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Proposed SMAC List Effective June 2018

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Maine Proposed SMACS June 2018 Maine Effective Drug Name proposed Date smacs *B-Complex w/ C & Folic Acid Cap 1 MG*** 0.09660 6/15/2018 *Pediatric Multiple Vitamins w/ Fluoride Chew Tab 0.5 MG*** 0.06583 6/15/2018 *Pediatric Multiple Vitamins w/ Fluoride Chew Tab 1 MG*** 0.08267 6/15/2018 *Pediatric Multiple Vitamins w/ Fluoride Soln 0.5 MG/ML*** 0.14500 6/15/2018 *Pediatric Vitamins ACD w/ Fluoride Soln 0.25 MG/ML*** 0.10820 6/15/2018 Acetazolamide Tab 250 MG 1.13615 6/15/2018 Acyclovir Oint 5% 6.87000 6/15/2018 Adapalene Cream 0.1% 3.31000 6/15/2018 Alclometasone Dipropionate Cream 0.05% 1.38000 6/15/2018 Allopurinol Tab 300 MG 0.14300 6/15/2018 Amitriptyline HCl Tab 100 MG 0.60065 6/15/2018 Amitriptyline HCl Tab 75 MG 0.52440 6/15/2018 Amlodipine Besylate-Atorvastatin Calcium Tab 10-40 MG 3.69400 6/15/2018 Amlodipine Besylate-Atorvastatin Calcium Tab 5-20 MG 4.01000 6/15/2018 Amlodipine-Valsartan-Hydrochlorothiazide Tab 10-160-25 MG 0.98000 6/15/2018 Amlodipine-Valsartan-Hydrochlorothiazide Tab 10-320-25 MG 1.41333 6/15/2018 Amphetamine-Dextroamphetamine Cap ER 24HR 30 MG 1.97000 6/15/2018 Amphetamine-Dextroamphetamine Tab 5 MG 0.53227 6/15/2018 Aripiprazole Oral Solution 1 MG/ML 2.36600 6/15/2018 Aripiprazole Tab 10 MG 0.32633 6/15/2018 Aripiprazole Tab 2 MG 0.34434 6/15/2018 Aripiprazole Tab 20 MG 0.51000 6/15/2018 Aripiprazole Tab 30 MG 0.39511 6/15/2018 Aripiprazole Tab 5 MG 0.42912 6/15/2018 Armodafinil Tab 250 MG 1.51716 6/15/2018 Atenolol & Chlorthalidone Tab 50-25 MG 0.31240 6/15/2018 Atenolol Tab 100 MG 0.05000 6/15/2018 Atomoxetine HCl Cap 100 MG (Base Equiv) 2.50000 6/15/2018 Atomoxetine HCl Cap 60 MG (Base Equiv) 2.12000 6/15/2018 Azathioprine Tab 50 MG 0.27375 6/15/2018 Azelastine HCl Nasal Spray 0.15% (205.5 MCG/SPRAY) 1.77117 6/15/2018 Benzoyl Peroxide-Erythromycin Gel 5-3% 5.10000 6/15/2018 Betamethasone Dipropionate Augmented Cream 0.05% 0.22882 6/15/2018 Betamethasone Dipropionate Augmented Oint 0.05% 2.72125 6/15/2018 Betamethasone Dipropionate Cream 0.05% 1.50000 6/15/2018 Betamethasone Dipropionate Lotion 0.05% 0.49917 6/15/2018 Betamethasone Valerate Cream 0.1% (Base Equivalent) 1.01000 6/15/2018 Betamethasone Valerate Oint 0.1% (Base Equivalent) 0.69763 6/15/2018 Budesonide Inhalation Susp 0.25 MG/2ML 1.32767 6/15/2018 Bumetanide Tab 1 MG 0.39720 6/15/2018 Buprenorphine HCl-Naloxone HCl SL Tab 2-0.5 MG (Base Equiv) 2.41000 6/15/2018 Buprenorphine HCl-Naloxone HCl SL Tab 8-2 MG (Base Equiv) 2.38370 6/15/2018 Bupropion HCl Tab ER 24HR 300 MG 0.36090 6/15/2018 Calcipotriene Cream 0.005% 2.15000 6/15/2018 Calcipotriene Soln 0.005% (50 MCG/ML) 1.56200 6/15/2018 Calcitriol Cap 0.25 MCG 0.15948 6/15/2018 Candesartan Cilexetil Tab 8 MG 1.66611 6/15/2018 Capecitabine Tab 500 MG 4.91583 6/15/2018 Carbamazepine Tab 200 MG 0.39575 6/15/2018 Carbamazepine Tab ER 12HR 100 MG 0.54345 6/15/2018 Carbamazepine Tab ER 12HR 200 MG 0.90340 6/15/2018 Carbamazepine Tab ER 12HR 400 MG 1.77000 6/15/2018 Carisoprodol Tab 250 MG 1.87370 6/15/2018 Carvedilol Phosphate Cap ER 24HR 20 MG 5.82500 6/15/2018 Carvedilol Phosphate Cap ER 24HR 80 MG 6.91250 6/15/2018 Cefdinir For Susp 125 MG/5ML 0.10693 6/15/2018 Cefprozil Tab 250 MG 0.77750 6/15/2018 Cefuroxime Axetil Tab 500 MG 0.84264 6/15/2018 Chlorthalidone Tab 25 MG 0.48310 6/15/2018 Chlorthalidone Tab 50 MG 0.78780 6/15/2018 Maine Proposed SMACS June 2018 Cholestyramine Powder Packets 4 GM 1.23333 6/15/2018 Choline Fenofibrate Cap DR 135 MG (Fenofibric Acid Equiv) 1.25674 6/15/2018 Ciclopirox Gel 0.77% 1.11000 6/15/2018 Ciclopirox Olamine Susp 0.77% (Base Equiv) 0.89833 6/15/2018 Ciclopirox Shampoo 1% 0.39030 6/15/2018 Ciclopirox Solution 8% 1.75000 6/15/2018 Clindamycin Phosphate Soln 1% 0.42338 6/15/2018 Clindamycin Phosphate Vaginal Cream 2% 1.66175 6/15/2018 Clobetasol Propionate Cream 0.05% 1.55000 6/15/2018 Clobetasol Propionate Emollient Base Cream 0.05% 1.74000 6/15/2018 Clobetasol Propionate Foam 0.05% 3.15200 6/15/2018 Clobetasol Propionate Gel 0.05% 2.30000 6/15/2018 Clobetasol Propionate Oint 0.05% 1.69997 6/15/2018 Clobetasol Propionate Shampoo 0.05% 1.52000 6/15/2018 Clobetasol Propionate Soln 0.05% 0.91485 6/15/2018 Clonazepam Orally Disintegrating Tab 0.125 MG 0.54167 6/15/2018 Clonazepam Orally Disintegrating Tab 0.5 MG 0.62917 6/15/2018 Clonidine HCl Tab ER 12HR 0.1 MG 2.36617 6/15/2018 Clotrimazole Cream 1% 0.30772 6/15/2018 Clotrimazole w/ Betamethasone Cream 1-0.05% 0.37000 6/15/2018 Clozapine Tab 100 MG 0.58154 6/15/2018 Cyproheptadine HCl Tab 4 MG 0.25302 6/15/2018 Dantrolene Sodium Cap 100 MG 1.15000 6/15/2018 Dantrolene Sodium Cap 50 MG 0.63900 6/15/2018 Desipramine HCl Tab 25 MG 0.87520 6/15/2018 Desmopressin Acetate Tab 0.1 MG 0.61910 6/15/2018 Desmopressin Acetate Tab 0.2 MG 0.60335 6/15/2018 Desonide Cream 0.05% 2.21200 6/15/2018 Desoximetasone Cream 0.25% 1.51200 6/15/2018 Diclofenac w/ Misoprostol Tab Delayed Release 75-0.2 MG 1.74367 6/15/2018 Digoxin Tab 125 MCG (0.125 MG) 0.38583 6/15/2018 Digoxin Tab 250 MCG (0.25 MG) 0.41165 6/15/2018 Diltiazem HCl Coated Beads Cap ER 24HR 180 MG 0.31413 6/15/2018 Doxazosin Mesylate Tab 8 MG 0.24163 6/15/2018 Doxepin HCl Cap 25 MG 0.49860 6/15/2018 Dutasteride Cap 0.5 MG 0.17979 6/15/2018 Econazole Nitrate Cream 1% 0.87056 6/15/2018 Enalapril Maleate Tab 10 MG 0.12094 6/15/2018 Entecavir Tab 1 MG 1.82200 6/15/2018 Eplerenone Tab 25 MG 1.44555 6/15/2018 Estradiol TD Patch Twice Weekly 0.025 MG/24HR 8.44250 6/15/2018 Fenofibrate Micronized Cap 200 MG 0.88740 6/15/2018 Fenofibrate Tab 145 MG 0.28443 6/15/2018 Fentanyl TD Patch 72HR 100 MCG/HR 6.88000 6/15/2018 Fentanyl TD Patch 72HR 12 MCG/HR 9.60000 6/15/2018 Fentanyl TD Patch 72HR 25 MCG/HR 2.12700 6/15/2018 Finasteride Tab 1 MG 0.42833 6/15/2018 Flecainide Acetate Tab 150 MG 0.45690 6/15/2018 Fluconazole Tab 100 MG 0.56622 6/15/2018 Fluconazole Tab 200 MG 0.51633 6/15/2018 Fludrocortisone Acetate Tab 0.1 MG 0.28110 6/15/2018 Fluocinolone Acetonide Oil 0.01% (Body Oil) 1.09390 6/15/2018 Fluocinonide Cream 0.05% 1.61000 6/15/2018 Fluocinonide Soln 0.05% 0.74317 6/15/2018 Fluorouracil Cream 5% 2.60000 6/15/2018 Fluticasone Propionate Cream 0.05% 0.33091 6/15/2018 Fluvoxamine Maleate Tab 100 MG 0.16238 6/15/2018 Fondaparinux Sodium Subcutaneous Inj 2.5 MG/0.5ML 24.52000 6/15/2018 Fosinopril Sodium Tab 10 MG 0.10244 6/15/2018 Frovatriptan Succinate Tab 2.5 MG (Base Equivalent) 25.76889 6/15/2018 Galantamine Hydrobromide Cap ER 24HR 8 MG 1.40000 6/15/2018 Gatifloxacin Ophth Soln 0.5% 24.56800 6/15/2018 Glyburide Tab 5 MG 0.06952 6/15/2018 Maine Proposed SMACS June 2018 Guanfacine HCl Tab ER 24HR 3 MG (Base Equiv) 0.53910 6/15/2018 Halobetasol Propionate Cream 0.05% 2.40000 6/15/2018 Halobetasol Propionate Oint 0.05% 3.10000 6/15/2018 Haloperidol Tab 20 MG 0.96000 6/15/2018 Hydrocodone-Acetaminophen Tab 5-300 MG 0.41600 6/15/2018 Hydrocodone-Acetaminophen Tab 7.5-300 MG 0.47530 6/15/2018 Hydrocortisone Cream 1% 0.07773 6/15/2018 Hydrocortisone Rectal Cream 2.5% 0.54037 6/15/2018 Hydrocortisone Valerate Cream 0.2% 2.21700 6/15/2018 Hydromorphone HCl Tab 8 MG 0.25950 6/15/2018 Isosorbide Dinitrate Tab 30 MG 0.48000 6/15/2018 Isosorbide Mononitrate Tab ER 24HR 120 MG 0.27910 6/15/2018 Isotretinoin Cap 20 MG 3.23000 6/15/2018 Isotretinoin Cap 40 MG 2.71200 6/15/2018 Ketoconazole Cream 2% 1.00200 6/15/2018 Ketoconazole Shampoo 2% 0.05426 6/15/2018 Lamivudine-Zidovudine Tab 150-300 MG 0.64000 6/15/2018 Lamotrigine Tab Chewable Dispersible 25 MG 0.08860 6/15/2018 Lamotrigine Tab ER 24HR 250 MG 8.60000 6/15/2018 Leflunomide Tab 20 MG 1.75625 6/15/2018 Levocarnitine Tab 330 MG 0.70406 6/15/2018 Levothyroxine Sodium Tab 100 MCG 0.60550 6/15/2018 Levothyroxine Sodium Tab 175 MCG 0.74431 6/15/2018 Levothyroxine Sodium Tab 75 MCG 0.58181 6/15/2018 Lidocaine HCl Cream 3% 1.08700 6/15/2018 Lidocaine Oint 5% 0.90000 6/15/2018 Lidocaine-Prilocaine Cream 2.5-2.5% 0.85000 6/15/2018 Medroxyprogesterone Acetate IM Susp 150 MG/ML 64.06800 6/15/2018 Medroxyprogesterone Acetate IM Susp Prefilled Syr 150 MG/ML 72.91625 6/15/2018 Memantine HCl Cap ER 24HR 14 MG 9.59225 6/15/2018 Memantine HCl Cap ER 24HR 28 MG 7.90000 6/15/2018 Mesalamine Tab Delayed Release 1.2 GM 6.38104 6/15/2018 Metformin HCl Tab ER 24HR Osmotic 1000 MG 4.64000 6/15/2018 Metformin HCl Tab ER 24HR Osmotic 500 MG 3.33250 6/15/2018 Methotrexate Sodium Tab 2.5 MG (Base Equiv) 0.64044 6/15/2018 Methylphenidate HCl Cap ER 24HR 40 MG (LA) 3.85230 6/15/2018 Methylphenidate HCl Tab 10 MG 0.22460 6/15/2018 Methylphenidate HCl Tab 5 MG 0.21270 6/15/2018 Methylphenidate HCl Tab ER 10 MG 2.50480 6/15/2018 Methylphenidate HCl Tab ER Osmotic Release (OSM) 18 MG 7.21000 6/15/2018 Metronidazole Cream 0.75% 1.34000 6/15/2018 Metronidazole Gel 1% 3.06000 6/15/2018 Metronidazole Vaginal Gel 0.75% 0.68482 6/15/2018 Mometasone Furoate Nasal Susp 50 MCG/ACT 3.44749 6/15/2018 Mometasone Furoate Oint 0.1% 0.21770 6/15/2018 Mometasone Furoate Solution 0.1% (Lotion) 0.19908 6/15/2018 Morphine Sulfate Tab ER 60 MG 0.60430 6/15/2018 Mupirocin Calcium Cream 2% 9.49707 6/15/2018 Mupirocin Oint 2% 0.28000 6/15/2018 Naltrexone HCl Tab 50 MG 0.57500 6/15/2018 Naproxen Sodium Tab 550 MG 0.88131 6/15/2018 Naratriptan HCl Tab 2.5 MG (Base Equiv) 2.24000 6/15/2018 Neomycin-Polymyxin-Dexamethasone Ophth Susp 0.1% 2.66000 6/15/2018 Nifedipine Tab ER 24HR Osmotic Release 30 MG 0.12832 6/15/2018 Nitroglycerin TD Patch 24HR 0.4 MG/HR 0.36667 6/15/2018 Norethindrone & Ethinyl Estradiol Tab 0.5 MG-35 MCG 0.64667 6/15/2018 Nystatin Cream 100000 Unit/GM 0.28476 6/15/2018 Nystatin Oint 100000 Unit/GM 0.47311 6/15/2018 Nystatin Topical Powder 100000 Unit/GM 0.42000
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    Placebo-controlled trials of Chinese Herbal Medicine and conventional medicine: Comparative study (Aijing Shang et al.) Appendix 2 – List of matched trials of conventional medicine (1) Ala-Houhala M, Koskinen T, Koskinen M, Visakorpi JK. Double Blind Study on the Need for Vitamin D Supplementation in Prepubertal Children. Acta Paediatr Scand 1988; 77(1):89-93. (2) Arienti V, Corazza GR, Sorge M, Boriani L, Ugenti F, Biagi F et al. The effects of levosulpiride on gastric and gall-bladder emptying in functional dyspepsia. Aliment Pharmacol Ther 1994; 8(6):631-638. (3) Avner DL, Dorsch ER, Jennings DE, Greski-Rose PA. A comparison of three doses of lansoprazole (15, 30 and 60 mg) and placebo in the treatment of duodenal ulcer. Aliment Pharmacol Ther 1995; 9(5):521-528. (4) Baelde Y, Dupont P. Cetirizine in Children with Chronic Allergic Rhinitis. A Multicentre Double- Blind Study of Two Doses of Cetirizine and Placebo. Drug Invest 1992; 4(6):466-472. (5) Barabino A, Galbariggi G, Pizzorni C, Lotti G. Comparative Effects of Long-Term Therapy with Captopril and Ibopamine in Chronic Congestive Heart Failure in Old Patients. Cardiology 1991; 78(3):243-256. (6) Barbier JP, Dorf G, Gordin J, Krainik F, Neveu D, Parlier H et al. Effet de l'association métiodure de buzépide-halopéridol dans le traitement des troubles fonctionnels intestinaux. Etude randomisée en double-aveugle contrôlée contre placebo. Ann de Gastroenterologie et d'Hepatologie 1989; 25(3):123-128. (7) Benedikter L, Deichsel G, Maurer HJ. Persumbran in der Praxis. Plazebokontrollierte Doppelblindprüfung bei Patienten mit Angina pectoris.
  • Preferred Drug List

    Preferred Drug List

    Kansas State Employee ANALGESICS Second Generation cefprozil Health Plan NSAIDs cefuroxime axetil diclofenac sodium delayed-rel Preferred Drug List diflunisal Third Generation etodolac cefdinir 2021 ibuprofen cefixime (SUPRAX) meloxicam nabumetone Erythromycins/Macrolides naproxen sodium tabs azithromycin naproxen tabs clarithromycin oxaprozin clarithromycin ext-rel sulindac erythromycin delayed-rel erythromycin ethylsuccinate NSAIDs, COMBINATIONS erythromycin stearate diclofenac sodium delayed-rel/misoprostol fidaxomicin (DIFICID) Effective 04/01/2021 NSAIDs, TOPICAL Fluoroquinolones diclofenac sodium gel 1% ciprofloxacin For questions or additional information, diclofenac sodium soln levofloxacin access the State of Kansas website at moxifloxacin http://www.kdheks.gov/hcf/sehp or call COX-2 INHIBITORS Penicillins the Kansas State Employees Prescription celecoxib amoxicillin Drug Program at 1-800-294-6324. amoxicillin/clavulanate The Preferred Drug List is subject to change. GOUT amoxicillin/clavulanate ext-rel To locate covered prescriptions online, allopurinol ampicillin access the State of Kansas website at colchicine tabs dicloxacillin http://www.kdheks.gov/hcf/sehp for the probenecid penicillin VK most current drug list. colchicine (MITIGARE) Tetracyclines What is a Preferred Drug List? OPIOID ANALGESICS doxycycline hyclate A Preferred Drug List is a list of safe and buprenorphine transdermal minocycline cost-effective drugs, chosen by a committee codeine/acetaminophen tetracycline of physicians and pharmacists. Drug lists fentanyl
  • Trichoconcept™ Compatibility Table

    Trichoconcept™ Compatibility Table

    TrichoConcept™ Compatibility table Legend TrichoSol™ TrichoFoam™ TrichoOil™ Compatible combination for 30 days 60 days 90 days Combination not studied Requires storage at 2-8 °C API/DCI Common concentration(s) (w/v) 17α-estradiol 0.025% - 0.05% Betamethasone dipropionate 0.05% Betamethasone valerate 0.1% Biotin 0.5% - 2% Caffeine 1% - 2% Cetirizine HCl 1% - 2% Cyproterone acetate 0.5% - 1% Clobetasol propionate 0.05% Dutasteride 0.25% Erythromycin 0.5% - 4% Estrone 0.01% - 0.05% Finasteride 0.1% - 0.25% Hydrocortisone butyrate 0.1% IGrantineF1™ 0.1% - 5% Ketoconazole 2% Latanoprost 0.005% Melatonin 0.0033% - 0.1% Minoxidil 2% - 5% Minoxidil and 17-α Estradiol 5% / 0.05% Minoxidil and 5% / 0.1% Betamethasone valerate Minoxidil and 5% / 0.05% Clobetasol propionate Minoxidil and Dutasteride 5% / 0.1% Minoxidil and Finasteride 5% / 0.1% Minoxidil and 5% / 0.1% Hydrocortisone butyrate Minoxidil and Latanoprost 5% / 0.005% Prednicarbate 0.1% Progesterone 0.5% - 1% Prostaquinon™ 3% Retinol (vit. A) 1% Salicylic Acid 6% Spironolactone 1% Tacrolimus 0.1% Tocopherol (vit. E) 2% Tretinoin 0.01% - 1% Triamcinolone acetonide 0.05% - 0.1% TrichoConcept™ Innovative TrichoTech™ technology for treatment of alopecia Fagron Hellas 12 km N.R. Trikala - Larisa T +30 24310 83633-5 P.C. 42100, P.O. Box 32 F +30 24310 83615 Trikala, Greece www.fagron.gr TRICHOCT02 herein. contained information or formulations the for case any in liable or responsible held be cannot and accept not does Fagron judgement. and table cannot be construed as (medical) advice, recommendation or opinion. Medical professionals, doctors and compounding pharmacists using this information are advised to do so solely if appropriate in their own professional opinion opinion professional own their in appropriate if solely so do to advised are information this using pharmacists compounding and doctors professionals, Medical opinion.