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Tcc 2006 pdl

Group Health Insurance Specialists
TCC, Inc. Preferred Drug List
January 2006
NOTE: Drugs in ALL
ALPHAGAN P
CAPS are considered
Brand-Named Drugs.

abapentin
alprazolam
Drugs that are all
lowercase are

ACCU-CHEK
considered Generic
ARIMIDEX
ACCUTANE
ALTOPREV
ARISTOCORT A
acebutolol
ARISTOCORT R
acetaminophen w/butalbital
amantadine
AROMASIN
acetaminophen w/codeine
ARTANE ELX
acetasol HC
AMBENYL SYP
ACLOVATE
aspirin w/codeine
ACTIGALL
amiloride
amiloride/hctz
aminophylline
ATACAND HCT
amiodarone
ACULAR PF
amitriptyline
atenolol
acyclovir
amitriptyline/chlordiazepoxide
atenolol/chlorthalidone
ADDERALL XR
amitriptyline/perphenazine
amnesteem
atropine sulfate
AGENERASE
amoxicillin
ATROVENT
AGGRENOX
amoxicillin/clavulanate
ATROVENT ORAL INHALER
AK-TRACIN OIN OP
amphetamine salt combination
albuterol
ampicillin
AVANDAMET
ALDACTAZIDE
ANAFRANIL
ALDACTONE
anagrelide
ANALPRAM-HC CRE
ANALPRAM-HC LOT
ANAPROX DS
ANDRODERM
ANDROGEL
ANTABUSE
ALLEGRA-D
ANTIVERT
allopurinol
APRESOLINE
azathioprine
The PDL is subject to change at any time during the year without prior notification to members or physicians. CILOSTAZOL
AZULFIDINE
CILOXAN OIN
cimetidine
bacitracin
CALCIMAR
CIPRO HC SUS OTIC
baclofen
calcitriol
CIPRO SUSPENSION
BACTROBAN CRM
BD SYRINGES
CIPRODEX
benazepril
ciprofloxacin
benazepril/hctz
captopril
citalopram
captopril/hctz
CITRACAL PRENATAL RX
claravis
BENZAC AC
carbamazepine
clarithromycin
CARBATROL
clemastine fumarate
BENZACLIN
BENZAGEL
carbidopa/levodopa
CLEOCIN-T
benzonatate
carisoprodol
clidinium/chlordiazepoxide
benzoyl peroxide
CARNITOR
benztropine mesylate
cartia xt
clindamycin
betamethasone dipropionate
CLINORIL
betamethasone valerate
clobetasol propionate
BETAPACE
cefaclor
clobetasol propionate-e
BETAPACE AF
cefaclor er
clomiphene citrate
betaxolol
cefadroxil
clomipramine
bethanechol
cefuroxime
clonazepam
CELEBREX
clonidine
BETOPTIC-S
CELLCEPT
clorazepate dipotassium
BIAXIN XL
CENESTIN
clotrimazole
bisoprolol fumarate
cephalexin
clotrimazole/betamethasone
bisoprolol fumarate/hctz
colchicine
BLEPH-10
chloral hydrate
COLESTID
BRETHINE
chlordiazepoxide
COMBIPATCH
brimonidine
chloroquine phosphate
COMBIVENT
bromocriptine
chlorothiazide
COMBIVIR
bumetanide
chlorpromazine
COMPAZINE
chlorpropamide
bupropion
chlorthalidone
CONCERTA
bupropion extended release
chlorzoxazone
CONDYLOX
cholestyramine
COPAXONE
buspirone
cholestyramine light
butalbital compound
choline mag trisalicylate
butorphanol tartrate
The PDL is subject to change at any time during the year without prior notification to members or physicians. DESQUAM-E
CORTIFOAM
DESQUAM-X
doxazosin mesylate
cortisone acetate
doxycycline hyclate
COUMADIN
DETROL LA
doxycycline monohydrate
dexamethasone
DEXEDRINE
duradrin
DURAGESIC
CRIXIVAN
dextroamphetamine sulfate
dyphylline
cromolyn sodium
cryselle
econazole nitrate
CUPRIMINE
diazepam
CUTIVATE
DIAZEPAM CONC
CYCLESSA
DIAZEPAM SOLN
EFFEXOR XR
cyclobenzaprine
diclofenac potassium
cyclopentolate
diclofenac sodium
cyclophosphamide
dicloxacillin sodium
cyclosporine
dicyclomine
EMBREX 600
CYMBALTA
didanosine delayed release
cyproheptadine
diethylpropion
DIFFERIN
CYTOVENE
diflorasone diacetate
diflunisal
enalapril maleate
DANOCRINE
enalapril maleate/hctz
dantrolene
DILANTIN
DILANTIN INFATABS
enpresse
DILAUDID
ENTOCORT EC
DECADRON
diltia xt
DECONAMINE
diltiazem
diltiazem extended release
EPIVIR HBV
DEPAKENE
DIPENTUM
DEPAKOTE
diphenhydramine
ergotamine tartrate/caffeine
DEPAKOTE ER
diphenoxylate w/atropine
DEPAKOTE SPRINKLE
DIPROLENE
erythromycin
DEPO-PROVERA
DIPROSONE
erythromycin base
DERMA-SMOOTH OIL FS
dipyridamole
erythromycin ethylsuccinate
desipramine
DISALCID
erythromycin stearate
desmopressin acetate
disopyramide phosphate
erythromycin/sulfisoxazole
desonide
DITROPAN XL
ESKALITH
estazolam
desoximetasone
DOSTINEX
ESTRADERM
The PDL is subject to change at any time during the year without prior notification to members or physicians. estradiol transdermal
hydralazine
FORTOVASE
hydrochlorothiazide
estropipate
hydrocodone/acetaminophen
ethambutol
FOSAMAX PLUS D
hydrocortisone
ethosuximide
fosinopril
hydrocortisone valerate
etodolac
furosemide
hydromorphone
etoposide
hydroxychloroquine sulfate
hydroxyurea
GABITRIL
hydroxyzine hci
ganciclovir
hydroxyzine pamoate
GANTRISIN SUSP
hyoscyamine
GARAMYCIN
famotidine
gemfibrozil
FARESTON
gentamicin sulfate
ibuprofen
fenoprofen calcium
glimepiride
fentanyl Patch
glipizide
imipramine
fexofenadine
glipizide extended release
GLUCAGEN
indapamide
FLEXERIL
GLUCAGON
INDERAL LA
GLUCOVANCE
glyburide
indomethacin
glyburide micronized
INFERGEN
floxacin
glyburide/metformin
FLOXIN OTIC
GOLYTELY PACKET
INTAL MDI
fluconazole
GRIS-PEG
fluocinolone acetonide
guanfacine
INVIRASE
fluocinonide
ipratropium bromide
fluocinonide-e
HABITROL
isoniazid
fluorometholone
FLUOROPLEX
fluorouracil
haloperidol
isosorbide dinitrate
fluoxetine
isosorbide mononitrate
fluphenazine
isoxsuprine
flurazepam
flurbiprofen
flutamide
fluvoxamine maleate
folic acid
The PDL is subject to change at any time during the year without prior notification to members or physicians. lorazepam
methocarbamol
ktoconazole
LORAZEPAM INTENSOL
methotrexate
ketoprofen
methyclothiazide
ketorolac tromethamine
LOTRIMIN
methyldopa
METHYLIN
KLONOPIN
low-ogestrel
methylphenidate
methylphenidate extended release
methylprednisolone
labetalol
metipranolol
lactulose
LYSODREN
metoclopramide
LAMICTAL
metolazone
LAMISIL TABLETS
MACROBID
metoprolol tartrate
MALARONE
METROGEL
METROGEL-VAGINAL
MATULANE
metronidazole
LEUCOVORIN CALCIUM
mexiletine
LEUKERAN
MAXAIR AUTOH
leuprolide acetate
MIACALCIN
LEVAQUIN
MAXIVATE
microgestin
MEBENDAZOLE
microgestin fe
levobunolol
meclizine
midazolam
midodrine
levothroid
medroxyprogesterone acetate
minocycline
levothyroxine sodium
medroxyprogesterone acetate
minoxidil
injectable
mefloquine
MIRCETTE
megestrol acetate
mirtazapine
MELLARIL CON
misoprostol
lindane shampoo
meperidine
mometasone furoate
LIORESAL
meperidine/promethazine
morphine sulfate
meprobamate
morphine sulfate extended release
lisinopril
mercaptopurine
lisinopril/hctz
MESTINON
lithium carbonate
METADATE CD
mupirocin oint
lithium carbonate extended release
METADATE ER
METAGLIP
metaproterenol sulfate
loperamide
metformin
MYSOLINE
metformin extended release
methazolamide
nabumetone
The PDL is subject to change at any time during the year without prior notification to members or physicians. NUTROPIN
pentazocine/naloxone
naloxone
NUTROPIN AQ
pentoxifylline extended release
naltrexone
NUVARING
pergolide
NAPROSYN
nystatin
perphenazine
naproxen
nystatin/triamcinolone
PERSA-GEL
naproxen sodium
PERSANTINE
omeprazole delayed release
phenazopyridine
NASACORT AQ
phendimetrazine
ONETOUCH
phenobarbital
NATAFORT
phentermine HCl
orphenadrine citrate
phenytoin sodium extended
ORTHO EVRA
neomycin sulfate
ORTHO TRI-CYCLEN LO
pilocarpine
NEUPOGEN
pindolol
NEURONTIN
oxaprozin
piroxicam
oxazepam
podofilox
oxybutynin chloride
polymyxin b/trimethoprim
nicardipine
oxycodone
POLY-VI-FLOR
NICODERM
oxycodone/acetaminophen
potassium chloride
nifedipine
oxycodone/aspirin
PRAVACHOL
nifedipine extended release
OXYCONTIN
prazosin
NILANDRON
NITRO-DUR
PRECARE CONCEIVE
nitrofurantoin macrocrystal
nitroglycerin
PACERONE
PRED MILD
NITROSTAT
PANCREASE
prednisolone
nizatidine
pancrelipase
prednisone
PREDNISONE SOLN
NOLVADEX
papaverine
NORITATE
PARLODEL
PREMARIN
NORMODYNE
PREMESIS RX
paroxetine hci
PREMPHASE
nortriptyline
PEDIAPRED
PREVACID
peg 3350/electrolytes
primidone
probenecid
PEG-INTRON
probenecid w/colchicine
penicillin vk
prochlorperazine
NULYTELY
pentazocine/acetaminophen
The PDL is subject to change at any time during the year without prior notification to members or physicians. sulindac
PROLOPRIM
rifampin
promethazine
RISPERDAL
PROMETRIUM
SYNTHROID
propoxyphene
RITALIN LA
propoxyphene
ROCALTROL
TAMBOCOR
nap/acetaminophen
propranolol
RONDEC-DM
tamoxifen citrate
propranolol/hctz
TAPAZOLE
propylthiouracil
TARGRETIN
PROTOPIC
ROXICODONE
PROVENTIL
TEGRETOL –XR
temazepam
PROVIGIL
salsalate
TEMOVATE
PSORCON E
selegiline
PULMICORT
pyridostigmine
SEREVENT
terazosin
SEROQUEL
terconazole
QUESTRAN
silver sulfadiazine
TESSALON
QUIBRON-T
tetracycline
quinapril
SINEMET CR
quinapril/hctz
SINEQUAN
THEO-DUR
SINGULAIR
theophylline
ranitidine
SLO-BID GYRO
THIOGUANINE
RAPAMUNE
SLO-PHYLLIN
thioridazine
RAZADYNE
SORBITRATE
thiothixene
RAZADYNE ER
sotalol hci
ticlopidine
SPECTAZOLE
timolol maleate soln
spironolactone
tizanidine
spironolactone/hctz
TOBRADEX
RESCRIPTOR
sprintec
tobramycin sulfate
RESTORIL
tolazamide
STRATTERA
tolmetin sodium
RETIN-A MICRO
STRONGSTART
RETROVIR
sucralfate
TOPICORT
sulfacetamide/prednisolone
TOPROL-XL
RHINOCORT AQUA
sulfamethoxazole/trimethoprim
torsemide
ribavirin
sulfasalazine
TRACLEER
The PDL is subject to change at any time during the year without prior notification to members or physicians. tramadol
ZONEGRAN
tramadol/acetaminophen
trazodone
VIRACEPT
ZYLOPRIM
tretinoin
VIRAMUNE
triamcinolone
ZYPREXA ZYDIS
triamterene/hctz
VITAFOL-PN
triazolam
ZYRTEC-D
trifluoperazine
VIVELLE-DOT
trihexyphenidyl
What is a Preferred Drug List (PDL)?
TRILAFON
VOLTAREN
A PDL is a list of prescription medica-
tions chosen for their clinical value and

TRILEPTAL
cost-effectiveness by an independent
trimethobenzamide/benzocaine
panel of physicians and pharmacists.
With our PDL, you and your doctor

trimethoprim
warfarin sodium
have the freedom to choose the medica-
trinessa
tion that works best for you. Since
there may be more than one drug avail-

tri-previfem
WELLBUTRIN XL
able for your medical condition, we
tri-sprintec
encourage you to use generic and pre-
ferred brand-name drugs whenever

possible to help manage your prescrip-
TRIZIVIR
tion costs. NOTE: The PDL is subject
to change without notice at any time

TYLENOL/COD TAB
during the year without prior notice to
members or physicians.
ULTRASE MT
ULTRAVATE
FOR YOUR INFORMATION: The
Preferred Drug List is not inclusive nor

does it guarantee coverage, but
UROCIT-K
represents a summary of prescription
coverage. The plan members specific

prescription benefit plan may have a
different co-pay for specific products on
the list.

Co-payment or co-pay means the
VALISONE
ZANAFLEX
amount a plan member is required to
pay for a prescription in accordance

valproic acid
ZANTAC SYRUP
with a Plan, which may be a deductible,
ZARONTIN
a percentage of the prescription price, a
fixed amount or other charge, with the

VANCOCIN HC
ZAROXOLYN
balance, if any, paid by a Plan.
VASOCIDIN
Unless specifically indicated, drug list
products will include all dosage forms.

verapamil
The Preferred Drug List contains
prescription brand name medicines that

verapamil extended release
are registered and/or unregistered
VESANOID
ZITHROMAX
trademarks of third-party
pharmaceutical companies unrelated to

and unaffiliated with TCC, Inc. These
ZOFRAN ODT
trademarks are included here for
informational purposes only and are not

intended to imply or suggest any
affiliation between TCC, Inc. and such
third-party pharmaceutical companies.

The PDL is subject to change at any time during the year without prior notification to members or physicians.

Source: http://www.pressomatic.com/thomascooper/upload/TCC%202006%20PDL.pdf

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