PTC 283228

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Products Found: 78

MFR

Review Status/
Past Decision(s)

ALMOTRIPTAN MALATE
ALMOTRIPTAN
12.5 MG
ORL  TAB
2.3478
2.3478
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

ALMOTRIPTAN MALATE
MYLAN-ALMOTRIPTAN
12.5 MG
ORL  TAB
2.3478
2.3478
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

ALMOTRIPTAN MALATE
SANDOZ ALMOTRIPTAN
12.5 MG
ORL  TAB
2.3478
2.3478
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

ALMOTRIPTAN MALATE
TEVA-ALMOTRIPTAN
12.5 MG
ORL  TAB
N/A
N/A
TAB
YES

UNDER REVIEW *

ALMOTRIPTAN MALATE
MYLAN-ALMOTRIPTAN
6.25 MG
ORL  TAB
7.0433
N/A
TAB
NO

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

NARATRIPTAN HCL
AMERGE
1 MG
ORL  TAB
14.7667
11.9041
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

NARATRIPTAN HCL
TEVA-NARATRIPTAN
1 MG
ORL  TAB
11.9041
11.9041
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

NARATRIPTAN HCL
AMERGE
2.5 MG
ORL  TAB
15.5646
6.1436
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

NARATRIPTAN HCL
SANDOZ NARATRIPTAN
2.5 MG
ORL  TAB
6.1436
6.1436
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

NARATRIPTAN HCL
TEVA-NARATRIPTAN
2.5 MG
ORL  TAB
6.1436
6.1436
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
ACT RIZATRIPTAN
10 MG
ORL  TAB
3.7050
3.7050
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
APO-RIZATRIPTAN
10 MG
ORL  TAB
3.7050
3.7050
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
AURO-RIZATRIPTAN
10 MG
ORL  TAB
3.7050
3.7050
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
CCP-RIZATRIPTAN ODT
10 MG
ORL  DISNTAB
N/A
N/A
TAB
YES

UNDER REVIEW *

RIZATRIPTAN BENZOATE
JAMP-RIZATRIPTAN
10 MG
ORL  TAB
3.7050
3.7050
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
JAMP-RIZATRIPTAN IR
10 MG
ORL  TAB
3.7050
3.7050
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
JAMP-RIZATRIPTAN ODT
10 MG
ORL  DISNTAB
3.7050
3.7050
WAF
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
MAR-RIZATRIPTAN
10 MG
ORL  TAB
3.7050
3.7050
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
MAR-RIZATRIPTAN ODT
10 MG
ORL  DISNTAB
3.7050
3.7050
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
MAXALT
10 MG
ORL  TAB
16.5163
3.7050
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
MAXALT RPD
10 MG
ORL  DISNTAB
16.5163
3.7050
WAF
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
MYLAN-RIZATRIPTAN ODT
10 MG
ORL  DISNTAB
3.7050
3.7050
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
NAT-RIZATRIPTAN ODT
10 MG
ORL  DISNTAB
3.7050
3.7050
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
PMS-RIZATRIPTAN RDT
10 MG
ORL  DISNTAB
3.7050
3.7050
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
RIZATRIPTAN ODT
10 MG
ORL  DISNTAB
3.7050
3.7050
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
RIZATRIPTAN ODT
10 MG
ORL  DISNTAB
3.7050
3.7050
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
SANDOZ RIZATRIPTAN ODT
10 MG
ORL  DISNTAB
3.7050
3.7050
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
TEVA-RIZATRIPTAN ODT
10 MG
ORL  DISNTAB
3.7050
3.7050
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
APO-RIZATRIPTAN
5 MG
ORL  TAB
3.7050
3.7050
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
CCP-RIZATRIPTAN ODT
5 MG
ORL  DISNTAB
N/A
N/A
TAB
YES

UNDER REVIEW *

RIZATRIPTAN BENZOATE
JAMP-RIZATRIPTAN
5 MG
ORL  TAB
3.7050
3.7050
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
JAMP-RIZATRIPTAN IR
5 MG
ORL  TAB
3.7050
3.7050
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
JAMP-RIZATRIPTAN ODT
5 MG
ORL  DISNTAB
3.7050
3.7050
WAF
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
MAR-RIZATRIPTAN ODT
5 MG
ORL  DISNTAB
3.7050
3.7050
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
MAXALT RPD
5 MG
ORL  DISNTAB
16.5163
3.7050
WAF
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
MYLAN-RIZATRIPTAN ODT
5 MG
ORL  DISNTAB
3.7050
3.7050
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
NAT-RIZATRIPTAN ODT
5 MG
ORL  DISNTAB
3.7050
3.7050
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
PMS-RIZATRIPTAN RDT
5 MG
ORL  DISNTAB
3.7050
3.7050
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
RIZATRIPTAN ODT
5 MG
ORL  DISNTAB
3.7050
3.7050
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
RIZATRIPTAN ODT
5 MG
ORL  DISNTAB
3.7050
3.7050
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
SANDOZ RIZATRIPTAN ODT
5 MG
ORL  DISNTAB
3.7050
3.7050
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

RIZATRIPTAN BENZOATE
TEVA-RIZATRIPTAN ODT
5 MG
ORL  DISNTAB
3.7050
3.7050
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

SUMATRIPTAN HEMISULFATE
IMITREX
20 MG / DOSE
NAS  SPU
16.0781
N/A
DOSE
NO

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

 

SUMATRIPTAN HEMISULFATE
IMITREX
5 MG / DOSE
NAS  SPU
15.6250
N/A
DOSE
NO

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

 

SUMATRIPTAN SUCCINATE
ACT SUMATRIPTAN
100 MG
ORL  TAB
3.0549
3.0549
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

SUMATRIPTAN SUCCINATE
APO-SUMATRIPTAN
100 MG
ORL  TAB
3.0549
3.0549
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

SUMATRIPTAN SUCCINATE
IMITREX DF
100 MG
ORL  TAB
17.3967
3.0549
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

 

SUMATRIPTAN SUCCINATE
MYLAN-SUMATRIPTAN
100 MG
ORL  TAB
3.0549
3.0549
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

 

SUMATRIPTAN SUCCINATE
PMS-SUMATRIPTAN
100 MG
ORL  TAB
3.0549
3.0549
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

SUMATRIPTAN SUCCINATE
SANDOZ SUMATRIPTAN
100 MG
ORL  TAB
3.0549
3.0549
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

SUMATRIPTAN SUCCINATE
SUMATRIPTAN
100 MG
ORL  TAB
3.0549
3.0549
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

SUMATRIPTAN SUCCINATE
SUMATRIPTAN DF
100 MG
ORL  TAB
3.0549
3.0549
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

SUMATRIPTAN SUCCINATE
TEVA-SUMATRIPTAN
100 MG
ORL  TAB
3.0549
3.0549
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

SUMATRIPTAN SUCCINATE
TEVA-SUMATRIPTAN DF
100 MG
ORL  TAB
3.0549
3.0549
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

SUMATRIPTAN SUCCINATE
APO-SUMATRIPTAN
50 MG
ORL  TAB
2.7732
2.7732
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

SUMATRIPTAN SUCCINATE
IMITREX DF
50 MG
ORL  TAB
15.7917
2.7732
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

 

SUMATRIPTAN SUCCINATE
MYLAN-SUMATRIPTAN
50 MG
ORL  TAB
2.7732
2.7732
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

 

SUMATRIPTAN SUCCINATE
PMS-SUMATRIPTAN
50 MG
ORL  TAB
2.7732
2.7732
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

SUMATRIPTAN SUCCINATE
SANDOZ SUMATRIPTAN
50 MG
ORL  TAB
2.7732
2.7732
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

SUMATRIPTAN SUCCINATE
SUMATRIPTAN
50 MG
ORL  TAB
2.7732
2.7732
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

SUMATRIPTAN SUCCINATE
SUMATRIPTAN DF
50 MG
ORL  TAB
2.7732
2.7732
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

SUMATRIPTAN SUCCINATE
TEVA-SUMATRIPTAN DF
50 MG
ORL  TAB
2.7732
2.7732
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

SUMATRIPTAN SUCCINATE
IMITREX (0.5 ML)
6 MG / SYR
INJ  NDL
47.1762
34.6200
SYR
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

 

SUMATRIPTAN SUCCINATE
TARO-SUMATRIPTAN (0.5 ML)
6 MG / SYR
INJ  NDL
34.6200
34.6200
SYR
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

02381575
ZOLMITRIPTAN
APO-ZOLMITRIPTAN RAPID
2.5 MG
ORL  DISPTAB
N/A
N/A
TAB
NO

NOT A BENEFIT *

ZOLMITRIPTAN
CCP-ZOLMITRIPTAN
2.5 MG
ORL  TAB
N/A
N/A
TAB
YES

UNDER REVIEW *

ZOLMITRIPTAN
JAMP-ZOLMITRIPTAN
2.5 MG
ORL  TAB
3.5375
3.5375
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

ZOLMITRIPTAN
JAMP-ZOLMITRIPTAN ODT
2.5 MG
ORL  DISPTAB
1.7532
0.0000
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

ZOLMITRIPTAN
MAR-ZOLMITRIPTAN
2.5 MG
ORL  TAB
3.5375
3.5375
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

ZOLMITRIPTAN
MINT-ZOLMITRIPTAN
2.5 MG
ORL  TAB
3.5375
3.5375
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

ZOLMITRIPTAN
NAT-ZOLMITRIPTAN
2.5 MG
ORL  TAB
3.5375
3.5375
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

ZOLMITRIPTAN
PMS-ZOLMITRIPTAN
2.5 MG
ORL  TAB
3.5375
3.5375
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

ZOLMITRIPTAN
SANDOZ ZOLMITRIPTAN
2.5 MG
ORL  TAB
3.5375
3.5375
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

ZOLMITRIPTAN
SEPTA-ZOLMITRIPTAN-ODT
2.5 MG
ORL  DISPTAB
1.7532
0.0000
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

ZOLMITRIPTAN
TEVA-ZOLMITRIPTAN
2.5 MG
ORL  TAB
3.5375
3.5375
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

ZOLMITRIPTAN
ZOMIG
2.5 MG
ORL  TAB
14.9600
3.5375
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

ZOLMITRIPTAN
ZOMIG RAPIMELT
2.5 MG
ORL  DISPTAB
14.9600
0.0000
TAB
YES

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION

ZOLMITRIPTAN
ZOMIG
5 MG / DOSE
NAS  SPU
14.9600
N/A
DOSE
NO

RESTRICTED BENEFIT/ SPECIAL AUTHORIZATION


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