DIN/NPN/ PIN | Generic Name | Product Name, Strength & Dosage Form | Unit Price, Unit of Issue | Manufacturer | LCA Price | MAC Price | Interchangeable Products | Coverage Status | |
---|---|---|---|---|---|---|---|---|---|
02409720 | ACLIDINIUM BROMIDE | TUDORZA GENUAIR 400 MCG / DOSE INHALATION METERED INHALATION POWDER |
0.9151 DOSE |
COV | N/A | N/A | NO | REGULAR BENEFIT | |
02439530 | ACLIDINIUM BROMIDE/ FORMOTEROL FUMARATE DIHYDRATE | DUAKLIR GENUAIR 400 MCG / DOSE * 12 MCG / DOSE INHALATION METERED INHALATION POWDER |
1.0454 DOSE |
COV | N/A | N/A | NO | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02432188 | ATROPINE SULFATE | ATROPINE INJECTION BP 0.4 MG / ML INJECTION |
N/A ML |
TGT | N/A | N/A | NO | UNDER REVIEW | |
00392782 | ATROPINE SULFATE | ATROPINE SULFATE 0.4 MG / ML INJECTION |
2.2880 ML |
SDZ | N/A | N/A | NO | REGULAR BENEFIT | |
02432196 | ATROPINE SULFATE | ATROPINE INJECTION BP 0.6 MG / ML INJECTION |
N/A ML |
TGT | N/A | N/A | NO | UNDER REVIEW | |
00392693 | ATROPINE SULFATE | ATROPINE SULFATE 0.6 MG / ML INJECTION |
2.4880 ML |
SDZ | N/A | N/A | NO | REGULAR BENEFIT | |
02391619 | DICYCLOMINE HCL | JAMP-DICYCLOMINE HCL 10 MG ORAL TABLET |
N/A TAB |
JPC | N/A | N/A | NO | NOT A BENEFIT | |
02366088 | DICYCLOMINE HCL | JAMP-DICYCLOMINE HCL 20 MG ORAL TABLET |
N/A TAB |
JPC | N/A | N/A | NO | NOT A BENEFIT | |
02473879 | GLYCOPYRROLATE | GLYCOPYRROLATE (0.2 MG/1 ML) 0.2 MG / ML INJECTION |
2.7825 ML |
STM | 2.7825 | N/A | YES | REGULAR BENEFIT | |
02473895 | GLYCOPYRROLATE | GLYCOPYRROLATE (0.4 MG/2 ML) 0.2 MG / ML INJECTION |
2.7825 ML |
STM | 2.7825 | N/A | YES | REGULAR BENEFIT | |
02473887 | GLYCOPYRROLATE | GLYCOPYRROLATE (4 MG/20 ML) 0.2 MG / ML INJECTION |
2.7825 ML |
STM | 2.7825 | N/A | YES | REGULAR BENEFIT | |
02039508 | GLYCOPYRROLATE | GLYCOPYRROLATE 0.2 MG / ML INJECTION |
2.7825 ML |
SDZ | 2.7825 | N/A | YES | REGULAR BENEFIT | |
02532379 | GLYCOPYRROLATE | GLYCOPYRROLATE 0.2 MG / ML INJECTION |
N/A ML |
JPC | N/A | N/A | YES | UNDER REVIEW | |
02382857 | GLYCOPYRROLATE | GLYCOPYRROLATE 0.2 MG / ML INJECTION |
2.7825 ML |
OMG | 2.7825 | N/A | YES | REGULAR BENEFIT | |
02382849 | GLYCOPYRROLATE | GLYCOPYRROLATE MULTIDOSE 0.2 MG / ML INJECTION |
2.7825 ML |
OMG | 2.7825 | N/A | YES | REGULAR BENEFIT | |
02512335 | HYOSCINE BUTYLBROMIDE | ACCEL-HYOSCINE 10 MG ORAL TABLET |
0.2711 TAB |
ACP | 0.2711 | N/A | YES | REGULAR BENEFIT | |
00363812 | HYOSCINE BUTYLBROMIDE | BUSCOPAN 10 MG ORAL TABLET |
0.3465 TAB |
SAV | 0.2711 | N/A | YES | REGULAR BENEFIT | |
00363839 | HYOSCINE BUTYLBROMIDE | BUSCOPAN 20 MG / ML INJECTION |
4.6360 ML |
SAV | N/A | N/A | NO | REGULAR BENEFIT | |
02501244 | INDACATEROL ACETATE/ GLYCOPYRRONIUM BROMIDE/ MOMETASONE FUROATE | ENERZAIR BREEZHALER 150 MCG * 50 MCG * 160 MCG INHALATION CAPSULE |
3.4273 CAP |
VLP | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02418282 | INDACATEROL MALEATE/ GLYCOPYRRONIUM BROMIDE | ULTIBRO BREEZHALER 110 MCG * 50 MCG INHALATION CAPSULE |
2.5830 CAP |
COV | N/A | N/A | NO | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02239627 | IPRATROPIUM BROMIDE | PMS-IPRATROPIUM 0.03 % NASAL SPRAY |
0.9127 ML |
PMS | N/A | N/A | NO | REGULAR BENEFIT | |
02231135 | IPRATROPIUM BROMIDE | PMS-IPRATROPIUM 125 MCG / ML INHALATION UNIT DOSE SOLUTION |
1.1505 ML |
PMS | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02247686 | IPRATROPIUM BROMIDE | ATROVENT HFA 20 MCG / DOSE INHALATION METERED DOSE AEROSOL |
0.1024 DOSE |
BOE | N/A | N/A | NO | REGULAR BENEFIT | |
02126222 | IPRATROPIUM BROMIDE | AA-IPRAVENT 250 MCG / ML INHALATION SOLUTION |
0.3155 ML |
AAP | 0.3155 | N/A | YES | REGULAR BENEFIT | |
02231244 | IPRATROPIUM BROMIDE | PMS-IPRATROPIUM (1ML) 250 MCG / ML INHALATION UNIT DOSE SOLUTION |
0.6590 ML |
PMS | 0.6590 | N/A | YES | SPECIAL AUTHORIZATION | |
02231245 | IPRATROPIUM BROMIDE | PMS-IPRATROPIUM (2ML) 250 MCG / ML INHALATION UNIT DOSE SOLUTION |
0.6590 ML |
PMS | 0.6590 | N/A | YES | SPECIAL AUTHORIZATION | |
02231136 | IPRATROPIUM BROMIDE | PMS-IPRATROPIUM 250 MCG / ML INHALATION SOLUTION |
0.3155 ML |
PMS | 0.3155 | N/A | YES | REGULAR BENEFIT | |
02216221 | IPRATROPIUM BROMIDE | TEVA-IPRATROPIUM STERINEBS 250 MCG / ML INHALATION UNIT DOSE SOLUTION |
0.6590 ML |
TEV | 0.6590 | N/A | YES | SPECIAL AUTHORIZATION | |
02419106 | IPRATROPIUM BROMIDE/ SALBUTAMOL | COMBIVENT RESPIMAT 20 MCG / DOSE * 100 MCG / DOSE INHALATION SOLUTION |
N/A DOSE |
BOE | N/A | N/A | NO | NOT A BENEFIT | |
02483394 | IPRATROPIUM BROMIDE/ SALBUTAMOL SULFATE | IPRATROPIUM BROMIDE/SALBUTAMOL SULPHATE 0.2 MG / ML * 1 MG / ML INHALATION SOLUTION |
0.3226 ML |
JUN | 0.3226 | N/A | YES | REGULAR BENEFIT | |
02272695 | IPRATROPIUM BROMIDE/ SALBUTAMOL SULFATE | TEVA-COMBO STERINEBS 0.2 MG / ML * 1 MG / ML INHALATION SOLUTION |
0.3226 ML |
TEV | 0.3226 | N/A | YES | REGULAR BENEFIT | |
02537850 | TIOTROPIUM BROMIDE MONOHYDRATE | LUPIN-TIOTROPIUM 18 MCG INHALATION CAPSULE |
N/A CAP |
LPC | N/A | N/A | NO | UNDER REVIEW | |
02246793 | TIOTROPIUM BROMIDE MONOHYDRATE | SPIRIVA 18 MCG INHALATION CAPSULE |
1.3715 CAP |
BOE | N/A | N/A | NO | REGULAR BENEFIT | |
02435381 | TIOTROPIUM BROMIDE MONOHYDRATE | SPIRIVA RESPIMAT 2.5 MCG / DOSE INHALATION SOLUTION |
0.9112 DOSE |
BOE | N/A | N/A | NO | REGULAR BENEFIT | |
02441888 | TIOTROPIUM BROMIDE MONOHYDRATE/ OLODATEROL HYDROCHLORIDE | INSPIOLTO RESPIMAT 2.5 MCG / DOSE * 2.5 MCG / DOSE INHALATION SOLUTION |
1.0692 DOSE |
BOE | N/A | N/A | NO | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02423596 | UMECLIDINIUM BROMIDE | INCRUSE ELLIPTA 62.5 MCG / DOSE INHALATION METERED INHALATION POWDER |
1.6667 DOSE |
GSK | N/A | N/A | NO | REGULAR BENEFIT | |
02418401 | UMECLIDINIUM BROMIDE/ VILANTEROL TRIFENATATE | ANORO ELLIPTA 62.5 MCG / DOSE * 25 MCG / DOSE INHALATION METERED INHALATION POWDER |
2.9503 DOSE |
GSK | N/A | N/A | NO | STEP THERAPY/ SPECIAL AUTHORIZATION |
DIN/NPN/ PIN | 02409720 |
Generic Name | ACLIDINIUM BROMIDE |
Product Name, Strength & Dosage Form | TUDORZA GENUAIR 400 MCG / DOSE INHALATION METERED INHALATION POWDER |
Unit Price, Unit of Issue | 0.9151 |
Manufacturer | COV |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02439530 |
Generic Name | ACLIDINIUM BROMIDE/ FORMOTEROL FUMARATE DIHYDRATE |
Product Name, Strength & Dosage Form | DUAKLIR GENUAIR 400 MCG / DOSE * 12 MCG / DOSE INHALATION METERED INHALATION POWDER |
Unit Price, Unit of Issue | 1.0454 |
Manufacturer | COV |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02432188 |
Generic Name | ATROPINE SULFATE |
Product Name, Strength & Dosage Form | ATROPINE INJECTION BP 0.4 MG / ML INJECTION |
Unit Price, Unit of Issue | N/A |
Manufacturer | TGT |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | UNDER REVIEW |
Details |
DIN/NPN/ PIN | 00392782 |
Generic Name | ATROPINE SULFATE |
Product Name, Strength & Dosage Form | ATROPINE SULFATE 0.4 MG / ML INJECTION |
Unit Price, Unit of Issue | 2.2880 |
Manufacturer | SDZ |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02432196 |
Generic Name | ATROPINE SULFATE |
Product Name, Strength & Dosage Form | ATROPINE INJECTION BP 0.6 MG / ML INJECTION |
Unit Price, Unit of Issue | N/A |
Manufacturer | TGT |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | UNDER REVIEW |
Details |
DIN/NPN/ PIN | 00392693 |
Generic Name | ATROPINE SULFATE |
Product Name, Strength & Dosage Form | ATROPINE SULFATE 0.6 MG / ML INJECTION |
Unit Price, Unit of Issue | 2.4880 |
Manufacturer | SDZ |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02391619 |
Generic Name | DICYCLOMINE HCL |
Product Name, Strength & Dosage Form | JAMP-DICYCLOMINE HCL 10 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | JPC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02366088 |
Generic Name | DICYCLOMINE HCL |
Product Name, Strength & Dosage Form | JAMP-DICYCLOMINE HCL 20 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | JPC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02473879 |
Generic Name | GLYCOPYRROLATE |
Product Name, Strength & Dosage Form | GLYCOPYRROLATE (0.2 MG/1 ML) 0.2 MG / ML INJECTION |
Unit Price, Unit of Issue | 2.7825 |
Manufacturer | STM |
LCA Price | 2.7825 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02473895 |
Generic Name | GLYCOPYRROLATE |
Product Name, Strength & Dosage Form | GLYCOPYRROLATE (0.4 MG/2 ML) 0.2 MG / ML INJECTION |
Unit Price, Unit of Issue | 2.7825 |
Manufacturer | STM |
LCA Price | 2.7825 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02473887 |
Generic Name | GLYCOPYRROLATE |
Product Name, Strength & Dosage Form | GLYCOPYRROLATE (4 MG/20 ML) 0.2 MG / ML INJECTION |
Unit Price, Unit of Issue | 2.7825 |
Manufacturer | STM |
LCA Price | 2.7825 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02039508 |
Generic Name | GLYCOPYRROLATE |
Product Name, Strength & Dosage Form | GLYCOPYRROLATE 0.2 MG / ML INJECTION |
Unit Price, Unit of Issue | 2.7825 |
Manufacturer | SDZ |
LCA Price | 2.7825 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02532379 |
Generic Name | GLYCOPYRROLATE |
Product Name, Strength & Dosage Form | GLYCOPYRROLATE 0.2 MG / ML INJECTION |
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 | 02382857 |
Generic Name | GLYCOPYRROLATE |
Product Name, Strength & Dosage Form | GLYCOPYRROLATE 0.2 MG / ML INJECTION |
Unit Price, Unit of Issue | 2.7825 |
Manufacturer | OMG |
LCA Price | 2.7825 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02382849 |
Generic Name | GLYCOPYRROLATE |
Product Name, Strength & Dosage Form | GLYCOPYRROLATE MULTIDOSE 0.2 MG / ML INJECTION |
Unit Price, Unit of Issue | 2.7825 |
Manufacturer | OMG |
LCA Price | 2.7825 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02512335 |
Generic Name | HYOSCINE BUTYLBROMIDE |
Product Name, Strength & Dosage Form | ACCEL-HYOSCINE 10 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.2711 |
Manufacturer | ACP |
LCA Price | 0.2711 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00363812 |
Generic Name | HYOSCINE BUTYLBROMIDE |
Product Name, Strength & Dosage Form | BUSCOPAN 10 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.3465 |
Manufacturer | SAV |
LCA Price | 0.2711 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00363839 |
Generic Name | HYOSCINE BUTYLBROMIDE |
Product Name, Strength & Dosage Form | BUSCOPAN 20 MG / ML INJECTION |
Unit Price, Unit of Issue | 4.6360 |
Manufacturer | SAV |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02501244 |
Generic Name | INDACATEROL ACETATE/ GLYCOPYRRONIUM BROMIDE/ MOMETASONE FUROATE |
Product Name, Strength & Dosage Form | ENERZAIR BREEZHALER 150 MCG * 50 MCG * 160 MCG INHALATION CAPSULE |
Unit Price, Unit of Issue | 3.4273 |
Manufacturer | VLP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02418282 |
Generic Name | INDACATEROL MALEATE/ GLYCOPYRRONIUM BROMIDE |
Product Name, Strength & Dosage Form | ULTIBRO BREEZHALER 110 MCG * 50 MCG INHALATION CAPSULE |
Unit Price, Unit of Issue | 2.5830 |
Manufacturer | COV |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02239627 |
Generic Name | IPRATROPIUM BROMIDE |
Product Name, Strength & Dosage Form | PMS-IPRATROPIUM 0.03 % NASAL SPRAY |
Unit Price, Unit of Issue | 0.9127 |
Manufacturer | PMS |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02231135 |
Generic Name | IPRATROPIUM BROMIDE |
Product Name, Strength & Dosage Form | PMS-IPRATROPIUM 125 MCG / ML INHALATION UNIT DOSE SOLUTION |
Unit Price, Unit of Issue | 1.1505 |
Manufacturer | PMS |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02247686 |
Generic Name | IPRATROPIUM BROMIDE |
Product Name, Strength & Dosage Form | ATROVENT HFA 20 MCG / DOSE INHALATION METERED DOSE AEROSOL |
Unit Price, Unit of Issue | 0.1024 |
Manufacturer | BOE |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02126222 |
Generic Name | IPRATROPIUM BROMIDE |
Product Name, Strength & Dosage Form | AA-IPRAVENT 250 MCG / ML INHALATION SOLUTION |
Unit Price, Unit of Issue | 0.3155 |
Manufacturer | AAP |
LCA Price | 0.3155 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02231244 |
Generic Name | IPRATROPIUM BROMIDE |
Product Name, Strength & Dosage Form | PMS-IPRATROPIUM (1ML) 250 MCG / ML INHALATION UNIT DOSE SOLUTION |
Unit Price, Unit of Issue | 0.6590 |
Manufacturer | PMS |
LCA Price | 0.6590 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02231245 |
Generic Name | IPRATROPIUM BROMIDE |
Product Name, Strength & Dosage Form | PMS-IPRATROPIUM (2ML) 250 MCG / ML INHALATION UNIT DOSE SOLUTION |
Unit Price, Unit of Issue | 0.6590 |
Manufacturer | PMS |
LCA Price | 0.6590 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02231136 |
Generic Name | IPRATROPIUM BROMIDE |
Product Name, Strength & Dosage Form | PMS-IPRATROPIUM 250 MCG / ML INHALATION SOLUTION |
Unit Price, Unit of Issue | 0.3155 |
Manufacturer | PMS |
LCA Price | 0.3155 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02216221 |
Generic Name | IPRATROPIUM BROMIDE |
Product Name, Strength & Dosage Form | TEVA-IPRATROPIUM STERINEBS 250 MCG / ML INHALATION UNIT DOSE SOLUTION |
Unit Price, Unit of Issue | 0.6590 |
Manufacturer | TEV |
LCA Price | 0.6590 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02419106 |
Generic Name | IPRATROPIUM BROMIDE/ SALBUTAMOL |
Product Name, Strength & Dosage Form | COMBIVENT RESPIMAT 20 MCG / DOSE * 100 MCG / DOSE INHALATION SOLUTION |
Unit Price, Unit of Issue | N/A |
Manufacturer | BOE |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02483394 |
Generic Name | IPRATROPIUM BROMIDE/ SALBUTAMOL SULFATE |
Product Name, Strength & Dosage Form | IPRATROPIUM BROMIDE/SALBUTAMOL SULPHATE 0.2 MG / ML * 1 MG / ML INHALATION SOLUTION |
Unit Price, Unit of Issue | 0.3226 |
Manufacturer | JUN |
LCA Price | 0.3226 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02272695 |
Generic Name | IPRATROPIUM BROMIDE/ SALBUTAMOL SULFATE |
Product Name, Strength & Dosage Form | TEVA-COMBO STERINEBS 0.2 MG / ML * 1 MG / ML INHALATION SOLUTION |
Unit Price, Unit of Issue | 0.3226 |
Manufacturer | TEV |
LCA Price | 0.3226 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02537850 |
Generic Name | TIOTROPIUM BROMIDE MONOHYDRATE |
Product Name, Strength & Dosage Form | LUPIN-TIOTROPIUM 18 MCG INHALATION CAPSULE |
Unit Price, Unit of Issue | N/A |
Manufacturer | LPC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | UNDER REVIEW |
Details |
DIN/NPN/ PIN | 02246793 |
Generic Name | TIOTROPIUM BROMIDE MONOHYDRATE |
Product Name, Strength & Dosage Form | SPIRIVA 18 MCG INHALATION CAPSULE |
Unit Price, Unit of Issue | 1.3715 |
Manufacturer | BOE |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02435381 |
Generic Name | TIOTROPIUM BROMIDE MONOHYDRATE |
Product Name, Strength & Dosage Form | SPIRIVA RESPIMAT 2.5 MCG / DOSE INHALATION SOLUTION |
Unit Price, Unit of Issue | 0.9112 |
Manufacturer | BOE |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02441888 |
Generic Name | TIOTROPIUM BROMIDE MONOHYDRATE/ OLODATEROL HYDROCHLORIDE |
Product Name, Strength & Dosage Form | INSPIOLTO RESPIMAT 2.5 MCG / DOSE * 2.5 MCG / DOSE INHALATION SOLUTION |
Unit Price, Unit of Issue | 1.0692 |
Manufacturer | BOE |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02423596 |
Generic Name | UMECLIDINIUM BROMIDE |
Product Name, Strength & Dosage Form | INCRUSE ELLIPTA 62.5 MCG / DOSE INHALATION METERED INHALATION POWDER |
Unit Price, Unit of Issue | 1.6667 |
Manufacturer | GSK |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 02418401 |
Generic Name | UMECLIDINIUM BROMIDE/ VILANTEROL TRIFENATATE |
Product Name, Strength & Dosage Form | ANORO ELLIPTA 62.5 MCG / DOSE * 25 MCG / DOSE INHALATION METERED INHALATION POWDER |
Unit Price, Unit of Issue | 2.9503 |
Manufacturer | GSK |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |