Parasympathetic Agents
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 |
|---|---|---|---|---|---|
| bethanechol chloride | BETHANECHOL CHLORIDE | TABLET | |||
| cevimeline HCl | EVOXAC | CAPSULE | |||
| cevimeline HCl | CEVIMELINE HCL | CAPSULE | |||
| glycopyrrolate/neostigmine | PREVDUO | SYRINGE | |||
| neostigmine methylsulfate | NEOSTIGMINE METHYLSULFATE | SYRINGE | |||
| neostigmine methylsulfate | BLOXIVERZ | VIAL | |||
| neostigmine methylsulfate | NEOSTIGMINE METHYLSULFATE | VIAL | |||
| physostigmine salicylate | ANTICHOLIUM | AMPUL | |||
| pilocarpine HCl | PILOCARPINE HCL | TABLET | |||
| pyridostigmine bromide | REGONOL | AMPUL | |||
| pyridostigmine bromide | PYRIDOSTIGMINE BROMIDE | SOLUTION | |||
| pyridostigmine bromide | MESTINON | SOLUTION | |||
| pyridostigmine bromide | PYRIDOSTIGMINE BROMIDE | TABLET | |||
| pyridostigmine bromide | MESTINON | TABLET | |||
| pyridostigmine bromide | PYRIDOSTIGMINE BROMIDE ER | TABLET ER | |||
| pyridostigmine bromide | MESTINON | TABLET ER |