MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES ANALGESICS ANALGESICS, DURAGESIC (fentanyl) AVINZA (morphine) NARCOTIC-LONG-ACTING fentanyl patches EMBEDA (morphine/naltrexone) KADIAN (morphine) OPANA ER (oxymorphone) methadone oxycodone ER morphine ER OXYCONTIN (oxycodone) RYZOLT (tramadol) ULTRAM ER (tramadol) ANALGESICS, NARCOTIC- acetaminophen/codeine butalbital/APAP/caffeine/codeine SHORT-ACTING aspirin/codeine butalbital/ASA/caffeine/codeine codeine DARVON-N (propoxyphene) dihydrocodeine/ APAP/caffeine DILAUDID liquid (hydromorphone) hydrocodone/APAP fentanyl hydrocodone/ibuprofen FENTORA (fentanyl) hydromorphone levorphanol IBUDONE (hydrocodone/ibuprofen) NUCYNTA (tapentadol) meperidine ONSOLIS (fentanyl) morphine OPANA (oxymorphone) oxycodone pentazocine/naloxone oxycodone/APAP propoxyphene oxycodone/aspirin REPREXAIN oxycodone/ibuprofen (hydrocodone/ibuprofen) pentazocine/APAP RYBIX (tramadol) propoxyphene/APAP ZAMICET (hydrocodone/APAP) tramadol tramadol/APAP
ANALGESICS/ANESTHETICS, FLECTOR (diclofenac epolamine)
TOPICAL LIDODERM (lidocaine)
VOLTAREN Gel (diclofenac sodium)
ANTIHYPERURICEMICS allopurinol COLCRYS (colchicine)
colchicine ULORIC (febuxostat)
probenecid
probenecid/colchicine
ANTIMIGRAINE AGENTS, ORAL TRIPTANS IMITREX (sumatriptan) AMERGE (naratriptan)
RELPAX (eletriptan) AXERT (almotriptan)
sumatriptan FROVA (frovatriptan)
TREXIMET (sumatriptan/naproxen) MAXALT (rizatriptan)
ZOMIG (zolmitriptan)
Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 1 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES ANALGESICS ANTIMIGRAINE AGENTS, NASAL TRIPTANS (continued) IMITREX (sumatriptan) ZOMIG (zolmitriptan) (CONTINUED) sumatriptan
INJECTABLE
IMITREX (sumatriptan)
sumatriptan
FIBROMYALGIA AGENTS LYRICA (pregabalin) CYMBALTA (duloxetine) Cymbalta will be SAVELLA (milnacipran) approved for patients with diabetic neuropathy NSAIDS NONSELECTIVE
diclofenac meclofenamate
etodolac mefenamic acid
fenoprofen nabumetone
flurbiprofen tolmetin
ibuprofen ZIPSOR (diclofenac)
indomethacin
ketoprofen
ketorolac
naproxen
oxaprozin
piroxicam
sulindac
NSAID/GI PROTECTANT COMBINATIONS
ARTHROTEC
(diclofenac/misoprostol)
PREVACID NAPRAPAC (naproxen/lansoprazole)
COX-II SELECTIVE
meloxicam CELEBREX (celecoxib)
Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 2 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES ANALGESICS SKELETAL MUSCLE baclofen AMRIX (cyclobenzaprine ER) (continued) RELAXANTS chlorzoxazone carisoprodol cyclobenzaprine carisoprodol compound dantrolene FEXMID (cyclobenzaprine) methocarbamol orphenadrine tizanidine orphenadrine compound SKELAXIN (metaxolone) SOMA (carisoprodol) ZANAFLEX (tizanidine) CARDIOVASCULAR ANGIOTENSIN MODULATORS ACE INHIBITORS benazepril ACEON (perindopril) captopril moexepril enalapril perindopril fosinopril lisinopril quinapril ramipril trandolapril
ACE INHIBITOR/DIURETIC COMBINATIONS
benazepril/HCTZ
captopril/HCTZ
enalapril/HCTZ
fosinopril/HCTZ
lisinopril/HCTZ
moexepril/HCTZ
quinapril/HCTZ
ANGIOTENSIN RECEPTOR BLOCKERS AVAPRO (irbesartan) ATACAND (candesartan) BENICAR (olmesartan) TEVETEN (eprosartan) COZAAR (losartan) DIOVAN (valsartan) MICARDIS (telmisartan)
Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 3 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES CARDIOVASCULAR ANGIOTENSIN MODULATORS (CONTINUED) (CONTINUED)
ANGIOTENSIN RECEPTOR BLOCKER/DIURETIC COMBINATIONS
AVALIDE (irbesartan/HCTZ) ATACAND-HCT (candesartan/HCTZ)
BENICAR-HCT (olmesartan/HCTZ) TEVETEN-HCT (eprosartan/HCTZ)
DIOVAN-HCT (valsartan/HCTZ)
HYZAAR (losartan/HCTZ)
MICARDIS-HCT (telmisartan/HCTZ)
DIRECT RENIN INHIBITOR
TEKTURNA (aliskerin) DIRECT RENIN INHIBITOR COMBINATIONS TEKTURNA-HCT (aliskerin/HCTZ) VALTURNA (Aliskerin/valsartan)
ANGIOTENSIN MODULATOR/ ACE INHIBITOR/CCB COMBINATIONS CCB COMBINATIONS benazepril/amlodipine LOTREL TARKA (trandolapril/verapamil) ANGIOTENSIN RECEPTOR BLOCKER/CCB COMBINATIONS AZOR (olmesartan/amlodipine) TWYNSTA (telmisartan/amlodipine) EXFORGE (valsartan/amlodipine) EXFORGE HCT (valsartan/amlodipine/HCTZ) ANTICOAGULANTS, ARIXTRA (fondaparinux) INNOHEP (tinzaparin) INJECTABLE FRAGMIN (dalteparin) LOVENOX (enoxaparin)
BETA-BLOCKERS BETA BLOCKERS
acebutolol betaxolol
atenolol BYSTOLIC (nebivolol)
bisoprolol INNOPRAN XL (propranolol)
metoprolol LEVATOL (penbutolol)
metopolol XL sotalol
nadolol
pindolol
propranolol
timolol
BETA- AND ALPHA- BLOCKERS
carvedilol COREG CR (carvedilol)
labetalol Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 4 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES CARDIOVASCULAR BETA-BLOCKERS BETA BLOCKER / DIURETIC COMBINATIONS (CONTINUED) (CONTINUED) atenolol/chlorthalidone bisoprolol/HCTZ metoprolol/HCTZ nadolol/bendroflumethiazide propranolol/HCTZ timolol/HCTZ
CALCIUM CHANNEL SHORT-ACTING BLOCKERS diltiazem isradipine
nicardipine
nifedipine
verapamil
LONG-ACTING amlodipine CARDENE SR (nicardipine) COVERA-HS (verapamil) CARDIZEM LA (diltiazem) diltiazem ER SULAR (nisoldipine) DYNACIRC CR (isradipine) nisoldipine felodipine ER verapamil ER PM nifedipine ER verapamil ER LIPOTROPICS, OTHER BILE ACID SEQUESTRANTS
(NON-STATINS) cholestyramine WELCHOL (colesevalam)
colestipol
CHOLESTEROL ABSORPTION INHIBITORS
ZETIA (ezetimibe)
FIBRIC ACID DERIVATIVES fenofibrate ANTARA (fenofibrate) gemfibrozil FENOGLIDE (fenofibrate) TRICOR (fenofibrate) FIBRICOR (fenofibric acid) TRILIPIX (fenofibric acid) LIPOFEN (fenofibrate) TRIGLIDE (fenofibrate)
NIACIN
NIACOR (niacin)
NIASPAN (niacin)
OMEGA-3 FATTY ACIDS LOVAZA (omega-3 fatty acids)
Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 5 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES CARDIOVASCULAR LIPOTROPICS, STATINS STATINS (CONTINUED) LESCOL (fluvastatin) ALTOPREV (lovastatin) LESCOL XL (fluvastatin) CRESTOR (rosuvastatin) LIPITOR (atorvastatin) lovastatin pravastatin simvastatin STATIN COMBINATIONS CADUET (atorvastatin/amlodipine) ADVICOR (lovastatin/niacin) VYTORIN (simvastatin/ezetimibe) SIMCOR (simvastatin/niacin) PLATELET AGGREGATION AGGRENOX (dipyridamole/aspirin) EFFIENT (prasugrel) INHIBITORS dipyridamole ticlopidine PLAVIX (clopidogrel) PULMONARY ARTERIAL LETAIRIS (ambrisentan) ADCIRCA (tadalafil) HYPERTENSION AGENTS REVATIO (sildenafil) TYVASO (treprostinil) TRACLEER (bosentan) VENTAVIS (iloprost) CNS ALZHEIMER’S AGENTS CHOLINESTERASE INHIBITORS ARICEPT (donepezil) COGNEX (tacrine) ARICEPT ODT (donepezil) galantamine EXELON (rivastigmine) galantamine ER
NMDA RECEPTOR ANTAGONIST
NAMENDA (memantine)
ANTICONVULSANTS HYDANTOINS DILANTIN (phenytoin) PEGANONE (ethotoin) PHENYTEK (phenytoin) phenytoin
SUCCINIMIDES
ethosuximide CELONTIN (methsuximide)
ADJUVANTS
carbamazepine BANZEL (rufinamide) CARBATROL (carbamazepine) FELBATOL (felbamate) DEPAKOTE ER (divalproex) KEPPRA XR (levetiracetam) DEPAKOTE SPRINKLE (divalproex) SABRIL (vigabatrin) divalproex STAVZOR (valproic acid) divalproex ER TRILEPTAL Tablets (oxcarbazepine) EQUETRO (carbamazepine) VIMPAT (lacosamide) Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 6 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES CNS ANTICONVULSANTS gabapentin (CONTINUED) (CONTINUED) GABITRIL (tiagabine) LAMICTAL ODT (lamotrigine) LAMICTAL XR (lamotrigine) lamotrigine levetiracetam oxcarbazepine TEGRETOL XR (carbamazepine) topiramate TRILEPTAL Suspension (oxcarbazepine) valproic acid zonisamide ANTIDEPRESSANTS, OTHERS bupropion APLENZIN (buproprion HBr) EFFEXOR XR (venlafaxine) EMSAM (selegiline transdermal) mirtazapine NARDIL (phenelzine) nefazodone tranylcypromine PRISTIQ (desvenlafaxine) venlafaxine trazodone VENLAFAXINE ER (venlafaxine) WELLBUTRIN XL (bupropion HCl)
ANTIDEPRESSANTS, SSRIs citalopram LEXAPRO (escitalopram) Lexapro will be
fluoxetine paroxetine CR approved for adolescents age fluvoxamine PEXEVA (paroxetine) 12 to 17 years old. LUVOX CR (fluvoxamine) PROZAC WEEKLY (fluoxetine)
paroxetine IR
sertraline
ANTIPARKINSON’S AGENTS ANTICHOLINERGICS
benztropine
trihexyphenidyl
COMT INHIBITORS
COMTAN (entacapone)
TASMAR (tolcapone)
DOPAMINE AGONISTS
ropinirole MIRAPEX (pramipexole)
NEUPRO (rotigotine)
REQUIP XL (ropinirole)
MAO-B INHIBITORS
selegiline AZILECT (rasagiline)
ZELAPAR (selegiline) Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 7 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES CNS ANTIPARKINSON’S AGENTS OTHERS (CONTINUED) (CONTINUED) levodopa/carbidopa STALEVO (levodopa/carbidopa/entacapone) bromocriptine
ANTIPSYCHOTICS ORAL
ABILIFY (aripiprazole) FANAPT (iloperidone)
amitriptyline/perphenazine FAZACLO (clozapine)
chlorpromazine INVEGA (paliperidone)
clozapine SYMBYAX (olanzapine/fluoxetine)
fluphenazine ZYPREXA (olanzapine)
GEODON (ziprasidone)
haloperidol
MOBAN (molindone)
perphenazine
risperidone
SAPHRIS (asenapine)
SEROQUEL (quetiapine)
SEROQUEL XR (quetiapine)
thioridazine
thiothixene
trifluoperazine
INJECTABLE, ATYPICALS ABILIFY (aripiprazole) GEODON (ziprasidone) INVEGA SUSTENNA (paliperidone palmitate) RISPERDAL CONSTA (risperidone) ZYPREXA (olanzapine) ZYPREXA RELPREVV (olanzapine) MULTIPLE SCLEROSIS AGENTS AVONEX (interferon beta-1a) EXTAVIA (interferon beta-1b) BETASERON (interferon beta-1b) COPAXONE (glatiramer) REBIF (interferon beta-1a)
SEDATIVE HYPNOTICS BENZODIAZEPINES Single source benzodiazepines estazolam temazepam (7.5mg and 22.5mg) and barbiturates
flurazepam are NOT covered; temazepam (15mg and 30mg) PAs will not be triazolam issued for these
Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 8 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES CNS OTHERS drugs. (CONTINUED) LUNESTA (eszopiclone) AMBIEN CR (zolpidem) Sedative/Hypnotics are limited to 31 zaleplon EDLUAR (zolpidem) cumulative units of zolpidem ROZEREM (ramelteon) all/any strengths per month. Any quantity required above these limits requires a PA. STIMULANTS AND RELATED STIMULANTS - SHORT ACTING Prior authorization AGENTS required for amphetamine salt combination DESOXYN (methamphetamine) patients >21 yrs of dexmethylphenidate IR PROCENTRA (dextroamphetamine) age. dextroamphetamine IR FOCALIN (dexmethylphenidate) METHYLIN chewable tablets (methylphenidate) METHYLIN solution (methylphenidate) methylphenidate IR STIMULANTS - LONG ACTING ADDERALL XR (amphetamine salt combination) amphetamine salt combination ER CONCERTA (methylphenidate) dextroamphetamine ER DAYTRANA (methylphenidate) NUVIGIL (armodafinil) FOCALIN XR (dexmethylphenidate) PROVIGIL (modafinil) METADATE CD (methylphenidate) RITALIN LA (methylphenidate) methylphenidate ER VYVANSE (lisdexamfetamine) NON-STIMULANTS INTUNIV (guanfacine ER) STRATTERA (atomoxetine)
DERMATOLOGICAL ACNE AGENTS, TOPICAL ANTIBIOTICS Acne agents will be authorized only clindamycin AKNE-MYCIN (erythromycin) for patients less
erythromycin CLINDAGEL (clindamycin) than 21 years of CLINDAREACH (clindamycin) age. EVOCLIN (clindamycin) sulfacetamide DERMATOLOGICAL ACNE AGENTS, TOPICAL RETINOIDS (CONTINUED) (CONTINUED) RETIN-A MICRO (tretinoin) ATRALIN (tretinoin)
DIFFERIN (adapalene)
EPIDUO
(adapalene/benzoyl peroxide)
Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 9 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES TAZORAC (tazarotene) tretinoin OTHERS
AZELEX (azelaic acid) ACANYA
BENZACLIN (benzoyl peroxide/clindamycin) (benzoyl peroxide/clindamycin)
benzoyl peroxide ACZONE (dapsone)
CLINAC BPO (benzoyl peroxide) BENZEFOAM (benzoyl peroxide)
INOVA (benzoyl peroxide) benzoyl peroxide/clindamycin
NUOX (benzoyl peroxide/sulfur) CLARIFOAM EF (sodium sulfacetamide/sulfur) PANOXYL (benzoyl peroxide) DUAC (benzoyl peroxide/clindamycin) sodium sulfacetamide/sulfur erythromycin/benzoyl peroxide ZACLIR (benzoyl peroxide) SE BPO (benzoyl peroxide)NR sodium sulfacetamide/sulfur/meratan ZIANA (clindaymcyin/tretinoin) ANTIFUNGALS, TOPICAL ANTIFUNGALS
ciclopirox cream/gel/suspension BENSAL HP
clotrimazole (benzoic acid/salicylic acid)
econazole ciclopirox shampoo
ketoconazole shampoo CNL 8 (ciclopirox)
miconazole OTC ERTACZO (sertaconazole)
NAFTIN (naftifine) EXTINA (ketoconazole)
nystatin ketoconazole cream
terbinafine OTC LOPROX (ciclopirox)
tolnaftate OTC MENTAX (butenafine)
OXISTAT (oxiconazole) VUSION (miconazole/petrolatum/ zinc oxide) XOLEGEL (ketoconazole) ANTIFUNGAL/STEROID COMBINATIONS
clotrimazole/betamethasone
nystatin/triamcinolone
DERMATOLOGICAL
(CONTINUED) ANTIPARASITICS, TOPICAL EURAX (crotamiton) lindane malathionpermethrin OVIDE (malathion) ULESFIA (benzyl alcohol) ATOPIC DERMATITIS ELIDEL (pimecrolimus) PROTOPIC (tacrolimus)
Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 10 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES STEROIDS, TOPICAL LOW POTENCY CAPEX (fluocinolone) alclometasone desonide DERMA-SMOOTHE-FS (fluocinolone) hydrocortisone DESONATE (desonide) DESOWEN (desonide) PEDIACARE HC (hydrocortisone)NR SCALACORT DK (hydrocortisone) VERDESO (desonide) MEDIUM POTENCY
fluocinolone CLODERM (clocortolone)
fluticasone CORDRAN (flurandrenolide)
hydrocortisone CUTIVATE (fluticasone)
LUXIQ (betamethasone)
MOMEXIN (mometasone)
prednicarbate
HIGH POTENCY
betamethasone amcinonide CAPEX (fluocinolone) betamethasone dipropionate fluocinolone desoximetasone fluocinonide diflorasone
triamcinolone KENALOG (triamcinolone) VANOS (fluocinonide) VERY HIGH POTENCY clobetasol CLOBEX (clobetasol) halobetasol HALONATE MR ULTRAVATE (halobetasol) (halobetasol/ammonium lactate) OLUX-E (clobetasol) OLUX-OLUX-E (clobetasol)
ENDOCRINE ANDROGENIC AGENTS ANDRODERM (testosterone patch) TESTIM (testosterone gel) ANDROGEL (testosterone gel)
ENDOCRINE BONE RESORPTION BISPHOSPHONATES (CONTINUED) SUPPRESSION AND RELATED ACTONEL (risedronate) BONIVA (ibandronate) AGENTS ACTONEL WITH CALCIUM (risedronate/calcium)
alendronate FOSAMAX PLUS D (alendronate/vitamin D) Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 11 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES OTHERS FORTICAL (calcitonin) DIDRONEL (etidronate) MIACALCIN (calcitonin) EVISTA (raloxifene) calcitonin salmon FORTEO (teriparatide)
GROWTH HORMONE NUTROPIN (somatropin) GENOTROPIN (somatropin) Prior authorization NUTROPIN AQ (somatropin) HUMATROPE (somatropin) required for patients >18 yrs of NORDITROPIN (somatropin) age. OMNITROPE (somatropin) SAIZEN (somatropin) SEROSTIM (somatropin) TEV-TROPIN (somatropin) ZORBTIVE (somatropin) HYPOGLYCEMICS, INCRETIN BYETTA (exenatide) SYMLIN (pramlintide) MIMETICS/ ENHANCERS JANUMET (sitagliptin/metformin) JANUVIA (sitagliptin) ONGLYZA (saxagliptin) HYPOGLYCEMICS, INSULIN LANTUS (insulin glargine) APIDRA (insulin glulisine) AND RELATED AGENTS LEVEMIR (insulin detemir) HUMALOG (insulin lispro) (INCLUDES VIALS AND PENS) NOVOLIN (insulin) HUMALOG MIX NOVOLOG (insulin aspart) (insulin lispro/lispro protamine) NOVOLOG MIX (insulin aspart/aspart protamine) HUMULIN (insulin) HYPOGLYCEMICS, PRANDIN (repaglinide) PRANDIMET (repaglinide/metformin) MEGLITINIDES STARLIX (nateglinide) HYPOGLYCEMICS, TZDS THIAZOLINEDIONES ACTOS (pioglitazone) AVANDIA (rosiglitazone) TZD COMBINATIONS ACTOPLUS MET (pioglitazone/metformin) AVANDAMET (rosiglitazone/metformin) AVANDARYL (rosiglitazone/glipizide) DUETACT (pioglitazone/glimepiride) GASTROINTESTINAL ANTIEMETICS CANNABINOIDS CESAMET (nabilone) dronabinol
5HT3 RECEPTOR BLOCKERS All injectable 5HT3 receptor blockers ondansetron ANZEMET (dolasetron) closed to point of Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 12 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES granisetron sale. ondansetron ODT Ondansetron ODT SANCUSO (granisetron) 4mg tablets are covered without a PA for ages 1-11. NMDA RECEPTOR ANTAGONIST EMEND (aprepitant) H. PYLORI AGENTS HELIDAC (bismuth subsalicylate, metronidazole, PYLERA tetracycline) (bismuth subcitrate potassium, PREVPAC (lansoprazole, amoxicillin, clarithromycin) metronidazole, tetracycline) PANCREATIC ENZYMES CREON (pancreatin) PANCRECARB MS (pancrelipase) pancrelipase PANCREASE MT (pancrelipase) VIOKASE (pancrelipase) ULTRASE (pancrelipase) ZENPEP (pancrelipase)NR PROTON PUMP INHIBITORS DEXILANT formerly KAPIDEX (dexlansoprazole) ACIPHEX (rabeprazole) omeprazole RX lansoprazole PREVACID SOLU-TAB (lansoprazole) NEXIUM (esomeprazole) pantoprazole PREVACID Rx (lansoprazole) PRILOSEC (omeprazole) ULCERATIVE COLITIS AGENTS ORAL APRISO (mesalamine) LIALDA (mesalamine) ASACOL (mesalamine) ASACOL HD (mesalamine) balsalazide DIPENTUM (olsalazine) PENTASA (mesalamine) sulfasalazine RECTAL CANASA (mesalamine) SFROWASA (mesalamine) mesalamine IMMUNOLOGIC CYTOKINE AND CAM CIMZIA (certolizumab) AMEVIVE (alefacept) Amevive, Orencia, AGENTS ANTAGONISTS ENBREL (etanercept) ORENCIA (abatacept) Remicade and Stelara are for HUMIRA (adalimumab) REMICADE (infliximab) administration in KINERET (anakinra) SIMPONI (golimumab) hospital or clinic STELARA (ustekinumab)NR setting. PA will not be issued at Point of Sale without justification.
Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 13 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES INFECTIOUS ANTIBIOTICS, GI ALINIA (nitazoxanide) FLAGYL ER (metronidazole) DISEASE metronidazole tinadazole neomycin VANCOCIN (vancomycin) TINDAMAX (tinadazole) XIFAXAN (rifaximin)
ANTIBIOTICS, VAGINAL CLEOCIN OVULES (clindamcyin) CLINDESSE (clindamycin)
clindamycin
metronidazole
VANDAZOLE (metronidazole)
ANTIFUNGALS, ORAL clotrimazole ANCOBON (flucytosine)
fluconazole GRIFULVIN V (griseofulvin)
GRIS-PEG (griseofulvin) itraconazole
ketoconazole LAMISIL (terbinafine)
nystatin NOXAFIL (posaconazole)
terbinafine TERBINEX Kit
(terbinafine/ciclopirox)NR
VFEND (voriconazole)
ANTIVIRALS, ORAL – acyclovir famciclovir
ANTIHERPETIC AGENTS valacyclovir
VALTREX
CEPHALOSPORINS AND BETA LACTAM/BETA-LACTAMASE INHIBITOR COMBINATIONS RELATED ANTIBIOTICS amoxicillin/clavulanate
AUGMENTIN 125 and 250 (amoxicillin/clavulanate)
Suspension
AUGMENTIN 250 mg (amoxicillin/ clavulanate)
Chewable Tablets
AUGMENTIN XR (amoxicillin/clavulanate)
CEPHALOSPORINS – First Generation
cefadroxil
cephalexin
INFECTIOUS CEPHALOSPORINS AND DISEASE CEPHALOSPORINS – Second Generation RELATED ANTIBIOTICS (CONTINUED) (CONTINUED) cefaclor
cefprozil
cefuroxime
CEPHALOSPORINS – Third Generation cefdinir suspension (for patients <18 yr only) CEDAX (ceftibuten) SUPRAX (cefixime) cefdinir capsules
Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 14 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES cefpodoxime SPECTRACEF (cefditoren)
FLUOROQUINOLONES, ORAL AVELOX (moxifloxacin) ciprofloxacin ER ciprofloxacin tablets CIPRO (ciprofloxacin) FACTIVE (gemifloxacin) LEVAQUIN (levofloxacin) NOROXIN (norfloxacin) ofloxacin PROQUIN XR (ciprofloxacin) HEPATITIS C TREATMENTS PEGASYS (peginterferon alfa-2a) INFERGEN (interferon alfacon-1) Peg-Intron will be PEG-INTRON (peginterferon alfa-2b) approved for patients with
history of treatment failure and/or <18 yr of age MACROLIDES/ KETOLIDES
KETOLIDES KETEK (telithromycin)
MACROLIDES
azithromycin clarithromycin ER clarithromycin IR ZMAX (azithromycin) erythromycin TETRACYCLINES doxycycline ADOXA CK (doxycycline) minocycline IR ADOXA TT (doxycycline) tetracycline demeclocycline minocycline ER NUTRIDOX (doxycycline) ORACEA (doxycycline) SOLODYN (minocycline)
NEPHROLOGIC ERYTHROPOIESIS ARANESP (darbepoetin) EPOGEN (rHuEPO) AGENTS STIMULATING PROTEINS PROCRIT (rHuEPO)
PHOSPHATE BINDERS ELIPHOS (calcium acetate) FOSRENOL (lanthanum)
PHOSLO (calcium acetate)
calcium acetate
RENAGEL (sevelamer HCl) RENVELA (sevelamer carbonate) NUTRITIONALS CALORIC AGENTS BOOST COMPLEAT
Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 15 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES BRIGHT BEGINNINGS EO28 SPLAST CARNATION INSTANT BREAKFAST FIBERSOURCE DUOCAL ISOSOURCE ENSURE JEVITY JUVEN KINDERCAL NUTREN PROMOTE OSMOLITE TOLEREX PEDIASURE VITAL POLYCOSE PROMOD RESOURCE TWOCAL HN OPHTHALMICS OPHTHALMIC AZASITE (azithromycin) BESIVANCE (besifloxacin) ANTIBIOTICS bacitracin CILOXAN (ciprofloxacin) bacitracin/polymyxin ciprofloxacin erythromycin NATACYN (natamycin) gentamicin ofloxacin IQUIX (levofloxacin) QUIXIN (levofloxacin) polymyxin/trimethoprim ZYMAR (gatifloxacin) sulfacetamide tobramycin TOBREX (tobramycin) Ointment triple antibiotic VIGAMOX (moxifloxacin)
OPHTHALMICS OPHTHALMIC dexamethasone ACULAR LS (ketorolac) (continued) ANTIINFLAMMATORIES diclofenac ACULAR PF (ketorolac) FLAREX (fluorometholone) DUREZOL (difluprednate) flurbiprofen PRED MILD (prednisolone) FML FORTE (fluorometholone) XIBROM (bromfenac) FML SOP (fluorometholone)
ketotifen OTC
LOTEMAX (loteprednol) MAXIDEX (dexamethasone) NEVANAC (nepafenac) VEXOL (rimexolone) OPHTHALMICS FOR ALLERGIC ALREX (loteprednol) ACULAR (ketorolac) CONJUNCTIVITIS cromolyn ACUVAIL (ketorolac)NR ELESTAT (epinastine) ALAMAST (pemirolast)
Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 16 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES EMADINE (emedastine) ALOCRIL (nedocromil) ketotifen ALOMIDE (lodoxamide) OPTIVAR (azelastine) BEPREVE (bepotastine) PATADAY (olopatadine) PATANOL (olopatadine) OPHTHALMICS, GLAUCOMA AZOPT (brinzolamide) ALPHAGAN P (brimonidine) AGENTS betaxolol BETOPTIC S (betaxolol) BETIMOL (timolol) LUMIGAN (bimatoprost) brimonidine carteolol COMBIGAN (brimonidine/timolol) COSOPT (dorzolamide/timolol) dipivefrin dorzolamide dorzolamide/timolol ISTALOL (timolol) levobunolol metipranolol pilocarpine timolol TRAVATAN/TRAVATAN Z (travoprost) TRUSOPT (dorzolamide) XALATAN (latanoprost) OTICS OTIC ANTIBIOTICS CETRAXAL (ciprofloxacin) CIPRO HC CIPRODEX (ciprofloxacin/dexamethasone) (ciprofloxacin/hydrocortisone) COLY-MYCIN S (colistin/neomycin/ hydrocortisone) ofloxacin CORTISPORIN-TC (colistin/neomycin/ hydrocortisone) neomycin/polymyxin/hydrocortisone
RESPIRATORY ANTIHISTAMINES-FIRST brompheniramine ALDEX AN (doxylamine) GENERATION brompheniramine/diphenhydramine CONEX (brompheniramine) carbinoxamine DIPHENMAX (diphenhydramine) chlorpheniramine J-TAN (brompheniramine) clemastine J-TAN PD (brompheniramine) cyproheptadine
Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 17 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES dexchlorpheniramine diphenhydramine doxylamine MYCI CHLOR-TAN (chlorpheniramine) triprolidine VAZOL (brompheniramine) ANTIHISTAMINES-FIRST ALAHIST LQ (phenylephrine/diphenhydramine) ACCUHIST (pseudoephedrine/ GENERATION/ chlorpheniramine) DALLERGY drops (phenylephrine/chlorpheniramine) DECONGESTANT phenylephrine/brompheniramine ALLERDUR (pseudoephedrine/ COMBINATIONS dexchlorpheniramine) phenylephrine/chlorpheniramine ALERSULE (phenylephrine/ phenylephrine/diphenhydramine chlorpheniramine) phenylephrine/phenyltoloxamine/chlorpheniramine ALLERTAN(phenylephrine/pyrilamine/
phenylephrine/promethazine chlorpheniramine)
phenylephrine/pyrilamine ALLERX (phenylephrine/
phenylephrine/pyrilamine/chlorpheniramine chlorpheniramine)
POLY TAN D BROMFED (pseudoephedrine/ (pseudoephedrine/pyrilamine/brompheniramine) brompheniramine) pseudoephedrine/brompheniramine BROMFED-PD (pseudoephedrine/ pseudoephedrine/chlorpheniramine brompheniramine) pseudoephedrine/dexchlorpheniramine DALLERGY-JR pseudoephedrine/triprolidine (phenylephrine/chlorpheniramine) RYNESA 12S (phenylephrine/pyrilamine) DECONSAL CT (phenylephrine/pyrilamine)
DISOPHROL (pseudoephedrine/ dexbrompheniramine)
DURATUSS DA (pseudoephedrine/ chlorpheniramine) HISTEX (pseudoephedrine/ chlorpheniramine) HISTEX SR (pseudoephedrine/ brompheniramine) J-TAN D (pseudoephedrine/ brompheniramine)
J-TAN D PD (pseudoephedrine/
brompheniramine)
RESPIRATORY ANTIHISTAMINES-FIRST GENERATION/ MYCI CHLORPED D (CONTINUED) (phenylephrine/chlorpheniramine) DECONGESTANT
COMBINATIONS NY-TANNIC (phenylephrine/chlorpheniramine) (CONTINUED) PEDIATAN D (phenylephrine/chlorpheniramine) Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 18 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES PHENA-PLUS (phenylephrine/ pyrilamine/chlorpheniramine) PHENA-S (phenylephrine/pyrilamine/ chlorpheniramine)
PHENA-S 12 (phenylephrine/
pyrilamine/chlorpheniramine)
POLY HIST FORTE (phenylephrine/ pyrilamine/chlorpheniramine) POLY HIST PD (phenylephrine/ pyrilamine/chlorpheniramine) RESCON-JR (phenylephrine/chlorpheniramine) RYNA 12 S (phenylephrine/pyrilamine) RYNA-12 (phenylephrine/pyrilamine) RYNATAN (phenylephrine/chlorpheniramine)
RYNATAN PEDIATRIC (phenylephrine/chlorpheniramine) SERADEX-LA (phenylephrine/brompheniramine) SUDAL 12 (pseudoephedrine/ chlorpheniramine) TIBAMINE LA (pseudoephedrine/ chlorpheniramine) TUSSANIL (phenylephrine/chlorpheniramine)
VAZOBID
(phenylephrine/brompheniramine)
VAZOTAB (phenylephrine/brompheniramine) VIRAVAN-P (pseudoephedrine/pyrilamine) ANTIHISTAMINES-FIRST brompheniramine/pseudoephedrine ALLERX 10 (pseudoephedrine/ GENERATION/DECONGESTANT/ chlorpheniramine/phenylephrine/methscopolamine methscopolamine/ chlorpheniramine/phenylephrine) ANTICHOLINERGIC DALLERGY COMBINATIONS (chlorpheniramine/ phenylephrine/methscopolamine) ALLERX 30 (pseudoephedrine/ methscopolamine/ RESPIRATORY phenylephrine/chlorpheniramine/belladonna alkaloids chlorpheniramine/phenylephrine) (CONTINUED) ANTIHISTAMINES-FIRST phenylephrine/dexchlorpheniramine/ ALLERX PE (phenylephrine/ GENERATION/DECONGESTANT/ methscopolamine chlorpheniramine/ ANTICHOLINERGIC pseudoephedrine/chlorpheniramine/methscopolamine methscopolamine) COMBINATIONS pseudoephedrine/dexchlorpheniramine/methscopolamine DALLERGY PE (chlorpheniramine/ (CONTINUED) pseudoephedrine/methscopolamine/chlorpheniramine/ phenylephrine/methscopolamine) Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 19 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES phenylephrine DALLERGY (pseudoephedrine/ chlorpheniramine/ methscopolamine)
DURAHIST (pseudoephedrine/
chlorpheniramine/ methscopolamine) DURAHIST D (pseudoephedrine/ dexchlorpheniramine/ methscopolamine) DURAHIST PE (phenylephrine/ chlorpheniramine/ methscopolamine)
DURATAN PE (phenylephrine/ chlorpheniramine/ methscopalamine) EXTENDRYL chew tab (phenylephrine/ chlorpheniramine/ methcopolamine)
EXTENDRYL JR (phenylephrine/
chlorpheniramine/ methscopolamine) EXTENDRYL SR (phenylephrine/ chlorpheniramine/ methscopolamine) EXTENDRYL syrup (phenylephrine/ dexchlorpheniramine/
methscopolamine)
RESCON (pseudoephedrine/ chlorpheniramine) TIME-HIST QD (pseudoephedrine/ chlorpheniramine/ methscopolamine) VISRX (pseudoephedrine/ RESPIRATORY chlorpheniramine/ methscopolamine) (CONTINUED) ANTIHISTAMINES-MINIMALLY cetirizine CLARINEX (desloratadine) *Xyzal will be SEDATING loratadine fexofenadine approved for patients failing XYZAL (levocetirizine)* therapy with cetirizine, loratadine or fexofenadine.
Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 20 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES ANTIHISTAMINES- cetirizine/pseudoephedrine CLARINEX-D (desloratadine/ MINIMALLY SEDATING/ loratadine/pseudoephedrine pseudoephedrine) DECONGESTANT SEMPREX-D (acrivastine/pseudoephedrine) fexofenadine/pseudoephedrine COMBINATIONS
DECONGESTANT/ pseudoephedrine/methscopolamine ALLERX-D (pseudoephedrine/
ANTICHOLINERGIC methscopolamine)
COMBINATIONS EXTENDRYL PEM (phenylephrine/ methscopolamine) EXTENDRYL PSE (pseudoephedrine/ methscopolamine) BRONCHODILATORS, ANTICHOLINERGICS ANTICHOLINERGIC ATROVENT HFA (ipratropium) ipratropium SPIRIVA (tiotropium)
ANTICHOLINERGIC-BETA AGONIST COMBINATIONS
COMBIVENT (albuterol/ipratropium) albuterol/ipratropium
BRONCHODILATORS, BETA INHALERS, SHORT-ACTING AGONIST VENTOLIN HFA (albuterol) MAXAIR (pirbuterol)
PROAIR HFA (albuterol)
PROVENTIL HFA (albuterol)
XOPENEX HFA (levalbuterol)
INHALERS, LONG ACTING
FORADIL (formoterol) SEREVENT (salmeterol)
INHALATION SOLUTION albuterol BROVANA (arformoterol) metaproterenol PERFOROMIST (formoterol) XOPENEX (levalbuterol)
RESPIRATORY BRONCHODILATORS, BETA (CONTINUED) ORAL AGONIST
(CONTINUED) albuterol metaproterenol terbutaline GLUCOCORTICOIDS, INHALED GLUCOCORTICOIDS
Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 21 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES AEROBID (flunisolide) ALVESCO (ciclosinide) AEROBID-M (flunisolide) ASMANEX (mometasone) budesonide FLOVENT Diskus (fluticasone) FLOVENT HFA (fluticasone) PULMICORT (budesonide) Respules PULMICORT (budesonide) Flexhaler QVAR (beclomethasone) GLUCOCORTICOID/BRONCHODILATOR COMBINATIONS ADVAIR Diskus (fluticasone/salmeterol) ADVAIR HFA (fluticasone/salmeterol) SYMBICORT (budesonide/formoterol) INTRANASAL RHINITIS AGENTS ANTICHOLINERGICS Ipratropium
ANTIHISTAMINES
ASTEPRO (azelastine) ASTELIN (azelastine)
PATANASE (olaptadine)
CORTICOSTEROIDS flunisolide BECONASE AQ (beclomethasone) NASAREL (flunisolide) FLONASE (fluticasone) NASONEX (mometasone) fluticasone VERAMYST (fluticasone) NASACORT AQ (triamcinolone) OMNARIS (ciclesonide) RHINOCORT AQUA (budesonide) LEUKOTRIENE MODIFIERS ACCOLATE (zafirlukast) ZYFLO CR (zafirlukast) SINGULAIR (montelukast)
UROLOGICAL BLADDER RELAXANT DETROL LA (tolterodine) DETROL (tolterodine) PREPARATIONS ENABLEX (darifenacin) oxybutynin ER GELNIQUE (oxybutynin) OXYTROL (oxybutynin) oxybutynin IR SANCTURA XR (trospium) TOVIAZ (fesoterodine fumurate) SANCTURA (trospium) VESICARE (solifenacin) Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 22 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients. MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective July 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES BPH AGENTS ALPHA BLOCKERS doxazosin CARDURA XL (doxazosin) FLOMAX RAPAFLO (silodosin) tamsulosin terazosin UROXATRAL (alfuzosin) 5-ALPHA-REDUCTASE (5AR) INHIBITORS AVODART (dutasteride) finasteride
Unless otherwise stated, the listing of a particular brand or generic name includes all dosage forms of that drug. NR indicates a new drug that has not yet been reviewed by the 23 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients.