Microsoft word - ap 2006-16 pdl.doc

MISSISSIPPI DIVISION OF MEDICAID
PREFERRED DRUG LIST
The agents listed below are preferred products on the Mississippi Medicaid Preferred Drug List (PDL). The preferred drug
list is a medication list recommended to the Division of Medicaid by the Pharmacy and Therapeutics Committee and
approved by the Executive Director of the Division of Medicaid. These drugs have been selected for their efficaciousness,
clinical significance, cost effectiveness and safety for Medicaid beneficiaries.
Most generic agents are preferred, do not require prior authorization, and are not individually listed below.
Unless otherwise specified, the listing of a particular brand or generic name includes all dosage forms of that drug.
For more information concerning the PDL including non-preferred agents, the OTC formulary and other specifics please
visit our website at www.dom.state.ms.us.

BPH AGENTS
Actonel®
Antihistamines &
Avodart®
DIABETES
Boniva®
Antihistamine
Flomax®
Incretin Mimetics
Evista®
Decongestant Combos.
Uroxatral®
Byetta™
Fosamax®
First Generation
CARDIOVASCULAR
INSULINS
Miacalcin®
Pediatex™, Pediatex™ D
ACE Inhibitors
ALL Novo Nordisk
RESPIRATORY
Pediatex™ 12 & 12 D
Altace®
products
Vazol™, Vazol™ D
ACE Inhibitor/Diuretics
Lantus® (Vial)
Advair®
Second Generation
Oral Agents
Asmanex®
Astelin Nasal Spray®
ACEI/CCB Combinations
Azmacort®
Clarinex®
Lexxel®
ACTOplus met™
Combivent®
Loratadine
Lotrel®
Avandamet®
Intal ® Aerosol Inhaler
Zyrtec®
Tarka®
Avandaryl™
Pulmicort Respules®
ANALGESICS
ARBs&Combinations
Avandia®
Serevent Diskus®
Cox- 2
Avapro®, Avalide®
Prandin®
Singulair®
Diovan®,Diovan HCT
Starlix®
Spiriva®
NSAIDS
Beta-Blockers
ELECTROLYTE
Tilade®
DEPLETERS
Narcotics
Toprol XL®
Magnebind® Rx
Xopenex HFA™
Avinza®
Beta-Blocker/Diuretics
Renagel®
Xopenex® Inhalation Sol.
Kadian®
ESTROGENS-
Smooth Muscle
ANTIBIOTICS (Oral)
Calcium Channel
PROGESTINS
Relaxants&Combinations
Cephalosporins
Blockers
Premarin®
Omnicef®
Norvasc®
Nasal Corticosteroids
Premphase®
Suprax® Suspension
CCB/Antihyperlipidemic
Flonase®
Prempro®
Macrolides
Caduet®
Nasonex®
GASTRO-INTEST.
Biaxin XL®
Diuretics& Aldosterone
THYROID/ANTI-
Zithromax® Suspension
Receptor Antagonists
THYROID AGENTS
Miscellaneous
H-2 Blockers
Cleocin Ped.Soln®
Platelet Aggregation
Axid® Solution
TOPICAL AGENTS
Penicillins
Inhibitors
Zantac® Syrup
Anti-inflammatory Agents
Aggrenox™
PPIs
Locoid®
Penicillin Combinations
clopidogrel
Prevacid®
Antibacterial Agents
Augmentin (versions not
CENTRAL NERVOUS
Zegerid®
MetroGel® Vaginal
available generically)
SYSTEM AGENTS
Misc.
Antifungals
Quinolones
Zelnorm®
Alzheimer’s Agents
Naftin®
Avelox®
G-U RELAXANTS
Aricept®
Antipruritic
Sulfonamides
Exelon®
Enablex®
Gantrisin® Susp
Namenda®
HEMATOPOIETIC
Antiviral
Tetracyclines
Anti-anxiety
Aranesp®
Procrit®
Miscellaneous-Skin and
ANTIFUNGALS (Oral)
Antidepressants
LAXATIVES(Rx)
Mucous Membrane Agents
Grifulvin V ®
Effexor XR®
Aldara®
Gris-PEG®
Wellbutrin XL®
Elidel ®
Lamisil®*
Sedative/Hypnotics
Advicor®
ANTIPROTOZOAL
Ambien® CR
Crestor®
Alinia®
Lunesta™
Lipitor®
ANTIVIRAL
Rozerem™
Niaspan®
Copegus®Tabs
Skeletal Muscle
Tricor®
Hepsera®
Relaxants
Vytorin®
Rebetol® Syrup
Valcyte®
5-HT3 Receptor
MIGRAINE
Valtrex®
Antagonists
Imitrex®
Zofran®
Maxalt®
OSTEOPOROSIS

Source: http://mshistoricalsociety.org/arrec/digital_archives/s34/pdf/740.pdf

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