| Document Date: 2014-12-30 13:45:10
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Company SR ketoprofen SA / / IndustryTerm computer technology / diclofenac topical solution / non-combination products / / MedicalCondition cirrhosis / Onychomycosis / hepatocellular carcinoma awaiting liver transplantation / cancer / documented cancer / Compensated cirrhosis / sickle-cell disease / HCV RNA / MS / sickle cell disease / / Organization CC CLINICAL CRITERIA / Federal Food and Drug Administration / NYS Medicaid Pharmacy Clinical Call Center / ST STEP THERAPY / / Person Reductase Inhibitors / / / Product Gris-PEG / efavirenz / Procardia / acetaminophen / Lopressor HCT / Valtrex / itraconazole / Duragesic / ofloxacin / Pravachol / ketoprofen / sulindac / Corzide / simvastatin / Daypro / Vicoprofen / Zestril / Azor / cholestyramine light / Tylenol / etodolac / Crestor / metoprolol tartrate / Hepsera / Opana / fosinopril sodium / Questran Light / nadolol / Levatol / Lopressor / Sular / Lescol / Advicor / peginterferon / Vibramycin / betaxolol / Mobic / indomethacin / Kadian / losartan / Colestid / Cardene SR / Univasc / Welchol / Ponstel / Epivir-HBV / Atacand HCT / Procardia XL / Adalat CC / cefdinir / Suboxone / telmisartan / diflunisal / Coreg CR / Voltaren / Vytorin / lisinopril / Cedax / ibuprofen / Percocet / Lotensin HCT / Tyzeka / Tekturna HCT / Prinivil / Copegus / Roxicet / Micardis HCT / ribavirin / famciclovir / quinapril / Vaseretic / Roxicodone / Pegasys / Aceon / Factive / diclofenac potassium / Norvasc / Zovirax / Rebetol / Cipro / fentanyl / Mavik / pindolol / captopril / flurbiprofen / ciprofloxacin / Suprax / Altace / trandolapril / nabumetone / Tenormin / carvedilol / atenolol / Hyzaar / Zocor / naproxen sodium / Demerol / Baraclude / Corgard / Lotrel / Noroxin / Inderal / Avinza / Zestoretic / Dynacin / morphine sulfate / Sporanox / Arthrotec / Oracea / valsartan / irbesartan / Anaprox DS / Ultram / Fiorinal / acyclovir / Lotensin / Coreg / Solodyn / Fioricet / butalbital compound / Ultram ER / meloxicam / Zebeta / Afeditab CR / Cataflam / Ribasphere / Tarka / doxycycline / Lipitor / PegIntron / Vasotec / Mevacor / Famvir / Ziac / Teveten / Simcor / Exforge / ReVia / Zetia / Avelox / nifedipine / naproxen / Naprelan / Teveten HCT / Feldene / Atacand / Avapro / Sectral / Celebrex / levofloxacin / Diovan HCT / naloxone / Bystolic / oxaprozin / Diovan / MS Contin / Opana ER / Spectracef / ramipril / Questran / Benicar HCT / cefpodoxime proxetil / Inderal LA / Doryx / isradipine / Accupril / Prevalite / Cozaar / Percodan / Accuretic / Ultracet / Naprosyn / Benicar / butalbital / griseofulvin / Tenoretic / Uniretic / diclofenac sodium / Trandate / Altoprev / Indocin / chlorthalidone / Caduet / lamivudine / doxycycline hyclate / Grifulvin / Levaquin / felodipine / Micardis / Tekturna / Lamisil / piroxicam / Oxycontin / valacyclovir / InnoPran XL / Flector / enalapril maleate / Lescol XL / misoprostol / lovastatin / cholestyramine / Anaprox / Avalide / Dutoprol / Dilaudid / / ProgrammingLanguage EC / DC / / Technology ANTI-INFECTIVES / computer technology / genotype / professional medical protocols / transplantation / / URL http /
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Revised: December 31, 2014 New York State Medicaid Fee-For-Service Pharmacy Programs OVERVIEW OF CONTENTS Preferred Drug Program (PDP) (Pages 2–35)