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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: 12/13/2022
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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
Apixaban Anticoagulant; Direct Oral Anticoagulant (DOAC); Factor Xa Inhibitor Direct Oral Anticoagulants (2017) Warfarin
Bupropion Antidepressant, Dopamine/Norepinephrine-Reuptake Inhibitor; Smoking Cessation Aid Nicotine Dependence (2015) Varenicline; Venlafaxine
Levonorgestrel (Plan B One-Step®) Contraceptive, Progestin Contraception (2016) *Branded product* Ulipristal
Umeclidinium/Vilanterol Long-Acting Muscarinic Antagonist (LAMA) / Long-Acting Beta2 Agonist (LABA) LAMAs (2019) Tiotropium (Spiriva®)
Metronidazole, oral Antibiotic, Miscellaneous 2021 CDC Guidelines for Sexually Transmitted Infections (2021) Tinidazole
Sildenafil Phosphodiesterase-5 Enzyme Inhibitor Erectile Dysfunction (Nov 2022) Tadalafil
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
Tadalafil Phosphodiesterase-5 Enzyme Inhibitor Erectile Dysfunction (Nov 2022) Sildenafil
Fluoxetine Antidepressant, Selective Serotonin Reuptake Inhibitor Sertraline
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
Methimazole Antithyroid Agent; Thioamide Hyperthyroidism (2021) Propylthiouracil
Doxazosin Alpha1 Blocker; Antihypertensive Benign Prostatic Hypertrophy (Nov 2022) Prazosin; Tamsulosin
Atorvastatin Antilipemic Agent, HMG-CoA Reductase Inhibitor Dyslipidemia Guideline Review (2014) Pravastatin; Rosuvastatin; Simvastatin
Lactulose Ammonium Detoxicant; Laxative, Osmotic Cirrhosis & Complications (2015) Polyethylene glycol
Permethrin 1% Antiparasitic Agent, Topical; Pediculocide; Scabicidal Agent Sexually Transmitted Infections, Part III (2022) *Any formulation* Permethrin 5% cream
Permethrin 5% cream Antiparasitic Agent, Topical; Pediculocide; Scabicidal Agent Sexually Transmitted Infections, Part III (2022) Permethrin 1%, any formulation
Oxybutynin, extended-release Antispasmodic Agent, Urinary Antimuscarinics (2019) Oxybutynin, Immediate-release
Oxybutynin, immediate-release Antispasmodic Agent, Urinary Antimuscarinics (2019) Oxybutynin, extended-release
Etonogestrel, implant Contraceptive; Progestin Contraception (2016) For use by a skilled and privileged provider Oral contraceptive pill, progestin only
Amitriptyline Antidepressant, Tricyclic Antidepressants in Pain Mgmt (2014) Nortriptyline
Isosorbide mononitrate Antianginal Agent; Vasodilator Nitroglycerin 0.4 Milligrams; Sublingual; Nitroglycerin patch
Naltrexone, oral Antidote; Opioid Antagonist Alcohol Use Disorder (2022) Naloxone
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
Oral contraceptive pill, triphasic Contraceptive *Any product* Monophasics ; Oral Contraceptive Pill
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
Fluticasone/Salmeterol Beta2 Agonist, Long-Acting; Corticosteroid, Inhalant LABAs (2019) Mometasone (Asmanex®)
Tinidazole Antibiotic, Miscellaneous 2021 CDC Guidelines for Sexually Transmitted Infections (2021) Metronidazole
Atenolol Antihypertensive; Beta-Blocker, Beta1 Selective Beta Blockers (2014) Metoprolol; Propranolol
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)
Propylthiouracil Antithyroid Agent; Thioamide Hyperthyroidism (2021) Methimazole
Medroxyprogesterone acetate, injection Contraceptive, Progestin (Injection/Depot) Contraception (2016) Medroxyprogesterone, oral; Oral contraceptive pill, progestin only
Medroxyprogesterone, oral Contraceptive; Progestin Polycystic Ovarian Syndrome (2017) Medroxyprogesterone acetate, injection; Oral contraceptive pill, progestin only
Clonazepam Benzodiazepine Alcohol Withdrawal Syndrome (2015) Lorazepam
Ulipristal Contraceptive; Progestin Receptor Modulator Contraception (2016) Levonorgestrel (Plan B One-Step®)
Hydroxychloroquine Antimalarial Non-biologic DMARDs (2016) Leflunomide; Methotrexate; Sulfasalazine
Glecaprevir/Pibrentasvir (Mavyret®) Antihepaciviral HCV Treatment (2018) Ledipasvir/sofosbuvir (Harvoni®); Sofosbuvir/velpatasvir (Epclusa®)
Polyethylene glycol Laxative, Osmotic Irritable Bowel Syndrome (2018) *Any product* Lactulose
Rifaximin Antibiotic, Rifamycin Hepatic Encephalopathy (2020) After failure of, or intolerance to, lactulose monotherapy as indicated for hepatic encephalopathy Lactulose
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
Ethambutol Antitubercular Agent Isoniazid; Pyrazinamide; Rifampin; Rifapentine
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
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®)
Diclofenac Nonsteroidal Anti-Inflammatory Drug NSAIDs (2014) *Any formulation* Ibuprofen; Indomethacin; Meloxicam; Naproxen
Leflunomide Antirheumatic, Disease Modifying Non-biologic DMARDs (2016) Hydroxychloroquine; Methotrexate; Sulfasalazine
Methotrexate Antineoplastic Agent; Antirheumatic; Disease Modifying; Immunosuppresant Agent Non-biologic DMARDs (2016) Hydroxychloroquine; Leflunomide; Sulfasalazine
Sulfasalazine 5-Aminosalicylic Acid Derivative Hydroxychloroquine; Leflunomide; Methotrexate
Chlorthalidone Antihypertensive; Thiazide-Related Diuretic Diuretic Agents (2014) Hydrochlorothiazide
Aripiprazole lauroxil Antipsychotic, Atypical (Second Generation) - Injectable Long-Acting Injectable Antipsychotics (2020) Injectable Haloperidol decanoate
Glucose, oral Antidote Glucagon Delivery Devices (2021) Any formulation Glucagon
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®)
Bumetanide -OR- Torsemide Antihypertensive HFpEF (2022) Furosemide; Torsemide -OR- Bumetanide
Oral contraceptive pill, progestin only Contraceptive *Any product* Etonogestrel; Implant; Intrauterine Device; Levonorgestrel
Isoniazid Antitubercular Agent Ethambutol; Pyrazinamide; Rifampin; Rifapentine
Pyrazinamide Antitubercular Agent Ethambutol; Isoniazid; Rfapentine ; Rifampin
Rifampin Antitubercular Agent Ethambutol; Isoniazid; Pyrazinamide; Rifapentine
Rifapentine Antitubercular Agent Rifapentine (2013) Ethambutol; Isoniazid; Pyrazinamide; Rifampin
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)
Estradiol for Injection Estrogen Derivative Gender Affirming Therapies (2022) Either valerate or cypionate product Estradiol tablets; Estradiol, transdermal
Estrogen vaginal cream Estrogen Derivative NPTC Meeting Update (May 2018) *Any product* Estradiol tablets
Estradiol tablets Estrogen Derivative Menopausal Hormone Therapy (2016) Estradiol for Injection; Estradiol, transdermal
Estradiol, transdermal Estrogen Derivative Gender Affirming Therapies (2022) *Any patch* Estradiol for Injection; Estradiol tablets
Citalopram Antidepressant, Selective Serotonin Reuptake Inhibitor SSRIs (2019) Escitalopram; Fluoxetine; Paroxetine; Sertraline
Dolutegravir Antiretroviral, Integrase Inhibitor (Anti-HIV) HIV Updates (2020) For HIV treatment in pregnant patients 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
Prazosin Alpha1 Blocker; Antihypertensive PTSD Indication (2012) Doxazosin; Tamsulosin
Tamsulosin Alpha1 Blocker Benign Prostatic Hypertrophy (Nov 2022) Doxazosin; Prazosin
Bictegravir/Emtricitabine/Tenofovir alafenamide Antiretroviral, Integrase Inhibitor (Anti-HIV) HIV Treatment (2019) Dolutegravir/abacavir/lamivudine; Emtricitabine/tenofovir disoproxil fumarate; Raltegravir
Carbamazepine Anticonvulsant, Miscellaneous Antiepileptics (2014) Divalproex; Lamotrigine; Levetiracetam; Phenytoin; Topiramate
Amlodipine Antihypertensive; Calcium Channel Blocker, Dihydropyridine Calcium Channel Blockers (2014) Diltiazem
Ibuprofen Nonsteroidal Anti-Inflammatory Drug NSAIDs (2014) Diclofenac; Indomethacin; Meloxicam; Naproxen
Indomethacin Nonsteroidal Anti-Inflammatory Drug NSAIDs (2014) Diclofenac; Ibuprofen; Meloxicam; Naproxen
Meloxicam Nonsteroidal Anti-Inflammatory Drug NSAIDs (2014) Diclofenac; Ibuprofen; Indomethacin; Naproxen
Naproxen Nonsteroidal Anti-Inflammatory Drug NSAIDs (2014) Diclofenac; Ibuprofen; Indomethacin
Atomoxetine Norepinephrine Reuptake Inhibitor, Selective ADHD (Jan 2020) Dextroamphetamine / Amphetamine (immediate release); Dextroamphetamine / Amphetamine (long-acting); Methylphenidate (immediate release); Methylphenidate (long-acting)
Corticosteriods (Topical) - High Potency (Class I and II) Topical Corticosteroids Psoriasis (2018) Corticosteroid (Topical) - Intermediate potency; Corticosteroid (Topical) - Low potency
Corticosteroid (Topical) - Intermediate Potency Topical Corticosteroids *Any product* Corticosteriods (Topical) - High Potency (Class I and II); Corticosteroid (Topical) - Low potency
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)
Corticosteroid (Topical) - Low Potency Topical Corticosteroids *Any product* Corticosteriods (Topical) - High Potency (Class I and II); Corticosteroid (Topical) - Intermediate Potency
Lorazepam Benzodiazepine Alcohol Withdrawal Syndrome (2015) Clonazepam
Escitalopram Antidepressant, Selective Serotonin Reuptake Inhibitor SSRIs (2019) Citalopram; Fluoxetine; Paroxetine; Sertraline
Paroxetine Antidepressant, Selective Serotonin Reuptake Inhibitor SSRIs (2019) Citalopram; Escitalopram; Fluoxetine; Sertraline
Sertraline Antidepressant, Selective Serotonin Reuptake Inhibitor Citalopram; Escitalopram; Fluoxetine; Paroxetine
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
Hydrochlorothiazide Antihypertensive; Thiazide Diuretic Diuretics (2014) Chlorthalidone
Cefdinir Antibiotic, Cephalosporin (Third Generation) Outpatient Abx Stewardship & URIs (2021) Pediatric and Adult oral formulations Cefixime; Ceftriaxone Injection; 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
Ceftriaxone, injection Antibiotic, Cephalosporin (Third Generation) STIs - PART 1 (2021) Cefdinir; Cefixime; Cephalexin
Cephalexin Antibiotic, Cephalosporin (First Generation) Outpatient Abx Stewardship & URIs (2021) Pediatric and Adult oral formulations Cefdinir; Cefixime; Ceftriaxone Injection
Divalproex Anticonvulsant, Miscellaneous ER Lithium & Divalproex (2012) Carbamazepine; Lamotrigine; Levetiracetam; Phenytoin; Topiramate
Lamotrigine Anticonvulsant, Miscellaneous Antiepileptics (2014) Carbamazepine; Divalproex; Levetiracetam; Phenytoin; Topiramate
Levetiracetam Anticonvulsant, Miscellaneous Antiepileptics (2014) Carbamazepine; Divalproex; Lamotrigine; Phenytoin; Topiramate
Phenytoin Anticonvulsant, Hydantoin Antiepileptics (2014) Carbamazepine; Divalproex; Lamotrigine; Levetiracetam; Topiramate
Topiramate Anticonvulsant, Miscellaneous Antiepileptic Medications (2014) Carbamazepine; Divalproex; Lamotrigine; Levetiracetam; Phenytoin
Ethosuximide Anticonvulsant, Succinimide Anti-Seizure Drugs (2021) Carbamazepine; Clonazepam; Divalproex; Gabapentin; Lamotrigine; Levetiracetam; Phenytoin; Topiramate
Oxcarbazepine Anticonvulsant, Miscellaneous Anti-Seizure Drugs (2021) Carbamazepine; Clonazepam; Divalproex; Gabapentin; Lamotrigine; Levetiracetam; Phenytoin; Topiramate
Sevelamer carbonate Phosphate Binder Phosphate Binders (2018) For patients on dialysis who cannot use calcium-based phosphate binders due to hypercalcemia Calcium
Duloxetine Antidepressant, Serotonin/Norepinephrine Reuptake Inhibitor/Antagonist Diabetic Neuropathy (2018) Bupropion; Venlafaxine
Nicotine replacement therapy (NRT), combination Smoking Cessation Aid Nicotine Dependence (2015) Combination NRT (nicotine patches + any short-acting NRT product) Bupropion; Varenicline
Venlafaxine Antidepressant, Serotonin/Norepinephrine Reuptake Inhibitor/Antagonist SNRIs (2012) Bupropion; Duloxetine
Varenicline Partial Nicotine Agonist, Smoking Cessation Aid Nicotine Dependence (2015) Bupropion
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, 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**)
Torsemide -OR- Bumetanide Antihypertensive HFpEF (2022) Bumetanide -OR- torsemide; Furosemide
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
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
Pravastatin Antilipemic Agent, HMG-CoA Reductase Inhibitor Hyperlipidemia (2017) Atorvastatin; 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
Carvedilol, immediate-release Antihypertensive; Beta-Blocker with Alpha-Blocking Activity Beta-blockers in Heart Failure (2017) Atenolol; Metoprolol; Propranolol
Propranolol Antihypertensive; Beta-Blocker, Non-Selective Beta Blockers (2014) Atenolol; Metoprolol
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
Clopidogrel Antiplatelet Agent Antiplatelets (2015) Aspirin
Ciprofloxacin, ophthalmic solution Antibiotic, Ophthalmic Fluoroquinolone Ocular Treatments (2022) Artificial Tear substitute, ophthalmic (preservative free); 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
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
Polymyxin B/Trimethoprim, ophthalmic solution Antibiotic, Ophthalmic Ocular Treatments (2022) Artificial Tear substitute, ophthalmic (preservative free); Ciprofloxacin, ophthalmic solution; Corticosteroid (Ophthalmic) - Low Potency
Atypical antipsychotic Antipsychotic, Atypical Bipolar Disorders (2022) *Any product* Aripiprazole lauroxil; Haloperidol decanoate
Haloperidol decanoate Antipsychotic, Typical (First Generation) - Injectable Long-Acting Injectable Antipsychotics (2020) Injectable Aripiprazole lauroxil
Warfarin Anticoagulant; Vitamin K Antagonist Direct Oral Anticoagulants (2017) Apixaban; Low-molecular weight heparin
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
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
Diltiazem Antihypertensive; Calcium Channel Blocker, Nondihydropyridine Calcium Channel Blockers (2014) Amlodipine
Nortriptyline Antidepressant, Tricyclic Antidepressants in Pain Mgmt (2014) Amitriptyline
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)
Ethinyl estradiol / Etonogestrel vaginal ring Contraceptive; Estrogen and Progestin Combination Contraception (2016)
Ethinyl estradiol / Norelgestromin, transdermal Contraceptive; Estrogen and Progestin Combination Contraception (2016)
Donepezil Acetylcholinesterase Inhibitor (Central) 5mg and 10mg strengths
Digoxin Antiarrhythmic Agent, Miscellaneous; Cardiac Glycoside Digoxin Use (2016)
Cyanocobalamin (Vitamin B12), oral Vitamin, Water Soluble Hematologic Supplements (2016)
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
Acetaminophen Analgesic, Miscellaneous
Calcium Electrolyte supplement *Any formulation*
Anastrozole Antineoplastic Agent, Aromatase Inhibitor
Aspirin Antiplatelet Agent; Nonsteroidal Anti-Inflammatory Drug; Salicylate
Albuterol, metered dose inhaler (MDI) Beta2 Agonist NPTC Meeting Update (Nov 2017) *Any product*
Albuterol nebulized solution Beta2 Agonist
Alendronate Bisphosphonate Derivative Osteoporosis (2016)
Allopurinol Antigout Agent; Xanthine Oxidase Inhibitor Gout (2016)
Laxative, bulk-forming Bulk-forming Laxative *Any product*
Laxative, stimulant Stimulant Laxative *Any product*
Iron, oral Iron Salt Hematologic Supplements (2016) *Any oral formulation*
Losartan Antihypertensive, Angiotensin II Receptor Blocker ACEIs & ARBs in Heart Failure (2017)
Low-molecular weight heparin Low-molecular Weight Heparin VTE Prophylaxis (2011) *Any product*
Letrozole Antineoplastic Agent, Aromatase Inhibitor
Levothyroxine Thyroid Agent
Lisinopril Antihypertensive, Angiotensin-Converting Enzyme Inhibitor ACEIs & ARBs in Heart Failure (2017)
Lithium Antimanic Agent ER Lithium & Divalproex (2012)
Finasteride 5 Alpha-Reductase Inhibitor Benign Prostatic Hypertrophy (Nov 2022)
Fluoride, oral Nutritional Supplement Supplements in Oral Health (2016) *Any oral formulation*
Folic Acid Vitamin, Water Soluble Supplements in Womens Health (2016) Any product containing >400 mcg / daily dose
Furosemide Antihypertensive; Loop Diuretic Heart Failure Overview (2017)
Gabapentin Anticonvulsant, Miscellaneous; GABA Analog Gabapentin & Pregabalin in Pain (2014)
Glipizide Antidiabetic Agent; Sulfonylurea Sulfonylureas (2015)
Glucagon Antidote; Hypoglycemia For outpatient use
H1 Antagonist (2nd generation), long-acting Histamine H1 Antagonist, Second Generation *Any product*
Insulin aspart (NovoLog®) Insulin, Rapid-Acting Insulins (2015) *Branded product*; Pen Device
Insulin aspart / Insulin aspart protamine (NovoLog® Mix 70/30) Insulin, Combination (70/30 Mix) Insulins (2015) *Branded product*; Pen Device
Insulin NPH (NovoLIN® N) Insulin, Intermediate-Acting Insulins (2015) *Branded product*
Insulin NPH / Regular human insulin (NovoLIN® 70/30) Insulin, Combination (70/30 Mix) Insulins (2015) *Branded product*
Insulin Regular human (NovoLIN® R) Insulin, Short-Acting Insulins (2015) *Branded product*
Corticosteroid, intranasal Intranasal Corticosteroid *Any product*
Ophthalmic Prostaglandin Analog Ophthalmic Prostaglandin Analog Ophth Prostaglandin Analogs (2018) *Any product*
Oral contraceptive pill, extended cycle Contraceptive Contraception (2016) *Any product*
Mometasone (Asmanex®) Corticosteroid, Inhalant *Branded product*
Montelukast Leukotriene Receptor Antagonist
Naloxone Antidote; Opioid Antagonist Treatment of Opioid Overdose (2014)
Metformin Antidiabetic Agent; Biguanide
Proton Pump Inhibitor Proton Pump Inhibitor GERD & PUD (2018) *Any product*
Prednisone Corticosteroid, Systemic
Pioglitazone Antidiabetic Agent, Thiazolidinedione Thiazolidinediones (2017)
Spironolactone Antihypertensive; Mineralocorticoid Receptor Antagonists; Potassium Sparing Diuretic Mineralocorticoid Receptor Antagonist in HF (2017)
Salsalate Salicylate
Vitamin D Vitamin D Analog Vitamin D (2010) *Any product*
Vaccines, All ACIP-recommended Vaccines Vaccine (2011) All ACIP recommended vaccines for routine use in accordance with ACIP guidelines
Tretinoin, topical Topical Skin Product, Acne Acne (2013) *Any product*
Tiotropium (Spiriva®) Long-Acting Anticholinergic Agent Inhaled Anticholinergics (2011) *Branded product*
Pyridoxine (Vitamin B6) Vitamin, Water Soluble Supplements in Obstetrics (2016)
Sumatriptan Antimigraine Agent; Serotonin 5-HT 1B/1D Receptor Agonist Triptans (2016) Any two (2) triptan medications are required, one must be sumatriptan
Tamoxifen Antineoplastic Agent, Estrogen Receptor Antagonist; Selective Estrogen Receptor Modulator
Naltrexone, extended-release for injection Antidote; Opioid Antagonist Opioid Use Disorder (2018)
Alogliptin Antidiabetic Agent, Dipeptidyl Peptidase 4 (DPP-4) Inhibitor DPP-IV Inhibitors (2019)
Phentermine and Topiramate ER (**REMS drug**) Anticonvulsant, Miscellaneous; Central Nervous System Stimulant Obesity Management (2022) **For REMS criteria, see Formulary Brief**
Vitamin D Analog, topical Vitamin D Analog Psoriasis (2018) *Any product*
Loperamide Antidiarrheal Irritable Bowel Syndrome (2018)
Dicyclomine Anticholinergic Agent Irritable Bowel Syndrome (2018)
Clindamycin Antibiotic, Lincosamide Outpatient Abx Stewardship & URIs (2021) Pediatric and Adult oral formulations
Nitrofurantoin Antibiotic, Miscellaneous Urinary Tract Infections (2021)
Trimethoprim-Sulfamethoxazole Antibiotic, Miscellaneous Skin & Soft Tissue Infections (2021)
Valacyclovir Antiviral Agent, Oral 2021 CDC Guidelines for Sexually Transmitted Infections (2021)
Mupirocin Antibiotic, Topical Skin & Soft Tissue Infections (2021)
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 
Metronidazole, topical Antibiotic, Topical Rosacea (2022)
Sunscreen, Sun Protection Factor (SPF) 30 or greater Ultraviolet light protectant, topical Rosacea Treatment (2022)
Sacubitril and Valsrtan Angiotensin II Receptor Blocker; Neprilysin Inhibitor HFrEF (2022)
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)
Hydroxyzine Histamine H1 Antagonist, First Generation Anxiety Disorders (2021)
Pramipexole Anti-Parkinson Agent, Dopamine Agonist Insomnia/Sleep Medications (2021)
Azithromycin Antibiotic, Macrolide STIs - PART 1 (2021)
Doxycycline Antibiotic, Tetracycline STIs - PART 1 (2021)
Ondansetron Antiemetic; Selective 5-HT3 Receptor Antagonist Antiemetic Agents (2021)
Prenatal Multivitamin Vitamin Pregnancy & Prenatal Care (2021) Must contain >400 mcg of folic acid/dose
Epinephrine Injection Devices (both 0.15mg and 0.3mg) Alpha-/Beta- Agonist Epinephrine Injection Devices (2020 Any device, auto-injector or pre-filled syringe
Memantine N-Methyl-D-Aspartate (NMDA) Receptor Antagonist
Carbidopa-Levodopa, immediate-release Anti-Parkinson Agent; Decarboxylase Inhibitor-Dopamine Precursor Parkinson's Disease (2019)
Ezetimibe Antilipemic Agent, 2-Azetidinone 2018 ACC/AHA Cholesterol Guidelines (2019)
Empagliflozin Antidiabetic Agent, Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitor SGLT-2 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
Oseltamivir Antiviral Agent; Neuraminidase Inhibitor Treatment of Influenza (2019)
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
Leuprolide Antineoplastic Agent, Gonadotropin-Releasing Hormone Agonist Treatment of Prostate Cancer (Nov 2022) **Any depot form**
Famotidine Histamine H2 Antagonist Fall 2022 NPTC Meeting Update