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2025配方排除药物清单
carbamazepine, carbamazepine ext-rel, clonazepam, divalproex sodium, divalproex sodium ext- rel, ethosuximide, gabapentin, lacosamide, lamotrigine, lamotrigine ext-rel, levetiracetam, levetiracetam ext-rel, oxcarbazepine, phenobarbital,苯妥英钠，苯妥英钠钠延伸，果蝇，甲状腺素，tiagabine，topiramate，tupiramate Ext-Rel，丙丙酸，丙烯酸，Zonisamide，Aptiom，aptiom，briviact，fycompa，fycompa，fycompa，oxtellar xr，oxtellar xr，xcopri
使用高级控制专业配方®
carbamazepine, carbamazepine ext-rel, clonazepam, divalproex sodium, divalproex sodium ext-rel, ethosuximide, gabapentin, lacosamide, lamotrigine, lamotrigine ext-rel, levetiracetam, levetiracetam ext-rel, oxcarbazepine, phenobarbital, phenytoin, phenytoin sodium extended, pregabalin, primidone, tiagabine, topiramate, valproic acid, zonisamide , APTIOM, BRIVIACT, FYCOMPA, OXTELLAR XR, XCOPRI DILANTIN carbamazepine, carbamazepine ext-rel, divalproex sodium, divalproex sodium ext-rel, gabapentin, lacosamide, lamotrigine, lamotrigine ext-rel, levetiracetam, levetiracetam ext-rel, oxcarbazepine, phenobarbital, phenytoin, phenytoin sodium er, pregabalin, primidone, tiagabine, topiramate, valproic acid, zonisamide , APTIOM, BRIVIACT, FYCOMPA，OXTELLAR XR，XCOPRI
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
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