Florida Medicaid Brand Drug Preferred List*

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FLORIDA MEDICAID BRAND DRUG PREFERRED LIST* Brand Name Generic Name Advair Diskus for inhalation fluticasone/salmeterol diskus Aggrenox capsules aspirin/dipyridamole Albenza tablets albendazole Androgel gel pack/pump** testosterone Avelox tablets** moxifloxacin Azactam vials aztreonam Benicar/Benicar-HCT tablets** olmesartan/olmesartan-HCTZ Bicnu vials carmustine Biltricide tablets praziquantel Butrans patch** buprenorphine transdermal Catapres TTS patch clonidine patch ER Cellcept suspension mycophenolate mofetil Cipro suspension (250mg/5ml & 500mg/5ml) ciprofloxacin Copaxone syringes 20mg glatiramer accetate/Glatopa Derma-Smoothe-FS oil fluocinolone 0.01% oil Differin cream and lotion adapalene erythromycin ethylsuccinate E.E.S. 200mg/5ml suspension - New addition suspension Elidel 1% cream pimecrolimus Emend capsules aprepitant Exelon patch rivastigmine transdermal Finacea GEL 15% azelaic acid Focalin XR capsules dexmethylphenidate hcl Gleevec tablets imatinib Mesylate Glyset tablets miglitol Humalog vial insulin lispro vial Kitabis Pak tobramycin pak Lamictal Dose Pak lamotrigine dose pak Lescol capsules / Lescol XL tablets** fluvastatin ER Letairis tablets** ambrisentan Lialda 1.2g tablets** mesalamine 1.2 g Lotemax 0.5% drops - New addition loteprednol 0.5% drops Makena single dose vial & auto inj** hydroxyprogesterone caproate vial Mephyton tablets phytonadione tablets Micardis and Micardis HCT tablets** telmisartan and telmisartan HCT Natroba suspension spinosad Norvir tablets ritonavir tablets Prevacid ODT lansoprazole ODT Proair and Proventil HFA Inhalers albuterol sulfate HFA inhalers Protopic ointment tacrolimus Ranexa ER tablets ranolazine ER Rapamune solution sirolimus solution Relpax tablets** eletriptan Renagel tablets sevelamer HCL tablets Renvela Powder Packet sevelamer carbonate powder pack Retin-A cream tretinoin cream Suboxone Film** buprenorphine/naloxone film Suprax capsules - New addition cefixime capsules Symbyax capsules** olanzapine/fluoxetine Tamiflu capsules and suspension oseltamivir Tasmar tablets** tolcapone Tikosyn capsules dofetilide caps Tobi nebulizers tobramycin nebs Tobradex drops suspension tobramycin/dexamethasone Transderm Scop patches** scopolamine Tribenzor tablets** olmesasartan-amlodipine-HCTZ Trizivir tablets abacavir/zidovudine/lamivudine Vagifem tablets estradiol Valstar vials valrubicin Vesicare tablets solifenacin Voltaren Gel 1% diclofenac gel 1% Xeloda tablets capecitabine Xopenex HFA** levalbuterol HFA Zavesca capsules miglustat Zovirax ointment and cream acyclovir ointment and cream Zytiga tablets abiraterone acetate *Drugs on the list have both, brand and generic formulations. When prescribed to Florida Medicaid recipients, the brand name formulation must be dispensed. ** Brand and generic formulations are NON-Preferred – Prior authorization required. If criteria is met, brand formulation will be approved. Drugs without ** do not require prior authorization..

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Azelaic Acid
Azelaic Acid (FINACEA) Topical Foam 15% National Drug Monograph August 2016 VA Pharmacy Benefits Management Services, Medical Advisory Panel, and VISN Pharmacist Executives The purpose of VA PBM Services drug monographs is to provide a focused drug review for making formulary decisions. Updates will be made when new clinical data warrant additional formulary discussion. Documents will be placed in the Archive section when the information is deemed to be no longer current. FDA Approval Information Description/Mechanism of Azelaic acid is a naturally occurring C9-dicarboxylic acid that is found in plants Action (such as whole grain cereals), animals and humans. Azelaic acid has antiinflammatory, antioxidative and antikeratinizing effects. In rosacea skin, azelaic acid decreases cathelicidin levels and kallikrein 5 (KLK5) activity and possibly inhibits toll-like receptor 2 (TLR2) expression.1 A 15% gel formulation has been marketed for rosacea, and 20% cream has been available for acne vulgaris. The newer foam formulation consists of an oil- in-water emulsion and was designed to have a higher lipid content than the gel for dry and sensitive skin. Indication(s) Under Review Topical treatment of inflammatory papules and pustules of mild to moderate in This Document rosacea. Dosage Form(s) Under Foam, 15% Review REMS REMS No REMS Postmarketing Requirements See Other Considerations for additional REMS information Pregnancy Rating Category B Executive Summary Efficacy There have been no head-to-head trials comparing the foam and gel formulations of azelaic acid in terms of safety, tolerability and efficacy in the treatment of papulopustular (PP) rosacea.. In two major randomized clinical trials, azelaic acid foam produced small benefits over vehicle foam in achieving Investigator’s Global Assessment (IGA) treatment success (NNTs of 9.2 and 11.5) and in reducing inflammatory lesion counts.
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Estonian Statistics on Medicines 2013 1/44
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