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| QualChoice Preferred Drug Formulary | ||
| DRUG CATEGORY | PREFERRED PRODUCTS | NON-PREFERRED PRODUCTS |
| Generic Copay | Non-Preferred Copay | |
| Brand Copay | Copay | |
| Anti-Ulcer Drugs | ||
| H2 Antagonists | cemetidine, ranitidine | All other brands are excluded |
| Axid AR, Pepcid AC | ||
| Tagamet HB, Zantac 75 | ||
| Proton Pump Inhibitors | Prevacid | Prilosec |
| Pain Management Drugs | ||
| Nonsteriodal Anti-Inflammatory Drugs | Any Generic | Arthrotec, Daypro, |
| Generics include: ibuprofen, | Relafen | Lodine XL, Naprelan, |
| indomethacin, naproxen, etc. | Celebrex (for arthritis) | Oruvail, Ponstel, Voltaren XR |
| Women's Health Products | ||
| Oral Contraceptives | Ortho-Cept, Ortho-Cyclen, | All other products excluded |
| Note: Only the 10 preferred brand | Ortho-Novum 7/7/7, Ortho-Tricyclen, | |
| name products listed will be covered | Alesse, Triphasil, Loestrin Fe | |
| Lo-Ovral, Nordette, Estroteop Fe | ||
| Oral Estrogen Replacement | Any Generic | Estinyl |
| generics include: estropipate, | Premarin | Estratest |
| estradiol, etc | Premphase, Prempro | All Other Brands |
| Estrogen Patches | Climara | Alora, FemPatch, Vivelle |
| Prenatal Vitamins / Iron | Any Generic | All Other Brands |
| Chromagen Products, Precare Ultra | ||
| Respiratory Agents | ||
| Nasal Steroids | Vancenase/AQ/84 | Beconase/AQ, Flonase, Nasalide |
| Nasacort/AQ, Nasonex | Nasarel, Rhinocort | |
| Inhaled Steroids | Azmacort, Vanceril DS | Aerobid/M, Beclovent, Flovent |
| Inhaled Beta-2 Agonists | Any Generic | Brethaire, Serevent |
| Generics inlcuded: albuterol | Maxair Autohaler, Proventil HFA | Tornalate |
| Antihistamines | ||
| Antihistamines | Allegra Products, Zyrtec | Claritin Products, Hismanal |
| Anti-Infectives | ||
| Cephalosporins | Any Generic | Ceclor CD, Ceftin, |
| Generics include: cefaclor, | Cedax, Cefzil, | Keftab, Lorabid |
| cefadroxil, cephelexin, cephradine | Suprax, Vantin | |
| Macrolides | erythromycin | Biaxin |
| Zithromax | ||
| Quinolones | Cipro | |
| Noroxin (for UTI'S only) | ||
| Trovan | ||
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