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Specialty Direct Supply Drug List

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Specialty Direct Supply Drug List DRAFT SPECIALTY DIRECT SUPPLY DRUG LIST (DSDL) 9/27/2005 Drug Description Effective Date 5-HT3 Receptor Antagonists ALOXI - SOLN 12/09/2004 ANZEMET - SOLN 12/09/2004 ANZEMET - TABS 12/09/2004 KYTRIL - SOLN 12/09/2004 KYTRIL - TABS 12/09/2004 Additional Solids ALPROSTADIL - POWD 12/09/2004 PROSTAGLANDIN E1 - POWD 12/09/2004 Agents for Gaucher Disease CEREZYME - SOLR 12/09/2004 Agents for Pheochromocytoma PHENTOLAMINE MESYLATE - SOLR 12/09/2004 REGITINE - SOLR 12/09/2004 Alkylating Agents CARBOPLATIN - SOLN 12/09/2004 CARBOPLATIN - SOLR 12/09/2004 CISPLATIN - SOLN 12/09/2004 CISPLATIN AQ - SOLN 12/09/2004 ELOXATIN - SOLR 12/09/2004 MYLERAN - TABS 12/09/2004 PARAPLATIN - SOLN 12/09/2004 PARAPLATIN - SOLR 12/09/2004 PLATINOL - SOLN 12/09/2004 PLATINOL AQ - SOLN 12/09/2004 THIOPLEX - SOLR 12/09/2004 THIOTEPA - SOLR 12/09/2004 Alpha-Proteinase Inhibitor (Human) ARALAST - SUSR 07/01/2005 PROLASTIN - SUSR 07/01/2005 ZEMAIRA - SOLR 07/01/2005 AMINOGLYCOSIDES APOGEN - SOLN 12/09/2004 GARAMYCIN - SOLN 12/09/2004 GENTAMICIN SULFATE - SOLN 12/09/2004 G-MYCIN - SOLN 12/09/2004 JENAMICIN - SOLN 12/09/2004 NEBCIN - SOLN 12/09/2004 NEBCIN MDV - SOLN 12/09/2004 STORZ-G - SOLN 12/09/2004 TOBI - NEBU 12/09/2004 TOBRAMYCIN SULFATE - SOLN 12/09/2004 TOBRAMYCIN SULFATE FLIPTO - SOLN 12/09/2004 Antianxiety Agents - Misc. rev A Page 1 of 13 MaineCare Direct Supply Drug List (DSDL) Drug Description Effective Date Antianxiety Agents - Misc. - Continued - DROPERIDOL - POWD 12/09/2004 DROPERIDOL - SOLN 12/09/2004 INAPSINE - SOLN 12/09/2004 Antiarrhythmics Type III TIKOSYN - CAPS 12/09/2004 ANTIDOTES DEFEROXAMINE MESYLATE - SOLR 12/09/2004 DESFERAL - SOLR 12/09/2004 Antihemophilic Products ADVATE - KIT 06/01/2005 ALPHANATE - SOLR 12/09/2004 ALPHANINE SD - SOLR 12/09/2004 AUTOPLEX T - SOLR 12/09/2004 BEBULIN VH - SOLR 12/09/2004 BENEFIX - SOLR 12/09/2004 FEIBA VH IMMUNO - SOLR 12/09/2004 HELIXATE - KIT 12/09/2004 HELIXATE FS - KIT 12/09/2004 HEMOFIL M HUMAN - SOLR 12/09/2004 HUMATE-P - SOLR 12/09/2004 HUMATE-P HUMAN - SOLR 12/09/2004 HYATE:C ANTIHEMOPHILIC FA - SOLR 12/09/2004 KOATE-DVI - SOLR 12/09/2004 KOATE-HP - SOLR 12/09/2004 KOGENATE - KIT 12/09/2004 KOGENATE FS - KIT 12/09/2004 KONYNE 80 - SOLR 12/09/2004 KONYNE-HT - SOLR 12/09/2004 MELATE - SOLR 12/09/2004 MONARC-M - SOLR 12/09/2004 MONOCLATE-P - KIT 12/09/2004 MONONINE - SOLR 12/09/2004 NOVOSEVEN - SOLR 12/09/2004 PROFILATE-HP HUMAN - SOLR 12/09/2004 PROFILNINE - SOLR 12/09/2004 PROFILNINE SD - SOLR 12/09/2004 RECOMBINATE - SOLR 12/09/2004 REFACTO - KIT 12/09/2004 Anti-IgE Monoclonal Antibodies XOLAIR - SOLR 12/09/2004 Anti-infective Agents - Misc. COLISTIMETHATE SODIUM - SOLR 12/09/2004 COLY-MYCIN-M - SOLR 12/09/2004 PENTACARINAT - SOLR 12/09/2004 PENTAM 300 - SOLR 12/09/2004 PENTAMIDINE ISETHIONATE - SOLR 12/09/2004 VANCOCIN HCL - SOLR 12/09/2004 VANCOLED - SOLR 12/09/2004 VANCOMYCIN HCL - POWD 12/09/2004 VANCOMYCIN HCL - SOLR 12/09/2004 VANCOR - SOLR 12/09/2004 rev A Page 2 of 13 MaineCare Direct Supply Drug List (DSDL) Drug Description Effective Date Antileprotics THALOMID - CAPS 12/09/2004 Antimetabolites ADRUCIL - SOLN 12/09/2004 ALIMTA - SOLR 12/09/2004 CLADRIBINE - SOLN 12/09/2004 CYTARABINE - SOLN 12/09/2004 CYTARABINE - SOLR 12/09/2004 CYTOSAR-U - SOLR 12/09/2004 FLUDARA - SOLR 12/09/2004 FLUDARABINE PHOSPHATE - SOLR 12/09/2004 FLUOROURACIL - SOLN 12/09/2004 GEMZAR - SOLR 12/09/2004 LEUSTATIN - SOLN 12/09/2004 TARABINE - SOLR 12/09/2004 THIOGUANINE - TABS 12/09/2004 XELODA - TABS 12/09/2004 Antineoplastic - Monoclonal Antibodies CAMPATH - SOLN 12/09/2004 ERBITUX - SOLN 12/09/2004 HERCEPTIN - SOLR 12/09/2004 RITUXAN - CONC 12/09/2004 Antineoplastic - Proteasome Inhibitors VELCADE - SOLR 12/09/2004 Antineoplastic - Protein-Tyrosine Kinase Inhibitors GLEEVEC - TABS 12/09/2004 IRESSA - TABS 12/09/2004 Antineoplastic Antibiotics ADRIAMYCIN - SOLN 12/09/2004 ADRIAMYCIN - SOLR 12/09/2004 ADRIAMYCIN PFS - SOLN 12/09/2004 ADRIAMYCIN RDF - SOLR 12/09/2004 BLENOXANE - SOLR 12/09/2004 BLEOMYCIN SULFATE - SOLR 12/09/2004 CERUBIDINE - SOLR 12/09/2004 DAUNORUBICIN HCL - INJ 12/09/2004 DAUNORUBICIN HCL - SOLR 12/09/2004 DOXIL - INJ 12/09/2004 DOXORUBICIN HCL - SOLN 12/09/2004 DOXORUBICIN HCL - SOLR 12/09/2004 ELLENCE - SOLN 12/09/2004 MITOMYCIN - SOLR 12/09/2004 MUTAMYCIN - SOLR 12/09/2004 NOVANTRONE - CONC 12/09/2004 NOVANTRONE HCL - CONC 12/09/2004 RUBEX - SOLR 12/09/2004 Antineoplastic Antibody-Drug Complexes MYLOTARG - SOLR 12/09/2004 Antineoplastic Antimetabolites - Topical EFUDEX - SOLN 12/09/2004 FLUOROURACIL - SOLN 12/09/2004 Antineoplastic Combinations rev A Page 3 of 13 MaineCare Direct Supply Drug List (DSDL) Drug Description Effective Date Antineoplastic Combinations - Continued - IFEX/MESNEX - KIT 12/09/2004 IFEX/MESNEX COMBO PACK - KIT 12/09/2004 IFOSFAMIDE/MESNA - KIT 12/09/2004 Antineoplastic Enzymes ELSPAR - SOLR 12/09/2004 Antineoplastics - Interleukins PROLEUKIN - SOLR 12/09/2004 Antineoplastics Misc. ACTIMMUNE - SOLN 12/09/2004 ALFERON N - SOLN 12/09/2004 DACARBAZINE - POWD 12/09/2004 DACARBAZINE - SOLR 12/09/2004 DTIC-DOME - SOLR 12/09/2004 INTRON-A - KIT 12/09/2004 INTRON-A - SOLN 12/09/2004 INTRON-A - SOLR 12/09/2004 INTRON-A W/DILUENT - SOLR 12/09/2004 NIPENT - SOLR 12/09/2004 ROFERON-A - KIT 12/09/2004 TICE BCG - SUSR 12/09/2004 TRISENOX - SOLN 12/09/2004 Antipsoriatics - Systemic AMEVIVE - SOLR 12/09/2004 RAPTIVA - KIT 12/09/2004 Anti-TNF-alpha - Monoclonoal Antibodies HUMIRA - KIT 12/09/2004 Antiviral Monoclonal Antibodies SYNAGIS - SOLR 10/30/2004 Bacterial Vaccines MENOMUNE - INJ 12/09/2004 MENOMUNE-A/C/Y/W-135 - INJ 12/09/2004 Beta Adrenergics BRETHINE - SOLN 12/09/2004 BRICANYL - SOLN 12/09/2004 TERBUTALINE SULFATE - SOLN 12/09/2004 Bisphosphonates AREDIA - SOLR 12/09/2004 PAMIDRONATE DISODIUM - SOLN 12/09/2004 PAMIDRONATE DISODIUM - SOLR 12/09/2004 ZOMETA - CONC 12/09/2004 Bulk Chemicals ALCLOMETASONE DIPROPIONAT - POWD 12/09/2004 AMINOCAPROIC ACID - POWD 12/09/2004 ATROPINE METHONITRATE - POWD 12/09/2004 BASE A POLYGLYCOL - POWD 12/09/2004 BETA CAROTENE - CRYS 12/09/2004 BLEOMYCIN SULFATE - POWD 12/09/2004 CALCIUM LEVULINATE - POWD 12/09/2004 CALCIUM STEARATE - POWD 12/09/2004 CALCIUM UNDECYLENATE - POWD 12/09/2004 CALOMEL - POWD 12/09/2004 rev A Page 4 of 13 MaineCare Direct Supply Drug List (DSDL) Drug Description Effective Date Bulk Chemicals - Continued - CARBOPLATIN - POWD 12/09/2004 CARRAGEENAN - POWD 12/09/2004 CEFOTAXIME SODIUM - POWD 12/09/2004 CERIUM OXALATE - POWD 12/09/2004 CETYLPYRIDINIUM CHLORIDE - POWD 12/09/2004 CHLOROTHYMOL - POWD 12/09/2004 CHLORPROMAZINE - POWD 12/09/2004 CHLORPROPAMIDE - POWD 12/09/2004 CIPROFLOXIN HCL - POWD 12/09/2004 DIBUCAINE - POWD 12/09/2004 DIGOXIN - CRYS 12/09/2004 DIHYDROXYALUMINUM AMINOAC - POWD 12/09/2004 DOXORUBICIN HCL - POWD 12/09/2004 D-RIBOSE REAGENT - POWD 12/09/2004 D-THYROXINE SODIUM - POWD 12/09/2004 ETHYL PARABEN - POWD 12/09/2004 ETHYLPARABEN - POWD 12/09/2004 FERRIC OXIDE - POWD 12/09/2004 FERRIC PHOSPHATE - POWD 12/09/2004 FERRIC PYROPHOSPHATE - POWD 12/09/2004 FURAZOLIDONE - POWD 12/09/2004 HALAZONE - POWD 12/09/2004 HEXYLRESORCINOL - CRYS 12/09/2004 HYDROCORTISONE BUTYRATE - POWD 12/09/2004 HYDROCORTISONE VALERATE - POWD 12/09/2004 HYDROCORTISONE VALERATE M - POWD 12/09/2004 HYDROFLUMETHIAZIDE - POWD 12/09/2004 HYDROXYAMPHETAMINE HYDROB - POWD 12/09/2004 HYOSCAMINE HYDROBROMIDE - POWD 12/09/2004 IDOXURIDINE - CRYS 12/09/2004 LACTASE 5000 - POWD 12/09/2004 L-ASPARAGINE MONOHYDRATE - POWD 12/09/2004 LEAD ACETATE - CRYS 12/09/2004 LEVULINIC ACID CALCIUM SA - POWD 12/09/2004 LITHIUM CITRATE - POWD 12/09/2004 LYSINE ACETATE - POWD 12/09/2004 MAGNESIUM LACTATE - POWD 12/09/2004 MANGANESE GLYCEROPHOSPHAT - POWD 12/09/2004 MEDRYSONE - POWD 12/09/2004 MERCAPTOPURINE - POWD 12/09/2004 NAPHAZOLINE HCL - CRYS 12/09/2004 NEOSTIGMINE BROMIDE - CRYS 12/09/2004 NIACINAMIDE ASCORBATE - POWD 12/09/2004 NICOTINYL ALCOHOL TARTRAT - POWD 12/09/2004 NIFUROXIME - POWD 12/09/2004 NOVOBIOCIN SODIUM - POWD 12/09/2004 PARGYLINE HCL - POWD 12/09/2004 PENTAMIDINE ISETHIONATE - CRYS 12/09/2004 PHENTOLAMINE - POWD 12/09/2004 PHENYLMERCURIC BORATE - POWD 12/09/2004 PHTHALYLSULFATHIAZOLE - POWD 12/09/2004 rev A Page 5 of 13 MaineCare Direct Supply Drug List (DSDL) Drug Description Effective Date Bulk Chemicals - Continued - POLYVINYLPYRROLIDONE K-30 - POWD 12/09/2004 POLYVINYLPYRROLIDONE K-90 - POWD 12/09/2004 POTASSIUM BENZOATE - CRYS 12/09/2004 POTASSIUM BROMIDE - CRYS 12/09/2004 POTASSIUM GLUCONATE - POWD 12/09/2004 PRAZIQUANTEL - POWD 12/09/2004 PROBENECID - POWD 12/09/2004 PROBENECID COMPACT GRADE - POWD 12/09/2004 PSYLLIUM HUSK - POWD 12/09/2004 PYRIDOSTIGMINE BROMIDE - POWD 12/09/2004 PYRVINIUM PAMOATE - POWD 12/09/2004 RESORCINOL MONOACETATE - POWD 12/09/2004 SENNA LEAF - POWD 12/09/2004 SODIUM CARBONATE ANHYDROU - POWD 12/09/2004 SODIUM CYCLAMATE - CRYS 12/09/2004 SODIUM GLYCEROPHOSPHATE - POWD 12/09/2004 SODIUM NITROPRUSSIDE - CRYS 12/09/2004 SODIUM PROPIONATE - CRYS 12/09/2004 SODIUM PYROPHOSPHATE ANHY - POWD 12/09/2004 SULFACHLORPYRIDAZINE - POWD 12/09/2004 SULFACHLORPYRIDAZINE SODI - POWD 12/09/2004 SULPHADIMIDINE SODIUM - CRYS 12/09/2004 THEOBROMINE - POWD 12/09/2004 THIORIDAZINE HCL - POWD 12/09/2004 TRIS(HYDROXYMETHYL)AMINOM - POWD 12/09/2004 Bulk Chemicals - Ci CISPLATIN - POWD 12/09/2004 Bulk Chemicals - Co's COLISTIMETHATE SODIUM - POWD 12/09/2004 COLISTIN METHANESULFONATE - POWD 12/09/2004 Bulk Chemicals - Fl's 5-FLUOROURACIL - POWD 12/09/2004 FLUOROURACIL - POWD 12/09/2004 Bulk Chemicals - Le's LEUCOVORIN CALCIUM - POWD 12/09/2004 LEUPROLIDE ACETATE - POWD 12/09/2004 Bulk Chemicals - Mi MITOMYCIN - POWD 12/09/2004
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