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
02349191 ALPRAZOLAM ALPRAZOLAM 0.25 MG ORAL TABLET 0.0609
TAB
SNS 0.0609 N/A YES REGULAR BENEFIT Details
00865397 ALPRAZOLAM APO-ALPRAZ 0.25 MG ORAL TABLET 0.0609
TAB
APX 0.0609 N/A YES REGULAR BENEFIT Details
02400111 ALPRAZOLAM JAMP-ALPRAZOLAM 0.25 MG ORAL TABLET 0.0609
TAB
JPC 0.0609 N/A YES REGULAR BENEFIT Details
01913484 ALPRAZOLAM TEVA-ALPRAZOL 0.25 MG ORAL TABLET 0.0609
TAB
TEV 0.0609 N/A YES REGULAR BENEFIT Details
02349205 ALPRAZOLAM ALPRAZOLAM 0.5 MG ORAL TABLET 0.0728
TAB
SNS 0.0728 N/A YES REGULAR BENEFIT Details
00865400 ALPRAZOLAM APO-ALPRAZ 0.5 MG ORAL TABLET 0.0728
TAB
APX 0.0728 N/A YES REGULAR BENEFIT Details
02400138 ALPRAZOLAM JAMP-ALPRAZOLAM 0.5 MG ORAL TABLET 0.0728
TAB
JPC 0.0728 N/A YES REGULAR BENEFIT Details
01913492 ALPRAZOLAM TEVA-ALPRAZOL 0.5 MG ORAL TABLET 0.0728
TAB
TEV 0.0728 N/A YES REGULAR BENEFIT Details
02243611 ALPRAZOLAM APO-ALPRAZ 1 MG ORAL TABLET N/A
TAB
APX N/A N/A NO NOT A BENEFIT Details
02243612 ALPRAZOLAM APO-ALPRAZ TS 2 MG ORAL TABLET N/A
TAB
APX N/A N/A NO NOT A BENEFIT Details
02177161 BROMAZEPAM APO-BROMAZEPAM 3 MG ORAL TABLET 0.0776
TAB
APX 0.0776 N/A YES REGULAR BENEFIT Details
02230584 BROMAZEPAM TEVA-BROMAZEPAM 3 MG ORAL TABLET 0.0776
TAB
TEV 0.0776 N/A YES REGULAR BENEFIT Details
02177188 BROMAZEPAM APO-BROMAZEPAM 6 MG ORAL TABLET 0.1134
TAB
APX 0.1134 N/A YES REGULAR BENEFIT Details
02230585 BROMAZEPAM TEVA-BROMAZEPAM 6 MG ORAL TABLET 0.1134
TAB
TEV 0.1134 N/A YES REGULAR BENEFIT Details
00522988 CHLORDIAZEPOXIDE HCL CHLORDIAZEPOXIDE 10 MG ORAL CAPSULE 0.1141
CAP
AAP N/A N/A NO REGULAR BENEFIT Details
00522996 CHLORDIAZEPOXIDE HCL CHLORDIAZEPOXIDE 25 MG ORAL CAPSULE 0.1769
CAP
AAP N/A N/A NO REGULAR BENEFIT Details
00522724 CHLORDIAZEPOXIDE HCL CHLORDIAZEPOXIDE 5 MG ORAL CAPSULE 0.0725
CAP
AAP N/A N/A NO REGULAR BENEFIT Details
00618454 CHLORDIAZEPOXIDE HCL/ CLIDINIUM BROMIDE CHLORAX 5 MG * 2.5 MG ORAL CAPSULE 0.2451
CAP
AAP 0.2451 N/A YES REGULAR BENEFIT Details
00115630 CHLORDIAZEPOXIDE HCL/ CLIDINIUM BROMIDE LIBRAX 5 MG * 2.5 MG ORAL CAPSULE 0.3405
CAP
VCL 0.2451 N/A YES REGULAR BENEFIT Details
00860697 CLORAZEPATE DIPOTASSIUM CLORAZEPATE 15 MG ORAL CAPSULE 0.4112
CAP
AAP N/A N/A NO REGULAR BENEFIT Details
00860689 CLORAZEPATE DIPOTASSIUM CLORAZEPATE 3.75 MG ORAL CAPSULE 0.1575
CAP
AAP N/A N/A NO REGULAR BENEFIT Details
00860700 CLORAZEPATE DIPOTASSIUM CLORAZEPATE 7.5 MG ORAL CAPSULE 0.2054
CAP
AAP N/A N/A NO REGULAR BENEFIT Details
00405337 DIAZEPAM DIAZEPAM 10 MG ORAL TABLET 0.0867
TAB
AAP N/A N/A NO REGULAR BENEFIT Details
00405329 DIAZEPAM DIAZEPAM 2 MG ORAL TABLET 0.0532
TAB
AAP N/A N/A NO REGULAR BENEFIT Details
02238162 DIAZEPAM DIASTAT RECTAL DELIVERY 5 MG RECTAL GEL N/A
SYS
VCL N/A N/A NO NOT A BENEFIT Details
00362158 DIAZEPAM DIAZEPAM 5 MG ORAL TABLET 0.0650
TAB
AAP N/A N/A NO REGULAR BENEFIT Details
00399728 DIAZEPAM DIAZEPAM 5 MG / ML INJECTION 1.6745
ML
SDZ N/A N/A NO REGULAR BENEFIT Details
00521698 FLURAZEPAM HCL FLURAZEPAM 15 MG ORAL CAPSULE 0.1219
CAP
AAP N/A N/A NO REGULAR BENEFIT Details
00521701 FLURAZEPAM HCL FLURAZEPAM 30 MG ORAL CAPSULE 0.1426
CAP
AAP N/A N/A NO REGULAR BENEFIT Details
00655740 LORAZEPAM APO-LORAZEPAM 0.5 MG ORAL TABLET 0.0359
TAB
APX 0.0359 N/A YES REGULAR BENEFIT Details
02041456 LORAZEPAM ATIVAN 0.5 MG ORAL SUBLINGUAL TABLET 0.1218
TAB
PFI 0.0875 N/A YES REGULAR BENEFIT Details
02041413 LORAZEPAM ATIVAN 0.5 MG ORAL TABLET 0.0401
TAB
PFI 0.0359 N/A YES REGULAR BENEFIT Details
02410745 LORAZEPAM LORAZEPAM 0.5 MG ORAL SUBLINGUAL TABLET 0.0875
TAB
AAP 0.0875 N/A YES REGULAR BENEFIT Details
00728187 LORAZEPAM PMS-LORAZEPAM 0.5 MG ORAL TABLET 0.0359
TAB
PMS 0.0359 N/A YES REGULAR BENEFIT Details
00711101 LORAZEPAM TEVA-LORAZEPAM 0.5 MG ORAL TABLET 0.0359
TAB
TEV 0.0359 N/A YES REGULAR BENEFIT Details
00655759 LORAZEPAM APO-LORAZEPAM 1 MG ORAL TABLET 0.0447
TAB
APX 0.0447 N/A YES REGULAR BENEFIT Details
02041464 LORAZEPAM ATIVAN 1 MG ORAL SUBLINGUAL TABLET 0.1534
TAB
PFI 0.1100 N/A YES REGULAR BENEFIT Details
02041421 LORAZEPAM ATIVAN 1 MG ORAL TABLET 0.0499
TAB
PFI 0.0447 N/A YES REGULAR BENEFIT Details
02410753 LORAZEPAM LORAZEPAM 1 MG ORAL SUBLINGUAL TABLET 0.1100
TAB
AAP 0.1100 N/A YES REGULAR BENEFIT Details
02351080 LORAZEPAM LORAZEPAM 1 MG ORAL TABLET 0.0447
TAB
SNS 0.0447 N/A YES REGULAR BENEFIT Details
00728195 LORAZEPAM PMS-LORAZEPAM 1 MG ORAL TABLET 0.0447
TAB
PMS 0.0447 N/A YES REGULAR BENEFIT Details
00637742 LORAZEPAM TEVA-LORAZEPAM 1 MG ORAL TABLET 0.0447
TAB
TEV 0.0447 N/A YES REGULAR BENEFIT Details
00655767 LORAZEPAM APO-LORAZEPAM 2 MG ORAL TABLET 0.0699
TAB
APX 0.0699 N/A YES REGULAR BENEFIT Details
02041472 LORAZEPAM ATIVAN 2 MG ORAL SUBLINGUAL TABLET 0.2383
TAB
PFI 0.1711 N/A YES REGULAR BENEFIT Details
02041448 LORAZEPAM ATIVAN 2 MG ORAL TABLET 0.0782
TAB
PFI 0.0699 N/A YES REGULAR BENEFIT Details
02410761 LORAZEPAM LORAZEPAM 2 MG ORAL SUBLINGUAL TABLET 0.1711
TAB
AAP 0.1711 N/A YES REGULAR BENEFIT Details
02351099 LORAZEPAM LORAZEPAM 2 MG ORAL TABLET 0.0699
TAB
SNS 0.0699 N/A YES REGULAR BENEFIT Details
00728209 LORAZEPAM PMS-LORAZEPAM 2 MG ORAL TABLET 0.0699
TAB
PMS 0.0699 N/A YES REGULAR BENEFIT Details
00637750 LORAZEPAM TEVA-LORAZEPAM 2 MG ORAL TABLET 0.0699
TAB
TEV 0.0699 N/A YES REGULAR BENEFIT Details
02240286 MIDAZOLAM HCL MIDAZOLAM 5 MG / ML INJECTION 4.1000
ML
SDZ N/A N/A NO REGULAR BENEFIT Details
00511536 NITRAZEPAM MOGADON 10 MG ORAL TABLET 0.2400
TAB
AAP N/A N/A NO REGULAR BENEFIT Details
00511528 NITRAZEPAM MOGADON 5 MG ORAL TABLET 0.1604
TAB
AAP N/A N/A NO REGULAR BENEFIT Details
00402680 OXAZEPAM APO-OXAZEPAM 10 MG ORAL TABLET 0.0420
TAB
APX N/A N/A NO REGULAR BENEFIT Details
00402745 OXAZEPAM APO-OXAZEPAM 15 MG ORAL TABLET 0.0660
TAB
APX N/A N/A NO REGULAR BENEFIT Details
00402737 OXAZEPAM APO-OXAZEPAM 30 MG ORAL TABLET 0.0900
TAB
APX N/A N/A NO REGULAR BENEFIT Details
00604453 TEMAZEPAM RESTORIL 15 MG ORAL CAPSULE 0.2163
CAP
AAP N/A N/A NO REGULAR BENEFIT Details
00604461 TEMAZEPAM RESTORIL 30 MG ORAL CAPSULE 0.2617
CAP
AAP N/A N/A NO REGULAR BENEFIT Details
00808571 TRIAZOLAM TRIAZO 0.25 MG ORAL TABLET 0.2669
TAB
AAP N/A N/A NO REGULAR BENEFIT Details
DIN/NPN/ PIN 02349191
Generic Name ALPRAZOLAM
Product Name, Strength & Dosage Form ALPRAZOLAM 0.25 MG ORAL TABLET
Unit Price, Unit of Issue 0.0609
Manufacturer SNS
LCA Price 0.0609
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00865397
Generic Name ALPRAZOLAM
Product Name, Strength & Dosage Form APO-ALPRAZ 0.25 MG ORAL TABLET
Unit Price, Unit of Issue 0.0609
Manufacturer APX
LCA Price 0.0609
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02400111
Generic Name ALPRAZOLAM
Product Name, Strength & Dosage Form JAMP-ALPRAZOLAM 0.25 MG ORAL TABLET
Unit Price, Unit of Issue 0.0609
Manufacturer JPC
LCA Price 0.0609
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 01913484
Generic Name ALPRAZOLAM
Product Name, Strength & Dosage Form TEVA-ALPRAZOL 0.25 MG ORAL TABLET
Unit Price, Unit of Issue 0.0609
Manufacturer TEV
LCA Price 0.0609
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02349205
Generic Name ALPRAZOLAM
Product Name, Strength & Dosage Form ALPRAZOLAM 0.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.0728
Manufacturer SNS
LCA Price 0.0728
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00865400
Generic Name ALPRAZOLAM
Product Name, Strength & Dosage Form APO-ALPRAZ 0.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.0728
Manufacturer APX
LCA Price 0.0728
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02400138
Generic Name ALPRAZOLAM
Product Name, Strength & Dosage Form JAMP-ALPRAZOLAM 0.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.0728
Manufacturer JPC
LCA Price 0.0728
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 01913492
Generic Name ALPRAZOLAM
Product Name, Strength & Dosage Form TEVA-ALPRAZOL 0.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.0728
Manufacturer TEV
LCA Price 0.0728
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02243611
Generic Name ALPRAZOLAM
Product Name, Strength & Dosage Form APO-ALPRAZ 1 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 NOT A BENEFIT
Details
DIN/NPN/ PIN 02243612
Generic Name ALPRAZOLAM
Product Name, Strength & Dosage Form APO-ALPRAZ TS 2 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 NOT A BENEFIT
Details
DIN/NPN/ PIN 02177161
Generic Name BROMAZEPAM
Product Name, Strength & Dosage Form APO-BROMAZEPAM 3 MG ORAL TABLET
Unit Price, Unit of Issue 0.0776
Manufacturer APX
LCA Price 0.0776
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02230584
Generic Name BROMAZEPAM
Product Name, Strength & Dosage Form TEVA-BROMAZEPAM 3 MG ORAL TABLET
Unit Price, Unit of Issue 0.0776
Manufacturer TEV
LCA Price 0.0776
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02177188
Generic Name BROMAZEPAM
Product Name, Strength & Dosage Form APO-BROMAZEPAM 6 MG ORAL TABLET
Unit Price, Unit of Issue 0.1134
Manufacturer APX
LCA Price 0.1134
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02230585
Generic Name BROMAZEPAM
Product Name, Strength & Dosage Form TEVA-BROMAZEPAM 6 MG ORAL TABLET
Unit Price, Unit of Issue 0.1134
Manufacturer TEV
LCA Price 0.1134
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00522988
Generic Name CHLORDIAZEPOXIDE HCL
Product Name, Strength & Dosage Form CHLORDIAZEPOXIDE 10 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.1141
Manufacturer AAP
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00522996
Generic Name CHLORDIAZEPOXIDE HCL
Product Name, Strength & Dosage Form CHLORDIAZEPOXIDE 25 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.1769
Manufacturer AAP
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00522724
Generic Name CHLORDIAZEPOXIDE HCL
Product Name, Strength & Dosage Form CHLORDIAZEPOXIDE 5 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.0725
Manufacturer AAP
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00618454
Generic Name CHLORDIAZEPOXIDE HCL/ CLIDINIUM BROMIDE
Product Name, Strength & Dosage Form CHLORAX 5 MG * 2.5 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.2451
Manufacturer AAP
LCA Price 0.2451
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00115630
Generic Name CHLORDIAZEPOXIDE HCL/ CLIDINIUM BROMIDE
Product Name, Strength & Dosage Form LIBRAX 5 MG * 2.5 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.3405
Manufacturer VCL
LCA Price 0.2451
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00860697
Generic Name CLORAZEPATE DIPOTASSIUM
Product Name, Strength & Dosage Form CLORAZEPATE 15 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.4112
Manufacturer AAP
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00860689
Generic Name CLORAZEPATE DIPOTASSIUM
Product Name, Strength & Dosage Form CLORAZEPATE 3.75 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.1575
Manufacturer AAP
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00860700
Generic Name CLORAZEPATE DIPOTASSIUM
Product Name, Strength & Dosage Form CLORAZEPATE 7.5 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.2054
Manufacturer AAP
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00405337
Generic Name DIAZEPAM
Product Name, Strength & Dosage Form DIAZEPAM 10 MG ORAL TABLET
Unit Price, Unit of Issue 0.0867
Manufacturer AAP
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00405329
Generic Name DIAZEPAM
Product Name, Strength & Dosage Form DIAZEPAM 2 MG ORAL TABLET
Unit Price, Unit of Issue 0.0532
Manufacturer AAP
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02238162
Generic Name DIAZEPAM
Product Name, Strength & Dosage Form DIASTAT RECTAL DELIVERY 5 MG RECTAL GEL
Unit Price, Unit of Issue N/A
Manufacturer VCL
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status NOT A BENEFIT
Details
DIN/NPN/ PIN 00362158
Generic Name DIAZEPAM
Product Name, Strength & Dosage Form DIAZEPAM 5 MG ORAL TABLET
Unit Price, Unit of Issue 0.0650
Manufacturer AAP
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00399728
Generic Name DIAZEPAM
Product Name, Strength & Dosage Form DIAZEPAM 5 MG / ML INJECTION
Unit Price, Unit of Issue 1.6745
Manufacturer SDZ
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00521698
Generic Name FLURAZEPAM HCL
Product Name, Strength & Dosage Form FLURAZEPAM 15 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.1219
Manufacturer AAP
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00521701
Generic Name FLURAZEPAM HCL
Product Name, Strength & Dosage Form FLURAZEPAM 30 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.1426
Manufacturer AAP
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00655740
Generic Name LORAZEPAM
Product Name, Strength & Dosage Form APO-LORAZEPAM 0.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.0359
Manufacturer APX
LCA Price 0.0359
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02041456
Generic Name LORAZEPAM
Product Name, Strength & Dosage Form ATIVAN 0.5 MG ORAL SUBLINGUAL TABLET
Unit Price, Unit of Issue 0.1218
Manufacturer PFI
LCA Price 0.0875
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02041413
Generic Name LORAZEPAM
Product Name, Strength & Dosage Form ATIVAN 0.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.0401
Manufacturer PFI
LCA Price 0.0359
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02410745
Generic Name LORAZEPAM
Product Name, Strength & Dosage Form LORAZEPAM 0.5 MG ORAL SUBLINGUAL TABLET
Unit Price, Unit of Issue 0.0875
Manufacturer AAP
LCA Price 0.0875
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00728187
Generic Name LORAZEPAM
Product Name, Strength & Dosage Form PMS-LORAZEPAM 0.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.0359
Manufacturer PMS
LCA Price 0.0359
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00711101
Generic Name LORAZEPAM
Product Name, Strength & Dosage Form TEVA-LORAZEPAM 0.5 MG ORAL TABLET
Unit Price, Unit of Issue 0.0359
Manufacturer TEV
LCA Price 0.0359
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00655759
Generic Name LORAZEPAM
Product Name, Strength & Dosage Form APO-LORAZEPAM 1 MG ORAL TABLET
Unit Price, Unit of Issue 0.0447
Manufacturer APX
LCA Price 0.0447
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02041464
Generic Name LORAZEPAM
Product Name, Strength & Dosage Form ATIVAN 1 MG ORAL SUBLINGUAL TABLET
Unit Price, Unit of Issue 0.1534
Manufacturer PFI
LCA Price 0.1100
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02041421
Generic Name LORAZEPAM
Product Name, Strength & Dosage Form ATIVAN 1 MG ORAL TABLET
Unit Price, Unit of Issue 0.0499
Manufacturer PFI
LCA Price 0.0447
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02410753
Generic Name LORAZEPAM
Product Name, Strength & Dosage Form LORAZEPAM 1 MG ORAL SUBLINGUAL TABLET
Unit Price, Unit of Issue 0.1100
Manufacturer AAP
LCA Price 0.1100
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02351080
Generic Name LORAZEPAM
Product Name, Strength & Dosage Form LORAZEPAM 1 MG ORAL TABLET
Unit Price, Unit of Issue 0.0447
Manufacturer SNS
LCA Price 0.0447
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00728195
Generic Name LORAZEPAM
Product Name, Strength & Dosage Form PMS-LORAZEPAM 1 MG ORAL TABLET
Unit Price, Unit of Issue 0.0447
Manufacturer PMS
LCA Price 0.0447
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00637742
Generic Name LORAZEPAM
Product Name, Strength & Dosage Form TEVA-LORAZEPAM 1 MG ORAL TABLET
Unit Price, Unit of Issue 0.0447
Manufacturer TEV
LCA Price 0.0447
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00655767
Generic Name LORAZEPAM
Product Name, Strength & Dosage Form APO-LORAZEPAM 2 MG ORAL TABLET
Unit Price, Unit of Issue 0.0699
Manufacturer APX
LCA Price 0.0699
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02041472
Generic Name LORAZEPAM
Product Name, Strength & Dosage Form ATIVAN 2 MG ORAL SUBLINGUAL TABLET
Unit Price, Unit of Issue 0.2383
Manufacturer PFI
LCA Price 0.1711
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02041448
Generic Name LORAZEPAM
Product Name, Strength & Dosage Form ATIVAN 2 MG ORAL TABLET
Unit Price, Unit of Issue 0.0782
Manufacturer PFI
LCA Price 0.0699
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02410761
Generic Name LORAZEPAM
Product Name, Strength & Dosage Form LORAZEPAM 2 MG ORAL SUBLINGUAL TABLET
Unit Price, Unit of Issue 0.1711
Manufacturer AAP
LCA Price 0.1711
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02351099
Generic Name LORAZEPAM
Product Name, Strength & Dosage Form LORAZEPAM 2 MG ORAL TABLET
Unit Price, Unit of Issue 0.0699
Manufacturer SNS
LCA Price 0.0699
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00728209
Generic Name LORAZEPAM
Product Name, Strength & Dosage Form PMS-LORAZEPAM 2 MG ORAL TABLET
Unit Price, Unit of Issue 0.0699
Manufacturer PMS
LCA Price 0.0699
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00637750
Generic Name LORAZEPAM
Product Name, Strength & Dosage Form TEVA-LORAZEPAM 2 MG ORAL TABLET
Unit Price, Unit of Issue 0.0699
Manufacturer TEV
LCA Price 0.0699
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02240286
Generic Name MIDAZOLAM HCL
Product Name, Strength & Dosage Form MIDAZOLAM 5 MG / ML INJECTION
Unit Price, Unit of Issue 4.1000
Manufacturer SDZ
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00511536
Generic Name NITRAZEPAM
Product Name, Strength & Dosage Form MOGADON 10 MG ORAL TABLET
Unit Price, Unit of Issue 0.2400
Manufacturer AAP
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00511528
Generic Name NITRAZEPAM
Product Name, Strength & Dosage Form MOGADON 5 MG ORAL TABLET
Unit Price, Unit of Issue 0.1604
Manufacturer AAP
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00402680
Generic Name OXAZEPAM
Product Name, Strength & Dosage Form APO-OXAZEPAM 10 MG ORAL TABLET
Unit Price, Unit of Issue 0.0420
Manufacturer APX
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00402745
Generic Name OXAZEPAM
Product Name, Strength & Dosage Form APO-OXAZEPAM 15 MG ORAL TABLET
Unit Price, Unit of Issue 0.0660
Manufacturer APX
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00402737
Generic Name OXAZEPAM
Product Name, Strength & Dosage Form APO-OXAZEPAM 30 MG ORAL TABLET
Unit Price, Unit of Issue 0.0900
Manufacturer APX
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00604453
Generic Name TEMAZEPAM
Product Name, Strength & Dosage Form RESTORIL 15 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.2163
Manufacturer AAP
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00604461
Generic Name TEMAZEPAM
Product Name, Strength & Dosage Form RESTORIL 30 MG ORAL CAPSULE
Unit Price, Unit of Issue 0.2617
Manufacturer AAP
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 00808571
Generic Name TRIAZOLAM
Product Name, Strength & Dosage Form TRIAZO 0.25 MG ORAL TABLET
Unit Price, Unit of Issue 0.2669
Manufacturer AAP
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
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