DIN/NPN/ PIN | Generic Name | Product Name, Strength & Dosage Form | Unit Price, Unit of Issue | Manufacturer | LCA Price | MAC Price | Interchangeable Products | Coverage Status | |
---|---|---|---|---|---|---|---|---|---|
02403137 | AMITRIPTYLINE HCL | APO-AMITRIPTYLINE 10 MG ORAL TABLET |
0.0664 TAB |
APX | 0.0664 | N/A | YES | REGULAR BENEFIT | |
00335053 | AMITRIPTYLINE HCL | ELAVIL 10 MG ORAL TABLET |
0.0664 TAB |
AAP | 0.0664 | N/A | YES | REGULAR BENEFIT | |
02429861 | AMITRIPTYLINE HCL | MAR-AMITRIPTYLINE 10 MG ORAL TABLET |
N/A TAB |
MAR | N/A | N/A | YES | NOT A BENEFIT | |
00654523 | AMITRIPTYLINE HCL | PMS-AMITRIPTYLINE 10 MG ORAL TABLET |
N/A TAB |
PMS | N/A | N/A | YES | NOT A BENEFIT | |
02468409 | AMITRIPTYLINE HCL | PMS-AMITRIPTYLINE 100 MG ORAL TABLET |
N/A TAB |
PMS | N/A | N/A | NO | UNDER REVIEW | |
02403145 | AMITRIPTYLINE HCL | APO-AMITRIPTYLINE 25 MG ORAL TABLET |
0.1211 TAB |
APX | 0.1211 | N/A | YES | REGULAR BENEFIT | |
00335061 | AMITRIPTYLINE HCL | ELAVIL 25 MG ORAL TABLET |
0.1211 TAB |
AAP | 0.1211 | N/A | YES | REGULAR BENEFIT | |
02429888 | AMITRIPTYLINE HCL | MAR-AMITRIPTYLINE 25 MG ORAL TABLET |
N/A TAB |
MAR | N/A | N/A | YES | NOT A BENEFIT | |
00654515 | AMITRIPTYLINE HCL | PMS-AMITRIPTYLINE 25 MG ORAL TABLET |
N/A TAB |
PMS | N/A | N/A | YES | NOT A BENEFIT | |
02326051 | AMITRIPTYLINE HCL | TEVA-AMITRIPTYLINE 25 MG ORAL TABLET |
N/A TAB |
TEV | N/A | N/A | YES | NOT A BENEFIT | |
02403153 | AMITRIPTYLINE HCL | APO-AMITRIPTYLINE 50 MG ORAL TABLET |
0.2347 TAB |
APX | 0.2347 | N/A | YES | REGULAR BENEFIT | |
00335088 | AMITRIPTYLINE HCL | ELAVIL 50 MG ORAL TABLET |
0.2347 TAB |
AAP | 0.2347 | N/A | YES | REGULAR BENEFIT | |
02429896 | AMITRIPTYLINE HCL | MAR-AMITRIPTYLINE 50 MG ORAL TABLET |
N/A TAB |
MAR | N/A | N/A | YES | NOT A BENEFIT | |
00654507 | AMITRIPTYLINE HCL | PMS-AMITRIPTYLINE 50 MG ORAL TABLET |
N/A TAB |
PMS | N/A | N/A | YES | NOT A BENEFIT | |
02326078 | AMITRIPTYLINE HCL | TEVA-AMITRIPTYLINE 50 MG ORAL TABLET |
N/A TAB |
TEV | N/A | N/A | YES | NOT A BENEFIT | |
02403161 | AMITRIPTYLINE HCL | APO-AMITRIPTYLINE 75 MG ORAL TABLET |
0.3634 TAB |
APX | 0.3634 | N/A | YES | REGULAR BENEFIT | |
00754129 | AMITRIPTYLINE HCL | ELAVIL 75 MG ORAL TABLET |
0.3634 TAB |
AAP | 0.3634 | N/A | YES | REGULAR BENEFIT | |
02429918 | AMITRIPTYLINE HCL | MAR-AMITRIPTYLINE 75 MG ORAL TABLET |
N/A TAB |
MAR | N/A | N/A | YES | NOT A BENEFIT | |
00330566 | CLOMIPRAMINE HCL | ANAFRANIL 10 MG ORAL TABLET |
0.3191 TAB |
APX | N/A | N/A | NO | REGULAR BENEFIT | |
00324019 | CLOMIPRAMINE HCL | ANAFRANIL 25 MG ORAL TABLET |
0.4349 TAB |
APX | N/A | N/A | NO | REGULAR BENEFIT | |
02497506 | CLOMIPRAMINE HCL | TARO-CLOMIPRAMINE 25 MG ORAL CAPSULE |
0.3417 CAP |
TAR | N/A | N/A | NO | REGULAR BENEFIT | |
00402591 | CLOMIPRAMINE HCL | ANAFRANIL 50 MG ORAL TABLET |
0.8008 TAB |
APX | N/A | N/A | NO | REGULAR BENEFIT | |
02497514 | CLOMIPRAMINE HCL | TARO-CLOMIPRAMINE 50 MG ORAL CAPSULE |
0.6291 CAP |
TAR | N/A | N/A | NO | REGULAR BENEFIT | |
02216248 | DESIPRAMINE HCL | DESIPRAMINE 10 MG ORAL TABLET |
0.4852 TAB |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
02216256 | DESIPRAMINE HCL | DESIPRAMINE 25 MG ORAL TABLET |
0.4852 TAB |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
02216264 | DESIPRAMINE HCL | DESIPRAMINE 50 MG ORAL TABLET |
0.8553 TAB |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
02216272 | DESIPRAMINE HCL | DESIPRAMINE 75 MG ORAL TABLET |
1.1373 TAB |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
00360201 | IMIPRAMINE HCL | IMIPRAMINE 10 MG ORAL TABLET |
0.1747 TAB |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
00312797 | IMIPRAMINE HCL | IMIPRAMINE 25 MG ORAL TABLET |
0.3152 TAB |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
00326852 | IMIPRAMINE HCL | IMIPRAMINE 50 MG ORAL TABLET |
0.6152 TAB |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
00644579 | IMIPRAMINE HCL | IMIPRAMINE 75 MG ORAL TABLET |
0.8048 TAB |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
00015229 | NORTRIPTYLINE HCL | AVENTYL 10 MG ORAL CAPSULE |
0.3148 CAP |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
00015237 | NORTRIPTYLINE HCL | AVENTYL 25 MG ORAL CAPSULE |
0.6363 CAP |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
00740829 | TRIMIPRAMINE MALEATE | TRIMIPRAMINE 100 MG ORAL TABLET |
1.1830 TAB |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
00740799 | TRIMIPRAMINE MALEATE | TRIMIPRAMINE 12.5 MG ORAL TABLET |
0.2749 TAB |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
00740802 | TRIMIPRAMINE MALEATE | TRIMIPRAMINE 25 MG ORAL TABLET |
0.3542 TAB |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
00740810 | TRIMIPRAMINE MALEATE | TRIMIPRAMINE 50 MG ORAL TABLET |
0.6932 TAB |
AAP | N/A | N/A | NO | REGULAR BENEFIT | |
02070987 | TRIMIPRAMINE MALEATE | TRIMIPRAMINE 75 MG ORAL CAPSULE |
0.9332 CAP |
AAP | N/A | N/A | NO | REGULAR BENEFIT |
DIN/NPN/ PIN | 02403137 |
Generic Name | AMITRIPTYLINE HCL |
Product Name, Strength & Dosage Form | APO-AMITRIPTYLINE 10 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.0664 |
Manufacturer | APX |
LCA Price | 0.0664 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00335053 |
Generic Name | AMITRIPTYLINE HCL |
Product Name, Strength & Dosage Form | ELAVIL 10 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.0664 |
Manufacturer | AAP |
LCA Price | 0.0664 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02429861 |
Generic Name | AMITRIPTYLINE HCL |
Product Name, Strength & Dosage Form | MAR-AMITRIPTYLINE 10 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | MAR |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 00654523 |
Generic Name | AMITRIPTYLINE HCL |
Product Name, Strength & Dosage Form | PMS-AMITRIPTYLINE 10 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | PMS |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02468409 |
Generic Name | AMITRIPTYLINE HCL |
Product Name, Strength & Dosage Form | PMS-AMITRIPTYLINE 100 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | PMS |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | UNDER REVIEW |
Details |
DIN/NPN/ PIN | 02403145 |
Generic Name | AMITRIPTYLINE HCL |
Product Name, Strength & Dosage Form | APO-AMITRIPTYLINE 25 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.1211 |
Manufacturer | APX |
LCA Price | 0.1211 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00335061 |
Generic Name | AMITRIPTYLINE HCL |
Product Name, Strength & Dosage Form | ELAVIL 25 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.1211 |
Manufacturer | AAP |
LCA Price | 0.1211 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02429888 |
Generic Name | AMITRIPTYLINE HCL |
Product Name, Strength & Dosage Form | MAR-AMITRIPTYLINE 25 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | MAR |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 00654515 |
Generic Name | AMITRIPTYLINE HCL |
Product Name, Strength & Dosage Form | PMS-AMITRIPTYLINE 25 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | PMS |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02326051 |
Generic Name | AMITRIPTYLINE HCL |
Product Name, Strength & Dosage Form | TEVA-AMITRIPTYLINE 25 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | TEV |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02403153 |
Generic Name | AMITRIPTYLINE HCL |
Product Name, Strength & Dosage Form | APO-AMITRIPTYLINE 50 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.2347 |
Manufacturer | APX |
LCA Price | 0.2347 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00335088 |
Generic Name | AMITRIPTYLINE HCL |
Product Name, Strength & Dosage Form | ELAVIL 50 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.2347 |
Manufacturer | AAP |
LCA Price | 0.2347 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02429896 |
Generic Name | AMITRIPTYLINE HCL |
Product Name, Strength & Dosage Form | MAR-AMITRIPTYLINE 50 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | MAR |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 00654507 |
Generic Name | AMITRIPTYLINE HCL |
Product Name, Strength & Dosage Form | PMS-AMITRIPTYLINE 50 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | PMS |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02326078 |
Generic Name | AMITRIPTYLINE HCL |
Product Name, Strength & Dosage Form | TEVA-AMITRIPTYLINE 50 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | TEV |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02403161 |
Generic Name | AMITRIPTYLINE HCL |
Product Name, Strength & Dosage Form | APO-AMITRIPTYLINE 75 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.3634 |
Manufacturer | APX |
LCA Price | 0.3634 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00754129 |
Generic Name | AMITRIPTYLINE HCL |
Product Name, Strength & Dosage Form | ELAVIL 75 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.3634 |
Manufacturer | AAP |
LCA Price | 0.3634 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02429918 |
Generic Name | AMITRIPTYLINE HCL |
Product Name, Strength & Dosage Form | MAR-AMITRIPTYLINE 75 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | MAR |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 00330566 |
Generic Name | CLOMIPRAMINE HCL |
Product Name, Strength & Dosage Form | ANAFRANIL 10 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.3191 |
Manufacturer | APX |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00324019 |
Generic Name | CLOMIPRAMINE HCL |
Product Name, Strength & Dosage Form | ANAFRANIL 25 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.4349 |
Manufacturer | APX |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02497506 |
Generic Name | CLOMIPRAMINE HCL |
Product Name, Strength & Dosage Form | TARO-CLOMIPRAMINE 25 MG ORAL CAPSULE |
Unit Price, Unit of Issue | 0.3417 |
Manufacturer | TAR |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00402591 |
Generic Name | CLOMIPRAMINE HCL |
Product Name, Strength & Dosage Form | ANAFRANIL 50 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8008 |
Manufacturer | APX |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02497514 |
Generic Name | CLOMIPRAMINE HCL |
Product Name, Strength & Dosage Form | TARO-CLOMIPRAMINE 50 MG ORAL CAPSULE |
Unit Price, Unit of Issue | 0.6291 |
Manufacturer | TAR |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02216248 |
Generic Name | DESIPRAMINE HCL |
Product Name, Strength & Dosage Form | DESIPRAMINE 10 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.4852 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02216256 |
Generic Name | DESIPRAMINE HCL |
Product Name, Strength & Dosage Form | DESIPRAMINE 25 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.4852 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02216264 |
Generic Name | DESIPRAMINE HCL |
Product Name, Strength & Dosage Form | DESIPRAMINE 50 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8553 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02216272 |
Generic Name | DESIPRAMINE HCL |
Product Name, Strength & Dosage Form | DESIPRAMINE 75 MG ORAL TABLET |
Unit Price, Unit of Issue | 1.1373 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00360201 |
Generic Name | IMIPRAMINE HCL |
Product Name, Strength & Dosage Form | IMIPRAMINE 10 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.1747 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00312797 |
Generic Name | IMIPRAMINE HCL |
Product Name, Strength & Dosage Form | IMIPRAMINE 25 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.3152 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00326852 |
Generic Name | IMIPRAMINE HCL |
Product Name, Strength & Dosage Form | IMIPRAMINE 50 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.6152 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00644579 |
Generic Name | IMIPRAMINE HCL |
Product Name, Strength & Dosage Form | IMIPRAMINE 75 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8048 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00015229 |
Generic Name | NORTRIPTYLINE HCL |
Product Name, Strength & Dosage Form | AVENTYL 10 MG ORAL CAPSULE |
Unit Price, Unit of Issue | 0.3148 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00015237 |
Generic Name | NORTRIPTYLINE HCL |
Product Name, Strength & Dosage Form | AVENTYL 25 MG ORAL CAPSULE |
Unit Price, Unit of Issue | 0.6363 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00740829 |
Generic Name | TRIMIPRAMINE MALEATE |
Product Name, Strength & Dosage Form | TRIMIPRAMINE 100 MG ORAL TABLET |
Unit Price, Unit of Issue | 1.1830 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00740799 |
Generic Name | TRIMIPRAMINE MALEATE |
Product Name, Strength & Dosage Form | TRIMIPRAMINE 12.5 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.2749 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00740802 |
Generic Name | TRIMIPRAMINE MALEATE |
Product Name, Strength & Dosage Form | TRIMIPRAMINE 25 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.3542 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00740810 |
Generic Name | TRIMIPRAMINE MALEATE |
Product Name, Strength & Dosage Form | TRIMIPRAMINE 50 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.6932 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02070987 |
Generic Name | TRIMIPRAMINE MALEATE |
Product Name, Strength & Dosage Form | TRIMIPRAMINE 75 MG ORAL CAPSULE |
Unit Price, Unit of Issue | 0.9332 |
Manufacturer | AAP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |