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肯塔基州医疗补助 - 首选药物清单 (PDL)
Adlarity 贴片 Aricept 片 多奈哌齐 23 毫克片 加兰他敏缓释胶囊 氢溴酸加兰他敏片 氢溴酸加兰他敏溶液 美金刚缓释洒剂胶囊 美金刚溶液 Namenda 片剂量包 Namenda 片 Namenda XR 洒剂胶囊 Namenda XR 胶囊剂量包 Namzaric 洒剂胶囊 Namzaric 胶囊剂量包 利伐斯的明贴片 抗惊厥药 卡马西平缓释胶囊 卡马西平缓释片 卡马西平咀嚼片 卡马西平片 Celontin 胶囊 氯巴占混悬液 氯巴占片 氯硝西泮片 地西泮套装 双丙戊酸钠缓释洒剂胶囊 双丙戊酸钠缓释片 双丙戊酸钠缓释片 Equetro 乙琥胺胶囊 乙琥胺溶液 非氨酯混悬剂 非氨酯片 加必曲片 拉科酰胺溶液 拉科酰胺片 拉莫三嗪片
卫生与公共服务执行办公室罗德岛...
当前审查日期：01/14/2025不需要PA第一代Divalproex片/er Divalproex撒上Ethosuximide felbamate felbamate schytoin capsule/悬浮甲氧二酰胺苯二酰胺苯二甲阵阵态chew tab chehytoin ext to ext capsule ext Capsule（gen egytek）胶囊/悬浮剂DiLantin咀嚼片Felbatol甲莫林苯酚苯甲蛋白胶囊/糖浆第二代LACOSAMIDE溶液lamotrigine单位剂量soln briviact lacosamide lacosamide lacotrigine lamotrigine xr Levetiracetam er Fycompa topiramate片剂/撒布Rufinamide悬浮液/XR * Zonisamide rufinamide片剂lamictal/odt/odt/xr/ds tiagabine tiagabine libervant topim topim topim er motpolotate er topolotpoly xr vig vigabatrin vig qudexim vig qudim vigim vig qudim aptrAd sprrad sprrict sprrict s sababatrilin s sababatrilin s sababatrilin sababatrilin平板电脑/洒水 * banzel trokendi xr vigafyde解决方案nr
首选药物清单
当前审查日期：01/14/2025不需要PA第一代Divalproex片/er Divalproex撒上Ethosuximide felbamate felbamate schytoin capsule/悬浮甲氧二酰胺苯二酰胺苯二甲阵阵态chew tab chehytoin ext to ext capsule ext Capsule（gen egytek）胶囊/悬浮剂DiLantin咀嚼片Felbatol甲莫林苯酚苯甲蛋白胶囊/糖浆第二代LACOSAMIDE溶液lamotrigine单位剂量soln briviact lacosamide lacosamide lacotrigine lamotrigine xr Levetiracetam er Fycompa topiramate片剂/撒布Rufinamide悬浮液/XR * Zonisamide rufinamide片剂lamictal/odt/odt/xr/ds tiagabine tiagabine libervant topim topim topim er motpolotate er topolotpoly xr vig vigabatrin vig qudexim vig qudim vigim vig qudim aptrAd sprrad sprrict sprrict s sababatrilin s sababatrilin s sababatrilin sababatrilin平板电脑/洒水 * banzel trokendi xr vigafyde解决方案nr
南达科他州医疗补助
Treatment Class Drug Class Drug Analgesics COX-2 Inhibitor celecoxib NSAIDs diclofenac, etodolac, fenoprofen, flurbiprofen, ibuprofen, indomethacin, ketoprofen, meclofenamate, mefenamic, meloxicam, naproxen, oxaprozin, piroxicam, sulindac, tolmetin – capsule/tablet NSAID Combination diclofenac-misoprostol, naproxen-esomeprazole Salicylate diflunisal, salsalate Pyrimidine Synthesis Inhibitor leflunomide Anticoagulants Coumarin Anticoagulant warfarin Anticonvulsants Anticonvulsants – 2 nd Generation carbamazepine, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, primidone, tiagabine topiramate, zonisamide Anticonvulsants – 1 st Generation ethosuximide, felbamate divalproex/ER phenytoin/ER, valproic acid Antidementia Agents Alzheimer's Treatment donepezil, galantamine, rivastigmine, memantine Antidepressants Monoamine氧化酶抑制剂（MAOI）苯嗪，三酰胺选择性5-羟色胺再摄取抑制剂（SSRI）
Tenncare自动免税和认证药物清单
卡马西平，卡马西平ER卡巴特罗®，Epitol®，Tegretol®，TegretolXr®Xclobazamonfi®，Sympazan®X氯硝西am，Clonazepam odt odtklonopin®xiazepam®xiazepamtimectal x Diaczepam timectal X Divalproex Divalproex®Ervipet®dival®ErpeateEr dippeate appeate deptepteptepteptepteptepteptepteptepteptepteptepti Sprinkles X EthosuximideZarontin®X FelbamateFelbatol®XGabapentin神经themottin®X Lacosamide MotpolyXr®，Vimpat®X Lamotrigine，Lamotrigine odtlamictal® Spritam® X oxcarbazepine Oxtellar XR®, Trileptal® X phenobarbital X phenytoin Diltantin-125®, Dilantin Kapseal®, Phenytek®, Dilantin Infatabs® X pregabalin Lyrica® X primidone Mysoline® X rufinamide Banzel® X tiagabine Gabitril® X topiramate, topiramate ER Qudexy XR®, Topamax®, Trokendi XR® X valproic acid Depakene® X vigabatrin Sabril®, Vigadrone®, Vigafyde® X zonisamide Zonisade® X Aptiom® X Briviact® X Celontin® X Diacomit® X Epidiolex® X Fintepla® X X Fycompa® X Nayzilam® X Peganone®XValtoco®XXCOPRI®XZTALMY®X