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Xxxxxx Anticonvulsants
Xxxxxx
Name AETNA BCBSMA BMCHP FCHP HPHC HNE NHP NTWK MAHLTH THP
PHENyTOIN [Dilantin] X X* PA X X NC X X X
PHENyTOIN [Dilantin Infatab] X X* X X X X X X X
PHENyTOIN [Phenytek] X X PA X X X X X X
PHENyTOIN ER X* X* X X X X X X X X
PREgABALIN [Lyrica] DL FE PA DL PA PA sT PA PA sT
PA sT
PRIMIDONE X* X* X X X X X X X X
RUFINAMIDE [Banzel] PA PA* X DL PA PA DL PA
TIAgABINE [gabitril] X X* X X X X X PA 1 X
TOPIRAMATE X* X* X X DL PA 2 X
TOPIRAMATE [Topamax] sT X PA X X X NC PA X
VALPROATE sODIUM X* X* X X X X X X X X
VALPROIC ACID X* X* X X X X X X X X
VALPROIC ACID [Depakene] X X PA X X NC PA X
VALPROIC ACID [stavzor] FE NC PA X PA X
VIgABATRIN [sabril] DL PA X X PA X
zONIsAMIDE PA* X* X X X X X X X X
zONIsAMIDE [zonegran] PA X PA X NC PA X
Antidepressants (Miscellaneous)
AMITRIPTyLINE X* X* X X X X X X X X
AMOXAPINE X* X* X X X X X X X X
BUDEPRION XL DL* DL* DL X DL DL X X*
BUPROPION DL* X* DL X X DL X X X X*
BUPROPION ER [Aplenzin] DL FE NC DL X NC PA sT 2
sT sT
BUPROPION sR DL* DL* DL X X DL X X X X*
BUPROPION [Wellbutrin] DL FE NC sT X NC sT 2
sT
BUPROPION sR [Wellbutrin sR] DL FE NC DL DL PA X sT 2 NC PA sT 2
sT sT
BUPROPION XL DL* DL* DL X X DL X X PA X*
1 ≥19 yrs old
2 ≥18 yrs old
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