L.A. Care Covered Drug Formulary (pdf)

Commercial FormularyT2 insulinLANTUS SOLOSTARglargine,hum.rec.anlogT3 insulin glulisine APIDRAT3 insulin glulisine APIDRA SOLOSTART2 insulin lispro HUMALOGT2 insulin npl/insulin lisproHUMALOG MIX 50-50T2 insulin npl/insulin lisproHUMALOG MIX 75-25T2 insulin regular, human HUMULIN RT2 insulin regular, human HUMULIN R(OTC)T2 insulin regular, human NOVOLIN R(OTC)T2 insuln asp prt/insulin NOVOLOG MIX 70-30aspartT2 insuln asp prt/insulin NOVOLOG MIX 70-30aspartFLEXPENT2 nph, human insulin HUMULIN N(OTC)isophaneT2 nph, human insulin NOVOLIN NisophaneINNOLET(OTC)T2 nph, human insulin NOVOLIN N(OTC)isophaneUrine Glucose/acetone Test Aids,stripsT3 urine gluc-acetcomb.tst,stripT3 urine gluc-acetcomb.tst,stripT3 urine gluc-acetcomb.tst,stripT3 urine gluc-acetcomb.tst,stripT3 urine gluc-acetcomb.tst,stripT3 urine gluc-acetcomb.tst,stripT3 urine gluc-acetcomb.tst,stripT3 urine gluc-acetcomb.tst,stripT3 urine gluc-acetcomb.tst,stripT3 urine gluc-acetcomb.tst,stripT3 urine gluc-acetcomb.tst,stripCHEMSTRIPUGK(OTC)DIASCREEN 10(OTC)DIASCREEN 2GKREAGENT(OTC)DIASCREEN 3REAGENT(OTC)DIASCREEN4OBL(OTC)DIASCREEN 5(OTC)DIASCREEN 6(OTC)DIASCREEN 7(OTC)DIASCREEN 8(OTC)DIASCREEN 9(OTC)KETO-DIASTIXREAGENT(OTC)EAR - GENERAL DISORDERSEar Preparations Anti-inflammatoryT1 fluocinolone DERMOTICacetonide oilT1 hc/pramoxine/chloro HYDROxylenol/bakEar Preparations, Misc. Anti-infectivesT1 acetic acidVOSOLT1 acetic acid/aluminum ACETIC ACIDacetateALUMINUMT1 aceticHYDROCORTISONEacid/hydrocortisoneACETIC ACIDT1 cresyl ace/ben CRESYLATEalc/butanol/ipaPRAMOXINE-HCCORTANE-BOTO-END 10Ear Preparations,antibioticsEar Preparations,local AnestheticsT1 hc/pramox hcl/clxylenol/waterT3 hc/pramoxinehcl/chloroxylenolT1 hc/pramoxinehcl/chloroxylenolT1 ciprofloxacin hcl CETRAXALT3 neo sul/plymx b PEDIOTICsu/buffers/hcT3 neomy sulf/colist COLY-MYCIN Ssul/hc/thonzT3 neomy sulf/colist CORTISPORIN-TCsul/hc/thonzT1 neomycin/polymyxin NEOMYCINbsulf/hcPOLYMYXIN-HCT3 ofloxacinFLOXINT1 aa/antipyrn/bcaine/poAURALGANlico#1/alT1 aa/antpy/bcaine/polic AABPo/al acetT3 antipy/benzocaine/poli OTIC CAREcos no.1T3 antipyrine/benzocain/glNEOTICy/zincT3 antipyrine/benzocain/glOTOZINy/zincT3 antipyrine/benzocaine AURALGANT1 antipyrine/benzocain AURAXeT1 antipyrine/benzocain ANTIPYRINEe/glycerinBENZOCAINET1 benzocaine BENZOTICT1 phenylephrine/antipy OTOGESIC/b-caineT2 ciprofloxacin CIPRODEXhcl/dexamethT3 ciprofloxacin/hydrocortiCIPRO HCsoneOtic,antiinfective-local AnestheticCombinationsOtic Preparations,anti-inflammatoryantibioticsT3 chloroxylenol/glyc/pra ZINOTICmox/zincT3 chloroxylenol/glyc/pra ZINOTIC ESmox/zincT1 chloroxylenol/pramo CHLOROXYLENOLxinehclPRAMOXINE HCLT3 chloroxylenol/pramoxinOTICINe hclPage 29 of 91