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Products found: 79New Search
DIN/ PIN/ NPNGeneric NameBrand Name, Strength & Dosage FormMFRDrug Benefit Price or Unit PriceAmount MOH PaysInter- change- ableLimited UseThera- peutic Notes
01926578ACEBUTOLOL HCLSectral (Not a Benefit) 400mg TabSAVN/AN/AYESNONO
01926551ACEBUTOLOL HCLSectral (Not a Benefit) 200mg TabSAVN/AN/AYESNONO
01926543ACEBUTOLOL HCLSectral (Not a Benefit) 100mg TabSAVN/AN/AYESNONO
02245565ALFUZOSIN HYDROCHLORIDEXatral 10mg Prolong-Rel TabSAV1.09000.2601YESYESNO
01926691CALCITONIN (SALMON SYNTHETIC)Calcimar 400IU/2mL Inj Sol-2mL PkSAV65.440065.4400NONONO
02330555CLOPIDOGREL BISULFATEPlavix (Off-Formulary Interchangeable) 300mg TabSAVN/AN/AYESNONO
02238682CLOPIDOGREL BISULFATEPlavix 75mg TabSAV2.81800.2631YESNONO
02018152DANAZOLCyclomen 100mg CapSAV1.59101.5910NONONO
02018160DANAZOLCyclomen 200mg CapSAV2.54252.5425NONONO
02018144DANAZOLCyclomen 50mg CapSAV1.07201.0720NONONO
02099128DESIPRAMINENorpramin (Not a Benefit) 25mg TabSAVN/AN/AYESNONO
02099136DESIPRAMINENorpramin (Not a Benefit) 50mg TabSAVN/AN/AYESNONO
02236564ENOXAPARINLovenox 100mg/mL Inj Sol-3mL Vial PkSAV68.750068.7500NOYESNO
02012472ENOXAPARINLovenox 30mg/0.3mL Pref Syr-0.3mL PkSAV6.87506.8750NOYESNO
02236883ENOXAPARINLovenox 40mg/0.4mL Pref Syr-0.4mL PkSAV9.16609.1660NOYESNO
02378426ENOXAPARINLovenox 60mg/0.6mL Pref Syr-0.6mL PkSAV13.749013.7490NOYESNO
02378434ENOXAPARINLovenox 80mg/0.8mL Pref Syr-0.8mL PkSAV18.333018.3330NOYESNO
02242692ENOXAPARINLovenox HP 120mg/0.8mL Pref Syr-0.8mL PkSAV27.499027.4990NOYESNO
02378442ENOXAPARINLovenox 100mg/mL Pref Syr-1mL PkSAV22.916022.9160NOYESNO
02378469ENOXAPARINLovenox HP 150mg/mL Pref Syr-1mL PkSAV34.375034.3750NOYESNO
02017598ERGOCALCIFEROLDrisdol (Not a Benefit) 8288IU/mL O/LSAVN/AN/AYESNONO
02222000FELODIPINERenedil (Not a Benefit) 10mg SR TabSAVN/AN/AYESNOYES
02221993FELODIPINERenedil (Not a Benefit) 5mg SR TabSAVN/AN/AYESNOYES
02224623FRAMYCETIN SULFATE & GRAMICIDIN & DEXAMETHASONESofracort 5mg & 50mcg & 0.5mg/mL Oph/Ot SolSAV2.12632.1263NONOYES
02224720FUROSEMIDELasix 10mg/mL O/LSAV0.34650.3465NONONO
02224704FUROSEMIDELasix (Not a Benefit) 40mg TabSAVN/AN/AYESNONO
02224690FUROSEMIDELasix (Not a Benefit) 20mg TabSAVN/AN/AYESNONO
02224755FUROSEMIDELasix Special 500mg TabSAV3.57003.5700NOYESNO
02245272GLIMEPIRIDEAmaryl (Off-Formulary Interchangeable) 1mg TabSAVN/AN/AYESNONO
02245273GLIMEPIRIDEAmaryl (Off-Formulary Interchangeable) 2mg TabSAVN/AN/AYESNONO
02245274GLIMEPIRIDEAmaryl (Off-Formulary Interchangeable) 4mg TabSAVN/AN/AYESNONO
02224569GLYBURIDEDiabeta (Not a Benefit) 5mg TabSAVN/AN/AYESNONO
02224550GLYBURIDEDiabeta (Not a Benefit) 2.5mg TabSAVN/AN/AYESNONO
02017709HYDROXYCHLOROQUINE SULFATEPlaquenil 200mg TabSAV0.65160.1576YESNONO
02245689INSULIN GLARGINELantus-(Vial) 100U/mL Inj Sol-10mL Vial PkSAV61.690061.6900NOYESNO
02294338INSULIN GLARGINELantus Solostar 100U/mL Inj Sol-5x3mL PkSAV92.850092.8500NOYESNO
02251930INSULIN GLARGINELantus-(Cartridge) 100U/mL Inj Sol-5x3mL PkSAV92.850092.8500NOYESNO
02279479INSULIN GLULISINE (DNA ORIGIN)Apidra 100U/mL Inj 5x3mL Cart ClickStar PenSAV54.700054.7000NONOYES
02279460INSULIN GLULISINE (DNA ORIGIN)Apidra 100U/mL Inj Sol-10mL VialSAV27.610027.6100NONOYES
02294346INSULIN GLULISINE (DNA ORIGIN)Apidra 100U/mL Inj Sol-5x3mL SoloSTAR Pref PenSAV55.220055.2200NONOYES
02237925IRBESARTANAvapro 300mg TabSAV1.26710.2281YESNONO
02237923IRBESARTANAvapro 75mg TabSAV1.26710.2281YESNONO
02237924IRBESARTANAvapro 150mg TabSAV1.26710.2281YESNONO
02241819IRBESARTAN & HYDROCHLOROTHIAZIDEAvalide 300mg & 12.5mg TabSAV1.31660.2281YESNONO
02241818IRBESARTAN & HYDROCHLOROTHIAZIDEAvalide 150mg & 12.5mg TabSAV1.31660.2281YESNONO
02280213IRBESARTAN & HYDROCHLOROTHIAZIDEAvalide (Not a Benefit) 300mg & 25mg TabSAVN/AN/AYESNONO
00761680KETOPROFENRhodis-EC (Not a Benefit) 100mg Ent TabSAVN/AN/AYESNOYES
02241889LEFLUNOMIDEArava 20mg TabSAV11.44432.0000YESNONO
02241888LEFLUNOMIDEArava 10mg TabSAV11.44402.0000YESNONO
02099233METFORMIN HCLGlucophage 500mg TabSAV0.28210.0247YESNONO
02162849METFORMIN HCLGlucophage (Off-Formulary Interchangeable) 850mg TabSAVN/AN/AYESNONO
01927655METHOTRIMEPRAZINENozinan (Not a Benefit) 5mg TabSAVN/AN/AYESNONO
01927663METHOTRIMEPRAZINENozinan (Not a Benefit) 25mg TabSAVN/AN/AYESNONO
01927671METHOTRIMEPRAZINENozinan (Not a Benefit) 50mg TabSAVN/AN/AYESNONO
00888400METOLAZONEZaroxolyn 2.5mg TabSAV0.22940.2294NONONO
01926861METRONIDAZOLEFlagyl 10% Vag Cr-AppSAV0.27400.2740NONONO
01926845METRONIDAZOLE & NYSTATINFlagystatin 500mg & 100000U/g Vag Cr-AppSAV0.60760.6076NONONO
01926829METRONIDAZOLE & NYSTATINFlagystatin 500mg & 100000U Vag SupSAV3.69803.6980NONONO
02231441NITROGLYCERINNitrolingual Pump Spray 0.4mg/Metered Dose Spray-200 Dose PkSAV16.00008.4200YESNONO
02221977PENTOXIFYLLINETrental (Not a Benefit) 400mg SR TabSAVN/AN/AYESNONO
02026961POLYSTYRENE SODIUM SULFONATEKayexalate 1mEq/g Oral Pd-454g PkSAV43.630029.4175YESNONO
02230619PREDNISOLONE SODIUM PHOSPHATEPediapred Oral Liquid 6.7mg/5mL O/LSAV0.15000.0900YESNONO
02221853RAMIPRILAltace Cap 10mgSAV1.42490.1034YESNONO
02221845RAMIPRILAltace Cap 5mgSAV1.10910.0817YESNONO
02221837RAMIPRILAltace Cap 2.5mgSAV1.08100.0817YESNONO
02221829RAMIPRILAltace Cap 1.25mgSAV0.96080.0708YESNONO
02281112RAMIPRILAltace (Off-Formulary Interchangeable) 15mg CapSAVN/AN/AYESNONO
02283131RAMIPRIL & HYDROCHLOROTHIAZIDEAltace HCT (Not a Benefit) 2.5mg & 12.5mg TabSAVN/AN/AYESNONO
02283158RAMIPRIL & HYDROCHLOROTHIAZIDEAltace HCT (Not a Benefit) 5mg & 12.5mg TabSAVN/AN/AYESNONO
02283182RAMIPRIL & HYDROCHLOROTHIAZIDEAltace HCT 10mg & 25mg TabSAV0.65250.2634YESNONO
02283166RAMIPRIL & HYDROCHLOROTHIAZIDEAltace HCT 10mg & 12.5mg TabSAV0.65250.2634YESNONO
02283174RAMIPRIL & HYDROCHLOROTHIAZIDEAltace HCT 5mg & 25mg TabSAV0.49810.2872YESNONO
02354586SEVELAMER CARBONATERenvela (Off-Formulary Interchangeable) 800mg TabSAV1.31251.2634YESNONO
01926624TAMOXIFEN CITRATETamofen (Not a Benefit) 10mg TabSAVN/AN/AYESNONO
01926632TAMOXIFEN CITRATETamofen (Not a Benefit) 20mg TabSAVN/AN/AYESNONO
02221950TIAPROFENIC ACIDSurgam (Not a Benefit) 300mg TabSAVN/AN/AYESNOYES
01926519TRETINOINVitamin A Acid (Not a Benefit) 0.05% CrSAVN/AN/AYESNONO
01926799ZOPICLONEImovane (Off-Formulary Interchangeable) 7.5mg TabSAVN/AN/AYESNONO
02216167ZOPICLONEImovane (Off-Formulary Interchangeable) 5mg TabSAVN/AN/AYESNONO