Listed below are medications currently available for the
treatment of chronic hepatitis C. This list was compiled
in consultation with a number of HCV medical specialists
and reflects medications recommended/prescribed for persons
who have HCV which are generally accepted by the medical
community.
*The HCV Medication List shall be periodically updated
in consultation with HCV medical specialists, at the Administrator's
discretion.
|
THERAPEUTIC
CLASS
|
MEDICATIONS
|
DISEASE
LEVELS
|
|
GENERIC NAME
|
BRAND NAME
|
3
|
4
|
5
|
6
|
| Analgesics |
Acetaminophen |
Tylenol |
|
|
|
|
| Acetaminophen, codeine, caffeine citrate |
Triatec |
|
|
|
|
| Cannabidiol |
Sativex |
N/A |
N/A |
|
|
| Dihydrocodine Hydrocodone |
Percocet |
N/A
|
N/A
|
|
|
| Fentanyl |
Duragesic |
|
|
|
|
| Hydromorphone Hydrochloride |
Dilaudid |
N/A
|
N/A
|
|
|
| Morphine Sulphate |
Morphine |
N/A
|
N/A
|
|
|
| Oxycodone HCL |
Supeudol |
N/A |
N/A |
|
|
| Pentazocine Hydrochloride |
Talwin |
|
|
|
|
| Propoxyphene Napsylate |
Darvon-N |
|
|
|
|
| Anemia Therapy |
Folic Acid |
Folic Acid |
|
|
|
|
| Anorectal Therapy |
Hydrocortisone |
Proctosedyl |
N/A |
N/A |
|
|
| Anti-anxiety |
Alprazolam |
Xanax |
|
|
|
|
| Nitrazepam |
Mogadon |
|
|
|
|
| Antibacterial (topical) |
Chlorhexidine Acetate |
Bactigras |
|
|
|
|
| Mupirocin |
Bactroban |
|
|
|
|
| Polymyxine B, Sulfate |
Polysporin |
|
|
|
|
| Antibiotics |
Amoxicillin
Trihydrate |
Amoxil |
|
|
|
|
| Ampicillin |
Novo-Ampicillin |
|
|
|
|
| Ampicillin Trihydrate |
Apo-Ampi |
|
|
|
|
| Azithromycin Dihydrate |
Zithromax |
|
|
|
|
| Bacampicillin Hydrochloride |
Penglobe |
|
|
|
|
| Clarithromycin |
Biaxin |
|
|
|
|
| Cefexime |
Suprax |
|
|
|
|
| Cefuroxime Axetil |
Ceftin |
|
|
|
|
| Cephalexin |
Apo-Cephalex |
|
|
|
|
| Ciprofloxacin |
Cipro |
|
|
|
|
| Clindamycin Hydrochloride |
Dalacin C |
|
|
|
|
| Erythromycin |
Erythromycin |
|
|
|
|
| Gatifloxacin |
Tequin |
|
|
|
|
| Gentamicin Sulfate |
Garamycin |
|
|
|
|
| Levofloxacin |
Levaquin |
|
|
|
|
| Metronidazole |
Flagyl |
|
|
|
|
| Moxifloxacin Hydrochloride |
Avelox |
|
|
|
|
| Mupirocin |
Bactroban |
|
|
|
|
| Nitrofurantoin |
MacroBID |
|
|
|
|
| Norfloxacin |
Apo-Norflox |
|
|
|
|
| Penicillin |
Penicillin G, V |
|
|
|
|
| Pivampicillin |
Pondocillin |
|
|
|
|
| Pivmecillinam Hydrochloride |
Selexid |
|
|
|
|
| Spiramycine |
Rovamycine |
|
|
|
|
| Tetracyclines |
Tetracyclines |
|
|
|
|
| Trimethoprim Sulfamethoxazole |
Septra |
|
|
|
|
| Vancomycin HCL |
Vancomycin |
|
|
|
|
| Antidepressants |
Amitriptyline Hydrochloride |
Elavil |
|
|
|
|
| Bupropion Hydrochloride |
Wellbutrin |
|
|
|
|
| Citalopram Hydrobromide |
Celexa |
|
|
|
|
| Doxepin Hydrochloride
|
Sinequan |
|
|
|
|
| Fluoxetine Hydrochloride
|
Prozac |
|
|
|
|
| Fluvoxamine Maleate |
Luvox |
|
|
|
|
| Imipramine Hydrochloride |
Tofranil |
|
|
|
|
| Mirtazapine |
Remeron |
|
|
|
|
| Paroxetine Hydrochloride |
Paxil |
|
|
|
|
| Sertraline Hydrochloride |
Zoloft |
|
|
|
|
| Trazodone Hydrochloride |
Desyrel |
|
|
|
|
| Venlafaxine Hydrochloride |
Effexor |
|
|
|
|
| Antidiarrheal |
Diphenoxylate Hydrochloride |
Lomotil |
|
|
|
|
| Loperamide Hydrochloride |
Imodium |
|
|
|
|
| Antiemetics |
Dimenhydrinate |
Gravol |
|
|
|
|
| Meclizine hydrochloride |
Bonamine |
|
|
|
|
| Metoclopramide hydrochloride |
Metoclopramide |
|
|
|
|
| Nabilone |
Cesamet |
|
|
|
|
| Prochlorperazine Mesylate |
Stemetil |
|
|
|
|
| Antiepileptic |
Gabapentin |
Neurontin |
|
|
|
|
| Antifungals |
Caspofungin |
Cancidas |
|
|
|
|
| Clotrimazole |
Clotrimaderm |
|
|
|
|
| Fluconazole |
Diflucan |
|
|
|
|
| Itraconazole |
Sporanox |
|
|
|
|
| Ketoconazole |
Nizoral |
|
|
|
|
| Voriconazole |
|
|
|
|
|
| Antihistamines |
Brompheniramine Maleate |
Dimetapp |
|
|
|
|
| Cetirizine Hydrochloride |
Reactine |
|
|
|
|
| Chlorpheniramine Maleate
|
Chlor-Tripolon |
|
|
|
|
| Diphenhydramine Hydrochloride
|
Benadryl |
|
|
|
|
| Fexofenadine Hydrochloride
|
Allegra |
|
|
|
|
| Hydroxyzine Hydrochloride |
Atarax |
|
|
|
|
| Levocasbastine Hydrochloride |
Livostin Eye Drops |
|
|
|
|
| Loratadine |
Claritin |
|
|
|
|
| Triprolidine HCL - Pseudophedrine HCL |
Actifed |
|
|
|
|
| Anti-hypercholesterolemic |
Atorvastatin Calcium |
Lipitor |
N/A
|
N/A
|
|
|
| Bezafibrate |
Bezalip |
N/A |
N/A |
|
|
| Cholestyramine Resin |
Questran |
N/A
|
N/A
|
|
|
| Colestipol Hydrochloride |
Colestid |
N/A
|
N/A
|
|
|
| Antihypertensives |
Acebutolol Hydrochloride |
Sectral |
N/A
|
N/A
|
|
|
| Amlodipine Besylate |
Norvasc |
N/A
|
N/A
|
|
|
| Atenolol |
Tenormin |
N/A
|
N/A
|
|
|
| Bisoprolol Fumarate |
Monocor |
N/A
|
N/A
|
|
|
| Carvedilol |
Coreg |
N/A
|
N/A
|
|
|
| Clonidine hydrochloride |
Catapres |
N/A |
N/A |
|
|
| Enalapril Maleate |
Vasotec |
N/A
|
N/A
|
|
|
| Esmolol Hydrochloride |
Brevibloc |
N/A
|
N/A
|
|
|
| Felodipine |
Renedil |
N/A
|
N/A
|
|
|
| Fosinopril Sodium |
Monopril |
N/A
|
N/A
|
|
|
| Indapamide Hemihydrate |
Gen-Indapamide |
N/A
|
N/A
|
|
|
| Irbesartan |
Avapro |
N/A
|
N/A
|
|
|
| Labetalol Hydrochloride |
Trandate |
N/A
|
N/A
|
|
|
| Losartan Potassium |
Cozaar |
N/A
|
N/A
|
|
|
| Metoprolol Tartrate |
Lopressor |
N/A
|
N/A
|
|
|
| Nadolol |
Corgard |
N/A
|
N/A
|
|
|
| Nifedipine |
Adalat |
N/A |
N/A |
|
|
| Pindolol |
Visken |
N/A
|
N/A
|
|
|
| Propranolol Hydrochloride |
Inderal |
N/A
|
N/A
|
|
|
| Ramipril |
Altace |
N/A
|
N/A
|
|
|
| Telmisartan |
Micardis |
N/A |
N/A |
|
|
| Terazosin hydrochloride |
Terazosin |
N/A |
N/A |
|
|
| Trandolapril |
Mavik |
N/A |
N/A |
|
|
| Verapamil Hydrochloride |
Verapamil Hydrochloride |
N/A
|
N/A
|
|
|
| Antipsychotics |
Chlorpromazine Hydrochloride |
Chlorpromazine Hydrochloride |
 |
|
|
|
| Olanzapine |
Zyprexa |
|
|
|
|
| Antivirals |
Acyclovir |
Zovirax |
N/A
|
N/A
|
|
|
| Famciclovir |
Famvir |
N/A
|
N/A
|
|
|
| Ganciclovir Sodium |
Cytovene |
N/A
|
N/A
|
|
|
| Oseltamivir Phosphate |
Tamiflu |
N/A
|
N/A
|
|
|
| Valacyclovir Hydrochloride
|
Valtrex |
N/A
|
N/A
|
|
|
| Valganciclovir |
Valcyte |
N/A |
N/A |
|
|
| Zanamivir |
Relenza |
N/A
|
N/A
|
|
|
| Anxiolytics/Sedatives |
Bromazepam |
Apo-Bromazepam |
|
|
|
|
| Clonazepam |
Apo-Clonazepam |
|
|
|
|
| Diazepam |
Valium |
|
|
|
|
| Lorazepam |
Ativan |
|
|
|
|
| Oxazepam |
Serax |
|
|
|
|
| Flurazepam |
Dalmane |
|
|
|
|
| Termazepam |
Restoril |
|
|
|
|
| Zopiclone |
Imovane |
|
|
|
|
| Bone Metabolism Regulator |
Risedronate Sodium Hemi-pentahydrate |
Actonel |
N/A |
N/A |
N/A |
|
| Ca Channel Blocker |
Diltiazem Hydrochloride |
Diltiazem |
|
|
|
|
| Cation-Exchange Resin |
Sodium Polystyrene Sulfonate |
Kayexalate |
N/A |
N/A |
N/A |
|
| Cholestatic Liver Diseases |
Ursodiol |
Urso |
|
|
|
|
| Cholinomimetic Agent |
Pilocarpine Hydrochloride |
Salagen |
|
|
|
|
| Corticosteroids/Glucocorticoids |
Methylprednisolone Sodium |
Solu-Medrol |
N/A |
N/A |
N/A |
|
| Prednisone |
Apo-Prednisone |
N/A |
N/A |
N/A |
|
| Inhaler: |
|
|
|
|
|
| Budesonide |
Pulmicort |
N/A |
N/A |
N/A |
|
| Fluticasone Propionate |
Flovent |
N/A |
N/A |
N/A |
|
| Salbutamol Sulfate |
Combivent |
N/A |
N/A |
N/A |
|
| Nasal: |
|
|
|
|
|
|
Fluticanose propionate
|
Flonase |
|
|
|
|
| Ophtalmic: |
|
|
|
|
|
| Dexamethasone |
Tobradex |
|
|
|
|
| Gentamicine |
Garamycin |
|
|
|
|
| Topical: |
|
|
|
|
|
| Betamethasone valerate |
Betnovate Preparations |
|
|
|
|
| Desonide |
Desocort |
|
|
|
|
| Diflucortolone Valerate |
Nerisone |
|
|
|
|
| Hydrocortisone |
Celestoderm |
|
|
|
|
| |
Cortate |
|
|
|
|
| |
Kenacomb |
|
|
|
|
| Triamcinolone Acetonide |
Triamcinolone |
|
|
|
|
| |
Uremol |
|
|
|
|
| |
Viaderm |
|
|
|
|
| Diabetic Therapy |
Insulin: |
|
|
|
|
|
| Intermediate |
|
|
|
|
|
| Long acting |
|
|
|
|
|
| Rapid |
|
|
|
|
|
| Oral agents: |
|
|
|
|
|
| Acarbose |
Prandase |
|
|
|
|
| Chlorpropamide |
Diabinese |
|
|
|
|
| Glimepiride |
Amaryl |
|
|
|
|
| Glyburide |
Diabeta |
|
|
|
|
| Metformin Hydrochloride |
Glucophage |
|
|
|
|
| Rosiglitazone Maleate |
Avandia |
|
|
|
|
| Diuretics |
Amiloride HCL |
Midamor |
N/A
|
N/A
|
|
|
| Furosemide |
Lasix |
N/A |
N/A |
|
|
| Hydrodiuril |
Hydrochlorothiazide |
N/A
|
N/A
|
|
|
| Lisinopril |
Zestoretic |
N/A |
N/A |
|
|
| Spironolactone |
Aldactone |
N/A
|
N/A
|
|
|
| Triamterene |
Nova-Triamzide |
N/A |
N/A |
|
|
| Erythropoiesis Regulating Hormone (while on Drug Therapy) |
Epoetin Alfa |
Eprex |
|
|
|
|
| HCV Drug Therapy |
Interferon alfa-2b |
Intron-A |
|
|
|
|
| Peg-Interferon alfa-2a |
Pegasys |
|
|
|
|
| Pegylated Interferon alfa-2b-Ribavirin |
Pegetron |
|
|
|
|
| Ribavirin - Interferon
alfa-2b |
Rebetron |
|
|
|
|
| Peg-Interferon alfa-2b |
Unitron PEG |
|
|
|
|
| Telaprevir |
Incivek |
|
|
|
|
| Boceprevir |
Victrelis |
|
|
|
|
| Sofosbuvir |
Sovaldi |
|
|
|
|
| Simeprevir |
Olysio |
|
|
|
|
| Harvoni |
Harvoni |
|
|
|
|
| Holkira Pak |
Holkira Pak |
|
|
|
|
| Technivie |
Technivie |
|
|
|
|
| Daklinza |
Daklinza |
|
|
|
|
| Zepatier |
Zepatier |
|
|
|
|
| Epclusa |
Epclusa |
|
|
|
|
|
Vosevi |
Vosevi |
|
|
|
|
|
Maviret |
Maviret |
|
|
|
|
| Hematopoietic Agents |
Filgrastim |
Neupogen |
N/A
|
N/A
|
|
|
| Hyperuricemia |
Allopurinol |
Allopurinol |
N/A |
N/A |
|
|
| Hypothyroidism Therapy |
Levothyroxine Sodium |
Eltroxin |
|
|
|
|
| Immunosuppressive |
Sirolimus |
Rapamune |
N/A |
N/A |
N/A |
|
| Laxative |
Psyllium Hydrophilic Mucilloid |
Metamucil |
|
|
|
|
| Migraine Therapy (during Pegetron treatment and after liver transplant) |
Rizatriptan Benzoate |
Maxalt |
|
|
|
|
| Nocturnal leg cramps |
Quinine Sulfate |
Quinine Sulfate |
N/A |
N/A |
|
|
| Nonsteroidal Anti-Inflammatory
Agents(or other similar anti-inflammatory agents |
ASA |
Novasen |
|
|
|
|
| Celecoxib |
Celebrex |
|
|
|
|
| Diclofenac Sodium |
Voltaren |
|
|
|
|
| Hydroxychloroquine Sulfate |
Plaquenil |
|
|
|
|
| Ibuprofen |
Motrin |
|
|
|
|
| Indomethacin |
Indocid |
|
|
|
|
| Ketoprofen |
Orudis |
|
|
|
|
| Ketorolac |
Toradol |
|
|
|
|
| Meloxicam |
Mobicox |
|
|
|
|
| Naproxen |
Naprosyn |
|
|
|
|
| Piroxicam |
Feldene |
|
|
|
|
| Hydroxychloroquine Sulfate |
Plaquenil |
|
|
|
|
| Rofecoxib |
Vioxx |
|
|
|
|
| Tolmetin Sodium |
Tolectin |
|
|
|
|
| Ophtalmic Insert (Sjögren's Syndrome) |
Hydroxypropyl Cellulose |
Lacrisert |
|
|
|
|
| Peristaltic Stimulant |
Docusate Sodium |
Senekot |
N/A
|
N/A
|
|
|
| Portal-Systemic Encephalopathy Therapy - Laxative |
Lactulose |
Acilac |
N/A |
N/A |
|
|
| Reflux Therapy |
Aluminum Hydroxide |
Gaviscon |
|
|
|
|
| Cimetidine |
Tagamet |
|
|
|
|
| Domperidone Maleate |
Apo-Domperidone |
|
|
|
|
| Esomeprazole |
Nexium |
|
|
|
|
| Famotidine |
Pepcid AC |
|
|
|
|
| Lansoprazole |
Prevacid |
|
|
|
|
| Magnesium Carbonate |
Maalox |
|
|
|
|
| Magnesium Hydroxide |
Mylanta |
|
|
|
|
| Metoclopramide Hydrochloride |
Apo-Metoclop |
|
|
|
|
| Nizatidine |
Axid |
|
|
|
|
| Omeprazole Magnesium |
Losec |
|
|
|
|
| Pantoprazole Sodium |
Pantoloc |
|
|
|
|
| Pinaverium Bromide |
Dicetel |
|
|
|
|
| Rabeprazole Sodium |
Pariet |
|
|
|
|
| Ranitidine Hydrochloride |
Zantac |
|
|
|
|
|
Skeletal Muscle
Relaxant
|
Cyclobenzaprine Hydrochloride |
Flexeril |
|
|
|
|
| Synthetic Octapeptide |
Octreotide Acetate |
Sandostatin |
|
|
|
|
| Supplements |
Boost |
|
|
|
|
|
| Ensure |
|
|
|
|
|
| Pedialyte |
|
|
|
|
|
| Topical Anaesthetic for Dermal Analgesia |
Lidocaine-Prilocaine |
Emla Cream |
N/A |
N/A |
N/A |
|
Vaccinations
**Vaccines for hepatitis A and B can now be reimbursed at levels 1 & 2** |
Hepatitis A |
Havrix |
|
|
|
|
| Hepatitis B |
Engerix / Recombivax |
|
|
|
|
| Hepatitis A and Hepatitis B |
Twinrix |
|
|
|
|
| Influenza |
|
|
|
|
|
| Pneumococcal Vaccine |
Pneumovax |
|
|
|
|
| Vitamins |
Cyanocobalamin |
Vitamin B12 |
N/A |
N/A |
N/A |
|
| Vitamin C |
|
N/A |
N/A |
|
|
| Vitamin D |
|
N/A |
N/A |
|
|
| Vitamin E |
|
N/A |
N/A |
|
|
| Multi-vitamins |
|
N/A |
N/A |
 |
|
