PRESCRIPTION DRUG - Public Employees' Benefits Program (PEBP)

13.1.2 SPECIALIZED OB/GYN DRUGS$ terbutaline sulfate(M) X$$$ BRETHINE* X terbutaline sulfate$$$ LYSTEDA(PAR) Treatment limit 90 days perPARX13.3 ANDROGEN DRUGS$$$ danazol (M) X$$$ methyltestosterone (M) (PAR) X$$ oxandrolone (M) X$$ testosterone cypionate X$$$$ ANDRODERM (PAR) X$$$$$ ANDROGEL (PAR) X$$$$ ANDROID (PAR) X$$$$ ANDROXY (PAR) X$$$$ AXIRON (PAR) X$$$$ FORTESTA GEL (PAR) X$$$ METHITEST (PAR) X$$$$ OXANDRIN* (PAR) X$$$$$ TESTIM (PAR) X$$$$ TESTRED (PAR) X13.4 ESTROGEN DRUGS$ estradiol (M) X$ estradiol transdermal patch (M) QLL=4 patches/Rx X$ estropipate (M) X$$ ALORA* QLL=8 patches/Rx X estradiol transdermal patch$$$$$ ANGELIQ X$$ CENESTIN X$$ CLIMARA* QLL=4 patches/Rx X estradiol transdermal patch$$$$ DIVIGEL X estradiol transdermal patch$$$$ ELESTRIN GEL X estradiol transdermal patch$$$$ EVAMIST X estradiol transdermal patch$$$$ ENJUVIA X$$$$ ESCLIM X estradiol transdermal patch$$ ESTRACE* X estradiol$$$ ESTRADERM* QLL=8 patches/Rx X estradiol transdermal patch$$$$$ ESTROGEL X estradiol$$$ ESTRASORB X estradiol$$ FEMRING X VAGIFEM$ MENEST X PREMARIN$$$ OGEN* X estropipate$$ ORTHO-EST* X estropipate$$$ PREMARIN X$$ VAGIFEM X$$ VIVELLE QLL=8 patches/Rx X estradiol transdermal patch$$$ VIVELLE-DOT* QLL=8 patches/Rx X estradiol transdermal patch13.4.1 ESTROGEN/PROGESTIN COMBINATIONS$$ ACTIVELLA X PREMPRO, PREMPHASE$$ CLIMARA PRO X COMBIPATCH$$$ COMBIPATCH X$$$ FEMHRT X$$ PREFEST X$$$ PREMPHASE X$$$ PREMPRO X13.4.3 SELECTIVE ESTROGEN RECEPTOR MODULATOR$$$$$ EVISTA X13.5 PROGESTIN DRUGS$ medroxyprogesterone acetate (M) X$ norethindrone acetate (M) X$$$ AYGESTIN* X norethindrone acetate$$$ PROMETRIUM X$$$ PROVERA* X medroxyprogesterone acetate13.7 CONTRACEPTIVES$ apri (M) X$ aranelle (M) X$ aviane (M) X$ balziva (M) X$ camila (M) X$ cesia (M) X$ cryselle (M) X$ ennpresse (M) X$ errin (M) X$ jolessa (M) X$ jolivette (M) X$ junel 1/20 (fe) (M) X$ junel 1.5/30 (fe) (M) X$ kariva (M) X$ kelnor 1/35 (M) X$ leena (M) X$ lessina (M) X$ levora (M) X$ low-ogestrel (M) X$$$ LYBREL X quasense$ medroxyprogesterone acetate inj(M) X$ microgestin 1/20 (fe) (M) X$ microgestin 1.5/30 (fe) (M) X$ mononessa (M) X$ necon 0.5/35 (M) X$ necon 1/35 (M) X$ necon 1/50 (M) X$ necon 7/7/7 (M) X$ necon 10/11-21 (M) X$ nora-be (M) X$ nor-qd (M) X$ nortrel 0.5/35 (M) X$ nortrel 1/35 (M) X$ notrel 7/7/7 (M) X$ portia (M) X$ previfem (M) X$ quasense (M) X$ reclipsen (M) X$ solia (M) X$ sprintec (M) X$ trinessa (M) X$$ tri-lo sprintec X$ tri-previfem (M) X$ tri-sprintec tablet (M) X$ trivora-28 (M) X$ velivet (M) X$ zenchent X19