NATIONAL ADAP MONITORING PROJECT - AIDS United
NATIONAL ADAP MONITORING PROJECT - AIDS United
NATIONAL ADAP MONITORING PROJECT - AIDS United
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Maine<br />
<strong>ADAP</strong> FORMULARIES<br />
ANTIRETROVIRALS<br />
NRTIs- abacavir (Ziagen), abacavir/lamivudine/zidovudine (Trizivir), didanosine (ddI, Videx, Videx EC), lamivudine (Epivir, 3TC),<br />
lamivudine/zidovudine (Combivir), stavudine (d4T, Zerit), tenofovir (Viread), zalcitabine (ddC, HIVID), zidovudine (AZT, Retrovir).<br />
PIs- amprenavir (Agenerase), indinavir (Crixivan), lopinavir/ritonavir (Kaletra), nelfinavir (Viracept), ritonavir (Norvir), saquinavir<br />
(Fortovase). NnRTIs- delavirdine (Rescriptor), efavirenz (Sustiva), nevirapine (Viramune). Other- hydroxyurea (Hydrea).<br />
OI DRUGS<br />
PHS “A1 OI”s- acyclovir (Zovirax), azithromycin (Zithromax), cidofovir (Vistide), clarithromycin (Biaxin), famciclovir (Famvir),<br />
fluconazole (Diflucan), foscarnet (Foscavir), ganciclovir (Cytovene), isoniazid (INH), itraconazole (Sporonox), leucovorin,<br />
pyrazinamide, pyrimethamine (Daraprim, Fansidar), rifampim, sulfadiazine, TMP/SMX (Bactrim). Other OIs- ciprofloxacin (Cipro),<br />
dapsone, ethambutol (Myambutol), pentamidine (Nebupent). Hepatitis C- none.<br />
Maryland<br />
ANTIRETROVIRALS<br />
NRTIs- abacavir (Ziagen), abacavir/lamivudine/zidovudine (Trizivir), didanosine (ddI, Videx), lamivudine (Epivir, 3TC),<br />
lamivudine/zidovudine (Combivir), stavudine (d4T, Zerit), tenofovir (Viread), zalcitabine (ddC, HIVID), zidovudine (AZT, Retrovir).<br />
PIs- amprenavir (Agenerase), indinavir (Crixivan), lopinavir/ritonavir (Kaletra), nelfinavir (Viracept), ritonavir (Norvir), saquinavir<br />
(Fortovase, Invirase). NnRTIs- delavirdine (Rescriptor), efavirenz (Sustiva), nevirapine (Viramune). Other- hydroxyurea (Hydrea).<br />
OI DRUGS<br />
PHS “A1 OI”s- acyclovir (Zovirax), azithromycin (Zithromax), cidofovir (Vistide), clarithromycin (Biaxin), famciclovir (Famvir),<br />
fluconazole (Diflucan), foscarnet (Foscavir), ganciclovir (Cytovene), isoniazid (Nydrazid, Rifamate), itraconazole (Sporonox),<br />
leucovorin, pyrazinamide, pyrimethamine (Daraprim, Fansidar), rifampim (Rifadin, Rimactane), sulfadiazine, TMP/SMX (Bactrim).<br />
Other OIs- amphotericin B (Fungisone), atovaquone (Mepron), ciprofloxacin (Cipro,Ciloxan), clindamycin (Cleocin), clotrimazole<br />
(Lotrimin, Mycelex), dapsone, daunorubicin citrate liposomal (DaunoXome), ethambutol (Myambutol), epoetin alpha (Epogen, Procrit),<br />
filgrastim (Neupogen), fomivirsen (Vitravene), ketoconazole (Nizoral), miconazole (Monistat), nystatin (Mycostatin), paromomycin<br />
(Humatin), pentamidine (Pentam, Nebupent), rifabutin (Mycobutin), valacyclovir (Valtrex).<br />
Hepatitis C- interferon alpha-2A (Roferon-A, Intron-A).<br />
TREATMENTS FOR METABOLIC DISORDERS<br />
Hyperlipidemia- atorvastatin (Lipitor), pravastatin (Pravachol). Wasting- megestrol acetate (Megace), nandrolone, oxandrolone<br />
(Oxandrin), testosterone (injection and patches), thalidomide (Thalomid).<br />
ALL OTHERS<br />
amitriptyline (Elavil), buproprion (Wellbutrin, Zyban), citalopran HBr (Celexa), clotrimazole/betamethasone (Lotrisone Cream),<br />
diphenoxylate-atropine (Lomotil), divalproex (Depakote, Depakene), fluoxetine (Prozac), fluphenazine (Prolixin), gabapentin<br />
(Neurontin), haldoperidol (Haldol), hydroxizine (Atarax), imiquimod (Aldara), loperamide (Imodium), nortriptyline (Aventlyl,<br />
Pamelor), octreotide (Sandostatin), olanzapine (Zyprexa), oxymetholone (Anadrol-50), paroxetine (Paxil), prochlorperazine<br />
(Compazine), risperidone (Risperdal), sertraline (Zoloft), trazadone (Desyrel/Desyrel Dividose).<br />
Massachusetts<br />
ANTIRETROVIRALS<br />
NRTIs- abacavir (Ziagen), abacavir/lamivudine/zidovudine (Trizivir), didanosine (ddI, Videx, Videx EC), lamivudine (Epivir, 3TC),<br />
lamivudine/zidovudine (Combivir), stavudine (d4T, Zerit), tenofovir (Viread), zalcitabine (ddC, HIVID), zidovudine (AZT, Retrovir).<br />
PIs- amprenavir (Agenerase), indinavir (Crixivan), lopinavir/ritonavir (Kaletra), nelfinavir (Viracept), ritonavir (Norvir), saquinavir<br />
(Fortovase, Invirase). NnRTIs- delavirdine (Rescriptor), efavirenz (Sustiva), nevirapine (Viramune). Other- hydroxyurea (Hydrea).<br />
OI DRUGS<br />
PHS “A1 OI”s- acyclovir (Zovirax), azithromycin (Zithromax), cidofovir (Vistide), clarithromycin (Biaxin), famciclovir (Famvir),<br />
fluconazole (Diflucan), foscarnet (Foscavir), ganciclovir (Cytovene), isoniazid (INH), itraconazole (Sporonox), leucovorin,<br />
pyrazinamide, pyrimethamine (Daraprim, Fansidar), rifampim, sulfadiazine, TMP/SMX (Bactrim). Hepatitis C- all FDA approved drugs.<br />
ALL OTHERS<br />
Open Formulary - All FDA approved drugs are covered except the following:<br />
Specific open formulary exclusions: antirheumatic injectables (e.g. Enbrel), botulinum toxin (e.g. botox, mylobloc) compounded<br />
medications for infusion, active medication containing more than one ingredient, gonadotropin, finasteride (Propecia), hyaluronic acid<br />
derivatives (e.g. Hyalgan, Synvisc), immune globulin intravenous IGIV (e.g. sandoglobulin, Venoglobulin), injectable muscle relaxants<br />
(e.g. Lioresal), mifepristone, minoxidil (Rogaine), monoclonal antibodies (e.g. Remicade, Synagis), propoxyphene, recombinant human<br />
growth hormone HGH (e.g. Geref, Humatrop), Viagra.<br />
Class Exculsions:fertility drugs, fluorides, herbal medicaitons, immunizing biologicals, iron, less than effective drugs, nutritional<br />
supplements, over the counter mediations exceptions:(Acetaminophen, Imodium and Metamucil), sex-reassignment drugs, smoking<br />
cessaton drugs, vitamins and minerals.
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