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Products found: 145

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DIN/ PIN/ NPN	Generic Name	Brand Name, Strength & Dosage Form	MFR	Drug Benefit Price or Unit Price	Amount MOH Pays	Interchangeable	Limited Use	Therapeutic Notes
02511061	ADALIMUMAB	Abrilada 20mg/0.4mL Inj Sol-0.4mL Pref Syr (Preservative-Free)	PFI	235.6300	235.6300	NO	YES	NO
02511045	ADALIMUMAB	Abrilada 40mg/0.8mL Inj Sol-0.8mL Pref Pen (Preservative-Free)	PFI	471.2700	471.2700	NO	YES	NO
02511053	ADALIMUMAB	Abrilada 40mg/0.8mL Inj Sol-0.8mL Pref Syr (Preservative-Free)	PFI	471.2700	471.2700	NO	YES	NO
02036282	AMIODARONE HCL	Cordarone (Not a Benefit) 200mg Tab	PFI	N/A	N/A	YES	NO	YES
02223724	AZITHROMYCIN	Zithromax (Not a Benefit) 200mg/5mL O/L-15mL Pk	PFI	N/A	N/A	YES	NO	YES
02223716	AZITHROMYCIN	Zithromax (Not a Benefit) 100mg/5mL O/L-15mL Pk	PFI	N/A	N/A	YES	NO	YES
09857315	AZITHROMYCIN	Zithromax (Not a Benefit) 200mg/5mL O/L-22.5mL Pk	PFI	N/A	N/A	YES	NO	YES
09857637	AZITHROMYCIN	Zithromax (Not a Benefit) 200mg/5mL O/L-37.5mL Pk	PFI	N/A	N/A	YES	NO	YES
02212021	AZITHROMYCIN	Zithromax (Not a Benefit) 250mg Tab	PFI	N/A	N/A	YES	NO	YES
02231143	AZITHROMYCIN	Zithromax (Not a Benefit) 600mg Tab	PFI	N/A	N/A	YES	NO	YES
02419149	BOSUTINIB	Bosulif (Off-Formulary Interchangeable) 100mg Tab	PFI	39.7190	21.4383	YES	NO	NO
02419157	BOSUTINIB	Bosulif (Off-Formulary Interchangeable) 500mg Tab	PFI	155.1328	83.7322	YES	NO	NO
00582301	CLINDAMYCIN	Dalacin T 1% (Off-Formulary Interchangeable) 1% Top Sol	PFI	N/A	N/A	YES	NO	NO
00030570	CLINDAMYCIN HCL	Dalacin C (Not a Benefit) 150mg Cap	PFI	N/A	N/A	YES	NO	NO
02182866	CLINDAMYCIN HCL	Dalacin C (Not a Benefit) 300mg Cap	PFI	N/A	N/A	YES	NO	NO
00225851	CLINDAMYCIN PALMITATE	Dalacin C Flavoured Granules 15mg/mL Pd for Oral Susp	PFI	0.3211	0.3211	NO	NO	NO
00260436	CLINDAMYCIN PHOSPHATE	Dalacin C 300mg/2mL Inj Sol-2mL Pk	PFI	8.8938	8.8938	YES	NO	YES
00642975	COLESTIPOL HCL	Colestid Regular Gran-5g Pk	PFI	1.4595	1.4595	NO	NO	YES
02414686	CONJUGATED ESTROGENS	Premarin 0.625mg SR Tab	PFI	0.4165	0.4165	NO	YES	NO
02043440	CONJUGATED ESTROGENS	Premarin Vaginal Cream 0.625mg/g Vag Cr	PFI	0.9283	0.9283	NO	NO	NO
02352664	DALTEPARIN SODIUM	Fragmin 12500IU/0.5mL Inj Pref Syr	PFI	30.2520	30.2520	NO	YES	NO
02352648	DALTEPARIN SODIUM	Fragmin 7500IU/0.3mL Inj Pref Syr	PFI	18.1504	18.1504	NO	YES	NO
02352680	DALTEPARIN SODIUM	Fragmin 18000IU/0.72mL Inj Pref Syr	PFI	43.5520	43.5520	NO	YES	NO
02352672	DALTEPARIN SODIUM	Fragmin 15000IU/0.6mL Inj Pref Syr	PFI	36.2927	36.2927	NO	YES	NO
02430789	DALTEPARIN SODIUM	Fragmin 3500IU/0.28mL Inj Pref Syr	PFI	8.4689	8.4689	NO	YES	NO
02352656	DALTEPARIN SODIUM	Fragmin 10000IU/0.4mL Inj Pref Syr	PFI	24.2012	24.2012	NO	YES	NO
02132648	DALTEPARIN SODIUM	Fragmin 5000IU/0.2mL Inj Pref Syr	PFI	12.0996	12.0996	NO	YES	NO
02132621	DALTEPARIN SODIUM	Fragmin 2500IU/0.2mL Inj Pref Syr	PFI	6.0498	6.0498	NO	YES	NO
02494582	DALTEPARIN SODIUM	Fragmin 16500IU/0.66mL Inj Pref Syr-0.66mL Pk	PFI	39.9223	39.9223	NO	YES	NO
02231171	DALTEPARIN SODIUM	Fragmin 25000IU/mL Multidose 3.8mL Pk	PFI	181.4839	181.4839	NO	YES	NO
02238348	DELAVIRDINE MESYLATE	Rescriptor 100mg Tab	PFI	0.7609	0.7609	NO	NO	NO
02321092	DESVENLAFAXINE	Pristiq (Off-Formulary Interchangeable) 50mg ER Tab	PFI	N/A	N/A	YES	NO	NO
02321106	DESVENLAFAXINE	Pristiq (Off-Formulary Interchangeable) 100mg ER Tab	PFI	N/A	N/A	YES	NO	NO
01917056	DICLOFENAC SODIUM & MISOPROSTOL	Arthrotec 50 50mg & 200mcg Tab	PFI	0.7788	0.3149	YES	NO	YES
02229837	DICLOFENAC SODIUM & MISOPROSTOL	Arthrotec 75 75mg & 200mcg Tab	PFI	1.0599	0.4286	YES	NO	YES
00036323	DIPHENOXYLATE HYDROCHLORIDE & ATROPINE SULFATE	Lomotil 2.5mg & 0.025mg Tab	PFI	0.5837	0.5837	NO	YES	NO
02269465	DONEPEZIL HCL	Aricept RDT (Off-Formulary Interchangeable) 10mg Orally Disintegrating Tab	PFI	N/A	N/A	YES	NO	NO
02269457	DONEPEZIL HCL	Aricept RDT (Off-Formulary Interchangeable) 5mg Orally Disintegrating Tab	PFI	N/A	N/A	YES	NO	NO
02232044	DONEPEZIL HCL	Aricept 10mg Tab	PFI	5.1856	0.4586	YES	YES	NO
02232043	DONEPEZIL HCL	Aricept 5mg Tab	PFI	5.1856	0.4586	YES	YES	NO
00578452	DOXYCYCLINE HYCLATE	Vibra-Tabs (Not a Benefit) 100mg Tab	PFI	N/A	N/A	YES	NO	NO
02168898	ESTRADIOL	Estring 2mg Vag Ring	PFI	106.5400	106.5400	NO	NO	NO
02236974	ETHINYL ESTRADIOL & LEVONORGESTREL	Alesse 21 20mcg & 100mcg Tab-21 Pk	PFI	16.0696	3.9425	YES	NO	NO
02042320	ETHINYL ESTRADIOL & LEVONORGESTREL	Min-Ovral 21 0.03mg & 0.15mg Tab-21 Pk	PFI	19.2900	7.2800	YES	NO	NO
02236975	ETHINYL ESTRADIOL & LEVONORGESTREL	Alesse 28 20mcg & 100mcg Tab-28 Pk	PFI	16.0696	3.9425	YES	NO	NO
02042339	ETHINYL ESTRADIOL & LEVONORGESTREL	Min-Ovral 28 0.03mg & 0.15mg Tab-28 Pk	PFI	19.2900	7.2800	YES	NO	NO
02187086	ETHINYL ESTRADIOL & NORETHINDRONE	Brevicon 0.035mg & 0.5mg Tab-21 Pk	PFI	16.4500	16.4500	NO	NO	NO
02189054	ETHINYL ESTRADIOL & NORETHINDRONE	Brevicon 1/35 0.035mg & 1mg Tab-21 Pk	PFI	16.4500	16.4500	NO	NO	NO
02187108	ETHINYL ESTRADIOL & NORETHINDRONE	Synphasic 3 Phase Tab-21 Pk	PFI	13.6400	13.6400	NO	NO	NO
02187094	ETHINYL ESTRADIOL & NORETHINDRONE	Brevicon 0.035mg & 0.5mg Tab-28 Pk	PFI	16.4500	16.4500	NO	NO	NO
02189062	ETHINYL ESTRADIOL & NORETHINDRONE	Brevicon 1/35 0.035mg & 1mg Tab-28 Pk	PFI	16.4500	16.4500	NO	NO	NO
02187116	ETHINYL ESTRADIOL & NORETHINDRONE	Synphasic 3 Phase Tab-28 Pk	PFI	13.6400	13.6400	NO	NO	NO
02242705	EXEMESTANE	Aromasin 25mg Tab	PFI	6.3649	3.1232	YES	NO	NO
02380021	FESOTERODINE FUMARATE	Toviaz 4mg Tab	PFI	1.5794	1.1250	YES	YES	NO
02380048	FESOTERODINE FUMARATE	Toviaz 8mg Tab	PFI	1.5794	1.1250	YES	YES	NO
02485575	FILGRASTIM	Nivestym 300mcg/0.5mL Inj Sol-0.5mL Pref Syr	PFI	105.6798	105.6798	NO	NO	NO
02485583	FILGRASTIM	Nivestym 480mcg/0.8mL Inj Sol-0.8mL Pref Syr	PFI	169.0872	169.0872	NO	NO	NO
02485656	FILGRASTIM	Nivestym 480mcg/1.6mL Inj Sol-1.6mL Vial Pk	PFI	169.0872	169.0872	NO	NO	NO
02485591	FILGRASTIM	Nivestym 300mcg/mL Inj Sol-1mL Vial Pk	PFI	105.6798	105.6798	NO	NO	NO
02141442	FLUCONAZOLE	Diflucan-150 150mg Cap	PFI	15.6500	3.9424	YES	YES	YES
02024152	FLUCONAZOLE	Diflucan P.O.S. 10mg/mL O/L	PFI	1.3654	1.3654	NO	YES	NO
00891819	FLUCONAZOLE	Diflucan (Not a Benefit) 100mg Tab	PFI	N/A	N/A	YES	NO	NO
00891800	FLUCONAZOLE	Diflucan (Not a Benefit) 50mg Tab	PFI	N/A	N/A	YES	NO	NO
00600792	FLURBIPROFEN	Ansaid (Not a Benefit) 100mg Tab	PFI	N/A	N/A	YES	NO	YES
00647942	FLURBIPROFEN	Ansaid (Not a Benefit) 50mg Tab	PFI	N/A	N/A	YES	NO	YES
00599026	GEMFIBROZIL	Lopid (Not a Benefit) 300mg Cap	PFI	N/A	N/A	YES	NO	NO
00659606	GEMFIBROZIL	Lopid (Off-Formulary Interchangeable) 600mg Tab	PFI	N/A	N/A	YES	NO	NO
00180408	HYDROCHLOROTHIAZIDE & SPIRONOLACTONE	Aldactazide-25 (Not a Benefit) 25mg & 25mg Tab	PFI	N/A	N/A	YES	NO	NO
00594377	HYDROCHLOROTHIAZIDE & SPIRONOLACTONE	Aldactazide-50 (Not a Benefit) 50mg & 50mg Tab	PFI	N/A	N/A	YES	NO	NO
00030929	HYDROCORTISONE	Cortef 20mg Tab	PFI	0.4155	0.2958	YES	NO	NO
00030910	HYDROCORTISONE	Cortef 10mg Tab	PFI	0.2301	0.1639	YES	NO	NO
09858155	HYDROCORTISONE	Cortef (Temporary Benefit) 10mg Tab	PFI	0.2185	0.2185	NO	NO	NO
00024384	HYDROXYZINE HCL	Atarax (Not a Benefit) 25mg Cap	PFI	N/A	N/A	YES	NO	NO
00024392	HYDROXYZINE HCL	Atarax (Not a Benefit) 50mg Cap	PFI	N/A	N/A	YES	NO	NO
00024376	HYDROXYZINE HCL	Atarax (Not a Benefit) 10mg Cap	PFI	N/A	N/A	YES	NO	NO
02523191	INFLIXIMAB	Ixifi 100mg/Vial Inj Pd-Vial Pk	PFI	493.0000	493.0000	NO	YES	NO
02243685	LINEZOLID	Zyvoxam (Off-Formulary Interchangeable) 2mg/mL Inj-300mL Pk	PFI	N/A	N/A	YES	NO	NO
02243684	LINEZOLID	Zyvoxam (Not a Benefit) 600mg Tab	PFI	N/A	N/A	YES	NO	NO
02041456	LORAZEPAM	Ativan (Off-Formulary Interchangeable) 0.5mg SL Tab	PFI	N/A	N/A	YES	NO	NO
02041472	LORAZEPAM	Ativan (Off-Formulary Interchangeable) 2mg SL Tab	PFI	N/A	N/A	YES	NO	NO
02041464	LORAZEPAM	Ativan (Off-Formulary Interchangeable) 1mg SL Tab	PFI	N/A	N/A	YES	NO	NO
02041413	LORAZEPAM	Ativan 0.5mg Tab	PFI	0.0479	0.0359	YES	NO	NO
02041421	LORAZEPAM	Ativan 1mg Tab	PFI	0.0565	0.0447	YES	NO	NO
02041448	LORAZEPAM	Ativan 2mg Tab	PFI	0.0885	0.0699	YES	NO	NO
00220442	MECLIZINE HCL	Bonamine 25mg Tab	PFI	0.2919	0.2919	NO	NO	NO
09858134	MEDROXYPROGESTERONE ACETATE	Depo-Provera (Temporary Benefit) 150mg/mL Inj Sol-1mL Pref Syr	PFI	31.6900	31.6900	NO	NO	NO
02523493	MEDROXYPROGESTERONE ACETATE	Depo-Provera (Temporary Benefit) 150mg/mL Inj Sol-1mL Pref Syr	PFI	34.7886	34.7886	NO	NO	NO
00030945	MEDROXYPROGESTERONE ACETATE	Provera (Not a Benefit) 100mg Tab	PFI	N/A	N/A	YES	NO	NO
00708917	MEDROXYPROGESTERONE ACETATE	Provera 2.5mg Tab	PFI	0.2567	0.1301	YES	NO	NO
00030937	MEDROXYPROGESTERONE ACETATE	Provera 5mg Tab	PFI	0.5274	0.2602	YES	NO	NO
00729973	MEDROXYPROGESTERONE ACETATE	Provera 10mg Tab	PFI	1.0271	0.5649	YES	NO	NO
02218496	MEROPENEM	Merrem (Off-Formulary Interchangeable) 1g/Vial Pd for Inj Sol	PFI	N/A	N/A	YES	NO	NO
02218488	MEROPENEM	Merrem (Off-Formulary Interchangeable) 500mg/Vial Pd for Inj Sol	PFI	N/A	N/A	YES	NO	NO
02182750	METHOTREXATE	Methotrexate Tablets, USP (Off-Formulary Interchangeable) 10mg Tab	PFI	N/A	N/A	YES	NO	NO
00030988	METHYLPREDNISOLONE	Medrol 4mg Tab	PFI	0.5465	0.5465	NO	NO	NO
00030759	METHYLPREDNISOLONE ACETATE	Depo-Medrol 40mg/mL Inj Susp-1mL Pk	PFI	6.8762	6.8762	NO	NO	NO
00030767	METHYLPREDNISOLONE ACETATE	Depo-Medrol 80mg/mL Inj Susp-1mL Pk	PFI	13.1816	13.1816	NO	NO	NO
01934325	METHYLPREDNISOLONE ACETATE	Depo-Medrol 100mg/5mL Inj Susp-5mL Pk	PFI	15.3767	15.3767	NO	NO	NO
00514497	MINOXIDIL	Loniten 2.5mg Tab	PFI	0.5387	0.5387	NO	NO	NO
00514500	MINOXIDIL	Loniten 10mg Tab	PFI	1.1884	1.1884	NO	NO	NO
02238617	NELFINAVIR MESYLATE	Viracept 250mg Tab	PFI	2.1814	2.1814	NO	NO	NO
02248761	NELFINAVIR MESYLATE	Viracept 625mg Tab	PFI	5.4642	5.4642	NO	NO	NO
02527804	NIRMATRELVIR & RITONAVIR	Paxlovid 150mg & 100mg Tab-20 Pk	PFI	580.0000	580.0000	NO	YES	NO
02524031	NIRMATRELVIR & RITONAVIR	Paxlovid 150mg & 100mg Tab-30 Pk	PFI	1288.8800	1288.8800	NO	YES	NO
02493551	PALBOCICLIB	Ibrance (Off-Formulary Interchangeable) 125mg Tab	PFI	253.9123	126.9562	YES	NO	NO
02493543	PALBOCICLIB	Ibrance (Off-Formulary Interchangeable) 100mg Tab	PFI	253.9123	126.9562	YES	NO	NO
02493535	PALBOCICLIB	Ibrance (Off-Formulary Interchangeable) 75mg Tab	PFI	253.9123	126.9562	YES	NO	NO
02506238	PEGFILGRASTIM	Nyvepria 6mg/0.6mL Inj Sol-0.6mL Pref Syr Pk (Preservative-Free)	PFI	1375.0000	1375.0000	NO	NO	NO
02170817	PIPERACILLIN SODIUM & TAZOBACTAM SODIUM	Tazocin (Off-Formulary Interchangeable) 2g & 250mg Inj Pd-2.25g Vial Pk	PFI	N/A	N/A	YES	NO	NO
00525596	PIROXICAM	Feldene (Not a Benefit) 10mg Cap	PFI	N/A	N/A	YES	NO	YES
00525618	PIROXICAM	Feldene (Not a Benefit) 20mg Cap	PFI	N/A	N/A	YES	NO	YES
02239157	POLYMYXIN B SULFATE & BACITRACIN (ZINC)	Polysporin 10000U & 500U/g Oph Oint 3.5g Pk	PFI	5.5400	5.5400	NO	NO	NO
00560960	PRAZOSIN HCL	Minipress 2mg Tab	PFI	0.3725	0.3725	YES	NO	NO
00560952	PRAZOSIN HCL	Minipress 1mg Tab	PFI	0.2743	0.2743	YES	NO	NO
00560979	PRAZOSIN HCL	Minipress 5mg Tab	PFI	0.5121	0.5121	YES	NO	NO
02042266	PROPRANOLOL	Inderal-LA (Off-Formulary Interchangeable) 120mg LA Cap	PFI	N/A	N/A	YES	NO	NO
01947664	QUINAPRIL	Accupril (Not a Benefit) 5mg Tab	PFI	N/A	N/A	YES	NO	NO
01947672	QUINAPRIL	Accupril (Not a Benefit) 10mg Tab	PFI	N/A	N/A	YES	NO	NO
01947680	QUINAPRIL	Accupril (Not a Benefit) 20mg Tab	PFI	N/A	N/A	YES	NO	NO
01947699	QUINAPRIL	Accupril (Not a Benefit) 40mg Tab	PFI	N/A	N/A	YES	NO	NO
02237367	QUINAPRIL & HYDROCHLOROTHIAZIDE	Accuretic (Not a Benefit) 10mg & 12.5mg Tab	PFI	N/A	N/A	YES	NO	NO
02237368	QUINAPRIL & HYDROCHLOROTHIAZIDE	Accuretic (Not a Benefit) 20mg & 12.5mg Tab	PFI	N/A	N/A	YES	NO	NO
02237369	QUINAPRIL & HYDROCHLOROTHIAZIDE	Accuretic (Not a Benefit) 20mg & 25mg Tab	PFI	N/A	N/A	YES	NO	NO
02063786	RIFABUTIN	Mycobutin 150mg Cap	PFI	6.3342	6.3342	NO	YES	NO
02495724	RITUXIMAB	Ruxience 10mg/mL Inj Sol (Preservative-Free)	PFI	29.7000	29.7000	NO	YES	NO
00028606	SPIRONOLACTONE	Aldactone 25mg Tab	PFI	0.2746	0.0405	YES	NO	YES
00285455	SPIRONOLACTONE	Aldactone 100mg Tab	PFI	0.6410	0.0955	YES	NO	YES
02064472	SULFASALAZINE	Salazopyrin EN-TABS 500 MG 500mg Ent Tab	PFI	0.5616	0.3863	YES	NO	NO
02064480	SULFASALAZINE	Salazopyrin 500mg Tab	PFI	0.3682	0.1807	YES	NO	NO
02280817	SUNITINIB MALATE	Sutent (Off-Formulary Interchangeable) 50mg Cap	PFI	265.4444	221.4208	YES	NO	NO
02280795	SUNITINIB MALATE	Sutent (Off-Formulary Interchangeable) 12.5mg Cap	PFI	66.3613	55.3553	YES	NO	NO
02280809	SUNITINIB MALATE	Sutent (Off-Formulary Interchangeable) 25mg Cap	PFI	132.7216	110.7100	YES	NO	NO
00030783	TESTOSTERONE CYPIONATE	Depo-Testosterone 100mg/mL Oily Inj Sol-10mL Pk	PFI	48.1300	34.8780	YES	YES	NO
00024422	TETRACYCLINE	Tetracyn (Not a Benefit) 250mg Cap	PFI	N/A	N/A	YES	NO	YES
02285401	TIGECYCLINE	Tygacil 50mg/Vial Pd for Inj-5mLVial Pk (Preservative-Free)	PFI	83.4740	83.4740	NO	NO	NO
02423898	TOFACITINIB	Xeljanz 5mg Tab	PFI	24.7733	5.9897	YES	YES	NO
02480786	TOFACITINIB	Xeljanz 10mg Tab	PFI	43.7833	10.5859	YES	YES	NO
02470608	TOFACITINIB CITRATE	Xeljanz XR 11mg ER Tab	PFI	49.5467	27.2507	YES	YES	NO
02064405	TRANEXAMIC ACID	Cyklokapron (Off-Formulary Interchangeable) 500mg Tab	PFI	N/A	N/A	YES	NO	NO
00443158	TRIAZOLAM	Halcion (Not a Benefit) 0.25mg Tab	PFI	N/A	N/A	YES	NO	NO
02291177	VARENICLINE TARTRATE	Champix (Not a Benefit) 0.5mg Tab	PFI	N/A	N/A	YES	NO	NO
02291185	VARENICLINE TARTRATE	Champix (Not a Benefit) 1.0mg Tab	PFI	N/A	N/A	YES	NO	NO
09857519	VARENICLINE TARTRATE	Champix (Not a Benefit) 0.5mg & 1.0mg Tab (Starter Pack-53 Tabs)	PFI	N/A	N/A	YES	NO	NO
02256479	VORICONAZOLE	Vfend 200mg Tab	PFI	54.2323	26.4807	YES	YES	NO
02256460	VORICONAZOLE	Vfend 50mg Tab	PFI	13.5635	6.7818	YES	YES	NO

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