Antifungals

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NAME
ALSO KNOW AS
DRUG CATEGORY
FORMULARY CATEGORY
WHAT WE COVER
COST SHARE
Itraconazole Caps 100Mg (Generic)

Sporanox Caps 100 Mg (Brand)
Antifungals
1
Generic
$14
Itraconazole Soln 10Mg/Ml (Generic)

Sporanox Soln 10 Mg/Ml (Brand)
Antifungals
1
Generic
$14
Ketoconazole Tabs 200Mg (Generic)

No Brand Option Available
Antifungals
1
Generic
$14
Lamisil Tabs 250 Mg (Brand)

Terbinafine Hcl Tabs 250Mg (Generic)
Antifungals
3
Non-Formulary Brand
$68
Micafungin Sodium Solr 100Mg (Generic)

Mycamine Solr 100 Mg (Brand)
Antifungals
MA
Administered in Medical Office
N/A
Micafungin Sodium Solr 50Mg (Generic)

Mycamine Solr 50 Mg (Brand)
Antifungals
MA
Administered in Medical Office
N/A
Noxafil Susp 40 Mg/Ml (Brand)

Posaconazole Susp 40Mg/Ml (Generic)
Antifungals
3
Non-Formulary Brand
$68
Noxafil Tbec 100 Mg (Brand)

Posaconazole Tbec 100Mg (Generic)
Antifungals
3
Non-Formulary Brand
$68
Nystatin (Mouth-Throat) Susp 100000Unit/Ml (Generic)

No Brand Option Available
Antifungals
1
Generic
$14
Nystatin Tabs 500000Unit (Generic)

No Brand Option Available
Antifungals
1
Generic
$14
Onmel Tabs 200 Mg (Brand)

Itraconazole Tabs 200Mg (Generic)
Antifungals
3
Non-Formulary Brand
$68
Posaconazole Susp (Generic)

No Brand Option Available
Antifungals
1
Generic
$14
Posaconazole Tbec 100Mg (Generic)

Noxafil Tbec 100 Mg (Brand)
Antifungals
1
Generic
$14
Sporanox Caps 100 Mg (Brand)

Itraconazole Caps 100Mg (Generic)
Antifungals
3
Non-Formulary Brand
$68
Sporanox Soln 10 Mg/Ml (Brand)

Itraconazole Soln 10Mg/Ml (Generic)
Antifungals
3
Non-Formulary Brand
$68
Terbinafine Hcl Tabs 250Mg (Generic)

Lamisil Tabs 250 Mg (Brand)
Antifungals
1
Generic
$14
Tolsura Caps 65 Mg (Brand)

Itraconazole Caps 65Mg (Generic)
Antifungals
3
Non-Formulary Brand
$68
Vfend Susr 40 Mg/Ml (Brand)

Voriconazole Susr 40Mg/Ml (Generic)
Antifungals
3
Non-Formulary Brand
$68
Vfend Tabs 200 Mg (Brand)

Voriconazole Tabs 200Mg (Generic)
Antifungals
3
Non-Formulary Brand
$68
Vfend Tabs 50 Mg (Brand)

Voriconazole Tabs 50Mg (Generic)
Antifungals
3
Non-Formulary Brand
$68
Voriconazole Solr 200Mg (Generic)

Vfend Iv Solr 200 Mg (Brand)
Antifungals
MA
Administered in Medical Office
N/A
Voriconazole Solr 200Mg (Generic)

Voriconazole Solr 200 Mg (Brand)
Antifungals
MA
Administered in Medical Office
N/A
Voriconazole Susr 40Mg/Ml (Generic)

Vfend Susr 40 Mg/Ml (Brand)
Antifungals
1
Generic
$14
Voriconazole Tabs 200Mg (Generic)

Vfend Tabs 200 Mg (Brand)
Antifungals
1
Generic
$14
Voriconazole Tabs 50Mg (Generic)

Vfend Tabs 50 Mg (Brand)
Antifungals
1
Generic
$14
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