L.A. Care Covered Drug Formulary (pdf)

Commercial FormularyOtic-antiinfective, Local Anesth & Anti-inflamCmbT1 chloroxylenol/benzocTRIOXIN/hydrocortELECTROLYTE REGULATIONArginine Vasopressin (avp) ReceptorAntagonistsT3 tolvaptan SAMSCA QLElectrolyte DepletersT1 calcium acetateT1 calcium acetateT3 calcium acetateT1 calciumcarbonate/magcarb/faT3 lanthanum carbonateT3 sevelamer carbonateT2 sevelamer carbonateT2 sevelamer hclT1 sodium polystyrenesulfonatePotassium ReplacementCALCIUM ACETATEPHOSLOPHOSLYRAMAGNEBIND 400 RXFOSRENOLRENVELA(POWDPACK)RENVELA(TAB)RENAGELSPST1 pot chloride/pot POTASSIUMbicarb/cit ac CHLORIDET3 potassium bicarbonate QUIC-KT3 potassiumEFFER-Kbicarbonate/cit acT1 potassiumKLOR-CON-EFbicarbonate/cit acT1 potassium chloride KAOCHLORT1 potassium chloride K-TABT1 potassium chloride MICRO-KT1 potassium chloride POTASSIUMCHLORIDET3 potassium chloride/pot KAOCHLOR-EFFbicarbT1 potassium gluconate POTASSIUMGLUCONATESodium/saline PreparationsT1 0.5 normal saline SODIUM CHLORIDET1 0.9 % sodium NORMAL SALINEchlorideFLUSHT1 normal saline SODIUM CHLORIDET1 sodium chloride 0.45 SODIUM CHLORIDE%ENDOCRINE DISORDER - FERTILITYDrugs To Treat ImpotencyT3 alprostadil CAVERJECT QLT3 alprostadil EDEX QLT3 alprostadil MUSE QLT2 sildenafil citrate VIAGRA G, QLT2 tadalafil CIALIS(TAB)(10 MG) G, QLT2 tadalafilCIALIS(TAB)(2.5 MG) G, QLT2 tadalafil CIALIS(TAB)(20 MG) G, QLT2 tadalafil CIALIS(TAB)(5 MG) G, QLT2 vardenafil hcl LEVITRA G, QLT2 vardenafil hcl STAXYN G, QLT1 yohimbine hcl YOHIMBINE HCLT1 yohimbine hcl/zincsulfateYOHIMARFertility Stimulating Preparations,non-fshT1 clomiphene citrateSEROPHENEFollicle Stim./luteinizing HormonesT4 menotropinsT4 menotropinsMENOPURREPRONEXFollicle-stimulating HormoneT4 follitropin alfa, recomb GONAL-FT4 follitropin alfa, recomb GONAL-F RFFT4 follitropin beta,recomb FOLLISTIM AQT4 urofollitropin BRAVELLEHuman Chorionic GonadotropinT2 chorionicCHORIONICgonadotropin, human GONADOTROPINT2 chorionicNOVARELgonadotropin, humanT2 chorionicPREGNYLgonadotropin, humanT2 hcg alpha,recombinant OVIDRELLuteinizing HormonesT3 lutropin alfaLUVERISPregnancy Facilitating/maintainingAgent,hormonalT3 progesterone FIRST-PROGESTERONEVGS 100T3 progesterone FIRST-PROGESTERONEVGS 200T3 progesterone FIRST-PROGESTERONEVGS 25T3 progesterone FIRST-PROGESTERONEVGS 400T3 progesterone FIRST-PROGESTERONEVGS 50T2 progesterone,microniz CRINONEedT2 progesterone,microniz ENDOMETRINedT2 progesterone,microniz PROCHIEVEedPage 30 of 91