' Dexamethasone
Endocrine
Glucocorticosteroids

Brand/Generic Name Dosage/Strength Status Restrictions Notes Relative Cost
Decadron generic.gif (400 bytes)
dexamethasone		 0.5 mg tablet; 1.5 mg tablet; 6 mg tablet; 4 mg tablet; 0.75 mg tablet; 2 mg tablet; 1 mg tablet   approved.gif (510 bytes)  

$$$
Decadron generic.gif (400 bytes)
dexamethasone		 0.5 mg/5 mL Elixir   approved.gif (510 bytes)  

$$$
Decadron generic.gif (400 bytes)
dexamethasone		 0.5 mg/5 mL Solution   approved.gif (510 bytes)  

$$$

Key for Product(s) Listed Above
Formulary Prior Authorization (PA may not be required for some benefit plans) Non-Formulary
(Third tier coverage applies for selected plans)		 Not Reimbursed
Quantity Limit Not available through mail order as 90-day supply* Step Therapy Generic Available. Brand name medication may be covered at a higher member cost or may not be covered for certain plans.
Notes $Relative cost compared to others in category Specialty distribution for selected plans (Fourth or fifth tier coverage applied for selected plans)

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