COMPREHENSIVE FORMULARY - RxAmerica

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Drug Name Drug Tier Notes azithromycin tab 500 mg azithromycin tab 600 mg AZULFIDINE TAB 500MG(Sulfasalazine) AZULFIDINE TAB 500MG EN(Sulfasalazine) BACITRACIN INJ 50000UNT(Bacitracin) bacitracin intramuscular for soln 50000 unit BACTOCILL INJ DEX 1GM(Oxacillin Sodium in Dextrose) BACTOCILL INJ DEX 2GM(Oxacillin Sodium in Dextrose) BACTRIM TAB 400-80MG(Sulfamethoxazole-Trimethoprim) BACTRIM DS TAB 800-160(Sulfamethoxazole-Trimethoprim) BARACLUDE SOL .05MG/ML(Entecavir) BARACLUDE TAB 0.5MG(Entecavir) BARACLUDE TAB 1MG(Entecavir) BIAXIN SUS 125/5ML(Clarithromycin) BIAXIN SUS 250/5ML(Clarithromycin) BIAXIN TAB 250MG(Clarithromycin) BIAXIN TAB 500MG(Clarithromycin) BIAXIN XL TAB 500MG(Clarithromycin) BIAXIN XL TAB PAC 500(Clarithromycin) BICILLIN C-R INJ 1200000(Penicillin G Procaine & Benzathine) BICILLIN C-R INJ 2400000(Penicillin G Procaine & Benzathine) BICILLIN C-R INJ 600000(Penicillin G Procaine & Benzathine) BICILLIN C-R INJ 900/300(Penicillin G Procaine & Benzathine) BICILLIN L-A INJ 1200000(Penicillin G Benzathine) BICILLIN L-A INJ 2400000(Penicillin G Benzathine) BICILLIN L-A INJ 600000(Penicillin G Benzathine) BILTRICIDE TAB 600MG(Praziquantel) BIO-STATIN CAP 1000000(Nystatin) BIO-STATIN CAP 500000(Nystatin) CANCIDAS INJ 50MG(Caspofungin Acetate) CANCIDAS INJ 70MG(Caspofungin Acetate) CAPASTAT SUL INJ 1GM(Capreomycin Sulfate) CEDAX CAP 400MG(Ceftibuten) CEDAX SUS 90MG/5ML(Ceftibuten) cefaclor cap 250 mg cefaclor cap 500 mg cefaclor for susp 125 mg/5ml cefaclor for susp 250 mg/5ml cefaclor for susp 375 mg/5ml cefaclor monohydrate tab sr 12hr 500 mg cefadroxil cap 500 mg cefadroxil for susp 250 mg/5ml cefadroxil for susp 500 mg/5ml cefadroxil tab 1 gm cefazolin in d5w inj 1 gm/50ml cefazolin in d5w inj 500 mg/50ml cefazolin sodium for inj 1 gm cefazolin sodium for inj 10 gm cefazolin sodium for inj 20 gm cefazolin sodium for inj 500 mg 01 01 04 04 04 01 04 04 04 04 02 02 02 04 04 04 04 02 02 04 04 04 04 04 04 04 02 04 04 04 04 02 04 04 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 11
Drug Name Drug Tier Notes cefazolin sodium for iv soln 1 gm cefazolin sodium for iv soln 1 gm and dextrose 4% cefdinir cap 300 mg cefdinir for susp 125 mg/5ml cefdinir for susp 250 mg/5ml cefepime hcl for inj 1 gm cefepime hcl for inj 2 gm CEFIZOX/D5W INJ 1GM(Ceftizoxime in D5W) CEFIZOX/D5W INJ 2GM(Ceftizoxime in D5W) cefotaxime sodium for inj 1 gm cefotaxime sodium for inj 10 gm cefotaxime sodium for inj 2 gm cefotaxime sodium for inj 20 gm cefotaxime sodium for inj 500 mg cefoxitin sodium for inj 1 gm cefoxitin sodium for inj 10 gm cefoxitin sodium for inj 2 gm cefpodoxime proxetil for susp 100 mg/5ml cefpodoxime proxetil for susp 50 mg/5ml cefpodoxime proxetil tab 100 mg cefpodoxime proxetil tab 200 mg cefprozil for susp 125 mg/5ml cefprozil for susp 250 mg/5ml cefprozil tab 250 mg cefprozil tab 500 mg ceftazidime for inj 1 gm ceftazidime for inj 2 gm ceftazidime for inj 500 mg ceftazidime for inj 6 gm ceftazidime for iv soln 1 gm ceftazidime for iv soln 2 gm CEFTIN SUS 125/5ML(Cefuroxime Axetil) CEFTIN SUS 250/5ML(Cefuroxime Axetil) CEFTIN TAB 250MG(Cefuroxime Axetil) CEFTIN TAB 500MG(Cefuroxime Axetil) CEFTRIAXONE INJ 100GM(Ceftriaxone Sodium) ceftriaxone sodium for inj 1 gm ceftriaxone sodium for inj 10 gm ceftriaxone sodium for inj 2 gm ceftriaxone sodium for inj 250 mg ceftriaxone sodium for inj 500 mg ceftriaxone sodium for iv soln 1 gm and dextrose 3.74% ceftriaxone sodium for iv soln 2 gm and dextrose 2.22% ceftriaxone sodium in dextrose inj 20 mg/ml ceftriaxone sodium in dextrose inj 40 mg/ml cefuroxime axetil tab 250 mg cefuroxime axetil tab 500 mg cefuroxime sodium 1.5 gm and dextrose 2.9% for iv soln cefuroxime sodium 750 mg and dextrose 4.1% for iv soln cefuroxime sodium for inj 1.5 gm 01 01 01 01 01 01 01 04 04 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 02 02 04 04 04 01 01 01 01 01 01 01 01 01 01 01 01 01 01 (PA) (PA) 12
Page 1 and 2: www.Meds4Medicare.com COMPREHENSIVE
Page 3 and 4: If we remove drugs from our formula
Page 5 and 6: condition. For example, if Drug A a
Page 7 and 8: RxAmerica’s Formulary The formula
Page 9 and 10: Drug Name Drug Tier Notes Antihista
Page 11: Drug Name Drug Tier Notes AMOXIL SU
Page 15 and 16: Drug Name Drug Tier Notes CLEOCIN C
Page 17 and 18: Drug Name Drug Tier Notes ethambuto
Page 19 and 20: Drug Name Drug Tier Notes MANDELAMI
Page 21: Drug Name Drug Tier Notes PEG-INTRO
Page 24 and 25: Drug Name Drug Tier Notes URISYM CA
Page 26 and 27: Drug Name Drug Tier Notes ARIMIDEX
Page 28 and 29: Drug Name Drug Tier Notes IDAMYCIN
Page 30 and 31: Drug Name Drug Tier Notes TESLAC TA
Page 32 and 33: Drug Name Drug Tier Notes COGNEX CA
Page 34 and 35: Drug Name Drug Tier Notes PROSTIGMI
Page 36 and 37: Drug Name Drug Tier Notes cilostazo
Page 38 and 39: Drug Name Drug Tier Notes warfarin
Page 40 and 41: Drug Name Drug Tier Notes CADUET TA
Page 42 and 43: Drug Name Drug Tier Notes COZAAR TA
Page 44 and 45: Drug Name Drug Tier Notes HYPERTENS
Page 46 and 47: Drug Name Drug Tier Notes LOTREL CA
Page 48 and 49: Drug Name Drug Tier Notes NITROSTAT
Page 50 and 51: Drug Name Drug Tier Notes sotalol h
Page 52 and 53: Drug Name Drug Tier Notes WELCHOL T
Page 54 and 55: Drug Name Drug Tier Notes AZILECT T
Page 56 and 57: Drug Name Drug Tier Notes CYMBALTA
Page 58 and 59: Drug Name Drug Tier Notes EMSAM DIS
Page 60 and 61: Drug Name Drug Tier Notes GEODON IN
Page 62 and 63:
Drug Name Drug Tier Notes ketoprofe
Page 64 and 65:
Drug Name Drug Tier Notes METADATE
Page 66 and 67:
Drug Name Drug Tier Notes naproxen
Page 68 and 69:
Drug Name Drug Tier Notes PAXIL TAB
Page 70 and 71:
Drug Name Drug Tier Notes RITALIN T
Page 72 and 73:
Drug Name Drug Tier Notes thiothixe
Page 74 and 75:
Drug Name Drug Tier Notes ZYDONE TA
Page 76 and 77:
Drug Name Drug Tier Notes CLINIMIX
Page 78 and 79:
Drug Name Drug Tier Notes LITHOSTAT
Page 80 and 81:
Drug Name Drug Tier Notes Enzymes A
Page 82 and 83:
Drug Name Drug Tier Notes BLEPH-10
Page 84 and 85:
Drug Name Drug Tier Notes OPTIPRANO
Page 86 and 87:
Drug Name Drug Tier Notes amylase-l
Page 88 and 89:
Drug Name Drug Tier Notes opium tin
Page 90 and 91:
Drug Name Drug Tier Notes sodium th
Page 92 and 93:
Drug Name Drug Tier Notes CYTOMEL T
Page 94 and 95:
Drug Name Drug Tier Notes FEMCON FE
Page 96 and 97:
Drug Name Drug Tier Notes JANUMET T
Page 98 and 99:
Drug Name Drug Tier Notes NORDITROP
Page 100 and 101:
Drug Name Drug Tier Notes PREMPRO T
Page 102 and 103:
Drug Name Drug Tier Notes tolbutami
Page 104 and 105:
Drug Name Drug Tier Notes PANGLOBUL
Page 106 and 107:
Drug Name Drug Tier Notes benzoyl p
Page 108 and 109:
Drug Name Drug Tier Notes DIPROLENE
Page 110 and 111:
Drug Name Drug Tier Notes lidocaine
Page 112 and 113:
Drug Name Drug Tier Notes ROZEX EMU
Page 114 and 115:
Drug Name Drug Tier Notes XYRALID L
Page 116 and 117:
Drug Name Drug Tier Notes NASCOBAL
Page 118 and 119:
Drug Name Drug Tier Notes IMURAN TA
Page 120 and 121:
Drug Name Drug Tier Notes THALOMID
Page 122 and 123:
Drug Name Drug Tier Notes insulin s
Page 124 and 125:
Drug Name Drug Tier Notes BENZOIC A
Page 126 and 127:
Drug Name Drug Tier Notes HYOSCYAMI
Page 128 and 129:
INDEX A ABBOKINASE 34 ABELCET 9 ABI
Page 130 and 131:
BD PEN MINI 119 BD PEN 119 BD ULTRA
Page 132 and 133:
clobetasol propionate emollient bas
Page 134 and 135:
EDECRIN 75 edetate calcium disodium
Page 136 and 137:
HALDOL DECAN 59 HALDOL 59 HALFLYTEL
Page 138 and 139:
LEXAPRO 61 LEXIVA 17 LEXXEL 44 LIAL
Page 140 and 141:
naloxone hcl 64 naltrexone hcl 64 N
Page 142 and 143:
peritoneal dialysis solutions 73 PE
Page 144 and 145:
S SAIZEN 99 SAL-TROPINE 33 SALAGEN
Page 146 and 147:
TRAVASOL 2.75%/DEXTROSE 5 78 TRAVAS
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