Displaying 151 - 200 of 5958 records found.

Items in this class
Brand Name/Generic Name NDC code Clinical Prior Auth Required PDL Prior Auth Required
ALDACTONE 100 MG TABLET
spironolactone
00025103131 No No
ALDACTONE 25 MG TABLET
spironolactone
00025100131 No No
ALDACTONE 50 MG TABLET
spironolactone
00025104131 No No
ALDURAZYME 2.9 MG/5 ML VIAL
laronidase
58468007001 No No
ALECENSA 150 MG CAPSULE
alectinib HCl
50242013001 No No
ALKERAN 2 MG TABLET
melphalan
52609000105 No No
ALLZITAL 25-325 MG TABLET
butalbital/acetaminophen
70362072201 No No
ALMACONE CHEWABLE TABLET
mag hydrox/aluminum hyd/simeth
00536101101 No No
ALMACONE LIQUID
mag hydrox/aluminum hyd/simeth
00536002583 No No
ALMACONE-2 LIQUID
mag hydrox/aluminum hyd/simeth
00536001583 No No
ALORA 0.025 MG PATCH
estradiol
52544088408 Yes No
ALORA 0.05 MG PATCH
estradiol
52544047108 Yes No
ALORA 0.075 MG PATCH
estradiol
52544047208 Yes No
ALORA 0.1 MG PATCH
estradiol
52544047308 Yes No
ALPHANATE 1,000-400 UNIT VIAL
antihemophilic factor/VWF
68516460302 No No
ALPHANATE 1,500-600 UNIT VIAL
antihemophilic factor/VWF
68516460402 No No
ALPHANATE 2,000-800 UNIT VIAL
antihemophilic factor/VWF
68516460902 No No
ALPHANATE 250-100 UNIT VIAL
antihemophilic factor/VWF
68516460101 No No
ALPHANATE 500-200 UNIT VIAL
antihemophilic factor/VWF
68516460201 No No
ALPHANINE SD 1,000 UNIT VIAL
factor IX
68516360202 No No
ALPHANINE SD 1,500 UNIT VIAL
factor IX
68516360302 No No
ALPHANINE SD 500 UNIT VIAL
factor IX
68516360102 No No
ALPROLIX 1,000 UNIT NOMINAL
factor IX rec, Fc fusion protn
64406092201 No No
ALPROLIX 2,000 UNIT NOMINAL
factor IX rec, Fc fusion protn
64406093301 No No
ALPROLIX 250 UNIT NOMINAL
factor IX rec, Fc fusion protn
64406096601 No No
ALPROLIX 3,000 UNIT NOMINAL
factor IX rec, Fc fusion protn
64406094401 No No
ALPROLIX 4,000 UNIT NOMINAL
factor IX rec, Fc fusion protn
64406097701 No No
ALPROLIX 500 UNIT NOMINAL
factor IX rec, Fc fusion protn
64406091101 No No
ALTAVERA-28 TABLET
levonorgestrel-ethin estradiol
00781558315 No No
ALUMINUM HYDROXIDE GEL
aluminum hydroxide
00536009185 No No
ALUNBRIG 180 MG TABLET
brigatinib
63020018030 No No
ALUNBRIG 30 MG TABLET
brigatinib
76189011318 No No
ALUNBRIG 30 MG TABLET
brigatinib
76189011321 No No
ALUNBRIG 30 MG TABLET
brigatinib
63020011330 No No
ALUNBRIG 90 MG TABLET
brigatinib
63020009007 No No
ALUNBRIG 90 MG TABLET
brigatinib
63020009030 No No
ALUNBRIG 90 MG-180 MG TAB PACK
brigatinib
63020019830 No No
ALYACEN 1-35-28 TABLET
norethindrone-ethinyl estrad
68462039429 No No
ALYACEN 7-7-7-28 TABLET
norethindrone-ethinyl estrad
68462055629 No No
AMABELZ 0.5 MG-0.1 MG TABLET
estradiol/norethindrone acet
68180082913 No No
AMABELZ 1 MG-0.5 MG TABLET
estradiol/norethindrone acet
68180083013 No No
AMARYL 1 MG TABLET
glimepiride
00039022110 No No
AMARYL 2 MG TABLET
glimepiride
00039022210 No No
AMARYL 4 MG TABLET
glimepiride
00039022310 No No
AMBISOME 50 MG VIAL
amphotericin B liposome
00469305130 No No
AMETHIA 0.15-0.03-0.01 MG TAB
L-norgest/e.estradiol-e.estrad
51862004791 No No
AMETHIA LO TABLET
L-norgest/e.estradiol-e.estrad
51862004591 No No
AMETHYST 90-20 MCG TABLET
levonorgestrel-ethin estradiol
52544029528 No No
AMICAR 0.25 GRAM/ML ORAL SOLN
aminocaproic acid
49411005208 No No
AMICAR 1,000 MG TABLET
aminocaproic acid
49411005130 No No