| Document Date: 2013-07-24 08:18:40
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Company BP / HP / EXELON / / Event FDA Phase / / IndustryTerm requested non-preferred product / pharmaceutical samples / chemical entities / chemical entity / long acting chemical entities / / MedicalCondition traveler’s diarrhea / moderate-to-severe Alzheimer’s Disease / E. coli diarrhea / chronic pain / strain / C. difficile infections / chronic pain therapy / injury / pulmonary embolism / MS / Alzheimer’s disease / cancer / Acne / C. difficile infection / hepatic encephalopathy / severe chronic pain requiring / unnecessary breakthrough pain / non-valvular atrial fibrillation / Deep vein thrombosis / / MedicalTreatment knee replacement surgeries / ANTIBIOTICS / hip replacement surgeries / / Organization BUREAU FOR MEDICAL SERVICES / / Product LOTREL / FLAGYL / clindamycin phosphate / AVINZA / ZESTORETIC / LOVENOX / acetaminophen / PRINZIDE / valsartan / irbesartan / TAZORAC / DURAGESIC / EMLA / ULTRAM / EVOCLIN / BENZAMYCIN PAK / FIORINAL / CLEOCIN / ARIXTRA / VICOPROFEN / ZESTRIL / LOTENSIN / FLAGYL ER / AZOR / ANDROGEL / ULTRAM ER / CLINDAGEL / FIORICET / TYLENOL / ALINIA / ACTIQ / OPANA / TARKA / RAZADYNE / VASOTEC / NORCO / TEVETEN / EXFORGE / TINDAMAX / ANDRODERM / erythromycin / ER capsules / ACZONE / tretinoin / BENZACLIN / VICODIN / ATACAND / RAZADYNE ER / losartan / KADIAN / dapsone / rivastigmine / UNIVASC / AVAPRO / FENTORA / tobramycin / ORAMORPH SR / KLARON / LORTAB / AZELEX / naloxone / telmisartan / DIOVAN / CAPOZIDE / MS CONTIN / OPANA ER / ramipril / VOLTAREN / ER tablets / COUMADIN / NEO-FRADIN / TOBI / ZYDONE / lisinopril / ACCUPRIL / metronidazole / DUAC / ibuprofen / LOTENSIN HCT / PERCOCET / REPREXAIN / COZAAR / ATRALIN / PERCODAN / TEKTURNA HCT / ACCURETIC / PRINIVIL / xylocaine / AKNE-MYCIN / ZIANA / ULTRACET / TESTIM / INNOHEP / ROXICET / BENICAR / testosterone / NAMENDA / butalbital / quinapril / VASERETIC / UNIRETIC / ROXICODONE / lidocaine / donepezil / SYNALGOS-DC / sulfacetamide sodium / ACEON / chlorthalidone / TYLOX / XIFAXAN / FRAGMIN / SYNERA / DIFFERIN / MAVIK / fentanyl / captopril / ciprofloxacin / MICARDIS / lactulose / TEKTURNA / ALTACE / AVITA / EXELON / trandolapril / OXYCONTIN / hydrocortisone / Aricept 23mg / FLECTOR / GI / HYZAAR / ARICEPT / AVALIDE / DEMEROL / DILAUDID / CRITERIA / PA / / ProvinceOrState Prince Edward Island / Pennsylvania / / Region WEST VIRGINIA / / URL http /
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BUREAU FOR MEDICAL SERVICES WEST VIRGINIA MEDICAID PREFERRED DRUG LIST WITH PRIOR AUTHORIZATION CRITERIA This is not an all-inclusive list of available covered drugs and includes only managed categories. Refer to cover p