NEW DRUG REVIEWS FOR 12/16/2010 PA MEETING FOR …
[Pages:4]NEW DRUG REVIEWS FOR 12/16/2010 PA MEETING FOR INFORMATION ONLY
OPEN ACCESS COMMON TRADE NAME
GENERIC NAME
Colyte with Flavor Packs 227.1-21.5 ml Solution Reconstituted Duet DHA Complete 27-1-430 mg Combo Pack DRCP Ketocon + Plus 2%-1% Combo Cream Gel Millipred DP 5 mg Tablet Disp Pack Natazia 3-2-1(28) mg Tablet Natelle One 28-1-250 mg Capsule Pancrease (Pancreaze) 21-37-61 K Capsule DR Pancrease (Pancreaze) 16.8 K-40-70 K Capsule DR Pancrease (Pancreaze) 10.5 K-25 K Capsule DR Pancrease (Pancreaze) 4.2 K -10 K Capsule DR PNV-DHA Plus 27-400-1 mg Capsule Prenatal Low Iron 27 mg-1 mg Tablet Suprep 17.5-3.13 G Solution/Kit Tachosil 9.5 x 4.8 CM Adhesive Patch
PEG 3350/NA SULF,BICARB,CL/KCL
PNV77/SOD IRON EDTA& PS/FA/OM3 Ketoconazole/Hydrocortisone Prednisolone Estradiol Valerate/Dienogest PNV WITH CA,NO.70/IRON/FA/DHA Lipase/Protease/Mylase Lipase/Protease/Mylase Lipase/Protease/Mylase Lipase/Protease/Mylase PNV,CA42/IRON/FA/LM FOL CA/DHA PNV WITH CA,NO.74/IRON/FA SODIUM,POTASSIUM,&MAG SULFATES FIBRINOGEN/THROMBIN (HUM PLAS)
Tachosil 4.8 x 4.8 CM Adhesive Patch
FIBRINOGEN/THROMBIN (HUM PLAS)
Tasigna 150 mg Capsule Tobradex ST 0.3%-0.05% Venatal-FA 29 mg-1 mg Vol-nate 28 mg-1 mg Tablet Vol-Plus 27 mg-1 mg Tablet Vol-Tab Rx 29 mg - 1 mg tablet
Nilotinib Tobramycin Sulf/Dexamethason PRENATAL VIT NO.78/IRON/FA PRENATAL VIT NO.73/IRON/FA PNV WITH CA,NO.71/IRON/FA PRENATAL VIT #76/IRON,CARB/FA
INDICATIONS
Used to clean the colon (large bowel or lower intestine) before certain tests or surgery of the colon.
Prenatal Vitamin Used in the systemic treatment of mycotic infections. Used to treat severe allergies, arthritis, asthma, and skin conditions. Oral Contraceptive. Prenatal Vitamin Indicated for the treatment of exocrine pancreatic insufficiency due to cystic fibrosis or other conditions. Indicated for the treatment of exocrine pancreatic insufficiency due to cystic fibrosis or other conditions. Indicated for the treatment of exocrine pancreatic insufficiency due to cystic fibrosis or other conditions. Indicated for the treatment of exocrine pancreatic insufficiency due to cystic fibrosis or other conditions. Prenatal Vitamin Prenatal Vitamin An osmotic laxative indicated for cleansing of the colon in preparation for colonoscopy in adults Indicated for supportive treatment in surgery for improvement of haemostasis, to promote tissue sealing, and for suture support in vascular surgery where standard techniques are insufficient. Indicated for supportive treatment in surgery for improvement of haemostasis, to promote tissue sealing, and for suture support in vascular surgery where standard techniques are insufficient. Indicated to treat certain types of leukemia in people who failed or are intolerant to Gleevec Used to treat ophthalmic bacterial infections. Prenatal Vitamin Prenatal Vitamin Prenatal Vitamin Prenatal Vitamin
PDL EDITS FOR IMPLEMENTATION COMMON TRADE NAME
Aricept 23 mg Tablet Dulera 100-5 mcg HFA Aerosol AD Dulera 200-5 mcg HFA Aerosol AD Jalyn 0.5-0.4 mg CPMP
Lumigan 0.01% Drops Simcor 1000-40 mg TBMP 24 H Simcor 500-40 mg TBMP24 H Tekamlo 150 mg-5 mg Tekamlo 150 mg-10 mg Tekamlo 300 mg-5 mg Tekamlo 300 mg-10 mg Tablet Tribenzor 20-5-12.5 mg Tablet Tribenzor 40-10-12.5 mg Tablet Tribenzor 40-10-25 mg Tablet Tribenzor 40-5-12.5 mg Tablet Tribenzor 40-5-25 mg Tablet Zuplenz 4 mg Soluble Film Zuplenz 8 mg Soluble Film
GENERIC NAME
Donepezil HCL Mometasone/Formoterol Mometasone/Formoterol Dutasteride/Tamsulosin HCL Bimatoprost Niacin/Simvastatin Niacin/Simvastatin ALISKIREN/AMLODIPINE ALISKIREN/AMLODIPINE ALISKIREN/AMLODIPINE ALISKIREN/AMLODIPINE OLMESARTAN MED/AMLODIPINE/HCTZ OLMESARTAN MED/AMLODIPINE/HCTZ OLMESARTAN MED/AMLODIPINE/HCTZ OLMESARTAN MED/AMLODIPINE/HCTZ OLMESARTAN MED/AMLODIPINE/HCTZ Ondansetron Ondansetron
INDICATIONS
Alzheimers PDL Edit
NON PREFERRED
Inhaled Corticosteroids PDL Edit
PREFERRED
Inhaled Corticosteroids PDL Edit
PREFERRED
Iandrogen Hormone PDL Edit
NON PREFERRED
Ophthalmic Prostagalndins PDL Edit PREFERRED
Lipotropics - Niacin Preparations
NON PREFERRED
Lipotropics - Niacin Preparations
NON PREFERRED
Direct Renin PDL Edit
NON PREFERRED
Direct Renin PDL Edit
NON PREFERRED
Direct Renin PDL Edit
NON PREFERRED
Direct Renin PDL Edit
NON PREFERRED
ARB/CCB PD Edit
NON PREFERRED
ARB/CCB PD Edit
NON PREFERRED
ARB/CCB PD Edit
NON PREFERRED
ARB/CCB PD Edit
NON PREFERRED
ARB/CCB PD Edit
NON PREFERRED
Antiemetics PDL Edit
NON PREFERRED
Antiemetics PDL Edit
NON PREFERRED
CLINICAL EDITS FOR IMPLEMENTATION COMMON TRADE NAME
Fazaclo 150 mg Tablet Rapid Dissolve Fazaclo 200 mg Tablet Rapid Dissolve Focalin XR 40 mg capsule Suboxone 2 mg-0.5 mg Film Suboxone 8 mg-2 mg Film
Xeomin 50 Units Vial Xeomin 100 Units Vial
GENERIC NAME
Clozapine Clozapine Dexmethylphenidate Buprenorphine/Naloxone Buprenorphine/Naloxone INCOBOTULINUMTOXINA INCOBOTULINUMTOXINA
INDICATIONS
Atypical Antipsychotics Clinical Edit Atypical Antipsychotics Clinical Edit ADHD Therapy Suboxone/Subutex Clinical Edit Suboxone/Subutex Clinical Edit Botox Clinical Edit Botox Clinical Edit
REQUEST FOR CONTINUED PRIOR AUTHORIZATION
COMMON TRADE NAME
GENERIC NAME
INDICATIONS
Asmalpred Plus 15 mg/5 ml Kit Clobeta+ Plus 0.05-2.3% Kit Cocet Plus 650 mg-60 mg Tablet Corzall-PE 1-10-20/5 ml Liquid Desonil + Plus 0.05% Combo Ointment Cream Desonil + Plus 0.05% Cream (GM) Halflytely-Bisacodyl 5 mg-210 G Kit Oleptro ER 150 mg Tablet SR 24 H Oleptro ER 300 mg Tablet SR 24 H Pediatex PS 10-0.938/1 ml Liquid Poly Hist Forte 10 mg-25mg Tablet Rosula 10%-4% Foam Solodyn 105 mg Tablet SR 24H
Solodyn 80 mg Tablet SR 24H
Solodyn 55 mg Tablet SR24H
Uramaxin GT 45% Gel/PF Applicator
Xerese 5%-1% Cream
PREDNISOLON SOD PHOS/PEAK FLOW Clobetasol Propionate/Coal TAR ACETAMINOPHEN WITH CODEINE DEXCHLORPHENIRAM-PE-CARBETAPEN Desonide/Emollient Combo.NO 3 Desonide/Emollient Combo.NO 3 BISAC/NACL/NAHCO3/KCL/PEG 3350 Trazodone HCL Trazodone HCL Pseudoephed & Triprolid Polist PHENYLEPHRINE/PYRILAMINE SULFACETAMIDE SODIUM/SULFUR Minocycline HCl
Minocycline HCl
Minocycline HCl
Urea
ACYCLOVIR/HYDROCORTISONE
Treatment for inflammation of the skin, conjunctiva, and cornea and for immunosuppression. An innovative topical solution, plus anesthetic for the treatment of psoriasis Indicated for the relief of mild to moderately severe pain Cough and Cold Indicated to treat a variety of skin conditions (e.g., eczema, dermatitis, allergies, rash). Indicated to treat a variety of skin conditions (e.g., eczema, dermatitis, allergies, rash). Used to clean the bowel before colonoscopy or other intestinal procedure. Indicated for the treatment of major depressive disorder in adults Indicated for the treatment of major depressive disorder in adults Cough and Cold Cough and Cold Used in the treatment of acne, rosacea, and seborrheic dermatitis (a red, flaking skin rash). Used to treat bacterial infections including pneumonia and other respiratory tract infections; acne; and infections of skin, genital, and urinary systems. Used to treat bacterial infections including pneumonia and other respiratory tract infections; acne; and infections of skin, genital, and urinary systems. Used to treat bacterial infections including pneumonia and other respiratory tract infections; acne; and infections of skin, genital, and urinary systems.
Indicated for the treatment of hyperkeratotic conditions such as dry, rough skin, dermatitis, psoriasis, xerosis, ichthyosis, eczema, keratosis, keratoderma, corns and calluses, as well as damaged, devitalized and ingrown nails. Indicated for the early treatment of recurrent herpes labialis (cold sores) to reduce the likelihood of ulcerative cold sores and to shorten the lesion healing time in adults and adolescents (12 years of age and older).
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