Displaying 151 - 200 of 1020 records found.

Items in this class
Brand Name/Generic Name NDC code Clinical Prior Auth Required PDL Prior Auth Required
ARIPIPRAZOLE 5 MG TABLET
aripiprazole
62332009830 Yes No
ARIPIPRAZOLE 5 MG TABLET
aripiprazole
62332009831 Yes No
ARIPIPRAZOLE 5 MG TABLET
aripiprazole
27241005203 Yes No
ARIPIPRAZOLE 5 MG TABLET
aripiprazole
27241005208 Yes No
ARIPIPRAZOLE ODT 10 MG TABLET
aripiprazole
62332010330 Yes Yes
ARIPIPRAZOLE ODT 10 MG TABLET
aripiprazole
13811069230 Yes Yes
ARIPIPRAZOLE ODT 10 MG TABLET
aripiprazole
43598073330 Yes Yes
ARIPIPRAZOLE ODT 15 MG TABLET
aripiprazole
62332010430 Yes Yes
ARIPIPRAZOLE ODT 15 MG TABLET
aripiprazole
13811069330 Yes Yes
ARIPIPRAZOLE ODT 15 MG TABLET
aripiprazole
43598073430 Yes Yes
ARISTADA ER 1064 MG/3.9 ML SYR
aripiprazole lauroxil
65757040403 Yes No
ARISTADA ER 441 MG/1.6 ML SYRN
aripiprazole lauroxil
65757040103 Yes No
ARISTADA ER 662 MG/2.4 ML SYRN
aripiprazole lauroxil
65757040203 Yes No
ARISTADA ER 882 MG/3.2 ML SYRN
aripiprazole lauroxil
65757040303 Yes No
CHLORPROMAZINE 10 MG TABLET
chlorpromazine HCl
51079051820 Yes No
CHLORPROMAZINE 10 MG TABLET
chlorpromazine HCl
00781591301 Yes No
CHLORPROMAZINE 10 MG TABLET
chlorpromazine HCl
00832030000 Yes No
CHLORPROMAZINE 100 MG TABLET
chlorpromazine HCl
00781591601 Yes No
CHLORPROMAZINE 100 MG TABLET
chlorpromazine HCl
00832030300 Yes No
CHLORPROMAZINE 100 MG TABLET
chlorpromazine HCl
00832030310 Yes No
CHLORPROMAZINE 200 MG TABLET
chlorpromazine HCl
51079051720 Yes No
CHLORPROMAZINE 200 MG TABLET
chlorpromazine HCl
00781591701 Yes No
CHLORPROMAZINE 200 MG TABLET
chlorpromazine HCl
00832030400 Yes No
CHLORPROMAZINE 200 MG TABLET
chlorpromazine HCl
00832030410 Yes No
CHLORPROMAZINE 25 MG TABLET
chlorpromazine HCl
51079051920 Yes No
CHLORPROMAZINE 25 MG TABLET
chlorpromazine HCl
00781591401 Yes No
CHLORPROMAZINE 25 MG TABLET
chlorpromazine HCl
00832030100 Yes No
CHLORPROMAZINE 25 MG TABLET
chlorpromazine HCl
00832030110 Yes No
CHLORPROMAZINE 50 MG TABLET
chlorpromazine HCl
00781591501 Yes No
CHLORPROMAZINE 50 MG TABLET
chlorpromazine HCl
00832030200 Yes No
CHLORPROMAZINE 50 MG TABLET
chlorpromazine HCl
00832030210 Yes No
CHLORPROMAZINE 50 MG TABLET
chlorpromazine HCl
51079013020 Yes No
CLOZAPINE 100 MG TABLET
clozapine
65862084601 Yes No
CLOZAPINE 100 MG TABLET
clozapine
65862084605 Yes No
CLOZAPINE 100 MG TABLET
clozapine
57664034713 Yes No
CLOZAPINE 100 MG TABLET
clozapine
57664034788 Yes No
CLOZAPINE 100 MG TABLET
clozapine
00378086001 Yes No
CLOZAPINE 100 MG TABLET
clozapine
16729014201 Yes No
CLOZAPINE 100 MG TABLET
clozapine
00378086005 Yes No
CLOZAPINE 100 MG TABLET
clozapine
16729014216 Yes No
CLOZAPINE 100 MG TABLET
clozapine
00781599201 Yes No
CLOZAPINE 100 MG TABLET
clozapine
00093777201 Yes No
CLOZAPINE 100 MG TABLET
clozapine
00093777205 Yes No
CLOZAPINE 100 MG TABLET
clozapine
00093777293 Yes No
CLOZAPINE 100 MG TABLET
clozapine
51079092220 Yes No
CLOZAPINE 100 MG TABLET
clozapine
51862027301 Yes No
CLOZAPINE 100 MG TABLET
clozapine
51862027305 Yes No
CLOZAPINE 200 MG TABLET
clozapine
65862084701 Yes No
CLOZAPINE 200 MG TABLET
clozapine
00378097301 Yes No
CLOZAPINE 200 MG TABLET
clozapine
00093440505 Yes No