11 DRUG NAME(S) PREFERRED OPTION(S) AKLIEF, EPIDUO, TWYNEO, WINLEVI adapalene pad 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 ADDERALL amphetamine- dextroamphetamine mixed salts, methylphenidate ADDERALL XR amphetamine- dextroamphetamine mixed salts ext-rel, dexmethylphenidate ext- rel, lisdexamfetamine, methylphenidate ext-rel, AZSTARYS ADRENALIN epinephrine (except NDCs 00093-XXXX-XX, 49502-XXXX- XX), AUVI-Q ADVAIR DISKUS, ADVAIR HFA budesonide-formoterol, fluticasone-salmeterol (except certain NDCs), Breyna, Wixela Inhub, BREO ELLIPTA (except certain NDCs) ADZENYS XR-ODT amphetamine- dextroamphetamine mixed salts ext-rel, dexmethylphenidate ext- rel, lisdexamfetamine, methylphenidate ext-rel, AZSTARYS AIMOVIG AJOVY, EMGALITY, QULIPTA albuterol sulfate CFC-free aerosol (NDCs 00093317431, 66993001968 only) albuterol sulfate CFC-free aerosol (except NDCs 00093317431, 66993001968), levalbuterol tartrate CFC-free aerosol ALEVICYN GEL, ALEVICYN SG, ALEVICYN SOLUTION desonide (except desonide gel), hydrocortisone ALIMTA pemetrexed ALLISON MEDICAL INSULIN SYRI NGES BD ULTRAFINE INSULIN SYRINGES, EMBECTA ULTRAFINE INSULIN SYRINGES (except certain NDCs) ALREX azelastine, bepotastine, cromolyn sodium, loteprednol, olopatadine ALTOPREV atorvastatin, ezetimibe- simvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, simvastatin ALVESCO ASMANEX HFA, PULMICORT DRUG NAME(S) PREFERRED OPTION(S) FLEXHALER AMITIZA lubiprostone, prucalopride, LINZESS, MOVANTIK, SYMPROIC AMRIX cyclobenzaprine (except cyclobenzaprine tablet 7.5 mg) ANDROGEL testosterone gel (except authorized generics for TESTIM and VOGELXO), testosterone solution, NATESTO APIDRA FIASP, NOVOLOG APLENZIN bupropion, bupropion ext-rel (except bupropion ext-rel tablet 450 mg) APTENSIO XR amphetamine- dextroamphetamine mixed salts ext-rel, dexmethylphenidate ext- rel, lisdexamfetamine, methylphenidate ext-rel, AZSTARYS ARAZLO 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 ARNUITY ELLIPTA ASMANEX HFA, PULMICORT FLEXHALER ARTHROTEC celecoxib; diclofenac sodium, ibuprofen, meloxicam tablet or naproxen (except naproxen CR or naproxen suspension) WITH esomeprazole delayed-rel, lansoprazole delayed-rel capsule, omeprazole delayed-rel, or pantoprazole delayed-rel tablet ASCENSIA 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 ASMANEX ASMANEX HFA, PULMICORT FLEXHALER ATACAND, ATACAND HCT candesartan, candesartan- hydrochlorothiazide, irbesartan, irbesartan-hydrochlorothiazide, losartan, losartan- hydrochlorothiazide, olmesartan, olmesartan-hydrochlorothiazide, telmisartan, telmisartan-