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Products found: 60New Search
DIN/ PIN/ NPNGeneric NameBrand Name, Strength & Dosage FormMFRDrug Benefit Price or Unit PriceAmount MOHLTC PaysInter- change- ableLimited UseThera- peutic Notes
00569771ACYCLOVIRZovirax (Off-Formulary Interchangeable) 5% Top OintVALN/AN/AYESNONO
02089602BECLOMETHASONE DIPROPIONATEPropaderm 0.025% CrVAL0.48510.4851NONONO
02473623BRODALUMABSiliq 210mg/1.5mL Inj Sol-Pref SyrVAL645.0000645.0000NOYESNO
02275104BUPROPION HCLWellbutrin XL 300mg ER TabVAL1.18330.2927YESYESNO
02275090BUPROPION HCLWellbutrin XL 150mg ER TabVAL0.59160.1463YESYESNO
02238441BUPROPION HCLZyban 150mg SR TabVAL1.07901.0790NOYESNO
02237825BUPROPION HCLWellbutrin SR 150mg TabVAL1.04720.2298YESYESNO
02250535CICLOPIROXPenlac (Off-Formulary Interchangeable) 8% W/W Top SolVALN/AN/AYESNOYES
02248472CLINDAMYCIN PHOSPHATE & BENZOYL PEROXIDEBenzaClin Topical Gel 1% & 5% Top GelVAL1.07040.7422YESNONO
02432463COLESEVELAM HYDROCHLORIDELodalis 3.75g/Pk Pd for Oral SuspVAL6.97706.9770NONOYES
02373955COLESEVELAM HYDROCHLORIDELodalis 625mg TabVAL1.16281.1628NONOYES
02238162DIAZEPAMDiastat 5mg/mL Rect Gel-2x 5mg PkVAL173.9700173.9700NONONO
09853340DIAZEPAMDiastat 5mg/mL Rect Gel-2x10mg PkVAL173.9700173.9700NONONO
09853430DIAZEPAMDiastat 5mg/mL Rect Gel-2x15mg PkVAL173.9700173.9700NONONO
02097273DILTIAZEM HCLCardizem CD 300mg LA CapVAL3.57550.7999YESNONO
02097265DILTIAZEM HCLCardizem CD 240mg LA CapVAL2.86040.6399YESNONO
02097257DILTIAZEM HCLCardizem CD 180mg LA CapVAL2.15650.4824YESNONO
02097249DILTIAZEM HCLCardizem CD 120mg LA CapVAL1.62440.3634YESNONO
02231155DILTIAZEM HCLTiazac 360mg SR CapVAL2.61110.5778YESNONO
02231154DILTIAZEM HCLTiazac 300mg SR CapVAL2.16880.4720YESNONO
02231152DILTIAZEM HCLTiazac 240mg SR CapVAL1.73160.3832YESNONO
02231151DILTIAZEM HCLTiazac 180mg SR CapVAL1.30550.2889YESNONO
02231150DILTIAZEM HCLTiazac 120mg SR CapVAL0.97730.2133YESNONO
00247960ETHAMBUTOL HCLEtibi 100mg TabVAL0.22630.2263YESNONO
00247979ETHAMBUTOL HCLEtibi 400mg TabVAL0.67910.6791YESNONO
00330582FLUOROURACILEfudex 5% CrVAL0.92180.9218NONONO
00012718FLURAZEPAMDalmane (Not a Benefit) 30mg CapVALN/AN/AYESNOYES
00012696FLURAZEPAMDalmane (Not a Benefit) 15mg CapVALN/AN/AYESNOYES
09857622IMIQUIMODAldara P (Off-Formulary Interchangeable) 5% Top CrVALN/AN/AYESNONO
02239505IMIQUIMODAldara (Off-Formulary Interchangeable) 5% Top Cr 250mg-UD PkVALN/AN/AYESNONO
00236683LITHIUM CARBONATECarbolith 300mg CapVAL0.10320.0657YESNONO
00461733LITHIUM CARBONATECarbolith 150mg CapVAL0.13290.0667YESNONO
02300451METFORMIN HCLGlumetza (Off-Formulary Interchangeable) 1000mg ER TabVALN/AN/AYESNONO
01946374METHOXSALENOxsoralen 10mg CapVAL0.55800.5580NONONO
02156091METRONIDAZOLENoritate 1% Top CrVAL0.64930.6493NONONO
00548375NABILONECesamet 1mg CapVAL7.12021.5513YESNONO
02256193NABILONECesamet 0.5mg CapVAL3.56040.7757YESNONO
02312263NABILONECesamet (Off-Formulary Interchangeable) 0.25mg CapVALN/AN/AYESNONO
00869945NEOSTIGMINE BROMIDEProstigmin 15mg TabVAL0.49780.4978NONONO
00268593NICOTINIC ACIDNiacin-ICN (Not a Benefit) 50mg TabVALN/AN/AYESNOYES
00511536NITRAZEPAMMogadon 10mg TabVAL0.22960.2296NONOYES
00511528NITRAZEPAMMogadon 5mg TabVAL0.15340.1534NONOYES
02247238PIMECROLIMUSElidel 1% CrVAL2.41572.4157NOYESNO
00283991PYRAZINAMIDETebrazid 500mg TabVAL0.49800.4980NONONO
00869953PYRIDOSTIGMINE BROMIDEMestinon 180mg LA TabVAL1.15731.1573NONONO
00869961PYRIDOSTIGMINE BROMIDEMestinon 60mg TabVAL0.51890.5189NONONO
00393444RIFAMPINRofact 150mg CapVAL0.73160.6765YESNOYES
00343617RIFAMPINRofact 300mg CapVAL1.15161.0649YESNOYES
00029246TESTOSTERONE ENANTHATEDelatestryl 1000mg/5mL Oily Inj Sol-5mL PkVAL54.900054.9000NOYESNO
02199270TETRABENAZINENitoman (Off-Formulary Interchangeable) 25mg TabVALN/AN/AYESNONO
00268631THIAMINE HCLVitamin B1-ICN (Not a Benefit) 50mg TabVALN/AN/AYESNONO
01926462TRETINOINVitamin A Acid 0.01% GelVAL0.35480.3548NOYESNO
01926489TRETINOINVitamin A Acid 0.05% GelVAL0.35480.3548NOYESNO
02194058TRIAMCINOLONE ACETONIDEAristocort R 0.1% CrVAL0.06080.0533YESNONO
00718149TRYPTOPHANTryptan (Off-Formulary Interchangeable) 500mg CapVALN/AN/AYESNONO
02239327TRYPTOPHANTryptan (Off-Formulary Interchangeable) 750mg TabVALN/AN/AYESNONO
02029456TRYPTOPHANTryptan (Off-Formulary Interchangeable) 500mg TabVALN/AN/AYESNONO
00654531TRYPTOPHANTryptan (Off-Formulary Interchangeable) 1g TabVALN/AN/AYESNONO
02391678ZOLPIDEM TARTRATESublinox (Off-Formulary Interchangeable) 5mg SL TabVALN/AN/AYESNOYES
02370433ZOLPIDEM TARTRATESublinox (Off-Formulary Interchangeable) 10mg SL TabVALN/AN/AYESNOYES