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Products found: 80New Search
DIN/ PIN/ NPNGeneric NameBrand Name, Strength & Dosage FormMFRDrug Benefit Price or Unit PriceAmount MOH PaysInter- change- ableLimited UseThera- peutic Notes
01926543ACEBUTOLOL HCLSectral (Not a Benefit) 100mg TabSAVN/AN/AYESNONO
01926551ACEBUTOLOL HCLSectral (Not a Benefit) 200mg TabSAVN/AN/AYESNONO
01926578ACEBUTOLOL HCLSectral (Not a Benefit) 400mg TabSAVN/AN/AYESNONO
02245565ALFUZOSIN HYDROCHLORIDEXatral 10mg Prolong-Rel TabSAV1.07580.2601YESYESNO
01926691CALCITONIN (SALMON SYNTHETIC)Calcimar 400IU/2mL Inj Sol-2mL PkSAV63.040063.0400NONONO
02238682CLOPIDOGREL BISULFATEPlavix 75mg TabSAV2.71250.2631YESNONO
02330555CLOPIDOGREL BISULFATEPlavix (Off-Formulary Interchangeable) 300mg TabSAVN/AN/AYESNONO
02018144DANAZOLCyclomen 50mg CapSAV1.03241.0324NONONO
02018160DANAZOLCyclomen 200mg CapSAV2.44862.4486NONONO
02018152DANAZOLCyclomen 100mg CapSAV1.53231.5323NONONO
02099136DESIPRAMINENorpramin (Not a Benefit) 50mg TabSAVN/AN/AYESNONO
02099128DESIPRAMINENorpramin (Not a Benefit) 25mg TabSAVN/AN/AYESNONO
02236564ENOXAPARINLovenox 100mg/mL Inj Sol-3mLVial PkSAV66.170066.1700NOYESNO
02012472ENOXAPARINLovenox 30mg/0.3mL Pref Syr-0.3mL PkSAV6.61706.6170NOYESNO
02236883ENOXAPARINLovenox 40mg/0.4mL Pref Syr-0.4mL PkSAV8.82208.8220NOYESNO
02378426ENOXAPARINLovenox 60mg/0.6mL Pref Syr-0.6mL PkSAV13.233013.2330NOYESNO
02378434ENOXAPARINLovenox 80mg/0.8mL Pref Syr-0.8mL PkSAV17.645017.6450NOYESNO
02242692ENOXAPARINLovenox HP 120mg/0.8mL Pref Syr-0.8mL PkSAV26.467026.4670NOYESNO
02378442ENOXAPARINLovenox 100mg/mL Pref Syr-1mL PkSAV22.056022.0560NOYESNO
02378469ENOXAPARINLovenox HP 150mg/mL Pref Syr-1mL PkSAV33.085033.0850NOYESNO
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/LSAV0.33400.3340NONONO
02224704FUROSEMIDELasix (Not a Benefit) 40mg TabSAVN/AN/AYESNONO
02224690FUROSEMIDELasix (Not a Benefit) 20mg TabSAVN/AN/AYESNONO
02224755FUROSEMIDELasix Special 500mg TabSAV3.44103.4410NOYESNO
02245272GLIMEPIRIDEAmaryl (Off-Formulary Interchangeable) 1mg TabSAVN/AN/AYESNONO
02245274GLIMEPIRIDEAmaryl (Off-Formulary Interchangeable) 4mg TabSAVN/AN/AYESNONO
02245273GLIMEPIRIDEAmaryl (Off-Formulary Interchangeable) 2mg 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 PenSAV52.650052.6500NONOYES
02279460INSULIN GLULISINE (DNA ORIGIN)Apidra 100U/mL Inj Sol-10mL VialSAV26.580026.5800NONOYES
02294346INSULIN GLULISINE (DNA ORIGIN)Apidra 100U/mL Inj Sol-5x3mL SoloSTAR Pref PenSAV53.150053.1500NONOYES
02237924IRBESARTANAvapro 150mg TabSAV1.26710.2281YESNONO
02237925IRBESARTANAvapro 300mg TabSAV1.26710.2281YESNONO
02237923IRBESARTANAvapro 75mg TabSAV1.26710.2281YESNONO
02241818IRBESARTAN & HYDROCHLOROTHIAZIDEAvalide 150mg & 12.5mg TabSAV1.26710.2281YESNONO
02241819IRBESARTAN & HYDROCHLOROTHIAZIDEAvalide 300mg & 12.5mg TabSAV1.26710.2281YESNONO
02280213IRBESARTAN & HYDROCHLOROTHIAZIDEAvalide (Not a Benefit) 300mg & 25mg TabSAVN/AN/AYESNONO
00761680KETOPROFENRhodis-EC (Not a Benefit) 100mg Ent TabSAVN/AN/AYESNOYES
02241888LEFLUNOMIDEArava 10mg TabSAV11.44402.0000YESNONO
02241889LEFLUNOMIDEArava 20mg TabSAV11.44432.0000YESNONO
02162849METFORMIN HCLGlucophage (Off-Formulary Interchangeable) 850mg TabSAVN/AN/AYESNONO
02099233METFORMIN HCLGlucophage 500mg TabSAV0.27160.0247YESNONO
01927698METHOTRIMEPRAZINENozinan 25mg/mL Inj Sol-1mL PkSAV3.80603.8060NONONO
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 TabSAV0.22090.2209NONONO
01926861METRONIDAZOLEFlagyl 10% Vag Cr-AppSAV0.26450.2645NONONO
01926845METRONIDAZOLE & NYSTATINFlagystatin 500mg & 100000U/g Vag Cr-AppSAV0.60760.6076NONONO
01926829METRONIDAZOLE & NYSTATINFlagystatin 500mg & 100000U Vag SupSAV3.56103.5610NONONO
02231441NITROGLYCERINNitrolingual Pump Spray 0.4mg/Metered Dose Spray-200 Dose PkSAV15.76008.4200YESNONO
02221977PENTOXIFYLLINETrental (Not a Benefit) 400mg SR TabSAVN/AN/AYESNONO
02026961POLYSTYRENE SODIUM SULFONATEKayexalate 1mEq/g Oral Pd-454g PkSAV42.020029.4175YESNONO
02230619PREDNISOLONE SODIUM PHOSPHATEPediapred Oral Liquid 6.7mg/5mL O/LSAV0.14460.0900YESNONO
02221837RAMIPRILAltace Cap 2.5mgSAV1.03940.0817YESNONO
02221845RAMIPRILAltace Cap 5mgSAV1.06640.0817YESNONO
02221853RAMIPRILAltace Cap 10mgSAV1.37010.1034YESNONO
02221829RAMIPRILAltace Cap 1.25mgSAV0.92390.0708YESNONO
02281112RAMIPRILAltace (Off-Formulary Interchangeable) 15mg CapSAVN/AN/AYESNONO
02283166RAMIPRIL & HYDROCHLOROTHIAZIDEAltace HCT 10mg & 12.5mg TabSAV0.62740.2634YESNONO
02283158RAMIPRIL & HYDROCHLOROTHIAZIDEAltace HCT 5mg & 12.5mg TabSAV0.47900.3016YESNONO
02283174RAMIPRIL & HYDROCHLOROTHIAZIDEAltace HCT 5mg & 25mg TabSAV0.47900.2872YESNONO
02283131RAMIPRIL & HYDROCHLOROTHIAZIDEAltace HCT 2.5mg & 12.5mg TabSAV0.37390.2242YESNONO
02283182RAMIPRIL & HYDROCHLOROTHIAZIDEAltace HCT 10mg & 25mg TabSAV0.62740.2634YESNONO
02354586SEVELAMER CARBONATERenvela (Off-Formulary Interchangeable) 800mg TabSAV1.26341.2634YESNONO
01926632TAMOXIFEN CITRATETamofen (Not a Benefit) 20mg TabSAVN/AN/AYESNONO
01926624TAMOXIFEN CITRATETamofen (Not a Benefit) 10mg TabSAVN/AN/AYESNONO
02221950TIAPROFENIC ACIDSurgam (Not a Benefit) 300mg TabSAVN/AN/AYESNOYES
01926519TRETINOINVitamin A Acid (Not a Benefit) 0.05% CrSAVN/AN/AYESNONO
02216167ZOPICLONEImovane (Off-Formulary Interchangeable) 5mg TabSAVN/AN/AYESNONO
01926799ZOPICLONEImovane (Off-Formulary Interchangeable) 7.5mg TabSAVN/AN/AYESNONO