| TIER | DRUG |
| Topical Anti-inflammatories – Topical Steroids |
| CLASS l |
| 1 | CLOBETASOL 0.05% OINTMENT |
| 2 | CLOBETASOL 0.05% SHAMPOO |
| 1 | CLOBETASOL 0.05% SOLUTION |
| CLASS 2 |
| 1 | FLUOCINONIDE 0.05% OINTMENT |
| 1 | FLUOCINONIDE 0.05% SOLUTION |
| 1 | DESOXIMETASONE 0.25% OINTMENT |
| CLASS 4 |
| 1 | TRIAMCINOLONE 0.1% CREAM |
| 2 | TRIAMCINOLONE 0.1% CREAM |
| 1 | TRIAMCINOLONE 0.1% OINTMENT |
| CLASS 5 |
| 1 | TRIAMCINOLONE 0.025% OINTMENT |
| CLASS 6 |
| 1 | HYDROCORTISONE 2.5% CREAM |
| 2 | DERMA-SMOOTHE-FS BODY OIL 0.01% |
| Topical Anti-inflammatories – Non Steroidals |
| 2 | TACROLIMUS 0.1% OINTMENT |
| Topical Antifungals |
| 1 | CICLOPIROX 0.77% CREAM |
| 1 | KETOCONAZOLE 2% CREAM |
| 2 | CICLOPIROX 1% SHAMPOO |
| Acne – Retinoids |
| 2 | TRETINOIN 0.025% CREAM |
| 2 | TRETINOIN 0.05% CREAM |
| 2 | DIFFERIN 0.3% GEL PUMP |
| 1 | ADAPALENE-BNZYL PEROX 0.3-2.5% |
| Other |
| 2 | SOD SULFACET-SULFUR 10-5% CLSR % (W/W) |
| 1 | BENZOYL PEROXIDE 10% WASH |
| 1 | METRONIDAZOLE 0.75% CREAM |
| 2 | CLINDAMYCIN PHOSP BENZOYL PEROX 1.2-5% GEL |
| 1 | CLINDAMYCIN PHOSP 1% GEL |
| Miscellaneous |
| 2 | DRYSOL DAB-O-MATIC SOLUTION |
| 2 | FLUOROURACIL 5% CREAM |
| 1 | HYDROQUINONE 4% CREAM |
| 2 | IMIQUIMOD 5% CREAM |
| 1 | MUPIROCIN 2% OINTMENT |
| 1 | PERMETHRIN 5% CREAM |
| Orals |
| 1 | PREDNISONE 10 MG TABLET |
| 1 | DOXYCYCLINE HYCLATE 100 MG TAB |
| 1 | DOXYCYCLINE HYCLATE 20 MG TAB |
| 1 | BACTRIM DS TABLET 800-160 MG |
| 2 | VALACYCLOVIR HCL 1 GRAM TABLET |
| 1 | TERBINAFINE HCL 250 MG TABLET |
| 1 | FLUCONAZOLE 100 MG TABLET |
| 1 | SPIRONOLACTONE 50 MG TABLET |
| 1 | CETIRIZINE HCL 10 MG TABLET |
| 1 | FINASTERIDE 1 MG TABLET |
| 1 | GABAPENTIN 300 MG CAPSULE |
| 1 | MINOXIDIL 2.5 MG TABLET |
