Displaying 1 - 50 of 60 records found.

Items in this class
Brand Name/Generic Name NDC code Clinical Prior Auth Required PDL Prior Auth Required
ACULAR 0.5% EYE DROPS
ketorolac tromethamine
00023218105 No Yes
ACULAR LS 0.4% OPHTH SOL
ketorolac tromethamine
00023927705 No Yes
ACUVAIL 0.45% OPHTH SOLUTION
ketorolac tromethamine/PF
00023350730 Yes Yes
BROMFENAC SODIUM 0.09% EYE DRP
bromfenac sodium
50383024971 No Yes
BROMFENAC SODIUM 0.09% EYE DRP
bromfenac sodium
60505059505 No Yes
BROMFENAC SODIUM 0.09% EYE DRP
bromfenac sodium
60505059604 No Yes
DEXAMETHASONE 0.1% EYE DROP
dexamethasone sodium phosphate
24208072002 No Yes
DICLOFENAC 0.1% EYE DROPS
diclofenac sodium
24208045705 No No
DICLOFENAC 0.1% EYE DROPS
diclofenac sodium
24208045725 No No
DICLOFENAC 0.1% EYE DROPS
diclofenac sodium
61314001405 No No
DICLOFENAC 0.1% EYE DROPS
diclofenac sodium
16571010125 No No
DICLOFENAC 0.1% EYE DROPS
diclofenac sodium
61314001425 No No
DICLOFENAC 0.1% EYE DROPS
diclofenac sodium
16571010150 No No
DICLOFENAC 0.1% EYE DROPS
diclofenac sodium
17478089210 No No
DICLOFENAC 0.1% EYE DROPS
diclofenac sodium
17478089225 No No
DUREZOL 0.05% EYE DROPS
difluprednate
00065924007 No No
FLAREX 0.1% EYE DROPS
fluorometholone acetate
00065009605 No Yes
FLUOROMETHOLONE 0.1% DROPS
fluorometholone
60758088005 No Yes
FLUOROMETHOLONE 0.1% DROPS
fluorometholone
60758088010 No Yes
FLUOROMETHOLONE 0.1% DROPS
fluorometholone
60758088015 No Yes
FLURBIPROFEN 0.03% EYE DROP
flurbiprofen sodium
24208031425 No No
FML FORTE 0.25% EYE DROPS
fluorometholone
11980022805 No Yes
FML FORTE 0.25% EYE DROPS
fluorometholone
11980022810 No Yes
FML LIQUIFILM 0.1% EYE DROP
fluorometholone
11980021105 No Yes
FML LIQUIFILM 0.1% EYE DROP
fluorometholone
11980021110 No Yes
FML S.O.P. 0.1% OINTMENT
fluorometholone
00023031604 No Yes
ILEVRO 0.3% OPHTH DROPS
nepafenac
00065175007 No Yes
ILEVRO 0.3% OPHTH DROPS
nepafenac
00065175014 No Yes
KETOROLAC 0.4% OPHTH SOLUTION
ketorolac tromethamine
60758077305 No Yes
KETOROLAC 0.5% OPHTH SOLUTION
ketorolac tromethamine
41616021990 No No
KETOROLAC 0.5% OPHTH SOLUTION
ketorolac tromethamine
41616022090 No No
KETOROLAC 0.5% OPHTH SOLUTION
ketorolac tromethamine
41616022190 No No
KETOROLAC 0.5% OPHTH SOLUTION
ketorolac tromethamine
60505100301 No No
KETOROLAC 0.5% OPHTH SOLUTION
ketorolac tromethamine
60505100302 No No
KETOROLAC 0.5% OPHTH SOLUTION
ketorolac tromethamine
61314012605 No No
KETOROLAC 0.5% OPHTH SOLUTION
ketorolac tromethamine
17478020910 No No
KETOROLAC 0.5% OPHTH SOLUTION
ketorolac tromethamine
61314012610 No No
KETOROLAC 0.5% OPHTH SOLUTION
ketorolac tromethamine
17478020911 No No
KETOROLAC 0.5% OPHTH SOLUTION
ketorolac tromethamine
17478020919 No No
LOTEMAX 0.5% EYE DROPS
loteprednol etabonate
24208029905 No No
LOTEMAX 0.5% EYE DROPS
loteprednol etabonate
24208029910 No No
LOTEMAX 0.5% EYE DROPS
loteprednol etabonate
24208029915 No No
LOTEMAX 0.5% EYE OINTMENT
loteprednol etabonate
24208044335 No Yes
LOTEMAX 0.5% OPHTHALMIC GEL
loteprednol etabonate
24208050307 No Yes
MAXIDEX 0.1% EYE DROPS
dexamethasone
00998061505 No Yes
NEVANAC 0.1% DROPTAINER
nepafenac
00065000203 No No
OMNIPRED 1% EYE DROPS
prednisolone acetate
00065063825 No Yes
OMNIPRED 1% EYE DROPS
prednisolone acetate
00065063827 No Yes
PRED FORTE 1% EYE DROPS
prednisolone acetate
11980018005 No Yes
PRED FORTE 1% EYE DROPS
prednisolone acetate
11980018010 No Yes