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Microsoft word - prescription sol'n wallchart_october 2013

(Generic)                  
Opioid Analgesics

3 – Tiered Prescription Drug Formulary  
October 2013 
This formulary listing is to serve as a reference guide for the selection of cost-effective medications and does not guarantee coverage or imply therapeutic equivalence. Certain products may be excluded from Anesthetics
your plan or require additional authorization. Please see your plan Local Anesthetics
document for exact details as coverage may vary. This formulary is not all inclusive. Generic products will process as Tier 1 drugs at your lowest copay, Tier 2 contains formulary brands, and Tier 3 contains non-preferred brands and are subject to your highest copay. Anticonvulsants
This formulary is to be used with your medical practitioner to be sure that any medication selected is both cost effective and clinically appropriate. This formulary listing is subject to change, please contact the ProAct help desk number on the back of your card for the most up Analgesics
Migraine
Antidotes, Deterrents, and Toxicologic Agents
Antidotes
Muscle Relaxants
Deterrents
Anti-Infective
Amebicides
Anti-Bacterials; Aminoglycosides
Nonsteroidal Anti-inflammatory Drugs
Antibiotic; Cephalosporins
Antibiotic; Macrolides
Antibiotic; Penicillins
(Generic)                   (Generic)                   Antimetabolites
Antibiotic; Quinolones
Hormonal

Antibiotic; Sulfonamides

Antibiotic; Tetracyclines
Cardiovascular Agents
Alpha-adrenergic Agonists
Antibacterials; Other
Alpha-adrenergic Blocking Agents
Antiarrhythmics
Antifungals
clotrimazole Natacyn Diflucan digoxin (AB rated) Beta-adrenergic Blocking Agents
Anti-influenza Agents
Antimycobacterials, Other
Anti-parasitics
Blood Modifiers/Coagulation Inhibitors
Antitubercular Agents
Anti-Virals
Calcium Channel Blocking Agents
Valtrex diltiazem/ER/SR Exforge/HCT Cardizem/SR/CD Antimyasthenic Agents
Parasympathomimetics
Diuretics
Antineoplastics
Alkylating Agents
(Generic)                   (Generic)                   Dyslipidemics
atorvastatin Crestor Advicor entacapone Parlodel cholestyramine Lipofen Cough/Cold
gemfibrozil Welchol Livalo Antihistamines
Angiotensin Converting Enzyme Inhibitors
Antitussive
Dermatological Agents

Angiotensin II Antagonists

candesartan/hctz Benicar/HCT Atacand/HCT acitretin Finacea Actinic Keratosis
Antihypertensive Combinations
Antibacterials
Renin Inhibitors
Vasodilators
Antifungals
Cardiovascular; Other
Atopic Dermatitis
Central Nervous System Agents
Cerebral Stimulants; Amphetamines
Glucocorticoids/Mineralocorticoids
Cerebral Stimulants; Non-Amphetamines
Dementia
Dermatological Agents; Other
Parkinsons
(Generic)                   (Generic)                   Pediculicides/Scabicides
Glucocorticoids/Mineralocorticoids
Hormone Replacement Therapy
Diabetes
Diabetic items including supplies and medication may be subject to alternate copays and/or coverage strategy. Please see your plan document or contact ProAct for additional details. Antidiabetic Agents
Metabolic Bone Disease Agents
Diabetic Supplies
Pituitary Agents
Glycemic Agents
Gastrointestinal Agents
Antiemetics
Insulins /Misc.
Antispasmodics
Endocrine
Androgens
Proton Pump Inhibitors
Testim Testred lansoprazole Dexilant Aciphex Antiandrogens
Ulcer Agents
Contraception
Gastrointestinal Agents, Other
(Generic)                   (Generic)                   Genitourinary Agents
Otic Agents
Antispasmodics; Urinary
Anesthetics
VESIcare Enablex Antibacterials
Benign Prostatic Hypertrophy Agents
Psychological
finasteride Jalyn Proscar Anti-Depressants; MAOi
Erectile Dysfunction
Anti-Depressants; SSRIs/SNRIs
Phosphate Binders
Genitourinary Agents; Other
Anti-Depressants; Tricyclics
Antigout Agents
allopurinol Colcrys Indocin clomipramine Pamelor probenecid Uloric Zyloprim desipramine Parnate Immunological Agents
Immunomodulators
Antidepressants; Other
Ophthalmic Agents
Anti-allergy Agents
Alocril Antipsychotics
nedocromil Patanol Alomide chlorpromazine Abilify/Discmelt Antibacterials
Anti-Inflammatory
Flarex Bipolar Agents
Sedatives and Hypnotics
Glaucoma Agents
(Generic)                   (Generic)                   Respiratory Tract Agents
Please contact the ProAct Clinical Department at:  Bronchodilators, Anticholinergic
1‐877‐776‐2285 x3624or email us at  for recommendations on cost saving alternatives  Bronchodilators, Phosphodiesterase Inhibitors (Xanthines)
Bronchodilators; Sympathomimetic
Leukotriene Inhibitors
Mast Cell Stabilizers
Nasal Inhalations
Oral Corticosteroids
Respiratory Device
Supplements
Electrolytes/Minerals
Enzyme Replacements/Modifiers
Vitamins and misc.
ProAct Specialty Drug Listing
Specialty medications can be described as medications that are high cost, highly complex, or typically require specialized administration, handling or distribution. They are often biology-based and mimic substances found in the body to produce their effects. These medications will process according to your plan design, and may require prior authorization and/or have other restrictions. Medications listed as bold are available generically.
(*) Indicates product is a formulary item, all others are non-formulary. Abacavir
Granisetron
Octreotide
Ribasphere
Capecitabine
Lamivudine
Enoxaparin
Lamiv/Zidov
Ribavirin
Epirubicin
Carboplatin
Topotecan
Epoprostenol
Adefovir
Tranexamic acid Zemplar (IV)
Adriamycin
Oxaliplatin
Tretinoin (oral)
Paclitaxel
Lupron-Dep Ped* Pamidronate
Etoposide
Zidovudine
Cisplatin
Cladribine
Pentostatin
Sildenafil
Melphalan
Idarubicin
Amifostine
Ifosfamide
Stavudine
Mitomycin
Cyclophophamide Floxuridine
Mitoxantrone
Cyclosporine
Fludarabine
Fluorouracil
Vinblastine
Cytarabine
Vincasar
Mycophenolate Promacta
Vincristine
Dacarbazine
Fondaparinux
Vinorelbine
Dactinomycin
Irinotecan
Daunorubicin
Decitabine
Dexrazoxane
Tacrolimus
Didanosine
Docetaxel
Nevirapine
Doxorubicin
Gemcitabine
Bleomycin
Temozolomide Xeloda
Specialty list not all‐inclusive.  Please contact the ProAct Helpdesk at 1‐877‐776‐2285 with questions regarding specialty medications. 

Source: http://www.ongov.net/ebenefits/documents/ProActWallchartOctober2013.pdf

msma.org

early treatment of tick Borne illnesses by Edwin J. Masters, MD† Both doxycycline and azithromycin are generally well tolerated, have long track records and low incidences of true allergy, are excreted through the G. I. tract, and available as generics. illness,4,5 Lyme disease, Ehrlichia chaffeensis , Ehrlichia ewingii , Human Granulocytic Anaplasmosis ,

Brief

Uitspraak van de Huurcommissie Verzoek Wet op het overleg huurders verhuurder (WOHV) Woonruimte 73 woningen in de . te . Zaaknummer WOHV 005 Datum zitting 21 december 2012 Verzoeker Naam: Verzonden op 16 januari 2013 Vertegenwoordigd door: Heer ., voorzitter bestuur en heer . Wederpartij Naam: Vertegenwoordigd door: Heer ., bedrijfsjurist, heer . en heer .

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