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 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
CEFAZOLIN SODIUM CEFAZOLIN SODIUM 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 MAXIPIME VIAL    
CEFEPIME HCL CEFEPIME HCL VIAL    
CEFEPIME HCL MAXIPIME VIAL PORT    
CEFEPIME HCL IN DEXTROSE 5 % CEFEPIME-DEXTROSE PIGGYBACK    
CEFEPIME IN ISO-OSM DEXTROSE CEFEPIME FROZ.PIGGY    
CEFOTAXIME SODIUM CEFOTAXIME SODIUM VIAL    
CEFOTETAN DISOD/ISOSM DEXTROSE CEFOTETAN & DEXTROSE PIGGYBACK    
CEFOTETAN DISODIUM CEFOTETAN VIAL    
CEFOTETAN DISODIUM CEFOTAN VIAL    
CEFOXITIN SODIUM CEFOXITIN VIAL    
CEFOXITIN SODIUM/DEXTROSE,ISO CEFOXITIN SODIUM PIGGYBACK    
CEFTAROLINE FOSAMIL ACETATE TEFLARO VIAL    
CEFTAZIDIME FORTAZ VIAL    
CEFTAZIDIME TAZICEF VIAL    
CEFTAZIDIME CEFTAZIDIME VIAL    
CEFTAZIDIME TAZICEF VIAL PORT    
CEFTAZIDIME FORTAZ VIAL PORT    
CEFTAZIDIME IN DEXTROSE5%WATER CEFTAZIDIME PIGGYBACK    
CEFTAZIDIME IN IS-OSM DEXTROSE FORTAZ IN ISO-OSMOTIC 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 ZINACEF VIAL    
CEFUROXIME SODIUM CEFUROXIME SODIUM VIAL    
CEFUROXIME SODIUM ZINACEF VIAL PORT    
CEFUROXIME SODIUM/WATER ZINACEF FROZ.PIGGY