Cephalosporins, Parenteral
PDL Status Values
Y = preferred
N = non-preferred. Non-preferred drugs listed as N but without clinical drug use criteria are subject to the
Non-Preferred Drugs in Select PDL Classes prior authorization criteria.
New drugs will be listed as N until reviewed by the P&T Committee and are subject to the
New Drug Policy.
V = voluntary non-preferred. Non-preferred mental health drugs are listed as V and prior authorization is not required.
Null (i.e. blank) = indicates the class or specific drug has not been reviewed for PDL placement.
To request a Prior Authorization, please use this form.
| Generic Name | Brand Name | Form | PDL Status |
Current Drug Use Criteria | New Drug Evaluation |
|---|---|---|---|---|---|
| cefamandole in dextrose 5 % | MANDOL IN DEXTROSE | PIGGYBACK | |||
| cefazolin sodium | ANCEF | VIAL | |||
| cefazolin sodium | CEFAZOLIN SODIUM | VIAL | |||
| cefazolin sodium | CEFAZOLIN SODIUM | VIAL PORT | |||
| cefazolin sodium/dextrose,iso | CEFAZOLIN SODIUM-DEXTROSE | FROZ.PIGGY | |||
| cefazolin sodium/dextrose,iso | CEFAZOLIN SODIUM-DEXTROSE | PIGGYBACK | |||
| cefepime HCl | CEFEPIME HCL | VIAL | |||
| cefepime HCl in dextrose 5 % | CEFEPIME-DEXTROSE | PIGGYBACK | |||
| cefepime in iso-osm dextrose | CEFEPIME | FROZ.PIGGY | |||
| cefiderocol sulfate tosylate | FETROJA | VIAL | |||
| cefotaxime sodium | CLAFORAN | VIAL | |||
| cefotaxime sodium | CEFOTAXIME SODIUM | VIAL | |||
| cefotaxime sodium | CLAFORAN | VIAL PORT | |||
| cefotetan disodium | CEFOTETAN | VIAL | |||
| cefoxitin sodium | CEFOXITIN | VIAL | |||
| cefoxitin sodium/dextrose,iso | CEFOXITIN SODIUM | PIGGYBACK | |||
| ceftaroline fosamil acetate | TEFLARO | VIAL | |||
| ceftazidime | TAZICEF | VIAL | |||
| ceftazidime | CEFTAZIDIME | VIAL | |||
| ceftazidime | TAZICEF | VIAL PORT | |||
| ceftazidime in dextrose5%water | CEFTAZIDIME | PIGGYBACK | |||
| ceftazidime-dextrose (iso-osm) | TAZICEF IN DEXTROSE | FROZ.PIGGY | |||
| ceftazidime/avibactam | AVYCAZ | VIAL | |||
| ceftolozane/tazobactam | ZERBAXA | VIAL | |||
| ceftriaxone in is-osm dextrose | CEFTRIAXONE | FROZ.PIGGY | |||
| ceftriaxone in is-osm dextrose | CEFTRIAXONE | PIGGYBACK | |||
| ceftriaxone sodium | CEFTRIAXONE | VIAL | |||
| ceftriaxone sodium | CEFTRIAXONE | VIAL PORT | |||
| cefuroxime sodium | CEFUROXIME SODIUM | VIAL | |||
| cefuroxime sodium/D5W | ZINACEF | PIGGYBACK |