Displaying 1 - 50 of 1405 records found. Return to search page.
Search results: Formulary Drugs
Brand Name/Generic Name NDC PDL Class FFS Clinical Prior Auth Required PDL Prior Auth Required Programs
ACETAMIN-CAFF-DIHYDROCOD 320.5
acetaminophen/caff/dihydrocod
42195084010 ANALGESICS: NARCOTICS SHORT Yes Yes Medicaid, CHIP, CSHCN
ACETAMIN-CAFF-DIHYDROCOD 325
acetaminophen/caff/dihydrocod
68047072001 ANALGESICS: NARCOTICS SHORT No Yes Medicaid, CHIP, CSHCN
ACETAMINOP-CODEINE 120-12 MG/5
acetaminophen with codeine
00121050404 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACETAMINOP-CODEINE 120-12 MG/5
acetaminophen with codeine
00121050416 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACETAMINOP-CODEINE 120-12 MG/5
acetaminophen with codeine
50383007916 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN
ACETAMINOP-CODEINE 120-12 MG/5
acetaminophen with codeine
60432024516 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACETAMINOPHEN-COD #2 TABLET
acetaminophen with codeine
00093005001 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACETAMINOPHEN-COD #2 TABLET
acetaminophen with codeine
13107005801 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACETAMINOPHEN-COD #2 TABLET
acetaminophen with codeine
00603233721 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACETAMINOPHEN-COD #2 TABLET
acetaminophen with codeine
00406048301 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACETAMINOPHEN-COD #3 TABLET
acetaminophen with codeine
00603233832 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACETAMINOPHEN-COD #3 TABLET
acetaminophen with codeine
00406048410 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACETAMINOPHEN-COD #3 TABLET
acetaminophen with codeine
00406048462 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACETAMINOPHEN-COD #3 TABLET
acetaminophen with codeine
65162003310 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACETAMINOPHEN-COD #3 TABLET
acetaminophen with codeine
65162003311 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACETAMINOPHEN-COD #3 TABLET
acetaminophen with codeine
00093015001 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACETAMINOPHEN-COD #3 TABLET
acetaminophen with codeine
00093015010 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACETAMINOPHEN-COD #3 TABLET
acetaminophen with codeine
51079016120 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN
ACETAMINOPHEN-COD #3 TABLET
acetaminophen with codeine
13107005901 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACETAMINOPHEN-COD #3 TABLET
acetaminophen with codeine
13107005999 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACETAMINOPHEN-COD #3 TABLET
acetaminophen with codeine
00603233821 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACETAMINOPHEN-COD #3 TABLET
acetaminophen with codeine
00406048401 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACETAMINOPHEN-COD #4 TABLET
acetaminophen with codeine
00603233921 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACETAMINOPHEN-COD #4 TABLET
acetaminophen with codeine
00603233928 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACETAMINOPHEN-COD #4 TABLET
acetaminophen with codeine
00406048501 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACETAMINOPHEN-COD #4 TABLET
acetaminophen with codeine
00406048505 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACETAMINOPHEN-COD #4 TABLET
acetaminophen with codeine
00093035001 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACETAMINOPHEN-COD #4 TABLET
acetaminophen with codeine
00093035005 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACETAMINOPHEN-COD #4 TABLET
acetaminophen with codeine
00093035010 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACETAMINOPHEN-COD #4 TABLET
acetaminophen with codeine
13107006001 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACETAMINOPHEN-COD #4 TABLET
acetaminophen with codeine
13107006005 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACETAMINOPHEN-COD #4 TABLET
acetaminophen with codeine
13107006099 ANALGESICS: NARCOTICS SHORT Yes No Medicaid, CHIP, CSHCN, KHC
ACTIQ 1,200 MCG LOZENGE
fentanyl citrate
63459051230 ANALGESICS: NARCOTICS SHORT Yes Yes Medicaid, CHIP, CSHCN
ACTIQ 1,600 MCG LOZENGE
fentanyl citrate
63459051630 ANALGESICS: NARCOTICS SHORT Yes Yes Medicaid, CHIP, CSHCN
ACTIQ 200 MCG LOZENGE
fentanyl citrate
63459050230 ANALGESICS: NARCOTICS SHORT Yes Yes Medicaid, CHIP, CSHCN
ACTIQ 400 MCG LOZENGE
fentanyl citrate
63459050430 ANALGESICS: NARCOTICS SHORT Yes Yes Medicaid, CHIP, CSHCN
ACTIQ 600 MCG LOZENGE
fentanyl citrate
63459050630 ANALGESICS: NARCOTICS SHORT Yes Yes Medicaid, CHIP, CSHCN
ACTIQ 800 MCG LOZENGE
fentanyl citrate
63459050830 ANALGESICS: NARCOTICS SHORT Yes Yes Medicaid, CHIP, CSHCN
ALPRAZOLAM 0.25 MG TABLET
alprazolam
47335060313 Yes No Medicaid, CHIP, CSHCN
ALPRAZOLAM 0.25 MG TABLET
alprazolam
47335060318 Yes No Medicaid, CHIP, CSHCN
ALPRAZOLAM 0.25 MG TABLET
alprazolam
47335060388 Yes No Medicaid, CHIP, CSHCN
ALPRAZOLAM 0.25 MG TABLET
alprazolam
00904585861 Yes No Medicaid, CHIP, CSHCN
ALPRAZOLAM 0.25 MG TABLET
alprazolam
00378400105 Yes No Medicaid, CHIP, CSHCN
ALPRAZOLAM 0.25 MG TABLET
alprazolam
65862067699 Yes No Medicaid, CHIP, CSHCN
ALPRAZOLAM 0.25 MG TABLET
alprazolam
59762371901 Yes No Medicaid, CHIP, CSHCN
ALPRAZOLAM 0.25 MG TABLET
alprazolam
59762371903 Yes No Medicaid, CHIP, CSHCN
ALPRAZOLAM 0.25 MG TABLET
alprazolam
59762371904 Yes No Medicaid, CHIP, CSHCN
ALPRAZOLAM 0.25 MG TABLET
alprazolam
00781106101 Yes No Medicaid, CHIP, CSHCN
ALPRAZOLAM 0.25 MG TABLET
alprazolam
00781106105 Yes No Medicaid, CHIP, CSHCN
ALPRAZOLAM 0.25 MG TABLET
alprazolam
51991070401 Yes No Medicaid, CHIP, CSHCN