Transcription of CONNECTICUT MEDICAID ACNE AGENTS, TOPICAL ‡ …
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CONNECTICUT MEDICAID ACNE AGENTS, TOPICAL ‡ …
ACNE AGENTS, TOPICAL ANGIOTENSIN MODULATOR COMBINATIONSANTICONVULSANTS, CONT.(STEP THERAPY CATEGORY)AMLODIPINE / BENAZEPRIL (ORAL)ETHOSUXIMIDE SOLUTION (ORAL)(DX CODE REQUIRED - DIFFERIN and EPIDUO)AMLODIPINE / OLMESARTAN (ORAL)GABITRIL TABLET (ORAL)AZELEX 20% CREAM ( TOPICAL )AMLODIPINE / VALSARTAN (ORAL)LAMOTRIGINE CHEW DISPERS TAB (not ODT) (ORAL)CLINDAMYCIN PHOS 1% PLEGET ( TOPICAL )AMLODIPINE / VALSARTAN / HCTZ (ORAL)LAMOTRIGINE STARTER PACK (not ODT) (ORAL)CLINDAMYCIN PHOS 1% SOLUTION ( TOPICAL )LAMOTRIGINE TABLET (IR) (not ER) (ORAL)CLINDAMYCIN-BENZOYL PEROXIDE 1-5% PUMP ( TOPICAL )ANTHELMINTICSLEVETIRACETAM SOLUTION, IR TABLET (not ER) (ORAL)DIFFERIN CREAM ( TOPICAL ) (DX CODE REQ.)ALBENZA TABLET (ORAL)OXCARBAZEPINE SUSPENSION, TABLET (ORAL)DIFFERIN GEL ( TOPICAL ) (DX CODE REQ.)
Jan 01, 2022 · antifungals, topical antiparkinson's agents, cont. antivirals, topical bronchodilators, beta agonist, cont. clotrimazole 1% cream (rx and otc) (topical) carbidopa / levodopa / entacapone tablet (oral) acyclovir 5% ointment (not cream) (topical) proair hfa 90 mcg inhaler (inhalation) clotrimazole 1% solution (rx only) (topical) pramipexole ir tablet (not er) …
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