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>AntileproticsT1 dapsoneDAPSONET4 thalidomide THALOMID PAAnti-mycobacterium AgentsT3 aminosalicylic acidT1 ethambutol hclT3 ethionamideT1 isoniazidT1 pyrazinamideT3 rifabutinAntitubercular AntibioticsPASERMYAMBUTOLTRECATORISONIAZIDPYRAZINAMIDEMYCOBUTINT1 cycloserine SEROMYCINT1 rifampinRIFADINT1 rifampin/isoniazid ISONARIFT2 rifampin/isoniazid RIFAMATET3 rifampin/isoniazid/pyra RIFATERzinamidT3 rifapentinePRIFTINLincosamidesT1 clindamycin hclT1 clindamycinpalmitate hclCLEOCIN HCLCLINDAMYCINPALMITATE HCLRifamycins And Related DerivativeAntibioticsT3 rifaximinT2 rifaximinXIFAXAN(TAB)(200MG)XIFAXAN(TAB)(550MG)Vancomycin And DerivativesT1 vancomycin hcl VANCOCIN HCL QLINFECTIOUS DISEASE - PARASITIC2nd Gen. Anaerobic AntiprotozoalantibacterialT1 tinidazoleAmebacidesTINDAMAXT2 iodoquinolYODOXINT1 paromomycin sulfate PAROMOMYCINSULFATEAnaerobic Antiprotozoal-antibacterialAgentsT2 metronidazoleT2 metronidazoleT1 metronidazoleAnthelminticsT3 albendazoleT3 ivermectinT1 mebendazoleT2 praziquantelFLAGYLFLAGYL ERMETRONIDAZOLEALBENZASTROMECTOLMEBENDAZOLEBILTRICIDEQL, STAntimalarial <strong>Drug</strong>sT3 artemether/lumefantrin COARTEMeT1 atovaquone/proguani MALARONEl hclT1 chloroquine ARALENphosphatePHOSPHATET1 chloroquine CHLOROQUINEphosphatePHOSPHATET3 halofantrine hcl HALFANT1 hydroxychloroquine PLAQUENILsulfateT1 mefloquine hcl MEFLOQUINE HCLT2 primaquine phosphate PRIMAQUINET2 pyrimethamine DARAPRIMT2 pyrimethamine/sulfado FANSIDARxineT1 quinine sulfate QUALAQUINT1 quinine sulfate QUININE SULFATEAntiprotozoal <strong>Drug</strong>s,miscellaneousT3 atovaquoneT2 pentamidineisethionateMEPRONNEBUPENTINFECTIOUS DISEASE - VIRALAntivirals, GeneralT1 acyclovirZOVIRAXT1 famciclovirFAMVIRT1 ganciclovirGANCICLOVIRT2 oseltamivir phosphate TAMIFLUT2 ribavirinVIRAZOLET1 rimantadine hcl FLUMADINET1 valacyclovir hcl VALTREXT3 valganciclovir hcl VALCYTET3 zanamivirRELENZAAntivirals, Hiv-spec, Non-peptidic ProteaseInhibT4 darunavir ethanolateT4 darunavir ethanolateT2 darunavir ethanolateT4 darunavir ethanolateT4 darunavir ethanolateT4 darunavir ethanolateT4 darunavir ethanolateT4 tipranavirT4 tipranavir/vitamin etpgsPREZISTA(ORALSUSP)PREZISTA(TAB)(150MG)PREZISTA(TAB)(300MG)PREZISTA(TAB)(400MG)PREZISTA(TAB)(600MG)PREZISTA(TAB)(75MG)PREZISTA(TAB)(800MG)APTIVUSAPTIVUSPage 40 of 91
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