Drug Name Search Results | Formulary Search

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If you have questions about your prescription drug coverage, log into our website and click “Pharmacy,” or call the Customer Service number listed on the back of your member ID card.

Therapeutic Class Search: central nervous system agents/dopamine precursors

30 drug(s) found

To view other medications in a therapeutic class, click any class hyperlink in your search results.

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Definition of Status

Icon	Status	Definition
	Tier 1	Lowest cost share. Generic drugs are as effective, safe and high quality as their brand-name counterparts, yet less expensive.
	Tier 2	Considered “preferred” when there is no generic, and because of their value and effectiveness.
	Medical Benefit	Medical Benefit drugs are normally administered in a clinic, infusion center or provided by a home infusion service. These drugs and their services are covered under the medical benefit, not under the pharmacy benefit. This drug may require prior authorization. See the medical policy section for details.

Definition of Restrictions

Icon	Restriction	Definition
	ACA Preventive Drug	The Affordable Care Act (ACA) makes certain preventive medications available to you at no cost. Coverage of any medication flagged as “ACA PV” (including certain over-the-counter (OTC) medications) requires a prescription from a licensed health care provider. For additional details on coverage for these medications, please click on the "Coverage Note" icon next to the drug name.
	Coverage Note	Coverage restrictions based on age, gender, or condition may apply to this medication. Click on the "Coverage Note" icon for additional details.
	NonPreferred	This drug has a preferred drug option. You can find preferred options to non-preferred drugs by clicking on the therapeutic class above and selecting the appropriate subclass. Preferred drug options are listed without the NP flag. Talk to your provider to see if one of these options is right for you.
	Oral Chemo Drug	Oral Chemotherapy Drug. If you are employed by a Washington, Oregon or Alaska-based group (effective 1/1/17 for Alaskan groups) OR purchasing Individual coverage (non-employer based) in Washington, Oregon or Alaska (Alaska as of 1/1/17) , certain oral chemotherapy drugs may be covered under your medical plan. Please check your member booklet or call the customer service number on the back of your member ID card to verify your benefits.
	Prior Authorization	You (or your doctor) are required to get prior authorization from our plan before you fill your prescription for this drug. Without prior approval, we may not cover this drug. You can click on the "PA" icon next to the drug to see the coverage criteria. For information on how to request prior authorization, please see the “Drugs Requiring Approval” section on our website.
	Quantity Limit	Our plan limits the amount of this drug that is covered per prescription, or within a specific time frame. You can click on the "QL" icon next to the drug to see this limit. If you need an exception to this quantity limit, your doctor or pharmacist should call 1-888-261-1756.
	Specialty Pharmacy	Specialty drugs are typically self-injected and are often used to treat complex medical conditions. These drugs may require more involvement with your physician, and may require special storage and handling.

Brand Name Generic Name	Therapeutic Class Sub-Class	Dose/Strength
Carbidopa-Levodopa Oral Tablet 10-100 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Tablet 10-100 mg
Carbidopa-Levodopa Oral Tablet 25-100 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Tablet 25-100 mg
Carbidopa-Levodopa Oral Tablet 25-250 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Tablet 25-250 mg
Carbidopa-Levodopa Oral Tablet Extended Release 25-100 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Tablet Extended Release 25-100 mg
Carbidopa-Levodopa Oral Tablet Extended Release 50-200 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Tablet Extended Release 50-200 mg
Carbidopa-Levodopa Oral Tablet,Disintegrating 10-100 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Tablet,Disintegrating 10-100 mg
Carbidopa-Levodopa Oral Tablet,Disintegrating 25-100 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Tablet,Disintegrating 25-100 mg
Carbidopa-Levodopa Oral Tablet,Disintegrating 25-250 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Tablet,Disintegrating 25-250 mg
Carbidopa-Levodopa-Entacapone Oral Tablet 12.5-50-200 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Tablet 12.5-50-200 mg
Carbidopa-Levodopa-Entacapone Oral Tablet 18.75-75-200 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Tablet 18.75-75-200 mg
Carbidopa-Levodopa-Entacapone Oral Tablet 25-100-200 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Tablet 25-100-200 mg
Carbidopa-Levodopa-Entacapone Oral Tablet 31.25-125-200 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Tablet 31.25-125-200 mg
Carbidopa-Levodopa-Entacapone Oral Tablet 37.5-150-200 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Tablet 37.5-150-200 mg
Carbidopa-Levodopa-Entacapone Oral Tablet 50-200-200 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Tablet 50-200-200 mg
Duopa J-Tube Intestinal Pump Suspension 4.63-20 Mg/Ml Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Intestinal Pump Suspension 4.63-20 mg/mL
Inbrija Inhalation Capsule 42 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Capsule 42 mg
Inbrija Inhalation Capsule, W/Inhalation Device 42 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Capsule, W/Inhalation Device 42 mg
Rytary Oral Capsule, Extended Release 23.75-95 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Capsule, Extended Release 23.75-95 mg
Rytary Oral Capsule, Extended Release 36.25-145 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Capsule, Extended Release 36.25-145 mg
Rytary Oral Capsule, Extended Release 48.75-195 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Capsule, Extended Release 48.75-195 mg
Rytary Oral Capsule, Extended Release 61.25-245 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Capsule, Extended Release 61.25-245 mg
Sinemet Oral Tablet 10-100 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Tablet 10-100 mg
Sinemet Oral Tablet 25-100 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Tablet 25-100 mg
Sinemet Oral Tablet 25-250 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Tablet 25-250 mg
Stalevo 100 Oral Tablet 25-100-200 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Tablet 25-100-200 mg
Stalevo 125 Oral Tablet 31.25-125-200 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Tablet 31.25-125-200 mg
Stalevo 150 Oral Tablet 37.5-150-200 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Tablet 37.5-150-200 mg
Stalevo 200 Oral Tablet 50-200-200 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Tablet 50-200-200 mg
Stalevo 50 Oral Tablet 12.5-50-200 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Tablet 12.5-50-200 mg
Stalevo 75 Oral Tablet 18.75-75-200 Mg Central Nervous System Agents Dopamine Precursors	Central Nervous System Agents Dopamine Precursors	Tablet 18.75-75-200 mg

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Definition of Restrictions