L.A. Care Covered Drug Formulary (pdf)

IndexMONOCLATE-P........................................................35MONODOX(CAP)(100 MG)......................................39MONODOX(CAP)(50 MG)........................................39MONODOX(CAP)(75 MG)........................................39MONOJECTOR LANCET DEVICE(OTC).................28MONONINE..............................................................35MONOPRIL...............................................................11MONTELUKAST SODIUM......................................... 7MONUROL............................................................... 38MORGIDOX..............................................................39MORPHINE SULFATE..............................................48MORPHINE SULFATE ER........................................48MORPHINE SULFATE LIPOSOMAL/PF.................. 48MORPHINE SULFATE(PCA SYRINGE)...................48MORPHINE SULFATE(PCA VIAL)........................... 48MORPHINE SULFATE(VIAL)................................... 48MORPHINE SULFATE/NALTREXONE.................... 48MORPHINE SULFATE/PF........................................ 48MOTOFEN................................................................44MOVIPREP...............................................................44MOXATAG................................................................ 38MOXEZA...................................................................33MOXIFLOXACIN HCL........................................ 33, 38MS CONTIN..............................................................48MST 600................................................................... 47M-TETRAHYROFOLATE/NIACIN/CU/ZN................ 56MTH/ME BLUE/SOD PHOS/PHEN/HYOS...............38MULTAQ................................................................... 10MULTICHEW............................................................ 56MULTIGEN............................................................... 55MULTIGEN PLUS..................................................... 55MULTI-LANCET DEVICE(OTC)............................... 28MULTI-RET FOLIC 500............................................ 55MULTIVIT, IRON, MIN #4, FA................................... 56MULTIVIT, IRON, MIN #5, FA................................... 56MULTIVIT, IRON, MIN #6, FA................................... 56MULTIVIT, IRON, MIN NO. 9, FA..............................56MULTIVIT, MIN CMB#20/IRON/FA........................... 56MULTIVIT, MIN NO.21/FOLIC ACID.........................56MULTIVIT, MIN NO.23/FOLIC ACID.........................56MULTIVIT, MINCMB#11/FOLIC ACID...................... 57MULTIVITAMIN AND FLUORIDE............................. 56MULTIVITAMIN W/IRON, MINERALS...................... 56MULTIVITAMIN, MIN CMB#25/FA/D3...................... 57MULTIVITAMINS WITH FLUORIDE......................... 56MULTIVITAMINS WITH MIN NO.7/FA......................56MULTIVITAMINS, MIN #28/FA/LYCO.......................55MULTIVIT-MIN #14/FOLIC ACID..............................56MULTIVIT-MIN12/FA/LYCOPENE/LUT.................... 56MULTIVITS W-IRON,HEMATINIC............................ 56MULTIVITS WITH IRON & FLUORIDE.................... 56MULTIVITS,THERAP W-FE,HEMATIN.....................56MUPIROCIN............................................................. 17MUPIROCIN CALCIUM......................................17, 46MUROCOLL-2.......................................................... 34MUSE................................................................. 30, 61MV, MIN CMB #6/FA/LUT/LYCO/Q10...................... 56MV, MIN CMB#16/FA/LUTEIN/LYCOP.....................55MV, MIN CMB#24/IRON PS CMP/FA.......................56MV, MIN CMB#26/FA/ALA/LUTEIN.......................... 57MV, MIN CMB#8/FA/CO Q10/OMEGA3................... 56MV, MIN CMB#9/FA/SAW PALMET XT....................56MV,MIN #10/FA/D3/ALIP ACID/LUT.........................56MV/DIETARY 4/DNA/RNA........................................56MYAMBUTOL........................................................... 40MYCI CHLOR-TAN..................................................... 5MYCOBUTIN............................................................ 40MYCOPHENOLATE MOFETIL.................................37MYCOPHENOLATE SODIUM.................................. 37MYCOSTATIN...........................................................39MYDRAL...................................................................34MYFORTIC............................................................... 37MYLERAN................................................................ 45MYO VYT..................................................................56MYRBETRIQ................................................ 53, 61, 68MYSOLINE............................................................... 51MYTELASE.................................................................7- N -NA PHOS MONO&DIBASIC/CELLULOSE.............. 44NA PHOS,M-B/K PHOS,MONOB.............................54NA SULFACETM/PREDNIS SP............................... 33NABILONE..................................................................6NABUMETONE........................................................ 43NADOLOL................................................................ 12NADOLOL/BENDROFLUMETHIAZIDE....................12NAFARELIN ACETATE.............................................31NAFRINSE DAILY-NEUTRAL...................................54NAFTIFINE HCL.......................................................18NAFTIN.....................................................................18NALBUPHINE HCL.................................................. 48NALEX JR................................................................ 15NALFON................................................................... 43NALIDIXIC ACID.......................................................38NALTREXONE HCL................................................... 9NAMENDA..................................................................7NAPH,MB-DB/K PH,MBDB/ZINC/UREA..................22NAPHAZOLINE HCL................................................ 33NAPHAZOLINE HCL W/ANTAZOLINE.................... 33NAPHAZOLINE HCL/ANTAZOLINE.........................33NAPHOS M-B M-H/NA PHOS,DI-BA....................... 44NAPRELAN.............................................................. 43NAPRELAN CR DOSE CARD..................................43NAPROSYN..............................................................43NAPROXEN..............................................................43NAPROXEN SODIUM.............................................. 43NAPROXEN/ESOMEPRAZOLE MAG......................42NAPROXEN/IRR CNTR-IRRIT CMB #2...................43NARATRIPTAN HCL.................................................49NARDIL.......................................................................7NASACORT AQ....................................................5, 61NASAREL.............................................................5, 61NASCOBAL.............................................................. 57NASONEX............................................................ 5, 61NATACYN................................................................. 33NATALCARE PLUS.................................................. 56NATAMYCIN............................................................. 33NATAZIA............................................................. 14, 68NATEGLINIDE.......................................................... 24NATROBA.................................................................18NATURETIN-5.......................................................... 13NAVANE(CAP)(10 MG).............................................. 9NAVANE(CAP)(2 MG)................................................ 9NAVANE(CAP)(20 MG).............................................. 9NAVANE(CAP)(5 MG)................................................ 9NEBIVOLOL HCL..................................................... 12NEBUPENT.............................................................. 40NECON.....................................................................15NEDOCROMIL SODIUM..........................................33NEFAZODONE HCL...................................................8NEGGRAM............................................................... 38NELFINAVIR MESYLATE.........................................41NEO SUL/PLYMX B SU/BUFFERS/HC....................29NEO/POLYMYX B SULF/DEXAMETH..................... 32NEOBENZ MICRO(CREAM)....................................21NEOBENZ MICRO(KIT CL&CRM)........................... 21NEOBENZ MICRO(KIT)........................................... 21NEOMY SULF/BACITRA/POLYMYXIN B.................33NEOMY SULF/BACITRAC ZN/POLY/HC.................32NEOMY SULF/COLIST SUL/HC/THONZ.................29NEOMY SULF/POLYMYX B SULF/PRED................32NEOMY SULF/POLYMYXIN B SULFATE................ 20NEOMYCIN SULFATE..............................................39NEOMYCIN SULFATE/DEX NA PH......................... 32NEOMYCIN W/DEXAMETHASONE........................ 32NEOMYCIN/BACITRA/POLYMYXIN/HC..................18NEOMYCIN/POLYMYXIN B SULF/HC...............18, 29NEOMYCIN/POLYMYXN B/GRAMICIDIN................33NEOMYCIN-BACITRACIN-POLY-HC.......................32NEOMYCIN-POLYMYXIN-DEXAMETH................... 32NEOMYCIN-POLYMYXIN-HC.................................. 29NEO-POLYCIN......................................................... 33NEORAL...................................................................37NEOSALUS.............................................................. 20NEOSALUS CP........................................................ 20NEOSPORIN............................................................ 33NEOSPORIN G.U. IRRIGANT..................................20NEOSTIGMINE BROMIDE.........................................7NEOTIC.................................................................... 29NEPAFENAC............................................................ 32NEPHPLEX RX........................................................ 57NEPHROCAPS QT...................................................57NEPHRON FA.......................................................... 55NEPTAZANE............................................................ 33NERVIDOX............................................................... 57NESINA.............................................................. 24, 68NEULASTA......................................................... 35, 73NEUMEGA................................................................35NEUPOGEN....................................................... 35, 73NEUPRO...................................................... 50, 61, 69NEURIN-SL.............................................................. 57NEURONTIN............................................................ 50NEVANAC.................................................................32NEVIRAPINE............................................................41NEXAVAR........................................................... 45, 73NEXAVIR.................................................................. 45NEXICLON XR(SUS ER 24H).................................. 11NEXICLON XR(TAB ER 24H)...................................11NEXIUM........................................................53, 61, 69NIACIN......................................................................14NIACIN SR 250MG...................................................14NIACIN/LOVASTATIN...............................................13NIACIN/SIMVASTATIN............................................. 13NIACOR....................................................................14NICARDIPINE HCL.................................................. 12NICOMIDE................................................................56NICOTINAMIDE........................................................56NICOTINE.................................................................51NICOTROL......................................................... 51, 61NICOTROL NS................................................... 51, 61NIFEDIPINE..............................................................12NIFEDIPINE ER........................................................12NIFEREX GOLD.......................................................55NILANDRON.............................................................45NILOTINIB HCL........................................................45NILUTAMIDE............................................................ 45NIMODIPINE............................................................ 12NIMOTOP................................................................. 12NIRON KOMPLETE..................................................55NISOLDIPINE...........................................................12NITAZOXANIDE....................................................... 17NITRIC OXIDE..........................................................12NITRO-BID............................................................... 14NITRO-DUR(PATCH TD24)(0.1MG/HR).................. 14NITRO-DUR(PATCH TD24)(0.2MG/HR).................. 14NITRO-DUR(PATCH TD24)(0.3 MG/HR)................. 14NITRO-DUR(PATCH TD24)(0.4MG/HR).................. 14NITRO-DUR(PATCH TD24)(0.6MG/HR).................. 14NITRO-DUR(PATCH TD24)(0.8MG/HR).................. 14NITROFURANTOIN..................................................38NITROFURANTOIN MACROCRYSTAL...................38NITROFURANTOIN MONOHYD/M-CRYST............ 38NITROFURAZONE...................................................17NITROGLYCERIN.............................................. 14, 44NITROSTAT..............................................................14NIZATIDINE.............................................................. 53NIZORAL.................................................................. 17NORCO.............................................................. 48, 61NORDETTE-28.........................................................14NORDITROPIN...................................................31, 73NORDITROPIN FLEXPRO.................................31, 73NORDITROPIN NORDIFLEX.............................31, 73NORELGESTROMIN/ETHIN.ESTRADIOL.............. 15NORETH A-ET ESTRA/FE FUMARATE.................. 14NORETH-ETHINYL ESTRADIOL/IRON...................15NORETHIND AC/ETHINYL ESTRADIOL.................37NORETHINDRONE..................................................15NORETHINDRONE ACETATE.................................37NORETHINDRONE A-E ESTRADIOL......................15NORETHINDRONE-ETHIN ESTRADIOL.................15NORETHINDRONE-ETHINYL ESTRAD..................15NORETHINDRONE-MESTRANOL.......................... 15NORFLOXACIN........................................................38NORFLURANE/HFC 245FA..................................... 22NORGESTIMATE-ETHINYL ESTRADIOL............... 15NORGESTREL-ETHINYL ESTRADIOL................... 15NORITATE................................................................ 16NORMAL SALINE.................................................... 30NORMAL SALINE FLUSH........................................30NORMLGEL AG....................................................... 17NOROXIN.................................................................38NORPACE................................................................ 10NORPACE CR.......................................................... 10NORPRAMIN..............................................................8NORTRIPTYLINE HCL...............................................8NORVASC................................................................ 12NORVIR(CAP).......................................................... 41NORVIR(SOLUTION)............................................... 41NORVIR(TAB)...........................................................41NOVA MAX GLUCOSE CONTROL SOLN(OTC)......2 7NOVACORT..............................................................22NOVAFERRUM........................................................ 55NOVAREL.................................................................30NOVOLIN 70-30 INNOLET(OTC).............................28NOVOLIN 70-30(OTC)............................................. 28NOVOLIN N INNOLET(OTC)................................... 29NOVOLIN N(OTC)....................................................29NOVOLIN R(OTC)....................................................29NOVOLOG................................................................28NOVOLOG FLEXPEN.............................................. 28NOVOLOG MIX 70-30..............................................29NOVOLOG MIX 70-30 FLEXPEN............................ 29NOVOSEVEN...........................................................35NOVOSEVEN RT..................................................... 35NOXAFIL.................................................................. 39NP THYROID............................................................32NPH, HUMAN INSULIN ISOPHANE........................ 29Page 85 of 91