HIV / AIDS Related Treatments HIV Treatment and Prevention Website: Antiretrovirals Nucleoside/Nucleotide Reverse Non-Nucleoside Reverse Protease Inhibitors Transcriptase Inhibitors Transcriptase Inhibitors
Delavirdine (RESCRIPTOR) ST1 Atazanavir
Efavirenz (SUSTIVA) ST1 Darunavir
Abacavir/lamivudine/zidovudine (TRIZIVIR) Nevirapine (VIRAMUNE) ST1
Etravirine () ST2 Indinavir HIV Integrase Inhibitor CCR-5 Inhibitor
Maraviroc ) (PA is required) Fusion Inhibitors NNRTI/NRTI Combination
* Enfuvirtide ) (PA is required) Efavirenz/emtricitabine/tenofovir
1. Not to be used in treatment Naive patients
Opportunistic Infections PCP infections Toxoplasmosis Fungal infections Mycobacterial infections Herpes infections
Famciclovir (FAMVIR) ST2 Pneumococcal
Valacyclovir (VALTREX) ST2 Influenza
Ribavirin (REBETOL, RIBASPHERE, COPEGUS)* PA CMV infections
Interferon alfa-2b (INTRON-A) PA Cryptosporidiosis
Peginterferon alfa-2a (PEGASYS) PA
Peginterferon alfa-2b (PEG-INTRON KIT)PA
1) BRAND NAMEs indicated by CAPITAL, generic names indicated by lower case, * indicates the generic equivalent is available. 2) MANDATORY GENERIC PROGRAM - MIDAP excludes coverage of brand-name drugs with FDA approved generic equivalents. 3) PA = Prior Authorization required. 4) QL= Quantity Limit. 5) Step Therapy: ST1 = the prerequisite drug for ST2 drug(s) in same
category; ST2 drugs require a trial of ST1 drug in same category. Analgesics Cephalosporins Nonsteroidal Anti-inflammatory Agents Antiretroviral Agents Quinolones Opiate Agonists Macrolides
Delavirdine (RESCRIPTOR) ST1
acetaminophen/caffeine/butabital/codeine
Efavirenz (SUSTIVA) ST1 Penicillins
Enfuvirtid) PA
Etravirine ()ST2 Tetracyclines
Maraviro) (PA) Vaginal Antimicrobials
Nevirapine (VIRAMUNE) ST1 Ophthalmic Antimicrobials
Oxycodone/Acetaminophen (PERCOCET)* Stavudine (ZERIT)*
Otic Antimicrobials Antituberculosis Agents
Topical Antimicrobials Anti-Infectives Other Antivirals Antifungal Antibiotics
Famciclovir (FAMVIR)ST2
COPEGUS)* PA Antiprotozoals, Miscellaneous
Valacyclovir (VALTREX)ST2
1) BRAND NAMEs indicated by CAPITAL, generic names indicated by lower case, * indicates the generic equivalent is available. 2) MANDATORY GENERIC PROGRAM - MIDAP excludes coverage of brand-name drugs with FDA approved generic equivalents. 3) PA = Prior Authorization required. 4) QL= Quantity Limit. 5) Step Therapy: ST1 = the prerequisite drug for ST2 drug(s) in same
category; ST2 drugs require a trial of ST1 drug in same category. Other Antimicrobials Central Agonists Anxiolytics, Sedatives and Hypnotics Lipid Lowering Agents Benzodiazepines Interferons
Interferon alfa-2b (INTRON-A)PA Nitrates and Nitrites
Peginterferon alfa-2a (PEGASYS)PA
Nitroglycerin sublingual tab, spray, cap*
Selective Serotonin Agonists
KIT )PA Diuretics Skeletal Muscle Relaxants Cardiovasculars Angiotensin II Receptor Antagonists Smoking Cessation Anticonvulsants Angiotensin-Converting Enzyme Inhibitors Substance Abuse Agents Antidepressants Endocrine
WELLBUTRIN XL ST2) Antidiabetic: Combinations Beta-Adrenergic Blocking Agents
Escitalopram (LEXAPRO) ST2 Antidiabetic: Bigunanides ST2)
Sertraline (ZOLOFT)ST2 Antidiabetic: Sulfonylureas Calcium-Channel Blocking Agents
XR)ST2 Antipsychotics Antidiabetic: Thiazolidinediones Antidiabetic: Insulins
1) BRAND NAMEs indicated by CAPITAL, generic names indicated by lower case, * indicates the generic equivalent is available. 2) MANDATORY GENERIC PROGRAM - MIDAP excludes coverage of brand-name drugs with FDA approved generic equivalents. 3) PA = Prior Authorization required. 4) QL= Quantity Limit. 5) Step Therapy: ST1 = the prerequisite drug for ST2 drug(s) in same
category; ST2 drugs require a trial of ST1 drug in same category. Proton-Pump Inhibitors Bronchodilators
Lansoprazole (PREVACID) ST2
Omeprazole ST2 (PRILOSECST2)* Inhaled Corticosteroids Leukotrene Modifier Histamine H2-Antagonists Bone Metabolism Nasal Corticosteroids Estrogen and Estrogen Modifier Anticholinergics/Motility Urologicals Thyroid Agents Miscellaneous GI Androgens Topical Agents Topical Anti-inflammatory Agents Blood Modifiers, Nutritionals, Electrolytes Anticoagulants/Antiplatelets Miscellaneous Dermatological Agent Corticosteroids Ophthalmic Agents Gastrointestinal Hematopoietic Agents
Epoetin alfa (OCRIT) PA
Filgrastim) PA Antiemetics Vaccines Vitamines and K replacement Respiratory Antidiarrhea Agents Antihistamines
Cetirizine (ZYRTEC) ST2
Cetirizine/p-ephedrine (ZYRTEC-D)ST2 Digestants ST2 Dental Products and DM device
Acrivastine/p-ephedrine (SEMPREX-D) ST2
1) BRAND NAMEs indicated by CAPITAL, generic names indicated by lower case, * indicates the generic equivalent is available. 2) MANDATORY GENERIC PROGRAM - MIDAP excludes coverage of brand-name drugs with FDA approved generic equivalents. 3) PA = Prior Authorization required. 4) QL= Quantity Limit. 5) Step Therapy: ST1 = the prerequisite drug for ST2 drug(s) in same
category; ST2 drugs require a trial of ST1 drug in same category.
Amoxicillin/clarithromycin/lansoprazole, 4
Acetaminophen /caffeine/butabital/codeine, 2
Conjugated estrogens tablet, vaginal cream, 4
1) BRAND NAMEs indicated by CAPITAL, generic names indicated by lower case, * indicates the generic equivalent is available. 2) MANDATORY GENERIC PROGRAM - MIDAP excludes coverage of brand-name drugs with FDA approved generic equivalents. 3) PA = Prior Authorization required. 4) QL= Quantity Limit. 5) Step Therapy: ST1 = the prerequisite drug for ST2 drug(s) in same
category; ST2 drugs require a trial of ST1 drug in same category.
Loratadine/pseudoephedrine, 4 Lorazepam, 3
1) BRAND NAMEs indicated by CAPITAL, generic names indicated by lower case, * indicates the generic equivalent is available. 2) MANDATORY GENERIC PROGRAM - MIDAP excludes coverage of brand-name drugs with FDA approved generic equivalents. 3) PA = Prior Authorization required. 4) QL= Quantity Limit. 5) Step Therapy: ST1 = the prerequisite drug for ST2 drug(s) in same
category; ST2 drugs require a trial of ST1 drug in same category.
Nitroglycerin sublingual tab, spray, cap, 3
1) BRAND NAMEs indicated by CAPITAL, generic names indicated by lower case, * indicates the generic equivalent is available. 2) MANDATORY GENERIC PROGRAM - MIDAP excludes coverage of brand-name drugs with FDA approved generic equivalents. 3) PA = Prior Authorization required. 4) QL= Quantity Limit. 5) Step Therapy: ST1 = the prerequisite drug for ST2 drug(s) in same
category; ST2 drugs require a trial of ST1 drug in same category.
1) BRAND NAMEs indicated by CAPITAL, generic names indicated by lower case, * indicates the generic equivalent is available. 2) MANDATORY GENERIC PROGRAM - MIDAP excludes coverage of brand-name drugs with FDA approved generic equivalents. 3) PA = Prior Authorization required. 4) QL= Quantity Limit. 5) Step Therapy: ST1 = the prerequisite drug for ST2 drug(s) in same
category; ST2 drugs require a trial of ST1 drug in same category.
Paraquat is a safe and effective herbicide when used as directed on the label. However, exposure to toxic doses of paraquat (largely with suicidal intention) is oftenfatal, despite aggressive medical intervention. Early recognition, and attempts atremoval of paraquat from the body remain the cornerstone of therapy. In recent years there has been little change in the general management of paraquat
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