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
Search Medications Results
The following is a list of Medications currently in the queue. 225 record(s) found.
| Medication | Pharmacological Category | Formulary Brief | Notes | Similar Medications |
|---|---|---|---|---|
| Albuterol nebulized solution | Beta2 Agonist | Asthma & COPD Guidelines Review (2019) | ||
| Alendronate | Bisphosphonate Derivative | Osteoporosis (2016) | ||
| Allopurinol | Antigout Agent; Xanthine Oxidase Inhibitor | Gout (2016) | ||
| Amitriptyline | Antidepressant, Tricyclic | Bipolar Disorder (2022) | Nortriptyline | |
| Amlodipine | Antihypertensive; Calcium Channel Blocker, Dihydropyridine | Hypertension (2022) | Diltiazem | |
| Anastrozole | Antineoplastic Agent, Aromatase Inhibitor | NPTC Update Spring 2021 | ||
| Aspirin | Antiplatelet Agent; Nonsteroidal Anti-Inflammatory Drug; Salicylate | Pregnancy & Prenatal Care (2021) | ||
| Atenolol | Antihypertensive; Beta-Blocker, Beta1 Selective | Hypertension (2022) | Propranolol | |
| Atorvastatin | Antilipemic Agent, HMG-CoA Reductase Inhibitor | Hyperlipidemia (2022) | Pravastatin; Rosuvastatin; Simvastatin | |
| Acetaminophen | Analgesic, Miscellaneous | Short-Acting Opioids (2014) | ||
| Bupropion | Antidepressant, Dopamine/Norepinephrine-Reuptake Inhibitor; Smoking Cessation Aid | Stimulant Use Disorder (2022) | Varenicline; Venlafaxine | |
| Carbamazepine | Anticonvulsant, Miscellaneous | Bipolar Disorder (2022) | Divalproex; Lamotrigine; Levetiracetam; Phenytoin; Topiramate | |
| Carvedilol, immediate-release | Antihypertensive; Beta-Blocker with Alpha-Blocking Activity | Heart Failure with Reduced Ejection Fraction (HFrEF) (2022) | Atenolol; Propranolol | |
| Chlorthalidone | Antihypertensive; Thiazide-Related Diuretic | Hypertension (2022) | Hydrochlorothiazide | |
| Clonazepam | Benzodiazepine | Antiseizure Drugs (2021) | Lorazepam | |
| Clopidogrel | Antiplatelet Agent | Antiplatelets (2015) | Aspirin | |
| Cyanocobalamin (Vitamin B12), oral | Vitamin, Water Soluble | Hematologic Supplements (2016) | ||
| Digoxin | Antiarrhythmic Agent, Miscellaneous; Cardiac Glycoside | Heart Failure with Reduced Ejection Fraction (HFrEF) (2022) | ||
| Diltiazem | Antihypertensive; Calcium Channel Blocker, Nondihydropyridine | Hypertension (2022) | Amlodipine | |
| Divalproex | Anticonvulsant, Miscellaneous | Bipolar Disorder (2022) | Carbamazepine; Lamotrigine; Levetiracetam; Phenytoin; Topiramate | |
| Doxazosin | Alpha1 Blocker; Antihypertensive | Benign Prostatic Hypertrophy (Nov 2022) | Prazosin; Tamsulosin | |
| Estradiol tablets | Estrogen Derivative | Gender-Affirming Medications (2022) | Estradiol for Injection; Estradiol, transdermal | |
| Ethambutol | Antitubercular Agent | Treatment of Tuberculosis (2021) | Isoniazid; Pyrazinamide; Rifampin; Rifapentine | |
| Ethinyl estradiol / Etonogestrel vaginal ring | Contraceptive; Estrogen and Progestin Combination | Contraception (2016) | ||
| Ethinyl estradiol / Norelgestromin, transdermal | Contraceptive; Estrogen and Progestin Combination | Contraception (2016) | ||
| Finasteride | 5 Alpha-Reductase Inhibitor | Benign Prostatic Hypertrophy (Nov 2022) | ||
| Fluoxetine | Antidepressant, Selective Serotonin Reuptake Inhibitor | Bipolar Disorder (2022) | Sertraline | |
| Furosemide | Antihypertensive | Heart Failure with Preserved Ejection Fraction (HFpEF) (2022) | ||
| Gabapentin | Anticonvulsant, Miscellaneous; GABA Analog | Antiseizure Drugs (2021) | ||
| Glipizide | Antidiabetic Agent; Sulfonylurea | Diabetes Treatment Overview (2017) | ||
| Hydrochlorothiazide | Antihypertensive; Thiazide Diuretic | Hypertension (2022) | Chlorthalidone | |
| Hydroxychloroquine | Antimalarial | Non-biologic DMARDs (2016) | Leflunomide; Methotrexate; Sulfasalazine | |
| Ibuprofen | Nonsteroidal Anti-Inflammatory Drug | NSAIDs (2014) | Diclofenac; Indomethacin; Meloxicam; Naproxen | |
| Indomethacin | Nonsteroidal Anti-Inflammatory Drug | NSAIDs (2014) | Diclofenac; Ibuprofen; Meloxicam; Naproxen | |
| Isoniazid | Antitubercular Agent | Treatment of Tuberculosis (2021) | Ethambutol; Pyrazinamide; Rifampin; Rifapentine | |
| Isosorbide mononitrate | Antianginal Agent; Vasodilator | Anti-Anginal Treatment (2013) | Nitroglycerin patch | |
| Lactulose | Ammonium Detoxicant; Laxative, Osmotic | Hepatic Encephalopathy (2020) | Polyethylene glycol | |
| Lamotrigine | Anticonvulsant, Miscellaneous | Bipolar Disorder (2022) | Carbamazepine; Divalproex; Levetiracetam; Phenytoin; Topiramate | |
| Leflunomide | Antirheumatic, Disease Modifying | Non-biologic DMARDs (2016) | Hydroxychloroquine; Methotrexate; Sulfasalazine | |
| Letrozole | Antineoplastic Agent, Aromatase Inhibitor | NPTC Update Spring 2021 | ||
| Levetiracetam | Anticonvulsant, Miscellaneous | Antiseizure Drugs (2021) | Carbamazepine; Divalproex; Lamotrigine; Phenytoin; Topiramate | |
| Levothyroxine | Thyroid Agent | Originally added 2004 | ||
| Lisinopril | Antihypertensive, Angiotensin-Converting Enzyme Inhibitor | Hypertension (2022) | ||
| Lithium | Antimanic Agent | Bipolar Disorder (2022) | ||
| Lorazepam | Benzodiazepine | Alcohol Withdrawal Syndrome (2015) | Clonazepam | |
| Losartan | Antihypertensive, Angiotensin II Receptor Blocker | Hypertension (2022) | ||
| Medroxyprogesterone acetate, injection | Contraceptive, Progestin (Injection/Depot) | Contraception (2016) | Medroxyprogesterone, oral; Oral contraceptive pill, progestin only | |
| Meloxicam | Nonsteroidal Anti-Inflammatory Drug | NSAIDs (2014) | Diclofenac; Ibuprofen; Indomethacin; Naproxen | |
| Metformin | Antidiabetic Agent; Biguanide | Diabetes Treatment Overview (2017) | ||
| Methotrexate | Antineoplastic Agent; Antirheumatic; Disease Modifying; Immunosuppresant Agent | Non-biologic DMARDs (2016) | Hydroxychloroquine; Leflunomide; Sulfasalazine | |
| Metoprolol succinate | Antihypertensive; Beta-Blocker, Beta1 Selective | Heart Failure with Reduced Ejection Fraction (HFrEF) (2022) | Atenolol; Carvedilol, immediate-release; Propranolol | |
| Montelukast | Leukotriene Receptor Antagonist | Asthma & COPD Guidelines Review (2019) | ||
| Naloxone | Antidote; Opioid Antagonist | Opioid Use Disorder (2018) | ||
| Naltrexone, oral | Antidote; Opioid Antagonist | Alcohol Use Disorder (2022) | Naloxone | |
| Naproxen | Nonsteroidal Anti-Inflammatory Drug | NSAIDs (2014) | Diclofenac; Ibuprofen; Indomethacin | |
| Nitroglycerin 0.4 milligrams, sublingual | Antianginal Agent; Antidote, Extravasation; Vasodilator | Anti-Anginal Treatment (2013) | Isosorbide mononitrate; Nitroglycerin patch | |
| Nitroglycerin patch | Antianginal Agent; Antidote, Extravasation; Vasodilator | Anti-Anginal Treatment (2013) | Isosorbide mononitrate | |
| Nortriptyline | Antidepressant, Tricyclic | Bipolar Disorder (2022) | Amitriptyline | |
| Oxybutynin, immediate-release | Antispasmodic Agent, Urinary | Antimuscarinics (2019) | Oxybutynin, extended-release | |
| Phenytoin | Anticonvulsant, Hydantoin | Antiseizure Drugs (2021) | Carbamazepine; Divalproex; Lamotrigine; Levetiracetam; Topiramate | |
| Pioglitazone | Antidiabetic Agent, Thiazolidinedione | Thiazolidinediones (2017) | ||
| Pravastatin | Antilipemic Agent, HMG-CoA Reductase Inhibitor | Hyperlipidemia (2022) | Atorvastatin; Rosuvastatin; Simvastatin | |
| Prazosin | Alpha1 Blocker; Antihypertensive | Post Traumatic Stress Disorder (2021) | Doxazosin; Tamsulosin | |
| Prednisone | Corticosteroid, Systemic | Atopic Dermatitis (2020) | ||
| Propranolol | Antihypertensive; Beta-Blocker, Non-Selective | Migraine Prevention (2019) | Atenolol | |
| Rifampin | Antitubercular Agent | Treatment of Tuberculosis (2021) | Ethambutol; Isoniazid; Pyrazinamide; Rifapentine | |
| Rifapentine | Antitubercular Agent | Treatment of Tuberculosis (2021) | Ethambutol; Isoniazid; Pyrazinamide; Rifampin | |
| Rosuvastatin | Antilipemic Agent, HMG-CoA Reductase Inhibitor | Hyperlipidemia (2022) | Atorvastatin; Pravastatin; Simvastatin | |
| Salsalate | Salicylate | Added June 2008 (NSAIDs) | ||
| Pyrazinamide | Antitubercular Agent | Treatment of Tuberculosis (2021) | Ethambutol; Isoniazid; Rifampin | |
| Pyridoxine (Vitamin B6) | Vitamin, Water Soluble | Pregnancy & Prenatal Care (2021) | ||
| Sertraline | Antidepressant, Selective Serotonin Reuptake Inhibitor | Bipolar Disorder (2022) | Citalopram; Escitalopram; Fluoxetine; Paroxetine | |
| Simvastatin | Antilipemic Agent, HMG-CoA Reductase Inhibitor | Hyperlipidemia (2022) | Atorvastatin; Pravastatin; Rosuvastatin | |
| Spironolactone | Antihypertensive; Mineralocorticoid Receptor Antagonists; Potassium Sparing Diuretic | Heart Failure with Reduced Ejection Fraction (HFrEF) (2022) | ||
| Sulfasalazine | 5-Aminosalicylic Acid Derivative | Inflammatory Bowel Disease (2018) | Hydroxychloroquine; Leflunomide; Methotrexate | |
| Tamoxifen | Antineoplastic Agent, Estrogen Receptor Antagonist; Selective Estrogen Receptor Modulator | NPTC Update Spring 2021 | ||
| Tamsulosin | Alpha1 Blocker | Benign Prostatic Hypertrophy (Nov 2022) | Doxazosin; Prazosin | |
| Topiramate | Anticonvulsant, Miscellaneous | Alcohol Use Disorder (2022) | Carbamazepine; Divalproex; Lamotrigine; Levetiracetam; Phenytoin | |
| Ulipristal | Contraceptive; Progestin Receptor Modulator | Contraception (2016) | Levonorgestrel (Plan B One-Step®) | |
| Varenicline | Partial Nicotine Agonist, Smoking Cessation Aid | Nicotine Dependence (2020) | Bupropion | |
| Venlafaxine | Antidepressant, Serotonin/Norepinephrine Reuptake Inhibitor/Antagonist | Bipolar Disorder (2022) | Bupropion; Duloxetine | |
| Warfarin | Anticoagulant; Vitamin K Antagonist | Direct Oral Anticoagulants (2017) | Apixaban; Low-molecular weight heparin | |
| Medroxyprogesterone, oral | Contraceptive; Progestin | Polycystic Ovarian Syndrome (2017) | Medroxyprogesterone acetate, injection; Oral contraceptive pill, progestin only | |
| Apixaban | Anticoagulant; Direct Oral Anticoagulant (DOAC); Factor Xa Inhibitor | Direct Oral Anticoagulants (2017) | Warfarin | |
| Duloxetine | Antidepressant, Serotonin/Norepinephrine Reuptake Inhibitor/Antagonist | Bipolar Disorder (2022) | Bupropion; Venlafaxine | |
| Corticosteroids (Topical) - High Potency (Class I and II) | Topical Corticosteroids | Alopecia Areata (2022) | Corticosteroid (Topical) - Intermediate Potency; Corticosteroid (Topical) - Low Potency | |
| 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®) | |
| Alogliptin | Antidiabetic Agent, Dipeptidyl Peptidase 4 (DPP-4) Inhibitor | DPP-IV Inhibitors (2019) | ||
| Oxybutynin, extended-release | Antispasmodic Agent, Urinary | Antimuscarinics (2019) | Oxybutynin, Immediate-release | |
| Umeclidinium/Vilanterol | Long-Acting Muscarinic Antagonist (LAMA) / Long-Acting Beta2 Agonist (LABA) | LAMAs (2019) | Tiotropium (Spiriva®) | |
| Fluticasone/Salmeterol | Beta2 Agonist, Long-Acting; Corticosteroid, Inhalant | LABAs (2019) | Mometasone (Asmanex®) | |
| Memantine | N-Methyl-D-Aspartate (NMDA) Receptor Antagonist | Alzheimer's disease (2019) | ||
| Carbidopa-Levodopa, immediate-release | Anti-Parkinson Agent; Decarboxylase Inhibitor-Dopamine Precursor | Parkinson's Disease (2019) | ||
| Bictegravir/Emtricitabine/Tenofovir alafenamide | Antiretroviral, Integrase Inhibitor (Anti-HIV) | HIV Treatment (2019) | Dolutegravir/abacavir/lamivudine; Emtricitabine/tenofovir disoproxil fumarate; Raltegravir | |
| Loperamide | Antidiarrheal | Irritable Bowel Syndrome (2018) | ||
| Dicyclomine | Anticholinergic Agent | Irritable Bowel Syndrome (2018) | ||
| Citalopram | Antidepressant, Selective Serotonin Reuptake Inhibitor | Bipolar Disorder (2022) | Escitalopram; Fluoxetine; Paroxetine; Sertraline | |
| Escitalopram | Antidepressant, Selective Serotonin Reuptake Inhibitor | Bipolar Disorder (2022) | Citalopram; Fluoxetine; Paroxetine; Sertraline | |
| Paroxetine | Antidepressant, Selective Serotonin Reuptake Inhibitor | Bipolar Disorder (2022) | Citalopram; Escitalopram; Fluoxetine; Sertraline | |
| Ezetimibe | Antilipemic Agent, 2-Azetidinone | Hyperlipidemia (2022) | ||
| Empagliflozin | Antidiabetic Agent, Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitor | Heart Failure with Reduced Ejection Fraction (HFrEF) (2022) | ||
| Naltrexone, extended-release for injection | Antidote; Opioid Antagonist | Opioid Use Disorder (2018) | ||
| Oseltamivir | Antiviral Agent; Neuraminidase Inhibitor | Treatment of Influenza (2019) | ||
| 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 | |
| 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 | |
| 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) | |
| Atomoxetine | Norepinephrine Reuptake Inhibitor, Selective | ADHD (Jan 2020) | Dextroamphetamine / Amphetamine (immediate release); Dextroamphetamine / Amphetamine (long-acting); Methylphenidate (immediate release); Methylphenidate (long-acting) | |
| Methimazole | Antithyroid Agent; Thioamide | Hyperthyroidism (2021) | Propylthiouracil | |
| Propylthiouracil | Antithyroid Agent; Thioamide | Hyperthyroidism (2021) | Methimazole | |
| Ondansetron | Antiemetic; Selective 5-HT3 Receptor Antagonist | Antiemetic Agents (2021) | ||
| Ceftriaxone, injection | Antibiotic, Cephalosporin (Third Generation) | STIs - PART 1 (2021) | Cefdinir; Cefixime; Cephalexin | |
| Azithromycin | Antibiotic, Macrolide | STIs - PART 1 (2021) | ||
| Doxycycline | Antibiotic, Tetracycline | STIs - PART 1 (2021) | ||
| Penicillin G benzathine | Antibiotic, Penicillin | STIs - PART 1 (2021) | Amoxicillin; Amoxicillin and Clavulanate; Penicllin V potassium | |
| Hydroxyzine | Histamine H1 Antagonist, First Generation | Anxiety Disorders (2021) | ||
| Pramipexole | Anti-Parkinson Agent, Dopamine Agonist | Insomnia/Sleep Medications (2021) | ||
| Ethosuximide | Anticonvulsant, Succinimide | Anti-Seizure Drugs (2021) | Carbamazepine; Clonazepam; Divalproex; Gabapentin; Lamotrigine; Levetiracetam; Phenytoin; Topiramate | |
| Oxcarbazepine | Anticonvulsant, Miscellaneous | Bipolar Disorder (2022) | Carbamazepine; Clonazepam; Divalproex; Gabapentin; Lamotrigine; Levetiracetam; Phenytoin; Topiramate | |
| 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 | |
| Valacyclovir | Antiviral Agent, Oral | 2021 CDC Guidelines for Sexually Transmitted Infections (2021) | ||
| Mupirocin | Antibiotic, Topical | Skin & Soft Tissue Infections (2021) | ||
| Ciprofloxacin, ophthalmic solution | Antibiotic, Ophthalmic Fluoroquinolone | Ocular Treatments (2022) | Artificial Tear substitute, ophthalmic (preservative free); Corticosteroid (Ophthalmic) - Low Potency; Polymyxin B/trimethoprim, Ophthalmic Solution | |
| Polymyxin B/Trimethoprim, ophthalmic solution | Antibiotic, Ophthalmic | Ocular Treatments (2022) | Artificial Tear substitute, ophthalmic (preservative free); Ciprofloxacin, ophthalmic solution; Corticosteroid (Ophthalmic) - Low Potency | |
| Torsemide -OR- Bumetanide | Antihypertensive | Heart Failure with Preserved Ejection Fraction (HFpEF) (2022) | Bumetanide -OR- Torsemide; Furosemide | |
| Bumetanide -OR- Torsemide | Antihypertensive | Heart Failure with Preserved Ejection Fraction (HFpEF) (2022) | Furosemide; Torsemide -OR- Bumetanide | |
| Sacubitril and Valsrtan | Angiotensin II Receptor Blocker; Neprilysin Inhibitor | Heart Failure with Reduced Ejection Fraction (HFrEF) (2022) | ||
| Metoprolol tartrate | Antihypertensive; Beta-Blocker, Beta1 Selective | Heart Failure with Reduced Ejection Fraction (HFrEF) (2022) | Atenolol; Carvedilol, immediate-release; Metoprolol succinate | |
| Metronidazole, topical | Antibiotic, Topical | Rosacea (2022) | ||
| Sunscreen, Sun Protection Factor (SPF) 30 or greater | Ultraviolet light protectant, topical | Rosacea Treatment (2022) | ||
| Permethrin 5% cream | Antiparasitic Agent, Topical; Pediculocide; Scabicidal Agent | Sexually Transmitted Infections, Part III (2022) | Permethrin 1%, any formulation | |
| Ciprofloxacin, oral | Antibiotic, Fluoroquinolone | Male Genitourinary Infections (Nov 2022) | ||
| Clotrimazole, topical | Antifungal Agent, Imidazole Derivative | Male Genitourinary Infections (Nov 2022) | ||
| Fluconazole, oral | Antifungal Agent, Azole Derivative | Male Genitourinary Infections (Nov 2022) | ||
| Sildenafil | Phosphodiesterase-5 Enzyme Inhibitor | Erectile Dysfunction (Nov 2022) | Tadalafil | |
| Tadalafil | Phosphodiesterase-5 Enzyme Inhibitor | Erectile Dysfunction (Nov 2022) | Sildenafil | |
| 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 | |
| Famotidine | Histamine H2 Antagonist | Fall 2022 NPTC Meeting Update | ||
| Leuprolide | Antineoplastic Agent, Gonadotropin-Releasing Hormone Agonist | Treatment of Prostate Cancer (Nov 2022) | **Any depot form** | |
| Phentermine and Topiramate ER (**REMS drug**) | Anticonvulsant, Miscellaneous; Central Nervous System Stimulant | Obesity Management (2022) | **For REMS criteria, see Formulary Brief** | |
| Diclofenac | Nonsteroidal Anti-Inflammatory Drug | NSAIDs (2014) | *Any formulation* | Ibuprofen; Indomethacin; Meloxicam; Naproxen |
| Calcium | Electrolyte Supplement | Osteoporosis (2016) | *Any formulation* | |
| Permethrin 1% | Antiparasitic Agent, Topical; Pediculocide; Scabicidal Agent | Sexually Transmitted Infections, Part III (2022) | *Any formulation* | Permethrin 5% cream |
| Fluoride, oral | Nutritional Supplement | Supplements in Oral Health (2016) | *Any oral formulation* | |
| Iron, oral | Iron Salt | Pregnancy & Prenatal Care (2021) | *Any oral formulation* | |
| Estradiol, transdermal | Estrogen Derivative | Gender Affirming Therapies (2022) | *Any patch* | Estradiol for Injection; Estradiol tablets |
| 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 |
| 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 |
| H1 Antagonist (2nd generation), long-acting | Histamine H1 Antagonist, Second Generation | Allergic Rhinitis (2018) | *Any product* | |
| Ophthalmic Prostaglandin Analog | Ophthalmic Prostaglandin Analog | Ophth Prostaglandin Analogs (2018) | *Any product* | |
| Oral contraceptive pill, extended cycle | Contraceptive | Contraception (2016) | *Any product* | |
| Oral contraceptive pill, monophasic: 20mcg EE (low) | Contraceptive | Contraception (2016) | *Any product* | |
| Oral contraceptive pill, monophasic: 30-35mcg EE (medium) | Contraceptive | Contraception (2016) | *Any product* | |
| Oral contraceptive pill, progestin only | Contraceptive | Contraception (2016) | *Any product* | |
| Oral contraceptive pill, triphasic | Contraceptive | Contraception (2016) | *Any product* | |
| Proton Pump Inhibitor | Proton Pump Inhibitor | GERD & PUD (2018) | *Any product* | |
| Estrogen vaginal cream | Estrogen Derivative | NPTC Meeting Update (May 2018) | *Any product* | Estradiol tablets |
| Vitamin D Analog, topical | Vitamin D Analog | Psoriasis (2018) | *Any product* | |
| Vitamin D | Vitamin D Analog | Pregnancy & Prenatal Care (2021) | *Any product* | |
| Tretinoin, topical | Topical Skin Product, Acne | Treatment of Acne vulgaris (2020) | *Any product* | |
| Corticosteroid, intranasal | Intranasal Corticosteroid | Allergic Rhinitis (2018) | *Any product* | |
| Low-molecular weight heparin | Low-molecular Weight Heparin | VTE Prophylaxis (2011) | *Any product* | |
| Laxative, bulk-forming | Bulk-forming Laxative | Added July 2011 (Constipation) | *Any product* | |
| Polyethylene glycol | Laxative, Osmotic | Irritable Bowel Syndrome (2018) | *Any product* | Lactulose |
| Laxative, stimulant | Stimulant Laxative | Added July 2011 (Constipation) | *Any product* | |
| Corticosteroid (Topical) - Intermediate Potency | Topical Corticosteroids | Atopic Dermatitis (2020) | *Any product* | Corticosteroid (Topical) - Low Potency |
| Corticosteroid (Topical) - Low Potency | Topical Corticosteroids | Atopic Dermatitis (2020) | *Any product* | Corticosteroid (Topical) - Intermediate Potency |
| Atypical antipsychotic | Antipsychotic, Atypical | Bipolar Disorders (2022) | *Any product* | Aripiprazole lauroxil; Haloperidol decanoate |
| Albuterol, metered dose inhaler (MDI) | Beta2 Agonist | Asthma & COPD Guidelines Review (2019) | *Any product* | |
| Intrauterine device, copper | Contraceptive | Long Acting Reversible Contraception (2021) | *Any product*; For use by a skilled and privileged provider | Intrauterine device, levonorgestrel |
| Intrauterine device, levonorgestrel | Contraceptive, Progestin | Long Acting Reversible Contraception (2021) | *Any product*; For use by a skilled and privileged provider | Intrauterine device, copper |
| Insulin NPH (NovoLIN® N) | Insulin, Intermediate-Acting | Diabetes Treatment Overview (2017) | *Branded product* | |
| Insulin NPH / Regular human insulin (NovoLIN® 70/30) | Insulin, Combination (70/30 Mix) | Diabetes Treatment Overview (2017) | *Branded product* | |
| Insulin Regular human (NovoLIN® R) | Insulin, Short-Acting | Diabetes Treatment Overview (2017) | *Branded product* | |
| Levonorgestrel (Plan B One-Step®) | Contraceptive, Progestin | Contraception (2016) | *Branded product* | Ulipristal |
| Tiotropium (Spiriva®) | Long-Acting Anticholinergic Agent | Long Acting Muscarinic Antagonists (2019) | *Branded product* | |
| Mometasone (Asmanex®) | Corticosteroid, Inhalant | Asthma & COPD Guidelines Review (2019) | *Branded product* | |
| Insulin aspart (NovoLog®) | Insulin, Rapid-Acting | Diabetes Treatment Overview (2017) | *Branded product*; Pen Device | |
| Insulin aspart / Insulin aspart protamine (NovoLog® Mix 70/30) | Insulin, Combination (70/30 Mix) | Diabetes Treatment Overview (2017) | *Branded product*; Pen Device | |
| Insulin detemir (Levemir®) | Insulin, Long-Acting | Long-acting Insulins & Biosimilars (2021) | *Branded product*; Pen Device | |
| 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 |
| Buprenorphine-Naloxone (**REMS drug**) | Analgesic, Opioid; Analgesic, Opioid Partial Agonist | MAT for OUD (2021) | **See REMS here** | 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** | Buprenorphine, long-acting (**REMS drug**); Buprenorphine-Naloxone (**REMS drug**) |
| 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** | Buprenorphine, short-acting (**REMS drug**); Buprenorphine-Naloxone (**REMS drug**) |
| Testosterone (**REMS Drug**) | Androgen | Male Hypogonadism (2022) | Any formulation; Certain formulations (i.e., undecoanate) have REMS requirements | |
| Donepezil | Acetylcholinesterase Inhibitor (Central) | Alzheimer's disease (2019) | 5mg and 10mg strengths | |
| Rifaximin | Antibiotic, Rifamycin | Hepatic Encephalopathy (2020) | After failure of, or intolerance to, lactulose monotherapy as indicated for hepatic encephalopathy | Lactulose |
| Vaccines, All ACIP-recommended | Vaccines | Vaccine (2011) | All ACIP recommended vaccines for routine use in accordance with ACIP guidelines | |
| 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®) |
| Epinephrine Injection Devices (both 0.15mg and 0.3mg) | Alpha-/Beta- Agonist | Epinephrine Injection Devices (2020 | Any device, auto-injector or pre-filled syringe | |
| Glucose, oral | Antidote | Glucagon Products Review (2021) | Any formulation | Glucagon |
| Folic Acid | Vitamin, Water Soluble | Pregnancy & Prenatal Care (2021) | Any product containing >400 mcg / daily dose | |
| Sumatriptan | Antimigraine Agent; Serotonin 5-HT 1B/1D Receptor Agonist | Acute Migraine (2021) | Any two (2) triptan medications are required, one must be sumatriptan | |
| Serotonin 5-HT1 agonist (Triptan) | Antimigraine Agent; Serotonin 5-HT 1B/1D Receptor Agonist | Acute Migraine (2021) | Any two (2) triptan medications are required, one must be sumatriptan | Sumatriptan |
| Nicotine replacement therapy (NRT), combination | Smoking Cessation Aid | Nicotine Dependence (2020) | Combination NRT (nicotine patches + any short-acting NRT product) | Bupropion; Varenicline |
| Estradiol for Injection | Estrogen Derivative | Gender Affirming Therapies (2022) | Either valerate or cypionate product | Estradiol tablets; Estradiol, transdermal |
| 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 |
| Dolutegravir | Antiretroviral, Integrase Inhibitor (Anti-HIV) | HIV Updates (2020) | For HIV treatment in pregnant patients | Emtricitabine/tenofovir disoproxil fumarate; Raltegravir |
| 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 |
| Glucagon | Antidote; Hypoglycemia | Glucagon Products Review (2021) | For outpatient use | |
| Sevelamer carbonate | Phosphate Binder | Phosphate Binders (2018) | For patients on dialysis who cannot use calcium-based phosphate binders due to hypercalcemia | Calcium |
| Etonogestrel, implant | Contraceptive; Progestin | Long Acting Reversible Contraception (2021) | For use by a skilled and privileged provider | Oral contraceptive pill, progestin only |
| 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 |
| Prenatal Multivitamin | Vitamin | Pregnancy & Prenatal Care (2021) | Must contain >400 mcg of folic acid/dose | |
| 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) |
| 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 |
| Cefdinir | Antibiotic, Cephalosporin (Third Generation) | Outpatient Abx Stewardship & URIs (2021) | Pediatric and Adult oral formulations | Cefixime; Ceftriaxone Injection; Cephalexin |
| Cephalexin | Antibiotic, Cephalosporin (First Generation) | Outpatient Abx Stewardship & URIs (2021) | Pediatric and Adult oral formulations | Cefdinir; Cefixime; Ceftriaxone Injection |
| Clindamycin | Antibiotic, Lincosamide | Outpatient Abx Stewardship & URIs (2021) | Pediatric and Adult oral formulations | |
| Penicllin V potassium | Antibiotic, Penicillin | Outpatient Abx Stewardship & URIs (2021) | Pediatric and Adult oral formulations | Amoxicillin; Amoxicillin and Clavulanate; Penicillin G benzathine |
| Dextroamphetamine / Amphetamine (immediate release) | Central Nervous System Stimulant | ADHD (Jan 2020) | Pediatric use only | |
| Dextroamphetamine / Amphetamine (long-acting) | Central Nervous System Stimulant | ADHD (Jan 2020) | Pediatric use only | |
| Methylphenidate (immediate release) | Central Nervous System Stimulant | ADHD (Jan 2020) | Pediatric use only | Methylphenidate (long-acting) |
| Methylphenidate (long-acting) | Central Nervous System Stimulant | ADHD (Jan 2020) | Pediatric use only | Methylphenidate (immediate release) |
| 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 | Long-term Pharmacotherapy for the Patient with Overweight or Obesity (2022) | Select either of these subcutaneous agents, no preference given |
