Transcription of OTC COVERED PRODUCTS LIST
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OTC COVERED PRODUCTS LIST
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 Ibuprofen Capsule 200mg Advil/Motrin X Ibuprofen Tablet 200mg Advil/Motrin X Naproxen Sodium Capsule 220mg Aleve X Naproxen Sodium Tablet 220mg Aleve X Anti-Diarrheals
GENERIC NAME DOSAGE FORM STRENGTH COMMON TRADE NAME PDL* Adapalene Gel 0.1% Differin X Acetaminophen Liquid 160mg/5ml Tylenol Acetaminophen Suspension 160mg/5ml Tylenol
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