02126230 | ALTRETAMINE | Hexalen 50mg Cap | LIL | 3.3600 | 3.3600 | NO | NO | NO |
02279347 | ATOMOXETINE HCL | Strattera (Off-Formulary Interchangeable) 80mg Cap | LIL | N/A | N/A | YES | NO | NO |
02262843 | ATOMOXETINE HCL | Strattera 60mg Cap | LIL | 5.3011 | 0.8092 | YES | NO | NO |
02262835 | ATOMOXETINE HCL | Strattera 40mg Cap | LIL | 4.8275 | 0.7369 | YES | NO | NO |
02279355 | ATOMOXETINE HCL | Strattera (Off-Formulary Interchangeable) 100mg Cap | LIL | N/A | N/A | YES | NO | NO |
02262827 | ATOMOXETINE HCL | Strattera 25mg Cap | LIL | 4.2054 | 0.6420 | YES | NO | NO |
02262800 | ATOMOXETINE HCL | Strattera 10mg Cap | LIL | 3.3443 | 0.5106 | YES | NO | NO |
02262819 | ATOMOXETINE HCL | Strattera 18mg Cap | LIL | 3.7657 | 0.5748 | YES | NO | NO |
02480018 | BARICITINIB | Olumiant 2mg Tab | LIL | 52.9433 | 52.9433 | NO | YES | NO |
02301482 | DULOXETINE | Cymbalta 30mg DR Cap | LIL | 2.3604 | 0.3611 | YES | NO | NO |
02301490 | DULOXETINE | Cymbalta 60mg DR Cap | LIL | 4.7907 | 0.7327 | YES | NO | NO |
00210641 | ERYTHROMYCIN ESTOLATE | Ilosone (Not a Benefit) 50mg/mL O/L | LIL | N/A | N/A | YES | NO | YES |
02018985 | FLUOXETINE HCL | Prozac (Off-Formulary Interchangeable) 10mg Cap | LIL | N/A | N/A | YES | NO | YES |
00636622 | FLUOXETINE HCL | Prozac 20mg Cap | LIL | 2.2570 | 0.3311 | YES | NO | YES |
01917021 | FLUOXETINE HCL | Prozac (Not a Benefit) 20mg/5mL Oral Sol | LIL | N/A | N/A | YES | NO | YES |
02492415 | GLUCAGON | Baqsimi 3mg Nas Pd Device | LIL | 139.8300 | 139.8300 | NO | YES | NO |
02243297 | GLUCAGON RDNA ORIGIN | Glucagon 1mg/Vial Inj Pd-Vial Pk | LIL | 111.2000 | 111.2000 | NO | NO | NO |
00587737 | INSULIN (ISOPHANE) HUMAN BIOSYNTHETIC (RDNA ORIGIN) | Humulin NPH 1000U/10mL Inj Susp-10mL Pk | LIL | 27.1900 | 27.1900 | NO | NO | NO |
09853804 | INSULIN (ISOPHANE) HUMAN BIOSYNTHETIC (RDNA ORIGIN) | Humulin N 100U/mL Inj Susp-5x3mL Pk | LIL | 53.3500 | 53.3500 | NO | NO | NO |
00586714 | INSULIN (ZINC CRYSTALLINE) HUMAN BIOSYNTHETIC (RDNA ORIGIN) | Humulin Regular 1000U/10mL Inj Sol-10mL Pk | LIL | 27.1900 | 27.1900 | NO | NO | NO |
09853766 | INSULIN (ZINC CRYSTALLINE) HUMAN BIOSYNTHETIC (RDNA ORIGIN) | Humulin R 100U/mL Inj Sol-5x3mL Pk | LIL | 53.3500 | 53.3500 | NO | NO | NO |
02444844 | INSULIN GLARGINE | Basaglar 100U/mL Inj Sol-Cartridge 5x3mL Pk | LIL | 76.1100 | 76.1100 | NO | NO | NO |
02461528 | INSULIN GLARGINE | Basaglar 100U/mL Inj Sol-KwikPen (80U) Pref Pen 5x3mL Pk | LIL | 76.1100 | 76.1100 | NO | NO | NO |
00795879 | INSULIN HUMAN BIOSYNTHETIC 30% & ISOPHANE 70% | Humulin 30/70 1000U/10mL Inj Susp-10mL Pk | LIL | 27.1900 | 27.1900 | NO | NO | NO |
09853855 | INSULIN HUMAN BIOSYNTHETIC 30% & ISOPHANE 70% | Humulin 30/70 100U/mL Inj Susp-5x3mL Pk | LIL | 53.3500 | 53.3500 | NO | NO | NO |
02466864 | INSULIN INJECTION, HUMAN BIOSYNTHETIC | Entuzity KwikPen 500U/mL Inj Sol-Pref Pen 2x3mL Pk | LIL | 103.6000 | 103.6000 | NO | NO | NO |
09858243 | INSULIN LISPRO | Humalog 100U/mL Inj Sol-10mL Pk | LIL | 33.0400 | 33.0400 | NO | NO | NO |
02229704 | INSULIN LISPRO | Humalog 100U/mL Inj Sol-10mL Pk | LIL | 33.0400 | 33.0400 | NO | YES | NO |
09858242 | INSULIN LISPRO | Humalog 100U/mL Inj Sol-5x3mL Pk | LIL | 65.6400 | 65.6400 | NO | NO | NO |
09853715 | INSULIN LISPRO | Humalog 100U/mL Inj Sol-5x3mL Pk | LIL | 65.6400 | 65.6400 | NO | YES | NO |
09858240 | INSULIN LISPRO | Humalog Kwikpen 100U/mL Inj Sol-5x3mL Pk | LIL | 65.1700 | 65.1700 | NO | NO | NO |
02403412 | INSULIN LISPRO | Humalog Kwikpen 100U/mL Inj Sol-5x3mL Pk | LIL | 65.1700 | 65.1700 | NO | YES | NO |
02439611 | INSULIN LISPRO | Humalog 200 units/mL KwikPen 200U/mL Inj Sol-Pref Pen 5x3mL Pk | LIL | 121.3200 | 121.3200 | NO | NO | YES |
09858241 | INSULIN LISPRO | Humalog 100U/mL Inj Sol-Pref Pen 5x3mL Pk (Junior KwikPen) | LIL | 69.3900 | 69.3900 | NO | NO | NO |
02470152 | INSULIN LISPRO | Humalog 100U/mL Inj Sol-Pref Pen 5x3mL Pk (Junior KwikPen) | LIL | 69.3900 | 69.3900 | NO | YES | NO |
02240294 | INSULIN LISPRO & INSULIN LISPRO PROTAMINE | Humalog Mix25 25% & 75% Inj Susp-5x3mL Pk | LIL | 66.4200 | 66.4200 | NO | NO | NO |
02403420 | INSULIN LISPRO & INSULIN LISPRO PROTAMINE | Humalog Mix25 Kwikpen 25% & 75% Inj Susp-5x3mL Pk | LIL | 65.9300 | 65.9300 | NO | NO | NO |
02240297 | INSULIN LISPRO & INSULIN LISPRO PROTAMINE | Humalog Mix50 50% & 50% Inj Susp-5x3mL Pk | LIL | 65.4100 | 65.4100 | NO | NO | NO |
02403439 | INSULIN LISPRO & INSULIN LISPRO PROTAMINE | Humalog Mix50 Kwikpen 50% & 50% Inj Susp-5x3mL Pk | LIL | 64.8300 | 64.8300 | NO | NO | NO |
02455102 | IXEKIZUMAB | Taltz 80mg/mL Inj Sol-Pref Autoinj | LIL | 1723.8900 | 1723.8900 | NO | YES | NO |
02455110 | IXEKIZUMAB | Taltz 80mg/mL Inj Sol-Pref Syr | LIL | 1723.8900 | 1723.8900 | NO | YES | NO |
02243086 | OLANZAPINE | Zyprexa Zydis 5mg Rapid Dissolve Tab | LIL | 4.4982 | 0.3574 | YES | NO | NO |
02243089 | OLANZAPINE | Zyprexa Zydis (Off-Formulary Interchangeable) 20mg Rapid Dissolve Tab | LIL | N/A | N/A | YES | NO | NO |
02243088 | OLANZAPINE | Zyprexa Zydis 15mg Rapid Dissolve Tab | LIL | 13.5861 | 1.0711 | YES | NO | NO |
02243087 | OLANZAPINE | Zyprexa Zydis 10mg Rapid Dissolve Tab | LIL | 8.9886 | 0.7143 | YES | NO | NO |
02229277 | OLANZAPINE | Zyprexa 7.5mg Tab | LIL | 6.7850 | 0.5316 | YES | NO | NO |
02238851 | OLANZAPINE | Zyprexa (Off-Formulary Interchangeable) 20mg Tab | LIL | N/A | N/A | YES | NO | NO |
02229285 | OLANZAPINE | Zyprexa 10mg Tab | LIL | 9.0468 | 0.7088 | YES | NO | NO |
02229250 | OLANZAPINE | Zyprexa 2.5mg Tab | LIL | 2.2996 | 0.1772 | YES | NO | NO |
02229269 | OLANZAPINE | Zyprexa 5mg Tab | LIL | 4.5232 | 0.3544 | YES | NO | NO |
02238850 | OLANZAPINE | Zyprexa 15mg Tab | LIL | 13.8011 | 1.0631 | YES | NO | NO |
02349124 | PRASUGREL | Effient (Not a Benefit) 10mg Tab | LIL | N/A | N/A | YES | NO | NO |
02239028 | RALOXIFENE HCL | Evista 60mg Tab | LIL | 2.0536 | 1.0268 | YES | YES | NO |
02338327 | TADALAFIL | Adcirca (Off-Formulary Interchangeable) 20mg Tab | LIL | 13.0150 | 11.4725 | YES | NO | NO |
02248089 | TADALAFIL | Cialis (Off-Formulary Interchangeable) 20mg Tab | LIL | N/A | N/A | YES | NO | NO |
02296896 | TADALAFIL | Cialis (Off-Formulary Interchangeable) 5mg Tab | LIL | N/A | N/A | YES | NO | NO |
02248088 | TADALAFIL | Cialis (Off-Formulary Interchangeable) 10mg Tab | LIL | N/A | N/A | YES | NO | NO |
02296888 | TADALAFIL | Cialis (Off-Formulary Interchangeable) 2.5mg Tab | LIL | N/A | N/A | YES | NO | NO |
09857535 | TERIPARATIDE | Forteo (Off-Formulary Interchangeable) 250mcg/mL Inj Sol-2.4mL Pref Pen | LIL | 1070.9400 | 565.2600 | YES | NO | NO |
00325449 | TOBRAMYCIN SULFATE | Nebcin (Not a Benefit) 80mg/2mL Inj Sol-2mL Pk | LIL | N/A | N/A | YES | NO | YES |
00611182 | VINCRISTINE SULFATE | Oncovin (Not a Benefit) 1mg/mL Inj Sol | LIL | N/A | N/A | YES | NO | NO |