Physician Preferred Drug List - Catalyst Rx
Physician Preferred Drug List - Catalyst Rx
Physician Preferred Drug List - Catalyst Rx
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<strong>Physician</strong> <strong>Preferred</strong> <strong>Drug</strong> <strong>List</strong> (cont.)<br />
ANTIINFECTIVES<br />
chloramphenicol<br />
ciprofloxacin<br />
neomycin/bacitracin/pol hc<br />
neomycin/bacitracin/<br />
polymyxin<br />
neomycin/polymyxin/<br />
dexameth<br />
ofloxacin<br />
polymyxin b sulfate/tmp<br />
sulfacetamide sodium<br />
tobramycin/dexamethasone<br />
tobramycin<br />
NATACYN<br />
VIGAMOX<br />
ZYLET<br />
ZYMAR<br />
ZYMAXID<br />
ANTIINFLAMMATORY<br />
dexamethasone<br />
sod phosphate<br />
fluorometholone<br />
prednisolone acetate<br />
prednisolone<br />
sod phosphate<br />
ALREX<br />
LOTEMAX<br />
PRED MILD<br />
RETISERT<br />
RESPIRATORY<br />
ANTIHISTAMINES/<br />
DECONGESTANTS/<br />
ANTITUSSIVES<br />
benzonatate<br />
clemastine fumarate<br />
guaifenesin/codeine<br />
hydrocodone/homatropine<br />
BRONCHODILATORS &<br />
RELATED DRUGS<br />
acetylcysteine<br />
albuterol<br />
albuterol/sulfate<br />
aminophylline<br />
cromolyn<br />
dyphylline<br />
ipratropium/albuterol<br />
ipratropium/albuterol<br />
isoetharine hcl<br />
metaproterenol<br />
sodium chloride<br />
terbutaline sulfate<br />
theophylline<br />
theophylline SR<br />
ADVAIR<br />
ATROVENT HFA<br />
COMBIVENT<br />
DULERA<br />
FORADIL<br />
BRONCHODILATORS &<br />
RELATED DRUGS (cont.)<br />
PERFOROMIST<br />
PROAIR HFA<br />
SEREVENT DISKUS<br />
SPIRIVA<br />
SYMBICORT<br />
XOPENEX HFA<br />
LEUKOTRIENE INHIBITORS<br />
zarfirlukast<br />
SINGULAIR<br />
NONSEDATING<br />
ANTIHISTAMINES<br />
cetirizine<br />
fexofenadine<br />
loratadine<br />
PULMONARY<br />
CORTICOSTEROIDS<br />
budesonide neb<br />
ASMANEX<br />
FLOVENT HFA<br />
PULMICORT<br />
FlexHALER<br />
QVAR<br />
UROLOGICS<br />
BENIGN PROSTATIC<br />
HYPERTROPHY DRUGS<br />
BENIGN PROSTATIC<br />
HYPERTROPHY DRUGS<br />
alfuzosin<br />
doxazosin<br />
finasteride<br />
terazosin<br />
tamsulosin<br />
AVODART<br />
JALYN<br />
ANTICHOLINERGICS/<br />
ANTISPASMODICS<br />
flavoxate<br />
hyoscyamine<br />
oxybutynin/ER<br />
DETROL/LA<br />
ENABLEX<br />
OXYTROL<br />
SANCTURA XR<br />
DRUGS REQUIRING PRIOR AUTHORIZATION<br />
ACCUTANE<br />
ACTIQ, FENTORA, MARINOL, OXYCONTIN (unless prescribed by an oncologist or PPO pain management specialist)<br />
ADD/ADHD (over age 18)<br />
avinza, duragesic, MS Contin, Opana (unless prescribed by a PPO provider)<br />
CONTRACEPTIVES (authorization required for dependent children, under the age of 19)<br />
INCIVEK COVERED UNDER INCIVEK TREATMENT PLAN PROTOCOL<br />
INJECTABLES (except INSULIN, SUMATRIPTAN)<br />
LEXAPRO<br />
NEW DRUGS TO MARKET<br />
RETIN A (over age 24)<br />
SEXUAL DYSFUNCTION<br />
WEIGHT LOSS<br />
ZOMIG<br />
Brand-names are the property of their respective manufacturers.<br />
DL 01 1630 0512<br />
For prescription information, call <strong>Catalyst</strong> <strong>Rx</strong> at 1-866-611-5960.<br />
For prescription benefits, call Culinary Customer Service at 702-733-9938.<br />
For a complete formulary, please visit www.culinaryhealthfund.org or www.catalystrx.com.
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