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Xxxxxx Anticonvulsants
Xxxxxx
6
Name AETNA BCBSMA BMCHP FCHP HPHC HNE NHP NTWK MAHLTH THP
CLORAzEPATE X* X* X X X X X X X X
DIAzEPAM X* X* X X X X X X X X
DIAzEPAM [Diastat] X X* X X X DL DL DL DL
DIVALPROEX sODIUM X* X* X X X X X X X
DIVALPROEX sODIUM [Depakote] FE sT X* PA X X X NC PA X
DIVALPROEX sODIUM [Depakote ER] FE sT X* PA X X NC PA X
DIVALPROEX sODIUM [Depakote X X* X NC X
sprinkle]
DIVALPROEX sODIUM ER X X* X X X X
ETHOsUXIMIDE X* X* X X X X X X X X
ETHOsUXIMIDE [zarontin] X X PA X NC PA X
ETHOTOIN [Peganone] X X* X X X X
FELBAMATE [Felbatol] X X* X X X X X
gABAPENTIN DL* X* X X X X X X X X
gABAPENTIN [Neurontin] DL NC X NC X
LACOsAMIDE [Vimpat] DL PA X X PA PA DL PA
LAMOTRIgINE X* X* X X X X DL X X
LAMOTRIgINE [Lamictal] FE sT X PA X X NC PA X
LAMOTRIgINE chewable
dispersable tablets
X* X* X X X X X DL X X
LAMOTRIgINE ODT [Lamictal ODT] sT NC X PA X
LAMOTRIgINE XR [Lamictal XR] sT NC X PA PA DL
LEVETIRACETAM X* X* X X X X X X X X
LEVETIRACETAM [Keppra] X* X PA X NC PA X
LEVETIRACETAM XR [Keppra XR] X* NC PA X X PA PA NC
LORAzEPAM X* X* X X X X X X X X
MEPHOBARBITAL X* X* X X X X X X X X
MEPHOBARBITAL [Mebaral] X X PA X X NC X X X
METHsUXIMIDE [Celontin] X X* X X X X X
OXCARBAzEPINE tablets X* X* X X X X X X X X
OXCARBAzEPINE [Trileptal] FE X PA X NC PA X
PHENOBARBITAL X* X* X X X X X X X X
PHENyTOIN X* X* X X X X X X X X