A
Acarbose (PRECOSE)
Acrivastine/
pseudoephedrine
(SEMPREX-D)
Alosetron (LOTRONEX)
Appetite suppressants
APRI
Ardeparin (NORMIFLO)
AVIANE
Azelastine hydrochloride
ophthalmic solution
(OPTIVAR)
B
Bepridil (VASCOR)
BIAXIN XL
Bitolterol inhaler
(TORNALATE)
BRONTEX
(Guaifenesin/codeine)
Butorphanol nasal spray
(STADOL NS)
C
Candesartan (ATACAND)
Cefaclor
Cefixime tablets (SUPRAX)
Cefprozil tablets (CEFZIL)
Ceftibuten (CEDAX)
Celicoxib (CELEBREX)
CENESTIN (synthetic
conjugated estrogens)
Cephradine
Cerivastatin (BAYCOL)
COVERA-HS
CYCLESSA
D
D.A. II
Dalteparin (FRAGMIN)
Desogestrel Ethinyl Estradiol
(ORTHO-CEPT)
Dexamethasone inhaler
(DECADRON TURBINAIRE)
Diclofenac/Misoprostol
(ARTHROTEC)
Diclofenac potassium
(CATAFLAM)
Diflunisol
Diltiazem HCI
(CARDIZEM CD)
Diltiazem SR (DILACOR XR)
Dipyridamole/Aspirin
(AGGRENOX)
Dirithromycin (DYNABAC)
DYAZIDE
E
EC-NAPROSYN or NAPRELAN
Eflornithine (VANIQA)
Emadastine diflumarate
(EMADINE)
Enalapril/felodipine (LEXXEL)
Enoxacin (PENETREX)
Estradiol/norethindrone
transdermal system
(COMBIPATCH)
Ethinyl estradiol/noreth AC
(FemHRT)
Ethynodiol-mestranol
(OVULEN)
Etodolac
F
Famciclovir (FAMVIR)
Famotidine (PEPCID) except
generic 20 mg
and 40 mg tablets
Fenofibrate (LIPIDIL)
Fenoprofen
Fexofenadine hydrochloride
(ALLEGRA)
Fexofenadine/pseudoephedrine
(ALLEGRA D)
Flunisolide nasal inhaler
(NASALIDE, NASAREL)
Flunisolide oral inhaler
(AEROBID, AEROBID-M)
Fluoxetine HCl (tablets)
Flurbiprofen
Fluticasone nasal inhaler
(FLONASE AQ)
Fosfomycin (MONUROL)
Fosinopril (MONOPRIL)
G
Gatifloxacin (TEQUIN)
H
HELIDAC
Human growth hormone
brands other than
Humatrope (Humatrope
requires prior authorization
I
Ibuprofen/hydrocodone
(VICOPROFEN)
Irbesartan (AVAPRO)
Isoproterenol inhaler
(MEDIHALER-ISO
or ISUPREL)
Isosorbide mononitrate
(ISMO)
Isradipine (DYNACIRC CR)
J
JENSET-28
|
K
Ketoprofen
Ketotifen fumarate
ophthalmic solution
(ZADITOR)
L
Levafloxacin (LEVAQUIN)
Levalbuterol (XOPENEX)
LEVLITE
Levonorgestrel Ethinyl
Estradiol (NORDETTE)
Excluded 9/1/02
LEVORA
LODINE XL
Lomefloxacin (MAXAQUIN)
Loracarbef capsules
(LORABID)
Loratadine melting tablets
(CLARITIN REDITABS)
(Ages > 6)
M
Mefenamic acid (PONSTEL)
Metaproterenol Inhaler
(ALUPENT INHALER)
MICORGESTIN FE
Minoxidil topical solution
(ROGAINE)
MODICON
N
Naphazoline/antazoline
ophthalmic solution
Naphazoline HCL/
pheniramine maleate
ophthalmic solution
NAPROSYN EC
NECON
Nicardipine (CARDENE and
CARDENE SR)
Nifedipine (PROCARDIA XL)
Nisoldipine (SULAR)
Nizatidine (AXID)
Norethindrone Acetate Ethinyl
Estradiol (LOESTRIN)
Norethindrone Ethinyl
Estradiol (MODICON)
NOVOLIN 70/30
NOVOLIN L
NOVOLIN N
NOVOLIN R
O
Ogestrel
Omeprazole (PRILOSEC)
Over-the-counter drugs
Oxaprozin (DAYPRO)
P
Pemirolast potassium
ophthalmic solution
(ALAMAST)
Phenylpropanolamine-
containing products
Phenytoin (all generics)
Pravastatin (PRAVACHOL)
Progesterone oral (other
than PROMETRIUM,
which requires prior
authorization)
PROPECIA
Q
Quinapril (ACCUPRIL)
R
Rabeprazole (ACIPHEX)
Ramipril (ALTACE)
Ranitidine capsules
S
Sildenafil (VIAGRA)
Smoking cessation products
Sparfloxacin (ZAGAM)
T
Tacrine (COGNEX)
Telmisartan (MICARDIS)
Terbutaline inhaler
(BRETHAIRE)
Tiludronate (SKELID)
Tinzaparin (INNOHEP)
Tolmetin
Toremifene (FARESTON)
Torsemide (DEMADEX)
Tramadol
Trandolapril (MAVIK)
Trandolapril/verapamil
(TARKA)
Triamcinolone nasal inhaler
(NASACORT)
TRILEVLEN
TRITEC
Troglitazone (REZULIN)
Trovafloxacin (TROVAN)
U
Unoprostone isopropyl
(RESCULA)
V
VERELAN
VOLTAREN XR
Y
YASMIN
Z
Zaleplon (SONATA)
Zanamivir (RELENZA)
Zileuton (ZYFLO)
ZOVIA
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