Displaying 101 - 150 of 5958 records found.

Items in this class
Brand Name/Generic Name NDC code Clinical Prior Auth Required PDL Prior Auth Required
ACITRETIN 25 MG CAPSULE
acitretin
00115166908 No No
ACITRETIN 25 MG CAPSULE
acitretin
00115175308 No No
ACITRETIN 25 MG CAPSULE
acitretin
00093113656 No No
ACNE MEDICATION 10% GEL
benzoyl peroxide
00536105656 No No
ACNE MEDICATION 10% LOTION
benzoyl peroxide
00536105875 No No
ACNE MEDICATION 5% GEL
benzoyl peroxide
00536105556 No No
ACNE MEDICATION 5% LOTION
benzoyl peroxide
00536105775 No No
ACTIDOSE 50 GM LIQUID
charcoal/sorbitol solution
00574012008 No No
ACTIMMUNE 100 MCG/0.5 ML VIAL
interferon gamma-1b,recomb.
75987011110 No No
ACTIMMUNE 100 MCG/0.5 ML VIAL
interferon gamma-1b,recomb.
75987011111 No No
ACTIMMUNE 100 MCG/0.5 ML VIAL
interferon gamma-1b,recomb.
42238011101 No No
ACTIMMUNE 100 MCG/0.5 ML VIAL
interferon gamma-1b,recomb.
42238011112 No No
ADAGEN 250 UNITS/ML VIAL
pegademase bovine
57665000101 No No
ADEFOVIR DIPIVOXIL 10 MG TAB
adefovir dipivoxil
42794000308 No No
ADMELOG 100 UNIT/ML VIAL
insulin lispro
00024592410 No No
ADMELOG SOLOSTAR 100 UNIT/ML
insulin lispro
00024592505 No No
ADVATE 1,201-1,800 UNIT VIAL
antihemophil.FVIII,full length
00944305402 No No
ADVATE 1,801-2,400 UNIT VIAL
antihemophil.FVIII,full length
00944304510 No No
ADVATE 2,401-3,600 UNIT VIAL
antihemophil.FVIII,full length
00944304610 No No
ADVATE 200-400 UNIT VIAL
antihemophil.FVIII,full length
00944305102 No No
ADVATE 3,601-4,800 UNIT VIAL
antihemophil.FVIII,full length
00944304710 No No
ADVATE 401-800 UNIT VIAL
antihemophil.FVIII,full length
00944305202 No No
ADVATE 801-1,200 UNIT VIAL
antihemophil.FVIII,full length
00944305302 No No
ADYNOVATE 1,251-2,500 UNIT VL
antihemo.FVIII,full length peg
00944425802 No No
ADYNOVATE 1,251-2,500 UNIT VL
antihemo.FVIII,full length peg
00944462501 No No
ADYNOVATE 1,500 UNIT VIAL
antihemo.FVIII,full length peg
00944462701 No No
ADYNOVATE 200-400 UNIT VIAL
antihemo.FVIII,full length peg
00944425202 No No
ADYNOVATE 200-400 UNIT VIAL
antihemo.FVIII,full length peg
00944462201 No No
ADYNOVATE 3,000 UNIT VIAL
antihemo.FVIII,full length peg
00944462801 No No
ADYNOVATE 401-800 UNIT VIAL
antihemo.FVIII,full length peg
00944425402 No No
ADYNOVATE 401-800 UNIT VIAL
antihemo.FVIII,full length peg
00944462301 No No
ADYNOVATE 750 UNIT VIAL
antihemo.FVIII,full length peg
00944462601 No No
ADYNOVATE 801-1,250 UNIT VIAL
antihemo.FVIII,full length peg
00944425602 No No
ADYNOVATE 801-1,250 UNIT VIAL
antihemo.FVIII,full length peg
00944462401 No No
AFINITOR 10 MG TABLET
everolimus
00078056751 No No
AFINITOR 2.5 MG TABLET
everolimus
00078059451 No No
AFINITOR 5 MG TABLET
everolimus
00078056651 No No
AFINITOR 7.5 MG TABLET
everolimus
00078062051 No No
AFINITOR DISPERZ 2 MG TABLET
everolimus
00078062651 No No
AFINITOR DISPERZ 3 MG TABLET
everolimus
00078062751 No No
AFINITOR DISPERZ 5 MG TABLET
everolimus
00078062851 No No
AFSTYLA 1,000 UNIT VIAL
antihem.FVIII,sin-chn,B-dm tru
69911047602 No No
AFSTYLA 2,000 UNIT VIAL
antihem.FVIII,sin-chn,B-dm tru
69911047702 No No
AFSTYLA 250 UNIT VIAL
antihem.FVIII,sin-chn,B-dm tru
69911047402 No No
AFSTYLA 3,000 UNIT VIAL
antihem.FVIII,sin-chn,B-dm tru
69911047802 No No
AFSTYLA 500 UNIT VIAL
antihem.FVIII,sin-chn,B-dm tru
69911047502 No No
AGRYLIN 0.5 MG CAPSULE
anagrelide HCl
54092006301 No No
ALBENZA 200 MG TABLET
albendazole
52054055022 No No
ALDACTAZIDE 25-25 TABLET
spironolact/hydrochlorothiazid
00025101131 Yes No
ALDACTAZIDE 50-50 TABLET
spironolact/hydrochlorothiazid
00025102131 Yes No