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IEHP Dualchoice Cal Mediconnect Formulary Maintenance Drug List

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IEHP DualChoice Cal MediConnect (Medicare-Medicaid Plan) Formulary Maintenance Drug List The following formulary medications may be approvable up to a three-month supply. Certain medications on this list may require prior approval from the plan based on existing criteria before being covered. For coverage information please see our formulary located on our website. BRAND GENERIC STREGTH DOSAGE FORM ABACAVIR ABACAVIR SULFATE 300 MG TABLET ABACAVIR ABACAVIR SULFATE 20 MG/ML SOLUTION TRIUMEQ ABACAVIR SULFATE/DOLUTEGRAVIR 600-50-300 TABLET SODIUM/LAMIVUDINE ABACAVIR-LAMIVUDINE ABACAVIR SULFATE/LAMIVUDINE 600-300MG TABLET ABACAVIR-LAMIVUDINE- ABACAVIR SULFATE/LAMIVUDINE/ZIDOVUDINE 150-300 MG TABLET ZIDOVUDINE TYMLOS ABALOPARATIDE 80MCG/DOSE PEN INJCTR ORENCIA ABATACEPT 125 MG/ML SYRINGE ORENCIA CLICKJECT ABATACEPT 125 MG/ML AUTO INJCT ORENCIA ABATACEPT 50MG/0.4ML SYRINGE ORENCIA ABATACEPT 87.5MG/0.7 SYRINGE VERZENIO ABEMACICLIB 50 MG TABLET VERZENIO ABEMACICLIB 100 MG TABLET VERZENIO ABEMACICLIB 150 MG TABLET VERZENIO ABEMACICLIB 200 MG TABLET ABIRATERONE ACETATE ABIRATERONE ACETATE 500 MG TABLET ABIRATERONE ACETATE ABIRATERONE ACETATE 250 MG TABLET YONSA ABIRATERONE ACETATE, SUBMICRONIZED 125 MG TABLET CALQUENCE ACALABRUTINIB 100 MG CAPSULE ACAMPROSATE CALCIUM ACAMPROSATE CALCIUM 333 MG TABLET DR ACARBOSE ACARBOSE 25 MG TABLET ACARBOSE ACARBOSE 50 MG TABLET ACARBOSE ACARBOSE 100 MG TABLET ACEBUTOLOL HCL ACEBUTOLOL HCL 200 MG CAPSULE ACEBUTOLOL HCL ACEBUTOLOL HCL 400 MG CAPSULE ACETAZOLAMIDE ER ACETAZOLAMIDE 500 MG CAPSULE ER ACETAZOLAMIDE ACETAZOLAMIDE 125 MG TABLET ACETAZOLAMIDE ACETAZOLAMIDE 250 MG TABLET TUDORZA PRESSAIR ACLIDINIUM BROMIDE 400 MCG AER POW BA 411_CMC_FormularyMaintenance_May2021 Page 1 of 57 BRAND GENERIC STREGTH DOSAGE FORM ACYCLOVIR ACYCLOVIR 200 MG/5ML ORAL SUSP ACYCLOVIR ACYCLOVIR 400 MG TABLET ACYCLOVIR ACYCLOVIR 800 MG TABLET ACYCLOVIR ACYCLOVIR 200 MG CAPSULE HUMIRA(CF) ADALIMUMAB 40MG/0.4ML SYRINGEKIT HUMIRA(CF) PEN ADALIMUMAB 40MG/0.4ML PEN IJ KIT HUMIRA(CF) ADALIMUMAB 20MG/0.2ML SYRINGEKIT HUMIRA(CF) ADALIMUMAB 10MG/0.1ML SYRINGEKIT HUMIRA(CF) PEDIATRIC ADALIMUMAB 80MG/0.8ML SYRINGEKIT CROHN'S HUMIRA ADALIMUMAB 40MG/0.8ML SYRINGEKIT HUMIRA PEN ADALIMUMAB 40MG/0.8ML PEN IJ KIT HUMIRA PEN CROHN'S- ADALIMUMAB 40MG/0.8ML PEN IJ KIT UC-HS HUMIRA PEN PSOR- ADALIMUMAB 40MG/0.8ML PEN IJ KIT UVEITS-ADOL HS GILOTRIF AFATINIB DIMALEATE 30 MG TABLET GILOTRIF AFATINIB DIMALEATE 40 MG TABLET GILOTRIF AFATINIB DIMALEATE 20 MG TABLET VENTOLIN HFA ALBUTEROL SULFATE 90 MCG HFA AER AD ALBUTEROL SULFATE ALBUTEROL SULFATE 2 MG TABLET ALBUTEROL SULFATE ALBUTEROL SULFATE 4 MG TABLET ALBUTEROL SULFATE ALBUTEROL SULFATE 4 MG TAB ER 12H ALBUTEROL SULFATE ALBUTEROL SULFATE 8 MG TAB ER 12H ALBUTEROL SULFATE ALBUTEROL SULFATE 0.63MG/3ML VIAL-NEB ALBUTEROL SULFATE ALBUTEROL SULFATE 1.25MG/3ML VIAL-NEB ALBUTEROL SULFATE ALBUTEROL SULFATE 2 MG/5 ML SYRUP ALBUTEROL SULFATE ALBUTEROL SULFATE 2.5 MG/3ML VIAL-NEB ALBUTEROL SULFATE ALBUTEROL SULFATE 2.5 MG/0.5 VIAL-NEB ALBUTEROL SULFATE HFA ALBUTEROL SULFATE 90 MCG HFA AER AD ALECENSA ALECTINIB HCL 150 MG CAPSULE ALENDRONATE SODIUM ALENDRONATE SODIUM 10 MG TABLET ALENDRONATE SODIUM ALENDRONATE SODIUM 70 MG TABLET ALENDRONATE SODIUM ALENDRONATE SODIUM 35 MG TABLET ALFUZOSIN HCL ER ALFUZOSIN HCL 10 MG TAB ER 24H ALISKIREN ALISKIREN HEMIFUMARATE 150 MG TABLET ALISKIREN ALISKIREN HEMIFUMARATE 300 MG TABLET ALLOPURINOL ALLOPURINOL 100 MG TABLET 411_CMC_FormularyMaintenance_May2021 Page 2 of 57 BRAND GENERIC STREGTH DOSAGE FORM ALLOPURINOL ALLOPURINOL 300 MG TABLET ALOGLIPTIN ALOGLIPTIN BENZOATE 6.25 MG TABLET ALOGLIPTIN ALOGLIPTIN BENZOATE 12.5 MG TABLET ALOGLIPTIN ALOGLIPTIN BENZOATE 25 MG TABLET ALOGLIPTIN-METFORMIN ALOGLIPTIN BENZOATE/METFORMIN HCL 12.5-500MG TABLET ALOGLIPTIN-METFORMIN ALOGLIPTIN BENZOATE/METFORMIN HCL 12.5-1000 TABLET PIQRAY ALPELISIB 200 MG/DAY TABLET PIQRAY ALPELISIB 300 MG/DAY TABLET PIQRAY ALPELISIB 250 MG/DAY TABLET ZEMAIRA ALPHA-1-PROTEINASE INHIBITOR 1000 MG VIAL AMANTADINE AMANTADINE HCL 50 MG/5 ML SOLUTION AMANTADINE AMANTADINE HCL 100 MG TABLET AMANTADINE AMANTADINE HCL 100 MG CAPSULE AMBRISENTAN AMBRISENTAN 5 MG TABLET AMBRISENTAN AMBRISENTAN 10 MG TABLET AMILORIDE HCL AMILORIDE HCL 5 MG TABLET AMIODARONE HCL AMIODARONE HCL 400 MG TABLET AMIODARONE HCL AMIODARONE HCL 200 MG TABLET AMITRIPTYLINE HCL AMITRIPTYLINE HCL 25 MG TABLET AMITRIPTYLINE HCL AMITRIPTYLINE HCL 50 MG TABLET AMITRIPTYLINE HCL AMITRIPTYLINE HCL 75 MG TABLET AMITRIPTYLINE HCL AMITRIPTYLINE HCL 100 MG TABLET AMITRIPTYLINE HCL AMITRIPTYLINE HCL 150 MG TABLET AMITRIPTYLINE HCL AMITRIPTYLINE HCL 10 MG TABLET AMLODIPINE BESYLATE AMLODIPINE BESYLATE 2.5 MG TABLET AMLODIPINE BESYLATE AMLODIPINE BESYLATE 5 MG TABLET AMLODIPINE BESYLATE AMLODIPINE BESYLATE 10 MG TABLET AMLODIPINE BESYLATE- AMLODIPINE BESYLATE/BENAZEPRIL HCL 2.5MG-10MG CAPSULE BENAZEPRIL AMLODIPINE BESYLATE- AMLODIPINE BESYLATE/BENAZEPRIL HCL 5 MG-10 MG CAPSULE BENAZEPRIL AMLODIPINE BESYLATE- AMLODIPINE BESYLATE/BENAZEPRIL HCL 5 MG-20 MG CAPSULE BENAZEPRIL AMLODIPINE BESYLATE- AMLODIPINE BESYLATE/BENAZEPRIL HCL 5 MG-40 MG CAPSULE BENAZEPRIL AMLODIPINE BESYLATE- AMLODIPINE BESYLATE/BENAZEPRIL HCL 10 MG-20MG CAPSULE BENAZEPRIL AMLODIPINE BESYLATE- AMLODIPINE BESYLATE/BENAZEPRIL HCL 10 MG-40MG CAPSULE BENAZEPRIL 411_CMC_FormularyMaintenance_May2021 Page 3 of 57 BRAND GENERIC STREGTH DOSAGE FORM AMOXAPINE AMOXAPINE 25 MG TABLET AMOXAPINE AMOXAPINE 50 MG TABLET AMOXAPINE AMOXAPINE 100 MG TABLET AMOXAPINE AMOXAPINE 150 MG TABLET ANAGRELIDE HCL ANAGRELIDE HCL 1 MG CAPSULE ANAGRELIDE HCL ANAGRELIDE HCL 0.5 MG CAPSULE KINERET ANAKINRA 100MG/0.67 SYRINGE ANASTROZOLE ANASTROZOLE 1 MG TABLET ERLEADA APALUTAMIDE 60 MG TABLET ELIQUIS APIXABAN 2.5 MG TABLET ELIQUIS APIXABAN 5 MG TABLET APOKYN APOMORPHINE HCL 10 MG/ML CARTRIDGE ARIPIPRAZOLE ARIPIPRAZOLE 2 MG TABLET ARIPIPRAZOLE ARIPIPRAZOLE 5 MG TABLET ARIPIPRAZOLE ARIPIPRAZOLE 10 MG TABLET ARIPIPRAZOLE ARIPIPRAZOLE 15 MG TABLET ARIPIPRAZOLE ARIPIPRAZOLE 20 MG TABLET ARIPIPRAZOLE ARIPIPRAZOLE 30 MG TABLET ABILIFY MAINTENA ARIPIPRAZOLE 300 MG SUSER VIAL ABILIFY MAINTENA ARIPIPRAZOLE 400 MG SUSER VIAL ABILIFY MAINTENA ARIPIPRAZOLE 300 MG SUSER SYR ABILIFY MAINTENA ARIPIPRAZOLE 400 MG SUSER SYR ARIPIPRAZOLE ODT ARIPIPRAZOLE 10 MG TAB RAPDIS ARIPIPRAZOLE ODT ARIPIPRAZOLE 15 MG TAB RAPDIS ARIPIPRAZOLE ARIPIPRAZOLE 1 MG/ML SOLUTION ARMODAFINIL ARMODAFINIL 200 MG TABLET ARMODAFINIL ARMODAFINIL 50 MG TABLET ARMODAFINIL ARMODAFINIL 150 MG TABLET ARMODAFINIL ARMODAFINIL 250 MG TABLET SECUADO ASENAPINE 3.8MG/24HR PATCH TD24 SECUADO ASENAPINE 5.7MG/24HR PATCH TD24 SECUADO ASENAPINE 7.6MG/24HR PATCH TD24 ASENAPINE MALEATE ASENAPINE MALEATE 2.5 MG TAB SUBL ASENAPINE MALEATE ASENAPINE MALEATE 5 MG TAB SUBL ASENAPINE MALEATE ASENAPINE MALEATE 10 MG TAB SUBL ASPIRIN-DIPYRIDAMOLE ASPIRIN/DIPYRIDAMOLE 25MG- CPMP 12HR ER 200MG 411_CMC_FormularyMaintenance_May2021 Page 4 of 57 BRAND GENERIC STREGTH DOSAGE FORM REYATAZ ATAZANAVIR SULFATE 50 MG POWD PACK ATAZANAVIR SULFATE ATAZANAVIR SULFATE 150 MG CAPSULE ATAZANAVIR SULFATE ATAZANAVIR SULFATE 200 MG CAPSULE ATAZANAVIR SULFATE ATAZANAVIR SULFATE 300 MG CAPSULE EVOTAZ ATAZANAVIR SULFATE/COBICISTAT 300-150 MG TABLET ATENOLOL ATENOLOL 50 MG TABLET ATENOLOL ATENOLOL 100 MG TABLET ATENOLOL ATENOLOL 25 MG TABLET ATENOLOL- ATENOLOL/CHLORTHALIDONE 50 MG-25MG TABLET CHLORTHALIDONE ATENOLOL- ATENOLOL/CHLORTHALIDONE 100MG- TABLET CHLORTHALIDONE 25MG ATOMOXETINE HCL ATOMOXETINE HCL 10 MG CAPSULE ATOMOXETINE HCL ATOMOXETINE HCL 18 MG CAPSULE ATOMOXETINE HCL ATOMOXETINE HCL 25 MG CAPSULE ATOMOXETINE HCL ATOMOXETINE HCL 40 MG CAPSULE ATOMOXETINE HCL ATOMOXETINE HCL 60 MG CAPSULE ATOMOXETINE HCL ATOMOXETINE HCL 80 MG CAPSULE ATOMOXETINE HCL ATOMOXETINE HCL 100 MG CAPSULE ATORVASTATIN CALCIUM ATORVASTATIN CALCIUM 10 MG TABLET ATORVASTATIN CALCIUM ATORVASTATIN CALCIUM 20 MG TABLET ATORVASTATIN CALCIUM ATORVASTATIN CALCIUM 40 MG TABLET ATORVASTATIN CALCIUM ATORVASTATIN CALCIUM 80 MG TABLET RIDAURA AURANOFIN 3 MG CAPSULE AYVAKIT AVAPRITINIB 100 MG TABLET AYVAKIT AVAPRITINIB 200 MG TABLET AYVAKIT AVAPRITINIB 300 MG TABLET INLYTA AXITINIB 1 MG TABLET INLYTA AXITINIB 5 MG TABLET ONUREG AZACITIDINE 200 MG TABLET ONUREG AZACITIDINE 300 MG TABLET AZATHIOPRINE AZATHIOPRINE 50 MG TABLET AZELASTINE HCL AZELASTINE HCL 137 MCG SPRAY/PUMP BACLOFEN BACLOFEN 10 MG TABLET BACLOFEN BACLOFEN 20 MG TABLET QVAR REDIHALER BECLOMETHASONE DIPROPIONATE 40 MCG HFA AEROBA QVAR REDIHALER BECLOMETHASONE DIPROPIONATE 80 MCG HFA AEROBA BENAZEPRIL HCL BENAZEPRIL HCL 5 MG TABLET 411_CMC_FormularyMaintenance_May2021 Page 5 of 57 BRAND GENERIC STREGTH DOSAGE FORM BENAZEPRIL HCL BENAZEPRIL HCL 10 MG TABLET BENAZEPRIL HCL BENAZEPRIL HCL 20 MG TABLET BENAZEPRIL HCL BENAZEPRIL HCL 40 MG TABLET BENAZEPRIL- BENAZEPRIL HCL/HYDROCHLOROTHIAZIDE 20-12.5 MG TABLET HYDROCHLOROTHIAZIDE BENAZEPRIL- BENAZEPRIL HCL/HYDROCHLOROTHIAZIDE 5-6.25MG TABLET HYDROCHLOROTHIAZIDE BENAZEPRIL- BENAZEPRIL HCL/HYDROCHLOROTHIAZIDE 20 MG-25MG TABLET HYDROCHLOROTHIAZIDE BENAZEPRIL- BENAZEPRIL HCL/HYDROCHLOROTHIAZIDE 10-12.5MG TABLET HYDROCHLOROTHIAZIDE BENZTROPINE MESYLATE BENZTROPINE MESYLATE 0.5 MG TABLET BENZTROPINE MESYLATE BENZTROPINE MESYLATE 1 MG TABLET BENZTROPINE MESYLATE BENZTROPINE MESYLATE 2 MG TABLET CYSTADANE BETAINE 1 G/1.7 ML POWDER BETAXOLOL HCL BETAXOLOL HCL 10 MG TABLET BETAXOLOL HCL BETAXOLOL HCL 20 MG TABLET BETHANECHOL CHLORIDE BETHANECHOL CHLORIDE 5 MG TABLET BETHANECHOL CHLORIDE BETHANECHOL CHLORIDE 10 MG TABLET BETHANECHOL CHLORIDE BETHANECHOL CHLORIDE 25 MG TABLET BETHANECHOL CHLORIDE BETHANECHOL CHLORIDE 50 MG TABLET BEXAROTENE
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    Journal of Clinical and Basic Cardiology An Independent International Scientific Journal Journal of Clinical and Basic Cardiology 2001; 4 (1), 53-56 Different beta-blocking effects of carvedilol and bisoprolol in humans Koshucharova G, Klein W, Lercher P, Maier R, Stepan V Stoschitzky K, Zweiker R Homepage: www.kup.at/jcbc Online Data Base Search for Authors and Keywords Indexed in Chemical Abstracts EMBASE/Excerpta Medica Krause & Pachernegg GmbH · VERLAG für MEDIZIN und WIRTSCHAFT · A-3003 Gablitz/Austria ORIGINAL PAPERS, CLINICAL CARDIOLOGY Different Beta-Blocking Effects of Carvedilol and Bisoprolol J Clin Basic Cardiol 2001; 4: 53 Different Beta-Blocking Effects of Carvedilol and Bisoprolol in Humans G. Koshucharova, R. Zweiker, R. Maier, P. Lercher, V. Stepan, W. Klein, K. Stoschitzky Bisoprolol is a beta1-selective beta-adrenergic antagonist while carvedilol is a non-selective beta-blocker with additional blockade of alpha1-adrenoceptors. Administration of bisoprolol has been shown to cause up-regulation of β-adrenoceptor density and to decrease nocturnal melatonin release, whereas carvedilol lacks these typical effects of beta-blocking drugs. The objective of the present study was to investigate beta-blocking effects of bisoprolol and carvedilol in healthy subjects. We compared the effects of single oral doses of clinically recommended amounts of bisoprolol (2.5, 5 and 10 mg) and carvedilol (25, 50 and 100 mg) to those of placebo in a randomised, double-blind, cross-over study in 12 healthy male volun- teers. Three hours after oral administration of the drugs heart rate and blood pressure were measured at rest, after 10 min. of exercise, and after 15 min.
  • PRODUCT MONOGRAPH ELAVIL® Amitriptyline Hydrochloride Tablets

    PRODUCT MONOGRAPH ELAVIL® Amitriptyline Hydrochloride Tablets

    PRODUCT MONOGRAPH ELAVIL® amitriptyline hydrochloride tablets USP 10, 25, 50 and 75 mg Antidepressant AA PHARMA INC. DATE OF PREPARATION: 1165 Creditstone Road Unit #1 August 29, 2018 Vaughan, ON L4K 4N7 Control No.: 217626 1 PRODUCT MONOGRAPH ELAVIL® amitriptyline hydrochloride tablets USP 10, 25, 50, 75 mg THERAPEUTIC CLASSIFICATION Antidepressant ACTIONS AND CLINICAL PHARMACOLOGY Amitriptyline hydrochloride is a tricyclic antidepressant with sedative properties. Its mechanism of action in man is not known. Amitriptyline inhibits the membrane pump mechanism responsible for the re-uptake of transmitter amines, such as norepinephrine and serotonin, thereby increasing their concentration at the synaptic clefts of the brain. Amitriptyline has pronounced anticholinergic properties and produces EKG changes and quinidine-like effects on the heart (See ADVERSE REACTIONS). It also lowers the convulsive threshold and causes alterations in EEG and sleep patterns. Orally administered amitriptyline is readily absorbed and rapidly metabolized. Steady-state plasma concentrations vary widely and this variation may be genetically determined. Amitriptyline is primarily excreted in the urine, mostly in the form of metabolites, with some excretion also occurring in the feces. INDICATIONS AND CLINICAL USE ELAVIL® (amitriptyline hydrochloride) is indicated in the drug management of depressive illness. ELAVIL® may be used in depressive illness of psychotic or endogenous nature and in selected patients with neurotic depression. Endogenous depression is more likely to be alleviated than are other depressive states. ELAVIL® ®, because of its sedative action, is also of value in alleviating the anxiety component of depression. As with other tricyclic antidepressants, ELAVIL® may precipitate hypomanic episodes in patients with bipolar depression. These drugs are not indicated in mild depressive states and depressive reactions.
  • Therapeutic Class Overview Beta-Adrenergic Blocking Agents

    Therapeutic Class Overview Beta-Adrenergic Blocking Agents

    Therapeutic Class Overview Beta-adrenergic Blocking Agents INTRODUCTION Approximately 92.1 million American adults have at least 1 type of cardiovascular disease according to the American Heart Association (AHA) Heart Disease and Stroke Statistics 2018 update. From 2003 to 2015, mortality associated with cardiovascular disease declined 25.5% (Benjamin et al 2018). Beta-adrenergic blocking agents (beta-blockers) are a group of drugs that block the sympathomimetic effects of catecholamines on beta receptors. This results in negative inotropic and chronotropic effects and relaxation of smooth muscle. Beta-blockers have varied pharmacologic properties. ○ Cardioselective beta-blockers preferentially interact with beta1-receptors, which are predominantly found in the heart. Non-cardioselective beta-blockers also interact with beta2-receptors found on smooth muscle in the lungs, blood vessels, and other tissues. The cardioselectivity of beta-blockers is dose dependent; therefore, beta2 blockade can occur at higher doses with certain cardioselective agents. ○ Some beta-blockers (acebutolol and pindolol) have intrinsic sympathomimetic activity (ISA), which may result in a lower incidence of bradycardia and bronchoconstriction (Facts and Comparisons 2018). In addition, some beta- blockers (nebivolol and propranolol) have higher lipophilicity, which may increase the risk for central nervous system- related adverse events (Facts and Comparisons 2018). ○ Carvedilol and labetalol also block alpha-adrenergic receptors and may reduce peripheral resistance more than other beta-blockers (Clinical Pharmacology 2018). Specific indications for the beta-blockers vary by product. Most beta-blockers (all except sotalol) are approved to treat hypertension (HTN). The 2017 American College of Cardiology (ACC)/AHA clinical practice guideline defines HTN as blood pressure (BP) ≥ 130/80 mm Hg (Whelton et al 2017).