dru g formulary - Kern Health Systems

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40GENERIC BRAND FORMSKFHC DRUG FORMULARYVitamins – Dietary Supplements, continued • SEE PREVIOUS PAGE G Pediatric Vitamins w/Fluoride Poly-Vi-Flor®,Tri-Vi-Flor® 0.25mg/ml, 0.5mg/ml, Chew tabs0.25mg, 0.5mg, 1mgRestriction: Restricted to pts. < 5 yo. G Prenatal Vitamins w/Minerals,capsules or tabletsIron & FARestriction: Pregnant female pts. only.
OVER THE COUNTER DRUGSKFHC DRUG FORMULARY*See Healthy Families Exception Warning on Page Below41GENERIC Healthy Families Members BRAND Exception- The State of FORMS California, by contract, does not allow Kern HealthSystems to reimburse for over the counter (OTC) medications. Insulin and diabetic testing materials arethe only exception. The members have up to a $15 co-payment and often that co-payment is more than thecost of the OTC medication.GENERIC BRAND FORMSAnalgesic – Antacid/OTCAspirin, Alum & Mg Hydroxides Ascriptin® 325-50-50-87mg tabletCalcium CarbonateAnalgesic – Non-narcotic/OTCAcetaminophen (APAP, Tylenol®) hepatoxicity can result from frequent and/or high doses of thosemedications with an acetaminophen component. Maximum recommended daily dose of APAP for apatient who does not drink alcohol is 4000mg. Patients may also aggravate the problem by takingother OTC drugs with APAP or receiving prescriptions of other APAP combinations (Tylenol #3). G Acetaminophen Tylenol® 325mg, 500mg, 650mg tablet,100mg/ml, 160mg/5ml soln G Aspirin ASA 81mg, 325mg, 650mg tablet & ec tablet, 325mgbuffered tablet, 975mg ec tablet, 800mg cr tablet G Ibuprofen Motrin® 100mg/5ml suspRestricted: FDA does not recommend in children < 6 months.Cardiovascular – Antilipid/OTC G Niacin100mg, 250mg, 500mg, 1000mg tablet,125mg cr capsule, 125mg, 250mg cr tabletCardiovascular – Electrolyte/OTC G Oral Electrolyte Soln Pedialyte® SolnContraceptives/OTCCondoms-MaleRestricted: Limited to 12 per 30 days.Nonoxynol-9 Emko® 8%,12.5% foam, 2% gelDevice/OTCTablet Splitter41Continued on next page
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