RA Messages for October 15, 2002
PHARMACY PROVIDERS, PLEASE NOTE!!!
IF YOU ARE UNSURE ABOUT THE COVERAGE OF A DRUG PRODUCT, PLEASE CONTACT
THE PBM HELP DESK AT 1-800-648-0790
PLEASE MAKE THE FOLLOWING CHANGES
TO THE 1/01/02 VERSION OF APPENDIX A:
| DRUG |
DOSAGE |
STRENGTH |
MAC |
EFF DATE |
| DISULFIRAM |
TABLET |
250MG |
OFF MAC |
08/01/02 |
| HYDROXYZINE HCL |
TABLET |
10MG |
OFF MAC |
08/01/02 |
| HYDROXYZINE HCL |
TABLET |
25MG |
OFF MAC |
08/01/02 |
| HYDROXYZINE HCL |
TABLET |
50MG |
OFF MAC |
08/01/02 |
| NORETHINDRONE-ETHINYL EST |
TABLET |
1/0.035MG 21 TAB |
OFF MAC |
08/01/02 |
| NORETHINDRONE-MESTRANOL |
TABLET |
1/0.05MG 21 TAB |
OFF MAC |
08/01/02 |
| NORETHINDRONE-MESTRANOL |
TABLET |
1/0.05MG 28 TAB |
OFF MAC |
08/01/02 |