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

R-TANNA (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

RABAVERT (IMMUNOLOGICALS AND VACCINES)

rabies immune globulin (IMMUNOLOGICALS AND VACCINES)

rabies vac,pf chick-emb cell (IMMUNOLOGICALS AND VACCINES)

rabies vaccine,human diploid (IMMUNOLOGICALS AND VACCINES)

RADIAGEL (TOPICAL DERMATOLOGICAL DRUGS)

RADIAPLEXRX (TOPICAL DERMATOLOGICAL DRUGS)

RADIGEL (TOPICAL DERMATOLOGICAL DRUGS)

raloxifene (SELECTIVE ESTROGEN RECEPTOR MODULATOR)

ramipril (ANGIOTENSIN CONVERTING ENZYME INHIBITORS)

RANEXA (OTHER CARDIOVASCULAR DRUGS)

ranitidine (ANTIULCER DRUGS)

ranitidine hcl (ANTIULCER DRUGS)

RANITIDINE HCL (ANTIULCER DRUGS)

RANITIDINE HCL (150MG - Not Covered) (ANTIULCER DRUGS)

RAPAFLO (OTHER GENITOURINARY PRODUCTS)

RAPAMUNE (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

RAZADYNE (ANTIDEMENTIA DRUGS)

RAZADYNE ER (ANTIDEMENTIA DRUGS)

RE-DRYLEX (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

RE-NATA 29 (PRENATAL VITAMINS)

re-nata 29 ob (PRENATAL VITAMINS)

re-pb hyos (ANTISPASMODICS/DRUGS AFFECT GI MOTILITY)

RE-U40 (TOPICAL DERMATOLOGICAL DRUGS)

RE2+30 (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

READI-CAT (DIAGNOSTIC PRODUCTS)

READI-CAT 2 (DIAGNOSTIC PRODUCTS)

REBETOL (OTHER ANTIVIRAL DRUGS)

REBIF (INTERFERONS)

RECAL D (VITAMINS & MINERALS & RELATED PRODUCTS)

RECLAST (OTHER ENDOCRINE DRUGS)

reclipsen (CONTRACEPTIVES)

RECOMBINATE (HEMOSTATICS)

RECOMBIVAX HB (IMMUNOLOGICALS AND VACCINES)

RECOTHROM (HEMOSTATICS)

RECTAGEL HC (OTHER GI DRUGS)

REFACTO (HEMOSTATICS)

REFISSA (TOPICAL DERMATOLOGICAL DRUGS)

REGENECARE (TOPICAL ANESTHETICS)

REGLAN (ANTISPASMODICS/DRUGS AFFECT GI MOTILITY)

REGONOL (OTHER CNS/AUTONOMIC DRUGS)

REGRANEX (TOPICAL DERMATOLOGICAL DRUGS)

RELAGARD (OB/GYN TOPICAL ANTIINFECTIVES)

RELAGESIC (ANALGESICS)

RELAMINE (NUTRITIONAL/SUPPLEMENT PRODUCTS)

RELCOF CPM (ANTIHISTAMINES)

RELCOF DN PE (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

RELCOF DN PSE (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

relcof pe (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

RELCOF PSE (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

RELENZA (OTHER ANTIVIRAL DRUGS)

RELIEFBAND (MEDICAL (MISCELLANEOUS) SUPPLIES)

RELPAX (DRUGS TO PREVENT AND TREAT HEADACHES)

REME HIST DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

REME TUSSIN DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

REMERON (OTHER ANTIDEPRESSANTS)

REMEVEN (TOPICAL DERMATOLOGICAL DRUGS)

REMICADE (PAR) (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

RENA-VITE RX (VITAMINS & MINERALS & RELATED PRODUCTS)

RENACIDIN (OTHER GENITOURINARY PRODUCTS)

renaf (FLUORIDE PRODUCTS)

RENAGEL (BLOOD DETOXICANTS)

RENAL CAPS (VITAMINS & MINERALS & RELATED PRODUCTS)

RENATABS (VITAMINS & MINERALS & RELATED PRODUCTS)

RENATABS WITH IRON (VITAMINS & MINERALS & RELATED PRODUCTS)

RENATE (PRENATAL VITAMINS)

RENATE DHA (PRENATAL VITAMINS)

RENATE DHA EXTRA (PRENATAL VITAMINS)

RENAX (VITAMINS & MINERALS & RELATED PRODUCTS)

RENO CAPS (VITAMINS & MINERALS & RELATED PRODUCTS)

RENOVA (TOPICAL DERMATOLOGICAL DRUGS)

RENOVA PUMP (TOPICAL DERMATOLOGICAL DRUGS)

RENVELA (BLOOD DETOXICANTS)

REOCYTE PLUS (VITAMINS & MINERALS & RELATED PRODUCTS)

repaglinide (ORAL HYPOGLYCEMICS & COMBOS)

repan (DRUGS TO PREVENT AND TREAT HEADACHES)

REPREXAIN (CLASS III NARCOTICS)

REPRONEX (OVULATORY STIMULANTS)

REQ49+ (VITAMINS & MINERALS & RELATED PRODUCTS)

REQUIP (OTHER ANTIPARKINSON DRUGS)

REQUIP XL (OTHER ANTIPARKINSON DRUGS)

RESCON (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

RESCON-JR (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

RESCON-MX (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

RESCRIPTOR (ANTIRETROVIRALS & PROTEASE INH)

RESECTISOL (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

RESERPINE (ALPHA-ADRENERGIC ANTAGONISTS)

RESPA A.R. (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

RESPA C&C (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

RESPA-BR (ANTIHISTAMINES)

respahist (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

RESPAHIST-II (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

RESPAIRE-30 (ANTITUSSIVE AND EXPECTORANT DRUGS)

RESPERAL (ANTITUSSIVE AND EXPECTORANT DRUGS)

RESPERAL-DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

RESPI-TANN (ANTITUSSIVE AND EXPECTORANT DRUGS)

RESPI-TANN PD (ANTITUSSIVE AND EXPECTORANT DRUGS)

RESPIVENT DF (ANTIHISTAMINES)

RESPIVENT DF 30 (ANTIHISTAMINES)

RESPIVENT-D (DECONGESTANTS)

RESTASIS (OTHER OPHTHALMIC DRUGS)

RESTORIL (SEDATIVE/HYPNOTIC DRUGS)

RETIN-A (PAR age > 29) (ANTIACNE DRUGS)

RETIN-A MICRO (PAR age > 29) (ANTIACNE DRUGS)

RETIN-A MICRO PUMP (ANTIACNE DRUGS)

RETISERT (OPHTHALMIC CORTICOSTEROID DRUGS)

RETROVIR (ANTIRETROVIRALS & PROTEASE INH)

REVATIO (PAR) (OTHER VASODILATING DRUGS)

revatio (sildenafil citrate) (OTHER VASODILATING DRUGS)

REVIA (prescribing limited to psychiatrists) (OTHER CNS/AUTONOMIC DRUGS)

REVINA (TOPICAL DERMATOLOGICAL DRUGS)

REVLIMID (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

REYATAZ (ANTIRETROVIRALS & PROTEASE INH)

REZYST IM (ANTIDIARRHEAL DRUGS)

RHEUMATREX (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

RHINACON A (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

RHINOCORT AQUA (QL = 3/rx) (DRUGS AFFECTING THE NOSE)

RHINOFLEX (ANALGESICS)

RHINOFLEX-650 (ANALGESICS)

rho(d) immune globulin (IMMUNOLOGICALS AND VACCINES)

RHOGAM (IMMUNOLOGICALS AND VACCINES)

RHOGAM PLUS (IMMUNOLOGICALS AND VACCINES)

RHOPHYLAC (IMMUNOLOGICALS AND VACCINES)

RIBAPAK (OTHER ANTIVIRAL DRUGS)

ribasphere (OTHER ANTIVIRAL DRUGS)

RIBASPHERE (OTHER ANTIVIRAL DRUGS)

ribavirin (OTHER ANTIVIRAL DRUGS)

RIBAVIRIN (OTHER ANTIVIRAL DRUGS)

RICOBID (ANTITUSSIVE AND EXPECTORANT DRUGS)

RICOBID-H (ANTIHISTAMINES)

RICOTUSS (ANTITUSSIVE AND EXPECTORANT DRUGS)

RIDAURA (OTHER DRUGS FOR ARTHRITIS)

rifabutin (ANTITUBERCULOSIS DRUGS)

RIFADIN (ANTITUBERCULOSIS DRUGS)

RIFAMATE (ANTITUBERCULOSIS DRUGS)

rifampin (ANTITUBERCULOSIS DRUGS)

rifampin/inh/pyrazinamide (ANTITUBERCULOSIS DRUGS)

rifampin/isoniazid (ANTITUBERCULOSIS DRUGS)

rifapentine (ANTITUBERCULOSIS DRUGS)

RIFATER (ANTITUBERCULOSIS DRUGS)

RILUTEK (OTHER MUSCULOSKELETAL DRUGS)

riluzole (OTHER MUSCULOSKELETAL DRUGS)

RIMANTADINE HCL (OTHER ANTIVIRAL DRUGS)

rimexolone (OPHTHALMIC CORTICOSTEROID DRUGS)

RIMSO-50 (OTHER GENITOURINARY PRODUCTS)

ringers injection (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

ringers irrigation (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

ringers solution (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

ringers solution,lactated (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

RINNOVI (TOPICAL DERMATOLOGICAL DRUGS)

RIOMET (ORAL HYPOGLYCEMICS & COMBOS)

risedron sod/calcium carbona (OTHER ENDOCRINE DRUGS)

RISPERDAL (ANTIPSYCHOTIC DRUGS)

RISPERDAL CONSTA (ANTIPSYCHOTIC DRUGS)

RISPERDAL M (ANTIPSYCHOTIC DRUGS)

risperidone (ANTIPSYCHOTIC DRUGS)

risperidone m-tab (ANTIPSYCHOTIC DRUGS)

RISPERIDONE M-TAB (ANTIPSYCHOTIC DRUGS)

risperidone odt (ANTIPSYCHOTIC DRUGS)

RISPERIDONE ODT (ANTIPSYCHOTIC DRUGS)

RITALIN (CNS STIMULANT DRUGS)

RITALIN LA (CNS STIMULANT DRUGS)

RITALIN-SR (CNS STIMULANT DRUGS)

RITEFLO (MEDICAL (MISCELLANEOUS) SUPPLIES)

ritonavir (ANTIRETROVIRALS & PROTEASE INH)

ritonavir/lopinavir (ANTIRETROVIRALS & PROTEASE INH)

RITUXAN (Restricted to rheumatology and oncology) (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

rituximab (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

rivastigmine tartrate (ANTIDEMENTIA DRUGS)

rizatriptan benzoate (DRUGS TO PREVENT AND TREAT HEADACHES)

robafen ac (ANTITUSSIVE AND EXPECTORANT DRUGS)

ROBAXIN (CNS MUSCLE RELAXANTS)

ROBAXIN-750 (CNS MUSCLE RELAXANTS)

ROBINUL (ANTISPASMODICS/DRUGS AFFECT GI MOTILITY)

ROBINUL FORTE (ANTISPASMODICS/DRUGS AFFECT GI MOTILITY)

ROCALTROL (THERAPEUTIC VITAMINS & MINERALS)

ROCEPHIN (CEPHALOSPORINS)

ROMAZICON (OTHER CNS/AUTONOMIC DRUGS)

ropinirole (OTHER ANTIPARKINSON DRUGS)

ropinirole hcl (OTHER ANTIPARKINSON DRUGS)

ROSAC (ANTIACNE DRUGS)

ROSADERM (ANTIACNE DRUGS)

ROSANIL (ANTIACNE DRUGS)

ROSULA (ANTIACNE DRUGS)

ROSULA CLK (ANTIACNE DRUGS)

ROSULA NS (ANTIACNE DRUGS)

rosuvastatin calcium (HMG-COA REDUCTASE INHIBITORS)

ROTARIX (IMMUNOLOGICALS AND VACCINES)

ROTATEQ (IMMUNOLOGICALS AND VACCINES)

ROWASA (OTHER GI DRUGS)

ROXANOL (CLASS II NARCOTICS)

ROXICET (CLASS II NARCOTICS)

ROXICODONE (CLASS II NARCOTICS)

ROXICODONE INTENSOL (CLASS II NARCOTICS)

ROZEREM (SEDATIVE/HYPNOTIC DRUGS)

RU-HIST FORTE (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

RU-TUSS (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

RU-TUSS DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

rubella vaccine (IMMUNOLOGICALS AND VACCINES)

rufinamide (OTHER ANTICONVULSANTS)

RY-T-12 (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

RYNA-12 (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

RYNA-12 S (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

RYNA-12X (ANTITUSSIVE AND EXPECTORANT DRUGS)

RYNATAN (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

RYNATAN PEDIATRIC (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

RYNATUSS (ANTITUSSIVE AND EXPECTORANT DRUGS)

RYNEZE (ANTIHISTAMINES)

RYTHMOL (CLASS 1C)

RYTHMOL SR (CLASS 1C)

RYZOLT (ANALGESICS)

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