Displaying 1 - 50 of 243 records found.

Items in this class
Brand Name/Generic Name NDC code Clinical Prior Auth Required PDL Prior Auth Required
CHOLESTYRAMINE LIGHT PACKET
cholestyramine/aspartame
68382052960 No No
CHOLESTYRAMINE LIGHT PACKET
cholestyramine/aspartame
49884046665 No No
CHOLESTYRAMINE LIGHT PACKET
cholestyramine/aspartame
00185093998 No No
CHOLESTYRAMINE LIGHT POWDER
cholestyramine/aspartame
68382052942 No No
CHOLESTYRAMINE LIGHT POWDER
cholestyramine/aspartame
49884046667 No No
CHOLESTYRAMINE LIGHT POWDER
cholestyramine/aspartame
00185093997 No No
CHOLESTYRAMINE PACKET
cholestyramine (with sugar)
00245053660 No No
CHOLESTYRAMINE PACKET
cholestyramine (with sugar)
68382052860 No No
CHOLESTYRAMINE PACKET
cholestyramine (with sugar)
49884046565 No No
CHOLESTYRAMINE PACKET
cholestyramine (with sugar)
00185094098 No No
CHOLESTYRAMINE POWDER
cholestyramine (with sugar)
00245053637 No No
CHOLESTYRAMINE POWDER
cholestyramine (with sugar)
62559062037 No No
CHOLESTYRAMINE POWDER
cholestyramine (with sugar)
68382052842 No No
CHOLESTYRAMINE POWDER
cholestyramine (with sugar)
49884046566 No No
CHOLESTYRAMINE POWDER
cholestyramine (with sugar)
00185094097 No No
COLESEVELAM 625 MG TABLET
colesevelam HCl
00115132019 No Yes
COLESEVELAM 625 MG TABLET
colesevelam HCl
75834015218 No Yes
COLESEVELAM 625 MG TABLET
colesevelam HCl
43598023018 No Yes
COLESEVELAM 625 MG TABLET
colesevelam HCl
69452015825 No Yes
COLESEVELAM 625 MG TABLET
colesevelam HCl
68462043318 No Yes
COLESEVELAM 625 MG TABLET
colesevelam HCl
67877050651 No Yes
COLESEVELAM HCL 3.75 G PACKET
colesevelam HCl
67877052330 No Yes
COLESEVELAM HCL 3.75 G PACKET
colesevelam HCl
68462062030 No Yes
COLESTID 1 GM TABLET
colestipol HCl
00009045003 No Yes
COLESTID FLAVORED GRANULES
colestipol HCl
00009037003 No Yes
COLESTID FLAVORED GRANULES
colestipol HCl
00009037005 No Yes
COLESTID GRANULES
colestipol HCl
00009026002 No Yes
COLESTID GRANULES PACKET
colestipol HCl
00009026001 No Yes
COLESTIPOL HCL 1 GM TABLET
colestipol HCl
00115521116 No No
COLESTIPOL HCL GRANULES
colestipol HCl
59762026003 No Yes
COLESTIPOL HCL GRANULES
colestipol HCl
00115521302 No Yes
COLESTIPOL HCL GRANULES PACKET
colestipol HCl
59762026001 No Yes
COLESTIPOL HCL GRANULES PACKET
colestipol HCl
59762026002 No Yes
COLESTIPOL HCL GRANULES PACKET
colestipol HCl
00115521218 No Yes
COLESTIPOL HCL GRANULES PACKET
colestipol HCl
00115521229 No Yes
COLESTIPOL MICRONIZED 1 GM TAB
colestipol HCl
59762045001 No No
EZETIMIBE 10 MG TABLET
ezetimibe
51660020005 No Yes
EZETIMIBE 10 MG TABLET
ezetimibe
51660020030 No Yes
EZETIMIBE 10 MG TABLET
ezetimibe
51660020090 No Yes
EZETIMIBE 10 MG TABLET
ezetimibe
59651005230 No Yes
EZETIMIBE 10 MG TABLET
ezetimibe
59651005290 No Yes
EZETIMIBE 10 MG TABLET
ezetimibe
69238115403 No Yes
EZETIMIBE 10 MG TABLET
ezetimibe
69238115405 No Yes
EZETIMIBE 10 MG TABLET
ezetimibe
69238115409 No Yes
EZETIMIBE 10 MG TABLET
ezetimibe
60505294503 No Yes
EZETIMIBE 10 MG TABLET
ezetimibe
60505294509 No Yes
EZETIMIBE 10 MG TABLET
ezetimibe
00591371305 No Yes
EZETIMIBE 10 MG TABLET
ezetimibe
68382077305 No Yes
EZETIMIBE 10 MG TABLET
ezetimibe
67877049005 No Yes
EZETIMIBE 10 MG TABLET
ezetimibe
00591371319 No Yes