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Commonly Prescribed Drug List

Antifungal Agents-----------------------------------------
October 2009
INTRODUCTION
How to Use This List
This list features select generic and brand-name ANTIVIRALS--------------------------------------------------
drugs. It can serve as a guide for you and your OTHER--------------------------------------------------------
provider to use when choosing a drug that meets your needs. To help you quickly identify the least expensive drugs, each category is organized by ANTIHISTAMINE / DECONGESTANTS
How to Lower Your Out-of-Pocket Costs
NASAL CORTICOSTEROIDS--------------------------
AUTONOMIC AND CENTRAL
You can keep your out-of-pocket costs as low as NERVOUS SYSTEM
possible by fol owing these simple steps and using ANALGESICS AND NONSTEROIDAL
ANTI-INFLAMMATORY----------------------------------
1. Over-the-counter drugs ($): First ask your
provider if there is an over-the-counter (OTC) drug that may be appropriate for you. OTC NASAL ANTIHISTAMINES-----------------------------
drugs are not included in this list, but may of er a lower-cost alternative to prescription drugs. 2. Generic drugs ($$): If an OTC drug is not OTHER NASAL AGENTS--------------------------------
available, ask your provider to prescribe a ANTICONVULSANTS--------------------------------------
generic drug, whenever feasible. Generic drugs are general y the lowest cost to you and ANTI-INFECTIVE AGENTS (ORAL)
included on this list are also available. ANTIBIOTICS------------------------------------------------
3. Preferred brand-name drugs ($$$): If a Cephalosporins. . . . . . . . . . . . . . . . . . . . . . . . . .
generic is not available, ask your provider to consider prescribing a preferred brand-name drug from this list, which may provide cost savings to you when selected instead of a
nonpreferred brand-name drug. Additional Macrolides/Ketolides . . . . . . . . . . . . . . . . . . . . . . . ANXIOLYTICS, SEDATIVES, AND HYPNOTICS-
preferred brand-name drugs not included on Nonpreferred brand-name drugs ($$$$):
These are the most expensive option and are not included on this list, and may also be subject to Prior Authorization. Choosing one of these drugs may result in higher out-of- Penicil ins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
CEREBRAL STIMULANTS------------------------------
pocket costs. For a more complete list, please see the formulary on our website. Drugs in the Prior Authorization program are subject to Please note: This is not a complete list of covered drugs. Your benefit coverage may not be limited to this list or the select therapeutic categories shown. Quinolones . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
MIGRAINE AGENTS--------------------------------------
In some cases, drugs on this list may not be covered by your plan or may have certain coverage limits. Refer to your benefit materials for ANTIDIABETIC AGENTS
Sulfonamides . . . . . . . . . . . . . . . . . . . . . . . . . . .
INSULINS----------------------------------------------------
PSYCHOTHERAPEUTIC AGENTS-------------------
Tetracyclines . . . . . . . . . . . . . . . . . . . . . . . . . . . Antidepressants . . . . . . . . . . . . . . . . . . . . . . . . . .
ORAL----------------------------------------------------------
CARDIOVASCULAR AGENTS
RESPIRATORY / ASTHMA
ANGIOTENSIN I ANTAGONISTS----------------------
ANTI-ASTHMATIC AGENTS-----------------------------
PROGESTIN ONLY------------------------------------------ Corticosteroids . . . . . . . . . . . . . . . . . . . . . . . . . .
ANGIOTENSIN CONVERTING ENZYME
INHIBITORS--------------------------------------------------- CONTRACEPTIVE DEVICES----------------------------- QVAR
Sympathomimetics . . . . . . . . . . . . . . . . . . . . . .
DIAGNOSTICS
GLUCOSE TEST STRIPS---------------------------------
ANTI-ADRENERGIC AGENTS –
BETA-BLOCKERS------------------------------------------
LifeScan and Roche product lines preferred GASTROINTESTINAL AGENTS
ANTIULCER--------------------------------------------------- OTHER RESPIRATORY/ASTHMA AGENTS--------
ANTILIPEMICS-----------------------------------------------
HORMONES
THYROID AND ANTITHYROID AGENTS
ESTROGENS-------------------------------------------------
CALCIUM CHANNEL BLOCKERS---------------------
COMBINATION ANTIHYPERTENSIVES-------------- ESTROGEN AND PROGESTERONE
COMBINATIONS---------------------------------------------
SELECTIVE RECEPTOR MODULATORS------------
OPHTHALMICS
CONTRACEPTIVES
ANTI-ALLERGIC AGENTS--------------------------------
MONOPHASIC----------------------------------------------
Administered by:
8407 Fal brook Avenue West Hil s, CA 91304 ANTI-GLAUCOMA AGENTS-----------------------------
Wel Point NextRx is a registered service mark of Wel Point, Inc. Services are provided by a BI-PHASIC-----------------------------------------------------
Wel Point PBM (either NextRx Services, Inc. or NextRx, LLC, as applicable). Wel Point NextRx This list is subject to change without notice.
TRI-PHASIC---------------------------------------------------
For the most current information, please cal
Wel Point NextRx Customer Service at
1-866-841-8951.

Source: http://www.trustmarkins.com/group/products/CommonlyPrescribedDrugList.pdf

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