Medication Brand Reference Age Prior Limit Required Quantity Name Additional Limitation Generic Name Authorization Information Formulation(s) thiamine hcl Vitamin B1 - Various Tab Various Tab multiple vitamin multiple vitamin / Various Tab minerals Miscellaneous Ear, Nose & Throat Drug saliva substitute Salivart Spray Cathartics and Laxatives Colace Cap docusate sodium Metamucil Powder psyllium
Medication Generic Name Brand Reference Name Formulation(s) Age Limitation Prior Authorization Required Quantity Limit Additional Information thiamine hcl Vitamin B1 - Various Tab multiple vitamin Various Tab multiple vitamin / minerals Various Tab Miscellaneous Ear, Nose & Throat Drug saliva substitute Salivart Spray Cathartics and Laxatives docusate sodium Colace Cap psyllium Metamucil Powder
ADHSDBHS%20BH%20Drug%20List.docx