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Formulary drug list - by therapy group - no cost - (updatable).xls

Formulary Drug List - MINNESOTA
6/9/2011
If you have any questions regarding pharmaceutical pricing, please contact PharmaCorr for clarification.
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Toll Free: 800-259-3067 Local: 317-299-3426 Fax: 800-259-3066 Formulary Drug List - MINNESOTA
Table of Contents
Analgesics and Anti-Inflammatories
Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) Other Analgesics and Anti-Inflammatories Antihistamines / Decongestants / Antitussives / Expectorants
Anti-Infectives
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) Nucleos(t)ide Reverse Transcriptase Inhibitors (NRTIs) Macrolides / Azalides / Lincosamides / Oxazolidinones Formulary Drug List - MINNESOTA
Table of Contents
Cancer-Related Agents
Cardiovascular Agents
Angiotensin-Converting Enzyme Inhibitors (ACE) Central Nervous System Agents
Serotonin +/- Norepinephrine Reuptake Inhibitors (SSRI / SNRI) Formulary Drug List - MINNESOTA
Table of Contents
Dental Agents
Dermatological Agents
Diagnostics and Supplies
Emergency Medications
Endocrine – Metabolic Agents
Formulary Drug List - MINNESOTA
Table of Contents
Gastrointestinal Agents
Genitourinary Agents
Hematological Agents
Immunosuppressants
Neurological Agents
Obstetric – Gynecologic Agents
Otic – Ophthalmic Preparations
Formulary Drug List - MINNESOTA
Table of Contents
Respiratory Agents
Vaccines - Exposure Immune Globulin
Vitamins – Minerals – Dietary Supplements
Miscellaneous and Unclassified Agents
Formulary Drug List - MINNESOTA
1. Analgesics and Anti-Inflammatories
Acetaminophen Agents (01.01)
Anti-Gout Agents (01.02)
Anti-Migraine Agents (01.03)
Narcotic Analgesics / Antagonists (01.04)
Neuropathic Pain Agents (01.05)
1. Analgesics and Anti-Inflammatories
Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) (01.06)
Salicylates (01.07)
Skeletal Muscle Relaxants (01.08)
Other Analgesics and Anti-Inflammatories (01.09)
Formulary Drug List - MINNESOTA
2. Antihistamines / Decongestants / Antitussives / Expectorants
1st Generation Antihistamines (02.01)
2nd Generation Antihistamines (02.02)
Antitussives (02.03)
Expectorants (02.04)
Decongestants (02.05)
Combination Products (02.06)
CHLORPHEN/PHENYLEPHRINE 8 MG-20 MG TAB CR Formulary Drug List - MINNESOTA
3. Anti-Infectives
Aminoglycosides (03.01)
Antifungals (03.02)
Antihelmintics (03.03)
Antimalarials (03.04)
Antituberculars (03.05)
Antivirals (non-HIV) (03.06)
Cephalosporins (03.07)
3. Anti-Infectives
Fluoroquinolones (03.08)
HIV Agents - Fusion Inhibitors (03.09.01)
HIV Agents - Integrase Inhibitors (03.09.02)
HIV Agents - Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) (03.09.03)
HIV Agents - Nucleos(t)ide Reverse Transcriptase Inhibitors (NRTIs) (03.09.04)
3. Anti-Infectives
HIV Agents - Protease Inhibitors (03.09.05)
HIV Agents - Combination Products (03.09.06)
EFAVIRENZ/EMTRICIT/TENOFOVIR 600-200-300 MG TABLET EMTRICITABINE/TENOFOVIR 200-300 MG TABLET HIV Agents - Supportive Agents (03.09.07)
Macrolides / Azalides / Lincosamides / Oxazolidinones (03.10)
CLINDAMYCIN PHOS ADV 600 MG/4 ML INJECTION 3. Anti-Infectives
Penicillins (03.11)
PEN-G BENZATHINE 1.2 MILLION UNITS INJECTION PEN-G BENZATHINE 2.4 MILLION UNITS INJECTION PEN-G PROCAINE 1.2 MILLION UNITS INJECTION Sulfonamides (03.12)
SULFAMETH/TRIMETH VL 80-16 MG/ML INJECTION SULFAMETH\TRIMETH 200-40 MG/5 ML SUSPENSION Tetracyclines (03.13)
Other Anti-Infectives (03.14)
METRONIDAZOLE/NACL 500 MG/100 ML INJECTION 3. Anti-Infectives
Formulary Drug List - MINNESOTA
4. Cancer-Related Agents
Antineoplastics (04.01)
Formulary Drug List - MINNESOTA
5. Cardiovascular Agents
Alpha-adrenergic Blockers (05.01)
Angiotensin-Converting Enzyme Inhibitors (ACE) (05.02)
Angiotensin Receptor Blockers (ARBs) (05.03)
Antidysrhythmics - Type 1a (05.04.01)
Antidysrhythmics - Type 1b (05.04.02)
Antidysrhythmics - Type 1c (05.04.03)
5. Cardiovascular Agents
Antidysrhythmics - Type III (05.04.04)
Antilipidemics - HMG-Coenzyme A Reductase Inhibitors (05.05.01)
Antilipidemics - Other Antilipidemics (05.05.02)
Beta-Adrenergic Blockers - Selective Agents (05.06.01)
Beta-Adrenergic Blockers - Non-Selective Agents (05.06.02)
Beta-Adrenergic Blockers - a,ß Antagonists (05.06.03)
5. Cardiovascular Agents
Calcium Channel Blockers - Dihydropyridine (05.07.01)
Calcium Channel Blockers - Non-Dihydropyridine (05.07.02)
Cardiac Glycosides (05.08)
Centrally-Acting Antihypertensives (05.09)
Diuretics (05.10)
5. Cardiovascular Agents
Hemorrheologic Agents (05.11)
Vasodilators - Nitrates (05.12.01)
ISOSORBIDE-MONONIT 1/2 OF 30MG TAB SR 24 HR 5. Cardiovascular Agents
Vasodilators - Non-Nitrates (05.12.02)
Combination Agents (05.13)
Other CV Agents (05.14)
Formulary Drug List - MINNESOTA
6. Central Nervous System Agents
Antidepressants - Tricyclic Antidepressants (06.01.01)
Antidepressants - Serotonin +/- Norepinephrine Reuptake Inhibitors (SSRI / SNRI) (06.01.02)
SERTRALINE ORAL CONC 20 MG\ ML CONCENTRATE Antidepressants - Other Antidepressants (06.01.03)
6. Central Nervous System Agents
Antipsychotic Agents - 1st Generation Agents (06.02.01)
6. Central Nervous System Agents
Antipsychotic Agents - 2nd Generation Agents (06.02.02)
Barbiturates (06.03)
Cerebral Stimulants (06.04)
Mood Stabilizers (06.05)
Sedatives / Hypnotics - Benzodiazepine (06.06.01)
6. Central Nervous System Agents
Sedatives / Hypnotics - Other Agents (06.06.02)
Other CNS Agents (06.07)
Formulary Drug List - MINNESOTA
7. Dental Agents
Dental Agents (07.01)
Formulary Drug List - MINNESOTA
8. Dermatological Agents
Anti-Acne Products (08.01)
Antifungals (08.02)
Anti-Infectives (08.03)
Antipsoriatics (08.04)
Antipruritics & Local Anesthetics (08.05)
Moisturizing and Barrier Agents (08.06)
Scabicides (08.07)
Steroid Anti-Inflammatories - Very High Potency (08.08.01)
8. Dermatological Agents
Steroid Anti-Inflammatories - High Potency (08.08.02)
Steroid Anti-Inflammatories - Medium Potency (08.08.03)
Steroid Anti-Inflammatories - Low Potency (08.08.04)
Other Derm Agents (08.09)
Formulary Drug List - MINNESOTA
9. Diagnostics and Supplies
Diagnostics and Supplies (09.01)
D5-NS + KCL 20 MEQ 5%-0.9%-20MEQ INJECTION SOD CHL BACTERIOSTAT VL (10ML 0.9% INJECTION SOD CHL BACTERIOSTAT VL (30ML 0.9% INJECTION SOD CHL PRESERV-FREE VL (10ML 0.9% INJECTION SOD CHL PRESERV-FREE VL (20ML 0.9% INJECTION Formulary Drug List - MINNESOTA
10. Emergency Medications
Emergency Medications (10.01)
CHARCOAL + SORBITOL 50 GM/240 ML SUSPENSION FOSPHENYTOIN SOD VIAL 500 MG/10 ML INJECTION 10. Emergency Medications
Formulary Drug List - MINNESOTA
11. Endocrine – Metabolic Agents
Androgens (11.01)
Estrogens – Progestins (11.02)
Insulins (11.03)
Hypoglycemics - Sulfonylureas (11.04.01)
Hypoglycemics - Biguanides (11.04.02)
Hypoglycemics - Thiazolidinediones (11.04.03)
Hypoglycemics - Incretin Mimetics (11.04.04)
Hypoglycemics - Combination Agents (11.04.05)
11. Endocrine – Metabolic Agents
Hypoglycemics - Other Agents (11.04.06)
Thyroid Agents (11.05)
Adrenal Corticosteroids (11.06)
Osteoporosis Agents (11.07)
Other Endocrine - Metabolic Agents (11.08)
Formulary Drug List - MINNESOTA
12. Gastrointestinal Agents
Aminosalicylates (12.01)
Antacids (12.02)
MAG/ALUM HYD/SIMETH 200/200/20 SUSPENSION Anti-Diarrheals (12.03)
Anti-Emetics (12.04)
Cathartics / Laxatives (12.05)
12. Gastrointestinal Agents
Digestive Enzymes (12.06)
GI Motility Agents (12.07)
Hepatitis Medications - Hepatitis B Agents (12.08.01)
Hepatitis Medications - Hepatitis C Agents (12.08.02)
Histamine-2 Receptor Antagonists (H2RAs) (12.09)
Proton Pump Inhibitors (PPIs) (12.10)
Other GI Agents (12.11)
Hemorrhoidal Agents (12.12)
Formulary Drug List - MINNESOTA
13. Genitourinary Agents
Benign Prostatic Hypertrophy Agents (13.01)
Other GU Agents (13.02)
Formulary Drug List - MINNESOTA
14. Hematological Agents
Hematological Agents (14.01)
DARBEPOETIN ALFA SYRG 100 MCG/0.5 ML INJECTION DARBEPOETIN ALFA SYRG 150 MCG/0.3 ML INJECTION DARBEPOETIN ALFA SYRG 200 MCG/0.4 ML INJECTION DARBEPOETIN ALFA SYRG 300 MCG/0.6 ML INJECTION DARBEPOETIN ALFA SYRG 500 MCG/ML INJECTION DARBEPOETIN ALFA SYRG 60 MCG/0.3 ML INJECTION Formulary Drug List - MINNESOTA
15. Immunosuppressants
Immunosuppressants (15.01)
Formulary Drug List - MINNESOTA
16. Neurological Agents
Alzheimer’s Agents (16.01)
Anticonvulsants (16.02)
Anti-Parkinsons Agents (16.03)
16. Neurological Agents
Multiple Sclerosis Agents (16.04)
Other Neuro Agents (16.05)
Formulary Drug List - MINNESOTA
17. Obstetric – Gynecologic Agents
Contraceptives (17.01)
Anti-Infectives (17.02)
Other OB Agents (17.03)
Formulary Drug List - MINNESOTA
18. Otic – Ophthalmic Preparations
Anti-Glaucoma Agents (18.01)
Antihistamines / Decongestants (18.02)
Anti-Infective Agents (18.03)
Anti-Inflammatory Agents (18.04)
Otic Preparations (18.05)
18. Otic – Ophthalmic Preparations
Other Otic-Ophthalmic Agents (18.06)
FLUORESCEIN NA/BENOX O/S 0.25% OPHTHALMIC Formulary Drug List - MINNESOTA
19. Respiratory Agents
Anticholinergics (19.01)
Beta Agonists (19.02)
Inhaled Oral Steroids (19.03)
Nasal Sprays (19.04)
Combination Products (19.05)
Other Respiratory Agents (19.06)
Formulary Drug List - MINNESOTA
20. Vaccines
Vaccines - Exposure Immune Globulin (20.01)
HEPATITIS B VACCINE VIAL 20 MCG INJECTION Formulary Drug List - MINNESOTA
21. Vitamins – Minerals – Dietary Supplements
Vitamins – Minerals – Dietary Supplements (21.01)
Formulary Drug List - MINNESOTA
22. Miscellaneous and Unclassified Agents
Miscellaneous and Unclassified Agents (22.01)
Formulary Drug List - MINNESOTA
- Index -
Product Name
Equivalent Brand Name
Therapy Section
Formulary Drug List - MINNESOTA
- Index -
Product Name
Equivalent Brand Name
Therapy Section
Formulary Drug List - MINNESOTA
- Index -
Product Name
Equivalent Brand Name
Therapy Section
Formulary Drug List - MINNESOTA
- Index -
Product Name
Equivalent Brand Name
Therapy Section
CHARCOAL + SORBITOL 50 GM/240 ML SUSPENSION CHLORPHEN/PHENYLEPHRINE 8 MG-20 MG TAB CR CLINDAMYCIN PHOS ADV 600 MG/4 ML INJECTION Formulary Drug List - MINNESOTA
- Index -
Product Name
Equivalent Brand Name
Therapy Section
D5-NS + KCL 20 MEQ 5%-0.9%-20MEQ INJECTION DARBEPOETIN ALFA SYRG 100 MCG/0.5 ML INJECTION DARBEPOETIN ALFA SYRG 150 MCG/0.3 ML INJECTION DARBEPOETIN ALFA SYRG 200 MCG/0.4 ML INJECTION DARBEPOETIN ALFA SYRG 300 MCG/0.6 ML INJECTION DARBEPOETIN ALFA SYRG 500 MCG/ML INJECTION DARBEPOETIN ALFA SYRG 60 MCG/0.3 ML INJECTION Formulary Drug List - MINNESOTA
- Index -
Product Name
Equivalent Brand Name
Therapy Section
EFAVIRENZ/EMTRICIT/TENOFOVIR 600-200-300 MG TABLET Formulary Drug List - MINNESOTA
- Index -
Product Name
Equivalent Brand Name
Therapy Section
EMTRICITABINE/TENOFOVIR 200-300 MG TABLET FLUORESCEIN NA/BENOX O/S 0.25% OPHTHALMIC Formulary Drug List - MINNESOTA
- Index -
Product Name
Equivalent Brand Name
Therapy Section
FOSPHENYTOIN SOD VIAL 500 MG/10 ML INJECTION Formulary Drug List - MINNESOTA
- Index -
Product Name
Equivalent Brand Name
Therapy Section
HEPATITIS B VACCINE VIAL 20 MCG INJECTION Formulary Drug List - MINNESOTA
- Index -
Product Name
Equivalent Brand Name
Therapy Section
ISOSORBIDE-MONONIT 1/2 OF 30MG TAB SR 24 HR Formulary Drug List - MINNESOTA
- Index -
Product Name
Equivalent Brand Name
Therapy Section
MAG/ALUM HYD/SIMETH 200/200/20 SUSPENSION Formulary Drug List - MINNESOTA
- Index -
Product Name
Equivalent Brand Name
Therapy Section
METRONIDAZOLE/NACL 500 MG/100 ML INJECTION Formulary Drug List - MINNESOTA
- Index -
Product Name
Equivalent Brand Name
Therapy Section
Formulary Drug List - MINNESOTA
- Index -
Product Name
Equivalent Brand Name
Therapy Section
PEN-G BENZATHINE 1.2 MILLION UNITS INJECTION PEN-G BENZATHINE 2.4 MILLION UNITS INJECTION PEN-G PROCAINE 1.2 MILLION UNITS INJECTION Formulary Drug List - MINNESOTA
- Index -
Product Name
Equivalent Brand Name
Therapy Section
Formulary Drug List - MINNESOTA
- Index -
Product Name
Equivalent Brand Name
Therapy Section
SERTRALINE ORAL CONC 20 MG\ ML CONCENTRATE SOD CHL BACTERIOSTAT VL (10ML 0.9% INJECTION SOD CHL BACTERIOSTAT VL (30ML 0.9% INJECTION SOD CHL PRESERV-FREE VL (10ML 0.9% INJECTION SOD CHL PRESERV-FREE VL (20ML 0.9% INJECTION Formulary Drug List - MINNESOTA
- Index -
Product Name
Equivalent Brand Name
Therapy Section
SULFAMETH/TRIMETH VL 80-16 MG/ML INJECTION SULFAMETH\TRIMETH 200-40 MG/5 ML SUSPENSION Formulary Drug List - MINNESOTA
- Index -
Product Name
Equivalent Brand Name
Therapy Section
Formulary Drug List - MINNESOTA
- Index -
Product Name
Equivalent Brand Name
Therapy Section

Source: http://www.co.scott.mn.us/CountyGov/DoingBusiness/RFPs/Minnesota%20Formulary%20Drug%20List.pdf