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Products found: 81New Search
DIN/ PIN/ NPNGeneric NameBrand Name, Strength & Dosage FormMFRDrug Benefit Price or Unit PriceAmount MOH PaysInter- change- ableLimited UseThera- peutic Notes
01911635ACYCLOVIRZovirax 800mg TabGSK5.06921.2673YESNONO
01911627ACYCLOVIRZovirax (Not a Benefit) 400mg TabGSKN/AN/AYESNONO
00634506ACYCLOVIRZovirax (Not a Benefit) 200mg TabGSKN/AN/AYESNONO
02337630ALITRETINOINToctino (Not a Benefit) 10mg CapGSKN/AN/AYESNOYES
02337649ALITRETINOINToctino (Not a Benefit) 30mg CapGSKN/AN/AYESNOYES
02307065AMBRISENTANVolibris (Off-Formulary Interchangeable) 5mg TabGSK133.9247106.3288YESNONO
02307073AMBRISENTANVolibris (Off-Formulary Interchangeable) 10mg TabGSK133.9247106.3288YESNONO
01916874AMOXICILLIN & CLAVULANIC ACIDClavulin 50mg & 12.5mg/mL O/LGSK0.25540.1824YESNOYES
01916882AMOXICILLIN & CLAVULANIC ACIDClavulin 25mg & 6.25mg/mL O/LGSK0.11730.1173NONOYES
02238831AMOXICILLIN & CLAVULANIC ACIDClavulin (BID) 200mg & 28.5mg/5mL SuspGSK0.18310.1831NONOYES
02238830AMOXICILLIN & CLAVULANIC ACIDClavulin (BID) 400mg & 57mg/5mL SuspGSK0.35710.2386YESNOYES
01916858AMOXICILLIN & CLAVULANIC ACIDClavulin 500mg & 125mg TabGSK1.88750.3778YESNOYES
01916866AMOXICILLIN & CLAVULANIC ACIDClavulin (Not a Benefit) 250mg & 125mg TabGSKN/AN/AYESNOYES
02238829AMOXICILLIN & CLAVULANIC ACIDClavulin (BID) 875mg & 125mg TabGSK2.75150.5551YESNOYES
02217422ATOVAQUONEMepron 750mg/5mL O/LGSK3.55962.3785YESNONO
02238151ATOVAQUONE & PROGUANIL HCLMalarone (Off-Formulary Interchangeable) 250mg & 100mg TabGSK6.20084.1308YESNONO
02229650CARVEDILOLCoreg (Not a Benefit) 3.125mg TabGSKN/AN/AYESNONO
02229651CARVEDILOLCoreg (Not a Benefit) 6.25mg TabGSKN/AN/AYESNONO
02229652CARVEDILOLCoreg (Not a Benefit) 12.5mg TabGSKN/AN/AYESNONO
02229653CARVEDILOLCoreg (Not a Benefit) 25mg TabGSKN/AN/AYESNONO
02212285CEFUROXIME AXETILCeftin (Not a Benefit) 500mg TabGSKN/AN/AYESNONO
02212277CEFUROXIME AXETILCeftin (Not a Benefit) 250mg TabGSKN/AN/AYESNONO
02214415CLOBETASONE BUTYRATEEumovate 0.05% CrGSK0.38170.3817NONONO
02247813DUTASTERIDEAvodart 0.5mg CapGSK2.10700.2565YESYESNO
02361825ELTROMBOPAG OLAMINERevolade (Off-Formulary Interchangeable) 25mg TabGSK65.000055.2500YESNONO
02361833ELTROMBOPAG OLAMINERevolade (Off-Formulary Interchangeable) 50mg TabGSK130.0000110.5000YESNONO
01923420FERROUS FUMARATEPalafer (Not a Benefit) 300mg CapGSKN/AN/AYESNONO
01923439FERROUS FUMARATEPalafer 60mg/mL O/LGSK0.09810.0981NONONO
02446561FLUTICASONE FUROATEArnuity Ellipta 100mcg Blister Pd Inh-30 Dose PkGSK48.020048.0200NONONO
02446588FLUTICASONE FUROATEArnuity Ellipta 200mcg Blister Pd Inh-30 Dose PkGSK96.020096.0200NONONO
02474522FLUTICASONE FUROATE & UMECLIDINIUM BROMIDE & VILANTEROL TRIFENATATETrelegy Ellipta 100mcg & 62.5mcg & 25mcg Pd Inh-30 Dose PkGSK137.6700137.6700NOYESYES
02444186FLUTICASONE FUROATE & VILANTEROLBreo Ellipta 200mcg & 25mcg Blister Pd Inh-30 Dose PkGSK162.4700162.4700NOYESNO
02408872FLUTICASONE FUROATE & VILANTEROLBreo Ellipta 100mcg & 25mcg Blister Pd Inh-30 Dose PkGSK104.4400104.4400NOYESNO
02244293FLUTICASONE PROPIONATEFlovent HFA 250mcg/Metered Dose Inh-120 Dose PkGSK110.040045.0200YESNONO
02244292FLUTICASONE PROPIONATEFlovent HFA 125mcg/Metered Dose Inh-120 Dose PkGSK55.020023.4100YESNONO
02244291FLUTICASONE PROPIONATEFlovent HFA 50mcg/Metered Dose Inh-120 Dose PkGSK31.900021.3150YESNONO
02213672FLUTICASONE PROPIONATEFlonase (Off-Formulary Interchangeable) 50mcg/Actuation Nas Sp-120 Dose PkGSKN/AN/AYESNOYES
02237247FLUTICASONE PROPIONATEFlovent Diskus 500mcg/Blister Pd Inh-60 Dose PkGSK85.590085.5900NONONO
02237246FLUTICASONE PROPIONATEFlovent Diskus 250mcg/Blister Pd Inh-60 Dose PkGSK55.020055.0200NONONO
02239193LAMIVUDINEHeptovir 100mg TabGSK5.47652.6154YESYESNO
02142082LAMOTRIGINELamictal 25mg TabGSK0.51060.0698YESNONO
02142104LAMOTRIGINELamictal 100mg TabGSK2.03970.2787YESNONO
02142112LAMOTRIGINELamictal 150mg TabGSK3.00600.4107YESNONO
02083531NABUMETONERelafen (Off-Formulary Interchangeable) 500mg TabGSKN/AN/AYESNOYES
02237820NARATRIPTAN HYDROCHLORIDEAmerge (Off-Formulary Interchangeable) 1mg TabGSKN/AN/AYESNONO
02237821NARATRIPTAN HYDROCHLORIDEAmerge (Off-Formulary Interchangeable) 2.5mg TabGSKN/AN/AYESNONO
01940473PAROXETINE HCLPaxil 30mg TabGSK2.51200.3453YESNONO
01940481PAROXETINE HCLPaxil 20mg TabGSK2.36490.3250YESNONO
02352303PAZOPANIBVotrient (Off-Formulary Interchangeable) 200mg TabGSK40.504630.9655YESNONO
02212374RANITIDINE HCLZantac (Not a Benefit) 15mg/mL Oral SolGSKN/AN/AYESNONO
02212358RANITIDINE HCLZantac (Not a Benefit) 300mg TabGSKN/AN/AYESNONO
02212331RANITIDINE HCLZantac (Not a Benefit) 150mg TabGSKN/AN/AYESNONO
02232568ROPINIROLEReQuip (Not a Benefit) 2mg TabGSKN/AN/AYESNONO
02232567ROPINIROLEReQuip (Not a Benefit) 1mg TabGSKN/AN/AYESNONO
02232565ROPINIROLEReQuip (Not a Benefit) 0.25mg TabGSKN/AN/AYESNONO
02232569ROPINIROLEReQuip (Not a Benefit) 5mg TabGSKN/AN/AYESNONO
02241113ROSIGLITAZONEAvandia (Off-Formulary Interchangeable) 4mg TabGSKN/AN/AYESNONO
02241114ROSIGLITAZONEAvandia (Off-Formulary Interchangeable) 8mg TabGSKN/AN/AYESNONO
02241112ROSIGLITAZONEAvandia (Off-Formulary Interchangeable) 2mg TabGSKN/AN/AYESNONO
02213427SALBUTAMOLVentolin Nebules P.F. 2mg/mL Inh Sol- 2.5mL PkGSK0.77050.6750YESYESNO
02213419SALBUTAMOLVentolin Nebules P.F. 1mg/mL Inh Sol- 2.5mL PkGSK0.65650.3617YESYESNO
02213486SALBUTAMOLVentolin 5mg/mL Inh Sol-10mL PkGSK2.94002.9400NOYESNO
02241497SALBUTAMOLVentolin HFA 100mcg/Metered Dose Inh-200 dose PkGSK6.00005.0000YESNONO
02231129SALMETEROL XINAFOATESereVent Diskus 50mcg Pd Inh-60 Dose PkGSK75.200075.2000NOYESNO
02245126SALMETEROL XINAFOATE & FLUTICASONE PROPIONATEAdvair 125 25/125mcg/Metered Dose Inh-120 Dose PkGSK128.4200128.4200NOYESNO
02245127SALMETEROL XINAFOATE & FLUTICASONE PROPIONATEAdvair 250 25/250mcg/Metered Dose Inh-120 Dose PkGSK182.3100182.3100NOYESNO
02240837SALMETEROL XINAFOATE & FLUTICASONE PROPIONATEAdvair Diskus 50/500mcg Inh-60 Dose PkGSK182.310072.0600YESYESNO
02240835SALMETEROL XINAFOATE & FLUTICASONE PROPIONATEAdvair Diskus 50/100mcg Inh-60 Dose PkGSK107.270042.4050YESYESNO
02240836SALMETEROL XINAFOATE & FLUTICASONE PROPIONATEAdvair Diskus 50/250mcg Inh-60 Dose PkGSK128.420050.7600YESYESNO
09857299SUMATRIPTAN SUCCINATEImitrex (Off-Formulary Interchangeable) 25mg TabGSKN/AN/AYESNONO
02163764SUMATRIPTAN SUCCINATEImitrex (Off-Formulary Interchangeable) 50mg TabGSKN/AN/AYESNONO
01950614SUMATRIPTAN SUCCINATEImitrex (Off-Formulary Interchangeable) 100mg TabGSKN/AN/AYESNONO
02212161SUMATRIPTAN SUCCINATEImitrex DF (Off-Formulary Interchangeable) 100mg TabGSK20.59839.9866YESNONO
02239738SUMATRIPTAN SUCCINATEImitrex DF (Off-Formulary Interchangeable) 25mg TabGSKN/AN/AYESNONO
02212153SUMATRIPTAN SUCCINATEImitrex DF (Off-Formulary Interchangeable) 50mg TabGSK18.69679.0650YESNONO
01919598TRANYLCYPROMINE SULFATEParnate 10mg TabGSK0.50790.5079NONOYES
02423596UMECLIDINIUMIncruse Ellipta 62.5mcg Blister Pd Inh-30 Dose PkGSK50.000050.0000NONONO
02418401UMECLIDINIUM & VILANTEROLAnoro Ellipta 62.5mcg & 25mcg Blister Pd Inh-30 Dose PkGSK88.510088.5100NOYESNO
02219492VALACYCLOVIRValtrex 500mg TabGSK4.31430.6198YESNONO
02246559VALACYCLOVIRValtrex (Off-Formulary Interchangeable) 1000mg TabGSKN/AN/AYESNONO
02240863ZANAMIVIRRelenza 5mg Pd Inh-5 Rotadisks PkGSK46.530046.5300NOYESNO