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Products found: 21

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DIN/ PIN/ NPN	Generic Name	Brand Name, Strength & Dosage Form	MFR	Drug Benefit Price or Unit Price	Amount MOH Pays	Inter- change- able	Limited Use	Thera- peutic Notes
02070847	ACITRETIN	Soriatane 10mg Cap	ALL	3.2773	1.2965	YES	NO	YES
02070863	ACITRETIN	Soriatane 25mg Cap	ALL	5.7557	2.2770	YES	NO	YES
02083523	BEZAFIBRATE	Bezalip 400mg SR Tab	ALL	2.9427	1.7460	YES	NO	NO
02245860	BIMATOPROST	Lumigan (Not a Benefit) 0.03% Oph Sol	ALL	N/A	N/A	YES	NO	NO
09857368	BIMATOPROST	Lumigan RC 0.01% Oph Sol-5mL Pk	ALL	60.1892	60.1892	NO	YES	NO
09857398	BIMATOPROST	Lumigan RC 0.01% Oph Sol-7.5mL Pk	ALL	90.2838	90.2838	NO	YES	NO
02236876	BRIMONIDINE	Alphagan 0.2% Oph Sol	ALL	3.7970	1.1550	YES	YES	NO
02248151	BRIMONIDINE	Alphagan P 0.15% Oph Sol	ALL	2.6017	2.0305	YES	YES	NO
09857298	BRIMONIDINE TARTRATE & TIMOLOL MALEATE	Combigan 0.2% & 0.5% Oph Sol-10mL Pk	ALL	46.5800	23.2900	YES	YES	NO
02355655	CYCLOSPORINE	Restasis (Off-Formulary Interchangeable) 0.05% w/v Oph Emuls-0.4mL Pk	ALL	N/A	N/A	YES	NO	NO
00247855	FLUOROMETHOLONE	FML 0.1% Oph Susp	ALL	3.5440	3.5440	NO	NO	YES
02257270	GATIFLOXACIN	Zymar (with preservative) (Off-Formulary Interchangeable) 0.3% w/v Oph Sol	ALL	N/A	N/A	YES	NO	NO
01968300	KETOROLAC TROMETHAMINE	Acular 0.5% Oph Sol	ALL	3.6780	2.8997	YES	NO	YES
00637661	LEVOBUNOLOL HCL	Betagan 0.5% Oph Sol	ALL	3.8153	3.8153	NO	NO	NO
00001147	NAPHAZOLINE HCL	Albalon (Not a Benefit) 0.1% Oph Sol	ALL	N/A	N/A	YES	NO	NO
02143291	OFLOXACIN	Ocuflox 0.3% Oph Sol	ALL	2.8720	2.8720	NO	YES	NO
00210889	PETROLATUM/MINERAL OIL	Lacri-Lube 55% & 42.5% Oph Oint-3.5g Pk	ALL	7.9000	7.9000	NO	YES	NO
00045616	POLYVINYL ALCOHOL	Liquifilm Tears 1.4% Oph-Sol	ALL	0.6373	0.6373	NO	YES	NO
00579408	POLYVINYL ALCOHOL & POLYVINYLPYRROLIDONE	Tears Plus Oph-Sol	ALL	0.3840	0.3840	NO	YES	NO
00301175	PREDNISOLONE ACETATE	Pred Forte (Not a Benefit) 1% Oph Susp	ALL	N/A	N/A	YES	NO	YES
02230621	SODIUM CROMOGLYCATE	Opticrom (Not a Benefit) 2% Oph Sol	ALL	N/A	N/A	YES	NO	NO

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