Eliquis 5 mg starter pack
[DOCX File]ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS - …
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ELIQUIS XARELTO. Heparins And Heparinoid-Like Agents. GENERIC. heparin lock flush heparin sodium in 0.45% nacl heparin sodium in 5% dextrose heparin sodium syringe. NON PREFERRED. HEPARIN SODIUM IN 0.45% NACL 12500/500. Low Molecular Weight Heparins. GENERIC. enoxaparin sodium. NON PREFERRED. FRAGMIN. Synthetic Heparinoid-Like Agents
[DOCX File]CY2021 Standard MAPD 5T_21333_353_441
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lamotrigine starter kit-orange oral kit 42 x 25 mg & 7 x 100 mg. 2. GC. levetiracetam er oral tablet extended release 24 hour 500 mg, 750 mg. 2. GC. ... XCOPRI ORAL TABLET THERAPY PACK 14 X 12.5 MG & 14 X 25 MG, 14 X 150 MG & 14 X200 MG, 14 X 50 MG & 14 X100 MG. 4. ST2; QL (28 EA per 28 days) Calcium Channel Modifying Agents. CELONTIN ORAL ...
[DOCX File]PPHP Part D 1-Tier CY20
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lamotrigine starter kit-blue oral kit. 35 x 25 mg. 1. MO. lamotrigine starter kit-green oral kit. 84 x 25 mg & 14x100 mg. 1. MO. lamotrigine starter kit-orange oral kit. 42 x 25 mg & 7 x 100 mg ... KISQALI FEMARA(200 MG DOSE) ORAL TABLET THERAPY PACK 200 & 2.5 MG. 1. PA2; MO. LENVIMA (10 MG DAILY DOSE) ORAL CAPSULE THERAPY PACK 10 MG. 1. PA2 ...
[DOCX File]Standard ISNP 1-Tier CY21
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VALTOCO 15 MG DOSE NASAL LIQUID THERAPY PACK 7.5 MG/0.1ML. 1. ... ELIQUIS DVT/PE STARTER PACK ORAL TABLET 5 MG. 1. ELIQUIS ORAL TABLET 2.5 MG, 5 MG. 1. enoxaparin sodium subcutaneous solution 100 mg/ml, 120 mg/0.8ml, 150 mg/ml, 30 mg/0.3ml, 40 mg/0.4ml, 60 mg…
[DOCX File]2018 - AgeWell New York
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AgeWell 1-Tier. 2018. Formulary Addendum. Formulary ID: 18327 Version 15. Last Updated: 11/01/2018. Page 1 of 21
[DOCX File]Department of Health | State of Louisiana
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Eliquis® Starter Pack. Tablet Dose Pack. 1 unit/365 days. Dabigatran Etexilate Mesylate . ... Prescriptions for Zubsolv® are allowed a maximum of up to 17.1 mg/day (based on buprenorphine) per recipient for an initial 90 consecutive day period. After the initial 90 day period, a maximum daily dose of up to 11.4 mg/day (based on buprenorphine ...
Lilly Cares is a patient assistance program administered ...
Victoza® (liraglutide) injection 1.2 mg 2 pen pack* Victoza® (liraglutide) injection 1.8 mg 3 pen pack* Xultophy® 100/3.6 (insulin degludec & liraglutide injection) 100 U/mL & 3.6 mg/mL. Xultophy® 100/3.6 100 U/3.6 mg/mL (5 pens x 3 mL/pen)* Other useful medication assistance information: Patient Medication Assistance Program Websites. RxAssist
[DOCX File]Clear Springs - MAPD 2021 Comp
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xpovio oral tablet 100 mg/week (20 mg x 5), 40mg twice week (80 mg/week), 60 mg/week (20 mg x 3), 80 mg/week (20 mg x 4), 80mg twice week (160 mg/week)
[DOCX File]Adenosine Receptor Antagonist
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ELIQUIS XARELTO. Heparins And Heparinoid-Like Agents. GENERIC. heparin lock flush heparin sodium in 0.45% nacl heparin sodium in 5% dextrose heparin sodium syringe. NON PREFERRED. HEPARIN SODIUM IN 0.45% NACL 12500/500. Low Molecular Weight Heparins. GENERIC. enoxaparin sodium. NON PREFERRED. FRAGMIN. Synthetic Heparinoid-Like Agents
[DOC File]AR Medicaid DUR Board edits approved at the April 15, 2015 ...
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Oral Anticoagulant Criteria: warfarin, ELIQUIS® (apixaban) 2.5 mg, 5 mg tablet, PRADAXA® (dabigatran etexilate mesylate) 75 mg, 150 mg capsules, XARELTO® (Rivaroxaban) 10 mg, 15 mg, 20 mg tablets, and XARELTO® Starter Pack, SAVAYSA™ (edoxaban tosylate) tablet 15 MG, 30 MG, 60 MG: The point-of-sale criteria have been revised as follows:
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