Preferred Drug List 2013 Standard Formulary (3 ... - Express Scripts
Preferred Drug List 2013 Standard Formulary (3 ... - Express Scripts
Preferred Drug List 2013 Standard Formulary (3 ... - Express Scripts
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TIER<br />
DRUG NAME<br />
1 2 3 SUGGESTED PREFFERED ALTERNATIVES<br />
CHAPTER 10: IMMUNOLOGICALS AND VACCINES<br />
10.0 IMMUNOLOGICALS AND VACCINES<br />
SYNAGIS X<br />
ZOSTAVAX X<br />
10.2.1 MYELOID STIMULANTS<br />
NEULASTA X<br />
NEUPOGEN X<br />
10.2.2 ERYTHROID STIMULANTS<br />
ARANESP X<br />
PROCRIT X<br />
10.2.3 INTERFERONS<br />
AVONEX PA X<br />
AVONEX ADMINISTRATION PACK PA X<br />
AVONEX PEN PA X<br />
BETASERON PA X<br />
COPAXONE X<br />
EXTAVIA PA X AVONEX, BETASERON, REBIF<br />
PEGASYS/PROCLICK X<br />
PEGINTRON/REDIPEN X<br />
REBIF PA X<br />
10.2.4 GROWTH HORMONES AND RELATED DRUGS<br />
GENOTROPIN PA X<br />
HUMATROPE PA X<br />
NORDITROPIN FLEXPRO PA X GENOTROP,HUMATROP,NUTROPIN/AQ<br />
NORDITROPIN NORDIFLEX PA X GENOTROP,HUMATROP,NUTROPIN/AQ<br />
NUTROPIN/AQ/AQ NUSPIN PA X<br />
OMNITROPE PA X GENOTROP,HUMATROP,NUTROPIN/AQ<br />
SAIZEN PA X GENOTROP,HUMATROP,NUTROPIN/AQ<br />
TEV‐TROPIN PA X GENOTROP,HUMATROP,NUTROPIN/AQ<br />
10.2.6 INTERLEUKIN RECEPTOR ANTAGONIST<br />
KINERET PA X ORENCIA<br />
10.2.7 IMMUNOGLOBULIN ANTIBODIES<br />
XOLAIR X<br />
CHAPTER 11: MUSCULOSKELETAL MEDICATIONS<br />
11.1.1 SALICYLATES AND RELATED DRUGS<br />
aspirin X<br />
aspirin ec X<br />
choline mag trisalicylate X<br />
diflunisal X<br />
salsalate X<br />
11.1.2 NON‐STEROIDAL ANTIINFLAMMATORY AGENTS<br />
diclofenac potassium X<br />
diclofenac sodium X<br />
etodolac X
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