Transcription of OTC Covered Products
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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
Calcium Citrate Tablet 200mg Citracal X Calcium Citrate/Vitamin D3 Tablet 315mg-250u Citracal + D X Electrolytes/Dextrose Popsicles/Solution Pedialyte ... Omeprazole Magnesium Tablet 20mg Prilosec X Omeprazole/Sodium Bicarbonate Capsule 20mg-1g Zegerid X Hydrocortisone Cream 0.5% Cortizone X
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