New Business Underwriting Guidelines and Procedure Manual · Underwriting Guidelines. 5 More...
Transcript of New Business Underwriting Guidelines and Procedure Manual · Underwriting Guidelines. 5 More...
New Business Underwriting Guidelines and Procedure Manual
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New Business Procedure Manual
Jennifer Golden, Manager [email protected]
Wendi Beauchaine, Assistant Manager [email protected]
Jennel Riggs, Supervisor [email protected]
Antonia Ebert, Underwriter [email protected]
Melanie Smith, Texas Contract Specialist [email protected]
Jamie Pettinger, Texas Contract Specialist [email protected]
Questions? Call us at 1-866-SNL-4SNL (Then press 1)
Sara Burke, Policy Issue Clerk/Texas Contract Specialist [email protected]
Annalise Sparkuhl, Policy Issue Clerk [email protected]
Erika Sanchez, Policy Issue Clerk/Spanish Specialist [email protected]
Morgan Cano, Pending Specialist [email protected]
Lashara Moreno, Assembly Clerk [email protected]
The New Business Team
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Common TermsProposed Insured Signature - Only the proposed insured may sign on the Proposed Insured signature line. No one else may sign the proposed insured’s name. The proposed insured must be able to sign their own name. A “mark” or “X” is not acceptable. Power of Attorney signatures are not acceptable.
Policy Owner Signature - Only the owner may sign on the Owner signature line. The policy owner signature is required if the policy owner is different than the proposed insured.
Payor Information - We need the payors full address and signature. If the insured has a representative payee, paperwork is required.
Replacements - State regulations require that applicable replacement forms be completed at the time of application and be submitted with the application.
Application Date - Applications must be dated the day the application is completed and signed by the proposed insured.
Policy Effective Date- The policy becomes effective on the issue date as long as underwriting approves the application, collects first premium and there are no changes in the proposed insured’s insurability between the applications signed date and the issue date. A future effective date of no more than 30 days in the future from the application may be requested.
Forms of Payment - EFT with completed information, personal check, credit or debit card (Visa, MC or AMEX), or money order. Cash is not acceptable and a check from the agent is not acceptable unless the agent check is for their own personal policy.
Bank Draft Date - A premium will be drafted on the same date each month. A draft date of the 1st through the 28th of each month is an acceptable draft date. If a specific draft date is not specified, SNL will draft immediately upon the approval of the application and the application date will be the future draft date each month. Initial draft date must be within 30 days of the application date.
Initial Premium - The initial draft may be drafted on any business day of the month as long as completed EFT information is filled out on the application. SNL requires a premium with applications OR completed EFT/CC information to draft the first premium within 30 days (We will run the bank account information through our Toolbox, if this comes back with “deny” or “insufficient information” we will require a voided check or a bank statement).
1035 Exchanges - SNL cannot accommodate 1035 exchanges for life insurance contracts.
Agent Splits - Split commissions between agents are acceptable. Both agents need to sign the application and write the percentage of the commission payable to each agent’s signature.
Social Security Numbers – The proposed insured’s Social Security Number is required for all applications.
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SNL Provides Three Methods to Submit Applications:
1. Website Upload (Preferred) This is the preferred method. You need to scan and save the application with any applicable documents to your computer. Next, log into our agent portal via www.SNLFinalExpense.com then the Agent Login button. Then click New Business Upload and select Secure Upload.
You should click on First Time Contract Submission then click Browse and go to the file you saved on your computer. Double click your file name. You may duplicate the file name as many times as needed to upload all documents (total of 15 megabyte limit on total submission). Lastly, click Submit to Underwriters and you will receive an email saying it was received successfully. The acceptable file types are png, jpg / jpeg, bmp, tif / tiff, pdf. (If you have problems logging into our agent portal please call our Marketing Department at 1-855-SNL-4SNL (Then press 4).
2. Mail You may mail applications via USPS to:Security National LifeNew BusinessPO Box 57220Salt Lake City, UT 84157
3. Overnight Via US Mail, UPS or FedExSecurity National Life5300 South 360 WestSalt Lake City, UT 84123
**Please note – we do not allow applications to be submitted via fax or email as this is not a secure way to transmit personal and confidential information.**
New Business must be received by 10:30 a.m. MST. Every piece of business that is received by 10:30 a.m. MST is guaranteed to be ENTERED and counted as received, but not necessarily issued.
• If you submit via UPS or FedEx, it is guaranteed to be ENTERED, but not necessarily issued.
• If it is submitted via express mail or priority mail through USPS, it is not guaranteed to be entered that day. It will depend on when it gets to the department.
• If you submit the application through secure online upload it is not necessary to mail in the originals. You may keep these for your records.
Corrections for policies that are pending due to problems must be received by 2:00 p.m. MST (12:00 p.m. (noon) MST on the last working day of the month) in order to issue the pending policy.
The preferred way to send corrections is through our secure online upload – this will help the business will be issued (IF the problem has been corrected).
Submitting New Business
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General Underwriting Guidelines1. All application sections must be completed correctly, signed and dated by the agent (agent number must be
written on application), proposed insured and the owner (if different than the applicant).
2. If the insured is a minor, we must have the parent or legal guardian sign for them. If there is a guardian, we will need a copy of the guardianship papers.
3. If the beneficiary is the estate or trustee, they must have an estate set up and we need copies of the estate papers or trust papers.
4. All applications are void 30 days after the written (signed) date; applications must be received by the home office before the 30-day deadline.
5. CWA (cash with application) must be submitted by the proposed insured/owner. No agent checks are allowed. We do allow COD business including credit/debit cards. When a credit/debit card is used for CWA the direct bill premium rate applies.
6. If the CWA is returned to us as non-sufficient funds (NSF) we will contact the agent to verify account information or collect different information to allow one additional attempt in collecting the CWA. The agent has 48 hours to provide us this information. We will cancel the policy as “rescinded” if we don’t hear from the agent.
7. If a policy is received by 10:30 a.m. MST it is guaranteed to be entered, but not guaranteed to be issued.
Medical Underwriting Guidelines
1. All Health questions on the application must be asked of the proposed insured and the complete information written on the application. Depending on how the health questions are answered will determine which coverage will be issued. By following the application guidelines in the health section of the application, the agent will easily be able to determine which plan to offer the proposed insured.
2. Medication for medical conditions means the applicant is being treated for that medical condition, which means that health questions for that condition must be marked “yes”. Refer to the Medical Guidelines section for additional information, or call the Underwriting Department with your questions.
3. All insured applications require Rx search as part of the underwriting process. We need the applicants SSN and signature on the application to complete this process. If this information is not on the application, the application will be held for 30 days (from the application date) to allow the agent to get the necessary information.
4. Applications that require an Rx search will be issued/amended/declined upon underwriting review. If amended/declined the agent and regional manager will be notified via email.
5. Applicant’s that are incarcerated in any type of facility cannot be issued on any type of plan. Do not submit an application.
6. Any phone verification calls or underwriting clarification calls will be made by the underwriting department directly to the applicant.
Underwriting Guidelines
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More Helpful Underwriting GuidelinesThese are helpful GUIDELINES for your assessment of the medical history on an application. Keep in mind that you actually visit with the insured, see them face to face and have an advantage over the Home Office. We rely on you for “field underwriting”.
Please remember that not all medical conditions are listed. If the condition was serious enough to seek medical attention and medications were given in aid of this condition, they may not qualify for the fully insured plan. Exceptions are minor acute conditions such as colds, flu, allergies, and other minor conditions from which the applicant has fully recovered. As individual situations vary, so do underwriting decisions. The primary insured must sign his/her own application. The only exception is for minor children. Insurance on those who cannot read or write and their signature is an “X”, must be witnessed by another person of legal age other than the agent. Make certain that all of the medical questions are asked and fully answered, as the application becomes a part of any policy issued.
If the primary insured has seen a doctor and they are currently running tests or are awaiting further news from the doctor this policy is to not be written. We need to postpone until either the doctor has given a clean bill of health or a diagnosis has been made.
4’10” 200 223 4’11” 207 229 5’0” 213 235 5’1” 219 241 5’2” 225 246 5’3” 231 251 5’4” 237 256 5’5” 243 262 5’6” 249 268 5’7” 255 274 5’8” 262 280 5’9” 270 287 5’10” 277 294 5’11” 285 301 6’0” 292 308 6’1” 299 316 6’2” 306 324 6’3” 313 332 6’4” 321 340 6’5” 329 348 6’6” 335 356 6’7” 341 365
Height Preferred/Standard Graded
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Underwriting Blood Thinner Maintenance Therapy (Simple Security Plan)Improved Underwriting:
We are now accepting certain blood thinning medications available for immediate coverage on the preferred class with the following conditions:Ailments: Atrial Fibrillation, Pulmonary Embolism, Stroke (including TIA’s), and StentsMedications: Aggrenox, Aspirin, Clopidogrel, Dipyridamole, Effient, Persantine, Plavix, Prasugrel, Ticlid, Ticlopidine
Underwriting:• If qualifying event was more than two years ago and they are on the maintenance medication with no
other ailments we will issue a first day coverage plan at the preferred rate.• If qualifying event was more than two years ago, they are on the maintenance medications, and are type
one diabetic (insulin dependent) we will issue the graded plan.• If the qualifying event is within two years we will issue based on severity and any other complications –
first day coverage will not be given.
Medications Not Included:Warfarin and Coumadin will remain graded at all times. Please check our underwriting guide. Our Rx list has been updated.
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Afinitor Afinitor CancerGraded
Decline
Agenerase Agenerase AIDS Decline
Aggrastat Aggrastat Heart Graded
AgrylinAnagrelide Hy-
drochlorideCancer
Graded
Decline
Akineton Akineton Parkinson’s Disease Graded
Albuterol Albuterol Asthma COPDPreferred
Graded
Aldactone Spironolactone Heart Graded
Aldomet Methyldopa Hypertension heartPreferred
Graded
Alimta Alimta CancerGraded
Decline
Alkeran Alkeran CancerGraded
Decline
Allopurinol Allopurinol Gout Preferred
Aloxi Aloxi CancerGraded
Decline
Alprazolam AlprazolamAnxiety Panic Dis-
orderPreferred
Altace Alupent Hypertension CHFPreferred
Graded
Altace Alupent Hypertension CHFPreferred
Graded
Alupent Alupent Asthma COPDPreferred
Graded
Amantadine Hcl Amantadine Hcl Parkinson’s Disease Graded
Amaryl Glimepiride Type 2 Diabetes Preferred
Ambisome Ambisome AIDS Decline
Medical Guidelines
Abacavir Ziagen AIDS Decline
Abilify AbilifySchizophrenia Bipolar
DisorderGraded
Abraxane Abraxane CancerGraded
Decline
Acarbos Precose Type 2 Diabetes Preferred
Accupril Quinapril Hypertension heartPreferred
Graded
Accuretic Quinaretic Hypertension heartPreferred
Graded
Aceon Aceon Hypertension CHFPreferred
Graded
Acetaminophen Hydrocodone Pain Preferred
Acetohexamide Acetohexamide Type 2 Diabetes Preferred
Actiq Actiq CancerGraded
Decline
Activase Activase Stroke HeartPreferred
Graded
Actoplus Met Actoplus Met Type 2 Diabetes Preferred
Actos Actos Type 2 Diabetes Preferred
Adcetris Adcetris CancerGraded
Decline
Adriamycin Adriamycin CancerGraded
Decline
Adrucil Fluorouracil CancerGraded
decline
Advair Diskus Advair Diskus Asthma COPDPreferred
Graded
Advicor Advicor Cholesterol Preferred
Product Name Popular Name Indications Decision Product Name Popular Name Indications Decision
Use this chart to choose how medications should be graded at on your new applications.
Disclosures:
1. This list is not all inclusive and is intended as a guide only. All cases subject to review.
2. This list only identifies some uses for the medications. There may be other uses that could positively or negatively impact the final classification of the case being reviewed. We only list the uses we are concerned about. For example, we don’t list elevated blood pressure because it is acceptable on the final expense application.
3. If a medication is being taken for a reason other than what is listed, please document the medication and reason taking on the Application.
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Aromasin Aromasin CancerGraded
Decline
Arranon Arranon CancerGraded
Decline
Arzerra Arzerra Cancer Graded
Asthmahaler Asthmahaler Lung DisorderPreferred
Graded
Atacand Atacand Hypertension HeartPreferred
Graded
AtametCarbidopa/
LevodopaParkinson’s Disease Graded
Atarax Hydroxyzine Allergies Anxiety Preferred
Atenolol Atenolol Hypertension Graded
Atgam Atgam Organ Transplant Decline
Ativan Lorazepam Anxiety Disorder Preferred
Atorvastatin
CalciumLipitor Cholesterol Preferred
Atripla Atripla AIDS Decline
AtroventIpratropium
BromideLung Disorder Graded
Atrovent Hfa Atrovent Hfa COPD Graded
Avalide Avalide Hypertension Preferred
Avandamet Avandamet Type 2 Diabetes Preferred
Avandaryl Avandaryl Type 2 Diabetes Preferred
Avandia Avandia Type 2 Diabetes Preferred
Avapro Avapro
Hypertension Diabetic
Nephropathy (Kidney
Problems)
Preferred
Graded
Avastin Avastin CancerGraded
Decline
Azasan Azathioprine
Organ Transplant
Rejection Rhumatoid
Arthritis
Please Call
Azathioprine Azathioprine
Organ Transplant
Rejection Rhumatoid
Arthritis
Please Call
Azilect Azilect Parkinson’s Disease Graded
Azmacort Azmacort Lung DisorderPreferred
Graded
Azor Azor Hypertension Preferred
Baraclude Baraclude Liver Disorder Graded
Benazepril Hcl Benazepril Hcl Hypertension HeartPreferred
Graded
Benicar Benicar Hypertension Preferred
Amifostine Amifostine CancerGraded
Decline
Amiloride Hcl Amiloride Hcl Hypertension CHFPreferred
Graded
Amiloride/Hydro-
chlorothia
Amiloride/Hydro-
chlorothiazideHypertension Preferred
Aminophylline Aminophylline Lung DisorderPreferred
Graded
Amitriptyline Hcl Amitriptyline Hcl DepressionPreferred
Graded
Amlodipine
Besylate
Amlodipine
BesylateHypertension Heart
Preferred
Graded
Amlodipine
Besylate/AtorvCaduet Hypertension Heart
Preferred
Graded
Ampyra Ampyra Multiple Sclerosis Graded
Amturnide Amturnide Hypertension Preferred
Amyl Nitrite Amyl Nitrite Heart Graded
Anagrelide Hy-
drochloride
Anagrelide Hy-
drochlorideCancer
Graded
Decline
Anastrozole Arimidex Cancer Graded
Angiomax Angiomax Circulatory Disorder Graded
Antabuse Antabuse Alcoholism Graded
Anzemet Anzemet Cancer Graded
Apidra Apidra Type 1 DiabetesStandard
Graded
Apidra Solostar Apidra Type 1 DiabetesStandard
Graded
Aplenzin AplenzinMajor Depressive
DisorderGraded
Apokyn Apokyn Parkinson’s Disease Graded
Apresoline Hydralazine Hypertension heartPreferred
Graded
Aptivus Aptivus AIDS Decline
Aquatensen Methyclothiazide Hypertension heartPreferred
Graded
Aralast Prolastin COPD Graded
Aranesp Aranesp Kidney Disease Graded
Arcapta Neohaler Arcapta Neohaler COPD Graded
ArediaPamidronate Diso-
diumCancer
Graded
Decline
Argatroban Argatroban Circulatory Disorder Graded
Aricept AriceptAlzheimer’s Disease
DementiaDecline
Arimidex Arimidex Cancer Graded
Product Name Popular Name Indications Decision Product Name Popular Name Indications Decision
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Product Name Popular Name Indications Decision
Benztropine
Mesylate
Benztropine
MesylateParkinson’s Disease Graded
Betaseron Betaseron Multiple Sclerosis Graded
Betaxolol Hcl Betaxolol Hcl Hypertension Preferred
Bexxar Bexxar CancerGraded
Decline
Bicalutamide Casodex CancerGraded
Decline
Bicnu Bicnu CancerGraded
Decline
Bicnu W/Diluent
AbsoluteBicnu Cancer
Graded
Decline
Bidil Bidil Heart Graded
Bisoprolol Fuma-
rate/Hydro
Bisoprolol Fuma-
rate/Hydrochloro-
thiazide
Hypertension Preferred
Bitartrate Asthmahaler Lung DisorderPreferred
Graded
Blenoxane Bleomycin Sulfate CancerGraded
Decline
Bleomycin Sulfate Bleomycin Sulfate CancerGraded
Decline
Bosulif Bosulif CancerGraded
Decline
Bretylium Tosylate Bretylium Tosylate Heart Graded
Bromocriptine
Mesylate
Bromocriptine
Mesylate
Cancer Parkinson's
Disease Type 2 Dia-
betes
Please Call
Bumetanide Bumetanide Hypertension HeartPreferred
Graded
Bumex Bumetanide Hypertension HeartPreferred
Graded
Busulfex Myleran CancerGraded
decline
Bydureon Byetta Type 2 Diabetes Preferred
Byetta Byetta Type 2 Diabetes Preferred
Bystolic Bystolic Hypertension Preferred
Caduet Caduet Hypertension HeartPreferred
Graded
Calan Verapamil Hypertension heartPreferred
Graded
Calcium FolinateLeucovorin Cal-
ciumcancer
Graded
Decline
Campath Campath CancerGraded
Decline
Campral Campral Alcoholism drugs Graded
Camptosar Irinotecan Cancer Graded
Decline
CapozideCaptopril/Hydro-
chlorothiazideHypertension Heart
Preferred
Graded
Caprelsa Caprelsa CancerGraded
Decline
Captopril/Hydro-
chlorothia
Captopril/Hydro-
chlorothiazideHypertension Heart
Preferred
Graded
Carbidopa/
Levodopa/EntacaStalevo Parkinson’s Disease Graded
Carboplatin Carboplatin CancerGraded
Decline
Cardene Nicardipine Hcl Hypertension heartPreferred
Graded
Cardiosterol Cardiosterol Cholesterol HeartPreferred
Graded
Cardizem Cd Diltiazem Hypertension heartPreferred
Graded
CarduraDoxazosin
MesylateHypertension Preferred
Carnitor Carnitor Kidney Disease Graded
Carnitor Levocarnitine Liver Disorder Graded
Cartia Diltiazem Hypertension heartPreferred
Graded
Carvedilol Carvedilol Hypertension HeartPreferred
Graded
Casodex Casodex CancerGraded
Decline
Catapres Clonidine Hcl Hypertension Preferred
Ceenu Ceenu CancerGraded
Decline
Celebrex Celebrex Arthritis Preferred
CelexaCitalopram Hyd-
robromideDepression Preferred
Cellcept Cellcept Organ Transplant Decline
Celontin Celontin Seizure Graded
Cerebyx Cerebyx Seizure Graded
Cerubidine Cerubidine CancerGraded
Decline
Cesamet Cesamet CancerGraded
Decline
Chlorambucil Chlorambucil CancerGraded
Decline
Chlorothiazide Chlorothiazide Hypertension HeartPreferred
Graded
Chlorpromazine
Hcl
Chlorpromazine
HclMental Disorders Graded
Chlorthalidone Chlorthalidone Hypertension heartPreferred
Graded
Product Name Popular Name Indications Decision Product Name Popular Name Indications Decision
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Cidofovir Vistide AIDS Decline
Cilostazol Cilostazol Circulatory Disorder Graded
Cisplatin Cisplatin CancerGraded
Decline
Cladribine Cladribine CancerGraded
Decline
Clolar Clolar CancerGraded
Decline
Clopidogrel Plavix Stroke heartPreferred
Graded
CogentinBenztropine
MesylateParkinson’s Disease Graded
Cognex CognexAlzheimer’s Disease
DementiaDecline
Combivir Combivir AIDS Decline
Complera Complera AIDS Decline
Conzip Tramadol Hcl Pain Preferred
Copaxone Copaxone Multiple Sclerosis Graded
Copegus Ribasphere Liver Disorder Graded
Coreg Carvedilol Hypertension HeartPreferred
Graded
Coreg Cr Coreg Cr Hypertension heartPreferred
Graded
Corgard Nadolol Hypertension heartPreferred
Graded
Corvert Corvert Heart Graded
Coumadin Warfarin Stroke heart Graded
Covera-Hs Verapamil Hypertension heartPreferred
Graded
Cozaar Cozaar Hypertension heartPreferred
Graded
Crestor Crestor Cholesterol Preferred
Crixivan Crixivan AIDS Decline
Cyclosporine Cylosporine Organ Transplant Decline
Cyclosporine A Cylosporine Organ Transplant Decline
Cyclosporine
ModifiedNeoral Organ Transplant Decline
Cymbalta Cymbalta Depression Preferred
Cystagon Cystagon Kidney Disease Graded
Cytogam Cytogam Organ Transplant Decline
Cytosar-U Cytarabine CancerGraded
Decline
CytoxanCyclophospha-
mideCancer
Graded
Decline
Dacarbazine Dacarbazine CancerGraded
Decline
Dacogen Dacogen CancerGraded
decline
Dactinomycin Cosmegen CancerGraded
Decline
Daliresp Daliresp Lung Disorder Graded
Daunoxome Daunoxome CancerGraded
Decline
Demadex Torsemide Hypertension heartPreferred
Graded
Depacon Valproic Acid Seizure Graded
Depade Naltrexone Alcoholism Drugs Graded
Depakene Valproic Acid Seizure Graded
Depakote Depakote Seizure Graded
Depocyt Depocyt CancerGraded
Decline
Diabeta Glyburide Type 2 Diabetes Preferred
Diazepam DiazepamAnxiety Panic Dis-
orderPreferred
Didanosine Didanosine AIDS Decline
Digitek Digoxin Heart Graded
Dilantin Dilantin Seizure Graded
Dilatrate Sr Isosorbide Heart Graded
Diltiazem Diltiazem Hypertension heartPreferred
Graded
Diovan Diovan Hypertension heartPreferred
Graded
Disulfiram Antabuse Alcoholism Graded
Diuril Chlorothiazide Hypertension HeartPreferred
Graded
Divalproex Depakote Seizure Graded
Docefrez Taxotere CancerGraded
Decline
Docetaxel Taxotere CancerGraded
Decline
Dolophine Methadone Alcoholism Drugs Graded
Donepezil Hcl AriceptAlzheimer’s Disease
DementiaDecline
Doxil Doxil CancerGraded
Decline
Product Name Popular Name Indications Decision Product Name Popular Name Indications Decision
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Product Name Popular Name Indications Decision
Dtic-Dome Dacarbazine CancerGraded
Decline
Duetact Duetact Type 2 Diabetes Preferred
Duoneb Combivent Lung Disorder Graded
Duragesic Fentanyl CancerGraded
Decline
DyazideTriamterene/Hy-
drochlorothiazideHypertension heart
Preferred
Graded
Edecrin Edecrin Hypertension HeartPreferred
Graded
Edurant Edurant AIDS Decline
Effexor EffexorDepression Anxiety
DisorderPreferred
Elavil Amitriptyline Hcl DepressionPreferred
Graded
Eldepryl Selegiline Parkinson’s Disease Graded
Eligard Eligard CancerGraded
Decline
Eligard Lupron Depot CancerGraded
Decline
Eliquis Eliquis Stroke heart Graded
Elitek Elitek CancerGraded
Decline
Ellence Ellence CancerGraded
Decline
Eloxatin Eloxatin CancerGraded
Decline
Elspar Elspar CancerGraded
Decline
Emcyt Emcyt CancerGraded
Decline
Emend Emend CancerGraded
Decline
Eminase Eminase Heart Graded
Emtriva Emtriva AIDS Decline
Enalapril Maleate Enalapril Maleate Hypertension heartPreferred
Graded
Enalaprilat Enalaprilat Hypertension heartPreferred
Graded
Enduron Methyclothiazide Hypertension heartPreferred
Graded
Entacapone Comtan Parkinson’s Disease Graded
Epinephrine Asthmahaler Lung DisorderPreferred
Graded
Epirubicin Hcl Ellence CancerGraded
Decline
Epivir Epivir AIDS Decline
Epivir Hbv Epivir AIDS Decline
Eplerenone Eplerenone Heart Graded
Epzicom Epzicom AIDS Decline
Equetro EquetroBipolar Mood Dis-
orderGraded
Erbitux Erbitux CancerGraded
Decline
Erivedge Erivedge CancerGraded
Decline
Erwinaze Erwinaze CancerGraded
Decline
Escitalopram
Oxalate Lexapro Depression Preferred
Eskalith Lithium CarbonateBipolar Disorder Graded
Estrogens, Conju-
gatedPremarin
Menopausal Symp-
tomsPreferred
Ethosuximide Ethosuximide Seizures Graded
Etopophos Etopophos CancerGraded
Decline
Etoposide Etoposide Cancer Graded
Eulexin Flutamide CancerGraded
decline
Evista Evista Osteoporosis Please Call
Exelon ExelonAlzheimer’s Disease
DimentiaDecline
Exemestane Aromasin Cancer Graded
Exforge Exforge Hypertension heartPreferred
Graded
Extavia Betaseron Multiple Sclerosis Graded
Fanapt Fanapt Schizophrenia Graded
Fanapt Titration
PackFanapt Schizophrenia Graded
Fareston Fareston CancerGraded
Decline
Faslodex Faslodex CancerGraded
Decline
Felbamate Felbatol Seizure Graded
Felbatol Felbatol Seizure Graded
Felodipine Felodipine Hypertension HeartPreferred
Graded
Femara Femara CancerGraded
Decline
Fentanyl Fentanyl CancerGraded
Decline
Flecainide Acetate Flecainide Acetate Heart Graded
Flomax Flomax Enlarged Prostate Preferred
Flovent Flovent Diskus Asthma Lung Disor-
der
Preferred
Graded
Product Name Popular Name Indications Decision Product Name Popular Name Indications Decision
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Flovent Diskus Flovent Diskus Asthma Lung Disor-
der
Preferred
Graded
Floxuridine Floxuridine CancerGraded
Decline
Fludarabine Phos-
phateFludara Cancer
Graded
Decline
Fluorouracil Fluorouracil CancerGraded
Decline
Fluoxetine FluoxetineAnxiety Panic Dis-
orderPreferred
Flutamide Flutamide CancerGraded
Decline
Folotyn Folotyn CancerGraded
Decline
Foradil Aerolizer Foradil AerolizerAsthma Lung Disor-
der
Preferred
Graded
Fortamet MetforminType 2 Diabetes
MellitusPreferred
Fortovase Fortovase AIDS Decline
Fosamax Plus D Fosamax Osteoporosis Preferred
Foscarnet Sodium Foscarnet Sodium AIDS Decline
Foscavir Foscarnet Sodium AIDS Decline
Fosinopril Sodium Fosinopril Sodium Hypertension heartPreferred
Graded
Fosphenytoin
SodiumCerebyx Seizure Graded
Fudr Floxuridine CancerGraded
Decline
Furosemide Furosemide Hypertension heartPreferred
Graded
Fusilev Fusilev CancerGraded
Decline
Fuzeon Fuzeon AIDS Decline
Gabapentin Gabapentin Seizure Neuropathy Please Call
Gabarone Gabapentin Seizure Neuropathy Please Call
Gablofen BaclofenMuscle Spasticity
Multiple SclerosisPlease Call
Galantamine Razadyne ErAlzheimer’s Disease
DimentiaDecline
Gemfibrozil Gemfibrozil Cholesterol Preferred
Gengraf Neoral Organ Transplant Decline
Geodon GeodonBipolar Mood Disor-
der schizphreniaGraded
Glassia Prolastin COPD Graded
Gliadel Wafer Gliadel Wafer CancerGraded
Decline
Glibenclamide Glyburide Type 2 Diabetes Preferred
Glimepiride Glimepiride Type 2 Diabetes Preferred
Glipizide Glipizide Type 2 Diabetes Preferred
Glucophage MetforminType 2 Diabetes
MellitusPreferred
Glyburide Glyburide Type 2 Diabetes Preferred
Glyset Glyset Type 2 Diabetes Preferred
Granisetron Hcl Kytril CancerGraded
Decline
Granisol Kytril CancerGraded
Decline
Halaven Halaven CancerGraded
Decline
HaldoHaloperidol Deca-
noateSchizophrenia Graded
Haloperidol
Decanoate
Haloperidol Deca-
noateSchizophrenia Graded
Hctz Hctz Hypertension Preferred
Hecoria Prograf Organ Transplant Decline
Hectorol Hectorol Kidney Disease Graded
Heparin Heparin Stroke heart Graded
Heparin Lock
FlushHeparin Stroke heart Graded
Herceptin Herceptin CancerGraded
Decline
Hexalen Hexalen CancerGraded
Decline
Hivid Hivid AIDS Decline
Horizant HorizantRestless Leg Syn-
dromePreferred
Humalog Humalog Type 1 DiabetesStandard
Graded
Humulin 70/30 Humulin 70/30 Type 1 Diabetes Standard
Graded
Hybolin Improved Hybolin Improved CancerGraded
Decline
Hycamtin Hycamtin CancerGraded
Decline
Hydralazine Hydralazine Hypertension heartPreferred
Graded
Hydralazine Hydralazine Hypertension heartPreferred
Graded
Hydralazine Hcl Hydralazine Hypertension heartPreferred
Graded
Hydralazine/Hy-
drochlorothHydralazine Hypertension heart
Preferred
Graded
Product Name Popular Name Indications Decision Product Name Popular Name Indications Decision
13
Product Name Popular Name Indications Decision
Hydrea Hydroxyurea CancerGraded
Decline
Hydrochlorothi Lisinopril Hypertension Preferred
Hydrochlorothi-
azide
Hydrochlorothi-
azideHypertension heart
Preferred
Graded
Hydrocodone Hydrocodone Pain Preferred
Hydroxychloro-
quine Sulfate
Hydroxychloro-
quine SulfateCancer
Graded
Decline
Hydroxyurea Hydroxyurea CancerGraded
Decline
Hydroxyzine Hydroxyzine Allergies Anxiety Preferred
Hytrin Terazosin Hcl Hypertension heart Graded
Hyzaar Hyzaar Hypertension heart Preferred
Ibutilide Fumarate Corvert Heart Graded
Iclusig Iclusig CancerGraded
Decline
Idamycin Pfs Idarubicin Hcl CancerGraded
Decline
Idarubicin Hcl Idarubicin Hcl CancerGraded
Decline
Ifex Ifex CancerGraded
Decline
Ifex/Mesnex
Combo Pack
Ifex/Mesnex Com-
bo PackCancer
Graded
Decline
Ifosfamide Ifex CancerGraded
Decline
Ifosfamide/MesnaIfex/Mesnex Com-
bo PackCancer
Graded
Decline
Iletin I Lente Iletin I Lente Type 1 DiabetesGraded
Decline
Imuran Azathioprine
Organ Transplant
Rejection Rhumatoid
Arthritis
Please Call
Inamrinone Inamrinone Heart Graded
Incivek Incivek Liver Disorder Graded
Indapamide Indapamide Hypertension heartPreferred
Graded
Inderal Propranolol Hypertension heartPreferred
Graded
Infergen Infergen Liver Disorder Graded
Inlyta Inlyta CancerGraded
Decline
Innolet Humulin 70/30 Type 1 Diabetes Standard
Graded
Inspra Eplerenone Heart Graded
Insulin Insulin Type 1 DiabetesStandard
Graded
Intelence Intelence AIDS Decline
Intron-A W/
DiluentIntron-A Cancer
Graded
Decline
Invega Invega Schizophrenia Graded
Invirase Invirase AIDS Decline
Ipratropium
Bromide
Ipratropium
BromideLung Disorder Graded
Ipratropium Bro-
mide/AlbutCombivent Lung Disorder Graded
Irbesartan Avapro Avapro
Hypertension Diabetic
Nephropathy (Kidney
Problems)
Preferred
Graded
Irbesartan/Hydro-
chlorothiAvalide Hypertension Preferred
Iressa Iressa CancerGraded
Decline
Irinotecan Irinotecan Cancer Graded
Decline
Isentress Isentress AIDS Decline
Isochron Isosorbide Heart Graded
Isoptin Verapamil Hypertension heartPreferred
Graded
Isosorbide Isosorbide Heart Graded
Isoxsuprine Hcl Isoxsuprine Hcl Stroke heart Graded
Istodax Istodax CancerGraded
Decline
Jantoven Warfarin Stroke heart Graded
Janumet Janumet Type 2 Diabetes Preferred
Janumet Xr Janumet Type 2 Diabetes Preferred
Januvia Januvia Type 2 Diabetes Preferred
Jentadueto Jentadueto Type 2 Diabetes Preferred
Jevtana Jevtana CancerGraded
Decline
Kaletra Kaletra AIDS Decline
Kalydeco Kalydeco Cystic Fibrosis Graded
Kazano Kazano Type 2 Diabetes Preferred
Kemadrin Kemadrin Parkinson’s Disease Graded
Kepivance Kepivance CancerGraded
Decline
Keppra Keppra Seizures Graded
Kerlone Betaxolol Hcl Hypertension Preferred
Klonopin ClonazepamAnxiety Panic Dis-
orderPreferred
Klonopin Wafers ClonazepamAnxiety Panic Dis-
orderPreferred
Product Name Popular Name Indications Decision Product Name Popular Name Indications Decision
14
Kombiglyze Xr Kombiglyze Xr Type 2 Diabetes Preferred
Kyprolis Kyprolis CancerGraded
Decline
Kytril Kytril CancerGraded
Decline
Labetalol Hcl Labetalol Hcl Hypertension heartPreferred
Graded
Lamictal Lamictal Seizure Graded
Lamivudine Epivir AIDS Decline
Lamivudine/Zid-
ovudineCombivir AIDS Decline
Lanoxicaps Digoxin Heart Graded
Lanoxin Digoxin Heart Graded
Lantus Lantus Type 1 DiabetesStandard
Graded
Lasix Furosemide Hypertension heartPreferred
Graded
Latuda Latuda Schizophrenia Graded
Letrozole Femara CancerGraded
Decline
Leucovorin
Calcium
Leucovorin Cal-
ciumcancer
Graded
Decline
Leukeran Leukeran CancerGraded
Decline
Leukine Leukine CancerGraded
Decline
Leuprolide
AcetateLupron Depot Cancer
Graded
Decline
Leustatin Cladribine CancerGraded
Decline
Levamisole Hcl Levamisole Hcl CancerGraded
Decline
Levetiracetam Levetiracetam Seizures Graded
Levetiracetam Keppra Seizures Graded
Levocarnitine Levocarnitine Liver Disorder Graded
Levodopa Larodopa Parkinson’s Disease Graded
Lexapro Lexapro Depression Preferred
Lexiva Lexiva AIDS Decline
Lexxel Lexxel Hypertension heartPreferred
Graded
Lioresal Intra-
thecalBaclofen
Muscle Spasticity
Multiple SclerosisPlease Call
Lipitor Lipitor Cholesterol Preferred
Lipodox Doxil CancerGraded
Decline
Lisinopril Lisinopril Hypertension Preferred
Lithium Carbon-
ateLithium CarbonateBipolar Disorder Graded
Lodosyn Lodosyn Parkinson’s Disease Graded
Lopid Gemfibrozil Cholesterol Preferred
LopressorMetoprolol
TartrateHypertension heart
Preferred
Graded
Lorazepam Lorazepam Anxiety Disorder Preferred
Losartan Potas-
siumCozaar Hypertension heart
Preferred
Graded
Losartan Potassi-
um/HydrocHyzaar Hypertension heart
Preferred
Graded
Lotensin Benazepril Hcl Hypertension HeartPreferred
Graded
Loxapine Loxapine Schizophrenia Graded
Loxapine Succi-
nateLoxapine Schizophrenia Graded
Loxitane Loxapine Schizophrenia Graded
Lozol Indapamide Hypertension heartPreferred
Graded
Lupron Depot Eligard CancerGraded
Decline
Lupron Depot Lupron Depot CancerGraded
Decline
Lyrica LyricaFibromyalgia Syn-
drome Seizures
Preferred
Graded
Lysodren Lysodren CancerGraded
Decline
Matulane Matulane CancerGraded
Decline
Megace Oral MegestrolMenopausal Symp-
toms cancerPlease Call
Megestrol MegestrolMenopausal Symp-
toms cancerPlease Call
Megestrol AcetateMegestrolMenopausal Symp-
toms cancerPlease Call
Mellaril Thioridazine Schizophrenia Graded
Mepron Mepron AIDS Graded
Mercaptopurine Mercaptopurine CancerGraded
Decline
Mesna Mesnex CancerGraded
Decline
Mesnex Mesnex CancerGraded
Decline
Metaglip Glipizide Type 2 Diabetes Preferred
Metformin Glipizide Type 2 Diabetes Preferred
Product Name Popular Name Indications Decision Product Name Popular Name Indications Decision
15
Product Name Popular Name Indications Decision
Metformin MetforminType 2 Diabetes
MellitusPreferred
Methadone Methadone Alcoholism Drugs Graded
Methotrexate Methotrexate Rheumatoid Arthritis Preferred
Methyclothiazide Methyclothiazide Hypertension heartPreferred
Graded
Methyldopa Methyldopa Hypertension heartPreferred
Graded
Methyldopa
AnhydrousMethyldopa Hypertension heart
Preferred
Graded
Metolazone Metolazone Hypertension heartPreferred
Graded
Metoprolol Succi-
nate ErToprol Hypertension heart
Preferred
Graded
Metoprolol
Tartrate
Metoprolol
TartrateHypertension heart
Preferred
Graded
Micardis Micardis Hypertension heartPreferred
Graded
MicrozideHydrochlorothi-
azideHypertension heart
Preferred
Graded
Milrinone Milrinone Heart Graded
Milrinone Lactate Milrinone Heart Graded
Minitran Nitrostat Heart Graded
Mirapex Mirapex
Restless Leg Syn-
drome Parkinson's
Disease
Preferred
Graded
Mithracin Mithracin CancerGraded
Decline
Mitomycin Mitomycin CancerGraded
Decline
Mitoxantrone Hcl Novantrone CancerGraded
Decline
Moban Moban Schizophrenia Graded
Moexipril Hcl Univasc Hypertension heartPreferred
Graded
Moexipril/Hydro-
chlorothiaUniretic Hypertension heart
Preferred
Graded
Monopril Fosinopril Sodium Hypertension heartPreferred
Graded
Mustargen Mustargen CancerGraded
Decline
Mutamycin Mitomycin CancerGraded
Decline
Mycobutin Mycobutin AIDS Decline
Myfortic Myfortic Organ Transplant Decline
Mykrox Metolazone Hypertension heartPreferred
Graded
Myleran Myleran CancerGraded
Decline
Mylocel Hydroxyurea CancerGraded
Decline
Mylotarg Mylotarg CancerGraded
Decline
Mysoline Primidone Seizure Graded
Nadolol Nadolol Hypertension heartPreferred
Graded
Naloxone Hcl Naloxone Hcl Alcoholism Drugs Graded
Naltrexone Naltrexone Alcoholism Drugs Graded
Naltrexone Hcl Naltrexone Alcoholism Drugs Graded
Namenda Titra-
tion PakNamenda
Alzheimer's Disease
DimentiaDecline
Narcan Naloxone Hcl Alcoholism Drugs Graded
Natrecor Natrecor Heart Graded
Navane Thiothixene Mental Disorder Graded
Navelbine Navelbine CancerGraded
Decline
Nebupent Nebupent AIDS Decline
Neonatal Naloxone Hcl Alcoholism Drugs Graded
Neoral Neoral Organ Transplant Decline
NeosarCyclophospha-
mideCancer
Graded
Decline
Nesina Nesina Type 2 Diabetes Preferred
Neulasta Neulasta CancerGraded
Decline
Neumega Neumega CancerGraded
Decline
Neupogen Neupogen Cancer Graded
Neupro Neupro
Restless Leg Syn-
drome Parkinson's
Disease
Preferred
Graded
Neurontin Gabapentin Seizure Neuropathy Please Call
Neutrexin Neutrexin AIDS Decline
Nevirapine Viramune AIDS Decline
Nexavar Nexavar Cancer Graded
Nexiclon Xr Clonidine Hcl Hypertension Preferred
Nicardipine Hcl Nicardipine Hcl Hypertension heartPreferred
Graded
Product Name Popular Name Indications Decision Product Name Popular Name Indications Decision
16
Nifedipine Nifedipine Hypertension heartPreferred
Graded
Nilandron Nilandron CancerGraded
Decline
Nimodipine Nimodipine Stroke heart Graded
Nimotop Nimodipine Stroke heart Graded
Nitrek Nitrostat Heart Graded
Nitro-Bid Nitrostat Heart Graded
Nitroglycerin Nitroglycerin Heart Graded
Nitrostat Nitrostat Heart Graded
Nolvadex Tamoxifen Citrate CancerGraded
Decline
Normodyne Labetalol Hcl Hypertension heartPreferred
Graded
Norvasc Besylate heart Graded
Norvir Norvir AIDS Decline
Novantrone Novantrone CancerGraded
Decline
Novolin Humulin 70/30 Type 1 Diabetes Standard
Graded
Novolog Novolog Type 1 Diabetes Standard
Graded
Noxafil Noxafil CancerGraded
Decline
Octreotide
Acetate
Sandostatin Lar
DepotCancer
Graded
Decline
Oforta Fludara CancerGraded
Decline
Olanzapine Zyprexa Mental Disorder Graded
Olanzapine Odt Zyprexa Mental Disorder Graded
Olanzapine/Fluox-
etine Symbyax
Depression Bipolar
mood disorder
Preferred
Graded
Omontys Omontys Liver Disorder Graded
Oncaspar Oncaspar CancerGraded
Decline
Ondansetron Ondansetron CancerGraded
Decline
Ondansetron Hcl Ondansetron CancerGraded
Decline
Ondansetron Hcl Zofran CancerGraded
Decline
Ontak Ontak CancerGraded
Decline
Onxol Paclitaxel CancerGraded
Decline
OreticHydrochlorothi-
azideHypertension heart
Preferred
Graded
Orthoclone Okt3 Orthoclone Okt3 Organ Transplant Decline
Oxaliplatin Eloxatin CancerGraded
Decline
Oxcarbazepine Trileptal Seizures Graded
Oxtellar Xr Trileptal Seizures Graded
Paclitaxel Paclitaxel CancerGraded
Decline
Pamidronate
Disodium
Pamidronate Diso-
diumCancer
Graded
Decline
Panretin Panretin AIDS Decline
Paraplatin Carboplatin CancerGraded
Decline
ParlodelBromocriptine
Mesylate
Cancer Parkinson's
Disease Type 2 Dia-
betes
Please Call
Paroxetine Hcl Paroxetine Hcl Depression Preferred
Paxil Paroxetine Hcl Depression Preferred
Peganone Peganone Seizures Graded
Pegasys Pegasys Liver Disorder Graded
Pegasys Proclick Pegasys Liver Disorder Graded
Peg-Intron Peg-Intron Liver Disorder Graded
Peg-Intron
RedipenPeg-Intron Liver Disorder Graded
Pentam 300 Nebupent AIDS Decline
Pentamidine
IsethionateNebupent AIDS Decline
Perforomist Foradil AerolizerAsthma Lung Disor-
der
Preferred
Graded
Pergolide
MesylatePergolide Mesylate Parkinson’s Disease Graded
Permax Pergolide Mesylate Parkinson’s Disease Graded
Perphenazine Perphenazine Mental Disorder Graded
Phenobarbital Phenobarbital Seizures Graded
Phenurone Phenurone Seizures Graded
Phenytoin Sodium Phenytoin Sodium Seizures Graded
Product Name Popular Name Indications Decision Product Name Popular Name Indications Decision
17
Product Name Popular Name Indications Decision
Nevirapine Viramune AIDS Decline
Nexavar Nexavar Cancer Graded
Nexiclon Xr Clonidine Hcl Hypertension Preferred
Nicardipine Hcl Nicardipine Hcl Hypertension heartpreferred
graded
Nifedipine Nifedipine Hypertension heartpreferred
graded
Nilandron Nilandron CancerGraded
decline
Nimodipine Nimodipine Stroke heart graded
Nimotop Nimodipine Stroke heart graded
Nitrek Nitrostat Heart Graded
Nitro-Bid Nitrostat Heart Graded
Nitroglycerin Nitroglycerin Heart Graded
Nitrostat Nitrostat Heart Graded
Nolvadex Tamoxifen Citrate CancerGraded
decline
Normodyne Labetalol Hcl Hypertension heartpreferred
graded
Norvasc Besylate heart graded
Norvir Norvir AIDS Decline
Novantrone Novantrone CancerGraded
decline
Novolin Humulin 70/30 Type 1 Diabetes Standard
graded
Novolog Novolog Type 1 Diabetes Standard
graded
Noxafil Noxafil CancerGraded
decline
Octreotide
Acetate
Sandostatin Lar
DepotCancer
Graded
decline
Oforta Fludara CancerGraded
Decline
Olanzapine Zyprexa Mental Disorder Graded
Olanzapine Odt Zyprexa Mental Disorder Graded
Olanzapine/Fluox-
etine Symbyax
Depression Bipolar
mood disorder
preferred
graded
Omontys Omontys Liver Disorder Graded
Oncaspar Oncaspar CancerGraded
decline
Ondansetron Ondansetron CancerGraded
decline
Ondansetron Hcl Ondansetron CancerGraded
decline
Ondansetron Hcl Zofran CancerGraded
decline
Ontak Ontak CancerGraded
decline
Onxol Paclitaxel CancerGraded
decline
OreticHydrochlorothi-
azideHypertension heart
preferred
graded
Orthoclone Okt3 Orthoclone Okt3 Organ Transplant Graded
decline
Oxaliplatin Eloxatin CancerGraded
Decline
Oxcarbazepine Trileptal Seizures Graded
Oxtellar Xr Trileptal Seizures Graded
Paclitaxel Paclitaxel CancerGraded
decline
Pamidronate
Disodium
Pamidronate Diso-
diumCancer
Graded
decline
Panretin Panretin AIDS Decline
Paraplatin Carboplatin CancerGraded
Decline
ParlodelBromocriptine
Mesylate
Cancer Parkinson's
Disease Type 2 Dia-
betes
Please Call
Paroxetine Hcl Paroxetine Hcl Depression Preferred
Paxil Paroxetine Hcl Depression Preferred
Peganone Peganone Seizures Graded
Pegasys Pegasys Liver Disorder Graded
Pegasys Proclick Pegasys Liver Disorder Graded
Peg-Intron Peg-Intron Liver Disorder Graded
Peg-Intron
RedipenPeg-Intron Liver Disorder Graded
Pentam 300 Nebupent AIDS Decline
Pentamidine
IsethionateNebupent AIDS Decline
Perforomist Foradil AerolizerAsthma Lung Dis-
order
Preferred
graded
Pergolide
MesylatePergolide Mesylate Parkinson’s Disease Graded
Product Name Popular Name Indications Decision Product Name Popular Name Indications Decision
Photofrin Photofrin CancerGraded
Decline
Pindolol Pindolol Hypertension heartPreferred
Graded
Pioglitazone
Hcl-GlimepirDuetact Type 2 Diabetes Preferred
PlaquenilHydroxychloro-
quine SulfateCancer
Graded
Decline
Platinol Aq Cisplatin CancerGraded
Decline
Plavix Plavix Stroke heartPreferred
Graded
Plenaxis Plenaxis CancerGraded
Decline
Plendil Felodipine Hypertension HeartPreferred
Graded
Pletal Cilostazol Circulatory Disorder Graded
Potiga Potiga Seizures Graded
Pramipexole
DihydrochloriMirapex
Restless Leg Syn-
drome Parkinson's
Disease
Preferred
Graded
Prandimet Prandimet Type 2 Diabetes Preferred
Prandin Prandin Type 2 Diabetes Preferred
PravacholPravastatin So-
diumCholesterol Preferred
Pravastatin
Sodium
Pravastatin So-
diumCholesterol Preferred
Pravigard Pac Pravigard Pac Heart Graded
Precose Precose Type 2 Diabetes Preferred
Prezista Prezista AIDS Decline
Primacor Milrinone Heart Graded
Primidone Primidone Seizure Graded
Prinzide Lisinopril Hypertension Preferred
Prolastin Prolastin COPD Graded
Proleukin Proleukin CancerGraded
Decline
Propranolol Propranolol Hypertension heartPreferred
Graded
Propranolol Hcl Propranolol Hypertension heartPreferred
Graded
Prozac FluoxetineAnxiety Panic Dis-
orderPreferred
Purinethol Mercaptopurine CancerGraded
Decline
Quetiapine Fu-
marateSeroquel Mental Disorder Graded
Quinapril Quinapril Hypertension heartPreferred
Graded
Quinapril Hcl Quinapril Hypertension heartPreferred
Graded
Quinapril/Hydro-
chlorothiaQuinaretic Hypertension heart
Preferred
Graded
Quinidine Gluco-
nate Cr
Quinidine Gluco-
nate CrHeart Graded
Ramipril Alupent Hypertension CHFPreferred
Graded
Ranexa Ranexa Heart Graded
Rapamune Rapamune Organ Transplant Decline
Razadyne Er Razadyne ErAlzheimer’s Disease
DimentiaDecline
Razadyne Er Razadyne ErAlzheimer’s Disease
DimentiaDecline
Rebetron Rebetron Liver Disorder Graded
Reclast Reclast CancerGraded
Decline
Relion Humulin 70/30 Type 1 Diabetes Standard
Graded
Reminyl Razadyne ErAlzheimer’s Disease
DimentiaDecline
Requip Requip
Restless Leg Syn-
drome Parkinson's
Disease
Preferred
Graded
Requip Xl Requip
Restless Leg Syn-
drome Parkinson's
Disease
Preferred
Graded
Rescriptor Rescriptor AIDS Decline
Retavase Retavase Heart Graded
Retavase Half-Kit Retavase Heart Graded
Retrovir Zidovudine AIDS Decline
Retrovir Iv Infu-
sionZidovudine AIDS Decline
Revex Revex Alcoholism Drugs Graded
Revia Naltrexone Alcoholism Drugs Graded
Revlimid Revlimid CancerGraded
Decline
18
Nevirapine Viramune AIDS Decline
Nexavar Nexavar Cancer Graded
Nexiclon Xr Clonidine Hcl Hypertension Preferred
Nicardipine Hcl Nicardipine Hcl Hypertension heartpreferred
graded
Nifedipine Nifedipine Hypertension heartpreferred
graded
Nilandron Nilandron CancerGraded
decline
Nimodipine Nimodipine Stroke heart graded
Nimotop Nimodipine Stroke heart graded
Nitrek Nitrostat Heart Graded
Nitro-Bid Nitrostat Heart Graded
Nitroglycerin Nitroglycerin Heart Graded
Nitrostat Nitrostat Heart Graded
Nolvadex Tamoxifen Citrate CancerGraded
decline
Normodyne Labetalol Hcl Hypertension heartpreferred
graded
Norvasc Besylate heart graded
Norvir Norvir AIDS Decline
Novantrone Novantrone CancerGraded
decline
Novolin Humulin 70/30 Type 1 Diabetes Standard
graded
Novolog Novolog Type 1 Diabetes Standard
graded
Noxafil Noxafil CancerGraded
decline
Octreotide
Acetate
Sandostatin Lar
DepotCancer
Graded
decline
Oforta Fludara CancerGraded
Decline
Olanzapine Zyprexa Mental Disorder Graded
Olanzapine Odt Zyprexa Mental Disorder Graded
Olanzapine/Fluox-
etine Symbyax
Depression Bipolar
mood disorder
preferred
graded
Omontys Omontys Liver Disorder Graded
Oncaspar Oncaspar CancerGraded
decline
Ondansetron Ondansetron CancerGraded
decline
Ondansetron Hcl Ondansetron CancerGraded
decline
Ondansetron Hcl Zofran CancerGraded
decline
Ontak Ontak CancerGraded
decline
Onxol Paclitaxel CancerGraded
decline
OreticHydrochlorothi-
azideHypertension heart
preferred
graded
Orthoclone Okt3 Orthoclone Okt3 Organ Transplant Graded
decline
Oxaliplatin Eloxatin CancerGraded
Decline
Oxcarbazepine Trileptal Seizures Graded
Oxtellar Xr Trileptal Seizures Graded
Paclitaxel Paclitaxel CancerGraded
decline
Pamidronate
Disodium
Pamidronate Diso-
diumCancer
Graded
decline
Panretin Panretin AIDS Decline
Paraplatin Carboplatin CancerGraded
Decline
ParlodelBromocriptine
Mesylate
Cancer Parkinson's
Disease Type 2 Dia-
betes
Please Call
Paroxetine Hcl Paroxetine Hcl Depression Preferred
Paxil Paroxetine Hcl Depression Preferred
Peganone Peganone Seizures Graded
Pegasys Pegasys Liver Disorder Graded
Pegasys Proclick Pegasys Liver Disorder Graded
Peg-Intron Peg-Intron Liver Disorder Graded
Peg-Intron
RedipenPeg-Intron Liver Disorder Graded
Pentam 300 Nebupent AIDS Decline
Pentamidine
IsethionateNebupent AIDS Decline
Perforomist Foradil AerolizerAsthma Lung Dis-
order
Preferred
graded
Product Name Popular Name Indications Decision Product Name Popular Name Indications Decision
Permax Pergolide Mesylate Parkinson’s Disease Graded
Perphenazine Perphenazine Mental Disorder Graded
Phenobarbital Phenobarbital Seizures Graded
Phenurone Phenurone Seizures Graded
Phenytoin Sodium Phenytoin Sodium Seizures Graded
Photofrin Photofrin CancerGraded
decline
Pindolol Pindolol Hypertension heartpreferred
graded
Pioglitazone
Hcl-GlimepirDuetact Type 2 Diabetes Preferred
PlaquenilHydroxychloro-
quine SulfateCancer
Graded
decline
Platinol Aq Cisplatin CancerGraded
Decline
Plavix Plavix Stroke heart graded
Plenaxis Plenaxis CancerGraded
decline
Plendil Felodipine Hypertension HeartPreferred
Graded
Pletal Cilostazol Circulatory Disorder Graded
Potiga Potiga Seizures Graded
Pramipexole
DihydrochloriMirapex
Restless Leg Syn-
drome Parkinson's
Disease
preferred
graded
Prandimet Prandimet Type 2 Diabetes Preferred
Prandin Prandin Type 2 Diabetes Preferred
PravacholPravastatin So-
diumCholesterol Preferred
Pravastatin
Sodium
Pravastatin So-
diumCholesterol Preferred
Pravigard Pac Pravigard Pac Heart Graded
Precose Precose Type 2 Diabetes Preferred
Prezista Prezista AIDS Decline
Primacor Milrinone Heart Graded
Primidone Primidone Seizure Graded
Prinzide Lisinopril Hypertension Preferred
Prolastin Prolastin COPD Graded
Reyataz Reyataz AIDS Decline
Ribasphere Ribasphere Liver Disorder Graded
Rilutek Rilutek
Amyotrophic Lateral
Sclerosis Lou Gherig's
Disease
Graded
Risperdal Risperdal Mental DisordersGraded
Decline
Risperdal M-Tab Risperdal Mental DisordersGraded
Decline
Risperidone Risperdal Mental DisordersGraded
Decline
Rituxan Rituxan CancerGraded
Decline
Roferon-A Roferon-A CancerGraded
Decline
Ropinirole Er Requip
Restless Leg Syn-
drome Parkinson's
Disease
Preferred
Graded
Ropinirole Hcl Requip
Restless Leg Syn-
drome Parkinson's
Disease
Preferred
Graded
Rybix Odt Tramadol Hcl Pain Preferred
Ryzolt Tramadol Hcl Pain Preferred
Sancuso Sancuso Cancer Graded
Sandostatin Sandostatin Lar
DepotCancer
Graded
Decline
Sandostatin Lar
Depot
Sandostatin Lar
DepotCancer
Graded
Decline
Saphris Saphris Mental Disorder Graded
Selegiline Selegiline Parkinson’s Disease Graded
Selzentry Selzentry AIDS Decline
Sensipar Sensipar Liver Disorder Graded
Serentil Serentil Mental Disorders Graded
Seroquel Seroquel Mental Disorder Graded
Sertraline Sertraline Depression Preferred
Sertraline Hcl Sertraline Depression Preferred
Simulect SimulectOrgan Transplant
RejectionDecline
Simvastatin Simvastatin Cholesterol Preferred
SinemetCarbidopa/
LevodopaParkinson’s Disease Graded
Soltamox Tamoxifen Citrate CancerGraded
Decline
Spiriva Spiriva Lung Disorder Graded
Spiriva Handihaler Spiriva Lung Disorder Graded
Spironolactone Spironolactone Heart Graded
Sprycel Sprycel CancerGraded
Decline
Stalevo Stalevo Parkinson’s Disease Graded
Stalevo 100 Stalevo Parkinson’s Disease Graded
Starlix Starlix Type 2 Diabetes Preferred
Stavudine Zerit AIDS Decline
Stilphostrol Stilphostrol CancerGraded
Decline
Stribild Stribild AIDS Decline
Subsys Fentanyl CancerGraded
Decline
Symbicort SymbicortAsthma Lung Disor-
der
Preferred
Graded
Symbyax SymbyaxDepression Bipolar
mood disorder
Preferred
Graded
Symlinpen Symlinpen Type 1 Diabetes Standard
Graded
Symlinpen 120 Symlinpen Type 1 Diabetes Standard
Graded
Symlinpen 60 Symlinpen Type 1 Diabetes Standard
Graded
Symmetrel Amantadine Hcl Parkinson’s Disease Graded
Synribo Synribo CancerGraded
Decline
Tabloid Tabloid CancerGraded
Decline
Tacrolimus Prograf Organ Transplant Decline
Tambocor Flecainide Acetate Heart Graded
Tamoxifen Citrate Tamoxifen Citrate CancerGraded
Decline
Tamsulosin Hcl Flomax Enlarged Prostate Preferred
Tarceva Tarceva CancerGraded
Decline
Targretin Targretin CancerGraded
Decline
Tarka Tarka Hypertension heartPreferred
Graded
19
Product Name Popular Name Indications Decision
Nevirapine Viramune AIDS Decline
Nexavar Nexavar Cancer Graded
Nexiclon Xr Clonidine Hcl Hypertension Preferred
Nicardipine Hcl Nicardipine Hcl Hypertension heartpreferred
graded
Nifedipine Nifedipine Hypertension heartpreferred
graded
Nilandron Nilandron CancerGraded
decline
Nimodipine Nimodipine Stroke heart graded
Nimotop Nimodipine Stroke heart graded
Nitrek Nitrostat Heart Graded
Nitro-Bid Nitrostat Heart Graded
Nitroglycerin Nitroglycerin Heart Graded
Nitrostat Nitrostat Heart Graded
Nolvadex Tamoxifen Citrate CancerGraded
decline
Normodyne Labetalol Hcl Hypertension heartpreferred
graded
Norvasc Besylate heart graded
Norvir Norvir AIDS Decline
Novantrone Novantrone CancerGraded
decline
Novolin Humulin 70/30 Type 1 Diabetes Standard
graded
Novolog Novolog Type 1 Diabetes Standard
graded
Noxafil Noxafil CancerGraded
decline
Octreotide
Acetate
Sandostatin Lar
DepotCancer
Graded
decline
Oforta Fludara CancerGraded
Decline
Olanzapine Zyprexa Mental Disorder Graded
Olanzapine Odt Zyprexa Mental Disorder Graded
Olanzapine/Fluox-
etine Symbyax
Depression Bipolar
mood disorder
preferred
graded
Omontys Omontys Liver Disorder Graded
Oncaspar Oncaspar CancerGraded
decline
Ondansetron Ondansetron CancerGraded
decline
Ondansetron Hcl Ondansetron CancerGraded
decline
Ondansetron Hcl Zofran CancerGraded
decline
Ontak Ontak CancerGraded
decline
Onxol Paclitaxel CancerGraded
decline
OreticHydrochlorothi-
azideHypertension heart
preferred
graded
Orthoclone Okt3 Orthoclone Okt3 Organ Transplant Graded
decline
Oxaliplatin Eloxatin CancerGraded
Decline
Oxcarbazepine Trileptal Seizures Graded
Oxtellar Xr Trileptal Seizures Graded
Paclitaxel Paclitaxel CancerGraded
decline
Pamidronate
Disodium
Pamidronate Diso-
diumCancer
Graded
decline
Panretin Panretin AIDS Decline
Paraplatin Carboplatin CancerGraded
Decline
ParlodelBromocriptine
Mesylate
Cancer Parkinson's
Disease Type 2 Dia-
betes
Please Call
Paroxetine Hcl Paroxetine Hcl Depression Preferred
Paxil Paroxetine Hcl Depression Preferred
Peganone Peganone Seizures Graded
Pegasys Pegasys Liver Disorder Graded
Pegasys Proclick Pegasys Liver Disorder Graded
Peg-Intron Peg-Intron Liver Disorder Graded
Peg-Intron
RedipenPeg-Intron Liver Disorder Graded
Pentam 300 Nebupent AIDS Decline
Pentamidine
IsethionateNebupent AIDS Decline
Perforomist Foradil AerolizerAsthma Lung Dis-
order
Preferred
graded
Product Name Popular Name Indications Decision Product Name Popular Name Indications Decision
Permax Pergolide Mesylate Parkinson’s Disease Graded
Perphenazine Perphenazine Mental Disorder Graded
Phenobarbital Phenobarbital Seizures Graded
Phenurone Phenurone Seizures Graded
Phenytoin Sodium Phenytoin Sodium Seizures Graded
Photofrin Photofrin CancerGraded
decline
Pindolol Pindolol Hypertension heartpreferred
graded
Pioglitazone
Hcl-GlimepirDuetact Type 2 Diabetes Preferred
PlaquenilHydroxychloro-
quine SulfateCancer
Graded
decline
Platinol Aq Cisplatin CancerGraded
Decline
Plavix Plavix Stroke heart graded
Plenaxis Plenaxis CancerGraded
decline
Plendil Felodipine Hypertension HeartPreferred
Graded
Pletal Cilostazol Circulatory Disorder Graded
Potiga Potiga Seizures Graded
Pramipexole
DihydrochloriMirapex
Restless Leg Syn-
drome Parkinson's
Disease
preferred
graded
Prandimet Prandimet Type 2 Diabetes Preferred
Prandin Prandin Type 2 Diabetes Preferred
PravacholPravastatin So-
diumCholesterol Preferred
Pravastatin
Sodium
Pravastatin So-
diumCholesterol Preferred
Pravigard Pac Pravigard Pac Heart Graded
Precose Precose Type 2 Diabetes Preferred
Prezista Prezista AIDS Decline
Primacor Milrinone Heart Graded
Primidone Primidone Seizure Graded
Prinzide Lisinopril Hypertension Preferred
Prolastin Prolastin COPD Graded
Tasigna Tasigna CancerGraded
Decline
Tasmar Tasmar Parkinson’s Disease Graded
Taxol Paclitaxel CancerGraded
Decline
Taxotere Taxotere CancerGraded
Decline
Temodar Temodar CancerGraded
Decline
Tenormin Atenolol Hypertension Preferred
Terazosin Hcl Terazosin Hcl Hypertension heart Graded
Terazosin Hcl Terazosin Hcl Hypertension heart Graded
Teslac Teslac CancerGraded
Decline
Thalitone Chlorthalidone Hypertension heartPreferred
Graded
Thalomid Thalomid CancerGraded
Decline
Theracys Tice Bcg CancerGraded
Decline
Thioplex Thiotepa CancerGraded
Decline
Thioridazine Thioridazine Schizophrenia Graded
Thioridazine Hcl Thioridazine Schizophrenia Graded
Thiothixene Thiothixene Mental Disorder Graded
ThorazineChlorpromazine
HclMental Disorders Graded
Thorazine Thorazine Mental Disorders Graded
Thymoglobulin Thymoglobulin Organ TransplantGraded
Decline
Tiagabine Hydro-
chlorideGabitril Seizure Graded
Tice Bcg Tice Bcg CancerGraded
Decline
Ticlid Ticlopidine Hcl Stroke heartPreferred
Graded
Ticlopidine Hcl Ticlopidine Hcl Stroke heartPreferred
Graded
Tikosyn Tikosyn Heart Graded
Tnkase Tnkase Heart Graded
Tolazamide Tolazamide Type 2 Diabetes Preferred
Tolbutamide Tolbutamide Type 2 Diabetes Preferred
Tolinase Tolazamide Type 2 Diabetes Preferred
Topamax Topamax Migraine SeizuresPreferred
Graded
Topiragen Topamax Migraine SeizuresPreferred
Graded
Topiramate Topamax Migraine SeizuresPreferred
Graded
Toposar Etoposide Cancer Graded
Topotecan Hcl Hycamtin CancerGraded
Decline
Toprol Toprol Hypertension heartPreferred
Graded
Toprol Xl Toprol Hypertension heartPreferred
Graded
Torisel Torisel CancerGraded
Decline
Torsemide Torsemide Hypertension heartPreferred
Graded
Totect Dexrazoxane CancerGraded
Decline
Trandate Labetalol Hcl Hypertension heartPreferred
Graded
Trandolapril/Ver-
apamil HcTarka Hypertension heart
Preferred
Graded
Treanda Treanda CancerGraded
Decline
Tretinoin Tretinoin CancerGraded
Decline
Triamterene/Hy-
drochlorothiazide
Triamterene/Hy-
drochlorothiazideHypertension heart
Preferred
Graded
Trihexyphenidyl
Hcl
Trihexyphenidyl
HclParkinson’s Disease Graded
Trileptal Trileptal Seizures Graded
Trisenox Trisenox CancerGraded
Decline
Trizivir Trizivir AIDS Decline
Truvada Truvada AIDS Decline
Tykerb Tykerb CancerGraded
Decline
Tyzeka Tyzeka Liver Disorder Graded
Ultram Tramadol Hcl Pain Preferred
Uniretic Uniretic Hypertension heartPreferred
Graded
Univasc Univasc Hypertension heartPreferred
Graded
20
Nevirapine Viramune AIDS Decline
Nexavar Nexavar Cancer Graded
Nexiclon Xr Clonidine Hcl Hypertension Preferred
Nicardipine Hcl Nicardipine Hcl Hypertension heartpreferred
graded
Nifedipine Nifedipine Hypertension heartpreferred
graded
Nilandron Nilandron CancerGraded
decline
Nimodipine Nimodipine Stroke heart graded
Nimotop Nimodipine Stroke heart graded
Nitrek Nitrostat Heart Graded
Nitro-Bid Nitrostat Heart Graded
Nitroglycerin Nitroglycerin Heart Graded
Nitrostat Nitrostat Heart Graded
Nolvadex Tamoxifen Citrate CancerGraded
decline
Normodyne Labetalol Hcl Hypertension heartpreferred
graded
Norvasc Besylate heart graded
Norvir Norvir AIDS Decline
Novantrone Novantrone CancerGraded
decline
Novolin Humulin 70/30 Type 1 Diabetes Standard
graded
Novolog Novolog Type 1 Diabetes Standard
graded
Noxafil Noxafil CancerGraded
decline
Octreotide
Acetate
Sandostatin Lar
DepotCancer
Graded
decline
Oforta Fludara CancerGraded
Decline
Olanzapine Zyprexa Mental Disorder Graded
Olanzapine Odt Zyprexa Mental Disorder Graded
Olanzapine/Fluox-
etine Symbyax
Depression Bipolar
mood disorder
preferred
graded
Omontys Omontys Liver Disorder Graded
Oncaspar Oncaspar CancerGraded
decline
Ondansetron Ondansetron CancerGraded
decline
Ondansetron Hcl Ondansetron CancerGraded
decline
Ondansetron Hcl Zofran CancerGraded
decline
Ontak Ontak CancerGraded
decline
Onxol Paclitaxel CancerGraded
decline
OreticHydrochlorothi-
azideHypertension heart
preferred
graded
Orthoclone Okt3 Orthoclone Okt3 Organ Transplant Graded
decline
Oxaliplatin Eloxatin CancerGraded
Decline
Oxcarbazepine Trileptal Seizures Graded
Oxtellar Xr Trileptal Seizures Graded
Paclitaxel Paclitaxel CancerGraded
decline
Pamidronate
Disodium
Pamidronate Diso-
diumCancer
Graded
decline
Panretin Panretin AIDS Decline
Paraplatin Carboplatin CancerGraded
Decline
ParlodelBromocriptine
Mesylate
Cancer Parkinson's
Disease Type 2 Dia-
betes
Please Call
Paroxetine Hcl Paroxetine Hcl Depression Preferred
Paxil Paroxetine Hcl Depression Preferred
Peganone Peganone Seizures Graded
Pegasys Pegasys Liver Disorder Graded
Pegasys Proclick Pegasys Liver Disorder Graded
Peg-Intron Peg-Intron Liver Disorder Graded
Peg-Intron
RedipenPeg-Intron Liver Disorder Graded
Pentam 300 Nebupent AIDS Decline
Pentamidine
IsethionateNebupent AIDS Decline
Perforomist Foradil AerolizerAsthma Lung Dis-
order
Preferred
graded
Product Name Popular Name Indications Decision Product Name Popular Name Indications Decision
Permax Pergolide Mesylate Parkinson’s Disease Graded
Perphenazine Perphenazine Mental Disorder Graded
Phenobarbital Phenobarbital Seizures Graded
Phenurone Phenurone Seizures Graded
Phenytoin Sodium Phenytoin Sodium Seizures Graded
Photofrin Photofrin CancerGraded
decline
Pindolol Pindolol Hypertension heartpreferred
graded
Pioglitazone
Hcl-GlimepirDuetact Type 2 Diabetes Preferred
PlaquenilHydroxychloro-
quine SulfateCancer
Graded
decline
Platinol Aq Cisplatin CancerGraded
Decline
Plavix Plavix Stroke heart graded
Plenaxis Plenaxis CancerGraded
decline
Plendil Felodipine Hypertension HeartPreferred
Graded
Pletal Cilostazol Circulatory Disorder Graded
Potiga Potiga Seizures Graded
Pramipexole
DihydrochloriMirapex
Restless Leg Syn-
drome Parkinson's
Disease
preferred
graded
Prandimet Prandimet Type 2 Diabetes Preferred
Prandin Prandin Type 2 Diabetes Preferred
PravacholPravastatin So-
diumCholesterol Preferred
Pravastatin
Sodium
Pravastatin So-
diumCholesterol Preferred
Pravigard Pac Pravigard Pac Heart Graded
Precose Precose Type 2 Diabetes Preferred
Prezista Prezista AIDS Decline
Primacor Milrinone Heart Graded
Primidone Primidone Seizure Graded
Prinzide Lisinopril Hypertension Preferred
Prolastin Prolastin COPD Graded
Valproic Acid Valproic Acid Seizure Graded
Valproic Sodium Valproic Acid Seizure Graded
Valstar Valstar CancerGraded
Decline
Valturna Valturna Hypertension heartPreferred
Graded
Vanatrip Amitriptyline Hcl DepressionPreferred
Graded
Vandetanib Caprelsa CancerGraded
Decline
Vantas Vantas CancerGraded
Decline
Vasodilan Isoxsuprine Hcl Stroke heart Graded
Vasotec Enalapril Maleate Hypertension heartPreferred
Graded
Velosulin Br Velosulin Br Type 1 Diabetes Standard
Graded
Vepesid Etoposide Cancer Graded
Verapamil Verapamil Hypertension heartPreferred
Graded
Vesanoid Tretinoin CancerGraded
Decline
Vesprin Vesprin Mental Disorder Graded
Victoza Victoza Type 2 Diabetes Preferred
Victrelis Victrelis Liver Disorder Graded
Vidaza Vidaza CancerGraded
Decline
Videx Didanosine AIDS Decline
Videx Ec Didanosine AIDS Decline
Vinblastine Sulfate Vinblastine Sulfate CancerGraded
Decline
Vincasar Pfs Vincristine Sulfate CancerGraded
Decline
Vinorelbine
TartrateNavelbine Cancer
Graded
Decline
Viracept Viracept AIDS Decline
Viramune Viramune AIDS Decline
Viramune Xr Viramune AIDS Decline
Viread Viread AIDS Decline
Visken Pindolol Hypertension heartPreferred
Graded
Vistide Vistide AIDS Decline
Vivitrol Vivitrol Alcoholism Drugs Graded
Vumon Vumon CancerGraded
Decline
Warfarin Warfarin Stroke heart Graded
Xalkori Xalkori CancerGraded
Decline
Xarelto Xarelto Stroke heart Graded
Xeloda Xeloda CancerGraded
Decline
Yervoy Yervoy CancerGraded
Decline
Zaltrap Zaltrap CancerGraded
Decline
Zanosar Zanosar CancerGraded
Decline
Zarontin Ethosuximide Seizures Graded
Zaroxolyn Metolazone Hypertension heartPreferred
Graded
Zelapar Selegiline Parkinson’s Disease Graded
Zelboraf Zelboraf CancerGraded
Decline
Zemaira Prolastin COPD Graded
Zemplar Zemplar Liver Disorder Graded
Zenapax Zenapax Organ Transplant Decline
Zerit Zerit AIDS Decline
Zestoretic Lisinopril Hypertension Preferred
Zetia Zetia Cholesterol Preferred
Zevalin In-111 Zevalin In-111 CancerGraded
Decline
Zevalin Y-90 Zevalin Y-90 CancerGraded
Decline
Ziac
Bisoprolol Fuma-
rate/Hydrochloro-
thiazide
Hypertension Preferred
Ziagen Ziagen AIDS Decline
Zidovudine Zidovudine AIDS Decline
Zinecard Dexrazoxane CancerGraded
Decline
Ziprasidone Hcl GeodonBipolar Mood Disor-
der schizphreniaGraded
21
Product Name Popular Name Indications Decision Product Name Popular Name Indications Decision
Zocor Simvastatin Cholesterol Preferred
Zofran Ondansetron Cancer Graded Decline
Zofran Zofran Cancer Graded Decline
Zoladex Zoladex Cancer Graded Decline
Zolinza Zolinza Cancer Graded Decline
Zoloft Sertraline Depression Preferred
Zometa Reclast Cancer Graded Decline
Zonegran Zonisamide Seizure Graded
Zonisamide Zonisamide Seizure Graded
Zortress Zortress Organ Transplant Graded Decline
Zyprexa Zyprexa Mental Disorder Graded
Zytiga Zytiga Cancer Graded decline
22
Notes
23
Notes
P. O. Box 57220, Salt Lake City, UT 84157 5300 South 360 West, Suite 250, Salt Lake City, UT 84123