Notify your doctor if you develop irregular heartbeat, anxiety,tremors, confusion, depression, low blood pressure, fainting or yellowing of the eyes or skin.

In the unlikely event you have an allergic reaction to this drug, seek immediate medical attention.

Symptoms of an allergic reaction include rash, itching, swelling, dizziness or trouble breathing.

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Precautions:

Tell your doctor your medical history especially of kidney or liver disease, breathing problems, history of alcohol and/or drug use, colitis or other intestinal/stomach problems, severe diarrhea, head injury, heart problems and of any drug allergies.

Use caution when engaging in activities requiring alertness such as driving.

Limit alcohol intake because it may add to the dizziness/drowsiness effects of this medication.

This medication should be used during pregnancy only when clearly needed.

Discuss the risks and benefits with your doctor.

This medication is excreted into breast milk.

Though to date, no problems have been noted in nursing infants, consult your doctor before breast-feeding.

Generic Name: Propoxyphene HCl/Acetaminophen

Wygesic 65-650 mg Tablet - Prescription

Propoxyphene HCl/APAP 65-650 mg Tablet - Prescription

MAL447.pdf

http://www.odjfs.state.oh.us/lpc/mtl/MAL447.pdf

preferred drugs, prior authorization, PDL, age, tablets, Beta-Agonists, requests, nebs, DILTIAZEM, First Health, pharmacy.

Effective April 7, 2003 Ohio Medicaid will move to the next phase of pharmacy management -- a Preferred Drug List (PDL).

The classes listed below were reviewed to determine those products that the Department considers "preferred" for Ohio Medicaid recipients.

A "preferred" status in these classes indicates that the product does not require prior authorization (PA) in most situations.

Those products in these classes that are "non-preferred" are subject to prior authorization.

If you have additional questions or would like to schedule an educational visit, please call our vendor, First Health Services, at 614-481-3519.

Note: Fax requests are responded to within 24 hrs.

xibcselectpocketguiderx.pdf

tabs, HCl, brand-name, sodium, hydrocortisone, codeine, prednisolone, phosphate, cream, estradiol, erythromycin.

BRAND-NAME GENERIC NAME Accutane (derm consult isotretinoin suggested) Bactroban mupirocin Benzamycin Gel benzoyl peroxide/ (except pouch) erythromycin Cleocin T clindamycin Diprolene ointment augmented Diprosone aerosol Diprosone, Maxivate Diprosone, Maxivate Drithocreme, HP, Dritho-SC Efudex, Fluoroplex Elimite Emla Erycette, T-Stat Erygel, Emgel Erymax Garamycin Hytone Kenalog Kenalog betamethasone dipropionate ointment betamethasone dipropionate 0.1% aerosol betamethasone dipropionate 0.05% oint betamethasone dipropionate 0.05% cream, lotion anthralin fluorouracil cream, soln.

BRAND-NAME GENERIC NAME Alesse levonorgestrel/ ethinyl estradiol Aygestin norethindrone acetate Brethine terbutaline sulfate tabs Cleocin Vaginal clindamycin vaginal Climara estradiol transdermal Demulen ethynodiol/ethinyl estradiol Depo-Provera medroxyprogesterone Diflucan fluconazole (oral, single dose) Estrace estradiol Estraderm estradiol transdermal Estratest, HS esterified estrogens/ methyltestosterone Estring estradiol vaginal ring Femhrt ethinyl estradiol/ norethindrone Loestrin norethindrone/ethinyl estradiol Loestrin Fe norethindrone/ethinyl estradiol, Fe Lo/Ovral ethinyl estradiol/norgestrel Lunelle estradiol/medroxyprogesterone Methergine methylergonovine MetroGel vaginal metronidazole vaginal cream Mircette desogestrel/ethinyl estradiol Modicon norethindrone/ethinyl estradiol Mycostatin nystatin Nordette levonorgestrel/ethinyl estradiol Ortho-Cept desogestrel/ethinyl estradiol Ortho-Cyclen norgestimate/ethinyl estradiol Ortho-Est estropipate Ortho Evra ethinyl estradiol/ norelgestromin Ortho Micronor, norethindrone Nor-Q.D.

medicare_form_guide.pdf

http://www.site65.com/sdf_pdf/medicare_form_guide.pdf

cream, drug, physician, HCl, cost, bold, brand, brand-name, prior authorization, prescription, medications.

A formulary is a comprehensive list of U.S. Food and Drug Administration (FDA) approved prescription medications selected by the IBC Pharmacy and Therapeutics Committee.

IBC has established this independent committee of physicians and pharmacists to help ensure that our formularies are medically sound and support patients' health.

n/a Not available - There is no FDA-approved generic drug available at the time this formulary was printed.

Ativan lorazepam Non-bolded is a brand Bold is an available nonformulary drug.

1. The prescribing physician completes a prior authorization form -- available from IBC Pharmacy Services by calling 1 215 241-9550 in Philadelphia or 1 888 671-5280 outside Philadelphia -- or writes a letter describing the medical necessity and submits it to IBC's Pharmacy Services Department.

Sometimes your physician may prescribe a medication to be dispensed as written when a preferred brand-name or generic drug is available.