Microsoft word - nv_pdl o080508-n082008.doc

STATE OF NEVADA
DIVISION OF HEALTH CARE FINANCING AND POLICY
Nevada Medicaid Preferred Drug List
ANALGESICS: Long Acting
ANTIBIOTICS:
ANTIHISTAMINES: 2nd Generation
CARDIOVASCULAR:
CARDIOVASCULAR: Beta Blockers
Narcotics
Quinolones 3rd Generation
A two week trial of one of these drugs is Angiotensin II Receptor Blockers &
ACEBUTOLOL (generic Sectral®)
DURAGESIC® PATCHES (PA required)
AVELOX®
required before a non-preferred drug will Diuretic Combination
ATENOLOL (generic Tenormin®)
KADIAN®
AVELOX ABC PACK®
COZAAR®
ATENOLOL/CHLORTHALIDONE
MORPHINE SULFATE SA TABS
ANTICOAGULANTS: Injectable
CETIRIZINE D OTC
DIOVAN®
(generic Tenoretic®)
(generic MS Contin®)
(generic Zyrtec D®) (new)
ARIXTRA®
DIOVAN HCTZ®
BETAXOLOL (generic Kerlone®)
ORAMORPH SR®
CETIRIZINE OTC TABS, CHEW TABS
FRAGMIN®
HYZAAR®
BISOPROLOL (generic Zebeta®)
AND SYRUP (generic Zyrtec®) (new)
ANTIBIOTICS:
LOVENOX®
BISOPROLOL/HCTZ (generic Ziac®)
CLARINEX® SYRUP
CARDIOVASCULAR:
Cephalosporins 2nd Generation
BYSTOLIC®
ANTIDEPRESSANTS: Other
(PA not required for < 2 years)
Antihyperlipidemics: Cholesterol
(Restricted to
CEFACLOR CAPS & SUSP
BUPROPION (generic Wellbutrin®)
LORATADINE OTC TABS, SYRUP, &
Absorption Inhibitors
ICD-9 codes 490-496)
(generic Ceclor®)
BUPROPION SR
RAPID DISINTEGRATING TABS
CARVEDILOL
CEFACLOR ER
are effective
(generic Wellbutrin SR®)
(generic Claritin®) Class changes
(generic Coreg®)
(generic Ceclor CD®) 09/25/08.
CARDIOVASCULAR:
CYMBALTA® (PA not
LORATADINE D OTC are effective
LABETALOL
CEFUROXIME SUSP (generic Ceftin®) (new)
09/25/08.
Antihyperlipidemics: Niacin Agents
required for
(generic Claritin D®)
(generic Normodyne®, Trandate®)
CEFUROXIME TABS (generic Ceftin®)
ICD-9-CM code 356.9)
ANTI-MIGRAINE AGENTS: Triptans
NIASPAN®
METOPROLOL (generic Lopressor®)
CEFPROZIL SUSP (generic Cefzil®)
MIRTAZAPINE (generic Remeron®)
IMITREX® INJECTION
NIACIN ER
NADOLOL (generic Corgard®)
ANTIBIOTICS:
MIRTAZAPINE RAPID TABS
IMITREX® TABS & NASAL SPRAY
CARDIOVASCULAR:
PINDOLOL (generic Visken®)
(generic Remeron Soltabs®)
Antihyperlipidemics: Statins & Statin
Cephalosporins 3rd Generation
MAXALT® TABS
PROPRANOLOL (generic Inderal®)
TRAZODONE (generic Desyrel®)
CEDAX® CAPS & SUSP
MAXALT® MLT
WELLBUTRIN XL 150MG®
ADVICOR®
PROPRANOLOL/HCTZ
CEFDINIR CAPS & SUSP
RELPAX®
Class changes
(generic Inderide®)
WELLBUTRIN XL 300MG®
CRESTOR®
are effective
(generic Omnicef®)
BONE OSSIFICATIONS AGENTS:
09/25/08.
LESCOL®
CEFPODOXIME TABS
ANTIDEPRESSANTS: SSRIs
Bisphosphonates
(generic Betapace®, Sorine®)
(generic Vantin®)
CITALOPRAM (generic Celexa®)
LESCOL XL®
FOSAMAX® TABS & SOLUTION
TIMOLOL (generic Blocadren®)
FLUOXETINE (generic Prozac®)
LIPITOR® (new)
ANTIBIOTICS: Macrolides
FOSAMAX PLUS D®
PAROXETINE (generic Paxil®)
LOVASTATIN (generic Mevacor®)
AZITHROMYCIN TABS & SUSP
CARDIOVASCULAR: ACE Inhibitors
PRAVASTATIN (generic Pravachol®)
(generic for Zithromax)
PEXEVA®
& Diuretic Combinations
SIMCOR® (new)
CLARITHROMYCIN TABS & SUSP
SERTRALINE (generic Zoloft®)
ALTACE® (PA is required)
(generic Biaxin®)
ANTIEMETICS: Oral, 5-T3s
SIMVASTATIN (generic Zocor®)
BENAZEPRIL (generic Lotensin®)
ERYTHROMYCIN BASE
GRANISETRON (generic Kytril®) (new)
VYTORIN®
BENAZEPRIL HCTZ
(generic E-Mycin®, Ery-Tab®, PCE®) ONDANSETRON
Class changes are
(generic Lotensin HCT®)
CARDIOVASCULAR:
ERYTHROMYCIN ESTOLATE
(generic Zofran®) effective 09/25/08. CAPTOPRIL (generic Capoten®)
Antihyperlipidemics:
ERYTHROMYCIN ETHYLSUCCINATE
ANTIFUNGALS:
CAPTOPRIL HCTZ (generic Capozide®)
Triglyceride Lowering Agents
(generic EES®)
Onychomycosis Agents
ENALAPRIL (generic Vasotec®)
GEMFIBROZIL (generic Lopid®)
ERYTHROMYCIN STEARATE
Prior authorization is required for all ENALAPRIL HCTZ
TRICOR®
ANTIBIOTICS:
(generic Vaseretic®)
Quinolones 2nd Generation
TERBINAFINE TABS
LISINOPRIL
Class changes
CIPROFLOXACIN TABS
(generic Lamisil®) are effective
(generic Prinivil®, Zestril®)
(generic Cipro®)
CIDOPIROX SOLN
09/25/08.
LISINOPRIL HCTZ
CIPRO® SUSP
(generic Penlac®) (new)
(generic Prinzide®, Zestoretic®)
This list contains “preferred” drugs for each Class shown above. Prior authorization is required for non-listed drugs within these Classes and as otherwise noted. Unlisted Classes are free from PDL requirements at this time.
Questions? Contact First Health Services’ Clinical Call Center. Phone: (800) 505-9185 Fax: (800) 229-3928 Website: http://nevada.fhsc.com
STATE OF NEVADA
DIVISION OF HEALTH CARE FINANCING AND POLICY
Nevada Medicaid Preferred Drug List
CARDIOVASCULAR: Calcium
METHYLPHENIDATE ER
GROWTH HORMONE AGENTS
NASAL CALCITONINS
RESPIRATORY:
Channel Blockers & Combinations
(generic Ritalin SR®)
Prior authorization is required for all MIACALCIN®
Inhaled Corticosteroids/Nebs
AFEDITAB CR® (generic Adalat CC®)
PROVIGIL® (No PA required for
OPHTHALMIC ANTIHISTAMINES
ADVAIR DISKUS®
AMLODIPINE (generic Norvasc®)
ICD-9-CM codes 347.00, 347.01,
GENOTROPIN®
ALAWAY®
ADVAIR HFA®
CARTIA XT®
347.10, 347.11, 780.53 and 780.57)
NORDITROPIN®
NUTROPIN®
PATADAY®
ASMANEX®
DILTIA XT®
RITALIN LA®
NUTROPIN AQ®
PATANOL®
AZMACORT®
DILTIAZEM HCL (generic Cardizem®)
STRATTERA®
SAIZEN®
ZADITOR OTC®
FLOVENT HFA®
DILTIAZEM EXTENDED RELEASE
VYVANSE®
OPHTHALMIC GLAUCOMA AGENTS
PULMICORT RESPULES®
DYNACIRC CR®
CENTRAL NERVOUS SYSTEM:
HEPATITIS C AGENTS
ALPHAGAN P® Class changes are
(No PA required < 4 years)
FELODIPINE ER (generic Plendil®)
Sedative Hypnotics
PEGASYS®
effective 09/25/08.
ISRADIPINE (generic for Dynacirc®)
ESTAZOLAM (generic ProSom®)
PEGASYS® CONVENIENT PACK
BETAXOLOL (generic Betoptic®)
RESPIRATORY: Long Acting Beta
LOTREL®
FLURAZEPAM (generic Dalmane®)
PEG-INTRON® & REDIPEN
BETOPTIC S®
Adrenergics
NICARDIPINE (generic Cardene®)
ROZEREM® (PA not required for
RIBAVIRIN
BRIMONIDINE (generic Alphagan®)
FORADIL®
ICD-9-CM code 307.42)
CARTEOLOL (generic Ocupress®)
NIFEDIAC CC (generic Adalat CC®)
HERPETIC ANTIVIRAL AGENTS
SEREVENT DISKUS®
TEMAZEPAM
COMBIGAN® (new)
NIFEDICAL XL (generic Procardia XL®)
(generic Restoril®)
ACYCLOVIR (generic Zovirax®)
COSOPT®
RESPIRATORY: Nasal Corticosteroids
NIFEDIPINE ER (generic Procardia XL®)
TRIAZOLAM
FAMVIR®
LEVOBUNOLOL
FLUTICASONE (generic Flonase®)(new)
(generic Halcion®)
VALTREX®
(generic Betagan®)
NASONEX® Class changes are
TAZTIA XT®
ZOLPIDEM
IMMUNOMODULATORS: Injectable
LUMIGAN®
effective 09/25/08.
VERAPAMIL (generic Calan®, Isoptin®)
(generic Ambien®)
METIPRANOLOL
Prior authorization is required for all RESPIRATORY: Short Acting Beta
VERAPAMIL ER
(generic Optipranolol®)
ELECTROLYTE DEPLETERS
Adrenergics-Inhalers/Nebs
TIMOLOL DROPS & GEL SOLUTION
ALBUTEROL MDI/NEB/SOLN
CENTRAL NERVOUS SYSTEM:
PHOSLO®
ENBREL®
(generic Timoptic® & Timoptic XE®)
(generic Proventil®, Ventolin®)
ADHD/Stimulants -- Prior authorization
RENAGEL®
HUMIRA®
TRAVATAN®
is required for all drugs in this Class. MAXAIR®
ERYTHROPOIESIS STIMULATING
IMMUNOMODULATORS: Topical
TRUSOPT®
METAPROTERENOL NEB
ADDERALL XR®
PROTEINS -- Prior authorization is
XALATAN® (new)
Prior authorization is required for all (generic Alupent® Nebs)
AMPHETAMINE SALT COMBINATION
required for all drugs in this Class. OPHTHALMIC QUINOLONES
PROVENTIL® HFA
(generic Adderall®)
ARANESP®
ELIDEL®
CIPROFLOXACIN (generic Ciloxan®)
VENTOLIN® HFA
CONCERTA®
PROCRIT®
PROTOPIC®
VIGAMOX®
XOPENEX® HFA
DEXTROAMPHETAMINE SA
GASTROINTESTINAL AGENTS: H2RAs
OTIC FLUOROQUINOLONES
XOPENEX® NEBS
(generic Dexedrine SA®)
FAMOTIDINE (generic Pepcid®)
LEUKOTRIENE MODIFIERS
CIPRODEX®
Class changes are
(No PA required for < 12 years)
DEXTROAMPHETAMINE TAB
RANITIDINE (generic Zantac®)
ACCOLATE®
effective 09/25/08.
(generic Dexedrine®)
ZANTAC SYRUP
SINGULAIR®
(generic Floxin®)
URINARY TRACT ANTISPAMODICS
DEXTROSTAT®
(PA not required for < 12 years)
MULTIPLE SCLEROSIS AGENTS
RESPIRATORY:
DETROL LA®
FOCALIN®
GASTROINTESTINAL AGENTS: PPIs
AVONEX®
Inhaled Anticholinergic Agents
ENABLEX®
FOCALIN XR®
Prior authorization is required for all AVONEX® ADMINSTRATION PACK
ATROVENT® HFA INHALER
OXYBUTYNIN TABS & SYRUP
METADATE CD®
(generic Ditropan®)
BETASERON®
COMBIVENT® INHALER
METADATE ER®
NEXIUM® CAPSULES
VESICARE
COPAXONE®
DUONEB® SOLUTION
METHYLIN®
OMEPRAZOLE OTC TABS (new)
IPRATROPIUM NEBS
METHYLIN ER®
PREVACID® CAPSULES Class changes
(generic Atrovent® Nebs)
are effective
METHYLPHENIDATE (generic Ritalin®)
PRILOSEC® OTC TABS
09/25/08.
SPIRIVA®
This list contains “preferred” drugs for each Class shown above. Prior authorization is required for non-listed drugs within these Classes and as otherwise noted. Unlisted Classes are free from PDL requirements at this time.
Questions? Contact First Health Services’ Clinical Call Center. Phone: (800) 505-9185 Fax: (800) 229-3928 Website: http://nevada.fhsc.com

Source: http://calderonmed.com/formulary/medicaid.pdf

"natural preservatives"

"NATURAL PRESERVATIVES" Research Director, Peter Black Medicare Ltd., White Horse Business Park, Aintree Avenue, Trowbridge, Wiltshire, UK. BA14 0XB SUMMARY This paper looks at the theoretical development of a natural preservative system using the author's data base on medicinal plants as a source of references. The legal aspects of this concept are considered. The traditio

Microsoft word - janedoesample.doc

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