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 PoliciesPage80DateAugust 1, 2013Drug ProductQuantityDays’SupplyXalatan (latanoprost) 5 ml 30Xalkori 200 mg (crizotinib) 60 30Xalkori 250 mg (crizotinib) 60 30Xanax 0.25 mg (alprazolam) 150 30Xanax 0.5 mg (alprazolam) 150 30Xanax 1 mg (alprazolam) 150 30Xanax 2 mg (alprazolam) 150 30Xanax XR 0.5 mg (alprazolam ER) 30 30Xanax XR 1 mg (alprazolam ER) 30 30Xodol 5/300 mg (hydrocodone/ 360 30acetaminophen)Xodol 7.5/300 mg (hydrocodone/ 180 30acetaminophen)Xodol 10/300 mg (hydrocodone/ 180 30acetaminophen)Xolair sol 150 mg (omalizumab) 6 30Xyrem 500 mg/ml (sodium oxybate) 540 ml 30Zamicet (hydrocodone/2700 ml 30acetaminophen)Zavesca (miglustat) 90 30Zebeta 5 mg (bisoprolol) 30 30Zelboraf 250 mg (vemurafenib) 240 30Zetia 10 mg (ezetimibe) 30 30Zocor 5 mg (simvastatin) 30 30Zocor 10 mg (simvastatin) 30 30Zocor 20 mg (simvastatin) 30 30Zocor 40 mg(simvastatin) 30 30Zol<strong>of</strong>t 50 mg (sertraline) 45 30Zonalon 5% cream (doxepin) 45 m 30Zovirax 5% ointment (acyclovir) 30 gm 30Zydone 5/400 mg (hydrocodone/ 240 30acetaminophen)Zydone 7.5/400 mg (hydrocodone/ 240 30acetaminophen)Zydone 10/400 mg (hydrocodone/ 180 30acetaminophen)Zyprexa 2.5 mg (olanzapine) 30 30Zyprexa 5 mg (olanzapine) 30 30Zyprexa 7.5 mg (olanzapine) 30 30Zyprexa 10 mg (olanzapine) 30 30Comments
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