vigabatrin 50 Sabril PACKET 500 MG Oral 1 NF Formulary Update mg/ml, 1 efavirenz 50 Sustiva CAPSULE 50 MG Oral 1 NF Formulary Update mg, 1 Symdeko Tablet Therapy Pack 100-150 NF 1 + PA1 + LA Formulary Enhancement N/A & 150 MG Oral scopolamine Transderm-Scop (1.5 MG) 72 Hour 1 NF Formulary Update 0.0139 mg/hr, 1 MG/3DAYS Transdermal 1 Trientine HCl CAPSULE 250 MG Oral NF 1 Formulary Enhancement N/A Trisenox SOLUTION 10 MG/10ML 1 + BD NF CMS Required Deletion N/A Intravenous Videx EC CAPSULE DELAYED NF 1 Formulary Enhancement N/A RELEASE 125 MG Oral moxifloxacin Vigamox SOLUTION 0.5 % Ophthalmic 1 NF Formulary Update 5 mg/ml, 1 Zenpep CAPSULE DELAYED RELEASE PARTICLES 25000-79000 NF 1 Formulary Enhancement N/A UNIT Oral Zenpep CAPSULE DELAYED RELEASE PARTICLES 5000-24000 NF 1 Formulary Enhancement N/A UNIT Oral EFFECTIVE 06/01/2018 Abilify Maintena Suspension NF 1 Formulary Enhancement N/A Reconstituted ER 400 MG Intramuscular Alimta SOLUTION RECONSTITUTED NF 1 Formulary Enhancement N/A 100 MG Intravenous Daliresp Tablet 250 MCG Oral NF 1 Formulary Enhancement N/A
Sabril PACKET 500 MG Oral 1 NF Formulary Update vigabatrin 50 mg/ml, 1 Sustiva CAPSULE 50 MG Oral 1 NF Formulary Update efavirenz 50 mg, 1 Symdeko Tablet Therapy Pack 100-150 & 150 MG Oral NF 1 + PA1 + LA Formulary Enhancement N/A Transderm-Scop (1.5 MG) 72 Hour 1 MG/3DAYS Transdermal 1 NF Formulary Update scopolamine 0.0139 mg/hr, 1 Trientine HCl CAPSULE 250 MG Oral NF 1 Formulary Enhancement N/A Trisenox SOLUTION 10 MG/10ML Intravenous 1 + BD NF CMS Required Deletion N/A Videx EC CAPSULE DELAYED RELEASE 125 MG Oral NF 1 Formulary Enhancement N/A Vigamox SOLUTION 0.5 % Ophthalmic 1 NF Formulary Update moxifloxacin 5 mg/ml, 1 Zenpep CAPSULE DELAYED RELEASE PARTICLES 25000-79000 UNIT Oral NF 1 Formulary Enhancement N/A Zenpep CAPSULE DELAYED RELEASE PARTICLES 5000-24000 UNIT Oral NF 1 Formulary Enhancement N/A EFFECTIVE 06/01/2018 Abilify Maintena Suspension Reconstituted ER 400 MG Intramuscular NF 1 Formulary Enhancement N/A Alimta SOLUTION RECONSTITUTED 100 MG Intravenous NF 1 Formulary Enhancement N/A Daliresp Tablet 250 MCG Oral NF 1 Formulary Enhancement N/A
AgeWell-1-Tier_2018_Addendum_Eff_08012018.docx