dru g formulary - Kern Health Systems

22GENERIC BRAND FORMSKFHC DRUG FORMULARYGastrointestinal – Proton Pump InhibitorProton Pump Inhibitors (PPIs) are one of the highest expense medication categories for mosthealth plans. It is important to guide patients with life style changes to eliminate possible causes ofGERD. KHS offers triple therapy for the treatment of Heliobacter Pylori (H. Pylori). See notes onpage 21. While bedtime dosing of a H2 antagonist for break through may tried, usually takinga PPI and H2 antagonist together is not clinically justified and may actually make the PPI lesseffective.Cost of PPI per patient month to KHSMedication Drug Cost for 30Pantaprazole $8Omeprazole $16Lansoprazole $19Non-Formulary Prescription PPI's Monthly Additional Cost Annual Additional CostAciphex $293 $3420Dexilant $103 $1140Nexium $251 $2916(Note in comparison a 30 days supply of an OTC H2 Antagonist dosed at prescription level costs about $9 depending on thedrug and brand.) G Lansoprazole Prevacid® 30mg capsule G Omeprazole Prilosec® 20mg capsule G Pantoprazole Protonix® 20mg, 40mg tabletsHematology – Anticoagulant G Enoxaparin Lovenox® 30mg/0.3ml, 40mg/0.4ml, 60mg/0.6ml,80mg/0.8ml, 100mg/1ml injectionRestriction: Restricted to a 7 day supply. Authorization is required for additional amounts.Heparin1000 units/ml, 5000 units/ml, 10,000 units/ml(bovine), 1000 units/ml, 5000 units/ml,10,000 units/ml, 20,000 units/ml, 40,000 units/ml,100 units/ml lock flush (porcine) G Warfarin Coumadin® 1mg, 2mg, 2.5mg, 3mg, 4mg, 5mg, 6mg, 7.5mg,10mg tabletsNote: Generic substitution is not mandatory.Hematology – Antiplatelet G Dipyridamole Persantine® 25mg, 50mg, 75mg tablet