Other Hormones

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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
00009043601 R-GENE 10 arginine HCl IV SOLN 10 % Y N  
00093542088 CABERGOLINE cabergoline TABLET 0.5 mg Y N  
23155082373 CABERGOLINE cabergoline TABLET 0.5 mg Y N  
50742011808 CABERGOLINE cabergoline TABLET 0.5 mg Y N  
59762010001 CABERGOLINE cabergoline TABLET 0.5 mg Y N  
59762100501 CABERGOLINE cabergoline TABLET 0.5 mg Y N  
69238269301 CABERGOLINE cabergoline TABLET 0.5 mg Y N  
70069082408 CABERGOLINE cabergoline TABLET 0.5 mg Y N  
70512086008 CABERGOLINE cabergoline TABLET 0.5 mg Y N  
00480358301 CETRORELIX ACETATE cetrorelix acetate KIT 0.25 mg Y N  
00480579508 CETRORELIX ACETATE cetrorelix acetate KIT 0.25 mg Y N  
60505627001 CETRORELIX ACETATE cetrorelix acetate KIT 0.25 mg Y N  
60505628100 CETRORELIX ACETATE cetrorelix acetate KIT 0.25 mg Y N  
65219029002 CETRORELIX ACETATE cetrorelix acetate KIT 0.25 mg Y N  
65219029277 CETRORELIX ACETATE cetrorelix acetate KIT 0.25 mg Y N  
71288055602 CETRORELIX ACETATE cetrorelix acetate KIT 0.25 mg Y N  
71288055890 CETRORELIX ACETATE cetrorelix acetate KIT 0.25 mg Y N  
44087122501 CETROTIDE cetrorelix acetate KIT 0.25 mg Y N  
44087115001 OVIDREL choriogonadotropin alfa SYRINGE 250 mcg/0.5 mL Y N  
63323003011 CHORIONIC GONADOTROPIN chorionic gonadotropin, human VIAL 10,000 unit Y N  
78206015001 PREGNYL chorionic gonadotropin, human VIAL 10,000 unit Y N  
78206015099 PREGNYL chorionic gonadotropin, human VIAL 10,000 unit Y N  
55566150201 NOVAREL chorionic gonadotropin, human VIAL 5,000 unit Y N  
00713088506 CLOMID clomiphene citrate TABLET 50 mg Y N Pharmacy PA
00713088509 CLOMID clomiphene citrate TABLET 50 mg Y N Pharmacy PA
00713088530 CLOMID clomiphene citrate TABLET 50 mg Y N Pharmacy PA
00254252002 CLOMIPHENE CITRATE clomiphene citrate TABLET 50 mg Y N Pharmacy PA
00254252019 CLOMIPHENE CITRATE clomiphene citrate TABLET 50 mg Y N Pharmacy PA
49884070152 CLOMIPHENE CITRATE clomiphene citrate TABLET 50 mg Y N Pharmacy PA
62584022410 CLOMIPHENE CITRATE clomiphene citrate TABLET 50 mg Y N Pharmacy PA
64980069001 CLOMIPHENE CITRATE clomiphene citrate TABLET 50 mg Y N Pharmacy PA
64980069003 CLOMIPHENE CITRATE clomiphene citrate TABLET 50 mg Y N Pharmacy PA
72888021308 CLOMIPHENE CITRATE clomiphene citrate TABLET 50 mg Y N Pharmacy PA
72888021358 CLOMIPHENE CITRATE clomiphene citrate TABLET 50 mg Y N Pharmacy PA
35573047030 MILOPHENE clomiphene citrate TABLET 50 mg Y N Pharmacy PA
00527136801 DANAZOL danazol CAPSULE 100 mg Y N  
00555063402 DANAZOL danazol CAPSULE 100 mg Y N  
62135047660 DANAZOL danazol CAPSULE 100 mg Y N  
00527136901 DANAZOL danazol CAPSULE 200 mg Y N  
00527136906 DANAZOL danazol CAPSULE 200 mg Y N  
00555063502 DANAZOL danazol CAPSULE 200 mg Y N  
00555063509 DANAZOL danazol CAPSULE 200 mg Y N  
62135047760 DANAZOL danazol CAPSULE 200 mg Y N  
00527139201 DANAZOL danazol CAPSULE 50 mg Y N  
00555063302 DANAZOL danazol CAPSULE 50 mg Y N  
62135047560 DANAZOL danazol CAPSULE 50 mg Y N  
47335078891 DESMOPRESSIN ACETATE desmopressin (nonrefrigerated) SPRAY/PUMP 10 mcg/spray (0.1 mL) Y N  
60505081500 DESMOPRESSIN ACETATE desmopressin (nonrefrigerated) SPRAY/PUMP 10 mcg/spray (0.1 mL) Y N  
00075094502 DDAVP desmopressin acetate AMPUL 15 mcg/mL Y N  
55566220000 DDAVP desmopressin acetate AMPUL 4 mcg/mL Y N  
43598093109 DESMOPRESSIN ACETATE desmopressin acetate AMPUL 4 mcg/mL Y N  
43598093111 DESMOPRESSIN ACETATE desmopressin acetate AMPUL 4 mcg/mL Y N  
69918089901 DESMOPRESSIN ACETATE desmopressin acetate AMPUL 4 mcg/mL Y N  
69918089902 DESMOPRESSIN ACETATE desmopressin acetate AMPUL 4 mcg/mL Y N  
69918089910 DESMOPRESSIN ACETATE desmopressin acetate AMPUL 4 mcg/mL Y N  
69918089911 DESMOPRESSIN ACETATE desmopressin acetate AMPUL 4 mcg/mL Y N  
24208034205 DESMOPRESSIN ACETATE desmopressin acetate SPRAY/PUMP 10 mcg/spray (0.1 mL) Y N  
62756016191 DESMOPRESSIN ACETATE desmopressin acetate SPRAY/PUMP 10 mcg/spray (0.1 mL) Y N  
54436032510 NOCDURNA desmopressin acetate TAB RAPDIS 27.7 mcg Y N  
54436035010 NOCDURNA desmopressin acetate TAB RAPDIS 55.3 mcg Y N  
55566260000 DDAVP desmopressin acetate TABLET 0.1 mg Y N  
23155048901 DESMOPRESSIN ACETATE desmopressin acetate TABLET 0.1 mg Y N  
59651024901 DESMOPRESSIN ACETATE desmopressin acetate TABLET 0.1 mg Y N  
60505025701 DESMOPRESSIN ACETATE desmopressin acetate TABLET 0.1 mg Y N  
60687072111 DESMOPRESSIN ACETATE desmopressin acetate TABLET 0.1 mg Y N  
60687072121 DESMOPRESSIN ACETATE desmopressin acetate TABLET 0.1 mg Y N  
68001057400 DESMOPRESSIN ACETATE desmopressin acetate TABLET 0.1 mg Y N  
69918010101 DESMOPRESSIN ACETATE desmopressin acetate TABLET 0.1 mg Y N  
55566270000 DDAVP desmopressin acetate TABLET 0.2 mg Y N  
10702017001 DESMOPRESSIN ACETATE desmopressin acetate TABLET 0.2 mg Y N  
23155049001 DESMOPRESSIN ACETATE desmopressin acetate TABLET 0.2 mg Y N  
59651025001 DESMOPRESSIN ACETATE desmopressin acetate TABLET 0.2 mg Y N  
60505025801 DESMOPRESSIN ACETATE desmopressin acetate TABLET 0.2 mg Y N  
60687073211 DESMOPRESSIN ACETATE desmopressin acetate TABLET 0.2 mg Y N  
60687073221 DESMOPRESSIN ACETATE desmopressin acetate TABLET 0.2 mg Y N  
68001057500 DESMOPRESSIN ACETATE desmopressin acetate TABLET 0.2 mg Y N  
69918020101 DESMOPRESSIN ACETATE desmopressin acetate TABLET 0.2 mg Y N  
55566230000 DDAVP desmopressin acetate VIAL 4 mcg/mL Y N  
25021046001 DESMOPRESSIN ACETATE desmopressin acetate VIAL 4 mcg/mL Y N  
25021046110 DESMOPRESSIN ACETATE desmopressin acetate VIAL 4 mcg/mL Y N  
39822620001 DESMOPRESSIN ACETATE desmopressin acetate VIAL 4 mcg/mL Y N  
39822620002 DESMOPRESSIN ACETATE desmopressin acetate VIAL 4 mcg/mL Y N  
39822625001 DESMOPRESSIN ACETATE desmopressin acetate VIAL 4 mcg/mL Y N  
43598005311 DESMOPRESSIN ACETATE desmopressin acetate VIAL 4 mcg/mL Y N  
65219029300 DESMOPRESSIN ACETATE desmopressin acetate VIAL 4 mcg/mL Y N  
65219029301 DESMOPRESSIN ACETATE desmopressin acetate VIAL 4 mcg/mL Y N  
65219029510 DESMOPRESSIN ACETATE desmopressin acetate VIAL 4 mcg/mL Y N  
69918090110 DESMOPRESSIN ACETATE desmopressin acetate VIAL 4 mcg/mL Y N  
69918090111 DESMOPRESSIN ACETATE desmopressin acetate VIAL 4 mcg/mL Y N  
69918090112 DESMOPRESSIN ACETATE desmopressin acetate VIAL 4 mcg/mL Y N  
70095002601 DESMOPRESSIN ACETATE desmopressin acetate VIAL 4 mcg/mL Y N  
70095002602 DESMOPRESSIN ACETATE desmopressin acetate VIAL 4 mcg/mL Y N  
70095003101 DESMOPRESSIN ACETATE desmopressin acetate VIAL 4 mcg/mL Y N  
70860045441 DESMOPRESSIN ACETATE desmopressin acetate VIAL 4 mcg/mL Y N  
83634045101 DESMOPRESSIN ACETATE desmopressin acetate VIAL 4 mcg/mL Y N  
83634045110 DESMOPRESSIN ACETATE desmopressin acetate VIAL 4 mcg/mL Y N  
83634045141 DESMOPRESSIN ACETATE desmopressin acetate VIAL 4 mcg/mL Y N  
44087111501 GONAL-F RFF REDI-JECT follitropin alfa, recombinant PEN INJCTR 300 unit/0.48 mL Y N  
44087111601 GONAL-F RFF REDI-JECT follitropin alfa, recombinant PEN INJCTR 450 unit/0.72 mL Y N  
44087111701 GONAL-F RFF REDI-JECT follitropin alfa, recombinant PEN INJCTR 900 unit/1.44 mL Y N  
44087907001 GONAL-F follitropin alfa, recombinant VIAL 1,050 unit Y N  
44087903001 GONAL-F follitropin alfa, recombinant VIAL 450 unit Y N  
00052031301 FOLLISTIM AQ follitropin beta,recomb CARTRIDGE 300 unit/0.36 mL Y N  
78206012901 FOLLISTIM AQ follitropin beta,recomb CARTRIDGE 300 unit/0.36 mL Y N  
78206013001 FOLLISTIM AQ follitropin beta,recomb CARTRIDGE 600 unit/0.72 mL deliverable (833 unit/mL) Y N  
00052032601 FOLLISTIM AQ follitropin beta,recomb CARTRIDGE 900 unit/1.08 mL Y N  
78206013101 FOLLISTIM AQ follitropin beta,recomb CARTRIDGE 900 unit/1.08 mL Y N  
00052030221 FOLLISTIM/ANTAGON follitropin beta/ganirelix KIT 75 unit-250 mcg Y N  
55566101001 FYREMADEL ganirelix acetate SYRINGE 250 mcg/0.5 mL Y N  
00548500100 GANIRELIX ACETATE ganirelix acetate SYRINGE 250 mcg/0.5 mL Y N  
65219002805 GANIRELIX ACETATE ganirelix acetate SYRINGE 250 mcg/0.5 mL Y N  
70700032798 GANIRELIX ACETATE ganirelix acetate SYRINGE 250 mcg/0.5 mL Y N  
70748027401 GANIRELIX ACETATE ganirelix acetate SYRINGE 250 mcg/0.5 mL Y N  
71288055480 GANIRELIX ACETATE ganirelix acetate SYRINGE 250 mcg/0.5 mL Y N  
78206013801 GANIRELIX ACETATE ganirelix acetate SYRINGE 250 mcg/0.5 mL Y N  
78206013802 GANIRELIX ACETATE ganirelix acetate SYRINGE 250 mcg/0.5 mL Y N  
55566720805 LUTREPULSE gonadorelin acetate KIT 0.8 mg Y N  
55566723205 LUTREPULSE gonadorelin acetate KIT 3.2 mg Y N  
55566720800 LUTREPULSE gonadorelin acetate VIAL 0.8 mg Y N  
55566723200 LUTREPULSE gonadorelin acetate VIAL 3.2 mg Y N  
69097087067 LANREOTIDE ACETATE lanreotide acetate SYRINGE 120 mg/0.5 mL Y N  
69097090667 LANREOTIDE ACETATE lanreotide acetate SYRINGE 120 mg/0.5 mL Y N  
76282072067 LANREOTIDE ACETATE lanreotide acetate SYRINGE 120 mg/0.5 mL Y N  
15054112004 SOMATULINE DEPOT lanreotide acetate SYRINGE 120 mg/0.5 mL Y N  
69097090767 LANREOTIDE ACETATE lanreotide acetate SYRINGE 60 mg/0.2 mL Y N  
15054106004 SOMATULINE DEPOT lanreotide acetate SYRINGE 60 mg/0.2 mL Y N  
69097090867 LANREOTIDE ACETATE lanreotide acetate SYRINGE 90 mg/0.3 mL Y N  
15054109004 SOMATULINE DEPOT lanreotide acetate SYRINGE 90 mg/0.3 mL Y N  
15054104005 INCRELEX mecasermin VIAL 10 mg/mL Y N  
71863021604 INCRELEX mecasermin VIAL 10 mg/mL Y N  
55566750102 MENOPUR menotropins VIAL 75 unit Y N  
10122021001 MYALEPT metreleptin VIAL 5 mg/mL (final concentration) Y N Pharmacy PA
10122021002 MYALEPT metreleptin VIAL 5 mg/mL (final concentration) Y N Pharmacy PA
76431021001 MYALEPT metreleptin VIAL 5 mg/mL (final concentration) Y N Pharmacy PA
76336045518 METOPIRONE metyrapone CAPSULE 250 mg Y N  
00078018101 SANDOSTATIN octreotide acetate AMPUL 100 mcg/mL Y N  
00078018161 SANDOSTATIN octreotide acetate AMPUL 100 mcg/mL Y N  
00078018001 SANDOSTATIN octreotide acetate AMPUL 50 mcg/mL Y N  
00078018061 SANDOSTATIN octreotide acetate AMPUL 50 mcg/mL Y N  
00078018201 SANDOSTATIN octreotide acetate AMPUL 500 mcg/mL Y N  
00078018261 SANDOSTATIN octreotide acetate AMPUL 500 mcg/mL Y N  
69880012028 MYCAPSSA octreotide acetate CAPSULE DR 20 mg Y N  
67457024500 OCTREOTIDE ACETATE octreotide acetate SYRINGE 100 mcg/mL (1 mL) Y N  
67457024501 OCTREOTIDE ACETATE octreotide acetate SYRINGE 100 mcg/mL (1 mL) Y N  
67457023900 OCTREOTIDE ACETATE octreotide acetate SYRINGE 50 mcg/mL (1 mL) Y N  
67457023901 OCTREOTIDE ACETATE octreotide acetate SYRINGE 50 mcg/mL (1 mL) Y N  
67457024600 OCTREOTIDE ACETATE octreotide acetate SYRINGE 500 mcg/mL (1 mL) Y N  
67457024601 OCTREOTIDE ACETATE octreotide acetate SYRINGE 500 mcg/mL (1 mL) Y N  
00641617801 OCTREOTIDE ACETATE octreotide acetate VIAL 1,000 mcg/mL Y N  
23155068631 OCTREOTIDE ACETATE octreotide acetate VIAL 1,000 mcg/mL Y N  
25021046705 OCTREOTIDE ACETATE octreotide acetate VIAL 1,000 mcg/mL Y N  
63323037905 OCTREOTIDE ACETATE octreotide acetate VIAL 1,000 mcg/mL Y N  
00641617501 OCTREOTIDE ACETATE octreotide acetate VIAL 100 mcg/mL Y N  
00641617510 OCTREOTIDE ACETATE octreotide acetate VIAL 100 mcg/mL Y N  
23155068831 OCTREOTIDE ACETATE octreotide acetate VIAL 100 mcg/mL Y N  
23155068841 OCTREOTIDE ACETATE octreotide acetate VIAL 100 mcg/mL Y N  
25021046401 OCTREOTIDE ACETATE octreotide acetate VIAL 100 mcg/mL Y N  
62756009440 OCTREOTIDE ACETATE octreotide acetate VIAL 100 mcg/mL Y N  
63323037600 OCTREOTIDE ACETATE octreotide acetate VIAL 100 mcg/mL Y N  
63323037601 OCTREOTIDE ACETATE octreotide acetate VIAL 100 mcg/mL Y N  
63323037604 OCTREOTIDE ACETATE octreotide acetate VIAL 100 mcg/mL Y N  
63323037641 OCTREOTIDE ACETATE octreotide acetate VIAL 100 mcg/mL Y N  
68462089601 OCTREOTIDE ACETATE octreotide acetate VIAL 100 mcg/mL Y N  
68462089610 OCTREOTIDE ACETATE octreotide acetate VIAL 100 mcg/mL Y N  
00641617701 OCTREOTIDE ACETATE octreotide acetate VIAL 200 mcg/mL Y N  
23155068531 OCTREOTIDE ACETATE octreotide acetate VIAL 200 mcg/mL Y N  
25021046605 OCTREOTIDE ACETATE octreotide acetate VIAL 200 mcg/mL Y N  
63323037805 OCTREOTIDE ACETATE octreotide acetate VIAL 200 mcg/mL Y N  
00641617401 OCTREOTIDE ACETATE octreotide acetate VIAL 50 mcg/mL Y N  
00641617410 OCTREOTIDE ACETATE octreotide acetate VIAL 50 mcg/mL Y N  
23155068731 OCTREOTIDE ACETATE octreotide acetate VIAL 50 mcg/mL Y N  
23155068741 OCTREOTIDE ACETATE octreotide acetate VIAL 50 mcg/mL Y N  
25021046301 OCTREOTIDE ACETATE octreotide acetate VIAL 50 mcg/mL Y N  
00641617601 OCTREOTIDE ACETATE octreotide acetate VIAL 500 mcg/mL Y N  
00641617610 OCTREOTIDE ACETATE octreotide acetate VIAL 500 mcg/mL Y N  
23155068931 OCTREOTIDE ACETATE octreotide acetate VIAL 500 mcg/mL Y N  
23155068941 OCTREOTIDE ACETATE octreotide acetate VIAL 500 mcg/mL Y N  
25021046501 OCTREOTIDE ACETATE octreotide acetate VIAL 500 mcg/mL Y N  
63323037700 OCTREOTIDE ACETATE octreotide acetate VIAL 500 mcg/mL Y N  
63323037701 OCTREOTIDE ACETATE octreotide acetate VIAL 500 mcg/mL Y N  
63323037704 OCTREOTIDE ACETATE octreotide acetate VIAL 500 mcg/mL Y N  
63323037741 OCTREOTIDE ACETATE octreotide acetate VIAL 500 mcg/mL Y N  
68462089701 OCTREOTIDE ACETATE octreotide acetate VIAL 500 mcg/mL Y N  
68462089710 OCTREOTIDE ACETATE octreotide acetate VIAL 500 mcg/mL Y N  
00480925601 OCTREOTIDE ACETATE ER octreotide acetate,mi-spheres VIAL 10 mg Y N  
00480925708 OCTREOTIDE ACETATE ER octreotide acetate,mi-spheres VIAL 10 mg Y N  
00078079061 SANDOSTATIN LAR DEPOT octreotide acetate,mi-spheres VIAL 10 mg Y N  
00078081181 SANDOSTATIN LAR DEPOT octreotide acetate,mi-spheres VIAL 10 mg Y N  
00480925801 OCTREOTIDE ACETATE ER octreotide acetate,mi-spheres VIAL 20 mg Y N  
00480925908 OCTREOTIDE ACETATE ER octreotide acetate,mi-spheres VIAL 20 mg Y N  
00078079761 SANDOSTATIN LAR DEPOT octreotide acetate,mi-spheres VIAL 20 mg Y N  
00078081881 SANDOSTATIN LAR DEPOT octreotide acetate,mi-spheres VIAL 20 mg Y N  
00480926001 OCTREOTIDE ACETATE ER octreotide acetate,mi-spheres VIAL 30 mg Y N  
00480926208 OCTREOTIDE ACETATE ER octreotide acetate,mi-spheres VIAL 30 mg Y N  
00078080461 SANDOSTATIN LAR DEPOT octreotide acetate,mi-spheres VIAL 30 mg Y N  
00078082581 SANDOSTATIN LAR DEPOT octreotide acetate,mi-spheres VIAL 30 mg Y N  
55292032020 ISTURISA osilodrostat phosphate TABLET 1 mg Y N Pharmacy PA
55292032060 ISTURISA osilodrostat phosphate TABLET 1 mg Y N Pharmacy PA
55292032120 ISTURISA osilodrostat phosphate TABLET 5 mg Y N Pharmacy PA
55292032160 ISTURISA osilodrostat phosphate TABLET 5 mg Y N Pharmacy PA
55292013101 SIGNIFOR pasireotide diaspartate AMPUL 0.3 mg/mL (1 mL) Y N  
55292013106 SIGNIFOR pasireotide diaspartate AMPUL 0.3 mg/mL (1 mL) Y N  
55292013160 SIGNIFOR pasireotide diaspartate AMPUL 0.3 mg/mL (1 mL) Y N  
55292013201 SIGNIFOR pasireotide diaspartate AMPUL 0.6 mg/mL (1 mL) Y N  
55292013206 SIGNIFOR pasireotide diaspartate AMPUL 0.6 mg/mL (1 mL) Y N  
55292013260 SIGNIFOR pasireotide diaspartate AMPUL 0.6 mg/mL (1 mL) Y N  
55292013301 SIGNIFOR pasireotide diaspartate AMPUL 0.9 mg/mL (1 mL) Y N  
55292013306 SIGNIFOR pasireotide diaspartate AMPUL 0.9 mg/mL (1 mL) Y N  
55292013360 SIGNIFOR pasireotide diaspartate AMPUL 0.9 mg/mL (1 mL) Y N  
55292013401 SIGNIFOR LAR pasireotide pamoate VIAL 10 mg Y N  
55292013901 SIGNIFOR LAR pasireotide pamoate VIAL 10 mg Y N  
55292013501 SIGNIFOR LAR pasireotide pamoate VIAL 20 mg Y N  
55292014001 SIGNIFOR LAR pasireotide pamoate VIAL 20 mg Y N  
55292013601 SIGNIFOR LAR pasireotide pamoate VIAL 30 mg Y N  
55292014101 SIGNIFOR LAR pasireotide pamoate VIAL 30 mg Y N  
55292013701 SIGNIFOR LAR pasireotide pamoate VIAL 40 mg Y N  
55292014201 SIGNIFOR LAR pasireotide pamoate VIAL 40 mg Y N  
55292013801 SIGNIFOR LAR pasireotide pamoate VIAL 60 mg Y N  
55292014301 SIGNIFOR LAR pasireotide pamoate VIAL 60 mg Y N  
67066000501 CHIRHOSTIM secretin acetate (human) VIAL 16 mcg Y N  
42023023701 VASOSTRICT vasopressin INFUS. BTL 20 unit/100 mL (0.2 unit/mL) Y N  
42023023710 VASOSTRICT vasopressin INFUS. BTL 20 unit/100 mL (0.2 unit/mL) Y N  
42023021901 VASOSTRICT vasopressin INFUS. BTL 40 unit/100 mL (0.4 unit/mL) Y N  
42023021910 VASOSTRICT vasopressin INFUS. BTL 40 unit/100 mL (0.4 unit/mL) Y N  
00517102001 VASOPRESSIN vasopressin VIAL 20 unit/mL Y N  
00517103001 VASOPRESSIN vasopressin VIAL 20 unit/mL Y N  
00548970100 VASOPRESSIN vasopressin VIAL 20 unit/mL Y N  
25021047401 VASOPRESSIN vasopressin VIAL 20 unit/mL Y N  
43598091406 VASOPRESSIN vasopressin VIAL 20 unit/mL Y N  
43598091411 VASOPRESSIN vasopressin VIAL 20 unit/mL Y N  
43598091425 VASOPRESSIN vasopressin VIAL 20 unit/mL Y N  
55150037000 VASOPRESSIN vasopressin VIAL 20 unit/mL Y N  
55150037001 VASOPRESSIN vasopressin VIAL 20 unit/mL Y N  
55150037024 VASOPRESSIN vasopressin VIAL 20 unit/mL Y N  
55150037025 VASOPRESSIN vasopressin VIAL 20 unit/mL Y N  
60793042003 VASOPRESSIN vasopressin VIAL 20 unit/mL Y N  
63323093000 VASOPRESSIN vasopressin VIAL 20 unit/mL Y N  
63323093001 VASOPRESSIN vasopressin VIAL 20 unit/mL Y N  
65219003900 VASOPRESSIN vasopressin VIAL 20 unit/mL Y N  
65219003901 VASOPRESSIN vasopressin VIAL 20 unit/mL Y N  
70121164201 VASOPRESSIN vasopressin VIAL 20 unit/mL Y N  
70121164205 VASOPRESSIN vasopressin VIAL 20 unit/mL Y N  
70121164207 VASOPRESSIN vasopressin VIAL 20 unit/mL Y N  
72572086001 VASOPRESSIN vasopressin VIAL 20 unit/mL Y N  
72572086025 VASOPRESSIN vasopressin VIAL 20 unit/mL Y N  
42023016401 VASOSTRICT vasopressin VIAL 20 unit/mL Y N  
42023016410 VASOSTRICT vasopressin VIAL 20 unit/mL Y N  
42023016425 VASOSTRICT vasopressin VIAL 20 unit/mL Y N  
42023016483 VASOSTRICT vasopressin VIAL 20 unit/mL Y N  
42023016489 VASOSTRICT vasopressin VIAL 20 unit/mL Y N  
42023019001 VASOSTRICT vasopressin VIAL 20 unit/mL Y N  
81298855201 VASOPRESSIN-0.9% NACL vasopressin in 0.9 % NaCl INFUS. BTL 20 unit/100 mL (0.2 unit/mL) Y N  
81298855203 VASOPRESSIN-0.9% NACL vasopressin in 0.9 % NaCl INFUS. BTL 20 unit/100 mL (0.2 unit/mL) Y N  
81298855401 VASOPRESSIN-0.9% NACL vasopressin in 0.9 % NaCl INFUS. BTL 40 unit/100 mL (0.4 unit/mL) Y N  
81298855403 VASOPRESSIN-0.9% NACL vasopressin in 0.9 % NaCl INFUS. BTL 40 unit/100 mL (0.4 unit/mL) Y N  
00338964012 VASOPRESSIN-0.9% NACL vasopressin in 0.9 % NaCl PLAST. BAG 20 unit/100 mL (0.2 unit/mL) Y N  
00338964712 VASOPRESSIN-0.9% NACL vasopressin in 0.9 % NaCl PLAST. BAG 40 unit/100 mL (0.4 unit/mL) Y N  
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