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L.A. Care Covered Drug Formulary (pdf)

L.A. Care Covered Drug Formulary (pdf)

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Commercial <strong>Formulary</strong>Anti-inflammatory Tumor Necrosis FactorInhibitorT4 adalimumab HUMIRA PAT4 etanercept ENBREL PAT4 golimumab SIMPONI PAAnti-inflammatory, Pyrimidine SynthesisInhibitorT1 leflunomideARAVAAntinflammatory, Sel.costim.mod.,t-cellInhibitorT4 abatacept ORENCIA PABradykinin B2 Receptor AntagonistsT4 icatibant acetate FIRAZYR PAC1 Esterase InhibitorsT4 c1 esterase inhibitor BERINERT PAT4 c1 esterase inhibitor CINRYZEGlucocorticoidsT3 betamethasone CELESTONET1 budesonide ENTOCORT ECT3 budesonide UCERIS STT1 cortisone acetate CORTISONEACETATET1 dexamethasone DEXAMETHASONET3 dexamethasone DEXAMETHASONEINTENSOLT3 dexamethasone DEXPAKT1 hydrocortisone CORTEFT1 methylprednisolone MEDROL(TAB DS PK)T1 methylprednisolone MEDROL(TAB)(16MG)T2 methylprednisolone MEDROL(TAB)(2 MG)T1 methylprednisolone MEDROL(TAB)(32MG)T1 methylprednisolone MEDROL(TAB)(4 MG)T1 methylprednisolone MEDROL(TAB)(8 MG)T1 methylprednisolone METHYLPREDNISOLONET2 prednisolone MILLIPREDT2 prednisolone MILLIPRED DPT1 prednisolone PREDNISOLONET3 prednisolone acetate FLO-PREDT3 prednisolone sod ASMALPREDph/peak flowT3 prednisolone sod ASMALPRED PLUSph/peak flowT3 prednisolone sod MILLIPREDphosphateT1 prednisolone sod ORAPREDphosphateT3 prednisolone sod ORAPRED ODTphosphateT1 prednisolone sodphosphatePEDIAPREDT1 prednisolone sodphosphateT3 prednisolone sodphosphateT1 prednisoneT2 prednisonePREDNISOLONESODIUMPHOSPHATEVERIPRED 20PREDNISONEPREDNISONEINTENSOLT3 prednisone RAYOS STT3 triamcinolone diacetateARISTOCORTGold SaltsT3 auranofinRIDAURAJanus Kinase (jak) InhibitorsT4 tofacitinib citrate XELJANZ PAMineralocorticoidsT1 fludrocortisoneacetateFLUDROCORTISONEACETATEMonoclonal Antibody-human Interleukin12/23 InhibT4 ustekinumabSTELARANasal Nsaids, Cox Non-selective,systemicAnalgesicT3 ketorolactromethamineSPRIXQLNsaid & Histamine H2 Receptor AntagonistComb.T3 ibuprofen/famotidine DUEXIS QL, STNsaid, Cox Inhibitor-type & Proton PumpInhib CombT2 naproxen/esomeprazol VIMOVOe magNsaids (cox Non-specific Inhib)&Prostaglandin CmbT1 diclofenacARTHROTEC 50sodium/misoprostolT1 diclofenacARTHROTEC 75sodium/misoprostolSTNsaids, Cyclooxygenase 2 Inhibitor - TypeT2 celecoxib CELEBREX AGE,STNsaids, Cyclooxygenase Inhibitor-typeT1 diclofenac potassiumCATAFLAMT3 diclofenac potassium ZIPSORT1 diclofenac sodium DICLOFENACSODIUMT1 diclofenac sodium VOLTARENT1 diclofenac sodium VOLTAREN-XRPage 42 of 91

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