$ |
product A least expensive |
$$ |
product B more expensive than A |
$$$ |
product C more expensive than B |
$$$$ |
product D more expensive than C |
$$$$$ |
product E more expensive than D |
!!!!! |
product F is substantially more expensive than A-E |
Non-Formulary |
product G not part of the formulary |
MAC |
Maximum Allowable Cost - the maximum charge that will be paid for the product whether generic or brand. |
Drug Name (Generic Name) |
The BRAND NAME of the drug followed by generic in parentheses or the generic name only. |
Drug and/or Generic Comments |
Comments such as: (suspension only), (caps, tabs only), (tablets non-form), etc. |
Strength and/or Dosage |
The dosage of a drug covered if not all strengths are formulary as in half-strength program. |
Strength and/or Dosage Comments |
Comments related to dosage/quantity limitations. |
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| Prev. Page | Prev. Class | Next Class | Next Page |
URINARY ANTIINFECTIVES
Relative Cost |
MAC |
Drug Name (Generic Name) Drug and/or Generic Comments |
Strength and/or Dosage Strength and/or Dosage Comments |
$ |
|
MACRODANTIN (nitrofurantoin macrocrystal) |
|
$ |
|
nitrofurantoin (nitrofurantoin macrocrystal) |
|
$ |
|
nitrofurantoin macrocrystal (nitrofurantoin/nitrofuran mac) |
|
$ |
|
trimethoprim (trimethoprim) |
|
$ |
|
uretron d-s (meth/meth blue/salol/sod/hyos) |
tab |
$$ |
|
MACROBID (nitrofurantoin/nitrofuran mac) |
|
$$$ |
|
MONUROL (fosfomycin tromethamine) |
|
$$$$$ |
|
FURADANTIN (nitrofurantoin) |
|
Non-Formulary |
|
HIPREX |
|
Non-Formulary |
|
METHENAMINE HIPPURATE |
|
Non-Formulary |
|
PRIMSOL |
|
Non-Formulary |
|
URETRON D-S |
|
Non-Formulary |
|
URIMAR-T |
|
Non-Formulary |
|
URO BLUE |
|
Non-Formulary |
|
UROGESIC-BLUE |
|
Non-Formulary |
|
UROQID-ACID NO.2 |
|
Non-Formulary |
|
UTAC |
|
Non-Formulary |
|
UTIRA-C |
|
Non-Formulary |
|
VISQID A-A |
|
Formulary Date: 10/07/2008 Update Date: 10/09/2008 V1.3.0