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PAB Fax Forms for Specific Conditions/Medications
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4Rx Limit
5-Alpha-Reductase Inhibitors - Age Edit
ADHD/Narcolepsy
Antifungal Oral Therapy
Angiotensin Receptor Blockers
Byetta® (exenatide)
Ciprodex® (ciprofloxacin/dexamethasone)
Cosmetic Medications (Anti-Aging)
Differin® (adapalene)
Diovan®
Dovonex® (calcipotriene)
Elidel® (pimecrolimus) and Protopic® (tacrolimus)
Emcyt® (estramustine phosphate sodium)
Enbrel® (etanercept)
Epogen® and Procrit® (epoetin alfa)
Gleevec® (Imatinib)
Gonadotropin Releasing Hormone Analogs
Hepatitis B Agents
Human Growth Hormone (HGH)
Isotretinoin Agents
Leukotriene Modifiers
Mental Health Dose Optimization
Mental Health Duplicate Therapy
Non-Pegylated Interferons
Promethazine Products
Proton Pump Inhibitors Duplicate Therapy
Proton Pump Inhibitors General
Ribavirin Oral
Singulair
Stadol NS (Butorphanol Tartrate Nasal Spray)
Targretin® (bexarotene)
Topamax® (topiramate)
Topical Androgens
Zavesca® (miglustate)
Zetia (ezetimibe)