The NMHC Preferred Drug List

NOTE:
This Preferred Drug List (PDL) addresses only the most commonly used categories of drugs. If you are taking a drug that is not listed on this PDL, please contact NMHC Rx to determine its classification status. This is a current sample listing that is subject to change during the year.
This list is not all-inclusive and is not a guarantee of coverage. Certain drugs (*) may be subject to Quantity Limits (QL) or Prior Authorization (PA) requirements according to Benefit Design. Use of generic drugs can save you and your health plan money. Branded products with an available generic equivalent may be subject to the highest co-payment according to Benefit Design.

Tier 1 (Generic Drug)	Tier 2 (Preferred Brand)	Tier 3 (Non-preferred Brand)
Anti-infectives
Antibiotics - Cephalosporins
cefaclor	Cedax	Ceclor
cefadroxil	Spectracef	Ceftin
cefdinir	Suprax Susp	Cefzil
cefprozil		Duricef
cefuroxime		Keflex
cephadrine		Omnicef
cephalexin		Velosef
Antibiotics - Fluoroquinolones
ciprofloxacin/xr	Avelox	Cipro
ofloxacin	Levaquin	Cipro XR
		Floxin
		Maxaquin
		Noroxin
		Penetrex
Antibiotics - Macrolides
azithromycin	Zithromax (no generics)	Biaxin
clarithromycin	Zmax	Biaxin XL
clarithromycin er		E.E.S.
erythromycin		Zithromax (with generics)
		Zithromycin (with generics), Z-Pak
Antibiotics - Other
minocycline		Adoxa
		Dynacin Tabs
		Ketek
		Zyvox
Antibiotics - Penicillins
amoxicillin	Augmentin XR	Amoxil
amoxicillin/clavulanic acid		Augmentin ( with generics)
ampicillin		Pen-Vee K
penicillin		V-Cillin-K
Antifungals (PA)
fluconazole	Gris-Peg	Diflucan
griseofulvin		Lamisil(QL)
itraconazole		Penlac (QL)
ketaconazole		Spectazole
nystatin		Sporanox
terbinafine (QL)
Antivirals - Flu
amantadine	Tamiflu (QL)	Relenza (QL)
rimantadine
Antivirals - Herpes
acyclovir	Valtrex	Famvir
		Zovirax
Antivirals - Other - Interferons / Interferon comb
ribavirin	Infergen	Copegus
	Pegasys	Rebetol
	Peg-Intron

Tier 1 (Generic Drug)	Tier 2 (Preferred Brand)	Tier 3 (Non-preferred Brand)
Cardiovascular
ACE Inhibitors and ACE Inhibitor Combinations
benazepril/hctz		Accupril
captopril		Accuretic
captopril hctz		Aceon
enalapril/hctz		Altace
fosinopril/hctz		Capoten
lisinopril		Capozide
lisinopril hctz		Lotensin/HCT
moexipril/hctz		Mavik
quinapril		Monopril
quinapril hctz		Prinivil
trandolapril		Prinzide
		Uniretic
		Univasc
		Vasotec
		Zestoretic
		Zestril
Alpha/Beta Blockers
acebutolol		Coreg
atenolol		Coreg CR
bisoprolol		Inderal
carvedilol		Inderal LA
labetalol		Inderide
metoprolol/hctz/er		Inderide LA
propranolol/hctz/er		Innopran XL
		Lopressor
		Lopressor HCT
		Tenoretic
		Tenormin
		Toprol XL
Angiotensin II Rec Antagonist (ARB) & ARB Combinations
	Atacand	Avalide
	Atacand HCT	Avapro
	Benicar	Cozaar
	Benicar HCT	Hyzaar
	Diovan	Micardis
	Diovan HCT	Micardis HCT
		Teveten
		Teveten HCT
Antiarrhythmics
amiodarone, disopyramide, flecainide, procainamide, propafenone, quinidine, sotalol/af	Rythmol SR
Antihyperlipidemic - HMG (Statins)
lovastatin	Crestor	Altoprev
pravastatin	Lipitor	Lescol
simvastatin		Lescol XL
		Mevacor
		Pravachol
		Zocor
Antihyperlipidemic Agents - Other
cholestyramine resin	Advicor	Colestid
colestipol	Antara	Lofibra
fenofibrate	Niaspan	Lopid
gemfibrozil	Simcor	Questran, Questran Light
	Tricor
	Triglide
	Vytorin
	Welchol
	Zetia
Antihypertensive Combinations
amlodipine-benazepril	Lotrel (no generics)	Azor
		Exforge
		Lexxel
		Lotrel (with generics)
		Tarka
		Teczem CR
Antihypertensive Others
spironolactone/hctz		Aldactone, Aldactazide
		Inspra
		Tekturna
Antihypertensive/Antihyperlipidemic Combination
	Caduet
Antiplatelet Agents
anagrelide	Aggrenox	Agrylin
cilostazol	Plavix	Persantine
dipyridamole		Pletal
Calcium Channel Blockers
amlodipine		Cardene SR
diltiazem		Cardizem, SR, CD, LA
felodipine, nicardipine		Covera HS
verapamil		DynaCirc/CR
		Norvasc
		Plendil
		Sular
		Tiazac
		Verelan/PM

Tier 1 (Generic Drug)	Tier 2 (Preferred Brand)	Tier 3 (Non-preferred Brand)
Central Nervous System
ADHD Medications (QL) (ST)
dextroamphetamine	Adderall XR	Dexedrine
methylphenidate	Concerta	Dextrostat
	Strattera	Focalin/XR
		Metadate CD,ER
		Ritalin LA, Tab,SR
Alzheimers
	Aricept
	Exelon
	Namenda
Analgesics - Cox 2 Inhibitors (PA) (QL)
	Celebrex
Analgesics - Narcotic (PA) (QL)
codeine-apap	Actiq	Darvocet N-100
fentanyl patch	Avinza	Darvon
hydrocodone combinations	OxyContin	Demerol
meperidine		Duragesic
morphine sulfate		Fentora
oxycodone combinations		Fioricet
propoxyphene		Fiorinal
propoxyphene-n		Kadian
		Opana/ER
		Percocet
		Percodan
		Tylenol w Codeine
Analgesics - NSAIDs
diclofenac		Anaprox
etodolac		Anaprox DS
ibuprofen		Clinoril
indomethacin		Indocin
meloxicam		Lodine
naproxen/sodium		Mobic
sulindac		Motrin
		Naprosyn
		Prevacid Nap Kit
		Voltaren
Antianxiety
alprazolam/er		Ativan
diazepam		Valium
lorazepam		Xanax
		Xanax XR
Anticonvulsants
carbamazepine	Depakote ER	Depakene
gabapentin	Dilantin	Depakote
lamotrigine	Gabitril	Lamictal
oxcarbazepine	Keppra	Neurontin
phenytoin	Lyrica	Tegretol
valproic acid	Phenytek	Trileptal
zonisamide		Zonegran
Antidepressants - Other
amitriptyline	Tofranil PM	Aventyl
bupropion er	Wellbutrin XL 150mg	Norpramin
bupropion immediate release		Remeron
bupropion sr		Tofranil Tablets
bupropion xl 300mg		Wellbutrin Immediate Release
desipramine		Wellbutrin SR
imipramine		Wellbutrin XL 300mg
mirtazapine
nortriptyline
Antidepressants - SSNRI
venlafaxine immediate release	Effexor XR	Cymbalta
		Effexor Immediate Release
Antidepressants - SSRI
citalopram		Celexa
fluoxetine		Lexapro
paroxetine/cr		Paxil
sertraline		Paxil CR
		Pexeva
		Prozac
		Zoloft
Antiparkinson
amantadine	Comtan	Requip
benztropine	Mirapex	Sinemet
bromocriptine		Sinemet CR
carbidopa/levadopa		Stalevo
pergolide
ropininole
selegiline
trihexyphenidyl
Antipsychotic Agents
clozapine	Abilify	Clozaril
risperidone tablets	Geodon	Invega
	Risperdal-M	Risperdal Tablets
	Seroquel
	Seroquel XR
	Symbyax
	Zyprexa
	Zyprexa Zydis
Migraine Products (QL)
	Amerge	Maxalt
	Axert	Maxalt MLT
	Imitrex
	Relpax
	Zomig
	Zomig ZMT
Multiple Sclerosis Drugs
	Copaxone	Avonex
	Rebif	Betaseron
Sedative Hypnotics (QL)
flurazepam	Restoril 7.5mg/22.5mg	Ambien
temazepam	Rozerem	Ambien CR
triazolam		Dalmane
zolpedim immediate release		Halcion
		Lunesta
		Restoril 15/30mg
		Sonata
Skeletal Muscle Relaxants
carisoprodol	Skelaxin	Flexeril
cyclobenzaprine		Soma
tizanidine		Zanaflex

Tier 1 (Generic Drug)	Tier 2 (Preferred Brand)	Tier 3 (Non-preferred Brand)
Endocrine
Corticosteroids - Systemic
dexamethasone, methylprednisolone, prednisone, prednisolone		Orapred Solution
Diabetes - Combinations
glipizide/metformin	Actoplus Met	Glucovance
glyburide/metformin	Avandamet	Metaglip
	Avandaryl
	Duetact
Diabetes - Insulin
	Apidra
	Humalog
	Humulin
	Lantus
	Levemir
	Novolin
	NovoLog
Diabetes - Insulin Secreting Agents
chlorpropamide	Prandin	Amaryl
glimepiride	Starlix	Diabeta
glipzide		Diabinese
glipzide ER		Glucotrol
glyburide		Glucotrol XL
glyburide		Micronase
tolazamide		Tolinase
Diabetes - Insulin Sensitizing Agents
metformin	Actos	Fortamet
metformin ER	Avandia	Glucophage Immediate Release
		Glucophage XR
		Glumetza
		Riomet
Diabetes - Other Medications (CT) (ST)
acarbose	Byetta	Janumet
	Symlin	Januvia
		Precose
Diabetic Supplies (QL)
	Accu-Chek - Active, Advantage, Aviva, Compact, Complete	Encore Meters, Exatech Meters
	BD-Pen Needles, BD-Syringes	Glucometer Meters
	Lifescan: One Touch II, Basic, InDuo, FastTake, SureStep, Ultra, UltraSmart
Thyroid Agents
levothyroxine	Synthroid
Levoxyl

Tier 1 (Generic Drug)	Tier 2 (Preferred Brand)	Tier 3 (Non-preferred Brand)
Gastrointestinal/Urinary
Antispasmodic
generics		Donnatal
		Levsin
		Librax
		Pamine
		Robinul
Digestive Aids
pancrelipase	Creon
	Ultrase
	Viokase
Gallstone Solubilizing Agents
ursodiol	Urso
Genitourinary Medications
oxybutynin/XL	Detrol	Ditropan XL
	Detrol LA	Vesicare
	Enablex
	Oxytrol Patch
	Sanctura/XR
H-2 Antagonists
cimetidine		Axid
famotidine		Pepcid
nizatidine		Tagamet
ranitidine		Zantac
Inflammatory Bowel (ST)
balsalazide	Asacol	Colazal
mesalamine enema	Canasa	Lialda
sulfasalazine	Entocort EC	Rowasa
Proton Pump Inhibitors (PA) (QL)
omeprazole	Nexium	Aciphex
pantoprazole		Prevacid
		Prevacid SoluTabs
		Prilosec Rx
		Protonix
		Zegerid

Tier 1 (Generic Drug)	Tier 2 (Preferred Brand)	Tier 3 (Non-preferred Brand)
Men’s Health
Erectile Dysfunction (QL)
	Cialis
	Levitra
Erectile Dysfunction (QL) (PA)
	Muse
	Viagra
Hormone Replacement
	Androgel
	Testim
Prostate Health
doxazosin	Avodart	Proscar
finasteride	Flomax	Uroxatral
terazosin

Tier 1 (Generic Drug)	Tier 2 (Preferred Brand)	Tier 3 (Non-preferred Brand)
Miscellaneous
Anaphylaxis
	Epipen
	Twinject
Antiemetics (QL) (PA)
granisetron (QL)	Emend(QL)	Anzemet(QL)
ondansetron		Cesamet (1QL)
		Kytril (QL)
		Zofran(QL)
Antipsoriatics
	Tazorac	Amevive
Bowel Preparation
	Halflytely
Fertility
ganirelix	Antagon	Gonal-F
	Bravelle
	Cetrotide
	Crinone
	Follistim AQ
	Luveris
	Menopur
	Ovidrel
	Repronex
Growth Hormone (PA)
	Genotropin	Humatrope
	Norditropin	Nutropin/AQ
	Norditropin AQ	Omnitrope
	Norditropin Nordiflex	Saizen
		Serostim
		Tev-Tropin
Hematopoetic Growth Factors
	Epogen	Aranesp
	Procrit
Immunosuppressive Agents
azathioprine	CellCept	Myfortic
cyclosporine
PTH Ca Phos Regulator
	Sensipar
Rheumatoid Arthritis
methotrexate	Trexall	Remicade
Saliva Stimulants
	Evoxac

Tier 1 (Generic Drug)	Tier 2 (Preferred Brand)	Tier 3 (Non-preferred Brand)
Respiratory
Antihistamines (Low Sedating) (ST)
Antihistamines (Non - Sedating) (ST)
Alavert OTC, loratadine OTC Coverage/Co-payment Plan Dependent		Allegra (Coverage/Co-payment Plan Dependent)
fexofenadine	Clarinex, Clarinex Syrup (Coverage/Co-payment Plan Dependent)	Allegra-D (Coverage/Co-payment Plan Dependent)
		Clarinex/Clarinex Syrup (Coverage/Co-payment Plan Dependent)
Asthma - Beta Agonists - Long Acting
	Foradil
	Serevent Diskus
Asthma - Beta Agonists - Short Acting
albuterol	ProAir HFA	Alupent
metaproterenol	Proventil HFA	Maxair
		Ventolin HFA
		Xopenex
Asthma - COPD Other
generics, theophylline	Advair/HFA	Atrovent Solution
ipratropium	Atrovent/HFA Inhaler	Brovana
prednisolone	Combivent	DuoNeb
theophylline	Spiriva	Perforomist
theophylline	Symbicort	Prelone
	Tilade	Uniphyl
	T-Phyl	Xolair(PA)
Asthma - Leukotriene Modulators (ST)
	Accolate	Zyflo/CR
	Singulair
Asthma - Steroid Inhalants
	Asmanex	AeroBid
	Flovent/HFA	AeroBid-M
	Pulmicort	Azmacort
	QVAR	Beclovent
		Vanceril
Cough and Cold
generics
Nasal Products (QL)
flunisolide	Astelin	Beconase
fluticasone	Nasonex	Beconase AQ
	Rhinocort AQ	Flonase
		Nasacort AQ
		Nasalide
		Nasarel
		Vancenase
		Vancenase AQ
		Veramyst