Displaying 1 - 47 of 47 records found.

Items in this class
Brand Name/Generic Name NDC code Clinical Prior Auth Required PDL Prior Auth Required
AURYXIA 210 MG TABLET
ferric citrate
59922063101 Yes Yes
CALCIUM ACETATE 667 MG CAPSULE
calcium acetate
69097086283 Yes No
CALCIUM ACETATE 667 MG CAPSULE
calcium acetate
00904666825 Yes No
CALCIUM ACETATE 667 MG CAPSULE
calcium acetate
00054008813 Yes No
CALCIUM ACETATE 667 MG CAPSULE
calcium acetate
00054008826 Yes No
CALCIUM ACETATE 667 MG CAPSULE
calcium acetate
23155053102 Yes No
CALCIUM ACETATE 667 MG CAPSULE
calcium acetate
29033002602 Yes No
CALCIUM ACETATE 667 MG CAPSULE
calcium acetate
76282037702 Yes No
CALCIUM ACETATE 667 MG CAPSULE
calcium acetate
62135019122 Yes No
CALCIUM ACETATE 667 MG CAPSULE
calcium acetate
65162059020 Yes No
CALCIUM ACETATE 667 MG CAPSULE
calcium acetate
68180013415 Yes No
CALCIUM ACETATE 667 MG GELCAP
calcium acetate
00781208102 Yes No
CALCIUM ACETATE 667 MG TABLET
calcium acetate
23155062102 Yes No
CALCIUM ACETATE 667 MG TABLET
calcium acetate
62135019222 Yes No
FOSRENOL 1,000 MG POWDER PACK
lanthanum carbonate
54092025702 Yes Yes
FOSRENOL 1,000 MG TABLET CHEW
lanthanum carbonate
54092025490 Yes Yes
FOSRENOL 500 MG TABLET CHEW
lanthanum carbonate
54092025290 Yes Yes
FOSRENOL 750 MG POWDER PACKET
lanthanum carbonate
54092025602 Yes Yes
FOSRENOL 750 MG TABLET CHEW
lanthanum carbonate
54092025390 Yes Yes
LANTHANUM CARB 1,000 MG TB CHW
lanthanum carbonate
68180082147 Yes Yes
LANTHANUM CARB 1,000 MG TB CHW
lanthanum carbonate
66993042485 Yes Yes
LANTHANUM CARB 500 MG TAB CHEW
lanthanum carbonate
68180081942 Yes Yes
LANTHANUM CARB 500 MG TAB CHEW
lanthanum carbonate
66993042285 Yes Yes
LANTHANUM CARB 750 MG TAB CHEW
lanthanum carbonate
68180082046 Yes Yes
LANTHANUM CARB 750 MG TAB CHEW
lanthanum carbonate
66993042385 Yes Yes
PHOSLYRA 667 MG/5 ML SOLUTION
calcium acetate
49230064331 Yes Yes
RENAGEL 800 MG TABLET
sevelamer HCl
58468002101 No No
RENVELA 2.4 GM POWDER PACKET
sevelamer carbonate
58468013102 No Yes
RENVELA 800 MG TABLET
sevelamer carbonate
58468013001 No Yes
SEVELAMER 0.8 GM POWDER PACKET
sevelamer carbonate
43598047890 No Yes
SEVELAMER 0.8 GM POWDER PACKET
sevelamer carbonate
00955105290 No Yes
SEVELAMER 0.8 GM POWDER PACKET
sevelamer carbonate
65862093090 No Yes
SEVELAMER 2.4 GM POWDER PACKET
sevelamer carbonate
43598047990 No Yes
SEVELAMER 2.4 GM POWDER PACKET
sevelamer carbonate
00955105490 No Yes
SEVELAMER 2.4 GM POWDER PACKET
sevelamer carbonate
65862093190 No Yes
SEVELAMER CARBONATE 800 MG TAB
sevelamer carbonate
69097096793 No Yes
SEVELAMER CARBONATE 800 MG TAB
sevelamer carbonate
00955105027 No Yes
SEVELAMER CARBONATE 800 MG TAB
sevelamer carbonate
55111078911 No Yes
SEVELAMER CARBONATE 800 MG TAB
sevelamer carbonate
55111078927 No Yes
SEVELAMER CARBONATE 800 MG TAB
sevelamer carbonate
24979018646 No Yes
SEVELAMER CARBONATE 800 MG TAB
sevelamer carbonate
76282040727 No Yes
SEVELAMER CARBONATE 800 MG TAB
sevelamer carbonate
65162005827 No Yes
SEVELAMER CARBONATE 800 MG TAB
sevelamer carbonate
65862092127 No Yes
SEVELAMER HCL 400 MG TABLET
sevelamer HCl
68462044626 No Yes
SEVELAMER HCL 800 MG TABLET
sevelamer HCl
68462044718 No Yes
SEVELAMER HCL 800 MG TABLET
sevelamer HCl
00955104818 No Yes
VELPHORO 500 MG CHEWABLE TAB
sucroferric oxyhydroxide
49230064551 Yes Yes