Interchangeable Grouping
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12:00 AUTONOMIC AGENTS
12:08:08 PARASYMPATHOLYTIC (CHOLINERGIC BLOCKING) AGENTS ANTIMUSCARINICS/ANTISPASMODICS
LU Criteria Text
GLYCOPYRROLATE
0.2mg/mL Inj Sol
Interchangeables found: 5
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DIN/ PIN/ NPN
Brand Name
Drug Benefit Price or Unit Price
Amount MOH Pays:
02382857
Glycopyrrolate Injection
2.7825
2.7825
02532379
Glycopyrrolate Injection USP
2.7825
2.7825
02473879
Glycopyrrolate Injection USP
2.7825
2.7825
02043610
Robinul
(Not a Benefit)
N/A
N/A
02039508
Sandoz Glycopyrrolate
2.7825
2.7825
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