17 DRUG NAME(S) PREFERRED OPTION(S) flucytosine capsule 500 mg fluconazole fluocinonide cream 0.1% clobetasol cream, clobetasol foam (except clobetasol emollient foam), clobetasol gel, clobetasol lotion, clobetasol ointment, halobetasol cream, halobetasol ointment fluorouracil cream 0.5% fluorouracil cream 5%, fluorouracil solution, imiquimod fluoxetine tablet (generics for SARAFEM only) fluoxetine (except fluoxetine tablet 60 mg, fluoxetine tablet [generics for SARAFEM]), paroxetine HCl ext-rel (except NDC 60505367503), sertraline fluoxetine tablet 60 mg, FLUOXETINE 60 MG citalopram, escitalopram, fluoxetine (except fluoxetine tablet 60 mg, fluoxetine tablet [generics for SARAFEM]), paroxetine HCl, paroxetine HCl ext-rel (except NDC 60505367503), sertraline, vilazodone, AUVELITY, TRINTELLIX flurandrenolide cream, flurandrenolide lotion desonide (except desonide gel), hydrocortisone flurandrenolide ointment hydrocortisone butyrate cream, hydrocortisone butyrate ointment, hydrocortisone butyrate solution, mometasone, triamcinolone cream, triamcinolone lotion, triamcinolone ointment (except triamcinolone ointment 0.05%) FML FORTE, FML LIQUIFILM dexamethasone, difluprednate, loteprednol, prednisolone acetate 1% FOCALIN XR amphetamine- dextroamphetamine mixed salts ext-rel, dexmethylphenidate ext- rel, lisdexamfetamine, methylphenidate ext-rel, AZSTARYS FORTAMET metformin, metformin ext-rel (except generics for FORTAMET and GLUMETZA) FOSRENOL calcium acetate, sevelamer carbonate, AURYXIA FOSTEUM, FOSTEUM PLUS alendronate, ibandronate, risedronate FREESTYLE LIBRE CONTINUOUS GLUCOSE MONITORING SYSTEM DEXCOM CONTINUOUS GLUCOSE MONITORING SYSTEM FREESTYLE STRIPS AND KITS ACCU-CHEK AVIVA PLUS STRIPS AND KITS, ACCU-CHEK GUIDE DRUG NAME(S) PREFERRED OPTION(S) STRIPS AND KITS, ACCU- CHEK SMARTVIEW STRIPS AND KITS, TRUE METRIX STRIPS AND KITS GLUMETZA metformin, metformin ext-rel (except generics for FORTAMET and GLUMETZA) GLYCOPYRROLATE TABLET 1.5 MG dicyclomine GOLYTELY peg 3350-electrolytes (except generics for MOVIPREP), sodium sulfate-potassium sulfate- magnesium sulfate, CLENPIQ GUARDIAN CONNECT CONTINUOUS GLUCOSE MONITORING SYSTEM DEXCOM CONTINUOUS GLUCOSE MONITORING SYSTEM GUARDIAN REAL-TIME CONTINUOUS GLUCOSE MONITORING SYSTEM DEXCOM CONTINUOUS GLUCOSE MONITORING SYSTEM halcinonide cream desoximetasone (except desoximetasone ointment 0.05%), fluocinonide (except fluocinonide cream 0.1%), BRYHALI HALOG desoximetasone (except desoximetasone ointment 0.05%), fluocinonide (except fluocinonide cream 0.1%), BRYHALI HEPARIN SODIUM IN 5% DEXTROSE enoxaparin, fondaparinux HORIZANT gabapentin, pregabalin, pregabalin ext-rel, GRALISE HUMALOG FIASP, NOVOLOG HUMALOG MIX 50/50 NOVOLOG MIX 70/30 HUMALOG MIX 75/25 NOVOLOG MIX 70/30 HUMULIN 70/30 NOVOLIN 70/30 HUMULIN N NOVOLIN N HUMULIN R NOVOLIN R hydrocortisone butyrate lotion hydrocortisone butyrate cream, hydrocortisone butyrate ointment, hydrocortisone butyrate solution, mometasone, triamcinolone cream, triamcinolone lotion, triamcinolone ointment (except triamcinolone ointment 0.05%) HylaVite generic multivitamins hyoscyamine sulfate ext-rel dicyclomine HYSINGLA ER fentanyl transdermal, hydrocodone ext-rel,