CBCA Rx

CBCA Rx Formulary/Preferred Prescription Drug List

This condensed Preferred Drug List is a listing of approved medications that is designed to serve as a reference guide to assist in the selection of cost-effective drug products. This guide lists the most commonly prescribed drugs in the CBCA Preferred Drug List. It is not intended to be an all-inclusive list and is subject to change. Please share this reference with your doctor and use generic drugs whenever appropriate.

Review your plan documents to determine specific coverage and copays. This list does not guarantee coverage of medications listed in the pocket Preferred Drug List. If a listed medication is not part of the selected plan's covered services, the medication will be excluded.

Please contact CBCA member services if you require help in determining if your prescription is on the Preferred Drug List. Thank you in advance for your cooperation.

Member Services Helpdesk:
1-800-383-8737

How to Use This Prescription Drug List:

Brand Name Medications are listed individually.
Generic medications are listed with their Brand Name Equivalents. For example: Ibuprofen (generic for Motrin) means Ibuprofen is the generic for Motrin.
Non-Preferred Brand Medications not listed here have a Non-Preferred Copay.

* = Coverage is contingent upon plan benefits.

Please note that if a listed medication is not part of the selected plan's covered services, the medication will be excluded.

Click on the first letter of the Drug:

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Special Medication Classes
All oral FDA-approved antineoplastic (chemotherapy), immunosuppressive, HIV treatment, and related infection agents are eligible for coverage as preferred agents under the prescription drug benefit. Generic Medications are Preferred.
A (Back to Top)
Abilify Accolate Accupril Accu-Chek Test Strips Acetazolamide (generic for Diamox) Alclometasone (Generic for Aclovate) Actiq Activella Actonel Actos Acyclovir (generic for Zovirax) Advair Advicor Aggrenox Agrylin Albuterol Inhaler (generic for Proventil/Ventolin) Albuterol Tablets/Syrup (generic for Ventolin) Allegra/Allegra D Aldara Alomide Alora Alphagan P Alprazolam (generic for Xanax) Altace Amantadine (generic for Symmetrel) Amaryl Ambien Aminophylline (generic medication) Amiodarone (generic for Cordarone) Amitriptyline (generic for Elavil) Amnesteem (generic for Accutane) Amoxicillin (generic for Amoxil)	Amoxicillin\clavulanate potassium (generic for Augmentin) Amphetamine/Dextroamphetamine (generic for Adderall, Adderall XR) Ampicillin (generic for Principen) Androderm* Androgel* APAP/Caffeine/Butalbital (generic for Fioricet) APAP/Codeine (generic for Tylenol w/ Codeine) APAP/Hydrocodone (generic for Vicodin) Apokyn Aranesp* Arava Aricept Armour Thyroid Arthrotec ASA/Caffeine/Butalbital (generic for Fiorinal) ASA/Codeine (generic for Empirin w/ Codeine) Asacol Astelin Atenolol (generic for Tenormin) Atrovent Inhaler Augmentin/Augmentin ES (generic available) Augmentin XR Avandia Avandamet Avodart Azmacort Azopt
B (Back to Top)
Baclofen (generic for Lioresal) Beclovent Beconase/Beconase AQ Belladonna Alkaloids/PB (generic for Donnatal) BenzaClin Benzamycin (generic avialable) Benazepril/Benazepril/hctz Benztropine Mesylate (generic for Cogentin) Betamethasone Dipropionate (generic for Diprosone) Betamethasone Valerate (generic for Valisone)	Betaseron* Betaxolol (generic for Betoptic/S) Bethanechol (generic for Urecholine) Biaxin/Biaxin XL Bisoprolol/HCTZ (generic for Ziac) Brimonidine (generic for Alphagan) Bromocriptine (generic for Parlodel) Bupropion (generic for Wellbutrin, Wellbutrin SR*) Buspirone (generic for Buspar)
C (Back to Top)
Caduet Canasa Captopril (generic for Capoten) Captopril/hctz (generic for Capozide) Carbamazepine (generic for Tegretol) Carbidopa/Levodopa (generic for Sinemet/CR) Carbinoxamine/Pseudoephedrine (generic for Rondec) Carbinoxamine/Pseudoephedrine/DM (generic for Rondec DM) Cardizem CD 360mg Carisoprodol (generic for Soma) Catapres TTS Cefadroxil (generic for Duricef) Cefuroxime (generic for Ceftin) Cefzil Celebrex* Celexa (generic available) Cephalexin (generic for Keflex) Cephradine (generic for Velosef) Cetrotide* Chlordiazepoxide (generic for Librium) Chlorpromazine (generic for Thorazine) Cholestyramine (generic for Questran/Light) Choline Magnesium Trisalicylate (generic for Trilisate) Chorex-10* Chorionic Gonadotropins* (generic medication) Cimetidine (generic for Tagamet) Ciprodex	Ciprofloxacin (generic for Cipro) Cleocin Vaginal Cream Clidinium/Chlordiazepoxide (generic for Librax) Climara/Climara Pro Clindamycin (generic for Cleocin T) Clindamycin HCl (generic for Cleocin) Clobetasol Propionate (generic for Temovate) Clomiphene* (generic for Clomid) Clonazepam (generic for Klonopin) Clonidine (generic for Catapres) Clorazepate (generic for Tranxene) Codeine Phosphate/Aspirin/Caffeine/ Butalbital (generic for Fiorinal w/ Codeine) Colazal Colestid Combipatch Combivent Comtan Copaxone Copegus Coreg Cotazym-S Coumadin (generic avialable) Cozaar Cromolyn Sodium Cyclessa Cyclobenzaprine (generic for Flexeril) Cytomel
D (Back to Top)
Dantrium Depakote, Depakote ER Desipramine (generic for Norpramin) Desmopressin (generic for DDAVP, Minirin) Desonide (generic for Tridesilon) Detrol/Detrol LA Dexamethasone (generic for Decadron) Diamox Sequels Diastat Diazepam (generic for Valium) Diclofenac (generic for Voltaren) Dicloxacillin (generic for Dynapen) Differin* Diflucan Digoxin (generic for Lanoxin) Dilatrate-SR	Diovan/Diovan HCT Diltiazem (generic for Cardizem) Diltiazem SR (generic for Cardizem CD/ Dilacor XR) Dipentum Diprolene/Diprolene AF Disopyramide (generic for Norpace & Norpace CR) Ditropan XL Dovonex Doxazosin Mesylate (generic for Cardura) Doxycycline (generic for Doryx/Vibramycin) Duac Duragesic DynaCirc/DynaCirc CR
E (Back to Top)
Edex* Effexor/XR Efudex Elidel Emend* Enalapril (generic for Vasotec) Enalapril/HCTZ (generic for Vaseretic) Enbrel* Epipen/Epipen Jr. Epivir-HBV Epogen* Ergomar Ergotamine/Caffeine (generic for Wigraine & Cafergot) Erythromycin (generic for A/T/S) Erythromycin (generic for Ilotycin) Erythromycin Base (generic for Film Tab or Enteric) Erythromycin-Benzoyl Peroxide (generic for Benzamycin) Erythromycin ES/Sulfisoxazole (generic for Pediazole) Erythromycin Ethylsuccinate (generic for E.E.S.) Erythromycin Stearate (generic for Erythrocin) Esclim Eskalith CR (generic available)	Estradiol (generic for Estrace) Estraderm Estratest/Estratest HS Estrace/Estrace Vaginal Cream Estring Estrogens, Esterified (generic for Estratab) Estropipate (generic for Ortho-Est/Ogen) Estrostep Fe Ethambutol (generic for Myambutol) Ethosuximide (generic for Zarontin) Ethinyl Estradiol/Desogestrel (generic for Desogen, Apri) Ethinyl Estradiol/Norgestrel (generic for Lo-Ovral/Ovral) Ethinyl Estradiol/Ethynodiol (generic for Demulen) Ethinyl Estradiol/Levonorgestrel (generic for Triphasil) Ethinyl Estradiol/Norethindrone (generic for Brevicon 0.5-35, Norinyl 1+35) Ethinyl Estradiol/Norethindrone (generic for Ortho Novum 10/11) Etodolac (generic for Lodine) Evista Evoxac Exelon
F (Back to Top)
FemHRT Femring Finacea Flecainide (generic for Tambocor) Flomax Flonase Flovent Floxin Otic Fluocinolone Acetonide (generic for Synalar, Derma-Smoothe) Fluocinolone Acetonide (generic for Synalar & Synalar-HP) Fluocinonide (generic for Lidex & Lidex E)	Fluoxetine (generic for Prozac) Fluphenazine (generic for Prolixin & Permitil) Flurbiprofen (generic for Ansaid) Fluvoxamine (generic for Luvox) Follistim/Follistim AQ Foradil Forteo* Fosamax Fosinopril (generic for Monopril) Furosemide (generic for Lasix)
G (Back to Top)
Gabapentin (generic for Neurontin) Gabitril Gemfibrozil (generic for Lopid) Gentamicin (generic for Garamycin) Glipizide (generic for Glucotrol, Glucotrol XL) Glucagon Glucotrol XL (generic available) Glucophage XR 750mg Glucovance	Glyburide (generic for Micronase/ DiaBeta/ Glynase/ PresTab) Gonal-F* Guaifenesin 550mg/Pseudeophedrine 60mg (generic for Maxifed-G) Guaifenesin PSE SR (generic for Sudal SR) Guaifenesin/Codeine (generic for Robitussin AC) Gynazole-1
H (Back to Top)
Haloperidol (generic for Haldol) Halobetasol (Generic for Ultravate) HCTZ/Triamterene (generic for Dyazide/Maxzide) Hepsera Humalog/Humalog Mix Humegon* Humulin N, R, & U Hydralazine (generic for Apresoline) Hydrochlorothiazide (generic for Esidrix)	Hydrocodone/Homatropine (generic for Hycodan) Hydroxychloroquine (generic for Plaquenil) Hydroxyzine HCI (generic for Atarax) Hydroxyzine Pamoate (generic for Vistaril) Hyoscyamine (generic for Levsin) Hyzaar
I (Back to Top)
Ibuprofen (generic for Motrin) Imipramine (generic for Tofranil) Imitrex* Indapamide (generic for Lozol) Indomethacin (generic for Indocin/Indocin SR) Infergen Innohep* Inspra Insulin Lente (Pork) (Iletin II Lente, Insulin L Pure Pork) Insulin Lente Human (Humulin L, Novolin L)	Insulin NPH (Pork) (Iletin II NPH, Insulin N Pure Pork) Insulin Regular (Pork) (Iletin I Regular, Iletin II Regular, Insulin R Pork, Velosulin Human BR, Insulin R Pure Pork) Intal Inhaler Intron-A Ipratropium bromide (generic for Atrovent Spray/Solution) Isotretinoin (Amnesteem, Claravis) Isosorbide Dinirate (generic for Isordil) Itraconazole (generic for Sporanox)
J / K / L (Back to Top)
Jantoven (generic for Coumadin) Junel Fe (generic for Microgestin Fe) Kadian Keppra Ketoconazole (generic for Nizoral) Ketorolac (generic for Toradol) Kineret Lamictal Lamisil* Lantus Leuprolide Acetate* (generic for Lupron/Lupron Depot*) Levaquin Levobunolol (generic for Betagan) Levothyroxine Levoxyl Lexapro	Lexiva Lipitor Lisinopril (generic for Zestril/Prinivil) Lisinopril/HCTZ (generic for Zestoretic/Prinzide) Lithium Carbonate (generic for Eskalith, Lithobid) Lithobid (generic avaialble) Livostin Loprox Lorazepam (generic for Ativan) Lotrel Lotrisone Lovastatin (generic for Mevacor) Lovenox* Lumigan Luxiq
M (Back to Top)
Maxalt/Maxalt MLT Medroxyprogesterone Acetate (generic for Provera) Megestrol Acetate (generic for Megace) Meperidine (generic for Demerol) Mepron Mesalamine (generic for Rowasa) Mestranol/Norethindrone (generic for Norinyl 1+50) Metadate-CD Metformin (generic for Glucophage, Glucophage XR) Methadone (generic for Dolophine) Methocarbamol (generic for Robaxin) Methotrexate (generic medication) Methylphenidate (generic for Ritalin, Ritalin-SR, Metadate-ER) Methylprednisolone (generic for Medrol) Metoclopramide (generic for Reglan)	Metolazone (generic for Zaroxolyn) Metoprolol (generic for Lopressor) MetroCream (generic available) MetroGel/MetroGel Vaginal MetroLotion Metronidazole (generic for Flagyl) Miacalcin NS Migranal Minirin (generic available) Minocycline (generic for Minocin) Minoxidil (generic for Loniten) Mintezol Mirapex Mirtazapine (generic for Remeron, Remeron Solutabs) Misoprostol (generic for Cytotec) Morphine Sulfate (generic for MSIR) Morphine Sulfate, SR (generic for MS Contin) Mysoline (generic available)
N (Back to Top)
Nabumetone (generic for Relafen) Namenda Naphazoline (generic for Vasocon) Naphazoline/Antazoline (generic for Vasocon-A) Naproxen (generic for Naprosyn/EC-Naprosyn) Nasonex Neulasta* Nexium Niaspan Nimotop Nitrofurantoin (generic for Macrodantin) Nifedipine, SR (generic for Adalat CC) Nitroglycerin Patch (generic for Nitrek, Nitro-Dur, Minitran) Nitroglycerin Sublingual (generic for Nitrostat)	Nitroglycerin, SR (generic medication) Nitroglycerin, Topical (generic for Nitrol) Nordette Norethindrone (generic for Nor-Q-D) Norethindrone Acetate (generic for Aygestin) Nortriptyline (generic for Aventyl) Norvasc Novolin L, N, R, & 70/30 NovoLog/NovoLog Mix Nutropin, Nutropin AQ, Nutropin Depot* NuvaRing Nystatin (generic for Mycostatin) Nystatin/Triamcinolone (generic for Mycolog II)
O (Back to Top)
Olux Omnicef One Touch Test Strips Ortho-Evra Oxaprozin (generic for Daypro) Oxistat Oxybutynin Chloride (generic for Ditropan)	Oxycodone Oxycodone/APAP (generic for Percocet) Oxycodone/ASA (generic for Percodan) Oxycontin
P (Back to Top)
Pancrelipase (generic for Creon, Pancrelipase Viokase) Paroxetine (generic for Paxil) Patanol Paxil CR/Paxil Oral Suspension Pegasys* Peg-Intron* Penicillin VK (generic for Pen-Vee K) Pentasa Pentoxifylline (generic for Trental) Phenobarbital Phenytek Phenytoin (generic for Dilantin) Phoslo Plavix Plendil (generic available) Plexion/TS (generic available) Polyethylene Glycol (generic for CoLyte/ Golytely) Potassium Chloride (generic for K-Dur) Prandin Pravachol Pravigard PAC Precose Prednisolone Acetate (generic for Pred Forte & Pred Mild) Prednisolone Liquid, Pediapred/Orapred, generic for Prelone) Prednisone (generic for Deltasone/Orasone)	Prefest Premarin Premarin Vaginal Cream Premphase Prempro PrevPac Primidone (generic for Mysoline) Prochieve 4% Prochlorperazine (generic for Compazine) Procrit* Promethazine (generic for Phenergan) Promethazine/Codeine (generic for Phenergan/Codeine) Promethazine DM (generic for Phenergan DM) Prometrium Propoxyphene Napsylate/APAP (generic for Darvocet N-100) Propranolol (generic for Inderal & Inderal LA) Proscar Proventil Protonix Protopic Protropin* Proventil Repetabs Provigil* Pulmicort
Q / R (Back to Top)
Quinaretic (generic for Accuretic) Quinidine Gluconate, SR (generic for Quinaglute) Quinidine Sulfate (generic medication) Quinidine Sulfate, SR (generic for Quinidex Extentabs) Qvar Ranitidine (generic for Zantac) Raptiva* Rebetol Rebif* Regranex*	Remeron 45mg Soltabs Reminyl Renagel Repronex* Rhinocort Aqua Ribavirin (Generic for Rebetol, Copegus) Rifamate Risperdal Ritalin LA Roferon-A Rowasa (generic available)
S (Back to Top)
Seasonale* Sensipar Serentil Serevent Seroquel Singulair Sodium Sulfacetamide/Sulfur (Sulfacet-R Lotion) Soriatane Sotalol (generic for Betapace/Betapace AF)	Spiriva Spironolactone (generic for Aldactone) Sporanox* Sucralfate (generic for Carafate) Sulfacetamide (generic for Sulamyd/Bleph 10) Synarel Syntest Synthroid
T (Back to Top)
Tamiflu Tamoxifen (generic for Nolvadex) Tazorac* Tegretol XR Terazol Terazosin (generic for Hytrin) Testoderm* Testim* Tetracycline (generic for Achromycin V) Theophylline SR (generic for Theo-Dur, Uniphyl) Timolol (generic for Timoptic) Tizanidine (generic for Zanaflex) TMP-SMX DS (generic for Septra DS) Tobi Tobradex	Tobramycin (generic for Tobrex) Tonocard Topamax Toprol XL Torecan Torsemide (generic for Demadex) Tracleer* Tranxene SD Trazodone (generic for Desyrel) Tretinoin (generic for Retin-A, Avita, Retin-A Micro)* Triamcinolone Acetonide (generic for Aristocort & Aristocort-HP) Tricor Trileptal Triple Sulfa Cream (generic for Sultrin)
U / V (Back to Top)
Ultrase Unithroid URSO Ursodiol (generic for Actigall) Vagifem Valcyte Valproic Acid (generic for Depakene) Valtrex Vantin (generic available) Velosef	Verapamil (generic for Calan) Verapamil SR (generic for Calan SR, Verelan) Verelan PM Vfend* Viagra* Vigamox Vira-A Vivelle/DOT Volmax
W / X / Y / Z (Back to Top)
Warfarin Sodium (generic for Coumadin) Wellbutrin SR 200mg/Wellbutrin XL Xalatan Xenical* Xolair* Xyrem* Yasmin Zaditor Zanaflex (generic tizanidine available) Zarontin (generic ethosuximide available) Zaroxolyn (generic available)	Zavesca Zetacet Zithromax Zofran* Zoloft Zomig/Zomig ZMT Zonegran Zovirax Zyprexa Zyrtec/Zyrtec D Zyvox*
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