Limited Coverage Drugs - Psychiatric Medications Program - Hydroxyzine
|
Generic Name / Strength / Form |
|
| Atarax Syrup 2mg/Ml 10 MG/5 ML Solution | |
| Apo Hydroxyzine Cap 50mg 50 MG Capsule | |
| Apo Hydroxyzine Cap 25mg 25 MG Capsule | |
| Apo Hydroxyzine Cap 10mg 10 MG Capsule | |
| Novo-Hydroxyzin 10 MG Capsule | |
| Novo-Hydroxyzin 25 MG Capsule | |
| Novo-Hydroxyzin 50 MG Capsule | |
| Pms Hydroxyzine Syr 10mg/5ml 10 MG/5 ML Solution |
|
Criteria |
Approval Period |
|
For the treatment of anxiety. |
Indefinite |
Practitioner Exemptions
- No practitioner exemptions
Special Notes
- None
