PTC 28160804

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Products Found: 300

MFR

Review Status/
Past Decision(s)

ARIPIPRAZOLE
ABILIFY
10 MG
ORL  TAB
4.1016
1.0754
TAB
YES

REGULAR BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
APO-ARIPIPRAZOLE
10 MG
ORL  TAB
1.0754
1.0754
TAB
YES

REGULAR BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
AURO-ARIPIPRAZOLE
10 MG
ORL  TAB
1.0754
1.0754
TAB
YES

REGULAR BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
PMS-ARIPIPRAZOLE
10 MG
ORL  TAB
1.0754
1.0754
TAB
YES

REGULAR BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
SANDOZ ARIPIPRAZOLE
10 MG
ORL  TAB
1.0754
1.0754
TAB
YES

REGULAR BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
TEVA-ARIPIPRAZOLE
10 MG
ORL  TAB
1.0754
1.0754
TAB
YES

REGULAR BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
ABILIFY
15 MG
ORL  TAB
4.1016
1.2692
TAB
YES

REGULAR BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
APO-ARIPIPRAZOLE
15 MG
ORL  TAB
1.2692
1.2692
TAB
YES

REGULAR BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
AURO-ARIPIPRAZOLE
15 MG
ORL  TAB
1.2692
1.2692
TAB
YES

REGULAR BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
PMS-ARIPIPRAZOLE
15 MG
ORL  TAB
1.2692
1.2692
TAB
YES

REGULAR BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
SANDOZ ARIPIPRAZOLE
15 MG
ORL  TAB
1.2692
1.2692
TAB
YES

REGULAR BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
TEVA-ARIPIPRAZOLE
15 MG
ORL  TAB
1.2692
1.2692
TAB
YES

REGULAR BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
ABILIFY
2 MG
ORL  TAB
3.1618
0.8092
TAB
YES

RESTRICTED BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
APO-ARIPIPRAZOLE
2 MG
ORL  TAB
0.8092
0.8092
TAB
YES

RESTRICTED BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
AURO-ARIPIPRAZOLE
2 MG
ORL  TAB
0.8092
0.8092
TAB
YES

RESTRICTED BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
PMS-ARIPIPRAZOLE
2 MG
ORL  TAB
0.8092
0.8092
TAB
YES

RESTRICTED BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
SANDOZ ARIPIPRAZOLE
2 MG
ORL  TAB
0.8092
0.8092
TAB
YES

RESTRICTED BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
TEVA-ARIPIPRAZOLE
2 MG
ORL  TAB
0.8092
0.8092
TAB
YES

RESTRICTED BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
ABILIFY
20 MG
ORL  TAB
4.1016
1.0017
TAB
YES

REGULAR BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
APO-ARIPIPRAZOLE
20 MG
ORL  TAB
1.0017
1.0017
TAB
YES

REGULAR BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
AURO-ARIPIPRAZOLE
20 MG
ORL  TAB
1.0017
1.0017
TAB
YES

REGULAR BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
PMS-ARIPIPRAZOLE
20 MG
ORL  TAB
1.0017
1.0017
TAB
YES

REGULAR BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
SANDOZ ARIPIPRAZOLE
20 MG
ORL  TAB
1.0017
1.0017
TAB
YES

REGULAR BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
TEVA-ARIPIPRAZOLE
20 MG
ORL  TAB
1.0017
1.0017
TAB
YES

REGULAR BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
ABILIFY
30 MG
ORL  TAB
4.1016
1.0017
TAB
YES

REGULAR BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
APO-ARIPIPRAZOLE
30 MG
ORL  TAB
1.0017
1.0017
TAB
YES

REGULAR BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
AURO-ARIPIPRAZOLE
30 MG
ORL  TAB
1.0017
1.0017
TAB
YES

REGULAR BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
PMS-ARIPIPRAZOLE
30 MG
ORL  TAB
1.0017
1.0017
TAB
YES

REGULAR BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
SANDOZ ARIPIPRAZOLE
30 MG
ORL  TAB
1.0017
1.0017
TAB
YES

REGULAR BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
TEVA-ARIPIPRAZOLE
30 MG
ORL  TAB
1.0017
1.0017
TAB
YES

REGULAR BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
ABILIFY MAINTENA
300 MG / VIAL
INJ 
456.1800
N/A
VIAL
NO

SPECIAL AUTHORIZATION

ARIPIPRAZOLE
ABILIFY MAINTENA
400 MG / VIAL
INJ 
456.1800
N/A
VIAL
NO

SPECIAL AUTHORIZATION

ARIPIPRAZOLE
ABILIFY
5 MG
ORL  TAB
3.5591
0.9046
TAB
YES

RESTRICTED BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
APO-ARIPIPRAZOLE
5 MG
ORL  TAB
0.9046
0.9046
TAB
YES

RESTRICTED BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
AURO-ARIPIPRAZOLE
5 MG
ORL  TAB
0.9046
0.9046
TAB
YES

RESTRICTED BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
PMS-ARIPIPRAZOLE
5 MG
ORL  TAB
0.9046
0.9046
TAB
YES

RESTRICTED BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
SANDOZ ARIPIPRAZOLE
5 MG
ORL  TAB
0.9046
0.9046
TAB
YES

RESTRICTED BENEFIT/RESTRICTED BENEFIT

ARIPIPRAZOLE
TEVA-ARIPIPRAZOLE
5 MG
ORL  TAB
0.9046
0.9046
TAB
YES

RESTRICTED BENEFIT/RESTRICTED BENEFIT

ASENAPINE MALEATE
SAPHRIS
10 MG
ORL  SLT
1.4848
N/A
TAB
NO

SPECIAL AUTHORIZATION

ASENAPINE MALEATE
SAPHRIS
5 MG
ORL  SLT
1.4848
N/A
TAB
NO

SPECIAL AUTHORIZATION

BREXPIPRAZOLE
REXULTI
0.25 MG
ORL  TAB
3.5000
N/A
TAB
NO

REGULAR BENEFIT

BREXPIPRAZOLE
REXULTI
0.5 MG
ORL  TAB
3.5000
N/A
TAB
NO

REGULAR BENEFIT

BREXPIPRAZOLE
REXULTI
1 MG
ORL  TAB
3.5000
N/A
TAB
NO

REGULAR BENEFIT

BREXPIPRAZOLE
REXULTI
2 MG
ORL  TAB
3.5000
N/A
TAB
NO

REGULAR BENEFIT

BREXPIPRAZOLE
REXULTI
3 MG
ORL  TAB
3.5000
N/A
TAB
NO

REGULAR BENEFIT

BREXPIPRAZOLE
REXULTI
4 MG
ORL  TAB
3.5000
N/A
TAB
NO

REGULAR BENEFIT

CLOZAPINE
AA-CLOZAPINE
100 MG
ORL  TAB
2.6446
2.6446
TAB
YES

REGULAR BENEFIT

CLOZAPINE
CLOZARIL
100 MG
ORL  TAB
3.7780
2.6446
TAB
YES

REGULAR BENEFIT

 

CLOZAPINE
GEN-CLOZAPINE
100 MG
ORL  TAB
2.6446
2.6446
TAB
YES

REGULAR BENEFIT

CLOZAPINE
AA-CLOZAPINE
200 MG
ORL  TAB
N/A
N/A
TAB
NO

UNDER REVIEW *

CLOZAPINE
GEN-CLOZAPINE
200 MG
ORL  TAB
5.2892
N/A
TAB
NO

REGULAR BENEFIT

CLOZAPINE
AA-CLOZAPINE
25 MG
ORL  TAB
0.6594
0.6594
TAB
YES

REGULAR BENEFIT

CLOZAPINE
CLOZARIL
25 MG
ORL  TAB
0.9420
0.6594
TAB
YES

REGULAR BENEFIT

 

CLOZAPINE
GEN-CLOZAPINE
25 MG
ORL  TAB
0.6594
0.6594
TAB
YES

REGULAR BENEFIT

CLOZAPINE
AA-CLOZAPINE
50 MG
ORL  TAB
N/A
N/A
TAB
NO

UNDER REVIEW *

CLOZAPINE
GEN-CLOZAPINE
50 MG
ORL  TAB
1.3188
N/A
TAB
NO

REGULAR BENEFIT

LURASIDONE HCL
LATUDA
120 MG
ORL  TAB
4.2500
N/A
TAB
NO

REGULAR BENEFIT

LURASIDONE HCL
LATUDA
20 MG
ORL  TAB
4.2500
N/A
TAB
NO

REGULAR BENEFIT

LURASIDONE HCL
LATUDA
40 MG
ORL  TAB
4.2500
N/A
TAB
NO

REGULAR BENEFIT

LURASIDONE HCL
LATUDA
60 MG
ORL  TAB
4.2500
N/A
TAB
NO

REGULAR BENEFIT

LURASIDONE HCL
LATUDA
80 MG
ORL  TAB
4.2500
N/A
TAB
NO

REGULAR BENEFIT

OLANZAPINE
ACT OLANZAPINE ODT
10 MG
ORL  DISNTAB
0.7143
0.7143
TAB
YES

REGULAR BENEFIT

OLANZAPINE
APO-OLANZAPINE
10 MG
ORL  TAB
0.7088
0.7088
TAB
YES

REGULAR BENEFIT

OLANZAPINE
APO-OLANZAPINE ODT
10 MG
ORL  DISNTAB
0.7143
0.7143
TAB
YES

REGULAR BENEFIT

OLANZAPINE
AURO-OLANZAPINE ODT
10 MG
ORL  DISNTAB
0.7143
0.7143
TAB
YES

REGULAR BENEFIT

OLANZAPINE
JAMP OLANZAPINE FC
10 MG
ORL  TAB
0.7088
0.7088
TAB
YES

REGULAR BENEFIT

OLANZAPINE
JAMP-OLANZAPINE ODT
10 MG
ORL  DISNTAB
0.7143
0.7143
TAB
YES

REGULAR BENEFIT

OLANZAPINE
MAR-OLANZAPINE ODT
10 MG
ORL  DISNTAB
0.7143
0.7143
TAB
YES

REGULAR BENEFIT

OLANZAPINE
MINT-OLANZAPINE ODT
10 MG
ORL  DISNTAB
0.7143
0.7143
TAB
YES

REGULAR BENEFIT

OLANZAPINE
OLANZAPINE
10 MG
ORL  TAB
0.7088
0.7088
TAB
YES

REGULAR BENEFIT

OLANZAPINE
OLANZAPINE
10 MG
ORL  TAB
0.7088
0.7088
TAB
YES

REGULAR BENEFIT

OLANZAPINE
OLANZAPINE ODT
10 MG
ORL  DISNTAB
0.7143
0.7143
TAB
YES

REGULAR BENEFIT

OLANZAPINE
OLANZAPINE ODT
10 MG
ORL  DISNTAB
0.7143
0.7143
TAB
YES

REGULAR BENEFIT

OLANZAPINE
PMS-OLANZAPINE
10 MG
ORL  TAB
0.7088
0.7088
TAB
YES

REGULAR BENEFIT

OLANZAPINE
PMS-OLANZAPINE ODT
10 MG
ORL  DISNTAB
0.7143
0.7143
TAB
YES

REGULAR BENEFIT

OLANZAPINE
RAN-OLANZAPINE ODT
10 MG
ORL  DISNTAB
0.7143
0.7143
TAB
YES

REGULAR BENEFIT

OLANZAPINE
SANDOZ OLANZAPINE
10 MG
ORL  TAB
0.7088
0.7088
TAB
YES

REGULAR BENEFIT

OLANZAPINE
SANDOZ OLANZAPINE ODT
10 MG
ORL  DISNTAB
0.7143
0.7143
TAB
YES

REGULAR BENEFIT

OLANZAPINE
TEVA-OLANZAPINE
10 MG
ORL  TAB
0.7088
0.7088
TAB
YES

REGULAR BENEFIT

OLANZAPINE
ZYPREXA
10 MG
ORL  TAB
7.5582
0.7088
TAB
YES

REGULAR BENEFIT

 

OLANZAPINE
ZYPREXA ZYDIS
10 MG
ORL  DISNTAB
7.5098
0.7143
TAB
YES

REGULAR BENEFIT

 

OLANZAPINE
APO-OLANZAPINE
15 MG
ORL  TAB
1.0631
1.0631
TAB
YES

REGULAR BENEFIT

OLANZAPINE
JAMP OLANZAPINE FC
15 MG
ORL  TAB
1.0631
1.0631
TAB
YES

REGULAR BENEFIT

OLANZAPINE
OLANZAPINE
15 MG
ORL  TAB
1.0631
1.0631
TAB
YES

REGULAR BENEFIT

OLANZAPINE
OLANZAPINE
15 MG
ORL  TAB
1.0631
1.0631
TAB
YES

REGULAR BENEFIT

OLANZAPINE
PMS-OLANZAPINE
15 MG
ORL  TAB
1.0631
1.0631
TAB
YES

REGULAR BENEFIT

02303213
OLANZAPINE
PMS-OLANZAPINE ODT
15 MG
ORL  DISNTAB
N/A
N/A
TAB
NO

NOT A BENEFIT *

OLANZAPINE
SANDOZ OLANZAPINE
15 MG
ORL  TAB
1.0631
1.0631
TAB
YES

REGULAR BENEFIT

OLANZAPINE
TEVA-OLANZAPINE
15 MG
ORL  TAB
1.0631
1.0631
TAB
YES

REGULAR BENEFIT

OLANZAPINE
ZYPREXA
15 MG
ORL  TAB
11.3373
1.0631
TAB
YES

REGULAR BENEFIT

 

02243088
OLANZAPINE
ZYPREXA ZYDIS
15 MG
ORL  DISNTAB
N/A
N/A
TAB
NO

NOT A BENEFIT *

OLANZAPINE
APO-OLANZAPINE
2.5 MG
ORL  TAB
0.1772
0.1772
TAB
YES

REGULAR BENEFIT

OLANZAPINE
JAMP OLANZAPINE FC
2.5 MG
ORL  TAB
0.1772
0.1772
TAB
YES

REGULAR BENEFIT

OLANZAPINE
OLANZAPINE
2.5 MG
ORL  TAB
0.1772
0.1772
TAB
YES

REGULAR BENEFIT

OLANZAPINE
OLANZAPINE
2.5 MG
ORL  TAB
0.1772
0.1772
TAB
YES

REGULAR BENEFIT

OLANZAPINE
PMS-OLANZAPINE
2.5 MG
ORL  TAB
0.1772
0.1772
TAB
YES

REGULAR BENEFIT

OLANZAPINE
SANDOZ OLANZAPINE
2.5 MG
ORL  TAB
0.1772
0.1772
TAB
YES

REGULAR BENEFIT

OLANZAPINE
TEVA-OLANZAPINE
2.5 MG
ORL  TAB
0.1772
0.1772
TAB
YES

REGULAR BENEFIT

OLANZAPINE
ZYPREXA
2.5 MG
ORL  TAB
1.8894
0.1772
TAB
YES

REGULAR BENEFIT

 

02238851
OLANZAPINE
ZYPREXA
20 MG
ORL  TAB
N/A
N/A
TAB
NO

NOT A BENEFIT *

02243089
OLANZAPINE
ZYPREXA ZYDIS
20 MG
ORL  DISNTAB
N/A
N/A
TAB
NO

NOT A BENEFIT *

OLANZAPINE
ACT OLANZAPINE ODT
5 MG
ORL  DISNTAB
0.3574
0.3574
TAB
YES

REGULAR BENEFIT

OLANZAPINE
APO-OLANZAPINE
5 MG
ORL  TAB
0.3544
0.3544
TAB
YES

REGULAR BENEFIT

OLANZAPINE
APO-OLANZAPINE ODT
5 MG
ORL  DISNTAB
0.3574
0.3574
TAB
YES

REGULAR BENEFIT

OLANZAPINE
AURO-OLANZAPINE ODT
5 MG
ORL  DISNTAB
0.3574
0.3574
TAB
YES

REGULAR BENEFIT

OLANZAPINE
JAMP OLANZAPINE FC
5 MG
ORL  TAB
0.3544
0.3544
TAB
YES

REGULAR BENEFIT

OLANZAPINE
JAMP-OLANZAPINE ODT
5 MG
ORL  DISNTAB
0.3574
0.3574
TAB
YES

REGULAR BENEFIT

OLANZAPINE
MAR-OLANZAPINE ODT
5 MG
ORL  DISNTAB
0.3574
0.3574
TAB
YES

REGULAR BENEFIT

OLANZAPINE
MINT-OLANZAPINE ODT
5 MG
ORL  DISNTAB
0.3574
0.3574
TAB
YES

REGULAR BENEFIT

OLANZAPINE
OLANZAPINE
5 MG
ORL  TAB
0.3544
0.3544
TAB
YES

REGULAR BENEFIT

OLANZAPINE
OLANZAPINE
5 MG
ORL  TAB
0.3544
0.3544
TAB
YES

REGULAR BENEFIT

OLANZAPINE
OLANZAPINE ODT
5 MG
ORL  DISNTAB
0.3574
0.3574
TAB
YES

REGULAR BENEFIT

OLANZAPINE
OLANZAPINE ODT
5 MG
ORL  DISNTAB
0.3574
0.3574
TAB
YES

REGULAR BENEFIT

OLANZAPINE
PMS-OLANZAPINE
5 MG
ORL  TAB
0.3544
0.3544
TAB
YES

REGULAR BENEFIT

OLANZAPINE
PMS-OLANZAPINE ODT
5 MG
ORL  DISNTAB
0.3574
0.3574
TAB
YES

REGULAR BENEFIT

OLANZAPINE
RAN-OLANZAPINE ODT
5 MG
ORL  DISNTAB
0.3574
0.3574
TAB
YES

REGULAR BENEFIT

OLANZAPINE
SANDOZ OLANZAPINE
5 MG
ORL  TAB
0.3544
0.3544
TAB
YES

REGULAR BENEFIT

OLANZAPINE
SANDOZ OLANZAPINE ODT
5 MG
ORL  DISNTAB
0.3574
0.3574
TAB
YES

REGULAR BENEFIT

OLANZAPINE
TEVA-OLANZAPINE
5 MG
ORL  TAB
0.3544
0.3544
TAB
YES

REGULAR BENEFIT

OLANZAPINE
ZYPREXA
5 MG
ORL  TAB
3.7791
0.3544
TAB
YES

REGULAR BENEFIT

 

OLANZAPINE
ZYPREXA ZYDIS
5 MG
ORL  DISNTAB
3.7583
0.3574
TAB
YES

REGULAR BENEFIT

 

OLANZAPINE
APO-OLANZAPINE
7.5 MG
ORL  TAB
0.5316
0.5316
TAB
YES

REGULAR BENEFIT

OLANZAPINE
JAMP OLANZAPINE FC
7.5 MG
ORL  TAB
0.5316
0.5316
TAB
YES

REGULAR BENEFIT

OLANZAPINE
OLANZAPINE
7.5 MG
ORL  TAB
0.5316
0.5316
TAB
YES

REGULAR BENEFIT

OLANZAPINE
OLANZAPINE
7.5 MG
ORL  TAB
0.5316
0.5316
TAB
YES

REGULAR BENEFIT

OLANZAPINE
PMS-OLANZAPINE
7.5 MG
ORL  TAB
0.5316
0.5316
TAB
YES

REGULAR BENEFIT

OLANZAPINE
SANDOZ OLANZAPINE
7.5 MG
ORL  TAB
0.5316
0.5316
TAB
YES

REGULAR BENEFIT

OLANZAPINE
TEVA-OLANZAPINE
7.5 MG
ORL  TAB
0.5316
0.5316
TAB
YES

REGULAR BENEFIT

OLANZAPINE
ZYPREXA
7.5 MG
ORL  TAB
5.6685
0.5316
TAB
YES

REGULAR BENEFIT

 

PALIPERIDONE
INVEGA
3 MG
ORL  ERT
3.8660
N/A
TAB
NO

REGULAR BENEFIT

PALIPERIDONE
INVEGA
6 MG
ORL  ERT
5.7833
N/A
TAB
NO

REGULAR BENEFIT

PALIPERIDONE
INVEGA
9 MG
ORL  ERT
7.7080
N/A
TAB
NO

REGULAR BENEFIT

PALIPERIDONE PALMITATE
INVEGA SUSTENNA (1 ML SYR)
100 MG / SYR
INJ  NDL
467.1800
N/A
SYR
NO

SPECIAL AUTHORIZATION

PALIPERIDONE PALMITATE
INVEGA SUSTENNA (1.5 ML SYR)
150 MG / SYR
INJ  NDL
622.8900
N/A
SYR
NO

SPECIAL AUTHORIZATION

PALIPERIDONE PALMITATE
INVEGA TRINZA (0.875 ML SYR)
175 MG / SYR
INJ  NDL
934.2900
N/A
SYR
NO

SPECIAL AUTHORIZATION

PALIPERIDONE PALMITATE
INVEGA TRINZA (1.315 ML SYR)
263 MG / SYR
INJ  NDL
1401.5400
N/A
SYR
NO

SPECIAL AUTHORIZATION

PALIPERIDONE PALMITATE
INVEGA TRINZA (1.75 ML SYR)
350 MG / SYR
INJ  NDL
1401.5400
N/A
SYR
NO

SPECIAL AUTHORIZATION

PALIPERIDONE PALMITATE
INVEGA SUSTENNA (0.5 ML SYR)
50 MG / SYR
INJ  NDL
311.4300
N/A
SYR
NO

SPECIAL AUTHORIZATION

PALIPERIDONE PALMITATE
INVEGA TRINZA (2.625 ML SYR)
525 MG / SYR
INJ  NDL
1868.6700
N/A
SYR
NO

SPECIAL AUTHORIZATION

PALIPERIDONE PALMITATE
INVEGA SUSTENNA (0.75 ML SYR)
75 MG / SYR
INJ  NDL
467.1800
N/A
SYR
NO

SPECIAL AUTHORIZATION

QUETIAPINE FUMARATE
ACT QUETIAPINE
100 MG
ORL  TAB
0.1318
0.1318
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
APO-QUETIAPINE
100 MG
ORL  TAB
0.1318
0.1318
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
AURO-QUETIAPINE
100 MG
ORL  TAB
0.1318
0.1318
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
BIO-QUETIAPINE
100 MG
ORL  TAB
0.1318
0.1318
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
JAMP-QUETIAPINE
100 MG
ORL  TAB
0.1318
0.1318
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
MAR-QUETIAPINE
100 MG
ORL  TAB
0.1318
0.1318
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
MINT-QUETIAPINE
100 MG
ORL  TAB
0.1318
0.1318
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
NAT-QUETIAPINE
100 MG
ORL  TAB
0.1318
0.1318
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
PMS-QUETIAPINE
100 MG
ORL  TAB
0.1318
0.1318
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
QUETIAPINE
100 MG
ORL  TAB
0.1318
0.1318
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
QUETIAPINE
100 MG
ORL  TAB
0.1318
0.1318
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
QUETIAPINE
100 MG
ORL  TAB
0.1318
0.1318
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
RAN-QUETIAPINE
100 MG
ORL  TAB
0.1318
0.1318
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
SANDOZ QUETIAPINE
100 MG
ORL  TAB
0.1318
0.1318
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
SEROQUEL
100 MG
ORL  TAB
1.3860
0.1318
TAB
YES

REGULAR BENEFIT

 

QUETIAPINE FUMARATE
APO-QUETIAPINE XR
150 MG
ORL  ERT
0.4926
0.4926
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
NAT-QUETIAPINE
150 MG
ORL  TAB
1.0195
N/A
TAB
NO

REGULAR BENEFIT

QUETIAPINE FUMARATE
QUETIAPINE XR
150 MG
ORL  ERT
0.4926
0.4926
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
SANDOZ QUETIAPINE XRT
150 MG
ORL  ERT
0.4926
0.4926
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
SEROQUEL XR
150 MG
ORL  ERT
1.9701
0.4926
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
TEVA-QUETIAPINE XR
150 MG
ORL  ERT
0.4926
0.4926
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
ACT QUETIAPINE
200 MG
ORL  TAB
0.2647
0.2647
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
APO-QUETIAPINE
200 MG
ORL  TAB
0.2647
0.2647
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
APO-QUETIAPINE XR
200 MG
ORL  ERT
0.6661
0.6661
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
AURO-QUETIAPINE
200 MG
ORL  TAB
0.2647
0.2647
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
BIO-QUETIAPINE
200 MG
ORL  TAB
0.2647
0.2647
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
JAMP-QUETIAPINE
200 MG
ORL  TAB
0.2647
0.2647
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
MAR-QUETIAPINE
200 MG
ORL  TAB
0.2647
0.2647
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
MINT-QUETIAPINE
200 MG
ORL  TAB
0.2647
0.2647
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
NAT-QUETIAPINE
200 MG
ORL  TAB
0.2647
0.2647
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
PMS-QUETIAPINE
200 MG
ORL  TAB
0.2647
0.2647
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
QUETIAPINE
200 MG
ORL  TAB
0.2647
0.2647
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
QUETIAPINE
200 MG
ORL  TAB
0.2647
0.2647
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
QUETIAPINE
200 MG
ORL  TAB
0.2647
0.2647
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
QUETIAPINE XR
200 MG
ORL  ERT
0.6661
0.6661
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
RAN-QUETIAPINE
200 MG
ORL  TAB
0.2647
0.2647
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
SANDOZ QUETIAPINE
200 MG
ORL  TAB
0.2647
0.2647
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
SANDOZ QUETIAPINE XRT
200 MG
ORL  ERT
0.6661
0.6661
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
SEROQUEL
200 MG
ORL  TAB
2.7830
0.2647
TAB
YES

REGULAR BENEFIT

 

QUETIAPINE FUMARATE
SEROQUEL XR
200 MG
ORL  ERT
2.6641
0.6661
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
TEVA-QUETIAPINE XR
200 MG
ORL  ERT
0.6661
0.6661
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
ACT QUETIAPINE
25 MG
ORL  TAB
0.0494
0.0494
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
APO-QUETIAPINE
25 MG
ORL  TAB
0.0494
0.0494
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
AURO-QUETIAPINE
25 MG
ORL  TAB
0.0494
0.0494
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
BIO-QUETIAPINE
25 MG
ORL  TAB
0.0494
0.0494
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
JAMP-QUETIAPINE
25 MG
ORL  TAB
0.0494
0.0494
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
MAR-QUETIAPINE
25 MG
ORL  TAB
0.0494
0.0494
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
MINT-QUETIAPINE
25 MG
ORL  TAB
0.0494
0.0494
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
NAT-QUETIAPINE
25 MG
ORL  TAB
0.0494
0.0494
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
PMS-QUETIAPINE
25 MG
ORL  TAB
0.0494
0.0494
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
QUETIAPINE
25 MG
ORL  TAB
0.0494
0.0494
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
QUETIAPINE
25 MG
ORL  TAB
0.0494
0.0494
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
QUETIAPINE
25 MG
ORL  TAB
0.0494
0.0494
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
RAN-QUETIAPINE
25 MG
ORL  TAB
0.0494
0.0494
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
SANDOZ QUETIAPINE
25 MG
ORL  TAB
0.0494
0.0494
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
SEROQUEL
25 MG
ORL  TAB
0.5195
0.0494
TAB
YES

REGULAR BENEFIT

 

QUETIAPINE FUMARATE
ACT QUETIAPINE
300 MG
ORL  TAB
0.3863
0.3863
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
APO-QUETIAPINE
300 MG
ORL  TAB
0.3863
0.3863
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
APO-QUETIAPINE XR
300 MG
ORL  ERT
0.9776
0.9776
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
AURO-QUETIAPINE
300 MG
ORL  TAB
0.3863
0.3863
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
BIO-QUETIAPINE
300 MG
ORL  TAB
0.3863
0.3863
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
JAMP-QUETIAPINE
300 MG
ORL  TAB
0.3863
0.3863
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
MAR-QUETIAPINE
300 MG
ORL  TAB
0.3863
0.3863
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
MINT-QUETIAPINE
300 MG
ORL  TAB
0.3863
0.3863
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
NAT-QUETIAPINE
300 MG
ORL  TAB
0.3863
0.3863
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
PMS-QUETIAPINE
300 MG
ORL  TAB
0.3863
0.3863
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
QUETIAPINE
300 MG
ORL  TAB
0.3863
0.3863
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
QUETIAPINE
300 MG
ORL  TAB
0.3863
0.3863
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
QUETIAPINE
300 MG
ORL  TAB
0.3863
0.3863
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
QUETIAPINE XR
300 MG
ORL  ERT
0.9776
0.9776
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
RAN-QUETIAPINE
300 MG
ORL  TAB
0.3863
0.3863
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
SANDOZ QUETIAPINE
300 MG
ORL  TAB
0.3863
0.3863
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
SANDOZ QUETIAPINE XRT
300 MG
ORL  ERT
0.9776
0.9776
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
SEROQUEL
300 MG
ORL  TAB
4.0610
0.3863
TAB
YES

REGULAR BENEFIT

 

QUETIAPINE FUMARATE
SEROQUEL XR
300 MG
ORL  ERT
3.9101
0.9776
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
TEVA-QUETIAPINE XR
300 MG
ORL  ERT
0.9776
0.9776
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
APO-QUETIAPINE XR
400 MG
ORL  ERT
1.3270
1.3270
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
QUETIAPINE XR
400 MG
ORL  ERT
1.3270
1.3270
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
SANDOZ QUETIAPINE XRT
400 MG
ORL  ERT
1.3270
1.3270
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
SEROQUEL XR
400 MG
ORL  ERT
5.3080
1.3270
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
TEVA-QUETIAPINE XR
400 MG
ORL  ERT
1.3270
1.3270
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
APO-QUETIAPINE XR
50 MG
ORL  ERT
0.2501
0.2501
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
PMS-QUETIAPINE
50 MG
ORL  TAB
0.5778
N/A
TAB
NO

REGULAR BENEFIT

QUETIAPINE FUMARATE
QUETIAPINE XR
50 MG
ORL  ERT
0.2501
0.2501
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
SANDOZ QUETIAPINE XRT
50 MG
ORL  ERT
0.2501
0.2501
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
SEROQUEL XR
50 MG
ORL  ERT
1.0003
0.2501
TAB
YES

REGULAR BENEFIT

QUETIAPINE FUMARATE
TEVA-QUETIAPINE XR
50 MG
ORL  ERT
0.2501
0.2501
TAB
YES

REGULAR BENEFIT

RISPERIDONE
APO-RISPERIDONE
0.25 MG
ORL  TAB
0.1036
0.1036
TAB
YES

REGULAR BENEFIT

RISPERIDONE
JAMP-RISPERIDONE
0.25 MG
ORL  TAB
0.1036
0.1036
TAB
YES

REGULAR BENEFIT

RISPERIDONE
MAR-RISPERIDONE
0.25 MG
ORL  TAB
0.1036
0.1036
TAB
YES

REGULAR BENEFIT

RISPERIDONE
MINT-RISPERIDON
0.25 MG
ORL  TAB
0.1036
0.1036
TAB
YES

REGULAR BENEFIT

RISPERIDONE
PMS-RISPERIDONE
0.25 MG
ORL  TAB
0.1036
0.1036
TAB
YES

REGULAR BENEFIT

RISPERIDONE
RAN-RISPERIDONE
0.25 MG
ORL  TAB
0.1036
0.1036
TAB
YES

REGULAR BENEFIT

RISPERIDONE
RISPERIDONE
0.25 MG
ORL  TAB
0.1036
0.1036
TAB
YES

REGULAR BENEFIT

RISPERIDONE
SANDOZ RISPERIDONE
0.25 MG
ORL  TAB
0.1036
0.1036
TAB
YES

REGULAR BENEFIT

RISPERIDONE
TEVA-RISPERIDONE
0.25 MG
ORL  TAB
0.1036
0.1036
TAB
YES

REGULAR BENEFIT

RISPERIDONE
APO-RISPERIDONE
0.5 MG
ORL  TAB
0.1735
0.1735
TAB
YES

REGULAR BENEFIT

RISPERIDONE
JAMP-RISPERIDONE
0.5 MG
ORL  TAB
0.1735
0.1735
TAB
YES

REGULAR BENEFIT

RISPERIDONE
MAR-RISPERIDONE
0.5 MG
ORL  TAB
0.1735
0.1735
TAB
YES

REGULAR BENEFIT

RISPERIDONE
MINT-RISPERIDON
0.5 MG
ORL  TAB
0.1735
0.1735
TAB
YES

REGULAR BENEFIT

RISPERIDONE
MYLAN-RISPERIDONE ODT
0.5 MG
ORL  DISNTAB
0.5588
N/A
TAB
NO

REGULAR BENEFIT

RISPERIDONE
PMS-RISPERIDONE
0.5 MG
ORL  TAB
0.1735
0.1735
TAB
YES

REGULAR BENEFIT

RISPERIDONE
RAN-RISPERIDONE
0.5 MG
ORL  TAB
0.1735
0.1735
TAB
YES

REGULAR BENEFIT

RISPERIDONE
RISPERIDONE
0.5 MG
ORL  TAB
0.1735
0.1735
TAB
YES

REGULAR BENEFIT

RISPERIDONE
SANDOZ RISPERIDONE
0.5 MG
ORL  TAB
0.1735
0.1735
TAB
YES

REGULAR BENEFIT

RISPERIDONE
TEVA-RISPERIDONE
0.5 MG
ORL  TAB
0.1735
0.1735
TAB
YES

REGULAR BENEFIT

RISPERIDONE
APO-RISPERIDONE
1 MG
ORL  TAB
0.2397
0.2397
TAB
YES

REGULAR BENEFIT

RISPERIDONE
JAMP-RISPERIDONE
1 MG
ORL  TAB
0.2397
0.2397
TAB
YES

REGULAR BENEFIT

RISPERIDONE
MAR-RISPERIDONE
1 MG
ORL  TAB
0.2397
0.2397
TAB
YES

REGULAR BENEFIT

RISPERIDONE
MINT-RISPERIDON
1 MG
ORL  TAB
0.2397
0.2397
TAB
YES

REGULAR BENEFIT

RISPERIDONE
MYLAN-RISPERIDONE ODT
1 MG
ORL  DISNTAB
0.5150
N/A
TAB
NO

REGULAR BENEFIT

RISPERIDONE
PMS-RISPERIDONE
1 MG
ORL  TAB
0.2397
0.2397
TAB
YES

REGULAR BENEFIT

RISPERIDONE
RAN-RISPERIDONE
1 MG
ORL  TAB
0.2397
0.2397
TAB
YES

REGULAR BENEFIT

RISPERIDONE
RISPERIDONE
1 MG
ORL  TAB
0.2397
0.2397
TAB
YES

REGULAR BENEFIT

RISPERIDONE
SANDOZ RISPERIDONE
1 MG
ORL  TAB
0.2397
0.2397
TAB
YES

REGULAR BENEFIT

RISPERIDONE
TEVA-RISPERIDONE
1 MG
ORL  TAB
0.2397
0.2397
TAB
YES

REGULAR BENEFIT

RISPERIDONE
APO-RISPERIDONE
2 MG
ORL  TAB
0.4795
0.4795
TAB
YES

REGULAR BENEFIT

RISPERIDONE
JAMP-RISPERIDONE
2 MG
ORL  TAB
0.4795
0.4795
TAB
YES

REGULAR BENEFIT

RISPERIDONE
MAR-RISPERIDONE
2 MG
ORL  TAB
0.4795
0.4795
TAB
YES

REGULAR BENEFIT

RISPERIDONE
MINT-RISPERIDON
2 MG
ORL  TAB
0.4795
0.4795
TAB
YES

REGULAR BENEFIT

RISPERIDONE
MYLAN-RISPERIDONE ODT
2 MG
ORL  DISNTAB
1.0187
N/A
TAB
NO

REGULAR BENEFIT

RISPERIDONE
PMS-RISPERIDONE
2 MG
ORL  TAB
0.4795
0.4795
TAB
YES

REGULAR BENEFIT

RISPERIDONE
RAN-RISPERIDONE
2 MG
ORL  TAB
0.4795
0.4795
TAB
YES

REGULAR BENEFIT

RISPERIDONE
RISPERIDONE
2 MG
ORL  TAB
0.4795
0.4795
TAB
YES

REGULAR BENEFIT

RISPERIDONE
SANDOZ RISPERIDONE
2 MG
ORL  TAB
0.4795
0.4795
TAB
YES

REGULAR BENEFIT

RISPERIDONE
TEVA-RISPERIDONE
2 MG
ORL  TAB
0.4795
0.4795
TAB
YES

REGULAR BENEFIT

RISPERIDONE
RISPERDAL CONSTA
25 MG / VIAL
INJ 
169.5900
N/A
VIAL
NO

SPECIAL AUTHORIZATION

RISPERIDONE
APO-RISPERIDONE
3 MG
ORL  TAB
0.7180
0.7180
TAB
YES

REGULAR BENEFIT

RISPERIDONE
JAMP-RISPERIDONE
3 MG
ORL  TAB
0.7180
0.7180
TAB
YES

REGULAR BENEFIT

RISPERIDONE
MAR-RISPERIDONE
3 MG
ORL  TAB
0.7180
0.7180
TAB
YES

REGULAR BENEFIT

RISPERIDONE
MINT-RISPERIDON
3 MG
ORL  TAB
0.7180
0.7180
TAB
YES

REGULAR BENEFIT

RISPERIDONE
MYLAN-RISPERIDONE ODT
3 MG
ORL  DISNTAB
1.5275
N/A
TAB
NO

REGULAR BENEFIT

RISPERIDONE
PMS-RISPERIDONE
3 MG
ORL  TAB
0.7180
0.7180
TAB
YES

REGULAR BENEFIT

RISPERIDONE
RAN-RISPERIDONE
3 MG
ORL  TAB
0.7180
0.7180
TAB
YES

REGULAR BENEFIT

RISPERIDONE
RISPERIDONE
3 MG
ORL  TAB
0.7180
0.7180
TAB
YES

REGULAR BENEFIT

RISPERIDONE
SANDOZ RISPERIDONE
3 MG
ORL  TAB
0.7180
0.7180
TAB
YES

REGULAR BENEFIT

RISPERIDONE
TEVA-RISPERIDONE
3 MG
ORL  TAB
0.7180
0.7180
TAB
YES

REGULAR BENEFIT

RISPERIDONE
RISPERDAL CONSTA
37.5 MG / VIAL
INJ 
254.3600
N/A
VIAL
NO

SPECIAL AUTHORIZATION

RISPERIDONE
APO-RISPERIDONE
4 MG
ORL  TAB
0.9574
0.9574
TAB
YES

REGULAR BENEFIT

RISPERIDONE
JAMP-RISPERIDONE
4 MG
ORL  TAB
0.9574
0.9574
TAB
YES

REGULAR BENEFIT

RISPERIDONE
MAR-RISPERIDONE
4 MG
ORL  TAB
0.9574
0.9574
TAB
YES

REGULAR BENEFIT

RISPERIDONE
MINT-RISPERIDON
4 MG
ORL  TAB
0.9574
0.9574
TAB
YES

REGULAR BENEFIT

RISPERIDONE
MYLAN-RISPERIDONE ODT
4 MG
ORL  DISNTAB
2.0425
N/A
TAB
NO

REGULAR BENEFIT

RISPERIDONE
PMS-RISPERIDONE
4 MG
ORL  TAB
0.9574
0.9574
TAB
YES

REGULAR BENEFIT

RISPERIDONE
RAN-RISPERIDONE
4 MG
ORL  TAB
0.9574
0.9574
TAB
YES

REGULAR BENEFIT

RISPERIDONE
RISPERIDONE
4 MG
ORL  TAB
0.9574
0.9574
TAB
YES

REGULAR BENEFIT

RISPERIDONE
SANDOZ RISPERIDONE
4 MG
ORL  TAB
0.9574
0.9574
TAB
YES

REGULAR BENEFIT

RISPERIDONE
TEVA-RISPERIDONE
4 MG
ORL  TAB
0.9574
0.9574
TAB
YES

REGULAR BENEFIT

RISPERIDONE
RISPERDAL CONSTA
50 MG / VIAL
INJ 
339.1500
N/A
VIAL
NO

SPECIAL AUTHORIZATION

RISPERIDONE TARTRATE
JAMP-RISPERIDONE
1 MG / ML
ORL  SOL
0.4895
0.4895
ML
YES

RESTRICTED BENEFIT

RISPERIDONE TARTRATE
PMS-RISPERIDONE
1 MG / ML
ORL  SOL
0.4895
0.4895
ML
YES

RESTRICTED BENEFIT

RISPERIDONE TARTRATE
RISPERDAL
1 MG / ML
ORL  SOL
1.4118
0.4895
ML
YES

RESTRICTED BENEFIT

 

ZIPRASIDONE HYDROCHLORIDE MONOHYDRATE
AURO-ZIPRASIDONE
20 MG
ORL  CAP
1.3784
1.3784
CAP
YES

REGULAR BENEFIT

ZIPRASIDONE HYDROCHLORIDE MONOHYDRATE
ZELDOX
20 MG
ORL  CAP
1.8579
1.3784
CAP
YES

REGULAR BENEFIT

ZIPRASIDONE HYDROCHLORIDE MONOHYDRATE
AURO-ZIPRASIDONE
40 MG
ORL  CAP
1.5786
1.5786
CAP
YES

REGULAR BENEFIT

ZIPRASIDONE HYDROCHLORIDE MONOHYDRATE
ZELDOX
40 MG
ORL  CAP
2.1282
1.5786
CAP
YES

REGULAR BENEFIT

ZIPRASIDONE HYDROCHLORIDE MONOHYDRATE
AURO-ZIPRASIDONE
60 MG
ORL  CAP
1.5786
1.5786
CAP
YES

REGULAR BENEFIT

ZIPRASIDONE HYDROCHLORIDE MONOHYDRATE
ZELDOX
60 MG
ORL  CAP
2.1282
1.5786
CAP
YES

REGULAR BENEFIT

ZIPRASIDONE HYDROCHLORIDE MONOHYDRATE
AURO-ZIPRASIDONE
80 MG
ORL  CAP
1.5786
1.5786
CAP
YES

REGULAR BENEFIT

ZIPRASIDONE HYDROCHLORIDE MONOHYDRATE
ZELDOX
80 MG
ORL  CAP
2.1282
1.5786
CAP
YES

REGULAR BENEFIT


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NOTICE:
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.