New Hampshire ADAP FORMULARIES New drugs added s<strong>in</strong>ce June 2002 <strong>in</strong>dicated <strong>in</strong> bold. ANTIRETROVIRALS NRTIs- abacavir (Ziagen), abacavir/lamivud<strong>in</strong>e/zidovud<strong>in</strong>e (Trizivir), didanos<strong>in</strong>e (ddI, Videx), emtricitab<strong>in</strong>e (Emtriva), lamivud<strong>in</strong>e (Epivir, 3TC), lamivud<strong>in</strong>e/zidovud<strong>in</strong>e (Combivir), stavud<strong>in</strong>e (d4T, Zerit), tenofovir (Viread), zalcitab<strong>in</strong>e (ddC, Hivid), zidovud<strong>in</strong>e (AZT, Retrovir). PIs- amprenavir (Agenerase), atazanavir (Reyataz), fosamprenavir (Lexiva), <strong>in</strong>d<strong>in</strong>avir (Crixivan), lop<strong>in</strong>avir/ritonavir (Kaletra), nelf<strong>in</strong>avir (Viracept), ritonavir (Norvir), saqu<strong>in</strong>avir (Fortovase, Invirase). NNRTIs- delavird<strong>in</strong>e (Rescriptor), efavirenz (Sustiva), nevirap<strong>in</strong>e (Viramune). Other- hydroxyurea (Hydrea). OI DRUGS PHS “A1 OI”s- acyclovir (Zovirax), azithromyc<strong>in</strong> (Zithromax), clarithromyc<strong>in</strong> (Biax<strong>in</strong>), famciclovir (Famvir), fluconazole (Diflucan), ganciclovir (Cytovene), isoniazid (Rifater), itraconazole (Sporonox), leucovor<strong>in</strong> (Wellcovor<strong>in</strong>), pyrimetham<strong>in</strong>e (Daraprim), TMP/SMX (Bactrim, Septra). Hepatitis C- all FDA approved drugs. ALL OTHERS Open formulary, all FDA approved drugs are covered with follow<strong>in</strong>g exclusions: Class Exclusions:Cosmetics, Erectile Dysfunction Medications, Fertility Drugs, Hair Growth Stimulants, Herbal Medications, Immuniz<strong>in</strong>g Biologicals, Less than Effective Drugs, Nutritional Supplements, Over the Counter Medications, Sex Reassignment Drugs, Vitam<strong>in</strong>s and M<strong>in</strong>erals. Specific drug exclusions: Active medication conta<strong>in</strong><strong>in</strong>g more than one <strong>in</strong>gredient, antir heumatic <strong>in</strong>jectables, botul<strong>in</strong>um tox<strong>in</strong> compounded mediations for <strong>in</strong>fusion, contraceptives, enfuvirtide (Fuzeon), f<strong>in</strong>asteride, gonadatrop<strong>in</strong>s, hyaluronic acid derivatives, immune globul<strong>in</strong> <strong>in</strong>travenous IGIV, <strong>in</strong>jectable muscle relaxants, medroxyprogesterone, mifepristone, monoclonal antibodies, propoxyphene, recomb<strong>in</strong>ant human growth hormone HGH. New Jersey ANTIRETROVIRALS NRTIs- abacavir (Ziagen), abacavir/lamivud<strong>in</strong>e/zidovud<strong>in</strong>e (Trizivir), didanos<strong>in</strong>e (ddI, Videx, Videx EC), emtricitab<strong>in</strong>e (Emtriva), lamivud<strong>in</strong>e (Epivir, 3TC), lamivud<strong>in</strong>e/zidovud<strong>in</strong>e (Combivir), stavud<strong>in</strong>e (d4T, Zerit), tenofovir (Viread), zalcitab<strong>in</strong>e (ddC, Hivid), zidovud<strong>in</strong>e (AZT, Retrovir). PIs- amprenavir (Agenerase), atazanavir (Reyataz), fosamprenavir (Lexiva), <strong>in</strong>d<strong>in</strong>avir (Crixivan), lop<strong>in</strong>avir/ritonavir (Kaletra), nelf<strong>in</strong>avir (Viracept), ritonavir (Norvir), saqu<strong>in</strong>avir (Fortovase, Invirase). NNRTIs- delavird<strong>in</strong>e (Rescriptor), efavirenz (Sustiva), nevirap<strong>in</strong>e (Viramune). Other- hydroxyurea (Hydrea). Entry Inhibitor- enfuvirtide (Fuzeon). OI DRUGS PHS “A1 OI”s- acyclovir (Zovirax), azithromyc<strong>in</strong> (Zithromax), cidofovir (Vistide), clarithromyc<strong>in</strong> (Biax<strong>in</strong>), famciclovir (Famvir), fluconazole (Diflucan), foscarnet (Foscavir), ganciclovir (Cytovene), isoniazid (INH), itraconazole (Sporonox), leucovor<strong>in</strong>, pyrimetham<strong>in</strong>e (Daraprim, Fansidar), sulfadiaz<strong>in</strong>e, TMP/SMX (Bactrim). Hepatitis C- all FDA approved drugs. ALL OTHERS Open <strong>Formulary</strong>. all FDA approved drugs are covered. Specific exclusions: cosmetics, fertility drugs, less than effective drugs, over the counter mediations, impotence treatments limited to four times a year. New Mexico ANTIRETROVIRALS NRTIs- abacavir (Ziagen), abacavir/lamivud<strong>in</strong>e/zidovud<strong>in</strong>e (Trizivir), didanos<strong>in</strong>e (ddI, Videx), emtricitab<strong>in</strong>e (Emtriva), lamivud<strong>in</strong>e (Epivir, 3TC), lamivud<strong>in</strong>e/zidovud<strong>in</strong>e (Combivir), stavud<strong>in</strong>e (d4T, Zerit), tenofovir (Viread), zalcitab<strong>in</strong>e (ddC, Hivid), zidovud<strong>in</strong>e (AZT, Retrovir). PIs- amprenavir (Agenerase), atazanavir (Reyataz), fosamprenavir (Lexiva), <strong>in</strong>d<strong>in</strong>avir (Crixivan), lop<strong>in</strong>avir/ritonavir (Kaletra), nelf<strong>in</strong>avir (Viracept), ritonavir (Norvir), saqu<strong>in</strong>avir (Fortovase, Invirase). NNRTIs- delavird<strong>in</strong>e (Rescriptor), efavirenz (Sustiva), nevirap<strong>in</strong>e (Viramune). Other- hydroxyurea (Hydrea). OI DRUGS PHS “A1 OI”s- acyclovir (Zovirax), azithromyc<strong>in</strong> (Zithromax), clarithromyc<strong>in</strong> (Biax<strong>in</strong>), famciclovir (Famvir), fluconazole (Diflucan), foscarnet (Foscavir), ganciclovir (Cytovene), itraconazole (Sporonox), leucovor<strong>in</strong>, pyrimetham<strong>in</strong>e (Daraprim), sulfadiaz<strong>in</strong>e, TMP/SMX (Bactrim, Septra). Other OIs- amikac<strong>in</strong> (Amik<strong>in</strong>), amphoteric<strong>in</strong> B, atovaquone (Mepron), ciprofloxac<strong>in</strong> (Cipro), cl<strong>in</strong>damyc<strong>in</strong> (Cleoc<strong>in</strong>), clofazim<strong>in</strong>e (Lamprene), clotrimazole (Mycelex), dapsone, erythropoiet<strong>in</strong> (Epogen), ethambutol (Myambutol), filgrastim (G-CSF, Neupogen), ketoconazole (Nizoral), metronidazole (Flagyl), nystat<strong>in</strong> (Mycostat<strong>in</strong>), pentamid<strong>in</strong>e (Nebupent, Pentam), primaqu<strong>in</strong>e, rifabut<strong>in</strong> (Mycobut<strong>in</strong>), trimethoprim (Proloprim), valacyclovir (Valtrex), valganciclovir (Valcyte). Hepatitis C- none. TREATMENTS FOR METABOLIC DISORDERS Diabetic- metform<strong>in</strong> (Glucophage). Hyperlipidemia- atorvastat<strong>in</strong> (Lipitor), gemfibrozil (Lopid), pravastat<strong>in</strong> (Pravachol). Wast<strong>in</strong>g- Megestrol (Megace). Vacc<strong>in</strong>es- Enterix-B (HBV), Haverix (HAV), Tw<strong>in</strong>rix (HAV and HBV) ALL OTHERS Centrum Silver, Cerovite Silver, Nizoral Cream, Prenatal-S, sertral<strong>in</strong>e (Zoloft), Tegr<strong>in</strong> Shampoo. contraceptives (condoms with/without nonoxynol 9, Spermicidal Foam, VCF Spermicidal Film, Depo-Provera, Norplant, Ovulation thermometer, Fertility Awareness book, charts, videotape“All Methods” counsel<strong>in</strong>g pamphlet, Oral Contraceptives, Loestr<strong>in</strong> Fe, Micronor, Nordette, Ortho-Cyclen, Ortho Novum, Triphasil).
New York ADAP FORMULARIES New drugs added s<strong>in</strong>ce June 2002 <strong>in</strong>dicated <strong>in</strong> bold. ANTIRETROVIRALS NRTIs- abacavir (Ziagen), abacavir/lamivud<strong>in</strong>e/zidovud<strong>in</strong>e (Trizivir), didanos<strong>in</strong>e (ddI, Videx, Videx EC), emtricitab<strong>in</strong>e (Emtriva), lamivud<strong>in</strong>e (Epivir, 3TC), lamivud<strong>in</strong>e/zidovud<strong>in</strong>e (Combivir), stavud<strong>in</strong>e (d4T, Zerit), tenofovir (Viread), zalcitab<strong>in</strong>e (ddC, Hivid), zidovud<strong>in</strong>e (AZT, Retrovir). PIs- amprenavir (Agenerase), atazanavir (Reyataz), fosamprenavir (Lexiva), <strong>in</strong>d<strong>in</strong>avir (Crixivan), lop<strong>in</strong>avir/ritonavir (Kaletra), nelf<strong>in</strong>avir (Viracept), ritonavir (Norvir), saqu<strong>in</strong>avir (Fortovase, Invirase). NNRTIs- delavird<strong>in</strong>e (Rescriptor), efavirenz (Sustiva), nevirap<strong>in</strong>e (Viramune). Other- hydroxyurea (Hydrea). Entry Inhibitor- enfufuvirtide (Fuzeon). OI DRUGS PHS “A1 OI”s- acyclovir, azithromyc<strong>in</strong>, cidofovir, clarithromyc<strong>in</strong>, fluconazole, foscarnet, ganciclovir, isoniazid, itraconazole, leucovor<strong>in</strong>, pyrimetham<strong>in</strong>e, sulfadiaz<strong>in</strong>e, TMP/SMX. Other OIs- albendazole, amikac<strong>in</strong>, amphoteric<strong>in</strong> B, atovaquone, bleomyc<strong>in</strong>, caspofung<strong>in</strong>, capreomyc<strong>in</strong>, ciprofloxac<strong>in</strong>, cl<strong>in</strong>damyc<strong>in</strong>, clotrimazole, cyclophosphamide, cycloser<strong>in</strong>e, cytarab<strong>in</strong>e, dapsone, dexamethasone, doxorubic<strong>in</strong>, econazole nitrate, epoet<strong>in</strong> alfa, ethionamide, ethambutol, etoposide, filgrastim, flucytos<strong>in</strong>e, formivirsen, gatifloxac<strong>in</strong>, griseofulv<strong>in</strong>, immune globul<strong>in</strong> Rho (W<strong>in</strong> Rho SDF), IVIG, kanamyc<strong>in</strong>, ketoconazole, liposomal doxorubic<strong>in</strong>, liposomal daunorubic<strong>in</strong>, lomust<strong>in</strong>e, moxifloxac<strong>in</strong>, miconazole, methotrexate, nystat<strong>in</strong>, ofloxac<strong>in</strong>, oprelvek<strong>in</strong> (Neumega), paclitaxel, panret<strong>in</strong> gel, para-am<strong>in</strong>o salicyclic acid, paromomyc<strong>in</strong>, penciclovir, pentamid<strong>in</strong>e, prednisone, primaqu<strong>in</strong>e, procarbaz<strong>in</strong>e, pyraz<strong>in</strong>amide,rifabut<strong>in</strong>, rifampim, rifampim <strong>in</strong> comb<strong>in</strong>ation, rifapent<strong>in</strong>e,sargramostim, streptomyc<strong>in</strong>, sulfadox<strong>in</strong>e/pyrimetham<strong>in</strong>e, sulfamethoxazole, terb<strong>in</strong>af<strong>in</strong>e, terconazole, trimethoprim, triple sulfa ,valganciclovir, valacyclovir, valgancyclovir, v<strong>in</strong>blast<strong>in</strong>e, v<strong>in</strong>crist<strong>in</strong>e. Hepatitis C- peg-<strong>in</strong>terferon alfa-2a & ribavir<strong>in</strong> (Pegasys/Copegus), peg-<strong>in</strong>terferon alfa-2b (Peg-Intron), ribavir<strong>in</strong>, Intron A (Rebetron). TREATMENTS FOR METABOLIC DISORDERS Cardiac- acebutolol, amiloride, amlodip<strong>in</strong>e, atenolol, benazepril, bendroflumethiazide, betaxolol, bisoprolol,bumetanide, candesartan, captopril, carteolol, carvedilol, chlorothiazide, chlorthalidone, clonid<strong>in</strong>e, cyclandelate, digox<strong>in</strong>, diltiazem, doxazos<strong>in</strong>, enalapril, felbamate, felodip<strong>in</strong>e, fos<strong>in</strong>opril, furosemide,guanabenz, guanadrel, guanfac<strong>in</strong>e, hydralaz<strong>in</strong>e, hydrochlorothiazide, hydroflumethiazide, <strong>in</strong>dapamide, irbesartan, isosorbide, isoxsupr<strong>in</strong>e, isradip<strong>in</strong>e, labetalol, lamotrig<strong>in</strong>e, levetracetam, lis<strong>in</strong>opril, losartan, methyclothiazide, methyldopa, metolazone, metoprolol, m<strong>in</strong>oxidil, moexipril, moriciz<strong>in</strong>e, nadolol, nicardip<strong>in</strong>e, nifedip<strong>in</strong>e, nisoldip<strong>in</strong>e, nitroglycer<strong>in</strong>, papaver<strong>in</strong>e, penbutolol, p<strong>in</strong>dolol, polythiazide,prazos<strong>in</strong>, proca<strong>in</strong>amide, propranolol, qu<strong>in</strong>april, ramipril, sotalol, spironolactone, telmisartan, terazos<strong>in</strong>, toca<strong>in</strong>ide, torsemide, trandolapril, triamterene, trichlormethiazide, valsartan, verapamil. Diabetic- acarbose, acetohexamide, chlorpropamide, glimepiride, glipizide, glyburide, <strong>in</strong>sul<strong>in</strong>, metform<strong>in</strong>, miglitol, pioglitazone, repagl<strong>in</strong>ide, rosiglitazone, tolazamide, tolbutamide, troglitazone.Hyperlipidemia-atorvastat<strong>in</strong>, cerivastat<strong>in</strong>, cholestyram<strong>in</strong>e, clofibrate, colestipol, fenofibrate, fluvastat<strong>in</strong>, gemfibrozil, niac<strong>in</strong>, pravastat<strong>in</strong>, Wast<strong>in</strong>g-cyproheptad<strong>in</strong>e, dronab<strong>in</strong>ol, megestrol acetate, nandrolone, testosterone, thalidomide. ALL OTHERS acetylcyste<strong>in</strong>e, acrivast<strong>in</strong>e/pseudoephedr<strong>in</strong>e, albuterol, alclometasone, alpha N3, alprazolam, amc<strong>in</strong>onide, amitriptyl<strong>in</strong>e, amoxicill<strong>in</strong>, amoxicill<strong>in</strong>/clavulanate, ansaid, ampicill<strong>in</strong>, apraclonid<strong>in</strong>e, aripiprazole, atrop<strong>in</strong>e, azatad<strong>in</strong>e, azatad<strong>in</strong>e/pseudoephedr<strong>in</strong>e, aztreonam, bacitrac<strong>in</strong>, beclomethasone, benztrop<strong>in</strong>e mesylate, betamethasone dipropionate, betamethasone valerate, betaxolol, bitolterol, brimonid<strong>in</strong>e, br<strong>in</strong>zolamide, brompheniram<strong>in</strong>e w/wo comb<strong>in</strong>ations, budesonide, bupropion, buspirone, butabarbital, butalbital comb<strong>in</strong>ation w/wo/ code<strong>in</strong>e, carbamazep<strong>in</strong>e, carb<strong>in</strong>oxam<strong>in</strong>e, carb<strong>in</strong>oxam<strong>in</strong>e/pseudoephedr<strong>in</strong>e, carteolol, cefaclor, cefadroxil, cefazol<strong>in</strong>, cefixime, cefoxit<strong>in</strong>, cefpodoxime, cefprozil, ceftazidime, ceftriaxone, cefuroxime, cephalex<strong>in</strong>, cephrad<strong>in</strong>e, cetiriz<strong>in</strong>e, chloral hydrate, chloramphenicol, chlordiazepoxide w/wo clid<strong>in</strong>ium, chlorhexid<strong>in</strong>e, chlorpheniram<strong>in</strong>e w/wo/ comb<strong>in</strong>ations, chlorpromaz<strong>in</strong>e, cimetid<strong>in</strong>e, citalopram, clemast<strong>in</strong>e, clobetasol, clocortolone, clomipram<strong>in</strong>e, clonazepam, clorazepate, cloxacill<strong>in</strong>, clozap<strong>in</strong>e, code<strong>in</strong>e w/wo/ ASA, APAP, cromolyn sodium, cyclopentolate, demearium, desipram<strong>in</strong>e, desonide, desoximetasone, dexbrompheniram<strong>in</strong>e / pseudo, dexchlorpheniram<strong>in</strong>e, dextroamphetam<strong>in</strong>e sulfate, diazepam, diclofenac, dicloxacill<strong>in</strong>, diflorasone, diflunisal, diphenhydram<strong>in</strong>e, diphenoxylate w/atrop<strong>in</strong>e sulfate, dipivefr<strong>in</strong>, divalproex sodium, dolasetron, dorzolamide, dorzolamide w/ timolol, doxep<strong>in</strong>, doxycycl<strong>in</strong>e, dyphyll<strong>in</strong>e, ecothiopate, ep<strong>in</strong>ephr<strong>in</strong>e, ep<strong>in</strong>ephryl borate, erythromyc<strong>in</strong>, erythromyc<strong>in</strong> ethylsucc<strong>in</strong>ate, erythromyc<strong>in</strong> ethylsucc<strong>in</strong>ate and sulfisoxazole acetyl, esomeprazle, estrogen, estrogens w/progest<strong>in</strong>s, fenoprofen, fentanyl (patch only), fexofenad<strong>in</strong>e hcl/pseudo,fexofenad<strong>in</strong>e, flavoxate, flunisolide, fluoride, fluoc<strong>in</strong>onide, fluorometh/sulfacetamide, fluorometholone, fluoxet<strong>in</strong>e, fluphenaz<strong>in</strong>e,flurandrenolide, flurazepam, flurbiprofen, fluticasone, fluvoxam<strong>in</strong>e, fosfomyc<strong>in</strong> trometham<strong>in</strong>e, furazolidone, gabapent<strong>in</strong>, gentamic<strong>in</strong>, granisetron, halazepam, halc<strong>in</strong>onide, halobetasol, haloperidol, hepatitis A & B vacc<strong>in</strong>es, homatrop<strong>in</strong>e, hydrocodone w/ ASA, APAP, hydrocortisone w/wo/ comb<strong>in</strong>ations, hydromorphone, hydoxyz<strong>in</strong>e HCI, hydoxyz<strong>in</strong>e pamoate, ibuprofen, imipenem/cilastat<strong>in</strong>, imipram<strong>in</strong>e, imiquimod, <strong>in</strong>domethac<strong>in</strong>, ipratropium, ipratropium and albuterol, ketoprofen, ketorolac ,lansoprazole, latanoprost, levetiracetam, levobunolol, levofloxac<strong>in</strong>, levorphanol, lithium carbonate, lithium citrate, loperamide, loracarbef, loratad<strong>in</strong>e/pseudoephedr<strong>in</strong>e, lorazepam, loteprednol , loxap<strong>in</strong>e, magnesium sulfate, medrysone, mesoridaz<strong>in</strong>e, metaproterenol, methadone, methylphenidate, metipranol, metoclopramide, metronidazole, m<strong>in</strong>ocycl<strong>in</strong>e, mirtazap<strong>in</strong>e, misoprostol, mol<strong>in</strong>done, mometasone, montelukast, morph<strong>in</strong>e sulfate, mupiroc<strong>in</strong>, mydriatic comb<strong>in</strong>ations, naphazol<strong>in</strong>e w/wo comb<strong>in</strong>ations, naproxen, nedocromil, nefazodone, neomyc<strong>in</strong> w/wo/ comb<strong>in</strong>ations, nitrofuranto<strong>in</strong>, nortriptyl<strong>in</strong>e, olanzap<strong>in</strong>e, omeprazole, ondansetron, opium (t<strong>in</strong>cture), oxazepam, oxcarazep<strong>in</strong>e, oxtriphyll<strong>in</strong>e, oxybutyn<strong>in</strong>, oxycodone w/wo/ ASA, APAP, pancreatic enzymes, pantoprazole, paregoric, paroxet<strong>in</strong>e,, pemol<strong>in</strong>e, penicill<strong>in</strong> G, penicill<strong>in</strong> V potassium, pentobarbital, perphenaz<strong>in</strong>e, phenir/ppa/phenylt./pyrilam<strong>in</strong>e, phenylprop/pyril/pheniram<strong>in</strong>e, phenyltolox/APAP, phenyltolox/pyril/pheniram<strong>in</strong>e,phenyto<strong>in</strong>, pilocarp<strong>in</strong>e, pilocarp<strong>in</strong>e w/ ep<strong>in</strong>ephr<strong>in</strong>e, pirbuterol, piroxicam, podofilox, prazepam, prednisolone, prednicarbate, primidone, probenecid, prochlorperaz<strong>in</strong>e, progest<strong>in</strong>s, prometh/phenylephr<strong>in</strong>e, promethaz<strong>in</strong>e, quetiap<strong>in</strong>e fumarate, rabeprozole, ranitid<strong>in</strong>e, rimexolone, risperidone, salmeterol, scopolam<strong>in</strong>e, secobarbital, sertral<strong>in</strong>e, sparfloxac<strong>in</strong>, spect<strong>in</strong>omyc<strong>in</strong>, sucralfate, sulfacetamide sodium/prednisolone, sulfasalaz<strong>in</strong>e, sul<strong>in</strong>dac, suprofen, temazepam, terbutal<strong>in</strong>e, tetracycl<strong>in</strong>e, theophyll<strong>in</strong>e, thiethylperaz<strong>in</strong>e, thioridaz<strong>in</strong>e, thiothixene, ticarcill<strong>in</strong> /clavulanate, timolol, tobramyc<strong>in</strong>, tolmet<strong>in</strong>, tolterod<strong>in</strong>e, tramadol, trazodone, triamc<strong>in</strong>olone acetonide, triazolam, triamc<strong>in</strong>olone, trifluoperaz<strong>in</strong>e, trimethobenzamide, trimipram<strong>in</strong>e, tripelennam<strong>in</strong>e, triprolid<strong>in</strong>e hcl/pseudo, tropicamide, vancomyc<strong>in</strong>, valproic acid, venlafax<strong>in</strong>e, zafirlukast, zileuton, ziprasidone HCL, zolpidem.
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