Preferred Drug List 2013 Standard Formulary (3 ... - Express Scripts

More documents

Recommendations

Info

DRUG NAME 1 2 3 SUGGESTED PREFFERED ALTERNATIVES fenofibric acid X gemfibrozil X ANTARA X fenofibrate, TRICOR, TRILPIX FENOGLIDE X fenofibrate, TRICOR, TRILPIX FIBRICOR X fenofibric acid LIPOFEN X fenofibrate, TRICOR, TRILPIX LOVAZA X NIASPAN X TRICOR X TRIGLIDE X fenofibrate, TRICOR, TRILPIX TRILIPIX X WELCHOL X ZETIA X 4.8.2 HMG‐COA REDUCTASE INHIBITORS atorvastatin calcium X fluvastatin sodium X lovastatin X pravastatin sodium X simvastatin X ALTOPREV ST X atorvastatn,simvastatn,CRESTOR CRESTOR ST X LESCOL ST X fluvastatin LESCOL XL ST X atorvastatn,simvastatn,CRESTOR LIPITOR ST X atorvastatin LIVALO ST X atorvastatn,simvastatn,CRESTOR 4.8.2.1 HMG‐COA COMBINATIONS amlodipine‐atorvastatin X ADVICOR ST X CADUET ST X amlodipine/atorvastatin CADUET ST X amlodipine/atorvastatin SIMCOR ST X VYTORIN ST X simvastatin + ZETIA, CRESTOR VYTORIN ST X simvastatin + ZETIA, CRESTOR 4.9 OTHER CARDIOVASCULAR DRUGS pentoxifylline X RANEXA X CHAPTER 5: AUTONOMIC AND CNS MEDICATIONS 5.1.1 ANALGESICS butorphanol tartrate X tramadol hcl/er X tramadol hcl‐acetaminophen X 5.1.1.1 CLASS II NARCOTICS endocet X fentanyl X TIER
DRUG NAME 1 2 3 SUGGESTED PREFFERED ALTERNATIVES hydromorphone hcl X methadone hcl X morphine sulfate/er X oxycodone hcl X oxycodone‐acetaminophen X oxymorphone hcl X roxicet X ABSTRAL X AVINZA X gen,NUCYN ER,OPANA ER,OXYCONTN EXALGO X gen,NUCYN ER,OPANA ER,OXYCONTN FENTORA X KADIAN X gen,NUCYN ER,OPANA ER,OXYCONTN LAZANDA X fentanyl citra,ABSTRAL,FENTORA NUCYNTA/ER X ONSOLIS X fentanyl citra,ABSTRAL,FENTORA OPANA X oxymorphone OPANA ER X OXYCONTIN X SUBSYS X fentanyl citra,ABSTRAL,FENTORA 5.1.1.2 CLASS III NARCOTICS acetaminophen‐codeine X buprenorphine hcl X hydrocodone bit‐ibuprofen X hydrocodone‐acetaminophen X reprexain X zamicet X BUTRANS X SUBOXONE X 5.1.1.3 CLASS IV NARCOTICS buprenorphine hcl X 5.1.2 DRUGS TO PREVENT AND TREAT HEADACHES butalbital compound‐codeine X butalbital‐aspirin‐caffeine X naratriptan hcl X sumatriptan X AXERT ST X sumatriptan, RELPAX, ZOMIG/ZMT FROVA ST X sumatriptan, RELPAX, ZOMIG/ZMT IMITREX ST X sumatriptan MAXALT/MLT ST X sumatriptan, RELPAX, ZOMIG/ZMT MIGRANAL X RELPAX ST X SUMAVEL DOSEPRO ST X TREXIMET ST X ZOMIG/ZMT ST X TIER
Page 1 and 2: Preferred Drug List 2013 Standard F
Page 3 and 4: Prior Authorization Process If a pa
Page 5 and 6: DRUG NAME 2.1.5 PENICILLINS amox tr
Page 7 and 8: DRUG NAME 1 2 3 SUGGESTED PREFFERED
Page 11: DRUG NAME 1 2 3 SUGGESTED PREFFERED
Page 15 and 16: TIER DRUG NAME 1 2 3 primidone X SU
Page 23 and 24: TIER DRUG NAME 1 2 3 ACTONEL ST X A
Page 25 and 26: TIER DRUG NAME 1 2 3 SUGGESTED PREF
Page 35 and 36: DRUG NAME 16.1.3 URINARY ANESTHETIC
Page 39 and 40: AVALIDE 4.5.4.2 AVANDAMET 8.1.3 AVA
Page 41 and 42: donepezil hcl 5.9.3 DORYX 2.1.7 dor
Page 43 and 44: KAPVAY 5.9.6 kariva 13.7 kelnor 1
Page 45 and 46: ONGLYZA 8.1.5.2 ONSOLIS 5.1.1.1 OPA
Page 47 and 48: SUPREP 9.6 SURESTEP 18.1 SURE‐T 1

Preferred Drug List 2013 Standard Formulary (3 ... - Express Scripts

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?