L.A. Care Covered Drug Formulary (pdf)

Commercial FormularyT2 norethind ac/ethinylestradiolT1 norethind ac/ethinylestradiolProgestational AgentsFEMHRT(TAB)(0.5MG-2.5)FEMHRT(TAB)(1MG-5MCG)T1 medroxyprogesterone acetMEDROXYPROGESTERONE ACETATET1 medroxyprogesteron PROVERAe acetateT1 norethindrone AYGESTINacetateT3 progesterone PROGESTERONET1 progesterone,micronizedPROMETRIUMIMMUNIZATIONAntiseraT4 immune glob,gamcaprylate(igg)T4 immune glob,gamcaprylate(igg)T4 immuneglobulin,gamma(igg)T3 immuneglobulin,gamma(igg)GAMMAKEDGAMUNEX-CHIZENTRAVIVAGLOBINIMMUNOSUPPRESSION/MODULATIONImmunomodulatorsT1 imiquimod ALDARA PAT3 imiquimod ZYCLARA PAT2 interferon alfa- INTRON A(PEN INJ PA2b,recomb.KIT)(10MM/0.2ML)T4 interferon alfa-2b,recomb.INTRON A(PEN INJKIT)(3MM/0.2 ML)PAPAPAPAT2 interferon alfa-2b,recomb.INTRON A(PEN INJKIT)(5MM/0.2ML)T4 interferon alfa- INTRON A(VIAL)2b,recomb.T4 interferon alfa-n3 ALFERON NT4 interferon gamma- ACTIMMUNE1b,recomb.ImmunosuppressivesT3 azathioprine AZASANT1 azathioprine IMURANT4 cyclosporine CYCLOSPORINET4 cyclosporine SANDIMMUNET4 cyclosporine,NEORALmodifiedT4 everolimus ZORTRESST1 mycophenolate CELLCEPT(CAP)mofetilT2 mycophenolate mofetil CELLCEPT(SUSPRECON)T1 mycophenolate CELLCEPT(TAB)mofetilT3 mycophenolate sodium MYFORTICT4 sirolimus RAPAMUNET4 tacrolimus HECORIAINFECTIOUS DISEASE - BACTERIALAbsorbable SulfonamidesT1 sulfamethoxazole/tri BACTRIMmethoprimT1 sulfamethoxazole/trimethoprimSULFAMETHOXAZOLE-TRIMETHOPRIMT2 sulfisoxazole acetyl GANTRISINBetalactamsT4 aztreonam lysine CAYSTON PACephalosporins - 1st GenerationT1 cefadroxil hydrate CEFADROXILT1 cephalexin CEPHALEXINT1 cephalexin KEFLEX(CAP)(250MG)T1 cephalexin KEFLEX(CAP)(500MG)T3 cephalexin KEFLEX(CAP)(750MG)Cephalosporins - 2nd GenerationT1 cefaclor CEFACLORT3 cefaclor RANICLORT1 cefprozil CEFPROZILT2 cefuroxime axetil CEFTIN(SUSPRECON)T1 cefuroxime axetil CEFTIN(TAB)Cephalosporins - 3rd GenerationT1 cefdinir OMNICEFT1 cefditoren pivoxil SPECTRACEFT2 cefixime SUPRAXT1 cefpodoxime proxetil CEFPODOXIMEPROXETILPAPAPage 37 of 91