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ACNE AGENTS, TOPICAL ‡ ANGIOTENSIN MODULATOR COMBINATIONS ANTICONVULSANTS, CONT. CONNECTICUT MEDICAID (STEP THERAPY CATEGORY) AMLODIPINE / BENAZEPRIL (ORAL) LAMOTRIGINE CHEW DISPERS TAB (not ODT) (ORAL) (DX CODE REQUIRED - DIFFERIN, EPIDUO and RETIN-A) AMLODIPINE / OLMESARTAN (ORAL) LAMOTRIGINE TABLET (IR) (not ER) (ORAL) Preferred Drug List (PDL) ACNE MEDICATION LOTION (BENZOYL PEROXIDE) (TOPICAL)AMLODIPINE / VALSARTAN (ORAL) LEVETIRACETAM SOLUTION, IR TABLET (not ER) (ORAL) • The Connecticut Medicaid Preferred Drug List (PDL) is a BENZOYL PEROXIDE CREAM, WASH (not FOAM) (TOPICAL) OXCARBAZEPINE TABLET (ORAL) listing of prescription products selected by the BENZOYL PEROXIDE 5% and 10% GEL (OTC) (TOPICAL) ANTHELMINTICS PHENOBARBITAL ELIXIR, TABLET (ORAL) Pharmaceutical and Therapeutics Committee as efficacious, BENZOYL PEROXIDE 6% CLEANSER (OTC) (TOPICAL) ALBENDAZOLE TABLET (ORAL) PHENYTOIN CHEW TABLET, SUSPENSION (ORAL) safe and cost effective choices when prescribing for HUSKY CLINDAMYCIN PH 1% PLEGET (TOPICAL) BILTRICIDE TABLET (ORAL) PHENYTOIN SOD EXT CAPSULE (ORAL) A, HUSKY C, HUSKY D, Tuberculosis (TB) and Family CLINDAMYCIN PH 1% SOLUTION (not GEL or LOTION) (TOPICAL)IVERMECTIN TABLET (ORAL) PRIMIDONE (ORAL) Planning (FAMPL) clients. CLINDAMYCIN / BENZOYL PEROXIDE 1.2%-5% (DUAC) (TOPICAL) SABRIL 500 MG POWDER PACK (ORAL) • Preferred or Non-preferred status only applies to DIFFERIN 0.1% CREAM (TOPICAL) (not OTC GEL) (DX CODE REQ.) ANTI-ALLERGENS, ORAL SABRIL TABLET (ORAL) those medications that fall within the drug classes DIFFERIN 0.1% LOTION (TOPICAL) (DX CODE REQ.) All agents require non-PDL PA TEGRETOL SUSPENSION (ORAL) listed on this PDL DIFFERIN 0.3% GEL PUMP (TOPICAL) (DX CODE REQ.) TEGRETOL XR (ORAL) • HIV medications are excluded from the PDL and do EPIDUO FORTE 0.3-2.5% GEL PUMP (TOPICAL) (DX CODE REQ.)* ANTIBIOTICS, GI TOPIRAMATE SPRINKLE CAPSULE (ORAL) not require prior authorization ERYTHROMYCIN 2% SOLUTION (not GEL) (TOPICAL) FIRVANQ SOLUTION (ORAL) TOPIRAMATE TABLET (not ER) (ORAL) • The brand-name of a generically available medication PANOXYL 10% ACNE FOAMING WASH (OTC) (TOPICAL) METRONIDAZOLE TABLET (not CAPSULE) (ORAL) TRILEPTAL SUSPENSION (ORAL) will not be covered without a PA, unless the brand is RETIN-A CREAM (TOPICAL) (DX CODE REQ.) TINIDAZOLE TABLET (ORAL)* VALPROIC ACID CAPSULE, SOLUTION (ORAL) listed on the PDL RETIN-A GEL (not MICRO)(TOPICAL) (DX CODE REQ.) VANCOMYCIN CAPSULE (ORAL)* VIMPAT SOLUTION, TABLET (not STARTER KIT) (ORAL) ANTIBIOTICS, INHALED ZONISAMIDE CAPSULE (ORAL) • Preferred brand-name medications with non- ALZHEIMER'S AGENTS BETHKIS AMPULE (INHALATION) preferred generic equivalents are listed in BOLD DONEPEZIL ODT (ORAL) KITABIS PAK 300 MG/5 ML (INHALATION) ANTIDEPRESSANTS, OTHER • DX CODE REQUIRED NOTATION will appear for DONEPEZIL 5MG & 10MG TABLET (not 23MG) (ORAL) TOBI PODHALER 28MG INHALE CAPSULE (INHALATION) BUPROPION TABLET (ORAL) preferred agents that require ICD-10 code for EXELON PATCH (TRANSDERMAL) BUPROPION SR, BUPROPION XL (NOT 450MG) (ORAL) reimbursement MEMANTINE IR TABLET (not ER CAPSULES) (ORAL) ANTIBIOTICS, TOPICAL DESVENLAFAXINE SUC ER (generic PRISTIQ) (ORAL) HUSKY Therapeutic Class ICD-10 Diagnosis List MEMANTINE 5-10MG TITRATION PACK (ORAL) GENTAMICIN 0.1% CREAM (TOPICAL) MIRTAZAPINE TABLET, ODT (ORAL) • UPDATED NOTATIONS: CHEWABLE notation will RIVASTIGMINE CAPSULES (ORAL) GENTAMICIN 0.1% OINTMENT (TOPICAL) TRAZODONE TABLET (ORAL) appear for preferred agents ANALGESICS, NARCOTICS SHORT MUPIROCIN 2% OINTMENT (not CREAM) (TOPICAL) TRINTELLIX (BRINTELLIX) (ORAL) ** New Therapeutic Class added to PDL effective 7/1/21 APAP / CODEINE 300-30 MG/12.5 ML SOLUTION (ORAL) VENLAFAXINE ER CASPULES (not TABLET) (ORAL) * New Drug added to the PDL effective 7/1/21 APAP / CODEINE 120-12 MG/5 ML SOLUTION (ORAL) ANTIBIOTICS, VAGINAL VIIBRYD TABLET (not STARTER PACK) (ORAL) Non - PDL PA Requirements APAP / CODEINE #2, #3, #4 TABLET (ORAL) CLEOCIN OVULES (VAGINAL) CONNECTICUT MEDICAID PDL PA FORM HYDROCODONE / APAP SOLUTION (ORAL) CLINDESSE 2% CREAM (VAGINAL) • Intolerance of the preferred agents HYDROCODONE / APAP TABLET (ORAL) METRONIDAZOLE VAGINAL 0.75% GEL (VAGINAL)* ANTIDEPRESSANTS, SSRIs • Adverse reaction to the preferred agents HYDROMORPHONE TABLET (IR) (ORAL) NUVESSA VAGINAL 1.3% GEL (VAGINAL) CITALOPRAM TABLET, SOLUTION (ORAL) • Inadequate response from the preferred agents MORPHINE CONC, SOLUTION, SYRUP (ORAL) ESCITALOPRAM TABLET, SOLUTION (ORAL) • Determined medically necessary appropriate MORPHINE IR TABLET (ORAL) ANTICOAGULANTS FLUOXETINE 20 MG/5 ML SOLUTION (ORAL) • Absence of appropriate formulation of the preferred OXYCODONE / APAP CAPSULE, TABLET (ORAL) ELIQUIS STARTER PACK (ORAL) FLUOXETINE CAPSULE (not 90 MG) (ORAL) agent OXYCODONE TABLET (not CAPSULE) (ORAL) ELIQUIS TABLET (ORAL) FLUOXETINE TABLET (ORAL) 10 MG only Step Therapy PA Requirements OXYCODONE 5 MG/5 ML SOLUTION (ORAL) ENOXAPARIN SYRINGE (SUBCUTANEOUS) FLUVOXAMINE TABLET (IR) (ORAL) STEP THERAPY PA FORM PROLATE TABLET (ORAL) ENOXAPARIN VIAL (SUBCUTANEOUS) PAROXETINE TABLET (IR only) (ORAL) ‡ Agents from the following FIVE categories: TRAMADOL 50 MG TABLET (not 100 MG) (ORAL) PRADAXA CAPSULE (ORAL) SERTRALINE TABLET, ORAL CONC (ORAL) ACNE AGENTS, TOPICAL, ANTIMIGRAINE TRAMADOL / APAP (ORAL) WARFARIN TABLET (ORAL) AGENTS, CYTOKINE/CAM ANTAGONISTS, XARELTO TABLET (ORAL) LIPOTROPICS, STATINS, PROTON PUMP ANDROGENIC AGENTS XARELTO STARTER PACK (ORAL) ANTIEMETIC / ANTIVERTIGO AGENTS INHIBITORS ANDROGEL 1.62% GEL PUMP (TRANSDERMAL)* APREPITANT CAPSULE (not PACK) (ORAL) Important Connecticut Medicaid Phone Numbers ANTICONVULSANTS DICLEGIS (ORAL) ANGIOTENSIN MODULATORS CARBAMAZEPINE TAB CHEW, TABLET (ORAL) DRONABINOL CAPSULE (ORAL) Gainwell Technologies Pharmacy Prior Authorization Center BENAZEPRIL TABLET (ORAL)* CARBATROL (ORAL) EMEND 80 MG CAPSULE (not TRIPACK) (ORAL)* Phone #: 1-866-409-8386 (toll-free) Fax #: 1-866-759-4110 (toll-free) DIOVAN TABLET (ORAL) CLOBAZAM TABLET (ORAL) ONDANSETRON ODT, SOLUTION, TABLET (ORAL) ENALAPRIL, ENALAPRIL / HCTZ (ORAL) CLONAZEPAM IR TABLET (not ODT or ER) (ORAL) PA forms are available on our website: ENTRESTO TABLET (ORAL) DEPAKOTE SPRINKLE (ORAL) http://www.CTDSSMAP.com IRBESARTAN, IRBESARTAN / HCTZ (ORAL) DIAZEPAM (RECTAL) (generic DIASTAT) ANTIFUNGALS, ORAL Navigate to: Pharmacy Information LISINOPRIL, LISINOPRIL / HCTZ (ORAL) DIAZEPAM DEVICE (RECTAL) (generic DIASTAT ACUDIAL) CLOTRIMAZOLE 10 MG TROCHE (MUCOUS MEM) or: information > publications > forms LOSARTAN, LOSARTAN / HCTZ (ORAL) DIVALPROEX ER (ORAL) FLUCONAZOLE SUSPENSION, TABLET (ORAL) Gainwell Technologies Provider Assistance Center OLMESARTAN, OLMESARTAN / HCTZ (ORAL)* DIVALPROEX SOD DR TABLET (ORAL) GRISEOFULVIN SUSPENSION (not TABLET) (ORAL) 1-800-842-8440 (toll-free) QUINAPRIL, QUINIPRIL / HCTZ (ORAL) EPIDIOLEX (ORAL) NOXAFIL DR 100 MG TABLET (ORAL)* Dept of Social Services Rx Consultant RAMIPRIL CAPSULE (ORAL) ETHOSUXIMIDE CAPSULE, SOLUTION (ORAL) NYSTATIN SUSPENSION (not TABLET) (ORAL) 1-860-424-5150 VALSARTAN / HCTZ (ORAL) GABITRIL TABLET (ORAL) TERBINAFINE TABLET (ORAL) Updated September 8, 2021 ANTIFUNGALS, TOPICAL ANTIPARKINSON'S AGENTS, CONT. ANTIVIRALS, TOPICAL BRONCHODILATORS, BETA AGONIST, CONT. CLOTRIMAZOLE 1% CREAM (RX and OTC) (TOPICAL) CARBIDOPA / LEVODOPA / ENTACAPONE TABLET (ORAL) ZOVIRAX 5% CREAM (TOPICAL) PROAIR HFA (INHALATION) CLOTRIMAZOLE 1% SOLUTION (RX ONLY) (TOPICAL) PRAMIPEXOLE (IR) (ORAL) ZOVIRAX 5% OINTMENT (TOPICAL) SEREVENT DISKUS (INHALATION) CLOTRIMAZOLE-BETAMETHASONE CREAM (TOPICAL) ROPINIROLE (IR) (ORAL) KETOCONAZOLE CREAM (TOPICAL) SELEGILINE CAPSULE, TABLET (ORAL) ANXIOLYTICS CALCIUM CHANNEL BLOCKERS KETOCONAZOLE 2% SHAMPOO (TOPICAL) TRIHEXYPHENIDYL ELIXIR, TABLET (ORAL) ALPRAZOLAM IR TABLET (not ER or ODT) (ORAL) AMLODIPINE TABLET (ORAL) MICONAZOLE 2% CREAM (OTC) (TOPICAL) BUSPIRONE TABLET (ORAL) DILTIAZEM 12HR ER CAPSULE (ORAL) MICONAZOLE POWDER (not POWDER SPRAY) (OTC) (TOPICAL) CHLORDIAZEPOXIDE CAPSULE (ORAL) DILTAIZEM 24HR ER CAPSULE (not TABLET) (ORAL) NYSTATIN CREAM, OINTMENT, POWDER (TOPICAL) ANTIPSORIATICS, ORAL DIAZEPAM 5 MG/5 ML SOLUTION (not 5 MG/ML CONC) (ORAL)DILTIAZEM TABLET (ORAL) NYSTATIN-TRIAMCINOLONE CREAM, OINTMENT (TOPICAL)* ACITRETIN CAPSULE (ORAL) DIAZEPAM TABLET (ORAL) FELODIPINE ER (ORAL) ANTIHISTAMINES, MINIMALLY SEDATING LORAZEPAM TABLET, 2MG/ML INTENSOL (ORAL) NIFEDIPINE ER (ORAL) CETIRIZINE SOFTGEL (not TABLETS) (OTC) (ORAL) ANTIPSORIATICS, TOPICAL VERAPAMIL TABLET (ORAL) CETIRIZINE SOLUTION, SYRUP (RX ONLY) (ORAL) CALCIPOTRIENE 0.005% OINTMENT, SOLUTION (TOPICAL) BETA-BLOCKERS VERAPAMIL TABLET ER TABLET (not CAPSULE) (ORAL) CETIRIZINE-D TABLET (OTC) (ORAL) DOVONEX 0.005% CREAM (TOPICAL) ATENOLOL TABLET (ORAL) FEXOFENADINE 30 MG/5 ML SUSP (OTC) (ORAL) TACLONEX OINTMENT (TOPICAL) ATENOLOL / CHLORTHALIDONE (ORAL) CEPHALOSPORINS AND RELATED ANTIBIOTICS FEXOFENADINE-D TABLET (OTC) (ORAL) VECTICAL 3 MCG/G OINTMENT (TOPICAL) BISOPROLOL (ORAL) AMOXICILLIN / CLAV SUSPENSION (ORAL) LEVOCETIRIZINE TABLETS (RX & OTC) (ORAL) CARVEDILOL TABLET (not ER) (ORAL) AMOXICILLIN / CLAV TABLET (not CHEW TAB or ER) (ORAL) LORATADINE SOLUTION, SYRUP (OTC) (ORAL) ANTIPSYCHOTICS LABETALOL TABLET (ORAL) CEFACLOR CAPSULE (not SUSPENSION) (ORAL) LORATADINE OTC TABLET (not ODT) (ORAL) ABILIFY MAINTENA ER (INTRAMUSC.) METOPROLOL TARTRATE (ORAL) CEFADROXIL CAPSULE, SUSPENSION (not TABLET) (ORAL) ADASUVE (INHALATION) METOPROLOL SUCCINATE ER (ORAL) CEFDINIR CAPSULE, SUSPENSION (ORAL) ANTIHYPERTENSIVES, SYMPATHOLYTICS ARIPIPRAZOLE SOLUTION, TABLET (not ODT) (ORAL)
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    PATIENT & CAREGIVER EDUCATION Ketoconazole (Systemic) This information from Lexicomp® explains what you need to know about this medication, including what it’s used for, how to take it, its side effects, and when to call your healthcare provider. Brand Names: Canada APO-Ketoconazole; Ketoconazole-200; TEVA-Ketoconazole Warning This drug is not for use to treat certain types of fungal infections. This includes fungal infections of the skin, nails, or brain. Talk with the doctor. This drug must only be used when other drugs cannot be used or have not worked. Talk with your doctor to be sure that the benefits of this drug are more than the risks. Very bad and sometimes deadly liver problems like the need for a liver transplant have happened with this drug. Some people did not have a raised chance of liver problems before taking this drug. Most of the time, but not always, liver problems have gone back to normal after this drug was stopped. Call your doctor right away if you have signs of liver problems like dark urine, feeling tired, not hungry, upset stomach or stomach pain, light-colored stools, throwing up, or yellow skin or eyes. Blood tests will be needed to watch for any liver problems. Talk with your doctor. Taking this drug with certain other drugs may raise the chance of very bad and sometimes deadly heart problems like a heartbeat that is not normal. Do not take this drug if you are taking any of these drugs: Cisapride, disopyramide, dofetilide, dronedarone, methadone, pimozide, quinidine, or ranolazine. Ketoconazole (Systemic) 1/6 What is this drug used for? It is used to treat fungal infections.
  • Treatment of Peripheral Precocious Puberty

    Treatment of Peripheral Precocious Puberty

    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by IUPUIScholarWorks Treatment of Peripheral Precocious Puberty Melissa Schoelwer, MD and Erica A Eugster, MD Section of Pediatric Endocrinology, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana Send correspondence to: 705 Riley Hospital Drive, Room 5960 Indianapolis, IN 46202 Phone: 317-944-3889 Fax: 317-944-3882 Email: [email protected] __________________________________________________________________________________________ This is the author's manuscript of the article published in final edited form as: Schoelwer, M., & Eugster, E. A. (2016). Treatment of Peripheral Precocious Puberty. In Puberty from Bench to Clinic (Vol. 29, pp. 230-239). Karger Publishers. http://dx.doi.org/10.1159/000438895 Peripheral Precocious Puberty Abstract There are many etiologies of peripheral precocious puberty (PPP) with diverse manifestations resulting from exposure to androgens, estrogens, or both. The clinical presentation depends on the underlying process and may be acute or gradual. The primary goals of therapy are to halt pubertal development and restore sex steroids to prepubertal values. Attenuation of linear growth velocity and rate of skeletal maturation in order to maximize height potential are additional considerations for many patients. McCune-Albright syndrome (MAS) and Familial Male-Limited Precocious Puberty (FMPP) represent rare causes of PPP that arise from activating mutations in GNAS1 and the LH receptor gene, respectively. Several different therapeutic approaches have been investigated for both conditions with variable success. Experience to date suggests that the ideal therapy for precocious puberty secondary to MAS in girls remains elusive. In contrast, while the number of treated patients remains small, several successful therapeutic options for FMPP are available.
  • California Essential Drug List

    California Essential Drug List

    California Essential Drug List The Essential Drug List (formulary) includes a list of drugs covered by Health Net. The drug list is updated at least monthly and is subject to change. All previous versions are no longer in effect. You can view the most current drug list by going to our website at www.healthnet.com. Refer to Evidence of Coverage or Certificate of Insurance for specific cost share information. For California Individual & Family Plans: Drug Lists Select Health Net Large Group – Formulary (pdf). For Small Business Group: Drug Lists Select Health Net Small Business Group – Formulary (pdf). NOTE: To search the drug list online, open the (pdf) document. Hold down the “Control” (Ctrl) and “F” keys. When the search box appears, type the name of your drug and press the “Enter” key. If you have questions or need more information call us toll free. California Individual & Family Plans (off-Exchange) If you have questions about your pharmacy coverage call Customer Service at 1-800-839-2172 California Individual & Family Plans (on-Exchange) If you have questions about your pharmacy coverage call Customer Service at 1-888-926-4988 Hours of Operation 8:00am – 7:00pm Monday through Friday 8:00am – 5:00pm Saturday Small Business Group If you have questions about your pharmacy coverage call Customer Service at 1-800-361-3366 Hours of Operation 8:00am – 6:00pm Monday through Friday Updated September 1, 2021 Health Net of California, Inc. and Health Net Life Insurance Company are subsidiaries of Health Net, LLC and Centene Corporation. Health Net is a registered service mark of Health Net, LLC Table of Contents What If I Have Questions Regarding My Pharmacy Benefit? ...................................