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| Brand Name/Generic Name/Package Size | NDC/Manufacturer/Class | PA Required | Programs/Coverage Dates |
|---|---|---|---|
| AMLOD-VALSA-HCTZ 5-160-25 MG amlodipine/valsartan/hcthiazid 30 EA |
65862083530 AUROBINDO PHARM ANGIOTENSIN MODULATOR COMBINATIONS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 09/19/2019 CHIP start: 09/19/2019 CSHCN start: 09/19/2019 KHC start: 09/19/2019 |
| AMLOD-VALSA-HCTZ 5-160-25 MG amlodipine/valsartan/hcthiazid 30 EA |
64380019801 STRIDES PHARMA ANGIOTENSIN MODULATOR COMBINATIONS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 03/02/2023 CHIP start: 03/02/2023 CSHCN start: 03/02/2023 |
| AMLODIPINE-ATORVAST 10-10 MG amlodipine/atorvastatin 30 EA |
66993027030 PRASCO LABS LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 06/20/2022 CHIP start: 06/20/2022 CSHCN start: 06/20/2022 |
| AMLODIPINE-ATORVAST 10-10 MG amlodipine/atorvastatin 30 EA |
00378451793 MYLAN LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 04/11/2019 CHIP start: 04/11/2019 CSHCN start: 04/11/2019 KHC start: 04/11/2019 |
| AMLODIPINE-ATORVAST 10-10 MG amlodipine/atorvastatin 30 EA |
60505347903 APOTEX CORP LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 04/21/2021 CHIP start: 04/21/2021 CSHCN start: 04/21/2021 KHC start: 04/21/2021 |
| AMLODIPINE-ATORVAST 10-20 MG amlodipine/atorvastatin 30 EA |
66993027130 PRASCO LABS LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 10/31/2022 CHIP start: 10/31/2022 CSHCN start: 10/31/2022 |
| AMLODIPINE-ATORVAST 10-20 MG amlodipine/atorvastatin 30 EA |
00378451893 MYLAN LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 04/11/2019 CHIP start: 04/11/2019 CSHCN start: 04/11/2019 KHC start: 04/11/2019 |
| AMLODIPINE-ATORVAST 10-20 MG amlodipine/atorvastatin 30 EA |
60505348403 APOTEX CORP LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 04/21/2021 CHIP start: 04/21/2021 CSHCN start: 04/21/2021 KHC start: 04/21/2021 |
| AMLODIPINE-ATORVAST 10-40 MG amlodipine/atorvastatin 30 EA |
66993027230 PRASCO LABS LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 06/20/2022 CHIP start: 06/20/2022 CSHCN start: 06/20/2022 |
| AMLODIPINE-ATORVAST 10-40 MG amlodipine/atorvastatin 30 EA |
00378451993 MYLAN LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 04/11/2019 CHIP start: 04/11/2019 CSHCN start: 04/11/2019 KHC start: 04/11/2019 |
| AMLODIPINE-ATORVAST 10-40 MG amlodipine/atorvastatin 30 EA |
60505348903 APOTEX CORP LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 04/21/2021 CHIP start: 04/21/2021 CSHCN start: 04/21/2021 KHC start: 04/21/2021 |
| AMLODIPINE-ATORVAST 10-40 MG amlodipine/atorvastatin 30 EA |
43598031530 DR.REDDY'S LAB LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 07/24/2014 Medicaid end: 01/31/2024 CHIP start: 07/24/2014 CHIP end: 01/31/2024 CSHCN start: 07/24/2014 CSHCN end: 01/31/2024 KHC start: 07/24/2014 KHC end: 01/31/2024 |
| AMLODIPINE-ATORVAST 10-40 MG amlodipine/atorvastatin 90 EA |
43598031590 DR.REDDY'S LAB LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 09/29/2014 Medicaid end: 01/31/2024 CHIP start: 09/29/2014 CHIP end: 01/31/2024 CSHCN start: 09/29/2014 CSHCN end: 01/31/2024 KHC start: 09/29/2014 KHC end: 01/31/2024 |
| AMLODIPINE-ATORVAST 10-80 MG amlodipine/atorvastatin 30 EA |
66993027330 PRASCO LABS LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 09/21/2022 CHIP start: 09/21/2022 CSHCN start: 09/21/2022 |
| AMLODIPINE-ATORVAST 10-80 MG amlodipine/atorvastatin 30 EA |
60505349303 APOTEX CORP LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 04/21/2021 CHIP start: 04/21/2021 CSHCN start: 04/21/2021 KHC start: 04/21/2021 |
| AMLODIPINE-ATORVAST 2.5-10 MG amlodipine/atorvastatin 30 EA |
66993026330 PRASCO LABS LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 10/31/2022 CHIP start: 10/31/2022 CSHCN start: 10/31/2022 |
| AMLODIPINE-ATORVAST 2.5-20 MG amlodipine/atorvastatin 30 EA |
66993026430 PRASCO LABS LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 09/21/2022 CHIP start: 09/21/2022 CSHCN start: 09/21/2022 |
| AMLODIPINE-ATORVAST 2.5-20 MG amlodipine/atorvastatin 30 EA |
43598032030 DR.REDDY'S LAB LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 09/18/2014 Medicaid end: 12/31/2023 CHIP start: 09/18/2014 CHIP end: 12/31/2023 CSHCN start: 09/18/2014 CSHCN end: 12/31/2023 KHC start: 09/18/2014 KHC end: 12/31/2023 |
| AMLODIPINE-ATORVAST 2.5-40 MG amlodipine/atorvastatin 30 EA |
43598031730 DR.REDDY'S LAB LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 08/13/2014 Medicaid end: 12/31/2023 CHIP start: 08/13/2014 CHIP end: 12/31/2023 CSHCN start: 08/13/2014 CSHCN end: 12/31/2023 KHC start: 08/13/2014 KHC end: 12/31/2023 |
| AMLODIPINE-ATORVAST 2.5-40 MG amlodipine/atorvastatin 30 EA |
66993026530 PRASCO LABS LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 06/20/2022 CHIP start: 06/20/2022 CSHCN start: 06/20/2022 |
| AMLODIPINE-ATORVAST 5-10 MG amlodipine/atorvastatin 30 EA |
60505347803 APOTEX CORP LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 04/21/2021 CHIP start: 04/21/2021 CSHCN start: 04/21/2021 KHC start: 04/21/2021 |
| AMLODIPINE-ATORVAST 5-10 MG amlodipine/atorvastatin 30 EA |
66993026630 PRASCO LABS LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 10/31/2022 CHIP start: 10/31/2022 CSHCN start: 10/31/2022 |
| AMLODIPINE-ATORVAST 5-20 MG amlodipine/atorvastatin 30 EA |
66993026730 PRASCO LABS LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 10/31/2022 CHIP start: 10/31/2022 CSHCN start: 10/31/2022 |
| AMLODIPINE-ATORVAST 5-20 MG amlodipine/atorvastatin 30 EA |
00378451493 MYLAN LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 04/11/2019 CHIP start: 04/11/2019 CSHCN start: 04/11/2019 KHC start: 04/11/2019 |
| AMLODIPINE-ATORVAST 5-20 MG amlodipine/atorvastatin 30 EA |
60505348303 APOTEX CORP LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 04/21/2021 CHIP start: 04/21/2021 CSHCN start: 04/21/2021 KHC start: 04/21/2021 |