Drug Benefit List - April 2009

86:00 SMOOTH MUSCLE RELAXANTS

86:12.00 GENITOURINARY SMOOTH MUSCLE RELAXANTS

FLAVOXATE HCL

200MG Tablet

02244842 APO-FLAVOXATE APX

02245480 PMS-FLAVOXATE PMS

00728179 URISPAS PAL

OXYBUTYNIN CHLORIDE

1MG/ML Syrup

02231089 APO-OXYBUTYNIN APX

02223376 PMS-OXYBUTYNIN PMS

2.5MG Tablet

02240549 PMS-OXYBUTYNIN PMS

5MG Tablet

02163543 APO-OXYBUTYNIN APX

02241285 DOM-OXYBUTYNIN DPC

02230800 GEN-OXYBUTYNIN GEN

02230394 NOVO-OXYBUTYNIN NOP

02158590 NU-OXYBUTYN NXP

02220636 OXYBUTYNINE PDL

02239073 PENTA-OXYBUTYNIN PEN

02240550 PMS-OXYBUTYNIN PMS

02299364 RIVA-OXYBUTYNIN RIV

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

02244612 DETROL LA PFI

4MG Extended Release Capsule

02244613 DETROL LA PFI

1MG Tablet

02239064 DETROL PFI

2MG Tablet

02239065 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

02275066 TROSEC ORY

86:16.00 RESPIRATORY SMOOTH MUSCLE RELAXANTS

AMINOPHYLLINE

225MG Sustained Release Tablet

02014270 PHYLLOCONTIN PFR

350MG Sustained Release Tablet

02014289 PHYLLOCONTIN PFR

OXTRIPHYLLINE

20MG/ML Elixir

00476366 CHOLEDYL PFI

00792942 PMS-OXTRIPHYLLINE PMS

100MG Tablet

00441724 APO-OXTRIPHYLLINE APX

200MG Tablet

00441732 APO-OXTRIPHYLLINE APX

300MG Tablet

00511692 APO-OXTRIPHYLLINE APX

THEOPHYLLINE

5.33MG/ML Elixir

00575151 PMS-THEOPHYLLINE PMS

00466409 PULMOPHYLLIN RIV

00627410 THEOPHYLLINE ATL

5.33MG/ML Solution

01966219 THEOLAIR MMH

100MG Sustained Release Tablet

00692689 APO-THEO APX

02230085 NOVO-THEOPHYL SR NOP

200MG Sustained Release Tablet

00692697 APO-THEO LA APX

02230086 NOVO-THEOPHYL SR NOP

300MG Sustained Release Tablet

00692700 APO-THEO LA APX

02230087 NOVO-THEOPHYL SR NOP

400MG Sustained Release Tablet

02014165 UNIPHYL PFR

600MG Sustained Release Tablet

02014181 UNIPHYL PFR