Search Results: Formulary Drugs
Displaying 1 - 2 of 2 drugs found. Return to search page.
A drug with a termination date will appear on the search for 90 days following the termination date.
| Brand Name/Generic Name/Package Size | NDC/Manufacturer | PDL Class | FFS Clinical Prior Auth Required | PDL Prior Auth Required | Programs |
|---|---|---|---|---|---|
| ENEMEEZ MINI ENEMA docusate sodium 5 ML |
17433987603 ALLIANCE LABS, |
No | No | Medicaid CSHCN | |
| ENEMEEZ PLUS MINI ENEMA docusate sodium/benzocaine 5 ML |
17433987703 ALLIANCE LABS, |
No | No | Medicaid CSHCN |