$ |
product A least expensive |
$$ |
product B more expensive than A |
$$$ |
product C more expensive than B |
$$$$ |
product D more expensive than C |
$$$$$ |
product E more expensive than D |
!!!!! |
product F is substantially more expensive than A-E |
Non-Formulary |
product G not part of the formulary |
MAC |
Maximum Allowable Cost - the maximum charge that will be paid for the product whether generic or brand. |
Drug Name (Generic Name) |
The BRAND NAME of the drug followed by generic in parentheses or the generic name only. |
Drug and/or Generic Comments |
Comments such as: (suspension only), (caps, tabs only), (tablets non-form), etc. |
Strength and/or Dosage |
The dosage of a drug covered if not all strengths are formulary as in half-strength program. |
Strength and/or Dosage Comments |
Comments related to dosage/quantity limitations. |
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| Prev. Page | Prev. Class | Next Class | Next Page |
OTHER ANTIHYPERTENSIVES
Relative Cost |
MAC |
Drug Name (Generic Name) Drug and/or Generic Comments |
Strength and/or Dosage Strength and/or Dosage Comments |
|
|
CORLOPAM (fenoldopam mesylate) |
|
|
|
nadolol-bendroflumethiazide (bendroflumethiazide/nadolol) |
|
|
|
propranolol hcl-hctz (hctz/propranolol) |
|
$ |
|
atenolol-chlorthalidone (chlorthalidone/atenolol) |
|
$ |
|
benazepril hcl-hctz (benazepril/hctz) |
|
$ |
|
bisoprolol fumarate-hctz (hctz/bisoprolol fumarate) |
|
$ |
|
captopril-hydrochlorothiazide (captopril/hctz) |
|
$ |
|
LOTENSIN HCT (benazepril/hctz) |
|
$ |
|
ZIAC (hctz/bisoprolol fumarate) |
|
$$ |
|
CLORPRES (clonidine hcl/chlorthalidone) |
|
$$ |
|
enalapril maleate-hctz (enalapril maleate/hctz) |
|
$$ |
|
fosinopril-hydrochlorothiazide (fosinopril/hctz) |
|
$$ |
|
hydra-zide (hydralazine/hctz) |
|
$$ |
|
lisinopril-hctz (lisinopril/hctz) |
|
$$ |
|
methyldopa-hydrochlorothiazide (methyldopa/hctz) |
|
$$ |
|
metoprolol-hydrochlorothiazide (hctz/metoprolol) |
|
$$ |
|
moexipril-hydrochlorothiazide (moexipril/hctz) |
|
$$ |
|
PRINZIDE (lisinopril/hctz) |
|
$$ |
|
VASERETIC (enalapril maleate/hctz) |
|
$$$ |
|
DIOVAN HCT (requires trial of ACE Inhibitor) (hctz/valsartan) |
|
$$$ |
|
HYZAAR (requires trial of ACE Inhibitor) (losartan /hctz) |
|
$$$ |
|
LOPRESSOR HCT (hctz/metoprolol) |
|
$$$ |
|
TEKTURNA (requires trial of ACE or ARB) (aliskiren hemifumarate) |
|
$$$$ |
|
amlodipine besylate-benazepril (benazepril/amlodipine besylate) |
|
$$$$ |
|
CORZIDE (bendroflumethiazide/nadolol) |
|
$$$$$ |
|
LOTREL (benazepril/amlodipine besylate) |
|
Non-Formulary |
|
ACCURETIC |
|
Non-Formulary |
|
ATACAND HCT |
|
Non-Formulary |
|
ATACAND HCT (requires trial of ACE inhibitor) |
|
Non-Formulary |
|
AVALIDE |
|
Non-Formulary |
|
AZOR |
|
Non-Formulary |
|
BENICAR HCT |
|
Non-Formulary |
|
EXFORGE |
|
Non-Formulary |
|
EXFORGE HCT |
|
Non-Formulary |
|
LYTENSOPRIL |
|
Non-Formulary |
|
MICARDIS HCT |
|
Non-Formulary |
|
MONOPRIL HCT |
|
Non-Formulary |
|
QUINAPRIL-HYDROCHLOROTHIAZIDE |
|
Non-Formulary |
|
TARKA |
|
Non-Formulary |
|
TEKTURNA HCT |
|
Non-Formulary |
|
TENORETIC 100 |
|
Non-Formulary |
|
TENORETIC 50 |
|
Non-Formulary |
|
TEVETEN HCT |
|
Non-Formulary |
|
UNIRETIC |
|
Non-Formulary |
|
VALTURNA |
|
Non-Formulary |
|
ZESTORETIC |
|
Formulary Date: 10/21/2009 Update Date: 10/26/2009 V1.3.0