Drug List

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V

Drug name	Tier	Restrictions	Mail order
VAGIFEM	2		Yes
VALACYCLOVIR	1		Yes
VALCYTE	3	Prior authorization, Quantity limit, Step therapy	Yes
VALPROIC	1		Yes
VALSARTAN/HCTZ	1		Yes
VALTREX	3		Yes
VANCOCIN HCL	2		No
VANDAZOLE	2		No
VANIQA	NC		No
VANOS	3	Prior authorization, Quantity limit, Step therapy	No
VASOTEC	3		Yes
VELIVET PAK	3		No
VELTIN	3		Yes
VENLAFAXINE ER CAP	1		No
VENLAFAXINE ER TAB	1		No
VENLAFAXINE HCL	1		No
VENTOLIN HFA AER	1	Quantity limit	Yes
VEPESID	3	Prior authorization, Quantity limit	No
VERALEN SR	3	Prior authorization	No
VERAMYST	2	Quantity limit, Step therapy	Yes
VERAPAMIL HCL	1		Yes
VERELAN PM	3	Prior authorization	No
VESICARE	2		Yes
VFEND	2		No
VIAGRA	2	Quantity limit	Yes
VIBRAMYCIN	3		No
VICODIN ES	3		No
VICTOZA	3		No
VICTRELIS	2	Prior authorization	No
VIGAMOX	3		Yes
VINATAL FORTE	3		No
VIRACEPT	2		Yes
VIRAMUNE	3	Prior authorization	No
VIREAD	2		Yes
VISICOL	2		No
VISTARIL	3	Prior authorization	No
VITAFOL-OB	3		No
VITAMIN D	1		No
VIVACTIL	2		No
VIVAGLOBIN	3	Prior authorization	No
VIVELLE-DOT	3		Yes
VIVOTIF BERNA	3	Travel	No
VOLTAREN GEL	2	Prior authorization, Quantity limit	Yes
VOLTAREN SOL 0.1% OP	3	Prior authorization	No
VOLTAREN TAB 75MG EC	3		Yes
VORTEX CHAMBER	1		Yes
VOSPIRE ER TAB 4 MG	2	Quantity limit	No
VYTORIN	2	Prior authorization, Quantity limit	Yes
VYVANSE	3		No