Step Therapy Criteria Step Therapy Group Drug Names Step Therapy Criteria
PREVIOUS USE OF 30 DAYS OF TAMSULOSIN BEFORE UROXATRAL CAN BE
Step Therapy Group Drug Names Step Therapy Criteria
PREVIOUS USE OF 30 DAYS OF FINASTERIDE BEFORE AVODART CAN BE
Step Therapy Group Drug Names
DETROL, DETROL LA, SANCTURA XR, TOLTERODINE TARTRATE, TROSPIUM
Step Therapy Criteria
PREVIOUS USE OF 30 DAYS OF OXYBUTYNIN OR TROSPIUM. Step Therapy Group Drug Names Step Therapy Criteria
PREVIOUS USE OF 30 DAYS OF WARFARIN HAS BEEN INEFFECTIVE, NOT
TOLERATED OR IS CONTRAINDICATED BEFORE PRADAXA CAN BE APPROVED
Step Therapy Group Drug Names
BENICAR, BENICAR HCT, IRBESARTAN, IRBESARTAN/HYDROCHLOROTHI
Step Therapy Criteria
PREVIOUS USE OF 30 DAYS OF A FORMULARY PREFERRED GENERIC ARB. Step Therapy Group Drug Names Step Therapy Criteria
PREVIOUS USE OF 30 DAYS EACH OF TWO GENERIC BETA BLOCKERS BEFORE
Step Therapy Group Drug Names Step Therapy Criteria
PREVIOUS USE OF 60 DAYS OF DORZOLAMIDE HAS BEEN INEFFECTIVE, NOT
TOLERATED OR IS CONTRAINDICATED BEFORE AZOPT CAN BE APPROVED
Step Therapy Group Drug Names Step Therapy Criteria
FOR DOSES LESS THAN 20 MG REQUIRE 60 DAY TRIAL OF AT LEAST ONE
FORMULARY GENERIC STATIN: SIMVASTATIN, LOVASTATIN, PRAVASTATIN, OR
Step Therapy Group Drug Names
ACTOPLUS MET, ACTOPLUS MET XR, ACTOS, DUETACT, JANUMET, ONGLYZA,
PIOGLITAZONE HCL, PIOGLITAZONE HCL-GLIMEPIR, PIOGLITAZONE
Step Therapy Criteria
PREVIOUS USE OF 30 DAYS OF METFORMIN BEFORE OTHER ORAL DIABETIC
Step Therapy Group Drug Names Step Therapy Criteria
PREVIOUS USE OF 30 DAYS EACH OF TWO FORMULARY GENERIC TOPICAL
STEROIDS WITHIN THE PAST 180 DAYS HAS BEEN INEFFECTIVE, NOT
TOLERATED OR IS CONTRAINDICATED BEFORE ELIDEL CAN BE APPROVED. Step Therapy Group Drug Names Step Therapy Criteria
PREVIOUS USE OF 30 DAYS EACH OF TWO OF THE FOLLOWING GENERIC
SSRIs BEFORE ESCITALOPRAM CAN BE APPROVED: CITALOPRAM,
FLUOXETINE, FLUVOXAMINE, PAROXETINE, OR SERTRALINE. Step Therapy Group Drug Names Step Therapy Criteria
PREVIOUS USE OF 30 DAYS EACH OF OMEPRAZOLE AND PANTOPRAZOLE
HAVE BEEN INEFFECTIVE, NOT TOLERATED OR CONTRAINDICATED BEFORE
Step Therapy Group Drug Names Step Therapy Criteria
PREVIOUS USE OF 60 DAYS OF GENERIC FENOFIBRATE BEFORE TRICOR CAN
Step Therapy Group Drug Names
FENTANYL, FENTANYL CITRATE ORAL TRA, MORPHINE SULFATE ER
Step Therapy Criteria
PREVIOUS USE OF 7 DAYS OF METHADONE FIRST AND 7 DAYS OF MORPHINE
SULFATE ER SECOND WERE INEFFECTIVE, NOT TOLERATED OR ARE
CONTRAINDICATED BEFORE FENTANYL CAN BE APPROVED. Step Therapy Group Drug Names Step Therapy Criteria
PREVIOUS USE OF 30 DAYS EACH OF ZOLPIDEM AND ZALEPLON BEFORE
Step Therapy Group Drug Names
ASMANEX 120 METERED DOSES, ASMANEX 14 METERED DOSES, ASMANEX 30
METERED DOSES, ASMANEX 60 METERED DOSES, FLOVENT DISKUS,
Step Therapy Criteria
PREVIOUS USE OF 30 DAYS EACH OF QVAR FIRST AND PULMICORT SECOND
BEFORE OTHER INHALED CORTICOSTEROIDS CAN BE APPROVED. Step Therapy Group Drug Names Step Therapy Criteria
PREVIOUS USE OF AT LEAST 30 DAYS OF A GENERIC FORMULARY STIMULANT
SUCH AS METHYLPHENIDATE, AMPHETAMINE- DEXTROAMPHETAMINE, OR
Step Therapy Group Drug Names Step Therapy Criteria
PREVIOUS USE OF AT LEAST 30 DAYS OF GENERIC LEVETIRACETAM HAS
BEEN INEFFECTIVE, NOT TOLERATED OR IS CONTRAINDICATED BEFORE
Step Therapy Group Drug Names Step Therapy Criteria
PREVIOUS USE OF 7 DAYS OF METHADONE WAS INEFFECTIVE, NOT
Step Therapy Group Drug Names Step Therapy Criteria
PREVIOUS USE OF 30 DAYS EACH OF TWO GENERIC PPIs HAVE BEEN
INEFFECTIVE, NOT TOLERATED OR CONTRAINDICATED BEFORE OTHER PPIs
Step Therapy Group Drug Names Step Therapy Criteria
PREVIOUS USE OF 30 DAYS OF VENLAFAXINE ER BEFORE OTHER SNRI CAN
Step Therapy Group Drug Names Step Therapy Criteria
PREVIOUS USE OF 30 DAYS EACH OF TWO GENERIC SSRIs BEFORE OTHER
Step Therapy Group Drug Names Step Therapy Criteria
PREVIOUS USE OF 30 DAYS OF DIVALPROEX, DIVALPROEX ER, OR VALPROIC
ACID BEFORE STAVZOR CAN BE APPROVED. Step Therapy Group Drug Names Step Therapy Criteria
PREVIOUS USE OF 30 DAYS EACH OF TWO GENERIC ANTICONVULSANTS
INCLUDING CARBAMAZEPINE HAVE BEEN INEFFECTIVE, NOT TOLERATED OR
CONTRAINDICATED BEFORE TEGRETOL XR CAN BE APPROVED
Step Therapy Group Drug Names
MAXALT, MAXALT-MLT, RELPAX, RIZATRIPTAN BENZOATE, RIZATRIPTAN
Step Therapy Criteria
PREVIOUS USE OF A 10 DAY SUPPLY EACH OF SUMATRIPTAN AND
NARATRIPTAN BEFORE BRAND NAME TRIPTANS CAN BE APPROVED. Step Therapy Group Drug Names Step Therapy Criteria
PREVIOUS USE OF 30 DAYS OF LACTULOSE BEFORE XIFAXAN CAN BE
Step Therapy Group Drug Names Step Therapy Criteria
PREVIOUS USE OF 10 DAYS OF AZITHROMYCIN, ERYTHROMYCIN, OR
CLARITHROMYCIN WERE INEFFECTIVE, NOT TOLERATED OR IS
CONTRAINDICATED BEFORE ZMAX CAN BE APPROVED
SILICOLOR HIGHLY TRANSPIRING SILICON WATER PAINT FOR INTERIORS AND EXTERIORS On damp-proof plaster in refurbished rooms or in any case in the presen- ce of notable humidity in the walls it is necessary to use a transpiring fini- sh which decorates and protects the restored surfaces. It is therefore ne- cessary to pay particular attention to the choice of the paint to be used, which
CRISIS STABILIZATION / RESIDENTIAL DETOXIFICATION PROGRAM Informed Consent for Medication Consumer: _____________________________ ___CSP ___ Detox ___ Dual Chart # _____________ While you are at the Crisis/Detox/Touchstone Dual Diagnosis Program for care and treatment one of the following classes of medications may be prescribed to you. The side effects and adverse reactions are listed be