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Products found: 82New Search
DIN/ PIN/ NPNGeneric NameBrand Name, Strength & Dosage FormMFRDrug Benefit Price or Unit PriceAmount MOH PaysInter- change- ableLimited UseThera- peutic Notes
02371065ABIRATERONE ACETATEZytiga (Off-Formulary Interchangeable) 250mg TabJAN31.415026.0313YESNONO
02457113ABIRATERONE ACETATEZytiga (Off-Formulary Interchangeable) 500mg TabJAN62.830052.0625YESNONO
02163934ACETAMINOPHEN & CAFFEINE & CODEINE PHOSPHATETylenol with Codeine No. 2 (Not a Benefit) 300mg & 15mg & 15mg TabJANN/AN/AYESNOYES
02163926ACETAMINOPHEN & CAFFEINE & CODEINE PHOSPHATETylenol with Codeine No. 3 (Not a Benefit) 300mg & 15mg & 30mg TabJANN/AN/AYESNOYES
02163942ACETAMINOPHEN & CODEINE PHOSPHATETylenol With Codeine Elixir (Not a Benefit) 160mg & 8mg/5mL O/LJANN/AN/AYESNOYES
02163918ACETAMINOPHEN & CODEINE PHOSPHATETylenol with Codeine No. 4 (Not a Benefit) 300mg & 60mg TabJANN/AN/AYESNOYES
02244981BOSENTAN MONOHYDRATETracleer (Off-Formulary Interchangeable) 62.5mg TabJAN71.980032.0893YESNONO
02244982BOSENTAN MONOHYDRATETracleer (Off-Formulary Interchangeable) 125mg TabJAN71.980032.0893YESNONO
02425483CANAGLIFLOZINInvokana 100mg TabJAN2.89102.8910NONOYES
02425491CANAGLIFLOZINInvokana 300mg TabJAN2.89102.8910NONOYES
02338432DARUNAVIRPrezista 75mg TabJAN1.89301.8930NONOYES
02369753DARUNAVIRPrezista 150mg TabJAN4.00804.0080NONOYES
02393050DARUNAVIRPrezista 800mg TabJAN23.31805.8295YESNOYES
02324024DARUNAVIRPrezista 600mg TabJAN17.70304.2970YESNOYES
02426501DARUNAVIR & COBICISTATPrezcobix 800mg & 150mg TabJAN25.187025.1870NONOYES
00855820DOMPERIDONE MALEATEMotilium (Not a Benefit) 10mg TabJANN/AN/AYESNONO
02240722EPOETIN ALFAEprex 40,000IU/mL Pref Syr - 1mL PkJAN486.7900486.7900NOYESNO
02231587EPOETIN ALFAEprex 10,000IU/mL Pref Syr - 1mL PkJAN142.5000142.5000NOYESNO
02243239EPOETIN ALFAEprex 20,000IU/0.5mL Pref Syr-0.5mL PkJAN325.0900325.0900NOYESNO
02306778ETRAVIRINEIntelence 100mg TabJAN6.57106.5710NONOYES
02375931ETRAVIRINEIntelence 200mg TabJAN12.619512.6195NONOYES
02275856FENTANYL TRANSDERMAL SYSTEMDuragesic (Off-Formulary Interchangeable) 100mcg/hr Trans PatchJANN/AN/AYESNOYES
02275848FENTANYL TRANSDERMAL SYSTEMDuragesic (Off-Formulary Interchangeable) 75mcg/hr Trans PatchJANN/AN/AYESNOYES
02275821FENTANYL TRANSDERMAL SYSTEMDuragesic (Not a Benefit) 50mcg/hr Trans PatchJANN/AN/AYESNOYES
02275813FENTANYL TRANSDERMAL SYSTEMDuragesic (Not a Benefit) 25mcg/hr Trans PatchJANN/AN/AYESNOYES
02266725GALANTAMINE HYDROBROMIDEReminyl ER (Not a Benefit) 16mg ER CapJANN/AN/AYESNONO
02266733GALANTAMINE HYDROBROMIDEReminyl ER (Not a Benefit) 24mg ER CapJANN/AN/AYESNONO
02266717GALANTAMINE HYDROBROMIDEReminyl ER (Not a Benefit) 8mg ER CapJANN/AN/AYESNONO
02047454ITRACONAZOLESporanox 100mg CapJAN5.48803.9270YESNONO
02231347ITRACONAZOLESporanox 10mg/mL Oral SolJAN1.02360.4111YESYESNO
00703974KETOCONAZOLENizoral (Not a Benefit) 2% CrJANN/AN/AYESNOYES
00633836KETOCONAZOLENizoral (Not a Benefit) 200mg TabJANN/AN/AYESNOYES
02236842LEVOFLOXACINLevaquin (Not a Benefit) 500mg TabJANN/AN/AYESNONO
02236841LEVOFLOXACINLevaquin (Not a Benefit) 250mg TabJANN/AN/AYESNONO
02246804LEVOFLOXACINLevaquin (Off-Formulary Interchangeable) 750mg TabJANN/AN/AYESNONO
00860743LOPERAMIDE HCLImodium (Not a Benefit) 2mg CapletJANN/AN/AYESNONO
00556734MEBENDAZOLEVermox 100mg TabJAN8.50008.5000NONONO
02247732METHYLPHENIDATE HCLConcerta 18mg SR TabJAN2.84100.5246YESNOYES
02247733METHYLPHENIDATE HCLConcerta 36mg SR TabJAN3.71640.6863YESNOYES
02247734METHYLPHENIDATE HCLConcerta 54mg SR TabJAN4.59140.8479YESNOYES
02250241METHYLPHENIDATE HCLConcerta 27mg SR TabJAN3.27860.6055YESNOYES
00037605NORETHINDRONEMicronor (Not a Benefit) 0.35mg Tab-28 PkJANN/AN/AYESNONO
02028700NORGESTIMATE & ETHINYL ESTRADIOLTri-Cyclen (Not a Benefit) 3 Phase Tab-21 PkJANN/AN/AYESNONO
02258560NORGESTIMATE & ETHINYL ESTRADIOLTri-Cyclen Lo (Not a Benefit) 3 Phase Tab-21 PkJANN/AN/AYESNONO
02029421NORGESTIMATE & ETHINYL ESTRADIOLTri-Cyclen (Not a Benefit) 3 Phase Tab-28 PkJANN/AN/AYESNONO
02258587NORGESTIMATE & ETHINYL ESTRADIOLTri-Cyclen Lo (Not a Benefit) 3 Phase Tab-28 PkJANN/AN/AYESNONO
02300303PALIPERIDONEInvega 9mg ER TabJAN7.93907.9390NONONO
02300281PALIPERIDONEInvega 6mg ER TabJAN5.95605.9560NONONO
02300273PALIPERIDONEInvega 3mg ER TabJAN3.98203.9820NONONO
02354217PALIPERIDONE PALMITATEInvega Sustenna 50mg Inj Pref SyrJAN327.4500327.4500NONOYES
02354241PALIPERIDONE PALMITATEInvega Sustenna 150mg Inj Pref SyrJAN654.9000654.9000NONOYES
02354233PALIPERIDONE PALMITATEInvega Sustenna 100mg Inj Pref SyrJAN491.1800491.1800NONOYES
02354225PALIPERIDONE PALMITATEInvega Sustenna 75mg Inj Pref SyrJAN491.1800491.1800NONOYES
02455986PALIPERIDONE PALMITATEInvega Trinza 263mg/1.315mL Inj Susp-Pref SyrJAN1430.61001430.6100NONOYES
02455994PALIPERIDONE PALMITATEInvega Trinza 350mg/1.75mL Inj Susp-Pref SyrJAN1430.61001430.6100NONOYES
02456001PALIPERIDONE PALMITATEInvega Trinza 525mg/2.625mL Inj Susp-Pref SyrJAN1907.49001907.4900NONOYES
02455943PALIPERIDONE PALMITATEInvega Trinza 175mg/0.875mL Inj Susp-Pref SyrJAN953.7300953.7300NONOYES
02377012PRUCALOPRIDEResotran (Off-Formulary Interchangeable) 1mg TabJANN/AN/AYESNONO
02377020PRUCALOPRIDEResotran (Off-Formulary Interchangeable) 2mg TabJANN/AN/AYESNONO
02243797RABEPRAZOLE SODIUMPariet 20mg TabJAN2.68820.1338YESNONO
02243796RABEPRAZOLE SODIUMPariet 10mg TabJAN1.34410.0669YESNONO
02370603RILPIVIRINE HYDROCHLORIDEEdurant 25mg TabJAN16.287016.2870NONOYES
02236950RISPERIDONERisperdal 1mg/mL O/LJAN1.41600.7080YESNONO
02247706RISPERIDONERisperdal M-Tab (Not a Benefit) 2mg Orally Disintegrating TabJANN/AN/AYESNONO
02247704RISPERIDONERisperdal M-Tab (Not a Benefit) 0.5mg Orally Disintegrating TabJANN/AN/AYESNONO
02247705RISPERIDONERisperdal M-Tab (Not a Benefit) 1mg Orally Disintegrating TabJANN/AN/AYESNONO
02268086RISPERIDONERisperdal M-Tab (Not a Benefit) 3mg Orally Disintegrating TabJANN/AN/AYESNONO
02268094RISPERIDONERisperdal M-Tab (Not a Benefit) 4mg Orally Disintegrating TabJANN/AN/AYESNONO
02255707RISPERIDONERisperdal Consta 25mg Pd for Inj-Vial PkJAN175.3700175.3700NONOYES
02255758RISPERIDONERisperdal Consta 50mg Pd for Inj-Vial PkJAN350.7200350.7200NONOYES
02255723RISPERIDONERisperdal Consta 37.5mg Pd for Inj-Vial PkJAN263.0300263.0300NONOYES
02025280RISPERIDONERisperdal 1mg TabJAN1.33150.2031YESNONO
02240551RISPERIDONERisperdal 0.25mg TabJAN0.57550.0878YESNONO
02025310RISPERIDONERisperdal 4mg TabJAN5.31900.8111YESNONO
02240552RISPERIDONERisperdal 0.5mg TabJAN0.96410.1470YESNONO
02025302RISPERIDONERisperdal 3mg TabJAN3.98900.6083YESNONO
02025299RISPERIDONERisperdal 2mg TabJAN2.66400.4062YESNONO
00894729TERCONAZOLETerazol 7 (Not a Benefit) 0.4% Vag CrJANN/AN/AYESNOYES
02349469TRAMADOL HCLUltram (Off-Formulary Interchangeable) 50mg TabJANN/AN/AYESNOYES
02264846TRAMADOL HCL & ACETAMINOPHENTramacet (Off-Formulary Interchangeable) 37.5mg & 325mg TabJANN/AN/AYESNOYES
02320673USTEKINUMABStelara 45mg/0.5mL Inj Sol-Pref Syr PkJAN4593.14004593.1400NOYESNO
02320681USTEKINUMABStelara 90mg/mL Inj Sol-Pref Syr PkJAN4593.14004593.1400NOYESNO