Search Results: Formulary Drugs

Displaying 1 - 50 of 21959 records found. Return to search page.

Search results: Formulary Drugs
Brand Name/Generic Name	NDC/Manufacturer	PDL Class	FFS Clinical Prior Auth Required	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

You are here