UWSP Student Health Service Pharmacy Formulary updated: 1/2017
|
|
- Todd Wheeler
- 5 years ago
- Views:
Transcription
1 UWSP Student Health Service Pharmacy Formulary updated: 1/2017 Medication Name Strength DosageForm Route Acetaminophen 325 MG Tablet Oral Acetaminophen-Codeine # MG Tablet Oral Acetaminophen-Codeine # MG Tablet Oral AcetaZOLAMIDE 125 MG Tablet Oral Acyclovir 400 MG Tablet Oral Acyclovir 800 MG Tablet Oral Albuterol Sulfate (2.5 MG/3ML) 0.083% Nebulization Solution Inhalation Amitriptyline HCl 10 MG Tablet Oral Amitriptyline HCl 25 MG Tablet Oral Amoxicillin 250 MG Capsule Oral Amoxicillin 500 MG Capsule Oral Amoxicillin-Pot Clavulanate MG Tablet Oral Antacid Liquid MG/5ML Suspension Oral Anucort-HC 25 MG Suppository Rectal Apri MG-MCG Tablet Oral Assess Full Range Peak Meter (peak flow meter) Device Atovaquone-Proguanil HCl MG Tablet Oral Aviane MG-MCG Tablet Oral Azithromycin 250 MG Tablet Oral Azithromycin 500 MG Tablet Oral Bacitracin 500 UNIT/GM Ointment External Bactrim DS MG Tablet Oral Benzocaine-Menthol MG Lozenge Mouth/Throat Benzonatate 100 MG Capsule Oral Benzoyl Peroxide 5% Gel External Betamethasone Dipropionate 0.05% Cream External Betamethasone Dipropionate Aug 0.05% Cream External Betasept Surgical Scrub 4% Liquid External Bismatrol (bismuth subsalicylate) 262 MG Tablet Chewable Oral Breathe Right Large Strip Breathe Right Small/Medium Strip BuPROPion HCl ER (SR) 100 MG Tablet Extended Release 12 Hr Oral BuPROPion HCl ER (SR) 150 MG Tablet Extended Release 12 Hr Oral BuPROPion HCl ER (XL) 150 MG Tablet Extended Release 24 Hr Oral BuPROPion HCl ER (XL) 300 MG Tablet Extended Release 24 Hr Oral BusPIRone HCl 15 MG Tablet Oral Camila 0.35 MG Tablet Oral Cefuroxime Axetil 250 MG Tablet Oral Cefuroxime Axetil 500 MG Tablet Oral Cepacol Sore Throat MG Lozenge Mouth/Throat Cephalexin 250 MG Capsule Oral Cephalexin 500 MG Capsule Oral CeraORS 75 Natural (oral rehydration) Packet Oral
2 Cetirizine HCl 10 MG Tablet Oral Ciprofloxacin HCl 0.3% Solution Ophthalmic Ciprofloxacin HCl 250 MG Tablet Oral Ciprofloxacin HCl 500 MG Tablet Oral Citalopram Hydrobromide 20 MG Tablet Oral Clindamycin HCl 150 MG Capsule Oral Clindamycin Phosphate 1% Gel External ClonazePAM 0.5 MG Tablet Oral Clotrimazole 1% Cream External Clotrimazole 1% Cream Vaginal Clotrimazole 10 MG Troche Mouth/Throat Clotrimazole 2% Cream Vaginal Condoms Miscellaneous Cough Drops Menthol Lozenge Mouth/Throat Cryselle MG-MCG Tablet Oral Cyclobenzaprine HCl 10 MG Tablet Oral Cyclobenzaprine HCl 5 MG Tablet Oral Deep Sea Nasal Spray 0.65% Solution Nasal Depo-Provera 150 MG/ML Suspension Intramuscular Dexamethasone 4 MG Tablet Oral Dexamethasone Sod Phosphate PF 10 MG/ML Solution Injection Dicloxacillin Sodium 250 MG Capsule Oral Dicloxacillin Sodium 500 MG Capsule Oral Dicyclomine HCl 20 MG Tablet Oral DiphenhydrAMINE HCl 25 MG Capsule Oral Docusate Sodium 100 MG Capsule Oral Domeboro 25% Packet External Doxycycline Monohydrate 100 MG Capsule Oral Drysol 20% Solution External Ella 30 MG Tablet Oral Epinephrine 0.3 MG inj Pen injector Intramuscular Erythromycin 5 MG/GM Ointment Ophthalmic Estradiol 2 MG Tablet Oral Estradiol Valerate 200 MG/ML Solution Intramuscular Famotidine 20 MG Tablet Oral Ferrous Gluconate 324 (37.5 Fe) MG Tablet Oral Ferrous Sulfate 325 (65 Fe) MG Tablet Oral Fluconazole 150 MG Tablet Oral Fluorouracil 5% Cream External FLUoxetine HCl 10 MG Capsule Oral FLUoxetine HCl 10 MG Tablet Oral FLUoxetine HCl 20 MG Capsule Oral Fluticasone Propionate 50 MCG/ACT Suspension Nasal Gianvi MG Tablet Oral GuaiFENesin 100 MG/5ML Liquid Oral Guaifenesin-DM MG/5ML Liquid Oral Halls Cough Drops 5.8 MG Lozenge Mouth/Throat Hibiclens 4% Liquid External
3 Hydrocodone-Acetaminophen MG Tablet Oral Hydrocortisone 1% Cream External Hydrocortisone 1% Ointment External Hydrocortisone Acetate 25 MG Suppository Rectal Hydrogen Peroxide 3% Miscellaneous External Hydroxychloroquine Sulfate 200 MG Tablet Oral HydrOXYzine HCl 10 MG Tablet Oral Hypercare 20% Solution External Ibuprofen 200 MG Tablet Oral Ibuprofen 600 MG Tablet Oral Imiquimod 5% Cream External Iron 325 (65 Fe) MG Tablet Oral Jolessa MG Tablet Oral Junel FE 1.5/ MG-MCG Tablet Oral Junel FE 1/ MG-MCG Tablet Oral Kariva /0.01 MG (21/5) Tablet Oral Kelnor 1/ MG-MCG Tablet Oral Ketoconazole 2% Cream External Ketoconazole 2% Shampoo External Ketorolac Tromethamine 30 MG/ML Solution Injection Ketotifen Fumarate 0.025% Solution Ophthalmic LamoTRIgine 100 MG Tablet Oral LamoTRIgine 25 MG Tablet Oral Levofloxacin 500 MG Tablet Oral Lidocaine HCl 2% Gel External Lidocaine Viscous 2% Solution Mouth/Throat Lomedia 24 FE 1-20 MG-MCG(24) Tablet Oral Loperamide HCl 2 MG Capsule Oral Loratadine 10 MG Tablet Oral Malarone MG Tablet Oral Meclizine HCl 25 MG Tablet Chewable Oral Mediplast 40% Miscellaneous External MedroxyPROGESTERone Acetate 10 MG Tablet Oral MedroxyPROGESTERone Acetate 150 MG/ML Suspension Intramuscular Mefloquine HCl 250 MG Tablet Oral Melatonin Maximum Strength 5 MG Tablet Oral MetroNIDAZOLE 0.75% Gel Vaginal MetroNIDAZOLE 500 MG Tablet Oral Minocycline HCl 100 MG Capsule Oral Minocycline HCl 50 MG Capsule Oral Mirtazapine 15 MG Tablet Oral Montelukast Sodium 10 MG Tablet Oral Mupirocin 2% Ointment External Naproxen Sodium 220 MG Tablet Oral Naproxen Sodium 500 MG Tablet Oral Nasal Decongestant Spray 0.05% Solution Nasal Neomycin-Polymyxin-HC Suspension Otic Nicotine Polacrilex 2 MG Gum Mouth/Throat
4 Nicotine Polacrilex 4 MG Gum Mouth/Throat Nicotine Step 1 21 MG/24HR Patch 24 Hour Transdermal Nicotine Step 2 14 MG/24HR Patch 24 Hour Transdermal Nicotine Step 3 7 MG/24HR Patch 24 Hour Transdermal Nitrofurantoin Monohyd Macro 100 MG Capsule Oral Nortrel 1/35 (28) 1-35 MG-MCG Tablet Oral NuvaRing MG/24HR Ring Vaginal Ocella MG Tablet Oral Ofloxacin 0.30% Solution Ophthalmic Ofloxacin 0.30% Solution Otic Omeprazole 20 MG Capsule Delayed Release Oral Ondansetron ODT 4 MG Tablet Dispersible Oral Ortho Tri-Cyclen Lo Tablet Oral Oseltamivir 75 MG Tablet Oral Oxymetazoline HCl 0.05% Solution Nasal Pantoprazole Sodium 20 MG Tablet Delayed Release Oral Penicillin V Potassium 500 MG Tablet Oral Pepto-Bismol 262 MG Tablet Chewable Oral Permethrin 5% Cream External Petrolatum Ointment External Phenazopyridine HCl 95 MG Tablet Oral Phenol 1.40% Liquid Mouth/Throat Pill Splitter Miscellaneous Plan B One-Step 1.5 MG Tablet Oral Pocket Chamber (MDI spacer) Device Polymyxin B-Trimethoprim UNIT/ML-% Solution Ophthalmic Portia MG-MCG Tablet Oral PrednisoLONE Acetate 1% Suspension Ophthalmic PredniSONE 20 MG Tablet Oral PredniSONE 50 MG Tablet Oral Prenatal Plus 27-1 MG Tablet Oral Promethazine HCl 12.5 MG Suppository Rectal Promethazine HCl 12.5 MG Tablet Oral Propranolol HCl 10 MG Tablet Oral Propranolol HCl 20 MG Tablet Oral QUEtiapine Fumarate 100 MG Tablet Oral QUEtiapine Fumarate 25 MG Tablet Oral Ranitidine HCl 150 MG Tablet Oral Reclipsen MG-MCG Tablet Oral Ricola Lozenge Mouth/Throat Ricola Cherry Honey Herb 2 MG Lozenge Mouth/Throat Ricola Honey Herb 2 MG Lozenge Mouth/Throat Ricola Lemon Mint 1.5 MG Lozenge Mouth/Throat Rifampin 300 MG Tablet Oral Rizatriptan 10 MG Tablet Oral Saline 0.65% Solution Nasal Seasonique &0.01 MG Tablet Oral Selenium Sulfide 2.50% Lotion External
5 Sertraline HCl 100 MG Tablet Oral Sertraline HCl 50 MG Tablet Oral Silver Sulfadiazine 1% Cream External Singulair 10 MG Tablet Oral Sinus Rinse Bottle Kit Packet Nasal Sinus Wash Salt Crystals Nasal SMZ-TMP DS MG Tablet Oral Sore Throat MG Lozenge Mouth/Throat Sore Throat Spray 1.40% Liquid Mouth/Throat Spironolactone 25 MG Tablet Oral Spironolactone 100mg Tablet Oral Sprintec MG-MCG Tablet Oral SSD 1% Cream External SudoGest 30 MG Tablet Oral SudoGest 60 MG Tablet Oral Sudogest PE 10 MG Tablet Oral SUMAtriptan Succinate 100 MG Tablet Oral SUMAtriptan Succinate 50 MG Tablet Oral SUMAtriptan Succinate 6 MG/0.5ML Solution Subcutaneous Tamiflu 75 MG Capsule Oral Terbinafine HCl 1% Cream External Terbinafine HCl 250 MG Tablet Oral Terconazole 0.80% Cream Vaginal Testosterone cypionate 200 MG/ML Solution Intramuscular Thera-M (multi-vitamin) Tablet Oral TraZODone HCl 50 MG Tablet Oral Tretinoin 0.01% Gel External Tretinoin 0.025% Cream External Tri-Sprintec Tablet Oral Triamcinolone Acetonide 0.10% Cream External Triamcinolone Acetonide 0.10% Ointment External Triamcinolone Acetonide 0.10% Paste Mouth/Throat Ulipristal Acetate 30 MG Tablet Oral Ultrathon Insect Repellent 34.34% Lotion External Ultrathon Permethrin Spray0.5% Urinary Pain Relief 95 MG Tablet Oral ValACYclovir HCl 1 GM Tablet Oral Ventolin HFA 108 (90 Base) MCG/ACT Aerosol Solution Inhalation Visc Lido2%/Benadryl/Maalox 1:1:1 Suspension Oral Vitamin D 1000 UNIT Tablet Oral Vivotif Berna Vaccine Capsule Delayed Release Oral White Petrolatum Ointment Zarah MG Tablet Oral
UWSP Student Health Service Pharmacy Formulary 1/22/2015
UWSP Student Health Service Pharmacy Formulary 1/22/2015 UWSP Student Health Service Pharmacy Formulary 1/22/2015 Medication Name Strength DosageForm Route Acetaminophen 325 MG Tablet Oral Acetaminophen-Codeine
More informationFORMULARY Revised January 2019
MEDICATION STRENGTH NOTES ANTIMICROBIALS-ANTIBIOTICS AMOXICILLIN CAPS 500 MG AMOXICILLIN SUSP 125 MG/5 ML 250 MG/5 ML 400 MG/5 ML AMOXICILLIN CHEW 250 MG AMOXICILLIN AND CLAVULANIC ACID CAPS (AUGMENTIN)
More informationFORMULARY NOTES ABOUT FORMULARY AND PHARMACY
FORMULARY NOTES ABOUT FORMULARY AND PHARMACY 1. Purposes: Assist team leaders in preparing for trips Limit the number of interchangeable drugs Limit pharmacy errors Improve efficiency and organization
More informationRiesbeck's Pharmacy Reward Club Generic Medication List February 2018 $4 30 Day Supply
Allergy, Cold & Flu Antibiotic Treatments Arthritis & Pain Benzonatate 100mg cap 14 42 Diphenhydramine HCl Cap 50 MG 30 90 Diphenhydramine HCl Inj 50MG/ML 1 3 Diphenhydramine HCl Liquid 12.5 MG/5ML 720ml
More information$4 Prescription Program May 5, 2008
Allergies & Cold and Flu Benzonatate 100mg 14 42 Ceron DM syrup 120ml 360ml Ceron drops* 30ml 90ml Dec-Chlorphen drops* 30ml 90ml Dec-Chlorphen DM syrup* 118ml 354ml Loratadine 10mg 30 90 Promethazine
More informationRiesbeck's Pharmacy Reward Club Generic Medication List October 2017
Allergy, Cold & Flu Antibiotic Treatments Arthritis & Pain Benzonatate 100mg cap 14 42 Diphenhydramine HCl Cap 50 MG 30 90 Diphenhydramine HCl Inj 50MG/ML 1 3 Diphenhydramine HCl Liquid 12.5 MG/5ML 720ml
More informationPRESCRIPTION SAVINGS CLUB FLAT- PRICED GENERIC DRUG LIST (EMDEON) Effective August 20, 2014
PRESCRIPTION SAVINGS CLUB FLAT- PRICED GENERIC DRUG LIST (EMDEON) Effective August 20, 2014 The Prescription Savings Club provides its members with significant savings on prescription medications. The
More informationOffice of Medicaid Policy and Planning Over-the-Counter Drug Formulary ANALGESICS ANTACIDS ANTI-FLATULENTS
Acetaminophen 80mg/0.8mL Suspension Drops Acetaminophen 120mg Suppository Acetaminophen 160mg/5mL Suspension Acetaminophen 325mg Suppository Acetaminophen 325mg Tablet, Caplet, or Capsule Acetaminophen
More information$4 Prescription Program October 23, 2007
Allergies & Cold and Flu Benzonatate 100mg 14 Ceron DM syrup Ceron drops Dec-Chlorphen drops Dec-Chlorphen DM syrup 118ml* Loratadine 10mg Promethazine DM syrup Trivent DPC syrup * Antibiotic Treatments
More informationProfessionalism & Service with Great Prices
Acyclovir Capsules 200mg Viruses 30 90 Albuterol Syrup 2mg/5ml Asthma 120 360 Albuterol Sulfate Solution 0.05% * Asthma ----- ----- 20 60 Albuterol Sulfate Solution 0.083% Asthma ----- ----- 75 225 Alendronate
More informationFORMULARY Revised January 2018 NOTES ABOUT FORMULARY AND PHARMACY
FORMULARY Revised NOTES ABOUT FORMULARY AND PHARMACY 1. Purposes: Assist team leaders in preparing for trips Limit the number of interchangeable drugs Limit pharmacy errors Improve efficiency and organization
More informationRiesbeck's Pharmacy Reward Club Generic Medication List September 2017
Drug Category Allergy, Cold & Flu Antibiotic Treatments Arthritis & Pain Riesbeck's Benzonatate 100mg cap 14 42 Diphenhydramine HCl Cap 50 MG 30 90 Diphenhydramine HCl Liquid 12.5 MG/5ML 720ml 2160ml Hydroxyzine
More informationADDITIONAL DRUG LISTING FOR MEDICARE & MEDI-CAL MEMBERS
MEDICARE & MEDICAL MEMBERS! Please read carefully! The following pages include additional drugs which may be covered for you with your doctor s prescription by MediCal (Medicaid). These drugs CANNOT be
More informationSpecial Generic Drug Pricing Program
FREE PICK-UP & DELIVERY Flu-Shots Specialty prescription Compounding Wellness center providing health screenings for hypertension and diabetes $3 Special Generic Prescription Drug Program only offered
More informationANTI COLD / ANTI ALLERGIC / ANTI-ASTHMATICS GIT PRODUCTS
SR. NO 1 ANTI COLD / ANTI ALLERGIC / ANTI-ASTHMATICS Paracetamol 500 mg, Phenylephrine HCL 5 mg With Chlorpheniramine Maleate 2 mg & Caffeine 30 mg Tablets 2 Salbutamol Tablets BP 2 mg 3 Salbutamol Tablets
More informationCash Wise Pharmacy $4 GENERIC MEDICATION FORMULARY. Cash Wise Pharmacy s $4 generic medication formulary is sorted by medical condition.
Cash Wise Pharmacy $4 GENERIC MEDICATION FORMULARY Cash Wise Pharmacy s $4 generic medication formulary is sorted by medical condition. 30- day 90- day 30- day 90- day quantity quantity quantity quantity
More informationAllergy, Cough and Cold. Analgesic. Anti-Anxiety. Antibiotic
For your convenience, this list is sorted by drug category. Drugs are categorized based on their most common use and may be included in more than one category. Drugs are not categorized by all of their
More information90-Day Generic Drug Discount List Treatment Medication Strength Dose Quantity Price Allergy/Cold&Flu Benzonatate 100mg Tablet 42 $15.
90-Day Generic Drug Discount List Treatment Medication Strength Dose Quantity Price Allergy/Cold&Flu Benzonatate 100mg Tablet 42 $15.00 Allergy/Cold&Flu C-Phen Drops n/a Drops 90 $15.00 Allergy/Cold&Flu
More informationEveryday Low Cost Generics
Antibiotics Antifungal Antiviral Arthritis/ Pain 30 Day Qty* Free AMOXICILLIN 125 MG/5 ML (150 ML BOTTLE) AMOXICILLIN 125 MG/5 ML (100 ML BOTTLE) AMOXICILLIN 125 MG/5 ML (80 ML BOTTLE) AMOXICILLIN 200
More informationRETAIL PRESCRIPTION PROGRAM DRUG LIST -- WALMART Revised 8/24/11
Allergies & Cold and Flu $4, 30-day $10, 90-day Benzonatate 100mg cap 14 42 Loratadine 10mg tab 30 90 Promethazine DM syrup 120ml 360ml Antibiotic Treatments Amoxicillin 125mg/5ml susp (80ml bottle) 1
More informationHundreds of Choices. More Savings Every Day. 8 and $ 12 Generics Also Available. Based on 30-day supply at commonly prescribed doses
4$ Hundreds of Choices. More Savings Every Day. $ 8 and $ 12 Generics Also Available. Based on 30-day supply at commonly prescribed doses EFF. DATE 09/2017 List subject to change ALLERGIES, COLD AND FLU
More informationFruth Pharmacy Prescription Savings Club Prescription Club October 2010 Generics item list 30 Day Qty
Fruth Pharmacy Prescription Savings Club Prescription Club October 2010 Generics item list Antihistamine Drugs Cyproheptadine HCl Tab 4 mg Anti-Infective Agents Diphenhydramine HCl Cap mg Promethazine
More information2017 Formulary Changes Year to Date
2017 Formulary Changes Year to Date Health Choice Arizona may add or remove drugs from our formulary during the year. If we remove drugs from our formulary, add prior authorization, quantity limits and/or
More informationAETNA BETTER HEALTH January 2017 Formulary Change(s)
AETNA BETTER HEALTH January 2017 Formulary Change(s) The following updates will be made to the Aetna Better Health of MI formulary on March 1, 2017 Drug Name, Strength, Dosage Form ALFUZOSIN HCL ER 10
More informationAmitriptyline Hydrochloride Heart Health & BP Amlodipine Besylate 5mg Norvasc Antibiotics Amoxicillin 500 mg Amoxil
School Corp Formulary Antiviral Acyclovir 400mg Zovirax Asthma Advair Diskus Diskus 250/50 Fluticasone/Salmeterol Asthma Albuterol Sulfate 2.5 mg/3 ml Proventil Arthritis and Pain Allendronate Sodium 70
More informationTennCare Program TN MAC Price Change List As of: 03/30/2017
1 TN List Run : 03/30/17 Old PRAZOSIN HCL 5 MG CAPSULE ORAL 03/29/2017 1.11209 1.12560 ( 1.2) CAPTOPRIL 12.5 MG TABLET ORAL 07/07/2015 1.07191 1.10416 ( 2.9) ISOSORBIDE DINITRATE 5 MG TABLET ORAL 03/29/2017
More informationFormulary for the JHM Outpatient Medication Assistance Program (OMAP)
Note: The JHM Outpatient is a clinic-based program and may only be used by outpatient clinics and JHCP sites approved to participate in the program. To be eligible for OMAP, the patient must not have any
More informationAmitriptyline Hydrochloride Heart Health & BP Amlodipine Besylate 5mg Norvasc Antibiotics Amoxicillin 500 mg Amoxil
Antiviral Acyclovir 400mg Zovirax Asthma Advair Diskus Diskus 250/50 Fluticasone/Salmeterol Asthma Albuterol Sulfate 2.5 mg/3 ml Proventil Arthritis and Pain Allendronate Sodium 70 mg Fosamax Arthritis
More informationWellCare s South Carolina Preferred Drug List Update
WellCare s South Carolina Preferred Drug List Update This is a list of changes to our preferred drug list. These are a result of the latest WellCare Pharmacy & Therapeutics meeting held on 09/03/2015.
More informationAll Pharmacy and Prescribing Providers. Subject: State Maximum Allowable Cost (MAC) Updates
INDIANA HEALTH COVERAGE PROGRAMS P R O V I D E R B U L L E T I N B T 2 0 0 7 1 2 M A Y 2 9, 2 0 0 7 To: All Pharmacy and Prescribing Providers Subject: State Maximum Allowable Cost (MAC) Updates Effective
More informationPharmacy Savings Program
Pharmacy Savings Program SELECT GENERICS DRUG LIST The Pharmacy Savings Program provides you with savings on select generic medications included on this list. The prices for these select generic medications
More informationAMMONIA AROMATIC 15 % (W/V) SOLUTION FOR
NDC Code HCPCS Code Medication Name & Amount Inpatient Fee 00904525646 J8499 ACETAMINOPHEN 80 MG CHEWABLE TABLET 1.00 00904198261 J3490 ACETAMINOPHEN 325 MG TABLET 1.00 50580050110 J3490 ACETAMINOPHEN
More informationAMANTADINE 50 MG/5 ML SYRUP ACYCLOVIR 200 MG CAPSULES ACYCLOVIR 400 MG TABLETS ACYCLOVIR 800 MG TABLETS 30 90
Antibiotics Qty* DRUG NAME $0.00 Copay $ 4.00 $ 10.00 AMOXICILLIN 125 MG/5 ML (150 ML BOTTLE) 150 AMOXICILLIN 125 MG/5 ML (100 ML BOTTLE) 100 AMOXICILLIN 125 MG/5 ML (80 ML BOTTLE) 80 AMOXICILLIN 200 MG/5
More information2019 CHP+/MEDICAID CHOICE OVER-THE-COUNTER (OTC) LIST
2019 CHP+/MEDICAID CHOICE OVER-THE-COUNTER (OTC) LIST Note: Prescriptions for OTCs must be written by a Denver Health provider and filled at a Denver Health Pharmacy ACETAMINOPHEN ALCOHOL ANTISEPTIC PADS
More informationGeneric Drug List - Alphabetical
Generic Drug List - Alphabetical *** Individual pages can be printed by entering the page number in the Print Range field of the Print menu (Ctrl+P)*** Medication Name Category 30-Day 90-Day ACYCLOVIR
More information2018 CHP+/MEDICAID CHOICE OVER-THE-COUNTER (OTC) LIST
2018 CHP+/MEDICAID CHOICE OVER-THE-COUNTER (OTC) LIST Note: Prescriptions for OTCs must be written by a Denver Health provider and filled at a Denver Health Pharmacy Drug Name Strength Dosage Form 80mg-160mg,
More informationAETNA BETTER HEALTH January 2017 Formulary Change(s)
AETNA BETTER HEALTH January 2017 Formulary Change(s) The following updates will be made to the Aetna Better Health of MI formulary on February 1, 2017 Drug Name, Strength, Dosage Form IVERMECTIN 3 MG TABLET
More informationOver-the-Counter Item List
ITEM Over-the-Counter Item List **All prices are subject to change. Tax is not included in these prices.** *To purchase any items italicized, you MUST bring government issued identification with you. Your
More informationClub Members save even more with the $4 Plus Plan!
Club Members save even more with the $4 Plus Plan! ITEM DESCRIPTION Acephen Supp 650MG 12 Acetam Tab 325MG 30 90 Acyclovir Cap 200MG 30 90 Albuterol Syr 2MG/5ML 120 360 Albuterol Sulfate Nebulizer Ud Sol
More informationPRIOR ADAP FORMULARY - RX OPTIONS
PRIOR ADAP FORMULARY - RX OPTIONS Created by Care Directions Case Manageent - 602-264-2273 MEDICATION Pharacies ALLERGY/COUGH/COLD DIPHENHYDRAMINE 50 MG FLUTICASONE $35 HYDROXYZINE 25 MG, 50 MG X LORATIDINE
More informationPRODUCT LIST GENERAL - TABLETS
SR. NO. PRODUCT LIST GENERAL - TABLETS 1 Ciprofloxacin Tablets IP 500 mg 2 Ciprofloxacin And Tinidazole Tablets 3 Cefpodoxime Proxetil Tablets IP 4 Cefixime Dispersible Tablets 200 mg 5 Cefixime Dispersible
More informationHome Delivery Prescription Program Drug List
Home Delivery Prescription Program Drug List Low-cost prescriptions, right in your mailbox. Now you can have your generic prescriptions mailed right to your home, no matter where you live. Because we think
More informationOakwood Healthcare Low Cost Drug List for OHSCare & BCN
Oakwood Healthcare Low Cost Drug List for OHSCare & BCN ACETAMINOPHEN-CODEINE ELIXIR Analgesic 240 720 ACYCLOVIR CAP 200MG Antiviral 30 90 AKTOB 0.3% EYE DROPS Miscellaneous 5 15 ALBUTEROL INH SOL 0.083%
More informationUPDATE Ohana QUEST Integration Medicaid
UPDATE Ohana QUEST Integration Medicaid Preferred Drug List June 29, 2015 Dear Provider: At the June 04, 2015 WellCare Pharmacy & Therapeutics Committee meeting, it was decided that the following changes
More informationAcyclovir Ointment. Aetna Better Health Pennsylvania. Products Affected. acyclovir ointment 5 % external Details. Criteria
Medications that require Step Therapy (ST) require trial and failure of preferred formulary agents prior to their authorization. If the prerequisite medications have been filled within the specified time
More informationCombined Troop Medical Clinic Outpatient Formulary. The availability of formulary items is subject to change.
Combined Troop Medical Clinic Outpatient Formulary Alphabetical Listing by Therapeutic Category This document is current as of September 6, 2013. The availability of formulary items is subject to change.
More informationUPDATE WellCare s South Carolina
September 3, 2015 UPDATE WellCare s South Carolina Preferred Drug List Dear Provider: At the September 3, 2015 WellCare Pharmacy & Therapeutics Committee meeting, it was decided that the following changes
More informationOTC PRODUCTS. 4 Gama Benzene HCL 0.1% + Proflavine Hermisulphate 0.1% + Cetrimide 0.45% Cream
OTC PRODUCTS SR. No. COMPOSITION Allantoin 0.2% + Dimethicone 1% + Urea 10% + Propylene Glycol 5% + Glyserine 5% + 1 Light Liquid Paraffin 8% Cream (FOOT CREAM) 2 Aquous Cream 3 Cetrimide 0.5% + Chlorhexidine
More informationProduct List Finished Dosage Forms (FDF) B2B Business
Product List 2017 Finished Dosage Forms (FDF) B2B Business Anaesthetics Dermatology Lidocaine Lidocaine and Prilocaine Dexmedetomidine Hydrochloride Anti-Infectives Amoxicillin Trihydrate and Potassium
More informationHome Delivery Prescription Program Drug List
Home Delivery Prescription Program Drug List Low-cost prescriptions, right in your mailbox. Now you can have your generic prescriptions mailed right to your home, no matter where you live. Because we think
More informationRajasthan Medical Services Corporation Limited, Jaipur
Rajasthan Medical Services Corporation Limited, Jaipur List of Drugs- Purchase order placed to successful Bidders Tendered on 05/07/2011 S.No. Name of Drug 1 Atropine Sulphate Injection 0.6 mg /ml (SC/IM/IV
More informationMcKinley Health Center Formulary
Anti-Infectives Antibiotics McKinley Health Center Formulary 2018-2019 Amoxicillin 250mg, 500mg, 875 cap/tab $5 Amoxicilin 250mg/5ml Oral Susp. 150ml Amox/Clav. 500/125mg, 875/125mg tab $5 Ampicillin 250mg,
More informationLET S TALK PREVENTION
LET S TALK PREVENTION YOUR NO-COST PRESCRIPTION DRUGS FOR PREVENTIVE CARE Your health plan offers certain preventive service benefits at no cost to you. This means you don t have to pay a copay* or coinsurance,
More informationUPDATE WellCare s New Jersey
UPDATE WellCare s New Jersey Preferred Drug List July 13, 2015 Dear Provider: At the June 04, 2015 WellCare Pharmacy & Therapeutics Committee meeting, it was decided that the following changes will be
More informationAetna Better Health of Illinois Medicaid Formulary Updates
October 2017 o DOXYLAMINE SUCCINATE 25mg-QL o DULOXETINE CAP 40MG DR-QL o GUANFACIN ER TABS (all strengths)-ql o TOBRAMYCIN NEBU SOLUTION- PA August 2017 Aetna Better Health of Illinois Medicaid 2017 Formulary
More informationBC Cancer Agency & Canadian Cancer Society Financial Support Drug Program (FSDP) for Cancer Patients. Drug Benefit List. Updated August 1, 2017
BC Cancer Agency & Canadian Cancer Society Financial Support Drug Program (FSDP) for Cancer Patients Drug Benefit List Updated August 1, 2017 The FSDP will operate following rules established by the BC
More informationCalgary Long Term Care Formulary. Pharmacy & Therapeutics. February 2015
Calgary Long Term Care Formulary Pharmacy & Therapeutics February 2015 Highlights http://www.albertahealthservices.ca/4070.aspx 1 Contents February 2016... 3 Added Product(s)... 3 Not Listed, Delisted
More informationAll Pharmacy Providers and Prescribing Practitioners. Subject: Updated and Revised Over-the-Counter Drug Formulary
Indiana Health Coverage Pros P R O V I D E R B U L L E T I N B T 2 0 0 3 5 8 A U G U S T 2 8, 2 0 0 3 To: All Pharmacy Providers and Prescribing Practitioners Subject: Overview Note: The information referenced
More informationDry injection list 1-Ceftriaxone 1000 mg & Sulbactam 500 mg Inj. 2-Ceftriaxone 500 mg & Sulbactam 250 mg Inj.
Dry injection list 1-Ceftriaxone 1000 mg & Sulbactam 500 mg Inj. 2-Ceftriaxone 500 mg & Sulbactam 250 mg Inj. 3-Ceftriaxone 250mg & Sulbactam 125mg Inj. 4-Ceftriaxone 125mg & Sulbactam 62.5mg Inj. 5-Rabeprazole
More informationUPLB-S , SUPPLY AND DELIVERY OF DRUGS AND MEDICINES TECHNICAL SPECIFICATION FOR THE PUBLIC BIDDING OF: OPENING OF BIDS:
1 1 0.3 Sodium Chloride with 5% Dextrose in 1000 ml in plastic bottle 2 0.3 Sodium Chloride With 5% Dextrose In 500 ml In Plastic Bottle 3 0.9 Sodium Chloride with 5% Dextrose 1000 ml in plastic bottle
More informationTN Cover Rx Tennessee CoverRx MAC Price Change List As of: 04/26/2018
1 Tennessee CoverRx List Run : 04/26/18 Dosage Form amiodarone HCl 200 MG TABLET ORAL 04/25/2018 0.16102 0.14405 11.8 hydralazine HCl 100 MG TABLET ORAL 04/25/2015 0.11390 0.10854 4.9 hydralazine HCl 25
More informationBradford Contraception and Sexual Health Services FORMULARY
Bradford Contraception and Sexual Health Services FORMULARY Medication Stock Item Strength Form Pack Size Indication Acetone Liquid 50ml For lab use Aciclovir TTO (PGD) 400mg Tablets 15 Herpes Treatment
More informationOHIO MEDICAID PHARMACY COVERAGE
OHIO MEDICAID PHARMACY COVERAGE This information is intended for use by providers to help select the most appropriate cost-effective medication and formulation for their patients. Prescribers should utilize
More informationDT Description Price Category Price change
Tariff T Watch October 2014 Readers are no doubt aware of this quarter's bad news for primary care prescribing allocations: NHS England has d the remuneration mechanism for community pharmacies gaining
More informationAlaska Medicaid 90 Day** Generic Prescription Medication List
1 ACYCLOVIR 200 MG CAPSULE BUPROPION HCL 150 MG TAB ER 24H ACYCLOVIR 200 MG/5ML BUPROPION HCL 150 MG TABLET ER ACYCLOVIR 400 MG TABLET BUPROPION HCL 150 MG TABLET ER ACYCLOVIR 800 MG TABLET BUPROPION HCL
More informationAPREPITANT ARMODAFINIL BELSOMRA BUPAP BUPRENORPHINE HCL BUTALBITAL-ACETAMINOPHEN BUTALBITAL-APAP-CAFF-COD BUTALBITAL-APAP-CAFFEINE
APREPITANT Aprepitant Oral Capsule 125, 40, 80 Aprepitant Oral Capsule 80 & 125 Quantity Limit: 8 EA Per 30 Days Quantity Limit: 12 EA Per 30 Days ARMODAFINIL Armodafinil Oral Tablet 150, 200, 250, 50
More informationPacking List SS#: From: HEALTH PARTNERS INTERNATIONAL 2907 PORTLAND DRIVE OAKVILLE ON CANADA L6H 5S4. Ship to: Carrier:
30 907 PORTLAND DRIVE OAKVILLE ON CANADA LH S4 PHONE:(90) 70-990 X FAX:(90) 70-74 ShipDate: /9/ Shipper# PTP30- Bott/0ml 0 TUBE/7G Tube/30g Box/ Box/ Kaopectate OS 70mg/mL, Bottle/0mL 790043 Attapulgite
More informationACYCLOVIR OINT (CCHP2017)
ACYCLOVIR OINT (CCHP2017) acyclovir 5 % topical ointment Step Therapy requires trial of one (1) of the following: oral generic acyclovir, oral generic famciclovir, oral generic valacyclovir. 1 ALPHAGAN
More informationPyeongChang 2018 Paralympic Winter Games Formulary
PyeongChang 2018 Paralympic Winter Games Formulary [NOTE: The WADA status and notes will be rechecked in November 2017 as they may change for 2018.] ] This formulary contains the list of medications that
More informationDT Description Price Category Price change Percentage BNF 1.2 Mebeverine 135mg tablets (100) 759 M %
June 2016 On 13th May, the DH announced that there would be reductions to Category M prices from June until September. http://psnc.org.uk/our-news/contractor-notice-category-m-price-reduction/ This has
More information(D) Standard Indications Included (Refer to Appendix A for list of medications)
Name of Policy:PolicyNumber: PRN Indications }-.+-`-+,tr---fi::-'..1- :-` -.,-_ -` E-..,',,=.:~1,EffectiveDate:9/1/2018 Department: ApprovlnResponslScope: g Officer:bleAgent: 3364-133-103 Pharmacy Chief
More informationACYCLOVIR OINT (CCHP2017)
ACYCLOVIR OINT (CCHP2017) acyclovir 5 % topical ointment Step Therapy requires trial of one (1) of the following: oral generic acyclovir, oral generic famciclovir, oral generic valacyclovir. 1 ALPHAGAN
More informationUpper Peninsula Health Plan Advantage (HMO) (List of Covered Drugs)
Analgesics Opioid Analgesics, Long-acting fentanyl 100 mcg/hr patch td72 morphine sulfate 30 mg tablet er Opioid Analgesics, Short-acting fentanyl citrate 200 mcg lozenge hd hydrocodone/acetaminophen 5
More informationcalcium chloride 100 mg/ml (10 %) intravenous solution,calcium chloride 100 mg/ml (10 %) $ 60.00
Px Code Generic Name CPT(R)/ HCPCS NDC Unit Price 2500000200 insulin human U-100 NPH-regulr 70-30 mix 100 J1815 00002871517 $ 223.05 2500000200 labetalol 5 mg/ml intravenous solution 00409226720 $ 60.00
More informationPalliative Care Drug Plan (Plan P) Formulary List of drugs PharmaCare covers
Palliative Care Drug Plan (Plan P) Formulary List of drugs PharmaCare covers This formulary is current as of February 11, 2010. Important Notes: Pharmacists must submit a claim on PharmaNet at the time
More informationGeneral products list. NDC Product Description Strength Form Brand Name Therapeutic Class Class Size
PharmRCE USA General products list NDC Product Description Strength Form Brand Name Therapeutic Class Class Size 65162-0669-10 Acebutolol HCl 200 mg Capsules Sectral Antihypertensive RX 100 65162-0670-10
More informationImportant Pharmacy Information
Important Pharmacy Information There is no copay when your Primary Care Provider (PCP) or UnitedHealthcare Community Plan Specialist writes you a covered prescription. But you can get many over-the-counter
More information2018 Over-the-Counter (OTC) Benefit Catalog
2018 Over-the-Counter (OTC) Benefit Catalog Place your OTC order NOW. A Special Benefit at NO COST TO YOU. Get your OTC products every quarter. Simply fill out the order form at the back of the catalog
More informationMedications & Mothers Milk 2017
See Monograph for Details Alesse, Aviane, Lessina, Levlite, Lutera, Sronyx Monophasic Ethinyl estradiol 20 mcg Levonorgestrel 0.1 mg Angeliq Monophasic Estradiol 1 mg Drospirenone 0.5 mg Approved in Europe
More informationKansas Health Advantage (HMO SNP) 2018 Formulary Quantity Limit Criteria
APREPITANT Kansas Health Advantage (HMO SNP) 2018 Formulary Aprepitant Oral Capsule 125, 40, 80 Aprepitant Oral Capsule 80 & 125 Quantity Limit: 8 EA Per 30 Days Quantity Limit: 12 EA Per 30 Days ARMODAFINIL
More informationAlprazolam 0.25mg, 0.5mg, 1mg tablets
Presbyterian Senior Care (HMO) / Presbyterian MediCare PPO Quantity Limits Effective November 1, 2014 For the most recent list of drugs or other questions, please contact the Presbyterian Customer Service
More informationACYCLOVIR OINT (CCHP2017)
ACYCLOVIR OINT (CCHP2017) acyclovir 5 % topical ointment Step Therapy requires trial of one (1) of the following: oral generic acyclovir, oral generic famciclovir, oral generic valacyclovir. 1 ALPHAGAN
More informationDATE OF PRE-BID CONFERENCE: DEADLINE OF SUBMISSION OF BIDS: OPENING OF BIDS:
UHS FC: 8703417 Dr. Marilyn Reaño 1 1 0.3 Sodium Chloride with 5% Dextrose in 1000 ml in plastic 120 btl 70.00 8,400.00 2 0.3 Sodium Chloride With 5% Dextrose In 500 ml In Plastic 240 btl 70.00 16,800.00
More informationDRUG SCHEDULES REGULATION CHANGES JUNE 2018
DRUG SCHEDULES REGULATION CHANGES JUNE 2018 The following amendments to the Schedules to the Drug Schedules Regulation made under the Pharmacy Operations and Drug Scheduling Act came into effect on June
More informationUseful Medications for Oral Conditions *
Useful Medications for Oral Conditions * DISCLAIMER: Drug information is constantly changing and is often subject to interpretation. While care has been taken to ensure the accuracy of the information
More informationOver-the-Counter Item List **All prices are subject to change. Tax is not included in these prices.**
Over-the-Counter Item List **All prices are subject to change. Tax is not included in these prices.** *To purchase any items italicized, you MUST bring government issued identification with you. Your employee
More informationWellCare of South Carolina Preferred Drug List Update
WellCare of South Carolina Preferred Drug List Update This is a list of changes to our preferred drug list. These are a result of the latest WellCare Pharmacy & Therapeutics meeting held on August 21,
More informationPharma X Consultancy Inc. Inventory List
Pharma X Consultancy Inc. Inventory List Location: Pharma X Consultancy Inc 2 Aceclofenac 100mg Tablets 60S 1205 ID Aciclovir 200mg Tablets 25S 1213 Aciclovir 400mg Tablets 56S 1214 Aciclovir 5% Cream
More informationNetwork Health Insurance Corporation Upcoming Negative Changes to the Medicare Part D Formulary
Requesting an Exception to the Formulary You can ask Network Health Insurance Corporation to make an exception to our coverage rules. Generally, we will only approve your request for an exception if alternative
More informationNALC Health Benefit Plan High Option 2019 Prescription Benefits Overview
NALC Health Benefit Plan High Option 2019 Prescription Benefits Overview This booklet is a summary of some of the features of the NALC Health Benefit Plan High Option. Detailed information on the benefits
More informationTribute 2018 Formulary 2018 Quantity Limit Criteria
APREPITANT Aprepitant Oral Capsule 125, 40, 80 Aprepitant Oral Capsule 80 & 125 Quantity Limit: 8 EA Per 30 Days Quantity Limit: 12 EA Per 30 Days ARMODAFINIL Armodafinil Oral Tablet 150, 200, 250, 50
More informationMemorial Hermann Advantage HMO February 2019 Formulary Addendum
Memorial Hermann Advantage HMO February 2019 Formulary Addendum Changes may have occurred since the printing of your current Memorial Hermann Advantage HMO Formulary. Medications that may have been added
More informationJuly Formulary Policy
Formulary Policy July 2017 Responsible Committee: Quality Committee Date Effective: July 2017 Author: Rahinatu Amadu Supersedes: July 2016 Next Review Due: July 2018 Formulary Policy 2016-2018 1. INTRODUCTION
More informationTribute 2018 Formulary 2018 Quantity Limit Criteria
APREPITANT Aprepitant ORAL CAPSULE 125, 40, 80 Aprepitant Oral CAPSULE 80 & 125 Quantity Limit: 8 EA Per 30 Days Quantity Limit: 12 EA Per 30 Days ARMODAFINIL Armodafinil ORAL TABLET 150, 200, 250, 50
More informationCare at the Chemist. Formulary
Care at the Chemist Formulary 1 Acute bacterial conjunctivitis Chloramphenicol 0.5% eye drops (10ml) For ages 2 years and over. Chloramphenicol 1% eye oint. (4g) For ages 2 years and over. Allergy Loratadine
More information