L.A. Care Covered Drug Formulary (pdf)

Commercial FormularyTopical HemostaticsT3 cellulose,oxidized OXYCELT3 cellulose,oxidized SURGICELT3 ferric subsulfate ASTRINGYNT3 fibrinogen/thrombin TACHOSIL(hum plas)T3 gelatinGELFOAMsponge,absorbableT3 gelatinGELFOAM PACKSsponge,absorbableT3 gelatinSURGIFOAMsponge,absorbableT3 microfibrillar collagen AVITENET3 microfibrillar collagen ENDO-AVITENET3 microfibrillar collagen HELITENET3 microfibrillar collagen ULTRAFOAMT1 thrombin (bovine) THROMBIN-JMIT3 thrombinRECOTHROM(recombinant)T3 thrombin(hum TISSEEL VHSDplas)/fib/apro/caT3 thrombin(hum EVICELplas)/fibrinog/caT1 thrombin/fibrinogen/apro/calHEMASEELAPR(KIT)(1 ML)T3 thrombin/fibrinogen/aprHEMASEELo/calAPR(KIT)(2 ML)T1 thrombin/fibrinogen/apro/calHEMASEELAPR(KIT)(5ML)Vitamin K PreparationsT1 phytonadioneT2 phytonadioneAQUA-MEPHYTONMEPHYTONHORMONAL DEFICIENCYAndrogenic AgentsT1 fluoxymesterone ANDROXYT2 methyltestosterone ANDROIDT2 methyltestosterone METHITESTT2 methyltestosterone TESTREDT1 oxandrolone OXANDRINT3 oxymetholone ANADROL-50T3 testosterone ANDRODERM(PATCHTD24)(2 MG/24 HR)T2 testosterone ANDRODERM(PATCH PATD24)(2.5MG/24HR)T3 testosterone ANDRODERM(PATCH PATD24)(4 MG/24 HR)T2 testosterone ANDRODERM(PATCH PATD24)(5 MG/24 HR)T2 testosterone ANDROGEL PAT2 testosterone AXIRON PAT3 testosterone FORTESTA PAT3 testosterone STRIANT PAT3 testosterone TESTIM PATESTOSTERONE(VIAL)(100 MG/ML)PAT2 testosterone cypionate DEPO-T1 testosterone DEPO-PAcypionateTESTOSTERONE(VIAL)(200 MG/ML)T1 testosterone TESTOSTERONE PAcypionateCYPIONATET2 testosterone enanthateDELATESTRYL PAT1 testosterone TESTOSTERONE PAenanthateENANTHATET3 testosteronepropionateFIRST-TESTOSTERONET3 testosteronepropionateFIRST-TESTOSTERONE MCEstrogen & Progestin WithAntimineralocorticoid CbT3 drospirenone/estradiol ANGELIQEstrogen/androgen CombinationsT1 estrogen,ester/metestosteroneT1 estrogen,ester/metestosteroneEstrogenic AgentsESTRATESTESTROGEN &METHYLTESTOSTERONET2 estradiol ALORA QLT1 estradiol CLIMARA QLT3 estradiolDIVIGELT3 estradiolELESTRINT1 estradiolESTRACET2 estradiol ESTRADERM QLT3 estradiolESTRASORBT3 estradiolESTROGELT3 estradiolEVAMISTT3 estradiol MENOSTAR QLT2 estradiol MINIVELLE QLT2 estradiol VIVELLE QLT2 estradiol VIVELLE-DOT QLT3 estradiol acetate FEMTRACET3 estradiol/levonorgestre CLIMARA PRO QLlT1 estradiol/norethindro ACTIVELLAne acetT2 estradiol/norethindroneCOMBIPATCHQLacetT1 estradiol/norethindro ESTRADIOLneacetNORETHINDRONEACETATT3 estradiol/norgestimate PREFESTT2 estrogen,con/mprogestPREMPHASEacetT2 estrogen,con/mprogestPREMPROacetT2 estrogens, conjugated PREMARINT3 estrogens,conj.,synthetCENESTINic aT3 estrogens,conj.,synthetENJUVIAic bT2 estrogens,esterified MENESTT1 estropipate OGENPage 36 of 91