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PRESCRIPTION DRUG BENEFITS |
233 KB |
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Quantity Limit or High Dose Exceptions Only
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39 KB |
PDF File
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TEKAMLO 150 MG-5 MG TABLET, TEKAMLO 150 MG-10 MG TABLET, TEKTURNA 150 MG TABLET, TEKTURNA HCT 150-12.5 MG TAB, TEKTURNA HCT 150-25 MG TABLET |
64 KB |
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AMTURNIDE 300-5-25 MG TAB, TEKTURNA 300 MG TABLET, TEKTURNA HCT 300-12.5 MG TAB, TEKTURNA HCT 300-25 MG TABLET |
64 KB |
PDF File
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zafirlukast (ACCOLATE) |
59 KB |
PDF File
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STAR and STAR KID Members Only
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ABSORICA cap, isotretinoin cap |
126 KB |
PDF File
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STAR and STAR KIDS Members Only
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CLEOCIN-T LOTION, clindamycin gel (CLINDAGEL), clindamycin lotion, dapsone gel, erythromycin pads (ERY PADS), EVOCLIN FOAM, sulfacetamide lotion |
21 KB |
PDF File
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tocilizumab (ACTEMRA) |
63 KB |
PDF File
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pioglitazone (ACTOS), pioglitazone/metformin (ACTOPLUS MET), pioglitazone/glimepiride (DUETACT) |
148 KB |
PDF File
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clonidine ER |
58 KB |
PDF File
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NOTE: Drugs listed are a representative list, only. See plan formulary to verify coverage status. Formulary available at www.txvendordrug.com
|
amphetamine salts (MYDAYIS), amphetamine/dextroamphetamine salts (ADDERALL XR, DYANAVEL XR, ADZENYS ER, ADZENYS XR-ODT), AZSTARYS, dexmethylphenidate (FOCALIN XR), dextroamphetamine (DEXEDRINE SPANSULE), methylphenidate (ADHANSIA XR, APTENSIO XR, CONCERTA, COTEMPLA XR-ODT, DAYTRANA TD, JORNAY PM, QUILLICHEW ER, QUILLIVANT XR, RITALIN LA), lisdexamfetamine (VYVANSE capsule, VYVANSE chewable tablet) |
199 KB |
PDF File
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NOTE: Drugs listed are a representative list, only. See plan formulary to verify coverage status. Formulary available at www.txvendordrug.com
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amphetamine/dextroamphetamine salts (ADDERALL), amphetamine sulfate (EVEKEO, EVEKEO ODT), dexmethylphenidate (FOCALIN), dextroamphetamine (DEXEDRINE, PROCENTRA, ZENZEDI), methamphetamine (DESOXYN), methylphenidate (METHYLIN, RITALIN) |
196 KB |
PDF File
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NOTE: Drugs listed are a representative list, only. See plan formulary to verify coverage status. Formulary available at www.txvendordrug.com
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guanfacine SR (INTUNIV), atomoxetine (STRATTERA) |
59 KB |
PDF File
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CERDELGA, CEREZYME, ELELYSO, miglustat (ZAVESCA), VPRIV |
20 KB |
PDF File
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imiquimod 5% cream (ALDARA) |
45 KB |
PDF File
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nitazoxanide (ALINIA) tablets |
59 KB |
PDF File
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ramipril (ALTACE), valsartan (DIOVAN) |
169 KB |
PDF File
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donepezil (ARICEPT), galantamine (RAZADYNE ER), titration pack (NAMENDA), memantine extended-release (NAMENDA XR), NAMZARIC, NAMZARIC PACK, rivastigmine patch |
30 KB |
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Osmolex ER, Gocovri |
64 KB |
PDF File
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lubiprostone (AMITIZA) |
64 KB |
PDF File
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dalfampridine (AMPYRA) |
53 KB |
PDF File
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STAR and STAR KID Members Only
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amlodipine/olmesartan (AZOR), amlodipine/valsartan/hydrochlorothiazide (EXFORGE), LOTREL, olmesartan medoxomil/amlodipine/hydrochlorothiazide (TRIBENZOR), telmisartan/amlodipine, trandolapril/verapamil (TARKA) |
126 KB |
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azilsartan (EDARBI), azilsartan/chlorthalidone (EDARBYCLOR), benazepril/hydrochlorothiazide (LOTENSIN HCT), candesartan/hydrochlorothiazide (ATACAND HCT), candesartan (ATACAND), captopril/hydrochlorothiazide (CAPOZIDE), captopril (CAPOTEN), enalapril/hctz (VASERETIC), enalapril (VASOTEC), fosinopril/hydrochlorothiazide (MONOPRIL HCT), irbesartan/hctz (AVALIDE), irbesartan (AVAPRO), losartan (COZAAR), moexipril (UNIVASC), olmesartan/hydrochlorothiazide (BENICAR HCT), olmesartan (BENICAR), perindopril (ACEON), lisinopril (PRINIVIL), lisinopril (QBRELIS), lisinopril/hctz (ZESTORETIC), quinapril (ACCUPRIL), quinapril/hydrochlorothiazide (ACCURETIC), telmisartan/hydrochlorothiazide (MICARDIS HCT), telmisartan (MICARDIS), trandolapril (MAVIK), valsartan/hydrochlorothiazide (DIOVAN HCT), valsartan (DIOVAN) |
63 KB |
PDF File
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STAR and STAR KIDS Members Only
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COUMADIN, fondaparinux (ARIXTRA), FRAGMIN, FRAGMIN INJ, LOVENOX, SAVAYSA |
126 KB |
PDF File
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bupropion (APLENZIN, FORFIVO XL, WELLBUTRIN), desvenlafaxine (PRISTIQ), EMSAM, FETZIMA, MARPLAN, mirtazapine (REMERON), NARDIL, nefazodone, tranylcypromine, TRINTELLIX, venlafaxine (EFFEXOR XR), VIIBRYD |
30 KB |
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citalopram (CELEXA), escitalopram (LEXAPRO), fluoxetine (PROZAC), fluvoxamine, paroxetine (PAXIL), sertraline (ZOLOFT) |
30 KB |
PDF File
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STAR and STAR KIDS Members Only
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amoxapine, clomipramine (ANAFRANIL), desipramine, imipramine pamoate (TOFRANIL), maprotiline, nortriptyline (PAMELOR), protriptyline, trimipramine |
127 KB |
PDF File
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STAR and STAR KIDS Members Only
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meclizine (ANTIVERT), GIMOTI, dronabinol (MARINOL), metoclopramide (REGLAN), prochlorperazine (COMPRO), scopolamine, TRANSDERM-SC, trimethobenzamide, ZUPLENZ |
21 KB |
PDF File
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AKYNZEO, ANZEMET, aprepitant (EMEND), EMEND SUSPENSION, GRANISETRON, SANCUSO |
28 KB |
PDF File
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STAR and STAR KIDS Members Only
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BREXAFEMME, CRESEMBA, DIFLUCAN, flucytosine (ANCOBON), griseofulvin, itraconazole (SPORANOX, TOLSURA), ORAVIG, posaconazole (NOXAFIL), voriconazole (VFEND) |
126 KB |
PDF File
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STAR and STAR KIDS Members Only
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athletes foot spray, ciclopirox (LOPROX), clotrimazole/betamethasone, econazole, FUNGOID TINCTURE, ketoconazole (EXTINA), luliconazole, MENTAX, miconazole/petrolatum/zinc oxide, naftifine, nystatin/triamcinolone, oxiconazole (OXISTAT), VUSION |
126 KB |
PDF File
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STAR and STAR KIDS Members Only
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24-Hour Allergy, Allergy D, Allergy Relief, Allergy Relief-D, antihistamine, cetirizine/pseudoephedrine, cetirizine, desloratadine (CLARINEX), fexofenadine/pseudoephedrine, fexofenadine, levocetirizine, loratadine-D, SEMPREX-D |
126 KB |
PDF File
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STAR and STAR KIDS Members Only
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CATAPRES tab, clonidine patch, methyldopa/hydrochlorothiazide |
126 KB |
PDF File
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STAR and STAR KIDS Members Only
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colchicine cap/tab (COLCRYS), febuxostat (ULORIC), GLOPERBA, ZYLOPRIM |
126 KB |
PDF File
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STAR and STAR KIDS Members Only
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CAMBIA, dihydroergotamine (D.H.E. 45, MIGRANAL), REYVOW |
21 KB |
PDF File
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STAR and STAR KIDS Members Only
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almotriptan, naratriptan (AMERGE), eletriptan (RELPAX), frovatriptan (FROVA), sumatriptan (ONZETRA, ZEMBRACE), MAXALT, sumatriptan/naproxen (TREXIMET), zolmitriptan tab/ODT (ZOMIG**) |
126 KB |
PDF File
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STAR and STAR KIDS Members Only
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EURAX, LINDANE shampoo, malathion lotion (OVIDE), ivermectin (SKLICE) lotion |
126 KB |
PDF File
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STAR and STAR KIDS Members Only
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carbidopa/levodopa tab (SINEMET), bromocriptine, carbidopa tab (LODOSYN), entacapone (COMTAN), DUOPA susp, GOCOVRI, pramipexole ER (MIRAPEX ER), NEUPRO, ONGENTYS CAP, OSMOLEX ER, rasagiline (AZILECT), ropinirole ER (REQUIP XL 6mg and 12mg), RYTARY, selegiline, STALEVO, tolcapone (TASMAR), ZELAPAR |
212 KB |
PDF File
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NOTE: Drugs listed are a representative list, only. See plan formulary to verify coverage status. Formulary available at www.txvendordrug.com
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ABILIFY, ABILIFY DISCMELT, ABILIFY MYCITE, amitriptyline/perphenazine, aripiprazole, CAPLYTA, chlorpromazine, chlorpromazine inj, clozapine, CLOZARIL, FANAPT, FAZACLO, fluphenazine, fluphenazine inj, GEODON, GEODON inj, haloperidol lactate injection, haloperidol tablet, INVEGA, LATUDA, LYBALVI, loxapine, loxitane, MOLINDONE, NUPLAZID, olanzapine, olanzapine inj, olanzapine/fluoxetine, ORAP, paliperidone, perphenazine, pimozide, quetiapine, quetiapine ER, REXULTI, RISPERDAL, risperidone, SAPHRIS, SECUADO, SEROQUEL, SEROQUEL XR, SYMBYAX, thioridazine, thiothixene, trifluoperazine, VERSACLOZ, VRAYLAR, ziprasidone, ZYPREXA, ZYPREXA ZYDIS |
37 KB |
PDF File
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STAR and STAR KIDS Members Only
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RELENZA, rimantadine, SITAVIG, TAMIFLU, VALTREX, XOFLUZA |
126 KB |
PDF File
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alprazolam (XANAX) |
64 KB |
PDF File
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chlordiazepoxide, meprobamate, oxazepam |
72 KB |
PDF File
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clonazepam (KLONOPIN), diazepam |
75 KB |
PDF File
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clorazepate (TRANXENE) |
74 KB |
PDF File
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lorazepam |
69 KB |
PDF File
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darbepoetin alfa (ARANESP) |
26 KB |
PDF File
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rilonacept (ARCALYST) |
59 KB |
PDF File
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amikacin (ARIKAYCE) |
70 KB |
PDF File
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teriflunomide (AUBAGIO) |
75 KB |
PDF File
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All Plans Except Texas Children’s Health Plan
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deutetrabenazine (AUSTEDO), tetrabenazine (XENAZINE) |
102 KB |
PDF File
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Texas Children’s Health Plan Only
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deutetrabenazine (AUSTEDO), tetrabenazine (XENAZINE) |
118 KB |
PDF File
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rosiglitazone (AVANDIA) |
137 KB |
PDF File
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doxazosin (CARDURA), terazosin, dutasteride-tamsulosin (JALYN), dutasteride (AVODART), PROSCAR, silodosin (RAPAFLO), FLOMAX |
30 KB |
PDF File
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belimumab (BENLYSTA) |
63 KB |
PDF File
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STAR and STAR KIDS Members Only
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ALBUTEROL AEROSOL HFA, ALBUTEROL TABLETS, ARCAPTA CAPSULES, BROVANA, levalbuterol nebulizer (XOPENEX), metaproterenol syrup, PERFOROMIST, PROAIR RESPICLICK, SEREVENT DISKUS, STRIVERDI RESPIMAT, terbutaline tablets |
22 KB |
PDF File
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STAR and STAR KIDS Members Only
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betaxolol, BYSTOLIC, carvedilol ER (COREG CR), COREG, metoprolol/hydrochlorothiazide, nadolol, pindolol, propranolol/hydrochlorothiazide, propranolol ER (INDERAL LA, INDERAL XL, INNOPRAN XL), SOTYLIZE, timolol maleate tab, TENORMIN, TENORETIC, TOPROL XL, ZIAC |
126 KB |
PDF File
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STAR and STAR KIDS Members Only
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CHENODAL, CHOLBAM, OCALIVA, URSO, URSO FORTE, ursodiol 300mg cap |
126 KB |
PDF File
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darifenacin (ENABLEX), tolterodine (DETROL), tolterodine ER (DETROL LA), oxybutynin (DITROPAN XL), flavoxate, GELNIQUE, MYRBETRIQ, OXYTROL, solifenacin, trospium, trospium ER, VESICARE LS |
29 KB |
PDF File
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22 KB |
PDF File
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STAR and STAR KIDS Members Only
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risedronate (ACTONEL), alendronate soln, ATELVIA, ibandronate (BONIVA), calcitonin, raloxifene, FOSAMAX, FOSAMAX+D, TERIPARATIDE, TYMLOS |
126 KB |
PDF File
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doxylamine/pyridoxine (BONJESTA, DICLEGIS) |
58 KB |
PDF File
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buprenorphine/naloxone (BUNAVAIL, SUBOXONE, ZUBSOLV) |
55 KB |
PDF File
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buprenorphine |
55 KB |
PDF File
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odevixibat (BYLVAY) |
58 KB |
PDF File
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CALAN SR, CARDIZEM, CARDIZEM CD, CARDIZEM LA, isradipine capsule, KATERZIA, matzim la tablet, nicardipine capule, nifedipine capsule (ADALAT CC), nimodipine, nisoldipine, NORVASC, NYMALIZE, PROCARDIA, PROCARDIA XL, verapamil (VERELAN), VERELAN PM |
30 KB |
PDF File
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CARISOPRODOL, CARISOPRODOL-ASPIRIN, CARISOPRODOL COMPOUND TAB, SOMA |
143 KB |
PDF File
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STAR and STAR KIDS Members Only
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amoxicillin/potassium clavulanate, amoxicillin and clavulanate potassium chewable, cefaclor, cefaclor ER, cefadroxil, cefixime (SUPRAX), cefpodoxime tablet, cefpodoxime proxetil oral suspension, cephalexin tablet |
126 KB |
PDF File
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cetirizine 5mg |
23 KB |
PDF File
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erenumab (AIMOVIG), fremanezumab (AJOVY), galcanezumab (EMGALITY) |
97 KB |
PDF File
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certolizumab pegol (CIMZIA) |
64 KB |
PDF File
|
STAR and STAR KIDS Members Only
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GRANIX, LEUKINE, NEULASTA, UDENYCA, ZARXIO, ZIEXTENZO |
126 KB |
PDF File
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Compound Drugs over $200
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30 KB |
PDF File
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18 KB |
PDF File
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18 KB |
PDF File
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STAR and STAR KIDS Members Only
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BEVESPI, DALIRESP, DUAKLIR, INCRUSE, LONHALA, SEEBRI, SPIRIVA Respimat (Handihaler is PDL), TUDORZA, UTIBRON, YUPELRI |
126 KB |
PDF File
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carvedilol ER (COREG CR) capsules |
29 KB |
PDF File
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secukinumab (COSENTYX) |
62 KB |
PDF File
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Table A
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ALA-HIST PE TABLET, APRODINE TABLET, BROTAPP LIQUID, CHEST CONGESTION RELIEF PE, CHEST CONGESTION RELIEF TABLET, CHL MUCINEX CHEST CONGEST LIQ, CHLD MUCINEX STUFFY NOSE-COLD, CHLO TUSS LIQUID, COUGH SYRUP 200 MG/10 ML, DECONEX IR TABLET, DIMAPHEN ELIXIR, ED BRON GP LIQUID, ED CHLORPED D PEDIATRIC DROPS, ED-A-HIST PSE TABLET, GUAIFENESIN 100 MG/5 ML SYRUP, HISTEX-PE SYRUP, IOPHEN NR LIQUID, KID'S MUCINEX MINI-MELTS PACK, LODRANE D CAPSULE, LORTUSS LQ LIQUID, MAXIPHEN TABLET, MUCUS RELIEF 400 MG TABLET, MUCUS RELIEF SINUS TABLET, NOSE DROPS, ORGAN-I NR 200 MG TABLET, POLY-HIST PD LIQUID, POLY-VENT IR TABLET, PROMETHAZINE VC SYRUP, Q-TUSSIN 100 MG/5 ML SOLUTION, RESCON-GG LIQUID, RESPAIRE-30 CAPSULE, ROBAFEN 100 MG/5 ML SYRUP, RU-HIST D 10-4 MG TABLET, RYNEX PE LIQUID, RYNEX PSE LIQUID, SILTUSSIN SA 100 MG/5 ML SYR, STAHIST AD LIQUID, STAHIST AD TABLET, TUSSIN 100 MG/5 ML SYRUP |
131 KB |
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Table B
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ALAHIST, ALA-HIST DM LIQUID, ALLFEN DM TABLET, AP-HIST DM LIQUID, BROMFED DM COUGH SYRUP, BROMPHENIR-PSEUDOEPHED-DM SYR, BROTAPP DM LIQUID, CHILD DELSYM, CHILD MUCINEX, CHILDREN COLD & COUGH DM ELIXI, COUGH DM 30 MG/5 ML SUSPENSION,
DALLERGY, DECONEX DMX TABLET, DELSYM 30 MG/5 ML SUSPENSION, DEXTROMETHORPHAN ER 30 MG/5 ML, DIMAPHEN DM ELIXIR, ED A-HIST, ENDACOF-DM LIQUID, EXTRA ACTION COUGH SYRUP, HISTEX-DM SYRUP, IOPHEN DM-NR LIQUID, KIDKARE COUGH & COLD LIQUID,
LOHIST, LORTUSS DM LIQUID, MAXIPHEN DM TABLET, M-END DMX LIQUID, M-HIST DM LIQUID, MUCINEX, NASAL DECONGESTANT 0.05% SPRAY, NASOPEN PE LIQUID, NINJACOF LIQUID, NOHIST, PEDIATRIC COUGH-COLD LIQUID, PHENYLEPHRINE-PYRILAMINE 10-25, POLY HIST, POLYTUSSIN DM SYRUP, POLY-VENT DM TABLET, PROMETHAZINE-DM SYRUP, Q-TUSSIN DM SYRUP, RESCON-DM LIQUID, ROBAFEN, RYMED TABLET, RYNEX DM LIQUID, SILTUSSIN, SM NASAL SPRAY 0.05%, SM TUSSIN, TUSSIN, VANACOF, VANATAB |
120 KB |
PDF File
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Table C
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BENZONATATE |
102 KB |
PDF File
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Table D
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DELSYM COUGH + CHEST CONGST DM LQ, GUAIFENESIN ER 1,200 MG TABLET, GUAIFENESIN/PSE ER 600-60 MG, MUCINEX D ER 1,200-120 MG TABLET, MUCINEX D ER 600-60 MG TABLET, MUCINEX DM ER 1,200-60 MG TAB, MUCINEX DM ER 600-30 MG TABLET, MUCINEX ER 1,200 MG TABLET, MUCINEX ER 600 MG TABLET, MUCINEX FAST-MAX CONGEST-COUGH, MUCINEX FAST-MAX DM MAX LIQUID, RESCON TABLET, ROBAFEN COUGH 15 MG LIQUIDGEL, SUDOGEST SINUS & ALLERGY TAB |
113 KB |
PDF File
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SINUS CONGESTION/PAIN TAB 5-325MG, MAPAP COLD FORMULA TAB, ALL-NITE COLD AND FLU LIQUID, COLD/FLU CAP DAYTIME, COLD AND FLU NIGHTTIME CAP, DURAFLU TAB, MUCINEX FAST-MAX SEVERE COLD LIQUID, MUCINEX FAST-MAX LIQUID, MUCINEX FAST-MAX DAY/NIGHT LIQUID, MUCINEX FAST-MAX DAY/NIGHT TAB, MUCINEX MULTI-SYMPTOM LIQUID, SEVERE COLD/COUGH PAK, FLU HBP TAB 10-325-2, SINUS RELIEF TAB 5-325MG, NIGHTTIME COLD/FLU LIQUID, NIGHTTIME COLD/FLU LIQUID, NIGHTTIME COLD/FLU LIQUID, NIGHTTIME COLD/FLU LIQUID, DAYTIME COLD/FLU LIQUID 10-5-325, DAYTIME COLD/FLU RELIEF LIQUID 10/5/325, SINUS CONGESTION/PAIN SEVERE TAB, ALLERGY MULTI SYMPTOM TAB, SEVERE COLD/FLU TAB, NIGHTTIME COLD/FLU LIQUID, COLD/FLU RELIEF DAYTIME CAP, COLD/FLU REL CAP NITETIME, COLD AND FLU RELIEF NIGHTTIME CAP, SEVERE COLD AND FLU TAB, SINUS+HEADACHE TAB 5-325MG |
21 KB |
PDF File
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celecoxib (CELEBREX) |
68 KB |
PDF File
|
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meloxicam 15mg (MOBIC) |
66 KB |
PDF File
|
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meloxicam 7.5mg (MOBIC) |
71 KB |
PDF File
|
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cyclobenzaprine (FLEXERIL / AMRIX) |
138 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
ENSPRYNG INJ, ARCALYST |
21 KB |
PDF File
|
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desmopressin injectable (DDAVP) |
21 KB |
PDF File
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desmopressin oral (DDAVP) |
51 KB |
PDF File
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|
|
19 KB |
PDF File
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stiripentol (DIACOMIT) |
49 KB |
PDF File
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diclofenac 1.5% topical solution, diclofenac 2% topical solution (PENNSAID 2% PUMP) |
57 KB |
PDF File
|
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diclofenac 3% gel (SOLARAZE 3% GEL) |
53 KB |
PDF File
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divalproex 250mg (DEPAKOTE ER) |
23 KB |
PDF File
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apomorphine hydrochloride (KYNMOBI) |
74 KB |
PDF File
|
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alogliptin 6.25 mg (NESINA 6.25 MG), JANUVIA 25 MG, ONGLYZA 2.5 MG, TRADJENTA 5 MG |
136 KB |
PDF File
|
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alogliptin 12.5 mg (NESINA 12.5 MG), JANUVIA 50 MG |
61 KB |
PDF File
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alogliptin 25 mg (NESINA 25 MG), JANUVIA 100 MG, ONGLYZA 5 MG |
139 KB |
PDF File
|
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alogliptin-metformin (KAZANO), alogliptin-pioglitazone (OSENI), GLYXAMBI, JANUMET (XR), JENTADUETO (XR), KOMBIGLYZE XR, QTERN, STEGLUJAN |
137 KB |
PDF File
|
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dupilumab (DUPIXENT) |
74 KB |
PDF File
|
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dupilumab (DUPIXENT) |
30 KB |
PDF File
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deflazacort (EMFLAZA) |
76 KB |
PDF File
|
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deflazacort (EMFLAZA) |
26 KB |
PDF File
|
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etanercept (ENBREL) |
61 KB |
PDF File
|
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satralizumab (ENSPRYNG) |
68 KB |
PDF File
|
NOTE: Drugs listed are a representative list, only. See plan formulary to verify coverage status. Formulary available at www.txvendordrug.com
|
ALDURAZYME, CEPROTIN, ELAPRASE, FABRAZYME, LUMIZYME, NAGLAZYME, NITYR, ORFADIN, REVCOVI, VIMIZIM |
67 KB |
PDF File
|
For Cook Children’s Health Plans Only
|
ALDURAZYME, CEPROTIN, ELAPRASE, FABRAZYME, LUMIZYME, NAGLAZYME, NITYR, ORFADIN, REVCOVI, VIMIZIM |
67 KB |
PDF File
|
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cannabidiol (EPIDIOLEX) |
49 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
EPIPEN, EPIPEN-JR |
126 KB |
PDF File
|
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epoetin alfa (EPOGEN) |
35 KB |
PDF File
|
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risdiplam (EVRYSDI) |
54 KB |
PDF File
|
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risdiplam (EVRYSDI) |
54 KB |
PDF File
|
|
benralizumab (FASENRA) |
57 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
carbinoxamine (KARBINAL ER, RYVENT), clemastine, ED CHLORPED, triprolidine (M-HIST PD), VANACLEAR, VANAMINE, VISTARIL |
126 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
BAXDELA, CIPRO, levofloxacin soln, moxifloxacin tab |
126 KB |
PDF File
|
|
gabapentin (NEURONTIN) |
74 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
DIFICID, DIFICID SUSP, metronidazole (FLAGYL), paromomycin, vancomycin (VANCOCIN HCL) |
21 KB |
PDF File
|
|
ADLYXIN, BYDUREON, BYDUREON BCISE, BYETTA, OZEMPIC, RYBELSUS, SOLIQUA, TRULICITY, VICTOZA, XULTOPHY |
76 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
DIAZOXIDE SUS, GVOKE, GLUCAGON EMR SOL, ZEGALOGUE |
126 KB |
PDF File
|
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glipizide XL (GLUCOTROL XL) |
23 KB |
PDF File
|
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gabapentin extended release (GRALISE) |
135 KB |
PDF File
|
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somatropin (SEROSTIM) |
143 KB |
PDF File
|
|
somatropin (ZORBITIVE) |
137 KB |
PDF File
|
All Plans Except Cook Children’s Health Plan, Driscoll Children’s Health Plan & Texas Children’s Health Plan
|
GENOTROPIN, NORDITROPIN |
125 KB |
PDF File
|
For Cook Children’s Health Plan Only
|
GENOTROPIN, NORDITROPIN |
279 KB |
PDF File
|
Driscoll Children’s Health Plan Only
|
GENOTROPIN & NORDITROPIN |
124 KB |
PDF File
|
For Texas Children’s Health Plan Only
|
GENOTROPIN, NORDITROPIN |
271 KB |
PDF File
|
|
HUMATROPE, NUTROPIN AQ, OMNITROPE, SAIZEN |
272 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
HELIDAC, lansoprazole/amoxicillin/clarithromycin, omeprazole/clarithromycin/amoxicillin (listed as "omeclamox"), TALICIA CAP |
21 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
PEGASYS |
22 KB |
PDF File
|
|
sofosbuvir/velpatasvir (EPCLUSA), ledipasvir/sofosbuvir (HARVONI), glecaprevir/pibrentasvir (MAVYRET), sofosbuvir (SOVALDI), ombitasvir/paritaprevir/ritonavir and dasabuvir (VIEKIRA PAK), sofosbuvir/velpatasvir/voxilaprevir (VOSEVI), elbasvir/grazoprevir (ZEPATIER) |
87 KB |
PDF File
|
|
BERINERT, CINRYZE, icatibant (FIRAZYR), HAEGARDA, KALBITOR, RUCONEST, TAKHZYRO |
71 KB |
PDF File
|
|
tasimelteon (HETLIOZ) capsules |
65 KB |
PDF File
|
|
tasimelteon (HETLIOZ LQ) suspension |
60 KB |
PDF File
|
|
gabapentin enacarbil (HORIZANT) |
138 KB |
PDF File
|
|
corticotropin (HP ACTHAR) |
66 KB |
PDF File
|
|
adalimumab (HUMIRA) |
71 KB |
PDF File
|
STAR and STAR KID Members Only
|
TRIJARDY XR |
21 KB |
PDF File
|
STAR and STAR KID Members Only
|
AFREZZA, APIDRA, BASAGLAR, FIASP, HUMULIN N KWIKPEN, HUMALOG, ADMELOG, NOVOLIN, NOVOLIN N, NOVOLIN R, TOUJEO, TRESIBA |
126 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
repaglinide/metformin, STARLIX |
126 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
glipizide/metformin 2.5-250MG, GLIPIZIDE/METFORMIN TAB 5-500MG, GLUMETZA, RIOMET soln, metformin soln 500/5ML, metformin ER 500mg tab, metformin ER 1000mg tab, metformin ER osmotic tab 500mg, metformin ER osmotic tab 1000mg |
126 KB |
PDF File
|
|
canakinumab (ILARIS) |
72 KB |
PDF File
|
|
tildrakizumab (ILUMYA) |
134 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
BIVIGAM, CUVITRU, FLEBOGAMMA, HYQVIA, OCTAGAM, PRIVIGEN, XEMBIFY |
126 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
ASTAGRAF XL, cyclosporine (SANDIMMUNE), ENVARSUS XR, everolimus (ZORTRESS), mycophenolic (MYFORTIC, CELLCEPT), NEORAL, PROGRAF, sirolimus tab, RAPAMUNE SOLN |
126 KB |
PDF File
|
|
mecasermin (INCRELEX) |
60 KB |
PDF File
|
|
valbenazine (INGREZZA) |
62 KB |
PDF File
|
|
BETHKIS, CAYSTON, KITABIS, tobramycin (TOBI, TOBI PODHALER) |
140 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
AIRDUO, ALVESCO, ARMONAIR, ARNUITY, ASMANEX HFA (Twisthaler is PDL), BREO, BREZTRI, budesonide/formoterol, FLOVENT Diskus (HFA is PDL), budesonide (PULMICORT), QVAR, TRELEGY, fluticasone/salmeterol (WIXELA) |
126 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
allergy relief spray, azelastine-fluticasone (DYMISTA), azelastine, BECONASE AQ, budesonide, flunisolide, ipratropium, fluticasone, mometasone (NASONEX), nasal allergy spray, olopatadine (PATANASE), OMNARIS, QNASL CHILD, QNASL, triamcinolone acetonide, XHANCE |
126 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
CITRANATAL, CORVITE, CORVITE FE, FERIVA, FERIVAFA, FERRAPLUS, FUSION PLUS, IROSPAN, TARON FORTE CAP |
21 KB |
PDF File
|
|
lomitapide (JUXTAPID) |
71 KB |
PDF File
|
|
ivacaftor (KALYDECO) |
58 KB |
PDF File
|
|
ketorolac (TORADOL equiv) injection, ketorolac nasal spray |
160 KB |
PDF File
|
|
oral ketorolac (TORADOL equiv) |
76 KB |
PDF File
|
|
dichlorphenamide (KEVEYIS) |
50 KB |
PDF File
|
|
sarilumab (KEVZARA) |
60 KB |
PDF File
|
|
anakinra (KINERET) |
62 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
montelukast granules (SINGULAIR), SINGULAIR chewable 4mg/5mg, SINGULAIR tablets 10mg |
21 KB |
PDF File
|
|
lidocaine (LIDODERM) 5% patch, ZTLIDO 1.8% |
136 KB |
PDF File
|
STAR and STAR KIDS Only Members
|
CLEOCIN, LINCOCIN, SIVEXTRO, ZYVOX |
126 KB |
PDF File
|
|
linaclotide (LINZESS) |
125 KB |
PDF File
|
|
colesevelam (WELCHOL), colestipol (COLESTID), ezetimibe, fenofibrate (FENOGLIDE, LIPOFEN, TRICOR, TRILIPIX), fenofibric acid , LOPID, niacin extended-release (NIASPAN ER), NEXLETOL, NEXLIZET, QUESTRAN |
29 KB |
PDF File
|
|
amlodipine/atorvastatin (CADUET), rosuvastatin (CRESTOR), ezetimibe/simvastatin (VYTORIN), fluvastatin, fluvastatin ER (LESCOL XL), lovastatin, atorvastatin (LIPITOR), LIVALO, pravastatin (PRAVACHOL), simvastatin (ZOCOR), ZYPITAMAG |
30 KB |
PDF File
|
|
ABILIFY MAINTENA, ARISTADA, ARISTADA INITIO, fluphenazine decanoate inj, HALDOL DECANOATE INJ, haloperidol decanoate inj, INVEGA SUSTENNA, INVEGA TRINZA, PERSERIS, RISPERDAL CONSTA, ZYPREXA RELPREVV |
36 KB |
PDF File
|
|
alosetron (LOTRONEX) |
136 KB |
PDF File
|
|
omega-3-acid ethyl esters (LOVAZA), icosapent ethyl (VASCEPA) |
61 KB |
PDF File
|
|
voclosporin (LUPKYNIS) |
63 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
CLARITHROMYCIN, E.E.S. tab, ERY-TAB, ERYPED, ERYTHROCIN, ERYTHROMYCIN, ERYTHROMYCIN ETHYLSUCCINATE, ZITHROMAX |
23 KB |
PDF File
|
For Community First Health Plan (CFHP), Dell Children's (Seton), Driscoll Children's, El Paso, FirstCare Parkland, and Baylor Scott & White Health Plans
|
hydroxyprogesterone caproate injection (MAKENA) |
43 KB |
PDF File
|
For Community Health Choice, Cook Children’s Health Plans, and Texas Children’s Health Plans
|
hydroxyprogesterone caproate injection (MAKENA) |
43 KB |
PDF File
|
|
cladribine (MAVENCLAD) |
58 KB |
PDF File
|
|
siponimod (MAYZENT) |
69 KB |
PDF File
|
|
prucalopride (MOTEGRITY) |
135 KB |
PDF File
|
|
naloxegol (MOVANTIK) |
132 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
chlorzoxazone (LORZONE), dantrolene (DANTRIUM), metaxalone (SKELAXIN), orphenadrine extended-release, ROBAXIN-750, tizanidine |
21 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
duloxetine (CYMBALTA), pregabalin (LYRICA, LYRICA CR) |
126 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
diclofenac sodium/misoprostol (ARTHROTEC), diclofenac (FLECTOR), diflunisal, DUEXIS, EC-NAPROXEN, etodolac, etodolac extended-release, fenoprofen (NALFON), flurbiprofen, indomethacin (INDOCIN), ketoprofen, meclofenamic, meloxicam capsules (VIVLODEX), nabumetone (RELAFEN), naproxen/esomeprazole (VIMOVO), oxaprozin (DAYPRO), piroxicam (FELDENE), sulindac, tolmetin |
21 KB |
PDF File
|
|
mepolizumab (NUCALA) |
70 KB |
PDF File
|
|
pimavanserin (NUPLAZID) |
61 KB |
PDF File
|
|
rimegepant (NURTEC): Acute or As Needed Use Only |
63 KB |
PDF File
|
|
rimegepant (NURTEC): Prophylaxis or Long Term Preventive Use Only |
64 KB |
PDF File
|
|
armodafinil (NUVIGIL) |
63 KB |
PDF File
|
|
baricitinib (OLUMIANT) |
146 KB |
PDF File
|
|
EYSUVIS, RESTASIS, XIIDRA |
67 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
apraclonidine, betaxolol (BETOPTIC-S), bimatiprost (LUMIGAN), brimonidine (ALPHAGAN P), brinzolomide (AZOPT equiv), dorzolamide-timolol (COSOPT, COSOPT PF) , PHOSPHOLINE, timolol maleate (ISTALOL), TIMOPTIC, TIMOPTIC XE, TRAVOPROST, TRUSOPT, VYZULTA, XALATAN, ZIOPTAN |
126 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
ALOCRIL, ALOMIDE, ALREX, azelastine, BEPREVE, epinastine, LASTACAFT, olopatadine 0.1%, 0.2%, (PATANOL, PATADAY) |
126 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
ACUVAIL, bromfenac, difluprednate (DUREZOL), dexamethason sodium phosphate (MAXIDEX), FLAREX, fluoromethol (FML FORTE, FML), FML LIQUIFLM, flurbiprofen 0.03% sol, ILEVRO, INVELTYS, ketorolac (ACULAR, ACULAR LS), loteprednol (LOTEMAX 0.5% SUSP, LOTEMAX GEL, LOTEMAX SM), NEVANAC 0.1% SUSP, prednisolone sodium acetate (PRED MILD, PRED FORTE) |
126 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
BLEPHAMIDE, MAXITROL, neomycin-bacitracin-poly-HC, neomycin-bacitracin-polymyxin, PRED-G, TIOBRADEX ST, tobramycin-dexamethasone (TOBRADEX), ZYLET |
212 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
AZASITE, bacitracin, BESIVANCE, BLEPH-10, CILOXAN, gatofloxacin, levofloxacin, MOXEZA, NATACYN, neomycin-bacitracin-polymyxin (NEO-POLYCIN), neo-poly-gramicidin, OCUFLOX, POLYTRIM, sodium sulfacetamide (SULFACET), TOBREX, moxifloxacin (VIGAMOX) |
126 KB |
PDF File
|
|
CARISOPRODOL ASPIRIN AND CODEINE PHOSPHATE |
168 KB |
PDF File
|
|
codeine-guaifenesin (GUAIATUSSIN, NINJACOF-XG, VIRTUSSIN AC), hydrocodone-homatropine (HYDROMET), hydrocodone-chlorpheniramine polistirex (TUSSIONEX), pseudoephedrine/codeine/guaifenesin (VIRTUSSIN DAC) |
154 KB |
PDF File
|
|
oral transmucosal fentanyl (ACTIQ) |
92 KB |
PDF File
|
|
buccal fentanyl (FENTORA) |
92 KB |
PDF File
|
|
transdermal fentanyl (DURAGESIC) |
88 KB |
PDF File
|
|
oxycodone (OXYCONTIN) 60mg & 80mg |
165 KB |
PDF File
|
|
oxycodone (OXYCONTIN) 10mg, 15mg, 20mg, 30mg, 40mg / XTAMPZA |
165 KB |
PDF File
|
|
PROMETHAZINE VC-CODEINE SYRUP, PROMETHAZINE-CODEINE SYRUP |
150 KB |
PDF File
|
|
ACETAMINOPHEN/CAFFEINE/DIHYDROCODEINE, ACETAMINOPHEN/CODEINE, ASCOMP WITH CODEINE, BELBUCA, BELLADONNA/OPIUM, BENZHYDROCODONE/ACETAMINOPHEN, BUPRENORPHINE PATCH, BUTALBITAL/CAFFEINE/ACETAMINOPHEN/CODEINE, BUTALBITAL/CAFFEINE/ASPIRIN/CODEINE, BUTORPHANOL, BUTRANS, CODEINE SULFATE, DEMEROL, DILAUDID, ENDOCET, HYDROCODONE/ACETAMINOPHEN, HYDROCODONE/IBUPROFEN, HYDROMORPHONE, HYSINGLA ER, KADIAN, LEVORPHANOL, LORCET, MEPERIDINE, METHADONE, METHADOSE, MORPHABOND, MORPHINE SULFATE, MS CONTIN, NALBUPHINE, NALOCET, NORCO, NUCYNTA (ER), OPIUM TINCTURE, OXYCODONE, OXYCODONE/ACETAMINOPHEN, OXYCODONE/ASPIRIN, OXYCODONE/IBUPROFEN, OXYMORPHONE, PENTAZOCINE/NALOXONE, PERCOCET, ROXICODONE, TRAMADOL/ACETAMINOPHEN, TRAMADOL HYDROCHLORIDE, ULTRACET, ULTRAM |
154 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
ALKINDI SPRINKLE CAP, CORTEF, CORTISONE, dexamethasone, ENTOCORT, methylprednisolone (MEDROL), prednisolone (MILLIPRED), prednisone, TAPERDEX |
126 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
valganciclovir soln/tab |
126 KB |
PDF File
|
|
Grass Pollen Allergen Extract (ORALAIR) |
57 KB |
PDF File
|
|
abatacept (ORENCIA) |
63 KB |
PDF File
|
|
elagolix, estradiol and norethindrone (ORIAHNN) |
142 KB |
PDF File
|
|
elagolix (ORILISSA) |
64 KB |
PDF File
|
|
lumacaftor / ivacaftor (ORKAMBI) |
59 KB |
PDF File
|
|
apremilast (OTEZLA) |
58 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
hydrocortisone/acetic acid, PINNACAINE |
126 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
CIPRO HC, ciprofloxacin/dexamethasone (CIPRODEX), CORTISPORIN, OTOVEL |
126 KB |
PDF File
|
|
voxelotor (OXBRYTA) |
63 KB |
PDF File
|
|
cenegermin-bkbj (OXERVATE) |
52 KB |
PDF File
|
|
peanut allergen powder (PALFORZIA) |
61 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
PANCREAZE, PERTZYE, VIOKACE |
126 KB |
PDF File
|
|
sildenafil (REVATIO), tadalafil (ADCIRCA), tadalafil (ALYQ) |
68 KB |
PDF File
|
STAR and STAR KID Members Only
|
ivermectin cream, METROGEL, METROCREAM, MIRVASO GEL |
21 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
ANIMAL SHAPE CHW + IRON, mulitvitamin with fluoride (FLORIVA, POLY-VI-FLOR, QUFLORA, TRI-VI-FLOR suspension, TRI-VIT/FLUO drops), vitamin A, C, D and fluroide drops |
134 KB |
PDF File
|
|
AURYXIA, calcium acetate (PHOSLYRA), lanthanum (FOSRENOL), sevelamer (RENAGEL), sevelamer carbonate (RENVELA), VELPHORO |
76 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
dipyridamole (PERSANTINE), prasugrel (EFFIENT), clopidogrel (PLAVIX), vorapaxar (ZONTIVITY) |
126 KB |
PDF File
|
|
ponesimod (PONVORY) |
69 KB |
PDF File
|
|
alirocumab (PRALUENT) |
66 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
CITRANATAL, COMPLETENATE, CONCEPT DHA, CONCEPT OB, ELITE-OB, FOLIVANE-OB, NESTABS, NESTABS DHA, OB COMPLETE, PNV-DHA, PNV-OMEGA, PNV-SELECT, PRENAISSANCE, PRENATE, PRENATE AM, PRENATE DHA, PRENATE MINI, PRENATE STAR, SELECT-OB, SE-NATAL 19, TARON-C DHA, THRIVITE 19, THRIVITE RX, TRISTART DHA, VP-CH-PNV, VP-PNV-DHA, ZATEAN-PN |
126 KB |
PDF File
|
|
epoetin alfa (PROCRIT) |
34 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
megestrol ES 625mg/5ml susp |
126 KB |
PDF File
|
|
PHENADOZ, PHENERGAN, PROMETHAZINE, PROMETHEGAN |
57 KB |
PDF File
|
|
propylthiouracil |
18 KB |
PDF File
|
|
ACIPHEX/rabeprazole, DEXILANT, esomeprazole, lansoprazole, NEXIUM cap, ZEGERID/omepra/bicar (omeprazole/bicarbonate), omeprazole cap 20.6mg, omeprazole tab, PREVACID cap/solutab, PROTONIX tab. |
30 KB |
PDF File
|
|
modafinil (PROVIGIL) |
63 KB |
PDF File
|
|
ADEMPAS, ambrisentan (LETAIRIS), OPSUMIT, ORENITRAM, bosentan (TRACLEER), TYVASO inhalation solution, UPTRAVI, VENTAVIS inhalation solution |
29 KB |
PDF File
|
|
dornase alfa (PULMOZYME) |
53 KB |
PDF File
|
|
viloxazine (QELBREE) |
58 KB |
PDF File
|
|
ranolazine (RANEXA) |
93 KB |
PDF File
|
|
methylnaltrexone (RELISTOR) |
135 KB |
PDF File
|
|
evolocumab (REPATHA) |
111 KB |
PDF File
|
|
epoetin alfa (RETACRIT) |
28 KB |
PDF File
|
|
upadacitinib (RINVOQ) |
76 KB |
PDF File
|
|
ramelteon (ROZEREM) |
66 KB |
PDF File
|
|
milnacipran (SAVELLA) |
141 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
doxepin (SILENOR) |
126 KB |
PDF File
|
|
AMBIEN, AMBIEN CR, BELSOMRA, DAYVIGO, EDLUAR, ESTAZOLAM, ESZOPICLONE, INTERMEZZO, LUNESTA, RESTORIL, SONATA, TEMAZEPAM, TRIAZOLAM, ZALEPLON, ZOLPIDEM, ZOLPIDEM ER |
64 KB |
PDF File
|
|
flurazepam |
64 KB |
PDF File
|
|
INVOKAMET (XR), SEGLUROMET, SYNJARDY (XR), XIGDUO XR |
139 KB |
PDF File
|
|
FARXIGA, INVOKANA, JARDIANCE, STEGLATRO |
67 KB |
PDF File
|
|
brodalumab (SILIQ) |
61 KB |
PDF File
|
|
golimumab (SIMPONI) |
67 KB |
PDF File
|
|
risankizumab (SKYRIZI) |
62 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
NICOTROL INHALER, NICOTROL NS, varenicline |
126 KB |
PDF File
|
|
ustekinumab (STELARA) |
62 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
alclometason, amcinonide, betamethsone dipropionate (DIPROLENE, SERNIVO), betamethasone valerate, BRYHALI, clobetasol (CLOBEX, OLUX, OLUX-E, TEMOVATE), desonide, desoximetas (TOPICORT, TOPICORT LP), diflorasone (APEXICON E), fluocinolone acetate oil, fluocinonide (VANOS), halcinonide (HALOG), hydrocortisone butyrate, hydrocortisone valerate, hydrocortisone (TEXACORT), LEXETTE, prednicarbate, triamcinolone acetate (TRIANEX) |
126 KB |
PDF File
|
|
solriamfetol (SUNOSI) |
62 KB |
PDF File
|
|
tezacaftor/ivacaftor and ivacaftor (SYMDEKO) |
54 KB |
PDF File
|
|
pramlintide (SYMLIN) |
132 KB |
PDF File
|
|
naldemedine (SYMPROIC) |
139 KB |
PDF File
|
For Community First Health Plan Only - RSV Season Dates 2021-2022
|
palivizumab (SYNAGIS) |
315 KB |
PDF File
|
For Community Health Choice Only - RSV Season Dates 2021-2022
|
palivizumab (SYNAGIS) |
299 KB |
PDF File
|
For Cook Children's Health Plan Only - RSV Season Dates 2021-2022
|
palivizumab (SYNAGIS) |
299 KB |
PDF File
|
For Dell Children's Health (Seton) Plan Only - RSV Dates 2021-2022
|
palivizumab (SYNAGIS) |
299 KB |
PDF File
|
For Driscoll Children's Health Plan Only - RSV Season Dates 2021-2022
|
palivizumab (SYNAGIS) |
300 KB |
PDF File
|
For El Paso First Health Plan Only - RVS Season Dates 2021-2022
|
palivizumab (SYNAGIS) |
299 KB |
PDF File
|
For FirstCare Health Plan Only - RSV Dates 2021-2022
|
palivizumab (SYNAGIS) |
301 KB |
PDF File
|
For Parkland Community Health Plans Only - RSV Season Dates 2021-2022
|
palivizumab (SYNAGIS) |
299 KB |
PDF File
|
|
|
27 KB |
PDF File
|
For Scott & White Health Plan Only - RSV Season Dates 2021-2022
|
palivizumab (SYNAGIS) |
301 KB |
PDF File
|
For Texas Children's Health Plan Only - RSV Season Dates 2021-2022
|
palivizumab (SYNAGIS) |
289 KB |
PDF File
|
|
ixekizumab (TALTZ) |
140 KB |
PDF File
|
|
inotersen (TEGSEDI) |
58 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
demeclocycline, doxycycline monohydrate (ORACEA), doxycycline suspension (VIBRAMYCIN), minocycline (SOLODYN, MINOLIRA), NUZYRA, tetracycline |
126 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
DOPTELET, MULPLETA, PROMACTA POW, TAVALISSE |
126 KB |
PDF File
|
|
AMZEEQ FOAM 4%, BENZACLIN GEL, BENZACLIN GEL PUMP, clindamycin 1% foam, clindamycin/benzoyl peroxide gel 1-5%, clindamycin/benzoyl peroxide gel 1.2-2.5%, clindamycin/benzoyl peroxide gel 1.2-5%, erythromycin/benzoyl peroxide gel 5-3% |
26 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
testosterone (ANDRODERM, ANDROGEL, FORTESTA, TESTIM, VOGELXO) |
126 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
bacitracin zinc, gentamicin, mupirocin (CENTANY) |
126 KB |
PDF File
|
|
CICLOPIROX 8% SOLUTION, JUBLIA 10% TOPICAL SOLUTION, and KERYDIN (TAVABOROLE) 5% TOPICAL SOLUTION |
66 KB |
PDF File
|
STAR and STAR KIDS Members Only
|
acyclovir cream, acyclovir ointment, docosanol cream, XERESE |
126 KB |
PDF File
|
|
pimecrolimus (ELIDEL), tacrolimus (PROTOPIC 0.03%) |
70 KB |
PDF File
|
|
crisaborole (EUCRISA) |
21 KB |
PDF File
|
|
tacrolimus (PROTOPIC) 0.1% |
65 KB |
PDF File
|
|
ADAPALENE, ADAPALENE-BENZYL PEROXIDE, ALTRENO, ARAZLO, ATRALIN, AVITA, CLINDAMYCIN-TRETINOIN, DIFFERIN, EPIDUO FORTE, FABIOR, RETIN-A MICRO GEL, TAZAROTENE, TRETINOIN, ZIANA |
26 KB |
PDF File
|
|
guselkumab (TREMFYA) |
57 KB |
PDF File
|
|
elexcaftor/tezacaftor/ivacaftor (TRIKAFTA) |
56 KB |
PDF File
|
|
plecanatide (TRULANCE) |
135 KB |
PDF File
|
|
ubrogepant (UBRELVY) |
57 KB |
PDF File
|
STAR and STAR KIDS Members Only
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azulfidine, balsalazide (COLAZAL), budesonide ER, CANASA, DIPENTUM, mesalamine 800mg (ASACOL HD), mesalamine 0.375gm (APRISO, PENTASA), mesalamine 1.2 gm, mesalamine ENE 4gm, UCERIS |
21 KB |
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CARBAGLU, RAVICTI, sodium phenylbutyrate (BUPHENYL) |
25 KB |
PDF File
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STAR and STAR KIDS Members Only
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clindamycin (CLEOCIN), metronidazole 0.75% vaginal gel, SOLOSEC, VANDAZOLE |
126 KB |
PDF File
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eluxadoline (VIBERZI) |
139 KB |
PDF File
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STAR and STAR KIDS Members Only
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CITRANATAL, CORVITE 150, CORVITE FE, EZFE 200, ferrous sulfate (FEOSOL, FER-IN-SOL, SLOW FE), ferrous gluconate (FERATE, FERGON), FERIVA, FERIVAFA, FERRAPLUS 90, FERREX 150, ferrous fumarate (FERRIMIN 150, HEMOCYTE), FOLITAB 500, FUSION PLUS, GNP IRON, HEMOCYTE, ICAR PEDS, ICAR-C, INTEGRA, Iron 100/C, Iron Supplement Drops, polysaccharide iron complex (FEOSOL bifera, POLY-IRON, NU-IRON 150), IROSPAN, TARON FORTE, WEE CARE |
135 KB |
PDF File
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STAR and STAR KIDS Members Only
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antacids - calcium salts, antacids - magnesium salts, antidotes, b-complex vitamins, b-complex w/ c, b-complex w/ folic acid, b-complex w/ iron, b-complex w/ minerals, bioflavonoid products, calcium, cobalamins, dietary management products, fluoride, folic acid/folates, hematopoietic mixtures, iron, magnesium, mineral combinations, misc. nutritional substances, multiple vitamins w/ calcium, multiple vitamins w/ iron, multiple vitamins w/ minerals, multivitamins, oil soluble vitamins, ped multiple vitamins w/ minerals, ped mv w/ fluoride, ped mv w/ iron, pediatric multiple vitamins, phosphate, saline laxatives, specialty vitamins products, trace minerals, vitamin mixtures, vitamins w/ lipotropics, water soluble vitamins, zinc |
124 KB |
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tafamidis (VYNDAMAX) and tafamidis meglumine (VYNDAQEL) |
58 KB |
PDF File
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pitolisant (WAKIX) |
66 KB |
PDF File
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tofacitinib citrate (XELJANZ / XELJANZ XR) |
67 KB |
PDF File
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orlistat (XENICAL) |
44 KB |
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rifaximin 200mg (XIFAXAN 200mg) |
135 KB |
PDF File
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rifaximin 550mg (XIFAXAN 550mg) |
139 KB |
PDF File
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sodium oxybate (XYREM) / XYWAV |
56 KB |
PDF File
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vemurafenib (ZELBORAF) |
21 KB |
PDF File
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ozanimod (ZEPOSIA) |
72 KB |
PDF File
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imiquimod 3.75 % cream (ZYCLARA) |
45 KB |
PDF File
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zileuton (ZYFLO) |
57 KB |