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Download 2007 ESI National Preferred Formulary
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2007 ESI National Preferred Formulary 2007 Additions to the Formulary: U Drug Activella Actoplus Met Actos Benzaclin Colazal Levemir vials only Protopic Uroxatral 2007 Deletions to the Formulary: (These drugs will move from Formulary (first/second tier) to Non-Formulary status (third tier) effective January 1, 2007_ U U Non Formulary Drugs Effective 1/1/2007 Metadate CD/ER Prefest Sonata Synvisc prascion cleansing cloths Aloprim Augmentin 250-125 mg Carbocaine vial Carnitor 1gm/5ml vial Cleocin vaginal cream Clindamax vaginal Colestid Copegus Detuss Dialyte Lm W/Dextrose 2.5% & W/Dextrose 4.25% Dianeal W/Dextrose 4.25% Dianeal PD-2 W/Dextrose Dilaudid 1& 2 mg ampule Dostinex Effexor Entuss Eskalith,CR Folbee Plus Inpersol W/Dextrose Isotonic Gentamicin Sulfate Alternative Formulary Drugs (First and Second Tier Drugs) methylphenidate,Concerta Activella,Prempro/Premphase temazepam,Ambien (non-CR) supartz,Euflexxa prascion liquid cleanser allopurinol sodium 500 mg vial amox tr-k clv 250-125 mg polocaine 1% vial levocarnitine clindamycin vaginal clindamycin vaginal colestipol ribasphere,ribavirin 200 mg hydron psc liquid delflex w/dextrose delflex w/dextrose delflex w/dextrose hydromorphone cabergoline venlafaxine prolex dh,hydone lithium carbonate,er dexfol tablet delflex w/dextrose gentamicin/sodium chloride 1 This document is proprietary and confidential to Express Scripts, Inc. Unauthorized use and distribution are prohibited. ESI National Preferred formulary Changes Document 2007 Draft 1 Created 08/10/2006 Non Formulary Drugs Effective 1/1/2007 Lithobid M.T.E.-5 Mebaral Metadate ER 10 mg Metrolotion Novantrone Nydrazid Osmitrol OTN Pamidronate vial Otogesic Plavix Re-Tann Retrovir Terazol 3 Tridesilon 0.05% cream Urocit-K Zithromax suspension/IV Zonegran Alternative Formulary Drugs (First and Second Tier Drugs) lithium carbonate er 300 mg multitrace-5 conc vial mephobarbital methylin er 10 mg tablet sa metronidazole 0.75% lotion mitoxantrone hcl isoniazid mannitol pamidronate ear-gesic drops clopidogrel carb pseudo-tan suspension zidovudine terconazole 80 mg suppository desonide 0.05% cream potassium citrate er azithromycin zonisamide Note: Brand name drugs are capitalized; generic drugs are in lower case. 2 This document is proprietary and confidential to Express Scripts, Inc. Unauthorized use and distribution are prohibited. ESI National Preferred formulary Changes Document 2007 Draft 1 Created 08/10/2006
