Group Health Insurance Specialists TCC, Inc. Preferred Drug List January 2006 NOTE: Drugs in ALL ALPHAGAN P CAPS are considered Brand-Named Drugs. abapentin alprazolam Drugs that are all lowercase are ACCU-CHEK considered Generic ARIMIDEX ACCUTANE ALTOPREV ARISTOCORT A acebutolol ARISTOCORT R acetaminophen w/butalbital amantadine AROMASIN acetaminophen w/codeine ARTANE ELX acetasol HC AMBENYL SYP ACLOVATE aspirin w/codeine ACTIGALL amiloride amiloride/hctz aminophylline ATACAND HCT amiodarone ACULAR PF amitriptyline atenolol acyclovir amitriptyline/chlordiazepoxide atenolol/chlorthalidone ADDERALL XR amitriptyline/perphenazine amnesteem atropine sulfate AGENERASE amoxicillin ATROVENT AGGRENOX amoxicillin/clavulanate ATROVENT ORAL INHALER AK-TRACIN OIN OP amphetamine salt combination albuterol ampicillin AVANDAMET ALDACTAZIDE ANAFRANIL ALDACTONE anagrelide ANALPRAM-HC CRE ANALPRAM-HC LOT ANAPROX DS ANDRODERM ANDROGEL ANTABUSE ALLEGRA-D ANTIVERT allopurinol APRESOLINE azathioprine
The PDL is subject to change at any time during the year without prior notification to members or physicians.
CILOSTAZOL AZULFIDINE CILOXAN OIN cimetidine bacitracin CALCIMAR CIPRO HC SUS OTIC baclofen calcitriol CIPRO SUSPENSION BACTROBAN CRM BD SYRINGES CIPRODEX benazepril ciprofloxacin benazepril/hctz captopril citalopram captopril/hctz CITRACAL PRENATAL RX claravis BENZAC AC carbamazepine clarithromycin CARBATROL clemastine fumarate BENZACLIN BENZAGEL carbidopa/levodopa CLEOCIN-T benzonatate carisoprodol clidinium/chlordiazepoxide benzoyl peroxide CARNITOR benztropine mesylate cartia xt clindamycin betamethasone dipropionate CLINORIL betamethasone valerate clobetasol propionate BETAPACE cefaclor clobetasol propionate-e BETAPACE AF cefaclor er clomiphene citrate betaxolol cefadroxil clomipramine bethanechol cefuroxime clonazepam CELEBREX clonidine BETOPTIC-S CELLCEPT clorazepate dipotassium BIAXIN XL CENESTIN clotrimazole bisoprolol fumarate cephalexin clotrimazole/betamethasone bisoprolol fumarate/hctz colchicine BLEPH-10 chloral hydrate COLESTID BRETHINE chlordiazepoxide COMBIPATCH brimonidine chloroquine phosphate COMBIVENT bromocriptine chlorothiazide COMBIVIR bumetanide chlorpromazine COMPAZINE chlorpropamide bupropion chlorthalidone CONCERTA bupropion extended release chlorzoxazone CONDYLOX cholestyramine COPAXONE buspirone cholestyramine light butalbital compound choline mag trisalicylate butorphanol tartrate
The PDL is subject to change at any time during the year without prior notification to members or physicians.
DESQUAM-E CORTIFOAM DESQUAM-X doxazosin mesylate cortisone acetate doxycycline hyclate COUMADIN DETROL LA doxycycline monohydrate dexamethasone DEXEDRINE duradrin DURAGESIC CRIXIVAN dextroamphetamine sulfate dyphylline cromolyn sodium cryselle econazole nitrate CUPRIMINE diazepam CUTIVATE DIAZEPAM CONC CYCLESSA DIAZEPAM SOLN EFFEXOR XR cyclobenzaprine diclofenac potassium cyclopentolate diclofenac sodium cyclophosphamide dicloxacillin sodium cyclosporine dicyclomine EMBREX 600 CYMBALTA didanosine delayed release cyproheptadine diethylpropion DIFFERIN CYTOVENE diflorasone diacetate diflunisal enalapril maleate DANOCRINE enalapril maleate/hctz dantrolene DILANTIN DILANTIN INFATABS enpresse DILAUDID ENTOCORT EC DECADRON diltia xt DECONAMINE diltiazem diltiazem extended release EPIVIR HBV DEPAKENE DIPENTUM DEPAKOTE diphenhydramine ergotamine tartrate/caffeine DEPAKOTE ER diphenoxylate w/atropine DEPAKOTE SPRINKLE DIPROLENE erythromycin DEPO-PROVERA DIPROSONE erythromycin base DERMA-SMOOTH OIL FS dipyridamole erythromycin ethylsuccinate desipramine DISALCID erythromycin stearate desmopressin acetate disopyramide phosphate erythromycin/sulfisoxazole desonide DITROPAN XL ESKALITH estazolam desoximetasone DOSTINEX ESTRADERM
The PDL is subject to change at any time during the year without prior notification to members or physicians.
estradiol transdermal hydralazine FORTOVASE hydrochlorothiazide estropipate hydrocodone/acetaminophen ethambutol FOSAMAX PLUS D hydrocortisone ethosuximide fosinopril hydrocortisone valerate etodolac furosemide hydromorphone etoposide hydroxychloroquine sulfate hydroxyurea GABITRIL hydroxyzine hci ganciclovir hydroxyzine pamoate GANTRISIN SUSP hyoscyamine GARAMYCIN famotidine gemfibrozil FARESTON gentamicin sulfate ibuprofen fenoprofen calcium glimepiride fentanyl Patch glipizide imipramine fexofenadine glipizide extended release GLUCAGEN indapamide FLEXERIL GLUCAGON INDERAL LA GLUCOVANCE glyburide indomethacin glyburide micronized INFERGEN floxacin glyburide/metformin FLOXIN OTIC GOLYTELY PACKET INTAL MDI fluconazole GRIS-PEG fluocinolone acetonide guanfacine INVIRASE fluocinonide ipratropium bromide fluocinonide-e HABITROL isoniazid fluorometholone FLUOROPLEX fluorouracil haloperidol isosorbide dinitrate fluoxetine isosorbide mononitrate fluphenazine isoxsuprine flurazepam flurbiprofen flutamide fluvoxamine maleate folic acid
The PDL is subject to change at any time during the year without prior notification to members or physicians.
lorazepam methocarbamol ktoconazole LORAZEPAM INTENSOL methotrexate ketoprofen methyclothiazide ketorolac tromethamine LOTRIMIN methyldopa METHYLIN KLONOPIN low-ogestrel methylphenidate methylphenidate extended release methylprednisolone labetalol metipranolol lactulose LYSODREN metoclopramide LAMICTAL metolazone LAMISIL TABLETS MACROBID metoprolol tartrate MALARONE METROGEL METROGEL-VAGINAL MATULANE metronidazole LEUCOVORIN CALCIUM mexiletine LEUKERAN MAXAIR AUTOH leuprolide acetate MIACALCIN LEVAQUIN MAXIVATE microgestin MEBENDAZOLE microgestin fe levobunolol meclizine midazolam midodrine levothroid medroxyprogesterone acetate minocycline levothyroxine sodium medroxyprogesterone acetate minoxidil injectable mefloquine MIRCETTE megestrol acetate mirtazapine MELLARIL CON misoprostol lindane shampoo meperidine mometasone furoate LIORESAL meperidine/promethazine morphine sulfate meprobamate morphine sulfate extended release lisinopril mercaptopurine lisinopril/hctz MESTINON lithium carbonate METADATE CD mupirocin oint lithium carbonate extended release METADATE ER METAGLIP metaproterenol sulfate loperamide metformin MYSOLINE metformin extended release methazolamide nabumetone
The PDL is subject to change at any time during the year without prior notification to members or physicians.
NUTROPIN pentazocine/naloxone naloxone NUTROPIN AQ pentoxifylline extended release naltrexone NUVARING pergolide NAPROSYN nystatin perphenazine naproxen nystatin/triamcinolone PERSA-GEL naproxen sodium PERSANTINE omeprazole delayed release phenazopyridine NASACORT AQ phendimetrazine ONETOUCH phenobarbital NATAFORT phentermine HCl orphenadrine citrate phenytoin sodium extended ORTHO EVRA neomycin sulfate ORTHO TRI-CYCLEN LO pilocarpine NEUPOGEN pindolol NEURONTIN oxaprozin piroxicam oxazepam podofilox oxybutynin chloride polymyxin b/trimethoprim nicardipine oxycodone POLY-VI-FLOR NICODERM oxycodone/acetaminophen potassium chloride nifedipine oxycodone/aspirin PRAVACHOL nifedipine extended release OXYCONTIN prazosin NILANDRON NITRO-DUR PRECARE CONCEIVE nitrofurantoin macrocrystal nitroglycerin PACERONE PRED MILD NITROSTAT PANCREASE prednisolone nizatidine pancrelipase prednisone PREDNISONE SOLN NOLVADEX papaverine NORITATE PARLODEL PREMARIN NORMODYNE PREMESIS RX paroxetine hci PREMPHASE nortriptyline PEDIAPRED PREVACID peg 3350/electrolytes primidone probenecid PEG-INTRON probenecid w/colchicine penicillin vk prochlorperazine NULYTELY pentazocine/acetaminophen
The PDL is subject to change at any time during the year without prior notification to members or physicians.
sulindac PROLOPRIM rifampin promethazine RISPERDAL PROMETRIUM SYNTHROID propoxyphene RITALIN LA propoxyphene ROCALTROL TAMBOCOR nap/acetaminophen propranolol RONDEC-DM tamoxifen citrate propranolol/hctz TAPAZOLE propylthiouracil TARGRETIN PROTOPIC ROXICODONE PROVENTIL TEGRETOL –XR temazepam PROVIGIL salsalate TEMOVATE PSORCON E selegiline PULMICORT pyridostigmine SEREVENT terazosin SEROQUEL terconazole QUESTRAN silver sulfadiazine TESSALON QUIBRON-T tetracycline quinapril SINEMET CR quinapril/hctz SINEQUAN THEO-DUR SINGULAIR theophylline ranitidine SLO-BID GYRO THIOGUANINE RAPAMUNE SLO-PHYLLIN thioridazine RAZADYNE SORBITRATE thiothixene RAZADYNE ER sotalol hci ticlopidine SPECTAZOLE timolol maleate soln spironolactone tizanidine spironolactone/hctz TOBRADEX RESCRIPTOR sprintec tobramycin sulfate RESTORIL tolazamide STRATTERA tolmetin sodium RETIN-A MICRO STRONGSTART RETROVIR sucralfate TOPICORT sulfacetamide/prednisolone TOPROL-XL RHINOCORT AQUA sulfamethoxazole/trimethoprim torsemide ribavirin sulfasalazine TRACLEER
The PDL is subject to change at any time during the year without prior notification to members or physicians.
tramadol ZONEGRAN tramadol/acetaminophen trazodone VIRACEPT ZYLOPRIM tretinoin VIRAMUNE triamcinolone ZYPREXA ZYDIS triamterene/hctz VITAFOL-PN triazolam ZYRTEC-D trifluoperazine VIVELLE-DOT trihexyphenidyl What is a Preferred Drug List (PDL)? TRILAFON VOLTAREN A PDL is a list of prescription medica- tions chosen for their clinical value and TRILEPTAL cost-effectiveness by an independent trimethobenzamide/benzocaine panel of physicians and pharmacists. With our PDL, you and your doctor trimethoprim warfarin sodium have the freedom to choose the medica- trinessa tion that works best for you. Since there may be more than one drug avail- tri-previfem WELLBUTRIN XL able for your medical condition, we tri-sprintec encourage you to use generic and pre- ferred brand-name drugs whenever possible to help manage your prescrip- TRIZIVIR tion costs. NOTE: The PDL is subject to change without notice at any time TYLENOL/COD TAB during the year without prior notice to members or physicians. ULTRASE MT ULTRAVATE FOR YOUR INFORMATION: The Preferred Drug List is not inclusive nor does it guarantee coverage, but UROCIT-K represents a summary of prescription coverage. The plan members specific prescription benefit plan may have a different co-pay for specific products on the list. Co-payment or co-pay means the VALISONE ZANAFLEX amount a plan member is required to pay for a prescription in accordance valproic acid ZANTAC SYRUP with a Plan, which may be a deductible, ZARONTIN a percentage of the prescription price, a fixed amount or other charge, with the VANCOCIN HC ZAROXOLYN balance, if any, paid by a Plan. VASOCIDIN Unless specifically indicated, drug list products will include all dosage forms.
verapamil The Preferred Drug List contains prescription brand name medicines that verapamil extended release are registered and/or unregistered VESANOID ZITHROMAX trademarks of third-party pharmaceutical companies unrelated to and unaffiliated with TCC, Inc. These ZOFRAN ODT trademarks are included here for informational purposes only and are not intended to imply or suggest any affiliation between TCC, Inc. and such third-party pharmaceutical companies.
The PDL is subject to change at any time during the year without prior notification to members or physicians.
REV ESP PATOL 2007; Vol 40, n.º 1: 53-56 CASUÍSTICA Colagenosis perforante reactiva adquirida. Estudio de un caso de origen traumático Acquired reactive perforating collagenosis. Report of a case of traumatic origin Vicente Sabater Marco, Eugenio Salgado Jaldo Introducción: La colagenosis perforante reactiva es una Introduction: Reactive perforating collagenosis is a dermat
Group Health Insurance Specialists