Immunosuppressants

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PDL Reference Documents

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
60219203701 AZATHIOPRINE azathioprine TABLET 100 mg Y Y N  
68382012001 AZATHIOPRINE azathioprine TABLET 100 mg Y Y N  
16571083501 AZATHIOPRINE azathioprine TABLET 50 mg Y Y N  
60219107601 AZATHIOPRINE azathioprine TABLET 50 mg Y Y N  
67877049301 AZATHIOPRINE azathioprine TABLET 50 mg Y Y N  
67877049305 AZATHIOPRINE azathioprine TABLET 50 mg Y Y N  
68084022901 AZATHIOPRINE azathioprine TABLET 50 mg Y Y N  
68084022911 AZATHIOPRINE azathioprine TABLET 50 mg Y Y N  
68382000301 AZATHIOPRINE azathioprine TABLET 50 mg Y Y N  
68382000305 AZATHIOPRINE azathioprine TABLET 50 mg Y Y N  
68462050201 AZATHIOPRINE azathioprine TABLET 50 mg Y Y N  
54766059010 IMURAN azathioprine TABLET 50 mg Y Y N  
60219203601 AZATHIOPRINE azathioprine TABLET 75 mg Y Y N  
68382011901 AZATHIOPRINE azathioprine TABLET 75 mg Y Y N  
60505013400 CYCLOSPORINE cyclosporine CAPSULE 100 mg Y Y N  
68084092125 CYCLOSPORINE cyclosporine CAPSULE 100 mg Y Y N  
68084092195 CYCLOSPORINE cyclosporine CAPSULE 100 mg Y Y N  
00078024115 SANDIMMUNE cyclosporine CAPSULE 100 mg Y Y N  
00078024161 SANDIMMUNE cyclosporine CAPSULE 100 mg Y Y N  
60505013300 CYCLOSPORINE cyclosporine CAPSULE 25 mg Y Y N  
68084087925 CYCLOSPORINE cyclosporine CAPSULE 25 mg Y Y N  
68084087995 CYCLOSPORINE cyclosporine CAPSULE 25 mg Y Y N  
00078024015 SANDIMMUNE cyclosporine CAPSULE 25 mg Y Y N  
00078024061 SANDIMMUNE cyclosporine CAPSULE 25 mg Y Y N  
00078011022 SANDIMMUNE cyclosporine SOLUTION 100 mg/mL Y Y N  
00093902019 CYCLOSPORINE MODIFIED cyclosporine, modified CAPSULE 100 mg Y Y N  
00093902065 CYCLOSPORINE MODIFIED cyclosporine, modified CAPSULE 100 mg Y Y N  
23155083911 CYCLOSPORINE MODIFIED cyclosporine, modified CAPSULE 100 mg Y Y N  
23155083930 CYCLOSPORINE MODIFIED cyclosporine, modified CAPSULE 100 mg Y Y N  
51862046001 CYCLOSPORINE MODIFIED cyclosporine, modified CAPSULE 100 mg Y Y N  
51862046047 CYCLOSPORINE MODIFIED cyclosporine, modified CAPSULE 100 mg Y Y N  
60505463203 CYCLOSPORINE MODIFIED cyclosporine, modified CAPSULE 100 mg Y Y N  
75907004830 CYCLOSPORINE MODIFIED cyclosporine, modified CAPSULE 100 mg Y Y N  
75907004881 CYCLOSPORINE MODIFIED cyclosporine, modified CAPSULE 100 mg Y Y N  
00074310932 GENGRAF cyclosporine, modified CAPSULE 100 mg Y Y N  
00078024815 NEORAL cyclosporine, modified CAPSULE 100 mg Y Y N  
00078024861 NEORAL cyclosporine, modified CAPSULE 100 mg Y Y N  
00093901819 CYCLOSPORINE MODIFIED cyclosporine, modified CAPSULE 25 mg Y Y N  
00093901865 CYCLOSPORINE MODIFIED cyclosporine, modified CAPSULE 25 mg Y Y N  
23155083711 CYCLOSPORINE MODIFIED cyclosporine, modified CAPSULE 25 mg Y Y N  
23155083730 CYCLOSPORINE MODIFIED cyclosporine, modified CAPSULE 25 mg Y Y N  
51862045801 CYCLOSPORINE MODIFIED cyclosporine, modified CAPSULE 25 mg Y Y N  
51862045847 CYCLOSPORINE MODIFIED cyclosporine, modified CAPSULE 25 mg Y Y N  
60505463003 CYCLOSPORINE MODIFIED cyclosporine, modified CAPSULE 25 mg Y Y N  
75907004730 CYCLOSPORINE MODIFIED cyclosporine, modified CAPSULE 25 mg Y Y N  
75907004781 CYCLOSPORINE MODIFIED cyclosporine, modified CAPSULE 25 mg Y Y N  
00074310832 GENGRAF cyclosporine, modified CAPSULE 25 mg Y Y N  
00078024615 NEORAL cyclosporine, modified CAPSULE 25 mg Y Y N  
00078024661 NEORAL cyclosporine, modified CAPSULE 25 mg Y Y N  
00093901919 CYCLOSPORINE MODIFIED cyclosporine, modified CAPSULE 50 mg Y Y N  
00093901965 CYCLOSPORINE MODIFIED cyclosporine, modified CAPSULE 50 mg Y Y N  
23155083811 CYCLOSPORINE MODIFIED cyclosporine, modified CAPSULE 50 mg Y Y N  
23155083830 CYCLOSPORINE MODIFIED cyclosporine, modified CAPSULE 50 mg Y Y N  
60505463103 CYCLOSPORINE MODIFIED cyclosporine, modified CAPSULE 50 mg Y Y N  
00172731320 CYCLOSPORINE MODIFIED cyclosporine, modified SOLUTION 100 mg/mL Y Y N  
00074726950 GENGRAF cyclosporine, modified SOLUTION 100 mg/mL Y Y N  
00078027422 NEORAL cyclosporine, modified SOLUTION 100 mg/mL Y Y N  
00054047021 EVEROLIMUS everolimus TABLET 0.25 mg Y Y N  
49884015802 EVEROLIMUS everolimus TABLET 0.25 mg Y Y N  
49884015852 EVEROLIMUS everolimus TABLET 0.25 mg Y Y N  
51991037906 EVEROLIMUS everolimus TABLET 0.25 mg Y Y N  
51991037960 EVEROLIMUS everolimus TABLET 0.25 mg Y Y N  
51991037999 EVEROLIMUS everolimus TABLET 0.25 mg Y Y N  
67877071831 EVEROLIMUS everolimus TABLET 0.25 mg Y Y N  
67877071833 EVEROLIMUS everolimus TABLET 0.25 mg Y Y N  
70377006911 EVEROLIMUS everolimus TABLET 0.25 mg Y Y N  
00078041720 ZORTRESS everolimus TABLET 0.25 mg Y Y N  
00078041761 ZORTRESS everolimus TABLET 0.25 mg Y Y N  
00054047121 EVEROLIMUS everolimus TABLET 0.5 mg Y Y N  
49884015902 EVEROLIMUS everolimus TABLET 0.5 mg Y Y N  
49884015952 EVEROLIMUS everolimus TABLET 0.5 mg Y Y N  
51991038006 EVEROLIMUS everolimus TABLET 0.5 mg Y Y N  
51991038060 EVEROLIMUS everolimus TABLET 0.5 mg Y Y N  
51991038099 EVEROLIMUS everolimus TABLET 0.5 mg Y Y N  
67877071931 EVEROLIMUS everolimus TABLET 0.5 mg Y Y N  
67877071933 EVEROLIMUS everolimus TABLET 0.5 mg Y Y N  
70377007011 EVEROLIMUS everolimus TABLET 0.5 mg Y Y N  
00078041420 ZORTRESS everolimus TABLET 0.5 mg Y Y N  
00078041461 ZORTRESS everolimus TABLET 0.5 mg Y Y N  
00054047221 EVEROLIMUS everolimus TABLET 0.75 mg Y Y N  
49884016002 EVEROLIMUS everolimus TABLET 0.75 mg Y Y N  
49884016052 EVEROLIMUS everolimus TABLET 0.75 mg Y Y N  
51991038106 EVEROLIMUS everolimus TABLET 0.75 mg Y Y N  
51991038160 EVEROLIMUS everolimus TABLET 0.75 mg Y Y N  
51991038199 EVEROLIMUS everolimus TABLET 0.75 mg Y Y N  
67877072031 EVEROLIMUS everolimus TABLET 0.75 mg Y Y N  
67877072033 EVEROLIMUS everolimus TABLET 0.75 mg Y Y N  
70377007111 EVEROLIMUS everolimus TABLET 0.75 mg Y Y N  
00078041520 ZORTRESS everolimus TABLET 0.75 mg Y Y N  
00078041561 ZORTRESS everolimus TABLET 0.75 mg Y Y N  
00054060421 EVEROLIMUS everolimus TABLET 1 mg Y Y N  
49884028302 EVEROLIMUS everolimus TABLET 1 mg Y Y N  
49884028352 EVEROLIMUS everolimus TABLET 1 mg Y Y N  
67877072131 EVEROLIMUS everolimus TABLET 1 mg Y Y N  
67877072133 EVEROLIMUS everolimus TABLET 1 mg Y Y N  
70377011211 EVEROLIMUS everolimus TABLET 1 mg Y Y N  
00078042220 ZORTRESS everolimus TABLET 1 mg Y Y N  
00078042261 ZORTRESS everolimus TABLET 1 mg Y Y N  
00054048213 EVEROLIMUS everolimus TABLET 10 mg Y N Pharmacy PA
00093776919 EVEROLIMUS everolimus TABLET 10 mg Y N Pharmacy PA
00093776924 EVEROLIMUS everolimus TABLET 10 mg Y N Pharmacy PA
49884012852 EVEROLIMUS everolimus TABLET 10 mg Y N Pharmacy PA
49884012891 EVEROLIMUS everolimus TABLET 10 mg Y N Pharmacy PA
51991082428 EVEROLIMUS everolimus TABLET 10 mg Y N Pharmacy PA
51991082433 EVEROLIMUS everolimus TABLET 10 mg Y N Pharmacy PA
51991082499 EVEROLIMUS everolimus TABLET 10 mg Y N Pharmacy PA
70377001311 EVEROLIMUS everolimus TABLET 10 mg Y N Pharmacy PA
70377001322 EVEROLIMUS everolimus TABLET 10 mg Y N Pharmacy PA
70377001323 EVEROLIMUS everolimus TABLET 10 mg Y N Pharmacy PA
72603025701 EVEROLIMUS everolimus TABLET 10 mg Y N Pharmacy PA
00054048013 EVEROLIMUS everolimus TABLET 2.5 mg Y N Pharmacy PA
00093776619 EVEROLIMUS everolimus TABLET 2.5 mg Y N Pharmacy PA
00093776624 EVEROLIMUS everolimus TABLET 2.5 mg Y N Pharmacy PA
49884011952 EVEROLIMUS everolimus TABLET 2.5 mg Y N Pharmacy PA
49884011991 EVEROLIMUS everolimus TABLET 2.5 mg Y N Pharmacy PA
51991082128 EVEROLIMUS everolimus TABLET 2.5 mg Y N Pharmacy PA
51991082133 EVEROLIMUS everolimus TABLET 2.5 mg Y N Pharmacy PA
51991082199 EVEROLIMUS everolimus TABLET 2.5 mg Y N Pharmacy PA
70377001011 EVEROLIMUS everolimus TABLET 2.5 mg Y N Pharmacy PA
70377001022 EVEROLIMUS everolimus TABLET 2.5 mg Y N Pharmacy PA
70377001023 EVEROLIMUS everolimus TABLET 2.5 mg Y N Pharmacy PA
72603025401 EVEROLIMUS everolimus TABLET 2.5 mg Y N Pharmacy PA
00054048113 EVEROLIMUS everolimus TABLET 5 mg Y N Pharmacy PA
00093776719 EVEROLIMUS everolimus TABLET 5 mg Y N Pharmacy PA
00093776724 EVEROLIMUS everolimus TABLET 5 mg Y N Pharmacy PA
49884012552 EVEROLIMUS everolimus TABLET 5 mg Y N Pharmacy PA
49884012591 EVEROLIMUS everolimus TABLET 5 mg Y N Pharmacy PA
51991082228 EVEROLIMUS everolimus TABLET 5 mg Y N Pharmacy PA
51991082233 EVEROLIMUS everolimus TABLET 5 mg Y N Pharmacy PA
51991082299 EVEROLIMUS everolimus TABLET 5 mg Y N Pharmacy PA
70377001111 EVEROLIMUS everolimus TABLET 5 mg Y N Pharmacy PA
70377001122 EVEROLIMUS everolimus TABLET 5 mg Y N Pharmacy PA
70377001123 EVEROLIMUS everolimus TABLET 5 mg Y N Pharmacy PA
72603025501 EVEROLIMUS everolimus TABLET 5 mg Y N Pharmacy PA
00054049713 EVEROLIMUS everolimus TABLET 7.5 mg Y N Pharmacy PA
00093776819 EVEROLIMUS everolimus TABLET 7.5 mg Y N Pharmacy PA
00093776824 EVEROLIMUS everolimus TABLET 7.5 mg Y N Pharmacy PA
49884012752 EVEROLIMUS everolimus TABLET 7.5 mg Y N Pharmacy PA
49884012791 EVEROLIMUS everolimus TABLET 7.5 mg Y N Pharmacy PA
51991082328 EVEROLIMUS everolimus TABLET 7.5 mg Y N Pharmacy PA
51991082333 EVEROLIMUS everolimus TABLET 7.5 mg Y N Pharmacy PA
51991082399 EVEROLIMUS everolimus TABLET 7.5 mg Y N Pharmacy PA
70377001211 EVEROLIMUS everolimus TABLET 7.5 mg Y N Pharmacy PA
70377001222 EVEROLIMUS everolimus TABLET 7.5 mg Y N Pharmacy PA
70377001223 EVEROLIMUS everolimus TABLET 7.5 mg Y N Pharmacy PA
72603025601 EVEROLIMUS everolimus TABLET 7.5 mg Y N Pharmacy PA
00004025901 CELLCEPT mycophenolate mofetil CAPSULE 250 mg Y Y N  
00004025943 CELLCEPT mycophenolate mofetil CAPSULE 250 mg Y Y N  
00054016325 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
00054016329 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
00093733401 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
00093733405 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
00378225005 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
00781206701 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
00781206705 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
00781206789 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
16729009401 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
16729009416 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
23155083001 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
23155083005 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
31722087801 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
31722087805 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
42543098807 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
50268055711 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
50268055715 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
51079072101 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
51079072120 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
59651062401 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
59651062405 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
60687049401 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
60687049411 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
60687088501 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
60687088511 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
64380072606 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
64380072607 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
67877026601 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
67877026605 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
72888019201 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
72888019205 MYCOPHENOLATE MOFETIL mycophenolate mofetil CAPSULE 250 mg Y Y N  
24338001801 MYHIBBIN mycophenolate mofetil ORAL SUSP 200 mg/mL N Y N  
00004026129 CELLCEPT mycophenolate mofetil SUSP RECON 200 mg/mL Y Y N  
00527516082 MYCOPHENOLATE MOFETIL mycophenolate mofetil SUSP RECON 200 mg/mL Y Y N  
23155084851 MYCOPHENOLATE MOFETIL mycophenolate mofetil SUSP RECON 200 mg/mL Y Y N  
59651064626 MYCOPHENOLATE MOFETIL mycophenolate mofetil SUSP RECON 200 mg/mL Y Y N  
66689030708 MYCOPHENOLATE MOFETIL mycophenolate mofetil SUSP RECON 200 mg/mL Y Y N  
67877023022 MYCOPHENOLATE MOFETIL mycophenolate mofetil SUSP RECON 200 mg/mL Y Y N  
69238159502 MYCOPHENOLATE MOFETIL mycophenolate mofetil SUSP RECON 200 mg/mL Y Y N  
00004026001 CELLCEPT mycophenolate mofetil TABLET 500 mg Y Y N  
00004026043 CELLCEPT mycophenolate mofetil TABLET 500 mg Y Y N  
00054016625 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
00054016629 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
00378447201 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
00378447205 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
00781517501 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
00781517505 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
00904707861 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
16729001901 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
16729001916 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
23155083601 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
23155083605 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
31722087901 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
31722087905 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
42543098907 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
42658010105 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
42658010107 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
50268055811 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
50268055815 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
51079037901 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
51079037920 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
59651063801 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
59651063805 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
60687043801 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
60687043811 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
64380072506 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
64380072507 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
67877022501 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
67877022505 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
72888018501 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
72888018505 MYCOPHENOLATE MOFETIL mycophenolate mofetil TABLET 500 mg Y Y N  
00904678504 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 180 mg Y Y N  
00904678561 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 180 mg Y Y N  
16729026129 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 180 mg Y Y N  
24979016044 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 180 mg Y Y N  
59651062108 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 180 mg Y Y N  
60505296507 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 180 mg Y Y N  
67877042612 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 180 mg Y Y N  
68084090711 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 180 mg Y Y N  
68084090721 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 180 mg Y Y N  
70377003911 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 180 mg Y Y N  
70377012611 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 180 mg Y Y N  
70436017223 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 180 mg Y Y N  
70748021716 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 180 mg Y Y N  
72819015508 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 180 mg Y Y N  
72888019912 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 180 mg Y Y N  
00078038566 MYFORTIC mycophenolate sodium TABLET DR 180 mg Y Y N  
00904678604 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 360 mg Y Y N  
00904678661 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 360 mg Y Y N  
00904737261 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 360 mg Y Y N  
16729018929 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 360 mg Y Y N  
24979016144 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 360 mg Y Y N  
59651062208 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 360 mg Y Y N  
60505296607 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 360 mg Y Y N  
67877042712 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 360 mg Y Y N  
68084091825 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 360 mg Y Y N  
68084091895 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 360 mg Y Y N  
70377004011 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 360 mg Y Y N  
70377012711 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 360 mg Y Y N  
70436017323 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 360 mg Y Y N  
70748021816 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 360 mg Y Y N  
72819015608 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 360 mg Y Y N  
72888020012 MYCOPHENOLIC ACID mycophenolate sodium TABLET DR 360 mg Y Y N  
00078038666 MYFORTIC mycophenolate sodium TABLET DR 360 mg Y Y N  
31722031631 SIROLIMUS sirolimus SOLUTION 1 mg/mL Y Y N  
59762120504 SIROLIMUS sirolimus SOLUTION 1 mg/mL Y Y N  
59762120506 SIROLIMUS sirolimus SOLUTION 1 mg/mL Y Y N  
60505619702 SIROLIMUS sirolimus SOLUTION 1 mg/mL Y Y N  
66689034702 SIROLIMUS sirolimus SOLUTION 1 mg/mL Y Y N  
69238159403 SIROLIMUS sirolimus SOLUTION 1 mg/mL Y Y N  
69238159406 SIROLIMUS sirolimus SOLUTION 1 mg/mL Y Y N  
72205009978 SIROLIMUS sirolimus SOLUTION 1 mg/mL Y Y N  
72603040901 SIROLIMUS sirolimus SOLUTION 1 mg/mL Y Y N  
16714018701 SIROLIMUS sirolimus TABLET 0.5 mg Y Y N  
59762100101 SIROLIMUS sirolimus TABLET 0.5 mg Y Y N  
67877074601 SIROLIMUS sirolimus TABLET 0.5 mg Y Y N  
68382052001 SIROLIMUS sirolimus TABLET 0.5 mg Y Y N  
68462068201 SIROLIMUS sirolimus TABLET 0.5 mg Y Y N  
00008104105 RAPAMUNE sirolimus TABLET 1 mg Y Y N  
00904724804 SIROLIMUS sirolimus TABLET 1 mg Y Y N  
16714018801 SIROLIMUS sirolimus TABLET 1 mg Y Y N  
50268071811 SIROLIMUS sirolimus TABLET 1 mg Y Y N  
50268071813 SIROLIMUS sirolimus TABLET 1 mg Y Y N  
55111065301 SIROLIMUS sirolimus TABLET 1 mg Y Y N  
59762100201 SIROLIMUS sirolimus TABLET 1 mg Y Y N  
67877074701 SIROLIMUS sirolimus TABLET 1 mg Y Y N  
68084091525 SIROLIMUS sirolimus TABLET 1 mg Y Y N  
68084091595 SIROLIMUS sirolimus TABLET 1 mg Y Y N  
68382035101 SIROLIMUS sirolimus TABLET 1 mg Y Y N  
68462068301 SIROLIMUS sirolimus TABLET 1 mg Y Y N  
16714018901 SIROLIMUS sirolimus TABLET 2 mg Y Y N  
55111065401 SIROLIMUS sirolimus TABLET 2 mg Y Y N  
59762100301 SIROLIMUS sirolimus TABLET 2 mg Y Y N  
67877074801 SIROLIMUS sirolimus TABLET 2 mg Y Y N  
68382035201 SIROLIMUS sirolimus TABLET 2 mg Y Y N  
68462068401 SIROLIMUS sirolimus TABLET 2 mg Y Y N  
00469064773 ASTAGRAF XL tacrolimus CAP ER 24H 0.5 mg Y Y N  
00469067773 ASTAGRAF XL tacrolimus CAP ER 24H 1 mg Y Y N  
00469068773 ASTAGRAF XL tacrolimus CAP ER 24H 5 mg Y Y N  
00469060773 PROGRAF tacrolimus CAPSULE 0.5 mg Y Y N  
00378204501 TACROLIMUS tacrolimus CAPSULE 0.5 mg Y Y N  
00781210201 TACROLIMUS tacrolimus CAPSULE 0.5 mg Y Y N  
00904662361 TACROLIMUS tacrolimus CAPSULE 0.5 mg Y Y N  
16714009801 TACROLIMUS tacrolimus CAPSULE 0.5 mg Y Y N  
16729004101 TACROLIMUS tacrolimus CAPSULE 0.5 mg Y Y N  
51079081701 TACROLIMUS tacrolimus CAPSULE 0.5 mg Y Y N  
51079081720 TACROLIMUS tacrolimus CAPSULE 0.5 mg Y Y N  
55111052501 TACROLIMUS tacrolimus CAPSULE 0.5 mg Y Y N  
59746079801 TACROLIMUS tacrolimus CAPSULE 0.5 mg Y Y N  
64380072006 TACROLIMUS tacrolimus CAPSULE 0.5 mg Y Y N  
67877027801 TACROLIMUS tacrolimus CAPSULE 0.5 mg Y Y N  
68084044901 TACROLIMUS tacrolimus CAPSULE 0.5 mg Y Y N  
68084044911 TACROLIMUS tacrolimus CAPSULE 0.5 mg Y Y N  
68462068501 TACROLIMUS tacrolimus CAPSULE 0.5 mg Y Y N  
70377001411 TACROLIMUS tacrolimus CAPSULE 0.5 mg Y Y N  
72572076001 TACROLIMUS tacrolimus CAPSULE 0.5 mg Y Y N  
82009016401 TACROLIMUS tacrolimus CAPSULE 0.5 mg Y Y N  
00469061773 PROGRAF tacrolimus CAPSULE 1 mg Y Y N  
00378204601 TACROLIMUS tacrolimus CAPSULE 1 mg Y Y N  
00781210301 TACROLIMUS tacrolimus CAPSULE 1 mg Y Y N  
00904709761 TACROLIMUS tacrolimus CAPSULE 1 mg Y Y N  
16714009901 TACROLIMUS tacrolimus CAPSULE 1 mg Y Y N  
16729004201 TACROLIMUS tacrolimus CAPSULE 1 mg Y Y N  
51079081801 TACROLIMUS tacrolimus CAPSULE 1 mg Y Y N  
51079081820 TACROLIMUS tacrolimus CAPSULE 1 mg Y Y N  
55111052601 TACROLIMUS tacrolimus CAPSULE 1 mg Y Y N  
59746079901 TACROLIMUS tacrolimus CAPSULE 1 mg Y Y N  
64380072106 TACROLIMUS tacrolimus CAPSULE 1 mg Y Y N  
67877027901 TACROLIMUS tacrolimus CAPSULE 1 mg Y Y N  
68084045001 TACROLIMUS tacrolimus CAPSULE 1 mg Y Y N  
68084045011 TACROLIMUS tacrolimus CAPSULE 1 mg Y Y N  
68462068601 TACROLIMUS tacrolimus CAPSULE 1 mg Y Y N  
70377001511 TACROLIMUS tacrolimus CAPSULE 1 mg Y Y N  
72572076101 TACROLIMUS tacrolimus CAPSULE 1 mg Y Y N  
82009005401 TACROLIMUS tacrolimus CAPSULE 1 mg Y Y N  
00469065773 PROGRAF tacrolimus CAPSULE 5 mg Y Y N  
00378204701 TACROLIMUS tacrolimus CAPSULE 5 mg Y Y N  
00781210401 TACROLIMUS tacrolimus CAPSULE 5 mg Y Y N  
00904662461 TACROLIMUS tacrolimus CAPSULE 5 mg Y Y N  
16714010001 TACROLIMUS tacrolimus CAPSULE 5 mg Y Y N  
16729004301 TACROLIMUS tacrolimus CAPSULE 5 mg Y Y N  
51079002801 TACROLIMUS tacrolimus CAPSULE 5 mg Y Y N  
51079002820 TACROLIMUS tacrolimus CAPSULE 5 mg Y Y N  
55111052701 TACROLIMUS tacrolimus CAPSULE 5 mg Y Y N  
59746080001 TACROLIMUS tacrolimus CAPSULE 5 mg Y Y N  
64380072206 TACROLIMUS tacrolimus CAPSULE 5 mg Y Y N  
67877028001 TACROLIMUS tacrolimus CAPSULE 5 mg Y Y N  
68084045101 TACROLIMUS tacrolimus CAPSULE 5 mg Y Y N  
68084045111 TACROLIMUS tacrolimus CAPSULE 5 mg Y Y N  
68462068701 TACROLIMUS tacrolimus CAPSULE 5 mg Y Y N  
70377001611 TACROLIMUS tacrolimus CAPSULE 5 mg Y Y N  
82009016501 TACROLIMUS tacrolimus CAPSULE 5 mg Y Y N  
00469123050 PROGRAF tacrolimus GRAN PACK 0.2 mg Y Y N  
00469133050 PROGRAF tacrolimus GRAN PACK 1 mg Y Y N  
68992307501 ENVARSUS XR tacrolimus TAB ER 24H 0.75 mg Y Y N  
68992307503 ENVARSUS XR tacrolimus TAB ER 24H 0.75 mg Y Y N  
68992301001 ENVARSUS XR tacrolimus TAB ER 24H 1 mg Y Y N  
68992301003 ENVARSUS XR tacrolimus TAB ER 24H 1 mg Y Y N  
68992304001 ENVARSUS XR tacrolimus TAB ER 24H 4 mg Y Y N  
68992304003 ENVARSUS XR tacrolimus TAB ER 24H 4 mg Y Y N  
14789013505 TACROLIMUS tacrolimus VIAL 5 mg/mL Y N  
14789013507 TACROLIMUS tacrolimus VIAL 5 mg/mL Y N  
75626000101 LUPKYNIS voclosporin CAPSULE 7.9 mg N Y N Pharmacy PA
75626000102 LUPKYNIS voclosporin CAPSULE 7.9 mg N Y N Pharmacy PA
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