Pharmacy Instructions & Formulary

This is the home page for all things pharmacy in EHHOP. This includes information on routine prescribing, EHHOP's formulary, as well as information about supplies and storage in clinic.

Quick Links

Below are a few quick links that are helpful while managing patients in and between clinic.

Medication Management on Epic

DOH enrollment instructions

Dispensary of Hope (DOH) information

Prescribing Urgent and In-Clinic Medications

Refill Instructions for Patients

Storage, Locker Codes, and Diabetes Supplies

PDAP Medications

PPI Prescribing Guide

Reimbursements

Using the Formulary

The formulary can be used to search for medications that are 'on-formulary', which means they are offered by the Mount Sinai pharmacy.

If a medication is marked 'Do Not Prescribe - Apply for PDAP', that means it is a specialty medication that we obtain for free through the use of PDAP (Patient Drug Assistance Programs) from pharmaceutical companies. To request a PDAP medication, please follow the instructions on this form.

If a medication is not on formulary and can't be obtained through PDAP, please see if there is a similar medication on formulary that can be prescribed.

If a medication is not on formulary, can't be obtained by PDAP, and can't be replaced, we can sometimes try to obtain it through purchasing with cash at a local pharmacy; however, please always check-in with the pharmacy team prior to pursuing this option.

If a medication is marked 'Available In-Clinic - See TS', it can be prescribed in clinic for urgent, single treatments.

If a medication is marked 'Available via DOH - Flexible/Primary', this should be the preferred medication since it is free of charge. If it is marked 'Primary', order it normally and the patient can pick it up normally. If this is their first time receiving medications via DOH, tell the patient not to go to the pharmacy until Tuesday. If it is marked 'Flexible', please order normally through Epic and email james.blum@icahn.mssm.edu that it is being prescribed. The medication will arrive in 7-10 days so make sure the patient knows it won't be ready immediately.

Please make sure patients do not pick up medications on Mondays before 12:00 p.m. so the pharmacy can be sure the medications are ready.

If you have any questions/difficulties please contact the pharmacy chair, Sharon Barazani.

• Formulary
• GENERAL
• Calcium Acetate (Phoslo)
  $0.42 (667 mg) GENERAL
• Sodium Bicarbonate
  $0.01 (650 mg) GENERAL
• Methylprednisolone
  4mg, 16mg GENERAL Available via DOH - Flexible
• Colchicine
  300mg, 0.6 GENERAL Available via DOH - Flexible
• Naltrexone
  $0.79 (50mg tab) GENERAL
• ANALGESICS
• Acetaminophen
  $0.01 (325mg) ANALGESICS
• Aspirin
  325mg ANALGESICS Available In Clinic - See TS Available via DOH - Flexible
• Ibuprofen
  $0.07 (400mg), $0.04 (600mg) ANALGESICS
• Celecoxib
  100mg, 200mg ANALGESICS Available via DOH - Primary Oral NSAID
• Naproxen
  $0.07 (500mg), $0.04 (250mg) ANALGESICS
• Diclofenac
  50mg tablet, 3% topical gel ANALGESICS NSAID Available via DOH - Primary
• Lidocaine
  5% Topical Ointment ANALGESICS Available via DOH - Flexible Local Anesthetic
• Lidocaine
  5% Transdermal Patch ANALGESICS Available via DOH - Flexible Local Anesthetic
• Codeine/Acetaminophen (Tylenol 3)
  $0.04 (30mg/300mg) ANALGESICS
• Oxycodone/Acetaminophen (Percocet)
  $0.08 (5mg/325mg) ANALGESICS
• Morphine Extended Release
  $0.21 (15mg), $0.54 (30mg) ANALGESICS
• Morphine SR
  $0.42 (30mg), $2.42 (60mg) ANALGESICS
• Hydromorphone
  $0.09 (2mg), $0.11 (4mg) ANALGESICS
• Oxycodone
  $0.10 (5mg) ANALGESICS
• Gabapentin (Neurontin)
  $0.58 (600mg), $0.05 (300mg), $0.06 (400mg), $0.03 (100mg) ANALGESICS
• Amitriptyline
  25mg, 50mg, 75mg ANALGESICS Available via DOH - Primary
• Pregabalin (Lyrica)
  $3.16 (75mg, 100mg), $2.88 (25mg, 50mg) ANALGESICS Do Not Prescribe - Apply for PDAP
• Duloxetine
  20mg, 30mg, 60mg ANALGESICS Available via DOH - Primary
• Fentanyl Patches
  $2.88 (25mg, 50mg), $3.16 (75mg, 100mg) ANALGESICS Do Not Prescribe - Apply for PDAP
• Liquid Morphine (Roxanol)
  $3.16 (75mg, 100mg), $2.88 (25mg, 50mg) ANALGESICS Do Not Prescribe
• VITAMINS
• Calcium Carbonate
  $0.01 (648mg), $0.02 (1250mg) VITAMINS
• Cyanocobalamin Tablets and Injections (B12)
  10000mcg/10mL VITAMINS Available via DOH - Flexible
• Folate
  $0.01 (1mg) VITAMINS
• Iron Sulfate (Ferrous sulfate)
  $0.01 (325mg) VITAMINS
• Ferrous Gluconate 325mg
  $0.01 (325mg) VITAMINS
• Multivitamin
  $0.01 VITAMINS
• Multigen Caplet
  VITAMINS Available via DOH - Flexible Multivitamin
• Prena1
  VITAMINS Available via DOH - Flexible Multivitamin
• Multivitamin High Potency
  $0.03 VITAMINS
• Potassium Chloride
  8mEq VITAMINS Available via DOH - Primary Electrolyte Replacement
• Pyridoxine B6
  $0.01 (50mg) VITAMINS
• Thiamine B1
  $0.01 (50mg) VITAMINS
• Vitamin D
  $0.01 (400IU) VITAMINS
• Aqueous Vitamin D
  4000u/mL VITAMINS Available via DOH - Flexible
• Vitamin D2 Ergocalciferol
  $0.12 (50000IU) VITAMINS
• Vitamin D3 Cholecalciferol
  $0.01 () VITAMINS
• Folbee Plus
  VITAMINS Available via DOH - Primary
• Folbic (Folic Acid-B6-B12)
  2mg-2.5mg-25mg VITAMINS Available via DOH - Primary
• VitaPearl Prenatal Multivitamin
  VITAMINS Available via DOH - Primary
• ANTIFUNGALS
• Clotrimazole Topical Cream
  $0.91 (15g) ANTIFUNGALS Topical
• Bacitracin Ointment 0.5%
  $3.21 (1oz) ANTIFUNGALS Topical
• Econazole Nit Cream 1%
  $4.28 (15g) ANTIFUNGALS Topical
• Erythromycin Ophthalmic Ointment 0.5%
  $6.39 (3.5 g) ANTIFUNGALS Topical
• Ketoconazole Cream 2%
  $30.04 (30g) ANTIFUNGALS Topical
• Econazole Nitrate (Spectrazole)
  $4.79 () ANTIFUNGALS Do Not Prescribe Topical
• Metrogel
  ANTIFUNGALS Do Not Prescribe Topical
• Clindamycin
  1% Solution, 150mg ANTIFUNGALS Check with TS Topical
• Patanol
  $36 (5mL) ANTIFUNGALS Do Not Prescribe - Apply for PDAP Eye Drops
• ANTIMICROBIALS
• Penicillin V
  $0.07 (250mg) ANTIMICROBIALS Oral antibiotics / antifungals / antivirals / anti-mycobacterium
• Amoxicillin
  $0.06 (500mg) ANTIMICROBIALS Oral antibiotics / antifungals / antivirals / anti-mycobacterium
• Doxycycline
  100mg ANTIMICROBIALS Available via DOH - Primary Tetracycline
• Doxycycline Hyclate
  50mg ANTIMICROBIALS Available via DOH - Flexible Tetracycline
• Amoxicillin / Clavulanate
  600-42.9mg (Pediatric - DOH) ANTIMICROBIALS Available via DOH - Flexible Oral antibiotics / antifungals / antivirals / anti-mycobacterium
• Cephalexin
  $0.10 (500mg), $0.07 (250mg) ANTIMICROBIALS Oral antibiotics / antifungals / antivirals / anti-mycobacterium
• Ceftriaxone
  $0.71 () ANTIMICROBIALS Oral antibiotics/ Injectable antibiotics
• Ciprofloxacin
  $0.28 (750mg), $0.19 (500mg), $0.11 (250mg) ANTIMICROBIALS Oral antibiotics / antifungals / antivirals / anti-mycobacterium
• Levaquin (Levofloxacin)
  250mg ANTIMICROBIALS Oral antibiotics / antifungals / antivirals / anti-mycobacterium
• Erythromycin
  $2.68 (250mg) ANTIMICROBIALS Oral antibiotics / antifungals / antivirals / anti-mycobacterium
• Azithromycin
  $0.64 (250mg) ANTIMICROBIALS Oral antibiotics / antifungals / antivirals / anti-mycobacterium
• Fluconazole
  50mg ANTIMICROBIALS Available In Clinic - See TS Available via DOH - Primary Oral antibiotics / antifungals / antivirals / anti-mycobacterium
• Itraconazole
  $0.53 (100mg), $0.06 (50mg), $0.20 (200mg), $0.37 (150mg) ANTIMICROBIALS Oral antibiotics / antifungals / antivirals / anti-mycobacterium
• Ketoconazole
  $0.16 (200mg) ANTIMICROBIALS Oral antibiotics / antifungals / antivirals / anti-mycobacterium
• Metronidazole
  $0.03 (250mg) ANTIMICROBIALS Oral antibiotics / antifungals / antivirals / anti-mycobacterium
• Miconazole 2% Vaginal Cream
  $6.85 (1 tube) ANTIMICROBIALS Oral antibiotics / antifungals / antivirals / anti-mycobacterium
• Nitrofurantoin (Macrobid)
  50mg, 100mg ANTIMICROBIALS Available In Clinic - See TS Available via DOH - Flexible Oral antibiotics
• Isoniazid
  $0.14 (300mg) ANTIMICROBIALS Oral antibiotics / antifungals / antivirals / anti-mycobacterium
• Rifampin
  $0.54 (400mg) ANTIMICROBIALS Oral antibiotics / antifungals / antivirals / anti-mycobacterium
• RIPE Therapy
  $0.54 (400mg) ANTIMICROBIALS Check First With TS Oral antibiotics / antifungals / antivirals / anti-mycobacterium
• Terbinafine
  $0.9 (250mg) ANTIMICROBIALS Oral antibiotics / antifungals / antivirals / anti-mycobacterium
• TMP/SMX (Bactrim)
  80/400mg ANTIMICROBIALS Available In Clinic - See TS Available via DOH - Flexible Oral antibiotics / antifungals / antivirals / anti-mycobacterium
• Valacyclovir (Valtrex)
  500mg, 1000mg ANTIMICROBIALS Available via DOH - Primary Oral antibiotics / antifungals / antivirals / anti-mycobacterium
• Famciclovir
  $1.76 (500mg) ANTIMICROBIALS Oral antibiotics / antifungals / antivirals / anti-mycobacterium
• Acyclovir
  5% Topical Ointment ANTIMICROBIALS Available via DOH - Flexible Oral antibiotics / antifungals / antivirals / anti-mycobacterium
• PeP/PrEP
  $0.00 (0) ANTIMICROBIALS Do Not Prescribe - Apply for PDAP or Jack Martin Clinic Oral antibiotics / antifungals / antivirals / anti-mycobacterium
• Ganciclovir
  $0.05 (200mg) ANTIMICROBIALS Restricted Use - Check With TS Oral antibiotics / antifungals / antivirals / anti-mycobacterium
• Oseltamivir
  30mg, 75mg ANTIMICROBIALS Available via DOH - Flexible Antiviral
• Moxifloxacin
  400mg ANTIMICROBIALS Quinolone
• Vancomycin
  250mg Powder for Injection ANTIMICROBIALS Available via DOH - Flexible Antiviral
• ANTIHYPERTENSIVES/CARDIOVASCULAR
• Lisinopril
  $0.03 (5mg), $0.04 (10mg), $0.06 (20mg), $0.11 (40mg) ANTIHYPERTENSIVES/CARDIOVASCULAR Available In Clinic - See TS ACE inhibitors
• Enalapril
  $0.02 (20mg) ANTIHYPERTENSIVES/CARDIOVASCULAR ACE inhibitors
• Losartan (Cozaar)
  $0.07 (100mg), $0.04 (50mg), $0.05 (25mg) ANTIHYPERTENSIVES/CARDIOVASCULAR ARBs
• Valsartan
  $0.81 (80mg) ANTIHYPERTENSIVES/CARDIOVASCULAR ARBs
• Hydralazine
  25mg ANTIHYPERTENSIVES/CARDIOVASCULAR Available via DOH - Primary Available In Clinic - See TS
• Furosemide (Lasix)
  20mg, 40mg, 80mg ANTIHYPERTENSIVES/CARDIOVASCULAR Available via DOH - Primary Diuretics
• Chlorthalidone
  25mg ANTIHYPERTENSIVES/CARDIOVASCULAR Available via DOH - Primary Diuretics
• Hydrochlorothiazide
  12.5mg ANTIHYPERTENSIVES/CARDIOVASCULAR Available via DOH - Flexible Diuretics
• Metolazone
  2.5mg, 5mg ANTIHYPERTENSIVES/CARDIOVASCULAR Available via DOH - Primary Diuretics
• Spironolactone
  50mg, 100mg ANTIHYPERTENSIVES/CARDIOVASCULAR Available via DOH - Primary
• Acetazolamide
  $1.96 (250mg) ANTIHYPERTENSIVES/CARDIOVASCULAR Diuretics
• Propranolol
  10mg, 20mg, 40mg ANTIHYPERTENSIVES/CARDIOVASCULAR Available via DOH - Primary Beta-blockers
• Atenolol
  25mg, 50mg, 100mg ANTIHYPERTENSIVES/CARDIOVASCULAR Available via DOH - Primary Beta-blockers
• Carvedilol
  3.125mg, 6.25mg, 12.5mg, 25mg ANTIHYPERTENSIVES/CARDIOVASCULAR Available via DOH - Primary Beta-blockers
• Metoprolol Succinate
  25mg ANTIHYPERTENSIVES/CARDIOVASCULAR Available via DOH - Primary Beta-blockers
• Metoprolol Tartrate
  25mg, 50mg, 100mg ANTIHYPERTENSIVES/CARDIOVASCULAR Available via DOH - Primary Beta Blockers
• Labetalol
  100mg ANTIHYPERTENSIVES/CARDIOVASCULAR Available In Clinic - See TS Available via DOH - Primary Beta Blockers
• Nifedipine (ER)
  30mg, 60mg, 90mg ANTIHYPERTENSIVES/CARDIOVASCULAR Available via DOH - Primary Calcium Channel Blockers
• Amlodipine
  5mg ANTIHYPERTENSIVES/CARDIOVASCULAR Available In Clinic - See TS Calcium Channel Blockers
• Amlodipine Besylate
  2.5mg ANTIHYPERTENSIVES/CARDIOVASCULAR Available via DOH - Primary Antihypertensive
• Diltiazem
  120mg ANTIHYPERTENSIVES/CARDIOVASCULAR Available via DOH - Primary Calcium Channel Blockers
• Verapamil
  $0.56 (120mg), $0.05 (80mg) ANTIHYPERTENSIVES/CARDIOVASCULAR Calcium Channel Blockers
• Verapamil (SR)
  $0.16 (240mg), $0.56 (120mg), $0.17 (180mg) ANTIHYPERTENSIVES/CARDIOVASCULAR Calcium Channel Blockers
• Nitroglycerin
  0.4mg/hr Transdermal Patch ANTIHYPERTENSIVES/CARDIOVASCULAR Available via DOH - Primary Nitrate
• Isosorbide Mononitrate
  $0.12 (60mg), $0.18 (30mg) ANTIHYPERTENSIVES/CARDIOVASCULAR Nitrate
• Digoxin
  $0.26 (0.25mg), $0.26 (0.125mg) ANTIHYPERTENSIVES/CARDIOVASCULAR
• Terazosin
  $0.04 (1mg), $0.12 (5mg) ANTIHYPERTENSIVES/CARDIOVASCULAR
• Clonidine
  0.1mg, 0.2mg, 0.3mg ANTIHYPERTENSIVES/CARDIOVASCULAR Available In Clinic - See TS Available via DOH - Primary
• Olmesartan
  20mg ANTIHYPERTENSIVES/CARDIOVASCULAR Antihypertensive
• Prazosin
  1 mg, 5mg ANTIHYPERTENSIVES/CARDIOVASCULAR Available via DOH - Primary Antihypertensive
• Captopril
  12.5mg, 25mg ANTIHYPERTENSIVES/CARDIOVASCULAR Available via DOH - Primary Antihypertensive
• Digitek
  0.125mg, 0.25mg ANTIHYPERTENSIVES/CARDIOVASCULAR Available via DOH - Primary Antiarrhythmic
• Digoxin
  0.125mg, 0.25mg ANTIHYPERTENSIVES/CARDIOVASCULAR Available via DOH - Primary Antiarrhythmic
• Triamterene
  37.5-25mg, 75-50mg ANTIHYPERTENSIVES/CARDIOVASCULAR Available via DOH - Primary
• Benazepril
  10mg, 20mg ANTIHYPERTENSIVES/CARDIOVASCULAR Available via DOH - Flexible
• Felodipine
  10mg ANTIHYPERTENSIVES/CARDIOVASCULAR Available via DOH - Flexible
• ANTIHYPERLIPIDEMICS
• Simvastatin (Zocor)
  10mg, 20mg, 40mg ANTIHYPERLIPIDEMICS Available via DOH - Primary Statins
• Rosuvastatin (Crestor)
  $0.06 (5 mg), $0.23 (10mg) ANTIHYPERLIPIDEMICS Statins
• Pravastatin (Pravachol)
  40mg ANTIHYPERLIPIDEMICS Available via DOH - Primary Statins
• Atorvastatin (Lipitor)
  10mg, 20mg, 40mg ANTIHYPERLIPIDEMICS Available via DOH - Primary Statins
• Ezetimibe/Simvastatin
  10/10mg, 10/20mg, 10/40mg ANTIHYPERLIPIDEMICS Available via DOH - Primary Antihyperlipidemic
• Ezetimibe
  1mg, 10mg ANTIHYPERLIPIDEMICS Available via DOH - Primary Antihyperlipidemic
• Red yeast rice
  $0.16 (80mg), $0.07 (10mg), $0.18 (20mg), $0.07 (40mg) ANTIHYPERLIPIDEMICS Statins
• Niacin (Vit B6)
  $0.2 (500mg) ANTIHYPERLIPIDEMICS Statins
• Gemfibrozil (Lopid)
  $0.15 (600mg) ANTIHYPERLIPIDEMICS Statins
• Fenofibrate (Tricor, Triglide)
  145mg, 54mg ANTIHYPERLIPIDEMICS Available via DOH - Primary Antihyperlipidemic
• Colesevelam
  625mg ANTIHYPERLIPIDEMICS Available via DOH - Primary Antihyperlipidemic
• ANTICOAGULANTS
• Aspirin
  325mg ANTICOAGULANTS Available via DOH - Primary
• Warfrin(Coumadin)
  $0.04 (2mg, 2.5mg, 3mg, 4mg, 5mg), $0.03 (1mg), $0.05 (5mg, 7.5mg, 10mg) ANTICOAGULANTS
• Clopidogrel
  300mg ANTICOAGULANTS Available via DOH - Flexible
• Apixaban (Eliquis)
  $6.24 (2.5/5mg) ANTICOAGULANTS Do Not Prescribe - Apply for PDAP
• Dabigatran (Pradaxa)
  $5.75 (110mg) ANTICOAGULANTS
• Dabigatran (Pradaxa)
  $4.49 (75/150mg) ANTICOAGULANTS<br>
• Rivaroxaban (Xarelto)
  $11.62 (10/15/20mg) ANTICOAGULANTS
• DIABETES
• Metformin
  500mg, 850mg, 1000mg DIABETES Available via DOH - Primary Orals
• Glimepiride
  4mg DIABETES Preferred Sulfonylurea Orals
• Glipizide (ER)
  5mg, 10mg DIABETES Available via DOH - Flexible Orals
• Glucometer Lancets
  DIABETES Available in clinic
• Glucometer Test Strips
  DIABETES Available in clinic
• Glucometers
  DIABETES Available in clinic
• Insulin NPH (Novolin)
  $128.16 (10 mL) DIABETES Do Not Prescribe - See TS for Management
• Insulin Lantus (Basaglar)
  DIABETES Do Not Prescribe - Apply for PDAP
• Insulin syringes
  DIABETES Available in clinic
• Rosiglitazone (Avandia)
  DIABETES Do Not Prescribe
• Januvia
  DIABETES Do Not Prescribe - Apply for PDAP
• Dulaglutide (Trulicity)
  DIABETES Do Not Prescribe - Apply for PDAP Consider as Substitute for Liraglutide (Victoza)
• GI DRUGS
• Tums (Calcium Carbonate)
  $0.91 (4mg) GI DRUGS Review PPI Guidelines Above
• Maalox (Calcium Carbonate)
  $0.91 (4mg) GI DRUGS Review PPI Guidelines Above
• Omeprazole
  10mg, 20mg GI DRUGS Review PPI Guidelines Above Available via DOH - Primary
• Esomeprazole (Nexium)
  20mg, 40mg GI DRUGS Do Not Prescribe - Review PPI Guidelines Above Available via DOH - Primary
• Famotidine (Pepcid)
  20mg GI DRUGS Available via DOH - Primary Antiulcer
• Ranitidine (Zantac)
  $0.05 (150mg) GI DRUGS Preferred H2RA
• Pantoprazole (Protonix)
  40mg GI DRUGS Preferred PPI - Review PPI Guidelines Above Available via DOH - Primary
• Lansoprazole
  15mg GI DRUGS Available via DOH - Flexible Antiulcer
• Misoprostol
  $0.35 (100mg), $0.45 (50mg) GI DRUGS Mucosal protection
• Docusate sodium (Colace)
  $0.02 (100mg) GI DRUGS Laxatives and stool softeners
• Dicyclomine
  20mg GI DRUGS Available via DOH - Primary Anticholinergic
• Senna
  $0.01 (8.6mg) GI DRUGS Laxatives and stool softeners
• Bisacodyl (Dulcolax)
  $0.01 (5mg), $0.12 (10mg) GI DRUGS Laxatives and stool softeners
• Miralax (polyethylene glycol)
  $0.01 (5mg), $0.12 (10mg) GI DRUGS Laxatives and stool softeners
• MoviPrep (polyethylene glycol in 2L, colonoscopy prep)
  $0.12 (10mg), $0.01 (5mg) GI DRUGS Laxatives and stool softeners
• Erythromycin
  $2.68 (250mg) GI DRUGS Pro-motility
• Meclizine
  12.5mg, 25mg GI DRUGS Available via DOH - Flexible Antiemetic
• Ondansetron (Zofran)
  4mg, 8 mg GI DRUGS Available In Clinic - See TS Available via DOH - Primary Antiemetic
• Metoclopramide
  5mg, 10mg GI DRUGS Available via DOH - Primary Anti-emetic
• Simethicone
  $0.01 (80mg) GI DRUGS Other
• Loperamide
  2mg GI DRUGS Available via DOH - Flexible Antidiarrheal
• Prochlorperazine
  5mg, 10mg GI DRUGS Available via DOH - Primary Antiemetic
• Sucralfate
  1g GI DRUGS Available via DOH - Primary Antiulcer
• PSYCHOTROPICS
• Fluoxetine (Prozac)
  10mg, 20mg PSYCHOTROPICS Available via DOH - Primary Antidepressants/SSRIs
• Citalopram (Celexa)
  10mg, 20mg, 40mg PSYCHOTROPICS Available via DOH - Primary Antidepressants/SSRIs
• Escitalopram
  5mg, 20mg PSYCHOTROPICS Available via DOH - Flexible Antidepressants/SSRIs
• Mirtazapine
  15mg, 30mg, 45mg PSYCHOTROPICS Available via DOH - Primary Antidepressants/SSRIs
• Paroxetine (Paxil)
  20mg, 40mg PSYCHOTROPICS Available via DOH - Primary Antidepressants/SSRIs
• Sertraline (Zoloft)
  $0.05 (25 mg), $0.04 (50 mg), $0.05 (100 mg) PSYCHOTROPICS Antidepressants/SSRIs
• Buproprion (Wellbutrin)
  75mg PSYCHOTROPICS Available via DOH - Primary Antidepressants/SNRIs
• Nortryptiline
  $0.11 (25mg), $0.07 (10mg) PSYCHOTROPICS Tricyclic Antidepressants
• Amitriptyline
  $0.22 (25mg), $0.02 (10mg), $0.47 (50mg) PSYCHOTROPICS
• Lithium
  300mg PSYCHOTROPICS Available via DOH - Primary Antipsychotics
• Haloperidol (Haldol)
  $0.40-$0.59 (0.5mg, 1mg, 2mg, 5mg, 10mg) PSYCHOTROPICS Antipsychotics: Typical
• Haloperidol Decanoate
  100mg/mL PSYCHOTROPICS Available via DOH - Flexible
• Risperidone (Risperadol)
  2mg, 3mg PSYCHOTROPICS Available via DOH - Flexible Antipsychotics: Atypicals
• Chlorpromazine
  50mg, 100 mg, 200 mg PSYCHOTROPICS Available via DOH - Primary Antipsychotic
• Fluphenazine
  10mg PSYCHOTROPICS Available via DOH - Primary Antipsychotic
• Quetiapine (Seroquel)
  50mg PSYCHOTROPICS Available via DOH - Flexible Antipsychotics: Atypicals
• Aripiprazole (Abilify)
  2mg, 5mg, 10mg, 15mg, 20mg, 30mg PSYCHOTROPICS Available via DOH - Flexible Antipsychotics: Atypicals
• Olanzapine
  2.5mg, 5mg, 10mg, 15mg, 20mg PSYCHOTROPICS Available via DOH - Flexible Antipsychotics: Atypicals
• Alprazolam (Xanax)
  $0.03 (0.25mg, 0.5mg, 1mg) PSYCHOTROPICS Benzodiazepenes
• Lorazepam (Ativan)
  $0.03 (1mg), $0.02 (0.5mg), $0.05 (2mg) PSYCHOTROPICS Benzodiazepenes
• Clonazepam (Klonopin)
  $0.01 (0.5mg), $0.03 (1mg), $0.04 (2mg) PSYCHOTROPICS Benzodiazepenes
• Cyclobenzaprine (Flexeril)
  5mg, 7.5mg, 10mg PSYCHOTROPICS Available via DOH - Flexible Muscle relaxant
• Zolpidem (Ambien)
  $0.04 (10mg), $0.02 (5mg) PSYCHOTROPICS Anti-insomnia/non-BZD
• Trazodone
  50mg PSYCHOTROPICS Available via DOH - Primary Anti-insomnia/non-BZD
• Buspirone
  5mg, 10mg, 15mg, 30mg, 75mg PSYCHOTROPICS Available via DOH - Primary Anxiolytic
• Topamax (Topiramate)
  $0.03 (25mg), $0.05 (100mg) PSYCHOTROPICS Anticonvulsants
• Valproate/Valproic Acid (Depakote)
  $0.07-$0.13 (125mg, 250mg, 500mg) PSYCHOTROPICS Anticonvulsants
• Lamotrigine (Lamictal)
  25mg, 100mg, 150mg, 200mg PSYCHOTROPICS Available via DOH - Flexible Anticonvulsants
• Carbamazepine
  $0.67 (200mg) PSYCHOTROPICS Anti-convulsants
• Divalproex
  250mg, 500mg PSYCHOTROPICS Available via DOH - Primary Anticonvulsant
• Gabapentin (Neurontin)
  $0.15 (600mg), $0.06 (400mg), $0.04 (300mg), $0.02 (100mg) PSYCHOTROPICS Anticonvulsants
• Pregabalin (Lyrica)
  $3.16 (75mg, 100mg), $2.88 (25mg, 50mg) PSYCHOTROPICS Do Not Prescribe - Apply for PDAP Anticonvulsants
• Pramipexole
  0.25mg PSYCHOTROPICS Antiparkinsonian
• Rizatriptan
  10mg PSYCHOTROPICS Available via DOH - Primary Anti-Migraine
• Ropinirole
  0.5mg, 1mg, 2mg PSYCHOTROPICS Available via DOH - Primary Antiparksonian
• Venlafaxine
  37.5mg, 75 mg PSYCHOTROPICS Available via DOH - Primary Antidepressant
• Zolmitriptan
  2.5mg, 5mg PSYCHOTROPICS Available via DOH - Flexible Anti-Migraine
• Clomipramine
  50mg PSYCHOTROPICS Available via DOH - Flexible Antidepressant
• Doxepin
  10mg, 25mg, 50mg, 100mg PSYCHOTROPICS Available via DOH - Primary Antidepressant
• Paliperidone
  3mg, 6mg PSYCHOTROPICS Available via DOH - Primary Atypical Antipsychotic
• Phenytoin
  100mg PSYCHOTROPICS Available via DOH - Primary Anticonvulsant
• Sumatriptan
  25mg, 50mg PSYCHOTROPICS Available via DOH - Primary Anti-Migraine
• Sumatriptan Injection
  6mg/0.5mL PSYCHOTROPICS Available via DOH - Primary Anti-Migraine
• Tizanidine
  2mg, 4mg PSYCHOTROPICS Available via DOH - Primary
• Levetiracetam
  100mg/ml solution, 500mg PSYCHOTROPICS Available via DOH - Flexible
• Perphenazine
  2mg PSYCHOTROPICS Available via DOH - Flexible
• ASTHMA/COPD
• Prednisone
  5mg, 10mg ASTHMA/COPD Available In Clinic - See TS Available via DOH - Flexible Systemic corticosteroids
• Albuterol HFA Inhaler
  0.08% 3mL ASTHMA/COPD Available In Clinic - See TS Available via DOH - Flexible Bronchodilators
• Levalbuterol
  0.63mg/3mL ASTHMA/COPD Available via DOH - Primary SABA
• Fluticasone Inhaler (Flovent)
  ASTHMA/COPD Do Not Prescribe - Apply for PDAP Inhaled corticosteroids
• Montelukast (Singulair)
  4mg, 10mg ASTHMA/COPD Available via DOH - Flexible
• Fluticasone/Salmeterol (Advair)
  0.02% ASTHMA/COPD Do Not Prescribe - Apply for PDAP ICS/LABA
• Ipratroprium Bromide(Atrovent)
  0.02% ASTHMA/COPD Available via DOH - Primary ICS/LABA
• Budesonide/Formeterol (Symbicort)
  ASTHMA/COPD Do Not Prescribe - Apply for PDAP ICS/LABA
• Asthma Medication Spacer
  ASTHMA/COPD Do Not Prescribe - Available in Clinic Other
• ALLERGIES
• Diphenhydramine (Benadryl)
  $0.02 (50mg), $0.02 (25mg) ALLERGIES First generation anti-histamine
• Loratadine (Claritin)
  10mg ALLERGIES Available via DOH - Primary Second generation anti-histamine
• Cetirizine (Zyrtec)
  10mg ALLERGIES Available via DOH - Primary Second generation anti-histamine
• Isotonic Saline Spray 0.65% 45mL
  $0.59 () ALLERGIES Sprays
• Beclomethasone Nasal (Beconase AQ)
  $0.59 () ALLERGIES Do Not Prescribe - Apply for PDAP Sprays
• Fluticasone Nasal Spray (Flonase)
  $3.55 () ALLERGIES Sprays
• Hydroxyzine
  $0.09 (25mg), $0.12 (10mg), $0.15 (50mg) ALLERGIES Sprays
• Epipen
  ALLERGIES Check First with TS Available In Clinic - See TS $150 (Dual Pack)
• DERMATOLOGY
• Minocycline
  75mg DERMATOLOGY Available via DOH - Primary
• Hydrocortisone 1% Cream
  $1.21 (30g) DERMATOLOGY Mild potency
• Hydrocortisone 2.5% Cream
  DERMATOLOGY Available via DOH - Flexible Mild potency
• Hydrocortisone 0.5% Ointment
  $2.76 (30g) DERMATOLOGY Mild potency
• Hydrocortisone 1% Ointment
  $0.76 (30g) DERMATOLOGY Mild potency
• Triamcinolone Acetonide (TAC)
  0.1% Topical Cream DERMATOLOGY Check First with TS Available via DOH - Flexible Moderate potency
• Mometasone Furoate 0.1% cream 45gm
  $7.25 () DERMATOLOGY Moderate potency
• Betamethasone 0.1%
  $2.74 (15g) DERMATOLOGY Moderate potency
• Clobetasol Cream
  0.05% DERMATOLOGY Available via DOH - Primary High potency
• Fluocinonide (Lidex)
  0.05% Topical Gel DERMATOLOGY Check First with TS Available via DOH - Flexible Topical
• BenzaClin Gel
  $380 () DERMATOLOGY Do Not Prescribe
• Dovonex
  $204 DERMATOLOGY Do Not Prescribe Topical
• Metrogel
  $89 DERMATOLOGY Do Not Prescribe Topical
• MALE GU
• Terazosin
  $0.07 (1mg, 2mg, 5mg) MALE GU BPH
• Finasteride
  $0.06 (5mg) MALE GU BPH
• Tamsulosin (Flomax)
  0.4 mg MALE GU Available via DOH - Flexible BPH
• Doxazosin
  1mg, 2mg, 4mg MALE GU Available via DOH - Primary BPH
• Sildenafil (Viagra)
  $0.23 (5mg) MALE GU Not Available - Consider Cialis
• Tadalafil (Cialis)
  20mg MALE GU Do Not Prescribe - Apply for PDAP
• Caverject (Alprostadil)
  $0.23 (5mg) MALE GU Do Not Prescribe - Apply for PDAP
• IMMUNE/METABOLIC/ENDOCRINE
• Prednisone
  $0.10 (1mg), $0.02 (5mg), $0.12 (10mg), $0.04 (20mg), $0.16 (50mg) IMMUNE/METABOLIC/ENDOCRINE Immune Modulators
• Methotrexate
  2.5mg IMMUNE/METABOLIC/ENDOCRINE Available via DOH - Primary Immune Modulators
• Hydroxychloroquine (Plaquenil)
  $0.11 (200mg) IMMUNE/METABOLIC/ENDOCRINE Immune Modulators
• Azathioprine
  $0.12 (50mg) IMMUNE/METABOLIC/ENDOCRINE Immune Modulators
• Sulfasalazine
  $0.17 (500mg) IMMUNE/METABOLIC/ENDOCRINE Immune Modulators
• Levothyroxine
  25mcg, 50mcg, 75mcg, 88mcg, 100mcg, 112mcg, 125mcg, 137mcg, 150mcg, 175mcg, 200mcg IMMUNE/METABOLIC/ENDOCRINE Available via DOH - Primary Hypothyroid
• Methimazole
  $0.18 (10mg) IMMUNE/METABOLIC/ENDOCRINE Hyperthyroid
• Propylthiouracil
  $0.35 (50mg) IMMUNE/METABOLIC/ENDOCRINE Hyperthyroid
• Alendronate (Flosamax)
  35mg IMMUNE/METABOLIC/ENDOCRINE Available via DOH - Flexible
• Risedronate
  150mg IMMUNE/METABOLIC/ENDOCRINE Available via DOH - Primary Bone Resorption Inhibitor
• Allopurinol
  100mg, 300mg IMMUNE/METABOLIC/ENDOCRINE Available via DOH - Primary Antigout
• Ursodiol
  300mg IMMUNE/METABOLIC/ENDOCRINE Available via DOH - Primary Bile Acid
• SMOKING CESSATION
• Nicotine Patches
  $0.60 (70mg) SMOKING CESSATION Call 1-866-NY-QUITS
• Buproprion (Wellbutrin)
  75mg SMOKING CESSATION Available via DOH - Primary Antidepressants/SNRIs
• Topiramate
  25mg, 100mg SMOKING CESSATION Available via DOH - Flexible
• VACCINES: All Vaccines in IMA cabinet.
• Hepatitis A
  $0.03 (25mg) VACCINES: All Vaccines in IMA cabinet.
• Hepatitis B
  $0.03 (25mg) VACCINES: All Vaccines in IMA cabinet.
• Pneumovax
  $0.03 (25mg) VACCINES: All Vaccines in IMA cabinet.
• Tetanus toxoid
  $0.03 (25mg) VACCINES: All Vaccines in IMA cabinet.
• Diptheria and Tetanus
  $0.03 (25mg) VACCINES: All Vaccines in IMA cabinet.
• Diptheria, Pertussis and Tetanus
  $0.03 (25mg) VACCINES: All Vaccines in IMA cabinet.
• MMR
  $0.03 (25mg) VACCINES: All Vaccines in IMA cabinet.
• Polio
  $0.03 (25mg) VACCINES: All Vaccines in IMA cabinet.
• Meningococcal
  $0.03 (25mg) VACCINES: All Vaccines in IMA cabinet.
• Zoster Vax
  VACCINES: All Vaccines in IMA cabinet. Do Not Prescribe or Administer
• Gardasil
  $0.03 (25mg) VACCINES: All Vaccines in IMA cabinet. Not Available in WHC
• Meningococcal
  $0.03 (25mg) VACCINES: All Vaccines in IMA cabinet.
• Gardasil (HPV)
  $0.03 (25mg) VACCINES: All Vaccines in IMA cabinet.
• CONTRACEPTION/FEMALE GU
• Ethinyl estradiol w/ Norgestimate (Ortho-Tricyclen)
  $10.08 (28-day pack) CONTRACEPTION/FEMALE GU Preferred
• Ethinyl estradiol w/ Norethidrone (Ortho-Novum) 1/35
  $16.52 (28-day pack) CONTRACEPTION/FEMALE GU
• Ethinyl estradiol w/ Desogestrel (Ortho-cept)
  $17.64 (28-day pack) CONTRACEPTION/FEMALE GU
• Ethinyl estradiol w/ Levonorgestrel triphasic (Tri-phasil)
  $17.64 (28-day pack) CONTRACEPTION/FEMALE GU
• Ethinyl estradiol w/ Levonorgestrel (Alesse)
  $19.04 (28-day pack) CONTRACEPTION/FEMALE GU
• Norelgestromin/ethinyl estradiol (Ortho-evra, Xulane)
  $99 (Box of 3 patches) CONTRACEPTION/FEMALE GU Do Not Prescribe - Apply for PDAP
• Copper IUD
  $0 (1 device) CONTRACEPTION/FEMALE GU Available Free at WHC
• Liletta Hormonal IUD
  $0 (1 device) CONTRACEPTION/FEMALE GU Available Free at WHC
• Nexplanon Progestin Implant
  $0 (1 device) CONTRACEPTION/FEMALE GU Available Free at WHC
• Medroxyprogesterone IM injection (Depo Provera)
  $0 (dose) CONTRACEPTION/FEMALE GU Available Free at WHC
• Levonorgestrel (Plan B)
  CONTRACEPTION/FEMALE GU
• Estradiol Vaginal Cream
  0.01% CONTRACEPTION/FEMALE GU Available via DOH - Primary Estrogen
• Estradiol
  0.5mg, 1mg CONTRACEPTION/FEMALE GU Available via DOH - Primary Estrogen
• ESTROGEN THERAPY
• Medroxyprogesterone 2.5mg tab
  $0.04 (1 tab) ESTROGEN THERAPY
• Condoms
  $0.23 (5mg) ESTROGEN THERAPY
• Conjugated Estrogens Vaginal Cream
  $45 () ESTROGEN THERAPY Do Not Prescribe - Apply for PDAP
• OPHTHALMOLOGY: 1 mL ~ 20 drops
• Visine (Artificial) Tears
  $5.16 (0.5oz) OPHTHALMOLOGY: 1 mL ~ 20 drops lubricant
• Artificial Tear (Night-time) Gel
  $1.90 OPHTHALMOLOGY: 1 mL ~ 20 drops lubricant
• Latanoprost 0.005%
  $6 (2.5mL) OPHTHALMOLOGY: 1 mL ~ 20 drops Preferred pressure-lowering
• Timolol maleate 0.5%
  $3.22 (5mL) OPHTHALMOLOGY: 1 mL ~ 20 drops pressure-lowering
• Dorzolamide 2%
  $8 (10mL) OPHTHALMOLOGY: 1 mL ~ 20 drops pressure-lowering
• Acetazolamide (Diamox) - oral
  $1.88 (250mg) OPHTHALMOLOGY: 1 mL ~ 20 drops pressure-lowering
• Prednisolone acetate 1% (Predforte)
  $33 (5mL) OPHTHALMOLOGY: 1 mL ~ 20 drops steroid
• Diclofenac 0.1%
  $3 (2.5mL) OPHTHALMOLOGY: 1 mL ~ 20 drops NSAID
• Gentamicin
  $4 (5mL) OPHTHALMOLOGY: 1 mL ~ 20 drops antibiotic
• Polytrim Ophthalmic Solution (Trimethoprim/Polymyxin B)
  $5 (10mL) OPHTHALMOLOGY: 1 mL ~ 20 drops antibiotic
• Neomycin-polymyxin B-gramicidin (Neosporin)
  $42 (10mL) OPHTHALMOLOGY: 1 mL ~ 20 drops Do Not Prescribe Without TS Approval antibiotic
• Neomycin-polymyxin B-dexamethasone (Maxitrol)
  $13 (5mL) OPHTHALMOLOGY: 1 mL ~ 20 drops antibiotic+steroid
• Erythromycin Ophthalmic Ointment
  $5.90 (1g) OPHTHALMOLOGY: 1 mL ~ 20 drops topical antibiotic
• Acyclovir - oral
  $7 (100 200mg tablets) OPHTHALMOLOGY: 1 mL ~ 20 drops antiviral
• Atropine sulfate 1%
  $25 (15mL) OPHTHALMOLOGY: 1 mL ~ 20 drops cycloplegic+mydriatic
• Olopatadine 0.1%
  OPHTHALMOLOGY: 1 mL ~ 20 drops Available via DOH - Primary