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*Denotes a generic available in at least one dosage form or strength - page 4 / 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.

Amoxil*

amoxicillin amoxicillin and clavulanate amoxicillin and clavulanate

nafcillin penicillin G

ampicillin and sulbactam piperacillin and tazobactam ampicillin dicloxacillin oxacillin penicillin V piperacillin

Augmentin* Augmentin ES* Augmentin XR Bicillin C-R Bicillin L-A Moxatag Nallpen* Pfizerpen* Ticar Timentin Unasyn* Zosyn*

none

ciprofloxacin ciprofloxacin ER

ofloxacin

Avelox Cipro* Cipro XR* Factive Floxin* Levaquin Noroxin ProQuin XR

none

sulfasalazine

sulfamethoxazole and trimethoprim

Azulfidine* Bactrim*

sulfamethoxazole and trimethoprim

Bactrim DS*

sulfamethoxazole and trimethoprim

Gantrisin Septra*

sulfamethoxazole and trimethoprim

Septra DS*

none

sulfadiazine doxycycline

minocycline minocycline minocycline

doxycycline doxycycline demeclocycline tetracycline

Adoxa* Doryx Dynacin* Minocin* Myrac* Terramycin Tygacil Vibramycin* Vibra-tabs*

*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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