Skin And Mucous Membrane Agents, Miscellaneous
Showing 1–12 of 125 results
NAME | ALSO KNOW AS | DRUG CATEGORY | FORMULARY CATEGORY | WHAT WE COVER | COST SHARE |
|---|---|---|---|---|---|
|
Isotretinoin Caps 10Mg (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Isotretinoin Caps 20Mg (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Isotretinoin Caps 25Mg (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Isotretinoin Caps 30Mg (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Isotretinoin Caps 35Mg (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Isotretinoin Caps 40Mg (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Soriatane Caps 10 Mg (Brand) |
Skin And Mucous Membrane Agents, Miscellaneous |
1 |
Generic |
$14 |
|
|
Soriatane Caps 17.5 Mg (Brand) |
Skin And Mucous Membrane Agents, Miscellaneous |
1 |
Generic |
$14 |
|
|
Soriatane Caps 25 Mg (Brand) |
Skin And Mucous Membrane Agents, Miscellaneous |
1 |
Generic |
$14 |
|
|
Dapsone (Topical) Gel 5% (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Differin Crea 0.1 % (Brand) |
Skin And Mucous Membrane Agents, Miscellaneous |
1 |
Generic |
$14 |
|
|
Differin Gel 0.1 % (Brand) |
Skin And Mucous Membrane Agents, Miscellaneous |
1 |
Generic |
$14 |
|
|
Differin Gel 0.3 % (Brand) |
Skin And Mucous Membrane Agents, Miscellaneous |
1 |
Generic |
$14 |
|
|
No Brand Option Available |
Skin And Mucous Membrane Agents, Miscellaneous |
1 |
Generic |
$14 |
|
|
No Brand Option Available |
Skin And Mucous Membrane Agents, Miscellaneous |
1 |
Generic |
$14 |
|
|
No Brand Option Available |
Skin And Mucous Membrane Agents, Miscellaneous |
1 |
Generic |
$14 |
|
|
Epiduo Forte Gel 0.3-2.5% (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
1 |
Generic |
$14 |
|
|
Epiduo Gel 0.1-2.5 % (Brand) |
Skin And Mucous Membrane Agents, Miscellaneous |
1 |
Generic |
$14 |
|
|
Tralokinumab-ldrm Sosy 150Mg/Ml (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Imiquimod Crea 5% (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Finacea Gel 15 % (Brand) |
Skin And Mucous Membrane Agents, Miscellaneous |
1 |
Generic |
$14 |
|
|
Azelaic Acid (Acne) Crea 20% (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Dovonex Crea 0.005 % (Brand) |
Skin And Mucous Membrane Agents, Miscellaneous |
1 |
Generic |
$14 |
|
|
No Brand Option Available |
Skin And Mucous Membrane Agents, Miscellaneous |
1 |
Generic |
$14 |
|
|
No Brand Option Available |
Skin And Mucous Membrane Agents, Miscellaneous |
1 |
Generic |
$14 |
|
|
Vectical Oint 3 Mcg/Gm (Brand) |
Skin And Mucous Membrane Agents, Miscellaneous |
1 |
Generic |
$14 |
|
|
Fluorouracil (Topical) Crea .5% (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Ziana Gel 1.2-0.025 % (Brand) |
Skin And Mucous Membrane Agents, Miscellaneous |
1 |
Generic |
$14 |
|
|
Podofilox Gel .5% (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Secukinumab Sosy 150Mg/Ml (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Secukinumab Soaj 150Mg/Ml (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Aczone Gel 5 % (Brand) |
Skin And Mucous Membrane Agents, Miscellaneous |
1 |
Generic |
$14 |
|
|
Adapalene Crea .1% (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Adapalene Gel .1% (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
|
Adapalene Gel .3% (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |