Drug List - F

F
Drug Name Tier Restrictions
FABRAZYME INJ 35MG UD $0 Prior authorization
FAMCICLOVIR 1
FAMOTIDINE NC
FAMOTIDINE 40MG/5ML ORAL SUSPENSION (AGE RESTRICTION 4-12 YEARS OLD) 1
FAMVIR 3 Prior authorization
FANAPT 3 Prior authorization
FARXIGA TAB 10MG 3 Step therapy
FASTCLIX MIS LANCETS 1
FELBAMATE TAB 1
FELODIPINE 1
FEMARA 3 Prior authorization
FEMCON FE 3
FEMHRT 3 Prior authorization
FEMHRT LOW 3 Prior authorization
FENOFIBRATE 1
FENTANYL DIS 1 Quantity limit
FEROTRINSIC 1 Over-the-counter
FERREX 150 CAP FORTE 1
FERREX 28 TAB 1
FERROUS SULFATE 1*
FETZIMA CAP 80MG 3
FINACEA 3 Quantity limit
FINASTERIDE 1MG NC
FINASTERIDE 5mg 1
FIRST PROGESTONE VAG 3
FIRST-HYDROCORTISONE 2 Quantity limit
FIRST-TESTOS OIN 2% 2
FIRST-TESTOSTERONE MC COMPO 2
FLAREX 3
FLECAINIDE ACETATE 1
FLECTOR PAD 2 Prior authorization, Quantity limit
FLOMAX 3 Prior authorization
FLONASE SPR NC
FLOVENT 2 Quantity limit
FLOVENT DISK AER 2
FLUCONAZOLE 1
FLUDROCORTISONE ACETATE 1
FLUNISOLIDE NC
FLUOCINOLONE 1 Quantity limit
FLUOCINOLONE ACETONIDE S 1 Quantity limit
FLUOCINOLONE-E 1 Quantity limit
FLUOCINONIDE 0.1% CR 1
FLUOR-A-DAY 3 Prior authorization
FLUORIDE CHW 1MG F $0
FLUOROMETHOLONE 1
FLUOROPLEX 2 Prior authorization, Quantity limit
FLUOROURACIL CRE 5% 1
FLUOXETINE 1
FLUPHENAZINE DECANOATE INJ 1
FLUPHENAZINE TABS 1
FLURAZEPAM HCL 1
FLURBIPROFEN 1
FLUTAMIDE 1
FLUTIC/SALMET INH 1
FLUTICASONE SPRAY NC
FLUVASTATIN 1
FLUVOXAMINE CR 1
FLUVOXAMINE MALEATE 1
FML FORTE 3 Prior authorization
FML-S.O.P. 3 Prior authorization
FOCALIN 3 Prior authorization
FOCALIN XR 3 Prior authorization
FOLBIC 1
FOLGARD OS 2
FOLGARD RX 3 Prior authorization
FOLIC ACID 1*
FOLLISTIM AQ INJ 3 Quantity limit
FOLPLEX 1
FORADIL AEROLIZER 2 Quantity limit
FORFIVO XL TAB 450MG 3 Prior Authorization
FORTEO SOL 600/2.4 3 Prior Authorization
FORTICAL SPR 200/ACT 3 Prior authorization
FORVIVO 3 Prior authorization
FOSAMAX 3 Prior authorization
FOSAMAX PLUS D 2
FOSINOPRIL SODIUM 1
FOSINOPRIL SODIUM/HYDROCHOLO 1
FOSRENOL 2
FRAGMIN 3 Prior authorization, Quantity limit
FREESTYLE LITE TEST STRIP AND LANCETS 1
FREESTYLE TEST STRIP AND LANCETS 1
FROVA 3 Quantity limit, Step therapy
FROVATRIPTAN TAB 1
FURADANTIN 2
FUROSEMIDE 1