Opdivo SOLUTION 100 MG/10ML NF 2 + PA2 Formulary Enhancement N/A Intravenous Oseltamivir Phosphate SUSPENSION NF 1 Formulary Enhancement N/A RECONSTITUTED 6 MG/ML Oral Oxaliplatin SOLUTION RECONSTITUTED 100 MG NF 1 + BD Formulary Enhancement N/A Intravenous PARoxetine Mesylate CAPSULE 7.5 NF 1 Formulary Enhancement N/A MG Oral PEG 3350/Electrolytes SOLUTION NF 1 Formulary Enhancement N/A RECONSTITUTED 240 GM ORAL Phrenilin Forte CAPSULE 50-300-40 NF 1 Formulary Enhancement N/A MG Oral Piperacillin Sod-Tazobactam So SOLUTION RECONSTITUTED 2.25 NF 1 Formulary Enhancement N/A (2-0.25) GM Intravenous Primsol SOL 50 MG/5ML 2 NF CMS Required Deletion N/A Rexulti TABLET 0.25 MG ORAL 2 + PA2 2 Formulary Enhancement N/A Rexulti TABLET 0.5 MG ORAL 2 + PA2 2 Formulary Enhancement N/A Rexulti TABLET 1 MG ORAL 2 + PA2 2 Formulary Enhancement N/A Rexulti TABLET 2 MG ORAL 2 + PA2 2 Formulary Enhancement N/A Rexulti TABLET 3 MG ORAL 2 + PA2 2 Formulary Enhancement N/A Rexulti TABLET 4 MG ORAL 2 + PA2 2 Formulary Enhancement N/A Rituxan SOLUTION 100 MG/10ML NF 2 Formulary Enhancement N/A Intravenous Scopolamine Patch 72 Hour 1 NF 1 Formulary Enhancement N/A MG/3DAYS Transdermal
Opdivo SOLUTION 100 MG/10ML Intravenous NF 2 + PA2 Formulary Enhancement N/A Oseltamivir Phosphate SUSPENSION RECONSTITUTED 6 MG/ML Oral NF 1 Formulary Enhancement N/A Oxaliplatin SOLUTION RECONSTITUTED 100 MG Intravenous NF 1 + BD Formulary Enhancement N/A PARoxetine Mesylate CAPSULE 7.5 MG Oral NF 1 Formulary Enhancement N/A PEG 3350/Electrolytes SOLUTION RECONSTITUTED 240 GM ORAL NF 1 Formulary Enhancement N/A Phrenilin Forte CAPSULE 50-300-40 MG Oral NF 1 Formulary Enhancement N/A Piperacillin Sod-Tazobactam So SOLUTION RECONSTITUTED 2.25 (2-0.25) GM Intravenous NF 1 Formulary Enhancement N/A Primsol SOL 50 MG/5ML 2 NF CMS Required Deletion N/A Rexulti TABLET 0.25 MG ORAL 2 + PA2 2 Formulary Enhancement N/A Rexulti TABLET 0.5 MG ORAL 2 + PA2 2 Formulary Enhancement N/A Rexulti TABLET 1 MG ORAL 2 + PA2 2 Formulary Enhancement N/A Rexulti TABLET 2 MG ORAL 2 + PA2 2 Formulary Enhancement N/A Rexulti TABLET 3 MG ORAL 2 + PA2 2 Formulary Enhancement N/A Rexulti TABLET 4 MG ORAL 2 + PA2 2 Formulary Enhancement N/A Rituxan SOLUTION 100 MG/10ML Intravenous NF 2 Formulary Enhancement N/A Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal NF 1 Formulary Enhancement N/A
AgeWell-MMP_2018_Addendum_Eff_07012018.docx