How to Use This Guide Within this guide you will find commonly prescribed medications listed by medication category. Refer to this list with your doctor to select the right medication to meet your needs. All strengths of a medication listed on the Pocket Formulary are considered preferred unless otherwise noted. This guide lists preferred Copay Tier 1 and Copay Tier 2 medications: n n Copay Tier 1 – Lowest-Cost Option. These are typically generic medications and are the lowest out-of-pocket expense. Copay Tier 2 – Midrange-Cost Option. These are typically Brand name medications. * An asterick next to a medication indicates that the medication is part of a Progressive Medication Program (PMP). This means that a trial of a firstline medication(s) is required prior to coverage of a second-line medication regardless of copay tier. Example below. First-Line Medications Second-Line Medications atorvastatin, Crestor Lescol XL*, Vytorin* fluvastatin, lovastatin, pravastatin, simvastatin omeprazole (OTC, Rx), lansoprazole (OTC), pantoprazole, Zegerid OTC Aciphex*, Dexilant*, Nexium* fenofibrate Antara*, Lipofen*, Lovaza fenofibrate (Tricor*), Triglide*, Trilipix* Note: This Pocket Formulary is subject to change. To view the most up-to-date document, please visit www.avmed.org. Category Class co-pay tier 1 (lowest cost option) preferred generics co-pay tier 2 (midrange cost option) preferred brands Anti-Anxiety Benzodiazepines alprazolam/XR, diazepam, lorazepam, oxazepam Other buspirone, chlorazepate, chlordiazepoxide Anti-Diabetic Oral Medications glimepiride, glipizide, glyburide, metformin, Avandia products, Januvia products, Onglyza, pioglitazone products Kombiglyze XR Insulins Lantus, Levemir, Novolin, Novolog Injectable Medications Byetta, Bydureon, Symlin* Diabetic Supplies Accu-Chek Meters/Strips Anti-Inflammatory NSAIDs diclofenac, ibuprofen, meloxicam, naproxen Ketoprofen ER Corticosteroids dexamethasone, methylprednisolone, prednisone Antibiotics Penicillins amoxicillin, amoxicillin/clavulanate, penicillin Quinolones ciprofloxacin, levofloxacin, ofloxacin Avelox Cephalosporins cefadroxil, cefdinir, cefpodoxime, cephalexin Macrolides azithromycin, clarithromycin, erythromycin Anti-Seizure All Classes carbamazepine/ER/XR, divalproex/ER, gabapentin, Sabril lamotrigine, levetiracetam, levetiracetam ER, oxcarbazepine, phenytoin, tiagabine, topiramate Antidepressants SSRI citalopram, fluoxetine, olanzapine/fluoxetine, paroxetine, sertraline Other amitriptyline, bupropion (SR/XL), venlafaxine SR” Savella Antipsychotics Atypical olanzapine, quetiapine, risperidone, ziprasidone Anti-Migraine Triptans sumatriptan (non-injectable), naratriptan Other apap/butalbital/caffeine, isometh/apap/dichlor Cardiovascular ACE Inhibitors (ACEI) benazepril, captopril, enalapril, fosinopril, lisinopril, quinapril, ramipril ACEI/CCB Combo amlodipine/benazepril Alpha/Alpha-Beta doxazosin, labetalol, prazosin, terazosin Anti-Coagulants warfarin, clopidogrel Effient, Pradaxa, Xarelto ARB/ARB Combo candesartan HCT*, irbesartan/HCT, losartan/HCT, Diovan, Amtumide, Exforge*, Tekturna/HCT, Tekamlo valsartan HCT Beta Blocker atenolol, carvedilol, metoprolol, propranolol Bystolic, Coreg CR, Dutoprol, Innopran XL Calcium Channel Blocker amlodipine, diltiazem, nifedipine, verapamil Advicor, Simocor, Welchol nisoldipine tab SR 24hr Lipid Reducers atorvastatin, lovastatin, pravastatin, Crestor simvastatin, fenofibrate GI Agents H2 Antagonist cimetidine, famotidine, nizatadine, ranitidine Bowel Agents balsalazide, budesonide SR, mesalamine enema, Apriso, Asacol HD, Canasa, Pentasa sulfasalazine Delzicol to preferred PPIs lansoprazole (OTC, Rx), omeprazole (OTC, Rx), pantoprazole, omeprazole/sodium bicarbonate, Zegerid OTC HRT Agents Estrogen/Combo estradiol, estradiol patch, estradio/norethindrone Cenestin, Combipatch, Estrace, Estraderm, Evista, acetate, estropopate, norethindrone acetate-ethinyl Femtrace, FemHRT Low Dose, Menest, Prefest, estradiol tab, alora tier 1 of estrogen Premarin, Premphase, Prempro Ophthalmic Antibiotic ciprofloxacin, ofloxacin, tobramycin Alphagan P (0.1% only), Moxeza, Vigamox, Zymar, Zymaxid Glaucoma brimonidine, dorzolamide, dorzolamide/timolol, Azopt, Betimol, Betoptic-S, Istalol, Pilopine HS, latanoprost, pilocarpine, timolol Osteoporosis Respiratory Agents Sedatives Bisphosphonates alendronate, ibandronate* Nasal Inhaler azelastine, flunisolide fluticasone, triamcinolone acetonide Steroid/Combo MDI Bronchodilator albuterol, albuterol/ipratropium, ipratropium, levalbuterol All Classes temazepam, zaleplon, zolpidem ER*, zolpidem IR Fosamax Plus D*, Fosamax solution Astepro, Nasonex Advair, Asmanex, Dulera, Flovent, QVAR, Symbicort Combivent Respimat, Foradil, Serevent, Spiriva, Ventolin HFA Maxair, Tudorza NOTE: This is not a comprehensive list of generics. Please refer to the full formulary on www.avmed.org for a complete list of generics. Recently Approved Generics Dear AvMed Member, This Pocket Formulary includes the medication categories most often used by AvMed members. Note that these are the most commonly prescribed medication classes. For a comprehensive list of AvMed’s preferred medications, visit www.avmed.org. You may request a printed copy by calling the AvMed Member Services number listed on your card. Helpful Hints n n Take this Pocket Formulary with you to your doctor’s appointment. Always check to make sure your prescription is covered by AvMed. If not, ask the doctor for an alternative. n Covered generic medications are preferred and will be dispensed when available. n All strengths of a medication listed on the Pocket Formulary are considered preferred unless otherwise noted. The following generic medications have been added to the Formulary in 2013: • acyclovir: generic for Zovirax ointment • buprenorphine/naloxine: generic for Suboxone • candesartan/-hctz: generic for Atacand & Atacand HCT • clobetasol propionate: generic for Olux-E • diclofenac/misoprostol: generic for Arthrotec • entacapone: generic for Comtan • fenofibrate: generic for Tricor • levalbuterol: generic for Xopenex nebulizer solution • methylphenidate ER: generic for Concert • methylphenidate: generic for Metadate CD • mupirocin: generic for Bactroban Cream • pioglitatazone/glimepiride: generic for Duetact • rizatriptan: generic for Maxalt & Maxalt MLT • tolterodine tartrate: generic for Detrol • zolmitriptan: generic for Zomig & Zomig ZMT Generics Save You Money FDA-approved generic products are just as effective and safe as the brand name products. Generic medications contain identical active ingredients, are used for the same purposes, meet the same manufacturing standards, and are identical in strength and dosage form as brand name medications. Using a generic alternative can save you money! Mail Order This Pocket Formulary is subject to change. (Updates are issued quarterly.) Revised 8/13 Using mail order to fill your maintenance medications can save you money. Contact AvMed’s Member Services or refer to your benefits for an explanation of your coverage for filling medications through our mail order pharmacy provider, Medco. MP-5394(8/13) 2013 Pocket Formulary REVISED AUGUST 2013 Your Guide to AvMed’s Top Prescribed Categories of Medications for AvMed’s Commercial Products 4300 NW 89th Blvd. Gainesville, FL 32606 www.avmed.org