San Diego County Medical Services Drug Formulary

San Diego County Medical Services Drug FormularyGeneric NameRepresentativeBrand NameUtilization ManagementGlucocorticosteroidsCortisone Acetate OralDexamethasone OralHydrocortisone Tab OralPrednisolonePrednisolone SodiumPhosphate PowderPrednisolone SodiumPhosphate OralPrednisone OralMineralocorticoidsFludrocortisone Acetate OralENDOCRINE_AND METABOLIC DRUGSCortisoneDecadron, DexoneCortefPrelonePrednisoloneMeticorten,Deltasone,Liquid PredFlorinefDIABETIC AGENTSHuman InsulinLimited to vials only.Insulin Aspart Inj 100 U/mL Novolog Limited to 2 vials/monthInsulin Aspart Prot & Aspart Inj100 U/mLNovolog MixInsulin Detemir Inj U/mL LevemirInsulin Glargine Inj 100 U/mL Lantus (vials only) Limited to 4 vials/monthInsulin Lispro Inj 100 U/mL HumalogInsulin Lispro Prot & Lispro Inj100 U/mL (75-25)Humalog Mix 75/25Insulin Regular Inj 100 U/mL Humulin R, Novolin R Limited to 2 vials/monthInsulin Regular Inj 500 U/mL Humulin R Limited to 2 vials/monthInsulin Isophane Inj 100 U/mL Humulin N, Novolin N Limited to 2 vials/monthInsulin Regular & Isophane Inj100 U/mLInsulin Regular & Isophane Inj100 U/mL (50)Humulin 70/30Novolin 70/30Humulin 50/50Limited to 2 vials/monthLimited to 2 vials/monthInsulin Zinc Inj 100 U/mL Humulin L, Novolin L Limited to 2 vials/monthSulfonylureasGlimepiride Oral Amaryl Limited to 1/tablet/day for 1mg & 2mg and2 tablets/day for 4mgGlipizide Tab OralGlucotrolGlyburide Oral Diabeta, Micronase Limited to 120/30 daysGlyburide Micronized Glynase Limited to 120/30 daysBiguanides–MetforminMetformin HCL Oral Glucophage Limited to 2500 mg/dayJune 2009 Page 6 of 42