2019 Select-WF Formulary - Broward
2019 Select-WF FormularyEffective 01/01/2019The Formulary List is a guide providing tier designation for common medicineswithin select therapeutic categories. The Formulary List may not include all drugscovered by your prescription drug benefit. Generic medicines are available withinmany of the therapeutic categories listed, in addition to categories not listed, andshould be considered as the first line of prescribing.For benefit coverage or restrictions please check your benefit plan document(s).This listing is revised periodically as new drugs and new prescribing informationbecomes available. It is recommended that you bring this list of medications whenyou or a covered family member sees a physician or other healthcare provider.Tier Definitions1 Generics2 Preferred Brands3 Non-Preferred Brands4 Excluded Drugs - 100% Patient Liability(ST) Step Therapy(PA) Prior Authorization
Major Drug Class OverviewNon-Preferred Drugs With Preferred Options2019Drug ClassNon-Preferred / Excluded *PreferredANALGESICSEUFLEXXA*, GEL-ONE*, HYALGAN*,MONOVISC*, ORTHOVISC*, SYNVISC*,SYNVISC ONE*ABSTRAL*, EMBEDA*, FENTORA*, KADIAN,ZOHYDRO ERDUROLANE, GELSYN-3, SUPARTZ FXANTIVIRALSREBETOLHEPATITIS CDAKLINZA*, EPCLUSA*, HARVONI*,SOVALDI*, TECHNIVIE*, VIEKIRA PAK*,ZEPATIER*DOXYCYCLINE*, ORACEAmoderiba, ribavirin, ribavirin, tanyl, fentanyl citrate oraltransmucosal, morphine sulfate er,oxycodone hcl, HYSINGLA ER, NUCYNTAER, OXYCONTINANTI-INFECTIVESTETRACYCLINESminocycline hcl, tetracycline hcl,SOLODYNCARDIACANGIOTENSIN RECEPTOR BLOCKERBENICAR HCT, EDARBI, vastatin calcium, ezetimibe,ezetimibe/simvastatin, rosuvastatincalcium, simvastatin, LIVALOADHDADDERALL VA, SARAFEMANTI-PSYCHOTICFANAPT, REXULTISLEEPZOLPIMISTcitalopram hydrobromide, escitalopramoxalate, escitalopram oxalate, fluoxetinehcl, fluvoxamine maleate, paroxetine hcl er,sertraline hcl, trazodone hcl, VIIBRYDaripiprazole, olanzapine, olanzapine odt,quetiapine fumarate, quetiapine fumarateer, LATUDA, SAPHRISeszopiclone, zaleplon, zolpidem tartrate er,BELSOMRA, ROZEREMcandesartan rothiazide, drochlorothiazideclopidogrel, ELIQUIS, , KAZANO*, KOMBIGLYZE XR*,NESINA*, OSENI*BYETTA*, TANZEUM*INSULIN: LONG ACTINGAFREZZA, APIDRA*, HUMALOG*, HUMALOGMIX 50/50*, HUMALOG MIX 75/25*, HUMULIN70/30*, HUMULIN N*, HUMULIN R*BASAGLAR KWIKPEN*OTHERGLUMETZA, RIOMETSGLT-2JANUMET XR, JANUVIA, JENTADUETO,ONGLYZA, TRADJENTABYDUREON PEN, OZEMPIC, TRULICITY,VICTOZAFIASP, FIASP FLEXTOUCH, NOVOLIN70/30, NOVOLOG FLEXPEN, NOVOLOGMIX 70/30, NOVOLOG PENFILLLANTUS, LANTUS SOLOSTAR, LEVEMIR,TOUJEO SOLOSTAR, TRESIBAFLEXTOUCHmetformin hcl erFARXIGA, INVOKAMET, INVOKANA,JARDIANCE, SYNJARDY, XIGDUO XR
Drug ClassTESTINGNon-Preferred / Excluded *PreferredACCU-CHEK AVIVA CONNECT*, ACCU-CHEKONETOUCH ULTRA BLUE, ONETOUCHAVIVA PLUS*, ADVOCATE BLOOD GLUCOSEVERIO TEST STRIPSMONITORING SYSTEM*, BAYER BREEZE 2TEST DISC*, BAYER CONTOUR BLOODGLUCOSE TEST STRIPS*, EMBRACE BLOODGLUCOSE TEST STRIPS*, FREESTYLE TESTSTRIPS*, PRODIGY AUTOCODE BLOODGLUCOSE MONITORING SYSTEM*, TRUETESTSTRIPS*, TRUETRACK SMART SYSTEM*,UNISTRIP1 GENERIC*ENDOCRINEESTROGENSCLIMARA PRO*, ESTRACE, ESTROGEL*estradiol, DIVIGEL, ESTRING, PREMARINFERTILITY AGENTSBRAVELLE*, FOLLISTIM AQ*, FOLLISTIM AQ*,GANIRELIX ACETATE*, PREGNYL W/DILUENTBENZYLALCOHOL/NACL*CRINONEclomiphene citrate, CETROTIDE, GONAL-F,MENOPUR, NOVARELAXIRON*, FORTESTA*, NATESTO*, STRIANT,TESTIM*, VOGELXO*ANDROGEL PUMPDIGESTIVE ENZYMESPANCREAZE*, PERTZYE*CREON, VIOKACE, ZENPEPOTHERDELZICOL*, DIPENTUM, LIALDAPROTON PUMP INHIBITORSDEXILANT*balsalazide disodium, AMITIZA, APRISO,LINZESS, PENTASAlansoprazole, omeprazole, GASTROINTESTINALGROWTH HORMONESGENOTROPIN*, HUMATROPE*, NUTROPIN AQNUSPIN 10*, OMNITROPE*, SAIZENCLICK.EASY*, ZOMACTON*, ZORBTIVE*NORDITROPIN FLEXPROARANESP ALBUMIN FREE*, EPOGEN*,MIRCERA*PROCRITCIMZIA*, ILUMYA, KEVZARA, KINERET*,ORENCIA*, REMICADE*, SILIQ*, SIMPONI*,TALTZ*, TALTZ*, TREMFYAACTEMRA, COSENTYX, COSENTYXSENSOREADY PEN, ENBREL SURECLICK,ENTYVIO, HUMIRA PEN, OTEZLA,STELARA, XELJANZ, XELJANZ XRHEMATOLOGYMUSCULOSKELETALANTI-INFLAMMATORY **(1) Trial of TWO preferred products required [documentation required](2) Trial of ONE preferred product required(3) Trial of Humira required / Other preferred products not requiring Humira first for Psoriasis are Cosentyx, Otezla & StelaraIndicationNon-Preferred ProductsPreferred ProductsCIMZIA (1) or KEVZARA (1) or KINERET (1) orORENCIA (1) or SIMPONI 50mg (1)ACTEMRA or ENBREL or HUMIRA or XELJANZor XELJANZ XRORENCIA (2)ENBREL or HUMIRACIMZIA (1) or SIMPONI 50mg (1)COSENTYX or ENBREL or HUMIRAPsoriatic ArthritisCIMZIA (1) or ORENCIA (1) or OTEZLA (2) orSIMPONI 50mg (1) or TALTZ (1) or XELJANZ (1) orXELJANZ XR (1)COSENTYX or ENBREL or HUMIRA orSTELARAPlaque PsoriasisCIMZIA (1) or ILUMYA (1) or SILIQ (1) or TALTZ (1)or TREMFYA (1)COSENTYX or HUMIRA or OTEZLA or STELARACrohn's DiseaseCIMZIA (1)HUMIRA or STELARAUlcerative ColitisSIMPONI 100mg (2) or XELJANZ (2) or XELJANZ XR(2)HUMIRARheumatoid ArthritisJuvenille Idiopathic ArthritisAnkylosing SpondylitisOPHTHALMICGLAUCOMACOSOPT PF, SIMBRINZA, ZIOPTAN*dorzolamide hcl, latanoprost, AZOPT,COMBIGAN, TRAVATAN Z
Drug ClassNon-Preferred / Excluded *PreferredNSAIDSACUVAIL*, NEVANAC*bromfenac, diclofenac sodium, ketorolactromethamine, ILEVRO, PROLENSAMISCELLANEOUSCETRAXALciprofloxacinDULERA*, INCRUSE ELLIPTA*, TUDORZAPRESSAIR*FORADIL AEROLIZER, PROVENTIL HFA*,XOPENEX HFA*ALVESCO*, ASMANEX TWISTHALER 120METERED DOSES*ADVAIR DISKUS, ANORO ELLIPTA, BREOELLIPTA, STIOLTO RESPIMAT, SYMBICORTARCAPTA NEOHALER, PERFOROMIST,PROAIR HFA, SAVELLA, VENTOLIN HFAARNUITY ELLIPTA, FLOVENT DISKUS,FLOVENT HFA, PULMICORT FLEXHALER,QVARflunisolide, DYMISTAOTICRESPIRATORYASTHMA/COPDBETA AGONISTSINHALED STEROIDSNASAL STEROIDSBECONASE AQ*, NASONEX, OMNARIS*,QNASL*, ZETONNA*TOPICALACNEATRALIN, AVAGE, AZELEX, BENZACLINWITH PUMP, EPIDUO, VELTIN*MISCELLANEOUSALDARA, FLUOROURACIL*, ZYCLARA PUMP*adapalene, clindamycinphosphate/tretinoin, clindamycin/benzoylperoxide, erythromycin, tretinoin,ACANYA, TAZORACfluorouracil, imiquimod, PICATOROSACEANORITATE, SOOLANTRAmetronidazole, FINACEAANTISPASMODICSENABLEX, GELNIQUEERECTILE DYSFUNCTIONCIALIS*, LEVITRA*, STAXYN*, STENDRA*,VIAGRA*tolterodine tartrate, MYRBETRIQ, TOVIAZ,VESICAREsildenafil citrate, tadalafilUROLOGICALPlease Note: Drugs Marked with * are ExcludedAdditional covered alternatives m ay be available. Costs for covered alternatives m ay vary. O therprescription benefit considerations m ay apply.
ANALGESICSANTIARTHRITICSDUROLANETablet2Prefilled SyringeGELSYN-32221Tablet3CONZIP4Capsule Extended Release 24 HourNARCOTIC ANTAGONIST (NON-OPIOD)Solution Prefilled SyringeMONOVISC1Tablet Extended Release 24 Hourtramadol hydrochloride/acetaminophen4Solution Prefilled SyringeHYMOVIS1Tablettramadol hcl er4Solution Prefilled SyringeHYALGAN1Tablettramadol hcl4Prefilled SyringeGENVISC 8501Tabletsalsalate4Solution Prefilled SyringeGEL-ONEMISCELLANEOUSdiflunisalSolution Prefilled SyringeEUFLEXXA4TREXIMETTabletSolution Prefilled SyringeSUPARTZ FX4SUMAVEL DOSEPROSolution Jet-injectorSolution Prefilled SyringeSUPARTZ3RELPAX24LUCEMYRA4NARCOTIC ANTAGONISTS (OPIOD)4Tablet Sublingual4TabletSolution Prefilled SyringeORTHOVISCSolution Prefilled SyringeSYNVISCSolution Prefilled SyringeSYNVISC aminophenCapsulenaratriptan hclTabletrizatriptan benzoateTablet22Film2Suspension Reconstituted2Tablet Sublingual4Solution nesumatriptan succinatesumatriptan1naltrexone hclSolution Prefilled Syringedihydroergotamine mesylate1buprenorphine hcl/naloxone hcl1TabletSolution Auto-injectoracetaminophen/codeinesumatriptan succinate1SolutionTabletbuprenorphine hclzolmitriptan1Tablet olmitriptan odt11111TabletTablet codeineCAFERGOT3Capsule3Tablet3Patch 72 HourTabletERGOMARTablet SublingualFROVAcodeine sulfatefentanyl11111TabletPage 5 2019 Select-WF FormularyPrinted Date:10/9/2018Data Last Updated:10/9/2018
NARCOTICSfentanyl citrate oral transmucosalFENTORA1Lozenge on a Handlehydrocodone /acetaminophen111111111111122222333334Capsule Extended ReleasePage 6 2019 Select-WF FormularyPrinted en sodium1oxaprozin1piroxicam1sulindac1tolmetin Patch WeeklyEMBEDA1SolutionTablet SublingualBUTRANSmeloxicamSuppositoryCapsule ER 12 Hour Abuse-DeterrentABSTRAL1TabletLiquidZOHYDRO ERmefenamic acidCapsuleTabletSUBSYS1CapsuleCapsule Extended Release 24 HourPRIMLEVmeclofenamate sodiumTabletSuspensionKADIAN1CapsuleTablet ER 12 Hour Abuse-DeterrentCAPITAL/CODEINEketorolac tromethamineTabletTablet Extended Release 12 HourOXYCONTIN1TabletTabletNUCYNTA ERketoprofenTabletTablet ER 24 Hour Abuse-DeterrentNUCYNTA1TabletPatchHYSINGLA oxymorphone etSolutionoxycodone/acetaminophen1CapsuleTablet Extended Releaseoxycodone hcldiclofenac sodium/misoprostolCapsuleSuppositorymorphine sulfate er1TabletTablet Solublemorphine sulfatediclofenac sodium erTabletSolutionmethadone hcl1Tablet Delayed ReleaseSolutionmethadone hcldiclofenac potassiumTablet Extended Release 24 HourTabletmeperidine hcl1TabletTablethydromorphone letZIPSOR3Capsule4ZORVOLEX3CapsuleData Last Updated:10/9/2018
NSAIDSfenoprofen ablet Delayed ine sulfateTabletmefloquine hclTabletquinine sulfateCapsule3311Tablet1Suspensionamantadine sionacyclovir12Tablet Extended Release 24 HourTabletchloroquine phosphate2TabletSTROMECTOL11Suspension letTabletatovaquone/proguanil hcl3TabletFLAGYL Suspension omycin sulfate1Suspensionterbinafine vin ultramicrosize1CapsuleSuspensiongriseofulvin microsizeisoniazidTabletCapsulegriseofulvin microsize1TabletTabletflucytosineethambutol hclTabletSuspension lotrimazole2TabletPRIMAQUINE PHOSPHATE42Tablet1Syrupamantadine hcl1CapsulePage 7 2019 Select-WF FormularyPrinted Date:10/9/2018Data Last Updated:10/9/2018
TITIS C3Tablet* Based on Clinical Indications Only3DAKLINZA3EPCLUSASuspension ReconstitutedVALCYTETabletVALCYTESolution Reconstituted1Capsule11111Tablet1abacavir1abacavir ension ReconstitutedPage 8 2019 Select-WF FormularyPrinted Date:10/9/201841Suspension ReconstitutedCapsule4Tablet Extended Release 24 HourZEPATIERSuspension Reconstitutedceftibuten4Tablet Therapy PackVIEKIRA XRCapsuleceftibuten4TabletVIEKIRA PAKSuspension abletcefaclorcefadroxil4TabletSuspension Reconstitutedcefadroxil2 (PA)MAVYRETHARVONICEPHALOSPORINScefaclor3PCETablet Delayed rythromycin ethylsuccinateTabletSolutionSITAVIG1erythromycin baseTabletTabletREBETOL1ery-tabTablet Delayed ReleaseTabletBARACLUDE1clarithromycin erTablet Extended Release 24 HourSolutionRIBASPHERE RIBAPAK1clarithromycinSuspension ReconstitutedTabletEPIVIR HBV1clarithromycinTabletTabletvalacyclovir hcl1azithromycinSuspension ReconstitutedTabletrimantadine hcl3Suspension rin3Suspension ReconstitutedSUPRAX1Capsuleribavirin1Suspension sule Delayed ReleaseData Last Updated:10/9/2018
estavudineSolution NTTabletEMTRIVA2222222222TabletPage 9 2019 Select-WF FormularyPrinted Date:10/9/2018methenamine mandelate1nitrofurantoin macrocrystals1nitrofurantoin ensionRESCRIPTOR1TabletTabletPREZISTAmethenamine Sclindamycin palmitate hclTabletTabletINVIRASE1Solution ReconstitutedTabletINTELENCEclindamycin olution 2vancomycin hcl1CapsuleData Last Updated:10/9/2018
MISCELLANEOUSTOBI PODHALERCapsuleXIFAXAN111QUINOLONES1Tablet Extended Release 24 Hour1111Tablet1Tabletdoxycycline monohydrate1Capsuleminocycline hcl1Capsulemorgidox 1x100mg1Capsuletetracycline hclCapsule11benazepril hcl1benazepril ESdoxycycline hyclateamlodipine besylate/benazepril hydrochlorideTabletTabletdemeclocycline hclCARDIACACE abletlevofloxacin3CreamGYNAZOLE-11Solution Reconstitutedciprofloxacin hcl1SuppositoryAVC1Tabletciprofloxacin er1Creamterconazole1Capsulepenicillin v potassium1Suppositoryterconazole1Capsulepenicillin v potassium1Gelmiconazole 31Suspension Reconstituteddicloxacillin sodium1Creammetronidazole vaginal1Tablet Extended Release 12 HourampicillinVAGINALclindamycin phosphate1Suspension Reconstitutedampicillin4DOXYCYCLINECapsule Delayed ReleaseTabletamoxicillin/clavulanate potassium er3VIBRAMYCINSyrupSuspension Reconstitutedamoxicillin/clavulanate potassium3Capsule Delayed ReleaseTabletamoxicillin/clavulanate uleMONODOX3Tabletamoxicillin3Tablet Delayed ReleaseMINOCIN3TabletZYVOX3Tablet Delayed IMSOLTablet Extended Release 24 drochlorothiazideTablet1enalapril maleateTablet1fosinopril sodiumTabletfosinopril lisinopril/hydrochlorothiazide1Tabletmoexipril hcl1TabletPage 10 2019 Select-WF FormularyPrinted Date:10/9/2018Data Last Updated:10/9/2018
ACE /hydrochlorothiazide1Tabletperindopril erbuminevalsartan1Tabletquinapril LTabletQBRELISSolutionTARKATablet Extended ReleaseVASOTECTabletZESTRILTabletamiodarone hcl1Tabletcandesartan tirbesartan/hydrochlorothiazideTabletlosartan potassiumTabletlosartan potassium/hydrochlorothiazideTabletolmesartan medoxomilTabletolmesartan pineTablet1Solutionquinidine sulfate11Tabletquinidine gluconate11Solutionpropafenone hcl11Tabletprocainamide hcl11Capsulepacerone11Tabletmexiletine hcl11Capsuleflecainide acetate11Solutiondisopyramide sartan mesylate3TabletANTIARRHYTHMICANGIOTENSIN RECEPTOR BLOCKERcandesartan cilexetil3TabletTRIBENZOR33TabletEXFORGE 33TabletDIOVAN HCT33TabletBENICAR HCT33TabletBENICAR33TabletAZOR32TabletATACAND HCT32TabletTEKTURNA n/hydrochlorothiazide11Tablet1Tabletquinidine sulfate er1Tablet Extended ReleasePage 11 2019 Select-WF FormularyPrinted Date:10/9/2018Data Last Updated:10/9/2018
ANTIARRHYTHMICsorineTabletsotalol hcl11111111112222Tablet Therapy PackCapsule Extended Release 12 HourCOUMADINTabletEFFIENTTabletPRADAXACapsuleBETA BLOCKERSPage 12 2019 Select-WF FormularyPrinted Date:10/9/20181Capsule Extended Release 24 Hourfelodipine er41Tabletdiltiazem hcl er31Capsule Extended Release 24 Hourdiltiazem hcl31Capsule Extended Release 24 Hourdiltiazem cd31Tabletcartia xt21Tablet Extended Release 24 Houramlodipine besylate2TabletAGGRENOXCALCIUM CHANNEL BLOCKERSafeditab cr2TabletXARELTO STARTER PACK3LEVATOLTabletSolutionXARELTO3COREG CRCapsule Extended Release 24 BYSTOLICTabletCapsuleELIQUIS1timolol othiazideTabletTabletBEVYXXA1propranolol hclSolutionTablet Extended Releasewarfarin sodium1propranolol hclTabletTabletticlopidine hcl1pindololTabletSolutionpentoxifylline en1nadololTabletSolutionheparin sodium1metoprolol tartrateTabletTabletfondaparinux sodium1labetalol hclTabletTabletenoxaparin TICOAGULANTSclopidogrel1Tabletbisoprolol letbisoprolol fumarate2Capsule Extended Release 12 HourTIKOSYN1Tabletbetaxolol hcl2TabletNORPACE leatenolol1Tabletsotalol hcl (af)1acebutolol hcl11Tablet Extended Release 24 Hourisradipine1CapsuleData Last Updated:10/9/2018
CALCIUM CHANNEL BLOCKERSnifedipineCapsulenifedipine er111113Tablet none2Patch 24 chlorothiazide2DILATRATE SRCapsule Extended ReleaseDIURETICSamiloride hcl1nitroglycerin transdermalPatch 24 HourCapsule Extended Release 24 Houracetazolamide1nitroglycerin lingualAerosol SolutionTabletverapamil hcl er1minitranPatch 24 HourCapsule Extended Release 24 Hourverapamil hcl1isosorbide mononitrateTabletTablet Extended Release 24 Hourtaztia xt1isosorbide dinitrateTabletCapsulenisoldipine erSolution ReconstitutedNITRATES1Tablet Extended Release 24 Hournimodipine3HAEGARDA12RANEXATablet Extended Release 12 Hour1Tablet3VECAMYLTablet1OTHER ethydralazine hiazideclonidine hclclorpresdoxazosin mesylateguanfacine hiazideTabletDYRENIUMprazosin hclreserpineCapsuleterazosin hclHEREDITARY ANGIOEDEMA (HAE)CapsuleRUCONEST2Solution IDIL1CARDURA XL3Tablet Extended Release 24 Hour3STATINSSolution ReconstitutedPage 13 2019 Select-WF FormularyPrinted Date:10/9/2018Data Last Updated:10/9/2018
STATINSamlodipine besylate/atorvastatin calciumTRIGLIDE1Tabletatorvastatin l tfenofibrateTabletfenofibric acid drfluvastatinREPATHA SURECLICKSolution Capsulegemfibrozil1lovastatin1niacin er1pravastatin sodium1prevalite1rosuvastatin calcium1guanidine hclsimvastatinTablet1LIPOFENmethylphenidate R3FENOGLIDE3JUXTAPID3LESCOL XL3LOVAZA3NIACOR3223Capsule Extended Release 24 HourADZENYS XR-ODTCapsule2Tablet ChewableADDERALL XRTablet Extended Release 24 Hour2CapsuleVYVANSECapsule2Suspension ReconstitutedVYVANSETablet2Tablet Chewable Extended ReleaseQUILLIVANT XRTablet1Capsule Extended Release 24 HourQUILLICHEW tion Prefilled Syringe1Capsule Extended Releasemethylphenidate hydrochlorideSolution Pen-injector1Tabletmethylphenidate hcl cdTablet1Tabletmethylphenidate amine sulfatePacket1Capsule Extended Release 24 Hourdextroamphetamine sulfateTablet1Tabletdexmethylphenidate hcl erTablet Extended Release1Capsule Extended Release 24 Hourdexmethylphenidate t4Solution Prefilled Syringe1Capsule Delayed Release4Tablet Extended Release 24 LCHOL13TabletWELCHOL13Tablet3Tablet Extended Release DisintegratingTabletPage 14 2019 Select-WF FormularyPrinted Date:10/9/2018Data Last Updated:10/9/2018
ADHDFOCALIN XRgabapentin3Capsule Extended Release 24 HourINTUNIVlamotrigine3Tablet Extended Release 24 HourSTRATTERACapsulegalantamine ne er1Tablet Extended Release 12 Hourcarbamazepine er1Tablet Extended Release 12 Hourclonazepam1Tabletclonazepam odt1Tablet Disintegratingdiazepam1Geldivalproex sodium dr1Tablet Delayed Releasedivalproex sodium er1Tablet Extended Release 24 ate1Suspensionfosphenytoin sodium1SolutiongabapentinTabletPage 15 2019 Select-WF FormularyPrinted Date:10/9/2018phenobarbital1phenytoin1phenytoin sodium ine1CapsuleCapsule Extended Release 24 MENDA XR1TabletPatch 24 HourNAMENDAoxcarbazepineElixirCapsule ER 24 Hour Therapy PackEXELON1SuspensionCapsule Extended Release 24 utionCapsule Extended Release 24 Hourrivastigmine tiracetam31Capsule1tiagabine hydrochloride1Tablettopiramate1Tabletvalproic acid1Capsulevalproic A2TabletLYRICA2CapsuleONFI2SuspensionOXTELLAR XR2Tablet Extended Release 24 HourPEGANONE2TabletSABRIL2TabletTROKENDI XR2Capsule Extended Release 24 HourVIMPAT2TabletVIMPAT2SolutionDEPAKOTE ER3Tablet Extended Release 24 HourEQUETRO3Capsule Extended Release 12 HourData Last Updated:10/9/2018
efazodone hcl3Tablet Extended ReleaseLAMICTAL ODTTablet DisintegratingLAMICTAL XRKitPOTIGATabletQUDEXY XRCapsule ER 24 Hour SprinkleLYRICA CRTablet Extended Release 24 Houramitriptyline hcl111111111111111111TabletPage 16 2019 Select-WF FormularyPrinted Date:10/9/20182VIIBRYD2VIIBRYD2VIIBRYD STARTER PACK2APLENZIN3DESVENLAFAXINE ER3EMSAM3FORFIVO XL3KHEDEZLA3MARPLAN3Tablet1Capsulemaprotiline hclTRINTELLIXTablet Extended Release 24 HourTabletimipramine pamoate2Tablet Extended Release 24 HourTabletimipramine hclFETZIMA TITRATION PACKPatch 24 HourCapsulefluvoxamine maleate2Tablet Extended Release 24 HourSolutionfluoxetine hclFETZIMATablet Extended Release 24 HourSolutionfluoxetine hcl1KitTabletescitalopram oxalatevenlafaxine hcl erTabletCapsule Delayed Release Particlesescitalopram oxalate1KitConcentrateduloxetine hclvenlafaxine hclTabletCapsuledoxepin hcl1Capsule ER 24 Hour Therapy PackTabletdoxepin hcltrazodone hclCapsule Extended Release 24 HourCapsuledesipramine hcl1Capsule Extended Release 24 HourTabletclomipramine hcltranylcypromine sulfateTabletSolutioncitalopram hydrobromide1TabletTabletcitalopram hydrobromidesertraline hclTabletTablet Extended Release 24 ropion hcl xlprotriptyline hclTabletTabletbupropion hcl1TabletTabletamoxapine1Tabletphenelzine sulfateANTIDEPRESSANTS1Tablet Extended Release 24 Hourperphenazine/amitriptyline41Tabletparoxetine hcl er31Solutionparoxetine hcl31Capsulenortriptyline hcl31Tabletnortriptyline hcl31TabletPEXEVA3Tablet1PRISTIQ3Tablet Extended Release 24 HourData Last Updated:10/9/2018
aloperidol decanoate4Capsulebenztropine Tabletclozapine odt1Tablet Disintegratingfluphenazine hcl1Concentratefluphenazine hcl1TablethaloperidolConcentratePage 17 2019 Select-WF FormularyPrinted Date:10/9/20181thiothixene1trifluoperazine hcl1ziprasidone hcl1ABILIFY MAINTENA2INVEGA SUSTENNA2INVEGA TRINZA2INVEGA TRINZA2LATUDA2RISPERDAL CONSTA2Suspension ReconstitutedANTI-PSYCHOTICchlorpromazine hclthioridazine hclTabletPatch 24 Houraripiprazole1SuspensionTablet DisintegratingNEUPROrisperidone isperidonePrefilled SyringeTabletTASMAR1CapsuleTablet Extended Release 24 HourSTALEVO 75quetiapine fumarate erTabletTabletMIRAPEX ER1CapsuleCapsule Extended ReleaseAZILECTquetiapine fumarateTabletTabletRYTARY1Tablet DisintegratingElixirtrihexyphenidyl hclperphenazineTabletTablettrihexyphenidyl hcl1Tablet Extended Release 24 HourTabletselegiline hclolanzapine/fluoxetineTabletTabletropinirole hcl1TabletTabletentacaponeolanzapine odtCapsuleTablet Extended Releasecarbidopa/levodopa/entacapone1Tablet DisintegratingTabletcarbidopa/levodopa Tabletbromocriptine mesylate1Solutionloxapine succinateANTIPARKINSONISM1Tablet1SAPHRIS2Tablet SublingualVRAYLAR2CapsuleVRAYLAR2Capsule Therapy PackABILIFY3TabletFANAPT3TabletFAZACLO3Tablet DisintegratingORAP3TabletData Last Updated:10/9/2018
ANTI-PSYCHOTICREXULTITabletSEROQUEL XR3TabletConcentratelorazepamTabletlorazepam tion3DIABETESDPP-4JANUMET3233Tablet SublingualZOLPIMISTSolution2Tablet2Solution Pen-injector1TabletINTERMEZZO21TabletBUTISOL SODIUM21Tablet Extended et Extended ReleaseBELVIQ1Capsulezolpidem tartrate m carbonate erflurazepam hcltemazepam1Tabletlithium suleConcentratearmodafinil1TabletCapsuleALPRAZOLAM entratemidazolam hcl3Solution Prefilled SyringeEXTAVIA12Capsule Delayed ReleaseCOPAXONE12Solution Prefilled SyringeTECFIDERA12Solution Auto-injectorREBIF TITRATION PACK1Tabletdiazepam intensol2Solution Auto-injectorREBIF REBIDOSE TITRATIONPACK1Capsulediazepam2Solution Prefilled SyringeREBIF REBIDOSE1Tabletclorazepate dipotassium2CapsuleREBIF1Tablet Extended Release 24 Hourchlordiazepoxide hcl2KitGILENYA1Tablet Disintegratingbuspirone hclKitBETASERON1Tablet Extended Release 24 Houralprazolam xr2AVONEX1Tabletalprazolam odt2AUBAGIOTabletANXIOLYTICSalprazolam er2AMPYRATablet Extended Release 12 HourSuspensionalprazolamCapsule Extended Release 24 HourMULTIPLE SCLEROSIS3Tablet Extended Release 24 HourVERSACLOZ4QSYMIA332TabletTabletPage 18 2019 Select-WF FormularyPrinted Date:10/9/2018Data Last Updated:10/9/2018
DPP-4JANUMET XRTablet Extended Release 24 HourJANUVIA2222222222TRESIBA FLEXTOUCHBASAGLAR KWIKPEN224OTHERacarbose2SolutionSuspension1Tablet Extended Release 24 Hournateglinide21Tabletmetformin hcl er21Tabletmetformin hcl2Solution Pen-injectorNOVOLOG MIX 70/30 PREFILLED FLEXPENTOUJEO SOLOSTARSolution Pen-injectorSolutionNOVOLOG MIX 70/302Solution Pen-injectorSuspensionNOVOLOG FLEXPENLEVEMIR FLEXTOUCHSolution Pen-injectorSuspensionNOVOLOG2Solution Pen-injectorSolution Pen-injectorNOVOLIN R2Solution Pen-injectorSolutionSolutionNOVOLIN N2SolutionLEVEMIRINSULINNOVOLIN 70/304INSULIN: LONG ACTINGLANTUS SOLOSTAR4Pen-injectorFIASP FLEXTOUCHHUMULIN R U-500 KWIKPENLANTUS4Solution Pen-injectorFIASP4Solution Pen-injectorSolution Pen-injectorTANZEUMHUMULIN R U-500 (CONCENTRATED)SolutionSolution Pen-injectorBYETTA4HUMULIN RSolutionSolution Pen-injectorVICTOZA4HUMULIN ion Reconstituted EROZEMPIC4SuspensionHUMULIN 70/30INCRETINSBYDUREON PEN4SuspensionHUMALOG MIX 75/254TabletBYDUREON4SolutionHUMALOG MIX 50/504TabletOSENI4Solution Pen-injectorHUMALOG4Tablet Extended Release 24 HourNESINA4SolutionAPIDRA SOLOSTAR4TabletKOMBIGLYZE XR4Solution Pen-injectorAPIDRA4TabletKAZANO4SolutionADMELOG SOLOSTAR4TabletALOGLIPTIN/METFORMIN HCL3PowderADMELOG2TabletALOGLIPTIN2Solution Pen-injectorAFREZZA2TabletTRADJENTA2Solution Pen-injectorXULTOPHY 100/3.62TabletONGLYZASolution CartridgeSOLIQUA 100/332TabletJENTADUETO2NOVOLOG PENFILL21TabletSuspension Pen-injectorPage 19 2019 Select-WF FormularyPrinted Date:10/9/2018Data Last Updated:10/9/2018
OTHERrepaglinideDEXCOM G4 PLATINUM RECEIVER KIT1TabletCYCLOSETDEXCOM G5 MOBILE RECEIVERKIT2TabletGLUCAGEN HYPOKITSolution ReconstitutedGLUCAGON EMERGENCY KITKitSYMLINPEN 1202Solution Pen-injectorGLUMETZA3Tablet Extended Release 24 1Tablet Extended Release 24 Hourglipizide/metformin hcl1Tabletglyburide1Tabletglyburide micronized1Tabletglyburide/metformin hcl1Tablet2MiscellaneousBD NEEDLE/27G X 1/2"2MiscellaneousBD PEN NEEDLE/MINI/ULTRAFINE/31G X 3/16"MiscellaneousPage 20 2019 Select-WF FormularyPrinted Date:10/9/20182TRUEPLUS INSULIN SYRINGE/U-100/0.3ML/30G X 5/16"2TRUEPLUS INSULIN SYRINGE/U-100/0.3ML/31G X 5/16"2TRUEPLUS INSULIN SYRINGE/U-100/0.5ML/28G X 1/2"2
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412 Broward County residents participated in the 2015 assessment of quality of life . calendar year and to update the implementation plan to include more clearly defined . Broward County Charter Schools, Broward County Libraries, Broward County Schools Tween SNAC Program, Broward County Schools, Broward Health, Broward Healthy Start Coalition,
6 BROWARD 1871 Crystal Lakes Middle School 82.52 6 BROWARD 1781 Cypress Elementary School 89.31 6 BROWARD 2123 Cypress Run Alternative 75.15 6 BROWARD 1071 Dandy, William Middle School 92.09 6 BROWARD 0101 Dania Elementary School 81.38 6 BROWARD 3651 Dave Thomas Education Center 73.36 6 BROWARD 2801 Davie Elementary School 83.13
Broward County residents and 25% of either Miami Dade County or Broward County residents. The required percentage of Broward residents will increase 10% yearly beginning in fiscal year 2023-24. 50% of expenditures must be Broward County businesses and (15%) of those Broward County businesses must be Certified small businesses/C.B.E.
MDwise Formulary Introduction – Hoosier Healthwise (HHW) HHW members must use MDwise network pharmacies to access their prescription drug benefit. How do I use the formulary? There are two ways to find your drug within the formulary: Medical Condition Drugs in this formulary are grouped into categories depending on the type of medical
5 COMMENCEMENT 2021 BROWARD COLLEGE COMMENCEMENT SPEAKER Germaine Smith-Baugh, Ed.D President and Chief Executive Officer, Urban League of Broward County Dr. Germaine Smith-Baugh is President and CEO of the Urban League of Broward County—a nonprofit organization dedicated to elevating the standard of living
Nov 01, 2019 · Anthem Blue MedicareRx Standard (PDP)’s Formulary?” Drugs removed from the market. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug’s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and pr
Express Scripts Medicare (PDP) 2019 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION . ABOUT THE DRUGS WE COVER IN THIS PLAN . Formulary ID Number: 19155, Version 5 . This formulary was updated on 09/27/2018. For more recent information or
Express Scripts Medicare (PDP) 2019 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION . ABOUT SOME OF THE DRUGS COVERED BY THIS PLAN. Formulary ID Number: 19057, v5. This formulary was updated on 08/24/2018. For more recent information or to price a medication,
