$ |
product A least expensive |
$$ |
product B more expensive than A |
$$$ |
product C more expensive than B |
$$$$ |
product D more expensive than C |
$$$$$ |
product E more expensive than D |
!!!!! |
product F is substantially more expensive than A-E |
Non-Formulary |
product G not part of the formulary |
MAC |
Maximum Allowable Cost - the maximum charge that will be paid for the product whether generic or brand. |
Drug Name (Generic Name) |
The BRAND NAME of the drug followed by generic in parentheses or the generic name only. |
Drug and/or Generic Comments |
Comments such as: (suspension only), (caps, tabs only), (tablets non-form), etc. |
Strength and/or Dosage |
The dosage of a drug covered if not all strengths are formulary as in half-strength program. |
Strength and/or Dosage Comments |
Comments related to dosage/quantity limitations. |
|
|
|
|
|
| Prev. Page | Prev. Class | Next Class | Next Page |
DRUGS AFFECTING THE EAR
Relative Cost |
MAC |
Drug Name (Generic Name) Drug and/or Generic Comments |
Strength and/or Dosage Strength and/or Dosage Comments |
|
|
a-b otic (antipyrine/benzocaine) |
|
|
|
acetic acid (acetic acid) |
otic drops |
|
|
CORTISPORIN (neomycin sulfate/polymyxin/hc) |
otic drops |
|
|
CORTISPORIN (neomycin sulfate/polymyxin/hc) |
suspensions |
|
|
CORTISPORIN (neomycin sulfate/polymyxin/hc) |
not oral |
|
|
DOMEBORO (acetic acid/aluminum acetate) |
|
|
|
neomycin-polymyxin-hc (neomycin sulfate/polymyxin/hc) |
|
|
|
ofloxacin (ofloxacin) |
|
|
|
otocidin (neomycin sulfate/polymyxin/hc) |
|
|
|
otomycet-hc (acetic acid/hydrocortisone) |
|
$ |
|
acetic acid-aluminum (acetic acid/aluminum acetate) |
|
$ |
|
antipyrine-benzocaine (antipyrine/benzocaine) |
|
$ |
|
aurodex ear drops (antipyrine/benzocaine) |
|
$ |
|
auroguard (antipyrine/benzocaine) |
|
$ |
|
BENZOTIC (antipyrine/benzocaine) |
|
$ |
|
borofair (acetic acid/aluminum acetate) |
|
$ |
|
OTOGESIC (antipyrine/benzocaine) |
otic drops |
$$ |
|
acetasol hc (acetic acid/hydrocortisone) |
|
$$ |
|
acetic acid-hydrocortisone (acetic acid/hydrocortisone) |
|
$$ |
|
cortomycin (neomycin sulfate/polymyxin/hc) |
|
$$$ |
|
COLY-MYCIN S (neomycin sulfate/colist sul/hc) |
|
$$$$ |
|
oticin hc (neomycin sulfate/polymyxin/hc) |
otic drops |
$$$$ |
|
oticin hc (neomycin sulfate/polymyxin/hc) |
suspensions |
$$$$ |
|
oticin hc (neomycin sulfate/polymyxin/hc) |
not oral |
$$$$ |
|
PEDIOTIC (neomycin suf/polymy/buffers/hc) |
|
$$$$$ |
|
CIPRO HC (ciprofloxacin/hc) |
|
$$$$$ |
|
CIPRODEX (ciprofloxacin/dexameth) |
|
$$$$$ |
|
CORTISPORIN-TC (neomycin/colist sul/hc/thonz) |
|
$$$$$ |
|
FLOXIN (ofloxacin) |
|
Non-Formulary |
|
AERO OTIC HC |
|
Non-Formulary |
|
ALBA-3 |
|
Non-Formulary |
|
AURALGAN |
|
Non-Formulary |
|
CHLOROXYLENOL-PRAMOXINE HCL |
|
Non-Formulary |
|
CHLORPRAM Z |
|
Non-Formulary |
|
CORTAMOX |
|
Non-Formulary |
|
CORTANE-B |
|
Non-Formulary |
|
CORTANE-B |
|
Non-Formulary |
|
CORTIC-ND |
|
Non-Formulary |
|
CRESYLATE |
|
Non-Formulary |
|
DERMOTIC |
|
Non-Formulary |
|
EAR-GESIC |
|
Non-Formulary |
|
EXOTIC-HC |
|
Non-Formulary |
|
HYDRO |
|
Non-Formulary |
|
NEOTIC |
|
Non-Formulary |
|
OMEDIA OTIC |
|
Non-Formulary |
|
OTIC EDGE |
|
Non-Formulary |
|
OTICAINE |
|
Non-Formulary |
|
OTICIN HC |
|
Non-Formulary |
|
OTILAM |
|
Non-Formulary |
|
OTIRX |
|
Non-Formulary |
|
OTO-END 10 |
|
Non-Formulary |
|
OTOGESIC |
|
Non-Formulary |
|
OTOMAR |
|
Non-Formulary |
|
OTOMAX-HC |
|
Non-Formulary |
|
OTOSPORIN |
|
Non-Formulary |
|
OTOZONE |
|
Non-Formulary |
|
PR OTIC SOLUTION |
|
Non-Formulary |
|
PRAMOTIC |
|
Non-Formulary |
|
ZINOTIC |
|
Non-Formulary |
|
ZOTO-HC |
|
Formulary Date: 10/07/2008 Update Date: 10/09/2008 V1.3.0