FORMULARY PRODUCT QUICK REFERENCE
| NonFormulary Product |
Formulary Alternatives |
| Lexapro |
sertraline (generic Zoloft), citalopram (generic Celexa), fluoxetine (generic Prozac), and paroxetine (generic Paxil) |
| Lyrica |
Gabapentin (generic Neurontin), Cymbalta |
| Chantix |
Smoking cessation therapies (lozenges, gum, patches, inhaler and nasal spray) and bupropion sr (Zyban) |
| Vyvanse |
Concerta, Metadate CD, methylphenidate er, Ritalin SR, Focalin XR, generic Dexedrine, generic Adderall XR, and Strattera |
| Nexium |
Prilosec OTC, then Prevacid |
| Protonix |
Prilosec OTC, then Prevacid |
| Oxycontin |
Avinza, morphine sulfate extended release (generic MS Contin), and fentanyl transdermal patches (generic Duragesic) |
| Zetia |
simvastatin (generic Zocor), lovastatin (generic Mevacor), pravastatin (generic Pravochol), cholestyramine light (generic Questran), colestipol (generic Colestid), and Niaspan |
| Lipitor |
simvastatin (generic Zocor), lovastatin (generic Mevacor), and pravastatin (generic Pravachol) |
| Xopenex |
Ventolin HFA |
| Pristiq |
sertraline (generic Zoloft), citalopram (generic Celexa), fluoxetine (generic Prozac), and paroxetine (generic Paxil), venlafaxine (generic Effexor) THEN Effexor XR or Cymbalta |
| Januvia |
Metformin (generic Glucophage), glyburide (generic Diabeta/Micronase), glimepiride (generic Amaryl), glipizide (generic Glucotrol), THEN Actos, ActoPlus Met, Duetact, Avandia, Avandaryl, and Avandamet |
| Crestor |
Simvastatin (generic Zocor), lovastatin (generic Mevacor), and pravastatin (generic Pravachol) |
| Daytrana |
Generic Adderall XR, Concerta, Metadate CD, methylphenidate er, Focalin XR, and Strattera |
| Provigil |
Generic Dexedrine, generic Adderall, and methylphenidate (generic Ritalin) |
| Symbicort |
Advair Diskus, Advair HFA, Flovent HFA, Asmanex |
| Amerge |
sumatriptan (generic Imitrex) tablets, sumatriptan (generic Imitrex) nasal spray, sumatriptan (generic Imitrex) injection, Maxalt, Maxalt MLT |
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Medicaid |
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