L.A. Care Covered Drug Formulary (pdf)

IndexPYRILAMINE TANNATE.............................................5PYRIMETHAMINE....................................................40PYRIMETHAMINE/SULFADOXINE..........................40PYRLEX..................................................................... 5PYROGALLIC ACID................................................. 23PYROGALLOL......................................................... 23- Q -QNASL........................................................... 5, 61, 69QSYMIA..............................................................57, 73QUALAQUIN.............................................................40QUAZEPAM................................................................9QUESTRAN..............................................................13QUETIAPINE FUMARATE......................................... 9QUIBRON...................................................................6QUIC-K..................................................................... 30QUICKTEK(OTC)..................................................... 27QUILLIVANT XR........................................... 10, 61, 69QUINAPRIL HCL...................................................... 11QUINAPRIL/HYDROCHLOROTHIAZIDE.................10QUINAPRIL-HYDROCHLOROTHIAZIDE................ 10QUINIDINE GLUCONATE........................................ 10QUINIDINE SULFATE.............................................. 10QUININE SULFATE.................................................. 40QUIXIN..................................................................... 33QUTENZA...........................................................21, 73QVAR....................................................................6, 61- R -RABEPRAZOLE SODIUM........................................53RADIAPLEXRX........................................................ 22RALOXIFENE HCL...................................................31RALTEGRAVIR POTASSIUM...................................41RAMELTEON..............................................................9RAMIPRIL................................................................. 11RANEXA...................................................................14RANICLOR............................................................... 37RANITIDINE............................................................. 53RANITIDINE 150MG.................................................53RANITIDINE HCL..................................................... 53RANOLAZINE...........................................................14RAPAFLO........................................................... 53, 70RAPAMUNE..............................................................37RAPIFLUX.................................................................. 7RAPTIVA...................................................................23RASAGILINE MESYLATE........................................ 50RAVICTI..............................................................44, 73RAYOS............................................................... 42, 70RAZADYNE................................................................ 7RAZADYNE ER.......................................................... 7REBETOL(CAP)....................................................... 41REBETOL(SOLUTION)............................................ 41REBIF....................................................................... 46RECOMBINATE........................................................34RECOTHROM.......................................................... 36RECTAGEL HC........................................................ 43RECTIV.....................................................................44REDERM.................................................................. 19REFACTO.................................................................34REFUAH PLUS GLUCOSE CONTROL(OTC)......... 25REGENECARE.........................................................22REGIMEX................................................................. 57REGLAN...................................................................53REGORAFENIB........................................................45REGRANEX..............................................................28RELENZA................................................................. 40RELIAMED MINI LANCING DEVICE(OTC)............. 28RELISTOR..........................................................44, 73RELPAX........................................................49, 61, 70REMERGENT HQ.................................................... 22REMERON................................................................. 7REMESENSE........................................................... 46REMODULIN...................................................... 12, 73RENACIDIN..............................................................53RENAGEL................................................................ 30RENAL CAPS...........................................................57RENATABS...............................................................57RENATABS WITH IRON...........................................57RENA-VITE RX.........................................................57RENAX..................................................................... 56RENEW ADVANCED LANCING SYSTEM(OTC)......2 8RENOVA...................................................................17RENOVA PUMP....................................................... 17RENVELA(POWD PACK).........................................30RENVELA(TAB)........................................................30REPAGLINIDE..........................................................24REPAGLINIDE/METFORMIN HCL...........................24REPLIVA 21-7...........................................................55REPRONEX..............................................................30REQ49+....................................................................55REQUIP....................................................................50REQUIP XL.................................................. 50, 61, 70RESCRIPTOR.......................................................... 41RESCULA.....................................................34, 61, 70RESECTISOL...........................................................12RESERPINE............................................................. 11RESERPINE/HYDROCHLOROTHIAZIDE............... 11RESTASIS................................................................ 33RESTORIL..................................................................9RETAPAMULIN.........................................................18RETIN-A............................................................. 17, 58RETIN-A MICRO................................................ 17, 58RETROVIR............................................................... 41REVATIO............................................................ 12, 61REVIA.........................................................................9REVLIMID...........................................................45, 73REXAVITE 150......................................................... 55REYATAZ..................................................................41REZIRA.....................................................................16RHINOCORT AQUA.......................................5, 61, 70RIBATAB.............................................................41, 70RIBAVIRIN.......................................................... 40, 41RICOBID...................................................................15RICOBID-H.................................................................5RIDAURA..................................................................42RIFABUTIN...............................................................40RIFADIN....................................................................40RIFAMATE................................................................ 40RIFAMPIN.................................................................40RIFAMPIN/ISONIAZID..............................................40RIFAMPIN/ISONIAZID/PYRAZINAMID.................... 40RIFAPENTINE.......................................................... 40RIFATER...................................................................40RIFAXIMIN................................................................40RIGHTEST CONTROL SOLUTION(OTC)..........25, 27RIGHTEST GD500(OTC)......................................... 28RILONACEPT...........................................................41RILPIVIRINE HCL.................................................... 41RILUTEK...................................................................46RILUZOLE................................................................ 46RIMANTADINE HCL................................................. 40RIMEXOLONE..........................................................32RINGERS IRRIGATION............................................20RINGERS SOLUTION..............................................20RINGERS SOLUTION,LACTATED...........................20RINNOVI...................................................................21RIOMET....................................................................24RISEDRONATE SOD/CALCIUM CARB................... 31RISEDRONATE SODIUM.........................................31RISPERDAL(SOLUTION).....................................9, 61RISPERDAL(TAB)................................................ 9, 61RISPERIDONE...........................................................9RITALIN LA...................................................10, 58, 61RITONAVIR.............................................................. 41RIVAROXABAN........................................................ 35RIVASTIGMINE.......................................................... 7RIVASTIGMINE TARTRATE.......................................7RIZATRIPTAN BENZOATE.......................................49ROBAXIN..................................................................51ROBAXIN-750.......................................................... 51ROBINUL..................................................................53ROBINUL FORTE.....................................................53ROCALTROL............................................................ 57ROFLUMILAST...........................................................7ROMYCIN.................................................................33RONDEC-DM........................................................... 16ROPINIROLE HCL................................................... 50ROSADAN................................................................16ROSADERM.............................................................18ROSANIL..................................................................18ROSE BENGAL........................................................34ROSE BENGAL SODIUM.........................................34ROSIGLITAZONE MALEATE................................... 24ROSIGLITAZONE/GLIMEPIRIDE.............................24ROSIGLITAZONE/METFORMIN HCL......................24ROSULA...................................................................18ROSULA CLK...........................................................18ROSULA NS.............................................................20ROSUVASTATIN CALCIUM..................................... 13ROTARIX.................................................................. 37ROTATEQ.................................................................37ROTAVIRUS VAC,LIVE ATT, 89-12.......................... 37ROTAVIRUS VAC,LIVE PENTAV............................. 37ROTIGOTINE........................................................... 50ROWASA..................................................................43ROXICODONE INTENSOL...................................... 48ROXICODONE(SOLUTION).................................... 48ROXICODONE(TAB)................................................ 48ROZEREM......................................................9, 61, 70R-TANNA.................................................................. 15RUFINAMIDE........................................................... 51RU-TUSS DM........................................................... 16RUXOLITINIB PHOSPHATE.................................... 45RYBIX ODT.............................................................. 49RYNATAN PEDIATRIC............................................. 15RYTHMOL................................................................ 10RYTHMOL SR.......................................................... 10RYZOLT....................................................................49- S -SABRIL...............................................................51, 61SACROSIDASE........................................................51SAFYRAL........................................................... 14, 70SAIZEN...............................................................31, 73SAL ACID/BENZ PER/EMOL CMB#47.................... 21SALACYN.................................................................21SALAGEN.................................................................45SAL-AMIDE/ACETAMIN/P-TLOX/CAFF...................47SAL-AMIDE/ACETAMINOPHN/P-TLOX...................47SALEX...................................................................... 21SALICYLAMIDE/ACETAMINOPHEN....................... 47SALICYLIC AC/BENZOYL PER/VIT E..................... 21SALICYLIC ACID......................................................21SALICYLIC ACID/AMMON LACT/ALOE.................. 21SALICYLIC ACID/AMMONIATED HG...................... 21SALICYLIC ACID/BENZ PER...................................21SALICYLIC ACID/CERAMIDE CMB #1....................21SALICYLIC ACID/UREA...........................................21SALMETEROL XINAFOATE...................................... 6SALSALATE............................................................. 47SAL-TROPINE..........................................................52SALURON................................................................ 13SALVAX DUO........................................................... 21SALVAX DUO PLUS.................................................21SAMSCA............................................................ 30, 61SANCTURA........................................................54, 70SANCTURA XR..................................................54, 70SANCUSO......................................................6, 61, 70SANDIMMUNE......................................................... 37SANTYL....................................................................22SAPHRIS........................................................9, 61, 70SAQUINAVIR MESYLATE........................................41SARAFEM.................................................................. 7SARGRAMOSTIM.................................................... 35SAVELLA.................................................................. 46SAXAGLIPTIN HCL..................................................24SAXAGLIPTIN HCL/METFORMIN HCL...................23SCALACORT DK......................................................19SCLEROSOL............................................................45SCOPACE.................................................................. 6SCOPOLAMINE......................................................... 6SCOPOLAMINE HYDROBROMIDE.....................6, 34SE 10-5 SS...............................................................18SECOBARBITAL SODIUM......................................... 9SECONAL SODIUM................................................... 9SECTRAL................................................................. 11SELECT-LITE(OTC)................................................. 28SELEGILINE...............................................................9SELEGILINE HCL.................................................... 50SELENIUM SULFIDE............................................... 20SELZENTRY.............................................................41SEMPREX-D.............................................................. 5SENILEZOL..............................................................56SENSIPAR................................................................31SEREVENT DISKUS............................................6, 61SEROMYCIN............................................................40SEROPHENE........................................................... 30SEROQUEL..........................................................9, 61SEROQUEL XR....................................................9, 61SEROSTIM.........................................................31, 73SERTACONAZOLE NITRATE.................................. 18SERTRALINE HCL..................................................... 8SE-TAN PLUS.......................................................... 55SEVELAMER CARBONATE.....................................30SEVELAMER HCL................................................... 30SIBUTRAMINE HCL M-HYDRATE...........................57SIDEROL..................................................................55SILDENAFIL CITRATE....................................... 12, 30SILENOR........................................................9, 61, 70SILODOSIN.............................................................. 53SILVER..................................................................... 17SILVER CARBONATE.............................................. 17SILVER NITRATE............................................... 17, 21SILVER NITRATE APPLICATOR..............................21SILVER SULFADIAZINE...........................................18SILVRSTAT...............................................................17SIMCOR(TBMP 24HR)(1000-20MG)........... 13, 61, 70SIMCOR(TBMP 24HR)(1000-40 MG).......... 13, 61, 70SIMCOR(TBMP 24HR)(500MG-20MG)....... 13, 61, 70Page 88 of 91