Appendix B: Iowa ADAP Formulary
Iowa AIDS Drug Assistance Program (ADAP)
Formulary as of Feb. 26, 2015
ANTIRETROVIRALS
Trade Name
Aptivus
Atripla
Combivir
Complera
Crixivan
Edurant
Emtriva
Epzicom
Epivir
Evotaz
Fuzeon
Intelence
Invirase
Isentress
Kaletra
Lexiva
Norvir
Prezcobix
Prezista
Rescriptor
Retrovir
Reyataz
Selzentry
OI PREVENTION/TREATMENT
Trade Name
Ancobon
Bactrim, Septra
Copegus
Dapsone
Daraprim
Diflucan
Famvir
Foscavir
Harvoni
Laniazid
Mepron
Microsulfon
Myambutol
Mycobutin
Mycostatin
Mycelex
Nebupent
Nizoral
Pegasys
Pentam 300
Sovaldi*
Sporanox
Valcyte
Generic Name
Flucytosine
TMP/SMX
Ribivirin
Dapsone
Pyrimethamine
Fluconazole
Famciclovir
Foscarnet
Ledipasvir/Sofosbuvir
Isoniazid
Atovaquone
Sulfadiazine
Ethambutol
Rifabutin
Nystatin
Clotrimazole
Pentamidine
Ketoconazole
Peginterferon alph-2a
Aerosol Pentamidine
Sofosbuvir
Itraconzole
Valganiciclovir
Stribild
Generic Name
Tipranavir
Efavirenz/Emtricitabine/Tenofovir
Lamivudine/Zidovudine
Rilpivirine/Tenofovir/Emtricitabine
Indinavir
Rilpivirine
Emtricitabine
Abacavir/Lamivudine
Lamivudine
Atazanavir/Cobicistat
Enfuvirtide
Etravirine
Saquinavir
Raltegravir
Lopinavir/ritonavir
Fosamprenavir
Ritonavir
Darunavir/Cobicistat
Darunavir
Delavirdine
Zidovudine (AZT)
Atazanavir
Maraviroc
Elvitegravir/Cobicistat/Tenofovir/Emtric
itabine
Valtrex
Valacyclovir
Sustiva
Tivicay
Trizivir
Triumeq
Truvada
Tybost
Videx
Viracept
Viramune
Viread
Zerit
Ziagen
Efavirenz
Dolutegravir
Abacavir/Lamivudine/Zidovudine
Dolutegravir/Abacavir/Lamivudine
Emtricitabine/Tenofovir
cobicistat
Didanosine (ddl)
Nelfinavir
Nevirapine
Tenofovir
Stavudine (d4T)
Abacavir
Viekira Pak
Vistide
Wellcovorin
Zithromax
Zovirax
Ombitasvir/Paritaprevir/Ritonavir
Cidofovir
Leucovorin
Azithromycin
Acyclovir
*Only for insurance clients
ANTIDEPRESSANTS/ANXIETY
ANTIPSYCHOTIC/HYPNOTIC
Trade Name
Celexa
Cymbalta
Effexor
Desyrel
Lexapro
Luvox
Paxil
Prozac
Remeron
Seroquel
Wellbutrin
Zoloft
Trade Name
Neurontin
Generic Name
Citalopram
Duloxetine
Venlafaxine
Trazodone
Escitalopram
Fluvoxamine
Paroxetine
Fluvoxamine
Mirtazapine
Quetiapine
Bupropion
Sertraline
Generic Name
Gabapentin
Nicotine Replacement Therapy
Trade Name
Generic Name
Chantix
varenicline
Nicorette
nicotine gum
Nicoderm CQ
nicotine patch