Displaying 1 - 50 of 492 records found.
| Brand Name/Generic Name | NDC code | Clinical Prior Auth Required | PDL Prior Auth Required |
|---|---|---|---|
|
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 |
60432024516 | Yes | No |
|
ACETAMINOP-CODEINE 120-12 MG/5 acetaminophen with codeine |
50383007916 | Yes | No |
|
ACETAMINOPHEN-COD #2 TABLET acetaminophen with codeine |
71930005412 | Yes | No |
|
ACETAMINOPHEN-COD #2 TABLET acetaminophen with codeine |
71930005452 | Yes | No |
|
ACETAMINOPHEN-COD #2 TABLET acetaminophen with codeine |
00406048301 | Yes | No |
|
ACETAMINOPHEN-COD #2 TABLET acetaminophen with codeine |
00093005001 | Yes | No |
|
ACETAMINOPHEN-COD #2 TABLET acetaminophen with codeine |
00603233721 | Yes | No |
|
ACETAMINOPHEN-COD #2 TABLET acetaminophen with codeine |
13107005801 | Yes | No |
|
ACETAMINOPHEN-COD #3 TABLET acetaminophen with codeine |
71930005512 | Yes | No |
|
ACETAMINOPHEN-COD #3 TABLET acetaminophen with codeine |
71930005552 | 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 |
00093015001 | Yes | No |
|
ACETAMINOPHEN-COD #3 TABLET acetaminophen with codeine |
00093015010 | 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 |
65162003310 | Yes | No |
|
ACETAMINOPHEN-COD #3 TABLET acetaminophen with codeine |
65162003311 | Yes | No |
|
ACETAMINOPHEN-COD #3 TABLET acetaminophen with codeine |
51079016120 | Yes | No |
|
ACETAMINOPHEN-COD #3 TABLET acetaminophen with codeine |
13107005901 | Yes | No |
|
ACETAMINOPHEN-COD #3 TABLET acetaminophen with codeine |
13107005999 | 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 |
71930005612 | Yes | No |
|
ACETAMINOPHEN-COD #4 TABLET acetaminophen with codeine |
71930005652 | 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 |
|
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 |
13107006001 | Yes | No |
|
ACETAMINOPHEN-COD #4 TABLET acetaminophen with codeine |
13107006005 | Yes | No |
|
ACETAMINOPHEN-COD #4 TABLET acetaminophen with codeine |
13107006099 | Yes | No |
|
ACETAMN-CAF-DIHYDRCODEIN 320.5 acetaminophen/caff/dihydrocod |
42195084010 | Yes | Yes |
|
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 |
|
ASA-BUTALB-CAFF-COD #3 CAPSULE codeine/butalbital/ASA/caffein |
69238199301 | Yes | Yes |
|
ASCOMP WITH CODEINE CAPSULE codeine/butalbital/ASA/caffein |
51991007401 | Yes | Yes |
|
ASCOMP WITH CODEINE CAPSULE codeine/butalbital/ASA/caffein |
51991007405 | Yes | Yes |
|
BENZHYDROCOD-ACETAMIN 4.08-325 benzhydrocodone/acetaminophen |
10702034301 | Yes | Yes |
|
BENZHYDROCOD-ACETAMIN 6.12-325 benzhydrocodone/acetaminophen |
10702034401 | Yes | Yes |
|
BENZHYDROCOD-ACETAMIN 8.16-325 benzhydrocodone/acetaminophen |
10702034501 | Yes | Yes |
|
BUTALB-ACETAMIN-CAF-COD 50-300 butalbit/acetamin/caff/codeine |
00591264101 | Yes | Yes |