Platelet Inhibitors
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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 & Updates |
---|---|---|---|---|---|
aspirin | ASPIRIN | TAB CHEW | Y | ||
aspirin | CHILDREN'S ASPIRIN | TAB CHEW | Y | ||
aspirin | ST. JOSEPH ASPIRIN | TAB CHEW | Y | ||
aspirin | CHILDREN'S CHEWABLE ASPIRIN | TAB CHEW | Y | ||
aspirin | ADULT ASPIRIN | TAB CHEW | Y | ||
aspirin | CHILDREN'S ASPIRIN | TAB CHEW | Y | ||
aspirin | ASPIRIN | TAB CHEW | Y | ||
aspirin | BAYER CHEWABLE ASPIRIN | TAB CHEW | Y | ||
aspirin | LITE COAT ASPIRIN | TABLET | Y | ||
aspirin | ASPIRIN | TABLET | Y | ||
aspirin | LITE COAT ASPIRIN | TABLET | Y | ||
aspirin | BAYER ASPIRIN | TABLET | Y | ||
aspirin | ASPIRIN LITE COAT | TABLET | Y | ||
aspirin | ASPIRIN | TABLET | Y | ||
aspirin | ASPIRIN REGIMEN | TABLET DR | Y | ||
aspirin | ASPIRIN EC | TABLET DR | Y | ||
aspirin | ASPIRIN | TABLET DR | Y | ||
aspirin | ECOTRIN | TABLET DR | Y | ||
aspirin | ENCOPRIN | TABLET DR | Y | ||
aspirin | LO-DOSE ASPIRIN EC | TABLET DR | Y | ||
aspirin | ST. JOSEPH ASPIRIN EC | TABLET DR | Y | ||
aspirin | REGRIPRIN | TABLET DR | Y | ||
aspirin | SUREPRIN 81 | TABLET DR | Y | ||
aspirin | LOW DOSE ASPIRIN EC | TABLET DR | Y | ||
aspirin | ASPIR-TRIN | TABLET DR | Y | ||
aspirin | ASPIRIN LOW STRENGTH | TABLET DR | Y | ||
aspirin | ASPIRIN EC | TABLET DR | Y | ||
aspirin | ASPIRIN | TABLET DR | Y | ||
aspirin | ADULT LOW DOSE ASPIRIN EC | TABLET DR | Y | ||
aspirin | ADULT ASPIRIN REGIMEN | TABLET DR | Y | ||
aspirin | LOW DOSE ASPIRIN | TABLET DR | Y | ||
aspirin/dipyridamole | ASPIRIN-DIPYRIDAMOLE ER | CPMP 12HR | Y | ||
cilostazol | CILOSTAZOL | TABLET | Y | ||
clopidogrel bisulfate | CLOPIDOGREL | TABLET | Y | ||
clopidogrel bisulfate | PLAVIX | TABLET | Y | ||
dipyridamole | DIPYRIDAMOLE | TABLET | Y | ||
prasugrel HCl | EFFIENT | TABLET | Y | Nov 17, 2011 | |
prasugrel HCl | PRASUGREL HCL | TABLET | Y | ||
ticagrelor | BRILINTA | TABLET | Y | Nov 17, 2011 | |
aspirin/omeprazole | YOSPRALA | TAB IR DR | N | ||
aspirin/omeprazole | ASPIRIN-OMEPRAZOLE | TAB IR DR | N |