Home Health iDBL
Interactive Drug Benefit List
DIN/NPN/ PIN Generic Name Product Name, Strength & Dosage Form Unit Price, Unit of Issue Manufacturer LCA Price MAC Price Interchangeable Products Coverage Status
02487713 APIXABAN ACH-APIXABAN 2.5 MG ORAL TABLET 0.4084
TAB 		AHI 0.4084 N/A YES REGULAR BENEFIT Details
02530708 APIXABAN APIXABAN 2.5 MG ORAL TABLET 0.4084
TAB 		SIV 0.4084 N/A YES REGULAR BENEFIT Details
02487381 APIXABAN APO-APIXABAN 2.5 MG ORAL TABLET 0.4084
TAB 		APX 0.4084 N/A YES REGULAR BENEFIT Details
02486806 APIXABAN AURO-APIXABAN 2.5 MG ORAL TABLET 0.4084
TAB 		AUR 0.4084 N/A YES REGULAR BENEFIT Details
02377233 APIXABAN ELIQUIS 2.5 MG ORAL TABLET 1.6337
TAB 		BMS 0.4084 N/A YES REGULAR BENEFIT Details
02528924 APIXABAN JAMP APIXABAN 2.5 MG ORAL TABLET 0.4084
TAB 		JPC 0.4084 N/A YES REGULAR BENEFIT Details
02529009 APIXABAN M-APIXABAN 2.5 MG ORAL TABLET 0.4084
TAB 		MTR 0.4084 N/A YES REGULAR BENEFIT Details
02492369 APIXABAN MAR-APIXABAN 2.5 MG ORAL TABLET 0.4084
TAB 		MAR 0.4084 N/A YES REGULAR BENEFIT Details
02495430 APIXABAN MINT-APIXABAN 2.5 MG ORAL TABLET 0.4084
TAB 		MPI 0.4084 N/A YES REGULAR BENEFIT Details
02492814 APIXABAN NAT-APIXABAN 2.5 MG ORAL TABLET 0.4084
TAB 		NTP 0.4084 N/A YES REGULAR BENEFIT Details
02526050 APIXABAN NRA-APIXABAN 2.5 MG ORAL TABLET 0.4084
TAB 		NRA 0.4084 N/A YES REGULAR BENEFIT Details
02489228 APIXABAN SANDOZ APIXABAN SDZ 2.5 MG ORAL TABLET 0.4084
TAB 		SDZ 0.4084 N/A YES REGULAR BENEFIT Details
02510464 APIXABAN TARO-APIXABAN 2.5 MG ORAL TABLET 0.4084
TAB 		TAR 0.4084 N/A YES REGULAR BENEFIT Details
02484994 APIXABAN TEVA-APIXABAN 2.5 MG ORAL TABLET 0.4084
TAB 		TEV 0.4084 N/A YES REGULAR BENEFIT Details
02487721 APIXABAN ACH-APIXABAN 5 MG ORAL TABLET 0.4084
TAB 		AHI 0.4084 N/A YES REGULAR BENEFIT Details
02530716 APIXABAN APIXABAN 5 MG ORAL TABLET 0.4084
TAB 		SIV 0.4084 N/A YES REGULAR BENEFIT Details
02487403 APIXABAN APO-APIXABAN 5 MG ORAL TABLET 0.4084
TAB 		APX 0.4084 N/A YES REGULAR BENEFIT Details
02486814 APIXABAN AURO-APIXABAN 5 MG ORAL TABLET 0.4084
TAB 		AUR 0.4084 N/A YES REGULAR BENEFIT Details
02397714 APIXABAN ELIQUIS 5 MG ORAL TABLET 1.6337
TAB 		BMS 0.4084 N/A YES REGULAR BENEFIT Details
02528932 APIXABAN JAMP APIXABAN 5 MG ORAL TABLET 0.4084
TAB 		JPC 0.4084 N/A YES REGULAR BENEFIT Details
02529017 APIXABAN M-APIXABAN 5 MG ORAL TABLET 0.4084
TAB 		MTR 0.4084 N/A YES REGULAR BENEFIT Details
02492377 APIXABAN MAR-APIXABAN 5 MG ORAL TABLET 0.4084
TAB 		MAR 0.4084 N/A YES REGULAR BENEFIT Details
02495449 APIXABAN MINT-APIXABAN 5 MG ORAL TABLET 0.4084
TAB 		MPI 0.4084 N/A YES REGULAR BENEFIT Details
02492822 APIXABAN NAT-APIXABAN 5 MG ORAL TABLET 0.4084
TAB 		NTP 0.4084 N/A YES REGULAR BENEFIT Details
02526069 APIXABAN NRA-APIXABAN 5 MG ORAL TABLET 0.4084
TAB 		NRA 0.4084 N/A YES REGULAR BENEFIT Details
02489236 APIXABAN SANDOZ APIXABAN SDZ 5 MG ORAL TABLET 0.4084
TAB 		SDZ 0.4084 N/A YES REGULAR BENEFIT Details
02510472 APIXABAN TARO-APIXABAN 5 MG ORAL TABLET 0.4084
TAB 		TAR 0.4084 N/A YES REGULAR BENEFIT Details
02485001 APIXABAN TEVA-APIXABAN 5 MG ORAL TABLET 0.4084
TAB 		TEV 0.4084 N/A YES REGULAR BENEFIT Details
02458640 EDOXABAN TOSYLATE MONOHYDRATE LIXIANA 15 MG ORAL TABLET 2.9393
TAB 		SEV N/A N/A NO STEP THERAPY/ SPECIAL AUTHORIZATION Details
02458659 EDOXABAN TOSYLATE MONOHYDRATE LIXIANA 30 MG ORAL TABLET 2.9393
TAB 		SEV N/A N/A NO STEP THERAPY/ SPECIAL AUTHORIZATION Details
02458667 EDOXABAN TOSYLATE MONOHYDRATE LIXIANA 60 MG ORAL TABLET 2.9393
TAB 		SEV N/A N/A NO STEP THERAPY/ SPECIAL AUTHORIZATION Details
02470497 RIVAROXABAN APO-RIVAROXABAN 10 MG ORAL TABLET 0.7175
TAB 		APX 0.7175 N/A YES REGULAR BENEFIT Details
02516292 RIVAROXABAN JAMP RIVAROXABAN 10 MG ORAL TABLET N/A
TAB 		JPC N/A N/A YES UNDER REVIEW Details
02512041 RIVAROXABAN PMS-RIVAROXABAN 10 MG ORAL TABLET 0.7175
TAB 		PMS 0.7175 N/A YES REGULAR BENEFIT Details
02472414 RIVAROXABAN REDDY-RIVAROXABAN 10 MG ORAL TABLET 0.7175
TAB 		DRL 0.7175 N/A YES REGULAR BENEFIT Details
02541475 RIVAROXABAN RIVAROXABAN 10 MG ORAL TABLET 0.7175
TAB 		SIV 0.7175 N/A YES REGULAR BENEFIT Details
02482223 RIVAROXABAN SANDOZ RIVAROXABAN 10 MG ORAL TABLET 0.7175
TAB 		SDZ 0.7175 N/A YES REGULAR BENEFIT Details
02483807 RIVAROXABAN TARO-RIVAROXABAN 10 MG ORAL TABLET 0.7175
TAB 		TAR 0.7175 N/A YES REGULAR BENEFIT Details
02507196 RIVAROXABAN TEVA-RIVAROXABAN 10 MG ORAL TABLET 0.7175
TAB 		TEV 0.7175 N/A YES REGULAR BENEFIT Details
02316986 RIVAROXABAN XARELTO 10 MG ORAL TABLET 2.8700
TAB 		BAI 0.7175 N/A YES REGULAR BENEFIT Details
02470500 RIVAROXABAN APO-RIVAROXABAN 15 MG ORAL TABLET 0.7175
TAB 		APX 0.7175 N/A YES REGULAR BENEFIT Details
02516306 RIVAROXABAN JAMP RIVAROXABAN 15 MG ORAL TABLET N/A
TAB 		JPC N/A N/A YES UNDER REVIEW Details
02512068 RIVAROXABAN PMS-RIVAROXABAN 15 MG ORAL TABLET 0.7175
TAB 		PMS 0.7175 N/A YES REGULAR BENEFIT Details
02472430 RIVAROXABAN REDDY-RIVAROXABAN 15 MG ORAL TABLET 0.7175
TAB 		DRL 0.7175 N/A YES REGULAR BENEFIT Details
02541483 RIVAROXABAN RIVAROXABAN 15 MG ORAL TABLET 0.7175
TAB 		SIV 0.7175 N/A YES REGULAR BENEFIT Details
02482231 RIVAROXABAN SANDOZ RIVAROXABAN 15 MG ORAL TABLET 0.7175
TAB 		SDZ 0.7175 N/A YES REGULAR BENEFIT Details
02483815 RIVAROXABAN TARO-RIVAROXABAN 15 MG ORAL TABLET 0.7175
TAB 		TAR 0.7175 N/A YES REGULAR BENEFIT Details
02507218 RIVAROXABAN TEVA-RIVAROXABAN 15 MG ORAL TABLET 0.7175
TAB 		TEV 0.7175 N/A YES REGULAR BENEFIT Details
02378604 RIVAROXABAN XARELTO 15 MG ORAL TABLET 2.8700
TAB 		BAI 0.7175 N/A YES REGULAR BENEFIT Details
02541734 RIVAROXABAN APO-RIVAROXABAN 2.5 MG ORAL TABLET 0.3550
TAB 		APX 0.3550 N/A YES REGULAR BENEFIT Details
02527537 RIVAROXABAN PMS-RIVAROXABAN 2.5 MG ORAL TABLET 0.3550
TAB 		PMS 0.3550 N/A YES REGULAR BENEFIT Details
02524503 RIVAROXABAN REDDY-RIVAROXABAN 2.5 MG ORAL TABLET 0.3550
TAB 		DRL 0.3550 N/A YES REGULAR BENEFIT Details
02541467 RIVAROXABAN RIVAROXABAN 2.5 MG ORAL TABLET 0.3550
TAB 		SIV 0.3550 N/A YES REGULAR BENEFIT Details
02537877 RIVAROXABAN SANDOZ RIVAROXABAN 2.5 MG ORAL TABLET 0.3550
TAB 		SDZ 0.3550 N/A YES REGULAR BENEFIT Details
02526786 RIVAROXABAN TARO-RIVAROXABAN 2.5 MG ORAL TABLET 0.3550
TAB 		TAR 0.3550 N/A YES REGULAR BENEFIT Details
02480808 RIVAROXABAN XARELTO 2.5 MG ORAL TABLET 1.4200
TAB 		BAI 0.3550 N/A YES REGULAR BENEFIT Details
02470519 RIVAROXABAN APO-RIVAROXABAN 20 MG ORAL TABLET 0.7175
TAB 		APX 0.7175 N/A YES REGULAR BENEFIT Details
02516314 RIVAROXABAN JAMP RIVAROXABAN 20 MG ORAL TABLET N/A
TAB 		JPC N/A N/A YES UNDER REVIEW Details
02512076 RIVAROXABAN PMS-RIVAROXABAN 20 MG ORAL TABLET 0.7175
TAB 		PMS 0.7175 N/A YES REGULAR BENEFIT Details
02472422 RIVAROXABAN REDDY-RIVAROXABAN 20 MG ORAL TABLET 0.7175
TAB 		DRL 0.7175 N/A YES REGULAR BENEFIT Details
02541491 RIVAROXABAN RIVAROXABAN 20 MG ORAL TABLET 0.7175
TAB 		SIV 0.7175 N/A YES REGULAR BENEFIT Details
02482258 RIVAROXABAN SANDOZ RIVAROXABAN 20 MG ORAL TABLET 0.7175
TAB 		SDZ 0.7175 N/A YES REGULAR BENEFIT Details
02483823 RIVAROXABAN TARO-RIVAROXABAN 20 MG ORAL TABLET 0.7175
TAB 		TAR 0.7175 N/A YES REGULAR BENEFIT Details
02507226 RIVAROXABAN TEVA-RIVAROXABAN 20 MG ORAL TABLET 0.7175
TAB 		TEV 0.7175 N/A YES REGULAR BENEFIT Details
02378612 RIVAROXABAN XARELTO 20 MG ORAL TABLET 2.8700
TAB 		BAI 0.7175 N/A YES REGULAR BENEFIT Details
DIN/NPN/ PIN 02487713
Generic Name APIXABAN
Product Name, Strength & Dosage Form ACH-APIXABAN 2.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.4084
Manufacturer AHI
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02530708
Generic Name APIXABAN
Product Name, Strength & Dosage Form APIXABAN 2.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.4084
Manufacturer SIV
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02487381
Generic Name APIXABAN
Product Name, Strength & Dosage Form APO-APIXABAN 2.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.4084
Manufacturer APX
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02486806
Generic Name APIXABAN
Product Name, Strength & Dosage Form AURO-APIXABAN 2.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.4084
Manufacturer AUR
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02377233
Generic Name APIXABAN
Product Name, Strength & Dosage Form ELIQUIS 2.5 MG ORAL TABLET
Unit Price, Unit of Issue 1.6337
Manufacturer BMS
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02528924
Generic Name APIXABAN
Product Name, Strength & Dosage Form JAMP APIXABAN 2.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.4084
Manufacturer JPC
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02529009
Generic Name APIXABAN
Product Name, Strength & Dosage Form M-APIXABAN 2.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.4084
Manufacturer MTR
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02492369
Generic Name APIXABAN
Product Name, Strength & Dosage Form MAR-APIXABAN 2.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.4084
Manufacturer MAR
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02495430
Generic Name APIXABAN
Product Name, Strength & Dosage Form MINT-APIXABAN 2.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.4084
Manufacturer MPI
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02492814
Generic Name APIXABAN
Product Name, Strength & Dosage Form NAT-APIXABAN 2.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.4084
Manufacturer NTP
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02526050
Generic Name APIXABAN
Product Name, Strength & Dosage Form NRA-APIXABAN 2.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.4084
Manufacturer NRA
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02489228
Generic Name APIXABAN
Product Name, Strength & Dosage Form SANDOZ APIXABAN SDZ 2.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.4084
Manufacturer SDZ
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02510464
Generic Name APIXABAN
Product Name, Strength & Dosage Form TARO-APIXABAN 2.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.4084
Manufacturer TAR
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02484994
Generic Name APIXABAN
Product Name, Strength & Dosage Form TEVA-APIXABAN 2.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.4084
Manufacturer TEV
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02487721
Generic Name APIXABAN
Product Name, Strength & Dosage Form ACH-APIXABAN 5 MG ORAL TABLET
Unit Price, Unit of Issue 0.4084
Manufacturer AHI
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02530716
Generic Name APIXABAN
Product Name, Strength & Dosage Form APIXABAN 5 MG ORAL TABLET
Unit Price, Unit of Issue 0.4084
Manufacturer SIV
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02487403
Generic Name APIXABAN
Product Name, Strength & Dosage Form APO-APIXABAN 5 MG ORAL TABLET
Unit Price, Unit of Issue 0.4084
Manufacturer APX
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02486814
Generic Name APIXABAN
Product Name, Strength & Dosage Form AURO-APIXABAN 5 MG ORAL TABLET
Unit Price, Unit of Issue 0.4084
Manufacturer AUR
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02397714
Generic Name APIXABAN
Product Name, Strength & Dosage Form ELIQUIS 5 MG ORAL TABLET
Unit Price, Unit of Issue 1.6337
Manufacturer BMS
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02528932
Generic Name APIXABAN
Product Name, Strength & Dosage Form JAMP APIXABAN 5 MG ORAL TABLET
Unit Price, Unit of Issue 0.4084
Manufacturer JPC
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02529017
Generic Name APIXABAN
Product Name, Strength & Dosage Form M-APIXABAN 5 MG ORAL TABLET
Unit Price, Unit of Issue 0.4084
Manufacturer MTR
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02492377
Generic Name APIXABAN
Product Name, Strength & Dosage Form MAR-APIXABAN 5 MG ORAL TABLET
Unit Price, Unit of Issue 0.4084
Manufacturer MAR
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02495449
Generic Name APIXABAN
Product Name, Strength & Dosage Form MINT-APIXABAN 5 MG ORAL TABLET
Unit Price, Unit of Issue 0.4084
Manufacturer MPI
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02492822
Generic Name APIXABAN
Product Name, Strength & Dosage Form NAT-APIXABAN 5 MG ORAL TABLET
Unit Price, Unit of Issue 0.4084
Manufacturer NTP
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02526069
Generic Name APIXABAN
Product Name, Strength & Dosage Form NRA-APIXABAN 5 MG ORAL TABLET
Unit Price, Unit of Issue 0.4084
Manufacturer NRA
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02489236
Generic Name APIXABAN
Product Name, Strength & Dosage Form SANDOZ APIXABAN SDZ 5 MG ORAL TABLET
Unit Price, Unit of Issue 0.4084
Manufacturer SDZ
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02510472
Generic Name APIXABAN
Product Name, Strength & Dosage Form TARO-APIXABAN 5 MG ORAL TABLET
Unit Price, Unit of Issue 0.4084
Manufacturer TAR
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02485001
Generic Name APIXABAN
Product Name, Strength & Dosage Form TEVA-APIXABAN 5 MG ORAL TABLET
Unit Price, Unit of Issue 0.4084
Manufacturer TEV
LCA Price 0.4084
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02458640
Generic Name EDOXABAN TOSYLATE MONOHYDRATE
Product Name, Strength & Dosage Form LIXIANA 15 MG ORAL TABLET
Unit Price, Unit of Issue 2.9393
Manufacturer SEV
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02458659
Generic Name EDOXABAN TOSYLATE MONOHYDRATE
Product Name, Strength & Dosage Form LIXIANA 30 MG ORAL TABLET
Unit Price, Unit of Issue 2.9393
Manufacturer SEV
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02458667
Generic Name EDOXABAN TOSYLATE MONOHYDRATE
Product Name, Strength & Dosage Form LIXIANA 60 MG ORAL TABLET
Unit Price, Unit of Issue 2.9393
Manufacturer SEV
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02470497
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form APO-RIVAROXABAN 10 MG ORAL TABLET
Unit Price, Unit of Issue 0.7175
Manufacturer APX
LCA Price 0.7175
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02516292
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form JAMP RIVAROXABAN 10 MG ORAL TABLET
Unit Price, Unit of Issue N/A
Manufacturer JPC
LCA Price N/A
MAC Price N/A
Interchangeable Products YES
Coverage Status UNDER REVIEW
Details
DIN/NPN/ PIN 02512041
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form PMS-RIVAROXABAN 10 MG ORAL TABLET
Unit Price, Unit of Issue 0.7175
Manufacturer PMS
LCA Price 0.7175
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02472414
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form REDDY-RIVAROXABAN 10 MG ORAL TABLET
Unit Price, Unit of Issue 0.7175
Manufacturer DRL
LCA Price 0.7175
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02541475
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form RIVAROXABAN 10 MG ORAL TABLET
Unit Price, Unit of Issue 0.7175
Manufacturer SIV
LCA Price 0.7175
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02482223
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form SANDOZ RIVAROXABAN 10 MG ORAL TABLET
Unit Price, Unit of Issue 0.7175
Manufacturer SDZ
LCA Price 0.7175
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02483807
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form TARO-RIVAROXABAN 10 MG ORAL TABLET
Unit Price, Unit of Issue 0.7175
Manufacturer TAR
LCA Price 0.7175
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02507196
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form TEVA-RIVAROXABAN 10 MG ORAL TABLET
Unit Price, Unit of Issue 0.7175
Manufacturer TEV
LCA Price 0.7175
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02316986
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form XARELTO 10 MG ORAL TABLET
Unit Price, Unit of Issue 2.8700
Manufacturer BAI
LCA Price 0.7175
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02470500
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form APO-RIVAROXABAN 15 MG ORAL TABLET
Unit Price, Unit of Issue 0.7175
Manufacturer APX
LCA Price 0.7175
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02516306
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form JAMP RIVAROXABAN 15 MG ORAL TABLET
Unit Price, Unit of Issue N/A
Manufacturer JPC
LCA Price N/A
MAC Price N/A
Interchangeable Products YES
Coverage Status UNDER REVIEW
Details
DIN/NPN/ PIN 02512068
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form PMS-RIVAROXABAN 15 MG ORAL TABLET
Unit Price, Unit of Issue 0.7175
Manufacturer PMS
LCA Price 0.7175
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02472430
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form REDDY-RIVAROXABAN 15 MG ORAL TABLET
Unit Price, Unit of Issue 0.7175
Manufacturer DRL
LCA Price 0.7175
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02541483
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form RIVAROXABAN 15 MG ORAL TABLET
Unit Price, Unit of Issue 0.7175
Manufacturer SIV
LCA Price 0.7175
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02482231
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form SANDOZ RIVAROXABAN 15 MG ORAL TABLET
Unit Price, Unit of Issue 0.7175
Manufacturer SDZ
LCA Price 0.7175
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02483815
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form TARO-RIVAROXABAN 15 MG ORAL TABLET
Unit Price, Unit of Issue 0.7175
Manufacturer TAR
LCA Price 0.7175
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02507218
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form TEVA-RIVAROXABAN 15 MG ORAL TABLET
Unit Price, Unit of Issue 0.7175
Manufacturer TEV
LCA Price 0.7175
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02378604
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form XARELTO 15 MG ORAL TABLET
Unit Price, Unit of Issue 2.8700
Manufacturer BAI
LCA Price 0.7175
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02541734
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form APO-RIVAROXABAN 2.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.3550
Manufacturer APX
LCA Price 0.3550
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02527537
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form PMS-RIVAROXABAN 2.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.3550
Manufacturer PMS
LCA Price 0.3550
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02524503
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form REDDY-RIVAROXABAN 2.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.3550
Manufacturer DRL
LCA Price 0.3550
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02541467
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form RIVAROXABAN 2.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.3550
Manufacturer SIV
LCA Price 0.3550
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02537877
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form SANDOZ RIVAROXABAN 2.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.3550
Manufacturer SDZ
LCA Price 0.3550
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02526786
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form TARO-RIVAROXABAN 2.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.3550
Manufacturer TAR
LCA Price 0.3550
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02480808
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form XARELTO 2.5 MG ORAL TABLET
Unit Price, Unit of Issue 1.4200
Manufacturer BAI
LCA Price 0.3550
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02470519
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form APO-RIVAROXABAN 20 MG ORAL TABLET
Unit Price, Unit of Issue 0.7175
Manufacturer APX
LCA Price 0.7175
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02516314
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form JAMP RIVAROXABAN 20 MG ORAL TABLET
Unit Price, Unit of Issue N/A
Manufacturer JPC
LCA Price N/A
MAC Price N/A
Interchangeable Products YES
Coverage Status UNDER REVIEW
Details
DIN/NPN/ PIN 02512076
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form PMS-RIVAROXABAN 20 MG ORAL TABLET
Unit Price, Unit of Issue 0.7175
Manufacturer PMS
LCA Price 0.7175
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02472422
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form REDDY-RIVAROXABAN 20 MG ORAL TABLET
Unit Price, Unit of Issue 0.7175
Manufacturer DRL
LCA Price 0.7175
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02541491
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form RIVAROXABAN 20 MG ORAL TABLET
Unit Price, Unit of Issue 0.7175
Manufacturer SIV
LCA Price 0.7175
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02482258
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form SANDOZ RIVAROXABAN 20 MG ORAL TABLET
Unit Price, Unit of Issue 0.7175
Manufacturer SDZ
LCA Price 0.7175
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02483823
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form TARO-RIVAROXABAN 20 MG ORAL TABLET
Unit Price, Unit of Issue 0.7175
Manufacturer TAR
LCA Price 0.7175
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02507226
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form TEVA-RIVAROXABAN 20 MG ORAL TABLET
Unit Price, Unit of Issue 0.7175
Manufacturer TEV
LCA Price 0.7175
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02378612
Generic Name RIVAROXABAN
Product Name, Strength & Dosage Form XARELTO 20 MG ORAL TABLET
Unit Price, Unit of Issue 2.8700
Manufacturer BAI
LCA Price 0.7175
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
To return to the printable Drug Benefit List and related publications, click here
Last Updated:
NOTICE:
The DBL, DBS and related publications require knowledgeable interpretation and are intended primarily for professional health care practitioners, pharmacies, hospitals and organizations associated with the manufacture, distribution and use of pharmaceutical preparations.
Electronic versions of all DBL and DBS related publications are unofficial versions and are provided for convenience and private use only. Official paper versions can be obtained from Alberta Blue Cross who publishes them on behalf of Alberta Health and Alberta Human Services.
Alberta Health reserves the right to make changes, without notice, to the List through the Interactive DBL(iDBL), and any such changes to the Interactive DBL(iDBL) are effective the date of the change (unless otherwise stated) and regardless of the date of publication in the paper version or updates.