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HNE Formulary: Tier 2 Brand/Formulary Drug Listing
Introduction How To Use The List Tier 1 Tier 2 Limitations Brand/Non-Formulary Search

The formulary list was last updated on 09/01/07, please be advised the information listed may not reflect the most current data and may be updated at any time without notice.

Please call HNE Member Services at (413) 787-4000 or
(800) 310-2835 for assistance.

Alphabetic Listing Tier 2
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Tier 2 Brand/Formulary Drug Listing

Brand/Formulary Drugs (Tier 2) are marketed under a trademarked brand name, usually by one manufacturer, and do not have less costly generic equivalents. Brand/Formulary Drugs are selected based on a review of the relative safety, effectiveness and cost of the many FDA-approved drugs on the market. Your copayment for Brand/Formulary Drugs is higher than for Generic Drugs, but lower than for Brand/Non-Formulary Drugs.

* indicates covered over the counter (OTC) medications

**Indicates a medication with a Limit/PA or Step Therapy, please click limitations link above.

NOTE: The contents of this Formulary are subject to change at any time without member notification.

A

Actonel
Actonel w/ calcium
Actos
Acular
Acular LS
Acular PF
Adderall XR
Advair Diskus
Advair HFA
Aerochamber
Agenerase
Agrylin
Akne-Mycin
Albenza
Alinia
Alkeran
Alphagan P
Alupent
Androderm
Apidra
Aptivus
Aquasol A
Aricept
Arimidex
Aristocort A
Armour thyroid
Asacol
Asmanex
Astelin
Atripla
Atrovent inhaler
Augmentin Susp
Augmentin XR
Avalide
Avandia
Avapro
Avonex
Azelex
Azopt
Azulfidine EN

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B

Bactroban
Beconase
Betaseron
Betoptic S
Blephamide or Vasocidin
Bromfenex PD
Byetta

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C

Calcimar
Capitrol
Carnitor
Casodex
Catapres TTS-1
Catapres TTS-2
Catapres TTS-3
Caverject
Celebrex
Cellcept
Centany
Cerumenex
Cetrotide
Chemet
Chloromycetin Otic
Cibalith-S
CiproDex
Cleocin Pediatric
Climara Pro
Combipatch
Combivent
Combivir
Compazine Spansule
Comvax
Concerta
Condylox
Copaxone
Coreg
Cortone
Cosopt
Creon 10
Creon 20
Creon 5
Crinone
Crixivan
Cuprimine
Cyclogyl
Cytomel

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D

Dantrium
Daraprim
Deconamine
Deconamine SR
Depakote
Depakote
Depakote ER
Depakote ER
Depakote Sprinkle
Depakote Sprinkles
Depakote Sprinkles
Dermasmooth/FS
Dexacort Turbinaire
DHT
Diamox Sequels
Dilantin Infatab
Dilatrate-SR
Dilaudid-HP
Dimetane-DC
Diovan
Diovan HCT
Diprolene
Diprolene AF
Dovonex
Drithrocreme
Drithro-Scalp
Drysol
Drysol Dabamatic
Duragesic

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E

Edex
Effexor XR
Emtriva
Enbrel
Enfamil Natalins
Engerix-B
Entocort EC
Epi-pen Epi-pen Jr
Epivir
Epogen
Epzicom
Ergamisol
Ergomar
Eryped
Eryped Chewable
Estrace Vag. Cream
Estratab
Estratest
Estratest HS
Estring
Estrostep
Estrostep FE
Eurax
Evista

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F

Fansidar
Femara
Femhrt
Femring
Flavored Colytely
Flomax
Flovent
Flovent Rotadisk
Floxin Otic
Follistim/Anatagon Kit
Foradil Aerolizer
Fortovase
Fosamax
Fosamax plus D
Furadantin Suspension
Furoxone
Fuzeon

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G

Ganirelix
Gel-Kam
Glucagon
Glucagon Emergency kit
Gonal-F
Grifulvin V

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H

Haldol Inj
Havrix
Hepsera
Humalog
Humegon
Humira
Humira
Humulin
Hydromet
hytekerol

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I

Imitrex, injection
Imitrex, intranasal
Imitrex, oral
Insulin, all Lilly products
Insulin, all Novo products
Intal inhaler
Intron A
Invirase
Isopto Atropine

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J

Januvia

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K

Kaletra
Kefzol
Ketostix

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L

Lamictal
Lamictal CD
Lamprene
Lancets
Lantus
Lantus Solostar
Lente Insulin
Leukeran
Levaquin
Levemir
Levothroid
Lexapro
Lexiva
Liquid Pred
Lovenox
Lumigan
Lysodren

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M

Matulane
Maxair/ Maxair Autohaler
Menest
Mephyton
Mepron
Mesnex
Mestinon Timespan
Metandren
Methergine
MetroCreme
Metrodin
Metrogel Vaginal
Migranal Nasal Spray
Mintezol
Mirapex
Mission Prenatal
Mission Prenatal FA
MUSE
Myambutol
Mycelex Troche
Mycobutin
Myfortic
Myleran

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N

Naftin
Naftin Gel
Namenda
Nardil
Nasacort
Nasonex
Nebupent
Nembutal
Nephrocap
Nestabs FA
Niacor
Niaspan
Nizoral Shampoo
Noritate
Norvir
Novolin

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O

Obstetrix-100
O-Cal FA
Optivar
Orap
Oraspan-FA
Orfadin
Ortho Dienestrol

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P

Pancrease
Pancrease MT 10
Pancrease MT 16
Pancrease MT 20
Pancrease MT 4
Pediarix
Pentasa
Pergonal
Phisohex
Phospholine Iodide
Pilopine HS
Plavix
Poly Vi Flor
Poly Vi Flor/ Iron
Precose
Pred Mild
Premarin
Premarin Vaginal Cream
Premphase
Prempro
Prempro Low Dose
PrevPac
Prezista
Proair
Prochieve
Procrit
Proctofoam HC
Profasi HP
Prograf
Protonix
Protopic
Pulmicort Respule
Pulmicort Turbuhaler
Pulmozyme

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Q

Quinaquin
Qvar

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R

Rapamune
Rebetol 40mg/ml sol
Rebetron
Rebetron 600
Rebif
Recombivax HB
Relion N Innolet
Renagel
Repronex
Rescriptor
Retrovir
Revatio
Reyataz
Rhinocort
Rhinocort Aqua
Riomet
Risperdal
Risperdal M tabs
Rondec
Rondec TR
Rowasa Rectal
Roxanol
Roxicet

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S

Sandimmune
Sandostatin
Sansert
Semprex-D
Semprex-D
Serevent
Serevent Diskus
Seroquel
Seroquel XR
Singulair
Slo-Phyllin
Solatene
Solganal
Sorbitrate
Spiriva
Stalevo
Suprax
Sustiva
Symlin
Synarel
Synthroid

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T

Tegretol XR
Teslac
Test Strips- Roche/Lifescan
Tev-Tropin
Thalomid
Thioguanine
Tilade
TOBI
Tobradex
Tobradex Opth. Drops
Tobradex Opth. Oint.
Topamax
Torecan
Transderm Scop
Tri Vi Flor/Iron
TriCor
Trizivir
Trusopt
Truvada
Tussionex
Twinrix

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U

Uni-Dur
Uniretic
Unithroid

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V

Vagifem
Valtrex
Vancenase Pockethaler
Vanceril
Vanceril DS
Vancocin
Vaqta
Ventolin Rotocap
Viagra
Videx
Videx EC
Viokase
Vioxx
Vira- A
Viracept
Viramune
Vytorin

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W

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X

Xalatan

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Y

Yocon
Yodoxin

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Z

Zavesca
Zenate
Zerit
Zetia
Ziagen
Zmax
Zomig
Zomig Nasal Spray
Zomig ZMT
Zovirax oint/cream
Zyprexa

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