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Central Health

Travis County Hospital District

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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.

More information on pharmacy benefits can be found in the MAP and MAP Basic Provider Handbook.

NON-FORMULARY DRUG REQUEST (NFDR) FORM

Request an addition to the MAP/MAP Basic formulary

Request an addition to the Central Health floor stock formulary


MAP Formulary (March 2025 corrected edition)

Generic CodeGeneric Sequence NumberTherapeutic ClassBrandNameGenericNameFormulationStrengthCoverageLocationComments
1 49.291 17.037 040800-SECOND GENERATION ANTIHISTAMINES Zyrtec CETIRIZINE HCL TABLET 10 MG COVERED FORMULARY
2 60.563 18.698 040800-SECOND GENERATION ANTIHISTAMINES Claritin LORATADINE TABLET 10 MG COVERED FORMULARY
3 17.853 50.714 120808-ANTIMUSCARINICS/ANTISPASMODICS Spiriva Handihaler TIOTROPIUM BROMIDE CAP W/DEV 18 MCG COVERED FORMULARY CUC prescribers must send to in-house pharmacies only. Non-CUC may fill at network pharmacies
4 3.421 16.425 129200-AUTONOMIC DRUGS, MISCELLANEOUS NICOTINE NICOTINE PATCH TD24 7 MG/24HR COVERED FORMULARY
5 3.422 16.426 129200-AUTONOMIC DRUGS, MISCELLANEOUS NICOTINE NICOTINE PATCH TD24 14 MG/24HR COVERED FORMULARY
6 3.423 16.427 129200-AUTONOMIC DRUGS, MISCELLANEOUS NICOTINE NICOTINE PATCH TD24 21 MG/24HR COVERED FORMULARY
7 27.047 60.897 129200-AUTONOMIC DRUGS, MISCELLANEOUS Varenicline (Chantix) VARENICLINE TARTRATE TABLET 1 MG COVERED FORMULARY
8 27.046 60.896 129200-AUTONOMIC DRUGS, MISCELLANEOUS Varenicline (Chantix) VARENICLINE TARTRATE TABLET 0.5 MG COVERED FORMULARY
9 18.387 51.214 240605-CHOLESTEROL ABSORPTION INHIBITORS Zetia EZETIMIBE TABLET 10 MG COVERED FORMULARY
10 42.001 41.285 280804-NONSTEROIDAL ANTI-INFLAMMATORY AGENTS Celebrex CELECOXIB CAPSULE 100 MG COVERED FORMULARY
11 42.002 41.286 280804-NONSTEROIDAL ANTI-INFLAMMATORY AGENTS Celebrex CELECOXIB CAPSULE 200 MG COVERED FORMULARY
12 97.785 62.001 280804-NONSTEROIDAL ANTI-INFLAMMATORY AGENTS Celebrex CELECOXIB CAPSULE 50 MG COVERED FORMULARY
13 18.127 50.832 280804-NONSTEROIDAL ANTI-INFLAMMATORY AGENTS Celebrex CELECOXIB CAPSULE 400 MG COVERED FORMULARY
14 23.046 57.800 281292-ANTICONVULSANTS, MISCELLANEOUS Lyrica PREGABALIN CAPSULE 50 MG COVERED FORMULARY
15 23.047 57.801 281292-ANTICONVULSANTS, MISCELLANEOUS Lyrica PREGABALIN CAPSULE 75 MG COVERED FORMULARY
16 23.048 57.802 281292-ANTICONVULSANTS, MISCELLANEOUS Lyrica PREGABALIN CAPSULE 100 MG COVERED FORMULARY
17 23.049 57.803 281292-ANTICONVULSANTS, MISCELLANEOUS Lyrica PREGABALIN CAPSULE 150 MG COVERED FORMULARY
18 23.051 57.804 281292-ANTICONVULSANTS, MISCELLANEOUS Lyrica PREGABALIN CAPSULE 200 MG COVERED FORMULARY
19 23.052 57.805 281292-ANTICONVULSANTS, MISCELLANEOUS Lyrica PREGABALIN CAPSULE 300 MG COVERED FORMULARY
20 23.039 57.799 281292-ANTICONVULSANTS, MISCELLANEOUS Lyrica PREGABALIN CAPSULE 25 MG COVERED FORMULARY
21 25.019 59.401 281292-ANTICONVULSANTS, MISCELLANEOUS Lyrica PREGABALIN CAPSULE 225 MG COVERED FORMULARY
22 32.359 69.339 281292-ANTICONVULSANTS, MISCELLANEOUS Lyrica PREGABALIN Solution 20 mg/ml COVERED FORMULARY
23 18.537 51.333 281608-ANTIPSYCHOTIC AGENTS Abilify ARIPIPRAZOLE TABLET 10 MG COVERED FORMULARY
24 18.538 51.334 281608-ANTIPSYCHOTIC AGENTS Abilify ARIPIPRAZOLE TABLET 15 MG COVERED FORMULARY
25 18.539 51.335 281608-ANTIPSYCHOTIC AGENTS Abilify ARIPIPRAZOLE TABLET 20 MG COVERED FORMULARY

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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).

Questions about MAP or MAP Basic:

512.978.8130

CommUnityCare:

512.978.9015

Sendero Health Plans:

844.800.4693

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1111 East Cesar Chavez St.
Austin, TX 78702
512.978.8000

Copyright © 2025 Central Health. All rights reserved.

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).

Copyright © 2025 Central Health. All Rights Reserved.

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