caspofungin Cancidas SOLUTION 2 NF Formulary Update acetate 70 mg, RECONSTITUTED 70 MG Intravenous 2 glatiramer Copaxone Solution Prefilled Syringe 20 acetate 20 2 + PA1 NF Formulary Update MG/ML Subcutaneous mg/ml, 2 + PA1 glatiramer Copaxone Solution Prefilled Syringe 40 acetate 40 2 + PA1 NF Formulary Update MG/ML Subcutaneous mg/ml, 2 + PA1 Cosmegen SOLUTION dactinomycin RECONSTITUTED 0.5 MG 2 + BD NF Formulary Update 0.5 mg, 1 + Intravenous BD Didanosine CAPSULE DELAYED 1 NF CMS Required Deletion N/A RELEASE 125 MG Oral TABLET 125 MCG Oral NF 1 Formulary Enhancement N/A TABLET 250 MCG Oral NF 1 Formulary Enhancement N/A Efavirenz CAPSULE 200 MG Oral NF 1 Formulary Enhancement N/A Efavirenz TABLET 600 MG Oral NF 1 Formulary Enhancement N/A 2 + QL 180 + Endari PACKET 5 GM Oral NF Formulary Enhancement N/A PA1 + LA Erleada TABLET 60 MG Oral NF 2 + PA2 + LA Formulary Enhancement N/A Gentamicin Sulfate SOLUTION 10 1 NF CMS Required Deletion N/A MG/ML Intravenous Haloperidol Lactate SOLUTION 5 MG/ML Injection (1 ml Prefilled NF 1 Formulary Enhancement N/A Syringe)
Cancidas SOLUTION RECONSTITUTED 70 MG Intravenous 2 NF Formulary Update caspofungin acetate 70 mg, 2 Copaxone Solution Prefilled Syringe 20 MG/ML Subcutaneous 2 + PA1 NF Formulary Update glatiramer acetate 20 mg/ml, 2 + PA1 Copaxone Solution Prefilled Syringe 40 MG/ML Subcutaneous 2 + PA1 NF Formulary Update glatiramer acetate 40 mg/ml, 2 + PA1 Cosmegen SOLUTION RECONSTITUTED 0.5 MG Intravenous 2 + BD NF Formulary Update dactinomycin 0.5 mg, 1 + BD Didanosine CAPSULE DELAYED RELEASE 125 MG Oral 1 NF CMS Required Deletion N/A TABLET 125 MCG Oral NF 1 Formulary Enhancement N/A TABLET 250 MCG Oral NF 1 Formulary Enhancement N/A Efavirenz CAPSULE 200 MG Oral NF 1 Formulary Enhancement N/A Efavirenz TABLET 600 MG Oral NF 1 Formulary Enhancement N/A Endari PACKET 5 GM Oral NF 2 + QL 180 + PA1 + LA Formulary Enhancement N/A Erleada TABLET 60 MG Oral NF 2 + PA2 + LA Formulary Enhancement N/A Gentamicin Sulfate SOLUTION 10 MG/ML Intravenous 1 NF CMS Required Deletion N/A Haloperidol Lactate SOLUTION 5 MG/ML Injection (1 ml Prefilled Syringe) NF 1 Formulary Enhancement N/A
AgeWell-MMP_2018_Addendum_Eff_07012018.docx