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Products found: 54New Search
DIN/ PIN/ NPNGeneric NameBrand Name, Strength & Dosage FormMFRDrug Benefit Price or Unit PriceAmount MOH PaysInter- change- ableLimited UseThera- peutic Notes
00259527CLONIDINE HCLCatapres (Not a Benefit) 0.1mg TabBOEN/AN/AYESNOYES
00291889CLONIDINE HCLCatapres (Not a Benefit) 0.2mg TabBOEN/AN/AYESNOYES
00519251CLONIDINE HCLDixarit (Off-Formulary Interchangeable) 0.025mg TabBOEN/AN/AYESNOYES
02358808DABIGATRAN ETEXILATEPradaxa 150mg CapBOE1.73101.2540YESYESNO
02312441DABIGATRAN ETEXILATEPradaxa 110mg CapBOE1.73101.2540YESYESNO
02312433DABIGATRAN ETEXILATEPradaxa (Off-Formulary Interchangeable) 75mg CapBOEN/AN/AYESNONO
00067385DIPYRIDAMOLEPersantine (Off-Formulary Interchangeable) 25mg TabBOEN/AN/AYESNONO
00452092DIPYRIDAMOLEPersantine (Off-Formulary Interchangeable) 75mg TabBOEN/AN/AYESNONO
00067393DIPYRIDAMOLEPersantine (Off-Formulary Interchangeable) 50mg TabBOEN/AN/AYESNONO
02242119DIPYRIDAMOLE & ACETYLSALICYLIC ACIDAggrenox (Not a Benefit) 200mg/25mg CapBOEN/AN/AYESNONO
02443945EMPAGLIFLOZINJardiance 25mg TabBOE2.76712.7671NONOYES
02443937EMPAGLIFLOZINJardiance 10mg TabBOE2.76712.7671NONOYES
02456613EMPAGLIFLOZIN & METFORMINSynjardy 12.5mg & 850mg TabBOE1.39321.3932NONOYES
02456621EMPAGLIFLOZIN & METFORMINSynjardy 12.5mg & 1000mg TabBOE1.39321.3932NONOYES
02456583EMPAGLIFLOZIN & METFORMINSynjardy 5mg & 850mg TabBOE1.39321.3932NONOYES
02456605EMPAGLIFLOZIN & METFORMINSynjardy 12.5mg & 500mg TabBOE1.39321.3932NONOYES
02456575EMPAGLIFLOZIN & METFORMINSynjardy 5mg & 500mg TabBOE1.39321.3932NONOYES
02456591EMPAGLIFLOZIN & METFORMINSynjardy 5mg & 1000mg TabBOE1.39321.3932NONOYES
00731439IPRATROPIUM BROMIDEAtrovent (Not a Benefit) 250mcg/mL Inh Sol-20mL PkBOEN/AN/AYESNONO
02026759IPRATROPIUM BROMIDEAtrovent UDV (Not a Benefit) 125mcg/mL Inh Sol-2mL UDV PkBOEN/AN/AYESNONO
01950681IPRATROPIUM BROMIDEAtrovent UDV (Not a Benefit) 250mcg/mL Inh Sol-2mL UDV PkBOEN/AN/AYESNONO
02247686IPRATROPIUM BROMIDEAtrovent HFA 20mcg/Metered Dose Inh-200 Dose PkBOE20.460020.4600NONONO
02163705IPRATROPIUM BROMIDEAtrovent (Not a Benefit) 0.03% Nasal SprayBOEN/AN/AYESNONO
02163713IPRATROPIUM BROMIDEAtrovent (Off-Formulary Interchangeable) 0.06% Nasal SprayBOEN/AN/AYESNONO
02231675IPRATROPIUM BROMIDE/SALBUTAMOLCombivent UDV (Not a Benefit) 500mcg/2.5mg/2.5mL Inh Sol-2.5mL Amp PkBOEN/AN/AYESNONO
02370921LINAGLIPTINTrajenta 5mg TabBOE2.69542.6954NONOYES
02403269LINAGLIPTIN & METFORMINJentadueto 2.5mg & 850mg TabBOE1.41321.4132NONOYES
02403250LINAGLIPTIN & METFORMINJentadueto 2.5mg & 500mg TabBOE1.41321.4132NONOYES
02403277LINAGLIPTIN & METFORMINJentadueto 2.5mg & 1000mg TabBOE1.41321.4132NONOYES
02242785MELOXICAMMobicox 7.5mg TabBOE0.85720.2003YESNOYES
02242786MELOXICAMMobicox 15mg TabBOE0.98910.2311YESNOYES
00599956MEXILETINE HCLMexitil (Not a Benefit) 100mg CapBOEN/AN/AYESNONO
00599964MEXILETINE HCLMexitil (Not a Benefit) 200mg CapBOEN/AN/AYESNONO
02367289NEVIRAPINEViramune XR 400mg ER TabBOE2.64201.8519YESNOYES
02238748NEVIRAPINEViramune (Not a Benefit) 200mg TabBOEN/AN/AYESNOYES
00249920ORCIPRENALINE SULFATEAlupent (Not a Benefit) 2mg/mL O/LBOEN/AN/AYESNONO
09857268PRAMIPEXOLE DIHYDROCHLORIDE MONOHYDRATEMirapex 0.25mg TabBOE1.17220.1950YESNOYES
02241594PRAMIPEXOLE DIHYDROCHLORIDE MONOHYDRATEMirapex (Off-Formulary Interchangeable) 0.5mg TabBOEN/AN/AYESNONO
09857269PRAMIPEXOLE DIHYDROCHLORIDE MONOHYDRATEMirapex (Not a Benefit) 1mg TabBOEN/AN/AYESNOYES
02237145PRAMIPEXOLE DIHYDROCHLORIDE MONOHYDRATEMirapex 0.25mg TabBOE1.17221.1722NONOYES
09857270PRAMIPEXOLE DIHYDROCHLORIDE MONOHYDRATEMirapex (Not a Benefit) 1.5mg TabBOEN/AN/AYESNOYES
02270102TAMSULOSIN HCLFlomax CR Tab 0.4mgBOE0.67000.1500YESNOYES
02238123TAMSULOSIN HCLFlomax (Not a Benefit) 0.4mg CapBOEN/AN/AYESNOYES
02240769TELMISARTANMicardis 40mg TabBOE1.26120.2161YESNONO
02240770TELMISARTANMicardis 80mg TabBOE1.26120.2161YESNONO
02371057TELMISARTAN & AMLODIPINE BESYLATETwynsta 80mg & 10mg TabBOE0.73760.5472YESNONO
02371049TELMISARTAN & AMLODIPINE BESYLATETwynsta 80mg & 5mg TabBOE0.73760.5472YESNONO
02371030TELMISARTAN & AMLODIPINE BESYLATETwynsta 40mg & 10mg TabBOE0.73760.7376NONONO
02371022TELMISARTAN & AMLODIPINE BESYLATETwynsta 40mg & 5mg TabBOE0.73760.7376NONONO
02244344TELMISARTAN & HYDROCHLOROTHIAZIDEMicardis Plus 80mg & 12.5mg TabBOE1.26120.2098YESNONO
02318709TELMISARTAN & HYDROCHLOROTHIAZIDEMicardis Plus 80mg & 25mg TabBOE1.26120.2098YESNONO
02246793TIOTROPIUM BROMIDE MONOHYDRATESpiriva 18mcg Inh CapBOE1.82861.8286NONOYES
02435381TIOTROPIUM BROMIDE MONOHYDRATESpiriva Respimat 2.5mcg/Actuation Inh Sol-60 Actuation PkBOE54.858054.8580NONOYES
02441888TIOTROPIUM BROMIDE MONOHYDRATE & OLODATEROL HYDROCHLORIDEInspiolto Respimat 2.5mcg & 2.5mcg/Actuation Inh Sol-60 Actuation PkBOE64.374064.3740NOYESYES