Caterpillar Drug Formulary

Caterpillar Drug Formulary
Generated October 26, 2016
Caterpillar Drug Formulary
As Applied to Active Employees and Certain Retirees
Effective November 1, 2016 to December 31, 2016
DESCRIPTION
Prescription medications in this formulary are listed by common categories and classes. They are placed into cost
levels known as tiers. Both brand and generic prescription medications are included.
The following list represents commonly prescribed medications. This is not a complete list of medications, and
not all medications listed may be covered under the plan. Not all dosage forms and strengths are covered
under the prescription drug benefit provision (i.e. infusions, injections, etc). Where differences are noted
between this drug formulary and your summary plan document (SPD), the plan document will rule. Please look at
your SPD provided at www.catatwork.cat.com > Compensation & Benefits > Summary Plan Descriptions to learn
more about your prescription drug benefit plan.
ELIGIBILITY
This list contains medications and/or products covered by the prescription drug benefit provisions of the
Caterpillar Inc. Employee Health, Life and Disability Benefit Program, the Caterpillar Inc. Retiree Benefit Program,
the Caterpillar Inc. Group Insurance Plan A, and the Caterpillar Inc. Group Insurance Plan B:
for those participants who are eligible for and who elect to participate in the preferred provider organization
(“PPO”) product administered by UnitedHealthcare (UHC).
for those participants who are eligible for and who elect to participate in the EPO or EPO-like product
administered by Blue Cross Blue Shield (BCBS).
for the Solar Turbines Inc. participants who are eligible for and who elect to participate in the plan.
Please refer to your summary plan description (SPD) provided at www.catatwork.cat.com > Compensation &
Benefits > Summary Plan Descriptions for additional information.
FOR ADDITIONAL INFORMATION
Visit https://benefits.cat.com/en.html > RX
Prescription Drug Lists & Updates
Obtain the Network Pharmacy Directory
View Rx Videos and Education materials
Visit www.myCatamaranRx.com
Locate Network Pharmacies
View your Explanation of Benefits (EOB)
Obtain specific drug pricing and out of pocket costs
View drug information and interactions
Download the OptumRx/CatamaranRx Mobile App
Call the OptumRx Member Services (formerly Catamaran) number on the back of your ID card
FORMULARY DESIGN
Caterpillar utilizes a clinical team of Physicians and Pharmacists to help ensure that our formulary is medically
sound and supports patients’ health. This team of professionals reviews and evaluates medications that are
placed on the formulary based on safety and efficacy to help maintain clinical integrity.
The formulary is reviewed quarterly for possible additions and deletions. Please note that brand name
medications new to the market will be considered for addition to the formulary at that time. New generics for a
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Caterpillar Drug Formulary
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covered brand name medication may be a covered benefit between quarterly updates upon availability.
If a medication or product that has been prescribed for you or your covered dependents is not on the formulary
(and thus, not covered), you may consult with your physician regarding treatment alternatives. You also have the
option to purchase the medication at full retail cost.
Note: Brand name medications may move to non-preferred status if a generic version becomes available
on the next drug formulary update. This will result in a higher cost share for the member.
PLAN DESIGN
The co-pay for Tier 1 products will be $0 when prescriptions are filled at a Walmart pharmacy (and its affiliates) or
a Kroger pharmacy (and its affiliates).
Plan Design Structure effective January 1, 2016
Co-pay or Co-insurance amounts are based on a 30-day supply unless otherwise noted.
LIMITATIONS
The plan requires as a condition for reimbursement, that if there is a generic medication alternative for a
Brand name medication, the generic medication alternative be obtained first.
There may not be a generic alternative for all dosage strengths of a brand medication.
If a prescription medication is re-classified from a generic to a brand, the brand co-insurance will apply.
OUT OF NETWORK
Some pharmacies may not be able to submit an electronic claim.
The member will be required to pay 100% of the prescription medication cost at the point of service.
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Caterpillar Drug Formulary
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The pharmacy may not be aware of step therapies, prior authorizations, quantity limits or if the
medication is covered under the plan. If one of these is applied to the prescription medication
you purchase, it could possibly reduce or eliminate the amount of your reimbursement.
Submit a Caterpillar Prescription Drug Expense Claim Form to OptumRx for processing. You will
receive an explanation of benefits (EOB) and any applicable reimbursement. The Caterpillar
Prescription Drug Expense Claim Form is available on www.benefits.cat.com > RX > Forms >
Caterpillar Prescription Drug Expense Claim Form.
INDICATORS
MEDICAL BENEFIT CONTACTS
Please note that some items that may be purchased at a pharmacy but are not listed below may be covered
under the medical benefit provisions of the above-referenced plans. If you have questions about coverage under
the medical benefit provisions of the PPO offering, please contact UnitedHealthcare (UHC) at 866-228-4215. If
you have questions about coverage under the medical benefit provisions of the EPO product, please contact Blue
Cross Blue Shield (BCBS) at 844-228-2227.
PATIENT PROTECTION AND AFFORDABLE CARE ACT
The list also includes preventive care medications covered in accordance with the Patient Protection and
Affordable Care Act, as modified by the Healthcare and Education Reconciliation Act of 2010. Certain preventive
care medications are covered at 100% by the Program if you use a Network Provider, and the primary purpose of
your visit is the delivery of such preventive care service. If you use a non-Network Provider, you will be subject to
the applicable Co-pay or Co-insurance. For additional information on preventive care medications covered by the
Program, please visit: www.healthcare.gov/center/regulations/prevention.html,
or www.uspreventiveservicestaskforce.org.
The information regarding alternatives is not intended and should not be construed, in any way, as medical advice, opinion, diagnosis or
as advice about the treatment of any specific medical condition. You should consult with your physician regarding your particular health
needs and whether any of the alternative treatments is right for you. In the event that the content of this document or any representations
made by any person regarding the plan conflict with or are inconsistent with the provisions of the plan document, the provisions of the plan
document are controlling. To the fullest extent permitted by law, Caterpillar reserves the right to amend, modify, suspend, replace or
terminate any of its plans, policies or programs, in whole or in part, at any time and for any reason, by appropriate company action.
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Caterpillar Drug Formulary
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ADHD/ANTI-NARCOLEPSY ...................................................................... 6
ANALGESICS - ANTI-INFLAMMATORY ............................................................. 6
ANALGESICS - NONNARCOTIC ................................................................... 7
ANALGESICS - OPIOID ......................................................................... 7
ANDROGENS-ANABOLIC ....................................................................... 8
ANORECTAL AGENTS .......................................................................... 9
ANTHELMINTICS .............................................................................. 9
ANTIANGINAL AGENTS ......................................................................... 9
ANTIANXIETY AGENTS ........................................................................ 10
ANTIARRHYTHMICS .......................................................................... 10
ANTIBIOTICS ................................................................................ 10
ANTICOAGULANTS ........................................................................... 12
ANTICONVULSANTS .......................................................................... 12
ANTIDEPRESSANTS .......................................................................... 13
ANTIDIABETICS .............................................................................. 14
ANTIDIARRHEALS ............................................................................ 15
ANTIDOTES ................................................................................. 16
ANTIEMETICS ............................................................................... 16
ANTIFUNGALS ............................................................................... 16
ANTIHISTAMINES ............................................................................ 17
ANTIHYPERLIPIDEMICS ....................................................................... 17
ANTIHYPERTENSIVES ......................................................................... 18
ANTIMALARIALS ............................................................................. 19
ANTIMYASTHENIC AGENTS .................................................................... 19
ANTIMYCOBACTERIAL AGENTS ................................................................. 19
ANTINEOPLASTICS .......................................................................... 19
ANTIPARKINSON AGENTS ..................................................................... 20
ANTIPROTOZOAL AGENTS ..................................................................... 21
ANTIPSYCHOTICS/ANTIMANIC AGENTS ........................................................... 21
ANTISEPTICS & DISINFECTANTS ................................................................ 22
ANTIVIRALS ................................................................................. 22
BETA BLOCKERS ............................................................................ 23
CALCIUM CHANNEL BLOCKERS ................................................................ 24
CARDIOTONICS .............................................................................. 24
CARDIOVASCULAR AGENTS - MISC. ............................................................. 24
CHEMICALS ................................................................................. 25
CONTRACEPTIVES ........................................................................... 25
CORTICOSTEROIDS .......................................................................... 26
COUGH/COLD/ALLERGY ....................................................................... 26
DERMATOLOGICALS ......................................................................... 27
DIABETIC SUPPLIES .......................................................................... 31
DIGESTIVE AIDS ............................................................................. 31
DIURETICS .................................................................................. 31
ENDOCRINE AND METABOLIC AGENTS - MISC. ..................................................... 32
ESTROGENS ................................................................................ 33
GASTROINTESTINAL AGENTS - MISC. ............................................................ 33
GENITOURINARY AGENTS ..................................................................... 34
GOUT AGENTS .............................................................................. 35
HEMATOLOGICAL AGENTS - MISC. .............................................................. 35
HEMATOPOIETIC AGENTS ..................................................................... 35
HEMOSTATICS .............................................................................. 36
HYPNOTICS ................................................................................. 36
IMMUNE MEDIATORS ......................................................................... 37
LAXATIVES ................................................................................. 37
MEDICAL DEVICES ........................................................................... 37
MIGRAINE PRODUCTS ........................................................................ 37
MINERALS & ELECTROLYTES .................................................................. 38
MOUTH/THROAT/DENTAL AGENTS .............................................................. 39
MUSCULOSKELETAL THERAPY AGENTS ......................................................... 39
NASAL AGENTS - SYSTEMIC AND TOPICAL ........................................................ 40
NEUROMUSCULAR AGENTS .................................................................... 40
OPHTHALMIC AGENTS ........................................................................ 40
OTIC AGENTS ............................................................................... 42
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OXYTOCICS .................................................................................
PHARMACEUTICAL ADJUVANTS ................................................................
PROGESTINS ................................................................................
PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. ........................................
RESPIRATORY AGENTS .......................................................................
THYROID AGENTS ............................................................................
ULCER DRUGS ..............................................................................
URINARY ANTI-INFECTIVES ....................................................................
URINARY ANTISPASMODICS ...................................................................
URINE TEST STRIPS ..........................................................................
VAGINAL PRODUCTS .........................................................................
VASOPRESSORS .............................................................................
VITAMINS ...................................................................................
43
43
43
43
44
45
46
46
47
47
47
48
48
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Caterpillar Drug Formulary
Generated October 26, 2016
ADHD/ANTI-NARCOLEPSY
Amphetamines
Tier 1
amphetamine/dextroamphet er PA QL
amphetamine/dextroampheta PA QL
dextroamphetamine sulfate PA
methamphetamine hcl PA
ADDERALL PA QL
Tier 3
ADDERALL XR PA QL
DESOXYN PA
DEXEDRINE PA
PROCENTRA PA
Attention-Deficit/Hyperactivity Disorder (ADHD) Agents Misc.
Tier 1
guanfacine hcl
Tier 2
STRATTERA
Tier 3
INTUNIV
Miscellaneous
Tier 1
caffeine citrate
Tier 3
CAFCIT
Stimulants - Misc.
Tier 1
Tier 2
Tier 3
dexmethylphenidate hcl
dexmethylphenidate sr QL
methylin
methylphenidate hcl
methylphenidate hcl er
methylphenidate hcl sr
metadate er 20mg
methylphenidate hcl cd
methylphenidate hcl cr
modafinil PA QL
CONCERTA
DAYTRANA QL
FOCALIN
FOCALIN XR QL
METADATE CD
METHYLIN CHEW & SOLN
RITALIN
RITALIN LA
RITALIN SR
Tier 4
PROVIGIL PA QL
ANALGESICS - ANTI-INFLAMMATORY
Miscellaneous
Tier 1
leflunomide
Tier 2
RIDAURA
Tier 3
ARAVA
RHEUMATREX
ACTEMRA INJ PA SP
ARCALYST PA
ENBREL PA SP
HUMIRA PA SP
KINERET PA
ORENCIA SQ PA SP
SIMPONI SQ PA SP
STELARA SQ PA SP
XELJANZ PA SP
XELJANZ XR PA SP
Tier 4
+
Preventive
PA
Prior Authorization
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
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Caterpillar Drug Formulary
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Nonsteroidal Anti-inflammatory Agents (NSAIDs)
Tier 1
celecoxib QL
diclofenac potassium
diclofenac sodium dr
diclofenac sodium er
diclofenac sodium sr
diclofenac sodium xr
diclofenac-misoprostil
etodolac
etodolac er
fenoprofen cap
flurbiprofen
ibuprofen 400mg
ibuprofen 600mg
ibuprofen 800mg
indomethacin
indomethacin cr
indomethacin er
indomethacin sa
indomethacin sr
ketoprofen
mefenamic acid
meloxicam QL
ketorolac tromethamine
Tier 3
nabumetone
naproxen
naproxen dr
naproxen ec
oxaprozin
piroxicam
sulindac
tolmetin sodium
ANAPROX
ANAPROX DS
ARTHROTEC 50
ARTHROTEC 75
CATAFLAM
CELEBREX QL
CLINORIL
DAYPRO
EC-NAPROSYN
FELDENE
INDOCIN
KETOPROFEN ER
KETOPROFEN ULTRA MICRONIZ
LODINE
MECLOFENAMATE SODIUM
MOBIC QL
NAPRELAN
NAPROSYN
PONSTEL
VOLTAREN GEL PA QL
VOLTAREN XR
ANALGESICS - NONNARCOTIC
Analgesic Combinations
ali-flex
anolor 300
butalbital/acetaminophen
Tier 1
Tier 3
biogesic
butalbital compound
capacet
cephadyn
dologesic
dolorex
duraxin
ed-flex
margesic
marten-tab
promacet
repan
rhinoflex
tencon
zebutal
zflex
BIOREGESIC
DOLGIC PLUS
EQUAGESIC
ESGIC
ESGIC-PLUS
FIORICET
FIORINAL
PHRENILIN FORTE
RELAGESIC
RHINOFLEX-650
STAFLEX
Non-Opioid Analgesic
Tier 3
NUCYNTA ER PA QL
NUCYNTA IR PA QL
Salicylates
Tier 0
aspirin + QL
Tier 1
choline magnesium trisali
diflunisal
salsalate
ANALGESICS - OPIOID
Opioid Agonists
Tier 1
codeine sulfate
fentanyl QL
fentanyl citrate oral tra QL
meperidine hcl
meperitab
methadone hcl
morphine sulfate er tabs
oxycodone hcl
oxycodone solution 5mg/5ml
oxymorphone hcl QL
oxymorphone hcl er QL ST
tramadol hcl QL
+
Preventive
PA
Prior Authorization
QL
Quantity Limitations
ST
Step Therapy
morphine sulfate cr
tramadol hcl er QL
SP
Specialty
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Caterpillar Drug Formulary
Generated October 26, 2016
Opioid Agonists
hydromorphone er
Tier 2
Tier 3
hydromorphone hcl
morphine sulfate er caps
ACTIQ QL
DEMEROL
DILAUDID
DOLOPHINE
DURAGESIC
EXALGO
FENTORA
KADIAN
LEVORPHANOL TARTRATE
METHADOSE
MORPHINE SULFATE
MS CONTIN
OPANA ER QL ST
OPANA IR QL ST
OXYCODONE SOL 5MG/5ML
ULTRAM QL
OXYCONTIN
ULTRAM ER
Opioid Combinations
acetaminophen/codeine #3, #4 QL
asa compound/codeine
Tier 1
Tier 3
apap/caff/dihydrocodeine
butalbital compound/codeinei
butalbital/apap/caff
butalbital/aspirn/caffeine
co-gesic QL
codeine/acetaminophen QL
endocet
endodan
hydrocodone/acetaminophen QL
hydrocodone/ibuprofen
hydrogesic QL
ibudone
oxycodone/acetaminophen
oxycodone/apap soln
oxycodone/aspirin
pentazocine/acetaminophen
roxicet
stagesic QL
tramadol /apap QL
ANEXSIA QL
CAPITAL/CODEINE
FIORICET/CODEINE
HYCET
HYDROCODONE/APAP
LORCET QL
LORCET PLUS QL
LORTAB
MAXIDONE
NORCO QL
PERCOCET
PERCODAN
PRIMLEV
REPREXAIN
ROXICET SOLN
SYNALGOS-DC
TYLOX
ULTRACET QL
XOLOX
ZAMICET
TYLENOL/CODEINE #3, #4 QL
VICOPROFEN
XODOL
ZOLVIT
ZYDONE
Opioid Partial Agonists
buprenorphine hcl sl
Tier 1
Tier 3
buprenorphine-naloxone sl
butorphanol tartrate
pentazocine/naloxone hcl
BUTRANS
SUBOXONE
TALWIN
ANDROGENS-ANABOLIC
Anabolic Steroids
Tier 2
oxandrolone
Tier 3
OXANDRIN
Androgens
danazol
Tier 1
Tier 2
methyltestosterone
testosterone cypionate
testosterone enanthate
testosterone gel 12.5mg
+
Preventive
PA
Prior Authorization
testosterone gel 25mg
QL
Quantity Limitations
ST
Step Therapy
testosterone gel 50mg
SP
Specialty
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Androgens
Tier 3
ANDRODERM
ANDROGEL
ANDROID
DELATESTRYL
DEPO-TESTOSTERONE
METHITEST
METHYLTESTOSTERONE PWD
TESTRED
ANDROXY
STRIANT
TESTIM
VOGELXO
ANORECTAL AGENTS
Intrarectal Steroids
Tier 1
colocort
Tier 2
CORTIFOAM
Tier 3
CORTENEMA
hydrocortisone rectal
Rectal Combinations
Tier 1
lidazone hc
Tier 2
lidocaine hcl/hydrocortis crm
Tier 3
ANALPRAM-HC
PROCTOFOAM HC
LIDOCAINE HCL-HYDROCORTIS GEL
Rectal Steroids
anucort-hc
anusol-hc supp
hydrocortisone acetate
Tier 1
proctocare-hc
proctocream hc
hemorrhoidal-hc
hemril-30
procto-med cre hc 2.5%
procto-pak
proctosol hc
proctozone-hc
rectacort-hc
Tier 3
ANUSOL-HC CRE
PROCTOCORT
ANTHELMINTICS
Antimalarials
Tier 1
ivermectin
Tier 3
ALBENZA
BILTRICIDE
STROMECTOL
ANTIANGINAL AGENTS
Antianginals-Other
Tier 3
RANEXA
Nitrates
Tier 1
isoditrate er
isosorbide dinitrate
isosorbide dinitrate er
isosorbide dinitrate sl
isosorbide mononitrate
isosorbide mononitrate er
minitran
nitro-time
nitroglycerin
nitroglycerin spray
nitroglycerin sr
nitroglycerin transdermal
+
Preventive
PA
Prior Authorization
QL
Quantity Limitations
isosorbide dinitrate sa
nitroglycerin er
ST
Step Therapy
SP
Specialty
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Caterpillar Drug Formulary
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Nitrates
Tier 3
DILATRATE SR
IMDUR
ISORDIL TITRADOSE
NITRO-BID
NITRO-DUR
NITROGLYCERIN LINGUAL
NITROLINGUAL PUMPSPRAY
NITROMIST
NITROSTAT
ANTIANXIETY AGENTS
Antianxiety Agents - Misc.
buspirone hcl
Tier 1
Tier 3
droperidol
hydroxyzine hcl
hydroxyzine pamoate
meprobamate
VISTARIL
Benzodiazepines
Tier 1
Tier 3
alprazolam
alprazolam er
alprazolam odt
alprazolam xr
chlordiazepoxide hcl
clorazepate dipotassium
diazepam tab
lorazepam
oxazepam
ALPRAZOLAM INTENSOL
ATIVAN
DIAZEPAM INTENSOL
NIRAVAM
TRANXENE T
VALIUM
XANAX
XANAX XR
diazepam rectal gel
ANTIARRHYTHMICS
Antiarrhythmics
Tier 1
amiodarone hcl
disopyramide phosphate
dofetilide
flecainide acetate
mexiletine hcl
pacerone
procainamide hcl er
propafenone hcl
propafenone hcl er
quinidine gluconate cr
quinidine gluconate er
quinidine sulfate
CORDARONE
MULTAQ
NORPACE
NORPACE CR
RYTHMOL
RYTHMOL SR
TAMBOCOR
TIKOSYN
quinidine sulfate er
Tier 3
ANTIBIOTICS
Aminoglycosides
Tier 1
gentamicin inj PA
Tier 2
tobramycin neb PA QL SP
Tier 3
AMIKACIN SULFATE PA
Tier 4
TOBI PA QL
neomycin sulfate
tobramycin inj PA
Azithromycin
Tier 1
azithromycin
Tier 3
ZITHROMAX
+
Preventive
PA
Prior Authorization
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
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Cephalosporins - 1st Generation
Tier 1
cefadroxil
Tier 3
KEFLEX
cephalexin
Cephalosporins - 2nd Generation
Tier 1
cefaclor
cefprozil
Tier 3
CEFACLOR ER
CEFTIN
cefuroxime axetil
Cephalosporins - 3rd Generation
Tier 1
cefixime susp
cefpodoxime proxetil
Tier 2
cefdinir
ceftibuten
Tier 3
CEDAX
CEFDITOREN PIVOXIL
SPECTRACEF
SUPRAX
Clarithromycin
Tier 1
clarithromycin
clarithromycin er
Tier 3
BIAXIN
BIAXIN XL
BIAXIN XL PAC
Erythromycins
Tier 1
Tier 3
erythromycin cap ec
erythromycin ethylsuccina
erythromycin gel
E.E.S. 400
E.E.S. GRANULES
ERY-TAB
ERYPED 200
ERYPED 400
ERYTHROCIN STEARATE
ERYTHROMYCIN
ERYTHROMYCIN BASE
ERYTHROMYCIN STEARATE
PCE
Fidaxomicin
Tier 3
DIFICID PA QL
Fluoroquinolones
ciprofloxacin er
Tier 1
Tier 3
levofloxacin
levofloxacin inj PA
moxifloxacin
AVELOX
CIPRO
CIPRO XR
FACTIVE
LEVAQUIN TABS
NOROXIN
ofloxacin
Misc.- Combinations
e.s.p.
Tier 1
Tier 3
erythromycin/sulfisoxazol
smz-tmp ds
sulfamethoxazole/trimetho
BACTRIM
BACTRIM DS
Miscellaneous
Tier 1
clindamycin hcl
clindamycin palmitate hcl
colistimethate sodium
dapsone
linezolid susp
linezolid tbs
metronidazole
tinidazole
trimethoprim
vancomycin hcl inj PA
+
Preventive
PA
Prior Authorization
clindamycin phos inj PA
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
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Miscellaneous
Tier 2
vancomycin caps
BACITRACIN OINT
CHLORAMPHENICOL
CLEOCIN PEDIATRIC GRANULE
Tier 3
Tier 4
CLEOCIN CAPS
CLEOCIN PHOSPHATE
COLY-MYCIN M PA
FLAGYL
FLAGYL ER
KETEK
PRIMSOL
SIVEXTRO
TINDAMAX
VANCOCIN HCL
VANCOMYCIN ORAL SOLN
XIFAXAN PA QL
ZYVOX
CAYSTON PA
IMPAVIDO
amoxicillin/clavulanate
ampicillin
dicloxacillin sodium
AUGMENTIN ES-600
AUGMENTIN XR
Penicillins
amoxicillin
Tier 1
Tier 3
penicillin vk
AUGMENTIN
Tetracyclines
demeclocycline hcl
Tier 1
Tier 3
doxycycline hyclate 20mg tb
doxycycline hyclate caps
doxycycline monohydrate caps
minocycline hcl
morgidox
DYNACIN
MINOCIN
MONODOX
TETRACYCLINE HCL
VIBRAMYCIN
ANTICOAGULANTS
Coumarin Anticoagulants
Tier 1
jantoven +
Tier 3
COUMADIN +
warfarin sodium +
Direct Factor Xa Inhibitors
Tier 3
ELIQUIS +
SAVAYSA +
XARELTO +
Heparins And Heparinoid-Like Agents
Tier 1
heparin sodium +
Tier 2
enoxaparin sodium +
fondaparinux sodium +
Tier 3
ARIXTRA +
FRAGMIN +
LOVENOX +
Thrombin Inhibitors
Tier 3
PRADAXA +
ANTICONVULSANTS
Benzodiazepines
Tier 1
clonazepam
+
Preventive
PA
Prior Authorization
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
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Caterpillar Drug Formulary
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Benzodiazepines
Tier 3
DIASTAT
KLONOPIN
ONFI PA
ONFI SUSP PA
Carbamates
Tier 1
felbamate
Tier 3
FELBATOL
GABA Modulators
Tier 1
tiagabine hydrochloride
Tier 3
GABITRIL
SABRIL
Hydantoins
Tier 1
phenytoin
phenytoin sodium extended
Tier 3
DILANTIN
PHENYTEK
Miscellaneous
Tier 1
carbamazepine
carbamazepine er
epitol
gabapentin
lamotrigine
levetiracetam
levetiracetam er
oxcarbazepine
primidone
roweepra
topiragen
topiramate
BANZEL
BRIVIACT SOLN PA
BRIVIACT TAB PA
CARBATROL
FYCOMPA PA
KEPPRA
LAMICTAL
LAMICTAL XR
LYRICA
LYRICA SOL
MYSOLINE
NEURONTIN
POTIGA PA QL
QUDEXY XR ST
TEGRETOL
TEGRETOL-XR
TOPAMAX
TRILEPTAL
TROKENDI XR ST
VIMPAT PA
zonisamide
Tier 3
ZONEGRAN
Succinimides
Tier 1
ethosuximide
Tier 3
ZARONTIN
Valproic Acid
Tier 1
divalproex sodium
divalproex sodium dr
divalproex sodium er
valproic acid
Tier 3
DEPAKENE
DEPAKOTE
DEPAKOTE ER
DEPAKOTE SPRINKLES
ANTIDEPRESSANTS
Alpha-2 Receptor Antagonists (Tetracyclics)
Tier 1
mirtazapine
Tier 3
REMERON
+
Preventive
mirtazapine odt
PA
Prior Authorization
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
13 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Miscellaneous
Tier 1
Tier 3
budeprion sr
bupropion hcl
bupropion hcl er
bupropion hcl xl
nefazodone hcl
trazodone hcl
MAPROTILINE HCL
WELLBUTRIN
WELLBUTRIN SR
bupropion hcl sr
WELLBUTRIN XL
Monoamine Oxidase Inhibitors (MAOIs)
Tier 1
phenelzine sulfate
tranylcypromine sulfate
Tier 3
EMSAM PA QL
NARDIL
PARNATE
Selective Serotonin Reuptake Inhibitors (SSRIs)
citalopram hydrobromide
Tier 1
escitalopram oxalate
fluoxetine dr QL ST
fluvoxamine maleate
paroxetine hcl
paroxetine hcl er PA ST
CELEXA
LEXAPRO
PAXIL
PAXIL CR PA ST
PEXEVA PA ST
PROZAC
PROZAC WEEKLY PA QL ST
SELFEMRA PA
ZOLOFT
fluoxetine hcl
sertraline hcl
Tier 3
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Tier 1
duloxetine
venlafaxine hcl cap
Tier 3
CYMBALTA
EFFEXOR XR PA ST
venlafaxine hcl er cap
Tricyclic Agents
Tier 1
Tier 2
Tier 3
amitriptyline hcl
desipramine hcl
doxepin hcl
imipramine hcl
imipramine pamoate
nortriptyline hcl
protriptyline hcl
trimipramine maleate
AMOXAPINE
ANAFRANIL
NORPRAMIN
PAMELOR
SURMONTIL
TOFRANIL
TOFRANIL-PM
VIVACTIL
clomipramine hcl
ANTIDIABETICS
Alpha-Glucosidase Inhibitors
Tier 1
acarbose +
miglitol +
Tier 3
GLYSET +
PRECOSE +
Antidiabetic - Amylin Analogs
Tier 3
SYMLIN + PA
Antidiabetic Combinations
Tier 0
glyburide/metformin hcl +
glipizide/metformin hcl +
Tier 1
pioglitazone hcl/metformi +
pioglitazone-glimepiride +
+
Preventive
PA
Prior Authorization
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
14 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Antidiabetic Combinations
Tier 3
ACTOPLUS MET +
DUETACT +
GLUCOVANCE +
Biguanides
Tier 0
metformin hcl +
metformin hcl er +
Tier 3
GLUCOPHAGE +
GLUCOPHAGE XR +
RIOMET +
Diabetic Other
Tier 2
GLUCAGEN
Tier 4
KORLYM PA
GLUCAGEN HYPOKIT
GLUCAGON EMERGENCY KIT
Incretin Mimetic Agents (GLP-1 Receptor Agonists)
Tier 3
BYETTA + PA
VICTOZA + PA
Insulin
Tier 0
Tier 1
Tier 2
Tier 3
HUMULIN N VIAL +
HUMULIN R VIAL +
NOVOLIN 70/30 RELION +
NOVOLIN N VIAL +
NOVOLIN R RELION +
NOVOLIN R VIAL +
NOVOLOG MIX 70/30 VIAL +
NOVOLOG VIAL +
LANTUS VIAL +
NOVOLIN PENS +
NOVOLOG MIX 70/30 PREFILL +
NOVOLIN N RELION +
NOVOLOG FLEXPEN +
NOVOLOG PENFILL +
APIDRA VIAL +
HUMALOG MIX 50/50 VIAL +
LANTUS SOLOSTAR + PA
LEVEMIR VIAL +
HUMALOG MIX 75/25 VIAL +
HUMALOG VIAL +
Insulin Sensitizing Agents
Tier 1
pioglitazone hcl +
Tier 3
ACTOS +
AVANDIA +
Meglitinide Analogues
Tier 1
nateglinide +
repaglinide +
Tier 3
PRANDIN +
STARLIX +
Sulfonylureas
glimepiride +
glipizide +
glyburide +
glyburide micronized +
Tier 1
chlorpropamide +
tolazamide +
tolbutamide +
Tier 3
AMARYL +
GLUCOTROL +
GLUCOTROL XL +
Tier 0
glipizide er +
glipizide xl +
GLYNASE +
ANTIDIARRHEALS
Antiperistaltic Agents
Tier 1
diphenatol
diphenoxylate/atropine
loperamide hcl
opium tincture
+
Preventive
PA
Prior Authorization
lofene
QL
Quantity Limitations
lonox
ST
Step Therapy
SP
Specialty
15 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Antiperistaltic Agents
Tier 3
LOMOTIL
MOTOFEN
PAREGORIC
Miscellaneous
Tier 3
MYTESI PA
ANTIDOTES
Chelating Agents-Misc.
Tier 2
CUPRIMINE
Tier 3
CHEMET
DEPEN TITRATABS
Tier 4
EXJADE PA
FERRIPROX PA
JADENU PA
Opioid Antagonists
Tier 1
depade
Tier 3
REVIA
naltrexone hcl
ANTIEMETICS
5-HT3 Receptor Antagonists
Tier 1
Tier 3
granisetron hcl QL
ondansetron hcl QL
ondansetron odt
ANZEMET INJ QL
ANZEMET TABS QL
GRANISOL QL
ZOFRAN
ZOFRAN ODT
SANCUSO PA QL
Antiemetics - Anticholinergic
Tier 1
trimethobenzamide hcl
Tier 3
TIGAN
TRANSDERM-SCOP
Antiemetics - Miscellaneous
Tier 1
dronabinol
Tier 3
DICLEGIS QL
Tier 4
EMEND SUS PA QL
EMEND CAP PA QL
MARINOL
ANTIFUNGALS
Antifungals
Tier 1
bio-statin
Tier 2
flucytosine
Tier 3
griseofulvin microsize
terbinafine hcl
AMPHOTERICIN B PA
ANCOBON
CRESEMBA PA
GRIS-PEG
LAMISIL
+
Preventive
PA
Prior Authorization
QL
Quantity Limitations
ST
Step Therapy
GRIFULVIN V
SP
Specialty
16 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Imidazole-Related Antifungals
Tier 1
fluconazole
Tier 2
voriconazole PA
DIFLUCAN
Tier 3
fluconazole 150mg QL
itraconazole
ketoconazole
DIFLUCAN 150MG QL
NOXAFIL PA
SPORANOX
VFEND PA
ANTIHISTAMINES
Antihistamines - Alkylamines
AHIST
Tier 3
BROMPHENIRAMINE TANNATE
DEXCHLORPHENIRAMINE MALEA
ED CHLORPED
ED-CHLOR-TAN
RESPA-BR
Antihistamines - Ethanolamines
Tier 1
arbinoxa
Tier 3
PALGIC
carbinoxamine maleate
clemastine fumarate
diphenhydramine hcl
Antihistamines - Phenothiazines
Tier 1
Tier 3
phenadoz
promethazine hcl
promethegan 25mg supp
promethegan tabs
PHENERGAN
promethegan 50mg supp
promethegan 12.5mg supp
Antihistamines - Piperidines
Tier 1
cyproheptadine hcl
ANTIHYPERLIPIDEMICS
Bile Acid Sequestrants
Tier 1
cholestyramine +
Tier 2
WELCHOL +
Tier 3
COLESTID +
cholestyramine light +
colestipol hcl +
QUESTRAN +
QUESTRAN LIGHT +
prevalite +
Fibric Acid Derivatives
fenofibrate +
Tier 1
Tier 3
fenofibrate 130mg + ST
fenofibrate micronized +
fenofibrate 43mg + ST
fenofibric acid + ST
gemfibrozil +
LOPID + ST
HMG CoA Reductase Inhibitors
Tier 0
Tier 1
atorvastatin calcium +
lovastatin + QL
rosuvastatin PA QL ST
simvastatin + QL
fluvastatin + QL
fluvastatin xl + PA ST
+
Preventive
PA
Prior Authorization
pravastatin sodium + QL
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
17 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
HMG CoA Reductase Inhibitors
Tier 3
ALTOPREV + PA QL ST
CRESTOR + PA QL ST
LESCOL + QL
LESCOL XL + PA ST
LIPITOR + QL
MEVACOR + QL
PRAVACHOL + QL
ZOCOR + QL
Intestinal Cholesterol Absorption Inhibitors
Tier 2
ZETIA + PA QL ST
Nicotinic Acid Derivatives
Tier 1
niacin er tab +
Tier 3
NIASPAN +
ANTIHYPERTENSIVES
ACE Inhibitors
Tier 0
Tier 1
Tier 3
benazepril hcl +
captopril +
enalapril maleate +
lisinopril +
fosinopril sodium +
moexipril hcl +
perindopril erbumine +
quinapril hcl +
ramipril +
trandolapril +
ACCUPRIL +
ACEON +
ALTACE +
EPANED ORAL SOL + PA
LOTENSIN +
MAVIK +
PRINIVIL +
QBRELIS + PA
VASOTEC +
ZESTRIL +
Angiotensin II Receptor Antagonists
Tier 1
Tier 3
candesartan +
eprosartan mesylate +
telmisartan +
valsartan +
ATACAND +
AVAPRO +
DIOVAN +
MICARDIS +
irbesartan +
losartan potassium +
BENICAR + PA ST
COZAAR +
Antiadrenergic Antihypertensives
Tier 1
Tier 3
clonidine hcl +
doxazosin mesylate +
prazosin hcl +
terazosin hcl +
CARDURA +
CATAPRES +
RESERPINE +
TENEX +
guanfacine hcl +
methyldopa +
CATAPRES-TTS +
MINIPRESS +
Antihypertensive Combinations
Tier 0
Tier 1
captopril hctz +
enalapril hctz +
amlodipine/benazapril +
atenolol/chlorthalidone +
bisoprolol hctz +
candesartan hctz +
eprosartan mesylate hctz +
fosinopril hctz +
irbesartan hctz +
losartan potassium hctz +
methyldopa hctz +
metoprolol hctz +
moexipril hctz +
nadolol/bendroflumethiazi +
propranolol hctz +
quinapril hctz +
telmisartan hctz +
trandolapril/verapamil + ST
+
Preventive
PA
Prior Authorization
lisinopril hctz +
valsartan hctz +
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
18 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Antihypertensive Combinations
Tier 3
ACCURETIC +
ATACAND HCTZ +
AVALIDE +
BENICAR HCTZ + PA ST
CLORPRES +
CORZIDE +
DIOVAN HCTZ +
ENTRESTO + PA
HYZAAR +
LOPRESSOR HCTZ +
LOTENSIN HCTZ +
LOTREL +
MICARDIS HCTZ +
TARKA + ST
TENORETIC +
VASERETIC +
ZESTORETIC +
ZIAC +
phenoxybenzamine +
Miscellaneous
Tier 1
eplerenone +
hydralazine hcl +
minoxidil +
Tier 3
DIBENZYLINE +
INSPRA +
PHENTOLAMINE MESYLATE
ANTIMALARIALS
Antimalarials
Tier 1
Tier 3
atovaquone/proguanil hcl
chloroquine phosphate
hydroxychloroquine sulfat
mefloquine hcl
quinine sulf 324mg PA
MALARONE
PLAQUENIL
ARALEN
COARTEM
PRIMAQUINE PHOSPHATE
QUALAQUIN PA
ANTIMYASTHENIC AGENTS
Antimyasthenic Agents
Tier 1
pyridostigmine bromide
Tier 3
MESTINON
MESTINON TIMESPAN
PROSTIGMIN
ANTIMYCOBACTERIAL AGENTS
Antibacterial Agents
Tier 1
rifabutin
Tier 3
MYCOBUTIN
Antimycobacterial Agents
Tier 1
ethambutol hcl
isoniazid tb
rifampin
Tier 3
ISONIAZID SYRP
MYAMBUTOL
RIFADIN
Tier 4
SIRTURO
ANTINEOPLASTICS
Alkylating Agents
Tier 2
CYCLOPHOSPHAMIDE CAPS
temozolomide PA SP
Tier 3
ALKERAN
LEUKERAN
Tier 4
HEXALEN PA SP
TEMODAR PA SP
+
Preventive
PA
Prior Authorization
LOMUSTINE
QL
Quantity Limitations
MYLERAN
ST
Step Therapy
SP
Specialty
19 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Antineoplastic Enzyme Inhibitors
Tier 2
Tier 4
imatinib PA SP
AFINITOR PA SP
ALECENSA PA
BOSULIF PA
CAPRELSA PA
GILOTRIF PA
GLEEVEC PA SP
IMBRUVICA PA
INLYTA PA
JAKAFI PA
NEXAVAR PA
SPRYCEL PA SP
STIVARGA PA
SUTENT PA
TARCEVA PA SP
TASIGNA PA SP
TYKERB PA SP
VOTRIENT PA SP
XALKORI PA
ZELBORAF PA SP
ZOLINZA PA QL SP
ZORTRESS
Antineoplastics Misc.
Tier 1
Tier 2
Tier 3
Tier 4
anastrozole
bexarotene oral PA SP
bicalutamide
exemestane
flutamide
hydroxyurea
letrozole
leuprolide acetate
megestrol acetate
mercaptopurine
methotrexate
tamoxifen citrate +
capecitabine PA SP
FARESTON
TABLOID
ACTIMMUNE
ARIMIDEX
AROMASIN
CASODEX
ELIGARD
EMCYT
ETOPOSIDE
FEMARA
HYDREA
LUPRON DEPOT SP
MATULANE
MEGACE ORAL
nilutamide PA SP
OFORTA PA
PURINETHOL
PURIXAN SUS PA
SOLTAMOX
TREXALL
ERIVEDGE PA
HYCAMTIN PA SP
INTRON-A PA SP
LONSURF PA
LYSODREN PA SP
NILANDRON PA SP
SYLATRON PA SP
TARGRETIN ORAL PA SP
XELODA PA SP
XTANDI PA
ZYTIGA PA SP
Chemotherapy Rescue/Antidote Agents
Tier 1
leucovorin calcium
Tier 3
MESNEX
Immunomodulators
Tier 4
POMALYST PA SP
REVLIMID PA SP
THALOMID PA SP
ANTIPARKINSON AGENTS
Antiparkinson Anticholinergics
Tier 1
benztropine mesylate
trihexyphenidyl hcl
Antiparkinson COMT Inhibitors
Tier 1
ENTACAPONE
tolcapone
Tier 3
COMTAN
TASMAR
+
Preventive
PA
Prior Authorization
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
20 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Antiparkinson Dopaminergics
Tier 1
amantadine hcl
bromocriptine mesylate
carbidopa/levodopa
carbidopa/levodopa er
carbidopa/levodopa odt
carbidopa/levodopa sr
carbidopa/levodopa/entaca
carbidopa/levodopa cr
pramipexole
ropinirole er PA
ropinirole hcl
Tier 3
MIRAPEX
NEUPRO PATCH PA
PARCOPA
PARLODEL
REQUIP
REQUIP XL PA
SINEMET
SINEMET CR
STALEVO
Tier 4
DUOPA
Antiparkinson Monoamine Oxidase Inhibitors
Tier 1
selegiline hcl cap
Tier 3
AZILECT QL
ELDEPRYL
Miscellaneous
Tier 2
carbidopa
ANTIPROTOZOAL AGENTS
Antiprotozoal Agents
Tier 2
atovaquone
Tier 3
ALINIA
MEPRON
ANTIPSYCHOTICS/ANTIMANIC AGENTS
Antimanic Agents
Tier 1
lithium carbonate
lithium carbonate er
Tier 3
LITHIUM CARBONATE
LITHIUM CITRATE
LITHOBID
Butyrophenones
Tier 1
haloperidol
haloperidol decanoate
Tier 3
HALDOL
HALDOL DECANOATE
haloperidol lactate
Dibenzapines
Tier 1
clozapine
Tier 2
SEROQUEL XR QL ST
Tier 3
loxapine
olanzapine
quetiapine fumarate
CLOZARIL
LOXITANE
SAPHRIS PA QL
SEROQUEL IR
ZYPREXA
ZYPREXA SOLN
ZYPREXA ZYDIS
Miscellaneous
Tier 1
aripiprazole
+
Preventive
risperidone
PA
Prior Authorization
thiothixene
QL
Quantity Limitations
ziprasidone hcl
ST
Step Therapy
SP
Specialty
21 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Miscellaneous
ABILIFY
Tier 3
Tier 4
EQUETRO
GEODON
LATUDA PA
fluphenazine hcl
perphenazine
RISPERDAL
NUPLAZID PA QL
Phenothiazines
chlorpromazine hcl
Tier 1
prochlorperazine edisylat
thioridazine hcl
Tier 3
compro
prochlorperazine maleate
trifluoperazine hcl
FLUPHENAZINE DECANOATE
ANTISEPTICS & DISINFECTANTS
Antiseptics & Disinfectants
Tier 1
formadon
Tier 3
FORMA-RAY
FORMALDEHYDE
POTASSIUM PERMANGANATE
Chlorine Antiseptics
Tier 3
CHLORHEXIDINE GLUCONATE
PHISOHEX
ANTIVIRALS
Antiretrovirals
abacav/lamiv/zido SP
Tier 1
Tier 2
Tier 3
Tier 4
abacavir SP
lamivudine/zidovudine SP
didanosine
lamivudine SP
nevirapine SP
nevirapine er SP
stavudine
zidovudine
abacav/sulf/lamiv SP
APTIVUS CAPS
ATRIPLA SP
COMPLERA SP
CRIXIVAN
DESCOVY SP
EDURANT
EMTRIVA SP
INTELENCE SP
INVIRASE CAPS
ISENTRESS POW PACK PA SP
ISENTRESS TAB SP
KALETRA SP
LEXIVA
NORVIR SP
PREZISTA SP
RESCRIPTOR
REYATAZ SP
SELZENTRY SP
STRIBILD SP
SUSTIVA SP
TIVICAY SP
TRUVADA PA SP
VIRACEPT 250
VIREAD 300MG SP
VITEKTA SP
ZIAGEN SOLN SP
APTIVUS SOLN
COMBIVIR SP
EPIVIR SP
EPZICOM SP
GENVOYA SP
INVIRASE TB
RETROVIR
TRIUMEQ SP
TRIZIVIR SP
VIDEX
VIDEX EC
VIRACEPT 625
VIRAMUNE SUS SP
VIRAMUNE TAB SP
VIRAMUNE XR SP
VIREAD SP
ZERIT
ZIAGEN TB SP
EVOTAZ SP
FUZEON PA SP
ODEFSEY SP
PREZCOBIX SP
TYBOST SP
+
Preventive
PA
Prior Authorization
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
22 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
CMV Agents
Tier 2
valganciclovir
Tier 3
VALCYTE SOLN
VALCYTE TB
Hepatitis Agents
Tier 1
entecavir PA SP
Tier 2
adefovir dipivoxil PA SP
Tier 3
Tier 4
ribasphere SP
ribavirin SP
BARACLUDE PA SP
COPEGUS SP
MODERIBA SP
REBETOL SP
RIBAPAK SP
RIBATAB SP
DAKLINZA PA SP
EPCLUSA PA SP
HARVONI PA SP
HEPSERA PA SP
INCIVEK PA SP
OLYSIO PA SP
PEG-INTRON PA QL SP
PEGASYS PA SP
SOVALDI PA SP
TECHNIVIE PA SP
TYZEKA PA SP
VIEKIRA PA SP
VIEKIRA XR PA SP
Herpes Agents
Tier 1
acyclovir
famciclovir
valacyclovir hcl
Tier 3
FAMVIR
VALTREX
ZOVIRAX ORAL
Influenza Agents
Tier 1
rimantadine hcl
Tier 3
FLUMADINE
BETA BLOCKERS
Alpha-Beta Blockers
Tier 1
carvedilol +
Tier 3
COREG +
labetalol hcl +
Beta Blockers Cardio-Selective
acebutolol hcl +
Tier 1
Tier 3
atenolol +
betaxolol hcl +
metoprolol succinate er +
bisoprolol fumarate +
metoprolol tartrate +
KERLONE +
LOPRESSOR +
TOPROL XL +
ZEBETA +
SECTRAL +
TENORMIN +
Beta Blockers Non-Selective
Tier 1
Tier 3
nadolol +
pindolol +
propranolol hcl +
sorine +
sotalol hcl +
timolol maleate +
BETAPACE +
CORGARD +
INDERAL LA +
INNOPRAN XL +
LEVATOL +
SOTYLIZE + PA
+
Preventive
PA
Prior Authorization
QL
Quantity Limitations
ST
Step Therapy
propranolol hcl er +
INDERAL XL +
SP
Specialty
23 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
CALCIUM CHANNEL BLOCKERS
Calcium Channel Blockers
Tier 1
Tier 3
afeditab cr +
amlodipine besylate +
cartia xt +
dilt-xr +
diltiazem +
diltiazem cd +
diltiazem er +
diltiazem sr +
diltzac +
felodipine er +
isradipine +
matzim la +
nicardipine hcl +
nifediac cc +
nifedical xl +
nifedipine +
nifedipine er +
nimodipine + QL
nisoldipine +
nisoldipine er +
taztia xt +
verapamil hcl +
verapamil hcl cr +
verapamil hcl er +
verapamil hcl sa +
verapamil hcl sr +
ADALAT CC +
CALAN +
CALAN SR +
CARDIZEM +
CARDIZEM CD +
CARDIZEM LA +
ISOPTIN SR +
NORVASC +
PROCARDIA +
PROCARDIA XL +
SULAR +
TIAZAC +
VERELAN +
VERELAN PM +
CARDIOTONICS
Cardiac Glycosides
Tier 1
digoxin
Tier 3
LANOXIN
digoxin solution
CARDIOVASCULAR AGENTS - MISC.
Impotence Agents
Tier 3
CAVERJECT
CAVERJECT IMPULSE
CIALIS QL
EDEX
LEVITRA QL
MUSE
STAXYN QL
VIAGRA QL
Misc. - Combinations
Tier 1
isosorb dinitrate/hyral QL
Tier 3
BIDIL QL
Miscellaneous
Tier 1
papaverine hcl
Tier 3
ISOXSUPRINE HCL
Tier 4
CORLANOR
Pulmonary Hypertension
Tier 2
Tier 4
sildenafil PA QL SP
ADCIRCA PA QL SP
ADEMPAS PA
LETAIRIS PA QL
ORENITRAM PA
REVATIO PA QL SP
TRACLEER PA QL
+
Preventive
PA
Prior Authorization
QL
Quantity Limitations
ST
Step Therapy
OPSUMIT PA QL
SP
Specialty
24 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
CHEMICALS
Solids
Tier 3
BORIC ACID
CONTRACEPTIVES
Combination Contraceptives - Oral
Tier 0
altavera +
alyacen 1/35 +
alyacen 7/7/7 +
amethia +
amethia lo +
apri +
aranelle +
aviane +
azurette +
balziva +
briellyn +
camrese +
camrese lo +
caziant +
cesia +
cryselle +
cryselle-28 +
cyclafem 1/35 +
cyclafem 7/7/7 +
dasetta 1/35 +
dasetta 7/7/7 +
daysee +
elinest +
emoquette +
enpresse-28 +
estarylla +
falmina +
femynor +
gianvi +
gildess fe 1.5/30 +
gildess fe 1/20 +
INTROVALE +
jolessa +
junel 1.5/30 +
junel 1/20 +
junel fe 1.5/30 +
junel fe 1/20 +
kariva +
kelnor 1/35 +
kurvelo +
leena +
lessina-28 +
levo/ethi/estradio +
levonest +
levora 0.15/30-28 +
loryna +
low-ogestrel +
lutera +
marlissa +
microgestin 1.5/30 +
microgestin 1/20 +
microgestin fe +
microgestin fe 1.5/30 +
mono-linyah +
mononessa +
myzilra +
necon 0.5/35-28 +
necon 1/35-28 +
necon 7/7/7 +
noreth/ethinyl/ferr fum +
Tier 3
norgestimate/ethinyl estr +
nortrel 0.5/35 (28) +
nortrel 1/35 (21) +
nortrel 1/35 (28) +
nortrel 7/7/7 +
ocella +
orsythia +
philith +
portia-28 +
previfem +
quanese +
QUARTETTE +
reclipsen +
solia +
sprintec 28 +
sronyx +
syeda +
tilia fe +
tri-estarylla +
tri-legest fe +
tri-linyah +
tri-lo-estarylla +
tri-lo-marzia +
tri-lo-sprintec +
tri-previfem +
tri-sprintec +
trinessa +
trinessa lo +
trivora-28 +
velivet +
VESTURA +
viorele +
wera +
wymzya fe +
zarah +
zenchent +
zenchent fe +
zeosa +
zovia 1/35e +
AMETHYST
BREVICON-28
CYCLESSA
DESOGEN
ESTROSTEP FE
FEMCON FE
LO LOESTRIN FE
LOESTRIN 1.5/30-21
LOESTRIN 1/20-21
LOESTRIN 24 FE
LOESTRIN FE 1.5/30
LOESTRIN FE 1/20
MIRCETTE
MODICON
MODICON-28
NECON 1/50-28
NORDETTE-28
NORINYL 1+35
NORINYL 1+50
OGESTREL
ORTHO TRI-CYCLEN
ORTHO TRI-CYCLEN LO
ORTHO-CEPT
ORTHO-CYCLEN
ORTHO-CYCLEN-28
ORTHO-NOVUM 1/35-28
ORTHO-NOVUM 7/7/7
ORTHO-NOVUM 7/7/7-28
OVCON-35
TRI-NORINYL 28
YASMIN 28
YAZ
ZOVIA 1/50E
+
Preventive
PA
Prior Authorization
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
25 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Combination Contraceptives - Transdermal
Tier 0
XULANE +
Combination Contraceptives - Vaginal
Tier 0
NUVARING +
Device-Diaphragm
Tier 0
OMNIFLEX ALL +
ORTHOFLEX ALL +
Miscellaneous
Tier 0
Tier 3
cervical caps +
condoms (female) +
spermicides gel +
sponges (contraceptives) +
spermicides (foam, film, supp) +
CONCEPTROL GEL +
Progestin Contraceptives - Injectable
Tier 0
DEPO-SUBQ PROVERA 104 +
Tier 3
DEPO-PROVERA CONTRACEPTIV
medroxyprogesterone im +
Progestin Contraceptives - Oral
Tier 0
Tier 3
camila +
errin +
heather +
nora-be +
norethindrone +
NOR-QD
ORTHO MICRONOR
jolivette +
CORTICOSTEROIDS
Glucocorticosteroids
Tier 1
Tier 2
a-hydrocort
a-methapred
asmalpred
baycadron
cortisone acetate
dexamethasone
fludrocortisone acetate
hydrocortisone
methylprednisolone
methylprednisolone dose pak
prednisolone
prednisone
budesonide cap
CELESTONE
CORTEF
DEPO-MEDROL
DEXAMETHASONE INTENSOL
Tier 3
asmalpred plus
DEXPAK 10 DAY
DEXPAK 13 DAY
DEXPAK 6 DAY
ENTOCORT EC
KENALOG-10
KENALOG-40
MEDROL
MEDROL DOSEPAK
MILLIPRED
ORAPRED
PREDNISONE INTENSOL
PRELONE
SOLU-CORTEF
SOLU-MEDROL
COUGH/COLD/ALLERGY
Antitussives
benzonatate
Tier 1
hydrocodone/homatropine
hydromet
tussigon
+
Preventive
PA
Prior Authorization
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
26 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Antitussives
Tier 3
TESSALON
TESSALON PERLES
ZONATUSS
Miscellaneous
Tier 1
acetylcysteine
sodium chloride neb
Tier 3
HYPER-SAL
NEBUSAL
DERMATOLOGICALS
Acne Products
adapalene
avar cleanser
avar-e emollient
avita crm PA
avita gel PA
cerisa wash
clindacin-p
clindamax
ery
myorisan
clindamycin phosphate topical
Tier 1
Tier 2
Tier 3
prascion
prascion fc
prascion ra with sunscree
rosanil cleanser
rosula pad 10-5%
sodium sulfacetamide
tretinoin crm/gel PA
tretinoin gel 0.1% PA
tretinoin micro gel PA
virti-sulf
zenatane
claravis
tretinoin caps
ABSORICA CAP
AKNE-MYCIN
ATRALIN GEL PA
AZELEX
CLEOCIN-T
CLINDAGEL
DIFFERIN
ERYTHROMYCIN TOP
EVOCLIN
KLARON
METRONIDAZOLE BENZOATE
NUOX
RETIN-A PA
RETIN-A MICRO PA
SODIUM SULFACETAMIDE/SULF
TRETIN-X PA
VANOXIDE-HC
ZIANA
VELTIN
TRETINOIN GEL 0.04% PA
Antibiotics - Topical
Tier 2
mupirocin
ALTABAX
Tier 3
BACTROBAN
CENTANY
CORTISPORIN
GENTAMICIN SULFATE
Antifungals - Topical
Tier 1
ciclodan
ciclopirox
clotrimazole/betamethason
dermazene
econazole nitrate
exoderm
hydrocortisone/iodoquinol
ketoconazole top
nyamyc
nystatin/triamcinolone
nystop
oxiconazole cre
ALA QUIN
ALCORTIN A
CLIOQUINOL
ERTACZO
EXELDERM
LOPROX
LOPROX SHAMPOO
LOTRISONE
MICONAZOLE NITRATE
NIZORAL
OXISTAT
nystatin top
pedi-dri
Tier 3
Antineoplastic or Premalignant Lesion Agents - Topical
Tier 1
fluorouracil
+
Preventive
tretinoin crm/gel PA
PA
Prior Authorization
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
27 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Antineoplastic or Premalignant Lesion Agents - Topical
Tier 2
CARAC
diclofenac gel 3%
FLUOROPLEX
Tier 3
EFUDEX
SOLARAZE
TOLAK CRE
Tier 4
TARGRETIN TOP PA SP
VALCHLOR GEL 0.16% PA
Antipruritics - Topical
Tier 1
doxepin hcl cre
Tier 3
PRUDOXIN
ZONALON
Antipsoriatics
Tier 1
acitretin
Tier 2
TAZORAC PA
Tier 3
Tier 4
calcipotriene sol
methoxalen
8-MOP
CALCIPOTRIENE OINT
CALCITRENE
OXSORALEN ULTRA
SORIATANE
COSENTYX PA SP
TALTZ PA
DRITHO-CREME HP
Antiseborrheic Products
mexar wash
Tier 1
OVACE PLUS
Tier 3
re 10 wash
seb-prev wash
selenium sulfide
OVACE PLUS WASH
OVACE WASH
SEB-PREV
sodium sulfacetamide wash
SELSUN SHAMPOO
Antivirals - Topical
Tier 3
DENAVIR
ZOVIRAX TOP
Burn Products
Tier 1
silver sulfadiazine
ssd
Tier 3
SILVADENE
SULFAMYLON
thermazene
Cauterizing Agents
Tier 1
grafco silver nitrate app
Tier 3
ARZOL SILVER NITRATE APP
+
Preventive
PA
Prior Authorization
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
28 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Corticosteroids - Topical
Tier 1
ala cort
alclometasone dipropionat
amcinonide
apexicon oint
augmented betamethasone
betamethasone dipropionat
betamethasone val foam
betamethasone valerate
betamethasone valerate oint
clobetasol propionate
cormax scalp application
desonide
desoximetasone
diflorasone diacetate
diflorasone oint
fluocinolone acetonide
flurandrenolide
fluticasone propionate
halobetasol propionate
hydrocortisone butyrate
Tier 3
cortalo
hydrocortisone in absorba
hydrocortisone topical
hydrocortisone valerate
mometasone furoate
pramcort
triamcinolone acetonide
Tier 2
alphatrex
lokara
prednicarbate
scalacort
triderm
u-cort
calcip/betameth oint
fluocinonide
fluocinonide-e
HALOG
ACLOVATE
ALA SCALP
APEXICON E
CAPEX
CARMOL-HC
CLOBEX
CLODERM
CORDRAN
CORDRAN TAPE
CORTANE-B
CUTIVATE
DERMA-SMOOTHE/FS BODY OIL
DERMA-SMOOTHE/FS SCALP OI
DERMATOP
DESOWEN
DIFLORASONE CRM
DIPROLENE
DIPROLENE AF
ELOCON
EPIFOAM
KENALOG
LOCOID
LOCOID LIPOCREAM
LUXIQ
NOVACORT
NUZON
OLUX
OLUX-E
PANDEL
PRAMOSONE
SYNALAR
TACLONEX OINT
TACLONEX SCALP
TEMOVATE
TEMOVATE E
TOPICORT
TRIANEX
VANOS
VERDESO
WESTCORT
Emollient/Keratolytic Agents
Tier 1
cerovel
remeven
u-kera e
urea
urea 40% nail film
urea nail
urea topical
urea-c40
CEM-UREA
GORDONS UREA
UMECTA
UMECTA NAIL FILM
URAMAXIN
URAMAXIN GT
x-viate
Tier 3
Emollients
Tier 1
Tier 3
ammonium lactate
laclotion
lactic acid
ATOPICLAIR
ELETONE
HYLATOPIC PLUS
LAC-HYDRIN
MIMYX
Enzymes - Topical
Tier 1
revina
tbc aer
Tier 3
SANTYL
XENADERM
+
Preventive
PA
Prior Authorization
vasolex
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
29 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Immunomodulating Agents - Topical
Tier 1
imiquimod
Tier 3
ALDARA
ZYCLARA CRM 3.75%
Immunosuppressive Agents - Topical
Tier 3
ELIDEL
PROTOPIC
Keratolytic/Antimitotic Agents
podocon 25 in benzoin tin
Tier 1
Tier 3
podofilox
salacyn
salicylic acid
CANTHARIDIN
CONDYLOX
Local Anesthetics - Topical
Tier 1
lidocaine 2% gel
Tier 2
lidocaine pad 5%
Tier 3
LIDODERM
lidocaine 3% crm
lidocaine 4% soln
lidocaine 5% oint
XYLOCAINE
Miscellaneous
Tier 1
aluminum chloride
hypercare
tetrix
Tier 3
DRYSOL
VEREGEN
XCLAIR
Nonsteroidal Anti-inflammatory Agts(NSAIDs)
Tier 1
diclofenac gel 1% PA QL
FLECTOR PATCH PA QL
Tier 3
diclofenac soln 1.5% PA QL
PENNSAID SOLN 1.5% PA QL
PENNSAID SOLN 2.0% PA QL
VOLTAREN GEL PA QL
Pigmenting-Depigmenting Agents
Tier 3
OXSORALEN
Rosacea Agents
Tier 1
metronidazole top
Tier 2
FINACEA
Tier 3
METROCREAM
rosadan
vitazol
METROGEL
METROLOTION
NORITATE
Scabicides & Pediculicides
Tier 1
acticin
lindane
malathion
permethrin
Tier 3
ELIMITE
EURAX
OVIDE
ULESFIA
Tar Products
Tier 3
COAL TAR
+
Preventive
PA
Prior Authorization
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
30 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Wound Care Products
ATRAPRO ANTIPRURITIC HYDR
CARRASYN HYDROGEL WOUND D
CURAFIL GEL WOUND DRESSIN
Tier 3
RADIAPLEXRX
RADIGEL
DIAB
DIAB F.D.G. FREEZE-DRIED
REGRANEX
SILVASORB
SPECTRAGEL
DIABETIC SUPPLIES
Blood Glucose Monitors
Tier 2
ACCU-CHEK MONITORS QL
Tier 3
BLOOD GLUCOSE MONITOR-OTHER QL
ONETOUCH MONITORS QL
Lancets
Tier 1
lancets QL
Syringes
Tier 1
needles (insulin)
syringes insulin
Test Strips
Tier 1
ACCU-CHEK STRIPS QL
Tier 2
COAGUCHEK QL
Tier 3
BLOOD GLUCOSE STRIPS-OTHER QL
ONETOUCH STRIPS QL
DIGESTIVE AIDS
Digestive Aids - Misc
Tier 3
COTAZYM
Digestive Enzymes
Tier 2
Tier 3
CREON
PANCREAZE
PANCRELIPASE
PEPSIN
SUCRAID
ULTRESA
ZENPEP
PERTZYE
DIURETICS
Carbonic Anhydrase Inhibitors
Tier 1
acetazolamide
acetazolamide er
Tier 3
DIAMOX
NEPTAZANE
methazolamide
Diuretic Combinations
Tier 0
amiloride hctz +
Tier 1
spironolactone hctz
Tier 3
ALDACTAZIDE
+
Preventive
triamterene hctz +
DYAZIDE
PA
Prior Authorization
MAXZIDE
QL
Quantity Limitations
MAXZIDE-25
ST
Step Therapy
SP
Specialty
31 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Loop Diuretics
Tier 1
bumetanide
furosemide tabs & soln
torsemide
Tier 3
DEMADEX
EDECRIN
LASIX
Potassium Sparing Diuretics
Tier 1
amiloride hcl
spironolactone
Tier 3
ALDACTONE
DYRENIUM
Thiazides and Thiazide-Like Diuretics
chlorothiazide +
Tier 0
chlorthalidone +
hydrochlorothiazide 12.5mg +
hydrochlorothiazide 25mg +
hydrochlorothiazide 50mg +
indapamide +
Tier 1
methyclothiazide
metolazone
Tier 3
DIURIL
MICROZIDE
ZAROXOLYN
ENDOCRINE AND METABOLIC AGENTS - MISC.
Antidotes-Potassium Removing Agents
Tier 1
kionex
Tier 3
SPS
Tier 4
VISTOGARD QL
sodium polystyrene sulfon
Bone Density Regulators
alendronate sodium + QL
Tier 1
Tier 3
ibandronate +
risedronate + PA QL ST
ACTONEL + PA QL ST
BONIVA +
FOSAMAX + QL
MIACALCIN + QL
calcitonin-salmon + QL
etidronate disodium +
FORTEO + PA
FORTICAL + QL
Enzymes
Tier 4
STRENSIQ INJ PA
XURIDEN PA
Growth Hormones
GENOTROPIN PA SP
Tier 4
HUMATROPE PA SP
NORDITROPIN FLEXPRO PA SP
NORDITROPIN NORDIFLEX PEN PA SP
NUTROPIN PA
SAIZEN PA SP
SEROSTIM PA SP
ZOMACTON PA SP
ZORBTIVE PA SP
TEV-TROPIN PA SP
Lipodystrophy Agents
Tier 4
MYALEPT INJ PA QL
Miscellaneous
Tier 1
cabergoline
calcitriol +
desmopressin acetate
doxercalciferol +
levocarnitine
minirin
paricalcitol +
raloxifene +
+
Preventive
PA
Prior Authorization
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
32 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Miscellaneous
Tier 2
Tier 3
Tier 4
octreotide acetate PA SP
BUPHENYL
CARNITOR
CARNITOR SF
DDAVP
EVISTA +
HECTOROL +
OSPHENA
ROCALTROL +
SENSIPAR
STIMATE
ZEMPLAR +
ACTHAR PA
CERDELGA PA SP
CYSTAGON
INCRELEX PA
KUVAN PA
ORFADIN
PROSCYBI ST
RAVICTI PA
SAMSCA PA SP
SANDOSTATIN PA SP
SANDOSTATIN LAR DEPOT PA SP
SIGNIFOR PA
SOMAVERT
SYNAREL PA SP
ESTROGENS
Estrogen Combinations
Tier 1
amabelz
covaryx
covaryx hs
eemt hs
essian
essian h.s.
esterified estrogens/meth
jinteli
eemt
estradiol/norethindrone
methyltestosterone/esteri
mimvey
norethindrone/thinyl estradiol
Tier 2
Tier 3
CLIMARA PRO
PREMPHASE
PREMPRO
ACTIVELLA
ANGELIQ
COMBIPATCH
FEMHRT LOW DOSE
estradiol td patch +
estradiol valerate +
estropipate +
ALORA +
CLIMARA +
DELESTROGEN +
DEPO-ESTRADIOL +
DIVIGEL +
ENJUVIA +
ESTRACE TABS +
ESTROGEL +
ESTRONE +
EVAMIST +
MENEST +
MENOSTAR +
PREFEST
Estrogens
Tier 1
estradiol tabs +
Tier 2
PREMARIN TABS +
Tier 3
VIVELLE-DOT +
GASTROINTESTINAL AGENTS - MISC.
Gallstone Solubilizing Agents
Tier 1
ursodiol
Tier 3
ACTIGALL
CHENODAL
URSO 250
URSO FORTE
Gastrointestinal Stimulants
Tier 1
metoclopramide hcl
Tier 3
REGLAN
+
Preventive
PA
Prior Authorization
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
33 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Inflammatory Bowel Agents
Tier 1
Tier 2
Tier 3
Tier 4
azathioprine
balsalazide disodium
colocort
hydrocortisone rectal
mercaptopurine
mesalamine
prednisone
sulfasalazine
sulfazine
sulfazine ec
ASACOL HD
CANASA
CORTIFOAM
DELZICOL
APRISO
AZULFIDINE
AZULFIDINE EN-TABS
COLAZAL
CORTENEMA
LIALDA
PENTASA
ROWASA
CIMZIA PA SP
HUMIRA PA SP
DIPENTUM
Intestinal Acidifiers
Tier 1
enulose
generlac
Irritable Bowel Syndrome (IBS) Agents
Tier 3
AMITIZA QL
LINZESS QL
LOTRONEX QL
Miscellaneous
Tier 3
MOVANTIK PA
RELISTOR PA
Tier 4
CHOLBAM PA
OCALIVA PA
Phosphate Binder Agents
Tier 1
calcium acetate
sevelamer carbonate tab PA
Tier 2
RENAGEL PA
RENVELA POW PACK PA
AURYXIA PA
ELIPHOS
PHOSLYRA PA
RENVELA TAB PA
Tier 3
FOSRENOL PA
PHOSLO
GENITOURINARY AGENTS
Alkalinizers
Tier 1
citric acid/sodium citrat
cytra k crystals
cytra-2
cytra-3
cytra-k
potassium citrate
potassium citrate/citric
taron-crystals
POLYCITRA-K CRYSTALS
SHOHLS SOLUTION MODIFIED
tricitrates
ORACIT
Tier 3
UROCIT-K
Miscellaneous
Tier 2
ELMIRON
Tier 3
K-PHOS NO 2
LITHOSTAT
RENACIDIN
THIOLA
Prostatic Hypertrophy Agents
Tier 1
alfuzosin hcl er
+
Preventive
duasteride
PA
Prior Authorization
finasteride 5mg
QL
Quantity Limitations
ST
Step Therapy
tamsulosin hcl
SP
Specialty
34 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Prostatic Hypertrophy Agents
Tier 3
AVODART
FLOMAX
PROSCAR
UROXATRAL
Urinary Analgesics
Tier 1
phenazopyridine hcl
Tier 3
PYRIDIUM
GOUT AGENTS
Gout Agents
Tier 1
allopurinol +
probenecid +
probenecid/colchicine +
Tier 3
COLCRYS +
ULORIC + PA QL
ZYLOPRIM +
HEMATOLOGICAL AGENTS - MISC.
Bradykinin B2 Receptor Antagonists
Tier 4
FIRAZYR PA QL SP
Hematorheologic Agents
Tier 1
pentoxifylline cr
Tier 3
TRENTAL
pentoxifylline er
Platelet Aggregation Inhibitors
anagrelide hydrochloride
Tier 1
Tier 3
aspirin/dipyridamole
cilostazol
EFFIENT
clopidogrel QL
dipyridamole
AGGRENOX
AGRYLIN
BRILINTA
PERSANTINE
PLAVIX QL
PLETAL
HEMATOPOIETIC AGENTS
Agents for Gaucher Disease
Tier 4
ZAVESCA
Cobalamins
Tier 1
cyanocobalamin
Folic Acid/Folates
Tier 0
folic acid 400mcg +
Tier 1
folic acid 1mg
folic acid 800mcg +
Hematopoietic Growth Factors
Tier 3
ARANESP ALBUMIN FREE PA SP
+
Preventive
PA
Prior Authorization
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
35 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Hematopoietic Growth Factors
Tier 4
ARANESP PA SP
EPOGEN PA SP
GRANIX PA SP
LEUKINE PA SP
NEULASTA PA SP
NEUMEGA PA SP
NEUPOGEN PA SP
PROCRIT PA SP
Hematopoietic Mixtures
Tier 1
airavite
fabb
fe c plus
ferocon
ferotrinsic
ferrex 150 forte
ferrogels forte
folbee
folcaps
folic acid/cyanocobalamin
folplex 2.2
foltrin
hematinic/folic acid
hematogen
hematogen forte
hemocyte-f
iferex 150 forte
martinic
myferon 150 forte
nufol
poly-iron 150 forte
polysaccharide iron forte
Tier 3
folic acid/vitamin b-6/vi
purevit dualfe plus
se-tan plus
tl icon
tl-fol 500
MULTIGEN
senilezol
tl gard rx
tricon
trigels-f forte
FOLGARD RX
HEMATOGEN FA
ICAR-C PLUS
NEPHRON FA
PROFERRIN-FORTE
TANDEM PLUS
Miscellaneous
Tier 4
PROMACTA PA QL SP
HEMOSTATICS
Hemostatics - Systemic
Tier 1
tranexamic acid
Tier 2
aminocaproic acid
Tier 3
AMICAR
LYSTEDA
HYPNOTICS
Barbiturate Hypnotics
Tier 1
phenobarbital
Tier 3
BUTISOL SODIUM
SECONAL
Miscellaneous
Tier 3
ROZEREM QL
Non-Barbiturate Hypnotics
Tier 1
estazolam QL
eszopiclone QL
flurazepam hcl QL
triazolam QL
zaleplon QL
zolpidem tartrate QL
AMBIEN QL
AMBIEN CR QL
HALCION QL
RESTORIL QL
SONATA QL
temazepam QL
zolpidem tartrate er QL
Tier 3
+
Preventive
PA
Prior Authorization
QL
Quantity Limitations
LUNESTA QL
ST
Step Therapy
SP
Specialty
36 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
IMMUNE MEDIATORS
Immunomodulators
Tier 4
POMALYST PA SP
REVLIMID PA SP
THALOMID PA SP
Immunosuppressive Agents
Tier 1
Tier 3
azathioprine
cyclosporine
gengraf
hecoria
mycophenolate mofetil
sirolimus
tacrolimus caps SP
AZASAN
CELLCEPT
CYCLOSPORINE MODIFIED
IMURAN
MYFORTIC
NEORAL
PROGRAF CAPS SP
RAPAMUNE
SANDIMMUNE
LAXATIVES
Laxative Combinations
Tier 0
Tier 3
gavilyte-c +
gavilyte-g +
peg 3350/electrolytes +
trilyte +
gavilyte-n/flavor pack +
COLYTE-FLAVOR PACKS
GOLYTELY
NULYTELY/FLAVOR PACKS
SUPREP BOWEL PREP
Laxatives - Miscellaneous
Tier 1
constulose
Tier 2
KRISTALOSE
lactulose
Saline Laxatives
Tier 2
VISICOL
Tier 3
OSMOPREP
MEDICAL DEVICES
Contraceptives
FEMCAP +
Tier 0
ORTHO DIAPHRAGM ALL-FLEX/ +
PRENTIF CAVITY-RIM CERVIC +
PRENTIF FITTING SET +
Parenteral Therapy Supplies
Tier 1
SYRINGES INSULIN
SYRINGES VARIOUS
MIGRAINE PRODUCTS
Migraine Combinations
epidrin
Tier 1
Tier 3
isometheptene/caff/apap
isometheptene/dichloral/apap
CAFERGOT
MIGERGOT
migragesic ida
nodolor
MIGRALAM
PRODRIN
Migraine Products
Tier 1
dihydroergotamine mesylat
+
Preventive
PA
Prior Authorization
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
37 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Migraine Products
Tier 3
D.H.E. 45
ERGOMAR
MIGRANAL
Serotonin Agonists
Tier 1
Tier 3
almotriptan PA QL ST
naratriptan hcl QL
rizatriptan QL
rizatriptan mlt QL
sumatriptan inj QL
sumatriptan nasal PA QL
AMERGE QL ST
AXERT PA QL ST
FROVA PA QL ST
IMITREX QL
IMITREX NASAL PA QL
MAXALT PA QL ST
MAXALT-MLT PA QL ST
RELPAX PA QL ST
ZECUITY ST
ZOMIG QL ST
ZOMIG NASL PA QL
sumatriptan tabs QL
MINERALS & ELECTROLYTES
Bicarbonates
Tier 3
NEUT
Fluoride
Tier 0
Tier 1
Tier 3
sodium fluoride +
epiflur
fluor-a-day
fluoride
fluoritab
flura-drops 0.125
karidium
ludent
nafrinse drops
FLURA-DROPS 0.25
LURIDE
k-effervescent
k-prime
Iodine Products
Tier 3
SSKI
Iron-Misc.
Tier 0
ferrous sulfate +
Tier 3
VITAFOL
Magnesium
Tier 3
MAGNEBIND 400
Phosphate
Tier 1
phospha 250 neutral
Tier 3
K-PHOS
K-PHOS NEUTRAL
Potassium
effervescent pot chloride
Tier 1
Tier 3
k-vescent
klor-con
klor-con 10
klor-con 8
klor-con m10
klor-con m20
klor-con/ef
potassium chloride cr
potassium chloride er
potassium chloride sa
potassium chloride sr
EFFER-K
K-TABS
KLOR-CON 25
KLOR-CON M15
MICRO-K
+
Preventive
PA
Prior Authorization
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
38 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Sodium
Tier 1
sodium chloride tab
Tier 3
SODIUM CHLORIDE
MOUTH/THROAT/DENTAL AGENTS
Anesthetics Topical Oral
Tier 1
lidocaine viscous
Tier 2
BXN MOUTHWASH SUSP
Tier 3
LTA 360 KIT
Anti-infectives - Throat
Tier 1
clotrimazole troches
nystatin
Antiallergy Agents - Mouth/Throat
Tier 3
APHTHASOL
Antiseptics - Mouth/Throat
Tier 1
periogard
Tier 3
DEBACTEROL
PERIDEX
Steroids - Mouth/Throat
Tier 1
oralone
triamcinolone in orabase
Throat Products - Misc.
Tier 1
Tier 3
cevimeline hcl
pilocarpine hydrochloride
CAPHOSOL
EVOXAC
GELCLAIR
NUMOISYN
SALAGEN
MUSCULOSKELETAL THERAPY AGENTS
Central Muscle Relaxants
Tier 1
baclofen
carisoprodol 250mg
carisoprodol 350mg
chlorzoxazone
cyclobenzaprine hcl
ed baclofen
metaxalone
methocarbamol
orphenadrine citrate
orphenadrine citrate cr
orphenadrine citrate er
Tier 3
tizanidine hcl
FLEXERIL
NORFLEX
PARAFON FORTE DSC
SKELAXIN
SOMA
ZANAFLEX
ROBAXIN
Direct Muscle Relaxants
Tier 1
dantrolene sodium
Tier 3
DANTRIUM
+
Preventive
PA
Prior Authorization
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
39 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Muscle Relaxant Combinations
Tier 1
carisoprodol/asa/codeine
carisoprodol/aspirin
orphenadrine compound ds
orphenadrine/asa/caffeine
Phosphodiesterase Inhibitor
Tier 4
OTEZLA PA
NASAL AGENTS - SYSTEMIC AND TOPICAL
Nasal Anti-infectives
Tier 3
BACTROBAN NASAL
Nasal Antiallergy
Tier 1
azelastine nasal
Tier 3
ASTELIN
Nasal Anticholinergics
Tier 1
ipratropium bromide nasal
Tier 3
ATROVENT
Sympathomimetic Decongestants
Tier 3
LUSONAL
TYZINE
NEUROMUSCULAR AGENTS
ALS Agents
Tier 3
RILUTEK
OPHTHALMIC AGENTS
Artificial Tears and Lubricants
Tier 3
LACRISERT
Beta-blockers - Ophthalmic
Tier 1
Tier 2
Tier 3
betaxolol ophth
carteolol hcl
metipranolol
timolol ophth
dorzolamide/timolol
levobunolol hcl
BETIMOL
BETOPTIC-S
BETAGAN
BETAGAN C CAP QD
COMBIGAN
COSOPT
ISTALOL
OPTIPRANOLOL
TIMOPTIC
TIMOPTIC-XE
Cycloplegic Mydriatics
Tier 1
atropine sulfate
cyclopentolate hcl
mydral
tropicamide
+
Preventive
PA
Prior Authorization
homatropaire
QL
Quantity Limitations
homatropine hbr
ST
Step Therapy
SP
Specialty
40 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Cycloplegic Mydriatics
Tier 3
CYCLOGYL
CYCLOMYDRIL
ISOPTO HYOSCINE
MYDRIACYL
ISOPTO ATROPINE
ISOPTO HOMATROPINE
Cystine-Depleting Agents
Tier 3
CYSTARAN
Miotics
Tier 1
pilocarpine ophth
ISOPTO CARBACHOL
Tier 3
ISOPTO CARPINE
MIOSTAT
PHOSPHOLINE IODIDE
PILOPINE HS
Ophthalmic Adrenergic Agents
Tier 1
apraclonidine
brimonidine tartrate
Tier 3
ALPHAGAN P
IOPIDINE
SIMBRINZA
Ophthalmic Anti-infectives
Tier 1
Tier 2
Tier 3
ak-poly-bac
bacitracin/polymyxin b
ciprofloxacin hcl
erythromycin ophth
gatifloxacin
gentak
gentamicin ophth
ilotycin
levofloxacin ophth
neo-polycin
neomycin/polymyxin/bacitr/hc
neomycin/polymyxin/gramic
ofloxacin ophth
polycin b
romycin
sodium sulfacetamide ophth
tobramycin sulfate
trifluridine
trimethoprim/polymyxin b
triple antibiotic
MOXEZA
VIGAMOX
AZASITE
BACITRACIN OPHTH
BLEPH-10
CILOXAN
GARAMYCIN
NATACYN
NEOSPORIN
OCUFLOX
POLYTRIM
TOBREX
VIROPTIC
ZIRGAN
ZYMAXID
Ophthalmic Decongestants
Tier 1
ak-con
Tier 3
MYDFRIN
altafrin
neofrin
phenylephrine hcl
Ophthalmic Immunomodulators
Tier 3
RESTASIS
Ophthalmic Local Anesthetics
Tier 1
Tier 3
altacaine
parcaine
proparacaine hcl
tetracaine hcl
tetravisc
tetravisc forte
tetcaine
ALCAINE
+
Preventive
PA
Prior Authorization
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
41 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Ophthalmic Steroids
Tier 1
Tier 2
Tier 3
dexamethasone ophth
diclofenac ophth 0.1%
fluor-op
fluorometholone
ketorolac ophth
neomycin/polymyxin/hc ophth
neomycin/polymyxin/dexame
poly-dex
prednisolone ophth
sulfacetamide/prednisolon
tobramycin/dexamethasone
LOTEMAX
PRED MILD
ALREX
BLEPHAMIDE
FLAREX
FML
FML FORTE
FML LIQUIFILM
ILEVRO
MAXIDEX
MAXITROL
OMNIPRED
PRED FORTE
PRED-G
PRED-G S.O.P.
TOBRADEX
VEXOL
ZYLET
Ophthalmics - Misc.
Tier 1
Tier 3
azelastine ophth
bromfenac
cromolyn sodium ophth
diclofenac sodium
dorzolamide hcl
epinastine hcl
flurbiprofen ophth
ACULAR
ACULAR LS
ALOCRIL
ALOMIDE
AZOPT
ELESTAT
NEVANAC
OCUFEN
OPTIVAR
TRUSOPT
XIIDRA QL
Prostaglandins - Ophthalmic
Tier 1
latanoprost QL
Tier 3
LUMIGAN QL ST
TRAVATAN Z QL ST
XALATAN QL ST
ZIOPTAN QL ST
OTIC AGENTS
Otic Agents - Miscellaneous
Tier 1
acetic acid
acetic acid/aluminum acet
Tier 3
CRESYLATE
VOSOL
Otic Analgesics
Tier 3
PINNACAINE OTIC
Otic Anti-infectives
Tier 1
ofloxacin otic
Otic Combinations
Tier 1
Tier 2
aero otic hc
antibiotic ear
antipyrine/benzocaine
aurodex
auroguard
cortic-nd
cyotic
exotic-hc
oticin
oto-end 10
neomycin/polymyxin/hc otic
otomar
otomax-hc
CIPRODEX
OTOVEL
+
Preventive
PA
Prior Authorization
pramoxine-hc
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
42 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Otic Combinations
Tier 3
CIPRO HC
COLY-MYCIN S PA
CORTANE-B AQUEOUS
CORTISPORIN OTIC
CORTISPORIN-TC
PRAMOTIC
CORTANE-B-OTIC
Otic Steroids
Tier 1
acetasol hc
fluocinolone otic
Tier 3
DERMOTIC
VOSOL HC
hydrocortisone/acetic aci
OXYTOCICS
Oxytocics
Tier 1
methylergonovine maleate
Tier 3
METHERGINE
PHARMACEUTICAL ADJUVANTS
Irrigation Solutions
Tier 1
sterile water irrigation
tis-u-sol
Liquid Vehicles
Tier 1
sodium chloride bacterios
sterile water for injecti
Tier 3
BACTERIOSTATIC WATER INJ
COLLODION
Placebos
Tier 3
PLACEBO #00
PROGESTINS
Progestins
medroxyprogesterone
Tier 1
progesterone micronized
MAKENA SP
MEGACE ES
progesterone oral
AYGESTIN
Tier 3
norethindrone acetate
PROMETRIUM
PROVERA
PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC.
Agents for Chemical Dependency
bupropion hcl er 150mg + QL
Tier 0
CHANTIX + QL
nicotine replacement + QL
Tier 1
acampro
disulfiram
Tier 3
ANTABUSE
CAMPRAL
+
Preventive
PA
Prior Authorization
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
43 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Antidementia Agents
Tier 1
Tier 3
donepezil 10mg
donepezil 5mg
donepezil odt
galantamine
memantine hcl
memantine sol
rivastigmine patch QL
rivastigmine tartrate
ARICEPT 10MG
ARICEPT 5MG
ARICEPT ODT
EXELON
EXELON PATCH QL
NAMENDA
NAMENDA SOL
NAMENDA XR
RAZADYNE ER
RAZADYNE SOLN
RAZADYNE TBS
Combination Psychotherapeutics
chlordiazepoxide/amitript
Tier 1
Tier 3
olanzapine/fluoxetine QL
perphenazine/amitriptylin
SYMBYAX QL
Miscellaneous
Tier 1
pimozide
Tier 2
tetrabenazine PA QL
Tier 3
NUEDEXTA PA QL
ORAP
Tier 4
XENAZINE PA QL
XYREM PA QL
Multiple Sclerosis Agents
Tier 4
AMPYRA PA QL
AUBAGIO PA
AVONEX PA SP
BETASERON PA SP
COPAXONE 20MG PA SP
COPAXONE 40MG PA SP
EXTAVIA PA SP
GILENYA PA SP
PLEGRIDY INJ PA SP
REBIF PA SP
TECFIDERA PA QL SP
ZINBRYTA PA SP
RESPIRATORY AGENTS
Bronchodilator Combinations
Tier 3
ANORO ELLIPTA +
Bronchodilators
Tier 1
ipratropium bromide +
Tier 2
ATROVENT HFA +
SPIRIVA + QL
Tier 3
INCRUSE ELLIPTA + PA
TUDORZA PRESSAIR + PA
Combinations
Tier 1
difil-g forte +
Devices
Tier 3
AEROCHAMBER
Leukotriene Modulators
Tier 1
montelukast sodium +
+
Preventive
zafirlukast + ST
PA
Prior Authorization
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
44 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Leukotriene Modulators
Tier 3
ACCOLATE + PA ST
SINGULAIR +
Miscellaneous
Tier 1
cromolyn sodium +
Tier 3
DALIRESP + PA
Tier 4
KALYDECO PA
PULMOZYME + PA SP
Steroid Inhalants
Tier 1
budesonide inh +
Tier 2
FLOVENT +
QVAR +
Tier 3
ALVESCO +
ASMANEX +
PULMICORT +
PULMICORT FLEXHALER +
Sympathomimetics
albuterol sulfate +
Tier 1
Tier 2
Tier 3
albuterol sulfate er +
albuterol sulfate neb +
ipratropium/albuterol +
levalbuterol neb +
metaproterenol sulfate +
terbutaline sulfate +
VENTOLIN HFA +
FORADIL AEROLIZER +
PROVENTIL HFA +
DULERA +
ADVAIR +
COMBIVENT +
SEREVENT DISKUS +
SYMBICORT +
ADRENALIN +
ARCAPTA NEOHALER +
BREO ELLIPTA +
PERFOROMIST + PA
PROAIR +
STRIVERDI AER RESPIMAT +
VOSPIRE ER +
XOPENEX +
Xanthines
Tier 1
theochron +
theophylline cr +
theophylline er +
Tier 3
ELIXOPHYLLIN +
THEO-24 +
THEOPHYLLINE 400,600 CR,ER +
theophylline sr +
THYROID AGENTS
Antithyroid Agents
Tier 1
methimazole
Tier 3
TAPAZOLE
propylthiouracil
Thyroid Hormones
Tier 1
Tier 3
levothroid
levothyroxine sodium
levoxyl
liothyronine tab
np thyroid 30
np thyroid 60
np thyroid 90
unithroid
ARMOUR THYROID
CYTOMEL
NATURE-THROID
NATURE-THROID NT-2.5
SYNTHROID
THYROLAR
TRIIODO-L-THYRONINE
WESTHROID
+
Preventive
PA
Prior Authorization
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
45 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
ULCER DRUGS
Antispasmodics
belladonna & opium supp
Tier 1
Tier 3
chlordiazepoxide/clidnium bro
dicyclomine hcl
ed-spaz
glycopyrrolate
hyomax -dt
hyomax-sl
hyomax-sr
hyoscyamine sulfate
hyoscyamine sulfate er
hyoscyamine sulfate sr
hyosyne
hyoscyamine sulfate odt
me-pb-hyos
methscopolamine bromide
oscimin
oscimin sr
symax-sl
symax-sr
ANASPAZ
DONNATAL
nulev
phenohytro/b-donna
symax fastabs
BENTYL
CANTIL
CUVPOSA
LEVBID
LEVSIN
LEVSIN/SL
LIBRAX
PAMINE
PAMINE FORTE
PROPANTHELINE BROMIDE
ROBINUL
ROBINUL FORTE
SCOPOLAMINE HBR
SYMAX DUOTAB
H-2 Antagonists
Tier 1
ranitidine syrup
Misc. Anti-Ulcer
Tier 1
sucralfate
Tier 3
CARAFATE
Proton Pump Inhibitors
Tier 3
NEXIUM GRANULES PA
PREVACID SOLUTAB PA
Ulcer Drugs - Prostaglandins
Tier 1
misoprostol
Tier 3
CYTOTEC
Ulcer Therapy Combinations
Tier 3
PYLERA
URINARY ANTI-INFECTIVES
Urinary Anti-infective Combinations
Tier 1
Tier 3
azuphen mb
hyophen
ur n-c
urimar-t
uro-mp
uroav-b
urophen mb
ustell
uta
uticap
PROSED/DS
URAMIT MB
uretron d/s
URIBEL
UROQID #2
Urinary Anti-infectives
methenamine hippurate
Tier 1
methenamine mandelate
nitrofurantoin macrocryst
+
Preventive
PA
Prior Authorization
nitrofurantoin
nitrofurantoin monohydrat
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
46 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
Urinary Anti-infectives
Tier 3
FURADANTIN
HIPREX
MONUROL
UREX
MACROBID
MACRODANTIN
URINARY ANTISPASMODICS
Beta-3 Adrenergic Agonists
Tier 3
MYRBETRIQ PA ST
Urinary Antispasmodic Combinations
Tier 1
phenazopyridine plus
phenazopyridine/butabarb
urelief plus
Urinary Antispasmodics
Tier 1
bethanechol chloride
darifenacin hbr er PA ST
oxybutynin chloride
oxybutynin chloride er
tolterodine er
flavoxate hcl
tolterodine tartrate
DETROL
DETROL LA
DITROPAN XL ST
ENABLEX PA ST
OXYTROL PA ST
URECHOLINE
VESICARE PA ST
trospium chloride
Tier 3
URINE TEST STRIPS
Miscellaneous
Tier 2
CHEMSTRIP K QL
CLINITEST TABS - STRIPS QL ST
KETO-DIASTIX QL
KETOCARE QL
COMBISTIX QL
URISTIX QL
VAGINAL PRODUCTS
Miscellaneous Vaginal Products
Tier 3
ACID JELLY
FEM PH
RELAGARD
Vaginal Anti-infectives
Tier 1
Tier 3
clindamycin phosphate
metronidazole vaginal
miconazole 3 combo pack
terconazole
vandazole
zazole
AVC
CLEOCIN
METROGEL-VAGINAL
NYSTATIN VAGINAL
TERAZOL 3
TERAZOL 7
MICONAZOLE 3
Vaginal Estrogens
Tier 1
yuvafem
Tier 2
FEMRING
PREMARIN CRM
Tier 3
ESTRACE
ESTRING
VAGIFEM
Vaginal Progestins
Tier 3
CRINONE PA
+
Preventive
PA
Prior Authorization
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
47 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
VASOPRESSORS
Anaphylaxis Therapy Agents
Tier 2
epinephrine injector
Tier 3
ADRENACLICK
EPIPEN
EPIPEN 2-PAK
EPIPEN-JR 2-PAK
Vasopressors
Tier 1
midodrine hcl
VITAMINS
B-Complex w/ Folic Acid
Tier 1
Tier 3
b-plex
dialyvite
ferrocite plus
folbee plus cz
hematinic plus complex
hematinic plus vitamins/m
nephronex
rena-vite rx
renal
reno caps
triphrocaps
vol-care rx
DIATX ZN
FOLBEE PLUS
HEMOCYTE-PLUS
mynephrocaps
renalpren
NEPHRO-VITE RX
NEPHROCAPS
Multiple Vitamins w/ Minerals
v-c forte
Tier 1
Tier 3
vic-forte
vicap forte
vita-min
PROTECT PLUS
PROTECT PLUS NR
vitamin forte
FORTAVIT
Oil Soluable Vitamins
Tier 1
ergocalciferol + QL
phytonadione
Tier 3
DRISDOL + QL
MEPHYTON
+
Preventive
PA
Prior Authorization
vitamin d + QL
QL
Quantity Limitations
ST
Step Therapy
SP
Specialty
48 / 61
Caterpillar Drug Formulary
Generated October 26, 2016
8-MOP - 28
A-HYDROCORT - 26
A-METHAPRED - 26
ABACAV/LAMIV/ZIDO - 22
ABACAV/SULF/LAMIV - 22
ABACAVIR - 22
ABILIFY - 22
ABSORICA CAP - 27
ACAMPRO - 43
ACARBOSE - 14
ACCOLATE - 45
ACCU-CHEK MONITORS - 31
ACCU-CHEK STRIPS - 31
ACCUPRIL - 18
ACCURETIC - 19
ACEBUTOLOL HCL - 23
ACEON - 18
ACETAMINOPHEN/CODEINE #3, #4 - 8
ACETASOL HC - 43
ACETAZOLAMIDE - 31
ACETAZOLAMIDE ER - 31
ACETIC ACID - 42
ACETIC ACID/ALUMINUM ACET - 42
ACETYLCYSTEINE - 27
ACID JELLY - 47
ACITRETIN - 28
ACLOVATE - 29
ACTEMRA INJ - 6
ACTHAR - 33
ACTICIN - 30
ACTIGALL - 33
ACTIMMUNE - 20
ACTIQ - 8
ACTIVELLA - 33
ACTONEL - 32
ACTOPLUS MET - 15
ACTOS - 15
ACULAR - 42
ACULAR LS - 42
ACYCLOVIR - 23
ADALAT CC - 24
ADAPALENE - 27
ADCIRCA - 24
ADDERALL - 6
ADDERALL XR - 6
ADEFOVIR DIPIVOXIL - 23
ADEMPAS - 24
ADRENACLICK - 48
ADRENALIN - 45
ADVAIR - 45
AERO OTIC HC - 42
AEROCHAMBER - 44
AFEDITAB CR - 24
AFINITOR - 20
AGGRENOX - 35
AGRYLIN - 35
AHIST - 17
AIRAVITE - 36
AK-CON - 41
AK-POLY-BAC - 41
AKNE-MYCIN - 27
ALA CORT - 29
ALA QUIN - 27
ALA SCALP - 29
ALBENZA - 9
ALBUTEROL SULFATE - 45
ALBUTEROL SULFATE ER - 45
ALBUTEROL SULFATE NEB - 45
ALCAINE - 41
ALCLOMETASONE DIPROPIONAT - 29
ALCORTIN A - 27
ALDACTAZIDE - 31
ALDACTONE - 32
ALDARA - 30
ALECENSA - 20
ALENDRONATE SODIUM - 32
ALFUZOSIN HCL ER - 34
ALI-FLEX - 7
ALINIA - 21
ALKERAN - 19
ALLOPURINOL - 35
ALMOTRIPTAN - 38
ALOCRIL - 42
ALOMIDE - 42
ALORA - 33
ALPHAGAN P - 41
ALPHATREX - 29
ALPRAZOLAM - 10
ALPRAZOLAM ER - 10
ALPRAZOLAM INTENSOL - 10
ALPRAZOLAM ODT - 10
ALPRAZOLAM XR - 10
ALREX - 42
ALTABAX - 27
ALTACAINE - 41
ALTACE - 18
ALTAFRIN - 41
ALTAVERA - 25
ALTOPREV - 18
ALUMINUM CHLORIDE - 30
ALVESCO - 45
ALYACEN 1/35 - 25
ALYACEN 7/7/7 - 25
AMABELZ - 33
AMANTADINE HCL - 21
AMARYL - 15
AMBIEN - 36
AMBIEN CR - 36
AMCINONIDE - 29
AMERGE - 38
AMETHIA - 25
AMETHIA LO - 25
AMETHYST - 25
AMICAR - 36
AMIKACIN SULFATE - 10
AMILORIDE HCL - 32
AMILORIDE HCTZ - 31
AMINOCAPROIC ACID - 36
AMIODARONE HCL - 10
AMITIZA - 34
AMITRIPTYLINE HCL - 14
AMLODIPINE BESYLATE - 24
AMLODIPINE/BENAZAPRIL - 18
AMMONIUM LACTATE - 29
AMOXAPINE - 14
AMOXICILLIN - 12
AMOXICILLIN/CLAVULANATE - 12
AMPHETAMINE/DEXTROAMPHET ER - 6
AMPHETAMINE/DEXTROAMPHETA - 6
AMPHOTERICIN B - 16
AMPICILLIN - 12
AMPYRA - 44
ANAFRANIL - 14
ANAGRELIDE HYDROCHLORIDE - 35
ANALPRAM-HC - 9
ANAPROX - 7
ANAPROX DS - 7
ANASPAZ - 46
ANASTROZOLE - 20
ANCOBON - 16
ANDRODERM - 9
ANDROGEL - 9
ANDROID - 9
ANDROXY - 9
ANEXSIA - 8
ANGELIQ - 33
ANOLOR 300 - 7
ANORO ELLIPTA - 44
ANTABUSE - 43
ANTIBIOTIC EAR - 42
ANTIPYRINE/BENZOCAINE - 42
ANUCORT-HC - 9
ANUSOL-HC CRE - 9
ANUSOL-HC SUPP - 9
ANZEMET INJ - 16
ANZEMET TABS - 16
APAP/CAFF/DIHYDROCODEINE - 8
APEXICON E - 29
APEXICON OINT - 29
APHTHASOL - 39
APIDRA VIAL - 15
APRACLONIDINE - 41
APRI - 25
APRISO - 34
APTIVUS CAPS - 22
APTIVUS SOLN - 22
ARALEN - 19
ARANELLE - 25
ARANESP - 36
ARANESP ALBUMIN FREE - 35
ARAVA - 6
ARBINOXA - 17
ARCALYST - 6
ARCAPTA NEOHALER - 45
ARICEPT 10MG - 44
ARICEPT 5MG - 44
ARICEPT ODT - 44
ARIMIDEX - 20
ARIPIPRAZOLE - 21
ARIXTRA - 12
ARMOUR THYROID - 45
AROMASIN - 20
ARTHROTEC 50 - 7
ARTHROTEC 75 - 7
ARZOL SILVER NITRATE APP - 28
ASA COMPOUND/CODEINE - 8
ASACOL HD - 34
ASMALPRED - 26
ASMALPRED PLUS - 26
ASMANEX - 45
ASPIRIN - 7
ASPIRIN/DIPYRIDAMOLE - 35
ASTELIN - 40
ATACAND - 18
ATACAND HCTZ - 19
ATENOLOL - 23
ATENOLOL/CHLORTHALIDONE - 18
ATIVAN - 10
ATOPICLAIR - 29
ATORVASTATIN CALCIUM - 17
ATOVAQUONE - 21
ATOVAQUONE/PROGUANIL HCL - 19
ATRALIN GEL - 27
ATRAPRO ANTIPRURITIC HYDR - 31
ATRIPLA - 22
ATROPINE SULFATE - 40
ATROVENT - 40
Caterpillar Drug Formulary
Generated October 26, 2016
ATROVENT HFA - 44
AUBAGIO - 44
AUGMENTED BETAMETHASONE - 29
AUGMENTIN - 12
AUGMENTIN ES-600 - 12
AUGMENTIN XR - 12
AURODEX - 42
AUROGUARD - 42
AURYXIA - 34
AVALIDE - 19
AVANDIA - 15
AVAPRO - 18
AVAR CLEANSER - 27
AVAR-E EMOLLIENT - 27
AVC - 47
AVELOX - 11
AVIANE - 25
AVITA CRM - 27
AVITA GEL - 27
AVODART - 35
AVONEX - 44
AXERT - 38
AYGESTIN - 43
AZASAN - 37
AZASITE - 41
AZATHIOPRINE - 34, 37
AZELASTINE NASAL - 40
AZELASTINE OPHTH - 42
AZELEX - 27
AZILECT - 21
AZITHROMYCIN - 10
AZOPT - 42
AZULFIDINE - 34
AZULFIDINE EN-TABS - 34
AZUPHEN MB - 46
AZURETTE - 25
B-PLEX - 48
BACITRACIN OINT - 12
BACITRACIN OPHTH - 41
BACITRACIN/POLYMYXIN B - 41
BACLOFEN - 39
BACTERIOSTATIC WATER INJ - 43
BACTRIM - 11
BACTRIM DS - 11
BACTROBAN - 27
BACTROBAN NASAL - 40
BALSALAZIDE DISODIUM - 34
BALZIVA - 25
BANZEL - 13
BARACLUDE - 23
BAYCADRON - 26
BELLADONNA & OPIUM SUPP - 46
BENAZEPRIL HCL - 18
BENICAR - 18
BENICAR HCTZ - 19
BENTYL - 46
BENZONATATE - 26
BENZTROPINE MESYLATE - 20
BETAGAN - 40
BETAGAN C CAP QD - 40
BETAMETHASONE DIPROPIONAT - 29
BETAMETHASONE VAL FOAM - 29
BETAMETHASONE VALERATE - 29
BETAMETHASONE VALERATE OINT - 29
BETAPACE - 23
BETASERON - 44
BETAXOLOL HCL - 23
BETAXOLOL OPHTH - 40
BETHANECHOL CHLORIDE - 47
BETIMOL - 40
BETOPTIC-S - 40
BEXAROTENE ORAL - 20
BIAXIN - 11
BIAXIN XL - 11
BIAXIN XL PAC - 11
BICALUTAMIDE - 20
BIDIL - 24
BILTRICIDE - 9
BIO-STATIN - 16
BIOGESIC - 7
BIOREGESIC - 7
BISOPROLOL FUMARATE - 23
BISOPROLOL HCTZ - 18
BLEPH-10 - 41
BLEPHAMIDE - 42
BLOOD GLUCOSE MONITOR-OTHER - 31
BLOOD GLUCOSE STRIPS-OTHER - 31
BONIVA - 32
BORIC ACID - 25
BOSULIF - 20
BREO ELLIPTA - 45
BREVICON-28 - 25
BRIELLYN - 25
BRILINTA - 35
BRIMONIDINE TARTRATE - 41
BRIVIACT SOLN - 13
BRIVIACT TAB - 13
BROMFENAC - 42
BROMOCRIPTINE MESYLATE - 21
BROMPHENIRAMINE TANNATE - 17
BUDEPRION SR - 14
BUDESONIDE CAP - 26
BUDESONIDE INH - 45
BUMETANIDE - 32
BUPHENYL - 33
BUPRENORPHINE HCL SL - 8
BUPRENORPHINE-NALOXONE SL - 8
BUPROPION HCL - 14
BUPROPION HCL ER - 14
BUPROPION HCL ER 150MG - 43
BUPROPION HCL SR - 14
BUPROPION HCL XL - 14
BUSPIRONE HCL - 10
BUTALBITAL COMPOUND - 7
BUTALBITAL COMPOUND/CODEINEI - 8
BUTALBITAL/ACETAMINOPHEN - 7
BUTALBITAL/APAP/CAFF - 8
BUTALBITAL/ASPIRN/CAFFEINE - 8
BUTISOL SODIUM - 36
BUTORPHANOL TARTRATE - 8
BUTRANS - 8
BXN MOUTHWASH SUSP - 39
BYETTA - 15
CABERGOLINE - 32
CAFCIT - 6
CAFERGOT - 37
CAFFEINE CITRATE - 6
CALAN - 24
CALAN SR - 24
CALCIP/BETAMETH OINT - 29
CALCIPOTRIENE OINT - 28
CALCIPOTRIENE SOL - 28
CALCITONIN-SALMON - 32
CALCITRENE - 28
CALCITRIOL - 32
CALCIUM ACETATE - 34
CAMILA - 26
CAMPRAL - 43
CAMRESE - 25
CAMRESE LO - 25
CANASA - 34
CANDESARTAN - 18
CANDESARTAN HCTZ - 18
CANTHARIDIN - 30
CANTIL - 46
CAPACET - 7
CAPECITABINE - 20
CAPEX - 29
CAPHOSOL - 39
CAPITAL/CODEINE - 8
CAPRELSA - 20
CAPTOPRIL - 18
CAPTOPRIL HCTZ - 18
CARAC - 28
CARAFATE - 46
CARBAMAZEPINE - 13
CARBAMAZEPINE ER - 13
CARBATROL - 13
CARBIDOPA - 21
CARBIDOPA/LEVODOPA - 21
CARBIDOPA/LEVODOPA CR - 21
CARBIDOPA/LEVODOPA ER - 21
CARBIDOPA/LEVODOPA ODT - 21
CARBIDOPA/LEVODOPA SR - 21
CARBIDOPA/LEVODOPA/ENTACA - 21
CARBINOXAMINE MALEATE - 17
CARDIZEM - 24
CARDIZEM CD - 24
CARDIZEM LA - 24
CARDURA - 18
CARISOPRODOL 250MG - 39
CARISOPRODOL 350MG - 39
CARISOPRODOL/ASA/CODEINE - 40
CARISOPRODOL/ASPIRIN - 40
CARMOL-HC - 29
CARNITOR - 33
CARNITOR SF - 33
CARRASYN HYDROGEL WOUND D - 31
CARTEOLOL HCL - 40
CARTIA XT - 24
CARVEDILOL - 23
CASODEX - 20
CATAFLAM - 7
CATAPRES - 18
CATAPRES-TTS - 18
CAVERJECT - 24
CAVERJECT IMPULSE - 24
CAYSTON - 12
CAZIANT - 25
CEDAX - 11
CEFACLOR - 11
CEFACLOR ER - 11
CEFADROXIL - 11
CEFDINIR - 11
CEFDITOREN PIVOXIL - 11
CEFIXIME SUSP - 11
CEFPODOXIME PROXETIL - 11
CEFPROZIL - 11
CEFTIBUTEN - 11
CEFTIN - 11
CEFUROXIME AXETIL - 11
CELEBREX - 7
CELECOXIB - 7
CELESTONE - 26
CELEXA - 14
CELLCEPT - 37
CEM-UREA - 29
Caterpillar Drug Formulary
Generated October 26, 2016
CENTANY - 27
CEPHADYN - 7
CEPHALEXIN - 11
CERDELGA - 33
CERISA WASH - 27
CEROVEL - 29
CERVICAL CAPS - 26
CESIA - 25
CEVIMELINE HCL - 39
CHANTIX - 43
CHEMET - 16
CHEMSTRIP K - 47
CHENODAL - 33
CHLORAMPHENICOL - 12
CHLORDIAZEPOXIDE HCL - 10
CHLORDIAZEPOXIDE/AMITRIPT - 44
CHLORDIAZEPOXIDE/CLIDNIUM BRO - 46
CHLORHEXIDINE GLUCONATE - 22
CHLOROQUINE PHOSPHATE - 19
CHLOROTHIAZIDE - 32
CHLORPROMAZINE HCL - 22
CHLORPROPAMIDE - 15
CHLORTHALIDONE - 32
CHLORZOXAZONE - 39
CHOLBAM - 34
CHOLESTYRAMINE - 17
CHOLESTYRAMINE LIGHT - 17
CHOLINE MAGNESIUM TRISALI - 7
CIALIS - 24
CICLODAN - 27
CICLOPIROX - 27
CILOSTAZOL - 35
CILOXAN - 41
CIMZIA - 34
CIPRO - 11
CIPRO HC - 43
CIPRO XR - 11
CIPRODEX - 42
CIPROFLOXACIN ER - 11
CIPROFLOXACIN HCL - 41
CITALOPRAM HYDROBROMIDE - 14
CITRIC ACID/SODIUM CITRAT - 34
CLARAVIS - 27
CLARITHROMYCIN - 11
CLARITHROMYCIN ER - 11
CLEMASTINE FUMARATE - 17
CLEOCIN - 47
CLEOCIN CAPS - 12
CLEOCIN PEDIATRIC GRANULE - 12
CLEOCIN PHOSPHATE - 12
CLEOCIN-T - 27
CLIMARA - 33
CLIMARA PRO - 33
CLINDACIN-P - 27
CLINDAGEL - 27
CLINDAMAX - 27
CLINDAMYCIN HCL - 11
CLINDAMYCIN PALMITATE HCL - 11
CLINDAMYCIN PHOS INJ - 11
CLINDAMYCIN PHOSPHATE - 47
CLINDAMYCIN PHOSPHATE TOPICAL - 27
CLINITEST TABS - STRIPS - 47
CLINORIL - 7
CLIOQUINOL - 27
CLOBETASOL PROPIONATE - 29
CLOBEX - 29
CLODERM - 29
CLOMIPRAMINE HCL - 14
CLONAZEPAM - 12
CLONIDINE HCL - 18
CLOPIDOGREL - 35
CLORAZEPATE DIPOTASSIUM - 10
CLORPRES - 19
CLOTRIMAZOLE TROCHES - 39
CLOTRIMAZOLE/BETAMETHASON - 27
CLOZAPINE - 21
CLOZARIL - 21
CO-GESIC - 8
COAGUCHEK - 31
COAL TAR - 30
COARTEM - 19
CODEINE SULFATE - 7
CODEINE/ACETAMINOPHEN - 8
COLAZAL - 34
COLCRYS - 35
COLESTID - 17
COLESTIPOL HCL - 17
COLISTIMETHATE SODIUM - 11
COLLODION - 43
COLOCORT - 9, 34
COLY-MYCIN M - 12
COLY-MYCIN S - 43
COLYTE-FLAVOR PACKS - 37
COMBIGAN - 40
COMBIPATCH - 33
COMBISTIX - 47
COMBIVENT - 45
COMBIVIR - 22
COMPLERA - 22
COMPRO - 22
COMTAN - 20
CONCEPTROL GEL - 26
CONCERTA - 6
CONDOMS (FEMALE) - 26
CONDYLOX - 30
CONSTULOSE - 37
COPAXONE 20MG - 44
COPAXONE 40MG - 44
COPEGUS - 23
CORDARONE - 10
CORDRAN - 29
CORDRAN TAPE - 29
COREG - 23
CORGARD - 23
CORLANOR - 24
CORMAX SCALP APPLICATION - 29
CORTALO - 29
CORTANE-B - 29
CORTANE-B AQUEOUS - 43
CORTANE-B-OTIC - 43
CORTEF - 26
CORTENEMA - 9, 34
CORTIC-ND - 42
CORTIFOAM - 9, 34
CORTISONE ACETATE - 26
CORTISPORIN - 27
CORTISPORIN OTIC - 43
CORTISPORIN-TC - 43
CORZIDE - 19
COSENTYX - 28
COSOPT - 40
COTAZYM - 31
COUMADIN - 12
COVARYX - 33
COVARYX HS - 33
COZAAR - 18
CREON - 31
CRESEMBA - 16
CRESTOR - 18
CRESYLATE - 42
CRINONE - 47
CRIXIVAN - 22
CROMOLYN SODIUM - 45
CROMOLYN SODIUM OPHTH - 42
CRYSELLE - 25
CRYSELLE-28 - 25
CUPRIMINE - 16
CURAFIL GEL WOUND DRESSIN - 31
CUTIVATE - 29
CUVPOSA - 46
CYANOCOBALAMIN - 35
CYCLAFEM 1/35 - 25
CYCLAFEM 7/7/7 - 25
CYCLESSA - 25
CYCLOBENZAPRINE HCL - 39
CYCLOGYL - 41
CYCLOMYDRIL - 41
CYCLOPENTOLATE HCL - 40
CYCLOPHOSPHAMIDE CAPS - 19
CYCLOSPORINE - 37
CYCLOSPORINE MODIFIED - 37
CYMBALTA - 14
CYOTIC - 42
CYPROHEPTADINE HCL - 17
CYSTAGON - 33
CYSTARAN - 41
CYTOMEL - 45
CYTOTEC - 46
CYTRA K CRYSTALS - 34
CYTRA-2 - 34
CYTRA-3 - 34
CYTRA-K - 34
D.H.E. 45 - 38
DAKLINZA - 23
DALIRESP - 45
DANAZOL - 8
DANTRIUM - 39
DANTROLENE SODIUM - 39
DAPSONE - 11
DARIFENACIN HBR ER - 47
DASETTA 1/35 - 25
DASETTA 7/7/7 - 25
DAYPRO - 7
DAYSEE - 25
DAYTRANA - 6
DDAVP - 33
DEBACTEROL - 39
DELATESTRYL - 9
DELESTROGEN - 33
DELZICOL - 34
DEMADEX - 32
DEMECLOCYCLINE HCL - 12
DEMEROL - 8
DENAVIR - 28
DEPADE - 16
DEPAKENE - 13
DEPAKOTE - 13
DEPAKOTE ER - 13
DEPAKOTE SPRINKLES - 13
DEPEN TITRATABS - 16
DEPO-ESTRADIOL - 33
DEPO-MEDROL - 26
DEPO-PROVERA CONTRACEPTIV - 26
DEPO-SUBQ PROVERA 104 - 26
DEPO-TESTOSTERONE - 9
DERMA-SMOOTHE/FS BODY OIL - 29
DERMA-SMOOTHE/FS SCALP OI - 29
Caterpillar Drug Formulary
Generated October 26, 2016
DERMATOP - 29
DERMAZENE - 27
DERMOTIC - 43
DESCOVY - 22
DESIPRAMINE HCL - 14
DESMOPRESSIN ACETATE - 32
DESOGEN - 25
DESONIDE - 29
DESOWEN - 29
DESOXIMETASONE - 29
DESOXYN - 6
DETROL - 47
DETROL LA - 47
DEXAMETHASONE - 26
DEXAMETHASONE INTENSOL - 26
DEXAMETHASONE OPHTH - 42
DEXCHLORPHENIRAMINE MALEA - 17
DEXEDRINE - 6
DEXMETHYLPHENIDATE HCL - 6
DEXMETHYLPHENIDATE SR - 6
DEXPAK 10 DAY - 26
DEXPAK 13 DAY - 26
DEXPAK 6 DAY - 26
DEXTROAMPHETAMINE SULFATE - 6
DIAB - 31
DIAB F.D.G. FREEZE-DRIED - 31
DIALYVITE - 48
DIAMOX - 31
DIASTAT - 13
DIATX ZN - 48
DIAZEPAM INTENSOL - 10
DIAZEPAM RECTAL GEL - 10
DIAZEPAM TAB - 10
DIBENZYLINE - 19
DICLEGIS - 16
DICLOFENAC GEL 1% - 30
DICLOFENAC GEL 3% - 28
DICLOFENAC OPHTH 0.1% - 42
DICLOFENAC POTASSIUM - 7
DICLOFENAC SODIUM - 42
DICLOFENAC SODIUM DR - 7
DICLOFENAC SODIUM ER - 7
DICLOFENAC SODIUM SR - 7
DICLOFENAC SODIUM XR - 7
DICLOFENAC SOLN 1.5% - 30
DICLOFENAC-MISOPROSTIL - 7
DICLOXACILLIN SODIUM - 12
DICYCLOMINE HCL - 46
DIDANOSINE - 22
DIFFERIN - 27
DIFICID - 11
DIFIL-G FORTE - 44
DIFLORASONE CRM - 29
DIFLORASONE DIACETATE - 29
DIFLORASONE OINT - 29
DIFLUCAN - 17
DIFLUCAN 150MG - 17
DIFLUNISAL - 7
DIGOXIN - 24
DIGOXIN SOLUTION - 24
DIHYDROERGOTAMINE MESYLAT - 37
DILANTIN - 13
DILATRATE SR - 10
DILAUDID - 8
DILT-XR - 24
DILTIAZEM - 24
DILTIAZEM CD - 24
DILTIAZEM ER - 24
DILTIAZEM SR - 24
DILTZAC - 24
DIOVAN - 18
DIOVAN HCTZ - 19
DIPENTUM - 34
DIPHENATOL - 15
DIPHENHYDRAMINE HCL - 17
DIPHENOXYLATE/ATROPINE - 15
DIPROLENE - 29
DIPROLENE AF - 29
DIPYRIDAMOLE - 35
DISOPYRAMIDE PHOSPHATE - 10
DISULFIRAM - 43
DITROPAN XL - 47
DIURIL - 32
DIVALPROEX SODIUM - 13
DIVALPROEX SODIUM DR - 13
DIVALPROEX SODIUM ER - 13
DIVIGEL - 33
DOFETILIDE - 10
DOLGIC PLUS - 7
DOLOGESIC - 7
DOLOPHINE - 8
DOLOREX - 7
DONEPEZIL 10MG - 44
DONEPEZIL 5MG - 44
DONEPEZIL ODT - 44
DONNATAL - 46
DORZOLAMIDE HCL - 42
DORZOLAMIDE/TIMOLOL - 40
DOXAZOSIN MESYLATE - 18
DOXEPIN HCL - 14
DOXEPIN HCL CRE - 28
DOXERCALCIFEROL - 32
DOXYCYCLINE HYCLATE 20MG TB - 12
DOXYCYCLINE HYCLATE CAPS - 12
DOXYCYCLINE MONOHYDRATE CAPS - 12
DRISDOL - 48
DRITHO-CREME HP - 28
DRONABINOL - 16
DROPERIDOL - 10
DRYSOL - 30
DUASTERIDE - 34
DUETACT - 15
DULERA - 45
DULOXETINE - 14
DUOPA - 21
DURAGESIC - 8
DURAXIN - 7
DYAZIDE - 31
DYNACIN - 12
DYRENIUM - 32
E.E.S. 400 - 11
E.E.S. GRANULES - 11
E.S.P. - 11
EC-NAPROSYN - 7
ECONAZOLE NITRATE - 27
ED BACLOFEN - 39
ED CHLORPED - 17
ED-CHLOR-TAN - 17
ED-FLEX - 7
ED-SPAZ - 46
EDECRIN - 32
EDEX - 24
EDURANT - 22
EEMT - 33
EEMT HS - 33
EFFER-K - 38
EFFERVESCENT POT CHLORIDE - 38
EFFEXOR XR - 14
EFFIENT - 35
EFUDEX - 28
ELDEPRYL - 21
ELESTAT - 42
ELETONE - 29
ELIDEL - 30
ELIGARD - 20
ELIMITE - 30
ELINEST - 25
ELIPHOS - 34
ELIQUIS - 12
ELIXOPHYLLIN - 45
ELMIRON - 34
ELOCON - 29
EMCYT - 20
EMEND CAP - 16
EMEND SUS - 16
EMOQUETTE - 25
EMSAM - 14
EMTRIVA - 22
ENABLEX - 47
ENALAPRIL HCTZ - 18
ENALAPRIL MALEATE - 18
ENBREL - 6
ENDOCET - 8
ENDODAN - 8
ENJUVIA - 33
ENOXAPARIN SODIUM - 12
ENPRESSE-28 - 25
ENTACAPONE - 20
ENTECAVIR - 23
ENTOCORT EC - 26
ENTRESTO - 19
ENULOSE - 34
EPANED ORAL SOL - 18
EPCLUSA - 23
EPIDRIN - 37
EPIFLUR - 38
EPIFOAM - 29
EPINASTINE HCL - 42
EPINEPHRINE INJECTOR - 48
EPIPEN - 48
EPIPEN 2-PAK - 48
EPIPEN-JR 2-PAK - 48
EPITOL - 13
EPIVIR - 22
EPLERENONE - 19
EPOGEN - 36
EPROSARTAN MESYLATE - 18
EPROSARTAN MESYLATE HCTZ - 18
EPZICOM - 22
EQUAGESIC - 7
EQUETRO - 22
ERGOCALCIFEROL - 48
ERGOMAR - 38
ERIVEDGE - 20
ERRIN - 26
ERTACZO - 27
ERY - 27
ERY-TAB - 11
ERYPED 200 - 11
ERYPED 400 - 11
ERYTHROCIN STEARATE - 11
ERYTHROMYCIN - 11
ERYTHROMYCIN BASE - 11
ERYTHROMYCIN CAP EC - 11
ERYTHROMYCIN ETHYLSUCCINA - 11
ERYTHROMYCIN GEL - 11
ERYTHROMYCIN OPHTH - 41
Caterpillar Drug Formulary
Generated October 26, 2016
ERYTHROMYCIN STEARATE - 11
ERYTHROMYCIN TOP - 27
ERYTHROMYCIN/SULFISOXAZOL - 11
ESCITALOPRAM OXALATE - 14
ESGIC - 7
ESGIC-PLUS - 7
ESSIAN - 33
ESSIAN H.S. - 33
ESTARYLLA - 25
ESTAZOLAM - 36
ESTERIFIED ESTROGENS/METH - 33
ESTRACE - 47
ESTRACE TABS - 33
ESTRADIOL TABS - 33
ESTRADIOL TD PATCH - 33
ESTRADIOL VALERATE - 33
ESTRADIOL/NORETHINDRONE - 33
ESTRING - 47
ESTROGEL - 33
ESTRONE - 33
ESTROPIPATE - 33
ESTROSTEP FE - 25
ESZOPICLONE - 36
ETHAMBUTOL HCL - 19
ETHOSUXIMIDE - 13
ETIDRONATE DISODIUM - 32
ETODOLAC - 7
ETODOLAC ER - 7
ETOPOSIDE - 20
EURAX - 30
EVAMIST - 33
EVISTA - 33
EVOCLIN - 27
EVOTAZ - 22
EVOXAC - 39
EXALGO - 8
EXELDERM - 27
EXELON - 44
EXELON PATCH - 44
EXEMESTANE - 20
EXJADE - 16
EXODERM - 27
EXOTIC-HC - 42
EXTAVIA - 44
FABB - 36
FACTIVE - 11
FALMINA - 25
FAMCICLOVIR - 23
FAMVIR - 23
FARESTON - 20
FE C PLUS - 36
FELBAMATE - 13
FELBATOL - 13
FELDENE - 7
FELODIPINE ER - 24
FEM PH - 47
FEMARA - 20
FEMCAP - 37
FEMCON FE - 25
FEMHRT LOW DOSE - 33
FEMRING - 47
FEMYNOR - 25
FENOFIBRATE - 17
FENOFIBRATE 130MG - 17
FENOFIBRATE 43MG - 17
FENOFIBRATE MICRONIZED - 17
FENOFIBRIC ACID - 17
FENOPROFEN CAP - 7
FENTANYL - 7
FENTANYL CITRATE ORAL TRA - 7
FENTORA - 8
FEROCON - 36
FEROTRINSIC - 36
FERREX 150 FORTE - 36
FERRIPROX - 16
FERROCITE PLUS - 48
FERROGELS FORTE - 36
FERROUS SULFATE - 38
FINACEA - 30
FINASTERIDE 5mg - 34
FIORICET - 7
FIORICET/CODEINE - 8
FIORINAL - 7
FIRAZYR - 35
FLAGYL - 12
FLAGYL ER - 12
FLAREX - 42
FLAVOXATE HCL - 47
FLECAINIDE ACETATE - 10
FLECTOR PATCH - 30
FLEXERIL - 39
FLOMAX - 35
FLOVENT - 45
FLUCONAZOLE - 17
FLUCONAZOLE 150MG - 17
FLUCYTOSINE - 16
FLUDROCORTISONE ACETATE - 26
FLUMADINE - 23
FLUOCINOLONE ACETONIDE - 29
FLUOCINOLONE OTIC - 43
FLUOCINONIDE - 29
FLUOCINONIDE-E - 29
FLUOR-A-DAY - 38
FLUOR-OP - 42
FLUORIDE - 38
FLUORITAB - 38
FLUOROMETHOLONE - 42
FLUOROPLEX - 28
FLUOROURACIL - 27
FLUOXETINE DR - 14
FLUOXETINE HCL - 14
FLUPHENAZINE DECANOATE - 22
FLUPHENAZINE HCL - 22
FLURA-DROPS 0.125 - 38
FLURA-DROPS 0.25 - 38
FLURANDRENOLIDE - 29
FLURAZEPAM HCL - 36
FLURBIPROFEN - 7
FLURBIPROFEN OPHTH - 42
FLUTAMIDE - 20
FLUTICASONE PROPIONATE - 29
FLUVASTATIN - 17
FLUVASTATIN XL - 17
FLUVOXAMINE MALEATE - 14
FML - 42
FML FORTE - 42
FML LIQUIFILM - 42
FOCALIN - 6
FOCALIN XR - 6
FOLBEE - 36
FOLBEE PLUS - 48
FOLBEE PLUS CZ - 48
FOLCAPS - 36
FOLGARD RX - 36
FOLIC ACID 1mg - 35
FOLIC ACID 400mcg - 35
FOLIC ACID 800mcg - 35
FOLIC ACID/CYANOCOBALAMIN - 36
FOLIC ACID/VITAMIN B-6/VI - 36
FOLPLEX 2.2 - 36
FOLTRIN - 36
FONDAPARINUX SODIUM - 12
FORADIL AEROLIZER - 45
FORMA-RAY - 22
FORMADON - 22
FORMALDEHYDE - 22
FORTAVIT - 48
FORTEO - 32
FORTICAL - 32
FOSAMAX - 32
FOSINOPRIL HCTZ - 18
FOSINOPRIL SODIUM - 18
FOSRENOL - 34
FRAGMIN - 12
FROVA - 38
FURADANTIN - 47
FUROSEMIDE TABS & SOLN - 32
FUZEON - 22
FYCOMPA - 13
GABAPENTIN - 13
GABITRIL - 13
GALANTAMINE - 44
GARAMYCIN - 41
GATIFLOXACIN - 41
GAVILYTE-C - 37
GAVILYTE-G - 37
GAVILYTE-N/FLAVOR PACK - 37
GELCLAIR - 39
GEMFIBROZIL - 17
GENERLAC - 34
GENGRAF - 37
GENOTROPIN - 32
GENTAK - 41
GENTAMICIN INJ - 10
GENTAMICIN OPHTH - 41
GENTAMICIN SULFATE - 27
GENVOYA - 22
GEODON - 22
GIANVI - 25
GILDESS FE 1.5/30 - 25
GILDESS FE 1/20 - 25
GILENYA - 44
GILOTRIF - 20
GLEEVEC - 20
GLIMEPIRIDE - 15
GLIPIZIDE - 15
GLIPIZIDE ER - 15
GLIPIZIDE XL - 15
GLIPIZIDE/METFORMIN HCL - 14
GLUCAGEN - 15
GLUCAGEN HYPOKIT - 15
GLUCAGON EMERGENCY KIT - 15
GLUCOPHAGE - 15
GLUCOPHAGE XR - 15
GLUCOTROL - 15
GLUCOTROL XL - 15
GLUCOVANCE - 15
GLYBURIDE - 15
GLYBURIDE MICRONIZED - 15
GLYBURIDE/METFORMIN HCL - 14
GLYCOPYRROLATE - 46
GLYNASE - 15
GLYSET - 14
GOLYTELY - 37
GORDONS UREA - 29
GRAFCO SILVER NITRATE APP - 28
GRANISETRON HCL - 16
Caterpillar Drug Formulary
Generated October 26, 2016
GRANISOL - 16
GRANIX - 36
GRIFULVIN V - 16
GRIS-PEG - 16
GRISEOFULVIN MICROSIZE - 16
GUANFACINE HCL - 6, 18
HALCION - 36
HALDOL - 21
HALDOL DECANOATE - 21
HALOBETASOL PROPIONATE - 29
HALOG - 29
HALOPERIDOL - 21
HALOPERIDOL DECANOATE - 21
HALOPERIDOL LACTATE - 21
HARVONI - 23
HEATHER - 26
HECORIA - 37
HECTOROL - 33
HEMATINIC PLUS COMPLEX - 48
HEMATINIC PLUS VITAMINS/M - 48
HEMATINIC/FOLIC ACID - 36
HEMATOGEN - 36
HEMATOGEN FA - 36
HEMATOGEN FORTE - 36
HEMOCYTE-F - 36
HEMOCYTE-PLUS - 48
HEMORRHOIDAL-HC - 9
HEMRIL-30 - 9
HEPARIN SODIUM - 12
HEPSERA - 23
HEXALEN - 19
HIPREX - 47
HOMATROPAIRE - 40
HOMATROPINE HBR - 40
HUMALOG MIX 50/50 VIAL - 15
HUMALOG MIX 75/25 VIAL - 15
HUMALOG VIAL - 15
HUMATROPE - 32
HUMIRA - 6, 34
HUMULIN N VIAL - 15
HUMULIN R VIAL - 15
HYCAMTIN - 20
HYCET - 8
HYDRALAZINE HCL - 19
HYDREA - 20
HYDROCHLOROTHIAZIDE 12.5MG - 32
HYDROCHLOROTHIAZIDE 25MG - 32
HYDROCHLOROTHIAZIDE 50MG - 32
HYDROCODONE/ACETAMINOPHEN - 8
HYDROCODONE/APAP - 8
HYDROCODONE/HOMATROPINE - 26
HYDROCODONE/IBUPROFEN - 8
HYDROCORTISONE - 26
HYDROCORTISONE ACETATE - 9
HYDROCORTISONE BUTYRATE - 29
HYDROCORTISONE IN ABSORBA - 29
HYDROCORTISONE RECTAL - 9, 34
HYDROCORTISONE TOPICAL - 29
HYDROCORTISONE VALERATE - 29
HYDROCORTISONE/ACETIC ACI - 43
HYDROCORTISONE/IODOQUINOL - 27
HYDROGESIC - 8
HYDROMET - 26
HYDROMORPHONE ER - 8
HYDROMORPHONE HCL - 8
HYDROXYCHLOROQUINE SULFAT - 19
HYDROXYUREA - 20
HYDROXYZINE HCL - 10
HYDROXYZINE PAMOATE - 10
HYLATOPIC PLUS - 29
HYOMAX -DT - 46
HYOMAX-SL - 46
HYOMAX-SR - 46
HYOPHEN - 46
HYOSCYAMINE SULFATE - 46
HYOSCYAMINE SULFATE ER - 46
HYOSCYAMINE SULFATE ODT - 46
HYOSCYAMINE SULFATE SR - 46
HYOSYNE - 46
HYPER-SAL - 27
HYPERCARE - 30
HYZAAR - 19
IBANDRONATE - 32
IBUDONE - 8
IBUPROFEN 400mg - 7
IBUPROFEN 600MG - 7
IBUPROFEN 800MG - 7
ICAR-C PLUS - 36
IFEREX 150 FORTE - 36
ILEVRO - 42
ILOTYCIN - 41
IMATINIB - 20
IMBRUVICA - 20
IMDUR - 10
IMIPRAMINE HCL - 14
IMIPRAMINE PAMOATE - 14
IMIQUIMOD - 30
IMITREX - 38
IMITREX NASAL - 38
IMPAVIDO - 12
IMURAN - 37
INCIVEK - 23
INCRELEX - 33
INCRUSE ELLIPTA - 44
INDAPAMIDE - 32
INDERAL LA - 23
INDERAL XL - 23
INDOCIN - 7
INDOMETHACIN - 7
INDOMETHACIN CR - 7
INDOMETHACIN ER - 7
INDOMETHACIN SA - 7
INDOMETHACIN SR - 7
INLYTA - 20
INNOPRAN XL - 23
INSPRA - 19
INTELENCE - 22
INTRON-A - 20
INTROVALE - 25
INTUNIV - 6
INVIRASE CAPS - 22
INVIRASE TB - 22
IOPIDINE - 41
IPRATROPIUM BROMIDE - 44
IPRATROPIUM BROMIDE NASAL - 40
IPRATROPIUM/ALBUTEROL - 45
IRBESARTAN - 18
IRBESARTAN HCTZ - 18
ISENTRESS POW PACK - 22
ISENTRESS TAB - 22
ISODITRATE ER - 9
ISOMETHEPTENE/CAFF/APAP - 37
ISOMETHEPTENE/DICHLORAL/APAP - 37
ISONIAZID SYRP - 19
ISONIAZID TB - 19
ISOPTIN SR - 24
ISOPTO ATROPINE - 41
ISOPTO CARBACHOL - 41
ISOPTO CARPINE - 41
ISOPTO HOMATROPINE - 41
ISOPTO HYOSCINE - 41
ISORDIL TITRADOSE - 10
ISOSORB DINITRATE/HYRAL - 24
ISOSORBIDE DINITRATE - 9
ISOSORBIDE DINITRATE ER - 9
ISOSORBIDE DINITRATE SA - 9
ISOSORBIDE DINITRATE SL - 9
ISOSORBIDE MONONITRATE - 9
ISOSORBIDE MONONITRATE ER - 9
ISOXSUPRINE HCL - 24
ISRADIPINE - 24
ISTALOL - 40
ITRACONAZOLE - 17
IVERMECTIN - 9
JADENU - 16
JAKAFI - 20
JANTOVEN - 12
JINTELI - 33
JOLESSA - 25
JOLIVETTE - 26
JUNEL 1.5/30 - 25
JUNEL 1/20 - 25
JUNEL FE 1.5/30 - 25
JUNEL FE 1/20 - 25
K-EFFERVESCENT - 38
K-PHOS - 38
K-PHOS NEUTRAL - 38
K-PHOS NO 2 - 34
K-PRIME - 38
K-TABS - 38
K-VESCENT - 38
KADIAN - 8
KALETRA - 22
KALYDECO - 45
KARIDIUM - 38
KARIVA - 25
KEFLEX - 11
KELNOR 1/35 - 25
KENALOG - 29
KENALOG-10 - 26
KENALOG-40 - 26
KEPPRA - 13
KERLONE - 23
KETEK - 12
KETO-DIASTIX - 47
KETOCARE - 47
KETOCONAZOLE - 17
KETOCONAZOLE TOP - 27
KETOPROFEN - 7
KETOPROFEN ER - 7
KETOPROFEN ULTRA MICRONIZ - 7
KETOROLAC OPHTH - 42
KETOROLAC TROMETHAMINE - 7
KINERET - 6
KIONEX - 32
KLARON - 27
KLONOPIN - 13
KLOR-CON - 38
KLOR-CON 10 - 38
KLOR-CON 25 - 38
KLOR-CON 8 - 38
KLOR-CON M10 - 38
KLOR-CON M15 - 38
KLOR-CON M20 - 38
KLOR-CON/EF - 38
KORLYM - 15
KRISTALOSE - 37
Caterpillar Drug Formulary
Generated October 26, 2016
KURVELO - 25
KUVAN - 33
LABETALOL HCL - 23
LAC-HYDRIN - 29
LACLOTION - 29
LACRISERT - 40
LACTIC ACID - 29
LACTULOSE - 37
LAMICTAL - 13
LAMICTAL XR - 13
LAMISIL - 16
LAMIVUDINE - 22
LAMIVUDINE/ZIDOVUDINE - 22
LAMOTRIGINE - 13
LANCETS - 31
LANOXIN - 24
LANTUS SOLOSTAR - 15
LANTUS VIAL - 15
LASIX - 32
LATANOPROST - 42
LATUDA - 22
LEENA - 25
LEFLUNOMIDE - 6
LESCOL - 18
LESCOL XL - 18
LESSINA-28 - 25
LETAIRIS - 24
LETROZOLE - 20
LEUCOVORIN CALCIUM - 20
LEUKERAN - 19
LEUKINE - 36
LEUPROLIDE ACETATE - 20
LEVALBUTEROL NEB - 45
LEVAQUIN TABS - 11
LEVATOL - 23
LEVBID - 46
LEVEMIR VIAL - 15
LEVETIRACETAM - 13
LEVETIRACETAM ER - 13
LEVITRA - 24
LEVO/ETHI/ESTRADIO - 25
LEVOBUNOLOL HCL - 40
LEVOCARNITINE - 32
LEVOFLOXACIN - 11
LEVOFLOXACIN INJ - 11
LEVOFLOXACIN OPHTH - 41
LEVONEST - 25
LEVORA 0.15/30-28 - 25
LEVORPHANOL TARTRATE - 8
LEVOTHROID - 45
LEVOTHYROXINE SODIUM - 45
LEVOXYL - 45
LEVSIN - 46
LEVSIN/SL - 46
LEXAPRO - 14
LEXIVA - 22
LIALDA - 34
LIBRAX - 46
LIDAZONE HC - 9
LIDOCAINE 2% GEL - 30
LIDOCAINE 3% CRM - 30
LIDOCAINE 4% SOLN - 30
LIDOCAINE 5% OINT - 30
LIDOCAINE HCL-HYDROCORTIS GEL - 9
LIDOCAINE HCL/HYDROCORTIS CRM - 9
LIDOCAINE PAD 5% - 30
LIDOCAINE VISCOUS - 39
LIDODERM - 30
LINDANE - 30
LINEZOLID SUSP - 11
LINEZOLID TBS - 11
LINZESS - 34
LIOTHYRONINE TAB - 45
LIPITOR - 18
LISINOPRIL - 18
LISINOPRIL HCTZ - 18
LITHIUM CARBONATE - 21
LITHIUM CARBONATE ER - 21
LITHIUM CITRATE - 21
LITHOBID - 21
LITHOSTAT - 34
LO LOESTRIN FE - 25
LOCOID - 29
LOCOID LIPOCREAM - 29
LODINE - 7
LOESTRIN 1.5/30-21 - 25
LOESTRIN 1/20-21 - 25
LOESTRIN 24 FE - 25
LOESTRIN FE 1.5/30 - 25
LOESTRIN FE 1/20 - 25
LOFENE - 15
LOKARA - 29
LOMOTIL - 16
LOMUSTINE - 19
LONOX - 15
LONSURF - 20
LOPERAMIDE HCL - 15
LOPID - 17
LOPRESSOR - 23
LOPRESSOR HCTZ - 19
LOPROX - 27
LOPROX SHAMPOO - 27
LORAZEPAM - 10
LORCET - 8
LORCET PLUS - 8
LORTAB - 8
LORYNA - 25
LOSARTAN POTASSIUM - 18
LOSARTAN POTASSIUM HCTZ - 18
LOTEMAX - 42
LOTENSIN - 18
LOTENSIN HCTZ - 19
LOTREL - 19
LOTRISONE - 27
LOTRONEX - 34
LOVASTATIN - 17
LOVENOX - 12
LOW-OGESTREL - 25
LOXAPINE - 21
LOXITANE - 21
LTA 360 KIT - 39
LUDENT - 38
LUMIGAN - 42
LUNESTA - 36
LUPRON DEPOT - 20
LURIDE - 38
LUSONAL - 40
LUTERA - 25
LUXIQ - 29
LYRICA - 13
LYRICA SOL - 13
LYSODREN - 20
LYSTEDA - 36
MACROBID - 47
MACRODANTIN - 47
MAGNEBIND 400 - 38
MAKENA - 43
MALARONE - 19
MALATHION - 30
MAPROTILINE HCL - 14
MARGESIC - 7
MARINOL - 16
MARLISSA - 25
MARTEN-TAB - 7
MARTINIC - 36
MATULANE - 20
MATZIM LA - 24
MAVIK - 18
MAXALT - 38
MAXALT-MLT - 38
MAXIDEX - 42
MAXIDONE - 8
MAXITROL - 42
MAXZIDE - 31
MAXZIDE-25 - 31
ME-PB-HYOS - 46
MECLOFENAMATE SODIUM - 7
MEDROL - 26
MEDROL DOSEPAK - 26
MEDROXYPROGESTERONE - 43
MEDROXYPROGESTERONE IM - 26
MEFENAMIC ACID - 7
MEFLOQUINE HCL - 19
MEGACE ES - 43
MEGACE ORAL - 20
MEGESTROL ACETATE - 20
MELOXICAM - 7
MEMANTINE HCL - 44
MEMANTINE SOL - 44
MENEST - 33
MENOSTAR - 33
MEPERIDINE HCL - 7
MEPERITAB - 7
MEPHYTON - 48
MEPROBAMATE - 10
MEPRON - 21
MERCAPTOPURINE - 20, 34
MESALAMINE - 34
MESNEX - 20
MESTINON - 19
MESTINON TIMESPAN - 19
METADATE CD - 6
METADATE ER 20MG - 6
METAPROTERENOL SULFATE - 45
METAXALONE - 39
METFORMIN HCL - 15
METFORMIN HCL ER - 15
METHADONE HCL - 7
METHADOSE - 8
METHAMPHETAMINE HCL - 6
METHAZOLAMIDE - 31
METHENAMINE HIPPURATE - 46
METHENAMINE MANDELATE - 46
METHERGINE - 43
METHIMAZOLE - 45
METHITEST - 9
METHOCARBAMOL - 39
METHOTREXATE - 20
METHOXALEN - 28
METHSCOPOLAMINE BROMIDE - 46
METHYCLOTHIAZIDE - 32
METHYLDOPA - 18
METHYLDOPA HCTZ - 18
METHYLERGONOVINE MALEATE - 43
METHYLIN - 6
METHYLIN CHEW & SOLN - 6
METHYLPHENIDATE HCL - 6
Caterpillar Drug Formulary
Generated October 26, 2016
METHYLPHENIDATE HCL CD - 6
METHYLPHENIDATE HCL CR - 6
METHYLPHENIDATE HCL ER - 6
METHYLPHENIDATE HCL SR - 6
METHYLPREDNISOLONE - 26
METHYLPREDNISOLONE DOSE PAK - 26
METHYLTESTOSTERONE - 8
METHYLTESTOSTERONE PWD - 9
METHYLTESTOSTERONE/ESTERI - 33
METIPRANOLOL - 40
METOCLOPRAMIDE HCL - 33
METOLAZONE - 32
METOPROLOL HCTZ - 18
METOPROLOL SUCCINATE ER - 23
METOPROLOL TARTRATE - 23
METROCREAM - 30
METROGEL - 30
METROGEL-VAGINAL - 47
METROLOTION - 30
METRONIDAZOLE - 11
METRONIDAZOLE BENZOATE - 27
METRONIDAZOLE TOP - 30
METRONIDAZOLE VAGINAL - 47
MEVACOR - 18
MEXAR WASH - 28
MEXILETINE HCL - 10
MIACALCIN - 32
MICARDIS - 18
MICARDIS HCTZ - 19
MICONAZOLE 3 - 47
MICONAZOLE 3 COMBO PACK - 47
MICONAZOLE NITRATE - 27
MICRO-K - 38
MICROGESTIN 1.5/30 - 25
MICROGESTIN 1/20 - 25
MICROGESTIN FE - 25
MICROGESTIN FE 1.5/30 - 25
MICROZIDE - 32
MIDODRINE HCL - 48
MIGERGOT - 37
MIGLITOL - 14
MIGRAGESIC IDA - 37
MIGRALAM - 37
MIGRANAL - 38
MILLIPRED - 26
MIMVEY - 33
MIMYX - 29
MINIPRESS - 18
MINIRIN - 32
MINITRAN - 9
MINOCIN - 12
MINOCYCLINE HCL - 12
MINOXIDIL - 19
MIOSTAT - 41
MIRAPEX - 21
MIRCETTE - 25
MIRTAZAPINE - 13
MIRTAZAPINE ODT - 13
MISOPROSTOL - 46
MOBIC - 7
MODAFINIL - 6
MODERIBA - 23
MODICON - 25
MODICON-28 - 25
MOEXIPRIL HCL - 18
MOEXIPRIL HCTZ - 18
MOMETASONE FUROATE - 29
MONO-LINYAH - 25
MONODOX - 12
MONONESSA - 25
MONTELUKAST SODIUM - 44
MONUROL - 47
MORGIDOX - 12
MORPHINE SULFATE - 8
MORPHINE SULFATE CR - 7
MORPHINE SULFATE ER CAPS - 8
MORPHINE SULFATE ER TABS - 7
MOTOFEN - 16
MOVANTIK - 34
MOXEZA - 41
MOXIFLOXACIN - 11
MS CONTIN - 8
MULTAQ - 10
MULTIGEN - 36
MUPIROCIN - 27
MUSE - 24
MYALEPT INJ - 32
MYAMBUTOL - 19
MYCOBUTIN - 19
MYCOPHENOLATE MOFETIL - 37
MYDFRIN - 41
MYDRAL - 40
MYDRIACYL - 41
MYFERON 150 FORTE - 36
MYFORTIC - 37
MYLERAN - 19
MYNEPHROCAPS - 48
MYORISAN - 27
MYRBETRIQ - 47
MYSOLINE - 13
MYTESI - 16
MYZILRA - 25
NABUMETONE - 7
NADOLOL - 23
NADOLOL/BENDROFLUMETHIAZI - 18
NAFRINSE DROPS - 38
NALTREXONE HCL - 16
NAMENDA - 44
NAMENDA SOL - 44
NAMENDA XR - 44
NAPRELAN - 7
NAPROSYN - 7
NAPROXEN - 7
NAPROXEN DR - 7
NAPROXEN EC - 7
NARATRIPTAN HCL - 38
NARDIL - 14
NATACYN - 41
NATEGLINIDE - 15
NATURE-THROID - 45
NATURE-THROID NT-2.5 - 45
NEBUSAL - 27
NECON 0.5/35-28 - 25
NECON 1/35-28 - 25
NECON 1/50-28 - 25
NECON 7/7/7 - 25
NEEDLES (INSULIN) - 31
NEFAZODONE HCL - 14
NEO-POLYCIN - 41
NEOFRIN - 41
NEOMYCIN SULFATE - 10
NEOMYCIN/POLYMYXIN/BACITR/HC - 41
NEOMYCIN/POLYMYXIN/DEXAME - 42
NEOMYCIN/POLYMYXIN/GRAMIC - 41
NEOMYCIN/POLYMYXIN/HC OPHTH - 42
NEOMYCIN/POLYMYXIN/HC OTIC - 42
NEORAL - 37
NEOSPORIN - 41
NEPHRO-VITE RX - 48
NEPHROCAPS - 48
NEPHRON FA - 36
NEPHRONEX - 48
NEPTAZANE - 31
NEULASTA - 36
NEUMEGA - 36
NEUPOGEN - 36
NEUPRO PATCH - 21
NEURONTIN - 13
NEUT - 38
NEVANAC - 42
NEVIRAPINE - 22
NEVIRAPINE ER - 22
NEXAVAR - 20
NEXIUM GRANULES - 46
NIACIN ER TAB - 18
NIASPAN - 18
NICARDIPINE HCL - 24
NICOTINE REPLACEMENT - 43
NIFEDIAC CC - 24
NIFEDICAL XL - 24
NIFEDIPINE - 24
NIFEDIPINE ER - 24
NILANDRON - 20
NILUTAMIDE - 20
NIMODIPINE - 24
NIRAVAM - 10
NISOLDIPINE - 24
NISOLDIPINE ER - 24
NITRO-BID - 10
NITRO-DUR - 10
NITRO-TIME - 9
NITROFURANTOIN - 46
NITROFURANTOIN MACROCRYST - 46
NITROFURANTOIN MONOHYDRAT - 46
NITROGLYCERIN - 9
NITROGLYCERIN ER - 9
NITROGLYCERIN LINGUAL - 10
NITROGLYCERIN SPRAY - 9
NITROGLYCERIN SR - 9
NITROGLYCERIN TRANSDERMAL - 9
NITROLINGUAL PUMPSPRAY - 10
NITROMIST - 10
NITROSTAT - 10
NIZORAL - 27
NODOLOR - 37
NOR-QD - 26
NORA-BE - 26
NORCO - 8
NORDETTE-28 - 25
NORDITROPIN FLEXPRO - 32
NORDITROPIN NORDIFLEX PEN - 32
NORETH/ETHINYL/FERR FUM - 25
NORETHINDRONE - 26
NORETHINDRONE ACETATE - 43
NORETHINDRONE/THINYL ESTRADIOL - 33
NORFLEX - 39
NORGESTIMATE/ETHINYL ESTR - 25
NORINYL 1+35 - 25
NORINYL 1+50 - 25
NORITATE - 30
NOROXIN - 11
NORPACE - 10
NORPACE CR - 10
NORPRAMIN - 14
NORTREL 0.5/35 (28) - 25
NORTREL 1/35 (21) - 25
NORTREL 1/35 (28) - 25
Caterpillar Drug Formulary
Generated October 26, 2016
NORTREL 7/7/7 - 25
NORTRIPTYLINE HCL - 14
NORVASC - 24
NORVIR - 22
NOVACORT - 29
NOVOLIN 70/30 RELION - 15
NOVOLIN N RELION - 15
NOVOLIN N VIAL - 15
NOVOLIN PENS - 15
NOVOLIN R RELION - 15
NOVOLIN R VIAL - 15
NOVOLOG FLEXPEN - 15
NOVOLOG MIX 70/30 PREFILL - 15
NOVOLOG MIX 70/30 VIAL - 15
NOVOLOG PENFILL - 15
NOVOLOG VIAL - 15
NOXAFIL - 17
NP THYROID 30 - 45
NP THYROID 60 - 45
NP THYROID 90 - 45
NUCYNTA ER - 7
NUCYNTA IR - 7
NUEDEXTA - 44
NUFOL - 36
NULEV - 46
NULYTELY/FLAVOR PACKS - 37
NUMOISYN - 39
NUOX - 27
NUPLAZID - 22
NUTROPIN - 32
NUVARING - 26
NUZON - 29
NYAMYC - 27
NYSTATIN - 39
NYSTATIN TOP - 27
NYSTATIN VAGINAL - 47
NYSTATIN/TRIAMCINOLONE - 27
NYSTOP - 27
OCALIVA - 34
OCELLA - 25
OCTREOTIDE ACETATE - 33
OCUFEN - 42
OCUFLOX - 41
ODEFSEY - 22
OFLOXACIN - 11
OFLOXACIN OPHTH - 41
OFLOXACIN OTIC - 42
OFORTA - 20
OGESTREL - 25
OLANZAPINE - 21
OLANZAPINE/FLUOXETINE - 44
OLUX - 29
OLUX-E - 29
OLYSIO - 23
OMNIFLEX ALL - 26
OMNIPRED - 42
ONDANSETRON HCL - 16
ONDANSETRON ODT - 16
ONETOUCH MONITORS - 31
ONETOUCH STRIPS - 31
ONFI - 13
ONFI SUSP - 13
OPANA ER - 8
OPANA IR - 8
OPIUM TINCTURE - 15
OPSUMIT - 24
OPTIPRANOLOL - 40
OPTIVAR - 42
ORACIT - 34
ORALONE - 39
ORAP - 44
ORAPRED - 26
ORENCIA SQ - 6
ORENITRAM - 24
ORFADIN - 33
ORPHENADRINE CITRATE - 39
ORPHENADRINE CITRATE CR - 39
ORPHENADRINE CITRATE ER - 39
ORPHENADRINE COMPOUND DS - 40
ORPHENADRINE/ASA/CAFFEINE - 40
ORSYTHIA - 25
ORTHO DIAPHRAGM ALL-FLEX/ - 37
ORTHO MICRONOR - 26
ORTHO TRI-CYCLEN - 25
ORTHO TRI-CYCLEN LO - 25
ORTHO-CEPT - 25
ORTHO-CYCLEN - 25
ORTHO-CYCLEN-28 - 25
ORTHO-NOVUM 1/35-28 - 25
ORTHO-NOVUM 7/7/7 - 25
ORTHO-NOVUM 7/7/7-28 - 25
ORTHOFLEX ALL - 26
OSCIMIN - 46
OSCIMIN SR - 46
OSMOPREP - 37
OSPHENA - 33
OTEZLA - 40
OTICIN - 42
OTO-END 10 - 42
OTOMAR - 42
OTOMAX-HC - 42
OTOVEL - 42
OVACE PLUS - 28
OVACE PLUS WASH - 28
OVACE WASH - 28
OVCON-35 - 25
OVIDE - 30
OXANDRIN - 8
OXANDROLONE - 8
OXAPROZIN - 7
OXAZEPAM - 10
OXCARBAZEPINE - 13
OXICONAZOLE CRE - 27
OXISTAT - 27
OXSORALEN - 30
OXSORALEN ULTRA - 28
OXYBUTYNIN CHLORIDE - 47
OXYBUTYNIN CHLORIDE ER - 47
OXYCODONE HCL - 7
OXYCODONE SOL 5MG/5ML - 8
OXYCODONE SOLUTION 5MG/5ML - 7
OXYCODONE/ACETAMINOPHEN - 8
OXYCODONE/APAP SOLN - 8
OXYCODONE/ASPIRIN - 8
OXYCONTIN - 8
OXYMORPHONE HCL - 7
OXYMORPHONE HCL ER - 7
OXYTROL - 47
PACERONE - 10
PALGIC - 17
PAMELOR - 14
PAMINE - 46
PAMINE FORTE - 46
PANCREAZE - 31
PANCRELIPASE - 31
PANDEL - 29
PAPAVERINE HCL - 24
PARAFON FORTE DSC - 39
PARCAINE - 41
PARCOPA - 21
PAREGORIC - 16
PARICALCITOL - 32
PARLODEL - 21
PARNATE - 14
PAROXETINE HCL - 14
PAROXETINE HCL ER - 14
PAXIL - 14
PAXIL CR - 14
PCE - 11
PEDI-DRI - 27
PEG 3350/ELECTROLYTES - 37
PEG-INTRON - 23
PEGASYS - 23
PENICILLIN VK - 12
PENNSAID SOLN 1.5% - 30
PENNSAID SOLN 2.0% - 30
PENTASA - 34
PENTAZOCINE/ACETAMINOPHEN - 8
PENTAZOCINE/NALOXONE HCL - 8
PENTOXIFYLLINE CR - 35
PENTOXIFYLLINE ER - 35
PEPSIN - 31
PERCOCET - 8
PERCODAN - 8
PERFOROMIST - 45
PERIDEX - 39
PERINDOPRIL ERBUMINE - 18
PERIOGARD - 39
PERMETHRIN - 30
PERPHENAZINE - 22
PERPHENAZINE/AMITRIPTYLIN - 44
PERSANTINE - 35
PERTZYE - 31
PEXEVA - 14
PHENADOZ - 17
PHENAZOPYRIDINE HCL - 35
PHENAZOPYRIDINE PLUS - 47
PHENAZOPYRIDINE/BUTABARB - 47
PHENELZINE SULFATE - 14
PHENERGAN - 17
PHENOBARBITAL - 36
PHENOHYTRO/B-DONNA - 46
PHENOXYBENZAMINE - 19
PHENTOLAMINE MESYLATE - 19
PHENYLEPHRINE HCL - 41
PHENYTEK - 13
PHENYTOIN - 13
PHENYTOIN SODIUM EXTENDED - 13
PHILITH - 25
PHISOHEX - 22
PHOSLO - 34
PHOSLYRA - 34
PHOSPHA 250 NEUTRAL - 38
PHOSPHOLINE IODIDE - 41
PHRENILIN FORTE - 7
PHYTONADIONE - 48
PILOCARPINE HYDROCHLORIDE - 39
PILOCARPINE OPHTH - 41
PILOPINE HS - 41
PIMOZIDE - 44
PINDOLOL - 23
PINNACAINE OTIC - 42
PIOGLITAZONE HCL - 15
PIOGLITAZONE HCL/METFORMI - 14
PIOGLITAZONE-GLIMEPIRIDE - 14
PIROXICAM - 7
PLACEBO #00 - 43
Caterpillar Drug Formulary
Generated October 26, 2016
PLAQUENIL - 19
PLAVIX - 35
PLEGRIDY INJ - 44
PLETAL - 35
PODOCON 25 IN BENZOIN TIN - 30
PODOFILOX - 30
POLY-DEX - 42
POLY-IRON 150 FORTE - 36
POLYCIN B - 41
POLYCITRA-K CRYSTALS - 34
POLYSACCHARIDE IRON FORTE - 36
POLYTRIM - 41
POMALYST - 20, 37
PONSTEL - 7
PORTIA-28 - 25
POTASSIUM CHLORIDE CR - 38
POTASSIUM CHLORIDE ER - 38
POTASSIUM CHLORIDE SA - 38
POTASSIUM CHLORIDE SR - 38
POTASSIUM CITRATE - 34
POTASSIUM CITRATE/CITRIC - 34
POTASSIUM PERMANGANATE - 22
POTIGA - 13
PRADAXA - 12
PRAMCORT - 29
PRAMIPEXOLE - 21
PRAMOSONE - 29
PRAMOTIC - 43
PRAMOXINE-HC - 42
PRANDIN - 15
PRASCION - 27
PRASCION FC - 27
PRASCION RA WITH SUNSCREE - 27
PRAVACHOL - 18
PRAVASTATIN SODIUM - 17
PRAZOSIN HCL - 18
PRECOSE - 14
PRED FORTE - 42
PRED MILD - 42
PRED-G - 42
PRED-G S.O.P. - 42
PREDNICARBATE - 29
PREDNISOLONE - 26
PREDNISOLONE OPHTH - 42
PREDNISONE - 26, 34
PREDNISONE INTENSOL - 26
PREFEST - 33
PRELONE - 26
PREMARIN CRM - 47
PREMARIN TABS - 33
PREMPHASE - 33
PREMPRO - 33
PRENTIF CAVITY-RIM CERVIC - 37
PRENTIF FITTING SET - 37
PREVACID SOLUTAB - 46
PREVALITE - 17
PREVIFEM - 25
PREZCOBIX - 22
PREZISTA - 22
PRIMAQUINE PHOSPHATE - 19
PRIMIDONE - 13
PRIMLEV - 8
PRIMSOL - 12
PRINIVIL - 18
PROAIR - 45
PROBENECID - 35
PROBENECID/COLCHICINE - 35
PROCAINAMIDE HCL ER - 10
PROCARDIA - 24
PROCARDIA XL - 24
PROCENTRA - 6
PROCHLORPERAZINE EDISYLAT - 22
PROCHLORPERAZINE MALEATE - 22
PROCRIT - 36
PROCTO-MED CRE HC 2.5% - 9
PROCTO-PAK - 9
PROCTOCARE-HC - 9
PROCTOCORT - 9
PROCTOCREAM HC - 9
PROCTOFOAM HC - 9
PROCTOSOL HC - 9
PROCTOZONE-HC - 9
PRODRIN - 37
PROFERRIN-FORTE - 36
PROGESTERONE MICRONIZED - 43
PROGESTERONE ORAL - 43
PROGRAF CAPS - 37
PROMACET - 7
PROMACTA - 36
PROMETHAZINE HCL - 17
PROMETHEGAN 12.5MG SUPP - 17
PROMETHEGAN 25MG SUPP - 17
PROMETHEGAN 50MG SUPP - 17
PROMETHEGAN TABS - 17
PROMETRIUM - 43
PROPAFENONE HCL - 10
PROPAFENONE HCL ER - 10
PROPANTHELINE BROMIDE - 46
PROPARACAINE HCL - 41
PROPRANOLOL HCL - 23
PROPRANOLOL HCL ER - 23
PROPRANOLOL HCTZ - 18
PROPYLTHIOURACIL - 45
PROSCAR - 35
PROSCYBI - 33
PROSED/DS - 46
PROSTIGMIN - 19
PROTECT PLUS - 48
PROTECT PLUS NR - 48
PROTOPIC - 30
PROTRIPTYLINE HCL - 14
PROVENTIL HFA - 45
PROVERA - 43
PROVIGIL - 6
PROZAC - 14
PROZAC WEEKLY - 14
PRUDOXIN - 28
PULMICORT - 45
PULMICORT FLEXHALER - 45
PULMOZYME - 45
PUREVIT DUALFE PLUS - 36
PURINETHOL - 20
PURIXAN SUS - 20
PYLERA - 46
PYRIDIUM - 35
PYRIDOSTIGMINE BROMIDE - 19
QBRELIS - 18
QUALAQUIN - 19
QUANESE - 25
QUARTETTE - 25
QUDEXY XR - 13
QUESTRAN - 17
QUESTRAN LIGHT - 17
QUETIAPINE FUMARATE - 21
QUINAPRIL HCL - 18
QUINAPRIL HCTZ - 18
QUINIDINE GLUCONATE CR - 10
QUINIDINE GLUCONATE ER - 10
QUINIDINE SULFATE - 10
QUINIDINE SULFATE ER - 10
QUININE SULF 324mg - 19
QVAR - 45
RADIAPLEXRX - 31
RADIGEL - 31
RALOXIFENE - 32
RAMIPRIL - 18
RANEXA - 9
RANITIDINE SYRUP - 46
RAPAMUNE - 37
RAVICTI - 33
RAZADYNE ER - 44
RAZADYNE SOLN - 44
RAZADYNE TBS - 44
RE 10 WASH - 28
REBETOL - 23
REBIF - 44
RECLIPSEN - 25
RECTACORT-HC - 9
REGLAN - 33
REGRANEX - 31
RELAGARD - 47
RELAGESIC - 7
RELISTOR - 34
RELPAX - 38
REMERON - 13
REMEVEN - 29
RENA-VITE RX - 48
RENACIDIN - 34
RENAGEL - 34
RENAL - 48
RENALPREN - 48
RENO CAPS - 48
RENVELA POW PACK - 34
RENVELA TAB - 34
REPAGLINIDE - 15
REPAN - 7
REPREXAIN - 8
REQUIP - 21
REQUIP XL - 21
RESCRIPTOR - 22
RESERPINE - 18
RESPA-BR - 17
RESTASIS - 41
RESTORIL - 36
RETIN-A - 27
RETIN-A MICRO - 27
RETROVIR - 22
REVATIO - 24
REVIA - 16
REVINA - 29
REVLIMID - 20, 37
REYATAZ - 22
RHEUMATREX - 6
RHINOFLEX - 7
RHINOFLEX-650 - 7
RIBAPAK - 23
RIBASPHERE - 23
RIBATAB - 23
RIBAVIRIN - 23
RIDAURA - 6
RIFABUTIN - 19
RIFADIN - 19
RIFAMPIN - 19
RILUTEK - 40
RIMANTADINE HCL - 23
RIOMET - 15
RISEDRONATE - 32
Caterpillar Drug Formulary
Generated October 26, 2016
RISPERDAL - 22
RISPERIDONE - 21
RITALIN - 6
RITALIN LA - 6
RITALIN SR - 6
RIVASTIGMINE PATCH - 44
RIVASTIGMINE TARTRATE - 44
RIZATRIPTAN - 38
RIZATRIPTAN MLT - 38
ROBAXIN - 39
ROBINUL - 46
ROBINUL FORTE - 46
ROCALTROL - 33
ROMYCIN - 41
ROPINIROLE ER - 21
ROPINIROLE HCL - 21
ROSADAN - 30
ROSANIL CLEANSER - 27
ROSULA PAD 10-5% - 27
ROSUVASTATIN - 17
ROWASA - 34
ROWEEPRA - 13
ROXICET - 8
ROXICET SOLN - 8
ROZEREM - 36
RYTHMOL - 10
RYTHMOL SR - 10
SABRIL - 13
SAIZEN - 32
SALACYN - 30
SALAGEN - 39
SALICYLIC ACID - 30
SALSALATE - 7
SAMSCA - 33
SANCUSO - 16
SANDIMMUNE - 37
SANDOSTATIN - 33
SANDOSTATIN LAR DEPOT - 33
SANTYL - 29
SAPHRIS - 21
SAVAYSA - 12
SCALACORT - 29
SCOPOLAMINE HBR - 46
SE-TAN PLUS - 36
SEB-PREV - 28
SEB-PREV WASH - 28
SECONAL - 36
SECTRAL - 23
SELEGILINE HCL CAP - 21
SELENIUM SULFIDE - 28
SELFEMRA - 14
SELSUN SHAMPOO - 28
SELZENTRY - 22
SENILEZOL - 36
SENSIPAR - 33
SEREVENT DISKUS - 45
SEROQUEL IR - 21
SEROQUEL XR - 21
SEROSTIM - 32
SERTRALINE HCL - 14
SEVELAMER CARBONATE TAB - 34
SHOHLS SOLUTION MODIFIED - 34
SIGNIFOR - 33
SILDENAFIL - 24
SILVADENE - 28
SILVASORB - 31
SILVER SULFADIAZINE - 28
SIMBRINZA - 41
SIMPONI SQ - 6
SIMVASTATIN - 17
SINEMET - 21
SINEMET CR - 21
SINGULAIR - 45
SIROLIMUS - 37
SIRTURO - 19
SIVEXTRO - 12
SKELAXIN - 39
SMZ-TMP DS - 11
SODIUM CHLORIDE - 39
SODIUM CHLORIDE BACTERIOS - 43
SODIUM CHLORIDE NEB - 27
SODIUM CHLORIDE TAB - 39
SODIUM FLUORIDE - 38
SODIUM POLYSTYRENE SULFON - 32
SODIUM SULFACETAMIDE - 27
SODIUM SULFACETAMIDE OPHTH - 41
SODIUM SULFACETAMIDE WASH - 28
SODIUM SULFACETAMIDE/SULF - 27
SOLARAZE - 28
SOLIA - 25
SOLTAMOX - 20
SOLU-CORTEF - 26
SOLU-MEDROL - 26
SOMA - 39
SOMAVERT - 33
SONATA - 36
SORIATANE - 28
SORINE - 23
SOTALOL HCL - 23
SOTYLIZE - 23
SOVALDI - 23
SPECTRACEF - 11
SPECTRAGEL - 31
SPERMICIDES (FOAM, FILM, SUPP) - 26
SPERMICIDES GEL - 26
SPIRIVA - 44
SPIRONOLACTONE - 32
SPIRONOLACTONE HCTZ - 31
SPONGES (CONTRACEPTIVES) - 26
SPORANOX - 17
SPRINTEC 28 - 25
SPRYCEL - 20
SPS - 32
SRONYX - 25
SSD - 28
SSKI - 38
STAFLEX - 7
STAGESIC - 8
STALEVO - 21
STARLIX - 15
STAVUDINE - 22
STAXYN - 24
STELARA SQ - 6
STERILE WATER FOR INJECTI - 43
STERILE WATER IRRIGATION - 43
STIMATE - 33
STIVARGA - 20
STRATTERA - 6
STRENSIQ INJ - 32
STRIANT - 9
STRIBILD - 22
STRIVERDI AER RESPIMAT - 45
STROMECTOL - 9
SUBOXONE - 8
SUCRAID - 31
SUCRALFATE - 46
SULAR - 24
SULFACETAMIDE/PREDNISOLON - 42
SULFAMETHOXAZOLE/TRIMETHO - 11
SULFAMYLON - 28
SULFASALAZINE - 34
SULFAZINE - 34
SULFAZINE EC - 34
SULINDAC - 7
SUMATRIPTAN INJ - 38
SUMATRIPTAN NASAL - 38
SUMATRIPTAN TABS - 38
SUPRAX - 11
SUPREP BOWEL PREP - 37
SURMONTIL - 14
SUSTIVA - 22
SUTENT - 20
SYEDA - 25
SYLATRON - 20
SYMAX DUOTAB - 46
SYMAX FASTABS - 46
SYMAX-SL - 46
SYMAX-SR - 46
SYMBICORT - 45
SYMBYAX - 44
SYMLIN - 14
SYNALAR - 29
SYNALGOS-DC - 8
SYNAREL - 33
SYNTHROID - 45
SYRINGES INSULIN - 31, 37
SYRINGES VARIOUS - 37
TABLOID - 20
TACLONEX OINT - 29
TACLONEX SCALP - 29
TACROLIMUS CAPS - 37
TALTZ - 28
TALWIN - 8
TAMBOCOR - 10
TAMOXIFEN CITRATE - 20
TAMSULOSIN HCL - 34
TANDEM PLUS - 36
TAPAZOLE - 45
TARCEVA - 20
TARGRETIN ORAL - 20
TARGRETIN TOP - 28
TARKA - 19
TARON-CRYSTALS - 34
TASIGNA - 20
TASMAR - 20
TAZORAC - 28
TAZTIA XT - 24
TBC AER - 29
TECFIDERA - 44
TECHNIVIE - 23
TEGRETOL - 13
TEGRETOL-XR - 13
TELMISARTAN - 18
TELMISARTAN HCTZ - 18
TEMAZEPAM - 36
TEMODAR - 19
TEMOVATE - 29
TEMOVATE E - 29
TEMOZOLOMIDE - 19
TENCON - 7
TENEX - 18
TENORETIC - 19
TENORMIN - 23
TERAZOL 3 - 47
TERAZOL 7 - 47
TERAZOSIN HCL - 18
TERBINAFINE HCL - 16
Caterpillar Drug Formulary
Generated October 26, 2016
TERBUTALINE SULFATE - 45
TERCONAZOLE - 47
TESSALON - 27
TESSALON PERLES - 27
TESTIM - 9
TESTOSTERONE CYPIONATE - 8
TESTOSTERONE ENANTHATE - 8
TESTOSTERONE GEL 12.5MG - 8
TESTOSTERONE GEL 25MG - 8
TESTOSTERONE GEL 50MG - 8
TESTRED - 9
TETCAINE - 41
TETRABENAZINE - 44
TETRACAINE HCL - 41
TETRACYCLINE HCL - 12
TETRAVISC - 41
TETRAVISC FORTE - 41
TETRIX - 30
TEV-TROPIN - 32
THALOMID - 20, 37
THEO-24 - 45
THEOCHRON - 45
THEOPHYLLINE 400,600 CR,ER - 45
THEOPHYLLINE CR - 45
THEOPHYLLINE ER - 45
THEOPHYLLINE SR - 45
THERMAZENE - 28
THIOLA - 34
THIORIDAZINE HCL - 22
THIOTHIXENE - 21
THYROLAR - 45
TIAGABINE HYDROCHLORIDE - 13
TIAZAC - 24
TIGAN - 16
TIKOSYN - 10
TILIA FE - 25
TIMOLOL OPHTH - 40
TIMOLOL MALEATE - 23
TIMOPTIC - 40
TIMOPTIC-XE - 40
TINDAMAX - 12
TINIDAZOLE - 11
TIS-U-SOL - 43
TIVICAY - 22
TIZANIDINE HCL - 39
TL GARD RX - 36
TL ICON - 36
TL-FOL 500 - 36
TOBI - 10
TOBRADEX - 42
TOBRAMYCIN INJ - 10
TOBRAMYCIN NEB - 10
TOBRAMYCIN SULFATE - 41
TOBRAMYCIN/DEXAMETHASONE - 42
TOBREX - 41
TOFRANIL - 14
TOFRANIL-PM - 14
TOLAK CRE - 28
TOLAZAMIDE - 15
TOLBUTAMIDE - 15
TOLCAPONE - 20
TOLMETIN SODIUM - 7
TOLTERODINE ER - 47
TOLTERODINE TARTRATE - 47
TOPAMAX - 13
TOPICORT - 29
TOPIRAGEN - 13
TOPIRAMATE - 13
TOPROL XL - 23
TORSEMIDE - 32
TRACLEER - 24
TRAMADOL /APAP - 8
TRAMADOL HCL - 7
TRAMADOL HCL ER - 7
TRANDOLAPRIL - 18
TRANDOLAPRIL/VERAPAMIL - 18
TRANEXAMIC ACID - 36
TRANSDERM-SCOP - 16
TRANXENE T - 10
TRANYLCYPROMINE SULFATE - 14
TRAVATAN Z - 42
TRAZODONE HCL - 14
TRENTAL - 35
TRETIN-X - 27
TRETINOIN CAPS - 27
TRETINOIN CRM/GEL - 27
TRETINOIN GEL 0.04% - 27
TRETINOIN GEL 0.1% - 27
TRETINOIN MICRO GEL - 27
TREXALL - 20
TRI-ESTARYLLA - 25
TRI-LEGEST FE - 25
TRI-LINYAH - 25
TRI-LO-ESTARYLLA - 25
TRI-LO-MARZIA - 25
TRI-LO-SPRINTEC - 25
TRI-NORINYL 28 - 25
TRI-PREVIFEM - 25
TRI-SPRINTEC - 25
TRIAMCINOLONE ACETONIDE - 29
TRIAMCINOLONE IN ORABASE - 39
TRIAMTERENE HCTZ - 31
TRIANEX - 29
TRIAZOLAM - 36
TRICITRATES - 34
TRICON - 36
TRIDERM - 29
TRIFLUOPERAZINE HCL - 22
TRIFLURIDINE - 41
TRIGELS-F FORTE - 36
TRIHEXYPHENIDYL HCL - 20
TRIIODO-L-THYRONINE - 45
TRILEPTAL - 13
TRILYTE - 37
TRIMETHOBENZAMIDE HCL - 16
TRIMETHOPRIM - 11
TRIMETHOPRIM/POLYMYXIN B - 41
TRIMIPRAMINE MALEATE - 14
TRINESSA - 25
TRINESSA LO - 25
TRIPHROCAPS - 48
TRIPLE ANTIBIOTIC - 41
TRIUMEQ - 22
TRIVORA-28 - 25
TRIZIVIR - 22
TROKENDI XR - 13
TROPICAMIDE - 40
TROSPIUM CHLORIDE - 47
TRUSOPT - 42
TRUVADA - 22
TUDORZA PRESSAIR - 44
TUSSIGON - 26
TYBOST - 22
TYKERB - 20
TYLENOL/CODEINE #3, #4 - 8
TYLOX - 8
TYZEKA - 23
TYZINE - 40
U-CORT - 29
U-KERA E - 29
ULESFIA - 30
ULORIC - 35
ULTRACET - 8
ULTRAM - 8
ULTRAM ER - 8
ULTRESA - 31
UMECTA - 29
UMECTA NAIL FILM - 29
UNITHROID - 45
UR N-C - 46
URAMAXIN - 29
URAMAXIN GT - 29
URAMIT MB - 46
UREA - 29
UREA 40% NAIL FILM - 29
UREA NAIL - 29
UREA TOPICAL - 29
UREA-C40 - 29
URECHOLINE - 47
URELIEF PLUS - 47
URETRON D/S - 46
UREX - 47
URIBEL - 46
URIMAR-T - 46
URISTIX - 47
URO-MP - 46
UROAV-B - 46
UROCIT-K - 34
UROPHEN MB - 46
UROQID #2 - 46
UROXATRAL - 35
URSO 250 - 33
URSO FORTE - 33
URSODIOL - 33
USTELL - 46
UTA - 46
UTICAP - 46
V-C FORTE - 48
VAGIFEM - 47
VALACYCLOVIR HCL - 23
VALCHLOR GEL 0.16% - 28
VALCYTE SOLN - 23
VALCYTE TB - 23
VALGANCICLOVIR - 23
VALIUM - 10
VALPROIC ACID - 13
VALSARTAN - 18
VALSARTAN HCTZ - 18
VALTREX - 23
VANCOCIN HCL - 12
VANCOMYCIN CAPS - 12
VANCOMYCIN HCL INJ - 11
VANCOMYCIN ORAL SOLN - 12
VANDAZOLE - 47
VANOS - 29
VANOXIDE-HC - 27
VASERETIC - 19
VASOLEX - 29
VASOTEC - 18
VELIVET - 25
VELTIN - 27
VENLAFAXINE HCL CAP - 14
VENLAFAXINE HCL ER CAP - 14
VENTOLIN HFA - 45
VERAPAMIL HCL - 24
VERAPAMIL HCL CR - 24
VERAPAMIL HCL ER - 24
Powered by TCPDF (www.tcpdf.org)
Caterpillar Drug Formulary
Generated October 26, 2016
VERAPAMIL HCL SA - 24
VERAPAMIL HCL SR - 24
VERDESO - 29
VEREGEN - 30
VERELAN - 24
VERELAN PM - 24
VESICARE - 47
VESTURA - 25
VEXOL - 42
VFEND - 17
VIAGRA - 24
VIBRAMYCIN - 12
VIC-FORTE - 48
VICAP FORTE - 48
VICOPROFEN - 8
VICTOZA - 15
VIDEX - 22
VIDEX EC - 22
VIEKIRA - 23
VIEKIRA XR - 23
VIGAMOX - 41
VIMPAT - 13
VIORELE - 25
VIRACEPT 250 - 22
VIRACEPT 625 - 22
VIRAMUNE SUS - 22
VIRAMUNE TAB - 22
VIRAMUNE XR - 22
VIREAD - 22
VIREAD 300mg - 22
VIROPTIC - 41
VIRTI-SULF - 27
VISICOL - 37
VISTARIL - 10
VISTOGARD - 32
VITA-MIN - 48
VITAFOL - 38
VITAMIN D - 48
VITAMIN FORTE - 48
VITAZOL - 30
VITEKTA - 22
VIVACTIL - 14
VIVELLE-DOT - 33
VOGELXO - 9
VOL-CARE RX - 48
VOLTAREN GEL - 7, 30
VOLTAREN XR - 7
VORICONAZOLE - 17
VOSOL - 42
VOSOL HC - 43
VOSPIRE ER - 45
VOTRIENT - 20
WARFARIN SODIUM - 12
WELCHOL - 17
WELLBUTRIN - 14
WELLBUTRIN SR - 14
WELLBUTRIN XL - 14
WERA - 25
WESTCORT - 29
WESTHROID - 45
WYMZYA FE - 25
X-VIATE - 29
XALATAN - 42
XALKORI - 20
XANAX - 10
XANAX XR - 10
XARELTO - 12
XCLAIR - 30
XELJANZ - 6
XELJANZ XR - 6
XELODA - 20
XENADERM - 29
XENAZINE - 44
XIFAXAN - 12
XIIDRA - 42
XODOL - 8
XOLOX - 8
XOPENEX - 45
XTANDI - 20
XULANE - 26
XURIDEN - 32
XYLOCAINE - 30
XYREM - 44
YASMIN 28 - 25
YAZ - 25
YUVAFEM - 47
ZAFIRLUKAST - 44
ZALEPLON - 36
ZAMICET - 8
ZANAFLEX - 39
ZARAH - 25
ZARONTIN - 13
ZAROXOLYN - 32
ZAVESCA - 35
ZAZOLE - 47
ZEBETA - 23
ZEBUTAL - 7
ZECUITY - 38
ZELBORAF - 20
ZEMPLAR - 33
ZENATANE - 27
ZENCHENT - 25
ZENCHENT FE - 25
ZENPEP - 31
ZEOSA - 25
ZERIT - 22
ZESTORETIC - 19
ZESTRIL - 18
ZETIA - 18
ZFLEX - 7
ZIAC - 19
ZIAGEN SOLN - 22
ZIAGEN TB - 22
ZIANA - 27
ZIDOVUDINE - 22
ZINBRYTA - 44
ZIOPTAN - 42
ZIPRASIDONE HCL - 21
ZIRGAN - 41
ZITHROMAX - 10
ZOCOR - 18
ZOFRAN - 16
ZOFRAN ODT - 16
ZOLINZA - 20
ZOLOFT - 14
ZOLPIDEM TARTRATE - 36
ZOLPIDEM TARTRATE ER - 36
ZOLVIT - 8
ZOMACTON - 32
ZOMIG - 38
ZOMIG NASL - 38
ZONALON - 28
ZONATUSS - 27
ZONEGRAN - 13
ZONISAMIDE - 13
ZORBTIVE - 32
ZORTRESS - 20
ZOVIA 1/35E - 25
ZOVIA 1/50E - 25
ZOVIRAX ORAL - 23
ZOVIRAX TOP - 28
ZYCLARA CRM 3.75% - 30
ZYDONE - 8
ZYLET - 42
ZYLOPRIM - 35
ZYMAXID - 41
ZYPREXA - 21
ZYPREXA SOLN - 21
ZYPREXA ZYDIS - 21
ZYTIGA - 20
ZYVOX - 12