Microsoft word - rxadvantage - 2013 nf

RxAdvantage
2013 Edition
DRUG LIST DETAILS:
ANTIFUNGALS
The following list by drug category contains available to members of the RxAdvantage TOPICAL ANTIBACTERIAL
(listed in al CAPS) and generic drugs (listed in lower case) are available at a copay up griseofulvin (generic Gris-PEG/ Grifulvin) TOPICAL ANTIFUNGALS
plan. All drugs not contained on this list are nystatin/ triamcinolone (generic Mycolog) A U T O N O M I C A N D C E N T R A L
Exclusions; Quantity Limits per copay may N E R V O U S S Y S T E M
ANTIFUNGALS (VAGINAL)
apply to certain medications. This list is ANALGESICS, ANTIMIGRAINAL
to confirm the most current drug list. We encourage you to share this list with your physician at the time of your treatment. ANTIHELMINICS
ANALGESICS, NARCOTIC
A N T I - I N F E C T IV E
ANTIBIOTICS
ANTI-INFECTIVE SPECIALIZED INDICATIONS
Cephalosporins
Erythromycins & Other Macrolides
clarithromycin (generic Biaxin, Biaxin XL) ANTINEOPLASTIC/IMMUNOSUPPRESANTS
erythromycin stearate (generic Erythrocin) Penicillins
amoxicillin/ pot. clav (generic Augmentin) ANTI-TUBERCULAR
ANTIVIRALS
Quinolones
ANALGESICS, NON-STEROIDAL
ANTI-INFLAMMATORY
diclofenac sodium (generic Voltraren/ XR) Sulfonamides
OTHER ANTI-INFECTIVES

Tetracyclines
Page 1 of 5
xAdvantage
2013 Edition
ANXIOLYTICS, SEDATIVES AND HYPNOTICS
ANTICONVULSANTS
CNS STIMULANTS
C A R D I O V A S C U L A R
ACE INHIBITORS
ANTIPARKINSONS
DRUGS TO PREVENT AND TREAT GOUT
ALPHA BLOCKERS
MUSCLE RELAXANTS/ ANTISPASMODICS
ANTIPSYCHOTICS
ANGIOTENSIN RECEPTOR BLOCKERS
carisoprodol, aspirin, caffeine (generic ANTIARRHYTHMICS
OTHER CNS/ AUTONOMIC
BETA-ADRENERGIC ANTAGONISTS
PSYCHOTHERAPEUTIC
ANTIVERTIGO/ ANTIEMETICS
Antidepressants
amitriptyline/ chlordiazepoxide (generic Page 2 of 5
xAdvantage
2013 Edition
metoprolol succinate (generic Toprol XL) fosinopril/ hydrochlorothiazide (generic lisinopril/ hydrochlorothiazide (generic CALCIUM CHANNEL BLOCKERS
propranolol/ hydrochlorothiazide (generic diltiazem (generic Cardizem/ SR/ Dilacor OTHER ANTIHYPERTENSIVES
verapamil (generic Calan SR/ Isoptin SR) E A R , N O S E , A N D T H R O A T
M E D I C A T I O NS
CARDIAC GLYCOSIDES
DRUGS AFFECTING THE EAR
CHOLESTEROL-LOWERING
OTHER CARDIOVASCULAR DRUGS
VASODILATING
DRUGS AFFECTING THE THROAT AND
DIURETICS
D E R M A T O L O G I C A L S
ANTI-ACNE
clindamycin (generic Cleocin-T/ Clindets E N D O C R I N E M E D I C A T I O NS
sulfacetamide/ sulfur, sublimed (generic ADRENAL CORTICOSTEROID
ANTIPSORIASIS
selenium sulfide (generic Exsel/ Selsun) DIURETIC COMBINATIONS
OTHER DERMATOLOGICAL
TOPICAL CORTICOSTEROIDS
ANTIDIABETIC AGENTS
Page 3 of 5
xAdvantage
2013 Edition
N U T R I T I O N , BL O O D M O D I F I E R S
OPHTHALMIC ANTI-INFECTIVES/
A N D E L E C T RO L Y T E S
CORTICOSTEROIDS
DRUGS AND VITAMINS AFFECTING
COAGULATION
FLUORIDE PRODUCTS
DRUGS TO TREAT OSTEOPOROSIS
sodium fluoride (generic Karidium/ Luride) POTASSIUM SUPPLEMENTS
THYROID AND ANTI-THYROID
levothyroxine (generic Synthroid/ Levoxyl)
VITAMINS/ MINERALS
B-complex w/ c & folic acid (generic) OPHTHALMIC CORTICOSTEROIDS
G A S T R O I N T ES T I N A L
ANTISPASMODICS
diphenoxylate/ atropine (generic Lomotil) belladonna alkaloids (generic Anti-Spas) OPHTHALMIC TOPICAL ANTIVIRALS
O P H T H A L M I C
GLAUCOMA
OTHER OPHTHALMIC
atropine sulfate (generic Isopto Atropine) OTHER GASTROINTESTINAL
O B S T E T R I C AL A N D
G Y N E C O L O G I C A L
ANDROGENS
OPHTHALMIC TOPICAL ANTIBACTERIAL
CONTRACEPTIVES
ethinyl estradiol and desogestrel (generic pramoxine/ hydrocortisone/ chloroxylenol ethinyl estradiol and ethynodiol diacetate PROTON PUMP INHIBITORS
M I S C E L L A N EO U S P R O D U C T S
OPHTHALMIC ANTIHISTAMINES
norethindrone/ ethinyl estradiol (generic Page 4 of 5
xAdvantage
2013 Edition
norethindrone/ ethinyl estradiol (generic norgestimate/ ethinyl estradiol (generic LEUKOTRIENE MODIFIERS
norgestimate/ ethinyl estradiol (generic MISCELLANEOUS PULMONARY AGENTS
ESTROGEN PATCHES
ESTROGEN/ PROGESTIN COMBINATIONS
PULMONARY AGENTS
Xanthines
theophylline (generic Theo-Dur/Slo-Phyllin/ ORAL ESTROGENS
U R O L O G I C AL M E D I C A T I O N S
ANTICHOLINERGICS/ ANTISPASMODICS
BETA AGONIST INHALERS
OTHER ESTROGEN PRODUCTS
BENIGN PROSTATIC HYPERTROPHY
PRENATAL VITAMINS
Inhaled Corticosteroids
MISCELLANEOUS UROLOGICALS
PROGESTINS
Intranasal Steroids
OTHER GENITOURINARY PRODUCTS
R E S P I R A T O R Y , A L L E R G Y , C O U G H
ANTIHISTAMINES/ ANTI-ALLERGENICS
BETA AGONIST ORAL
DECONGESTANTS/ ANTIHISTAMINES
ANTI-TUSSIVE COMBINATIONS
guaifenesin/ codeine (generic Robistussin EXPECTORANT COMBINATIONS
Page 5 of 5

Source: http://kravetz.247docrx.com/CoveredPrescriptions.pdf

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