Herceptin SOLUTION RECONSTITUTED 150 MG NF 1+ BD Formulary Enhancement N/A Intravenous Kurvelo TABLET 0.15-30 MG-MCG NF 1 Formulary Enhancement N/A ORAL Levalbuterol HCl Nebulization Solution NF 1+ BD Formulary Enhancement N/A 0.63 MG/3ML Inhalation Levocetirizine Dihydrochloride NF 1 Formulary Enhancement N/A TABLET 5 MG Oral Levonorgestrel-Ethinyl Estrad TABLET NF 1 Formulary Enhancement N/A 0.15-30 MG-MCG ORAL Lidocaine Viscous SOLUTION 2 % NF 1 Formulary Enhancement N/A Mouth/Throat MedroxyPROGESTERone Acetate Suspension Prefilled Syringe 150 NF 1 Formulary Enhancement N/A MG/ML Intramuscular Roweepra XR Tablet Extended Release NF 1 Formulary Enhancement N/A 24 Hour 500 MG Oral Roweepra XR Tablet Extended Release NF 1 Formulary Enhancement N/A 24 Hour 750 MG Oral Selzentry SOLUTION 20 MG/ML Oral NF 1 Formulary Enhancement N/A Shingrix SUSPENSION RECONSTITUTED 50 MCG NF 1 Formulary Enhancement N/A Intramuscular Tacrolimus OINTMENT 0.03 % NF 1 Formulary Enhancement N/A EXTERNAL Tacrolimus OINTMENT 0.1 % NF 1 Formulary Enhancement N/A EXTERNAL
Herceptin SOLUTION RECONSTITUTED 150 MG Intravenous NF 1+ BD Formulary Enhancement N/A Kurvelo TABLET 0.15-30 MG-MCG ORAL NF 1 Formulary Enhancement N/A Levalbuterol HCl Nebulization Solution 0.63 MG/3ML Inhalation NF 1+ BD Formulary Enhancement N/A Levocetirizine Dihydrochloride TABLET 5 MG Oral NF 1 Formulary Enhancement N/A Levonorgestrel-Ethinyl Estrad TABLET 0.15-30 MG-MCG ORAL NF 1 Formulary Enhancement N/A Lidocaine Viscous SOLUTION 2 % Mouth/Throat NF 1 Formulary Enhancement N/A MedroxyPROGESTERone Acetate Suspension Prefilled Syringe 150 MG/ML Intramuscular NF 1 Formulary Enhancement N/A Roweepra XR Tablet Extended Release 24 Hour 500 MG Oral NF 1 Formulary Enhancement N/A Roweepra XR Tablet Extended Release 24 Hour 750 MG Oral NF 1 Formulary Enhancement N/A Selzentry SOLUTION 20 MG/ML Oral NF 1 Formulary Enhancement N/A Shingrix SUSPENSION RECONSTITUTED 50 MCG Intramuscular NF 1 Formulary Enhancement N/A Tacrolimus OINTMENT 0.03 % EXTERNAL NF 1 Formulary Enhancement N/A Tacrolimus OINTMENT 0.1 % EXTERNAL NF 1 Formulary Enhancement N/A
AgeWell-1-Tier_2018_Addendum_Eff_08012018.docx