Transcription of OTC Covered Lilst - Missouri Department of Social Services
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OTC Covered Lilst - Missouri Department of Social Services
OTC Covered PRODUCTS LIST *Preferred Drug List - Items listed as being a part of a Preferred Drug List Edit may require prior authorization. Edit documents containing approval criteria can be found at GENERIC NAME DOSAGE FORM STRENGTH COMMON TRADE NAME PDL* Acne Products Adapalene Gel Differin X Analgesics Acetaminophen Liquid 160mg/5ml Tylenol Acetaminophen Suspension 160mg/5ml Tylenol Acetaminophen Suppository 120mg Feverall Acetaminophen Suppository 325mg Feverall Acetaminophen Tablet 325mg Tylenol Acetaminophen Tablet 500mg Tylenol Aspirin Chewable Tablet 81mg Bayer Children's Aspirin Enteric-Coated Tablet 81mg Ecotrin Aspirin Enteric-Coated Tablet 325mg Ecotrin Aspirin Tablet 325mg Bayer Ibuprofen Drops 50 Advil/Motrin X Ibuprofen Suspension 100mg/5ml Advil/Motrin X Ibuprofen Chewable Tablet 100mg Advil/Motrin X Ibuprofen Tablet 100mg Advil/Motrin X
Ketotifen Fumarate Drops 0.025% Zaditor X Mineral Oil/Petrolatum, White Ointment 42.5-56.8% Lacri-Lube S.O.P. Olopatadine Hcl Drops 0.1% Patanol X Olopatadine Hcl Drops 0.2% Pataday X Olopatadine Hcl Drops 0.7% Pataday X Polyvinyl Alchohol Drops 1.4% Akwa Tears X Polyvinyl Alchohol/Povidone Drops 0.5%-0.6% Artificial Tears X
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