Non-Formulary Brand
Showing all 4 results
NAME | ALSO KNOW AS | DRUG CATEGORY | FORMULARY CATEGORY | WHAT WE COVER | COST SHARE |
---|---|---|---|---|---|
Amphetamine-Dextroamphetamine Tabs (Generic) |
Non-Formulary Brand |
3 |
N/A |
$68 |
|
Amphetamine-Dextroamphetamine Tabs (Generic) |
Non-Formulary Brand |
3 |
N/A |
$68 |
|
Methylphenidate Hcl Tbcr 36Mg (Generic) |
Non-Formulary Brand |
3 |
N/A |
$68 |
|
Selegiline Hcl Caps 5Mg (Generic) |
Non-Formulary Brand |
3 |
Yes |
$68 |