$ |
product A least expensive |
$$ |
product B more expensive than A |
$$$ |
product C more expensive than B |
$$$$ |
product D more expensive than C |
$$$$$ |
product E more expensive than D |
!!!!! |
product F is substantially more expensive than A-E |
Non-Formulary |
product G not part of the formulary |
MAC |
Maximum Allowable Cost - the maximum charge that will be paid for the product whether generic or brand. |
Drug Name (Generic Name) |
The BRAND NAME of the drug followed by generic in parentheses or the generic name only. |
Drug and/or Generic Comments |
Comments such as: (suspension only), (caps, tabs only), (tablets non-form), etc. |
Strength and/or Dosage |
The dosage of a drug covered if not all strengths are formulary as in half-strength program. |
Strength and/or Dosage Comments |
Comments related to dosage/quantity limitations. |
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POTASSIUM SUPPLEMENTS
Relative Cost |
MAC |
Drug Name (Generic Name) Drug and/or Generic Comments |
Strength and/or Dosage Strength and/or Dosage Comments |
|
|
K-LYTE/CL (25meq) (pot bicarb/pot chloride/ca) |
|
|
|
KAOCHLOR (potassium chloride) |
|
|
|
KAOCHLOR-EFF (pot bicarb/pot chloride) |
|
|
|
klor-con 8 (potassium chloride) |
|
|
|
klor-con-ef (potassium bicarb/ca) |
|
|
|
liqui-dualcitra (sodium citrate/citric acid) |
|
|
|
potassium acetate (potassium acetate) |
|
$ |
|
effer-k (potassium bicarb/ca) |
25 meq unique tablet formulation |
$ |
|
k effervescent (potassium bicarb/ca) |
|
$ |
|
KAY CIEL (potassium chloride) |
|
$ |
|
klor-con (potassium chloride) |
20 meq pkt |
$ |
|
KLOR-CON (potassium chloride) |
25 meq pkt |
$ |
|
klor-con m10 (potassium chloride) |
|
$ |
|
potassium bicarbonate (potassium bicarb/ca) |
|
$ |
|
vis-phos n (phosphorus) |
|
$$ |
|
cytra-2 (sodium citrate/citric acid) |
|
$$ |
|
K-PHOS NEUTRAL (phosphorus) |
|
$$ |
|
kaon-cl 10 (potassium chloride) |
|
$$ |
|
klor-con 10 (potassium chloride) |
|
$$ |
|
klor-con m15 (potassium chloride) |
|
$$ |
|
klor-con m20 (potassium chloride) |
|
$$ |
|
KLOTRIX (potassium chloride) |
|
$$ |
|
MICRO-K (potassium chloride) |
|
$$ |
|
ORACIT (sodium citrate/citric acid) |
|
$$ |
|
phospha 250 neutral (phosphorus) |
|
$$ |
|
potassium chloride (pot bicarb/pot chloride/ca) |
|
$$ |
|
potassium chloride (potassium chloride) |
|
$$$ |
|
sodium citrate & citric acid (sodium citrate/citric acid) |
|
$$$$ |
|
K-TAB (potassium chloride) |
|
Non-Formulary |
|
EFFER-K |
|
Formulary Date: 10/07/2008 Update Date: 10/09/2008 V1.3.0