Formulary 01 19 10 - website.xls
Kitchen Clinic Formulary as of Jan. 19, 2010
Generic (Brand name)
Pharmaceutical Company
ANALGESICS:
Celecoxib
(Celebrex)
Eletriptan
(Relpax)
Lidocaine patches
(Lidoderm patches)
ANTIBIOTICS: Amoxicillin
Azithromycin
(Zithromax)
Moxifloxacin
(Avelox)
Sulfamethoxazole/Timethoprim DS (Bactrim DS)
CARDIOVASCULAR: Amlodipine
(Norvasc)
Clopidogrel
(Plavix)
DiltiazemER
(Tiazac)
Dipyridamole/aspirin
(Aggrenox)
Doxazosin mesylate
(Cardura)
Gemfibrozil
(Lopid)
Isosorbide Mononitrate
(Imdur)
Potassium chloride
(K-Dur)
Spironolactone
(Aldactone)
Tamsulosin HCl
(Flomax)
Telmisartan
(Micardis)
Kitchen Clinic Formulary as of Jan. 19, 2010
Generic (Brand name)
Pharmaceutical Company
DIABETES:
Glipizide
(Glucotrol)
Insulin Aspart
(Novolog)
Insulin Aspart Protamine/Insulin Aspart
(Novolog 70/30)
Insulin Glargine
(Lantus)
GASTROINTESTINAL
Esomeprazole
(Nexium)
Hydroxyzine
(Vistaril)
Magnesium hydroxide (Milk of Magnesia)Metoclopramide (Reglan)
Polyenthylene glycol-electrolyte solution (Golytely)
GENITOURINARY: Doxazosin
(Cardura)
Tamsulosin HCl
(Flomax)
INJECTABLES: Cyanocobalamin (Vit B-12)
Ketorolac Tromethamine (Toradol)
Medroxyprogesterone acetate
(Depo-provera)
Rocephin
NEUROPSYCHIATRIC: Acamprosate Calcium
(Campral)
Atomoxetine
(Strattera)
Aripiprazole
(Abilify)
Bupropion HCl
(Wellbutrin)
Carbamazepine
(Tegretol)
Citalopram
(Celexa)
Eletriptan
(Relpax)
Fluoxetine
(Prozac)
Gabapentin
(Neurontin)
Hydroxyzine
(Vistaril)
Kitchen Clinic Formulary as of Jan. 19, 2010
Generic (Brand name)
Pharmaceutical Company
NEUROPSYCHIATRIC (cont'd):
Lamotrigine
(Lamictal)
Phenytoin
(Dilantin)
Quetiapine Fumarate
(Seroquel)
Risperidone
(Risperdal)
Sertraline
(Zoloft)
Valproic Acid
(Depakote)
Venlafaxine
(Effexor XR)
OPHTHALMIC PREPARATIONS: Erythromycin Ophthalmic Ointment
OTHER ANTI-INFECTIVES: Fluconazole
(Diflucan)
Miconazole cream (Monistat)Permethrin cream (Elimite)
Premarin vaginal cream
Rocephin
OTIC PREPARATIONS: Ciprofloxacin HCL
RESPIRATORY: Aerochamber Albuterol INH
(Proventil HFA)
Atrovent HFA
Budesonide Nasal
(Rhinocort Aqua)
Dextromethorphan/ GuaifenesinLoratadine (Claritin)
Montelukast
(Singulair)
Pulmicort
Saline nasal rinse
Tiotripium Bromide
(Spiriva)
STEROIDS/HORMONES: Enpresse 28
Estradiol (Estrace)
Estrogens conjugated/medroxyprogesterone
(Prempro)
Levothyroxine
(Levothroid)
Medroxyprogesterone acetate
(Depo-provera shot)
Medroxyprogesterone acetate tablets (Provera)
Progesterone micronized
(Prometrium)
Kitchen Clinic Formulary as of Jan. 19, 2010
Generic (Brand name)
Pharmaceutical Company
TOBACCO CESSATION:
Nicotine Inhalers
(Nicotrol) Nicotine Patch
TOPICALS:
Clindamycin phosphate solutionDouble antibiotic ointmentHydrocortisone cream
Lice shampooLubricant for eyesLubriderm lotionPermethrin cream (Elimite)
Viscous lidocaine
VITAMINS/ SUPPLEMENTS/ OTC: Alendronate Sodium (Fosamax)
Calcium Carbonate (Tums)Calcium with vitamin DCondomsGlucosamine chondroitinFerrous SulfateMagnesium hydroxide (Milk of Magnesia)Magnesium oxide (Mag-Ox)
Prenatal vitaminsQ-tussin DMSaline nasal rinseSuper B complex
Source: http://www.thekitcheninc.org/pdf/formulary.pdf
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Welcome to your UnitedHealthcare Pharmacy Benefit Effective July 1, 2009, your pharmacy benefits, associated with your medical plan, will also be changing to UnitedHealthcare. As a result, the list of medications covered under your pharmacy benefit may change. Your Prescription Drug List (PDL) will consist of three tiers – Tier 1 is the lowest copayment tier and Tier 3 is the highest copay
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