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*Denotes a generic available in at least one dosage form or strength - page 23 / 26

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This PDL reference tool is to aid a prescribing physician with generic availability and preferred product status. A “substitution allowed” physician signature on a prescription should not require a PA to be obtained if a generic agent is available.

none

Doak Tar Distillate

coal tar

Elidel Protopic

podofilox

calcipotriene fluorouracil

formaldehyde formaldehyde

Aldara Artiss Carac Condylox* Constant-Clens Dovonex* Efudex* Fluoroplex Formalaz* Lazerformalyde* Panretin Podocon-25 Regranex Santyl Solaraze Soriatane CK Taclonex Targretin Tazorac Vectical**

phenylephrine, shark liver oil, glycerin and white petrolatum

phenylephrine, shark liver oil, mineral oil and white petrolatum

*Denotes a generic available in at least one dosage form or strength **Will be reviewed at a future time when eligible

Effective 4/1/2010

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