Approved PDL List

Alabama Medicaid Agency Pharmacy and TherapeuticsCommittee Preferred Drug List FinalDRUG CLASSPREFERREDGENERIC/OTCINTRANASALCORTICOSTEROID AGENTSPREFERREDBRANDNON-PREFERREDBRANDINTRANASAL All covered products FLONASE BECONASE AQCORTICOSTEROIDS NASAREL NASACORTNASONEXNASACORT AQTRI-NASALRHINOCORT AQUA* Denotes genericavailable in at least onedosage form or strengthDrug name denotes alldosage forms andstrengthsUpdated 4/15/04

Alabama Medicaid Agency Pharmacy and TherapeuticsCommittee Preferred Drug List FinalDRUG CLASSPREFERREDGENERIC/OTCRESPIRATORY AGENTSPREFERREDBRANDNON-PREFERREDBRANDSMOOTH MUSCLE All covered products None ELIXOPHYLLIN*RELAXANTSLUFYLLINSINGLE ENTITYQUIBRON-T/SR*THEO-24THEOLAIR*UNIPHYL* Denotes genericavailable in at least onedosage form or strengthDrug name denotes alldosage forms andstrengthsDRUG CLASSPREFERREDGENERIC/OTCPREFERREDBRANDNON-PREFERREDBRANDSMOOTH MUSCLE All covered products None DILEX-GRELAXANTSED-BRON GCOMBINATIONLUFYLLIN-GGPANFIL G* Denotes genericavailable in at least onedosage form or strengthDrug name denotes alldosage forms andstrengthsUpdated 4/15/04

DRUG CLASSPREFERREDGENERIC/OTCPREFERREDBRANDSYMPATHOMIMETIC All covered products ALUPENT* ACCUNEBAGENTS SINGLE BRETHINE* FORADILENTITY PROVENTIL HFA ISUPREL* Denotes genericavailable in at least onedosage form or strengthDrug name denotes alldosage forms andstrengthsPROVENTIL*SEREVENTVENTOLIN HFAVENTOLIN*NON-PREFERREDBRANDMAXAIR AUTOHALERVOLMAXVOSPIRE ERXOPENEXDRUG CLASSPREFERREDGENERIC/OTCPREFERREDBRANDNON-PREFERREDBRANDSYMPATHOMIMETIC All covered products ADVAIR DISKUS COMBIVENTCOMBINATIONDUONEBPRODUCTS* Denotes genericavailable in at least onedosage form or strengthDrug name denotes alldosage forms andstrengthsUpdated 4/15/04

DRUG CLASSPREFERREDGENERIC/OTCPREFERREDBRANDNON-PREFERREDBRANDINHALED All covered products AEROBID PULMICORTCORTICOSTEROID AEROBID-M QVARAGENTSAZMACORTFLOVENT* Denotes genericavailable in at least onedosage form or strengthDrug name denotes alldosage forms andstrengthsUpdated 4/15/04

DRUG CLASSPREFERREDGENERIC/OTCPREFERREDBRANDLEUKOTRIENE All covered products ACCOLATEMODIFIERSSINGULAIRZYFLONON-PREFERREDBRAND* Denotes genericavailable in at least onedosage form or strengthDrug name denotes alldosage forms andstrengthsUpdated 4/15/04

DRUG CLASSPREFERREDGENERIC/OTCPREFERREDBRANDINHALED All covered products ATROVENT* NoneANTIMUSCARNICANTISPASMOTICAGENTSNON-PREFERREDBRAND* Denotes genericavailable in at least onedosage form or strengthDrug name denotes alldosage forms andstrengthsUpdated 4/15/04

DRUG CLASSPREFERREDGENERIC/OTCPREFERREDBRANDMAST CELL All covered products TILADE INTAL*STABILIZERNON-PREFERREDBRAND* Denotes genericavailable in at least onedosage form or strengthDrug name denotes alldosage forms andstrengthsUpdated 4/15/04

Alabama Medicaid Agency Pharmacy and TherapeuticsCommittee Preferred Drug List FinalDRUG CLASSPREFERREDGENERIC/OTCCARDIAC AGENTSPREFERREDBRANDNON-PREFERREDBRANDANTIARRHYTHMICS All covered products MEXITIL* CORDARONE*NORPACE CR* ETHMOZINENORPACE*PROCANBID*PRONESTYL* RYTHMOL*PRONESTYL-SR* TAMBOCOR*QUINIDEX*TIKOSYNTONOCARD** Denotes genericavailable in at least onedosage form or strengthDrug name denotes alldosage forms andstrengthsUpdated 4/15/04

DRUG CLASSPREFERREDGENERIC/OTCPREFERREDBRANDCARDIOTONIC All covered products LANOXICAPS LANOXIN*AGENTSNON-PREFERREDBRAND* Denotes genericavailable in at least onedosage form or strengthDrug name denotes alldosage forms andstrengthsUpdated 4/15/04

DRUG CLASSPREFERREDGENERIC/OTCPREFERREDBRANDNON-PREFERREDBRANDNITRATES and All covered products ISORDIL* DILATRATE-SRNITRITES NITRO-BID IMDUR*NITROSTAT*ISMO*ISOCHRON*MONOKET*NITRO-DUR*NITROGLYN*NITROGUARDNITROLNITROLINGUAL* Denotes generic TRANSDERM NITRO*available in at least onedosage form or strengthDrug name denotes alldosage forms andstrengthsTRIDILUpdated 4/15/04

Alabama Medicaid Agency Pharmacy and TherapeuticsCommittee Preferred Drug List FinalDRUG CLASSPREFERREDGENERIC/OTCESTROGEN AGENTSPREFERREDBRANDESTROGENS All covered products CENESTIN ALORASINGLE ENTITY MENEST CLIMARA*PREMARINNON-PREFERREDBRANDDELESTROGENDEPO-ESTRADIOLESCLIM*ESTRACE CREAMESTRACE*ESTRADERM*ESTRINGFEMRING* Denotes generic OGEN CREAMavailable in at least oneOGEN*dosage form or strengthORTHO-EST*PREMARIN CREAMDrug name denotes allVAGIFEMdosage forms andVIVELLE*strengthsVIVELLE-DOT*Updated 4/15/04

DRUG CLASSPREFERREDGENERIC/OTCPREFERREDBRANDNON-PREFERREDBRANDESTROGENS All covered products COMBIPATCH ACTIVELLACOMBINATIONCLIMARA PRO**FEMHRTORTHO-PREFESTPREFESTPREMPHASEPREMPRO* Denotes genericavailable in at least onedosage form or strengthDrug name denotes alldosage forms andstrengths** Will be reviewedwhen eligible for PDLinclusionUpdated 4/15/04

Alabama Medicaid Agency Pharmacy and TherapeuticsCommittee Preferred Drug List FinalDRUG CLASSPREFERREDGENERIC/OTCTRIPTAN AGENTSPREFERREDBRANDTRIPTANS All covered products AMERGE AXERTIMITREXFROVAMAXALTNON-PREFERREDBRANDMAXALT MLTRELPAXZOMIGZOMIG ZMT* Denotes genericavailable in at least onedosage form or strengthDrug name denotes alldosage forms andstrengthsUpdated 4/15/04