Home Health iDBL
Interactive Drug Benefit List
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 Details
02417200 ALOGLIPTIN BENZOATE NESINA 25 MG ORAL TABLET N/A
TAB 		TAK N/A N/A NO NOT A BENEFIT Details
02417189 ALOGLIPTIN BENZOATE NESINA 6.25 MG ORAL TABLET N/A
TAB 		TAK N/A N/A NO NOT A BENEFIT Details
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 Details
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 Details
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 Details
02370921 LINAGLIPTIN TRAJENTA 5 MG ORAL TABLET 2.6863
TAB 		BOE N/A N/A NO STEP THERAPY/ SPECIAL AUTHORIZATION Details
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 Details
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 Details
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 Details
02507471 SAXAGLIPTIN HCL APO-SAXAGLIPTIN 2.5 MG ORAL TABLET 1.2650
TAB 		APX 1.2650 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02375842 SAXAGLIPTIN HCL ONGLYZA 2.5 MG ORAL TABLET 2.7173
TAB 		AZC 1.2650 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02468603 SAXAGLIPTIN HCL SANDOZ SAXAGLIPTIN 2.5 MG ORAL TABLET 1.2650
TAB 		SDZ 1.2650 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02507498 SAXAGLIPTIN HCL APO-SAXAGLIPTIN 5 MG ORAL TABLET 1.5195
TAB 		APX 1.5195 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02333554 SAXAGLIPTIN HCL ONGLYZA 5 MG ORAL TABLET 3.2225
TAB 		AZC 1.5195 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02468611 SAXAGLIPTIN HCL SANDOZ SAXAGLIPTIN 5 MG ORAL TABLET 1.5195
TAB 		SDZ 1.5195 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
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 Details
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 Details
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 Details
02512491 SITAGLIPTIN ACH-SITAGLIPTIN 100 MG ORAL TABLET 0.8197
TAB 		AHI 0.8197 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02508672 SITAGLIPTIN APO-SITAGLIPTIN MALATE 100 MG ORAL TABLET 0.8197
TAB 		APX 0.8197 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02529882 SITAGLIPTIN AURO-SITAGLIPTIN 100 MG ORAL TABLET 0.8197
TAB 		AUR 0.8197 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02534150 SITAGLIPTIN JAMP SITAGLIPTIN 100 MG ORAL TABLET 0.8197
TAB 		JPC 0.8197 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02303922 SITAGLIPTIN JANUVIA 100 MG ORAL TABLET 3.2229
TAB 		MFC 0.8197 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02504065 SITAGLIPTIN SANDOZ SITAGLIPTIN 100 MG ORAL TABLET 0.8197
TAB 		SDZ 0.8197 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02529068 SITAGLIPTIN SITAGLIPTIN 100 MG ORAL TABLET 0.8197
TAB 		SIV 0.8197 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02531666 SITAGLIPTIN TARO-SITAGLIPTIN FUMARATE 100 MG ORAL TABLET 0.8197
TAB 		TAR 0.8197 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02522721 SITAGLIPTIN TEVA-SITAGLIPTIN MALATE 100 MG ORAL TABLET N/A
TAB 		TEV N/A N/A YES UNDER REVIEW Details
02512475 SITAGLIPTIN ACH-SITAGLIPTIN 25 MG ORAL TABLET 0.8197
TAB 		AHI 0.8197 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02508656 SITAGLIPTIN APO-SITAGLIPTIN MALATE 25 MG ORAL TABLET 0.8197
TAB 		APX 0.8197 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02529866 SITAGLIPTIN AURO-SITAGLIPTIN 25 MG ORAL TABLET 0.8197
TAB 		AUR 0.8197 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02534134 SITAGLIPTIN JAMP SITAGLIPTIN 25 MG ORAL TABLET 0.8197
TAB 		JPC 0.8197 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02388839 SITAGLIPTIN JANUVIA 25 MG ORAL TABLET 3.2229
TAB 		MFC 0.8197 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02504049 SITAGLIPTIN SANDOZ SITAGLIPTIN 25 MG ORAL TABLET 0.8197
TAB 		SDZ 0.8197 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02529033 SITAGLIPTIN SITAGLIPTIN 25 MG ORAL TABLET 0.8197
TAB 		SIV 0.8197 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02531631 SITAGLIPTIN TARO-SITAGLIPTIN FUMARATE 25 MG ORAL TABLET 0.8197
TAB 		TAR 0.8197 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02522705 SITAGLIPTIN TEVA-SITAGLIPTIN MALATE 25 MG ORAL TABLET N/A
TAB 		TEV N/A N/A YES UNDER REVIEW Details
02512483 SITAGLIPTIN ACH-SITAGLIPTIN 50 MG ORAL TABLET 0.8197
TAB 		AHI 0.8197 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02508664 SITAGLIPTIN APO-SITAGLIPTIN MALATE 50 MG ORAL TABLET 0.8197
TAB 		APX 0.8197 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02529874 SITAGLIPTIN AURO-SITAGLIPTIN 50 MG ORAL TABLET 0.8197
TAB 		AUR 0.8197 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02534142 SITAGLIPTIN JAMP SITAGLIPTIN 50 MG ORAL TABLET 0.8197
TAB 		JPC 0.8197 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02388847 SITAGLIPTIN JANUVIA 50 MG ORAL TABLET 3.2229
TAB 		MFC 0.8197 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02504057 SITAGLIPTIN SANDOZ SITAGLIPTIN 50 MG ORAL TABLET 0.8197
TAB 		SDZ 0.8197 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02529041 SITAGLIPTIN SITAGLIPTIN 50 MG ORAL TABLET 0.8197
TAB 		SIV 0.8197 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02531658 SITAGLIPTIN TARO-SITAGLIPTIN FUMARATE 50 MG ORAL TABLET 0.8197
TAB 		TAR 0.8197 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02522713 SITAGLIPTIN TEVA-SITAGLIPTIN MALATE 50 MG ORAL TABLET N/A
TAB 		TEV N/A N/A YES UNDER REVIEW Details
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 Details
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 Details
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 Details
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 Details
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 Details
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 Details
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 Details
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 Details
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 Details
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 Details
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 Details
02333856 SITAGLIPTIN/ METFORMIN HCL JANUMET 50 MG * 500 MG ORAL TABLET 1.7465
TAB 		MFC 0.8893 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
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 Details
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 Details
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 Details
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 Details
02333864 SITAGLIPTIN/ METFORMIN HCL JANUMET 50 MG * 850 MG ORAL TABLET 1.7465
TAB 		MFC 0.0000 0.0000 YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
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 Details
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 N/A
Manufacturer TEV
LCA Price N/A
MAC Price N/A
Interchangeable Products YES
Coverage Status UNDER REVIEW
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 N/A
Manufacturer TEV
LCA Price N/A
MAC Price N/A
Interchangeable Products YES
Coverage Status UNDER REVIEW
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 N/A
Manufacturer TEV
LCA Price N/A
MAC Price N/A
Interchangeable Products YES
Coverage Status UNDER REVIEW
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
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The DBL, DBS and related publications require knowledgeable interpretation and are intended primarily for professional health care practitioners, pharmacies, hospitals and organizations associated with the manufacture, distribution and use of pharmaceutical preparations.
Electronic versions of all DBL and DBS related publications are unofficial versions and are provided for convenience and private use only. Official paper versions can be obtained from Alberta Blue Cross who publishes them on behalf of Alberta Health and Alberta Human Services.
Alberta Health reserves the right to make changes, without notice, to the List through the Interactive DBL(iDBL), and any such changes to the Interactive DBL(iDBL) are effective the date of the change (unless otherwise stated) and regardless of the date of publication in the paper version or updates.