PRESCRIPTION DRUG - Public Employees' Benefits Program (PEBP)

$$$$$ SANCUSO X ondansetron, Kytril, Emend$$$$$ ZOFRAN*QLL=12 tabs/Rx (4mg,8mg); 1/Rx(24mg) X ondansetron!!!!! ZOFRAN IN DEXTROSE X$$$$ ZOFRAN ODT* QLL=12 tabs/Rx (4mg,8mg) X ondansetron ODT5.7.1 ANTIPARKINSON ANTICHOLINERGIC DRUGS$ amantadine hcl (M) X$ benztropine(M) X$ bromocriptine mesylate (M) X$ carbidopa/levodopa (M) X$$$$$ pramipexole X$$$ ropinirole X$ selegiline hcl (M) X$ trihexyphenidyl(M) X!!!!! APOKYN (PAR) Spec. Pharm. QLL=10/Rx X(ST) showing a history of anynondopaminergic antiparkinson!!!!! AZILECTagent.X$$ COGENTIN* X benztropine$$ ELDEPRYL* X selegiline$$$$ MIRAPEX X$$$$(ST) history of carbidopa &MIRAPEX ER 0.375, 0.75, 1.5, 3.0, 4.5 mg levodopaX$$ PARLODEL* X bromocriptine mesylate$$$$$ REQUIP * X ropinirole$$ SINEMET* (M)/ SINEMET CR* X carbidopa/levodopa(ST) history of carbidopa &!!!!! STALEVOlevodopaX$$ SYMMETREL* (M) X amantadine hcl$$$$$ ZELAPAR (ST) history of levodopa products X5.8 ANTIPSYCHOTIC DRUGS5.8.1 CONVENTIONAL (TYPICAL)$ chlorpromazine X$ fluphenazine (M) X$ haloperidol (M) X$$ loxapine succinate(M) X$ perphenazine(M) X$ thioridazine hcl (M) X$ thiothixene(M) X$$ trifluoperazine(M) X$$$ ORAP X5.8.2 NOVEL (ATYPICAL)$ clozapine (M) X$$$ risperidone tabs X$$$ olanzapine X!!!!! ABILIFY QLL= 30/Rx X$$$$$ CLOZARIL* X clozapine$$$$ FANAPT 1,2,4,6,8,10,12 MG (ST) history of risperdal X$$$$ FAZACLO (ST) history of risperdal X(QLL=60 caps/Rx); 80mg isconsidered to be a SpecialPharmaceutical X XGEODON, RISPERDAL,SEROQUEL$$$$$ GEODON$$$$ INVEGA (ST) history of risperdal X risperidone tabs$$$$ LATUDA (ST) history of risperdal X risperidone tabs$$$ RISPERDAL * X risperidone tabs!!!!! RISPERDAL CONSTA X risperidone tabs$$$ RISPERDAL M-TAB X risperidone tabs$$$ SAPHRIS 5, 10 mg (ST) history of risperdal XSpec. Pharm. (4th Tier) forSeroquel 200mg and 300mg. X X$$$ SEROQUEL$$$ SEROQUEL XR X Seroquel$$$$ ZYPREXA X$$$$$ ZYPREXA ZYDIS X olanzapine5.9.1 CNS STIMULANT DRUGS$ amphetamine salt combo (M)PAR for over 17 years of age andother diagnosisX$ dextroamphetamine(M)PAR for over 17 years of age andother diagnosisX$ methamphetamine hcl (M)PAR for over 17 years of age andother diagnosisX$ methylin (M)PAR for over 17 years of age andother diagnosisX$ methylin er (M)PAR for over 17 years of age andother diagnosisX$ methylphenidate er (M)PAR for over 17 years of age andother diagnosisX$ methylphenidate hcl (M)PAR for over 17 years of age andother diagnosisXPAR for over 17 years of age and$$$ ADDERALL* (M)other diagnosis X amphetamine salt comboPAR for over 17 years of age and$$$$ ADDERALL XRother diagnosis QLL=30 tabs/RxX$$$$ CONCERTAPAR for over 17 years of age andother diagnosis QLL=30 tabs/Rx X methylphenidate er (M)$$$ DESOXYNPAR for over 17 years of age andother diagnosisXPAR for over 17 years of age and$$$ DEXEDRINE*other diagnosis X dextroamphetaminePAR for over 17 years of age and$$$ DEXEDRINE SPANSULEother diagnosisX$$ FOCALINPAR for over 17 years of age andother diagnosisXmethylphenidate, ADDERALL XR,CONCERTA, METADATE CD$$$ FOCALIN XRPAR for over 17 years of age andother diagnosisXmethylphenidate, ADDERALL XR,CONCERTA, METADATE CD$$$$ METADATE CD*PAR for over 17 years of age andother diagnosis X methylphenidate er$$$$$ METADATE ER*PAR for over 17 years of age andother diagnosis X methylphenidate er$$$$ NUVIGIL (PAR) QLL=30/Rx X$$$$ PROVIGIL(PAR) Age Edit= 18 yrs old or olderQLL=30/RxX$$$$ RITALIN*PAR for over 17 years of age andother diagnosis X methylphenidate hcl$$$$ RITALIN LAPAR for over 17 years of age andother diagnosisXmethylphenidate er, CONCERTA,METADATE CD/ERPAR for over 17 years of age and$$$$ RITALIN SRother diagnosisX11