$ |
product A least expensive |
$$ |
product B more expensive than A |
$$$ |
product C more expensive than B |
$$$$ |
product D more expensive than C |
$$$$$ |
product E more expensive than D |
!!!!! |
product F is substantially more expensive than A-E |
Non-Formulary |
product G not part of the formulary |
MAC |
Maximum Allowable Cost - the maximum charge that will be paid for the product whether generic or brand. |
Drug Name (Generic Name) |
The BRAND NAME of the drug followed by generic in parentheses or the generic name only. |
Drug and/or Generic Comments |
Comments such as: (suspension only), (caps, tabs only), (tablets non-form), etc. |
Strength and/or Dosage |
The dosage of a drug covered if not all strengths are formulary as in half-strength program. |
Strength and/or Dosage Comments |
Comments related to dosage/quantity limitations. |
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| Prev. Page | Prev. Class | Next Class | Next Page |
ESTROGEN DRUGS
Relative Cost |
MAC |
Drug Name (Generic Name) Drug and/or Generic Comments |
Strength and/or Dosage Strength and/or Dosage Comments |
|
|
DELESTROGEN (estradiol valerate) |
|
|
|
DEPO-ESTRADIOL (estradiol cypionate) |
|
|
|
estradiol valerate (estradiol valerate) |
|
$ |
|
estradiol (estradiol) |
|
$ |
|
estropipate (estropipate) |
|
$ |
|
OGEN (estropipate) |
|
$$ |
|
ALORA (estradiol) |
|
$$ |
|
CLIMARA (estradiol) |
|
$$$ |
|
covaryx (me-testosterone/estrogen,ester) |
|
$$$ |
|
covaryx h.s. (me-testosterone/estrogen,ester) |
|
$$$ |
|
eemt (me-testosterone/estrogen,ester) |
|
$$$ |
|
eemt h.s. (me-testosterone/estrogen,ester) |
|
$$$ |
|
essian (me-testosterone/estrogen,ester) |
|
$$$ |
|
essian h.s. (me-testosterone/estrogen,ester) |
|
$$$ |
|
ESTRADERM (estradiol) |
|
$$$ |
|
estrogen & methyltestosterone (me-testosterone/estrogen,ester) |
|
$$$ |
|
PREMARIN (estrogens,conjugated) |
|
$$$ |
|
VAGIFEM (estradiol) |
|
$$$ |
|
VIVELLE-DOT (estradiol) |
|
$$$$ |
|
ESTRACE (estradiol) |
|
$$$$ |
|
ESTROGEL (estradiol) |
|
$$$$$ |
|
ELESTRIN (estradiol) |
|
$$$$$ |
|
ESTRATEST (me-testosterone/estrogen,ester) |
|
$$$$$ |
|
ESTRATEST H.S. (me-testosterone/estrogen,ester) |
|
$$$$$ |
|
ESTRING (estradiol) |
|
Non-Formulary |
|
CENESTIN |
|
Non-Formulary |
|
DIVIGEL |
|
Non-Formulary |
|
ENJUVIA |
|
Non-Formulary |
|
ESTRASORB |
|
Non-Formulary |
|
EVAMIST |
|
Non-Formulary |
|
FEMRING |
|
Non-Formulary |
|
FEMTRACE |
|
Non-Formulary |
|
MENEST |
|
Non-Formulary |
|
MENOSTAR |
|
Non-Formulary |
|
VIVELLE |
|
Formulary Date: 10/07/2008 Update Date: 10/09/2008 V1.3.0