COMPREHENSIVE FORMULARY - RxAmerica

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Drug Name Drug Tier Notes cefuroxime sodium for inj 7.5 gm cefuroxime sodium for inj 750 mg CEFZIL SUS 125/5ML(Cefprozil) CEFZIL SUS 250/5ML(Cefprozil) CEFZIL TAB 250MG FC(Cefprozil) CEFZIL TAB 500MG FC(Cefprozil) CEPHALEXIN TAB 500MG(Cephalexin) cephalexin cap 250 mg cephalexin cap 500 mg cephalexin for susp 125 mg/5ml cephalexin for susp 250 mg/5ml cephalexin tab 250 mg cephalexin tab 500 mg chloramphenicol sodium succinate for iv inj 1 gm chloroquine phosphate tab 250 mg chloroquine phosphate tab 500 mg CIPRO TAB 250MG(Ciprofloxacin HCl) CIPRO TAB 500MG(Ciprofloxacin HCl) CIPRO TAB 750MG(Ciprofloxacin HCl) CIPRO (5%) SUS 250MG/5(Ciprofloxacin) CIPRO I.V. INJ 200MG(Ciprofloxacin) CIPRO I.V. INJ 400MG(Ciprofloxacin) CIPRO I.V. SOL 200MG(Ciprofloxacin in D5W) CIPRO I.V. SOL 400MG(Ciprofloxacin in D5W) CIPRO XR TAB 1000MG(Ciprofloxacin-Ciprofloxacin HCl) CIPRO XR TAB 500MG(Ciprofloxacin-Ciprofloxacin HCl) ciprofloxacin for oral susp 250 mg/5ml (5%) (5 gm/100ml) ciprofloxacin for oral susp 500 mg/5ml (10%) (10 gm/100ml) ciprofloxacin hcl tab 100 mg (base equiv) ciprofloxacin hcl tab 250 mg (base equiv) ciprofloxacin hcl tab 500 mg (base equiv) ciprofloxacin hcl tab 750 mg (base equiv) ciprofloxacin iv soln 1% ciprofloxacin-ciprofloxacin hcl tab sr 24hr 1000 mg(base eq) ciprofloxacin-ciprofloxacin hcl tab sr 24hr 500 mg (base eq) CLAFORAN INJ 10GM(Cefotaxime Sodium) CLAFORAN INJ 1GM(Cefotaxime Sodium) CLAFORAN INJ 1GM(Cefotaxime Sodium) CLAFORAN INJ 2GM(Cefotaxime Sodium) CLAFORAN INJ 2GM(Cefotaxime Sodium) CLAFORAN INJ 500MG(Cefotaxime Sodium) CLAFORAN/D5W INJ 1GM(Cefotaxime Sodium in D5W) CLAFORAN/D5W INJ 2GM(Cefotaxime Sodium in D5W) CLARITHROMYC SUS 250/5ML(Clarithromycin) clarithromycin for susp 125 mg/5ml clarithromycin for susp 250 mg/5ml clarithromycin tab 250 mg clarithromycin tab 500 mg clarithromycin tab sr 24hr 500 mg CLEERAVUE-M KIT 50MG(Minocycline HCl w/ Eyelid Cleanser) 01 01 04 04 04 04 04 01 01 01 01 01 01 01 01 01 04 04 04 04 04 04 04 04 04 04 01 01 01 01 01 01 01 01 01 04 04 04 04 04 04 04 04 02 01 01 01 01 01 04 13
Drug Name Drug Tier Notes CLEOCIN CAP 150MG(Clindamycin HCl) CLEOCIN CAP 300MG(Clindamycin HCl) CLEOCIN CAP 75MG(Clindamycin HCl) CLEOCIN INJ 300MG(Clindamycin Phosphate in D5W) CLEOCIN INJ 600MG(Clindamycin Phosphate in D5W) CLEOCIN INJ 900MG(Clindamycin Phosphate in D5W) CLEOCIN PED SOL 75MG/5ML(Clindamycin Palmitate Hydrochloride) CLEOCIN PHOS INJ 150MG/ML(Clindamycin Phosphate) CLEOCIN PHOS INJ 300MG(Clindamycin Phosphate) CLEOCIN PHOS INJ 600MG(Clindamycin Phosphate) CLEOCIN PHOS INJ 900MG(Clindamycin Phosphate) CLEOCIN PHOS INJ 9GM(Clindamycin Phosphate) clindamycin hcl cap 150 mg clindamycin hcl cap 300 mg clindamycin phosphate inj 150 mg/ml clindamycin phosphate iv soln 150 mg/ml colistimethate sodium for inj 150 mg COLY-MYCIN-M INJ 150MG(Colistimethate Sodium) COMBIVIR TAB(Lamivudine-Zidovudine) COPEGUS TAB 200MG(Ribavirin (Hepatitis C)) CRIXIVAN CAP 100MG(Indinavir Sulfate) CRIXIVAN CAP 200MG(Indinavir Sulfate) CRIXIVAN CAP 333MG(Indinavir Sulfate) CRIXIVAN CAP 400MG(Indinavir Sulfate) CUBICIN SOL 500MG(Daptomycin) CYTOVENE INJ 500MG(Ganciclovir Sodium) dapsone tab 100 mg dapsone tab 25 mg DARAPRIM TAB 25MG(Pyrimethamine) DECLOMYCIN TAB 150MG(Demeclocycline HCl) DECLOMYCIN TAB 300MG(Demeclocycline HCl) demeclocycline hcl tab 150 mg demeclocycline hcl tab 300 mg dicloxacillin sodium cap 250 mg dicloxacillin sodium cap 500 mg didanosine delayed release capsule 200 mg didanosine delayed release capsule 250 mg didanosine delayed release capsule 400 mg DIFLUCAN SUS 10MG/ML(Fluconazole) DIFLUCAN SUS 40MG/ML(Fluconazole) DIFLUCAN TAB 100MG(Fluconazole) DIFLUCAN TAB 150MG(Fluconazole) DIFLUCAN TAB 200MG(Fluconazole) DIFLUCAN TAB 50MG(Fluconazole) DIFLUCAN/ INJ NACL 200(Fluconazole in NaCl) DIFLUCAN/ INJ NACL 400(Fluconazole in NaCl) DIFLUCAN/DEX INJ 2MG/ML(Fluconazole in Dextrose) DORYX TAB 100MG(Doxycycline Hyclate) DORYX TAB 75MG(Doxycycline Hyclate) DOXYCYCL HYC CAP 100MG(Doxycycline Hyclate) 04 04 02 04 04 04 04 04 04 04 04 04 01 01 01 01 01 04 02 02 02 02 02 02 04 04 01 01 02 04 04 01 01 01 01 01 01 01 04 04 04 04 04 04 04 04 04 04 04 04 (PA) 14
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 and 12: Drug Name Drug Tier Notes AMOXIL SU
Page 13: Drug Name Drug Tier Notes cefazolin
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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