2009
Medicare Assured
®
Online Formulary:
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SM
Drug Exception Form
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*NOTES
GC
- Generic Covered
PA
- Prior Authorization
ST
- Step Therapy
QL
- Quantity Limited
GA
- Generic Available
SP
- Specialty Pharmacy
OTC
- Over The Counter - This drug does not count towards your total out of pocket expenditure and if you are receiving extra help to pay for your prescription, you will not receive any extra help to pay for it.
Generic Name:
Alendronate Sodium/Vitamin D3
Brand Name:
Fosamax Plus D
Therapeutic Category:
Miscellaneous Therapeutic Agents
Therapeutic Class:
Miscellaneous Therapeutic Agents
Notes:
QL
Effective Date:
12/31/2008
Reason:
Formulary deletion.