Displaying 51 - 100 of 5958 records found.

Items in this class
Brand Name/Generic Name NDC code Clinical Prior Auth Required PDL Prior Auth Required
ACARBOSE 50 MG TABLET
acarbose
00115115101 No No
ACARBOSE 50 MG TABLET
acarbose
64380075906 No No
ACARBOSE 50 MG TABLET
acarbose
00115115102 No No
ACEPHEN 120 MG SUPPOSITORY
acetaminophen
00713011801 No No
ACEPHEN 120 MG SUPPOSITORY
acetaminophen
00713011812 No No
ACEPHEN 120 MG SUPPOSITORY
acetaminophen
00713011850 No No
ACEPHEN 325 MG SUPPOSITORY
acetaminophen
00713016401 No No
ACEPHEN 325 MG SUPPOSITORY
acetaminophen
00713016412 No No
ACEPHEN 325 MG SUPPOSITORY
acetaminophen
00713016450 No No
ACEPHEN 650 MG SUPPOSITORY
acetaminophen
00713016501 No No
ACEPHEN 650 MG SUPPOSITORY
acetaminophen
00713016512 No No
ACEPHEN 650 MG SUPPOSITORY
acetaminophen
00713016550 No No
ACETA-GESIC 325-12.5 MG TABLET
acetaminophen/diphenhydramine
00536100301 Yes No
ACETAMINOPHEN 325 MG TABLET
acetaminophen
63739044001 No No
ACETAMINOPHEN-DIPHENHYD 500-25
acetaminophen/diphenhydramine
00536101506 Yes No
ACETAZOLAMIDE 125 MG TABLET
acetazolamide
23155028701 No No
ACETAZOLAMIDE 125 MG TABLET
acetazolamide
64380083306 No No
ACETAZOLAMIDE 125 MG TABLET
acetazolamide
51672402201 No No
ACETAZOLAMIDE 250 MG TABLET
acetazolamide
23155028801 No No
ACETAZOLAMIDE 250 MG TABLET
acetazolamide
64380083406 No No
ACETAZOLAMIDE 250 MG TABLET
acetazolamide
00527105001 No No
ACETAZOLAMIDE 250 MG TABLET
acetazolamide
51672402301 No No
ACETAZOLAMIDE ER 500 MG CAP
acetazolamide
00555051302 No No
ACETAZOLAMIDE ER 500 MG CAP
acetazolamide
23155012001 No No
ACETAZOLAMIDE ER 500 MG CAP
acetazolamide
29033003001 No No
ACETAZOLAMIDE ER 500 MG CAP
acetazolamide
68382026101 No No
ACETAZOLAMIDE ER 500 MG CAP
acetazolamide
50742023301 No No
ACETIC ACID 0.25% IRRIG SOLN
acetic acid
00409614309 No No
ACETIC ACID 0.25% IRRIG SOLN
acetic acid
00264230400 No No
ACETIC ACID 0.25% IRRIG SOLN
acetic acid
00264230410 No No
ACETYLCYSTEINE 10% VIAL
acetylcysteine
00517750425 No No
ACETYLCYSTEINE 10% VIAL
acetylcysteine
00517751003 No No
ACETYLCYSTEINE 10% VIAL
acetylcysteine
00409330703 No No
ACETYLCYSTEINE 20% VIAL
acetylcysteine
00517760425 No No
ACETYLCYSTEINE 20% VIAL
acetylcysteine
00409330803 No No
ACETYLCYSTEINE 6 GRAM/30 ML VL
acetylcysteine
00574080530 No No
ACID GONE ANTACID LIQUID
mag carb/aluminum hydrox/algin
00904772714 No No
ACID REDUCER 20 MG TABLET
famotidine
37205086163 No No
ACITRETIN 10 MG CAPSULE
acitretin
66993089430 No No
ACITRETIN 10 MG CAPSULE
acitretin
42794008008 No No
ACITRETIN 10 MG CAPSULE
acitretin
00115166708 No No
ACITRETIN 10 MG CAPSULE
acitretin
00115175008 No No
ACITRETIN 10 MG CAPSULE
acitretin
00093113556 No No
ACITRETIN 10 MG CAPSULE
acitretin
00378702093 No No
ACITRETIN 17.5 MG CAPSULE
acitretin
42794008108 No No
ACITRETIN 17.5 MG CAPSULE
acitretin
00115166808 No No
ACITRETIN 17.5 MG CAPSULE
acitretin
00093113856 No No
ACITRETIN 25 MG CAPSULE
acitretin
00378702393 No No
ACITRETIN 25 MG CAPSULE
acitretin
66993089630 No No
ACITRETIN 25 MG CAPSULE
acitretin
42794008308 No No