75 items matched your search.
Denotes a drug that is not covered.- ADENOSINE INJ 12MG/4ML
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - ADENOSINE INJ 6MG/2ML
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - AMIODARONE INJ 150MG/3M
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - AMIODARONE INJ 450MG/9M
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - AMIODARONE INJ 50MG/ML
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - AMIODARONE INJ 900MG/18
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - AMIODARONE TAB 200MG
Classification: Tier 1 (preferred generic tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - DOFETILIDE CAP 125MCG
Classification: Tier 3 (preferred brand tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: AntiarrhythmicsQuantity Limit: 180 per 30-days (* depending on package size)
- DOFETILIDE CAP 250MCG
Classification: Tier 3 (preferred brand tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: AntiarrhythmicsQuantity Limit: 60 per 30-days (* depending on package size)
- DOFETILIDE CAP 500MCG
Classification: Tier 3 (preferred brand tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: AntiarrhythmicsQuantity Limit: 60 per 30-days (* depending on package size)
- FLECAINIDE TAB 100MG
Classification: Tier 2 (generic tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - FLECAINIDE TAB 150MG
Classification: Tier 2 (generic tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - FLECAINIDE TAB 50MG
Classification: Tier 2 (generic tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - IBUTILIDE INJ 1MG/10ML
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - LIDOCAIN/D5W INJ 4MG/ML
Classification: Tier 4 (nonpreferred brand tier) brand drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: AntiarrhythmicsPrior Authorization: Part B vs. Part D Prior Authorization
- LIDOCAIN/D5W INJ 8MG/ML
Classification: Tier 4 (nonpreferred brand tier) brand drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: AntiarrhythmicsPrior Authorization: Part B vs. Part D Prior Authorization
- LIDOCAINE INJ 10MG/ML
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: AntiarrhythmicsPrior Authorization: Part B vs. Part D Prior Authorization
- LIDOCAINE INJ 20MG/ML
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: AntiarrhythmicsPrior Authorization: Part B vs. Part D Prior Authorization
- MEXILETINE CAP 150MG
Classification: Tier 3 (preferred brand tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - MEXILETINE CAP 200MG
Classification: Tier 3 (preferred brand tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - MEXILETINE CAP 250MG
Classification: Tier 3 (preferred brand tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - MULTAQ TAB 400MG
Classification: Tier 3 (preferred brand tier) brand drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: AntiarrhythmicsQuantity Limit: 60 per 30-days (* depending on package size)
- PACERONE TAB 200MG
Classification: Tier 1 (preferred generic tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - PROCAINAMIDE INJ 1000/10
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - PROCAINAMIDE INJ 100MG/ML
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - PROCAINAMIDE INJ 500MG/ML
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - PROPAFENONE CAP 225MG ER
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - PROPAFENONE CAP 325MG ER
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - PROPAFENONE CAP 425MG ER
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - PROPAFENONE TAB 150MG
Classification: Tier 2 (generic tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - PROPAFENONE TAB 225MG
Classification: Tier 2 (generic tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - PROPAFENONE TAB 300MG
Classification: Tier 2 (generic tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - QUINIDINE GL TAB 324MG CR
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - QUINIDINE GL TAB 324MG ER
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - QUINIDINE SU TAB 200MG
Classification: Tier 2 (generic tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - QUINIDINE SU TAB 300MG
Classification: Tier 2 (generic tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - SORINE TAB 120MG
Classification: Tier 2 (generic tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - SORINE TAB 160MG
Classification: Tier 2 (generic tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - SORINE TAB 240MG
Classification: Tier 2 (generic tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - SORINE TAB 80MG
Classification: Tier 2 (generic tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - SOTALOL TAB 120MG
Classification: Tier 2 (generic tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - SOTALOL TAB 160MG
Classification: Tier 2 (generic tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - SOTALOL TAB 80MG
Classification: Tier 2 (generic tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - SOTALOL AF TAB 120MG
Classification: Tier 2 (generic tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - SOTALOL AF TAB 160MG
Classification: Tier 2 (generic tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - SOTALOL AF TAB 80MG
Classification: Tier 2 (generic tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - SOTALOL HCL TAB 120MG
Classification: Tier 2 (generic tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - SOTALOL HCL TAB 160MG
Classification: Tier 2 (generic tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - SOTALOL HCL TAB 240MG
Classification: Tier 2 (generic tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - SOTALOL HCL TAB 80MG
Classification: Tier 2 (generic tier) generic drug
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - AMIODARONE TAB 100MG
Classification: Not Covered
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - AMIODARONE TAB 400MG
Classification: Not Covered
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - BETAPACE TAB 120MG
Classification: Not Covered
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - BETAPACE TAB 160MG
Classification: Not Covered
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - BETAPACE TAB 80MG
Classification: Not Covered
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - BETAPACE AF TAB 120MG
Classification: Not Covered
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - BETAPACE AF TAB 160MG
Classification: Not Covered
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - BETAPACE AF TAB 80MG
Classification: Not Covered
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - CORVERT INJ 1MG/10ML
Classification: Not Covered
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - DISOPYRAMIDE CAP 100MG
Classification: Not Covered
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - DISOPYRAMIDE CAP 150MG
Classification: Not Covered
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - NEXTERONE INJ
Classification: Not Covered
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - NORPACE CAP 100MG CR
Classification: Not Covered
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - NORPACE CAP 100MG
Classification: Not Covered
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - NORPACE CAP 150MG CR
Classification: Not Covered
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - NORPACE CAP 150MG
Classification: Not Covered
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - PACERONE TAB 100MG
Classification: Not Covered
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - PACERONE TAB 400MG
Classification: Not Covered
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - RYTHMOL SR CAP 225MG
Classification: Not Covered
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - RYTHMOL SR CAP 325MG
Classification: Not Covered
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - RYTHMOL SR CAP 425MG
Classification: Not Covered
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - SOTYLIZE SOL 5MG/ML
Classification: Not Covered
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - TIKOSYN CAP 125MCG
Classification: Not Covered
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - TIKOSYN CAP 250MCG
Classification: Not Covered
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics - TIKOSYN CAP 500MCG
Classification: Not Covered
Therapeutic Category: Cardiovascular Agents
Therapeutic Class: Antiarrhythmics
Last updated 09/13/2022