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Products found: 56

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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
02415682	AFATINIB	Giotrif (Off-Formulary Interchangeable) 40mg Tab	BOE	77.4784	38.7392	YES	NO	NO
02415674	AFATINIB	Giotrif (Off-Formulary Interchangeable) 30mg Tab	BOE	77.4784	38.7392	YES	NO	NO
02415666	AFATINIB	Giotrif (Off-Formulary Interchangeable) 20mg Tab	BOE	77.4784	38.7392	YES	NO	NO
00259527	CLONIDINE HCL	Catapres (Not a Benefit) 0.1mg Tab	BOE	N/A	N/A	YES	NO	YES
00291889	CLONIDINE HCL	Catapres (Not a Benefit) 0.2mg Tab	BOE	N/A	N/A	YES	NO	YES
00519251	CLONIDINE HCL	Dixarit (Off-Formulary Interchangeable) 0.025mg Tab	BOE	N/A	N/A	YES	NO	YES
02312441	DABIGATRAN ETEXILATE	Pradaxa 110mg Cap	BOE	1.7310	1.2540	YES	NO	NO
02312433	DABIGATRAN ETEXILATE	Pradaxa (Off-Formulary Interchangeable) 75mg Cap	BOE	N/A	N/A	YES	NO	NO
02358808	DABIGATRAN ETEXILATE	Pradaxa 150mg Cap	BOE	1.7310	1.2540	YES	NO	NO
00452092	DIPYRIDAMOLE	Persantine (Off-Formulary Interchangeable) 75mg Tab	BOE	N/A	N/A	YES	NO	NO
00067393	DIPYRIDAMOLE	Persantine (Off-Formulary Interchangeable) 50mg Tab	BOE	N/A	N/A	YES	NO	NO
00067385	DIPYRIDAMOLE	Persantine (Off-Formulary Interchangeable) 25mg Tab	BOE	N/A	N/A	YES	NO	NO
02242119	DIPYRIDAMOLE & ACETYLSALICYLIC ACID	Aggrenox (Not a Benefit) 200mg/25mg Cap	BOE	N/A	N/A	YES	NO	NO
02443937	EMPAGLIFLOZIN	Jardiance 10mg Tab	BOE	2.7671	2.7671	NO	NO	YES
02443945	EMPAGLIFLOZIN	Jardiance 25mg Tab	BOE	2.7671	2.7671	NO	NO	YES
02456605	EMPAGLIFLOZIN & METFORMIN	Synjardy 12.5mg & 500mg Tab	BOE	1.3932	1.3932	NO	NO	YES
02456575	EMPAGLIFLOZIN & METFORMIN	Synjardy 5mg & 500mg Tab	BOE	1.3932	1.3932	NO	NO	YES
02456583	EMPAGLIFLOZIN & METFORMIN	Synjardy 5mg & 850mg Tab	BOE	1.3932	1.3932	NO	NO	YES
02456621	EMPAGLIFLOZIN & METFORMIN	Synjardy 12.5mg & 1000mg Tab	BOE	1.3932	1.3932	NO	NO	YES
02456591	EMPAGLIFLOZIN & METFORMIN	Synjardy 5mg & 1000mg Tab	BOE	1.3932	1.3932	NO	NO	YES
02456613	EMPAGLIFLOZIN & METFORMIN	Synjardy 12.5mg & 850mg Tab	BOE	1.3932	1.3932	NO	NO	YES
00731439	IPRATROPIUM BROMIDE	Atrovent (Not a Benefit) 250mcg/mL Inh Sol-20mL Pk	BOE	N/A	N/A	YES	NO	NO
01950681	IPRATROPIUM BROMIDE	Atrovent UDV (Not a Benefit) 250mcg/mL Inh Sol-2mL UDV Pk	BOE	N/A	N/A	YES	NO	NO
02026759	IPRATROPIUM BROMIDE	Atrovent UDV (Not a Benefit) 125mcg/mL Inh Sol-2mL UDV Pk	BOE	N/A	N/A	YES	NO	NO
02247686	IPRATROPIUM BROMIDE	Atrovent HFA 20mcg/Metered Dose Inh-200 Dose Pk	BOE	20.4600	11.2530	YES	NO	NO
02163705	IPRATROPIUM BROMIDE	Atrovent (Not a Benefit) 0.03% Nasal Spray	BOE	N/A	N/A	YES	NO	NO
02163713	IPRATROPIUM BROMIDE	Atrovent (Off-Formulary Interchangeable) 0.06% Nasal Spray	BOE	N/A	N/A	YES	NO	NO
02231675	IPRATROPIUM BROMIDE/SALBUTAMOL	Combivent UDV (Not a Benefit) 500mcg/2.5mg/2.5mL Inh Sol-2.5mL Amp Pk	BOE	N/A	N/A	YES	NO	NO
02370921	LINAGLIPTIN	Trajenta 5mg Tab	BOE	2.6954	2.6954	NO	NO	YES
02403277	LINAGLIPTIN & METFORMIN	Jentadueto 2.5mg & 1000mg Tab	BOE	1.4132	1.4132	NO	NO	YES
02403269	LINAGLIPTIN & METFORMIN	Jentadueto 2.5mg & 850mg Tab	BOE	1.4132	1.4132	NO	NO	YES
02403250	LINAGLIPTIN & METFORMIN	Jentadueto 2.5mg & 500mg Tab	BOE	1.4132	1.4132	NO	NO	YES
02242786	MELOXICAM	Mobicox (Not a Benefit) 15mg Tab	BOE	N/A	N/A	YES	NO	YES
02242785	MELOXICAM	Mobicox (Not a Benefit) 7.5mg Tab	BOE	N/A	N/A	YES	NO	YES
00599956	MEXILETINE HCL	Mexitil (Not a Benefit) 100mg Cap	BOE	N/A	N/A	YES	NO	NO
00599964	MEXILETINE HCL	Mexitil (Not a Benefit) 200mg Cap	BOE	N/A	N/A	YES	NO	NO
02367289	NEVIRAPINE	Viramune XR (Not a Benefit) 400mg ER Tab	BOE	N/A	N/A	YES	NO	NO
02238748	NEVIRAPINE	Viramune (Not a Benefit) 200mg Tab	BOE	N/A	N/A	YES	NO	NO
00249920	ORCIPRENALINE SULFATE	Alupent (Not a Benefit) 2mg/mL O/L	BOE	N/A	N/A	YES	NO	NO
09857269	PRAMIPEXOLE DIHYDROCHLORIDE MONOHYDRATE	Mirapex (Not a Benefit) 1mg Tab	BOE	N/A	N/A	YES	NO	NO
09857270	PRAMIPEXOLE DIHYDROCHLORIDE MONOHYDRATE	Mirapex (Not a Benefit) 1.5mg Tab	BOE	N/A	N/A	YES	NO	NO
02241594	PRAMIPEXOLE DIHYDROCHLORIDE MONOHYDRATE	Mirapex (Off-Formulary Interchangeable) 0.5mg Tab	BOE	N/A	N/A	YES	NO	NO
02237145	PRAMIPEXOLE DIHYDROCHLORIDE MONOHYDRATE	Mirapex 0.25mg Tab	BOE	1.2915	0.1950	YES	NO	NO
02270102	TAMSULOSIN HCL	Flomax CR Tab 0.4mg	BOE	0.6700	0.1500	YES	NO	YES
02238123	TAMSULOSIN HCL	Flomax (Not a Benefit) 0.4mg ER Cap	BOE	N/A	N/A	YES	NO	YES
02240769	TELMISARTAN	Micardis 40mg Tab	BOE	1.3897	0.2161	YES	NO	NO
02240770	TELMISARTAN	Micardis 80mg Tab	BOE	1.3897	0.2161	YES	NO	NO
02371057	TELMISARTAN & AMLODIPINE BESYLATE	Twynsta 80mg & 10mg Tab	BOE	0.8128	0.8128	NO	NO	NO
02371022	TELMISARTAN & AMLODIPINE BESYLATE	Twynsta 40mg & 5mg Tab	BOE	0.8128	0.8128	NO	NO	NO
02371049	TELMISARTAN & AMLODIPINE BESYLATE	Twynsta 80mg & 5mg Tab	BOE	0.8128	0.8128	NO	NO	NO
02371030	TELMISARTAN & AMLODIPINE BESYLATE	Twynsta 40mg & 10mg Tab	BOE	0.8128	0.8128	NO	NO	NO
02318709	TELMISARTAN & HYDROCHLOROTHIAZIDE	Micardis Plus 80mg & 25mg Tab	BOE	1.3897	0.2098	YES	NO	NO
02244344	TELMISARTAN & HYDROCHLOROTHIAZIDE	Micardis Plus 80mg & 12.5mg Tab	BOE	1.3897	0.2098	YES	NO	NO
02246793	TIOTROPIUM BROMIDE MONOHYDRATE	Spiriva 18mcg Inh Cap	BOE	0.9143	0.9143	YES	NO	YES
02435381	TIOTROPIUM BROMIDE MONOHYDRATE	Spiriva Respimat 2.5mcg/Actuation Inh Sol-60 Actuation Pk	BOE	54.8580	54.8580	NO	NO	YES
02441888	TIOTROPIUM BROMIDE MONOHYDRATE & OLODATEROL HYDROCHLORIDE	Inspiolto Respimat 2.5mcg & 2.5mcg/Actuation Inh Sol-60 Actuation Pk	BOE	64.3740	64.3740	NO	YES	YES

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