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Qll drug list.xlsx

Quantity Level Limit Program: Limit per Refill
Quantity
Quantity
Acanya 1.2 - 2.5%
Emend® 40 and 125 mg
Acular LS® ophthalmic
Emend® 80 mg
Acuvail®
Emend® Unit of Use Pack
Aczone® 5%
Epiduo™
Adrenaclick® 0.15 and 0.3 mg
EpiPen® 0.15 and 0.3 mg
Afinitor® 2.5 and 5 mg
Evoclin®
Afinitor® 10 mg
Extina® Foam
Aldara cream
Famvir® 125 and 250 mg
Alinia® 100 mg/mL suspension
Famvir® 500 mg
Alinia® 500 mg tablets
Firazyr® 10 mg/ml
Alphagan® P 0.1 and 0.15%
Fragmin®
Alrex® ophthalmic
Frova® 2.5 mg
Alsuma™ 6 mg
Gleevec® 100mg
Altabax®
Gleevec® 400 mg
Amerge® 1 and 2.5 mg
Glucagon/Glucagen®
Analapram E kit™ with 1 oz tube and 30
Granisol™ 2 mg/10 mL
single use kit
Anzemet® 50 and 100 mg

Hycamtin® 0.25 mg
Arixtra® 2.5, 5, 7.5, and 10 mg
Hycamtin® 1 mg
Astelin® Nasal Spray
Imiquimod
Astepro 0.1 and 0.15%
Imitrex® 4 mg Syringe/injection
Avita® 0.025% gel
Imitrex® 6 mg Syringe/Injection
Axert® 6.25 and 12.5 mg
Imitrex® 6 mg vials
Azasite 1%
Imitre® Nasal Spray 20 mg
Azopt® ophthalmic
Imitrex® Nasal Spray 5 mg
Bactroban® Cream
Imitrex® Tablets 25, 50, and 100 mg
Bactroban® Ointment
Innohep®
Beconase AQ®
Iressa® 250 mg
BenzaClin® kit
Kytril® 1 mg
BenzEfoam™
Lastacaft™ 0.25%
Bepreve®
Lindane Lotion and Shampoo
Betimol®
Locoid lipocream®
Bromday™ 0.09%
Locoid lotion®
Lovenox® 30, 40, 60, 80, 100, 120, and 150
Butorphanol NS
Cambia® 50 mg packets
Lovenox® 300 mg
Caprelsa® 100 mg
Lumigan®
Caprelsa® 300 mg
Luxiq® 50 and 100 gram
Clobex® lotion and spray
Maxair Autohaler®
Clobex® shampoo
Maxalt®/Maxalt MLT® 5 and 10 mg
Cloderm® 30 and 75 gram pump
Momexin combo pack™
Cloderm® 45 and 90 gram tube
Nasacort® AQ
Combigan® 0.2% / 0.5% ophthalmic
Nasonex®
Desonate™
Nevanac® Ophthalmic
Diastat® 2.5 mg/ Diastat® AcuDial™ 10 and
Nexavar® 200 mg
Dovonex®
Nitrolingual Pump/spray
Dovonex® Scalp Solution
Nitromist® 0.4mg/spray
Elestat® ophthalmic
Nitromist lingual aerosol
Elidel®
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Quantity
Quantity
Omnaris® 50 mcg nasal spray
Treximet® 85/500 mg
Optivar® Ophthalmic
Trianex™
Oravig™ 50 mg
Triaz foaming cloths®
Pataday™ Ophthalmic
Tussionex®
Twinject® 0.15 and 0.3 mg inj. Single
Patanase 0.60% grams
cartridge
Patanol® Ophthalmic
Tykerb® 250 mg
Prevpac®
Ultracet®
Proair HFA
Valtrex® 1 gram
Protopic®
Valtrex® 500 mg
Proventil® HFA
Relpax® 20 and 40 mg
Vectical ®
Restasis® 0.05%
Ventolin® HFA
Revlimid® 15 and 25 mg
Verdeso™
Revlimid® 5 mg
Vfend® 200 mg
Revlimid® 10 mg
Vfend® 50 mg
Rhinocort Aqua® Nasal Spray (32 mcg/spray) 2 bottles (18 g)
Voltaren Ophthalmic®
Sancuso®
Votrient™ 200 mg
Sprycel® 20
Xalatan®
Sprycel® 50, 70, 100, and 140 mg
Xeloda® 150 mg
Sprycel® 80
Xeloda® 500 mg
Sumavel™ DosePro™
Xibrom®
Sutent® 12.5 mg
Xifaxan® 200 mg
Sutent® 25 and 50 mg
Xopenex HFA®
Xopenex® 0.31 mg/3mL, 0.63 mg/3 mL, and
Taclonex®
1.25 mg/3 mL Solution
Taclonex Scalp®
Xopenex® 1.25 mg/0.5 mL Solution
Tarceva® 100 and 150 mg
Zelboraf® 240 mg
Tarceva® 25 mg
Zirgan® 0.15%
Tasigna 150 and 200 mg
Zolinza® 100 mg
Tazorac® 0.5 and 0.1% cream
Zomig® 2.5 and 5 mg
Tazorac® 0.5 and 0.1% gel
Zomig® Nasal Spray 5 mg
Thalomid® 50 mg
Zomig ZMT® 2.5 and 5 mg
Thalomid® 100 mg
Zovirax 5% cream
Thalomid® 150 mg
Zuplenz® 4 and 8 mg
Thalomid® 200 mg
Zutripro™ 5mg/4mg/60mg per 5ml
Tobradex ST 0.3%/0.05% solution
Zyclara 3.75%®
Travatan Z®
Tretinoin 10mg
Zytiga™ 250 mg
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.

Source: http://schneider.welcometouhc.com/files/schneider/content/schneider_qll_drug_list.pdf

Microsoft word - kenadler.doc

KENNETH A. ADLER Partner and Chair, Technology and Outsourcing Practice Group 212.407.4284 Fax 212.202.6039 Kenneth Adler specializes in complex global and domestic outsourcing and technologytransactions. With over 20 years of experience, his practice includes drafting and negotiating alltypes of outsourcing and technology agreements, including business process and informationtechnology outs

Microsoft word - 2013-14 medical form-3.doc

UCUCC YOUTH PROGRAM HEALTH FORM A completed and signed health form must be on file for all youth program participants. This form is to be completed by the parent/guardian. Please notify Margaret Irribarra if any of this information should change or need to be updated. Youth’s Name Gender: F / M / Gender Neutral / Transgender Birth date____________ Height_____ Weight Parent’s/Guardi

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