L.A. Care Covered Drug Formulary (pdf)

IndexEMEND(CAP)(125 MG)........................................6, 59EMEND(CAP)(40 MG)..........................................6, 59EMEND(CAP)(80 MG)..........................................6, 59EMERSAL................................................................ 21EMGEL..................................................................... 17EMLA........................................................................22EMOL53/NAMGFS/HA/NAHYPOCHLORIT............. 20EMOLLIENT #43/SKIN CLEANSER#27.................. 20EMOLLIENT COMBINATION NO. 25.......................20EMOLLIENT COMBINATION NO.10........................20EMOLLIENT COMBINATION NO.32........................20EMOLLIENT COMBINATION NO.35........................20EMOLLIENT COMBINATION NO.38........................20EMOLLIENT COMBINATION NO.43........................20EMOLLIENT COMBINATION NO.44........................20EMOLLIENT COMBINATION NO.47........................20EMOLLIENT COMBINATION NO.48........................20EMOLLIENT COMBINATION NO.53........................20EMOLLIENT COMBINATION NO.57........................20EMOLLIENT COMBINATION NO.60........................20EMOLLIENT COMBO NO.47 & NO.60.................... 20EMOLLIENT NO.35/SKIN CLNSRNO.7...................20EMSAM.................................................................9, 59EMTRICITAB/RILPIVIRINE/TENOFOV....................41EMTRICITABINE...................................................... 41EMTRICITABINE/TENOFOVIR................................ 41EMTRIVA.................................................................. 41EMULSION SB......................................................... 20ENABLEX........................................................... 54, 66ENALAPRIL MALEATE.............................................11ENALAPRIL/HYDROCHLOROTHIAZIDE................ 10ENALAPRIL-HYDROCHLOROTHIAZIDE................10ENBREL............................................................. 42, 73ENCORA.................................................................. 56ENDACOF-C............................................................ 15ENDO-AVITENE....................................................... 36ENDOMETRIN..........................................................30ENFUVIRTIDE..........................................................41ENJUVIA...................................................................36ENOXAPARIN SODIUM........................................... 35ENTACAPONE......................................................... 50ENTECAVIR............................................................. 41ENTEREG................................................................ 44ENTOCORT EC........................................................42ENVISION(OTC).................................................25, 26ENZALUTAMIDE...................................................... 45ENZYMAX................................................................ 52EPIDUO....................................................................16EPIFOAM..................................................................22EPINASTINE HCL.................................................... 32EPINEPHRINE............................................... 6, 44, 45EPIPEN.................................................................... 44EPIPEN 2-PAK......................................................... 44EPIPEN JR............................................................... 45EPIPEN JR 2-PAK.................................................... 45EPIQUIN MICRO......................................................22EPIVIR HBV............................................................. 41EPIVIR(SOLUTION)................................................. 41EPIVIR(TAB).............................................................41EPLERENONE......................................................... 12EPOETIN ALFA........................................................ 35EPOGEN............................................................ 35, 73EPROSARTAN MESYLATE......................................11EPROSARTAN/HYDROCHLOROTHIAZIDE............11EPZICOM................................................................. 41EQUAGESIC............................................................ 47EQUETRO..................................................................8ERGOCALCIFEROL (VITAMIN D2)......................... 57ERGOLOID MESYLATES........................................ 14ERGOMAR......................................................... 49, 59ERGONOVINE MALEATE........................................15ERGOTAMINE TARTRATE...................................... 49ERGOTAMINE TARTRATE/CAFFEINE....................49ERGOTRATE............................................................15ERIVEDGE......................................................... 45, 73ERLOTINIB HCL.......................................................45ERTACZO.................................................................18ERY E-SUCC/SULFISOXAZOLE............................. 38ERYPED 200............................................................ 38ERYPED 400............................................................ 38ERY-TAB...................................................................38ERYTHROCIN STEARATE...................................... 38ERYTHROMYCIN...............................................17, 38ERYTHROMYCIN BASE.............................. 17, 33, 38ERYTHROMYCIN BASE/ETHANOL........................ 17ERYTHROMYCIN ETHYLSUCCINATE................... 38ERYTHROMYCIN ETHYLSUCCINATE(SUSPRECON)....................................................................38ERYTHROMYCIN ETHYLSUCCINATE(TAB).......... 38ERYTHROMYCIN STEARATE.................................38ERYTHROMYCIN/BENZOYL PEROXIDE............... 17ERYTHROMYCIN-SULFISOXAZOLE......................38ESCITALOPRAM OXALATE...................................... 7ESGIC-PLUS(CAP).................................................. 47ESGIC-PLUS(TAB)...................................................47ESKALITH.................................................................. 8ESOMEPRAZOLE MAGNESIUM.............................53ESTAZOLAM.............................................................. 9ESTRACE...........................................................36, 54ESTRADERM..................................................... 36, 59ESTRADIOL....................................................... 36, 54ESTRADIOL ACETATE...................................... 36, 54ESTRADIOL VALERATE/DIENOGEST....................14ESTRADIOL/LEVONORGESTREL..........................36ESTRADIOL/NORETHINDRONE ACET..................36ESTRADIOL/NORGESTIMATE................................36ESTRADIOL-NORETHINDRONE ACETAT..............36ESTRAMUSTINE PHOSPHATE SODIUM............... 46ESTRASORB............................................................36ESTRATEST.............................................................36ESTRING............................................................54, 59ESTROGEL.............................................................. 36ESTROGEN & METHYLTESTOSTERONE............. 36ESTROGEN,CON/M-PROGEST ACET................... 36ESTROGEN,ESTER/ME-TESTOSTERONE............36ESTROGENS, CONJUGATED...........................36, 54ESTROGENS,CONJ.,SYNTHETIC A.......................36ESTROGENS,CONJ.,SYNTHETIC B.......................36ESTROGENS,ESTERIFIED.....................................36ESTROPIPATE......................................................... 36ESZOPICLONE.......................................................... 9ETANERCEPT..........................................................42ETHACRYNIC ACID.................................................12ETHAMBUTOL HCL................................................. 40ETHAVERINE HCL...................................................14ETHCHLORVYNOL....................................................9ETHINYL ESTRADIOL/DROSPIRENONE...............14ETHIONAMIDE.........................................................40ETHOSUXIMIDE...................................................... 50ETHOTOIN............................................................... 50ETHYL CHLORIDE...................................................22ETHYNODIOL D-ETHINYL ESTRADIOL.................14ETIDRONATE DISODIUM........................................31ETODOLAC.............................................................. 43ETONOGESTREL/ETHINYL ESTRADIOL...............14ETOPOSIDE.............................................................45ETRAVIRINE............................................................ 41EURAX..................................................................... 18EVAMIST.................................................................. 36EVENCARE G2(OTC).............................................. 24EVENCARE G3(OTC).............................................. 24EVENCARE(OTC)....................................................24EVEROLIMUS.................................................... 37, 45EVICEL.....................................................................36EVISTA............................................................... 31, 59EVOCLIN..................................................................17EVOLUTION CONTROL SOLUTION(OTC).............27EVOXAC...................................................................45EXACTACAIN........................................................... 22EXALGO...................................................................48EXELDERM..............................................................18EXELON(CAP)........................................................... 7EXELON(PATCH TD24)(13.3MG/24H)...................... 7EXELON(PATCH TD24)(4.6MG/24HR)......................7EXELON(PATCH TD24)(9.5MG/24HR)......................7EXELON(SOLUTION)................................................ 7EXEMESTANE......................................................... 45EXENATIDE..............................................................23EXENATIDE MICROSPHERES............................... 23EXFORGE.......................................................... 11, 67EXFORGE HCT.................................................. 11, 67EXODERM................................................................18EXTAVIA............................................................. 46, 67EZ SMART(OTC)................................................ 25-27EZETIMIBE...............................................................13EZETIMIBE/SIMVASTATIN.......................................13EZOGABINE.............................................................50- F -FA/MULTIVITS-MIN/MIN AA CHEL.......................... 56FA/MU-VITS-MIN TH/LYCOPENE/LUT....................56FA/NIACINAMIDE/CUPRIC OX/ZN OX....................56FA/VIT BCOMP&C/SE/MIN AA/ZN...........................57FACTIVE...................................................................38FACTOR IX...............................................................35FACTOR IX COMPLEX HUMAN.............................. 35FACTOR IX HUMAN RECOMBINANT..................... 35FACTOR XIII.............................................................35FAC-X....................................................................... 56FAMCICLOVIR......................................................... 40FAMOTIDINE............................................................53FAMVIR.................................................................... 40FANAPT(TAB DS PK).....................................9, 59, 67FANAPT(TAB).................................................9, 59, 67FANATREX............................................................... 50FANSIDAR................................................................40FARESTON.............................................................. 46FAZACLO....................................................... 9, 59, 67FE BISGLY/FE P/DOSS/C/FA/MV 14.......................55FE FUM/DOSS NA/C/E/B12-IF/FA...........................55FE FUMARATE/CAL/E/FA/MULTIVIT.......................55FE FUMARATE/DOSS/FA/BCOMP&C.....................55FE FUMARATE/FA/MV, MIN COMB#15...................55FE FUMARATE/FA/VIT BCOMP&C......................... 56FE FUMARATE/FE PS CMPLX/FA.......................... 55FE FUMARATE/VIT C/B12/STOMC......................... 55FE FUMARATE/VIT C/B12-IF/FA............................. 55FE HEME POLYPEPTIDE/FOLIC ACID...................55FEBUXOSTAT.......................................................... 34FEIBA NF..................................................................35FEIBA VH IMMUNO................................................. 35FELBAMATE.............................................................50FELBATOL(ORAL SUSP).............................50, 59, 67FELBATOL(TAB)(400 MG)........................... 50, 60, 67FELBATOL(TAB)(600 MG)........................... 50, 60, 67FELDENE................................................................. 43FELODIPINE............................................................ 12FELODIPINE ER...................................................... 12FEMARA...................................................................45FEMHRT(TAB)(0.5MG-2.5)...................................... 37FEMHRT(TAB)(1MG-5MCG)....................................37FEMRING........................................................... 54, 60FEMTABS................................................................. 56FEMTRACE..............................................................36FENOFIBRATE.........................................................13FENOFIBRATE NANOCRYSTALLIZED.............13, 14FENOFIBRATE,MICRONIZED................................. 14FENOFIBRIC ACID.................................................. 14FENOFIBRIC ACID (CHOLINE)...............................14FENOGLIDE.......................................................13, 67FENOPROFEN CALCIUM........................................43FENTANYL............................................................... 47FENTANYL CITRATE............................................... 47FENTORA...........................................................47, 73FERAHEME..............................................................55FERIVA..................................................................... 55FEROCON................................................................55FERRALET 90 DUAL-IRON..................................... 55FERRAPLUS 90....................................................... 55FERREX 150 FORTE PLUS.....................................55FERREX 28.............................................................. 55FERRIC AMCIT/CYANOCOBALAMIN/FA................ 55FERRIC AMCIT/LYS/VIT B COMP/FA..................... 55FERRIC SUBSULFATE............................................ 36FERROGELS FORTE.............................................. 55FERRO-PLEX HEMATINIC...................................... 55FERROUS FUMARATE/FOLIC ACID...................... 55FERROUS FUMARATE/VIT C/B12-IF......................55FERROUS FUMARATE/VIT C/FA............................ 55FERROUS SULF/FA/VIT B & C NO.8...................... 55FERROUS SULFATE/FA/VIT BCOMP&C................ 55FERROUS SULFATE/VIT C/FA................................55FERUMOXYTOL...................................................... 55FESOTERODINE FUMARATE.................................54FETRIN.....................................................................55FEXMID.................................................................... 51FEXOFENADINE HCL................................................5FEXOFENADINE/PSEUDOEPHEDRINE...................5FIBRICOR.................................................................14FIBRINOGEN/THROMBIN (HUM PLAS)................. 36FIDAXOMICIN.......................................................... 38FILGRASTIM............................................................ 35FINACEA.................................................................. 16FINACEA PLUS........................................................16FINASTERIDE..........................................................53FINGOLIMOD HCL...................................................46FIORICET.................................................................47FIORICET WITH CODEINE..................................... 49FIORINAL WITH CODEINE #3.................................49FIRAZYR............................................................ 42, 73FIRMAGON.............................................................. 45FIRST-BXN...............................................................39FIRST-DUKE'S......................................................... 39FIRST-HYDROCORTISONE.................................... 19FIRST-LANSOPRAZOLE......................................... 53FIRST-MARY'S.........................................................39FIRST-OMEPRAZOLE............................................. 53FIRST-PROGESTERONE VGS 100........................ 30Page 80 of 91