Ezmusa_drug_list.indd

Medication
www. .FET
yourezmeds.com
This list updated September 1, 2007. Drugs are added and
deleted sporadically, so use this list as a reference only. This list
has all the drugs and dosages that are available through patient
assistance programs, sorted alphabetically by brand name. The
generic name is in parentheses. Drugs in bold are also available
to Part D enrollees, in the donut hole.
Allegra D (fexofenadine with pseudoephedrine) Alrex (loteprednol) NO ONE MEDICARE ELIGIBLE Accuretic (quinapril with hydrochlorothiazide) Anadrol-50 (oxymethalone) NO ONE MEDICARE ELIGIBLE Aceon (perindopril) NO ONE MEDICARE ELIGIBLE Analpram (hydrocortisone acetate and pramoxine Activella (estradiol with norethindrone) Ancoban (flucytosine) NO ONE MEDICARE ELIGIBLE Androgel (testosterone) NO ONE MEDICARE ELIGIBLE Actoplus met (pioglitazone hci/metformin hci) Adrucil (fluorouracil) NO ONE MEDICARE ELIGIBLE Apidra (insulin glulisine [rdna origin]) Advair Diskus (fluticasone with salmeterol) Aptivus (tipranavir) NO ONE MEDICARE ELIGIBLE Aggrenox (dipyridamole with aspirin) NO ONE MEDICARE Atacand HCT (candesartan cilexetil with hydrochlorothiazide) This list updated September 1, 2007. Drugs are added and deleted sporadically, so use this list as a reference only. This list has all the
drugs and dosages that are available through patient assistance programs, sorted alphabetically by brand name. The generic name is
in parentheses. Drugs in bold are also available to Part D enrollees, in the donut hole.
Atrovent Inhalation (ipratropium) NO ONE MEDICARE ELIGIBLE Avandamet (rosiglitazone maleate & metformin hydrochloride) Avandaryl (rosiglitazone maleate and glimepiride) Azulfidine (sulfasalazine, enteric coated) Carmol Scalp Treatment (sulfacetamide sodium (10%) Carteolol HCL (chi ophthalmic solution 1%) Catapres (clonidine) NO ONE MEDICARE ELIGIBLE Beconase AQ (beclomethasone dipropionate) Catapres-TTS Transdermal (clonidine) NO ONE MEDICARE Caverject (alprostadil injection- aqueous) BenzaClin (clindamycin with benzoyl peroxide) Bicitra (sodium citrate and citric acid) (dextran 70 with hydroxypropyl methylcellulose) Bleomycin Sulfate (bleomycin sulfate) NO ONE MEDICARE Botox (botulinum toxin type a) NO ONE MEDICARE ELIGIBLE Cenestin (synthetic conjugated estrogens) Brevoxyl 4 (benzoyl peroxide) NO ONE MEDICARE ELIGIBLE Brevoxyl 8 (benzoyl peroxide) NO ONE MEDICARE ELIGIBLE Caduet (amlodipine besylate/atorvastatin calcium) Ciloxan (ciprofloxacin hcl ophthalmic solution) This list updated September 1, 2007. Drugs are added and deleted sporadically, so use this list as a reference only. This list has all the
drugs and dosages that are available through patient assistance programs, sorted alphabetically by brand name. The generic name is
in parentheses. Drugs in bold are also available to Part D enrollees, in the donut hole.
Cipro HC (ciprofloxacin with hydrocortisone) Ciprodex (ciprofloxacin with dexamethasone) Creon DR (pancrelipase) NO ONE MEDICARE ELIGIBLE Cisplatin AQ (cisplatin aq) NO ONE MEDICARE ELIGIBLE (desloratadine 5mg/pseudoephedrine sulfate) Claripel (hydroquinone) NO ONE MEDICARE ELIGIBLE Cymbalta (duloxetine hydrochloride) NO ONE MEDICARE Cleocin Pediatric (clindamycin palmitate hydrochloride) Dacarbazine (dacarbazine) NO ONE MEDICARE ELIGIBLE Climara Pro (estradiol transdermal system) Clobevate (clobetasol propionate) NO ONE MEDICARE ELIGIBLE Daunorubicin (daunorubicin) NO ONE MEDICARE ELIGIBLE Combivent (albuterol with ipratropium) NO ONE MEDICARE Declomycin (demeclocyline) NO ONE MEDICARE ELIGIBLE Depo -Medrol (sterile methylprednisolone acetate) Depo- Provera (medroxyprogesterone acetate) Dexedrine Spansule (dextroamphetamine sulfate) Corzide (nadolol & bendroflumethiazide) DHE 45 (dihydroergotamine mesylate) NO ONE MEDICARE Diastat (diazepam) NO ONE MEDICARE ELIGIBLE This list updated September 1, 2007. Drugs are added and deleted sporadically, so use this list as a reference only. This list has all the
drugs and dosages that are available through patient assistance programs, sorted alphabetically by brand name. The generic name is
in parentheses. Drugs in bold are also available to Part D enrollees, in the donut hole.
Fareston (toremifene) NO ONE MEDICARE ELIGIBLE Diovan HCT (valsartan with hydrochlorothiazide) Ferrlecit (sodium ferric gluconate complex) NO ONE MEDICARE Duetact (pioglitazone hci and glimedpiride) Dyazide (triamterene with hydrochlorothiazide) Dynacirc CR (isradipine) NO ONE MEDICARE ELIGIBLE Flomax (tamsulosin) NO ONE MEDICARE ELIGIBLE Fludarabine (fludarabine) NO ONE MEDICARE ELIGIBLE Enjuvia (synthetic conjugated estrogens, b) Foradil (formoterol fumerate inhalation powder) Ensure Fiber with FOS (nutritional supplement) Ensure High Calcium (nutritional supplement) Ensure High Protein (nutritional supplement) Epzicom (abacavir sulfate & lamivudine) Estratest (esterified estrogens with methyltestosterone) NO ONE Gabitril (tiagabine) NO ONE MEDICARE ELIGIBLE Estratest H.S. (esterified estrogens with methyltestosterone) Galzin (zinc salts) NO ONE MEDICARE ELIGIBLE Ethyol (amifostine) NO ONE MEDICARE ELIGIBLE Etoposide (etoposide) NO ONE MEDICARE ELIGIBLE Evista (raloxifene) NO ONE MEDICARE ELIGIBLE This list updated September 1, 2007. Drugs are added and deleted sporadically, so use this list as a reference only. This list has all the
drugs and dosages that are available through patient assistance programs, sorted alphabetically by brand name. The generic name is
in parentheses. Drugs in bold are also available to Part D enrollees, in the donut hole.
Glucagon Emergency Kit (glucagon) NO ONE MEDICARE ELIGIBLE Glucerna Select (nutritional supplement) Glucotrol XL (glipizide extended release) GlutoFac-ZX (multivitamin/multimineral formula Kayexalate (sodium polystyrene sulfonate) Kenalog 10 (sterile triamcinolone acetonide suspension) Kenalog 40 (sterile triamcinolone acetonide suspension) Humalog (insulin lispro) NO ONE MEDICARE ELIGIBLE Humalog 75/25 (insulin lispro) NO ONE MEDICARE ELIGIBLE Humira (adalimumab) NO ONE MEDICARE ELIGIBLE Humulin (all types) (insulin,human) NO ONE MEDICARE ELIGIBLE Hyalgan (sodium hyaluronate) NO ONE MEDICARE ELIGIBLE Hyzaar (losartan with hydrochlorothiazide) Idarubicin (idarubicin) NO ONE MEDICARE ELIGIBLE Ifosfamide (ifosfamide) NO ONE MEDICARE ELIGIBLE Leucovorin (leucovorin) NO ONE MEDICARE ELIGIBLE Inderide (propranolol with hydrochlorothiazide) InFed (iron dextran) NO ONE MEDICARE ELIGIBLE This list updated September 1, 2007. Drugs are added and deleted sporadically, so use this list as a reference only. This list has all the
drugs and dosages that are available through patient assistance programs, sorted alphabetically by brand name. The generic name is
in parentheses. Drugs in bold are also available to Part D enrollees, in the donut hole.
Maxitrol (dexamethasone with neomycin and polymyxin b) Lodrane (antihistamines, decongestants) NO ONE MEDICARE Mestinon (pyridostigmine) NO ONE MEDICARE ELIGIBLE Lodrane 12 hour (antihistamines, decongestants) NO ONE Lodrane 24 (antihistamines, decongestants) NO ONE MEDICARE Micardis (telmisartan) NO ONE MEDICARE ELIGIBLE Lodrane D (antihistamines, decongestants) NO ONE MEDICARE Micardis HCT (telmisartan with hydrochlorothiazide) NO ONE Lodrane XR (antihistamines, decongestants) NO ONE MEDICARE Lotemax (loteprednol) NO ONE MEDICARE ELIGIBLE Migranal (dihydroergotamine with caffeine) NO ONE MEDICARE Lotrisone (clotrimazole with betamethasone) MimyX (non-steriodal anti-inflammatory cream) NO ONE Lumigan ophthalmic solution 0.03% (7.5ml) Luxiq (betamethasone valerate) NO ONE MEDICARE ELIGIBLE Mirapex (pramipexole) NO ONE MEDICARE ELIGIBLE Myleran (busulfan) NO ONE MEDICARE ELIGIBLE Mylotarg (gemtuzumab ozogamicin for injection) Malarone (atovaquone and proguanil hydrochloride) Malarone Pedatric (atovaquone and proguanil hydrochloride) Malarone Pediatric (atovaquone and proguanil hydrochloride) Nepro with Carb Steady (nutritional supplement) Marinol (dronabinol) NO ONE MEDICARE ELIGIBLE This list updated September 1, 2007. Drugs are added and deleted sporadically, so use this list as a reference only. This list has all the
drugs and dosages that are available through patient assistance programs, sorted alphabetically by brand name. The generic name is
in parentheses. Drugs in bold are also available to Part D enrollees, in the donut hole.
Oxsoralen (methoxsalen capsules) NO ONE MEDICARE ELIGIBLE Oxsoralen-Ultra (methoxsalen capsules) NO ONE MEDICARE Neutra-Phos (oral sodium and potassium phosphate) Neutra-Phos-K (oral potassium phosphate mixture) Neutrexin (trimetrexate glucuronate) NO ONE MEDICARE Pancrecarb MS-16 (amylase with lipase pancrelipase protease) Pancrecarb MS-4 (amylase with lipase pancrelipase protease) Pancrecarb MS-8 (amylase with lipase pancrelipase protease) Nitrolingual (nitroglycerin lingual spray) PediaSure Enteral Formula (nutritional supplement) PediaSure Enteral Formula w/Fiber (nutritional supplement) PediaSure w/Fiber (nutritional supplement) Novolin InnoLet (recombinant human insulin) Novolin N InnoLet (recombinant human insulin) Phospholine Iodide (echothiophate iodide) Novolin R InnoLet (recombinant human insulin) Novolin R Vials (recombinant human insulin) PolyCitra LC (tricitrates oral solution) PolyCitra-K (potassium citrate and citric acid for oral solution) Pramosone (pramoxine with hydrocortisone) Olux (clobetasol propionate) NO ONE MEDICARE ELIGIBLE Orap (pimozide) NO ONE MEDICARE ELIGIBLE Prempro (estrogens, conjugated and medroxyprogesterone) Osmolite 1.2 cal (nutritional supplement) This list updated September 1, 2007. Drugs are added and deleted sporadically, so use this list as a reference only. This list has all the
drugs and dosages that are available through patient assistance programs, sorted alphabetically by brand name. The generic name is
in parentheses. Drugs in bold are also available to Part D enrollees, in the donut hole.
Procardia XL (nifedipine extended release) Proglycem (diazoxide) NO ONE MEDICARE ELIGIBLE Prometrium (progesterone) NO ONE MEDICARE ELIGIBLE Promote with Fiber (nutritional supplement) Risperdal Consta Long Acting (risperidone) Prostigmin (neostigmine methysulfate) NO ONE MEDICARE Roferon-A (interferon alfa-2a, recombinant) Rosac (sodium sulfacetamide and sulfur) NO ONE MEDICARE Rosula (sodium sulfacetamide 10% and sulfur 5%) NO ONE Rosula Cleanser (sodium sulfacetamide and sulfur) NO ONE Prozac (fluoxetine) NO ONE MEDICARE ELIGIBLE Rythmol SR (propafenone) NO ONE MEDICARE ELIGIBLE Prozac Weekly (fluoxetine) NO ONE MEDICARE ELIGIBLE Serevent Diskus powder for inhalation 50 mcg Pulmicort Respules inhalation suspension 0.25mg/2ml Pulmicort Respules inhalation suspension 0.5mg/2ml Purinethol (mercaptorpurine) NO ONE MEDICARE ELIGIBLE RCF (Ross Carbohydrate Free) (medical food) Soriatane (acitretin) NO ONE MEDICARE ELIGIBLE ReoPro (abciximab) NO ONE MEDICARE ELIGIBLE Spiriva (tiotropium) NO ONE MEDICARE ELIGIBLE Stalevo (carbidopa with levodopa and entacapone) Strattera (atomoxetine) NO ONE MEDICARE ELIGIBLE Sulfacet-R Tint Free (sulfacetamide and sulfur) Sulfoxyl (benzoyl peroxide 5% and sulfur 2%) NO ONE MEDICARE Restasis ophthalmic ointment 0.05 % (32 x 0.4 ml) This list updated September 1, 2007. Drugs are added and deleted sporadically, so use this list as a reference only. This list has all the
drugs and dosages that are available through patient assistance programs, sorted alphabetically by brand name. The generic name is
in parentheses. Drugs in bold are also available to Part D enrollees, in the donut hole.
Suplena with Carb Steady (nutritional supplement) Symbyax (olonzapine and fluoxetine) NO ONE MEDICARE 923 TriLuma (gluocinolone acetonide, hydroquinone, tretinoin) Trizivir (abacavir with lamivudine and zidovudine) Truvada (emtricitabine and tenofovir disoproxil fumarate) Tasmar (tolcapone) NO ONE MEDICARE ELIGIBLE Thalomid (thalidomide) NO ONE MEDICARE ELIGIBLE Thyrolar 1 (levothyroxine and liothyronine) Thyrolar 1/2 (levothyroxine and liothyronine) Thyrolar 1/4 (levothyroxine and liothyronine) Thyrolar 2 (levothyroxine and liothyronine) Thyrolar 3 (levothyroxine and liothyronine) Tilade (nedocromil sodium inhalation aerosol) Timentin (ticarcillin disodium and clavulanate potassium) Timoptic-XE (timolol maleate-hydrochlorothiazde) Vincasar PFS (vincristine sulfate) NO ONE MEDICARE ELIGIBLE Vincristine (vincristine sulfate) NO ONE MEDICARE ELIGIBLE Toposar (etoposide) NO ONE MEDICARE ELIGIBLE Vinorelbine (vinorelbine tartrate) NO ONE MEDICARE ELIGIBLE Toprol XL (metoprolol succinate extended release tablets) This list updated September 1, 2007. Drugs are added and deleted sporadically, so use this list as a reference only. This list has all the
drugs and dosages that are available through patient assistance programs, sorted alphabetically by brand name. The generic name is
in parentheses. Drugs in bold are also available to Part D enrollees, in the donut hole.
Viramune (nevirapine) NO ONE MEDICARE ELIGIBLE 1020 Zofran ODT (ondansetron hydrochloride) 1022 Zofran tablets-orally disintergrating 4 mg 1023 Zofran tablets-orally disintergrating 8 mg 1024 Zoladex (goserelin acetate implant) Zanosar (streptozocin) NO ONE MEDICARE ELIGIBLE Zantac EFFERdose (ranitidine hydrochloride effervescent) 1040 Zyban SR (bupropion hydrochloride sustained release) 1043 Zyprexa (olanzapine) NO ONE MEDICARE ELIGIBLE 1044 Zyrtec (cetirizine hcl/pseudooephedrine hcl)

Source: http://www.professionalmassmarketing.com/ez_meds/Your%20EZMeds_Drust%20Sep%202007.pdf

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2008 State Health Benefit Plan (SHBP) Prescription Drug Listfor PPO, PPO Consumer Choice and IndemnityThis Prescription Drug List (PDL) contains the most commonly prescribed medications for certainconditions. It represents an abbreviated version of the PDL that is the core of your prescriptiondrug benefit program. Prescription medications are classified within Tiers based on clinical effectivene

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