dru g formulary - Kern Health Systems

KFHC DRUG FORMULARYAppendix*See Healthy Families Exception Warning on Page 41GENERIC These medications are carved out BRAND by Medi-Cal as stated in the December FORMS 2011 Medi-Cal bulletin. The prescriptions for any of thecarved out medications are transmitted to Medi-Cal. If the claim for the above drugs is rejected by EDS for a Kern Family HealthCare patient with a message stating to bill the primary insurance it is likely the patient has insurance in addition to KernHealth Systems.Psychotherapeutic Agents for Kern Family Health Care Patients (KHS Medi-Cal Patients) are Carved Out to Fee for Service Medi-CalAmantadine*Aripipazole..................Abilify ®Asenapine.....................Saphris ®Benztropine..................Cogentin ®Biperidin.......................Akineton ®Chlorpromazine.............Thorazine ®Chlorprothixene.............Taractan ®Clozapine.....................Clozaril ®Selegiline.....................Emsam ®Fluphenazine................Prolixin ®Haloperidol...................Haldol ®Iloperidone...................Fanapt ® *Isocarboxazid..............Marplan ®LithiumLoxapine......................Loxitane ®Lurasidone....................Latuda ®Mesoridazine................Serentil ®Molindone....................Moban ®Olanzapine...................Zyprexa ®*Olanzapine/Fluoxetine.Symbyax ®*Paliperidone................Invega ®Perphenazine................Trilafon ®*Phenelzine..................Nardil ®*Pimozide....................Orap ®Procyclidine...................Kemadrin ®*Promazine..................Sparine ®*Quetiapine..................Seroquel ®*Risperidone.................Risperdal ®Thioridazine..................Mellaril ®Thiothixene...................Navane ®*Tranylcypromine..........Parnate ®*Trifluoperazine.............Stelazine ®*Trifluopromazine..........Vesprin ®Trihexyphenidyl.............Artane ®Ziprasidone...................Geodon ®Psychotherapeutic Agents for The Healthy Families Program patients are billed to Kern Health SystemsAlcohol, Heroin Detoxification and Dependency Treatment drugsAcamposate........................................Campral ®Buprenorphine/Naloxone......................Suboxone ®Buprenorphine.....................................Subutex ® Naltexone...........................................Revia ®49Abacavir............................ Ziagen ®Abacavir, Lamivudine........... Epzicom ®Abacavir, Lamivudine &Zidovudine......................... Trivizir ®Amprenavir........................ Agenerase ®Atazanivir.......................... Reyataz ®Darunavir........................... Prezista ®Delavirdine........................ Rescriptor ®Efavirenz........................... Sustiva ®Antiviral Agents Carved Out by Medi-CalEfavirenz, Emtricitabine,Tenofivir............................ Atripla ®Emtricitabine, Rilpivirine,Tenofovir........................... Complera ®Emtricitabine...................... Emitriva ®Enfuvirtide......................... Fuzeon ®Fosamprenavir................... Levixa ®Indinavir............................ Crixivan ®Lamivudine & Zidovudine..... Combivir ®Lamivudine........................ Epivir ®Lopinavir & Ritonavir........... Kaletra ®*Will require TAR from Medi-CalMaraviroc.......................... Selzentry ®Nelfinavir........................... Viracept ®Nevirapine......................... Viramune ®Raltegravir......................... Isentress ®Rilpivirine.......................... Edurant ®Ritonavir............................ Norvir ®Saquinavir......................... Invirase ®Stavudine.......................... Zerit ®Tenofovir........................... Viread ®Tenofovir, Emtricitabine........ Truvada ®Tipranavir.......................... Aptivus ®