Central Nervous System Agents, Miscellaneous
Showing 1–12 of 67 results
NAME | ALSO KNOW AS | DRUG CATEGORY | FORMULARY CATEGORY | WHAT WE COVER | COST SHARE |
|---|---|---|---|---|---|
|
Memantine Hcl Cp24 7Mg (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Memantine Hcl Cp24 (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Memantine Hcl-Donepezil Hcl C4Pk (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Memantine Hcl-Donepezil Hcl Cp24 (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Memantine Hcl-Donepezil Hcl Cp24 (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Memantine Hcl-Donepezil Hcl Cp24 (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Memantine Hcl-Donepezil Hcl Cp24 (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Istradefylline Tabs 20Mg (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Istradefylline Tabs 40Mg (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Dextromethorphan Hbr-Quinidine Sulfate Caps (Generic) |
Central Nervous System Agents, Miscellaneous |
2 |
Formulary Brand |
$38 |
|
|
Edaravone Soln 30Mg/100Ml (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Riluzole Tabs 50Mg (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Rilutek Tabs 50 Mg (Brand) |
Central Nervous System Agents, Miscellaneous |
1 |
Generic |
$14 |
|
|
Milnacipran Hcl Tabs 100Mg (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Milnacipran Hcl Tabs 12.5Mg (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Milnacipran Hcl Tabs 25Mg (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Milnacipran Hcl Tabs 50Mg (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Milnacipran Hcl Misc (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Atomoxetine Hcl Caps 10Mg (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Atomoxetine Hcl Caps 100Mg (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Atomoxetine Hcl Caps 18Mg (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Atomoxetine Hcl Caps 25Mg (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Atomoxetine Hcl Caps 40Mg (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Atomoxetine Hcl Caps 60Mg (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Atomoxetine Hcl Caps 80Mg (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Xenazine Tabs 12.5 Mg (Brand) |
Central Nervous System Agents, Miscellaneous |
1 |
Generic |
$14 |
|
|
Xenazine Tabs 25 Mg (Brand) |
Central Nervous System Agents, Miscellaneous |
1 |
Generic |
$14 |
|
|
Riluzole Susp 50Mg/10Ml (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Tetrabenazine Tabs 12.5Mg (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Tetrabenazine Tabs 25Mg (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Sodium Oxybate Soln 500Mg/Ml (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Calcium, Magnesium, Potassium, & Sodium Oxybates Soln 500Mg/ml (Generic) |
Central Nervous System Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |