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>T3 na phos,m-b/k K-PHOS M.F.phos,monobT3 na phos,m-b/k K-PHOS NO.2phos,monobT1 phosphorus #1 PHOSPHA 250NEUTRALT1 potassium citrate UROCIT-K(TABER)(10 MEQ)T3 potassium citrate UROCIT-K(TABER)(15 MEQ)T1 potassium citrate UROCIT-K(TAB ER)(5MEQ)T1 potassiumCYTRA-Kcitrate/citric acidT3 potassiumK-PHOS ORIGINALphosphate,monobasicT1 sod/pot/k & sod cit/c TRICITRATESac/sucroT1 sod/pot/k cit/sod CYTRA-3cit/cit acidUrinary Tract Analgesic AgentsT2 pentosan polysulfatesodiumELMIRONUrinary Tract Anesthetic/analgesic AgntT1 phenazopyPYRELLE HBhcl/hyoscy/butabarbT1 phenazopyridine hcl PHENAZOPYRIDINEHCLT1 phenazopyridine hcl PYRIDIUMT1 phenazopyridine hcl URODOLUrinary Tract Antispasmodic, M(3) SelectiveAntag.T3 darifenacinENABLEXSThydrobromideT2 solifenacin succinate VESICARE STUrinary TractAntispasmodic/antiincontinence AgentT2 fesoterodine fumarate TOVIAZSTT1 flavoxate hcl FLAVOXATE HCLT3 oxybutynin GELNIQUE STT3 oxybutynin OXYTROL STT3 oxybutynin chloride GELNIQUE STT1 oxybutynin chloride OXYBUTYNINCHLORIDET1 tolterodine tartrate DETROL STT2 tolterodine tartrate DETROL LA STT1 trospium chloride SANCTURA STT1 trospium chloride SANCTURA XR STVAGINAL DISORDERSVaginal AntibioticsT1 clindamycin CLEOCIN(CREAM/APphosphatePL)T3 clindamycin phosphate CLEOCIN(SUPP VAG)T3 clindamycin phosphate CLINDESSET1 metronidazoleT2 metronidazoleVaginal AntifungalsMETROGEL-VAGINALVANDAZOLET2 butoconazole nitrate GYNAZOLE-1T1 miconazole nitrate MICONAZOLE 3T1 terconazole TERCONAZOLEVaginal AntisepticsT1 aceticACID JELLYac/ricinoleic/oxyquinolVaginal Estrogen PreparationsT2 estradiolESTRACET3 estradiol ESTRING QLT2 estradiolVAGIFEMT3 estradiol acetate FEMRING QLT2 estrogens, conjugated PREMARINVaginal SulfonamidesT2 sulfanilamideAVCVaginal/cervical <strong>Care</strong> And Treatment AgentsT1 sodAMINO ACIDpropion/inositol/aa14 CERVICAL/ureaVITAMIN AND/OR MINERALDEFICIENCYAntioxidant Multivitamin CombinationsT1 vita,c,e/zinc/copper/lut/zeaxCalcium ReplacementMACUTEKT1 calFOLGARD OScarb/mgox/d3/b12/fa/b6/borFluoride PreparationsT3 sodium fluoride CLINPRO 5000T1 sodium fluoride FLUORIDE(TABCHEW)(0.25(0.55))T3 sodium fluoride FLUORIDE(TABCHEW)(1MG(2.2MG))T3 sodium fluoride NAFRINSE DAILY-NEUTRALT1 sodium fluoride/pot FLUORIDEXnitrateSENSITIVITY RELIEFT3 sodium fluoride/pot PREVIDENT 5000nitrateENAMEL PROTECTT3 sodium fluoride/pot PREVIDENT 5000nitrateSENSITIVET1 stannous fluoride GEL-KAMFolic Acid PreparationsT1 folic acidFOLIC ACIDPage 54 of 91
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