Antibacterials

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ALSO KNOW AS
DRUG CATEGORY
FORMULARY CATEGORY
WHAT WE COVER
COST SHARE
Azithromycin Susr 200Mg/5Ml (Generic)

Zithromax Susr 200 Mg/5Ml (Brand)
Antibacterials
1
Generic
$14
Azithromycin Tabs 250Mg (Generic)

Zithromax Tabs 250 Mg (Brand)
Antibacterials
1
Generic
$14
Azithromycin Tabs 500Mg (Generic)

Zithromax Tabs 500 Mg (Brand)
Antibacterials
1
Generic
$14
Azithromycin Tabs 600Mg (Generic)

Zithromax Tabs 600 Mg (Brand)
Antibacterials
1
Generic
$14
Azulfidine En-Tabs Tbec 500 Mg (Brand)

Sulfasalazine Tbec 500Mg (Generic)
Antibacterials
3
Non-Formulary Brand
$68
Azulfidine Tabs 500 Mg (Brand)

Sulfasalazine Tabs 500Mg (Generic)
Antibacterials
3
Non-Formulary Brand
$68
Bactrim Ds Tabs 800-160 Mg (Brand)

Sulfamethoxazole-Trimethoprim Tabs (Generic)
Antibacterials
3
Non-Formulary Brand
$68
Bactrim Tabs 400-80 Mg (Brand)

Sulfamethoxazole-Trimethoprim Tabs (Generic)
Antibacterials
3
Non-Formulary Brand
$68
Baxdela Tabs 450 Mg (Brand)

Delafloxacin Meglumine Tabs 450Mg (Generic)
Antibacterials
3
Non-Formulary Brand
$68
Bethkis Nebu 300 Mg/4Ml (Brand)

Tobramycin Nebu 300Mg/4Ml (Generic)
Antibacterials
3
Non-Formulary Brand
$68
Bicillin C-R 900/300 Susp 900000-300000 Unit/2Ml (Brand)

Penicillin G Benzathine & Procaine Susp (Generic)
Antibacterials
3
Non-Formulary Brand
$68
Cefaclor Caps 250Mg (Generic)

No Brand Option Available
Antibacterials
1
Generic
$14
Cefaclor Caps 500Mg (Generic)

No Brand Option Available
Antibacterials
1
Generic
$14
Cefaclor Monohydrate Tb12 500Mg (Generic)

No Brand Option Available
Antibacterials
1
Generic
$14
Cefaclor Susr 125Mg/5Ml (Generic)

No Brand Option Available
Antibacterials
1
Generic
$14
Cefaclor Susr 250Mg/5Ml (Generic)

No Brand Option Available
Antibacterials
1
Generic
$14
Cefaclor Susr 375Mg/5Ml (Generic)

No Brand Option Available
Antibacterials
1
Generic
$14
Cefadroxil Caps 500Mg (Generic)

No Brand Option Available
Antibacterials
1
Generic
$14
Cefadroxil Susr 250Mg/5Ml (Generic)

No Brand Option Available
Antibacterials
1
Generic
$14
Cefadroxil Susr 500Mg/5Ml (Generic)

No Brand Option Available
Antibacterials
1
Generic
$14
Cefadroxil Tabs 1Gm (Generic)

No Brand Option Available
Antibacterials
1
Generic
$14
Cefazolin Sodium Solr 10Gm (Generic)

Cefazolin Sodium Solr 10 Gm (Brand)
Antibacterials
MA
Administered in Medical Office
N/A
Cefazolin Sodium Solr 1Gm (Generic)

Cefazolin Sodium Solr 1 Gm (Brand)
Antibacterials
MA
Administered in Medical Office
N/A
Cefazolin Sodium Solr 500Mg (Generic)

Cefazolin Sodium Solr 500 Mg (Brand)
Antibacterials
MA
Administered in Medical Office
N/A
Cefdinir Caps 300Mg (Generic)

No Brand Option Available
Antibacterials
1
Generic
$14
Cefdinir Susr 125Mg/5Ml (Generic)

No Brand Option Available
Antibacterials
1
Generic
$14
Cefdinir Susr 250Mg/5Ml (Generic)

No Brand Option Available
Antibacterials
1
Generic
$14
Cefepime Hcl Solr 1Gm (Generic)

Cefepime Hcl Solr 1 Gm (Brand)
Antibacterials
MA
Administered in Medical Office
N/A
Cefepime Hcl Solr 1Gm (Generic)

Maxipime Solr 1 Gm (Brand)
Antibacterials
MA
Administered in Medical Office
N/A
Cefepime Hcl Solr 2Gm (Generic)

Cefepime Hcl Solr 2 Gm (Brand)
Antibacterials
MA
Administered in Medical Office
N/A
Cefepime Hcl Solr 2Gm (Generic)

Maxipime Solr 2 Gm (Brand)
Antibacterials
MA
Administered in Medical Office
N/A
Cefixime Caps 400Mg (Generic)

Suprax Caps 400 Mg (Brand)
Antibacterials
1
Generic
$14
Cefixime Susr 100Mg/5Ml (Generic)

Suprax Susr 100 Mg/5Ml (Brand)
Antibacterials
1
Generic
$14
Cefixime Susr 200Mg/5Ml (Generic)

Suprax Susr 200 Mg/5Ml (Brand)
Antibacterials
1
Generic
$14
Cefotaxime Sodium Solr 1Gm (Generic)

Cefotaxime Sodium Solr 1 Gm (Brand)
Antibacterials
MA
Administered in Medical Office
N/A
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