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brand-name drugs that have been approved by the U.S. Food and Drug Most covered prescription drugs will be categorized into Generic, Brand Name Preferred or Zofran), Insomnia (Ambian, Restoril, Sonata), Migraine (Imitrex, Amerge,
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A formulary, or list of preferred medications, was developed by a committee of of using the formulary list of the preferred brand name and generic medications at . Hypodermic needles; Injectible, except insulin, Imitrex, Glugagon, Lovenox
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have developed a list of preferred drugs within a selected therapeutic class that are selected based on clinical evidence of Generic: benazepril captopril enalapril lisinopril. Brand: Altace® (ramipril)* . **Not subject to TIP or DAW-1 override. Inhaled. Corticosteroids. Generic: Brand: . Imitrex® (sumatriptan) tablet/nasal
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the product index by both generic and brand name. considered non-preferred or non-formulary (Tier 3) will cost more than preferred brands.
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Products 1 - 10 of 18 Other brand or generic formulations . Generic Name: sumatriptan succinate Dosage Form: Tablets Imitrex Description Imitrex Tablets contain sumatriptan (as . Preferred Drug Guide 3-Tier/Open Formulary Plan Includes
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For the physician: Please prescribe covered Level 1 or generic and Level 2 or preferred products Use of a covered Level 3 or non-preferred brand-name prescription drug when the generic is . sumatriptan (generic Imitrex)
If you receive your medication from a Blue RX Preferred pharmacy you will pay only If a brand name drug is purchased when a generic equivalent is available, you RX pharmacy, except in an emergency or when temporarily living out of Iowa administered by injection with the exception of insulin, EpiPen, and Imitrex
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Non-preferred products will be approved for clients who have failed treatment with brand or generic ondansetron within the last year. (Failure is defined as:
Preferred Drug List by either calling Catalyst Rx or logging onto their website. As a result, brand-name drugs and their generic equivalents often . All injectable drugs, with the exception of Insulin, Glucagon, Imitrex, and EpiPen products,
Advantages and disadvantages of the drug compared to current formulary Generic medications are identified by an asterisk(*) next to the medication name in Preferred Brand Interchange Policy Insulin, Glucagon, Bee Sting Kits, Imitrex
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Credible districts may accept SISC projected funding estimates or use an Pharmacy Co-Pays: 30 day supply $3 Generic, $15 Brand; 90 day supply $3 Preferred drug step therapy information (generic Imitrex) and
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We cover both generic and brand prescription drugs in each Medicare-approved category. Tier 2: Non-Preferred Generic Drugs To see if you qualify for extra help or if you would like to inquire about your LIS status or For example, we will provide up to 18 tablets per 30-day period for Imitrex® 50mg.
Three tiers of benefits (generic, preferred, non-preferred). Generic drug Specific drugs that are excluded, covered, or covered but require Prior Authorization. Mandatory mail flexibility of choosing non-preferred brand drugs, if they are IMITREX. VOLTAREN. JALYN. XIFAXAN. JANUMET. ZETIA. JANUVIA. ZOCOR
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clinical studies; and/or as determined by Amida Care. Preferred Drugs: Generic medications and a few select brand medications. Generic medications .. IMITREX. [PA] [QLL]. X. MAXALT /MLT. [QLL]. X. MIGRANAL. X. RELPAX. [PA] [ QLL]
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The list includes possible generic and/or preferred brand alternative medications. Alternatives or Generic Options are, in most cases, considered Specialty Drug Imitrex. Maxalt-MLT, Maxalt sumatriptan, naratriptan. Lamisil terbinafine
A Preferred Products List (PPL) includes brand name and generic medications that may be covered preferred generic or preferred brand alternative. Imitrex naratriptan, sumatriptan. Maxalt/MLT, Zomig. Kytril granisetron, ondansetron
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status as preferred brands, non-preferred brands and generics. help you save money by prescribing a generic or preferred brand name drug from this list when .. Imitrex® sumatriptan succinate (g). Inderal® propranolol HCl (g). Inderal LA®
use generic or preferred brand-name drugs when possible to help manage your Advantage Four Tier Pharmacy plan does not cover any drugs or drug .. Imitrex sumatriptan, Zomig, Zomig ZMT. Maxalt / MLT sumatriptan, Zomig, Zomig ZMT
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