Displaying 151 - 200 of 21542 records found. Return to search page.
Brand Name/Generic Name | NDC | PDL Class | FFS Clinical Prior Auth Required | PDL Prior Auth Required | Programs |
---|---|---|---|---|---|
ACETYLCYSTEINE 6 GRAM/30 ML VL acetylcysteine |
00574080530 | No | No | Medicaid, CHIP, CSHCN | |
ACID GONE ANTACID LIQUID mag carb/aluminum hydrox/algin |
00904772714 | No | No | Medicaid, CSHCN | |
ACID REDUCER 20 MG TABLET famotidine |
37205086163 | No | No | Medicaid, CSHCN | |
ACIPHEX DR 20 MG TABLET rabeprazole sodium |
62856024330 | PROTON PUMP INHIBITORS | No | Yes | Medicaid, CHIP, CSHCN |
ACIPHEX SPRINKLE DR 10 MG CAP rabeprazole sodium |
13551021001 | PROTON PUMP INHIBITORS | No | Yes | Medicaid, CHIP, CSHCN |
ACIPHEX SPRINKLE DR 10 MG CAP rabeprazole sodium |
23594021001 | PROTON PUMP INHIBITORS | No | Yes | Medicaid, CHIP, CSHCN |
ACIPHEX SPRINKLE DR 5 MG CAP rabeprazole sodium |
13551020501 | PROTON PUMP INHIBITORS | No | Yes | Medicaid, CHIP, CSHCN |
ACIPHEX SPRINKLE DR 5 MG CAP rabeprazole sodium |
23594020501 | PROTON PUMP INHIBITORS | No | Yes | Medicaid, CHIP, CSHCN |
ACITRETIN 10 MG CAPSULE acitretin |
00093113556 | No | No | Medicaid, CHIP, CSHCN | |
ACITRETIN 10 MG CAPSULE acitretin |
00115175008 | No | No | Medicaid, CHIP, CSHCN | |
ACITRETIN 10 MG CAPSULE acitretin |
00378702093 | No | No | Medicaid, CHIP, CSHCN | |
ACITRETIN 10 MG CAPSULE acitretin |
42794008008 | No | No | Medicaid, CHIP, CSHCN | |
ACITRETIN 10 MG CAPSULE acitretin |
66993089430 | No | No | Medicaid, CHIP, CSHCN | |
ACITRETIN 17.5 MG CAPSULE acitretin |
00093113856 | No | No | Medicaid, CHIP, CSHCN | |
ACITRETIN 17.5 MG CAPSULE acitretin |
00115166808 | No | No | Medicaid, CHIP, CSHCN | |
ACITRETIN 17.5 MG CAPSULE acitretin |
42794008108 | No | No | Medicaid, CHIP, CSHCN | |
ACITRETIN 25 MG CAPSULE acitretin |
00093113656 | No | No | Medicaid, CHIP, CSHCN | |
ACITRETIN 25 MG CAPSULE acitretin |
00115166908 | No | No | Medicaid, CHIP, CSHCN | |
ACITRETIN 25 MG CAPSULE acitretin |
00115175308 | No | No | Medicaid, CHIP, CSHCN | |
ACITRETIN 25 MG CAPSULE acitretin |
00378702393 | No | No | Medicaid, CHIP, CSHCN | |
ACITRETIN 25 MG CAPSULE acitretin |
42794008308 | No | No | Medicaid, CHIP, CSHCN | |
ACITRETIN 25 MG CAPSULE acitretin |
66993089630 | No | No | Medicaid, CHIP, CSHCN | |
ACNE MEDICATION 10% GEL benzoyl peroxide |
00536105656 | No | No | Medicaid, CSHCN | |
ACNE MEDICATION 10% LOTION benzoyl peroxide |
00536105875 | No | No | Medicaid, CSHCN | |
ACNE MEDICATION 5% GEL benzoyl peroxide |
00536105556 | No | No | Medicaid, CSHCN | |
ACNE MEDICATION 5% LOTION benzoyl peroxide |
00536105775 | No | No | Medicaid, CSHCN | |
ACTEMRA 162 MG/0.9 ML SYRINGE tocilizumab |
50242013801 | CYTOKINE AND CAM ANTAGONISTS | Yes | Yes | Medicaid, CHIP, CSHCN |
ACTIDOSE 50 GM LIQUID charcoal/sorbitol solution |
00574012008 | No | No | Medicaid, CSHCN | |
ACTIGALL 300 MG CAPSULE ursodiol |
52544093001 | BILE SALTS | No | Yes | Medicaid, CHIP, CSHCN |
ACTIMMUNE 100 MCG/0.5 ML VIAL interferon gamma-1b,recomb. |
42238011101 | No | No | Medicaid, CHIP, CSHCN | |
ACTIMMUNE 100 MCG/0.5 ML VIAL interferon gamma-1b,recomb. |
42238011112 | No | No | Medicaid, CHIP, CSHCN | |
ACTIMMUNE 100 MCG/0.5 ML VIAL interferon gamma-1b,recomb. |
75987011110 | No | No | Medicaid, CHIP, CSHCN | |
ACTIMMUNE 100 MCG/0.5 ML VIAL interferon gamma-1b,recomb. |
75987011111 | No | No | Medicaid, CHIP, CSHCN | |
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 |
ACTONEL 150 MG TABLET risedronate sodium |
00430047801 | BONE RESORPTION SUPPRESSION AND RELATED AGENTS | No | Yes | Medicaid, CHIP, CSHCN |
ACTONEL 150 MG TABLET risedronate sodium |
00430047802 | BONE RESORPTION SUPPRESSION AND RELATED AGENTS | No | Yes | Medicaid, CHIP, CSHCN |
ACTONEL 30 MG TABLET risedronate sodium |
00430047015 | BONE RESORPTION SUPPRESSION AND RELATED AGENTS | No | Yes | Medicaid, CHIP, CSHCN |
ACTONEL 35 MG TABLET risedronate sodium |
00430047203 | BONE RESORPTION SUPPRESSION AND RELATED AGENTS | No | Yes | Medicaid, CHIP, CSHCN |
ACTONEL 5 MG TABLET risedronate sodium |
00430047115 | BONE RESORPTION SUPPRESSION AND RELATED AGENTS | No | Yes | Medicaid, CHIP, CSHCN |
ACTOPLUS MET XR 15-1,000 MG TB pioglitazone HCl/metformin HCl |
64764051030 | HYPOGLYCEMICS: TZD | Yes | Yes | Medicaid, CHIP, CSHCN |
ACTOPLUS MET XR 30-1,000 MG TB pioglitazone HCl/metformin HCl |
64764031030 | HYPOGLYCEMICS: TZD | Yes | Yes | Medicaid, CHIP, CSHCN |
ACULAR 0.5% EYE DROPS ketorolac tromethamine |
00023218105 | OPHTHALMICS: ANTI-INFLAMMATORIES | No | Yes | Medicaid, CHIP, CSHCN |
ACULAR LS 0.4% OPHTH SOL ketorolac tromethamine |
00023927705 | OPHTHALMICS: ANTI-INFLAMMATORIES | No | Yes | Medicaid, CHIP, CSHCN |
ACUVAIL 0.45% OPHTH SOLUTION ketorolac tromethamine/PF |
00023350730 | OPHTHALMICS: ANTI-INFLAMMATORIES | Yes | Yes | Medicaid, CHIP, CSHCN |
ACYCLOVIR 200 MG CAPSULE acyclovir |
00093894001 | ANTIVIRALS: ORAL | No | No | Medicaid, CHIP, CSHCN, KHC, HTW |