CATEGORY DRUG NAME HOW SUPPLIED
2 1. ALLERGIC DISORDERS
Chlorpheniramine,Pyrilamine, Phenylephrine (Rynatan)
Chlorpheniramine tan-phenylephrine (Rynatan
14 2. CARDIOVASCULAR SYSTEM 15
Capsule 120mg, 180mg, 240mg $$ generic only
Amlodipine (Norvasc) - Prior Authorization
Clopidogrel (Plavix) - Prior Authorization Required
Tablets 5mg, 10mg, 20mg, 40mg $ generic only 1/2 tablet programTablets 2.5mg, 5mg, 10mg,
Tablets 5mg, 10mg, 20mg, 40mg $$ generic only
38 CATEGORY DRUG NAME HOW SUPPLIED
63 3. DERMATOLOGICAL AGENTS
400gm size half the cost per gram, more cost effective due to
A. Topical Anti-Infective Creams Silver Sulfadiazine 1% (Silvadene)
71 CATEGORY DRUG NAME HOW SUPPLIED
Miconazole (Monastat 7) Vaginal Cream 45mg
4. EYE, EAR AND THROAT
77 AGENTS 78
Sulfacetamide Sodium 10% (Sodium Sulamyd)
Ofloxacin Ophth Soln 0.3% (Occuflox Ophthalmic)
Polymixin B sulfate, neomycin, hydrocortisone suspension
89 90 91 92 5. ENDOCRINE SYSTEM 93
Tablets 500mg, 850mg, 1000mg $$ generic only
Oral Contraceptives (All available generics)
112 CATEGORY DRUG NAME HOW SUPPLIED 6. GASTROINTESTINAL
121 SYSTEM 122
$ generic only MAC .374$ generic only no mac awp's
$ generic only$ generic only (capsules not
Sodium biophosphate/sodium phosphate (Fleet Enema)
Polyethylene glycol 3350 (Miralax, Glycolax)
Suppository (adult and pediatric) $ generic only
Polyethylene glycol 3350, NaCl, KCl, Sodium Bicarb,
152 CATEGORY DRUG NAME HOW SUPPLIED
153 7. INFESTATIONS 154
156 157 8. INFECTIONS 158
$ generic only$$ generic only (250mg dose
Ciprofloxacin (Cipro) use as second line agent only
Levofloxacin (Levaquin) use as second line agent only
Sulfamethaxazole/Trimethoprim DS (Septra DS)
$ generic onlynot available generic/ use
Nitrofurantoin Macrocyrstalline (Macrobid)
Valacyclovir (Valtrex) - prior authorization use as second
190 CATEGORY DRUG NAME HOW SUPPLIED 9. MUSCULOSKELETAL
191 SYSTEM 192
$ generic only $ generic only slightly more expensive than cyclobenzaprine $ generic only costs less than cyclobenzaprine
201 202 203 10. NEOPLASMS 204
Leuprolide (Lupron) - Prior authorization
Ondansetron (Zofran) - prior authorization
209 11. NEUROLOGY
Pramipexole (Mirapex) - Prior authorization
Gabapentin (Neurontin) - Prior authorization - for seizure
Lamotrigine (Lamictal) - Prior Authorization
Diazepam (Diastat) pediatric dose only
Dichloralphenazone, isomeheptene, acetaminophen
227 CATEGORY DRUG NAME HOW SUPPLIED 12. NUTRITIONAL
228 SUPPLEMENTS 229
Tablets, Capsules 10meq 20meq $ generic only
Prenatal Vitamins (Natalins RX, Stuart Natal)
Pediatric multivitamin with fluoride (Poly-Vi-Flor)
236 237 238 13. PAIN 239 Tablet 50/325/40mg
Morphine Sulfate (MS Contin) - Prior authorization
Celecoxib (Celebrex) - Prior Authorization Required
256 257 258 14. PSYCHIATRY
263 CATEGORY DRUG NAME HOW SUPPLIED
Bupropion SR (Wellbutrin SR) - NOT for smoking
$ generic only (40mg generic still very high priced) Lithium Carbonate (LithoBid) Tablets slow release 300mg no generic Divalproex sodium (Depakote) Tablet 125mg, 250mg, 500mg $$ no generic Diazepam (Valium) Tablet 2mg, 5mg, 10mg $ generic only
Tablet 0.25mg, 0.5mg, 1mg, 2mg $ generic only
287 15. RESPIRATORY AGENTS
$ generic only (generic may be hard to get)
$ generic only (not repetabs)
Salmeterol/Fluticasone (Advair) - Prior Authorization
$$$ $$ (about $20 less per inhaler
Beclomethasone Dipropionate (Q-Var) than Azmacort)
$ ( AWP is 9.24)
298 CATEGORY DRUG NAME HOW SUPPLIED
B. Antitussive Agents Promethazine/Codeine
Guaifenesin/Dextromethorphan (Robitussin DM)
16. RHEUMATOLOGY
Statin use in postmenopausal women increases risk of type 2 diabetes, but benefits may still outweigh risks A recent study has found that that the use of statins in postmenopausal women is associated with an increased risk of diabetes mel itus (DM). However, further studies are warranted, and some experts say that the benefits stil outweigh the risks. The study set out to evaluate whether
As post-modern pilferers, we knew immediately this one was just too good to pass over. And so it has proved as we researched the features of the alchemical tradition, spanning at least 2500 years as a complex network of schools and philosophical systems appearing in Egypt, India, China, ancient Greece, early Islamic and medieval and early modern Europe, and the following 22 points will readily dis