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General drug forms
Specific drug formsA B C D E F G H I J K L M N O P Q R S T U V W X Y ZAAciphex (52KB PDF) - Updated 11/2008Actemra (102KB PDF) Added 03/2010 Acthar (85KB PDF) - Updated 11/2009 Actimmune - Medicare only (68KB PDF) - Updated 11/2009 Actiq (94KB PDF) - Reveiwed 11/2009 Aloxi (54KB PDF) - Updated 07/2009 Amevive (135KB PDF) - Updated 09/2009 Amitiza - (68KB PDF) - Updated 07/2009 Amnesteem - Medicaid only (66KB PDF) - Updated 11/2008 Ampyra (119KB PDF) - Updated 07/2010 Amprya - Medicare only (183KB PDF) - Added 07/2010 Antiemetic Medication - Medicare only (95KB PDF) - Updated 07/2009 Anzemet (54KB PDF) - Updated 07/2009 Aralast (278KB PDF) - Added 04/2010 Aranesp - Medicaid only (Use specialty order form for HMO, PPO, POS) (165KB PDF) - Updated 07/2010 Aranesp - Medicare only (Use specialty order form for HMO, PPO, POS) (214KB PDF) - Updated 07/2010 BBanzel (101KB PDF) - Updated 05/2010Boniva IV - Medicare only (175KB PDF) - Added 04/2010 Boniva IV (90KB PDF) - Updated 01/2010 Botox (172KB PDF) - Updated 02/2010 Byetta (120KB PDF) - Updated 05/2010 CCelebrex (124KB PDF) - Updated 11/2009Chantix (54KB PDF) - Updated 11/2009 Cimzia (certolizumab) (126KB PDF) - Added 11/2009 DDysport - (146KB PDF) - Updated 02/2010EEmend - Medicare only (101KB PDF) - Updated 07/2010Enbrel (148KB PDF) - Updated 09/2009 Enteral Formulas (441KB PDF) - Updated 04/2010 Enteral Formulas - Medicare only (57KB PDF) - Updated 07/2009 Epogen - Medicare only (Use specialty order form for HMO, PPO, POS) (214KB PDF) - Updated 07/2010 Erbitux (67KB PDF) - Updated 09/2009 FFabrazyme (67KB PDF) - Updated 01/2010Fentora (94KB PDF) - Reviewed 11/2009 Forteo (67KB PDF) - Updated 09/2009 GHHepsera (adefovir) (64KB PDF) - Updated 11/2009Human Growth Hormone (174KB PDF) - Updated 09/2009 Humira (180KB PDF) - Updated 05/2009 Hyalurate (219KB PDF) - Reviewed 01/2010 IIlaris (103KB PDF) - Added 12/2009Immunosuppressive Drugs - Oral - Medicare only (70KB PDF) - Updated 09/2009 Increlex (114KB PDF) - Updated 01/2010 Infergen (59KB PDF) - Updated 01/2010 Inhalation Solutions used with a nebulizer - Medicare only (115KB PDF) - Updated 09/2009 Intravenous Immunoglobin (IVIG) (112KB PDF) - Updated 09/2009 Iressa (60KB PDF) - Updated 11/2009 Intravenous 5-HT3 Antagonists - (54KB PDF) - Added 07/2009 JJanuvia (109KB PDF) - Updated 05/2010KKineret (114KB PDF) - Updated 09/2009Kytril and Zofran - Medicare only (82KB PDF) - Updated 11/2009 LLidoderm - Medicare only (62KB PDF) - Added 12/2009Lidoderm (64KB PDF) - Updated 11/2009 Lovaza (formerly Omacor) (62KB PDF) - Updated 01/2010 MMarinol - Medicare only (40KB PDF) - Updated 11/2009Migraine Abortive Medication (67KB PDF) - Updated 11/2009 Multiple Sclerosis Agents - Medicaid only (122KB PDF) - Updated 03/2009 Myobloc (156KB PDF) - Updated 02/2010 NNeulasta - Medicare and Medicaid only (61KB PDF) - Updated 09/2009Neupogen - Medicare and Medicaid only (Use specialty order form for HMO, PPO, POS) (74KB PDF) - Updated 09/2009 Nexium (112KB PDF) - Updated 07/2010 Non-Covered Medication (42KB PDF) - Updated 01/2010 Nplate (174KB PDF) - Updated 07/2010 Nuvigil (102KB PDF) - Updated 08/2010 OOmacor -- see LovazaOnglyza (109KB PDF) - Updated 05/2010 Onsolis (94KB PDF) - Reviewed 11/2009 Orencia (111KB PDF) - Updated 10/2009 Oxycodone SR - Medicaid only (151KB PDF) - Updated 11/2009 PParenteral Formulations - Medicare only (69KB PDF) - Updated 11/2009PEG-Intron (95KB PDF) - Updated 09/2009 Prevacid Solutabs (50KB PDF) - Updated 07/2010 Procrit - Medicare only (Use specialty order form for HMO, PPO, POS) (214KB PDF) - Updated 07/2010 Prolastin (278KB PDF) - Added 04/2010 Promacta (174KB PDF) - Updated 07/2010 Proton Pump Inhibitor (PPI) (69KB PDF) - Updated 07/2010 Provigil (172KB PDF) - Updated 07/2010 QR
Reclast (68KB PDF) - Updated 09/2009
SSamsca (109KB PDF) - Added 10/2009Sancuso (50KB PDF) - Updated 05/2009 Selzentry (74KB PDF) - Updated 11/2009 Sotret - Medicaid only (77KB PDF) - Updated 11/2009 Stelara (240KB PDF) - Added 12/2009 Supplemental Supply (51KB PDF) - Updated 01/2010 Symlin (99KB PDF) - Updated 05/2010 Synagis (115KB PDF) - Updated 11/2009 TTamiflu (69KB PDF) - Updated 11/2009Tarceva - Medicare and Medicaid only (43KB PDF) - Updated 11/2009 Testim - Medicare only (66KB PDF) - Added 01/2010 Tykerb (100KB PDF) - Updated 05/2010 Tysabri (178KB PDF) - Updated 07/2010 Tyvaso (56KB PDF) - Added 01/2010 UVVaccines - Medicare only (44KB PDF) - Updated 11/2009Vectibix (72KB PDF) - Updated 07/2009
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