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Search results: Formulary Drugs
Brand Name/Generic Name NDC PDL Class FFS Clinical Prior Auth Required PDL Prior Auth Required Programs
12HR NASAL DECONGEST ER 120 MG
pseudoephedrine HCl
70000016401 No No Medicaid, CSHCN
12HR NASAL DECONGEST ER 120 MG
pseudoephedrine HCl
70000047501 No No Medicaid, CSHCN
24HR ALLERGY(LEVOCETIRZN) 5 MG
levocetirizine dihydrochloride
70000036201 ANTIHISTAMINES: MINIMALLY SEDATING Yes Yes Medicaid, CSHCN
24HR ALLERGY(LEVOCETIRZN) 5 MG
levocetirizine dihydrochloride
70000036202 ANTIHISTAMINES: MINIMALLY SEDATING Yes Yes Medicaid, CSHCN
8HR ARTHRITIS PAIN ER 650 MG
acetaminophen
70000018001 No No Medicaid, CSHCN
8HR ARTHRITIS PAIN ER 650 MG
acetaminophen
70000018002 No No Medicaid, CSHCN
8HR ARTHRITIS PAIN ER 650 MG
acetaminophen
70000018003 No No Medicaid, CSHCN
8HR MUSCLE ACHE-PAIN ER 650 MG
acetaminophen
70000030601 No No Medicaid, CSHCN
ABACAVIR 20 MG/ML SOLUTION
abacavir sulfate
64980040524 No No Medicaid, CHIP, CSHCN
ABACAVIR 20 MG/ML SOLUTION
abacavir sulfate
31722056224 No No Medicaid, CHIP, CSHCN
ABACAVIR 300 MG TABLET
abacavir sulfate
51079020406 No No Medicaid, CHIP, CSHCN
ABACAVIR 300 MG TABLET
abacavir sulfate
60505358306 No No Medicaid, CHIP, CSHCN
ABACAVIR 300 MG TABLET
abacavir sulfate
65862007360 No No Medicaid, CHIP, CSHCN
ABACAVIR 300 MG TABLET
abacavir sulfate
69097051403 No No Medicaid, CHIP, CSHCN
ABACAVIR 300 MG TABLET
abacavir sulfate
00378410591 No No Medicaid, CHIP, CSHCN
ABACAVIR 300 MG TABLET
abacavir sulfate
00904652304 No No Medicaid, CHIP, CSHCN
ABACAVIR 300 MG TABLET
abacavir sulfate
00904652306 No No Medicaid, CHIP, CSHCN
ABACAVIR 300 MG TABLET
abacavir sulfate
31722055760 No No Medicaid, CHIP, CSHCN
ABACAVIR-LAMIVUDINE 600-300 MG
abacavir sulfate/lamivudine
65862033530 No No Medicaid, CHIP, CSHCN
ABACAVIR-LAMIVUDINE 600-300 MG
abacavir sulfate/lamivudine
65862090030 No No Medicaid, CHIP, CSHCN
ABACAVIR-LAMIVUDINE 600-300 MG
abacavir sulfate/lamivudine
00093538256 No No Medicaid, CHIP, CSHCN
ABACAVIR-LAMIVUDINE 600-300 MG
abacavir sulfate/lamivudine
66993048230 No No Medicaid, CHIP, CSHCN
ABACAVIR-LAMIVUDINE 600-300 MG
abacavir sulfate/lamivudine
68180028806 No No Medicaid, CHIP, CSHCN
ABACAVIR-LAMIVUDINE 600-300 MG
abacavir sulfate/lamivudine
69097036202 No No Medicaid, CHIP, CSHCN
ABACAVIR-LAMIVUDINE 600-300 MG
abacavir sulfate/lamivudine
35573040230 No No Medicaid, CHIP, CSHCN
ABACAVIR-LAMIVUDINE-ZIDOV TAB
abacavir/lamivudine/zidovudine
68180028607 No No Medicaid, CHIP, CSHCN
ABELCET 100 MG/20 ML VIAL
amphotericin B lipid complex
57665010141 No No Medicaid, CHIP, CSHCN
ABILIFY 10 MG TABLET
aripiprazole
59148000813 ANTIPSYCHOTICS Yes Yes Medicaid, CHIP, CSHCN
ABILIFY 15 MG TABLET
aripiprazole
59148000913 ANTIPSYCHOTICS Yes Yes Medicaid, CHIP, CSHCN
ABILIFY 2 MG TABLET
aripiprazole
59148000613 ANTIPSYCHOTICS Yes Yes Medicaid, CHIP, CSHCN
ABILIFY 20 MG TABLET
aripiprazole
59148001013 ANTIPSYCHOTICS Yes Yes Medicaid, CHIP, CSHCN
ABILIFY 30 MG TABLET
aripiprazole
59148001113 ANTIPSYCHOTICS Yes Yes Medicaid, CHIP, CSHCN
ABILIFY 5 MG TABLET
aripiprazole
59148000713 ANTIPSYCHOTICS Yes Yes Medicaid, CHIP, CSHCN
ABILIFY MAINTENA ER 300 MG SYR
aripiprazole
59148004580 ANTIPSYCHOTICS Yes No Medicaid, CHIP, CSHCN
ABILIFY MAINTENA ER 300 MG VL
aripiprazole
59148001871 ANTIPSYCHOTICS Yes No Medicaid, CHIP, CSHCN
ABILIFY MAINTENA ER 400 MG SYR
aripiprazole
59148007280 ANTIPSYCHOTICS Yes No Medicaid, CHIP, CSHCN
ABILIFY MAINTENA ER 400 MG VL
aripiprazole
59148001971 ANTIPSYCHOTICS Yes No Medicaid, CHIP, CSHCN
ABILIFY MYCITE 10 MG KIT
aripiprazole
59148003185 ANTIPSYCHOTICS Yes Yes Medicaid, CHIP, CSHCN
ABILIFY MYCITE 15 MG KIT
aripiprazole
59148003285 ANTIPSYCHOTICS Yes Yes Medicaid, CHIP, CSHCN
ABILIFY MYCITE 2 MG KIT
aripiprazole
59148002985 ANTIPSYCHOTICS Yes Yes Medicaid, CHIP, CSHCN
ABILIFY MYCITE 20 MG KIT
aripiprazole
59148003385 ANTIPSYCHOTICS Yes Yes Medicaid, CHIP, CSHCN
ABILIFY MYCITE 30 MG KIT
aripiprazole
59148003485 ANTIPSYCHOTICS Yes Yes Medicaid, CHIP, CSHCN
ABILIFY MYCITE 5 MG KIT
aripiprazole
59148003085 ANTIPSYCHOTICS Yes Yes Medicaid, CHIP, CSHCN
ABIRATERONE ACETATE 250 MG TAB
abiraterone acetate
57894015512 No No Medicaid, CHIP, CSHCN
ABIRATERONE ACETATE 250 MG TAB
abiraterone acetate
60505432701 No No Medicaid, CHIP, CSHCN
ABIRATERONE ACETATE 250 MG TAB
abiraterone acetate
00093112589 No No Medicaid, CHIP, CSHCN
ABIRATERONE ACETATE 250 MG TAB
abiraterone acetate
64679002101 No No Medicaid, CHIP, CSHCN
ABIRATERONE ACETATE 250 MG TAB
abiraterone acetate
64980041812 No No Medicaid, CHIP, CSHCN
ABIRATERONE ACETATE 250 MG TAB
abiraterone acetate
69238116507 No No Medicaid, CHIP, CSHCN
ABIRATERONE ACETATE 250 MG TAB
abiraterone acetate
72205003092 No No Medicaid, CHIP, CSHCN