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

More documents

Recommendations

Info

DRUG NAME 1 2 3 SUGGESTED PREFFERED ALTERNATIVES ORAVIG X gen nystat, clotrimazol troche 2.4.1 VAGINAL ANTIFUNGALS clotrimazole X terconazole X 2.4.2 OTHER TOPICAL ANTIFUNGALS ciclopirox X clotrimazole X econazole nitrate X ketoconazole X nystatin X ERTACZO X ciclopirox, ketoconazole EXELDERM X econazole, ketoconazole OXISTAT X ciclopirox, ketoconazole 2.4.3 TOPICAL ANTIFUNGAL‐CORTICOSTEROID COMB. clotrimazole‐betamethasone X nystatin‐triamcinolone X 2.5.1 ANTIRETROVIRALS & PROTEASE INHIBITORS lamivudine X lamivudine‐zidovudine X nevirapine X ATRIPLA X COMBIVIR X lamivudine/zidovudine COMPLERA X ATRIPLA EPIVIR X EPZICOM X INCIVEK X INTELENCE X ISENTRESS X KALETRA X LEXIVA X NORVIR X PREZISTA X REYATAZ X SUSTIVA X TRUVADA X VICTRELIS X VIRAMUNE X nevirapine VIRAMUNE XR X VIREAD X ZIAGEN X abacavir 2.5.2 OTHER ANTIVIRAL DRUGS acyclovir X amantadine X famciclovir X TIER
DRUG NAME 1 2 3 SUGGESTED PREFFERED ALTERNATIVES ribapak X ribavirin PA X valacyclovir X BARACLUDE X DENAVIR X EPIVIR HBV X RELENZA X TAMIFLU X VALTREX X valacyclovir 2.6 TOPICAL ANTIVIRAL DRUGS XERESE X ZOVIRAX X 2.7.2 ANTITUBERCULOSIS DRUGS isoniazid X rifampin X 2.7.3 PLASMODICIDES atovaquone‐proguanil hcl X hydroxychloroquine sulfate X mefloquine hcl X MALARONE X atovaquone/proguanil hcl QUALAQUIN X quinine sulfate 2.7.4 SULFONES DAPSONE X 2.7.5 TRICHOMONOCIDES metronidazole X tinidazole X 2.8 OTHER ANTIINFECTIVE DRUGS bacitracin X vancomycin hcl X DIFICID X metronidazole VANCOCIN HCL X vancomycin XIFAXAN X ZYVOX X 2.8.2 AMINOGLYCOSIDES gentamicin sulfate X tobramycin sulfate X TOBI X CHAPTER 3: ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS 3.0 ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS anagrelide hcl X anastrozole X azathioprine X bicalutamide X cyclosporine modified X TIER
Page 1 and 2: Preferred Drug List 2013 Standard F
Page 3 and 4: Prior Authorization Process If a pa
Page 5: DRUG NAME 2.1.5 PENICILLINS amox tr
Page 9 and 10: 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

Create successful ePaper yourself

Delete template?

Save as template?