$ |
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 |
GLUCOCORTICOID DRUGS
Relative Cost |
MAC |
Drug Name (Generic Name) Drug and/or Generic Comments |
Strength and/or Dosage Strength and/or Dosage Comments |
|
|
baycadron (dexamethasone) |
|
|
|
betamethasone acetate-sod phos (betamethasone/betamethasone) |
|
|
|
dexamethasone sodium phosphate (dexamethasone sod phosphate) |
|
|
|
hydrocortisone (hydrocortisone) |
|
|
|
prednisolone sodium phosphate (prednisolone sod phosphate) |
|
|
|
triamcinolone acetonide (triamcinolone acetonide) |
|
$ |
|
a-methapred (methylprednisolone sod succ) |
|
$ |
|
ARISTOSPAN (triamcinolone hexacetonide) |
|
$ |
|
cortisone (cortisone) |
|
$ |
|
DEPO-MEDROL (methylprednisolone acetate) |
|
$ |
|
dexamethasone (dexamethasone) |
|
$ |
|
KENALOG-10 (triamcinolone acetonide) |
|
$ |
|
MEDROL (methylprednisolone) |
|
$ |
|
meprolone unipak (methylprednisolone) |
|
$ |
|
methylprednisolone (methylprednisolone) |
|
$ |
|
methylprednisolone acetate (methylprednisolone acetate) |
|
$ |
|
methylprednisolone sod succ (methylprednisolone sod succ) |
|
$ |
|
ORAPRED (prednisolone sod phosphate) |
|
$ |
|
PEDIAPRED (prednisolone sod phosphate) |
|
$ |
|
prednisolone (prednisolone) |
|
$ |
|
prednisone (prednisone) |
|
$ |
|
PRELONE (prednisolone) |
|
$ |
|
SOLU-CORTEF (hydrocortisone sod succinate) |
|
$ |
|
STERAPRED (prednisone) |
|
$$ |
|
CELESTONE (betamethasone/betamethasone) |
inj |
$$ |
|
CORTEF (hydrocortisone) |
|
$$ |
|
DEXPAK (dexamethasone) |
|
$$ |
|
KENALOG-40 (triamcinolone acetonide) |
|
$$ |
|
prednisone intensol (prednisone) |
|
$$ |
|
SOLU-MEDROL (methylprednisolone sod succ) |
|
Non-Formulary |
|
CELESTONE |
|
Non-Formulary |
|
DEXAMETHASONE INTENSOL |
|
Non-Formulary |
|
MILLIPRED |
|
Non-Formulary |
|
MILLIPRED |
|
Non-Formulary |
|
MILLIPRED DP |
|
Non-Formulary |
|
ORAPRED ODT |
|
Non-Formulary |
|
VERIPRED 20 |
|
Formulary Date: 10/21/2009 Update Date: 10/26/2009 V1.3.0