Search Results: Formulary Drugs

Displaying 1 - 25 of 8125 records found. Return to search page.

Brand Name/Generic Name/Package Size	NDC/Manufacturer	PDL Class	FFS Clinical Prior Auth Required	PDL Prior Auth Required	Programs
24HR ALLERGY(LEVOCETIRZN) 5 MG levocetirizine dihydrochloride 10 EA	70000036201 LEADER	ANTIHISTAMINES: MINIMALLY SEDATING	Yes	Yes	Medicaid CSHCN
24HR ALLERGY(LEVOCETIRZN) 5 MG levocetirizine dihydrochloride 35 EA	70000036202 LEADER	ANTIHISTAMINES: MINIMALLY SEDATING	Yes	Yes	Medicaid CSHCN
24HR ALLERGY-CONGST 180-240 MG fexofenadine/pseudoephedrine 10 EA	70000060701 LEADER	ANTIHISTAMINES: MINIMALLY SEDATING	Yes	Yes	Medicaid CSHCN
ABILIFY 10 MG TABLET aripiprazole 30 EA	59148000813 OTSUKA AMERICA	ANTIPSYCHOTICS	Yes	Yes	Medicaid CHIP CSHCN
ABILIFY 15 MG TABLET aripiprazole 30 EA	59148000913 OTSUKA AMERICA	ANTIPSYCHOTICS	Yes	Yes	Medicaid CHIP CSHCN
ABILIFY 2 MG TABLET aripiprazole 30 EA	59148000613 OTSUKA AMERICA	ANTIPSYCHOTICS	Yes	Yes	Medicaid CHIP CSHCN
ABILIFY 20 MG TABLET aripiprazole 30 EA	59148001013 OTSUKA AMERICA	ANTIPSYCHOTICS	Yes	Yes	Medicaid CHIP CSHCN
ABILIFY 30 MG TABLET aripiprazole 30 EA	59148001113 OTSUKA AMERICA	ANTIPSYCHOTICS	Yes	Yes	Medicaid CHIP CSHCN
ABILIFY 5 MG TABLET aripiprazole 30 EA	59148000713 OTSUKA AMERICA	ANTIPSYCHOTICS	Yes	Yes	Medicaid CHIP CSHCN
ABILIFY MAINTENA ER 300 MG SYR aripiprazole 1 EA	59148004580 OTSUKA AMERICA	ANTIPSYCHOTICS	Yes	No	Medicaid CHIP CSHCN
ABILIFY MAINTENA ER 300 MG VL aripiprazole 1 EA	59148001871 OTSUKA AMERICA	ANTIPSYCHOTICS	Yes	No	Medicaid CHIP CSHCN
ABILIFY MAINTENA ER 400 MG SYR aripiprazole 1 EA	59148007280 OTSUKA AMERICA	ANTIPSYCHOTICS	Yes	No	Medicaid CHIP CSHCN
ABILIFY MAINTENA ER 400 MG VL aripiprazole 1 EA	59148001971 OTSUKA AMERICA	ANTIPSYCHOTICS	Yes	No	Medicaid CHIP CSHCN
ACCURETIC 20-25 MG TABLET quinapril/hydrochlorothiazide 90 EA	00071022323 PFIZER US PHARM	ANGIOTENSIN MODULATORS	Yes	Yes	Medicaid CHIP CSHCN KHC
ACETAMINOP-CODEINE 120-12 MG/5 acetaminophen with codeine 118 ML	00121050404 PHARM ASSOC INC	ANALGESICS: NARCOTICS SHORT	Yes	No	Medicaid CHIP CSHCN KHC
ACETAMINOP-CODEINE 120-12 MG/5 acetaminophen with codeine 473 ML	50383007916 HI-TECH/AKORN C	ANALGESICS: NARCOTICS SHORT	Yes	No	Medicaid CHIP CSHCN
ACETAMINOP-CODEINE 120-12 MG/5 acetaminophen with codeine 473 ML	00121050416 PHARM ASSOC INC	ANALGESICS: NARCOTICS SHORT	Yes	No	Medicaid CHIP CSHCN KHC
ACETAMINOP-CODEINE 120-12 MG/5 acetaminophen with codeine 473 ML	60432024516 MORTON GROVE PH	ANALGESICS: NARCOTICS SHORT	Yes	No	Medicaid CHIP CSHCN KHC
ACETAMINOPHEN-COD #2 TABLET acetaminophen with codeine 100 EA	00406048301 MALLINCKRODT PH	ANALGESICS: NARCOTICS SHORT	Yes	No	Medicaid CHIP CSHCN KHC
ACETAMINOPHEN-COD #2 TABLET acetaminophen with codeine 100 EA	71930005412 EYWA PHARMA INC	ANALGESICS: NARCOTICS SHORT	Yes	No	Medicaid CHIP CSHCN
ACETAMINOPHEN-COD #2 TABLET acetaminophen with codeine 500 EA	71930005452 EYWA PHARMA INC	ANALGESICS: NARCOTICS SHORT	Yes	No	Medicaid CHIP CSHCN
ACETAMINOPHEN-COD #2 TABLET acetaminophen with codeine 100 EA	13107005801 AUROBINDO PHARM	ANALGESICS: NARCOTICS SHORT	Yes	No	Medicaid CHIP CSHCN KHC
ACETAMINOPHEN-COD #3 TABLET acetaminophen with codeine 100 EA	65162003310 AMNEAL PHARMACE	ANALGESICS: NARCOTICS SHORT	Yes	No	Medicaid CHIP CSHCN KHC
ACETAMINOPHEN-COD #3 TABLET acetaminophen with codeine 100 EA	00406048401 MALLINCKRODT PH	ANALGESICS: NARCOTICS SHORT	Yes	No	Medicaid CHIP CSHCN KHC
ACETAMINOPHEN-COD #3 TABLET acetaminophen with codeine 1000 EA	00406048410 MALLINCKRODT PH	ANALGESICS: NARCOTICS SHORT	Yes	No	Medicaid CHIP CSHCN KHC