$ |
product A least expensive |
$$ |
product B more expensive than A |
$$$ |
product C more expensive than B |
$$$$ |
product D more expensive than C |
$$$$$ |
product E more expensive than D |
!!!!! |
product F is substantially more expensive than A-E |
Non-Formulary |
product G not part of the formulary |
MAC |
Maximum Allowable Cost - the maximum charge that will be paid for the product whether generic or brand. |
Drug Name (Generic Name) |
The BRAND NAME of the drug followed by generic in parentheses or the generic name only. |
Drug and/or Generic Comments |
Comments such as: (suspension only), (caps, tabs only), (tablets non-form), etc. |
Strength and/or Dosage |
The dosage of a drug covered if not all strengths are formulary as in half-strength program. |
Strength and/or Dosage Comments |
Comments related to dosage/quantity limitations. |
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| Prev. Page | Prev. Class | Next Class | Next Page |
OTHER ENDOCRINE DRUGS
Relative Cost |
MAC |
Drug Name (Generic Name) Drug and/or Generic Comments |
Strength and/or Dosage Strength and/or Dosage Comments |
|
|
alendronate sodium (alendronate) |
|
|
|
calcitonin-salmon (calcitonin) |
|
|
|
CEREDASE (alglucerase) |
|
|
|
RECLAST (zoledronic acid) |
|
|
|
vasopressin (vasopressin) |
|
$$$ |
|
ACTONEL WITH CALCIUM (Step Therapy-Requires trial of alendronate prior to use) (risedron sod/calcium carbona) |
|
$$$ |
|
fortical (calcitonin) |
|
$$$ |
|
FOSAMAX (alendronate) |
tab |
$$$$ |
|
CORTROSYN (cosyntropin) |
|
$$$$ |
|
desmopressin acetate (desmopressin acetate) |
|
$$$$ |
|
MIACALCIN (calcitonin) |
|
$$$$ |
|
pamidronate disodium (pamidronate disodium) |
|
$$$$$ |
|
ACTHAR H.P. (corticotropin) |
|
$$$$$ |
|
AREDIA (pamidronate disodium) |
|
$$$$$ |
|
cabergoline (cabergoline) |
|
$$$$$ |
|
CEREZYME (imiglucerase) |
|
$$$$$ |
|
DDAVP (PAR) (desmopressin acetate) |
|
$$$$$ |
|
DIDRONEL (etidronate) |
|
$$$$$ |
|
etidronate disodium (etidronate) |
|
$$$$$ |
|
FORTEO (teriparatide) |
|
$$$$$ |
|
STIMATE (PAR) (desmopressin acetate) |
|
Non-Formulary |
|
ACTONEL (Step Therapy-requires trial of alendronate prior to use) |
|
Non-Formulary |
|
BONIVA (Step Therapy-requires trial of alendronate prior to use) |
|
Non-Formulary |
|
FOSAMAX |
|
Non-Formulary |
|
FOSAMAX (Q) |
|
Non-Formulary |
|
FOSAMAX PLUS D |
|
Non-Formulary |
|
KUVAN |
|
Non-Formulary |
|
SENSIPAR |
|
Non-Formulary |
|
SKELID |
|
Non-Formulary |
|
ZAVESCA |
|
Formulary Date: 05/13/2009 Update Date: 05/15/2009 V1.3.0