Table of Contents Index Policy Information
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ANESTHETICS
ANTIINFECTIVES
ANTINEOPLASTIC/IMMUNOSUPPRESSANT DRUGS
CARDIOVASCULAR MEDICATIONS
AUTONOMIC AND CNS MEDICATIONS
DERMATOLOGICAL MEDICATIONS
EAR-NOSE-THROAT MEDICATIONS
ENDOCRINE MEDICATIONS
GASTROINTESTINAL MEDICATIONS
IMMUNOLOGICALS AND VACCINES
MUSCULOSKELETAL MEDICATIONS
NUTRITION,BLOOD MODIFIERS,ELECTROLYTES
OBSTETRICAL & GYNECOLOGICAL MEDICATIONS
OPHTHALMIC MEDICATIONS
RESPIRATORY MEDICATIONS
UROLOGICAL MEDICATIONS
DIAGNOSTIC & MISCELLANEOUS MEDICATIONS
MEDICAL (MISCELLANEOUS) SUPPLIES
MEDICAID OTC SUPPLY CODES
HOMEOPATHIC AND HERBAL PROD
LOCAL ANESTHETICS
TOPICAL ANESTHETICS
ANTIBACTERIAL DRUGS
CEPHALOSPORINS
CHLORAMPHENICOLS
CLINDAMYCINS
ERYTHROMYCINS
OTHER MACROLIDES
KETOLIDES
PENICILLINS
SULFONAMIDES
TETRACYCLINES
URINARY ANTIINFECTIVES
QUINOLONES
TOPICAL ANTIBACTERIAL DRUGS
ORAL ANTIFUNGAL DRUGS
TOPICAL ANTIFUNGAL DRUGS
VAGINAL ANTIFUNGALS
OTHER TOPICAL ANTIFUNGALS
TOPICAL ANTIFUNGAL-CORTICOSTEROID COMB.
ANTIVIRAL DRUGS
ANTIRETROVIRALS & PROTEASE INH
OTHER ANTIVIRAL DRUGS
TOPICAL ANTIVIRAL DRUGS
ANTIINFECTIVES SPECIALIZED INDICATIONS
AMEBICIDES
ANTITUBERCULOSIS DRUGS
PLASMODICIDES
SULFONES
TRICHOMONOCIDES
ANTHELMINTICS
OTHER ANTIINFECTIVE DRUGS
PARENTERAL ANTIFUNGALS
AMINOGLYCOSIDES
THIOPURINES
CARDIAC GLYCOSIDES
CALCIUM ANTAGONISTS
TETRALOLS
DIURETICS
LOOP DIURETICS
THIAZIDE AND RELATED DRUGS
POTASSIUM SPARING DIURETICS
BETA-ADRENERGIC ANTAGONIST DRUGS
ANTIHYPERTENSIVE DRUGS
VASODILATOR ANTIHYPERTENSIVES
CENTRALLY ACTING ANTIHYPERTENSIVES
ALPHA-ADRENERGIC ANTAGONISTS
ANGIOTENSIN MODIFYING AGENTS
ANGIOTENSIN CONVERTING ENZYME INHIBITORS
ANGIOTENSIN II RECEPTOR ANTAGONISTS
DRUGS FOR PHEOCHROMOCYTOMA
OTHER ANTIHYPERTENSIVES
VASODILATING DRUGS
NITRATES
OTHER VASODILATING DRUGS
ENDOTHELIN RECPTR ANTAGONIST
ANTIDYSRHYTHMIC DRUGS
CLASS 1 - MEMBRANE STABILIZING
CLASS 1A
CLASS 1B
CLASS 1C
NOT USED
AMIODARONES
OTHER ANTIARRHYTHMICS
ANTILIPIDEMIC DRUGS
HYPOLIPOPROTEINEMICS
HMG-COA REDUCTASE INHIBITORS
HMG-COA COMBINATIONS
OTHER CARDIOVASCULAR DRUGS
ANALGESICS AND MEDICATIONS FOR HEADACHES
ANALGESICS
CLASS II NARCOTICS
CLASS III NARCOTICS
CLASS IV NARCOTICS
DRUGS TO PREVENT AND TREAT HEADACHES
ANTIANXIETY AND SEDATIVE-HYPNOTIC DRUGS
ANXIOLYTICS
SEDATIVE/HYPNOTIC DRUGS
ANTIMANIA DRUGS
ANTICONVULSANT DRUGS
CARBAMAZEPINES
ANTICONVULSANT BENZODIAZEPINES
HYDANTOINS
VALPROIC ACID AND DERIVATIVES
SUCCINIMIDES
ANTICONVULSANT BARBITURATES
OTHER ANTICONVULSANTS
ANTIDEPRESSANT DRUGS
GENERAL ANTIDEPRESSANTS
TERTIARY AMINES
SECONDARY AMINES
SELECTIVE SEROTONIN REUPTAKE INHIBITORS
OTHER ANTIDEPRESSANTS
MAO INHIBITORS
ANTIVERTIGO AND ANTIEMETIC DRUGS
ANTIPARKINSON DRUGS
ANTIPARKINSON ANTICHOLINERGIC DRUGS
OTHER ANTIPARKINSON DRUGS
ANTIPSYCHOTIC DRUGS
ALIPHATIC PHENOTHIAZINES
PSYCHOTHERAPEUTIC COMBINATIONS
CNS STIMULANT/OTHER CNS-AUTONOMIC DRUGS
CNS STIMULANT DRUGS
OTHER CNS/AUTONOMIC DRUGS
ALCOHOL ANTAGONIST
ANTIDEMENTIA DRUGS
DRUGS TO TREAT MULTIPLE SCLEROSIS
SMOKING CESSATION PRODUCTS
OTHER DRUGS FOR ADHD
TOPICAL CORTICOSTEROID DRUGS
ANTIPRURITIC DRUGS
ANTIACNE DRUGS
ACCUTANES
KERATOLYTIC DRUGS
ANTIPSORIASIS AND ANTIECZEMA DRUGS
DERMATOLOGICAL PREPS/COMPOUNDED DRUGS
ORAL DERMATOLOGICAL DRUGS
TOPICAL DERMATOLOGICAL DRUGS
SCABICIDES
INJECTABLE DERMATOLOGICALS
TOPICAL ANTI-INFLAMMATORY DRUGS
DRUGS AFFECTING THE EAR
DRUGS AFFECTING THE NOSE
DRUGS AFFECTING THE THROAT AND MOUTH
HYPOGLYCEMIC DRUGS
INSULIN
ALL PRODS MOVED TO TC 81400
INSULIN- INHALED
ORAL HYPOGLYCEMICS & COMBOS
INSULIN SENSITIZERS & COMBOS
AMYLIN ANALOGUES
INCRETIN ENHANCING DRUGS
INCRETIN MIMETICS
DIPEPTIDYL PEPTIDASE-IV INHIB & COMBOS
GLUCOSE ELEVATING DRUGS
ADRENAL CORTICOSTEROID DRUGS
GLUCOCORTICOID DRUGS
MINERALOCORTICOID DRUGS
THYROID AND ANTITHYROID DRUGS
THYROID SUPPLEMENTS
ANTITHYROID DRUGS
ANDROGEN AND ESTROGEN DRUGS
OTHER ENDOCRINE DRUGS
DRUGS FOR HEARTBURN
ANTACIDS
OTC H2 ANTAGONISTS
ANTIDIARRHEAL DRUGS
ANTISPASMODICS/DRUGS AFFECT GI MOTILITY
ANTIULCER DRUGS
OTHER ANTIULCER DRUGS
PROTON PUMP INHIBITORS
PROTON PUMP INHIBITORS- OTC
HELICOBACTER PYLORI DRUGS
LAXATIVES AND CATHARTICS
OTHER GI DRUGS
IRRITABLE BOWEL DRUGS
BIOTECHNOLOGY DRUGS
MYELOID STIMULANTS
THROMBOPOIETIC AGENTS
ERYTHROID STIMULANTS
INTERFERONS
GROWTH HORMONES AND RELATED DRUGS
INSULIN LIKE GROWTH FACTORS-1
INTERLEUKINS
INTERLEUKIN RECPTR ANTAGONIST
IMMUNOGLOBULIN ANTIBODIES
KERATINOCYTE GROWTH FACTOR
DRUGS FOR INFLAMMATORY DISEASES
SALICYLATES AND RELATED DRUGS
NON-STEROIDAL ANTIINFLAMMATORY AGENTS
CORTICOSTEROID DRUGS
OTHER DRUGS FOR ARTHRITIS
DRUGS TO PREVENT AND TREAT GOUT
SKELETAL MUSCLE RELAXANTS
DIRECT MUSCLE RELAXANTS
CNS MUSCLE RELAXANTS
OTHER MUSCULOSKELETAL DRUGS
INJECTABLE VITAMINS
VITAMINS & MINERALS & RELATED PRODUCTS
THERAPEUTIC VITAMINS & MINERALS
FLUORIDE PRODUCTS
POTASSIUM SUPPLEMENTS
POTASSIUM REMOVING RESINS
DRUGS AND VITAMINS AFFECTING COAGULATION
ORAL ANTICOAGULANTS, VITAMIN K
INJECTABLE ANTICOAGULANTS
OTHER DRUGS AFFECTING COAGULATION
HEPARIN ANTAGONISTS
ANTIPLATELET DRUGS
HEMOSTATICS
BLOOD DETOXICANTS
NUTRITIONAL/SUPPLEMENT PRODUCTS
ELECTROLYTES, IRRIGATING SOLUTIONS, ETC.
PRENATAL,SPECIALIZED,TOP ANTIINFECTIVES
PRENATAL VITAMINS
SPECIALIZED OB/GYN DRUGS
OB/GYN TOPICAL ANTIINFECTIVES
OVULATORY STIMULANTS
ANDROGEN DRUGS
ESTROGEN DRUGS
ESTROGEN/PROGESTIN COMBINATIONS
SELECTIVE ESTROGEN RECEPTOR MODULATOR
PROGESTIN DRUGS
CHM - MAIL ORDER
CONTRACEPTIVES
ABORTIFACIENTS
OXYTOCICS
OPHTHALMIC ANTIINFECTIVE DRUGS
OPHTHALMIC TOPICAL ANTIBACTERIAL DRUGS
OPHTHALMIC TOPICAL ANTIVIRAL DRUGS
OPHTHALMIC CORTICOSTEROID DRUGS
OPHTHALMIC ANTIINFECTIVE/CORTICOSTEROIDS
ANTIGLAUCOMA DRUGS
OTHER OPHTHALMIC DRUGS
BRONCHODILATORS AND RELATED DRUGS
BETA-2 ADRENERGIC DRUGS
METHYL XANTHINE DRUGS
OTHER DRUGS FOR ASTHMA
LEUKOTRIENE MODIFIERS
ANTIHISTAMINE AND DECONGESTANT DRUGS
ANTIHISTAMINES
DECONGESTANTS
ANTIHISTAMINE/DECONGESTANT COMBINATIONS
ANTITUSSIVE AND EXPECTORANT DRUGS
OTHER RESPIRATORY DRUGS
DRUGS TO TREAT URINARY TRACT DISORDERS
ANTICHOLINERGIC ANTISPASMODICS
CHOLINERGIC STIMULANTS
URINARY ANESTHETICS
OTHER GENITOURINARY PRODUCTS
DIAGNOSTIC PRODUCTS
MISCELLANEOUS DRUGS
WEIGHT LOSS PRODUCTS
APPETITE SUPPRESSANTS
OTHER WEIGHT LOSS PRODUCTS
DIABETIC SUPPLIES
OSTOMY SUPPLIES
PHARMACEUTICAL NECESSITIES
MEDICAID SUPPLIES OTC
TEST THERAPY CLASS
HOMEOPATHIC DRUGS
HERBAL PRODUCTS
INTERNAL USE ONLY
SUPPLIES AND MISCELLANEOUS
CLIENT SPECIFIC PSEUDO NDC
UNKNOWN
Formulary Date: 10/07/2008 Update Date: 10/09/2008 V1.3.0
