Digitalis Preps

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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
digoxin LANOXIN PEDIATRIC AMPUL    
digoxin LANOXIN AMPUL    
digoxin DIGOXIN AMPUL    
digoxin DIGOXIN SOLUTION    
digoxin DIGOXIN SYRINGE    
digoxin DIGOXIN TABLET    
digoxin DIGOX TABLET    
digoxin DIGITEK TABLET    
digoxin LANOXIN PEDIATRIC VIAL    
digoxin LANOXIN VIAL