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Below is a list of abbreviations that may appear on the following pages in the Requirement/Limits columnthat tells you if there are any special requirements for coverage of your drug.
List of Abbreviations
PA: Prior Authorization. The Plan requires you or your physician to get prior authorization for certain drugs.
This means that you will need to get approval before you fill your prescriptions. If you don’t get approval, we
may not cover the drug.
GC: Gap Coverage. We provide coverage of this prescription drug in the coverage gap. Please refer to our
Evidence of Coverage for more information about this coverage.
LA: Limited Availability. This prescription may be available only at certain pharmacies. For more
information, call Customer Service.
ED: Enhanced Drug. This prescription drug is not normally covered in a Medicare prescription drug plan.
The amount you pay when you fill a prescription for this drug does not count toward your total drug costs
(that is, the amount you pay does not help you qualify for catastrophic coverage). In addition, if you are
receiving extra help to pay for your prescriptions, you will not get any extra help to pay for this drug.
.Commonly Prescribed Therapeutic
Drug Reqs./
Drug Categories
Anti - Infectives
Antifungal Agents
Drug Reqs./
Generics
Antivirals
Generics
Cephalosporins
Generics
ceftriaxone in iso-osmotic dextrose 1 Drug Reqs./
Drug Reqs./
Erythromycins / Other Macrolides
Generics
Miscellaneous Anti - Infectives
Generics
Drug Reqs./
Drug Reqs./
Sulfa's / Related Agents
Generics

Penicillins
Generics
amoxicillin/potassium clavulanate 1 Tetracyclines
Generics
doxycycline hyclate caps, INJ, tabs 1 Urinary Tract Agents
Generics
Vancomycin
Generics

Quinolones
Generics
Drug Reqs./
Drug Reqs./
Antineoplastic /
Immunosuppressant Drugs
Adjunctive Agents
Generics
Brands
ELITEK
Antineoplastic / Immunosuppressant
Generics
Drug Reqs./
Drug Reqs./
Autonomic / CNS Drugs,
Neurology / Psych
Anticonvulsants
Generics
Drug Reqs./
Drug Reqs./
Antiparkinsonism Agents
Generics
Muscle Relaxants / Antispasmodic
Generics
Brands
MESTINON
Migraine / Cluster Headache Therapy
Generics
dihydroergotamine mesylate
Narcotic Analgesics
Generics
hydromorphone hcl tabs 2mg, 8mg 1levorphanol tartrate Miscellaneous Neurological Therapy
Drug Reqs./
Drug Reqs./
Propoxyphene
Generics
Psychotherapeutic Drugs
Generics

Non-Narcotic Analgesics
Generics
Drug Reqs./
Drug Reqs./
Cardiovascular, Hypertension
Antiarrhythmic Agents
Generics
Drug Reqs./
Drug Reqs./
Antihypertensive Therapy
Generics
benazepril hcl/hydrochlorothiazide 1 Drug Reqs./
Drug Reqs./
Lipid/Cholesterol Lowering Agents
Generics
Cardiac Glycosides
Generics
Coagulation Therapy
Generics
Miscellaneous Cardiovascular Agents
Drug Reqs./
Drug Reqs./
Nitrates
Generics
Therapy For Acne
Generics
Dermatologicals/Topical
Antipsoriatic / Antiseborrheic
Generics
Topical Anesthetics
Burn Therapy
Generics
lidocaine
Generics
Brands
EMLA /TEGADERM
Miscellaneous Dermatologicals
Generics
Topical Antibacterials
Generics
Brands
8-MOP
Topical Antifungals
Generics
Drug Reqs./
Drug Reqs./
Topical Enzymes
Topical Antivirals
Topical Scabicides / Pediculicides
Generics
Topical Corticosteroids
Generics
Diagnostics / Miscellaneous
Miscellaneous Agents
Generics
dextrose 5%/sodium chloride 0.2% 1 dextrose 5%/sodium chloride 0.9% 1 Drug Reqs./
Drug Reqs./
Ear, Nose / Throat
Medications
Miscellaneous Agents
Generics
sodium polystyrene sulfonate powd, 1 Miscellaneous Otic Preparations
Generics
Otic Steroid / Antibiotic
Generics
Endocrine/Diabetes
Smoking Deterrents
Adrenal Hormones
Generics
Generics
Drug Reqs./
Drug Reqs./
Antithyroid Agents
Generics
Diabetes Therapy
Generics
Drug Reqs./
Drug Reqs./
Thyroid Hormones
Generics
Gastroenterology
Antidiarrheals / Antispasmodics
Generics
Miscellaneous Hormones
Generics
Miscellaneous Gastrointestinal Agents
Generics
Drug Reqs./
Drug Reqs./
Ulcer Therapy
Generics
Immunology, Vaccines /
Biotechnology
Biotechnology Drugs
Drug Reqs./
Drug Reqs./
Musculoskeletal /
Rheumatology
Vaccines / Miscellaneous
Gout Therapy
Immunologicals
Generics
Generics
Osteoporosis Therapy
Generics
Other Rheumatologicals
Generics
Drug Reqs./
Drug Reqs./
Miscellaneous Ob/Gyn
Generics
Obstetrics / Gynecology
Estrogens / Progestins
Generics
Oral Contraceptives / Related Agents
Generics
Drug Reqs./
Drug Reqs./
Antivirals
Generics
Beta-Blockers
Generics
Oxytocics
Cycloplegic Mydriatics
Generics
Ophthalmology
Antibiotics
Generics

Direct Acting Miotics
Miscellaneous Ophthalmologics
Generics
Non-Steroidal Anti-Inflammatory
Drug Reqs./
Drug Reqs./
Generics
Oral Drugs For Glaucoma
Sulfonamides
Generics
Generics
Sympathomimetics
Generics
Other Glaucoma Drugs
Vasoconstrictor Decongestants
Generics
Respiratory And Allergy
Antihistamine / Antiallergenic Agents
Steroid-Antibiotic Combinations
Generics
Generics
Steroid-Sulfonamide Combinations
Generics
sulfacetamide sodium/prednisolone 1 Steroids
Generics
Drug Reqs./
Drug Reqs./
Pulmonary Agents
Generics
Urologicals
Anticholinergics / Antispasmodics
Generics
Benign Prostatic Hyperplasia(BPH)
Generics
Cholinergic Stimulants
Generics
Miscellaneous Urologicals
Generics
potassium citrate extended-release 1 Drug Reqs./
Drug Reqs./
Vitamins, Hematinics /
Electrolytes
Electrolytes
Generics
potassium chloride 0.15% d5w/nacl1 potassium chloride 0.15% d5w/nacl1 Miscellaneous Nutrition Products
Generics
potassium chloride er cpcr 10meq 1 Drug Reqs./
Drug Reqs./
Vitamins / Hematinics
Generics
25%CLINIMIX 5%/DEXTROSE 15% 2CLINIMIX 5%/DEXTROSE 20% 2CLINIMIX 5%/DEXTROSE 25% 2CLINISOL SF 15% /ELECTROLYTE #75 VIAFLEXFREAMINE HBC 6.9% amiloride /hydrochlorothiazide .10 amlodipine besylate/benazepril hydrochloride .10 amoxicillin/potassium clavulanate . 4 bacitracin /neomycin /polymyxin.20 benazepril hcl/hydrochlorothiazide.10 augmented betamethasone dipropionate.13 bisoprolol fumarate/hydrochlorothiazide .10 ceftriaxone in iso-osmotic dextrose . 2 chlordiazepoxide /amitriptyline. 8 clobetasol propionate emollient .13 clotrimazole/betamethasone dipropionate .13 dexamethasone sodium phosphate .15 dexamethasone sodium phosphate .21 dextrose 2.5%/sodium chloride 0.45%.13 dextrose 5%/sodium chloride 0.2%.13 dextrose 5%/sodium chloride 0.45%.13 dextrose 5%/sodium chloride 0.9%.13 diclofenac sodium. 8diclofenac sodium.21 E
e.e.s. 200 . 3
erythromycin ethylsuccinate .
enalapril maleate/hydrochlorothiazide .10 FLOXIN OTIC SINGLES.14fluconazole. 2 gentamicin sulfate/0.9% sodium chloride . 3 fosinopril sodium/hydrochlorothiazide .10 heparin sodium/sodium chloride 0.9% premix.11HEPATAMINE .24 ipratropium bromide/albuterol sulfate .22 LINDANE .13liothyronine sodium .16 lisinopril /hydrochlorothiazide .10 lactated ringer's dextrose 5% viaflex .14 lamotrigine chewable dispersible. 6 methotrexate sodium. 5methyclothiazide .10 methylprednisolone sodiumsuccinate .15 metoprolol /hydrochlorothiazide .10 moexipril /hydrochlorothiazide .10 nitrofurantoin macrocrystalline . 4 neomycin /polymyxin /dexamethasone .21 neomycin /polymyxin /gramicidin .20 neomycin /polymyxin /hydrocortisone.14 neomycin /polymyxin /hydrocortisone.21 pancrelipase.16pancrelipase mst-16.16 potassium chloride 0.15% d5w/nacl 0.33% .23 potassium chloride 0.15% d5w/nacl 0.45% potassium chloride 0.15% nacl 0.9% .23 potassium chloride 0.15%/nacl 0.9% .23 potassium chloride 0.224%d5w/nacl 0.33% .23 potassium citrate extended-release .22 polymyxin b sulfate/trimethoprim sulfate.20 probenecid/colchicine .18procainamide hcl. 9 propranolol /hydrochlorothiazide .10 quinapril /hydrochlorothiazide .10 spironolactone /hydrochlorothiazide.10 sulfacetamide sodium/prednisolone sodium sulfamethoxazole /trimethoprim . 4 triamterene /hydrochlorothiazide .10 vancomycin hcl . 4VANCOMYCIN HCL ISO-OSMOTIC zolpidem tartrate . 9ZOMIG. 7ZOMIG ZMT . 7ZONALON.12zonisamide. 6ZOSTAVAX .18ZOSYN. 4zovia 1/35e.20zovia 1/50e.20ZOVIRAX.13ZYLET .21ZYMAR .20ZYPREXA . 9ZYPREXA ZYDIS. 9ZYVOX. 4

Source: http://www.seniorschoiceplan.com/forms/2009MedcoFormulary.pdf

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FAEL – FACULDADE EDUCACIONAL DA LAPA CURSO DE PEDAGOGIA - EAD FUNDAMENTOS E METODOLOGIA DA EDUCAÇÃO DE JOVENS E MATERIAL COMPLEMENTAR - AULA 4 O Pensamento político e pedagógico de Paulo Freire Para Paulo Freire, as questões e problemas principais da educação não são questões pedagógicas, ao contrário, são questões políticas. Para ele, a educação e o sistema d

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