L.A. Care Covered Drug Formulary (pdf)

Commercial FormularyT1 levetiracetam KEPPRAT1 levetiracetam KEPPRA XRT1 levetiracetam LEVETIRACETAMT3 mephobarbital MEBARALT1 mephobarbital MEPHOBARBITALT3 methsuximide CELONTINT1 oxcarbazepine OXCARBAZEPINET3 oxcarbazepine OXTELLAR XR(TAB QL, STER 24H)(150 MG)T3 oxcarbazepine OXTELLAR XR(TAB QL, STER 24H)(300 MG)T3 oxcarbazepine OXTELLAR XR(TAB QL, STER 24H)(600 MG)T2 oxcarbazepine TRILEPTAL(ORALSUSP)T1 oxcarbazepine TRILEPTAL(TAB)T1 phenytoinDILANTINT1 phenytoinDILANTIN-125T1 phenytoinPHENYTOINT1 phenytoin sodiumextendedDILANTIN(CAP)(100MG)T2 phenytoin sodiumextendedDILANTIN(CAP)(30MG)T2 phenytoin sodium PHENYTEKextendedT1 phenytoin sodiumextendedPHENYTOIN SODIUMEXTENDEDT2 pregabalinLYRICAT1 primidoneMYSOLINET3 rufinamideBANZEL(ORAL SUSP)QL, STT3 rufinamideBANZEL(TAB)(200 QL, STMG)T3 rufinamideBANZEL(TAB)(400 QL, STMG)T3 tiagabine hcl GABITRIL(TAB)(12 QL, STMG)T3 tiagabine hcl GABITRIL(TAB)(16 QL, STMG)T1 tiagabine hcl GABITRIL(TAB)(2 MG)QL, STT1 tiagabine hcl GABITRIL(TAB)(4 MG)QL, STT1 topiramateTOPAMAXT1 valproate sodium DEPAKENET1 valproate sodium VALPROIC ACIDT1 valproic acid DEPAKENET3 valproic acid STAVZOR STT1 valproic acid VALPROIC ACIDT3 vigabatrin SABRIL QLT1 zonisamide ZONEGRANT1 zonisamide ZONISAMIDESKELETAL MUSCLE DISORDERSkeletal Muscle RelaxantsT1 baclofenBACLOFENT1 carisoprodol SOMAT1 carisoprodol/aspirin CARISOPRODOLCOMPOUNDT1 chlorzoxazone CHLORZOXAZONET3 chlorzoxazone LORZONET1 chlorzoxazone PARAFON FORTEDSCT1 chlorzoxazone/aceta CHLORZOXAZONEminophenW/ACETAMINOPHENT3 cyclobenzaprine hcl AMRIXT1 cyclobenzaprine hcl CYCLOBENZAPRINEHCLT1 cyclobenzaprine hcl FEXMIDT1 cyclobenzaprine hcl FLEXERILT1 dantrolene sodium DANTRIUMT1 metaxalone SKELAXINT1 methocarbamol ROBAXINT1 methocarbamol ROBAXIN-750T1 orphenadrine citrate ORPHENADRINECITRATET1 orphenadrine/aspirin/ ORPHENADRINEcaffeineCOMPOUND FORTET1 tizanidine hcl ZANAFLEXUnknownT3 cyclobenz hcl/irr cntrirrcb2T3 tizanidine/irr cntr-irrcmb #2SMOKING CESSATIONSmoking Deterrent AgentsCOMFORT PAC-CYCLOBENZAPRINECOMFORT PAC-TIZANIDINET3 nicotine NICOTROL QLT3 nicotine NICOTROL NS QLSmoking Deterrent-nicotinic Recept.partialAgonistT3 varenicline tartrate CHANTIX QLSmoking Deterrents, OtherT1 bupropion hclBUPROBANUPPER GASTROINTESTINALDISORDERS - DIGESTIVEGastric EnzymesT4 sacrosidase SUCRAID PAPancreatic EnzymesT2 lipase/protease/amylasCREONeT2 lipase/protease/amylasCREON 10eT2 lipase/protease/amylasCREON 20eT2 lipase/protease/amylasCREON 5eT2 lipase/protease/amylasDYGASEeT2 lipase/protease/amylasLAPASEeT2 lipase/protease/amylasPANCREASE MT-10eT2 lipase/protease/amylasPANCREASE MT-16ePage 51 of 91