dru g formulary - Kern Health Systems

OVER THE COUNTER DRUGSKFHC DRUG FORMULARY*See Healthy Families Exception Warning on Page 41GENERIC BRAND FORMS47Respiratory – Expectorant/OTCRestricted: This whole category allowed for members between the age of 4-21 years old. G Guaifenesin Robitussin® 100mg/5ml, 200mg/5ml syrupRespiratory – Miscellaneous/OTC G Sodium Chloride0.9% nebulizer solnOstomy Items/OTCvariousSupplies – Diabetic/OTCAlcohol70%, 91% topical solnBlood Glucose StripsstripRestricted to True Track®, and True Test® brands. Meters are supplied to patients directly from True Track®, True Test®companies. True Track®, True Test® meters are allowed, but the True Test is preferred as it requires no coding. Please writeyour patient prescriptions for strips, lancets, etc and have them fill the prescriptions after they receive their meter to receivethe correct strips. Allow #100/30 days for Type I, and #100/90 days for Type II diabetics. The pharmacy runs the script forthe meter at the point of sale.LancetsSyringes, Syringes w/NeedlesRestricted: Requires insulin to clear. G Urine Test Strips Keto-Diastix®, Ketostix® stripTopical – Acne/OTC G Benzoyl Peroxide Benzagel® 5%, 10% gelTopical – Antibiotic/OTC G Bacitracin G Neomycin, Bacitracin & Polymyxin Neosporin®Topical – Antifungal/OTCointmentointmentAluminum Acetate Domeboro’s Soln® Powder, soln G Clotrimazole Lotrimin® 1% cream, lotion, soln G Miconazole Micatin® 2% cream G Tolnaftate Tinactin® 1% cream and soln