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 PoliciesPage63DateAugust 1, 2013Drug ProductQuantityDays’SupplyAmpyra 10 mg (dalfampridine) 60 30Androgel 1% (25 mg) gel30 pkts 30(testosterone)Androgel 1% (50 mg) gel60 pkts 30(testosterone)Androgel 1% pump (testosterone) 300 gm 30Androgel 1.62% pump150 gm 30(testosterone)Arava 10 mg (leflunomide) 30 30Arava 20 mg (leflunomide) 30 30Arava 100 mg (leflunomide) 3 30Aricept ODT 5 mg (donepezil) 30 30Aricept ODT 10 mg (donepezil) 30 30Aricept 5 mg (donepezil) 30 30Aricept 10 mg (donepezil) 30 30Aricept 23 mg (donepezil) 30 30Astelin nasal spray (azelastine) 30 ml 30Atacand 4 mg (candesartan) 30 30Atacand 8 mg (candesartan) 30 30Atacand 16 mg (candesartan) 30 30Atacand 32 mg (candesartan) 30 30Atacand HCT 16-12.5 mg30 30(candesartan/HCTZ)Atacand HCT 32-12.5 mg30 30(candesartan/HCTZ)Ativan 0.5mg tablet (lorazepam) 150 30Ativan 1 mg tablet (lorazepam) 150 30Ativan 2 mg tablet (lorazepam) 150 30Atrovent HFA (ipratropium)2 bottles 30(25.8 gm)Atrovent inhaler (ipratropium) 2 inhalers 30(28 gm)Atrovent 0.03% nasal spray2 bottles 30(ipratropium)Atrovent 0.06% nasal spray2 bottles 30(ipratropium)Auvi-Q (epinephrine) 2 units 30Comments
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