Prescribed Drugs Provider Manual - Iowa Department of Human ...
Prescribed Drugs Provider Manual - Iowa Department of Human ...
Prescribed Drugs Provider Manual - Iowa Department of Human ...
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<strong>Iowa</strong><strong>Department</strong><strong>of</strong> <strong>Human</strong>Services<strong>Provider</strong> and Chapter<strong>Prescribed</strong> <strong>Drugs</strong>Chapter III. <strong>Provider</strong>-Specific PoliciesPage62DateAugust 1, 2013Drug ProductAdderall XR 10 mg(amphetamine combo)Adderall XR 15 mg(amphetamine combo)Adderall XR 20 mg(amphetamine ER)Adderall XR 25 mg(amphetamine ER)Adderall XR 30 mg(amphetamine ER)Advair 100/50 diskus(fluticasone/salmeterol)Advair 250/50 diskus(fluticasone/salmeterol)Advair 500/50 diskus(fluticasone/salmeterol)Advair HFA (fluticasone/salmeterol)Days’Quantity Supply30 3030 3060 3060 3060 3060 3060 3060 301 inhaler(12 gm)30CommentsAerobid (flunisolide) 21 30Aerobid-M (flunisolide) 21 30Afinitor 2.5 mg (everolimus) 30 30Afinitor 5 mg (everolimus) 30 30Afinitor 7.5 mg (everolimus) 30 30Afinitor 10 mg (everolimus) 30 30Aldara (imiquimod) 12 pkts 28 Max 48 pkts/16 weeksAllegra 30 mg (fex<strong>of</strong>enadine) 60 30Allegra 60 mg (fex<strong>of</strong>enadine) 60 30Allegra 180 mg (fex<strong>of</strong>enadine) 30 30Alphagan P (brimonidine tartrate) 15 ml 30Alprazolam intensol 1 mg/ml180 ml 30(alprazolam)Altace 1.25 mg (ramipril) 30 30Altace 2.5 mg (ramipril) 30 30Altace 5 mg (ramipril) 30 30Altace 10 mg (ramipril) 60 30Amaryl 1 mg (glimepiride) 30 30Amaryl 2 mg (glimepiride) 30 30Amaryl 4 mg (glimepiride) 60 30Ambien 5 mg (zolpidem) 30 30Ambien 10 mg (zolpidem) 30 30Ambien CR 6.25 mg (zolpidem) 30 30Ambien CR 12.5 mg (zolpidem) 30 30
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