Microsoft word - 102013 preventive drug list - bnsf.docx
BNSF Medical Program Preventive Therapy Drug List (10/01/13) ANTICONVULSANTS ORAL ANTIANGINAL AGENTS
COMBINATION ANTIHYPERLIPIDEMICS SL and chewable formulations are not includedTRANSDERMAL/TOPICAL ANTIANGINAL DIABETES DIAGNOSTIC AGENTS AND SUPPLIES CORONARY ARTERY DISEASE ANTIHYPERLIPIDEMICS INJECTABLE DIABETES AGENTS Over-the-Counter (OTC) products require a prescription. ORAL DIABETES AGENTS CARDIOVASCULAR CONDITIONS - ANTIARRHYTHMIC AGENTS * Products are not covered by the BNSF Medical Program ( ) CVS Caremark Formulary Exclusions – you may be required to pay the full cost. Some strengths or dosage forms may not be included in the BNSF Medical Program Preventative Therapy Drug List.Please note: This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics.
HYPERTENSION ACE INHIBITORS/ANGIOTENSIN II RECEPTOR BETA-BLOCKERS ANTAGONISTS CALCIUM CHANNEL BLOCKERS HEMATOLOGIC AGENTS ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS *Products are not covered by the BNSF Medical Program ( ) CVS Caremark Formulary Exclusions – you may be required to pay the full cost. Some strengths or dosage forms may not be included in the BNSF Medical Program Preventative Therapy Drug List.Please note: This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics.
DIURETICS spironolactone/hydrochlorothiazideANTIPSYCHOTICS MENTAL HEALTH ANTIDEPRESSANTS OTHER ANTIHYPERTENSIVE AGENTS olanzapine orally disintegrating tabsIMMUNIZING AGENTS OSTEOPOROSIS *Products are not covered by the BNSF Medical Program ( ) CVS Caremark Formulary Exclusions – you may be required to pay the full cost. Some strengths or dosage forms may not be included in the BNSF Medical Program Preventative Therapy Drug List.Please note: This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics.
PREVENTIVE CARE SERVICES WOMEN'S HEALTH AGENTS FOR CHEMICAL DEPENDENCY ANTIESTROGENS ANTICOAGULANTS/ AROMATASE INHIBITORS PLATELET AGGREGATION INHIBITORS ANTI-OBESITY AGENTS CONTRACEPTIVES LOW-DOSE MONOPHASIC PILLS levonorgestrel/EE 0.1/20 and EE 10VARIOUS CONDITIONS ANTI-MALARIAL AGENTS norethindrone acetate/EE 1/20 and ironSMOKING DETERRENTS norethindrone acetate/EE 1.5/30 and DENTAL CARIES PREVENTION HIGH-DOSE MONOPHASIC PILLS Over-the-Counter (OTC) products require a prescription. HEREDITARY ANGIOEDEMA AGENTS BIPHASIC PILLS RESPIRATORY DISORDERS IMMUNOSUPPRESSIVE AGENTS TRIPHASIC PILLS MULTIPLE SCLEROSIS AGENTS FOUR-PHASIC EXTENDED-CYCLE PILLS ANTICOAGULANTS *Products are not covered by the BNSF Medical Program ( ) CVS Caremark Formulary Exclusions – you may be required to pay the full cost. Some strengths or dosage forms may not be included in the BNSF Medical Program Preventative Therapy Drug List.Please note: This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics.
levonorgestrel/EE 0.15/30 and EE 10EMERGENCY CONTRACEPTION levonorgestrel - Next Choice One DoseTRANSDERMAL PATCH CONTINUOUS-CYCLE PILLS PRENATAL VITAMINS MISCELLANEOUS CONTRACEPTIVES PROGESTIN-ONLY PILLS *Products are not covered by the BNSF Medical Program ( ) CVS Caremark Formulary Exclusions – you may be required to pay the full cost. Some strengths or dosage forms may not be included in the BNSF Medical Program Preventative Therapy Drug List.Please note: This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics.
PATIENT PREPARATION GUIDELINES Blood work requirements for CT with IV Contrast Creatinine labs are needed for patients who are diabetic within 2 weeks of exam and for patients greater than 65 years old within 6months of exam. Blood work requirements for MRI with IV Contrast Creatinine labs are needed for patients who are diabetic within 2 weeks of exam and for patients greater than 60
Case 1:09-cv-01761-AJB Document 27 Filed 05/17/10 Page 1 of 58 IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF GEORGIA ATLANTA DIVISION GRACIE MARIE JAMIAH, Plaintiff, CIVIL ACTION FILE NO. 1:09-CV-01761-AJB MICHAEL J. ASTRUE, Commissioner of Social Security Administration , Defendant. ORDER 1 AND MEMORANDUM OPINION Plaintiff, Gracie Ma