10 testosterone gel (except authorized generics for TESTIM and VOGELXO) testosterone solution tetracycline tiagabine timolol maleate solution TOBRADEX OINTMENT tobramycin tobramycin-dexamethasone tolterodine tolterodine ext-rel topiramate topiramate ext-rel torsemide TOSYMRA TOUJEO tramadol (except tramadol tablet 100 mg) tramadol ext-rel tablet travoprost trazodone TRELEGY ELLIPTA TRESIBA tretinoin triamcinolone cream, lotion, ointment (except triamcinolone ointment 0.05%) triamterene triamterene- hydrochlorothiazide trifluridine TRIJARDY XR trimethobenzamide TRINTELLIX trospium trospium ext-rel TRUE METRIX STRIPS AND KITS TRULICITY TWIIST INSULIN INFUSION PUMP AND SUPPLIES TWYNEO U UBRELVY V VAGIFEM valacyclovir valganciclovir valproic acid valsartan valsartan-hydrochlorothiazide VALTOCO vancomycin capsule VASCEPA VELTASSA venlafaxine venlafaxine ext-rel capsule verapamil ext-rel VERQUVO VEVYE VIBERZI vilazodone VIOKACE VRAYLAR VTAMA W warfarin WEGOVY WINLEVI Wixela Inhub X XARELTO XCOPRI XDEMVY XHANCE XIFAXAN 550 MG XIGDUO XR XULTOPHY Y YUPELRI Z zafirlukast ZEGALOGUE ZEMBRACE SYMTOUCH ZENPEP ziprasidone ZITUVIMET ZITUVIMET XR ZITUVIO zolmitriptan zolpidem zolpidem ext-rel zonisamide ZORYVE CREAM ZORYVE CREAM ZORYVE FOAM ZUBSOLV PREFERRED OPTIONS LIST FOR FORMULARY DRUG REMOVALS AND DRUGS COVERED ONLY WHEN PREFERRED OPTIONS ARE NOT CLINICALLY APPROPRIATE The preferred options listed below are a broad representation of available treatment options and do not necessarily represent clinical equivalency. DRUG NAME(S) PREFERRED OPTION(S) ABILIFY aripiprazole, clozapine, lurasidone, olanzapine, quetiapine, quetiapine ext-rel, risperidone, ziprasidone, VRAYLAR ACANYA adapalene (except adapalene pad), benzoyl peroxide, clindamycin gel (except NDC 68682046275), clindamycin solution, clindamycin-benzoyl peroxide, dapsone, erythromycin solution, erythromycin-benzoyl peroxide, tazarotene, tretinoin, AKLIEF, EPIDUO, TWYNEO, WINLEVI ACIPHEX, ACIPHEX SPRINKLE esomeprazole delayed-rel, lansoprazole delayed-rel capsule, DRUG NAME(S) PREFERRED OPTION(S) omeprazole delayed-rel, pantoprazole delayed-rel tablet Activite generic multivitamins ACTOS pioglitazone ACUVAIL bromfenac, diclofenac, ketorolac, ILEVRO acyclovir cream acyclovir capsule, acyclovir tablet, valacyclovir ACZONE adapalene (except adapalene pad), benzoyl peroxide, clindamycin gel (except NDC 68682046275), clindamycin solution, clindamycin-benzoyl peroxide, dapsone, erythromycin solution, erythromycin-benzoyl peroxide, tazarotene, tretinoin,