Miscellaneous Pulmonary Agents

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Generic Name Brand Name Form PDL
Status
Current Drug Use Criteria Carveout
‐ Bill FFS
New Drug Evaluation & Updates
montelukast sodium SINGULAIR TAB CHEW Y   N  
montelukast sodium MONTELUKAST SODIUM TAB CHEW Y   N  
montelukast sodium SINGULAIR TABLET Y   N  
montelukast sodium MONTELUKAST SODIUM TABLET Y   N  
ensifentrine OHTUVAYRE AMPUL-NEB N Pharmacy PA N  
montelukast sodium MONTELUKAST SODIUM GRAN PACK N   N  
nerandomilast JASCAYD TABLET N   N  
roflumilast ROFLUMILAST TABLET N Pharmacy PA N  
roflumilast DALIRESP TABLET N Pharmacy PA N Feb 23, 2012
zafirlukast ZAFIRLUKAST TABLET N   N  
zafirlukast ACCOLATE TABLET N   N  
zileuton ZYFLO TABLET N   N  
zileuton ZILEUTON ER TBMP 12HR N   N