20 DRUG NAME(S) PREFERRED OPTION(S) rel MAXALT, MAXALT-MLT eletriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan, NURTEC ODT, TOSYMRA, UBRELVY, ZEMBRACE SYMTOUCH MAXIDEX dexamethasone, difluprednate, loteprednol, prednisolone acetate 1% mefenamic acid (NDC 69336012830 only) diclofenac sodium, ibuprofen, meloxicam tablet, naproxen (except naproxen CR or naproxen suspension) meloxicam capsule diclofenac sodium, ibuprofen, meloxicam tablet, naproxen (except naproxen CR or naproxen suspension) MENEST estradiol MENOSTAR estradiol metaxalone 400 mg cyclobenzaprine (except cyclobenzaprine tablet 7.5 mg) metformin ext-rel (generics for FORTAMET and GLUMETZA only) metformin, metformin ext-rel (except generics for FORTAMET and GLUMETZA) methocarbamol 500 mg (NDC 69036091010 only), methocarbamol 750 mg (NDCs 69036093090, 70868090190 only) cyclobenzaprine (except cyclobenzaprine tablet 7.5 mg) MIACALCIN INJECTION alendronate, calcitonin-salmon, ibandronate, risedronate, teriparatide, PROLIA, TYMLOS MICARDIS, MICARDIS HCT candesartan, candesartan- hydrochlorothiazide, irbesartan, irbesartan-hydrochlorothiazide, losartan, losartan- hydrochlorothiazide, olmesartan, olmesartan-hydrochlorothiazide, telmisartan, telmisartan- hydrochlorothiazide, valsartan, valsartan-hydrochlorothiazide Migergot eletriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan, NURTEC ODT, TOSYMRA, UBRELVY, ZEMBRACE SYMTOUCH MINIVELLE estradiol minocycline ext-rel doxycycline hyclate 20 mg, doxycycline hyclate capsule, minocycline, tetracycline MIRVASO azelaic acid gel, brimonidine gel, ivermectin cream, metronidazole, FINACEA FOAM DRUG NAME(S) PREFERRED OPTION(S) MITIGARE colchicine Mondoxyne NL capsule 75 mg doxycycline hyclate 20 mg, doxycycline hyclate capsule, minocycline, tetracycline MOVIPREP peg 3350-electrolytes (except generics for MOVIPREP), sodium sulfate-potassium sulfate- magnesium sulfate, CLENPIQ MultiPro generic multivitamins mupirocin cream gentamicin, mupirocin ointment MYDAYIS amphetamine- dextroamphetamine mixed salts ext-rel, dexmethylphenidate ext- rel, lisdexamfetamine, methylphenidate ext-rel, AZSTARYS MYRBETRIQ darifenacin ext-rel, fesoterodine ext-rel, oxybutynin ext-rel, solifenacin, tolterodine, tolterodine ext-rel, trospium, trospium ext-rel, GEMTESA MYTESI diphenoxylate-atropine, loperamide NAPRELAN diclofenac sodium, ibuprofen, meloxicam tablet, naproxen (except naproxen CR or naproxen suspension) naproxen CR diclofenac sodium, ibuprofen, meloxicam tablet, naproxen (except naproxen CR or naproxen suspension) naproxen suspension diclofenac sodium, ibuprofen, meloxicam tablet, naproxen (except naproxen CR or naproxen suspension) naproxen-esomeprazole 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 NEO-SYNALAR desonide (except desonide gel) or hydrocortisone WITH gentamicin NEVANAC bromfenac, diclofenac, ketorolac, ILEVRO NEXIUM esomeprazole delayed-rel, lansoprazole delayed-rel capsule, omeprazole delayed-rel, pantoprazole delayed-rel tablet NEXTERONE amiodarone niacin tablet 500 mg niacin ext-rel

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