Gi Drugs, Miscellaneous
Showing 1–12 of 48 results
NAME | ALSO KNOW AS | DRUG CATEGORY | FORMULARY CATEGORY | WHAT WE COVER | COST SHARE |
---|---|---|---|---|---|
Ursodiol Caps 300Mg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Lubiprostone Caps 24Mcg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Lubiprostone Caps 8Mcg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Chenodiol Tabs 250Mg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Cholic Acid Caps 250Mg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Cholic Acid Caps 50Mg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Teduglutide (Rdna) Kit 5Mg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Linaclotide Caps 145Mcg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Linaclotide Caps 290Mcg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Linaclotide Caps 72Mcg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
MARALIXIBAT CHLORIDE SOLN 9.5 MG/ML (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Lubiprostone Caps 24Mcg (Generic) |
Gi Drugs, Miscellaneous |
1 |
Generic |
$14 |
|
Lubiprostone Caps 8Mcg (Generic) |
Gi Drugs, Miscellaneous |
1 |
Generic |
$14 |
|
No Brand Option Available |
Gi Drugs, Miscellaneous |
1 |
Generic |
$14 |
|
Reglan Tabs 10 Mg (Brand) |
Gi Drugs, Miscellaneous |
1 |
Generic |
$14 |
|
Reglan Tabs 5 Mg (Brand) |
Gi Drugs, Miscellaneous |
1 |
Generic |
$14 |
|
No Brand Option Available |
Gi Drugs, Miscellaneous |
1 |
Generic |
$14 |
|
No Brand Option Available |
Gi Drugs, Miscellaneous |
1 |
Generic |
$14 |
|
Prucalopride Tabs 1Mg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Prucalopride Succinate Tabs 1Mg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Prucalopride Tabs 2 Mg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Prucalopride Succinate Tabs 2Mg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Naloxegol Oxalate Tabs 12.5Mg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Naloxegol Oxalate Tabs 25Mg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Glutamine Pack 5Gm (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Obeticholic Acid Tabs 10Mg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Obeticholic Acid Tabs 5Mg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
HYDROCORTISONE ACETATE W/ PRAMOXINE 1-1% (Brand) |
Gi Drugs, Miscellaneous |
1 |
Generic |
$14 |
|
Metoclopramide Hcl Tabs 10Mg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Metoclopramide Hcl Tabs 5Mg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Methylnaltrexone Bromide Soln 12Mg/0.6Ml (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Methylnaltrexone Bromide Soln 8Mg/0.4Ml (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Methylnaltrexone Bromide Tabs 150Mg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Ursodiol Caps 200Mg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Ursodiol Caps 400Mg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |