Medications are listed below by generic and brand name. They are grouped by indication or use. The indication or use must be HIV-related.
Ryan White Part B Formulary (rev. 08/07/19)
| GENERIC NAME | AVAILABLE BRAND NAME*
Must use generic when available |
CLASS OR TYPE OF DRUG**
Must be HIV related or for conditions that affect health outcomes related to HIV management |
| alprazolam | Xanax | anti-anxiety |
| diazepam | Valium | anti-anxiety |
| lorazepam | Ativan | anti-anxiety |
| triazolam | Halcion | anti-anxiety |
| amoxicillin | Amoxil | anti-bacterial |
| amoxicillin/clavulanic acid | Augmentin | anti-bacterial |
| cefuroxime | Ceftin | anti-bacterial |
| cephalexin | Keflex | anti-bacterial |
| ciprofloxacin | Cipro | anti-bacterial |
| dicloxacillin | anti-bacterial | |
| doxycycline | Vibramycin | anti-bacterial |
| moxifloxacin | Avelox | anti-bacterial |
| mupirocin | Bactroban | anti-bacterial |
| nitrofurantoin | Macrobid | anti-bacterial |
| penicillin | anti-bacterial | |
| warfarin | Coumadin | anti-coagulant |
| betamethasone/clotrimazole | Lotrisone | anti-infective |
| clotrimazole | Lotrimin, Mycelex | anti-infective |
| clotrimazole troches | Mycelex Troches | anti-infective |
| ketoconazole | Nizoral | anti-infective |
| metronidazole | Flagyl | anti-infective |
| nystatin | Mycostatin Susp. | anti-infective |
| valacyclovir | Valtrex | anti-viral |
| oseltamivir | Tamiflu | anti-viral |
| zanamivir | Relenza | anti-viral |
| amlodipine | Norvasc | cardiac |
| atenolol | Tenormin | cardiac |
| clonidine hydrochloride | Catapres | cardiac, opioid use disorder treatment |
| diltiazem | Cardizem | cardiac |
| doxazosin | Cardura | cardiac |
| enalapril | Vasotec | cardiac |
| fosinopril | Monopril | cardiac |
| irbesartan | Avapro | cardiac |
| labetolol | Trandate | cardiac |
| lisinopril | Zestril | cardiac |
| losartan | Cozaar | cardiac |
| metoprolol | Lopressor | cardiac |
| potassium | cardiac | |
| propranolol | Inderal | cardiac |
| verapamil | Covera, Calan | cardiac |
* RWHAP B funds will pay for brand name formulations only if a generic formulation is not available. Brand names listed on the formulary are for reference only. ** Use of medications must be HIV-related, but is not restricted to the indication/use cited on the formulary. Alternatively, the medication must treat a co-morbid condition or disorder that affects HIV management or an individual’s health outcomes such as HIV viral load suppression. The information provided is only a resource and does not provide clinical advice or information.
| GENERIC NAME | AVAILABLE BRAND NAME*
Must use generic when available |
CLASS OR TYPE OF DRUG**
Must be HIV related or for conditions that affect health outcomes related to HIV management |
| fluocinonide | Lidex | dermatologic |
| imiquimod | Aldara Cream | dermatologic |
| bacitracin/neomycin/polymyxin B | Neosporin | dermatologic |
| triamcinolone: Eucerin (compond) | dermatologic | |
| diphenoxylate/atropine | Lomotil, Lonox | diarrhea |
| loperamide | Imodium | diarrhea |
| furosemide | Lasix | diuretic |
| hydrochlorothiazide | diuretic | |
| spironolactone | Aldactone | diuretic |
| levothyroxine | Synthroid | hormone |
| prednisone | Deltasone | hormone |
| testosterone | Androderm, Androdgel, Oxandrin | hormone |
| buprenorphine/naloxone | Suboxone (sublingual film), Zubsolv (sublingual tablet), Bunavail (buccal film) | opioid use disorder treatment |
| buprenorphine (monoproduct) | Sublocade (injection), buprenorphine tablets | opioid use disorder treatment♦ |
| lofexidine | Lucemyra | opioid use disorder treatment |
| methadone | Dolophine, Methadose | opioid use disorder treatment‡ |
| naltrexone | Vivitrol (tablet and injection) | opioid use disorder treatment, alcohol use disorder treatment |
| acetaminophen/codeine | Tylenol 3 | pain |
| butalbital/acetaminophen/caffeine | Fioricet | pain |
| celecoxib | Celebrex | pain |
| fentanyl | Duragesic | pain |
| gabapentin | Neurontin | pain (neuropathic) |
| hydrocodone | Hycodan, Lortab, Vicodin | pain |
| hydromorphone | Dilaudid | pain |
| methadone | Dolophine | pain |
| morphine sulphate | MS Contin | pain |
| naproxen sodium | Naprosyn, Alleve | pain |
| oxycodone | Roxicodone, OxyContin | pain |
| propoxyphene | Darvon, Darvocet | pain |
| tramadol | Ultram | pain |
| albuterol | Ventolin, Accuneb, Duoneb, Proventil | respiratory |
| beclomethasone | QVAR | respiratory |
| guaifenesin/codeine | respiratory | |
| salmeterol | Serevent | respiratory |
* RWHAP B funds will pay for brand name formulations only if a generic formulation is not available. Brand names listed on the formulary are for reference only. ** Use of medications must be HIV-related, but is not restricted to the indication/use cited on the formulary. Alternatively, the medication must treat a co-morbid condition or disorder that affects HIV management or an individual’s health outcomes such as HIV viral load suppression. The information provided is only a resource and does not provide clinical advice or information. ♦The Drug Addiction and Treatment Act of 2000 limits office-based use of buprenorphine-containing products to prescribers who have met the qualifications to receive a waiver. These prescribers will have a special DEA number starting with the letter “X”. ‡ By law, methadone can only be dispensed through an opioid treatment program (OTP) certified by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA).
| GENERIC NAME | AVAILABLE BRAND NAME*
Must use generic when available |
CLASS OR TYPE OF DRUG**
Must be HIV related or for conditions that affect health outcomes related to HIV management |
| carbamazepine | Tegretol | seizures |
| clonazepam | Klonopin | seizures |
| divalproex sodium | Depakote | seizures |
| gabapentin | Neurontin | seizures |
| phenytoin | Dilantin | seizures |
| temazepam | Restoril | sleep |
| zolpidem | Ambien | sleep |
| dronabinol | Marinol | wasting |
| meningococcal conjugate | vaccine |
* RWHAP B funds will pay for brand name formulations only if a generic formulation is not available. Brand names listed on the formulary are for reference only. ** Use of medications must be HIV-related, but is not restricted to the indication/use cited on the formulary. Alternatively, the medication must treat a co-morbid condition or disorder that affects HIV management or an individual’s health outcomes such as HIV viral load suppression. The information provided is only a resource and does not provide clinical advice or information.
Last Updated: November 14, 2022.