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Pharmaceutical Benefits 2005 2006 Formulary Prior Authorization Formulary: The Medi-Cal List of Contract Drugs is a preferred drug list. It contains over 600 drugs, in differing strengths and dosage forms, listed generically. The PDL is managed through performed products, exclusion of products based on contracting issues, restrictions on use, and prior authorization. Patients can get prior authorization for unlisted drugs or for listed drugs that are restricted to specific use s ; , if medically justified. Manufacturers frequently petition Medi-Cal to add drugs to the List of Contract Drugs. Based on Medi-Cal's five criteria safety, efficacy, misuse potential, essential need, and cost ; , a drug may be added to the list by contractual agreement with the manufacturer to provide the State a negotiated rebate. The Medi-Cal website at: : dhs .gov mcs mcpd MBB contracting h tml faqpage has details of how the drug contracting process works. Examples of general limitations and exclusions other uses require prior authorization ; : 1. CNS stimulants, e.g., amphetamines and methylphenidate, are restricted to attention deficit disorder in individuals between 4 and 16 years of age. Diazepam is restricted to use in cerebral palsy, athetoid states, and spinal cord degeneration. Most non-steroidal anti-inflammatory agents are restricted to use for arthritis. Some antibiotics have diagnostic and or age restrictions. Acyclovir capsules are restricted to herpes genitalis, immunocompromised, and herpes zoster shingles ; patients. Codeine Combinations: payment to a pharmacy for ASA or APAP with codeine 30 mg is limited to a maximum dispensing quantity of 45 tablets or capsules and a maximum of 3 claims for the same beneficiary in any 75-day period. Enteral nutritional supplements or replacements are covered, subject to prior authorization, if used as a therapeutic regimen to prevent serious disability or death in patients with medically diagnosed conditions that preclude the full use of regular foodstuffs. Cancer, AIDS, and DESI Drugs: Any antineoplastic drug approved by FDA for the treatment of cancer and any drug approved by FDA for the treatment of AIDS or AIDS-related condition is covered through the Medi-Cal List of Contract Drugs; most DESI drugs rated lessthan-effective by FDA are not covered. MANAGED DRUG LIMITATIONS MDL ; The Managed Drug Limitation program provides for a maximum quantity of drug product that a member may receive per prescription and or over a specific period of time. Many drug products on the MedStar Family Choice Prescribing Guide have quantity limits based upon the dosage described in product labeling. The following drugs are subject to MDL because they are typically not taken on a regular schedule. This list is subject to change. Contact MedStar Family Choice at 1-800-905-1722 for an updated list. Drugs Anzemet 50 mg, 100 mg Astelin Atrovent HFA Cipro XR 500 mg Diflucan 150 mg Fioricet Fioricet w Codeine Fiorinal Fiorinal w Codeine Fleet Enema-Pediatric Flovent HFA Imitrex 25 mg, 50 mg, 100 mg Imitrex injection kits Imitrex injection vials Imitrex nasal ketorolac Kytril 1 mg Lovenox 30 mg Lovenox, except 30 mg Migranal nasal Monurol Nexium Nicotine Patches OTC only ; Plan B Proventil Proventil HFA Relenza Serevent Tamiflu Ultram Zantac 75 mg Zofran 24 mg Zofran 4 mg, 8 mg Zomig Zomig-ZMT 2.5 mg Zomig Zomig-ZMT 5 mg Zomig nasal Limits 6 tablets per 23 days 3 inhalers per 23 days 3 inhalers per 23 days 3 tablets per 23 days 2 tablets per 23 days 30 units per 23 days 30 units per 23 days 30 units per 23 days 30 units per 23 days 2 kits per 72 hours 2 inhalers per 23 days 9 tablets per 23 days 3 kits 6 injections ; per 23 days 6 vials 6 injections ; per 23 days 6 units 1 package ; per 23 days 20 tablets per 23 days 10 tablets per 23 days 28 prefilled syringes 23 days 14 prefilled syringes 23 days 4 mL 1 package ; per 23 days 1 packet per 23 days 90 day supply per calendar year 90 day supply per calendar year 3 regimens per calendar year 2 inhalers per 23 days 2 inhalers per 23 days 1 course of treatment 20 capsules ; per calendar year 1 inhaler per 23 days 1 course of treatment 10 capsules ; per calendar year 120 tablets per 23 days 240 tablets per 23 days 10 tablets per 23 days 15 tablets per 23 days 12 tablets per 23 days 6 tablets per 23 days 6 units 1 package ; per 23 days.

Tito gave me many codeine tablets out of that bottle. James A. Schwartz, Director of Development Summer set a different pace at Saint Bede. The sisters' agenda included retreats, conferences and workshops, visits with family and friends, and countless tasks to maintain the Monastery and Center to meticulous standards. For the Development Office, the season - an especially warm one - was a time for planning activities, recognizing donors for their generosity, preparing publications and working with others on projects to extend the sisters' values to the wider community. We also analyzed and celebrated the importance of donated gifts, thoughtful advice and volunteered energies to Saint Bede. The more than 2, 000 contributed during fiscal year 2000-01 enhances the spiritual and corporal good works of 42 Benedictine sisters. Most are based at the monastery and the sisters' unit at Clairemont; others are assigned elsewhere in Wisconsin and in Missouri, Texas and Jamaica. With several sisters retiring each year from salaried posts to live at Saint Bede, support from donors becomes increasingly critical. Typically, sisters who served in schools, parishes, health care facilities and elsewhere accepted modest stipends. Few had opportunities to accumulate savings, participate in pension plans or qualify for significant Social Security earnings. That's why they Continued on page 7 and cogentin.

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