Puerto Rico AIDS Drug Assisstance Program Formulary

Puerto Rico ADAP Formulary
Which drugs are covered?

All drugs are listed by catagory and alphabetically, starting with their generic names followed by the brand names in parenthesis. Click on a high-lighted item in green to see a detailed description of the drug. To search for a specific drug, hold down both the control key (command key on the Mac) and the F key, then type in the drug name. For a list of specific medical criterias, see the bottom of this page.

Antiretroviral
Nucleoside/tide Reverse Transcriptase Inhibitor (NRTI) abacavir (Ziagen) abacavir/lamivudine/zidovudine (Trizivir) didanosine (ddI, Videx) emtricitabine (Emtriva) lamivudine (Epivir, 3TC) lamivudine/zidovudine (Combivir) stavudine (d4T, Zerit) tenofovir (Viread) zalcitabine (ddC, HIVID) zidovudine (AZT, Retrovir)	Protease Inhibitor (PI) amprenavir (Agenerase) atazanavir (Reyataz) indinavir (Crixivan) lopinavir/ritonavir (Kaletra) nelfinavir (Viracept) ritonavir (Norvir) saquinavir (Fortavase)	Non-nucleoside Reverse Transcriptase Inhibitor (NnRTI) delavirdine (Rescriptor) efavirenz (Sustiva) nevirapine (Viramune) Entry Inhibitor enfuvirtide (Fuzeon)*

HIV Drug Resistance Tests: Genotypic tests provided through the HIV Care Consortiae.

Opportunistic Infection (OI) Treatment & Prophylaxis
Public Health Service Recommanded OI drugs acyclovir (Zovirax) azithromycin (Zithromax) clarithromycin (Biaxin) famciclovir (Famvir) fluconazole (Diflucan) foscarnet (Foscavir) ganciclovir (Cytovene) isoniazid (INH) itraconazole (Sporanox) leucovorin pyrimethamine (Daraprim) sulfadiazine TMP/SMX (Septra)	Other OI drugs amikacin (Amikin) amphotericin B (Fungizone) atovaquone (Mepron) capreomycin (Capastat) ciprofloxacin (Cipro) clindamycin (Cleocin) clofazimine (Lamprene) clotrimazole (Lotrimin, Mycelex) cycloserine (Sermycin) dapsone epoetin alfa (Procrit) ethambutol (Myambutol) ethionamide (Trecator SC)	filgrastim (Neupogen) IVIG (Gamimune-N, Gammagard) kanamycin (Kantrex) ketoconazole (Nizoral) metronidazole (Flagyl) nystatin (Mycostatin) ofloxacin (Floxin) para aminosalicyclic acid (Paser) pentamidine (NebuPent, Pentam) pyrazinamide (PZA) rifabutin (Mycobutin) rifampin (Rifadin) triple sulfa valacyclovir (Valtrex) valganciclovir (Valcyte)

Hepatitis C Treatment
peg-interferon alfa-2b (Peg-Intron) ribavirin (Rebetol, generic)


Wasting
megestrol acetate (Megace)

Other
acetaminophen (Tylenol) albuterol (Proventil) amytriptyline (Elavil) amoxicillin (Trimox) amoxicillin/clavulanate (Augmentin) antacids (Mylanta, Maalox) betamethasone dipropionate (Diprolene) betamethason/ clotrimazole cream (Lotrisone) capsaicin (Zostrix) cefadroxil (Duricef) ceftriaxone (Rocephin) cetirizine (Zyrtec) clindamycin vaginal cream (Cleocin) clotrimazole vaginal cream (Gyne-Lotrimin) cold cream (generic) diphenhydramine (Benadryl) doxycycline (Vibramycin)	econazole nitrate (Spetazole) erythromycin base (PCE) flurbiprofen (Ansaid) fluocinonide (Synalar) fluoxetine (Prozac) guaifenesin/oxtriphylline (Brondelate) guaifenesin/phenylephrine (Albatussin SR, NN) hydrocortisone cream hydroxyzine pamoate imiquimod (Aldara) Ionil-T shampoo ketaconazole shampoo Ku-Zyme (amylase, cellullase, lipase, protease) lanzoprazole (Prevacid) lidocaine HCI (Emla Cream, Xylocaine) loperamide (Imodium) loratidine (Claritin)	metronidazole vaginal cream (Metrogel) mometasone (Elocon) Neosporin Nutraderm lotion penicillin G benzathine (Bicillin LA) podophyllin pseudoephedrine / triprolidine (Actifed) ranitidine (Zantac) sertraline HCI (Zoloft) spectomycin (Trobicin) sucralfate (Carafate) terconazole vaginal cream (Terazol) triamicinolone (Kenalog) tubercullin (Tubersol) vitamins and minerals (Albafort, Alba-Lybe, ferrous sulfate, folic acid, Iberet folic, Nervidox, Piridoxina, Tia-Doce, Unicap)

Medical Criteria

*Additional Eligibility Requirements for Fuzeon: (Limited to 64 slots) Antiretroviral treatment experianced. Viral replication with a VL > 5000, dispite ART A resistance test to determain an OBR, including 2 ART agents expected to be active and tolerated by patient with in the last 3 months The clinc must have capacity and expertise to train patient in administration of Fuzeon
The following drugs are for patients already taking it and/or approved by the infectious disease technician or medical director of the clinic: delavirdine (Rescriptor) nevirapine (Viramune) lamivudine/retrovir/abacavir (Trizivir) lopinavir/ritonavir (Kaletra) amphotericin B (Fungizone) paromomycin (Humatin) terbinafine HCL (Lamisil) Current treatment guidelines: CD4 > 500, viral load <10,000 AZT /3TC. TB prevention (if indicated) with isoniazid and vitamin B6. Influenza vaccine, Varivax, Pneumovax, and hepatitis B vaccine. CD4 201-499, viral load >10,000 AZT/3TC/protease inhibitor. TB prevention (if indicated) with isoniazid and vitamin B6. Influenza vaccine. CD4 100-200, viral load >10,000 AZT/3TC/protease inhibitor. TB prevention (if indicated) with isoniazid and vitamin B6. PCP prevention with TMP/SMX (Septra) or dapsone. Fluconazole antifungal prophylaxis at 100 mg/wk. Alpha-interferon available for Kaposi's sarcoma, hepatitis B or hepatitis C. Treatment for active TB. Treatments for other opportunistic infections. CD4 < 99, viral load >100,000 AZT/3TC/protease inhibitor, with a note to consider the side effects versus the benefits of stopping treatment. Fluconazole antifungal prophylaxis at 100 mg/wk. Azithromycin for MAC prophylaxis. Treatment for active TB. Treatments for other opportunistic infections. "ADAP actual formulary provides for any medically indicated drug as requested by the RICs HIV specialist doctor according to the approved treatment guidelines. No pre-authorization, compliance requirements or restrictions on off-label use are established or recommended by the Pharmaceutic and Therapeutic Committee."

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Puerto Rico ADAP FormularyWhich drugs are covered?

Puerto Rico ADAP Formulary
Which drugs are covered?