$ |
product A least expensive |
$$ |
product B more expensive than A |
$$$ |
product C more expensive than B |
$$$$ |
product D more expensive than C |
$$$$$ |
product E more expensive than D |
!!!!! |
product F is substantially more expensive than A-E |
Non-Formulary |
product G not part of the formulary |
MAC |
Maximum Allowable Cost - the maximum charge that will be paid for the product whether generic or brand. |
Drug Name (Generic Name) |
The BRAND NAME of the drug followed by generic in parentheses or the generic name only. |
Drug and/or Generic Comments |
Comments such as: (suspension only), (caps, tabs only), (tablets non-form), etc. |
Strength and/or Dosage |
The dosage of a drug covered if not all strengths are formulary as in half-strength program. |
Strength and/or Dosage Comments |
Comments related to dosage/quantity limitations. |
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| Prev. Page | Prev. Class | Next Class | Next Page |
TOPICAL CORTICOSTEROID DRUGS
Relative Cost |
MAC |
Drug Name (Generic Name) Drug and/or Generic Comments |
Strength and/or Dosage Strength and/or Dosage Comments |
|
|
betanate (betamethasone dipropionate) |
|
|
|
del-beta (betamethasone dipropionate) |
|
|
|
DERMA-SMOOTHE-FS (fluocinolone acetonide) |
|
|
|
DIPROSONE (betamethasone dipropionate) |
|
|
|
fluocinonide emollient (fluocinonide) |
|
|
|
fluticasone propionate (fluticasone propionate) |
|
|
|
hydrocortisone (hydrocortisone) |
|
|
|
hydrocortisone (hydrocortisone/mo/petrolatum) |
|
|
|
triamcinolone acetonide (triamcinolone acetonide) |
|
|
|
TRIDESILON (desonide) |
|
$ |
|
ALA-CORT (hydrocortisone) |
|
$ |
|
beta-val (betamethasone valerate) |
|
$ |
|
betamethasone valerate (betamethasone valerate) |
|
$ |
|
desonide (desonide) |
|
$ |
|
fluocinolone acetonide (fluocinolone acetonide) |
|
$ |
|
hydrocortisone valerate (hydrocortisone valerate) |
|
$ |
|
HYTONE (hydrocortisone) |
|
$ |
|
triderm (triamcinolone acetonide) |
|
$ |
|
WESTCORT (hydrocortisone valerate) |
|
$$ |
|
ACLOVATE (alclometasone) |
|
$$ |
|
alclometasone dipropionate (alclometasone) |
|
$$ |
|
betamethasone dipropionate (betameth/propylene glycol) |
|
$$ |
|
betamethasone dipropionate (betamethasone dipropionate) |
|
$$ |
|
clobetasol propionate (clobetasol propionate) |
cream |
$$ |
|
clobetasol propionate (clobetasol propionate) |
gel |
$$ |
|
clobetasol propionate (clobetasol propionate) |
oint |
$$ |
|
clobetasol propionate (clobetasol propionate) |
soln |
$$ |
|
clobetasol propionate (clobetasol propionate) |
top |
$$ |
|
cormax (clobetasol propionate) |
|
$$ |
|
dermazene (iodoquinol/hydrocortisone) |
|
$$ |
|
DIPROLENE AF (betameth/propylene glycol) |
|
$$ |
|
fluocinonide (fluocinonide) |
|
$$ |
|
fluocinonide-e (fluocinonide) |
|
$$ |
|
hydrocortisone-iodoquinol (iodoquinol/hydrocortisone) |
|
$$ |
|
KENALOG (triamcinolone acetonide) |
|
$$ |
|
TEMOVATE (clobetasol propionate) |
|
$$ |
|
TEXACORT (hydrocortisone) |
|
$$$ |
|
amcinonide (amcinonide) |
lotion |
$$$ |
|
ELOCON (mometasone) |
|
$$$ |
|
mometasone furoate (mometasone) |
|
$$$ |
|
PRAMOSONE (pramoxine/hydrocortisone) |
|
$$$$ |
|
APEXICON (diflorasone) |
|
$$$$ |
|
APEXICON E (diflorasone) |
|
$$$$ |
|
clobetasol emollient (clobetasol propionate) |
|
$$$$ |
|
diflorasone diacetate (diflorasone) |
|
$$$$ |
|
FIRST-HYDROCORTISONE (hydrocortisone) |
|
$$$$ |
|
halobetasol propionate (halobetasol propionate) |
|
$$$$ |
|
HALOG (halcinonide) |
|
$$$$ |
|
TEMOVATE EMOLLIENT (clobetasol propionate) |
|
$$$$ |
|
TOPICORT LP (desoximetasone) |
|
$$$$ |
|
ULTRAVATE (halobetasol propionate) |
|
$$$$$ |
|
CAPEX SHAMPOO (fluocinolone acetonide) |
|
$$$$$ |
|
CUTIVATE (fluticasone propionate) |
cream |
$$$$$ |
|
CUTIVATE (fluticasone propionate) |
oint |
$$$$$ |
|
desoximetasone (desoximetasone) |
cream |
$$$$$ |
|
desoximetasone (desoximetasone) |
gel |
$$$$$ |
|
DIPROLENE (betameth/propylene glycol) |
|
$$$$$ |
|
TOPICORT (desoximetasone) |
|
Non-Formulary |
|
ALA-QUIN |
|
Non-Formulary |
|
ALA-SCALP HP |
|
Non-Formulary |
|
ALCORTIN A |
|
Non-Formulary |
|
AMCINONIDE |
|
Non-Formulary |
|
ANAMANTLE HC |
|
Non-Formulary |
|
ANAMANTLE HC FORTE |
|
Non-Formulary |
|
CARMOL HC |
|
Non-Formulary |
|
CLIOQUINOL-HYDROCORTISONE |
|
Non-Formulary |
|
CLOBETASOL PROPIONATE |
|
Non-Formulary |
|
CLOBEX |
|
Non-Formulary |
|
CLODERM |
|
Non-Formulary |
|
CORDRAN |
|
Non-Formulary |
|
CORDRAN SP |
|
Non-Formulary |
|
CUTIVATE |
|
Non-Formulary |
|
DERMATOP |
|
Non-Formulary |
|
DESONATE |
|
Non-Formulary |
|
DESOWEN |
|
Non-Formulary |
|
DESOWEN |
|
Non-Formulary |
|
DESOXIMETASONE |
|
Non-Formulary |
|
EPIFOAM |
|
Non-Formulary |
|
HYDROCORTISONE ACETATE |
|
Non-Formulary |
|
HYDROCORTISONE BUTYRATE |
|
Non-Formulary |
|
KERATOL HC |
|
Non-Formulary |
|
LIDAMANTLE HC |
|
Non-Formulary |
|
LIDAMANTLE HC |
|
Non-Formulary |
|
LIDAZONE HC |
|
Non-Formulary |
|
LIDOCAINE-HC |
|
Non-Formulary |
|
LIDOCAINE-HYDROCORTISONE |
|
Non-Formulary |
|
LOCOID |
|
Non-Formulary |
|
LOCOID |
|
Non-Formulary |
|
LOCOID LIPOCREAM |
|
Non-Formulary |
|
LOKARA |
|
Non-Formulary |
|
LUXIQ |
|
Non-Formulary |
|
NOVACORT |
|
Non-Formulary |
|
NUZON |
|
Non-Formulary |
|
OLUX |
|
Non-Formulary |
|
OLUX-E |
|
Non-Formulary |
|
OLUX-OLUX-E |
|
Non-Formulary |
|
PANDEL |
|
Non-Formulary |
|
PERANEX HC |
|
Non-Formulary |
|
PREDNICARBATE |
|
Non-Formulary |
|
U-CORT |
|
Non-Formulary |
|
ULTRAVATE PAC |
|
Non-Formulary |
|
VANOS |
|
Non-Formulary |
|
VANOXIDE-HC |
|
Non-Formulary |
|
VERDESO |
|
Non-Formulary |
|
XYRALID |
|
Non-Formulary |
|
XYRALID LP |
|
Non-Formulary |
|
ZYTOPIC |
|
Formulary Date: 07/08/2008 Update Date: 07/09/2008 V1.3.0