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Search results: Formulary Drugs
Brand Name/Generic Name NDC/Manufacturer PDL Class FFS Clinical Prior Auth Requiredsort descending PDL Prior Auth Required Programs
PROTRIPTYLINE HCL 5 MG TABLET
protriptyline HCl
42794000402
SIGMAPHARM LABO
No Yes Medicaid, CHIP, CSHCN
CLOBETASOL 0.05% OINTMENT
clobetasol propionate
00713065615
COSETTE PHARMAC
STEROIDS: TOPICAL VERY HIGH No No Medicaid, CHIP, CSHCN
ASPIRIN 81 MG CHEWABLE TABLET
aspirin
00904404073
MAJOR PHARMACEU
No No Medicaid
DAILY MULTI VITAMIN-IRON TAB
multivitamin with iron
11845000001
MASON DISTRIB.
No No KHC
AMINOCAPROIC ACID 500 MG TAB
aminocaproic acid
17478076830
AKORN INC.
No No Medicaid, CHIP, CSHCN
ACETAZOLAMIDE ER 500 MG CAP
acetazolamide
50742023301
INGENUS PHARMAC
No No Medicaid, CHIP, CSHCN
DESOXIMETASONE 0.25% CREAM
desoximetasone
45802049535
PERRIGO CO.
STEROIDS: TOPICAL HIGH No Yes Medicaid, CHIP, CSHCN
BUTALBITAL-ACETAMINOPHN 50-300
butalbital/acetaminophen
51862053801
MAYNE PHARMA IN
No No Medicaid, CHIP, CSHCN
GLIMEPIRIDE 1 MG TABLET
glimepiride
55111032001
DR.REDDY'S LAB
No No Medicaid, CHIP, CSHCN, HTW
PAROXETINE HCL 40 MG TABLET
paroxetine HCl
60505010104
APOTEX CORP
ANTIDEPRESSANTS: SSRIs No No Medicaid, CHIP, CSHCN
VIREAD POWDER
tenofovir disoproxil fumarate
61958040301
GILEAD SCIENCES
No No Medicaid, CHIP, CSHCN
DIVALPROEX SOD DR 500 MG TAB
divalproex sodium
62756079813
SUN PHARMACEUTI
No No Medicaid, CHIP, CSHCN
DIPYRIDAMOLE 25 MG TABLET
dipyridamole
64980013301
RISING PHARM
PLATELET AGGREGATION INHIBITORS No Yes Medicaid, CHIP, CSHCN, HTWPlus
HEPARIN 40,000 UNIT/4 ML VIAL
heparin sodium,porcine
67457060399
MYLAN INSTITUTI
No No Medicaid, CHIP, CSHCN
DULOXETINE HCL DR 20 MG CAP
duloxetine HCl
68180029407
LUPIN PHARMACEU
NEUROPATHIC PAIN No No Medicaid, CHIP, CSHCN
TIADYLT ER 120 MG CAPSULE
diltiazem HCl
68382074516
ZYDUS PHARMACEU
CALCIUM CHANNEL BLOCKERS No No Medicaid, CHIP, CSHCN, KHC, HTW
OCTAGAM 10% VIAL
immun globG(IgG)/malt/IgA ov50
68982085004
OCTAPHARMA USA
IMMUNE GLOBULINS No Yes Medicaid, CHIP, CSHCN
MAGNESIUM OXIDE 400 MG TABLET
magnesium oxide
69543021712
VIRTUS PHARMACE
No No Medicaid, CSHCN
NOVOSEVEN RT 2 MG VIAL
coagulation factor VIIa,recomb
00169720201
NOVO NORDISK
No No Medicaid, CHIP
CLEOCIN HCL 150 MG CAPSULE
clindamycin HCl
00009022502
PHARMACI/PFIZER
LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS No Yes Medicaid, CHIP, CSHCN
LEVONOR-ETH ESTRAD 0.15-0.03
levonorgestrel/ethin.estradiol
00378655053
MYLAN
No No Medicaid, CHIP, CSHCN, HTW
DOXYCYCLINE HYCLATE 75 MG TAB
doxycycline hyclate
00591610060
ACTAVIS/TEVA
TETRACYCLINES No Yes Medicaid, CHIP, CSHCN, KHC
CALCITRIOL 0.25 MCG CAPSULE
calcitriol
00054000713
WEST-WARD/HIKMA
No No Medicaid, CHIP, CSHCN, KHC
BUMETANIDE 1 MG TABLET
bumetanide
16714083201
NORTHSTAR RX LL
No No Medicaid, CHIP, CSHCN
TINIDAZOLE 500 MG TABLET
tinidazole
43386055102
GAVIS/LUPIN
ANTIBIOTICS: GI No No Medicaid, CHIP, CSHCN, HTW
SELZENTRY 75 MG TABLET
maraviroc
49702023508
VIIV HEALTHCARE
No No Medicaid, CHIP, CSHCN
FLUOXETINE HCL 40 MG CAPSULE
fluoxetine HCl
50228011501
SCIEGEN PHARMAC
ANTIDEPRESSANTS: SSRIs No No Medicaid, CHIP, CSHCN, HTW
CLOBETASOL 0.05% CREAM
clobetasol propionate
51672125802
TARO PHARM USA
STEROIDS: TOPICAL VERY HIGH No No Medicaid, CHIP, CSHCN
ONDANSETRON ODT 4 MG TABLET
ondansetron
57237007730
RISING PHARM
ANTIEMETIC/ANTIVERTIGO AGENTS No No Medicaid, CHIP, CSHCN
PRIFTIN 150 MG TABLET
rifapentine
00088210224
SANOFI-AVENTIS
No No Medicaid, CHIP, CSHCN
DUTASTERIDE 0.5 MG CAPSULE
dutasteride
60505387709
APOTEX CORP
BPH TREATMENTS No Yes Medicaid, CHIP, CSHCN
PROCARDIA XL 60 MG TABLET
nifedipine
00069266066
PFIZER US PHARM
CALCIUM CHANNEL BLOCKERS No Yes Medicaid, CHIP, CSHCN, KHC
FELBAMATE 600 MG TABLET
felbamate
65162073509
AMNEAL PHARMACE
No No Medicaid, CHIP, CSHCN
NORG-ETHIN ESTRA 0.25-0.035 MG
norgestimate-ethinyl estradiol
68180084073
LUPIN PHARMACEU
No No Medicaid, CHIP, CSHCN
SEVELAMER HCL 800 MG TABLET
sevelamer HCl
68462044718
GLENMARK PHARMA
PHOSPHATE BINDERS No Yes Medicaid, CHIP, CSHCN
DOXEPIN 50 MG CAPSULE
doxepin HCl
69238117109
AMNEAL PHARMACE
No No Medicaid, CHIP, CSHCN
MEMANTINE HCL 5 MG TABLET
memantine HCl
72578000314
VIONA PHARMACEU
ALZHEIMER'S AGENTS No No Medicaid, CHIP, CSHCN
MESTINON 60 MG TABLET
pyridostigmine bromide
00187301030
VALEANT/BAUSCH
No No Medicaid, CHIP, CSHCN
LITHIUM CARBONATE 300 MG CAP
lithium carbonate
00054852725
WEST-WARD/HIKMA
No No Medicaid, CHIP, CSHCN
FLUVOXAMINE MALEATE 100 MG TAB
fluvoxamine maleate
00832167211
UPSHER-SMITH LA
ANTIDEPRESSANTS: SSRIs No No Medicaid, CHIP, CSHCN
DESIPRAMINE 75 MG TABLET
desipramine HCl
45963034402
ACTAVIS/TEVA
No Yes Medicaid, CHIP, CSHCN
TOPAMAX 25 MG SPRINKLE CAP
topiramate
50458064565
JANSSEN PHARM.
No No Medicaid, CHIP, CSHCN
BENZOYL PEROXIDE 5% GEL
benzoyl peroxide
45802021696
PERRIGO CO.
No No Medicaid, CSHCN
ONDANSETRON HCL 8 MG TABLET
ondansetron HCl
55111015430
DR.REDDY'S LAB
ANTIEMETIC/ANTIVERTIGO AGENTS No No Medicaid, CHIP, CSHCN
IMBRUVICA 420 MG TABLET
ibrutinib
57962042028
PHARMACYCLICS,
No No Medicaid, CHIP, CSHCN
CEFACLOR 500 MG CAPSULE
cefaclor
61442017230
CARLSBAD TECH
CEPHALOSPORINS AND RELATED ANTIBIOTICS No Yes Medicaid, CHIP, CSHCN
OCTREOTIDE ACET 200 MCG/ML VL
octreotide acetate
62756035040
SUN PHARMACEUTI
No No Medicaid, CHIP, CSHCN
FOSAMAX PLUS D 70 MG-5,600 IU
alendronate sodium/vitamin D3
00006027044
MERCK SHARP & D
BONE RESORPTION SUPPRESSION AND RELATED AGENTS No Yes Medicaid, CHIP, CSHCN
FLUOXETINE HCL 20 MG CAPSULE
fluoxetine HCl
65862019399
AUROBINDO PHARM
ANTIDEPRESSANTS: SSRIs No No Medicaid, CHIP, CSHCN, HTW
TERBINAFINE HCL 250 MG TABLET
terbinafine HCl
67405050010
HARRIS PHARM
ANTIFUNGALS: ORAL No No Medicaid, CHIP, CSHCN