MedStar Family Choice - Maryland HealthChoice Prescribing Guide 2020 (710) (10/01/2020) INTRODUCTION .............................................................................................................................................................................. 5 NONDISCRIMINATION STATEMENT ............................................................................................................................................. 5 PREFACE ......................................................................................................................................................................................... 7 PHARMACY AND THERAPEUTICS (P&T) COMMITTEE .............................................................................................................. 8 PRODUCT SELECTION CRITERIA ................................................................................................................................................. 8 GENERIC AVAILABILITY ................................................................................................................................................................ 8 GENERIC SUBSTITUTION .............................................................................................................................................................. 8 MAIL SERVICE PRESCRIPTIONS .................................................................................................................................................. 9 MEDICAL EXCEPTION .................................................................................................................................................................... 9 PRIOR AUTHORIZATION (PA) ....................................................................................................................................................... 9 Drugs requiring Prior Authorization ............................................................................................................................................. 9 MANAGED DRUG LIMITATIONS (MDL) ....................................................................................................................................... 10 STEP THERAPY (ST) .................................................................................................................................................................... 12 OVER-THE-COUNTER (OTC) DRUG COVERAGE ...................................................................................................................... 13 EDITOR .......................................................................................................................................................................................... 16 NOTICE .......................................................................................................................................................................................... 16 LEGEND ......................................................................................................................................................................................... 17 ANALGESICS ................................................................................................................................................................................ 18 NSAIDs .................................................................................................................................................................................. 18 NSAIDs, TOPICAL ................................................................................................................................................................ 18 COX-2 INHIBITORS .............................................................................................................................................................. 18 GOUT .................................................................................................................................................................................... 18 OPIOID ANALGESICS .......................................................................................................................................................... 18 NON-OPIOID ANALGESICS ................................................................................................................................................. 19 VISCOSUPPLEMENTS......................................................................................................................................................... 19 ANTI-INFECTIVES ......................................................................................................................................................................... 19 ANTIBACTERIALS ................................................................................................................................................................ 20 ANTIFUNGALS ..................................................................................................................................................................... 21 ANTIMALARIALS .................................................................................................................................................................. 21 ANTIRETROVIRAL AGENTS................................................................................................................................................ 21 ANTITUBERCULAR AGENTS .............................................................................................................................................. 22 ANTIVIRALS ......................................................................................................................................................................... 22 MISCELLANEOUS ................................................................................................................................................................ 23 ANTINEOPLASTIC AGENTS ........................................................................................................................................................ 23 ALKYLATING AGENTS ........................................................................................................................................................ 23 ANTIMETABOLITES ............................................................................................................................................................. 23 HORMONAL ANTINEOPLASTIC AGENTS .......................................................................................................................... 23 KINASE INHIBITORS ............................................................................................................................................................ 24 TOPOISOMERASE INHIBITORS ......................................................................................................................................... 25 MISCELLANEOUS ................................................................................................................................................................ 25 1 CARDIOVASCULAR ...................................................................................................................................................................... 25 ACE INHIBITORS ................................................................................................................................................................. 25 ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS.................................................................................. 26 ACE INHIBITOR/DIURETIC COMBINATIONS ..................................................................................................................... 26 ADRENOLYTICS, CENTRAL ................................................................................................................................................ 26 ALDOSTERONE RECEPTOR ANTAGONISTS.................................................................................................................... 26 ALPHA BLOCKERS .............................................................................................................................................................. 26 ANGIOTENSIN II RECEPTOR ANTAGONISTS/DIURETIC COMBINATIONS .................................................................... 26 ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER COMBINATIONS ................................... 27 ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER/DIURETIC COMBINATIONS ................. 27 ANTIARRHYTHMICS ............................................................................................................................................................ 27 ANTILIPEMICS ..................................................................................................................................................................... 27 BETA-BLOCKERS ................................................................................................................................................................ 28 BETA-BLOCKER/DIURETIC COMBINATIONS .................................................................................................................... 28 CALCIUM CHANNEL BLOCKERS.......................................................................................................................................