L.A. Care Covered Drug Formulary (pdf)

IndexCICLODAN............................................................... 17CICLOPIROX............................................................17CICLOPIROX OLAMINE.......................................... 17CICLOPIROX/NAIL LACQ/FT DEOD#4...................17CICLOPIROX/SKIN CLEANSER NO.28.................. 17CICLOPIROX/URE/CAMPH/MENTH/EUC...............17CICLOPIROX/VITE/NAIL LACQ REMO...................17CILOSTAZOL............................................................35CILOXAN(DROPS)...................................................33CILOXAN(OINT).......................................................33CIMETIDINE.............................................................53CIMETIDINE HCL.....................................................53CIMZIA................................................................43, 73CINACALCET HCL...................................................31CINERARIA 3X.........................................................34CINRYZE.................................................................. 42CIPRO...................................................................... 38CIPRO HC................................................................ 29CIPRO XR................................................................ 38CIPRODEX...............................................................29CIPROFLOXACIN.................................................... 38CIPROFLOXACIN HCL................................ 29, 33, 38CIPROFLOXACIN HCL/DEXAMETH....................... 29CIPROFLOXACIN/CIPROFLOXA HCL....................38CIPROFLOXACIN/HYDROCORTISONE................. 29CITALOPRAM HYDROBROMIDE..............................7CITRATE PHOSPHATE DEXTROSE.......................35CITRATE-PHOS-DEX SOLUTION........................... 35CITRIC ACID/G-LACTONE/MAG CARB.................. 53CITRIC ACID/SODIUM CITRATE.............................53CITRIC/CITRONELLYL/HYDROX/METH.................18CLARAVIS................................................................ 16CLARINEX(SYRUP).......................................5, 59, 66CLARINEX(TAB RDP DIS)............................. 5, 59, 66CLARINEX(TAB).............................................5, 59, 66CLARINEX-D 12 HOUR................................. 5, 59, 66CLARINEX-D 24 HOUR................................. 5, 59, 66CLARITHROMYCIN................................................. 38CLEANSE & TREAT PLUS.......................................21CLEANSE AND TREAT............................................21CLEMASTINE FUMARATE........................................ 5CLEOCIN HCL..........................................................40CLEOCIN T...............................................................17CLEOCIN(CREAM/APPL)........................................ 54CLEOCIN(SUPP VAG)............................................. 54CLEVER CHOICE CONTROL SOLUTION(OTC)......25, 26CLIMARA............................................................36, 59CLIMARA PRO...................................................36, 59CLINAC BPO............................................................21CLINDACIN ETZ.......................................................17CLINDACIN PAC...................................................... 17CLINDAGEL............................................................. 17CLINDAMYCIN HCL.................................................40CLINDAMYCIN PALMITATE HCL.............................40CLINDAMYCIN PHOS/BENZOYL PEROX.............. 16CLINDAMYCIN PHOS/SKIN CLNSR 19.................. 17CLINDAMYCIN PHOSPHATE............................ 17, 54CLINDAMYCIN/BENZ PER/HYALUR NA.................16CLINDAMYCIN/TRETINOIN.....................................16CLINDAMYCIN-BENZOYL PEROXIDE................... 16CLINDAREACH........................................................17CLINDESSE............................................................. 54CLINORIL................................................................. 43CLINPRO 5000.........................................................54CLIOQUINOL/HYDROCORTISONE........................ 16CLIOQUINOL/HYDROCORTISONE/PRAM.............17CLOBAZAM..............................................................50CLOBETA................................................................. 23CLOBETA + PLUS....................................................23CLOBETASOL EMOLLIENT.....................................19CLOBETASOL PROPIONATE..................................19CLOBETASOL PROPIONATE/COAL TAR...............23CLOBETASOL PROPIONATE/EMOLL.................... 19CLOBEX(LOTION)................................................... 19CLOBEX(SHAMPOO).............................................. 19CLOBEX(SPRAY).....................................................19CLOCORTOLONE PIVALATE.................................. 19CLODERM................................................................19CLOMIPHENE CITRATE..........................................30CLOMIPRAMINE HCL................................................8CLONAZEPAM......................................................... 50CLONIDINE.............................................................. 11CLONIDINE HCL.......................................... 10, 11, 47CLONIDINE HCL/CHLORTHALIDONE.................... 11CLONIDINE HCL/PF................................................ 47CLOPIDOGREL BISULFATE....................................35CLORAZEPATE DIPOTASSIUM................................ 8CLORPRES.............................................................. 11CLOTRIMAZOLE................................................17, 39CLOTRIMAZOLE/BETAMETHASONE DIP..............17CLOZAPINE............................................................... 9CLOZARIL............................................................ 9, 59COAGULATION FACTOR VIIA,RECOMB................35COAL TAR................................................................ 21COARTEM................................................................40COCAINE HCL......................................................... 22CODEINE PHOS/ACETAMINOPHEN...................... 49CODEINE PHOSPHATE.......................................... 47CODEINE SULFATE.................................................47CODEINE/BUTALBITAL/ASA/CAFFEIN...................49CODEINE/CARISOPRODOL/ASPIRIN....................47COGNEX.................................................................... 7COLAZAL................................................................. 43COLCHICINE............................................................34COLCHICINE/PROBENECID...................................34COLCRYS................................................................ 34COLESEVELAM HCL...............................................13COLESTID................................................................13COLESTIPOL HCL...................................................13COLLAGEN.............................................................. 23COLLAGENASE CLOSTRIDIUM HIST.................... 22COLY-MYCIN S........................................................ 29COMBIGAN.............................................................. 33COMBIPATCH.................................................... 36, 59COMBIVENT.............................................................. 6COMBIVENT RESPIMAT........................................... 6COMBIVIR................................................................41COMBUNOX.............................................................47COMETRIQ........................................................ 45, 73COMFORT PAC-CYCLOBENZAPRINE...................51COMFORT PAC-IBUPROFEN................................. 43COMFORT PAC-MELOXICAM.................................43COMFORT PAC-NAPROXEN.................................. 43COMFORT PAC-TIZANIDINE.................................. 51COMPAZINE...............................................................6COMPLERA..............................................................41COMTAN.................................................................. 50CONCERTA(TAB ER 24H)(18 MG)..............10, 58, 59CONCERTA(TAB ER 24H)(27 MG)..............10, 58, 59CONCERTA(TAB ER 24H)(36 MG)..............10, 58, 59CONCERTA(TAB ER 24H)(54 MG)..............10, 58, 59CONDYLOX(GEL)....................................................21CONDYLOX(SOLUTION).........................................21CONSTANT CLENS................................................. 22CONTOUR NEXT CONTROL SOLUTION(OTC)......2 6CONTOUR(OTC)................................................25, 26CONTROL SOLUTION(OTC).............................25, 26CONZIP........................................................ 49, 59, 66COPAXONE..............................................................46COPEGUS................................................................41CORAZ..................................................................... 19CORDRAN................................................................19CORDRAN SP..........................................................19COREG.....................................................................10COREG CR.............................................................. 10CORGARD............................................................... 12CORIFACT................................................................35CORTANE-B.............................................................29CORTEF................................................................... 42CORTENEMA...........................................................44CORTIFOAM............................................................ 44CORTISONE ACETATE........................................... 42CORTISPORIN.........................................................18CORTISPORIN-TC...................................................29CORVITA.................................................................. 56CORVITE..................................................................56CORVITE 150...........................................................55CORVITE FE............................................................ 55CORVITE FREE....................................................... 56CORZIDE..................................................................12COSOPT...................................................................33COTAB A.................................................................. 15COTAB AX................................................................15COUMADIN.............................................................. 34COVERA-HS............................................................ 12COZAAR................................................................... 11CPM 12.......................................................................5CREON.....................................................................51CREON 10................................................................51CREON 20................................................................51CREON 5..................................................................51CRESTOR(TAB)(10 MG)..............................13, 59, 66CRESTOR(TAB)(20 MG)..............................13, 59, 66CRESTOR(TAB)(40 MG)..............................13, 59, 66CRESTOR(TAB)(5 MG)................................13, 59, 66CRESYL ACE/BEN ALC/BUTANOL/IPA.................. 29CRESYLATE.............................................................29CRINONE................................................................. 30CRIXIVAN................................................................. 41CRIZOTINIB............................................................. 45CROFELEMER.........................................................44CROMOLYN SODIUM..........................................7, 33CROTAMITON..........................................................18C-THERAPY NIGHT CREAM...................................23CUPRIMINE..............................................................41CUROSURF............................................................. 46CUTIVATE................................................................ 19CUVPOSA................................................................ 53CYANOCOBALAMIN................................................ 57CYANOCOBALAMIN (VITAMIN B-12)......................57CYANOCOBALAMIN INJECTION............................ 57CYANOCOBALAMIN/FA/PYRIDOXINE................... 56CYANOCOBALAMIN/MECOBALAMIN.................... 57CYANOCOBALAMIN/THIAMINE..............................57CYANOCOBALAMIN/VIT BCOMP&C...................... 57CYCLOBENZ HCL/IRR CNTR-IRR CB2..................51CYCLOBENZAPRINE HCL...................................... 51CYCLOGYL(DROPS)(0.5 %)................................... 34CYCLOGYL(DROPS)(1 %)...................................... 34CYCLOGYL(DROPS)(2 %)...................................... 34CYCLOMYDRIL........................................................34CYCLOPENTOLATE HCL........................................ 34CYCLOPENTOLATE/PHENYLEPHRINE.................34CYCLOPHOSPHAMIDE...........................................45CYCLOSERINE........................................................40CYCLOSET........................................................ 23, 66CYCLOSPORINE............................................... 33, 37CYCLOSPORINE, MODIFIED..................................37CYMBALTA...........................................................8, 59CYPROHEPTADINE HCL.......................................... 5CYSTAGON..............................................................53CYSTEAMINE BITARTRATE....................................53CYSTOSPAZ-M........................................................ 52CYTOMEL................................................................ 32CYTOTEC.................................................................53CYTRA-2.................................................................. 53CYTRA-3.................................................................. 54CYTRA-K..................................................................54- D -D.H.E.45............................................................. 49, 59DABIGATRAN ETEXILATE MESYLATE.................. 35DALFAMPRIDINE.....................................................46DALIRESP......................................................7, 59, 66DALLERGY-JR......................................................... 15DALTEPARIN SODIUM,PORCINE...........................35DANAZOL.................................................................32DANTRIUM...............................................................51DANTROLENE SODIUM..........................................51DAPSONE.......................................................... 16, 40DARAPRIM...............................................................40DARBEPOETIN ALFA IN POLYSORBAT.................35DARIFENACIN HYDROBROMIDE...........................54DARUNAVIR ETHANOLATE.................................... 40DARVOCET A500.............................................. 49, 59DARVOCET-N 100............................................. 49, 59DARVOCET-N 50............................................... 49, 59DARVON.................................................................. 49DARVON-N...............................................................49DASATINIB............................................................... 45DAYPRO...................................................................43DAYTRANA........................................................ 10, 59DAZIDOX..................................................................48DDAVP......................................................................31DDAVP(AMPUL)(15 MCG/ML)................................. 31DDAVP(AMPUL)(4MCG/ML).................................... 31DDAVP(SOLUTION).................................................31DDAVP(TAB)............................................................ 31DECADRON............................................................. 32DECLOMYCIN..........................................................39DEGARELIX ACETATE............................................ 45DELATESTRYL.................................................. 36, 73DELAVIRDINE MESYLATE...................................... 41DELOS..................................................................... 21DELTUSS DMX........................................................ 16DELZICOL.......................................................... 43, 66DEMADEX................................................................12DEMECARIUM BROMIDE....................................... 33DEMECLOCYCLINE HCL........................................ 39DEMEROL................................................................48DEMSER...................................................................11DENAVIR.................................................................. 18DEPAKENE.............................................................. 51DEPAKOTE ER........................................................ 50DEPEN..................................................................... 41DEPODUR................................................................48Page 78 of 91