Displaying 1 - 8 of 8
Contract Number Brand Code Brand Name Package Size Formulary Category Unit Price Strength Max. Reimbursable / Month Drug Contract Start Date Drug Contract End Date Restrict To Ophthalmologist Restrict To Pulmonologist Status Description Max Repeats
40 A5311 XALATAN 0.005% EYE DR (PFI/STO) LATANOPROST 2.5ML A 11.66 0.005% 1 2022-04-01 2024-03-31 Price Change 6
40 A531AH LOUTEN EMULSION 0.005% EYE DR (LPO/COL) LATAN 2.5ML A 9.08 0.005% 1 2022-04-01 2024-03-31 6
41 A531AH LOUTEN EMULSION 0.005% EYE DR (LPO) LATA 2.5ML A 9.0792 0.005% 1 2024-04-01 2026-03-31 Yes 6
42 A531AH LOUTEN EMULSION 0.005% EYE DR (LPO) LATA 2.5ML C 16.31 0.005% 1 2026-04-01 No No 6
41 A531BF XALATAN 0.005% EYE DR (PFI) LATANOPROST 2.5ML A 8.8617 0.005% 2 2024-04-01 2026-03-31 Yes 6
42 A531BF XALATAN 0.005% EYE DR (PFI) LATANOPROST 2.5ML A 8.51 0.005% 1 2026-04-01 No No 6
40 A531H XALATAN 0.005% EYE DR (PFI/SBI) LATANOPROST 2.5ML A 11.66 0.005% 1 2022-04-01 2024-03-31 Price Change 6
41 A531H XALATAN 0.005% EYE DR (PFI) LATANOPROST 2.5ML A 8.8617 0.005% 1 2024-04-01 2026-03-31 Yes 6