MISSISSIPPI DIVISION OF MEDICAID PREFERRED DRUG LIST Effective January 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) DURAGESIC MATRIX (fentanyl) ANALGESICS, NARCOTIC- acetaminophen/codeine butalbital/APAP/caffeine/codeine All short-acting SHORT-ACTING aspirin/codeine butalbital/ASA/caffeine/codeine oxycodone- containing tablets/ codeine DARVON-N (propoxyphene) capsules are limited dihydrocodeine/ APAP/caffeine DILAUDID liquid (hydromorphone) to 62 total hydrocodone/APAP fentanyl cumulative units of hydrocodone/ibuprofen FENTORA (fentanyl) all/any strengths hydromorphone levorphanol per month. Oxycodone oral IBUDONE (hydrocodone/ibuprofen) NUCYNTA (tapentadol) liquid is limited to NR meperidine ONSOLIS (fentanyl) 180 total cumulative morphine OPANA (oxymorphone) milliliters of all/any oxycodone pentazocine/naloxone strengths per month. Any quantity oxycodone/APAP propoxyphene required above
oxycodone/aspirin REPREXAIN these limits requires oxycodone/ibuprofen (hydrocodone/ibuprofen) a PA. pentazocine/APAP ZAMICET (hydrocodone/APAP) propoxyphene/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
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 January 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES ANALGESICS ANTIMIGRAINE AGENTS, ORAL TRIPTANS (continued) IMITREX (sumatriptan) AMERGE (naratriptan) RELPAX (eletriptan) AXERT (almotriptan) sumatriptan FROVA (frovatriptan) TREXIMET (sumatriptan/naproxen) MAXALT (rizatriptan) ZOMIG (zolmitriptan)
NASAL
IMITREX (sumatriptan) ZOMIG (zolmitriptan)
sumatriptan
INJECTABLE IMITREX (sumatriptan) SUMAVEL (sumatriptan)NR sumatriptan FIBROMYALGIA AGENTS LYRICA (pregabalin) CYMBALTA (duloxetine) Cymbalta will be SAVELLA (milnacipran) approved for patients with diabetic neuropathy and a history of treatment failure with LYRICA (pregabalin) NSAIDS NONSELECTIVE diclofenac meclofenamate etodolac mefenamic acid
fenoprofen nabumetone flurbiprofen tolmetin
ibuprofen ZIPSOR (diclofenac) indomethacin ketoprofen ketorolac naproxen oxaprozin piroxicam sulindac
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 January 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES ANALGESICS NSAIDS (CONTINUED) NSAID/GI PROTECTANT COMBINATIONS (continued) ARTHROTEC (diclofenac/misoprostol) PREVACID NAPRAPAC (naproxen/lansoprazole) COX-II SELECTIVE meloxicam CELEBREX (celecoxib) SKELETAL MUSCLE baclofen AMRIX (cyclobenzaprine ER) RELAXANTS chlorzoxazone carisoprodol cyclobenzaprine carisoprodol compound dantrolene FEXMID (cyclobenzaprine) methocarbamol orphenadrine tizanidine orphenadrine compound SKELAXIN (metaxolone) SOMA (carisoprodol) ZANAFLEX (tizanidine) CARDIOVASCULAR ANGIOTENSIN ACE INHIBITORS MODULATORS ACEON (perindopril) perindopril
benazepril
captopril
enalapril
fosinopril
lisinopril
moexepril
quinapril
ramipril
trandolapril
ACE INHIBITOR/DIURETIC COMBINATIONS
benazepril/HCTZ
captopril/HCTZ
enalapril/HCTZ
fosinopril/HCTZ
lisinopril/HCTZ
moexepril/HCTZ
quinapril/HCTZ
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 January 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES CARDIOVASCULAR ANGIOTENSIN ANGIOTENSIN RECEPTOR BLOCKERS MODULATORS (CONTINUED) (CONTINUED) AVAPRO (irbesartan) ATACAND (candesartan)
BENICAR (olmesartan) TEVETEN (eprosartan) COZAAR (losartan) DIOVAN (valsartan) MICARDIS (telmisartan)
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)NR
ANGIOTENSIN MODULATOR/ ACE INHIBITOR/CCB COMBINATIONS CCB COMBINATIONS benazepril/amlodipine TARKA (trandolapril/verapamil) ANGIOTENSIN RECEPTOR BLOCKER/CCB COMBINATIONS AZOR (olmesartan/amlodipine) TWYNSTA (telmisartan/amlodipine)NR EXFORGE (valsartan/amlodipine) EXFORGE HCT (valsartan/amlodipine/HCTZ)
ANTICOAGULANTS, ARIXTRA (fondaparinux) INNOHEP (tinzaparin)
INJECTABLE FRAGMIN (dalteparin)
LOVENOX (enoxaparin)
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 January 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES CARDIOVASCULAR BETA-BLOCKERS BETA BLOCKERS (CONTINUED) acebutolol LEVATOL (penbutolol) atenolol betaxolol bisoprolol BYSTOLIC (nebivolol) INNOPRAN XL (propranolol) metoprolol metopolol XL nadolol pindolol propranolol sotalol timolol
BETA- AND ALPHA- BLOCKERS
carvedilol COREG CR (carvedilol)
labetalol
BETA BLOCKER / DIURETIC COMBINATIONS atenolol/chlorthalidone bisoprolol/HCTZ metoprolol/HCTZ nadolol/bendroflumethiazide propranolol/HCTZ timolol/HCTZ
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 January 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES CARDIOVASCULAR CALCIUM CHANNEL SHORT-ACTING BLOCKERS (CONTINUED) 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 fenofibric acid TRICOR (fenofibrate) FENOGLIDE (fenofibrate) TRILIPIX (fenofibric acid) FIBRICOR (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 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 January 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) SIMCOR (simvastatin/niacin) VYTORIN (simvastatin/ezetimibe) PLATELET AGGREGATION AGGRENOX (dipyridamole/aspirin) EFFIENT (prasugrel) INHIBITORS dipyridamole ticlopidine PLAVIX (clopidogrel) PULMONARY ARTERIAL LETAIRIS (ambrisentan) ADCIRCA (tadalafil) HYPERTENSION AGENTS REVATIO (sildenafil) TRACLEER (bosentan) 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)
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 January 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES CNS ANTICONVULSANTS ADJUVANTS (CONTINUED) (CONTINUED) 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) gabapentin GABITRIL (tiagabine) LAMICTAL ODT (lamotrigine) LAMICTAL XR (lamotrigine) lamotrigine levetiracetam oxcarbazepine TEGRETOL XR (carbamazepine) topiramate TRILEPTAL Suspension (oxcarbazepine) valproic acid zonisamide
ANTIDEPRESSANTS, bupropion APLENZIN (buproprion HBr)
OTHERS 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 automatically approved for fluvoxamine PEXEVA (paroxetine) adolescents (age LUVOX CR (fluvoxamine) PROZAC WEEKLY (fluoxetine) 12-17) paroxetine IR
sertraline
ANTIPARKINSON’S AGENTS ANTICHOLINERGICS benztropine trihexyphenidyl
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 January 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES CNS ANTIPARKINSON’S AGENTS COMT INHIBITORS (CONTINUED) (CONTINUED) COMTAN (entacapone) TASMAR (tolcapone)
DOPAMINE AGONISTS
ropinirole MIRAPEX (pramipexole)
NEUPRO (rotigotine)
REQUIP XL (ropinirole)
MAO-B INHIBITORS selegiline AZILECT (rasagiline) ZELAPAR (selegiline) OTHERS
levodopa/carbidopa
STALEVO (levodopa/carbidopa/entacapone)
ANTIPSYCHOTICS ORAL NR 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
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 January 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES CNS ANTIPSYCHOTICS INJECTABLE, ATYPICALS (CONTINUED) (CONTINUED) ABILIFY (aripiprazole) GEODON (ziprasidone) INVEGA SUSTENNA (paliperidone palmitate) RISPERDAL CONSTA (risperidone) ZYPREXA (olanzapine)
MULTIPLE SCLEROSIS AVONEX (interferon beta-1a)
AGENTS BETASERON (interferon beta-1b)
COPAXONE (glatiramer)
EXTAVIA (interferon beta-1b)
REBIF (interferon beta-1a)
SEDATIVE HYPNOTICS BENZODIAZEPINES Single source
benzodiazepines estazolam and barbiturates
flurazepam are NOT covered; temazepam PAs will not be triazolam issued for these drugs. OTHERS Sedative/Hypnotics LUNESTA (eszopiclone) AMBIEN CR (zolpidem) are limited to 31 ROZEREM (ramelteon) EDLUAR (zolpidem) cumulative units of zaleplon all/any strengths per month. Any zolpidem quantity required
above these limits requires a PA.
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 January 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES CNS STIMULANTS AND RELATED STIMULANTS - SHORT ACTING Prior authorization AGENTS required for patients (CONTINUED) amphetamine salt combination DESOXYN (methamphetamine) ≥21 yrs of age. dexmethylphenidate IR PROCENTRA (dextroamphetamine) 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 for clindamycin AKNE-MYCIN (erythromycin) patients less than
erythromycin CLINDAGEL (clindamycin) 21 years of age. CLINDAREACH (clindamycin) EVOCLIN (clindamycin) sulfacetamide
RETINOIDS
RETIN-A MICRO (tretinoin) ATRALIN (tretinoin)
DIFFERIN (adapalene)
EPIDUO
(adapalene/benzoyl peroxide)
TAZORAC (tazarotene)
tretinoin
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 January 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES DERMATOLOGICAL ACNE AGENTS, TOPICAL OTHERS (CONTINUED) (CONTINUED) 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) NR SE BPO (benzoyl peroxide) sodium sulfacetamide/sulfur/meratan ZIANA (clindaymcyin/tretinoin) ANTIFUNGALS, TOPICAL ANTIFUNGALS ciclopirox cream/gel/suspension BENSAL HP clotrimazole (benzoic acid/salicylic acid) econazole ciclopirox lotion/shampoo/solution 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
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 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 January 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES DERMATOLOGICAL STEROIDS, TOPICAL LOW POTENCY (CONTINUED) CAPEX (fluocinolone) alclometasone desonide DERMA-SMOOTHE-FS (fluocinolone) hydrocortisone DESONATE (desonide) DESOWEN (desonide) PEDIADERM HC (hydrocortisone)NR SCALACORT DK (hydrocortisone) VERDESO (desonide) MEDIUM POTENCY fluocinolone CLODERM (clocortolone) fluticasone CORDRAN (flurandrenolide) hydrocortisone CUTIVATE (fluticasone) LUXIQ (betamethasone) mometasone MOMEXIN (mometasone) prednicarbate HIGH POTENCY betamethasone valerate amcinonide fluocinonide desoximetasone triamcinolone diflorasone 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) BONE RESORPTION BISPHOSPHONATES SUPPRESSION AND ACTONEL (risedronate) BONIVA (ibandronate) RELATED AGENTS ACTONEL WITH CALCIUM (risedronate/calcium)
alendronate
FOSAMAX PLUS D (alendronate/vitamin D)
FOSAMAX Solution (alendronate)
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 January 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES ENDOCRINE BONE RESORPTION OTHERS SUPPRESSION AND (CONTINUED) EVISTA (raloxifene) FORTEO (teriparatide) RELATED AGENTS FORTICAL (calcitonin) (CONTINUED) MIACALCIN (calcitonin) calcitonin salmon GROWTH HORMONE GENOTROPIN (somatropin) HUMATROPE (somatropin) Prior authorization NUTROPIN (somatropin) NORDITROPIN (somatropin) required for patients ≥18 yrs of age. NUTROPIN AQ (somatropin) OMNITROPE (somatropin) SAIZEN (somatropin) SEROSTIM (somatropin) TEV-TROPIN (somatropin) ZORBTIVE (somatropin) HYPOGLYCEMICS, BYETTA (exenatide) SYMLIN (pramlintide) INCRETIN MIMETICS/ JANUMET (sitagliptin/metformin) ENHANCERS JANUVIA (sitagliptin) ONGLYZA (saxagliptin) HYPOGLYCEMICS, INSULIN LANTUS (insulin glargine) APIDRA (insulin glulisine) AND RELATED AGENTS LEVEMIR (insulin detemir) HUMALOG (insulin lispro) (INCLUDES VIALS AND NOVOLIN (insulin) HUMALOG MIX PENS) NOVOLOG (insulin aspart) (insulin lispro/lispro protamine) NOVOLOG MIX (insulin aspart/aspart protamine) HUMULIN (insulin) HYPOGLYCEMICS, nateglinide PRANDIMET (repaglinide/metformin) MEGLITINIDES PRANDIN (repaglinide) 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
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 January 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES GASTROINTESTINAL ANTIEMETICS (CONTINUED) 5HT3 RECEPTOR BLOCKERS All injectable 5HT3 receptor blockers (CONTINUED) ondansetron ANZEMET (dolasetron) closed to point of granisetron sale. SANCUSO (granisetron) 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) PANCREASE MT (pancrelipase) ZENPEP (pancrelipase)NR pancrelipase ULTRASE (pancrelipase) VIOKASE (pancrelipase) PROTON PUMP INHIBITORS KAPIDEX (dexlansoprazole) ACIPHEX (rabeprazole) lansoprazole NEXIUM (esomeprazole) omeprazole pantoprazole PREVACID Rx (lansoprazole) PRILOSEC (omeprazole) ULCERATIVE COLITIS ORAL AGENTS ASACOL (mesalamine) APRISO (mesalamine)
ASACOL HD (mesalamine) balsalazide DIPENTUM (olsalazine) LIALDA (mesalamine) PENTASA (mesalamine) sulfasalazine RECTAL CANASA (mesalamine) SFROWASA (mesalamine) mesalamine
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 January 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES 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. INFECTIOUS ANTIBIOTICS, GI ALINIA (nitazoxanide) FLAGYL ER (metronidazole) DISEASE metronidazole tinidazole neomycin VANCOCIN (vancomycin) TINDAMAX (tinidazole) XIFAXAN (rifaximin)
ANTIBIOTICS, VAGINAL CLEOCIN OVULES (clindamcyin) CLINDESSE (clindamycin)
clindamycin
metronidazole
VANDAZOLE (metronidazole)
ANTIFUNGALS, ORAL clotrimazole ANCOBON (flucytosine)
fluconazole GRIFULVIN V (griseofulvin)
griseofulvin itraconazole
GRIS-PEG (griseofulvin) LAMISIL (terbinafine)
ketoconazole NOXAFIL (posaconazole)
nystatin TERBINEX Kit NR terbinafine (terbinafine/ciclopirox)
VFEND (voriconazole)
ANTIVIRALS, ORAL – acyclovir famciclovir
ANTIHERPETIC AGENTS VALTREX (valacyclovir) valacyclovir
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
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 January 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES INFECTIOUS CEPHALOSPORINS – Second Generation DISEASE cefaclor cefprozil cefuroxime CEPHALOSPORINS – Third Generation cefdinir suspension (for patients <18 yr only) CEDAX (ceftibuten) SUPRAX (cefixime) cefdinir capsules cefpodoxime SPECTRACEF (cefditoren) FLUOROQUINOLONES, AVELOX (moxifloxacin) ciprofloxacin ER ORAL 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 <3 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)
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 January 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES PHOSPHATE BINDERS ELIPHOS (calcium acetate) RENVELA (sevelamer carbonate) FOSRENOL (lanthanum) PHOSLO (calcium acetate) calcium acetate RENAGEL (sevelamer HCl) NUTRITIONALS CALORIC AGENTS BOOST COMPLEAT 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)
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 January 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES OPHTHALMICS OPHTHALMIC dexamethasone ACULAR LS (ketorolac) (continued) ANTIINFLAMMATORIES diclofenac ACULAR PF (ketorolac) FLAREX (fluorometholone) ACUVAIL (ketorolac)NR flurbiprofen DUREZOL (difluprednate) fluorometholone ketorolac LS FML FORTE (fluorometholone) PRED MILD (prednisolone) FML SOP (fluorometholone) XIBROM (bromfenac) LOTEMAX (loteprednol) MAXIDEX (dexamethasone) NEVANAC (nepafenac) VEXOL (rimexolone) OPHTHALMICS FOR ALREX (loteprednol) ALAMAST (pemirolast) ALLERGIC CONJUNCTIVITIS cromolyn ALOCRIL (nedocromil) ELESTAT (epinastine) ALOMIDE (lodoxamide) EMADINE (emedastine) BEPREVE (bepotastine) ketotifen OTC ketorolac OPTIVAR (azelastine) PATADAY (olopatadine) PATANOL (olopatadine) OPHTHALMICS, GLAUCOMA AZOPT (brinzolamide) BETOPTIC S (betaxolol) AGENTS betaxolol brimonidine P 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)
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 January 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES 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 GENERATION brompheniramine ALA-HIST (brompheniramine/ brompheniramine/diphenhydramine diphenhydramine) carbinoxamine ALDEX AN (doxylamine) chlorpheniramine CONEX (brompheniramine) clemastine DIPHENMAX (diphenhydramine) cyproheptadine J-TAN (brompheniramine) dexchlorpheniramine J-TAN PD (brompheniramine) diphenhydramine doxylamine MYCI CHLORPED (chlorpheniramine) MYCI CHLOR-TAN (chlorpheniramine) PEDIATAN (chlorpheniramine) POLY TAN (pyrilamine/dexbrompheniramine) P-TEX (brompheniramine) triprolidine VAZOL (brompheniramine)
ANTIHISTAMINES-FIRST GENERATION/DECONGESTANT COMBINATIONS
ALA-HIST D (brompheniramine/ ACCUHIST (pseudoephedrine/
diphenhydramine/phenylephrine) chlorpheniramine)
ALAHIST LQ (phenylephrine/diphenhydramine) ALLERDUR (pseudoephedrine/
DALLERGY drops (phenylephrine/chlorpheniramine) dexchlorpheniramine)
NALDEX (phenylephrine/dexchlorpheniramine) ALERSULE (phenylephrine/ chlorpheniramine) phenylephrine/brompheniramine ALLERTAN(phenylephrine/pyrilamine/ phenylephrine/chlorpheniramine chlorpheniramine) phenylephrine/diphenhydramine ALLERX (phenylephrine/ phenylephrine/phenyltoloxamine/chlorpheniramine chlorpheniramine) phenylephrine/promethazine BROMFED (pseudoephedrine/ phenylephrine/pyrilamine brompheniramine)
phenylephrine/pyrilamine/chlorpheniramine BROMFED-PD (pseudoephedrine/
POLY TAN D brompheniramine) (pseudoephedrine/pyrilamine/brompheniramine) DALLERGY-JR (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 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 January 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES RESPIRATORY pseudoephedrine/brompheniramine DECONSAL CT (continued) pseudoephedrine/chlorpheniramine (phenylephrine/pyrilamine) pseudoephedrine/dexchlorpheniramine DISOPHROL (pseudoephedrine/ dexbrompheniramine) pseudoephedrine/triprolidine DURATUSS DA (pseudoephedrine/ RYNESA 12S (phenylephrine/pyrilamine) chlorpheniramine)
HISTEX (pseudoephedrine/ chlorpheniramine) HISTEX SR (pseudoephedrine/ brompheniramine) J-TAN D (pseudoephedrine/ brompheniramine) J-TAN D PD (pseudoephedrine/ brompheniramine) MYCI CHLORPED D (phenylephrine/chlorpheniramine)
NY-TANNIC (phenylephrine/chlorpheniramine) PEDIATAN D (phenylephrine/chlorpheniramine) 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)
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 January 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES RESPIRATORY SUDAL 12 (pseudoephedrine/ (continued) chlorpheniramine) TIBAMINE LA (pseudoephedrine/ chlorpheniramine)
TUSSANIL
(phenylephrine/chlorpheniramine)
VAZOBID (phenylephrine/brompheniramine) VAZOTAB (phenylephrine/brompheniramine) VIRAVAN-P (pseudoephedrine/pyrilamine) ANTIHISTAMINES-FIRST GENERATION/DECONGESTANT/ANTICHOLINERGIC COMBINATIONS brompheniramine/pseudoephedrine ALLERX 10 (pseudoephedrine/ chlorpheniramine/phenylephrine/methscopolamine methscopolamine/ chlorpheniramine/phenylephrine) DALLERGY (chlorpheniramine/ phenylephrine/methscopolamine) ALLERX 30 (pseudoephedrine/ methscopolamine/ phenylephrine/chlorpheniramine/belladonna alkaloids chlorpheniramine/phenylephrine) phenylephrine/dexchlorpheniramine/ ALLERX PE (phenylephrine/ methscopolamine chlorpheniramine/ pseudoephedrine/chlorpheniramine/methscopolamine methscopolamine) pseudoephedrine/dexchlorpheniramine/methscopolamine DALLERGY PE (chlorpheniramine/ pseudoephedrine/methscopolamine/chlorpheniramine/ phenylephrine/methscopolamine) phenylephrine DALLERGY (pseudoephedrine/ chlorpheniramine/
methscopolamine)
DURAHIST (pseudoephedrine/ chlorpheniramine/ methscopolamine) DURAHIST D (pseudoephedrine/ dexchlorpheniramine/ methscopolamine) DURAHIST PE (phenylephrine/ chlorpheniramine/ methscopolamine) DURATAN PE (phenylephrine/ chlorpheniramine/ methscopalamine)
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 January 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES RESPIRATORY EXTENDRYL chew tab (continued) (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/ chlorpheniramine/
methscopolamine)
ANTIHISTAMINES-MINIMALLY SEDATING
cetirizine CLARINEX (desloratadine) *Xyzal will be approved for loratadine fexofenadine patients failing XYZAL (levocetirizine)* therapy with cetirizine, loratadine or fexofenadine. ANTIHISTAMINES-MINIMALLY SEDATING/DECONGESTANT COMBINATIONS cetirizine/pseudoephedrine CLARINEX-D (desloratadine/ loratadine/pseudoephedrine pseudoephedrine) SEMPREX-D (acrivastine/pseudoephedrine) fexofenadine/pseudoephedrine
DECONGESTANT/ANTICHOLINERGIC COMBINATIONS
pseudoephedrine/methscopolamine ALLERX-D (pseudoephedrine/ methscopolamine)
EXTENDRYL PEM (phenylephrine/ methscopolamine) EXTENDRYL PSE (pseudoephedrine/ 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 23 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 January 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES RESPIRATORY BRONCHODILATORS, ANTICHOLINERGICS ANTICHOLINERGIC (continued) ATROVENT HFA (ipratropium) ipratropium SPIRIVA (tiotropium)
ANTICHOLINERGIC-BETA AGONIST COMBINATIONS
COMBIVENT (albuterol/ipratropium) albuterol/ipratropium
BRONCHODILATORS, BETA INHALERS, SHORT-ACTING AGONIST albuterol MAXAIR (pirbuterol)
PROAIR HFA (albuterol) XOPENEX HFA (levalbuterol) PROVENTIL HFA (albuterol) VENTOLIN HFA (albuterol) INHALERS, LONG ACTING
FORADIL (formoterol) SEREVENT (salmeterol)
INHALATION SOLUTION albuterol BROVANA (arformoterol) levalbuterol metaproterenol PERFOROMIST (formoterol) ORAL albuterol metaproterenol terbutaline
GLUCOCORTICOIDS, GLUCOCORTICOIDS INHALED AEROBID (flunisolide) ALVESCO (ciclosinide) AEROBID-M (flunisolide) budesonide respules ASMANEX (mometasone) PULMICORT (budesonide) Flexhaler AZMACORT (triamcinolone) FLOVENT Diskus (fluticasone) FLOVENT HFA (fluticasone) PULMICORT (budesonide) Respules QVAR (beclomethasone) GLUCOCORTICOID/BRONCHODILATOR COMBINATIONS ADVAIR Diskus (fluticasone/salmeterol) ADVAIR HFA (fluticasone/salmeterol) SYMBICORT (budesonide/formoterol) 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 24 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 January 1, 2010 BODY SYSTEM THERAPEUTIC CLASS PREFERRED AGENTS NON-PREFERRED AGENTS NOTES RESPIRATORY INTRANASAL RHINITIS ANTICHOLINERGICS AGENTS (continued) Ipratropium
ANTIHISTAMINES
ASTELIN (azelastine) ASTEPRO (azelastine) azelastine PATANASE (olaptadine) CORTICOSTEROIDS FLONASE (fluticasone) BECONASE AQ (beclomethasone) flunisolide NASACORT AQ (triamcinolone) fluticasone OMNARIS (ciclesonide) NASAREL (flunisolide) RHINOCORT AQUA (budesonide) NASONEX (mometasone) VERAMYST (fluticasone) LEUKOTRIENE MODIFIERS ACCOLATE (zafirlukast) ZYFLO CR (zafirlukast) SINGULAIR (montelukast) UROLOGICAL BLADDER RELAXANT DETROL LA (tolterodine) DETROL (tolterodine) PREPARATIONS ENABLEX (darifenacin) GELNIQUE (oxybutynin) oxybutynin IR oxybutynin ER OXYTROL (oxybutynin) TOVIAZ (fesoterodine fumurate) SANCTURA (trospium) VESICARE (solifenacin) SANCTURA XR (trospium) BPH AGENTS ALPHA BLOCKERS doxazosin CARDURA XL (doxazosin) FLOMAX (tamsulosin) RAPAFLO (silodosin) 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 25 P&T Committee. See separate Antihistamine/Decongestant Product and Active Ingredient Cross-Reference List for complete list of product names and active ingredients.