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Products found: 56New Search
DIN/ PIN/ NPNGeneric NameBrand Name, Strength & Dosage FormMFRDrug Benefit Price or Unit PriceAmount MOH PaysInter- change- ableLimited UseThera- peutic Notes
02126230ALTRETAMINEHexalen 50mg CapLIL3.36003.3600NONONO
02262819ATOMOXETINE HCLStrattera 18mg CapLIL4.14860.5748YESNONO
02262827ATOMOXETINE HCLStrattera 25mg CapLIL4.20540.6420YESNONO
02262835ATOMOXETINE HCLStrattera 40mg CapLIL4.82750.7369YESNONO
02262800ATOMOXETINE HCLStrattera 10mg CapLIL3.34430.5106YESNONO
02262843ATOMOXETINE HCLStrattera 60mg CapLIL5.84000.8092YESNONO
02279355ATOMOXETINE HCLStrattera (Off-Formulary Interchangeable) 100mg CapLILN/AN/AYESNONO
02279347ATOMOXETINE HCLStrattera (Off-Formulary Interchangeable) 80mg CapLILN/AN/AYESNONO
02480018BARICITINIBOlumiant 2mg TabLIL57.205757.2057NOYESNO
02301490DULOXETINECymbalta 60mg DR CapLIL5.27790.7327YESNONO
02301482DULOXETINECymbalta 30mg DR CapLIL2.60040.3611YESNONO
00210641ERYTHROMYCIN ESTOLATEIlosone (Not a Benefit) 50mg/mL O/LLILN/AN/AYESNOYES
00636622FLUOXETINE HCLProzac 20mg CapLIL2.48650.3311YESNOYES
02018985FLUOXETINE HCLProzac (Off-Formulary Interchangeable) 10mg CapLILN/AN/AYESNOYES
01917021FLUOXETINE HCLProzac (Not a Benefit) 20mg/5mL Oral SolLILN/AN/AYESNOYES
02492415GLUCAGONBaqsimi 3mg Nas Pd DeviceLIL154.0500154.0500NOYESNO
00587737INSULIN (ISOPHANE) HUMAN BIOSYNTHETIC (RDNA ORIGIN)Humulin NPH 1000U/10mL Inj Susp-10mL PkLIL28.550028.5500NONONO
09853804INSULIN (ISOPHANE) HUMAN BIOSYNTHETIC (RDNA ORIGIN)Humulin N 100U/mL Inj Susp-5x3mL PkLIL56.020056.0200NONONO
00586714INSULIN (ZINC CRYSTALLINE) HUMAN BIOSYNTHETIC (RDNA ORIGIN)Humulin Regular 1000U/10mL Inj Sol-10mL PkLIL28.550028.5500NONONO
09853766INSULIN (ZINC CRYSTALLINE) HUMAN BIOSYNTHETIC (RDNA ORIGIN)Humulin R 100U/mL Inj Sol-5x3mL PkLIL56.020056.0200NONONO
02444844INSULIN GLARGINEBasaglar 100U/mL Inj Sol-Cartridge 5x3mL PkLIL79.920079.9200NONONO
02461528INSULIN GLARGINEBasaglar 100U/mL Inj Sol-KwikPen (80U) Pref Pen 5x3mL PkLIL79.920079.9200NONONO
00795879INSULIN HUMAN BIOSYNTHETIC 30% & ISOPHANE 70%Humulin 30/70 1000U/10mL Inj Susp-10mL PkLIL28.550028.5500NONONO
09853855INSULIN HUMAN BIOSYNTHETIC 30% & ISOPHANE 70%Humulin 30/70 100U/mL Inj Susp-5x3mL PkLIL56.020056.0200NONONO
02466864INSULIN INJECTION, HUMAN BIOSYNTHETICEntuzity KwikPen 500U/mL Inj Sol-Pref Pen 2x3mL PkLIL108.7800108.7800NONONO
02229704INSULIN LISPROHumalog 100U/mL Inj Sol-10mL PkLIL34.690034.6900NOYESNO
09853715INSULIN LISPROHumalog 100U/mL Inj Sol-5x3mL PkLIL68.920068.9200NOYESNO
02403412INSULIN LISPROHumalog Kwikpen 100U/mL Inj Sol-5x3mL PkLIL68.430068.4300NOYESNO
02439611INSULIN LISPROHumalog 200 units/mL KwikPen 200U/mL Inj Sol-Pref Pen 5x3mL PkLIL127.3900127.3900NONOYES
02470152INSULIN LISPROHumalog 100U/mL Inj Sol-Pref Pen 5x3mL Pk (Junior KwikPen)LIL72.860072.8600NOYESNO
02240294INSULIN LISPRO & INSULIN LISPRO PROTAMINEHumalog Mix25 25% & 75% Inj Susp-5x3mL PkLIL69.740069.7400NONONO
02403420INSULIN LISPRO & INSULIN LISPRO PROTAMINEHumalog Mix25 Kwikpen 25% & 75% Inj Susp-5x3mL PkLIL69.230069.2300NONONO
02240297INSULIN LISPRO & INSULIN LISPRO PROTAMINEHumalog Mix50 50% & 50% Inj Susp-5x3mL PkLIL68.680068.6800NONONO
02403439INSULIN LISPRO & INSULIN LISPRO PROTAMINEHumalog Mix50 Kwikpen 50% & 50% Inj Susp-5x3mL PkLIL68.070068.0700NONONO
02455102IXEKIZUMABTaltz 80mg/mL Inj Sol-Pref AutoinjLIL1865.14001865.1400NOYESNO
02455110IXEKIZUMABTaltz 80mg/mL Inj Sol-Pref SyrLIL1877.85001877.8500NOYESNO
02243088OLANZAPINEZyprexa Zydis 15mg Rapid Dissolve TabLIL13.58611.0711YESNONO
02243089OLANZAPINEZyprexa Zydis (Off-Formulary Interchangeable) 20mg Rapid Dissolve TabLILN/AN/AYESNONO
02243087OLANZAPINEZyprexa Zydis 10mg Rapid Dissolve TabLIL8.98860.7143YESNONO
02243086OLANZAPINEZyprexa Zydis 5mg Rapid Dissolve TabLIL4.49820.3574YESNONO
02229269OLANZAPINEZyprexa 5mg TabLIL4.52320.3544YESNONO
02238851OLANZAPINEZyprexa (Off-Formulary Interchangeable) 20mg TabLILN/AN/AYESNONO
02229277OLANZAPINEZyprexa 7.5mg TabLIL6.78500.5316YESNONO
02229250OLANZAPINEZyprexa 2.5mg TabLIL2.29960.1772YESNONO
02238850OLANZAPINEZyprexa 15mg TabLIL13.80111.0631YESNONO
02229285OLANZAPINEZyprexa 10mg TabLIL9.04680.7088YESNONO
02349124PRASUGRELEffient (Not a Benefit) 10mg TabLILN/AN/AYESNONO
02239028RALOXIFENE HCLEvista 60mg TabLIL2.26251.0268YESYESNO
02338327TADALAFILAdcirca (Off-Formulary Interchangeable) 20mg TabLIL14.338611.4725YESNONO
02296888TADALAFILCialis (Off-Formulary Interchangeable) 2.5mg TabLILN/AN/AYESNONO
02296896TADALAFILCialis (Off-Formulary Interchangeable) 5mg TabLILN/AN/AYESNONO
02248088TADALAFILCialis (Off-Formulary Interchangeable) 10mg TabLILN/AN/AYESNONO
02248089TADALAFILCialis (Off-Formulary Interchangeable) 20mg TabLILN/AN/AYESNONO
09857535TERIPARATIDEForteo 250mcg/mL Inj Sol-2.4mL Pref PenLIL1179.8500535.4700YESYESNO
00325449TOBRAMYCIN SULFATENebcin (Not a Benefit) 80mg/2mL Inj Sol-2mL PkLILN/AN/AYESNOYES
00611182VINCRISTINE SULFATEOncovin (Not a Benefit) 1mg/mL Inj SolLILN/AN/AYESNONO