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
02293269 ACAMPROSATE CALCIUM CAMPRAL 333 MG ORAL DELAYED-RELEASE TABLET 0.8996
TAB 		MYP N/A N/A NO SPECIAL AUTHORIZATION Details
02503034 AMIFAMPRIDINE RUZURGI 10 MG ORAL TABLET 20.0000
TAB 		MDK N/A N/A NO SPECIAL AUTHORIZATION Details
02318024 ATOMOXETINE HCL APO-ATOMOXETINE 10 MG ORAL CAPSULE 0.5106
CAP 		APX 0.5106 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02445883 ATOMOXETINE HCL ATOMOXETINE 10 MG ORAL CAPSULE 0.5106
CAP 		SIV 0.5106 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02467747 ATOMOXETINE HCL ATOMOXETINE 10 MG ORAL CAPSULE 0.5106
CAP 		SNS 0.5106 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02471485 ATOMOXETINE HCL AURO-ATOMOXETINE 10 MG ORAL CAPSULE N/A
CAP 		AUR N/A N/A YES UNDER REVIEW Details
02506807 ATOMOXETINE HCL JAMP ATOMOXETINE 10 MG ORAL CAPSULE 0.5106
CAP 		JPC 0.5106 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02381028 ATOMOXETINE HCL PMS-ATOMOXETINE 10 MG ORAL CAPSULE 0.5106
CAP 		PMS 0.5106 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02386410 ATOMOXETINE HCL SANDOZ ATOMOXETINE 10 MG ORAL CAPSULE 0.5106
CAP 		SDZ 0.5106 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02262800 ATOMOXETINE HCL STRATTERA 10 MG ORAL CAPSULE N/A
CAP 		LIL N/A N/A YES NOT A BENEFIT Details
02314541 ATOMOXETINE HCL TEVA-ATOMOXETINE 10 MG ORAL CAPSULE 0.5106
CAP 		TEV 0.5106 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02318083 ATOMOXETINE HCL APO-ATOMOXETINE 100 MG ORAL CAPSULE 1.3382
CAP 		APX 1.3382 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02467828 ATOMOXETINE HCL ATOMOXETINE 100 MG ORAL CAPSULE 1.3382
CAP 		SNS 1.3382 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02471558 ATOMOXETINE HCL AURO-ATOMOXETINE 100 MG ORAL CAPSULE N/A
CAP 		AUR N/A N/A YES UNDER REVIEW Details
02506874 ATOMOXETINE HCL JAMP ATOMOXETINE 100 MG ORAL CAPSULE 1.3382
CAP 		JPC 1.3382 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02386488 ATOMOXETINE HCL SANDOZ ATOMOXETINE 100 MG ORAL CAPSULE 1.3382
CAP 		SDZ 1.3382 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02318032 ATOMOXETINE HCL APO-ATOMOXETINE 18 MG ORAL CAPSULE 0.5748
CAP 		APX 0.5748 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02445905 ATOMOXETINE HCL ATOMOXETINE 18 MG ORAL CAPSULE 0.5748
CAP 		SIV 0.5748 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02467755 ATOMOXETINE HCL ATOMOXETINE 18 MG ORAL CAPSULE 0.5748
CAP 		SNS 0.5748 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02471493 ATOMOXETINE HCL AURO-ATOMOXETINE 18 MG ORAL CAPSULE N/A
CAP 		AUR N/A N/A YES UNDER REVIEW Details
02506815 ATOMOXETINE HCL JAMP ATOMOXETINE 18 MG ORAL CAPSULE 0.5748
CAP 		JPC 0.5748 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02381036 ATOMOXETINE HCL PMS-ATOMOXETINE 18 MG ORAL CAPSULE 0.5748
CAP 		PMS 0.5748 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02386429 ATOMOXETINE HCL SANDOZ ATOMOXETINE 18 MG ORAL CAPSULE 0.5748
CAP 		SDZ 0.5748 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02262819 ATOMOXETINE HCL STRATTERA 18 MG ORAL CAPSULE N/A
CAP 		LIL N/A N/A YES NOT A BENEFIT Details
02314568 ATOMOXETINE HCL TEVA-ATOMOXETINE 18 MG ORAL CAPSULE 0.5748
CAP 		TEV 0.5748 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02318040 ATOMOXETINE HCL APO-ATOMOXETINE 25 MG ORAL CAPSULE 0.6420
CAP 		APX 0.6420 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02445913 ATOMOXETINE HCL ATOMOXETINE 25 MG ORAL CAPSULE 0.6420
CAP 		SIV 0.6420 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02467763 ATOMOXETINE HCL ATOMOXETINE 25 MG ORAL CAPSULE 0.6420
CAP 		SNS 0.6420 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02471507 ATOMOXETINE HCL AURO-ATOMOXETINE 25 MG ORAL CAPSULE N/A
CAP 		AUR N/A N/A YES UNDER REVIEW Details
02506823 ATOMOXETINE HCL JAMP ATOMOXETINE 25 MG ORAL CAPSULE 0.6420
CAP 		JPC 0.6420 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02381044 ATOMOXETINE HCL PMS-ATOMOXETINE 25 MG ORAL CAPSULE 0.6420
CAP 		PMS 0.6420 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02386437 ATOMOXETINE HCL SANDOZ ATOMOXETINE 25 MG ORAL CAPSULE 0.6420
CAP 		SDZ 0.6420 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02262827 ATOMOXETINE HCL STRATTERA 25 MG ORAL CAPSULE N/A
CAP 		LIL N/A N/A YES NOT A BENEFIT Details
02314576 ATOMOXETINE HCL TEVA-ATOMOXETINE 25 MG ORAL CAPSULE 0.6420
CAP 		TEV 0.6420 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02318059 ATOMOXETINE HCL APO-ATOMOXETINE 40 MG ORAL CAPSULE 0.7369
CAP 		APX 0.7369 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02445948 ATOMOXETINE HCL ATOMOXETINE 40 MG ORAL CAPSULE 0.7369
CAP 		SIV 0.7369 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02467771 ATOMOXETINE HCL ATOMOXETINE 40 MG ORAL CAPSULE 0.7369
CAP 		SNS 0.7369 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02471515 ATOMOXETINE HCL AURO-ATOMOXETINE 40 MG ORAL CAPSULE N/A
CAP 		AUR N/A N/A YES UNDER REVIEW Details
02506831 ATOMOXETINE HCL JAMP ATOMOXETINE 40 MG ORAL CAPSULE 0.7369
CAP 		JPC 0.7369 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02381052 ATOMOXETINE HCL PMS-ATOMOXETINE 40 MG ORAL CAPSULE 0.7369
CAP 		PMS 0.7369 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02386445 ATOMOXETINE HCL SANDOZ ATOMOXETINE 40 MG ORAL CAPSULE 0.7369
CAP 		SDZ 0.7369 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02262835 ATOMOXETINE HCL STRATTERA 40 MG ORAL CAPSULE N/A
CAP 		LIL N/A N/A YES NOT A BENEFIT Details
02314584 ATOMOXETINE HCL TEVA-ATOMOXETINE 40 MG ORAL CAPSULE 0.7369
CAP 		TEV 0.7369 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02318067 ATOMOXETINE HCL APO-ATOMOXETINE 60 MG ORAL CAPSULE 0.8092
CAP 		APX 0.8092 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02467798 ATOMOXETINE HCL ATOMOXETINE 60 MG ORAL CAPSULE 0.8092
CAP 		SNS 0.8092 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02445956 ATOMOXETINE HCL ATOMOXETINE 60 MG ORAL CAPSULE 0.8092
CAP 		SIV 0.8092 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02471523 ATOMOXETINE HCL AURO-ATOMOXETINE 60 MG ORAL CAPSULE N/A
CAP 		AUR N/A N/A YES UNDER REVIEW Details
02506858 ATOMOXETINE HCL JAMP ATOMOXETINE 60 MG ORAL CAPSULE 0.8092
CAP 		JPC 0.8092 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02381060 ATOMOXETINE HCL PMS-ATOMOXETINE 60 MG ORAL CAPSULE 0.8092
CAP 		PMS 0.8092 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02386453 ATOMOXETINE HCL SANDOZ ATOMOXETINE 60 MG ORAL CAPSULE 0.8092
CAP 		SDZ 0.8092 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02262843 ATOMOXETINE HCL STRATTERA 60 MG ORAL CAPSULE N/A
CAP 		LIL N/A N/A YES NOT A BENEFIT Details
02314592 ATOMOXETINE HCL TEVA-ATOMOXETINE 60 MG ORAL CAPSULE 0.8092
CAP 		TEV 0.8092 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02318075 ATOMOXETINE HCL APO-ATOMOXETINE 80 MG ORAL CAPSULE 1.2193
CAP 		APX 1.2193 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02467801 ATOMOXETINE HCL ATOMOXETINE 80 MG ORAL CAPSULE 1.2193
CAP 		SNS 1.2193 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02471531 ATOMOXETINE HCL AURO-ATOMOXETINE 80 MG ORAL CAPSULE N/A
CAP 		AUR N/A N/A YES UNDER REVIEW Details
02506866 ATOMOXETINE HCL JAMP ATOMOXETINE 80 MG ORAL CAPSULE 1.2193
CAP 		JPC 1.2193 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02386461 ATOMOXETINE HCL SANDOZ ATOMOXETINE 80 MG ORAL CAPSULE 1.2193
CAP 		SDZ 1.2193 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02362511 ATOMOXETINE HCL TEVA-ATOMOXETINE 80 MG ORAL CAPSULE 1.2193
CAP 		TEV 1.2193 N/A YES STEP THERAPY/ SPECIAL AUTHORIZATION Details
02495341 DIMETHYL FUMARATE ACH-DIMETHYL FUMARATE 120 MG ORAL DELAYED-RELEASE CAPSULE 4.4266
CAP 		AHI 4.4266 N/A YES SPECIAL AUTHORIZATION Details
02505762 DIMETHYL FUMARATE APO-DIMETHYL FUMARATE 120 MG ORAL DELAYED-RELEASE CAPSULE 4.4266
CAP 		APX 4.4266 N/A YES SPECIAL AUTHORIZATION Details
02494809 DIMETHYL FUMARATE GLN-DIMETHYL FUMARATE 120 MG ORAL DELAYED-RELEASE CAPSULE 4.4266
CAP 		GLM 4.4266 N/A YES SPECIAL AUTHORIZATION Details
02516047 DIMETHYL FUMARATE JAMP DIMETHYL FUMARATE 120 MG ORAL DELAYED-RELEASE CAPSULE 4.4266
CAP 		JPC 4.4266 N/A YES SPECIAL AUTHORIZATION Details
02502690 DIMETHYL FUMARATE MAR-DIMETHYL FUMARATE 120 MG ORAL DELAYED-RELEASE CAPSULE 4.4266
CAP 		MAR 4.4266 N/A YES SPECIAL AUTHORIZATION Details
02497026 DIMETHYL FUMARATE PMS-DIMETHYL FUMARATE 120 MG ORAL DELAYED-RELEASE CAPSULE 4.4266
CAP 		PMS 4.4266 N/A YES SPECIAL AUTHORIZATION Details
02513781 DIMETHYL FUMARATE SANDOZ DIMETHYL FUMARATE 120 MG ORAL DELAYED-RELEASE CAPSULE 4.4266
CAP 		SDZ 4.4266 N/A YES SPECIAL AUTHORIZATION Details
02404508 DIMETHYL FUMARATE TECFIDERA 120 MG ORAL DELAYED-RELEASE CAPSULE 17.7064
CAP 		BIO 4.4266 N/A YES SPECIAL AUTHORIZATION Details
02505770 DIMETHYL FUMARATE APO-DIMETHYL FUMARATE 240 MG ORAL DELAYED-RELEASE CAPSULE 8.6888
CAP 		APX 8.6888 N/A YES SPECIAL AUTHORIZATION Details
02516055 DIMETHYL FUMARATE JAMP DIMETHYL FUMARATE 240 MG ORAL DELAYED-RELEASE CAPSULE 8.6888
CAP 		JPC 8.6888 N/A YES SPECIAL AUTHORIZATION Details
02497034 DIMETHYL FUMARATE PMS-DIMETHYL FUMARATE 240 MG ORAL DELAYED-RELEASE CAPSULE 8.6888
CAP 		PMS 8.6888 N/A YES SPECIAL AUTHORIZATION Details
02513803 DIMETHYL FUMARATE SANDOZ DIMETHYL FUMARATE 240 MG ORAL DELAYED-RELEASE CAPSULE 8.6888
CAP 		SDZ 8.6888 N/A YES SPECIAL AUTHORIZATION Details
02420201 DIMETHYL FUMARATE TECFIDERA 240 MG ORAL DELAYED-RELEASE CAPSULE N/A
CAP 		BIO N/A N/A YES NOT A BENEFIT Details
02475472 EDARAVONE RADICAVA 0.3 MG / ML INJECTION 4.7380
ML 		MIT N/A N/A NO SPECIAL AUTHORIZATION Details
02532611 EDARAVONE RADICAVA 21 MG / ML ORAL SUSPENSION 189.5200
ML 		MIT N/A N/A NO SPECIAL AUTHORIZATION Details
02481383 INOTERSEN SODIUM TEGSEDI 284 MG / SYR INJECTION SYRINGE 8,043.4874
SYR 		AKC N/A N/A NO SPECIAL AUTHORIZATION Details
02260638 MEMANTINE HYDROCHLORIDE EBIXA 10 MG ORAL TABLET N/A
TAB 		LBC N/A N/A NO NOT A BENEFIT Details
02352583 RILUZOLE APO-RILUZOLE 50 MG ORAL TABLET 3.4361
TAB 		APX 3.4361 N/A YES SPECIAL AUTHORIZATION Details
02390299 RILUZOLE MYLAN-RILUZOLE 50 MG ORAL TABLET 3.4361
TAB 		MYP 3.4361 N/A YES SPECIAL AUTHORIZATION Details
02242763 RILUZOLE RILUTEK 50 MG ORAL TABLET 10.5500
TAB 		SAV 3.4361 N/A YES SPECIAL AUTHORIZATION Details
02268272 SODIUM OXYBATE XYREM 500 MG / ML ORAL SOLUTION N/A
ML 		JAZ N/A N/A NO NOT A BENEFIT Details
02527707 SODIUM PHENYLBUTYRATE/ URSODOXICOLTAURINE ALBRIOZA 3 G * 1 G ORAL POWDER PACKET 306.7123
PCKT 		AYX N/A N/A NO SPECIAL AUTHORIZATION Details
DIN/NPN/ PIN 02293269
Generic Name ACAMPROSATE CALCIUM
Product Name, Strength & Dosage Form CAMPRAL 333 MG ORAL DELAYED-RELEASE TABLET
Unit Price, Unit of Issue 0.8996
Manufacturer MYP
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02503034
Generic Name AMIFAMPRIDINE
Product Name, Strength & Dosage Form RUZURGI 10 MG ORAL TABLET
Unit Price, Unit of Issue 20.0000
Manufacturer MDK
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02318024
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form APO-ATOMOXETINE 10 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.5106
Manufacturer APX
LCA Price 0.5106
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02445883
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form ATOMOXETINE 10 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.5106
Manufacturer SIV
LCA Price 0.5106
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02467747
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form ATOMOXETINE 10 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.5106
Manufacturer SNS
LCA Price 0.5106
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02471485
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form AURO-ATOMOXETINE 10 MG ORAL CAPSULE
Unit Price, Unit of Issue N/A
Manufacturer AUR
LCA Price N/A
MAC Price N/A
Interchangeable Products YES
Coverage Status UNDER REVIEW
Details
DIN/NPN/ PIN 02506807
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form JAMP ATOMOXETINE 10 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.5106
Manufacturer JPC
LCA Price 0.5106
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02381028
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form PMS-ATOMOXETINE 10 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.5106
Manufacturer PMS
LCA Price 0.5106
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02386410
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form SANDOZ ATOMOXETINE 10 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.5106
Manufacturer SDZ
LCA Price 0.5106
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02262800
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form STRATTERA 10 MG ORAL CAPSULE
Unit Price, Unit of Issue N/A
Manufacturer LIL
LCA Price N/A
MAC Price N/A
Interchangeable Products YES
Coverage Status NOT A BENEFIT
Details
DIN/NPN/ PIN 02314541
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form TEVA-ATOMOXETINE 10 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.5106
Manufacturer TEV
LCA Price 0.5106
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02318083
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form APO-ATOMOXETINE 100 MG ORAL CAPSULE
Unit Price, Unit of Issue 1.3382
Manufacturer APX
LCA Price 1.3382
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02467828
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form ATOMOXETINE 100 MG ORAL CAPSULE
Unit Price, Unit of Issue 1.3382
Manufacturer SNS
LCA Price 1.3382
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02471558
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form AURO-ATOMOXETINE 100 MG ORAL CAPSULE
Unit Price, Unit of Issue N/A
Manufacturer AUR
LCA Price N/A
MAC Price N/A
Interchangeable Products YES
Coverage Status UNDER REVIEW
Details
DIN/NPN/ PIN 02506874
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form JAMP ATOMOXETINE 100 MG ORAL CAPSULE
Unit Price, Unit of Issue 1.3382
Manufacturer JPC
LCA Price 1.3382
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02386488
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form SANDOZ ATOMOXETINE 100 MG ORAL CAPSULE
Unit Price, Unit of Issue 1.3382
Manufacturer SDZ
LCA Price 1.3382
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02318032
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form APO-ATOMOXETINE 18 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.5748
Manufacturer APX
LCA Price 0.5748
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02445905
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form ATOMOXETINE 18 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.5748
Manufacturer SIV
LCA Price 0.5748
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02467755
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form ATOMOXETINE 18 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.5748
Manufacturer SNS
LCA Price 0.5748
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02471493
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form AURO-ATOMOXETINE 18 MG ORAL CAPSULE
Unit Price, Unit of Issue N/A
Manufacturer AUR
LCA Price N/A
MAC Price N/A
Interchangeable Products YES
Coverage Status UNDER REVIEW
Details
DIN/NPN/ PIN 02506815
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form JAMP ATOMOXETINE 18 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.5748
Manufacturer JPC
LCA Price 0.5748
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02381036
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form PMS-ATOMOXETINE 18 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.5748
Manufacturer PMS
LCA Price 0.5748
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02386429
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form SANDOZ ATOMOXETINE 18 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.5748
Manufacturer SDZ
LCA Price 0.5748
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02262819
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form STRATTERA 18 MG ORAL CAPSULE
Unit Price, Unit of Issue N/A
Manufacturer LIL
LCA Price N/A
MAC Price N/A
Interchangeable Products YES
Coverage Status NOT A BENEFIT
Details
DIN/NPN/ PIN 02314568
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form TEVA-ATOMOXETINE 18 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.5748
Manufacturer TEV
LCA Price 0.5748
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02318040
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form APO-ATOMOXETINE 25 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.6420
Manufacturer APX
LCA Price 0.6420
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02445913
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form ATOMOXETINE 25 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.6420
Manufacturer SIV
LCA Price 0.6420
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02467763
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form ATOMOXETINE 25 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.6420
Manufacturer SNS
LCA Price 0.6420
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02471507
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form AURO-ATOMOXETINE 25 MG ORAL CAPSULE
Unit Price, Unit of Issue N/A
Manufacturer AUR
LCA Price N/A
MAC Price N/A
Interchangeable Products YES
Coverage Status UNDER REVIEW
Details
DIN/NPN/ PIN 02506823
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form JAMP ATOMOXETINE 25 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.6420
Manufacturer JPC
LCA Price 0.6420
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02381044
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form PMS-ATOMOXETINE 25 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.6420
Manufacturer PMS
LCA Price 0.6420
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02386437
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form SANDOZ ATOMOXETINE 25 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.6420
Manufacturer SDZ
LCA Price 0.6420
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02262827
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form STRATTERA 25 MG ORAL CAPSULE
Unit Price, Unit of Issue N/A
Manufacturer LIL
LCA Price N/A
MAC Price N/A
Interchangeable Products YES
Coverage Status NOT A BENEFIT
Details
DIN/NPN/ PIN 02314576
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form TEVA-ATOMOXETINE 25 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.6420
Manufacturer TEV
LCA Price 0.6420
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02318059
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form APO-ATOMOXETINE 40 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.7369
Manufacturer APX
LCA Price 0.7369
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02445948
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form ATOMOXETINE 40 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.7369
Manufacturer SIV
LCA Price 0.7369
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02467771
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form ATOMOXETINE 40 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.7369
Manufacturer SNS
LCA Price 0.7369
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02471515
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form AURO-ATOMOXETINE 40 MG ORAL CAPSULE
Unit Price, Unit of Issue N/A
Manufacturer AUR
LCA Price N/A
MAC Price N/A
Interchangeable Products YES
Coverage Status UNDER REVIEW
Details
DIN/NPN/ PIN 02506831
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form JAMP ATOMOXETINE 40 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.7369
Manufacturer JPC
LCA Price 0.7369
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02381052
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form PMS-ATOMOXETINE 40 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.7369
Manufacturer PMS
LCA Price 0.7369
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02386445
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form SANDOZ ATOMOXETINE 40 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.7369
Manufacturer SDZ
LCA Price 0.7369
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02262835
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form STRATTERA 40 MG ORAL CAPSULE
Unit Price, Unit of Issue N/A
Manufacturer LIL
LCA Price N/A
MAC Price N/A
Interchangeable Products YES
Coverage Status NOT A BENEFIT
Details
DIN/NPN/ PIN 02314584
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form TEVA-ATOMOXETINE 40 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.7369
Manufacturer TEV
LCA Price 0.7369
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02318067
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form APO-ATOMOXETINE 60 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.8092
Manufacturer APX
LCA Price 0.8092
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02467798
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form ATOMOXETINE 60 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.8092
Manufacturer SNS
LCA Price 0.8092
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02445956
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form ATOMOXETINE 60 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.8092
Manufacturer SIV
LCA Price 0.8092
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02471523
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form AURO-ATOMOXETINE 60 MG ORAL CAPSULE
Unit Price, Unit of Issue N/A
Manufacturer AUR
LCA Price N/A
MAC Price N/A
Interchangeable Products YES
Coverage Status UNDER REVIEW
Details
DIN/NPN/ PIN 02506858
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form JAMP ATOMOXETINE 60 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.8092
Manufacturer JPC
LCA Price 0.8092
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02381060
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form PMS-ATOMOXETINE 60 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.8092
Manufacturer PMS
LCA Price 0.8092
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02386453
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form SANDOZ ATOMOXETINE 60 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.8092
Manufacturer SDZ
LCA Price 0.8092
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02262843
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form STRATTERA 60 MG ORAL CAPSULE
Unit Price, Unit of Issue N/A
Manufacturer LIL
LCA Price N/A
MAC Price N/A
Interchangeable Products YES
Coverage Status NOT A BENEFIT
Details
DIN/NPN/ PIN 02314592
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form TEVA-ATOMOXETINE 60 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.8092
Manufacturer TEV
LCA Price 0.8092
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02318075
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form APO-ATOMOXETINE 80 MG ORAL CAPSULE
Unit Price, Unit of Issue 1.2193
Manufacturer APX
LCA Price 1.2193
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02467801
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form ATOMOXETINE 80 MG ORAL CAPSULE
Unit Price, Unit of Issue 1.2193
Manufacturer SNS
LCA Price 1.2193
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02471531
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form AURO-ATOMOXETINE 80 MG ORAL CAPSULE
Unit Price, Unit of Issue N/A
Manufacturer AUR
LCA Price N/A
MAC Price N/A
Interchangeable Products YES
Coverage Status UNDER REVIEW
Details
DIN/NPN/ PIN 02506866
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form JAMP ATOMOXETINE 80 MG ORAL CAPSULE
Unit Price, Unit of Issue 1.2193
Manufacturer JPC
LCA Price 1.2193
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02386461
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form SANDOZ ATOMOXETINE 80 MG ORAL CAPSULE
Unit Price, Unit of Issue 1.2193
Manufacturer SDZ
LCA Price 1.2193
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02362511
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form TEVA-ATOMOXETINE 80 MG ORAL CAPSULE
Unit Price, Unit of Issue 1.2193
Manufacturer TEV
LCA Price 1.2193
MAC Price N/A
Interchangeable Products YES
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02495341
Generic Name DIMETHYL FUMARATE
Product Name, Strength & Dosage Form ACH-DIMETHYL FUMARATE 120 MG ORAL DELAYED-RELEASE CAPSULE
Unit Price, Unit of Issue 4.4266
Manufacturer AHI
LCA Price 4.4266
MAC Price N/A
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02505762
Generic Name DIMETHYL FUMARATE
Product Name, Strength & Dosage Form APO-DIMETHYL FUMARATE 120 MG ORAL DELAYED-RELEASE CAPSULE
Unit Price, Unit of Issue 4.4266
Manufacturer APX
LCA Price 4.4266
MAC Price N/A
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02494809
Generic Name DIMETHYL FUMARATE
Product Name, Strength & Dosage Form GLN-DIMETHYL FUMARATE 120 MG ORAL DELAYED-RELEASE CAPSULE
Unit Price, Unit of Issue 4.4266
Manufacturer GLM
LCA Price 4.4266
MAC Price N/A
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02516047
Generic Name DIMETHYL FUMARATE
Product Name, Strength & Dosage Form JAMP DIMETHYL FUMARATE 120 MG ORAL DELAYED-RELEASE CAPSULE
Unit Price, Unit of Issue 4.4266
Manufacturer JPC
LCA Price 4.4266
MAC Price N/A
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02502690
Generic Name DIMETHYL FUMARATE
Product Name, Strength & Dosage Form MAR-DIMETHYL FUMARATE 120 MG ORAL DELAYED-RELEASE CAPSULE
Unit Price, Unit of Issue 4.4266
Manufacturer MAR
LCA Price 4.4266
MAC Price N/A
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02497026
Generic Name DIMETHYL FUMARATE
Product Name, Strength & Dosage Form PMS-DIMETHYL FUMARATE 120 MG ORAL DELAYED-RELEASE CAPSULE
Unit Price, Unit of Issue 4.4266
Manufacturer PMS
LCA Price 4.4266
MAC Price N/A
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02513781
Generic Name DIMETHYL FUMARATE
Product Name, Strength & Dosage Form SANDOZ DIMETHYL FUMARATE 120 MG ORAL DELAYED-RELEASE CAPSULE
Unit Price, Unit of Issue 4.4266
Manufacturer SDZ
LCA Price 4.4266
MAC Price N/A
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02404508
Generic Name DIMETHYL FUMARATE
Product Name, Strength & Dosage Form TECFIDERA 120 MG ORAL DELAYED-RELEASE CAPSULE
Unit Price, Unit of Issue 17.7064
Manufacturer BIO
LCA Price 4.4266
MAC Price N/A
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02505770
Generic Name DIMETHYL FUMARATE
Product Name, Strength & Dosage Form APO-DIMETHYL FUMARATE 240 MG ORAL DELAYED-RELEASE CAPSULE
Unit Price, Unit of Issue 8.6888
Manufacturer APX
LCA Price 8.6888
MAC Price N/A
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02516055
Generic Name DIMETHYL FUMARATE
Product Name, Strength & Dosage Form JAMP DIMETHYL FUMARATE 240 MG ORAL DELAYED-RELEASE CAPSULE
Unit Price, Unit of Issue 8.6888
Manufacturer JPC
LCA Price 8.6888
MAC Price N/A
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02497034
Generic Name DIMETHYL FUMARATE
Product Name, Strength & Dosage Form PMS-DIMETHYL FUMARATE 240 MG ORAL DELAYED-RELEASE CAPSULE
Unit Price, Unit of Issue 8.6888
Manufacturer PMS
LCA Price 8.6888
MAC Price N/A
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02513803
Generic Name DIMETHYL FUMARATE
Product Name, Strength & Dosage Form SANDOZ DIMETHYL FUMARATE 240 MG ORAL DELAYED-RELEASE CAPSULE
Unit Price, Unit of Issue 8.6888
Manufacturer SDZ
LCA Price 8.6888
MAC Price N/A
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02420201
Generic Name DIMETHYL FUMARATE
Product Name, Strength & Dosage Form TECFIDERA 240 MG ORAL DELAYED-RELEASE CAPSULE
Unit Price, Unit of Issue N/A
Manufacturer BIO
LCA Price N/A
MAC Price N/A
Interchangeable Products YES
Coverage Status NOT A BENEFIT
Details
DIN/NPN/ PIN 02475472
Generic Name EDARAVONE
Product Name, Strength & Dosage Form RADICAVA 0.3 MG / ML INJECTION
Unit Price, Unit of Issue 4.7380
Manufacturer MIT
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02532611
Generic Name EDARAVONE
Product Name, Strength & Dosage Form RADICAVA 21 MG / ML ORAL SUSPENSION
Unit Price, Unit of Issue 189.5200
Manufacturer MIT
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02481383
Generic Name INOTERSEN SODIUM
Product Name, Strength & Dosage Form TEGSEDI 284 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue 8,043.4874
Manufacturer AKC
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02260638
Generic Name MEMANTINE HYDROCHLORIDE
Product Name, Strength & Dosage Form EBIXA 10 MG ORAL TABLET
Unit Price, Unit of Issue N/A
Manufacturer LBC
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status NOT A BENEFIT
Details
DIN/NPN/ PIN 02352583
Generic Name RILUZOLE
Product Name, Strength & Dosage Form APO-RILUZOLE 50 MG ORAL TABLET
Unit Price, Unit of Issue 3.4361
Manufacturer APX
LCA Price 3.4361
MAC Price N/A
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02390299
Generic Name RILUZOLE
Product Name, Strength & Dosage Form MYLAN-RILUZOLE 50 MG ORAL TABLET
Unit Price, Unit of Issue 3.4361
Manufacturer MYP
LCA Price 3.4361
MAC Price N/A
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02242763
Generic Name RILUZOLE
Product Name, Strength & Dosage Form RILUTEK 50 MG ORAL TABLET
Unit Price, Unit of Issue 10.5500
Manufacturer SAV
LCA Price 3.4361
MAC Price N/A
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02268272
Generic Name SODIUM OXYBATE
Product Name, Strength & Dosage Form XYREM 500 MG / ML ORAL SOLUTION
Unit Price, Unit of Issue N/A
Manufacturer JAZ
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status NOT A BENEFIT
Details
DIN/NPN/ PIN 02527707
Generic Name SODIUM PHENYLBUTYRATE/ URSODOXICOLTAURINE
Product Name, Strength & Dosage Form ALBRIOZA 3 G * 1 G ORAL POWDER PACKET
Unit Price, Unit of Issue 306.7123
Manufacturer AYX
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status 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.