Displaying 1 - 50 of 243 records found.
| 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 |