Drug Benefit List - April 2009

84:00 SKIN AND MUCOUS MEMBRANE AGENTS (SMMA)

84:04.04 SMMA - ANTIBIOTICS

BACITRACIN

500IU Ointment

00584908 BACITIN PMS

BACITRACIN ZINC, POLYMYXIN B SULFATE

500IU & 10,000IU Ointment

02237227 POLYSPORIN ANTIBIOTIC PFI

CLINDAMYCIN PHOSPHATE

1% Solution

00582301 DALACIN T PFI

02266938 TARO-CLINDAMYCIN TAR

2% Vaginal Cream

02060604 DALACIN PMJ

ERYTHROMYCIN, TRETINOIN

4% & 0.01% Gel

02015994 STIEVAMYCIN MILD STI

4% & 0.025% Gel

01905112 STIEVAMYCIN STI

4% & 0.05% Gel

01945262 STIEVAMYCIN FORTE STI

FUSIDATE SODIUM

2% Ointment

00586676 FUCIDIN LEO

FUSIDIC ACID

2% Cream

00586668 FUCIDIN LEO

GRAMICIDIN, POLYMYXIN B SULFATE

0.25MG & 10,000IU Cream

02230844 POLYSPORIN ANTIBIOTIC PFI

MUPIROCIN

2% Cream

02239757 BACTROBAN GSK

2% Ointment

01916947 BACTROBAN GSK

02279983 TARO-MUPIROCIN 2% OINTMENT TAR

POLYMYXIN B SULFATE, BACITRACIN

10,000IU & 500IU Ointment

00792217 ANTIBIOTIC PDD

00876488 BACIMYXIN PMS

00621366 BIODERM ODN

01942921 POLYTOPIC SDZ

84:04.06 SMMA - ANTIVIRALS

ACYCLOVIR

5% Cream

02039524 ZOVIRAX GSK

5% Ointment

00569771 ZOVIRAX GSK

IDOXURIDINE

0.1% Topical Solution

00001317 HERPLEX-D LIQUIFILM ALL

02237187 SANDOZ-IDOXURIDINE SDZ

84:04.08 SMMA - ANTIFUNGALS

CLOTRIMAZOLE

1% Cream

02150867 CANESTEN BCD

00812382 CLOTRIMADERM TAR

1% & 200MG Cream & Vaginal Suppository

02264099 CANESTEN 3 COMFORT COMBI PAK BCD

1% & 500MG Cream & Vaginal Suppository

02264102 CANESTEN 1 COMFORT COMBI PAK BCD

1% Vaginal Cream

02150891 CANESTEN BCD

00812366 CLOTRIMADERM TAR

2% Vaginal Cream

02150905 CANESTEN BCD

00812374 CLOTRIMADERM TAR

ECONAZOLE NITRATE

1% Cream

02011948 ECOSTATIN WSB

150MG Vaginal Suppository

02010267 ECOSTATIN WSB

KETOCONAZOLE

2% Cream

02245662 KETODERM TAR

00703974 NIZORAL MCL

2% Shampoo

02182920 NIZORAL MCL

MICONAZOLE NITRATE

2% Cream

02085852 MICATIN MCL

02126567 MONISTAT-DERM MCL

2% & 100MG Cream & Vaginal Suppository

02126257 MONISTAT 7 DUAL PAK MCL

2% & 400MG Cream & Vaginal Suppository

02126249 MONISTAT 3 DUAL PAK MCL

2% Vaginal Cream

02231106 MICOZOLE TAR

00980625 MONISTAT MCL *

02084309 MONISTAT 7 MCL

100MG Vaginal Suppository

02084295 MONISTAT 7 MCL

400MG Vaginal Suppository

02171775 MICONAZOLE VTH

02126605 MONISTAT 3 MCL

NYSTATIN

100,000IU Cream

00029092 MYCOSTATIN BMS

00716871 NYADERM TAR

02194236 RATIO-NYSTATIN RPH

100,000IU Ointment

02194228 RATIO-NYSTATIN RPH

Powder

00907472 NYSTATIN WLR *

25,000IU Vaginal Cream

00716901 NYADERM TAR

100,000IU Vaginal Cream

02194163 RATIO-NYSTATIN RPH

100,000IU Vaginal Tablet

02194171 RATIO-NYSTATIN RPH

TERBINAFINE HCL

1% Cream

02031094 LAMISIL NVR

TERCONAZOLE

0.4% Vaginal Cream

02247651 TARO-TERCONAZOLE TAR

00894729 TERAZOL 7 JNO

0.8% & 80MG Vaginal Cream & Vaginal Suppository

02130874 TERAZOL 3 DUAL PAK JNO

TOLNAFTATE

1% Cream

00576034 TINACTIN SCH

1% Powder

01919245 ATHLETES FOOT SPRAY SCH

00576042 TINACTIN SCH

02029081 ZEASORB AF STI

1% Solution

00576026 TINACTIN SCH

1% Spray

00576050 TINACTIN AEROSOL SCH

84:04.12 SMMA - SCABICIDES AND PEDICULICIDES

CROTAMITON

10% Cream

00623377 EURAX NVC

ISOPROPYL MYRISTATE

50% Solution

02279592 RESULTZ ALN

LINDANE

1% Lotion

00703591 PMS-LINDANE PMS

1% Shampoo

00430617 HEXIT ODN

00703605 PMS-LINDANE PMS

PERMETHRIN

5% Cream

02219905 NIX DERMAL GSK

5% Lotion

02231348 KWELLADA-P GSK

1% Rinse

02231480 KWELLADA-P GSK

00771368 NIX WLA

PIPERONYL BUTOXIDE, PYRETHRINS

3% & 0.3% Shampoo

02125447 R & C GSK

84:04.92 SMMA - MISCELLANEOUS LOCAL ANTI-INFECTIVES

BENZOYL PEROXIDE

2.5% Gel (Acetone Base)

00406813 ACETOXYL STI

5% Gel (Acetone Base)

00406821 ACETOXYL STI

10% Gel (Acetone Base)

00406848 ACETOXYL VAO

5% Gel (Alcohol Base)

02162113 BENZAGEL NVC

00263702 PANOXYL-5 STI

10% Gel (Alcohol Base)

00263699 PANOXYL-10 STI

20% Gel (Alcohol Base)

00373036 PANOXYL-20 STI

2.5% Gel (Water Base)

02214830 PANOXYL AQUAGEL STI

4% Gel (Water Base)

01975382 SOLUGEL STI

5% Gel (Water Base)

00899453 BENZAC AC GAC

01925180 BENZAC W5 GAC *

02214849 PANOXYL AQUAGEL STI

8% Gel (Water Base)

02019825 SOLUGEL STI

10% Gel (Water Base)

01912437 BENZAC AC GAC

01908871 DESQUAM X WSB

2.5% Lotion

02046539 OXY 5 GSK

5% Lotion

00236063 BENOXYL STI

02166607 BENZAGEL 5 NVC

00374326 OXYDERM VAE

10% Lotion

00370568 BENOXYL STI

5% Soap

00483184 PANOXYL-5 STI

10% Soap

00527661 PANOXYL-10 STI

5% Wash

00896276 BENZAC W GAC

02162121 BENZAGEL NVC

02214857 PANOXYL STI

10% Wash

01925199 BENZAC W GAC

CHLORHEXIDINE ACETATE

0.5% Dressing

00433497 BACTIGRAS SNE

00905097 BACTIGRAS 5X5CM SNE *

00960330 BACTIGRAS 5X5CM SNE *

CHLORHEXIDINE GLUCONATE

2% Liquid

01938991 STANHEXIDINE OMG

4% Liquid

01938983 STANHEXIDINE OMG

HYDROGEN PEROXIDE

3% Liquid

00167703 HYDROGEN PEROXIDE 10V RWP

00485721 HYDROGEN PEROXIDE 10V RPH *

00579297 PEROXIDE D'HYDROGENE ATL

ISOPROPYL ALCOHOL

70% Liquid

00426539 DUONALC VAE

METRONIDAZOLE

0.75% Cream

02226839 METROCREAM GAC

1% Cream

02156091 NORITATE SAC

02242919 ROSASOL STI

0.75% Gel

02092832 METROGEL GAC

1% Gel

02297809 METROGEL GAC

0.75% Lotion

02248206 METROLOTION GAC

10% Vaginal Cream

01926861 FLAGYL SAC

0.75% Vaginal Gel

02125226 NIDAGEL MMH

METRONIDAZOLE, NYSTATIN

100MG & 20,000U/G Vaginal Cream

01926845 FLAGYSTATIN AVT

500MG & 100,000IU Vaginal Suppository

01926829 FLAGYSTATIN AVT

POVIDONE-IODINE

10% Dressing

00276731 BETADINE SWAB AIDS PFR

10% Liquid

00158348 BETADINE PFR

SELENIUM SULFIDE

2.5% Lotion

00243000 SELSUN ABB

00594601 VERSEL VAO

SILVER SULFADIAZINE

1% Cream

02010917 DERMAZIN PMS

00323098 FLAMAZINE SNE

09854037 FLAMAZINE 50G SNE *

02170310 SSD ABB

TRICLOSAN

0.5% Liquid

00632317 TERSASEPTIC STI

84:06.00 SMMA - ANTI-INFLAMMATORY AGENTS

AMCINONIDE

0.1% Cream

02192284 CYCLOCORT STI

02247098 RATIO-AMCINONIDE RPH

02246714 TARO-AMCINONIDE TAR

0.1% Lotion

02192276 CYCLOCORT STI

02247097 RATIO-AMCINONIDE RPH

0.1% Ointment

02192268 CYCLOCORT STI

02247096 RATIO-AMCINONIDE RPH

BECLOMETHASONE DIPROPIONATE

0.025% Cream

02089602 PROPADERM SHI

BETAMETHASONE DIPROPIONATE

0.05% Cream

00323071 DIPROSONE SCH

00804991 RATIO-TOPISONE RPH

02122049 ROSONE RIV

01925350 TARO-SONE TAR

0.05% Lotion

00417246 DIPROSONE SCH

00809187 RATIO-TOPISONE RPH

02122030 ROSONE RIV

0.05% Ointment

00344923 DIPROSONE SCH

00805009 RATIO-TOPISONE RPH

02122057 ROSONE RIV

BETAMETHASONE DIPROPIONATE IN PROPYLENE GLYCOL

0.05% Cream

00688622 DIPROLENE SCH

00849650 RATIO-TOPILENE GLYCOL RPH

02122073 ROLENE RIV

0.05% Lotion

00862975 DIPROLENE SCH

01927914 RATIO-TOPILENE GLYCOL RPH

02122065 ROLENE RIV

0.05% Ointment

00629367 DIPROLENE SCH

00849669 RATIO-TOPILENE GLYCOL RPH

02122081 ROLENE RIV

BETAMETHASONE DIPROPIONATE, CLOTRIMAZOLE

0.05% & 1% Cream

00611174 LOTRIDERM SCH

BETAMETHASONE DIPROPIONATE, SALICYLIC ACID

0.05% & 2% Lotion

00578428 DIPROSALIC SCH

02245688 RATIO-TOPISALIC RPH

0.05% & 3% Ointment

00578436 DIPROSALIC SCH

BETAMETHASONE DISODIUM PHOSPHATE

0.05MG/ML Enema

02060884 BETNESOL SHI

BETAMETHASONE VALERATE

0.05% Cream

00535427 RATIO-ECTOSONE RPH

0.1% Cream

00716626 BETADERM TAR

00804541 PREVEX B STI

00535435 RATIO-ECTOSONE RPH

0.05% Lotion

00653209 RATIO-ECTOSONE RPH

0.1% Lotion

00750050 RATIO-ECTOSONE RPH

01940112 RIVASONE RIV

0.05% Ointment

00716642 BETADERM TAR

0.1% Ointment

00716650 BETADERM TAR

0.1% Scalp Lotion

00716634 BETADERM TAR

00027944 VALISONE SCH

BUDESONIDE

0.02MG/ML Enema

02052431 ENTOCORT AZC

CLOBETASOL PROPIONATE

0.05% Cream

02245523 CLOBETASOL PROPIONATE TAR

02213265 DERMOVATE TAR

02024187 GEN-CLOBETASOL GEN

02093162 NOVO-CLOBETASOL NOP

02232191 PMS-CLOBETASOL PMS

01910272 RATIO-CLOBETASOL RPH

0.05% Ointment

02245524 CLOBETASOL PROPIONATE TAR

02213273 DERMOVATE TAR

02026767 GEN-CLOBETASOL GEN

02126192 NOVO-CLOBETASOL NOP

02232193 PMS-CLOBETASOL PMS

01910280 RATIO-CLOBETASOL RPH

0.05% Scalp Lotion

02213281 DERMOVATE TAR

02216213 GEN-CLOBETASOL GEN

02232195 PMS-CLOBETASOL PMS

01910299 RATIO-CLOBETASOL RPH

0.05% Solution

02245522 CLOBETASOL PROPIONATE TAR

CLOBETASONE BUTYRATE

0.05% Cream

02214415 EUMOVATE GSK

0.05% Ointment

02214423 EUMOVATE GSK

DESONIDE

0.05% Cream

02048639 DESOCORT GAC

02229315 PMS-DESONIDE PMS

02154862 TRIDESILON SCN

0.05% Lotion

02115514 DESOCORT GAC

0.05% Ointment

02115522 DESOCORT GAC

02229323 PMS-DESONIDE PMS

02154870 TRIDESILON SCN

DESOXIMETASONE

0.05% Cream

02221918 TOPICORT SAC

0.25% Cream

02221896 TOPICORT SAC

0.05% Gel

02221926 TOPICORT SAC

0.25% Ointment

02221934 TOPICORT SAC

DIFLUCORTOLONE VALERATE

0.1% Cream

00587826 NERISONE STI

00587818 NERISONE OILY STI

0.1% Ointment

00587834 NERISONE STI

DIFLUCORTOLONE VALERATE, SALICYLIC ACID

0.1% & 3% Cream

02028719 NERISALIC OILY STI

FLUOCINOLONE ACETONIDE

0.025% Ointment

02162512 SYNALAR MDC

0.01% Scalp Lotion

00873292 DERMA-SMOOTHE HIL

0.01% Shampoo

02242738 CAPEX GAC

FLUOCINONIDE

0.05% Cream

02161923 LIDEX MDC

00716863 LYDERM OPT

00908274 TOPACTIN NEO *

0.05% Emollient Cream

02163152 LIDEMOL MDC

00598933 TIAMOL TAR

0.05% Gel

02236997 LYDERM OPT

02161974 TOPSYN HLR

0.05% Ointment

02161966 LIDEX HLR

02236996 LYDERM OPT

FLUTICASONE PROPIONATE

0.05% Cream

02089912 CUTIVATE GSK

HALCINONIDE

0.1% Cream

02011921 HALOG WSB

0.1% Ointment

02010283 HALOG WSB

HALOBETASOL PROPIONATE

0.05% Cream

01962701 ULTRAVATE WSB

0.05% Ointment

01962728 ULTRAVATE WSB

HYDROCORTISONE

0.5% Cream

00513288 CORTATE SCH

1% Cream

02086034 BARRIERE HC SHI

00192597 EMO CORT STI

00804533 PREVEX HC STI

2.5% Cream

00595799 EMO CORT STI

100MG/60ML Enema

02112736 CORTENEMA AXC

00230316 HYCORT VAE

0.5% Lotion

00513253 CORTATE SCH

1% Lotion

00192600 EMO CORT STI

00578541 SARNA HC STI

2.5% Lotion

00595802 EMO CORT STI

00641154 EMO CORT SCALP STI

00856711 SARNA HC STI

0.5% Ointment

00513261 CORTATE SCH

00716685 CORTODERM TAR

1% Ointment

00716693 CORTODERM TAR

HYDROCORTISONE ACETATE

10% Aerosol Foam

00579335 CORTIFOAM SQU

0.5% Cream

00716820 HYDERM TAR

1% Cream

00716839 HYDERM TAR

2% Cream

00749834 NEO-HC NEO

1% Lotion

00681997 DERMAFLEX HC NEO

HYDROCORTISONE ACETATE, ZINC SULFATE

0.5% & 0.5% Ointment

02128446 ANODAN-HC ODN

00505773 ANUSOL HC PFI

02209764 EGOZINC-HC PMS

00607789 RATIO-HEMCORT HC RPH

02179547 RIVASOL HC RIV

02247691 SANDOZ-ANUZINC HC SDZ

10MG & 10MG Suppository

02236399 ANODAN-HC ODN

00476285 ANUSOL HC PFI

02210517 EGOZINC HC PMS

00607797 RATIO-HEMCORT HC RPH

02240112 RIVASOL-HC RIV

02242798 SAB-ANUZINC HC SAB

HYDROCORTISONE ACETATE, ZINC SULFATE, PRAMOXINE HCL

0.5% & 0.5% & 1% Ointment

00505781 ANUGESIC HC PFI

02234466 PROCTODAN HC ODN

02247692 SANDOZ-ANUZINC HC PLUS SDZ

10MG & 10MG & 20MG Suppository

00476242 ANUGESIC HC PFI

02240851 PROCTODAN HC ODN

02242797 SAB-ANUZINC HC PLUS SAB

HYDROCORTISONE VALERATE

0.2% Cream

02242984 HYDROVAL TAR

01910124 WESTCORT WSB

0.2% Ointment

02242985 HYDROVAL TAR

01910132 WESTCORT WSB

HYDROCORTISONE, DIBUCAINE HCL, ESCULIN, FRAMYCETIN SULFATE

5MG & 5MG & 10MG & 10MG Ointment

02247322 PROCTOL ODN

02223252 PROCTOSEDYL AXC

02226383 RATIO-PROCTOSONE RPH

02242527 SANDOZ-PROCTOMYXIN HC SDZ

5MG & 5MG & 10MG & 10MG Suppository

02247882 PROCTOL ODN

02223260 PROCTOSEDYL AXC

02226391 RATIO-PROCTOSONE RPH

02242528 SAB-PROCTOMYXIN HC SAB

HYDROCORTISONE, UREA

1% & 10% Cream

00503134 UREMOL HC STI

1% & 10% Lotion

00560022 UREMOL HC STI

MOMETASONE FUROATE

0.1% Cream

00851744 ELOCOM SCH

0.1% Lotion

00871095 ELOCOM SCH

0.1% Ointment

00851736 ELOCOM SCH

02244769 PMS-MOMETASONE PMS

02270862 PMS-MOMETASONE PMS

02248130 RATIO-MOMETASONE RPH

02264749 TARO-MOMETASONE TAR

TRIAMCINOLONE ACETONIDE

0.1% Cream

02194058 ARISTOCORT R VAO

0.5% Cream

02194066 ARISTOCORT C VAO

0.1% Ointment

02194031 ARISTOCORT R VAO

0.1% Paste

01964054 ORACORT TAR

84:08.00 SMMA - ANTIPRURITICS AND LOCAL ANESTHETICS

LIDOCAINE HCL

2% Liquid

01968823 LIDODAN VISCOUS ODN

00811874 PMS-LIDOCAINE VISCOUS PMS

00001686 XYLOCAINE VISCOUS AZC

LIDOCAINE, PRILOCAINE

2.5% & 2.5% Cream

00886858 EMLA AZC

2.5% & 2.5% Patch

02057794 EMLA AZC

PHENAZOPYRIDINE HCL

100MG Tablet

00271489 PHENAZO VAE

200MG Tablet

00454583 PHENAZO VAE

84:16.00 SMMA - CELL STIMULANTS AND PROLIFERANTS

TRETINOIN

0.01% Cream

00897329 RETIN A JAJ

00657204 STIEVA-A STI

0.025% Cream

00897310 RETIN A JAJ

00578576 STIEVA-A STI

0.05% Cream

00443794 RETIN A JAJ

00518182 STIEVA-A STI

0.1% Cream

00870021 RETIN A JAJ

00662348 STIEVA-A FORTE STI

0.01% Gel

00587958 STIEVA-A STI

01926462 VITAMIN A ACID SAC

0.025% Gel

00587966 STIEVA-A STI

01926470 VITAMIN A ACID SAC

0.05% Gel

00641863 STIEVA-A STI

01926489 VITAMIN A ACID SAC

0.025% Solution

00578568 STIEVA-A STI

84:24.12 BASIC OINTMENTS AND PROTECTANTS

DIMETHICONE

20% Cream

02060841 BARRIERE WPC

PETROLATUM

67% Cream

00635189 PREVEX STI

ZINC OXIDE

15% Cream

02215799 ZINC HJS

15% Ointment

00907480 ZINC UNK *

25% Ointment

00532576 IHLES PASTE RPH

40% Ointment

02239160 ZINCOFAX EXTRA STRENGTH GSK

84:28.00 KERATOLYTIC AGENTS

ADAPALENE

0.1% Cream

02231592 DIFFERIN GAC

0.1% Gel

02148749 DIFFERIN GAC

CANTHARIDIN

0.7% Liquid

00589497 CANTHACUR PMS

00619035 CANTHARONE DOR

CANTHARIDIN, PODOPHYLLIN, SALICYLIC ACID

1% & 2% & 30% Liquid

00772011 CANTHARONE PLUS DOR

1% & 5% & 30% Liquid

00589500 CANTHACUR PS PMS

DITHRANOL

0.1% Cream

00537594 ANTHRANOL-1 MTI

0.2% Cream

00537608 ANTHRANOL-2 MTI

0.4% Lotion

00695351 ANTHRASCALP MTI

1% Ointment

00566756 ANTHRAFORTE MTI

2% Ointment

00566748 ANTHRAFORTE MTI

FORMALDEHYDE, LACTIC ACID, SALICYLIC ACID

10% & 5% & 25% Ointment

00513091 DUOPLANT STI

LACTIC ACID, SALICYLIC ACID

17% & 17% Liquid

00370576 DUOFILM STI

PODOFILOX

0.5% Solution

01945149 CONDYLINE CDX

PODOPHYLLIN

25% Liquid

00598208 PODOFILM PMS

SALICYLIC ACID

27% Gel

01939645 DUOFORTE 27 STI

20% Liquid

00690333 SOLUVER DER

26% Liquid

00754951 OCCLUSAL HP GEN

27% Liquid

00837733 SOLUVER PLUS DER

15% Plaster

02050285 TRANS PLANTAR WSB

02050293 TRANS-VER-SAL WSB

40% Plaster

01974335 CLEAR AWAY SCH

4% Shampoo

00666106 SEBCUR DER

SALICYLIC ACID, TRICLOSAN

2% & 0.5% Gel

00754927 PANOXYL ACNE STI

84:32.00 KERATOPLASTIC AGENTS

COAL TAR

10% Gel

00344508 TARGEL ODN

20% Liquid

00358495 ODANS LIQUOR CARBONIS DETERGENT ODN

1% Shampoo

00632295 TERSA-TAR MILD STI

3% Shampoo

00632309 TERSA-TAR STI

4.3% Shampoo

00740314 PENTRAX GEN

2.5% Solution

01908855 BALNETAR WSB

COAL TAR, JUNIPER TAR, PINE TAR

1% Shampoo

00249866 POLYTAR STI

COAL TAR, JUNIPER TAR, PINE TAR, ZINC PYRITHIONE

0.166% & 0.166% & 0.166% & 1% Shampoo

00628042 MULTI-TAR PLUS MILD VAE *

0.33% & 0.33% & 0.33% & 1% Shampoo

02240942 MULTITAR PLUS VAE

COAL TAR, SALICYLIC ACID

8% & 2% Gel

00560448 P&S PLUS BAK *

10% & 3% Liquid

00510335 TARGEL SA ODN

10% & 4% Shampoo

00666114 SEBCUR-T DER

COAL TAR, SALICYLIC ACID, SULFUR

2% & 2% & 2% Shampoo

00444448 STEREX IDE

84:50.06 PIGMENTING AGENTS

METHOXSALEN

10MG Capsule

00252654 OXSORALEN VAE

01946374 OXSORALEN VAE

00646237 ULTRA MOP CDX

1% Lotion

01907476 OXSORALEN VAE

00698059 ULTRA MOP CDX

84:92.00 MISCELLANEOUS SKIN AND MUCOUS MEMBRANE AGENTS

ACITRETIN

Soriatane should be used with caution in women of childbearing potential due to its teratogenicity. Pregnancy must be excluded. Effective contraception must be used. Manufacturer's literature regarding contraindications and warnings, should be consulted prior to prescribing or dispensing this drug.

10MG Capsule

02070847 SORIATANE HLR

25MG Capsule

02070863 SORIATANE HLR

CALCIPOTRIOL

50MCG/G Cream

02150956 DOVONEX LEO

50MCG/G Ointment

01976133 DOVONEX LEO

50MCG/ML Solution

02194341 DOVONEX LEO

CAPSAICIN

0.025% Cream

02157101 CAPSAICIN VAO

02244952 ZODERM EUO

00740306 ZOSTRIX GEN

0.075% Cream

02004240 ZOSTRIX HP GEN

0.075% Ointment

02157128 CAPSAICIN HP VAO

COLLAGENASE

250U Ointment

02063670 SANTYL KNO

FLUOROURACIL

5% Cream

00330582 EFUDEX VAE

ISOTRETINOIN

Accutane should be used with caution in women of childbearing potential due to its teratogenicity. Pregnancy must be excluded. Effective contraception must be used. Manufacturer's literature regarding contraindications and warnings should be consulted prior to prescribing or dispensing this drug.

10MG Capsule

00582344 ACCUTANE HLR

02257955 CLARUS PRE

40MG Capsule

00582352 ACCUTANE HLR

02257963 CLARUS PRE

PIMECROLIMUS

Limited use benefit (prior approval required).

For patients who have failed topical corticosteroid therapy or have experienced side effects from such treatment.

Note: Contraindicated in children less than 2 years of age.

1% Cream

02247238 ELIDEL NVC

TACROLIMUS (PROTOPIC)

Limited use benefit (prior approval required).

For patients who have failed topical corticosteroid therapy or have experienced side effects from such treatment.

Note: Contraindicated in children less than 2 years of age.

0.03% Ointment

02244149 PROTOPIC AST

0.1% Ointment

02244148 PROTOPIC AST

TAZAROTENE

0.05% Cream

02243894 TAZORAC ALL

0.1% Cream

02243895 TAZORAC ALL

0.05% Gel

02230784 TAZORAC ALL

0.1% Gel

02230785 TAZORAC ALL

VITAMIN E

30IU Ointment

01910787 VITAMIN E JLF