Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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%