QUICKLIST of Formulary
Prescription Medications with Price Comparisons
Comparisons
$	less than $10.00
$$	$10.00 - $20.00
$$$	$20.00 - $30.00
$$$$	$30.00 - $40.00
$$$$$	greater than $40.00
ANTIHISTAMINES
CETIRIZINE 10MG TAB	ZYRTEC	$$$$$
DIPHENHYDRAMINE 25MG CAP	BENADRYL	$
FEXOFENADINE 60MG CAP	ALLEGRA	$$$$
HYDROXYZINE 10MG TAB	ATARAX, VISTARIL	$
HYDROXYZINE 25MG TAB	ATARAX, VISTARIL	$
LORATADINE 10MG TAB	CLARITIN	$$$$$
ANTI-INFECTIVES
AMEBACIDE
IODOQUINOL 650MG TAB	YODOXIN	$$$$
ANTIHELMINTIC
MEBENDAZOLE 100MG CHEWTAB	VERMOX	$$
ANTIFUNGALS
FLUCONAZOLE 150MG TAB	DIFLUCAN	$$
ITRACONAZOLE 100MG CAP	SPORANOX	$$$$$
ITRACONAZOLE 100MG CAP #28/PAK	SPORANOX PULSE PAK	$$$$$
KETOCONAZOLE 200MG TAB	NIZORAL	$$
CEPHALOSPORINS
CEFPODOXIME PROXETIL 200MG TAB	VANTIN	$$$$$
CEPHALEXIN 250MG CAP	KEFLEX	$
CEPHALEXIN 500MG CAP	KEFLEX	$
ERYTHROMYCINS
AZITHROMYCIN 250MG TABLETS	ZITHROMAX	$$$$
AZITHROMYCIN 250MG TABLETS #6/PACK	ZITHROMAX Z-PAK	$$$$
CLARITHROMYCIN 250MG TAB	BIAXIN	$$$$$
CLARITHROMYCIN 500MG TAB	BIAXIN	$$$$$
ERYTHROMYCIN BASE 250MG EC TAB	ERY-TAB	$
ERYTHROMYCIN ETHYLSUCC 400MG TAB	EES	$$
PENICILLINS
AMOXICILLIN 250MG CAP	AMOXIL	$
AMOXICILLIN 500MG CAP	AMOXIL	$
AMOXICILLIN 250MG/ CLAV 125MG TAB	AUGMENTIN 250	$$$$$
AMOXICILLIN 500MG/ CLAV 125MG TAB	AUGMENTIN 500	$$$$$
DICLOXACILLIN 250MG CAP	DYNAPEN	$
DICLOXACILLIN 500MG CAP	DYNAPEN	$$
PENICILLIN VK 250MG TAB	PEN VK, VEETIDS	$
PENICILLIN VK 500MG TAB	PEN VK, VEETIDS	$
TETRACYCLINES
DOXYCYCLINE 100MG TAB/CAP	VIBRAMYCIN	$
MINOCYCLINE 50MG CAP	MINOCIN	$
MINOCYCLINE 100MG CAP	MINOCIN	$$
TETRACYCLINE 250MG CAP	ACHROMYCIN, SUMYCIN	$
TETRACYCLINE 500MG CAP	ACHROMYCIN, SUMYCIN	$
ANTI-TUBERCULOSIS
ISONIAZID 300MG TAB 30s	INH	N/A
RIFAMPIN 300MG CAP	RIFAMPIN	$$$
ANTIVIRALS
ACYCLOVIR 200MG CAP	ZOVIRAX	$
ACYCLOVIR 800MG TAB	ZOVIRAX	$$
RIMANTADINE 100MG TAB	FLUMADINE	$$$
ANTIMALARIALS
CHLOROQUINE PHOSPHATE 500MG TAB	ARALEN	$$$
MEFLOQUINE 250MG TAB	LARIAM	$$$
QUINOLONES
CIPROFLOXACIN 250MG TAB	CIPRO	$$$$$
CIPROFLOXACIN 500MG TAB	CIPRO	$$$$$
CIPROFLOXACIN 750MG TAB	CIPRO	$$$$$
URINARY ANTIBIOTICS
NITROFURANTOIN 50MG MACROCRYSTAL CAP	MACRODANTIN	$
NITROFURANTOIN 100MG MACROCRYSTAL CAP	MACRODANTIN	$
NITROFURANTOIN 100MG MACROCRYSTAL SR CAP	MACROBID	$$$
MISCELLANEOUS ANTI-INFECTIVES
METRONIDAZOLE 250MG TAB	FLAGYL	$$
METRONIDAZOLE 500MG TAB	FLAGYL	$
COTRIMOXAZOLE-DS TAB	BACTRIM-DS, SEPTRA-DS	$
CARDIOVASCULAR
GENERAL CARDIOVASCULAR
ATENOLOL 50MG TAB	TENORMIN	$
ATENOLOL 100MG TAB	TENORMIN	$
PROPRANOLOL 10MG TAB	INDERAL	$
PROPRANOLOL 20MG TAB	INDERAL	$
PROPRANOLOL 40MG TAB	INDERAL	$
VERAPAMIL 240MG SUSTAINED RELEASE	ISOPTIN SR, CALAN SR	$$
HYPOTENSIVES
ENALAPRIL 5MG TAB	VASOTEC	$$$$
ENALAPRIL 10MG TAB	VASOTEC	$$$$
DIURETICS
HYDROCHLORTHIAZIDE 25MG TAB	HYDRODIURIL, HCTZ	$
HYDROCHLORTHIAZIDE 50MG TAB	ESIDRIX, HCTZ	$
SPIRONOLACTONE 25MG TAB	ALDACTONE	$$$$
ANALGESICS
NONSTEROIDAL ANTI-INFLAMMATORY
IBUPROFEN 600MG TAB	MOTRIN	$
IBUPROFEN 800MG TAB	MOTRIN	$
INDOMETHACIN 25MG CAP	INDOCIN	$
NAPROXEN 375MG TAB	NAPROSYN	$
NAPROXEN 500MG TAB	NAPROSYN	$
NAPROXEN SODIUM 275MG TAB	ANAPROX	$
NAPROXEN SODIUM 550MG TAB	ANAPROX DS	$
OXAPROZIN 600MG TABLET	DAYPRO	$$$$
SALSALATE 500MG TAB	DISALCID	$
SALSALATE 750MG TAB	DISALCID	$
NARCOTIC ANALGESICS
CODEINE 15MG/ ACET 300MG TAB C3	TYLENOL #2	$
CODEINE 30MG/ ACET 300MG TAB C3	TYLENOL #3	$
HYDROCODONE 5MG/ACETAM 500MG TAB	VICODIN	$
PROPOXYPHENE 65MG/ACETAM 650MG TAB	WYGESIC	$$
MISCELLANEOUS ANALGESICS
ISOMETHEPTENE/DICHLORAL/ACETAM CAP	MIDRIN, IDA, MIDCHLOR	$$
ERGOTAMINE/CAFFEINE	CAFERGOT, WIGRAINE	$$
SUMATRIPTAN SUCC 25MG TAB	IMITREX	$$$$
SMOOTH MUSCLE RELAXANTS
CYCLOBENZAPRINE 10MG TAB	FLEXERIL	$
METHOCARBAMOL 500MG TAB	ROBAXIN	$
METHOCARBAMOL 750MG TAB	ROBAXIN	$$
ANTICONVULSANTS
PHENYTOIN SOD 100MG EXTENDED CAP	DILANTIN	$$$
CARBAMAZEPINE 100MG EXTEND RELEASE	TEGRETOL-XR 100MG	$$$
CARBAMAZEPINE 200MG EXTEND RELEASE	TEGRETOL-XR 200MG	$$$$
CARBAMAZEPINE 100MG CHEWTAB	TEGRETOL	$$$
CARBAMAZEPINE 200MG TAB	TEGRETOL	$$$$
DIVALPROEX DISOD 250MG DEL REL TAB	DEPAKOTE	$$$$
DIVALPROEX DISOD 500MG DEL REL TAB	DEPAKOTE	$$$$
VALPROIC ACID 250MG CAP	DEPAKENE	$$
PSYCHOACTIVE MEDICATIONS
ANTIDEPRESSANTS
AMITRIPTYLINE 10MG TAB	ELAVIL	$
AMITRIPTYLINE 25MG TAB	ELAVIL	$
AMITRIPTYLINE 50MG TAB	ELAVIL	$
BUPROPION 75MG TAB	WELLBUTRIN	$$$$
BUPROPION 100MG TAB	WELLBUTRIN	$$$$$
BUPROPION 100MG SR TAB	WELLBUTRIN SR	$$$$$
BUPROPION 150MG SR TAB	WELLBUTRIN SR	$$$$$
DESIPRAMINE 10MG TAB	NORPRAMIN	$
DESIPRAMINE 25MG TAB	NORPRAMIN	$
DOXEPIN 10MG CAP	SINEQUAN	$
DOXEPIN 25MG CAP	SINEQUAN	$
FLUOXETINE 10MG CAP	PROZAC	$$$$$
FLUOXETINE 20MG CAP	PROZAC	$$$$$
FLUVOXAMINE 50MG TAB	LUVOX	$$$$$
FLUVOXAMINE 100MG TAB	LUVOX	$$$$$
IMIPRAMINE 10MG TAB	TOFRANIL	$
IMIPRAMINE 25MG TAB	TOFRANIL	$
NEFAZODONE 100MG TAB	SERZONE	$$$$$
NEFAZODONE 150MG TAB	SERZONE	$$$$$
NORTRIPTYLINE 10MG CAP	PAMELOR	$
NORTRIPTYLINE 25MG CAP	PAMELOR	$
PAROXETINE 20MG TAB	PAXIL	$$$$$
PAROXETINE 30MG TAB	PAXIL	$$$$$
SERTRALINE 50MG SCORED TAB	ZOLOFT	$$$$$
SERTRALINE 100MG SCORED TAB	ZOLOFT	$$$$$
TRAZODONE 50MG TAB	DESYREL	$
TRAZODONE 100MG TAB	DESYREL	$
VENLAXAFINE 37.5MG SCORED TAB	EFFEXOR	$$$$$
VENLAXAFINE 75MG SCORED TAB	EFFEXOR	$$$$$
VENLAXAFINE 100MG SCORED TAB	EFFEXOR	$$$$$
ANTIPSYCHOTICS
HALOPERIDOL 5MG SCORED TAB	HALDOL	$
RISPERIDONE 1MG TAB	RISPERDAL	$$$$$
RISPERIDONE 3MG TAB	RISPERDAL	$$$$$
BENZODIAZEPINES
ALPRAZOLAM 0.25MG TAB C4	XANAX	$
ALPRAZOLAM 0.5MG TAB C4	XANAX	$
CLONAZEPAM 0.5MG TAB C4	KLONOPIN	$
CLONAZEPAM 1MG TAB C4	KLONOPIN	$
DIAZEPAM 5MG TAB C4	VALIUM	$
TEMAZEPAM 15MG CAP C4	RESTORIL	$
ANXIOLYTICS
BUSPIRONE 5MG TAB	BUSPAR	$$$$$
BUSPIRONE 10MG TAB	BUSPAR	$$$$$
HYPNOTICS
ZOLPIDEM 5MG TAB C4	AMBIEN	$$$$$
ZOLPIDEM 10MG TAB C4	AMBIEN	$$$$$
ANTIMANIC MEDICATIONS
LITHIUM CARBONATE 300MG CAP	LITHIUM, ESKALITH	$
ANTITUSSIVES
BENZONATATE 100MG CAP	TESSALON	$
GUAIFENESIN/COD 10MG/5ML 120ML SYR C5	ROBITUSSIN AC	$
GUAIF 400MG/PHENYLPROP 75MG LA TAB	ENTEX-LA	$
OPHTHALMIC PREPARATIONS
CROMOLYN SODIUM 4% OPHTH SOL	CROLOM	$$
DEXAMETHASONE 0.1% OPHTH. 5ML SOL	MAXIDEX	$
DEXAMETHASONE/NEO/POLY OPHTH.SUSP. 5ML	MAXITROL, DEXACIDIN	$
ERYTHROMYCIN 0.5% OPHTH.OINT 3.5G	ILOTYCIN	$
FLUOROMETHOLONE 0.1% OPHTH. OINT 3.5G	FML	$$$
LEVOCABASTINE 0.05% OPHTH SUSP 5ML	LIVOSTIN	$$
LODOXAMIDE 0.1% OPHTH SOL 10ML	ALOMIDE	$$$$
NEOMYCIN/POLY B/BAC OPHTH OINT 3.5G	NEOSPORIN	$
PREDNISOLONE/SULFACETAMIDE OPHTH.OINT 3.5G	BLEPHAMIDE, CETAPRED	$
PREDNISOLONE/SULFACETAMIDE OPHTH.SUSP 10ML	BLEPHAMIDE, CETAPRED	$$$
SULFACETAMIDE SOD 10% OPHTH.OINT	SULAMYD, BLEPH-10	$$
SULFACETAMIDE SOD 10% OPHTH.SOL	SULAMYD, BLEPH-10	$
TOBRAMYCIN 0.3% OPHTH.OINT 3.5G	TOBREX, AKTOB	$$$
TOBRAMYCIN 0.3% OPHTH.SOL 5ML	TOBREX, AKTOB	$
OTIC PREPARATIONS
ACETIC ACID 2% OTIC SOL 15ML	VOSOL	$
ACETIC ACID 2%/HC 1% OTIC SOL 10ML	VOSOL-HC	$
ANTIPYRINE/BENZOCAINE OTIC SOL 10ML	AURALGAN, AURODEX	$
HYDROCORT 1%/POLY/NEO OTIC SOL 10ML	CORTISPORIN	$$
ORAL CONTRACEPTIVES & CONTRACEPTIVE DEVICES
DEVICES
DIAPHRAGHM COIL SPRING 70/80MM	ORTHO COIL	$$$
DIAPHRAGM ARCING SPRING 65/70/75/80/85MM	ALL-FLEX	$$$
BIRTH CONTROL PILLS
DESOGESTREL 0.15MG/ EE 30 MCG TAB 28s	ORTHO-CEPT, DESOGEN	$
ETHYNODIOL 1MG/EE 35MCG TAB 28s	DEMULEN 1/35	$
LEVONORGESTREL 0.1MG/EE 0.02MG TAB	ALESSE	$
LEVONORGESTREL/EE TRIPHASIC TAB 28s	TRIPHASIL	$
NORETHINDRONE 0.35MG	MICRONOR, NOR-Q.D.	$
NORETHINDRONE 0.5MG/EE 35MCG TAB 28s	MODICON, BREVICON	$
NORETHINDRONE 1MG/EE 35MCG TAB 28s	ORTHONOVUM 1/35	$
NORETHINDRONE/EE TRIPHASIC TAB 28s	ORTHO 7/7/7	$
NORGESTIMATE/EE TAB	ORTHO-CYCLEN	$
NORGESTIMATE/EE TRIPHASIC TAB	TRI-CYCLEN	$
NORGESTREL 0.3MG/EE 30MCG TAB 28s	LO/OVRAL	$
NORGESTREL 0.5MG/EE 50MCG TAB	OVRAL	$$
INHALERS
ALBUTEROL ORAL INHALATION 200 DOSES	VENTOLIN, PROVENTIL	$$
BECLOMETHASONE AQ NASAL SPR	BECONASE-AQ	$$$$
BECLOMETHASONE NASAL INH 200 DOSES	BECONASE	$$$$
BECLOMETHASONE ORAL INH 200 DOSES	BECLOVENT	$$$$
CROMOLYN ORAL INHALER	INTAL	$$$$$
FLUNISOLIDE 250MCG/DOSE ORAL INH	AEROBID	$$$$$
FLUTICASONE PROPIONATE 16GM	FLONASE	$$$$$
FLUTICASONE PROPIONATE ORAL INH	FLOVENT	$$$$$
SALMETEROL 25MCG/DOSE 120 DOSE INH	SEREVENT	$$$$$
TRIAMCINOLONE ORAL INH 240 DOSES	AZMACORT	$$$$$
ORAL ANTI-ASTHMATIC MEDICATIONS
MONTELUKAST SODIUM 10MG	SINGULAIR	$$$$$
THEOPHYLLINE 100MG SR TAB	THEODUR	$
THEOPHYLLINE 200MG SR TAB	THEODUR	$
THEOPHYLLINE 300MG SR TAB	THEODUR	$
ZAFIRLUKAST 20MG TAB	ACCOLATE	$$$$$
GASTROINTESTINAL AGENTS
ANTISPASMODICS
BELLADONNA/PHENOBARBITAL 16MG TAB	DONNATAL	$
DICYCLOMINE 10MG CAP	BENTYL	$
PROPANTHELINE 15MG TAB	PRO-BANTHINE	$
ANTIDIARRHEALS
BISACODYL 5MG EC TAB	DULCOLAX	$
BISACODYL 10MG RECTAL SUPPOS	DULCOLAX	$
ANTIEMETICS
MECLIZINE 25MG TAB	ANTIVERT	$
TRIMETHOBENZAMIDE 200MG RECTAL SUP	TIGAN	$
TRIMETHOBENZAMIDE 250MG CAP	TIGAN	$
MISCELLANEOUS
MESALAMINE 400MG DEL REL TAB	ASACOL	$$$$$
MESALAMINE 4G/60ML RETENTION ENEMA	ROWASA	$$$$$
OMEPRAZOLE 20MG DEL REL CAP	PRILOSEC	$$$$$
RANITIDINE 150MG TAB	ZANTAC	$
RANITIDINE 300MG TAB	ZANTAC	$$
TOPICAL MEDICATIONS
TOPICAL ANTIBIOTICS
CLINDAMYCIN 1% TOP SOL 60ML	CLEOCIN T	$$
CLINDAMYCIN 1% TOP GEL 30G	CLEOCIN T	$$$
CLINDAMYCIN 2% VAG CREAM 40G	CLEOCIN	$$$$$
ERYTHROMYCIN 2% SOL 60ML	A/T/S	$
ERYTHROMYCIN 2% TOP GEL 27G	EMGEL	$$$
MUPIROCIN 2% OINT 15G	BACTROBAN	$$$
TOPICAL ANTI-INFECTIVES
METRONIDAZOLE 0.75% TOPICAL GEL 28G	METROGEL	$$$$
METRONIDAZOLE 0.75% VAGINAL GEL 70G	METROGEL	$$$$
SELENIUM SULFIDE 2.5% LOTION 120ML	SELSUN	$
SILVER SULFADIAZINE 1% CREAM 50G	SILVADENE	$$
SILVER SULFADIAZINE 1% CREAM 85G	SILVADENE	$$
TOPICAL ANTIVIRAL & ANTIFUNGAL
ACYCLOVIR 5% OINT 15G	ZOVIRAX	$$$$$
CICLOPIROX 1% CREAM 15G	LOPROX	$$
CICLOPIROX 1% CREAM 30G	LOPROX	$$$
CICLOPIROX 1% CREAM 90G	LOPROX	$$$$
CLOTRIMAZOLE 10MG LOZENGES	MYCELEX TROCHE	$$$$
KETOCONAZOLE 2% CREAM 15G	NIZORAL	$$$
KETOCONAZOLE 2% CREAM 30G	NIZORAL	$$$$
KETOCONAZOLE 2% CREAM 60G	NIZORAL	$$$$$
KETOCONAZOLE 2% SHAMPOO 120ML	NIZORAL	$$$
NYSTATIN 100,000U/ML ORAL SUSP 60ML	MYCOSTATIN	$
NYSTATIN 500,000U ORAL TABLET	MYCOSTATIN	$$$
TERCONAZOLE 0.4% VAGINAL CREAM 45G	TERAZOL-7	$$$$
TERCONAZOLE 0.8% VAGINAL CREAM 20G	TERAZOL-3	$$$$
TERCONAZOLE 80MG VAGINAL SUPPOS 3s	TERAZOL-3	$$$$
SCABICIDES
LINDANE 1% LOTION 60ML	KWELL	$
PERMETHRIN 5% CREAM 60G	ELIMITE	$$$
TOPICAL STEROIDS
CLOBETASOL 0.05% CREAM 15G	TEMOVATE	$$$
CLOBETASOL 0.05% CREAM 30G	TEMOVATE	$$
CLOBETASOL 0.05% OINT 15G	TEMOVATE	$$
CLOBETASOL 0.05% OINT 30G	TEMOVATE	$$
CLOBETASOL 0.05% TOPICAL SOLN 50ML	TEMOVATE	$$$
FLUOCINONIDE 0.05% CREAM 15G	LIDEX	$
FLUOCINONIDE 0.05% CREAM 60G	LIDEX	$$
FLUOCINONIDE 0.05% OINT 15G	LIDEX	$$
FLUOCINONIDE 0.05% OINT 60G	LIDEX	$$$$
FLUOCINONIDE 0.05% SOL'N 60ML	LIDEX	$$$
FLURANDRENOLIDE 4MCG/CM2 TAPE 3"x80"	CORDRAN TAPE	$$$$
HYDROCORT 25MG RECTAL SUPP	ANUSOL-HC SUPP	$
HYDROCORTISONE 2.5% CREAM	ANUSOL-HC	$
HYDROCORTISONE 2.5% OINTMENT	ANUSOL-HC	$
TRIAMCINOLONE 0.1% CREAM 15G	KENALOG, ARISTOCORT	$
TRIAMCINOLONE 0.1% CREAM 80G	KENALOG, ARISTOCORT	$
TRIAMCINOLONE 0.1% DENT.PASTE 5G	KENALOG IN ORABASE	$
TRIAMCINOLONE 0.1% LOTION 60ML	KENALOG, ARISTOCORT	$$
TRIAMCINOLONE 0.1% OINT 15G	KENALOG, ARISTOCORT	$
TRIAMCINOLONE 0.1% OINT 80G	KENALOG, ARISTOCORT	$
CELL STIMULANTS
ADAPALENE 0.1% GEL 15G	DIFFERIN	$$$
ADAPALENE 0.1% GEL 45G	DIFFERIN	$$$$$
TRETINOIN 0.025% CREAM 20G	RETIN-A	$$$$
TRETINOIN 0.025% CREAM 45G	RETIN-A	$$$$$
TRETINOIN 0.05% CREAM 20G	RETIN-A	$$$$
TRETINOIN 0.05% CREAM 45G	RETIN-A	$$$$$
TRETINOIN 0.1% MICROSPHERE GEL 20G	RETIN-A MICRO	$$$$
TRETINOIN 0.1% MICROSPHERE GEL 45G	RETIN-A MICRO	$$$$$
RETINOIDS
ISOTRETINOIN 40MG CAP 10s	ACCUTANE	$$$$$
MISCELLANEOUS TOPICALS
ALUMINUM CHLORIDE 20% SOLN 60ML	DRYSOL	$$
AZELAIC ACID 20% CREAM 30G	AZELEX	$$$$
BENZOYL PEROXIDE 5% AQ GEL 90G	BENZAC W 5	$$$
BENZOYL PEROXIDE 10% AQ GEL 90G	BENZAC W 10	$$$
FLUOROURACIL 5% CREAM 25G	EFUDEX	$$$$$
LIDOCAINE 2% VISC ORAL SOLN 100ML	XYLOCAINE	$
LIDOCAINE 2% JELLY 30ML*	XYLOCAINE	$$
PODOFILOX 0.5% SOL'N 3.5ML	CONDYLOX	$$$$$