Antiepileptics, Parenteral

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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
00121107502 BRIVARACETAM brivaracetam VIAL 50 mg/5 mL N Y  
00121107555 BRIVARACETAM brivaracetam VIAL 50 mg/5 mL N Y  
42571037092 BRIVARACETAM brivaracetam VIAL 50 mg/5 mL N Y  
42571037099 BRIVARACETAM brivaracetam VIAL 50 mg/5 mL N Y  
72205027201 BRIVARACETAM brivaracetam VIAL 50 mg/5 mL N Y  
72205027207 BRIVARACETAM brivaracetam VIAL 50 mg/5 mL N Y  
50474097063 BRIVIACT brivaracetam VIAL 50 mg/5 mL N Y  
50474097075 BRIVIACT brivaracetam VIAL 50 mg/5 mL N Y  
00832602211 CARBAMAZEPINE ER carbamazepine TAB ER 12H 100 mg Y Y  
13668028401 CARBAMAZEPINE ER carbamazepine TAB ER 12H 100 mg Y Y  
16571068001 CARBAMAZEPINE ER carbamazepine TAB ER 12H 100 mg Y Y  
16714006301 CARBAMAZEPINE ER carbamazepine TAB ER 12H 100 mg Y Y  
42806027401 CARBAMAZEPINE ER carbamazepine TAB ER 12H 100 mg Y Y  
50742025701 CARBAMAZEPINE ER carbamazepine TAB ER 12H 100 mg Y Y  
51672412301 CARBAMAZEPINE ER carbamazepine TAB ER 12H 100 mg Y Y  
59746078901 CARBAMAZEPINE ER carbamazepine TAB ER 12H 100 mg Y Y  
62135092760 CARBAMAZEPINE ER carbamazepine TAB ER 12H 100 mg Y Y  
62332042031 CARBAMAZEPINE ER carbamazepine TAB ER 12H 100 mg Y Y  
68382055501 CARBAMAZEPINE ER carbamazepine TAB ER 12H 100 mg Y Y  
72603088601 CARBAMAZEPINE ER carbamazepine TAB ER 12H 100 mg Y  
00832602311 CARBAMAZEPINE ER carbamazepine TAB ER 12H 200 mg Y Y  
13668028501 CARBAMAZEPINE ER carbamazepine TAB ER 12H 200 mg Y Y  
16571068101 CARBAMAZEPINE ER carbamazepine TAB ER 12H 200 mg Y Y  
16714006401 CARBAMAZEPINE ER carbamazepine TAB ER 12H 200 mg Y Y  
42806027501 CARBAMAZEPINE ER carbamazepine TAB ER 12H 200 mg Y Y  
50742025801 CARBAMAZEPINE ER carbamazepine TAB ER 12H 200 mg Y Y  
51672412401 CARBAMAZEPINE ER carbamazepine TAB ER 12H 200 mg Y Y  
59746079001 CARBAMAZEPINE ER carbamazepine TAB ER 12H 200 mg Y Y  
60687058311 CARBAMAZEPINE ER carbamazepine TAB ER 12H 200 mg Y Y  
60687058321 CARBAMAZEPINE ER carbamazepine TAB ER 12H 200 mg Y Y  
62135092860 CARBAMAZEPINE ER carbamazepine TAB ER 12H 200 mg Y Y  
62332042131 CARBAMAZEPINE ER carbamazepine TAB ER 12H 200 mg Y Y  
68382055601 CARBAMAZEPINE ER carbamazepine TAB ER 12H 200 mg Y Y  
72603088701 CARBAMAZEPINE ER carbamazepine TAB ER 12H 200 mg Y  
00832602411 CARBAMAZEPINE ER carbamazepine TAB ER 12H 400 mg Y Y  
13668028601 CARBAMAZEPINE ER carbamazepine TAB ER 12H 400 mg Y Y  
16571068201 CARBAMAZEPINE ER carbamazepine TAB ER 12H 400 mg Y Y  
16714006501 CARBAMAZEPINE ER carbamazepine TAB ER 12H 400 mg Y Y  
42806027601 CARBAMAZEPINE ER carbamazepine TAB ER 12H 400 mg Y Y  
50742025901 CARBAMAZEPINE ER carbamazepine TAB ER 12H 400 mg Y Y  
51672412501 CARBAMAZEPINE ER carbamazepine TAB ER 12H 400 mg Y Y  
59746079101 CARBAMAZEPINE ER carbamazepine TAB ER 12H 400 mg Y Y  
60687059411 CARBAMAZEPINE ER carbamazepine TAB ER 12H 400 mg Y Y  
60687059421 CARBAMAZEPINE ER carbamazepine TAB ER 12H 400 mg Y Y  
62135093060 CARBAMAZEPINE ER carbamazepine TAB ER 12H 400 mg Y Y  
62332042231 CARBAMAZEPINE ER carbamazepine TAB ER 12H 400 mg Y Y  
68382055701 CARBAMAZEPINE ER carbamazepine TAB ER 12H 400 mg Y Y  
72603088801 CARBAMAZEPINE ER carbamazepine TAB ER 12H 400 mg Y  
00069547101 CEREBYX fosphenytoin sodium VIAL 100 mg PE/2 mL Y  
00069547102 CEREBYX fosphenytoin sodium VIAL 100 mg PE/2 mL Y  
00069600102 CEREBYX fosphenytoin sodium VIAL 100 mg PE/2 mL Y  
00069600125 CEREBYX fosphenytoin sodium VIAL 100 mg PE/2 mL Y  
00641613601 FOSPHENYTOIN SODIUM fosphenytoin sodium VIAL 100 mg PE/2 mL Y  
00641613625 FOSPHENYTOIN SODIUM fosphenytoin sodium VIAL 100 mg PE/2 mL Y  
25021079802 FOSPHENYTOIN SODIUM fosphenytoin sodium VIAL 100 mg PE/2 mL Y  
63323040301 FOSPHENYTOIN SODIUM fosphenytoin sodium VIAL 100 mg PE/2 mL Y  
63323040302 FOSPHENYTOIN SODIUM fosphenytoin sodium VIAL 100 mg PE/2 mL Y  
68462062102 FOSPHENYTOIN SODIUM fosphenytoin sodium VIAL 100 mg PE/2 mL Y  
68462062154 FOSPHENYTOIN SODIUM fosphenytoin sodium VIAL 100 mg PE/2 mL Y  
70121138101 FOSPHENYTOIN SODIUM fosphenytoin sodium VIAL 100 mg PE/2 mL Y  
00069547401 CEREBYX fosphenytoin sodium VIAL 500 mg PE/10 mL Y  
00069547402 CEREBYX fosphenytoin sodium VIAL 500 mg PE/10 mL Y  
00069600110 CEREBYX fosphenytoin sodium VIAL 500 mg PE/10 mL Y  
00069600121 CEREBYX fosphenytoin sodium VIAL 500 mg PE/10 mL Y  
00641613701 FOSPHENYTOIN SODIUM fosphenytoin sodium VIAL 500 mg PE/10 mL Y  
00641613710 FOSPHENYTOIN SODIUM fosphenytoin sodium VIAL 500 mg PE/10 mL Y  
25021079810 FOSPHENYTOIN SODIUM fosphenytoin sodium VIAL 500 mg PE/10 mL Y  
63323040304 FOSPHENYTOIN SODIUM fosphenytoin sodium VIAL 500 mg PE/10 mL Y  
63323040310 FOSPHENYTOIN SODIUM fosphenytoin sodium VIAL 500 mg PE/10 mL Y  
67457051710 FOSPHENYTOIN SODIUM fosphenytoin sodium VIAL 500 mg PE/10 mL Y  
68462062210 FOSPHENYTOIN SODIUM fosphenytoin sodium VIAL 500 mg PE/10 mL Y  
68462062264 FOSPHENYTOIN SODIUM fosphenytoin sodium VIAL 500 mg PE/10 mL Y  
68462094510 FOSPHENYTOIN SODIUM fosphenytoin sodium VIAL 500 mg PE/10 mL Y  
68462094564 FOSPHENYTOIN SODIUM fosphenytoin sodium VIAL 500 mg PE/10 mL Y  
70121139001 FOSPHENYTOIN SODIUM fosphenytoin sodium VIAL 500 mg PE/10 mL Y  
70121139007 FOSPHENYTOIN SODIUM fosphenytoin sodium VIAL 500 mg PE/10 mL Y  
45861010801 ACTIVE-PAC gabapentin/lidocaine/menthol KIT GEL-CP 300 mg-4 %-1 % N Y  
13811020740 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
13811020774 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
25021079120 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
31722020320 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
31722020331 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
31722020332 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
31722020333 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
43598008711 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
43598008758 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
60505623500 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
60505623504 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
65219020401 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
65219020420 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
68462069720 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
68462069730 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
69367035210 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
69367035220 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
69543045510 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
69543045520 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
70069047101 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
70069047110 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
70710135901 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
70710135906 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
70710188601 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
70710188606 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
72205022001 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
72205022007 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
72266024201 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
72266024205 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
72603026301 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
72603026302 LACOSAMIDE lacosamide VIAL 200 mg/20 mL Y  
00131181067 VIMPAT lacosamide VIAL 200 mg/20 mL Y  
50474000263 KEPPRA levetiracetam VIAL 500 mg/5 mL Y  
00143967301 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
00143967325 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
00409188602 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
00409188622 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
00409201105 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
00409201125 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
25021078005 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
43547045410 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
43547045441 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
55150017705 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
58657086000 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
58657086001 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
58657086010 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
58657086025 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
63323040001 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
63323040005 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
63323040041 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
63323040044 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
67457079000 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
67457079005 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
68094031301 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
68094031310 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
68094031325 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
72205012001 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
72205012007 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
72205012025 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
72485010601 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
72485010610 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
72485010625 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
72572036001 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
72572036025 LEVETIRACETAM levetiracetam VIAL 500 mg/5 mL Y  
00143928201 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,000 mg/100 mL Y  
00143928210 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,000 mg/100 mL Y  
00264100990 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,000 mg/100 mL Y  
14789022008 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,000 mg/100 mL Y  
14789022010 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,000 mg/100 mL Y  
25021079482 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,000 mg/100 mL Y  
36000035601 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,000 mg/100 mL Y  
36000035640 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,000 mg/100 mL Y  
43598063610 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,000 mg/100 mL Y  
43598063652 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,000 mg/100 mL Y  
43598075710 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,000 mg/100 mL Y  
43598075752 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,000 mg/100 mL Y  
44567050201 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,000 mg/100 mL Y  
44567050210 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,000 mg/100 mL Y  
55150024747 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,000 mg/100 mL Y  
65145017401 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,000 mg/100 mL Y  
65145017410 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,000 mg/100 mL Y  
65219004421 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,000 mg/100 mL Y  
65219004471 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,000 mg/100 mL Y  
67457026500 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,000 mg/100 mL Y  
67457026510 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,000 mg/100 mL Y  
70069084601 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,000 mg/100 mL Y  
70069084610 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,000 mg/100 mL Y  
00143928301 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,500 mg/100 mL Y  
00143928310 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,500 mg/100 mL Y  
00264150990 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,500 mg/100 mL Y  
14789033008 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,500 mg/100 mL Y  
14789033015 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,500 mg/100 mL Y  
25021079582 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,500 mg/100 mL Y  
36000035401 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,500 mg/100 mL Y  
36000035440 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,500 mg/100 mL Y  
43598063710 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,500 mg/100 mL Y  
43598063752 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,500 mg/100 mL Y  
43598075910 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,500 mg/100 mL Y  
43598075952 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,500 mg/100 mL Y  
44567050301 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,500 mg/100 mL Y  
44567050310 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,500 mg/100 mL Y  
55150024847 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,500 mg/100 mL Y  
65145017501 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,500 mg/100 mL Y  
65145017510 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,500 mg/100 mL Y  
65219004621 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,500 mg/100 mL Y  
65219004671 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,500 mg/100 mL Y  
67457026600 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,500 mg/100 mL Y  
67457026610 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,500 mg/100 mL Y  
70069084701 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,500 mg/100 mL Y  
70069084710 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 1,500 mg/100 mL Y  
44567050001 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 250 mg/50 mL Y  
44567050010 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 250 mg/50 mL Y  
00143928101 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 500 mg/100 mL Y  
00143928110 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 500 mg/100 mL Y  
00264500990 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 500 mg/100 mL Y  
14789011005 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 500 mg/100 mL Y  
14789011008 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 500 mg/100 mL Y  
25021079382 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 500 mg/100 mL Y  
36000035201 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 500 mg/100 mL Y  
36000035240 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 500 mg/100 mL Y  
43598063510 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 500 mg/100 mL Y  
43598063552 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 500 mg/100 mL Y  
43598075510 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 500 mg/100 mL Y  
43598075552 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 500 mg/100 mL Y  
44567050101 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 500 mg/100 mL Y  
44567050102 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 500 mg/100 mL Y  
44567050110 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 500 mg/100 mL Y  
44567050190 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 500 mg/100 mL Y  
55150024647 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 500 mg/100 mL Y  
65145017301 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 500 mg/100 mL Y  
65145017310 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 500 mg/100 mL Y  
65219004221 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 500 mg/100 mL Y  
65219004271 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 500 mg/100 mL Y  
67457025500 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 500 mg/100 mL Y  
67457025510 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 500 mg/100 mL Y  
70069084501 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 500 mg/100 mL Y  
70069084510 LEVETIRACETAM-NACL levetiracetam in NaCl (iso-os) PIGGYBACK 500 mg/100 mL Y  
00904726261 OXCARBAZEPINE oxcarbazepine TABLET 150 mg Y Y  
00904759361 OXCARBAZEPINE oxcarbazepine TABLET 150 mg Y  
31722002301 OXCARBAZEPINE oxcarbazepine TABLET 150 mg Y Y  
31722002305 OXCARBAZEPINE oxcarbazepine TABLET 150 mg Y Y  
50268067911 OXCARBAZEPINE oxcarbazepine TABLET 150 mg Y Y  
50268067915 OXCARBAZEPINE oxcarbazepine TABLET 150 mg Y Y  
51991005301 OXCARBAZEPINE oxcarbazepine TABLET 150 mg Y Y  
51991005305 OXCARBAZEPINE oxcarbazepine TABLET 150 mg Y Y  
51991029201 OXCARBAZEPINE oxcarbazepine TABLET 150 mg Y Y  
51991029205 OXCARBAZEPINE oxcarbazepine TABLET 150 mg Y Y  
60687071101 OXCARBAZEPINE oxcarbazepine TABLET 150 mg Y Y  
60687071111 OXCARBAZEPINE oxcarbazepine TABLET 150 mg Y Y  
62559022001 OXCARBAZEPINE oxcarbazepine TABLET 150 mg Y Y  
62756018313 OXCARBAZEPINE oxcarbazepine TABLET 150 mg Y Y  
62756018318 OXCARBAZEPINE oxcarbazepine TABLET 150 mg Y Y  
62756018388 OXCARBAZEPINE oxcarbazepine TABLET 150 mg Y Y  
68462013701 OXCARBAZEPINE oxcarbazepine TABLET 150 mg Y Y  
72888008701 OXCARBAZEPINE oxcarbazepine TABLET 150 mg Y Y  
72888008705 OXCARBAZEPINE oxcarbazepine TABLET 150 mg Y Y  
72888046201 OXCARBAZEPINE oxcarbazepine TABLET 150 mg Y Y  
72888046202 OXCARBAZEPINE oxcarbazepine TABLET 150 mg Y Y  
00904726361 OXCARBAZEPINE oxcarbazepine TABLET 300 mg Y Y  
00904759461 OXCARBAZEPINE oxcarbazepine TABLET 300 mg Y  
31722002401 OXCARBAZEPINE oxcarbazepine TABLET 300 mg Y Y  
31722002405 OXCARBAZEPINE oxcarbazepine TABLET 300 mg Y Y  
50268068011 OXCARBAZEPINE oxcarbazepine TABLET 300 mg Y Y  
50268068015 OXCARBAZEPINE oxcarbazepine TABLET 300 mg Y Y  
51991005401 OXCARBAZEPINE oxcarbazepine TABLET 300 mg Y Y  
51991005405 OXCARBAZEPINE oxcarbazepine TABLET 300 mg Y Y  
51991029301 OXCARBAZEPINE oxcarbazepine TABLET 300 mg Y Y  
51991029305 OXCARBAZEPINE oxcarbazepine TABLET 300 mg Y Y  
60687072201 OXCARBAZEPINE oxcarbazepine TABLET 300 mg Y Y  
60687072211 OXCARBAZEPINE oxcarbazepine TABLET 300 mg Y Y  
62559022101 OXCARBAZEPINE oxcarbazepine TABLET 300 mg Y Y  
62559022105 OXCARBAZEPINE oxcarbazepine TABLET 300 mg Y Y  
68462013801 OXCARBAZEPINE oxcarbazepine TABLET 300 mg Y Y  
72603027101 OXCARBAZEPINE oxcarbazepine TABLET 300 mg Y Y  
72603027102 OXCARBAZEPINE oxcarbazepine TABLET 300 mg Y Y  
72888008801 OXCARBAZEPINE oxcarbazepine TABLET 300 mg Y Y  
72888008805 OXCARBAZEPINE oxcarbazepine TABLET 300 mg Y Y  
72888046001 OXCARBAZEPINE oxcarbazepine TABLET 300 mg Y Y  
72888046002 OXCARBAZEPINE oxcarbazepine TABLET 300 mg Y Y  
00904726461 OXCARBAZEPINE oxcarbazepine TABLET 600 mg Y Y  
31722002501 OXCARBAZEPINE oxcarbazepine TABLET 600 mg Y Y  
31722002505 OXCARBAZEPINE oxcarbazepine TABLET 600 mg Y Y  
50268068111 OXCARBAZEPINE oxcarbazepine TABLET 600 mg Y Y  
50268068115 OXCARBAZEPINE oxcarbazepine TABLET 600 mg Y Y  
51991005501 OXCARBAZEPINE oxcarbazepine TABLET 600 mg Y Y  
51991005505 OXCARBAZEPINE oxcarbazepine TABLET 600 mg Y Y  
51991029401 OXCARBAZEPINE oxcarbazepine TABLET 600 mg Y Y  
51991029405 OXCARBAZEPINE oxcarbazepine TABLET 600 mg Y Y  
60687073301 OXCARBAZEPINE oxcarbazepine TABLET 600 mg Y Y  
60687073311 OXCARBAZEPINE oxcarbazepine TABLET 600 mg Y Y  
62559022201 OXCARBAZEPINE oxcarbazepine TABLET 600 mg Y Y  
62559022205 OXCARBAZEPINE oxcarbazepine TABLET 600 mg Y Y  
68462013901 OXCARBAZEPINE oxcarbazepine TABLET 600 mg Y Y  
72603027201 OXCARBAZEPINE oxcarbazepine TABLET 600 mg Y Y  
72603027202 OXCARBAZEPINE oxcarbazepine TABLET 600 mg Y Y  
72888008901 OXCARBAZEPINE oxcarbazepine TABLET 600 mg Y Y  
72888008905 OXCARBAZEPINE oxcarbazepine TABLET 600 mg Y Y  
72888046101 OXCARBAZEPINE oxcarbazepine TABLET 600 mg Y Y  
72888046102 OXCARBAZEPINE oxcarbazepine TABLET 600 mg Y Y  
00641049321 PHENYTOIN SODIUM phenytoin sodium VIAL 50 mg/mL Y  
00641049325 PHENYTOIN SODIUM phenytoin sodium VIAL 50 mg/mL Y  
00641255510 PHENYTOIN SODIUM phenytoin sodium VIAL 50 mg/mL Y  
00641255541 PHENYTOIN SODIUM phenytoin sodium VIAL 50 mg/mL Y  
00641613801 PHENYTOIN SODIUM phenytoin sodium VIAL 50 mg/mL Y  
00641613825 PHENYTOIN SODIUM phenytoin sodium VIAL 50 mg/mL Y  
00641613901 PHENYTOIN SODIUM phenytoin sodium VIAL 50 mg/mL Y  
00641613910 PHENYTOIN SODIUM phenytoin sodium VIAL 50 mg/mL Y  
42192061402 PHENYTOIN SODIUM phenytoin sodium VIAL 50 mg/mL Y  
42192061405 PHENYTOIN SODIUM phenytoin sodium VIAL 50 mg/mL Y  
42192061410 PHENYTOIN SODIUM phenytoin sodium VIAL 50 mg/mL Y  
42192061430 PHENYTOIN SODIUM phenytoin sodium VIAL 50 mg/mL Y  
00143963701 VALPROATE SODIUM valproic acid (as sodium salt) VIAL 500 mg/5 mL (100 mg/mL) Y BILL FFS  
00143963710 VALPROATE SODIUM valproic acid (as sodium salt) VIAL 500 mg/5 mL (100 mg/mL) Y BILL FFS  
00143978501 VALPROATE SODIUM valproic acid (as sodium salt) VIAL 500 mg/5 mL (100 mg/mL) Y BILL FFS  
00143978510 VALPROATE SODIUM valproic acid (as sodium salt) VIAL 500 mg/5 mL (100 mg/mL) Y BILL FFS  
25021079705 VALPROATE SODIUM valproic acid (as sodium salt) VIAL 500 mg/5 mL (100 mg/mL) Y BILL FFS  
63323049401 VALPROATE SODIUM valproic acid (as sodium salt) VIAL 500 mg/5 mL (100 mg/mL) Y BILL FFS  
63323049405 VALPROATE SODIUM valproic acid (as sodium salt) VIAL 500 mg/5 mL (100 mg/mL) Y BILL FFS  
63323049416 VALPROATE SODIUM valproic acid (as sodium salt) VIAL 500 mg/5 mL (100 mg/mL) Y BILL FFS  
63323049441 VALPROATE SODIUM valproic acid (as sodium salt) VIAL 500 mg/5 mL (100 mg/mL) Y BILL FFS  
70860078441 VALPROATE SODIUM valproic acid (as sodium salt) VIAL 500 mg/5 mL (100 mg/mL) Y BILL FFS  
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