I-J-K

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.


I
ibuprofen (Motrin)
imipramine (Tofranil)
INCRELEX, PA, RD
indapamide (Lozol)
indomethacin (Indocin)
indomethacin extended-release (Indocin SR)
INFERGEN, RD
INTAL inhaler
INTELENCE
INTRON A, RD
INVIRASE
IOPIDINE
ipratropium nasal spray (Atrovent)
ipratropium soln for nebulization (Atrovent)
ipratropium/albuterol soln for nebulization (Duoneb)
IRESSA, oncologists only, RD
iron/b12/intrinsic factor (Multigen, Chromagen)
ISENTRESS, RD
isometheptene/acetaminophen/dichloralphenazone (Midrin)
isoniazide
ISOPTO CARBACHOL
isosorbide dinitrate (Isordil)
isosorbide dinitrate extended release
isosorbide mononitrate (Ismo)
isosorbide mononitrate extended release (Imdur)
isotretinoin (Accutane)
isradipine (Dynacirc)
itraconazole caps (Sporanox), PA

J-K
JANUMET, ST
JANUVIA, ST
jolessa (Seasonale)
jolivette (Ortho Micronor, Nor-Q-D)
junel (Loestrin)
junel fe (Loestrin FE)
KALETRA
kariva (Mircette)
kelnor 1/35 (Demulen 1/35)
KETEK
ketoconazole (Nizoral)
ketoprofen (Orudis)
ketoprofen extended-release (Oruvail)
ketorolac tabs (Toradol), QL
KETOSTIX
KINERET, PA, RD 


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