Transcription of Molina Healthcare of Illinois Preferred Drug List …
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Molina Healthcare of Illinois Preferred Drug List …
July 2018 Molina Healthcare of Illinois Preferred drug List (Formulary) 1 Molina Healthcare of Illinois Preferred drug List (Formulary) (07/01/2018) INTRODUCTION .. 4 PREFACE .. 4 PHARMACY AND THERAPEUTICS (P&T) COMMITTEE .. 4 drug LIST PRODUCT DESCRIPTIONS .. 4 GENERIC SUBSTITUTION .. 5 PLAN DESIGN .. 5 NON-COVERED MEDICATIONS .. 5 PRIOR AUTHORIZATION REQUEST PROCEDURE .. 5 PRIOR AUTHORIZATION HELPFUL HINTS .. 6 LEGEND .. 6 REQUESTING FORMULARY CHANGES .. 6 URGENT AND AFTER-HOURS MEDICATION POLICY .. 6 NOTICE .. 6 ANALGESICS .. 7 ANALGESICS, 7 NSAIDs .. 7 NSAIDs, TOPICAL .. 7 COX-2 7 GOUT .. 7 OPIOID ANALGESICS .. 7 NON-OPIOID ANALGESICS .. 8 VISCOSUPPLEMENTS .. 8 ANTI-INFECTIVES .. 8 8 ANTIFUNGALS .. 9 ANTIMALARIALS .. 9 ANTIRETROVIRAL AGENTS .. 9 ANTITUBERCULAR AGENTS .. 10 ANTIVIRALS .. 10 11 ANTINEOPLASTIC AGENTS .. 11 ALKYLATING AGENTS .. 11 ANTIMETABOLITES.
4 INTRODUCTION We are pleased to provide the 2018 Molina Healthcare of Illinois Preferred Drug List (Formulary) as a useful reference and informational tool. This document can assist medical providers in selecting clinically-appropriate and cost-effective products for
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