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 PoliciesPage78DateAugust 1, 2013Drug ProductTilade inhaler (nedocromil sodium)Timoptic ophthalmic solution 0.25%(timolol)Timoptic ophthalmic solution 0.5%(timolol)Timoptic-XE 0.25% (timolol gelforming)Timoptic-XE 0.5% (timolol gelforming)Days’Quantity Supply3 inhalers 30(48.6 gm)15 ml 3015 ml 3015 ml 3015 ml 30Topamax 25 mg (topiramate) 60 30Topamax 50 mg (topiramate) 60 30Topamax 100 mg (topiramate) 60 30Toprol XL 25 mg (metoprolo ER) 45 30Toprol XL 50 mg (metoprolol ER) 45 30Toprol XL 100 mg (metoprolo ER) 45 30Toprol XL 200 mg (metoprolol ER) 60 30Toviaz 4 mg (fesoterodine) 30 30Toviaz 8 mg (fesoterodine) 30 30Transderm Scop 1.5mg10 30(scopolamine)Travatan Z (travoprost) 5 ml 30Tricor 48 mg (fen<strong>of</strong>ibrate) 30 30Tricor 145 mg (fen<strong>of</strong>ibrate) 30 30Triglide 160 mg (fen<strong>of</strong>ibrate) 30 30Twinject (epinephrine) 4 units 30Tylenol w/ codeine elixir2700 ml 30(acetaminophen/codeine)Tylenol with codeine No. 2390 30(acetaminophen/codeine)Tylenol wth codeine No. 3390 30(acetaminophen/codeine)Tylenol wth codeine No. 4390 30(acetaminophen/codeine)Uloric 40 mg (febuxostat) 30 30Ultracet (tramadol/apap) 240 30Ultram 50 mg (tramadol) 240 30Ultram ER 100 mg (tramadol ER) 30 30Ultram ER 200 mg (tramadol ER) 30 30Ultram ER 300 mg (tramadol ER) 30 30Uroxatral (alfuzosin) 30 30Comments
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