|
|
Generic Name
|
Trade Name
|
Dosage Forms
|
Strength
|
Comment
|
Change
|
Date
|
|
1:
|
Methyl aminolevulinate
|
Metvixia
|
Topical cream
|
16.8%
|
Dermatological topical agent
|
Added
|
3/16/2010
|
|
2:
|
Gadoteridol
|
ProHance
|
Injection
|
5mL, 10mL, 15mL, 20mL, 50mL
|
Contrast agent
|
Added
|
3/16/2010
|
|
3:
|
Pegaspargase
|
Oncaspar
|
Injection
|
750 units/mL (5mL)
|
Antineoplastic
|
Added (restricted)
|
3/16/2010
|
|
4:
|
Flutamide
|
Eulexin
|
Capsule
|
All
|
Anti-androgen
|
Deleted
|
2/18/2010
|
|
5:
|
Phenytoin
|
Generic
|
Injection
|
All
|
Anticonvulsant
|
Deleted
|
2/16/2010
|
|
6:
|
Nebivolol
|
Bystolic
|
Tablet
|
2.5mg, 5mg, 10mg, 20mg
|
Beta-blocker
|
Added
|
2/16/2010
|
|
7:
|
Fosphenytoin
|
Cerebyx
|
Injection
|
75mg/mL (2mL, 10mL)
|
Anticonvulsant
|
Added
|
2/16/2010
|
|
8:
|
Prothrombin complex concentrate
|
Bebulin VH
|
Injection
|
10mL, 20mL
|
Antihemophilic agent
|
Added (restricted)
|
2/16/2010
|
|
9:
|
Pralatrexate
|
Folotyn
|
Injection
|
20mg, 40mg
|
Antineoplastic
|
Added (restricted)
|
1/19/2010
|
|
10:
|
Promethazine
|
Promethazine
|
Injection
|
50mg/mL
|
Antiemetic
|
Deleted
|
12/15/2009
|
|
11:
|
Budesonide/Formoterol
|
Symbicort
|
Metered dose inhaler
|
80/4.5mcg; 160/4.5mcg
|
Corticosteroid/Beta agonist
|
Added
|
12/15/2009
|
|
12:
|
Lepirudin
|
Refludan
|
Injection
|
50mg
|
Direct thrombin inhibitor
|
Deleted
|
11/17/2009
|
|
13:
|
Argatroban
|
Argatroban
|
Injection
|
100mg/mL
|
Direct thrombin inhibitor
|
Deleted
|
11/17/2009
|
|
14:
|
Dronedarone
|
Multaq
|
Tablet
|
400mg
|
Anti-arrhythmic agent
|
Added
|
10/20/2009
|
|
15:
|
Prasugrel
|
Effient
|
Tablet
|
5mg, 10mg
|
Platelet aggregation inhibitor
|
Added (restricted)
|
10/20/2009
|
|
16:
|
Clevidipine
|
Cleviprex
|
Injection
|
0.5mg/mL (50mL; 100mL)
|
Calcium channel blocker
|
Added (restricted)
|
9/15/2009
|
|
17:
|
Triamcinolone acetonide (preservative-free)
|
Triesence
|
Injection (intraocular)
|
40mg/mL (1mL)
|
Corticosteroid
|
Added
|
6/16/2009
|
|
18:
|
Plerixafor
|
Mozobil
|
Injection
|
20mg/mL (1.2mL)
|
Hematopoietic stem cell mobilizer
|
Added (restricted)
|
6/16/2009
|
|
19:
|
Fibrin sealant (human)
|
Artiss
|
Solution, external
|
4mL, 10mL
|
Fibrin sealant
|
Added
|
6/16/2009
|
|
20:
|
Rho (D) Immune Globulin
|
Generic
|
injection
|
50mcg
|
Immune globulin
|
Deleted
|
4/21/2009
|
|