Alberta Health - Drug Benefit List

Interactive Drug Benefit List

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Products Found: 91

DIN/NPN/ PIN	Generic Name	Product Name, Strength & Dosage Form	Unit Price, Unit of Issue	Manufacturer	LCA Price	MAC Price	Interchangeable Products	Coverage Status
02246714	AMCINONIDE	TARO-AMCINONIDE 0.1 % TOPICAL CREAM	0.4522 G	TAR	N/A	N/A	NO	REGULAR BENEFIT	Details
02089602	BECLOMETHASONE DIPROPIONATE	PROPADERM 250 MCG / G TOPICAL CREAM	0.5138 G	VCL	N/A	N/A	NO	REGULAR BENEFIT	Details
00629367	BETAMETHASONE DIPROPIONATE	DIPROLENE GLYCOL 0.05 % TOPICAL GLYCOL OINTMENT	0.5186 G	ORC	0.5186	N/A	YES	REGULAR BENEFIT	Details
00323071	BETAMETHASONE DIPROPIONATE	DIPROSONE 0.05 % TOPICAL CREAM	0.2114 G	ORC	0.2046	N/A	YES	REGULAR BENEFIT	Details
00417246	BETAMETHASONE DIPROPIONATE	DIPROSONE 0.05 % TOPICAL LOTION	0.2044 ML	ORC	0.2022	N/A	YES	REGULAR BENEFIT	Details
00344923	BETAMETHASONE DIPROPIONATE	DIPROSONE 0.05 % TOPICAL OINTMENT	0.2221 G	ORC	0.2186	N/A	YES	REGULAR BENEFIT	Details
00849650	BETAMETHASONE DIPROPIONATE	TEVA-TOPILENE 0.05 % TOPICAL GLYCOL CREAM	0.5186 G	TEV	N/A	N/A	NO	REGULAR BENEFIT	Details
01927914	BETAMETHASONE DIPROPIONATE	TEVA-TOPILENE 0.05 % TOPICAL GLYCOL LOTION	0.2832 ML	TEV	N/A	N/A	NO	REGULAR BENEFIT	Details
00849669	BETAMETHASONE DIPROPIONATE	TEVA-TOPILENE 0.05 % TOPICAL GLYCOL OINTMENT	0.5186 G	TEV	0.5186	N/A	YES	REGULAR BENEFIT	Details
00804991	BETAMETHASONE DIPROPIONATE	TEVA-TOPISONE 0.05 % TOPICAL CREAM	0.2046 G	TEV	0.2046	N/A	YES	REGULAR BENEFIT	Details
00809187	BETAMETHASONE DIPROPIONATE	TEVA-TOPISONE 0.05 % TOPICAL LOTION	0.2022 ML	TEV	0.2022	N/A	YES	REGULAR BENEFIT	Details
00805009	BETAMETHASONE DIPROPIONATE	TEVA-TOPISONE 0.05 % TOPICAL OINTMENT	0.2186 G	TEV	0.2186	N/A	YES	REGULAR BENEFIT	Details
00611174	BETAMETHASONE DIPROPIONATE/ CLOTRIMAZOLE	LOTRIDERM 0.05 % * 1 % TOPICAL CREAM	0.8650 G	ORC	0.6964	N/A	YES	REGULAR BENEFIT	Details
02496410	BETAMETHASONE DIPROPIONATE/ CLOTRIMAZOLE	TARO-CLOTRIMAZOLE/BETAMETHASONE 0.05 % * 1 % TOPICAL CREAM	0.6964 G	TAR	0.6964	N/A	YES	REGULAR BENEFIT	Details
00578436	BETAMETHASONE DIPROPIONATE/ SALICYLIC ACID	DIPROSALIC 0.5 MG / G * 30 MG / G TOPICAL OINTMENT	0.9084 G	ORC	N/A	N/A	NO	REGULAR BENEFIT	Details
02245688	BETAMETHASONE DIPROPIONATE/ SALICYLIC ACID	RATIO-TOPISALIC 0.5 MG / ML * 20 MG / ML TOPICAL LOTION	0.4512 ML	TEV	N/A	N/A	NO	REGULAR BENEFIT	Details
00716618	BETAMETHASONE VALERATE	BETADERM MILD 0.05 % TOPICAL CREAM	0.0596 G	TAR	0.0596	N/A	YES	REGULAR BENEFIT	Details
00716642	BETAMETHASONE VALERATE	BETADERM MILD 0.05 % TOPICAL OINTMENT	0.0781 G	TAR	N/A	N/A	NO	REGULAR BENEFIT	Details
00535427	BETAMETHASONE VALERATE	TEVA-ECTOSONE MILD 0.05 % TOPICAL CREAM	0.0596 G	TEV	0.0596	N/A	YES	REGULAR BENEFIT	Details
00653209	BETAMETHASONE VALERATE	TEVA-ECTOSONE MILD 0.05 % TOPICAL LOTION	0.2846 ML	TEV	N/A	N/A	NO	REGULAR BENEFIT	Details
00716626	BETAMETHASONE VALERATE	BETADERM REGULAR 0.1 % TOPICAL CREAM	0.0889 G	TAR	0.0889	N/A	YES	REGULAR BENEFIT	Details
00716650	BETAMETHASONE VALERATE	BETADERM REGULAR 0.1 % TOPICAL OINTMENT	0.1165 G	TAR	N/A	N/A	NO	REGULAR BENEFIT	Details
02357852	BETAMETHASONE VALERATE	CELESTODERM-V 0.1 % TOPICAL OINTMENT	N/A G	VCL	N/A	N/A	NO	NOT A BENEFIT	Details
00535435	BETAMETHASONE VALERATE	TEVA-ECTOSONE REGULAR 0.1 % TOPICAL CREAM	0.0889 G	TEV	0.0889	N/A	YES	REGULAR BENEFIT	Details
00750050	BETAMETHASONE VALERATE	TEVA-ECTOSONE REGULAR 0.1 % TOPICAL LOTION	0.3529 ML	TEV	N/A	N/A	NO	REGULAR BENEFIT	Details
00653217	BETAMETHASONE VALERATE	TEVA-ECTOSONE SCALP 0.1 % SCALP LOTION	0.0853 ML	TEV	0.0000	0.0000	NO	REGULAR BENEFIT	Details
02366924	BETAMETHASONE VALERATE	LUXIQ 0.12 % TOPICAL FOAM	N/A G	GSK	N/A	N/A	NO	NOT A BENEFIT	Details
02052431	BUDESONIDE	ENTOCORT (115 ML) 2.3 MG / ENM RECTAL ENEMA	10.8035 ENM	TPG	N/A	N/A	NO	REGULAR BENEFIT	Details
02244126	CALCIPOTRIOL MONOHYDRATE/ BETAMETHASONE DIPROPIONATE	DOVOBET 50 MCG / G * 0.5 MG / G TOPICAL OINTMENT	1.6885 G	LEO	1.2545	N/A	YES	REGULAR BENEFIT	Details
02427419	CALCIPOTRIOL MONOHYDRATE/ BETAMETHASONE DIPROPIONATE	TEVA-BETAMETHASONE/CALCIPOTRIOL 50 MCG / G * 0.5 MG / G TOPICAL OINTMENT	1.2545 G	TEV	1.2545	N/A	YES	REGULAR BENEFIT	Details
02213281	CLOBETASOL 17-PROPIONATE	DERMOVATE 0.05 % SCALP LOTION	0.8303 ML	TPT	0.0000	0.0000	YES	REGULAR BENEFIT	Details
02213265	CLOBETASOL 17-PROPIONATE	DERMOVATE 0.05 % TOPICAL CREAM	1.0353 G	TPT	0.2279	N/A	YES	REGULAR BENEFIT	Details
02213273	CLOBETASOL 17-PROPIONATE	DERMOVATE 0.05 % TOPICAL OINTMENT	1.0353 G	TPT	0.2279	N/A	YES	REGULAR BENEFIT	Details
02216213	CLOBETASOL 17-PROPIONATE	MYLAN-CLOBETASOL 0.05 % SCALP LOTION	0.1990 ML	MYP	0.0000	0.0000	YES	REGULAR BENEFIT	Details
02024187	CLOBETASOL 17-PROPIONATE	MYLAN-CLOBETASOL 0.05 % TOPICAL CREAM	0.2279 G	MYP	0.2279	N/A	YES	REGULAR BENEFIT	Details
02026767	CLOBETASOL 17-PROPIONATE	MYLAN-CLOBETASOL 0.05 % TOPICAL OINTMENT	0.2279 G	MYP	0.2279	N/A	YES	REGULAR BENEFIT	Details
02245522	CLOBETASOL 17-PROPIONATE	TARO-CLOBETASOL 0.05 % SCALP LOTION	0.1990 ML	TAR	0.0000	0.0000	YES	REGULAR BENEFIT	Details
02245523	CLOBETASOL 17-PROPIONATE	TARO-CLOBETASOL 0.05 % TOPICAL CREAM	0.2279 G	TAR	0.2279	N/A	YES	REGULAR BENEFIT	Details
02245524	CLOBETASOL 17-PROPIONATE	TARO-CLOBETASOL 0.05 % TOPICAL OINTMENT	0.2279 G	TAR	0.2279	N/A	YES	REGULAR BENEFIT	Details
01910299	CLOBETASOL 17-PROPIONATE	TEVA-CLOBETASOL 0.05 % SCALP LOTION	0.1990 ML	TEV	0.0000	0.0000	YES	REGULAR BENEFIT	Details
01910272	CLOBETASOL 17-PROPIONATE	TEVA-CLOBETASOL 0.05 % TOPICAL CREAM	0.2279 G	TEV	0.2279	N/A	YES	REGULAR BENEFIT	Details
01910280	CLOBETASOL 17-PROPIONATE	TEVA-CLOBETASOL 0.05 % TOPICAL OINTMENT	0.2279 G	TEV	0.2279	N/A	YES	REGULAR BENEFIT	Details
00999110	COMPOUND PRESCRIPTION	COMBINATION ANTI-INFECTIVE /CORTICOSTEROID	0.0000 MIS	XXX	0.0000	0.0000	NO	RESTRICTED BENEFIT	Details
00999211	COMPOUND PRESCRIPTION	COMBINATION ANTI-INFECTIVE/CORTICOSTEROID	0.0000 MIS	XXX	0.0000	0.0000	NO	RESTRICTED BENEFIT	Details
00999107	COMPOUND PRESCRIPTION	COMPOUND-CORTICOSTEROIDS - TOPICAL TOPICAL	0.0000 MIS	XXX	0.0000	0.0000	NO	RESTRICTED BENEFIT	Details
00999207	COMPOUND PRESCRIPTION	COMPOUND-CORTICOSTEROIDS - TOPICAL TOPICAL	0.0000 MIS	XXX	0.0000	0.0000	NO	RESTRICTED BENEFIT	Details
02229315	DESONIDE	PDP-DESONIDE 0.05 % TOPICAL CREAM	0.4267 G	PPH	N/A	N/A	NO	REGULAR BENEFIT	Details
02229323	DESONIDE	PDP-DESONIDE 0.05 % TOPICAL OINTMENT	0.4526 G	PPH	N/A	N/A	NO	REGULAR BENEFIT	Details
02221918	DESOXIMETASONE	TOPICORT MILD 0.05 % TOPICAL CREAM	0.5687 G	VCL	N/A	N/A	NO	REGULAR BENEFIT	Details
02221896	DESOXIMETASONE	TOPICORT 0.25 % TOPICAL CREAM	0.8002 G	VCL	N/A	N/A	NO	REGULAR BENEFIT	Details
00716863	FLUOCINONIDE	LYDERM 0.05 % TOPICAL CREAM	0.2783 G	TPT	N/A	N/A	NO	REGULAR BENEFIT	Details
02236997	FLUOCINONIDE	LYDERM 0.05 % TOPICAL GEL	0.3806 G	TPT	N/A	N/A	NO	REGULAR BENEFIT	Details
02236996	FLUOCINONIDE	LYDERM 0.05 % TOPICAL OINTMENT	0.3645 G	TPT	N/A	N/A	NO	REGULAR BENEFIT	Details
00598933	FLUOCINONIDE	TIAMOL 0.05 % TOPICAL EMOLLIENT CREAM	0.2468 G	TPT	N/A	N/A	NO	REGULAR BENEFIT	Details
02506262	HALOBETASOL PROPIONATE	BRYHALI 0.01 % TOPICAL LOTION	0.9816 G	VCL	N/A	N/A	NO	REGULAR BENEFIT	Details
01962701	HALOBETASOL PROPIONATE	ULTRAVATE 0.05 % TOPICAL CREAM	1.0852 G	VCL	N/A	N/A	NO	REGULAR BENEFIT	Details
02499967	HALOBETASOL PROPIONATE/ TAZAROTENE	DUOBRII 0.01 % * 0.045 % TOPICAL LOTION	1.9300 G	VCL	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
00716685	HYDROCORTISONE	CORTODERM MILD 0.5 % TOPICAL OINTMENT	0.2113 G	TAR	N/A	N/A	NO	REGULAR BENEFIT	Details
00716693	HYDROCORTISONE	CORTODERM REGULAR 1 % TOPICAL OINTMENT	0.0658 G	TAR	N/A	N/A	NO	REGULAR BENEFIT	Details
80057191	HYDROCORTISONE	JAMP-HYDROCORTISONE 1 % TOPICAL LOTION	0.1191 ML	JPC	N/A	N/A	NO	REGULAR BENEFIT	Details
80057178	HYDROCORTISONE	JAMP-HYDROCORTISONE ACETATE 1 % TOPICAL CREAM	0.0875 G	JPC	N/A	N/A	NO	REGULAR BENEFIT	Details
02412926	HYDROCORTISONE	SANDOZ HYDROCORTISONE 1 % TOPICAL CREAM	N/A G	SDZ	N/A	N/A	NO	NOT A BENEFIT	Details
02242984	HYDROCORTISONE 17-VALERATE	HYDROVAL 0.2 % TOPICAL CREAM	0.1750 G	TPT	N/A	N/A	NO	REGULAR BENEFIT	Details
02242985	HYDROCORTISONE 17-VALERATE	HYDROVAL 0.2 % TOPICAL OINTMENT	0.1877 G	TPT	N/A	N/A	NO	REGULAR BENEFIT	Details
00716820	HYDROCORTISONE ACETATE	HYDERM 0.5 % TOPICAL CREAM	0.2150 G	TAR	N/A	N/A	NO	REGULAR BENEFIT	Details
00716839	HYDROCORTISONE ACETATE	HYDERM 1 % TOPICAL CREAM	0.0533 G	TAR	N/A	N/A	NO	REGULAR BENEFIT	Details
00363014	HYDROCORTISONE ACETATE/ PRAMOXINE HCL	PROCTOFOAM-HC 1 % * 1 % RECTAL FOAM	1.7857 G	DUI	N/A	N/A	NO	REGULAR BENEFIT	Details
02234466	HYDROCORTISONE ACETATE/ PRAMOXINE HCL/ ZINC SULFATE	PROCTODAN-HC 0.5 % * 1 % * 0.5 % RECTAL OINTMENT	1.2861 G	ODN	N/A	N/A	NO	REGULAR BENEFIT	Details
02240851	HYDROCORTISONE ACETATE/ PRAMOXINE HCL/ ZINC SULFATE	PROCTODAN-HC 10 MG * 20 MG * 10 MG RECTAL SUPPOSITORY	1.9847 SUP	ODN	N/A	N/A	NO	REGULAR BENEFIT	Details
00681989	HYDROCORTISONE ACETATE/ UREA	DERMAFLEX HC 1 % * 10 % TOPICAL CREAM	0.2021 G	PAL	N/A	N/A	NO	REGULAR BENEFIT	Details
00681997	HYDROCORTISONE ACETATE/ UREA	DERMAFLEX HC 1 % * 10 % TOPICAL LOTION	0.1137 ML	PAL	N/A	N/A	NO	REGULAR BENEFIT	Details
80061501	HYDROCORTISONE ACETATE/ UREA	JAMP-HYDROCORTISONE ACETATE/UREA 1 % * 10 % TOPICAL CREAM	0.0915 G	JPC	N/A	N/A	NO	REGULAR BENEFIT	Details
80073645	HYDROCORTISONE ACETATE/ UREA	M-HC/UREA 1 % * 10 % TOPICAL CREAM	0.0915 G	MTR	N/A	N/A	NO	REGULAR BENEFIT	Details
02128446	HYDROCORTISONE ACETATE/ ZINC SULFATE	ANODAN-HC 0.5 % * 0.5 % RECTAL OINTMENT	0.3850 G	ODN	0.3850	N/A	YES	REGULAR BENEFIT	Details
02387239	HYDROCORTISONE ACETATE/ ZINC SULFATE	JAMPZINC-HC 0.5 % * 0.5 % RECTAL OINTMENT	0.3850 G	JPC	0.3850	N/A	YES	REGULAR BENEFIT	Details
02236399	HYDROCORTISONE ACETATE/ ZINC SULFATE	ANODAN-HC 10 MG * 10 MG RECTAL SUPPOSITORY	0.9506 SUP	ODN	0.9506	N/A	NO	REGULAR BENEFIT	Details
02247882	HYDROCORTISONE/ CINCHOCAINE HCL/ FRAMYCETIN SULFATE/ ESCULIN	PROCTOL 5 MG * 5 MG * 10 MG * 10 MG RECTAL SUPPOSITORY	1.3708 SUP	ODN	N/A	N/A	NO	REGULAR BENEFIT	Details
02247322	HYDROCORTISONE/ CINCHOCAINE HCL/ FRAMYCETIN SULFATE/ ESCULIN	PROCTOL 5 MG / G * 5 MG / G * 10 MG / G * 10 MG / G RECTAL OINTMENT	0.7712 G	ODN	0.7712	N/A	YES	REGULAR BENEFIT	Details
02223252	HYDROCORTISONE/ CINCHOCAINE HCL/ FRAMYCETIN SULFATE/ ESCULIN	PROCTOSEDYL 5 MG / G * 5 MG / G * 10 MG / G * 10 MG / G RECTAL OINTMENT	0.9073 G	AXC	0.7712	N/A	YES	REGULAR BENEFIT	Details
02226383	HYDROCORTISONE/ CINCHOCAINE HCL/ FRAMYCETIN SULFATE/ ESCULIN	TEVA-PROCTOSONE 5 MG / G * 5 MG / G * 10 MG / G * 10 MG / G RECTAL OINTMENT	0.4000 G	TEV	0.7712	N/A	YES	REGULAR BENEFIT	Details
00851744	MOMETASONE FUROATE	ELOCOM 0.1 % TOPICAL CREAM	0.7393 G	ORC	0.6296	N/A	YES	REGULAR BENEFIT	Details
00871095	MOMETASONE FUROATE	ELOCOM 0.1 % TOPICAL LOTION	0.4992 ML	ORC	0.4178	N/A	YES	REGULAR BENEFIT	Details
00851736	MOMETASONE FUROATE	ELOCOM 0.1 % TOPICAL OINTMENT	0.6698 G	ORC	0.6013	N/A	YES	REGULAR BENEFIT	Details
02367157	MOMETASONE FUROATE	TARO-MOMETASONE 0.1 % TOPICAL CREAM	0.6296 G	TAR	0.6296	N/A	YES	REGULAR BENEFIT	Details
02266385	MOMETASONE FUROATE	TARO-MOMETASONE 0.1 % TOPICAL LOTION	0.4178 ML	TAR	0.4178	N/A	YES	REGULAR BENEFIT	Details
02248130	MOMETASONE FUROATE	TEVA-MOMETASONE 0.1 % TOPICAL OINTMENT	0.6013 G	TEV	0.6013	N/A	YES	REGULAR BENEFIT	Details
02194058	TRIAMCINOLONE ACETONIDE	ARISTOCORT R 0.1 % TOPICAL CREAM	0.1549 G	VCL	0.1177	N/A	YES	REGULAR BENEFIT	Details
02194031	TRIAMCINOLONE ACETONIDE	ARISTOCORT R 0.1 % TOPICAL OINTMENT	0.1566 G	VCL	N/A	N/A	NO	REGULAR BENEFIT	Details
01964054	TRIAMCINOLONE ACETONIDE	ORACORT 0.1 % DENTAL PASTE	1.6563 G	TAR	N/A	N/A	NO	REGULAR BENEFIT	Details
00716960	TRIAMCINOLONE ACETONIDE	TRIADERM REGULAR 0.1 % TOPICAL CREAM	0.1177 G	TAR	0.1177	N/A	YES	REGULAR BENEFIT	Details
02194066	TRIAMCINOLONE ACETONIDE	ARISTOCORT C 0.5 % TOPICAL CREAM	1.3702 G	VCL	N/A	N/A	NO	REGULAR BENEFIT	Details

DIN/NPN/ PIN	02246714
Generic Name	AMCINONIDE
Product Name, Strength & Dosage Form	TARO-AMCINONIDE 0.1 % TOPICAL CREAM
Unit Price, Unit of Issue	0.4522
Manufacturer	TAR
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02089602
Generic Name	BECLOMETHASONE DIPROPIONATE
Product Name, Strength & Dosage Form	PROPADERM 250 MCG / G TOPICAL CREAM
Unit Price, Unit of Issue	0.5138
Manufacturer	VCL
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00629367
Generic Name	BETAMETHASONE DIPROPIONATE
Product Name, Strength & Dosage Form	DIPROLENE GLYCOL 0.05 % TOPICAL GLYCOL OINTMENT
Unit Price, Unit of Issue	0.5186
Manufacturer	ORC
LCA Price	0.5186
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00323071
Generic Name	BETAMETHASONE DIPROPIONATE
Product Name, Strength & Dosage Form	DIPROSONE 0.05 % TOPICAL CREAM
Unit Price, Unit of Issue	0.2114
Manufacturer	ORC
LCA Price	0.2046
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00417246
Generic Name	BETAMETHASONE DIPROPIONATE
Product Name, Strength & Dosage Form	DIPROSONE 0.05 % TOPICAL LOTION
Unit Price, Unit of Issue	0.2044
Manufacturer	ORC
LCA Price	0.2022
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00344923
Generic Name	BETAMETHASONE DIPROPIONATE
Product Name, Strength & Dosage Form	DIPROSONE 0.05 % TOPICAL OINTMENT
Unit Price, Unit of Issue	0.2221
Manufacturer	ORC
LCA Price	0.2186
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00849650
Generic Name	BETAMETHASONE DIPROPIONATE
Product Name, Strength & Dosage Form	TEVA-TOPILENE 0.05 % TOPICAL GLYCOL CREAM
Unit Price, Unit of Issue	0.5186
Manufacturer	TEV
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	01927914
Generic Name	BETAMETHASONE DIPROPIONATE
Product Name, Strength & Dosage Form	TEVA-TOPILENE 0.05 % TOPICAL GLYCOL LOTION
Unit Price, Unit of Issue	0.2832
Manufacturer	TEV
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00849669
Generic Name	BETAMETHASONE DIPROPIONATE
Product Name, Strength & Dosage Form	TEVA-TOPILENE 0.05 % TOPICAL GLYCOL OINTMENT
Unit Price, Unit of Issue	0.5186
Manufacturer	TEV
LCA Price	0.5186
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00804991
Generic Name	BETAMETHASONE DIPROPIONATE
Product Name, Strength & Dosage Form	TEVA-TOPISONE 0.05 % TOPICAL CREAM
Unit Price, Unit of Issue	0.2046
Manufacturer	TEV
LCA Price	0.2046
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00809187
Generic Name	BETAMETHASONE DIPROPIONATE
Product Name, Strength & Dosage Form	TEVA-TOPISONE 0.05 % TOPICAL LOTION
Unit Price, Unit of Issue	0.2022
Manufacturer	TEV
LCA Price	0.2022
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00805009
Generic Name	BETAMETHASONE DIPROPIONATE
Product Name, Strength & Dosage Form	TEVA-TOPISONE 0.05 % TOPICAL OINTMENT
Unit Price, Unit of Issue	0.2186
Manufacturer	TEV
LCA Price	0.2186
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00611174
Generic Name	BETAMETHASONE DIPROPIONATE/ CLOTRIMAZOLE
Product Name, Strength & Dosage Form	LOTRIDERM 0.05 % * 1 % TOPICAL CREAM
Unit Price, Unit of Issue	0.8650
Manufacturer	ORC
LCA Price	0.6964
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02496410
Generic Name	BETAMETHASONE DIPROPIONATE/ CLOTRIMAZOLE
Product Name, Strength & Dosage Form	TARO-CLOTRIMAZOLE/BETAMETHASONE 0.05 % * 1 % TOPICAL CREAM
Unit Price, Unit of Issue	0.6964
Manufacturer	TAR
LCA Price	0.6964
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00578436
Generic Name	BETAMETHASONE DIPROPIONATE/ SALICYLIC ACID
Product Name, Strength & Dosage Form	DIPROSALIC 0.5 MG / G * 30 MG / G TOPICAL OINTMENT
Unit Price, Unit of Issue	0.9084
Manufacturer	ORC
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02245688
Generic Name	BETAMETHASONE DIPROPIONATE/ SALICYLIC ACID
Product Name, Strength & Dosage Form	RATIO-TOPISALIC 0.5 MG / ML * 20 MG / ML TOPICAL LOTION
Unit Price, Unit of Issue	0.4512
Manufacturer	TEV
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00716618
Generic Name	BETAMETHASONE VALERATE
Product Name, Strength & Dosage Form	BETADERM MILD 0.05 % TOPICAL CREAM
Unit Price, Unit of Issue	0.0596
Manufacturer	TAR
LCA Price	0.0596
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00716642
Generic Name	BETAMETHASONE VALERATE
Product Name, Strength & Dosage Form	BETADERM MILD 0.05 % TOPICAL OINTMENT
Unit Price, Unit of Issue	0.0781
Manufacturer	TAR
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00535427
Generic Name	BETAMETHASONE VALERATE
Product Name, Strength & Dosage Form	TEVA-ECTOSONE MILD 0.05 % TOPICAL CREAM
Unit Price, Unit of Issue	0.0596
Manufacturer	TEV
LCA Price	0.0596
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00653209
Generic Name	BETAMETHASONE VALERATE
Product Name, Strength & Dosage Form	TEVA-ECTOSONE MILD 0.05 % TOPICAL LOTION
Unit Price, Unit of Issue	0.2846
Manufacturer	TEV
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00716626
Generic Name	BETAMETHASONE VALERATE
Product Name, Strength & Dosage Form	BETADERM REGULAR 0.1 % TOPICAL CREAM
Unit Price, Unit of Issue	0.0889
Manufacturer	TAR
LCA Price	0.0889
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00716650
Generic Name	BETAMETHASONE VALERATE
Product Name, Strength & Dosage Form	BETADERM REGULAR 0.1 % TOPICAL OINTMENT
Unit Price, Unit of Issue	0.1165
Manufacturer	TAR
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02357852
Generic Name	BETAMETHASONE VALERATE
Product Name, Strength & Dosage Form	CELESTODERM-V 0.1 % TOPICAL OINTMENT
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	00535435
Generic Name	BETAMETHASONE VALERATE
Product Name, Strength & Dosage Form	TEVA-ECTOSONE REGULAR 0.1 % TOPICAL CREAM
Unit Price, Unit of Issue	0.0889
Manufacturer	TEV
LCA Price	0.0889
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00750050
Generic Name	BETAMETHASONE VALERATE
Product Name, Strength & Dosage Form	TEVA-ECTOSONE REGULAR 0.1 % TOPICAL LOTION
Unit Price, Unit of Issue	0.3529
Manufacturer	TEV
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00653217
Generic Name	BETAMETHASONE VALERATE
Product Name, Strength & Dosage Form	TEVA-ECTOSONE SCALP 0.1 % SCALP LOTION
Unit Price, Unit of Issue	0.0853
Manufacturer	TEV
LCA Price	0.0000
MAC Price	0.0000
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02366924
Generic Name	BETAMETHASONE VALERATE
Product Name, Strength & Dosage Form	LUXIQ 0.12 % TOPICAL FOAM
Unit Price, Unit of Issue	N/A
Manufacturer	GSK
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	NOT A BENEFIT
Details

DIN/NPN/ PIN	02052431
Generic Name	BUDESONIDE
Product Name, Strength & Dosage Form	ENTOCORT (115 ML) 2.3 MG / ENM RECTAL ENEMA
Unit Price, Unit of Issue	10.8035
Manufacturer	TPG
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02244126
Generic Name	CALCIPOTRIOL MONOHYDRATE/ BETAMETHASONE DIPROPIONATE
Product Name, Strength & Dosage Form	DOVOBET 50 MCG / G * 0.5 MG / G TOPICAL OINTMENT
Unit Price, Unit of Issue	1.6885
Manufacturer	LEO
LCA Price	1.2545
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02427419
Generic Name	CALCIPOTRIOL MONOHYDRATE/ BETAMETHASONE DIPROPIONATE
Product Name, Strength & Dosage Form	TEVA-BETAMETHASONE/CALCIPOTRIOL 50 MCG / G * 0.5 MG / G TOPICAL OINTMENT
Unit Price, Unit of Issue	1.2545
Manufacturer	TEV
LCA Price	1.2545
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02213281
Generic Name	CLOBETASOL 17-PROPIONATE
Product Name, Strength & Dosage Form	DERMOVATE 0.05 % SCALP LOTION
Unit Price, Unit of Issue	0.8303
Manufacturer	TPT
LCA Price	0.0000
MAC Price	0.0000
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02213265
Generic Name	CLOBETASOL 17-PROPIONATE
Product Name, Strength & Dosage Form	DERMOVATE 0.05 % TOPICAL CREAM
Unit Price, Unit of Issue	1.0353
Manufacturer	TPT
LCA Price	0.2279
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02213273
Generic Name	CLOBETASOL 17-PROPIONATE
Product Name, Strength & Dosage Form	DERMOVATE 0.05 % TOPICAL OINTMENT
Unit Price, Unit of Issue	1.0353
Manufacturer	TPT
LCA Price	0.2279
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02216213
Generic Name	CLOBETASOL 17-PROPIONATE
Product Name, Strength & Dosage Form	MYLAN-CLOBETASOL 0.05 % SCALP LOTION
Unit Price, Unit of Issue	0.1990
Manufacturer	MYP
LCA Price	0.0000
MAC Price	0.0000
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02024187
Generic Name	CLOBETASOL 17-PROPIONATE
Product Name, Strength & Dosage Form	MYLAN-CLOBETASOL 0.05 % TOPICAL CREAM
Unit Price, Unit of Issue	0.2279
Manufacturer	MYP
LCA Price	0.2279
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02026767
Generic Name	CLOBETASOL 17-PROPIONATE
Product Name, Strength & Dosage Form	MYLAN-CLOBETASOL 0.05 % TOPICAL OINTMENT
Unit Price, Unit of Issue	0.2279
Manufacturer	MYP
LCA Price	0.2279
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02245522
Generic Name	CLOBETASOL 17-PROPIONATE
Product Name, Strength & Dosage Form	TARO-CLOBETASOL 0.05 % SCALP LOTION
Unit Price, Unit of Issue	0.1990
Manufacturer	TAR
LCA Price	0.0000
MAC Price	0.0000
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02245523
Generic Name	CLOBETASOL 17-PROPIONATE
Product Name, Strength & Dosage Form	TARO-CLOBETASOL 0.05 % TOPICAL CREAM
Unit Price, Unit of Issue	0.2279
Manufacturer	TAR
LCA Price	0.2279
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02245524
Generic Name	CLOBETASOL 17-PROPIONATE
Product Name, Strength & Dosage Form	TARO-CLOBETASOL 0.05 % TOPICAL OINTMENT
Unit Price, Unit of Issue	0.2279
Manufacturer	TAR
LCA Price	0.2279
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	01910299
Generic Name	CLOBETASOL 17-PROPIONATE
Product Name, Strength & Dosage Form	TEVA-CLOBETASOL 0.05 % SCALP LOTION
Unit Price, Unit of Issue	0.1990
Manufacturer	TEV
LCA Price	0.0000
MAC Price	0.0000
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	01910272
Generic Name	CLOBETASOL 17-PROPIONATE
Product Name, Strength & Dosage Form	TEVA-CLOBETASOL 0.05 % TOPICAL CREAM
Unit Price, Unit of Issue	0.2279
Manufacturer	TEV
LCA Price	0.2279
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	01910280
Generic Name	CLOBETASOL 17-PROPIONATE
Product Name, Strength & Dosage Form	TEVA-CLOBETASOL 0.05 % TOPICAL OINTMENT
Unit Price, Unit of Issue	0.2279
Manufacturer	TEV
LCA Price	0.2279
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00999110
Generic Name	COMPOUND PRESCRIPTION
Product Name, Strength & Dosage Form	COMBINATION ANTI-INFECTIVE /CORTICOSTEROID
Unit Price, Unit of Issue	0.0000
Manufacturer	XXX
LCA Price	0.0000
MAC Price	0.0000
Interchangeable Products	NO
Coverage Status	RESTRICTED BENEFIT
Details

DIN/NPN/ PIN	00999211
Generic Name	COMPOUND PRESCRIPTION
Product Name, Strength & Dosage Form	COMBINATION ANTI-INFECTIVE/CORTICOSTEROID
Unit Price, Unit of Issue	0.0000
Manufacturer	XXX
LCA Price	0.0000
MAC Price	0.0000
Interchangeable Products	NO
Coverage Status	RESTRICTED BENEFIT
Details

DIN/NPN/ PIN	00999107
Generic Name	COMPOUND PRESCRIPTION
Product Name, Strength & Dosage Form	COMPOUND-CORTICOSTEROIDS - TOPICAL TOPICAL
Unit Price, Unit of Issue	0.0000
Manufacturer	XXX
LCA Price	0.0000
MAC Price	0.0000
Interchangeable Products	NO
Coverage Status	RESTRICTED BENEFIT
Details

DIN/NPN/ PIN	00999207
Generic Name	COMPOUND PRESCRIPTION
Product Name, Strength & Dosage Form	COMPOUND-CORTICOSTEROIDS - TOPICAL TOPICAL
Unit Price, Unit of Issue	0.0000
Manufacturer	XXX
LCA Price	0.0000
MAC Price	0.0000
Interchangeable Products	NO
Coverage Status	RESTRICTED BENEFIT
Details

DIN/NPN/ PIN	02229315
Generic Name	DESONIDE
Product Name, Strength & Dosage Form	PDP-DESONIDE 0.05 % TOPICAL CREAM
Unit Price, Unit of Issue	0.4267
Manufacturer	PPH
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02229323
Generic Name	DESONIDE
Product Name, Strength & Dosage Form	PDP-DESONIDE 0.05 % TOPICAL OINTMENT
Unit Price, Unit of Issue	0.4526
Manufacturer	PPH
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02221918
Generic Name	DESOXIMETASONE
Product Name, Strength & Dosage Form	TOPICORT MILD 0.05 % TOPICAL CREAM
Unit Price, Unit of Issue	0.5687
Manufacturer	VCL
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02221896
Generic Name	DESOXIMETASONE
Product Name, Strength & Dosage Form	TOPICORT 0.25 % TOPICAL CREAM
Unit Price, Unit of Issue	0.8002
Manufacturer	VCL
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00716863
Generic Name	FLUOCINONIDE
Product Name, Strength & Dosage Form	LYDERM 0.05 % TOPICAL CREAM
Unit Price, Unit of Issue	0.2783
Manufacturer	TPT
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02236997
Generic Name	FLUOCINONIDE
Product Name, Strength & Dosage Form	LYDERM 0.05 % TOPICAL GEL
Unit Price, Unit of Issue	0.3806
Manufacturer	TPT
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02236996
Generic Name	FLUOCINONIDE
Product Name, Strength & Dosage Form	LYDERM 0.05 % TOPICAL OINTMENT
Unit Price, Unit of Issue	0.3645
Manufacturer	TPT
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00598933
Generic Name	FLUOCINONIDE
Product Name, Strength & Dosage Form	TIAMOL 0.05 % TOPICAL EMOLLIENT CREAM
Unit Price, Unit of Issue	0.2468
Manufacturer	TPT
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02506262
Generic Name	HALOBETASOL PROPIONATE
Product Name, Strength & Dosage Form	BRYHALI 0.01 % TOPICAL LOTION
Unit Price, Unit of Issue	0.9816
Manufacturer	VCL
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	01962701
Generic Name	HALOBETASOL PROPIONATE
Product Name, Strength & Dosage Form	ULTRAVATE 0.05 % TOPICAL CREAM
Unit Price, Unit of Issue	1.0852
Manufacturer	VCL
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02499967
Generic Name	HALOBETASOL PROPIONATE/ TAZAROTENE
Product Name, Strength & Dosage Form	DUOBRII 0.01 % * 0.045 % TOPICAL LOTION
Unit Price, Unit of Issue	1.9300
Manufacturer	VCL
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	00716685
Generic Name	HYDROCORTISONE
Product Name, Strength & Dosage Form	CORTODERM MILD 0.5 % TOPICAL OINTMENT
Unit Price, Unit of Issue	0.2113
Manufacturer	TAR
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00716693
Generic Name	HYDROCORTISONE
Product Name, Strength & Dosage Form	CORTODERM REGULAR 1 % TOPICAL OINTMENT
Unit Price, Unit of Issue	0.0658
Manufacturer	TAR
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	80057191
Generic Name	HYDROCORTISONE
Product Name, Strength & Dosage Form	JAMP-HYDROCORTISONE 1 % TOPICAL LOTION
Unit Price, Unit of Issue	0.1191
Manufacturer	JPC
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	80057178
Generic Name	HYDROCORTISONE
Product Name, Strength & Dosage Form	JAMP-HYDROCORTISONE ACETATE 1 % TOPICAL CREAM
Unit Price, Unit of Issue	0.0875
Manufacturer	JPC
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02412926
Generic Name	HYDROCORTISONE
Product Name, Strength & Dosage Form	SANDOZ HYDROCORTISONE 1 % TOPICAL CREAM
Unit Price, Unit of Issue	N/A
Manufacturer	SDZ
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	NOT A BENEFIT
Details

DIN/NPN/ PIN	02242984
Generic Name	HYDROCORTISONE 17-VALERATE
Product Name, Strength & Dosage Form	HYDROVAL 0.2 % TOPICAL CREAM
Unit Price, Unit of Issue	0.1750
Manufacturer	TPT
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02242985
Generic Name	HYDROCORTISONE 17-VALERATE
Product Name, Strength & Dosage Form	HYDROVAL 0.2 % TOPICAL OINTMENT
Unit Price, Unit of Issue	0.1877
Manufacturer	TPT
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00716820
Generic Name	HYDROCORTISONE ACETATE
Product Name, Strength & Dosage Form	HYDERM 0.5 % TOPICAL CREAM
Unit Price, Unit of Issue	0.2150
Manufacturer	TAR
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00716839
Generic Name	HYDROCORTISONE ACETATE
Product Name, Strength & Dosage Form	HYDERM 1 % TOPICAL CREAM
Unit Price, Unit of Issue	0.0533
Manufacturer	TAR
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00363014
Generic Name	HYDROCORTISONE ACETATE/ PRAMOXINE HCL
Product Name, Strength & Dosage Form	PROCTOFOAM-HC 1 % * 1 % RECTAL FOAM
Unit Price, Unit of Issue	1.7857
Manufacturer	DUI
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02234466
Generic Name	HYDROCORTISONE ACETATE/ PRAMOXINE HCL/ ZINC SULFATE
Product Name, Strength & Dosage Form	PROCTODAN-HC 0.5 % * 1 % * 0.5 % RECTAL OINTMENT
Unit Price, Unit of Issue	1.2861
Manufacturer	ODN
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02240851
Generic Name	HYDROCORTISONE ACETATE/ PRAMOXINE HCL/ ZINC SULFATE
Product Name, Strength & Dosage Form	PROCTODAN-HC 10 MG * 20 MG * 10 MG RECTAL SUPPOSITORY
Unit Price, Unit of Issue	1.9847
Manufacturer	ODN
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00681989
Generic Name	HYDROCORTISONE ACETATE/ UREA
Product Name, Strength & Dosage Form	DERMAFLEX HC 1 % * 10 % TOPICAL CREAM
Unit Price, Unit of Issue	0.2021
Manufacturer	PAL
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00681997
Generic Name	HYDROCORTISONE ACETATE/ UREA
Product Name, Strength & Dosage Form	DERMAFLEX HC 1 % * 10 % TOPICAL LOTION
Unit Price, Unit of Issue	0.1137
Manufacturer	PAL
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	80061501
Generic Name	HYDROCORTISONE ACETATE/ UREA
Product Name, Strength & Dosage Form	JAMP-HYDROCORTISONE ACETATE/UREA 1 % * 10 % TOPICAL CREAM
Unit Price, Unit of Issue	0.0915
Manufacturer	JPC
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	80073645
Generic Name	HYDROCORTISONE ACETATE/ UREA
Product Name, Strength & Dosage Form	M-HC/UREA 1 % * 10 % TOPICAL CREAM
Unit Price, Unit of Issue	0.0915
Manufacturer	MTR
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02128446
Generic Name	HYDROCORTISONE ACETATE/ ZINC SULFATE
Product Name, Strength & Dosage Form	ANODAN-HC 0.5 % * 0.5 % RECTAL OINTMENT
Unit Price, Unit of Issue	0.3850
Manufacturer	ODN
LCA Price	0.3850
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02387239
Generic Name	HYDROCORTISONE ACETATE/ ZINC SULFATE
Product Name, Strength & Dosage Form	JAMPZINC-HC 0.5 % * 0.5 % RECTAL OINTMENT
Unit Price, Unit of Issue	0.3850
Manufacturer	JPC
LCA Price	0.3850
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02236399
Generic Name	HYDROCORTISONE ACETATE/ ZINC SULFATE
Product Name, Strength & Dosage Form	ANODAN-HC 10 MG * 10 MG RECTAL SUPPOSITORY
Unit Price, Unit of Issue	0.9506
Manufacturer	ODN
LCA Price	0.9506
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02247882
Generic Name	HYDROCORTISONE/ CINCHOCAINE HCL/ FRAMYCETIN SULFATE/ ESCULIN
Product Name, Strength & Dosage Form	PROCTOL 5 MG * 5 MG * 10 MG * 10 MG RECTAL SUPPOSITORY
Unit Price, Unit of Issue	1.3708
Manufacturer	ODN
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02247322
Generic Name	HYDROCORTISONE/ CINCHOCAINE HCL/ FRAMYCETIN SULFATE/ ESCULIN
Product Name, Strength & Dosage Form	PROCTOL 5 MG / G * 5 MG / G * 10 MG / G * 10 MG / G RECTAL OINTMENT
Unit Price, Unit of Issue	0.7712
Manufacturer	ODN
LCA Price	0.7712
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02223252
Generic Name	HYDROCORTISONE/ CINCHOCAINE HCL/ FRAMYCETIN SULFATE/ ESCULIN
Product Name, Strength & Dosage Form	PROCTOSEDYL 5 MG / G * 5 MG / G * 10 MG / G * 10 MG / G RECTAL OINTMENT
Unit Price, Unit of Issue	0.9073
Manufacturer	AXC
LCA Price	0.7712
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02226383
Generic Name	HYDROCORTISONE/ CINCHOCAINE HCL/ FRAMYCETIN SULFATE/ ESCULIN
Product Name, Strength & Dosage Form	TEVA-PROCTOSONE 5 MG / G * 5 MG / G * 10 MG / G * 10 MG / G RECTAL OINTMENT
Unit Price, Unit of Issue	0.4000
Manufacturer	TEV
LCA Price	0.7712
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00851744
Generic Name	MOMETASONE FUROATE
Product Name, Strength & Dosage Form	ELOCOM 0.1 % TOPICAL CREAM
Unit Price, Unit of Issue	0.7393
Manufacturer	ORC
LCA Price	0.6296
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00871095
Generic Name	MOMETASONE FUROATE
Product Name, Strength & Dosage Form	ELOCOM 0.1 % TOPICAL LOTION
Unit Price, Unit of Issue	0.4992
Manufacturer	ORC
LCA Price	0.4178
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00851736
Generic Name	MOMETASONE FUROATE
Product Name, Strength & Dosage Form	ELOCOM 0.1 % TOPICAL OINTMENT
Unit Price, Unit of Issue	0.6698
Manufacturer	ORC
LCA Price	0.6013
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02367157
Generic Name	MOMETASONE FUROATE
Product Name, Strength & Dosage Form	TARO-MOMETASONE 0.1 % TOPICAL CREAM
Unit Price, Unit of Issue	0.6296
Manufacturer	TAR
LCA Price	0.6296
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02266385
Generic Name	MOMETASONE FUROATE
Product Name, Strength & Dosage Form	TARO-MOMETASONE 0.1 % TOPICAL LOTION
Unit Price, Unit of Issue	0.4178
Manufacturer	TAR
LCA Price	0.4178
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02248130
Generic Name	MOMETASONE FUROATE
Product Name, Strength & Dosage Form	TEVA-MOMETASONE 0.1 % TOPICAL OINTMENT
Unit Price, Unit of Issue	0.6013
Manufacturer	TEV
LCA Price	0.6013
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02194058
Generic Name	TRIAMCINOLONE ACETONIDE
Product Name, Strength & Dosage Form	ARISTOCORT R 0.1 % TOPICAL CREAM
Unit Price, Unit of Issue	0.1549
Manufacturer	VCL
LCA Price	0.1177
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02194031
Generic Name	TRIAMCINOLONE ACETONIDE
Product Name, Strength & Dosage Form	ARISTOCORT R 0.1 % TOPICAL OINTMENT
Unit Price, Unit of Issue	0.1566
Manufacturer	VCL
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	01964054
Generic Name	TRIAMCINOLONE ACETONIDE
Product Name, Strength & Dosage Form	ORACORT 0.1 % DENTAL PASTE
Unit Price, Unit of Issue	1.6563
Manufacturer	TAR
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	00716960
Generic Name	TRIAMCINOLONE ACETONIDE
Product Name, Strength & Dosage Form	TRIADERM REGULAR 0.1 % TOPICAL CREAM
Unit Price, Unit of Issue	0.1177
Manufacturer	TAR
LCA Price	0.1177
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	REGULAR BENEFIT
Details

DIN/NPN/ PIN	02194066
Generic Name	TRIAMCINOLONE ACETONIDE
Product Name, Strength & Dosage Form	ARISTOCORT C 0.5 % TOPICAL CREAM
Unit Price, Unit of Issue	1.3702
Manufacturer	VCL
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	REGULAR BENEFIT
Details

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