Drug List - V

V
Drug Name Tier Restrictions
VAGIFEM 2
VALACYCLOVIR 1
VALCYTE 3 Prior authorization, Quantity limit, Step therapy
VALGANCICLOV TAB 450MG 1
VALPROIC 1
VALPROIC ACD SYP 250/5ML 1
VALSARTAN TAB 1
VALSARTAN/HCTZ 1
VALTREX 3 Prior authorization
VANCOCIN HCL 3 Prior authorization
VANCOMYCIN CAP 1
VANDAZOLE 2
VANIQA NC
VANOS 3 Prior authorization, Quantity limit, Step therapy
VASOTEC 3 Prior authorization
VAXCHORA 3
VELIVET PAK 1*
VELTIN 3
VEMLIDY 2
VENLAFAXINE ER CAP 1
VENLAFAXINE ER TAB 1
VENLAFAXINE HCL 1
VENTOLIN HFA AER 1 Quantity limit
VEPESID 3 Prior authorization, Quantity limit
VERALEN SR 3 Prior authorization
VERAMYST NC
VERAPAMIL HCL 1
VERELAN PM 3 Prior authorization
VESICARE 2
VESTURA TAB 3-0.02MG 1*
VFEND 2
VIAGRA 2 Quantity limit
VIBRAMYCIN 3 Prior authorization
VICODIN ES 3 Prior authorization
VICTOZA 2 Step therapy
VICTRELIS 2 Prior authorization
VIEKIRA PAK 3 Prior authorization
VIGAMOX 3 Prior authorization
VIIBRYD TAB 3
VIMPAT TAB 3
VINATAL FORTE 3
VIOKACE TAB 20880 3
VIRACEPT 2
VIRAMUNE 3 Prior authorization
VIREAD 2
VISICOL 2
VISTARIL 3 Prior authorization
VITAFOL-OB 3
VITAMIN D 1
VITAMIN D3 CAP 50000UNT 1
VIVACTIL 2
VIVAGLOBIN 3 Prior authorization
VIVELLE-DOT 3 Prior authorization
VIVITROL INJ 3
VIVOTIF BERNA 3 Travel
VOL-CARE RX TAB 1
VOLTAREN GEL 2 Prior authorization, Quantity limit
VOLTAREN SOL 0.1% OP 3 Prior authorization
VOLTAREN TAB 75MG EC 3 Prior authorizaton
VORICONAZOLE TAB 200MG 1
VORTEX CHAMBER 1
VOSPIRE ER TAB 4 MG 2 Quantity limit
VSL#3 NC
VYTORIN 3 Prior authorization, Quantity limit
VYVANSE 3