Search Results: Formulary Drugs

Displaying 1 - 1 of 1 records found. Return to search page.
Brand Name/Generic Name NDC/Manufacturer PDL Class FFS Clinical Prior Auth Required PDL Prior Auth Required Programs
KYLEENA 19.5 MG SYSTEM
levonorgestrel
50419042401
BAYER,PHARM DIV
No No Medicaid HTW