PREFERRED DRUG LIST CONVERSION TABLE January 2002 BOLD TYPEFACE indicates product is available at the preferred generic copayment tier. CAPS indicates product is available at the preferred brand copayment tier. NON-PREFERRED DRUG PREFERRED ALTERNATIVE Ranitidine 300mg Cimetidine 800mg Famotidine 40mg
Cardiovascular Agents – Calcium Channel Blockers
Diltiazem PLENDIL Nifedipine Verapamil Fluoxetine (error on original document) Erythromycin Amoxicillin Ibuprofen Diclofenac Sodium Naproxen Salsalate Ketoprofen COMPLETE PREFERRED DRUG LIST BOLD TYPEFACE indicates product is available at the preferred generic copayment tier. CAPS indicates product is available at the preferred brand copayment tier. Amylase/Lipase/Protease Alprazolam /Pancreatin APAP/Dichloralphenazone/ Acebutolol lsometheptene Acetaminophen/Codeine2 Amantadine Acetaminophen/Hydrocodone2 AGENERASE Bacitracin Acetazolamide Albuterol Amiloride/HCTZ Baclofen Acetic Acid/ Hydrocortisone ALDARA Amiodarone Amitriptyline Atenolol Amoxicillin Atenolol/Chlorthalidone Acyclovir Oral Ampicillin Atropine Belladonna/Phenobarbital Allopurinol Amylase/Lipase/Protease Atropine Sulfate THE BLUEGRASS FAMILY HEALTH PREFERRED DRUG LIST HAS BEEN COMPILED TO RESPOND TO THE CONSTANTLY CHANGING NATURE OF DRUG THERAPY. THE LIST IS DYNAMIC AND IT IS SUBJECT TO CHANGE. YOU WILL BE NOTIFIED AT LEAST 30 DAYS IN ADVANCE OF ALL CHANGES. EVERY EFFORT HAS BEEN MADE TO INSURE THE ACCURACY OF THIS DOCUMENT. WE APOLOGIZE FOR ANY INCONVENIENCE ERRORS MAY CAUSE. PDL 11/01 Benzocaine/Antipyrine Otic Cyclopentolate Metronidazole Benzonatate Cyclophosphamide Benztropine Mesylate Cyproheptadine Minocycline (Susp. Not Betamethasone Dipropionate CYTOMEL Covered at Generic Tier) 3 Betamethasone Valerate Isoniazid Minoxidil Betaxolol Bethanechol Fenoprofen Isosorbide Dinitrate Famotidine Isosorbide Mononitrate Morphine2 Bromocriptine Ketoconazole Bumetanide Desipramine Fluocinolone Ketoprofen Bupropion Desmopressin Fluocinolone Acetonide Ketorolac Tromethamine Butoconazole Dexamethasone Fluocinonide Labetalol Captopril Dexamethasone/Neomycin Fluoride/Polyvitamins; /FE Lactulose Nabumetone Captopril/HCTZ Dexameth/Poly/Neomycin Fluoride/Vitamin A, D, C; /FE LAMICTAL Carbachol Dexchlorpheniramine Fluorometholone Naphazoline Carbamazepine Dextroamphetamine3 Fluphenazine Naproxen Carbidopa/Levodopa Diabetic Lancets - All Flurazepam Naproxen Sodium Carisoprodol
DIABETIC TEST STRIPS – ALL Flurbiprofen Sodium Diazepam Leucovorin Folic Acid Cefaclor Diclofenac Sodium Cefadroxil Dicloxacillin Dicyclomine Levobunolol Diflunisal Furosemide Cephalexin Levothyroxine Neomycin Sulfate Cephradine Diltiazem Gemfibrozil Lidocaine Viscous Neomycin/Gramicidin Chloral Hydrate Diltiazem SA Caps Gentamicin /Polymyxin Chlordiazepoxide Diltiazem SR Gentamicin Sulfate Neomycin/Polymyxin/HC Lithium Carbonate (All Forms) NEORAL Chloroquine Phosphate Glipizide Chlorpromazine Diphenoxylate/Atropine Chlorpropamide Dipivefrin Nicardipine Chlorthalidone Glyburide Lorazepam Cholestyramine Nifedipine Choline Mag. Trisalicylate Dipyridamole Nifedipine SR Cimetidine Disopyramide Griseofulvin Ultramicrosize Low-Ogestrel Disopyramide CR Guaifenesin Loxapine Nitrofurantoin Clemastine Doxazosin Mesylate Guaifenesin/Codeine Nitrofurantoin Macrocrystals Guaifenesin/Codeine/ PSE Nitroglycerin Ointment Doxycycline (Tabs, Caps Guaifenesin/Pseudoephedrine Maprotiline Nitroglycerin Patches Clindamycin Guanabenz Nitroglycerin Sublingual Clindamycin Solution Guenfacine Clobetasol Haloperidol Nortriptyline Clofibrate Mebendazole Clonazepam Meclofenamate Clonidine Medroxyprogesterone Clorazepate Homatropine Megestrol Nystatin (Oral Powder Not Codeine/Aspirin Meperidine2 Covered) Codeine/CPM/ PSE Enalapril Mephobarbital Colchicine Epinephrine Hydralazine Ogestrel Hydrochlorothiazide (HCTZ) METAPREL Hydrocodone/Homatropine Metaproterenol Oral Hydrocortisone Metformin Hydrocortisone Rectal Methadone2 Hydrocortisone/Pramox Methazolamide Orphenadrine Citrate Ergotamine Tartrate Hydromorphone Methimazole Orphenadrine/Aspirin/Caffeine Ergotamine/Caffeine/Bella/ Pb Hydroxychloroquine Methocarbamol Erlotamine/Caffeine Hydroxyurea Methotrexate Erythromycin Hydroxyzine Methyldopa Esterified Estrogens Hyoscyamine Sulfate Methylphenidate3 Cromolyn Ophthalmic Solution Estradiol Ibuprofen Methylprednisolone Estradiol Patches Imipramine Methyltestosterone Metoclopramide Oxazepam Estropipate Indapamide Metoprolol Tartrate Cyclobenzaprine Indomethacin Indomethacin SR Oxybutynin THE BLUEGRASS FAMILY HEALTH PREFERRED DRUG LIST HAS BEEN COMPILED TO RESPOND TO THE CONSTANTLY CHANGING NATURE OF DRUG THERAPY. THE LIST IS DYNAMIC AND IT IS SUBJECT TO CHANGE. YOU WILL BE NOTIFIED AT LEAST 30 DAYS IN ADVANCE OF ALL CHANGES. EVERY EFFORT HAS BEEN MADE TO INSURE THE ACCURACY OF THIS DOCUMENT. WE APOLOGIZE FOR ANY INCONVENIENCE ERRORS MAY CAUSE. PDL 11/01 Oxycodone/Acetaminophen2 PREMARIN Rifampin Oxycodone/Aspirin2 Tetracycline Papavarine CR Theophylline Ursodiol Salsalate Theophylline SR Valproic Acid Thiethylperazine Primidone Pemoline Probenecid Thioridazine Penicillin VK Procainamide Selegiline Thiothixene Verapamil Procainamide SR Selenium Sulfide 2.5% Thyroid, Desiccated Verapamil LA Tablets Pentoxifylline Prochlorperazine Maleate Perphenazine Promethazine Phenazopyridine Promethazine/Codeine Silver Sulfadiazine
PHENERGAN 12.5MG, 25MG Promethazine DM Tobramycin Drops Promethazine/Codeine/PE Phenobarbital Propafenone Tolazamide Phenyleph/Pyril Propoxyphene Sodium Chloride Tolbutamide Warfarin Sodium Phenylephrine Propoxyphene-N/APAP Sodium Polystyrene Sulfonate Tolmetin Phenylephrine/Hydrocodone/ Propoxyphene/ASA/Caffeine SORIATANE Propranolol Phenylephrine/Promethazine Propranolol LA Spironolactone Trazodone Phenytoin Propranolol/HCTZ Spironolactone/HCTZ Tretinoin3– Limited to Acne Propylthiouracil Triamcinolone Pilocarpine Sucralfate Triamcinolone/Nystatin Pindolol PSE/Carbinox. Triamterene/HCTZ Piroxicam Sulfacetamide/Prednisolone Triazolam P-tlox/Phenir/Pyril Trifluoperazine Sulfasalazine Trifluridine Sulfisoxazole Trihexyphenidyl Polymixin B Sulgate/TMP Pyrazinamide Sulfonylureas Tri-Levlen Zovia Polymyxin B/Bacitracin Quinidine Gluconate Sulindac Trimethobenzamide Potassium Chloride 10mEq Quinidine Sulfate Trimethoprim Potassium Iodide Quinidine Sulfate SR Pramoxine/Hydrocortisone Prazosin Ranitidine Prednisolone Tamoxifen Citrate Triple Sulfa Vaginal Prednisolone Acetate Temazepam Prednisolone Phosphate Terazosin Tropicamide Prednisone Terbutaline Sulfate
1 Available via Step Therapy (online prior authorization) 2 Quantity Limits Apply 3 Prior Authorization Required 4 Limited to Specialist Use Only
If a drug you are looking for is not on this list, it may be available at your non-preferred drug copayment. Any medications prescribed for the treatment of diagnoses excluded from coverage will not be covered at any copayment tier. EXCEPTIONS POLICY – Most covered non-preferred medications are available upon payment of the third tier prescription copayment. However, there are certain drugs that, due to the nature of the medication, require prior authorization before the plan will cover them at any copayment tier. Only physicians may request prior authorizations as they are based on medical history. In addition, the plan will not cover in any way certain categories of drugs because they are plan exclusions. Examples include, but are not limited to, drugs used for smoking cessation, weight loss, sexual dysfunction and cosmetic purposes. Prior authorizations are based on established clinical guidelines and the patient’s medical history and only physicians may request medication approvals. THE BLUEGRASS FAMILY HEALTH PREFERRED DRUG LIST HAS BEEN COMPILED TO RESPOND TO THE CONSTANTLY CHANGING NATURE OF DRUG THERAPY. THE LIST IS DYNAMIC AND IT IS SUBJECT TO CHANGE. YOU WILL BE NOTIFIED AT LEAST 30 DAYS IN ADVANCE OF ALL CHANGES. EVERY EFFORT HAS BEEN MADE TO INSURE THE ACCURACY OF THIS DOCUMENT. WE APOLOGIZE FOR ANY INCONVENIENCE ERRORS MAY CAUSE. PDL 11/01
Prostate Basic description In American men, prostate cancer is the most common cancer (other than skin cancer) and the second leading cause of cancer death. The prostate gland is walnut-sized and is located in front of the rectum, behind the penis, and under the bladder. It makes some of the seminal fluid, which protects and nourishes sperm cells in semen. Most prostate cancers grow very
CONGRESSO NACIONAL DE ENFERMAGEM DE REABILITAÇÃO O ENFERMEIRO ESPECIALISTA E A SEXUALIDADE RESPOSTAS! Célia Mota – Enfª Especialista em Reabilitação – CoimbraO conceito de sexualidade humana engloba a forma como se pensa, sente e actua como um ser sexuado, com necessidades e impulsos, expressões de virilidade ou de feminilidade, papeis associados aos géneros, inter