73
December 2023
73
DRUG PAGE DRUG PAGE
Covered Drugs Index
avoxate ...............................................58
ecainide
..............................................34
FLOVENT DISKUS INHALATION BLISTER WITH
DEVICE 100 MCG/ACTUATION, 50 MCG/ACTUATION
...57
FLOVENT DISKUS INHALATION BLISTER WITH
DEVICE 250 MCG/ACTUATION
.........................57
FLOVENT HFA INHALATION HFA AEROSOL
INHALER 44 MCG/ACTUATION
.........................57
FLOVENT HFA INHALATION HFA AEROSOL
INHALER 110 MCG/ACTUATION
........................57
FLOVENT HFA INHALATION HFA AEROSOL
INHALER 220 MCG/ACTUATION
.......................57
oxuridine
..............................................18
uconazole
.............................................10
uconazole in nacl (iso-osm)
............................10
ucytosine
.............................................10
udarabine
.............................................18
udrocortisone
.........................................43
unisolide
..............................................57
uocinolone acetonide oil
...............................42
uocinolone and shower cap
............................40
uocinolone topical cream
...............................40
uocinolone topical oil
..................................40
uocinolone topical ointment
............................40
uocinolone topical solution
.............................40
uocinonide topical cream 0.1%
.........................40
uocinonide topical cream 0.05%
........................40
uocinonide topical gel
..................................40
uocinonide topical ointment
............................40
uocinonide topical solution
.............................40
uoride (sodium) dental paste
...........................42
uoride (sodium) oral tablet
.............................60
uoride (sodium) oral tablet,chewable 1 mg
(2.2 mg sod. uoride)
...................................60
FLUOROMETHOLONE
.................................56
uorouracil intravenous
.................................18
uorouracil topical cream 0.5%
..........................38
uorouracil topical cream 5%
............................38
uorouracil topical solution
..............................38
uoxetine oral capsule 10 mg
...........................31
uoxetine oral capsule 20 mg, 40 mg
....................31
uoxetine oral capsule,delayed release(dr/ec)
............31
uoxetine oral solution
..................................31
uoxetine oral tablet 10 mg, 20 mg
......................31
uoxetine (pmdd)
.......................................31
uphenazine decanoate
.................................31
uphenazine hcl injection
...............................31
uphenazine hcl oral concentrate
........................31
uphenazine hcl oral elixir
...............................31
uphenazine hcl oral tablet
..............................31
urbiprofen oral tablet 100 mg
...........................28
urbiprofen sodium
.....................................55
uticasone propionate nasal
.............................57
uticasone propionate topical cream
.....................40
uticasone propionate topical ointment
...................40
uticasone propion-salmeterol inhalation blister with
device
.................................................57
uvastatin oral capsule 20 mg
...........................37
uvastatin oral capsule 40 mg
...........................37
uvastatin oral tablet extended release 24 hr
.............37
uvoxamine oral tablet 50 mg
...........................31
uvoxamine oral tablet 100 mg, 25 mg
...................31
FOLIVANE-OB
.........................................60
FOLOTYN
.............................................18
fomepizole
.............................................49
fondaparinux subcutaneous syringe 2.5 mg/0.5 ml
........36
fondaparinux subcutaneous syringe
10 mg/0.8 ml, 5 mg/0.4 ml, 7.5 mg/0.6 ml
................36
formoterol fumarate
.....................................57
FORTEO
...............................................50
fosamprenavir
..........................................11
fosfomycin tromethamine
...............................16
fosinopril
...............................................35
fosinopril-hydrochlorothiazide
...........................35
fosphenytoin
...........................................24
FOTIVDA
..............................................18
fulvestrant
..............................................18
furosemide injection solution
............................35
furosemide oral solution 10 mg/ml, 40 mg/5 ml
(8 mg/ml)
..............................................35
FUROSEMIDE ORAL SOLUTION 40 MG/4 ML
...........35