Antithyroid Preps

← Back to Class List

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.

< Return to summary view

NDC Brand Name Generic Name Form Strength PDL
Status
Rebate Current Drug Use Criteria
00832607311 METHIMAZOLE methimazole TABLET 10 mg Y  
23155007101 METHIMAZOLE methimazole TABLET 10 mg Y  
33342033611 METHIMAZOLE methimazole TABLET 10 mg Y  
60687068001 METHIMAZOLE methimazole TABLET 10 mg Y  
60687068011 METHIMAZOLE methimazole TABLET 10 mg Y  
62135020618 METHIMAZOLE methimazole TABLET 10 mg Y  
62135020690 METHIMAZOLE methimazole TABLET 10 mg Y  
64380021301 METHIMAZOLE methimazole TABLET 10 mg Y  
64980026501 METHIMAZOLE methimazole TABLET 10 mg Y  
69452032920 METHIMAZOLE methimazole TABLET 10 mg Y  
72603031601 METHIMAZOLE methimazole TABLET 10 mg Y  
00832607211 METHIMAZOLE methimazole TABLET 5 mg Y  
23155007001 METHIMAZOLE methimazole TABLET 5 mg Y  
33342033511 METHIMAZOLE methimazole TABLET 5 mg Y  
62135020518 METHIMAZOLE methimazole TABLET 5 mg Y  
62135020590 METHIMAZOLE methimazole TABLET 5 mg Y  
64380021201 METHIMAZOLE methimazole TABLET 5 mg Y  
64380021202 METHIMAZOLE methimazole TABLET 5 mg Y  
64980026401 METHIMAZOLE methimazole TABLET 5 mg Y  
69452032820 METHIMAZOLE methimazole TABLET 5 mg Y  
72603031501 METHIMAZOLE methimazole TABLET 5 mg Y  
00228234810 PROPYLTHIOURACIL propylthiouracil TABLET 50 mg Y  
00480924201 PROPYLTHIOURACIL propylthiouracil TABLET 50 mg Y  
33342031411 PROPYLTHIOURACIL propylthiouracil TABLET 50 mg Y  
62135060690 PROPYLTHIOURACIL propylthiouracil TABLET 50 mg Y  
67253065110 PROPYLTHIOURACIL propylthiouracil TABLET 50 mg Y  
67253065111 PROPYLTHIOURACIL propylthiouracil TABLET 50 mg Y  
68084096425 PROPYLTHIOURACIL propylthiouracil TABLET 50 mg Y  
68084096495 PROPYLTHIOURACIL propylthiouracil TABLET 50 mg Y  
70752017110 PROPYLTHIOURACIL propylthiouracil TABLET 50 mg Y