S

PA = Prior Authorization is required; QL = Quantity limits apply; ST = Step Therapy applies; 
RD = Specialty Formulary, please refer to Specialty Pharmacy Program section for additional information;
OTC = Over-the-counter Product, may be covered if a prescription is written, and it is filled at a retail or mailorder pharmacy

Medications written in all CAPITAL letters are Brand names.
Medications written in all lower case letters are available generically. The brand name is listed in parenthesis for reference only.


S
SABRIL, RD, QL
salicylic acid 6% cream/foam/shampoo/kit (Salex, Salkera)
salsalate (Disalcid)
SANDOSTATIN, RD
SANDOSTATIN LAR, RD
SANTYL
selegiline (Eldepryl)
selenium sulfide shampoo 2.5% (Selsun)
SELZENTRY, RD
SENSIPAR
SEREVENT DISKUS
SEROQUEL
SEROQUEL XR
sertraline (Zoloft)
silver sulfadiazine (Silvadene)
simvastatin (Zocor)
SINGULAIR
sodium citrate soln (Bicitra)
sodium fluoride (Luride)
sodium polystyrene sulfonate (Kayexalate)
sodium propionate/amino acid/urea (Amino-Cerv)
sodium sulfa/sulfur/meratan topical kit (Rosula CLK)
solia (Desogen, Ortho-Cept)
SOMATULINE DEPOT, RD, QL
sotalol (Betapace, Betapace AF)
SPIRIVA
spironolactone (Aldactone)
spironolactone/hydrochlorothiazide (Aldactazide)
SPORANOX oral soln, PA
sprintec (Ortho-Cyclen)
SPRYCEL, RD
sronyx (Alesse, Levlite)
stannous fluoride (Gel-Kam )
stavudine (Zerit)
STIMATE
STRATTERA, QL
STROMECTOL
SUBOXONE, PA  
sucralfate (Carafate)
sulfacetamide sodium (Bleph-10, Klaron)
sulfacetamide/prednisolone (Vasocidin)
sulfacetamide/sulfur (Rosula, Sulfacet-R, Rosac)
sulfacetamide/urea (Rosula NS)
sulfadiazine
sulfamethoxazole/trimethoprim (Bactrim)
SULFAMYLON
sulfasalazine (Azulfidine)
sulfasalazine delayed release (Azulfidine EN-Tab)
sulfinpyrazone
sulfisoxazole
SULFOXYL
sulindac (Clinoril)
sumatriptan tablets/nasal spray/injection (Imitrex), QL
SUPRAX 
SUSTIVA
SUTENT, RD
SYNAREL, RD

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