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