2006 preliminary_

Preliminary 2006 Three-Tier Prescription Drug List Consumer Reference Guide Here is your Preliminary 2006 Prescription Drug List. This booklet provides information onmedications that are covered under your pharmacy plan and lists those drugs that are available at themost affordable cost to you. This Prescription Drug List is provided for open enrollment purposes toassist you in your benefit plan decisions as well as Flexible Spending Account allocations. Please notethat the list effective for 2006 is subject to change prior to 12/1/05. After December 1st, you mayobtain the most current Prescription Drug List and information on your drug coverage atwww.myuhc.com/pharmacy.
Some drugs are noted with N, QD, QL, or DS. The definitions for these symbols are listed below.
QD = Quantity Duration. Some drugs have a limited amount that can be covered for a specific Your benefit plan determines how these drugs may be covered for you.
N = Notification. There are a few drugs that your physician must notify us of to make sure their QL = Quantity Level. Some drugs have a limited amount that can be covered at one time.
DS = Diabetic Supplies. Diabetic supplies may be covered by your benefit plan.
Preliminary 2006 Three-Tier Prescription Drug List Consumer Reference GuideDidanosine 200, 250, 400 mg Enalapril with Hydrochlorothiazide Hydrocortisone Valerate Some drugs are noted with N, QD, QL, or DS. The definitions for these symbols are listed below.
QD = Quantity Duration. Some drugs have a limited amount that can be covered for a specific Your benefit plan determines how these drugs may be covered for you.
N = Notification. There are a few drugs that your physician must notify us of to make sure their QL = Quantity Level. Some drugs have a limited amount that can be covered at one time.
DS = Diabetic Supplies. Diabetic supplies may be covered by your benefit plan.
Preliminary 2006 Three-Tier Prescription Drug List Consumer Reference Guide Some drugs are noted with N, QD, QL, or DS. The definitions for these symbols are listed below.
QD = Quantity Duration. Some drugs have a limited amount that can be covered for a specific Your benefit plan determines how these drugs may be covered for you.
N = Notification. There are a few drugs that your physician must notify us of to make sure their QL = Quantity Level. Some drugs have a limited amount that can be covered at one time.
DS = Diabetic Supplies. Diabetic supplies may be covered by your benefit plan.
Preliminary 2006 Three-Tier Prescription Drug List Consumer Reference Guide Some drugs are noted with N, QD, QL, or DS. The definitions for these symbols are listed below.
QD = Quantity Duration. Some drugs have a limited amount that can be covered for a specific Your benefit plan determines how these drugs may be covered for you.
N = Notification. There are a few drugs that your physician must notify us of to make sure their QL = Quantity Level. Some drugs have a limited amount that can be covered at one time.
DS = Diabetic Supplies. Diabetic supplies may be covered by your benefit plan.
Preliminary 2006 Three-Tier Prescription Drug List Consumer Reference Guide Some drugs are noted with N, QD, QL, or DS. The definitions for these symbols are listed below.
QD = Quantity Duration. Some drugs have a limited amount that can be covered for a specific Your benefit plan determines how these drugs may be covered for you.
N = Notification. There are a few drugs that your physician must notify us of to make sure their QL = Quantity Level. Some drugs have a limited amount that can be covered at one time.
DS = Diabetic Supplies. Diabetic supplies may be covered by your benefit plan.
Preliminary 2006 Three-Tier Prescription Drug List Consumer Reference Guide Some drugs are noted with N, QD, QL, or DS. The definitions for these symbols are listed below.
QD = Quantity Duration. Some drugs have a limited amount that can be covered for a specific Your benefit plan determines how these drugs may be covered for you.
N = Notification. There are a few drugs that your physician must notify us of to make sure their QL = Quantity Level. Some drugs have a limited amount that can be covered at one time.
DS = Diabetic Supplies. Diabetic supplies may be covered by your benefit plan.
Preliminary 2006 Three-Tier Prescription Drug List Consumer Reference Guide Retin-A Micro NRhinocort QLRhinocort Aqua QLRitalin LA QLRobinul ForteRosanilSarafem QLSkelaxinSonata QL/QDStarlix QLStrattera QLTamiflu QL, NTarkaTequin QLTeveten QL/QDTheo-24Tracer BG Test Strips DSTransderm-ScopTriazTri-NorinylTussionexUltracet QLUniphylUnireticUnivascVagifemVancenase AQ QLVantinVerelan PMVicodin ES NOTE:• Compounded prescriptions are Tier Three • Pens & cartridges are Tier Three except for Novolin and Novolog pens and cartridgesthat are Tier Two.
XalatanXanax XRXopenex QLZegerid QL/QDZelnorm QLZymar Some drugs are noted with N, QD, QL, or DS. The definitions for these symbols are listed below.
QD = Quantity Duration. Some drugs have a limited amount that can be covered for a specific Your benefit plan determines how these drugs may be covered for you.
N = Notification. There are a few drugs that your physician must notify us of to make sure their QL = Quantity Level. Some drugs have a limited amount that can be covered at one time.
DS = Diabetic Supplies. Diabetic supplies may be covered by your benefit plan.
Preliminary 2006 Three-Tier Prescription Drug List Consumer Reference Guide Some drugs are noted with N, QD, QL, or DS. The definitions for these symbols are listed below.
QD = Quantity Duration. Some drugs have a limited amount that can be covered for a specific Your benefit plan determines how these drugs may be covered for you.
N = Notification. There are a few drugs that your physician must notify us of to make sure their QL = Quantity Level. Some drugs have a limited amount that can be covered at one time.
DS = Diabetic Supplies. Diabetic supplies may be covered by your benefit plan.

Source: http://www.cityofdallasemployees.com/FormularyUHC2006PharmacyDrugListPrelimary11012005.pdf