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National Core Formulary

The IHS National Core Formulary represents the basic standard of care drugs which must be carried by all federal facilities to generally promote the parity, portability, quality, safety, convenience, and cost-effectiveness of the pharmacy benefit.

  • It establishes the "floor" for the pharmacy benefit.
  • Except in closed classes, facilities are expected to add other drugs to the local formulary as needed.
Last Updated: 11/10/2022
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The following is a list of Medications currently in the queue. 225 record(s) found.
The following is a list of Medications currently in the queue. 225 record(s) found.
MedicationPharmacological CategoryFormulary BriefNotesSimilar Medications
Finasteride 5 Alpha-Reductase Inhibitor Benign Prostatic Hypertrophy (2016)
Sulfasalazine 5-Aminosalicylic Acid Derivative Hydroxychloroquine; Leflunomide; Methotrexate
Donepezil Acetylcholinesterase Inhibitor (Central) 5mg and 10mg strengths
Epinephrine Injection Devices (both 0.15mg and 0.3mg) Alpha-/Beta- Agonist Epinephrine Injection Devices (2020 Any device, auto-injector or pre-filled syringe
Tamsulosin Alpha1 Blocker Benign Prostatic Hypertrophy (2016) Doxazosin; Prazosin
Prazosin Alpha1 Blocker; Antihypertensive PTSD Indication (2012) Doxazosin; Tamsulosin
Doxazosin Alpha1 Blocker; Antihypertensive Benign Prostatic Hypertrophy (2016) Prazosin; Tamsulosin
Lactulose Ammonium Detoxicant; Laxative, Osmotic Cirrhosis & Complications (2015) Polyethylene glycol
Acetaminophen Analgesic, Miscellaneous
Buprenorphine, long-acting (**REMS drug**) Analgesic, Opioid; Analgesic, Opioid Partial Agonist MAT for OUD (2021) Any formulation; Restricted to treatment of Opioid Use Disorder; **See REMS here** Exit Disclaimer: You Are Leaving www.ihs.gov  Buprenorphine, short-acting (**REMS drug**); Buprenorphine-naloxone (**REMS drug**)
Buprenorphine-Naloxone (**REMS drug**) Analgesic, Opioid; Analgesic, Opioid Partial Agonist Opioid Use Disorder (2018) **See REMS here** Exit Disclaimer: You Are Leaving www.ihs.gov  Naloxone
Buprenorphine, short-acting (**REMS drug**) Analgesic, Opioid; Analgesic, Opioid Partial Agonist MAT for OUD (2021) Any formulation; Restricted to treatment of Opioid Use Disorder; **See REMS here** Exit Disclaimer: You Are Leaving www.ihs.gov  Buprenorphine, long-acting (**REMS drug**); Buprenorphine-naloxone (**REMS drug**)
Testosterone (**REMS Drug**) Androgen Gender-Affirming Medications (2022) Any formulation; Certain formulations (i.e., undecoanate) have REMS requirements Exit Disclaimer: You Are Leaving www.ihs.gov 
Sacubitril and Valsrtan Angiotensin II Receptor Blocker; Neprilysin Inhibitor HFrEF (2022)
Nitroglycerin 0.4 milligrams, sublingual Antianginal Agent; Antidote, Extravasation; Vasodilator Isosorbide mononitrate; Nitroglycerin patch
Nitroglycerin patch Antianginal Agent; Antidote, Extravasation; Vasodilator Isosorbide mononitrate; Nitroglycerin 0.4 milligrams; Sublingual
Isosorbide mononitrate Antianginal Agent; Vasodilator Nitroglycerin 0.4 Milligrams; Sublingual; Nitroglycerin patch
Digoxin Antiarrhythmic Agent, Miscellaneous; Cardiac Glycoside Digoxin Use (2016)
Cephalexin Antibiotic, Cephalosporin (First Generation) Outpatient Abx Stewardship & URIs (2021) Pediatric and Adult oral formulations Cefdinir; Cefixime; Ceftriaxone Injection
Cefdinir Antibiotic, Cephalosporin (Third Generation) Outpatient Abx Stewardship & URIs (2021) Pediatric and Adult oral formulations Cefixime; Ceftriaxone Injection; Cephalexin
Ceftriaxone, injection Antibiotic, Cephalosporin (Third Generation) STIs - PART 1 (2021) Cefdinir; Cefixime; Cephalexin
Cefixime Antibiotic, Cephalosporin (Third Generation) STIs - PART 1 (2021) For outpatient treatment of gonorrhea for Expedited Partner Therapy or when injection therapy is not possible Cefdinir; Ceftriaxone Injection; Cephalexin
Ciprofloxacin, oral Antibiotic, Fluoroquinolone **Coming soon**
Clindamycin Antibiotic, Lincosamide Outpatient Abx Stewardship & URIs (2021) Pediatric and Adult oral formulations
Azithromycin Antibiotic, Macrolide STIs - PART 1 (2021)
Nitrofurantoin Antibiotic, Miscellaneous Urinary Tract Infections (2021)
Trimethoprim-Sulfamethoxazole Antibiotic, Miscellaneous Skin & Soft Tissue Infections (2021)
Metronidazole, oral Antibiotic, Miscellaneous 2021 CDC Guidelines for Sexually Transmitted Infections (2021) Tinidazole
Tinidazole Antibiotic, Miscellaneous 2021 CDC Guidelines for Sexually Transmitted Infections (2021) Metronidazole
Polymyxin B/Trimethoprim, ophthalmic solution Antibiotic, Ophthalmic Ocular Treatments (2022) Artificial Tear substitute, ophthalmic (preservative free); Ciprofloxacin, ophthalmic solution; Corticosteroid (Ophthalmic) - Low Potency
Ciprofloxacin, ophthalmic solution Antibiotic, Ophthalmic Fluoroquinolone Ocular Treatments (2022) Artificial Tear substitute, ophthalmic (preservative free); Corticosteroid (Ophthalmic) - Low Potency; Polymyxin B/trimethoprim, Ophthalmic Solution
Penicllin V potassium Antibiotic, Penicillin Outpatient Abx Stewardship & URIs (2021) Pediatric and Adult oral formulations Amoxicillin; Amoxicillin and Clavulanate; Penicillin G benzathine
Amoxicillin Antibiotic, Penicillin Outpatient Abx Stewardship & URIs (2021) Pediatric and Adult oral formulations Amoxicillin and Clavulanate; Penicillin G benzathine; Penicllin V potassium
Amoxicillin and Clavulanate Antibiotic, Penicillin Outpatient Abx Stewardship & URIs (2021) Pediatric and Adult oral formulations Amoxicillin; Penicillin G benzathine; Penicllin V potassium
Penicillin G benzathine Antibiotic, Penicillin STIs - PART 1 (2021) Amoxicillin; Amoxicillin and Clavulanate; Penicllin V potassium
Rifaximin Antibiotic, Rifamycin Hepatic Encephalopathy (2020) After failure of, or intolerance to, lactulose monotherapy as indicated for hepatic encephalopathy Lactulose
Doxycycline Antibiotic, Tetracycline STIs - PART 1 (2021)
Mupirocin Antibiotic, Topical Skin & Soft Tissue Infections (2021)
Metronidazole, topical Antibiotic, Topical Rosacea (2022)
Dicyclomine Anticholinergic Agent Irritable Bowel Syndrome (2018)
Apixaban Anticoagulant; Direct Oral Anticoagulant (DOAC); Factor Xa Inhibitor Direct Oral Anticoagulants (2017) Warfarin
Warfarin Anticoagulant; Vitamin K Antagonist Direct Oral Anticoagulants (2017) Apixaban; Low-molecular weight heparin
Phenytoin Anticonvulsant, Hydantoin Antiepileptics (2014) Carbamazepine; Divalproex; Lamotrigine; Levetiracetam; Topiramate
Topiramate Anticonvulsant, Miscellaneous Antiepileptic Medications (2014) Carbamazepine; Divalproex; Lamotrigine; Levetiracetam; Phenytoin
Carbamazepine Anticonvulsant, Miscellaneous Antiepileptics (2014) Divalproex; Lamotrigine; Levetiracetam; Phenytoin; Topiramate
Levetiracetam Anticonvulsant, Miscellaneous Antiepileptics (2014) Carbamazepine; Divalproex; Lamotrigine; Phenytoin; Topiramate
Lamotrigine Anticonvulsant, Miscellaneous Antiepileptics (2014) Carbamazepine; Divalproex; Levetiracetam; Phenytoin; Topiramate
Divalproex Anticonvulsant, Miscellaneous ER Lithium & Divalproex (2012) Carbamazepine; Lamotrigine; Levetiracetam; Phenytoin; Topiramate
Oxcarbazepine Anticonvulsant, Miscellaneous Anti-Seizure Drugs (2021) Carbamazepine; Clonazepam; Divalproex; Gabapentin; Lamotrigine; Levetiracetam; Phenytoin; Topiramate
Phentermine and Topiramate ER (**REMS drug**) Anticonvulsant, Miscellaneous; Central Nervous System Stimulant Obesity Management (2022) **For REMS criteria, see Formulary Brief**
Gabapentin Anticonvulsant, Miscellaneous; GABA Analog Gabapentin & Pregabalin in Pain (2014)
Ethosuximide Anticonvulsant, Succinimide Anti-Seizure Drugs (2021) Carbamazepine; Clonazepam; Divalproex; Gabapentin; Lamotrigine; Levetiracetam; Phenytoin; Topiramate
Bupropion Antidepressant, Dopamine/Norepinephrine-Reuptake Inhibitor; Smoking Cessation Aid Nicotine Dependence (2015) Varenicline; Venlafaxine
Fluoxetine Antidepressant, Selective Serotonin Reuptake Inhibitor Sertraline
Sertraline Antidepressant, Selective Serotonin Reuptake Inhibitor Citalopram; Escitalopram; Fluoxetine; Paroxetine
Citalopram Antidepressant, Selective Serotonin Reuptake Inhibitor SSRIs (2019) Escitalopram; Fluoxetine; Paroxetine; Sertraline
Escitalopram Antidepressant, Selective Serotonin Reuptake Inhibitor SSRIs (2019) Citalopram; Fluoxetine; Paroxetine; Sertraline
Paroxetine Antidepressant, Selective Serotonin Reuptake Inhibitor SSRIs (2019) Citalopram; Escitalopram; Fluoxetine; Sertraline
Duloxetine Antidepressant, Serotonin/Norepinephrine Reuptake Inhibitor/Antagonist Diabetic Neuropathy (2018) Bupropion; Venlafaxine
Venlafaxine Antidepressant, Serotonin/Norepinephrine Reuptake Inhibitor/Antagonist SNRIs (2012) Bupropion; Duloxetine
Nortriptyline Antidepressant, Tricyclic Antidepressants in Pain Mgmt (2014) Amitriptyline
Amitriptyline Antidepressant, Tricyclic Antidepressants in Pain Mgmt (2014) Nortriptyline
Alogliptin Antidiabetic Agent, Dipeptidyl Peptidase 4 (DPP-4) Inhibitor DPP-IV Inhibitors (2019)
Liraglutide -or- Semaglutide Antidiabetic Agent, Glucagon-Like Peptide-1 (GLP-1) Receptor Agonist GLP-1 Receptor Agonists (2019) Select either of these subcutaneous agents, no preference given
Semaglutide -or- Liraglutide Antidiabetic Agent, Glucagon-Like Peptide-1 (GLP-1) Receptor Agonist GLP-1 Receptor Agonists (2019) Select either of these subcutaneous agents, no preference given
Empagliflozin Antidiabetic Agent, Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitor SGLT-2 Inhibitors (2019)
Pioglitazone Antidiabetic Agent, Thiazolidinedione Thiazolidinediones (2017)
Metformin Antidiabetic Agent; Biguanide
Glipizide Antidiabetic Agent; Sulfonylurea Sulfonylureas (2015)
Loperamide Antidiarrheal Irritable Bowel Syndrome (2018)
Glucose, oral Antidote Glucagon Delivery Devices (2021) Any formulation Glucagon
Glucagon Antidote; Hypoglycemia For outpatient use
Naloxone Antidote; Opioid Antagonist Treatment of Opioid Overdose (2014)
Naltrexone, oral Antidote; Opioid Antagonist Alcohol Use Disorder (2022) Naloxone
Naltrexone, extended-release for injection Antidote; Opioid Antagonist Opioid Use Disorder (2018)
Ondansetron Antiemetic; Selective 5-HT3 Receptor Antagonist Antiemetic Agents (2021)
Fluconazole, oral Antifungal Agent, Azole Derivative
Clotrimazole, topical Antifungal Agent, Imidazole Derivative **Coming soon**
Allopurinol Antigout Agent; Xanthine Oxidase Inhibitor Gout (2016)
Glecaprevir/Pibrentasvir (Mavyret®) Antihepaciviral HCV Treatment (2018) Ledipasvir/sofosbuvir (Harvoni®); Sofosbuvir/velpatasvir (Epclusa®)
Ledipasvir/Sofosbuvir (Harvoni®) Antihepaciviral HCV Treatment (2018) Glecaprevir/Pibrentasvir (Mavyret®); Sofosbuvir/velpatasvir (Epclusa®)
Sofosbuvir/Velpatasvir (Epclusa®) Antihepaciviral HCV Treatment (2018) Glecaprevir/Pibrentasvir (Mavyret®); Ledipasvir/Sofosbuvir (Harvoni®)
Torsemide -OR- Bumetanide Antihypertensive HFpEF (2022) Bumetanide -OR- torsemide; Furosemide
Bumetanide -OR- Torsemide Antihypertensive HFpEF (2022) Furosemide; Torsemide -OR- Bumetanide
Losartan Antihypertensive, Angiotensin II Receptor Blocker ACEIs & ARBs in Heart Failure (2017)
Lisinopril Antihypertensive, Angiotensin-Converting Enzyme Inhibitor ACEIs & ARBs in Heart Failure (2017)
Carvedilol, immediate-release Antihypertensive; Beta-Blocker with Alpha-Blocking Activity Beta-blockers in Heart Failure (2017) Atenolol; Metoprolol; Propranolol
Atenolol Antihypertensive; Beta-Blocker, Beta1 Selective Beta Blockers (2014) Metoprolol; Propranolol
Metoprolol succinate Antihypertensive; Beta-Blocker, Beta1 Selective HFrEF (2022) Atenolol; Carvedilol, immediate-release; Propranolol
Metoprolol tartrate Antihypertensive; Beta-Blocker, Beta1 Selective HFrEF (2022) Atenolol; Carvedilol, immediate-release; Metoprolol succinate
Propranolol Antihypertensive; Beta-Blocker, Non-Selective Beta Blockers (2014) Atenolol; Metoprolol
Amlodipine Antihypertensive; Calcium Channel Blocker, Dihydropyridine Calcium Channel Blockers (2014) Diltiazem
Diltiazem Antihypertensive; Calcium Channel Blocker, Nondihydropyridine Calcium Channel Blockers (2014) Amlodipine
Furosemide Antihypertensive; Loop Diuretic Heart Failure Overview (2017)
Spironolactone Antihypertensive; Mineralocorticoid Receptor Antagonists; Potassium Sparing Diuretic Mineralocorticoid Receptor Antagonist in HF (2017)
Hydrochlorothiazide Antihypertensive; Thiazide Diuretic Diuretics (2014) Chlorthalidone
Chlorthalidone Antihypertensive; Thiazide-Related Diuretic Diuretic Agents (2014) Hydrochlorothiazide
Ezetimibe Antilipemic Agent, 2-Azetidinone 2018 ACC/AHA Cholesterol Guidelines (2019)
Atorvastatin Antilipemic Agent, HMG-CoA Reductase Inhibitor Dyslipidemia Guideline Review (2014) Pravastatin; Rosuvastatin; Simvastatin
Rosuvastatin Antilipemic Agent, HMG-CoA Reductase Inhibitor Hyperlipidemia (2017) Atorvastatin; Pravastatin; Simvastatin
Simvastatin Antilipemic Agent, HMG-CoA Reductase Inhibitor Dyslipidemia Guideline Review (2014) Atorvastatin; Pravastatin; Rosuvastatin
Pravastatin Antilipemic Agent, HMG-CoA Reductase Inhibitor Hyperlipidemia (2017) Atorvastatin; Rosuvastatin; Simvastatin
Hydroxychloroquine Antimalarial Non-biologic DMARDs (2016) Leflunomide; Methotrexate; Sulfasalazine
Lithium Antimanic Agent ER Lithium & Divalproex (2012)
Serotonin 5-HT1 agonist (Triptan) Antimigraine Agent; Serotonin 5-HT 1B/1D Receptor Agonist Triptans (2016) Any two (2) triptan medications are required, one must be sumatriptan Sumatriptan
Sumatriptan Antimigraine Agent; Serotonin 5-HT 1B/1D Receptor Agonist Triptans (2016) Any two (2) triptan medications are required, one must be sumatriptan
Letrozole Antineoplastic Agent, Aromatase Inhibitor
Anastrozole Antineoplastic Agent, Aromatase Inhibitor
Tamoxifen Antineoplastic Agent, Estrogen Receptor Antagonist; Selective Estrogen Receptor Modulator
Leuprolide Antineoplastic Agent, Gonadotropin-Releasing Hormone Agonist **Coming soon**
Methotrexate Antineoplastic Agent; Antirheumatic; Disease Modifying; Immunosuppresant Agent Non-biologic DMARDs (2016) Hydroxychloroquine; Leflunomide; Sulfasalazine
Permethrin 5% cream Antiparasitic Agent, Topical; Pediculocide; Scabicidal Agent Sexually Transmitted Infections, Part III (2022) Permethrin 1%, any formulation
Permethrin 1% Antiparasitic Agent, Topical; Pediculocide; Scabicidal Agent Sexually Transmitted Infections, Part III (2022) *Any formulation* Permethrin 5% cream
Pramipexole Anti-Parkinson Agent, Dopamine Agonist Insomnia/Sleep Medications (2021)
Carbidopa-Levodopa, immediate-release Anti-Parkinson Agent; Decarboxylase Inhibitor-Dopamine Precursor Parkinson's Disease (2019)
Clopidogrel Antiplatelet Agent Antiplatelets (2015) Aspirin
Aspirin Antiplatelet Agent; Nonsteroidal Anti-Inflammatory Drug; Salicylate
Atypical antipsychotic Antipsychotic, Atypical Bipolar Disorders (2022) *Any product* Aripiprazole lauroxil; Haloperidol decanoate
Aripiprazole lauroxil Antipsychotic, Atypical (Second Generation) - Injectable Long-Acting Injectable Antipsychotics (2020) Injectable Haloperidol decanoate
Haloperidol decanoate Antipsychotic, Typical (First Generation) - Injectable Long-Acting Injectable Antipsychotics (2020) Injectable Aripiprazole lauroxil
Dolutegravir Antiretroviral, Integrase Inhibitor (Anti-HIV) HIV Updates (2020) For HIV treatment in pregnant patients Emtricitabine/tenofovir disoproxil fumarate; Raltegravir
Bictegravir/Emtricitabine/Tenofovir alafenamide Antiretroviral, Integrase Inhibitor (Anti-HIV) HIV Treatment (2019) Dolutegravir/abacavir/lamivudine; Emtricitabine/tenofovir disoproxil fumarate; Raltegravir
Dolutegravir/Abacavir/Lamivudine Antiretroviral, Integrase Inhibitor (Anti-HIV) HIV Treatment (2019) *Note: HLA B5701 testing required prior to initiation Bictegravir/Emtricitabine/Tenofovir alafenamide; Dolutegravir; Emtricitabine/tenofovir disoproxil fumarate; Raltegravir
Raltegravir Antiretroviral, Integrase Inhibitor (Anti-HIV) HIV Treatment (2019) For (1) HIV Post-Exposure Prophylaxis (with emtricitabine/ tenofovir DF) or (2) HIV Treatment (with emtricitabine/tenofovir DF) in patients with contraindications for 1st line anti-HIV agents Emtricitabine/tenofovir disoproxil fumarate
Emtricitabine/Tenofovir disoproxil fumarate Antiretroviral, Reverse Transcriptase Inhibitor, Nucleoside (Anti-HIV); Antiretroviral, Reverse Transcriptase Inhibitor, Nucleotide (Anti-HIV) HIV Pre-Exposure Prophylaxis (PrEP) (2018) For (1) Pre-Exposure HIV Prophylaxis, (2) Post-Exposure HIV Prophylaxis (with raltegravir) or (3) HIV Treatment (with raltegravir) in patients with contraindications for 1st line anti-HIV agents Raltegravir
Leflunomide Antirheumatic, Disease Modifying Non-biologic DMARDs (2016) Hydroxychloroquine; Methotrexate; Sulfasalazine
Etanercept -OR- Adalimumab (can choose either product) Antirheumatic, Disease Modifying; Tumor Necrosis Factor (TNF) Blocking Agent TNF Inhibitors (2016) ONLY In consultation with a rheumatologist Adalimumab -OR- Etanercept (can choose either product)
Adalimumab -OR- Etanercept (can choose either product) Antirheumatic, Disease Modifying; Tumor Necrosis Factor (TNF) Blocking Agent TNF Inhibitors (2016) ONLY In consultation with a rheumatologist Etanercept -OR- Adalimumab (can choose either product)
Oxybutynin, immediate-release Antispasmodic Agent, Urinary Antimuscarinics (2019) Oxybutynin, extended-release
Oxybutynin, extended-release Antispasmodic Agent, Urinary Antimuscarinics (2019) Oxybutynin, Immediate-release
Methimazole Antithyroid Agent; Thioamide Hyperthyroidism (2021) Propylthiouracil
Propylthiouracil Antithyroid Agent; Thioamide Hyperthyroidism (2021) Methimazole
Rifampin Antitubercular Agent Ethambutol; Isoniazid; Pyrazinamide; Rifapentine
Rifapentine Antitubercular Agent Rifapentine (2013) Ethambutol; Isoniazid; Pyrazinamide; Rifampin
Pyrazinamide Antitubercular Agent Ethambutol; Isoniazid; Rfapentine ; Rifampin
Ethambutol Antitubercular Agent Isoniazid; Pyrazinamide; Rifampin; Rifapentine
Isoniazid Antitubercular Agent Ethambutol; Pyrazinamide; Rifampin; Rifapentine
Valacyclovir Antiviral Agent, Oral 2021 CDC Guidelines for Sexually Transmitted Infections (2021)
Oseltamivir Antiviral Agent; Neuraminidase Inhibitor Treatment of Influenza (2019)
Clonazepam Benzodiazepine Alcohol Withdrawal Syndrome (2015) Lorazepam
Lorazepam Benzodiazepine Alcohol Withdrawal Syndrome (2015) Clonazepam
Albuterol, metered dose inhaler (MDI) Beta2 Agonist NPTC Meeting Update (Nov 2017) *Any product*
Albuterol nebulized solution Beta2 Agonist
Fluticasone/Salmeterol Beta2 Agonist, Long-Acting; Corticosteroid, Inhalant LABAs (2019) Mometasone (Asmanex®)
Alendronate Bisphosphonate Derivative Osteoporosis (2016)
Laxative, bulk-forming Bulk-forming Laxative *Any product*
Tacrolimus, topical Calcineurin Inhibitor; Immunosuppressant Agent; Topical Skin Product Atopic Dermatitis (2020) Corticosteriods (Topical) - High Potency (Class I and II); Corticosteroid (Topical) - Intermediate Potency; Corticosteroid (Topical) - Low Potency; Moisturizers (both cream- AND petroleum-based)
Dextroamphetamine / Amphetamine (immediate release) Central Nervous System Stimulant Pediatric use only Dextroamphetamine and amphetamine (long-acting)
Dextroamphetamine / Amphetamine (long-acting) Central Nervous System Stimulant Pediatric use only Dextroamphetamine and amphetamine (immediate release)
Methylphenidate (immediate release) Central Nervous System Stimulant Pediatric use only Methylphenidate (long-acting)
Methylphenidate (long-acting) Central Nervous System Stimulant Pediatric use only Methylphenidate (immediate release)
Oral contraceptive pill, extended cycle Contraceptive Contraception (2016) *Any product*
Oral contraceptive pill, monophasic: 20mcg EE (low) Contraceptive *Any product* Monophasic: 30-35mcg EE (medium); Oral contraceptive pill
Oral contraceptive pill, monophasic: 30-35mcg EE (medium) Contraceptive *Any product* Monophasic: 20mcg EE (low) ; Oral contraceptive pill
Oral contraceptive pill, progestin only Contraceptive *Any product* Etonogestrel; Implant; Intrauterine Device; Levonorgestrel
Oral contraceptive pill, triphasic Contraceptive *Any product* Monophasics ; Oral Contraceptive Pill
Intrauterine device, copper Contraceptive Contraception (2016) *Any product*; For use by a skilled and privileged provider Intrauterine device, levonorgestrel
Intrauterine device, levonorgestrel Contraceptive, Progestin Contraception (2016) *Any product*; For use by a skilled and privileged provider Intrauterine device, copper
Levonorgestrel (Plan B One-Step®) Contraceptive, Progestin Contraception (2016) *Branded product* Ulipristal
Medroxyprogesterone acetate, injection Contraceptive, Progestin (Injection/Depot) Contraception (2016) Medroxyprogesterone, oral; Oral contraceptive pill, progestin only
Ethinyl estradiol / Etonogestrel vaginal ring Contraceptive; Estrogen and Progestin Combination Contraception (2016)
Ethinyl estradiol / Norelgestromin, transdermal Contraceptive; Estrogen and Progestin Combination Contraception (2016)
Etonogestrel, implant Contraceptive; Progestin Contraception (2016) For use by a skilled and privileged provider Oral contraceptive pill, progestin only
Medroxyprogesterone, oral Contraceptive; Progestin Polycystic Ovarian Syndrome (2017) Medroxyprogesterone acetate, injection; Oral contraceptive pill, progestin only
Ulipristal Contraceptive; Progestin Receptor Modulator Contraception (2016) Levonorgestrel (Plan B One-Step®)
Mometasone (Asmanex®) Corticosteroid, Inhalant *Branded product*
Corticosteroid (Ophthalmic) - Low Potency Corticosteroid, Ophthalmic Ocular Treatments (2022) *Any product - see Form Brief for suggested products Artificial Tear substitute, Ophthalmic (Preservative Free); Ciprofloxacin, Ophthalmic Solution; Polymyxin B/trimethoprim, Ophthalmic Solution; Prednisolone, Ophthalmic Suspension
Prednisolone acetate, ophthalmic suspension Corticosteroid, Ophthalmic Ocular Treatments (2022) Artificial Tear substitute, ophthalmic (preservative free); Ciprofloxacin, ophthalmic solution; Corticosteroid (Ophthalmic) - Low Potency; Polymyxin B/Trimethoprim, ophthalmic solution
Prednisone Corticosteroid, Systemic
Calcium Electrolyte supplement *Any formulation*
Estradiol tablets Estrogen Derivative Menopausal Hormone Therapy (2016) Estradiol for Injection; Estradiol, transdermal
Estrogen vaginal cream Estrogen Derivative NPTC Meeting Update (May 2018) *Any product* Estradiol tablets
Estradiol, transdermal Estrogen Derivative Gender Affirming Therapies (2022) *Any patch* Estradiol for Injection; Estradiol tablets
Estradiol for Injection Estrogen Derivative Gender Affirming Therapies (2022) Either valerate or cypionate product Estradiol tablets; Estradiol, transdermal
Hydroxyzine Histamine H1 Antagonist, First Generation Anxiety Disorders (2021)
H1 Antagonist (2nd generation), long-acting Histamine H1 Antagonist, Second Generation *Any product*
Famotidine Histamine H2 Antagonist **Coming soon**
Insulin aspart / Insulin aspart protamine (NovoLog® Mix 70/30) Insulin, Combination (70/30 Mix) Insulins (2015) *Branded product*; Pen Device
Insulin NPH / Regular human insulin (NovoLIN® 70/30) Insulin, Combination (70/30 Mix) Insulins (2015) *Branded product*
Insulin NPH (NovoLIN® N) Insulin, Intermediate-Acting Insulins (2015) *Branded product*
Insulin detemir (Levemir®) Insulin, Long-Acting Insulins (2015) *Branded product*; Pen Device Insulin glargine, any "interchangeable" product (Semglee® -OR- Lantus®)
Insulin glargine, any Insulin, Long-Acting Long-Acting Insulins & Biosimilars (2021) An interchangeable biosimilar product is a biosimilar that meets additional requirements outlined by the law that allows for the FDA to approve biosimilar and interchangeable biosimilar medications. Insulin detemir (Levemir®)
Insulin aspart (NovoLog®) Insulin, Rapid-Acting Insulins (2015) *Branded product*; Pen Device
Insulin Regular human (NovoLIN® R) Insulin, Short-Acting Insulins (2015) *Branded product*
Corticosteroid, intranasal Intranasal Corticosteroid *Any product*
Iron, oral Iron Salt Hematologic Supplements (2016) *Any oral formulation*
Polyethylene glycol Laxative, Osmotic Irritable Bowel Syndrome (2018) *Any product* Lactulose
Montelukast Leukotriene Receptor Antagonist
Tiotropium (Spiriva®) Long-Acting Anticholinergic Agent Inhaled Anticholinergics (2011) *Branded product*
Umeclidinium/Vilanterol Long-Acting Muscarinic Antagonist (LAMA) / Long-Acting Beta2 Agonist (LABA) LAMAs (2019) Tiotropium (Spiriva®)
Low-molecular weight heparin Low-molecular Weight Heparin VTE Prophylaxis (2011) *Any product*
Memantine N-Methyl-D-Aspartate (NMDA) Receptor Antagonist
Meloxicam Nonsteroidal Anti-Inflammatory Drug NSAIDs (2014) Diclofenac; Ibuprofen; Indomethacin; Naproxen
Naproxen Nonsteroidal Anti-Inflammatory Drug NSAIDs (2014) Diclofenac; Ibuprofen; Indomethacin
Ibuprofen Nonsteroidal Anti-Inflammatory Drug NSAIDs (2014) Diclofenac; Indomethacin; Meloxicam; Naproxen
Indomethacin Nonsteroidal Anti-Inflammatory Drug NSAIDs (2014) Diclofenac; Ibuprofen; Meloxicam; Naproxen
Diclofenac Nonsteroidal Anti-Inflammatory Drug NSAIDs (2014) *Any formulation* Ibuprofen; Indomethacin; Meloxicam; Naproxen
Atomoxetine Norepinephrine Reuptake Inhibitor, Selective ADHD (2020) Dextroamphetamine / Amphetamine (immediate release); Dextroamphetamine / Amphetamine (long-acting); Methylphenidate (immediate release); Methylphenidate (long-acting)
Fluoride, oral Nutritional Supplement Supplements in Oral Health (2016) *Any oral formulation*
Artificial Tear substitute, ophthalmic (preservative free) Ophthalmic Agent, Miscellaneous Ocular Treatments (2022) *Any Preservative-Free product* Ciprofloxacin, Ophthalmic Solution; Corticosteroid (Ophthalmic) - Low Potency; Polymyxin B/trimethoprim, Ophthalmic Solution
Ophthalmic Prostaglandin Analog Ophthalmic Prostaglandin Analog Ophth Prostaglandin Analogs (2018) *Any product*
Varenicline Partial Nicotine Agonist, Smoking Cessation Aid Nicotine Dependence (2015) Bupropion
Sevelamer carbonate Phosphate Binder Phosphate Binders (2018) For patients on dialysis who cannot use calcium-based phosphate binders due to hypercalcemia Calcium
Sildenafil Phosphodiesterase-5 Enzyme Inhibitor **Coming soon** Tadalafil
Tadalafil Phosphodiesterase-5 Enzyme Inhibitor **Coming soon** Sildenafil
Proton Pump Inhibitor Proton Pump Inhibitor GERD & PUD (2018) *Any product*
Salsalate Salicylate
Moisturizers (both cream- AND petroleum-based) Skin and Mucous Membrane Agent, Miscellaneous; Topical Skin Product Atopic Dermatitis (2020) Corticosteriods (Topical) - High potency (Class I and II); Corticosteroid (Topical) - Intermediate potency; Corticosteroid (Topical) - Low potency; Tacrolimus
Nicotine replacement therapy (NRT), combination Smoking Cessation Aid Nicotine Dependence (2015) Combination NRT (nicotine patches + any short-acting NRT product) Bupropion; Varenicline
Laxative, stimulant Stimulant Laxative *Any product*
Levothyroxine Thyroid Agent
Corticosteroid (Topical) - Intermediate Potency Topical Corticosteroids *Any product* Corticosteriods (Topical) - High Potency (Class I and II); Corticosteroid (Topical) - Low potency
Corticosteroid (Topical) - Low Potency Topical Corticosteroids *Any product* Corticosteriods (Topical) - High Potency (Class I and II); Corticosteroid (Topical) - Intermediate Potency
Corticosteriods (Topical) - High Potency (Class I and II) Topical Corticosteroids Psoriasis (2018) Corticosteroid (Topical) - Intermediate potency; Corticosteroid (Topical) - Low potency
Tretinoin, topical Topical Skin Product, Acne Acne (2013) *Any product*
Benzoyl Peroxide Topical Skin Product, Acne Acne Treatment (2020) Benzoyl Peroxide AND Clindamycin, topical combination
Benzoyl Peroxide AND Clindamycin, topical combination Topical Skin Product, Acne; Topical Skin Product, Acne (Lincosamide Antibiotic) Acne Treatment (2020) Benzoyl Peroxide
Sunscreen, Sun Protection Factor (SPF) 30 or greater Ultraviolet light protectant, topical Rosacea Treatment (2022)
Vaccines, All ACIP-recommended Vaccines Vaccine (2011) All ACIP recommended vaccines for routine use in accordance with ACIP guidelines
Prenatal Multivitamin Vitamin Pregnancy & Prenatal Care (2021) Must contain >400 mcg of folic acid/dose
Vitamin D Vitamin D Analog Vitamin D (2010) *Any product*
Vitamin D Analog, topical Vitamin D Analog Psoriasis (2018) *Any product*
Pyridoxine (Vitamin B6) Vitamin, Water Soluble Supplements in Obstetrics (2016)
Cyanocobalamin (Vitamin B12), oral Vitamin, Water Soluble Hematologic Supplements (2016)
Folic Acid Vitamin, Water Soluble Supplements in Womens Health (2016) Any product containing >400 mcg / daily dose