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>Oxidizing AgentsT3 elect wtr/sod ch/sodhy/hyp acT1 hydrogen peroxideProtectivesT3 carbit/equisxt/ethan/chit/msmT3 hyaluronsod/allantoin/aloe xtT3 hyaluronate sodiumT1 hyaluronate sodiumT3 hyaluronatesodium/he-cell/pegT3 naph,mb-db/kph,mbdb/zinc/ureaT3 poly-ureaurethaneT1 protectcmb2/ceramide 1,3,6-11Surface Active AgentsT1 benzalkoniumchlorideATRAPRO DERMALSPRAYHYDROGENPEROXIDEGENADURRADIAPLEXRXBIONECTSODIUMHYALURONATEHYLASECONSTANT CLENSNUVAILPR CREAMBENZALKONIUMCHLORIDETopical Anti-inflammatory Steroid-localAnestheticT3 hydrocortisone LIDAMANTLEac/lidocaineHC(CREAM)T1 hydrocortisone LIDAMANTLEac/lidocaine HC(LOTION)T3 hydrocortisone LIDAMANTLEac/lidocaineHC(MED PAD)T1 hydrocortisone LIDOCAINEac/lidocaineHYDROCORTISONET3 hydrocortisone/lidocainXYRALIDe/clns6T3 hydrocortisone/lidocainXYRALID LPe/clns6T3 hydrocortisone/pramox EPIFOAMineT1 hydrocortisone/pram PRAMOSONE(CREAoxineM)T2 hydrocortisone/pramox PRAMOSONE(LOTIOineN)T2 hydrocortisone/pramox PRAMOSONE(OINT)ineT3 hydrocortisone/pramox NOVACORTine/aloeT2 hydrocortisone/pramox PRAMOSONE Eine/emollTopical Antineoplastic & PremalignantLesion AgntsT4 alitretinoinPANRETINT4 bexarotene TARGRETIN PAT3 diclofenac sodium SOLARAZE PAT3 fluorouracilT1 fluorouracilT3 fluorouracilT1 fluorouracilT2 ingenol mebutateTopical Local AnestheticsCARACEFUDEXFLUOROPLEXFLUOROURACILPICATOT3 benzocaineAMERICAINET3 benzocaineANACAINET1 cocaine hcl COCAINE HCLT3 dichlorotetrafluoroetha GEBAUER'S 114neT1 ethyl chloride ETHYL CHLORIDET1 lidocaineLIDOCAINET3 lidocaineLIDODERMT1 lidocaine hcl LIDAMANTLET1 lidocaine/prilocaine EMLAT3 lidocaine/tetracaine PLIAGLIST3 lidocaine/tetracaine SYNERAT3 norflurane/hfc 245fa PAIN EASET3 norflurane/hfc 245fa SPRAY ANDSTRETCHT1 pramoxine hcl PRAMOXT3 tetracaine hcl PONTOCAINET3 tetracaine/benzocaine/ CETACAINEbutambenT3 tetracaine/benzocaine/ CETACAINEbutambenANESTHETICT3 tetracaine/benzocaine/ CETACAINEbutambenMEDICAL KIT ET3 tetracaine/benzocain EXACTACAINe/butambenT3 vit e/lidocain/alo REGENECAREver/colagnTopical/mucous Membr./subcut. EnzymesT3 collagenaseclostridium hist.T3 trypsin/balsamperu/castor oilT1 trypsin/balsamperu/castor oilSANTYLOPTASEXENADERMDERMATOLOGY - PIGMENTATIONDISORDERSHypopigmentation AgentsT3 dioxybenzone/hydroquiNUQUIN HPnoneT1 dioxybenzone/pdo/hyNUQUIN HPdroquinoneT3 fluocinolone/tretinoin/h TRI-LUMA-quinT1 hydroquinone HYDROQUINONET3 hydroquinone REMERGENT HQT3 hydroquinone EPIQUIN MICROmicrospheresT1 hydroquinone HYDROQUINONEmicrospheresT3 hydroquinone/ascorbic C-CLARIFYINGacidSERUMPage 22 of 91
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