14 DRUG NAME(S) PREFERRED OPTION(S) 0.05%) COLAZAL balsalazide, mesalamine delayed- rel, mesalamine ext-rel, sulfasalazine, sulfasalazine delayed-rel COLCRYS colchicine COMBIGAN brimonidine-timolol CONCERTA amphetamine- dextroamphetamine mixed salts ext-rel, dexmethylphenidate ext- rel, lisdexamfetamine, methylphenidate ext-rel, AZSTARYS CONTOUR NEXT STRIPS AND KI TS ACCU-CHEK AVIVA PLUS STRIPS AND KITS, ACCU-CHEK GUIDE STRIPS AND KITS, ACCU- CHEK SMARTVIEW STRIPS AND KITS, TRUE METRIX STRIPS AND KITS CONTOUR STRIPS AND KITS ACCU-CHEK AVIVA PLUS STRIPS AND KITS, ACCU-CHEK GUIDE STRIPS AND KITS, ACCU- CHEK SMARTVIEW STRIPS AND KITS, TRUE METRIX STRIPS AND KITS CONTRAVE orlistat, QSYMIA, SAXENDA, WEGOVY CORDRAN TAPE clobetasol cream, clobetasol foam (except clobetasol emollient foam), clobetasol gel, clobetasol lotion, clobetasol ointment, halobetasol cream, halobetasol ointment COREG CR acebutolol, atenolol, carvedilol, carvedilol phosphate ext-rel, metoprolol succinate ext-rel, metoprolol tartrate, nadolol, nebivolol, pindolol, propranolol, propranolol ext-rel COZAAR candesartan, irbesartan, losartan, olmesartan, telmisartan, valsartan CRESEMBA itraconazole CRESTOR atorvastatin, ezetimibe- simvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, simvastatin cyclobenzaprine ext-rel capsule, cyclobenzaprine tablet 7.5 mg cyclobenzaprine (except cyclobenzaprine tablet 7.5 mg) CYMBALTA desvenlafaxine ext-rel, duloxetine, venlafaxine, venlafaxine ext-rel capsule CYTOMEL levothyroxine, liothyronine, SYNTHROID DRUG NAME(S) PREFERRED OPTION(S) DALIRESP roflumilast DARAPRIM pyrimethamine DAYTRANA amphetamine- dextroamphetamine mixed salts ext-rel, dexmethylphenidate ext- rel, lisdexamfetamine, methylphenidate ext-rel, AZSTARYS DAYVIGO doxepin, eszopiclone, ramelteon, zolpidem, zolpidem ext-rel, BELSOMRA, QUVIVIQ DELZICOL balsalazide, mesalamine delayed- rel, mesalamine ext-rel, sulfasalazine, sulfasalazine delayed-rel DEPAKOTE, DEPAKOTE ER, DEPAKOTE SPRINKLE carbamazepine, carbamazepine ext-rel, clonazepam, divalproex sodium, divalproex sodium ext- rel, eslicarbazepine, ethosuximide, 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 desonide gel desonide (except desonide gel), hydrocortisone desoximetasone ointment 0.05% hydrocortisone butyrate cream, hydrocortisone butyrate ointment, hydrocortisone butyrate solution, mometasone, triamcinolone cream, triamcinolone lotion, triamcinolone ointment (except triamcinolone ointment 0.05%) DETROL LA darifenacin ext-rel, fesoterodine ext-rel, oxybutynin ext-rel, solifenacin, tolterodine, tolterodine ext-rel, trospium, trospium ext-rel, GEMTESA dexchlorpheniramine levocetirizine Dexifol generic multivitamins DEXILANT esomeprazole delayed-rel, lansoprazole delayed-rel capsule, omeprazole delayed-rel, pantoprazole delayed-rel tablet dexlansoprazole delayed-rel esomeprazole delayed-rel, lansoprazole delayed-rel capsule, omeprazole delayed-rel,