L.A. Care Covered Drug Formulary (pdf)

Index- # -0.5 NORMAL SALINE.............................................. 300.9 % SODIUM CHLORIDE......................................301 + 1-F...................................................................... 172TEK(OTC)...............................................................248-MOP...................................................................... 23- A -AA/ANTIPYRN/BCAINE/POLICO#1/AL................... 29AA/ANTPY/BCAINE/POLICO/AL ACET...................29AABP........................................................................ 29ABACAVIR SULFATE............................................... 41ABACAVIR SULFATE/LAMIVUDINE........................ 41ABACAVIR/LAMIVUDINE/ZIDOVUDINE..................41ABATACEPT.............................................................42ABILIFY DISCMELT(TAB RDP DIS)(10 MG)......8, 59,6 4ABILIFY DISCMELT(TAB RDP DIS)(15 MG)......8, 59,6 4ABILIFY(SOLUTION)..................................... 9, 59, 64ABILIFY(TAB)................................................. 9, 59, 64ABIRATERONE ACETATE....................................... 45ABSORICA............................................................... 16ABSTRAL........................................................... 47, 73ACAMPROSATE CALCIUM....................................... 8ACANYA................................................................... 16ACARBOSE..............................................................23ACCOLATE.................................................................7ACCU-CHEK FASTCLIX(OTC)................................ 28ACCU-CHEK SMARTVIEW(OTC)............................26ACCU-CHEK SOFTCLIX(OTC)................................28ACCU-CHEK(OTC)...................................... 24, 25, 28ACCUNEB.................................................................. 6ACCUPRIL................................................................11ACCUTREND GLUCOSE(OTC)...............................24ACEBUTOLOL HCL..................................................11ACEON..................................................................... 11ACETAMINOPH-CAFF-DIHYDROCODEIN............. 47ACETAMINOPHEN W/CODEINE.............................49ACETAMINOPHEN WITH CODEINE....................... 49ACETAMINOPHEN/CAFFEINE/BUTALB................. 47ACETAMINOPHEN/PHENYLTOLOX/CAFF.............47ACETAMINOPHEN-CODEINE................................. 49ACETAZOLAMIDE....................................................33ACETIC AC/RICINOLEIC/OXYQUINOL...................54ACETIC ACID.....................................................20, 29ACETIC ACID/ALUMINUM ACETATE......................29ACETIC ACID/HYDROCORTISONE........................29ACETIC ACID-ALUMINUM.......................................29ACETOHYDROXAMIC ACID................................... 44ACETYLCYSTEINE..................................................46ACID JELLY..............................................................54ACIPHEX......................................................53, 59, 64ACITRETIN...............................................................23ACLARO...................................................................23ACLARO PD.............................................................23ACLIDINIUM BROMIDE............................................. 6ACLOVATE............................................................... 18ACTIGALL................................................................ 44ACTIMMUNE............................................................37ACTIQ.................................................................47, 73ACTIVELLA.............................................................. 36ACTONEL WITH CALCIUM......................... 31, 59, 64ACTONEL(TAB)(150 MG)............................ 31, 59, 64ACTONEL(TAB)(30 MG).............................. 31, 59, 64ACTONEL(TAB)(35 MG).............................. 31, 59, 64ACTONEL(TAB)(5 MG)................................ 31, 59, 64ACTONEL(TAB)(75 MG).................................... 31, 64ACTOPLUS MET................................................24, 64ACTOPLUS MET XR..........................................24, 64ACTOS..................................................................... 24ACULAR................................................................... 32ACULAR LS..............................................................32ACURA CONTROL SOLUTION LOW(OTC)............25ACURA CONTROL SOLUTION NORMAL(OTC)......2 6ACURA CONTROL SOLUTION(OTC)..................... 25ACUVAIL...................................................................32ACYCLOVIR.......................................................18, 40ACYCLOVIR/HYDROCORTISONE..........................18ACYCLOVIR/LIDOCAINE HCL................................ 18ACZONE...................................................................16ADALAT CC..............................................................12ADALIMUMAB..........................................................42ADAPALENE............................................................ 17ADAPALENE/BENZOYL PEROXIDE....................... 16ADCIRCA..................................................... 12, 64, 73ADDERALL...........................................................8, 59ADEFOVIR DIPIVOXIL.............................................41ADIPEX-P.................................................................57ADJUSTABLE LANCING DEVICE(OTC)................. 27ADOXA..................................................................... 39ADOXA CK............................................................... 39ADOXA PAK................................................. 39, 59, 64ADOXA TT................................................................39ADRENACLICK(AUTO INJECT)(0.15/0.15).............44ADRENACLICK(AUTO INJECT)(0.3MG/0.3)........... 44ADVAIR DISKUS............................................ 6, 59, 64ADVAIR HFA...................................................6, 59, 64ADVANCE INTUITION(OTC)....................................26ADVANCE(OTC).......................................................26ADVANCED LANCING DEVICE(OTC).....................28ADVATE....................................................................34ADVATE H................................................................ 34ADVATE L.................................................................34ADVATE M................................................................34ADVATE SH..............................................................34ADVATE UH..............................................................34ADVICOR(TBMP 24HR)(1000-20MG)......... 13, 59, 64ADVICOR(TBMP 24HR)(1000-40 MG)........ 13, 59, 64ADVICOR(TBMP 24HR)(500MG-20MG)......13, 59,6 4ADVICOR(TBMP 24HR)(750MG-20MG)......13, 59,6 4ADVOCATE CONTROL SOLUTION(OTC).............. 25ADVOCATE LANCING DEVICE(OTC).....................27ADVOCATE REDI-CODE+ CTRL SOLN(OTC)........25AEROBID-M............................................................... 7AFINITOR........................................................... 45, 73AGAMATRIX CONTROL(OTC).......................... 24, 25AGGRENOX.............................................................35AGRYLIN.................................................................. 35AHIST......................................................................... 5AKNE-MYCIN........................................................... 17AKTEN......................................................................32AKURZA................................................................... 21ALA-HIST....................................................................5ALAMAST.................................................................33ALA-QUIN.................................................................16ALA-TET...................................................................39ALBALON................................................................. 33ALBENDAZOLE....................................................... 40ALBENZA................................................................. 40ALBUTEROL SULFATE..............................................6ALC/ISOPROPANOL/PROP GLY/WATER............... 20ALCAFTADINE......................................................... 32ALCLOMETASONE DIPROPIONATE...................... 18ALCORTIN A............................................................ 17ALDACTAZIDE(TAB)(25 MG-25MG)........................12ALDACTAZIDE(TAB)(50 MG-50MG)........................12ALDACTONE............................................................12ALDARA............................................................. 37, 73ALDEX AN..................................................................5ALDOMET.................................................................11ALDORIL-D50...........................................................11ALENDRONATE SODIUM........................................31ALENDRONATE SODIUM/VITAMIN D3...................31ALFERON N............................................................. 37ALFUZOSIN HCL..................................................... 53ALINIA...................................................................... 17ALISKIREN HEMIFUMARATE................................. 13ALISKIREN/AMLODIPIN/HCTHIAZIDE....................12ALISKIREN/AMLODIPINE BESYLATE.................... 13ALISKIREN/HYDROCHLOROTHIAZIDE................. 13ALISKIREN/VALSARTAN......................................... 13ALITRETINOIN.........................................................22ALKERAN.................................................................45ALL ABBOTT PRODUCTS (FREESTYLE ANDPRECISION TEST STRIPS).....................................24ALL BAYER PRODUCTS (CONTOUR AND BREEZETEST STRIPS)......................................................... 24ALLEGRA................................................................... 5ALLEGRA-D 12 HOUR...............................................5ALLEGRA-D 24 HOUR...............................................5ALLERX....................................................................15ALLFEN CD..............................................................16ALLFEN CDX........................................................... 16ALLOPURINOL........................................................ 34ALMOTRIPTAN MALATE......................................... 49ALOCRIL.................................................................. 33ALODOX...................................................................33ALOGLIPTIN BENZ/METFORMIN HCL...................23ALOGLIPTIN BENZ/PIOGLITZONE.........................23ALOGLIPTIN BENZOATE........................................ 24ALOMIDE..................................................................33ALOQUIN..................................................................17ALORA............................................................... 36, 59ALOSETRON HCL................................................... 44ALPHAGAN P(DROPS)(0.1 %)................................33ALPHAGAN P(DROPS)(0.15 %)..............................33ALPHANATE.......................................................34, 35ALPHANINE SD....................................................... 35ALPHAQUIN HP.......................................................23ALPRAZOLAM............................................................8ALPRAZOLAM INTENSOL.........................................8ALPROSTADIL......................................................... 30ALREX......................................................................32ALSUMA.............................................................49, 59ALTABAX.................................................................. 18ALTACE(CAP)...........................................................11ALTACE(TAB)........................................................... 11ALTERNATE SITE LANCING DEVICE(OTC)...........27ALTOPREV...................................................13, 59, 64ALTRETAMINE......................................................... 45ALUMINUM ACETATE............................................. 16ALUMINUM CHLORIDE...........................................20ALUVEA................................................................... 21ALVESCO............................................................. 7, 59ALVIMOPAN............................................................. 44AMANTADINE.......................................................... 50AMANTADINE HCL.................................................. 50AMARYL................................................................... 24AMBENONIUM CHLORIDE....................................... 7AMBIEN................................................................9, 59AMBIFED..................................................................15AMBIFED DM........................................................... 16AMBIFED-G..............................................................15AMBIFED-G DM....................................................... 16AMBRISENTAN........................................................ 12AMCINONIDE...........................................................18AMERGE............................................................ 49, 59AMERICAINE........................................................... 22AMERICET............................................................... 47AMETHYST........................................................ 14, 64AMICAR(SOLUTION)...............................................34AMICAR(TAB)(1000 MG)......................................... 34AMICAR(TAB)(500 MG)........................................... 34AMILORIDE HCL......................................................12AMILORIDE/HYDROCHLOROTHIAZIDE................ 12AMILORIDE-HYDROCHLOROTHIAZIDE................12AMINO AC/FA/MV-MN/DIETARY 2.......................... 55AMINO ACID CERVICAL......................................... 54AMINO ACIDS/MV,FE,OTHER MIN......................... 56AMINOBENZOATE POTASSIUM.............................57AMINOCAPROIC ACID............................................34AMINOLEVULINIC ACID HCL..................................46AMINOPHYLLINE.......................................................7AMINOSALICYLIC ACID..........................................40AMIODARONE HCL.................................................10AMITIZA..............................................................44, 59AMITRIP HCL/CHLORDIAZEPOXIDE....................... 8AMITRIPTYLINE HCL................................................ 8AMLODIPINE BES/OLMESARTAN MED................. 11AMLODIPINE BESYLATE........................................ 12AMLODIPINE BESYLATE/BENAZEPRIL.................10AMLODIPINE/ATORVASTATIN................................ 14AMLODIPINE/VALSARTAN...................................... 11AMLODIPINE/VALSARTAN/HCTHIAZID..................11AMMONIUM LACTATE.............................................20AMOX TR-POTASSIUM CLAVULANATE.................38AMOXAPINE.............................................................. 8AMOXICILLIN...........................................................38AMOXICILLIN TRIHYDRATE................................... 38AMOXICILLIN/POTASSIUM CLAV...........................38AMOXIL.................................................................... 38AMPICILLIN TRIHYDRATE...................................... 38AMPYRA............................................................ 46, 73AMRIX...................................................................... 51AMTURNIDE...................................................... 12, 73AMYL NITRITE.........................................................14ANACAINE............................................................... 22ANADROL-50........................................................... 36ANAFRANIL................................................................8ANAGRELIDE HCL.................................................. 35ANAKINRA............................................................... 41ANALPRAM E.......................................................... 43ANALPRAM HC........................................................43ANAMANTLE HC............................................... 43, 44ANAMANTLE HC FORTE........................................ 43ANAPROX................................................................ 43ANAPROX DS.......................................................... 43ANASTROZOLE.......................................................45ANCOBON................................................................39ANDRODERM(PATCH TD24)(2 MG/24 HR)............36ANDRODERM(PATCH TD24)(2.5MG/24HR)......36,7 3ANDRODERM(PATCH TD24)(4 MG/24 HR)......36, 73ANDRODERM(PATCH TD24)(5 MG/24 HR)......36, 73Page 75 of 91