Hematopoietic Agents
Showing 1–12 of 72 results
NAME | ALSO KNOW AS | DRUG CATEGORY | FORMULARY CATEGORY | WHAT WE COVER | COST SHARE |
|---|---|---|---|---|---|
|
Methoxy Polyethylene Glycol-Epoetin Beta Sosy 75Mcg/0.3Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Lusutrombopag Tabs 3Mg (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Pegfilgrastim Pskt 6Mg/0.6Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Pegfilgrastim Sosy 6Mg/0.6Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Filgrastim Sosy 300Mcg/0.5Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Filgrastim Sosy 480Mcg/0.8Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Filgrastim-Aafi Soln 300Mcg/Ml (Generic) |
Hematopoietic Agents |
2 |
Formulary Brand |
$38 |
|
|
Filgrastim-Aafi Soln 480Mcg/0.8Ml (Generic) |
Hematopoietic Agents |
2 |
Formulary Brand |
$38 |
|
|
Filgrastim-Aafi Sosy 300Mcg/0.5Ml (Generic) |
Hematopoietic Agents |
2 |
Formulary Brand |
$38 |
|
|
Filgrastim-Aafi Sosy 480Mcg/0.8Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Romiplostim Solr 125Mcg (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Romiplostim Solr 250Mcg (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Romiplostim Solr 500Mcg (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Epoetin Alfa Soln 10000Unit/Ml (Generic) |
Hematopoietic Agents |
2 |
Formulary Brand |
$38 |
|
|
Epoetin Alfa Soln 2000Unit/Ml (Generic) |
Hematopoietic Agents |
2 |
Non-Formulary Brand |
$68 |
|
|
Epoetin Alfa Soln 20000Unit/Ml (Generic) |
Hematopoietic Agents |
2 |
Non-Formulary Brand |
$68 |
|
|
Epoetin Alfa Soln 3000Unit/Ml (Generic) |
Hematopoietic Agents |
2 |
Non-Formulary Brand |
$68 |
|
|
Epoetin Alfa Soln 4000Unit/Ml (Generic) |
Hematopoietic Agents |
2 |
Non-Formulary Brand |
$68 |
|
|
Epoetin Alfa Soln 40000Unit/Ml (Generic) |
Hematopoietic Agents |
2 |
Formulary Brand |
$38 |
|
|
Eltrombopag Olamine Pack 12.5Mg (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Eltrombopag Olamine Tabs 12.5Mg (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Eltrombopag Olamine Tabs 25Mg (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Eltrombopag Olamine Tabs 50Mg (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Eltrombopag Olamine Tabs 75Mg (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Luspatercept-Aamt Solr 25Mg (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Luspatercept-Aamt Solr 75Mg (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Epoetin Alfa-Epbx Soln 10000Unit/Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Epoetin Alfa-Epbx Soln 2000Unit/Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Epoetin Alfa-Epbx Soln 3000Unit/Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Epoetin Alfa-Epbx Soln 4000Unit/Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Epoetin Alfa-Epbx Soln 40000Unit/Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Fostamatinib Disodium Tabs 100Mg (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Fostamatinib Disodium Tabs 150Mg (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Pegfilgrastim-Cbqv Sosy 6Mg/0.6Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |
|
|
Filgrastim-Sndz Sosy 300Mcg/0.5Ml (Generic) |
Hematopoietic Agents |
3 |
Non-Formulary Brand |
$68 |