Page 1
USP Category USP ClassExample Drugs
(included for illustrative purposes only and
inclusion does not infer Part D coverage)
Analgesics
Nonsteroidal Anti-inflammatory DrugsCelecoxib
Diclofenac
Diflunisal
Etodolac
Fenoprofen
Flurbiprofen
Ibuprofen
Indomethacin
Ketoprofen
Ketorolac
Meclofenamate
Mefenamic Acid
Meloxicam
Nabumetone
Naproxen
Oxaprozin
Piroxicam
Sulindac
Tolmetin
Opioid Analgesics, Long-actingHydromorphone
Fentanyl
Levorphanol
Methadone
Morphine
Oxycodone
Oxymorphone
Tramadol
Opioid Analgesics, Short-actingButorphanol
Codeine
Fentanyl
Hydromorphone
Meperidine
Nalbuphine
Oxycodone
Oxymorphone
Pentazocine
Tapentadol
Tramadol
Anesthetics
Local Anesthetics
Lidocaine
Lidocaine and Prilocaine
Anti-Addiction/Substance
Abuse Treatment Agents
Alcohol Deterrents/Anti-craving Acamprosate
Disulfiram
Naltrexone
Opioid AntagonistsBuprenorphine
Naloxone
Naltrexone
Smoking Cessation AgentsBupropion
Nicotine
Varenicline
USP Model Guidelines v5.0 (with Example Drugs)
Page 1
Page 2
USP Category USP ClassExample Drugs
(included for illustrative purposes only and
inclusion does not infer Part D coverage)
USP Model Guidelines v5.0 (with Example Drugs)
Antibacterials
AminoglycosidesAmikacin
Gentamicin
Kanamycin
Neomycin
Paromomycin
Streptomycin
Tobramycin
Tobramycin and Dexamethasone
Beta-lactam, CephalosporinsCefadroxil
Cefazolin
Cephalexin
Cefaclor
Cefoxitin
Cefprozil
Cefuroxime
Cefdinir
Cefditoren
Cefixime
Cefotaxime
Cefpodoxime
Ceftazidime
Ceftibuten
Ceftriaxone
Cefepime
Beta-lactam, PenicillinsAmoxicillin
Amoxicillin and Clavulanate Potassium
Ampicillin
Ampicillin Sodium and Sulbactam Sodium
Piperacillin
Piperacillin Sodium and Tazobactam Sodium
Ticarcillin Disodium and Clavulanate
Potassium
Penicillin G
Penicillin V
Dicloxacillin
Nafcillin
Oxacillin
Beta-lactam, OtherAztreonam
Doripenem
Ertapenem
Imipenem and Cilastatin Sodium
Meropenem
MacrolidesAzithromycin
Clarithromycin
Erythromycin
Telithromycin
QuinolonesBesifloxacin
Ciprofloxacin
Page 2
Page 3
USP Category USP ClassExample Drugs
(included for illustrative purposes only and
inclusion does not infer Part D coverage)
USP Model Guidelines v5.0 (with Example Drugs)
Gatifloxacin
Gemifloxacin
Levofloxacin
Moxifloxacin
Norfloxacin
Ofloxacin
SulfonamidesSulfacetamide
Sulfadiazine
Sulfamethoxazole and Trimethoprim
TetracyclinesDemeclocycline
Doxycycline
Minocycline
Tetracycline
Antibacterials, OtherTrimethoprim
Vancomycin
Clindamycin
Lincomycin
Nitrofurantoin
Linezolid
Acetic Acid
Bacitracin
Chloramphenicol
Daptomycin
Fosfomycin
Gramicidin
Mafenide
Methenamine
Metronidazole
Mupirocin
Polymyxin B
Retapamulin
Rifaximin
Telavancin
Tigecycline
Anticonvulsants
Calcium Channel Modifying AgentsEthosuximide
Methsuximide
Pregabalin
Zonisamide
Gamma-aminobutyric Acid (GABA) Augmenting Agents
Divalproex
Gabapentin
Primidone
Tiagabine
Valproate
Vigabatrin
Glutamate Reducing AgentsFelbamate
Lamotrigine
Topiramate
Page 3
Page 4
USP Category USP ClassExample Drugs
(included for illustrative purposes only and
inclusion does not infer Part D coverage)
USP Model Guidelines v5.0 (with Example Drugs)
Sodium Channel AgentsCarbamazepine
Ethotoin
Fosphenytoin
Lacosamide
Oxcarbazepine
Phenytoin
Rufinamide
Anticonvulsants, OtherLevetiracetam
Antidementia Agents
Cholinesterase InhibitorsDonepezil
Galantamine
Rivastigmine
Tacrine
N-methyl-D-aspartate (NMDA) Receptor AntagonistMemantine
Antidementia Agents, Other
Ergoloid Mesylates
Antidepressants
Monoamine Oxidase InhibitorsPhenelzine
Selegiline
Tranylcypromine
Serotonin/Norepinephrine Reuptake Inhibitors Citalopram
Desvenlafaxine
Duloxetine
Escitalopram
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline
Venlafaxine
TricyclicsAmitriptyline
Amoxapine
Clomipramine
Desipramine
Doxepin
Imipramine
Nortriptyline
Protriptyline
Trimipramine
Antidepressants, OtherBupropion
Maprotiline
Mirtazapine
Nefazodone
Trazodone
Aripiprazole
Quetiapine
Antiemetics
Emetogenic Therapy AdjunctsDolasetron
Granisetron
Ondansetron
Page 4
Page 5
USP Category USP ClassExample Drugs
(included for illustrative purposes only and
inclusion does not infer Part D coverage)
USP Model Guidelines v5.0 (with Example Drugs)
Palonosetron
Aprepitant
Dronabinol
Nabilone
Antiemetics, OtherChlorpromazine
Diphenhydramine
Hydroxyzine
Meclizine
Metoclopramide
Perphenazine
Prochlorperazine
Promethazine
Scopolamine
Trimethobenzamide
Antifungals
Naftifine
Terbinafine
Butoconazole
Clotrimazole
Econazole
Fluconazole
Itraconazole
Ketoconazole
Miconazole
Oxiconazole
Posaconazole
Sertaconazole
Sulconazole
Terconazole
Voriconazole
Anidulafungin
Caspofungin
Micafungin
Natamycin
Nystatin
Butenafine
Ciclopirox
Flucytosine
Griseofulvin
Antigout Agents
Probenecid
Allopurinol
Febuxostat
Colchicine
Anti-inflammatory Agents
Glucocorticoids
Nonsteroidal Anti-inflammatory DrugsCelecoxib
Diclofenac
Diflunisal
Etodolac
Fenoprofen
Page 5
Page 6
USP Category USP ClassExample Drugs
(included for illustrative purposes only and
inclusion does not infer Part D coverage)
USP Model Guidelines v5.0 (with Example Drugs)
Flurbiprofen
Ibuprofen
Indomethacin
Ketoprofen
Ketorolac
Meclofenamate
Mefenamic Acid
Meloxicam
Nabumetone
Naproxen
Oxaprozin
Piroxicam
Sulindac
Tolmetin
Antimigraine Agents
Ergot AlkaloidsDihydroergotamine
Ergotamine
Serotonin (5-HT) 1b/1d Receptor AgonistsAlmotriptan
Eletriptan
Frovatriptan
Naratriptan
Rizatriptan
Sumatriptan
Zolmitriptan
Prophylactic Timolol
Divalproex
Topiramate
Valproic Acid
Antimyasthenic Agents
ParasympathomimeticsAmbenonium
Guanidine
Pyridostigmine
Antimycobacterials
AntitubercularsCapreomycin
Cycloserine
Ethambutol
Ethionamide
Isoniazid
Pyrazinamide
Rifampin
Rifampin and Isoniazid
Rifampin, Isoniazid, and Pyrazinamide
Rifapentine
Antimycobacterials, OtherDapsone
Rifabutin
Antineoplastics
Alkylating Agents
Altretamine
Chlorambucil
Melphalan
Lomustine
Page 6
Page 7
USP Category USP ClassExample Drugs
(included for illustrative purposes only and
inclusion does not infer Part D coverage)
USP Model Guidelines v5.0 (with Example Drugs)
Busulfan
Cyclophosphamide
Procarbazine
Antiangiogenic AgentsLenalidomide
Thalidomide
Antiestrogens/ModifiersEstramustine
Tamoxifen
Toremifene
AntimetabolitesMercaptopurine
Thioguanine
Hydroxyurea
Aromatase Inhibitors, 3rd GenerationAnastrozole
Exemestane
Letrozole
Enzyme InhibitorsEtoposide
Topotecan
Molecular Target InhibitorsErlotinib
Gefitinib
Everolimus
Dasatinib
Imatinib
Nilotinib
Lapatinib
Pazopanib
Sorafenib
Sunitinib
Monoclonal AntibodiesRituximab
RetinoidsAlitretinoin
Bexarotene
Tretinoin
Antineoplastics, OtherFludarabine
Leucovorin
Mitoxantrone
Antiparasitics
AnthelminticsAlbendazole
Ivermectin
Mebendazole
Praziquantel
AntiprotozoalsArtemether and Lumefantrine
Atovaquone and Proguanil Hydrochloride
Chloroquine
Hydroxychloroquine
Page 7
Page 8
USP Category USP ClassExample Drugs
(included for illustrative purposes only and
inclusion does not infer Part D coverage)
USP Model Guidelines v5.0 (with Example Drugs)
Mefloquine
Primaquine
Pyrimethamine
Quinine
Atovaquone
Nitazoxanide
Pentamidine
Pediculicides/ScabicidesBenzyl alcohol
Crotamiton
Lindane
Malathion
Permethrin
Antiparkinson Agents
AnticholinergicsBenztropine
Diphenhydramine
Trihexyphenidyl
Dopamine AgonistsApomorphine
Bromocriptine
Pramipexole
Ropinirole
Dopamine Precursors/ L-Amino Acid Decarboxylase
InhibitorsCarbidopa
Carbidopa and Levodopa
Monoamine Oxidase B (MAO-B) InhibitorsRasagiline
Selegiline
Antiparkinson Agents, OtherEntacapone
Tolcapone
Amantadine
Antipsychotics
1st Generation/Typical Chlorpromazine
Fluphenazine
Haloperidol
Loxapine
Perphenazine
Pimozide
Prochlorperazine
Thioridazine
Thiothixene
Trifluoperazine
2nd Generation/Atypical Aripiprazole
Asenapine
Iloperidone
Lurasidone
Olanzapine
Quetiapine
Paliperidone
Risperidone
Ziprasidone
Treatment-Resistant
Clozapine
Antispasticity Agents
Page 8
Page 9
USP Category USP ClassExample Drugs
(included for illustrative purposes only and
inclusion does not infer Part D coverage)
USP Model Guidelines v5.0 (with Example Drugs)
Baclofen
Dantrolene
Tizanidine
Antivirals
Anti-cytomegalovirus (CMV) AgentsCidofovir
Foscarnet
Ganciclovir
Valganciclovir
Antihepatitis AgentsAdefovir
Entecavir
Lamivudine
Ribavirin
Telbivudine
Tenofovir
Interferon Alfa-2b, Recombinant
Interferon Alfa-2b and Ribavirin
Interferon Alfa-n3
Interferon Alfacon-1
Peginterferon Alfa-2a
Peginterferon Alfa-2b
Antiherpetic AgentsAcyclovir
Famciclovir
Foscarnet
Idoxuridine
Trifluridine
Penciclovir
Valacyclovir
Anti-HIV Agents, Non-nucleoside Reverse Transcriptase
Inhibitors Delavirdine
Efavirenz
Etravirine
Nevirapine
Anti-HIV Agents, Nucleoside and Nucleotide Reverse
Transcriptase Inhibitors Abacavir
Abacavir and Lamivudine
Abacavir, Lamivudine, and Zidovudine
Didanosine
Emtricitabine
Emtricitabine and Tenofovir
Lamivudine
Lamivudine and Zidovudine
Stavudine
Tenofovir
Zidovudine
Anti-HIV Agents, Protease Inhibitors Atazanavir
Darunavir
Fosamprenavir
Indinavir
Lopinavir and Ritonavir
Nelfinavir
Ritonavir
Saquinavir
Tipranavir
Page 9
Page 10
USP Category USP ClassExample Drugs
(included for illustrative purposes only and
inclusion does not infer Part D coverage)
USP Model Guidelines v5.0 (with Example Drugs)
Anti-HIV Agents, Other Enfuvirtide
Maraviroc
Raltegravir
Anti-influenza AgentsAmantadine
Oseltamivir
Rimantadine
Zanamivir
Anxiolytics
SSRIs/SNRIs (Selective Serotonin Reuptake Inhibitors/
Serotonin and Norepinephrine Reuptake Inhibitors)Duloxetine
Escitalopram
Paroxetine
Sertraline
Venlafaxine
Anxiolytics, OtherBuspirone
Doxepin
Hydroxyzine
Meprobamate
Bipolar Agents
Mood StabilizersCarbamazepine
Divalproex
Lamotrigine
Lithium
Valproic Acid
Bipolar Agents, OtherAripiprazole
Asenapine
Olanzapine
Quetiapine
Risperidone
Ziprasidone
Blood Glucose Regulators
Antidiabetic AgentsAcarbose
Miglitol
Pramlintide
Metformin
Colesevelam
Saxagliptin
Sitagliptin
Bromocriptine
Exenatide
Liraglutide
Nateglinide
Repaglinide
Chlorpropamide
Glimepiride
Page 10
Page 11
USP Category USP ClassExample Drugs
(included for illustrative purposes only and
inclusion does not infer Part D coverage)
USP Model Guidelines v5.0 (with Example Drugs)
Glipizide
Glyburide
Tolazamide
Tolbutamide
Pioglitazone
Rosiglitazone
Glycemic AgentsDiazoxide
Glucagon
InsulinsInsulin Aspart
Insulin Glulisine
Insulin Lispro
Insulin Human (Regular)
Isophane Insulin (Human)
Insulin Detemir
Insulin Glargine
Insulin Aspart Rapid-acting and Insulin Aspart
Protamine
Insulin Lispro Rapid-acting and Insulin Lispro
Protamine
Insulin Human Regular and Isophane Insulin
Blood Products/Modifiers/
Volume Expanders
AnticoagulantsDabigatran
Fondaparinux
Dalteparin
Enoxaparin
Tinzaparin
Warfarin
Blood Formation ModifiersFilgrastim
Pegfilgrastim
Sargramostim
Darbepoetin Alfa
Epoetin Alfa
Anagrelide
Eltrombopag Olamine
Romiplostim
Plerixafor
CoagulantsTranexamic Acid
Platelet Modifying AgentsClopidogrel
Prasugrel
Ticlopidine
Page 11
Page 12
USP Category USP ClassExample Drugs
(included for illustrative purposes only and
inclusion does not infer Part D coverage)
USP Model Guidelines v5.0 (with Example Drugs)
Dipyridamole
Dipyridamole and Aspirin
Cilostazol
Cardiovascular Agents
Alpha-adrenergic AgonistsClonidine
Guanabenz
Guanfacine
Methyldopa
Methyldopate
Midodrine
Phenylephrine
Alpha-adrenergic Blocking AgentsDoxazosin
Phenoxybenzamine
Prazosin
Terazosin
Angiotensin-converting Enzyme (ACE) InhibitorsBenazepril
Captopril
Enalapril
Fosinopril
Lisinopril
Moexipril
Perindopril
Quinapril
Ramipril
Trandolapril
Angiotensin II Receptor AntagonistsCandesartan
Eprosartan
Irbesartan
Losartan
Olmesartan
Telmisartan
Valsartan
AntiarrhythmicsAmiodarone
Disopyramide
Dofetilide
Dronedarone
Flecainide
Mexiletine
Procainamide
Propafenone
Quinidine
Sotalol
Beta-adrenergic Blocking AgentsAcebutolol
Atenolol
Betaxolol
Bisoprolol
Carvedilol
Labetalol
Metoprolol
Nadolol
Nebivolol
Penbutolol
Pindolol
Propranolol
Page 12
Page 13
USP Category USP ClassExample Drugs
(included for illustrative purposes only and
inclusion does not infer Part D coverage)
USP Model Guidelines v5.0 (with Example Drugs)
Timolol
Calcium Channel Blocking Agents Amlodipine
Felodipine
Isradipine
Nicardipine
Nifedipine
Nimodipine
Nisoldipine
Diltiazem
Verapamil
Diuretics, Carbonic Anhydrase InhibitorsAcetazolamide
Methazolamide
Diuretics, LoopBumetanide
Ethacrynate
Ethacrynic Acid
Furosemide
Torsemide
Diuretics, Potassium-sparing Amiloride
Eplerenone
Spironolactone
Triamterene
Diuretics, Thiazide Bendroflumethiazide
Chlorothiazide
Chlorthalidone
Hydrochlorothiazide
Indapamide
Methyclothiazide
Metolazone
Dyslipidemics, Fibric Acid DerivativesCholine Fenofibrate
Fenofibrate
Fenofibric Acid
Gemfibrozil
Dyslipidemics, HMG CoA Reductase InhibitorsAtorvastatin
Fluvastatin
Lovastatin
Pitavastatin
Pravastatin
Rosuvastatin
Simvastatin
Dyslipidemics, OtherCholestyramine
Colesevelam
Colestipol
Ezetimibe
Niacin
Omega-3-acid Ethyl Esters
Vasodilators, Direct-acting ArterialHydralazine
Minoxidil
Vasodilators, Direct-acting Arterial/VenousIsosorbide Dinitrate
Isosorbide Mononitrate
Nitroglycerin
Page 13
Page 14
USP Category USP ClassExample Drugs
(included for illustrative purposes only and
inclusion does not infer Part D coverage)
USP Model Guidelines v5.0 (with Example Drugs)
Cardiovascular Agents, OtherAliskiren
Digoxin
Pentoxifylline
Ranolazine
Central Nervous System
Agents
Attention Deficit Hyperactivity Disorder Agents,
AmphetaminesDextroamphetamine
Dextroamphetamine and Amphetamine
Lisdexamfetamine
Methamphetamine
Attention Deficit Hyperactivity Disorder Agents, Non-
amphetaminesAtomoxetine
Clonidine
Dexmethylphenidate
Guanfacine
Methylphenidate
Fibromyalgia AgentsDuloxetine
Milnacipran
Pregabalin
Multiple Sclerosis AgentsInterferon Beta-1a
Interferon Beta-1b
Dalfampridine
Fingolimod
Glatiramer
Mitoxantrone
Natalizumab
Central Nervous System, Other
Tetrabenazine
Riluzole
Dextromethorphan/Quinidine
Dental and Oral AgentsAmlexanox
Cevimeline
Chlorhexidine
Doxycycline
Minocycline
Palifermin
Pilocarpine
Prilocaine
Triamcinolone
Dermatological AgentsIsotretinoin
Adapalene
Azelaic Acid
Benzoyl Peroxide
Tazarotene
Doxycycline
Doxepin
Page 14
Page 15
USP Category USP ClassExample Drugs
(included for illustrative purposes only and
inclusion does not infer Part D coverage)
USP Model Guidelines v5.0 (with Example Drugs)
Pimecrolimus
Tacrolimus
Podofilox
Ammonium Lactate
Imiquimod
Sinecatechins
Selenium
Diclofenac
Fluorouracil
Imiquimod
Methoxsalen
Acitretin
Alefacept
Calcitriol
Ustekinumab
Calcipotriene
Becaplermin
Collagenase
Enzyme Replacement/
Modifiers
Cysteamine
Agalsidase Beta
Alglucerase
Imiglucerase
Miglustat
Nitisinone
Betaine
Idursulfase
Galsulfase
Laronidase
Pancrelipase
Sapropterin
Pegademase Bovine
Sodium Phenylbutyrate
Gastrointestinal Agents
Antispasmodics, GastrointestinalAtropine
Dicyclomine
Glycopyrrolate
Mepenzolate
Methscopolamine
Page 15
Page 16
USP Category USP ClassExample Drugs
(included for illustrative purposes only and
inclusion does not infer Part D coverage)
USP Model Guidelines v5.0 (with Example Drugs)
Scopolamine
Histamine2 (H2) Receptor Antagonists
Cimetidine
Famotidine
Nizatidine
Ranitidine
Irritable Bowel Syndrome AgentsAlosetron
Lubiprostone
LaxativesLactulose
Polyethylene Glycol 3350 NF
ProtectantsMisoprostol
Sucralfate
Proton Pump InhibitorsDexlansoprazole
Esomeprazole
Lansoprazole
Omeprazole
Pantoprazole
Rabeprazole
Gastrointestinal Agents, OtherAlvimopan
Difenoxin Hydrochloride and Atropine Sulfate
Diphenoxylate Hydrochloride and Atropine
Sulfate
Loperamide
Methylnaltrexone
Metoclopramide
Rifaximin
Ursodiol
Genitourinary Agents
Antispasmodics, UrinaryDarifenacin
Fesoterodine
Flavoxate
Oxybutynin
Solifenacin
Tolterodine
Trospium
Benign Prostatic Hypertrophy AgentsAlfuzosin
Doxazosin
Prazosin
Silodosin
Tamsulosin
Terazosin
Dutasteride
Finasteride
Phosphate BindersCalcium Acetate
Lanthanum
Sevelamer
Genitourinary Agents, OtherBethanechol
Penicillamine
Pentosan Polysulfate
Page 16
Page 17
USP Category USP ClassExample Drugs
(included for illustrative purposes only and
inclusion does not infer Part D coverage)
USP Model Guidelines v5.0 (with Example Drugs)
Hormonal Agents,
Stimulant/ Replacement/
Modifying (Adrenal)
Glucocorticoids/MineralocorticoidsBetamethasone
Budesonide
Cortisone
Dexamethasone
Hydrocortisone
Methylprednisolone
Prednisolone
Prednisone
Triamcinolone
Alclometasone
Clocortolone
Desonide
Dexamethasone
Hydrocortisone
Betamethasone
Desoximetasone
Fluocinolone
Flurandrenolide
Fluticasone
Hydrocortisone
Mometasone
Prednicarbate
Triamcinolone
Amcinonide
Betamethasone
Desoximetasone
Diflorasone
Fluocinolone
Fluocinonide
Halcinonide
Triamcinolone
Betamethasone
Clobetasol
Diflorasone
Halobetasol
Fludrocortisone
Hormonal Agents,
Stimulant/Replacement/
Modifying (Pituitary)
Chorionic Gonadotropin
Somatropin, Recombinant
Tesamorelin
Mecasermin
Page 17
Page 18
USP Category USP ClassExample Drugs
(included for illustrative purposes only and
inclusion does not infer Part D coverage)
USP Model Guidelines v5.0 (with Example Drugs)
Desmopressin
Hormonal Agents,
Stimulant/ Replacement/
Modifying (Prostaglandins)
Alprostadil
Carboprost
Misoprostol
Hormonal Agents,
Stimulant/ Replacement/
Modifying (Sex Hormones/
Modifiers)
Anabolic Steroids
Oxandrolone
Oxymetholone
Androgens
Danazol
Fluoxymesterone
Methyltestosterone
Testosterone
Estrogens
Estradiol
Estrogens, Conjugated
Estrogens, Conjugated Synthetic
Estrogens, Esterified
Estrone
Estropipate
Ethinyl Estradiol
Progesterone Agonists/Antagonists
Ulipristal
Progestins
Levonorgestrel
Medroxyprogesterone
Megestrol
Norethindrone
Norgestrel
Progesterone
Selective Estrogen Receptor Modifying Agents
Raloxifene
Hormonal Agents,
Stimulant/Replacement/
Modifying (Thyroid)
Levothyroxine
Liothyronine
Liotrix
Hormonal Agents,
Suppressant (Adrenal)
Mitotane
Hormonal Agents,
Suppressant (Parathyroid)
Cinacalcet
Hormonal Agents,
Suppressant (Pituitary)
Bromocriptine
Cabergoline
Page 18
Page 19
USP Category USP ClassExample Drugs
(included for illustrative purposes only and
inclusion does not infer Part D coverage)
USP Model Guidelines v5.0 (with Example Drugs)
Leuprolide
Nafarelin
Triptorelin
Degarelix
Pegvisomant
Lanreotide
Octreotide
Hormonal Agents,
Suppressant (Sex
Hormones/ Modifiers)
Antiandrogens
Bicalutamide
Dutasteride
Finasteride
Flutamide
Nilutamide
Hormonal Agents,
Suppressant (Thyroid)
Antithyroid Agents
Methimazole
Propylthiouracil
Immunological Agents
Immune Suppressants Mycophenolic Acid
Tacrolimus
Cyclosporine
Sirolimus
6- mercaptopurine
Abatacept
Anakinra
Everolimus
Methotrexate
Penicillamine
Pimecrolimus
Temsirolimus
Azathioprine
Adalimumab
Certolizumab Pegol
Etanercept
Golimumab
Infliximab
Immunizing Agents, PassiveAnti-thymocyte Globulin
Immune Globulin Intramuscular (Human)
Immune Globulin Intravenous (Human)
ImmunomodulatorsInterferon Beta-1a
Interferon Beta-1b
Interferon Gamma-1b, Recombinant
Page 19
Page 20
USP Category USP ClassExample Drugs
(included for illustrative purposes only and
inclusion does not infer Part D coverage)
USP Model Guidelines v5.0 (with Example Drugs)
Canakinumab
Rilonacept
Tocilizumab
Auranofin
Leflunomide
Natalizumab
VaccinesDiphtheria and Tetanus Toxoids Adsorbed
(DT)
Diphtheria and Tetanus Toxoids and Acellular
Pertussis Vaccine Adsorbed (DTaP)
Diphtheria and Tetanus Toxoids and Acellular
Pertussis Vaccine Adsorbed, Hepatitis B
(Recombinant) and Inactivated Poliovirus
Vaccine
Diphtheria and Tetanus Toxoids and Acellular
Pertussis Absorbed and Inactivated
Poliovirus (DTaP-IPV) Vaccine Tetanus and Diphtheria Toxoids Adsorbed for
Adult Use (Td)
Tetanus Toxoid, Reduced Diphtheria Toxoid
and Acellular Pertussis Vaccine, Adsorbed
(Tdap)
Haemophilus B Conjugate Vaccine
Haemophilus B Conjugate Vaccine and
Hepatitis B Vaccine (Recombinant)
Hepatitis A Vaccine Inactivated
Hepatitis A Virus Vaccine Inactivated and
Hepatitis B Virus Vaccine Recombinant
Diphtheria and Tetanus Toxoids and Acellular
Pertussis Vaccine Adsorbed, Hepatitis B
(Recombinant) and Inactivated Poliovirus
Vaccine
Haemophilus B Conjugate Vaccine and
Hepatitis B Vaccine (Recombinant)
Hepatitis B Virus Vaccine Recombinant
Japanese Encephalitis Virus Vaccine
Inactivated
Measles Virus Vaccine Live
Measles, Mumps, and Rubella Virus Vaccine
Live
Measles, Mumps, Rubella, and Varicella
Virus Vaccine Live
Meningococcal Oligosaccharide Diphtheria
CRM197 Conjugate Vaccine
Meningococcal Polysaccharide Vaccine
Meningococcal Polysaccharide Diphtheria
Toxoid Conjugate Vaccine
Measles, Mumps, and Rubella Virus Vaccine
Live
Measles, Mumps, Rubella, and Varicella
Virus Vaccine Live
Human Papillomavirus Bivalent (type 16 and
18) Vaccine Recombinant
Human Papillomavirus Quadrivalent (types 6,
11, 16 and 18) Vaccine Recombinant
Page 20
Page 21
USP Category USP ClassExample Drugs
(included for illustrative purposes only and
inclusion does not infer Part D coverage)
USP Model Guidelines v5.0 (with Example Drugs)
Diphtheria and Tetanus Toxoids and Acellular
Pertussis Vaccine Adsorbed (DTaP)
Diphtheria and Tetanus Toxoids and Acellular
Pertussis Vaccine Adsorbed, Hepatitis B
(Recombinant) and Inactivated Poliovirus
Vaccine
Diphtheria and Tetanus Toxoids and Acellular
Pertussis Absorbed and Inactivated
Poliovirus (DTaP-IPV) VaccineTetanus Toxoid, Reduced Diphtheria Toxoid,
and Acellular Pertussis Vaccine, Adsorbed
(Tdap)Diphtheria and Tetanus Toxoids and Acellular
Pertussis Absorbed and Inactivated
Poliovirus (DTaP-IPV) Vaccine
Diphtheria and Tetanus Toxoids and Acellular
Pertussis Vaccine Adsorbed, Hepatitis B
(Recombinant) and Inactivated Poliovirus
Vaccine
Poliovirus Vaccine Inactivated
Rabies Vaccine
Rotavirus Vaccine Live
Measles, Mumps, and Rubella Virus Vaccine
Live
Measles, Mumps, Rubella, and Varicella
Virus Vaccine Live
Rubella Virus Vaccine
Diphtheria and Tetanus Toxoids Adsorbed
(DT)
Diphtheria and Tetanus Toxoids and Acellular
Pertussis Vaccine Adsorbed (DTaP)
Diphtheria and Tetanus Toxoids and Acellular
Pertussis Vaccine Adsorbed, Hepatitis B
(Recombinant) and Inactivated Poliovirus
Vaccine
Diphtheria and Tetanus Toxoids and Acellular
Pertussis Absorbed and Inactivated
Poliovirus (DTaP-IPV) VaccineTetanus and Diphtheria Toxoids Adsorbed for
Adult Use (Td)
Tetanus Toxoid
Tetanus Toxoid Adsorbed
Tetanus Toxoid, Reduced Diphtheria Toxoid,
and Acellular Pertussis Vaccine, Adsorbed
(Tdap)
Typhoid Vaccine Live Oral
Typhoid Vi Polysaccharide Vaccine
Measles, Mumps, Rubella, and Varicella
Virus Vaccine Live
Varicella Virus Vaccine
Yellow Fever Vaccine
Zoster Virus Vaccine Live
Inflammatory Bowel Disease
Agents
Glucocorticoids
Betamethasone
Budesonide
Cortisone
Dexamethasone
Hydrocortisone
Page 21
Page 22
USP Category USP ClassExample Drugs
(included for illustrative purposes only and
inclusion does not infer Part D coverage)
USP Model Guidelines v5.0 (with Example Drugs)
Methylprednisolone
Prednisolone
Prednisone
Triamcinolone
Aminosalicylates
Balsalazide
Mesalamine
Olsalazine
Sulfonamides
Sulfasalazine
Metabolic Bone Disease
Agents
Alendronate
Etidronate
Ibandronate
Risedronate
Tiludronate
Ibandronate
Pamidronate
Zoledronic Acid
Calcitonin, Salmon
Teriparatide
Denosumab
Calcitriol
Doxercalciferol
Paricalcitol
Ophthalmic Agents
Ophthalmic Anti-allergy Agents
Azelastine
Bepotastine
Cromolyn
Emedastine
Epinastine
Lodoxamide
Nedocromil
Olopatadine
Pemirolast
Ophthalmic Antiglaucoma Agents
Apraclonidine
Brimonidine
Dipivefrin
Betaxolol
Carteolol
Levobunolol
Metipranolol
Timolol
Acetazolamide
Brinzolamide
Dorzolamide
Page 22
Page 23
USP Category USP ClassExample Drugs
(included for illustrative purposes only and
inclusion does not infer Part D coverage)
USP Model Guidelines v5.0 (with Example Drugs)
Methazolamide
Echothiophate
Pilocarpine
Ophthalmic Anti-inflammatories
Dexamethasone
Difluprednate
Fluorometholone
Loteprednol
Prednisolone
Rimexolone
Bromfenac
Diclofenac
Flurbiprofen
Ketorolac
Nepafenac
Ophthalmic Prostaglandin and Prostamide Analogs
Bimatoprost
Latanoprost
Travoprost
Ophthalmic Agents, Other
Hydroxypropyl Cellulose
Naphazoline
Cyclosporine
Otic Agents
Fluocinolone
Respiratory Tract Agents
AntihistaminesAzelastine
Cetirizine
Desloratadine
Fexofenadine
Levocetirizine
Olopatadine
Carbinoxamine
Clemastine
Cyproheptadine
Dexchlorpheniramine
Diphenhydramine
Hydroxyzine
Promethazine
Anti-inflammatories, Inhaled CorticosteroidsBeclomethasone
Budesonide
Ciclesonide
Flunisolide
Fluticasone
Mometasone
Triamcinolone
AntileukotrienesMontelukast
Zafirlukast
Zileuton
Page 23
Page 24
USP Category USP ClassExample Drugs
(included for illustrative purposes only and
inclusion does not infer Part D coverage)
USP Model Guidelines v5.0 (with Example Drugs)
Bronchodilators, AnticholinergicIpratropium
Tiotropium
Bronchodilators, Phosphodiesterase Inhibitors
(Xanthines)Aminophylline
Dyphylline
Theophylline
Bronchodilators, SympathomimeticAlbuterol
Arformoterol
Epinephrine
Formoterol
Levalbuterol
Metaproterenol
Pirbuterol
Salmeterol
Terbutaline
Mast Cell StabilizersCromolyn
Pulmonary AntihypertensivesAmbrisentan
Bosentan
Sildenafil
Tadalafil
Epoprostenol
Iloprost
Treprostinil
Respiratory Tract Agents, OtherAcetylcysteine
Alpha-1 Proteinase Inhibitor, Human
Tetrahydrozoline
Skeletal Muscle Relaxants
Carisoprodol
Chlorzoxazone
Cyclobenzaprine
Metaxalone
Methocarbamol
Orphenadrine
Sleep Disorder Agents
GABA Receptor ModulatorsEszopiclone
Zaleplon
Zolpidem
Sleep Disorders, OtherArmodafinil
Doxepin
Modafinil
Ramelteon
Sodium Oxybate
Therapeutic Nutrients/
Minerals/ Electrolytes
Electrolyte/Mineral ModifiersDeferasirox
Penicillamine
Sodium Polystyrene Sulfonate
Succimer
Page 24
Page 25
USP Category USP ClassExample Drugs
(included for illustrative purposes only and
inclusion does not infer Part D coverage)
USP Model Guidelines v5.0 (with Example Drugs)
Tolvaptan
Trientine
Electrolyte/Mineral Replacement
Ammonium
Carglumic Acid
Chromic
Citric Acid, Potassium Citrate, and Sodium
Citrate
Fluoride
Magnesium
Manganese
Potassium
Potassium Bicarbonate and Potassium
CitratePotassium Citrate and Citric Acid
Potassium Citrate and Sodium Citrate
Potassium Gluconate and Potassium
ChloridePotassium Gluconate and Potassium Citrate
Potassium Phosphate and Sodium
PhosphateSelenium
Sodium
Vitamins
Page 25