18 DRUG NAME(S) PREFERRED OPTION(S) hydromorphone ext-rel, methadone, morphine ext-rel HYZAAR candesartan-hydrochlorothiazide, irbesartan-hydrochlorothiazide, losartan-hydrochlorothiazide, olmesartan-hydrochlorothiazide, telmisartan-hydrochlorothiazide, valsartan-hydrochlorothiazide Iclofenac CP diclofenac sodium, diclofenac sodium gel 1%, diclofenac sodium solution 1.5%, ibuprofen, meloxicam tablet, naproxen (except naproxen CR or naproxen suspension) icosapent ethyl omega-3 acid ethyl esters, VASCEPA INCRUSE ELLIPTA SPIRIVA INDERAL LA, INDERAL XL acebutolol, atenolol, carvedilol, carvedilol phosphate ext-rel, metoprolol succinate ext-rel, metoprolol tartrate, nadolol, nebivolol, pindolol, propranolol, propranolol ext-rel Indocin, INDOCIN diclofenac sodium, ibuprofen, meloxicam tablet, naproxen (except naproxen CR or naproxen suspension) Inflammacin diclofenac sodium, diclofenac sodium gel 1%, diclofenac sodium solution 1.5%, ibuprofen, meloxicam tablet, naproxen (except naproxen CR or naproxen suspension) INNOPRAN XL acebutolol, atenolol, carvedilol, carvedilol phosphate ext-rel, metoprolol succinate ext-rel, metoprolol tartrate, nadolol, nebivolol, pindolol, propranolol, propranolol ext-rel INTRAROSA estradiol vaginal cream, IMVEXXY, VAGIFEM INTUNIV amphetamine- dextroamphetamine mixed salts ext-rel, atomoxetine, dexmethylphenidate ext-rel, guanfacine ext-rel, lisdexamfetamine, methylphenidate ext-rel, AZSTARYS, QELBREE INVELTYS dexamethasone, difluprednate, loteprednol, prednisolone acetate 1% INVOKAMET, INVOKAMET XR SYNJARDY, SYNJARDY XR, XIGDUO XR DRUG NAME(S) PREFERRED OPTION(S) INVOKANA FARXIGA, JARDIANCE isosorbide dinitrate 40 mg isosorbide dinitrate (except isosorbide dinitrate 40 mg), isosorbide mononitrate isotretinoin capsule 25 mg, 35 mg isotretinoin capsule 10 mg, 20 mg, 30 mg, 40 mg JANUMET, JANUMET XR saxagliptin-metformin ext-rel, ZITUVIMET, ZITUVIMET XR JANUVIA saxagliptin, ZITUVIO JATENZO testosterone gel (except authorized generics for TESTIM and VOGELXO), testosterone solution, NATESTO JENTADUETO, JENTADUETO XR saxagliptin-metformin ext-rel, ZITUVIMET, ZITUVIMET XR JORNAY PM amphetamine- dextroamphetamine mixed salts ext-rel, dexmethylphenidate ext- rel, lisdexamfetamine, methylphenidate ext-rel, AZSTARYS KAMDOY desonide (except desonide gel), hydrocortisone Kapzin DC diclofenac sodium, diclofenac sodium gel 1%, diclofenac sodium solution 1.5%, ibuprofen, meloxicam tablet, naproxen (except naproxen CR or naproxen suspension) KEPPRA, KEPPRA XR carbamazepine, carbamazepine ext-rel, divalproex sodium, divalproex sodium ext-rel, eslicarbazepine, gabapentin, lacosamide, lamotrigine, lamotrigine ext-rel, levetiracetam, levetiracetam ext-rel, oxcarbazepine, phenobarbital, phenytoin, phenytoin sodium extended, pregabalin, primidone, tiagabine, topiramate, topiramate ext-rel, valproic acid, zonisamide, BRIVIACT, OXTELLAR XR, XCOPRI KETO-DIASTIX Talk to your doctor ketoconazole foam 2% ketoconazole shampoo 2%, selenium sulfide lotion 2.5%, ZORYVE FOAM Ketodan ketoconazole shampoo 2%, selenium sulfide lotion 2.5%, ZORYVE FOAM ketoprofen capsule 25 mg diclofenac sodium, ibuprofen, meloxicam tablet, naproxen (except naproxen CR or naproxen suspension)

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