BLUE - Formulary
RED - Non Formulary

Table of Contents Index Policy Information

Formulary Index

Numbers A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

L-ALL 12 NF (ANTITUSSIVE AND EXPECTORANT DRUGS)

l-cysteine (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

labetalol (BETA-ADRENERGIC ANTAGONIST DRUGS)

labetalol hcl (BETA-ADRENERGIC ANTAGONIST DRUGS)

LAC-HYDRIN (12%) (TOPICAL DERMATOLOGICAL DRUGS)

LACLOTION (TOPICAL DERMATOLOGICAL DRUGS)

LACRISERT (OTHER OPHTHALMIC DRUGS)

lactate, ammonium (TOPICAL DERMATOLOGICAL DRUGS)

lactated ringers (ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.)

LACTIC ACID (TOPICAL DERMATOLOGICAL DRUGS)

LACTINOL (TOPICAL DERMATOLOGICAL DRUGS)

LACTINOL-E (TOPICAL DERMATOLOGICAL DRUGS)

LACTOCAL-F (PRENATAL VITAMINS)

lactose (DIAGNOSTIC PRODUCTS)

lactulose (BLOOD DETOXICANTS)

LAGESIC (ANALGESICS)

LAMICTAL (OTHER ANTICONVULSANTS)

LAMICTAL (BLUE) (OTHER ANTICONVULSANTS)

LAMICTAL (GREEN) (OTHER ANTICONVULSANTS)

LAMICTAL (ORANGE) (OTHER ANTICONVULSANTS)

LAMISIL (ORAL ANTIFUNGAL DRUGS)

LAMISIL (PAR) (OTHER TOPICAL ANTIFUNGALS)

lamivudine (ANTIRETROVIRALS & PROTEASE INH)

lamivudine (OTHER ANTIVIRAL DRUGS)

lamivudine/zidovudine (ANTIRETROVIRALS & PROTEASE INH)

lamotrigine (OTHER ANTICONVULSANTS)

LANOXIN (CARDIAC GLYCOSIDES)

LANOXIN PEDIATRIC (CARDIAC GLYCOSIDES)

lansoprazole (PROTON PUMP INHIBITORS)

LANTUS (QLL = 5 cartridges) (INSULIN)

LANTUS SOLOSTAR (INSULIN)

lapase (OTHER GI DRUGS)

LARIAM (PLASMODICIDES)

LASIX (LOOP DIURETICS)

latanoprost (ANTIGLAUCOMA DRUGS)

LATRIX (TOPICAL DERMATOLOGICAL DRUGS)

LAVOCLEN-4 (ANTIACNE DRUGS)

LAVOCLEN-8 (ANTIACNE DRUGS)

LAZERFORMALYDE (KERATOLYTIC DRUGS)

LC PLUS (MEDICAL (MISCELLANEOUS) SUPPLIES)

LEENA (CONTRACEPTIVES)

leflunomide (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

LESCOL (primary prevention only) (HMG-COA REDUCTASE INHIBITORS)

LESCOL XL (HMG-COA REDUCTASE INHIBITORS)

lessina (CONTRACEPTIVES)

LETAIRIS (ENDOTHELIN RECPTR ANTAGONIST)

letrozole (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

leucovorin (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

leucovorin calcium (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

LEUKERAN (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

leuprolide (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

leuprolide (SPECIALIZED OB/GYN DRUGS)

leuprolide acetate (SPECIALIZED OB/GYN DRUGS)

LEUSTATIN (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

LEVACET (SALICYLATES AND RELATED DRUGS)

LEVALL (ANTITUSSIVE AND EXPECTORANT DRUGS)

LEVALL-12 (ANTITUSSIVE AND EXPECTORANT DRUGS)

LEVAQUIN (QUINOLONES)

LEVATOL (BETA-ADRENERGIC ANTAGONIST DRUGS)

LEVBID (ANTISPASMODICS/DRUGS AFFECT GI MOTILITY)

LEVEMIR (INSULIN)

LEVER LOCK CANNULA (MEDICAL (MISCELLANEOUS) SUPPLIES)

levetiracetam (OTHER ANTICONVULSANTS)

LEVISTICUM (HOMEOPATHIC DRUGS)

LEVITRA (OTHER GENITOURINARY PRODUCTS)

LEVLEN 28 (CONTRACEPTIVES)

LEVO-DROMORAN (CLASS II NARCOTICS)

levobunolol (ANTIGLAUCOMA DRUGS)

levobunolol hcl (ANTIGLAUCOMA DRUGS)

levocarnitine (THERAPEUTIC VITAMINS & MINERALS)

LEVOCARNITINE (THERAPEUTIC VITAMINS & MINERALS)

levofloxacin (QUINOLONES)

levonorgestrel-ethin estradiol (CONTRACEPTIVES)

levora-28 (CONTRACEPTIVES)

levorphanol (CLASS II NARCOTICS)

LEVORPHANOL TARTRATE (CLASS II NARCOTICS)

levothroid (THYROID SUPPLEMENTS)

levothyroxine (THYROID SUPPLEMENTS)

levothyroxine sodium (THYROID SUPPLEMENTS)

levoxyl (THYROID SUPPLEMENTS)

LEVSIN (ANTISPASMODICS/DRUGS AFFECT GI MOTILITY)

LEVSIN-SL (ANTISPASMODICS/DRUGS AFFECT GI MOTILITY)

LEVULAN (TOPICAL DERMATOLOGICAL DRUGS)

LEXAPRO (SELECTIVE SEROTONIN REUPTAKE INHIBITORS)

LEXAPRO (requires trial of generic fluoxetine) (SELECTIVE SEROTONIN REUPTAKE INHIBITORS)

LEXIVA (ANTIRETROVIRALS & PROTEASE INH)

LIALDA (OTHER GI DRUGS)

LIBRAX (ANTISPASMODICS/DRUGS AFFECT GI MOTILITY)

LIBRIUM (ANXIOLYTICS)

LIDAMANTLE (TOPICAL ANESTHETICS)

LIDAMANTLE HC (TOPICAL CORTICOSTEROID DRUGS)

LIDAZONE HC (TOPICAL CORTICOSTEROID DRUGS)

lidocaine (LOCAL ANESTHETICS)

lidocaine (TOPICAL ANESTHETICS)

lidocaine (OTHER ANTIARRHYTHMICS)

lidocaine (DRUGS AFFECTING THE THROAT AND MOUTH)

lidocaine hcl (LOCAL ANESTHETICS)

lidocaine hcl (TOPICAL ANESTHETICS)

LIDOCAINE HCL (TOPICAL ANESTHETICS)

lidocaine hcl (OTHER ANTIARRHYTHMICS)

lidocaine hcl viscous (TOPICAL ANESTHETICS)

lidocaine hcl-epinephrine (LOCAL ANESTHETICS)

lidocaine hydrochloride/epi (LOCAL ANESTHETICS)

LIDOCAINE-HC (TOPICAL CORTICOSTEROID DRUGS)

LIDOCAINE-HYDROCORTISONE (TOPICAL CORTICOSTEROID DRUGS)

LIDOCAINE-HYDROCORTISONE (OTHER GI DRUGS)

lidocaine-prilocaine (TOPICAL ANESTHETICS)

lidocaine/prilocaine (TOPICAL ANESTHETICS)

LIDODERM (PAR) (TOPICAL ANESTHETICS)

LIMBITROL (OTHER ANTIDEPRESSANTS)

LIMBITROL DS (OTHER ANTIDEPRESSANTS)

LIMBREL (NUTRITIONAL/SUPPLEMENT PRODUCTS)

LINCOCIN (OTHER ANTIINFECTIVE DRUGS)

lincoject (OTHER ANTIINFECTIVE DRUGS)

lincomycin (OTHER ANTIINFECTIVE DRUGS)

LINDANE (SCABICIDES)

linezolid (OTHER ANTIINFECTIVE DRUGS)

LIORESAL INTRATHECAL (DIRECT MUSCLE RELAXANTS)

liothyronine (THYROID SUPPLEMENTS)

LIPITOR (HMG-COA REDUCTASE INHIBITORS)

LIPITOR (Q) (HMG-COA REDUCTASE INHIBITORS)

LIPOCHOL PLUS (VITAMINS & MINERALS & RELATED PRODUCTS)

LIPOFEN (HYPOLIPOPROTEINEMICS)

LIPOSYN II (VITAMINS & MINERALS & RELATED PRODUCTS)

LIPOSYN III (VITAMINS & MINERALS & RELATED PRODUCTS)

lipram-ul12 (OTHER GI DRUGS)

lipram-ul18 (OTHER GI DRUGS)

lipram-ul20 (OTHER GI DRUGS)

LIQUADD (CNS STIMULANT DRUGS)

liqui-dualcitra (POTASSIUM SUPPLEMENTS)

LIQUIBID (ANTITUSSIVE AND EXPECTORANT DRUGS)

LIQUICET (CLASS III NARCOTICS)

LIQUICOUGH DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

lisinopril (ANGIOTENSIN CONVERTING ENZYME INHIBITORS)

lisinopril-hctz (OTHER ANTIHYPERTENSIVES)

lisinopril/hctz (OTHER ANTIHYPERTENSIVES)

lithium carbonate (ANTIMANIA DRUGS)

lithium citrate (ANTIMANIA DRUGS)

LITHOBID (ANTIMANIA DRUGS)

LITHOSTAT (OTHER GENITOURINARY PRODUCTS)

LIVETAN DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

LO-OVRAL-28 (CONTRACEPTIVES)

LOCOID (TOPICAL CORTICOSTEROID DRUGS)

LOCOID LIPOCREAM (TOPICAL CORTICOSTEROID DRUGS)

LODOSYN (OTHER ANTIPARKINSON DRUGS)

lodoxamide (OTHER OPHTHALMIC DRUGS)

LODRANE (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

LODRANE 24 (ANTIHISTAMINES)

LODRANE 24D (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

LODRANE D (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

LOESTRIN (CONTRACEPTIVES)

LOESTRIN 24 FE (CONTRACEPTIVES)

LOESTRIN FE (CONTRACEPTIVES)

LOFIBRA (HYPOLIPOPROTEINEMICS)

LOHIST 12D (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

LOHIST 12HR (ANTIHISTAMINES)

LOHIST-D (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

LOHIST-DM (ANTITUSSIVE AND EXPECTORANT DRUGS)

LOHIST-PD (ANTIHISTAMINE/DECONGESTANT COMBINATIONS)

LOKARA (TOPICAL CORTICOSTEROID DRUGS)

LOMA ACNE (HOMEOPATHIC DRUGS)

LOMA ASTHMA (HOMEOPATHIC DRUGS)

LOMA ECZEMA (HOMEOPATHIC DRUGS)

LOMA PSORIASIS (HOMEOPATHIC DRUGS)

LOMOTIL (ANTIDIARRHEAL DRUGS)

lomustine (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

lonox (ANTIDIARRHEAL DRUGS)

LOPERAMIDE (ANTIDIARRHEAL DRUGS)

LOPID (HYPOLIPOPROTEINEMICS)

LOPRESSOR (BETA-ADRENERGIC ANTAGONIST DRUGS)

LOPRESSOR HCT (OTHER ANTIHYPERTENSIVES)

LOPROX (OTHER TOPICAL ANTIFUNGALS)

lorazepam (ANXIOLYTICS)

lorazepam intensol (ANXIOLYTICS)

LORCET 10-650 (CLASS III NARCOTICS)

LORCET PLUS (CLASS III NARCOTICS)

LORTAB (CLASS III NARCOTICS)

losartan (ANGIOTENSIN II RECEPTOR ANTAGONISTS)

losartan /hctz (OTHER ANTIHYPERTENSIVES)

LOTEMAX (OPHTHALMIC CORTICOSTEROID DRUGS)

LOTENSIN (ANGIOTENSIN CONVERTING ENZYME INHIBITORS)

LOTENSIN HCT (OTHER ANTIHYPERTENSIVES)

loteprednol etabonate (OPHTHALMIC CORTICOSTEROID DRUGS)

LOTREL (OTHER ANTIHYPERTENSIVES)

LOTRISONE (TOPICAL ANTIFUNGAL-CORTICOSTEROID COMB.)

LOTRONEX (covered only if prescribed by gasteroenterologist) (IRRITABLE BOWEL DRUGS)

lovastatin (HMG-COA REDUCTASE INHIBITORS)

lovastatin/niacin (HMG-COA COMBINATIONS)

LOVAZA (HYPOLIPOPROTEINEMICS)

LOVENOX (INJECTABLE ANTICOAGULANTS)

low-ogestrel (CONTRACEPTIVES)

loxapine (ANTIPSYCHOTIC DRUGS)

loxapine succinate (ANTIPSYCHOTIC DRUGS)

LOXITANE (ANTIPSYCHOTIC DRUGS)

LUFYLLIN (METHYL XANTHINE DRUGS)

LUFYLLIN-GG (METHYL XANTHINE DRUGS)

lugol's (THYROID SUPPLEMENTS)

LUMIGAN (ANTIGLAUCOMA DRUGS)

LUMINAL SODIUM (ANTICONVULSANT BARBITURATES)

LUNESTA (SEDATIVE/HYPNOTIC DRUGS)

LUPRON (PAR) (SPECIALIZED OB/GYN DRUGS)

LUPRON DEPOT (PAR) (SPECIALIZED OB/GYN DRUGS)

LUPRON DEPOT-PED (PAR) (SPECIALIZED OB/GYN DRUGS)

LURIDE (FLUORIDE PRODUCTS)

LUSONAL (ANTITUSSIVE AND EXPECTORANT DRUGS)

LUSTRA (TOPICAL DERMATOLOGICAL DRUGS)

LUSTRA-AF (TOPICAL DERMATOLOGICAL DRUGS)

LUSTRA-ULTRA (TOPICAL DERMATOLOGICAL DRUGS)

lutera (CONTRACEPTIVES)

LUVOX CR (SELECTIVE SEROTONIN REUPTAKE INHIBITORS)

LUXIQ (TOPICAL CORTICOSTEROID DRUGS)

LYBREL (CONTRACEPTIVES)

lymphocyte immune globulin (IMMUNOLOGICALS AND VACCINES)

LYRICA (Requires trial of gabapentin) (OTHER ANTICONVULSANTS)

LYSIPLEX (VITAMINS & MINERALS & RELATED PRODUCTS)

LYSODREN (ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS)

LYTENSOPRIL (OTHER ANTIHYPERTENSIVES)

Formulary Date: 10/07/2008 Update Date: 10/09/2008 V1.3.0