MedStar Family Choice - DC Healthy Families and DC Healthcare Alliance Prescribing Guide 2020 (10/01/2020) INTRODUCTION .............................................................................................................................................................................. 5 NONDISCRIMINATION STATEMENT ............................................................................................................................................. 5 PREFACE ....................................................................................................................................................................................... 10 PHARMACY AND THERAPEUTICS (P&T) COMMITTEE ............................................................................................................ 10 PRODUCT SELECTION CRITERIA ............................................................................................................................................... 10 GENERIC AVAILABILITY .............................................................................................................................................................. 10 GENERIC SUBSTITUTION ............................................................................................................................................................ 10 MAIL SERVICE PRESCRIPTIONS ................................................................................................................................................ 11 MEDICAL EXCEPTION .................................................................................................................................................................. 11 PRIOR AUTHORIZATION (PA) ..................................................................................................................................................... 11 Drugs requiring Prior Authorization ........................................................................................................................................... 11 MANAGED DRUG LIMITATIONS (MDL) ....................................................................................................................................... 12 STEP THERAPY (ST) .................................................................................................................................................................... 14 OVER-THE-COUNTER (OTC) DRUG COVERAGE ...................................................................................................................... 15 EDITOR .......................................................................................................................................................................................... 18 NOTICE .......................................................................................................................................................................................... 18 LEGEND ......................................................................................................................................................................................... 19 ANALGESICS ................................................................................................................................................................................ 20 NSAIDs .................................................................................................................................................................................. 20 NSAIDs, TOPICAL ................................................................................................................................................................ 20 COX-2 INHIBITORS .............................................................................................................................................................. 20 GOUT .................................................................................................................................................................................... 20 OPIOID ANALGESICS .......................................................................................................................................................... 20 NON-OPIOID ANALGESICS ................................................................................................................................................. 21 VISCOSUPPLEMENTS......................................................................................................................................................... 21 ANTI-INFECTIVES ......................................................................................................................................................................... 21 ANTIBACTERIALS ................................................................................................................................................................ 22 ANTIFUNGALS ..................................................................................................................................................................... 23 ANTIMALARIALS .................................................................................................................................................................. 23 ANTIRETROVIRAL AGENTS................................................................................................................................................ 23 ANTITUBERCULAR AGENTS .............................................................................................................................................. 23 ANTIVIRALS ......................................................................................................................................................................... 23 MISCELLANEOUS ................................................................................................................................................................ 24 ANTINEOPLASTIC AGENTS ........................................................................................................................................................ 24 ALKYLATING AGENTS ........................................................................................................................................................ 24 ANTIMETABOLITES ............................................................................................................................................................. 24 HORMONAL ANTINEOPLASTIC AGENTS .......................................................................................................................... 24 KINASE INHIBITORS ............................................................................................................................................................ 25 TOPOISOMERASE INHIBITORS ......................................................................................................................................... 26 MISCELLANEOUS ................................................................................................................................................................ 26 1 CARDIOVASCULAR ...................................................................................................................................................................... 26 ACE INHIBITORS ................................................................................................................................................................. 26 ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS .................................................................................. 27 ACE INHIBITOR/DIURETIC COMBINATIONS ..................................................................................................................... 27 ADRENOLYTICS, CENTRAL ................................................................................................................................................ 27 ALDOSTERONE RECEPTOR ANTAGONISTS .................................................................................................................... 27 ALPHA BLOCKERS .............................................................................................................................................................. 27 ANGIOTENSIN II RECEPTOR ANTAGONISTS/DIURETIC COMBINATIONS .................................................................... 27 ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER COMBINATIONS ................................... 28 ANGIOTENSIN II RECEPTOR ANTAGONIST/CALCIUM CHANNEL BLOCKER/DIURETIC COMBINATIONS ................. 28 ANTIARRHYTHMICS ............................................................................................................................................................ 28 ANTILIPEMICS ..................................................................................................................................................................... 28 BETA-BLOCKERS ................................................................................................................................................................ 29 BETA-BLOCKER/DIURETIC COMBINATIONS .................................................................................................................... 29 CALCIUM CHANNEL BLOCKERS.......................................................................................................................................