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The following is a list of the most commonly prescribed drugs. It represents anabbreviated version of the preferred drug list that is at the core of your pharmacybenefit plan. The list is not all-inclusive and does not guarantee coverage. In additionto using this list, you are encouraged to ask your doctor to prescribe generic drugs Georgia Preferred Drug List
PLEASE NOTE: The symbol * next to a drug signifies subject to non-preferred
State Health Benefit Plan
status when generic is available throughout the year. For prior authorization
(PA) inquiries or questions regarding the preferred status of drugs not listed on

this document, please contact Express Scripts, Inc. at 1-877-650-9340.
ANTIINFECTIVES
Antidepressants
Insulins
Antivirals
Angiotensin II
Receptor Antagonists
(excluding cartridges) PEGASYS [INJ] [QLL] + HCT Combos
Tertiary Amines
Cephalosporins
Insulin Sensitizers
MUSCULOSKELETAL
Beta-Adrenergic
DERMATOLOGICAL
MEDICATIONS
Antagonists
MEDICATIONS
Oral Hypoglycemics
Macrolides
Antipsychotic Drugs
CNS Muscle Relaxants
Antiacne Drugs
Oral Antifungals
Non-Steroidal Anti-
Inflammatory Agents
Calcium Antagonists
Thyroid Supplements
Penicillins
Other Endocrine
Centrally Acting
Antivertigo &
Quinolones
Antihypertensives
Antiemetics
Antipsoriasis &
Salicylates & Related
Antieczema Drugs
HMG-CoA Reductase
Inhibitors
Class II Narcotics
Topical Antifungals
GASTROINTESTINAL
Corticosteroids
MEDICATIONS
NUTRITION & BLOOD
MODIFIERS
Antispasmodics/Drugs
Topical Antifungal-
Combinations
Affecting GI Motility
Antiplatelet Drugs
Corticosteroids
Keratolytics
Hypolipoproteinemics
Class III Narcotics
Miscellaneous
H. Pylori Drugs
Urinary Antiinfectives
Dermatologicals
Blood Detoxicants
Proton Pump
Inhibitors
CNS Stimulants
Therapeutic Vitamins
Thiazide & Related
& Minerals
ANTINEOPLASTIC/
EAR-NOSE
Other GI Drugs
IMMUNOSUPPRESS-
MEDICATIONS
ANT DRUGS
Drugs Affecting The
Antihypertensives
OBSTETRICAL &
GYNECOLOGICAL
MEDICATIONS
AUTONOMIC & CNS
MEDICATIONS
Drugs Affecting The
Androgen Drugs
Other Drugs For ADHD Nose
Anticonvulsants
Contraceptives
Drugs To Prevent &
Treat Headaches
CARDIOVASCULAR
MEDICATIONS
IMMUNOLOGICALS
ACE Inhibitors + HCT
Sedative/Hypnotics
ENDOCRINE
MEDICATIONS
Interferons
Antidementia Drugs
Glucocorticoids
Selective Serotonin
Pegylated Interferons/
Reuptake Inhibitors
Oral Ribavirin Agents
REVISED JUNE 14, 2005. THIS LIST IS SUBJECT TO CHANGE.
The symbol [G] next to a drug name signifies that a generic is available for at least one or more strengths of the brand medication. Most generics are available at the lowest copay.
2005 Express Scripts, Inc.
PRMT-GAP-05 (06/14/05)
All Rights Reserved
Antihistamine/
Preferred Product Listing for Non-Preferred Drugs
Decongestants
The following is a list of some non-preferred brand medications with examples of selected alternatives that are on the preferred Column 1 lists examples of non-preferred medications.
Column 2 lists some alternatives that can be prescribed. Antitussive &
Expectorants
Non-Preferred
Preferred Alternative Drugs
Non-Preferred
Preferred Alternative Drugs
Beta-2 Adrenergics
Leukotriene Modifiers
Methyl Xanthines
Estrogen Drugs
Other Drugs For
OTC benzoyl peroxide + generic clindamycin Estrogen/Progestin
Combinations
nifedipine extended release, felodipine er, Prenatal Vitamins
lovastatin, Crestor, Lipitor + aspirin, Zocor fluoxetine (daily), citalopram, paroxetine, Progestin Drugs
ciprofloxacin, ofloxacin, Ciloxan ointment*, UROLOGICAL
OTC benzoyl peroxide + generic clindamycin MEDICATIONS
OPHTHALMIC
nifedipine extended release, felodipine er, MEDICATIONS
Anticholinergic
Antispasmodics
Antibacterial Drugs
Other Genitourinary
Products
nifedipine extended release, felodipine er, DIABETIC SUPPLIES
Meters & Strips
Antiglaucoma Drugs
fosinopril/hctz, lisinopril/hctz, quinaretic Corticosteroid Drugs
Other Ophthalmic
fluoxetine (daily), citalopram, paroxetine, The symbol [G] next to a drug name indicates that a generic is available for at least one or more strengths of the brand medication.
The symbol [INJ] next to a drug name indicates that the drug is available in injectable form only.
RESPIRATORY
The symbol [PA] next to a drug name indicates that prior authorization is required.
The symbol [PDMP] next to a drug name indicates the drug is part of the Progressive Drug Management Program.
MEDICATIONS
The symbol [QLL] next to a drug name indicates that quantity or therapy limits exist.
The symbol [SNRI] stands for Serotonin-Norepinephrine Reuptake Inhibitor.
Antihistamines
For the member: Generic medications contain the same active ingredients as their corresponding brand name medications,
although they may look different in color or shape. They have been FDA-approved under strict standards.
For the physician: Please prescribe preferred products and allow generic substitutions when medically appropriate. Thank you.
Brand name drugs are listed in CAPITAL letters.
Generic drugs are listed in lower case letters.
REVISED JUNE 14, 2005. THIS LIST IS SUBJECT TO CHANGE.
The symbol [G] next to a drug name signifies that a generic is available for at least one or more strengths of the brand medication. Most generics are available at the lowest copay.
2005 Express Scripts, Inc.
PRMT-GAP-05 (06/14/05)
All Rights Reserved

Source: http://www.neurosoup.com/pdf/druglistbystate/georgia.pdf

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