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Products found: 61

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DIN/ PIN/ NPN	Generic Name	Brand Name, Strength & Dosage Form	MFR	Drug Benefit Price or Unit Price	Amount MOH Pays	Inter- change- able	Limited Use	Thera- peutic Notes
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

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