ANTIMIGRAINE AGENTS: TRIPTANS

Displaying 1 - 10 of 169 records found.
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Brand Name/Generic Name NDC/Manufacturer FFS Clinical Prior Auth Required PDL Prior Auth Required Programs
IMITREX 20 MG NASAL SPRAY
sumatriptan 		00173052300
GLAXOSMITHKLINE 		Yes No Medicaid CHIP CSHCN
IMITREX 4 MG/0.5 ML CARTRIDGES
sumatriptan succinate 		00173073902
GLAXOSMITHKLINE 		Yes No Medicaid CHIP CSHCN
IMITREX 4 MG/0.5 ML PEN INJECT
sumatriptan succinate 		00173073900
GLAXOSMITHKLINE 		Yes No Medicaid CHIP CSHCN
IMITREX 5 MG NASAL SPRAY
sumatriptan 		00173052400
GLAXOSMITHKLINE 		Yes No Medicaid CHIP CSHCN
IMITREX 6 MG/0.5 ML CARTRIDGES
sumatriptan succinate 		00173047800
GLAXOSMITHKLINE 		Yes No Medicaid CHIP CSHCN
IMITREX 6 MG/0.5 ML PEN INJECT
sumatriptan succinate 		00173047900
GLAXOSMITHKLINE 		Yes No Medicaid CHIP CSHCN
RIZATRIPTAN 10 MG ODT
rizatriptan benzoate 		65862062612
AUROBINDO PHARM 		Yes No Medicaid CHIP CSHCN
RIZATRIPTAN 10 MG ODT
rizatriptan benzoate 		65862062690
AUROBINDO PHARM 		Yes No Medicaid CHIP CSHCN
RIZATRIPTAN 10 MG ODT
rizatriptan benzoate 		57237008663
RISING PHARM 		Yes No Medicaid CHIP CSHCN
RIZATRIPTAN 10 MG ODT
rizatriptan benzoate 		51991036378
BRECKENRIDGE 		Yes No Medicaid CHIP CSHCN