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Search results: Formulary Drugs
Brand Name/Generic Name NDC/Manufacturer PDL Class FFS Clinical Prior Auth Requiredsort ascending PDL Prior Auth Required Programs
METHOCARBAMOL 500 MG TABLET
methocarbamol
43547040510
SOLCO HEALTHCAR
SKELETAL MUSCLE RELAXANTS Yes No Medicaid, CHIP, CSHCN
ARIPIPRAZOLE 30 MG TABLET
aripiprazole
31722083030
CAMBER PHARMACE
ANTIPSYCHOTICS Yes No Medicaid, CHIP, CSHCN
CLOZAPINE 100 MG TABLET
clozapine
51079092220
MYLAN INSTITUTI
ANTIPSYCHOTICS Yes No Medicaid, CHIP, CSHCN
EPOGEN 3,000 UNITS/ML VIAL
epoetin alfa
55513026701
AMGEN
ERYTHROPOIESIS STIMULATING PROTEINS Yes No Medicaid, CHIP, CSHCN
OTEZLA 28 DAY STARTER PACK
apremilast
59572063255
CELGENE/AMGEN
CYTOKINE AND CAM ANTAGONISTS Yes No Medicaid, CHIP, CSHCN
VERELAN PM 100 MG CAP PELLET
verapamil HCl
62175057037
KREMERS/LANNETT
CALCIUM CHANNEL BLOCKERS Yes Yes Medicaid, CHIP, CSHCN
METHYLPHENIDATE LA 40 MG CAP
methylphenidate HCl
00093323201
TEVA USA
STIMULANTS AND RELATED AGENTS Yes Yes Medicaid, CHIP, CSHCN
OXYCODONE HCL 5 MG TABLET
oxycodone HCl
65162004750
AMNEAL PHARMACE
ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN
OLMESARTAN MEDOXOMIL 20 MG TAB
olmesartan medoxomil
67877044630
ASCEND LABORATO
ANGIOTENSIN MODULATORS Yes Yes Medicaid, CHIP, CSHCN
PRAVASTATIN SODIUM 10 MG TAB
pravastatin sodium
68180048509
LUPIN PHARMACEU
LIPOTROPICS: STATINS Yes No Medicaid, CHIP, CSHCN, KHC, HTW
GABAPENTIN 100 MG CAPSULE
gabapentin
69097081307
CIPLA USA, INC.
Yes No Medicaid, CHIP, CSHCN
RESTORIL 15 MG CAPSULE
temazepam
00406991601
MALLINCKRODT PH
SEDATIVE HYPNOTICS Yes Yes Medicaid, CHIP, CSHCN
NASAL SPRAY 0.05%
oxymetazoline HCl
70000000101
LEADER
COUGH AND COLD: COLD Yes No Medicaid, CSHCN
PROMETHAZINE 12.5 MG TABLET
promethazine HCl
10702000201
KVK-TECH, INC.
ANTIEMETIC/ANTIVERTIGO AGENTS Yes No Medicaid, CHIP, CSHCN
HYDROXYZINE HCL 50 MG TABLET
hydroxyzine HCl
16714008311
NORTHSTAR RX LL
Yes No Medicaid, CHIP, CSHCN
ARIPIPRAZOLE 5 MG TABLET
aripiprazole
16729027901
ACCORD HEALTHCA
ANTIPSYCHOTICS Yes No Medicaid, CHIP, CSHCN
MORPHINE SULF 100 MG/5 ML CONC
morphine sulfate
27808008202
TRIS PHARMA INC
ANALGESICS: NARCOTICS SHORT Yes Yes Medicaid, CHIP, CSHCN
GRANISETRON HCL 1 MG TABLET
granisetron HCl
42043039021
ORCHIDPHARMA, I
ANTIEMETIC/ANTIVERTIGO AGENTS Yes Yes Medicaid, CHIP, CSHCN
PROMETHAZINE 6.25 MG/5 ML SOLN
promethazine HCl
50383080116
HI-TECH/AKORN C
ANTIEMETIC/ANTIVERTIGO AGENTS Yes No Medicaid, CHIP, CSHCN
WARFARIN SODIUM 2 MG TABLET
warfarin sodium
51672402801
TARO PHARM USA
ANTICOAGULANTS Yes No Medicaid, CHIP, CSHCN, KHC
FOSRENOL 750 MG TABLET CHEW
lanthanum carbonate
54092025390
SHIRE US INC.
PHOSPHATE BINDERS Yes Yes Medicaid, CHIP, CSHCN
CLOZAPINE 100 MG TABLET
clozapine
57664034788
CARACO/SUN PHAR
ANTIPSYCHOTICS Yes No Medicaid, CHIP, CSHCN
PERPHENAZINE 16 MG TABLET
perphenazine
00378535301
MYLAN
ANTIPSYCHOTICS Yes No Medicaid, CHIP, CSHCN
TRULANCE 3 MG TABLET
plecanatide
70194000330
SYNERGY/BAUSCH
GI MOTILITY: CHRONIC Yes Yes Medicaid, CHIP, CSHCN
HYDROXYPROGEST 250 MG/ML VIAL
hydroxyprogesterone caproat/PF
00517176701
AMER. REGENT
Yes Yes Medicaid, CHIP, CSHCN
NABUMETONE 500 MG TABLET
nabumetone
00591367005
ACTAVIS/TEVA
NSAIDS Yes Yes Medicaid, CHIP, CSHCN
ROBAFEN CF LIQUID
guaifen/dextromethorphan/PE
00904653720
MAJOR PHARMACEU
COUGH AND COLD: NON-NARCOTIC Yes No Medicaid, CSHCN
CELECOXIB 50 MG CAPSULE
celecoxib
16714073101
NORTHSTAR RX LL
NSAIDS Yes Yes Medicaid, CHIP, CSHCN
NINJACOF-XG LIQUID
codeine phosphate/guaifenesin
23359004016
CENTURION LABS
COUGH AND COLD: NARCOTIC Yes Yes Medicaid, CSHCN
DEXMETHYLPHENIDATE ER 25 MG CP
dexmethylphenidate HCl
49884033301
PAR PHARMACEUTI
STIMULANTS AND RELATED AGENTS Yes No Medicaid, CHIP, CSHCN
ATORVASTATIN 40 MG TABLET
atorvastatin calcium
51079021020
MYLAN INSTITUTI
LIPOTROPICS: STATINS Yes No Medicaid, CHIP, CSHCN, HTW
RITALIN 20 MG TABLET
methylphenidate HCl
00078044105
NOVARTIS
STIMULANTS AND RELATED AGENTS Yes Yes Medicaid, CHIP, CSHCN
QVAR REDIHALER 80 MCG
beclomethasone dipropionate
59310030480
TEVA SPECIALTY
GLUCOCORTICOIDS: INHALED Yes Yes Medicaid, CHIP, CSHCN, HTWPlus
RAMIPRIL 2.5 MG CAPSULE
ramipril
62135027201
CHARTWELL RX LL
ANGIOTENSIN MODULATORS Yes No Medicaid, CHIP, CSHCN
CLONAZEPAM 1 MG TABLET
clonazepam
00093321201
TEVA USA
Yes No Medicaid, CHIP, CSHCN, KHC
ATOMOXETINE HCL 60 MG CAPSULE
atomoxetine HCl
64980037703
RISING PHARM
STIMULANTS AND RELATED AGENTS Yes No Medicaid, CHIP, CSHCN
OLANZAPINE-FLUOXETINE 12-25 MG
olanzapine/fluoxetine HCl
00093550656
TEVA USA
ANTIPSYCHOTICS Yes Yes Medicaid, CHIP, CSHCN
METHYLPREDNISOLONE 4 MG TABLET
methylprednisolone
68382091601
ZYDUS PHARMACEU
GLUCOCORTICOIDS: ORAL Yes Yes Medicaid, CHIP, CSHCN, KHC
METHYLPHENIDATE 20 MG TABLET
methylphenidate HCl
00115180201
AMNEAL PHARMACE
STIMULANTS AND RELATED AGENTS Yes No Medicaid, CHIP, CSHCN
OXYCODONE-ACETAMINOPHEN 10-325
oxycodone HCl/acetaminophen
00406052305
MALLINCKRODT PH
ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN
ENOXAPARIN 60 MG/0.6 ML SYR
enoxaparin sodium
00548560300
AMPHASTAR PHARM
ANTICOAGULANTS Yes No Medicaid, CHIP, CSHCN, HTWPlus
PREDNISONE 2.5 MG TABLET
prednisone
00603533621
QUALITEST/PAR P
GLUCOCORTICOIDS: ORAL Yes No Medicaid, CHIP, CSHCN, HTWPlus
PREDNISONE 5 MG TABLET
prednisone
70954005820
NOVITIUM PHARMA
GLUCOCORTICOIDS: ORAL Yes No Medicaid, CHIP, CSHCN
PREDNISONE 20 MG TABLET
prednisone
00378064205
MYLAN
GLUCOCORTICOIDS: ORAL Yes No Medicaid, CHIP, CSHCN
AMLODIPINE-OLMESARTAN 5-20 MG
amlodipine bes/olmesartan med
27241008309
AJANTA PHARMA L
ANGIOTENSIN MODULATOR COMBINATIONS Yes Yes Medicaid, CHIP, CSHCN
METHOCARBAMOL 750 MG TABLET
methocarbamol
35573041402
BUREL PHARMACEU
SKELETAL MUSCLE RELAXANTS Yes No Medicaid, CHIP, CSHCN
ARIPIPRAZOLE 5 MG TABLET
aripiprazole
65162089709
AMNEAL PHARMACE
ANTIPSYCHOTICS Yes No Medicaid, CHIP, CSHCN
GS IBUPROFEN 200 MG TABLET
ibuprofen
00113060471
PERRIGO/GOODSEN
NSAIDS Yes No Medicaid, CSHCN
METHYLPHENIDATE LA 20 MG CAP
methylphenidate HCl
70010001301
GRANULES PHARMA
STIMULANTS AND RELATED AGENTS Yes Yes Medicaid, CHIP, CSHCN
OLANZAPINE 10 MG TABLET
olanzapine
00904637661
MAJOR PHARMACEU
ANTIPSYCHOTICS Yes No Medicaid, CHIP, CSHCN