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Products found: 88

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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
01914006	AMANTADINE HCL	Symmetrel (Not a Benefit) 100mg Cap	BQU	N/A	N/A	YES	NO	YES
01913999	AMANTADINE HCL	Symmetrel (Not a Benefit) 10mg/mL O/L	BQU	N/A	N/A	YES	NO	YES
02397714	APIXABAN	Eliquis 5mg Tab	BQU	1.6336	0.4084	YES	NO	NO
02377233	APIXABAN	Eliquis 2.5mg Tab	BQU	1.6336	0.4084	YES	NO	NO
02248610	ATAZANAVIR SULFATE	Reyataz 150mg Cap	BQU	11.6950	2.8386	YES	NO	NO
02294176	ATAZANAVIR SULFATE	Reyataz (Off-Formulary Interchangeable) 300mg Cap	BQU	N/A	N/A	YES	NO	NO
02248611	ATAZANAVIR SULFATE	Reyataz 200mg Cap	BQU	11.7633	2.8552	YES	NO	NO
00603821	BUSPIRONE HYDROCHLORIDE	Buspar (Not a Benefit) 10mg Tab	BQU	N/A	N/A	YES	NO	NO
02113031	BUTORPHANOL TARTRATE	Stadol NS (Off-Formulary Interchangeable) 10mg/mL Nas Sp-2.5mL Pk	BQU	N/A	N/A	YES	NO	NO
00546305	CAPTOPRIL	Capoten (Not a Benefit) 100mg Tab	BQU	N/A	N/A	YES	NO	NO
00546291	CAPTOPRIL	Capoten (Not a Benefit) 50mg Tab	BQU	N/A	N/A	YES	NO	NO
00695661	CAPTOPRIL	Capoten (Not a Benefit) 12.5mg Tab	BQU	N/A	N/A	YES	NO	NO
00546283	CAPTOPRIL	Capoten (Not a Benefit) 25mg Tab	BQU	N/A	N/A	YES	NO	NO
00507245	CEFADROXIL	Duricef (Not a Benefit) 500mg Cap	BQU	N/A	N/A	YES	NO	NO
02163640	CEFEPIME	Maxipime (Off-Formulary Interchangeable) 2g Inj Pd-Vial Pk	BQU	N/A	N/A	YES	NO	NO
02163632	CEFEPIME	Maxipime (Off-Formulary Interchangeable) 1g Inj Pd-Vial Pk	BQU	N/A	N/A	YES	NO	NO
09857358	CEFPROZIL	Cefzil (Not a Benefit) 125mg/5mL Oral Susp-100mL Pk	BQU	N/A	N/A	YES	NO	NO
09857359	CEFPROZIL	Cefzil (Not a Benefit) 250mg/5mL Oral Susp-100mL Pk	BQU	N/A	N/A	YES	NO	NO
02163675	CEFPROZIL	Cefzil (Not a Benefit) 125mg/5mL Oral Susp-75mL Pk	BQU	N/A	N/A	YES	NO	NO
02163683	CEFPROZIL	Cefzil (Not a Benefit) 250mg/5mL Oral Susp-75mL Pk	BQU	N/A	N/A	YES	NO	NO
02163667	CEFPROZIL	Cefzil (Not a Benefit) 500mg Tab	BQU	N/A	N/A	YES	NO	NO
02163659	CEFPROZIL	Cefzil (Not a Benefit) 250mg Tab	BQU	N/A	N/A	YES	NO	NO
01918486	CHOLESTYRAMINE RESIN	Questran Light 4g Pk (Not a Benefit) Oral Pd-Pouch Pk	BQU	N/A	N/A	YES	NO	NO
00029165	CYANOCOBALAMIN	Rubramin (Not a Benefit) 1mg/mL Inj Sol-10mL Pk	BQU	N/A	N/A	YES	NO	NO
00344885	CYCLOPHOSPHAMIDE	Cytoxan (Not a Benefit) 50mg Tab	BQU	N/A	N/A	YES	NO	NO
02320193	DASATINIB	Sprycel (Off-Formulary Interchangeable) 100mg Tab	BQU	155.6083	132.2671	YES	NO	NO
02360810	DASATINIB	Sprycel (Off-Formulary Interchangeable) 80mg Tab	BQU	N/A	N/A	YES	NO	NO
02360829	DASATINIB	Sprycel (Off-Formulary Interchangeable) 140mg Tab	BQU	N/A	N/A	YES	NO	NO
02293137	DASATINIB	Sprycel (Off-Formulary Interchangeable) 50mg Tab	BQU	77.8567	66.1783	YES	NO	NO
02293129	DASATINIB	Sprycel (Off-Formulary Interchangeable) 20mg Tab	BQU	38.6850	32.8823	YES	NO	NO
02293145	DASATINIB	Sprycel (Off-Formulary Interchangeable) 70mg Tab	BQU	85.8042	72.9337	YES	NO	NO
02246045	EFAVIRENZ	Sustiva (Not a Benefit) 600mg Tab	BQU	N/A	N/A	YES	NO	NO
02300699	EFAVIRENZ/TENOFOVIR DISOPROXIL FUMARATE/EMTRICITABINE	Atripla 600mg/300mg/200mg Tab	BQU	45.3200	11.3300	YES	NO	NO
02282224	ENTECAVIR	Baraclude 0.5mg Tab	BQU	22.6600	4.4000	YES	YES	NO
00029408	FLUPHENAZINE HCL	Moditen HCL (Not a Benefit) 5mg Tab	BQU	N/A	N/A	YES	NO	NO
00029378	FLUPHENAZINE HCL	Moditen HCL (Not a Benefit) 1mg Tab	BQU	N/A	N/A	YES	NO	NO
00029386	FLUPHENAZINE HCL	Moditen HCL (Not a Benefit) 2mg Tab	BQU	N/A	N/A	YES	NO	NO
01907115	FOSINOPRIL SODIUM	Monopril (Not a Benefit) 20mg Tab	BQU	N/A	N/A	YES	NO	NO
01907107	FOSINOPRIL SODIUM	Monopril (Not a Benefit) 10mg Tab	BQU	N/A	N/A	YES	NO	NO
01916580	HYDROCODONE BITARTRATE	Hycodan (Not a Benefit) 1mg/mL O/L	BQU	N/A	N/A	YES	NO	NO
01910124	HYDROCORTISONE VALERATE	Westcort (Not a Benefit) 0.2% Cr	BQU	N/A	N/A	YES	NO	NO
01910132	HYDROCORTISONE VALERATE	Westcort (Not a Benefit) 0.2% Oint	BQU	N/A	N/A	YES	NO	NO
00465283	HYDROXYUREA	Hydrea 500mg Cap	BQU	1.1727	1.0203	YES	NO	NO
02459418	LENALIDOMIDE	Revlimid 2.5mg Cap	BQU	329.5000	82.3750	YES	YES	NO
02317699	LENALIDOMIDE	Revlimid 15mg Cap	BQU	382.0000	95.5000	YES	YES	NO
02440601	LENALIDOMIDE	Revlimid 20mg Cap	BQU	403.0000	100.7500	YES	YES	NO
02304902	LENALIDOMIDE	Revlimid 10mg Cap	BQU	361.0000	90.2500	YES	YES	NO
02304899	LENALIDOMIDE	Revlimid 5mg Cap	BQU	340.0000	85.0000	YES	YES	NO
02317710	LENALIDOMIDE	Revlimid 25mg Cap	BQU	424.0000	106.0000	YES	YES	NO
00360414	LOMUSTINE (CCNU)	CeeNU 100mg Cap	BQU	22.4550	22.4550	NO	NO	NO
00360422	LOMUSTINE (CCNU)	CeeNU 40mg Cap	BQU	13.6025	13.6025	NO	NO	NO
00360430	LOMUSTINE (CCNU)	CeeNU 10mg Cap	BQU	7.8900	7.8900	NO	NO	NO
00731323	MEGESTROL ACETATE	Megace (Not a Benefit) 160mg Tab	BQU	N/A	N/A	YES	NO	NO
00386391	MEGESTROL ACETATE	Megace (Not a Benefit) 40mg Tab	BQU	N/A	N/A	YES	NO	NO
00607126	NADOLOL	Corgard (Not a Benefit) 40mg Tab	BQU	N/A	N/A	YES	NO	NO
00463256	NADOLOL	Corgard (Not a Benefit) 80mg Tab	BQU	N/A	N/A	YES	NO	NO
00523372	NADOLOL	Corgard (Not a Benefit) 160mg Tab	BQU	N/A	N/A	YES	NO	NO
00029092	NYSTATIN	Mycostatin (Not a Benefit) 100000U/g Cr	BQU	N/A	N/A	YES	NO	YES
00248169	NYSTATIN	Mycostatin (Not a Benefit) 100000U/mL O/L	BQU	N/A	N/A	YES	NO	NO
00029556	NYSTATIN	Mycostatin (Not a Benefit) 100000U/g Oint	BQU	N/A	N/A	YES	NO	YES
00295973	NYSTATIN	Mycostatin (Not a Benefit) 25000U/g Vag Cr	BQU	N/A	N/A	YES	NO	YES
01916548	OXYCODONE HCL & ACETAMINOPHEN	Endocet 5mg & 325mg Tab	BQU	0.1285	0.1285	YES	NO	YES
01916475	OXYCODONE HCL & ACETAMINOPHEN	Percocet (Not a Benefit) 5mg & 325mg Tab	BQU	N/A	N/A	YES	NO	YES
01916572	OXYCODONE HCL & ACETYLSALICYLIC ACID	Percodan (Not a Benefit) 5mg & 325mg Tab	BQU	N/A	N/A	YES	NO	YES
02419580	POMALIDOMIDE	Pomalyst (Off-Formulary Interchangeable) 1mg Cap	BQU	500.0000	425.0000	YES	NO	NO
02419599	POMALIDOMIDE	Pomalyst (Off-Formulary Interchangeable) 2mg Cap	BQU	500.0000	425.0000	YES	NO	NO
02419602	POMALIDOMIDE	Pomalyst (Off-Formulary Interchangeable) 3mg Cap	BQU	500.0000	425.0000	YES	NO	NO
02419610	POMALIDOMIDE	Pomalyst (Off-Formulary Interchangeable) 4mg Cap	BQU	500.0000	425.0000	YES	NO	NO
02222051	PRAVASTATIN SODIUM	Pravachol (Not a Benefit) 40mg Tab	BQU	N/A	N/A	YES	NO	NO
00893749	PRAVASTATIN SODIUM	Pravachol (Not a Benefit) 10mg Tab	BQU	N/A	N/A	YES	NO	NO
00893757	PRAVASTATIN SODIUM	Pravachol (Not a Benefit) 20mg Tab	BQU	N/A	N/A	YES	NO	NO
00897272	SOTALOL HCL	Sotacor (Not a Benefit) 80mg Tab	BQU	N/A	N/A	YES	NO	NO
00483923	SOTALOL HCL	Sotacor (Not a Benefit) 160mg Tab	BQU	N/A	N/A	YES	NO	NO
00579351	TRAZODONE HYDROCHLORIDE	Desyrel (Not a Benefit) 50mg Tab	BQU	N/A	N/A	YES	NO	NO
00579378	TRAZODONE HYDROCHLORIDE	Desyrel (Not a Benefit) 100mg Tab	BQU	N/A	N/A	YES	NO	NO
00702277	TRAZODONE HYDROCHLORIDE	Desyrel Dividose (Not a Benefit) 150mg Tab	BQU	N/A	N/A	YES	NO	NO
00990876	TRIAMCINOLONE ACETONIDE	Kenalog-40 40mg/mL Inj Susp-1mL Pk	BQU	8.9610	8.9610	NO	NO	NO
01999761	TRIAMCINOLONE ACETONIDE	Kenalog-10 50mg/5mL Inj Susp-5mL Pk	BQU	19.4500	19.4500	NO	NO	NO
01999869	TRIAMCINOLONE ACETONIDE	Kenalog-40 200mg/5mL Inj Susp-5mL Pk	BQU	31.6500	31.6500	NO	NO	NO
01999788	TRIAMCINOLONE ACETONIDE 0.1% IN ORABASE	Kenalog-Orabase (Not a Benefit) Oral Top Oint	BQU	N/A	N/A	YES	NO	NO
02007959	WARFARIN	Coumadin (Not a Benefit) 4mg Tab	BQU	N/A	N/A	YES	NO	YES
02240205	WARFARIN	Coumadin (Not a Benefit) 3mg Tab	BQU	N/A	N/A	YES	NO	YES
01918362	WARFARIN	Coumadin (Not a Benefit) 10mg Tab	BQU	N/A	N/A	YES	NO	YES
01918338	WARFARIN	Coumadin (Not a Benefit) 2mg Tab	BQU	N/A	N/A	YES	NO	YES
01918311	WARFARIN	Coumadin (Not a Benefit) 1mg Tab	BQU	N/A	N/A	YES	NO	YES
01918354	WARFARIN	Coumadin (Not a Benefit) 5mg Tab	BQU	N/A	N/A	YES	NO	YES
02240206	WARFARIN	Coumadin (Not a Benefit) 6mg Tab	BQU	N/A	N/A	YES	NO	YES
01918346	WARFARIN	Coumadin (Not a Benefit) 2.5mg Tab	BQU	N/A	N/A	YES	NO	YES

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