IU Health Free Prescription Formulary

MSDWT Clinic Form Data as of 9/13/2019

Brand ACTIFED ACTOS ACTOS ACTOS ACULAR ADVIL AERO CHAMBER AFRIN ALDACTONE ALEVE ALLEGRA 180 AMARYL AMOXIL AMOXIL AMOXIL AMOXIL AMOXIL AMOXIL AMOXIL ATARAX ATARAX AUGMENTIN AUGMENTIN AUGMENTIN AUGMENTIN AVAPRO AZO URINARY PAIN RELIEF AZULFIDINE BACITRACIN BACTRIM DS BACTRIM DS BACTRIM DS BACTRIM DS BACTROBAN BENADRYL BENADRYL BENADRYL CHILDRENS BENTYL BIAXIN BIAXIN

Generic Pseudoephedrine/Triprolidine Pioglitazone HCl Pioglitazone HCl Pioglitazone HCl Ketorolac Tromethamine Ibuprofen Aerosol Holding Chamber Oxymetazoline HCL Spironolactone Naproxen Sodium Fexofenadine HCl Glimepiride Amoxicillin Amoxicillin Amoxicillin Amoxicillin Amoxicillin Amoxicillin Amoxicillin Hydroxyzine Hcl Hydroxyzine Hcl Amoxicillin/Clavulanate Potassium Amoxicillin/Clavulanate Potassium Amoxicillin/Clavulanate Potassium Amoxicillin/Clavulanate Potassium Irbesartan Phenazopyridine HCl Sulfasalazine Bacitracin Zinc Sulfamethoxazole/Trimethoprim Sulfamethoxazole/Trimethoprim Sulfamethoxazole/Trimethoprim Sulfamethoxazole/Trimethoprim Mupirocin Diphenhydramine HCl Diphenhydramine HCl Diphenhydramine HCl Childrens Dicyclomine HCl Clarithromycin Clarithromycin

Form TAB TAB TAB TAB SOLN TAB MEDV SOLN TAB TAB TAB TAB CAP CAP CAP SUSP CAP TAB SUSP TAB TAB TAB TAB TAB SUSP TAB TAB TAB OINT TAB TAB TAB TAB OINT CAP INJ LIQD TAB TAB TAB

BUSPAR Buspirone HCl CALCIUM CARBONATE/VITAMIN D3 ( Calcium Carbonate/Vitamin D3 CAPOTEN Captopril CARDIZEM CD Diltiazem HCI/(Once-A-Day Dosage) CATAPRES Clonidine HCl CATAPRES Clonidine HCl CELEBREX Celecoxib CELEBREX Celecoxib CELEXA Citalopram Hbr CELEXA Citalopram Hbr CELEXA Citalopram Hbr CHANTIX STARTING MONTH PAK Varenicline Tartrate CHILDREN'S TYLENOL Acetaminophen Children's CILOXAN Ciprofloxacin HCI CILOXAN Ciprofloxacin HCI CIPRO Ciprofloxacin CIPRO Ciprofloxacin CIPRO Ciprofloxacin CIPRO Ciprofloxacin CLARITIN Loratadine CLEOCIN Clindamycin HCl COREG Carvedilol COREG Carvedilol CORTISPORIN Neomycin/Polymyxin B/Hydrocortisone COZAAR Losartan Potassium COZAAR Losartan Potassium COZAAR Losartan Potassium CRESTOR Rosuvastatin Calcium CYMBALTA Duloxetine HCl CYMBALTA Duloxetine HCl DEBROX Carbamide Peroxide (Otic) DELSYM Dextromethorphan Polistirex DELTASONE Prednisone DELTASONE Prednisone DELTASONE Prednisone DELTASONE Prednisone DELTASONE Prednisone DELTASONE Prednisone DELTASONE Prednisone DELTASONE Prednisone DEPO-MEDROL Methylprednisolone Acetate DEPO-MEDROL Methylprednisolone Acetate DESYREL Trazodone HCl DIABETA Glyburide DIABETA Glyburide DIFLUCAN Fluconazole DIPROLENE AF Betamethasone Dipropionate (Augmented)

TAB TAB TAB CAP TAB TAB CAP CAP TAB TAB TAB TAB SUPP SOLN SOLN TAB TAB TAB TAB TAB CAP TAB TAB SOLN TAB TAB TAB TAB CAP CAP SOLN SOLN TAB TAB TAB TAB TAB TAB TAB TAB INJ INJ TAB TAB TAB TAB CRM

DITROPAN DYAZIDE ECOTRIN EFFEXOR EFFEXOR XR ELAVIL EPIPEN JR ESTRACE EXTRA STRENGTH TYLENOL FERROUS SULFATE FLAGYL FLEXERIL FLEXERIL FLEXERIL FLOMAX FLONASE FLOXIN Fluzone High-Dose for 65+ Fluzone Quad Ped. 2018-2019 Fluzone Quadrivalent 2018-2019 FOLVITE / FOLICET FOSAMAX GARAMYCIN GLUCAGON EMERGENCY KIT GLUCOPHAGE GLUCOPHAGE GLUCOPHAGE GLUCOPHAGE GLUCOPHAGE XR GLUCOTROL GLUCOTROL GLUCOTROL ER GLUCOVANCE HUMALOG HUMALOG KWIKPEN HUMULIN N HUMULIN R HYDROCORTISONE HYDROCORTISONE HYDRODIURIL HYDRODIURIL HYDRODIURIL HYGROTON HYGROTON HYTONE HYZAAR HYZAAR

Oxybutynin Chloride Triamterene/Hydrochlorothiazide Aspirin Venlafaxine HCl Venlafaxine HCl ER Amitriptyline HCl Epinephrine Estradiol Acetaminophen/Extra Strength Ferrous Sulfate Metronidazole Cyclobenzaprine HCl Cyclobenzaprine HCl Cyclobenzaprine HCl Tamsulosin HCl Fluticasone Propionate Ofloxacin Fluzone High-Dose for 65+ Fluzone Quad Ped. 2018-2019 Fluzone Quadrivalent 2018-2019 Folic Acid Alendronate Sodium Gentamicin Sulfate Glucagon (rDNA) Metformin HCl Metformin HCl Metformin HCl Metformin HCl Metformin HCl ER Glipizide Glipizide Glipizide ER Glyburide/Metformin Insulin Lispro Insulin Lispro Insulin NPH (Human) (Isophane) Insulin Regular (Human) Hydrocortisone Hydrocortisone Hydrochlorothiazide Hydrochlorothiazide Hydrochlorothiazide Chlorthalidone Chlorthalidone Hydrocortisone Losartan Potassium/Hydrochlorothiazide Losartan Potassium/Hydrochlorothiazide

TAB CAP TAB TAB CAP TAB AINJ TAB TAB TAB TAB TAB TAB TAB CAP SOLN SOLN iNJ INJ INJ TAB TAB SOLN KIT TAB TAB TAB TAB TAB TAB TAB TAB TAB INJ INJ INJ INJ CRM OINT TAB TAB TAB TAB TAB CRM TAB TAB

HYZAAR ILOTYCIN IMITREX IMITREX IMITREX IMODIUM IMODIUM IMODIUM INDOCIN INDOCIN KEFLEX KEFLEX KEFLEX KEFLEX KEFLEX KENALOG KENALOG KENALOG LAMISIL LANTUS LANTUS SOLOSTAR LASIX LASIX LEVAQUIN LEVAQUIN LEVEMIR FLEXTOUCH LEXAPRO LEXAPRO LIDEX LIPITOR LIPITOR LIPITOR LIPITOR LIQUITEARS LOFIBRA LOPID LOPRESSOR LOPRESSOR LOTENSIN LOTENSIN LOTENSIN LOTREL LOTRIMIN LOTRIMIN LOTRISONE MACROBID MAXITROL

Losartan Potassium/Hydrochlorothiazide Erythromycin Sumatriptan Succinate Sumatriptan Succinate Sumatriptan Succinate Loperamide HCl Loperamide HCl Loperamide HCl Indomethacin Indomethacin Cephalexin Cephalexin Cephalexin Cephalexin Cephalexin Triamcinolone Acetonide Triamcinolone Acetonide Triamcinolone Acetonide Terbinafine HCl Insulin Glargine Insulin Glargine Furosemide Furosemide Levofloxacin Levofloxacin Insulin Detemir Escitalopram Oxalate Escitalopram Oxalate Fluocinonide Atorvastatin Calcium Atorvastatin Calcium Atorvastatin Calcium Atorvastatin Calcium Polyvinyl Alcohol Fenofibrate Gemfibrozil Metoprolol Tartrate Metoprolol Tartrate Benazepril HCl Benazepril HCl Benazepril HCl Amlodipine Besylate/Benazepril HCl Clotrimazole Clotrimazole Clotrimazole w/Betamethasone Nitrofurantoin Monohydrate/Macrocrystals Neomycin/Polymyxin B/Dexamethasone

TAB OINT TAB TAB TAB CAP CAP CAP CAP CAP CAP CAP CAP CAP SUSP CRM CRM INJ TAB INJ INJ TAB TAB TAB TAB INJ TAB TAB CRM TAB TAB TAB TAB SOLN TAB TAB TAB TAB TAB TAB TAB CAP CRM CRM CRM CAP SUSP

MECLIZINE NON-PRESCRIPTION MEDROL DOSEPAK MEVACOR MEVACOR MICRONOR/NOR-Qd MICROZIDE MILK OF MAGNESIA-MINT FLAVOR MINOCIN MOBIC MOBIC MONODOX MOTRIN MOTRIN MUCINEX MUCINEX D MUCINEX DM MUCINEX DM MAX STRENGTH MYCOSTATIN NAPROSYN NEOSPORIN NEURONTIN NEURONTIN NICODERM NICODERM NITROSTAT NIZORAL NORVASC NORVASC NOVOLIN 70/30 NOVOLIN N NOVOLIN R NOVOLOG NOVOLOG FLEXPEN OCEAN OCUFLOX OMNICEF OMNICEF OPHTHAINE/OPHTHETIC ORTHO-CYCLEN PAMELOR PAXIL PAXIL PEPCID PHENERGAN PHENERGAN PLAQUENIL PLAVIX

Meclizine HCl CTB TAB Methylprednisolone Lovastatin TAB Lovastatin TAB TAB Norethindrone Hydrochlorothiazide CAP Magnesium Hydroxide LIQD CAP Minocycline HCl Meloxicam TAB Meloxicam TAB CAP Doxycycline (Monohydrate) Ibuprofen TAB Ibuprofen TAB TAB Guaifenesin Guaifenesin/Pseudoephedrine Hcl TAB Dextromethorphan/Guaifenesin TAB Dextromethorphan/Guaifenesin TAB Nystatin CRM Naproxen TAB Triple Antibiotic Ointment (Neomycin-Bacitracin-PolymOINT Gabapentin CAP Gabapentin CAP Nicotine Transdermal System PTCH Nicotine Transdermal System PTCH Nitroglycerin TAB Ketoconazole CRM Amlodipine Besylate TAB Amlodipine Besylate TAB Insulin NPH Isophane & Reg (Human) INJ Insulin NPH (Human) (Isophane) INJ Insulin Regular (Human) INJ Insulin Aspart INJ Insulin Aspart INJ Saline SOLN Ofloxacin SOLN Cefdinir SUSP Cefdinir CAP Proparacaine SOLN Norgestimate/Ethinyl Estradiol TAB Nortriptyline HCl CAP Paroxetine HCl TAB Paroxetine HCl TAB Famotidine TAB Promethazine HCl TAB Promethazine HCl INJ Hydroxychloroquine Sulfate TAB Clopidogrel Bisulfate TAB

POLYTRIM PRAVACHOL PRAVACHOL PREPLUS PRILOSEC PROTONIX PROVENTIL PROZAC PROZAC PROZAC PYRIDIUM PYRIDIUM QVAR REDIHALER QVAR REDIHALER RELAFEN RELAFEN ROBAXIN ROBAXIN ROBITUSSIN ROBITUSSIN DM ROCEPHIN SILVADENE SINGULAIR SINGULAIR SINGULAIR SODIUM CHLORIDE SODIUM SULAMYD SUDAFED SYNTHROID SYNTHROID SYNTHROID SYNTHROID SYNTHROID SYNTHROID SYNTHROID SYNTHROID SYNTHROID SYNTHROID TAGAMET TAMIFLU TEMOVATE TEMOVATE TENORMIN TENORMIN TENORMIN TESSALON PEARLS TESSALON PEARLS

Polymyxin B/Trimethoprim Pravastatin Sodium Pravastatin Sodium Prenatal Vit w/Ferrous Fumarate-Folic Acid Omeprazole Pantoprazole Sodium Albuterol Sulfate Fluoxetine HCl Fluoxetine HCl Fluoxetine HCl Phenazopyridine HCl Phenazopyridine HCl Beclomethasone Dipropionate HFA Beclomethasone Dipropionate HFA Nabumetone Nabumetone Methocarbamol Methocarbamol Guaifenesin/Alcohol Free Dextromethorphan/Guaifenesin Ceftriaxone Sodium Silver Sulfadiazine Montelukast Sodium Montelukast Sodium Montelukast Sodium Sodium Chloride Sulfacetamide Sodium Pseudoephedrine HCl Levothyroxine Sodium Levothyroxine Sodium Levothyroxine Sodium Levothyroxine Sodium Levothyroxine Sodium Levothyroxine Sodium Levothyroxine Sodium Levothyroxine Sodium Levothyroxine Sodium Levothyroxine Sodium Cimetidine Oseltamivir Phosphate Clobetasol Propionate Clobetasol Propionate Atenolol Atenolol Atenolol Benzonatate Benzonatate

SOLN TAB TAB TAB CAP TAB NEBU CAP CAP CAP TAB TAB INH INH TAB TAB TAB TAB SOLN SOLN INJ CRM TAB CTB CTB INJ SOLN TAB TAB TAB TAB TAB TAB TAB TAB TAB TAB TAB TAB CAP CRM OINT TAB TAB TAB CAP CAP

TINACTIN TOBREX TOPAMAX TOPICORT TOPROL XL TOPROL XL TOPROL XL TOPROL XL TORADOL TRICOR TRUE METRIX NOT RETAIL SALE TYLENOL VALISONE VALIUM VALTREX VASOTEC VEETIDS VEETIDS VEETIDS VENTOLIN HFA VENTOLIN HFA VISTARIL VITAMIN B-6 VITAMIN D-3 VOLTAREN WELLBUTRIN SR WELLBUTRIN XL WELLBUTRIN XL XYLOCAINE XYLOCAINE ZANTAC ZANTAC ZESTORETIC ZESTORETIC ZESTORETIC ZESTORETIC ZESTRIL ZESTRIL/PRINIVIL ZESTRIL/PRINIVIL ZITHROMAX ZITHROMAX Z-PAK ZOCOR ZOCOR ZOCOR ZOCOR ZOCOR ZOFRAN

Tolnaftate Tobramycin Topiramate Desoximetasone Metoprolol Succinate Metoprolol Succinate Metoprolol Succinate Metoprolol Succinate Ketorolac Tromethamine Fenofibrate Glucose Blood Test Strips Acetaminophen Betamethasone Valerate Diazepam Valacyclovir HCl Enalapril Maleate Penicillin V Potassium Penicillin V Potassium Penicillin V Potassium Albuterol Sulfate Albuterol Sulfate HFA Hydroxyzine Pamoate Pyridoxine HCl (Vitamin B6) Cholecalciferol Diclofenac Sodium Bupropion HCl SR Bupropion HCl XL Bupropion HCl XL Lidocaine HCl Lidocaine HCl Ranitidine HCl Ranitidine HCl Lisinopril/Hydrochlorothiazide Lisinopril/Hydrochlorothiazide Lisinopril/Hydrochlorothiazide Lisinopril/Hydrochlorothiazide Lisinopril Lisinopril Lisinopril Azithromycin Azithromycin Simvastatin Simvastatin Simvastatin Simvastatin Simvastatin Ondansetron HCl

CRM SOLN TAB CRM TAB TAB TAB TAB INJ TAB STRP LIQD CRM INJ TAB TAB TAB TAB TAB AERO INH CAP TAB TAB TAB TAB TAB TAB INJ INJ TAB TAB TAB TAB TAB TAB TAB TAB TAB SUSP TAB TAB TAB TAB TAB TAB TAB

ZOFRAN ODT ZOLOFT ZOLOFT ZOLOFT ZOVIRAX ZOVIRAX ZYLOPRIM ZYRTEC ZYRTEC

Ondansetron Sertraline HCl Sertraline HCl Sertraline HCl Acyclovir Acyclovir Allopurinol Cetirizine HCl Cetirizine HCl

TAB TAB TAB TAB TAB TAB TAB TAB SOLN

mulary Strength 2.5-60M 15mg 30mg 45mg 0.005 200mg PLUS 0.0005 25mg 220mg 180mg 4mg 500mg 500mg 500mg 125mg/5ml 500mg 875mg 400mg/5ml 50mg 25mg 500mg/125mg 875mg/125mg 875mg/125mg 400mg/5ml 150mg 95mg 500mg 500uni/gm 800-160 800-160 800-160 800-160 0.02 25mg 50mg/ml 12.5mg 20mg 500mg 500mg

10mg 600mg 25mg 120mg 0.1mg 0.2mg 200mg 200mg 20mg 40mg 10mg 0.5& 1M 120mg 0.003 0.003 500mg 500mg 500mg 250mg 10mg 300mg 6.25mg 12.5mg 0.01 50mg 25mg 100mg 10mg 60mg 30mg 0.065 30mg/5ml 5mg 10mg 10mg 10mg 20mg 20mg 20mg 20mg 40mg/ML 80mg/ML 50mg 2.5mg 5mg 150mg 0.0005

5mg 37.5mg/25mg 81mg 37.5mg 75mg 25mg 0.15mg 1mg 500mg 325mg 500mg 10mg 10mg 10mg 0.4mg 50mcg 0.003 0.5ml 0.25ml 0.5ml 1mg 70mg 0.003 1mg 500mg 500mg 500mg 1000mg 500mg 5mg 10mg 5mg 5mg/500mg 100/ML 100/ML U-100 U-100 0.01 0.01 25mg 25mg 50mg 25mg 50mg 0.025 100mg/25mg 50mg/12.5mg

50mg/12.5mg 0.005 50mg 100mg 25mg 2mg 2mg 2mg 50mg 25mg 500mg 500mg 500mg 500mg 250mg/5ml 0.001 0.005 40mg/ML 250 mg 100/ML SOLOSTA 20mg 40mg 500mg 750mg FLEXTOU 10mg 20mg 0.0005 10mg 20mg 40mg 80mg 0.014 160mg 600mg 50mg 100mg 10mg 20mg 40mg 5mg/10mg 0.01 0.01 100mg 0.001

25mg 4mg 20mg 40mg 0.35mg 12.5mg 400mg/5ml 100mg 7.5mg 15mg 100mg 600mg 800mg 600mg 600mg/60mg 30mg/600mg 60mg/1200mg 100000u/gm 500mg 400uni/3.5mg/5000uni 300mg 100mg 14mg 21mg 0.4mg 0.02 5mg 10mg 70/30 U-100 U-100 100/ML FLEXPEN 0.0065 0.003 250mg/5ml 300mg 0.005 0.25/35 25mg 20 mg 40 mg 20mg 25mg 50mg/ML 200mg 75mg

10000uni/1mg/ml 20mg 40mg PNV-Ca/27mg/1mg 20mg 40mg 0.00083 20mg 10mg 40mg 200mg 200mg 40mcg 80mcg 500mg 750mg 750mg 500mg 100mg/5ml 100mg/10mg/5ml 500mg 0.01 10mg 5mg 4mg 0.009 0.1 30mg 0.050 mg 0.1mg 0.075 mg 0.075 mg 0.125 mg 150mcg 0.025mg 0.088mg 0.137mg 112mcg 400mg 75mg 0.0005 0.0005 50mg 100mg 25mg 100mg 200mg

0.01 0.003 25mg 0.0025 25mg 50mg 100mg 100mg 30mg/ml 145mg GLUCOSE 160mg/5ml 0.001 5mg/ml 1gm 10mg 250mg 500mg 500mg 90mcg 90mcg 25mg 50mg 1000UNI 75mg 150mg 300mg 150mg 0.01 0.02 150mg 150mg 10mg/12.5mg 10mg/12.5mg 20mg/12.5mg 20mg/25mg 40mg 10mg 20mg 200mg/5ml 250mg 20mg 40mg 40mg 80mg 10mg 8mg

4mg ODT 50mg 100mg 25mg 400mg 400mg 300mg 10mg 1mg/ml