Drug - Proton Pump Inhibitors (PPIs)
October 2015
Therapeutic area - Gastrointestinal
Preferred
omeprazole - generic
pantoprazole - generic
Nexium packet for suspension
Nonpreferred
Capsule formulation
Aciphex(rabeprazole)
Dexilant (dexlansoprazole)
Nexium (esomeprazole)
Prilosec brand (omeprazole)
Prevacid (lansoprazole)
Protonix (pantoprazole)
lansoprazole – generic
omeprazole/bicarbonate generic
Zegerid (legend)(omeprazole/bicarbonate)
Other dosage forms
Prevacid Solutab
Lansoprazole solutab
Prilosec packet for suspension
Prilosec OTC excluded from coverage.
Prevacid OTC is excluded from coverage.
Zegerid OTC is excluded from coverage
Nonpreferred drugs- capsule formulation (Excludes Nexium)
Other dosage forms including Prevacid Solutab, lansoprazole solutab, or Prilosec packet
MHCP Provider Call Center 651-431-2700 or 800-366-5411