Prescription Drug Formulary [pdf]

IsentressKaletraLexivaNorvirPrezistaRescriptorRetrovirReyatazSelzentrystavudineSustivaTrizivirTruvadaVidexViraceptViramuneVireadZeritZiagenzidovudineHIV (CONT.)Additional Information:General Specialty Questions1.800.850.9122Compounded SpecialtyMedication Questions1.800.951.0175HORMONAL THERAPIESEligardleuprolide acetateLupron DepotLupron Depot-PEDMakena*Supprelin LASynarelTrelstarVantasZoladexSpecialty medications may require prior authorization to ensure appropriate usage. Coverage for these medications may vary with respect tobenefit design. This list is subject to change without notice to accommodate the introduction, removal and availability of new drugs andclinical information. * Limited Distribution Product - Contact BriovaRx for more information.Catamaran Preferred Drug List - Effective January 1, 2013214-091112-3 © 2012 Catamaran Inc. All rights reserved. Catamaran is a registered trademark of Catamaran Inc.