KP Wellness
1:26 PM - Public
Musculoskeletal & Rheumatology
10.2 Gout Therapy
TIER 1
Allopurinol (Zyloprim)
Probenecid (Benemid)
TIER 2
Colcrys (Colchine)
TIER 3
Febuxostat (Uloric)
10.3 Other Rheumatologicals
10.3.1 CORTICOSTEROIDS
TIER 1
Dexamethasone (Decadron)
Hydrocortisone Tablet (Cortef)
Methylprednisolone Tablet, Dose Pack (Medrol 4, 16 mg)
Orapred (Prednisolone Sodium Phosphate Solution, Oral)
Prednisolone Sodium Phosphate Solution, Oral (Pediapred)
Prednisolone Syrup (Prelone)
Prednisone (Meticorten)
TIER 2
Medrol 2, 8, 24, 32 mg (Methylprednisolone Tablet)
Pediapred (Prednisolone Sodium Phosphate Oral)
10.3.2 MISCELLANEOUS RHEUMATOLOGICAL AGENTS
TIER 1
Azathioprine (Imuran)
Hydroxychloroquine Sulfate (Plaquenil)
Leflunomide (Arava)
Methotrexate Sodium (Methotrexate)
Sulfasalazine Tablet (Azulfidine)
Sulfasalazine Tablet, Enteric-Coated (Azulfidine)
TIER 2
Cimzia (Certolizumab Pegol)
Cuprimine (Penicillamine)
Enbrel (Etanercept)
Simponi (Golimumab)
Trexall (Methotrexate Sodium)
TIER 3
Adalimumab (Humira)
Anakinra (Kineret)
Milnacipran (Savella)
10.2 Gout Therapy
TIER 1
Allopurinol (Zyloprim)
Probenecid (Benemid)
TIER 2
Colcrys (Colchine)
TIER 3
Febuxostat (Uloric)
10.3 Other Rheumatologicals
10.3.1 CORTICOSTEROIDS
TIER 1
Dexamethasone (Decadron)
Hydrocortisone Tablet (Cortef)
Methylprednisolone Tablet, Dose Pack (Medrol 4, 16 mg)
Orapred (Prednisolone Sodium Phosphate Solution, Oral)
Prednisolone Sodium Phosphate Solution, Oral (Pediapred)
Prednisolone Syrup (Prelone)
Prednisone (Meticorten)
TIER 2
Medrol 2, 8, 24, 32 mg (Methylprednisolone Tablet)
Pediapred (Prednisolone Sodium Phosphate Oral)
10.3.2 MISCELLANEOUS RHEUMATOLOGICAL AGENTS
TIER 1
Azathioprine (Imuran)
Hydroxychloroquine Sulfate (Plaquenil)
Leflunomide (Arava)
Methotrexate Sodium (Methotrexate)
Sulfasalazine Tablet (Azulfidine)
Sulfasalazine Tablet, Enteric-Coated (Azulfidine)
TIER 2
Cimzia (Certolizumab Pegol)
Cuprimine (Penicillamine)
Enbrel (Etanercept)
Simponi (Golimumab)
Trexall (Methotrexate Sodium)
TIER 3
Adalimumab (Humira)
Anakinra (Kineret)
Milnacipran (Savella)
KP Wellness
1:22 PM - Public
10.3.3 MUSCLE RELAXANTS & ANTISPASMODIC
THERAPY
TIER 1
Baclofen (Lioresal)
Carisoprodol (Soma 350 mg)
Chlorzoxazone (Parafon Forte DSC)
Cyclobenzaprine HCl (Flexeril)
Dantrolene Sodium (Dantrium)
Diazepam (Valium)
Methocarbamol (Robaxin)
Oxybutynin Chloride (Ditropan)
Oxybutynin Chloride Tablet, Sustained-Release (Ditropan XL)
Tizanidine HCl (Zanaflex)
Trospium Chloride (Sanctura)
TIER 2
Enablex (Darifenacin)
Gelnique (Oxybutynin Chloride)
Orphenadrine (Norflex)
Orphenadrine Compound (Norgesic, Norgesic Forte)
Oxytrol (Oxybutynin Transdermal System)
Sanctura XR (Trospium Chloride Capsule, Sustained-Release 24 Hour)
Skelaxin^^ (Metaxalone)^^
Vesicare (Solifenacin)
TIER 3
Carisoprodol (Soma 250 mg)
Cyclobenzaprine Capsule, Extended-Release 24 Hour (Amrix)
Tolterodine (Detrol)
Tolterodine Tartrate (Detrol LA)
Metaxalone (Skelaxin 800 mg)
Fesoterodine fumarate (Toviaz)
THERAPY
TIER 1
Baclofen (Lioresal)
Carisoprodol (Soma 350 mg)
Chlorzoxazone (Parafon Forte DSC)
Cyclobenzaprine HCl (Flexeril)
Dantrolene Sodium (Dantrium)
Diazepam (Valium)
Methocarbamol (Robaxin)
Oxybutynin Chloride (Ditropan)
Oxybutynin Chloride Tablet, Sustained-Release (Ditropan XL)
Tizanidine HCl (Zanaflex)
Trospium Chloride (Sanctura)
TIER 2
Enablex (Darifenacin)
Gelnique (Oxybutynin Chloride)
Orphenadrine (Norflex)
Orphenadrine Compound (Norgesic, Norgesic Forte)
Oxytrol (Oxybutynin Transdermal System)
Sanctura XR (Trospium Chloride Capsule, Sustained-Release 24 Hour)
Skelaxin^^ (Metaxalone)^^
Vesicare (Solifenacin)
TIER 3
Carisoprodol (Soma 250 mg)
Cyclobenzaprine Capsule, Extended-Release 24 Hour (Amrix)
Tolterodine (Detrol)
Tolterodine Tartrate (Detrol LA)
Metaxalone (Skelaxin 800 mg)
Fesoterodine fumarate (Toviaz)
KP Wellness
1:15 PM - Public
10.4 Osteoporosis Therapy
TIER 1
+ Alendronate Sodium (Fosamax)
+ Estradiol (Estrace)
+ Estradiol Patch, Transdermal Weekly (Climara)
+ Estropipate Tablet (Ogen)
TIER 2
Actonel (Risedronate Sodium)
Boniva (Ibandronate Sodium)
Calcitonin Salmon Nasal Spray (Miacalcin)
Calcitonin, Salmon, Synthetic Nasal Spray (Fortical)
Climara (Estradiol Patch, Transdermal Weekly)
Estraderm (Estradiol Patch, Transdermal Biweekly)
Evista (Raloxifene HCl)
Forteo (Teriparatide)
Vivelle, Vivelle-Dot (Estradiol Patch, Transdermal Biweekly)
TIER 3
Alendronate Sodium & Cholecalciferol (Fosamax Plus D)
Conjugated Estrogens (Premarin)
TIER 1
+ Alendronate Sodium (Fosamax)
+ Estradiol (Estrace)
+ Estradiol Patch, Transdermal Weekly (Climara)
+ Estropipate Tablet (Ogen)
TIER 2
Actonel (Risedronate Sodium)
Boniva (Ibandronate Sodium)
Calcitonin Salmon Nasal Spray (Miacalcin)
Calcitonin, Salmon, Synthetic Nasal Spray (Fortical)
Climara (Estradiol Patch, Transdermal Weekly)
Estraderm (Estradiol Patch, Transdermal Biweekly)
Evista (Raloxifene HCl)
Forteo (Teriparatide)
Vivelle, Vivelle-Dot (Estradiol Patch, Transdermal Biweekly)
TIER 3
Alendronate Sodium & Cholecalciferol (Fosamax Plus D)
Conjugated Estrogens (Premarin)
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