Gi Drugs, Miscellaneous
Showing 1–12 of 48 results
NAME | ALSO KNOW AS | DRUG CATEGORY | FORMULARY CATEGORY | WHAT WE COVER | COST SHARE |
|---|---|---|---|---|---|
|
Naldemedine Tosylate Tabs .2Mg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Plecanatide Tabs 3Mg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Ursodiol Tabs 250Mg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Ursodiol Tabs 500Mg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Reltone Caps 200Mg (Brand) |
Gi Drugs, Miscellaneous |
1 |
Generic |
$14 |
|
|
Actigall Caps 300 Mg (Brand) |
Gi Drugs, Miscellaneous |
1 |
Generic |
$14 |
|
|
Reltone Caps 400Mg (Brand) |
Gi Drugs, Miscellaneous |
1 |
Generic |
$14 |
|
|
Urso 250 Tabs 250 Mg (Brand) |
Gi Drugs, Miscellaneous |
1 |
Generic |
$14 |
|
|
Urso Forte Tabs 500 Mg (Brand) |
Gi Drugs, Miscellaneous |
1 |
Generic |
$14 |
|
|
Entyvio Solr 300 Mg (Brand) |
Gi Drugs, Miscellaneous |
MA |
Administered in Medical Office |
N/A |
|
|
Eluxadoline Tabs 100Mg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Eluxadoline Tabs 75Mg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Tegaserod Maleate Tabs 6Mg (Generic) |
Gi Drugs, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |