influenza virus vaccine trivalent (Rx)

Brand and Other Names:Afluria, Fluzone, more...Agriflu, Fluvirin, Fluzone High-Dose (DSC), Fluzone Intradermal
  • Print

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

IM injection, regular strength

  • 22.5mcg/0.25mL
  • 45mcg/0.5mL

ID injection

  • 27mcg/0.1mL (Fluzone Intradermal)

Influenza Prophylaxis

United States 2021-2022 influenza season: All vaccines expected to be available are quadrivalent

CDC recommends that everyone 6 months of age and older receive an annual influenza vaccination

For more vaccine information see http://www.cdc.gov/vaccines/schedules/hcp/index.html

IM regular strength

  • 0.5 mL IM x1 dose

Intradermal

  • Fluzone Intradermal (18-64 yr): 0.1 mL ID x1 dose

Dosing Considerations

Contains the following 3 viral strains for 2021-2022 Northern Hemisphere season

  • A/Victoria/2570/2019 (H1N1)pdm09-like virus (new for 2021-2022)
  • A/Cambodia/30826360/2020 (H3N2)-like virus (new for 2021-2022)
  • B/Washington/02/2019 (B/Victoria lineage)-like virus (no change from last season)

Dosage Forms & Strengths

injection, regular strength

  • 22.5mcg/0.25mL
  • 45mcg/0.5mL

Influenza Prophylaxis

United States 2021-2022 influenza season: All vaccines expected to be available are quadrivalent

CDC's ACIP recommends that everyone 6 months of age and older receive an annual influenza vaccination

See Administration section for information regarding if 1 or 2 doses are required for the influenza vaccine in children aged 6 months through 8 years

Fluzone

  • Approved for children >6 months
  • 6-18 months: 0.25 mL IM x1-2 doses/season
  • 18-35 months: 0.25 mL IM x1-2 doses/season
  • 3-8 years: 0.5 mL IM x1-2 doses/season
  • ≥9 years: 0.5 mL IM x1 dose/season

Fluvirin

  • <4 years: Safety and efficacy not established
  • 4-8 years: 0.5 mL IM x1-2 doses/season
  • ≥9 years: 0.5 mL IM x1 dose/season

Afluria

  • <6 months: Safety and efficacy not established
  • 6-35 months: 0.25 mL IM x1-2 doses/season
  • 3-8 years: 0.5 mL IM x1-2 doses/season
  • 9 years or older: 0.5 mL IM xq dose/season

Dosing Considerations

Contains the following 3 viral strains for 2021-2022 Northern Hemisphere season

  • A/Victoria/2570/2019 (H1N1)pdm09-like virus (new for 2021-2022)
  • A/Cambodia/30826360/2020 (H3N2)-like virus (new for 2021-2022)
  • B/Washington/02/2019 (B/Victoria lineage)-like virus (no change from last season)
Next:

Interactions

Interaction Checker

and influenza virus vaccine trivalent

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 

            Contraindicated (0)

              Serious - Use Alternative (37)

              • adalimumab

                adalimumab decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • alefacept

                alefacept decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • anakinra

                anakinra decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • antithymocyte globulin equine

                antithymocyte globulin equine decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • antithymocyte globulin rabbit

                antithymocyte globulin rabbit decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • azathioprine

                azathioprine decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • basiliximab

                basiliximab decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • budesonide

                budesonide decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

              • canakinumab

                canakinumab decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • cortisone

                cortisone decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

              • deflazacort

                deflazacort decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

              • dexamethasone

                dexamethasone decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

              • etanercept

                etanercept decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • everolimus

                everolimus decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • fludrocortisone

                fludrocortisone decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

              • glatiramer

                glatiramer decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • golimumab

                golimumab decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • hydrocortisone

                hydrocortisone decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

              • hydroxychloroquine sulfate

                hydroxychloroquine sulfate decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • infliximab

                infliximab decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • leflunomide

                leflunomide decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • methylprednisolone

                methylprednisolone decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

              • muromonab CD3

                muromonab CD3 decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • mycophenolate

                mycophenolate decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • ocrelizumab

                ocrelizumab decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Vaccination with live-attenuated or live vaccines is not recommended during ocrelizumab treatment and until B-cell repletion.

              • ofatumumab SC

                ofatumumab SC decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Administer all immunizations according to immunization guidelines at least 2 weeks before initiating ofatumumab SC for inactivated vaccines, and whenever possible.

              • prednisolone

                prednisolone decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

              • prednisone

                prednisone decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

              • rilonacept

                rilonacept decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • secukinumab

                secukinumab decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.

              • siponimod

                siponimod decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Pause vaccinations beginning 1 week before initiating siponimod and for 4 weeks after stopping treatment. Coadministration with live attenuated vaccines may increase infection risk.

              • sirolimus

                sirolimus decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • tacrolimus

                tacrolimus decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • temsirolimus

                temsirolimus decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • tocilizumab

                tocilizumab decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • triamcinolone acetonide injectable suspension

                triamcinolone acetonide injectable suspension decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

              • ustekinumab

                ustekinumab decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Prior initiating therapy, patients should receive all age-appropriate immunizations as recommended by current guidelines. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              Monitor Closely (18)

              • certolizumab pegol

                certolizumab pegol decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Use Caution/Monitor.

              • cyclosporine

                cyclosporine decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. If possible, complete all age-appropriate vaccinations at least 2 weeks before initiating immunosuppressant therapy. Patients vaccinated <14 days before starting immunosuppressive therapy or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued if immune competence has been restored. Longer waiting periods may be required for drugs that maintain their immunosuppressive effects for more than 3 months after discontinuation (eg, ocrelizumab). .

              • dengue vaccine

                dengue vaccine, influenza virus vaccine trivalent. unspecified interaction mechanism. Use Caution/Monitor. Data are not available to establish safety and immunogenicity of coadministration of dengue vaccine with recommended adolescent vaccines.

              • ibrutinib

                ibrutinib decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

              • ifosfamide

                ifosfamide decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

              • lomustine

                lomustine decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

              • mechlorethamine

                mechlorethamine decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

              • melphalan

                melphalan decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

              • mercaptopurine

                mercaptopurine decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressants also increase risk of infection with concomitant live vaccines.

              • methotrexate

                methotrexate decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Use Caution/Monitor. Concomitant administration of methotrexate can decrease the immunological response of vaccines.

              • onasemnogene abeparvovec

                onasemnogene abeparvovec decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Adjust vaccinations to accommodate concomitant corticosteroid administration prior to and following onasemnogene abeparvovec infusion. When initiating systemic corticosteriod therapy, wait 2 weeks after an inactivated vaccine.

              • oseltamivir

                oseltamivir decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Use Caution/Monitor. Avoid administration of live attenuated influenza vaccine intranasal within 2 weeks before or 48 hours after administration of oseltamivir, unless medically indicated.

              • oxaliplatin

                oxaliplatin decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

              • ponesimod

                ponesimod decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.

              • procarbazine

                procarbazine decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .

              • rituximab

                rituximab, influenza virus vaccine trivalent. immunosuppressive effects; risk of infection. Use Caution/Monitor. When used for rheumatoid arthritis, follow current immunization guidelines and administer non-live vaccines at least 4 weeks prior to a course of rituximab.

              • rituximab-hyaluronidase

                rituximab-hyaluronidase, influenza virus vaccine trivalent. immunosuppressive effects; risk of infection. Use Caution/Monitor. When used for rheumatoid arthritis, follow current immunization guidelines and administer non-live vaccines at least 4 weeks prior to a course of rituximab.

              • voclosporin

                voclosporin decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.

              Minor (5)

              • chloroquine

                chloroquine decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Minor/Significance Unknown.

              • ethotoin

                influenza virus vaccine trivalent, ethotoin. Mechanism: unknown. Minor/Significance Unknown. Vaccine administration may incr or decr phenytoin levels.

              • fosphenytoin

                influenza virus vaccine trivalent, fosphenytoin. Mechanism: unknown. Minor/Significance Unknown. Vaccine administration may incr or decr phenytoin levels.

              • ozanimod

                ozanimod decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Minor/Significance Unknown. No clinical data are available on the efficacy and safety of vaccinations in patients taking ozanimod. Vaccinations may be less effective if coadministered with ozanimod.

              • phenytoin

                influenza virus vaccine trivalent, phenytoin. Mechanism: unknown. Minor/Significance Unknown. Vaccine administration may incr or decr phenytoin levels.

              Previous
              Next:

              Adverse Effects

              Suspected adverse events after administration of any vaccine may be reported to Vaccine Adverse Events Reporting System (VAERS), 1-800-822-7967

              >10%

              Soreness at injection site (10-70%)

              Frequency Not Defined

              Fever

              Malaise

              Myalgia

              Headache

              Allergic reactions

              Presyncope

              Previous
              Next:

              Warnings

              Contraindications

              Hypersensitivity to eggs, sulfites (persons with hives-only allergy to eggs, can receive the inactivated influenza vaccine)

              Cautions

              Use split or purified surface antigen in children

              Defer vaccine with febrile illnesses until illness is resolved; may administer vaccine with minor illnesses without fever (eg, URIs)

              Expected immune response may not be obtained in immunocompromised individuals, including those receiving immunosuppressive therapy

              Shoulder injury (eg, tendinopathy or shoulder bursitis) may result from administration of the vaccine that is too high on the upper arm; symptoms may include reduced shoulder motion or shoulder pain; to reduce risk of injury, inject in the central, thickest part of the deltoid muscle

              Syncope (fainting) can occur in association with administration of injectable vaccines; can be accompanied by transient neurological signs such as visual disturbance, paresthesia, and tonic-clonic limb movements; procedures should be in place to avoid falling injury and to restore cerebral perfusion following syncope by maintaining a supine or Trendelenburg position

              Oculorespiratory syndrome resulting from inactivated influenza vaccine reported; symptoms that may appear within 2 to 24 hours after administration may include cough, chest tightness, sore throat, wheezing, difficulty breathing, red eyes, or facial swelling; symptoms are self-limiting and may resolve within 48 hr of onset; cause of the syndrome has not been established

              Vaccination may not protect all vaccine recipients against influenza disease

              Previous
              Next:

              Pregnancy & Lactation

              Pregnancy

              Manufacturers are maintaining prospective pregnancy exposure registries to collect data on pregnancy outcomes following vaccination

              Animal data

              • No adverse effects observed on preweaning or vaccine-related fetal malformations when administered to female rabbits before pregnancy or during pregnancy

              Clinical considerations

              • Pregnant women are at increased risk of complication associated with influenza infection compared with nonpregnant women
              • The CDC recommends pregnant women be immunized with influenza vaccine by injection and not the live attenuated influenza vaccine (LAIV; intranasal influenza vaccine)
              • Vaccination has been shown to reduce the risk of flu-associated acute respiratory infection in pregnant women by up to 50%; immunization also confers some immunity to infants for the first several months after their birth, when they are too young to be vaccinated

              Lactation

              Unknown if distributed in human breast milk

              Consider the developmental and health benefits of breastfeeding along with the mother’s clinical need for the drug, and any potential adverse effects on the breastfed infant from the drug or from the underlying maternal condition

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

              Previous
              Next:

              Pharmacology

              Mechanism of Action

              Inactivated influenza virus types A & B subunits

              Convey active immunity via stimulation of production of endogenously produced antibodies

              Pharmacokinetics

              Onset: ~2 weeks

              Duration: Several months

              Effectiveness: Varies seasonally, depending on viral strain and mutations; lower antibody response in patients aged >65 yr or immunosuppressed individuals

              Previous
              Next:

              Administration

              Instructions

              Administer at beginning of influenza season

              Should not be mixed with any other vaccine in the same syringe or vial

              Shake well before administration

              Adults and children >8 years

              • IM: Administer IM in deltoid muscle of upper arm
              • ID (18-64 yr): Administer ID in deltoid region of upper arm
              • Afluria
                • For IM injection only, by either needle and syringe (age ≥6 months) or by the PharmaJet Stratis Needle-Free Injection System (aged 18 through 64 years)
                • PharmaJet Stratis is a needleless injection device that delivers an IM injection

              Children aged 6 months through 8 years

              • IM (aged 6-35 months): Administer IM in anterolateral thigh; do not inject in the gluteal area or areas where there may be a major nerve trunk
              • IM (aged 3-8 years): Administer IM in deltoid muscle of upper arm
              • If child requires 2 doses, administer at least 4 weeks apart (see number of doses)
              • Number of doses
                • 2 doses administered a minimum of 4 weeks apart are required during child’s first season of vaccination for optimal protection
                • Children who have previously received ≥2 total doses of trivalent or quadrivalent influenza vaccine at least 4 weeks apart, require only 1 dose for the current flu season
                • The 2 doses of influenza vaccine do not have to have been administered in the same season or consecutive seasons
                • From ACIP recommendations: MMWR 2018 Aug 24 / 67(3);1-20
              Previous
              Next:

              Images

              No images available for this drug.
              Previous
              Next:

              Patient Handout

              A Patient Handout is not currently available for this monograph.
              Previous
              Next:

              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
              Additional Offers
              Email to Patient

              From:

              To:

              The recipient will receive more details and instructions to access this offer.

              By clicking send, you acknowledge that you have permission to email the recipient with this information.

              Email Forms to Patient

              From:

              To:

              The recipient will receive more details and instructions to access this offer.

              By clicking send, you acknowledge that you have permission to email the recipient with this information.

              Previous
              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.