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*Denotes a generic available in at least one dosage form or strength - page 3 / 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.

  • The preferred status of this product is contingent

upon statewide influenza epidemiology status as reported by the CDC.

Cleocin*

none none

none none

Relenza

Tamiflu

none

polymyxin B sulfate dapsone

none

metronidazole

Alinia Flagyl* Flagyl ER Mepron Nebupent Pentam 300* Tindamax*

pentamidine tinidazole

foscarnet

Foscavir*

cefoxitin

Azactam Doribax Invanz Mefoxin* Merrem Primaxin

clindamycin bacitracin colistimethate

vancomycin

Baciim* Coly-Mycin M* Cubicin Helidac Lincocin Pylera Synercid Vancocin* Vibativ** Xifaxan Zyvox

cefotetan none

ribavirin ganciclovir famciclovir

ribavirin

valacyclovir

acyclovir

Baraclude Copegus* Cytovene* Famvir* Hepsera Rebetol* Tyzeka Valcyte Valtrex* Virazole Vistide Zovirax*

*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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