Formulary Drug Search
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Displaying 1 - 25 of 8317 drugs found. Return to search page.
A drug with a termination date will appear on the search for 90 days following the termination date.
| Brand Name/Generic Name/Package Size | NDC/Manufacturer/Class | Medicaid PA Required | Programs/Coverage Dates |
|---|---|---|---|
| 24HR ALLERGY(LEVOCETIRZN) 5 MG - 10EA levocetirizine dihydrochloride 10 EA |
70000036201 LEADER ANTIHISTAMINES, MINIMALLY SEDATING |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 11/13/2019 CSHCN start: 11/13/2019 |
| 24HR ALLERGY(LEVOCETIRZN) 5 MG - 35EA levocetirizine dihydrochloride 35 EA |
70000036202 LEADER ANTIHISTAMINES, MINIMALLY SEDATING |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 11/13/2019 CSHCN start: 11/13/2019 |
| ABILIFY 10 MG TABLET - 30EA aripiprazole 30 EA |
59148000813 OTSUKA AMERICA ANTIPSYCHOTICS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 11/22/2002 CHIP start: 11/22/2002 CSHCN start: 11/22/2002 |
| ABILIFY 15 MG TABLET - 30EA aripiprazole 30 EA |
59148000913 OTSUKA AMERICA ANTIPSYCHOTICS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 11/22/2002 CHIP start: 11/22/2002 CSHCN start: 11/22/2002 |
| ABILIFY 2 MG TABLET - 30EA aripiprazole 30 EA |
59148000613 OTSUKA AMERICA ANTIPSYCHOTICS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 02/09/2006 CHIP start: 02/09/2006 CSHCN start: 02/09/2006 |
| ABILIFY 20 MG TABLET - 30EA aripiprazole 30 EA |
59148001013 OTSUKA AMERICA ANTIPSYCHOTICS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 11/22/2002 CHIP start: 11/22/2002 CSHCN start: 11/22/2002 |
| ABILIFY 30 MG TABLET - 30EA aripiprazole 30 EA |
59148001113 OTSUKA AMERICA ANTIPSYCHOTICS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 11/22/2002 CHIP start: 11/22/2002 CSHCN start: 11/22/2002 |
| ABILIFY 5 MG TABLET - 30EA aripiprazole 30 EA |
59148000713 OTSUKA AMERICA ANTIPSYCHOTICS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 09/08/2003 CHIP start: 09/08/2003 CSHCN start: 09/08/2003 |
| ABILIFY ASIMTUFII 720 MG/2.4ML - 2.4ML aripiprazole 2.4 ML |
59148010280 OTSUKA AMERICA ANTIPSYCHOTICS |
FFS Clinical: Yes PDL: No |
Medicaid start: 09/11/2023 CHIP start: 09/11/2023 CSHCN start: 09/11/2023 |
| ABILIFY ASIMTUFII 960 MG/3.2ML - 3.2ML aripiprazole 3.2 ML |
59148011480 OTSUKA AMERICA ANTIPSYCHOTICS |
FFS Clinical: Yes PDL: No |
Medicaid start: 09/11/2023 CHIP start: 09/11/2023 CSHCN start: 09/11/2023 |
| ABILIFY MAINTENA ER 300 MG SYR - 1EA aripiprazole 1 EA |
59148004580 OTSUKA AMERICA ANTIPSYCHOTICS |
FFS Clinical: Yes PDL: No |
Medicaid start: 05/12/2015 CHIP start: 05/12/2015 CSHCN start: 05/12/2015 |
| ABILIFY MAINTENA ER 300 MG VL - 1EA aripiprazole 1 EA |
59148001871 OTSUKA AMERICA ANTIPSYCHOTICS |
FFS Clinical: Yes PDL: No |
Medicaid start: 04/09/2013 Medicaid end: 02/14/2026 CHIP start: 04/09/2013 CHIP end: 02/14/2026 CSHCN start: 04/09/2013 CSHCN end: 02/14/2026 |
| ABILIFY MAINTENA ER 400 MG SYR - 1EA aripiprazole 1 EA |
59148007280 OTSUKA AMERICA ANTIPSYCHOTICS |
FFS Clinical: Yes PDL: No |
Medicaid start: 05/12/2015 CHIP start: 05/12/2015 CSHCN start: 05/12/2015 |
| ABILIFY MAINTENA ER 400 MG VL - 1EA aripiprazole 1 EA |
59148001971 OTSUKA AMERICA ANTIPSYCHOTICS |
FFS Clinical: Yes PDL: No |
Medicaid start: 04/09/2013 Medicaid end: 02/14/2026 CHIP start: 04/09/2013 CHIP end: 02/14/2026 CSHCN start: 04/09/2013 CSHCN end: 02/14/2026 |
| ACCURETIC 20-25 MG TABLET - 90EA quinapril/hydrochlorothiazide 90 EA |
00071022323 PFIZER US PHARM ANGIOTENSIN MODULATORS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 10/07/2002 CHIP start: 10/07/2002 CSHCN start: 10/07/2002 KHC start: 10/07/2002 |
| ACETAMINOPHEN-COD #2 TABLET - 100EA acetaminophen with codeine 100 EA |
64850064101 ELITE LABORATOR ANALGESICS, NARCOTICS SHORT |
FFS Clinical: Yes PDL: No |
Medicaid start: 04/17/2025 CHIP start: 04/17/2025 |
| ACETAMINOPHEN-COD #2 TABLET - 100EA acetaminophen with codeine 100 EA |
13107005801 AUROBINDO PHARM ANALGESICS, NARCOTICS SHORT |
FFS Clinical: Yes PDL: No |
Medicaid start: 08/12/2014 CHIP start: 08/12/2014 CSHCN start: 08/12/2014 KHC start: 04/01/2015 |
| ACETAMINOPHEN-COD #2 TABLET - 100EA acetaminophen with codeine 100 EA |
00406048301 MALLINCK-SPECGX ANALGESICS, NARCOTICS SHORT |
FFS Clinical: Yes PDL: No |
Medicaid start: 03/01/2002 CHIP start: 03/01/2002 CSHCN start: 03/01/2002 KHC start: 03/01/2002 |
| ACETAMINOPHEN-COD #2 TABLET - 100EA acetaminophen with codeine 100 EA |
64380044801 STRIDES PHARMA ANALGESICS, NARCOTICS SHORT |
FFS Clinical: Yes PDL: No |
Medicaid start: 09/25/2024 CHIP start: 09/25/2024 |
| ACETAMINOPHEN-COD #2 TABLET - 100EA acetaminophen with codeine 100 EA |
71930005412 EYWA PHARMA INC ANALGESICS, NARCOTICS SHORT |
FFS Clinical: Yes PDL: No |
Medicaid start: 12/18/2019 CHIP start: 12/18/2019 CSHCN start: 12/18/2019 |
| ACETAMINOPHEN-COD #2 TABLET - 500EA acetaminophen with codeine 500 EA |
71930005452 EYWA PHARMA INC ANALGESICS, NARCOTICS SHORT |
FFS Clinical: Yes PDL: No |
Medicaid start: 12/18/2019 CHIP start: 12/18/2019 CSHCN start: 12/18/2019 |
| ACETAMINOPHEN-COD #3 TABLET - 1000EA acetaminophen with codeine 1000 EA |
13107005999 AUROBINDO PHARM ANALGESICS, NARCOTICS SHORT |
FFS Clinical: Yes PDL: No |
Medicaid start: 08/12/2014 CHIP start: 08/12/2014 CSHCN start: 08/12/2014 KHC start: 04/01/2015 |
| ACETAMINOPHEN-COD #3 TABLET - 1000EA acetaminophen with codeine 1000 EA |
00406048410 MALLINCK-SPECGX ANALGESICS, NARCOTICS SHORT |
FFS Clinical: Yes PDL: No |
Medicaid start: 03/01/2002 CHIP start: 03/01/2002 CSHCN start: 03/01/2002 KHC start: 03/01/2002 |
| ACETAMINOPHEN-COD #3 TABLET - 100EA acetaminophen with codeine 100 EA |
64850064201 ELITE LABORATOR ANALGESICS, NARCOTICS SHORT |
FFS Clinical: Yes PDL: No |
Medicaid start: 04/17/2025 CHIP start: 04/17/2025 |
| ACETAMINOPHEN-COD #3 TABLET - 100EA acetaminophen with codeine 100 EA |
65162003310 AMNEAL PHARMACE ANALGESICS, NARCOTICS SHORT |
FFS Clinical: Yes PDL: No |
Medicaid start: 12/18/2012 CHIP start: 12/18/2012 CSHCN start: 12/18/2012 KHC start: 12/18/2012 |