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Preferred Prescriptions®/
RX Selections™
Member Guide
Please bring this guide with you on your next doctor visit.
Express Scripts manages your prescription drug benefit for your employer, plan sponsor, or health plan.
Medco is now a part of the Express Scripts family of pharmacies.
Preferred Prescriptions®/RX Selections™ is a formulary list of
medications that may be covered under your prescription drug
plan.This list was reviewed by an independent group of practicing
doctors and pharmacists, and it contains medications made by
most pharmaceutical manufacturers. It includes medications for
many covered conditions.
SAVING MONEY ON PRESCRIPTIONS
Your plan may prefer some medications over others. These are
called preferred drugs.
You may pay:•  Lowest co-payment/co-insurance for generic drugs•  Higher co-payment/co-insurance for preferred brand-name •  Highest co-payment/co-insurance for nonpreferred Your doctor may be able to help you save money by prescribing
generic and preferred brand-name drugs if appropriate. So be sure
to bring this guide with you on every visit to your doctor. Some
commonly prescribed nonpreferred drugs are also listed in this
guide for your reference.
Please note: This guide does not contain a complete list of
formulary and nonformulary drugs. It only lists the most
commonly prescribed drugs. Visit Express-Scripts.com anytime to
check the price and coverage of medications under your plan.
Simply select “Price a medication” from the left hand menu and
search for your medication to see pricing. Click “View coverage
notes” on the pricing results page to see any coverage details. If
you are a first-time visitor to Express-Scripts.com, please take a
moment to register. (Be sure to have your member ID number
and a recent prescription number handy.) Not all medications
listed here are covered by every prescription drug plan.
FINDING MEDICATIONS WITH LOWER
CO-PAYMENTS/CO-INSURANCE
This guide lists medications two ways to help you find some
generic, preferred, and nonpreferred brand-name drugs.
SECTION I - ALPHABETICALLY BY DRUG CATEGORY (SUCH AS RESPIRATORY)Within each category, medications are listed in alphabetical order, with generic, preferred brand-name, and nonpreferredbrand-name drugs sorted separately: Means a nonpreferred brand-name medication SECTION II - ALPHABETICALLY BY BRAND NAMEAfter each nonpreferred brand-name drug, you will find possible generic and preferred brand-name alternatives.
SAFETY CONSIDERATION SYMBOLS
Here is a quick guide for you and your doctor, which explains
our safety symbols. These symbols appear next to certain
medications.
Means weigh risk of birth defects or other adverse outcomes. The information in this guide was in effect at the time of printing and may
be subject to change.
SECTION I:
THERAPEUTIC DRUG CATEGORIES
ANTI-INFECTIVES (Antibiotics/Antifungals)
Oral Penicillins
Oral Cephalosporins
Oral Tetracyclines
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes.
Oral Erythromycins
Oral Urinary Tract
Oral Quinolones
Oral Antifungal
Oral Sulfas
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes.
PSYCHOTHERAPEUTICS (Anxiety/Depression)
Hypnotic Agents
Tricyclic
Antidepressants
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes.
Miscellaneous
Antidepressants
Anxiolytics
Antipsychotics
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes.
Antidepressants
SSRI Antidepressants
Miscellaneous
Psychotherapeutic
amphetamine aspartate/amphetamine sulfate/dextroamphetamine Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes.
CARDIOVASCULAR
(Blood Pressure/Heart/Cholesterol)
Beta Blockers
Dihydropyridines
Nitroglycerin Patches
Calcium Blockers
Adrenergic
Antagonists & Related
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes.
Antilipidemics
Angiotensin II
Blockers & Renin
Inhibitors
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes.
Combination
Antihypertensives
ACE Inhibitors
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes.
ENDOCRINE (Diabetes/Hormones/Contraceptives)
Insulin Therapy
Non-Insulin
Hypoglycemic Agents
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes.
Contraceptive Agents
Blood Glucose Test
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes.
Estrogens/Estrogen
Combinations
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes.
G I (Ulcer)
Ulcer Drugs
NSAIDS (Pain Relievers)
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes.
NSAID COX-
Inhibitors
DRUGS TO TREAT OVERACTIVE BLADDER
RESPIRATORY (Allergy/Asthma)
Beta Agonists Oral
Beta Agonist Inhalers
Inhaled Steroids
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes.
Nasal Corticosteroids
Miscellaneous
Pulmonary Agents
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes.
OSTEOPOROSIS/PAGET’S DISEASE
NEUROLOGICALS
Anticonvulsants/
Anti-Seizure
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes.
Drugs to treat
Alzheimers Disease
Migraine/Headache
Means a preferred generic medication.
Means a preferred brand-name medication.
Means a nonpreferred brand-name medication.
Means weigh risk of birth defects or other adverse outcomes.
SECTION II:
NONPREFERRED DRUGS AND THEIR POSSIBLE PREFERRED
ALTERNATIVES
Nonpreferred
Possible Preferred Products
omeprazole (generic), Nexium® (AstraZeneca) estradiol/norethindrone acetate (generic) alendronate sodium (generic), ibandronate sodium nifedipine ER (generic), amlodipine besylate (generic),nisoldipine (generic) dextroamphetamine-amphetamine ER (generic) atorvastatin calcium (generic), lovastatin (generic),pravastatin (generic), simvastatin (generic), Crestor®(AstraZeneca), Niaspan® (Abbott), VytorinTM(Merck/Schering) Asmanex® (Schering), Pulmicort Flexhaler®(AstraZeneca), QVAR® (Ivax) Asmanex® (Schering), Pulmicort Flexhaler®(AstraZeneca), QVAR® (Ivax) Aviane® (Barr-branded generic*), Lessina® (Barr-branded generic*), Lutera® (Watson-branded generic*),Lybrel® (Wyeth) estradiol patch (generic), Climara® (Berlex), Estraderm®(Novartis), Vivelle® (Novartis) *Branded generics have the same co-payment as regular generics.
Nonpreferred
Possible Preferred Products
estradiol/norethindrone acetate (generic), Premphase® (Wyeth), Prempro® (Wyeth) Arcapta Neohaler® Foradil® (Schering), Serevent Diskus® (GlaxoSmithKline) Aricept® 5mg,10mg donepezil HCl (generic) ibuprofen (generic), naproxen (generic), Celebrex®(Pfizer) candesartan/hydrochlorothiazide (generic) amoxicillin trihydrate/potassium clavulanate (generic) amoxicillin trihydrate/potassium clavulanate (generic) suspension200-28.5mg/5, 250-62.5mg/5,400-57mg/5 amoxicillin trihydrate/potassium clavulanate (generic) amoxicillin trihydrate/potassium clavulanate (generic) amoxicillin trihydrate/potassium clavulanate (generic) metformin HCl (generic), pioglitazone (generic) glimepiride (generic), pioglitazone (generic) naratriptan HCl (generic), rizatriptan (generic), sumatriptan succinate (generic), Relpax® (Pfizer), Zomig®(AstraZeneca) *Branded generics have the same co-payment as regular generics.
Nonpreferred
Possible Preferred Products
flunisolide (generic), fluticasone propionate (generic),triamcinolone acetonide (generic), Nasonex®(Schering), Rhinocort Aqua® (AstraZeneca), Veramyst®(GlaxoSmithKline) Necon® (Watson-branded generic*), Nortrel®(Barr-branded generic*) Foradil® (Schering), Perforomist® (Dey Labs), Proair HFA®(Teva), Serevent Diskus® (GlaxoSmithKline) chloral hydrate (generic), temazepam (generic), triazolam (generic) amlodipine besylate (generic), atorvastatin calcium(generic) verapamil HCl tablet, sustained action (generic) etodolac (generic), ibuprofen (generic), naproxen(generic) amlodipine besylate (generic), nifedipine ER (generic) diltiazem HCl capsule, sustained release 24 hr (generic) diltiazem HCl capsule, sustained release 12 hr (generic) etodolac (generic), ibuprofen (generic), naproxen(generic) cefaclor (generic), cefdinir (generic), cefuroxime axetil (generic) cefaclor (generic), cefdinir (generic), cefuroxime axetil (generic) *Branded generics have the same co-payment as regular generics.
Nonpreferred
Possible Preferred Products
chlorthalidone (generic), clonidine HCl (generic) cholestyramine (generic), Welchol® (Sankyo) bisoprolol fumarate/hydrochlorothiazide (generic),metoprolol/hydrochlorothiazide (generic), propranololHCl/hydrochlorothiazide (generic) verapamil HCl capsule, 24 hr sustained release (generic) Caziant® (Watson-branded generic*), Cesia® (PrascoLabs-branded generic*), Velivet® (Barr-branded generic*) metformin HCl (generic), Byetta® (Amylin Pharma),Janumet® (Merck), Januvia® (Merck), Onglyza®(Bristol-Myers Squibb) Depakote® Sprinkle divalproex sodium (generic)Desogen® Apri® (Barr-branded generic*), Solia® (Prasco Labs-branded generic*) omeprazole (generic), Nexium® (AstraZeneca) etodolac (generic), ibuprofen (generic), naproxen etodolac (generic), ibuprofen (generic), naproxen *Branded generics have the same co-payment as regular generics.
Nonpreferred
Possible Preferred Products
temazepam (generic), triazolam (generic), zaleplon(generic), zolpidem tartrate (generic) famotidine (generic), ibuprofen (generic), naproxen(generic), omeprazole (generic) hydrochlorothiazide (generic), metoprolol succinate(generic) amlodipine besylate (generic), nifedipine ER (generic),nisoldipine (generic) losartan potassium (generic), Atacand® (AstraZeneca),Benicar® (Daiichi Sankyo), Diovan® (Novartis), Micardis®(BIPI) candesartan/hydrochlorothiazide (generic),irbesartan/hydrochlorothiazide (generic),losartan/hydrochlorothiazide (generic),valsartan/hydrochlorothiazide (generic), Benicar HCT®(Daiichi Sankyo), Micardis HCT® (Boehringer Ingelheim) estradiol patch (generic), Climara® (Berlex), Divigel®(Upsher Smith), Estraderm® (Novartis), Vivelle®(Novogyne) phenelzine sulfate (generic), tranylcypromine sulfate(generic) carbamazepine (generic), divalproex sodium (generic),lithium carbonate (generic) estradiol patch (generic), Divigel® (Upsher Smith) estradiol patch (generic), Climara® (Berlex), Divigel®(Upsher Smith), Estraderm® (Novartis), Vivelle®(Novartis) *Branded generics have the same co-payment as regular generics.
Nonpreferred
Possible Preferred Products
Apri® (Barr-branded generic*), Kariva® (Barr-brandedgeneric*), Microgestin Fe® (Watson-branded generic*) Exelon® Capsules rivastigmine tartrate (generic)Factive® ciprofloxacin (generic), levofloxacin (generic) clozapine (generic), olanzapine (generic), quetiapinefumarate (generic), risperidone (generic), ziprasidoneHCl (generic), Seroquel XR® (AstraZeneca) Estrace Vaginal Cream® (Warner Chilcott), Estring®(Pfizer) fenofibrate (generic), Triglide® (Sciele), Trilipix® (Abbott) Alvesco® (Sunovion), Asmanex® (Schering), PulmicortFlexhaler® (AstraZeneca), QVAR® (Ivax) Alvesco® (Sunovion), Asmanex® (Schering), PulmicortFlexhaler® (AstraZeneca), QVAR® (Ivax) dextroamphetamine-amphetamine ER (generic),methylphenidate CD (generic), methylphenidate ER(generic), Daytrana® (Shire US Inc.), Methylin ER®(Mallinckrodt Pharmaceuticals) metformin HCl ER (generic), metformin HCl tablet(generic) alendronate sodium (generic), Actonel® (WarnerChilcott), Atelvia® (Warner Chilcott), alendronate sodium (generic), ibandronate sodium(generic) naratriptan HCl (generic), rizatriptan (generic), sumatriptan succinate (generic), Relpax® (Pfizer), Zomig® (AstraZeneca), Zomig ZMT® (AstraZeneca) metformin HCl ER (generic), metformin HCl tablet(generic) *Branded generics have the same co-payment as regular generics.
Nonpreferred
Possible Preferred Products
griseofulvin ultramicrosize (generic), itraconazole(generic), ketoconazole (generic), terbinafine HCl(generic) griseofulvin ultramicrosize (generic), itraconazole(generic), ketoconazole (generic), terbinafine HCl(generic) clonidine HCl (generic), methyldopa (generic) propranolol capsule, sustained action (generic) propranolol capsule, sustained action (generic) olanzapine (generic), quetiapine fumarate (generic),risperidone (generic), ziprasidone HCl (generic),Seroquel XR® (AstraZeneca) verapamil HCl tablet, sustained action (generic) clonidine HCl (generic), Intuniv® (Shire US Inc.) *Branded generics have the same co-payment as regular generics.
Nonpreferred
Possible Preferred Products
atorvastatin calcium (generic), lovastatin (generic),simvastatin (generic), Altoprev® (Andrx), Crestor®(AstraZeneca), VytorinTM (Merck/Schering) acebutolol HCl (generic), atenolol (generic), metoprolol tartrate (generic) Aviane® (Barr-branded generic*), Lessina®(Barr-branded generic*), Lybrel® (Wyeth) lithium carbonate tablet, sustained action (generic) atorvastatin calcium (generic), lovastatin (generic),pravastatin (generic), simvastatin (generic), Crestor®(AstraZeneca) Junel® (Barr-branded generic*), Microgestin®(Watson-branded generic*) Junel Fe® (Barr-branded generic*), Microgestin Fe®(Watson-branded generic*) fenofibrate (generic), Triglide® (First Horizon), Trilipix®(Abbott) Amethia Lo® (Watson-branded generic*), Camrese Lo®(Teva-branded generic*) benazepril HCl/hydrochlorothiazide (generic) Maxair Autohaler® Proair HFA® (Teva), Ventolin HFA® (GlaxoSmithKline) *Branded generics have the same co-payment as regular generics.
Nonpreferred
Possible Preferred Products
estradiol (generic), estropipate (generic), Cenestin®(Duramed/Barr), Enjuvia® (Duramed/Barr),Premarin® (Wyeth) Climara Patch® (Berlex), Vivelle Patch® (Novartis) isometheptene/apap/dichloralphenazone (generic) naratriptan HCl (generic), rizatriptan (generic), sumatriptan nasal spray (generic), Relpax® (Pfizer),Zomig® Nasal Spray (AstraZeneca) nitroglycerin patch (generic), Nitro-Dur® (Schering) Necon® (Watson-branded generic*), Nortrel®(Barr-branded generic*) Monistat 3 Vaginal miconazole 3 vaginal suppository (generic) ciprofloxacin HCl (generic), sulfamethoxazole/trimethoprim (generic), trimethoprim (generic) etodolac (generic), ibuprofen (generic), indomethacin(generic), meclofenamate sodium (generic), naproxen (generic), sulindac (generic) chloral hydrate (generic), temazepam (generic), *Branded generics have the same co-payment as regular generics.
Nonpreferred
Possible Preferred Products
Levora® (Watson-branded generic*), Portia®(Barr-branded generic*) Necon® (Watson-branded generic*), Nortrel®(Barr-branded generic*) ciprofloxacin HCl (generic), levofloxacin (generic),Avelox® (Merck) flunisolide (generic), fluticasone propionate (generic),triamcinolone acetonide (generic), Nasonex®(Schering), Rhinocort Aqua® (AstraZeneca), Veramyst®(GlaxoSmithKline) clotrimazole (generic), fluconazole (generic), nystatinsuspension (generic) Apri®(Barr-branded generic*), Solia®(Prasco Labs-branded generic*) MonoNessa® (Watson-branded generic*), Previfem®(Teva-branded generic*), Sprintec® (Barr-branded generic*) MonoNessa® (Watson-branded generic*), TriNessa®(Watson-branded generic*) Necon® (Watson-branded generic*), Nortrel® estradiol/norethindrone acetate (generic), Premphase® (Wyeth), Prempro® (Wyeth) TriNessa® (Watson-branded generic*), Tri-Previfem®(Teva-branded generic*), Tri-Sprintec® (Barr-brandedgeneric*) TriNessa® (Watson-branded generic*), Tri-Previfem® (Teva-branded generic*), Tri-Sprintec® (Barr-brandedgeneric*) *Branded generics have the same co-payment as regular generics.
Nonpreferred
Possible Preferred Products
paroxetine HCl sustained release tab (generic) etodolac (generic), ibuprofen (generic), naproxen(generic) Plan B One-Step® Next Choice One Dose® (Watson-branded generic*)Ponstel® etodolac (generic), ibuprofen (generic), indomethacin(generic), meclofenamate sodium (generic), naproxen (generic), sulindac (generic) estradiol/norethindrone acetate (generic), Premphase® (Wyeth), Prempro® (Wyeth) Estrace® Vaginal Cream (Warner Chilcott) lansoprazole (generic), omeprazole (generic), Nexium®(AstraZeneca) omeprazole (generic), Nexium® (AstraZeneca) alendronate sodium (generic), ibandronate sodium(generic), Evista® (Eli Lilly), Forteo® (Eli Lilly) pantoprazole sodium (generic), omeprazole (generic),Nexium® (AstraZeneca) Proair HFA® (Teva), Ventolin HFA® (GlaxoSmithKline) *Branded generics have the same co-payment as regular generics.
Nonpreferred
Possible Preferred Products
cholestyramine (generic), prevalite (generic) cholestyramine/aspartame (generic), prevalite (generic) mirtazapine soltabs (generic), mirtazapine tabs (generic) methylphenidate ER (generic), dextroamphetamine sulfate (generic), dextroamphetamine-amphetamineER (generic), methylphenidate CD (generic), Daytrana®(Shire US Inc.) clozapine (generic), olanzapine (generic), quetiapinefumarate (generic), risperidone (generic), ziprasidoneHCl (generic), Seroquel XR® (AstraZeneca) Amethyst® (Watson-branded generic*), Jolessa®(Barr-branded generic*), Quasense® (Watson-brandedgeneric*), Amethia® (Watson-branded generic*), Camrese®(Teva-branded generic*) chloral hydrate (generic), temazepam (generic), triazolam (generic) minocycline HCl (generic), doxycycline monohydrate(generic) cefaclor (generic), cefdinir (generic), cefuroxime axetil(generic) *Branded generics have the same co-payment as regular generics.
Nonpreferred
Possible Preferred Products
etodolac (generic), ibuprofen (generic), naproxen(generic) nisoldipine (generic), amlodipine besylate (generic),isradipine (generic), nifedipine ER (generic) cefdinir (generic), cefuroxime axetil (generic) fluoxetine HCl (generic), olanzapine (generic), quetiapine fumarate (generic), risperidone (generic),Seroquel XR® (AstraZeneca) eprosartan mesylate (generic), losartan potassium(generic), Atacand® (AstraZeneca), Benicar® (DaiichiSankyo), Diovan® (Novartis), Micardis® (BIPI) candesartan/hydrochlorothiazide (generic),losartan/hydrochlorothiazide (generic),valsartan/hydrochlorothiazide (generic), Benicar HCT®(Daiichi Sankyo), Micardis HCT® (BIPI) Thioridazine HCl® chlorpromazine HCl (generic), haloperidol (generic), quetiapine fumarate (generic), risperidone (generic) diltiazem HCl capsule, sustained release 24 hr (generic) etodolac (generic), ibuprofen (generic), indomethacin(generic), meclofenamate sodium (generic), naproxen (generic), sulindac (generic) *Branded generics have the same co-payment as regular generics.
Nonpreferred
Possible Preferred Products
Necon® (Watson-branded generic*), Nortrel®(Barr-branded generic*) enalapril maleate/hydrochlorothiazide (generic) Vibramycin® Syrup Vibramycin® Suspension (Pfizer)Vivactil® Voltaren® Tablets etodolac (generic), ibuprofen (generic), naproxen etodolac (generic), ibuprofen (generic), naproxen(generic) bupropion HCl tablet, sustained release (generic) bupropion HCl tablet, extended release (generic) clonidine HCl (generic), methyldopa (generic) Proair HFA® (Teva), Ventolin HFA® (GlaxoSmithKline) omeprazole/sodium bicarbonate (generic), omeprazole(generic), Nexium® (AstraZeneca) bisoprolol fumarate/hydrochlorothiazide (generic) *Branded generics have the same co-payment as regular generics.
Nonpreferred
Possible Preferred Products
carbamazepine (generic), clonazepam (generic) ethosuximide (generic,) phenobarbital (generic), phenytoin sodium (generic), Lyrica® (Pfizer) *Branded generics have the same co-payment as regular generics.
This guide does not contain a complete list of formulary and nonformulary drugs. It only liststhe most commonly prescribed drugs. Visit Express-Scripts.com anytime to check the priceand coverage of medications under your plan.
Simply select “Price a medication” from the left-hand menu and search for your medication to seepricing. Click “View coverage notes” on the pricingresults page to see any coverage details. If you area first-time visitor to Express-Scripts.com, pleasetake a moment to register. (Be sure to have yourmember ID number and a recent prescriptionnumber handy.) Or, for an updated and completelisting of your prescription benefit, call customerservice at the phone number on the back of yourprescription card.
Express Scripts and Medco have come together as one company, soMedco is now a part of the Express Scripts family of pharmacies.
2013 Express Scripts Holding Company.
All rights reserved.

Source: https://www.tamus.edu/assets/files/benefits/pdf/Medcoformularyprescripts.pdf