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.
Q-R
quasense (Seasonale)
quinapril (Accupril)
quinapril/hydrochlorothiazide (Accuretic)
quinidine gluconate
quinidine sulfate
QVAR
ramipril (Altace)
ranitidine (Zantac)
RAPAMUNE
re fac-x (Glutofac-ZX)
REBETOL soln,
RD REBETRON,
RD REBIF,
RD reclipsen (Desogen, Ortho-Cept)
REGRANEX,
QL
RELENZA,
QLRELISTOR,
RDRENACIDIN
RENAGEL
RENVELA
REPRONEX,
reproductive specialists only, RD RESCRIPTOR
RESTASIS,
Ophthalmologist, optometrist, rheumatologist only,QLRETIN-A MICRO,
PA REVATIO,
PA, RD REVLIMID,
RD, QLREYATAZ
ribavirin (Copegus),
RD RIBASPHERE,
RD RIDAURA
rifampin (Rifadin)
rifampin/isoniazid (Rifamate)
RIFATER
RILUTEK
rimantadine (Flumadine)
risperidone oral (Risperdal)
RISPERDAL CONSTA
RITALIN LA
ROFERON-A,
RD ropinirole (Requip)
RYTHMOL SR
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