BLUE - Formulary
RED - Non Formulary

Table of Contents Index Policy Information

Formulary Index

Numbers A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

P CHLOR (ANTITUSSIVE AND EXPECTORANT DRUGS)

P-TEX (ANTIHISTAMINES)

paba/oxyben/dioxyb/hydroquinon (TOPICAL DERMATOLOGICAL DRUGS)

pacerone (AMIODARONES)

PACERONE (AMIODARONES)

paclitaxel (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

PACNEX (ANTIACNE DRUGS)

PAIN EASE (TOPICAL ANESTHETICS)

PALGIC (ANTIHISTAMINES)

paliperidone (ANTIPSYCHOTIC DRUGS)

palivizumab (IMMUNOLOGICALS AND VACCINES)

PAMELOR (SECONDARY AMINES)

pamidronate disodium (OTHER ENDOCRINE DRUGS)

PAMINE (ANTISPASMODICS/DRUGS AFFECT GI MOTILITY)

PAMINE FORTE (ANTISPASMODICS/DRUGS AFFECT GI MOTILITY)

PAMINE FQ (ANTISPASMODICS/DRUGS AFFECT GI MOTILITY)

PANATUSS DXP (ANTITUSSIVE AND EXPECTORANT DRUGS)

PANCREASE MT 10 (OTHER GI DRUGS)

PANCREASE MT 16 (OTHER GI DRUGS)

PANCREASE MT 20 (OTHER GI DRUGS)

PANCREASE MT 4 (OTHER GI DRUGS)

PANCRECARB MS-16 (OTHER GI DRUGS)

PANCRECARB MS-4 (OTHER GI DRUGS)

PANCRECARB MS-8 (OTHER GI DRUGS)

pancrelipase ec (OTHER GI DRUGS)

PANDEL (TOPICAL CORTICOSTEROID DRUGS)

PANLOR DC (CLASS III NARCOTICS)

PANLOR SS (CLASS III NARCOTICS)

PANRETIN (TOPICAL DERMATOLOGICAL DRUGS)

pantoprazole (PROTON PUMP INHIBITORS)

pantoprazole sodium (PROTON PUMP INHIBITORS)

PANTOPRAZOLE SODIUM (Requires trial of H2 and OTC omeprazole) (PROTON PUMP INHIBITORS)

papaverine (OTHER VASODILATING DRUGS)

papaverine hcl (OTHER VASODILATING DRUGS)

PAPAVERINE HCL (OTHER VASODILATING DRUGS)

PARADIGM (MEDICAL (MISCELLANEOUS) SUPPLIES)

PARADIGM INFUSION (MEDICAL (MISCELLANEOUS) SUPPLIES)

PARADIGM INSULIN PUMP (DIABETIC SUPPLIES)

PARADIGM REAL-TIME (DIAGNOSTIC PRODUCTS)

PARADIGM SILHOUETTE (MEDICAL (MISCELLANEOUS) SUPPLIES)

PARAFON FORTE DSC (CNS MUSCLE RELAXANTS)

PARAGARD T 380-A (MEDICAL (MISCELLANEOUS) SUPPLIES)

PARALDEHYDE (SEDATIVE/HYPNOTIC DRUGS)

PARCOPA (OTHER ANTIPARKINSON DRUGS)

PAREGORIC (ANTIDIARRHEAL DRUGS)

PARLODEL (OTHER ANTIPARKINSON DRUGS)

PARNATE (MAO INHIBITORS)

paromomycin (AMEBICIDES)

paromomycin sulfate (AMEBICIDES)

paroxetine (SELECTIVE SEROTONIN REUPTAKE INHIBITORS)

paroxetine hcl (SELECTIVE SEROTONIN REUPTAKE INHIBITORS)

PASER (ANTITUBERCULOSIS DRUGS)

PATADAY (OTHER OPHTHALMIC DRUGS)

PATANASE (DRUGS AFFECTING THE NOSE)

PATANOL (OTHER OPHTHALMIC DRUGS)

PAXIL (Requires trial of generic fluoxetine) (10mg not covered) (SELECTIVE SEROTONIN REUPTAKE INHIBITORS)

PAXIL CR (SELECTIVE SEROTONIN REUPTAKE INHIBITORS)

PBM ALLERGY (ANTITUSSIVE AND EXPECTORANT DRUGS)

PCCA COSMETIC HRT BASE (PHARMACEUTICAL NECESSITIES)

PCCA LIPODERM BASE (PHARMACEUTICAL NECESSITIES)

PCE (ERYTHROMYCINS)

PCM LA (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

PDM GG (ANTITUSSIVE AND EXPECTORANT DRUGS)

PE-HIST DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

pe/cod/pro (ANTITUSSIVE AND EXPECTORANT DRUGS)

pe/cpm/scop (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

pe/pro (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

pedi-dri (OTHER TOPICAL ANTIFUNGALS)

PEDIAHIST DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

PEDIAPRED (GLUCOCORTICOID DRUGS)

PEDIATEX TD (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

PEDVAXHIB (IMMUNOLOGICALS AND VACCINES)

peg 3350-electrolyte (OTHER GI DRUGS)

peg-3350 and electrolytes (OTHER GI DRUGS)

peg-3350 with flavor packs (OTHER GI DRUGS)

pegademase bovine (MISCELLANEOUS DRUGS)

PEGANONE (HYDANTOINS)

pegaspargase (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

PEGASYS (INTERFERONS)

pegfilgrastim (MYELOID STIMULANTS)

peginterferon alfa-2a (INTERFERONS)

peginterferon alfa-2b (INTERFERONS)

PEGINTRON (INTERFERONS)

PEGINTRON REDIPEN (INTERFERONS)

pen g pot/dextrose-water (PENICILLINS)

pen g procaine/pen g benz (PENICILLINS)

penicillamine (OTHER DRUGS FOR ARTHRITIS)

penicillin g benzathine (PENICILLINS)

penicillin g potassium (PENICILLINS)

PENICILLIN G POTASSIUM IN D5W (PENICILLINS)

penicillin g procaine (PENICILLINS)

penicillin g sodium (PENICILLINS)

PENICILLIN GK-ISO-OSM DEXTROSE (PENICILLINS)

penicillin v potassium (PENICILLINS)

PENLAC (OTHER TOPICAL ANTIFUNGALS)

PENTAM 300 (OTHER ANTIINFECTIVE DRUGS)

pentamidine (OTHER ANTIINFECTIVE DRUGS)

pentamidine isethionate (OTHER ANTIINFECTIVE DRUGS)

PENTASA (OTHER GI DRUGS)

pentazocine (CLASS IV NARCOTICS)

PENTAZOCINE-ACETAMINOPHEN (CLASS IV NARCOTICS)

PENTAZOCINE-NALOXONE HCL (CLASS IV NARCOTICS)

pentobarbital sodium (SEDATIVE/HYPNOTIC DRUGS)

pentosan polysulfate sodium (OTHER GENITOURINARY PRODUCTS)

pentostatin (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

pentoxifylline (OTHER CARDIOVASCULAR DRUGS)

pentoxil (OTHER CARDIOVASCULAR DRUGS)

PEPCID (ANTIULCER DRUGS)

PEPCID (Not Covered. OTC Equivalent available) (ANTIULCER DRUGS)

PERANEX HC (TOPICAL CORTICOSTEROID DRUGS)

PERANEX HC (OTHER GI DRUGS)

PERCOCET (CLASS II NARCOTICS)

PERCODAN (CLASS II NARCOTICS)

PERFOROMIST (BETA-2 ADRENERGIC DRUGS)

PERIDEX (DRUGS AFFECTING THE THROAT AND MOUTH)

PERIO MED (FLUORIDE PRODUCTS)

periogard (DRUGS AFFECTING THE THROAT AND MOUTH)

PERIOSTAT (DRUGS AFFECTING THE THROAT AND MOUTH)

perisol (DRUGS AFFECTING THE THROAT AND MOUTH)

permethrin (SCABICIDES)

PERMETHRIN (PHARMACEUTICAL NECESSITIES)

perphenazine (ANTIPSYCHOTIC DRUGS)

perphenazine-amitriptyline (OTHER ANTIDEPRESSANTS)

PERSANTINE (ANTIPLATELET DRUGS)

PEXEVA (SELECTIVE SEROTONIN REUPTAKE INHIBITORS)

PFIZERPEN (PENICILLINS)

PHENA-PLUS (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

PHENA-S (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

PHENA-S 12 (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

PHENABID (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

PHENABID DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

phenadoz (ANTIVERTIGO AND ANTIEMETIC DRUGS)

PHENAZOFORTE PLUS (OTHER GENITOURINARY PRODUCTS)

phenazopyridine (URINARY ANESTHETICS)

phenazopyridine hcl (URINARY ANESTHETICS)

PHENAZOPYRIDINE PLUS (OTHER GENITOURINARY PRODUCTS)

PHENCARB GG (ANTITUSSIVE AND EXPECTORANT DRUGS)

PHENDIMETRAZINE TARTRATE (APPETITE SUPPRESSANTS)

phenelzine (MAO INHIBITORS)

PHENERGAN (ANTIHISTAMINES)

PHENFLU DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

phenobarbital (ANTICONVULSANT BARBITURATES)

phenobarbital sodium (ANTICONVULSANT BARBITURATES)

PHENOL (PHARMACEUTICAL NECESSITIES)

phenol (PHARMACEUTICAL NECESSITIES)

phenoxybenzamine (DRUGS FOR PHEOCHROMOCYTOMA)

PHENTERMINE HCL (APPETITE SUPPRESSANTS)

phentolamine (DRUGS FOR PHEOCHROMOCYTOMA)

PHENTOLAMINE MESYLATE (DRUGS FOR PHEOCHROMOCYTOMA)

PHENYL CHLOR-TAN (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

PHENYLEPH-CHLORPHEN (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

phenylephrine hcl (OTHER CARDIOVASCULAR DRUGS)

phenylephrine hcl (OTHER OPHTHALMIC DRUGS)

PHENYLEPHRINE-BROMPHENIRAMIN (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

PHENYLEPHRINE-GUAIFENESIN (ANTITUSSIVE AND EXPECTORANT DRUGS)

PHENYLTOLOXAMINE PE CPM (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

PHENYTEK (HYDANTOINS)

phenytoin (HYDANTOINS)

phenytoin sodium (HYDANTOINS)

phenytoin sodium extended (HYDANTOINS)

PHISOHEX (TOPICAL ANTIBACTERIAL DRUGS)

PHOS-FLUR (FLUORIDE PRODUCTS)

PHOSLO (THERAPEUTIC VITAMINS & MINERALS)

phospha 250 neutral (POTASSIUM SUPPLEMENTS)

PHOSPHOLINE IODIDE (ANTIGLAUCOMA DRUGS)

PHOSPHORIC ACID (PHARMACEUTICAL NECESSITIES)

phosphoric acid, diluted (PHARMACEUTICAL NECESSITIES)

phosphorus (POTASSIUM SUPPLEMENTS)

PHRENILIN (DRUGS TO PREVENT AND TREAT HEADACHES)

PHRENILIN FORTE (DRUGS TO PREVENT AND TREAT HEADACHES)

PHYSIOLYTE (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

PHYSIOSOL (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

PHYTONADIONE (ORAL ANTICOAGULANTS, VITAMIN K)

phytonadione (ORAL ANTICOAGULANTS, VITAMIN K)

PHYTONADIONE (ORAL ANTICOAGULANTS, VITAMIN K)

pilocarpine hcl (DRUGS AFFECTING THE THROAT AND MOUTH)

pilocarpine hcl (ANTIGLAUCOMA DRUGS)

PILOPINE HS (ANTIGLAUCOMA DRUGS)

pimecrolimus (TOPICAL DERMATOLOGICAL DRUGS)

pimozide (ANTIPSYCHOTIC DRUGS)

pindolol (BETA-ADRENERGIC ANTAGONIST DRUGS)

pioglitazone hcl (INSULIN SENSITIZERS & COMBOS)

pioglitazone hcl/metformin hc (INSULIN SENSITIZERS & COMBOS)

piperacillin (PENICILLINS)

piperacillin-tazobactam (PENICILLINS)

piperacillin/tazobactam na/d5w (PENICILLINS)

piperacillin/tazobactam sodium (PENICILLINS)

PIPRACIL IN DEXTROSE (PENICILLINS)

piroxicam (NON-STEROIDAL ANTIINFLAMMATORY AGENTS)

PIROXICAM (Requires trial of OTC NSAID) (NON-STEROIDAL ANTIINFLAMMATORY AGENTS)

PITOCIN (OXYTOCICS)

PLAN B (CONTRACEPTIVES)

PLAN B ONE-STEP (CONTRACEPTIVES)

PLAQUENIL (PLASMODICIDES)

PLASBUMIN-25 (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

PLASMA-LYTE 56 IN DEXTROSE (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

PLAVIX (ANTIPLATELET DRUGS)

PLETAL (ANTIPLATELET DRUGS)

PLEXION (ANTIACNE DRUGS)

PLEXION SCT (ANTIACNE DRUGS)

pneumococcal vaccine (IMMUNOLOGICALS AND VACCINES)

PNEUMOVAX 23 (IMMUNOLOGICALS AND VACCINES)

PODOCON-25 (KERATOLYTIC DRUGS)

podofilox (KERATOLYTIC DRUGS)

PODOPHYLLUM RESIN (KERATOLYTIC DRUGS)

poliomyelitis vac,killed (IMMUNOLOGICALS AND VACCINES)

POLOCAINE (LOCAL ANESTHETICS)

POLY HIST DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

POLY HIST FORTE (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

POLY HIST PD (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

poly iron pn (PRENATAL VITAMINS)

POLY IRON PN FORTE (PRENATAL VITAMINS)

POLY TAN (ANTIHISTAMINES)

POLY TAN D (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

POLY TAN DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

POLY-650 (ANALGESICS)

POLY-IRON 150 FORTE (VITAMINS & MINERALS & RELATED PRODUCTS)

POLY-PRED (OPHTHALMIC ANTIINFECTIVE/CORTICOSTEROIDS)

POLY-TUSSIN AC (ANTITUSSIVE AND EXPECTORANT DRUGS)

POLY-TUSSIN DHC (ANTITUSSIVE AND EXPECTORANT DRUGS)

POLY-TUSSIN DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

polyethylene glycol 3350 (LAXATIVES AND CATHARTICS)

POLYETHYLENE GLYCOL 3350 (LAXATIVES AND CATHARTICS)

POLYFIN (MEDICAL (MISCELLANEOUS) SUPPLIES)

POLYFIN QR (MEDICAL (MISCELLANEOUS) SUPPLIES)

POLYGESIC (CLASS III NARCOTICS)

polymyxin b (OTHER ANTIINFECTIVE DRUGS)

polymyxin b sul-trimethoprim (OPHTHALMIC TOPICAL ANTIBACTERIAL DRUGS)

polymyxin b sulfate (OTHER ANTIINFECTIVE DRUGS)

POLYMYXIN B SULFATE (OTHER ANTIINFECTIVE DRUGS)

polymyxin b sulfate/tmp (OPHTHALMIC TOPICAL ANTIBACTERIAL DRUGS)

POLYSACCHARIDE IRON FORTE (VITAMINS & MINERALS & RELATED PRODUCTS)

POLYTRIM (OPHTHALMIC TOPICAL ANTIBACTERIAL DRUGS)

POLYVITAMIN WITH IRON-FLUORIDE (VITAMINS & MINERALS & RELATED PRODUCTS)

polyvitamins-fluoride (VITAMINS & MINERALS & RELATED PRODUCTS)

PONSTEL (NON-STEROIDAL ANTIINFLAMMATORY AGENTS)

PONSTEL (requires trial of 2 first line NSAIDs within 6 months) (NON-STEROIDAL ANTIINFLAMMATORY AGENTS)

PONTOCAINE (TOPICAL ANESTHETICS)

portia (CONTRACEPTIVES)

posiflush saline (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

pot acid phos/sod acid phos (OTHER GENITOURINARY PRODUCTS)

pot bicarb/pot chloride (POTASSIUM SUPPLEMENTS)

pot bicarb/pot chloride/ca (POTASSIUM SUPPLEMENTS)

pot chloride/na chlor (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

POTABA (VITAMINS & MINERALS & RELATED PRODUCTS)

potassium acetate (POTASSIUM SUPPLEMENTS)

potassium acid phosphate (OTHER GENITOURINARY PRODUCTS)

potassium bicarb/ca (POTASSIUM SUPPLEMENTS)

potassium bicarbonate (POTASSIUM SUPPLEMENTS)

potassium chl-normal saline (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

potassium chloride (POTASSIUM SUPPLEMENTS)

potassium chloride in d5lr (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

potassium chloride/d5w (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

POTASSIUM CITRATE (OTHER GENITOURINARY PRODUCTS)

potassium citrate-citric acid (OTHER GENITOURINARY PRODUCTS)

potassium iodide (ANTITUSSIVE AND EXPECTORANT DRUGS)

potassium iodine/iodine (THYROID SUPPLEMENTS)

potassium phosphate (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

PR OTIC SOLUTION (DRUGS AFFECTING THE EAR)

pramipexole (OTHER ANTIPARKINSON DRUGS)

pramlintide acetate (AMYLIN ANALOGUES)

PRAMOSONE (TOPICAL CORTICOSTEROID DRUGS)

PRAMOTIC (DRUGS AFFECTING THE EAR)

pramox (TOPICAL ANESTHETICS)

pramoxine (TOPICAL ANESTHETICS)

PRAMOXINE-HC (DRUGS AFFECTING THE EAR)

pramoxine/hc acetate (OTHER GI DRUGS)

pramoxine/hydrocortisone (TOPICAL CORTICOSTEROID DRUGS)

pramoxine/hydrocortisone (OTHER GI DRUGS)

PRANDIMET (ORAL HYPOGLYCEMICS & COMBOS)

PRANDIN (ORAL HYPOGLYCEMICS & COMBOS)

PRASCION (ANTIACNE DRUGS)

PRASCION FC (ANTIACNE DRUGS)

PRASCION RA (ANTIACNE DRUGS)

PRASCION TS (ANTIACNE DRUGS)

PRAVACHOL (Q) (HMG-COA REDUCTASE INHIBITORS)

pravastatin (HMG-COA REDUCTASE INHIBITORS)

pravastatin sodium (HMG-COA REDUCTASE INHIBITORS)

praziquantel (ANTHELMINTICS)

prazosin (VASODILATOR ANTIHYPERTENSIVES)

prazosin hcl (VASODILATOR ANTIHYPERTENSIVES)

PRECARE (PRENATAL VITAMINS)

PRECARE CONCEIVE (PRENATAL VITAMINS)

PRECARE PREMIER (PRENATAL VITAMINS)

PRECISION (DIABETIC SUPPLIES)

PRECISION PCX (DIABETIC SUPPLIES)

PRECISION PCX PLUS (DIABETIC SUPPLIES)

PRECISION Q-I-D (DIABETIC SUPPLIES)

PRECISION SOF-TACT (DIABETIC SUPPLIES)

PRECISION XTRA (DIAGNOSTIC PRODUCTS)

PRECISION XTRA (DIABETIC SUPPLIES)

PRECOSE (ORAL HYPOGLYCEMICS & COMBOS)

PRED FORTE (OPHTHALMIC CORTICOSTEROID DRUGS)

PRED MILD (OPHTHALMIC CORTICOSTEROID DRUGS)

PRED-G (OPHTHALMIC ANTIINFECTIVE/CORTICOSTEROIDS)

PREDNICARBATE (TOPICAL CORTICOSTEROID DRUGS)

prednisolone (GLUCOCORTICOID DRUGS)

prednisolone acetate (OPHTHALMIC CORTICOSTEROID DRUGS)

prednisolone sod phosphate (GLUCOCORTICOID DRUGS)

prednisolone sod phosphate (OPHTHALMIC CORTICOSTEROID DRUGS)

prednisolone sodium phosphate (GLUCOCORTICOID DRUGS)

prednisolone sodium phosphate (OPHTHALMIC CORTICOSTEROID DRUGS)

prednisone (GLUCOCORTICOID DRUGS)

prednisone intensol (GLUCOCORTICOID DRUGS)

PREFERA-OB (PRENATAL VITAMINS)

PREFERA-OB PLUS DHA (PRENATAL VITAMINS)

PREFEST (ESTROGEN/PROGESTIN COMBINATIONS)

pregabalin (OTHER ANTICONVULSANTS)

PREGNYL (SPECIALIZED OB/GYN DRUGS)

PREHIST (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

prehist d (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

PRELONE (GLUCOCORTICOID DRUGS)

PREMARIN (ESTROGEN DRUGS)

PREMASOL (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

PREMESIS RX (PRENATAL VITAMINS)

PREMPHASE (ESTROGEN/PROGESTIN COMBINATIONS)

PREMPRO (ESTROGEN/PROGESTIN COMBINATIONS)

prenacare (PRENATAL VITAMINS)

PRENAFIRST (PRENATAL VITAMINS)

prenaplus (PRENATAL VITAMINS)

prenatabs fa (PRENATAL VITAMINS)

prenatabs rx (PRENATAL VITAMINS)

PRENATAL 19 (PRENATAL VITAMINS)

PRENATAL AD (PRENATAL VITAMINS)

prenatal low iron (PRENATAL VITAMINS)

prenatal multivitamin w-iron (PRENATAL VITAMINS)

prenatal plus (PRENATAL VITAMINS)

prenatal vit( = or > 1mg fa) (PRENATAL VITAMINS)

prenatal vitamins (< 1mg fa) (PRENATAL VITAMINS)

PRENATAL-U (PRENATAL VITAMINS)

PRENATE DHA (PRENATAL VITAMINS)

PRENATE ELITE (PRENATAL VITAMINS)

PRENEXA (PRENATAL VITAMINS)

PREPIDIL (SPECIALIZED OB/GYN DRUGS)

PRESTIGE (DIABETIC SUPPLIES)

PRESTIGE METER (DIABETIC SUPPLIES)

PRESTIGE SMART SYSTEM (DIABETIC SUPPLIES)

PRESTIGE SMART SYSTEM IQ (DIABETIC SUPPLIES)

PRESTIGE TEST STRIPS (DIABETIC SUPPLIES)

PREVACID (PROTON PUMP INHIBITORS)

prevalite (HYPOLIPOPROTEINEMICS)

PREVIDENT (FLUORIDE PRODUCTS)

PREVIDENT 5000 (FLUORIDE PRODUCTS)

PREVIDENT 5000 PLUS (FLUORIDE PRODUCTS)

PREVIDENT 5000 SENSITIVE (FLUORIDE PRODUCTS)

previfem (CONTRACEPTIVES)

PREVIT+DHA (PRENATAL VITAMINS)

previte rx (PRENATAL VITAMINS)

PREVPAC (HELICOBACTER PYLORI DRUGS)

PREZISTA (ANTIRETROVIRALS & PROTEASE INH)

PRIFTIN (ANTITUBERCULOSIS DRUGS)

PRILOSEC (Requires trial of H2 and OTC Omeprazole) (PROTON PUMP INHIBITORS)

PRIMALEV (CLASS II NARCOTICS)

PRIMAQUINE (PLASMODICIDES)

primaquine (PLASMODICIDES)

PRIMAXIN (OTHER ANTIINFECTIVE DRUGS)

PRIMAXIN I.M. (OTHER ANTIINFECTIVE DRUGS)

primidone (ANTICONVULSANT BARBITURATES)

PRIMSOL (URINARY ANTIINFECTIVES)

PRINIVIL (ANGIOTENSIN CONVERTING ENZYME INHIBITORS)

PRINZIDE (OTHER ANTIHYPERTENSIVES)

PRISTIQ (QLL=34) (OTHER ANTIDEPRESSANTS)

PRIVIGEN (IMMUNOLOGICALS AND VACCINES)

PRO-CLEAR AC (ANTITUSSIVE AND EXPECTORANT DRUGS)

PRO-FAST HS (APPETITE SUPPRESSANTS)

PRO-FAST SA (APPETITE SUPPRESSANTS)

PRO-FAST SR (APPETITE SUPPRESSANTS)

PRO-HYO (ANTISPASMODICS/DRUGS AFFECT GI MOTILITY)

PRO-RED AC (ANTITUSSIVE AND EXPECTORANT DRUGS)

PROAIR HFA (BETA-2 ADRENERGIC DRUGS)

PROAMATINE (OTHER CARDIOVASCULAR DRUGS)

PROBARIMIN QT (NUTRITIONAL/SUPPLEMENT PRODUCTS)

probenecid (DRUGS TO PREVENT AND TREAT GOUT)

probenecid-colchicine (DRUGS TO PREVENT AND TREAT GOUT)

procainamide (CLASS 1A)

procainamide hcl (CLASS 1A)

procaine (LOCAL ANESTHETICS)

PROCALAMINE (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

procarbazine (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

PROCARDIA (CALCIUM ANTAGONISTS)

PROCARDIA XL (CALCIUM ANTAGONISTS)

PROCENTRA (CNS STIMULANT DRUGS)

PROCHIEVE (PROGESTIN DRUGS)

prochlorperazine edisylate (ANTIVERTIGO AND ANTIEMETIC DRUGS)

prochlorperazine maleate (ANTIVERTIGO AND ANTIEMETIC DRUGS)

PROCRIT (ERYTHROID STIMULANTS)

PROCRIT (PAR) (ERYTHROID STIMULANTS)

procto-kit (OTHER GI DRUGS)

procto-pak (OTHER GI DRUGS)

PROCTOCORT (OTHER GI DRUGS)

PROCTOCREAM-HC (OTHER GI DRUGS)

PROCTOFOAM-HC (OTHER GI DRUGS)

proctosol-hc (OTHER GI DRUGS)

proctozone-hc (OTHER GI DRUGS)

PRODIGY (DIABETIC SUPPLIES)

PRODIGY AUTOCODE (DIABETIC SUPPLIES)

PRODIGY VOICE (DIABETIC SUPPLIES)

PRODRIN (DRUGS TO PREVENT AND TREAT HEADACHES)

PROFASI (SPECIALIZED OB/GYN DRUGS)

PROFERRIN-FORTE (VITAMINS & MINERALS & RELATED PRODUCTS)

PROFILNINE SD (HEMOSTATICS)

progesterone (PROGESTIN DRUGS)

PROGESTERONE (injectable only) (PROGESTIN DRUGS)

progesterone in oil (PROGESTIN DRUGS)

PROGLYCEM (GLUCOSE ELEVATING DRUGS)

PROGRAF (PAR) (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

PROLEUKIN (INTERLEUKINS)

PROLEX DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

promacet (DRUGS TO PREVENT AND TREAT HEADACHES)

PROMACTA (THROMBOPOIETIC AGENTS)

PROMAR (VITAMINS & MINERALS & RELATED PRODUCTS)

promethazine (ANTIVERTIGO AND ANTIEMETIC DRUGS)

promethazine (ANTIHISTAMINES)

promethazine hcl (ANTIVERTIGO AND ANTIEMETIC DRUGS)

promethazine hcl (ANTIHISTAMINES)

promethazine vc (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

promethazine vc-codeine (ANTITUSSIVE AND EXPECTORANT DRUGS)

promethazine-codeine (ANTITUSSIVE AND EXPECTORANT DRUGS)

promethazine-dm (ANTITUSSIVE AND EXPECTORANT DRUGS)

promethegan (ANTIVERTIGO AND ANTIEMETIC DRUGS)

PROMETRIUM (PROGESTIN DRUGS)

PROMISEB (TOPICAL DERMATOLOGICAL DRUGS)

PRONEB ULTRA (MEDICAL (MISCELLANEOUS) SUPPLIES)

PRONEB ULTRA II (MEDICAL (MISCELLANEOUS) SUPPLIES)

PRONESTYL (CLASS 1A)

propafenone (CLASS 1C)

propafenone hcl (CLASS 1C)

propantheline (ANTISPASMODICS/DRUGS AFFECT GI MOTILITY)

propantheline bromide (ANTISPASMODICS/DRUGS AFFECT GI MOTILITY)

PROPARACAINE HCL (OTHER OPHTHALMIC DRUGS)

proparacaine/fluorescein (OTHER OPHTHALMIC DRUGS)

PROPECIA (ORAL DERMATOLOGICAL DRUGS)

PROPINE (ANTIGLAUCOMA DRUGS)

propofol (LOCAL ANESTHETICS)

propoxyphene hcl (CLASS IV NARCOTICS)

propoxyphene hcl-apap (CLASS IV NARCOTICS)

propoxyphene hcl/acetaminophen (CLASS IV NARCOTICS)

propoxyphene napsylate-apap (CLASS IV NARCOTICS)

PROPOXYPHENE NAPSYLATE-APAP (CLASS IV NARCOTICS)

propoxyphene napsylate/apap (CLASS IV NARCOTICS)

propranolol (BETA-ADRENERGIC ANTAGONIST DRUGS)

propranolol hcl (BETA-ADRENERGIC ANTAGONIST DRUGS)

propranolol hcl-hctz (OTHER ANTIHYPERTENSIVES)

propylthiouracil (ANTITHYROID DRUGS)

PROQUIN XR (QUINOLONES)

PROSCAR (OTHER GENITOURINARY PRODUCTS)

PROSCAR (PAR) (OTHER GENITOURINARY PRODUCTS)

PROSED-DS (OTHER GENITOURINARY PRODUCTS)

PROSTIGMIN (OTHER CNS/AUTONOMIC DRUGS)

PROSTIN E2 VAGINAL SUPPOSITORY (ABORTIFACIENTS)

PROSTIN VR PEDIATRIC (OTHER CARDIOVASCULAR DRUGS)

PROTECT PLUS (VITAMINS & MINERALS & RELATED PRODUCTS)

PROTECT PLUS NR (VITAMINS & MINERALS & RELATED PRODUCTS)

PROTONIX (Requires trial of H2 and OTC omeprazole) (PROTON PUMP INHIBITORS)

PROTONIX Inj & Susp (PROTON PUMP INHIBITORS)

PROTOPIC (Covered if prescribed by dermatologist) (TOPICAL DERMATOLOGICAL DRUGS)

protriptyline (SECONDARY AMINES)

protriptyline hcl (SECONDARY AMINES)

PROVENT (MEDICAL (MISCELLANEOUS) SUPPLIES)

PROVENTIL HFA (BETA-2 ADRENERGIC DRUGS)

PROVERA (PROGESTIN DRUGS)

PROVIGIL (PAR) (CNS STIMULANT DRUGS)

PROVISC (OTHER OPHTHALMIC DRUGS)

PROVOCHOLINE (DIAGNOSTIC PRODUCTS)

PROZAC (SELECTIVE SEROTONIN REUPTAKE INHIBITORS)

PROZAC WEEKLY (Requires trial of generic fluoxetine) (SELECTIVE SEROTONIN REUPTAKE INHIBITORS)

PRUDOXIN (TOPICAL DERMATOLOGICAL DRUGS)

PRUET DHA (PRENATAL VITAMINS)

PRUET DHA EC (PRENATAL VITAMINS)

PRUMYX (TOPICAL DERMATOLOGICAL DRUGS)

PRUVATE 21-7 (VITAMINS & MINERALS & RELATED PRODUCTS)

pse bpm (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

PSE BROM (ANTITUSSIVE AND EXPECTORANT DRUGS)

pse/bpm (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

pse/cpm (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

PSEUDO COUGH (ANTITUSSIVE AND EXPECTORANT DRUGS)

PSEUDO DM GG (ANTITUSSIVE AND EXPECTORANT DRUGS)

PSEUDOEPHEDRINE GG (ANTITUSSIVE AND EXPECTORANT DRUGS)

pseudoephedrine hcl (DECONGESTANTS)

PSEUDOEPHEDRINE-CHLORPHENIRAMI (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

PUDENDAL & PARASYMPATHETIC (MEDICAL (MISCELLANEOUS) SUPPLIES)

PULMARI-GP (ANTITUSSIVE AND EXPECTORANT DRUGS)

PULMICORT (PAR age < 4) (OTHER DRUGS FOR ASTHMA)

PULMICORT FLEXHALER (OTHER DRUGS FOR ASTHMA)

PULMO-AIDE (MEDICAL (MISCELLANEOUS) SUPPLIES)

PULMOZYME (PAR) (OTHER RESPIRATORY DRUGS)

PURINETHOL (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

PYLERA (HELICOBACTER PYLORI DRUGS)

pyrazinamide (ANTITUBERCULOSIS DRUGS)

PYRELLE HB (OTHER GENITOURINARY PRODUCTS)

PYRIDIUM (URINARY ANESTHETICS)

pyridostigmine (OTHER CNS/AUTONOMIC DRUGS)

pyridostigmine bromide (OTHER CNS/AUTONOMIC DRUGS)

pyridoxine (INJECTABLE VITAMINS)

pyridoxine hcl (INJECTABLE VITAMINS)

pyrimethamine (PLASMODICIDES)

pyrimethamine/sulfadoxine (PLASMODICIDES)

Formulary Date: 10/21/2009 Update Date: 10/26/2009 V1.3.0