dru g formulary - Kern Health Systems

Recommendations

Info

38GENERIC BRAND FORMSKFHC DRUG FORMULARYTopical – Glucocorticoid Low Potency, continued • SEE PREVIOUS PAGE G Fluocinolone Synalar® 0.01%, 0.25% cream or oint, 0.01% soln G Flurandrenolide Cordran® 0.025%, 0.05% cream or oint, 0.05% lotion G Hydrocortisone0.5%, 1% cream, 2.5% cream, oint & lotion are alsoavailable OTC G Triamcinolone Kenalog® 0.025% cream, oint, lotionTopical – Glucocorticoid Medium Potency G Mometasone Elocon® 0.1% cr, lot G Triamcinolone Kenalog® 0.1% cream, oint, lotionTopical – Glucocorticoid High Potency G Betamethasone Diprosone® 0.05% cream, oint G Clobetasol Temovate® 0.05% cr, oint, soln, lotion G Fluocinonide Lidex® 0.05% cream, oint, soln, gel G Triamcinolone Kenalog® 0.5% cream, ointTopical – Miscellaneous G Acetic Acid0.25% soln G Anthralin Drithrocreme® 0.1%, 0.25%, 0.5%, 1% cream G Calcipotriene Dovonex® 0.005% cr, solnRestriction: Pt needs to fail topical steroids. (triamcinolone, betamethasone.) G Coal Tar G Sodium ChlorideTopical – Scabicide2.5%, 30% emulsion0.9% solnCrotamiton Eurax® 10% cream and lotion G Permethrin Elimite® 5% creamUrinary Tract G Oxybutynin Ditropan® 5mg tablet G Pentosan Elmiron® 100mg capsule G Phenazopyridine Pyridium® 100mg, 200mg tabletRestriction: Limited to 3 day therapy.
KFHC DRUG FORMULARY 39GENERIC BRAND FORMSVaginal – Anti-infectiveButoconazole Gynazole-1® 2% vaginal creamRestriction: Restricted to pts. who have failed first line agents. (Clotrimazole, Miconazole) G Clindamycin Cleocin® 2% vaginal cream G Metronidazole Metrogel® 0.75% vaginal gel G Nystatin Mycostatin® 100000 units vaginal tabletSulfanilamide Sultrin® 15% vaginal cream, 1.05 gm vaginal suppos G Terconazole Terazol® 0.4%, 0.8% vaginal cream, 80mg vaginal supposRestriction: Restricted to pts. who have failed first line agents. (Clotrimazole, Miconazole) G Tioconazole Vagistat-1® 6.5% vaginal ointRestriction: Restricted to pts. who have failed first line agents. (Clotrimazole, Miconazole)Vaginal – EstrogensEstrogens, Conjugated Premarin® 0.625mg/gm vaginal creamVitamins – Dietary Supplements G Calcitriol Rocaltrol® 0.25mcg, 0.5mcg capsuleDihydrotachysterol Hytakerol® 0.2mg/ml, 0.2mg/5ml soln, 0.125mg capsule,0.125mg, 0.2mg, 0.4mg tablet G Ergocalciferol Drisdol® 50,000 IU capsule G Folic Acid1mg tabletRestriction: Restricted to pregnant women and those on MTX therapy. Others will require prior authorization.Levocarnitine Carnitor® 10% soln, 330mg tabletRestriction: Prior authorization required. G Sodium Fluoride Luride® 0.55mg(0.25mgF), 1.1mg(0.5mgF), 2.2mg(1mgF)chewable tablets, 0.125mg/drop, 0.25mg/drop,1.1mg/ml G Pediatric Vitamins Poly-Vi-Flor w/Iron®, 0.25mg-10mg/mlw/Fluoride & IronTri-Vi-Flor w/Iron®Restriction: Restricted to pts. < 5 yo.0.275mg/drop, 0.44mg/ml, 0.55mg/drop,Continued on next page
Page 4: iiKFHC DRUG FORMULARYNon-Formulary
Page 8: viKFHC DRUG FORMULARYTopical - Misc
Page 11 and 12: KFHC DRUG FORMULARY 3GENERIC BRAND
Page 41: KFHC DRUG FORMULARY 33GENERIC BRAND
Page 44 and 45: 36GENERIC BRAND FORMSKFHC DRUG FORM
Page 48 and 49: 40GENERIC BRAND FORMSKFHC DRUG FORM
Page 50 and 51: OVER THE COUNTER DRUGS42 KFHC DRUG
Page 52 and 53: OVER THE COUNTER DRUGS44 KFHC DRUG
Page 54 and 55: 46 KFHC DRUG FORMULARY*See Healthy
Page 64 and 65: Non-Formulary or Restricted Medicat
Page 66 and 67: Non-Formulary or Restricted Medicat
Page 68 and 69: KFHC DRUG FORMULARYINDEX-GENERIC an
Page 74: KFHC DRUG FORMULARYINDEX-GENERIC an

dru g formulary - Kern Health Systems

Create successful ePaper yourself

Delete template?

Save as template?