| Medication | PacifiCare (Cost per Month) | Aetna | Cigna | RMHP | United | Anthem | |
| ACE Inhibitors | captopril/HCTZ | captopril/HCTZ | captopril/HCTZ | captopril/HCTZ | captopril/HCTZ | captopril/HCTZ | captopril/HCTZ |
| lisinopril/HCTZ | lisinopril/HCTZ ($10-$40) | lisinopril/HCTZ | lisinopril/HCTZ | lisinopril/HCTZ | lisinopril/HCTZ | lisinopril/HCTZ | |
| enalapril/HCTZ | enalapril/HCTZ | enalapril/HCTZ | enalapril/HCTZ | enalapril/HCTZ | enalapril/HCTZ | ||
| moexipril/Uniretic | moexipril/Uniretic ($10-$40) | moexipril | moexipril/Uniretic | moexipril/Uniretic | moexipril/Uniretic | ||
| Lotensin/HCT | Lotensin/HCT | Lotensin/HCT | 3rd Tier | Lotensin/HCT | |||
| Mavik | Mavik | 3rd Tier | |||||
| Accupril/retic | Accupril/retic | 3rd Tier | Accupril/retic | Accupril/retic | |||
| fosinopril/Monopril HCT | fosinopril | fosinopril | fosinopril/Monopril HCT | ||||
| Altace | Altace | Altace | Altace | Altace | |||
| Angiotensin | Benicar | NF Preferred | 3rd Tier | Benicar | |||
| Receptor | Avapro/Avalide | 3rd Tier | Avapro/Avalide | ||||
| Blockers | Diovan/HCT | NF Preferred | Diovan/HCT | Diovan/HCT | 3rd Tier | Diovan/HCT | Diovan/HCT |
| Atacand/HCT | 3rd Tier | ||||||
| Cozaar/Hyzaar | Cozaar/Hyzaar | Cozaar/Hyzaar | Cozaar/Hyzaar | Cozaar/Hyzaar | |||
| Antibiotics (2nd Line) | Zithromax | Zithromax | Zithromax | Zithromax | Zithromax | Zithromax | Zithromax |
| 1st Line Generic | Levaquin | Levaquin | Levaquin | Levaquin | |||
| are formulary! | Augmentin/ES/XR | Augmentin/ES/XR | Augmentin/ES/XR | Augmentin/ES | Augmentin/ES | Augmentin/ES/XR | Augmentin/ES/XR |
| cefuroxime | cefuroxime | cefuroxime | cefuroxime | cefuroxime | |||
| Cipro | Cipro | Cipro | Cipro | Cipro | Cipro | Cipro/XR | |
| Tequin | Tequin | ||||||
| Avelox | Avelox | Avelox | 3rd Tier | ||||
| Cefzil | Cefzil | Cefzil | Cefzil | Cefzil | Cefzil | ||
| Biaxin/XL | Biaxin/XL | Biaxin/XL | Biaxin/XL | Biaxin/XL | Biaxin/XL | ||
| Lorabid | Lorabid | ||||||
| Cedax | Cedax | ||||||
| PacifiCare (Cost per Month) | Aetna | Cigna | RMHP | United | Anthem | ||
| Antidepressants | fluoxetine | fluoxetine ($10/10&20mg cap) | fluoxetine | fluoxetine | fluoxetine | fluoxetine | fluoxetine |
| ($60/40mg caps) | |||||||
| Lexapro | Lexapro ($70/20mg tab) | Lexapro | Lexapro | ||||
| Celexa | Celexa | Celexa | Celexa | ||||
| paroxetine/CR | paroxetine/CR ($50-60) | paroxetine/CR | paroxetine/CR | paroxetine/CR | paroxetine/CR | paroxetine/CR | |
| Paxil CR | Not Covered 4/15/04 | ||||||
| Zoloft | Zoloft | Zoloft | 3rd Tier | Zoloft | Zoloft | ||
| Serzone | Serzone | 3rd Tier | Serzone | ||||
| bupropion/SR | bupropion/SR | bupropion/SR | bupropion/SR/XL | bupropion/SR | bupropion/SR | bupropion/SR | |
| Effexor/XR | Effexor/XR | Effexor XR only | Effexor/XR | Effexor/XR | Effexor/XR | Effexor/XR | |
| Antihistamines | Zyrtec/D | 3rd Tier | Zyrtec/D | ||||
| Clarinex | Clarinex ($70-$80) | Not Covered | Clarinex | ||||
| Allegra/D | Allegra ($70-$80) | 3rd Tier | |||||
| PacifiCare (Cost per Month) | Aetna | Cigna | RMHP | United | Anthem | ||
| Asthma/COPD | albuterol | albuterol ($10-$20) | albuterol | albuterol | albuterol | albuterol | albuterol |
| Atrovent | Atrovent | Atrovent | Atrovent | Atrovent | Atrovent | Atrovent | |
| Combivent | Combivent ($60) | Combivent | Combivent | Combivent | Combivent | ||
| Foradil | Foradil | Foradil | Foradil | ||||
| Maxair | Maxair | Maxair | Maxair | 3rd Tier | Maxair | ||
| Serevent | Serevent ($90-$100) | Serevent | Serevent | Serevent | Serevent | Serevent | |
| Advair | Advair (stp tx) | Advair | Advair | Advair | Advair | Advair | |
| QVAR | QVAR ($60-$80) | QVAR | 3rd Tier | ||||
| Flovent/Rotadisk | Flovent ($60-$80) | Flovent/Rotadisk | Flovent/Rotadisk | Flovent/Rotadisk | Flovent/Rotadisk | Flovent/Rotadisk | |
| Aerobid/M | Aerobid/M | 3rd Tier | |||||
| Azmacort | Azmacort | 3rd Tier | Azmacort | Azmacort | |||
| Pulmicort | Pulmicort Res | Pulmicort | Pulmicort (Respules 3rd Tier) | Pulmicort Res/Turbo | Pulmicort | ||
| Accolate | Accolate | Accolate | Accolate | Accolate | |||
| Proventil HFA | Proventil HFA | ||||||
| Singulair | Singulair ($70-$90) | Singulair | Singulair | Singulair | Singulair | Singulair | |
| PacifiCare (Cost per Month) | Aetna | Cigna | RMHP | United | Anthem | ||
| Calcium Channel | Verapamil ER, CR, SR | Verapamil ER, CR, SR ($20) | Verapamil ER, CR, SR | Verapamil ER, CR, SR | Verapamil ER, CR, SR | Verapamil ER, CR, SR | Verapamil ER, CR, SR |
| nicardipine/SR | nicardipine/SR | nicardipine | nicardipine | 3rd Tier | nicardipine/SR | ||
| Sular | Sular | 3rd Tier | |||||
| diltiazem CD/CR/ER/XT | diltiazem SR 12hr/XT 24hr ($60-$80) | diltiazem CD/CR/ER/XT | diltiazem CD/CR/ER/XT | diltiazem CD/CR/ER/XT | diltiazem CD/CR/ER/XT | diltiazem CD/CR/ER/XT | |
| Plendil | Plendil | Plendil | 3rd Tier | ||||
| nifedipine CR/ER | nifedipine CR ($60-$80) | nifedipine CR/ER | nifedipine CR/ER | nifedipine CR/ER | nifedipine ER | nifedipine CR/ER | |
| Norvasc | Norvasc | Norvasc | Norvasc | Norvasc | Norvasc | ||
| Tiazac | taztia XT | Tiazac | diltiazem | ||||
| Cardiac | Lexxel | Lexxel | |||||
| Combinations | Tarka | Tarka | Tarka | ||||
| Lotrel | Lotrel | Lotrel | Lotrel | ||||
| Dementia | Aricept | Aricept | Aricept | Aricept | Aricept | Aricept | |
| Exelon | Exelon | Exelon | Exelon | ||||
| Reminyl | Reminyl | Reminyl | |||||
| PacifiCare (Cost per Month) | Aetna | Cigna | RMHP | United | Anthem | ||
| Diabetes | glipizida/ER | glipizida ($10-$20) | glipizida/ER | glipizida/ER | glipizida/ER | glipizida/ER | glipizida/ER |
| glyburide | glyburide ($40-$50) | glyburide | glyburide | glyburide | glyburide | glyburide | |
| Amaryl | Amaryl | Amaryl | Amaryl | ||||
| metformin/ER 500 mg | metformin ($140) | metformin/ER | metformin | metformin | metformin | metformin/ER | |
| Metaglip | Metaglip | 3rd Tier | Metaglip | ||||
| Glucophage XR/Vance | Glucophage | Glucovance | metformin XR | Gluco XR/Vance | Glucophage XR/Vance | ||
| Avandia | Avandia ($130-$140) | Avandia | Avandia | 3rd Tier | Avandia | Avandia | |
| Avandamet | Avandamet | Avandamet | 3rd Tier | Avandamet | |||
| Actos | Actos | Actos | Actos | Actos | |||
| Insulin (R,N,L,NPH) | Humulin | Humulin | Humulin/Novolin | Humulin | Humulin/Novolin | Humulin | |
| Lantus | Lantus | Lantus | Lantus | Lantus | Lantus | ||
| Humalog/Novolog | Humalog | Humalog | Humalog/Novolog | Humalog | Humalog/Novolog | Humalog | |
| Prandin | Prandin | ||||||
| Starlix | Starlix | ||||||
| Glucose Meter | Fast Take, Sure Step, Ultra | One Touch, Precision | Accuchek | Unknown | Unknown | Fast Take, One Touch, Accuchek | |
| PacifiCare (Cost per Month) | Aetna | Cigna | RMHP | United | Anthem | ||
| Genitourinary | oxybutynin | oxybutynin | oxybutynin | oxybutynin | oxybutynin | oxybutynin | oxybutynin |
| Detrol/LA | Detrol/LA | Detrol/LA | Detrol/LA | ||||
| Oxytrol | Oxytrol | ||||||
| Ditropan XL | Ditropan XL | Ditropan XL | Ditropan XL | Ditropan XL | |||
| GI | cimetidine | cimetidine | cimetidine | cimetidine | cimetidine | cimetidine | cimetidine |
| ranitidine | ranitidine tabs | ranitidine | ranitidine | ranitidine tabs | ranitidine | ranitidine | |
| famotidine | famotidine | famotidine | famotidine | famotidine | famotidine | ||
| Protonix | Protonix (PA 8 wks) ($80/40mg tabs) | Protonix (PA) | Protonix | Protonix | Protonix | ||
| omeprazole | omeprazole ($70/40mg rx tabs) | omeprazole (10&40) | omeprazole (PA) | omeprazole (NOT 20mg) | |||
| Aciphex | Aciphex (PA 8 wks) ($110/20mg tabs) | Aciphex | 3rd Tier | Aciphex | |||
| Prevacid | Prevacid | Prevacid (PA) | 3rd Tier | ||||
| Nexium | Not Covered | Nexium | |||||
| Lipids | gemfibrozil | gemfibrozil ($20) | gemfibrozil | gemfibrozil | gemfibrozil | gemfibrozil | gemfibrozil |
| lovastatin | lovastatin ($30/40mg tab) | lovastatin | lovastatin | lovastatin | lovastatin | lovastatin | |
| Niaspan | Niaspan | Niaspan | Niaspan | Niaspan | Niaspan | ||
| Advicor | Advicor | Advicor | 3rd Tier | ||||
| Lescol/XL | Lescol/XL | Lescol/XL | 3rd Tier | ||||
| Zetia | 3rd Tier | Zetia | |||||
| Crestor | 3rd Tier | ||||||
| fenofibrate | Tricor | Tricor | Tricor | fenofibrate | Tricor | ||
| Lipitor | Lipitor | Lipitor | Lipitor | ||||
| Pravachol | Pravachol ($110-120/40,80 mg tabs) | Pravachol | Pravachol | Pravachol | |||
| Welchol | Welchol | ||||||
| Zocor | Zocor ($110-$120/20,40,80 mg tabs) | Zocor | Zocor | 3rd Tier | Zocor | ||
| PacifiCare (Cost per Month) | Aetna | Cigna | RMHP | United | Anthem | ||
| Migraines | Axert | 3rd Tier | Axert | ||||
| Zomig/ZMT | Zomig/ZMT | Zomig/ZMT | 3rd Tier | Zomig/ZMT | Zomig/ZMT | ||
| Relpax | 3rd Tier | ||||||
| Maxalt/MLT | Maxalt/MLT | Maxalt/MLT | Maxalt/MLT | ||||
| Imitrex | Imitrex tablets | Imitrex | Imitrex | Imitrex | Imitrex | Imitrex | |
| Amerge | Amerge | 3rd Tier | |||||
| Nasal Steriods | flunisolide | flunisolide | flunisolide | flunisolide | flunisolide | flunisolide | |
| Nasacort/AQ | Nasacort/AQ | Nasacort/AQ | |||||
| Flonase | Flonase | Flonase | Flonase | Flonase 2nd Tier 4/1/04 | Flonase | Flonase | |
| Rhinocort/AQ | Rhinocort/AQ | Rhinocort/AQ | Rhinocort/AQ | Rhinocort/AQ | |||
| Nasonex | Nasonex | Nasonex | Nasonex (2-12yrs) | Nasonex | Nasonex | ||
| NSAIDS/COX2s | generics | generics ($10-$30) | generics | generics | generics | generics | generics |
| Vioxx | Vioxx (PA) | 3rd Tier | |||||
| Bextra | 3rd Tier | ||||||
| Celebrex | NF Preferred | 3rd Tier | Celebrex (step tx) | ||||
| Osteoporosis/ | estradiol | estradiol ($10-$20) | estradiol | estradiol | estradiol | estradiol | estradiol |
| Women's Health | estropipate | estropipate ($10-$20) | estropipate | estropipate | estropipate | estropipate | estropipate |
| Menest | Menest ($20) | Menest | Menest | Menest | Menest | Menest | |
| Cenestin | Cenestin | Cenestin | Cenestin | ||||
| Premarin | Premarin ($30-$40) | Premarin | Premarin | Premarin | Premarin | ||
| Evista | NF Preferred | Evista | Evista | Evista | Evista | Evista | |
| Actonel | NF Preferred | Actonel | Actonel | Actonel | |||
| Estraderm | Estraderm ($30-$40) | Estraderm | |||||
| Ortho-Prefest | Ortho-Prefest | ||||||
| Vivelle | Vivelle ($30-$40) | Vivelle | |||||
| Fosamax | Fosamax | Fosamax | Fosamax | Fosamax | Fosamax | ||
| PacifiCare (Cost per Month) | Aetna | Cigna | RMHP | United | Anthem |