Generic drugs have the same active ingredients and work the same as brand-name drugs. We cover brand-name drugs only when a generic drug is not available.
Copayments for generic drugs are:
For additional information, see pharmacy copayments.
*Pharmacy copayments for covered generic, preferred brand-name and select over-the-counter drugs are $3.65. Generic drugs for diabetes, high blood pressure, and high cholesterol have a $1 copayment.
Generic name (What your doctor should prescribe)
Example of brand name
Benzoyl peroxide 5% and 10%
Benzac W 5
Cetirizine
Zyrtec OTC
Cetirizine/pseudoephedrine
Zyrtec-D OTC
Chlorpheniramine
Chlor-trimeton
Diphenhydramine
Benadryl
Fluticasone
Flonase
Loratadine
Alavert, Claritin
Loratadine/pseudoephedrine
Alavert-D, Claritin-D
Triamcinolone nasal spray
Nasacort Allergy
Acetaminophen (quantity limit 4 gm/day)
Tylenol
Aspirin
Bayer
Ibuprofen
Advil
Naproxen
Aleve
Aluminum hydroxide
Alternagel
Aluminum hydroxide/magnesium hydroxide
Maalox
Aluminum hydroxide/magnesium hydroxide/simethicone
Mylanta
Magaldrate, magaldrate/simethicone
Riopan
Meclizine
Dramamine
Simethicone
Mylicon
Selenium sulfide topical
Selsun Blue
Acidophilus, lactobacillus (age 18 and under)
Culturelle, Probiotic, Acidophilus
Bismuth subsalicylate, attapulgite
Pepto-Bismol, Kaopectate
Loperamide
Imodium AD
Clotrimazole 1% topical
Lotrimin
Clotrimazole 1% vaginal
Gyne-Lotrimin
Miconazole topical
Monistat-Derm
Miconazole vaginal
Monistat
Tolnaftate
Tinactin
Cimetidine
Tagamet
Esomeprazole (requires prior authorization)
Nexium OTC
Famotidine
Pepcid AC
Rantidine
Zantac
Levonorgestrel
Plan B
Nonoxynol-9
Conceptrol, Emko
Brompheniramine/phenylephrine
Dimetapp
Guaifenesin
Robitussin
Guaifenesin DM
Robitussin DM
Pseudoephedrine
Sudafed
Capsaicin
Zostrix
Glucose tablets and gel
Glucose
Ammonium lactate topical
Amlactin
White petrolatum
Hydrolatum
Carbamide peroxide
Debrox
Electrolyte solution
Pedialyte
Bacitracin topical
Bacitracin/polymyxin B
Double antibiotic
Chlorhexidine gluconate
Hibiclens
Hydrogen peroxide
Iodine
Isopropyl alcohol
Povidone
Betadine
Triple antibiotic ointment, neomycin/bacitracin/polymyxin B
Neosporin
Bisacodyl
Dulcolax
Cascara
Nature’s Remedy
Docusate sodium, docusate calcium
Colace, Surfak
Docusate sodium with casanthranol
Glycerin suppositories
Magnesium citrate
Citrate of Magnesia
Magnesium hydroxide
Milk of Magnesia
Methylcellulose
Citrucel
Mineral oil
Psyllium
Metamucil
Senna
Senokot
Sennosides/docusate sodium
Doc-Q-Lax
Sodium phosphate
Fleet Enema
Permethrin
NIX
Piperonyl butoxide/pyrethin
RID
Piperonyl butoxide/pyrethin/permethrin
RID Kit
Cromolyn
Nasalcrom
Oxymetazoline nasal spray
Afrin
Sodium chloride nasal spray
Ocean
Oxybutynin transdermal patch
Oxytrol
Ocular lubricant
Artificial Tears
Ketotifen fumarate
Alaway, Zaditor
Naphazoline
Naphcon
Naphazoline/pheniramine
Naphcon-A, Opcon-A, Visine-A
Sodium chloride 5% drops
Muro-128 drops
Tetrahydrozoline
Visine
Calamine lotion
Colloidal oatmeal
Aveeno Oatmeal Bath
Hydrocortisone topical
Anusol-HC
Zinc oxide topical
Balmex
Melatonin 1 mg, 3 mg, 5 mg
Melatonin
Nicotine gum
Nicorette, Nicorette DS
Nicotine lozenges
Commit
Nicotine patch
Nicoderm
Calcium carbonate
Oscal
Calcium carbonate with vitamin D
Oscal + D
Calcium citrate
Citracal
Calcium citrate with vitamin D
Citracal + D
Calcium with vitamin D
Co-enzyme Q10 (age 18 and under)
Co-enzyme Q10
Ferrous fumarate
Femiron
Ferrous gluconate
Fergon
Ferrous sulfate
Feosol
Fish oil
Folic acid
Folvite
Magnesium gluconate
Magonate
Magnesium oxide
Uro-Mag
Multivitamins
Multivitamins with minerals
Niacin
Niacinamide
Nicotinic acid
Niaspan ER
Omega-3 fish oil
Potassium phosphate
Neutra-Phos, Neutra-Phos K
Prenatal vitamins (without DHA)
Vitamin A
Vitamin B
Vitamin B-12
Vitamin C
Vitamin D
Vitamin E
Copayments and covered drugs are subject to change.
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