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Drug Formulary Lookup - Search Results

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DIN Brand Name Generic Name Description Eligibility
Status		 ATC Code
02509067  ACH-METHOTREXATE METHOTREXATE 2.5MG  TAB Part 1 Benefit L01BA01
02182963  APO-METHOTREXATE METHOTREXATE 2.5MG  TAB Part 1 Benefit L01BA01
02524023  AURO-METHOTREXATE METHOTREXATE 2.5MG  TAB Part 1 Benefit L04AX03
02553740  JAMP METHOTREXATE TABLETS METHOTREXATE 10MG  TAB Part 1 Benefit L01BA01
02534916  M-METHOTREXATE METHOTREXATE 2.5MG  TAB Part 1 Benefit L01BA01
02422182  METHOTREXATE METHOTREXATE 15MG/0.6ML INJ Part 1 Benefit L01BA
02422190  METHOTREXATE METHOTREXATE 20MG/0.8ML INJ Part 1 Benefit L01BA
02491362  METHOTREXATE METHOTREXATE 25MG/0.5ML INJ Part 1 Benefit L04AX03
02422204  METHOTREXATE METHOTREXATE 25MG/ML  INJ Part 1 Benefit L01BA
02422166  METHOTREXATE METHOTREXATE 7.5MG/0.3M INJ Part 1 Benefit L01BA
02182750  METHOTREXATE METHOTREXATE 10MG  TAB Part 1 Benefit L01BA01
02099705  METHOTREXATE (PF) METHOTREXATE 25MG/ML  INJ Part 1 Benefit L01BA01
02422174  METHOTREXATE INJ METHOTREXATE 10MG/0.4ML INJ Part 1 Benefit L01BA
02182947  METHOTREXATE INJECTION METHOTREXATE 20MG/2ML  LIQ Part 1 Benefit L01BA01
02464365  METHOTREXATE INJECTION BP METHOTREXATE W PRESERVATIVE 25MG/ML  INJ Part 1 Benefit L01BA01
02182777  METHOTREXATE INJECTION USP METHOTREXATE W PRESERVATIVE 25MG/ML  INJ Part 1 Benefit L01BA01
02182955  METHOTREXATE SODIUM WOP METHOTREXATE 25MG/ML  INJ Part 1 Benefit L01BA01
02182971  METHOTREXATE SODIUM WOP METHOTREXATE 25MG/ML  INJ Part 1 Benefit L01BA01
02491281  METHOTREXATE SUBCUTANEOUS METHOTREXATE 10MG/0.2ML INJ Part 1 Benefit L04AX03
02491303  METHOTREXATE SUBCUTANEOUS METHOTREXATE 12.5MG/.25 INJ Part 1 Benefit L04AX03
02491311  METHOTREXATE SUBCUTANEOUS METHOTREXATE 15MG/0.3ML INJ Part 1 Benefit L04AX03
02491338  METHOTREXATE SUBCUTANEOUS METHOTREXATE 17.5/.35ML INJ Part 1 Benefit L04AX03
02491346  METHOTREXATE SUBCUTANEOUS METHOTREXATE 20MG/0.4ML INJ Part 1 Benefit L04AX03
02491354  METHOTREXATE SUBCUTANEOUS METHOTREXATE 22.5/.45ML INJ Part 1 Benefit L04AX03
02454831  METOJECT SUBCUTANEOUS METHOTREXATE 10MG/0.2ML INJ Part 1 Benefit L04AX03

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Data Last Updated: 4/27/2026 6:00:06 AM