Anti-Infectives
Showing 1–12 of 39 results
NAME | ALSO KNOW AS | DRUG CATEGORY | FORMULARY CATEGORY | WHAT WE COVER | COST SHARE |
---|---|---|---|---|---|
Azithromycin (Ophth) Soln 1% (Generic) |
Anti-Infectives |
3 |
Non-Formulary Brand |
$68 |
|
No Brand Option Available |
Anti-Infectives |
1 |
Generic |
$14 |
|
No Brand Option Available |
Anti-Infectives |
1 |
Generic |
$14 |
|
Besifloxacin Hcl Susp .6% (Generic) |
Anti-Infectives |
3 |
Non-Formulary Brand |
$68 |
|
Sulfacetamide Sodium (Ophth) Soln 10% (Generic) |
Anti-Infectives |
3 |
Non-Formulary Brand |
$68 |
|
Ciprofloxacin Hcl (Otic) Soln .2% (Generic) |
Anti-Infectives |
3 |
Non-Formulary Brand |
$68 |
|
Periogard Soln 0.12 % (Brand) |
Anti-Infectives |
1 |
Generic |
$14 |
|
Ciprofloxacin Hcl (Ophth) Oint .3% (Generic) |
Anti-Infectives |
2 |
Formulary Brand |
$38 |
|
Ciprofloxacin Hcl (Ophth) Soln .3% (Generic) |
Anti-Infectives |
3 |
Non-Formulary Brand |
$68 |
|
Ciloxan Soln 0.3 % (Brand) |
Anti-Infectives |
1 |
Generic |
$14 |
|
Cetraxal Soln 0.2 % (Brand) |
Anti-Infectives |
1 |
Generic |
$14 |
|
Erythromycin Oint 5 Mg/Gm (Brand) |
Anti-Infectives |
1 |
Generic |
$14 |
|
Zymaxid Soln 0.5 % (Brand) |
Anti-Infectives |
1 |
Generic |
$14 |
|
Gentamicin Sulfate (Ophth) Oint .3% (Generic) |
Anti-Infectives |
3 |
Non-Formulary Brand |
$68 |
|
No Brand Option Available |
Anti-Infectives |
1 |
Generic |
$14 |
|
No Brand Option Available |
Anti-Infectives |
1 |
Generic |
$14 |
|
Moxifloxacin Hcl (Ophth) Soln .5% (Generic) |
Anti-Infectives |
3 |
Non-Formulary Brand |
$68 |
|
Vigamox Soln 0.5 % (Brand) |
Anti-Infectives |
1 |
Generic |
$14 |
|
Natamycin Susp 5% (Generic) |
Anti-Infectives |
2 |
Formulary Brand |
$38 |
|
No Brand Option Available |
Anti-Infectives |
1 |
Generic |
$14 |
|
No Brand Option Available |
Anti-Infectives |
1 |
Generic |
$14 |
|
Ofloxacin (Ophth) Soln .3% (Generic) |
Anti-Infectives |
3 |
Non-Formulary Brand |
$68 |
|
Ocuflox Soln 0.3 % (Brand) |
Anti-Infectives |
1 |
Generic |
$14 |
|
No Brand Option Available |
Anti-Infectives |
1 |
Generic |
$14 |
|
No Brand Option Available |
Anti-Infectives |
1 |
Generic |
$14 |
|
Ciprofloxacin-Fluocinolone Acetonide Soln (Generic) |
Anti-Infectives |
3 |
Non-Formulary Brand |
$68 |
|
Chlorhexidine Gluconate (Mouth-Throat) Soln .12% (Generic) |
Anti-Infectives |
3 |
Non-Formulary Brand |
$68 |
|
Polytrim Soln 10000-0.1 Unit/Ml-% (Brand) |
Anti-Infectives |
1 |
Generic |
$14 |
|
Polymyxin B-Trimethoprim Soln (Generic) |
Anti-Infectives |
3 |
Non-Formulary Brand |
$68 |
|
No Brand Option Available |
Anti-Infectives |
1 |
Generic |
$14 |
|
Bleph-10 Soln 10 % (Brand) |
Anti-Infectives |
1 |
Generic |
$14 |
|
Tobrex Soln 0.3 % (Brand) |
Anti-Infectives |
1 |
Generic |
$14 |
|
Tobramycin (Ophth) Oint .3% (Generic) |
Anti-Infectives |
2 |
Formulary Brand |
$38 |
|
Tobramycin (Ophth) Soln .3% (Generic) |
Anti-Infectives |
3 |
Non-Formulary Brand |
$68 |
|
Viroptic Soln 1 % (Brand) |
Anti-Infectives |
1 |
Generic |
$14 |