2012 Formulary Print document - Alameda Alliance for Health
2012 Formulary Print document - Alameda Alliance for Health
2012 Formulary Print document - Alameda Alliance for Health
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Drug Name<br />
Alpha-Adrenergic Blocking Agents<br />
Alpha-Adrenergic Blocking Agents<br />
Drug<br />
Tier<br />
Requirements/Limits<br />
doxazosin mesylate (Cardura) 1<br />
prazosin hcl (Minipress) 1<br />
terazosin hcl (Hytrin) 1<br />
Ammonia Detoxicants<br />
Ammonia Detoxicants<br />
BUPHENYL 2<br />
CARBAGLU 2<br />
lactulose (Lactulose) 1 solution<br />
lactulose (Lactulose) 1 syrup<br />
LITHOSTAT 2<br />
Analgesics and Antipyretics<br />
Analgesics And Antipyretics, Miscellaneous<br />
acetaminophen/phenyltolx<br />
cit<br />
(Staflex) 1 tablet: 500mg-<br />
30mg, 500mg-<br />
50mg, 650mg-<br />
50mg, 650mg-60mg<br />
(Durabac Forte) 1<br />
mg sal/acetaminophn/ptlox/caf<br />
OFIRMEV 2<br />
sal-amide/acetamin/p-tlox/ (Durabac) 1<br />
caff<br />
sal-amide/acetaminophn/ (Asp) 1<br />
p-tlox<br />
salicylamide/<br />
(Salicylamide/acetaminophen) 1<br />
acetaminophen<br />
Nonsteroidal Anti-inflammatory Agents<br />
aspirin (Easprin) 1<br />
CALDOLOR 2<br />
CELEBREX 2 ST, QL:<br />
62 in 31<br />
days<br />
choline sal/mag salicylate (Choline Sal/mag Salicylate) 1<br />
diclofenac potassium (Cataflam) 1<br />
diclofenac sodium (Voltaren) 1<br />
diflunisal (Diflunisal) 1<br />
etodolac (Etodolac) 1<br />
fenoprofen calcium (Fenoprofen Calcium) 1<br />
flurbiprofen (Ansaid) 1<br />
33<br />
<strong>Alliance</strong> CompleteCare <strong>2012</strong> Part D <strong>Formulary</strong> Effective: May 01, <strong>2012</strong><br />
<strong>Formulary</strong> ID: 12140.000, Version: 10
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