Displaying 1 - 28 of 28 records found.
| Brand Name/Generic Name | NDC code | Clinical Prior Auth Required | PDL Prior Auth Required |
|---|---|---|---|
|
ABSORICA 10 MG CAPSULE isotretinoin |
10631011531 | No | Yes |
|
ABSORICA 20 MG CAPSULE isotretinoin |
10631011631 | No | Yes |
|
ABSORICA 30 MG CAPSULE isotretinoin |
10631011731 | No | Yes |
|
ABSORICA 40 MG CAPSULE isotretinoin |
10631011831 | No | Yes |
|
AMNESTEEM 10 MG CAPSULE isotretinoin |
00378661193 | No | No |
|
AMNESTEEM 20 MG CAPSULE isotretinoin |
00378661293 | No | No |
|
AMNESTEEM 40 MG CAPSULE isotretinoin |
00378661493 | No | No |
|
CLARAVIS 10 MG CAPSULE isotretinoin |
00555105456 | No | No |
|
CLARAVIS 10 MG CAPSULE isotretinoin |
00555105486 | No | No |
|
CLARAVIS 20 MG CAPSULE isotretinoin |
00555105556 | No | No |
|
CLARAVIS 20 MG CAPSULE isotretinoin |
00555105586 | No | No |
|
CLARAVIS 30 MG CAPSULE isotretinoin |
00555105686 | No | No |
|
CLARAVIS 40 MG CAPSULE isotretinoin |
00555105756 | No | No |
|
CLARAVIS 40 MG CAPSULE isotretinoin |
00555105786 | No | No |
|
ISOTRETINOIN 10 MG CAPSULE isotretinoin |
69238117403 | No | No |
|
ISOTRETINOIN 20 MG CAPSULE isotretinoin |
69238117503 | No | No |
|
ISOTRETINOIN 30 MG CAPSULE isotretinoin |
69238101703 | No | No |
|
ISOTRETINOIN 40 MG CAPSULE isotretinoin |
69238117603 | No | No |
|
MYORISAN 10 MG CAPSULE isotretinoin |
61748030113 | No | No |
|
MYORISAN 20 MG CAPSULE isotretinoin |
61748030211 | No | No |
|
MYORISAN 20 MG CAPSULE isotretinoin |
61748030213 | No | No |
|
MYORISAN 30 MG CAPSULE isotretinoin |
61748030313 | No | No |
|
MYORISAN 40 MG CAPSULE isotretinoin |
61748030411 | No | No |
|
MYORISAN 40 MG CAPSULE isotretinoin |
61748030413 | No | No |
|
ZENATANE 10 MG CAPSULE isotretinoin |
55111013581 | No | No |
|
ZENATANE 20 MG CAPSULE isotretinoin |
55111013681 | No | No |
|
ZENATANE 30 MG CAPSULE isotretinoin |
55111011381 | No | No |
|
ZENATANE 40 MG CAPSULE isotretinoin |
55111013781 | No | No |