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Products found: 59New Search
DIN/ PIN/ NPNGeneric NameBrand Name, Strength & Dosage FormMFRDrug Benefit Price or Unit PriceAmount MOH PaysInter- change- ableLimited UseThera- peutic Notes
00518123BROMAZEPAMLectopam (Not a Benefit) 3mg TabHLRN/AN/AYESNONO
00682314BROMAZEPAMLectopam (Not a Benefit) 1.5mg TabHLRN/AN/AYESNONO
00518131BROMAZEPAMLectopam (Not a Benefit) 6mg TabHLRN/AN/AYESNONO
00481815CALCITRIOLRocaltrol 0.5mcg CapHLR1.12460.3723YESNONO
00481823CALCITRIOLRocaltrol 0.25mcg CapHLR0.70710.2341YESNONO
02238454CAPECITABINEXeloda 500mg TabHLR6.49331.5250YESNONO
02238453CAPECITABINEXeloda 150mg TabHLR1.94780.4575YESNONO
00657387CEFTRIAXONE DISODIUMRocephin (Not a Benefit) 0.25g/Vial Inj Pd-1 Vial PkHLRN/AN/AYESNONO
00657417CEFTRIAXONE DISODIUMRocephin (Not a Benefit) 1g/Vial Inj Pd-1 Vial PkHLRN/AN/AYESNONO
00851957CEFTRIAXONE DISODIUMRocephin (Off-Formulary Interchangeable) 10g/Vial Inj Pd-1 Vial PkHLRN/AN/AYESNONO
00657409CEFTRIAXONE DISODIUMRocephin (Not a Benefit) 2g/Vial Inj Pd-1 Vial PkHLRN/AN/AYESNONO
00012629CHLORDIAZEPOXIDELibrium (Not a Benefit) 5mg CapHLRN/AN/AYESNONO
00012645CHLORDIAZEPOXIDELibrium (Not a Benefit) 25mg CapHLRN/AN/AYESNONO
00012637CHLORDIAZEPOXIDELibrium (Not a Benefit) 10mg CapHLRN/AN/AYESNONO
01911473CILAZAPRILInhibace (Not a Benefit) 2.5mg TabHLRN/AN/AYESNONO
01911465CILAZAPRILInhibace (Not a Benefit) 1mg TabHLRN/AN/AYESNONO
01927078CLODRONATE DISODIUMOstac (Not a Benefit) 400mg CapHLRN/AN/AYESNONO
00382841CLONAZEPAMRivotril 2mg TabHLR0.47970.0721YESNONO
00382825CLONAZEPAMRivotril 0.5mg TabHLR0.27820.0418YESNONO
00013285DIAZEPAMValium (Not a Benefit) 5mg TabHLRN/AN/AYESNONO
00013277DIAZEPAMValium (Not a Benefit) 2mg TabHLRN/AN/AYESNONO
00013293DIAZEPAMValium (Not a Benefit) 10mg TabHLRN/AN/AYESNONO
02269023ERLOTINIBTarceva (Off-Formulary Interchangeable) 150mg TabHLRN/AN/AYESNONO
02269015ERLOTINIBTarceva (Off-Formulary Interchangeable) 100mg TabHLRN/AN/AYESNONO
02269007ERLOTINIBTarceva (Off-Formulary Interchangeable) 25mg TabHLRN/AN/AYESNONO
02527618FARICIMABVabysmo 6mg/0.05mL Inj Sol-0.24mL Vial Pk (Preservative-Free)HLR1350.00001350.0000NOYESNO
02185881GRANISETRON HCLKytril (Not a Benefit) 1mg TabHLRN/AN/AYESNONO
00582344ISOTRETINOINAccutane 10mg CapHLR0.95470.9313YESNOYES
00582352ISOTRETINOINAccutane 40mg CapHLR1.94801.9003YESNOYES
00386464LEVODOPA & BENSERAZIDEProlopa 100-25 100mg & 25mg CapHLR0.55280.5528NONONO
00386472LEVODOPA & BENSERAZIDEProlopa 200-50 200mg & 50mg CapHLR0.92810.9281NONONO
00522597LEVODOPA & BENSERAZIDEProlopa 50-12.5 50mg & 12.5mg CapHLR0.33570.3357NONONO
02018055MEFLOQUINE HCLLariam (Off-Formulary Interchangeable) 250mg TabHLRN/AN/AYESNONO
00766011MIDAZOLAMVersed (Not a Benefit) 5mg/mL Inj Sol (with Preservative)HLRN/AN/AYESNONO
00899348MOCLOBEMIDEManerix (Not a Benefit) 100mg TabHLRN/AN/AYESNONO
02192748MYCOPHENOLATE MOFETILCellCept 250mg CapHLR2.18460.3712YESNONO
02242145MYCOPHENOLATE MOFETILCellCept 200mg/mL Pd for Oral Susp-175mL PkHLR342.5800244.7025YESYESNO
02237484MYCOPHENOLATE MOFETILCellCept 500mg TabHLR4.36920.7423YESNONO
02162423NAPROXENNaprosyn E (Off-Formulary Interchangeable) 500mg Ent TabHLRN/AN/AYESNOYES
02162792NAPROXENNaprosyn E (Off-Formulary Interchangeable) 250mg Ent TabHLRN/AN/AYESNOYES
02162415NAPROXENNaprosyn E (Off-Formulary Interchangeable) 375mg Ent TabHLRN/AN/AYESNOYES
02162458NAPROXENNaprosyn (Not a Benefit) 500mg SupHLRN/AN/AYESNOYES
02162482NAPROXENNaprosyn (Not a Benefit) 375mg TabHLRN/AN/AYESNOYES
02162490NAPROXENNaprosyn (Not a Benefit) 500mg TabHLRN/AN/AYESNOYES
02162474NAPROXENNaprosyn (Not a Benefit) 250mg TabHLRN/AN/AYESNOYES
02162725NAPROXEN SODIUMAnaprox (Off-Formulary Interchangeable) 275mg TabHLRN/AN/AYESNOYES
02162717NAPROXEN SODIUMAnaprox DS (Off-Formulary Interchangeable) 550mg TabHLRN/AN/AYESNOYES
02241472OSELTAMIVIR PHOSPHATETamiflu 75mg CapHLR4.19401.0393YESYESNO
02304856OSELTAMIVIR PHOSPHATETamiflu 45mg CapHLR3.25401.6135YESYESNO
02304848OSELTAMIVIR PHOSPHATETamiflu 30mg CapHLR2.11500.5243YESYESNO
02381842OSELTAMIVIR PHOSPHATETamiflu (Off-Formulary Interchangeable) 6mg/mL O/LHLRN/AN/AYESNONO
02027860OXAPROZIN.Daypro (Off-Formulary Interchangeable) 600mg TabHLRN/AN/AYESNOYES
02464500PIRFENIDONEEsbriet (Off-Formulary Interchangeable) 801mg TabHLR40.272020.1361YESNONO
02464489PIRFENIDONEEsbriet (Off-Formulary Interchangeable) 267mg TabHLR13.42406.7120YESNONO
00272485SULFAMETHOXAZOLE & TRIMETHOPRIMBactrim Sugar Free (Not a Benefit) 40mg & 8mg/mL O/LHLRN/AN/AYESNOYES
00272469SULFAMETHOXAZOLE & TRIMETHOPRIMBactrim (Not a Benefit) 400mg & 80mg TabHLRN/AN/AYESNOYES
00371823SULFAMETHOXAZOLE & TRIMETHOPRIMBactrim-DS (Not a Benefit) 800mg & 160mg TabHLRN/AN/AYESNOYES
02162776TICLOPIDINE HCLTiclid (Not a Benefit) 250mg TabHLRN/AN/AYESNONO
02145839TRETINOINVesanoid (Off-Formulary Interchangeable) 10mg CapHLRN/AN/AYESNONO