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Medstar Family Choice - Maryland Healthchoice Prescribing Guide 2020 (710)

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Medstar Family Choice - Maryland Healthchoice Prescribing Guide 2020 (710) MedStar Family Choice - Maryland HealthChoice Prescribing Guide 2020 (710) (01/01/2020) INTRODUCTION .............................................................................................................................................................................. 5 NONDISCRIMINATION STATEMENT ............................................................................................................................................. 5 PREFACE ......................................................................................................................................................................................... 7 PHARMACY AND THERAPEUTICS (P&T) COMMITTEE .............................................................................................................. 8 PRODUCT SELECTION CRITERIA ................................................................................................................................................. 8 GENERIC AVAILABILITY ................................................................................................................................................................ 8 GENERIC SUBSTITUTION .............................................................................................................................................................. 8 MAIL SERVICE PRESCRIPTIONS .................................................................................................................................................. 9 MEDICAL EXCEPTION .................................................................................................................................................................... 9 PRIOR AUTHORIZATION (PA) ....................................................................................................................................................... 9 Drugs requiring Prior Authorization ............................................................................................................................................. 9 MANAGED DRUG LIMITATIONS (MDL) ....................................................................................................................................... 10 STEP THERAPY (ST) .................................................................................................................................................................... 12 OVER-THE-COUNTER (OTC) DRUG COVERAGE ...................................................................................................................... 12 EDITOR .......................................................................................................................................................................................... 16 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 .............................................................................................................................................. 21 ANTIVIRALS ......................................................................................................................................................................... 21 MISCELLANEOUS ................................................................................................................................................................ 22 ANTINEOPLASTIC AGENTS ........................................................................................................................................................ 22 ALKYLATING AGENTS ........................................................................................................................................................ 22 ANTIMETABOLITES ............................................................................................................................................................. 22 HORMONAL ANTINEOPLASTIC AGENTS .......................................................................................................................... 23 KINASE INHIBITORS ............................................................................................................................................................ 23 TOPOISOMERASE INHIBITORS ......................................................................................................................................... 24 MISCELLANEOUS ................................................................................................................................................................ 24 1 CARDIOVASCULAR ...................................................................................................................................................................... 24 ACE INHIBITORS ................................................................................................................................................................. 24 ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS.................................................................................. 25 ACE INHIBITOR/DIURETIC COMBINATIONS ..................................................................................................................... 25 ADRENOLYTICS, CENTRAL ................................................................................................................................................ 25 ALDOSTERONE RECEPTOR ANTAGONISTS.................................................................................................................... 25 ALPHA BLOCKERS .............................................................................................................................................................. 25 ANGIOTENSIN II RECEPTOR ANTAGONISTS/DIURETIC COMBINATIONS .................................................................... 25 ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER COMBINATIONS ................................... 25 ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER/DIURETIC COMBINATIONS ................. 25 ANTIARRHYTHMICS ............................................................................................................................................................ 25 ANTILIPEMICS ..................................................................................................................................................................... 26 BETA-BLOCKERS ................................................................................................................................................................ 27 BETA-BLOCKER/DIURETIC COMBINATIONS .................................................................................................................... 27 CALCIUM CHANNEL BLOCKERS.......................................................................................................................................
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