McLaren Health Advantage Drug Formulary September 2019 Key * Generic Available AG Age Limits F Females Only M Males Only OTC Over the Counter P Preventive PA Prior Authorization QL Quantity Limit SP Specialty Pharmacy ST Step Therapy MHA20190104 G-3245 Beecher Road • Flint, Michigan • 48532 tel (888) 327-0671 • fax (833) 540-8648 McLarenHealthPlan.org Rev. 9/2019 Table of Contents Allergy.......................................................................................................................................................................................3 Antiemesis/Antivertigo..............................................................................................................................................................7 Asthma And Copd.................................................................................................................................................................... 9 Autonomic Nervous System Disorders...................................................................................................................................18 Behavioral Health - Antidepressants...................................................................................................................................... 19 Behavioral Health - Other.......................................................................................................................................................24 Cardiovascular Disease - Arrhythmia..................................................................................................................................... 37 Cardiovascular Disease - Cardiac Stimulant.......................................................................................................................... 37 Cardiovascular Disease - Hypertension................................................................................................................................. 37 Cardiovascular Disease - Lipid Irregularity.............................................................................................................................47 Cardiovascular Disease - Miscellaneous Agents................................................................................................................... 54 Cardiovascular Disease - Vasodilation...................................................................................................................................54 Contraception/Oxytocics.........................................................................................................................................................55 Cough And Cold..................................................................................................................................................................... 65 Dermatology - Acne................................................................................................................................................................69 Dermatology - Antiinfective.....................................................................................................................................................72 Dermatology - Antiinflammatory............................................................................................................................................. 76 Dermatology - Antipruritic Drugs............................................................................................................................................ 81 Dermatology - Miscellaneous................................................................................................................................................. 81 Dermatology - Psoriasis/Eczema........................................................................................................................................... 87 Diabetes................................................................................................................................................................................. 89 Ear - General Disorders..........................................................................................................................................................99 Electrolyte Regulation...........................................................................................................................................................100 Endocrine Disorder - Fertility................................................................................................................................................ 102 Endocrine Disorder - Other...................................................................................................................................................104 Endocrine Disorder - Thyroid................................................................................................................................................109 Eye - General Disorders.......................................................................................................................................................110 Eye - Glaucoma....................................................................................................................................................................115 Eye - Miscellaneous............................................................................................................................................................. 119 Fluid Replacement................................................................................................................................................................119 Gout And Related Diseases................................................................................................................................................. 119 Hematological Disorders...................................................................................................................................................... 120 Hormonal Deficiency............................................................................................................................................................ 129 Immunization........................................................................................................................................................................ 133 Immunosuppression/Modulation...........................................................................................................................................136 Infectious Disease - Bacterial...............................................................................................................................................137 Infectious Disease - Fungal..................................................................................................................................................145 Infectious Disease - Miscellaneous...................................................................................................................................... 146 Infectious Disease - Parasitic............................................................................................................................................... 148 Infectious Disease - Viral......................................................................................................................................................149 Inflammatory Disease...........................................................................................................................................................154 Local Anesthesia.................................................................................................................................................................. 162 Lower Gastrointestinal Disorders - Bowel Inflammat............................................................................................................163 1 Lower Gastrointestinal Disorders - Other............................................................................................................................. 165 Medical Supplies.................................................................................................................................................................. 167 Miscellaneous Agents...........................................................................................................................................................185 Neoplastic Disease...............................................................................................................................................................187 Neurological Disease - Miscellaneous..................................................................................................................................199 Oral/Pharyngeal Disorders................................................................................................................................................... 201 Other Drugs..........................................................................................................................................................................201 Other Respiratory Disorders.................................................................................................................................................214 Pain Management - Analgesics............................................................................................................................................215 Parkinsons