PRESCRIPTION DRUG - Public Employees' Benefits Program (PEBP)

!!!!! TRUVADA X!!!!! VIDEX, VIDEX EC* X didanosine!!!!! VIRAMUNE X!!!!! VIRACEPT X!!!!! VIREAD X!!!!! ZERIT X!!!!! ZIAGEN X2.5.2 OTHER ANTIVIRAL DRUGS$ acyclovir (M) X$ amantadine hcl (M) X$ ribasphere (M) (PAR) Spec Pharm X$ ribavirin (M) (PAR) Spec Pharm X$ rimantadine hcl (M) X$$$$ valacyclovir QLL=30 tabs/Rx X acyclovir$$ BARACLUDE X$$$ CYTOVENE* X ganciclovir$ FLUMADINE* X amantadine, rimantadine$$$$$ INCIVEK (PAR)$$$ REBETOL* (PAR) X$$ RELENZA X$$ TAMIFLUQLL= 10 capsules/Rx, 50ml/Rxoral suspension. Max 2 fills peryearX$$$ TYZEKA X$$$ HEPSERA Spec. Pharm. X$$$$ COPEGUS (PAR) Spec. Pharm. X(PAR), (ST) history of any otherHIV med or any antivirals (ie.$$$$ VALCYTEAcyclovir, Valtrex)X$$$$ VALTREX* QLL=30 tabs/Rx X$$$$$ VICTRELIS (PAR)$$$$$ FAMVIR2.6 TOPICAL ANTIVIRAL DRUGSQLL=21 tabs/Rx (125mg,500mg);60/Rx (250mg) X acyclovir, VALTREX$$$$$ ZOVIRAX OINTMENT X acyclovir, VALTREX2.7 OTHER ANTI-INFECTIVES$ paromomycin sulfate X$$$ ALINIA X2.7.1 AMEBICIDES$$$ YODOXIN X2.7.2 ANTITUBERCULOSIS DRUGS$ ethambutol X$ isoniazid (M) X$ isoniazid/rifampin X$ pyrazinamide X$ rifampin (M) X$$ MYAMBUTOL* X ethambutol$$$ RIFATER X$$$ SEROMYCIN X$$$ TRECATOR X2.7.3 PLASMODICIDES$ chloroquine phosphate X$ hydroxychloroquine sulfate (M) X$ mefloquine X$ primaquine X X$$$ ARALEN* X chloroquine phosphate$$$ COARTEM X$$$ DARAPRIM X$$$ FANSIDAR X$$$ LARIAM* X mefloquine$$$ PLAQUENIL* X hydroxychloroquine sulfate$$$ QUALAQUIN (PAR) X2.7.5 TRICHOMONOCIDES$ metronidazole (M) X2.8 OTHER ANTIINFECTIVE DRUGS!!!!! ZYVOXQLL= 28 Tabs. (PAR-InfectiousDisease cosult req'd)X3.0 ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS$ azathioprine (M) X$$$$ bicalutamide X$ cyclophosphamide X$ cyclosporine (M) X$ etoposide X$ flutamide (M) X$ hydroxyurea X$ ifosfamide/mesna X$ megesterol acetate(M) X$ mercaptopurine (M) X$ methotrexate (M) X$$$$ mycophenolate X$ octreotide(M) X$ tamoxifen citrate (M) X!!!!! AFINITOR (PAR) QLL = 30 Tabs X$$ ALKERAN X!!!!! AMPYRA (PAR); Spec. Pharm. X$$$ ARIMIDEX X$$$$$ CAPRELSA X$$$$$ CASODEX X$$ CEENU X$$$$$ CELLCEPT* X$$$ CYTOXAN* X cyclophosphamide$$$$ EMCYTE X!!!!! ENBREL (PAR); Spec. Pharm. X$$$$ FEMARA X!!!!! GLEEVEC (PAR) X$$$ HEXALEN X!!!!! HUMIRA (PAR); Spec. Pharm. X$$$ IFEX/MESNEX X!!!!! IRESSA (PAR) X$$ LEUKERAN X$$$ LYSODREN X$$$ MATULANE X$$$$ MEGACE* X megesterol acetate!!!!! MESNEX X$$$ MYLERAN X$$$$$ MYFORTIC(ST) history of cyclosporine orprednisoneX$$$$ NEXAVAR (PAR) X3