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)

Tier 1 (Generic Drug)	Tier 2 (Preferred Brand)	Tier 3 (Non-preferred Brand)
Anti-infectives
Antibiotics - Cephalosporins
cefaclor	Ceftin 125mg	Ceclor
cefadroxil	Ceftin Oral Susp	Cedax
cefdinir		Cefzil
cefprozil		Duricef
cefuroxime		Keflex
cephadrine		Omnicef
cephalexin		Spectracef
		Suprax
		Velosef
Antibiotics - Fluoroquinolones
ciprofloxacin/xr	Cipro 100mg, Cipro Susp	Avelox
ofloxacin	Levaquin	Cipro
	Noroxin	Cipro XR
		Floxin
		Maxaquin
		Penetrex
Antibiotics - Macrolides
azithromycin		Biaxin
clarithromycin		Biaxin XL
clarithromycin er		E.E.S.
erythromycin		Zithromycin, Z-Pak
Antibiotics - Other
minocycline	Adoxa/Adoxa Pak1/150	Dynacin Tabs
	Zyvox	Ketek
Antibiotics - Penicillins
amoxicillin	Augmentin XR/Susp/Chewable (no generics)	Amoxil
amoxicillin/clavulanic acid		Augmentin ( with generics)
ampicillin		Pen-Vee K
penicillin		V-Cillin-K
Antifungals (PA)
fluconazole	Ancobon	Diflucan
griseofulvin	Lamisil Oral Granules	Gris-Peg
itraconazole	Sporanox Oral Solution	Lamisil Tabs(QL)
ketaconazole	Vfend	Penlac (QL)
nystatin		Spectazole
terbinafine (QL)		Sporanox
Antivirals - Flu
amantadine	Relenza (QL)
rimantadine	Tamiflu (QL)
Antivirals - Herpes
acyclovir	Valtrex	Famvir
famciclovir		Zovirax
Antivirals - Other - Interferons / Interferon comb
ribavirin	Pegasys	Copegus
	Peg-Intron	Infergen
		Rebetol
Miscellaneous
	Dapsone
	Furadantin
	Zyvox

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

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
	Daytrana	Focalin/XR
	Metadate CD	Metadate ER
	Provigil	Ritalin LA, Tab,SR
	Strattera
Alzheimers
galantamide cap er	Aricept, Aricept ODT	Razadyne Tab
galantamide tab	Exelon
	Namenda
	Razadyne ER
Analgesics - Cox 2 Inhibitors (PA) (QL)
	Celebrex
Analgesics - Narcotic (PA) (QL)
codeine-apap	Avinza	Actiq
fentanyl patch	MS-Contin	Darvocet N-100
hydrocodone combinations	OxyContin	Darvon
meperidine	OxyIR	Demerol
morphine sulfate		Duragesic
oxycodone combinations		Fentora
propoxyphene		Fioricet
propoxyphene-n		Fiorinal
		Kadian
		Opana/ER
		Percocet
		Percodan
		Tylenol w Codeine
Analgesics - NSAIDs
diclofenac		Anaprox
etodolac		Anaprox DS
ibuprofen		Arthrotec
indomethacin		Clinoril
meloxicam		Indocin
naproxen/sodium		Lodine
sulindac		Mobic
		Motrin
		Naprosyn
		Prevacid Nap Kit
		Voltaren
Antianxiety
alprazolam/er		Ativan
diazepam		Valium
lorazepam		Xanax
		Xanax XR
Anticonvulsants
carbamazepine	Depakote ER	Depakene
gabapentin	Diastat	Depakote
lamotrigine	Felbatol	Dilantin
oxcarbazepine	Gabitril	Keppra XR
phenytoin	Keppra Solution, 1000mg tab	Lamictal
valproic acid	Lyrica	Neurontin
zonisamide	Peganone	Tegretol
	Phenytek	Trileptal
	Tegretol XR	Zonegran
	Topamax
Antidepressants - Other
amitriptyline	Tofranil PM	Aventyl
bupropion er		Norpramin
bupropion immediate release		Remeron
bupropion sr		Tofranil Tablets
bupropion xl 300mg		Wellbutrin Immediate Release
desipramine		Wellbutrin SR
imipramine		Wellbutrin XL
mirtazapine
nortriptyline
Antidepressants - SSNRI
venlafaxine immediate release	Cymbalta	Effexor Immediate Release
	Effexor XR
	Pristiq
Antidepressants - SSRI
citalopram		Celexa
fluoxetine		Lexapro
paroxetine/cr		Paxil
sertraline		Paxil CR
		Pexeva
		Prozac
		Zoloft
Antiparkinson
amantadine	Apokyn	Requip
benztropine	Azilect	Sinemet
bromocriptine	Comtan	Sinemet CR
carbidopa/levadopa	Lodosyn	Stalevo
pergolide	Mirapex
ropininole	Requip XL
selegiline
trihexyphenidyl
Antipsychotic Agents
clozapine	Abilify	Invega
risperidone tablets	Clozaril	Risperdal Tablets
	Geodon	Symbyax
	Moban
	Orap
	Risperdal-M
	Serentil
	Seroquel
	Seroquel XR
	Zyprexa
	Zyprexa Zydis
Migraine Products (QL)
	Amerge	Axert
	Frova	Imitrex Tabs/Inj
	Imitrex Spray
	Maxalt
	Maxalt MLT
	Relpax
	Zomig
	Zomig ZMT
Multiple Sclerosis Drugs
	Avonex
	Betaseron
	Copaxone
	Rebif
Sedative Hypnotics (QL)
flurazepam	Ambien CR	Ambien
temazepam	Restoril 7.5mg/22.5mg	Dalmane
triazolam		Halcion
zolpedim immediate release		Lunesta
		Restoril 15/30mg
		Rozerem
		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	Novolin
	Humalog
	Humulin
	Lantus, Lantus Solostar
	Levemir
	NovoLog
Diabetes - Insulin Secreting Agents
chlorpropamide	Prandin	Amaryl
glimepiride	Starlix	Diabeta
glipzide		Diabinese
glipzide ER		Glucotrol
glyburide		Glucotrol XL
glyburide		Glynase
tolazamide		Micronase
		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	Glycet
	Janumet	Precose
	Januvia
	Symlin
Diabetic Supplies (QL)
	Accu-Chek - Active, Aviva, Comfort Curve	Encore Meters, Exatech Meters
	BD-Pen Needles, BD-Syringes	Glucometer Meters
	Fast Take, One Touch, One Touch Ultra, SureStep, SureStep Pro
Thyroid Agents
levothyroxine	Cytomel
Levoxyl	Synthroid

Tier 1 (Generic Drug)	Tier 2 (Preferred Brand)	Tier 3 (Non-preferred Brand)
Gastrointestinal/Urinary
Antispasmodic
generics	Pamine Forte	Donnatal
		Levsin
		Librax
		Robinul
Digestive Aids
pancrelipase	Creon
	Pancrelipase
	Ultrase
	Viokase
Gallstone Solubilizing Agents
ursodiol	Urso
Genitourinary Medications
oxybutynin/XL	Detrol	Ditropan XL
	Detrol LA	Sanctura
	Enablex
	Oxytrol Patch
	Sanctura XR
	Vesicare
H-2 Antagonists
cimetidine	Axid Oral Solution	Pepcid
famotidine		Tagamet
nizatidine		Zantac
ranitidine
Inflammatory Bowel (ST)
balsalazide	Amitiza	Lialda
mesalamine enema	Asacol	Rowasa
sulfasalazine	Canasa
	Colazal
	Entocort EC
	Gastrocrom
	Pentasa
Misc Stomach/Ulcer Products
	Carafate Suspension
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) (PA)
	Cialis	Levitra
	Muse
	Viagra
Hormone Replacement
	Androderm
	Androgel
	Methitest
	Testim
Prostate Health
doxazosin	Avodart	Proscar
finasteride	Flomax
terazosin	Uroxatral

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)
		Sancuso Patch
		Zofran(QL)
Antipsoriatics
	Tazorac	Amevive
Bowel Preparation
	Halflytely
Fertility
ganirelix	Bravelle	Follistim-AQ
	Cetrotide	Luveris
	Crinone	Menopur
	Gonal-F, Gonal-FRF
	Ovidrel
	Repronex
Growth Hormone (PA)
	Humatrope/Combo Pack	Genotropin
	Norditropin	Omnitrope
	Norditropin AQ	Saizen
	Norditropin Nordiflex	Serostim
	Nutropin AQ Pen	Tev-Tropin
Hematopoetic Growth Factors
	Aranesp Albumin Free
	Epogen
	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 (Non - Sedating) (ST)
Alavert OTC, loratadine OTC Coverage/Co-payment Plan Dependent	Allegra-D 12hr & 24hr, Allegra Susp	Allegra Tab 30/60/180mg, Allegra ODT
fexofenadine	Clarinex, Clarinex Reditabs
	Clarinex-D 12hr, Clarinex-D 24hr Clarinex-D Syrup
Asthma - Beta Agonists - Long Acting
	Foradil
	Serevent Diskus
Asthma - Beta Agonists - Short Acting
albuterol	Maxair Autohaler	Alupent
metaproterenol	ProAir HFA	Proventil HFA
	Xopenex/HFA	Ventolin HFA
Asthma - COPD Other
generics, theophylline	Advair/HFA	Atrovent Solution
ipratropium	Atrovent/HFA Inhaler	Brovana
prednisolone	Combivent	DuoNeb
theophylline	Perforomist	Prelone
theophylline	Spiriva	Xolair(PA)
	Symbicort
	Tilade
	T-Phyl
	Uniphyl
Asthma - Leukotriene Modulators (ST)
	Singulair	Accolate
		Zyflo/CR
Asthma - Steroid Inhalants
	Asmanex	AeroBid
	Flovent/HFA	AeroBid-M
	Pulmicort Respules/ Flexhaler	Alvesco
	QVAR	Azmacort
		Beclovent
		Vanceril
Cough and Cold
generics	Tussicaps
Nasal Products (QL)
flunisolide	Astelin	Beconase
fluticasone	Nasacort AQ	Beconase AQ
	Nasonex	Flonase
	Rhinocort AQ	Nasalide
	Veramyst	Nasarel
		Vancenase
		Vancenase AQ

Tier 1 (Generic Drug)	Tier 2 (Preferred Brand)	Tier 3 (Non-preferred Brand)
Topical
Ears
	Ciprodex
	Floxin Otic
Eye - Allergy
cromolyn	Alamast	Acular/LS/PF
ketotifen	Livostin	Alocril
	Optivar	Alomide
	Pataday	Crolom
	Patanol	Elestat
		Emadine
Eye - Glaucoma
betaxolol	Alphagan-P	Combigan
levobunolol	Alphgan-P	Timoptic
timolol	Azopt
	Betimol
	Betoptic-S
	Cosopt
	Isopto Carbachol
	Istalol
	Lumigan
	Pilopine HS
	Travatan, Travatan Z
	Trusopt
	Xalatan
Eye Miscellaneous
	Alrex
	Ciloxan
	Iquix
	Lotemax
	Natacyn
	Quixin
	Tobradex
	Tobrex Ointment
	Vigamox
	Voltaren
	ZyLET
	Zymar
Skin - Acne
benzoyl peroxide	Benzaclin	Accutane
benzoyl peroxide-erythromycin	Benzamycin	Cleocin-T
clindamycin topical	Duac CS Kit	Klaron
erythromycin topical	Metrocream	Noritate
isotretinoin	Metrogel
	Retin-A Micro
	Zoderm
Skin - all
betamethasone	Analpram-HC Lotion	Desonate Gel
desonide	Diprolene Lotion	Elocon
fluocinolone	Efudex	Lotrisone Lotion
mometasone	Elidel	Mycolog
mometasone	Ertaczo	Mycostatin
nystatin	Finacea Gel	Synalar
nystatin-triamcinolone	Lidoderm Patch	Valisone
	Locoid Lipocream
	Mentax
	Pramosone
	Protopic
	Solaraze

Tier 1 (Generic Drug)	Tier 2 (Preferred Brand)	Tier 3 (Non-preferred Brand)
Women's Health
Combination HRT
	Activella	Climara Pro
	CombiPatch	Prefest
	Premphase
	Prempro
	Prempro Low Dose
Contraceptives (QL)
Apri	Cyclessa	Alesse
Aviane	Lybrel	Brevicon
Balziva	Nuvaring	Demulen
Jolessa	Ortho-Tri-Cyclen Lo	Desogen
Kariva	Plan B	Estrostep Fe
Levora	Seasonique	Lo/Ovral
Low-Ogestrel	Yaz	Loestrin/Fe
Microgestin FE		Mircette
Necon		Nordette
Nortrel		Norinyl
Ocella		Ovcon
Quasense		Ovral
Sprintec		Ovrette
Tilia Fe		Seasonale
Trivora		Tri-Norinyl
Zovia		Triphasil
		Yasmin
Hormone Replacement Therapy HRT
estradiol	Cenestin	Estrace
	Climara	Estrogel Pump
	Enjuvia	Femring
	Estraderm	Menest
	Estring
	Evamist
	Premarin
	Prometrium
	Vagifem
	Vivelle-Dot
Osteoporosis - Calcium Regulators
alendronate	Boniva	Actonel/w Calcium
	Forteo	Didronel
	Fosamax+D, Fosamax Oral Solution	Fosamax
	Miacalcin
Osteoporosis - Hormone Receptor Modulators
	Evista
Prenatal Vitamins
Generics	Precare
	Precare Concieve
	Premesis Rx
	Primacare
Vaginal Products
clotrimazole	Clindesse	Diflucan 150mg (QL)
fluconazole	Gynazole-1	Metrogel Vaginal
terconazole		Terazol