15 DRUG NAME(S) PREFERRED OPTION(S) pantoprazole delayed-rel tablet diclofenac potassium capsule 25 mg, diclofenac potassium tablet 25 mg diclofenac sodium, ibuprofen, meloxicam tablet, naproxen (except naproxen CR or naproxen suspension) diclofenac potassium powder diclofenac sodium, ibuprofen, naproxen (except naproxen CR or naproxen suspension) diclofenac sodium solution 2% diclofenac sodium, diclofenac sodium gel 1%, diclofenac sodium solution 1.5%, ibuprofen, meloxicam tablet, naproxen (except naproxen CR or naproxen suspension) Diclofex DC diclofenac sodium, diclofenac sodium gel 1%, diclofenac sodium solution 1.5%, ibuprofen, meloxicam tablet, naproxen (except naproxen CR or naproxen suspension) Diclosaicin diclofenac sodium, diclofenac sodium gel 1%, diclofenac sodium solution 1.5%, ibuprofen, meloxicam tablet, naproxen (except naproxen CR or naproxen suspension) DIFFERIN LOTION 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 diflorasone cream, diflorasone ointment desoximetasone (except desoximetasone ointment 0.05%), fluocinonide (except fluocinonide cream 0.1%), BRYHALI dihydroergotamine spray eletriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan, NURTEC ODT, TOSYMRA, UBRELVY, ZEMBRACE SYMTOUCH DILANTIN 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 DRUG NAME(S) PREFERRED OPTION(S) extended, pregabalin, primidone, tiagabine, topiramate, topiramate ext-rel, valproic acid, zonisamide, BRIVIACT, OXTELLAR XR, XCOPRI diltiazem ext-rel (generics for CARDIZEM LA only) diltiazem ext-rel (except generics for CARDIZEM LA), verapamil ext- rel DIOVAN, DIOVAN HCT candesartan, candesartan- hydrochlorothiazide, irbesartan, irbesartan-hydrochlorothiazide, losartan, losartan- hydrochlorothiazide, olmesartan, olmesartan-hydrochlorothiazide, telmisartan, telmisartan- hydrochlorothiazide, valsartan, valsartan-hydrochlorothiazide Diphen Elixir levocetirizine DIVIGEL estradiol DORYX MPC doxycycline hyclate 20 mg, doxycycline hyclate capsule, minocycline, tetracycline doxepin cream desonide (except desonide gel), hydrocortisone, pimecrolimus, tacrolimus, EUCRISA, OPZELURA, VTAMA, ZORYVE CREAM doxycycline hyclate delayed-rel tablet doxycycline hyclate 20 mg, doxycycline hyclate capsule, minocycline, tetracycline doxycycline hyclate tablet 50 mg, doxycycline hyclate tablet 75 mg, doxycycline hyclate tablet 150 mg doxycycline hyclate 20 mg, doxycycline hyclate capsule, minocycline, tetracycline doxycycline monohydrate capsule 75 mg, doxycycline monohydrate capsule 150 mg doxycycline hyclate 20 mg, doxycycline hyclate capsule, minocycline, tetracycline doxycycline monohydrate delayed-rel capsule ORACEA DULERA budesonide-formoterol, fluticasone-salmeterol (except certain NDCs), Breyna, Wixela Inhub, BREO ELLIPTA (except certain NDCs) DUOBRII tazarotene WITH desoximetasone (except desoximetasone ointment 0.05%), fluocinonide (except fluocinonide cream 0.1%) or BRYHALI; calcipotriene ointment, calcipotriene solution, ENSTILAR, VTAMA, ZORYVE CREAM, ZORYVE FOAM DYANAVEL XR amphetamine- dextroamphetamine mixed salts