 |
Therapeutic Class Drug List
| II.
BLOOD MODIFIERS |
| A.
Anticoagulants |
| GENERIC
NAME |
RELATIVE
COST |
BRAND
NAME |
| warfarin |
$$$ |
COUMADIN®
|
| heparin sodium |
$$$ |
HEPARIN |
| enoxaparin sodium (MDL)
|
$$$$$$$$$$ |
LOVENOX®
(MDL) |
| B.
Platelet Aggregation Inhibitors |
| GENERIC
NAME |
RELATIVE
COST |
BRAND
NAME |
| dipyridamole |
$$$ |
PERSANTINE®
|
| clopidogrel |
$$$$$$$$ |
PLAVIX®
|
| C.
Miscellaneous |
| GENERIC
NAME |
RELATIVE
COST |
BRAND
NAME |
| pentoxifylline ext-rel
|
$$$$ |
TRENTAL®
|
| anagrelide |
$$$$$$$$$$ |
AGRYLIN® |
| Hematopoietic injectable
drugs are available at the nonformulary copay. See Prior Authorization
(PA) Criteria for information. |
| |
|
|
|
|
