2-Tier Open Preferred Drug List - Health Plan of Nevada

Alphabetical IndexDrug Name PDL Section Drug Name PDL SectionGABITRIL 4-Ggalantamine 4-Fganciclovir 1-HGANTANOL 1-LGANTRISIN 1-LGARAMYCIN 5-Cgatifloxacin ophth 11-Agefitinib 2-AGELNIQUE 8-DGELX 3-Lgemfibrozil 14-AGENADUR KIT 14-AGENERESS FE 14-AGENGRAF 2-BGENOTROPIN 14-AGENTAMICIN OINT 3% 11-Agentamicin topical 5-Cgentamycin sulfate ophth 11-AGEODON 4-DGESTICARE DHA 10-BGIANVI 6-DGILENYA 13-Eglatiramer acetate 13-EGLEEVEC 2-Aglimepiride 6-Fglipizide 6-Fglipizide CR 6-Fglipizide-metformin 6-FGLUCAGON 6-HGLUCOMETER DEX TEST STRIPS 6-KGLUCOPHAGE 6-FGLUCOPHAGE XR 6-FGLUCOTROL 6-FGLUCOTROL XL 6-FGLUCOVANCE 6-FGLUMETZA 6-Fglyburide 6-Fglyburide micronized 6-Fglyburide-metformin 6-Fglycerol phenylbutyrate 7-Hglycopyrroate 9-Fglycopyrrolate 7-CGLYNASE 6-FGLYSET 6-Fgolimumab 13-HGOLYTELY 7-Agranisetron 7-Fgranisetron patch 14-AGRIFULVIN V 1-Ggriseofulvin microsize 1-Ggriseofulvin ultramicrosize 1-GGRIS-PEG 1-Gguaifenesin-DM 12-Cguanfacine 3-Hguanfacine 4-FGYNAZOLE-1 8-Chalcinonide 5-HHALCION 4-CHALDOL 4-Dhalobetasol 5-HHALOG 5-Hhaloperidol 4-Dhc lot 2% sal acid sulfur 2-2% 5-Hhc-pramoxine cr-diet manage prod tab-cleans wipe kit14-AHECTOROL 10-AHELIDAC 7-CHEPSERA 7-HHEXALEN 2-AHIVID 1-Ihomatropine ophth 11-EHORIZANT 14-AHUMALOG 6-GHUMALOG MIX 6-GHUMALOG MIX PEN 6-GHUMALOG PEN 6-GHUMATROPE 14-AHUMIBID-DM 12-CHUMIRA 13-HHUMULIN 6-GHUMULIN PEN 6-G62 2-Tier (open) Drug Benefit Guide 09/01/13