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Products found: 138New Search
DIN/ PIN/ NPNGeneric NameBrand Name, Strength & Dosage FormMFRDrug Benefit Price or Unit PriceAmount MOH PaysInter- change- ableLimited UseThera- peutic Notes
02511045ADALIMUMABAbrilada 40mg/0.8mL Inj Sol-0.8mL Pref Pen (Preservative-Free)PFI471.2700471.2700NOYESNO
02511053ADALIMUMABAbrilada 40mg/0.8mL Inj Sol-0.8mL Pref Syr (Preservative-Free)PFI471.2700471.2700NOYESNO
02036282AMIODARONE HCLCordarone (Not a Benefit) 200mg TabPFIN/AN/AYESNOYES
02223724AZITHROMYCINZithromax 200mg/5mL O/L-15mL PkPFI24.988512.4943YESNOYES
02223716AZITHROMYCINZithromax 100mg/5mL O/L-15mL PkPFI17.64158.8208YESNOYES
09857315AZITHROMYCINZithromax 200mg/5mL O/L-22.5mL PkPFI37.482818.7425YESNOYES
09857637AZITHROMYCINZithromax (Not a Benefit) 200mg/5mL O/L-37.5mL PkPFIN/AN/AYESNOYES
02212021AZITHROMYCINZithromax 250mg TabPFI5.43820.9410YESNOYES
02231143AZITHROMYCINZithromax (Not a Benefit) 600mg TabPFIN/AN/AYESNOYES
00582301CLINDAMYCINDalacin T 1% (Off-Formulary Interchangeable) 1% Top SolPFIN/AN/AYESNONO
00030570CLINDAMYCIN HCLDalacin C 150mg CapPFI1.45040.2217YESNONO
02182866CLINDAMYCIN HCLDalacin C 300mg CapPFI2.90080.4434YESNONO
00225851CLINDAMYCIN PALMITATEDalacin C Flavoured Granules 15mg/mL Pd for Oral SuspPFI0.31520.3152NONONO
00260436CLINDAMYCIN PHOSPHATEDalacin C 300mg/2mL Inj Sol-2mL PkPFI8.89388.8938YESNOYES
00642975COLESTIPOL HCLColestid Regular Gran-5g PkPFI1.45951.4595NONOYES
02414686CONJUGATED ESTROGENSPremarin 0.625mg SR TabPFI0.40880.4088NOYESNO
02043440CONJUGATED ESTROGENSPremarin Vaginal Cream 0.625mg/g Vag CrPFI0.91100.9110NONONO
02352648DALTEPARIN SODIUMFragmin 7500IU/0.3mL Inj Pref SyrPFI17.812017.8120NOYESNO
02352680DALTEPARIN SODIUMFragmin 18000IU/0.72mL Inj Pref SyrPFI42.740042.7400NOYESNO
02352672DALTEPARIN SODIUMFragmin 15000IU/0.6mL Inj Pref SyrPFI35.616035.6160NOYESNO
02352664DALTEPARIN SODIUMFragmin 12500IU/0.5mL Inj Pref SyrPFI29.688029.6880NOYESNO
02352656DALTEPARIN SODIUMFragmin 10000IU/0.4mL Inj Pref SyrPFI23.750023.7500NOYESNO
02132648DALTEPARIN SODIUMFragmin 5000IU/0.2mL Inj Pref SyrPFI11.874011.8740NOYESNO
02132621DALTEPARIN SODIUMFragmin 2500IU/0.2mL Inj Pref SyrPFI5.93705.9370NOYESNO
02430789DALTEPARIN SODIUMFragmin 3500IU/0.28mL Inj Pref SyrPFI8.31108.3110NOYESNO
02494582DALTEPARIN SODIUMFragmin 16500IU/0.66mL Inj Pref Syr-0.66mL PkPFI39.178039.1780NOYESNO
02132664DALTEPARIN SODIUMFragmin 10000IU/mL Inj Sol-1mL PkPFI18.748018.7480NOYESNO
02231171DALTEPARIN SODIUMFragmin 25000IU/mL Multidose 3.8mL PkPFI178.1000178.1000NOYESNO
02238348DELAVIRDINE MESYLATERescriptor 100mg TabPFI0.76090.7609NONONO
02321106DESVENLAFAXINEPristiq (Off-Formulary Interchangeable) 100mg ER TabPFIN/AN/AYESNONO
02321092DESVENLAFAXINEPristiq (Off-Formulary Interchangeable) 50mg ER TabPFIN/AN/AYESNONO
01917056DICLOFENAC SODIUM & MISOPROSTOLArthrotec 50 50mg & 200mcg TabPFI0.74490.3149YESNOYES
02229837DICLOFENAC SODIUM & MISOPROSTOLArthrotec 75 75mg & 200mcg TabPFI1.01380.4286YESNOYES
00036323DIPHENOXYLATE HYDROCHLORIDE & ATROPINE SULFATELomotil 2.5mg & 0.025mg TabPFI0.55830.5583NOYESNO
02269457DONEPEZIL HCLAricept RDT (Off-Formulary Interchangeable) 5mg Orally Disintegrating TabPFIN/AN/AYESNONO
02269465DONEPEZIL HCLAricept RDT (Off-Formulary Interchangeable) 10mg Orally Disintegrating TabPFIN/AN/AYESNONO
02232044DONEPEZIL HCLAricept 10mg TabPFI5.18560.4586YESYESNO
02232043DONEPEZIL HCLAricept 5mg TabPFI5.18560.4586YESYESNO
00578452DOXYCYCLINE HYCLATEVibra-Tabs (Not a Benefit) 100mg TabPFIN/AN/AYESNONO
02168898ESTRADIOLEstring 2mg Vag RingPFI99.480099.4800NONONO
02236974ETHINYL ESTRADIOL & LEVONORGESTRELAlesse 21 20mcg & 100mcg Tab-21 PkPFI15.77003.9425YESNONO
02042320ETHINYL ESTRADIOL & LEVONORGESTRELMin-Ovral 21 0.03mg & 0.15mg Tab-21 PkPFI19.29007.2800YESNONO
02236975ETHINYL ESTRADIOL & LEVONORGESTRELAlesse 28 20mcg & 100mcg Tab-28 PkPFI15.77003.9425YESNONO
02042339ETHINYL ESTRADIOL & LEVONORGESTRELMin-Ovral 28 0.03mg & 0.15mg Tab-28 PkPFI19.29007.2800YESNONO
02187086ETHINYL ESTRADIOL & NORETHINDRONEBrevicon 0.035mg & 0.5mg Tab-21 PkPFI15.670015.6700NONONO
02189054ETHINYL ESTRADIOL & NORETHINDRONEBrevicon 1/35 0.035mg & 1mg Tab-21 PkPFI15.670015.6700NONONO
02187108ETHINYL ESTRADIOL & NORETHINDRONESynphasic 3 Phase Tab-21 PkPFI13.640013.6400NONONO
02187094ETHINYL ESTRADIOL & NORETHINDRONEBrevicon 0.035mg & 0.5mg Tab-28 PkPFI15.670015.6700NONONO
02189062ETHINYL ESTRADIOL & NORETHINDRONEBrevicon 1/35 0.035mg & 1mg Tab-28 PkPFI15.670015.6700NONONO
02187116ETHINYL ESTRADIOL & NORETHINDRONESynphasic 3 Phase Tab-28 PkPFI13.640013.6400NONONO
02242705EXEMESTANEAromasin 25mg TabPFI6.24631.3263YESNONO
02380021FESOTERODINE FUMARATEToviaz 4mg TabPFI1.55001.1250YESYESNO
02380048FESOTERODINE FUMARATEToviaz 8mg TabPFI1.55001.1250YESYESNO
02485575FILGRASTIMNivestym 300mcg/0.5mL Inj Sol-0.5mL Pref SyrPFI144.3100144.3100NONONO
02485583FILGRASTIMNivestym 480mcg/0.8mL Inj Sol-0.8mL Pref SyrPFI230.9000230.9000NONONO
02485656FILGRASTIMNivestym 480mcg/1.6mL Inj Sol-1.6mL Vial PkPFI230.9000230.9000NONONO
02485591FILGRASTIMNivestym 300mcg/mL Inj Sol-1mL Vial PkPFI144.3100144.3100NONONO
02141442FLUCONAZOLEDiflucan-150 150mg CapPFI15.76973.9424YESYESYES
02024152FLUCONAZOLEDiflucan P.O.S. 10mg/mL O/LPFI1.36541.3654NOYESNO
00891800FLUCONAZOLEDiflucan (Not a Benefit) 50mg TabPFIN/AN/AYESNONO
00891819FLUCONAZOLEDiflucan (Not a Benefit) 100mg TabPFIN/AN/AYESNONO
00600792FLURBIPROFENAnsaid (Not a Benefit) 100mg TabPFIN/AN/AYESNOYES
00647942FLURBIPROFENAnsaid (Not a Benefit) 50mg TabPFIN/AN/AYESNOYES
00599026GEMFIBROZILLopid (Not a Benefit) 300mg CapPFIN/AN/AYESNONO
00659606GEMFIBROZILLopid (Off-Formulary Interchangeable) 600mg TabPFIN/AN/AYESNONO
00180408HYDROCHLOROTHIAZIDE & SPIRONOLACTONEAldactazide-25 (Not a Benefit) 25mg & 25mg TabPFIN/AN/AYESNONO
00594377HYDROCHLOROTHIAZIDE & SPIRONOLACTONEAldactazide-50 (Not a Benefit) 50mg & 50mg TabPFIN/AN/AYESNONO
00030910HYDROCORTISONECortef 10mg TabPFI0.22590.1639YESNONO
09858155HYDROCORTISONECortef (Temporary Benefit) 10mg TabPFI0.21850.2185NONONO
00030929HYDROCORTISONECortef 20mg TabPFI0.40780.2958YESNONO
00024376HYDROXYZINE HCLAtarax (Not a Benefit) 10mg CapPFIN/AN/AYESNONO
00024384HYDROXYZINE HCLAtarax (Not a Benefit) 25mg CapPFIN/AN/AYESNONO
00024392HYDROXYZINE HCLAtarax (Not a Benefit) 50mg CapPFIN/AN/AYESNONO
02243685LINEZOLIDZyvoxam (Off-Formulary Interchangeable) 2mg/mL Inj-300mL PkPFIN/AN/AYESNONO
02243684LINEZOLIDZyvoxam (Not a Benefit) 600mg TabPFIN/AN/AYESNONO
02041464LORAZEPAMAtivan (Off-Formulary Interchangeable) 1mg SL TabPFIN/AN/AYESNONO
02041472LORAZEPAMAtivan (Off-Formulary Interchangeable) 2mg SL TabPFIN/AN/AYESNONO
02041456LORAZEPAMAtivan (Off-Formulary Interchangeable) 0.5mg SL TabPFIN/AN/AYESNONO
02041448LORAZEPAMAtivan 2mg TabPFI0.08850.0699YESNONO
02041421LORAZEPAMAtivan 1mg TabPFI0.05650.0447YESNONO
02041413LORAZEPAMAtivan 0.5mg TabPFI0.04790.0359YESNONO
00220442MECLIZINE HCLBonamine 25mg TabPFI0.29190.2919NONONO
02523493MEDROXYPROGESTERONE ACETATEDepo-Provera (Temporary Benefit) 150mg/mL Inj Sol-1mL Pref SyrPFI33.270033.2700NONONO
09858134MEDROXYPROGESTERONE ACETATEDepo-Provera (Temporary Benefit) 150mg/mL Inj Sol-1mL Pref SyrPFI31.690031.6900NONONO
00030945MEDROXYPROGESTERONE ACETATEProvera (Not a Benefit) 100mg TabPFIN/AN/AYESNONO
00729973MEDROXYPROGESTERONE ACETATEProvera 10mg TabPFI1.02710.1670YESNONO
00030937MEDROXYPROGESTERONE ACETATEProvera 5mg TabPFI0.52740.2365YESNONO
00708917MEDROXYPROGESTERONE ACETATEProvera 2.5mg TabPFI0.25670.1183YESNONO
02218496MEROPENEMMerrem (Off-Formulary Interchangeable) 1g/Vial Pd for Inj SolPFIN/AN/AYESNONO
02218488MEROPENEMMerrem (Off-Formulary Interchangeable) 500mg/Vial Pd for Inj SolPFIN/AN/AYESNONO
00030988METHYLPREDNISOLONEMedrol 4mg TabPFI0.53640.5364NONONO
00030759METHYLPREDNISOLONE ACETATEDepo-Medrol 40mg/mL Inj Susp-1mL PkPFI6.74806.7480NONONO
00030767METHYLPREDNISOLONE ACETATEDepo-Medrol 80mg/mL Inj Susp-1mL PkPFI12.935912.9359NONONO
01934325METHYLPREDNISOLONE ACETATEDepo-Medrol 100mg/5mL Inj Susp-5mL PkPFI15.090015.0900NONONO
00514500MINOXIDILLoniten 10mg TabPFI1.15821.1582NONONO
00514497MINOXIDILLoniten 2.5mg TabPFI0.52500.5250NONONO
02238617NELFINAVIR MESYLATEViracept 250mg TabPFI2.18142.1814NONONO
02248761NELFINAVIR MESYLATEViracept 625mg TabPFI5.46425.4642NONONO
02527804NIRMATRELVIR & RITONAVIRPaxlovid 150mg & 100mg Tab-20 PkPFI1288.88001288.8800NOYESNO
02524031NIRMATRELVIR & RITONAVIRPaxlovid 150mg & 100mg Tab-30 PkPFI1288.88001288.8800NOYESNO
02506238PEGFILGRASTIMNyvepria 6mg/0.6mL Inj Sol-0.6mL Pref Syr Pk (Preservative-Free)PFI1375.00001375.0000NONONO
02170817PIPERACILLIN SODIUM & TAZOBACTAM SODIUMTazocin (Off-Formulary Interchangeable) 2g & 250mg Inj Pd-2.25g Vial PkPFIN/AN/AYESNONO
00525596PIROXICAMFeldene (Not a Benefit) 10mg CapPFIN/AN/AYESNOYES
00525618PIROXICAMFeldene (Not a Benefit) 20mg CapPFIN/AN/AYESNOYES
02239157POLYMYXIN B SULFATE & BACITRACIN (ZINC)Polysporin 10000U & 500U/g Oph Oint 3.5g PkPFI5.54005.5400NONONO
00560960PRAZOSIN HCLMinipress 2mg TabPFI0.37250.3725YESNONO
00560952PRAZOSIN HCLMinipress 1mg TabPFI0.27430.2743YESNONO
00560979PRAZOSIN HCLMinipress 5mg TabPFI0.51210.5121YESNONO
02042266PROPRANOLOLInderal-LA (Off-Formulary Interchangeable) 120mg LA CapPFIN/AN/AYESNONO
01947664QUINAPRILAccupril 5mg TabPFI1.01310.4642YESNONO
01947672QUINAPRILAccupril 10mg TabPFI1.01310.2321YESNONO
01947680QUINAPRILAccupril 20mg TabPFI1.01310.2321YESNONO
01947699QUINAPRILAccupril 40mg TabPFI1.01310.2321YESNONO
02237367QUINAPRIL & HYDROCHLOROTHIAZIDEAccuretic 10mg & 12.5mg TabPFI1.01890.4786YESNONO
02237368QUINAPRIL & HYDROCHLOROTHIAZIDEAccuretic 20mg & 12.5mg TabPFI1.01890.4786YESNONO
02237369QUINAPRIL & HYDROCHLOROTHIAZIDEAccuretic 20mg & 25mg TabPFI0.97970.4602YESNONO
02063786RIFABUTINMycobutin 150mg CapPFI6.21616.2161NOYESNO
02495724RITUXIMABRuxience 10mg/mL Inj Sol-Vial (Preservative-Free)PFI29.700029.7000NOYESNO
00285455SPIRONOLACTONEAldactone 100mg TabPFI0.64100.0955YESNOYES
00028606SPIRONOLACTONEAldactone 25mg TabPFI0.27460.0405YESNOYES
02064472SULFASALAZINESalazopyrin EN-TABS 500 MG 500mg Ent TabPFI0.55120.3863YESNONO
02064480SULFASALAZINESalazopyrin 500mg TabPFI0.36140.2533YESNONO
02280817SUNITINIB MALATESutent (Off-Formulary Interchangeable) 50mg CapPFI260.4950221.4208YESNONO
02280795SUNITINIB MALATESutent (Off-Formulary Interchangeable) 12.5mg CapPFI65.124055.3553YESNONO
02280809SUNITINIB MALATESutent (Off-Formulary Interchangeable) 25mg CapPFI130.2470110.7100YESNONO
00030783TESTOSTERONE CYPIONATEDepo-Testosterone 100mg/mL Oily Inj Sol-10mL PkPFI48.130034.8780YESYESNO
00024422TETRACYCLINETetracyn (Not a Benefit) 250mg CapPFIN/AN/AYESNOYES
02285401TIGECYCLINETygacil 50mg/Vial Pd for Inj-5mLVial Pk (Preservative-Free)PFI83.474083.4740NONONO
02423898TOFACITINIBXeljanz 5mg TabPFI24.77335.9897YESYESNO
02480786TOFACITINIBXeljanz 10mg TabPFI43.783321.1718YESYESNO
02470608TOFACITINIB CITRATEXeljanz XR 11mg ER TabPFI49.546749.5467NOYESNO
02064405TRANEXAMIC ACIDCyklokapron (Off-Formulary Interchangeable) 500mg TabPFIN/AN/AYESNONO
00443158TRIAZOLAMHalcion (Not a Benefit) 0.25mg TabPFIN/AN/AYESNONO
02291177VARENICLINE TARTRATEChampix 0.5mg TabPFI1.84730.9237YESYESNO
02291185VARENICLINE TARTRATEChampix 1.0mg TabPFI1.84700.9235YESYESNO
09857519VARENICLINE TARTRATEChampix 0.5mg & 1.0mg Tab (Starter Pack-53 Tabs)PFI97.546948.7759YESYESNO
02256460VORICONAZOLEVfend 50mg TabPFI13.56353.3909YESYESNO
02256479VORICONAZOLEVfend 200mg TabPFI54.232313.2403YESYESNO