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HNE Formulary: Brand/Non-Formulary
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The formulary list was last updated on 09/01/07, please be advised the information listed may not reflect the most current data and may be updated at any time without notice.

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Alphabetic Listing Brand/Non-Formulary

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The brand name products on this list are covered as Brand/Non-Formulary Drugs (Tier 3) and the generic equivalents are covered as Generic Drugs (Tier 1). When a generic equivalent is not listed then a generic equivalent is not yet available.
  • You pay the highest copayment for brand products with available generic equivalents.
  • You pay the lowest copayment for generic products.
  • This list is not comprehensive. Please consult your local pharmacist if you think your drug is available as a generic product.

**Indicates a medication with a Limit/PA or Step Therapy, please click limitations link above.

Brand

Generic


A
Abilify aripiprazole
Accolate zafirlukast
Accuretic quinapril / hydrochlorothiazide
Accuzume papain/urea
Aciphex rabeprazole
Actiq fentanyl
Actoplus Met pioglitazone / metformin
Advicor lovastatin/niacin
Aerobid flunisolide
Aerobid-M flunisolide, mentholated
Aggrenox aspirin/ dipyridamole
Akineton biperiden
Alamast pemirolast
Allegra fexofenadine
Allegra-D-12 hour fexofenadine/pseudoephedrine
Allegra-D-24 hour fexofenadine/pseudoephedrine
Alocril nedocromil sodium
Alomide lodoxamide tromethamine
Alrex loteprednole etabonate
Altocor lovastatin, long acting
Altoprev lovastatin
Ambien zolpidem
Ambien CR zolpidem
Amerge naratriptan
Amitiza lubiprostone
Androgel testosterone gel
Antara fenofibrate
Antivert meclizine
Anzemet dolasetron
Apokyn apomorphine
Aranesp darbepoetin alfa
Arixtra fondiparinux
Atacand candesartan
Atacand HCT candesartan/HCTZ
Atrovent neb soln. ipratropium
Avandamet rosiglitazone/metformin
Avandaryl rosiglitazone/glimepiride
Avar sulfacetamide sodium/sulfur
Avinza morphine sulfate
Avodart dutasteride
Axert almotriptan
Azasan azathioprine
Azasite Eye Drops azithromycin ophth.
Azilect rasagiline
Azmacort triamcinolone
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B

Baraclude entecavir
Beclovent beclomethasone dipropionate
Beconase AQ beclomethasone dipropionate
Benicar olmesartan
Benicar HCT olmesartan/hctz
Biaxin XL clarithromycin
Biltricide praziquantel
Boniva ibandronate
Bravelle urofollitropin
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C

Caduet atorvastatin/amlodipine
Campral acamprosate
Carbatrol carbamazepine XR
Cardizem LA dilitiazem
Cardizem LA diltiazem LA
Cardura doxazosin
Cardura XL doxazosin
Cedax cefibuten
Celexa citalopram
Celontin methsuximide
Cenestin conjugated estrogens
Cesamet nabilone
Chantix varenicline tartrate
Cialis tadalafil
Ciloxin ciprofloxacin
Cipro XR ciprofloxacin
Clarinex desloratadine
Clarinex D 12 hour desloratadine/pseudoephedrine
Clarinex D 24hr desloratadine/pseudoephedrine
Clarinex Reditabs desloratadine
Climara estradiol transdermal
Clindareach 1% Kit clindamycin
Clobex clobetasol propionate
Clozaril clozapine
Colestid colestipol
Comtan entacapone
Coreg CR carvedilol CR
Cortef hydrocortisone
Cozaar losartan
Crestor rosuvastatin calcium
Crolom cromolyn sodium
Cymbalta duloxetine
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D

Daytrana patch methylphenidate
Decadron Phos dexamethasone
Demadex torsemide
Dermatop Prednicarbate
Desogen ethinyl estradiol/desogestrel
Desoxyn methamphetamine salts
Detrol tolterodine
Detrol LA tolterodine
Diastat diazepam rectal gel
Differin adaplene
Dipentum olsalazine
Ditropan XL oxybutynin
Divigel estradiol
Donnatal belladona alkaloids/phenobarbital
Doryx doxycycline monohydrate
Drithrocreme HP anthralin
Duetact glimepiride/pioglitazone
DuoNeb albuterol/ipratropium
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E

Edecrin ethacrynic acid
Effexor venlafaxine
Elestat epinastine hydrochloride
Elestrin estradiol gel
Elidel pimecrolimus
Eligard syringe leuprolide acetate
Elmiron pentosan polysulfate sodium
Emadine emedastine
Emcyt estramustine
Emend aprepitant
Emsam selegiline
Enablex darifenacin
Ery-Tab erythromycin base, enteric coated
Estrogel estradiol
Exelon rivastigmine
Exforge amlodipine/valsartan
Exjade deferasirox
Exubera human insulin inhaled
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F

Factive gemifloxacin
Famvir famciclovir
Fedahist chlorpheniramine HCI/pseudoephedrine
Felbatol felbamate
Femcon-FE ethinyl estradiol/norethindrone
Fentora fentanyl
Fertinex urofollitropin
Finacea azelaic acid
First Progesterone progesterone supp
First-Testosterone MC testosterone propionate
FML fluorometholone
Focalin dexmethylphenidate
Focalin XR dexmethylphenidate
Follistim follitropin beta
Forteo teriparatide
Fosrenol lanthanum
Fragmin dalteparin
Frova frovatriptan
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G

Gabitril tiagabine
Genotropin somatropin
Geodon ziprasidone
Gleevec imatinib
Glumetza ER metformin
Glycet miglitol
Glyset miglitol
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H

Hectorol doxercalciferol
Hexalen altretamine
Humatrope somatropin
Hytrin terazosin
Hyzaar losartan/HCTZ
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I

Increlex mecasermin
Inderal LA propranolol LA
Innohep tinzaparin
Innopran XL propranolol
Inspra eplerenone
Invega ER Paliperidone
Iopidine apraclonidine
Iressa gefitinib
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J

Janumet Sitagliptin/metformin
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K

K-Dur potassium chloride
Kemadrin procyclidine
Keppra levetiracetam
Ketek telithromycin
Kineret anakinra
Klonopin Wafer clonazepam
Kytril granisetron
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L

Lamictal dispersible tab lamotrigine chewable
Lamisil terbinafine
Lavoclen Creamy Wash benzoyl peroxide cleanser
Lescol, Lescol XL fluvastatin
Leucovorin leucovorin calcium
Leukine sargramostim
Levitra vardenafil
Lexxel enalapril / felodepine
Lialda mesalamine
Lipitor atorvastatin
Livostin levocabastine
Lotemax loteprednole etabonate
Lotrel amlodipine besylate/benazepril
Lotrimin AF miconazole nitrate
Lotronex alosetron
Lovaza (old name -Omacor) omega-3-acid ethyl esters
Lunesta eszopiclone
Luveris lutropin alfa
Luvox fluvoxamine
Lybrel ethinyl estradiol/levonorgestrel
Lyrica pregabalin
Lyrica pregabalin
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M

Marinol dronabinol
Mavik trandolapril
Maxalt rizatriptan
Maxalt MLT rizatriptan
Maxidex dexamethasone 1%
Menopur menotropin
Meridia sibutramin
Metadate CD methylphenidate, sustained release
Mevacor lovastatin
Micardis telmisarta
Micardis HCT telmisartan/HCTZ
Migrin-A isometheptene/apap/dichlphen
Minirin desmopressin
Minocin minocycline
Miralax PEG/NaSO4/NaHCO3/NaCl/KCl
Mobic meloxicam
Monodox doxycycline monohydrate
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N

Nasacort AQ triamcinolone
Nasalide flunisolide nasal spray
Neoral cyclosporine
Neulasta pegfilgrastim
Neupogen filgrastim
Nexavar sorafenib tosylate
Nexium esomeprazole
Nexium packet esomeprazole packet
Nicotrol Inhaler nicotine inhaler
Nicotrol Nasal Spray nicotine nasal spray
Nilandron nilutamide
Nitrostat nitroglycerin SL
Norditropin somatropin
Norvasc amlodipine
Noxafil posaconazole
Nutropin somatropin
Nuvaring ethinyl estradiol/etonogestrel
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O

Ocuflox ofloxacin ophthalmic
Omnicef cefdinir
Ortho Tri Cyclen Lo ethinyl estradiol/norgestimate
Ortho-Evra ethinyl estradiol/norelgestromin
Osmoprep sodium phosphate/sodium biphosphate
Otobiotic hydrocortisone/polymyxin B sulfate
Otosporin Otic acetic acid/aluminum acetate
Oxandrin oxandrolone
Oxycontin oxycodone HCl, controlled release
Oxytrol oxybutynin
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P

Palladone hydromorphone
Pamine Methscopolamine bromide
Panafil papain/urea/chlorophyllin
Parnate tranylcypromine
Pataday olopatadine hydrochloride 0.2%
Patanol olopatadine hydrochloride
Paxil paroxetine
Paxil CR paroxetine
Pegasys peginterferon alfa-2a
PEG-Intron peginterferon alfa-2b
Pexeva paroxetine mesylate
Phoslo calcium acetate
Polysporin polymyxin B sulfate/bacitracin
Pramosone pramoxine/ hydrocortisone
Pravachol pravastatin
Pravigard PAC pravastatin/asa/cal cb/magnesium
Pred-G prednisolone sod.phos/gentamycin
prednisolone (eq= orapred) prednisolone sodium
Prenatal Vitamins, all brand products prenatal vitamins
Prevacid lansoprazole
Prilosec omeprazole
Progesterone progesterone
Prometrium progesterone
Protect Plus multivitamin
Protropin somatrem
Proventil HFA albuterol
Proventil/Ventolin albuterol
Provigil modafinil
Prozac fluoxetine
Prozac Weekly fluoxetine
Pulmozyme dornase alfa
Pylera bismuth/metronidazole/tetracycline
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Q

Quixin levofloxacin
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R

Ranexa ranolazine
Raptiva efalizumab
Razadyne galantamine
Razadyne-ER galantamine ER
Regenecare vit e/lidocaine/aloe vera/colagen
Regranex becaplermin gel
Relenza zanamivir
Relpax eletriptan
Requip ropinirole
Restasis cyclosporine
Retin-A . tretinoin
Retin-A Micro tretinoin
Revlimid lenalidomide
Ritalin LA methylphenidate
Rosac sulfacetamide sodium/avobenzone/sulfur
Rozerem ramelteon
Rythmol SR propafenone HCl
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S

Saizen somatropin
Salagen pilocarpine
Salex salacylic acid shampoo
Sanctura trospium chloride
Sandostatin LAR octreotide acetate
Sarafem fluoxetine
Seasonale ethinyl estradiol/levonorgestrel
Sensipar cinacalcet
Serostim somatropin
Soltamox 10mg/5ml tamoxifen
Somavert pegvisomant
Sonata zaleplon
Spectracef cefdituren
Sporanox itraconazole
Sprycel dasatinib
Strattera atomoxetine
Striant testoterone
Suboxone buprenorphine/naloxone
Subutex buprenorphine
Sular nislodipine
Sutent sunitinib malate
Symbicort budesonide/formoterol fumerate
Symbyax olanzapine/fluoxetine
Symmetrel amantadine
Synera Patch lidocaine HCI/tetracaine
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T

Tamiflu oseltamivir
Tarka trandolapril/ verapamil
Tazorac tazarotene
Tegretol carbamazepine
Tegretol Chewable carbamazepine, chewable
Testim testosterone gel
Testosterone testosterone
Teveten eprosartan
Teveten HCT eprosartan hct
Timoptic, Betimol, Istalol timolol ophth
Tobrex tobramycin
Toprol XL metoprolol
Tracleer bosentan
Travatan travoprost
Travatan -Z travoprost (preservative free)
Triaz oscion cleanser
Twinject epinephrine
Tykerb Lapatinib
Tyzeka telbuvudine
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U

UroXatral alfuzosin
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V

Valcyte valganciclovir
Ventavis iloprost
Verelan PM verapamil
Vesanoid tretinoin
Vesicare solifenacin
Vexol rimexolone
Vfend voriconazole
Vigamox moxifloxacin
Vivelle estradiol transdermal
Voltaren diclofenac sodium eye drop
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W

Wellbutrin bupropion HCL
Wellbutrin SR bupropion
Wellbutrin XL bupropion XL
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X

Xeloda capecitabine
Xenical orlistat
Xibrom bromfenac
Xifaxan rifaximin
Xopenex levalbuterol
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Y

Yasmin ethinyl estradiol/drospirenone
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Z

Zaditor ketotifen
Zazole vaginal supp terconazole
Zegerid omeprazole
Zelapar ODT selegiline
Zelnorm tegaserod
Zemplar paricalcitol
Zithromax azithromycin
Zocor simvastatin
Zofran ondansetron HCI
Zofran (injectable) ondansetron HCI (injectable)
Zoladex goserelin
Zolinza Vorinostat
Zorbtive somatropin
Zyban bupropion SR
Zyflo xiluteon
Zylet tobramycin/loteprenol
Zymar gatifloxacin
Zyprexa (injectable) olanzapine (injectable)
Zyprexa Zydis olanzapine
Zyrtec cetirizine
Zyrtec-D cetirizine/ pseudoephedrine
Zyvox linezolid
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