Antivirals
Showing 1–12 of 250 results
NAME | ALSO KNOW AS | DRUG CATEGORY | FORMULARY CATEGORY | WHAT WE COVER | COST SHARE |
|---|---|---|---|---|---|
|
Etravirine Tabs 25Mg (Generic) |
Antivirals |
3 |
Non-Formulary Brand |
$68 |
|
|
Saquinavir Mesylate Caps 200Mg (Generic) |
Antivirals |
2 |
Formulary Brand |
$38 |
|
|
Saquinavir Mesylate Tabs 500Mg (Generic) |
Antivirals |
2 |
Formulary Brand |
$38 |
|
|
Raltegravir Potassium Chew 100Mg (Generic) |
Antivirals |
2 |
Formulary Brand |
$38 |
|
|
Raltegravir Potassium Chew 25Mg (Generic) |
Antivirals |
2 |
Formulary Brand |
$38 |
|
|
Raltegravir Potassium Tabs 600Mg (Generic) |
Antivirals |
2 |
Formulary Brand |
$38 |
|
|
Raltegravir Potassium Pack 100Mg (Generic) |
Antivirals |
2 |
Formulary Brand |
$38 |
|
|
Raltegravir Potassium Tabs 400Mg (Generic) |
Antivirals |
2 |
Formulary Brand |
$38 |
|
|
Dolutegravir Sodium-Rilpivirine Hcl Tabs (Generic) |
Antivirals |
2 |
Formulary Brand |
$38 |
|
|
Lopinavir-Ritonavir Soln (Generic) |
Antivirals |
3 |
Non-Formulary Brand |
$68 |
|
|
Lopinavir-Ritonavir Tabs 100-25 (Generic) |
Antivirals |
3 |
Non-Formulary Brand |
$68 |
|
|
Lopinavir-Ritonavir Tabs 200-50 (Generic) |
Antivirals |
3 |
Non-Formulary Brand |
$68 |
|
|
Epivir Hbv Tabs 100 Mg (Brand) |
Antivirals |
1 |
Generic |
$14 |
|
|
Epivir Soln 10 Mg/Ml (Brand) |
Antivirals |
1 |
Generic |
$14 |
|
|
Epivir Tabs 150 Mg (Brand) |
Antivirals |
1 |
Generic |
$14 |
|
|
Epivir Tabs 300 Mg (Brand) |
Antivirals |
1 |
Generic |
$14 |
|
|
Combivir Tabs 150-300 Mg (Brand) |
Antivirals |
1 |
Generic |
$14 |
|
|
Harvoni Tabs 90-400 Mg (Brand) |
Antivirals |
1 |
Generic |
$14 |
|
|
Prevymis Soln 240 Mg/12Ml (Brand) |
Antivirals |
MA |
Administered in Medical Office |
N/A |
|
|
Prevymis Soln 480 Mg/24Ml (Brand) |
Antivirals |
MA |
Administered in Medical Office |
N/A |
|
|
Fosamprenavir Calcium Susp 50Mg/Ml (Generic) |
Antivirals |
3 |
Non-Formulary Brand |
$68 |
|
|
Fosamprenavir Calcium Tabs 700Mg (Generic) |
Antivirals |
3 |
Non-Formulary Brand |
$68 |
|
|
Maribavir Tabs 200 Mg (Generic) |
Antivirals |
3 |
Non-Formulary Brand |
$68 |
|
|
Kaletra Soln 400-100 Mg/5Ml (Brand) |
Antivirals |
1 |
Generic |
$14 |
|
|
Kaletra Tabs 100-25 Mg (Brand) |
Antivirals |
1 |
Generic |
$14 |
|
|
Kaletra Tabs 200-50 Mg (Brand) |
Antivirals |
1 |
Generic |
$14 |
|
|
Selzentry Tabs 150Mg (Brand) |
Antivirals |
1 |
Generic |
$14 |
|
|
Selzentry Tabs 300Mg (Brand) |
Antivirals |
1 |
Generic |
$14 |
|
|
Glecaprevir-Pibrentasvir Tabs (Generic) |
Antivirals |
3 |
Non-Formulary Brand |
$68 |
|
|
Ribavirin (Hepatitis C) Tbpk 600Mg (Generic) |
Antivirals |
3 |
Non-Formulary Brand |
$68 |
|
|
Ribavirin (Hepatitis C) Tbpk 400Mg (Generic) |
Antivirals |
3 |
Non-Formulary Brand |
$68 |
|
|
Viramune Susp 50 Mg/5Ml (Brand) |
Antivirals |
1 |
Generic |
$14 |
|
|
Viramune Tabs 200 Mg (Brand) |
Antivirals |
1 |
Generic |
$14 |
|
|
Viramune Xr Tb24 100 Mg (Brand) |
Antivirals |
1 |
Generic |
$14 |
|
|
Viramune Xr Tb24 400 Mg (Brand) |
Antivirals |
1 |
Generic |
$14 |