Displaying 1 - 50 of 523 records found.

Items in this class
Brand Name/Generic Name NDC code Clinical Prior Auth Required PDL Prior Auth Required
ACETAMIN-CAFF-DIHYDROCOD 320.5
acetaminophen/caff/dihydrocod
42195084010 Yes Yes
ACETAMIN-CAFF-DIHYDROCOD 325
acetaminophen/caff/dihydrocod
68047072001 No Yes
ACETAMINOP-CODEINE 120-12 MG/5
acetaminophen with codeine
00121050404 Yes No
ACETAMINOP-CODEINE 120-12 MG/5
acetaminophen with codeine
00121050416 Yes No
ACETAMINOP-CODEINE 120-12 MG/5
acetaminophen with codeine
50383007916 Yes No
ACETAMINOP-CODEINE 120-12 MG/5
acetaminophen with codeine
60432024516 Yes No
ACETAMINOPHEN-COD #2 TABLET
acetaminophen with codeine
00603233721 Yes No
ACETAMINOPHEN-COD #2 TABLET
acetaminophen with codeine
00406048301 Yes No
ACETAMINOPHEN-COD #2 TABLET
acetaminophen with codeine
13107005801 Yes No
ACETAMINOPHEN-COD #2 TABLET
acetaminophen with codeine
00093005001 Yes No
ACETAMINOPHEN-COD #3 TABLET
acetaminophen with codeine
51079016120 Yes No
ACETAMINOPHEN-COD #3 TABLET
acetaminophen with codeine
00603233821 Yes No
ACETAMINOPHEN-COD #3 TABLET
acetaminophen with codeine
00603233832 Yes No
ACETAMINOPHEN-COD #3 TABLET
acetaminophen with codeine
00406048401 Yes No
ACETAMINOPHEN-COD #3 TABLET
acetaminophen with codeine
00406048410 Yes No
ACETAMINOPHEN-COD #3 TABLET
acetaminophen with codeine
00406048462 Yes No
ACETAMINOPHEN-COD #3 TABLET
acetaminophen with codeine
65162003310 Yes No
ACETAMINOPHEN-COD #3 TABLET
acetaminophen with codeine
65162003311 Yes No
ACETAMINOPHEN-COD #3 TABLET
acetaminophen with codeine
13107005901 Yes No
ACETAMINOPHEN-COD #3 TABLET
acetaminophen with codeine
13107005999 Yes No
ACETAMINOPHEN-COD #3 TABLET
acetaminophen with codeine
00093015001 Yes No
ACETAMINOPHEN-COD #3 TABLET
acetaminophen with codeine
00093015010 Yes No
ACETAMINOPHEN-COD #3 TABLET
acetaminophen with codeine
63739000410 Yes No
ACETAMINOPHEN-COD #4 TABLET
acetaminophen with codeine
00603233921 Yes No
ACETAMINOPHEN-COD #4 TABLET
acetaminophen with codeine
00603233928 Yes No
ACETAMINOPHEN-COD #4 TABLET
acetaminophen with codeine
00406048501 Yes No
ACETAMINOPHEN-COD #4 TABLET
acetaminophen with codeine
00406048505 Yes No
ACETAMINOPHEN-COD #4 TABLET
acetaminophen with codeine
13107006001 Yes No
ACETAMINOPHEN-COD #4 TABLET
acetaminophen with codeine
13107006005 Yes No
ACETAMINOPHEN-COD #4 TABLET
acetaminophen with codeine
13107006099 Yes No
ACETAMINOPHEN-COD #4 TABLET
acetaminophen with codeine
00093035001 Yes No
ACETAMINOPHEN-COD #4 TABLET
acetaminophen with codeine
00093035005 Yes No
ACETAMINOPHEN-COD #4 TABLET
acetaminophen with codeine
00093035010 Yes No
ACTIQ 1,200 MCG LOZENGE
fentanyl citrate
63459051230 Yes Yes
ACTIQ 1,600 MCG LOZENGE
fentanyl citrate
63459051630 Yes Yes
ACTIQ 200 MCG LOZENGE
fentanyl citrate
63459050230 Yes Yes
ACTIQ 400 MCG LOZENGE
fentanyl citrate
63459050430 Yes Yes
ACTIQ 600 MCG LOZENGE
fentanyl citrate
63459050630 Yes Yes
ACTIQ 800 MCG LOZENGE
fentanyl citrate
63459050830 Yes Yes
ASCOMP WITH CODEINE CAPSULE
codeine/butalbital/ASA/caffein
51991007401 Yes Yes
ASCOMP WITH CODEINE CAPSULE
codeine/butalbital/ASA/caffein
51991007405 Yes Yes
BUTALB-ACETAMINOPH-CAFF-CODEIN
butalbit/acetamin/caff/codeine
00591264101 Yes Yes
BUTALB-CAFF-ACETAMINOPH-CODEIN
butalbit/acetamin/caff/codeine
00591322001 Yes Yes
BUTALB-CAFF-ACETAMINOPH-CODEIN
butalbit/acetamin/caff/codeine
00603255321 Yes Yes
BUTALB-CAFF-ACETAMINOPH-CODEIN
butalbit/acetamin/caff/codeine
51991007301 Yes Yes
BUTALBITAL COMP-CODEINE #3 CAP
codeine/butalbital/ASA/caffein
00591354601 Yes Yes
BUTALBITAL COMP-CODEINE #3 CAP
codeine/butalbital/ASA/caffein
00591354605 Yes Yes
BUTALBITAL COMP-CODEINE #3 CAP
codeine/butalbital/ASA/caffein
00527131201 Yes Yes
BUTORPHANOL 10 MG/ML SPRAY
butorphanol tartrate
00054309036 Yes Yes
BUTORPHANOL 10 MG/ML SPRAY
butorphanol tartrate
00378963943 Yes Yes