Estrogen Replacement, Vaginal
PDL Reference Documents
- Estrogens - Aug 04, 2022
- Hormone Replacement Therapy Class Update - Jan 26, 2017
- Hormone Replacement Therapy DERP Scan Summary - Nov 20, 2014
- Hormone Replacement Therapy DERP Scan - Jan 30, 2014
- Hormone Replacement Therapy Scan Summary - Jan 30, 2014
- Class Scan: Hormone Replacement Therapies (HRT) - Nov 29, 2012
Drug Use Review Documents
Newsletters
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 |
|---|---|---|---|---|---|
| estradiol | ESTRADIOL | CREAM/APPL | Y | ||
| estradiol | ESTRACE | CREAM/APPL | Y | ||
| estradiol | ESTRADIOL | TABLET | Y | ||
| estradiol | VAGIFEM | TABLET | Y | ||
| estradiol | YUVAFEM | TABLET | Y | ||
| estradiol | ESTRING | VAG RING | Y | ||
| estradiol acetate | FEMRING | VAG RING | Y | ||
| estrogens, conjugated | PREMARIN | CREAM/APPL | Y |