Microsoft word - rxedo_select_120107_.doc
Non-Preferred
EDO Preferred
Brands ($$$)
Alternatives ($ or $$) *
Preferred Drug List
Dear Member:
Please review this Preferred Drug List (PDL) with
your physician at the time he or she writes your
Formulary Disclaimer:
prescription. This PDL, which includes both brand
Please be sure your prescription drug benefit is offered
and generic medications, is not a complete list,
through RxEDO before consulting this list. Coverage for
some drugs may be limited to specific dosage forms
but a summary of the most commonly prescribed
and/or strengths. Your benefit design determines what is
medications. Your plan’s benefit design
covered for you and what your co-payment will be.
determines which medications are included or
Please refer to your benefit materials for specific
excluded from coverage. Please refer to your
coverage information. The medications listed on this
benefit information for applicable copays and
formulary are subject to change pursuant to the
formulary management activities of RxEDO. The presence
of a medication on this formulary does not guarantee
that you as a plan member will be prescribed that drug
by your primary care physician or contracting provider for
a particular medical condition. These medications may be
Dear Physician:
subject to Prior Authorization. As new generics become
Please refer to this list when prescribing for your
available the corresponding brand name drug will no
patient. The medications listed and all generic
equivalents are Preferred Drug Choices under the
patient’s prescription benefit. The PDL is not
intended as a substitute for your professional
Preferred Drugs for your patients, out-of-pocket
expense and plan costs may be lowered. When
applicable, generic prescribing is optimal. As
generic equivalents become available in the
*Please note that the preferred alternatives listed here
You can access this list via our member portal at
are not a complete listing of all alternatives, only those
medications that are most commonly prescribed.
12/01/07
Growth Hormones
Multiple Sclerosis Agents
Anti-Inflammatory
Heart Disease/Blood
Pressure
Oral Anti-Diabetic Agents
CNS-Stimulants
Atypical Antipsychotics
Antibiotics
Blood Glucose Diagnostics
Contraceptives
Osteoporosis Agents
Cholesterol Reduction
Ophthalmics
Anti-Migraine Agents
CNS-Anxiety
Anti-Virals
Estrogens
Overactive Bladder
Antidepressants
CNS-Nausea
Prostate Agents
CNS-Parkinson’s
Asthma/COPD
Sleep Aids
Gastrointestinal
CNS-Seizures
Topical Preparations
Anti-Fungals
$ - Generic drugs (listed in all
lowercase letters) have the lowest copay
$$ - Preferred brand name drugs (listed in all
CAPITAL letters) have the middle copay
$$$ - Non-preferred brand name drugs (listed in all
CAPITAL letters on the front of this handout) have the highest copay
Source: http://archive.sbcisd.net/departments/humanResources/files/RxEDO07.pdf
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