DIN/NPN/ PIN | Generic Name | Product Name, Strength & Dosage Form | Unit Price, Unit of Issue | Manufacturer | LCA Price | MAC Price | Interchangeable Products | Coverage Status | |
---|---|---|---|---|---|---|---|---|---|
02417197 | ALOGLIPTIN BENZOATE | NESINA 12.5 MG ORAL TABLET |
N/A TAB |
TAK | N/A | N/A | NO | NOT A BENEFIT | |
02417200 | ALOGLIPTIN BENZOATE | NESINA 25 MG ORAL TABLET |
N/A TAB |
TAK | N/A | N/A | NO | NOT A BENEFIT | |
02417189 | ALOGLIPTIN BENZOATE | NESINA 6.25 MG ORAL TABLET |
N/A TAB |
TAK | N/A | N/A | NO | NOT A BENEFIT | |
02417235 | ALOGLIPTIN BENZOATE/ METFORMIN HCL | KAZANO 12.5 MG * 1,000 MG ORAL TABLET |
N/A TAB |
TAK | N/A | N/A | NO | NOT A BENEFIT | |
02417219 | ALOGLIPTIN BENZOATE/ METFORMIN HCL | KAZANO 12.5 MG * 500 MG ORAL TABLET |
N/A TAB |
TAK | N/A | N/A | NO | NOT A BENEFIT | |
02417227 | ALOGLIPTIN BENZOATE/ METFORMIN HCL | KAZANO 12.5 MG * 850 MG ORAL TABLET |
N/A TAB |
TAK | N/A | N/A | NO | NOT A BENEFIT | |
02370921 | LINAGLIPTIN | TRAJENTA 5 MG ORAL TABLET |
2.6863 TAB |
BOE | N/A | N/A | NO | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02403277 | LINAGLIPTIN/ METFORMIN HCL | JENTADUETO 2.5 MG * 1,000 MG ORAL TABLET |
1.4050 TAB |
BOE | N/A | N/A | NO | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02403250 | LINAGLIPTIN/ METFORMIN HCL | JENTADUETO 2.5 MG * 500 MG ORAL TABLET |
1.4050 TAB |
BOE | N/A | N/A | NO | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02403269 | LINAGLIPTIN/ METFORMIN HCL | JENTADUETO 2.5 MG * 850 MG ORAL TABLET |
1.4050 TAB |
BOE | N/A | N/A | NO | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02507471 | SAXAGLIPTIN HCL | APO-SAXAGLIPTIN 2.5 MG ORAL TABLET |
1.2650 TAB |
APX | 1.2650 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02375842 | SAXAGLIPTIN HCL | ONGLYZA 2.5 MG ORAL TABLET |
2.7173 TAB |
AZC | 1.2650 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02468603 | SAXAGLIPTIN HCL | SANDOZ SAXAGLIPTIN 2.5 MG ORAL TABLET |
1.2650 TAB |
SDZ | 1.2650 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02507498 | SAXAGLIPTIN HCL | APO-SAXAGLIPTIN 5 MG ORAL TABLET |
1.5195 TAB |
APX | 1.5195 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02333554 | SAXAGLIPTIN HCL | ONGLYZA 5 MG ORAL TABLET |
3.2225 TAB |
AZC | 1.5195 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02468611 | SAXAGLIPTIN HCL | SANDOZ SAXAGLIPTIN 5 MG ORAL TABLET |
1.5195 TAB |
SDZ | 1.5195 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02389185 | SAXAGLIPTIN HCL/ METFORMIN HCL | KOMBOGLYZE 2.5 MG * 1,000 MG ORAL TABLET |
1.3855 TAB |
AZC | N/A | N/A | NO | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02389169 | SAXAGLIPTIN HCL/ METFORMIN HCL | KOMBOGLYZE 2.5 MG * 500 MG ORAL TABLET |
1.3855 TAB |
AZC | N/A | N/A | NO | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02389177 | SAXAGLIPTIN HCL/ METFORMIN HCL | KOMBOGLYZE 2.5 MG * 850 MG ORAL TABLET |
1.3855 TAB |
AZC | N/A | N/A | NO | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02512491 | SITAGLIPTIN | ACH-SITAGLIPTIN 100 MG ORAL TABLET |
0.8197 TAB |
AHI | 0.8197 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02508672 | SITAGLIPTIN | APO-SITAGLIPTIN MALATE 100 MG ORAL TABLET |
0.8197 TAB |
APX | 0.8197 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02529882 | SITAGLIPTIN | AURO-SITAGLIPTIN 100 MG ORAL TABLET |
0.8197 TAB |
AUR | 0.8197 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02534150 | SITAGLIPTIN | JAMP SITAGLIPTIN 100 MG ORAL TABLET |
0.8197 TAB |
JPC | 0.8197 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02303922 | SITAGLIPTIN | JANUVIA 100 MG ORAL TABLET |
3.2229 TAB |
MFC | 0.8197 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02504065 | SITAGLIPTIN | SANDOZ SITAGLIPTIN 100 MG ORAL TABLET |
0.8197 TAB |
SDZ | 0.8197 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02529068 | SITAGLIPTIN | SITAGLIPTIN 100 MG ORAL TABLET |
0.8197 TAB |
SIV | 0.8197 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02531666 | SITAGLIPTIN | TARO-SITAGLIPTIN FUMARATE 100 MG ORAL TABLET |
0.8197 TAB |
TAR | 0.8197 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02522721 | SITAGLIPTIN | TEVA-SITAGLIPTIN MALATE 100 MG ORAL TABLET |
0.8197 TAB |
TEV | 0.8197 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02512475 | SITAGLIPTIN | ACH-SITAGLIPTIN 25 MG ORAL TABLET |
0.8197 TAB |
AHI | 0.8197 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02508656 | SITAGLIPTIN | APO-SITAGLIPTIN MALATE 25 MG ORAL TABLET |
0.8197 TAB |
APX | 0.8197 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02529866 | SITAGLIPTIN | AURO-SITAGLIPTIN 25 MG ORAL TABLET |
0.8197 TAB |
AUR | 0.8197 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02534134 | SITAGLIPTIN | JAMP SITAGLIPTIN 25 MG ORAL TABLET |
0.8197 TAB |
JPC | 0.8197 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02388839 | SITAGLIPTIN | JANUVIA 25 MG ORAL TABLET |
3.2229 TAB |
MFC | 0.8197 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02504049 | SITAGLIPTIN | SANDOZ SITAGLIPTIN 25 MG ORAL TABLET |
0.8197 TAB |
SDZ | 0.8197 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02529033 | SITAGLIPTIN | SITAGLIPTIN 25 MG ORAL TABLET |
0.8197 TAB |
SIV | 0.8197 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02531631 | SITAGLIPTIN | TARO-SITAGLIPTIN FUMARATE 25 MG ORAL TABLET |
0.8197 TAB |
TAR | 0.8197 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02522705 | SITAGLIPTIN | TEVA-SITAGLIPTIN MALATE 25 MG ORAL TABLET |
0.8197 TAB |
TEV | 0.8197 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02512483 | SITAGLIPTIN | ACH-SITAGLIPTIN 50 MG ORAL TABLET |
0.8197 TAB |
AHI | 0.8197 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02508664 | SITAGLIPTIN | APO-SITAGLIPTIN MALATE 50 MG ORAL TABLET |
0.8197 TAB |
APX | 0.8197 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02529874 | SITAGLIPTIN | AURO-SITAGLIPTIN 50 MG ORAL TABLET |
0.8197 TAB |
AUR | 0.8197 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02534142 | SITAGLIPTIN | JAMP SITAGLIPTIN 50 MG ORAL TABLET |
0.8197 TAB |
JPC | 0.8197 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02388847 | SITAGLIPTIN | JANUVIA 50 MG ORAL TABLET |
3.2229 TAB |
MFC | 0.8197 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02504057 | SITAGLIPTIN | SANDOZ SITAGLIPTIN 50 MG ORAL TABLET |
0.8197 TAB |
SDZ | 0.8197 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02529041 | SITAGLIPTIN | SITAGLIPTIN 50 MG ORAL TABLET |
0.8197 TAB |
SIV | 0.8197 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02531658 | SITAGLIPTIN | TARO-SITAGLIPTIN FUMARATE 50 MG ORAL TABLET |
0.8197 TAB |
TAR | 0.8197 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02522713 | SITAGLIPTIN | TEVA-SITAGLIPTIN MALATE 50 MG ORAL TABLET |
0.8197 TAB |
TEV | 0.8197 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02506297 | SITAGLIPTIN/ METFORMIN HCL | APO-SITAGLIPTIN/METFORMIN XR 100 MG * 1,000 MG ORAL EXTENDED-RELEASE TABLET |
N/A TAB |
APX | N/A | N/A | NO | UNDER REVIEW | |
02416808 | SITAGLIPTIN/ METFORMIN HCL | JANUMET XR 100 MG * 1,000 MG ORAL EXTENDED-RELEASE TABLET |
3.4691 TAB |
MFC | N/A | N/A | NO | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02529122 | SITAGLIPTIN/ METFORMIN HCL | SANDOZ SITAGLIPTIN-METFORMIN XR 100 MG * 1,000 MG ORAL EXTENDED-RELEASE TABLET |
N/A TAB |
SDZ | N/A | N/A | NO | UNDER REVIEW | |
02509431 | SITAGLIPTIN/ METFORMIN HCL | APO-SITAGLIPTIN MALATE/METFORMIN HCL 50 MG * 1,000 MG ORAL TABLET |
N/A TAB |
APX | N/A | N/A | YES | UNDER REVIEW | |
02506289 | SITAGLIPTIN/ METFORMIN HCL | APO-SITAGLIPTIN/METFORMIN XR 50 MG * 1,000 MG ORAL EXTENDED-RELEASE TABLET |
N/A TAB |
APX | N/A | N/A | NO | UNDER REVIEW | |
02333872 | SITAGLIPTIN/ METFORMIN HCL | JANUMET 50 MG * 1,000 MG ORAL TABLET |
1.7465 TAB |
MFC | 0.8893 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02416794 | SITAGLIPTIN/ METFORMIN HCL | JANUMET XR 50 MG * 1,000 MG ORAL EXTENDED-RELEASE TABLET |
1.7345 TAB |
MFC | N/A | N/A | NO | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02503972 | SITAGLIPTIN/ METFORMIN HCL | SANDOZ SITAGLIPTIN-METFORMIN 50 MG * 1,000 MG ORAL TABLET |
0.8893 TAB |
SDZ | 0.8893 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02529114 | SITAGLIPTIN/ METFORMIN HCL | SANDOZ SITAGLIPTIN-METFORMIN XR 50 MG * 1,000 MG ORAL EXTENDED-RELEASE TABLET |
N/A TAB |
SDZ | N/A | N/A | NO | UNDER REVIEW | |
02509415 | SITAGLIPTIN/ METFORMIN HCL | APO-SITAGLIPTIN MALATE/METFORMIN HCL 50 MG * 500 MG ORAL TABLET |
N/A TAB |
APX | N/A | N/A | YES | UNDER REVIEW | |
02506270 | SITAGLIPTIN/ METFORMIN HCL | APO-SITAGLIPTIN/METFORMIN XR 50 MG * 500 MG ORAL EXTENDED-RELEASE TABLET |
N/A TAB |
APX | N/A | N/A | NO | UNDER REVIEW | |
02333856 | SITAGLIPTIN/ METFORMIN HCL | JANUMET 50 MG * 500 MG ORAL TABLET |
1.7465 TAB |
MFC | 0.8893 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02416786 | SITAGLIPTIN/ METFORMIN HCL | JANUMET XR 50 MG * 500 MG ORAL EXTENDED-RELEASE TABLET |
1.7345 TAB |
MFC | N/A | N/A | NO | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02503956 | SITAGLIPTIN/ METFORMIN HCL | SANDOZ SITAGLIPTIN-METFORMIN 50 MG * 500 MG ORAL TABLET |
0.8893 TAB |
SDZ | 0.8893 | N/A | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02529106 | SITAGLIPTIN/ METFORMIN HCL | SANDOZ SITAGLIPTIN-METFORMIN XR 50 MG * 500 MG ORAL EXTENDED-RELEASE TABLET |
N/A TAB |
SDZ | N/A | N/A | NO | UNDER REVIEW | |
02509423 | SITAGLIPTIN/ METFORMIN HCL | APO-SITAGLIPTIN MALATE/METFORMIN HCL 50 MG * 850 MG ORAL TABLET |
N/A TAB |
APX | N/A | N/A | NO | UNDER REVIEW | |
02333864 | SITAGLIPTIN/ METFORMIN HCL | JANUMET 50 MG * 850 MG ORAL TABLET |
1.7465 TAB |
MFC | 0.0000 | 0.0000 | YES | STEP THERAPY/ SPECIAL AUTHORIZATION | |
02503964 | SITAGLIPTIN/ METFORMIN HCL | SANDOZ SITAGLIPTIN-METFORMIN 50 MG * 850 MG ORAL TABLET |
0.8893 TAB |
SDZ | 0.0000 | 0.0000 | YES | STEP THERAPY/ SPECIAL AUTHORIZATION |
DIN/NPN/ PIN | 02417197 |
Generic Name | ALOGLIPTIN BENZOATE |
Product Name, Strength & Dosage Form | NESINA 12.5 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | TAK |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02417200 |
Generic Name | ALOGLIPTIN BENZOATE |
Product Name, Strength & Dosage Form | NESINA 25 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | TAK |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02417189 |
Generic Name | ALOGLIPTIN BENZOATE |
Product Name, Strength & Dosage Form | NESINA 6.25 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | TAK |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02417235 |
Generic Name | ALOGLIPTIN BENZOATE/ METFORMIN HCL |
Product Name, Strength & Dosage Form | KAZANO 12.5 MG * 1,000 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | TAK |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02417219 |
Generic Name | ALOGLIPTIN BENZOATE/ METFORMIN HCL |
Product Name, Strength & Dosage Form | KAZANO 12.5 MG * 500 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | TAK |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02417227 |
Generic Name | ALOGLIPTIN BENZOATE/ METFORMIN HCL |
Product Name, Strength & Dosage Form | KAZANO 12.5 MG * 850 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | TAK |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02370921 |
Generic Name | LINAGLIPTIN |
Product Name, Strength & Dosage Form | TRAJENTA 5 MG ORAL TABLET |
Unit Price, Unit of Issue | 2.6863 |
Manufacturer | BOE |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02403277 |
Generic Name | LINAGLIPTIN/ METFORMIN HCL |
Product Name, Strength & Dosage Form | JENTADUETO 2.5 MG * 1,000 MG ORAL TABLET |
Unit Price, Unit of Issue | 1.4050 |
Manufacturer | BOE |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02403250 |
Generic Name | LINAGLIPTIN/ METFORMIN HCL |
Product Name, Strength & Dosage Form | JENTADUETO 2.5 MG * 500 MG ORAL TABLET |
Unit Price, Unit of Issue | 1.4050 |
Manufacturer | BOE |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02403269 |
Generic Name | LINAGLIPTIN/ METFORMIN HCL |
Product Name, Strength & Dosage Form | JENTADUETO 2.5 MG * 850 MG ORAL TABLET |
Unit Price, Unit of Issue | 1.4050 |
Manufacturer | BOE |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02507471 |
Generic Name | SAXAGLIPTIN HCL |
Product Name, Strength & Dosage Form | APO-SAXAGLIPTIN 2.5 MG ORAL TABLET |
Unit Price, Unit of Issue | 1.2650 |
Manufacturer | APX |
LCA Price | 1.2650 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02375842 |
Generic Name | SAXAGLIPTIN HCL |
Product Name, Strength & Dosage Form | ONGLYZA 2.5 MG ORAL TABLET |
Unit Price, Unit of Issue | 2.7173 |
Manufacturer | AZC |
LCA Price | 1.2650 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02468603 |
Generic Name | SAXAGLIPTIN HCL |
Product Name, Strength & Dosage Form | SANDOZ SAXAGLIPTIN 2.5 MG ORAL TABLET |
Unit Price, Unit of Issue | 1.2650 |
Manufacturer | SDZ |
LCA Price | 1.2650 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02507498 |
Generic Name | SAXAGLIPTIN HCL |
Product Name, Strength & Dosage Form | APO-SAXAGLIPTIN 5 MG ORAL TABLET |
Unit Price, Unit of Issue | 1.5195 |
Manufacturer | APX |
LCA Price | 1.5195 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02333554 |
Generic Name | SAXAGLIPTIN HCL |
Product Name, Strength & Dosage Form | ONGLYZA 5 MG ORAL TABLET |
Unit Price, Unit of Issue | 3.2225 |
Manufacturer | AZC |
LCA Price | 1.5195 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02468611 |
Generic Name | SAXAGLIPTIN HCL |
Product Name, Strength & Dosage Form | SANDOZ SAXAGLIPTIN 5 MG ORAL TABLET |
Unit Price, Unit of Issue | 1.5195 |
Manufacturer | SDZ |
LCA Price | 1.5195 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02389185 |
Generic Name | SAXAGLIPTIN HCL/ METFORMIN HCL |
Product Name, Strength & Dosage Form | KOMBOGLYZE 2.5 MG * 1,000 MG ORAL TABLET |
Unit Price, Unit of Issue | 1.3855 |
Manufacturer | AZC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02389169 |
Generic Name | SAXAGLIPTIN HCL/ METFORMIN HCL |
Product Name, Strength & Dosage Form | KOMBOGLYZE 2.5 MG * 500 MG ORAL TABLET |
Unit Price, Unit of Issue | 1.3855 |
Manufacturer | AZC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02389177 |
Generic Name | SAXAGLIPTIN HCL/ METFORMIN HCL |
Product Name, Strength & Dosage Form | KOMBOGLYZE 2.5 MG * 850 MG ORAL TABLET |
Unit Price, Unit of Issue | 1.3855 |
Manufacturer | AZC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02512491 |
Generic Name | SITAGLIPTIN |
Product Name, Strength & Dosage Form | ACH-SITAGLIPTIN 100 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8197 |
Manufacturer | AHI |
LCA Price | 0.8197 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02508672 |
Generic Name | SITAGLIPTIN |
Product Name, Strength & Dosage Form | APO-SITAGLIPTIN MALATE 100 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8197 |
Manufacturer | APX |
LCA Price | 0.8197 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02529882 |
Generic Name | SITAGLIPTIN |
Product Name, Strength & Dosage Form | AURO-SITAGLIPTIN 100 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8197 |
Manufacturer | AUR |
LCA Price | 0.8197 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02534150 |
Generic Name | SITAGLIPTIN |
Product Name, Strength & Dosage Form | JAMP SITAGLIPTIN 100 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8197 |
Manufacturer | JPC |
LCA Price | 0.8197 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02303922 |
Generic Name | SITAGLIPTIN |
Product Name, Strength & Dosage Form | JANUVIA 100 MG ORAL TABLET |
Unit Price, Unit of Issue | 3.2229 |
Manufacturer | MFC |
LCA Price | 0.8197 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02504065 |
Generic Name | SITAGLIPTIN |
Product Name, Strength & Dosage Form | SANDOZ SITAGLIPTIN 100 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8197 |
Manufacturer | SDZ |
LCA Price | 0.8197 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02529068 |
Generic Name | SITAGLIPTIN |
Product Name, Strength & Dosage Form | SITAGLIPTIN 100 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8197 |
Manufacturer | SIV |
LCA Price | 0.8197 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02531666 |
Generic Name | SITAGLIPTIN |
Product Name, Strength & Dosage Form | TARO-SITAGLIPTIN FUMARATE 100 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8197 |
Manufacturer | TAR |
LCA Price | 0.8197 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02522721 |
Generic Name | SITAGLIPTIN |
Product Name, Strength & Dosage Form | TEVA-SITAGLIPTIN MALATE 100 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8197 |
Manufacturer | TEV |
LCA Price | 0.8197 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02512475 |
Generic Name | SITAGLIPTIN |
Product Name, Strength & Dosage Form | ACH-SITAGLIPTIN 25 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8197 |
Manufacturer | AHI |
LCA Price | 0.8197 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02508656 |
Generic Name | SITAGLIPTIN |
Product Name, Strength & Dosage Form | APO-SITAGLIPTIN MALATE 25 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8197 |
Manufacturer | APX |
LCA Price | 0.8197 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02529866 |
Generic Name | SITAGLIPTIN |
Product Name, Strength & Dosage Form | AURO-SITAGLIPTIN 25 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8197 |
Manufacturer | AUR |
LCA Price | 0.8197 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02534134 |
Generic Name | SITAGLIPTIN |
Product Name, Strength & Dosage Form | JAMP SITAGLIPTIN 25 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8197 |
Manufacturer | JPC |
LCA Price | 0.8197 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02388839 |
Generic Name | SITAGLIPTIN |
Product Name, Strength & Dosage Form | JANUVIA 25 MG ORAL TABLET |
Unit Price, Unit of Issue | 3.2229 |
Manufacturer | MFC |
LCA Price | 0.8197 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02504049 |
Generic Name | SITAGLIPTIN |
Product Name, Strength & Dosage Form | SANDOZ SITAGLIPTIN 25 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8197 |
Manufacturer | SDZ |
LCA Price | 0.8197 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02529033 |
Generic Name | SITAGLIPTIN |
Product Name, Strength & Dosage Form | SITAGLIPTIN 25 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8197 |
Manufacturer | SIV |
LCA Price | 0.8197 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02531631 |
Generic Name | SITAGLIPTIN |
Product Name, Strength & Dosage Form | TARO-SITAGLIPTIN FUMARATE 25 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8197 |
Manufacturer | TAR |
LCA Price | 0.8197 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02522705 |
Generic Name | SITAGLIPTIN |
Product Name, Strength & Dosage Form | TEVA-SITAGLIPTIN MALATE 25 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8197 |
Manufacturer | TEV |
LCA Price | 0.8197 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02512483 |
Generic Name | SITAGLIPTIN |
Product Name, Strength & Dosage Form | ACH-SITAGLIPTIN 50 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8197 |
Manufacturer | AHI |
LCA Price | 0.8197 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02508664 |
Generic Name | SITAGLIPTIN |
Product Name, Strength & Dosage Form | APO-SITAGLIPTIN MALATE 50 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8197 |
Manufacturer | APX |
LCA Price | 0.8197 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02529874 |
Generic Name | SITAGLIPTIN |
Product Name, Strength & Dosage Form | AURO-SITAGLIPTIN 50 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8197 |
Manufacturer | AUR |
LCA Price | 0.8197 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02534142 |
Generic Name | SITAGLIPTIN |
Product Name, Strength & Dosage Form | JAMP SITAGLIPTIN 50 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8197 |
Manufacturer | JPC |
LCA Price | 0.8197 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02388847 |
Generic Name | SITAGLIPTIN |
Product Name, Strength & Dosage Form | JANUVIA 50 MG ORAL TABLET |
Unit Price, Unit of Issue | 3.2229 |
Manufacturer | MFC |
LCA Price | 0.8197 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02504057 |
Generic Name | SITAGLIPTIN |
Product Name, Strength & Dosage Form | SANDOZ SITAGLIPTIN 50 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8197 |
Manufacturer | SDZ |
LCA Price | 0.8197 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02529041 |
Generic Name | SITAGLIPTIN |
Product Name, Strength & Dosage Form | SITAGLIPTIN 50 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8197 |
Manufacturer | SIV |
LCA Price | 0.8197 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02531658 |
Generic Name | SITAGLIPTIN |
Product Name, Strength & Dosage Form | TARO-SITAGLIPTIN FUMARATE 50 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8197 |
Manufacturer | TAR |
LCA Price | 0.8197 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02522713 |
Generic Name | SITAGLIPTIN |
Product Name, Strength & Dosage Form | TEVA-SITAGLIPTIN MALATE 50 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8197 |
Manufacturer | TEV |
LCA Price | 0.8197 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02506297 |
Generic Name | SITAGLIPTIN/ METFORMIN HCL |
Product Name, Strength & Dosage Form | APO-SITAGLIPTIN/METFORMIN XR 100 MG * 1,000 MG ORAL EXTENDED-RELEASE TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | APX |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | UNDER REVIEW |
Details |
DIN/NPN/ PIN | 02416808 |
Generic Name | SITAGLIPTIN/ METFORMIN HCL |
Product Name, Strength & Dosage Form | JANUMET XR 100 MG * 1,000 MG ORAL EXTENDED-RELEASE TABLET |
Unit Price, Unit of Issue | 3.4691 |
Manufacturer | MFC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02529122 |
Generic Name | SITAGLIPTIN/ METFORMIN HCL |
Product Name, Strength & Dosage Form | SANDOZ SITAGLIPTIN-METFORMIN XR 100 MG * 1,000 MG ORAL EXTENDED-RELEASE TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | SDZ |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | UNDER REVIEW |
Details |
DIN/NPN/ PIN | 02509431 |
Generic Name | SITAGLIPTIN/ METFORMIN HCL |
Product Name, Strength & Dosage Form | APO-SITAGLIPTIN MALATE/METFORMIN HCL 50 MG * 1,000 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | APX |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | UNDER REVIEW |
Details |
DIN/NPN/ PIN | 02506289 |
Generic Name | SITAGLIPTIN/ METFORMIN HCL |
Product Name, Strength & Dosage Form | APO-SITAGLIPTIN/METFORMIN XR 50 MG * 1,000 MG ORAL EXTENDED-RELEASE TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | APX |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | UNDER REVIEW |
Details |
DIN/NPN/ PIN | 02333872 |
Generic Name | SITAGLIPTIN/ METFORMIN HCL |
Product Name, Strength & Dosage Form | JANUMET 50 MG * 1,000 MG ORAL TABLET |
Unit Price, Unit of Issue | 1.7465 |
Manufacturer | MFC |
LCA Price | 0.8893 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02416794 |
Generic Name | SITAGLIPTIN/ METFORMIN HCL |
Product Name, Strength & Dosage Form | JANUMET XR 50 MG * 1,000 MG ORAL EXTENDED-RELEASE TABLET |
Unit Price, Unit of Issue | 1.7345 |
Manufacturer | MFC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02503972 |
Generic Name | SITAGLIPTIN/ METFORMIN HCL |
Product Name, Strength & Dosage Form | SANDOZ SITAGLIPTIN-METFORMIN 50 MG * 1,000 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8893 |
Manufacturer | SDZ |
LCA Price | 0.8893 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02529114 |
Generic Name | SITAGLIPTIN/ METFORMIN HCL |
Product Name, Strength & Dosage Form | SANDOZ SITAGLIPTIN-METFORMIN XR 50 MG * 1,000 MG ORAL EXTENDED-RELEASE TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | SDZ |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | UNDER REVIEW |
Details |
DIN/NPN/ PIN | 02509415 |
Generic Name | SITAGLIPTIN/ METFORMIN HCL |
Product Name, Strength & Dosage Form | APO-SITAGLIPTIN MALATE/METFORMIN HCL 50 MG * 500 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | APX |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | UNDER REVIEW |
Details |
DIN/NPN/ PIN | 02506270 |
Generic Name | SITAGLIPTIN/ METFORMIN HCL |
Product Name, Strength & Dosage Form | APO-SITAGLIPTIN/METFORMIN XR 50 MG * 500 MG ORAL EXTENDED-RELEASE TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | APX |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | UNDER REVIEW |
Details |
DIN/NPN/ PIN | 02333856 |
Generic Name | SITAGLIPTIN/ METFORMIN HCL |
Product Name, Strength & Dosage Form | JANUMET 50 MG * 500 MG ORAL TABLET |
Unit Price, Unit of Issue | 1.7465 |
Manufacturer | MFC |
LCA Price | 0.8893 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02416786 |
Generic Name | SITAGLIPTIN/ METFORMIN HCL |
Product Name, Strength & Dosage Form | JANUMET XR 50 MG * 500 MG ORAL EXTENDED-RELEASE TABLET |
Unit Price, Unit of Issue | 1.7345 |
Manufacturer | MFC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02503956 |
Generic Name | SITAGLIPTIN/ METFORMIN HCL |
Product Name, Strength & Dosage Form | SANDOZ SITAGLIPTIN-METFORMIN 50 MG * 500 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8893 |
Manufacturer | SDZ |
LCA Price | 0.8893 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02529106 |
Generic Name | SITAGLIPTIN/ METFORMIN HCL |
Product Name, Strength & Dosage Form | SANDOZ SITAGLIPTIN-METFORMIN XR 50 MG * 500 MG ORAL EXTENDED-RELEASE TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | SDZ |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | UNDER REVIEW |
Details |
DIN/NPN/ PIN | 02509423 |
Generic Name | SITAGLIPTIN/ METFORMIN HCL |
Product Name, Strength & Dosage Form | APO-SITAGLIPTIN MALATE/METFORMIN HCL 50 MG * 850 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | APX |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | UNDER REVIEW |
Details |
DIN/NPN/ PIN | 02333864 |
Generic Name | SITAGLIPTIN/ METFORMIN HCL |
Product Name, Strength & Dosage Form | JANUMET 50 MG * 850 MG ORAL TABLET |
Unit Price, Unit of Issue | 1.7465 |
Manufacturer | MFC |
LCA Price | 0.0000 |
MAC Price | 0.0000 |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02503964 |
Generic Name | SITAGLIPTIN/ METFORMIN HCL |
Product Name, Strength & Dosage Form | SANDOZ SITAGLIPTIN-METFORMIN 50 MG * 850 MG ORAL TABLET |
Unit Price, Unit of Issue | 0.8893 |
Manufacturer | SDZ |
LCA Price | 0.0000 |
MAC Price | 0.0000 |
Interchangeable Products | YES |
Coverage Status | STEP THERAPY/ SPECIAL AUTHORIZATION |
Details |