Calcium/Vit D Replacement, Oral

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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 but eligible patients will encounter a co-pay at the pharmacy.
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
calcium carbonate CALCI-MIX CAPSULE Y    
calcium carbonate CALCIUM CARBONATE ORAL SUSP Y    
calcium carbonate CALCIUM CARBONATE ORAL SUSP Y    
calcium carbonate CAL-MINT TAB CHEW Y    
calcium carbonate CALCIUM CARBONATE TAB CHEW Y    
calcium carbonate CALCIUM CARBONATE TABLET Y    
calcium carbonate OYSTER SHELL TABLET Y    
calcium carbonate CALCIUM 500 TABLET Y    
calcium carbonate GOOD SENSE TABLET Y    
calcium carbonate CALTRATE 600 TABLET Y    
calcium carbonate CALPAK TABLET Y    
calcium carbonate CALCIUM CARBONATE TABLET Y    
calcium carbonate HI-CAL TABLET Y    
calcium carbonate HI CALCIUM TABLET Y    
calcium carbonate CALCIUM TABLET Y    
calcium carbonate CAL-CARB FORTE TABLET Y    
calcium carbonate CAL-600 TABLET Y    
calcium carbonate OYSTERCAL 500 TABLET Y    
calcium carbonate OYSCO-500 TABLET Y    
calcium carbonate UNI-CAL 500 TABLET Y    
calcium carbonate SUPER CALCIUM TABLET Y    
calcium carbonate OYSTER SHELL CALCIUM TABLET Y    
calcium carbonate OYSTER CALCIUM 500 TABLET Y    
calcium carbonate CALTRATE-600 TABLET Y    
calcium carbonate OYST-CAL-500 TABLET Y    
calcium carbonate HI-CALCIUM TABLET Y    
calcium carbonate OYSCAL 500 TABLET Y    
calcium carbonate OSTRARID TABLET Y    
calcium carbonate OS-CAL 500 TABLET Y    
calcium carbonate NATURAL O-S CAL TABLET Y    
calcium carbonate NATURAL CALCIUM TABLET Y    
calcium carbonate HM CALCIUM TABLET Y    
calcium carbonate HIGH POTENCY CALCIUM TABLET Y    
calcium carbonate OYSTER CALCIUM TABLET Y    
calcium carbonate/vitamin D3 LIQUID CALCIUM 600-VIT D3 CAPSULE Y    
calcium carbonate/vitamin D3 LIQUID CALCIUM +D CAPSULE Y    
calcium carbonate/vitamin D3 LIQUID CALCIUM + VITAMIN D CAPSULE Y    
calcium carbonate/vitamin D3 CALCIUM 600-VIT D3 CAPSULE Y    
calcium carbonate/vitamin D3 CALCIUM 600 + VITAMIN D CAPSULE Y    
calcium carbonate/vitamin D3 CALCIUM CARBONATE/VITAMIN D3 CAPSULE Y    
calcium carbonate/vitamin D3 CALCIUM + VIT D3 CAPSULE Y    
calcium carbonate/vitamin D3 CAL-QUICK LIQUID Y    
calcium carbonate/vitamin D3 OS-CAL 500+D TAB CHEW Y    
calcium carbonate/vitamin D3 CHEWABLE CALCIUM TAB CHEW Y    
calcium carbonate/vitamin D3 CALTRATE 600 + D TAB CHEW Y    
calcium carbonate/vitamin D3 CALCIUM 500 + VIT D TAB CHEW Y    
calcium carbonate/vitamin D3 OYSCO 500+D TAB CHEW Y    
calcium carbonate/vitamin D3 CALCIUM TAB CHEW Y    
calcium carbonate/vitamin D3 CALCIUM 500-VIT D3 TABLET Y    
calcium carbonate/vitamin D3 CALCIUM 600 + VIT D TABLET Y    
calcium carbonate/vitamin D3 OS-CAL 500-VIT D3 TABLET Y    
calcium carbonate/vitamin D3 CALCIUM 1000 + D3 TABLET Y    
calcium carbonate/vitamin D3 OSTEO-PORETICAL TABLET Y    
calcium citrate CALCIUM CITRATE TABLET Y    
cholecalciferol (vitamin D3) VITAMIN D3 CAPSULE Y    
cholecalciferol (vitamin D3) OPTIMAL D3 CAPSULE Y    
cholecalciferol (vitamin D3) VITAMIN D3 CAPSULE Y    
cholecalciferol (vitamin D3) MAXIMUM D3 CAPSULE Y    
cholecalciferol (vitamin D3) DECARA CAPSULE Y    
cholecalciferol (vitamin D3) D3-50 CAPSULE Y    
cholecalciferol (vitamin D3) VITAMIN D CAPSULE Y    
cholecalciferol (vitamin D3) VITAMIN D3 SPRAY SUSP Y    
cholecalciferol (vitamin D3) VITAMIN D3 TABLET Y    
cholecalciferol (vitamin D3) VITAMIN D TABLET Y    
cholecalciferol (vitamin D3) THERA-D TABLET Y    
cholecalciferol (vitamin D3) DIALYVITE VITAMIN D3 MAX TABLET Y    
cholecalciferol (vitamin D3) D3 DOTS TABLET Y    
ergocalciferol (vitamin D2) VITAMIN D2 CAPSULE Y    
ergocalciferol (vitamin D2) VITAMIN D TABLET Y    
ergocalciferol (vitamin D2) VITAMIN D2 TABLET Y    
calcium gluconate CALCIUM GLUCONATE TABLET N PA Document  
calcium/mag/D3/B12/FA/B6/boron TL G-FOL OS TABLET N PA Document  
calcium/mag/D3/B12/FA/B6/boron CALCIUM-FOLIC ACID PLUS D WAFER N PA Document  
calcium chloride CALCIUM CHLORIDE SYRINGE    
calcium chloride CALCIUM CHLORIDE VIAL    
calcium gluconate CALCIUM GLUCONATE VIAL