L.A. Care Covered Drug Formulary (pdf)

Commercial FormularyPARKINSONS DISEASEAntiparkinsonism Drugs,anticholinergicT1 benztropine mesylateBENZTROPINEMESYLATET1 trihexyphenidyl hcl TRIHEXYPHENIDYLHCLAntiparkinsonism Drugs,otherT1 amantadine hcl AMANTADINET4 apomorphine hcl APOKYN PA, QLT1 bromocriptine PARLODELmesylateT1 carbidopa/levodopa PARCOPAT1 carbidopa/levodopa SINEMET 10-100T1 carbidopa/levodopa SINEMET 25-100T1 carbidopa/levodopa SINEMET 25-250T1 carbidopa/levodopa SINEMET CRT1 carbidopa/levodopa/eSTALEVO 100ntacaponeT1 carbidopa/levodopa/eSTALEVO 125ntacaponeT1 carbidopa/levodopa/eSTALEVO 150ntacaponeT1 carbidopa/levodopa/eSTALEVO 200ntacaponeT1 carbidopa/levodopa/eSTALEVO 50ntacaponeT1 carbidopa/levodopa/eSTALEVO 75ntacaponeT1 entacapone COMTANT1 pramipexole di-hcl MIRAPEXT3 pramipexole di-hcl MIRAPEX ER QL, STT2 rasagiline mesylate AZILECT QLT1 ropinirole hcl REQUIPT1 ropinirole hcl REQUIP XL QL, STT2 rotigotine NEUPRO QL, STT1 selegiline hcl ELDEPRYLT1 selegiline hcl SELEGILINE HCLT3 selegiline hcl ZELAPAR QLT3 tolcapone TASMAR QL, STDecarboxylase InhibitorsT2 carbidopaSEIZURE DISORDERAnticonvulsantsLODOSYNT1 carbamazepine CARBAMAZEPINET1 carbamazepine CARBATROLT1 carbamazepine TEGRETOLT2 carbamazepine TEGRETOL XRT3 clobazam ONFI QL, STT1 clonazepam KLONOPINT1 diazepam DIASTAT QLT2 diazepamDIASTATQLACUDIAL(KIT)(12.5-15-20)T1 diazepamDIASTATACUDIAL(KIT)(5-7.5-10MG)QLT1 diazepamDIAZEPAMT1 divalproex sodium DEPAKOTE ERT1 ethosuximide ZARONTINT3 ethotoinPEGANONET3 ezogabinePOTIGA(TAB)(200 QL, STMG)T3 ezogabinePOTIGA(TAB)(300 QL, STMG)T3 ezogabinePOTIGA(TAB)(400 QL, STMG)T3 ezogabinePOTIGA(TAB)(50 MG) QL, STT1 felbamateFELBATOL(ORAL QL, STSUSP)T1 felbamateFELBATOL(TAB)(400 QL, STMG)T1 felbamateFELBATOL(TAB)(600 QL, STMG)T3 gabapentinFANATREXT1 gabapentin NEURONTINT3 lacosamideVIMPAT(SOLUTION)T3 lacosamide VIMPAT(TAB) QL, STT1 lamotrigine LAMICTALT1 lamotrigine LAMICTAL (BLUE)T1 lamotrigine LAMICTAL(GREEN)(TAB DSPK)(25(84)-100)T2 lamotrigineLAMICTAL(GREEN)(TAB DSPK)(25(84)-100)T2 lamotrigineLAMICTAL (ORANGE)T3 lamotrigineLAMICTAL ODT ST(BLUE)T3 lamotrigineLAMICTAL ODT ST(GREEN)T3 lamotrigineLAMICTAL ODT ST(ORANGE)T3 lamotrigineLAMICTAL ODT(TAB QL, STRDP DIS)(100 MG)T3 lamotrigineLAMICTAL ODT(TAB QL, STRDP DIS)(200 MG)T3 lamotrigineLAMICTAL ODT(TAB QL, STRDP DIS)(25 MG)T3 lamotrigineLAMICTAL ODT(TAB QL, STRDP DIS)(50 MG)T3 lamotrigineLAMICTAL XR (BLUE) STT3 lamotrigineLAMICTAL XR ST(GREEN)T3 lamotrigineLAMICTAL XR ST(ORANGE)T1 lamotrigine LAMICTAL XR(TAB QL, STER 24H)(100 MG)T1 lamotrigine LAMICTAL XR(TAB QL, STER 24H)(200 MG)T1 lamotrigine LAMICTAL XR(TAB QL, STER 24H)(25 MG)T1 lamotrigine LAMICTAL XR(TAB QL, STER 24H)(250 MG)T1 lamotrigine LAMICTAL XR(TAB QL, STER 24H)(300 MG)T1 lamotrigine LAMICTAL XR(TAB QL, STER 24H)(50 MG)T1 lamotrigine LAMOTRIGINEPage 50 of 91