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.


T
TACLONEX, dermatologists only
TACLONEX SCALP, dermatologists only
tacrolimus (Prograf)
TAMIFLU, QL
tamoxifen (Nolvadex)
TARCEVA, RD
TARGRETIN caps/topical gel, RD
TASIGNA, RD
TAZORAC
TBC
TEKTURNA, ST
TEKTURNA HCT, ST
temazepam (Restoril)
TEMODAR, RD 
terazosin (Hytrin)
terbinafine (Lamisil)
terbutaline (Brethine)
terconazole (Terazol)
TESLAC
testosterone cypionate (Depo-testosterone)
tetracycline (Sumycin)
THALOMID, RD, QL 
theophylline extended-release/elixer (Slo-Bid, Uniphyl, Elixophyllin)
THIOGUANINE
thioridazine (Mellaril)
thiothixene (Navane)
ticlopidine (Ticlid)
TIKOSYN
tilia fe (Estrostep FE)
timolol (Blocadren)
timolol maleate (Timoptic/-XE) 
timolol/dorzolamide (Trusopt)
tinzadole (Tindamax)
tizanidine (Zanaflex)
TOBI, RD  
TOBRADEX ointment/drops
tobramycin (Tobrex)
tobramycin/dexamethasone drops (Tobradex)
tolmetin (Tolectin)
topiramate (Topamax)
Torsemide (Demadex)
TRAC 2X
TRACLEER, RD
tramadol (Ultram)
tramadol/acetaminophen (Ultracet)
trandolapril (Mavik)
tranylcypromine (Parnate)
TRAVATAN
TRAVATAN Z
trazodone (Desyrel)
tretinoin, oral (Vesanoid)
tretinoin, topical (Retin-A), PA
triamcinolone cream/oint/lotion (Aristocort)
triamcinolone paste (Kenalog in Orabase)
triamterene/hydrochlorothiazide (Dyazide, Maxide - 25)
triazolam (Halcion)
trifluoperazine (Stelazine)
trifluridine (Viroptic)
trihexyphenidyl (Artane)
tri-legest fe (Estrostep FE)
trimethobenzamide (Tigan)
trimethoprim (Trimpex)
trimethoprim/polymyxin b (Polytrim)
trimipramine maleate (Surmontil)
trinessa (Ortho Tri-Cyclen)
triple sulfa vaginal
tri-previfem (Ortho Tri-Cyclen)
triprolidine
tri-sprintec (Ortho Tri-Cyclen)
trivora (Triphasil)
TRIZIVIR
TRUVADA
tussplex liquid (Poly-Tussin)
TYKERB, QL, RD


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