Drug Name |
Drug Strength |
Units in Package |
Tier Level |
Amount Limit |
Days Limit |
Prior Authorization Y/N |
Step Therapy Y/N |
Does the Deduct Apply |
Cost Prefered |
Max Cost Pref |
Cost Non Pref |
Max Cost Non Pref |
Cost Amt Mail |
Max Cost Mail |
Sabril |
500mg |
100 Tablet, Film Coated In 1 Bottle |
5 |
180 |
30 |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Sabril |
50mg/mL |
50 Packet In 1 Carton > 10 Ml In 1 Packet |
4 |
180 |
30 |
Y |
N |
Y |
$90 | None | $95 | None | $90 | None |
Samsca |
15mg |
1 Blister Pack In 1 Carton > 10 Tablet In 1 Blister Pack |
5 |
120 |
30 |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Samsca |
30mg |
1 Blister Pack In 1 Carton > 10 Tablet In 1 Blister Pack |
5 |
60 |
30 |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Sandostatin Lar Depot |
|
1 Kit In 1 Kit * 2.5 Ml In 1 Syringe * .75 Ml In 1 Packet * 5 Ml In 1 Vial, Single-use |
5 |
N |
N |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Sandostatin Lar Depot |
|
1 Kit In 1 Kit * 2.5 Ml In 1 Syringe * .75 Ml In 1 Packet * 5 Ml In 1 Vial, Single-use |
5 |
N |
N |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Sandostatin Lar Depot |
|
1 Kit In 1 Kit * 2.5 Ml In 1 Syringe * .75 Ml In 1 Packet * 5 Ml In 1 Vial, Single-use |
5 |
N |
N |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Saphris |
5mg |
10 Blister Pack In 1 Carton > 10 Tablet In 1 Blister Pack |
4 |
120 |
30 |
N |
N |
Y |
$90 | None | $95 | None | $90 | None |
Saphris |
10mg |
10 Blister Pack In 1 Carton > 10 Tablet In 1 Blister Pack |
4 |
60 |
30 |
N |
N |
Y |
$90 | None | $95 | None | $90 | None |
Savella |
|
1 Blister Pack In 1 Carton > 1 Kit In 1 Blister Pack |
3 |
1 |
365 |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Savella |
100mg |
60 Tablet, Film Coated In 1 Bottle |
3 |
60 |
30 |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Savella |
12.5mg |
60 Tablet, Film Coated In 1 Bottle |
3 |
480 |
30 |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Savella |
25mg |
60 Tablet, Film Coated In 1 Bottle |
3 |
240 |
30 |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Savella |
50mg |
60 Tablet, Film Coated In 1 Bottle |
3 |
120 |
30 |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Selegiline Hydrochloride |
5mg |
60 Capsule In 1 Bottle |
3 |
N |
N |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Selegiline Hydrochloride |
5mg |
500 Tablet In 1 Bottle |
3 |
N |
N |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Selenium Sulfide |
2.5mg/100mL |
118 Ml In 1 Bottle |
2 |
N |
N |
N |
N |
Y |
$15 | None | $20 | None | $15 | None |
Selzentry |
150mg |
60 Tablet, Film Coated In 1 Bottle |
5 |
N |
N |
N |
N |
N |
33% | None | 33% | None | 33% | None |
Selzentry |
300mg |
60 Tablet, Film Coated In 1 Bottle |
5 |
N |
N |
N |
N |
N |
33% | None | 33% | None | 33% | None |
Sensipar |
30mg |
30 Tablet, Coated In 1 Bottle, Plastic |
3 |
60 |
30 |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Sensipar |
60mg |
30 Tablet, Coated In 1 Bottle, Plastic |
5 |
60 |
30 |
N |
N |
N |
33% | None | 33% | None | 33% | None |
Sensipar |
90mg |
30 Tablet, Coated In 1 Bottle, Plastic |
5 |
120 |
30 |
N |
N |
N |
33% | None | 33% | None | 33% | None |
Serevent |
50ug |
60 Powder, Metered In 1 Inhaler |
3 |
60 |
30 |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Seroquel |
50mg |
100 Tablet, Extended Release In 1 Box, Unit-dose |
4 |
480 |
30 |
N |
N |
Y |
$90 | None | $95 | None | $90 | None |
Seroquel |
150mg |
100 Tablet, Extended Release In 1 Dose Pack |
4 |
160 |
30 |
N |
N |
Y |
$90 | None | $95 | None | $90 | None |
Seroquel |
200mg |
10 Blister Pack In 1 Carton > 10 Tablet, Extended Release In 1 Blister Pack |
4 |
120 |
30 |
N |
N |
Y |
$90 | None | $95 | None | $90 | None |
Seroquel |
300mg |
60 Tablet, Extended Release In 1 Bottle |
4 |
80 |
30 |
N |
N |
Y |
$90 | None | $95 | None | $90 | None |
Seroquel |
400mg |
10 Blister Pack In 1 Carton > 10 Tablet, Extended Release In 1 Blister Pack |
5 |
60 |
30 |
N |
N |
N |
33% | None | 33% | None | 33% | None |
Sertraline Hydrochloride |
20mg/mL |
1 Bottle In 1 Carton > 60 Ml In 1 Bottle |
2 |
300 |
30 |
N |
N |
Y |
$15 | None | $20 | None | $15 | None |
Sertraline Hydrochloride |
25mg |
30 Tablet In 1 Bottle |
2 |
240 |
30 |
N |
N |
Y |
$15 | None | $20 | None | $15 | None |
Sertraline Hydrochloride |
50mg |
30 Tablet In 1 Bottle |
1 |
120 |
30 |
N |
N |
N |
$5 | None | $10 | None | $5 | None |
Sertraline Hydrochloride |
100mg |
30 Tablet In 1 Bottle |
2 |
60 |
30 |
N |
N |
Y |
$15 | None | $20 | None | $15 | None |
Sildenafil |
20mg |
90 Tablet, Film Coated In 1 Bottle, Plastic |
5 |
90 |
30 |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Silver Sulfadiazene |
10g/1000g |
50 G In 1 Jar |
2 |
N |
N |
N |
N |
Y |
$15 | None | $20 | None | $15 | None |
Simcor |
500; 20mg/1; mg |
90 Tablet, Film Coated, Extended Release In 1 Bottle |
4 |
30 |
30 |
N |
N |
Y |
$90 | None | $95 | None | $90 | None |
Simcor |
750; 20mg/1; mg |
90 Tablet, Film Coated, Extended Release In 1 Bottle |
4 |
30 |
30 |
N |
N |
Y |
$90 | None | $95 | None | $90 | None |
Simcor |
1000; 20mg/1; mg |
90 Tablet, Film Coated, Extended Release In 1 Bottle |
4 |
60 |
30 |
N |
N |
Y |
$90 | None | $95 | None | $90 | None |
Simcor |
1000; 40mg/1; mg |
90 Tablet, Film Coated, Extended Release In 1 Bottle |
4 |
30 |
30 |
N |
N |
Y |
$90 | None | $95 | None | $90 | None |
Simcor |
500; 40mg/1; mg |
90 Tablet, Film Coated, Extended Release In 1 Bottle |
4 |
30 |
30 |
N |
N |
Y |
$90 | None | $95 | None | $90 | None |
Simponi |
50mg/.5mL |
1 Syringe, Glass In 1 Carton > .5 Ml In 1 Syringe, Glass |
5 |
1 |
28 |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Simponi |
100mg/mL |
1 Syringe, Glass In 1 Carton > 1 Ml In 1 Syringe, Glass |
5 |
1 |
28 |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Simulect |
20mg/5mL |
1 Vial, Single-use In 1 Carton > 5 Ml In 1 Vial, Single-use |
5 |
N |
N |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Simvastatin |
10mg |
30 Tablet, Film Coated In 1 Bottle |
6 |
30 |
30 |
N |
N |
N |
$0 | None | $0 | None | $0 | None |
Simvastatin |
5mg |
90 Tablet, Film Coated In 1 Bottle |
6 |
30 |
30 |
N |
N |
N |
$0 | None | $0 | None | $0 | None |
Simvastatin |
20mg |
500 Tablet, Film Coated In 1 Bottle |
6 |
30 |
30 |
N |
N |
N |
$0 | None | $0 | None | $0 | None |
Simvastatin |
40mg |
500 Tablet, Film Coated In 1 Bottle |
6 |
30 |
30 |
N |
N |
N |
$0 | None | $0 | None | $0 | None |
Simvastatin |
80mg |
1000 Tablet, Film Coated In 1 Bottle |
6 |
30 |
30 |
N |
N |
N |
$0 | None | $0 | None | $0 | None |
Sirolimus |
.5mg |
100 Tablet, Film Coated In 1 Bottle |
3 |
N |
N |
Y |
N |
Y |
$40 | None | $45 | None | $40 | None |
Sodium Chloride |
4.5g/1000mL |
1000 Ml In 1 Bag |
4 |
N |
N |
Y |
N |
Y |
$90 | None | $95 | None | $90 | None |
Sodium Chloride |
9g/1000mL |
4 Bag In 1 Package > 100 Ml In 1 Bag |
4 |
N |
N |
Y |
N |
Y |
$90 | None | $95 | None | $90 | None |
Sodium Chloride |
3g/100mL |
500 Ml In 1 Bag |
4 |
N |
N |
Y |
N |
Y |
$90 | None | $95 | None | $90 | None |
Sodium Chloride |
5g/100mL |
500 Ml In 1 Bag |
4 |
N |
N |
Y |
N |
Y |
$90 | None | $95 | None | $90 | None |
Sodium Chloride |
2.92g/20mL |
25 Vial In 1 Tray > 20 Ml In 1 Vial |
4 |
N |
N |
Y |
N |
Y |
$90 | None | $95 | None | $90 | None |
Sodium Chloride |
900mg/100mL |
9 Bottle, Plastic In 1 Case > 1500 Ml In 1 Bottle, Plastic |
4 |
N |
N |
N |
N |
Y |
$90 | None | $95 | None | $90 | None |
Sodium Lactate |
5.6g/10mL |
25 Vial, Single-dose In 1 Tray > 10 Ml In 1 Vial, Single-dose |
4 |
N |
N |
N |
N |
Y |
$90 | None | $95 | None | $90 | None |
Sodium Phenylbutyrate |
.94g/g |
1 Bottle In 1 Carton > 250 G In 1 Bottle |
5 |
N |
N |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Sodium Polystyrene Sulfonate |
15g/60mL |
473 Ml In 1 Bottle |
3 |
N |
N |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Solaraze |
30mg/g |
1 Tube In 1 Carton > 100 G In 1 Tube |
5 |
100 |
30 |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Soltamox |
10mg/5mL |
1 Bottle In 1 Carton > 150 Ml In 1 Bottle |
4 |
N |
N |
N |
N |
Y |
$90 | None | $95 | None | $90 | None |
Somatuline Depot |
60mg/.2mL |
1 Pouch In 1 Carton > 1 Syringe In 1 Pouch > .2 Ml In 1 Syringe |
5 |
N |
N |
N |
N |
N |
33% | None | 33% | None | 33% | None |
Somatuline Depot |
90mg/.3mL |
1 Pouch In 1 Carton > 1 Syringe In 1 Pouch > .3 Ml In 1 Syringe |
5 |
N |
N |
N |
N |
N |
33% | None | 33% | None | 33% | None |
Somatuline Depot |
120mg/.5mL |
1 Pouch In 1 Carton > 1 Syringe In 1 Pouch > .5 Ml In 1 Syringe |
5 |
N |
N |
N |
N |
N |
33% | None | 33% | None | 33% | None |
Somavert |
|
1 Kit In 1 Package * 1 Ml In 1 Vial, Single-dose |
5 |
N |
N |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Somavert |
|
1 Kit In 1 Package |
5 |
N |
N |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Somavert |
|
1 Kit In 1 Package * 1 Ml In 1 Vial, Single-dose |
5 |
N |
N |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Sorine |
80mg |
100 Blister Pack In 1 Carton |
2 |
N |
N |
N |
N |
Y |
$15 | None | $20 | None | $15 | None |
Sorine |
120mg |
100 Blister Pack In 1 Carton |
2 |
N |
N |
N |
N |
Y |
$15 | None | $20 | None | $15 | None |
Sorine |
160mg |
100 Blister Pack In 1 Carton |
2 |
N |
N |
N |
N |
Y |
$15 | None | $20 | None | $15 | None |
Sorine |
240mg |
100 Blister Pack In 1 Carton |
2 |
N |
N |
N |
N |
Y |
$15 | None | $20 | None | $15 | None |
Sotalol Hydrochloride |
240mg |
100 Tablet In 1 Bottle |
2 |
N |
N |
N |
N |
Y |
$15 | None | $20 | None | $15 | None |
Sotalol Hydrochloride |
160mg |
100 Tablet In 1 Bottle |
2 |
N |
N |
N |
N |
Y |
$15 | None | $20 | None | $15 | None |
Sotalol Hydrochloride |
120mg |
100 Tablet In 1 Bottle, Plastic |
2 |
N |
N |
N |
N |
Y |
$15 | None | $20 | None | $15 | None |
Sotalol Hydrochloride |
80mg |
100 Tablet In 1 Bottle, Plastic |
1 |
N |
N |
N |
N |
N |
$5 | None | $10 | None | $5 | None |
Sovaldi |
400mg |
28 Tablet, Film Coated In 1 Bottle |
5 |
N |
N |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Spiriva |
18ug |
9 Blister Pack In 1 Carton > 10 Capsule In 1 Blister Pack |
3 |
30 |
30 |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Spironolactone |
100mg |
100 Tablet, Film Coated In 1 Bottle, Plastic |
1 |
N |
N |
N |
N |
N |
$5 | None | $10 | None | $5 | None |
Spironolactone |
25mg |
100 Tablet, Film Coated In 1 Bottle, Plastic |
1 |
N |
N |
N |
N |
N |
$5 | None | $10 | None | $5 | None |
Spironolactone |
50mg |
100 Tablet, Film Coated In 1 Bottle, Plastic |
1 |
N |
N |
N |
N |
N |
$5 | None | $10 | None | $5 | None |
Spironolactone And Hydrochlorothiazide |
25; 25mg/1; mg |
500 Tablet In 1 Bottle, Plastic |
1 |
N |
N |
N |
N |
N |
$5 | None | $10 | None | $5 | None |
Sprintec |
|
6 Pouch In 1 Carton > 1 Blister Pack In 1 Pouch > 1 Kit In 1 Blister Pack |
4 |
N |
N |
N |
N |
Y |
$90 | None | $95 | None | $90 | None |
Sprycel |
70mg |
1 Bottle In 1 Carton > 60 Tablet In 1 Bottle |
5 |
N |
N |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Sprycel |
20mg |
1 Bottle In 1 Carton > 60 Tablet In 1 Bottle |
5 |
N |
N |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Sprycel |
50mg |
1 Bottle In 1 Carton > 60 Tablet In 1 Bottle |
5 |
N |
N |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Sprycel |
100mg |
1 Bottle In 1 Carton > 30 Tablet In 1 Bottle |
5 |
N |
N |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Sprycel |
80mg |
1 Bottle In 1 Carton > 30 Tablet In 1 Bottle |
5 |
N |
N |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Sprycel |
140mg |
1 Bottle In 1 Carton > 30 Tablet In 1 Bottle |
5 |
N |
N |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Sronyx |
|
6 Blister Pack In 1 Carton > 1 Kit In 1 Blister Pack |
4 |
N |
N |
N |
N |
Y |
$90 | None | $95 | None | $90 | None |
Ssd Cream |
10g/1000g |
85 G In 1 Tube |
2 |
N |
N |
N |
N |
Y |
$15 | None | $20 | None | $15 | None |
Stavudine |
15mg |
60 Capsule In 1 Bottle, Plastic |
3 |
N |
N |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Stavudine |
20mg |
60 Capsule In 1 Bottle, Plastic |
3 |
N |
N |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Stavudine |
30mg |
60 Capsule In 1 Bottle |
3 |
N |
N |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Stavudine |
40mg |
60 Capsule In 1 Bottle |
3 |
N |
N |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Stavudine |
1mg/mL |
200 Ml In 1 Bottle |
3 |
N |
N |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Sterile Water |
1mL/mL |
16 Container In 1 Case > 1000 Ml In 1 Container |
4 |
N |
N |
Y |
N |
Y |
$90 | None | $95 | None | $90 | None |
Stimate |
1.5mg/mL |
1 Bottle, Spray In 1 Carton > 2.5 Ml In 1 Bottle, Spray |
4 |
N |
N |
N |
N |
Y |
$90 | None | $95 | None | $90 | None |
Stivarga |
40mg |
3 Bottle, Plastic In 1 Box |
5 |
120 |
30 |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Strattera |
10mg |
30 Capsule In 1 Bottle |
4 |
60 |
30 |
Y |
N |
Y |
$90 | None | $95 | None | $90 | None |
Strattera |
25mg |
30 Capsule In 1 Bottle |
4 |
60 |
30 |
Y |
N |
Y |
$90 | None | $95 | None | $90 | None |
Strattera |
40mg |
30 Capsule In 1 Bottle |
4 |
60 |
30 |
Y |
N |
Y |
$90 | None | $95 | None | $90 | None |
Strattera |
18mg |
30 Capsule In 1 Bottle |
4 |
60 |
30 |
Y |
N |
Y |
$90 | None | $95 | None | $90 | None |
Strattera |
60mg |
30 Capsule In 1 Bottle |
4 |
30 |
30 |
Y |
N |
Y |
$90 | None | $95 | None | $90 | None |
Strattera |
80mg |
30 Capsule In 1 Bottle |
4 |
30 |
30 |
Y |
N |
Y |
$90 | None | $95 | None | $90 | None |
Strattera |
100mg |
30 Capsule In 1 Bottle |
4 |
30 |
30 |
Y |
N |
Y |
$90 | None | $95 | None | $90 | None |
Streptomycin |
1g |
10 Vial In 1 Box |
4 |
N |
N |
N |
N |
Y |
$90 | None | $95 | None | $90 | None |
Stribild |
150; 150; 200; 300mg/1; mg/1; mg/1; mg |
30 Tablet, Film Coated In 1 Bottle, Plastic |
5 |
N |
N |
N |
N |
N |
33% | None | 33% | None | 33% | None |
Stromectol |
3mg |
2 Blister Pack In 1 Carton > 10 Tablet In 1 Blister Pack |
3 |
N |
N |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Suboxone |
2; .5mg/1; mg |
30 Pouch In 1 Carton |
4 |
360 |
30 |
Y |
N |
Y |
$90 | None | $95 | None | $90 | None |
Suboxone |
4; 1mg/1; mg |
30 Pouch In 1 Carton |
4 |
180 |
30 |
Y |
N |
Y |
$90 | None | $95 | None | $90 | None |
Suboxone |
8; 2mg/1; mg |
30 Pouch In 1 Carton |
4 |
90 |
30 |
Y |
N |
Y |
$90 | None | $95 | None | $90 | None |
Suboxone |
12; 3mg/1; mg |
30 Pouch In 1 Carton |
4 |
60 |
30 |
Y |
N |
Y |
$90 | None | $95 | None | $90 | None |
Subsys |
.1mg |
10 Blister Pack In 1 Carton > 1 Bottle, Spray In 1 Blister Pack > 1 Spray In 1 Bottle, Spray |
5 |
120 |
30 |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Subsys |
.2mg |
30 Blister Pack In 1 Carton > 1 Bottle, Spray In 1 Blister Pack > 1 Spray In 1 Bottle, Spray |
5 |
120 |
30 |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Subsys |
.4mg |
30 Blister Pack In 1 Carton > 1 Bottle, Spray In 1 Blister Pack > 1 Spray In 1 Bottle, Spray |
5 |
120 |
30 |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Subsys |
.6mg |
30 Blister Pack In 1 Carton > 1 Bottle, Spray In 1 Blister Pack > 1 Spray In 1 Bottle, Spray |
5 |
120 |
30 |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Subsys |
.8mg |
30 Blister Pack In 1 Carton > 1 Bottle, Spray In 1 Blister Pack > 1 Spray In 1 Bottle, Spray |
5 |
120 |
30 |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Sucraid |
8500[iU]/mL |
2 Bottle In 1 Carton |
5 |
N |
N |
N |
N |
N |
33% | None | 33% | None | 33% | None |
Sucralfate |
1g |
500 Tablet In 1 Bottle |
2 |
N |
N |
N |
N |
Y |
$15 | None | $20 | None | $15 | None |
Sulfacetamide Sodium |
100mg/mL |
118 Ml In 1 Bottle |
2 |
N |
N |
N |
N |
Y |
$15 | None | $20 | None | $15 | None |
Sulfacetamide Sodium |
100mg/mL |
1 Bottle, Dropper In 1 Carton > 15 Ml In 1 Bottle, Dropper |
2 |
N |
N |
N |
N |
Y |
$15 | None | $20 | None | $15 | None |
Sulfacetamide Sodium |
100mg/g |
1 Tube In 1 Carton > 3.5 G In 1 Tube |
3 |
N |
N |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Sulfacetamide Sodium And Prednisolone Sodium Phosp |
2.5; 100mg/mL; mg/mL |
10 Ml In 1 Bottle |
1 |
N |
N |
N |
N |
N |
$5 | None | $10 | None | $5 | None |
Sulfadiazine |
500mg |
1000 Tablet In 1 Bottle |
3 |
N |
N |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Sulfamethoxazole And Trimethoprim |
400; 80mg/1; mg |
500 Tablet In 1 Bottle, Plastic |
1 |
N |
N |
N |
N |
N |
$5 | None | $10 | None | $5 | None |
Sulfamethoxazole And Trimethoprim |
80; 16mg/mL; mg/mL |
10 Vial, Multi-dose In 1 Carton |
4 |
N |
N |
Y |
N |
Y |
$90 | None | $95 | None | $90 | None |
Sulfamethoxazole And Trimethoprim |
200; 40mg/5mL; mg/5mL |
473 Ml In 1 Bottle |
2 |
N |
N |
N |
N |
Y |
$15 | None | $20 | None | $15 | None |
Sulfamethoxazole And Trimethoprim |
800; 160mg/1; mg |
100 Tablet In 1 Bottle |
1 |
N |
N |
N |
N |
N |
$5 | None | $10 | None | $5 | None |
Sulfasalazine |
500mg |
500 Tablet In 1 Bottle, Plastic |
2 |
N |
N |
N |
N |
Y |
$15 | None | $20 | None | $15 | None |
Sulfasalazine |
500mg |
300 Tablet, Delayed Release In 1 Bottle, Plastic |
2 |
N |
N |
N |
N |
Y |
$15 | None | $20 | None | $15 | None |
Sulindac |
150mg |
100 Tablet In 1 Bottle, Plastic |
2 |
N |
N |
N |
N |
Y |
$15 | None | $20 | None | $15 | None |
Sulindac |
200mg |
500 Tablet In 1 Bottle, Plastic |
2 |
N |
N |
N |
N |
Y |
$15 | None | $20 | None | $15 | None |
Sumatriptan |
20mg/100uL |
6 Container In 1 Box |
3 |
8 |
30 |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Sumatriptan |
5mg/100uL |
6 Container In 1 Box |
3 |
16 |
30 |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Sumatriptan |
100mg |
1 Blister Pack In 1 Carton > 9 Tablet In 1 Blister Pack |
2 |
9 |
30 |
N |
N |
Y |
$15 | None | $20 | None | $15 | None |
Sumatriptan |
50mg |
1 Blister Pack In 1 Carton > 9 Tablet In 1 Blister Pack |
2 |
9 |
30 |
N |
N |
Y |
$15 | None | $20 | None | $15 | None |
Sumatriptan Succinate |
6mg/.5mL |
2 Syringe In 1 Package > .5 Ml In 1 Syringe |
4 |
4 |
30 |
N |
N |
Y |
$90 | None | $95 | None | $90 | None |
Sumatriptan Succinate |
25mg |
9 Blister Pack In 1 Carton > 9 Tablet In 1 Blister Pack |
2 |
9 |
30 |
N |
N |
Y |
$15 | None | $20 | None | $15 | None |
Sumatriptan Succinate |
6mg/.5mL |
1 Vial, Single-dose In 1 Carton > .5 Ml In 1 Vial, Single-dose |
4 |
4 |
30 |
N |
N |
Y |
$90 | None | $95 | None | $90 | None |
Suprax |
400mg |
50 Tablet In 1 Bottle |
4 |
N |
N |
N |
N |
Y |
$90 | None | $95 | None | $90 | None |
Surmontil |
25mg |
100 Capsule In 1 Bottle |
4 |
N |
N |
Y |
N |
Y |
$90 | None | $95 | None | $90 | None |
Surmontil |
50mg |
100 Capsule In 1 Bottle |
4 |
N |
N |
Y |
N |
Y |
$90 | None | $95 | None | $90 | None |
Surmontil |
100mg |
100 Capsule In 1 Bottle |
4 |
N |
N |
Y |
N |
Y |
$90 | None | $95 | None | $90 | None |
Sustiva |
50mg |
30 Capsule, Gelatin Coated In 1 Bottle |
3 |
N |
N |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Sustiva |
200mg |
90 Capsule, Gelatin Coated In 1 Bottle |
3 |
N |
N |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Sustiva |
600mg |
30 Tablet, Film Coated In 1 Bottle |
3 |
N |
N |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Sutent |
12.5mg |
28 Capsule In 1 Bottle |
5 |
N |
N |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Sutent |
25mg |
28 Capsule In 1 Bottle |
5 |
N |
N |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Sutent |
50mg |
28 Capsule In 1 Bottle |
5 |
N |
N |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Sylatron |
|
1 Kit In 1 Carton |
5 |
N |
N |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Sylatron |
|
1 Kit In 1 Carton |
5 |
N |
N |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Sylatron |
|
1 Kit In 1 Carton |
5 |
N |
N |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Symlinpen |
1000ug/mL |
2 Cartridge In 1 Carton > 1.5 Ml In 1 Cartridge |
4 |
6 |
30 |
Y |
N |
Y |
$90 | None | $95 | None | $90 | None |
Symlinpen |
1000ug/mL |
2 Cartridge In 1 Carton > 2.7 Ml In 1 Cartridge |
5 |
11 |
30 |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Synagis |
50mg/.5mL |
.5 Ml In 1 Vial, Single-dose |
5 |
N |
N |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Synarel |
2mg/mL |
1 Bottle, Spray In 1 Carton > 8 Ml In 1 Bottle, Spray |
5 |
N |
N |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Synercid |
350; 150mg/5mL; mg/5mL |
10 Vial, Glass In 1 Carton |
5 |
N |
N |
N |
N |
N |
33% | None | 33% | None | 33% | None |
Synribo |
3.5mg/mL |
1 Vial, Single-use In 1 Carton > 1 Ml In 1 Vial, Single-use |
5 |
N |
N |
Y |
N |
N |
33% | None | 33% | None | 33% | None |
Synthroid |
137ug |
90 Tablet In 1 Bottle |
3 |
N |
N |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Synthroid |
25ug |
1000 Tablet In 1 Bottle |
3 |
N |
N |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Synthroid |
50ug |
1000 Tablet In 1 Bottle |
3 |
N |
N |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Synthroid |
75ug |
1000 Tablet In 1 Bottle |
3 |
N |
N |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Synthroid |
88ug |
1000 Tablet In 1 Bottle |
3 |
N |
N |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Synthroid |
100ug |
1000 Tablet In 1 Bottle |
3 |
N |
N |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Synthroid |
125ug |
1000 Tablet In 1 Bottle |
3 |
N |
N |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Synthroid |
150ug |
1000 Tablet In 1 Bottle |
3 |
N |
N |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Synthroid |
175ug |
1000 Tablet In 1 Bottle |
3 |
N |
N |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Synthroid |
200ug |
1000 Tablet In 1 Bottle |
3 |
N |
N |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Synthroid |
300ug |
1000 Tablet In 1 Bottle |
3 |
N |
N |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Synthroid |
112ug |
1000 Tablet In 1 Bottle |
3 |
N |
N |
N |
N |
Y |
$40 | None | $45 | None | $40 | None |
Syprine |
250mg |
1 Bottle In 1 Carton > 100 Capsule In 1 Bottle |
5 |
N |
N |
N |
N |
N |
33% | None | 33% | None | 33% | None |