2013 PHP Salud Formulary/Preferred Drug Listing By Therapeutic ...

More documents

Recommendations

Info

Drug Name Dosage Form NoteKALBITOR SOLN (PA)methylergonovine maleateNOVOFINE PEN NEEDLESNOVOTWIST PEN NEEDLESTABSMISCMISCSYNVISC INJ (SP)SYNVISC ONE INJ (SP)Ophthalmic AgentsDrug Name Dosage Form NoteacetazolamideACETAZOLAMIDEacetazolamide erALPHAGAN PTABSTABSCP12SOLNALREX SUSP (ST)ATROPINE SULFATE *atropine sulfate *AZOPTbetaxolol hclBETOPTIC-SBLEPHAMIDEBLEPHAMIDE S.O.P.brimonidine tartratecarteolol hclSUSPSOLNSUSPSUSPOINTSOLNSOLNCIPRODEX SUSP (AG) (PA) (QL)cromolyn sodiumdexamethasone sodium phosphatediclofenac sodiumdorzolamide hclfluorometholoneFMLFML FORTEhomatropaireISOPTO CARBACHOLISOPTO HOMATROPINEketorolac tromethamineketotifen fumaratelatanoprostLEVOBUNOLOL HCLlevobunolol hclSOLNSOLNSOLNSOLNSUSPOINTSUSPSOLNSOLNSOLNSOLNSOLNSOLNSOLNSOLNLOTEMAX SUSP (ST)LUMIGANSOLN[MPC031203] Page 40 of 48 August 15, 2013
Drug Name Dosage Form NotemethazolamideNAPHCON-Aneomycin/polymyxin/bacitracin/hydrocortisoneTABSSOLNOINTneomycin/polymyxin/dexamethasone *OPCON-Aphenylephrine hclSOLNSOLNphenylephrine hcl SOLN (OTC)PHOSPHOLINE IODIDEpilocarpine hclPRED MILDprednisolone acetatePREDNISOLONE SODIUM PHOSPHATESOLRSOLNSUSPSUSPSOLNRESTASIS EMUL (PA)timolol maleatetimolol maleate ophthalmic gel formingtropicamideSOLNSOLGSOLNOtic AgentsDrug Name Dosage Form Noteacetic acidACETIC ACID/ALUMINUM ACETATEantipyrine/benzocaineCOLY-MYCIN Shydrocortisone/acetic acidneomycin/polymyxin/hydrocortisoneNEOMYCIN/POLYMYXIN/HYDROCORTISONEneomycin/polymyxin/hydrocortisoneSOLNSOLNSOLNSUSPSOLNSOLNSUSPSUSPRespiratory Tract AgentsDrug Name Dosage Form NoteacetylcysteineSOLNADVAIR DISKUS AEPB (PA) (QL)ADVAIR HFA AERO (PA) (QL)albuterol sulfate *albuterol sulfate erTB12ALLEGRA ALLERGY CHILDRENS TABS (OTC)ALLEGRA ALLERGY CHILDRENS SUSP (OTC)allergy relief TBDP (OTC)ASMANEX 30 METERED DOSESASMANEX 60 METERED DOSESAEPBAEPB[MPC031203] Page 41 of 48 August 15, 2013
Page 1 and 2: 2013 PHP Salud Formulary/Preferred
Page 3 and 4: Drug Name Dosage Form NoteMETHADONE
Page 5 and 6: Drug Name Dosage Form Noteibuprofen
Page 7 and 8: Drug Name Dosage Form NoteMACRODANT
Page 9 and 10: Drug Name Dosage Form NoteDrug Name
Page 11 and 12: Drug Name Dosage Form Notechlorprom
Page 13 and 14: Drug Name Dosage Form Notetopiramat
Page 15 and 16: Drug Name Dosage Form NoteZOLINZA C
Page 17 and 18: Drug Name Dosage Form NoteRISPERDAL
Page 19 and 20: Drug Name Dosage Form NoteVIREAD *
Page 21 and 22: Drug Name Dosage Form Notequetiapin
Page 23 and 24: Drug Name Dosage Form Noteenoxapari
Page 25 and 26: Drug Name Dosage Form Notefosinopri
Page 27: Drug Name Dosage Form Noteamphetami
Page 30 and 31: Drug Name Dosage Form Notetretinoin
Page 32 and 33: Drug Name Dosage Form Notebetametha
Page 34 and 35: Drug Name Dosage Form Notedrospiren
Page 36 and 37: Drug Name Dosage Form NotevelivetTA
Page 38 and 39: Drug Name Dosage Form NoteGAMMAGARD
Page 42 and 43: Drug Name Dosage Form NoteATROVENT
Page 44 and 45: Drug Name Dosage Form Notecalcifero
Page 46 and 47: Drug Name Dosage Form NoteFERAHEME
Page 48: Pharmacy Prior Authorization Form.

2013 PHP Salud Formulary/Preferred Drug Listing By Therapeutic ...

Create successful ePaper yourself

Delete template?

Save as template?