Displaying 1 - 50 of 194 records found.

Items in this class
Brand Name/Generic Name NDC code Clinical Prior Auth Required PDL Prior Auth Required
AKYNZEO 300-0.5 MG CAPSULE
netupitant/palonosetron HCl
69639010101 Yes Yes
APREPITANT 125 MG CAPSULE
aprepitant
00781232368 Yes Yes
APREPITANT 125 MG CAPSULE
aprepitant
68462058576 Yes Yes
APREPITANT 125-80-80 MG PACK
aprepitant
00781406336 Yes Yes
APREPITANT 125-80-80 MG PACK
aprepitant
68462011233 Yes Yes
APREPITANT 40 MG CAPSULE
aprepitant
00781232106 Yes Yes
APREPITANT 40 MG CAPSULE
aprepitant
00781232151 Yes Yes
APREPITANT 40 MG CAPSULE
aprepitant
68462058340 Yes Yes
APREPITANT 40 MG CAPSULE
aprepitant
68462058385 Yes Yes
APREPITANT 80 MG CAPSULE
aprepitant
00781232246 Yes Yes
APREPITANT 80 MG CAPSULE
aprepitant
00781232268 Yes Yes
APREPITANT 80 MG CAPSULE
aprepitant
68462058458 Yes Yes
APREPITANT 80 MG CAPSULE
aprepitant
68462058476 Yes Yes
BONJESTA ER 20-20 MG TABLET
doxylamine succinate/vit B6
55494012060 No Yes
COMPRO 25 MG SUPPOSITORY
prochlorperazine
00574722612 No Yes
DICLEGIS DR 10-10 MG TABLET
doxylamine succinate/vit B6
55494010010 No Yes
DOXYLAMINE-PYRIDOXINE 10-10 MG
doxylamine succinate/vit B6
70505010010 No Yes
DOXYLAMINE-PYRIDOXINE 10-10 MG
doxylamine succinate/vit B6
49884018601 Yes Yes
DRIMINATE 50 MG TABLET
dimenhydrinate
00904677212 No No
DRONABINOL 10 MG CAPSULE
dronabinol
31722096260 No Yes
DRONABINOL 10 MG CAPSULE
dronabinol
42858086906 No Yes
DRONABINOL 10 MG CAPSULE
dronabinol
00527145206 No Yes
DRONABINOL 10 MG CAPSULE
dronabinol
67877057060 No Yes
DRONABINOL 2.5 MG CAPSULE
dronabinol
31722096060 No Yes
DRONABINOL 2.5 MG CAPSULE
dronabinol
42858086706 No Yes
DRONABINOL 2.5 MG CAPSULE
dronabinol
00527145006 No Yes
DRONABINOL 2.5 MG CAPSULE
dronabinol
00904674561 No Yes
DRONABINOL 2.5 MG CAPSULE
dronabinol
67877056860 No Yes
DRONABINOL 5 MG CAPSULE
dronabinol
31722096160 No Yes
DRONABINOL 5 MG CAPSULE
dronabinol
42858086806 No Yes
DRONABINOL 5 MG CAPSULE
dronabinol
00527145106 No Yes
DRONABINOL 5 MG CAPSULE
dronabinol
67877056960 No Yes
DRONABINOL 5 MG CAPSULE
dronabinol
17478076206 No Yes
EMEND 125 MG POWDER PACKET
aprepitant
00006306603 No Yes
EMEND 40 MG CAPSULE
aprepitant
00006046405 Yes Yes
EMEND 40 MG CAPSULE
aprepitant
00006046410 Yes Yes
EMEND 80 MG CAPSULE
aprepitant
00006046102 Yes Yes
EMEND TRIPACK
aprepitant
00006386203 Yes Yes
FORMULA EM SOLUTION
phosphorated carbo(dext-fruct)
00904004920 No No
GRANISETRON HCL 1 MG TABLET
granisetron HCl
42043039002 Yes Yes
GRANISETRON HCL 1 MG TABLET
granisetron HCl
42043039020 Yes Yes
GRANISETRON HCL 1 MG TABLET
granisetron HCl
42043039021 Yes Yes
GRANISETRON HCL 1 MG TABLET
granisetron HCl
00054014308 Yes Yes
GRANISETRON HCL 1 MG TABLET
granisetron HCl
00054014387 Yes Yes
GRANISETRON HCL 1 MG TABLET
granisetron HCl
16714022101 Yes Yes
GRANISETRON HCL 1 MG TABLET
granisetron HCl
16714022130 Yes Yes
GRANISETRON HCL 1 MG TABLET
granisetron HCl
51991073520 Yes Yes
GRANISETRON HCL 1 MG TABLET
granisetron HCl
16714022132 Yes Yes
GRANISETRON HCL 1 MG TABLET
granisetron HCl
51991073532 Yes Yes
MARINOL 10 MG CAPSULE
dronabinol
00051002321 No Yes