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
ABIRATERONE ACETATE 250 MG TAB abiraterone acetate	72205003092 NOVADOZ PHARMAC		No	No	Medicaid, CHIP, CSHCN
ABIRATERONE ACETATE 250 MG TAB abiraterone acetate	72606056601 CELLTRION USA,		No	No	Medicaid, CHIP, CSHCN
ABSORICA 10 MG CAPSULE isotretinoin	10631011531 SUN PHARMACEUTI	ACNE AGENTS: ORAL	No	Yes	Medicaid, CHIP, CSHCN
ABSORICA 20 MG CAPSULE isotretinoin	10631011631 SUN PHARMACEUTI	ACNE AGENTS: ORAL	No	Yes	Medicaid, CHIP, CSHCN
ABSORICA 30 MG CAPSULE isotretinoin	10631011731 SUN PHARMACEUTI	ACNE AGENTS: ORAL	No	Yes	Medicaid, CHIP, CSHCN
ABSORICA 40 MG CAPSULE isotretinoin	10631011831 SUN PHARMACEUTI	ACNE AGENTS: ORAL	No	Yes	Medicaid, CHIP, CSHCN
ACAMPROSATE CALC DR 333 MG TAB acamprosate calcium	51079024106 MYLAN INSTITUTI		No	No	Medicaid, CHIP, CSHCN
ACAMPROSATE CALC DR 333 MG TAB acamprosate calcium	00093535286 TEVA USA		No	No	Medicaid, CHIP, CSHCN
ACAMPROSATE CALC DR 333 MG TAB acamprosate calcium	68382056928 ZYDUS PHARMACEU		No	No	Medicaid, CHIP, CSHCN
ACAMPROSATE CALC DR 333 MG TAB acamprosate calcium	68462043518 GLENMARK PHARMA		No	No	Medicaid, CHIP, CSHCN
ACAMPROSATE CALC DR 333 MG TAB acamprosate calcium	00378633380 MYLAN		No	No	Medicaid, CHIP, CSHCN
ACARBOSE 100 MG TABLET acarbose	47781034201 ALVOGEN INC		No	No	Medicaid, CHIP, CSHCN
ACARBOSE 100 MG TABLET acarbose	64380076006 STRIDES PHARMA		No	No	Medicaid, CHIP, CSHCN
ACARBOSE 100 MG TABLET acarbose	69543012210 VIRTUS PHARMACE		No	No	Medicaid, CHIP, CSHCN
ACARBOSE 100 MG TABLET acarbose	69543012211 VIRTUS PHARMACE		No	No	Medicaid, CHIP, CSHCN
ACARBOSE 100 MG TABLET acarbose	00054014225 ROXANE/WEST-WAR		No	No	Medicaid, CHIP, CSHCN
ACARBOSE 25 MG TABLET acarbose	47781034001 ALVOGEN INC		No	No	Medicaid, CHIP, CSHCN
ACARBOSE 25 MG TABLET acarbose	64380075806 STRIDES PHARMA		No	No	Medicaid, CHIP, CSHCN
ACARBOSE 25 MG TABLET acarbose	69543012010 VIRTUS PHARMACE		No	No	Medicaid, CHIP, CSHCN
ACARBOSE 25 MG TABLET acarbose	69543012011 VIRTUS PHARMACE		No	No	Medicaid, CHIP, CSHCN
ACARBOSE 25 MG TABLET acarbose	00054014025 ROXANE/WEST-WAR		No	No	Medicaid, CHIP, CSHCN
ACARBOSE 50 MG TABLET acarbose	47781034101 ALVOGEN INC		No	No	Medicaid, CHIP, CSHCN
ACARBOSE 50 MG TABLET acarbose	64380075906 STRIDES PHARMA		No	No	Medicaid, CHIP, CSHCN
ACARBOSE 50 MG TABLET acarbose	69543012110 VIRTUS PHARMACE		No	No	Medicaid, CHIP, CSHCN
ACARBOSE 50 MG TABLET acarbose	69543012111 VIRTUS PHARMACE		No	No	Medicaid, CHIP, CSHCN
ACARBOSE 50 MG TABLET acarbose	00054014125 ROXANE/WEST-WAR		No	No	Medicaid, CHIP, CSHCN
ACCUPRIL 10 MG TABLET quinapril HCl	00071053023 PFIZER US PHARM	ANGIOTENSIN MODULATORS	No	Yes	Medicaid, CHIP, CSHCN, KHC
ACCUPRIL 10 MG TABLET quinapril HCl	00071053040 PFIZER US PHARM	ANGIOTENSIN MODULATORS	No	Yes	Medicaid, CHIP, CSHCN, KHC
ACCUPRIL 20 MG TABLET quinapril HCl	00071053223 PFIZER US PHARM	ANGIOTENSIN MODULATORS	No	Yes	Medicaid, CHIP, CSHCN, KHC
ACCUPRIL 20 MG TABLET quinapril HCl	00071053240 PFIZER US PHARM	ANGIOTENSIN MODULATORS	No	Yes	Medicaid, CHIP, CSHCN, KHC
ACCUPRIL 40 MG TABLET quinapril HCl	00071053523 PFIZER US PHARM	ANGIOTENSIN MODULATORS	No	Yes	Medicaid, CHIP, CSHCN, KHC
ACCUPRIL 5 MG TABLET quinapril HCl	00071052723 PFIZER US PHARM	ANGIOTENSIN MODULATORS	No	Yes	Medicaid, CHIP, CSHCN, KHC
ACCURETIC 10-12.5 MG TABLET quinapril/hydrochlorothiazide	00071022223 PFIZER US PHARM	ANGIOTENSIN MODULATORS	Yes	Yes	Medicaid, CHIP, CSHCN
ACCURETIC 20-12.5 MG TABLET quinapril/hydrochlorothiazide	00071022023 PFIZER US PHARM	ANGIOTENSIN MODULATORS	Yes	Yes	Medicaid, CHIP, CSHCN
ACCURETIC 20-25 MG TABLET quinapril/hydrochlorothiazide	00071022323 PFIZER US PHARM	ANGIOTENSIN MODULATORS	Yes	Yes	Medicaid, CHIP, CSHCN
ACEBUTOLOL 200 MG CAPSULE acebutolol HCl	53746066901 AMNEAL PHARMACE	BETA-BLOCKERS	No	No	Medicaid, CHIP, CSHCN, KHC
ACEBUTOLOL 200 MG CAPSULE acebutolol HCl	65162066910 AMNEAL PHARMACE	BETA-BLOCKERS	No	No	Medicaid, CHIP, CSHCN, KHC
ACEBUTOLOL 200 MG CAPSULE acebutolol HCl	00378120001 MYLAN	BETA-BLOCKERS	No	No	Medicaid, CHIP, CSHCN, KHC
ACEBUTOLOL 400 MG CAPSULE acebutolol HCl	53746067001 AMNEAL PHARMACE	BETA-BLOCKERS	No	No	Medicaid, CHIP, CSHCN, KHC
ACEBUTOLOL 400 MG CAPSULE acebutolol HCl	00378140001 MYLAN	BETA-BLOCKERS	No	No	Medicaid, CHIP, CSHCN, KHC
ACETAMINOP-CODEINE 120-12 MG/5 acetaminophen with codeine	50383007916 HI-TECH/AKORN C	ANALGESICS: NARCOTICS SHORT	Yes	No	Medicaid, CHIP, CSHCN
ACETAMINOP-CODEINE 120-12 MG/5 acetaminophen with codeine	60432024516 MORTON GROVE PH	ANALGESICS: NARCOTICS SHORT	Yes	No	Medicaid, CHIP, CSHCN, KHC
ACETAMINOP-CODEINE 120-12 MG/5 acetaminophen with codeine	00121050404 PHARMACEUTICAL	ANALGESICS: NARCOTICS SHORT	Yes	No	Medicaid, CHIP, CSHCN, KHC
ACETAMINOP-CODEINE 120-12 MG/5 acetaminophen with codeine	00121050416 PHARMACEUTICAL	ANALGESICS: NARCOTICS SHORT	Yes	No	Medicaid, CHIP, CSHCN, KHC
ACETAMINOPHEN 120 MG SUPPOS acetaminophen	45802073230 PERRIGO CO.		No	No	Medicaid, CSHCN
ACETAMINOPHEN 120 MG SUPPOS acetaminophen	45802073233 PERRIGO CO.		No	No	Medicaid, CSHCN
ACETAMINOPHEN 325 MG TABLET acetaminophen	63739044001 MCKESSON PACKAG		No	No	Medicaid, CSHCN
ACETAMINOPHEN 650 MG SUPPOS acetaminophen	45802073030 PERRIGO CO.		No	No	Medicaid, CSHCN
ACETAMINOPHEN 650 MG SUPPOS acetaminophen	45802073032 PERRIGO CO.		No	No	Medicaid, CSHCN
ACETAMINOPHEN 650 MG SUPPOS acetaminophen	45802073033 PERRIGO CO.		No	No	Medicaid, CSHCN

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