ALABAMA MEDICAID AGENCY 1st Generation Antihistamines Preferred Status st Effective July 1, 2010, the 1 generation antihistamines were included in the Alabama Medicaid Preferred Drug Program. The list below st includes the current preferred status of the covered 1 generation antihistamines. Preferred drugs are available without prior approval. The list is subject to change. For additional PDL and coverage information, visit our drug look-up site at https://www.medicaid.alabamaservices.org/ALPortal/NDC%20Look%20Up/tabId/39/Default.aspx. NDC Code 65224054201 65224055016 65224054501 63717087001 63717087116 51991033404 51991033416 64376061216 64376061240 51991033301 64376060501 23359001430 00093030912 60505035700 00093030801 00781135901 64661003230 64661003130 13551010105 65224053930 58809091201 Brand Name ALDEX AN 5 MG CHEWABLE TABLET ALDEX D SUSPENSION ALDEX-CT TABLET CHEWABLE ARBINOXA 4 MG TABLET ARBINOXA 4 MG/5 ML LIQUID CARBINOXAMINE 4 MG/5 ML LIQUID CARBINOXAMINE 4 MG/5 ML LIQUID CARBINOXAMINE 4 MG/5 ML LIQUID CARBINOXAMINE 4 MG/5 ML LIQUID CARBINOXAMINE MALEATE 4 MG TAB CARBINOXAMINE MALEATE 4 MG TAB CENTERGY PEDIATRIC DROPS CLEMASTINE 0.5 MG/5 ML SYRUP CLEMASTINE 0.67 MG/5 ML SYRUP CLEMASTINE FUM 2.68 MG TAB CLEMASTINE FUM 2.68 MG TAB J-TAN D PD DROPS J-TAN PD DROPS KARBINAL ER 4 MG/ 5 ML SUSP PEDIATEX TD LIQUID PHENA-S 12 SUSPENSION Generic Name DOXYLAMINE SUCCINATE ORAL 5 MG TAB CHEW PHENYLEPHRINE/PYRILAMINE ORAL 5-16MG/5ML ORAL SUSP PHENYLEPHRINE/DIPHENHYDRAMINE ORAL 5MG-12.5MG TAB CHEW CARBINOXAMINE MALEATE ORAL 4 MG TABLET CARBINOXAMINE MALEATE ORAL 4 MG/5 ML LIQUID CARBINOXAMINE MALEATE ORAL 4 MG/5 ML LIQUID CARBINOXAMINE MALEATE ORAL 4 MG/5 ML LIQUID CARBINOXAMINE MALEATE ORAL 4 MG/5 ML LIQUID CARBINOXAMINE MALEATE ORAL 4 MG/5 ML LIQUID CARBINOXAMINE MALEATE ORAL 4 MG TABLET CARBINOXAMINE MALEATE ORAL 4 MG TABLET PHENYLEPHRINE/CHLORPHENIRAMINE ORAL 2MG-1MG/ML DROPS CLEMASTINE FUMARATE ORAL 0.67MG/5ML SYRUP CLEMASTINE FUMARATE ORAL 0.67MG/5ML SYRUP CLEMASTINE FUMARATE ORAL 2.68 MG TABLET CLEMASTINE FUMARATE ORAL 2.68 MG TABLET PSEUDOEPHEDRINE/BROMPHENIRAMIN ORAL 7.5-1MG/ML DROPS BROMPHENIRAMINE MALEATE ORAL 1 MG/ML DROPS CARBINOXAMINE MALEATE ORAL 4 MG/5 ML SUS ER 12H PSEUDOEPHEDRINE/TRIPROLIDINE ORAL 10-0.938/1 LIQUID PE/PE & PYRILAMINE TANNATE/CPM ORAL 2.5-7.5-10 ORAL SUSP 1 PDL Status Non-preferred Non-preferred Non-preferred Non-preferred Non-preferred Preferred Preferred Preferred Preferred Preferred Preferred Preferred Preferred Preferred Preferred Preferred Non-preferred Non-preferred Non-preferred Non-preferred Non-preferred Effective 10/1/2014
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