Displaying 1 - 50 of 179 records found.
| Brand Name/Generic Name | NDC code | Clinical Prior Auth Required | PDL Prior Auth Required |
|---|---|---|---|
|
ALMOTRIPTAN MALATE 12.5 MG TAB almotriptan malate |
00093526129 | No | Yes |
|
ALMOTRIPTAN MALATE 12.5 MG TAB almotriptan malate |
27241004221 | No | Yes |
|
ALMOTRIPTAN MALATE 6.25 MG TAB almotriptan malate |
00093526018 | No | Yes |
|
ALMOTRIPTAN MALATE 6.25 MG TAB almotriptan malate |
27241004111 | No | Yes |
|
AMERGE 1 MG TABLET naratriptan HCl |
00173056100 | No | Yes |
|
AMERGE 2.5 MG TABLET naratriptan HCl |
00173056200 | No | Yes |
|
ELETRIPTAN HBR 20 MG TABLET eletriptan hydrobromide |
68382092286 | No | Yes |
|
ELETRIPTAN HBR 20 MG TABLET eletriptan hydrobromide |
59762232101 | No | Yes |
|
ELETRIPTAN HBR 20 MG TABLET eletriptan hydrobromide |
00093831018 | No | Yes |
|
ELETRIPTAN HBR 20 MG TABLET eletriptan hydrobromide |
27241003911 | No | Yes |
|
ELETRIPTAN HBR 20 MG TABLET eletriptan hydrobromide |
00378428785 | No | Yes |
|
ELETRIPTAN HBR 20 MG TABLET eletriptan hydrobromide |
59651010469 | No | Yes |
|
ELETRIPTAN HBR 40 MG TABLET eletriptan hydrobromide |
68382092386 | No | Yes |
|
ELETRIPTAN HBR 40 MG TABLET eletriptan hydrobromide |
59762232201 | No | Yes |
|
ELETRIPTAN HBR 40 MG TABLET eletriptan hydrobromide |
00093831118 | No | Yes |
|
ELETRIPTAN HBR 40 MG TABLET eletriptan hydrobromide |
27241004011 | No | Yes |
|
ELETRIPTAN HBR 40 MG TABLET eletriptan hydrobromide |
27241004021 | No | Yes |
|
ELETRIPTAN HBR 40 MG TABLET eletriptan hydrobromide |
00378428808 | No | Yes |
|
ELETRIPTAN HBR 40 MG TABLET eletriptan hydrobromide |
00378428885 | No | Yes |
|
ELETRIPTAN HBR 40 MG TABLET eletriptan hydrobromide |
59651010569 | No | Yes |
|
FROVA 2.5 MG TABLET frovatriptan succinate |
63481002509 | No | Yes |
|
FROVATRIPTAN SUCC 2.5 MG TAB frovatriptan succinate |
00378314085 | No | Yes |
|
FROVATRIPTAN SUCC 2.5 MG TAB frovatriptan succinate |
68462069497 | No | Yes |
|
FROVATRIPTAN SUCC 2.5 MG TAB frovatriptan succinate |
69238153909 | No | Yes |
|
IMITREX 100 MG TABLET sumatriptan succinate |
00173073701 | No | Yes |
|
IMITREX 20 MG NASAL SPRAY sumatriptan |
00173052300 | No | Yes |
|
IMITREX 25 MG TABLET sumatriptan succinate |
00173073500 | No | Yes |
|
IMITREX 4 MG/0.5 ML CARTRIDGES sumatriptan succinate |
00173073902 | No | Yes |
|
IMITREX 4 MG/0.5 ML PEN INJECT sumatriptan succinate |
00173073900 | No | Yes |
|
IMITREX 5 MG NASAL SPRAY sumatriptan |
00173052400 | No | Yes |
|
IMITREX 50 MG TABLET sumatriptan succinate |
00173073601 | No | Yes |
|
IMITREX 6 MG/0.5 ML CARTRIDGES sumatriptan succinate |
00173047800 | No | Yes |
|
IMITREX 6 MG/0.5 ML PEN INJECT sumatriptan succinate |
00173047900 | No | Yes |
|
IMITREX 6 MG/0.5 ML VIAL sumatriptan succinate |
00173044902 | No | Yes |
|
MAXALT 10 MG TABLET rizatriptan benzoate |
00006026718 | No | Yes |
|
MAXALT MLT 10 MG TABLET rizatriptan benzoate |
00006380118 | No | Yes |
|
NARATRIPTAN HCL 1 MG TABLET naratriptan HCl |
23155005419 | No | Yes |
|
NARATRIPTAN HCL 1 MG TABLET naratriptan HCl |
00054027803 | No | Yes |
|
NARATRIPTAN HCL 2.5 MG TABLET naratriptan HCl |
23155005519 | No | Yes |
|
NARATRIPTAN HCL 2.5 MG TABLET naratriptan HCl |
62756043769 | No | Yes |
|
NARATRIPTAN HCL 2.5 MG TABLET naratriptan HCl |
42043013109 | No | Yes |
|
NARATRIPTAN HCL 2.5 MG TABLET naratriptan HCl |
00054027903 | No | Yes |
|
ONZETRA XSAIL 11 MG/NOSEPIECE sumatriptan succinate |
64597031108 | No | Yes |
|
RELPAX 20 MG TABLET eletriptan hydrobromide |
00049233045 | No | Yes |
|
RELPAX 40 MG TABLET eletriptan hydrobromide |
00049234005 | No | Yes |
|
RELPAX 40 MG TABLET eletriptan hydrobromide |
00049234045 | No | Yes |
|
RIZATRIPTAN 10 MG ODT rizatriptan benzoate |
60505372401 | No | No |
|
RIZATRIPTAN 10 MG ODT rizatriptan benzoate |
68462046806 | No | No |
|
RIZATRIPTAN 10 MG ODT rizatriptan benzoate |
68462046840 | No | No |
|
RIZATRIPTAN 10 MG ODT rizatriptan benzoate |
65862062612 | No | No |