L.A. Care Covered Drug Formulary (pdf)

Commercial FormularyT1 budesonide PULMICORT(AMPUL- QLNEB)(0.5 MG/2ML)T2 budesonidePULMICORT(AMPUL- QLNEB)(1 MG/2 ML)T3 ciclesonide ALVESCO QLT3 flunisolide/menthol AEROBID-MT2 fluticasone propionate FLOVENTQLDISKUS(DISKW/DEV)(100 MCG)T2 fluticasone propionate FLOVENTQLDISKUS(DISKW/DEV)(250 MCG)T2 fluticasone propionate FLOVENTQLDISKUS(DISKW/DEV)(50 MCG)T2 fluticasone propionate FLOVENT HFA(AER QLW/ADAP)(110MCG)T2 fluticasone propionate FLOVENT HFA(AER QLW/ADAP)(220 MCG)T2 fluticasone propionate FLOVENT HFA(AER QLW/ADAP)(44MCG)T2 mometasone furoate ASMANEX QLT2 triamcinoloneacetonideAZMACORT QLLeukotriene Receptor AntagonistsT1 montelukast sodium SINGULAIRT1 zafirlukastACCOLATEMast Cell StabilizersT1 cromolyn sodiumT1 cromolyn sodiumT2 cromolyn sodiumCROMOLYN SODIUMGASTROCROMINTALPhosphodiesterase-4 (pde4) InhibitorsT2 roflumilast DALIRESP QL, STXanthinesT1 aminophylline AMINOPHYLLINET1 caffeine citrated CAFCITT3 dyphyllineDYLIXT3 dyphyllineLUFYLLINT3 dyphyllineLUFYLLIN-400T1 theophyll/ephed THEOTALhcl/phenobarbT2 theophylline anhydrousTHEO-24T1 theophylline THEOCHRONanhydrousT1 theophyllineanhydrousTHEOPHYLLINEANHYDROUSAUTONOMIC NERVOUS SYSTEMDISORDERSAlzheimer's Therapy, Nmda ReceptorAntagonistsT2 memantine hclCholinesterase InhibitorsNAMENDAT3 ambenonium chloride MYTELASET1 donepezil hcl ARICEPT ODTT1 donepezil hcl ARICEPT(TAB)(10MG)T2 donepezil hcl ARICEPT(TAB)(23MG)T1 donepezil hcl ARICEPT(TAB)(5 MG)T1 galantamine hbr RAZADYNET1 galantamine hbr RAZADYNE ERT2 neostigmine bromide PROSTIGMINT2 pyridostigmine MESTINON(SYRUP)bromideT2 pyridostigmine MESTINON(TAB ER)bromideT1 pyridostigmine MESTINON(TAB)bromideT3 rivastigmine EXELON(PATCHTD24)(13.3MG/24H)T2 rivastigmine EXELON(PATCHTD24)(4.6MG/24HR)T2 rivastigmine EXELON(PATCHTD24)(9.5MG/24HR)T1 rivastigmine tartrate EXELON(CAP)T2 rivastigmine tartrate EXELON(SOLUTION)T3 tacrine hclCOGNEXBEHAVIORAL HEALTH -ANTIDEPRESSANTSAlpha-2 Receptor AntagonistAntidepressantsT1 mirtazapineT1 mirtazapineMIRTAZAPINEREMERONMaois - Non-selective & IrreversibleT3 isocarboxazidT1 phenelzine sulfateT1 tranylcyprominesulfateMARPLANNARDILPARNATENorepinephrine And Dopamine ReuptakeInhibT3 bupropion hbr APLENZIN QL, STT3 bupropion hcl FORFIVO XL QL, STT1 bupropion hcl WELLBUTRIN SRSelective Serotonin Reuptake InhibitorT1 citalopramCELEXAhydrobromideT1 escitalopram oxalate LEXAPROT1 fluoxetine hcl FLUOXETINE HCLT1 fluoxetine hcl PROZACT1 fluoxetine hcl RAPIFLUXT3 fluoxetine hcl SARAFEMT1 fluvoxamine maleate FLUVOXAMINEMALEATET1 fluvoxamine maleate LUVOX CRT1 paroxetine hcl PAROXETINE HCLT1 paroxetine hcl PAXIL CRT2 paroxetine hcl PAXIL(ORAL SUSP)QL, STPage 7 of 91