L.A. Care Covered Drug Formulary (pdf)

IndexLOMEFLOXACIN HCL............................................. 38LOMITAPIDE MESYLATE........................................ 13LOMUSTINE.............................................................45LO-OVRAL-28.......................................................... 15LOPERAMIDE.......................................................... 44LOPERAMIDE HCL..................................................44LOPID.......................................................................14LOPINAVIR/RITONAVIR...........................................41LOPRESSOR........................................................... 12LOPRESSOR HCT...................................................12LOPROX...................................................................17LORAZEPAM..............................................................8LORCET 10-650.................................................48, 60LORCET PLUS...................................................48, 60LORTAB(SOLUTION).........................................48, 60LORTAB(TAB).................................................... 48, 60LORZONE................................................................ 51LOSARTAN POTASSIUM......................................... 11LOSARTAN/HYDROCHLOROTHIAZIDE................. 11LOTEMAX.................................................................32LOTENSIN................................................................ 11LOTENSIN HCT....................................................... 10LOTEPREDNOL ETABONATE.................................32LOTREL....................................................................10LOTRISONE.............................................................17LOTRONEX..............................................................44LOVASTATIN............................................................ 13LOVAZA..............................................................14, 60LOVENOX................................................................ 35LOXAPINE SUCCINATE............................................ 9LOXITANE.................................................................. 9LUBIPROSTONE......................................................44LUCINACTANT.........................................................46LUFYLLIN...................................................................7LUFYLLIN-400............................................................7LUFYLLIN-GG............................................................ 6LUGOL'S.................................................................. 17LUMIGAN........................................................... 33, 60LUNESTA....................................................... 9, 60, 68LURASIDONE HCL.................................................... 9LUTREPULSE.......................................................... 32LUTROPIN ALFA......................................................30LUVERIS.................................................................. 30LUVOX CR..................................................... 7, 60, 68LUXIQ.......................................................................18LYBREL.............................................................. 14, 68LYCELLE.................................................................. 18LYRICA..................................................................... 51LYSINE HCL/VIT B COMP/FA/ZINC........................ 57LYSINE/VITAMIN B COMPLEX/FA/ZN.....................57LYSIPLEX................................................................. 57LYSODREN.............................................................. 45LYSTEDA..................................................................34- M -MACROBID.............................................................. 38MACRODANTIN(CAP)(100 MG)..............................38MACRODANTIN(CAP)(25 MG)................................38MACRODANTIN(CAP)(50 MG)................................38MACUTEK................................................................ 54MAFENIDE ACETATE.............................................. 18MAGAN.....................................................................47MAGNACET....................................................... 48, 60MAGNEBIND 400 RX...............................................30MAGNESIUM SALICYLATE..................................... 47MAGNI-GUIDE MAGNIFIER(OTC).......................... 27MALARONE..............................................................40MALATHION............................................................. 18MANNITOL............................................................... 12MANNITOL/SORBITOL SOLUTION.........................20MAPROTILINE HCL................................................... 8MARAVIROC............................................................ 41MARINOL....................................................... 6, 60, 68MARPLAN.................................................................. 7MARTINIC................................................................ 57MATULANE.............................................................. 45MAVIK....................................................................... 11MAXAIR AUTOHALER............................................... 6MAXALT..............................................................49, 60MAXALT MLT......................................................49, 60MAXAQUIN...............................................................38MAXARON FORTE.................................................. 55MAXIDEX..................................................................32MAXIDONE........................................................ 48, 60MAXIFED..................................................................15MAXIFED DMX.........................................................16MAXITROL............................................................... 32MAXZIDE..................................................................12MAXZIDE-25 MG......................................................12MEBARAL................................................................ 51MEBENDAZOLE.......................................................40MECAMYLAMINE HCL.............................................11MECASERMIN......................................................... 31MECLIZINE HCL........................................................ 6MECLOFENAMATE SODIUM.................................. 43MECOBALAMIN/L-MEFOLATE/B6 PHOS............... 57MEDISENSE CONTROL(OTC)................................25MEDISENSE GLUCOSE KETONE CONTR(OTC)......2 7MEDISENSE GLUCOSE KETONE(OTC)................ 25MEDISENSE(OTC).............................................25, 27MEDROL(TAB DS PK)............................................. 42MEDROL(TAB)(16 MG)............................................ 42MEDROL(TAB)(2 MG).............................................. 42MEDROL(TAB)(32 MG)............................................ 42MEDROL(TAB)(4 MG).............................................. 42MEDROL(TAB)(8 MG).............................................. 42MEDROXYPROGESTERONE ACET.......................37MEDROXYPROGESTERONE ACETATE.......... 14, 37MEFENAMIC ACID...................................................43MEFLOQUINE HCL..................................................40MEGESTROL ACETATE.......................................... 46MELOXICAM............................................................ 43MELOXICAM/IRR CNTR-IRR CMB #2.....................43MELPHALAN............................................................45MEMANTINE HCL......................................................7M-END PE................................................................ 15M-END WC...............................................................15MENEST...................................................................36MENOPUR............................................................... 30MENOSTAR........................................................36, 60MENOTROPINS.......................................................30MENTAX................................................................... 17MENTHOL/BANDAGES, TUBULAR........................ 21MEPENZOLATE BROMIDE..................................... 53MEPERIDINE HCL................................................... 48MEPERIDINE HCL/PF..............................................48MEPHOBARBITAL................................................... 51MEPHYTON............................................................. 36MEPROBAMATE........................................................ 8MEPRON..................................................................40MERCAPTOPURINE................................................45MERIDIA...................................................................57MESALAMINE.......................................................... 43MESALAMINE W/CLEANSING WIPES................... 43MESEHIST WC........................................................ 15MESNA.....................................................................45MESNEX...................................................................45MESTINON(SYRUP)..................................................7MESTINON(TAB ER)..................................................7MESTINON(TAB)........................................................7METADATE ER.........................................................10METAGLIP................................................................24METAPROTERENOL SULFATE................................ 6METAXALONE......................................................... 51METER-CHECK(OTC)............................................. 27METFORMIN HCL....................................................24METHADONE HCL...................................................48METHAMPHETAMINE HCL....................................... 8METHAZOLAMIDE...................................................33METHEN MAND/NAPHOS M-B M-H....................... 53METHEN/M-BLUE/SAL/NA PHOS/HYOS................38METHEN/SOD PHOS/METH BLUE/HYOS..............38METHENAM/ME BLUE/BA/SALICY/HYO................38METHENAMINE HIPPURATE..................................38METHENAMINE MANDELATE................................ 38METHERGINE..........................................................15METHIMAZOLE........................................................32METHIONINE/INOSITOL/CHOLINE/FA................... 14METHITEST............................................................. 36METHOCARBAMOL.................................................51METHOTREXATE.............................................. 41, 45METHOTREXATE SODIUM............................... 41, 45METHOTREXATE SODIUM/PF............................... 45METHOXSALEN.......................................................23METHOXSALEN, RAPID..........................................23METHSCOPOLAMINE BROMIDE........................... 52METHSCP BR/LA/S.THM/L.PARA/BIF.................... 52METHSUXIMIDE...................................................... 51METHYCLOTHIAZIDE............................................. 13METHYL AMINOLEVULINATE HCL........................ 46METHYL SALICYLATE.............................................21METHYLDOPA......................................................... 11METHYLDOPA/HYDROCHLOROTHIAZIDE............11METHYLDOPA-HYDROCHLOROTHIAZIDE........... 11METHYLERGONOVINE MALEATE......................... 15METHYLIN................................................................10METHYLNALTREXONE BROMIDE......................... 44METHYLPHENIDATE...............................................10METHYLPHENIDATE ER(CPMP 50-50)(20 MG)......10, 58, 60METHYLPHENIDATE ER(CPMP 50-50)(30 MG)......10, 58, 60METHYLPHENIDATE ER(CPMP 50-50)(40 MG)......1 0METHYLPHENIDATE ER(TAB ER)..........................10METHYLPHENIDATE HCL.......................................10METHYLPREDNISOLONE.......................................42METHYLTESTOSTERONE...................................... 36METIPRANOLOL......................................................33METOCLOPRAMIDE HCL....................................... 53METOCLOPRAMIDE HCL INTENSOL.................... 53METOLAZONE......................................................... 13METOPROLOL SUCCINATE................................... 12METOPROLOL SUCCINATE/HCTZ.........................12METOPROLOL TARTRATE..................................... 12METOPROLOL/HYDROCHLOROTHIAZIDE........... 12METOPROLOL-HYDROCHLOROTHIAZIDE...........12METOZOLV ODT......................................................53METROGEL..............................................................16METROGEL-VAGINAL............................................. 54METROLOTION....................................................... 16METRONIDAZOLE.......................................16, 40, 54METRONIDAZOLE/SKIN CLEANSR #23................ 16METVIXIA.................................................................46METYROSINE.......................................................... 11MEVACOR................................................................13MEXILETINE HCL.................................................... 10MGOX/E AC SUCC/B-12/FA/B6...............................57MIACALCIN(SPRAY/PUMP).................................... 31MIACALCIN(VIAL)....................................................31MICARDIS.......................................................... 11, 68MICARDIS HCT.................................................. 11, 68MICONAZOLE..........................................................39MICONAZOLE 3.......................................................54MICONAZOLE NITRATE..........................................54MICONAZOLE NITRATE/HC....................................17MICONAZOLE NITRATE/ZINC OX/PET.................. 17MICRODOT(OTC).............................................. 24, 27MICROFIBRILLAR COLLAGEN...............................36MICROGESTIN........................................................ 15MICROGESTIN FE...................................................14MICRO-K.................................................................. 30MICROLET 2(OTC).................................................. 28MICROLET VACULANCE(OTC).............................. 28MICROZIDE..............................................................13MIDAMOR................................................................ 12MIDAZOLAM HCL...................................................... 9MIDODRINE HCL.....................................................14MIFEPRISTONE.......................................................24MIGERGOT........................................................ 49, 61MIGLITOL................................................................. 23MIGRAL....................................................................49MIGRALAM...............................................................49MIGRANAL.........................................................49, 61MIGRATEN............................................................... 49MILLIPRED...............................................................42MILLIPRED DP.........................................................42MILNACIPRAN HCL.................................................46MILTOWN................................................................... 8MINI LANCING DEVICE(OTC).................................28MINIPRESS.............................................................. 11MINIVELLE.........................................................36, 61MINOCIN.................................................................. 39MINOCYCLINE HCL.................................................39MINOCYCLINE HCL MICROSPHERES.................. 46MINOCYCLINE HCL/SKIN CL NO.4........................ 39MINOXIDIL................................................................11MIPOMERSEN SODIUM..........................................13MIRABEGRON......................................................... 53MIRAPEX..................................................................50MIRAPEX ER............................................... 50, 61, 68MIRCETTE............................................................... 14MIRTAZAPINE............................................................7MISOPROSTOL....................................................... 53MITOMYCIN............................................................. 34MITOSOL..................................................................34MITOTANE............................................................... 45MOBAN.......................................................................9MOBIC......................................................................43MODAFINIL................................................................ 9MOEXIPRIL HCL...................................................... 11MOEXIPRIL/HYDROCHLOROTHIAZIDE................ 10MOLINDONE HCL......................................................9MOMETASONE FUROAT/AMMONIUM LAC........... 19MOMETASONE FUROATE.............................. 5, 7, 19MOMETASONE/FORMOTEROL................................6MOMEXIN.................................................................19Page 84 of 91