Displaying 51 - 100 of 284 records found.

Items in this class
Brand Name/Generic Name NDC code Clinical Prior Auth Required PDL Prior Auth Required
ESOMEPRAZOLE MAG DR 40 MG CAP
esomeprazole magnesium
65862078430 No Yes
HEARTBURN TREATMNT 24 HR 15 MG
lansoprazole
00536103413 Yes Yes
LANSOPRAZOLE DR 15 MG CAPSULE
lansoprazole
45802024503 Yes Yes
LANSOPRAZOLE DR 15 MG CAPSULE
lansoprazole
68001011104 Yes Yes
LANSOPRAZOLE DR 15 MG CAPSULE
lansoprazole
68001011105 Yes Yes
LANSOPRAZOLE DR 15 MG CAPSULE
lansoprazole
27241001903 Yes Yes
LANSOPRAZOLE DR 15 MG CAPSULE
lansoprazole
55111039830 Yes Yes
LANSOPRAZOLE DR 15 MG CAPSULE
lansoprazole
55111039890 Yes Yes
LANSOPRAZOLE DR 15 MG CAPSULE
lansoprazole
00378801593 Yes Yes
LANSOPRAZOLE DR 15 MG CAPSULE
lansoprazole
00093735056 Yes Yes
LANSOPRAZOLE DR 15 MG CAPSULE
lansoprazole
68382054306 Yes Yes
LANSOPRAZOLE DR 15 MG CAPSULE
lansoprazole
68382054310 Yes Yes
LANSOPRAZOLE DR 15 MG CAPSULE
lansoprazole
51991077133 Yes Yes
LANSOPRAZOLE DR 15 MG CAPSULE
lansoprazole
00591244814 Yes Yes
LANSOPRAZOLE DR 15 MG CAPSULE
lansoprazole
00781214710 Yes Yes
LANSOPRAZOLE DR 15 MG CAPSULE
lansoprazole
70756080630 Yes Yes
LANSOPRAZOLE DR 15 MG CAPSULE
lansoprazole
00781214731 Yes Yes
LANSOPRAZOLE DR 15 MG CAPSULE
lansoprazole
45802024501 Yes Yes
LANSOPRAZOLE DR 15 MG CAPSULE
lansoprazole
45802024502 Yes Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
68001011203 No Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
68001011205 No Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
27241002003 No Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
27241002009 No Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
55111039905 No Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
27241002050 No Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
55111039990 No Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
51079012108 No Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
63739055510 No Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
00378803005 No Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
00378803077 No Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
00378803093 No Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
00093735156 No Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
68382054401 No Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
68382054406 No Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
70700026305 No Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
68382054410 No Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
70700026330 No Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
51991077205 No Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
68382054416 No Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
70700026390 No Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
51991077290 No Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
70756080730 No Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
00781214801 No Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
70756080751 No Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
00781214810 No Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
70756080790 No Yes
LANSOPRAZOLE DR 30 MG CAPSULE
lansoprazole
00781214892 No Yes
LANSOPRAZOLE ODT 15 MG TABLET
lansoprazole
00093300893 No Yes
LANSOPRAZOLE ODT 30 MG TABLET
lansoprazole
00093300993 No Yes
NEXIUM DR 10 MG PACKET
esomeprazole magnesium
00186401001 No No