Search Results: Formulary Drugs

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Search results: Formulary Drugs
Brand Name/Generic Name	NDC/Manufacturer	PDL Class	FFS Clinical Prior Auth Required	PDL Prior Auth Required	Programs
12HR NASAL DECONGEST ER 120 MG pseudoephedrine HCl	70000047501 LEADER		No	No	Medicaid, CSHCN
24HR ALLERGY(LEVOCETIRZN) 5 MG levocetirizine dihydrochloride	70000036201 LEADER	ANTIHISTAMINES: MINIMALLY SEDATING	Yes	Yes	Medicaid, CSHCN
24HR ALLERGY(LEVOCETIRZN) 5 MG levocetirizine dihydrochloride	70000036202 LEADER	ANTIHISTAMINES: MINIMALLY SEDATING	Yes	Yes	Medicaid, CSHCN
8HR ARTHRITIS PAIN ER 650 MG acetaminophen	70000018001 LEADER		No	No	Medicaid, CSHCN
8HR ARTHRITIS PAIN ER 650 MG acetaminophen	70000018002 LEADER		No	No	Medicaid, CSHCN
8HR ARTHRITIS PAIN ER 650 MG acetaminophen	70000018003 LEADER		No	No	Medicaid, CSHCN
8HR MUSCLE ACHE-PAIN ER 650 MG acetaminophen	70000030601 LEADER		No	No	Medicaid, CSHCN
ABACAVIR 20 MG/ML SOLUTION abacavir sulfate	64980040524 RISING PHARM		No	No	Medicaid, CHIP, CSHCN
ABACAVIR 20 MG/ML SOLUTION abacavir sulfate	31722056224 CAMBER PHARMACE		No	No	Medicaid, CHIP, CSHCN
ABACAVIR 300 MG TABLET abacavir sulfate	51079020406 MYLAN INSTITUTI		No	No	Medicaid, CHIP, CSHCN
ABACAVIR 300 MG TABLET abacavir sulfate	60505358306 APOTEX CORP		No	No	Medicaid, CHIP, CSHCN
ABACAVIR 300 MG TABLET abacavir sulfate	65862007360 AUROBINDO PHARM		No	No	Medicaid, CHIP, CSHCN
ABACAVIR 300 MG TABLET abacavir sulfate	69097051403 CIPLA USA, INC.		No	No	Medicaid, CHIP, CSHCN
ABACAVIR 300 MG TABLET abacavir sulfate	00378410591 MYLAN		No	No	Medicaid, CHIP, CSHCN
ABACAVIR 300 MG TABLET abacavir sulfate	31722055760 CAMBER PHARMACE		No	No	Medicaid, CHIP, CSHCN
ABACAVIR-LAMIVUDINE 600-300 MG abacavir sulfate/lamivudine	00093538256 TEVA USA		No	No	Medicaid, CHIP, CSHCN
ABACAVIR-LAMIVUDINE 600-300 MG abacavir sulfate/lamivudine	65862033530 AUROBINDO PHARM		No	No	Medicaid, CHIP, CSHCN
ABACAVIR-LAMIVUDINE 600-300 MG abacavir sulfate/lamivudine	65862090030 AUROBINDO PHARM		No	No	Medicaid, CHIP, CSHCN
ABACAVIR-LAMIVUDINE 600-300 MG abacavir sulfate/lamivudine	66993048230 PRASCO LABS		No	No	Medicaid, CHIP, CSHCN
ABACAVIR-LAMIVUDINE 600-300 MG abacavir sulfate/lamivudine	68180028806 LUPIN PHARMACEU		No	No	Medicaid, CHIP, CSHCN
ABACAVIR-LAMIVUDINE 600-300 MG abacavir sulfate/lamivudine	69097036202 CIPLA USA, INC.		No	No	Medicaid, CHIP, CSHCN
ABACAVIR-LAMIVUDINE 600-300 MG abacavir sulfate/lamivudine	35573040230 BUREL PHARMACEU		No	No	Medicaid, CHIP, CSHCN
ABACAVIR-LAMIVUDINE 600-300 MG abacavir sulfate/lamivudine	35573043030 BUREL PHARMACEU		No	No	Medicaid, CHIP, CSHCN
ABACAVIR-LAMIVUDINE-ZIDOV TAB abacavir/lamivudine/zidovudine	68180028607 LUPIN PHARMACEU		No	No	Medicaid, CHIP, CSHCN
ABELCET 100 MG/20 ML VIAL amphotericin B lipid complex	57665010141 LEADIANT BIOSCI		No	No	Medicaid, CHIP, CSHCN
ABILIFY 10 MG TABLET aripiprazole	59148000813 OTSUKA AMERICA	ANTIPSYCHOTICS	Yes	Yes	Medicaid, CHIP, CSHCN
ABILIFY 15 MG TABLET aripiprazole	59148000913 OTSUKA AMERICA	ANTIPSYCHOTICS	Yes	Yes	Medicaid, CHIP, CSHCN
ABILIFY 2 MG TABLET aripiprazole	59148000613 OTSUKA AMERICA	ANTIPSYCHOTICS	Yes	Yes	Medicaid, CHIP, CSHCN
ABILIFY 20 MG TABLET aripiprazole	59148001013 OTSUKA AMERICA	ANTIPSYCHOTICS	Yes	Yes	Medicaid, CHIP, CSHCN
ABILIFY 30 MG TABLET aripiprazole	59148001113 OTSUKA AMERICA	ANTIPSYCHOTICS	Yes	Yes	Medicaid, CHIP, CSHCN
ABILIFY 5 MG TABLET aripiprazole	59148000713 OTSUKA AMERICA	ANTIPSYCHOTICS	Yes	Yes	Medicaid, CHIP, CSHCN
ABILIFY MAINTENA ER 300 MG SYR aripiprazole	59148004580 OTSUKA AMERICA	ANTIPSYCHOTICS	Yes	No	Medicaid, CHIP, CSHCN
ABILIFY MAINTENA ER 300 MG VL aripiprazole	59148001871 OTSUKA AMERICA	ANTIPSYCHOTICS	Yes	No	Medicaid, CHIP, CSHCN
ABILIFY MAINTENA ER 400 MG SYR aripiprazole	59148007280 OTSUKA AMERICA	ANTIPSYCHOTICS	Yes	No	Medicaid, CHIP, CSHCN
ABILIFY MAINTENA ER 400 MG VL aripiprazole	59148001971 OTSUKA AMERICA	ANTIPSYCHOTICS	Yes	No	Medicaid, CHIP, CSHCN
ABILIFY MYCITE 10 MG KIT aripiprazole	59148003185 OTSUKA AMERICA	ANTIPSYCHOTICS	Yes	Yes	Medicaid, CHIP, CSHCN
ABILIFY MYCITE 15 MG KIT aripiprazole	59148003285 OTSUKA AMERICA	ANTIPSYCHOTICS	Yes	Yes	Medicaid, CHIP, CSHCN
ABILIFY MYCITE 2 MG KIT aripiprazole	59148002985 OTSUKA AMERICA	ANTIPSYCHOTICS	Yes	Yes	Medicaid, CHIP, CSHCN
ABILIFY MYCITE 20 MG KIT aripiprazole	59148003385 OTSUKA AMERICA	ANTIPSYCHOTICS	Yes	Yes	Medicaid, CHIP, CSHCN
ABILIFY MYCITE 30 MG KIT aripiprazole	59148003485 OTSUKA AMERICA	ANTIPSYCHOTICS	Yes	Yes	Medicaid, CHIP, CSHCN
ABILIFY MYCITE 5 MG KIT aripiprazole	59148003085 OTSUKA AMERICA	ANTIPSYCHOTICS	Yes	Yes	Medicaid, CHIP, CSHCN
ABIRATERONE ACETATE 250 MG TAB abiraterone acetate	43598035804 DR.REDDY'S LAB		No	No	Medicaid, CHIP, CSHCN
ABIRATERONE ACETATE 250 MG TAB abiraterone acetate	57894015512 PATRIOT PHARMAC		No	No	Medicaid, CHIP, CSHCN
ABIRATERONE ACETATE 250 MG TAB abiraterone acetate	60505432701 APOTEX CORP		No	No	Medicaid, CHIP, CSHCN
ABIRATERONE ACETATE 250 MG TAB abiraterone acetate	00093112589 TEVA USA		No	No	Medicaid, CHIP, CSHCN
ABIRATERONE ACETATE 250 MG TAB abiraterone acetate	64679002101 WOCKHARDT USA L		No	No	Medicaid, CHIP, CSHCN
ABIRATERONE ACETATE 250 MG TAB abiraterone acetate	64980041812 RISING PHARM		No	No	Medicaid, CHIP, CSHCN
ABIRATERONE ACETATE 250 MG TAB abiraterone acetate	69238116507 AMNEAL PHARMACE		No	No	Medicaid, CHIP, CSHCN
ABIRATERONE ACETATE 250 MG TAB abiraterone acetate	00143959721 WEST-WARD/HIKMA		No	No	Medicaid, CHIP, CSHCN
ABIRATERONE ACETATE 250 MG TAB abiraterone acetate	00378692078 MYLAN		No	No	Medicaid, CHIP, CSHCN

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