$ |
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 |
VITAMINS & MINERALS & RELATED PRODUCTS
Relative Cost |
MAC |
Drug Name (Generic Name) Drug and/or Generic Comments |
Strength and/or Dosage Strength and/or Dosage Comments |
|
|
FERRLECIT (sod ferric gluc complex/sucr) |
|
|
|
INTRALIPID (fat emulsions) |
|
|
|
LIPOSYN II (fat emulsions) |
|
|
|
LIPOSYN III (fat emulsions) |
inj |
|
|
liposyn iii (fat emulsions) |
30 % inj |
|
|
multi vitamins with fluoride (multivitamins w/fluoride) |
|
|
|
multivitamin with fluoride (multivitamins w/fluoride) |
|
|
|
multivitamins with fluoride (multivitamins w/fluoride) |
|
|
|
poly-vitamin with fluoride (multivitamins w/fluoride) |
|
|
|
polyvitamins-fluoride (multivitamins w/fluoride) |
|
|
|
tri-vit with fluoride-iron (triple vits w/fluor & iron) |
|
|
|
tri-vitamin with fluoride (triple vitamins w/fluoride) |
|
|
|
tri-vitamin with iron-fluoride (triple vits w/fluor & iron) |
|
|
|
tri-vitamins with fluoride (triple vitamins w/fluoride) |
|
|
|
VITAMAX (multivitamins) |
|
$ |
|
fa-cyanocobalamine-pyridoxine (cyanocobalamin/fa/pyridoxine) |
|
$ |
|
FLUORABON BASIC (triple vitamins w/fluoride) |
|
$ |
|
folamin (cyanocobalamin/fa/pyridoxine) |
|
$ |
|
folbee (cyanocobalamin/fa/pyridoxine) |
|
$ |
|
folcaps (cyanocobalamin/fa/pyridoxine) |
|
$ |
|
folic acid-cyancobal-pyridoxin (cyanocobalamin/fa/pyridoxine) |
|
$ |
|
folplex 2.2 (cyanocobalamin/fa/pyridoxine) |
|
$ |
|
multi-vita bets-fluoride (multivitamins w/fluoride) |
|
$ |
|
nufol (cyanocobalamin/fa/pyridoxine) |
|
$ |
|
PROTECT PLUS (amino acids/mv,fe,other min) |
|
$ |
|
THEROBEC (vitamin b comp w-c) |
|
$ |
|
tri-vitamin-fluoride (triple vitamins w/fluoride) |
|
$ |
|
vitalize plus (multivitamins w-iron, hematini) |
|
$$ |
|
allanfol rx (cyanocobalamin/fa/pyridoxine) |
|
$$ |
|
allantex (cyanocobalamin/fa/pyridoxine) |
|
$$ |
|
combgen (cyanocobalamin/fa/pyridoxine) |
|
$$ |
|
folbalin plus (cyanocobalamin/fa/pyridoxine) |
|
$$ |
|
folbic (cyanocobalamin/fa/pyridoxine) |
|
$$ |
|
FOLGARD RX (cyanocobalamin/fa/pyridoxine) |
|
$$ |
|
FOLTX (cyanocobalamin/fa/pyridoxine) |
|
$$ |
|
SENILEZOL (iron/vitamin b complex) |
|
$$ |
|
VITAFOL (multivits w fe,ca,fa,minerals) |
tab |
$$$$ |
|
NERVIDOX-6 NR (biot/vit b12/fa/vit b6/vit b1) |
|
Non-Formulary |
|
ALBALYBE |
|
Non-Formulary |
|
AMINOBENZOATE POTASSIUM |
|
Non-Formulary |
|
ANEMAGEN |
|
Non-Formulary |
|
ANEMAGEN FORTE |
|
Non-Formulary |
|
ANIMI-3 |
|
Non-Formulary |
|
ASCORBIC ACID |
|
Non-Formulary |
|
B-PLEX |
|
Non-Formulary |
|
B-PLEX PLUS |
|
Non-Formulary |
|
BACMIN |
|
Non-Formulary |
|
BONISARA |
|
Non-Formulary |
|
CALAFOL RX |
|
Non-Formulary |
|
CALCIFOL |
|
Non-Formulary |
|
CALCIFOLIC-D |
|
Non-Formulary |
|
CARDIOTEK RX |
|
Non-Formulary |
|
CARDIOTEK-RX |
|
Non-Formulary |
|
CARDIOVID PLUS |
|
Non-Formulary |
|
CEFOL |
|
Non-Formulary |
|
CEREFOLIN |
|
Non-Formulary |
|
CEREFOLIN NAC |
|
Non-Formulary |
|
CHROMAGEN |
|
Non-Formulary |
|
CHROMAGEN FA |
|
Non-Formulary |
|
CHROMAGEN FORTE |
|
Non-Formulary |
|
CONISON |
|
Non-Formulary |
|
CORVITA |
|
Non-Formulary |
|
CORVITE |
|
Non-Formulary |
|
CORVITE 150 |
|
Non-Formulary |
|
CORVITE FREE |
|
Non-Formulary |
|
DEXFOL |
|
Non-Formulary |
|
DIALYVITE |
|
Non-Formulary |
|
DIALYVITE 3000 |
|
Non-Formulary |
|
DIALYVITE 800 WITH IRON |
|
Non-Formulary |
|
DIALYVITE ZINC |
|
Non-Formulary |
|
DIATX ZN |
|
Non-Formulary |
|
ED CYTE F |
|
Non-Formulary |
|
ELDERCAPS |
|
Non-Formulary |
|
ENCORA |
|
Non-Formulary |
|
ERITROGEN |
|
Non-Formulary |
|
FABB |
|
Non-Formulary |
|
FE-TINIC 150 FORTE |
|
Non-Formulary |
|
FEMTABS |
|
Non-Formulary |
|
FERO-FOLIC-500 |
|
Non-Formulary |
|
FEROCON |
|
Non-Formulary |
|
FEROTRINSIC |
|
Non-Formulary |
|
FERRALET 90 |
|
Non-Formulary |
|
FERREX 150 FORTE |
|
Non-Formulary |
|
FERREX 150 FORTE PLUS |
|
Non-Formulary |
|
FERRO-PLEX HEMATINIC |
|
Non-Formulary |
|
FERROCITE PLUS |
|
Non-Formulary |
|
FERROGELS FORTE |
|
Non-Formulary |
|
FETRIN |
|
Non-Formulary |
|
FOLBEE PLUS |
|
Non-Formulary |
|
FOLBEE PLUS CZ |
|
Non-Formulary |
|
FOLGARD OS |
|
Non-Formulary |
|
FOLITAB 500 |
|
Non-Formulary |
|
FOLMOR |
|
Non-Formulary |
|
FOLPACE RX |
|
Non-Formulary |
|
FOLTRATE |
|
Non-Formulary |
|
FOLTRIN |
|
Non-Formulary |
|
FORMULA B PLUS |
|
Non-Formulary |
|
FORMULA-B |
|
Non-Formulary |
|
FUMATINIC |
|
Non-Formulary |
|
GLUTOFAC-MX |
|
Non-Formulary |
|
GLUTOFAC-ZX |
|
Non-Formulary |
|
HEMATINIC PLUS |
|
Non-Formulary |
|
HEMATINIC WITH FOLIC ACID |
|
Non-Formulary |
|
HEMATOGEN |
|
Non-Formulary |
|
HEMATOGEN FA |
|
Non-Formulary |
|
HEMATOGEN FORTE |
|
Non-Formulary |
|
HEMATRON |
|
Non-Formulary |
|
HEMATRON |
|
Non-Formulary |
|
HEMATRON-AF |
|
Non-Formulary |
|
HEMAX |
|
Non-Formulary |
|
HEMOCYTE PLUS |
|
Non-Formulary |
|
HEMOCYTE-F |
|
Non-Formulary |
|
HEMOCYTE-F |
|
Non-Formulary |
|
IBERET-FOLIC 500 |
|
Non-Formulary |
|
ICAR-C PLUS SR |
|
Non-Formulary |
|
IFEREX 150 |
|
Non-Formulary |
|
IFEREX 150 FORTE |
|
Non-Formulary |
|
IRCON-FA |
|
Non-Formulary |
|
LIPOCHOL PLUS |
|
Non-Formulary |
|
LYSIPLEX |
|
Non-Formulary |
|
MAXARON FORTE |
|
Non-Formulary |
|
METANX |
|
Non-Formulary |
|
MI-OMEGA |
|
Non-Formulary |
|
MULTI-RET FOLIC 500 |
|
Non-Formulary |
|
MULTICHEW |
|
Non-Formulary |
|
MULTIGEN |
|
Non-Formulary |
|
MULTIGEN PLUS |
|
Non-Formulary |
|
MULTIVITAMINS W-FLUORIDE-IRON |
|
Non-Formulary |
|
MYFERON-150 FORTE |
|
Non-Formulary |
|
MYKIDZ IRON FL |
|
Non-Formulary |
|
NEPHPLEX RX |
|
Non-Formulary |
|
NEPHRO-VITE RX |
|
Non-Formulary |
|
NEPHROCAPS |
|
Non-Formulary |
|
NEPHRON FA |
|
Non-Formulary |
|
NERVO B-12 |
|
Non-Formulary |
|
NEURIN-SL |
|
Non-Formulary |
|
NICOMIDE |
|
Non-Formulary |
|
NICOTINAMIDE |
|
Non-Formulary |
|
NICOTINAMIDE ZCF |
|
Non-Formulary |
|
NIFEREX GOLD |
|
Non-Formulary |
|
NIFEREX-150 FORTE |
|
Non-Formulary |
|
NUTRICAP |
|
Non-Formulary |
|
NUTRIVIT |
|
Non-Formulary |
|
OSTIVA |
|
Non-Formulary |
|
OXIPLEN |
|
Non-Formulary |
|
POLY-IRON 150 FORTE |
|
Non-Formulary |
|
POLYSACCHARIDE IRON FORTE |
|
Non-Formulary |
|
POLYVITAMIN WITH IRON-FLUORIDE |
|
Non-Formulary |
|
POTABA |
|
Non-Formulary |
|
POTABA ENVULE |
|
Non-Formulary |
|
PROMAR |
|
Non-Formulary |
|
PROTECT PLUS NR |
|
Non-Formulary |
|
RE DUALVIT F |
|
Non-Formulary |
|
RE DUALVIT PLUS |
|
Non-Formulary |
|
RE FAC-X |
|
Non-Formulary |
|
RE KAR C PLUS SR |
|
Non-Formulary |
|
RENA-VITE RX |
|
Non-Formulary |
|
RENAL CAPS |
|
Non-Formulary |
|
RENATABS WITH IRON |
|
Non-Formulary |
|
RENAX |
|
Non-Formulary |
|
REOCYTE PLUS |
|
Non-Formulary |
|
REPLIVA 21-7 |
|
Non-Formulary |
|
SIDEROL |
|
Non-Formulary |
|
SIDEROL |
|
Non-Formulary |
|
STROVITE |
|
Non-Formulary |
|
STROVITE ADVANCE |
|
Non-Formulary |
|
STROVITE ADVANCE + D |
|
Non-Formulary |
|
STROVITE FORTE |
|
Non-Formulary |
|
STROVITE PLUS |
|
Non-Formulary |
|
SUPERVITE |
|
Non-Formulary |
|
SUPPORT-500 |
|
Non-Formulary |
|
TANDEM F |
|
Non-Formulary |
|
TANDEM PLUS |
|
Non-Formulary |
|
THERAPEUTIC HEMATINIC |
|
Non-Formulary |
|
THERAPEUTIC VITAMIN W-MINERALS |
|
Non-Formulary |
|
THEROBEC PLUS |
|
Non-Formulary |
|
TRICON |
|
Non-Formulary |
|
TRINSICON |
|
Non-Formulary |
|
UDAMIN |
|
Non-Formulary |
|
UDAMIN SP |
|
Non-Formulary |
|
V-C FORTE |
|
Non-Formulary |
|
VI-C FORTE |
|
Non-Formulary |
|
VICA-FORTE |
|
Non-Formulary |
|
VITA S FORTE |
|
Non-Formulary |
|
VITA-RESPA |
|
Non-Formulary |
|
VITACEL |
|
Non-Formulary |
|
VITAFOL |
|
Non-Formulary |
|
VITAL-D RX |
|
Non-Formulary |
|
ZYCOSE |
|
Formulary Date: 10/07/2008 Update Date: 10/09/2008 V1.3.0