Drug Benefit List 2010

86:00 SMOOTH MUSCLE RELAXANTS

86:12.00 GENITOURINARY SMOOTH MUSCLE RELAXANTS

DARIFENACIN HYDROBROMIDE

7.5mg Long Acting Tablet

2273217 ENABLEX NOV

15mg Long Acting Tablet

2273225 ENABLEX NOV

FLAVOXATE HCL

200mg Tablet

2244842 APO-FLAVOXATE APX

728179 URISPAS PAL

OXYBUTYNIN CHLORIDE

1mg/mL Syrup

2231089 APO-OXYBUTYNIN APX

2223376 PMS-OXYBUTYNIN PMS

2.5mg Tablet

2240549 PMS-OXYBUTYNIN PMS

5mg Tablet

2163543 APO-OXYBUTYNIN APX

2241285 DOM-OXYBUTYNIN DPC

2230800 GEN-OXYBUTYNIN GEN

2230394 NOVO-OXYBUTYNIN NOP

2158590 NU-OXYBUTYN NXP

2220636 OXYBUTYNINE PDL

2239073 PENTA-OXYBUTYNIN PEN

2240550 PMS-OXYBUTYNIN PMS

2299364 RIVA-OXYBUTYNIN RIV

SOLIFENACIN SUCCINATE

Limited use benefit (prior approval required).

For symptomatic relief in patients with an overactive bladder with symptoms of urinary frequency, urgency or urge incontinence in patients who have failed on or are intolerant of therapy with oxybutynin.

5mg Tablet

2277263 VESICARE AST

10mg Tablet

2277271 VESICARE AST

TOLTERODINE

Limited use benefit (prior approval required).

For the symptomatic relief of patients with an overactive bladder with symptoms of urinary frequency, urgency or urge incontinence or any combination of these in patients who have failed on or are intolerant of therapy with oxybutynin.

2mg Extended Release Capsule

2244612 DETROL LA PFI

4mg Extended Release Capsule

2244613 DETROL LA PFI

1mg Tablet

2239064 DETROL PFI

2mg Tablet

2239065 DETROL PFI

TROSPIUM CHLORIDE

Limited use benefit (prior approval required).

For the symptomatic relief of patients with an overactive bladder with symptoms of urinary frequency, urgency or urge incontinence or any combination of these in patients who have failed on or are intolerant of therapy with oxybutynin.

20mg Tablet

2275066 TROSEC ORY

86:16.00 RESPIRATORY SMOOTH MUSCLE RELAXANTS

AMINOPHYLLINE

225mg Sustained Release Tablet

2014270 PHYLLOCONTIN PFR

350mg Sustained Release Tablet

2014289 PHYLLOCONTIN PFR

OXTRIPHYLLINE

20mg/mL Elixir

476366 CHOLEDYL PFI

792942 PMS-OXTRIPHYLLINE PMS

100mg Tablet

441724 APO-OXTRIPHYLLINE APX

200mg Tablet

441732 APO-OXTRIPHYLLINE APX

300mg Tablet

511692 APO-OXTRIPHYLLINE APX

THEOPHYLLINE

5.33mg/mL Elixir

575151 PMS-THEOPHYLLINE PMS

466409 PULMOPHYLLIN RIV

627410 THEOPHYLLINE ATL

5.33mg/mL Solution

1966219 THEOLAIR MMH

100mg Sustained Release Tablet

692689 APO-THEO APX

2230085 NOVO-THEOPHYL SR NOP

200mg Sustained Release Tablet

692697 APO-THEO LA APX

2230086 NOVO-THEOPHYL SR NOP

300mg Sustained Release Tablet

692700 APO-THEO LA APX

2230087 NOVO-THEOPHYL SR NOP

400mg Sustained Release Tablet

2014165 UNIPHYL PFR

600mg Sustained Release Tablet

2014181 UNIPHYL PFR