PTC 081832

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Products Found: 42

MFR

Review Status/
Past Decision(s)

ACYCLOVIR
APO-ACYCLOVIR
200 MG
ORL  TAB
0.6397
0.6397
TAB
YES

REGULAR BENEFIT

 

ACYCLOVIR
MYLAN-ACYCLOVIR
200 MG
ORL  TAB
0.6397
0.6397
TAB
YES

REGULAR BENEFIT

 

ACYCLOVIR
TEVA-ACYCLOVIR
200 MG
ORL  TAB
0.6397
0.6397
TAB
YES

REGULAR BENEFIT

ACYCLOVIR
ZOVIRAX
40 MG / ML
ORL  SUS
0.2595
N/A
ML
NO

REGULAR BENEFIT

 

ACYCLOVIR
APO-ACYCLOVIR
400 MG
ORL  TAB
1.2700
1.2700
TAB
YES

REGULAR BENEFIT

 

ACYCLOVIR
MYLAN-ACYCLOVIR
400 MG
ORL  TAB
1.2700
1.2700
TAB
YES

REGULAR BENEFIT

 

ACYCLOVIR
TEVA-ACYCLOVIR
400 MG
ORL  TAB
1.2700
1.2700
TAB
YES

REGULAR BENEFIT

ACYCLOVIR
APO-ACYCLOVIR
800 MG
ORL  TAB
1.2673
1.2673
TAB
YES

REGULAR BENEFIT

 

ACYCLOVIR
MYLAN-ACYCLOVIR
800 MG
ORL  TAB
1.2673
1.2673
TAB
YES

REGULAR BENEFIT

 

ACYCLOVIR
TEVA-ACYCLOVIR
800 MG
ORL  TAB
1.2673
1.2673
TAB
YES

REGULAR BENEFIT

ADEFOVIR DIPIVOXIL
APO-ADEFOVIR
10 MG
ORL  TAB
18.2518
18.2518
TAB
YES

RESTRICTED BENEFIT

ADEFOVIR DIPIVOXIL
HEPSERA
10 MG
ORL  TAB
23.8405
18.2518
TAB
YES

RESTRICTED BENEFIT

ENTECAVIR
APO-ENTECAVIR
0.5 MG
ORL  TAB
5.5000
5.5000
TAB
YES

RESTRICTED BENEFIT

ENTECAVIR
AURO-ENTECAVIR
0.5 MG
ORL  TAB
5.5000
5.5000
TAB
YES

RESTRICTED BENEFIT

ENTECAVIR
BARACLUDE
0.5 MG
ORL  TAB
22.6601
5.5000
TAB
YES

RESTRICTED BENEFIT

ENTECAVIR
JAMP-ENTECAVIR
0.5 MG
ORL  TAB
5.5000
5.5000
TAB
YES

RESTRICTED BENEFIT

ENTECAVIR
PMS-ENTECAVIR
0.5 MG
ORL  TAB
5.5000
5.5000
TAB
YES

RESTRICTED BENEFIT

02292068
FAMCICLOVIR
APO-FAMCICLOVIR
500 MG
ORL  TAB
N/A
N/A
TAB
NO

NOT A BENEFIT *

02278111
FAMCICLOVIR
PMS-FAMCICLOVIR
500 MG
ORL  TAB
N/A
N/A
TAB
NO

NOT A BENEFIT *

02278650
FAMCICLOVIR
SANDOZ FAMCICLOVIR
500 MG
ORL  TAB
N/A
N/A
TAB
NO

NOT A BENEFIT *

GANCICLOVIR SODIUM
CYTOVENE
500 MG / VIAL
INJ 
44.5480
N/A
VIAL
NO

REGULAR BENEFIT

 

RIBAVIRIN
IBAVYR
200 MG
ORL  TAB
11.5373
N/A
TAB
NO

SPECIAL AUTHORIZATION

RIBAVIRIN
IBAVYR
400 MG
ORL  TAB
23.0746
N/A
TAB
NO

SPECIAL AUTHORIZATION

RIBAVIRIN
IBAVYR
600 MG
ORL  TAB
34.6119
N/A
TAB
NO

SPECIAL AUTHORIZATION

VALACYCLOVIR
APO-VALACYCLOVIR (CAPLET)
1,000 MG
ORL  TAB
1.7218
1.7218
TAB
YES

REGULAR BENEFIT

VALACYCLOVIR
MYLAN-VALACYCLOVIR (CAPLET)
1,000 MG
ORL  TAB
1.7218
1.7218
TAB
YES

REGULAR BENEFIT

VALACYCLOVIR
PMS-VALACYCLOVIR (CAPLET)
1,000 MG
ORL  TAB
1.7218
1.7218
TAB
YES

REGULAR BENEFIT

VALACYCLOVIR
APO-VALACYCLOVIR (CAPLET)
500 MG
ORL  TAB
0.6198
0.6198
TAB
YES

REGULAR BENEFIT

VALACYCLOVIR
AURO-VALACYCLOVIR
500 MG
ORL  TAB
0.6198
0.6198
TAB
YES

REGULAR BENEFIT

VALACYCLOVIR
JAMP-VALACYCLOVIR
500 MG
ORL  TAB
0.6198
0.6198
TAB
YES

REGULAR BENEFIT

VALACYCLOVIR
MAR-VALACYCLOVIR
500 MG
ORL  TAB
0.6198
0.6198
TAB
YES

REGULAR BENEFIT

VALACYCLOVIR
MYLAN-VALACYCLOVIR (CAPLET)
500 MG
ORL  TAB
0.6198
0.6198
TAB
YES

REGULAR BENEFIT

VALACYCLOVIR
PMS-VALACYCLOVIR (CAPLET)
500 MG
ORL  TAB
0.6198
0.6198
TAB
YES

REGULAR BENEFIT

VALACYCLOVIR
SANDOZ VALACYCLOVIR
500 MG
ORL  TAB
0.6198
0.6198
TAB
YES

REGULAR BENEFIT

VALACYCLOVIR
TEVA-VALACYCLOVIR
500 MG
ORL  TAB
0.6198
0.6198
TAB
YES

REGULAR BENEFIT

VALACYCLOVIR
VALACYCLOVIR
500 MG
ORL  TAB
0.6198
0.6198
TAB
YES

REGULAR BENEFIT

VALACYCLOVIR
VALACYCLOVIR
500 MG
ORL  TAB
0.6198
0.6198
TAB
YES

REGULAR BENEFIT

VALACYCLOVIR
VALTREX (CAPLET)
500 MG
ORL  TAB
3.4436
0.6198
TAB
YES

REGULAR BENEFIT

 

VALGANCICLOVIR HCL
AURO-VALGANCICLOVIR
450 MG
ORL  TAB
11.7106
11.7106
TAB
YES

REGULAR BENEFIT

VALGANCICLOVIR HCL
TEVA-VALGANCICLOVIR
450 MG
ORL  TAB
11.7106
11.7106
TAB
YES

REGULAR BENEFIT

VALGANCICLOVIR HCL
VALCYTE
450 MG
ORL  TAB
24.7087
11.7106
TAB
YES

REGULAR BENEFIT

VALGANCICLOVIR HCL
VALCYTE
50 MG / ML
ORL  SUS
2.7452
N/A
ML
NO

REGULAR BENEFIT


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