©2008 Express Scripts, Inc. (10/15/2007)
20 Nombre del medicamento
| Composición química
| Nivel
| Requisitos/ Límites
| OTROS MEDICAMENTOS VASODILATADORES
| papaverine hcl
|
| 1
|
| para-time
|
| 1
|
| REVATIO
| revatio (sildenafil citrate)
| 3
| [PAR][QLL]
|
| DIURÉTICOS CONSERVADORES DE POTASIO
| amiloride hcl, -hctz
|
| 1
|
| spironolactone, -hctz
|
| 1
|
| triamterene/hctz
|
| 1
|
|
| TIAZIDAS Y MEDICAMENTOS RELACIONADOS
| chlorothiazide
|
| 1
|
| chlorthalidone
|
| 1
|
| hydrochlorothiazide
|
| 1
|
| indapamide
|
| 1
|
| methyclothiazide
|
| 1
|
| metolazone
|
| 1
|
|
| ANTIHIPERTENSIVOS VASODILATADORES
| doxazosin mesylate
|
| 1
| [QLL]
| hydralazine hcl
|
| 1
|
| minoxidil
|
| 1
|
| prazosin hcl
|
| 1
|
| terazosin hcl
|
| 1
| [QLL]
|
| MEDICAMENTOS DERMATOLÓGICOS
| MEDICAMENTOS PARA EL ACNÉ
| benprox
|
| 1
|
| benzoyl peroxide
|
| 1
|
| clenia emulsion
|
| 1
|
| clinda-derm
|
| 1
|
| clindamycin phosphate
|
| 1
|
| ery
|
| 1
|
| erythromycin, -benzoyl peroxide
|
| 1
|
| ethexderm
|
| 1
|
| FINACEA
| azelaic acid
| 2
|
| metronidazole
|
| 1
|
| oscion
|
| 1
|
| prascion, av, ra, ts
|
| 1
|
| rosaderm
|
| 1
|
| sodium sulfacetamide/sulfur
|
| 1
|
| sulfatol, -m
|
| 1
|
| suphera
|
| 1
|
| tretinoin crema (0.025 %, 0.05 %, 0.1 %), gel
|
| 1
| [PAR]
| ©2008 Express Scripts, Inc. (10/15/2007)
21 Nombre del medicamento
| Composición química
| Nivel
| Requisitos/ Límites
| zaclir
|
| 1
|
|
| ANTIPRURÍTICOS
| aluminum acetate
|
| 1
|
| hydroxyzine hcl, pamoate [CARE]
|
| 1
|
|
| MEDICAMENTOS PARA LA PSORIASIS Y LOS ECZEMAS
| DOVONEX
| calcipotriene
| 2
|
| drithocreme hp
|
| 1
|
| mexar
|
| 1
|
| re 10, sa
|
| 1
|
| salitop
|
| 1
|
| scalp treatment
|
| 1
|
| seb-prev crema, gel, soln
|
| 1
|
| selenium sulfide
|
| 1
|
| selenos
|
| 1
|
| sodium sulfacetamide
|
| 1
|
| SORIATANE CK
| acitretin/emollient comb
| 3
|
| sulfacetamide sodium
|
| 1
|
| TAZORAC
| tazarotene
| 2
| [PAR]
|
| MEDICAMENTOS QUERATOLÍTICOS
| CONDYLOX gel
| podofilox
| 2
|
| formalaz
|
| 1
|
| GORDOFILM
| salicylic acid/la/collodion
| 2
|
| KERALYT
| salicylic acid
| 2
|
| podofilox
|
| 1
|
| salicylic acid
|
| 1
|
|
| MEDICAMENTOS DERMATOLÓGICOS ORALES
| 8-MOP
| methoxsalen
| 3
|
| amnesteem
|
| 1
|
| claravis
|
| 1
|
| OXSORALEN-ULTRA
| methoxsalen
| 3
|
| sotret
|
| 1
|
|
| ESCABICIDAS
| acticin
|
| 1
|
| EURAX
| crotamiton
| 2
|
| LINDANE
| benzene hexachloride gamma
| 2
|
| permethrin crema
|
| 1
|
|
| MEDICAMENTOS CORTICOSTEROIDES TÓPICOS
| alclometasone dipropionate
| 1
|
| ©2008 Express Scripts, Inc. 22
(10/15/2007)
Nombre del medicamento
| Composición química
| Nivel
| Requisitos/ Límites
| amcinonide
|
| 1
|
| beta-val
|
| 1
|
| betamethasone dipropionate, valerate
|
| 1
|
| betanate
|
| 1
|
| clobetasol emollient, propionate
|
| 1
|
| cormax
|
| 1
|
| desonide
|
| 1
|
| desoximetasone
|
| 1
|
| diflorasone diacetate
|
| 1
|
| fluocinolone acetonide
|
| 1
|
| fluocinonide, -e
|
| 1
|
| fluticasone propionate
|
| 1
|
| halobetasol propionate
|
| 1
|
| hydrocortisone acetate gel
|
| 1
|
| hydrocortisone, butyrate, valerate
|
| 1
|
| keratol hc
|
| 1
|
| mometasone furoate
|
| 1
|
| prednicarbate
|
| 1
|
| triamcinolone acetonide
|
| 1
|
| triderm
|
| 1
|
|
MEDICAMENTOS DERMATOLÓGICOS TÓPICOS
| ALDARA
| imiquimod
| 2
|
| allanenzyme
|
| 1
|
| allanfillenzyme
|
| 1
|
| ammonium lactate
|
| 1
|
| benzoin
|
| 1
|
| cerovel
|
| 1
|
| diab
|
| 1
|
| EFUDEX crema, kit
| fluorouracil
| 2
|
| ELIDEL
| pimecrolimus
| 2
| [ST]
| ethezyme,650,830
|
| 1
|
| FLUOROPLEX
| fluorouracil
| 2
|
| fluorouracil
|
| 1
|
| gladase, -c
|
| 1
|
| hypercare
|
| 1
|
| keratol 40, plus
|
| 1
|
| kovia 6.5, ungüento
|
| 1
|
| lactic acid
|
| 1
|
| PANRETIN
| alitretinoin
| 3
|
| PROTOPIC
| tacrolimus
| 2
| [ST]
| PRUDOXIN [CARE]
| doxepin
| 2
|
| radiagel
|
| 1
|
| re urea 40
|
| 1
|
| |