Displaying 1 - 36 of 36 records found.

Items in this class
Brand Name/Generic Name NDC code Clinical Prior Auth Required PDL Prior Auth Required
ANDRODERM 2 MG/24HR PATCH
testosterone
00023599002 No Yes
ANDRODERM 2 MG/24HR PATCH
testosterone
00023599060 No Yes
ANDRODERM 4 MG/24HR PATCH
testosterone
00023599204 No Yes
ANDRODERM 4 MG/24HR PATCH
testosterone
00023599230 No Yes
ANDROGEL 1% (25 MG/2.5 G) PKT
testosterone
00051842530 No Yes
ANDROGEL 1% (50 MG/5 G) PKT
testosterone
00051845030 No Yes
ANDROGEL 1.62% GEL PUMP
testosterone
00051846233 No No
ANDROGEL 1.62%(1.25G) GEL PCKT
testosterone
00051846231 No Yes
ANDROGEL 1.62%(2.5G) GEL PCKT
testosterone
00051846230 No Yes
FORTESTA 10 MG GEL PUMP
testosterone
63481018316 No Yes
TESTIM 1% (50MG) GEL
testosterone
66887000105 No Yes
TESTOSTERONE 1% (25MG/2.5G) PK
testosterone
00591321630 No Yes
TESTOSTERONE 1% (50 MG/5 G) PK
testosterone
00591321730 No Yes
TESTOSTERONE 1.62% (2.5 G) PKT
testosterone
45802036665 No Yes
TESTOSTERONE 1.62% GEL PUMP
testosterone
68180094111 No Yes
TESTOSTERONE 1.62% GEL PUMP
testosterone
69238101302 No Yes
TESTOSTERONE 1.62% GEL PUMP
testosterone
70700011221 No Yes
TESTOSTERONE 1.62% GEL PUMP
testosterone
00591292418 No Yes
TESTOSTERONE 1.62% GEL PUMP
testosterone
16714096701 No Yes
TESTOSTERONE 1.62% GEL PUMP
testosterone
24979007815 No Yes
TESTOSTERONE 1.62% GEL PUMP
testosterone
45802075401 No Yes
TESTOSTERONE 1.62%(1.25 G) PKT
testosterone
45802028139 No Yes
TESTOSTERONE 10 MG GEL PUMP
testosterone
00591236360 No Yes
TESTOSTERONE 10 MG GEL PUMP
testosterone
00603783188 No Yes
TESTOSTERONE 12.5 MG/1.25 GRAM
testosterone
00591292102 No Yes
TESTOSTERONE 12.5 MG/1.25 GRAM
testosterone
00832112142 No Yes
TESTOSTERONE 30 MG/1.5 ML PUMP
testosterone
69097036344 No Yes
TESTOSTERONE 30 MG/1.5 ML PUMP
testosterone
00591211481 No Yes
TESTOSTERONE 30 MG/1.5 ML PUMP
testosterone
45802061001 No Yes
TESTOSTERONE 50 MG/5 GRAM GEL
testosterone
00254101211 No Yes
TESTOSTERONE 50 MG/5 GRAM GEL
testosterone
00591352430 No Yes
TESTOSTERONE 50 MG/5 GRAM GEL
testosterone
00832112005 No Yes
TESTOSTERONE 50 MG/5 GRAM PKT
testosterone
00832112035 No Yes
VOGELXO 12.5 MG/1.25 GRAM PUMP
testosterone
00245087242 No Yes
VOGELXO 50 MG/5 GRAM GEL
testosterone
00245087105 No Yes
VOGELXO 50 MG/5 GRAM GEL PACKT
testosterone
00245087135 No Yes