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: 04/12/2024
Search Medications Results
The following is a list of Medications currently in the queue. 233 record(s) found.
| Medication | Pharmacological Category | Formulary Brief | Notes | Similar Medications |
|---|---|---|---|---|
| Finasteride | 5 Alpha-Reductase Inhibitor | Benign Prostatic Hypertrophy (Nov 2022) | ||
| Sulfasalazine | 5-Aminosalicylic Acid Derivative | Inflammatory Bowel Disease (2018) | Hydroxychloroquine; Leflunomide; Methotrexate | |
| Mesalamine, oral | 5-Aminosalicylic Acid Derivative | Inflammatory Bowel Disease (2023) | Once-Daily Formulation | Sulfasalazine |
| Donepezil | Acetylcholinesterase Inhibitor (Central) | Alzheimer's disease (2019) | 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 (Nov 2022) | Doxazosin; Prazosin | |
| Prazosin | Alpha1 Blocker; Antihypertensive | Post Traumatic Stress Disorder (2021) | Doxazosin; Tamsulosin | |
| Doxazosin | Alpha1 Blocker; Antihypertensive | Benign Prostatic Hypertrophy (Nov 2022) | Prazosin; Tamsulosin | |
| Lactulose | Ammonium Detoxicant; Laxative, Osmotic | Hepatic Encephalopathy (2020) | Polyethylene glycol | |
| Acetaminophen | Analgesic, Miscellaneous | Short-Acting Opioids (2014) | ||
| Buprenorphine-Naloxone (**REMS drug**) | Analgesic, Opioid; Analgesic, Opioid Partial Agonist | MAT for OUD (2021) | **See REMS here** | Naloxone |
| 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**) |
| 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**) |
| Testosterone (**REMS Drug**) | Androgen | Male Hypogonadism (2022) | Any formulation; Certain formulations (i.e., undecoanate) have REMS requirements | |
| Sacubitril and Valsrtan | Angiotensin II Receptor Blocker; Neprilysin Inhibitor | Heart Failure with Reduced Ejection Fraction (HFrEF) (2022) | ||
| 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 | |
| Isosorbide mononitrate | Antianginal Agent; Vasodilator | Anti-Anginal Treatment (2013) | Nitroglycerin patch | |
| Digoxin | Antiarrhythmic Agent, Miscellaneous; Cardiac Glycoside | Heart Failure with Reduced Ejection Fraction (HFrEF) (2022) | ||
| 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 | Male Genitourinary Infections (Nov 2022) | ||
| 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 | |
| Penicillin 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 | Antiseizure Drugs (2021) | Carbamazepine; Divalproex; Lamotrigine; Levetiracetam; Topiramate | |
| Topiramate | Anticonvulsant, Miscellaneous | Alcohol Use Disorder (2022) | Carbamazepine; Divalproex; Lamotrigine; Levetiracetam; Phenytoin | |
| Carbamazepine | Anticonvulsant, Miscellaneous | Bipolar Disorder (2022) | Divalproex; Lamotrigine; Levetiracetam; Phenytoin; Topiramate | |
| Lamotrigine | Anticonvulsant, Miscellaneous | Bipolar Disorder (2022) | Carbamazepine; Divalproex; Levetiracetam; Phenytoin; Topiramate | |
| Levetiracetam | Anticonvulsant, Miscellaneous | Antiseizure Drugs (2021) | Carbamazepine; Divalproex; Lamotrigine; Phenytoin; Topiramate | |
| Divalproex | Anticonvulsant, Miscellaneous | Bipolar Disorder (2022) | Carbamazepine; Lamotrigine; Levetiracetam; Phenytoin; Topiramate | |
| Oxcarbazepine | Anticonvulsant, Miscellaneous | Bipolar Disorder (2022) | Carbamazepine; Clonazepam; Divalproex; Gabapentin; Lamotrigine; Levetiracetam; Phenytoin; Topiramate | |
| Gabapentin | Anticonvulsant, Miscellaneous; GABA Analog | Antiseizure Drugs (2021) | ||
| Ethosuximide | Anticonvulsant, Succinimide | Anti-Seizure Drugs (2021) | Carbamazepine; Clonazepam; Divalproex; Gabapentin; Lamotrigine; Levetiracetam; Phenytoin; Topiramate | |
| Bupropion | Antidepressant, Dopamine/Norepinephrine-Reuptake Inhibitor; Smoking Cessation Aid | Stimulant Use Disorder (2022) | Varenicline; Venlafaxine | |
| Fluoxetine | Antidepressant, Selective Serotonin Reuptake Inhibitor | Bipolar Disorder (2022) | Sertraline | |
| Sertraline | Antidepressant, Selective Serotonin Reuptake Inhibitor | Bipolar Disorder (2022) | Citalopram; Escitalopram; Fluoxetine; Paroxetine | |
| 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 | |
| Venlafaxine | Antidepressant, Serotonin/Norepinephrine Reuptake Inhibitor/Antagonist | Bipolar Disorder (2022) | Bupropion; Duloxetine | |
| Duloxetine | Antidepressant, Serotonin/Norepinephrine Reuptake Inhibitor/Antagonist | Bipolar Disorder (2022) | Bupropion; Venlafaxine | |
| Nortriptyline | Antidepressant, Tricyclic | Bipolar Disorder (2022) | Amitriptyline | |
| Amitriptyline | Antidepressant, Tricyclic | Bipolar Disorder (2022) | Nortriptyline | |
| Alogliptin | Antidiabetic Agent, Dipeptidyl Peptidase 4 (DPP-4) Inhibitor | DPP-IV Inhibitors (2019) | ||
| Semaglutide (Ozempic®) | Antidiabetic Agent, Glucagon-Like Peptide-1 (GLP-1) Receptor Agonist | GLP-1 & GLP-1/GIP Receptor Agonists for DM2 and Obesity (2023) | Subcutaneous formulation only | |
| Semaglutide (Wegovy®) -OR- Tirzepatide (Zepbound™) | Antidiabetic Agent, Glucagon-Like Peptide-1 (GLP-1) Receptor Agonist; Glucose-Dependent Insulinotropic Polypeptide (GIP)/Glucagon-Like Peptide (GLP-1) Receptor Agonist | NPTC Update (Jan 2024) | For weight management, with recommended local adoption of use criteria | Tirzepatide (Zepbound™) -OR- Semaglutide (Wegovy®) |
| Tirzepatide (Zepbound™) -OR- Semaglutide (Wegovy®) | Antidiabetic Agent, Glucagon-Like Peptide-1 (GLP-1) Receptor Agonist; Glucose-Dependent Insulinotropic Polypeptide (GIP)/Glucagon-Like Peptide (GLP-1) Receptor Agonist | NPTC Update (Jan 2024) | For weight management, with recommended local adoption of use criteria | Semaglutide (Wegovy®) -OR- Tirzepatide (Zepbound™) |
| Empagliflozin | Antidiabetic Agent, Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitor | Heart Failure with Reduced Ejection Fraction (HFrEF) (2022) | ||
| Pioglitazone | Antidiabetic Agent, Thiazolidinedione | Thiazolidinediones (2017) | ||
| Metformin | Antidiabetic Agent; Biguanide | Diabetes Treatment Overview (2017) | ||
| Glipizide | Antidiabetic Agent; Sulfonylurea | Diabetes Treatment Overview (2017) | ||
| Loperamide | Antidiarrheal | Irritable Bowel Syndrome (2018) | ||
| Bismuth subsalicylate | Antidiarrheal | Helicobacter pylori Treatment (2023) | Loperamide | |
| Glucose, oral | Antidote | Glucagon Products Review (2021) | Any formulation | Glucagon |
| Glucagon | Antidote; Hypoglycemia | Glucagon Products Review (2021) | For outpatient use | |
| Naloxone | Antidote; Opioid Antagonist | Opioid Use Disorder (2018) | ||
| 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 | Male Genitourinary Infections (Nov 2022) | ||
| Clotrimazole, topical | Antifungal Agent, Imidazole Derivative | Male Genitourinary Infections (Nov 2022) | ||
| 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 | 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 | |
| Furosemide | Antihypertensive | Heart Failure with Preserved Ejection Fraction (HFpEF) (2022) | ||
| Losartan | Antihypertensive, Angiotensin II Receptor Blocker | Hypertension (2022) | ||
| Lisinopril | Antihypertensive, Angiotensin-Converting Enzyme Inhibitor | Hypertension (2022) | ||
| Carvedilol, immediate-release | Antihypertensive; Beta-Blocker with Alpha-Blocking Activity | Heart Failure with Reduced Ejection Fraction (HFrEF) (2022) | Atenolol; Propranolol | |
| Atenolol | Antihypertensive; Beta-Blocker, Beta1 Selective | Hypertension (2022) | Propranolol | |
| Metoprolol succinate | Antihypertensive; Beta-Blocker, Beta1 Selective | Heart Failure with Reduced Ejection Fraction (HFrEF) (2022) | Atenolol; Carvedilol, immediate-release; Propranolol | |
| Metoprolol tartrate | Antihypertensive; Beta-Blocker, Beta1 Selective | Heart Failure with Reduced Ejection Fraction (HFrEF) (2022) | Atenolol; Carvedilol, immediate-release; Metoprolol succinate | |
| Propranolol | Antihypertensive; Beta-Blocker, Non-Selective | Migraine Prevention (2019) | Atenolol | |
| Amlodipine | Antihypertensive; Calcium Channel Blocker, Dihydropyridine | Hypertension (2022) | Diltiazem | |
| Diltiazem | Antihypertensive; Calcium Channel Blocker, Nondihydropyridine | Hypertension (2022) | Amlodipine | |
| Spironolactone | Antihypertensive; Mineralocorticoid Receptor Antagonists; Potassium Sparing Diuretic | Heart Failure with Reduced Ejection Fraction (HFrEF) (2022) | ||
| Hydrochlorothiazide | Antihypertensive; Thiazide Diuretic | Hypertension (2022) | Chlorthalidone | |
| Chlorthalidone | Antihypertensive; Thiazide-Related Diuretic | Hypertension (2022) | Hydrochlorothiazide | |
| Ezetimibe | Antilipemic Agent, 2-Azetidinone | Hyperlipidemia (2022) | ||
| Atorvastatin | Antilipemic Agent, HMG-CoA Reductase Inhibitor | Hyperlipidemia (2022) | Pravastatin; Rosuvastatin; Simvastatin | |
| Rosuvastatin | Antilipemic Agent, HMG-CoA Reductase Inhibitor | Hyperlipidemia (2022) | Atorvastatin; Pravastatin; Simvastatin | |
| Simvastatin | Antilipemic Agent, HMG-CoA Reductase Inhibitor | Hyperlipidemia (2022) | Atorvastatin; Pravastatin; Rosuvastatin | |
| Pravastatin | Antilipemic Agent, HMG-CoA Reductase Inhibitor | Hyperlipidemia (2022) | Atorvastatin; Rosuvastatin; Simvastatin | |
| Hydroxychloroquine | Antimalarial | Non-biologic DMARDs (2016) | Leflunomide; Methotrexate; Sulfasalazine | |
| Lithium | Antimanic Agent | Bipolar Disorder (2022) | ||
| 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 |
| Sumatriptan | Antimigraine Agent; Serotonin 5-HT 1B/1D Receptor Agonist | Acute Migraine (2021) | Any two (2) triptan medications are required, one must be sumatriptan | |
| Letrozole | Antineoplastic Agent, Aromatase Inhibitor | NPTC Update Spring 2021 | ||
| Anastrozole | Antineoplastic Agent, Aromatase Inhibitor | NPTC Update Spring 2021 | ||
| Tamoxifen | Antineoplastic Agent, Estrogen Receptor Antagonist; Selective Estrogen Receptor Modulator | NPTC Update Spring 2021 | ||
| Leuprolide | Antineoplastic Agent, Gonadotropin-Releasing Hormone Agonist | Treatment of Prostate Cancer (Nov 2022) | **Any depot form** | |
| 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 | Pregnancy & Prenatal Care (2021) | ||
| 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 | |
| Adalimumab-bwwd (Hadlima™) | Antirheumatic, Disease Modifying; Tumor Necrosis Factor (TNF) Blocking Agent | NPTC Update (Jan 2024) | Etanercept | |
| Etanercept | Antirheumatic, Disease Modifying; Tumor Necrosis Factor (TNF) Blocking Agent | TNF Inhibitors (2016) | Adalimumab-bwwd (Hadlima™) | |
| 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 | Treatment of Tuberculosis (2021) | Ethambutol; Isoniazid; Pyrazinamide; Rifapentine | |
| Rifapentine | Antitubercular Agent | Treatment of Tuberculosis (2021) | Ethambutol; Isoniazid; Pyrazinamide; Rifampin | |
| Pyrazinamide | Antitubercular Agent | Treatment of Tuberculosis (2021) | Ethambutol; Isoniazid; Rifampin | |
| Ethambutol | Antitubercular Agent | Treatment of Tuberculosis (2021) | Isoniazid; Pyrazinamide; Rifampin; Rifapentine | |
| Isoniazid | Antitubercular Agent | Treatment of Tuberculosis (2021) | Ethambutol; Pyrazinamide; Rifampin; Rifapentine | |
| Valacyclovir | Antiviral Agent, Oral | 2021 CDC Guidelines for Sexually Transmitted Infections (2021) | ||
| Nirmatrelvir and Ritonavir (Paxlovid®) | Antiviral Agent; Cytochrome P-450 Inhibitor | COVID-19 Update (2023) | ||
| Oseltamivir | Antiviral Agent; Neuraminidase Inhibitor | Treatment of Influenza (2019) | ||
| Clonazepam | Benzodiazepine | Antiseizure Drugs (2021) | Lorazepam | |
| Lorazepam | Benzodiazepine | Alcohol Withdrawal Syndrome (2015) | Clonazepam | |
| Albuterol, metered dose inhaler (MDI) | Beta2 Agonist | Asthma & COPD Guidelines Review (2019) | *Any product* | |
| Albuterol nebulized solution | Beta2 Agonist | Asthma & COPD Guidelines Review (2019) | ||
| Fluticasone/Salmeterol | Beta2 Agonist, Long-Acting; Corticosteroid, Inhalant | LABAs (2019) | Mometasone (Asmanex®) | |
| Beta-3 agonist, Any | Beta3 Agonist | Urinary Incontinence (2023) | Either mirabegron -or- vibegron | Oxybutynin, extended-release; Oxybutynin, immediate-release |
| Alendronate | Bisphosphonate Derivative | Osteoporosis (2016) | ||
| Laxative, bulk-forming | Bulk-forming Laxative | Added July 2011 (Constipation) | *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 | 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) |
| Oral contraceptive pill, triphasic | Contraceptive | Contraception (2016) | *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* | |
| 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 |
| Levonorgestrel (Plan B One-Step®) | Contraceptive, Progestin | Contraception (2016) | *Branded product* | Ulipristal |
| Oral contraceptive pill, progestin only (prescription) | Contraceptive, Progestin | Norgestrel OTC - Opill (2023) | *Any product* | |
| Norgestrel 0.075mg OTC tablets (Opill®) | Contraceptive, Progestin | Norgestrel OTC - Opill (2023) | Oral contraceptive pill, progestin only (prescription) | |
| Medroxyprogesterone acetate, injection (IM and SC formulations) | Contraceptive, Progestin (Injection/Depot) | SC Depot Medroxyprogesterone (2023) | Both SC and IM formulations should be made available | Medroxyprogesterone, oral |
| 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 | Long Acting Reversible Contraception (2021) | 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 | Asthma & COPD Guidelines Review (2019) | *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 | Atopic Dermatitis (2020) | ||
| Calcium | Electrolyte Supplement | Osteoporosis (2016) | *Any formulation* | |
| Estradiol tablets | Estrogen Derivative | Gender-Affirming Medications (2022) | 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 |
| Vancomycin, oral | Glycopeptide | Clostridioides Difficile (2023) | Metronidazole, oral | |
| Hydroxyzine | Histamine H1 Antagonist, First Generation | Anxiety Disorders (2021) | ||
| H1 Antagonist (2nd generation), long-acting | Histamine H1 Antagonist, Second Generation | Allergic Rhinitis (2018) | *Any product* | |
| Famotidine | Histamine H2 Antagonist | Fall 2022 NPTC Meeting Update | ||
| Long-acting monoclonal antibodies, All ACIP-recommended | Immune Globulin; Monoclonal Antibody | Prevention of RSV (2023) | For example: nirsevimab (Beyfortus®) | |
| Azathioprine -OR- Mercaptopurine | Immunosuppresant Agent | Inflammatory Bowel Disease (2023) | Methotrexate; Sulfasalazine | |
| Mercaptopurine -OR- Azathioprine | Immunosuppresant Agent | Inflammatory Bowel Disease (2023) | Methotrexate; Sumatriptan | |
| Insulin aspart / Insulin aspart protamine (NovoLog® Mix 70/30) | Insulin, Combination (70/30 Mix) | Diabetes Treatment Overview (2017) | *Branded product*; Pen Device | |
| Insulin NPH / Regular human insulin (NovoLIN® 70/30) | Insulin, Combination (70/30 Mix) | Diabetes Treatment Overview (2017) | *Branded product* | |
| Insulin NPH (NovoLIN® N) | Insulin, Intermediate-Acting | Diabetes Treatment Overview (2017) | *Branded product* | |
| Insulin glargine, Any | Insulin, Long-Acting | Long-Acting Insulins & Biosimilars (2021) | *Biosimilars of insulin glargine are intended to be included for consideration | |
| Insulin aspart (NovoLog®) | Insulin, Rapid-Acting | Diabetes Treatment Overview (2017) | *Branded product*; Pen Device | |
| Insulin Regular human (NovoLIN® R) | Insulin, Short-Acting | Diabetes Treatment Overview (2017) | *Branded product* | |
| Corticosteroid, intranasal | Intranasal Corticosteroid | Allergic Rhinitis (2018) | *Any product* | |
| Iron, oral | Iron Salt | Pregnancy & Prenatal Care (2021) | *Any oral formulation* | |
| Polyethylene glycol | Laxative, Osmotic | Irritable Bowel Syndrome (2018) | *Any product* | Lactulose |
| Montelukast | Leukotriene Receptor Antagonist | Asthma & COPD Guidelines Review (2019) | ||
| Tiotropium (Spiriva®) | Long-Acting Anticholinergic Agent | Long Acting Muscarinic Antagonists (2019) | *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 | Alzheimer's disease (2019) | ||
| 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 (Jan 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 (2020) | 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 | Erectile Dysfunction (Nov 2022) | Tadalafil | |
| Tadalafil | Phosphodiesterase-5 Enzyme Inhibitor | Erectile Dysfunction (Nov 2022) | Sildenafil | |
| Proton Pump Inhibitor | Proton Pump Inhibitor | GERD & PUD (2018) | *Any product* | |
| Salsalate | Salicylate | Added June 2008 (NSAIDs) | ||
| 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 (2020) | Combination NRT (nicotine patches + any short-acting NRT product) | Bupropion; Varenicline |
| Laxative, stimulant | Stimulant Laxative | Added July 2011 (Constipation) | *Any product* | |
| Levothyroxine | Thyroid Agent | Originally added 2004 | ||
| 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 |
| Corticosteroids (Topical) - High Potency (Class I and II) | Topical Corticosteroids | Alopecia Areata (2022) | Corticosteroid (Topical) - Intermediate Potency; Corticosteroid (Topical) - Low Potency | |
| Tretinoin, topical | Topical Skin Product, Acne | Treatment of Acne vulgaris (2020) | *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, Any | Vitamin D Analog | Vitamin D Analogues in CKD (2010) | *Any product* | |
| Vitamin D Analog, topical | Vitamin D Analog | Psoriasis (2018) | *Any product* | |
| Pyridoxine (Vitamin B6) | Vitamin, Water Soluble | Pregnancy & Prenatal Care (2021) | ||
| Cyanocobalamin (Vitamin B12), oral | Vitamin, Water Soluble | Hematologic Supplements (2016) | ||
| Folic Acid | Vitamin, Water Soluble | Pregnancy & Prenatal Care (2021) | Any product containing >400 mcg / daily dose |
