Preferred Drug List printable pdf download

MISSISSIPPI DIVISION OF MEDICAID

PREFERRED DRUG LIST

The agents listed below are preferred products on the Mississippi Medicaid Preferred Drug List (PDL). The preferred drug

list is a medication list recommended to the Division of Medicaid by the Pharmacy and Therapeutics Committee and

approved by the Executive Director of the Division of Medicaid. These drugs have been selected for their efficaciousness,

clinical significance, cost effectiveness and safety for Medicaid beneficiaries.

Most generic agents are preferred, do not require prior authorization, and are not individually listed below.

Unless otherwise specified, the listing of a particular brand or generic name includes all dosage forms of that drug.

For more information concerning the PDL including non-preferred agents, the OTC formulary and other specifics please

visit our website at

List Effective 1-1-2007

ALLERGY

Copegus®Tabs

Dilantin®

ELECTROLYTE

Hepsera®

Equetro™

Antihistamines &

DEPLETERS

Rebetol® Syrup

Gabitril®

Antihistamine

Magnebind® Rx

Valcyte®

Keppra®

Decongestant Combos.

Renagel®

Valtrex®

Lamictal®

First Generation

ESTROGENS-

Lyrica®

BPH AGENTS

Pediatex™, Pediatex™ D

PROGESTINS

Trileptal®

Pediatex™ 12 & 12 D

Avodart®

Premarin®

Topamax®

Vazol™, Vazol™ D

Flomax®

Premphase®

Tegretol®XR

Second Generation

Uroxatral®

Prempro®

Antidepressants

Astelin Nasal Spray®

CARDIOVASCULAR

GASTRO-INTEST.

Effexor XR®

Clarinex®

ACE Inhibitors

AGENTS

Wellbutrin XL®

Loratadine

Altace®

H-2 Blockers

Antipsychotics

Zyrtec®

ACE Inhibitor/Diuretics

Axid® Solution

Geodon®

ANALGESICS

Generics Only

Zantac® Syrup

Risperdal®

Cox- 2

ACEI/CCB Combinations

PPIs

Symbyax™

None

Lexxel®

Prevacid®

Zyprexa®

NSAIDS

Lotrel®

Zegerid®

Sedative/Hypnotics

Generics only

Tarka®

GROWTH HORMONES

Ambien® CR

Narcotics

ARBs&Combinations

Genotropin®

Lunesta™

Avinza®

Avapro®, Avalide®

Nutropin®/Nutropin®AQ

Rozerem™

Kadian®

Diovan®,Diovan HCT

Norditropin®

Skeletal Muscle

Beta-Blockers

ANTIBIOTICS (Oral)

Saizen®

Relaxants

Coreg ®

Cephalosporins

Serostim®

Generics only

Toprol XL®

Omnicef®

Tev-Tropin™

5-HT3 Receptor

Beta-Blocker/Diuretics

Suprax® Suspension

G-U RELAXANTS

Antagonists

Generics Only

Macrolides

Zofran®

Enablex®

Calcium Channel

Biaxin XL®

DIABETES

HEMATOPOIETIC

Blockers

Zithromax® Suspension

Incretin Mimetics

Aranesp®

Norvasc®

Miscellaneous

Byetta™

Procrit®

CCB/Antihyperlipidemic

Cleocin Ped.Soln®

INSULINS

LAXATIVES

Caduet®

(Rx)

Penicillins

ALL Novo Nordisk

Diuretics& Aldosterone

Generics Only

Generics only

products

Receptor Antagonists

LIPIDS

Penicillin Combinations

Lantus® (Vial)

Generics Only

Augmentin (versions not

Advicor®

Oral Agents

Platelet Aggregation

available generically)

Crestor®

Actos®

Inhibitors

Quinolones

Lipitor®

ACTOplus met™

Aggrenox™

Avelox®

Niaspan®

Avandamet®

clopidogrel

Sulfonamides

Tricor®

Avandaryl™

CENTRAL NERVOUS

Gantrisin® Susp

Vytorin®

Avandia®

Tetracyclines

SYSTEM AGENTS

Zetia®

Prandin®

Generics only

MIGRAINE

ADHD

Starlix®

ANTIBIOTICS (0TIC)

Adderall®-XR

Imitrex®

DIGESTIVE HEALTH

Ciprodex®

Concerta™

Maxalt®

AGENTS

Floxin®

Focalin™ XR

OSTEOPOROSIS

Asacol®

ANTICOAGULANTS-

Metadate® CD

Boniva®

Canasa®

Strattera®

INJECTABLE

Evista®

Dipentum®

Alzheimer’s Agents

Fosamax®

Arixtra™

Entocort EC®

Aricept®

Miacalcin®

Lovenox®

Pentasa®

Exelon®

RESPIRATORY

ANTIFUNGALS (Oral)

DISEASE-SPECIFIC

Namenda®

AGENTS

Grifulvin V ®

Anti-anxiety

IMMUNOSUPPRES-

Gris-PEG®

Advair®

Generics only

SANTS

Lamisil®

Asmanex®

Anticonvulsants

Enbrel®

ANTIPROTOZOAL

Azmacort®

Carbatrol®

Humira®

RESPIRATORY

Alinia®

Depakote®/Depakote®ER

Raptiva®

ANTIVIRAL

AGENTS -cont-

Preferred Drug List

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