Displaying 1 - 50 of 179 records found.

Items in this class
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