Monday, august 10, 2009

May 2002 Edition
NON-FORMULARY
FORMULARY
NON-FORMULARY
FORMULARY
NON-FORMULARY
FORMULARY
Eckerd Health Services
ALTERNATIVE(S)
ALTERNATIVE(S)
ALTERNATIVE(S)
Formulary Drug List
apri, low-ogestrel, microgestin fe, necon, ogestrel, zovia, ALESSE, BREVICON, DESOGEN, To avoid the higher copayment associated with non- formulary drugs, please ask your prescriber to refer to captopril/hctz, enalapril/hctz, ACCURETIC, this formulary drug list when prescribing medications for you and your dependents. Please note that you will apri, levora, low-ogestrel, microgestin fe, necon, ogestrel, zovia, ALESSE, BREVICON, pay a higher copayment for drugs listed in the Non- Formulary Drug column than for those therapeutically trazodone, CELEXA, EFFEXOR, PAXIL, ZOLOFT equivalent drugs listed in the Formulary Alternative(s) clindamycin, erythromycin, tretinoin, AVITA, It is also important to keep in mind that newly FDA- approved medications will also be subject to the non- formulary copayment pending a review by the Pharmacy apri, low-ogestrel, microgestin fe, necon, ogestrel, zovia, ALESSE, BREVICON, DESOGEN, Please note that this listing does not imply a guarantee trazodone, CELEXA, EFFEXOR, PAXIL, ZOLOFT of coverage, as covered products and/or categories are apri, low-ogestrel, microgestin fe, necon, subject to individual plan restrictions and/or limitations. ogestrel, zovia, ALESSE, BREVICON, DESOGEN, diclofenac sodium, etodolac, nabumetone, Substitution of generic products is encouraged when available and appropriate. All generic medications are theophylline er, T-PHYL, THEO-24, UNIPHYL considered as formulary agents. The drugs listed in lower case represent a generic medication.
Periodic updates to the formulary may occur. For the erythromycin base e.c., BIAXIN, BIAXIN XL, cyclobenzaprine, diazepam, methocarbamol, most current formulary information, please call Eckerd Health Services at the toll-free number printed on your diltiazem, nifedipine, verapamil, NORVASC, member I.D. card, or visit EHS at www.ehs.com.
clindamycin, erythromycin, tretinoin, AVITA, BENZAMYCIN, DIFFERIN, RETIN-A MICRO, ACCU-CHEK, FAST TAKE, ONE TOUCH, SURE STEP ACCU-CHEK, FAST TAKE, ONE TOUCH, SURE STEP etodolac, nabumetone, oxaprozin, tolmetin ON-FORMULARY
FORMULARY
ALTERNATIVE(S)
captopril/hctz, ACCURETIC, LOTENSIN HCT, diltiazem, nifedipine, verapamil, NORVASC, etodolac, flurbiprofen, ibuprofen, nabumetone, griseofulvin ultramicrosize, ketoconazole, QUESTRAN, QUESTRAN LIGHT cholestyramine, cholestyramine light, NON-FORMULARY
FORMULARY
NON-FORMULARY
FORMULARY
NON-FORMULARY
FORMULARY
NON-FORMULARY
FORMULARY
ALTERNATIVE(S)
ALTERNATIVE(S)
ALTERNATIVE(S)
ALTERNATIVE(S)
apri, low-ogestrel, microgestin fe, necon,ogestrel, zovia, ALESSE, BREVICON, DESOGEN, apri, low-ogestrel, microgestin fe, necon, ogestrel, zovia, ALESSE, BREVICON, DESOGEN, cefadroxil, cephalexin, cephradine, CEFTIN, apri, low-ogestrel, microgestin fe, necon, cefadroxil monohydrate, cephalexin, CEFZIL, ogestrel, zovia, ALESSE, BREVICON, DESOGEN, etodolac, nabumetone, naproxen, oxaprozin, apri, low-ogestrel, microgestin fe, necon, ogestrel, zovia, ALESSE, BREVICON, DESOGEN, LOCHOLEST, LOCHOLEST LIGHT cholestyramine, cholestyramine light, apri, low-ogestrel, microgestin fe, necon, ogestrel, zovia, ALESSE, BREVICON, DESOGEN, apri, low-ogestrel, microgestin fe, necon, ogestrel, zovia, ALESSE, BREVICON, DESOGEN, etodolac, nabumetone, oxaprozin, piroxicam, cefadroxil, cephalexin, cephradine, CEFTIN, clindamycin, erythromycin, tretinoin, AVITA, MAXAIR, MAXAIR AUTOHALER albuterol, PROVENTIL HFA ACCU-CHEK, FAST TAKE, ONE TOUCH, SURE STEP clindamycin, erythromycin, tretinoin, AVITA,

Source: http://www.jefflewishealth.com/newsletters/2002/2002-06-10.pdf