Download This tool will help you look up the reimbursement you will receive

This tool will help you look up the reimbursement you will receive under the new formulary effective October 1, 2008.
You can look up a drug by it's drug name or it's DIN - Drug Identification Number
To look up a drug, click on Edit, Search and enter the drug name or DIN and press enter. You will find the disease category, whether the drug is
brand or generic and the reimbursement percentage you will receive.
Tier 1 drugs are NASA Formulary drugs and are reimbursed at 100%. Tier 2 drugs are non-formulary drugs and are reimbursed at 70%. Lifestyle
drugs are reimbursed at 50%.
Data provided by Emergis and Sun Life. All information is current as of July 2008.
DIN
DRUG_NAME
GENERIC_CODE
DISEASE_CATEGORY
REIMBURSEMENT
02148749
DIFFERIN 0.1% GEL
00598208
PODOFILM 25% LIQUID
02264633
01926527
RETIN-A MICRO 0.04% GEL
VITAMIN A ACID 0.1% CREAM
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Generic Drug
02248809
ADDERALL XR 10MG CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. ADD/Narcolepsy
70%
02248810
ADDERALL XR 15MG CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. ADD/Narcolepsy
70%
02248811
ADDERALL XR 20MG CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. ADD/Narcolepsy
70%
02248813
ADDERALL XR 30MG CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. ADD/Narcolepsy
70%
02248808
ADDERALL XR 5MG CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. ADD/Narcolepsy
70%
02239665
02249324
02266687
ALERTEC 100MG TABLET
APO-METHYLPHENIDATE 10MG TABLET
APO-METHYLPHENIDATE SR 20MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. ADD/Narcolepsy
Generic Drug
ADD/Narcolepsy
Generic Drug
ADD/Narcolepsy
100%
100%
100%
02247732
CONCERTA 18MG ER TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. ADD/Narcolepsy
70%
02250241
CONCERTA 27MG ER TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. ADD/Narcolepsy
70%
Acne
100%
Acne
70%
Acne
Acne
100%
100%
DIN
DRUG_NAME
GENERIC_CODE
DISEASE_CATEGORY
REIMBURSEMENT
02247733
CONCERTA 36MG ER TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. ADD/Narcolepsy
70%
02247734
CONCERTA 54MG ER TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. ADD/Narcolepsy
70%
01924516
00584991
DEXEDRINE 5MG TABLET
PMS-METHYLPHENIDATE 10MG TABLET
00632775
RITALIN 20MG SR TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. ADD/Narcolepsy
Generic Drug
ADD/Narcolepsy
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
ADD/Narcolepsy
02262835
19999202
02239044
02245058
STRATTERA 40MG CAPSULE
(REIM) INFUSION SETS/KITS
APO-BENZYDAMINE ORAL RINSE
APO-OMEPRAZOLE 20MG CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
02232044
ARICEPT 10MG TABLET
00226327
00907073
FIORINAL CAPSULE
HYDROCORTISONE PWD
00846503
LOSEC 20MG CAPSULE
02190915
LOSEC 20MG SR TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Generic Drug
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
90800233
100%
100%
100%
ADD/Narcolepsy
All other
All other
All other
100%
70%
100%
100%
All other
100%
All other
All other
70%
100%
All other
70%
All other
100%
MIX: PROGESTERONE MIXTURE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. All other
100%
00990111
MIX:TOPICAL ESTROGEN(S) MIXTURE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. All other
70%
02244522
02229799
01964054
NEXIUM 40MG TABLET
NOVO-BENZYDAMINE ORAL RINSE
ORACORT 0.1% DENTAL PASTE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. All other
Generic Drug
All other
Generic Drug
All other
100%
100%
100%
DIN
DRUG_NAME
02229453
PANTOLOC 40MG TABLET
02243796
PARIET 10MG EC TABLET
02243797
PARIET 20MG EC TABLET
02237452
02229777
PERIDEX 0.12% ORAL RINSE
PMS-BENZYDAMINE ORAL RINSE
GENERIC_CODE
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Generic Drug
02165511
02230170
02260867
DISEASE_CATEGORY
REIMBURSEMENT
All other
100%
All other
100%
All other
100%
All other
All other
70%
100%
PREVACID 30MG CAPSULE
RATIO-BENZYDAMINE LIQ 0.15%
RATIO-OMEPRAZOLE 20MG SR TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. All other
Generic Drug
All other
Generic Drug
All other
100%
100%
100%
02244982
02294745
00646059
02246083
TRACLEER 125MG TABLET
APO-FLUTICASONE 50UG NASAL SPRAY
APO-HYDROXYZINE 10MG CAPSULE
APO-IPRAVENT 0.03% NASAL SPRAY
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
All other
Allergy conditions
Allergy conditions
Allergy conditions
70%
100%
100%
100%
00509558
EPIPEN 0.3MG AUTO-INJECTOR
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Allergy conditions
100%
00578657
EPIPEN JR 0.15MG AUTO-INJCT
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Allergy conditions
100%
02213672
02172712
02230648
FLONASE 0.05% NASAL SPRAY
GEN-BECLO AQ 50MCG SPRAY
GEN-BUDESONIDE AQ 100MCG NASAL
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Allergy conditions
Generic Drug
Allergy conditions
Generic Drug
Allergy conditions
100%
100%
100%
02131625
LIVOSTIN 0.05% DROPS
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Allergy conditions
100%
02020017
LIVOSTIN 0.05% NASAL SPRAY
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Allergy conditions
100%
02213834
NASACORT AQ 55MCG NASAL SPRAY
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Allergy conditions
100%
DIN
DRUG_NAME
GENERIC_CODE
DISEASE_CATEGORY
REIMBURSEMENT
02238465
00738832
NASONEX AQ. NASAL SPRAY 50MCG
NOVO-HYDROXYZIN 25MG CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Allergy conditions
Generic Drug
Allergy conditions
100%
100%
02233143
00872318
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Allergy conditions
PATANOL 0.1% OPH SOLUTION
Allergy conditions
RATIO-BECLOMETHASONE AQ 50MCG NASAL SPRA Generic Drug
100%
100%
01900978
REACTINE 20MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Allergy conditions
70%
02035324
RHINOCORT 100MCG TURBOHALER
02231923
RHINOCORT AQUA 64MCG/DOSE AEM NAS
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Allergy conditions
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Allergy conditions
100%
02242324
ZADITOR 0.25MG/ML OPH SOLUTION
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Allergy conditions
70%
02237618
ADALAT XL 20MG EXTENDED RELEASE TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Angina
100%
02155907
ADALAT XL 30MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Angina
100%
02155990
02230997
02230998
ADALAT XL 60MG TABLET
APO-DILTIAZ CD 120MG CAPSULE
APO-DILTIAZ CD 180MG CAPSULE
02231441
NITROLINGUAL 0.4MG PUMPSPRAY
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
00878936
NORVASC 10MG TABLET
00878928
02245918
NORVASC 5MG TABLET
SANDOZ-DILTIAZEM T 120MG SR CAPSULE
02162725
00839183
02091194
02162814
ANAPROX 275MG TABLET
APO-DICLO 50MG TABLET EC
APO-DICLO SR 100MG TAB SA
APO-DICLO SRT 75MG TABLET
100%
Angina
Angina
Angina
100%
100%
100%
Angina
100%
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Angina
100%
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Generic Drug
Generic Drug
Generic Drug
Angina
Angina
100%
100%
Anti Inflammatory/Analgesics
Anti Inflammatory/Analgesics
Anti Inflammatory/Analgesics
Anti Inflammatory/Analgesics
100%
100%
100%
100%
DIN
00585114
00611166
00842664
02229080
02229452
02248973
00784354
01940309
00522651
00600806
00592277
02177072
DRUG_NAME
APO-IBUPROFEN 600MG TABLET
APO-INDOMETHACIN 50MG CAPSULE
APO-KETO-E 100MG TABLET EC
APO-KETOROLAC 10MG TABLET
APO-MEFENAMIC 250MG CAPSULE
APO-MELOXICAM 7.5MG TABLET
APO-NAPRO-NA 275MG TABLET
APO-NAPRO-NA DS 550MG TABLET
APO-NAPROXEN 250MG TABLET
APO-NAPROXEN 375MG TABLET
APO-NAPROXEN 500MG TABLET
APO-NAPROXEN 750MG SR TABLET
GENERIC_CODE
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
DISEASE_CATEGORY
Anti Inflammatory/Analgesics
Anti Inflammatory/Analgesics
Anti Inflammatory/Analgesics
Anti Inflammatory/Analgesics
Anti Inflammatory/Analgesics
Anti Inflammatory/Analgesics
Anti Inflammatory/Analgesics
Anti Inflammatory/Analgesics
Anti Inflammatory/Analgesics
Anti Inflammatory/Analgesics
Anti Inflammatory/Analgesics
Anti Inflammatory/Analgesics
REIMBURSEMENT
100%
100%
100%
100%
70%
100%
100%
100%
100%
100%
100%
70%
01917056
ARTHROTEC 50MG/200MCG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Anti Inflammatory/Analgesics
100%
02229837
ARTHROTEC 75/200MCG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Anti Inflammatory/Analgesics
100%
02239941
CELEBREX 100MG CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Anti Inflammatory/Analgesics
100%
02239942
CELEBREX 200MG CAPSULE
02162415
NAPROSYN E 375MG TABLET EC
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Anti Inflammatory/Analgesics
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Anti Inflammatory/Analgesics
02162466
00808547
02048698
02158582
02230201
02258315
00337420
00565350
00627097
00589861
02231508
02231504
02248268
NAPROSYN SR 750MG TABLET SA
NOVO-DIFENAC 50MG TABLET EC
NOVO-DIFENAC SR 100MG TABLET
NOVO-DIFENAC SR 75MG TABLET
NOVO-KETOROLAC 10MG TABLET
NOVO-MELOXICAM 7.5MG TABLET
NOVO-METHACIN 25MG CAPSULE
NOVO-NAPROX 250MG TABLET
NOVO-NAPROX 375MG TABLET
NOVO-NAPROX 500MG TABLET
PMS-DICLOFENAC 100MG SUPPOSITORY
PMS-DICLOFENAC 75MG SR TABLET
PMS-MELOXICAM 15MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
02288036
PREXIGE 100MG TABLET
02162660
TORADOL 10MG TABLET
Anti Inflammatory/Analgesics
Anti Inflammatory/Analgesics
Anti Inflammatory/Analgesics
Anti Inflammatory/Analgesics
Anti Inflammatory/Analgesics
Anti Inflammatory/Analgesics
Anti Inflammatory/Analgesics
Anti Inflammatory/Analgesics
Anti Inflammatory/Analgesics
Anti Inflammatory/Analgesics
Anti Inflammatory/Analgesics
Anti Inflammatory/Analgesics
Anti Inflammatory/Analgesics
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Anti Inflammatory/Analgesics
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Anti Inflammatory/Analgesics
100%
70%
70%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
70%
100%
DIN
DRUG_NAME
GENERIC_CODE
DISEASE_CATEGORY
REIMBURSEMENT
00782459
00628131
00628158
00628115
00628123
02243987
02243351
02245623
02247423
02237501
02292998
02293951
02244393
00768723
00768715
02229521
02229522
02274752
02245232
02245233
00618284
00740713
00874256
00682020
00545066
02248562
02084104
00312738
00319511
00642215
00642231
00445282
00846465
00445274
00580929
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
VOLTAREN SR 75MG TABLET SA
APO-AMOXI 125/5ML SUGAR FREE
Generic Drug
APO-AMOXI 250/5ML SUGAR FREE
Generic Drug
APO-AMOXI 250MG CAPSULE
Generic Drug
APO-AMOXI 500MG CAPSULE
Generic Drug
APO-AMOXI CLAV 250MG POWDER FOR SOLUTION Generic Drug
APO-AMOXI CLAV 500MG TABLET
Generic Drug
APO-AMOXI CLAV 875/125MG TABLET
Generic Drug
APO-AZITHROMYCIN 250MG TABLET
Generic Drug
APO-CEFACLOR 250MG/5ML SUSP
Generic Drug
APO-CEFPROZIL 250MG TABLET
Generic Drug
APO-CEFPROZIL 50MG/ML SUSPENSION
Generic Drug
APO-CEFUROXIME 250MG TABLET
Generic Drug
APO-CEPHALEX 250MG TABLET
Generic Drug
APO-CEPHALEX 500MG TABLET
Generic Drug
APO-CIPROFLOX 250MG TABLET
Generic Drug
APO-CIPROFLOX 500MG TABLET
Generic Drug
APO-CLARITHROMYCIN 500MG TABLET
Generic Drug
APO-CLINDAMYCIN 150MG CAPSULE
Generic Drug
APO-CLINDAMYCIN 300MG CAPSULE
Generic Drug
APO-CLOXI 500MG CAPSULE
Generic Drug
APO-DOXY 100MG CAPSULE
Generic Drug
APO-DOXY-TABS 100MG TABLET
Generic Drug
APO-ERYTHRO-BASE 250MG TABLET
Generic Drug
APO-METRONIDAZOLE 250MG TABLET
Generic Drug
APO-METRONIDAZOLE 500MG CAPSULE
Generic Drug
APO-MINOCYCLINE 100MG CAPSULE
Generic Drug
APO-NITROFURANTOIN 100MG TABLET
Generic Drug
APO-NITROFURANTOIN 50MG TABLET
Generic Drug
APO-PEN-VK 300MG TABLET
Generic Drug
APO-PEN-VK 300MG/5ML SUSP
Generic Drug
APO-SULFATRIM DS TABLET
Generic Drug
APO-SULFATRIM SUSPENSION
Generic Drug
APO-SULFATRIM TABLET
Generic Drug
APO-TETRA 250MG CAPSULE
Generic Drug
02242965
AVELOX 400MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Antibiotics/Anti-infectives
100%
02146908
BIAXIN 125MG/5ML SUSPENSION
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Antibiotics/Anti-infectives
100%
02244641
BIAXIN 250MG/5ML POWDER FOR SUSPENSION
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Antibiotics/Anti-infectives
100%
00881635
VOLTAREN RAPIDE 50MG TABLET
Anti Inflammatory/Analgesics
100%
Anti Inflammatory/Analgesics
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
DIN
DRUG_NAME
GENERIC_CODE
DISEASE_CATEGORY
02244756
BIAXIN 500MG XL TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Antibiotics/Anti-infectives
01984853
BIAXIN BID 250MG TABLET
02126710
BIAXIN BID 500MG TABLET
02163675
CEFZIL 125MG/5ML SUSPENSION
02163659
CEFZIL 250MG TABLET
02163683
CEFZIL 250MG/5ML SUSPENSION
02163667
CEFZIL 500MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
02237514
REIMBURSEMENT
100%
Antibiotics/Anti-infectives
100%
Antibiotics/Anti-infectives
100%
Antibiotics/Anti-infectives
100%
Antibiotics/Anti-infectives
100%
Antibiotics/Anti-infectives
100%
Antibiotics/Anti-infectives
100%
CIPRO 10G/100ML ORAL SUSPENSION
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Antibiotics/Anti-infectives
70%
02247916
CIPRO 500MG XL TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Antibiotics/Anti-infectives
100%
02251787
02255340
02247339
02247340
CIPRO XL 1000MG TABLET
CO-AZITHROMYCIN 250MG TABLET
CO-CIPROFLOXACIN 250MG TABLET
CO-CIPROFLOXACIN 500MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
100%
100%
100%
100%
02229110
02242784
02242463
02248856
02258331
02258358
02230736
02230735
FAMVIR 125MG TABLET
GEN-ACYCLOVIR 200MG TABLET
GEN-ACYCLOVIR 400MG TABLET
GEN-CLARITHROMYCIN 250MG TABLET
GEN-CLINDAMYCIN 150MG CAPSULE
GEN-CLINDAMYCIN 300MG CAPSULE
GEN-MINOCYCLINE 100MG CAPSULE
GEN-MINOCYCLINE 50MG CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
100%
100%
100%
100%
100%
100%
100%
100%
DIN
DRUG_NAME
GENERIC_CODE
DISEASE_CATEGORY
02236842
LEVAQUIN 500MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Antibiotics/Anti-infectives
02063662
MACROBID 100MG CAPSULE
02173506
00406724
02036355
00452130
00406716
01934171
01934163
02241709
02241710
00725250
02231015
00342106
00583413
00342092
00583421
00021202
00726540
REIMBURSEMENT
100%
Antibiotics/Anti-infectives
100%
MINOCIN 100MG CAPSULE
NOVAMOXIN 250MG CAPSULE
NOVAMOXIN 250MG CHEW TABLET
NOVAMOXIN 250MG/5ML SUSP
NOVAMOXIN 500MG CAPSULE
NOVAMOXIN SUGAR-RED 125MG/5ML SUSP
NOVAMOXIN SUGAR-RED 250MG/5ML
NOVO-CLINDAMYCIN 150MG CAPSULE
NOVO-CLINDAMYCIN 300MG CAPSULE
NOVO-DOXYLIN 100MG CAPSULE
NOVO-FURANTOIN 50MG CAPSULE
NOVO-LEXIN 125MG/5ML SUSP
NOVO-LEXIN 250MG TABLET
NOVO-LEXIN 250MG/5ML SUSP
NOVO-LEXIN 500MG TABLET
NOVO-PEN-VK-500 300MG TABLET
NOVO-TRIMEL ORAL SUSPENSION
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
02247104
02274388
02274396
00783137
PERIOSTAT 20MG CAPSULE
PMS-AZITHROMYCIN 100MG/5ML SUSP
PMS-AZITHROMYCIN 200MG/5ML SUSP
PMS-METRONIDAZOLE 500MG CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
70%
100%
100%
100%
00582247
02293536
02267934
02267942
02244647
02243771
02078627
02078635
02246825
02246826
02091232
02265826
02278634
02266970
PONDOCILLIN 500MG TABLET
RAN-CEFPROZIL 500MG TABLET
RAN-CIPROFLOXACIN 250MG TABLET
RAN-CIPROFLOXACIN 500MG TABLET
RATIO-ACLAVULANATE 250F SUSPENSION
RATIO-ACLAVULANATE 500MG TABLET
RATIO-ACYCLOVIR 200MG TABLET
RATIO-ACYCLOVIR 400MG TABLET
RATIO-CIPROFLOXACIN 250MG TABLET
RATIO-CIPROFLOXACIN 500MG TABLET
RATIO-DOXYCYCLINE 100MG TABLET
SANDOZ-AZITHROMYCIN 250MG TAB
SANDOZ-FAMCICLOVIR 125MG TABLET
TARO-CIPROFLOXACIN 500MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
Antibiotics/Anti-infectives
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
DIN
DRUG_NAME
GENERIC_CODE
DISEASE_CATEGORY
REIMBURSEMENT
02246559
VALTREX 1G TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Antibiotics/Anti-infectives
02219492
VALTREX 500MG TABLET
00024368
VIBRAMYCIN 100MG CAPSULE
02223716
ZITHROMAX 100MG/5ML SUSP
02223724
ZITHROMAX 200MG/5ML SUSP
02212021
02241895
02237235
ZITHROMAX 250MG TABLET
APO-FLUCONAZOLE 150MG CAPSULE
APO-KETOCONAZOLE 200MG TABLET
02141442
02245697
DIFLUCAN 150MG CAPSULE
GEN-FLUCONAZOLE 150MG CAPSULE
02031116
02194201
LAMISIL 250MG TABLET
RATIO-NYSTATIN 100000U/ML SUSP
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Generic Drug
Generic Drug
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Generic Drug
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Generic Drug
02236606
ACCOLATE 20MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Asthma
100%
02245126
ADVAIR 125MCG MD INHALER
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Asthma
100%
02245127
ADVAIR 250MCG MD INHALER
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Asthma
100%
02240836
ADVAIR 250UG INHALATION DISKUS
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Asthma
100%
02240837
ADVAIR 500UG INHALATION DISKUS
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Asthma
100%
100%
Antibiotics/Anti-infectives
100%
Antibiotics/Anti-infectives
100%
Antibiotics/Anti-infectives
100%
Antibiotics/Anti-infectives
100%
Antibiotics/Anti-infectives
Antifungals
Antifungals
100%
100%
100%
Antifungals
Antifungals
100%
100%
Antifungals
Antifungals
100%
100%
DIN
DRUG_NAME
GENERIC_CODE
DISEASE_CATEGORY
REIMBURSEMENT
02285606
02250055
00598194
00550957
00312770
02245669
ALVESCO 100MCG INHALER METERED DOSE
APO-DEXAMETHASONE 4MG TABLET
APO-PREDNISONE 1MG TABLET
APO-PREDNISONE 50MG TABLET
APO-PREDNISONE 5MG TABLET
APO-SALVENT CFC FREE INHALER
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Asthma
Asthma
Asthma
Asthma
Asthma
Asthma
100%
100%
100%
100%
100%
100%
00786616
BRICANYL 0.5MG TURBUHALER
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Asthma
100%
00030759
DEPO-MEDROL 40MG/ML VIAL
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Asthma
100%
00030767
DEPO-MEDROL 8OMG/ML INJECTION
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Asthma
100%
02237246
FLOVENT DISKUS 250MCG BLISTER
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Asthma
100%
02237244
FLOVENT DISKUS 50MCG BLISTER
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Asthma
100%
02244292
FLOVENT HFA 125MCG INHALER (AEROSOL)
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Asthma
100%
02244293
FLOVENT HFA 250MCG INHALER (AEROSOL)
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Asthma
100%
02244291
FLOVENT HFA 50MCG INHALER (AEROSOL)
02230619
01964976
01964070
02231245
02245532
PEDIAPRED 5MG/5ML LIQUID
PMS-DEXAMETHASONE 0.5MG TABLET
PMS-DEXAMETHASONE 4MG TABLET
PMS-IPRATROPIUM POLYNEB-2ML
PMS-PREDNISOLONE 5MG/5ML ORAL SOLUTION
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
00851752
Asthma
100%
Asthma
Asthma
Asthma
Asthma
Asthma
100%
100%
100%
100%
100%
PULMICORT 200MCG TURBUHALER
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Asthma
100%
00851760
PULMICORT 400MCG TURBUHALER
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Asthma
100%
02242030
00851841
QVAR 100MCG INHALER
RATIO-SALBUTAMOL 100MCG INHALER
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Asthma
Generic Drug
Asthma
100%
100%
DIN
02244914
DRUG_NAME
RATIO-SALBUTAMOL HFA 100MCG/DOSE
GENERIC_CODE
Generic Drug
DISEASE_CATEGORY
Asthma
REIMBURSEMENT
100%
02238217
SINGULAIR 10MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Asthma
100%
02243602
SINGULAIR 4MG CHEW TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Asthma
100%
02238216
SINGULAIR 5MG CHEW TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Asthma
100%
02246793
SPIRIVA 18MCG CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Asthma
100%
02245385
SYMBICORT 100 TURBUHALER
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Asthma
100%
02245386
SYMBICORT 200 TURBUHALER
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Asthma
100%
02241497
Brand Name Drug. No Generic is available.
VENTOLIN 200MCG DISKUS POWDER FOR INHALAT Reimbursement is based on the price of the brand. Asthma
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
VENTOLIN HFA 100MCG INHALER
Asthma
02260565
XOLAIR 150MG/VIAL INJECTION
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Asthma
100%
02236974
ALESSE 21 TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Birth control
100%
02236975
ALESSE 28 TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Birth control
100%
02189054
BREVICON 1/35 21 TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Birth control
100%
01968440
CYCLEN 21 TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Birth control
100%
01992872
CYCLEN 28 TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Birth control
100%
00469327
DEMULEN 30 21 TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Birth control
100%
00585092
DEPO-PROVERA 150MG/ML VIAL
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Birth control
100%
02243115
100%
100%
DIN
DRUG_NAME
GENERIC_CODE
DISEASE_CATEGORY
REIMBURSEMENT
02248297
EVRA TRANSDERMAL PATCH
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Birth control
100%
00297143
LOESTRIN 1.5/30 21 TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Birth control
100%
00353027
LOESTRIN 1.5/30 TAB 28DAY PACK
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Birth control
100%
02042487
MARVELON 21 TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Birth control
100%
02042479
MARVELON 28 TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Birth control
100%
00037605
MICRONOR 0.35MG 28 TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Birth control
100%
00343838
MINESTRIN 1/20 28 TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Birth control
100%
02042320
MIN-OVRAL 21 TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Birth control
100%
02243005
MIRENA 52MG INSERT
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Birth control
70%
02187108
SYNPHASIC 21 TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Birth control
100%
02028700
TRI-CYCLEN 21 TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Birth control
100%
02029421
TRI-CYCLEN 28 TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Birth control
100%
02258560
TRI-CYCLEN LO 21 TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Birth control
100%
02258587
TRI-CYCLEN LO 28 TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Birth control
100%
02043734
TRIPHASIL 28 TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Birth control
100%
00707600
TRIQUILAR 21 TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Birth control
100%
DIN
DRUG_NAME
GENERIC_CODE
DISEASE_CATEGORY
REIMBURSEMENT
00707503
TRIQUILAR 28 TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Birth control
100%
02261723
YASMIN 21 TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Birth control
100%
02261731
00545031
00426849
YASMIN 28 TABLET
APO-FERROUS GLUCONATE 300 MG
APO-FOLIC ACID 5MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Birth control
Generic Drug
Blood formation
Generic Drug
Blood formation
100%
70%
100%
02240722
02237556
EPREX 40000IU/ML INJECTION
EURO-FER 300MG CAPSULE
00017884
02244532
FER-IN-SOL 150MG/5ML SYRUP
FERROUS GLUCONATE 300MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Generic Drug
02221780
INFUFER 50MG/ML INJECTION
Blood formation
Blood formation
70%
70%
Blood formation
Blood formation
70%
70%
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood formation
100%
02249790
Brand Name Drug. No Generic is available.
NEULASTA 10MG/ML PFS WITH ULTRASAFE NEEDLEReimbursement is based on the price of the brand. Blood formation
70%
01968017
00521515
NEUPOGEN 300MCG/ML VIAL
VITAMIN B12 1000MCG/ML VIAL
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood formation
Generic Drug
Blood formation
70%
70%
01947680
ACCUPRIL 20MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood pressure
100%
02237368
ACCURETIC 20/12.5MG
02221853
ALTACE 10MG CAPSULE
02281112
ALTACE 15MG CAPSULE
02221837
ALTACE 2.5MG CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood pressure
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Blood pressure
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood pressure
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Blood pressure
100%
100%
100%
100%
DIN
DRUG_NAME
02221845
00784400
00773697
00773689
02256134
00360279
00868949
00441635
00326844
00312800
02245246
02217511
00360260
00751170
00749354
02246010
00782505
00782467
02289296
00402788
00663719
00402753
02251582
02251531
02251574
02234502
00441775
ALTACE 5MG CAPSULE
APO-AMILZIDE TABLET
APO-ATENOL 100MG TABLET
APO-ATENOL 50MG TABLET
APO-BISOPROLOL 5MG TABLET
APO-CHLORTHALIDONE 50MG TABLET
APO-CLONIDINE 0.1MG TABLET
APO-HYDRALAZINE 50MG TABLET
APO-HYDRO 25MG TABLET
APO-HYDRO 50MG TABLET
APO-INDAPAMIDE 1.25MG TABLET
APO-LISINOPRIL 20MG TABLET
APO-METHYLDOPA 250MG TABLET
APO-METOPROLOL (TYPE L) 100 MG
APO-METOPROLOL (TYPE L)50 MG
APO-METOPROLOL 25MG TABLET
APO-NADOL 40MG TABLET
APO-NADOL 80MG TABLET
APO-PERINDOPRIL 8MG TABLET
APO-PROPRANOLOL 10MG TABLET
APO-PROPRANOLOL 20MG TABLET
APO-PROPRANOLOL 40MG TABLET
APO-RAMIPRIL 10MG CAPSULE
APO-RAMIPRIL 2.5MG CAPSULE
APO-RAMIPRIL 5MG CAPSULE
APO-TERAZOSIN 1MG TABLET
APO-TRIAZIDE TABLET
GENERIC_CODE
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
DISEASE_CATEGORY
REIMBURSEMENT
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
70%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
02239092
ATACAND 16MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood pressure
100%
02239090
ATACAND 4MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood pressure
100%
02239091
ATACAND 8MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood pressure
100%
02244021
ATACAND PLUS TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood pressure
100%
02241818
AVALIDE 150MG/12.5MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood pressure
100%
02241819
AVALIDE 300MG/12.5MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood pressure
100%
DIN
DRUG_NAME
GENERIC_CODE
DISEASE_CATEGORY
REIMBURSEMENT
02237924
AVAPRO 150MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood pressure
100%
02237925
AVAPRO 300MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood pressure
100%
02123282
COVERSYL 4MG TABLET
02246624
COVERSYL 8MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood pressure
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Blood pressure
02246569
COVERSYL PLUS TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood pressure
70%
02182882
COZAAR 100MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood pressure
100%
02182874
COZAAR 50MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood pressure
100%
02244782
DIOVAN 160MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood pressure
100%
02244781
DIOVAN 80MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood pressure
100%
02241901
DIOVAN-HCT 160/12.5MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood pressure
100%
02246955
DIOVAN-HCT 160MG/25MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood pressure
100%
02241900
02174553
02174545
DIOVAN-HCT 80/12.5MG TABLET
GEN-METOPROLOL 100MG TABLET
GEN-METOPROLOL 50MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood pressure
Generic Drug
Blood pressure
Generic Drug
Blood pressure
100%
100%
100%
02230047
HYZAAR (50MG/12.5MG) TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood pressure
100%
02241007
HYZAAR DS (100MG/25MG) TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood pressure
100%
02042258
INDERAL-LA 80MG CAPSULE SA
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood pressure
100%
100%
100%
DIN
DRUG_NAME
GENERIC_CODE
00514497
LONITEN 2.5MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood pressure
70%
02240769
MICARDIS 40MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood pressure
100%
02240770
MICARDIS 80MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood pressure
100%
02244344
01912062
02046121
00021474
00021482
00648035
00842648
00613223
00613215
02230806
00532657
02237601
02274086
MICARDIS PLUS TABLET
NOVO-ATENOL 50MG TABLET
NOVO-CLONIDINE 0.1MG TABLET
NOVO-HYDRAZIDE 25MG TABLET
NOVO-HYDRAZIDE 50MG TABLET
NOVO-METOPROL 50MG CAPLET
NOVO-METOPROL 50MG TABLET
NOVO-SPIROTON 100MG TABLET
NOVO-SPIROTON 25MG TABLET
NOVO-TERAZOSIN 2MG TABLET
NOVO-TRIAMZIDE TABLET
PMS-ATENOLOL 100MG TABLET
PMS-HYDROCHLOROTHIAZIDE 12.5MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
02108194
02171805
02171791
02300001
02287722
02287706
02287714
02218968
02247439
PRINZIDE 10/12.5 TABLET
RATIO-ATENOLOL 100MG TABLET
RATIO-ATENOLOL 50MG TABLET
RATIO-ENALAPRIL 8MG TABLET
RATIO-RAMIPRIL 10MG CAPSULE
RATIO-RAMIPRIL 2.5MG CAPSULE
RATIO-RAMIPRIL 5MG CAPSULE
RATIO-TERAZOSIN 2MG TABLET
SANDOZ BISOPROLOL 5MG TABLET
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
Blood pressure
100%
100%
100%
100%
100%
100%
100%
100%
100%
02039532
TENORMIN 50MG TABLET
Blood pressure
100%
00670928
VASOTEC 16MG TABLET
Blood pressure
100%
00708879
VASOTEC 4MG TABLET
Blood pressure
100%
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
DISEASE_CATEGORY
REIMBURSEMENT
DIN
DRUG_NAME
00670901
VASOTEC 8MG TABLET
02049376
ZESTRIL 10MG TABLET
02049384
ZESTRIL 20MG TABLET
GENERIC_CODE
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
02049333
DISEASE_CATEGORY
REIMBURSEMENT
Blood pressure
100%
Blood pressure
100%
Blood pressure
100%
ZESTRIL 5MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood pressure
100%
02242119
AGGRENOX CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood thinners
70%
09853880
FRAGMIN 0.6ML PFS (ODB)
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood thinners
100%
02236883
LOVENOX 100MG/ML SYRINGE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood thinners
100%
02238682
02242685
PLAVIX 75MG TABLET
TARO-WARFARIN 5MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Blood thinners
Generic Drug
Blood thinners
100%
100%
02246896
02248730
02258110
ACTONEL 35MG TABLET
APO-ALENDRONATE 70MG TABLET
CO-ALENDRONATE 70MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Bone metabolism
Generic Drug
Bone metabolism
Generic Drug
Bone metabolism
100%
100%
100%
02176017
DIDROCAL 1.25G-400MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Bone metabolism
100%
02239028
EVISTA 60MG TABLET
02245329
FOSAMAX 70MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Bone metabolism
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Bone metabolism
100%
02248625
FOSAMAX 70MG/75ML LIQUID
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Bone metabolism
100%
02276429
02261715
FOSAVANCE 70MG/2800U TABLET
NOVO-ALENDRONATE 70MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Bone metabolism
Generic Drug
Bone metabolism
70%
100%
100%
DIN
DRUG_NAME
GENERIC_CODE
DISEASE_CATEGORY
REIMBURSEMENT
02239505
02182963
ALDARA 50MG/G CREAM
APO-METHOTREXATE 2.5MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Cancer
Generic Drug
Cancer
100%
100%
02224135
ARIMIDEX 1MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Cancer
100%
00258482
BLENOXANE 15U VIAL
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Cancer
100%
02231384
02089858
FEMARA 2.5MG TABLET
GEN-TAMOXIFEN 20MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Cancer
Generic Drug
Cancer
100%
100%
02253275
GLEEVEC 100MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Cancer
100%
02253283
GLEEVEC 400MG TABLET
02170698
02182777
00004723
METHOTREXATE 2.5MG TABLET
METHOTREXATE 25MG/ML INJECTION
PURINETHOL 50MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Generic Drug
Generic Drug
02225166
Cancer
100%
Cancer
Cancer
Cancer
100%
100%
100%
SUPREFACT 1MG/ML INJECTION
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Cancer
100%
02280817
SUTENT 50MG CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Cancer
100%
02241095
TEMODAL 100MG CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Cancer
70%
02225905
00396788
00362166
00707570
00337730
00337749
02246860
02220172
02243508
02247013
02247014
02248104
02248105
ZOLADEX DEPOT 10.8MG SYRINGE
APO-FUROSEMIDE 20MG TABLET
APO-FUROSEMIDE 40MG TABLET
APO-FUROSEMIDE 80MG TABLET
NOVO-SEMIDE 20MG TABLET
NOVO-SEMIDE 40MG TABLET
APO-FENO-SUPER 160MG TABLET
APO-LOVASTATIN 20MG TABLET
APO-PRAVASTATIN 40MG TABLET
APO-SIMVASTATIN 20MG TABLET
APO-SIMVASTATIN 40MG TABLET
CO-SIMVASTATIN 10MG TABLET
CO-SIMVASTATIN 20MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Cancer
Cardiac disease
Cardiac disease
Cardiac disease
Cardiac disease
Cardiac disease
Cholesterol disorders
Cholesterol disorders
Cholesterol disorders
Cholesterol disorders
Cholesterol disorders
Cholesterol disorders
Cholesterol disorders
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
DIN
DRUG_NAME
GENERIC_CODE
02247162
CRESTOR 10MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Cholesterol disorders
100%
02247163
CRESTOR 20MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Cholesterol disorders
100%
02247164
CRESTOR 40MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Cholesterol disorders
100%
02265540
CRESTOR 5MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Cholesterol disorders
100%
02247521
02246737
EZETROL 10MG TABLET
GEN-SIMVASTATIN 20MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Cholesterol disorders
Generic Drug
Cholesterol disorders
100%
100%
02269082
LIPIDIL EZ 145MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Cholesterol disorders
100%
02230711
LIPITOR 10MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Cholesterol disorders
100%
02230713
LIPITOR 20MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Cholesterol disorders
100%
02230714
LIPITOR 40MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Cholesterol disorders
100%
02243097
LIPITOR 80MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Cholesterol disorders
100%
02262347
02289091
02250152
02250160
02210320
02250039
02245822
NIASPAN 500MG SR TABLET
NOVO-FENOFIBRATE-S 160MG TABLET
NOVO-SIMVASTATIN 10MG TABLET
NOVO-SIMVASTATIN 20MG TABLET
PMS-CHOLESTYRAMIN REG 4G/PACK
RATIO-FENOFIBRATE MC 200MG CAPSULE
RATIO-LOVASTATIN 20MG TABLET
00476242
ANUGESIC-HC SUPPOSITORY
00505773
ANUSOL-HC OINTMENT
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
DISEASE_CATEGORY
Cholesterol disorders
Cholesterol disorders
Cholesterol disorders
Cholesterol disorders
Cholesterol disorders
Cholesterol disorders
Cholesterol disorders
REIMBURSEMENT
70%
100%
100%
100%
100%
100%
100%
Circulatory disease
70%
Circulatory disease
70%
DIN
DRUG_NAME
00476285
ANUSOL-HC SUPPOSITORY
01988549
PROCTOSEDYL OINTMENT
02223252
PROCTOSEDYL OINTMENT
GENERIC_CODE
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
DISEASE_CATEGORY
REIMBURSEMENT
01916580
HYCODAN 1MG/ML SYRUP
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Cough and cold
100%
01916599
HYCODAN 5MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Cough and cold
70%
01916971
00335053
00335061
00335088
02246056
02049996
02050005
02050013
02216361
02231328
02231330
02231329
02240908
02238282
02238280
02238281
02147637
TUSSIONEX SUSPENSION
APO-AMITRIPTYLINE 10MG TABLET
APO-AMITRIPTYLINE 25MG TABLET
APO-AMITRIPTYLINE 50MG TABLET
APO-CITALOPRAM 20MG TABLET
APO-DOXEPIN 10MG CAPSULE
APO-DOXEPIN 25MG CAPSULE
APO-DOXEPIN 50MG CAPSULE
APO-FLUOXETINE 20MG CAPSULE
APO-FLUOXETINE 20MG/5 ML ORAL
APO-FLUVOXAMINE 100MG TABLET
APO-FLUVOXAMINE 50MG TABLET
APO-PAROXETINE 20MG TABLET
APO-SERTRALINE 100MG CAPSULE
APO-SERTRALINE 25MG CAPSULE
APO-SERTRALINE 50MG CAPSULE
APO-TRAZODONE 50MG TABLET
02239607
CELEXA 20MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
02263238
02263254
02284839
02284847
02248050
Circulatory disease
70%
Circulatory disease
70%
Circulatory disease
70%
Cough and cold
Depression
Depression
Depression
Depression
Depression
Depression
Depression
Depression
Depression
Depression
Depression
Depression
Depression
Depression
Depression
Depression
70%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
Depression
100%
CIPRALEX 10MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Depression
100%
CIPRALEX 20MG TABLET
CITALOPRAM 10MG TABLET
CITALOPRAM 20MG TABLET
CO-CITALOPRAM 20MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
100%
100%
100%
100%
Depression
Depression
Depression
Depression
DIN
DRUG_NAME
00702277
DESYREL DIVIDOSE 150MG TABLET
02237282
EFFEXOR XR 150MG SR CAPSULE
02237279
EFFEXOR XR 37.5MG SR CAPSULE
02237280
02246594
02246595
02139340
02248013
02260239
02216590
02259354
02231781
02248557
02144271
02144263
02275058
02275023
02275031
EFFEXOR XR 75MG SR CAPSULE
GEN-CITALOPRAM 20MG TABLET
GEN-CITALOPRAM 40MG TABLET
GEN-CLOMIPRAMINE 10MG TABLET
GEN-PAROXETINE 20MG TABLET
NOVO-BUPROPION SR 150MG TABLET
NOVO-FLUOXETINE 20MG CAPSULE
NOVO-MIRTAZAPINE 30MG TABLET
NOVO-NORTRIPTYLINE 10MG CAPSULE
NOVO-PAROXETINE 20MG TABLET
NOVO-TRAZODONE 100MG TABLET
NOVO-TRAZODONE 50MG TABLET
NOVO-VENLAFAXINE XR 150MG ER CAPSULE
NOVO-VENLAFAXINE XR 37.5MG ER CAPSULE
NOVO-VENLAFAXINE XR 75MG ER CAPSULE
02248504
02248762
02244840
02244839
01937227
02268000
02252112
02241374
02218461
02218453
02270927
02245788
02275074
02275082
PAXIL CR 25MG TABLET
PMS-MIRTAZAPINE 30MG TABLET
PMS-SERTRALINE 100MG CAPSULE
PMS-SERTRALINE 50MG CAPSULE
PMS-TRAZODONE 50MG TABLET
RAN-CITALOPRAM 20MG TABLET
RATIO-CITALOPRAM 20MG TABLET
RATIO-FLUOXETINE 20MG CAPSULE
RATIO-FLUVOXAMINE 100MG TABLET
RATIO-FLUVOXAMINE 50MG TABLET
RATIO-MIRTAZAPINE 30MG TABLET
RATIO-SERTRALINE 50MG CAPSULE
SANDOZ-BUPROPION SR 100MG TABLET
SANDOZ-BUPROPION SR 150MG TABLET
02237825
WELLBUTRIN 150MG SR TABLET
GENERIC_CODE
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
DISEASE_CATEGORY
REIMBURSEMENT
Depression
100%
Depression
100%
Depression
100%
Depression
Depression
Depression
Depression
Depression
Depression
Depression
Depression
Depression
Depression
Depression
Depression
Depression
Depression
Depression
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
Depression
Depression
Depression
Depression
Depression
Depression
Depression
Depression
Depression
Depression
Depression
Depression
Depression
Depression
70%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
Depression
100%
DIN
DRUG_NAME
GENERIC_CODE
DISEASE_CATEGORY
REIMBURSEMENT
02275090
WELLBUTRIN XL 150MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Depression
100%
02275104
WELLBUTRIN XL 300MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Depression
100%
09853626
ACCU-CHEK ADVANTAGE TEST STRIP
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
00990192
ACCU-CHEK AVIVA TEST STRIP
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
09857178
ACCU-CHEK AVIVA TEST STRIP (ON)
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
09854282
ACCU-CHEK COMPACT STRIP (ON)
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
00990183
ACCU-CHEK MULTICLIX LANCET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
00908436
ACCU-CHEK SOFTCLIX LANCET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
02242572
ACTOS 15MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
02242573
ACTOS 30MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
02242574
ACTOS 45MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
02245273
01913654
01913662
02167786
AMARYL 2MG TABLET
APO-GLYBURIDE 2.5MG TABLET
APO-GLYBURIDE 5MG TABLET
APO-METFORMIN 500MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
Diabetes
Diabetes
Diabetes
Diabetes
70%
100%
100%
100%
09853693
Brand Name Drug. No Generic is available.
ASCENSIA AUTODISC (ODB)(BREEZE/DEX 2/ GLUCOReimbursement is based on the price of the brand. Diabetes
100%
00990125
ASCENSIA CONTOUR TEST STRIP
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
09857127
ASCENSIA CONTOUR TEST STRIP (ON)
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
DIN
DRUG_NAME
GENERIC_CODE
DISEASE_CATEGORY
REIMBURSEMENT
09854088
ASCENSIA ELITE TEST STRIP (ODB)
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
00909440
ASCENSIA MICROLET LANCET (ON)
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
02248441
AVANDAMET 1000/4MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
02241112
AVANDIA 2MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
02241113
AVANDIA 4MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
02241114
AVANDIA 8MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
00909963
BD LATITUDE ULTRA-FINE 33G LANCET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
00906727
BD ULTRA-FINE 1/2CC SYRINGE (MT)
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
00906786
BD ULTRA-FINE 3/10CC SYRINGE (MT/ON)
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
00909335
BD ULTRAFINE II 30G LANCET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
97799882
BD ULTRAFINE II 30G LANCET 100'S(NS)
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
00909181
BD ULTRA-FINE III 31G 5MM PEN NEEDLE MINI
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
97799896
Brand Name Drug. No Generic is available.
BD ULTRA-FINE III 31G 5MM PEN NEEDLE MINI (NS) Reimbursement is based on the price of the brand. Diabetes
100%
02242987
DIAMICRON 30MG MR TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
00909653
FREESTYLE TEST STRIP (ON)
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
09857141
02148765
FREESTYLE TEST STRIP (ON)
GEN-METFORMIN 500MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
Generic Drug
Diabetes
100%
100%
DIN
DRUG_NAME
GENERIC_CODE
DISEASE_CATEGORY
REIMBURSEMENT
02241283
HUMALOG 3ML PEN
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
09853715
HUMALOG CARTRIDGE - 5X3ML(ODB)
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
02229704
HUMALOG INSULIN 100 UNITS/ML
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
02229705
HUMALOG INSULIN CARTRIDGE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
01959239
HUMULIN N CARTRIDGE 5X3ML
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
09853804
HUMULIN N CARTRIDGE-5X3ML(ODB)
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
09853286
KETOSTIX TEST STRIP (ON)
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
02245689
LANTUS 100U/ML INSULIN
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
02251930
LANTUS 100U/ML INSULIN CARTRIDGE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
02271842
LEVEMIR PENFILL
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
09853812
NOVO GE 30/70PENFILL-5X3ML(ODB)
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
09853782
NOVO GE NPH PENFILL-5X3ML(ODB
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
09853774
NOVO GE TOR.PENFILL-5X3ML(ODB)
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
00908169
Brand Name Drug. No Generic is available.
NOVOFINE 30G 8MM PEN NEEDLE (SK/ON)/ VEG OIL Reimbursement is based on the price of the brand. Diabetes
100%
00990163
01913689
NOVOFINE 32G 6MM PEN NEEDLE
NOVO-GLYBURIDE 5MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
Generic Drug
Diabetes
100%
100%
02025248
02045710
NOVOLIN GE 30/70 PENFILL 5X3ML
NOVO-METFORMIN 500MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
Generic Drug
Diabetes
100%
100%
DIN
DRUG_NAME
GENERIC_CODE
DISEASE_CATEGORY
REIMBURSEMENT
02244353
NOVORAPID 100U/ML INSULIN CARTRIDGE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
09854290
ONE TOUCH ULTRA TEST STRIP (ON)
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
99004240
ONE TOUCH ULTRA TEST STRIP (PQ)
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
00907707
Brand Name Drug. No Generic is available.
ONE-TOUCH FINE POINT LANCET (MT)/ DUODERM CReimbursement is based on the price of the brand. Diabetes
100%
00909394
02223562
ONE-TOUCH ULTRA SOFT LANCET
PMS-METFORMIN 500MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
Generic Drug
Diabetes
100%
100%
00909386
PRECISION XTRA KETONE TEST STRIP (ON)
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
09854070
02269031
02242974
02246820
02269597
PRECISION XTRA TEST STRIP (ODB)
RAN-METFORMIN 500MG TABLET
RATIO-METFORMIN 500MG TABLET
SANDOZ METFORMIN 500MG TABLET
SANDOZ-GLIMEPIRIDE 2MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Diabetes
Diabetes
Diabetes
Diabetes
Diabetes
100%
100%
100%
100%
70%
00909912
VITALET (EQUATE) 23G LANCET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Diabetes
100%
02237792
AVAXIM - 160U/0.5ML INJECTION
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Disease prevention vaccines
50%
02247208
DUKORAL ORAL VACCINE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Disease prevention vaccines
50%
02283190
GARDASIL VACCINE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Disease prevention vaccines
50%
02187078
HAVRIX-A 1440U/ML VACCINE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Disease prevention vaccines
50%
02231056
HAVRIX-A 720U/ML VACCINE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Disease prevention vaccines
50%
01959018
MENOMUNE 1 DOSE VIAL
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Disease prevention vaccines
50%
02284413
ROTATEQ VACCINE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Disease prevention vaccines
50%
DIN
DRUG_NAME
GENERIC_CODE
DISEASE_CATEGORY
REIMBURSEMENT
02230578
TWINRIX ADULT 1ML VACCINE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Disease prevention vaccines
50%
02237548
TWINRIX JUNIOR 0.5ML VACCINE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Disease prevention vaccines
50%
02130955
TYPHIM VI 25MCG/0.5ML VACCINE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Disease prevention vaccines
50%
00885975
00602884
VIVOTIF BERNA CAPSULE 2-6B
APO-K 600MG TABLET
02042304
MICRO-K 8MEQ EXTENCAPS
00074225
02177889
02239699
02239700
02244304
02244305
02245208
SLOW-K 600MG TABLET SA
APO-CLONAZEPAM 0.5MG TABLET
APO-DIVALPROEX 250MG TABLET
APO-DIVALPROEX 500MG TABLET
APO-GABAPENTIN 100MG CAPSULE
APO-GABAPENTIN 300MG CAPSULE
APO-LAMOTRIGINE 25MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
00022780
DILANTIN 100MG CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Epilepsy
100%
00023698
DILANTIN 50MG INFATAB
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Epilepsy
100%
02268450
LYRICA 150MG CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Epilepsy
100%
02268434
02239703
02244514
02248234
02207818
02243447
02263009
02256835
LYRICA 75MG CAPSULE
NOVO-DIVALPROEX 500MG TABLET
NOVO-GABAPENTIN 300MG CAPSULE
NOVO-LAMOTRIGINE 150MG TABLET
PMS-CLONAZEPAM R 0.5MG TABLET
PMS-GABAPENTIN 300MG CAPSULE
PMS-TOPIRAMATE 100MG TABLET
RATIO-TOPIRAMATE 100MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
100%
100%
100%
100%
100%
100%
100%
100%
02248089
CIALIS 20MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Erectile dysfunction
Disease prevention vaccines
Electrolyte replacement
50%
100%
Electrolyte replacement
100%
Electrolyte replacement
Epilepsy
Epilepsy
Epilepsy
Epilepsy
Epilepsy
Epilepsy
100%
100%
100%
100%
100%
100%
100%
Epilepsy
Epilepsy
Epilepsy
Epilepsy
Epilepsy
Epilepsy
Epilepsy
Epilepsy
50%
DIN
DRUG_NAME
GENERIC_CODE
02250489
LEVITRA 20MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Erectile dysfunction
50%
02239768
VIAGRA 100MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Erectile dysfunction
50%
02239767
02245821
02248398
VIAGRA 50MG TABLET
APO-KETOROLAC 0.5% OPH SOLUTION
APO-OFLOXACIN 0.3% OPH SOLUTION
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Erectile dysfunction
Generic Drug
Eye-ear-nose indicators
Generic Drug
Eye-ear-nose indicators
50%
100%
100%
01945270
CILOXAN 0.3% EYE/EAR DROPS
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Eye-ear-nose indicators
100%
02200864
CILOXAN 0.3% OPH OINTMENT
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Eye-ear-nose indicators
100%
02240035
CIPRO HC OTIC SUSPENSION
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Eye-ear-nose indicators
100%
02252716
CIPRODEX OTIC SUSPENSION
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Eye-ear-nose indicators
100%
00247855
FML LIQUIFILM 0.1% EYE DROP
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Eye-ear-nose indicators
100%
02243862
FUCITHALMIC VISCOUS EYE DROPS
00512192
GARAMYCIN 3MG/ML OPH DROP
00682217
00035017
01912755
02239577
00700401
02247920
02241755
02244999
GARASONE EYE/EAR DROPS
ISOPTO ATROPINE 1% EYE DROP
PMS-ERYTHROMYCIN OPH OINTMENT
PMS-TOBRAMYCIN 0.3% OPTHALMIC SOLUTION
RATIO-PREDNISONE 1% EYE DROPS
SANDOZ OPTICORT EYE/EAR DROP
SANDOZ TOBRAMYCIN 0.3% OPH DROP
SANDOZ-PENTASONE OPHTH/OTIC SOLUTION
02224623
SOFRACORT EYE/EAR DROPS
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
DISEASE_CATEGORY
REIMBURSEMENT
Eye-ear-nose indicators
70%
Eye-ear-nose indicators
100%
Eye-ear-nose indicators
Eye-ear-nose indicators
Eye-ear-nose indicators
Eye-ear-nose indicators
Eye-ear-nose indicators
Eye-ear-nose indicators
Eye-ear-nose indicators
Eye-ear-nose indicators
100%
100%
100%
100%
100%
100%
100%
100%
Eye-ear-nose indicators
100%
DIN
DRUG_NAME
GENERIC_CODE
DISEASE_CATEGORY
REIMBURSEMENT
02224860
SOFRAMYCIN NASAL SPRAY
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Eye-ear-nose indicators
70%
00778907
TOBRADEX OPH DROP
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Eye-ear-nose indicators
100%
00778915
TOBRADEX OPH OINTMENT
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Eye-ear-nose indicators
100%
00614254
TOBREX 0.3% OPH OINTMENT
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Eye-ear-nose indicators
100%
02252260
VIGAMOX 0.5% OPH SOLUTION
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Eye-ear-nose indicators
100%
01940414
VOLTAREN OPH 0.1% DROP
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Eye-ear-nose indicators
100%
02257270
02268140
ZYMAR 3MG/ML OPH DROP
BRAVELLE 75U/VIAL INJ
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Eye-ear-nose indicators
Generic Drug
Fertility disorders
100%
50%
02247459
CHORIONIC GONADTROPIN 10000U INJECTION
02091879
CLOMID 50MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Fertility disorders
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Fertility disorders
50%
02270382
GONAL-F 900U/1.5 ML PEN
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Fertility disorders
50%
02283093
MENOPUR 75IU INJECTION
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Fertility disorders
50%
00990054
MIX: PROGESTERONE SUPPOSITORY
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Fertility disorders
50%
02262088
OVIDREL 250MCG VIAL (SOL)
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Fertility disorders
50%
02243948
00893722
02103613
00842834
PUREGON 300IU CARTRIDGE
SEROPHENE 50MG TABLET
APO-DOMPERIDONE 10MG TABLET
APO-METOCLOP 10MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
01997580
ASACOL 400MG EC TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Gastrointestinal
Fertility disorders
Fertility disorders
Gastrointestinal
Gastrointestinal
50%
50%
50%
100%
100%
100%
DIN
DRUG_NAME
GENERIC_CODE
DISEASE_CATEGORY
REIMBURSEMENT
02230684
DICETEL 100MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Gastrointestinal
100%
00036323
LOMOTIL TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Gastrointestinal
70%
02099683
02236466
02268078
01912070
PENTASA 500MG TABLET SA
PMS-DOMPERIDONE 10MG TABLET
RAN-DOMPERIDONE 10MG TABLET
RATIO-DOMPERIDONE 10MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
Gastrointestinal
Gastrointestinal
Gastrointestinal
Gastrointestinal
100%
100%
100%
100%
02112809
SALOFALK 4GM/60ML ENEMA
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Gastrointestinal
100%
02112760
SALOFALK 500MG SUPPOSITORY
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Gastrointestinal
100%
02112787
SALOFALK 500MG TABLET EC
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Gastrointestinal
100%
02239325
SANDOSTATIN LAR 30MG INJ SUSP
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Gastrointestinal
70%
02240113
COSOPT 20MG/ML OPH SOLUTION
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Glaucoma
100%
02231493
XALATAN 50MCG/ML EYE DROP
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Glaucoma
100%
01926861
02247651
FLAGYL 10% CREAM
TARO-TERCONAZOLE 0.4% VAG CREAM
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Gynecological
Generic Drug
Gynecological
100%
100%
02253429
Brand Name Drug. No Generic is available.
PEGASYS RBV 180MCG/0.5ML + RIBAVIRIN 200MCG Reimbursement is based on the price of the brand. Hepatitis
02239213
COMBIVIR TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. HIV
100%
02285533
KALETRA 200/50MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. HIV
100%
02269341
KIVEXA 600MG/300MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. HIV
100%
02246045
SUSTIVA 600MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. HIV
100%
70%
DIN
DRUG_NAME
GENERIC_CODE
DISEASE_CATEGORY
02274906
TRUVADA TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. HIV
02247128
02225972
00808571
02218313
02238596
VIREAD 300MG TABLET
APO-TEMAZEPAM 30MG CAPSULE
APO-TRIAZO 0.25MG TABLET
APO-ZOPICLONE 7.5MG TABLET
GEN-ZOPICLONE 7.5MG TABLET
02216167
IMOVANE 5MG TABLET
01926799
02230095
02230102
00178802
02267926
02242481
00402818
00479799
00402796
02242907
02163543
IMOVANE 7.5MG TABLET
NOVO-TEMAZEPAM 15MG CAPSULE
NOVO-TEMAZEPAM 30MG TABLET
PMS-PHENOBARBITAL 30MG TABLET
RAN-ZOPICLONE 7.5MG TABLET
RATIO-ZOPICLONE 7.5MG TABLET
APO-ALLOPURINOL 100MG TABLET
APO-ALLOPURINOL 200MG TABLET
APO-ALLOPURINOL 300MG TABLET
APO-AZATHIOPRINE 50MG TABLET
APO-OXYBUTININ 5MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
02247813
REIMBURSEMENT
100%
HIV
Insomnia
Insomnia
Insomnia
Insomnia
100%
100%
100%
100%
100%
Insomnia
100%
Insomnia
Insomnia
Insomnia
Insomnia
Insomnia
Insomnia
Kidney & Bladder disorders
Kidney & Bladder disorders
Kidney & Bladder disorders
Kidney & Bladder disorders
Kidney & Bladder disorders
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
AVODART 0.5MG CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Kidney & Bladder disorders
100%
02192748
CELLCEPT 250MG CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Kidney & Bladder disorders
100%
02237484
00572349
CELLCEPT 500MG CAPSULE
COLCHICINE 0.6MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Kidney & Bladder disorders
Generic Drug
Kidney & Bladder disorders
100%
100%
02244613
DETROL LA 4MG SR CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Kidney & Bladder disorders
100%
02243960
DITROPAN 5MG XL ER TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Kidney & Bladder disorders
100%
02270102
02281392
00271489
00454583
FLOMAX 0.4MG CR TABLET
NOVO-TAMSULOSIN 0.4MG ER CAPSULE
PHENAZO 100MG TABLET
PHENAZO 200MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
100%
100%
100%
100%
Kidney & Bladder disorders
Kidney & Bladder disorders
Kidney & Bladder disorders
Kidney & Bladder disorders
DIN
DRUG_NAME
GENERIC_CODE
DISEASE_CATEGORY
02175991
PROGRAF 1MG CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Kidney & Bladder disorders
70%
02010909
02242821
PROSCAR 5MG TABLET
SANDOZ-CYCLOSPORINE 100MG CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Kidney & Bladder disorders
Generic Drug
Kidney & Bladder disorders
100%
100%
02239065
UNIDET SR/ DETROL LA 2MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Kidney & Bladder disorders
100%
02245565
00265470
XATRAL 10MG SR TABLET
C.E.S. 0.625MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Kidney & Bladder disorders
Generic Drug
Menopause
100%
100%
02148587
ESTRACE 1MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Menopause
100%
02148595
ESTRACE 2MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Menopause
100%
02243999
ESTRADOT 37.5UG TRANSDERMAL PATCH
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Menopause
100%
02244000
ESTRADOT 50UG TRANSDERMAL PATCH
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Menopause
100%
02244001
ESTRADOT 75UG TRANSDERMAL PATCH
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Menopause
100%
02238704
ESTROGEL .06% TRANSDERMAL GEL
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Menopause
100%
02242531
02229840
02229838
02221306
02221284
02221292
FEM HRT TABLET
GEN-MEDROXY 10MG TABLET
GEN-MEDROXY 2.5MG TABLET
NOVO-MEDRONE 10MG TABLET
NOVO-MEDRONE 2.5MG TABLET
NOVO-MEDRONE 5MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
100%
100%
100%
100%
100%
100%
02089793
02246627
OGEN 0.625MG TABLET
PMS-MEDROXYPROGEST 2.5MG TABLET
02043394
PREMARIN 0.3MG TABLET
Menopause
Menopause
Menopause
Menopause
Menopause
Menopause
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Menopause
Generic Drug
Menopause
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Menopause
REIMBURSEMENT
100%
100%
100%
DIN
DRUG_NAME
02043408
PREMARIN 0.625MG TABLET
GENERIC_CODE
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
DISEASE_CATEGORY
REIMBURSEMENT
Menopause
100%
02043440
PREMARIN VAGINAL CREAM/APPL
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Menopause
100%
02242878
PREMPLUS 2.5MG KIT
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Menopause
100%
02242879
PREMPLUS 5MG KIT
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Menopause
100%
02166704
PROMETRIUM 100MG CAPSULE
00729973
02148579
02148552
Menopause
100%
PROVERA 10MG TABLET
RATIO-MPA 10MG TABLET
RATIO-MPA 2.5MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Generic Drug
Generic Drug
Menopause
Menopause
Menopause
100%
100%
100%
02241332
02242838
02282127
02216140
VAGIFEM TABLET
APO-LITHIUM 300MG CAPSULE
APO-RISPERIDONE 0.5MG TABLET
PMS-LITHIUM CARB 300MG CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
Menopause
Mental disorders
Mental disorders
Mental disorders
100%
100%
100%
100%
02236952
SEROQUEL 100MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Mental disorders
100%
02236953
SEROQUEL 200MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Mental disorders
100%
02236951
SEROQUEL 25MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Mental disorders
100%
02244107
SEROQUEL 300MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Mental disorders
100%
02237821
02268396
AMERGE 2.5MG TABLET
APO-SUMATRIPTAN 100MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Migraines
Generic Drug
Migraines
100%
100%
02248129
AXERT 12.5MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Migraines
100%
02230420
IMITREX 20MG NASAL SPRAY
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Migraines
100%
DIN
DRUG_NAME
02212188
IMITREX 6MG/0.5ML VIAL
02212161
GENERIC_CODE
DISEASE_CATEGORY
REIMBURSEMENT
IMITREX DF 100MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Migraines
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Migraines
100%
02239738
IMITREX DF 25MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Migraines
100%
02240520
MAXALT 5MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Migraines
100%
02240519
MAXALT RPD 10MG WAFER
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Migraines
100%
02240518
02239367
MAXALT RPD 5MG WAFER
NOVO-SUMATRIPTAN 100MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Migraines
Generic Drug
Migraines
100%
100%
02256304
RELPAX 40MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Migraines
100%
02238660
ZOMIG 2.5MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Migraines
100%
02243045
ZOMIG RAPIMELT 2.5MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Migraines
100%
02237770
AVONEX 33MCG/VIAL INJ
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Multiple sclerosis
70%
02269201
AVONEX PS 30MCG/0.5ML SYR
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Multiple sclerosis
70%
02169649
BETASERON 0.3MG VIAL
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Multiple sclerosis
70%
02245619
COPAXONE 20MG/ML PFS
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Multiple sclerosis
70%
02237319
REBIF 22MCG (6MIU) PFS
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Multiple sclerosis
70%
02237320
REBIF 44MCG (12MIU) PFS
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Multiple sclerosis
70%
02281708
REBIF INITIATION PACK
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Multiple sclerosis
70%
100%
DIN
DRUG_NAME
GENERIC_CODE
DISEASE_CATEGORY
REIMBURSEMENT
02286386
02139332
02177145
TYSABRI 300MG/15ML IV
APO-BACLOFEN 10MG TABLET
APO-CYCLOBENZAPRINE 10MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Multiple sclerosis
Generic Drug
Muscle relaxants
Generic Drug
Muscle relaxants
70%
100%
100%
01981501
02088398
02080052
BOTOX 100U VIAL
GEN-BACLOFEN 10MG TABLET
NOVO-CYCLOPRINE 10MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Muscle relaxants
Generic Drug
Muscle relaxants
Generic Drug
Muscle relaxants
70%
100%
100%
02163748
CODEINE CONTIN 100MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Narcotic analgesics
100%
02163799
CODEINE CONTIN 200MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Narcotic analgesics
100%
02230302
CODEINE CONTIN 50MG
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Narcotic analgesics
100%
02138018
01916548
DEMEROL 50MG TABLET
ENDOCET TABLET
00176206
FIORINAL-C1/2 CAPSULE
00176192
FIORINAL-C1/4 CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
02125323
09850619
Narcotic analgesics
Narcotic analgesics
100%
100%
Narcotic analgesics
70%
Narcotic analgesics
70%
HYDROMORPH CONTIN 3MG CAPSULE
METHADONE SOLUTION ODB
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Narcotic analgesics
Generic Drug
Narcotic analgesics
100%
100%
02202441
OXYCONTIN 10MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Narcotic analgesics
100%
02202468
OXYCONTIN 20MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Narcotic analgesics
100%
02202476
OXYCONTIN 40MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Narcotic analgesics
100%
02202484
OXYCONTIN 80MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Narcotic analgesics
100%
02240131
OXY-IR 10MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Narcotic analgesics
70%
DIN
DRUG_NAME
GENERIC_CODE
DISEASE_CATEGORY
REIMBURSEMENT
02231934
00885444
02249413
00593451
00779474
00608882
02282968
00653241
00653276
02244790
00608165
OXY-IR 5MG TABLET
PMS-HYDROMORPHONE 1MG TABLET
RAN-FENTANYL 50MCG TRANSDERMAL PATCH
RATIO-CODEINE PHOS 30MG TABLET
RATIO-CODEINE PHOS 5MG/ML SYRUP
RATIO-EMTEC-30 TABLET
RATIO-FENTANYL 50MCG/HR PATCH
RATIO-LENOLTEC NO.2 TABLET
RATIO-LENOLTEC NO.3 TABLET
RATIO-MORPHINE SULF 15MG SR TABLET
RATIO-OXYCOCET TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Narcotic analgesics
Narcotic analgesics
Narcotic analgesics
Narcotic analgesics
Narcotic analgesics
Narcotic analgesics
Narcotic analgesics
Narcotic analgesics
Narcotic analgesics
Narcotic analgesics
Narcotic analgesics
70%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
02264846
TRAMACET 37.5/325MG TABLET
Narcotic analgesics
70%
02163934
TYLENOL W/CODEINE NO. 2 TABLET
Narcotic analgesics
100%
02163926
TYLENOL W/CODEINE NO. 3 TABLET
Narcotic analgesics
100%
02163918
00886432
TYLENOL W/CODEINE NO. 4 TABLET
APO-PROCHLORAZINE 10MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Generic Drug
Narcotic analgesics
Nausea
100%
100%
00548375
CESAMET 1MG CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Nausea
100%
00609129
02280191
02280205
DICLECTIN TABLET
NOVO-BETAHISTINE 16MG TABLET
NOVO-BETAHISTINE 24MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Nausea
Generic Drug
Nausea
Generic Drug
Nausea
100%
70%
70%
02247998
02202352
SERC 24MG TABLET
RIVASA 80MG CHEW TABLET
00036641
02246691
02244366
XYLOCAINE 2% SOLUTION
APO-HYDROXYQUINE 200MG TABLET
APO-MEFLOQUINE 250MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Generic Drug
Generic Drug
02018055
LARIAM 250MG TABLET
Nausea
Pain
70%
100%
Pain
Parasitic treatment
Parasitic treatment
70%
100%
100%
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Parasitic treatment
100%
DIN
DRUG_NAME
GENERIC_CODE
DISEASE_CATEGORY
REIMBURSEMENT
02238151
00021261
00021008
MALARONE TABLET
NOVO-CHLOROQUINE 250MG TABLET
NOVO-QUININE 200MG TABLET
02017709
02195941
PLAQUENIL 200MG TABLET
APO-LEVOCARB 25/100MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Generic Drug
02242903
ENBREL 25MG INJECTION
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Rheumatoid Arthritis
100%
02274728
ENBREL 50MG INJECTION
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Rheumatoid Arthritis
100%
02258595
HUMIRA 40MG/0.8ML PFS INJ
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Rheumatoid Arthritis
100%
02244016
REMICADE INJECTION
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Rheumatoid Arthritis
100%
00582352
ACCUTANE 40MG CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
100%
02259052
AMEVIVE 15MG/0.5ML IM
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
100%
02239757
BACTROBAN 2% CREAM
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
100%
01916947
02248472
00716618
00716626
00716650
02257955
02257963
BACTROBAN 2% OINTMENT
BENZACLIN 1% TOPICAL GEL
BETADERM 0.05% CREAM
BETADERM 0.1% CREAM
BETADERM 0.1% OINTMENT
CLARUS 10MG CAPSULE
CLARUS 40MG CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Skin disorders
Skin disorders
Skin disorders
Skin disorders
Skin disorders
Skin disorders
Skin disorders
100%
100%
100%
100%
100%
100%
100%
02243050
CLINDETS PLEDGETS 1% PADS
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
100%
02243158
CLINDOXYL 1% TOPICAL GEL
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
100%
02256371
00716693
CLOBEX 0.05% SHAMPOO
CORTODERM 1% OINTMENT
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
Generic Drug
Skin disorders
100%
100%
Parasitic treatment
Parasitic treatment
Parasitic treatment
70%
100%
70%
Parasitic treatment
Parkinson disease
100%
100%
DIN
DRUG_NAME
GENERIC_CODE
DISEASE_CATEGORY
00582301
DALACIN T 1% SOLUTION
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
100%
02227517
DERMATOP 0.1% OINTMENT
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
100%
02230642
DERMATOP EMOLLIENT CREAM 1MG/G
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
100%
02233542
DIANE-35 2MG/35MCG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
100%
00578428
DIPROSALIC LOTION
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
100%
02244126
DOVOBET OINTMENT
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
100%
02247238
ELIDEL 1% CREAM
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
70%
00851744
ELOCOM 0.1% CREAM
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
100%
00871095
00192597
ELOCOM 0.1% LOTION
EMO-CORT 1% CREAM
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
Generic Drug
Skin disorders
100%
100%
00595799
EMO-CORT 2.5% CREAM
00323098
FLAMAZINE 1% CREAM
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Skin disorders
00586668
FUCIDIN 2% CREAM
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
100%
00586676
FUCIDIN 2% OINTMENT
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
100%
02238578
02026767
00716839
02242984
02245662
FUCIDIN H CREAM
GEN-CLOBETASOL 0.05% OINT
HYDERM 1% CREAM
HYDROVAL 0.2% CREAM
KETODERM 2% CREAM
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
100%
100%
100%
100%
100%
Skin disorders
Skin disorders
Skin disorders
Skin disorders
Skin disorders
REIMBURSEMENT
100%
100%
DIN
DRUG_NAME
GENERIC_CODE
DISEASE_CATEGORY
02031094
LAMISIL 1% CREAM
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
100%
02221802
LOPROX 1% CREAM
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
100%
00611174
00716863
02236997
02236996
LOTRIDERM CREAM
LYDERM 0.05% CREAM
LYDERM 0.05% GEL
LYDERM 0.05% OINTMENT
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
Skin disorders
Skin disorders
Skin disorders
Skin disorders
70%
100%
100%
100%
02226839
METROCREAM 0.75% CREAM
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
100%
02092832
METROGEL 0.75% GEL
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
100%
00587818
NERISONE 0.1% OILY CREAM
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
100%
02156091
02093162
02126192
NORITATE 1% CREAM
NOVO-CLOBETASOL 0.05% CREAM
NOVO-CLOBETASOL 0.05% OINT
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
Generic Drug
Skin disorders
Generic Drug
Skin disorders
100%
100%
100%
02250535
PENLAC 8% TOPICAL SOLUTION
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
70%
02247265
PENNSAID 1.5% TOPICAL SOLUTION
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
100%
02017733
02229323
PHISOHEX 3% LIQUID
PMS-DESONIDE 0.05% OINT
00804541
PREVEX B 0.1% CREAM
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
Generic Drug
Skin disorders
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
Skin disorders
02244148
PROTOPIC 0.1% OINTMENT
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
02272504
02247097
01910272
00535427
00535435
RAPTIVA 150MG VIAL
RATIO-AMCINONIDE 0.1% LOTION
RATIO-CLOBETASOL 0.05% CREAM
RATIO-ECTOSONE 0.05% MILD CREAM
RATIO-ECTOSONE 0.1% CREAM
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Skin disorders
Skin disorders
Skin disorders
Skin disorders
Skin disorders
REIMBURSEMENT
70%
100%
70%
70%
100%
100%
100%
100%
100%
DIN
00653217
02248130
02242919
DRUG_NAME
RATIO-ECTOSONE 0.1% SCALP LOTION
RATIO-MOMETASONE 0.1% OINTMENT
ROSASOL 10MG/G CREAM
GENERIC_CODE
Generic Drug
Generic Drug
Generic Drug
DISEASE_CATEGORY
Skin disorders
Skin disorders
Skin disorders
02247228
STIEPROX 1.5% SHAMPOO
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
70%
01905112
STIEVAMYCIN GEL
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
100%
02015994
02246714
02279983
STIEVAMYCIN MILD GEL
TARO-AMCINONIDE 0.1% CREAM
TARO-MUPIROCIN 2% OINTMENT
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
Generic Drug
Skin disorders
Generic Drug
Skin disorders
100%
100%
100%
00503134
00717002
UREMOL HC CREAM
VIADERM K.C. CREAM
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
Generic Drug
Skin disorders
70%
100%
02039524
ZOVIRAX 5% CREAM
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
100%
00999080
ZOVIRAX 5% OINT - 4G PRICE /G
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
100%
00569771
ZOVIRAX 5% OINTMENT - 30G
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Skin disorders
100%
02291177
CHAMPIX 0.5MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Smoking cessation
50%
02291185
CHAMPIX 1MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Smoking cessation
50%
94799999
PIN:CHAMPIX STARTER PACK
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Smoking cessation
50%
02238441
02177161
00362158
00655740
00655759
00402745
00402737
ZYBAN 150MG SR TABLET
APO-BROMAZEPAM 3MG TABLET
APO-DIAZEPAM 5MG TABLET
APO-LORAZEPAM 0.5MG TABLET
APO-LORAZEPAM 1MG TABLET
APO-OXAZEPAM 15MG TABLET
APO-OXAZEPAM 30MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
02041456
ATIVAN 0.5MG TABLET SL
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Stress/Sedation
Smoking cessation
Stress/Sedation
Stress/Sedation
Stress/Sedation
Stress/Sedation
Stress/Sedation
Stress/Sedation
REIMBURSEMENT
100%
100%
100%
50%
100%
100%
100%
100%
100%
100%
100%
DIN
DRUG_NAME
02041421
ATIVAN 1MG TABLET
GENERIC_CODE
Brand Name Drug however Generic is available.
Reimbursement is based on price of the generic.
You may ask your pharmacist to substitute the
generic.
DISEASE_CATEGORY
REIMBURSEMENT
02041464
02137542
01913484
00637742
00728195
ATIVAN 1MG TABLET SL
GEN-ALPRAZOLAM 0.5MG TABLET
NOVO-ALPRAZOL 0.25MG TABLET
NOVO-LORAZEM 1MG TABLET
PMS-LORAZEPAM 1MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
00782327
ANDRIOL 40MG CAPSULE
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Thyroid & Glandular
100%
02245346
02242465
ANDROGEL 1% GEL-5G PK
APO-DESMOPRESSIN 10MCG NASAL SPRAY
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Thyroid & Glandular
Generic Drug
Thyroid & Glandular
100%
100%
02242471
DOSTINEX 0.5MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Thyroid & Glandular
100%
02213206
ELTROXIN 100MCG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Thyroid & Glandular
100%
02213214
ELTROXIN 150MCG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Thyroid & Glandular
100%
02213222
ELTROXIN 200MCG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Thyroid & Glandular
100%
02213230
ELTROXIN 300MCG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Thyroid & Glandular
100%
02213192
ELTROXIN 50MCG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Thyroid & Glandular
100%
02172062
SYNTHROID 0.025MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Thyroid & Glandular
100%
02172070
SYNTHROID 0.05MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Thyroid & Glandular
100%
02172089
SYNTHROID 0.075MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Thyroid & Glandular
100%
02172097
SYNTHROID 0.088MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Thyroid & Glandular
100%
Stress/Sedation
100%
Stress/Sedation
Stress/Sedation
Stress/Sedation
Stress/Sedation
Stress/Sedation
100%
100%
100%
100%
100%
DIN
DRUG_NAME
GENERIC_CODE
DISEASE_CATEGORY
02171228
SYNTHROID 0.112MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Thyroid & Glandular
100%
02172119
SYNTHROID 0.125MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Thyroid & Glandular
100%
02172127
SYNTHROID 0.15MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Thyroid & Glandular
100%
02172135
SYNTHROID 0.175MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Thyroid & Glandular
100%
02172100
01953834
02244023
00733059
00828564
02242453
SYNTHROID 0.1MG TABLET
APO-FAMOTIDINE 40MG TABLET
APO-MISOPROSTOL 200MCG TABLET
APO-RANITIDINE 150MG TABLET
NOVO-RANIDINE 150MG TABLET
PMS-RANITIDINE 150MG TABLET
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand.
Generic Drug
Generic Drug
Generic Drug
Generic Drug
Generic Drug
100%
100%
100%
100%
100%
100%
02103567
SULCRATE PLUS 1GM/5ML SUSP
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Ulcers
02246067
PREGVIT
Brand Name Drug. No Generic is available.
Reimbursement is based on the price of the brand. Vitamins and Minerals
Thyroid & Glandular
Ulcers
Ulcers
Ulcers
Ulcers
Ulcers
REIMBURSEMENT
100%
70%