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*Denotes a generic available in at least one dosage form or strength - page 16 / 26

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This PDL reference tool is to aid a prescribing physician with generic availability and preferred product status. A “substitution allowed” physician signature on a prescription should not require a PA to be obtained if a generic agent is available.

none

none

none

Aciphex

none

Prevacid OTC Prilosec OTC

lansoprazole omeprazole

Dexilant (formerly known as Kapidex)** Nexium pantoprazole (generic) Prevacid* Prilosec* Protonix*

none

Prevpac

meclizine trimethobenzamide dimenhydrinate

prochlorperazine edisylate

prochlorperazine maleate

Antivert* Tigan*

granisetron

ondansetron ondansetron

dronabinol

Aloxi Anzemet Granisol Kytril* Sancuso** Zofran* Zofran ODT* Cesamet Emend Marinol* Scopace Transderm-Scop

*Denotes a generic available in at least one dosage form or strength **Will be reviewed at a future time when eligible

Effective 4/1/2010

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