Rx Partnership Affiliate Clinic Formulary

Generics listed in (parentheses) are only available as brand name.
Updated 7/1/2024
Disease CategoryBrand NameGeneric Name Dosage FormAvailable Strengths Drug ClassManufacturer (Brand or Generic-GPO)
AnalgesicMobicMeloxicamTab7.5mg, 15mgAnalgesic, Nonopioid; Nonsteroidal Anti-inflammatory Drug (NSAID)GPO
AnalgesicNaprosynNaproxenTab500mgAnalgesic, Nonopioid; Nonsteroidal Anti-inflammatory Drug (NSAID)GPO
CardiovascularNorvascAmlodipine BesylateTab5mg, 10mgAntihypertensive; Calcium Channel Blocker, DihydropyridineGPO
CardiovascularLipitorAtorvastatinTab10mg, 20mg, 40mgAntilipemic Agent; HMG CoA Reductase InhibitorGPO
CardiovascularCoregCarvedilolTab3.125mg, 6.25mg, 12.5mgAntihypertensive; Beta-Blocker with Alpha-Blocking ActivityGPO
CardiovascularTriCorFenofibrateTab145mgAntilipemic Agent; Fibric Acid GPO
CardiovascularLasixFurosemideTab20mg, 40mg, 80mgAntihypertensive; Diuretic, LoopGPO
CardiovascularMicrozideHydrochlorothiazideCap and Tab (25mg)12.5mg, 25mgAntihypertensive; Diuretic, ThiazideGPO
CardiovascularZestrilLisinoprilTab5mg, 10mg, 20mg Antihypertensive; Angiotensin-Converting Enzyme (ACE) InhibitorGPO
CardiovascularCozaarLosartan PotassiumTab25mg, 50mg, 100mgAntihypertnsive; Angiotensin II Receptor Blocker (ARB)GPO
CardiovascularLopressor Metoprolol TartrateTab25mg, 50mgAntihypertensive; Beta-Blocker, Beta-1 Selective GPO
CardiovascularCrestorRosuvastatinTab10mg, 20mgAntilipemic Agent; HMG CoA Reductase InhibitorGPO
CardiovascularVerquvo(Vericiguat)Tab2.5mg, 5mg, 10mgSoluble Guanylate Cyclase (sGC) Stimulator MER
CardiovascularTikosyn(Dofetilide)Cap0.125mg, 0.250mg, 0.500mgAntiarrhythmic Agent; Class IIIPFZ
DiabetesGlucophageMetforminTab500mg, 1000mgAntidiabetic Agent; Biguanide GPO
DiabetesGlucophage ERMetformin ERTab500mgAntidiabetic Agent; Biguanide GPO
DiabetesGlucotrolGlipizideTab5mg, 10mgAntidiabetic Agent; Sulfonylurea GPO
DiabetesJanumet(Sitagliptin/Metformin)Tab50/500mg, 50/1000mgAntidiabetic Agent; Biguanide/Dipeptidyl Peptidase (DPP-IV) InhibitorMER
DiabetesJanumet XR(Sitagliptin/Metformin ER)Tab50/500mg, 50/1000mg, 100/1000mgAntidiabetic Agent; Biguanide/Dipeptidyl Peptidase (DPP-IV) InhibitorMER
DiabetesJanuvia(Sitagliptin)Tab 25mg, 50mg, 100mgAntidiabetic Agent; Dipeptidyl Peptidase (DPP-IV) Inhibitor MER
GastrointestinalEmend(Aprepitant)Pack (2 Cap)80mgAntiemetic MER
GastrointestinalEmend Combo Pack(Aprepitant)Pack (3 Cap)80mg & 125mgAntiemetic MER
GastrointestinalPepcidFamotidineTab20mg, 40mgHistamine H2 AntagonistGPO
GastrointestinalPrilosecOmeprazoleCap20mg, 40mgProton Pump Inhibitor (PPI)GPO
Hormone Therapy Duavee(Bazedoxifen/conjugated estrogens) Tab0.45/20mgEstrogen Derivative; Selective Estrogen Receptor Modulator (SERM)PFZ
Hormone Therapy Premarin Tablets(Conjugated estrogens)Tab0.3mg, 0.45mg, 0.625mg, 0.9mg, 1.25mgEstrogen DerivativePFZ
Hormone Therapy Premarin Vaginal Cream Tube(Conjugated estrogens)Tube (30 Grams)0.625mg/30mgEstrogen DerivativePFZ
Hormone Therapy Premphase(Conjugated estrogens/medroxyprogesterone acetate)Tab0.625/5mgEstrogen/ProgestinPFZ
Hormone Therapy Prempro(Conjugated estrogens/medroxyprogesterone acetate)Tab0.3/1.5mg, 0.45/1.5mg, 0.625/2.5mg, 0.625/5mgEstrogen/ProgestinPFZ
Infectious Disease (Anti-fungal)Mepron Suspension(Atovaquone)Oz (8)750mg/5mL 210mLAntiprotozoal GSK
Infectious Disease (Antibiotic)Malarone 100s(Atovaquone/proguanil)Tab250mg/100mg, Ped 62.5mg/25mgAntimalarial AgentGSK
Infectious Disease (Antiviral, Influenza)Relenza Inhalation Powder(Zanamivir)Blisters (20)Antiviral Agent; Neuraminidase InhibitorGSK
Infectious Disease (COVID-19) Lagevrio(Molnupiravir)Cap200mgAntiviral AgentMER
Infectious Disease (HIV)Delstrigo (Doravirine/lamivudine/tenofovir)Tab100/300/300mgAntiretroviral; Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)MER
Infectious Disease (HIV)Isentress(Raltegravir) Tab 100mg (chewable), 400mgAntiretroviral; Integrase Inhibitor MER
Infectious Disease (HIV)Pifeltro (Doravirine)Tabs100mgAntiretroviral; Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)MER
Mental HealthLexaproEscitalopramTab5mg, 10mg, 20mgAntidepressant; Selective Serotonin Reuptake Inhibitor (SSRI)GPO
Mental HealthZoloftSertraline HCLTab25mg, 50mgAntidepressant; Selective Serotonin Reuptake Inhibitor (SSRI)GPO
Mental HealthDesyrelTrazodoneTab50mg, 100mgAntidepressant; Serotonin Reuptake Inhibitor/AntagonistGPO
Mental HealthEffexor Venlafaxine HCL ERCap37.5mg, 75mg, 150mgAntidepressant; Serotonin/Norepinephrine Reuptake Inhibitor (SNRI)GPO
Mental Health/Smoking CessationWellbutrin SRBupropion SRTab150mgAntidepressant; Dopamine/Norepinephrine-Reuptake Inhibitor; Smoking Cessation AidGPO
MusculoskeletalFlexeril CyclobenzaprineTab10mgSkeletal Muscle RelaxantGPO
Neurological (Migraine)Nurtec ODT(Rimegepant)Tab75mgAntimigraine Agent; Calcitonin Gene-Related Peptide (CGRP) Receptor AntagonistPFZ
Neurological (Migraine)Zavzpret Nasal Spray(Zavegepant)Pack (6 Blisters)10mgAntimigraine Agent; Calcitonin Gene-Related Peptide (CGRP) Receptor AntagonistPFZ
Neurological (Migraine)TopamaxTopiramateTab25mg, 50mg Antiseizure Agent; AntimigraineGPO
Neurological (Seizure)KeppraLevetiracetamTab500mgAntiseizure AgentGPO
Neurological (Seizure)Depakote DR(Divalproex DR)Tab125mg, 250mg, *500mg (*currently unavailable)Antiseizure Agent; Histone Deacetylase InhibitorABB
Neurological (Seizure)Depakote ER (Divalproex ER)Tab250mg, *500mg (*currently unavailable)Antiseizure Agent; Histone Deacetylase InhibitorABB
Neurological (Seizure)Depakote Sprinkle Capsules(Divalproex sprinkle)Cap125mgAntiseizure Agent; Histone Deacetylase InhibitorABB
Neurological (Seizure)Lamictal(Lamotrigine)Tab25mg (chewable), 100mg, 150mg, 200mgAntiseizure AgentGSK
RespiratoryArnuity Ellipta(Fluticasone furoate)Inhaler (30 Blisters)50mcg, 100mcg, 200mcgCorticosteroid, InhalantGSK
RespiratoryBreo Ellipta (Fluticasone furoate/vilanterol)Diskus (14 or 30 Blisters)100/25mcg, 200/25mcgBeta 2 Agonist, Long Acting; Corticosteriod, InhalantGSK
RespiratoryIncruse Ellipta(Umeclidinium bromide)Diskus (30 Blisters)62.5mcgAnticholinergic Agent; Long ActingGSK
RespiratorySerevent Diskus(Salmeterol)Diskhaler (60 Blisters)50mcgBeta 2 Agonist, Long-ActingGSK
RespiratorySingularMontelukastTab10mgLeukotriene Receptor AntagonistGPO
RespiratoryTrelegy Ellipta(Fluticasone furoate, umeclidinium and vilanterol)Inhaler (60 Blisters)100mcg, 200mcgAnticholinergic Agent; Beta 2 Agonist, Long ActingGSK
Respiratory Anoro Ellipta(Umeclidinium bromide/vilanterol)Diskus (60 Blisters)62.5/25mcgAnticholinergic Agent; Beta 2 Agonist, Long ActingGSK
ThyroidSynthroid(Levothyroxine) Tab25mcg, 50mcg, 75mcg, 88mcg, 100mcg, 112mcg, 125mcg, 137mcg, 150mcg, 175mcg, 200mcg, 300mcgThyroid productABB
VaccineGardasil 9(9-valent HPV vaccine)Syringe (Tray of 10)0.5mLVaccine, Inactivated MER-VAC
VaccineM-M-R II Vaccine with Diluent(Measles, mumps, and rubella virus vaccine live)Vial (Tray of 10)0.5mL Vaccine, LiveMER-VAC
VaccinePneumovax 23Pneumococcal (conjugate and polysaccharide)Syringe (Tray of 10)0.5mLVaccine, Inactivated MER-VAC
VaccineRecombivax HB(Hepatitis B vaccine (recombinant)Syringe (Tray of 10)10mcg/mL Vaccine, Inactivated MER-VAC
VaccineRecombivax HB(Hepatitis B vaccine (recombinant)Vial (One Vial)40mcg/mLVaccine, Inactivated MER-VAC
VaccineVaqta (Hep A Vaccine)(Hepatitis A vaccine inactivated)Syringe (Tray of 10)50U/1mLVaccine, Inactivated MER-VAC
VaccineVarivax Vaccine with Diluent(Varicella virus vaccine) Vial (Tray of 10)0.5mLVaccine, Live MER-VAC
VaccineVaxneuvance (Pneumococcal 15-valent conjugate vaccine)Syringe (Tray of 10)0.5mLVaccine, Inactivated MER-VAC