Preferred Drug List - Tennessee - 2016 Page 7

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Tier 2
Amitiza
Creon
Prepopik
Analpram Advanced
Kristalose
Suclear
Analpram HC
Lialda
Suprep
Apriso
Linzess
Uceris
Canasa
Pentasa
Zenpep
Tier 3
Anzemet
Emend
Fulyzaq
Gout Therapy
Tier 1
allopurinol
probenecid
Tier 2
Colcrys
Uloric
Hormone Replacement
Tier 1
estradiol
estropipate
progesterone
estradiol transdermal
medroxyprogesterone
Tier 2
Androgel
PA
Enjuvia
Premphase
Cenestin
Evamist
Prempro
Divigel
Premarin
Vagifem
Tier 3
Androderm
PA
Combipatch
Estrace
Climara Pro
Duavee
Vivelle-Dot
Miscellaneous Drugs OB/GYN
Tier 2
Osphena
Oral Contraceptives Monophasic
Tier 1
all generic monophasic
Junel
Microgestin
Apri
Junel Fe
Microgestin Fe
Aviane
Levora
Necon 1/35, 1/50
Gianvi
Low-Ogestrel
Ocella
Tier 2
Minastrin 24 FE
Tier 3
Beyaz
Oral Contraceptives Biphasic
Tier 1
all generic biphasic
Kariva
Oral Contraceptives Triphasic
Tier 1
all generic triphasic
Tilia FE
Trinessa
Enpresse
Tri-Legest FE
Trivora
Necon 7/7/7
Tri-Previfem
norgestimate/ethinyl estradiol
Tri-Sprintec

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Related forms

Preferred Drug List Preferred Drug List Medical
Form F-11092 - Prior Authorization / Preferred Drug List (pa/pdl) For Growth Hormone Drugs Form F-11092 - Prior Authorization / Preferred Drug List (pa/pdl) For Growth Hormone Drugs Business
Form F-11077 - Prior Authorization / Preferred Drug List For Non-steroidal Anti-inflammatory Drugs Form F-11077 - Prior Authorization / Preferred Drug List For Non-steroidal Anti-inflammatory Drugs Medical
Prior Authorization / Preferred Drug List Prior Authorization / Preferred Drug List Medical
F-00194 - Forwardhealth Prior Authorization/preferred Drug List (pa/pdl) For Antiemetics, Cannabinoids F-00194 - Forwardhealth Prior Authorization/preferred Drug List (pa/pdl) For Antiemetics, Cannabinoids Medical
Form F-11304 - Prior Authorization/preferred Drug List (pa/pdl) For Cytokine Form F-11304 - Prior Authorization/preferred Drug List (pa/pdl) For Cytokine Medical
Form F-11035 - Prior Authorization/preferred Drug List (pa/pdl) For Cytokine Form F-11035 - Prior Authorization/preferred Drug List (pa/pdl) For Cytokine Medical
Form F-11078 - Prior Authorization / Preferred Drug List (pa/pdl) For Proton Pump Inhibitor (ppi) Capsules And Tablets Form F-11078 - Prior Authorization / Preferred Drug List (pa/pdl) For Proton Pump Inhibitor (ppi) Capsules And Tablets Medical
Prior Authorization / Preferred Drug List Prior Authorization / Preferred Drug List Medical
Form F-00080 - Prior Authorization / Preferred Drug List (pa/pdl) For Symlin Form F-00080 - Prior Authorization / Preferred Drug List (pa/pdl) For Symlin Medical

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