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Alaska Medicaid Preferred Drug List
Therapeutic Class Listing – Affected Classes
Not all categories of medications were selected for current inclusion in the PDL.
Any classes of medications that do not appear on this list are not affected at this time by the PDL.
PRODUCTS APPEARING IN BOLD DO NOT REQUIRE MEDICAL JUSTIFICATION
Drugs with an * imply that a generic is available without justification. ACE Inhibitors
Altace®
Benazepril
Captopril
Enalapril Maleate
Lisinopril
ACE Inhibitors
Drugs Requiring MEDICAL JUSTIFICATION
Accupril®
Aceon®
Capoten®*

* Drugs with an * imply that a generic is available without Fosinopril (generic of Monopril®) Lotensin®
Mavik®
Moexipril HCL (generic of Univasc®)
Monopril®
Prinivil®*
Univasc®
Vasotec®*
Zestril®*
ACEI/Calcium Channel Blocker
Lotrel®

ACEI/Calcium Channel Blocker
Drugs Requiring MEDICAL JUSTIFICATION
Lexxel®
Tarka®

ACE Inhibitor/Diuretic Combinations
Benazepril HCL-HCTZ
Enalapril/HCTZ
Lisinopril/HCTZ


All current clinical edits and prior authorizations still apply
Revision Date:11/01/2006
Alaska Medicaid Preferred Drug List
Therapeutic Class Listing – Affected Classes
Not all categories of medications were selected for current inclusion in the PDL.
Any classes of medications that do not appear on this list are not affected at this time by the PDL.
PRODUCTS APPEARING IN BOLD DO NOT REQUIRE MEDICAL JUSTIFICATION
Drugs with an * imply that a generic is available without justification. ACE Inhibitor/Diuretic Combinations Drugs Requiring MEDICAL JUSTIFICATION Accuretic® Capozide®* * Drugs with an * imply that a generic is available Lotensin HCT®*
Monopril HCT®
Prinzide®*
Uniretic®
Vaseretic®*
Zestoretic®*

Alpha2 adrenergic receptor agonists
Alphagan P®
Brimonidine (generic of Alphagan®)
Alpha2 adrenergic receptor agonists
Drugs Requiring MEDICAL JUSTIFICATION
Iopidine®

Alpha Blockers
Doxazosin®
Flomax®
Terazosin®
Uroxatral®
Alpha Blockers
Drugs Requiring MEDICAL JUSTIFICATION
Cardura®
Cardura XL®
Hytrin®
Alpha-Glucosidase Inhibitors – Oral Antidiabetic
Precose®
Glyset®
Alzheimer Drugs and Cholinesterase Inhibitors
Aricept ®

Aricept ODT®
Exelon ®
Namenda®



All current clinical edits and prior authorizations still apply
Revision Date:11/01/2006
Alaska Medicaid Preferred Drug List
Therapeutic Class Listing – Affected Classes
Not all categories of medications were selected for current inclusion in the PDL.
Any classes of medications that do not appear on this list are not affected at this time by the PDL.
PRODUCTS APPEARING IN BOLD DO NOT REQUIRE MEDICAL JUSTIFICATION
Drugs with an * imply that a generic is available without justification. Alzheimer Drugs and Cholinesterase Inhibitors
Drugs Requiring MEDICAL JUSTIFICATION
Cognex®

Razadyne® (formerly Reminyl®)

Androgen Hormone Inhibitor
Proscar®

Androgen Hormone Inhibitor
Drugs Requiring MEDICAL JUSTIFICATION
Avodart®
Angiotensin Receptor Blockers
Cozaar®
Benicar®
Micardis®
Diovan ®
Angiotensin Receptor Blockers
Drugs Requiring MEDICAL JUSTIFICATION
Atacand®
Avapro®
Teveten®

Angiotensin Receptor Blockers & Diuretics
Diovan HCT®
Benicar HCT®
Hyzaar®
Micardis HCT®

Angiotensin Receptor Blockers & Diuretics
Drugs Requiring MEDICAL JUSTIFICATION
Atacand HCT®
Avalide®
Teveten HCT®

All current clinical edits and prior authorizations still apply
Revision Date:11/01/2006
Alaska Medicaid Preferred Drug List
Therapeutic Class Listing – Affected Classes
Not all categories of medications were selected for current inclusion in the PDL.
Any classes of medications that do not appear on this list are not affected at this time by the PDL.
PRODUCTS APPEARING IN BOLD DO NOT REQUIRE MEDICAL JUSTIFICATION
Drugs with an * imply that a generic is available without justification. Antidepressants - (New Generation)
Buproprion
Budeprion SR
Buproprion tablet SA
Cymbalta®
Effexor®
Effexor XR®
Mirtazapine
Mirtazapine tablet rapids
Nefazodone
Trazodone
Wellbutrin XL®

Antidepressants - (New Generation)
Drugs Requiring MEDICAL JUSTIFICATION
Desyrel ®*

that a generic is available without justification. Remeron SolTab ®*
Wellbutrin ®*
Wellbutrin SR ®*
Antiherpes Virus Agents
Acyclovir (generic of Zovirax®)
Famvir® (Famciclovir)
Valtrex® (Valacyclovir)
Antiherpes Virus Agents
Drugs Requiring MEDICAL JUSTIFICATION

* Drugs with an * imply that a generic is available
Antihyperlipidemics - (Miscellaneous)
Vytorin®

Zetia®

Antihyperlipidemics - (Miscellaneous)
Drugs Requiring MEDICAL JUSTIFICATION
Caduet®

Antifungals
Lamisil® (Terbinafine)
Grifulvin V® (Griseofulvin) (125mg/5ml oral suspension)

All current clinical edits and prior authorizations still apply
Revision Date:11/01/2006
Alaska Medicaid Preferred Drug List
Therapeutic Class Listing – Affected Classes
Not all categories of medications were selected for current inclusion in the PDL.
Any classes of medications that do not appear on this list are not affected at this time by the PDL.
PRODUCTS APPEARING IN BOLD DO NOT REQUIRE MEDICAL JUSTIFICATION
Drugs with an * imply that a generic is available without justification.
Antifungals used in the treatment of onychomycosis
Drugs Requiring MEDICAL JUSTIFICATION
Fulvicin U/F® (Griseofulvin) (Microsize)
Grifulvin V® (Griseofulvin) (250 mg and 500mg tab, Microsize)
Gris-PEG® (Griseofulvin) (Ultramicrosize)
Sporanox® (Traconazole)
Anti-tumor Necrosis Factor
Enbrel®
Humira®
Anti-tumor Necrosis Factor
Drugs Requiring MEDICAL JUSTIFICATION
Kineret®

Beta2 Adrenergics - Long-Acting
Serevent® Diskus
Beta2 Adrenergics - Long-Acting
Drugs Requiring MEDICAL JUSTIFICATION
Foradil® Aerolizer

Beta2 Adrenergics - Long-Acting Inhaled Corticosteroids
Advair® Diskus
Beta2 Adrenergics Inhalers - Short-Acting
Albuterol HFA – (generic of Proventil® HFA)
Albuterol MDI-CFC (generic of Proventil MDI®)
Albuterol MDI-CFC (generic of Ventolin MDI®)

Beta2 Adrenergics Inhalers - Short-Acting
Drugs Requiring MEDICAL JUSTIFICATION

a generic is available without justification. Maxair® Autohaler
Proventil® HFA
Proventil ®* MDI- CFC
Ventolin®* MDI-CFC
Ventolin® HFA
Xopenex® HFA

Beta2 Adrenergics Nebulizer Agents - Short-Acting
Albuterol Nebulizer solution (generic of Proventil ®)

All current clinical edits and prior authorizations still apply
Revision Date:11/01/2006
Alaska Medicaid Preferred Drug List
Therapeutic Class Listing – Affected Classes
Not all categories of medications were selected for current inclusion in the PDL.
Any classes of medications that do not appear on this list are not affected at this time by the PDL.
PRODUCTS APPEARING IN BOLD DO NOT REQUIRE MEDICAL JUSTIFICATION
Drugs with an * imply that a generic is available without justification. Beta2 Adrenergics Nebulizer Agents - Short-Acting
Drugs Requiring MEDICAL JUSTIFICATION
Accunebs®
Metaproterenol Nebulizer solution
Proventil ®* Nebulizer solution
Xopenex®
Beta-Blockers used for Glaucoma
Betaxolol HCL (generic of Betoptic®)
Carteolol HCL (generic of Ocupress®)
Levobunolol HCL (generic of Betagan®)
Metipranolol (generic of Optipranolol®)
Timolol Maleate (generic of Timoptic® and Timoptic XE®)

Beta-Blockers used for Glaucoma
Drugs Requiring MEDICAL JUSTIFICATION
Betagan®*
Betimol®
Betoptic®*

that a generic is available without justification. Istalol®
Ocupress®*
Optipranolol®*
Timoptic®*
Timoptic-XE®*

Beta-Blockers – Oral
Acebutolol HCL (generic of Sectral®)
Atenolol (generic of Tenormin®)
Betaxolol HCL (generic of Kerlone®)
Bisoprolol Fumarate (generic of Zebeta®)
Coreg®
Labetalol HCL (generic of Normodyne® and Trandate®)
Metoprolol Tartrate (generic of Lopressor®)
Nadolol (generic of Corgard®)
Propranolol HCL (generic of Inderal®)
Sotalol (generic of Betapace®)
Timolol Maleate (generic of Blocadren®)
Toprol XL®


All current clinical edits and prior authorizations still apply
Revision Date:11/01/2006
Alaska Medicaid Preferred Drug List
Therapeutic Class Listing – Affected Classes
Not all categories of medications were selected for current inclusion in the PDL.
Any classes of medications that do not appear on this list are not affected at this time by the PDL.
PRODUCTS APPEARING IN BOLD DO NOT REQUIRE MEDICAL JUSTIFICATION
Drugs with an * imply that a generic is available without justification. Beta-Blockers – Oral Drugs Requiring MEDICAL JUSTIFICATION Betapace®* Betapace AF® * Drugs with an * imply that a generic is available Cartrol®
Corgard®*
Inderal®*
Inderal LA®
Innopran XL®
Kerlone®*
Levatol®
Normodyne®*
Pindolol (generic of Visken®)
Sectral®*
Sotalol ER (generic of Betapace AF®)
Tenormin®*
Trandate®*
Zebeta®*

Biguanides
Metformin (generic of Glucophage®)
Metformin ER (generic of Glucophage XR®)
Biguanides – single agents
Drugs Requiring MEDICAL JUSTIFICATION

* Drugs with an * imply that a generic is available Glucophage XR®*
Riomet (Metformin Liquid 500mg/5ml Syrup)
Biguanide – combination agents
Glyburide/Metformin (Generic of Glucovance®)

Biguanides – combination agents
Drugs Requiring MEDICAL JUSTIFICATION
Glucovance® (Glyburide/Metformin)*
Metaglip® (Glipizide/Metformin
)

Bisphosphonates
Fosamax®
Fosamax Plus D®
Fosamax® Solution


All current clinical edits and prior authorizations still apply
Revision Date:11/01/2006
Alaska Medicaid Preferred Drug List
Therapeutic Class Listing – Affected Classes
Not all categories of medications were selected for current inclusion in the PDL.
Any classes of medications that do not appear on this list are not affected at this time by the PDL.
PRODUCTS APPEARING IN BOLD DO NOT REQUIRE MEDICAL JUSTIFICATION
Drugs with an * imply that a generic is available without justification.
Bisphosphonates
Drugs Requiring MEDICAL JUSTIFICATION
Actonel®
Boniva®
Note: Didronel® and Skelid® are available without justification

Carbonic Anhydrase Inhibitors
Azopt®
Cosopt®
Trusopt®
Cephalosporins (Second Generation) - Oral
Cefuroxime Tabs
Cefzil ® (Cefprozil) suspension

Cephalosporins (Second Generation) - Oral
Drugs Requiring MEDICAL JUSTIFICATION
Ceclor®,
Ceclor® CD

* Drugs with an * imply that a generic is available Cefaclor ER
Ceftin® suspension
Ceftin®* tablets
Cefzil ® (Cefprozil) tablets
Lorabid ®

Cephalosporins (Third Generation) -
Oral
Cedax® (Ceftibuten) capsules & suspension
Cefpodoxime Tabs – generic of Vantin
® tablets
Omnicef® (Cefdinir) capsules & suspension
Suprax® suspension

Cephalosporins (Third Generation) - Oral
Drugs Requiring MEDICAL JUSTIFICATION Vantin®* (Cefpodoxime) tablets & suspension All current clinical edits and prior authorizations still apply
Revision Date:11/01/2006
Alaska Medicaid Preferred Drug List
Therapeutic Class Listing – Affected Classes
Not all categories of medications were selected for current inclusion in the PDL.
Any classes of medications that do not appear on this list are not affected at this time by the PDL.
PRODUCTS APPEARING IN BOLD DO NOT REQUIRE MEDICAL JUSTIFICATION
Drugs with an * imply that a generic is available without justification.
CNS Stimulants
Adderall XR ®
Amphetamine salt combo
Concerta ®
Dextroamphetamine sulfatate capsule SA
Dextroamphetamine sulfate tablet
Dextrostat ®
Focalin ®
Metadate CD ®
Metadate ER ®
Methylin ®
Methylin ER
Methylphenidate
Methylphenidate ER
Provigil ®
Ritalin LA ®
Strattera ®

CNS Stimulants
Drugs Requiring MEDICAL JUSTIFICATION
Adderall ® *
Desoxyn
Dexedrine ® *

* Drugs with an * imply that a generic is available Methamphetamine
Pemoline ®
Ritalin ® *
Ritalin SR ®*
COPD Anticholinergics
Atrovent®
Atrovent HFA®
Combivent®
Duoneb®
Spiriva®

Cox-II inhibitors
Drugs Requiring MEDICAL JUSTIFICATION
Celebrex ®


All current clinical edits and prior authorizations still apply
Revision Date:11/01/2006
Alaska Medicaid Preferred Drug List
Therapeutic Class Listing – Affected Classes
Not all categories of medications were selected for current inclusion in the PDL.
Any classes of medications that do not appear on this list are not affected at this time by the PDL.
PRODUCTS APPEARING IN BOLD DO NOT REQUIRE MEDICAL JUSTIFICATION
Drugs with an * imply that a generic is available without justification. Dihydropyridine Calcium Channel Blockers (DHPCCB)
Afeditab CR (Generic of Adalatt CC®)
DynaCirc® (Isradipine)

DynaCirc Cr® (Isradipine CR)
Felodipine (generic of Plendil®)
Nicardipine (Generic of Cardene®)
Nifedipine, Nifedipine SA (Generic of Adalatt®, Adalatt CC®)
Nifediac CC (Generic of Adalatt CC®)
Nifedipine, Nifedipine XL (Generic of Procardia ®, Procardia XL®)
Nifedical XL (Generic of Procardia XL®)
Norvasc® (Amlodipine)
Sular ® (Nisoldipine)

Dihydropyridine Calcium Channel Blockers (DHPCCB)
Drugs Requiring MEDICAL JUSTIFICATION
Adalat ®*

* Drugs with an * imply that a generic is available Cardene®* (Nicardipine) Cardene SR®, (Nicardipine SR) Nimotop® (Nimodipine) Plendil® (Felodipine)
Procardia ®*
Procardia XL®*

Electrolyte Depletors
Fosrenol®
PhosLo®
Renagel®
Gastrointestinals: Histamine-2 Receptor Antagonists (H2RA’s)
Famotidine (generic of Pepcid®)
Ranitidine HCL (generic of Zantac®)

Gastrointestinals: Histamine-2 Receptor Antagonists (H2RA’s)
Drugs Requiring MEDICAL JUSTIFICATION
Axid®
Cimetidine

* Drugs with an * imply that a generic is available without Pepcid®* Pepcid® Suspension Pepcid RPD® Tagamet® Zantac®* Zantac® Effervescent Zantac Syrup ® All current clinical edits and prior authorizations still apply
Revision Date:11/01/2006
Alaska Medicaid Preferred Drug List
Therapeutic Class Listing – Affected Classes
Not all categories of medications were selected for current inclusion in the PDL.
Any classes of medications that do not appear on this list are not affected at this time by the PDL.
PRODUCTS APPEARING IN BOLD DO NOT REQUIRE MEDICAL JUSTIFICATION
Drugs with an * imply that a generic is available without justification.
Gastrointestinals: Proton Pump Inhibitors (PPI’s)
Nexium®
Prevacid® (no age restriction)
Zegerid®

Gastrointestinals: Proton Pump Inhibitors (PPI’s)
Drugs Requiring MEDICAL JUSTIFICATION
Aciphex®
Omeprazole (Generic of Prilosec®)
Prevacid Naprapac®
Prevacid Rapid Tabs®
Prilosec®
Protonix®

Inhaled Corticosteroid Agents
Asmanex®
Azmacort® (Triamcinolone)
Flovent HFA® (Fluticasone)
Pulmicort Respules®
QVAR® (Beclomethasone)

Inhaled Corticosteroid Agents
Drugs Requiring MEDICAL JUSTIFICATION

Aerobid®,
AeroBid-M® (Flunisolide)
Pulmicort® Turbuhaler (Budesonide)
Insulins
Lantus ®
Levemir®
Novolin R®
Novolin N®
Novolin 70/30 ®
Novolog®
Novolog Mix 70/30 ®

All current clinical edits and prior authorizations still apply
Revision Date:11/01/2006
Alaska Medicaid Preferred Drug List
Therapeutic Class Listing – Affected Classes
Not all categories of medications were selected for current inclusion in the PDL.
Any classes of medications that do not appear on this list are not affected at this time by the PDL.
PRODUCTS APPEARING IN BOLD DO NOT REQUIRE MEDICAL JUSTIFICATION
Drugs with an * imply that a generic is available without justification. Insulins
Drugs Requiring MEDICAL JUSTIFICATION
Apidra®
Humulin R®
Humulin N®
Humulin 70/30 ®
Humulin-U ®
Humulin 50/50®
Humalog®
Humalog Mix 50/50®
Humalog Mix 75/25 ®
Velosulin BR® (manufacturer to cease production)
Intranasal Corticosteroid Agents
Nasonex®
Flunisolide – generic of Nasalide
®
Nasacort AQ®
Intranasal Corticosteroid Agents
Drugs Requiring MEDICAL JUSTIFICATION

that a generic is available without justification.
Flonase® Nasalide ® (Flunisolide)
Leukotriene inhibitors
Accolate®
Singulair®
Levothyroxine
The P&T Committee suggests substitutions between products in this class not
occur without participation of the patient and prescriber.
Generic Levothyroxine
Levothroid
Levo-T
Levoxyl
Synthroid
Novothrox
Synthroid
Unithroid
Lipotropics - Fibric Acid Derivatives
Gemfibrozil (Generic of Lopid®)
Tricor® (Fenofibrate, Micromized)

All current clinical edits and prior authorizations still apply
Revision Date:11/01/2006
Alaska Medicaid Preferred Drug List
Therapeutic Class Listing – Affected Classes
Not all categories of medications were selected for current inclusion in the PDL.
Any classes of medications that do not appear on this list are not affected at this time by the PDL.
PRODUCTS APPEARING IN BOLD DO NOT REQUIRE MEDICAL JUSTIFICATION
Drugs with an * imply that a generic is available without justification. Lipotropics - Fibric Acid Derivatives Drugs Requiring MEDICAL JUSTIFICATION that a generic is available without justification. Lopid ®*

Lipotropics – Niacin
Niacor®
Niaspan®
Macrolides - Oral
Azithromycin Tabs
Biaxin® (clarithromycin) tablets & suspension
Biaxin XL® (clarithromycin)
Erythromycin Ethylsuccinate (generic of EryPed®, E.E.S)

Erythrocin® Stearate (priced generically)
Erythromycin base (generic of ERYC®)
Erythromycin Stearate (generic of Erythrocin® Stearate)
Erythromycin w / sulfisoxazole (generic of Pediazole®)
Zithromax® suspension (Azithromycin)

Macrolides - Oral
Drugs Requiring MEDICAL JUSTIFICATION
Clarithromycin (generic for Biaxin®)
Dynabec®, (dirithromycin)
E.E.S® tabs *
ERYC®*

* Drugs with an * imply that a generic is available Ery-tab®*
PCE® dispertab
Pediazole®*
Zithromax® Capsules and Tablets

Meglitinides – Oral Antidiabetics
Prandin®
Starlix®

Multiple Sclerosis Drugs
Avonex®
Betaseron®
Copaxone®
Rebif®

All current clinical edits and prior authorizations still apply
Revision Date:11/01/2006
Alaska Medicaid Preferred Drug List
Therapeutic Class Listing – Affected Classes
Not all categories of medications were selected for current inclusion in the PDL.
Any classes of medications that do not appear on this list are not affected at this time by the PDL.
PRODUCTS APPEARING IN BOLD DO NOT REQUIRE MEDICAL JUSTIFICATION
Drugs with an * imply that a generic is available without justification.
Narcotics – Long Acting
Avinza
®
Duragesic
®
Kadian
®
Morphine Sulfate Tablet SA
Oramorph SR
®
OxyContin
®
Narcotics – Long Acting
Drugs Requiring MEDICAL JUSTIFICATION
MS Contin®
Oxycodone Tabs.SR 12H (generic)

Non-Dihydropyridine Calcium Channel Blockers (NDHPCCB)
Cartia XT

(generic of Cardizem CD®)
Diltiazem, Diltiazem ER (Generic of Cardizem® and Cardizem CD®)
Diltiazem SR (generic of Cardizem SR®)
Diltiazem XR (generic of Dilacor XR®)

Diltia XT
(generic of Dilacor XR®)
Vascor® (Bepridil)

Non-Dihydropyridine Calcium Channel Blockers (NDHPCCB)
Drugs Requiring MEDICAL JUSTIFICATION
Cardizem®*


Non-Ergot Dopamine Receptors
Mirapex®
Requip®
Ophthalmic Antihistamines
Patanol®

Ophthalmic antihistamines
Drugs Requiring MEDICAL JUSTIFICATION
Elestat®
Emadine®
Livostin®
Optivar®

All current clinical edits and prior authorizations still apply
Revision Date:11/01/2006
Alaska Medicaid Preferred Drug List
Therapeutic Class Listing – Affected Classes
Not all categories of medications were selected for current inclusion in the PDL.
Any classes of medications that do not appear on this list are not affected at this time by the PDL.
PRODUCTS APPEARING IN BOLD DO NOT REQUIRE MEDICAL JUSTIFICATION
Drugs with an * imply that a generic is available without justification. Zaditor®
Ophthalmic Immunomodulator
Restasis®

Ophthalmic Mast Cell Stablizers
Alocril ®;
Cromolyn (generic of Opticrom® & Crolom®)
Ophthalmic Mast Cell Stablizers
Drugs Requiring MEDICAL JUSTIFICATION
Alamast®
Alomide®
Opticrom® (Cromolyn)
Crolom® (Cromolyn
)
Opthalmic Quinolones
Ciprofloxacin (generic of Ciloxan®)
Vigamox®

Opthalmic Quinolones
Drugs Requiring MEDICAL JUSTIFICATION
Ciloxan® Oint/Drops
Cipro® (Ciprofloxacin)
Ocuflox®
Zymar®

Pegylated Interferon Alpha Products and Ribavirins
Copegus®
Pegasys®
Pegasys Convenience Pack®
Ribavirin (Generic for Rebetol®)
Pegylated Interferon Alpha Products and Ribavirins
Drugs Requiring MEDICAL JUSTIFICATION
Peg-Intron®
Rebetol®
Phenylalkylamine Non- Dihydropyridine Calcium Channel Blockers
(NDHPCCB)

Verapamil (Generic of Calan®)
Verapamil (Generic of Isoptin®)
Verapamil (Generic of Verelan®)

All current clinical edits and prior authorizations still apply
Revision Date:11/01/2006
Alaska Medicaid Preferred Drug List
Therapeutic Class Listing – Affected Classes
Not all categories of medications were selected for current inclusion in the PDL.
Any classes of medications that do not appear on this list are not affected at this time by the PDL.
PRODUCTS APPEARING IN BOLD DO NOT REQUIRE MEDICAL JUSTIFICATION
Drugs with an * imply that a generic is available without justification. Phenylalkylamine Non- Dihydropyridine Calcium Channel Blockers (NDHPCCB) Drugs Requiring MEDICAL JUSTIFICATION that a generic is available without justification.

Prostaglandin Agonists
Lumigan ®
Travatan®
Xalatan®

Prostaglandin Agonists
Drugs Requiring MEDICAL JUSTIFICATION
Rescula®
Quinolones (Second Generation)
Ciprofloxacin
Ofloxacin

Quinolones (Second Generation)
Drugs Requiring MEDICAL JUSTIFICATION

that a generic is available without justification.

Quinolones “Respiratory” (Third Generation)
Levaquin® (levofloxacin)


Quinolones “Respiratory” (Third Generation)
Drugs Requiring MEDICAL JUSTIFICATION
Avelox®
Tequin®

Sedative Hypnotics
Ambien
®
Estazolam
Flurazepam HCL
Temazepam
Triazolam

All current clinical edits and prior authorizations still apply
Revision Date:11/01/2006
Alaska Medicaid Preferred Drug List
Therapeutic Class Listing – Affected Classes
Not all categories of medications were selected for current inclusion in the PDL.
Any classes of medications that do not appear on this list are not affected at this time by the PDL.
PRODUCTS APPEARING IN BOLD DO NOT REQUIRE MEDICAL JUSTIFICATION
Drugs with an * imply that a generic is available without justification.
Sedative Hypnotics
Drugs Requiring MEDICAL JUSTIFICATION
Dalmane®*
Doral®

* Drugs with an * imply that a generic is available without Prosom®
Restoril®*
Restoril 7.5mg®
Sonata®

Serotonin Receptor Agonists
Imitrex ®
Imitrex Kit ®
Imitrex Nasal ®
Imitrex Vial ®
Maxalt ®
Maxalt MLT ®

Serotonin Receptor Agonists
Drugs Requiring MEDICAL JUSTIFICATION

Amerge ®
Axert ®
Frova ®
Relpax ®
Zomig ®
Zomig Spray ®
Zomig ZMT ®

Serotonin Receptor Antagonists,
Kytril®
Zofran®
Serotonin Receptor Antagonists
Drugs Requiring MEDICAL JUSTIFICATION

Anzemet®
SSRI
Fluoxetine HCL
Lexapro
®
Paroxetine HCL

All current clinical edits and prior authorizations still apply
Revision Date:11/01/2006
Alaska Medicaid Preferred Drug List
Therapeutic Class Listing – Affected Classes
Not all categories of medications were selected for current inclusion in the PDL.
Any classes of medications that do not appear on this list are not affected at this time by the PDL.
PRODUCTS APPEARING IN BOLD DO NOT REQUIRE MEDICAL JUSTIFICATION
Drugs with an * imply that a generic is available without justification.
SSRI
Drugs Requiring MEDICAL JUSTIFICATION
Celexa®
Paxil®*

a generic is available without justification. Pexeva®
Prozac®*
Prozac Weekly®
Sarafem®
Zoloft®
Statins
Advicor
®
Altoprev
® (formerly Altocor®)
Crestor
®
Lescol
®
Lescol XL
®
Lovastatin
Zocor
®
Statins
Drugs Requiring MEDICAL JUSTIFICATION

* Drugs with an * imply that a generic is available without Mevacor®*
Pravigard PAC®
Pravachol®

Sulfonylureas – Second Generation
Glimepiride (generic for Amaryl®)
Glipizide
Glipizide ER
Glyburide
Glyburide Micronized
Sulfonylureas – Second Generation
Drugs Requiring MEDICAL JUSTIFICATION
Amaryl®
Diabeta®*

generic is available without justification. Glucotrol XL®* Glynase®* Micronase®* All current clinical edits and prior authorizations still apply
Revision Date:11/01/2006
Alaska Medicaid Preferred Drug List
Therapeutic Class Listing – Affected Classes
Not all categories of medications were selected for current inclusion in the PDL.
Any classes of medications that do not appear on this list are not affected at this time by the PDL.
PRODUCTS APPEARING IN BOLD DO NOT REQUIRE MEDICAL JUSTIFICATION
Drugs with an * imply that a generic is available without justification.
Sulfonylureas – Second Generation Combinations
Glyburide/Metformin (generic of Glucovance)

Sulfonylureas – Second Generation Combinations
Drugs Requiring MEDICAL JUSTIFICATION
Glucovance®
Metaglip®

Thiazolidinediones – Oral Antidiabetic (TZD's)
Actos®
Avandia®

Thiazolidinediones – Combinations (TZD's)
ActoPlusMet® (Pioglitazone/Metformin)
Avandamet® (Rosiglitazone/Metformin)
Avandaryl® (Rosiglitazone/Glimepiride)

Topical Immunomodulators
Elidel®
Protopic®

Urinary Tract Antispasmodics
Detrol LA®
Enablex®
Oxybutynin
Vesicare®

Urinary Tract Antispasmodics
Drugs Requiring MEDICAL JUSTIFICATION

generic is available without justification. Ditropan®* Ditropan XL® Oxytrol® Sanctura® All current clinical edits and prior authorizations still apply
Revision Date:11/01/2006

Source: http://neurosoup.org/pdf/druglistbystate/alaska.pdf

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Dr. med. Carola Tausend, Fachärztin für Allgemeinmedizin Klassische Akupunktur und Kampo-Phytotherapie B-Diplom der Deutschen Ärztegesellschaft für Akupunktur (DÄGfA) DARM-MYKOSE Eine Darm-Mykose ( =Besiedelung des Darmes mit Pilzen ) ist im Rahmen des Gesamtthemas "Allergien" ein wichtiger und immer zu berücksichtigender Faktor. Fast immer handelt es sich um den Hefepi

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