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Molina Healthcare of Ohio Preferred Drug List (Formulary)

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Molina Healthcare of Ohio Preferred Drug List (Formulary) Molina Healthcare of Ohio Preferred Drug List (Formulary) (10/01/2019) INTRODUCTION .......................................................................................................................................................................................................................................... 4 PREFACE ..................................................................................................................................................................................................................................................... 4 PHARMACY AND THERAPEUTICS (P&T) COMMITTEE .......................................................................................................................................................................... 4 DRUG LIST PRODUCT DESCRIPTIONS ................................................................................................................................................................................................... 4 GENERIC SUBSTITUTION .......................................................................................................................................................................................................................... 4 PLAN DESIGN ............................................................................................................................................................................................................................................. 5 NON-COVERED MEDICATIONS ................................................................................................................................................................................................................ 5 STEP THERAPY (ST) .................................................................................................................................................................................................................................. 5 LEGEND ....................................................................................................................................................................................................................................................... 5 NOTICE ........................................................................................................................................................................................................................................................ 5 ANALGESICS .............................................................................................................................................................................................................................................. 6 ANALGESICS, OTHER ..................................................................................................................................................................................................................... 6 NSAIDs .............................................................................................................................................................................................................................................. 6 NSAIDs, TOPICAL ............................................................................................................................................................................................................................. 6 COX-2 INHIBITORS........................................................................................................................................................................................................................... 6 GOUT ................................................................................................................................................................................................................................................. 6 OPIOID ANALGESICS ...................................................................................................................................................................................................................... 6 NON-OPIOID ANALGESICS ............................................................................................................................................................................................................. 7 VISCOSUPPLEMENTS ..................................................................................................................................................................................................................... 7 ANTI-INFECTIVES ....................................................................................................................................................................................................................................... 7 ANTIBACTERIALS............................................................................................................................................................................................................................. 7 ANTIFUNGALS .................................................................................................................................................................................................................................. 8 ANTIMALARIALS ............................................................................................................................................................................................................................... 8 ANTIRETROVIRAL AGENTS ............................................................................................................................................................................................................ 8 ANTITUBERCULAR AGENTS ........................................................................................................................................................................................................... 9 ANTIVIRALS .................................................................................................................................................................................................................................... 10 MISCELLANEOUS........................................................................................................................................................................................................................... 10 ANTINEOPLASTIC AGENTS .................................................................................................................................................................................................................... 11 ALKYLATING AGENTS ................................................................................................................................................................................................................... 11 ANTIMETABOLITES ........................................................................................................................................................................................................................ 11 CYTOPROTECTIVE AGENTS ........................................................................................................................................................................................................ 11 HORMONAL ANTINEOPLASTIC AGENTS .................................................................................................................................................................................... 11 IMMUNOMODULATORS ................................................................................................................................................................................................................. 11 KINASE INHIBITORS ...................................................................................................................................................................................................................... 11 TOPOISOMERASE INHIBITORS .................................................................................................................................................................................................... 12 MISCELLANEOUS........................................................................................................................................................................................................................... 12 CARDIOVASCULAR.................................................................................................................................................................................................................................. 12 ACE INHIBITORS ............................................................................................................................................................................................................................ 12 ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS ............................................................................................................................................ 12 ACE INHIBITOR/DIURETIC COMBINATIONS................................................................................................................................................................................ 12 ADRENOLYTICS, CENTRAL .........................................................................................................................................................................................................
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