Non-Preferred EDO Preferred Brands ($$$) Alternatives ($ or $$) * Preferred Drug List Dear Member:
Please review this Preferred Drug List (PDL) with
your physician at the time he or she writes your
Formulary Disclaimer:
prescription. This PDL, which includes both brand
Please be sure your prescription drug benefit is offered
and generic medications, is not a complete list,
through RxEDO before consulting this list. Coverage for
some drugs may be limited to specific dosage forms
but a summary of the most commonly prescribed
and/or strengths. Your benefit design determines what is
medications. Your plan’s benefit design
covered for you and what your co-payment will be.
determines which medications are included or
Please refer to your benefit materials for specific
excluded from coverage. Please refer to your
coverage information. The medications listed on this
benefit information for applicable copays and
formulary are subject to change pursuant to the
formulary management activities of RxEDO. The presence
of a medication on this formulary does not guarantee
that you as a plan member will be prescribed that drug
by your primary care physician or contracting provider for
a particular medical condition. These medications may be
Dear Physician:
subject to Prior Authorization. As new generics become
Please refer to this list when prescribing for your
available the corresponding brand name drug will no
patient. The medications listed and all generic
equivalents are Preferred Drug Choices under the
patient’s prescription benefit. The PDL is not
intended as a substitute for your professional
Preferred Drugs for your patients, out-of-pocket
expense and plan costs may be lowered. When
applicable, generic prescribing is optimal. As
generic equivalents become available in the
*Please note that the preferred alternatives listed here
You can access this list via our member portal at
are not a complete listing of all alternatives, only those
medications that are most commonly prescribed.
12/01/07 Growth Hormones Multiple Sclerosis Agents Anti-Inflammatory Heart Disease/Blood Pressure Oral Anti-Diabetic Agents CNS-Stimulants Atypical Antipsychotics Antibiotics Blood Glucose Diagnostics Contraceptives Osteoporosis Agents Cholesterol Reduction Ophthalmics Anti-Migraine Agents CNS-Anxiety Anti-Virals Estrogens Overactive Bladder Antidepressants CNS-Nausea Prostate Agents CNS-Parkinson’s Asthma/COPD Sleep Aids Gastrointestinal CNS-Seizures Topical Preparations Anti-Fungals
$ - Generic drugs (listed in all lowercase letters) have the lowest copay
$$ - Preferred brand name drugs (listed in all CAPITAL letters) have the middle copay
$$$ - Non-preferred brand name drugs (listed in all CAPITAL letters on the front of this handout) have the highest copay
For inquiries between 8am-10pm and for emergencies 24 hours call: 1-888-511-6222 Ambulatory Care Pharmacists: 604-806-8151 Please call two weeks in advance to book your pharmacy appointments with the receptionist at 604-806-8060. DELAVIRDINE (Rescriptor ) What is Delavirdine? • A non-nucleoside reverse transcriptase inhibitor (NNRTI) used to inhibit the replication of the HIV
NO PURCHASE NECESSARY. Void where prohibited. * Promotion open to legal residents of the United States (excluding Rhode Island) and who are of legal age of majority (where they reside) at the time of entry. * Entries may be submitted from 12:00 a.m. Pacific Time on September 1, 2013 until 5:00 p.m. Pacific Time on September 28, 2013. * There are eleven ten (10) prizes offered: 1 ticket to each Sta
Non-Preferred