dru g formulary - Kern Health Systems

Recommendations

Info

OVER THE COUNTER DRUGS44 KFHC DRUG FORMULARY*See <strong>Health</strong>y Families Exception Warning on Page 41GENERIC BRAND FORMSOphthalmic – Antihistamine/OTC G Ketotifen Zaditor® 0.025% Ophth solnOphthalmic – Decongestant/OTC G Naphazoline Albalon® 0.1% Ophth solnOphthalmic – Decongestant – Antihistamine/OTC G Naphazoline & Pheniramine Naphcon-A® 0.025%-0.3% ophth soln G Naphazoline & Antazoline Vasocon-A® 0.05% - 0.5% ophth solnOtic/ OTC G Carbamide Peroxide Debrox® 6.5% solnRectal – Hemorrhoidal/OTC G Hemorrhoidal Suppos Anusol-HC® suppositoryw/HydrocortisoneRespiratory – Antihistamine/OTCThe FDA does not recommend antihistamines and other cough cold products in individuals under the ageof 2 years old. These products are restricted to members 2 years old and older. G Brompheniramine2mg/5ml elixir G Chlorpheniramine Chlortrimeton® 1mg/5ml liquid, 2mg/5ml syrup, 2mg, 4mg chewable tablet,4mg tablet, 8mg, 12mg cr tablet,6mg, 8mg, 12mg cr capsule G Diphenhydramine Benadryl® 12.5mg/5ml elixir or syrup, 25mg, 50mg capsule or tablet G Loratadine Claritin® 10mg tablet, 5mg/5ml syrupRestricted: Liquid allowed < 5 yo.Respiratory – Antihistamine – Decongestant/OTCRestricted: This whole category allowed for members between the age of 4-21 years old. G Brompheniramine & Dimetapp® 1mg-15mg/5ml elixirPseudoephedrineold formualtion G Brompheniramine &Dimetapp®Phenylephrine new formualtion 1m-2.5mg/5ml elixirContinued on next page
OVER THE COUNTER DRUGSKFHC DRUG FORMULARY*See <strong>Health</strong>y Families Exception Warning on Page 41GENERIC BRAND FORMS45Respiratory – Antihistamine – Decongestant/OTC, continued • SEE PREVIOUS PAGE G Brompheniramine & Bromfed® 2mg-30mg/5ml syrup, 4mg-30mg/5ml elixir,Pseudoephedrine6mg-60mg, 12mg-120mg cr capsule,4mg-60mg, 12mg-120mg cr tablet G Chlorpheniramine & Contac® 1mg-2.5mg/5ml, 2mg-5mg/5ml, 4mg-10mg/5ml syrupPhenylephrine1mg-2.5mg chew. tablet, 2mg-5mg tablet,4mg-20mg cr tablet or capsule, 8mg-20mg cr capsule, G Chlorpheniramine & Sudafed Plus® 1mg-15mg/5ml elixir, 2mg-30mg/5ml, 4mg-60mg/Pseudoephedrine5ml soln, 2mg-30mg/5ml, 3mg-30mg/5ml syrup,2mg-30mg, 4mg-30mg, 4mg-60mg tablet, 8mg-120mgcr tablet, 4mg-60mg capsule, 4mg-60mg, 4mg-120mg,8mg-120mg, 10mg-65mg, 12mg-120mg capsule G Diphenhydramine & Benadryl Decongestant® 12.5mg-30mg/5ml syrupPseudoephedrineRespiratory – Antihistamine – Decongestant – Antitussive/OTCRestricted: This whole category allowed for members between the age of 4-21 years old. G Phenylephrine, Brompheniramine Dimetapp DM® 2.5mg-1mg-5mg/5ml syrup& Dextromethorphan G Pseudoephedrine, Brompheniramine Dimetane DX®& Dextromethorphan G Pseudoephedrine, Chlorpheniramine Pediacare®& Dextromethorphan30mg-2mg-10mg/5ml syrup15mg-1mg-5mg chewable tablet, 10mg-0.6mg-5mg/5ml,15mg-1mg- 5mg/5ml, 15mg-1mg-7.5mg/5ml,30mg-2mg-10mg/5ml liquid & syrupRespiratory – Antitussive/OTCRestricted: This whole category allowed for members between the age of 4-21 years old. G Dextromethorphan Robitussin Pediatric® 7.5mg/5ml, 10mg/5ml syrup
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 50 and 51: OVER THE COUNTER DRUGS42 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?