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PEEHIP Maintenance Drug List The copays for a 90 day supply are: $12 generic drugs; $80 preferred brand drugs; $120 non-preferred brand drugs PLEASE NOTE: The first fill on new prescriptions for maintenance medications i
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Document Date: 2014-05-08 15:49:40


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Company

EXELON / Diabetic Supplies / ER SA / COGNEX / /

Currency

USD / /

IndustryTerm

retail pharmacy / /

NaturalFeature

MT PANCRECARB MS PENCRELIPASE / /

Organization

FDA / Medicare / /

Person

LA INDERIDE INDOCIN / SR / ROWASA RYTHMOL / SR / BUMEX CALAN / SR / KAY CIEL / /

Product

tamoxifen citrate / potassium chloride / ADALAT CC / FOSAMAX PLUS D / VENTOLIN HFA / ORTHO-EST / THEO-24 / DILACOR XR / tobramycin sulfate / taztia xt / EC-NAPROSYN / klor-con / THEO-DUR / guanabenz acetate / hydra-zide / nitro-bid / ACTOPLUS MET / VOSPIRE ER / COGNEX / ipratropium bromide / PROAIR HFA / calcitonin-salmon / folic acid / cromolyn sodium / K-TAB / valproic acid / cartia XT / bisoprolol fumarate / MICRO-K / afeditab cr / ADVAIR DISKUS / calcium acetate / DILATRATE-SR / benztropine mesylate / terbutaline sulfate / levothyroxine sodium / COGENTIN / DETROL LA / dilt-CD / losartan potassium / nitroglycerin / NITRO-DUR / INNOPRAN XL / LESCOL XL / ISOPTIN SR / FLOVENT HFA / doxazosin mesylate / quinidine sulfate / METADATE CD / COVERA-HS / desmopressin acetate / timolol maleate / /

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