Cephalosporins, Parenteral

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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
cefamandole in dextrose 5 % MANDOL IN DEXTROSE PIGGYBACK    
cefazolin sodium CEFAZOLIN SODIUM VIAL    
cefazolin sodium ANCEF VIAL    
cefazolin sodium CEFAZOLIN SODIUM VIAL PORT    
cefazolin sodium/dextrose,iso CEFAZOLIN SODIUM-DEXTROSE FROZ.PIGGY    
cefazolin sodium/dextrose,iso CEFAZOLIN SODIUM-DEXTROSE PIGGYBACK    
cefepime HCl CEFEPIME HCL VIAL    
cefepime HCl in dextrose 5 % CEFEPIME-DEXTROSE PIGGYBACK    
cefepime in iso-osm dextrose CEFEPIME FROZ.PIGGY    
cefiderocol sulfate tosylate FETROJA VIAL    
cefotaxime sodium CEFOTAXIME SODIUM VIAL    
cefotaxime sodium CLAFORAN VIAL    
cefotaxime sodium CLAFORAN VIAL PORT    
cefotetan disodium CEFOTETAN VIAL    
cefoxitin sodium CEFOXITIN VIAL    
cefoxitin sodium/dextrose,iso CEFOXITIN SODIUM PIGGYBACK    
ceftaroline fosamil acetate TEFLARO VIAL    
ceftazidime CEFTAZIDIME VIAL    
ceftazidime TAZICEF VIAL    
ceftazidime TAZICEF VIAL PORT    
ceftazidime in dextrose5%water CEFTAZIDIME PIGGYBACK    
ceftazidime-dextrose (iso-osm) TAZICEF IN DEXTROSE FROZ.PIGGY    
ceftazidime/avibactam AVYCAZ VIAL    
ceftolozane/tazobactam ZERBAXA VIAL    
ceftriaxone in is-osm dextrose CEFTRIAXONE FROZ.PIGGY    
ceftriaxone in is-osm dextrose CEFTRIAXONE PIGGYBACK    
ceftriaxone sodium CEFTRIAXONE VIAL    
ceftriaxone sodium CEFTRIAXONE VIAL PORT    
cefuroxime sodium CEFUROXIME SODIUM VIAL    
cefuroxime sodium/D5W ZINACEF PIGGYBACK