Emblem Medicaid 4th Quarter Formulary Updates

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Barbara Barker
6 years ago
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1 abacavir 20 mg/ml solution Added to Formulary (generic) with Quantity Limits 12/1/2017 abacavir 300 mg tablet Added Quantity Limits 10/1/2017 abacavir-lamivudine mg Added Quantity Limits 10/1/2017 abacavir-lamivudine-zidov tab Added Quantity Limits 10/1/2017 acetaminoph-caff-dihydrocodein Removed from Formulary (Obsolete Drug) 10/1/2017 AFLURIA SYRINGE Removed from Formulary (Obsolete Drug) 10/1/2017 AFLURIA VIAL Removed from Formulary (Obsolete Drug) 10/1/2017 AFLURIA SYRINGE Added to Formulary (BRAND) 10/1/2017 AFLURIA VIAL Added to Formulary (BRAND) 10/1/2017 AFLURIA QUAD SYRINGE Added to Formulary (BRAND) 10/1/2017 AFLURIA QUAD VIAL Added to Formulary (BRAND) 10/1/2017 akorn balanced salt soln Removed from Formulary (Obsolete Drug) 10/1/2017 ALBENZA 200 MG TABLET Added Quantity Limits 10/1/2017 ALINIA 100 MG/5 ML SUSPENSION Added Quantity Limits 10/1/2017 ALINIA 500 MG TABLET Added Quantity Limits 10/1/2017 APTIVUS 100 MG/ML SOLUTION Added Quantity Limits 10/1/2017 APTIVUS 250 MG CAPSULE Added Quantity Limits 10/1/2017 aspirin ec 975 mg tablet Removed from Formulary (Obsolete Drug) 10/1/2017 ATRIPLA TABLET Added Quantity Limits 10/1/2017 AVITENE SHEET 35MMX35MM Added to Formulary (BRAND) 10/1/2017 AVITENE SHEET 70MMX35MM Added to Formulary (BRAND) 10/1/2017 AXIRON 30 MG/ACTUATION SOLN Removed from Formulary (Generic Available) 10/1/2017 benzoyl peroxide 5.3% foam Added to Formulary (generic) 10/1/2017 bexarotene 75 mg capsule Added Prior Authorization 11/24/2017 budeprion sr 150 mg tablet Removed from Formulary (Obsolete Drug) 10/1/2017 butalb-acetamin-caff Removed from Formulary (Obsolete Drug) 10/1/2017 butalb-acetaminoph-caff-codein Added to Formulary (generic) 10/1/2017 butalb-aspirin-caffe Added to Formulary (generic) 10/1/2017 BYDUREON BCISE 2 MG AUTOINJECT Added to Formulary (BRAND) with Prior Authorization 12/1/2017 CALCIUM 500-VIT D3 600 CAPLET Added to Formulary (BRAND) 12/1/2017 choice-ob + dha combo pack Removed from Formulary (Obsolete Drug) 10/1/2017 choice-tabs tablet Removed from Formulary (Obsolete Drug) 10/1/2017 ciclodan 0.77% cream Added Quantity Limits 10/1/2017 ciclopirox 0.77% cream Added Quantity Limits 10/1/2017 ciclopirox 0.77% gel Added Quantity Limits 10/1/2017 ciclopirox 0.77% topical susp Added Quantity Limits 10/1/2017 ciclopirox 1% shampoo Added Quantity Limits 10/1/2017 clotrimazole 1% cream Added Quantity Limits 10/1/2017 clotrimazole 1% solution Added Quantity Limits 10/1/2017 clotrimazole-betamethasone crm Added Quantity Limits 10/1/2017 clotrimazole-betamethasone lot Added Quantity Limits 10/1/2017 COMBIVIR TABLET Added Quantity Limits 10/1/2017 COMPLERA TABLET Added Quantity Limits 10/1/2017 CRIXIVAN 200 MG CAPSULE Added Quantity Limits 10/1/2017 CRIXIVAN 400 MG CAPSULE Added Quantity Limits 10/1/2017 DESCOVY MG TABLET Added Quantity Limits 10/1/2017 didanosine dr 125 mg capsule Added Quantity Limits 10/1/2017 didanosine dr 200 mg capsule Added Quantity Limits 10/1/2017

2 didanosine dr 250 mg capsule Added Quantity Limits 10/1/2017 didanosine dr 400 mg capsule Added Quantity Limits 10/1/2017 difil-g 400 tablet Removed from Formulary (Obsolete Drug) 10/1/2017 dilt-cd 120 mg capsule Removed from Formulary (Obsolete Drug) 10/1/2017 dilt-cd 180 mg capsule Removed from Formulary (Obsolete Drug) 10/1/2017 dilt-cd 240 mg capsule Removed from Formulary (Obsolete Drug) 10/1/2017 dilt-cd er 300 mg capsule Removed from Formulary (Obsolete Drug) 10/1/2017 diltzac er 120 mg capsule Removed from Formulary (Obsolete Drug) 10/1/2017 diltzac er 180 mg capsule Removed from Formulary (Obsolete Drug) 10/1/2017 diltzac er 240 mg capsule Removed from Formulary (Obsolete Drug) 10/1/2017 diltzac er 300 mg capsule Removed from Formulary (Obsolete Drug) 10/1/2017 diltzac er 360 mg capsule Removed from Formulary (Obsolete Drug) 10/1/2017 dologesic capsule Removed from Formulary (Obsolete Drug) 12/1/2017 doxepin 5% cream Added Quantity Limits 10/1/2017 doxepin 5% cream Added Prior Authorization 11/1/2017 econazole nitrate 1% cream Added Quantity Limits 10/1/2017 EDURANT 25 MG TABLET Added Quantity Limits 10/1/2017 EMEND 125 MG CAPSULE Removed from Formulary (Generic Available) 12/1/2017 EMTRIVA 10 MG/ML SOLUTION Added Quantity Limits 10/1/2017 EMTRIVA 200 MG CAPSULE Added Quantity Limits 10/1/2017 EMVERM 100 MG TABLET CHEW Added Quantity Limits 10/1/2017 ENBREL 50 MG/ML MINI CARTRIDGE Added to Formulary (BRAND) with Prior Authorization and Q 12/1/2017 ENDO-AVITENE 10MM SHEET Added to Formulary (BRAND) 10/1/2017 endur-acin er 500 mg tablet Added to Formulary (generic) 12/1/2017 EPIVIR 10 MG/ML ORAL SOLN Added Quantity Limits 10/1/2017 EPIVIR 150 MG TABLET Added Quantity Limits 10/1/2017 EPIVIR 300 MG TABLET Added Quantity Limits 10/1/2017 EPZICOM TABLET Added Quantity Limits 10/1/2017 ergocalciferol 1.25 mg capsule Removed from Formulary (Obsolete Drug) 10/1/2017 erythromycin-sulfisox susp Removed from Formulary (Obsolete Drug) 10/1/2017 estradiol 10 mcg vaginal insrt Added to Formulary (generic) 10/1/2017 ethynodiol-eth estra 1mg-35mcg Added to Formulary (generic) with Quantity Limits 12/1/2017 EVOTAZ 300 MG-150 MG TABLET Added Quantity Limits 10/1/2017 E-Z SPACER PEDSPAK KIT Removed from Formulary (Obsolete Drug) 10/1/2017 FISH OIL 1;200 MG SOFTGEL Added to Formulary (BRAND) 12/1/2017 FLEXIFLO QUANTUM PUMP SET Removed from Formulary (Obsolete Drug) 10/1/2017 FLUAD SYRINGE Added to Formulary (BRAND) 10/1/2017 FLUARIX QUAD SYRINGE Added to Formulary (BRAND) 10/1/2017 FLUBLOK VIAL Added to Formulary (BRAND) 10/1/2017 FLUBLOK QUAD SYRINGE Added to Formulary (BRAND) 10/1/2017 FLUCELVAX QUAD SYR Added to Formulary (BRAND) 10/1/2017 FLUCELVAX QUAD VIAL Added to Formulary (BRAND) 10/1/2017 FLULAVAL QUAD SYR Added to Formulary (BRAND) 10/1/2017 FLULAVAL QUAD VIAL Added to Formulary (BRAND) 10/1/2017 FLUMIST NASAL VACCINE Removed from Formulary (Obsolete Drug) 10/1/2017 fluoxetine hcl 60 mg tablet Added to Formulary (generic) 12/1/2017 FLUVIRIN SYRINGE Added to Formulary (BRAND) 10/1/2017 FLUVIRIN VIAL Added to Formulary (BRAND) 10/1/2017

3 FLUZONE SYRINGE Removed from Formulary (Obsolete Drug) 10/1/2017 FLUZONE VIAL Removed from Formulary (Obsolete Drug) 10/1/2017 FLUZONE VIAL (PF) Removed from Formulary (Obsolete Drug) 10/1/2017 FLUZONE HIGH-DOSE SYR Removed from Formulary (Obsolete Drug) 10/1/2017 FLUZONE HIGH-DOSE SYR Added to Formulary (BRAND) 10/1/2017 FLUZONE INTRADER SYR Removed from Formulary (Obsolete Drug) 10/1/2017 FLUZONE INTRADERM QUAD Added to Formulary (BRAND) 10/1/2017 FLUZONE PEDI SYRINGE Removed from Formulary (Obsolete Drug) 10/1/2017 FLUZONE QUAD SYRINGE Removed from Formulary (Obsolete Drug) 10/1/2017 FLUZONE QUAD VIAL Removed from Formulary (Obsolete Drug) 10/1/2017 FLUZONE QUAD SYRINGE Added to Formulary (BRAND) 10/1/2017 FLUZONE QUAD VIAL Added to Formulary (BRAND) 10/1/2017 FLUZONE QUAD VIAL Added to Formulary (BRAND) 10/1/2017 FLUZONE QUAD PEDI SYR Removed from Formulary (Obsolete Drug) 10/1/2017 FLUZONE QUAD PEDI SYR Added to Formulary (BRAND) 10/1/2017 folcal dha capsule Removed from Formulary (Obsolete Drug) 10/1/2017 folcaps omega-3 capsule Removed from Formulary (Obsolete Drug) 10/1/2017 fosamprenavir 700 mg tablet Added to Formulary (generic) with Quantity Limits 12/1/2017 FUZEON 90 MG VIAL Added Quantity Limits 10/1/2017 GENVOYA TABLET Added Quantity Limits 10/1/2017 halonate combo pack Removed from Formulary (Obsolete Drug) 10/1/2017 halonate pac combo pack Removed from Formulary (Obsolete Drug) 10/1/2017 HUMALOG JR 100 UNIT/ML KWIKPEN Added to Formulary (BRAND) 12/1/2017 HUMULIN PEN Removed from Formulary (Obsolete Drug) 10/1/2017 HUMULIN N 100 UNITS/ML PEN Removed from Formulary (Obsolete Drug) 10/1/2017 hydrocodon-acetamin /15 Removed from Formulary (Obsolete Drug) 10/1/2017 hydrocodon-acetaminoph Removed from Formulary (Obsolete Drug) 10/1/2017 hydrocodon-acetaminoph Removed from Formulary (Obsolete Drug) 10/1/2017 hydrocodon-acetaminoph Removed from Formulary (Obsolete Drug) 10/1/2017 hydrocodon-acetaminophen Removed from Formulary (Obsolete Drug) 10/1/2017 hydrocodon-acetaminophn Removed from Formulary (Obsolete Drug) 10/1/2017 hydrocodon-acetaminophn Removed from Formulary (Obsolete Drug) 10/1/2017 hydrocodon-acetaminophn Removed from Formulary (Obsolete Drug) 10/1/2017 hydrocodon-acetaminophn Removed from Formulary (Obsolete Drug) 10/1/2017 hydrocodone-acetamin 5-334/10 Removed from Formulary (Obsolete Drug) 10/1/2017 INFERGEN 15 MCG/0.5 ML VIAL Removed from Formulary (Obsolete Drug) 10/1/2017 INFERGEN 9 MCG/0.3 ML VIAL Removed from Formulary (Obsolete Drug) 10/1/2017 INTELENCE 100 MG TABLET Added Quantity Limits 10/1/2017 INTELENCE 200 MG TABLET Added Quantity Limits 10/1/2017 INTELENCE 25 MG TABLET Added Quantity Limits 10/1/2017 INTUNIV ER 1 MG TABLET Removed from Formulary (Generic Available) 10/1/2017 INTUNIV ER 2 MG TABLET Removed from Formulary (Generic Available) 10/1/2017 INTUNIV ER 3 MG TABLET Removed from Formulary (Generic Available) 10/1/2017 INTUNIV ER 4 MG TABLET Removed from Formulary (Generic Available) 10/1/2017 INVIRASE 200 MG CAPSULE Added Quantity Limits 10/1/2017 INVIRASE 500 MG TABLET Added Quantity Limits 10/1/2017 ISENTRESS 100 MG POWDER PACKET Added Quantity Limits 10/1/2017 ISENTRESS 100 MG TABLET CHEW Added Quantity Limits 10/1/2017

4 ISENTRESS 25 MG TABLET CHEW Added Quantity Limits 10/1/2017 ISENTRESS 400 MG TABLET Added Quantity Limits 10/1/2017 ISENTRESS HD 600 MG TABLET Added to Formulary (BRAND) with Quantity Limits 10/1/2017 isomethept-caff-acetaminoph tb Removed from Formulary (Obsolete Drug) 10/1/2017 ivermectin 3 mg tablet Added Quantity Limits 10/1/2017 JADENU SPRINKLE 180 MG GRANULE Added to Formulary (BRAND) with Prior Authorization 10/1/2017 JADENU SPRINKLE 360 MG GRANULE Added to Formulary (BRAND) with Prior Authorization 10/1/2017 JADENU SPRINKLE 90 MG GRANULE Added to Formulary (BRAND) with Prior Authorization 10/1/2017 KALETRA MG TABLET Added Quantity Limits 10/1/2017 KALETRA MG TABLET Added Quantity Limits 10/1/2017 KALETRA 80 MG-20 MG/ML SOLN Added to Formulary (BRAND) with Quantity Limits 10/1/2017 ketoconazole 2% cream Added Quantity Limits 10/1/2017 ketoconazole 2% shampoo Added Quantity Limits 10/1/2017 ketodan 2% foam Added Quantity Limits 10/1/2017 lamivudine 10 mg/ml oral soln Added Quantity Limits 10/1/2017 lamivudine 150 mg tablet Added Quantity Limits 10/1/2017 lamivudine 300 mg tablet Added Quantity Limits 10/1/2017 lamivudine-zidovudine tablet Added Quantity Limits 10/1/2017 levonorg 0.15mg-ee mcg Added to Formulary (generic) with Quantity Limits 12/1/2017 LEXIVA 50 MG/ML SUSPENSION Added Quantity Limits 10/1/2017 LEXIVA 700 MG TABLET Added Quantity Limits 10/1/2017 lopinavir-ritonavir 80-20mg/ml Added Quantity Limits 10/1/2017 lozi-flur 1 mg lozenge Removed from Formulary (Obsolete Drug) 10/1/2017 melphalan 2 mg tablet Added to Formulary (generic) 10/1/2017 m-end wc liquid Removed from Formulary (Obsolete Drug) 10/1/2017 metformin hcl er 500 mg tablet Added Quantity Limits 12/1/2017 metformin hcl er 750 mg tablet Added Quantity Limits 12/1/2017 natal-v rx tablet Removed from Formulary (Obsolete Drug) 10/1/2017 nevirapine 200 mg tablet Added Quantity Limits 10/1/2017 nevirapine 50 mg/5 ml susp Added Quantity Limits 10/1/2017 nevirapine er 100 mg tablet Added Quantity Limits 10/1/2017 nevirapine er 400 mg tablet Added Quantity Limits 10/1/2017 norepinephrine-d5w 4 mg/250 ml Added to Formulary (generic) 10/1/2017 noreth-estrad-fe (21)-75 Added to Formulary (generic) with Quantity Limits 12/1/2017 NORVIR 100 MG SOFTGEL CAP Added Quantity Limits 10/1/2017 NORVIR 100 MG TABLET Added Quantity Limits 10/1/2017 NORVIR 80 MG/ML SOLUTION Added Quantity Limits 10/1/2017 nystatin 100;000 unit/gm cream Added Quantity Limits 10/1/2017 nystatin 100;000 units/gm oint Added Quantity Limits 10/1/2017 ocudox convenience kit Removed from Formulary (Obsolete Drug) 10/1/2017 ODEFSEY TABLET Added Quantity Limits 10/1/2017 ofloxacin 200 mg tablet Removed from Formulary (Obsolete Drug) 10/1/2017 olopatadine hcl 0.2% eye drop Added to Formulary (generic) 10/1/2017 ORTHO ALL-FLEX DIAPHRAGM 65MM Removed from Formulary (Obsolete Drug) 10/1/2017 ORTHO TRI-CYCLEN LO TABLET Removed from Formulary (Generic Available) 10/1/2017 oseltamivir 6 mg/ml suspension Added to Formulary (generic) with Quantity Limits 12/1/2017 oxycodon-acetaminophen Removed from Formulary (Obsolete Drug) 10/1/2017 oxycodone-acetaminophen Removed from Formulary (Obsolete Drug) 10/1/2017

5 oxycodone-acetaminophen Removed from Formulary (Obsolete Drug) 10/1/2017 palgic 4 mg tablet Removed from Formulary (Obsolete Drug) 10/1/2017 palgic 4 mg/5 ml liquid Removed from Formulary (Obsolete Drug) 10/1/2017 papaverine 150 mg capsule sa Removed from Formulary (Obsolete Drug) 10/1/2017 PATROL ENTERAL PUMP SET Removed from Formulary (Obsolete Drug) 10/1/2017 pnv-first softgel Removed from Formulary (Obsolete Drug) 10/1/2017 pnv-ob with dha combo pack Removed from Formulary (Obsolete Drug) 10/1/2017 POMALYST 1 MG CAPSULE Added Prior Authorization 11/24/2017 POMALYST 2 MG CAPSULE Added Prior Authorization 11/24/2017 POMALYST 3 MG CAPSULE Added Prior Authorization 11/24/2017 POMALYST 4 MG CAPSULE Added Prior Authorization 11/24/2017 pramoxine-hc otic drops Removed from Formulary (Obsolete Drug) 10/1/2017 prena1 chew tablet Removed from Formulary (Obsolete Drug) 10/1/2017 prenaissance harmony dha cmbpk Removed from Formulary (Obsolete Drug) 10/1/2017 PREZCOBIX 800 MG-150 MG TABLET Added Quantity Limits 10/1/2017 PREZISTA 100 MG/ML SUSPENSION Added Quantity Limits 10/1/2017 PREZISTA 150 MG TABLET Added Quantity Limits 10/1/2017 PREZISTA 400 MG TABLET Added Quantity Limits 10/1/2017 PREZISTA 600 MG TABLET Added Quantity Limits 10/1/2017 PREZISTA 75 MG TABLET Added Quantity Limits 10/1/2017 PREZISTA 800 MG TABLET Added Quantity Limits 10/1/2017 promacet mg tablet Removed from Formulary (Obsolete Drug) 10/1/2017 PROSTIGMIN 15 MG TABLET Removed from Formulary (Obsolete Drug) 10/1/2017 prudoxin 5% cream Added Quantity Limits 10/1/2017 prudoxin 5% cream Added Prior Authorization 11/1/2017 RESCRIPTOR 100 MG TABLET Added Quantity Limits 10/1/2017 RESCRIPTOR 200 MG TABLET Added Quantity Limits 10/1/2017 RETROVIR 10 MG/ML SYRUP Added Quantity Limits 10/1/2017 RETROVIR 100 MG CAPSULE Added Quantity Limits 10/1/2017 REYATAZ 150 MG CAPSULE Added Quantity Limits 10/1/2017 REYATAZ 200 MG CAPSULE Added Quantity Limits 10/1/2017 REYATAZ 300 MG CAPSULE Added Quantity Limits 10/1/2017 REYATAZ 50 MG POWDER PACKET Added Quantity Limits 10/1/2017 rhinoflex-650 tablet Removed from Formulary (Obsolete Drug) 10/1/2017 roxicet tablet Removed from Formulary (Obsolete Drug) 10/1/2017 SELZENTRY 150 MG TABLET Added Quantity Limits 10/1/2017 SELZENTRY 20 MG/ML ORAL SOLN Added to Formulary (BRAND) with Quantity Limits 10/1/2017 SELZENTRY 25 MG TABLET Added Quantity Limits 10/1/2017 SELZENTRY 300 MG TABLET Added Quantity Limits 10/1/2017 SELZENTRY 75 MG TABLET Added Quantity Limits 10/1/2017 setonet prenatal vitamin Removed from Formulary (Obsolete Drug) 10/1/2017 setonet-ec prenatal vitamins Removed from Formulary (Obsolete Drug) 10/1/2017 sod sulfacetamide-sulfur susp Removed from Formulary (Obsolete Drug) 10/1/2017 stavudine 1 mg/ml solution Added Quantity Limits 10/1/2017 stavudine 15 mg capsule Added Quantity Limits 10/1/2017 stavudine 20 mg capsule Added Quantity Limits 10/1/2017 stavudine 30 mg capsule Added Quantity Limits 10/1/2017 stavudine 40 mg capsule Added Quantity Limits 10/1/2017

6 STERILE TWO-FER NEEDLE Removed from Formulary (Obsolete Drug) 10/1/2017 STRIBILD TABLET Added Quantity Limits 10/1/2017 strovite plus caplet Removed from Formulary (Obsolete Drug) 10/1/2017 SUSTIVA 200 MG CAPSULE Added Quantity Limits 10/1/2017 SUSTIVA 50 MG CAPSULE Added Quantity Limits 10/1/2017 SUSTIVA 600 MG TABLET Added Quantity Limits 10/1/2017 tencon tablet Removed from Formulary (Obsolete Drug) 12/1/2017 tinidazole 500 mg tablet Added Quantity Limits 10/1/2017 TIVICAY 10 MG TABLET Added Quantity Limits 10/1/2017 TIVICAY 25 MG TABLET Added Quantity Limits 10/1/2017 TIVICAY 50 MG TABLET Added Quantity Limits 10/1/2017 TRACLEER 32 MG TABLET FOR SUSP Added to Formulary (BRAND) with Prior Authorization 12/1/2017 trezix capsule Removed from Formulary (Obsolete Drug) 10/1/2017 TRICHLOROACETIC ACID 25% Added to Formulary (BRAND) 10/1/2017 TRICHLOROACETIC ACID 75% Added to Formulary (BRAND) 10/1/2017 triderm 0.5% cream Added to Formulary (generic) 12/1/2017 trinatal ultra tablet Removed from Formulary (Obsolete Drug) 10/1/2017 TRIUMEQ TABLET Added Quantity Limits 10/1/2017 tri-zel tablet Removed from Formulary (Obsolete Drug) 10/1/2017 TRIZIVIR TABLET Added Quantity Limits 10/1/2017 TRUVADA 100 MG-150 MG TABLET Added Quantity Limits 10/1/2017 TRUVADA 133 MG-200 MG TABLET Added Quantity Limits 10/1/2017 TRUVADA 167 MG-250 MG TABLET Added Quantity Limits 10/1/2017 TRUVADA 200 MG-300 MG TABLET Added Quantity Limits 10/1/2017 ultimate ob dha combo pack Removed from Formulary (Obsolete Drug) 10/1/2017 VERZENIO 100 MG TABLET Added to Formulary (BRAND) with Prior Authorization and Q 12/1/2017 VERZENIO 150 MG TABLET Added to Formulary (BRAND) with Prior Authorization and Q 12/1/2017 VERZENIO 200 MG TABLET Added to Formulary (BRAND) with Prior Authorization and Q 12/1/2017 VERZENIO 50 MG TABLET Added to Formulary (BRAND) with Prior Authorization and Q 12/1/2017 VIDEX 2 GM PEDIATRIC SOLN Added Quantity Limits 10/1/2017 vinacal prenatal tablet Removed from Formulary (Obsolete Drug) 12/1/2017 vinate gt tablet Removed from Formulary (Obsolete Drug) 12/1/2017 vinate pn care tablet Removed from Formulary (Obsolete Drug) 12/1/2017 vinate ultra tablet Removed from Formulary (Obsolete Drug) 12/1/2017 VIRACEPT 250 MG TABLET Added Quantity Limits 10/1/2017 VIRACEPT 625 MG TABLET Added Quantity Limits 10/1/2017 VIREAD 150 MG TABLET Added Quantity Limits 10/1/2017 VIREAD 200 MG TABLET Added Quantity Limits 10/1/2017 VIREAD 250 MG TABLET Added Quantity Limits 10/1/2017 VIREAD 300 MG TABLET Added Quantity Limits 10/1/2017 VIREAD POWDER Added Quantity Limits 10/1/2017 vitafol-pn caplet Removed from Formulary (Obsolete Drug) 10/1/2017 VITAMAX TABLET CHEWABLE Removed from Formulary (Obsolete Drug) 10/1/2017 westhroid mg tablet Removed from Formulary (Obsolete Drug) 10/1/2017 westhroid mg tablet Removed from Formulary (Obsolete Drug) 10/1/2017 xolox mg tablet Removed from Formulary (Obsolete Drug) 10/1/2017 ZETIA 10 MG TABLET Removed from Formulary (Generic Available) 10/1/2017 zflex tablet Removed from Formulary (Obsolete Drug) 10/1/2017

7 zgesic tablet Removed from Formulary (Obsolete Drug) 10/1/2017 ZIAGEN 20 MG/ML SOLUTION Added Quantity Limits 10/1/2017 ZIAGEN 300 MG TABLET Added Quantity Limits 10/1/2017 zidovudine 100 mg capsule Added Quantity Limits 10/1/2017 zidovudine 300 mg tablet Added Quantity Limits 10/1/2017 zidovudine 50 mg/5 ml syrup Added Quantity Limits 10/1/2017 zinc sulfate 220 mg capsule Removed from Formulary (Obsolete Drug) 10/1/2017

HIV MEDICATIONS AT A GLANCE. Atripla 600/200/300 mg tablet tablet daily. Complera 200/25/300 mg tablet tablet daily

HIV MEDICATIONS AT A GLANCE. Atripla 600/200/300 mg tablet tablet daily. Complera 200/25/300 mg tablet tablet daily HIV MEDICATIONS AT A GLANCE Generic Name Trade Name Strength DIN Usual Dosage Single Tablet Regimen (STR) Products Efavirenz/ Emtricitabine/ rilpivirine/ elvitegravir/ cobicistat/ alafenamide Emtricitabine/