dru g formulary - Kern Health Systems

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10GENERIC BRAND FORMSKFHC DRUG FORMULARYAntineoplastic, continued • SEE PREVIOUS PAGE G Flutamide Eulexin® 125mg capsule G Hydroxyurea Hyrea® 500mg capsuleImatinib mesylate Gleevac® 100mg, 400mg tabletRestriction: Prior authorization required.Lomustine CEENU® 10mg, 40mg, 100mg capsule G Megestrol Megace® 40mg/ml susp, 20mg, 40mg tabletMelphalan Alkeran® 2mg tablet G Mercaptopurine Purinethol® 50mg tablet G Methotrexate2.5mg tabletMitotane Lysodren® 500mg tabletPazopanib Votrient® 200mg tabletRestriction: Prior authorization required.Pipobroman Vercyte® 25mg tabletProcarbazine Matulane® 50mg capsule G Tamoxifen Nolvadex® 10mg, 20mg tabletTemozolomide Temodar® 5mg, 20mg, 100mg, 140mg, 180mg, 250mg capsuleRestriction: Prior authorization required. G Thioguanine40mg tabletAntirheumaticAuranofin Ridaura® 3mg capsule G Azathioprine Imuran® 50mg tablet G Hydroxychloroquine Plaquenil® 200mg tablet G Leflunomide Arava® 10mg, 20mg tabletRestriction: Plan rheumatologists only. MTX, hydroxychloroquine prior therapy required. G Methotrexate10mg, 20mg tabletBenign Prostate Hypertrophy G Tamsulosin Flomax® 0.4mg capsuleRestriction: Pt. needs to fail alpha blocking agent.
KFHC DRUG FORMULARY 11GENERIC BRAND FORMSCardiovascular – ACEI G Benazepril Lotensin® 5mg, 10mg, 20mg, 40mg tablet G Captopril Capoten® 5mg ,12.5mg, 25mg, 50mg, 100mg tablet G Enalapril Vasotec® 5mg, 10mg, 20mg tablet G Fosinopril Monopril® 2.5mg, 20mg, 40mg tablet G Lisinopril Zestril® 5mg, 10mg, 20mg, 30mg, 40mg tablet G Moexipril Univasc® 5mg, 15mg tablet G Quinapril Accupril® 5mg, 10mg, 20mg, 40mg tablet G Ramipril Altace® 1.25mg, 2.5mg, 5mg, 10mg capsuleCardiovascular – Alphablocker G Clonidine Catapres® 0.1mg, 0.2mg, 0.3mg tablet G Doxazosin Cardura® 1mg, 2mg, 4mg, 8mg tablet G Guanfacine Tenex® 1mg, 2mg tablet G Methyldopa Aldomet® 125mg, 250mg, 500mg tablet G Prazosin Minipress® 1mg, 2mg, 5mg capsule G Terazocin Hytrin® 1mg, 2mg, 5mg, 10mg capsuleCardiovascular – Angiotensin II Receptor BlockersRestricted to pts. who have failed ACE Inhibitors or have had adverse reaction to them. Whenconsidering ARBs, use generic lorsartan before branded ARBs. Use half tablet dosing of higherstrength. Half tablet not required for Micardis or Losartan. G Irbetsartan Avapro® 150mg, 300mg tablet G Losartan Cozaar® 25mg, 50mg, 100mg tabletOlmesartan Benicar® 5mg, 40mg tabletTelmisartan Micardis® 40mg, 80mg tabletCardiovascular – Antiarrhythmic G Amiordarone Cordarone® 200mg tablet G Digoxin Lanoxin® 0.05mg/ml elixir, 0.125mg, 0.25mg, 0.5mg tabletNote: Generic substitution not required. G Disopyramide Norpace 100mg, 150mg capsule, 100mg, 150mg cr capsuleRestriction: Plan cardiologists only, others require prior authorization.Continued on next page
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