$ |
product A least expensive |
$$ |
product B more expensive than A |
$$$ |
product C more expensive than B |
$$$$ |
product D more expensive than C |
$$$$$ |
product E more expensive than D |
!!!!! |
product F is substantially more expensive than A-E |
Non-Formulary |
product G not part of the formulary |
MAC |
Maximum Allowable Cost - the maximum charge that will be paid for the product whether generic or brand. |
Drug Name (Generic Name) |
The BRAND NAME of the drug followed by generic in parentheses or the generic name only. |
Drug and/or Generic Comments |
Comments such as: (suspension only), (caps, tabs only), (tablets non-form), etc. |
Strength and/or Dosage |
The dosage of a drug covered if not all strengths are formulary as in half-strength program. |
Strength and/or Dosage Comments |
Comments related to dosage/quantity limitations. |
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| Prev. Page | Prev. Class | Next Class | Next Page |
CEPHALOSPORINS
Relative Cost |
MAC |
Drug Name (Generic Name) Drug and/or Generic Comments |
Strength and/or Dosage Strength and/or Dosage Comments |
|
|
CEFAZOLIN SODIUM (cefazolin) |
inj |
|
|
cefazolin sodium (cefazolin) |
20 gm inj |
|
|
cefazolin sodium (cefazolin) |
500 mg/ml inj |
|
|
cefazolin sodium (cefazolin) |
1000 mg inj |
|
|
cefazolin sodium (cefazolin) |
1000 mg/ml inj |
|
|
cefazolin sodium (cefazolin) |
10000 mg/ml inj |
|
|
cefepime hcl (cefepime) |
|
|
|
cefotaxime sodium (cefotaxime) |
|
|
|
cefoxitin (cefoxitin) |
|
|
|
ceftazidime (ceftazidime) |
|
|
|
ceftriaxone (ceftriaxone) |
|
|
|
cefuroxime axetil (cefuroxime axetil) |
|
|
|
cefuroxime sodium (cefuroxime) |
|
|
|
CLAFORAN (cefotaxime) |
|
|
|
CLAFORAN GALAXY (cefotaxime) |
|
|
|
FORTAZ (ceftazidime) |
|
|
|
FORTAZ IN ISO-OSMOTIC DEXTROSE (ceftazidime) |
|
|
|
MAXIPIME (cefepime) |
|
|
|
MEFOXIN (cefoxitin) |
|
|
|
ROCEPHIN (ceftriaxone) |
|
|
|
TAZICEF (ceftazidime) |
|
|
|
ZINACEF (cefuroxime) |
|
|
|
ZINACEF IN ISO-OSMOTIC WATER (cefuroxime) |
|
|
|
ZINACEF ISO-OSMOTIC DEXTROSE (cefuroxime) |
|
$ |
|
cefaclor (cefaclor) |
|
$ |
|
cephalexin (cephalexin) |
cap |
$ |
|
cephalexin (cephalexin) |
susp |
$$ |
|
cefadroxil (cefadroxil) |
|
$$ |
|
cefuroxime (ceftriaxone na/dextrose,iso) |
|
$$ |
|
cefuroxime (cefuroxime axetil) |
|
$$ |
|
KEFLEX (cephalexin) |
|
$$ |
|
VELOSEF (cephradine) |
|
$$$ |
|
cefdinir (cefdinir) |
|
$$$ |
|
cefprozil (cefprozil) |
|
$$$ |
|
CEFZIL (cefprozil) |
|
$$$ |
|
OMNICEF (cefdinir) |
|
$$$$ |
|
CEFTIN (cefuroxime axetil) |
|
Non-Formulary |
|
CEDAX |
|
Non-Formulary |
|
CEFACLOR ER |
|
Non-Formulary |
|
CEFPODOXIME PROXETIL |
|
Non-Formulary |
|
CEPHALEXIN |
|
Non-Formulary |
|
RANICLOR |
|
Non-Formulary |
|
SPECTRACEF |
|
Non-Formulary |
|
SUPRAX |
|
Non-Formulary |
|
VANTIN |
|
Formulary Date: 10/07/2008 Update Date: 10/09/2008 V1.3.0