| Document Date: 2014-04-18 17:53:17
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City CARDIZEM CD / / Company Bipolar CARBAMAZEPINE SA / / MedicalCondition Rheumatoid arthritis / MS / Migraine prophylaxis *Narrow therapeutic index drugs / MG TREXALL MISC Asthma / BACTRIM DS Disease / / Organization MS DIVISION OF MEDICAID / / Person Deborah Minor / Ryan Killough / / Product LOTREL / ZANTAC / TOPIRAMATE / DEPAKOTE ER / ZESTORETIC / IMMUNE SUPPRESSION Corticosteroid SEIZURE Anticonvulsant / LEVOXYL / PRINZIDE / CARBATROL / HYDROXYUREA / BACTRIM DS / RANITIDINE / PRAVACHOL / DEMADEX / NEORAL / DIFLUCAN / PHENYTEK / SIMVASTATIN / CYCLOSPORINE / DESYREL / ACYCLOVIR / RISPERDAL / CARDIZEM / LOPID / ZESTRIL / COREG / DIVALPROEX SODIUM / METOPROLOL SUCCINATE / CARBAMAZEPINE / GENGRAF / ZOLOFT / METOPROLOL TARTRATE / 5MG Antidepressant / PROZAC / RISPERIDONE / TORSEMIDE / LIPITOR / LOPRESSOR / TOPAMAX / METAGLIP / GEMFIBROZIL / ALLOPURINOL / LEVOTHROID / GLUCOVANCE / FLUCONAZOLE / LOSARTAN / PEPCID / CELLCEPT / CARDURA / COVERA-HS / LANOXIN / TREXALL / FLUOXETINE / ALDACTONE / ISOPTIN / ZYLOPRIM / SANDIMMUNE / HYDRODIURIL / GLIPIZIDE / TEGRETOL / CALAN / KEPPRA / Beta / CELEXA / VERELAN PM / ELDEPRYL / LISINOPRIL / SINEMET CR / DROXIA / COZAAR / DIGOXIN / PRINIVIL / LAMOTRIGINE / DILANTIN / COPEGUS / HYDREA / FAMOTIDINE / MYFORTIC / GLUCOPHAGE / RIBAVIRIN / LASIX / CLOPIDOGREL / BACTRIM / DELTASONE / PLAVIX / PROGRAF / NORVASC / GLYBURIDE / ZOVIRAX / REBETOL / SPIRONOLACTONE / GEODON / SINGULAIR / PAXIL / PREDNISONE / APRESOLINE / SYNTHROID / COGENTIN / AZATHIOPRINE / IMURAN / SINEMET / PHENYTOIN SODIUM / FUROSEMIDE / CARVEDILOL / SULFAMETHOXAZOLE / HYZAAR / DOXAZOSIN MESYLATE / DEPAKOTE / HYDROCHLOROTHIAZIDE / ZOCOR / GLUCOTROL / LAMICTAL / / Technology Alpha / / URL http /
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MS DIVISION OF MEDICAID 90 Day Maintenance List* Disease State Format *Limited to preferred agents, if applicable See http://www.medicaid.ms.gov/Pharmacy.aspx for current PDL DRUG CLASS/USE ACE-Inhibitor