/hydrochlorothiazide (generic)Zithromax® azithromycin (generic)Zmax® azithromycin (generic)Zocor® simvastatin (generic)Zoloft® sertraline HCl (generic)Zolpimist® zolpidem tartrate (generic)



33

Zonegran® carbamazepine (generic), clonazepam (generic) ethosuximide (generic,) phenobarbital (generic), phenytoin sodium (generic), Lyrica® (Pfizer)

Zyflo® montelukast sodium (generic)Zyflo CR® montelukast sodium (generic)Zyprexa® olanzapine (generic)Zyprexa Zydis® olanzapine ODT (generic)



This guide does not contain a complete list of formulary and nonformulary drugs. It only liststhe most commonly prescribed drugs. For anupdated and complete listing of your prescriptionbenefit, you can visit www.mywdrx.com.

www.mywdrx.com

© 2012 Used under License.

MG43376O

Documents

WellDyneRx Formulary Member Guide Formulary062113.pdfWellDyneRx Formulary Member Guideis a formulary list of medications that may be covered under your prescription drug plan.This