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

More documents

Recommendations

Info

DRUG NAME 1 2 3 SUGGESTED PREFFERED ALTERNATIVES brimonidine tartrate X dorzolamide hcl X dorzolamide‐timolol X latanoprost X levobunolol hcl X pilocarpine hcl X timolol maleate X ALPHAGAN P X brimonidine tartrate AZOPT X BETIMOL X generic, ALPHAGAN P, AZOPT, COMBIGAN COMBIGAN X COSOPT PF X generic, ALPHAGAN P, AZOPT, COMBIGAN ISTALOL X generic, ALPHAGAN P, AZOPT, COMBIGAN LUMIGAN ST X TIMOPTIC OCUDOSE X timolol maleate TRAVATAN Z ST X XALATAN ST X latanoprost ZIOPTAN ST X latanoprost, LUMIGAN, TRAVATAN Z 14.6 OTHER OPHTHALMIC DRUGS atropine sulfate X azelastine hcl X cromolyn sodium X diclofenac sodium X epinastine hcl X ketotifen fumarate X ACUVAIL X ALOCRIL X azelastine, PATADAY, PATANOL ALOMIDE X azelastine, PATADAY, PATANOL BEPREVE X azelastine, PATADAY, PATANOL BOTOX X BROMDAY X EMADINE X azelastine, PATADAY, PATANOL LASTACAFT X azelastine, PATADAY, PATANOL NEVANAC X PATADAY X PATANOL X RESTASIS X CHAPTER 15: RESPIRATORY MEDICATIONS 15.1.1 BETA‐2 ADRENERGIC DRUGS albuterol sulfate X metaproterenol sulfate X ARCAPTA NEOHALER X FORADIL, SEREVENT BROVANA X PERFOROMIST FORADIL X TIER
DRUG NAME 1 2 3 SUGGESTED PREFFERED ALTERNATIVES MAXAIR AUTOHALER X PROAIR HFA, VENTOLIN HFA PERFOROMIST X PROAIR HFA X PROVENTIL HFA X PROAIR HFA, VENTOLIN HFA SEREVENT DISKUS X VENTOLIN HFA X XOPENEX X levalbuterol XOPENEX CONCENTRATE X levalbuterol XOPENEX HFA ST X PROAIR HFA, VENTOLIN HFA 15.1.2 METHYL XANTHINE DRUGS theophylline X theophylline anhydrous X 15.1.3 OTHER DRUGS FOR ASTHMA budesonide X cromolyn sodium X epinephrine X ipratropium bromide X ipratropium‐albuterol X ADVAIR DISKUS X ADVAIR HFA X ALVESCO X ASMANEX, PULMICORT FLEX, QVAR ASMANEX X ATROVENT HFA X COMBIVENT X COMBIVENT RESPIMAT X DULERA X EPIPEN 2‐PAK X EPIPEN JR 2‐PAK X FLOVENT DISKUS X ASMANEX, PULMICORT FLEX, QVAR FLOVENT HFA X ASMANEX, PULMICORT FLEX, QVAR PULMICORT X PULMICORT FLEXHALER X QVAR X SPIRIVA X SYMBICORT X TUDORZA PRESSAIR X 15.1.4 LEUKOTRIENE MODIFIERS montelukast sodium X zafirlukast X ACCOLATE ST X zafirlukast SINGULAIR ST X montelukast 15.2.1 ANTIHISTAMINES arbinoxa X cetirizine 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 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 31: DRUG NAME 1 2 3 SUGGESTED PREFFERED
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

Create successful ePaper yourself

Delete template?

Save as template?