L.A. Care Covered Drug Formulary (pdf)

IndexTESAMORELIN ACETATE.......................................31TESSALON.............................................................. 15TESSALON PERLE..................................................15TESTIM...............................................................36, 73TESTOSTERONE.................................................... 36TESTOSTERONE CYPIONATE.........................36, 73TESTOSTERONE ENANTHATE........................36, 73TESTOSTERONE PROPIONATE............................ 36TESTRED.................................................................36TETCAINE................................................................33TETRABENAZINE....................................................46TETRACAINE HCL.............................................22, 33TETRACAINE HCL/PF............................................. 33TETRACAINE/BENZOCAINE/BUTAMBEN..............22TETRACYCLINE HCL.............................................. 39TETRAVISC..............................................................33TETRAVISC FORTE.................................................33TEVETEN HCT................................................... 11, 70TEVETEN(TAB)(400 MG)................................... 11, 70TEVETEN(TAB)(600 MG)................................... 11, 70TEV-TROPIN...................................................... 31, 73TEXACORT.............................................................. 19THALIDOMIDE......................................................... 40THALITONE..............................................................13THALOMID......................................................... 40, 73THEO-24.....................................................................7THEOCHRON.............................................................7THEOPHYLL/EPHED HCL/PHENOBARB................. 7THEOPHYLLINE ANHYDROUS................................ 7THEOTAL................................................................... 7THERMAZENE.........................................................18THEROBEC..............................................................56THEROBEC PLUS................................................... 56THIAMINE HCL........................................................ 57THIOGUANINE.........................................................45THIOLA.....................................................................53THIORIDAZINE HCL.................................................. 9THIOTHIXENE............................................................9THROMBIN (BOVINE)..............................................36THROMBIN (RECOMBINANT).................................36THROMBIN(HUM PLAS)/FIB/APRO/CA..................36THROMBIN(HUM PLAS)/FIBRINOG/CA................. 36THROMBIN/FIBRINOGEN/APRO/CAL....................36THROMBIN-JMI........................................................36THYROID..................................................................32THYROID,PORK...................................................... 32THYROLAR-1...........................................................32THYROLAR-1/2........................................................32THYROLAR-1/4........................................................32THYROLAR-2...........................................................32THYROLAR-3...........................................................32TIA DOCE.................................................................57TIAGABINE HCL...................................................... 51TICAGRELOR.......................................................... 35TICLOPIDINE HCL...................................................35TIGAN.........................................................................6TIKOSYN..................................................................10TILUDRONATE DISODIUM......................................31TIMOLOL..................................................................34TIMOLOL MALEATE.......................................... 12, 34TIMOPTIC.................................................................34TIMOPTIC-XE...........................................................34TINDAMAX............................................................... 40TINIDAZOLE.............................................................40TINZAPARIN SODIUM,PORCINE............................35TIOPRONIN..............................................................53TIOTROPIUM BROMIDE........................................... 6TIPRANAVIR............................................................ 40TIPRANAVIR/VITAMIN E TPGS...............................40TIROSINT.................................................................32TISSEEL VHSD........................................................36TIZANIDINE HCL......................................................51TIZANIDINE/IRR CNTR-IRR CMB #2...................... 51TL-FOL 500.............................................................. 55TL-HIST CD..............................................................15TOBI................................................................... 39, 73TOBRADEX ST........................................................ 32TOBRADEX(DROPS SUSP).................................... 32TOBRADEX(OINT)................................................... 32TOBRAMYCIN..........................................................33TOBRAMYCIN IN 0.225% NACL............................. 39TOBRAMYCIN/DEXAMETHASONE........................ 32TOBRAMYCIN/LOTEPRED ETAB........................... 32TOBREX................................................................... 33TOFACITINIB CITRATE........................................... 42TOFRANIL.................................................................. 8TOFRANIL-PM........................................................... 8TOLAZAMIDE...........................................................24TOLBUTAMIDE........................................................ 24TOLCAPONE............................................................50TOLMETIN SODIUM................................................ 43TOLTERODINE TARTRATE..................................... 54TOLVAPTAN............................................................. 30TOPAMAX................................................................ 51TOPICORT............................................................... 19TOPIRAMATE...........................................................51TOPOTECAN HCL................................................... 45TOPROL XL..............................................................12TORADOL(CARTRIDGE)(15 MG/ML)......................43TORADOL(CARTRIDGE)(30 MG/ML)......................43TOREMIFENE CITRATE.......................................... 46TORSEMIDE............................................................ 12TOURO ALLERGY................................................... 15TOVIAZ...............................................................54, 70TRACER(OTC)...................................................25, 27TRACLEER........................................................ 12, 73TRADJENTA.............................................................24TRAMADOL HCL......................................................49TRAMADOL HCL(CPMP 25-75).................. 49, 61, 70TRAMADOL HCL(TAB ER 24H)...............................49TRAMADOL HCL/ACETAMINOPHEN..................... 49TRANDATE...............................................................10TRANDOLAPRIL...................................................... 11TRANDOLAPRIL/VERAPAMIL HCL.........................10TRANDOLAPRIL-VERAPAMIL.................................10TRANEXAMIC ACID.................................................34TRANSDERM-SCOP..................................................6TRANXENE SD.......................................................... 8TRANXENE T-TAB..................................................... 8TRANYLCYPROMINE SULFATE............................... 7TRAVATAN Z...................................................... 34, 61TRAVOPROST......................................................... 34TRAZODONE HCL.....................................................8TRECATOR.............................................................. 40TREPROSTINIL SODIUM........................................ 12TREPROSTINIL/NEBULIZER/ACCESOR................12TRETINOIN........................................................ 17, 45TRETINOIN MICROSPHERE(GEL W/PUMP)......... 17TRETINOIN MICROSPHERE(GEL)...................17, 58TRETINOIN MICROSPHERES................................ 17TRETINOIN/EMOL 9/SKIN CLN1/GEL.................... 17TRETINOIN/EMOL CMB9/SKIN CLN1.....................17TRETINOIN/EMOLLIENT.........................................17TRETINOIN/MEQUINOL.......................................... 23TRETIN-X........................................................... 17, 58TREXALL..................................................................45TREXIMET................................................... 49, 61, 70TRIACETIN...............................................................39TRIAMCIN/HYDROPHILIC OINTMENT...................19TRIAMCIN/SKIN CLNSR 6/EMOLL 27.................... 19TRIAMCIN/UREA/HYDRO OINT..............................19TRIAMCINOLONE ACETONIDE................5, 7, 19, 46TRIAMCINOLONE DIACETATE............................... 42TRIAMCINOLONE/EMOLLIENT CMB#45............... 20TRIAMTERENE........................................................12TRIAMTERENE/HYDROCHLOROTHIAZID.............12TRIAMTERENE-HCTZ............................................. 12TRIAZOLAM............................................................... 9TRIBENZOR....................................................... 11, 70TRICITRATES.......................................................... 54TRICOR....................................................................13TRIDERM................................................................. 19TRIDESILON............................................................ 19TRIFLUOPERAZINE HCL.......................................... 9TRIFLURIDINE.........................................................32TRIGLIDE........................................................... 14, 70TRIHEXYPHENIDYL HCL........................................50TRILEPTAL(ORAL SUSP)........................................51TRILEPTAL(TAB)......................................................51TRILIPIX................................................................... 14TRI-LUMA.................................................................22TRIMETHOBENZAMIDE HCL....................................6TRIMETHOBENZAMIDE HCL/B-CAINE.................... 6TRIMETHOPRIM......................................................38TRIMIPRAMINE MALEATE........................................ 8TRIOXIN................................................................... 30TRIPELENNAMINE HCL............................................5TRIPLE DYE.............................................................17TRIPOHIST.................................................................5TRIPROLIDINE HCL.................................................. 5TRIPROLIDINE TANNATE......................................... 5TRISPEC PSE..........................................................16TRI-VIT WITH FLUORIDE-IRON..............................56TRIZIVIR...................................................................41TROPAZONE............................................................20TROPICAMIDE.........................................................34TROSPIUM CHLORIDE........................................... 54TRUECONTROL(OTC)...................................... 25, 26TRUETEST GLUCOSE CONTROL(OTC).......... 25-27TRUETRACK(OTC)............................................25, 26TRUSOPT.................................................................33TRUVADA.................................................................41TRYPSIN/BALSAM PERU/CASTOR OIL.................22TUDORZA PRESSAIR................................... 6, 61, 70TUSSICAPS............................................................. 16TUSSIONEX.............................................................16TUSSI-ORGANIDIN NR........................................... 16TWINJECT................................................................45TWYNSTA...........................................................11, 71TYKERB................................................................... 45TYLENOL-CODEINE NO.3...................................... 49TYLENOL-CODEINE NO.4...................................... 49TYLOX................................................................48, 61TYPHOID VACC,LIVE,ATTENUATED......................37TYVASO............................................................. 12, 73TYZEKA....................................................................41- U -UCEPHAN................................................................ 44UCERIS.............................................................. 42, 71UDAMIN..............................................................55, 56UDAMIN SP..............................................................56ULESFIA...................................................................18ULIPRISTAL ACETATE............................................ 15ULORIC.................................................................... 34ULTI-LANCE(OTC)................................................... 28ULTRACET............................................................... 49ULTRAFOAM............................................................36ULTRAM................................................................... 49ULTRASE................................................................. 52ULTRASE MT 12...................................................... 52ULTRASE MT 18...................................................... 52ULTRASE MT 20...................................................... 52ULTRATRAK PRO(OTC).......................................... 24ULTRATRAK ULTIMATE(OTC).................................25ULTRATRAK(OTC).............................................25, 27ULTRAVATE..............................................................19ULTRAVATE PAC(CMB CRM LT).............................19ULTRAVATE PAC(CMB ONT LT)..............................19ULTRAVATE X.......................................................... 19ULTRESA................................................................. 52UMECTA...................................................................21UMECTA PD.............................................................21UNIRETIC.................................................................10UNISTIK 2 EXTRA(OTC)..........................................28UNISTIK 2 NORMAL................................................ 28UNISTIK 2 NORMAL(OTC)...................................... 28UNISTIK 2(OTC).......................................................28UNISTIK 3 COMFORT(OTC)................................... 28UNISTIK 3 NEONATAL(OTC)...................................28UNISTIK 3(OTC).......................................................28UNISTIK(OTC)..........................................................28UNITHROID..............................................................32UNIVASC.................................................................. 11UNOPROSTONE ISOPROPYL................................34UR N-C..................................................................... 38URAMAXIN...............................................................21URAMAXIN GT.........................................................21UREA..................................................................21, 23UREA/EMOL/BAK CL/PVP/GRP SD XT.................. 21UREA/EMOLLIENT COMBINATION #65................. 21UREA/HYALURONATE SODIUM.............................21UREA/LACTIC AC/ZN UNDECYLENATE................ 21UREA/LACTIC ACID/SALICYL ACID.......................21URECHOLINE.......................................................... 45URELLE....................................................................38URETRON D-S.........................................................38UREX........................................................................38URIBEL.....................................................................38URIN D.S..................................................................38URINE GLUC-ACET COMB.TST,STRIP..................29UROCIT-K(TAB ER)(10 MEQ)..................................54UROCIT-K(TAB ER)(15 MEQ)..................................54UROCIT-K(TAB ER)(5 MEQ)....................................54URODOL.................................................................. 54UROFOLLITROPIN.................................................. 30UROLOGIC SOLUTION G....................................... 39UROLOGIC SOLUTION-G....................................... 39UROQID-ACID NO.2................................................ 53UROXATRAL............................................................ 53URSO....................................................................... 44URSO FORTE.......................................................... 44URSODIOL...............................................................44URYL........................................................................ 38USTEKINUMAB........................................................42UTA...........................................................................38UTAC........................................................................ 53- V -Page 90 of 91