Clickable Table
| Generic Name | Brand Name | Strength | Dosing | 90 Day Cost | Coverage | Comments | Category 1 | Category 2 |
|---|---|---|---|---|---|---|---|---|
| Paroxetine | Paxil | 20 mg | QD | $45 | BC / IA - Covered | G Psychiatry | Antidepressants | |
| Desvenlafaxine | Pristiq | 50 mg | QD | $255 | BC / IA - NC | G Psychiatry | Antidepressants | |
| Fluoxetine | Prozac | 20 mg | QD | $45 | BC / IA - Covered | G Psychiatry | Antidepressants | |
| Mirtazapine | Remeron | 30 mg | HS | $35 | BC / IA - Covered | G Psychiatry | Antidepressants | |
| Vortioxetine | Trintellix | 20 mg | QD | $345 | BC / IA - NC | G Psychiatry | Antidepressants | |
| Sertraline | Zoloft | 50 mg | QD | $45 | BC / IA - Covered | G Psychiatry | Antidepressants | |
| Aripiprazole | Abilify | 15 mg | QD | $140 | BC - RST / IA - SA | G Psychiatry | Antipsychotics | |
| Risperidone | Risperdal | 1 mg | QD | $40 | BC / IA - Covered | G Psychiatry | Antipsychotics | |
| Quetiapine | Seroquel | 25 mg | HS | $20 | BC / IA - Covered | G Psychiatry | Antipsychotics | |
| Quetiapine | Seroquel XR | 300 mg | QD | $110 | BC / IA - Covered | G Psychiatry | Antipsychotics | |
| Olanzapine | Zyprexa | 5 mg, 10 mg | QD | $85 | BC / IA - Covered | G Psychiatry | Antipsychotics | |
| Lorazepam | Ativan | 1 mg | PRN | $20 | BC / IA - Covered |
90 tablets |
G Psychiatry | Anxiolytic Sedative |
| Trazodone | Desyrel | 50 mg | PRN | $20 | BC / IA - Covered |
90 tablets |
G Psychiatry | Anxiolytic Sedative |
| Zopiclone | Imovane | 7.5 mg | PRN | $25 | BC - Covered / IA - NC |
90 tablets |
G Psychiatry | Anxiolytic Sedative |
| Temazepam | Restoril | 30 mg | PRN | $40 | BC / IA - Covered |
90 tablets |
G Psychiatry | Anxiolytic Sedative |
| Amphetamines, Mixed Salts | Adderall XR | 10 mg | QD | $265 | BC - NC / IA - Covered | G Psychiatry | Stimulants (ADHD) | |
| Methylphenidate | Concerta | 36 mg | QD | $345 | BC - NC / IA - Covered | G Psychiatry | Stimulants (ADHD) | |
| Methylphenidate | Ritalin | 10 mg | BID | $30 | BC / IA - Covered | G Psychiatry | Stimulants (ADHD) | |
| Lisdexamfetamine | Vyvanse | 20 mg | QD | $290 | BC - RST / IA - Covered | G Psychiatry | Stimulants (ADHD) | |
| Citalopram | Celexa | 20 mg | QD | $25 | BC / IA - Covered | G Psychiatry | Antidepressants | |
| Escitalopram | Cipralex | 10 mg | QD | $45 | BC / IA - Covered | G Psychiatry | Antidepressants | |
| Duloxetine | Cymbalta | 30 mg | QD | $60 | BC / IA - Covered | G Psychiatry | Antidepressants | |
| Venlafaxine | Effexor XR | 75 mg | QD | $30 | BC / IA - Covered | G Psychiatry | Antidepressants |