Hematopoietic Agents
Showing 1–12 of 72 results
NAME | ALSO KNOW AS | DRUG CATEGORY | FORMULARY CATEGORY | WHAT WE COVER | COST SHARE |
|---|---|---|---|---|---|
|
Darbepoetin Alfa Sosy 10Mcg/0.4Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Darbepoetin Alfa Sosy 100Mcg/0.5Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Darbepoetin Alfa Sosy 150Mcg/0.3Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Darbepoetin Alfa Sosy 200Mcg/0.4Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Darbepoetin Alfa Sosy 25Mcg/0.42Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Darbepoetin Alfa Sosy 300Mcg/0.6Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Darbepoetin Alfa Sosy 40Mcg/0.4Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Darbepoetin Alfa Sosy 500Mcg/Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Darbepoetin Alfa Sosy 60Mcg/0.3Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Cablivi Kit 11 Mg (Brand) |
Hematopoietic Agents |
MA |
Administered in Medical Office |
N/A |
|
|
Aranesp (Albumin Free) Soln 100 Mcg/Ml (Brand) |
Hematopoietic Agents |
MA |
Administered in Medical Office |
N/A |
|
|
Aranesp (Albumin Free) Soln 200 Mcg/Ml (Brand) |
Hematopoietic Agents |
MA |
Administered in Medical Office |
N/A |
|
|
Aranesp (Albumin Free) Soln 25 Mcg/Ml (Brand) |
Hematopoietic Agents |
MA |
Administered in Medical Office |
N/A |
|
|
Aranesp (Albumin Free) Soln 300 Mcg/Ml (Brand) |
Hematopoietic Agents |
MA |
Administered in Medical Office |
N/A |
|
|
Aranesp (Albumin Free) Soln 40 Mcg/Ml (Brand) |
Hematopoietic Agents |
MA |
Administered in Medical Office |
N/A |
|
|
Aranesp (Albumin Free) Soln 60 Mcg/Ml (Brand) |
Hematopoietic Agents |
MA |
Administered in Medical Office |
N/A |
|
|
Avatrombopag Maleate Tabs 20Mg (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Epoetin Alfa Soln 10000Unit/Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Epoetin Alfa Soln 2000Unit/Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Epoetin Alfa Soln 20000Unit/Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Epoetin Alfa Soln 3000Unit/Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Epoetin Alfa Soln 4000Unit/Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Neupogen Soln 300 Mcg/Ml (Brand) |
Hematopoietic Agents |
MA |
Administered in Medical Office |
N/A |
|
|
Neupogen Soln 480 Mcg/1.6Ml (Brand) |
Hematopoietic Agents |
MA |
Administered in Medical Office |
N/A |
|
|
Pegfilgrastim-Jmdb Sosy 6Mg/0.6Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Tbo-Filgrastim Soln 300Mcg/Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Tbo-Filgrastim Soln 480Mcg/1.6Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Tbo-Filgrastim Sosy 300Mcg/0.5Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Tbo-Filgrastim Sosy 480Mcg/0.8Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Sargramostim Solr 250Mcg (Generic) |
Hematopoietic Agents |
2 |
Formulary Brand |
$38 |
|
|
Methoxy Polyethylene Glycol-Epoetin Beta Sosy 100Mcg/0.3Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Methoxy Polyethylene Glycol-Epoetin Beta Sosy 150Mcg/0.3Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Methoxy Polyethylene Glycol-Epoetin Beta Sosy 200Mcg/0.3Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Methoxy Polyethylene Glycol-Epoetin Beta Sosy 30Mcg/0.3Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Methoxy Polyethylene Glycol-Epoetin Beta Sosy 50Mcg/0.3Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |