Tier 2 cover - Health Plan of Nevada
Tier 2 cover - Health Plan of Nevada
Tier 2 cover - Health Plan of Nevada
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dicl<strong>of</strong>enac potassium ZIPSOR<br />
dicl<strong>of</strong>enac sol PENNSAID<br />
donepezil ARICEPT 23mg<br />
doxepin SILENOR<br />
doxycycline hyclate DORYX<br />
doxycycline hyclate MORGIDOX<br />
doxycycline monohydrate ADOXA<br />
drospirenone-ethyinal-levomefolate BEYAZ<br />
drospirenone-ethyinyl SAFYRAL<br />
dutasteride-tamsulosin JALYN<br />
emedastine EMADINE<br />
epinastine ELESTAT<br />
esomeprazole NEXIUM<br />
felbamate FELBATOL<br />
fen<strong>of</strong>ibrate TRICOR<br />
fen<strong>of</strong>ibric acid TRILIPIX<br />
fentanyl citrate SL ABSTRAL<br />
fex<strong>of</strong>enadine ALLEGRA<br />
fex<strong>of</strong>enadine-pseudoephedrine ALLEGRA D<br />
fluticasone furoate nasal VERAMYST<br />
gabapentin enacarbil HORIZANT<br />
granisetron patch SANCUSO<br />
hc-pramoxine cr-diet manage prod tab-cleans wipe kit ANALPRAM ADVANCED KIT<br />
hydrocortisone topical HYDROCORTISONE 0.05%<br />
hydrocortisone topical HYDROCORTISONE 1%<br />
hydrocortisone topical HYTONE<br />
hydrocortisone topical NUCORT<br />
hydrocortisone-pramoxine PROCORT<br />
ibupr<strong>of</strong>en-famotidine DUEXIS<br />
imiquimod ZYCLARA<br />
interferon beta-1B EXTAVIA<br />
ketoconazole-hydrocortisone KETOCON<br />
ketorolac ophth ACUVAIL<br />
ketorolac tromethamine nasal SPRIX NASAL<br />
ketotifen ZADITOR<br />
ketotifen ZADITOR OTC<br />
lactic acid LAC-HYDRIN<br />
levocetirizine XYZAL<br />
loperamide IMODIUM<br />
loratadine CLARITIN<br />
metoclopramide METOZOLV ODT<br />
miconazole nitrate MICONAZOLE NITRATE<br />
minocycline SOLODYN<br />
mometasone MOMEXIN KIT<br />
morphine KADIAN<br />
mupurocin oint kit CENTANY AT<br />
naproxen NAPRELAN CR DOSE CARD<br />
QL - Quantity Limits<br />
AL - Age Limits<br />
PA - Prior Authorization Required<br />
ST - Step Therapy Required M - Mail-order/Maintenance drug<br />
SIO - Self-Injectable Orphan 29 2-<strong>Tier</strong> (closed) Drug Benefit Guide 01/04/12
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