L

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.


L
labetalol (Normodyne, Trandate)
lactulose syrup (Cephulac, Chronulac) 
lamotrigine (Lamictal)
LANTUS
leena (Tri-Norinyl)
leflunomide (Arava), QL
lessina (Alesse, Levlite)
LETAIRIS, RD, QL
leucovorin
LEUKERAN
LEUKINE, RD
leuprolide acetate (Lupron), RD
levalbuterol (Xopenex) 1.25mg/0.5ml strength only
LEVAQUIN
levetiracetam tabs, solution (Keppra)
levobunolol (Betagan)
levocarnitine (Carnitor)
levonorgestrel (Plan B, Next Choice) for ages < 17 years
levora (Nordette)
levothyroxine (Synthroid)
LEVOXYL
LEXAPRO, ST
LEXIVA tablets/suspension
lidocaine viscous (Xylocaine)
lidocaine/hydrocortisone gel (Rectagel HC)
lindane (Lindane) 
lisinopril (Prinivil, Zestril)
lisinopril/hydrochlorothiazide (Prinzide, Zestoretic)
lithium carbonate capsules (Eskalith)
lithium carbonate extended-release (Eskalith CR, Lithobid)
lithium carbonate tablets
liothyronine (Cytomel)
lodocortisone aloe (Alcortin)
loperamide capsules (Imodium)
loratadine (Claritin), OTC, QL
loratadine/pseudoephedrine (Claritin D), OTC, QL
lorazepam inj/tablets (Ativan)
LOTEMAX
lovastatin (Mevacor)
LOVENOX
low-ogestrel (Lo/Ovral)
loxapine (Loxitane)
LUPRON DEPOT, RD
lutera (Alesse, Levlite)
LYSODREN, RD


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