DIN/NPN/ PIN | Generic Name | Product Name, Strength & Dosage Form | Unit Price, Unit of Issue | Manufacturer | LCA Price | MAC Price | Interchangeable Products | Coverage Status | |
---|---|---|---|---|---|---|---|---|---|
00330582 | 5-FLUOROURACIL | EFUDEX 50 MG / G TOPICAL CREAM |
1.0040 G |
VCL | N/A | N/A | NO | REGULAR BENEFIT | |
02528371 | ABROCITINIB | CIBINQO 100 MG ORAL TABLET |
48.6667 TAB |
PFI | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02528398 | ABROCITINIB | CIBINQO 200 MG ORAL TABLET |
54.4667 TAB |
PFI | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02528363 | ABROCITINIB | CIBINQO 50 MG ORAL TABLET |
48.6667 TAB |
PFI | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02468840 | ACITRETIN | MINT-ACITRETIN 10 MG ORAL CAPSULE |
1.2965 CAP |
MPI | 1.2965 | N/A | YES | REGULAR BENEFIT | |
02070847 | ACITRETIN | SORIATANE 10 MG ORAL CAPSULE |
2.5805 CAP |
ALR | 1.2965 | N/A | YES | REGULAR BENEFIT | |
02466074 | ACITRETIN | TARO-ACITRETIN 10 MG ORAL CAPSULE |
1.2965 CAP |
TAR | 1.2965 | N/A | YES | REGULAR BENEFIT | |
02468859 | ACITRETIN | MINT-ACITRETIN 25 MG ORAL CAPSULE |
2.2770 CAP |
MPI | 2.2770 | N/A | YES | REGULAR BENEFIT | |
02070863 | ACITRETIN | SORIATANE 25 MG ORAL CAPSULE |
4.5314 CAP |
ALR | 2.2770 | N/A | YES | REGULAR BENEFIT | |
02466082 | ACITRETIN | TARO-ACITRETIN 25 MG ORAL CAPSULE |
2.2770 CAP |
TAR | 2.2770 | N/A | YES | REGULAR BENEFIT | |
02337649 | ALITRETINOIN | TOCTINO 30 MG ORAL CAPSULE |
N/A CAP |
GST | N/A | N/A | NO | NOT A BENEFIT | |
02270811 | AZELAIC ACID | FINACEA 15 % TOPICAL GEL |
0.6680 G |
LEO | N/A | N/A | NO | REGULAR BENEFIT | |
02525275 | BIMEKIZUMAB | BIMZELX (AUTO-INJECTOR) 160 MG / SYR INJECTION SYRINGE |
1,625.0000 SYR |
UCB | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02525267 | BIMEKIZUMAB | BIMZELX 160 MG / SYR INJECTION SYRINGE |
1,625.0000 SYR |
UCB | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02473623 | BRODALUMAB | SILIQ (1.5 ML PREFILLED SYRINGE) 210 MG / SYR INJECTION SYRINGE |
N/A SYR |
VCL | N/A | N/A | NO | NOT A BENEFIT | |
01976133 | CALCIPOTRIOL | DOVONEX 50 MCG / G TOPICAL OINTMENT |
0.8550 G |
LEO | N/A | N/A | NO | REGULAR BENEFIT | |
02319012 | CALCIPOTRIOL MONOHYDRATE/ BETAMETHASONE DIPROPIONATE | DOVOBET 50 MCG / G * 0.5 MG / G TOPICAL GEL |
1.6539 G |
LEO | 0.0000 | 0.0000 | YES | REGULAR BENEFIT | |
02457393 | CALCIPOTRIOL MONOHYDRATE/ BETAMETHASONE DIPROPIONATE | ENSTILAR 50 MCG / G * 0.5 MG / G TOPICAL FOAM |
1.6323 G |
LEO | N/A | N/A | NO | REGULAR BENEFIT | |
02525178 | CALCIPOTRIOL MONOHYDRATE/ BETAMETHASONE DIPROPIONATE | TARO-CALCIPOTRIOL / BETAMETHASONE GEL 50 MCG / G * 0.5 MG / G TOPICAL GEL |
1.3142 G |
TAR | 0.0000 | 0.0000 | YES | REGULAR BENEFIT | |
02338572 | CALCITRIOL | SILKIS 3 MCG / G TOPICAL OINTMENT |
N/A G |
GAL | N/A | N/A | NO | NOT A BENEFIT | |
02063670 | COLLAGENASE | SANTYL 250 UNIT / G TOPICAL OINTMENT |
3.2480 G |
SNE | N/A | N/A | NO | REGULAR BENEFIT | |
02524252 | DUPILUMAB | DUPIXENT (PEN) 200 MG / SYR INJECTION SYRINGE |
978.7000 SYR |
SAV | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02492504 | DUPILUMAB | DUPIXENT 200 MG / SYR INJECTION |
978.7000 SYR |
SAV | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02510049 | DUPILUMAB | DUPIXENT (PEN) 300 MG / SYR INJECTION SYRINGE |
978.7000 SYR |
SAV | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02470365 | DUPILUMAB | DUPIXENT 300 MG / SYR INJECTION |
978.7000 SYR |
SAV | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02469758 | GUSELKUMAB | TREMFYA 100 MG / SYR INJECTION SYRINGE |
3,059.7400 SYR |
JAI | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02487314 | GUSELKUMAB | TREMFYA ONE-PRESS 100 MG / SYR INJECTION SYRINGE |
3,059.7400 SYR |
JAI | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02239505 | IMIQUIMOD | ALDARA P 50 MG/G / G TOPICAL CREAM |
57.7455 G |
VCL | 43.4350 | N/A | YES | SPECIAL AUTHORIZATION | |
02482983 | IMIQUIMOD | TARO-IMIQUIMOD PUMP 50 MG/G / G TOPICAL CREAM |
43.4350 G |
TAR | 43.4350 | N/A | YES | SPECIAL AUTHORIZATION | |
00582344 | ISOTRETINOIN | ACCUTANE 10 MG ORAL CAPSULE |
0.9547 CAP |
HLR | 0.9313 | N/A | YES | REGULAR BENEFIT | |
02257955 | ISOTRETINOIN | CLARUS 10 MG ORAL CAPSULE |
0.9313 CAP |
MYP | 0.9313 | N/A | YES | REGULAR BENEFIT | |
02396971 | ISOTRETINOIN | EPURIS 10 MG ORAL CAPSULE |
N/A CAP |
CIP | N/A | N/A | YES | NOT A BENEFIT | |
02539055 | ISOTRETINOIN | ABSORICA LD 16 MG ORAL CAPSULE |
N/A CAP |
SPF | N/A | N/A | NO | NOT A BENEFIT | |
02396998 | ISOTRETINOIN | EPURIS 20 MG ORAL CAPSULE |
N/A CAP |
CIP | N/A | N/A | NO | NOT A BENEFIT | |
02539063 | ISOTRETINOIN | ABSORICA LD 24 MG ORAL CAPSULE |
N/A CAP |
SPF | N/A | N/A | NO | NOT A BENEFIT | |
02397005 | ISOTRETINOIN | EPURIS 30 MG ORAL CAPSULE |
N/A CAP |
CIP | N/A | N/A | NO | NOT A BENEFIT | |
02539071 | ISOTRETINOIN | ABSORICA LD 32 MG ORAL CAPSULE |
N/A CAP |
SPF | N/A | N/A | NO | NOT A BENEFIT | |
00582352 | ISOTRETINOIN | ACCUTANE 40 MG ORAL CAPSULE |
1.9480 CAP |
HLR | 1.9003 | N/A | YES | REGULAR BENEFIT | |
02257963 | ISOTRETINOIN | CLARUS 40 MG ORAL CAPSULE |
1.9003 CAP |
MYP | 1.9003 | N/A | YES | REGULAR BENEFIT | |
02397013 | ISOTRETINOIN | EPURIS 40 MG ORAL CAPSULE |
N/A CAP |
CIP | N/A | N/A | YES | NOT A BENEFIT | |
02539047 | ISOTRETINOIN | ABSORICA LD 8 MG ORAL CAPSULE |
N/A CAP |
SPF | N/A | N/A | NO | NOT A BENEFIT | |
02455110 | IXEKIZUMAB | TALTZ 80 MG / SYR INJECTION SYRINGE |
1,769.2800 SYR |
LIL | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02455102 | IXEKIZUMAB | TALTZ AUTOINJECTOR 80 MG / SYR INJECTION SYRINGE |
1,769.2800 SYR |
LIL | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02323273 | METHYL AMINOLEVULINATE HYDROCHLORIDE | METVIX 16.8 % TOPICAL CREAM |
N/A G |
GAL | N/A | N/A | NO | NOT A BENEFIT | |
02247238 | PIMECROLIMUS | ELIDEL 1 % TOPICAL CREAM |
N/A G |
VCL | N/A | N/A | NO | NOT A BENEFIT | |
02519291 | RISANKIZUMAB | SKYRIZI (PEN) 150 MG / SYR INJECTION SYRINGE |
4,935.0000 SYR |
ABV | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02519283 | RISANKIZUMAB | SKYRIZI 150 MG / SYR INJECTION SYRINGE |
4,935.0000 SYR |
ABV | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02532093 | RISANKIZUMAB | SKYRIZI 360 MG INJECTION CARTRIDGE |
4,593.1400 CTG |
ABV | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02532107 | RISANKIZUMAB | SKYRIZI 600 MG / VIAL INJECTION |
4,593.1400 VIAL |
ABV | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02438070 | SECUKINUMAB | COSENTYX 150 MG / SYR INJECTION SYRINGE |
906.6200 SYR |
NOV | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02244149 | TACROLIMUS | PROTOPIC 0.03 % TOPICAL OINTMENT |
2.4657 G |
LEO | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02244148 | TACROLIMUS | PROTOPIC 0.1 % TOPICAL OINTMENT |
2.6177 G |
LEO | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02517868 | TAZAROTENE | ARAZLO 0.045 % TOPICAL LOTION |
1.4051 G |
VCL | N/A | N/A | NO | REGULAR BENEFIT | |
02516098 | TILDRAKIZUMAB | ILUMYA 100 MG / SYR INJECTION SYRINGE |
4,935.0000 SYR |
SPF | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02543036 | USTEKINUMAB | JAMTEKI (0.5 ML SYRINGE) 45 MG / SYR INJECTION SYRINGE |
N/A SYR |
JPC | N/A | N/A | NO | UNDER REVIEW | |
02543044 | USTEKINUMAB | JAMTEKI (1 ML SYRINGE) 90 MG / SYR INJECTION SYRINGE |
N/A SYR |
JPC | N/A | N/A | NO | UNDER REVIEW |
DIN/NPN/ PIN | 00330582 |
Generic Name | 5-FLUOROURACIL |
Product Name, Strength & Dosage Form | EFUDEX 50 MG / G TOPICAL CREAM |
Unit Price, Unit of Issue | 1.0040 |
Manufacturer | VCL |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02528371 |
Generic Name | ABROCITINIB |
Product Name, Strength & Dosage Form | CIBINQO 100 MG ORAL TABLET |
Unit Price, Unit of Issue | 48.6667 |
Manufacturer | PFI |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02528398 |
Generic Name | ABROCITINIB |
Product Name, Strength & Dosage Form | CIBINQO 200 MG ORAL TABLET |
Unit Price, Unit of Issue | 54.4667 |
Manufacturer | PFI |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02528363 |
Generic Name | ABROCITINIB |
Product Name, Strength & Dosage Form | CIBINQO 50 MG ORAL TABLET |
Unit Price, Unit of Issue | 48.6667 |
Manufacturer | PFI |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02468840 |
Generic Name | ACITRETIN |
Product Name, Strength & Dosage Form | MINT-ACITRETIN 10 MG ORAL CAPSULE |
Unit Price, Unit of Issue | 1.2965 |
Manufacturer | MPI |
LCA Price | 1.2965 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02070847 |
Generic Name | ACITRETIN |
Product Name, Strength & Dosage Form | SORIATANE 10 MG ORAL CAPSULE |
Unit Price, Unit of Issue | 2.5805 |
Manufacturer | ALR |
LCA Price | 1.2965 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02466074 |
Generic Name | ACITRETIN |
Product Name, Strength & Dosage Form | TARO-ACITRETIN 10 MG ORAL CAPSULE |
Unit Price, Unit of Issue | 1.2965 |
Manufacturer | TAR |
LCA Price | 1.2965 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02468859 |
Generic Name | ACITRETIN |
Product Name, Strength & Dosage Form | MINT-ACITRETIN 25 MG ORAL CAPSULE |
Unit Price, Unit of Issue | 2.2770 |
Manufacturer | MPI |
LCA Price | 2.2770 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02070863 |
Generic Name | ACITRETIN |
Product Name, Strength & Dosage Form | SORIATANE 25 MG ORAL CAPSULE |
Unit Price, Unit of Issue | 4.5314 |
Manufacturer | ALR |
LCA Price | 2.2770 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02466082 |
Generic Name | ACITRETIN |
Product Name, Strength & Dosage Form | TARO-ACITRETIN 25 MG ORAL CAPSULE |
Unit Price, Unit of Issue | 2.2770 |
Manufacturer | TAR |
LCA Price | 2.2770 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02337649 |
Generic Name | ALITRETINOIN |
Product Name, Strength & Dosage Form | TOCTINO 30 MG ORAL CAPSULE |
Unit Price, Unit of Issue | N/A |
Manufacturer | GST |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02270811 |
Generic Name | AZELAIC ACID |
Product Name, Strength & Dosage Form | FINACEA 15 % TOPICAL GEL |
Unit Price, Unit of Issue | 0.6680 |
Manufacturer | LEO |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02525275 |
Generic Name | BIMEKIZUMAB |
Product Name, Strength & Dosage Form | BIMZELX (AUTO-INJECTOR) 160 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 1,625.0000 |
Manufacturer | UCB |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02525267 |
Generic Name | BIMEKIZUMAB |
Product Name, Strength & Dosage Form | BIMZELX 160 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 1,625.0000 |
Manufacturer | UCB |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02473623 |
Generic Name | BRODALUMAB |
Product Name, Strength & Dosage Form | SILIQ (1.5 ML PREFILLED SYRINGE) 210 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | N/A |
Manufacturer | VCL |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 01976133 |
Generic Name | CALCIPOTRIOL |
Product Name, Strength & Dosage Form | DOVONEX 50 MCG / G TOPICAL OINTMENT |
Unit Price, Unit of Issue | 0.8550 |
Manufacturer | LEO |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02319012 |
Generic Name | CALCIPOTRIOL MONOHYDRATE/ BETAMETHASONE DIPROPIONATE |
Product Name, Strength & Dosage Form | DOVOBET 50 MCG / G * 0.5 MG / G TOPICAL GEL |
Unit Price, Unit of Issue | 1.6539 |
Manufacturer | LEO |
LCA Price | 0.0000 |
MAC Price | 0.0000 |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02457393 |
Generic Name | CALCIPOTRIOL MONOHYDRATE/ BETAMETHASONE DIPROPIONATE |
Product Name, Strength & Dosage Form | ENSTILAR 50 MCG / G * 0.5 MG / G TOPICAL FOAM |
Unit Price, Unit of Issue | 1.6323 |
Manufacturer | LEO |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02525178 |
Generic Name | CALCIPOTRIOL MONOHYDRATE/ BETAMETHASONE DIPROPIONATE |
Product Name, Strength & Dosage Form | TARO-CALCIPOTRIOL / BETAMETHASONE GEL 50 MCG / G * 0.5 MG / G TOPICAL GEL |
Unit Price, Unit of Issue | 1.3142 |
Manufacturer | TAR |
LCA Price | 0.0000 |
MAC Price | 0.0000 |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02338572 |
Generic Name | CALCITRIOL |
Product Name, Strength & Dosage Form | SILKIS 3 MCG / G TOPICAL OINTMENT |
Unit Price, Unit of Issue | N/A |
Manufacturer | GAL |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02063670 |
Generic Name | COLLAGENASE |
Product Name, Strength & Dosage Form | SANTYL 250 UNIT / G TOPICAL OINTMENT |
Unit Price, Unit of Issue | 3.2480 |
Manufacturer | SNE |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02524252 |
Generic Name | DUPILUMAB |
Product Name, Strength & Dosage Form | DUPIXENT (PEN) 200 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 978.7000 |
Manufacturer | SAV |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02492504 |
Generic Name | DUPILUMAB |
Product Name, Strength & Dosage Form | DUPIXENT 200 MG / SYR INJECTION |
Unit Price, Unit of Issue | 978.7000 |
Manufacturer | SAV |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02510049 |
Generic Name | DUPILUMAB |
Product Name, Strength & Dosage Form | DUPIXENT (PEN) 300 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 978.7000 |
Manufacturer | SAV |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02470365 |
Generic Name | DUPILUMAB |
Product Name, Strength & Dosage Form | DUPIXENT 300 MG / SYR INJECTION |
Unit Price, Unit of Issue | 978.7000 |
Manufacturer | SAV |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02469758 |
Generic Name | GUSELKUMAB |
Product Name, Strength & Dosage Form | TREMFYA 100 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 3,059.7400 |
Manufacturer | JAI |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02487314 |
Generic Name | GUSELKUMAB |
Product Name, Strength & Dosage Form | TREMFYA ONE-PRESS 100 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 3,059.7400 |
Manufacturer | JAI |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02239505 |
Generic Name | IMIQUIMOD |
Product Name, Strength & Dosage Form | ALDARA P 50 MG/G / G TOPICAL CREAM |
Unit Price, Unit of Issue | 57.7455 |
Manufacturer | VCL |
LCA Price | 43.4350 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02482983 |
Generic Name | IMIQUIMOD |
Product Name, Strength & Dosage Form | TARO-IMIQUIMOD PUMP 50 MG/G / G TOPICAL CREAM |
Unit Price, Unit of Issue | 43.4350 |
Manufacturer | TAR |
LCA Price | 43.4350 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 00582344 |
Generic Name | ISOTRETINOIN |
Product Name, Strength & Dosage Form | ACCUTANE 10 MG ORAL CAPSULE |
Unit Price, Unit of Issue | 0.9547 |
Manufacturer | HLR |
LCA Price | 0.9313 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02257955 |
Generic Name | ISOTRETINOIN |
Product Name, Strength & Dosage Form | CLARUS 10 MG ORAL CAPSULE |
Unit Price, Unit of Issue | 0.9313 |
Manufacturer | MYP |
LCA Price | 0.9313 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02396971 |
Generic Name | ISOTRETINOIN |
Product Name, Strength & Dosage Form | EPURIS 10 MG ORAL CAPSULE |
Unit Price, Unit of Issue | N/A |
Manufacturer | CIP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02539055 |
Generic Name | ISOTRETINOIN |
Product Name, Strength & Dosage Form | ABSORICA LD 16 MG ORAL CAPSULE |
Unit Price, Unit of Issue | N/A |
Manufacturer | SPF |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02396998 |
Generic Name | ISOTRETINOIN |
Product Name, Strength & Dosage Form | EPURIS 20 MG ORAL CAPSULE |
Unit Price, Unit of Issue | N/A |
Manufacturer | CIP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02539063 |
Generic Name | ISOTRETINOIN |
Product Name, Strength & Dosage Form | ABSORICA LD 24 MG ORAL CAPSULE |
Unit Price, Unit of Issue | N/A |
Manufacturer | SPF |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02397005 |
Generic Name | ISOTRETINOIN |
Product Name, Strength & Dosage Form | EPURIS 30 MG ORAL CAPSULE |
Unit Price, Unit of Issue | N/A |
Manufacturer | CIP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02539071 |
Generic Name | ISOTRETINOIN |
Product Name, Strength & Dosage Form | ABSORICA LD 32 MG ORAL CAPSULE |
Unit Price, Unit of Issue | N/A |
Manufacturer | SPF |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 00582352 |
Generic Name | ISOTRETINOIN |
Product Name, Strength & Dosage Form | ACCUTANE 40 MG ORAL CAPSULE |
Unit Price, Unit of Issue | 1.9480 |
Manufacturer | HLR |
LCA Price | 1.9003 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02257963 |
Generic Name | ISOTRETINOIN |
Product Name, Strength & Dosage Form | CLARUS 40 MG ORAL CAPSULE |
Unit Price, Unit of Issue | 1.9003 |
Manufacturer | MYP |
LCA Price | 1.9003 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02397013 |
Generic Name | ISOTRETINOIN |
Product Name, Strength & Dosage Form | EPURIS 40 MG ORAL CAPSULE |
Unit Price, Unit of Issue | N/A |
Manufacturer | CIP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02539047 |
Generic Name | ISOTRETINOIN |
Product Name, Strength & Dosage Form | ABSORICA LD 8 MG ORAL CAPSULE |
Unit Price, Unit of Issue | N/A |
Manufacturer | SPF |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02455110 |
Generic Name | IXEKIZUMAB |
Product Name, Strength & Dosage Form | TALTZ 80 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 1,769.2800 |
Manufacturer | LIL |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02455102 |
Generic Name | IXEKIZUMAB |
Product Name, Strength & Dosage Form | TALTZ AUTOINJECTOR 80 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 1,769.2800 |
Manufacturer | LIL |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02323273 |
Generic Name | METHYL AMINOLEVULINATE HYDROCHLORIDE |
Product Name, Strength & Dosage Form | METVIX 16.8 % TOPICAL CREAM |
Unit Price, Unit of Issue | N/A |
Manufacturer | GAL |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02247238 |
Generic Name | PIMECROLIMUS |
Product Name, Strength & Dosage Form | ELIDEL 1 % TOPICAL CREAM |
Unit Price, Unit of Issue | N/A |
Manufacturer | VCL |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02519291 |
Generic Name | RISANKIZUMAB |
Product Name, Strength & Dosage Form | SKYRIZI (PEN) 150 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 4,935.0000 |
Manufacturer | ABV |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02519283 |
Generic Name | RISANKIZUMAB |
Product Name, Strength & Dosage Form | SKYRIZI 150 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 4,935.0000 |
Manufacturer | ABV |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02532093 |
Generic Name | RISANKIZUMAB |
Product Name, Strength & Dosage Form | SKYRIZI 360 MG INJECTION CARTRIDGE |
Unit Price, Unit of Issue | 4,593.1400 |
Manufacturer | ABV |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02532107 |
Generic Name | RISANKIZUMAB |
Product Name, Strength & Dosage Form | SKYRIZI 600 MG / VIAL INJECTION |
Unit Price, Unit of Issue | 4,593.1400 |
Manufacturer | ABV |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02438070 |
Generic Name | SECUKINUMAB |
Product Name, Strength & Dosage Form | COSENTYX 150 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 906.6200 |
Manufacturer | NOV |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02244149 |
Generic Name | TACROLIMUS |
Product Name, Strength & Dosage Form | PROTOPIC 0.03 % TOPICAL OINTMENT |
Unit Price, Unit of Issue | 2.4657 |
Manufacturer | LEO |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02244148 |
Generic Name | TACROLIMUS |
Product Name, Strength & Dosage Form | PROTOPIC 0.1 % TOPICAL OINTMENT |
Unit Price, Unit of Issue | 2.6177 |
Manufacturer | LEO |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02517868 |
Generic Name | TAZAROTENE |
Product Name, Strength & Dosage Form | ARAZLO 0.045 % TOPICAL LOTION |
Unit Price, Unit of Issue | 1.4051 |
Manufacturer | VCL |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02516098 |
Generic Name | TILDRAKIZUMAB |
Product Name, Strength & Dosage Form | ILUMYA 100 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 4,935.0000 |
Manufacturer | SPF |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02543036 |
Generic Name | USTEKINUMAB |
Product Name, Strength & Dosage Form | JAMTEKI (0.5 ML SYRINGE) 45 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | N/A |
Manufacturer | JPC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | UNDER REVIEW |
Details |
DIN/NPN/ PIN | 02543044 |
Generic Name | USTEKINUMAB |
Product Name, Strength & Dosage Form | JAMTEKI (1 ML SYRINGE) 90 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | N/A |
Manufacturer | JPC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | UNDER REVIEW |
Details |