CAREADVANTAGE (CMC/MMP) 2018 Updates
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- Rudolph Bishop
- 5 years ago
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1 January, /05/2018 atazanavir sulfate atazanavir sulfate 01/05/2018 TYPHIM VI typhoid vaccine vi capsular polysaccharide 01/12/2018 PROLASTIN C alpha-1-proteinase inhibitor 01/12/ /12/2018 LATUDA lurasidone hcl 01/12/2018 OPDIVO nivolumab 01/19/2018 sertraline hcl sertraline hcl 01/19/2018 romidepsin romidepsin 01/19/2018 ALUNBRIG brigatinib 01/26/2018 SAPHRIS asenapine maleate 01/26/2018 GAMMAPLEX immune globulin,gamma (igg)/glycine/iga 0 to 50 mcg/ml 01/27/2018 VENLAFAXINE HCL ER 01/27/2018 theratrum complete 50 plus venlafaxine hcl multivitamin with minerals/folic acid/lycopene/lutein 01/27/2018 reno caps vitamin b complex and vitamin c no.20/folic acid PAGE 1 UPDATED 10/2018
2 February, /01/2018 dextrose in water dextrose 5 % in water TERM AUTO RULE 02/01/2018 glucose in water dextrose 5 % in water TERM AUTO RULE 02/02/2018 geri-mucil psyllium husk (with sugar) 02/02/2018 geri-mucil psyllium husk 02/02/2018 QVAR REDIHALER beclomethasone dipropionate 02/02/2018 reno caps vitamin b complex and vitamin c no.20/folic acid 02/02/2018 core essentials ped peptid pls 02/02/2018 litetouch insulin syringe nutritional supplement/fiber syringe with needle,insulin,0.5 ml 02/02/2018 multihealth fiber psyllium husk/aspartame 02/02/2018 ELIQUIS apixaban 02/02/2018 natural fiber psyllium husk/aspartame 02/02/2018 core essentials ped standard 02/09/2018 assure id insulin safety nutritional supplement/fiber syringe with needle, insulin, safety, 0.5 ml 02/09/2018 my choice levonorgestrel 02/09/2018 efavirenz efavirenz 02/09/2018 assure id insulin safety syringe with needle, insulin, safety, 1 ml 02/16/2018 wera norethindrone-ethinyl PAGE 2 UPDATED 10/2018
3 02/17/2018 SILACE docusate sodium 02/18/2018 dulcoease docusate sodium 02/23/2018 trientine hcl trientine hcl 02/24/2018 arthritis hot pain relief methyl salicylate/menthol 02/25/2018 roweepra xr levetiracetam 02/25/2018 roweepra xr levetiracetam REMOVE FROM FORMULARY 02/25/2018 roweepra xr levetiracetam Non-Formulary 02/27/2018 roweepra xr levetiracetam 02/27/2018 roweepra xr levetiracetam REMOVE FROM FORMULARY Non-Formulary PAGE 3 UPDATED 10/2018
4 March, /01/2018 HERCEPTIN trastuzumab 03/01/2018 isibloom desogestrel-ethinyl 03/01/2018 altavera levonorgestrel-ethinyl 03/01/2018 isotretinoin isotretinoin 03/01/2018 HUMALOG JUNIOR KWIKPEN 03/01/2018 tri-vylibra norgestimate-ethinyl 03/01/2018 kurvelo levonorgestrel-ethinyl insulin lispro 03/01/2018 digox digoxin 03/01/2018 BIKTARVY bictegravir sodium/emtricitabine/tenofov ir alafenamide fumar 03/01/2018 TWINRIX hepatitis a virus and hepatitis b virus vaccine/pf 03/01/2018 levonorgestreleth levonorgestrel-ethinyl 03/01/2018 ADACEL TDAP diphtheria,pertussis(acellular ),tetanus vaccine/pf 03/01/2018 emoquette desogestrel-ethinyl 03/01/2018 cyred desogestrel-ethinyl 03/01/2018 vylibra norgestimate-ethinyl PAGE 4 UPDATED 10/2018
5 03/01/2018 haloperidol lactate haloperidol lactate 03/01/2018 roweepra levetiracetam 03/01/2018 bortezomib bortezomib 03/01/2018 juleber desogestrel-ethinyl 03/01/2018 VAQTA hepatitis a virus vaccine/pf 03/01/2018 meropenem- 0.9% nacl meropenem in 0.9 % sodium chloride 03/01/2018 HAVRIX hepatitis a virus vaccine/pf 03/01/2018 enskyce desogestrel-ethinyl 03/02/2018 ZENPEP lipase/protease/amylase 03/02/2018 memantine hcl er memantine hcl 03/09/2018 IMBRUVICA ibrutinib 03/09/2018 glatopa glatiramer acetate 03/10/2018 HONEY BEARS pediatric multivitamin no.159/ferrous sulfate 03/10/2018 DINO-LIFE pediatric multivitamin no.159/ferrous sulfate 03/16/2018 kelnor 1-50 ethynodiol diacetate-ethinyl 03/17/2018 ibu ibuprofen 03/17/2018 jock itch terbinafine hcl 03/23/2018 ibu ibuprofen 03/23/2018 DALIRESP roflumilast 03/23/2018 tiagabine hcl tiagabine hcl PAGE 5 UPDATED 10/2018
6 03/23/2018 ritonavir ritonavir PAGE 6 UPDATED 10/2018
7 April, /01/2018 ERLEADA apalutamide 04/01/2018 ERLEADA apalutamide TERM AUTO RULE 04/01/2018 SYMFI LO efavirenz/lamivudine/tenofov ir disoproxil fumarate 04/06/2018 TASIGNA nilotinib hcl 04/06/2018 palonosetron hcl palonosetron hcl 04/06/2018 EPINEPHRINE epinephrine 04/12/2018 VIDEX EC didanosine 04/13/2018 easy glide pen needle pen needle, diabetic 04/15/2018 CHANTIX varenicline tartrate TERM AUTO RULE 04/20/2018 safetyglide insulin syringe 04/20/2018 easy touch pen needle 04/20/2018 safetyglide insulin syringe 04/20/2018 safetyglide insulin syringe syringe with needle, insulin, safety, 0.3 ml pen needle, diabetic syringe with needle, insulin, safety, 1 ml syringe with needle, insulin, safety, 0.5 ml 04/27/2018 miglustat miglustat 04/27/2018 pain reliever acetaminophen 04/27/2018 ZENPEP lipase/protease/amylase PAGE 7 UPDATED 10/2018
8 May, /01/2018 VIDEX EC didanosine 05/04/2018 insulin syringe syringe with needle,insulin,0.3 ml 05/04/2018 veo insulin syringe 05/04/2018 veo insulin syringe syringe with needle,insulin,0.3 ml syringe with needle,insulin 0.3 ml (half unit mark) 05/04/2018 aspirin aspirin 05/04/2018 veo insulin syringe 05/04/2018 veo insulin syringe 05/04/2018 techlite insulin syringe syringe with needle,insulin,0.5 ml syringe with needle,disposable,insulin 1 ml syringe with needle,disposable,insulin 1 ml 05/04/2018 praziquantel praziquantel 05/04/2018 insulin syringe syringe with needle,disposable,insulin 1 ml 05/04/2018 insulin syringe syringe with needle,insulin,0.5 ml 05/11/2018 KYMRIAH tisagenlecleucel 05/11/2018 techlite insulin syringe syringe with needle,insulin 0.3 ml (half unit mark) 05/11/2018 HUMIRA adalimumab PAGE 8 UPDATED 10/2018
9 05/11/2018 techlite insulin syringe syringe with needle,insulin 0.5 ml (half unit mark) 05/11/2018 HUMIRA PEN adalimumab 05/15/2018 vancomycin hcl vancomycin in 5 % dextrose in water 05/15/2018 vancomycin hcld5w 05/15/2018 ganciclovir sodium vancomycin in 5 % dextrose in water 05/15/2018 vancomycin vancomycin in 5 % dextrose in water TERM AUTO RULE TERM AUTO RULE ganciclovir sodium TERM AUTO RULE 05/15/2018 RUBRACA rucaparib camsylate 05/15/2018 VIRAMUNE nevirapine 05/15/2018 vancomycin hcl- 0.9% nacl vancomycin in 0.9 % sodium chloride TERM AUTO RULE 05/15/2018 vancomycin hcl vancomycin hcl TERM AUTO RULE 05/15/2018 SYLVANT siltuximab 05/18/2018 ZENPEP lipase/protease/amylase 05/25/2018 colesevelam hcl colesevelam hcl 05/25/2018 NORVIR ritonavir 05/25/2018 insulin syringe syringe with needle,insulin,0.5 ml 05/25/2018 insulin syringe syringe with needle,disposable,insulin 1 ml 05/25/2018 insulin syringe syringe with needle,insulin,0.3 ml 05/25/2018 baclofen baclofen PAGE 9 UPDATED 10/2018
10 June, /01/2018 lansoprazole lansoprazole 06/01/2018 ZENPEP lipase/protease/amylase 06/01/2018 CIMDUO lamivudine/tenofovir disoproxil fumarate 06/01/2018 HEMLIBRA emicizumab-kxwh 06/01/2018 SYMFI efavirenz/lamivudine/tenofov ir disoproxil fumarate 06/08/2018 K-PHOS NEUTRAL 06/08/2018 pro comfort insulin syringe sodium phosphate,dibasic/pot phos,monob/sod phosphate mono syringe with needle,insulin,0.5 ml 06/08/2018 FLUORITAB fluoride (sodium) 06/08/2018 pro comfort insulin syringe syringe with needle,disposable,insulin 1 ml 06/08/2018 niva-plus multivitamin-minerals no.60/ferrous fumarate/folic acid 06/08/2018 tri-vit with fluoride-iron fluoride/iron/vitamins a,c,and d 06/08/2018 fluoride fluoride (sodium) 06/08/2018 VOL-NATE multivitamin with minerals no.64/ferrous fumarate/folic acid PAGE 10 UPDATED 10/2018
11 06/08/2018 VOL-PLUS multivitamin-minerals no.60/ferrous fumarate/folic acid 06/08/2018 FLUOR-A-DAY sodium fluoride/xylitol 06/08/2018 sodium fluoride fluoride (sodium) 06/08/2018 THRIVITE 19 multivit-mins no.59/ferrous fumarate/folic acid/docusate sod 06/08/2018 ludent fluoride fluoride (sodium) 06/08/2018 phospha 250 neutral sodium phosphate,dibasic/pot phos,monob/sod phosphate mono 06/08/2018 VOL-TAB RX multivitamin with minerals no.50/iron,carbonyl/folic acid 06/15/2018 subvenite (orange) lamotrigine 06/15/2018 subvenite (blue) lamotrigine 06/15/2018 mili norgestimate-ethinyl 06/15/2018 tri-mili norgestimate-ethinyl 06/15/2018 KIONEX sodium polystyrene sulfonate/sorbitol solution 06/15/2018 elite-ob prenatal vitamins no.123/iron,carbonyl/folic acid 06/15/2018 subvenite lamotrigine PAGE 11 UPDATED 10/2018
12 06/15/2018 subvenite (green) lamotrigine 06/29/2018 assure id pen needle pen needle, diabetic, safety 06/29/2018 daptomycin daptomycin PAGE 12 UPDATED 10/2018
13 July, /01/2018 tulana norethindrone 07/01/2018 JANUMET XR sitagliptin phosphate/metformin hcl 07/06/2018 ertapenem ertapenem sodium 07/06/2018 assure id pen needle pen needle, diabetic, safety 07/06/2018 vigadrone vigabatrin 07/13/2018 aspirin aspirin 07/20/2018 ketoprofen ketoprofen PAGE 13 UPDATED 10/2018
14 August, /01/2018 naratriptan naratriptan hcl UM AUTO RULE: QUANTITY 08/01/2018 naratriptan hcl naratriptan hcl UM AUTO RULE: QUANTITY 08/01/2018 rizatriptan rizatriptan benzoate UM AUTO RULE: QUANTITY 08/03/2018 stomach relief bismuth subsalicylate 9 / 30 OVER TIME 9 / 30 OVER TIME 12 / 30 OVER TIME 08/03/2018 NUPLAZID pimavanserin tartrate 08/10/2018 GAMASTAN immune globulin,gamma(igg)/glycine 08/10/2018 HEPLISAV-B hepatitis b vaccine recombinant/vaccine adjuvant cpg 1018/pf 08/10/2018 stomach relief bismuth subsalicylate 08/15/2018 mesalamine mesalamine with cleansing wipes 08/15/2018 YONSA abiraterone acetate, submicronized 08/15/2018 incassia norethindrone 08/15/2018 SYMTUZA darunavir eth/cobicistat/emtricitabine/t enofovir alafenamide 08/17/2018 ORKAMBI lumacaftor/ivacaftor 08/17/2018 KYPROLIS carfilzomib 08/17/2018 dropsafe pen needle pen needle, diabetic, safety PAGE 14 UPDATED 10/2018
15 08/24/2018 tadalafil tadalafil 08/24/2018 adriamycin doxorubicin hcl 08/24/2018 metformin hcl metformin hcl 08/24/2018 temsirolimus temsirolimus 08/31/2018 LENVIMA lenvatinib mesylate PAGE 15 UPDATED 10/2018
16 September, /01/2018 guaifenesin er guaifenesin 09/01/2018 ARMOUR THYROID thyroid,pork 09/01/2018 WP THYROID thyroid,pork 09/01/2018 NATURE- THROID thyroid,pork 09/01/2018 thyroid thyroid,pork 09/01/2018 organ-i nr guaifenesin 09/01/2018 coughtab guaifenesin 09/01/2018 hydrocortisonepramoxine hcl hydrocortisone acetate/pramoxine hcl 09/01/2018 WESTHROID thyroid,pork 09/01/2018 vitamin b-12 cyanocobalamin (vitamin b- 12) 09/01/2018 hydrocortisonepramoxine hydrocortisone acetate/pramoxine hcl 09/01/2018 pramcort hydrocortisone acetate/pramoxine hcl 09/01/2018 mucus er guaifenesin 09/01/2018 PYRIDIUM phenazopyridine hcl 09/01/2018 guaifenesin guaifenesin 09/01/2018 mezparox-hc hydrocortisone acetate/pramoxine hcl 09/01/2018 PRAMOSONE hydrocortisone acetate/pramoxine hcl PAGE 16 UPDATED 10/2018
17 09/01/2018 MUCINEX guaifenesin 09/01/2018 expectorant guaifenesin 09/01/2018 mucus relief chest congestion guaifenesin 09/01/2018 np thyroid thyroid,pork 09/01/2018 aubra eq levonorgestrel-ethinyl 09/01/2018 mucus relief guaifenesin 09/01/2018 phenazopyridine hcl 09/01/2018 ANALPRAM HC hydrocortisone acetate/pramoxine hcl phenazopyridine hcl 09/01/2018 acetic acid acetic acid 09/01/2018 chateal eq levonorgestrel-ethinyl 09/15/2018 ibu-200 ibuprofen 09/15/2018 SAPHRIS asenapine maleate 09/21/2018 ibu-200 ibuprofen 09/21/2018 dalfampridine er dalfampridine 09/21/2018 SAPHRIS asenapine maleate 09/22/2018 techlite pen needle pen needle, diabetic 09/22/2018 aspirin ec aspirin 09/28/2018 magnesium magnesium oxide PAGE 17 UPDATED 10/2018
18 09/28/2018 techlite pen needle pen needle, diabetic 09/28/2018 magnesium oxide magnesium oxide 09/28/2018 carmustine carmustine 09/28/2018 aspirin ec aspirin 09/28/2018 itraconazole itraconazole PAGE 18 UPDATED 10/2018
19 October, /01/2018 ensure compact lactose-reduced food Non-Formulary 10/01/2018 masophen acetaminophen 10/01/2018 pain & fever acetaminophen 10/01/2018 8hr arthritis pain acetaminophen 10/01/2018 pain relief acetaminophen 10/01/2018 arthritis pain reliever acetaminophen 10/01/2018 MEKTOVI binimetinib 10/01/2018 aspercreme lidocaine 10/01/2018 mapap acetaminophen 10/01/2018 TIBSOVO ivosidenib 10/01/2018 arthritis pain relief acetaminophen 10/01/2018 mapap arthritis pain acetaminophen 10/01/2018 acetaminophen acetaminophen 10/01/2018 VYVANSE lisdexamfetamine dimesylate 10/01/2018 extra strength non-aspirin 10/01/2018 non-aspirin pain relief acetaminophen acetaminophen 10/01/2018 arthritis pain acetaminophen 10/01/2018 acetaminophen extra strength acetaminophen 10/01/2018 pain reliever acetaminophen PAGE 19 UPDATED 10/2018
20 10/01/2018 pharbetol acetaminophen 10/01/2018 q-pap extra strength acetaminophen 10/01/2018 vancomycin hcl vancomycin hcl 10/01/2018 pain relief 8hr acetaminophen 10/01/2018 acetaminophen 8 hour acetaminophen 10/01/2018 TAVALISSE fostamatinib disodium 10/01/2018 atomoxetine hcl atomoxetine hcl UM AUTO RULE: QUANTITY 10/01/2018 lidocaine pain relief 10/01/2018 acetaminophen er 30 / 30 DAYS lidocaine acetaminophen 10/01/2018 lidocare lidocaine 10/01/2018 tactinal acetaminophen 10/01/ hour acetaminophen 10/01/2018 8hr arthritis pain relief 10/01/2018 HUMIRA PEN PSORIASIS- UVEITIS acetaminophen adalimumab 10/01/2018 verapamil hcl verapamil hcl 10/01/2018 tylophen acetaminophen 10/01/2018 pain relief extra strength 10/01/2018 TYLENOL 8 HOUR acetaminophen acetaminophen PAGE 20 UPDATED 10/2018
21 10/01/ hour pain relief acetaminophen 10/01/2018 lorazepam intensol 10/01/2018 ENSURE CLEAR nutritional therapy for impaired digestive function 10/01/2018 8hr muscle aches-pain lorazepam Non-Formulary acetaminophen 10/01/2018 BRAFTOVI encorafenib 10/01/2018 BELSOMRA suvorexant 10/01/2018 HUMIRA PEN CROHN-UC-HS STARTER adalimumab 10/01/2018 atomoxetine hcl atomoxetine hcl TERM AUTO RULE 10/01/2018 shake that ache acetaminophen 10/01/2018 non-aspirin extra strength acetaminophen 10/01/2018 ENSURE PLUS lactose-reduced food Non-Formulary 10/01/2018 lorazepam lorazepam 10/05/2018 magnesium oxide magnesium oxide 10/05/2018 magnesium magnesium oxide 10/05/2018 lactulose lactulose 10/05/2018 pro comfort pen needle pen needle, diabetic 10/05/2018 palonosetron hcl palonosetron hcl 10/05/2018 albendazole albendazole 10/12/2018 ex-lax sennosides PAGE 21 UPDATED 10/2018
22 10/12/2018 microgestin norethindrone acetateethinyl 10/12/2018 CHILDREN'S ALLEGRA ALLERGY fexofenadine hcl 10/12/2018 muro-128 sodium chloride 10/12/2018 ocella ethinyl /drospirenone 10/12/2018 gianvi ethinyl /drospirenone 10/12/2018 trinessa norgestimate-ethinyl 10/12/2018 nora-be norethindrone 10/12/2018 PREFEST /norgestimate 10/12/2018 mononessa norgestimate-ethinyl MMP OTC MMP OTC 10/12/2018 unifine pentips pen needle, diabetic 10/12/2018 pain & fever acetaminophen 10/12/2018 necon norethindrone-ethinyl 10/12/2018 dimetapp brompheniramine maleate/phenylephrine hcl 10/12/2018 daily vite multivitamin 10/12/2018 NICORETTE nicotine polacrilex PAGE 22 UPDATED 10/2018
23 10/12/2018 VENLAFAXINE HCL ER venlafaxine hcl 10/12/2018 cyred eq desogestrel-ethinyl 10/12/2018 BCG VACCINE (TICE STRAIN) bcg vaccine, live/pf 10/12/2018 DILANTIN phenytoin sodium extended 10/12/2018 triple antibiotic neomycin sulfate/bacitracin zinc/polymyxin b 10/12/2018 anti-dandruff selenium sulfide 10/12/2018 thera multivitamin with folic acid 10/12/2018 tears naturale free 10/12/2018 dexamethasone intensol dextran 70/hypromellose/pf dexamethasone 10/12/2018 ZADITOR ketotifen fumarate 10/12/2018 ribasphere ribavirin 10/12/2018 tinactin tolnaftate 10/12/2018 LAMISIL AT terbinafine hcl 10/12/2018 mucus relief guaifenesin 10/12/2018 mucus er guaifenesin PAGE 23 UPDATED 10/2018
24 10/12/2018 jolivette norethindrone 10/12/2018 rid piperonyl butoxide/pyrethrins/permethr in 10/12/2018 yuvafem 10/12/2018 EPINEPHRINE epinephrine 10/12/2018 nicoderm cq nicotine 10/12/2018 polyvitamin with iron 10/12/2018 daily multiple vitamin pediatric multivitamin no.46/ferrous sulfate multivitamin 10/12/2018 zantac 75 ranitidine hcl 98 / 365 DAYS 98 / 365 DAYS 10/12/2018 arsenic trioxide arsenic trioxide 10/12/2018 MONISTAT 3 miconazole nitrate 10/12/2018 prednisone intensol prednisone 10/12/2018 leena norethindrone-ethinyl 10/12/2018 stress formula multivitamin,stress formula 10/12/2018 polyvitamin with iron pediatric multivitamin no.156/ferrous fumarate 10/12/2018 prevident fluoride (sodium) PAGE 24 UPDATED 10/2018
25 10/12/2018 one daily plus minerals 10/12/2018 lorazepam intensol 10/12/2018 unifine pentips plus multivitamin with minerals lorazepam pen needle, diabetic 10/12/2018 poly-vitamin pediatric multivitamin no.20 10/12/2018 microgestin fe norethindrone acetateethinyl /ferrous fumarate 10/12/2018 daily vitamin + iron multivitamin with iron 10/15/2018 PIFELTRO doravirine 10/15/2018 DELSTRIGO doravirine/lamivudine/tenofo vir disoproxil fumarate 10/17/2018 take action levonorgestrel 10/17/2018 children's benadryl allergy 10/19/2018 NOVOLIN FLEXPEN 10/23/2018 ARISTADA INITIO diphenhydramine hcl insulin nph human isophane/insulin regular, human aripiprazole lauroxil, submicronized PAGE 25 UPDATED 10/2018
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Partners Notice of Change March 2017
New Added Products: Effective 3/1/2017 Drug Reason Tier Restrictions abacavir 600 mg-lamivudine 300 QL ADRENACLICK 0.15 MG/0.15 ML INJECTION,AUTO- INJECTOR ADRENACLICK 0.3 MG/0.3 ML INJECTION, AUTO- INJECTOR
Please consult your Benefit Booklet under Preventive Services or call Member Service if you have questions about your coverage for these drugs.
ACA Drug List Preventative Medications and Preferred Contraceptives In accordance with the Affordable Care Act (ACA) requirements for preventive services, most plans cover preventative care medicines and
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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
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Hundreds of Choices. More Savings Every Day. 8 and $ 12 Generics Also Available. Based on 30-day supply at commonly prescribed doses
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Healthy Resolutions ABREVA Cold Sore/Fever Blister Treatment On The Go Cream 2 g. Additional select Tylenol Cold items where available
January SALE! Caring, Knowledgeable Pharmacy Professionals! 100 S. Main St. Suite 104 Smyrna, DE 19977 302-653-9355 Monday - Friday: 8am-8pm Sat: 9am-4pm Sun: 11am-4pm 118 Sandhill Dr. Suite 101 Middletown,
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CORTIZONE-10 Hydrocortisone Anti-Itch Cream Assorted Varieties 1 oz. Assortment varies by location $ Assortment varies by location.
June SALE! Start of Summer Sale ALEVE Naproxen Sodium 220 mg Tablets, 50 Count BAYER Aspirin 325 mg 5 99 PRILOSEC OTC Omeprazole 20.6 mg Tablets, 14 Count Additional select Aleve & Bayer items GOLD BOND
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You ll find the most up-to-date comprehensive version of our formulary on our website, Click on Drug Finder.
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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
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Freedom 1st PDL CALCIUM CARBONATE ANTACID 500 MG CHEW CALCIUM CARBONATE ANTACID 500 MG CHEWABLE TABLET
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EFFECTIVE 01/04/2019. pimecrolimus 1 % cream (g) - Added to Tier 1 - ST Added: TOPICAL IMMUNOMODULATORS
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Coverage Period: 01/01/ /31/2018 Coverage for: Individual and/or Family Plan: Healthy Rewards HSA
This is only a summary of your GatorCare pharmacy benefits. If you would like detail about your coverage and costs, you can get the complete terms in the policy or plan document at gatorcare.magellanrx.com/member
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COMMERCIAL APIs. S. No Molecule Name Therapeutic Category USDMF EDMF CEP IH
1 Abacavir Sulphate Antiretroviral - * - 2 Abiraterone Acetate Oncology - - - 3 Albendazole Anti-infective - - - 4 Albuterol Sulphate Respiratory - - 5 Alendronate Sodium Trihydrate Metabolic Disorder
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