MAP formulary - Central Health
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Central Health

Travis County Hospital District

MAP / MAP Basic Formulary

NON-COMMUNITYCARE PROVIDERS: Medications restricted to CUC Prescribers and/or CUC in-house pharmacies are considered non-formulary outside of CUC. These medications may be obtained via Prescription Assistance Programs (PAP). If the patient does not qualify for PAP, the provider may submit a NON-FORMULARY DRUG REQUEST (NFDR) FORM. Documentation of PAP ineligibility or rejection should be submitted with the NDFR form.

MAP Formulary (July 2025 edition)

Generic CodeGeneric Sequence NumberTherapeutic ClassBrandNameGenericNameFormulationStrengthCoverageLocationComments
132 18 240408-CARDIOTONIC AGENTS Lanoxin DIGOXIN TABLET 125 MCG COVERED FORMULARY
133 19 240408-CARDIOTONIC AGENTS Lanoxin DIGOXIN TABLET 250 MCG COVERED FORMULARY
161 16.995 280804-NONSTEROIDAL ANTI-INFLAMMATORY AGENTS Aspirin Asprin Tablet EC 81 mg Covered FORMULARY
223 28.465 881600-VITAMIN D VITAMIN D3 VITAMIN D3 TABLET 25 MCG (1000 IU) Covered FORMULARY
410 90 861600-RESPIRATORY SMOOTH MUSCLE RELAXANTS Theophylline ER THEOPHYLLINE ANHYDROUS TAB ER 12H 100 MG COVERED FORMULARY
411 91 861600-RESPIRATORY SMOOTH MUSCLE RELAXANTS Theophylline ER THEOPHYLLINE ANHYDROUS TAB ER 12H 200 MG COVERED FORMULARY
413 93 861600-RESPIRATORY SMOOTH MUSCLE RELAXANTS Theophylline ER THEOPHYLLINE ANHYDROUS TAB ER 12H 300 MG COVERED FORMULARY
420 19.331 201204-ANTICOAGULANTS Lovenox ENOXAPARIN SODIUM SYRINGE 30 MG/0.3ML COVERED FORMULARY Limited to 14 day supplies, Prior Auth for >14 days
780 21.413 281292-ANTICONVULSANTS, MISCELLANEOUS Neurontin GABAPENTIN CAPSULE 100 MG COVERED FORMULARY
781 21.414 281292-ANTICONVULSANTS, MISCELLANEOUS Neurontin GABAPENTIN CAPSULE 300 MG COVERED FORMULARY
782 21.415 281292-ANTICONVULSANTS, MISCELLANEOUS Neurontin GABAPENTIN CAPSULE 400 MG COVERED FORMULARY
842 28.915 402820-THIAZIDE DIURETICS Hydrochlorothiazide HYDROCHLOROTHIAZIDE TABLET 12.5 MG COVERED FORMULARY
870 19.187 282492-ANXIOLYTICS, SEDATIVES & HYPNOTICS,MISC. Ambien ZOLPIDEM TARTRATE TABLET 5 MG COVERED FORMULARY Max 10mg/day
871 19.188 282492-ANXIOLYTICS, SEDATIVES & HYPNOTICS,MISC. Ambien ZOLPIDEM TARTRATE TABLET 10 MG COVERED FORMULARY Max 10mg/day
930 1.196 401818-POTASSIUM-REMOVING AGENTS Sodium Polystyrene Sulfonate SODIUM POLYSTYRENE SULFONATE ENEMA 30 G/120ML COVERED FORMULARY
960 387 243204-ANGIOTENSIN-CONVERTING ENZYME INHIBITORS Vasotec ENALAPRIL MALEATE TABLET 5 MG COVERED FORMULARY
961 384 243204-ANGIOTENSIN-CONVERTING ENZYME INHIBITORS Vasotec ENALAPRIL MALEATE TABLET 10 MG COVERED FORMULARY
962 386 243204-ANGIOTENSIN-CONVERTING ENZYME INHIBITORS Vasotec ENALAPRIL MALEATE TABLET 20 MG COVERED FORMULARY
963 385 243204-ANGIOTENSIN-CONVERTING ENZYME INHIBITORS Vasotec ENALAPRIL MALEATE TABLET 2.5 MG COVERED FORMULARY
1.011 215 240404-ANTIARRHYTHMIC AGENTS Quinidine QUINIDINE GLUCONATE TABLET ER 324 MG COVERED FORMULARY
1.070 3.095 561400-CHOLELITHOLYTIC AGENTS Actigall URSODIOL CAPSULE 300 MG COVERED FORMULARY
1.072 24.333 561400-CHOLELITHOLYTIC AGENTS Urso URSODIOL TABLET 250 MG COVERED FORMULARY
1.130 239 240404-ANTIARRHYTHMIC AGENTS Norpace DISOPYRAMIDE PHOSPHATE CAPSULE 100 MG COVERED FORMULARY
1.241 284 240820-DIRECT VASODILATORS Hydralazine HYDRALAZINE HCL TABLET 10 MG COVERED FORMULARY
1.242 285 240820-DIRECT VASODILATORS Hydralazine HYDRALAZINE HCL TABLET 100 MG COVERED FORMULARY
Showing 1 to 25 of 1,965 entries
Notice: The Travis County Healthcare District d/b/a Central Health adopted a tax rate that will raise more taxes for maintenance and operations than last year’s tax rate. The tax rate will effectively be raised by 6.5 percent and will raise taxes for maintenance and operations on a $100,000 home by approximately $6.32 (six dollars and thirty-two cents).

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