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MFC Formulary 4 1 2018

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MFC Formulary 4 1 2018 MedStar Family Choice - Maryland HealthChoice Prescribing Guide 2018 (710) (04/01/2018) INTRODUCTION .............................................................................................................................................................................. 5 NONDISCRIMINATION STATEMENT ............................................................................................................................................. 6 PREFACE ......................................................................................................................................................................................... 8 PHARMACY AND THERAPEUTICS (P&T) COMMITTEE .............................................................................................................. 8 PRODUCT SELECTION CRITERIA ................................................................................................................................................. 8 GENERIC AVAILABILITY ................................................................................................................................................................ 8 GENERIC SUBSTITUTION .............................................................................................................................................................. 8 DRUG EFFICACY STUDY IMPLEMENTATION (DESI) DRUGS .................................................................................................... 9 MAIL SERVICE PRESCRIPTIONS .................................................................................................................................................. 9 MEDICAL EXCEPTION .................................................................................................................................................................... 9 PRIOR AUTHORIZATION (PA) ....................................................................................................................................................... 9 MANAGED DRUG LIMITATIONS (MDL) ....................................................................................................................................... 10 STEP THERAPY (ST) .................................................................................................................................................................... 12 OVER-THE-COUNTER (OTC) DRUG COVERAGE ...................................................................................................................... 12 EDITOR .......................................................................................................................................................................................... 15 NOTICE .......................................................................................................................................................................................... 16 LEGEND ......................................................................................................................................................................................... 16 ANALGESICS ................................................................................................................................................................................ 17 NSAIDs .................................................................................................................................................................................. 17 NSAIDs, TOPICAL ................................................................................................................................................................ 17 COX-2 INHIBITORS .............................................................................................................................................................. 17 GOUT .................................................................................................................................................................................... 17 OPIOID ANALGESICS .......................................................................................................................................................... 17 NON-OPIOID ANALGESICS ................................................................................................................................................. 18 VISCOSUPPLEMENTS......................................................................................................................................................... 18 ANTI-INFECTIVES ......................................................................................................................................................................... 18 ANTIBACTERIALS ................................................................................................................................................................ 19 ANTIFUNGALS ..................................................................................................................................................................... 20 ANTIMALARIALS .................................................................................................................................................................. 20 ANTIRETROVIRAL AGENTS................................................................................................................................................ 20 ANTITUBERCULAR AGENTS .............................................................................................................................................. 20 ANTIVIRALS ......................................................................................................................................................................... 20 MISCELLANEOUS ................................................................................................................................................................ 20 ANTINEOPLASTIC AGENTS ........................................................................................................................................................ 21 ALKYLATING AGENTS ........................................................................................................................................................ 21 ANTIMETABOLITES ............................................................................................................................................................. 21 HORMONAL ANTINEOPLASTIC AGENTS .......................................................................................................................... 21 KINASE INHIBITORS ............................................................................................................................................................ 22 TOPOISOMERASE INHIBITORS ......................................................................................................................................... 22 MISCELLANEOUS ................................................................................................................................................................ 22 1 CARDIOVASCULAR ...................................................................................................................................................................... 22 ACE INHIBITORS ................................................................................................................................................................. 23 ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS.................................................................................. 23 ACE INHIBITOR/DIURETIC COMBINATIONS ..................................................................................................................... 23 ADRENOLYTICS, CENTRAL ................................................................................................................................................ 23 ALDOSTERONE RECEPTOR ANTAGONISTS.................................................................................................................... 23 ALPHA BLOCKERS .............................................................................................................................................................. 23 ANGIOTENSIN II RECEPTOR ANTAGONISTS/DIURETIC COMBINATIONS .................................................................... 23 ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER COMBINATIONS ................................... 24 ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER/DIURETIC COMBINATIONS ................. 24 ANTIARRHYTHMICS ............................................................................................................................................................ 24 ANTILIPEMICS ..................................................................................................................................................................... 24 BETA-BLOCKERS ................................................................................................................................................................ 25 BETA-BLOCKER/DIURETIC COMBINATIONS .................................................................................................................... 25 CALCIUM CHANNEL BLOCKERS........................................................................................................................................ 25 CALCIUM CHANNEL BLOCKER/ANTILIPEMIC
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