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

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prenatal vitamins, iron, folic acid

prenatal vitamins, iron, folic acid, docusate

prenatal vitamins, iron, folic acid

prenatal vitamins, iron, folic acid prenatal vitamins, iron, folic acid, docusate prenatal vitamins, iron, folic acid

prenatal vitamins, iron, folic acid prenatal vitamins, iron, folic acid, selenium prenatal vitamins, iron, folic acid prenatal vitamins, iron, folic acid, docusate prenatal vitamins, iron, folic acid, docusate

Tricare* Tricare DHA Vinacal* Vinate AZ Vinate AZ Extra Vinate C* Vinate Calcium Vinate Care* Vinate GT* Vinate IC* Vinate II Vinate III* Vinate M* Vinate One* Vinate PN Care* Vinate Ultra* Vitafol-OB Vitafol-OB+DHA Vitafol-PN Viva DHA

iron, docusate, folic acid

prenatal vitamins, iron, folic acid, DHA, EPA, omega- 3 fatty acids

*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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