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Products found: 15

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
02453819	ALIROCUMAB	Praluent 75mg/mL Inj Sol-Pref Pen	SAC	267.8300	267.8300	NO	YES	NO
02453835	ALIROCUMAB	Praluent 150mg/mL Inj Sol-Pref Pen	SAC	267.8300	267.8300	NO	YES	NO
02547732	ALIROCUMAB	Praluent 300mg/2mL Inj Sol-Pref Pen 2mL Pk (Preservative-Free)	SAC	535.6600	535.6600	NO	YES	NO
02529254	INSULIN ASPART	Trurapi 100U/mL Inj Sol-10mL Vial Pk	SAC	22.6430	22.6430	NO	NO	NO
02506564	INSULIN ASPART	Trurapi 100U/mL Inj Sol-5x3mL Cart Pk	SAC	45.0000	45.0000	NO	NO	NO
02506572	INSULIN ASPART	Trurapi 100U/mL Inj Sol-5x3mL SoloSTAR Pref Pen Pk	SAC	45.0000	45.0000	NO	NO	NO
02441829	INSULIN GLARGINE	TOUJEO SoloSTAR 300U/mL Inj Sol-1.5mL Pref Pen	SAC	26.4333	26.4333	NO	NO	NO
02493373	INSULIN GLARGINE	Toujeo DoubleSTAR 300U/mL Inj Sol-3mL Pref Pen	SAC	52.8666	52.8666	NO	NO	NO
02478293	INSULIN GLARGINE & LIXISENATIDE	Soliqua 100U/mL & 33mcg/mL Inj Sol-Pref Pen 5x3mL Pk	SAC	198.3700	198.3700	NO	NO	YES
02469901	INSULIN LISPRO	Admelog 100U/mL Inj Sol-10mL Vial Pk	SAC	22.7000	22.7000	NO	NO	NO
02469898	INSULIN LISPRO	Admelog 100U/mL Inj Sol-5x3mL Cart Pk	SAC	45.0000	45.0000	NO	NO	NO
02469871	INSULIN LISPRO	Admelog 100U/mL Inj Sol-5x3mL SoloSTAR Pref Pen Pk	SAC	45.0000	45.0000	NO	NO	NO
01926853	METRONIDAZOLE	Flagyl (Not a Benefit) 500mg Cap	SAC	N/A	N/A	YES	NO	NO
09858327	NITROGLYCERIN	Nitrolingual Pumpspray (Temporary Benefit) 0.4mg/Metered Dose Sp-75 Dose Pk	SAC	9.4000	9.4000	NO	NO	NO
02242763	RILUZOLE	Rilutek (Off-Formulary Interchangeable) 50mg Tab	SAC	10.5500	7.3630	YES	NO	NO