L.A. Care Covered Drug Formulary (pdf)

Commercial FormularyGeriatric Vitamin PreparationsT3 multivitamins, min UDAMIN#28/fa/lycoT3 mv, minREQ49+cmb#16/fa/lutein/lycopIron ReplacementT3 fe bisgly/feNIFEREX GOLDp/doss/c/fa/mv 14T1 fe fum/doss FERRO-PLEXna/c/e/b12-if/fa HEMATINICT1 feVITAFOLfumarate/cal/e/fa/multivitT1 feNEPHRON FAfumarate/doss/fa/bcomp&cT1 fe fumarate/fa/mv, HEMOCYTE PLUSmin comb#15T1 fe fumarate/fe ps DUALVIT Fcmplx/faT3 fe fumarate/fe ps TANDEM Fcmplx/faT1 fe fumarate/vit HEMATOGENc/b12/stomcT1 fe fumarate/vit c/b12- FEROCONif/faT3 fe hemePROFERRIN-FORTEpolypeptide/folic acidT3 ferricHEMATRONamcit/cyanocobalamin/faT3 ferric amcit/lys/vit b HEMATRONcomp/faT1 ferrous fumarate/folicHEMOCYTE-FacidT3 ferrous fumarate/vit FETRINc/b12-ifT3 ferrous fumarate/vit FUMATINICc/b12-ifT3 ferrous fumarate/vit CEVI-FERc/faT3 ferrous sulf/fa/vit b & c I-FOL PLUSno.8T1 ferrous sulfate/fa/vit MULTI-RET FOLICbcomp&c500T1 ferrous sulfate/vit TL-FOL 500c/faT3 ferumoxytolFERAHEMET3 iron &iron asp CORVITE FEgly/fa/mv,min27T1 iron &iron asp IRONgly/fa/mv,min38T1 iron ag&fum/c/fa/mv FERREX 28cmb11/ca-tT3 iron ag&fum/c/fa/mv REPLIVA 21-7cmb11/ca-tT1 ironMULTIGENag/c/b12/ca/suc.acid/stomT1 iron aspgly&pscmplx/c/sucacT1 ironaspgly&ps/c/b12/fa/ca/sucT1 ironaspgly/c/b12/fa/cath/sucREXAVITE 150FERREX 150 FORTEPLUSCHROMAGEN FAT1 iron bg&ps/vit TARON FORTEc/b12/fa/ca thrT3 iron bisgly & IROSPANps/fa/b&c#12/sucT1 iron fum &MULTIGEN PLUSag/c/b12/fa/ca/succT3 iron fum &NIRON KOMPLETEbisgly/fa/c/e/b12T1 iron fum & p/fa/vit b INTEGRA PLUS& c no.9T1 iron fum & ps INTEGRA Fcmp/fa/vit c/b3T1 ironSE-TAN PLUSfum&polysac#1/fa/mvno.18T1 iron fumarate/vit c/vit FERROGELS FORTEb12/faT3 iron gly&fum/c/b12/me-MAXAROthfolate FORTET3 iron ps cmplx/folic NOVAFERRUMacid/vit cT3 iron ps cmplx/vit b12/faHEMOCYTE-FT1 iron ps cmplx/vit POLY-IRON 150b12/faFORTET1 iron ps/iron hem BIFERA RXpoly/fa/b12T1 ironVITAFOLpyrophos/b12/fa/niac/b-6T1 iron, carb & FERRALET 90 DUALgluc/fa/b12/c/dssIRONT1 iron, carbonyl/fa/c/b- CORVITE 1506/b12/znT1 iron,carb/dss/b12if/fa HEMATRON-AF/mv-mnT3 iron,fum&ps/fa/vit FUSION PLUSb&c#18/l.caT1 iron/fa/b12/c/docusat FERRAPLUS 90e sodiumT1 iron/fa/vitamin b HEMATINIC PLUScomp w-c/minT3 iron/folic acid IROFOLT3 iron/folicFERIVAacid/c/b12/biotinT1 iron/liver ext/vit SIDEROLbcomp&c/minMineral Replacement,miscellaneousT3 docusateGLUTOFAC-MXsodium/fa/mv&iron/minMultivitamin PreparationsT3 amino ac/fa/mvmn/dietary2PROTECT PLUS NRPage 55 of 91