DIN/NPN/ PIN | Generic Name | Product Name, Strength & Dosage Form | Unit Price, Unit of Issue | Manufacturer | LCA Price | MAC Price | Interchangeable Products | Coverage Status | |
---|---|---|---|---|---|---|---|---|---|
02402475 | ABATACEPT | ORENCIA 125 MG / SYR INJECTION |
373.7875 SYR |
BMS | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02282097 | ABATACEPT | ORENCIA 250 MG / VIAL INJECTION |
500.3400 VIAL |
BMS | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02511061 | ADALIMUMAB | ABRILADA (20 MG/0.4 ML SYRINGE) 20 MG / SYR INJECTION SYRINGE |
235.6300 SYR |
PFI | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02459310 | ADALIMUMAB | AMGEVITA (20 MG/0.4 ML INJ SYR) 20 MG / SYR INJECTION SYRINGE |
235.6400 SYR |
AMG | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02502380 | ADALIMUMAB | HULIO (20 MG/0.4 ML INJ SYR) 20 MG / SYR INJECTION SYRINGE |
235.6350 SYR |
BBC | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02474263 | ADALIMUMAB | HUMIRA (20 MG/0.2 ML INJ SYR) 20 MG / SYR INJECTION SYRINGE |
N/A SYR |
ABV | N/A | N/A | NO | NOT A BENEFIT | |
02505258 | ADALIMUMAB | HYRIMOZ (20 MG/0.4 ML INJ SYR) 20 MG / SYR INJECTION SYRINGE |
235.6350 SYR |
SDZ | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02511045 | ADALIMUMAB | ABRILADA (40 MG/0.8 ML INJ PEN) 40 MG / SYR INJECTION SYRINGE |
471.2700 SYR |
PFI | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02511053 | ADALIMUMAB | ABRILADA (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE |
471.2700 SYR |
PFI | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02459299 | ADALIMUMAB | AMGEVITA (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE |
471.2700 SYR |
AMG | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02459302 | ADALIMUMAB | AMGEVITA 40 MG/0.8 ML AUTOINJECTOR PEN 40 MG / SYR INJECTION SYRINGE |
471.2700 SYR |
AMG | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02533472 | ADALIMUMAB | HADLIMA (40 MG/0.4 ML SYRINGE) 40 MG / SYR INJECTION SYRINGE |
471.2700 SYR |
SSB | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02473100 | ADALIMUMAB | HADLIMA (40 MG/0.8 ML INJ PEN) 40 MG / SYR INJECTION SYRINGE |
471.2700 SYR |
SSB | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02473097 | ADALIMUMAB | HADLIMA (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE |
471.2700 SYR |
SSB | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02533480 | ADALIMUMAB | HADLIMA PUSHTOUCH (40 MG/0.4 ML PEN) 40 MG / SYR INJECTION SYRINGE |
471.2700 SYR |
SSB | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02502402 | ADALIMUMAB | HULIO (40 MG/0.8 ML INJ PEN) 40 MG / SYR INJECTION SYRINGE |
471.2700 SYR |
BBC | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02502399 | ADALIMUMAB | HULIO (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE |
471.2700 SYR |
BBC | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02258595 | ADALIMUMAB | HUMIRA (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE |
N/A SYR |
ABV | N/A | N/A | NO | NOT A BENEFIT | |
02492156 | ADALIMUMAB | HYRIMOZ (40 MG/0.8 ML INJ PEN) 40 MG / SYR INJECTION SYRINGE |
471.2700 SYR |
SDZ | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02492164 | ADALIMUMAB | HYRIMOZ (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE |
471.2700 SYR |
SDZ | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02502674 | ADALIMUMAB | IDACIO (40 MG/0.8 ML INJ PEN) 40 MG / SYR INJECTION SYRINGE |
471.2700 SYR |
FKC | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02502682 | ADALIMUMAB | IDACIO (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE |
471.2700 SYR |
FKC | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02523957 | ADALIMUMAB | SIMLANDI (40 MG/0.4 ML AUTO-INJECTOR PEN) 40 MG / SYR INJECTION SYRINGE |
471.2700 SYR |
JPC | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02523949 | ADALIMUMAB | SIMLANDI (40 MG/0.4 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE |
471.2700 SYR |
JPC | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02523779 | ADALIMUMAB | YUFLYMA (40 MG/0.4 ML INJ PEN) 40 MG / SYR INJECTION SYRINGE |
471.2700 SYR |
CHC | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02523760 | ADALIMUMAB | YUFLYMA (40 MG/0.4 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE |
471.2700 SYR |
CHC | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02523965 | ADALIMUMAB | SIMLANDI (80 MG/0.8 ML INJ SYR) 80 MG / SYR INJECTION SYRINGE |
942.5400 SYR |
JPC | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02535084 | ADALIMUMAB | YUFLYMA (80 MG/0.8 ML INJ PEN) 80 MG / SYR INJECTION SYRINGE |
942.5400 SYR |
CHC | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02535076 | ADALIMUMAB | YUFLYMA (80 MG/0.8 ML INJ SYR) 80 MG / SYR INJECTION SYRINGE |
942.5400 SYR |
CHC | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02245913 | ANAKINRA | KINERET 100 MG / SYR INJECTION SYRINGE |
53.7889 SYR |
BVM | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02434334 | APREMILAST | OTEZLA 30 MG ORAL TABLET |
N/A TAB |
AMG | N/A | N/A | NO | NOT A BENEFIT | |
02434318 | APREMILAST/ APREMILAST/ APREMILAST | OTEZLA (STARTER PACK) 10 MG * 20 MG * 30 MG ORAL TABLET |
N/A TAB |
AMG | N/A | N/A | NO | NOT A BENEFIT | |
02331675 | CERTOLIZUMAB PEGOL | CIMZIA 200 MG / SYR INJECTION SYRINGE |
690.4259 SYR |
UCB | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02465574 | CERTOLIZUMAB PEGOL | CIMZIA AUTO-INJECTOR 200 MG / SYR INJECTION SYRINGE |
690.4259 SYR |
UCB | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02462877 | ETANERCEPT | ERELZI 25 MG / SYR INJECTION SYRINGE |
120.5000 SYR |
SDZ | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02530295 | ETANERCEPT | RYMTI 50 MG / ML INJECTION |
N/A ML |
LPC | N/A | N/A | NO | UNDER REVIEW | |
02530309 | ETANERCEPT | RYMTI 50 MG / ML INJECTION |
N/A ML |
LPC | N/A | N/A | NO | UNDER REVIEW | |
02455331 | ETANERCEPT | BRENZYS (AUTO INJECTOR) 50 MG / SYR INJECTION SYRINGE |
241.0000 SYR |
SSB | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02455323 | ETANERCEPT | BRENZYS 50 MG / SYR INJECTION SYRINGE |
241.0000 SYR |
SSB | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02274728 | ETANERCEPT | ENBREL 50 MG / SYR INJECTION SYRINGE |
N/A SYR |
AMG | N/A | N/A | YES | NOT A BENEFIT | |
02462850 | ETANERCEPT | ERELZI (SENSOREADY AUTO INJECTOR) 50 MG / SYR INJECTION SYRINGE |
241.0000 SYR |
SDZ | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02462869 | ETANERCEPT | ERELZI 50 MG / SYR INJECTION SYRINGE |
241.0000 SYR |
SDZ | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02413183 | GOLIMUMAB | SIMPONI (AUTO INJECTOR) 100 MG / SYR INJECTION SYRINGE |
1,516.0000 SYR |
JAI | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02413175 | GOLIMUMAB | SIMPONI 100 MG / SYR INJECTION SYRINGE |
1,516.0000 SYR |
JAI | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02324784 | GOLIMUMAB | SIMPONI (AUTO INJECTOR) 50 MG / SYR INJECTION SYRINGE |
1,516.0000 SYR |
JAI | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02324776 | GOLIMUMAB | SIMPONI 50 MG / SYR INJECTION SYRINGE |
1,516.0000 SYR |
JAI | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02496933 | INFLIXIMAB | AVSOLA 100 MG / VIAL INJECTION |
493.0000 VIAL |
AMG | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02419475 | INFLIXIMAB | INFLECTRA 100 MG / VIAL INJECTION |
525.0000 VIAL |
CHH | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02244016 | INFLIXIMAB | REMICADE 100 MG / VIAL INJECTION |
N/A VIAL |
JAI | N/A | N/A | NO | NOT A BENEFIT | |
02470373 | INFLIXIMAB | RENFLEXIS 100 MG / VIAL INJECTION |
493.0000 VIAL |
SSB | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02478862 | LEFLUNOMIDE | ACCEL-LEFLUNOMIDE 10 MG ORAL TABLET |
2.0000 TAB |
ACP | 2.0000 | N/A | YES | RESTRICTED BENEFIT | |
02256495 | LEFLUNOMIDE | APO-LEFLUNOMIDE 10 MG ORAL TABLET |
2.6433 TAB |
APX | 2.0000 | N/A | YES | RESTRICTED BENEFIT | |
02241888 | LEFLUNOMIDE | ARAVA 10 MG ORAL TABLET |
11.4440 TAB |
SAV | 2.0000 | N/A | YES | RESTRICTED BENEFIT | |
02351668 | LEFLUNOMIDE | LEFLUNOMIDE 10 MG ORAL TABLET |
2.6433 TAB |
SNS | 2.0000 | N/A | YES | RESTRICTED BENEFIT | |
02288265 | LEFLUNOMIDE | PMS-LEFLUNOMIDE 10 MG ORAL TABLET |
N/A TAB |
PMS | N/A | N/A | YES | NOT A BENEFIT | |
02283964 | LEFLUNOMIDE | SANDOZ LEFLUNOMIDE 10 MG ORAL TABLET |
2.6433 TAB |
SDZ | 2.0000 | N/A | YES | RESTRICTED BENEFIT | |
02261251 | LEFLUNOMIDE | TEVA-LEFLUNOMIDE 10 MG ORAL TABLET |
2.6433 TAB |
TEV | 2.0000 | N/A | YES | RESTRICTED BENEFIT | |
02478870 | LEFLUNOMIDE | ACCEL-LEFLUNOMIDE 20 MG ORAL TABLET |
2.0000 TAB |
ACP | 2.0000 | N/A | YES | RESTRICTED BENEFIT | |
02256509 | LEFLUNOMIDE | APO-LEFLUNOMIDE 20 MG ORAL TABLET |
2.6433 TAB |
APX | 2.0000 | N/A | YES | RESTRICTED BENEFIT | |
02241889 | LEFLUNOMIDE | ARAVA 20 MG ORAL TABLET |
11.4443 TAB |
SAV | 2.0000 | N/A | YES | RESTRICTED BENEFIT | |
02351676 | LEFLUNOMIDE | LEFLUNOMIDE 20 MG ORAL TABLET |
2.6433 TAB |
SNS | 2.0000 | N/A | YES | RESTRICTED BENEFIT | |
02288273 | LEFLUNOMIDE | PMS-LEFLUNOMIDE 20 MG ORAL TABLET |
N/A TAB |
PMS | N/A | N/A | YES | NOT A BENEFIT | |
02283972 | LEFLUNOMIDE | SANDOZ LEFLUNOMIDE 20 MG ORAL TABLET |
2.6433 TAB |
SDZ | 2.0000 | N/A | YES | RESTRICTED BENEFIT | |
02261278 | LEFLUNOMIDE | TEVA-LEFLUNOMIDE 20 MG ORAL TABLET |
2.6433 TAB |
TEV | 2.0000 | N/A | YES | RESTRICTED BENEFIT | |
02472961 | SARILUMAB | KEVZARA (PREFILLED PEN) 150 MG / SYR INJECTION |
745.6900 SYR |
SAV | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02472988 | SARILUMAB | KEVZARA (PREFILLED PEN) 200 MG / SYR INJECTION |
745.6900 SYR |
SAV | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02460548 | SARILUMAB | KEVZARA 200 MG / SYR INJECTION SYRINGE |
745.6900 SYR |
SAV | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02483327 | TOCILIZUMAB | ACTEMRA (0.9 ML AUTO INJECTOR) 162 MG / SYR INJECTION SYRINGE |
372.7500 SYR |
HLR | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02424770 | TOCILIZUMAB | ACTEMRA (0.9 ML SYRINGE) 162 MG / SYR INJECTION SYRINGE |
376.8502 SYR |
HLR | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02350106 | TOCILIZUMAB | ACTEMRA (10 ML) 200 MG / VIAL INJECTION |
479.8500 VIAL |
HLR | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02350114 | TOCILIZUMAB | ACTEMRA (20 ML) 400 MG / VIAL INJECTION |
959.7000 VIAL |
HLR | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02350092 | TOCILIZUMAB | ACTEMRA (4 ML) 80 MG / VIAL INJECTION |
191.9400 VIAL |
HLR | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02530015 | TOFACITINIB CITRATE | AURO-TOFACITINIB 10 MG ORAL TABLET |
21.1718 TAB |
AUR | 0.0000 | 0.0000 | YES | SPECIAL AUTHORIZATION | |
02511312 | TOFACITINIB CITRATE | TARO-TOFACITINIB 10 MG ORAL TABLET |
21.1718 TAB |
TAR | 0.0000 | 0.0000 | YES | SPECIAL AUTHORIZATION | |
02480786 | TOFACITINIB CITRATE | XELJANZ 10 MG ORAL TABLET |
43.7833 TAB |
PFI | 0.0000 | 0.0000 | YES | SPECIAL AUTHORIZATION | |
02470608 | TOFACITINIB CITRATE | XELJANZ XR 11 MG ORAL EXTENDED-RELEASE TABLET |
49.5467 TAB |
PFI | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02530007 | TOFACITINIB CITRATE | AURO-TOFACITINIB 5 MG ORAL TABLET |
5.9897 TAB |
AUR | 5.9897 | N/A | YES | SPECIAL AUTHORIZATION | |
02522896 | TOFACITINIB CITRATE | JAMP TOFACITINIB 5 MG ORAL TABLET |
5.9897 TAB |
JPC | 5.9897 | N/A | YES | SPECIAL AUTHORIZATION | |
02522799 | TOFACITINIB CITRATE | PMS-TOFACITINIB 5 MG ORAL TABLET |
5.9897 TAB |
PMS | 5.9897 | N/A | YES | SPECIAL AUTHORIZATION | |
02511304 | TOFACITINIB CITRATE | TARO-TOFACITINIB 5 MG ORAL TABLET |
5.9897 TAB |
TAR | 5.9897 | N/A | YES | SPECIAL AUTHORIZATION | |
02423898 | TOFACITINIB CITRATE | XELJANZ 5 MG ORAL TABLET |
24.7733 TAB |
PFI | 5.9897 | N/A | YES | SPECIAL AUTHORIZATION | |
02495155 | UPADACITINIB | RINVOQ 15 MG ORAL EXTENDED-RELEASE TABLET |
51.6810 TAB |
ABV | N/A | N/A | NO | SPECIAL AUTHORIZATION | |
02520893 | UPADACITINIB | RINVOQ 30 MG ORAL EXTENDED-RELEASE TABLET |
76.9600 TAB |
ABV | N/A | N/A | NO | SPECIAL AUTHORIZATION |
DIN/NPN/ PIN | 02402475 |
Generic Name | ABATACEPT |
Product Name, Strength & Dosage Form | ORENCIA 125 MG / SYR INJECTION |
Unit Price, Unit of Issue | 373.7875 |
Manufacturer | BMS |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02282097 |
Generic Name | ABATACEPT |
Product Name, Strength & Dosage Form | ORENCIA 250 MG / VIAL INJECTION |
Unit Price, Unit of Issue | 500.3400 |
Manufacturer | BMS |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02511061 |
Generic Name | ADALIMUMAB |
Product Name, Strength & Dosage Form | ABRILADA (20 MG/0.4 ML SYRINGE) 20 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 235.6300 |
Manufacturer | PFI |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02459310 |
Generic Name | ADALIMUMAB |
Product Name, Strength & Dosage Form | AMGEVITA (20 MG/0.4 ML INJ SYR) 20 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 235.6400 |
Manufacturer | AMG |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02502380 |
Generic Name | ADALIMUMAB |
Product Name, Strength & Dosage Form | HULIO (20 MG/0.4 ML INJ SYR) 20 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 235.6350 |
Manufacturer | BBC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02474263 |
Generic Name | ADALIMUMAB |
Product Name, Strength & Dosage Form | HUMIRA (20 MG/0.2 ML INJ SYR) 20 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | N/A |
Manufacturer | ABV |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02505258 |
Generic Name | ADALIMUMAB |
Product Name, Strength & Dosage Form | HYRIMOZ (20 MG/0.4 ML INJ SYR) 20 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 235.6350 |
Manufacturer | SDZ |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02511045 |
Generic Name | ADALIMUMAB |
Product Name, Strength & Dosage Form | ABRILADA (40 MG/0.8 ML INJ PEN) 40 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 471.2700 |
Manufacturer | PFI |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02511053 |
Generic Name | ADALIMUMAB |
Product Name, Strength & Dosage Form | ABRILADA (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 471.2700 |
Manufacturer | PFI |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02459299 |
Generic Name | ADALIMUMAB |
Product Name, Strength & Dosage Form | AMGEVITA (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 471.2700 |
Manufacturer | AMG |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02459302 |
Generic Name | ADALIMUMAB |
Product Name, Strength & Dosage Form | AMGEVITA 40 MG/0.8 ML AUTOINJECTOR PEN 40 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 471.2700 |
Manufacturer | AMG |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02533472 |
Generic Name | ADALIMUMAB |
Product Name, Strength & Dosage Form | HADLIMA (40 MG/0.4 ML SYRINGE) 40 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 471.2700 |
Manufacturer | SSB |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02473100 |
Generic Name | ADALIMUMAB |
Product Name, Strength & Dosage Form | HADLIMA (40 MG/0.8 ML INJ PEN) 40 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 471.2700 |
Manufacturer | SSB |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02473097 |
Generic Name | ADALIMUMAB |
Product Name, Strength & Dosage Form | HADLIMA (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 471.2700 |
Manufacturer | SSB |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02533480 |
Generic Name | ADALIMUMAB |
Product Name, Strength & Dosage Form | HADLIMA PUSHTOUCH (40 MG/0.4 ML PEN) 40 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 471.2700 |
Manufacturer | SSB |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02502402 |
Generic Name | ADALIMUMAB |
Product Name, Strength & Dosage Form | HULIO (40 MG/0.8 ML INJ PEN) 40 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 471.2700 |
Manufacturer | BBC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02502399 |
Generic Name | ADALIMUMAB |
Product Name, Strength & Dosage Form | HULIO (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 471.2700 |
Manufacturer | BBC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02258595 |
Generic Name | ADALIMUMAB |
Product Name, Strength & Dosage Form | HUMIRA (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | N/A |
Manufacturer | ABV |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02492156 |
Generic Name | ADALIMUMAB |
Product Name, Strength & Dosage Form | HYRIMOZ (40 MG/0.8 ML INJ PEN) 40 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 471.2700 |
Manufacturer | SDZ |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02492164 |
Generic Name | ADALIMUMAB |
Product Name, Strength & Dosage Form | HYRIMOZ (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 471.2700 |
Manufacturer | SDZ |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02502674 |
Generic Name | ADALIMUMAB |
Product Name, Strength & Dosage Form | IDACIO (40 MG/0.8 ML INJ PEN) 40 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 471.2700 |
Manufacturer | FKC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02502682 |
Generic Name | ADALIMUMAB |
Product Name, Strength & Dosage Form | IDACIO (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 471.2700 |
Manufacturer | FKC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02523957 |
Generic Name | ADALIMUMAB |
Product Name, Strength & Dosage Form | SIMLANDI (40 MG/0.4 ML AUTO-INJECTOR PEN) 40 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 471.2700 |
Manufacturer | JPC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02523949 |
Generic Name | ADALIMUMAB |
Product Name, Strength & Dosage Form | SIMLANDI (40 MG/0.4 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 471.2700 |
Manufacturer | JPC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02523779 |
Generic Name | ADALIMUMAB |
Product Name, Strength & Dosage Form | YUFLYMA (40 MG/0.4 ML INJ PEN) 40 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 471.2700 |
Manufacturer | CHC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02523760 |
Generic Name | ADALIMUMAB |
Product Name, Strength & Dosage Form | YUFLYMA (40 MG/0.4 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 471.2700 |
Manufacturer | CHC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02523965 |
Generic Name | ADALIMUMAB |
Product Name, Strength & Dosage Form | SIMLANDI (80 MG/0.8 ML INJ SYR) 80 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 942.5400 |
Manufacturer | JPC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02535084 |
Generic Name | ADALIMUMAB |
Product Name, Strength & Dosage Form | YUFLYMA (80 MG/0.8 ML INJ PEN) 80 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 942.5400 |
Manufacturer | CHC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02535076 |
Generic Name | ADALIMUMAB |
Product Name, Strength & Dosage Form | YUFLYMA (80 MG/0.8 ML INJ SYR) 80 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 942.5400 |
Manufacturer | CHC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02245913 |
Generic Name | ANAKINRA |
Product Name, Strength & Dosage Form | KINERET 100 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 53.7889 |
Manufacturer | BVM |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02434334 |
Generic Name | APREMILAST |
Product Name, Strength & Dosage Form | OTEZLA 30 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | AMG |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02434318 |
Generic Name | APREMILAST/ APREMILAST/ APREMILAST |
Product Name, Strength & Dosage Form | OTEZLA (STARTER PACK) 10 MG * 20 MG * 30 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | AMG |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02331675 |
Generic Name | CERTOLIZUMAB PEGOL |
Product Name, Strength & Dosage Form | CIMZIA 200 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 690.4259 |
Manufacturer | UCB |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02465574 |
Generic Name | CERTOLIZUMAB PEGOL |
Product Name, Strength & Dosage Form | CIMZIA AUTO-INJECTOR 200 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 690.4259 |
Manufacturer | UCB |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02462877 |
Generic Name | ETANERCEPT |
Product Name, Strength & Dosage Form | ERELZI 25 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 120.5000 |
Manufacturer | SDZ |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02530295 |
Generic Name | ETANERCEPT |
Product Name, Strength & Dosage Form | RYMTI 50 MG / ML INJECTION |
Unit Price, Unit of Issue | N/A |
Manufacturer | LPC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | UNDER REVIEW |
Details |
DIN/NPN/ PIN | 02530309 |
Generic Name | ETANERCEPT |
Product Name, Strength & Dosage Form | RYMTI 50 MG / ML INJECTION |
Unit Price, Unit of Issue | N/A |
Manufacturer | LPC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | UNDER REVIEW |
Details |
DIN/NPN/ PIN | 02455331 |
Generic Name | ETANERCEPT |
Product Name, Strength & Dosage Form | BRENZYS (AUTO INJECTOR) 50 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 241.0000 |
Manufacturer | SSB |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02455323 |
Generic Name | ETANERCEPT |
Product Name, Strength & Dosage Form | BRENZYS 50 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 241.0000 |
Manufacturer | SSB |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02274728 |
Generic Name | ETANERCEPT |
Product Name, Strength & Dosage Form | ENBREL 50 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | N/A |
Manufacturer | AMG |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02462850 |
Generic Name | ETANERCEPT |
Product Name, Strength & Dosage Form | ERELZI (SENSOREADY AUTO INJECTOR) 50 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 241.0000 |
Manufacturer | SDZ |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02462869 |
Generic Name | ETANERCEPT |
Product Name, Strength & Dosage Form | ERELZI 50 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 241.0000 |
Manufacturer | SDZ |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02413183 |
Generic Name | GOLIMUMAB |
Product Name, Strength & Dosage Form | SIMPONI (AUTO INJECTOR) 100 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 1,516.0000 |
Manufacturer | JAI |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02413175 |
Generic Name | GOLIMUMAB |
Product Name, Strength & Dosage Form | SIMPONI 100 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 1,516.0000 |
Manufacturer | JAI |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02324784 |
Generic Name | GOLIMUMAB |
Product Name, Strength & Dosage Form | SIMPONI (AUTO INJECTOR) 50 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 1,516.0000 |
Manufacturer | JAI |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02324776 |
Generic Name | GOLIMUMAB |
Product Name, Strength & Dosage Form | SIMPONI 50 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 1,516.0000 |
Manufacturer | JAI |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02496933 |
Generic Name | INFLIXIMAB |
Product Name, Strength & Dosage Form | AVSOLA 100 MG / VIAL INJECTION |
Unit Price, Unit of Issue | 493.0000 |
Manufacturer | AMG |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02419475 |
Generic Name | INFLIXIMAB |
Product Name, Strength & Dosage Form | INFLECTRA 100 MG / VIAL INJECTION |
Unit Price, Unit of Issue | 525.0000 |
Manufacturer | CHH |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02244016 |
Generic Name | INFLIXIMAB |
Product Name, Strength & Dosage Form | REMICADE 100 MG / VIAL INJECTION |
Unit Price, Unit of Issue | N/A |
Manufacturer | JAI |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02470373 |
Generic Name | INFLIXIMAB |
Product Name, Strength & Dosage Form | RENFLEXIS 100 MG / VIAL INJECTION |
Unit Price, Unit of Issue | 493.0000 |
Manufacturer | SSB |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02478862 |
Generic Name | LEFLUNOMIDE |
Product Name, Strength & Dosage Form | ACCEL-LEFLUNOMIDE 10 MG ORAL TABLET |
Unit Price, Unit of Issue | 2.0000 |
Manufacturer | ACP |
LCA Price | 2.0000 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 02256495 |
Generic Name | LEFLUNOMIDE |
Product Name, Strength & Dosage Form | APO-LEFLUNOMIDE 10 MG ORAL TABLET |
Unit Price, Unit of Issue | 2.6433 |
Manufacturer | APX |
LCA Price | 2.0000 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 02241888 |
Generic Name | LEFLUNOMIDE |
Product Name, Strength & Dosage Form | ARAVA 10 MG ORAL TABLET |
Unit Price, Unit of Issue | 11.4440 |
Manufacturer | SAV |
LCA Price | 2.0000 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 02351668 |
Generic Name | LEFLUNOMIDE |
Product Name, Strength & Dosage Form | LEFLUNOMIDE 10 MG ORAL TABLET |
Unit Price, Unit of Issue | 2.6433 |
Manufacturer | SNS |
LCA Price | 2.0000 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 02288265 |
Generic Name | LEFLUNOMIDE |
Product Name, Strength & Dosage Form | PMS-LEFLUNOMIDE 10 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | PMS |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02283964 |
Generic Name | LEFLUNOMIDE |
Product Name, Strength & Dosage Form | SANDOZ LEFLUNOMIDE 10 MG ORAL TABLET |
Unit Price, Unit of Issue | 2.6433 |
Manufacturer | SDZ |
LCA Price | 2.0000 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 02261251 |
Generic Name | LEFLUNOMIDE |
Product Name, Strength & Dosage Form | TEVA-LEFLUNOMIDE 10 MG ORAL TABLET |
Unit Price, Unit of Issue | 2.6433 |
Manufacturer | TEV |
LCA Price | 2.0000 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 02478870 |
Generic Name | LEFLUNOMIDE |
Product Name, Strength & Dosage Form | ACCEL-LEFLUNOMIDE 20 MG ORAL TABLET |
Unit Price, Unit of Issue | 2.0000 |
Manufacturer | ACP |
LCA Price | 2.0000 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 02256509 |
Generic Name | LEFLUNOMIDE |
Product Name, Strength & Dosage Form | APO-LEFLUNOMIDE 20 MG ORAL TABLET |
Unit Price, Unit of Issue | 2.6433 |
Manufacturer | APX |
LCA Price | 2.0000 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 02241889 |
Generic Name | LEFLUNOMIDE |
Product Name, Strength & Dosage Form | ARAVA 20 MG ORAL TABLET |
Unit Price, Unit of Issue | 11.4443 |
Manufacturer | SAV |
LCA Price | 2.0000 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 02351676 |
Generic Name | LEFLUNOMIDE |
Product Name, Strength & Dosage Form | LEFLUNOMIDE 20 MG ORAL TABLET |
Unit Price, Unit of Issue | 2.6433 |
Manufacturer | SNS |
LCA Price | 2.0000 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 02288273 |
Generic Name | LEFLUNOMIDE |
Product Name, Strength & Dosage Form | PMS-LEFLUNOMIDE 20 MG ORAL TABLET |
Unit Price, Unit of Issue | N/A |
Manufacturer | PMS |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 02283972 |
Generic Name | LEFLUNOMIDE |
Product Name, Strength & Dosage Form | SANDOZ LEFLUNOMIDE 20 MG ORAL TABLET |
Unit Price, Unit of Issue | 2.6433 |
Manufacturer | SDZ |
LCA Price | 2.0000 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 02261278 |
Generic Name | LEFLUNOMIDE |
Product Name, Strength & Dosage Form | TEVA-LEFLUNOMIDE 20 MG ORAL TABLET |
Unit Price, Unit of Issue | 2.6433 |
Manufacturer | TEV |
LCA Price | 2.0000 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 02472961 |
Generic Name | SARILUMAB |
Product Name, Strength & Dosage Form | KEVZARA (PREFILLED PEN) 150 MG / SYR INJECTION |
Unit Price, Unit of Issue | 745.6900 |
Manufacturer | SAV |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02472988 |
Generic Name | SARILUMAB |
Product Name, Strength & Dosage Form | KEVZARA (PREFILLED PEN) 200 MG / SYR INJECTION |
Unit Price, Unit of Issue | 745.6900 |
Manufacturer | SAV |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02460548 |
Generic Name | SARILUMAB |
Product Name, Strength & Dosage Form | KEVZARA 200 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 745.6900 |
Manufacturer | SAV |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02483327 |
Generic Name | TOCILIZUMAB |
Product Name, Strength & Dosage Form | ACTEMRA (0.9 ML AUTO INJECTOR) 162 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 372.7500 |
Manufacturer | HLR |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02424770 |
Generic Name | TOCILIZUMAB |
Product Name, Strength & Dosage Form | ACTEMRA (0.9 ML SYRINGE) 162 MG / SYR INJECTION SYRINGE |
Unit Price, Unit of Issue | 376.8502 |
Manufacturer | HLR |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02350106 |
Generic Name | TOCILIZUMAB |
Product Name, Strength & Dosage Form | ACTEMRA (10 ML) 200 MG / VIAL INJECTION |
Unit Price, Unit of Issue | 479.8500 |
Manufacturer | HLR |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02350114 |
Generic Name | TOCILIZUMAB |
Product Name, Strength & Dosage Form | ACTEMRA (20 ML) 400 MG / VIAL INJECTION |
Unit Price, Unit of Issue | 959.7000 |
Manufacturer | HLR |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02350092 |
Generic Name | TOCILIZUMAB |
Product Name, Strength & Dosage Form | ACTEMRA (4 ML) 80 MG / VIAL INJECTION |
Unit Price, Unit of Issue | 191.9400 |
Manufacturer | HLR |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02530015 |
Generic Name | TOFACITINIB CITRATE |
Product Name, Strength & Dosage Form | AURO-TOFACITINIB 10 MG ORAL TABLET |
Unit Price, Unit of Issue | 21.1718 |
Manufacturer | AUR |
LCA Price | 0.0000 |
MAC Price | 0.0000 |
Interchangeable Products | YES |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02511312 |
Generic Name | TOFACITINIB CITRATE |
Product Name, Strength & Dosage Form | TARO-TOFACITINIB 10 MG ORAL TABLET |
Unit Price, Unit of Issue | 21.1718 |
Manufacturer | TAR |
LCA Price | 0.0000 |
MAC Price | 0.0000 |
Interchangeable Products | YES |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02480786 |
Generic Name | TOFACITINIB CITRATE |
Product Name, Strength & Dosage Form | XELJANZ 10 MG ORAL TABLET |
Unit Price, Unit of Issue | 43.7833 |
Manufacturer | PFI |
LCA Price | 0.0000 |
MAC Price | 0.0000 |
Interchangeable Products | YES |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02470608 |
Generic Name | TOFACITINIB CITRATE |
Product Name, Strength & Dosage Form | XELJANZ XR 11 MG ORAL EXTENDED-RELEASE TABLET |
Unit Price, Unit of Issue | 49.5467 |
Manufacturer | PFI |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02530007 |
Generic Name | TOFACITINIB CITRATE |
Product Name, Strength & Dosage Form | AURO-TOFACITINIB 5 MG ORAL TABLET |
Unit Price, Unit of Issue | 5.9897 |
Manufacturer | AUR |
LCA Price | 5.9897 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02522896 |
Generic Name | TOFACITINIB CITRATE |
Product Name, Strength & Dosage Form | JAMP TOFACITINIB 5 MG ORAL TABLET |
Unit Price, Unit of Issue | 5.9897 |
Manufacturer | JPC |
LCA Price | 5.9897 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02522799 |
Generic Name | TOFACITINIB CITRATE |
Product Name, Strength & Dosage Form | PMS-TOFACITINIB 5 MG ORAL TABLET |
Unit Price, Unit of Issue | 5.9897 |
Manufacturer | PMS |
LCA Price | 5.9897 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02511304 |
Generic Name | TOFACITINIB CITRATE |
Product Name, Strength & Dosage Form | TARO-TOFACITINIB 5 MG ORAL TABLET |
Unit Price, Unit of Issue | 5.9897 |
Manufacturer | TAR |
LCA Price | 5.9897 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02423898 |
Generic Name | TOFACITINIB CITRATE |
Product Name, Strength & Dosage Form | XELJANZ 5 MG ORAL TABLET |
Unit Price, Unit of Issue | 24.7733 |
Manufacturer | PFI |
LCA Price | 5.9897 |
MAC Price | N/A |
Interchangeable Products | YES |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02495155 |
Generic Name | UPADACITINIB |
Product Name, Strength & Dosage Form | RINVOQ 15 MG ORAL EXTENDED-RELEASE TABLET |
Unit Price, Unit of Issue | 51.6810 |
Manufacturer | ABV |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |
DIN/NPN/ PIN | 02520893 |
Generic Name | UPADACITINIB |
Product Name, Strength & Dosage Form | RINVOQ 30 MG ORAL EXTENDED-RELEASE TABLET |
Unit Price, Unit of Issue | 76.9600 |
Manufacturer | ABV |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | SPECIAL AUTHORIZATION |
Details |