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 |
---|---|---|---|---|---|
Ixekizumab Soaj 80Mg/Ml (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Ixekizumab Sosy 80Mg/Ml (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Tazorac Crea 0.1 % (Brand) |
Skin And Mucous Membrane Agents, Miscellaneous |
1 |
Generic |
$14 |
|
Tazarotene Crea .05% (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Tazarotene Crea .1% (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Tazarotene Gel .05% (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Tazarotene Gel .1% (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Fluorouracil (Topical) Crea 4% (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Guselkumab Sopn 100Mg/Ml (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Guselkumab Sosy 100Mg/Ml (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Stelara Soln 130 Mg/26Ml (Brand) |
Skin And Mucous Membrane Agents, Miscellaneous |
MA |
Administered in Medical Office |
N/A |
|
Mechlorethamine Hcl (Topical) Gel .016% (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Calcitriol (Topical) Oint 3Mcg/Gm (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Sinecatechins Oint 15% (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Minocycline Hcl Cp24 135Mg (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Minocycline Hcl Cp24 45Mg (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Minocycline Hcl Cp24 90Mg (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Clindamycin Phosphate-Tretinoin Gel (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Imiquimod Crea 2.5% (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |
|
Imiquimod Crea 3.75% (Generic) |
Skin And Mucous Membrane Agents, Miscellaneous |
3 |
Non-Formulary Brand |
$68 |