Copy of dhs_drug formulary for the hwla initiative_july 2012_2.xls
DHS DRUG FORMULARY FOR THE HWLA INITIATIVE - BY DRUG NAME July 2012 Bolded and italicized denote Patient Assistance Program (PAP) availability Medication Therapeutic Class Additional Information $4 Program PAP Availability Allergies, Cold and Flu
Guaifenesin/ Dextromethorphan 100mg-10mg/5mL Oral Solution
Anticonvulsant
Divalproex delayed release 125mg sprinkle capsule
Divalproex ER 250mg tablet Anticonvulsant Abott Patient Assistance Foundation 3 YES Divalproex ER 500mg tablet Anticonvulsant Abott Patient Assistance Foundation 3 YES GlaxoSmithKline Bridges to Lamotrigine 100mg tablet Anticonvulsant Access 1 NO GlaxoSmithKline Bridges to Lamotrigine 150mg tablet Anticonvulsant Access 1 NO GlaxoSmithKline Bridges to Lamotrigine 200mg tablet Anticonvulsant Access 1 NO GlaxoSmithKline Bridges to Lamotrigine 25mg tablet Anticonvulsant Access 1 NO Anti-Infectives
Abacavir/Lamivudine/Zidovudine 300-150-300mg
Aminosalycylic Acid 4gm packet powder for suspension
Amoxicillin 125mg/5mL powder for suspension
Amoxicillin 250mg/5mL powder for suspension
Amoxicillin 400mg/5mL powder for suspension
PAP Legend: 1=Very Accessible, no SSN required 2=Accessible requires SSN
3=Less Accessible, requires SSN and additional information
DHS DRUG FORMULARY FOR THE HWLA INITIATIVE - BY DRUG NAME July 2012 Bolded and italicized denote Patient Assistance Program (PAP) availability Medication Therapeutic Class Additional Information $4 Program PAP Availability Anti-Infectives
Efavirenz/Emtricitabine/Tenofovir 600-200-300mg
Emtricitabine/Rilpivirine/Tenofovir 200-25-300mg tablet
Erythromycin Ethyl Succinate 200mg/5mL suspension
PAP Legend: 1=Very Accessible, no SSN required 2=Accessible requires SSN
3=Less Accessible, requires SSN and additional information
DHS DRUG FORMULARY FOR THE HWLA INITIATIVE - BY DRUG NAME July 2012 Bolded and italicized denote Patient Assistance Program (PAP) availability Medication Therapeutic Class Additional Information $4 Program PAP Availability Anti-Infectives
Lopinavir/Ritonavir 80mg/mL-20mg/mL solution
Pegylated Interferon Alfa 2B 120mcg/0.5mL
Antineoplastics
PAP Legend: 1=Very Accessible, no SSN required 2=Accessible requires SSN
3=Less Accessible, requires SSN and additional information
DHS DRUG FORMULARY FOR THE HWLA INITIATIVE - BY DRUG NAME July 2012 Bolded and italicized denote Patient Assistance Program (PAP) availability Medication Therapeutic Class Additional Information $4 Program PAP Availability Arthritis & Pain
Acetaminophen/ Hydrocodone 325mg/10mg (Norco) tablet
Acetaminophen/ Hydrocodone 325mg/5mg (Norco) tablet
Acetaminophen/ Oxycodone 325/5mg (Percocet)
Acetaminophen/Codeine 300mg/15mg (Tylenol #2) tablet
Acetaminophen/Codeine 300mg/30mg (Tylenol #3) tablet
Acetaminophen/Codeine 300mg/60mg (Tylenol #4) tablet
Acetaminophen/Hydrocodone 500mg/5mg (Vicodin) tablet
Aspirin 325mg (with or w/o enteric coating)
Colchicine/ probenecid 0.5mg/500mg tablet
Fentanyl Transdermal 100mcg/hr (Duragesic)
Fentanyl Transdermal 25mcg/hr (Duragesic)
Fentanyl Transdermal 50mcg/hr (Duragesic)
Fentanyl Transdermal 75mcg/hr (Duragesic)
Morphine Sulfate Extended-Release (MS Contin) 15mg
Morphine Sulfate Extended-Release (MS Contin) 30mg
Morphine Sulfate Extended-Release (MS Contin) 60mg
Morphine Sulfate Immediate-Release 15mg tablet
Morphine Sulfate Immediate-Release 30mg tablet
Asthma/COPD
Formoterol (Foradil) Aerolizer 12 mcg cap
Ipratropium HFA 17mcg inhaler Asthma/COPD Boehringer Ingelheim Cares 12.9gm Foundation, Inc. 1 YES Mometasone/Formoterol (Dulera) 100mcg/5mcg Asthma/COPD Merck Patient Assistance 13gm Program 2 YES Mometasone/Formoterol (Dulera) 200mcg/5mcg Asthma/COPD Merck Patient Assistance 13gm Program 2 YES Montelukast 10mg tablet Asthma/COPD Merck Patient Assistance Program 2 NO Cholesterol Ezetimibe 10mg tablet Cholesterol Merck Patient Assistance Program 2 NO
PAP Legend: 1=Very Accessible, no SSN required 2=Accessible requires SSN
3=Less Accessible, requires SSN and additional information
DHS DRUG FORMULARY FOR THE HWLA INITIATIVE - BY DRUG NAME July 2012 Bolded and italicized denote Patient Assistance Program (PAP) availability Medication Therapeutic Class Additional Information $4 Program PAP Availability Cholesterol
Niacin-controlled released (Slo Niacin) 500mg tablet
CNS Agents/ Sedative Hypnotic
Acetaminophen/ Butalbital/ Caffeine (Fioricet)
Acetaminophen/ Butalbital/ Caffeine (Fioricet) 325/50/40
Amphet ASP/Amphet/ Dextroamphet Salts 5mg tab
Amphetamine/ Dextroamphetamine Salts 5mg tab
Aripiprazole 10mg tablet CNS Agents/ Sedative Hypnotic BMS Patient Assistance Foundation 1 NO Aripiprazole 15mg tablet CNS Agents/ Sedative Hypnotic BMS Patient Assistance Foundation 1 NO Aripiprazole 20mg tablet CNS Agents/ Sedative Hypnotic BMS Patient Assistance Foundation 1 NO Aripiprazole 30mg tablet CNS Agents/ Sedative Hypnotic BMS Patient Assistance Foundation 1 NO
PAP Legend: 1=Very Accessible, no SSN required 2=Accessible requires SSN
3=Less Accessible, requires SSN and additional information
DHS DRUG FORMULARY FOR THE HWLA INITIATIVE - BY DRUG NAME July 2012 Bolded and italicized denote Patient Assistance Program (PAP) availability Medication Therapeutic Class Additional Information $4 Program PAP Availability CNS Agents/ Sedative Hypnotic Merck Patient Assistance Rizatriptan 10mg tablet CNS Agents/ Sedative Hypnotic Program 2 YES Diabetes Blood Glucose Meter Diabetes PAP/Prior Authorization Insulin glargine 100units/ml vial Diabetes Sanofi-Aventis U.S. Patient 10mL Assistance Program 1 YES
Insulin NPH/Regular 70/30 100units/ml vial
PAP Legend: 1=Very Accessible, no SSN required 2=Accessible requires SSN
3=Less Accessible, requires SSN and additional information
DHS DRUG FORMULARY FOR THE HWLA INITIATIVE - BY DRUG NAME July 2012 Bolded and italicized denote Patient Assistance Program (PAP) availability Medication Therapeutic Class Additional Information $4 Program PAP Availability Diabetes Takeda Pharmaceuticals Pioglitazone 15mg tablet Diabetes America Patient Assistance Program 1 YES Takeda Pharmaceuticals Pioglitazone 30mg tablet Diabetes America Patient Assistance Program 1 YES Takeda Pharmaceuticals Pioglitazone 45mg tablet Diabetes America Patient Assistance Program 1 YES Ear Health
Antipyrine/Benzocaine (Auralgan) otic solution (FDA REMOVED)
Carbamide Peroxide (Debrox) 6.5% Otic drop
Gastrointestinal Health
Belladonna/Phenobarbital (Donnatal) Elixir
Bismuth Subsalicylate (Pepto-Bismol) 262mg tablet
Bismuth Subsalicylate (Pepto-Bismol) 262mg/15mL Oral suspension
Diphenoxylate/Atropine 0.025mg/5mL-2.5mg/5mL solution
Diphenoxylate/Atropine 0.025mg-2.5mg tablet
Magnesium Hydroxide 400mg/5mL (Milk of Magnesia) oral suspension
Magnesium hydroxide/ aluminum hydroxide/ simethacone (Maalox) oral
Glaucoma & Eye Care
Brimonidine (Alphagan P) 0.15% eye drops
Naphazoline HCl 0.025%/ Pheniramine Maleate 0.3% Ophthalmic
Polymyxin Sulfate/TMP (Polytrim) ophthalmic solution
PAP Legend: 1=Very Accessible, no SSN required 2=Accessible requires SSN
3=Less Accessible, requires SSN and additional information
DHS DRUG FORMULARY FOR THE HWLA INITIATIVE - BY DRUG NAME July 2012 Bolded and italicized denote Patient Assistance Program (PAP) availability Medication Therapeutic Class Additional Information $4 Program PAP Availability Glaucoma & Eye Care
Sulfacetamide Sodium 10% ophthalmic solution
Tobramycin/ Dexamethasone ophthalmic drop
Heart Health & Blood Pressure
Aspirin 81mg (with or w/o enteric coating)
Triamterene/HCTZ 37.5/25mg capsule/tablet
PAP Legend: 1=Very Accessible, no SSN required 2=Accessible requires SSN
3=Less Accessible, requires SSN and additional information
DHS DRUG FORMULARY FOR THE HWLA INITIATIVE - BY DRUG NAME July 2012 Bolded and italicized denote Patient Assistance Program (PAP) availability Medication Therapeutic Class Additional Information $4 Program PAP Availability Heart Health & Blood Pressure Other Medical Conditions
Chlorhexidine Gluconate 0.12% oral solution
Hydrocortisone 2.5% Rectal Cream (Proctozone HC)
Skin Conditions
Bacitracin, neomycin, polymyxin B ointment/cream (Triple Antibiotic)
Betamethasone Dipropionate 0.05% ointment
PAP Legend: 1=Very Accessible, no SSN required 2=Accessible requires SSN
3=Less Accessible, requires SSN and additional information
DHS DRUG FORMULARY FOR THE HWLA INITIATIVE - BY DRUG NAME July 2012 Bolded and italicized denote Patient Assistance Program (PAP) availability Medication Therapeutic Class Additional Information $4 Program PAP Availability Skin Conditions
Nystatin/Triamcinolone cream/ointment (Mycolog II)
Thyroid Conditions Vitamins & Nutritional Health
Calcium Carbonate 500mg + Vitamin D 200 units tablet
Calcium Carbonate 600mg +Vitamin D 400 Units tablet
Ergocalciferol 50,000 International Units
Women's Health
Estrogen conjugated 0.625mg/gm vaginal cream
Estrogen conjugated/Medroxyprogesterone 0.3/1.5mg tablet (Prempro)
Estrogen conjugated/Medroxyprogesterone 0.625/2.5mg tablet (Prempro)
Estrogen conjugated/Medroxyprogesterone 0.625/5mg tablet
PAP Legend: 1=Very Accessible, no SSN required 2=Accessible requires SSN
3=Less Accessible, requires SSN and additional information
DHS DRUG FORMULARY FOR THE HWLA INITIATIVE - BY DRUG NAME July 2012 Bolded and italicized denote Patient Assistance Program (PAP) availability Medication Therapeutic Class Additional Information $4 Program PAP Availability Women's Health
Norethindrone/Eth Estradiol (Ortho-Novum) 1-35-28 tablet
PAP Legend: 1=Very Accessible, no SSN required 2=Accessible requires SSN
3=Less Accessible, requires SSN and additional information
ET DE MÉDECINE D’URGENCE http://www.rarmu.com/ Toxicité des anesthésiques locaux Toxicity by local anesthetic drugs ________________________________________________________________________________________________ Points essentiels à retenir : Actuellement, la prévention du risque toxique par les anesthésiques locaux repose sur: • le respect des posologies, • et la sur
eines schönen Morgens brechen wir mit John, dem amerikanischen Arzt, zu einer seiner Inspektionsfahrten auf. John betreut ein Trachoma-Programm der WHO hier in Guatemala. Die Indios aus den Bergdörfern gehen nie zum Arzt. Zum einen gibt es keinen Arzt in diesen Gegenden, zum zweiten käme der Besuch eines Arztes viel zu teuer, in der Tat so teuer, dass ein Indianer sich gar nicht vorstellen kann
DHS DRUG FORMULARY FOR THE HWLA INITIATIVE - BY DRUG NAME
DHS DRUG FORMULARY FOR THE HWLA INITIATIVE - BY DRUG NAME
DHS DRUG FORMULARY FOR THE HWLA INITIATIVE - BY DRUG NAME
DHS DRUG FORMULARY FOR THE HWLA INITIATIVE - BY DRUG NAME
DHS DRUG FORMULARY FOR THE HWLA INITIATIVE - BY DRUG NAME
DHS DRUG FORMULARY FOR THE HWLA INITIATIVE - BY DRUG NAME
DHS DRUG FORMULARY FOR THE HWLA INITIATIVE - BY DRUG NAME
DHS DRUG FORMULARY FOR THE HWLA INITIATIVE - BY DRUG NAME
DHS DRUG FORMULARY FOR THE HWLA INITIATIVE - BY DRUG NAME
DHS DRUG FORMULARY FOR THE HWLA INITIATIVE - BY DRUG NAME
DHS DRUG FORMULARY FOR THE HWLA INITIATIVE - BY DRUG NAME