Pharmacy
Listing

Preferred Drug List

Frequently Asked Questions

CBCA Rx Claim Form

IPS Mail Order Enrollment Form

Walgreens Prescription Mail Order Form

Walgreens Mail Order Instructions

Walgreens Physician Mail Order Fax Form

Preferred Alternative Prescription Drug List

This chart is a Preferred Alternative chart for the Preferred Drug List. If your medication is listed under the NON-PREFERRED column, you can see what alternative medications are available that are PREFERRED Drugs. In all cases, your physician is expected to select the appropriate drug therapy for an individual patient and provide high quality healthcare.

How to use this Preferred Drug List:

  • Brand Name Medications are listed individually.
  • Generic medications are listed with their Brand Name Equivalents. For example: Ibuprofen (generic for Motrin) means Ibuprofen is the generic for Motrin.
  • Non-Preferred Brand Medications not listed here have a Non-Preferred Copay.
  • This Preferred Medication/Drug List is subject to change without notice.

* - Coverage contingent upon plan benefits.

Member Services Helpdesk: 1-800-383-8737

Non-Preferred
Preferred
ACNE (Topical)
  • Avar
  • Azelex
  • Clenia
  • Cleocin-T
  • Clindets
  • Finevin
  • Novacet
  • Rosula
  • Clindamycin
  • Erythromycin
  • Tretinoin
  • Avita
  • BenzaClin, Benzamycin
  • Differin
  • Duac
  • Finacea
  • MetroGel, MetroLotion, MetroCream
  • Noritate
  • Plexion/TS (generic available)
  • Retin-A Micro
BACK TO TOP
Non-Preferred Preferred
ALLERGIES
Antihistamines
  • Allegra
  • Clarinex/Clarinex D
  • Fexofenadine
  • Allegra D
  • Zyrtec/Zyrtec D
Nasal Spray
  • Beconase AQ
  • Nasacort AQ
  • Nasarel
  • Rhinocort Aqua
  • Flonase
  • Nasonex
BACK TO TOP
Non-Preferred Preferred
ANTIBIOTICS
Cephalosporins
  • Ceclor/Ceclor CD
  • Cedax
  • Lorabid
  • Spectracef
  • Vantin
  • Cefadroxil
  • Cephalexin
  • Cephradine
  • Cefuroxime
  • Cefpodoxime
  • Cefzil
  • Omnicef
Macrolide
  • Biaxin
  • Dynabac
  • Zmax
  • Azithromycin
  • Clarithromycin
  • Erythromycin
  • Biaxin XL
  • Ketek
  • Zithromax
Quinolones
  • Avelox/ABC Pack
  • Cipro/Cipro XR
  • Floxin
  • Maxaquin
  • Noroxin
  • Tequin
  • Ciprofoxacin
  • Ofloxacin
  • Levaquin
Tetracyclines
  • Minocin
  • Doxycycline
  • Tetracycline
  • Minocycline
BACK TO TOP
Non-Preferred Preferred
ASTHMA
Beta-Agonists
  • Maxair
  • Tornalate
  • Xopenex
  • Albuterol
  • Foradil
  • Proventil HFA
  • Serevent/Serevent Diskus
  • Ventolin HFA
Corticosteroids
  • Aerobid/M
  • Azmacort
  • Flovent/Flovent HFA
  • Pulmicort
  • Qvar
BACK TO TOP
Non-Preferred Preferred
ATTENTION DEFICIT HYPERACTIVITY DISORDER
  • Adderall*
  • Concerta*
  • Focalin*
  • Ritalin*/Ritalin SR*
  • Methylphenidate*/SR*
  • Mixed Amphetamine Salts*
  • Adderall XR*
  • Metadate CD*
  • Ritalin LA*
Non-Preferred Preferred
BIRTH CONTROL (ORAL)
Monophasics
  • Alesse
  • Demulen
  • Loestrin Fe
  • Modicon
  • Ortho-Cept
  • Ortho-Cyclen
  • Ortho-Novum 1/50
  • Ovcon
  • Apri
  • Aviane
  • Levlen
  • Levora
  • Microgestin Fe
  • Norinyl
  • Sprintec
  • Nordette
  • Seasonale*
  • Yasmin
Biphasics
  • Mircette
  • Ortho-Novum 10/11
  • Kariva
  • Necon 10/11
Triphasics
  • Triphasil
  • Ortho-Novum 7/7/7
  • Ortho Tri-Cyclen
  • Ortho Tri-Cyclen Lo
  • Tri-Norinyl
  • Cesia
  • Necon 7/7/7
  • Nortrel 7/7/7
  • Velivet
  • Cyclessa
  • Estrostep-Fe
Progrestin Only
  • Micronor
  • Ovrette
  • Camila
  • Errin
  • Nora-Be
  • Nor-Q-D
BACK TO TOP
Non-Preferred Preferred
BLOOD PRESSURE
ACE Inhibitors
  • Accupril, Accuretic
  • Aceon
  • Lotensin/Lotensin HCT
  • Mavik
  • Monopril/Monopril HCT
  • Univasc/Uniretic
  • Benazepril/Benazepril HCTZ
  • Captopril/Captopril HCTZ
  • Enalapril/Enalapril HCTZ
  • Lisinopril/Lisinopril HCTZ
  • Quinapril/Quinaretic
  • Altace
Angiotensin II Blockers
  • Atacand/Atacand HCT
  • Benicar/Benicar HCT
  • Cozaar/Hyzaar
  • Micardis/Micardis HCT
  • Teveten/Teveten HCT
  • Avapro/Avalide
  • Diovan/ Diovan HCT
Calcium Channel Blockers
  • Cardene/SR
  • Cardizem CD
  • Covera-HS
  • DynaCirc/CR
  • Isoptin SR
  • Nimotop
  • Plendil
  • Tiazac
  • Vascor
  • Verelan/PM
  • Diltiazem/SR/CD
  • Felodipine
  • Nifedipine/SR
  • Verapamil/SR
  • Caduet
  • Norvasc
  • Sular
BACK TO TOP
Non-Preferred Preferred
CHOLESTEROL
  • Altoprev
  • Crestor
  • Lescol/XL
  • Mevacor
  • Pravachol
  • Pravagard PAC
  • Welchol
  • Zocor
  • Lovastatin
  • Advicor
  • Antara
  • Lipitor
  • Lofibra
  • Tricor
  • Vytorin
  • Zetia
BACK TO TOP
Non-Preferred Preferred
DEPRESSION
  • Celexa
  • Cymbalta
  • Paxil
  • Prozac/Prozac Weekly
  • Remeron/Remeron Soltab
  • Sarafem
  • Wellbutrin SR


  • Bupropion/SR
  • Citalopram
  • Fluoxetine
  • Mirazapine
  • Paroxetine
  • Effexor/XR
  • Lexapro
  • Paxil CR
  • Paxil Suspension
  • Wellbutrin XL
  • Zoloft
BACK TO TOP
Non-Preferred Preferred
DIABETES
Oral Hypogycelmics
  • Amaryl
  • Glucophage/XR
  • Glucotrol XL
  • Glucovance
  • Glimepiride
  • Glipizide/ER
  • Glyburide
  • Metformin/ER
  • Actos/Actoplus Met
  • Avandia/Avandamet
  • Prandin
  • Precose
  • Starlix
Non-Preferred Preferred
HORMONES (ESTROGENS)
  • Estrace
  • Femring
  • Estradiol
  • Estrogens, esterified
  • Estropipate
  • Alora
  • Cenestin
  • Climara/Climara Pro
  • Esclim
  • Estrace Vaginal Cream,
  • Estraderm
  • Estring
  • Premarin/Vaginal Cream
  • Vagifem
  • Vivelle/DOT
BACK TO TOP
Non-Preferred Preferred
MIGRAINE
Triptans*
  • Amerge*
  • Axert*
  • Frova*
  • Relpax*
  • Imitrex*
  • Maxalt*/Maxalt MLT*
  • Zomig*/Zomig ZMT*
BACK TO TOP
Non-Preferred Preferred
NAUSEA/VOMITING*
  • Anzemet*
  • Kytril*
  • Zofran*/Zofran ODT*
  • Emend*
Non-Preferred Preferred
PAIN
NSAIDs
  • Mobic
  • Diclofenac
  • Etodolac
  • Ibuprofen
  • Indomethacin
  • Ketoprofen
  • Naproxen
  • Naproxen Sodium
  • Arthrotec
  • Celebrex
Muscle Relaxants
  • Norflex
  • Parafon Forte
  • Skelaxin
  • Baclofen
  • Carisoprodol
  • Cyclobenzaprine
  • Methocarbamol
  • Tizanidine
BACK TO TOP
Non-Preferred Preferred
OSTEOPOROSIS
  • Didronel
  • Skelid
  • Actonel/Actonel with Calcium
  • Evista
  • Fosamax/Fosamax plus D
Non-Preferred Preferred
SLEEP DISORDER
  • Lunesta
  • Sonata
  • Rozerem
  • Ambien
Non-Preferred Preferred
ULCER / HEARTBURN
Proton Pump Inhibitors
  • Aciphex
  • Protonix
  • Prilosec
  • Zegerid
  • Omeprazole
  • Nexium
  • Prevacid
BACK TO TOP
Updated 1/2006