|
The following drug considerations were reviewed and determined
for formulary inclusion and tier placement by the U-M Pharmaceutical
Benefits Advisory Committee in March, April, and May 2005.
Drug Name |
Indication |
PDL Class
Yes/No |
Action |
| Regranex |
Diabetic Ulcers |
No |
Tier 3 |
| Rythmol SR |
Antiarrhythmic |
No |
Tier 2 |
| Tikosyn |
Antiarrhythmic |
No |
Tier 2 |
| Helidac |
H. Pylori |
No |
Tier 3 |
| Marinol |
Nausea & Vomiting |
No |
Tier 2 |
| Neulasta |
Hematopoietic |
No |
Tier 2 |
| Roferon-A |
Immunomodulators |
No |
Tier 2 |
| Pexeva |
Antidepressant |
No |
Tier 3 |
| Tracleer |
PAH |
No |
Tier 2 |
| Darvon |
Narcotic Analgesic |
No |
Tier 3, Generic available |
| Demerol |
Narcotic Analgesic |
No |
Tier 3, Generic available |
| Minipress |
Blood Pressure |
No |
Tier 3, Generic available |
| Noroxin |
Anit-Infective |
No |
Tier 3, Generic available |
| Percodan |
Narcotic Analgesic |
No |
Tier 3, Generic available |
| Zephrex LA |
Decongestant |
No |
Tier 3, Generic available |
| Donnatal |
IBS |
No |
Tier 3, Generic available |
| Librium |
Anitanxiety |
No |
Tier 3, Generic available |
| Peridex |
Gingivitis |
No |
Tier 3, Generic available |
| Enablex |
Urinary Incontinence |
Yes |
Tier 3 |
| Vesicare |
Urinary Incontinence |
Yes |
Tier 3 |
| Fosrenol |
Electrolyte Depleter |
No |
Tier 2 |
| Lunesta |
Sedative Hypnotic |
No |
Tier 3 |
| Luveris |
Fertility |
No |
Tier 2 |
| Ventavis |
PAH |
No |
Tier 2, PA |
| Combunox |
Narcotic Analgesic |
No |
Tier 3 |
| Flovent HFA |
Inhaler |
Yes |
Tier 2 |
| Estrace Vag |
Estrogen |
No |
Tier 2 |
| Prefest |
Estrogen |
Yes |
Tier 2 |
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