GI MOTILITY: CHRONIC | Vendor Drug Program

Brand Name/Generic Name	NDC/Manufacturer	FFS Clinical Prior Auth Required	PDL Prior Auth Required	Programs
AMITIZA 24 MCG CAPSULES lubiprostone	64764024060 TAKEDA PHARMACE	Yes	No	Medicaid CHIP CSHCN
AMITIZA 8 MCG CAPSULE lubiprostone	64764008060 TAKEDA PHARMACE	Yes	No	Medicaid CHIP CSHCN
LINZESS 145 MCG CAPSULE linaclotide	00456120130 ALLERGAN INC.	Yes	No	Medicaid CHIP CSHCN
LINZESS 290 MCG CAPSULE linaclotide	00456120230 ALLERGAN INC.	Yes	No	Medicaid CHIP CSHCN
LINZESS 72 MCG CAPSULE linaclotide	00456120330 ALLERGAN INC.	Yes	No	Medicaid CHIP CSHCN
LUBIPROSTONE 24 MCG CAPSULE lubiprostone	65162084206 AMNEAL PHARMACE	Yes	No	Medicaid CHIP CSHCN
LUBIPROSTONE 24 MCG CAPSULE lubiprostone	00254302902 PAR PHARM.	Yes	No	Medicaid CHIP CSHCN
LUBIPROSTONE 24 MCG CAPSULE lubiprostone	00480413806 TEVA PHARM	Yes	No	Medicaid CHIP CSHCN
LUBIPROSTONE 24 MCG CAPSULE lubiprostone	43598016860 DR.REDDY'S LAB	Yes	No	Medicaid CHIP CSHCN
LUBIPROSTONE 8 MCG CAPSULE lubiprostone	00254302802 PAR PHARM.	Yes	No	Medicaid CHIP CSHCN