dru g formulary - Kern Health Systems

30GENERIC BRAND FORMSKFHC DRUG FORMULARYOphthalmic – Glaucoma, continued • SEE PREVIOUS PAGE G Pilocarpine Isopto-Carpine® 0.25%, 0.5%, 1%-6%, 8%, 10% ophth soln,4% ophth gelScopolamine Isopto-Hyosine® 0.25% ophth soln G Timolol Timoptic® 0.25%, 0.5% ophth solnOphthalmic – Glucocorticoid G Fluorometholone FML® 0.1%, 0.25% ophth suspLoteprednol Lotemax® 0.5% ophth suspRestriction: Plan ophthalmologists only. G Prednisolone Pred, Pred Forte® 0.125%, 1% ophth suspOphthalmic – Miscellaneous G Cromolyn Crolom® 4% G Cyclosporine Restasis® 0.05%Restriction: Plan ophthalmologist only. G Sodium Chloride Muro® 2% ophth soln, 5% ophth oint or solnOphthalmic – Mydriatic G Atropine Isopto-Atropine® 0.5%, 1% ophth oint, 0.5%, 1%, 2%, 3% ophth soln G Cyclopentolate Cyclogyl® 0.5%, 1%, 2% ophth solnHomatropine Isopto-Homatropine® 2%, 5% ophth soln G Phenylephrine Neo-Synephrine® 0.125%, 2.5%, 10% ophth solnOphthalmic – NSAID G Diclofenac Voltaren® 1% G Ketorolac Acular®, Acular LS® 0.4%, 0.5% ophth solnRestriction: 3 ml size only. Plan ophthalmologist only.Nepafanac Nevanac® 0.1% ophth suspRestriction: Plan ophthalmologist only.Oral Contraceptive G Desogestrel & Ethinyl Estradiol Desogen® 0.15mg-30mcg tablet G Ethynodiol & Ethinyl Estradiol Demulen® 1mg-35mcg tablet G Levonorgestrel & Ethinyl Estradiol Levlen®0.15mg-30mcg tabletContinued on next page