Antihistamines, Second Generation
PDL Reference Documents
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 & Updates |
---|---|---|---|---|---|
cetirizine HCl | CETIRIZINE HCL | SOLUTION | Y | ||
cetirizine HCl | ALLERGY RELIEF | TABLET | Y | ||
cetirizine HCl | ALL DAY ALLERGY | TABLET | Y | ||
cetirizine HCl | CETIRIZINE HCL | TABLET | Y | ||
cetirizine HCl | CETIRIZINE HCL | TABLET | Y | ||
cetirizine HCl | WAL-ZYR | TABLET | Y | ||
cetirizine HCl | ALLER-TEC | TABLET | Y | ||
cetirizine HCl | ALLERGY RELIEF | TABLET | Y | ||
cetirizine HCl | ALLERGY | TABLET | Y | ||
cetirizine HCl | ALL DAY ALLERGY | TABLET | Y | ||
cetirizine HCl | 24HOUR ALLERGY | TABLET | Y | ||
cetirizine HCl | ZYRTEC | TABLET | Y | ||
loratadine | ALLERGY RELIEF | SOLUTION | Y | ||
loratadine | LORATADINE ALLERGY | SOLUTION | Y | ||
loratadine | CHILDREN'S ALLERGY | SOLUTION | Y | ||
loratadine | CHILDREN'S ALLERGY RELIEF | SOLUTION | Y | ||
loratadine | CHILDREN'S LORATADINE | SOLUTION | Y | ||
loratadine | LORATADINE | SOLUTION | Y | ||
loratadine | CHILDREN'S ALLERGY | SOLUTION | Y | ||
loratadine | CHILDREN'S ALLERGY RELIEF | SOLUTION | Y | ||
loratadine | CHILDREN'S CLARITIN | SOLUTION | Y | ||
loratadine | CHILDREN'S LORATADINE | SOLUTION | Y | ||
loratadine | ALLERGY RELIEF | SOLUTION | Y | ||
loratadine | CLARITIN | SOLUTION | Y | ||
loratadine | LORATADINE | SOLUTION | Y | ||
loratadine | WAL-ITIN | SOLUTION | Y | ||
loratadine | ALLERGY RELIEF | TAB RAPDIS | Y | ||
loratadine | LORATADINE | TAB RAPDIS | Y | ||
loratadine | ALLERGY RELIEF | TAB RAPDIS | Y | ||
loratadine | CLARITIN | TAB RAPDIS | Y | ||
loratadine | ALAVERT | TAB RAPDIS | Y | ||
loratadine | LORATADINE | TAB RAPDIS | Y | ||
loratadine | WAL-ITIN | TAB RAPDIS | Y | ||
loratadine | ALLERCLEAR | TABLET | Y | ||
loratadine | ALL DAY ALLERGY RELIEF | TABLET | Y | ||
loratadine | ALLERGY RELIEF | TABLET | Y | ||
loratadine | LORATADINE | TABLET | Y | ||
loratadine | ALLERGY RELIEF | TABLET | Y | ||
loratadine | ALLERCLEAR | TABLET | Y | ||
loratadine | LORADAMED | TABLET | Y | ||
loratadine | LORATADINE | TABLET | Y | ||
loratadine | WAL-ITIN | TABLET | Y | ||
loratadine | CLARITIN | TABLET | Y | ||
cetirizine HCl | ALL DAY ALLERGY RELIEF | CAPSULE | N | PA Document | |
cetirizine HCl | CHILDREN'S ALL DAY ALLERGY | SOLUTION | N | PA Document | |
cetirizine HCl | CHILDREN'S CETIRIZINE HCL | SOLUTION | N | PA Document | |
cetirizine HCl | CHILDREN'S ALLERGY RELIEF | SOLUTION | N | PA Document | |
cetirizine HCl | CETIRIZINE HCL | SOLUTION | N | PA Document | |
cetirizine HCl | CETIRIZINE HCL | TAB CHEW | N | PA Document | |
cetirizine HCl | CHILDREN'S CETIRIZINE HCL | TAB CHEW | N | PA Document | |
desloratadine | DESLORATADINE | TAB RAPDIS | N | PA Document | |
desloratadine | CLARINEX | TABLET | N | PA Document | |
desloratadine | DESLORATADINE | TABLET | N | PA Document | |
fexofenadine HCl | CHILDREN'S ALLERGY | ORAL SUSP | N | PA Document | |
fexofenadine HCl | FEXOFENADINE HCL | TABLET | N | PA Document | |
fexofenadine HCl | ALLERGY RELIEF | TABLET | N | PA Document | |
fexofenadine HCl | ALLER-EASE | TABLET | N | PA Document | |
levocetirizine dihydrochloride | LEVOCETIRIZINE DIHYDROCHLORIDE | SOLUTION | N | PA Document | |
levocetirizine dihydrochloride | LEVOCETIRIZINE DIHYDROCHLORIDE | TABLET | N | PA Document | |
levocetirizine dihydrochloride | ALLERGY RELIEF | TABLET | N | PA Document | |
levocetirizine dihydrochloride | 24HR ALLERGY RELIEF | TABLET | N | PA Document | |
loratadine | ALLERGY RELIEF | CAPSULE | N | PA Document | |
loratadine | CHILDREN'S LORATADINE | TAB CHEW | N | PA Document | |
loratadine | CHILDREN'S ALLERGY RELIEF | TAB CHEW | N | PA Document |