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PDL Status Values

Y = preferred
N = non-preferred. Non-preferred drugs listed as N but without clinical drug use criteria are subject to the Non-Preferred Drugs in Select PDL Classes prior authorization criteria. New drugs will be listed as N until reviewed by the P&T Committee and are subject to the New Drug Policy.
V = voluntary non-preferred. Non-preferred mental health drugs are listed as V and prior authorization is not required.
Null (i.e. blank) = indicates the class or specific drug has not been reviewed for PDL placement.

To request a Prior Authorization, please use this form.

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NDC Brand Name Generic Name Form Strength PDL
Status		 Rebate Carveout
‐ Bill FFS		 Current Drug Use Criteria
61755002101 PRALUENT PEN alirocumab PEN INJCTR 150 mg/mL N Y N Pharmacy PA
61755002102 PRALUENT PEN alirocumab PEN INJCTR 150 mg/mL N Y N Pharmacy PA
61755002000 PRALUENT PEN alirocumab PEN INJCTR 75 mg/mL N Y N Pharmacy PA
61755002001 PRALUENT PEN alirocumab PEN INJCTR 75 mg/mL N Y N Pharmacy PA
61755002002 PRALUENT PEN alirocumab PEN INJCTR 75 mg/mL N Y N Pharmacy PA
72426011803 NEXLETOL bempedoic acid TABLET 180 mg N Y N Pharmacy PA
72426081803 NEXLIZET bempedoic acid/ezetimibe TABLET 180 mg-10 mg N Y N Pharmacy PA
24658027095 CHOLESTYRAMINE LIGHT cholestyramine POWD PACK 4 gram Y Y N  
42806026998 CHOLESTYRAMINE LIGHT cholestyramine POWD PACK 4 gram Y Y N  
42806027095 CHOLESTYRAMINE LIGHT cholestyramine POWD PACK 4 gram Y Y N  
42806027098 CHOLESTYRAMINE LIGHT cholestyramine POWD PACK 4 gram Y Y N  
49884046663 CHOLESTYRAMINE LIGHT cholestyramine POWD PACK 4 gram Y Y N  
49884046665 CHOLESTYRAMINE LIGHT cholestyramine POWD PACK 4 gram Y Y N  
67877042257 CHOLESTYRAMINE LIGHT cholestyramine POWD PACK 4 gram Y Y N  
67877042260 CHOLESTYRAMINE LIGHT cholestyramine POWD PACK 4 gram Y Y N  
68094090620 CHOLESTYRAMINE LIGHT cholestyramine POWD PACK 4 gram Y Y N  
68382052960 CHOLESTYRAMINE LIGHT cholestyramine POWD PACK 4 gram Y Y N  
00245003642 PREVALITE cholestyramine POWD PACK 4 gram Y Y N  
00245003660 PREVALITE cholestyramine POWD PACK 4 gram Y Y N  
00245003689 PREVALITE cholestyramine POWD PACK 4 gram Y Y N  
24658027193 CHOLESTYRAMINE LIGHT cholestyramine POWDER 4 gram Y Y N  
24658027197 CHOLESTYRAMINE LIGHT cholestyramine POWDER 4 gram Y Y N  
42806027193 CHOLESTYRAMINE LIGHT cholestyramine POWDER 4 gram Y Y N  
42806027197 CHOLESTYRAMINE LIGHT cholestyramine POWDER 4 gram Y Y N  
49884046667 CHOLESTYRAMINE LIGHT cholestyramine POWDER 4 gram Y Y N  
62135093754 CHOLESTYRAMINE LIGHT cholestyramine POWDER 4 gram Y Y N  
68094090610 CHOLESTYRAMINE LIGHT cholestyramine POWDER 4 gram Y Y N  
68382052942 CHOLESTYRAMINE LIGHT cholestyramine POWDER 4 gram Y Y N  
00245003623 PREVALITE cholestyramine POWDER 4 gram Y Y N  
49884093767 QUESTRAN LIGHT cholestyramine POWDER 4 gram Y Y N  
24658026695 CHOLESTYRAMINE cholestyramine (with sugar) POWD PACK 4 gram Y Y N  
27241013421 CHOLESTYRAMINE cholestyramine (with sugar) POWD PACK 4 gram Y Y N  
27241013436 CHOLESTYRAMINE cholestyramine (with sugar) POWD PACK 4 gram Y Y N  
42806026695 CHOLESTYRAMINE cholestyramine (with sugar) POWD PACK 4 gram Y Y N  
42806026698 CHOLESTYRAMINE cholestyramine (with sugar) POWD PACK 4 gram Y Y N  
49884046564 CHOLESTYRAMINE cholestyramine (with sugar) POWD PACK 4 gram Y Y N  
49884046565 CHOLESTYRAMINE cholestyramine (with sugar) POWD PACK 4 gram Y Y N  
67877029809 CHOLESTYRAMINE cholestyramine (with sugar) POWD PACK 4 gram Y Y N  
67877029860 CHOLESTYRAMINE cholestyramine (with sugar) POWD PACK 4 gram Y Y N  
68094080620 CHOLESTYRAMINE cholestyramine (with sugar) POWD PACK 4 gram Y Y N  
68382052860 CHOLESTYRAMINE cholestyramine (with sugar) POWD PACK 4 gram Y Y N  
49884093664 QUESTRAN cholestyramine (with sugar) POWD PACK 4 gram Y Y N  
49884093665 QUESTRAN cholestyramine (with sugar) POWD PACK 4 gram Y Y N  
24658026693 CHOLESTYRAMINE cholestyramine (with sugar) POWDER 4 gram Y Y N  
24658026697 CHOLESTYRAMINE cholestyramine (with sugar) POWDER 4 gram Y Y N  
27241013451 CHOLESTYRAMINE cholestyramine (with sugar) POWDER 4 gram Y Y N  
42806026793 CHOLESTYRAMINE cholestyramine (with sugar) POWDER 4 gram Y Y N  
42806026797 CHOLESTYRAMINE cholestyramine (with sugar) POWDER 4 gram Y Y N  
49884046566 CHOLESTYRAMINE cholestyramine (with sugar) POWDER 4 gram Y Y N  
62135000856 CHOLESTYRAMINE cholestyramine (with sugar) POWDER 4 gram Y Y N  
67877029837 CHOLESTYRAMINE cholestyramine (with sugar) POWDER 4 gram Y Y N  
68094080610 CHOLESTYRAMINE cholestyramine (with sugar) POWDER 4 gram Y Y N  
68382052842 CHOLESTYRAMINE cholestyramine (with sugar) POWDER 4 gram Y Y N  
49884093666 QUESTRAN cholestyramine (with sugar) POWDER 4 gram Y Y N  
67877042224 CHOLESTYRAMINE LIGHT cholestyramine/aspartame POWDER 4 gram Y Y N  
00904419160 CHOLINE choline TABLET 650 mg N Y N  
00115186430 COLESEVELAM HCL colesevelam HCl POWD PACK 3.75 gram N Y N  
00713093530 COLESEVELAM HCL colesevelam HCl POWD PACK 3.75 gram N Y N  
51660099530 COLESEVELAM HCL colesevelam HCl POWD PACK 3.75 gram N Y N  
67877052330 COLESEVELAM HCL colesevelam HCl POWD PACK 3.75 gram N Y N  
68462062030 COLESEVELAM HCL colesevelam HCl POWD PACK 3.75 gram N Y N  
00713088030 WELCHOL colesevelam HCl POWD PACK 3.75 gram N Y N  
00115132019 COLESEVELAM HCL colesevelam HCl TABLET 625 mg N Y N  
00713093681 COLESEVELAM HCL colesevelam HCl TABLET 625 mg N Y N  
27808019001 COLESEVELAM HCL colesevelam HCl TABLET 625 mg N Y N  
43598023018 COLESEVELAM HCL colesevelam HCl TABLET 625 mg N Y N  
60687038525 COLESEVELAM HCL colesevelam HCl TABLET 625 mg N Y N  
60687038595 COLESEVELAM HCL colesevelam HCl TABLET 625 mg N Y N  
67877050651 COLESEVELAM HCL colesevelam HCl TABLET 625 mg N Y N  
68462043318 COLESEVELAM HCL colesevelam HCl TABLET 625 mg N Y N  
69452015825 COLESEVELAM HCL colesevelam HCl TABLET 625 mg N Y N  
00713087981 WELCHOL colesevelam HCl TABLET 625 mg N Y N  
00009026002 COLESTID colestipol HCl GRANULES 5 gram N Y N  
00009026017 COLESTID colestipol HCl GRANULES 5 gram N Y N  
59762026003 COLESTIPOL HCL colestipol HCl GRANULES 5 gram N Y N  
59762026001 COLESTIPOL HCL colestipol HCl PACKET 5 gram N Y N  
59762026002 COLESTIPOL HCL colestipol HCl PACKET 5 gram N Y N  
00009045003 COLESTID colestipol HCl TABLET 1 gram N Y N  
00115521116 COLESTIPOL HCL colestipol HCl TABLET 1 gram N Y N  
42799011501 COLESTIPOL HCL colestipol HCl TABLET 1 gram N Y N  
50742028412 COLESTIPOL HCL colestipol HCl TABLET 1 gram N Y N  
59762045001 COLESTIPOL HCL colestipol HCl TABLET 1 gram N Y N  
60687071511 COLESTIPOL HCL colestipol HCl TABLET 1 gram N Y N  
60687071521 COLESTIPOL HCL colestipol HCl TABLET 1 gram N Y N  
62559039512 COLESTIPOL HCL colestipol HCl TABLET 1 gram N Y N  
70710146707 COLESTIPOL HCL colestipol HCl TABLET 1 gram N Y N  
61755001001 EVKEEZA evinacumab-dgnb VIAL 1,200 mg/8 mL (150 mg/mL) N Y N Pharmacy PA
61755001301 EVKEEZA evinacumab-dgnb VIAL 345 mg/2.3 mL (150 mg/mL) N Y N Pharmacy PA
55513076091 REPATHA SURECLICK evolocumab PEN INJCTR 140 mg/mL Y Y N Pharmacy PA
72511039301 REPATHA SURECLICK evolocumab PEN INJCTR 140 mg/mL Y Y N Pharmacy PA
72511039302 REPATHA SURECLICK evolocumab PEN INJCTR 140 mg/mL Y Y N Pharmacy PA
72511076001 REPATHA SURECLICK evolocumab PEN INJCTR 140 mg/mL Y Y N Pharmacy PA
72511076002 REPATHA SURECLICK evolocumab PEN INJCTR 140 mg/mL Y Y N Pharmacy PA
72511050101 REPATHA SYRINGE evolocumab SYRINGE 140 mg/mL Y Y N Pharmacy PA
72511075001 REPATHA SYRINGE evolocumab SYRINGE 140 mg/mL Y Y N Pharmacy PA
55513077091 REPATHA PUSHTRONEX evolocumab WEAR INJCT 420 mg/3.5 mL Y Y N Pharmacy PA
72511077001 REPATHA PUSHTRONEX evolocumab WEAR INJCT 420 mg/3.5 mL Y Y N Pharmacy PA
00591371305 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
00591371319 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
00591371330 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
00904710304 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
00904710310 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
16714081301 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
16714081302 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
16714081303 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
16729043310 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
31722062805 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
31722062830 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
31722062890 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
50228037905 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
50228037930 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
50228037990 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
50268029811 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
50268029812 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
51660020005 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
51660020030 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
51660020090 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
59651005205 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
59651005230 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
59651005290 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
60687037311 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
60687037321 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
67877049005 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
67877049030 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
67877049090 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
68382077305 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
68382077306 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
68382077316 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
68462022605 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
68462022630 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
68462022690 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
69238115403 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
69238115409 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
82009002405 EZETIMIBE ezetimibe TABLET 10 mg Y Y N  
78206017801 ZETIA ezetimibe TABLET 10 mg Y Y N  
62559046190 FENOFIBRATE fenofibrate CAPSULE 150 mg N Y N  
62559030690 LIPOFEN fenofibrate CAPSULE 150 mg N Y N  
62559046090 FENOFIBRATE fenofibrate CAPSULE 50 mg N Y N  
62559030590 LIPOFEN fenofibrate CAPSULE 50 mg N Y N  
00378439177 FENOFIBRATE fenofibrate TABLET 120 mg N Y N  
73352010201 FENOFIBRATE fenofibrate TABLET 120 mg N Y N  
00115552202 FENOFIBRATE fenofibrate TABLET 160 mg Y Y N  
00115552210 FENOFIBRATE fenofibrate TABLET 160 mg Y Y N  
00904753904 FENOFIBRATE fenofibrate TABLET 160 mg Y Y N  
27241011703 FENOFIBRATE fenofibrate TABLET 160 mg Y Y N  
27241011705 FENOFIBRATE fenofibrate TABLET 160 mg Y Y N  
42858066045 FENOFIBRATE fenofibrate TABLET 160 mg Y Y N  
50268031311 FENOFIBRATE fenofibrate TABLET 160 mg Y Y N  
50268031315 FENOFIBRATE fenofibrate TABLET 160 mg Y Y N  
59651057690 FENOFIBRATE fenofibrate TABLET 160 mg Y Y N  
60219552205 FENOFIBRATE fenofibrate TABLET 160 mg Y Y N  
60219552209 FENOFIBRATE fenofibrate TABLET 160 mg Y Y N  
60687086411 FENOFIBRATE fenofibrate TABLET 160 mg Y Y N  
60687086421 FENOFIBRATE fenofibrate TABLET 160 mg Y Y N  
62135083890 FENOFIBRATE fenofibrate TABLET 160 mg Y Y N  
62332055590 FENOFIBRATE fenofibrate TABLET 160 mg Y Y N  
62332055591 FENOFIBRATE fenofibrate TABLET 160 mg Y Y N  
63304090190 FENOFIBRATE fenofibrate TABLET 160 mg Y Y N  
69367025405 FENOFIBRATE fenofibrate TABLET 160 mg Y Y N  
69367025409 FENOFIBRATE fenofibrate TABLET 160 mg Y Y N  
70756021551 FENOFIBRATE fenofibrate TABLET 160 mg Y Y N  
70756021590 FENOFIBRATE fenofibrate TABLET 160 mg Y Y N  
72603084101 FENOFIBRATE fenofibrate TABLET 160 mg Y Y N  
72603084102 FENOFIBRATE fenofibrate TABLET 160 mg Y Y N  
00378439077 FENOFIBRATE fenofibrate TABLET 40 mg N Y N  
73352010101 FENOFIBRATE fenofibrate TABLET 40 mg N Y N  
00115551110 FENOFIBRATE fenofibrate TABLET 54 mg Y Y N  
27241011603 FENOFIBRATE fenofibrate TABLET 54 mg Y Y N  
42858045445 FENOFIBRATE fenofibrate TABLET 54 mg Y Y N  
50268031211 FENOFIBRATE fenofibrate TABLET 54 mg Y Y N  
50268031215 FENOFIBRATE fenofibrate TABLET 54 mg Y Y N  
59651057590 FENOFIBRATE fenofibrate TABLET 54 mg Y Y N  
60219551109 FENOFIBRATE fenofibrate TABLET 54 mg Y Y N  
60687085311 FENOFIBRATE fenofibrate TABLET 54 mg Y Y N  
60687085321 FENOFIBRATE fenofibrate TABLET 54 mg Y Y N  
62135083790 FENOFIBRATE fenofibrate TABLET 54 mg Y Y N  
62332055490 FENOFIBRATE fenofibrate TABLET 54 mg Y Y N  
63304090090 FENOFIBRATE fenofibrate TABLET 54 mg Y Y N  
68180023109 FENOFIBRATE fenofibrate TABLET 54 mg Y Y N  
69367025709 FENOFIBRATE fenofibrate TABLET 54 mg Y Y N  
70756021451 FENOFIBRATE fenofibrate TABLET 54 mg Y Y N  
70756021490 FENOFIBRATE fenofibrate TABLET 54 mg Y Y N  
72603084001 FENOFIBRATE fenofibrate TABLET 54 mg Y Y N  
00378306605 FENOFIBRATE fenofibrate nanocrystallized TABLET 145 mg Y Y N  
00378306677 FENOFIBRATE fenofibrate nanocrystallized TABLET 145 mg Y Y N  
00904716104 FENOFIBRATE fenofibrate nanocrystallized TABLET 145 mg Y Y N  
00904716161 FENOFIBRATE fenofibrate nanocrystallized TABLET 145 mg Y Y N  
00904748004 FENOFIBRATE fenofibrate nanocrystallized TABLET 145 mg Y Y N  
00904748061 FENOFIBRATE fenofibrate nanocrystallized TABLET 145 mg Y Y N  
31722059690 FENOFIBRATE fenofibrate nanocrystallized TABLET 145 mg Y Y N  
43547043109 FENOFIBRATE fenofibrate nanocrystallized TABLET 145 mg Y Y N  
51079060801 FENOFIBRATE fenofibrate nanocrystallized TABLET 145 mg Y Y N  
51079060820 FENOFIBRATE fenofibrate nanocrystallized TABLET 145 mg Y Y N  
60687062901 FENOFIBRATE fenofibrate nanocrystallized TABLET 145 mg Y Y N  
60687062911 FENOFIBRATE fenofibrate nanocrystallized TABLET 145 mg Y Y N  
60687062921 FENOFIBRATE fenofibrate nanocrystallized TABLET 145 mg Y Y N  
62332036171 FENOFIBRATE fenofibrate nanocrystallized TABLET 145 mg Y Y N  
62332036190 FENOFIBRATE fenofibrate nanocrystallized TABLET 145 mg Y Y N  
63304044905 FENOFIBRATE fenofibrate nanocrystallized TABLET 145 mg Y Y N  
63304044990 FENOFIBRATE fenofibrate nanocrystallized TABLET 145 mg Y Y N  
65862076990 FENOFIBRATE fenofibrate nanocrystallized TABLET 145 mg Y Y N  
68180038902 FENOFIBRATE fenofibrate nanocrystallized TABLET 145 mg Y Y N  
68180038909 FENOFIBRATE fenofibrate nanocrystallized TABLET 145 mg Y Y N  
69097045805 FENOFIBRATE fenofibrate nanocrystallized TABLET 145 mg Y Y N  
82009006090 FENOFIBRATE fenofibrate nanocrystallized TABLET 145 mg Y Y N  
00074318990 TRICOR fenofibrate nanocrystallized TABLET 145 mg Y Y N  
00378306577 FENOFIBRATE fenofibrate nanocrystallized TABLET 48 mg Y Y N  
31722059590 FENOFIBRATE fenofibrate nanocrystallized TABLET 48 mg Y Y N  
43547043009 FENOFIBRATE fenofibrate nanocrystallized TABLET 48 mg Y Y N  
50268033811 FENOFIBRATE fenofibrate nanocrystallized TABLET 48 mg Y Y N  
50268033812 FENOFIBRATE fenofibrate nanocrystallized TABLET 48 mg Y Y N  
51079059901 FENOFIBRATE fenofibrate nanocrystallized TABLET 48 mg Y Y N  
51079059920 FENOFIBRATE fenofibrate nanocrystallized TABLET 48 mg Y Y N  
60687061811 FENOFIBRATE fenofibrate nanocrystallized TABLET 48 mg Y Y N  
60687061821 FENOFIBRATE fenofibrate nanocrystallized TABLET 48 mg Y Y N  
62332036071 FENOFIBRATE fenofibrate nanocrystallized TABLET 48 mg Y Y N  
62332036090 FENOFIBRATE fenofibrate nanocrystallized TABLET 48 mg Y Y N  
63304044805 FENOFIBRATE fenofibrate nanocrystallized TABLET 48 mg Y Y N  
63304044890 FENOFIBRATE fenofibrate nanocrystallized TABLET 48 mg Y Y N  
65862076890 FENOFIBRATE fenofibrate nanocrystallized TABLET 48 mg Y Y N  
68180038809 FENOFIBRATE fenofibrate nanocrystallized TABLET 48 mg Y Y N  
69097045905 FENOFIBRATE fenofibrate nanocrystallized TABLET 48 mg Y Y N  
00074317390 TRICOR fenofibrate nanocrystallized TABLET 48 mg Y Y N  
60505312103 FENOFIBRATE fenofibrate,micronized CAPSULE 130 mg Y Y N  
60505312109 FENOFIBRATE fenofibrate,micronized CAPSULE 130 mg Y Y N  
63304044430 FENOFIBRATE fenofibrate,micronized CAPSULE 130 mg Y Y N  
63304044490 FENOFIBRATE fenofibrate,micronized CAPSULE 130 mg Y Y N  
68180013106 FENOFIBRATE fenofibrate,micronized CAPSULE 130 mg Y Y N  
13668043901 FENOFIBRATE fenofibrate,micronized CAPSULE 134 mg Y Y N  
27241011904 FENOFIBRATE fenofibrate,micronized CAPSULE 134 mg Y Y N  
42858013401 FENOFIBRATE fenofibrate,micronized CAPSULE 134 mg Y Y N  
43975030510 FENOFIBRATE fenofibrate,micronized CAPSULE 134 mg Y Y N  
59651020201 FENOFIBRATE fenofibrate,micronized CAPSULE 134 mg Y Y N  
62135089490 FENOFIBRATE fenofibrate,micronized CAPSULE 134 mg Y Y N  
62332008531 FENOFIBRATE fenofibrate,micronized CAPSULE 134 mg Y Y N  
68462058101 FENOFIBRATE fenofibrate,micronized CAPSULE 134 mg Y Y N  
13668043801 FENOFIBRATE fenofibrate,micronized CAPSULE 200 mg Y Y N  
27241012004 FENOFIBRATE fenofibrate,micronized CAPSULE 200 mg Y Y N  
42858020001 FENOFIBRATE fenofibrate,micronized CAPSULE 200 mg Y Y N  
43975030610 FENOFIBRATE fenofibrate,micronized CAPSULE 200 mg Y Y N  
59651020301 FENOFIBRATE fenofibrate,micronized CAPSULE 200 mg Y Y N  
60687071311 FENOFIBRATE fenofibrate,micronized CAPSULE 200 mg Y Y N  
60687071321 FENOFIBRATE fenofibrate,micronized CAPSULE 200 mg Y Y N  
62135089990 FENOFIBRATE fenofibrate,micronized CAPSULE 200 mg Y Y N  
62332008631 FENOFIBRATE fenofibrate,micronized CAPSULE 200 mg Y Y N  
68462058201 FENOFIBRATE fenofibrate,micronized CAPSULE 200 mg Y Y N  
60505312003 FENOFIBRATE fenofibrate,micronized CAPSULE 43 mg Y Y N  
63304044330 FENOFIBRATE fenofibrate,micronized CAPSULE 43 mg Y Y N  
68180013006 FENOFIBRATE fenofibrate,micronized CAPSULE 43 mg Y Y N  
13668044001 FENOFIBRATE fenofibrate,micronized CAPSULE 67 mg Y Y N  
27241011804 FENOFIBRATE fenofibrate,micronized CAPSULE 67 mg Y Y N  
42858006701 FENOFIBRATE fenofibrate,micronized CAPSULE 67 mg Y Y N  
43975044410 FENOFIBRATE fenofibrate,micronized CAPSULE 67 mg Y Y N  
59651020101 FENOFIBRATE fenofibrate,micronized CAPSULE 67 mg Y Y N  
62135089390 FENOFIBRATE fenofibrate,micronized CAPSULE 67 mg Y Y N  
62332008431 FENOFIBRATE fenofibrate,micronized CAPSULE 67 mg Y Y N  
68462058001 FENOFIBRATE fenofibrate,micronized CAPSULE 67 mg Y Y N  
00115132510 FENOFIBRIC ACID fenofibric acid (choline) CAPSULE DR 135 mg Y Y N  
00115155510 FENOFIBRIC ACID fenofibric acid (choline) CAPSULE DR 135 mg Y Y N  
42385094590 FENOFIBRIC ACID fenofibric acid (choline) CAPSULE DR 135 mg Y Y N  
42571034890 FENOFIBRIC ACID fenofibric acid (choline) CAPSULE DR 135 mg Y Y N  
59651021790 FENOFIBRIC ACID fenofibric acid (choline) CAPSULE DR 135 mg Y Y N  
62332024590 FENOFIBRIC ACID fenofibric acid (choline) CAPSULE DR 135 mg Y Y N  
69315028209 FENOFIBRIC ACID fenofibric acid (choline) CAPSULE DR 135 mg Y Y N  
00115155410 FENOFIBRIC ACID fenofibric acid (choline) CAPSULE DR 45 mg Y Y N  
42385094490 FENOFIBRIC ACID fenofibric acid (choline) CAPSULE DR 45 mg Y Y N  
42571034790 FENOFIBRIC ACID fenofibric acid (choline) CAPSULE DR 45 mg Y Y N  
59651021690 FENOFIBRIC ACID fenofibric acid (choline) CAPSULE DR 45 mg Y Y N  
62332024490 FENOFIBRIC ACID fenofibric acid (choline) CAPSULE DR 45 mg Y Y N  
69315028109 FENOFIBRIC ACID fenofibric acid (choline) CAPSULE DR 45 mg Y Y N  
16571078406 GEMFIBROZIL gemfibrozil TABLET 600 mg N Y N  
16571078450 GEMFIBROZIL gemfibrozil TABLET 600 mg N Y N  
16714010102 GEMFIBROZIL gemfibrozil TABLET 600 mg N Y N  
16714010105 GEMFIBROZIL gemfibrozil TABLET 600 mg N Y N  
24658026005 GEMFIBROZIL gemfibrozil TABLET 600 mg N Y N  
24658026018 GEMFIBROZIL gemfibrozil TABLET 600 mg N Y N  
24658026060 GEMFIBROZIL gemfibrozil TABLET 600 mg N Y N  
31722012805 GEMFIBROZIL gemfibrozil TABLET 600 mg N Y N  
31722012860 GEMFIBROZIL gemfibrozil TABLET 600 mg N Y N  
42806026005 GEMFIBROZIL gemfibrozil TABLET 600 mg N Y N  
42806026060 GEMFIBROZIL gemfibrozil TABLET 600 mg N Y N  
50268035011 GEMFIBROZIL gemfibrozil TABLET 600 mg N Y N  
50268035015 GEMFIBROZIL gemfibrozil TABLET 600 mg N Y N  
60687022401 GEMFIBROZIL gemfibrozil TABLET 600 mg N Y N  
60687022411 GEMFIBROZIL gemfibrozil TABLET 600 mg N Y N  
62135016060 GEMFIBROZIL gemfibrozil TABLET 600 mg N Y N  
65862062405 GEMFIBROZIL gemfibrozil TABLET 600 mg N Y N  
65862062460 GEMFIBROZIL gemfibrozil TABLET 600 mg N Y N  
69097082103 GEMFIBROZIL gemfibrozil TABLET 600 mg N Y N  
69097082112 GEMFIBROZIL gemfibrozil TABLET 600 mg N Y N  
72603020601 GEMFIBROZIL gemfibrozil TABLET 600 mg N Y N  
72603020602 GEMFIBROZIL gemfibrozil TABLET 600 mg N Y N  
76282022505 GEMFIBROZIL gemfibrozil TABLET 600 mg N Y N  
76282022518 GEMFIBROZIL gemfibrozil TABLET 600 mg N Y N  
76282022560 GEMFIBROZIL gemfibrozil TABLET 600 mg N Y N  
00071073720 LOPID gemfibrozil TABLET 600 mg N Y N  
00071073730 LOPID gemfibrozil TABLET 600 mg N Y N  
00054062127 ICOSAPENT ETHYL icosapent ethyl CAPSULE 0.5 gram N Y N Pharmacy PA
00480012649 ICOSAPENT ETHYL icosapent ethyl CAPSULE 0.5 gram N Y N Pharmacy PA
31722029824 ICOSAPENT ETHYL icosapent ethyl CAPSULE 0.5 gram N Y N Pharmacy PA
43598074672 ICOSAPENT ETHYL icosapent ethyl CAPSULE 0.5 gram N Y N Pharmacy PA
69238259707 ICOSAPENT ETHYL icosapent ethyl CAPSULE 0.5 gram N Y N Pharmacy PA
70710173804 ICOSAPENT ETHYL icosapent ethyl CAPSULE 0.5 gram N Y N Pharmacy PA
00054050823 ICOSAPENT ETHYL icosapent ethyl CAPSULE 1 gram N Y N Pharmacy PA
00480012789 ICOSAPENT ETHYL icosapent ethyl CAPSULE 1 gram N Y N Pharmacy PA
16714063601 ICOSAPENT ETHYL icosapent ethyl CAPSULE 1 gram N Y N Pharmacy PA
31722029912 ICOSAPENT ETHYL icosapent ethyl CAPSULE 1 gram N Y N Pharmacy PA
42806056012 ICOSAPENT ETHYL icosapent ethyl CAPSULE 1 gram N Y N Pharmacy PA
43598026704 ICOSAPENT ETHYL icosapent ethyl CAPSULE 1 gram N Y N Pharmacy PA
60505403301 ICOSAPENT ETHYL icosapent ethyl CAPSULE 1 gram N Y N Pharmacy PA
60687076411 ICOSAPENT ETHYL icosapent ethyl CAPSULE 1 gram N Y N Pharmacy PA
60687076421 ICOSAPENT ETHYL icosapent ethyl CAPSULE 1 gram N Y N Pharmacy PA
69238259808 ICOSAPENT ETHYL icosapent ethyl CAPSULE 1 gram N Y N Pharmacy PA
70710159207 ICOSAPENT ETHYL icosapent ethyl CAPSULE 1 gram N Y N Pharmacy PA
72603012901 ICOSAPENT ETHYL icosapent ethyl CAPSULE 1 gram N Y N Pharmacy PA
00078100060 LEQVIO inclisiran sodium SYRINGE 284 mg/1.5 mL N Y N Pharmacy PA
00078100098 LEQVIO inclisiran sodium SYRINGE 284 mg/1.5 mL N Y N Pharmacy PA
00904419860 INOSITOL inositol TABLET N Y N Pharmacy PA
10122041028 JUXTAPID lomitapide mesylate CAPSULE 10 mg N Y N  
10122042028 JUXTAPID lomitapide mesylate CAPSULE 20 mg N Y N  
76431012001 JUXTAPID lomitapide mesylate CAPSULE 20 mg N Y N  
10122043028 JUXTAPID lomitapide mesylate CAPSULE 30 mg N Y N  
10122040528 JUXTAPID lomitapide mesylate CAPSULE 5 mg N Y N  
00904063360 NIACIN niacin CAPSULE ER 125 mg N Y N  
50111019401 NIACIN niacin CAPSULE ER 125 mg N Y N  
50111019403 NIACIN niacin CAPSULE ER 125 mg N Y N  
50111019601 NIACIN niacin CAPSULE ER 125 mg N Y N  
50111019603 NIACIN niacin CAPSULE ER 125 mg N Y N  
00904062970 NIACIN niacin CAPSULE ER 250 mg N Y N  
00904062980 NIACIN niacin CAPSULE ER 250 mg N Y N  
50111019901 NIACIN niacin CAPSULE ER 250 mg N Y N  
50111019903 NIACIN niacin CAPSULE ER 250 mg N Y N  
00904063060 NIACIN niacin CAPSULE ER 400 mg N Y N  
50111020201 NIACIN niacin CAPSULE ER 400 mg N Y N  
00904063180 NIACIN niacin CAPSULE ER 500 mg N Y N  
49483001801 NIACIN niacin CAPSULE ER 500 mg N Y N  
00093739486 NIACIN ER niacin TAB ER 24H 1,000 mg N Y N  
00093739498 NIACIN ER niacin TAB ER 24H 1,000 mg N Y N  
33342018910 NIACIN ER niacin TAB ER 24H 1,000 mg N Y N  
47335061381 NIACIN ER niacin TAB ER 24H 1,000 mg N Y N  
59651002018 NIACIN ER niacin TAB ER 24H 1,000 mg N Y N  
59651002090 NIACIN ER niacin TAB ER 24H 1,000 mg N Y N  
62135049890 NIACIN ER niacin TAB ER 24H 1,000 mg N Y N  
62175032246 NIACIN ER niacin TAB ER 24H 1,000 mg N Y N  
65162032309 NIACIN ER niacin TAB ER 24H 1,000 mg N Y N  
00093739286 NIACIN ER niacin TAB ER 24H 500 mg N Y N  
33342018710 NIACIN ER niacin TAB ER 24H 500 mg N Y N  
47335053981 NIACIN ER niacin TAB ER 24H 500 mg N Y N  
50268058411 NIACIN ER niacin TAB ER 24H 500 mg N Y N  
50268058413 NIACIN ER niacin TAB ER 24H 500 mg N Y N  
59651001818 NIACIN ER niacin TAB ER 24H 500 mg N Y N  
59651001890 NIACIN ER niacin TAB ER 24H 500 mg N Y N  
62135049790 NIACIN ER niacin TAB ER 24H 500 mg N Y N  
62175032046 NIACIN ER niacin TAB ER 24H 500 mg N Y N  
65162032109 NIACIN ER niacin TAB ER 24H 500 mg N Y N  
00093739386 NIACIN ER niacin TAB ER 24H 750 mg N Y N  
00093739398 NIACIN ER niacin TAB ER 24H 750 mg N Y N  
47335061481 NIACIN ER niacin TAB ER 24H 750 mg N Y N  
59651001918 NIACIN ER niacin TAB ER 24H 750 mg N Y N  
59651001990 NIACIN ER niacin TAB ER 24H 750 mg N Y N  
50268058211 NIACIN niacin TABLET 100 mg N Y N  
50268058215 NIACIN niacin TABLET 100 mg N Y N  
00904227080 NIACIN niacin TABLET 50 mg N Y N  
00904227260 NIACIN niacin TABLET 500 mg N Y N  
71269025010 SLO-NIACIN niacin TABLET ER 250 mg N Y N  
50268058311 NIACIN niacin TABLET ER 500 mg N Y N  
50268058315 NIACIN niacin TABLET ER 500 mg N Y N  
64980010301 NIADELAY niacin TABLET ER 500 mg N Y N  
71269050010 SLO-NIACIN niacin TABLET ER 500 mg N Y N  
71269050099 SLO-NIACIN niacin TABLET ER 500 mg N Y N  
00904434760 NIACIN niacin TABLET ER 750 mg N Y N  
71269075010 SLO-NIACIN niacin TABLET ER 750 mg N Y N  
00904420160 NIACINAMIDE niacinamide TABLET 100 mg N Y N  
83035185601 VITAMIN B3 niacinamide TABLET 250 mg Y N  
83035185401 VITAMIN B3 niacinamide TABLET 50 mg Y N  
83035185701 VITAMIN B3 niacinamide TABLET 500 mg N Y N  
71860010101 TRYNGOLZA olezarsen sodium AUTO INJCT 80 mg/0.8 mL Y N Pharmacy PA
00904749506 OMEGA-3 ACID ETHYL ESTERS omega-3 acid ethyl esters CAPSULE 1 gram Y Y N Pharmacy PA
24658035012 OMEGA-3 ACID ETHYL ESTERS omega-3 acid ethyl esters CAPSULE 1 gram Y Y N Pharmacy PA
31722093612 OMEGA-3 ACID ETHYL ESTERS omega-3 acid ethyl esters CAPSULE 1 gram Y Y N Pharmacy PA
42806055212 OMEGA-3 ACID ETHYL ESTERS omega-3 acid ethyl esters CAPSULE 1 gram Y Y N Pharmacy PA
60687084611 OMEGA-3 ACID ETHYL ESTERS omega-3 acid ethyl esters CAPSULE 1 gram Y Y N Pharmacy PA
60687084665 OMEGA-3 ACID ETHYL ESTERS omega-3 acid ethyl esters CAPSULE 1 gram Y Y N Pharmacy PA
62135078012 OMEGA-3 ACID ETHYL ESTERS omega-3 acid ethyl esters CAPSULE 1 gram Y Y N Pharmacy PA
64380076111 OMEGA-3 ACID ETHYL ESTERS omega-3 acid ethyl esters CAPSULE 1 gram Y Y N Pharmacy PA
65162003416 OMEGA-3 ACID ETHYL ESTERS omega-3 acid ethyl esters CAPSULE 1 gram Y Y N Pharmacy PA
69452017522 OMEGA-3 ACID ETHYL ESTERS omega-3 acid ethyl esters CAPSULE 1 gram Y Y N Pharmacy PA
70756042322 OMEGA-3 ACID ETHYL ESTERS omega-3 acid ethyl esters CAPSULE 1 gram Y Y N Pharmacy PA
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