Beta-Adrenergic Blocking Agents - Alameda Alliance for Health
Beta-Adrenergic Blocking Agents - Alameda Alliance for Health
Beta-Adrenergic Blocking Agents - Alameda Alliance for Health
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Benefit Coverage and Limitations<br />
This printed Formulary does not provide in<strong>for</strong>mation regarding the specific coverage and<br />
limitations an individual member may have. Many members have specific benefit inclusions,<br />
exclusions, copays, or a lack of coverage, which are not reflected in the Drug Formulary.<br />
The Drug Formulary applies only to outpatient drugs provided to members, and does not apply<br />
to medications used in inpatient settings. If a member has any specific questions regarding<br />
their coverage, they should contact their Plan Sponsor or MedImpact at (800) 788-2949.<br />
ALLERGY<br />
2nd Gen Antihistamine & Decongestant Combinations<br />
QL loratadine/pseudoephedrine CLARITIN-D 12 HOUR TAB ER 12H 5<br />
MG-120MG<br />
QL loratadine/pseudoephedrine CLARITIN-D 12 HOUR TAB ER 24H<br />
10MG-240MG<br />
Antihistamines<br />
tripelennamine hcl TRIPELENNAMINE HCL TABLET<br />
50MG<br />
Antihistamines - 1st Generation<br />
carbinoxamine maleate PALGIC LIQUID 4<br />
MG/5 ML<br />
chlorpheniramine maleate CHLOR-TRIMETON CAPSULE SA<br />
12MG<br />
chlorpheniramine maleate CHLOR-TRIMETON SYRUP 2<br />
MG/5 ML<br />
chlorpheniramine maleate CHLOR-TRIMETON TABLET 4<br />
MG<br />
clemastine fumarate TAVIST-1 TABLET 1.34<br />
MG<br />
clemastine fumarate TAVIST-1 SYRUP<br />
0.67MG/5ML<br />
cyproheptadine hcl CYPROHEPTADINE HCL SYRUP 2<br />
MG/5 ML<br />
cyproheptadine hcl CYPROHEPTADINE HCL TABLET 4<br />
MG<br />
diphenhydramine hcl BENADRYL TABLET 25<br />
MG<br />
diphenhydramine hcl BENADRYL CAPSULE 25<br />
MG<br />
diphenhydramine hcl BENADRYL CAPSULE 50<br />
MG
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