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Standard ql list (client friendly document)

Standard Quantity Limit List*
Therapeutic Category
Drug Name
Dispensing Limit
Anti-infectives
CIPRO XR (ciprofloxacin ext-release) 1000 mg CIPRO XR (ciprofloxacin ext-release) 500 mg PROQUIN XR (ciprofloxacin ext-release) 500 mg Cardiology
XARELTO (rivaroxaban) tablet 15 mg & 20 mg Central Nervous System
Standard Quantity Limit List*
Therapeutic Category
Drug Name
Dispensing Limit
Central Nervous System
HORIZANT (gabapentin enacarbil SR) 600 MG EFFEXOR XR (venlafaxine) caps 37.5 mg & 75 mg LEXAPRO (escitalopram) solution 5 mg/5 ml LEXAPRO (escitalopram) tabs 5 mg & 20 mg LUVOX (fluvoxamine) tabs 25 mg & 50 mg PAXIL CR (paroxetine) tabs 25 mg & 37.5 mg PROZAC WEEKLY (fluoxetine delayed-release) Venlafaxine SR (venlafaxine) tabs 225 mg IMITREX (sumatriptan ) Injection 6 mg/0.5 mL IMITREX (sumatriptan ) STATdose 4 mg/0.5 mL & 6 mg/0.5 mL Standard Quantity Limit List*
Therapeutic Category
Drug Name
Dispensing Limit
Central Nervous System
NUVIGIL (armodafinil) 150 mg & 250 mg Dermatology
TACLONEX (calcipotriene/betamethasone dipropionate) TACLONEX SCALP (calcipotriene/betamethasone dipropionate) 120 grams/30 days Endocrinology
Growth Hormones and Related Therapy EGRIFTA (tesamorelin) ACTONEL WITH CALCIUM (risedronate/calcium carbonate) FOSAMAX PLUS D (alendronate/cholecalciferol) Gastroenterology
EMEND (aprepitant) Combo Pack 125 mg/80 mg Standard Quantity Limit List*
Therapeutic Category
Drug Name
Dispensing Limit

Gastroenterology
Antiemetics
Immunology
Miscellaneous
Blood Glucose Monitors (blood glucose monitors) Diabetic Test Strips & Lancets (test strip & lancets) NICODERM (nicotine transdermal) Transdermal NICORETTE, COMMIT (nicotine) Gum, Lozenges SYNVISC, SYNVISC-ONE (sodium hyaluronate)
Obstetrics & Gynecology
DEPO/DEPO-SUBQ PROVERA (medroxyprogesterone) LOSEASONIQUE (ethinyl estradiol/levonorgestrel) SEASONALE (ethinyl estradiol/levonorgestrel) SEASONIQUE (ethinyl estradiol/levonorgestrel) 2 tabs (2 kits)/year (covered for females only) 2 tabs (2 kits)/year (covered for females <17 year PLAN B, NEXT CHOICE (levonorgestrel) 0.75 mg 4 tabs (2 kits)/year (covered for females <17 year Chorionic gonadotropin (chorionic gonadotropin) FOLLISTIM AQ (follitropin beta) Cartridge Standard Quantity Limit List*
Therapeutic Category
Drug Name
Dispensing Limit
Obstetrics & Gynecology
Oncology
LUPRON DEPOT (leuprolide) 11.25 mg & 22.5 mg (3-month) LUPRON DEPOT (leuprolide) 3.75 mg & 7.5 mg (1-month) LUPRON DEPOT (leuprolide) 30 mg (4-month) LUPRON DEPOT (leuprolide) 45 mg (6-month) LUPRON DEPOT-PED (leuprolide) 7.5 mg, 11.25 mg, & 15 mg TRELSTAR (triptorelin) 22.5 mg (6-month) TRELSTAR DEPOT (triptorelin) 3.75 mg (1-month) TRELSTAR LA (triptorelin) 11.25 mg (3-month) AFINITOR (everolimus) 2.5 mg & 10 mg SPRYCEL (dasatinib) 70 mg, 80mg & 100 mg
Ophthalmology
Standard Quantity Limit List*
Therapeutic Category
Drug Name
Dispensing Limit
Respiratory
BECONASE AQ (beclomethasone dipropionate) Albuterol (solution) 2.5 mg/3 mL (0.083%) ATROVENT (ipratropium) Inhalation Solution PROVENTIL (albuterol) Solution 0.083% (2.5 MG/3ML) PROVENTIL HFA, PROAIR HFA, VENTOLIN HFA (albuterol) XOPENEX (levalbuterol) 0.31 mg & 0.63 mg/3 mL 8 vials or suppositories/month (males only) CIALIS (tadalafil) 5 mg, 10 mg & 20 mg Standard Quantity Limit List*
Important note: dinical re ewfor higherquantitiesWII ONLYI:e pro ded fordrugsinthe folloWng dasses: antidepressants,L.MV\IHs,opidds,PDE-Sinhibitors andtrif:(ans. •nis drug list is sltljedto periodeupdates and may not be all inclusive.Drugs affected induded both brand and gereric 'Y'Ihere plicable Md indudes all strengths unless otterWse specifically ncted.lf a targeted dn.g has a newstrergth,it Wllautomatically be addedto thelist.

Source: http://www.botetourtva.us/insurance/documents/kroger_sql_list.pdf

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Research Outputs Publications The WADDP has over 100 research publications in top-ranking internationally ISI-recognizedpeer-reviewed scientific journals. Below is a representative list of original research articles and criticalreview papers published since 2010. (Access to publications prior to 2010 is available on request) 1. In vitro evaluation of the physicochemical effects of drug-l

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VOUS ALLEZ PASSER UN SCANNER Dr JP ABECASSISDr D. CHELLYDr V. PAPONDr D. PARIENTEDr S VENT édecin vous a proposé un examen radiologique. Il sera pratiqué avec votre N nt. Vous avez en effet la liberté de l’accepter ou de le refuser. Une information vous est fournie sur le déroulement de l’examen et de ses suites. Le médecin radiologue est qualifié pour juger de l’utilité de

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