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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DRUG NAME<br />
1 2 3 SUGGESTED PREFFERED ALTERNATIVES<br />
PREFERA‐OB ONE X prenatal mv & min capsule<br />
PREFERA‐OB PLUS DHA X hemenatal ob+dha combo pk<br />
PRENATE DHA X generic Rx prenatal vitamans<br />
PRENATE ELITE X generic Rx prenatal vitamans<br />
PRENATE ESSENTIAL X generic Rx prenatal vitamans<br />
13.1.2 SPECIALIZED OB/GYN DRUGS<br />
leuprolide acetate PA X<br />
novarel X<br />
CETROTIDE X<br />
GANIRELIX ACETATE X<br />
LUPRON DEPOT PA X ELIGARD, TRELSTAR<br />
OVIDREL X ch.gonadotrpin,novarel<br />
13.1.3 OB/GYN TOPICAL ANTIINFECTIVES<br />
clindamycin phosphate X<br />
metronidazole X<br />
vandazole X<br />
13.2 OVULATORY STIMULANTS<br />
clomiphene citrate X<br />
BRAVELLE X GONAL‐F/RFF<br />
FOLLISTIM AQ X GONAL‐F/RFF<br />
GONAL‐F/RFF X<br />
13.3 ANDROGEN DRUGS<br />
testosterone cypionate X<br />
ANDRODERM X<br />
ANDROGEL X<br />
AXIRON X<br />
FORTESTA X ANDRODERM, ANDROGEL, AXIRON<br />
STRIANT X ANDRODERM, ANDROGEL, AXIRON<br />
TESTIM X ANDRODERM, ANDROGEL, AXIRON<br />
13.4 ESTROGEN DRUGS<br />
estradiol X<br />
estrogen & methyltestosterone X<br />
estrogen‐methyltestosterone X<br />
estropipate X<br />
CENESTIN X<br />
DIVIGEL X<br />
ELESTRIN X estradiol ptch, DIVIGEL, EVAMIST<br />
ENJUVIA X<br />
ESTRACE X VAGIFEM<br />
ESTRASORB X estradiol ptch, DIVIGEL, EVAMIST<br />
ESTRING X VAGIFEM<br />
ESTROGEL X estradiol ptch, DIVIGEL, EVAMIST<br />
EVAMIST X<br />
MENEST X estradiol, CENESTIN, ENJUVIA, PREMARN<br />
TIER
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