IHS National Core Formulary
The IHS National Core Formulary is not an inclusive formulary, but should be considered a baseline to build upon. These agents were reviewed clinically and were considered as standard of care medications for frequently encountered disease states within the Indian Health System. Agents listed on the IHS National Core Formulary should be available on your local formulary.
Updated March 2013
Special Notes:
- To search by keyword through this page for a specific drug product, press "Control F".
- * RED ITEMS in the table below, indicate a closed class item. Facilties should not have any other formulary items from these classes.
- ** Removed from Formulary
| Generic |
References/Guidelines |
AHFS
Classification |
VA
Class |
| 5-HT agonist (Triptan)
| any product |
28:32.28 |
CN105 |
| Acetaminophen
| |
28:08.92 |
CN103 |
| Albuterol (Proventil HFA®)
| Branded product |
12:12.08 |
RE102 |
| Albuterol nebulized solution
| |
12:12.08 |
RE102 |
| Alendronate
| Medication Guide [PDF]
|
92:24.00 |
HS900 |
| Allopurinol
| |
84:08.00 |
MS400 |
| Anastrozole
| |
10:00.00 |
AN500 |
| Amitriptyline
| |
28:14.04 |
CN601 |
| Amlodipine
| |
24:28.08 |
CV200 |
| Angiotensin Receptor Blocker, ANY
| Removed April 2012; see Losartan |
24:32.08 |
CV805 |
| Aspirin
| |
28:08.04 |
CN103 |
| Atenolol
| |
24:24.00 |
CV100 |
| Atypical Antipsychotic
| any product |
28.16 |
CN700 |
| Buproprion
| Medication Guide [PDF]
|
28:16.04 |
AN200 |
| Calcium
| any formulation |
40:12 |
TN420 |
| Carvedilol (immediate release formulation only)
| |
24:04.00 |
CV100 |
| Chlorthalidone
| |
|
CV701 |
| Clindamycin topical
| any product |
84:04.04 |
DE752 |
| Clonazepam
| Medication Guide [PDF]
|
28:16.04 |
CN400 |
| Clopidogrel bisulfate
| Medication Guide [PDF]
|
20:12.18 |
BL117 |
| Combination (70/30) insulin, Novolin
| Branded product |
68:20.08 |
HS501 |
| Combination insulin, Novolog (70/30) mix
| Branded product |
68:20.08 |
HS501 |
| Copper Intrauterine Device, (Paragard)
| Branded product; CFU for use by a skilled and priveleged provider |
68.12 |
HS200 |
| Corticosteroid topical (low potency)
| any product |
84:06.00 |
DE200 |
| Corticosteroid topical (Intermediate potency)
| any product |
84:06.00 |
DE200 |
| Dedicated Emergency Contraceptive
| any product |
68.12 |
HS200 |
| Depo-Medroxyprogesterone injection
| |
68.32 |
HS800 |
| Dextroamphetamine and Amphetamine (immediate release)
| Pediatric use only |
28:20.04 |
CN801 |
| Dextroamphetamine and Amphetamine (long-acting)
| Pediatric use only |
28:20.04 |
CN801 |
| Digoxin
| |
24:04.08 |
CV049 |
| Diltiazem
| |
24:28.92 |
CV200 |
| Divalproex
| |
28:12.92 |
CN400 |
| Donepezil
| 5 mg and 10 mg strength |
12:04 |
CN900 |
| Doxazosin
| |
24:20.00 |
CV150 |
| Emtricitabine/Tenofovir (Truvada®)
| Post-Exposure Prophylaxis |
08:18.08 |
AM800 |
| Estradiol tablets
| |
68.16.04 |
HS000 |
| Ethambutol
| |
08:16.04 |
AM500 |
| Ethinyl estradiol/etonorgestrel vaginal ring (NuvaRing®)
| |
68.12 |
GU400 |
| Ethinyl estradiol/norelgestromin transdermal (Ortho-Evra®)
| |
68.12 |
GU400 |
| Etonogestril implant (Nexplanon®)
| Branded product; CFU for use by a skilled and priveleged provider |
68.12 |
HS200 |
| Finasteride
| |
92:00.00 |
HS900 |
| Fluoxetine
| |
28:12.08 |
CN609 |
| Fluticasone/Salmeterol (Advair®)
| Removed October 2012; Branded product
Medication Guide [PDF]
|
12:12.08.12 & 68.0 |
RE101/RE102 |
| Furosemide
| |
40:28.20 |
CV702 |
| Gabapentin
| Medication Guide [PDF]
|
28:12.92 |
CN400 |
| Gemfibrozil
| |
240:6.06 |
CV350 |
| Glipizide
| |
68:20.20 |
HS502 |
| Glucagon
| For outpatient use |
68:22.12 |
HS503 |
| Glyburide
| |
68:20.20 |
HS502 |
| H1 Antagonist-2nd generation, long-acting
| any product |
04:00 |
AH000 |
| Hydrochlorothiazide
| |
40:28.20 |
CV701 |
| Hydroxychloroquine
| |
08:30.08 |
AP101 |
| Ibuprofen
| |
28:08.04 |
MS102 |
| Imipramine
| |
28:14.04 |
CN601 |
| Indomethacin
| |
28:08.04 |
MS102 |
| Intermediate-acting (NPH) insulin, Novolin
| Branded product |
68:20.08 |
HS501 |
| Intranasal corticosteroid (any)
| any product |
52:08.08 |
NT200 |
| Ipratropium MDI
| |
12:08.08 |
RE105 |
| Isoniazid
| |
08:16.04 |
AM500 |
| Isosorbide dinitrate
| |
24:12.08 |
CV250 |
| Laxative, bulk forming
| any product |
56:12 |
GA201 |
| Laxative, stimulant
| any product |
56:12 |
GA204 |
| Laxative, osmotic
| any product |
56:12 |
GA202 |
| Letrozole
| |
10:00.00 |
AN900 |
| Levonorgestrel-releasing intrauterine device (Mirena®)
| Branded product; CFU for use by a skilled and priveleged provider |
68.12 |
HS200 |
| Levothyroxine
| |
68:36.04 |
HS851 |
| Lisinopril
| |
24:32.04 |
CV800 |
| Lithium
| |
28:28.00 |
CN750 |
| Long-acting insulin, Insulin Detemir (Levemir)
| Branded product |
68:20.08 |
HS501 |
| Lopinavir/Ritonavir (Kaletra®)
| Post-Exposure Prophylaxis
Medication Guide [PDF]
|
08:18.08 |
AM800 |
| Lorazepam
| |
28:12.08 |
CN400 |
|
Losartan
| |
24:32:08 |
CV805 |
| Lovastatin
| Removed April 2012 |
24:06.08 |
CV350 |
| Low-molecular weight heparin
| any product |
20:12.04 |
BL110 |
| Metformin
| |
68:20.04 |
HS502 |
| Methotrexate
| |
10:00.00 |
AN300 |
| Methylphenidate (immediate release)
| Pediatric use only |
28:20.92 |
CN802 |
| Methylphenidate (long-acting)
| Pediatric use only |
28:20.92 |
CN802 |
| Metoprolol
| |
24:24.00 |
CV100 |
| Mometasone (Asmanex®)
| Branded product |
68:04.00 |
RE101 |
| Mometasone/Formoterol (Dulera®)
| Branded product |
12:12.08.12 & 68.0 |
RE101/RE102 |
| Monophasic Oral Contraceptive Pill 30-35mcg EE (medium)
| any product |
68.12 |
HS200 |
| Monophasic Oral Contraceptive Pill (OCP) 20mcg EE (low)
| any product |
68:12 |
HS200 |
| Montelukast
| |
48:10.24 |
RE109 |
| Naproxen
| |
28:08.04 |
MS102 |
| Niacin extended release (Niaspan®)
| |
24:06.92 |
VT103 |
| Nicotine Replacement Therapy
| any product |
12:00 |
IM900 |
| Nifedipine ( controlled or extended release)
| |
24:28.08 |
CV200 |
| Nitroglycerin 0.4 milligrams, sublingual
| |
24:12.08 |
CV250 |
| Nitroglycerin patch
| |
24:12.08 |
CV250 |
| Nortriptyline
| |
26:16.04 |
CN601 |
| Omeprazole (enteric coated)
| Closed class status removed July 2012 |
56:28.36 |
GA900 |
| Ophthalmic Prostaglandin Analogue
| any product |
52.36.00 |
OP109 |
| ** Pioglitazone
| Removed February 2010
Medication Guide [PDF]
|
68:20.28 |
HS502 |
| Pravastatin
| |
24:06.08 |
CV350 |
| Prazosin
| |
24:20.00 |
CV150 |
| Prednisone
| |
68:04.00 |
HS051 |
| Premarin® Vaginal Cream
| Branded product |
68.16.04 |
HS000 |
| Progestin (oral)
| any product |
68.32 |
HS800 |
| Progestin Only Oral Contraceptive Pill
| any product |
68.32 |
HS800 |
| Pyrazinamide
| |
08:16.04 |
AM500 |
| Ranitidine
| |
56:28.12 |
GA301 |
| Rapid-acting (regular) insulin, Novolin
| Branded product |
68:20.08 |
HS501 |
| Rifampin
| |
08:16.04 |
AM500 |
| Rosuvastatin 20mg
| Removed April 2012 |
24:06.08 |
CV350 |
| Salmeterol (Serevent®)
| Removed September 2011; Medication guide, communication plan
[PDF]
|
12:12.08 |
RE102 |
| Salsalate
| |
28:08.04 |
MS102 |
| Sertraline
| |
28:16.04 |
CN609 |
| Sevelamer (Renvela®)
| For patients on dialysis that cannot use calcium based phosphate binders due to hypercalcemia; branded product |
92:00.00 |
AD900 |
| Simvastatin
| |
24:06.08 |
CV350 |
| Spironolactone
| |
24:32.20 |
CV704 |
| Sulfasalazine
| |
08:12.20 |
GA900 |
| Sulindac
| |
28:08.04 |
MS102 |
| Tamoxifen
| |
10:00.00 |
AN500 |
| Tamsulosin
| |
92:00.00 |
CV150 |
| Terazosin
| removed January 2012 |
24:20.00 |
CV150 |
| Tetanus, Diptheria, and acellular Pertussis (Tdap)
| |
80:08.00 |
IM100 |
| Tiotropium (Spiriva®)
| Branded product |
12:08.08 |
RE105 |
| Trazodone
| |
28:16.04 |
CN609 |
| Tretinoin Topical
| any product |
86:16.00 |
DE752 |
| Triphasic Oral Contraceptive Pill (any)
| any product |
68.12 |
HS200 |
| Ultra-rapid-acting insulin, Novolog
| Branded product |
68:20.08 |
HS501 |
| Vaccines
| all ACIP recommended vaccines for routine use in accordance with ACIP guidelines |
80:12.00 |
IM100 |
| Venlafaxine long-acting
| |
28:16.04 |
CN609 |
| Verapamil
| |
24:28.92 |
CV200 |
| Vitamin D
| any product |
88.16 |
VT500 |
| Warfarin
| |
20:12.04 |
BL110 |
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