Home Health iDBL
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
02425483 CANAGLIFLOZIN INVOKANA 100 MG ORAL TABLET 2.8560
TAB 		JAI N/A N/A NO STEP THERAPY/ SPECIAL AUTHORIZATION Details
02425491 CANAGLIFLOZIN INVOKANA 300 MG ORAL TABLET 2.9670
TAB 		JAI N/A N/A NO STEP THERAPY/ SPECIAL AUTHORIZATION Details
02455455 CANAGLIFLOZIN/ METFORMIN HCL INVOKAMET 150 MG * 1,000 MG ORAL TABLET N/A
TAB 		JAI N/A N/A NO NOT A BENEFIT Details
02455439 CANAGLIFLOZIN/ METFORMIN HCL INVOKAMET 150 MG * 500 MG ORAL TABLET N/A
TAB 		JAI N/A N/A NO NOT A BENEFIT Details
02455420 CANAGLIFLOZIN/ METFORMIN HCL INVOKAMET 50 MG * 1,000 MG ORAL TABLET N/A
TAB 		JAI N/A N/A NO NOT A BENEFIT Details
02455404 CANAGLIFLOZIN/ METFORMIN HCL INVOKAMET 50 MG * 500 MG ORAL TABLET N/A
TAB 		JAI N/A N/A NO NOT A BENEFIT Details
02527197 DAPAGLIFLOZIN APO-DAPAGLIFLOZIN 10 MG ORAL TABLET 0.6825
TAB 		APX 0.6825 N/A YES REGULAR BENEFIT Details
02531410 DAPAGLIFLOZIN AURO-DAPAGLIFLOZIN 10 MG ORAL TABLET 0.6825
TAB 		AUR 0.6825 N/A YES REGULAR BENEFIT Details
02435470 DAPAGLIFLOZIN FORXIGA 10 MG ORAL TABLET 2.7300
TAB 		AZC 0.6825 N/A YES REGULAR BENEFIT Details
02519860 DAPAGLIFLOZIN GLN-DAPAGLIFLOZIN 10 MG ORAL TABLET 0.6825
TAB 		GLM 0.6825 N/A YES REGULAR BENEFIT Details
02531372 DAPAGLIFLOZIN JAMP DAPAGLIFLOZIN 10 MG ORAL TABLET 0.6825
TAB 		JPC 0.6825 N/A YES REGULAR BENEFIT Details
02535300 DAPAGLIFLOZIN M-DAPAGLIFLOZIN 10 MG ORAL TABLET 0.6825
TAB 		MTR 0.6825 N/A YES REGULAR BENEFIT Details
02538342 DAPAGLIFLOZIN NRA-DAPAGLIFLOZIN 10 MG ORAL TABLET 0.6825
TAB 		NRA 0.6825 N/A YES REGULAR BENEFIT Details
02531569 DAPAGLIFLOZIN PMS-DAPAGLIFLOZIN 10 MG ORAL TABLET 0.6825
TAB 		PMS 0.6825 N/A YES REGULAR BENEFIT Details
02518740 DAPAGLIFLOZIN SANDOZ DAPAGLIFLOZIN 10 MG ORAL TABLET 0.6825
TAB 		SDZ 0.6825 N/A YES REGULAR BENEFIT Details
02523604 DAPAGLIFLOZIN TEVA-DAPAGLIFLOZIN 10 MG ORAL TABLET N/A
TAB 		TEV N/A N/A YES UNDER REVIEW Details
02527189 DAPAGLIFLOZIN APO-DAPAGLIFLOZIN 5 MG ORAL TABLET 0.6825
TAB 		APX 0.6825 N/A YES REGULAR BENEFIT Details
02531402 DAPAGLIFLOZIN AURO-DAPAGLIFLOZIN 5 MG ORAL TABLET 0.6825
TAB 		AUR 0.6825 N/A YES REGULAR BENEFIT Details
02435462 DAPAGLIFLOZIN FORXIGA 5 MG ORAL TABLET 2.7300
TAB 		AZC 0.6825 N/A YES REGULAR BENEFIT Details
02519852 DAPAGLIFLOZIN GLN-DAPAGLIFLOZIN 5 MG ORAL TABLET 0.6825
TAB 		GLM 0.6825 N/A YES REGULAR BENEFIT Details
02531364 DAPAGLIFLOZIN JAMP DAPAGLIFLOZIN 5 MG ORAL TABLET 0.6825
TAB 		JPC 0.6825 N/A YES REGULAR BENEFIT Details
02535297 DAPAGLIFLOZIN M-DAPAGLIFLOZIN 5 MG ORAL TABLET 0.6825
TAB 		MTR 0.6825 N/A YES REGULAR BENEFIT Details
02538334 DAPAGLIFLOZIN NRA-DAPAGLIFLOZIN 5 MG ORAL TABLET 0.6825
TAB 		NRA 0.6825 N/A YES REGULAR BENEFIT Details
02531550 DAPAGLIFLOZIN PMS-DAPAGLIFLOZIN 5 MG ORAL TABLET 0.6825
TAB 		PMS 0.6825 N/A YES REGULAR BENEFIT Details
02518732 DAPAGLIFLOZIN SANDOZ DAPAGLIFLOZIN 5 MG ORAL TABLET 0.6825
TAB 		SDZ 0.6825 N/A YES REGULAR BENEFIT Details
02523590 DAPAGLIFLOZIN TEVA-DAPAGLIFLOZIN 5 MG ORAL TABLET N/A
TAB 		TEV N/A N/A YES UNDER REVIEW Details
02536161 DAPAGLIFLOZIN/ METFORMIN HCL APO-DAPAGLIFLOZIN-METFORMIN 5 MG * 1,000 MG ORAL TABLET 0.6432
TAB 		APX 0.6432 N/A YES REGULAR BENEFIT Details
02533081 DAPAGLIFLOZIN/ METFORMIN HCL AURO-DAPAGLIFLOZIN/METFORMIN 5 MG * 1,000 MG ORAL TABLET 0.6432
TAB 		AUR 0.6432 N/A YES REGULAR BENEFIT Details
02449943 DAPAGLIFLOZIN/ METFORMIN HCL XIGDUO 5 MG * 1,000 MG ORAL TABLET 1.2863
TAB 		AZC 0.6432 N/A YES REGULAR BENEFIT Details
02536153 DAPAGLIFLOZIN/ METFORMIN HCL APO-DAPAGLIFLOZIN-METFORMIN 5 MG * 850 MG ORAL TABLET 0.6432
TAB 		APX 0.6432 N/A YES REGULAR BENEFIT Details
02533073 DAPAGLIFLOZIN/ METFORMIN HCL AURO-DAPAGLIFLOZIN/METFORMIN 5 MG * 850 MG ORAL TABLET 0.6432
TAB 		AUR 0.6432 N/A YES REGULAR BENEFIT Details
02449935 DAPAGLIFLOZIN/ METFORMIN HCL XIGDUO 5 MG * 850 MG ORAL TABLET 1.2863
TAB 		AZC 0.6432 N/A YES REGULAR BENEFIT Details
02443937 EMPAGLIFLOZIN JARDIANCE 10 MG ORAL TABLET 2.7576
TAB 		BOE N/A N/A NO STEP THERAPY/ SPECIAL AUTHORIZATION Details
02443945 EMPAGLIFLOZIN JARDIANCE 25 MG ORAL TABLET 2.7576
TAB 		BOE N/A N/A NO STEP THERAPY/ SPECIAL AUTHORIZATION Details
02456621 EMPAGLIFLOZIN/ METFORMIN HCL SYNJARDY 12.5 MG * 1,000 MG ORAL TABLET 1.3935
TAB 		BOE N/A N/A NO STEP THERAPY/ SPECIAL AUTHORIZATION Details
02456605 EMPAGLIFLOZIN/ METFORMIN HCL SYNJARDY 12.5 MG * 500 MG ORAL TABLET 1.3935
TAB 		BOE N/A N/A NO STEP THERAPY/ SPECIAL AUTHORIZATION Details
02456613 EMPAGLIFLOZIN/ METFORMIN HCL SYNJARDY 12.5 MG * 850 MG ORAL TABLET 1.3935
TAB 		BOE N/A N/A NO STEP THERAPY/ SPECIAL AUTHORIZATION Details
02456591 EMPAGLIFLOZIN/ METFORMIN HCL SYNJARDY 5 MG * 1,000 MG ORAL TABLET 1.3935
TAB 		BOE N/A N/A NO STEP THERAPY/ SPECIAL AUTHORIZATION Details
02456575 EMPAGLIFLOZIN/ METFORMIN HCL SYNJARDY 5 MG * 500 MG ORAL TABLET 1.3935
TAB 		BOE N/A N/A NO STEP THERAPY/ SPECIAL AUTHORIZATION Details
02456583 EMPAGLIFLOZIN/ METFORMIN HCL SYNJARDY 5 MG * 850 MG ORAL TABLET 1.3935
TAB 		BOE N/A N/A NO STEP THERAPY/ SPECIAL AUTHORIZATION Details
DIN/NPN/ PIN 02425483
Generic Name CANAGLIFLOZIN
Product Name, Strength & Dosage Form INVOKANA 100 MG ORAL TABLET
Unit Price, Unit of Issue 2.8560
Manufacturer JAI
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02425491
Generic Name CANAGLIFLOZIN
Product Name, Strength & Dosage Form INVOKANA 300 MG ORAL TABLET
Unit Price, Unit of Issue 2.9670
Manufacturer JAI
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02455455
Generic Name CANAGLIFLOZIN/ METFORMIN HCL
Product Name, Strength & Dosage Form INVOKAMET 150 MG * 1,000 MG ORAL TABLET
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 02455439
Generic Name CANAGLIFLOZIN/ METFORMIN HCL
Product Name, Strength & Dosage Form INVOKAMET 150 MG * 500 MG ORAL TABLET
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 02455420
Generic Name CANAGLIFLOZIN/ METFORMIN HCL
Product Name, Strength & Dosage Form INVOKAMET 50 MG * 1,000 MG ORAL TABLET
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 02455404
Generic Name CANAGLIFLOZIN/ METFORMIN HCL
Product Name, Strength & Dosage Form INVOKAMET 50 MG * 500 MG ORAL TABLET
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 02527197
Generic Name DAPAGLIFLOZIN
Product Name, Strength & Dosage Form APO-DAPAGLIFLOZIN 10 MG ORAL TABLET
Unit Price, Unit of Issue 0.6825
Manufacturer APX
LCA Price 0.6825
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02531410
Generic Name DAPAGLIFLOZIN
Product Name, Strength & Dosage Form AURO-DAPAGLIFLOZIN 10 MG ORAL TABLET
Unit Price, Unit of Issue 0.6825
Manufacturer AUR
LCA Price 0.6825
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02435470
Generic Name DAPAGLIFLOZIN
Product Name, Strength & Dosage Form FORXIGA 10 MG ORAL TABLET
Unit Price, Unit of Issue 2.7300
Manufacturer AZC
LCA Price 0.6825
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02519860
Generic Name DAPAGLIFLOZIN
Product Name, Strength & Dosage Form GLN-DAPAGLIFLOZIN 10 MG ORAL TABLET
Unit Price, Unit of Issue 0.6825
Manufacturer GLM
LCA Price 0.6825
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02531372
Generic Name DAPAGLIFLOZIN
Product Name, Strength & Dosage Form JAMP DAPAGLIFLOZIN 10 MG ORAL TABLET
Unit Price, Unit of Issue 0.6825
Manufacturer JPC
LCA Price 0.6825
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02535300
Generic Name DAPAGLIFLOZIN
Product Name, Strength & Dosage Form M-DAPAGLIFLOZIN 10 MG ORAL TABLET
Unit Price, Unit of Issue 0.6825
Manufacturer MTR
LCA Price 0.6825
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02538342
Generic Name DAPAGLIFLOZIN
Product Name, Strength & Dosage Form NRA-DAPAGLIFLOZIN 10 MG ORAL TABLET
Unit Price, Unit of Issue 0.6825
Manufacturer NRA
LCA Price 0.6825
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02531569
Generic Name DAPAGLIFLOZIN
Product Name, Strength & Dosage Form PMS-DAPAGLIFLOZIN 10 MG ORAL TABLET
Unit Price, Unit of Issue 0.6825
Manufacturer PMS
LCA Price 0.6825
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02518740
Generic Name DAPAGLIFLOZIN
Product Name, Strength & Dosage Form SANDOZ DAPAGLIFLOZIN 10 MG ORAL TABLET
Unit Price, Unit of Issue 0.6825
Manufacturer SDZ
LCA Price 0.6825
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02523604
Generic Name DAPAGLIFLOZIN
Product Name, Strength & Dosage Form TEVA-DAPAGLIFLOZIN 10 MG ORAL TABLET
Unit Price, Unit of Issue N/A
Manufacturer TEV
LCA Price N/A
MAC Price N/A
Interchangeable Products YES
Coverage Status UNDER REVIEW
Details
DIN/NPN/ PIN 02527189
Generic Name DAPAGLIFLOZIN
Product Name, Strength & Dosage Form APO-DAPAGLIFLOZIN 5 MG ORAL TABLET
Unit Price, Unit of Issue 0.6825
Manufacturer APX
LCA Price 0.6825
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02531402
Generic Name DAPAGLIFLOZIN
Product Name, Strength & Dosage Form AURO-DAPAGLIFLOZIN 5 MG ORAL TABLET
Unit Price, Unit of Issue 0.6825
Manufacturer AUR
LCA Price 0.6825
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02435462
Generic Name DAPAGLIFLOZIN
Product Name, Strength & Dosage Form FORXIGA 5 MG ORAL TABLET
Unit Price, Unit of Issue 2.7300
Manufacturer AZC
LCA Price 0.6825
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02519852
Generic Name DAPAGLIFLOZIN
Product Name, Strength & Dosage Form GLN-DAPAGLIFLOZIN 5 MG ORAL TABLET
Unit Price, Unit of Issue 0.6825
Manufacturer GLM
LCA Price 0.6825
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02531364
Generic Name DAPAGLIFLOZIN
Product Name, Strength & Dosage Form JAMP DAPAGLIFLOZIN 5 MG ORAL TABLET
Unit Price, Unit of Issue 0.6825
Manufacturer JPC
LCA Price 0.6825
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02535297
Generic Name DAPAGLIFLOZIN
Product Name, Strength & Dosage Form M-DAPAGLIFLOZIN 5 MG ORAL TABLET
Unit Price, Unit of Issue 0.6825
Manufacturer MTR
LCA Price 0.6825
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02538334
Generic Name DAPAGLIFLOZIN
Product Name, Strength & Dosage Form NRA-DAPAGLIFLOZIN 5 MG ORAL TABLET
Unit Price, Unit of Issue 0.6825
Manufacturer NRA
LCA Price 0.6825
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02531550
Generic Name DAPAGLIFLOZIN
Product Name, Strength & Dosage Form PMS-DAPAGLIFLOZIN 5 MG ORAL TABLET
Unit Price, Unit of Issue 0.6825
Manufacturer PMS
LCA Price 0.6825
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02518732
Generic Name DAPAGLIFLOZIN
Product Name, Strength & Dosage Form SANDOZ DAPAGLIFLOZIN 5 MG ORAL TABLET
Unit Price, Unit of Issue 0.6825
Manufacturer SDZ
LCA Price 0.6825
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02523590
Generic Name DAPAGLIFLOZIN
Product Name, Strength & Dosage Form TEVA-DAPAGLIFLOZIN 5 MG ORAL TABLET
Unit Price, Unit of Issue N/A
Manufacturer TEV
LCA Price N/A
MAC Price N/A
Interchangeable Products YES
Coverage Status UNDER REVIEW
Details
DIN/NPN/ PIN 02536161
Generic Name DAPAGLIFLOZIN/ METFORMIN HCL
Product Name, Strength & Dosage Form APO-DAPAGLIFLOZIN-METFORMIN 5 MG * 1,000 MG ORAL TABLET
Unit Price, Unit of Issue 0.6432
Manufacturer APX
LCA Price 0.6432
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02533081
Generic Name DAPAGLIFLOZIN/ METFORMIN HCL
Product Name, Strength & Dosage Form AURO-DAPAGLIFLOZIN/METFORMIN 5 MG * 1,000 MG ORAL TABLET
Unit Price, Unit of Issue 0.6432
Manufacturer AUR
LCA Price 0.6432
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02449943
Generic Name DAPAGLIFLOZIN/ METFORMIN HCL
Product Name, Strength & Dosage Form XIGDUO 5 MG * 1,000 MG ORAL TABLET
Unit Price, Unit of Issue 1.2863
Manufacturer AZC
LCA Price 0.6432
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02536153
Generic Name DAPAGLIFLOZIN/ METFORMIN HCL
Product Name, Strength & Dosage Form APO-DAPAGLIFLOZIN-METFORMIN 5 MG * 850 MG ORAL TABLET
Unit Price, Unit of Issue 0.6432
Manufacturer APX
LCA Price 0.6432
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02533073
Generic Name DAPAGLIFLOZIN/ METFORMIN HCL
Product Name, Strength & Dosage Form AURO-DAPAGLIFLOZIN/METFORMIN 5 MG * 850 MG ORAL TABLET
Unit Price, Unit of Issue 0.6432
Manufacturer AUR
LCA Price 0.6432
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02449935
Generic Name DAPAGLIFLOZIN/ METFORMIN HCL
Product Name, Strength & Dosage Form XIGDUO 5 MG * 850 MG ORAL TABLET
Unit Price, Unit of Issue 1.2863
Manufacturer AZC
LCA Price 0.6432
MAC Price N/A
Interchangeable Products YES
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02443937
Generic Name EMPAGLIFLOZIN
Product Name, Strength & Dosage Form JARDIANCE 10 MG ORAL TABLET
Unit Price, Unit of Issue 2.7576
Manufacturer BOE
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02443945
Generic Name EMPAGLIFLOZIN
Product Name, Strength & Dosage Form JARDIANCE 25 MG ORAL TABLET
Unit Price, Unit of Issue 2.7576
Manufacturer BOE
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02456621
Generic Name EMPAGLIFLOZIN/ METFORMIN HCL
Product Name, Strength & Dosage Form SYNJARDY 12.5 MG * 1,000 MG ORAL TABLET
Unit Price, Unit of Issue 1.3935
Manufacturer BOE
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02456605
Generic Name EMPAGLIFLOZIN/ METFORMIN HCL
Product Name, Strength & Dosage Form SYNJARDY 12.5 MG * 500 MG ORAL TABLET
Unit Price, Unit of Issue 1.3935
Manufacturer BOE
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02456613
Generic Name EMPAGLIFLOZIN/ METFORMIN HCL
Product Name, Strength & Dosage Form SYNJARDY 12.5 MG * 850 MG ORAL TABLET
Unit Price, Unit of Issue 1.3935
Manufacturer BOE
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02456591
Generic Name EMPAGLIFLOZIN/ METFORMIN HCL
Product Name, Strength & Dosage Form SYNJARDY 5 MG * 1,000 MG ORAL TABLET
Unit Price, Unit of Issue 1.3935
Manufacturer BOE
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02456575
Generic Name EMPAGLIFLOZIN/ METFORMIN HCL
Product Name, Strength & Dosage Form SYNJARDY 5 MG * 500 MG ORAL TABLET
Unit Price, Unit of Issue 1.3935
Manufacturer BOE
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02456583
Generic Name EMPAGLIFLOZIN/ METFORMIN HCL
Product Name, Strength & Dosage Form SYNJARDY 5 MG * 850 MG ORAL TABLET
Unit Price, Unit of Issue 1.3935
Manufacturer BOE
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status STEP THERAPY/ SPECIAL AUTHORIZATION
Details
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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.