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Products found: 59New Search
DIN/ PIN/ NPNGeneric NameBrand Name, Strength & Dosage FormMFRDrug Benefit Price or Unit PriceAmount MOH PaysInter- change- ableLimited UseThera- peutic Notes
00569771ACYCLOVIRZovirax (Off-Formulary Interchangeable) 5% Top OintVALN/AN/AYESNONO
02089602BECLOMETHASONE DIPROPIONATEPropaderm 0.025% CrVAL0.49960.4996NONONO
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 TabVAL1.11141.1114NOYESNO
02237825BUPROPION HCLWellbutrin SR 150mg TabVAL1.07870.2298YESYESNO
02250535CICLOPIROXPenlac (Off-Formulary Interchangeable) 8% W/W Top SolVALN/AN/AYESNOYES
02248472CLINDAMYCIN PHOSPHATE & BENZOYL PEROXIDEBenzaClin Topical Gel 1% & 5% Top GelVAL1.10240.7422YESNONO
02432463COLESEVELAM HYDROCHLORIDELodalis 3.75g/Pk Pd for Oral SuspVAL7.11677.1167NONOYES
02373955COLESEVELAM HYDROCHLORIDELodalis 625mg TabVAL1.18611.1861NONOYES
02238162DIAZEPAMDiastat 5mg/mL Rect Gel-2x 5mg PkVAL179.1900179.1900NONONO
09853340DIAZEPAMDiastat 5mg/mL Rect Gel-2x10mg PkVAL179.1900179.1900NONONO
09853430DIAZEPAMDiastat 5mg/mL Rect Gel-2x15mg PkVAL179.1900179.1900NONONO
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
02231154DILTIAZEM HCLTiazac 300mg SR CapVAL2.23380.4720YESNONO
02231152DILTIAZEM HCLTiazac 240mg SR CapVAL1.78360.3832YESNONO
02231151DILTIAZEM HCLTiazac 180mg SR CapVAL1.34470.2889YESNONO
02231150DILTIAZEM HCLTiazac 120mg SR CapVAL1.00660.2133YESNONO
02231155DILTIAZEM HCLTiazac 360mg SR CapVAL2.68940.5778YESNONO
00247960ETHAMBUTOL HCLEtibi 100mg TabVAL0.23310.2331YESNONO
00247979ETHAMBUTOL HCLEtibi 400mg TabVAL0.69950.6995YESNONO
00330582FLUOROURACILEfudex 5% CrVAL0.94950.9495NONONO
00012718FLURAZEPAMDalmane (Not a Benefit) 30mg CapVALN/AN/AYESNONO
00012696FLURAZEPAMDalmane (Not a Benefit) 15mg CapVALN/AN/AYESNONO
09857622IMIQUIMODAldara P (Off-Formulary Interchangeable) 5% Top CrVALN/AN/AYESNONO
00461733LITHIUM CARBONATECarbolith 150mg CapVAL0.13690.0667YESNONO
00236683LITHIUM CARBONATECarbolith 300mg CapVAL0.10630.0657YESNONO
02300451METFORMIN HCLGlumetza (Off-Formulary Interchangeable) 1000mg ER TabVALN/AN/AYESNONO
01946374METHOXSALENOxsoralen 10mg CapVAL0.55800.5580NONONO
02156091METRONIDAZOLENoritate 1% Top CrVAL0.66890.6689NONONO
02312263NABILONECesamet (Off-Formulary Interchangeable) 0.25mg CapVALN/AN/AYESNONO
00548375NABILONECesamet 1mg CapVAL7.33381.5513YESNONO
02256193NABILONECesamet 0.5mg CapVAL3.66720.7757YESNONO
00869945NEOSTIGMINE BROMIDEProstigmin 15mg TabVAL0.49780.4978NONONO
00268593NICOTINIC ACIDNiacin-ICN (Not a Benefit) 50mg TabVALN/AN/AYESNOYES
00511536NITRAZEPAMMogadon 10mg TabVAL0.22960.2296NONONO
00511528NITRAZEPAMMogadon 5mg TabVAL0.15340.1534NONONO
02247238PIMECROLIMUSElidel 1% CrVAL2.48802.4880NOYESNO
00283991PYRAZINAMIDETebrazid 500mg TabVAL0.49800.4980NONONO
00869953PYRIDOSTIGMINE BROMIDEMestinon 180mg LA TabVAL1.19201.1920NONONO
00869961PYRIDOSTIGMINE BROMIDEMestinon 60mg TabVAL0.53450.5345NONONO
00393444RIFAMPINRofact 150mg CapVAL0.75360.6765YESNOYES
00343617RIFAMPINRofact 300mg CapVAL1.18621.0649YESNOYES
00029246TESTOSTERONE ENANTHATEDelatestryl 1000mg/5mL Oily Inj Sol-5mL PkVAL56.550056.5500NOYESNO
02199270TETRABENAZINENitoman (Off-Formulary Interchangeable) 25mg TabVALN/AN/AYESNONO
00268631THIAMINE HCLVitamin B1-ICN (Not a Benefit) 50mg TabVALN/AN/AYESNONO
01926462TRETINOINVitamin A Acid 0.01% GelVAL0.36520.3652NOYESNO
01926489TRETINOINVitamin A Acid 0.05% GelVAL0.36520.3652NOYESNO
02194058TRIAMCINOLONE ACETONIDEAristocort R 0.1% CrVAL0.06390.0533YESNONO
00718149TRYPTOPHANTryptan (Off-Formulary Interchangeable) 500mg CapVALN/AN/AYESNONO
02029456TRYPTOPHANTryptan (Off-Formulary Interchangeable) 500mg TabVALN/AN/AYESNONO
00654531TRYPTOPHANTryptan (Off-Formulary Interchangeable) 1g TabVALN/AN/AYESNONO
02239327TRYPTOPHANTryptan (Off-Formulary Interchangeable) 750mg TabVALN/AN/AYESNONO
02391678ZOLPIDEM TARTRATESublinox (Off-Formulary Interchangeable) 5mg SL TabVALN/AN/AYESNONO
02370433ZOLPIDEM TARTRATESublinox (Off-Formulary Interchangeable) 10mg SL TabVALN/AN/AYESNONO