L.A. Care Covered Drug Formulary (pdf)

IndexFIRST-PROGESTERONE VGS 200........................ 30FIRST-PROGESTERONE VGS 25.......................... 30FIRST-PROGESTERONE VGS 400........................ 30FIRST-PROGESTERONE VGS 50.......................... 30FIRST-TESTOSTERONE......................................... 36FIRST-TESTOSTERONE MC.................................. 36FLAGYL....................................................................40FLAGYL ER..............................................................40FLAREX....................................................................32FLAVOXATE HCL.....................................................54FLECAINIDE ACETATE........................................... 10FLECTOR................................................................. 20FLEXERIL.................................................................51FLEXTRA PLUS....................................................... 47FLOMAX...................................................................53FLONASE.............................................................5, 60FLO-PRED................................................................42FLOVENT DISKUS(DISK W/DEV)(100 MCG)......7,6 0FLOVENT DISKUS(DISK W/DEV)(250 MCG)......7,6 0FLOVENT DISKUS(DISK W/DEV)(50 MCG)....... 7, 60FLOVENT HFA(AER W/ADAP)(110MCG)............7, 60FLOVENT HFA(AER W/ADAP)(220 MCG).......... 7, 60FLOVENT HFA(AER W/ADAP)(44MCG)............. 7, 60FLOXIN.....................................................................29FLU VACCINE 2012 (2-49YRS)............................... 37FLUCONAZOLE....................................................... 39FLUCYTOSINE.........................................................39FLUDARABINE PHOSPHATE..................................45FLUDROCORTISONE ACETATE.............................42FLUMADINE.............................................................40FLUMIST.................................................................. 37FLUNISOLIDE...................................................... 5, 60FLUNISOLIDE/MENTHOL..........................................7FLUOCINOLONE ACETONIDE............................... 19FLUOCINOLONE ACETONIDE OIL.........................29FLUOCINOLONE/EMOL CMB#65........................... 19FLUOCINOLONE/SHOWER CAP............................19FLUOCINOLONE/SKIN CLNSR28...........................19FLUOCINOLONE/TRETINOIN/H-QUIN................... 22FLUOCINONIDE.......................................................19FLUORESCEIN SODIUM.........................................34FLUORESCEIN-PROPARACAINE...........................33FLUORESCEIN-PROPARACAINE HCL.................. 33FLUORETS...............................................................34FLUORIDE(TAB CHEW)(0.25(0.55))........................54FLUORIDE(TAB CHEW)(1MG(2.2MG))................... 54FLUORIDE/IRON/VIT A,C&D...................................56FLUORIDEX SENSITIVITY RELIEF.........................54FLUOR-I-STRIP AT.................................................. 34FLUOROMETHOLONE............................................32FLUOROMETHOLONE ACETATE...........................32FLUOROPLEX......................................................... 22FLUOROURACIL......................................................22FLUOXETINE HCL.....................................................7FLUOXYMESTERONE.............................................36FLUPHENAZINE HCL................................................ 9FLURANDRENOLIDE.............................................. 19FLURA-SAFE........................................................... 34FLURAZEPAM HCL....................................................9FLURBIPROFEN......................................................43FLURBIPROFEN SODIUM.......................................32FLURESS................................................................. 32FLUTAMIDE..............................................................45FLUTICASONE FUROATE.........................................5FLUTICASONE PROPIONATE........................ 5, 7, 19FLUTICASONE/SALMETEROL................................. 6FLUVASTATIN SODIUM...........................................13FLUVOXAMINE MALEATE........................................ 7FML...........................................................................32FML FORTE............................................................. 32FML S.O.P................................................................ 32FOCALIN............................................................ 10, 60FOCALIN XR................................................ 10, 58, 60FOLAST....................................................................57FOLBIC.....................................................................56FOLBIC RF...............................................................56FOLGARD OS.......................................................... 54FOLIC ACID..............................................................54FOLIC ACID/B COMPLEX & C NO.17..................... 57FOLIC ACID/MULTIVITS-MIN.................................. 56FOLIC ACID/MU-VITS-MIN TH................................ 56FOLIC ACID/MV,FE,OTHER MIN.............................56FOLIC ACID/VIT BCOMP&C/CU/ZNOX...................57FOLIC ACID/VITAMIN B COMP W-C.......................57FOLIC ACID/VITAMIN B6/VIT B12...........................57FOLLISTIM AQ.........................................................30FOLLITROPIN ALFA, RECOMB...............................30FOLLITROPIN BETA,RECOMB............................... 30FOLPACE RX........................................................... 57FONDAPARINUX SODIUM...................................... 35FORA LANCING DEVICE(OTC).............................. 28FORADIL........................................................ 6, 60, 67FORFIVO XL.................................................. 7, 60, 67FORMOTEROL FUMARATE......................................6FORTAVIT.................................................................56FORTEO.............................................................31, 60FORTESTA.........................................................36, 73FORTICAL................................................................ 31FOSAMAX PLUS D.................................................. 31FOSAMAX(SOLUTION)..................................... 31, 60FOSAMAX(TAB)....................................................... 31FOSAMPRENAVIR CALCIUM..................................41FOSFOMYCIN TROMETHAMINE............................38FOSINOPRIL SODIUM.............................................11FOSINOPRIL/HYDROCHLOROTHIAZIDE.............. 10FOSINOPRIL-HYDROCHLOROTHIAZIDE..............10FOSRENOL..............................................................30FRAGMIN(DISP SYRINGE)..................................... 35FRAGMIN(VIAL)(10000/ML).................................... 35FRAGMIN(VIAL)(25000/ML).................................... 35FREESTYLE CONTROL SOLUTION(OTC).......24, 27FRENADOL.............................................................. 47FROVA..........................................................49, 60, 67FROVATRIPTAN SUCCINATE................................. 49FUL-GLO.................................................................. 34FULVICIN U/F...........................................................39FULYZAQ..................................................... 44, 60, 67FUMATINIC.............................................................. 55FUNGOID & HC........................................................17FURACIN..................................................................17FURADANTIN...........................................................38FURAZOLIDONE......................................................38FUROSEMIDE..........................................................12FUROXONE............................................................. 38FUSION PLUS..........................................................55FUZEON...................................................................41- G -GABAPENTIN.................................................... 46, 50GABAPENTIN ENACARBIL..................................... 46GABITRIL(TAB)(12 MG)............................... 51, 60, 67GABITRIL(TAB)(16 MG)............................... 51, 60, 67GABITRIL(TAB)(2 MG)................................. 51, 60, 67GABITRIL(TAB)(4 MG)................................. 51, 60, 67GALANTAMINE HBR..................................................7GAMMAKED.......................................................37, 73GAMUNEX-C......................................................37, 73GANCICLOVIR...................................................32, 40GANIRELIX ACETATE............................................. 31GANTRISIN.............................................................. 37GARAMYCIN............................................................33GASTRINEX NF....................................................... 52GASTROCROM..........................................................7GATIFLOXACIN........................................................33GATTEX..............................................................44, 73GAVILYTE-C.............................................................44GE100 CONTROL SOLUTION NORMAL(OTC)...... 27GEBAUER'S 114...................................................... 22GEFITINIB................................................................ 45GELATIN...................................................................34GELATIN SPONGE,ABSORBABLE......................... 36GELFILM.................................................................. 34GELFOAM................................................................ 36GELFOAM PACKS................................................... 36GEL-KAM..................................................................54GELNIQUE......................................................... 54, 67GEMFIBROZIL......................................................... 14GEMIFLOXACIN MESYLATE...................................38GENADUR................................................................22GENERESS FE........................................................ 15GENERLAC..............................................................44GENOTROPIN....................................................31, 73GENT VIOLET/BRLNT GRN/PROFLAV...................17GENTAMICIN SULFATE.....................................17, 33GENTAMICIN/PREDNISOL AC................................32GENTLE DRAW(OTC)............................................. 28GEODON..............................................................9, 60GIANVI............................................................... 14, 67GIAZO................................................................ 43, 67GILENYA............................................................ 46, 73GLATIRAMER ACETATE..........................................46GLEEVEC...........................................................45, 73GLIADEL.................................................................. 45GLIMEPIRIDE...........................................................24GLIPIZIDE................................................................ 24GLIPIZIDE/METFORMIN HCL................................. 24GLUCAGEN..............................................................28GLUCAGON EMERGENCY KIT.............................. 28GLUCAGON,HUMAN RECOMBINANT................... 28GLUCOCARD 01 CONTROL(OTC)......................... 27GLUCOCARD EXPRESSION(OTC)........................ 27GLUCOCARD X-METER CONTROL(OTC).............27GLUCOCOM CONTROL SOLUTION(OTC).......25, 27GLUCOLAB CONTROL(OTC)............................ 25-27GLUCOLEADER(OTC).......................................27, 28GLUCOLET 2(OTC)................................................. 28GLUCOPHAGE........................................................ 24GLUCOSE CONTROL SOLUTION(OTC)................ 27GLUCOSE CONTROL(OTC)....................................27GLUCOSOURCE(OTC)............................................28GLUCOTROL........................................................... 24GLUCOVANCE.........................................................24GLUMETZA........................................................ 24, 67GLUTETHIMIDE.........................................................9GLUTOFAC-MX........................................................55GLYBURIDE............................................................. 24GLYBURIDE,MICRONIZED..................................... 24GLYBURIDE/METFORMIN HCL.............................. 24GLYCERIN................................................................12GLYCEROL PHENYLBUTYRATE............................ 44GLYCINE.................................................................. 39GLYCOPYRROLATE................................................53GLYNASE................................................................. 24GLYSET....................................................................23GMATE CONTROL SOLUTION(OTC)............... 25, 27GOLIMUMAB............................................................42GOLYTELY............................................................... 44GONADORELIN ACETATE...................................... 32GONAL-F..................................................................30GONAL-F RFF..........................................................30GORDO-UREA...................................................21, 23GRALISE(TAB ER 24H)(300 MG)................ 46, 60, 67GRALISE(TAB ER 24H)(300-600 MG)......... 46, 60, 67GRALISE(TAB ER 24H)(600 MG)................ 46, 60, 67GRANISETRON......................................................... 6GRANISETRON HCL................................................. 6GRIFULVIN V........................................................... 39GRISEOFULVIN ULTRAMICROSIZE.......................39GRISEOFULVIN,MICROSIZE.................................. 39GRIS-PEG................................................................ 39GUAIACOL............................................................... 20GUAIFEN/THEOP ANHYD/P-EPHED........................6GUAIFENESIN/CODEINE PHOSPHATE................. 16GUAIFENESIN/DM/PSEUDOEPHEDRINE..............16GUAIFENESIN/DYPHYLLINE....................................6GUAIFENESIN/PSEUDOEPHEDRNE HCL.............15GUAIFENESIN/THEOPHYLLINE...............................6GUAIFENESIN-CODEINE........................................16GUANABENZ ACETATE...........................................11GUANFACINE HCL............................................ 10, 11GUANIDINE HCL......................................................45GYNAZOLE-1...........................................................54- H -HALCINONIDE......................................................... 19HALCION....................................................................9HALFAN....................................................................40HALFLYTELY-BISACODYL...................................... 44HALOBETASOL PROPIONATE............................... 19HALOBETASOL/AMMONIUM LACTATE..................19HALOBETASOL/LACTIC ACID................................ 19HALOFANTRINE HCL..............................................40HALOG..................................................................... 19HALONATE...............................................................19HALOPERIDOL.......................................................... 9HALOPERIDOL LACTATE......................................... 9HALOPROGIN..........................................................17HALOTIN.................................................................. 17HC/PRAMOX HCL/CL-XYLENOL/WATER...............29HC/PRAMOXINE HCL/CHLOROXYLENOL.............29HC/PRAMOXINE/CHLOROXYLENOL/BAK.............29HCG ALPHA,RECOMBINANT................................. 30HCTZ/RESERPINE/HYDRALAZINE........................ 11HEALTHY ACCENTS AUTOLET(OTC)....................28HECORIA................................................................. 37HECTOROL..............................................................31HELIDAC.................................................................. 53HELISTAT................................................................. 23HELITENE................................................................ 36HELIXATE FS........................................................... 34HEMASEEL APR(KIT)(1 ML)................................... 36HEMASEEL APR(KIT)(2 ML)................................... 36HEMASEEL APR(KIT)(5ML).................................... 36HEMATINIC PLUS....................................................55HEMATOGEN...........................................................55HEMATRON............................................................. 55HEMATRON-AF........................................................55Page 81 of 91