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>Photoactivated, Antineopls. & PremalignantLesionsT3 aminolevulinic acid hcl LEVULANT3 methyl aminolevulinate METVIXIAhclSelective Estrogen Receptor ModulatorsT2 tamoxifen citrateT1 tamoxifen citrateT4 toremifene citrateSOLTAMOXTAMOXIFEN CITRATEFARESTONSelective Retinoid X Receptor AgonistsT4 bexarotene TARGRETIN PASteroid AntineoplasticsT4 estramustinephosphate sodiumT1 megestrol acetateEMCYTMEGESTROLACETATENEUROLOGICAL DISEASE -MISCELLANEOUSAgents To Treat Multiple SclerosisT4 fingolimod hcl GILENYA PAT4 glatiramer acetate COPAXONET4 interferon beta-1a AVONEX STT4 interferon beta- AVONEXST1a/albuminADMINISTRATIONPACKT4 interferon beta- REBIF1a/albuminT4 interferon beta-1b BETASERON STT4 interferon beta-1b EXTAVIA STT4 teriflunomide AUBAGIO PAAgts Tx Neuromusc Transmission Dis,potchanBlkrT4 dalfampridine AMPYRA PAAmyotrophic Lateral Sclerosis AgentsT4 riluzoleRILUTEKFibromyalgia Agents,serotonin-norepinephRu InhibT2 milnacipran hclMovement DisordersSAVELLAT3 gabapentin enacarbil HORIZANT QL, STT4 tetrabenazine XENAZINEPostherpetic Neuralgia AgentsT3 gabapentinT3 gabapentinGRALISE(TAB ER24H)(300 MG)GRALISE(TAB ER24H)(300-600 MG)QL, STQL, STT3 gabapentinGRALISE(TAB ER24H)(600 MG)Pseudobulbar Affect (pba) Agents, NmdaAntagonistsT3 dextromethorphanhbr/quinidineNUEDEXTAORAL/PHARYNGEAL DISORDERSDental Aids And PreparationsT1 chlorhexidinegluconateT3 potassium oxalateT1 triamcinoloneacetonideT3 zinc cl/bcaine/cetylpyrdclPERISOLREMESENSETRIAMCINOLONEACETONIDEBUCALCIDENose Preparations AntibioticsT2 mupirocin calciumBACTROBAN NASALNose Preparations, MiscellaneousT1 ipratropium bromide ATROVENTPeriodontal Collagenase InhibitorsT3 doxycycline hyclateORAXYLQL, STPeriodontal Tetracycline Antiinfective, LocalT3 doxycycline hyclateT3 minocycline hclmicrospheresATRIDOXARESTINPAOTHER RESPIRATORY DISORDERSCystic Fib.transmembConduct.reg.(cftr)potentiatorT4 ivacaftor KALYDECO PALung SurfactantsT3 beractantT3 calfactantT3 lucinactantT3 poractant alfaMucolyticsSURVANTAINFASURFSURFAXINCUROSURFT1 acetylcysteine ACETYLCYSTEINET4 dornase alfa PULMOZYME PAPAIN MANAGEMENT - ANALGESICSAnalgesic, Non-salicylate & BarbiturateComb.T3 butalbital/acetaminoph BUPAPenT3 butalbital/acetaminoph ORBIVAN CFenPage 46 of 91
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