COUGH AND COLD: NON-NARCOTIC | Vendor Drug Program

Brand Name/Generic Name	NDC/Manufacturer	FFS Clinical Prior Auth Required	PDL Prior Auth Required	Programs
ALAHIST CF TABLET d-methorphan/pe/dexbromphenir	50991078490 POLY PHARMACEUT	Yes	No	Medicaid CSHCN
ALAHIST DM 2-15-7.5 MG/5 ML LQ d-methorphan/pe/dexbromphenir	50991082616 POLY PHARMACEUT	Yes	No	Medicaid CSHCN
BENZONATATE 100 MG CAPSULE benzonatate	51224001050 TAGI PHARMA	Yes	No	Medicaid CHIP CSHCN
BENZONATATE 100 MG CAPSULE benzonatate	67877057301 ASCEND LABORATO	Yes	No	Medicaid CHIP CSHCN
BENZONATATE 100 MG CAPSULE benzonatate	69452014320 BIONPHARMA INC.	Yes	No	Medicaid CHIP CSHCN
BENZONATATE 100 MG CAPSULE benzonatate	51224001060 TAGI PHARMA	Yes	No	Medicaid CHIP CSHCN
BENZONATATE 100 MG CAPSULE benzonatate	62135044031 CHARTWELL RX LL	Yes	No	Medicaid CHIP CSHCN
BENZONATATE 100 MG CAPSULE benzonatate	67877057305 ASCEND LABORATO	Yes	No	Medicaid CHIP CSHCN
BENZONATATE 100 MG CAPSULE benzonatate	69452014330 BIONPHARMA INC.	Yes	No	Medicaid CHIP CSHCN
BENZONATATE 100 MG CAPSULE benzonatate	62135044090 CHARTWELL RX LL	Yes	No	Medicaid CHIP CSHCN