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Products found: 173New Search
DIN/ PIN/ NPNGeneric NameBrand Name, Strength & Dosage FormMFRDrug Benefit Price or Unit PriceAmount MOH PaysInter- change- ableLimited UseThera- peutic Notes
02299712ALENDRONATEAlendronate 70mg TabSIV2.10142.1014YESNONO
02447576ALFUZOSIN HYDROCHLORIDEAlfuzosin 10mg Prolong-Rel TabSIV0.26010.2601YESYESNO
02385465AMIODARONE HCLAmiodarone 200mg TabSIV0.37060.3706YESNOYES
02385805AMLODIPINEAmlodipine 10mg TabSIV0.19930.1993YESNONO
02385791AMLODIPINEAmlodipine 5mg TabSIV0.13430.1343YESNONO
02401509AMOXICILLINAmoxicillin 500mg CapSIV0.13080.1308YESNOYES
02401541AMOXICILLINAmoxicillin 50mg/mL O/LSIV0.05400.0540YESNOYES
02445948ATOMOXETINE HCLAtomoxetine 40mg CapSIV0.73690.7369YESNONO
02445883ATOMOXETINE HCLAtomoxetine 10mg CapSIV0.51060.5106YESNONO
02445905ATOMOXETINE HCLAtomoxetine 18mg CapSIV0.57480.5748YESNONO
02445913ATOMOXETINE HCLAtomoxetine 25mg CapSIV0.64200.6420YESNONO
02445956ATOMOXETINE HCLAtomoxetine 60mg CapSIV0.80920.8092YESNONO
02411350ATORVASTATIN CALCIUMAtorvastatin-10 10mg TabSIV0.17430.1743YESNONO
02411369ATORVASTATIN CALCIUMAtorvastatin-20 20mg TabSIV0.21790.2179YESNONO
02411377ATORVASTATIN CALCIUMAtorvastatin-40 40mg TabSIV0.23420.2342YESNONO
02411385ATORVASTATIN CALCIUMAtorvastatin-80 80mg TabSIV0.23420.2342YESNONO
02442434AZITHROMYCINAzithromycin 250mg TabSIV0.94100.9410YESNOYES
02495562BISOPROLOL FUMARATEBisoprolol Tablets 5mg TabSIV0.07150.0715YESNONO
02495570BISOPROLOL FUMARATEBisoprolol Tablets 10mg TabSIV0.10440.1044YESNONO
02388715CANDESARTAN CILEXETILCandesartan 16mg TabSIV0.22810.2281YESNONO
02388707CANDESARTAN CILEXETILCandesartan 8mg TabSIV0.22810.2281YESNONO
02394812CANDESARTAN CILEXETIL & HYDROCHLOROTHIAZIDECandesartan HCT 16mg & 12.5mg TabSIV0.21560.2156YESNONO
02248752CARVEDILOLCarvedilol 3.125mg TabSIV0.24310.2431YESYESNO
02248754CARVEDILOLCarvedilol 12.5mg TabSIV0.24310.2431YESYESNO
02248755CARVEDILOLCarvedilol 25mg TabSIV0.24310.2431YESYESNO
02248753CARVEDILOLCarvedilol 6.25mg TabSIV0.24310.2431YESYESNO
02429675CELECOXIBCelecoxib 100mg CapSIV0.12790.1279YESYESYES
02429683CELECOXIBCelecoxib 200mg CapSIV0.25580.2558YESYESYES
02495651CEPHALEXIN MONOHYDRATECephalexin 500mg TabSIV0.17310.1731YESNONO
02386119CIPROFLOXACINCiprofloxacin 250mg TabSIV0.44540.4454YESNOYES
02386127CIPROFLOXACINCiprofloxacin 500mg TabSIV0.50250.5025YESNOYES
02387956CITALOPRAM HYDROBROMIDECitalopram 20mg TabSIV0.13320.1332YESNONO
02387964CITALOPRAM HYDROBROMIDECitalopram 40mg TabSIV0.13320.1332YESNONO
02442485CLARITHROMYCINClarithromycin (Off-Formulary Interchangeable) 500mg TabSIV2.2009N/AYESNOYES
02442469CLARITHROMYCINClarithromycin 250mg TabSIV0.41220.4122YESNOYES
02385813CLOPIDOGREL BISULFATEClopidogrel 75mg TabSIV0.26310.2631YESNONO
02424584CYCLOBENZAPRINE HCLCyclobenzaprine (Not a Benefit) 10mg TabSIVN/AN/AYESNOYES
02446022DILTIAZEM HCLDiltiazem CD 300mg LA CapSIV0.79990.7999YESNONO
02446014DILTIAZEM HCLDiltiazem CD 240mg LA CapSIV0.63990.6399YESNONO
02446006DILTIAZEM HCLDiltiazem CD 180mg LA CapSIV0.48240.4824YESNONO
02445999DILTIAZEM HCLDiltiazem CD 120mg LA CapSIV0.36340.3634YESNONO
02238341DOMPERIDONE MALEATEDomperidone 10mg TabSIV0.04280.0428YESNONO
02453649DULOXETINEDuloxetine 60mg DR CapSIV0.97690.9769YESNONO
02453630DULOXETINEDuloxetine 30mg DR CapSIV0.48140.4814YESNONO
02429012DUTASTERIDEDutasteride 0.5mg CapSIV0.30270.3027YESYESNO
02442957ENALAPRIL MALEATEEnalapril 2.5mg TabSIV0.18630.1863YESNONO
02442965ENALAPRIL MALEATEEnalapril 5mg TabSIV0.22030.2203YESNONO
02442973ENALAPRIL MALEATEEnalapril 10mg TabSIV0.26470.2647YESNONO
02442981ENALAPRIL MALEATEEnalapril 20mg TabSIV0.31950.3195YESNONO
02429039ESCITALOPRAMEscitalopram 10mg TabSIV0.31090.3109YESNONO
02429047ESCITALOPRAMEscitalopram 20mg TabSIV0.33100.3310YESNONO
02442507ESOMEPRAZOLEEsomeprazole DR Tab (Off-Formulary Interchangeable) 40mgSIV1.8690N/AYESNONO
02442493ESOMEPRAZOLEEsomeprazole (Off-Formulary Interchangeable) 20mg DR TabSIV1.8690N/AYESNONO
02429659EZETIMIBEEzetimibe 10mg TabSIV0.18110.1811YESYESNO
02447541FINASTERIDEFinasteride 5mg TabSIV0.41380.4138YESYESNO
02447568FINASTERIDEFinasteride (Off-Formulary Interchangeable) 1mg TabSIV1.1455N/AYESNONO
02374455FLUOXETINE HCLFluoxetine 20mg CapSIV0.33110.3311YESNOYES
02374447FLUOXETINE HCLFluoxetine (Off-Formulary Interchangeable) 10mg CapSIV1.1773N/AYESNOYES
02246316GABAPENTINGabapentin 400mg CapSIV0.12060.1206YESNONO
02246315GABAPENTINGabapentin 300mg CapSIV0.10120.1012YESNONO
02246314GABAPENTINGabapentin 100mg CapSIV0.04160.0416YESNONO
02388200GABAPENTINGabapentin (Off-Formulary Interchangeable) 600mg TabSIV1.3045N/AYESNONO
02388219GABAPENTINGabapentin (Off-Formulary Interchangeable) 800mg TabSIV1.7393N/AYESNONO
02385309IRBESARTANIrbesartan 300mg TabSIV0.22810.2281YESNONO
02385295IRBESARTANIrbesartan 150mg TabSIV0.22810.2281YESNONO
02385287IRBESARTANIrbesartan 75mg TabSIV0.22810.2281YESNONO
02385333IRBESARTAN & HYDROCHLOROTHIAZIDEIrbesartan HCT 300mg & 25mg TabSIV0.21840.2184YESNONO
02385325IRBESARTAN & HYDROCHLOROTHIAZIDEIrbesartan HCT 300mg & 12.5mg TabSIV0.22810.2281YESNONO
02385317IRBESARTAN & HYDROCHLOROTHIAZIDEIrbesartan HCT 150mg & 12.5mg TabSIV0.22810.2281YESNONO
02428229LAMOTRIGINELamotrigine 150mg TabSIV0.41070.4107YESNONO
02428210LAMOTRIGINELamotrigine 100mg TabSIV0.27870.2787YESNONO
02428202LAMOTRIGINELamotrigine 25mg TabSIV0.06980.0698YESNONO
02385767LANSOPRAZOLELansoprazole 15mg DR CapSIV0.50000.5000YESYESNO
02410389LANSOPRAZOLELansoprazole 30mg DR CapSIV0.50000.5000YESYESNO
02442531LEVETIRACETAMLevetiracetam 250mg TabSIV0.32100.3210YESYESNO
02442558LEVETIRACETAMLevetiracetam 500mg TabSIV0.39110.3911YESYESNO
02442566LEVETIRACETAMLevetiracetam 750mg TabSIV0.54160.5416YESYESNO
02386232LISINOPRILLisinopril 5mg TabSIV0.13470.1347YESNONO
02386259LISINOPRILLisinopril 20mg TabSIV0.19450.1945YESNONO
02386240LISINOPRILLisinopril 10mg TabSIV0.16190.1619YESNONO
02388790LOSARTAN POTASSIUMLosartan 25mg TabSIV0.31470.3147YESNONO
02388804LOSARTAN POTASSIUMLosartan 50mg TabSIV0.31470.3147YESNONO
02388812LOSARTAN POTASSIUMLosartan 100mg TabSIV0.31470.3147YESNONO
02388960LOSARTAN POTASSIUM & HYDROCHLOROTHIAZIDELosartan HCT 50mg & 12.5mg TabSIV0.31470.3147YESNONO
02388987LOSARTAN POTASSIUM & HYDROCHLOROTHIAZIDELosartan HCT 100mg & 25mg TabSIV0.31470.3147YESNONO
02388979LOSARTAN POTASSIUM & HYDROCHLOROTHIAZIDELosartan HCT 100mg & 12.5mg TabSIV0.30820.3082YESNONO
02446049MEMANTINE HCLMemantine (Off-Formulary Interchangeable) 10mg TabSIV1.6357N/AYESNONO
02385341METFORMIN HCLMetformin FC 500mg TabSIV0.02470.0247YESNONO
02385368METFORMIN HCLMetformin FC (Off-Formulary Interchangeable) 850mg TabSIV0.2090N/AYESNONO
02496674MIRTAZAPINEMirtazapine 30mg TabSIV0.31000.3100YESNONO
02382458MONTELUKAST SODIUMMontelukast 4mg Chew TabSIV0.27580.2758YESYESNO
02382466MONTELUKAST SODIUMMontelukast (Off-Formulary Interchangeable) 5mg Chew TabSIV1.20751.2075YESNONO
02382474MONTELUKAST SODIUMMontelukast (Off-Formulary Interchangeable) 10mg TabSIV1.77351.7735YESNONO
02343703OLANZAPINEOlanzapine ODT (Off-Formulary Interchangeable) 20mg Rapid Dissolve TabSIV7.5977N/AYESNONO
02343665OLANZAPINEOlanzapine ODT 5mg Rapid Dissolve TabSIV0.35740.3574YESNONO
02343673OLANZAPINEOlanzapine ODT 10mg Rapid Dissolve TabSIV0.71430.7143YESNONO
02343681OLANZAPINEOlanzapine ODT 15mg Rapid Dissolve TabSIV1.07111.0711YESNONO
02385864OLANZAPINEOlanzapine 2.5mg TabSIV0.17720.1772YESNONO
02385872OLANZAPINEOlanzapine 5mg TabSIV0.35440.3544YESNONO
02385880OLANZAPINEOlanzapine 7.5mg TabSIV0.53160.5316YESNONO
02385899OLANZAPINEOlanzapine 10mg TabSIV0.70880.7088YESNONO
02385902OLANZAPINEOlanzapine 15mg TabSIV1.06311.0631YESNONO
02411857OMEPRAZOLEOmeprazole-20 DR Cap 20mgSIV0.22870.2287YESYESNO
09857640OMEPRAZOLE MAGNESIUMOmeprazole-20 DR Cap 20mgSIV0.22870.2287YESYESNO
02428172PANTOPRAZOLE SODIUMPantoprazole-20 (Off-Formulary Interchangeable) 20mg Ent TabSIV1.2750N/AYESNONO
02428180PANTOPRAZOLE SODIUMPantoprazole-40 40mg Ent TabSIV0.20160.2016YESYESNO
02388243PAROXETINE HCLParoxetine 30mg TabSIV0.34530.3453YESNONO
02388227PAROXETINE HCLParoxetine (Off-Formulary Interchangeable) 10mg TabSIV1.0430N/AYESNONO
02388235PAROXETINE HCLParoxetine 20mg TabSIV0.32500.3250YESNONO
02479885PERINDOPRIL ERBUMINEPerindopril Erbumine 4mg TabSIV0.20420.2042YESNONO
02479893PERINDOPRIL ERBUMINEPerindopril Erbumine 8mg TabSIV0.28310.2831YESNONO
02479877PERINDOPRIL ERBUMINEPerindopril Erbumine 2mg TabSIV0.16320.1632YESNONO
02309130PRAMIPEXOLE DIHYDROCHLORIDE MONOHYDRATEPramipexole (Off-Formulary Interchangeable) 0.5mg TabSIV1.3860N/AYESNONO
02309149PRAMIPEXOLE DIHYDROCHLORIDE MONOHYDRATEPramipexole 1mg TabSIV0.39010.3901YESNOYES
02309157PRAMIPEXOLE DIHYDROCHLORIDE MONOHYDRATEPramipexole 1.5mg TabSIV0.39010.3901YESNOYES
02309122PRAMIPEXOLE DIHYDROCHLORIDE MONOHYDRATEPramipexole 0.25mg TabSIV0.19500.1950YESNOYES
02389703PRAVASTATIN SODIUMPravastatin 10mg TabSIV0.29160.2916YESNONO
02389746PRAVASTATIN SODIUMPravastatin 40mg TabSIV0.41430.4143YESNONO
02389738PRAVASTATIN SODIUMPravastatin 20mg TabSIV0.34400.3440YESNONO
02403706PREGABALINPregabalin 50mg CapSIV0.23240.2324YESNONO
02403714PREGABALINPregabalin 75mg CapSIV0.30070.3007YESNONO
02403722PREGABALINPregabalin 150mg CapSIV0.41450.4145YESNONO
02403730PREGABALINPregabalin 300mg CapSIV0.41450.4145YESNONO
02403692PREGABALINPregabalin 25mg CapSIV0.14810.1481YESNONO
02417391QUETIAPINEQuetiapine XR 400mg ER TabSIV1.32701.3270YESNONO
02417383QUETIAPINEQuetiapine XR 300mg ER TabSIV0.97760.9776YESNONO
02417375QUETIAPINEQuetiapine XR 200mg ER TabSIV0.66610.6661YESNONO
02417367QUETIAPINEQuetiapine XR 150mg ER TabSIV0.49260.4926YESNONO
02417359QUETIAPINEQuetiapine XR 50mg ER TabSIV0.25010.2501YESNONO
02317931QUETIAPINEQuetiapine 300mg TabSIV0.38630.3863YESNONO
02317907QUETIAPINEQuetiapine 100mg TabSIV0.13180.1318YESNONO
02317893QUETIAPINEQuetiapine 25mg TabSIV0.04940.0494YESNONO
02317923QUETIAPINEQuetiapine 200mg TabSIV0.26470.2647YESNONO
02385457RABEPRAZOLE SODIUMRabeprazole 20mg TabSIV0.13380.1338YESNONO
02385449RABEPRAZOLE SODIUMRabeprazole 10mg TabSIV0.06690.0669YESNONO
02287943RAMIPRILRamipril Cap 10mgSIV0.10340.1034YESNONO
02287935RAMIPRILRamipril Cap 5mgSIV0.08170.0817YESNONO
02287927RAMIPRILRamipril Cap 2.5mgSIV0.08170.0817YESNONO
02308363RAMIPRILRamipril Cap 1.25mgSIV0.07080.0708YESNONO
02411407RISEDRONATE SODIUMRisedronate-35 35mg TabSIV1.97871.9787YESNONO
02446111RIZATRIPTANRizatriptan ODT (Off-Formulary Interchangeable) 5mg Orally Disintegrating TabSIV11.115011.1150YESNONO
02446138RIZATRIPTANRizatriptan ODT (Off-Formulary Interchangeable) 10mg Orally Disintegrating TabSIV11.115011.1150YESNONO
02411628ROSUVASTATIN CALCIUMRosuvastatin 5mg TabSIV0.12840.1284YESNONO
02411652ROSUVASTATIN CALCIUMRosuvastatin 40mg TabSIV0.19900.1990YESNONO
02411636ROSUVASTATIN CALCIUMRosuvastatin 10mg TabSIV0.13540.1354YESNONO
02411644ROSUVASTATIN CALCIUMRosuvastatin 20mg TabSIV0.16920.1692YESNONO
02386097SERTRALINE HCLSertraline 100mg CapSIV0.33030.3303YESNOYES
02386089SERTRALINE HCLSertraline 50mg CapSIV0.30320.3032YESNOYES
02386070SERTRALINE HCLSertraline 25mg CapSIV0.15160.1516YESNOYES
02385589SUMATRIPTAN SUCCINATESumatriptan DF (Off-Formulary Interchangeable) 100mg TabSIV9.98669.9866YESNONO
02385570SUMATRIPTAN SUCCINATESumatriptan DF (Off-Formulary Interchangeable) 50mg TabSIV9.06509.0650YESNONO
02429667TAMSULOSIN HCLTamsulosin CR Tab 0.4mgSIV0.15000.1500YESNOYES
02390353TELMISARTANTelmisartan 80mg TabSIV0.21610.2161YESNONO
02390345TELMISARTANTelmisartan 40mg TabSIV0.21610.2161YESNONO
02390302TELMISARTAN & HYDROCHLOROTHIAZIDETelmisartan HCTZ 80mg & 12.5mg TabSIV0.20980.2098YESNONO
02390310TELMISARTAN & HYDROCHLOROTHIAZIDETelmisartan HCTZ 80mg & 25mg TabSIV0.20980.2098YESNONO
02385279TERBINAFINE HCLTerbinafine 250mg TabSIV0.77140.7714YESNONO
02389487TOPIRAMATETopiramate 100mg TabSIV0.45830.4583YESNONO
02389460TOPIRAMATETopiramate 25mg TabSIV0.24330.2433YESNONO
02442000VALACYCLOVIRValacyclovir 500mg TabSIV0.61980.6198YESNONO
02384558VALSARTANValsartan 160mg TabSIV0.21590.2159YESNONO
02384523VALSARTANValsartan (Off-Formulary Interchangeable) 40mg TabSIV0.5823N/AYESNONO
02384566VALSARTANValsartan 320mg TabSIV0.20980.2098YESNONO
02384531VALSARTANValsartan 80mg TabSIV0.21590.2159YESNONO
02384744VALSARTAN & HYDROCHLOROTHIAZIDEValsartan HCT 160mg & 12.5mg TabSIV0.22400.2240YESNONO
02384736VALSARTAN & HYDROCHLOROTHIAZIDEValsartan HCT 80mg & 12.5mg TabSIV0.22130.2213YESNONO
02384752VALSARTAN & HYDROCHLOROTHIAZIDEValsartan HCT 160mg & 25mg TabSIV0.22380.2238YESNONO
02384760VALSARTAN & HYDROCHLOROTHIAZIDEValsartan HCT 320mg & 12.5mg TabSIV0.22350.2235YESNONO
02385945VENLAFAXINE HCLVenlafaxine XR 150mg ER CapSIV0.19270.1927YESNONO
02385937VENLAFAXINE HCLVenlafaxine XR 75mg ER CapSIV0.18250.1825YESNONO
02385929VENLAFAXINE HCLVenlafaxine XR 37.5mg ER CapSIV0.09130.0913YESNONO
02385821ZOPICLONEZopiclone (Off-Formulary Interchangeable) 5mg TabSIV0.22310.2231YESNONO
02385848ZOPICLONEZopiclone (Off-Formulary Interchangeable) 7.5mg TabSIV0.46850.4685YESNONO