Preferred Drug List - Tennessee - 2016

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Preferred Drug List - 2016
List subject to change prior to Jan. 1, 2016
Allergy/Cough & Cold
Tier 1
azelastine
codeine/guaifenesin
fluticasone
benzonatate
cyproheptadine
hydroxyzine
brompheniramine/pseudoephedrine
desloratadine
levocetirizine
budesonide
flunisolide
Tier 2
Astepro
EpiPen
QL
Auvi-Q
QL
EpiPen Jr.
QL
Tier 3
Grastek
PA
Oralair
PA SPRx
Ragwitek
PA
Anti-Infectives Antibiotics/Antifungal/Antiviral
Tier 1
clindamycin cream
nystatin
amoxicillin
amoxicillin/potassium clavulanate
doxycycline
penicillin VK
PA SPRx
ampicillin
erythromycin
ribavirin
azithromycin
famciclovir
sulfamethoxazole/trimethoprim
cefdinir
fluconazole
terconazole
cefuroxime
ketoconazole
tetracycline
cephalexin
levofloxacin
valacyclovir
ciprofloxacin tabs
metronidazole
valganciclovir
clarithromycin
minocycline immediate-release
Zovirax ointment
moxifloxacin
clarithromycin ext-rel
clindamycin
nitrofurantoin macrocrystals
Tier 2
Cleocin Ovules
Pegasys
PA SPRx
Xifaxin 550mg
Clindesse
Sovaldi
PA SPRx
Zovirax cream
Harvoni
PA SPRx
Tobi Podhaler
QL SPRx
Tier 3
Avelox
Noxafil
Nuvessa
Antineoplastics and Immunosuppressants
Tier 1
anastrozole
exemestane
mycophenolate mofetil
azathioprine
letrozole
sirolimus
bicalutamide
mercaptopurine
tacrolimus
cyclosporine
methotrexate
tamoxifen
Tier 2
Alkeran
Leukeran

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Preferred Drug List Preferred Drug List Medical
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