Genitourinary
Anti-Infectives

Brand/Generic Name
(Generics in italics)		 Dosage/Strength Status Restrictions Notes Cost Sharing
Furadantin
Nitrofurantoin		   approved.gif (510 bytes)     Tier 2
Macrobid generic.gif (400 bytes)
Nitrofurantoin Monohyd Macro		   approved.gif (510 bytes)     Tier 2
Macrodantin generic.gif (400 bytes)
Nitrofurantoin Macrocrystal		   approved.gif (510 bytes)     Tier 2
Mandelamine generic.gif (400 bytes)
Methenamine Mandelate		   approved.gif (510 bytes)     Tier 2
Urised
Methen-Bella-Meth Bl-Phen Sal		   approved.gif (510 bytes)     Tier 2

Key for Product(s) Listed Above
Formulary Non-Formulary Prior Authorization Not Reimbursed
Quantity Limit   Generic Available (Most Generics
Available at Tier 1)		 Step Therapy Notes

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