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Products found: 55New Search
DIN/ PIN/ NPNGeneric NameBrand Name, Strength & Dosage FormMFRDrug Benefit Price or Unit PriceAmount MOH PaysInter- change- ableLimited UseThera- peutic Notes
02245329ALENDRONATEFosamax 70mg TabOCI12.62501.7804YESNONO
02314940ALENDRONATE & CHOLECALCIFEROLFosavance 70mg & 140mcg TabOCI5.42502.4348YESNONO
02276429ALENDRONATE & CHOLECALCIFEROLFosavance 70mg & 70mcg TabOCI5.53352.4348YESNOYES
02374811ASENAPINESaphris 10mg SL TabOCI1.59101.5910NONOYES
02374803ASENAPINESaphris 5mg SL TabOCI1.59101.5910NONOYES
00323071BETAMETHASONE DIPROPIONATEDiprosone 0.05% CrOCI0.21740.2048YESNONO
00417246BETAMETHASONE DIPROPIONATEDiprosone 0.05% LotOCI0.21000.1980YESNONO
00344923BETAMETHASONE DIPROPIONATEDiprosone 0.05% OintOCI0.22840.2152YESNONO
00629367BETAMETHASONE DIPROPIONATE IN A BASE CONTAINING PROPYLENE GLYCOLDiprolene 0.05% OintOCI0.51860.5186YESNONO
00670928ENALAPRIL MALEATEVasotec 20mg TabOCI1.76650.3195YESNOYES
00670901ENALAPRIL MALEATEVasotec 10mg TabOCI1.46380.2647YESNOYES
00708879ENALAPRIL MALEATEVasotec 5mg TabOCI1.21820.2203YESNOYES
00657298ENALAPRIL MALEATE & HYDROCHLOROTHIAZIDEVaseretic (Off-Formulary Interchangeable) 10mg & 25mg TabOCIN/AN/AYESNONO
02253186ETHINYL ESTRADIOL & ETONOGESTRELNuvaring (Off-Formulary Interchangeable) 0.120mg & 0.015mg/24 hr Slow Release Vag RingOCIN/AN/AYESNONO
02499509ETONOGESTRELNexplanon 68mg/Implant ER Subdermal ImplantOCI299.2500299.2500NONONO
02247521EZETIMIBEEzetrol 10mg TabOCI2.04150.1811YESYESNO
02238213FINASTERIDEPropecia (Off-Formulary Interchangeable) 1mg TabOCIN/AN/AYESNONO
02010909FINASTERIDEProscar 5mg TabOCI2.43900.3506YESYESNO
00328219LEVODOPA & CARBIDOPASinemet (Not a Benefit) 250mg & 25mg TabOCIN/AN/AYESNONO
00513997LEVODOPA & CARBIDOPASinemet (Not a Benefit) 100mg & 25mg TabOCIN/AN/AYESNONO
02182815LOSARTAN POTASSIUMCozaar 25mg TabOCI1.99240.3147YESNONO
02182882LOSARTAN POTASSIUMCozaar 100mg TabOCI1.99240.3147YESNONO
02182874LOSARTAN POTASSIUMCozaar 50mg TabOCI1.99240.3147YESNONO
02230047LOSARTAN POTASSIUM & HYDROCHLOROTHIAZIDEHyzaar 50mg & 12.5mg TabOCI1.99240.3147YESNONO
02297841LOSARTAN POTASSIUM & HYDROCHLOROTHIAZIDEHyzaar 100mg & 12.5mg TabOCI1.95080.3082YESNONO
02241007LOSARTAN POTASSIUM & HYDROCHLOROTHIAZIDEHyzaar DS 100mg & 25mg TabOCI1.99240.3147YESNONO
02248542MIRTAZAPINERemeron RD 15mg Orally Disintegrating TabOCI0.55290.4046YESNONO
02248544MIRTAZAPINERemeron RD 45mg Orally Disintegrating TabOCI1.65801.2132YESNONO
02248543MIRTAZAPINERemeron RD 30mg Orally Disintegrating TabOCI1.10520.8087YESNONO
02243910MIRTAZAPINERemeron 30mg TabOCI1.89870.3100YESNONO
00851744MOMETASONE FUROATEElocom 0.1% CrOCI0.73930.5542YESNONO
00871095MOMETASONE FUROATEElocom 0.1% LotOCI0.52550.3627YESNONO
02238465MOMETASONE FUROATENasonex (Off-Formulary Interchangeable) 50mcg/Dose Nas Sp-140 Dose PkOCIN/AN/AYESNOYES
00851736MOMETASONE FUROATEElocom 0.1% OintOCI0.73420.2252YESNONO
02243596MOMETASONE FUROATEAsmanex Twisthaler 400mcg/Metered Dose Pd Inh-30 Dose PkOCI40.410040.4100NONOYES
02243595MOMETASONE FUROATEAsmanex Twisthaler 200mcg/Metered Dose Pd Inh-60 Dose PkOCI40.410040.4100NONOYES
09857431MOMETASONE FUROATEAsmanex Twisthaler 400mcg/Metered Dose Pd Inh-60 Dose PkOCI80.790080.7900NONOYES
02361760MOMETASONE FUROATE & FORMOTEROL FUMARATE DIHYDRATEZenhale 200mcg & 5mcg Metered Dose Inh-120 Dose PkOCI138.9120138.9120NOYESNO
02361752MOMETASONE FUROATE & FORMOTEROL FUMARATE DIHYDRATEZenhale 100mcg & 5mcg Metered Dose Inh-120 Dose PkOCI114.6360114.6360NOYESNO
02238216MONTELUKAST SODIUMSingulair (Off-Formulary Interchangeable) 5mg Chew TabOCIN/AN/AYESNONO
02243602MONTELUKAST SODIUMSingulair 4mg Chew TabOCI1.67830.2758YESYESNO
02247997MONTELUKAST SODIUMSingulair (Off-Formulary Interchangeable) 4mg Gran PkOCIN/AN/AYESNONO
02238217MONTELUKAST SODIUMSingulair (Off-Formulary Interchangeable) 10mg TabOCIN/AN/AYESNONO
02318679OLMESARTAN MEDOXOMILOlmetec 40mg TabOCI1.33270.3019YESNONO
02318660OLMESARTAN MEDOXOMILOlmetec 20mg TabOCI1.33270.3019YESNONO
02319616OLMESARTAN MEDOXOMIL & HYDROCHLOROTHIAZIDEOlmetec Plus 20mg & 12.5mg TabOCI1.33270.3019YESNONO
02319632OLMESARTAN MEDOXOMIL & HYDROCHLOROTHIAZIDEOlmetec Plus 40mg & 25mg TabOCI1.33270.3019YESNONO
02319624OLMESARTAN MEDOXOMIL & HYDROCHLOROTHIAZIDEOlmetec Plus 40mg & 12.5mg TabOCI1.33270.3019YESNONO
02166704PROGESTERONEPrometrium (Off-Formulary Interchangeable) 100mg CapOCIN/AN/AYESNONO
02240519RIZATRIPTANMaxalt RPD (Off-Formulary Interchangeable) 10mg Orally Disintegrating TabOCI21.486511.1650YESNONO
02240518RIZATRIPTANMaxalt RPD (Off-Formulary Interchangeable) 5mg Orally Disintegrating TabOCI21.486511.1650YESNONO
02240521RIZATRIPTANMaxalt (Off-Formulary Interchangeable) 10mg TabOCI21.486511.1150YESNONO
00884359SIMVASTATINZocor 40mg TabOCI3.31820.2501YESNONO
00884340SIMVASTATINZocor 20mg TabOCI3.31820.2501YESNONO
00884332SIMVASTATINZocor 10mg TabOCI2.68480.2023YESNONO