No-Charge Psychiatric Medication Plan (Plan G) Formulary
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| BRAND® / generic name (by alphabetic order) |
Corresponding BRAND® / generic name |
Special Authority Approval Required? |
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| Jump to names starting with: A | B | C | D | E | F | G | H | I | K | L | M | N | O | P | R | S | T | V | W | X | Y | Z | ||
Abilify ® |
aripiprazole |
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alprazolam |
Xanax ® |
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amantadine |
Symmetrel ® |
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amitriptyline |
Elavil ® |
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Anafranil ® |
clomipramine |
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Androcur ® |
cyproterone |
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Antabuse ® |
disulfiram |
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aripiprazole |
Abilify ® |
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Artane ® |
trihexyphenidyl |
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Atarax ® |
hydroxyzine |
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atenolol |
Tenormin ® |
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Ativan ® |
lorazepam |
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Aventyl ® |
nortriptyline |
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Bensylate ® |
benztropine |
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benztropine |
Bensylate ® |
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bromazepam |
Lectopam ® |
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bromocriptine |
Parlodel ® |
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bupropion |
Wellbutrin ® Wellbutrin XL® |
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bupropion |
Zyban ® |
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Buspar ® |
buspirone |
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busiprone |
Buspar ® |
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carbamazepine |
Tegretol ® |
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carbidopa / levodopa |
Sinemet ® |
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Carbolith ® |
lithium carbonate |
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Catapres ® |
clonidine |
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Celexa ® |
citalopram |
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Champix ® |
varenicline |
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chloral hydrate |
Noctec ® |
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chlordiazepoxide |
Librium ® |
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chlorpromazine |
Largactil ® |
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Cipralex ® |
escitalopram |
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citalopram |
Celexa ® |
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clobazam |
Frisium ® |
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clomipramine |
Anafranil ® |
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clonazepam |
Rivotril ® |
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clonidine |
Catapres ®, Dixarit ® |
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Clopixol ® |
zuclopenthixol |
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clorazepate |
Tranxene ® |
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clozapine |
Clozaril ® |
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Concerta ® |
methylphenidate long-acting |
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Clozaril ® |
clozapine |
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Cytomel ® |
liothyronine |
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cyproterone |
Androcur ® |
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Dalmane ® |
flurazepam |
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Depakene ® |
valproic acid |
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desipramine |
Norpramin ® |
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Desyrel ® |
trazodone |
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Dexedrine ® |
dextroamphetamine |
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dextroamphetamine |
Dexedrine ® |
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diazepam |
Valium ®, Vivol ® |
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diphenhydramine injection |
diphenhydramine injection USP |
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disulfiram |
Antabuse ® |
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divalproex |
Epival ® |
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Dixarit ® |
clonidine |
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doxepin |
Sinequan ® |
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droperidol |
Inapsine ® |
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Duralith ® |
lithium carbonate |
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Effexor ® |
venlafaxine |
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Elavil ® |
amitriptyline |
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Eltroxin ® |
levothyroxine |
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Epival ® |
divalproex |
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escitalopram |
Cipralex ® |
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Fluanxol Depot ® |
flupenthixol decanoate |
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Fluanxol ® |
flupenthixol |
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fluoxetine |
FXT 40 ®, Prozac ® |
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fluphenazine |
Moditen ® |
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fluphenazine decanoate |
Modecate Concentrate ®, Modecate Injection ® |
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flupenthixol |
Fluanxol ® |
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flupenthixol decanoate |
Fluanxol Depot ® |
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flurazepam |
Dalmane ® |
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fluvoxamine |
Luvox ® |
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Frisium ® |
clobazam |
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FXT 40 ® |
fluoxetine |
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gabapentin |
Neurontin ® |
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Halcion ® |
triazolam |
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Haldol ® |
haloperidol |
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haloperidol |
Haldol ® |
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hydroxyzine |
Atarax ® |
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imipramine |
Impril ®, Tofranil ® |
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Imovane ® |
zopiclone |
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Impril ® |
imipramine |
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Inapsine ® |
droperidol |
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Inderal ® |
propranolol |
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Invega ® |
paliperidone |
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Invega ® Sustenna ® |
paliperidone palmitate |
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Isoptin ® |
verapamil |
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Kemadrin ® |
procyclidine |
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Lamictal ® |
lamotrigine |
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lamotrigine |
Lamictal ® |
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Largactil ® |
chlorpromazine |
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Lectopam ® |
bromazepam |
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levothyroxine |
Eltroxin ®, Synthroid ® |
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levodopa / carbidopa |
Sinemet ® |
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leuprolide |
Lupron ® |
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Librium ® |
chlordiazepoxide |
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Lithane ® |
lithium carbonate |
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lithium carbonate |
Carbolith ®, Duralith ®, |
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liothyronine |
Cytomel ® |
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lorazepam |
Ativan ® |
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Loxapac ® |
loxapine |
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loxapine |
Loxapac ® |
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Ludiomil ® |
maprotiline |
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Lupron ® |
leuprolide |
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Luvox ® |
fluvoxamine |
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Manerix ® |
moclobemide |
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maprotiline |
Ludiomil ® |
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methotrimeprazine |
Nozinan ® |
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methylphenidate long-acting |
Concerta ® |
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methylphenidate |
Ritalin ® |
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mirtazapine |
Remeron ® |
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moclobemide |
Manerix ® |
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Modecate Concentrate ® |
fluphenazine decanoate |
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Modecate Injection ® |
fluphenazine decanoate |
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Moditen ® |
fluphenazine |
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Mogadon ® |
nitrazepam |
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Nardil ® |
phenelzine |
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Navane ® |
thiothixene |
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Neurontin ® |
gabapentin |
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Nitoman ® |
tetrabenazine |
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nitrazapam |
Mogadon ® |
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Noctec ® |
chloral hydrate |
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Norpramin ® |
desipramine |
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nortriptyline |
Aventyl ® |
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Nozinan ® |
methotrimeprazine |
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olanzapine |
Zyprexa ® |
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Orap ® |
pimozide |
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oxazepam |
Serax ® |
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paliperidone |
Invega ® |
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paliperidone palmitate |
Invega ® Sustenna ® |
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Parlodel ® |
bromocriptine |
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Parnate ® |
tranylcypromine |
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paroxetine |
Paxil ® |
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Paxil ® |
paroxetine |
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perphenazine |
Trilafon ® |
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phenelzine |
Nardil ® |
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pericyazine |
Neuleptil ® |
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pimozide |
Orap ® |
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pindolol |
Visken ® |
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Piportil-L4 Injection ® |
pipotiazine |
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pipotiazine |
Piportil-L4 Injection ® |
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procyclidine |
Kemadrin ® |
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propranolol |
Inderal ® |
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Prozac ® |
fluoxetine |
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quetiapine |
Seroquel ® |
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Remeron ® |
mirtazapine |
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Restoril ® |
temazepam |
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Risperdal ® |
risperidone |
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Risperdal Consta ® |
risperidone microspheres |
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risperidone |
Risperdal ® |
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risperidone microspheres |
Risperdal Consta ® |
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Ritalin ® |
methylphenidate |
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Rivotril ® |
clonazepam |
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Serax ® |
oxazepam |
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Seroquel ® |
quetiapine |
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sertraline |
Zoloft ® |
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Sinemet ® |
carbidopa / levodopa |
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Sinequan ® |
doxepin |
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Stelazine ® |
trifluoperazine |
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Surmontil ® |
trimipramine |
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Symmetrel ® |
amantadine |
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Synthroid ® |
levothyroxine |
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Tegretol ® |
carbamazepine |
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temazepam |
Restoril ® |
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Tenormin ® |
atenolol |
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tetrabenazine |
Nitoman ® |
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thiothixene |
Navane ® |
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Tofranil ® |
imipramine |
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trazodone |
Desyrel ® |
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Tranxene ® |
clorazepate |
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tranylcypromine |
Parnate ® |
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triazolam |
Halcion ® |
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trifluoperazine |
Stelazine ® |
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trihexyphenidyl |
Artane ® |
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Trilafon ® |
perphenazine |
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trimipramine |
Surmontil ® |
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Tryptan ® |
tryptophan |
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tryptophan |
Tryptan ® |
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Valium ® |
diazepam |
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valproic acid |
Depakene ® |
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varenicline |
Champix ® |
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venlafaxine |
Effexor ® |
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verapamil |
Isoptin ® |
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Visken ® |
pindolol |
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Vivol ® |
diazepam |
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Wellbutrin ® |
bupropion |
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Xanax ® |
alprazolam |
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Yocan ® |
yohimbine |
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yohimbine |
Yocan ® |
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Zeldox ® |
ziprasidone |
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ziprasidone |
Zeldox ® |
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Zoloft ® |
sertraline |
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zopiclone |
Imovane ® |
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zuclopenthixol |
Clopixol ® |
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Zyban ® |
bupropion |
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Zyprexa ® |
olanzapine |
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