MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES ANALGESICS ANALGESICS, DURAGESIC (fentanyl) AVINZA (morphine) NARCOTIC-LONG-ACTING fentanyl patches EMBEDA (morphine/naltrexone) KADIAN (morphine) OPANA ER (oxymorphone) methadone oxycodone ER morphine ER OXYCONTIN (oxycodone) RYZOLT (tramadol) ULTRAM ER (tramadol) ANALGESICS, NARCOTIC- acetaminophen/codeine butalbital/APAP/caffeine/codeine SHORT-ACTING aspirin/codeine butalbital/ASA/caffeine/codeine codeine DARVON-N (propoxyphene) dihydrocodeine/ APAP/caffeine DILAUDID liquid (hydromorphone) hydrocodone/APAP fentanyl hydrocodone/ibuprofen FENTORA (fentanyl) hydromorphone levorphanol IBUDONE (hydrocodone/ibuprofen) NUCYNTA (tapentadol) meperidine ONSOLIS (fentanyl) morphine OPANA (oxymorphone) oxycodone pentazocine/naloxone oxycodone/APAP propoxyphene oxycodone/aspirin REPREXAIN oxycodone/ibuprofen (hydrocodone/ibuprofen) pentazocine/APAP RYBIX (tramadol) propoxyphene/APAP ZAMICET (hydrocodone/APAP) tramadol tramadol/APAP
ANALGESICS/ANESTHETICS, FLECTOR (diclofenac epolamine)
TOPICAL LIDODERM (lidocaine)
VOLTAREN Gel (diclofenac sodium)
ANTIHYPERURICEMICS allopurinol COLCRYS (colchicine)
colchicine ULORIC (febuxostat)
probenecid
probenecid/colchicine
ANTIMIGRAINE AGENTS, ORAL TRIPTANS IMITREX (sumatriptan) AMERGE (naratriptan)
RELPAX (eletriptan) AXERT (almotriptan)
sumatriptan FROVA (frovatriptan)
TREXIMET (sumatriptan/naproxen) MAXALT (rizatriptan)
naratriptan
ZOMIG (zolmitriptan) Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 1 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES ANALGESICS ANTIMIGRAINE AGENTS, TRIPTANS (continued) NASAL (CONTINUED) IMITREX (sumatriptan) ZOMIG (zolmitriptan)
sumatriptan
INJECTABLE
IMITREX (sumatriptan) sumatriptan FIBROMYALGIA AGENTS LYRICA (pregabalin) CYMBALTA (duloxetine) Cymbalta will be SAVELLA (milnacipran) approved for patients with diabetic neuropathy
NSAIDS NONSELECTIVE
diclofenac meclofenamate
etodolac mefenamic acid
fenoprofen nabumetone
flurbiprofen tolmetin
ibuprofen ZIPSOR (diclofenac)
indomethacin Vimovo (naproxen/esomeprazole)
ketoprofen
ketorolac
naproxen
oxaprozin
piroxicam
sulindac
NSAID/GI PROTECTANT COMBINATIONS
ARTHROTEC
(diclofenac/misoprostol)
PREVACID NAPRAPAC
(naproxen/lansoprazole)
COX-II SELECTIVE
meloxicam CELEBREX (celecoxib)
Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 2 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES ANALGESICS (continued) SKELETAL MUSCLE baclofen AMRIX (cyclobenzaprine ER) RELAXANTS chlorzoxazone carisoprodol cyclobenzaprine carisoprodol compound dantrolene FEXMID (cyclobenzaprine) methocarbamol orphenadrine tizanidine orphenadrine compound SKELAXIN (metaxolone) SOMA (carisoprodol) ZANAFLEX (tizanidine) CARDIOVASCULAR ANGIOTENSIN MODULATORS ACE INHIBITORS benazepril ACEON (perindopril) captopril moexepril enalapril perindopril fosinopril lisinopril quinapril ramipril trandolapril
ACE INHIBITOR/DIURETIC COMBINATIONS
benazepril/HCTZ
captopril/HCTZ
enalapril/HCTZ
fosinopril/HCTZ
lisinopril/HCTZ
moexepril/HCTZ
quinapril/HCTZ
ANGIOTENSIN RECEPTOR BLOCKERS AVAPRO (irbesartan) ATACAND (candesartan) BENICAR (olmesartan) TEVETEN (eprosartan) COZAAR (losartan) DIOVAN (valsartan) MICARDIS (telmisartan)
Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 3 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES
CARDIOVASCULAR ANGIOTENSIN MODULATORS (CONTINUED) (CONTINUED)
ANGIOTENSIN RECEPTOR BLOCKER/DIURETIC COMBINATIONS
AVALIDE (irbesartan/HCTZ) ATACAND-HCT (candesartan/HCTZ)
BENICAR-HCT (olmesartan/HCTZ) TEVETEN-HCT (eprosartan/HCTZ)
DIOVAN-HCT (valsartan/HCTZ)
HYZAAR (losartan/HCTZ)
MICARDIS-HCT (telmisartan/HCTZ)
DIRECT RENIN INHIBITOR
TEKTURNA (aliskerin) DIRECT RENIN INHIBITOR COMBINATIONS TEKTURNA-HCT (aliskerin/HCTZ) VALTURNA (Aliskerin/valsartan)
ANGIOTENSIN MODULATOR/ ACE INHIBITOR/CCB COMBINATIONS CCB COMBINATIONS benazepril/amlodipine LOTREL TARKA (trandolapril/verapamil) ANGIOTENSIN RECEPTOR BLOCKER/CCB COMBINATIONS AZOR (olmesartan/amlodipine) TWYNSTA (telmisartan/amlodipine) EXFORGE (valsartan/amlodipine) EXFORGE HCT (valsartan/amlodipine/HCTZ) ANTICOAGULANTS, ARIXTRA (fondaparinux) INNOHEP (tinzaparin) INJECTABLE FRAGMIN (dalteparin) LOVENOX (enoxaparin)
BETA-BLOCKERS BETA BLOCKERS
Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 4 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES acebutolol betaxolol atenolol INNOPRAN XL (propranolol) bisoprolol LEVATOL (penbutolol) BYSTOLIC (nebivolol) sotalol metoprolol metopolol XL nadolol CARDIOVASCULAR pindolol (CONTINUED) propranolol BETA-BLOCKERS timolol (CONTINUED) BETA- AND ALPHA- BLOCKERS
carvedilol COREG CR (carvedilol)
labetalol
BETA BLOCKER / DIURETIC COMBINATIONS
atenolol/chlorthalidone bisoprolol/HCTZ metoprolol/HCTZ nadolol/bendroflumethiazide propranolol/HCTZ timolol/HCTZ CALCIUM CHANNEL SHORT-ACTING BLOCKERS diltiazem isradipine nicardipine nifedipine verapamil
LONG-ACTING
amlodipine CARDENE SR (nicardipine) COVERA-HS (verapamil) CARDIZEM LA (diltiazem) diltiazem ER SULAR (nisoldipine) DYNACIRC CR (isradipine) nisoldipine felodipine ER verapamil ER PM nifedipine ER verapamil ER LIPOTROPICS, OTHER BILE ACID SEQUESTRANTS (NON-STATINS) cholestyramine WELCHOL (colesevalam) colestipol
CHOLESTEROL ABSORPTION INHIBITORS
Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 5 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES ZETIA (ezetimibe) FIBRIC ACID DERIVATIVES
fenofibrate ANTARA (fenofibrate)
gemfibrozil FENOGLIDE (fenofibrate)
TRICOR (fenofibrate) FIBRICOR (fenofibric acid)
TRILIPIX (fenofibric acid) LIPOFEN (fenofibrate)
TRIGLIDE (fenofibrate)
NIACIN CARDIOVASCULAR (CONTINUED) NIACOR (niacin) NIASPAN (niacin) LIPOTROPICS, OTHER OMEGA-3 FATTY ACIDS (CONTINUED) LOVAZA (omega-3 fatty acids) LIPOTROPICS, STATINS STATINS LESCOL (fluvastatin) ALTOPREV (lovastatin) LESCOL XL (fluvastatin) CRESTOR (rosuvastatin) LIPITOR (atorvastatin) lovastatin pravastatin simvastatin STATIN COMBINATIONS CADUET (atorvastatin/amlodipine) ADVICOR (lovastatin/niacin) VYTORIN (simvastatin/ezetimibe) SIMCOR (simvastatin/niacin) PLATELET AGGREGATION AGGRENOX (dipyridamole/aspirin) EFFIENT (prasugrel) INHIBITORS dipyridamole ticlopidine PLAVIX (clopidogrel) PULMONARY ARTERIAL LETAIRIS (ambrisentan) ADCIRCA (tadalafil) HYPERTENSION AGENTS REVATIO (sildenafil) TYVASO (treprostinil) TRACLEER (bosentan) VENTAVIS (iloprost) CNS ALZHEIMER’S AGENTS CHOLINESTERASE INHIBITORS ARICEPT (donepezil) COGNEX (tacrine) ARICEPT ODT (donepezil) galantamine EXELON (rivastigmine) galantamine ER rivastigmine
NMDA RECEPTOR ANTAGONIST
NAMENDA (memantine)
Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 6 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES ANTICONVULSANTS HYDANTOINS DILANTIN (phenytoin) PEGANONE (ethotoin) PHENYTEK (phenytoin) phenytoin
SUCCINIMIDES
ethosuximide CELONTIN (methsuximide)
ADJUVANTS carbamazepine BANZEL (rufinamide) CARBATROL (carbamazepine) FELBATOL (felbamate) DEPAKOTE ER (divalproex) KEPPRA XR (levetiracetam) DEPAKOTE SPRINKLE (divalproex) SABRIL (vigabatrin) CNS divalproex STAVZOR (valproic acid) (CONTINUED) ANTICONVULSANTS divalproex ER TRILEPTAL Tablets (oxcarbazepine) (CONTINUED) EQUETRO (carbamazepine) VIMPAT (lacosamide) gabapentin GABITRIL (tiagabine) LAMICTAL ODT (lamotrigine) LAMICTAL XR (lamotrigine) lamotrigine levetiracetam oxcarbazepine TEGRETOL XR (carbamazepine) topiramate TRILEPTAL Suspension (oxcarbazepine) valproic acid zonisamide ANTIDEPRESSANTS, OTHERS bupropion APLENZIN (buproprion HBr) EFFEXOR XR (venlafaxine) EMSAM (selegiline transdermal) mirtazapine NARDIL (phenelzine) nefazodone tranylcypromine PRISTIQ (desvenlafaxine) venlafaxine trazodone venlafaxine ER WELLBUTRIN XL (bupropion HCl) venlafaxine XR
ANTIDEPRESSANTS, SSRIs citalopram LEXAPRO (escitalopram) Lexapro will be
fluoxetine paroxetine CR approved for adolescents age fluvoxamine PEXEVA (paroxetine) 12 to 17 years old. LUVOX CR (fluvoxamine) PROZAC WEEKLY (fluoxetine)
paroxetine IR
Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 7 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES sertraline ANTIPARKINSON’S AGENTS ANTICHOLINERGICS
benztropine
trihexyphenidyl
COMT INHIBITORS
COMTAN (entacapone)
TASMAR (tolcapone)
DOPAMINE AGONISTS ropinirole MIRAPEX (pramipexole) NEUPRO (rotigotine) CNS REQUIP XL (ropinirole) (CONTINUED) ANTIPARKINSON’S AGENTS MAO-B INHIBITORS (CONTINUED) selegiline AZILECT (rasagiline) ZELAPAR (selegiline) OTHERS levodopa/carbidopa STALEVO (levodopa/carbidopa/entacapone) bromocriptine ANTIPSYCHOTICS ORAL
ABILIFY (aripiprazole) FANAPT (iloperidone)
amitriptyline/perphenazine FAZACLO (clozapine)
chlorpromazine INVEGA (paliperidone)
clozapine SYMBYAX (olanzapine/fluoxetine)
fluphenazine ZYPREXA (olanzapine)
GEODON (ziprasidone)
haloperidol
MOBAN (molindone)
perphenazine
risperidone
SAPHRIS (asenapine)
SEROQUEL (quetiapine)
SEROQUEL XR (quetiapine)
thioridazine
thiothixene
trifluoperazine
INJECTABLE, ATYPICALS ABILIFY (aripiprazole) Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 8 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES GEODON (ziprasidone) INVEGA SUSTENNA (paliperidone palmitate) RISPERDAL CONSTA (risperidone) ZYPREXA (olanzapine) ZYPREXA RELPREVV (olanzapine) MULTIPLE SCLEROSIS AGENTS AVONEX (interferon beta-1a) EXTAVIA (interferon beta-1b) BETASERON (interferon beta-1b) COPAXONE (glatiramer) REBIF (interferon beta-1a) CNS (CONTINUED)
SEDATIVE HYPNOTICS BENZODIAZEPINES Single source benzodiazepines estazolam temazepam (7.5mg and 22.5mg) and barbiturates
flurazepam are NOT covered; temazepam (15mg and 30mg) PAs will not be triazolam issued for these drugs. OTHERS Sedative/Hypnotics LUNESTA (eszopiclone) AMBIEN CR (zolpidem) are limited to 31 zaleplon EDLUAR (zolpidem) cumulative units of zolpidem ROZEREM (ramelteon) all/any strengths per month. Any quantity required above these limits requires a PA. STIMULANTS AND RELATED STIMULANTS - SHORT ACTING Prior authorization AGENTS required for amphetamine salt combination DESOXYN (methamphetamine) patients >21 yrs of dexmethylphenidate IR PROCENTRA (dextroamphetamine) age. dextroamphetamine IR FOCALIN (dexmethylphenidate) METHYLIN chewable tablets (methylphenidate) METHYLIN solution (methylphenidate) methylphenidate IR STIMULANTS - LONG ACTING ADDERALL XR (amphetamine salt combination) amphetamine salt combination ER CONCERTA (methylphenidate) dextroamphetamine ER DAYTRANA (methylphenidate) NUVIGIL (armodafinil) FOCALIN XR (dexmethylphenidate) PROVIGIL (modafinil) METADATE CD (methylphenidate) RITALIN LA (methylphenidate)
Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 9 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES methylphenidate ER VYVANSE (lisdexamfetamine) NON-STIMULANTS INTUNIV (guanfacine ER) STRATTERA (atomoxetine)
DERMATOLOGICAL ACNE AGENTS, TOPICAL ANTIBIOTICS Acne agents will be authorized only clindamycin AKNE-MYCIN (erythromycin) for patients less
erythromycin CLINDAGEL (clindamycin) than 21 years of CLINDAREACH (clindamycin) age. EVOCLIN (clindamycin) sulfacetamide DERMATOLOGICAL ACNE AGENTS, TOPICAL RETINOIDS (CONTINUED) (CONTINUED) RETIN-A MICRO (tretinoin) ATRALIN (tretinoin)
DIFFERIN (adapalene)
EPIDUO
(adapalene/benzoyl peroxide)
TAZORAC (tazarotene)
tretinoin
OTHERS
AZELEX (azelaic acid) ACANYA BENZACLIN (benzoyl peroxide/clindamycin) (benzoyl peroxide/clindamycin) benzoyl peroxide ACZONE (dapsone) CLINAC BPO (benzoyl peroxide) BENZEFOAM (benzoyl peroxide) INOVA (benzoyl peroxide) benzoyl peroxide/clindamycin NUOX (benzoyl peroxide/sulfur) CLARIFOAM EF (sodium sulfacetamide/sulfur) PANOXYL (benzoyl peroxide) DUAC (benzoyl peroxide/clindamycin) sodium sulfacetamide/sulfur erythromycin/benzoyl peroxide ZACLIR (benzoyl peroxide) SE BPO (benzoyl peroxide)
sodium sulfacetamide/sulfur/meratan
ZIANA (clindaymcyin/tretinoin)
ANTIFUNGALS, TOPICAL ANTIFUNGALS ciclopirox cream/gel/suspension BENSAL HP clotrimazole (benzoic acid/salicylic acid) econazole ciclopirox shampoo ketoconazole shampoo CNL 8 (ciclopirox) miconazole OTC ERTACZO (sertaconazole) NAFTIN (naftifine) EXTINA (ketoconazole) ketoconazole cream Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 10 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES nystatin LOPROX (ciclopirox) terbinafine OTC MENTAX (butenafine) tolnaftate OTC OXISTAT (oxiconazole) VUSION (miconazole/petrolatum/ zinc oxide) XOLEGEL (ketoconazole) ANTIFUNGAL/STEROID COMBINATIONS clotrimazole/betamethasone nystatin/triamcinolone
DERMATOLOGICAL ANTIPARASITICS, TOPICAL EURAX (crotamiton) lindane (CONTINUED) malathionpermethrin OVIDE (malathion)
ULESFIA (benzyl alcohol)
ATOPIC DERMATITIS ELIDEL (pimecrolimus) PROTOPIC (tacrolimus) STEROIDS, TOPICAL LOW POTENCY CAPEX (fluocinolone) alclometasone desonide DERMA-SMOOTHE-FS (fluocinolone) hydrocortisone DESONATE (desonide) DESOWEN (desonide) PEDIACARE HC (hydrocortisone)NR SCALACORT DK (hydrocortisone) VERDESO (desonide) MEDIUM POTENCY
fluocinolone CLODERM (clocortolone)
fluticasone CORDRAN (flurandrenolide)
hydrocortisone CUTIVATE (fluticasone)
LUXIQ (betamethasone)
mometasone
MOMEXIN (mometasone) prednicarbate
HIGH POTENCY
betamethasone amcinonide CAPEX (fluocinolone) betamethasone dipropionate fluocinolone desoximetasone fluocinonide diflorasone
triamcinolone KENALOG (triamcinolone) Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 11 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES VANOS (fluocinonide) VERY HIGH POTENCY
clobetasol CLOBEX (clobetasol)
halobetasol HALONATE MR ULTRAVATE (halobetasol) (halobetasol/ammonium lactate) OLUX-E (clobetasol) OLUX-OLUX-E (clobetasol)
ENDOCRINE ANDROGENIC AGENTS ANDRODERM (testosterone patch) TESTIM (testosterone gel) ANDROGEL (testosterone gel)
ENDOCRINE BONE RESORPTION BISPHOSPHONATES (CONTINUED) SUPPRESSION AND RELATED ACTONEL (risedronate) BONIVA (ibandronate) AGENTS ACTONEL WITH CALCIUM (risedronate/calcium)
alendronate FOSAMAX PLUS D (alendronate/vitamin D) OTHERS FORTICAL (calcitonin) DIDRONEL (etidronate) MIACALCIN (calcitonin) EVISTA (raloxifene) calcitonin salmon FORTEO (teriparatide)
GROWTH HORMONE NUTROPIN (somatropin) GENOTROPIN (somatropin) Prior authorization NUTROPIN AQ (somatropin) HUMATROPE (somatropin) required for patients >18 yrs of NORDITROPIN (somatropin) age. OMNITROPE (somatropin) SAIZEN (somatropin) SEROSTIM (somatropin) TEV-TROPIN (somatropin) ZORBTIVE (somatropin) HYPOGLYCEMICS, INCRETIN BYETTA (exenatide) SYMLIN (pramlintide) MIMETICS/ ENHANCERS JANUMET (sitagliptin/metformin) VICTOZA (liraglutide) JANUVIA (sitagliptin) ONGLYZA (saxagliptin) HYPOGLYCEMICS, INSULIN LANTUS (insulin glargine) APIDRA (insulin glulisine) AND RELATED AGENTS LEVEMIR (insulin detemir) HUMALOG (insulin lispro) (INCLUDES VIALS AND PENS) NOVOLIN (insulin) HUMALOG MIX NOVOLOG (insulin aspart) (insulin lispro/lispro protamine) NOVOLOG MIX (insulin aspart/aspart protamine) HUMULIN (insulin) Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 12 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES HYPOGLYCEMICS, PRANDIN (repaglinide) PRANDIMET (repaglinide/metformin) MEGLITINIDES STARLIX (nateglinide) HYPOGLYCEMICS, TZDS THIAZOLINEDIONES ACTOS (pioglitazone) AVANDIA (rosiglitazone) TZD COMBINATIONS ACTOPLUS MET (pioglitazone/metformin) AVANDAMET (rosiglitazone/metformin) AVANDARYL (rosiglitazone/glipizide) DUETACT (pioglitazone/glimepiride) GASTROINTESTINAL ANTIEMETICS CANNABINOIDS CESAMET (nabilone) dronabinol
5HT3 RECEPTOR BLOCKERS All injectable 5HT3 receptor blockers ondansetron ANZEMET (dolasetron) closed to point of ondansetron solution granisetron sale. ondansetron ODT Ondansetron ODT SANCUSO (granisetron) 4mg tablets are covered without a PA for ages 1-11. NMDA RECEPTOR ANTAGONIST EMEND (aprepitant) H. PYLORI AGENTS HELIDAC (bismuth subsalicylate, metronidazole, PYLERA tetracycline) (bismuth subcitrate potassium, PREVPAC (lansoprazole, amoxicillin, clarithromycin) metronidazole, tetracycline) PANCREATIC ENZYMES CREON (pancreatin) PANCRECARB MS (pancrelipase) pancrelipase PANCREASE (pancrelipase) VIOKASE (pancrelipase) PANCREASE MT (pancrelipase) ZENPEP (pancrelipase) ULTRASE (pancrelipase)
PROTON PUMP INHIBITORS DEXILANT formerly KAPIDEX (dexlansoprazole) ACIPHEX (rabeprazole) omeprazole RX lansoprazole PREVACID SOLU-TAB (lansoprazole) NEXIUM (esomeprazole) omeprazole sodium bicarbonate pantoprazole PREVACID Rx (lansoprazole) PRILOSEC (omeprazole)
Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 13 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES ULCERATIVE COLITIS AGENTS ORAL APRISO (mesalamine) LIALDA (mesalamine) ASACOL (mesalamine) ASACOL HD (mesalamine) balsalazide
DIPENTUM (olsalazine) PENTASA (mesalamine) sulfasalazine RECTAL CANASA (mesalamine) SFROWASA (mesalamine) mesalamine IMMUNOLOGIC CYTOKINE AND CAM CIMZIA (certolizumab) AMEVIVE (alefacept) Amevive, Orencia, AGENTS ANTAGONISTS ENBREL (etanercept) ORENCIA (abatacept) Remicade and Stelara are for HUMIRA (adalimumab) REMICADE (infliximab) administration in KINERET (anakinra) SIMPONI (golimumab) hospital or clinic STELARA (ustekinumab)NR setting. PA will not be issued at Point of Sale without justification. INFECTIOUS ANTIBIOTICS, GI ALINIA (nitazoxanide) FLAGYL ER (metronidazole) DISEASE metronidazole tinadazole neomycin VANCOCIN (vancomycin) TINDAMAX (tinadazole) XIFAXAN (rifaximin)
ANTIBIOTICS, VAGINAL CLEOCIN OVULES (clindamcyin) CLINDESSE (clindamycin)
clindamycin
metronidazole
VANDAZOLE (metronidazole)
ANTIFUNGALS, ORAL clotrimazole ANCOBON (flucytosine)
fluconazole GRIFULVIN V (griseofulvin)
GRIS-PEG (griseofulvin) itraconazole
ketoconazole LAMISIL (terbinafine)
nystatin NOXAFIL (posaconazole)
terbinafine TERBINEX Kit
(terbinafine/ciclopirox)
VFEND (voriconazole)
ANTIVIRALS, ORAL – acyclovir famciclovir
ANTIHERPETIC AGENTS valacyclovir
VALTREX Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 14 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES CEPHALOSPORINS AND BETA LACTAM/BETA-LACTAMASE INHIBITOR COMBINATIONS RELATED ANTIBIOTICS amoxicillin/clavulanate
AUGMENTIN 125 and 250 (amoxicillin/clavulanate) Suspension AUGMENTIN 250 mg (amoxicillin/ clavulanate) Chewable Tablets AUGMENTIN XR (amoxicillin/clavulanate) CEPHALOSPORINS – First Generation
cefadroxil cephalexin
CEPHALOSPORINS AND INFECTIOUS CEPHALOSPORINS – Second Generation DISEASE RELATED ANTIBIOTICS
(CONTINUED) (CONTINUED) cefaclor cefprozil cefuroxime CEPHALOSPORINS – Third Generation cefdinir suspension (for patients <18 yr only) CEDAX (ceftibuten) SUPRAX (cefixime) cefdinir capsules cefpodoxime SPECTRACEF (cefditoren) FLUOROQUINOLONES, ORAL AVELOX (moxifloxacin) ciprofloxacin ER ciprofloxacin tablets CIPRO (ciprofloxacin) FACTIVE (gemifloxacin) LEVAQUIN (levofloxacin) NOROXIN (norfloxacin) ofloxacin PROQUIN XR (ciprofloxacin)
HEPATITIS C TREATMENTS PEGASYS (peginterferon alfa-2a) INFERGEN (interferon alfacon-1) Peg-Intron will be
PEG-INTRON (peginterferon alfa-2b) approved for patients with history of treatment failure and/or <18 yr of age
MACROLIDES/ KETOLIDES KETOLIDES KETEK (telithromycin) MACROLIDES
azithromycin clarithromycin ER
clarithromycin IR ZMAX (azithromycin)
erythromycin Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 15 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES TETRACYCLINES doxycycline ADOXA CK (doxycycline) minocycline IR ADOXA TT (doxycycline) tetracycline demeclocycline minocycline ER NUTRIDOX (doxycycline) ORACEA (doxycycline) SOLODYN (minocycline)
NEPHROLOGIC ERYTHROPOIESIS ARANESP (darbepoetin) EPOGEN (rHuEPO) AGENTS STIMULATING PROTEINS PROCRIT (rHuEPO)
PHOSPHATE BINDERS ELIPHOS (calcium acetate) FOSRENOL (lanthanum)
PHOSLO (calcium acetate)
calcium acetate
RENAGEL (sevelamer HCl) RENVELA (sevelamer carbonate) NUTRITIONALS CALORIC AGENTS BOOST COMPLEAT BRIGHT BEGINNINGS EO28 SPLAST CARNATION INSTANT BREAKFAST FIBERSOURCE DUOCAL ISOSOURCE ENSURE JEVITY JUVEN KINDERCAL NUTREN PROMOTE OSMOLITE TOLEREX PEDIASURE VITAL POLYCOSE PROMOD RESOURCE TWOCAL HN OPHTHALMICS OPHTHALMIC AZASITE (azithromycin) BESIVANCE (besifloxacin) ANTIBIOTICS bacitracin CILOXAN (ciprofloxacin) bacitracin/polymyxin ciprofloxacin erythromycin NATACYN (natamycin) gentamicin ofloxacin IQUIX (levofloxacin) QUIXIN (levofloxacin) polymyxin/trimethoprim ZYMAR (gatifloxacin) sulfacetamide
Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 16 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES tobramycin TOBREX (tobramycin) Ointment triple antibiotic VIGAMOX (moxifloxacin) OPHTHALMIC dexamethasone ACULAR LS (ketorolac) ANTIINFLAMMATORIES diclofenac ACULAR PF (ketorolac) FLAREX (fluorometholone) DUREZOL (difluprednate) flurbiprofen PRED MILD (prednisolone) FML FORTE (fluorometholone) XIBROM (bromfenac) FML SOP (fluorometholone) Ketotifen OTC OPHTHALMICS OPHTHALMIC LOTEMAX (loteprednol) ANTIINFLAMMATORIES (continued) MAXIDEX (dexamethasone) (CONTINUED) NEVANAC (nepafenac) VEXOL (rimexolone) OPHTHALMICS FOR ALLERGIC ALREX (loteprednol) ACULAR (ketorolac) CONJUNCTIVITIS cromolyn ACUVAIL (ketorolac) ELESTAT (epinastine) ALAMAST (pemirolast) EMADINE (emedastine) ALOCRIL (nedocromil) ketotifen ALOMIDE (lodoxamide) OPTIVAR (azelastine) BEPREVE (bepotastine) PATADAY (olopatadine) PATANOL (olopatadine) OPHTHALMICS, GLAUCOMA AZOPT (brinzolamide) ALPHAGAN P (brimonidine) AGENTS betaxolol BETOPTIC S (betaxolol) BETIMOL (timolol) LUMIGAN (bimatoprost) brimonidine carteolol COMBIGAN (brimonidine/timolol) COSOPT (dorzolamide/timolol) dipivefrin dorzolamide dorzolamide/timolol ISTALOL (timolol) levobunolol metipranolol pilocarpine timolol TRAVATAN/TRAVATAN Z (travoprost)
Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 17 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES TRUSOPT (dorzolamide) XALATAN (latanoprost) OTICS OTIC ANTIBIOTICS CETRAXAL (ciprofloxacin) CIPRO HC CIPRODEX (ciprofloxacin/dexamethasone) (ciprofloxacin/hydrocortisone) COLY-MYCIN S (colistin/neomycin/ hydrocortisone) ofloxacin CORTISPORIN-TC (colistin/neomycin/ hydrocortisone) neomycin/polymyxin/hydrocortisone
RESPIRATORY ANTIHISTAMINES-FIRST brompheniramine ALDEX AN (doxylamine) GENERATION brompheniramine/diphenhydramine CONEX (brompheniramine) carbinoxamine DIPHENMAX (diphenhydramine) chlorpheniramine J-TAN (brompheniramine) clemastine J-TAN PD (brompheniramine) cyproheptadine dexchlorpheniramine diphenhydramine doxylamine MYCI CHLOR-TAN (chlorpheniramine) triprolidine VAZOL (brompheniramine) ANTIHISTAMINES-FIRST ALAHIST LQ (phenylephrine/diphenhydramine) ACCUHIST (pseudoephedrine/ GENERATION/ chlorpheniramine) DALLERGY drops (phenylephrine/chlorpheniramine) DECONGESTANT phenylephrine/brompheniramine ALLERDUR (pseudoephedrine/ COMBINATIONS dexchlorpheniramine) phenylephrine/chlorpheniramine ALERSULE (phenylephrine/ phenylephrine/diphenhydramine chlorpheniramine) phenylephrine/phenyltoloxamine/chlorpheniramine ALLERTAN(phenylephrine/pyrilamine/
phenylephrine/promethazine chlorpheniramine)
phenylephrine/pyrilamine ALLERX (phenylephrine/
phenylephrine/pyrilamine/chlorpheniramine chlorpheniramine)
POLY TAN D BROMFED (pseudoephedrine/ (pseudoephedrine/pyrilamine/brompheniramine) brompheniramine) pseudoephedrine/brompheniramine BROMFED-PD (pseudoephedrine/ pseudoephedrine/chlorpheniramine brompheniramine) pseudoephedrine/dexchlorpheniramine DALLERGY-JR pseudoephedrine/triprolidine (phenylephrine/chlorpheniramine) DECONSAL CT Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 18 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES RYNESA 12S (phenylephrine/pyrilamine) (phenylephrine/pyrilamine) DISOPHROL (pseudoephedrine/ dexbrompheniramine) DURATUSS DA (pseudoephedrine/ chlorpheniramine)
HISTEX (pseudoephedrine/ chlorpheniramine) HISTEX SR (pseudoephedrine/ brompheniramine) J-TAN D (pseudoephedrine/ brompheniramine) J-TAN D PD (pseudoephedrine/ brompheniramine) ANTIHISTAMINES-FIRST RESPIRATORY GENERATION/ MYCI CHLORPED D (phenylephrine/chlorpheniramine) (CONTINUED) DECONGESTANT COMBINATIONS NY-TANNIC
(CONTINUED) (phenylephrine/chlorpheniramine)
PEDIATAN D (phenylephrine/chlorpheniramine) PHENA-PLUS (phenylephrine/ pyrilamine/chlorpheniramine) PHENA-S (phenylephrine/pyrilamine/ chlorpheniramine) PHENA-S 12 (phenylephrine/ pyrilamine/chlorpheniramine) POLY HIST FORTE (phenylephrine/ pyrilamine/chlorpheniramine)
POLY HIST PD (phenylephrine/ pyrilamine/chlorpheniramine) RESCON-JR (phenylephrine/chlorpheniramine) RYNA 12 S (phenylephrine/pyrilamine) RYNA-12 (phenylephrine/pyrilamine) RYNATAN (phenylephrine/chlorpheniramine) RYNATAN PEDIATRIC (phenylephrine/chlorpheniramine)
SERADEX-LA (phenylephrine/brompheniramine) SUDAL 12 (pseudoephedrine/ chlorpheniramine) TIBAMINE LA (pseudoephedrine/ Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 19 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES chlorpheniramine) TUSSANIL (phenylephrine/chlorpheniramine) VAZOBID (phenylephrine/brompheniramine)
VAZOTAB (phenylephrine/brompheniramine) VIRAVAN-P (pseudoephedrine/pyrilamine)
ANTIHISTAMINES-FIRST brompheniramine/pseudoephedrine ALLERX 10 (pseudoephedrine/
GENERATION/DECONGESTANT/ chlorpheniramine/phenylephrine/methscopolamine methscopolamine/ chlorpheniramine/phenylephrine) ANTICHOLINERGIC DALLERGY COMBINATIONS (chlorpheniramine/ phenylephrine/methscopolamine) ALLERX 30 (pseudoephedrine/ methscopolamine/ phenylephrine/chlorpheniramine/belladonna alkaloids chlorpheniramine/phenylephrine) RESPIRATORY ANTIHISTAMINES-FIRST phenylephrine/dexchlorpheniramine/ ALLERX PE (phenylephrine/ (CONTINUED) GENERATION/DECONGESTANT/ methscopolamine chlorpheniramine/ ANTICHOLINERGIC pseudoephedrine/chlorpheniramine/methscopolamine methscopolamine) COMBINATIONS pseudoephedrine/dexchlorpheniramine/methscopolamine DALLERGY PE (chlorpheniramine/ (CONTINUED) pseudoephedrine/methscopolamine/chlorpheniramine/ phenylephrine/methscopolamine) phenylephrine DALLERGY (pseudoephedrine/ chlorpheniramine/ methscopolamine) DURAHIST (pseudoephedrine/ chlorpheniramine/ methscopolamine) DURAHIST D (pseudoephedrine/ dexchlorpheniramine/ methscopolamine) DURAHIST PE (phenylephrine/ chlorpheniramine/ methscopolamine)
DURATAN PE (phenylephrine/
chlorpheniramine/ methscopalamine) EXTENDRYL chew tab (phenylephrine/ chlorpheniramine/ methcopolamine)
EXTENDRYL JR (phenylephrine/
chlorpheniramine/ methscopolamine) EXTENDRYL SR (phenylephrine/ chlorpheniramine/ methscopolamine) Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 20 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES EXTENDRYL syrup (phenylephrine/ dexchlorpheniramine/ methscopolamine)
RESCON (pseudoephedrine/
chlorpheniramine)
TIME-HIST QD (pseudoephedrine/ chlorpheniramine/ methscopolamine) VISRX (pseudoephedrine/ chlorpheniramine/ RESPIRATORY methscopolamine) (CONTINUED) ANTIHISTAMINES-MINIMALLY cetirizine CLARINEX (desloratadine) *Xyzal will be SEDATING loratadine fexofenadine approved for patients failing XYZAL (levocetirizine)* therapy with cetirizine, loratadine or fexofenadine. ANTIHISTAMINES- cetirizine/pseudoephedrine CLARINEX-D (desloratadine/ MINIMALLY SEDATING/ loratadine/pseudoephedrine pseudoephedrine) DECONGESTANT SEMPREX-D (acrivastine/pseudoephedrine) fexofenadine/pseudoephedrine COMBINATIONS
DECONGESTANT/ pseudoephedrine/methscopolamine ALLERX-D (pseudoephedrine/
ANTICHOLINERGIC methscopolamine)
COMBINATIONS EXTENDRYL PEM (phenylephrine/ methscopolamine) EXTENDRYL PSE (pseudoephedrine/ methscopolamine) BRONCHODILATORS, ANTICHOLINERGICS ANTICHOLINERGIC ATROVENT HFA (ipratropium) ipratropium SPIRIVA (tiotropium)
ANTICHOLINERGIC-BETA AGONIST COMBINATIONS
COMBIVENT (albuterol/ipratropium) albuterol/ipratropium
BRONCHODILATORS, BETA INHALERS, SHORT-ACTING AGONIST VENTOLIN HFA (albuterol) MAXAIR (pirbuterol)
PROAIR HFA (albuterol)
PROVENTIL HFA (albuterol)
XOPENEX HFA (levalbuterol)
INHALERS, LONG ACTING Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 21 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES FORADIL (formoterol) SEREVENT (salmeterol) INHALATION SOLUTION
albuterol BROVANA (arformoterol)
metaproterenol
PERFOROMIST (formoterol)
XOPENEX (levalbuterol)
RESPIRATORY ORAL (CONTINUED) BRONCHODILATORS, BETA AGONIST albuterol (CONTINUED) metaproterenol terbutaline GLUCOCORTICOIDS, INHALED GLUCOCORTICOIDS AEROBID (flunisolide) ALVESCO (ciclosinide) AEROBID-M (flunisolide) Dulera ASMANEX (mometasone) budesonide FLOVENT Diskus (fluticasone) FLOVENT HFA (fluticasone) PULMICORT (budesonide) Respules PULMICORT (budesonide) Flexhaler QVAR (beclomethasone) GLUCOCORTICOID/BRONCHODILATOR COMBINATIONS ADVAIR Diskus (fluticasone/salmeterol) Duleda (mometasone/formoterol) ADVAIR HFA (fluticasone/salmeterol) SYMBICORT (budesonide/formoterol) INTRANASAL RHINITIS AGENTS ANTICHOLINERGICS Ipratropium
ANTIHISTAMINES
ASTEPRO (azelastine) ASTELIN (azelastine)
PATANASE (olaptadine)
CORTICOSTEROIDS flunisolide BECONASE AQ (beclomethasone) NASAREL (flunisolide) FLONASE (fluticasone) NASONEX (mometasone) fluticasone VERAMYST (fluticasone) NASACORT AQ (triamcinolone)
Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 22 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES OMNARIS (ciclesonide) RHINOCORT AQUA (budesonide) LEUKOTRIENE MODIFIERS ACCOLATE (zafirlukast) ZYFLO CR (zafirlukast) SINGULAIR (montelukast)
UROLOGICAL BLADDER RELAXANT DETROL LA (tolterodine) DETROL (tolterodine) PREPARATIONS ENABLEX (darifenacin) oxybutynin ER GELNIQUE (oxybutynin) OXYTROL (oxybutynin) oxybutynin IR SANCTURA XR (trospium) TOVIAZ (fesoterodine fumurate) SANCTURA (trospium) VESICARE (solifenacin) BPH AGENTS ALPHA BLOCKERS doxazosin CARDURA XL (doxazosin) FLOMAX RAPAFLO (silodosin) tamsulosin terazosin UROXATRAL (alfuzosin) 5-ALPHA-REDUCTASE (5AR) INHIBITORS AVODART (dutasteride) finasteride
Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 23 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients.