L.A. Care Covered Drug Formulary (pdf)
L.A. Care Covered Drug Formulary (pdf)
L.A. Care Covered Drug Formulary (pdf)
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Commercial <strong>Formulary</strong>Irritants/counter-irritantsT3 capsaicinCAPSICUMT3 capsaicin/skin cleanserQUTENZAT3 coal tarTAR DISTILLATET3 menthol/bandages, ICY HOT(OTC)tubularT1 methyl salicylate METHYLSALICYLATET3 oxalic acidOXALISKeratolyticsT1 benz perox/hc/skin BENCORTclnsr no.14T1 benzoyl peroxide BENZAC W 10T1 benzoyl peroxide BENZAC W 5T1 benzoyl peroxide BENZAC W WASHT2 benzoyl peroxide BENZASHAVET1 benzoyl peroxide BENZEFOAMT1 benzoyl peroxide BENZEFOAM ULTRAT1 benzoyl peroxide BENZOYL PEROXIDET2 benzoyl peroxide BP WASHT2 benzoyl peroxide CLINAC BPOT3 benzoyl peroxide DELOST3 benzoyl peroxide PACNEX HPT3 benzoyl peroxide PACNEX LPT1 benzoyl peroxide PACNEX MXT1 benzoyl peroxide PANOXYL AQ 2.5T3 benzoyl peroxide SOLUCLENZ RXT3 benzoyl peroxide BENZOYL PEROXIDEmicrospheresT1 benzoyl peroxide NEOBENZmicrospheres MICRO(CREAM)T3 benzoyl peroxide NEOBENZmicrospheres MICRO(KIT CL&CRM)T3 benzoyl peroxide NEOBENZmicrospheres MICRO(KIT)T1 benzoylBENZOYL PEROXIDEperoxide&skincleansr5T1 benzoylBENPROXperoxide/aloe veraT3 benzoyl peroxide/aloe BENZIQveraT3 benzoyl peroxide/aloe BENZIQ LSveraT3 benzoylBREZEperoxide/blemish cnclrT3 benzoylZACAREperoxide/hyaluront sodT1 benzoylBPSperoxide/sulfurT3 benzoyl peroxide/sulfurNUOXT1 benzoylBENZOYL PEROXIDEperoxide/ureaT1 benzoylZODERM(CLEANSEperoxide/urea R)T3 benzoyl peroxide/urea ZODERM(CREAM)T3 benzoyl peroxide/urea ZODERM(GEL)T3 benzoyl peroxide/urea ZODERM(MEDPAD)(4.5%-10%)PAT1 benzoylperoxide/ureaZODERM(MEDPAD)(6.5%-10%)T1 benzoylperoxide/ureaZODERM(MEDPAD)(8.5%-10%)T3 benzoyl peroxide/vit e INOVAmixT3 dichloroacetic acid BICHLORACETICACIDT2 podofiloxCONDYLOX(GEL)T1 podofiloxCONDYLOX(SOLUTION)T1 podophyllum resin PODOCON-25T1 potassium hydroxide POTASSIUMHYDROXIDET3 sal acid/benz per/emol CLEANSE & TREATcmb#47PLUST3 salicylic ac/benzoyl INOVA 4-1per/vit eT3 salicylic ac/benzoyl INOVA 8-2per/vit eT1 salicylic acid AKURZAT1 salicylic acid DURASALT1 salicylic acid KERALYTT3 salicylic acid KERALYT SCALPT1 salicylic acid SALACYNT1 salicylic acid SALEXT1 salicylic acid SALICYLIC ACIDT1 salicylic acid VIRASALT1 salicylic acid/ammon SALICYLIC ACIDlact/aloeT3 salicylicEMERSALacid/ammoniated hgT3 salicylic acid/benz per CLEANSE ANDTREATT1 salicylicSALEXacid/ceramide cmb#1T3 salicylic acid/urea SALVAX DUOT3 salicylic acid/urea SALVAX DUO PLUST1 silver nitrate SILVER NITRATET1 silver nitrateapplicatorSILVER NITRATEAPPLICATORT3 ureaALUVEAT3 ureaGORDO-UREAT3 urea HYDRO 35T3 ureaKERAFOAMT3 ureaKEROLT3 ureaUMECTAT3 ureaUMECTA PDT3 ureaURAMAXINT3 urea/emol/bak RINNOVIcl/pvp/grp sd xtT3 urea/emollient URAMAXIN GTcombination #65T1 urea/hyaluronate UREAsodiumT1 urea/lactic ac/zn BP-50% UREAundecylenateT1 urea/lacticUREAacid/salicyl acidPage 21 of 91
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