MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
ABACAVIR 300 MG TABLET
65862007360
AETNA (ARGUS)
RXAETD
1/18/2017
ABACAVIR 300 MG TABLET
65862007360
CATAMARAN
-
3/20/2017
ABACAVIR 300 MG TABLET
60505358306
CATAMARAN
(blank)
3/3/2017
ABACAVIR 300 MG TABLET
60505358306
CATAMARAN
(blank)
3/30/2017
ACAMPROSATE CALC DR 333 MG TAB
68462043518
CAREMARK
788257
5/5/2017
ACAMPROSATE CALC DR 333 MG TAB
68462043518
NAVITUS HEALTH SOLNS
OLC
11/8/2016
ACAMPROSATE CALC DR 333 MG TAB
00378633380
AETNA (ARGUS)
RXAETD
1/10/2017
ACARBOSE 100 MG TABLET
64380076006
AETNA (ARGUS)
RXAETD
1/10/2017
ACARBOSE 25 MG TABLET
23155014701
AETNA (ARGUS)
RXAETD
1/10/2017
ACETAMIN-CAFF-DIHYDROCOD 320.5
42195084010
CITIZENSRX LLC
LSYA
1/3/2017
ACETAMINOPHEN-COD #3 TABLET
00093015001
AETNA (ARGUS)
RXAETD
1/10/2017
ACETAMINOPHEN-COD #3 TABLET
00406048410
MAXOR PLUS
030201
3/31/2017
ACETAMINOPHEN-COD #4 TABLET
00603233928
AETNA (ARGUS)
RXAETD
1/18/2017
ACETAZOLAMIDE 250 MG TABLET
51672402301
AETNA (ARGUS)
RXAETD
1/18/2017
ACETAZOLAMIDE 250 MG TABLET
51672402301
CATAMARAN
(blank)
3/23/2017
ACETAZOLAMIDE 250 MG TABLET
51672402301
CITIZENSRX LLC
150
3/31/2017
ACETAZOLAMIDE ER 500 MG CAP
68382026101
AETNA (ARGUS)
RXAETD
1/10/2017
ACETAZOLAMIDE ER 500 MG CAP
68382026101
CATAMARAN
HSPMCAID
3/20/2017
ACETAZOLAMIDE ER 500 MG CAP
68382026101
CATAMARAN
246534615CIGV
3/30/2017
ACETAZOLAMIDE ER 500 MG CAP
68382026101
OPTUMRX
PDPIND
2/3/2017
ACETAZOLAMIDE ER 500 MG CAP
68382026101
OPTUMRX
U0744260
2/17/2017
ACETIC ACID 2% EAR SOLUTION
50383088915
AETNA (ARGUS)
RXAETD
1/10/2017
ACETIC ACID-ALUMINUM DROPS
24208061577
CATAMARAN
0616660
1/9/2017
ACETYLCYSTEINE 20% VIAL
00409330803
MERIDIANRX
HPMMCD
11/23/2016
ACITRETIN 10 MG CAPSULE
42794008008
AETNA (ARGUS)
RXAETD
1/10/2017
ACITRETIN 10 MG CAPSULE
42794008008
CATAMARAN
(blank)
3/23/2017
ACITRETIN 17.5 MG CAPSULE
42794008108
ARGUS
(blank)
3/20/2017
ACITRETIN 25 MG CAPSULE
42794008308
NMHC
EGWPS035
2/9/2017
ACITRETIN 25 MG CAPSULE
42794008308
OPTUMRX
COS
2/3/2017
ACITRETIN 25 MG CAPSULE
42794008308
MERIDIANRX
GMSSJBMANAGE
5/23/2017
ACYCLOVIR 200 MG CAPSULE
60505004206
NAVITUS HEALTH SOLNS
DAC
11/2/2016
ACYCLOVIR 200 MG/5 ML SUSP
00472008216
PRIME THERAPEUTICS
0151S50000
1/19/2017
ACYCLOVIR 200 MG/5 ML SUSP
00472008216
PRIME THERAPEUTICS
080869
4/7/2017
ACYCLOVIR 200 MG/5 ML SUSP
00472008216
NAVITUS HEALTH SOLNS
TCH
5/4/2017
ACYCLOVIR 400 MG TABLET
00093894305
MAXOR PLUS
(blank)
3/31/2017
ACYCLOVIR 5% OINTMENT
65162083594
AETNA (ARGUS)
RXAETD
1/10/2017
ACYCLOVIR 5% OINTMENT
65162083594
PRIME THERAPEUTICS
(blank)
5/19/2017
ACYCLOVIR 5% OINTMENT
65162083594
NAVITUS HEALTH SOLNS
CCHPREG
12/7/2016
ACYCLOVIR 5% OINTMENT
00378870049
OPTUMRX
PDPIND
2/3/2017
ACYCLOVIR 5% OINTMENT
00591115930
AETNA (ARGUS)
RXAETD
1/10/2017
ACYCLOVIR 800 MG TABLET
00093894705
MAXOR PLUS
V1480001
2/6/2017
ACYCLOVIR 800 MG TABLET
00093894701
OPTUMRX
U0744260
2/17/2017
ACYCLOVIR POWDER
15455950005
PRIME THERAPEUTICS
(blank)
5/19/2017
ADAPALENE 0.1% CREAM
00168042446
OPTUMRX
(blank)
ADAPALENE 0.1% CREAM
00168042446
OPTUMRX
02670003
12/12/2016
ADAPALENE 0.1% CREAM
45802045384
OPTUMRX
COS
5/18/2017
ADAPALENE 0.1% GEL
68462040355
CAREMARK
RXBCID
3/7/2017
ADAPALENE 0.1% GEL
68462040355
CATAMARAN
-
1/25/2017
ADAPALENE 0.1% GEL
68462040355
OPTUMRX
PDPIND
2/3/2017
ADAPALENE 0.3% GEL
00781714219
OPTUMRX
NCCM
4/6/2017
ADAPALENE 0.3% GEL
66993088445
OPTUMRX
OE501
6/2/2017
2/3/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
ADAPALENE 0.3% GEL PUMP
66993088448
OPTUMRX
01962021
MAC Effective Date
2/17/2017
ALBUTEROL 5 MG/ML SOLUTION
50383074120
CAREMARK
RXBCID
1/23/2017
ALBUTEROL 5 MG/ML SOLUTION
50383074120
CATAMARAN
3335948
11/4/2016
ALBUTEROL SUL 0.63 MG/3 ML SOL
00591346753
AETNA (ARGUS)
RXAETD
1/10/2017
ALBUTEROL SUL 1.25 MG/3 ML SOL
00487990425
CATAMARAN
(blank)
1/9/2017
ALBUTEROL SUL 1.25 MG/3 ML SOL
00487990401
AETNA (ARGUS)
RXAETD
1/10/2017
ALBUTEROL SUL 2.5 MG/3 ML SOLN
00487950160
AETNA (ARGUS)
RXAETD
1/10/2017
ALBUTEROL SUL 2.5 MG/3 ML SOLN
00487950160
PRIME THERAPEUTICS
000058
1/13/2017
ALBUTEROL SULFATE 4 MG TAB
00378057201
AETNA (ARGUS)
RXAETD
1/10/2017
ALBUTEROL SULFATE 4 MG TAB
00378057201
NMHC
CALPANTH
1/20/2017
ALCLOMETASONE DIPRO 0.05% CRM
51672130603
NMHC
EGWPS035
1/12/2017
ALCLOMETASONE DIPRO 0.05% CRM
00168026360
OPTUMRX
PDPIND
2/3/2017
ALENDRONATE SOD 70 MG/75 ML
51224030110
CAREMARK
65006500
4/3/2017
ALENDRONATE SODIUM 70 MG TAB
69543013104
MERIDIANRX
(blank)
2/16/2017
ALFUZOSIN HCL ER 10 MG TABLET
60505285001
CAREMARK
788257
12/22/2016
ALFUZOSIN HCL ER 10 MG TABLET
57237011490
NMHC
EGWPS032
3/9/2017
ALFUZOSIN HCL ER 10 MG TABLET
13668002101
CITIZENSRX LLC
(blank)
3/31/2017
ALLOPURINOL 100 MG TABLET
00591554301
CITIZENSRX LLC
1019
3/7/2017
ALLOPURINOL 100 MG TABLET
53489015601
NMHC
(blank)
3/3/2017
ALLOPURINOL 300 MG TABLET
00591554401
AETNA (ARGUS)
RXAETD
1/10/2017
ALPRAZOLAM 2 MG TABLET
67253090350
AETNA (ARGUS)
RXAETD
1/10/2017
ALPRAZOLAM 2 MG TABLET
67253090310
ARGUS
X0001000
5/11/2017
ALPRAZOLAM ODT 1 MG TAB
49884021374
PHS
10015841
4/6/2017
ALPRAZOLAM XR 1 MG TABLET
59762005901
AETNA (ARGUS)
RXAETD
1/10/2017
ALPRAZOLAM XR 1 MG TABLET
59762005901
OPTUMRX
COS
2/14/2017
ALPRAZOLAM XR 1 MG TABLET
59762005901
CATALYST (FUTURESCRIPTS)
-
11/17/2016
1/10/2017
ALPRAZOLAM XR 2 MG TABLET
59762006601
AETNA (ARGUS)
RXAETD
ALPRAZOLAM XR 3 MG TABLET
59762006801
OPTUMRX
PDPIND
3/17/2017
AMANTADINE 100 MG CAPSULE
00832201250
MERIDIANRX
(blank)
12/14/2016
AMANTADINE 100 MG CAPSULE
00832201200
AETNA (ARGUS)
RXAETD
1/10/2017
AMANTADINE 100 MG CAPSULE
00832201200
AETNA (ARGUS)
RXAETD
1/18/2017
AMANTADINE 100 MG CAPSULE
00832201200
PRIME THERAPEUTICS
24572
5/19/2017
AMANTADINE 100 MG TABLET
00832011100
CATAMARAN
CIHSCARE
3/23/2017
AMANTADINE 100 MG TABLET
00832011100
PROCARE RX
CGRX7856
11/30/2016
AMANTADINE 100 MG TABLET
00832011150
MERIDIANRX
(blank)
1/13/2017
AMCINONIDE 0.1% CREAM
00168027860
CATAMARAN
0726832
11/4/2016
AMETHIA 0.15-0.03-0.01 MG TAB
52544026829
CIGNA
(blank)
1/25/2017
AMETHIA 0.15-0.03-0.01 MG TAB
51862004791
NMHC
CALPANTH
5/29/2017
AMETHIA LO TABLET
52544022829
PRIME THERAPEUTICS
BCTX
1/13/2017
AMETHIA LO TABLET
52544022829
PRIME THERAPEUTICS
021185
1/13/2017
AMILORIDE HCL 5 MG TABLET
00574029201
CAREMARK
788257
3/7/2017
AMILORIDE HCL-HCTZ 5-50 MG TAB
00378057701
AETNA (ARGUS)
RXAETD
1/10/2017
AMILORIDE HCL-HCTZ 5-50 MG TAB
00378057701
PHS
26500002
4/6/2017
AMINOPHYLLINE 200 MG TABLET
47202232001
MERIDIANRX
(blank)
5/16/2017
AMIODARONE HCL 100 MG TABLET
51672405506
AETNA (ARGUS)
RXAETD
1/10/2017
AMIODARONE HCL 100 MG TABLET
51672405506
AETNA (ARGUS)
RXAETD
5/9/2017
AMIODARONE HCL 100 MG TABLET
51672405506
OPTUMRX
COS
2/3/2017
AMIODARONE HCL 400 MG TABLET
51672405706
CATAMARAN
-
3/20/2017
AMIODARONE HCL 400 MG TABLET
51672405706
NAVITUS HEALTH SOLNS
COD03
11/8/2016
AMIODARONE HCL 400 MG TABLET
51862015630
AETNA (ARGUS)
RXAETD
4/25/2017
AMITRIPTYLINE HCL 10 MG TAB
00378261001
MAXOR PLUS
S2559
3/7/2017
AMITRIPTYLINE HCL 150 MG TAB
00781149101
AETNA (ARGUS)
RXAETD
1/10/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
AMITRIPTYLINE HCL 150 MG TAB
00781149101
PROCARE RX
(blank)
11/30/2016
AMITRIPTYLINE HCL 150 MG TAB
00603221721
OPTUMRX
ACUAZ
2/14/2017
AMITRIPTYLINE HCL 150 MG TAB
16729017601
CITIZENSRX LLC
1019
3/31/2017
AMITRIPTYLINE HCL 25 MG TAB
00603221332
AETNA (ARGUS)
RXAETD
1/10/2017
AMITRIPTYLINE HCL 25 MG TAB
00603221332
CATAMARAN
3212816
1/9/2017
AMITRIPTYLINE HCL 50 MG TAB
00603221432
CATAMARAN
(blank)
1/25/2017
AMITRIPTYLINE HCL 50 MG TAB
00603221432
MEDIMPACT
UNV03
11/22/2016
AMITRIPTYLINE HCL 50 MG TAB
00781148801
CAREMARK
788257
12/22/2016
AMITRIPTYLINE HCL 50 MG TAB
00603221421
AETNA (ARGUS)
RXAETD
1/10/2017
AMITRIPTYLINE HCL 50 MG TAB
00603221421
PRIME THERAPEUTICS
(blank)
1/6/2017
AMITRIPTYLINE HCL 50 MG TAB
00781148810
CATAMARAN
(blank)
3/21/2017
AMITRIPTYLINE HCL 50 MG TAB
00781148810
PHS
-
AMITRIPTYLINE HCL 50 MG TAB
00781148810
MERIDIANRX
(blank)
10/31/2016
AMITRIPTYLINE HCL 75 MG TAB
16729017401
PRIME THERAPEUTICS
B0000002
1/19/2017
AMITRIPTYLINE HCL 75 MG TAB
16729017401
MERIDIANRX
(blank)
2/21/2017
AMITRIPTYLINE HCL 75 MG TAB
00603221521
AETNA (ARGUS)
RXAETD
4/11/2017
AMITRIPTYLINE HCL 75 MG TAB
00781148901
AETNA (ARGUS)
RXAETD
1/10/2017
AMITRIPTYLINE HCL 75 MG TAB
00781148901
AETNA (ARGUS)
RXAETD
4/11/2017
AMITRIPTYLINE HCL 75 MG TAB
00781148901
MERIDIANRX
(blank)
4/6/2017
AMLODIPINE BESYLATE 10 MG TAB
68382012305
PRIME THERAPEUTICS
080504
1/13/2017
AMLODIPINE BESYLATE 5 MG TAB
00093716755
PRIME THERAPEUTICS
(blank)
1/13/2017
AMLODIPINE-ATORVAST 10-40 MG
43598031530
AETNA (ARGUS)
RXAETD
1/31/2017
AMLODIPINE-ATORVAST 5-10 MG
59762672001
NMHC
CALPHLNT
1/12/2017
AMLODIPINE-ATORVAST 5-40 MG
59762672201
AETNA (ARGUS)
RXAETD
1/10/2017
AMLODIPINE-BENAZEPRIL 10-20 MG
68001013000
AETNA (ARGUS)
RXAETD
1/10/2017
AMLODIPINE-BENAZEPRIL 10-20 MG
68001013000
CATAMARAN
2499665
2/3/2017
AMLODIPINE-BENAZEPRIL 10-40 MG
68001013100
AETNA (ARGUS)
RXAETD
1/10/2017
AMLODIPINE-BENAZEPRIL 10-40 MG
68001013100
NAVITUS HEALTH SOLNS
HHX
11/2/2016
AMLODIPINE-BENAZEPRIL 5-20 MG
00591375905
CATAMARAN
-
3/21/2017
AMLODIPINE-BENAZEPRIL 5-20 MG
68001013400
CIGNA
3338841
3/21/2017
AMLODIPINE-BENAZEPRIL 5-40 MG
68001013500
AETNA (ARGUS)
RXAETD
1/10/2017
AMLODIPINE-BENAZEPRIL 5-40 MG
68001013500
AETNA (ARGUS)
0865450100001
5/2/2017
AMLODIPINE-BENAZEPRIL 5-40 MG
68001013500
CAREMARK
RXBCID
1/25/2017
AMLODIPINE-BENAZEPRIL 5-40 MG
68001013500
CAREMARK
RX3990
2/16/2017
AMLODIPINE-BENAZEPRIL 5-40 MG
68001013500
CAREMARK
WHART
5/8/2017
AMLODIPINE-OLMESARTAN 10-40 MG
33342019310
CATAMARAN
00610343
3/21/2017
AMLODIPINE-OLMESARTAN 10-40 MG
33342019310
MAXOR PLUS
(blank)
3/7/2017
AMLODIPINE-OLMESARTAN 10-40 MG
33342019307
NMHC
NISSAN
4/20/2017
AMLODIPINE-OLMESARTAN 5-20 MG
33342019007
CATAMARAN
(blank)
3/21/2017
AMLODIPINE-OLMESARTAN 5-40 MG
33342019110
CAREMARK
RX7546
3/7/2017
AMLODIPINE-OLMESARTAN 5-40 MG
33342019107
CATALYST
QCA
3/23/2017
AMLOD-VALSA-HCTZ 10-160-25 MG
13668032830
CITIZENSRX LLC
1019
1/3/2017
AMLOD-VALSA-HCTZ 10-160-25 MG
00781578731
OPTUMRX
U0744260
3/3/2017
AMLOD-VALSA-HCTZ 10-320-25 MG
00781579431
AETNA (ARGUS)
RXAETD
1/10/2017
AMLOD-VALSA-HCTZ 10-320-25 MG
00781579431
BCBS ALABAMA
29907
1/13/2017
AMLOD-VALSA-HCTZ 10-320-25 MG
00781579431
MERIDIANRX
(blank)
3/10/2017
AMLOD-VALSA-HCTZ 5-160-12.5 MG
00781575631
MERIDIANRX
(blank)
2/2/2017
AMMONIUM LACTATE 12% CREAM
51672130100
OPTUMRX
COS
2/14/2017
AMMONIUM LACTATE 12% CREAM
45802049326
AETNA (ARGUS)
RXAETD
1/10/2017
AMMONIUM LACTATE 12% CREAM
00591215738
AETNA (ARGUS)
RXAETD
4/11/2017
AMMONIUM LACTATE 12% LOTION
45802041954
AETNA (ARGUS)
RXAETD
1/18/2017
AMMONIUM LACTATE 12% LOTION
45802041926
AETNA (ARGUS)
RXAETD
11/9/2016
4/6/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
AMOX-CLAV 400-57 MG TAB CHEW
00093227234
CAREMARK
RXBCID
4/24/2017
AMOX-CLAV 400-57 MG TAB CHEW
00093227234
CATAMARAN
(blank)
2/16/2017
AMOX-CLAV 400-57 MG TAB CHEW
00093227234
OPTUMRX
02490008
12/12/2016
AMOX-CLAV 400-57 MG/5 ML SUSP
00781610446
AETNA (ARGUS)
RXAETD
1/18/2017
AMOX-CLAV 400-57 MG/5 ML SUSP
00781610446
CATAMARAN
3328612
12/21/2016
AMOX-CLAV 500-125 MG TABLET
66685100200
NAVITUS HEALTH SOLNS
RX4SISC
12/1/2016
AMOX-CLAV 500-125 MG TABLET
65862050220
AETNA (ARGUS)
RXAETD
1/10/2017
AMOX-CLAV 600-42.9 MG/5 ML SUS
00781613957
CATAMARAN
(blank)
11/15/2016
AMOX-CLAV 600-42.9 MG/5 ML SUS
00781613948
OPTUMRX
PDPIND
2/3/2017
AMOX-CLAV 600-42.9 MG/5 ML SUS
00781613954
OPTUMRX
U0744260
2/17/2017
AMOX-CLAV 600-42.9 MG/5 ML SUS
00093867574
CATAMARAN
(blank)
3/21/2017
AMOX-CLAV 875-125 MG TABLET
65862050320
OPTUMRX
ERSTX
2/13/2017
AMOXICILLIN 400 MG/5 ML SUSP
00143988775
CATAMARAN
-
1/9/2017
AMOXICILLIN 400 MG/5 ML SUSP
00143988701
CIGNA
(blank)
3/21/2017
AMOXICILLIN 500 MG CAPSULE
00781261305
CATAMARAN
(blank)
1/9/2017
AMOXICILLIN 500 MG CAPSULE
00781261305
CATAMARAN
3336239
3/21/2017
AMOXICILLIN 500 MG CAPSULE
00781261305
CATAMARAN
3332317
3/21/2017
AMOXICILLIN 500 MG CAPSULE
00781261305
CIGNA
(blank)
3/21/2017
AMOXICILLIN 875 MG TABLET
00143995101
OPTUMRX
COS
2/3/2017
ANAGRELIDE HCL 0.5 MG CAPSULE
00172524160
AETNA (ARGUS)
RXAETD
1/10/2017
ANAGRELIDE HCL 1 MG CAPSULE
00172524060
AETNA (ARGUS)
RXAETD
1/10/2017
ANAGRELIDE HCL 1 MG CAPSULE
00172524060
AETNA (ARGUS)
RXAETD
1/18/2017
ANASTROZOLE 1 MG TABLET
68001015504
AETNA (ARGUS)
RXAETD
1/10/2017
ANUCORT-HC 25 MG SUPPOSITORY
00713050312
PRIME THERAPEUTICS
0868590004
12/1/2016
APRACLONIDINE HCL 0.5% DROPS
17478071610
AETNA (ARGUS)
RXAETD
1/10/2017
ARIPIPRAZOLE 1 MG/ML SOLUTION
54838057059
CITIZENSRX LLC
1250006
1/3/2017
ARIPIPRAZOLE 20 MG TABLET
13811068330
RXWEST
(blank)
11/7/2016
ARIPIPRAZOLE 30 MG TABLET
60505267703
AETNA (ARGUS)
RXAETD
1/10/2017
ARIPIPRAZOLE 5 MG TABLET
60505267303
AETNA (ARGUS)
RXAETD
1/10/2017
ARMODAFINIL 150 MG TABLET
00378343293
OPTUMRX
(blank)
2/7/2017
ARMODAFINIL 200 MG TABLET
00591385630
OPTUMRX
01961779
6/1/2017
ARMODAFINIL 250 MG TABLET
00093309456
OPTUMRX
U0744260
5/18/2017
ARMODAFINIL 50 MG TABLET
00378343193
OPTUMRX
U0744260
5/25/2017
ARMOUR THYROID 60 MG TABLET
00456045901
CAREMARK
65006500
1/18/2017
ASPIRIN-DIPYRIDAM ER 25-200 MG
00054057521
OPTUMRX
COS
1/25/2017
ASPIRIN-DIPYRIDAM ER 25-200 MG
65162059606
CATAMARAN
(blank)
2/3/2017
ATENOLOL 100 MG TABLET
00378075710
CATAMARAN
00884700
3/21/2017
ATENOLOL 25 MG TABLET
00378021810
AETNA (ARGUS)
RXAETD
1/10/2017
ATENOLOL 50 MG TABLET
00378023110
NMHC
EGWPS032
1/12/2017
ATENOLOL 50 MG TABLET
00378023110
PHS
26500002
3/30/2017
ATENOLOL-CHLORTHALIDONE 100-25
00591578301
AETNA (ARGUS)
RXAETD
1/10/2017
ATENOLOL-CHLORTHALIDONE 100-25
00591578301
OPTUMRX
ACUTX
5/25/2017
ATENOLOL-CHLORTHALIDONE 50-25
00378206301
OPTUMRX
(blank)
11/7/2016
ATENOLOL-CHLORTHALIDONE 50-25
00591578201
AETNA (ARGUS)
RXAETD
1/10/2017
ATORVASTATIN 20 MG TABLET
59762015601
AETNA (ARGUS)
RXAETD
1/10/2017
ATORVASTATIN 20 MG TABLET
59762015601
PRIME THERAPEUTICS
R3332
1/13/2017
ATORVASTATIN 20 MG TABLET
59762015601
NAVITUS HEALTH SOLNS
CHX
3/2/2017
ATORVASTATIN 20 MG TABLET
60505257909
PHS
(blank)
5/29/2017
ATORVASTATIN 40 MG TABLET
60505258009
AETNA (ARGUS)
RXAETD
1/10/2017
ATOVAQUONE-PROGUANIL 250-100
68462040401
CATAMARAN
-
2/9/2017
ATOVAQUONE-PROGUANIL 250-100
66993006002
AETNA (ARGUS)
RXAETD
1/10/2017
AZATHIOPRINE 50 MG TABLET
69238107601
BCBS ALABAMA
16497
1/6/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
AZATHIOPRINE 50 MG TABLET
69238107601
PRIME THERAPEUTICS
152416
MAC Effective Date
1/6/2017
AZATHIOPRINE 50 MG TABLET
68382000301
AETNA (ARGUS)
RXAETD
1/10/2017
AZELASTINE 0.1% (137 MCG) SPRY
51991081403
CATAMARAN
(blank)
3/20/2017
AZELASTINE 0.1% (137 MCG) SPRY
60505083305
AETNA (ARGUS)
RXAETD
1/10/2017
AZELASTINE 0.15% NASAL SPRAY
51525023403
CATAMARAN
N/A
4/25/2017
AZELASTINE 0.15% NASAL SPRAY
51525023403
ARGUS
-
11/21/2016
AZELASTINE 0.15% NASAL SPRAY
45802002683
PRIME THERAPEUTICS
008543
1/13/2017
AZELASTINE HCL 0.05% DROPS
61314030802
AETNA (ARGUS)
RXAETD
1/10/2017
AZELASTINE HCL 0.05% DROPS
61314030802
RXWEST
279878M001
4/12/2017
AZELASTINE HCL 0.05% DROPS
61314030802
NAVITUS HEALTH SOLNS
FC2A
11/8/2016
AZELASTINE HCL 0.05% DROPS
60505057804
CATAMARAN
3340241
3/21/2017
AZITHROMYCIN 200 MG/5 ML SUSP
59762312001
CAREMARK
65006500
3/2/2017
AZITHROMYCIN 250 MG TABLET
60505258102
AETNA (ARGUS)
RXAETD
1/10/2017
AZITHROMYCIN 250 MG TABLET
50111078766
OPTUMRX
U0744260
2/17/2017
AZITHROMYCIN 250 MG TABLET
50111078766
ARGUS
086036
4/3/2017
AZITHROMYCIN 250 MG TABLET
00781149668
OPTUMRX
U0744260
2/17/2017
AZITHROMYCIN 250 MG TABLET
60505258100
OPTUMRX
U0744260
3/3/2017
AZITHROMYCIN 250 MG TABLET
68180016006
OPTUMRX
01960980
3/17/2017
AZITHROMYCIN 500 MG TABLET
68180016113
CATAMARAN
(blank)
4/6/2017
AZITHROMYCIN 500 MG TABLET
68180016113
MERIDIANRX
(blank)
11/23/2016
AZITHROMYCIN 500 MG TABLET
68180016106
NMHC
RXCVSD
1/12/2017
AZITHROMYCIN 500 MG TABLET
00781194133
OPTUMRX
U0744260
2/17/2017
AZITHROMYCIN 500 MG TABLET
50111078855
OPTUMRX
U0744260
2/17/2017
AZITHROMYCIN 600 MG TABLET
68180016206
AETNA (ARGUS)
RXAETD
1/10/2017
AZURETTE 28 DAY TABLET
51862007206
RXWEST
326
3/10/2017
AZURETTE 28 DAY TABLET
51862007206
MERIDIANRX
(blank)
2/2/2017
AZURETTE 28 DAY TABLET
52544094028
OPTUMRX
U0744260
2/13/2017
BACITRACIN 500 UNIT/GM OPHTH
00574402235
CATAMARAN
(blank)
3/29/2017
BACITRACIN-POLYMYXIN EYE OINT
24208055555
NAVITUS HEALTH SOLNS
CPM
11/8/2016
BACLOFEN 20 MG TABLET
00832102500
AETNA (ARGUS)
RXAETD
1/10/2017
BALSALAZIDE DISODIUM 750 MG CP
00054007928
AETNA (ARGUS)
RXAETD
1/10/2017
BELLADONNA-OPIUM 16.2-60 SUPP
00574704012
PROCARE RX
(blank)
11/30/2016
BENAZEPRIL HCL 10 MG TABLET
65162075250
NAVITUS HEALTH SOLNS
LCC
11/2/2016
BENAZEPRIL HCL 20 MG TABLET
65162075350
NAVITUS HEALTH SOLNS
COD11
11/2/2016
BENAZEPRIL HCL 40 MG TABLET
65162075410
NAVITUS HEALTH SOLNS
WIE80000
11/8/2016
BENAZEPRIL HCL 40 MG TABLET
65162075450
OPTUMRX
ILWU
2/27/2017
BENAZEPRIL HCL 40 MG TABLET
65162075450
NAVITUS HEALTH SOLNS
(blank)
11/8/2016
BENAZEPRIL HCL 5 MG TABLET
65162075110
NMHC
EGWPS032
3/3/2017
BENAZEPRIL-HCTZ 10-12.5 MG TAB
00832048311
RXWEST
40192H
3/10/2017
BENAZEPRIL-HCTZ 20-12.5 MG TAB
60505026301
CATAMARAN
3186956
1/13/2017
BENAZEPRIL-HCTZ 20-12.5 MG TAB
00832048411
CATAMARAN
884700
3/21/2017
BENAZEPRIL-HCTZ 20-12.5 MG TAB
00378474501
ARGUS
780734
4/3/2017
BENAZEPRIL-HCTZ 20-25 MG TAB
00832048511
NAVITUS HEALTH SOLNS
LLC
3/9/2017
BENZONATATE 200 MG CAPSULE
69452014420
CATAMARAN
3212840
1/31/2017
BENZONATATE 200 MG CAPSULE
51224000150
OPTUMRX
(blank)
2/2/2017
BENZONATATE 200 MG CAPSULE
69387012001
NAVITUS HEALTH SOLNS
984
BETAMETHASONE DP 0.05% CRM
00168005546
PROCARE RX
62TCS272
11/30/2016
BETAMETHASONE DP 0.05% LOT
45802002146
AETNA (ARGUS)
RXAETD
1/10/2017
BETAMETHASONE DP 0.05% OINT
00168005646
AETNA (ARGUS)
RXAETD
1/10/2017
BETAMETHASONE DP 0.05% OINT
00168005646
CATAMARAN
-
3/21/2017
BETAMETHASONE DP 0.05% OINT
00472038145
OPTUMRX
ERSTX
2/13/2017
BETAMETHASONE DP 0.05% OINT
00168005615
AETNA (ARGUS)
RXAETD
1/10/2017
3/2/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
BETAMETHASONE DP AUG 0.05% LOT
00168026760
AETNA (ARGUS)
RXAETD
1/10/2017
BETAMETHASONE DP AUG 0.05% OIN
66993089715
CATAMARAN
(blank)
2/7/2017
BETAMETHASONE DP AUG 0.05% OIN
66993089715
OPTUMRX
U0744260
3/14/2017
BETAMETHASONE DP AUG 0.05% OIN
00472038245
AETNA (ARGUS)
RXAETD
1/10/2017
BETAMETHASONE DP AUG 0.05% OIN
66993089749
CATAMARAN
00616610
3/21/2017
BETAMETHASONE DP AUG 0.05% OIN
66993089749
CATAMARAN
-
4/6/2017
BETAMETHASONE VA 0.1% CREAM
00168004046
CATAMARAN
NO GROUP
4/5/2017
BETAMETHASONE VA 0.1% LOTION
00168004160
AETNA (ARGUS)
RXAETD
1/10/2017
BETAXOLOL 10 MG TABLET
10702001301
CATAMARAN
328840000000491
3/30/2017
BETAXOLOL 20 MG TABLET
10702001401
AETNA (ARGUS)
RXAETD
1/18/2017
BETHANECHOL 25 MG TABLET
00527135601
AETNA (ARGUS)
RXAETD
1/10/2017
BETHANECHOL 25 MG TABLET
00527135601
CATAMARAN
(blank)
3/23/2017
BETHANECHOL 50 MG TABLET
00527132901
CATAMARAN
(blank)
3/30/2017
BEXAROTENE 75 MG CAPSULE
00378695501
AETNA (ARGUS)
RXAETD
1/10/2017
BEXAROTENE 75 MG CAPSULE
00378695501
AETNA (ARGUS)
RXAETD
1/18/2017
BEXAROTENE 75 MG CAPSULE
00378695501
MAGELLAN
REG22
3/14/2017
BICALUTAMIDE 50 MG TABLET
00093022056
CATAMARAN
(blank)
3/20/2017
BIMATOPROST 0.03% EYELASH SOLN
00781620675
OPTUMRX
LOCAL727
5/25/2017
BISOPROLOL-HCTZ 10-6.25 MG TAB
29300018913
NMHC
N14072
11/30/2016
BISOPROLOL-HCTZ 5-6.25 MG TAB
29300018805
NAVITUS HEALTH SOLNS
FCC82C00016T15T
11/8/2016
BLISOVI 24 FE TABLET
68180086413
CATAMARAN
3336239
1/25/2017
BRIMONIDINE 0.2% EYE DROP
24208041110
AETNA (ARGUS)
RXAETD
1/10/2017
BRIMONIDINE TARTRATE 0.15% DRP
61314014405
OPTUMRX
COS
1/9/2017
BRIMONIDINE TARTRATE 0.15% DRP
61314014405
OPTUMRX
AMCTN
1/10/2017
BRIMONIDINE TARTRATE 0.15% DRP
61314014405
OPTUMRX
SHWA
1/9/2017
BROMFED DM COUGH SYRUP
60432083704
US SCRIPT
18011
3/2/2017
BROMFENAC SODIUM 0.09% EYE DRP
50383024971
AETNA (ARGUS)
RXAETD
1/10/2017
BROMFENAC SODIUM 0.09% EYE DRP
50383024971
OPTUMRX
COS
2/3/2017
BROMFENAC SODIUM 0.09% EYE DRP
50383024971
OPTUMRX
GECRX
3/24/2017
BROMOCRIPTINE 5 MG CAPSULE
00378709693
CATAMARAN
(blank)
3/3/2017
BROMOCRIPTINE 5 MG CAPSULE
00378709601
OPTUMRX
PDPIND
4/4/2017
BUDESONIDE 0.25 MG/2 ML SUSP
00591376730
CATAMARAN
00611368
1/9/2017
BUDESONIDE 0.25 MG/2 ML SUSP
00093681573
OPTUMRX
IEBP
2/17/2017
BUDESONIDE 0.5 MG/2 ML SUSP
00591376830
AETNA (ARGUS)
RXAETD
1/10/2017
BUDESONIDE 0.5 MG/2 ML SUSP
00591376830
CATAMARAN
3332245
12/21/2016
BUDESONIDE 0.5 MG/2 ML SUSP
00093681673
CITIZENSRX LLC
LSYA
3/31/2017
BUDESONIDE 1 MG/2 ML INH SUSP
00093681773
OPTUMRX
IEBP
5/18/2017
BUDESONIDE 1 MG/2 ML INH SUSP
00093681773
ARGUS
(blank)
4/17/2017
BUDESONIDE 1 MG/2 ML INH SUSP
00781751787
OPTUMRX
MPDCSWI
5/25/2017
BUDESONIDE 1 MG/2 ML INH SUSP
00781751787
PRIME THERAPEUTICS
(blank)
6/2/2017
BUDESONIDE EC 3 MG CAPSULE
47781014601
PRIME THERAPEUTICS
N/A
1/19/2017
BUDESONIDE EC 3 MG CAPSULE
47781014601
MERIDIANRX
MHPMIMMP2015
3/10/2017
BUDESONIDE EC 3 MG CAPSULE
00378715501
AETNA (ARGUS)
RXAETD
1/10/2017
BUMETANIDE 0.5 MG TABLET
00185012801
PRIME THERAPEUTICS
(blank)
1/19/2017
BUMETANIDE 1 MG TABLET
00185012901
AETNA (ARGUS)
RXAETD
1/10/2017
BUMETANIDE 1 MG TABLET
00185012901
CATAMARAN
(blank)
3/20/2017
BUMETANIDE 1 MG TABLET
00185012901
CATAMARAN
N/A
3/20/2017
BUMETANIDE 2 MG TABLET
00185013001
CATAMARAN
HTHSPRING
3/20/2017
BUMETANIDE 2 MG TABLET
00185013001
OPTUMRX
COS
1/9/2017
BUMETANIDE 2 MG TABLET
00185013001
CATALYST (FUTURESCRIPTS)
N/A
11/23/2016
BUMETANIDE 2 MG TABLET
00185013001
MAGELLAN
REG25
3/14/2017
BUPRENORPHINE 2 MG TABLET SL
00228315603
AETNA (ARGUS)
RXAETD
1/31/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
BUPRENORPHINE 8 MG TABLET SL
00378092493
AETNA (ARGUS)
RXAETD
1/10/2017
BUPRENORPHINE 8 MG TABLET SL
00228315303
OPTUMRX
UHEALTH
3/22/2017
BUPRENORPHIN-NALOXON 8-2 MG SL
00093572156
AETNA (ARGUS)
RXAETD
1/18/2017
BUPRENORPHIN-NALOXON 8-2 MG SL
00093572156
CATAMARAN
3212392
11/15/2016
BUPRENORPHIN-NALOXON 8-2 MG SL
00093572156
OPTUMRX
ACUOH
11/16/2016
BUPRENORPHIN-NALOXON 8-2 MG SL
65162041503
CATAMARAN
-
4/18/2017
BUPRENORPHIN-NALOXON 8-2 MG SL
00054018913
AETNA (ARGUS)
RXAETD
1/10/2017
BUPRENORPHIN-NALOXON 8-2 MG SL
50383028793
NMHC
CALPANTH
5/23/2017
BUPRENORPHIN-NALOXON 8-2 MG SL
50383028793
MERIDIANRX
HCS150126
6/2/2017
BUPRENORPHN-NALOXN 2-0.5 MG SL
65162041603
CATAMARAN
-
2/3/2017
BUPRENORPHN-NALOXN 2-0.5 MG SL
00093572056
AETNA (ARGUS)
RXAETD
1/10/2017
BUPRENORPHN-NALOXN 2-0.5 MG SL
00093572056
OPTUMRX
ERSTX
2/13/2017
BUPRENORPHN-NALOXN 2-0.5 MG SL
00054018813
CATAMARAN
(blank)
3/3/2017
BUPRENORPHN-NALOXN 2-0.5 MG SL
00054018813
CATAMARAN
-
3/20/2017
BUPROPION HCL 100 MG TABLET
60505015701
CITIZENSRX LLC
1019
1/17/2017
BUPROPION HCL 100 MG TABLET
68001019800
CATAMARAN
(blank)
3/20/2017
BUPROPION HCL 75 MG TABLET
68001019900
CIGNA
GWLA
3/21/2017
BUPROPION HCL 75 MG TABLET
68001019900
PRIME THERAPEUTICS
-
1/6/2017
BUPROPION HCL 75 MG TABLET
60505015801
CITIZENSRX LLC
1019
1/30/2017
BUPROPION HCL SR 150 MG TABLET
69097087812
CAREMARK
788257
11/15/2016
BUPROPION HCL SR 150 MG TABLET
69097087812
MERIDIANRX
(blank)
11/7/2016
BUPROPION HCL SR 150 MG TABLET
00591354376
MERIDIANRX
HPMMCD
11/30/2016
BUPROPION HCL SR 150 MG TABLET
00591354160
OPTUMRX
ERSTX
2/13/2017
BUPROPION HCL SR 150 MG TABLET
00591354160
PRIME THERAPEUTICS
10193493
1/13/2017
BUPROPION HCL SR 150 MG TABLET
00378552101
AETNA (ARGUS)
RXAETD
1/10/2017
BUPROPION HCL SR 150 MG TABLET
00378552101
CATAMARAN
3334857
2/3/2017
BUPROPION HCL SR 150 MG TABLET
69097087803
OPTUMRX
U0744260
2/13/2017
BUPROPION HCL SR 150 MG TABLET
00591354105
AETNA (ARGUS)
RXAETD
1/10/2017
BUPROPION HCL SR 200 MG TABLET
69097087903
CATAMARAN
(blank)
3/30/2017
BUPROPION HCL XL 150 MG TABLET
00378200877
CATAMARAN
00005241
2/7/2017
BUPROPION HCL XL 150 MG TABLET
00378200877
NAVITUS HEALTH SOLNS
HHX
11/2/2016
BUPROPION HCL XL 150 MG TABLET
68001028704
OPTUMRX
COS
1/9/2017
BUPROPION HCL XL 150 MG TABLET
68001028703
NMHC
LINCARE
5/2/2017
BUPROPION HCL XL 150 MG TABLET
68001028703
PRIME THERAPEUTICS
14149121
1/13/2017
BUPROPION HCL XL 150 MG TABLET
10370010150
CATAMARAN
3328569
2/3/2017
BUPROPION HCL XL 150 MG TABLET
10370010103
OPTUMRX
ERSTX
2/13/2017
BUPROPION HCL XL 150 MG TABLET
69097087505
MERIDIANRX
(blank)
5/3/2017
BUPROPION HCL XL 300 MG TABLET
68001026404
CAREMARK
788257
12/22/2016
BUPROPION HCL XL 300 MG TABLET
45963014205
CATAMARAN
JTEKT
3/21/2017
BUPROPION HCL XL 300 MG TABLET
45963014205
PRIME THERAPEUTICS
1215
1/13/2017
BUPROPION HCL XL 300 MG TABLET
45963014290
OPTUMRX
IVM
3/29/2017
BUPROPION HCL XL 300 MG TABLET
45963014290
MERIDIANRX
(blank)
2/21/2017
BUPROPION HCL XL 300 MG TABLET
45963014290
MERIDIANRX
PRS
2/2/2017
BUPROPION HCL XL 300 MG TABLET
69097087612
CATAMARAN
00616249
3/21/2017
BUPROPION HCL XL 300 MG TABLET
45963014230
CATALYST
CTRSUNCO
4/6/2017
BUSPIRONE HCL 10 MG TABLET
00591065801
AETNA (ARGUS)
RXAETD
1/10/2017
BUSPIRONE HCL 10 MG TABLET
00591065805
CAREMARK
RX1134
4/4/2017
BUSPIRONE HCL 15 MG TABLET
00378116580
CATAMARAN
(blank)
3/21/2017
BUSPIRONE HCL 30 MG TABLET
00378117591
CITIZENSRX LLC
1019
1/3/2017
BUSPIRONE HCL 30 MG TABLET
68382018314
AETNA (ARGUS)
RXAETD
1/10/2017
BUSPIRONE HCL 30 MG TABLET
00093520006
CATAMARAN
(blank)
3/29/2017
BUTALB-ACETAMIN-CAFF 50-300-40
00591264001
CATAMARAN
(blank)
1/12/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
BUTALB-ACETAMIN-CAFF 50-325-40
00591336905
AETNA (ARGUS)
RXAETD
1/10/2017
BUTALB-ACETAMIN-CAFF 50-325-40
00591336901
NMHC
CALPANTH
5/29/2017
BUTALB-CAFF-ACETAMINOPH-CODEIN
00603255321
AETNA (ARGUS)
RXAETD
1/10/2017
BUTALB-CAFF-ACETAMINOPH-CODEIN
00591322001
AETNA (ARGUS)
RXAETD
1/10/2017
BUTALBITAL COMP-CODEINE #3 CAP
00591354601
AETNA (ARGUS)
RXAETD
1/10/2017
BUTALBITAL COMP-CODEINE #3 CAP
00591354601
OPTUMRX
COS
2/20/2017
BUTALBITAL-ACETAMINOPHN 50-325
00603254021
CAREMARK
RX2872
3/21/2017
BUTALBITAL-ASA-CAFFEINE CAP
00591321901
AETNA (ARGUS)
869888-011-0000
4/4/2017
BUTALBITAL-ASA-CAFFEINE CAP
00591321901
CATAMARAN
00600000
1/9/2017
BUTALBITAL-ASA-CAFFEINE CAP
00591321901
OPTUMRX
ERSTX
2/13/2017
BUTALBITAL-ASA-CAFFEINE CAP
00527155201
OPTUMRX
U0744260
2/17/2017
BUTORPHANOL 10 MG/ML SPRAY
60505081301
CATAMARAN
(blank)
3/23/2017
BUTORPHANOL 10 MG/ML SPRAY
60505081301
NMHC
EGWPS035
1/19/2017
BUTORPHANOL 10 MG/ML SPRAY
60505081301
CATALYST (FUTURESCRIPTS)
(blank)
11/15/2016
CALCIPOTRIENE 0.005% CREAM
68462050165
CATAMARAN
(blank)
3/3/2017
CALCIPOTRIENE 0.005% CREAM
68462050165
CATALYST (FUTURESCRIPTS)
(blank)
12/8/2016
CALCIPOTRIENE 0.005% CREAM
00781711783
AETNA (ARGUS)
RXAETD
1/10/2017
CALCIPOTRIENE 0.005% CREAM
00781711783
CATAMARAN
-
3/3/2017
CALCIPOTRIENE 0.005% CREAM
68462050166
CATAMARAN
BRVOHLTH
3/20/2017
CALCIPOTRIENE 0.005% SOLUTION
00713031853
AETNA (ARGUS)
RXAETD
1/10/2017
CALCITONIN-SALMON 200 UNITS SP
49884016111
AETNA (ARGUS)
RXAETD
1/10/2017
CALCITONIN-SALMON 200 UNITS SP
49884016111
CATAMARAN
(blank)
3/20/2017
CALCITRIOL 0.25 MCG CAPSULE
00054000713
NAVITUS HEALTH SOLNS
KYR
11/2/2016
CALCITRIOL 0.5 MCG CAPSULE
64380072406
AETNA (ARGUS)
RXAETD
1/10/2017
CALCITRIOL 1 MCG/ML SOLUTION
63304024159
MERIDIANRX
(blank)
2/10/2017
CALCITRIOL 1 MCG/ML SOLUTION
00054312041
AETNA (ARGUS)
RXAETD
1/10/2017
CALCIUM ACETATE 667 MG TABLET
00574011302
CATAMARAN
(blank)
4/6/2017
CANDESARTAN CILEXETIL 16 MG TB
49884066009
AETNA (ARGUS)
RXAETD
1/10/2017
CANDESARTAN CILEXETIL 16 MG TB
49884066009
CATAMARAN
N/A
1/25/2017
CANDESARTAN CILEXETIL 16 MG TB
49884066009
OPTUMRX
U0744260
2/13/2017
CANDESARTAN CILEXETIL 32 MG TB
49884066109
CATAMARAN
(blank)
3/23/2017
CANDESARTAN CILEXETIL 32 MG TB
49884066109
OPTUMRX
U0744260
2/13/2017
CANDESARTAN CILEXETIL 8 MG TAB
00781593731
CATALYST
RGNRN
11/30/2016
CANDESARTAN-HCTZ 16-12.5 MG TB
00378300177
CATAMARAN
(blank)
3/23/2017
CANDESARTAN-HCTZ 16-12.5 MG TB
33342013110
AETNA (ARGUS)
RXAETD
1/10/2017
CANDESARTAN-HCTZ 32-12.5 MG TB
33342013210
BENECARD PBF
1302
11/16/2016
CANDESARTAN-HCTZ 32-12.5 MG TB
33342013210
CATALYST
MPSERS
12/15/2016
CANDESARTAN-HCTZ 32-12.5 MG TB
33342013210
CATAMARAN
(blank)
3/3/2017
CANDESARTAN-HCTZ 32-12.5 MG TB
33342013210
OPTUMRX
(blank)
2/17/2017
CANDESARTAN-HCTZ 32-12.5 MG TB
33342013210
NAVITUS HEALTH SOLNS
FCC
11/2/2016
CANDESARTAN-HCTZ 32-25 MG TAB
00378300377
OPTUMRX
PDPIND
2/28/2017
CANDESARTAN-HCTZ 32-25 MG TAB
33342013310
AETNA (ARGUS)
RXAETD
1/10/2017
CAPECITABINE 500 MG TABLET
00093747489
PRIME THERAPEUTICS
(blank)
1/13/2017
CAPECITABINE 500 MG TABLET
00378251278
CATAMARAN
(blank)
1/25/2017
CAPTOPRIL 100 MG TABLET
00143117401
AETNA (ARGUS)
RXAETD
1/18/2017
CAPTOPRIL 100 MG TABLET
00143117401
CATAMARAN
-
3/23/2017
CAPTOPRIL 100 MG TABLET
00378302201
CATAMARAN
-
2/24/2017
CAPTOPRIL 12.5 MG TABLET
00143117101
AETNA (ARGUS)
RXAETD
1/10/2017
CAPTOPRIL 12.5 MG TABLET
00143117101
MERIDIANRX
-
4/13/2017
CAPTOPRIL 12.5 MG TABLET
00143117101
NPS
H0545012
4/5/2017
CAPTOPRIL 25 MG TABLET
00143117201
AETNA (ARGUS)
RXAETD
1/10/2017
CAPTOPRIL 25 MG TABLET
00143117201
CAREMARK
788257
12/22/2016
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
CAPTOPRIL 25 MG TABLET
00378301201
CITIZENSRX LLC
151
MAC Effective Date
CAPTOPRIL 25 MG TABLET
00378301210
CATAMARAN
246534620CI
4/6/2017
CAPTOPRIL 50 MG TABLET
00143117301
AETNA (ARGUS)
RXAETD
1/10/2017
CAPTOPRIL 50 MG TABLET
00143117301
OPTUMRX
HSF
2/14/2017
CAPTOPRIL 50 MG TABLET
00143117301
MERIDIANRX
(blank)
2/21/2017
CARBAMAZEPINE 200 MG TABLET
51672400501
AETNA (ARGUS)
RXAETD
2/14/2017
CARBAMAZEPINE 200 MG TABLET
51672400501
AETNA (ARGUS)
RXAETD
5/23/2017
CARBAMAZEPINE 200 MG TABLET
51672400501
CATAMARAN
3333554
1/9/2017
CARBAMAZEPINE 200 MG TABLET
51672400503
AETNA (ARGUS)
RXAETD
3/21/2017
CARBAMAZEPINE 200 MG TABLET
51672400503
AETNA (ARGUS)
RXAETD
3/29/2017
CARBAMAZEPINE 200 MG TABLET
51672400503
AETNA (ARGUS)
RXAETD
5/23/2017
CARBAMAZEPINE ER 100 MG CAP
66993040732
CATAMARAN
(blank)
4/6/2017
CARBAMAZEPINE ER 200 MG CAP
60505280607
AETNA (ARGUS)
RXAETD
1/10/2017
CARBAMAZEPINE ER 200 MG TABLET
00781598701
OPTUMRX
U0744260
2/17/2017
CARBAMAZEPINE ER 200 MG TABLET
00781598701
CITIZENSRX LLC
1019
1/30/2017
CARBAMAZEPINE ER 300 MG CAP
60505280707
CATAMARAN
(blank)
4/5/2017
CARBAMAZEPINE ER 400 MG TABLET
51672412501
AETNA (ARGUS)
RXAETD
1/10/2017
CARBIDOPA 25 MG TABLET
42799012301
CATAMARAN
(blank)
3/20/2017
CARBIDOPA-LEVO 10-100 MG ODT
47335018688
PROCARE RX
00000498
11/30/2016
CARBIDOPA-LEVO ER 25-100 TAB
68001017100
AETNA (ARGUS)
RXAETD
1/10/2017
CARBIDOPA-LEVO ER 25-100 TAB
68001017100
CATALYST
QCAQHP
11/24/2016
CARBIDOPA-LEVO ER 25-100 TAB
68001017100
CATAMARAN
(blank)
3/20/2017
CARBIDOPA-LEVO ER 25-100 TAB
68001017100
CATAMARAN
(blank)
3/30/2017
CARBIDOPA-LEVO ER 25-100 TAB
68001017100
PHS
(blank)
4/6/2017
CARBIDOPA-LEVO ER 50-200 TAB
68001017200
AETNA (ARGUS)
RXAETD
1/10/2017
CARBIDOPA-LEVO ER 50-200 TAB
68001017200
CATAMARAN
(blank)
2/7/2017
CARBIDOPA-LEVO ER 50-200 TAB
68001017200
CATAMARAN
(blank)
5/17/2017
CARBIDOPA-LEVODOPA 25-100 TAB
00228253950
AETNA (ARGUS)
RXAETD
1/10/2017
CARBIDOPA-LEVODOPA-ENTA 100 MG
00781563701
CATAMARAN
(blank)
3/20/2017
CARBIDOPA-LEVODOPA-ENTA 100 MG
64679078404
CATAMARAN
(blank)
4/6/2017
CARISOPRODOL 250 MG TABLET
42543043401
AETNA (ARGUS)
RXAETD
1/10/2017
CARISOPRODOL 350 MG TABLET
00591551310
ARGUS
(blank)
2/28/2017
CARISOPRODOL 350 MG TABLET
00591551301
ARGUS
X0001004
2/28/2017
CARISOPRODOL 350 MG TABLET
00591551305
RXWEST
40192H
4/6/2017
CARVEDILOL 6.25 MG TABLET
68001015403
CATAMARAN
(blank)
3/21/2017
CARVEDILOL 6.25 MG TABLET
68001015403
RESTAT (SXC)
W805
5/23/2017
CEFDINIR 250 MG/5 ML SUSP
68180072320
AETNA (ARGUS)
RXAETD
1/10/2017
CEFDINIR 250 MG/5 ML SUSP
68180072320
CATAMARAN
(blank)
1/9/2017
CEFDINIR 300 MG CAPSULE
42043025006
CAREMARK
UNLVR
1/4/2017
CEFDINIR 300 MG CAPSULE
00093316006
CAREMARK
RX1761
1/13/2017
CEFDINIR 300 MG CAPSULE
57237009960
NMHC
CGHC
3/30/2017
CEFDINIR 300 MG CAPSULE
57237009960
MERIDIANRX
HPMMCD
1/13/2017
CEFDINIR 300 MG CAPSULE
68001015006
AETNA (ARGUS)
RXAETD
1/10/2017
CEFDINIR 300 MG CAPSULE
68001015006
CAREMARK
SCB15
1/24/2017
CEFIXIME 100 MG/5 ML SUSP
65862075150
MERIDIANRX
MIMEDICAID
4/13/2017
CEFIXIME 100 MG/5 ML SUSP
68180040501
CAREMARK
MVPCOMM
4/24/2017
CEFPODOXIME 100 MG TABLET
65862009520
AETNA (ARGUS)
RXAETD
1/10/2017
CEFPODOXIME 200 MG TABLET
65862009620
AETNA (ARGUS)
RXAETD
1/10/2017
CEFPODOXIME 200 MG TABLET
65862009620
PRIME THERAPEUTICS
0027
6/2/2017
CEFPROZIL 250 MG/5 ML SUSP
68180040203
PHS
(blank)
3/30/2017
CEFPROZIL 500 MG TABLET
68180040401
AETNA (ARGUS)
RXAETD
1/10/2017
CEFPROZIL 500 MG TABLET
68180040401
CATAMARAN
(blank)
3/20/2017
1/3/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
CEFPROZIL 500 MG TABLET
68180040401
OPTUMRX
COS
MAC Effective Date
2/27/2017
CEFPROZIL 500 MG TABLET
68180040401
OPTUMRX
GECRX
2/13/2017
CEFTIBUTEN 180 MG/5 ML SUSP
44183018002
OPTUMRX
ROPER
3/17/2017
CEFTRIAXONE 1 GM VIAL
00409733201
AETNA (ARGUS)
RXAETD
1/18/2017
CEFTRIAXONE 1 GM VIAL
00409733201
OPTUMRX
PDPIND
3/16/2017
CEFUROXIME AXETIL 500 MG TAB
67877021660
OPTUMRX
COS
2/14/2017
CELECOXIB 100 MG CAPSULE
00093716501
NMHC
(blank)
5/2/2017
CELECOXIB 100 MG CAPSULE
13811065910
SXC HEALTH SOLNS
PHS
5/23/2017
CELECOXIB 100 MG CAPSULE
68180039601
BCBS AZ
EN038
5/23/2017
CELECOXIB 200 MG CAPSULE
13811066010
AETNA (ARGUS)
RXAETD
1/10/2017
CELECOXIB 200 MG CAPSULE
69097042112
MAXOR PLUS
5001
3/27/2017
CEPHALEXIN 250 MG/5 ML SUSP
00093417774
AETNA (ARGUS)
RXAETD
4/11/2017
CEPHALEXIN 250 MG/5 ML SUSP
00093417774
CATAMARAN
00884800
1/9/2017
CEPHALEXIN 250 MG/5 ML SUSP
00093417773
CATAMARAN
(blank)
1/9/2017
CEPHALEXIN 250 MG/5 ML SUSP
00093417773
CATAMARAN
N/A
3/21/2017
CEPHALEXIN 500 MG CAPSULE
68180012202
AETNA (ARGUS)
RXAETD
1/10/2017
CEPHALEXIN 500 MG CAPSULE
68180012202
CATAMARAN
00882900
3/21/2017
CEVIMELINE HCL 30 MG CAPSULE
00054033425
AETNA (ARGUS)
RXAETD
1/10/2017
CEVIMELINE HCL 30 MG CAPSULE
00054033425
CATAMARAN
(blank)
1/9/2017
CEVIMELINE HCL 30 MG CAPSULE
63304047901
CATAMARAN
(blank)
1/25/2017
CHLORDIAZEPOX-AMITRIPTYL 10-25
00378027701
CATAMARAN
(blank)
3/20/2017
CHLORDIAZEPOXIDE-CLIDINIUM CAP
76439030210
PROCARE RX
62TCS346
11/30/2016
CHLORDIAZEPOXIDE-CLIDINIUM CAP
68682040910
NMHC
EGWPS035
1/19/2017
CHLOROQUINE PH 250 MG TABLET
64980017750
AETNA (ARGUS)
RXAETD
5/2/2017
CHLOROQUINE PH 500 MG TABLET
64980017802
AETNA (ARGUS)
RXAETD
3/29/2017
CHLORPROMAZINE 10 MG TABLET
00832030000
CATAMARAN
(blank)
3/3/2017
CHLORPROMAZINE 10 MG TABLET
00832030000
CATAMARAN
-
3/20/2017
CHLORPROMAZINE 10 MG TABLET
00832030000
OPTUMRX
AMCTN
2/3/2017
CHLORPROMAZINE 100 MG TABLET
00832030300
CATAMARAN
-
3/3/2017
CHLORPROMAZINE 100 MG TABLET
00832030300
CATAMARAN
-
3/20/2017
CHLORPROMAZINE 100 MG TABLET
00832030300
OPTUMRX
COS
2/3/2017
CHLORPROMAZINE 100 MG TABLET
00832030300
OPTUMRX
COS
3/16/2017
CHLORPROMAZINE 100 MG TABLET
00832030300
OPTUMRX
PDPIND
2/3/2017
CHLORPROMAZINE 100 MG TABLET
00832030300
OPTUMRX
AMCTN
2/3/2017
CHLORPROMAZINE 200 MG TABLET
00832030400
CATAMARAN
(blank)
3/3/2017
CHLORPROMAZINE 200 MG TABLET
00781591701
OPTUMRX
COS
3/17/2017
CHLORPROMAZINE 25 MG TABLET
00832030100
OPTUMRX
UHEALTH
2/14/2017
CHLORPROMAZINE 50 MG TABLET
00832030200
CAREMARK
RX0815
5/4/2017
CHLORPROMAZINE 50 MG TABLET
00832030200
CATAMARAN
CIHSCARE
3/3/2017
CHLORPROMAZINE 50 MG TABLET
00832030200
OPTUMRX
PDPIND
2/3/2017
CHLORTHALIDONE 25 MG TABLET
00378022201
AETNA (ARGUS)
RXAETD
1/10/2017
CHLORTHALIDONE 25 MG TABLET
57664064888
CATAMARAN
HTHSPRING
4/5/2017
CHLORTHALIDONE 25 MG TABLET
57664064888
PHS
26500005
3/30/2017
CHLORTHALIDONE 50 MG TABLET
57664064988
MERIDIANRX
HPMMCD
11/7/2016
CHLORZOXAZONE 500 MG TABLET
00591252001
CIGNA
(blank)
1/10/2017
CHOLESTYRAMINE LIGHT PACKET
49884046665
AETNA (ARGUS)
RXAETD
1/10/2017
CHOLESTYRAMINE LIGHT POWDER
00185093997
AETNA (ARGUS)
RXAETD
1/18/2017
CHOLESTYRAMINE LIGHT POWDER
00185093997
OPTUMRX
U0744260
2/13/2017
CHOLESTYRAMINE PACKET
49884046565
CATAMARAN
(blank)
12/21/2016
CHOLESTYRAMINE PACKET
00185094098
AETNA (ARGUS)
RXAETD
1/10/2017
CHOLESTYRAMINE PACKET
00185094098
CATAMARAN
246534601CIGV
3/20/2017
CHOLESTYRAMINE POWDER
49884046566
AETNA (ARGUS)
RXAETD
1/10/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
CHOLESTYRAMINE POWDER
49884046566
CATAMARAN
(blank)
3/23/2017
CICLOPIROX 0.77% TOPICAL SUSP
45802040046
CIGNA
(blank)
3/21/2017
CICLOPIROX 1% SHAMPOO
00591215990
AETNA (ARGUS)
RXAETD
1/10/2017
CIMETIDINE 200 MG TABLET
00378005301
RXWEST
22207691
5/2/2017
CIMETIDINE 300 MG TABLET
00093819201
AETNA (ARGUS)
RXAETD
1/10/2017
CIMETIDINE 400 MG TABLET
00093820405
AETNA (ARGUS)
RXAETD
1/10/2017
CIMETIDINE 800 MG TABLET
00378054101
CATAMARAN
(blank)
2/9/2017
CITALOPRAM HBR 10 MG/5 ML SOLN
54838054070
AETNA (ARGUS)
RXAETD
1/10/2017
CITALOPRAM HBR 10 MG/5 ML SOLN
54838054070
AETNA (ARGUS)
RXAETD
4/11/2017
CITALOPRAM HBR 10 MG/5 ML SOLN
54838054070
CAREMARK
VAGRD
12/29/2016
CITALOPRAM HBR 40 MG TABLET
65162005450
PHS
26500001
4/6/2017
CLARAVIS 10 MG CAPSULE
00555105486
NMHC
N14072
12/8/2016
CLARAVIS 20 MG CAPSULE
00555105586
CATAMARAN
(blank)
2/3/2017
CLARAVIS 20 MG CAPSULE
00555105586
CATAMARAN
00600000
3/21/2017
CLARAVIS 20 MG CAPSULE
00555105586
CATALYST (FUTURESCRIPTS)
(blank)
3/23/2017
CLARAVIS 30 MG CAPSULE
00555105686
OPTUMRX
COS
5/31/2017
CLARAVIS 30 MG CAPSULE
00555105686
PHS
10003141
CLARAVIS 40 MG CAPSULE
00555105756
NMHC
GOODSHEP
CLARITHROMYCIN 250 MG/5 ML SUS
00781602346
AETNA (ARGUS)
00670000
2/2/2017
CLARITHROMYCIN 500 MG TABLET
00781196260
AETNA (ARGUS)
RXAETD
1/10/2017
CLARITHROMYCIN ER 500 MG TAB
00591280560
AETNA (ARGUS)
RXAETD
1/18/2017
CLIND PH-BENZOYL PEROX 1.2-5%
66993094945
OPTUMRX
U0744260
2/17/2017
CLIND PH-BENZOYL PEROX 1.2-5%
66993094945
MERIDIANRX
(blank)
3/3/2017
CLINDA-BENZOYL PEROX 1-5% PUMP
45802050704
CATAMARAN
(blank)
3/21/2017
CLINDAMYCIN 2% VAGINAL CREAM
00168027740
CATAMARAN
(blank)
3/20/2017
CLINDAMYCIN 2% VAGINAL CREAM
00168027740
CATAMARAN
(blank)
3/30/2017
CLINDAMYCIN 2% VAGINAL CREAM
59762500901
AETNA (ARGUS)
RXAETD
1/10/2017
CLINDAMYCIN HCL 150 MG CAPSULE
63304069205
CAREMARK
RX1021
12/28/2016
CLINDAMYCIN HCL 150 MG CAPSULE
00591570801
OPTUMRX
DER
2/14/2017
CLINDAMYCIN PH 1% GEL
00168020230
CAREMARK
RX6080
12/28/2016
CLINDAMYCIN PH 1% GEL
00168020260
OPTUMRX
PDPIND
2/7/2017
CLINDAMYCIN PH 1% GEL
59762374301
AETNA (ARGUS)
RXAETD
1/10/2017
CLINDAMYCIN PH 1% GEL
59762374301
CATAMARAN
3209704
3/21/2017
CLINDAMYCIN PH 1% GEL
59762374302
CITIZENSRX LLC
LSYA
3/31/2017
CLINDAMYCIN PHOSP 1% LOTION
00168020360
PROCARE RX
ALRX7777
11/30/2016
CLINDAMYCIN PHOSP 1% LOTION
59762374401
AETNA (ARGUS)
RXAETD
1/10/2017
CLINDAMYCIN PHOSPHATE 1% FOAM
45802066032
CATAMARAN
(blank)
1/9/2017
CLINDAMYCIN PHOSPHATE 1% FOAM
45802066032
CATAMARAN
(blank)
3/21/2017
CLINDAMYCIN PHOSPHATE 1% FOAM
45802066032
PRIME THERAPEUTICS
(blank)
4/21/2017
CLINDAMYCIN-BENZOYL PEROX 1-5%
00378868835
CATAMARAN
(blank)
12/21/2016
CLINDA-TRETINOIN 1.2%-0.025%
00472179030
BENECARD PBF
1730
12/2/2016
CLOBETASOL 0.05% CREAM
51672125803
AETNA (ARGUS)
RXAETD
1/10/2017
CLOBETASOL 0.05% CREAM
51672125803
OPTUMRX
U0744260
2/17/2017
CLOBETASOL 0.05% CREAM
51672125801
OPTUMRX
U0744260
2/17/2017
CLOBETASOL 0.05% CREAM
51672125806
AETNA (ARGUS)
RXAETD
1/10/2017
CLOBETASOL 0.05% CREAM
51672125802
AETNA (ARGUS)
RXAETD
1/10/2017
CLOBETASOL 0.05% GEL
45802092594
ARGUS
DSNP
3/13/2017
CLOBETASOL 0.05% GEL
00168029315
CAREMARK
65006500
5/10/2017
CLOBETASOL 0.05% OINTMENT
51672125906
AETNA (ARGUS)
RXAETD
1/10/2017
CLOBETASOL 0.05% OINTMENT
51672125906
MERIDIANRX
-
3/17/2017
CLOBETASOL 0.05% SHAMPOO
45802096126
CATAMARAN
-
1/20/2017
CLOBETASOL 0.05% SHAMPOO
45802096126
OPTUMRX
PDPIND
1/9/2017
4/6/2017
12/15/2016
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
CLOBETASOL 0.05% SHAMPOO
00472040394
AETNA (ARGUS)
RXAETD
1/10/2017
CLOBETASOL 0.05% SOLUTION
00168026950
AETNA (ARGUS)
RXAETD
1/10/2017
CLOBETASOL 0.05% SOLUTION
00168026950
US SCRIPT
(blank)
1/9/2017
CLOBETASOL 0.05% SOLUTION
00472040225
CATAMARAN
HA0018
2/7/2017
CLOBETASOL EMOLLIENT 0.05% CRM
51672129703
NPS
H0545001
4/5/2017
CLOBETASOL EMULSION 0.05% FOAM
40085089350
CITIZENSRX LLC
LSYA
1/30/2017
CLOBETASOL EMULSION 0.05% FOAM
40085089300
CATAMARAN
-
4/20/2017
CLOBETASOL PROP 0.05% FOAM
40085088800
AETNA (ARGUS)
RXAETD
1/10/2017
CLOBETASOL PROP 0.05% FOAM
40085088800
CITIZENSRX LLC
LSYA
2/8/2017
CLOBETASOL PROP 0.05% SPRAY
00591403946
CATAMARAN
-
5/3/2017
CLOMIPHENE CITRATE 50 MG TAB
49884070155
OPTUMRX
(blank)
3/30/2017
CLOMIPRAMINE 25 MG CAPSULE
51672401105
AETNA (ARGUS)
RXAETD
1/10/2017
CLOMIPRAMINE 25 MG CAPSULE
51672401106
OPTUMRX
PDPIND
CLOMIPRAMINE 50 MG CAPSULE
00406880701
PROCARE RX
XPT42224
CLOMIPRAMINE 75 MG CAPSULE
51672401305
CATAMARAN
(blank)
3/7/2017
CLONAZEPAM 0.25 MG ODT
49884030702
AETNA (ARGUS)
RXAETD
1/10/2017
CLONAZEPAM 0.25 MG ODT
49884030702
CATAMARAN
3338841
1/25/2017
CLONAZEPAM 1 MG DIS TABLET
00555009796
CATAMARAN
-
3/23/2017
CLONIDINE 0.1 MG/DAY PATCH
00555100916
AETNA (ARGUS)
RXAETD
1/10/2017
CLONIDINE 0.1 MG/DAY PATCH
00555100916
AETNA (ARGUS)
RXAETD
1/18/2017
CLONIDINE 0.1 MG/DAY PATCH
51862045304
MERIDIANRX
(blank)
5/3/2017
CLONIDINE 0.2 MG/DAY PATCH
51862045404
CATALYST (FUTURESCRIPTS)
-
12/8/2016
CLONIDINE 0.2 MG/DAY PATCH
00555101016
AETNA (ARGUS)
RXAETD
1/10/2017
CLONIDINE 0.2 MG/DAY PATCH
00555101016
AETNA (ARGUS)
RXAETD
1/18/2017
CLONIDINE 0.3 MG/DAY PATCH
00555101116
AETNA (ARGUS)
RXAETD
1/10/2017
CLONIDINE 0.3 MG/DAY PATCH
00555101116
CATAMARAN
(blank)
2/7/2017
CLONIDINE 0.3 MG/DAY PATCH
00555101116
CATAMARAN
-
2/7/2017
CLONIDINE HCL 0.1 MG TABLET
68001023703
AETNA (ARGUS)
RXAETD
1/10/2017
CLONIDINE HCL 0.3 MG TABLET
68001023900
CATAMARAN
(blank)
3/23/2017
CLORAZEPATE 15 MG TABLET
00378007001
BCBS ALABAMA
91005
2/3/2017
CLORAZEPATE 15 MG TABLET
00378007001
CATAMARAN
(blank)
3/20/2017
CLORAZEPATE 15 MG TABLET
00378007001
OPTUMRX
PDPIND
2/14/2017
CLORAZEPATE 15 MG TABLET
51672404401
AETNA (ARGUS)
RXAETD
5/16/2017
CLORAZEPATE 3.75 MG TABLET
00378003001
OPTUMRX
AMCTN
2/3/2017
CLORAZEPATE 3.75 MG TABLET
00378003005
AETNA (ARGUS)
RXAETD
1/10/2017
CLORAZEPATE 3.75 MG TABLET
00378003005
AETNA (ARGUS)
RXAETD
5/2/2017
CLORAZEPATE 3.75 MG TABLET
00378003005
CATAMARAN
DODA
3/30/2017
CLORAZEPATE 7.5 MG TABLET
00378004001
AETNA (ARGUS)
RXAETD
1/10/2017
CLORAZEPATE 7.5 MG TABLET
00378004001
CATAMARAN
(blank)
4/6/2017
CLORAZEPATE 7.5 MG TABLET
00378004001
CIGNA
N/A
1/25/2017
CLORAZEPATE 7.5 MG TABLET
00378004001
OPTUMRX
PDPIND
2/7/2017
CLOTRIMAZOLE 1% CREAM
51672127506
CATAMARAN
-
3/20/2017
CLOTRIMAZOLE 1% CREAM
51672127502
CAREMARK
788257
5/9/2017
CLOTRIMAZOLE 1% SOLUTION
51672126003
AETNA (ARGUS)
RXAETD
1/10/2017
CLOTRIMAZOLE 1% SOLUTION
51672126003
AETNA (ARGUS)
RXAETD
5/23/2017
CLOTRIMAZOLE 1% SOLUTION
51672126003
OPTUMRX
PDPIND
2/3/2017
CLOTRIMAZOLE 1% SOLUTION
51672126003
OPTUMRX
PDPIND
2/14/2017
CLOTRIMAZOLE 10 MG TROCHE
00574010770
AETNA (ARGUS)
RXAETD
1/10/2017
CLOTRIMAZOLE-BETAMETHASONE CRM
66993089845
NAVITUS HEALTH SOLNS
PASC
11/8/2016
CLOTRIMAZOLE-BETAMETHASONE CRM
66993089815
AETNA (ARGUS)
RXAETD
1/10/2017
CLOTRIMAZOLE-BETAMETHASONE LOT
51672130803
AETNA (ARGUS)
RXAETD
1/18/2017
CLOTRIMAZOLE-BETAMETHASONE LOT
51672130803
CATAMARAN
(blank)
3/30/2017
2/3/2017
11/30/2016
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
CLOTRIMAZOLE-BETAMETHASONE LOT
51672130803
CATAMARAN
-
MAC Effective Date
3/20/2017
CLOZAPINE 100 MG TABLET
00378086001
AETNA (ARGUS)
RXAETD
1/10/2017
CLOZAPINE 100 MG TABLET
00378086005
CATAMARAN
0
3/30/2017
CLOZAPINE ODT 100 MG TABLET
00093301001
AETNA (ARGUS)
RXAETD
12/6/2016
CLOZAPINE ODT 100 MG TABLET
00093301001
AETNA (ARGUS)
RXAETD
1/18/2017
CLOZAPINE ODT 100 MG TABLET
00093301001
AETNA (ARGUS)
RXAETD
4/11/2017
CLOZAPINE ODT 200 MG TABLET
00093308701
OPTUMRX
COS
2/3/2017
CLOZAPINE ODT 25 MG TABLET
00093301201
ARGUS
-
4/17/2017
COLCHICINE 0.6 MG TABLET
66993016502
PROCARE RX
62TCS281
11/30/2016
COLESTIPOL HCL 1 GM TABLET
00115521116
AETNA (ARGUS)
RXAETD
1/10/2017
COLESTIPOL HCL GRANULES PACKET
59762026001
AETNA (ARGUS)
RXAETD
1/10/2017
COLESTIPOL HCL GRANULES PACKET
00115521218
CATAMARAN
(blank)
4/20/2017
COLESTIPOL MICRONIZED 1 GM TAB
59762045001
CATAMARAN
-
1/12/2017
COLESTIPOL MICRONIZED 1 GM TAB
59762045001
CIGNA
00600000
1/9/2017
COLESTIPOL MICRONIZED 1 GM TAB
59762045001
OPTUMRX
PDPIND
1/9/2017
COLISTIMETHATE 150 MG VIAL
39822061702
OPTUMRX
PDPIND
2/3/2017
COLOCORT 100 MG ENEMA
00574202007
CATAMARAN
-
4/18/2017
CROMOLYN 20 MG/2 ML NEB SOLN
00172640649
OPTUMRX
U0744260
3/17/2017
CYANOCOBALAMIN 1,000 MCG/ML
00517003225
MAXOR PLUS
(blank)
1/13/2017
CYANOCOBALAMIN 1,000 MCG/ML
00517003125
AETNA (ARGUS)
RXAETD
3/29/2017
CYANOCOBALAMIN 1,000 MCG/ML
00517003125
CATAMARAN
3174704
1/25/2017
CYCLAFEM 1-35-28 TABLET
00603752117
PHS
30000109
3/30/2017
CYCLAFEM 1-35-28 TABLET
00603752117
PRIME THERAPEUTICS
(blank)
1/19/2017
CYCLAFEM 1-35-28 TABLET
00603752117
RXWEST
SDNYREG
3/2/2017
CYCLOBENZAPRINE 10 MG TABLET
00603307932
OPTUMRX
U0744260
2/27/2017
CYCLOBENZAPRINE 5 MG TABLET
00591325601
CAREMARK
UMWA
12/15/2016
CYCLOPHOSPHAMIDE 50 MG CAPSULE
00054038325
CATAMARAN
00183586
2/3/2017
CYPROHEPTADINE 4 MG TABLET
50742019001
AETNA (ARGUS)
RXAETD
1/18/2017
CYPROHEPTADINE 4 MG TABLET
50742019001
CATAMARAN
(blank)
12/21/2016
CYPROHEPTADINE 4 MG TABLET
50742019010
MERIDIANRX
QUICKEN
D-AMPHETAMINE ER 10 MG CAPSULE
51862034590
PRIME THERAPEUTICS
(blank)
D-AMPHETAMINE ER 10 MG CAPSULE
00406896101
CATAMARAN
0733576
2/7/2017
D-AMPHETAMINE ER 10 MG CAPSULE
54505032809
CATAMARAN
00611294
1/13/2017
D-AMPHETAMINE ER 15 MG CAPSULE
00406896201
AETNA (ARGUS)
RXAETD
1/18/2017
D-AMPHETAMINE ER 15 MG CAPSULE
00406896201
CATAMARAN
(blank)
3/23/2017
D-AMPHETAMINE ER 15 MG CAPSULE
00406896201
CATAMARAN
00611574
12/21/2016
D-AMPHETAMINE ER 15 MG CAPSULE
00406896201
MERIDIANRX
(blank)
D-AMPHETAMINE ER 15 MG CAPSULE
51862034690
CATALYST
HA0005
D-AMPHETAMINE ER 5 MG CAPSULE
00406896001
CATAMARAN
-
11/23/2016
D-AMPHETAMINE ER 5 MG CAPSULE
00406896001
PRIME THERAPEUTICS
P17267
12/16/2016
D-AMPHETAMINE ER 5 MG CAPSULE
00406896001
RXWEST
031403
1/26/2017
DANAZOL 100 MG CAPSULE
00555063402
RXWEST
SHOPIRON
5/30/2017
DANAZOL 200 MG CAPSULE
00555063502
CATAMARAN
3339080
2/24/2017
DANAZOL 200 MG CAPSULE
00555063502
NPS
H0544002
2/24/2017
DANAZOL 200 MG CAPSULE
00555063509
NMHC
MDCMEDD
2/9/2017
DANTROLENE SODIUM 25 MG CAP
00115441101
CATAMARAN
2500181
2/24/2017
DANTROLENE SODIUM 25 MG CAP
00115441101
CATAMARAN
2500181
3/21/2017
DANTROLENE SODIUM 25 MG CAP
00115441101
OPTUMRX
PDPIND
2/3/2017
DANTROLENE SODIUM 25 MG CAP
00115441101
OPTUMRX
U0744260
2/17/2017
DANTROLENE SODIUM 50 MG CAP
00115442201
AETNA (ARGUS)
RXAETD
1/10/2017
DAPSONE 100 MG TABLET
13925050530
AETNA (ARGUS)
RXAETD
1/10/2017
DAPSONE 100 MG TABLET
13925050530
CATAMARAN
00617497
2/7/2017
2/3/2017
11/10/2016
6/2/2017
3/3/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
DAPSONE 100 MG TABLET
13925050530
NPS
H0544015
MAC Effective Date
4/24/2017
DAPSONE 100 MG TABLET
49938010130
AETNA (ARGUS)
RXAETD
1/10/2017
DAPSONE 100 MG TABLET
29033003730
CATAMARAN
(blank)
3/3/2017
DAPSONE 100 MG TABLET
29033003730
CATAMARAN
-
3/20/2017
DAPSONE 25 MG TABLET
13925050401
AETNA (ARGUS)
RXAETD
1/10/2017
DAPSONE 25 MG TABLET
13925050401
CATAMARAN
(blank)
3/3/2017
DAPSONE 25 MG TABLET
13925050401
MERIDIANRX
BAPMCORX
5/11/2017
DAPSONE 25 MG TABLET
29033003630
CATAMARAN
-
4/6/2017
DAPSONE 25 MG TABLET
29033003630
MERIDIANRX
BAPMCORX
3/10/2017
DEMECLOCYCLINE 300 MG TABLET
42806014448
AETNA (ARGUS)
RXAETD
1/10/2017
DEMECLOCYCLINE 300 MG TABLET
42806014448
OPTUMRX
PDPIND
1/10/2017
DEPO-TESTOSTERONE 200 MG/ML
00009041702
MERIDIANRX
LYNDHURST
4/26/2017
DESIPRAMINE 10 MG TABLET
00781521801
CAREMARK
788257
11/15/2016
DESIPRAMINE 10 MG TABLET
00781521801
CATAMARAN
(blank)
4/6/2017
DESIPRAMINE 10 MG TABLET
00781521801
NMHC
(blank)
4/20/2017
DESIPRAMINE 100 MG TABLET
00781197501
CATAMARAN
(blank)
3/30/2017
DESIPRAMINE 100 MG TABLET
00781197501
CATAMARAN
611842
2/24/2017
DESIPRAMINE 25 MG TABLET
69238105501
CATAMARAN
-
3/23/2017
DESIPRAMINE 25 MG TABLET
00781197201
CATAMARAN
(blank)
3/30/2017
DESLORATADINE 5 MG TABLET
69543010730
CATAMARAN
(blank)
5/18/2017
DESMOPRESSIN 0.01% SOLUTION
24208034205
ARGUS
(blank)
5/30/2017
DESMOPRESSIN 10 MCG/0.1 ML SPR
47335078891
CATAMARAN
-
3/20/2017
DESMOPRESSIN 10 MCG/0.1 ML SPR
47335078891
PRIME THERAPEUTICS
(blank)
12/16/2016
DESMOPRESSIN 10 MCG/0.1 ML SPR
69918050105
AETNA (ARGUS)
RXAETD
1/10/2017
DESMOPRESSIN 10 MCG/0.1 ML SPR
69918050105
CATAMARAN
(blank)
3/3/2017
DESMOPRESSIN 10 MCG/0.1 ML SPR
69918050105
CATAMARAN
CIGNA2015
3/30/2017
3/8/2017
DESMOPRESSIN 10 MCG/0.1 ML SPR
69918050105
NMHC
SMWL263
DESMOPRESSIN 10 MCG/0.1 ML SPR
69918050105
PRIME THERAPEUTICS
(blank)
2/3/2017
DESMOPRESSIN ACETATE 0.1 MG TB
68001023300
AETNA (ARGUS)
RXAETD
1/10/2017
DESMOPRESSIN ACETATE 0.1 MG TB
68001023300
CATAMARAN
246534615CI
3/20/2017
DESMOPRESSIN ACETATE 0.2 MG TB
00591246501
CATAMARAN
BRAVOHLTH
1/20/2017
DESMOPRESSIN ACETATE 0.2 MG TB
00591246501
NAVITUS HEALTH SOLNS
THD
11/2/2016
DESMOPRESSIN ACETATE 0.2 MG TB
69918020101
CATAMARAN
3174376
1/9/2017
DESMOPRESSIN ACETATE 0.2 MG TB
68001023400
AETNA (ARGUS)
RXAETD
1/18/2017
DESOGESTR-ETH ESTRAD ETH ESTRA
00378729653
OPTUMRX
(blank)
2/13/2017
DESONIDE 0.05% CREAM
51672128003
AETNA (ARGUS)
RXAETD
1/10/2017
DESONIDE 0.05% CREAM
51672128003
OPTUMRX
PDPIND
2/3/2017
DESONIDE 0.05% LOTION
00168031004
PRIME THERAPEUTICS
B0000002
2/10/2017
DESONIDE 0.05% LOTION
51672407908
AETNA (ARGUS)
RXAETD
1/10/2017
DESONIDE 0.05% OINTMENT
00168030960
AETNA (ARGUS)
RXAETD
1/10/2017
DESOXIMETASONE 0.05% CREAM
51672127103
OPTUMRX
UNITEDCOAL
3/17/2017
DESOXIMETASONE 0.05% CREAM
51672127103
NPS
NBRX1000
3/21/2017
DESOXIMETASONE 0.05% GEL
51672126101
AETNA (ARGUS)
RXAETD
1/10/2017
DESOXIMETASONE 0.05% OINTMENT
51672135203
MERIDIANRX
(blank)
11/7/2016
DESOXIMETASONE 0.25% CREAM
45802049537
AETNA (ARGUS)
RXAETD
1/24/2017
DESOXIMETASONE 0.25% CREAM
51672127003
AETNA (ARGUS)
RXAETD
1/10/2017
DESOXIMETASONE 0.25% OINTMENT
51672126203
CAREMARK
RX2451
3/7/2017
DESOXIMETASONE 0.25% OINTMENT
51672126203
CATAMARAN
(blank)
3/20/2017
DESOXIMETASONE 0.25% OINTMENT
51672126203
OPTUMRX
IEBP
1/26/2017
DESOXIMETASONE 0.25% OINTMENT
51672126201
AETNA (ARGUS)
RXAETD
1/10/2017
DESOXIMETASONE 0.25% OINTMENT
52565003060
MAXOR PLUS
S2559
3/17/2017
DESVENLAFAXINE ER 50 MG TAB
63304019130
MERIDIANRX
-
3/10/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
DEXAMETHASONE 0.5 MG/5 ML ELX
54879000308
AETNA (ARGUS)
RXAETD
5/9/2017
DEXAMETHASONE 0.5 MG/5 ML ELX
54879000308
OPTUMRX
PDPIND
6/1/2017
DEXMETHYLPHENIDATE ER 10 MG CP
00781268301
MEDIMPACT
OGB
2/27/2017
DEXMETHYLPHENIDATE ER 10 MG CP
00781268301
MERIDIANRX
PRSC
3/10/2017
DEXMETHYLPHENIDATE ER 15 MG CP
00378408201
CATAMARAN
107093
11/2/2016
DEXMETHYLPHENIDATE ER 15 MG CP
49884042801
PRIME THERAPEUTICS
940
2/24/2017
DEXMETHYLPHENIDATE ER 20 MG CP
00781268501
CATAMARAN
3208036
1/9/2017
DEXMETHYLPHENIDATE ER 25 MG CP
00781268601
BCBS ALABAMA
(blank)
5/5/2017
DEXMETHYLPHENIDATE ER 30 MG CP
00378408401
AETNA (ARGUS)
RXAETD
1/10/2017
DEXMETHYLPHENIDATE ER 30 MG CP
68084093332
ARGUS
W0088055100APPO
5/23/2017
DEXMETHYLPHENIDATE ER 35 MG CP
00781268801
PRIME THERAPEUTICS
ILDR
3/17/2017
DEXMETHYLPHENIDATE ER 40 MG CP
00378408501
CAREMARK
RXBCID
1/3/2017
DEXTROAMP-AMPHET ER 10 MG CAP
00115132901
OPTUMRX
U0744260
2/13/2017
DEXTROAMP-AMPHET ER 15 MG CAP
00228306311
OPTUMRX
U0744260
2/13/2017
DEXTROAMP-AMPHET ER 15 MG CAP
00781234301
MERIDIANRX
QUICKEN
4/13/2017
DEXTROAMP-AMPHET ER 15 MG CAP
00781234301
SXC HEALTH SOLNS
PHS
5/23/2017
DEXTROAMP-AMPHET ER 20 MG CAP
00781235201
CATAMARAN
(blank)
1/25/2017
DEXTROAMP-AMPHET ER 20 MG CAP
00781235201
CIGNA
3335386
1/25/2017
DEXTROAMP-AMPHET ER 20 MG CAP
00781235201
MERIDIANRX
12981
3/24/2017
DEXTROAMP-AMPHET ER 20 MG CAP
00781235201
MAGELLAN
PRXCBG
3/14/2017
DEXTROAMP-AMPHET ER 20 MG CAP
00228306011
CIGNA
CPS
1/25/2017
DEXTROAMP-AMPHET ER 20 MG CAP
00115133101
AETNA (ARGUS)
RXAETD
1/10/2017
DEXTROAMP-AMPHET ER 25 MG CAP
00115133201
CATALYST
STOH
4/28/2017
DEXTROAMP-AMPHET ER 25 MG CAP
00115133201
SXC HEALTH SOLNS
MCL
4/6/2017
DEXTROAMP-AMPHET ER 25 MG CAP
00781236801
OPTUMRX
CBT
6/1/2017
DEXTROAMP-AMPHET ER 30 MG CAP
00115133301
CATAMARAN
3309644
1/25/2017
DEXTROAMP-AMPHET ER 30 MG CAP
00115133301
MEDIMPACT
34086
11/22/2016
DEXTROAMP-AMPHET ER 30 MG CAP
00781237101
MEDIMPACT
PRW02
11/22/2016
DEXTROAMP-AMPHET ER 30 MG CAP
00781237101
MERIDIANRX
QUICKEN
2/10/2017
DEXTROAMP-AMPHET ER 30 MG CAP
00115149101
CATAMARAN
00881200
1/25/2017
DEXTROAMP-AMPHET ER 30 MG CAP
00115149101
CIGNA
(blank)
1/25/2017
DEXTROAMP-AMPHET ER 30 MG CAP
00115149101
MEDIMPACT
38600
12/6/2016
DEXTROAMP-AMPHET ER 30 MG CAP
00555078902
PRIME THERAPEUTICS
0761550000
1/6/2017
DEXTROAMP-AMPHET ER 30 MG CAP
66993059902
OPTUMRX
U0744260
2/13/2017
DEXTROAMP-AMPHET ER 30 MG CAP
00228306111
SXC HEALTH SOLNS
PHS
5/23/2017
DEXTROAMP-AMPHETAMIN 10 MG TAB
00185084201
NMHC
GCOCOMM
5/23/2017
DEXTROAMP-AMPHETAMIN 10 MG TAB
00185084201
NMHC
NWL01
5/23/2017
DEXTROAMP-AMPHETAMIN 15 MG TAB
00555077702
AETNA (ARGUS)
RXAETD
1/10/2017
DEXTROAMP-AMPHETAMIN 20 MG TAB
00185085301
AETNA (ARGUS)
RXAETD
1/10/2017
DEXTROAMP-AMPHETAMIN 20 MG TAB
00185085301
AETNA (ARGUS)
RXAETD
1/18/2017
DEXTROAMP-AMPHETAMIN 20 MG TAB
00185085301
CATAMARAN
(blank)
3/21/2017
DEXTROAMP-AMPHETAMIN 20 MG TAB
00185085301
CATAMARAN
3338397
2/3/2017
DEXTROAMP-AMPHETAMIN 20 MG TAB
00185085301
CATAMARAN
3338099
2/3/2017
DEXTROAMP-AMPHETAMIN 20 MG TAB
00185085301
CATAMARAN
179494
3/21/2017
DEXTROAMP-AMPHETAMIN 20 MG TAB
00185085301
CIGNA
3336279
3/21/2017
DEXTROAMP-AMPHETAMIN 20 MG TAB
00185085301
OPTUMRX
COS
DEXTROAMP-AMPHETAMIN 20 MG TAB
00185085301
OPTUMRX
MILWCTY
11/16/2016
DEXTROAMP-AMPHETAMIN 20 MG TAB
64720013510
CATAMARAN
3317312
2/3/2017
DEXTROAMP-AMPHETAMIN 20 MG TAB
00555097302
CATAMARAN
(blank)
2/7/2017
DEXTROAMP-AMPHETAMIN 30 MG TAB
00185086401
OPTUMRX
PDPIND
DEXTROAMP-AMPHETAMIN 30 MG TAB
00185086401
OPTUMRX
UHEALTH
DEXTROAMP-AMPHETAMIN 30 MG TAB
00555097402
OPTUMRX
PDPIND
2/3/2017
2/7/2017
11/16/2016
2/3/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
DEXTROAMP-AMPHETAMIN 30 MG TAB
00555097402
OPTUMRX
PDPIND
2/7/2017
DEXTROAMP-AMPHETAMIN 30 MG TAB
00555097402
OPTUMRX
SHCA
2/7/2017
DEXTROAMP-AMPHETAMINE 5 MG TAB
00185083101
AETNA (ARGUS)
RXAETD
1/10/2017
DEXTROAMP-AMPHETAMINE 5 MG TAB
00185083101
CIGNA
(blank)
3/21/2017
DEXTROAMP-AMPHETAMINE 5 MG TAB
00185083101
CIGNA
(blank)
4/13/2017
DEXTROAMP-AMPHETAMINE 5 MG TAB
00185083101
CIGNA
CIGNA
2/24/2017
DEXTROAMP-AMPHETAMINE 5 MG TAB
00185083101
NMHC
VPSRX
3/30/2017
DEXTROAMP-AMPHETAMINE 5 MG TAB
00185083101
PRIME THERAPEUTICS
71455305
5/19/2017
DEXTROAMPHETAMINE 10 MG TAB
52536051001
AETNA (ARGUS)
RXAETD
1/10/2017
DEXTROAMPHETAMINE 10 MG TAB
52536051001
CATAMARAN
(blank)
3/20/2017
DEXTROAMPHETAMINE 10 MG TAB
52536051001
CATAMARAN
00616027
1/9/2017
DEXTROAMPHETAMINE 10 MG TAB
52536051001
CATAMARAN
3208324
1/25/2017
DEXTROAMPHETAMINE 5 MG TAB
52536050001
CATAMARAN
(blank)
3/23/2017
DEXTROAMPHETAMINE 5 MG TAB
52536050001
CATALYST (FUTURESCRIPTS)
(blank)
11/15/2016
DEXTROSE POWDER
54288123302
CATALYST
(blank)
5/23/2017
DIAZEPAM 5 MG/5 ML SOLUTION
00054318863
MAXOR PLUS
S2559
4/28/2017
DICLOFENAC 0.1% EYE DROPS
16571010150
OPTUMRX
SHII
12/6/2016
DICLOFENAC 0.1% EYE DROPS
16571010150
OPTUMRX
ACUNE
3/17/2017
DICLOFENAC 0.1% EYE DROPS
16571010150
NAVITUS HEALTH SOLNS
VTGX
12/7/2016
DICLOFENAC 0.1% EYE DROPS
16571010125
OPTUMRX
COS
3/3/2017
DICLOFENAC 0.1% EYE DROPS
17478089210
OPTUMRX
ACUAZ
3/30/2017
DICLOFENAC 0.1% EYE DROPS
24208045705
AETNA (ARGUS)
RXAETD
1/10/2017
DICLOFENAC 1.5% TOPICAL SOLN
60505039905
AETNA (ARGUS)
RXAETD
1/10/2017
DICLOFENAC POT 50 MG TABLET
00781501701
CATAMARAN
884700
1/25/2017
DICLOFENAC POT 50 MG TABLET
00781501701
CATAMARAN
3329543
3/21/2017
DICLOFENAC SOD DR 25 MG TAB
68001027900
CATAMARAN
-
1/12/2017
DICLOFENAC SOD DR 50 MG TAB
68001020100
AETNA (ARGUS)
RXAETD
1/10/2017
DICLOFENAC SOD DR 50 MG TAB
68001028000
OPTUMRX
01961686
2/13/2017
DICLOFENAC SOD DR 75 MG TAB
68001028108
MERIDIANRX
HPMMCD
11/7/2016
DICLOFENAC SOD DR 75 MG TAB
61442010310
AETNA (ARGUS)
RXAETD
1/10/2017
DICLOFENAC SOD EC 75 MG TAB
16571020111
AETNA (ARGUS)
RXAETD
1/10/2017
DICLOFENAC SOD ER 100 MG TAB
00591067601
OPTUMRX
U0744260
2/17/2017
DICLOFENAC SOD ER 100 MG TAB
00591067601
NAVITUS HEALTH SOLNS
FCC82C00015T15T
11/2/2016
DICLOFENAC SODIUM 1% GEL
65162083366
CATAMARAN
(blank)
3/20/2017
DICLOFENAC SODIUM 1% GEL
65162083366
CATAMARAN
0712456
DICLOFENAC SODIUM 1% GEL
65162083366
OPTUMRX
COS
12/12/2016
DICLOFENAC SODIUM 1% GEL
49884093547
AETNA (ARGUS)
RXAETD
1/10/2017
DICLOFENAC SODIUM 1% GEL
49884093547
CATAMARAN
3328279
1/9/2017
DICLOFENAC SODIUM 1% GEL
49884093547
CATAMARAN
3331258
1/25/2017
DICLOFENAC SODIUM 1% GEL
49884093547
CIGNA
3338841
3/21/2017
DICLOFENAC-MISOPROST 75-0.2 TB
68001023206
CATAMARAN
3214936
1/25/2017
DICLOFENAC-MISOPROST 75-0.2 TB
68001023206
PRIME THERAPEUTICS
102140
6/2/2017
DICLOFENAC-MISOPROST 75-0.2 TB
68001023206
CATALYST (FUTURESCRIPTS)
(blank)
11/15/2016
DICLOXACILLIN 250 MG CAPSULE
00093312301
AETNA (ARGUS)
RXAETD
1/18/2017
DICLOXACILLIN 250 MG CAPSULE
00093312301
OPTUMRX
COS
4/13/2017
DICLOXACILLIN 250 MG CAPSULE
00093312301
ARGUS
501493
12/27/2016
DICLOXACILLIN 500 MG CAPSULE
00093312501
AETNA (ARGUS)
RXAETD
5/23/2017
DICLOXACILLIN 500 MG CAPSULE
00093312501
CAREMARK
RX1113
12/21/2016
DICYCLOMINE 20 MG TABLET
00378162001
CAREMARK
788257
11/15/2016
DICYCLOMINE 20 MG TABLET
00591079501
AETNA (ARGUS)
RXAETD
1/10/2017
DIDANOSINE DR 400 MG CAPSULE
65862031330
CATAMARAN
(blank)
3/23/2017
DIDANOSINE DR 400 MG CAPSULE
65862031330
OPTUMRX
COS
2/3/2017
1/9/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
DIFLORASONE 0.05% CREAM
51672129603
CATAMARAN
-
MAC Effective Date
1/9/2017
DIFLORASONE 0.05% OINTMENT
51672129501
AETNA (ARGUS)
RXAETD
4/25/2017
DIFLORASONE 0.05% OINTMENT
51672129503
AETNA (ARGUS)
RXAETD
4/25/2017
DIFLUNISAL 500 MG TABLET
64980018106
AETNA (ARGUS)
RXAETD
1/10/2017
DIGOX 250 MCG TABLET
00527132501
PRIME THERAPEUTICS
07972
12/1/2016
DIGOXIN 125 MCG TABLET
00115981103
AETNA (ARGUS)
RXAETD
1/10/2017
DIGOXIN 125 MCG TABLET
00115981101
AETNA (ARGUS)
RXAETD
1/31/2017
DIGOXIN 125 MCG TABLET
00115981101
AETNA (ARGUS)
RXAETD
2/7/2017
DIGOXIN 250 MCG TABLET
00115982201
AETNA (ARGUS)
RXAETD
1/10/2017
DIGOXIN 250 MCG TABLET
00115982203
AETNA (ARGUS)
RXAETD
1/10/2017
DIHYDROERGOTAMINE 1 MG/ML AM
00574085010
OPTUMRX
PDPIND
6/2/2017
DILT XR 120 MG CAPSULE
60505001406
AETNA (ARGUS)
RXAETD
1/10/2017
DILTIAZEM 120 MG TABLET
00378052501
AETNA (ARGUS)
RXAETD
1/10/2017
DILTIAZEM 120 MG TABLET
00378052501
CAREMARK
UHSRX
1/31/2017
DILTIAZEM 120 MG TABLET
00378052501
NMHC
EGWPS032
1/12/2017
DILTIAZEM 120 MG TABLET
00378052501
OPTUMRX
COS
11/11/2016
DILTIAZEM 120 MG TABLET
00378052501
OPTUMRX
PDPIND
1/9/2017
DILTIAZEM 120 MG TABLET
00378052501
PHS
10005578
4/28/2017
DILTIAZEM 12HR ER 120 MG CAP
51079092620
NPS
H5649001
12/7/2016
DILTIAZEM 12HR ER 120 MG CAP
00378612001
CATAMARAN
246534606CI
2/7/2017
DILTIAZEM 12HR ER 60 MG CAP
00378606001
CATAMARAN
3328000
1/13/2017
DILTIAZEM 12HR ER 90 MG CAP
00378609001
CATAMARAN
HTHSPRING
1/20/2017
DILTIAZEM 24HR CD 120 MG CAP
49884082911
CAREMARK
ENGIN
1/31/2017
DILTIAZEM 24HR CD 180 MG CAP
49884083009
AETNA (ARGUS)
RXAETD
1/10/2017
DILTIAZEM 24HR CD 240 MG CAP
49884083109
CATALYST
CULINARY
1/12/2017
DILTIAZEM 24HR CD 240 MG CAP
49884083109
OPTUMRX
ACUAZ
2/7/2017
DILTIAZEM 24HR CD 240 MG CAP
49884083109
ARGUS
(blank)
2/21/2017
DILTIAZEM 24HR CD 240 MG CAP
49884083105
AETNA (ARGUS)
RXAETD
1/10/2017
DILTIAZEM 24HR CD 300 MG CAP
49884083209
AETNA (ARGUS)
RXAETD
1/10/2017
DILTIAZEM 24HR CD 360 MG CAP
68682052101
NAVITUS HEALTH SOLNS
FCC
12/22/2016
DILTIAZEM 24HR ER 240 MG CAP
68682036990
AETNA (ARGUS)
RXAETD
1/10/2017
DILTIAZEM 24HR ER 360 MG CAP
00228291809
AETNA (ARGUS)
RXAETD
1/10/2017
DILTIAZEM 24HR ER 360 MG CAP
00228291809
ARGUS
000990
5/30/2017
DILTIAZEM 24HR ER 360 MG CAP
68682037190
AETNA (ARGUS)
RXAETD
1/10/2017
DILTIAZEM 24HR ER 360 MG TAB
68682070830
CITIZENSRX LLC
1019
1/3/2017
DILTIAZEM 24HR ER 420 MG CAP
68682037290
AETNA (ARGUS)
RXAETD
1/10/2017
DILTIAZEM 60 MG TABLET
00378004501
CATAMARAN
(blank)
2/7/2017
DILTIAZEM 90 MG TABLET
00378013501
CAREMARK
788257
12/22/2016
DILTIAZEM ER 180 MG CAPSULE
00378528005
AETNA (ARGUS)
RXAETD
1/10/2017
DILTIAZEM ER 180 MG CAPSULE
00378528001
CATAMARAN
3338105
2/7/2017
DILTIAZEM ER 240 MG CAPSULE
00378534001
AETNA (ARGUS)
RXAETD
1/10/2017
DILTIAZEM ER 240 MG CAPSULE
00378534005
AETNA (ARGUS)
RXAETD
1/10/2017
DIPHENOXYLATE-ATROP 2.5-0.025
59762106102
AETNA (ARGUS)
RXAETD
1/18/2017
DIPHENOXYLATE-ATROP 2.5-0.025
59762106102
CATAMARAN
2500183
3/21/2017
DIPHENOXYLATE-ATROP 2.5-0.025
59762106102
PROCARE RX
LARX7722
11/30/2016
DIPYRIDAMOLE 25 MG TABLET
64980013301
AETNA (ARGUS)
00670000
5/3/2017
DIPYRIDAMOLE 25 MG TABLET
64980013301
CAREMARK
RX3989
5/3/2017
DIPYRIDAMOLE 75 MG TABLET
64980013501
CATAMARAN
(blank)
3/30/2017
DIPYRIDAMOLE 75 MG TABLET
64980013501
RXWEST
40293H
3/7/2017
DISOPYRAMIDE 100 MG CAPSULE
00093312701
CATAMARAN
(blank)
2/16/2017
DISOPYRAMIDE 100 MG CAPSULE
00093312701
OPTUMRX
COS
2/28/2017
DISOPYRAMIDE 150 MG CAPSULE
00093312901
AETNA (ARGUS)
476537
2/1/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
DISOPYRAMIDE 150 MG CAPSULE
00093312901
CAREMARK
788257
5/24/2017
DISOPYRAMIDE 150 MG CAPSULE
00093312901
CATAMARAN
(blank)
3/20/2017
DISOPYRAMIDE 150 MG CAPSULE
00093312901
CATAMARAN
(blank)
4/20/2017
DISOPYRAMIDE 150 MG CAPSULE
00093312901
PRIME THERAPEUTICS
TXVDP
3/17/2017
DISULFIRAM 250 MG TABLET
64980017101
AETNA (ARGUS)
RXAETD
1/10/2017
DISULFIRAM 250 MG TABLET
64980017101
AETNA (ARGUS)
RXAETD
1/23/2017
DISULFIRAM 250 MG TABLET
00054035613
CATAMARAN
S5932
3/3/2017
DIVALPROEX SOD DR 250 MG TAB
62756079788
CATAMARAN
(blank)
3/23/2017
DIVALPROEX SOD ER 250 MG TAB
10370051050
CITIZENSRX LLC
1019
1/3/2017
DIVALPROEX SOD ER 250 MG TAB
68001010500
OPTUMRX
U0744260
2/13/2017
DIVALPROEX SOD ER 250 MG TAB
10370051010
AETNA (ARGUS)
RXAETD
1/10/2017
DIVALPROEX SOD ER 500 MG TAB
68001010600
CATAMARAN
(blank)
1/25/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
DOFETILIDE 500 MCG CAPSULE
59762003902
CATAMARAN
-
MAC Effective Date
3/23/2017
DONEPEZIL HCL 23 MG TABLET
33342006107
CAREMARK
788257
12/22/2016
DONEPEZIL HCL 23 MG TABLET
33342006110
OPTUMRX
GEVRX
2/17/2017
DONEPEZIL HCL 23 MG TABLET
00228452903
AETNA (ARGUS)
RXAETD
1/10/2017
DONEPEZIL HCL ODT 5 MG TABLET
68382034606
AETNA (ARGUS)
RXAETD
1/10/2017
DORZOLAMIDE-TIMOLOL EYE DROPS
50383023310
CATAMARAN
(blank)
3/20/2017
DOXAZOSIN MESYLATE 1 MG TAB
59762231006
AETNA (ARGUS)
RXAETD
1/10/2017
DOXAZOSIN MESYLATE 1 MG TAB
59762231006
CATAMARAN
(blank)
1/9/2017
DOXAZOSIN MESYLATE 1 MG TAB
67253038010
CATAMARAN
3340006
1/10/2017
DOXAZOSIN MESYLATE 2 MG TAB
16729021201
AETNA (ARGUS)
RXAETD
1/10/2017
DOXAZOSIN MESYLATE 4 MG TAB
67253038210
AETNA (ARGUS)
RXAETD
1/10/2017
DOXAZOSIN MESYLATE 4 MG TAB
67253038210
CATAMARAN
N/A
3/3/2017
DOXAZOSIN MESYLATE 4 MG TAB
16729021301
OPTUMRX
PDPIND
3/3/2017
DOXAZOSIN MESYLATE 8 MG TAB
67253038310
AETNA (ARGUS)
RXAETD
1/10/2017
DOXEPIN 10 MG CAPSULE
00378104901
CATAMARAN
(blank)
3/21/2017
DOXEPIN 100 MG CAPSULE
00378641001
AETNA (ARGUS)
RXAETD
1/10/2017
DOXEPIN 100 MG CAPSULE
00378641001
CAREMARK
RX5439
11/29/2016
DOXEPIN 100 MG CAPSULE
00378641001
CATAMARAN
3335179
DOXEPIN 100 MG CAPSULE
00378641001
OPTUMRX
IEBP
11/16/2016
DOXEPIN 100 MG CAPSULE
00378641001
CITIZENSRX LLC
1019
4/19/2017
DOXEPIN 150 MG CAPSULE
49884022201
OPTUMRX
ACUPA
2/27/2017
DOXEPIN 25 MG CAPSULE
00378312501
AETNA (ARGUS)
RXAETD
1/10/2017
DOXEPIN 25 MG CAPSULE
00378312501
CATAMARAN
0712456
3/21/2017
DOXEPIN 25 MG CAPSULE
00378312501
US SCRIPT
18011
11/11/2016
DOXEPIN 25 MG CAPSULE
00378312501
CITIZENSRX LLC
1019
2/9/2017
DOXEPIN 25 MG CAPSULE
00378312501
SXC HEALTH SOLNS
PHS
1/20/2017
2/3/2017
DOXEPIN 25 MG CAPSULE
00378312501
PROCARE RX
FS222567
11/30/2016
DOXEPIN 50 MG CAPSULE
00378425010
AETNA (ARGUS)
RXAETD
1/10/2017
DOXEPIN 50 MG CAPSULE
00378425001
CATAMARAN
(blank)
3/22/2017
DOXEPIN 50 MG CAPSULE
00378425001
CIGNA
(blank)
3/21/2017
DOXEPIN 75 MG CAPSULE
00378537501
CATAMARAN
3340414
3/21/2017
DOXEPIN 75 MG CAPSULE
00378537501
CATAMARAN
3340414
4/13/2017
DOXEPIN 75 MG CAPSULE
00378537501
OPTUMRX
UHEALTH
3/30/2017
DOXY 100 VIAL
63323013011
CAREMARK
65006500
12/15/2016
DOXYCYCLINE HYC DR 100 MG TAB
68308071010
OPTUMRX
01962210
2/17/2017
DOXYCYCLINE HYC DR 150 MG TAB
00378303001
AETNA (ARGUS)
RXAETD
1/10/2017
DOXYCYCLINE HYC DR 200 MG TAB
68308071660
ARGUS
93078
3/20/2017
DOXYCYCLINE HYCLATE 100 MG CAP
00143314205
OPTUMRX
COS
2/3/2017
DOXYCYCLINE HYCLATE 100 MG CAP
00143314250
AETNA (ARGUS)
RXAETD
1/10/2017
DOXYCYCLINE HYCLATE 100 MG CAP
00143314250
NMHC
RXBENEFIT
5/23/2017
DOXYCYCLINE HYCLATE 100 MG TAB
62584069321
BCBS ALABAMA
53406001
12/27/2016
DOXYCYCLINE HYCLATE 100 MG TAB
69235032050
OPTUMRX
COS
2/3/2017
DOXYCYCLINE HYCLATE 100 MG TAB
00143211250
AETNA (ARGUS)
RXAETD
1/10/2017
DOXYCYCLINE HYCLATE 50 MG CAP
00143314150
CATALYST
UVARX
1/12/2017
DOXYCYCLINE HYCLATE 50 MG CAP
00143314150
OPTUMRX
01962163
2/17/2017
DOXYCYCLINE HYCLATE 50 MG CAP
53489011802
AETNA (ARGUS)
RXAETD
1/10/2017
DOXYCYCLINE MONO 100 MG TABLET
00527133850
CIGNA
(blank)
3/21/2017
DOXYCYCLINE MONO 100 MG TABLET
00527133850
OPTUMRX
U0744260
3/3/2017
DOXYCYCLINE MONO 100 MG TABLET
00527133850
OPTUMRX
02490122
3/17/2017
DRONABINOL 10 MG CAPSULE
49884086902
AETNA (ARGUS)
RXAETD
1/10/2017
DRONABINOL 10 MG CAPSULE
49884086902
CATAMARAN
(blank)
3/3/2017
DRONABINOL 10 MG CAPSULE
00591359360
CATAMARAN
(blank)
3/7/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
DRONABINOL 10 MG CAPSULE
00591359360
CATAMARAN
(blank)
3/30/2017
DRONABINOL 10 MG CAPSULE
00591359360
CATAMARAN
-
3/20/2017
DRONABINOL 2.5 MG CAPSULE
00591359160
AETNA (ARGUS)
RXAETD
1/10/2017
DRONABINOL 2.5 MG CAPSULE
00591359160
CATAMARAN
(blank)
3/3/2017
DRONABINOL 2.5 MG CAPSULE
00591359160
CATAMARAN
(blank)
3/30/2017
DRONABINOL 5 MG CAPSULE
00591359260
AETNA (ARGUS)
RXAETD
1/10/2017
DRONABINOL 5 MG CAPSULE
00591359260
CATAMARAN
(blank)
3/20/2017
DRONABINOL 5 MG CAPSULE
49884086802
CATAMARAN
HTHSPRING
3/30/2017
DROSPIRENONE-EE 3-0.03 MG TAB
00378730053
BCBS ALABAMA
91243
1/13/2017
DULOXETINE HCL DR 20 MG CAP
68001025506
CATALYST
HA0008
10/31/2016
DULOXETINE HCL DR 20 MG CAP
68001025506
CATALYST
HA0003
3/3/2017
DULOXETINE HCL DR 20 MG CAP
68001025506
CATAMARAN
(blank)
1/25/2017
DULOXETINE HCL DR 20 MG CAP
68001025506
HEALTHTRANS
BM1052
11/3/2016
DULOXETINE HCL DR 20 MG CAP
00228289006
OPTUMRX
PDPIND
2/3/2017
DULOXETINE HCL DR 20 MG CAP
13668010960
RXWEST
37FP
4/5/2017
DULOXETINE HCL DR 20 MG CAP
13668010960
SXC HEALTH SOLNS
MCL
4/20/2017
DULOXETINE HCL DR 30 MG CAP
68001025605
CATAMARAN
00615436
3/21/2017
DULOXETINE HCL DR 60 MG CAP
47335038318
AETNA (ARGUS)
RXAETD
1/10/2017
DUTASTERIDE 0.5 MG CAPSULE
60505387709
NMHC
PB1
11/30/2016
ECONAZOLE NITRATE 1% CREAM
00168031285
AETNA (ARGUS)
RXAETD
1/10/2017
ECONAZOLE NITRATE 1% CREAM
52565002230
PHS
36500006
5/29/2017
ENALAPRIL MALEATE 10 MG TAB
68682071201
MERIDIANRX
MA
12/1/2016
ENALAPRIL MALEATE 20 MG TAB
68682071301
MERIDIANRX
(blank)
11/7/2016
ENALAPRIL MALEATE 20 MG TAB
68682071310
AETNA (ARGUS)
RXAETD
1/10/2017
ENALAPRIL MALEATE 5 MG TABLET
68682071101
AETNA (ARGUS)
RXAETD
1/10/2017
ENALAPRIL MALEATE 5 MG TABLET
68682071101
MERIDIANRX
(blank)
12/9/2016
ENALAPRIL MALEATE 5 MG TABLET
68682071110
CATAMARAN
(blank)
3/21/2017
ENOXAPARIN 150 MG/ML SYRINGE
00703851023
AETNA (ARGUS)
RXAETD
1/10/2017
ENOXAPARIN 300 MG/3 ML VIAL
00955101601
PRIME THERAPEUTICS
(blank)
2/17/2017
ENOXAPARIN 40 MG/0.4 ML SYR
00548560200
CATAMARAN
CPS
12/21/2016
ENOXAPARIN 60 MG/0.6 ML SYR
00703856023
OPTUMRX
PDPIND
5/25/2017
ENOXAPARIN 80 MG/0.8 ML SYR
00955100810
OPTUMRX
PDPIND
2/14/2017
ENTACAPONE 200 MG TABLET
64679078102
CATAMARAN
*NG*1077
4/6/2017
ENTACAPONE 200 MG TABLET
00781557801
AETNA (ARGUS)
RXAETD
1/10/2017
ENTECAVIR 0.5 MG TABLET
65862084130
CAREMARK
788257
12/22/2016
ENTECAVIR 0.5 MG TABLET
00093578656
AETNA (ARGUS)
RXAETD
1/10/2017
EPINASTINE HCL 0.05% EYE DROPS
60505058401
CAREMARK
3527
1/26/2017
EPINASTINE HCL 0.05% EYE DROPS
60505058401
CIGNA
(blank)
3/21/2017
EPINEPHRINE 0.3 MG AUTO-INJECT
49502010202
MERIDIANRX
MHPMIMMP2015
5/4/2017
EPINEPHRINE 1 MG/ML VIAL
76329906100
RXWEST
RXWB0001
5/9/2017
ERGOLOID MESYL 1 MG TAB SL
51728019701
CATALYST
(blank)
5/23/2017
ERGOTAMINE-CAFFEINE 1-100MG TB
24470091710
CAREMARK
65006500
2/16/2017
ERYTHROCIN 250 MG FILMTAB
24338010620
CAREMARK
RX6027
5/4/2017
ERYTHROMYCIN 0.5% EYE OINTMENT
17478007035
AETNA (ARGUS)
RXAETD
1/10/2017
ERYTHROMYCIN 0.5% EYE OINTMENT
17478007035
OPTUMRX
U0744260
2/17/2017
ERYTHROMYCIN 0.5% EYE OINTMENT
00574402435
CATAMARAN
(blank)
3/20/2017
ERYTHROMYCIN 0.5% EYE OINTMENT
00574402435
OPTUMRX
PDPIND
2/7/2017
ERYTHROMYCIN 2% GEL
40085031530
PROCARE RX
(blank)
11/30/2016
ERYTHROMYCIN 2% GEL
00168021660
OPTUMRX
PDPIND
2/3/2017
ERYTHROMYCIN 2% GEL
45802096696
CATAMARAN
(blank)
ERYTHROMYCIN DR 250 MG CAP
68308025010
NPS
2084
11/21/2016
ERYTHROMYCIN DR 250 MG CAP
68308025010
NPS
2084
1/3/2017
2/9/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
ERYTHROMYCIN-BENZOYL GEL
68682090146
CIGNA
00600000
MAC Effective Date
ERYTHROMYCIN-BENZOYL GEL
68682090146
PHS
30000211
4/6/2017
ERYTHROMYCIN-BENZOYL GEL
68682090146
MAXOR PLUS
COMPSH
11/22/2016
ERYTHROMYCIN-BENZOYL GEL
68682090023
CAREMARK
UHSRX
1/20/2017
ERYTHROMYCIN-BENZOYL GEL
68682090023
PRIME THERAPEUTICS
BNCDRUG
1/13/2017
ERYTHROMYCIN-BENZOYL GEL
00781709459
PRIME THERAPEUTICS
NCPARTD
1/13/2017
ESCITALOPRAM 10 MG TABLET
00378385610
MERIDIANRX
MA
11/10/2016
ESCITALOPRAM 10 MG TABLET
68001019603
CATAMARAN
CIHSCARE
3/20/2017
ESCITALOPRAM 10 MG TABLET
16729016917
NMHC
CALPANTH
5/29/2017
ESCITALOPRAM 20 MG TABLET
00378385710
MERIDIANRX
MA
10/31/2016
ESCITALOPRAM 20 MG TABLET
16729017001
OPTUMRX
FFRX
3/17/2017
ESCITALOPRAM 5 MG TABLET
68001019500
CATAMARAN
(blank)
3/23/2017
ESCITALOPRAM OXALATE 5 MG/5 ML
65162070588
AETNA (ARGUS)
RXAETD
1/31/2017
ESCITALOPRAM OXALATE 5 MG/5 ML
65162070588
CITIZENSRX LLC
1250006
2/8/2017
ESOMEPRAZOLE MAG DR 20 MG CAP
43598050930
CATAMARAN
3339819
1/25/2017
ESOMEPRAZOLE MAG DR 20 MG CAP
43598050930
NMHC
EGWPS032
1/12/2017
ESOMEPRAZOLE MAG DR 20 MG CAP
43598050990
CATAMARAN
NO GROUP
3/22/2017
ESOMEPRAZOLE MAG DR 40 MG CAP
31722057330
AETNA (ARGUS)
RXAETD
1/10/2017
ESOMEPRAZOLE MAG DR 40 MG CAP
00093645156
CATAMARAN
18011
3/20/2017
ESTRADIOL 0.025 MG PATCH
00378464426
AETNA (ARGUS)
RXAETD
1/10/2017
ESTRADIOL 0.025 MG PATCH
00378464426
CATAMARAN
(blank)
3/21/2017
ESTRADIOL 0.0375 MG PATCH
00378464326
CIGNA
3337352
3/21/2017
ESTRADIOL 0.0375 MG PATCH
00378464326
PHS
10012482
3/30/2017
ESTRADIOL 0.05 MG PATCH
00378464226
CATAMARAN
(blank)
3/21/2017
ESTRADIOL 0.05 MG PATCH
00378464226
US SCRIPT
(blank)
4/21/2017
ESTRADIOL 0.075 MG PATCH
00378464126
AETNA (ARGUS)
RXAETD
1/10/2017
ESTRADIOL 0.075 MG PATCH
00378464126
MERIDIANRX
(blank)
2/21/2017
ESTRADIOL 0.075 MG/DAY PATCH
47781020804
AETNA (ARGUS)
RXAETD
1/10/2017
ESTRADIOL 0.075 MG/DAY PATCH
47781020804
CATAMARAN
3338036
11/15/2016
ESTRADIOL 0.075 MG/DAY PATCH
47781020804
CATAMARAN
-
3/23/2017
ESTRADIOL 0.1 MG PATCH
00378464026
AETNA (ARGUS)
RXAETD
1/18/2017
ESTRADIOL 0.1 MG PATCH
00378464026
OPTUMRX
01961082
2/27/2017
ESTRADIOL 0.5 MG TABLET
00591052801
NAVITUS HEALTH SOLNS
FCC
11/8/2016
ESTRADIOL 1 MG TABLET
51862033305
AETNA (ARGUS)
RXAETD
1/10/2017
ESTRADIOL 2 MG TABLET
00591048801
RXWEST
RWTMODA
12/9/2016
ESTRADIOL 2 MG TABLET
51862033405
NAVITUS HEALTH SOLNS
VTGC
12/7/2016
ESTRADIOL TDS 0.025 MG/DAY
47781020404
CATAMARAN
(blank)
3/23/2017
ESTRADIOL TDS 0.05 MG/DAY
47781020604
US SCRIPT
3005
11/2/2016
ESTRADIOL TDS 0.05 MG/DAY
47781020604
NPS
276
3/21/2017
ESTRADIOL TDS 0.05 MG/DAY
00378335099
CAREMARK
RX0659
12/21/2016
ESTRADIOL TDS 0.05 MG/DAY
00378335099
OPTUMRX
RXCUNY
2/13/2017
ESTRADIOL TDS 0.1 MG/DAY
47781020904
AETNA (ARGUS)
RXAETD
3/29/2017
ESTRADIOL TDS 0.1 MG/DAY
47781020904
CATAMARAN
(blank)
3/23/2017
ESTRADIOL TDS 0.1 MG/DAY
47781020904
CATALYST (FUTURESCRIPTS)
(blank)
11/16/2016
ESTRADIOL-NORETH 0.5-0.1 MG TB
51991062328
AETNA (ARGUS)
RXAETD
4/25/2017
ESTRADIOL-NORETH 1-0.5 MG TAB
51991047428
AETNA (ARGUS)
RXAETD
1/10/2017
ESTRADIOL-NORETH 1-0.5 MG TAB
51991047428
CATAMARAN
-
3/30/2017
ESTRADIOL-NORETH 1-0.5 MG TAB
51991047428
MERIDIANRX
(blank)
3/31/2017
ESTRADIOL-NORETH 1-0.5 MG TAB
51991047428
CITIZENSRX LLC
(blank)
2/8/2017
ESTROGEN-METHYLTESTOS H.S. TAB
13925017101
OPTUMRX
(blank)
3/3/2017
ESTROPIPATE 1.25(1.5 MG) TAB
00591041501
CATALYST (FUTURESCRIPTS)
(blank)
11/14/2016
ESZOPICLONE 2 MG TABLET
00093553801
RXWEST
SDNYREGA
11/28/2016
5/18/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
ESZOPICLONE 2 MG TABLET
00093553801
RXWEST
SDNYREGA
MAC Effective Date
ESZOPICLONE 2 MG TABLET
42043032101
MERIDIANRX
(blank)
5/3/2017
ESZOPICLONE 3 MG TABLET
00093553901
OPTUMRX
ERSTX
2/13/2017
ESZOPICLONE 3 MG TABLET
42043032201
AETNA (ARGUS)
RXAETD
1/10/2017
ETHAMBUTOL HCL 400 MG TABLET
68180028101
AETNA (ARGUS)
RXAETD
1/10/2017
ETHAMBUTOL HCL 400 MG TABLET
68180028101
MAXOR PLUS
MCISD
4/11/2017
ETHOSUXIMIDE 250 MG CAPSULE
23155053201
AETNA (ARGUS)
RXAETD
1/10/2017
ETHOSUXIMIDE 250 MG CAPSULE
23155053201
CATAMARAN
-
3/20/2017
ETHOSUXIMIDE 250 MG CAPSULE
23155053201
CATAMARAN
-
4/18/2017
ETHOSUXIMIDE 250 MG CAPSULE
23155053201
OPTUMRX
U0744260
2/17/2017
ETODOLAC 200 MG CAPSULE
60505003901
CATAMARAN
(blank)
3/3/2017
ETODOLAC 200 MG CAPSULE
60505003901
CATAMARAN
(blank)
3/20/2017
ETODOLAC 200 MG CAPSULE
60505003901
PRIME THERAPEUTICS
13690
6/2/2017
ETODOLAC 200 MG CAPSULE
51672401601
AETNA (ARGUS)
RXAETD
1/10/2017
ETODOLAC 300 MG CAPSULE
60505004001
AETNA (ARGUS)
RXAETD
1/10/2017
ETODOLAC 300 MG CAPSULE
60505004001
CATAMARAN
(blank)
3/3/2017
ETODOLAC 300 MG CAPSULE
60505004001
CATAMARAN
(blank)
3/20/2017
ETODOLAC 300 MG CAPSULE
60505004001
OPTUMRX
U0744260
3/14/2017
ETODOLAC 400 MG TABLET
60505004101
AETNA (ARGUS)
RXAETD
1/18/2017
ETODOLAC 400 MG TABLET
51672401801
OPTUMRX
IEBP
2/13/2017
ETODOLAC 400 MG TABLET
00185067501
OPTUMRX
ERSTX
2/13/2017
ETODOLAC 500 MG TABLET
51672403601
OPTUMRX
U0744260
2/13/2017
ETODOLAC ER 400 MG TABLET
51672405104
OPTUMRX
IEBP
2/27/2017
ETODOLAC ER 400 MG TABLET
51672405101
AETNA (ARGUS)
RXAETD
1/10/2017
ETODOLAC ER 400 MG TABLET
00093112201
NPS
PMN1001
3/21/2017
ETODOLAC ER 600 MG TABLET
00093111801
OPTUMRX
(blank)
12/1/2016
EXEMESTANE 25 MG TABLET
47781010830
AETNA (ARGUS)
RXAETD
1/10/2017
EXEMESTANE 25 MG TABLET
59762285801
CATAMARAN
-
4/18/2017
EZETIMIBE 10 MG TABLET
49884022811
MAGELLAN
REG25
3/14/2017
FAMCICLOVIR 500 MG TABLET
33342002607
RXWEST
SDNYREG
1/13/2017
FAMOTIDINE 20 MG TABLET
00172572880
OPTUMRX
U0744260
2/17/2017
FAMOTIDINE 20 MG TABLET
68001024008
AETNA (ARGUS)
RXAETD
1/10/2017
FAMOTIDINE 20 MG TABLET
68001024000
CAREMARK
RX7816
3/8/2017
FAMOTIDINE 20 MG TABLET
68001024000
CATAMARAN
(blank)
3/20/2017
FAMOTIDINE 40 MG TABLET
68001024100
NMHC
CALPUHC
1/26/2017
FAMOTIDINE 40 MG TABLET
00172572960
RXWEST
40192H
4/6/2017
FELBAMATE 600 MG TABLET
51525043101
CATAMARAN
2498619
11/23/2016
FELBAMATE 600 MG TABLET
51525043101
CATAMARAN
2498619
12/21/2016
FELBAMATE 600 MG TABLET
51525043101
OPTUMRX
AMCTN
FELODIPINE ER 10 MG TABLET
23155005001
NMHC
IQCAL
11/30/2016
FELODIPINE ER 10 MG TABLET
13668013401
CATAMARAN
-
3/23/2017
FELODIPINE ER 10 MG TABLET
00378501301
AETNA (ARGUS)
RXAETD
1/10/2017
FELODIPINE ER 5 MG TABLET
00378501201
CATAMARAN
(blank)
3/20/2017
FENOFIBRATE 130 MG CAPSULE
55111039530
AETNA (ARGUS)
RXAETD
1/10/2017
FENOFIBRATE 145 MG TABLET
00378306605
AETNA (ARGUS)
RXAETD
1/18/2017
FENOFIBRATE 145 MG TABLET
00378306605
CAREMARK
788257
11/15/2016
FENOFIBRATE 145 MG TABLET
00378306677
PHS
R935UBXA
FENOFIBRATE 145 MG TABLET
68382023016
CATAMARAN
(blank)
4/5/2017
FENOFIBRATE 150 MG CAPSULE
61269021290
CATAMARAN
(blank)
12/21/2016
FENOFIBRATE 160 MG TABLET
68180036309
AETNA (ARGUS)
RXAETD
1/10/2017
FENOFIBRATE 160 MG TABLET
68180036309
MERIDIANRX
BAPM200
1/27/2017
FENOFIBRATE 200 MG CAPSULE
00115053301
AETNA (ARGUS)
RXAETD
1/23/2017
3/2/2017
2/3/2017
4/6/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
FENOFIBRATE 43 MG CAPSULE
55111034930
CATAMARAN
3187828
11/15/2016
FENOFIBRATE 48 MG TABLET
00378306577
AETNA (ARGUS)
RXAETD
1/10/2017
FENOFIBRATE 48 MG TABLET
00378306577
NMHC
EGWPS032
1/12/2017
FENOFIBRATE 48 MG TABLET
00378306577
OPTUMRX
COS
11/7/2016
FENOFIBRATE 48 MG TABLET
00378306577
RXWEST
RXW04359
1/13/2017
FENOFIBRATE 50 MG CAPSULE
62559046090
CAREMARK
65006500
1/24/2017
FENOFIBRATE 54 MG TABLET
68180036209
AETNA (ARGUS)
RXAETD
1/10/2017
FENOFIBRATE 67 MG CAPSULE
00115051101
AETNA (ARGUS)
RXAETD
1/10/2017
FENOFIBRATE 67 MG CAPSULE
00115051101
CATAMARAN
(blank)
3/20/2017
FENOFIBRATE 67 MG CAPSULE
00378862877
OPTUMRX
U0744260
2/23/2017
FENOFIBRIC ACID 105 MG TABLET
69973010530
CIGNA
3336123
3/21/2017
FENOFIBRIC ACID DR 135 MG CAP
00115146010
PRIME THERAPEUTICS
B0000001
1/13/2017
FENOFIBRIC ACID DR 135 MG CAP
00378259077
AETNA (ARGUS)
RXAETD
1/10/2017
FENOFIBRIC ACID DR 135 MG CAP
00378259077
PRIME THERAPEUTICS
KANSAS1
1/13/2017
FENOFIBRIC ACID DR 45 MG CAP
00378258977
AETNA (ARGUS)
RXAETD
1/10/2017
FENOFIBRIC ACID DR 45 MG CAP
00115145910
CATAMARAN
-
3/30/2017
FENTANYL 100 MCG/HR PATCH
00406900076
CATAMARAN
00600000
3/21/2017
FENTANYL 100 MCG/HR PATCH
00406900076
CATAMARAN
3212816
1/9/2017
FENTANYL 100 MCG/HR PATCH
00406900076
CATAMARAN
N/A
3/20/2017
FENTANYL 100 MCG/HR PATCH
00378912498
AETNA (ARGUS)
RXAETD
1/10/2017
FENTANYL 100 MCG/HR PATCH
00378912498
AETNA (ARGUS)
RXAETD
1/18/2017
FENTANYL 100 MCG/HR PATCH
00378912498
CATAMARAN
N/A
1/9/2017
FENTANYL 100 MCG/HR PATCH
00378912498
PRIME THERAPEUTICS
100
5/19/2017
FENTANYL 100 MCG/HR PATCH
60505700902
CIGNA
(blank)
1/10/2017
FENTANYL 12 MCG/HR PATCH
00406901276
AETNA (ARGUS)
RXAETD
1/10/2017
FENTANYL 25 MCG/HR PATCH
00406902576
AETNA (ARGUS)
RXAETD
1/10/2017
FENTANYL 25 MCG/HR PATCH
00406902576
NAVITUS HEALTH SOLNS
CFGMDCAID1000
11/8/2016
FENTANYL 25 MCG/HR PATCH
60505700602
RXWEST
PRS101
11/18/2016
FENTANYL 25 MCG/HR PATCH
00378912198
CAREMARK
RX6460
2/9/2017
FENTANYL 50 MCG/HR PATCH
00406905076
AETNA (ARGUS)
RXAETD
1/10/2017
FENTANYL 50 MCG/HR PATCH
00406905076
OPTUMRX
PDPIND
2/7/2017
FENTANYL 50 MCG/HR PATCH
00378912298
AETNA (ARGUS)
RXAETD
1/10/2017
FENTANYL 50 MCG/HR PATCH
00378912298
OPTUMRX
GECRX
5/15/2017
FENTANYL 50 MCG/HR PATCH
00378912298
PRIME THERAPEUTICS
028163
4/21/2017
FENTANYL 50 MCG/HR PATCH
49884076278
ARGUS
(blank)
5/24/2017
FENTANYL 75 MCG/HR PATCH
00781724355
CAREMARK
788257
12/22/2016
FENTANYL 75 MCG/HR PATCH
60505700802
MERIDIANRX
(blank)
1/27/2017
FENTANYL 75 MCG/HR PATCH
60505700802
MERIDIANRX
(blank)
2/21/2017
FENTANYL 75 MCG/HR PATCH
00406907576
AETNA (ARGUS)
RXAETD
1/10/2017
FENTANYL 75 MCG/HR PATCH
00406907576
CATAMARAN
(blank)
3/3/2017
FENTANYL 75 MCG/HR PATCH
00406907576
CATAMARAN
(blank)
3/20/2017
FENTANYL 75 MCG/HR PATCH
00406907576
CATAMARAN
(blank)
3/22/2017
FINASTERIDE 5 MG TABLET
00093735556
AETNA (ARGUS)
RXAETD
1/10/2017
FLECAINIDE ACETATE 100 MG TAB
00054001121
AETNA (ARGUS)
RXAETD
1/10/2017
FLECAINIDE ACETATE 100 MG TAB
65162064210
CATAMARAN
(blank)
4/6/2017
FLECAINIDE ACETATE 100 MG TAB
65162064210
OPTUMRX
SHOR
11/7/2016
FLECAINIDE ACETATE 150 MG TAB
00054001225
NAVITUS HEALTH SOLNS
834
11/8/2016
FLECAINIDE ACETATE 150 MG TAB
00054001221
CATAMARAN
(blank)
3/23/2017
FLECAINIDE ACETATE 50 MG TAB
65162064110
AETNA (ARGUS)
RXAETD
1/10/2017
FLUCONAZOLE 100 MG TABLET
68001025204
AETNA (ARGUS)
RXAETD
1/10/2017
FLUCONAZOLE 100 MG TABLET
68001025204
CAREMARK
RX6270
4/19/2017
FLUCONAZOLE 100 MG TABLET
68001025204
CATAMARAN
(blank)
3/20/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
FLUCONAZOLE 100 MG TABLET
16571021110
OPTUMRX
SLL
MAC Effective Date
3/30/2017
FLUCONAZOLE 150 MG TABLET
68001025320
CAREMARK
190058
11/15/2016
FLUCONAZOLE 150 MG TABLET
68001025320
OPTUMRX
U0744260
2/17/2017
FLUCONAZOLE 200 MG TABLET
16571021310
OPTUMRX
PDPIND
2/3/2017
FLUCONAZOLE 200 MG TABLET
16571021310
MERIDIANRX
(blank)
12/14/2016
FLUCONAZOLE 200 MG TABLET
67405060403
AETNA (ARGUS)
RXAETD
1/10/2017
FLUDROCORTISONE 0.1 MG TABLET
00555099702
AETNA (ARGUS)
RXAETD
1/10/2017
FLUNISOLIDE 0.025% SPRAY
24208034425
AETNA (ARGUS)
RXAETD
1/10/2017
FLUOCINOLONE 0.01% CREAM
52565003160
CATAMARAN
3332040
11/23/2016
FLUOCINOLONE 0.01% CREAM
52565003160
NPS
H5649001
4/24/2017
FLUOCINOLONE 0.01% SCALP OIL
65162070386
CATAMARAN
(blank)
3/20/2017
FLUOCINOLONE 0.01% SCALP OIL
65162070386
CITIZENSRX LLC
(blank)
3/31/2017
FLUOCINOLONE 0.01% SCALP OIL
51672135708
AETNA (ARGUS)
RXAETD
1/10/2017
FLUOCINOLONE 0.01% SOLUTION
00168005960
AETNA (ARGUS)
RXAETD
1/10/2017
FLUOCINOLONE 0.01% SOLUTION
51672136504
OPTUMRX
PDPIND
2/3/2017
FLUOCINOLONE 0.01% SOLUTION
51672136504
CITIZENSRX LLC
85337
3/31/2017
FLUOCINOLONE 0.025% CREAM
52565002060
AETNA (ARGUS)
RXAETD
1/10/2017
FLUOCINOLONE 0.025% CREAM
52565002060
OPTUMRX
PDPIND
2/7/2017
FLUOCINOLONE 0.025% CREAM
52565002060
NPS
H5649004
3/21/2017
FLUOCINONIDE 0.05% CREAM
51672125303
CATAMARAN
(blank)
3/21/2017
FLUOCINONIDE 0.05% CREAM
51672125303
CATAMARAN
N/A
2/3/2017
FLUOCINONIDE 0.05% GEL
51672127901
AETNA (ARGUS)
RXAETD
1/10/2017
FLUOCINONIDE 0.05% SOLUTION
51672127304
CITIZENSRX LLC
LSYA
1/3/2017
FLUOCINONIDE 0.05% SOLUTION
00472082902
AETNA (ARGUS)
RXAETD
1/10/2017
FLUOCINONIDE 0.05% SOLUTION
00472082902
AETNA (ARGUS)
RXAETD
1/18/2017
FLUOCINONIDE 0.05% SOLUTION
00472082902
CATAMARAN
-
1/25/2017
FLUOCINONIDE 0.1% CREAM
45802015153
AETNA (ARGUS)
RXAETD
1/10/2017
FLUOCINONIDE 0.1% CREAM
45802015153
OPTUMRX
U0744260
2/17/2017
FLUOCINONIDE 0.1% CREAM
45802015153
RXWEST
CB160
5/2/2017
FLUOCINONIDE 0.1% CREAM
45802015153
CITIZENSRX LLC
LSYA
3/31/2017
FLUOCINONIDE-E 0.05% CREAM
51672125403
AETNA (ARGUS)
RXAETD
1/10/2017
FLUOROMETHOLONE 0.1% DROPS
60758088005
CAREMARK
65006500
4/24/2017
FLUOROMETHOLONE 0.1% DROPS
60758088005
OPTUMRX
AMNJ
2/7/2017
FLUOROURACIL 5% CREAM
66530024940
AETNA (ARGUS)
RXAETD
1/10/2017
FLUOROURACIL 5% CREAM
66530024940
OPTUMRX
PDPIND
3/28/2017
FLUOROURACIL 5% CREAM
51672411806
OPTUMRX
COS
3/28/2017
FLUOROURACIL 5% CREAM
51672411806
OPTUMRX
PDPIND
4/3/2017
FLUOROURACIL 5% CREAM
51672411806
OPTUMRX
PDPIND
3/28/2017
FLUOROURACIL 5% TOP SOLUTION
51672406301
AETNA (ARGUS)
(blank)
4/13/2017
FLUOROURACIL 5% TOP SOLUTION
51672406301
AETNA (ARGUS)
RXAETD
1/31/2017
FLUOXETINE DR 90 MG CAPSULE
55111028448
AETNA (ARGUS)
RXAETD
1/10/2017
FLUOXETINE DR 90 MG CAPSULE
55111028448
MAGELLAN
REG06
3/14/2017
FLUOXETINE HCL 10 MG TABLET
00378073493
OPTUMRX
UHEALTH
11/16/2016
FLUOXETINE HCL 10 MG TABLET
00378073493
PHS
10028642
2/7/2017
FLUOXETINE HCL 10 MG TABLET
00378073493
PRIME THERAPEUTICS
714553005
1/13/2017
FLUOXETINE HCL 10 MG TABLET
00378073401
CITIZENSRX LLC
85337
2/23/2017
FLUOXETINE HCL 20 MG TABLET
00378073501
OPTUMRX
PDPIND
FLUOXETINE HCL 20 MG TABLET
00378073593
NMHC
EGWPS015
FLUOXETINE HCL 40 MG CAPSULE
42543072705
CITIZENSRX LLC
1019
1/3/2017
FLUOXETINE HCL 40 MG CAPSULE
00781282401
AETNA (ARGUS)
RXAETD
1/10/2017
FLUOXETINE HCL 40 MG CAPSULE
63304063201
OPTUMRX
(blank)
2/17/2017
FLUOXETINE HCL 40 MG CAPSULE
68001012903
CATAMARAN
(blank)
3/20/2017
2/3/2017
12/15/2016
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
FLUOXETINE HCL 40 MG CAPSULE
68001012903
OPTUMRX
ACUTX
5/15/2017
FLUPHENAZINE 1 MG TABLET
00527178801
PRIME THERAPEUTICS
0003
1/13/2017
FLUPHENAZINE 10 MG TABLET
00527179105
AETNA (ARGUS)
RXAETD
1/10/2017
FLUPHENAZINE 10 MG TABLET
00527179101
MAGELLAN
H5306
6/1/2017
FLUPHENAZINE 5 MG TABLET
00378607401
AETNA (ARGUS)
RXAETD
1/18/2017
FLUPHENAZINE 5 MG TABLET
00378607401
OPTUMRX
PDPIND
3/3/2017
FLUPHENAZINE 5 MG TABLET
00527179001
MAGELLAN
coverrx
6/1/2017
FLUPHENAZINE DEC 125 MG/5 ML
42023012901
AETNA (ARGUS)
RXAETD
1/18/2017
FLUPHENAZINE DEC 125 MG/5 ML
42023012901
CATAMARAN
(blank)
4/28/2017
FLUPHENAZINE DEC 125 MG/5 ML
42023012901
MERIDIANRX
(blank)
12/9/2016
FLURANDRENOLIDE 0.05% CREAM
24470091912
AETNA (ARGUS)
RXAETD
2/28/2017
FLUTAMIDE 125 MG CAPSULE
00591246618
NAVITUS HEALTH SOLNS
SISC
12/7/2016
FLUTICASONE PROP 0.05% CREAM
45802022237
OPTUMRX
U0744260
2/17/2017
FLUTICASONE PROP 50 MCG SPRAY
50383070016
AETNA (ARGUS)
RXAETD
11/30/2016
FLUTICASONE PROP 50 MCG SPRAY
60505082901
NAVITUS HEALTH SOLNS
001
12/1/2016
FLUTICASONE PROP 50 MCG SPRAY
00054327099
AETNA (ARGUS)
RXAETD
1/10/2017
FLUTICASONE PROP 50 MCG SPRAY
60432026415
OPTUMRX
U0744260
2/13/2017
FLUVASTATIN ER 80 MG TABLET
00378512193
AETNA (ARGUS)
RXAETD
5/30/2017
FLUVASTATIN SODIUM 20 MG CAP
00378802093
AETNA (ARGUS)
RXAETD
1/10/2017
FLUVASTATIN SODIUM 40 MG CAP
00378802193
AETNA (ARGUS)
RXAETD
1/31/2017
FLUVASTATIN SODIUM 40 MG CAP
00378802193
OPTUMRX
SHCA
1/10/2017
FLUVASTATIN SODIUM 40 MG CAP
00378802193
ARGUS
-
3/13/2017
FLUVOXAMINE ER 100 MG CAPSULE
00228284803
CATALYST
CTRPEX
4/6/2017
FLUVOXAMINE ER 100 MG CAPSULE
00228284803
OPTUMRX
PDPIND
1/9/2017
FLUVOXAMINE ER 150 MG CAPSULE
00228284903
CATAMARAN
006078080001A00
11/4/2016
FLUVOXAMINE ER 150 MG CAPSULE
00228284903
OPTUMRX
COS
2/7/2017
FONDAPARINUX 10 MG/0.8 ML SYR
67457058508
CATAMARAN
(blank)
4/18/2017
FONDAPARINUX 2.5 MG/0.5 ML SYR
67457058210
AETNA (ARGUS)
731679
1/20/2017
FONDAPARINUX 2.5 MG/0.5 ML SYR
55111067810
CATAMARAN
-
3/20/2017
FONDAPARINUX 5 MG/0.4 ML SYR
67457058304
CAREMARK
NRECA
1/18/2017
FONDAPARINUX 7.5 MG/0.6 ML SYR
67457058406
OPTUMRX
UHEALTH
11/30/2016
FONDAPARINUX 7.5 MG/0.6 ML SYR
67457058406
OPTUMRX
AMCTN
2/28/2017
FONDAPARINUX 7.5 MG/0.6 ML SYR
55111068010
OPTUMRX
COS
3/3/2017
FOSINOPRIL SODIUM 10 MG TAB
69097085605
CAREMARK
RX7546
4/13/2017
FROVATRIPTAN SUCC 2.5 MG TAB
00378314085
PRIME THERAPEUTICS
HZRX
6/2/2017
GABAPENTIN 100 MG CAPSULE
45963055550
OPTUMRX
U0744260
2/17/2017
GABAPENTIN 300 MG CAPSULE
45963055650
OPTUMRX
U0744260
1/17/2017
GABAPENTIN 600 MG TABLET
68001000603
CATAMARAN
CIHSCARE
3/20/2017
GABAPENTIN 600 MG TABLET
68001000603
NMHC
GCOHBE
5/23/2017
GABAPENTIN 600 MG TABLET
68001000603
NAVITUS HEALTH SOLNS
FCMR
11/2/2016
GABAPENTIN 600 MG TABLET
68001000603
SXC HEALTH SOLNS
PHS
5/23/2017
GABAPENTIN 600 MG TABLET
42292002420
CAREMARK
788257
11/15/2016
GABAPENTIN 600 MG TABLET
68462012605
AETNA (ARGUS)
RXAETD
1/18/2017
GABAPENTIN 800 MG TABLET
69097081112
NAVITUS HEALTH SOLNS
AHP
11/8/2016
GABAPENTIN 800 MG TABLET
68001000703
CAREMARK
788257
12/22/2016
GABAPENTIN 800 MG TABLET
68001000703
CIGNA
3340276
3/21/2017
GABAPENTIN 800 MG TABLET
68001000703
OPTUMRX
AMCTN
1/10/2017
GABAPENTIN 800 MG TABLET
68001000703
OPTUMRX
U0744260
2/13/2017
GABAPENTIN 800 MG TABLET
67877042905
CATAMARAN
(blank)
3/20/2017
GALANTAMINE ER 16 MG CAPSULE
00591349730
NAVITUS HEALTH SOLNS
WIE80000
12/7/2016
GALANTAMINE ER 16 MG CAPSULE
47335083683
CATAMARAN
3340006
2/3/2017
GALANTAMINE ER 24 MG CAPSULE
00591349830
CATAMARAN
(blank)
3/23/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
GALANTAMINE ER 24 MG CAPSULE
47335083783
AETNA (ARGUS)
RXAETD
1/10/2017
GALANTAMINE HBR 12 MG TABLET
60505254406
AETNA (ARGUS)
RXAETD
1/10/2017
GALANTAMINE HBR 4 MG TABLET
00378272191
CATAMARAN
246534615CIGV
4/18/2017
GALANTAMINE HBR 8 MG TABLET
10147088206
OPTUMRX
PDPIND
1/9/2017
GALANTAMINE HBR 8 MG TABLET
00378272291
CATAMARAN
-
2/3/2017
GALANTAMINE HBR 8 MG TABLET
00378272291
NMHC
EGWPS032
1/12/2017
GEMFIBROZIL 600 MG TABLET
00093067005
OPTUMRX
UHEALTH
3/30/2017
GENTAK 0.3 % EYE OINTMENT
17478028435
OPTUMRX
COS
2/14/2017
GENTAK 0.3 % EYE OINTMENT
17478028435
OPTUMRX
ACUMI
2/17/2017
GENTAK 0.3 % EYE OINTMENT
17478028435
PHS
(blank)
4/6/2017
GENTAMICIN 0.1% CREAM
45802005635
RXWEST
40192H
11/18/2016
GENTAMICIN 0.1% CREAM
45802005611
AETNA (ARGUS)
RXAETD
3/14/2017
GENTAMICIN 0.1% CREAM
45802005611
CAREMARK
65006500
4/10/2017
GENTAMICIN 0.1% OINTMENT
45802004611
CATALYST
30355003
3/9/2017
GENTAMICIN 0.1% OINTMENT
45802004611
MERIDIANRX
25720
12/9/2016
GIANVI 3 MG-0.02 MG TABLET
00093542358
OPTUMRX
PDPIND
2/7/2017
GLIMEPIRIDE 1 MG TABLET
16729000101
NMHC
EGWPS032
1/26/2017
GLIMEPIRIDE 2 MG TABLET
00603374521
CAREMARK
788257
12/8/2016
GLIMEPIRIDE 2 MG TABLET
16729000201
CATAMARAN
3207452
1/9/2017
GLIMEPIRIDE 2 MG TABLET
55111032101
OPTUMRX
PDPIND
1/9/2017
GLIMEPIRIDE 2 MG TABLET
55111032105
AETNA (ARGUS)
RXAETD
1/10/2017
GLIMEPIRIDE 2 MG TABLET
68001017803
CIGNA
CPS
1/25/2017
GLIMEPIRIDE 2 MG TABLET
68001017800
CATAMARAN
3338841
3/21/2017
GLIMEPIRIDE 4 MG TABLET
68001017903
PRIME THERAPEUTICS
0006
12/27/2016
GLIMEPIRIDE 4 MG TABLET
69543012510
CAREMARK
788257
11/15/2016
GLIMEPIRIDE 4 MG TABLET
61442011701
SXC HEALTH SOLNS
PHS
11/4/2016
GLIMEPIRIDE 4 MG TABLET
16729000301
NMHC
EGWPS032
1/12/2017
GLIMEPIRIDE 4 MG TABLET
55111032205
AETNA (ARGUS)
RXAETD
1/10/2017
GLIPIZIDE 10 MG TABLET
60505014201
CATAMARAN
(blank)
1/9/2017
GLIPIZIDE 5 MG TABLET
60505014101
CATAMARAN
(blank)
3/20/2017
GLIPIZIDE ER 10 MG TABLET
00591084510
AETNA (ARGUS)
RXAETD
1/10/2017
GLIPIZIDE ER 5 MG TABLET
00591084401
CATAMARAN
(blank)
12/21/2016
GLIPIZIDE ER 5 MG TABLET
00591084401
CATAMARAN
-
1/25/2017
GLIPIZIDE ER 5 MG TABLET
00591084401
CATAMARAN
-
3/21/2017
GLIPIZIDE-METFORMIN 2.5-500 MG
00378313201
CATAMARAN
2499665
1/25/2017
GLIPIZIDE-METFORMIN 2.5-500 MG
00093745601
CATAMARAN
-
3/20/2017
GLIPIZIDE-METFORMIN 5-500 MG
23155011701
CATAMARAN
(blank)
3/20/2017
GLYBURIDE-METFORMIN 5-500 MG
65862008205
NMHC
CALPHLNT
5/18/2017
GLYCOPYRROLATE 2 MG TABLET
69315014001
AETNA (ARGUS)
RXAETD
1/10/2017
GLYCOPYRROLATE 2 MG TABLET
69315014001
CATAMARAN
(blank)
2/3/2017
GLYCOPYRROLATE 2 MG TABLET
69315014001
NMHC
(blank)
11/30/2016
GLYCOPYRROLATE 2 MG TABLET
69315014001
RXWEST
40192H
4/11/2017
GRANISETRON HCL 1 MG TABLET
00093748520
AETNA (ARGUS)
RXAETD
2/7/2017
GRANISETRON HCL 1 MG TABLET
00093748520
PRIME THERAPEUTICS
10189037
3/24/2017
GRISEOFULVIN MICRO 500 MG TAB
64980018603
US SCRIPT
202723
4/26/2017
GRISEOFULVIN ULTRA 125 MG TAB
64720029510
CATAMARAN
3340228
2/24/2017
GRISEOFULVIN ULTRA 250 MG TAB
64980018501
CATAMARAN
-
1/26/2017
GRISEOFULVIN ULTRA 250 MG TAB
64720029610
CATAMARAN
-
3/30/2017
GRISEOFULVIN ULTRA 250 MG TAB
64720029610
OPTUMRX
PDPIND
2/3/2017
GUAIFEN-CODEINE 100-10 MG/5 ML
00121077504
CAREMARK
RXHHSCB610
4/26/2017
GUAIFENESIN-CODEINE SYRUP
00121077516
CAREMARK
RXBCID
4/10/2017
GUANFACINE HCL ER 1 MG TABLET
00228285011
OPTUMRX
U0744260
2/13/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
GUANFACINE HCL ER 2 MG TABLET
00228285111
OPTUMRX
(blank)
2/17/2017
GUANFACINE HCL ER 2 MG TABLET
00228285111
RXWEST
97074
4/12/2017
HALOBETASOL PROP 0.05% CREAM
00168035550
MERIDIANRX
HPMMCD
11/10/2016
HALOBETASOL PROP 0.05% CREAM
00713064086
OPTUMRX
SHTX
2/7/2017
HALOBETASOL PROP 0.05% CREAM
45802012935
AETNA (ARGUS)
RXAETD
1/10/2017
HALOBETASOL PROP 0.05% OINTMNT
45802013132
AETNA (ARGUS)
RXAETD
1/18/2017
HALOBETASOL PROP 0.05% OINTMNT
45802013132
NPS
H5649004
3/21/2017
HALOPERIDOL 10 MG TABLET
68382008001
CITIZENSRX LLC
1019
2/13/2017
HALOPERIDOL 10 MG TABLET
00781139713
AETNA (ARGUS)
RXAETD
1/10/2017
HALOPERIDOL 2 MG TABLET
00378021401
AETNA (ARGUS)
RXAETD
1/10/2017
HALOPERIDOL 2 MG TABLET
00378021401
CAREMARK
DODA
4/20/2017
HALOPERIDOL 20 MG TABLET
68382008101
AETNA (ARGUS)
RXAETD
1/10/2017
HALOPERIDOL 5 MG TABLET
00904592561
AETNA (ARGUS)
RXAETD
1/10/2017
HALOPERIDOL DEC 100 MG/ML AMP
10147092205
AETNA (ARGUS)
RXAETD
1/10/2017
HEPARIN SOD 5,000 UNIT/ML VIAL
00409272301
AETNA (ARGUS)
RXAETD
1/10/2017
HOMATROPINE 5% EYE DROPS
54799043105
PRIME THERAPEUTICS
0981190001
4/21/2017
HYDRALAZINE 100 MG TABLET
64380073606
AETNA (ARGUS)
RXAETD
1/10/2017
HYDRALAZINE 25 MG TABLET
50111032701
CAREMARK
788257
12/22/2016
HYDRALAZINE 50 MG TABLET
50111032801
CAREMARK
788257
12/22/2016
HYDRALAZINE 50 MG TABLET
50111032801
CAREMARK
OPENG
4/7/2017
HYDRALAZINE 50 MG TABLET
50111032803
AETNA (ARGUS)
RXAETD
1/10/2017
HYDROCHLOROTHIAZIDE 12.5 MG CP
57237000299
AETNA (ARGUS)
RXAETD
1/10/2017
HYDROCHLOROTHIAZIDE 12.5 MG CP
57237000299
OPTUMRX
01960627
2/14/2017
HYDROCHLOROTHIAZIDE 12.5 MG TB
16729018217
OPTUMRX
COS
11/7/2016
HYDROCHLOROTHIAZIDE 12.5 MG TB
16729018201
AETNA (ARGUS)
RXAETD
1/10/2017
HYDROCHLOROTHIAZIDE 12.5 MG TB
16729018201
RXWEST
40192H
4/6/2017
HYDROCHLOROTHIAZIDE 12.5 MG TB
00228282011
CATAMARAN
(blank)
3/20/2017
HYDROCHLOROTHIAZIDE 25 MG TAB
00172208380
RXWEST
RXW075D
4/12/2017
HYDROCHLOROTHIAZIDE 50 MG TAB
00172208960
NAVITUS HEALTH SOLNS
83416
11/8/2016
HYDROCODON-ACETAMIN 7.5-325/15
00121077216
RXWEST
SDNYREGA
1/13/2017
HYDROCODON-ACETAMIN 7.5-325/15
64376064016
OPTUMRX
PDPIND
2/17/2017
HYDROCODON-ACETAMINOPH 7.5-325
00591260501
RXWEST
40192H
11/7/2016
HYDROCODON-ACETAMINOPH 7.5-325
27808003603
MERIDIANRX
(blank)
3/10/2017
HYDROCODON-ACETAMINOPH 7.5-325
00603389132
AETNA (ARGUS)
RXAETD
1/10/2017
HYDROCODON-ACETAMINOPH 7.5-325
00406012410
OPTUMRX
COS
5/25/2017
HYDROCODON-ACETAMINOPHEN 5-300
64376064801
CATALYST (FUTURESCRIPTS)
N/A
11/15/2016
HYDROCODON-ACETAMINOPHEN 5-300
64376064801
PROCARE RX
COPE0030
11/30/2016
HYDROCODON-ACETAMINOPHEN 5-300
64376064805
AETNA (ARGUS)
RXAETD
1/10/2017
HYDROCODON-ACETAMINOPHEN 5-325
53746010901
AETNA (ARGUS)
RXAETD
1/18/2017
HYDROCODON-ACETAMINOPHEN 5-325
00603389021
OPTUMRX
COS
2/13/2017
HYDROCODON-ACETAMINOPHEN 5-325
00603389021
OPTUMRX
PDPIND
2/3/2017
HYDROCODON-ACETAMINOPHEN 5-325
00603389021
OPTUMRX
PDPIND
3/16/2017
HYDROCODON-ACETAMINOPHN 10-300
64376064301
AETNA (ARGUS)
RXAETD
1/10/2017
HYDROCODON-ACETAMINOPHN 10-325
00603388732
CATAMARAN
SXC
3/20/2017
HYDROCODON-ACETAMINOPHN 10-325
00603388732
OPTUMRX
COS
2/3/2017
HYDROCODON-ACETAMINOPHN 10-325
00603388732
OPTUMRX
COS
2/7/2017
HYDROCODON-ACETAMINOPHN 10-325
00603388732
OPTUMRX
COS
2/27/2017
HYDROCODON-ACETAMINOPHN 10-325
00603388732
OPTUMRX
COS
3/16/2017
HYDROCODON-ACETAMINOPHN 10-325
00603388732
OPTUMRX
PDPIND
2/3/2017
HYDROCODON-ACETAMINOPHN 10-325
00603388732
OPTUMRX
PDPIND
2/7/2017
HYDROCODON-ACETAMINOPHN 10-325
00603388732
OPTUMRX
AMCTN
2/3/2017
HYDROCODON-ACETAMINOPHN 10-325
00603388732
OPTUMRX
SHCA
2/7/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
HYDROCODON-ACETAMINOPHN 10-325
00603388732
OPTUMRX
SHTX
MAC Effective Date
2/3/2017
HYDROCODON-ACETAMINOPHN 10-325
00603388732
MAXOR PLUS
LJISD
4/17/2017
HYDROCODON-ACETAMINOPHN 10-325
00591261205
OPTUMRX
COS
2/3/2017
HYDROCODON-ACETAMINOPHN 10-325
00591261205
OPTUMRX
COS
2/17/2017
HYDROCODON-ACETAMINOPHN 10-325
00591261205
OPTUMRX
COS
2/14/2017
HYDROCODON-ACETAMINOPHN 10-325
00591261205
OPTUMRX
COS
3/3/2017
HYDROCODON-ACETAMINOPHN 10-325
00591261205
OPTUMRX
COS
3/16/2017
HYDROCODON-ACETAMINOPHN 10-325
00591261205
OPTUMRX
PDPIND
2/3/2017
HYDROCODON-ACETAMINOPHN 10-325
00591261205
OPTUMRX
PDPIND
2/7/2017
HYDROCODON-ACETAMINOPHN 10-325
00591261205
OPTUMRX
PDPIND
3/16/2017
HYDROCODON-ACETAMINOPHN 10-325
00591261205
OPTUMRX
AMCTN
2/3/2017
HYDROCODON-ACETAMINOPHN 10-325
00591261205
OPTUMRX
AMCTN
2/17/2017
HYDROCODON-ACETAMINOPHN 10-325
00591261205
OPTUMRX
SHCA
2/7/2017
HYDROCODON-ACETAMINOPHN 10-325
00591261205
OPTUMRX
SHTX
2/3/2017
HYDROCODON-ACETAMINOPHN 10-325
00591261205
OPTUMRX
MPDCSLA
2/7/2017
HYDROCODON-ACETAMINOPHN 10-325
00591261205
OPTUMRX
ERSTX
2/13/2017
HYDROCODON-ACETAMINOPHN 10-325
27808003703
OPTUMRX
SHCA
2/3/2017
HYDROCODON-ACETAMINOPHN 10-325
27808003703
OPTUMRX
SHCA
2/13/2017
HYDROCODON-ACETAMINOPHN 10-325
00591261201
OPTUMRX
PDPIND
2/3/2017
HYDROCODON-ACETAMINOPHN 10-325
00591261201
OPTUMRX
PDPIND
2/17/2017
HYDROCODON-ACETAMINOPHN 10-325
00591261201
OPTUMRX
AMCTN
3/16/2017
HYDROCODON-ACETAMINOPHN 10-325
53746011001
OPTUMRX
PDPIND
2/3/2017
HYDROCODON-ACETAMINOPHN 10-325
13107002105
OPTUMRX
COS
2/3/2017
HYDROCODON-ACETAMINOPHN 10-325
13107002105
OPTUMRX
MPDCSFL
2/3/2017
HYDROCODON-ACETAMINOPHN 10-325
53746011005
OPTUMRX
COS
2/14/2017
HYDROCODON-ACETAMINOPHN 10-325
13107002199
NMHC
MHHPPO
3/7/2017
HYDROCODON-ACETAMINOPHN 10-325
00406012501
OPTUMRX
COS
3/16/2017
HYDROCODONE-CHLORPHEN ER SUSP
62175049064
AETNA (ARGUS)
RXAETD
12/13/2016
HYDROCODONE-CHLORPHEN ER SUSP
27808008602
PRIME THERAPEUTICS
0156
HYDROCODONE-IBUPROFEN 10-200
53746011701
AETNA (ARGUS)
RXAETD
4/4/2017
HYDROCODONE-IBUPROFEN 10-200
53746011701
AETNA (ARGUS)
RXAETD
3/29/2017
HYDROCODONE-IBUPROFEN 5-200 MG
53746014601
CATAMARAN
-
2/9/2017
HYDROCODONE-IBUPROFEN 7.5-200
53746014501
OPTUMRX
IEBP
2/17/2017
HYDROCODONE-IBUPROFEN 7.5-200
53746014501
RXWEST
460A
3/2/2017
HYDROCORTISON-ACETIC ACID SOLN
50383090110
OPTUMRX
PDPIND
2/3/2017
HYDROCORTISON-ACETIC ACID SOLN
50383090110
OPTUMRX
U0744260
3/14/2017
HYDROCORTISONE 1% CREAM
00168001531
AETNA (ARGUS)
RXAETD
1/10/2017
HYDROCORTISONE 1% CREAM
00168001531
NAVITUS HEALTH SOLNS
TCH
12/7/2016
HYDROCORTISONE 10 MG TABLET
54505033210
AETNA (ARGUS)
RXAETD
1/10/2017
HYDROCORTISONE 2.5% CREAM
00168008016
CAREMARK
RX0797
1/19/2017
HYDROCORTISONE 5 MG TABLET
59762007301
NAVITUS HEALTH SOLNS
SGP
11/2/2016
HYDROCORTISONE 5 MG TABLET
54505033105
AETNA (ARGUS)
RXAETD
1/10/2017
HYDROCORTISONE 5 MG TABLET
54505033105
PRIME THERAPEUTICS
(blank)
3/24/2017
HYDROCORTISONE AC 30 MG SUPP
00574709312
CITIZENSRX LLC
1019
1/3/2017
HYDROCORTISONE BUTY 0.1% CREAM
51672407401
AETNA (ARGUS)
RXAETD
1/10/2017
HYDROCORTISONE BUTYR 0.1% SOLN
51672406104
NAVITUS HEALTH SOLNS
CCH
2/9/2017
HYDROCORTISONE VAL 0.2% CREAM
45802045542
AETNA (ARGUS)
RXAETD
1/18/2017
HYDROCORTISONE VAL 0.2% CREAM
45802045542
CATAMARAN
-
12/21/2016
HYDROCORTISONE VAL 0.2% OINTMT
00713066937
PROCARE RX
618
11/30/2016
HYDROCORTISONE VAL 0.2% OINTMT
51672129203
AETNA (ARGUS)
RXAETD
1/10/2017
HYDROCORT-PRAMOXINE 1%-1% CRM
45802014464
NPS
MCS1005
5/8/2017
HYDROMORPHONE 2 MG TABLET
42858030101
AETNA (ARGUS)
RXAETD
1/10/2017
1/6/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
HYDROMORPHONE 2 MG/ML VIAL
00641234141
CATAMARAN
(blank)
3/20/2017
HYDROMORPHONE 4 MG TABLET
13107010801
CATALYST
MNNDB
3/3/2017
HYDROMORPHONE 4 MG TABLET
13107010801
CATAMARAN
-
3/20/2017
HYDROMORPHONE 4 MG TABLET
13107010801
MERIDIANRX
(blank)
11/7/2016
HYDROMORPHONE 8 MG TABLET
13107010901
CATAMARAN
3339280
3/21/2017
HYDROMORPHONE 8 MG TABLET
13107010901
CATAMARAN
-
1/9/2017
HYDROMORPHONE 8 MG TABLET
13107010901
CATAMARAN
-
3/21/2017
HYDROMORPHONE 8 MG TABLET
13107010901
OPTUMRX
PDPIND
2/3/2017
HYDROMORPHONE 8 MG TABLET
13107010901
PHS
10002446
4/3/2017
HYDROMORPHONE 8 MG TABLET
42858030301
AETNA (ARGUS)
RXAETD
5/16/2017
HYDROMORPHONE 8 MG TABLET
42858030301
CATAMARAN
3340646
2/3/2017
HYDROMORPHONE HCL 10 MG/ML AMP
17478054001
NMHC
CALPANTH
1/26/2017
HYDROMORPHONE HCL ER 16 MG TAB
00591363001
OPTUMRX
COS
2/3/2017
HYDROMORPHONE HCL ER 8 MG TAB
00574029301
CATAMARAN
-
3/20/2017
HYDROMORPHONE HCL ER 8 MG TAB
00591362901
PHS
100002446
4/3/2017
HYDROMORPHONE HCL ER 8 MG TAB
00591362901
PHS
N/A
5/17/2017
HYDROXYCHLOROQUINE 200 MG TAB
68382009605
CATAMARAN
3213484
12/21/2016
HYDROXYCHLOROQUINE 200 MG TAB
00781140797
BCBS ALABAMA
90100
11/10/2016
HYDROXYCHLOROQUINE 200 MG TAB
00591304105
PRIME THERAPEUTICS
(blank)
11/10/2016
HYDROXYCHLOROQUINE 200 MG TAB
00591304105
MAXOR PLUS
(blank)
4/17/2017
HYDROXYCHLOROQUINE 200 MG TAB
63304029605
CAREMARK
788257
12/22/2016
HYDROXYCHLOROQUINE 200 MG TAB
63304029605
MERIDIANRX
LYNDHURST
3/24/2017
HYDROXYCHLOROQUINE 200 MG TAB
68382009601
AETNA (ARGUS)
RXAETD
1/10/2017
HYDROXYUREA 500 MG CAPSULE
49884072401
AETNA (ARGUS)
RXAETD
1/10/2017
HYDROXYZINE 10 MG/5 ML SOLN
60432015004
PRIME THERAPEUTICS
61824
3/17/2017
HYDROXYZINE 10 MG/5 ML SYRUP
54838050280
AETNA (ARGUS)
RXAETD
1/10/2017
HYDROXYZINE HCL 10 MG TABLET
23155050001
CITIZENSRX LLC
1019
1/3/2017
HYDROXYZINE HCL 10 MG TABLET
68462035201
CATAMARAN
(blank)
3/3/2017
HYDROXYZINE HCL 10 MG TABLET
68462035201
CATAMARAN
246534615CIGV
3/23/2017
HYDROXYZINE HCL 25 MG TABLET
68462035301
AETNA (ARGUS)
RXAETD
1/10/2017
HYDROXYZINE HCL 50 MG TABLET
68462035401
AETNA (ARGUS)
533687
1/5/2017
HYDROXYZINE HCL 50 MG TABLET
68462035401
OPTUMRX
U0744260
2/17/2017
HYDROXYZINE HCL 50 MG TABLET
68462035401
NAVITUS HEALTH SOLNS
83445
11/8/2016
HYDROXYZINE HCL 50 MG TABLET
68462035405
CATAMARAN
3174704
2/3/2017
HYDROXYZINE PAM 25 MG CAP
00185067405
AETNA (ARGUS)
RXAETD
1/10/2017
HYDROXYZINE PAM 50 MG CAP
00185061505
AETNA (ARGUS)
RXAETD
1/23/2017
HYOSCYAMINE 0.125 MG ODT
43199001201
CATAMARAN
(blank)
2/3/2017
HYOSCYAMINE 0.125 MG TAB SL
43199001101
CATAMARAN
3338468
1/25/2017
HYOSCYAMINE 0.125 MG TAB SL
43199001101
PRIME THERAPEUTICS
HZRX
12/1/2016
IBANDRONATE SODIUM 150 MG TAB
60505279500
BCBS ALABAMA
74605
2/3/2017
IBANDRONATE SODIUM 150 MG TAB
60505279500
PRIME THERAPEUTICS
(blank)
12/16/2016
IBANDRONATE SODIUM 150 MG TAB
00591377031
CATAMARAN
(blank)
3/21/2017
IBUPROFEN 100 MG/5 ML SUSP
45802095243
CAREMARK
GLFTR
2/6/2017
IBUPROFEN 100 MG/5 ML SUSP
00472127016
OPTUMRX
PDPIND
2/14/2017
IBUPROFEN 100 MG/5 ML SUSP
00472127016
OPTUMRX
PDPIND
3/29/2017
IBUPROFEN 600 MG TABLET
55111068305
CITIZENSRX LLC
114
1/3/2017
IBUPROFEN 800 MG TABLET
55111068405
OPTUMRX
ACUAZ
2/14/2017
IMATINIB MESYLATE 100 MG TAB
00093762998
OPTUMRX
PDPIND
1/9/2017
IMATINIB MESYLATE 100 MG TAB
47335047281
OPTUMRX
PDPIND
1/9/2017
IMATINIB MESYLATE 400 MG TAB
47335047583
CATAMARAN
3339624
2/24/2017
IMATINIB MESYLATE 400 MG TAB
47335047583
PRIME THERAPEUTICS
B0000004
12/27/2016
IMATINIB MESYLATE 400 MG TAB
00093763056
BCBS ALABAMA
91005005
11/4/2016
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
IMATINIB MESYLATE 400 MG TAB
00093763056
PRIME THERAPEUTICS
P30865
11/4/2016
IMIPRAMINE HCL 50 MG TABLET
69315013501
AETNA (ARGUS)
RXAETD
1/10/2017
IMIQUIMOD 5% CREAM PACKET
64380077302
CAREMARK
788257
12/5/2016
IMIQUIMOD 5% CREAM PACKET
51672414506
CATALYST
SCW
2/9/2017
IMIQUIMOD 5% CREAM PACKET
51672414506
OPTUMRX
PDPIND
2/3/2017
IMIQUIMOD 5% CREAM PACKET
00168043224
OPTUMRX
U0744260
2/13/2017
IMIQUIMOD 5% CREAM PACKET
00168043224
MERIDIANRX
90009
2/10/2017
IMIQUIMOD 5% CREAM PACKET
45802036862
CATAMARAN
(blank)
3/21/2017
INDOMETHACIN 50 MG CAPSULE
68462030201
CATAMARAN
-
3/23/2017
INDOMETHACIN 50 MG CAPSULE
68462030201
OPTUMRX
U0744260
2/17/2017
INDOMETHACIN ER 75 MG CAPSULE
00185072005
AETNA (ARGUS)
RXAETD
1/10/2017
INTROVALE 0.15-0.03 MG TABLET
00781558436
AETNA (ARGUS)
RXAETD
1/10/2017
INTROVALE 0.15-0.03 MG TABLET
00781558436
CAREMARK
RXTHP
2/1/2017
INTROVALE 0.15-0.03 MG TABLET
00781558436
CIGNA
2499635
1/25/2017
IPRAT-ALBUT 0.5-3(2.5) MG/3 ML
76204060030
RXWEST
40192H
1/13/2017
IPRAT-ALBUT 0.5-3(2.5) MG/3 ML
76204060060
CATALYST
CULINARY
1/12/2017
IPRATROPIUM 0.03% SPRAY
00054004544
AETNA (ARGUS)
RXAETD
1/10/2017
IPRATROPIUM 0.06% SPRAY
00054004641
AETNA (ARGUS)
RXAETD
1/10/2017
IRBESARTAN 150 MG TABLET
68180041106
RXWEST
(blank)
11/28/2016
IRBESARTAN 300 MG TABLET
68180041206
AETNA (ARGUS)
RXAETD
1/10/2017
IRBESARTAN-HCTZ 150-12.5 MG TB
43547033003
PRIME THERAPEUTICS
HZRX
11/24/2016
IRBESARTAN-HCTZ 150-12.5 MG TB
43547033003
NAVITUS HEALTH SOLNS
FCC
11/3/2016
IRBESARTAN-HCTZ 150-12.5 MG TB
43547033009
AETNA (ARGUS)
RXAETD
1/10/2017
IRBESARTAN-HCTZ 150-12.5 MG TB
68180041309
OPTUMRX
01961118
2/17/2017
IRBESARTAN-HCTZ 300-12.5 MG TB
43547033103
PRIME THERAPEUTICS
RXHRZN
11/24/2016
IRBESARTAN-HCTZ 300-12.5 MG TB
68180041406
AETNA (ARGUS)
RXAETD
1/10/2017
ISOMETHEPT-DICHLORALP-ACETAMIN
58657040101
CATAMARAN
3338620
12/21/2016
ISONIAZID 300 MG TABLET
00555007102
US SCRIPT
(blank)
11/15/2016
ISONIAZID 50 MG/5 ML SOLUTION
46287000901
CAREMARK
RX6027
5/4/2017
ISOSORBIDE DN 10 MG TABLET
68001022500
MERIDIANRX
(blank)
12/29/2016
ISOSORBIDE DN 10 MG TABLET
00781155601
AETNA (ARGUS)
RXAETD
1/18/2017
ISOSORBIDE DN 10 MG TABLET
00781155601
CITIZENSRX LLC
151
1/17/2017
ISOSORBIDE DN 20 MG TABLET
68001022208
AETNA (ARGUS)
RXAETD
1/10/2017
ISOSORBIDE DN 30 MG TABLET
49884000901
CATAMARAN
(blank)
3/20/2017
ISOSORBIDE DN 5 MG TABLET
68001022300
AETNA (ARGUS)
RXAETD
1/10/2017
ISOSORBIDE DN 5 MG TABLET
68001022300
CATAMARAN
(blank)
4/6/2017
ISOSORBIDE DN 5 MG TABLET
68001022300
NPS
H5649002
3/21/2017
ISOSORBIDE DN ER 40 MG TABLET
57664060088
AETNA (ARGUS)
RXAETD
1/10/2017
ISOSORBIDE DN ER 40 MG TABLET
57664060088
CATAMARAN
246534622CIGV
3/20/2017
ISOSORBIDE MN 10 MG TABLET
62175010601
CATAMARAN
-
3/23/2017
ISOSORBIDE MN ER 120 MG TAB
62175012937
AETNA (ARGUS)
RXAETD
1/10/2017
ISRADIPINE 2.5 MG CAPSULE
16252053901
AETNA (ARGUS)
RXAETD
1/10/2017
ISRADIPINE 5 MG CAPSULE
16252054001
AETNA (ARGUS)
RXAETD
1/10/2017
ISRADIPINE 5 MG CAPSULE
16252054001
AETNA (ARGUS)
RXAETD
3/29/2017
ITRACONAZOLE 100 MG CAPSULE
10147170003
AETNA (ARGUS)
RXAETD
1/10/2017
ITRACONAZOLE 100 MG CAPSULE
10147170003
CATAMARAN
0722216
1/9/2017
ITRACONAZOLE 100 MG CAPSULE
00185055030
PRIME THERAPEUTICS
(blank)
4/21/2017
JUNEL FE 1 MG-20 MCG TABLET
00555902658
CATAMARAN
3340245
1/25/2017
JUNEL FE 24 TABLET
00093532862
CATAMARAN
(blank)
1/25/2017
KARIVA 28 DAY TABLET
00555905058
CATAMARAN
3339988
1/25/2017
KETOCONAZOLE 2% CREAM
51672129802
AETNA (ARGUS)
RXAETD
1/10/2017
KETOCONAZOLE 2% CREAM
51672129802
CATAMARAN
(blank)
5/18/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
KETOCONAZOLE 2% CREAM
51672129802
CITIZENSRX LLC
114
MAC Effective Date
1/3/2017
KETOCONAZOLE 2% CREAM
51672129803
AETNA (ARGUS)
RXAETD
1/10/2017
KETOCONAZOLE 2% CREAM
51672129803
CATAMARAN
3333770
3/29/2017
KETOCONAZOLE 2% SHAMPOO
45802046564
AETNA (ARGUS)
RXAETD
1/10/2017
KETOPROFEN 75 MG CAPSULE
00093319505
AETNA (ARGUS)
RXAETD
1/10/2017
KETOROLAC 0.4% OPHTH SOLUTION
60758077305
AETNA (ARGUS)
RXAETD
1/31/2017
KETOROLAC 0.4% OPHTH SOLUTION
60758077305
CAREMARK
RX4760
5/17/2017
KETOROLAC 10 MG TABLET
00093031401
CAREMARK
RX6270
4/20/2017
KETOROLAC 10 MG TABLET
00093031401
CAREMARK
CEC
2/22/2017
KETOROLAC 10 MG TABLET
00093031401
OPTUMRX
MPDCSTX
2/7/2017
KETOROLAC 10 MG TABLET
00093031401
RXWEST
(blank)
12/9/2016
KETOROLAC 10 MG TABLET
00378113401
CATAMARAN
(blank)
4/6/2017
KETOROLAC 30 MG/ML VIAL
00409379501
CATAMARAN
-
3/9/2017
KETOROLAC 60 MG/2 ML VIAL
00409379601
PRIME THERAPEUTICS
063781
1/6/2017
KURVELO TABLET
68180084413
OPTUMRX
RFE
3/24/2017
LABETALOL HCL 100 MG TABLET
68001020503
OPTUMRX
(blank)
2/7/2017
LABETALOL HCL 100 MG TABLET
68001020500
CITIZENSRX LLC
1019
2/23/2017
LABETALOL HCL 100 MG TABLET
00185001001
AETNA (ARGUS)
RXAETD
1/10/2017
LABETALOL HCL 200 MG TABLET
00591060601
NAVITUS HEALTH SOLNS
CLP
11/2/2016
LABETALOL HCL 200 MG TABLET
68001020400
AETNA (ARGUS)
RXAETD
1/10/2017
LABETALOL HCL 200 MG TABLET
68001020400
AETNA (ARGUS)
RXAETD
2/7/2017
LABETALOL HCL 200 MG TABLET
68001020400
CATAMARAN
00181908
3/21/2017
LABETALOL HCL 300 MG TABLET
68001020600
AETNA (ARGUS)
RXAETD
1/10/2017
LAMIVUDINE 150 MG TABLET
68180060207
AETNA (ARGUS)
RXAETD
1/10/2017
LAMIVUDINE 300 MG TABLET
68180060306
CATAMARAN
-
3/23/2017
LAMIVUDINE-ZIDOVUDINE TABLET
31722050660
CATAMARAN
3337865
2/3/2017
LAMOTRIGINE 150 MG TABLET
69097015112
CAREMARK
788257
12/22/2016
LAMOTRIGINE 25 MG DISPER TAB
16252059801
CAREMARK
CISCO
5/26/2017
LAMOTRIGINE ER 100 MG TABLET
49884056311
CATAMARAN
3338279
1/25/2017
LAMOTRIGINE ER 100 MG TABLET
55111071930
OPTUMRX
U0744260
2/13/2017
LAMOTRIGINE ER 200 MG TABLET
55111072030
CATAMARAN
326980000000509
3/20/2017
LAMOTRIGINE ER 200 MG TABLET
55111072030
OPTUMRX
ERSTX
2/17/2017
LAMOTRIGINE ER 25 MG TABLET
49884056111
CATAMARAN
-
3/9/2017
LAMOTRIGINE ER 300 MG TABLET
55111042830
CATAMARAN
(blank)
3/3/2017
LAMOTRIGINE ER 300 MG TABLET
55111042830
CATAMARAN
(blank)
3/23/2017
LAMOTRIGINE ER 300 MG TABLET
55111042830
CATAMARAN
-
4/6/2017
LANSOPRAZOLE DR 15 MG CAPSULE
68001011105
CATAMARAN
(blank)
3/23/2017
LANSOPRAZOLE DR 30 MG CAPSULE
00378803093
NAVITUS HEALTH SOLNS
WIE80000
12/1/2016
LANSOPRAZOLE DR 30 MG CAPSULE
68001011205
CAREMARK
555126218
1/10/2017
LANSOPRAZOLE DR 30 MG CAPSULE
68001011203
AETNA (ARGUS)
RXAETD
1/10/2017
LANSOPRAZOLE DR 30 MG CAPSULE
68001011203
CATAMARAN
(blank)
1/25/2017
LANSOPRAZOLE DR 30 MG CAPSULE
00378803077
CATAMARAN
(blank)
3/22/2017
LATANOPROST 0.005% EYE DROPS
61314054701
NAVITUS HEALTH SOLNS
CMC
11/2/2016
LATANOPROST 0.005% EYE DROPS
59762033302
AETNA (ARGUS)
RXAETD
1/10/2017
LAYOLIS FE CHEWABLE TABLET
52544006431
CATAMARAN
00616334
3/21/2017
LEFLUNOMIDE 10 MG TABLET
23155004303
PRIME THERAPEUTICS
-
11/4/2016
LEFLUNOMIDE 10 MG TABLET
13811067730
AETNA (ARGUS)
RXAETD
3/14/2017
LEFLUNOMIDE 10 MG TABLET
13811067730
AETNA (ARGUS)
RXAETD
4/25/2017
LEFLUNOMIDE 10 MG TABLET
13811067730
CAREMARK
PBARX
3/29/2017
LEFLUNOMIDE 20 MG TABLET
16714033101
PRIME THERAPEUTICS
S59470
11/4/2016
LEFLUNOMIDE 20 MG TABLET
60505250301
PRIME THERAPEUTICS
(blank)
12/27/2016
LEFLUNOMIDE 20 MG TABLET
13811067830
AETNA (ARGUS)
RXAETD
1/10/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
LEFLUNOMIDE 20 MG TABLET
13811067830
AETNA (ARGUS)
RXAETD
3/29/2017
LEFLUNOMIDE 20 MG TABLET
13811067830
CIGNA
(blank)
1/9/2017
LEFLUNOMIDE 20 MG TABLET
13811067830
OPTUMRX
ERSTX
2/17/2017
LEFLUNOMIDE 20 MG TABLET
13811067830
PHS
(blank)
5/23/2017
LEFLUNOMIDE 20 MG TABLET
13811067830
RXWEST
U81001UC1
5/2/2017
LEFLUNOMIDE 20 MG TABLET
00955173730
AETNA (ARGUS)
RXAETD
3/29/2017
LEFLUNOMIDE 20 MG TABLET
00955173730
OPTUMRX
U0744260
2/13/2017
LETROZOLE 2.5 MG TABLET
16729003415
CAREMARK
RX6270
11/2/2016
LETROZOLE 2.5 MG TABLET
16729003410
CATAMARAN
-
3/9/2017
LETROZOLE 2.5 MG TABLET
16729003410
OPTUMRX
U0744260
3/30/2017
LETROZOLE 2.5 MG TABLET
16729003410
PROCARE RX
621C5104
11/30/2016
LEUCOVORIN CALCIUM 25 MG TAB
00054449911
CAREMARK
RX0016
1/27/2017
LEUCOVORIN CALCIUM 25 MG TAB
00555048527
CATAMARAN
(blank)
LEUPROLIDE 2WK 14 MG/2.8 ML KT
00781400332
NMHC
GRXP263
12/15/2016
LEUPROLIDE 2WK 14 MG/2.8 ML KT
00781400332
RXWEST
RXW00279
11/28/2016
LEVALBUTEROL 0.63 MG/3 ML SOL
76204080024
OPTUMRX
ACUNE
2/17/2017
LEVALBUTEROL 0.63 MG/3 ML SOL
43598041025
OPTUMRX
U0744260
2/17/2017
LEVALBUTEROL 1.25 MG/3 ML SOL
76204090024
CATAMARAN
3186956
3/21/2017
LEVALBUTEROL 1.25 MG/3 ML SOL
76204090024
SXC HEALTH SOLNS
PHS
5/23/2017
LEVETIRACETAM 1,000 MG TABLET
68180011507
AETNA (ARGUS)
RXAETD
5/23/2017
LEVETIRACETAM 250 MG TABLET
68001011607
CATALYST
CULINARY
11/11/2016
LEVETIRACETAM 250 MG TABLET
68001011603
CATAMARAN
N/A
4/5/2017
LEVETIRACETAM 750 MG TABLET
68180011416
AETNA (ARGUS)
RXAETD
1/10/2017
LEVETIRACETAM ER 500 MG TABLET
68001011306
AETNA (ARGUS)
RXAETD
1/10/2017
LEVETIRACETAM ER 500 MG TABLET
68001011306
AETNA (ARGUS)
RXAETD
1/18/2017
LEVETIRACETAM ER 500 MG TABLET
68001011306
CAREMARK
RXBCID
1/3/2017
LEVETIRACETAM ER 500 MG TABLET
68001011306
CAREMARK
RX0852
1/9/2017
LEVETIRACETAM ER 500 MG TABLET
43547034506
CATAMARAN
3337093
2/10/2017
LEVETIRACETAM ER 750 MG TABLET
68001011406
AETNA (ARGUS)
RXAETD
1/10/2017
LEVETIRACETAM ER 750 MG TABLET
68001011406
CAREMARK
RXBCID
1/3/2017
LEVETIRACETAM ER 750 MG TABLET
68001011406
CATAMARAN
00108289
3/20/2017
LEVETIRACETAM ER 750 MG TABLET
68001011406
CATAMARAN
-
4/6/2017
LEVETIRACETAM ER 750 MG TABLET
68180011807
PHS
10002211
4/27/2017
LEVOCARNITINE 1 G/10 ML SOLN
50383017104
AETNA (ARGUS)
RXAETD
1/10/2017
LEVOCARNITINE 1 G/10 ML SOLN
50383017104
PHS
46540003
11/17/2016
LEVOCARNITINE 1 G/10 ML SOLN
50383017104
PRIME THERAPEUTICS
017117
11/4/2016
LEVOCARNITINE 330 MG TABLET
50383017290
OPTUMRX
PDPIND
12/2/2016
LEVOCARNITINE 330 MG TABLET
50383017290
OPTUMRX
PDPIND
12/7/2016
LEVOCARNITINE 330 MG TABLET
50383017290
WHI
586461
3/3/2017
LEVOCETIRIZINE 2.5 MG/5 ML SOL
51672416108
AETNA (ARGUS)
RXAETD
1/10/2017
LEVOCETIRIZINE 5 MG TABLET
68462034690
CATAMARAN
(blank)
3/20/2017
LEVOFLOXACIN 25 MG/ML SOLUTION
50383028616
AETNA (ARGUS)
RXAETD
1/10/2017
LEVONOR-ETH ESTRAD 0.1-0.02 MG
00378728753
CATAMARAN
3328213
3/21/2017
LEVONOR-ETH ESTRAD 0.15-0.03
68462067295
NMHC
(blank)
11/30/2016
LEVORA-28 TABLET
51862009706
PHS
-
LEVORA-28 TABLET
51862009706
MERIDIANRX
HPMMCD
11/23/2016
LEVORPHANOL 2 MG TABLET
42358010210
CAREMARK
RX5709
1/19/2017
LEVOTHYROXINE 100 MCG TABLET
00527134510
PRIME THERAPEUTICS
0700810
1/13/2017
LEVOTHYROXINE 100 MCG TABLET
00527134501
CITIZENSRX LLC
1019
1/3/2017
LEVOTHYROXINE 100 MCG TABLET
00378180901
AETNA (ARGUS)
RXAETD
1/10/2017
LEVOTHYROXINE 100 MCG TABLET
00378180910
MAGELLAN
REG25
3/14/2017
LEVOTHYROXINE 100 MCG TABLET
00781518410
MERIDIANRX
(blank)
4/13/2017
2/7/2017
4/6/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
LEVOTHYROXINE 100 MCG TABLET
00781518410
CITIZENSRX LLC
85337
MAC Effective Date
3/31/2017
LEVOTHYROXINE 100 MCG TABLET
17236020101
NMHC
FEDEX
5/23/2017
LEVOTHYROXINE 112 MCG TABLET
00527134601
PRIME THERAPEUTICS
B0000002
1/13/2017
LEVOTHYROXINE 112 MCG TABLET
00527134610
AETNA (ARGUS)
RXAETD
1/10/2017
LEVOTHYROXINE 112 MCG TABLET
00527134610
MERIDIANRX
(blank)
4/26/2017
LEVOTHYROXINE 112 MCG TABLET
00527134610
CITIZENSRX LLC
1250003
1/17/2017
LEVOTHYROXINE 112 MCG TABLET
00378181177
PHS
26500005
3/21/2017
LEVOTHYROXINE 112 MCG TABLET
00378181177
PHS
10015845
5/17/2017
LEVOTHYROXINE 125 MCG TABLET
00527134701
OPTUMRX
ACUMI
2/14/2017
LEVOTHYROXINE 125 MCG TABLET
00527134701
CITIZENSRX LLC
1019
2/25/2017
LEVOTHYROXINE 137 MCG TABLET
00527163801
AETNA (ARGUS)
RXAETD
1/10/2017
LEVOTHYROXINE 137 MCG TABLET
00527163801
AETNA (ARGUS)
RXAETD
4/11/2017
LEVOTHYROXINE 137 MCG TABLET
00527163801
MERIDIANRX
(blank)
2/16/2017
LEVOTHYROXINE 137 MCG TABLET
00527163801
CITIZENSRX LLC
1019
3/31/2017
LEVOTHYROXINE 137 MCG TABLET
00378182377
AETNA (ARGUS)
RXAETD
4/11/2017
LEVOTHYROXINE 137 MCG TABLET
00378182377
PRIME THERAPEUTICS
14149121
1/13/2017
LEVOTHYROXINE 137 MCG TABLET
00781519192
PHS
26500002
4/6/2017
LEVOTHYROXINE 137 MCG TABLET
00781519192
MERIDIANRX
(blank)
4/26/2017
LEVOTHYROXINE 150 MCG TABLET
00378181577
AETNA (ARGUS)
RXAETD
1/10/2017
LEVOTHYROXINE 150 MCG TABLET
00378181577
PRIME THERAPEUTICS
(blank)
1/13/2017
LEVOTHYROXINE 150 MCG TABLET
00527134910
CITIZENSRX LLC
85337
2/23/2017
LEVOTHYROXINE 150 MCG TABLET
00527134901
AETNA (ARGUS)
RXAETD
LEVOTHYROXINE 175 MCG TABLET
00378181777
CATAMARAN
00884700
12/21/2016
LEVOTHYROXINE 175 MCG TABLET
00527135010
NAVITUS HEALTH SOLNS
WIE80000
12/22/2016
LEVOTHYROXINE 175 MCG TABLET
00378181710
PRIME THERAPEUTICS
ILDR
1/13/2017
LEVOTHYROXINE 175 MCG TABLET
00527135001
MERIDIANRX
-
3/17/2017
LEVOTHYROXINE 175 MCG TABLET
00527135001
MAGELLAN
REG25
3/14/2017
LEVOTHYROXINE 200 MCG TABLET
00781518992
AETNA (ARGUS)
RXAETD
4/11/2017
LEVOTHYROXINE 200 MCG TABLET
00781518992
CITIZENSRX LLC
PNL100
1/3/2017
LEVOTHYROXINE 200 MCG TABLET
00378181901
CATAMARAN
(blank)
1/9/2017
LEVOTHYROXINE 200 MCG TABLET
00527135101
PRIME THERAPEUTICS
PGIGN
1/13/2017
LEVOTHYROXINE 25 MCG TABLET
00378180001
AETNA (ARGUS)
RXAETD
1/10/2017
LEVOTHYROXINE 300 MCG TABLET
00781519092
AETNA (ARGUS)
RXAETD
1/10/2017
LEVOTHYROXINE 50 MCG TABLET
00378180377
PRIME THERAPEUTICS
09210
12/27/2016
LEVOTHYROXINE 50 MCG TABLET
00527134201
BCBS ALABAMA
87100
1/13/2017
LEVOTHYROXINE 50 MCG TABLET
00527134201
PHS
10012928
3/30/2017
LEVOTHYROXINE 50 MCG TABLET
00527134210
MERIDIANRX
(blank)
3/10/2017
LEVOTHYROXINE 75 MCG TABLET
00781518210
AETNA (ARGUS)
RXAETD
5/16/2017
LEVOTHYROXINE 75 MCG TABLET
00781518210
CITIZENSRX LLC
85337
1/3/2017
LEVOTHYROXINE 75 MCG TABLET
00378180510
OPTUMRX
UHEALTH
2/13/2017
LEVOTHYROXINE 75 MCG TABLET
00378180510
PRIME THERAPEUTICS
8097
1/19/2017
LEVOTHYROXINE 75 MCG TABLET
00527134310
SXC HEALTH SOLNS
PHS
5/23/2017
LEVOTHYROXINE 88 MCG TABLET
00527134410
PRIME THERAPEUTICS
5BL05550
12/27/2016
LEVOTHYROXINE 88 MCG TABLET
00527134410
MERIDIANRX
N/A
3/31/2017
LEVOTHYROXINE 88 MCG TABLET
00527134410
CITIZENSRX LLC
85337
1/17/2017
LEVOTHYROXINE 88 MCG TABLET
00527134401
CATAMARAN
0192105
1/9/2017
LEVOTHYROXINE 88 MCG TABLET
00378180710
AETNA (ARGUS)
RXAETD
1/10/2017
LEVOTHYROXINE 88 MCG TABLET
00781518392
PHS
26500002
LIDOCAINE 3% CREAM
13925015901
PROCARE RX
(blank)
11/30/2016
LIDOCAINE 5% OINTMENT
50383093355
AETNA (ARGUS)
RXAETD
1/18/2017
LIDOCAINE 5% OINTMENT
50383093355
CATAMARAN
-
1/9/2017
LIDOCAINE 5% OINTMENT
50383093355
CIGNA
(blank)
1/9/2017
5/9/2017
4/6/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
LIDOCAINE 5% OINTMENT
68462041827
MERIDIANRX
MAGOLD
MAC Effective Date
1/13/2017
LIDOCAINE 5% PATCH
00591352530
CAREMARK
788257
11/15/2016
LIDOCAINE 5% PATCH
00591352530
CIGNA
(blank)
3/21/2017
LIDOCAINE 5% PATCH
00591352530
NMHC
GCOHBE
5/23/2017
LIDOCAINE 5% PATCH
00591352530
PHS
N/A
5/17/2017
LIDOCAINE HCL 2% JELLY
76329301305
OPTUMRX
PDPIND
2/3/2017
LIDOCAINE-PRILOCAINE CREAM
00115146845
AETNA (ARGUS)
RXAETD
1/10/2017
LIDOCAINE-PRILOCAINE CREAM
00115146845
CITIZENSRX LLC
LSYA
2/9/2017
LIDOCAINE-PRILOCAINE CREAM
00115146845
CATALYST (FUTURESCRIPTS)
N/A
11/15/2016
LINDANE 1% SHAMPOO
61748040002
AETNA (ARGUS)
RXAETD
1/10/2017
LINDANE 1% SHAMPOO
60432083460
CATAMARAN
246534622CIGV
LINEZOLID 600 MG TABLET
67877041984
CAREMARK
RX1021
LINEZOLID 600 MG TABLET
00378707794
OPTUMRX
COS
2/3/2017
LINEZOLID 600 MG TABLET
59762130701
MAXOR PLUS
31003
4/11/2017
LIOTHYRONINE SOD 25 MCG TAB
00574022201
OPTUMRX
ILWU
3/30/2017
LIOTHYRONINE SOD 5 MCG TAB
00574022001
AETNA (ARGUS)
RXAETD
1/10/2017
LIOTHYRONINE SOD 5 MCG TAB
00574022001
PRIME THERAPEUTICS
(blank)
1/13/2017
LIOTHYRONINE SOD 50 MCG TAB
00574022301
AETNA (ARGUS)
RXAETD
1/10/2017
LISINOPRIL 10 MG TABLET
00185061010
MAXOR PLUS
7700
11/22/2016
LISINOPRIL 10 MG TABLET
16729037717
PRIME THERAPEUTICS
10186743
1/13/2017
LISINOPRIL 10 MG TABLET
68180051403
AETNA (ARGUS)
RXAETD
1/10/2017
LISINOPRIL 2.5 MG TABLET
68180051202
CATAMARAN
-
3/20/2017
LISINOPRIL 2.5 MG TABLET
68180051202
CATAMARAN
-
3/30/2017
LISINOPRIL 20 MG TABLET
00185062010
OPTUMRX
01960627
2/17/2017
LISINOPRIL 20 MG TABLET
00185062010
PRIME THERAPEUTICS
10181304
1/13/2017
LISINOPRIL 20 MG TABLET
68180051503
AETNA (ARGUS)
RXAETD
1/10/2017
LISINOPRIL 30 MG TABLET
00185063001
AETNA (ARGUS)
RXAETD
1/10/2017
LISINOPRIL 30 MG TABLET
00185063001
CATAMARAN
0712456
1/9/2017
LISINOPRIL 30 MG TABLET
00185063001
PHS
02050000
4/6/2017
LISINOPRIL 30 MG TABLET
00185063001
CITIZENSRX LLC
1019
1/30/2017
LISINOPRIL 30 MG TABLET
68001027000
MAXOR PLUS
MCISD
4/11/2017
LISINOPRIL 40 MG TABLET
00185064010
AETNA (ARGUS)
RXAETD
1/10/2017
LISINOPRIL 40 MG TABLET
00185064010
PRIME THERAPEUTICS
BCTX
1/13/2017
LISINOPRIL 40 MG TABLET
68180051703
CAREMARK
RX7546
3/2/2017
LISINOPRIL 5 MG TABLET
00185540010
PRIME THERAPEUTICS
B0000001
1/13/2017
LISINOPRIL-HCTZ 10-12.5 MG TAB
68180051802
CAREMARK
RX0274
3/7/2017
LITHIUM CARBONATE ER 450 MG TB
00054002025
AETNA (ARGUS)
RXAETD
1/10/2017
LOMEDIA 24 FE 1 MG-20 MCG TAB
65162031684
CATAMARAN
00612843
1/31/2017
LOPERAMIDE 2 MG CAPSULE
00093031101
NMHC
EGWPS016
1/19/2017
LOPERAMIDE 2 MG CAPSULE
00378210001
AETNA (ARGUS)
RXAETD
1/10/2017
LORAZEPAM 0.5 MG TABLET
00591024010
OPTUMRX
U0744260
2/17/2017
LOSARTAN POTASSIUM 100 MG TAB
50268051815
AETNA (ARGUS)
RXAETD
1/10/2017
LOSARTAN POTASSIUM 25 MG TAB
68382013516
PHS
(blank)
4/6/2017
LOSARTAN POTASSIUM 50 MG TAB
00093736510
AETNA (ARGUS)
RXAETD
1/10/2017
LOSARTAN-HCTZ 100-12.5 MG TAB
00781520492
CAREMARK
788257
12/22/2016
LOVASTATIN 20 MG TABLET
68001022400
NMHC
EGWPS032
1/26/2017
LOVASTATIN 40 MG TABLET
68001021400
AETNA (ARGUS)
RXAETD
1/10/2017
LOVASTATIN 40 MG TABLET
68001021400
CAREMARK
788257
12/22/2016
LOVASTATIN 40 MG TABLET
68001021400
CATAMARAN
00882900
2/7/2017
LOW-OGESTREL-28 TABLET
51862056406
AETNA (ARGUS)
RXAETD
1/10/2017
LOW-OGESTREL-28 TABLET
51862056406
OPTUMRX
OXFRDHP
2/7/2017
LOXAPINE 25 MG CAPSULE
00527139601
AETNA (ARGUS)
RXAETD
1/10/2017
3/3/2017
12/29/2016
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
LOXAPINE 50 MG CAPSULE
00527139701
OPTUMRX
PDPIND
MAC Effective Date
2/3/2017
LUTERA-28 TABLET
51862002806
MERIDIANRX
BAPMCORX
3/10/2017
MARLISSA-28 TABLET
68462038829
RXWEST
SF100
4/12/2017
MATZIM LA 240 MG TABLET
52544069230
AETNA (ARGUS)
RXAETD
1/10/2017
MECLIZINE 25 MG TABLET
65162044211
NMHC
EGWPS016
1/19/2017
MEDROXYPROGESTERONE 10 MG TAB
59762374202
CAREMARK
RX4760
5/2/2017
MEDROXYPROGESTERONE 150 MG/ML
59762453701
AETNA (ARGUS)
RXAETD
1/10/2017
MEDROXYPROGESTERONE 150 MG/ML
59762453701
MAXOR PLUS
003
2/9/2017
MEDROXYPROGESTERONE 150 MG/ML
59762453802
OPTUMRX
COS
2/20/2017
MEFENAMIC ACID 250 MG CAPSULE
66993007030
NAVITUS HEALTH SOLNS
83445
11/8/2016
MEFENAMIC ACID 250 MG CAPSULE
62250067730
OPTUMRX
COS
2/3/2017
MEFLOQUINE HCL 250 MG TABLET
00555017178
AETNA (ARGUS)
RXAETD
1/10/2017
MEGESTROL ACET 40 MG/ML SUSP
00054354258
MEDIMPACT
MGI01
11/1/2016
MELOXICAM 7.5 MG TABLET
68382005005
CATAMARAN
024
3/20/2017
MEMANTINE HCL 10 MG TABLET
33342029809
CATAMARAN
-
MEPERIDINE 100 MG TABLET
00054459625
MERIDIANRX
(blank)
12/14/2016
MEPERIDINE 100 MG TABLET
00054459625
MERIDIANRX
(blank)
1/13/2017
MEPERIDINE 50 MG TABLET
42806005001
AETNA (ARGUS)
RXAETD
5/9/2017
MEPERIDINE 50 MG TABLET
00054459525
AETNA (ARGUS)
RXAETD
5/9/2017
MERCAPTOPURINE 50 MG TABLET
00054458111
CATAMARAN
00600000
3/20/2017
MERCAPTOPURINE 50 MG TABLET
00054458111
CATAMARAN
127600ECSW1N02
12/21/2016
MERCAPTOPURINE 50 MG TABLET
68258910301
AETNA (ARGUS)
RXAETD
5/23/2017
METAXALONE 800 MG TABLET
68001000400
AETNA (ARGUS)
RXAETD
1/10/2017
METAXALONE 800 MG TABLET
64720032110
PRIME THERAPEUTICS
HZRX
12/16/2016
METAXALONE 800 MG TABLET
00185044801
CATAMARAN
3174104
12/21/2016
METFORMIN ER 1,000 MG OSM-TAB
68180033707
CATAMARAN
-
3/30/2017
METFORMIN ER 1,000 MG OSM-TAB
68180033707
PRIME THERAPEUTICS
HZRX
11/10/2016
METFORMIN ER 1,000 MG OSM-TAB
00591272060
CITIZENSRX LLC
150
2/13/2017
METFORMIN ER 1,000 MG OSM-TAB
00378600191
CATAMARAN
-
3/9/2017
METFORMIN ER 1,000 MG OSM-TAB
00378600191
OPTUMRX
HCLRX
4/6/2017
METFORMIN HCL 1,000 MG TABLET
68382076001
CATAMARAN
(blank)
1/25/2017
METFORMIN HCL 1,000 MG TABLET
68382076010
CATAMARAN
3336570
1/25/2017
METFORMIN HCL 500 MG TABLET
68382075810
PRIME THERAPEUTICS
B0000002
1/13/2017
METFORMIN HCL ER 500 MG OSM-TB
68180033607
AETNA (ARGUS)
RXAETD
5/16/2017
METFORMIN HCL ER 500 MG TABLET
68180033801
MERIDIANRX
(blank)
11/23/2016
METHADONE HCL 10 MG TABLET
67877011601
CAREMARK
RX6270
11/28/2016
METHADONE HCL 5 MG TABLET
00054457025
CATALYST (FUTURESCRIPTS)
(blank)
11/11/2016
METHADONE HCL 5 MG TABLET
00054457025
PROCARE RX
INSV0030
11/30/2016
METHAZOLAMIDE 50 MG TABLET
62559024101
OPTUMRX
PDPIND
12/7/2016
METHENAMINE HIPP 1 GM TABLET
65862078201
AETNA (ARGUS)
RXAETD
1/10/2017
METHIMAZOLE 5 MG TABLET
49884064001
OPTUMRX
PDPIND
2/3/2017
METHOCARBAMOL 500 MG TABLET
31722053301
OPTUMRX
PDPIND
2/3/2017
METHOTREXATE 2.5 MG TABLET
67253032010
AETNA (ARGUS)
RXAETD
1/10/2017
METHOTREXATE 2.5 MG TABLET
67253032010
CATAMARAN
(blank)
3/20/2017
METHOTREXATE 2.5 MG TABLET
67253032010
OPTUMRX
ACUNY
2/7/2017
METHOTREXATE 2.5 MG TABLET
67253032010
OPTUMRX
ERSTX
2/13/2017
METHOTREXATE 50 MG/2 ML VIAL
00703367103
AETNA (ARGUS)
RXAETD
1/10/2017
METHSCOPOLAMINE BROM 5 MG TAB
64376060461
BCBS ALABAMA
23998
12/16/2016
METHYLDOPA 500 MG TABLET
16729003101
CAREMARK
65006500
2/16/2017
METHYLDOPA 500 MG TABLET
16729003101
NMHC
N14072
11/30/2016
METHYLPHENIDATE 10 MG TABLET
00603457721
AETNA (ARGUS)
RXAETD
1/10/2017
METHYLPHENIDATE 20 MG TABLET
00603457821
PROCARE RX
SWIF0030
11/30/2016
3/3/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
METHYLPHENIDATE 20 MG TABLET
00406114601
CATAMARAN
3209240
12/21/2016
METHYLPHENIDATE 5 MG TABLET
00603457621
OPTUMRX
UHEALTH
3/22/2017
METHYLPHENIDATE CD 20 MG CAP
00093529601
RXWEST
J021SJU
4/14/2017
METHYLPHENIDATE CD 20 MG CAP
00093529601
CATALYST (FUTURESCRIPTS)
(blank)
11/17/2016
METHYLPHENIDATE ER 10 MG TAB
00406144501
CATAMARAN
(blank)
3/21/2017
METHYLPHENIDATE ER 10 MG TAB
00406144501
CATAMARAN
3339711
1/9/2017
METHYLPHENIDATE ER 10 MG TAB
00406144501
CATAMARAN
3339711
3/21/2017
METHYLPHENIDATE ER 18 MG TAB
00591271501
OPTUMRX
U0744260
2/17/2017
METHYLPHENIDATE ER 18 MG TAB
00591271501
RXWEST
(blank)
3/2/2017
METHYLPHENIDATE ER 20 MG TAB
10702007606
AETNA (ARGUS)
RXAETD
1/10/2017
METHYLPHENIDATE ER 20 MG TAB
10702007606
CATAMARAN
3336714
1/9/2017
METHYLPHENIDATE ER 20 MG TAB
10702007601
AETNA (ARGUS)
RXAETD
1/10/2017
METHYLPHENIDATE ER 20 MG TAB
10702007601
CATAMARAN
(blank)
3/3/2017
METHYLPHENIDATE ER 20 MG TAB
00406147301
PRIME THERAPEUTICS
0803780001
1/13/2017
METHYLPHENIDATE ER 27 MG TAB
00591271601
CATAMARAN
0721419
3/21/2017
METHYLPHENIDATE ER 27 MG TAB
00591271601
CIGNA
(blank)
1/9/2017
METHYLPHENIDATE ER 27 MG TAB
00591271601
CIGNA
00600000
1/9/2017
METHYLPHENIDATE ER 27 MG TAB
00591271601
PHS
(blank)
4/18/2017
METHYLPHENIDATE ER 27 MG TAB
00591271601
US SCRIPT
18011
2/10/2017
METHYLPHENIDATE ER 36 MG TAB
00591271701
CAREMARK
65006500
3/31/2017
METHYLPHENIDATE ER 36 MG TAB
00591271701
US SCRIPT
18011
2/6/2017
METHYLPHENIDATE ER 36 MG TAB
00591271701
US SCRIPT
18011
2/17/2017
METHYLPHENIDATE ER 36 MG TAB
00406013601
OPTUMRX
ACUMS
3/24/2017
METHYLPHENIDATE ER 54 MG TAB
00591271801
OPTUMRX
U0744260
2/13/2017
METHYLPHENIDATE ER 54 MG TAB
00591271801
LDI
83105
1/17/2017
METHYLPHENIDATE LA 30 MG CAP
45963020111
CATAMARAN
(blank)
4/6/2017
METHYLPREDNISOLONE 4 MG DOSEPK
59746000103
AETNA (ARGUS)
RXAETD
1/10/2017
METHYLPREDNISOLONE 4 MG DOSEPK
59746000103
MERIDIANRX
MHPILMCD
3/31/2017
METHYLPREDNISOLONE 4 MG DOSEPK
68001000501
CATAMARAN
(blank)
3/20/2017
METHYLPREDNISOLONE 4 MG TABLET
00603459321
AETNA (ARGUS)
RXAETD
1/10/2017
METOCLOPRAMIDE 5 MG TABLET
00093220401
OPTUMRX
U0744260
2/13/2017
METOLAZONE 10 MG TABLET
00378617401
AETNA (ARGUS)
RXAETD
1/10/2017
METOLAZONE 2.5 MG TABLET
65580064371
AETNA (ARGUS)
RXAETD
1/10/2017
METOLAZONE 5 MG TABLET
65580064471
AETNA (ARGUS)
RXAETD
1/18/2017
METOLAZONE 5 MG TABLET
00378617301
CAREMARK
788257
12/22/2016
METOPROLOL SUCC ER 100 MG TAB
68001011903
AETNA (ARGUS)
RXAETD
1/10/2017
METOPROLOL SUCC ER 100 MG TAB
68001011903
NMHC
GCOCOMM
5/23/2017
METOPROLOL SUCC ER 100 MG TAB
68001011903
SXC HEALTH SOLNS
PHS
5/23/2017
METOPROLOL SUCC ER 200 MG TAB
68001012000
AETNA (ARGUS)
RXAETD
1/10/2017
METOPROLOL SUCC ER 200 MG TAB
68001012000
AETNA (ARGUS)
RXAETD
1/18/2017
METOPROLOL SUCC ER 25 MG TAB
68001012103
AETNA (ARGUS)
RXAETD
1/10/2017
METOPROLOL SUCC ER 25 MG TAB
68001012103
OPTUMRX
01961686
4/6/2017
METOPROLOL SUCC ER 50 MG TAB
68001012203
AETNA (ARGUS)
RXAETD
1/18/2017
METOPROLOL SUCC ER 50 MG TAB
68001012203
CATAMARAN
(blank)
3/21/2017
METOPROLOL SUCC ER 50 MG TAB
68001012203
MAXOR PLUS
H870468L
4/17/2017
METOPROLOL SUCC ER 50 MG TAB
68001012200
PRIME THERAPEUTICS
ILSC
1/13/2017
METOPROLOL SUCC ER 50 MG TAB
62037083110
CATAMARAN
0707885
3/21/2017
METOPROLOL-HCTZ 50-25 MG TAB
13811066910
AETNA (ARGUS)
RXAETD
1/24/2017
METRONIDAZOLE 0.75% CREAM
00168032346
AETNA (ARGUS)
RXAETD
1/10/2017
METRONIDAZOLE 0.75% CREAM
00168032346
CIGNA
0192105
12/21/2016
METRONIDAZOLE 0.75% CREAM
69007083645
CATAMARAN
(blank)
12/21/2016
METRONIDAZOLE 0.75% LOTION
00168038360
AETNA (ARGUS)
RXAETD
1/10/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
METRONIDAZOLE 250 MG TABLET
68001022900
OPTUMRX
ERSTX
MAC Effective Date
2/13/2017
METRONIDAZOLE 250 MG TABLET
68001022900
RXWEST
RXW075B
11/18/2016
METRONIDAZOLE 250 MG TABLET
50111033302
CATAMARAN
(blank)
3/20/2017
METRONIDAZOLE 500 MG TABLET
68001026303
OPTUMRX
U0744260
2/17/2017
METRONIDAZOLE TOP 1% GEL PUMP
00781708055
AETNA (ARGUS)
RXAETD
1/10/2017
METRONIDAZOLE TOPICAL 0.75% GL
66993096245
MERIDIANRX
HPMMCD
11/10/2016
METRONIDAZOLE TOPICAL 0.75% GL
00168027545
AETNA (ARGUS)
RXAETD
1/10/2017
METRONIDAZOLE TOPICAL 1% GEL
51672529503
AETNA (ARGUS)
RXAETD
1/10/2017
METRONIDAZOLE TOPICAL 1% GEL
51672529503
CATALYST (FUTURESCRIPTS)
(blank)
11/15/2016
METRONIDAZOLE VAGINAL 0.75% GL
00781707787
AETNA (ARGUS)
RXAETD
1/18/2017
METRONIDAZOLE VAGINAL 0.75% GL
00781707787
CATAMARAN
(blank)
11/23/2016
METRONIDAZOLE VAGINAL 0.75% GL
00781707787
CATAMARAN
N/A
4/6/2017
METRONIDAZOLE VAGINAL 0.75% GL
00781707787
CIGNA
0615436
3/21/2017
METRONIDAZOLE VAGINAL 0.75% GL
00781707787
OPTUMRX
COS
2/14/2017
METRONIDAZOLE VAGINAL 0.75% GL
00781707787
RXWEST
PRS101
11/28/2016
METRONIDAZOLE VAGINAL 0.75% GL
00781707787
RXWEST
PRS101
12/23/2016
MEXILETINE 200 MG CAPSULE
00093874001
CATAMARAN
328840000000491
MICROGESTIN 21 1.5-30 TAB
52544029021
OPTUMRX
AGCGLASS
MICROGESTIN 21 1.5-30 TAB
52544029021
OPTUMRX
UNITEDCOAL
MICROGESTIN 21 1.5-30 TAB
51862027906
PRIME THERAPEUTICS
0946501
12/27/2016
MICROGESTIN 21 1-20 TABLET
52544027621
CATAMARAN
00881200
11/23/2016
MICROGESTIN 21 1-20 TABLET
51862000706
MERIDIANRX
(blank)
1/13/2017
MICROGESTIN FE 1.5-30 TAB
51862029206
CATAMARAN
3211876
1/25/2017
MICROGESTIN FE 1.5-30 TAB
51862029206
CATAMARAN
3339275
3/21/2017
MICROGESTIN FE 1.5-30 TAB
51862029206
CIGNA
CIGNA
3/21/2017
MICROGESTIN FE 1.5-30 TAB
51862029206
CIGNA
3333214
1/25/2017
MICROGESTIN FE 1.5-30 TAB
51862029206
CIGNA
0615436
1/25/2017
MICROGESTIN FE 1.5-30 TAB
51862029206
CIGNA
0615436
3/21/2017
MICROGESTIN FE 1.5-30 TAB
51862029206
OPTUMRX
NCDENTAL
12/14/2016
MICROGESTIN FE 1.5-30 TAB
51862029206
NAVITUS HEALTH SOLNS
70662
11/2/2016
MICROGESTIN FE 1.5-30 TAB
51862029206
MERIDIANRX
(blank)
11/23/2016
MICROGESTIN FE 1-20 TABLET
51862001206
CATAMARAN
(blank)
1/25/2017
MICROGESTIN FE 1-20 TABLET
51862001206
MERIDIANRX
(blank)
1/6/2017
MICROGESTIN FE 1-20 TABLET
52544024928
CATAMARAN
(blank)
1/25/2017
MIDODRINE HCL 10 MG TABLET
00245021311
AETNA (ARGUS)
RXAETD
5/9/2017
MIDODRINE HCL 10 MG TABLET
00245021311
CATAMARAN
-
3/20/2017
MIDODRINE HCL 10 MG TABLET
00378190301
AETNA (ARGUS)
RXAETD
1/10/2017
MIDODRINE HCL 2.5 MG TABLET
60505132001
NMHC
EGWPS035
1/26/2017
MIDODRINE HCL 2.5 MG TABLET
00245021111
OPTUMRX
(blank)
2/13/2017
MINOCYCLINE 100 MG CAPSULE
13668048450
OPTUMRX
UHEALTH
12/19/2016
MINOCYCLINE 50 MG CAPSULE
00591569401
CAREMARK
RX8633
2/13/2017
MINOCYCLINE 75 MG CAPSULE
00591315301
AETNA (ARGUS)
RXAETD
1/10/2017
MINOCYCLINE ER 90 MG TABLET
00781538631
MEDTRAK
10001560
2/10/2017
MINOXIDIL 10 MG TABLET
53489038701
CATAMARAN
N/A
3/20/2017
MINOXIDIL 2.5 MG TABLET
53489038601
CATAMARAN
(blank)
3/30/2017
MINOXIDIL 2.5 MG TABLET
53489038601
CATAMARAN
-
3/20/2017
MINOXIDIL 2.5 MG TABLET
53489038601
NMHC
EGWPS032
3/9/2017
MIRTAZAPINE 15 MG ODT
65862002106
AETNA (ARGUS)
RXAETD
1/18/2017
MIRTAZAPINE 45 MG TABLET
13107003205
CATAMARAN
-
3/23/2017
MIRTAZAPINE 7.5 MG TABLET
13107000130
CATAMARAN
3339967
2/3/2017
MIRTAZAPINE 7.5 MG TABLET
13107000105
AETNA (ARGUS)
RXAETD
3/29/2017
MIRTAZAPINE 7.5 MG TABLET
13107000105
AETNA (ARGUS)
RXAETD
3/28/2017
4/6/2017
12/14/2016
2/7/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
MISOPROSTOL 200 MCG TABLET
59762500802
AETNA (ARGUS)
RXAETD
1/10/2017
MODAFINIL 100 MG TABLET
50742015230
CATAMARAN
(blank)
3/3/2017
MODAFINIL 100 MG TABLET
50742015230
CATAMARAN
(blank)
3/23/2017
MODAFINIL 100 MG TABLET
50742015230
OPTUMRX
U0744260
2/13/2017
MODAFINIL 100 MG TABLET
50742015230
MERIDIANRX
(blank)
11/7/2016
MODAFINIL 100 MG TABLET
50742015290
AETNA (ARGUS)
RXAETD
1/10/2017
MODAFINIL 200 MG TABLET
50742015330
CATALYST
LEAR
2/7/2017
MODAFINIL 200 MG TABLET
50742015330
NAVITUS HEALTH SOLNS
AHPM
12/1/2016
MODAFINIL 200 MG TABLET
50742015330
SXC HEALTH SOLNS
CC3822
3/3/2017
MODAFINIL 200 MG TABLET
50742015390
CATAMARAN
246534619CIGV
3/3/2017
MOEXIPRIL HCL 15 MG TABLET
00093515001
CITIZENSRX LLC
LSYA
2/25/2017
MOEXIPRIL-HCTZ 15-12.5 MG TAB
00093521401
CATAMARAN
-
3/30/2017
MOEXIPRIL-HCTZ 7.5-12.5 MG TAB
68462020701
CATAMARAN
(blank)
3/20/2017
MOMETASONE FUROATE 50 MCG SPRY
60505083001
CATAMARAN
3338397
12/21/2016
MONTELUKAST SOD 10 MG TABLET
16729011917
CAREMARK
788257
11/15/2016
MONTELUKAST SOD 10 MG TABLET
68001024803
CAREMARK
788257
12/1/2016
MONTELUKAST SOD 10 MG TABLET
16729011915
AETNA (ARGUS)
RXAETD
1/10/2017
MONTELUKAST SOD 10 MG TABLET
69452010532
CATALYST
QCAPPO
4/28/2017
MONTELUKAST SOD 4 MG TAB CHEW
00093742498
MAXOR PLUS
(blank)
11/22/2016
MONTELUKAST SOD 5 MG TAB CHEW
00603465428
NAVITUS HEALTH SOLNS
FCC
11/8/2016
MORPHINE SULF ER 100 MG TABLET
00406839001
AETNA (ARGUS)
RXAETD
1/10/2017
MORPHINE SULF ER 100 MG TABLET
00406839001
CATAMARAN
(blank)
2/3/2017
MORPHINE SULF ER 100 MG TABLET
00406839001
CIGNA
(blank)
2/7/2017
MORPHINE SULF ER 15 MG TABLET
42858080101
SAVRX
P38825
11/11/2016
MORPHINE SULF ER 15 MG TABLET
00406831501
AETNA (ARGUS)
RXAETD
1/18/2017
MORPHINE SULF ER 15 MG TABLET
00406831501
OPTUMRX
ACUNM
5/4/2017
MORPHINE SULF ER 200 MG TABLET
00406832001
AETNA (ARGUS)
RXAETD
1/10/2017
MORPHINE SULF ER 200 MG TABLET
00406832001
CATAMARAN
(blank)
3/30/2017
MORPHINE SULF ER 30 MG TABLET
00406833001
CATAMARAN
N/A
1/25/2017
MORPHINE SULF ER 30 MG TABLET
00406833001
NMHC
ENERFLEX
3/8/2017
MORPHINE SULF ER 30 MG TABLET
42858080201
AETNA (ARGUS)
RXAETD
1/10/2017
MORPHINE SULF ER 60 MG TABLET
00406838001
AETNA (ARGUS)
RXAETD
1/18/2017
MORPHINE SULF ER 60 MG TABLET
00406838001
CATAMARAN
(blank)
3/20/2017
MORPHINE SULF ER 60 MG TABLET
00406838001
CATAMARAN
328840000000551
3/20/2017
MORPHINE SULF ER 60 MG TABLET
00406838001
CATAMARAN
N/A
1/25/2017
MORPHINE SULF ER 60 MG TABLET
00406838001
CATAMARAN
N/A
3/20/2017
MORPHINE SULF ER 60 MG TABLET
00406838001
NMHC
CALPANTH
5/23/2017
MORPHINE SULF ER 60 MG TABLET
00406838001
PRIME THERAPEUTICS
074721
5/19/2017
MORPHINE SULFATE ER 10 MG CAP
00832022500
CAREMARK
RXBCID
1/3/2017
MORPHINE SULFATE ER 10 MG CAP
00832022500
OPTUMRX
(blank)
5/25/2017
MORPHINE SULFATE ER 100 MG CAP
00115128201
CAREMARK
RX6270
4/19/2017
MORPHINE SULFATE ER 20 MG CAP
00115127701
PHS
(blank)
4/6/2017
MORPHINE SULFATE ER 30 MG CAP
00832022700
NMHC
EGWPS031
MORPHINE SULFATE ER 45 MG CAP
00228311611
MERIDIANRX
31060
MORPHINE SULFATE IR 15 MG TAB
00054023525
OPTUMRX
COS
6/2/2017
MORPHINE SULFATE IR 15 MG TAB
00054023525
OPTUMRX
PDPIND
5/15/2017
MORPHINE SULFATE IR 15 MG TAB
00054023525
OPTUMRX
MPDCSFL
6/1/2017
MORPHINE SULFATE IR 15 MG TAB
00054023525
OPTUMRX
ACUPA
3/24/2017
MOXIFLOXACIN HCL 400 MG TABLET
13668020130
CATAMARAN
(blank)
3/23/2017
MUPIROCIN 2% CREAM
68462056435
AETNA (ARGUS)
RXAETD
1/10/2017
MUPIROCIN 2% CREAM
68462056435
AETNA (ARGUS)
RXAETD
3/29/2017
MUPIROCIN 2% CREAM
68462056417
CATAMARAN
(blank)
1/12/2017
2/9/2017
11/23/2016
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
MUPIROCIN 2% CREAM
68462056417
PRIME THERAPEUTICS
153208
11/10/2016
MUPIROCIN 2% CREAM
68462056417
MERIDIANRX
90009
2/21/2017
MUPIROCIN 2% CREAM
68462056417
CITIZENSRX LLC
PNL100
3/7/2017
MUPIROCIN 2% OINTMENT
45802011222
CAREMARK
RX1113
10/31/2016
MYCOPHENOLATE 200 MG/ML SUSP
67877023022
MERIDIANRX
(blank)
11/7/2016
MYCOPHENOLATE 250 MG CAPSULE
16729009416
PRIME THERAPEUTICS
ER007-02
1/6/2017
MYCOPHENOLATE 250 MG CAPSULE
00781206705
CATAMARAN
3336028
2/24/2017
MYCOPHENOLATE 500 MG TABLET
16729001901
CATAMARAN
-
3/9/2017
MYCOPHENOLATE 500 MG TABLET
00093747701
CATAMARAN
(blank)
4/6/2017
MYCOPHENOLIC ACID DR 180 MG TB
60505296507
BCBS ALABAMA
37729
2/3/2017
MYCOPHENOLIC ACID DR 180 MG TB
60505296507
CATAMARAN
-
3/9/2017
MYCOPHENOLIC ACID DR 180 MG TB
60505296507
CATAMARAN
-
4/6/2017
MYCOPHENOLIC ACID DR 180 MG TB
60505296507
MERIDIANRX
MHPILMCD
6/2/2017
MYCOPHENOLIC ACID DR 360 MG TB
68084091825
OPTUMRX
PDPIND
1/9/2017
MYORISAN 20 MG CAPSULE
61748030213
CATAMARAN
-
4/13/2017
NABUMETONE 500 MG TABLET
00185014505
AETNA (ARGUS)
RXAETD
1/10/2017
NABUMETONE 500 MG TABLET
00185014505
RXWEST
40192H
11/28/2016
NABUMETONE 750 MG TABLET
00185014601
AETNA (ARGUS)
RXAETD
1/10/2017
NABUMETONE 750 MG TABLET
00185014601
CATAMARAN
3334033
3/21/2017
NABUMETONE 750 MG TABLET
00185014601
OPTUMRX
PDPIND
2/3/2017
NADOLOL 20 MG TABLET
51079081220
PRIME THERAPEUTICS
ARPARTD
1/6/2017
NADOLOL 20 MG TABLET
68001022100
AETNA (ARGUS)
RXAETD
1/10/2017
NADOLOL 20 MG TABLET
68001022100
MERIDIANRX
(blank)
4/26/2017
NADOLOL 40 MG TABLET
68084076321
NAVITUS HEALTH SOLNS
FCC82C00015T15T
11/8/2016
NADOLOL 80 MG TABLET
00378113201
AETNA (ARGUS)
RXAETD
1/18/2017
NADOLOL 80 MG TABLET
00378113201
CATAMARAN
(blank)
4/6/2017
NADOLOL 80 MG TABLET
68001021900
AETNA (ARGUS)
RXAETD
1/10/2017
NADOLOL 80 MG TABLET
68001021900
OPTUMRX
U0744260
2/17/2017
NADOLOL 80 MG TABLET
00781118301
CATAMARAN
(blank)
3/20/2017
NALBUPHINE 100 MG/10 ML VIAL
00409146401
OPTUMRX
COS
2/14/2017
NALTREXONE 50 MG TABLET
00406117001
AETNA (ARGUS)
RXAETD
1/10/2017
NAPROXEN 125 MG/5 ML SUSPEN
68134020116
AETNA (ARGUS)
RXAETD
2/18/2017
NAPROXEN 125 MG/5 ML SUSPEN
68134020116
AETNA (ARGUS)
RXAETD
5/30/2017
NAPROXEN 125 MG/5 ML SUSPEN
68134020116
CAREMARK
RX6027
2/9/2017
NAPROXEN DR 500 MG TABLET
00093100601
AETNA (ARGUS)
RXAETD
1/10/2017
NAPROXEN DR 500 MG TABLET
69097085207
CATAMARAN
-
3/23/2017
NAPROXEN SODIUM 550 MG TAB
68462017901
AETNA (ARGUS)
RXAETD
4/4/2017
NAPROXEN SODIUM 550 MG TAB
53746019405
AETNA (ARGUS)
RXAETD
5/23/2017
NARATRIPTAN HCL 2.5 MG TABLET
00054027903
CATAMARAN
-
3/20/2017
NARATRIPTAN HCL 2.5 MG TABLET
00054027903
RXWEST
1725MED01
4/14/2017
NATEGLINIDE 120 MG TABLET
49884098501
AETNA (ARGUS)
RXAETD
1/10/2017
NATEGLINIDE 120 MG TABLET
49884098501
CATAMARAN
(blank)
4/6/2017
NATEGLINIDE 120 MG TABLET
49884098501
RXWEST
40192H
3/2/2017
NATEGLINIDE 120 MG TABLET
55111032990
CATAMARAN
(blank)
3/22/2017
NATEGLINIDE 60 MG TABLET
55111032890
AETNA (ARGUS)
RXAETD
1/10/2017
NATEGLINIDE 60 MG TABLET
00591335401
AETNA (ARGUS)
RXAETD
4/25/2017
NECON 1-35-28 TABLET
52544055228
AETNA (ARGUS)
RXAETD
1/10/2017
NECON 1-35-28 TABLET
52544055228
OPTUMRX
U0744260
2/13/2017
NECON 1-35-28 TABLET
52544055228
PRIME THERAPEUTICS
BNCDRUG
1/13/2017
NECON 1-35-28 TABLET
52544055228
NAVITUS HEALTH SOLNS
DHP172DX38
11/2/2016
NEFAZODONE HCL 250 MG TABLET
42291062760
PRIME THERAPEUTICS
0000
5/19/2017
NEOMYCIN-POLYMYXIN-HC EAR SOLN
24208063110
AETNA (ARGUS)
RXAETD
1/10/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
NEOMYCIN-POLYMYXIN-HC EAR SOLN
61314064610
CATAMARAN
(blank)
3/20/2017
NEOMYCIN-POLYMYXIN-HC EAR SOLN
61314064610
RXWEST
N/A
1/31/2017
NEOMYCIN-POLYMYXIN-HC EAR SUSP
61314064511
AETNA (ARGUS)
RXAETD
1/10/2017
NEOMYCIN-POLYMYXIN-HC EAR SUSP
61314064511
CATAMARAN
00617134
1/25/2017
NEOMYCIN-POLYMYXIN-HC EAR SUSP
24208063562
OPTUMRX
DER
2/14/2017
NEOMYC-POLYM-DEXAMET EYE OINTM
24208079535
AETNA (ARGUS)
RXAETD
11/15/2016
NEOMYC-POLYM-DEXAMETH EYE DROP
24208083060
AETNA (ARGUS)
RXAETD
1/10/2017
NEOMYC-POLYM-DEXAMETH EYE DROP
24208083060
OPTUMRX
U0744260
3/14/2017
NEOMY-POLYMYXIN B 40 MG/ML AMP
00591219045
AETNA (ARGUS)
RXAETD
1/10/2017
NEOMY-POLYMYXIN B 40 MG/ML AMP
00591219045
AETNA (ARGUS)
RXAETD
1/18/2017
NEVIRAPINE ER 400 MG TABLET
69097040302
AETNA (ARGUS)
RXAETD
1/10/2017
NIACIN ER 1,000 MG TABLET
00093739498
AETNA (ARGUS)
RXAETD
1/10/2017
NIACIN ER 500 MG TABLET
00093739298
PRIME THERAPEUTICS
714553005
1/13/2017
NIACIN ER 500 MG TABLET
00093739298
RXWEST
RXW9523
5/2/2017
NIACIN ER 500 MG TABLET
68382020116
AETNA (ARGUS)
RXAETD
1/10/2017
NIACIN ER 750 MG TABLET
68382020216
BCBS ALABAMA
(blank)
12/16/2016
NIACIN ER 750 MG TABLET
00093739398
AETNA (ARGUS)
RXAETD
5/9/2017
NIACIN ER 750 MG TABLET
00093739398
PRIME THERAPEUTICS
122589
3/31/2017
NICARDIPINE 20 MG CAPSULE
42806050109
AETNA (ARGUS)
RXAETD
1/10/2017
NIFEDICAL XL 60 MG TABLET
00093517355
AETNA (ARGUS)
RXAETD
1/10/2017
NIFEDIPINE 10 MG CAPSULE
00228249710
AETNA (ARGUS)
RXAETD
1/10/2017
NIFEDIPINE 20 MG CAPSULE
00228253010
CATAMARAN
-
2/3/2017
NIFEDIPINE ER 30 MG TABLET
62175026055
AETNA (ARGUS)
RXAETD
1/10/2017
NIFEDIPINE ER 30 MG TABLET
62175026055
NAVITUS HEALTH SOLNS
FCC
11/2/2016
NIFEDIPINE ER 30 MG TABLET
00378035301
PHS
26500002
4/18/2017
NIFEDIPINE ER 60 MG TABLET
24979001012
AETNA (ARGUS)
RXAETD
1/10/2017
NIFEDIPINE ER 60 MG TABLET
62175026137
AETNA (ARGUS)
RXAETD
1/10/2017
NIFEDIPINE ER 60 MG TABLET
62175026137
CATAMARAN
HTHSPRING
4/5/2017
NIFEDIPINE ER 90 MG TABLET
62175026237
AETNA (ARGUS)
RXAETD
1/10/2017
NIFEDIPINE ER 90 MG TABLET
62175026237
CATAMARAN
(blank)
3/21/2017
NIFEDIPINE ER 90 MG TABLET
62175026237
CATAMARAN
(blank)
3/20/2017
NIFEDIPINE ER 90 MG TABLET
62175026237
CATAMARAN
HTHSPRING
3/20/2017
NIFEDIPINE ER 90 MG TABLET
62175026237
CATAMARAN
3340052
2/3/2017
NIFEDIPINE ER 90 MG TABLET
62175026237
OPTUMRX
01961812
12/1/2016
NIFEDIPINE ER 90 MG TABLET
62175026237
NAVITUS HEALTH SOLNS
CHX
11/2/2016
NIFEDIPINE ER 90 MG TABLET
00378039001
CATAMARAN
246534613
3/20/2017
NISOLDIPINE ER 17 MG TABLET
00378209701
MERIDIANRX
LYNDHURST
3/17/2017
NISOLDIPINE ER 8.5 MG TABLET
00378209601
AETNA (ARGUS)
RXAETD
1/10/2017
NISOLDIPINE ER 8.5 MG TABLET
00378209601
CATAMARAN
(blank)
1/26/2017
NISOLDIPINE ER 8.5 MG TABLET
00378209601
OPTUMRX
SHCA
1/10/2017
NITROFURANTOIN MCR 50 MG CAP
68001000200
AETNA (ARGUS)
RXAETD
1/10/2017
NITROFURANTOIN MONO-MCR 100 MG
68001000100
AETNA (ARGUS)
RXAETD
1/10/2017
NITROFURANTOIN MONO-MCR 100 MG
68001000100
CAREMARK
788257
11/22/2016
NITROGLYCERIN 0.1 MG/HR PATCH
47781029603
OPTUMRX
PDPIND
12/7/2016
NITROGLYCERIN 0.1 MG/HR PATCH
47781029603
OPTUMRX
PDPIND
1/9/2017
NITROGLYCERIN 0.4 MG TABLET SL
43598043601
CITIZENSRX LLC
1019
1/3/2017
NITROGLYCERIN 0.4 MG TABLET SL
59762330403
CATAMARAN
N/A
3/20/2017
NITROGLYCERIN 0.4 MG TABLET SL
59762330403
OPTUMRX
COS
1/9/2017
NITROGLYCERIN 0.4 MG TABLET SL
59762330403
OPTUMRX
ACUTX
1/9/2017
NITROGLYCERIN 0.4 MG TABLET SL
59762330403
OPTUMRX
U0744260
5/18/2017
NITROGLYCERIN 0.4 MG TABLET SL
59762330403
PRIME THERAPEUTICS
H3815
1/19/2017
NITROGLYCERIN 0.4 MG TABLET SL
59762330401
MERIDIANRX
MHPILMCD
5/4/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
NITROGLYCERIN 0.4 MG/HR PATCH
49730011230
AETNA (ARGUS)
RXAETD
MAC Effective Date
1/10/2017
NITROGLYCERIN 400 MCG SPRAY
43478041007
CATAMARAN
3338105
11/23/2016
NITROGLYCERIN LINGUAL 0.4 MG
52536030065
AETNA (ARGUS)
RXAETD
1/10/2017
NITROGLYCERIN LINGUAL 0.4 MG
52536030020
CATAMARAN
-
3/20/2017
NITROGLYCERIN LINGUAL 0.4 MG
52536030020
OPTUMRX
COS
5/15/2017
NITROGLYCERIN LINGUAL 0.4 MG
70003030020
CATAMARAN
-
4/6/2017
NITROGLYCERIN LINGUAL 0.4 MG
70003030065
OPTUMRX
COS
5/15/2017
NITROSTAT 0.4 MG TABLET SL
00071041813
CAREMARK
SOHRX
11/15/2016
NIZATIDINE 15 MG/ML SOLUTION
60846030115
MEDCO
RRW0000
5/1/2017
NORETHINDRONE 0.35 MG TABLET
00378729253
CATAMARAN
3337971
1/25/2017
NORETHINDRONE 0.35 MG TABLET
00378727253
CATAMARAN
(blank)
4/6/2017
NORETHINDRONE 5 MG TABLET
00555021110
CATAMARAN
(blank)
1/25/2017
NORETHINDRONE 5 MG TABLET
68462030450
AETNA (ARGUS)
RXAETD
1/10/2017
NORETHINDRONE 5 MG TABLET
68462030450
CAREMARK
788257
5/24/2017
NORETHINDRONE 5 MG TABLET
68462030450
CATAMARAN
(blank)
3/20/2017
NORETHINDRONE 5 MG TABLET
68462030450
OPTUMRX
U0744260
2/17/2017
NORETHINDRONE 5 MG TABLET
68462030450
OPTUMRX
IVM
3/24/2017
NORG-EE 0.18-0.215-0.25/0.035
68462056529
PRIME THERAPEUTICS
HZRX
1/19/2017
NORTREL 1-35 28 TABLET
00555901058
PRIME THERAPEUTICS
(blank)
1/19/2017
NORTRIPTYLINE HCL 25 MG CAP
51672400201
AETNA (ARGUS)
RXAETD
1/10/2017
NORTRIPTYLINE HCL 25 MG CAP
51672400201
CATAMARAN
(blank)
3/20/2017
NORTRIPTYLINE HCL 25 MG CAP
51672400202
PHS
26500001
4/6/2017
NORTRIPTYLINE HCL 50 MG CAP
51672400301
CATAMARAN
-
3/23/2017
NORTRIPTYLINE HCL 75 MG CAP
51672400401
CATAMARAN
-
3/20/2017
NYSTATIN 100,000 UNIT/GM CREAM
00713067831
OPTUMRX
(blank)
2/17/2017
NYSTATIN 100,000 UNIT/GM CREAM
00713067815
OPTUMRX
ERSTX
2/13/2017
NYSTATIN 100,000 UNIT/GM CREAM
00603781878
AETNA (ARGUS)
RXAETD
1/10/2017
NYSTATIN 100,000 UNIT/GM POWD
68308015260
NMHC
EGWPS035
1/19/2017
NYSTATIN 100,000 UNIT/ML SUSP
66689000816
AETNA (ARGUS)
RXAETD
1/24/2017
NYSTATIN 100,000 UNIT/ML SUSP
66689000816
CAREMARK
VAGRD
3/20/2017
NYSTATIN 100,000 UNIT/ML SUSP
60432053716
AETNA (ARGUS)
RXAETD
1/10/2017
NYSTATIN 100,000 UNITS/GM OINT
00472016630
OPTUMRX
PDPINDD
2/14/2017
NYSTATIN 500,000 UNIT ORAL TAB
00093098301
AETNA (ARGUS)
RXAETD
1/10/2017
NYSTATIN 500,000 UNIT ORAL TAB
00093098301
CATAMARAN
(blank)
4/6/2017
NYSTATIN 500,000 UNIT ORAL TAB
00093098301
NAVITUS HEALTH SOLNS
PCH
11/8/2016
NYSTATIN-TRIAMCINOLONE CREAM
00472015060
AETNA (ARGUS)
RXAETD
1/10/2017
NYSTATIN-TRIAMCINOLONE CREAM
00168008130
AETNA (ARGUS)
RXAETD
1/10/2017
NYSTATIN-TRIAMCINOLONE OINTM
51672127202
CATAMARAN
07422216
1/25/2017
NYSTATIN-TRIAMCINOLONE OINTM
51672127202
PROCARE RX
PRO21000
11/30/2016
NYSTATIN-TRIAMCINOLONE OINTM
00472015530
OPTUMRX
COS
OCTREOTIDE 1,000 MCG/5 ML VIAL
25021045405
MEDIMPACT
UPH20
3/7/2017
OFLOXACIN 0.3% EYE DROPS
17478071310
AETNA (ARGUS)
RXAETD
1/10/2017
OFLOXACIN 0.3% EYE DROPS
17478071310
ARGUS
(blank)
12/5/2016
OFLOXACIN 0.3% EYE DROPS
17478071311
CITIZENSRX LLC
1019
1/17/2017
OFLOXACIN 0.3% EYE DROPS
17478071311
CITIZENSRX LLC
1019
3/31/2017
OLANZAPINE 10 MG TABLET
43598016630
OPTUMRX
U0744260
2/13/2017
OLANZAPINE 10 MG TABLET
43598016630
RXWEST
40192H
3/2/2017
OLANZAPINE 10 MG TABLET
43598016605
NMHC
863
5/26/2017
OLANZAPINE 10 MG VIAL
00781315972
AETNA (ARGUS)
RXAETD
1/10/2017
OLANZAPINE 15 MG TABLET
55111016730
CATAMARAN
BRAVOHLTH
3/23/2017
OLANZAPINE 15 MG TABLET
55111016730
OPTUMRX
PDPIND
2/3/2017
OLANZAPINE 2.5 MG TABLET
55111016330
NAVITUS HEALTH SOLNS
PSF
11/8/2016
3/3/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
OLANZAPINE 20 MG TABLET
55111016830
NMHC
EGWPS032
MAC Effective Date
OLANZAPINE 20 MG TABLET
55111016830
OPTUMRX
PDPIND
2/3/2017
OLANZAPINE 20 MG TABLET
55111016830
OPTUMRX
U0744260
2/13/2017
OLANZAPINE 7.5 MG TABLET
43598016530
CATAMARAN
(blank)
3/23/2017
OLANZAPINE ODT 10 MG TABLET
55111026381
CATAMARAN
(blank)
11/15/2016
OLANZAPINE ODT 15 MG TABLET
59746030832
AETNA (ARGUS)
RXAETD
1/10/2017
OLANZAPINE ODT 15 MG TABLET
59746030832
OPTUMRX
PDPIND
2/14/2017
OLANZAPINE ODT 15 MG TABLET
66993068838
CATAMARAN
(blank)
3/30/2017
OLANZAPINE ODT 20 MG TABLET
66993068938
NAVITUS HEALTH SOLNS
HHD
11/8/2016
OLANZAPINE ODT 20 MG TABLET
66993068938
NAVITUS HEALTH SOLNS
HHD
12/7/2016
OLANZAPINE ODT 20 MG TABLET
55111026581
AETNA (ARGUS)
RXAETD
1/10/2017
OLANZAPINE ODT 20 MG TABLET
59746030932
CATAMARAN
(blank)
3/20/2017
OLANZAPINE-FLUOXETINE 3-25 MG
49884027711
CATAMARAN
-
3/20/2017
OLANZAPINE-FLUOXETINE 3-25 MG
49884027711
OPTUMRX
COS
2/14/2017
OLANZAPINE-FLUOXETINE 6-50 MG
00093550556
OPTUMRX
SHCA
5/31/2017
OLMESARTAN MEDOXOMIL 40 MG TAB
00378712493
CIGNA
(blank)
3/21/2017
OLMESARTAN MEDOXOMIL 5 MG TAB
00378701293
CATAMARAN
(blank)
3/23/2017
OLMESARTAN-HCTZ 40-12.5 MG TAB
00378142293
CATAMARAN
(blank)
1/25/2017
OLMESARTAN-HCTZ 40-12.5 MG TAB
00378142293
CATAMARAN
N/A
3/29/2017
OLMESARTAN-HCTZ 40-25 MG TAB
00378142593
PHS
26500004
4/6/2017
OLMSRTN-AMLDPN-HCTZ 40-10-25MG
57664080083
OPTUMRX
PDPIND
2/14/2017
OLMSRTN-AMLDPN-HCTZ 40-10-25MG
57664080083
PRIME THERAPEUTICS
013349
2/17/2017
OLMSRTN-AMLDPN-HCTZ 40-5-25 MG
49884078811
WHI
512161
3/23/2017
OLOPATADINE 665 MCG NASAL SPRY
45802002801
PRIME THERAPEUTICS
B0000001
1/13/2017
OLOPATADINE 665 MCG NASAL SPRY
60505084505
NMHC
EGWPS032
1/20/2017
OLOPATADINE HCL 0.1% EYE DROPS
65862075705
AETNA (ARGUS)
RXAETD
1/10/2017
OMEGA-3 ETHYL ESTERS 1 GM CAP
00093540189
AETNA (ARGUS)
RXAETD
1/10/2017
OMEGA-3 ETHYL ESTERS 1 GM CAP
00093540189
OPTUMRX
PDPIND
2/3/2017
OMEGA-3 ETHYL ESTERS 1 GM CAP
00093540189
RXWEST
45600
4/5/2017
OMEGA-3 ETHYL ESTERS 1 GM CAP
49884001908
CIGNA
00607343
1/9/2017
OMEGA-3 ETHYL ESTERS 1 GM CAP
65162003416
OPTUMRX
PDPIND
OMEPRAZOLE DR 40 MG CAPSULE
62037064001
PRIME THERAPEUTICS
STMS
OMEPRAZOLE DR 40 MG CAPSULE
68462023210
AETNA (ARGUS)
RXAETD
1/10/2017
OMEPRAZOLE-BICARB 20-1,680 PKT
68682099030
PRIME THERAPEUTICS
S59219
12/27/2016
OMEPRAZOLE-BICARB 40-1,100 CAP
68682010430
CATAMARAN
006167730001A00
11/4/2016
OMEPRAZOLE-BICARB 40-1,100 CAP
49884045511
PRIME THERAPEUTICS
B0000003
2/17/2017
OMEPRAZOLE-BICARB 40-1,100 CAP
55111036430
AETNA (ARGUS)
RXAETD
1/10/2017
OMEPRAZOLE-BICARB 40-1,100 CAP
55111036430
CATAMARAN
-
3/21/2017
OMEPRAZOLE-BICARB 40-1,100 CAP
55111036430
PRIME THERAPEUTICS
011403
4/7/2017
ONDANSETRON 4 MG/5 ML SOLUTION
65162069179
CAREMARK
788257
11/15/2016
ONDANSETRON 4 MG/5 ML SOLUTION
51672409103
CATAMARAN
3209440
3/21/2017
ONDANSETRON ODT 4 MG TABLET
68001024617
OPTUMRX
U0744260
2/13/2017
ONDANSETRON ODT 4 MG TABLET
00378773293
OPTUMRX
PDPIND
5/25/2017
ONDANSETRON ODT 8 MG TABLET
00781523964
AETNA (ARGUS)
RXAETD
1/10/2017
ONDANSETRON ODT 8 MG TABLET
00378773493
CATAMARAN
(blank)
3/20/2017
ONDANSETRON ODT 8 MG TABLET
00378773493
CATAMARAN
00615436
1/25/2017
ONDANSETRON ODT 8 MG TABLET
00378773493
MERIDIANRX
(blank)
11/10/2016
ONDANSETRON ODT 8 MG TABLET
00378773493
MERIDIANRX
(blank)
12/9/2016
ONDANSETRON ODT 8 MG TABLET
57237007830
MERIDIANRX
MIMEDICAID
4/26/2017
OSELTAMIVIR PHOS 30 MG CAPSULE
47781046813
CATAMARAN
2500183
3/21/2017
OSELTAMIVIR PHOS 75 MG CAPSULE
47781047013
CATAMARAN
N/A
3/21/2017
OSELTAMIVIR PHOS 75 MG CAPSULE
47781047013
CIGNA
(blank)
3/21/2017
1/20/2017
2/3/2017
12/27/2016
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
OSELTAMIVIR PHOS 75 MG CAPSULE
47781047013
CIGNA
71574
MAC Effective Date
3/21/2017
OSELTAMIVIR PHOS 75 MG CAPSULE
47781047013
OPTUMRX
U0744260
5/18/2017
OSELTAMIVIR PHOS 75 MG CAPSULE
47781047013
MERIDIANRX
(blank)
3/3/2017
OXANDROLONE 10 MG TABLET
49884030202
AETNA (ARGUS)
RXAETD
1/18/2017
OXANDROLONE 10 MG TABLET
486113501
PRIME THERAPEUTICS
10201739
5/19/2017
OXAPROZIN 600 MG CAPLET
59762600201
AETNA (ARGUS)
RXAETD
1/10/2017
OXAPROZIN 600 MG CAPLET
59762600201
CATAMARAN
(blank)
3/20/2017
OXAPROZIN 600 MG TABLET
57664039108
CITIZENSRX LLC
1019
1/17/2017
OXAPROZIN 600 MG TABLET
55111017001
OPTUMRX
ERSTX
2/17/2017
OXAPROZIN 600 MG TABLET
00185014101
CATALYST
STOH
4/6/2017
OXAZEPAM 15 MG CAPSULE
00781281001
AETNA (ARGUS)
RXAETD
1/10/2017
OXAZEPAM 15 MG CAPSULE
00781281001
CATAMARAN
-
4/6/2017
OXCARBAZEPINE 300 MG TABLET
68462013801
OPTUMRX
ERSTX
2/13/2017
OXCARBAZEPINE 300 MG TABLET
68462013801
RXWEST
1725MED
3/10/2017
OXCARBAZEPINE 300 MG/5 ML SUSP
00054019959
AETNA (ARGUS)
RXAETD
1/10/2017
OXYBUTYNIN 5 MG TABLET
00603497528
CAREMARK
788257
12/1/2016
OXYBUTYNIN 5 MG TABLET
00603497532
CITIZENSRX LLC
1019
2/13/2017
OXYBUTYNIN 5 MG TABLET
00603497521
AETNA (ARGUS)
RXAETD
1/10/2017
OXYBUTYNIN CL ER 10 MG TABLET
62175027137
AETNA (ARGUS)
RXAETD
1/10/2017
OXYBUTYNIN CL ER 10 MG TABLET
62175027137
OPTUMRX
PSR
OXYBUTYNIN CL ER 5 MG TABLET
00093520601
ARGUS
-
OXYBUTYNIN CL ER 5 MG TABLET
65162037110
OPTUMRX
COS
1/9/2017
OXYBUTYNIN CL ER 5 MG TABLET
62175027037
AETNA (ARGUS)
RXAETD
1/10/2017
OXYBUTYNIN CL ER 5 MG TABLET
62175027037
CATAMARAN
(blank)
3/20/2017
OXYBUTYNIN CL ER 5 MG TABLET
65162037150
CATAMARAN
(blank)
5/18/2017
OXYCODON-ACETAMINOPHEN 7.5-325
00406052201
AETNA (ARGUS)
RXAETD
1/10/2017
OXYCODON-ACETAMINOPHEN 7.5-325
00406052201
CAREMARK
RXCVSD
1/24/2017
OXYCODON-ACETAMINOPHEN 7.5-325
65162020750
AETNA (ARGUS)
RXAETD
1/10/2017
OXYCODON-ACETAMINOPHEN 7.5-325
65162020750
CATAMARAN
00615436
1/25/2017
OXYCODON-ACETAMINOPHEN 7.5-325
65162020750
CIGNA
(blank)
1/25/2017
OXYCODON-ACETAMINOPHEN 7.5-325
65162020750
NMHC
RHA
5/23/2017
OXYCODON-ACETAMINOPHEN 7.5-325
00406052205
AETNA (ARGUS)
RXAETD
2/7/2017
OXYCODON-ACETAMINOPHEN 7.5-325
65162020710
AETNA (ARGUS)
RXAETD
1/10/2017
OXYCODON-ACETAMINOPHEN 7.5-325
42858010301
MAXOR PLUS
2001065
4/17/2017
OXYCODONE HCL 10 MG TABLET
42858000201
MERIDIANRX
(blank)
3/31/2017
OXYCODONE HCL 10 MG TABLET
10702005601
OPTUMRX
COS
5/25/2017
OXYCODONE HCL 100 MG/5 ML SOLN
68462034737
CATALYST (FUTURESCRIPTS)
(blank)
11/17/2016
OXYCODONE HCL 15 MG TABLET
10702000801
CATAMARAN
(blank)
3/21/2017
OXYCODONE HCL 15 MG TABLET
10702000801
OPTUMRX
COS
2/2/2017
OXYCODONE HCL 15 MG TABLET
42858000301
CAREMARK
RX4760
4/26/2017
OXYCODONE HCL 30 MG TABLET
10702000950
OPTUMRX
COS
2/3/2017
OXYCODONE HCL 30 MG TABLET
10702000901
OPTUMRX
COS
3/16/2017
OXYCODONE HCL 30 MG TABLET
10702000901
OPTUMRX
SHCA
2/7/2017
OXYCODONE HCL 30 MG TABLET
10702000901
PHS
10032295
5/17/2017
OXYCODONE HCL 30 MG TABLET
10702000901
PHS
N/A
5/17/2017
OXYCODONE HCL 30 MG TABLET
42858000501
CAREMARK
RX4760
4/26/2017
OXYCODONE HCL 30 MG TABLET
42858000501
OPTUMRX
U0744260
2/13/2017
OXYCODONE HCL 5 MG TABLET
10702001801
AETNA (ARGUS)
RXAETD
1/18/2017
OXYCODONE HCL 5 MG TABLET
10702001801
PHS
88060196
5/17/2017
OXYCODONE HCL 5 MG TABLET
00603499021
CATAMARAN
00880800
3/21/2017
OXYCODONE HCL 5 MG TABLET
00603499021
OPTUMRX
ACUAZ
2/14/2017
OXYCODONE HCL 5 MG TABLET
42858000101
AETNA (ARGUS)
RXAETD
1/10/2017
4/7/2017
12/12/2016
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
OXYCODONE HCL 5 MG TABLET
42858000101
OPTUMRX
PDPIND
2/14/2017
OXYCODONE HCL 5 MG TABLET
42858000101
MERIDIANRX
(blank)
3/24/2017
OXYCODONE HCL 5 MG/5 ML SOLN
00054039063
AETNA (ARGUS)
RXAETD
1/10/2017
OXYCODONE HCL ER 10 MG TABLET
00093573101
PROCARE RX
SWIF0030
11/30/2016
OXYCODONE HCL ER 10 MG TABLET
00781570301
CAREMARK
PBARX
1/25/2017
OXYCODONE HCL ER 20 MG TABLET
00093573201
CATAMARAN
(blank)
4/5/2017
OXYCODONE HCL ER 80 MG TABLET
63304068401
CATAMARAN
(blank)
4/28/2017
OXYCODONE-ACETAMINOPHEN 10-325
53746020405
AETNA (ARGUS)
RXAETD
1/10/2017
OXYCODONE-ACETAMINOPHEN 10-325
53746020405
CATAMARAN
(blank)
11/23/2016
OXYCODONE-ACETAMINOPHEN 10-325
53746020405
CIGNA
CIGNA
11/23/2016
OXYCODONE-ACETAMINOPHEN 10-325
53746020405
OPTUMRX
COS
12/7/2016
OXYCODONE-ACETAMINOPHEN 10-325
53746020405
OPTUMRX
SHII
2/2/2017
OXYCODONE-ACETAMINOPHEN 10-325
53746020405
OPTUMRX
SHCA
5/25/2017
OXYCODONE-ACETAMINOPHEN 10-325
53746020405
MAXOR PLUS
22204044
4/21/2017
OXYCODONE-ACETAMINOPHEN 10-325
00406052305
OPTUMRX
PDPIND
11/30/2016
OXYCODONE-ACETAMINOPHEN 10-325
53746020401
CATAMARAN
N/A
3/20/2017
OXYCODONE-ACETAMINOPHEN 10-325
53746020401
OPTUMRX
MPDCSFL
5/25/2017
OXYCODONE-ACETAMINOPHEN 10-325
53746020401
OPTUMRX
MPDCSFL
6/1/2017
OXYCODONE-ACETAMINOPHEN 10-325
47781023005
CATAMARAN
N/A
3/20/2017
OXYCODONE-ACETAMINOPHEN 5-325
53746020301
OPTUMRX
PDPIND
5/25/2017
OXYCODONE-ACETAMINOPHEN 5-325
00406051201
OPTUMRX
MPDACUNY
6/1/2017
OXYCODONE-ASPIRIN 4.8355-325
00591355101
AETNA (ARGUS)
RXAETD
1/10/2017
OXYMORPHONE HCL 10 MG TABLET
10702007101
AETNA (ARGUS)
RXAETD
1/10/2017
OXYMORPHONE HCL 10 MG TABLET
10702007101
CATAMARAN
(blank)
2/7/2017
OXYMORPHONE HCL 10 MG TABLET
00406101001
CIGNA
00900000
1/9/2017
OXYMORPHONE HCL 10 MG TABLET
00054028425
PRIME THERAPEUTICS
RXHRZN
1/13/2017
OXYMORPHONE HCL 5 MG TABLET
00406100901
AETNA (ARGUS)
RXAETD
1/10/2017
OXYMORPHONE HCL 5 MG TABLET
00406100901
PRIME THERAPEUTICS
0
4/21/2017
OXYMORPHONE HCL 5 MG TABLET
00054028325
AETNA (ARGUS)
RXAETD
1/10/2017
OXYMORPHONE HCL ER 10 MG TAB
00115123201
CAREMARK
RX6031
3/1/2017
OXYMORPHONE HCL ER 10 MG TAB
00115123213
AETNA (ARGUS)
81892505000100
2/23/2017
OXYMORPHONE HCL ER 15 MG TAB
00115131601
AETNA (ARGUS)
RXAETD
1/10/2017
OXYMORPHONE HCL ER 15 MG TAB
00115131601
CATAMARAN
N/A
3/20/2017
OXYMORPHONE HCL ER 15 MG TAB
00115131601
OPTUMRX
COS
6/2/2017
OXYMORPHONE HCL ER 30 MG TAB
00115131713
NMHC
CAESARS
1/26/2017
OXYMORPHONE HCL ER 30 MG TAB
00115131701
AETNA (ARGUS)
RXAETD
1/10/2017
OXYMORPHONE HCL ER 30 MG TAB
00115131701
OPTUMRX
019962192
3/17/2017
OXYMORPHONE HCL ER 30 MG TAB
00115131701
ARGUS 4-D
(blank)
6/1/2017
OXYMORPHONE HCL ER 40 MG TAB
00115123401
OPTUMRX
ACUAZ
3/24/2017
OXYMORPHONE HCL ER 5 MG TABLET
00115123101
CATAMARAN
-
3/20/2017
OXYMORPHONE HCL ER 5 MG TABLET
00115123113
CATAMARAN
(blank)
4/18/2017
PALIPERIDONE ER 3 MG TABLET
00591369330
AETNA (ARGUS)
RXAETD
1/10/2017
PALIPERIDONE ER 9 MG TABLET
00591369530
CATAMARAN
00880800
PANTOPRAZOLE SOD DR 40 MG TAB
66993006885
CATALYST (FUTURESCRIPTS)
(blank)
11/15/2016
PARICALCITOL 2 MCG CAPSULE
68382026706
OPTUMRX
COS
12/15/2016
PAROXETINE ER 12.5 MG TABLET
00378200393
MERIDIANRX
1000503
11/10/2016
PAROXETINE ER 12.5 MG TABLET
00378200393
ARGUS
93078
4/17/2017
PAROXETINE ER 25 MG TABLET
00378200493
RXWEST
J021SJU
5/2/2017
PAROXETINE ER 37.5 MG TABLET
00378200593
AETNA (ARGUS)
RXAETD
2/28/2017
PENICILLIN VK 250 MG/5 ML SOLN
00093412773
CATALYST
NOVRX
4/6/2017
PENICILLIN VK 500 MG TABLET
00781165501
AETNA (ARGUS)
RXAETD
1/10/2017
PENICILLIN VK 500 MG TABLET
00781165501
CATAMARAN
-
1/10/2017
2/3/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
PENTAZOCINE-NALOXONE TABLET
43386068001
AETNA (ARGUS)
RXAETD
1/10/2017
PENTOXIFYLLINE ER 400 MG TAB
68682010150
CATAMARAN
3337186
2/7/2017
PENTOXIFYLLINE ER 400 MG TAB
68682010150
MERIDIANRX
MIMEDICAID
1/27/2017
PENTOXIFYLLINE ER 400 MG TAB
68682010110
AETNA (ARGUS)
RXAETD
1/10/2017
PERMETHRIN 5% CREAM
45802026937
CATAMARAN
0716923
1/9/2017
PERMETHRIN 5% CREAM
45802026937
OPTUMRX
COS
2/3/2017
PERMETHRIN 5% CREAM
00472024260
AETNA (ARGUS)
RXAETD
1/10/2017
PERMETHRIN 5% CREAM
00472024260
AETNA (ARGUS)
RXAETD
1/18/2017
PERPHEN-AMITRIP 4 MG-50 MG TAB
00378007301
CATAMARAN
N/A
11/15/2016
PERPHENAZINE 16 MG TABLET
00603506321
AETNA (ARGUS)
RXAETD
1/10/2017
PERPHENAZINE 16 MG TABLET
00603506321
AETNA (ARGUS)
RXAETD
1/18/2017
PERPHENAZINE 16 MG TABLET
00603506321
CATAMARAN
(blank)
3/20/2017
PERPHENAZINE 4 MG TABLET
00603506121
AETNA (ARGUS)
RXAETD
1/18/2017
PERPHENAZINE 8 MG TABLET
00781104801
AETNA (ARGUS)
RXAETD
1/10/2017
PHENADOZ 25 MG SUPPOSITORY
00591299239
AETNA (ARGUS)
RXAETD
1/10/2017
PHENAZOPYRIDINE 200 MG TAB
42937070210
US SCRIPT
202738
11/2/2016
PHENAZOPYRIDINE 200 MG TAB
51293081101
NPS
2084
2/7/2017
PHENELZINE SULFATE 15 MG TAB
43386036021
AETNA (ARGUS)
RXAETD
1/10/2017
PHENOBARBITAL 16.2 MG TABLET
00603516521
OPTUMRX
COS
1/9/2017
PHENOBARBITAL 20 MG/5 ML ELIX
00603150858
CATAMARAN
(blank)
3/20/2017
PHENOBARBITAL 20 MG/5 ML ELIX
00603150858
OPTUMRX
COS
2/21/2017
PHENOBARBITAL 32.4 MG TABLET
00603516632
MERIDIANRX
PRS
2/2/2017
PHENOBARBITAL 32.4 MG TABLET
00603516621
CATAMARAN
(blank)
3/20/2017
PHENOBARBITAL 64.8 MG TABLET
00603516721
CITIZENSRX LLC
1019
2/9/2017
PHENOBARBITAL 97.2 MG TABLET
00603516821
OPTUMRX
PDPIND
2/3/2017
PHENYTOIN 125 MG/5 ML SUSP
51672406901
AETNA (ARGUS)
RXAETD
1/10/2017
PHENYTOIN 50 MG TABLET CHEW
00378385001
AETNA (ARGUS)
RXAETD
1/10/2017
PHENYTOIN SOD EXT 100 MG CAP
51672411103
AETNA (ARGUS)
RXAETD
1/10/2017
PHENYTOIN SOD EXT 100 MG CAP
51672411103
PRIME THERAPEUTICS
123064
1/13/2017
PHENYTOIN SOD EXT 200 MG CAP
62756029983
CATAMARAN
3335219
11/30/2016
PILOCARPINE HCL 5 MG TABLET
00115592201
AETNA (ARGUS)
RXAETD
1/10/2017
PINDOLOL 5 MG TABLET
57664065588
CAREMARK
RX0659
11/23/2016
PIOGLITAZONE HCL 15 MG TABLET
00093727198
CATAMARAN
(blank)
3/23/2017
PIOGLITAZONE-GLIMEPIRIDE 30-4
66993082230
CATAMARAN
3334985
2/3/2017
PIOGLITAZONE-GLIMEPIRIDE 30-4
66993082230
OPTUMRX
WTKNSRX
4/11/2017
PIOGLITAZONE-METFORMIN 15-500
00378155091
AETNA (ARGUS)
RXAETD
1/10/2017
PIOGLITAZONE-METFORMIN 15-500
00378155091
CATAMARAN
3340052
1/25/2017
PIOGLITAZONE-METFORMIN 15-500
00378155091
CATAMARAN
3340052
3/21/2017
PIOGLITAZONE-METFORMIN 15-500
00093504906
CATAMARAN
(blank)
4/6/2017
PIOGLITAZONE-METFORMIN 15-500
13668028060
RXWEST
RXWBOXCO
4/14/2017
PIPERACIL-TAZOBACT 40.5 GRAM
63323030478
AETNA (ARGUS)
RXAETD
1/10/2017
PIROXICAM 10 MG CAPSULE
00093075601
AETNA (ARGUS)
RXAETD
1/10/2017
PIROXICAM 20 MG CAPSULE
00378046701
NMHC
NMCHC
5/23/2017
POLYETHYLENE GLYCOL 3350 POWD
62175044231
CAREMARK
788257
12/1/2016
POLYETHYLENE GLYCOL 3350 POWD
62175044215
AETNA (ARGUS)
RXAETD
1/10/2017
PORTIA-28 TABLET
00555902058
NAVITUS HEALTH SOLNS
SGP
11/8/2016
POTASSIUM CIT-CITRIC ACID SOLN
00121067616
CATAMARAN
3338454
12/9/2016
POTASSIUM CITRATE ER 10 MEQ TB
68382053701
AETNA (ARGUS)
RXAETD
1/24/2017
POTASSIUM CITRATE ER 10 MEQ TB
68382053701
PRIME THERAPEUTICS
(blank)
1/13/2017
POTASSIUM CITRATE ER 10 MEQ TB
00245007111
AETNA (ARGUS)
RXAETD
1/10/2017
POTASSIUM CITRATE ER 15 MEQ TB
68382053801
AETNA (ARGUS)
RXAETD
1/10/2017
POTASSIUM CITRATE ER 15 MEQ TB
68382053801
RXWEST
RXW9523
3/2/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
POTASSIUM CITRATE ER 5 MEQ TAB
68382053601
CATAMARAN
(blank)
MAC Effective Date
2/7/2017
POTASSIUM CL 10% (20 MEQ/15 ML
00603154258
OPTUMRX
PDPIND
3/28/2017
POTASSIUM CL 10% (20 MEQ/15 ML
00603154258
NPS
H0545001
1/5/2017
POTASSIUM CL 10% (40 MEQ/30 ML
00121146530
MERIDIANRX
(blank)
POTASSIUM CL 20 MEQ PACKET
51862013530
CAREMARK
65006500
POTASSIUM CL 20 MEQ PACKET
00603155416
CATAMARAN
(blank)
1/11/2017
POTASSIUM CL 20 MEQ PACKET
00603155416
OPTUMRX
PDPIND
11/30/2016
POTASSIUM CL 20 MEQ PACKET
69543037930
CAREMARK
65006500
2/7/2017
POTASSIUM CL 20 MEQ PACKET
69543037930
CAREMARK
RX0797
2/28/2017
POTASSIUM CL 20% (40 MEQ/15 ML
00603154358
OPTUMRX
PDPIND
12/7/2016
POTASSIUM CL 20% (40 MEQ/15 ML
00603154358
OPTUMRX
PDPIND
2/21/2017
POTASSIUM CL ER 10 MEQ CAPSULE
68382070105
AETNA (ARGUS)
RXAETD
1/10/2017
POTASSIUM CL ER 10 MEQ CAPSULE
68382070105
NAVITUS HEALTH SOLNS
INT
12/7/2016
POTASSIUM CL ER 10 MEQ CAPSULE
68462035705
MERIDIANRX
(blank)
12/14/2016
POTASSIUM CL ER 10 MEQ CAPSULE
68001025903
OPTUMRX
U0744260
2/17/2017
POTASSIUM CL ER 10 MEQ CAPSULE
68001025903
PRIME THERAPEUTICS
054773
1/13/2017
POTASSIUM CL ER 10 MEQ CAPSULE
68382070101
NAVITUS HEALTH SOLNS
SISC
1/8/2017
POTASSIUM CL ER 10 MEQ TABLET
68382060001
CAREMARK
788257
1/6/2017
POTASSIUM CL ER 10 MEQ TABLET
00781571001
AETNA (ARGUS)
RXAETD
1/10/2017
POTASSIUM CL ER 20 MEQ TABLET
68001023500
CAREMARK
788257
11/15/2016
POTASSIUM CL ER 20 MEQ TABLET
62037099910
PRIME THERAPEUTICS
10191418
1/13/2017
POTASSIUM CL ER 8 MEQ CAPSULE
68382070201
NAVITUS HEALTH SOLNS
SSC40003D0290SP
11/8/2016
POTASSIUM CL ER 8 MEQ CAPSULE
00574018001
CITIZENSRX LLC
PNL100
1/3/2017
PRAMIPEXOLE 0.25 MG TABLET
13668009290
OPTUMRX
UHEALTH
2/17/2017
PRAMIPEXOLE 0.25 MG TABLET
13668009290
NAVITUS HEALTH SOLNS
SGP
11/8/2016
PRAMIPEXOLE ER 0.75 MG TABLET
55111061230
OPTUMRX
PDPIND
3/29/2017
PRAMIPEXOLE ER 1.5 MG TABLET
55111061330
AETNA (ARGUS)
RXAETD
1/10/2017
PRAVASTATIN SODIUM 10 MG TAB
68180048509
CATAMARAN
(blank)
3/20/2017
PRAVASTATIN SODIUM 10 MG TAB
68180048509
CATAMARAN
N/A
3/20/2017
PRAVASTATIN SODIUM 40 MG TAB
68180048702
CATAMARAN
HTHSPRING
3/20/2017
PRAVASTATIN SODIUM 80 MG TAB
68180048802
AETNA (ARGUS)
RXAETD
1/10/2017
PRAZOSIN 1 MG CAPSULE
51079063020
PRIME THERAPEUTICS
HZRX
11/4/2016
PRAZOSIN 1 MG CAPSULE
00378110101
AETNA (ARGUS)
RXAETD
1/10/2017
PRAZOSIN 2 MG CAPSULE
00378230201
AETNA (ARGUS)
RXAETD
1/10/2017
PRAZOSIN 2 MG CAPSULE
00378230201
CAREMARK
RXBCID
1/3/2017
PRAZOSIN 2 MG CAPSULE
00378230201
PHS
25500002
4/6/2017
PRAZOSIN 2 MG CAPSULE
00378230201
CITIZENSRX LLC
1019
1/3/2017
PRAZOSIN 5 MG CAPSULE
00378320501
AETNA (ARGUS)
RXAETD
1/10/2017
PRAZOSIN 5 MG CAPSULE
00378320501
CATAMARAN
(blank)
4/20/2017
PRAZOSIN 5 MG CAPSULE
00378320501
PROCARE RX
INSV0030
11/30/2016
PRAZOSIN 5 MG CAPSULE
00093406901
CAREMARK
RX4760
5/23/2017
PREDNICARBATE 0.1% CREAM
66993088061
CATAMARAN
3209868
11/15/2016
PREDNISOLONE 5 MG/5 ML SOLN
13925016604
OPTUMRX
PDPIND
3/29/2017
PREDNISOLONE AC 1% EYE DROP
60758011905
MERIDIANRX
(blank)
11/7/2016
PREDNISOLONE AC 1% EYE DROP
61314063705
AETNA (ARGUS)
RXAETD
1/18/2017
PREDNISOLONE AC 1% EYE DROP
61314063705
AETNA (ARGUS)
RXAETD
2/7/2017
PREDNISOLONE AC 1% EYE DROP
61314063710
CITIZENSRX LLC
(blank)
2/23/2017
PREDNISONE 1 MG TABLET
59746017110
AETNA (ARGUS)
RXAETD
3/29/2017
PREDNISONE 10 MG TAB DOSE PACK
00603533815
CATAMARAN
(blank)
1/26/2017
PREDNISONE 10 MG TAB DOSE PACK
00603533815
CATAMARAN
00617894
3/21/2017
PREDNISONE 10 MG TAB DOSE PACK
00603533831
OPTUMRX
GECRX
2/27/2017
PREDNISONE 10 MG TABLET
00603533832
AETNA (ARGUS)
RXAETD
1/10/2017
1/6/2017
11/18/2016
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
PREDNISONE 10 MG TABLET
59746017306
OPTUMRX
COS
MAC Effective Date
2/3/2017
PREDNISONE 20 MG TABLET
59746017506
CITIZENSRX LLC
1019
2/25/2017
PREDNISONE 20 MG TABLET
00143973810
AETNA (ARGUS)
RXAETD
1/10/2017
PREDNISONE 20 MG TABLET
59746017509
RXWEST
RXW075P
PREDNISONE 5 MG TABLET
59746017210
CAREMARK
788257
11/15/2016
PREDNISONE 5 MG TABLET
00603533715
PROCARE RX
SBGRXGE7
11/30/2016
PREVIFEM TABLET
00603764217
CATAMARAN
333788
2/3/2017
PROBENECID 500 MG TABLET
00527136701
AETNA (ARGUS)
RXAETD
1/10/2017
PROBENECID 500 MG TABLET
00378015601
CAREMARK
65006500
2/23/2017
PROBENECID-COLCHICINE TABS
64980014901
AETNA (ARGUS)
RXAETD
1/10/2017
PROCTOSOL-HC 2.5% CREAM
10631040701
CITIZENSRX LLC
150
2/25/2017
PROCTOZONE-HC 2.5% CREAM
64980030130
AETNA (ARGUS)
RXAETD
1/10/2017
PROCTOZONE-HC 2.5% CREAM
64980032430
AETNA (ARGUS)
RXAETD
1/10/2017
PROGESTERONE 100 MG CAPSULE
69387010101
AETNA (ARGUS)
RXAETD
1/10/2017
PROGESTERONE 100 MG CAPSULE
69387010101
CATAMARAN
(blank)
3/21/2017
PROGESTERONE 200 MG CAPSULE
69387010201
CATAMARAN
0726832
12/21/2016
PROGESTERONE 200 MG CAPSULE
69387010201
PRIME THERAPEUTICS
BCTX
1/13/2017
PROGESTERONE 200 MG CAPSULE
17478076710
AETNA (ARGUS)
RXAETD
1/10/2017
PROGESTERONE 200 MG CAPSULE
69452014920
CATAMARAN
-
3/21/2017
PROMETHAZINE 12.5 MG SUPPOS
51672529601
OPTUMRX
PDPIND
5/31/2017
PROMETHAZINE 25 MG TABLET
68001016208
AETNA (ARGUS)
RXAETD
1/18/2017
PROMETHAZINE 25 MG TABLET
68001016208
OPTUMRX
U0744260
2/13/2017
PROMETHAZINE 25 MG/ML VIAL
00641092825
AETNA (ARGUS)
RXAETD
1/10/2017
PROMETHAZINE 50 MG TABLET
68001016300
CATALYST
CULINARY
PROMETHAZINE 50 MG/ML VIAL
00641092925
MEDIMPACT
HTH
PROMETHEGAN 12.5 MG SUPPOS
00713053612
ARGUS
-
4/10/2017
PROPAFENONE HCL 150 MG TABLET
00603544825
CATAMARAN
N/A
1/31/2017
PROPAFENONE HCL 150 MG TABLET
00591058201
AETNA (ARGUS)
RXAETD
1/10/2017
PROPAFENONE HCL ER 225 MG CAP
66993011460
AETNA (ARGUS)
RXAETD
1/18/2017
PROPAFENONE HCL ER 325 MG CAP
66993011560
AETNA (ARGUS)
RXAETD
1/10/2017
PROPAFENONE HCL ER 425 MG CAP
66993011660
CIGNA
00608469
5/3/2017
PROPAFENONE HCL ER 425 MG CAP
66993011660
PHS
10012785
4/18/2017
PROPRANOLOL 10 MG TABLET
00591555401
CATAMARAN
00882900
3/21/2017
PROPRANOLOL 10 MG TABLET
00591555401
CATAMARAN
HSPMCAID
3/20/2017
PROPRANOLOL 10 MG TABLET
00591555401
PROCARE RX
62TCS130
11/30/2016
PROPRANOLOL 10 MG TABLET
00591555410
CATAMARAN
(blank)
3/20/2017
PROPRANOLOL 20 MG TABLET
00591555501
BENECARD PBF
3239
2/7/2017
PROPRANOLOL 20 MG TABLET
43353096160
PRIME THERAPEUTICS
(blank)
5/19/2017
PROPRANOLOL 40 MG TABLET
00591555610
CATAMARAN
(blank)
3/20/2017
PROPRANOLOL 40 MG TABLET
00591555601
AETNA (ARGUS)
RXAETD
1/10/2017
PROPRANOLOL 60 MG TABLET
50111047001
CATAMARAN
(blank)
3/20/2017
PROPRANOLOL 80 MG TABLET
50111047101
AETNA (ARGUS)
RXAETD
1/10/2017
PROPRANOLOL ER 120 MG CAPSULE
43478090288
OPTUMRX
ERSTX
2/13/2017
PROPRANOLOL ER 120 MG CAPSULE
00228278011
AETNA (ARGUS)
RXAETD
1/10/2017
PROPRANOLOL ER 160 MG CAPSULE
51991082001
AETNA (ARGUS)
RXAETD
1/10/2017
PROPRANOLOL ER 160 MG CAPSULE
00228278111
AETNA (ARGUS)
RXAETD
1/10/2017
PROPRANOLOL ER 80 MG CAPSULE
51991081801
AETNA (ARGUS)
RXAETD
11/1/2016
PROPRANOLOL ER 80 MG CAPSULE
51991081801
AETNA (ARGUS)
RXAETD
1/10/2017
PROPRANOLOL ER 80 MG CAPSULE
51991081801
CATAMARAN
N/A
1/31/2017
PROPRANOLOL ER 80 MG CAPSULE
43478090188
CIGNA
CIGNA
3/21/2017
PROPYLTHIOURACIL 50 MG TABLET
67253065110
CATAMARAN
094472
11/24/2016
PROPYLTHIOURACIL 50 MG TABLET
67253065110
PHS
(blank)
4/6/2017
3/2/2017
3/9/2017
12/30/2016
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
PROTRIPTYLINE HCL 5 MG TABLET
00054021025
AETNA (ARGUS)
RXAETD
MAC Effective Date
1/10/2017
PYRAZINAMIDE 500 MG TABLET
60687013801
NMHC
EGWPS009
12/15/2016
PYRIDOSTIGMINE BR 60 MG TABLET
68682030210
AETNA (ARGUS)
RXAETD
11/15/2016
PYRIDOSTIGMINE BR 60 MG TABLET
68682030210
AETNA (ARGUS)
RXAETD
1/10/2017
PYRIDOSTIGMINE BR 60 MG TABLET
68682030210
OPTUMRX
(blank)
2/17/2017
PYRIDOSTIGMINE ER 180 MG TAB
47781033530
AETNA (ARGUS)
70450224123
1/10/2017
PYRIDOSTIGMINE ER 180 MG TAB
47781033530
PRIME THERAPEUTICS
NCPARTD
12/27/2016
PYRIDOSTIGMINE ER 180 MG TAB
47781033530
ARGUS
(blank)
1/31/2017
PYRIDOSTIGMINE ER 180 MG TAB
68682030130
OPTUMRX
SHCA
2/3/2017
QUETIAPINE ER 300 MG TABLET
49884080802
MERIDIANRX
MAGOLD
5/23/2017
QUETIAPINE ER 400 MG TABLET
16729009712
CATAMARAN
(blank)
3/20/2017
QUETIAPINE FUMARATE 100 MG TAB
16729014701
NMHC
EGWPS032
1/20/2017
QUETIAPINE FUMARATE 100 MG TAB
68001018400
OPTUMRX
U0744260
2/17/2017
QUETIAPINE FUMARATE 100 MG TAB
68001018400
OPTUMRX
ERSTX
2/13/2017
QUETIAPINE FUMARATE 100 MG TAB
68180044701
AETNA (ARGUS)
RXAETD
1/10/2017
QUETIAPINE FUMARATE 200 MG TAB
47335090588
ARGUS
S300
12/5/2016
QUETIAPINE FUMARATE 200 MG TAB
16729014817
PRIME THERAPEUTICS
0005
1/13/2017
QUETIAPINE FUMARATE 200 MG TAB
68180044801
NMHC
FEDEX
1/26/2017
QUETIAPINE FUMARATE 200 MG TAB
68001018200
OPTUMRX
U0744260
2/13/2017
QUETIAPINE FUMARATE 25 MG TAB
68001018500
AETNA (ARGUS)
RXAETD
1/10/2017
QUETIAPINE FUMARATE 25 MG TAB
68001018500
CAREMARK
788257
11/15/2016
QUETIAPINE FUMARATE 25 MG TAB
68001018508
CAREMARK
RX0797
1/16/2017
QUETIAPINE FUMARATE 25 MG TAB
68001018508
OPTUMRX
U0744260
2/17/2017
QUETIAPINE FUMARATE 25 MG TAB
16729014517
CAREMARK
UMWA
5/4/2017
QUETIAPINE FUMARATE 300 MG TAB
68001018300
NMHC
EGWPS032
1/20/2017
QUETIAPINE FUMARATE 300 MG TAB
16729014917
AETNA (ARGUS)
RXAETD
1/10/2017
QUETIAPINE FUMARATE 400 MG TAB
00054023025
CATAMARAN
00880800
2/3/2017
QUETIAPINE FUMARATE 400 MG TAB
68001018103
OPTUMRX
U0744260
2/13/2017
QUETIAPINE FUMARATE 50 MG TAB
68001018008
NMHC
EGWPS032
1/12/2017
QUETIAPINE FUMARATE 50 MG TAB
68001018008
RXWEST
40192H
1/13/2017
QUINAPRIL 10 MG TABLET
68001018805
CATAMARAN
(blank)
3/23/2017
QUINAPRIL 10 MG TABLET
68001018805
NAVITUS HEALTH SOLNS
FTCESHX
11/2/2016
QUINAPRIL 40 MG TABLET
68001026005
AETNA (ARGUS)
RXAETD
1/10/2017
QUININE SULFATE 324 MG CAPSULE
00378718093
OPTUMRX
PDPIND
12/2/2016
QUININE SULFATE 324 MG CAPSULE
53489070007
AETNA (ARGUS)
RXAETD
1/10/2017
RABEPRAZOLE SOD DR 20 MG TAB
00378670993
AETNA (ARGUS)
RXAETD
1/10/2017
RABEPRAZOLE SOD DR 20 MG TAB
00378670993
OPTUMRX
MPDCSNM
2/14/2017
RABEPRAZOLE SOD DR 20 MG TAB
00378670977
RXWEST
22207691
3/2/2017
RALOXIFENE HCL 60 MG TABLET
00093729001
AETNA (ARGUS)
RXAETD
1/10/2017
RAMIPRIL 1.25 MG CAPSULE
68001014004
CATAMARAN
(blank)
3/23/2017
RAMIPRIL 5 MG CAPSULE
68001014303
AETNA (ARGUS)
RXAETD
1/10/2017
RAMIPRIL 5 MG CAPSULE
68001014303
CIGNA
3328569
1/25/2017
RAMIPRIL 5 MG CAPSULE
68001014300
MAXOR PLUS
MCISD
12/19/2016
RANITIDINE 15 MG/ML SYRUP
00121072716
OPTUMRX
0401122000
4/14/2017
RANITIDINE 150 MG CAPSULE
55111012905
NMHC
(blank)
4/18/2017
RANITIDINE 150 MG CAPSULE
00781285560
AETNA (ARGUS)
RXAETD
1/10/2017
RANITIDINE 150 MG TABLET
53746025305
OPTUMRX
(blank)
12/1/2016
RANITIDINE 150 MG TABLET
53746025310
AETNA (ARGUS)
RXAETD
1/10/2017
RANITIDINE 150 MG TABLET
53746025310
OPTUMRX
U0744260
1/26/2017
RANITIDINE 150 MG TABLET
68462024805
OPTUMRX
ERSTX
2/17/2017
RANITIDINE 150 MG TABLET
64380080308
MERIDIANRX
(blank)
3/10/2017
RANITIDINE 300 MG CAPSULE
55111013030
CATAMARAN
(blank)
3/22/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
RANITIDINE 300 MG CAPSULE
55111013030
PHS
60017593
MAC Effective Date
RANITIDINE 300 MG TABLET
68462024920
PHS
26500003
4/6/2017
RANITIDINE 300 MG TABLET
68462024920
MERIDIANRX
-
11/7/2016
RANITIDINE 300 MG TABLET
53746025401
CATAMARAN
884700
1/25/2017
RANITIDINE 300 MG TABLET
64380080438
MERIDIANRX
HPMMCD
3/31/2017
RASAGILINE MESYLATE 0.5 MG TAB
47781013830
PRIME THERAPEUTICS
169493
3/24/2017
RASAGILINE MESYLATE 1 MG TAB
47781013930
PRIME THERAPEUTICS
3000097
5/19/2017
RECLIPSEN 28 DAY TABLET
52544095428
CATAMARAN
-
3/20/2017
REPAGLINIDE 2 MG TABLET
57664074788
AETNA (ARGUS)
RXAETD
1/10/2017
RIBAVIRIN 200 MG CAPSULE
68382026012
RXWEST
RXW0757
11/28/2016
RIBAVIRIN 200 MG TABLET
68382004603
CAREMARK
RXCVSD
2/15/2017
RIFAMPIN 300 MG CAPSULE
00527131506
AETNA (ARGUS)
RXAETD
1/10/2017
RISEDRONATE SOD DR 35 MG TAB
00591387604
AETNA (ARGUS)
RXAETD
1/10/2017
RISEDRONATE SOD DR 35 MG TAB
00591387604
CATALYST (FUTURESCRIPTS)
(blank)
11/16/2016
RISEDRONATE SODIUM 150 MG TAB
00591204454
AETNA (ARGUS)
RXAETD
1/31/2017
RISEDRONATE SODIUM 150 MG TAB
00591204454
CATAMARAN
246534606CIGV
3/3/2017
RISPERIDONE 0.25 MG ODT
49884021255
AETNA (ARGUS)
RXAETD
1/10/2017
RISPERIDONE 1 MG ODT
51079034505
AETNA (ARGUS)
RXAETD
1/10/2017
RISPERIDONE 1 MG/ML SOLUTION
65162067384
OPTUMRX
PDPIND
2/3/2017
RISPERIDONE 3 MG ODT
49884040291
CAREMARK
788257
11/15/2016
RISPERIDONE 3 MG TABLET
50458059460
CATAMARAN
(blank)
3/20/2017
RISPERIDONE 4 MG ODT
00781531408
AETNA (ARGUS)
RXAETD
1/10/2017
RISPERIDONE 4 MG ODT
00781531408
CATAMARAN
-
3/30/2017
RIVASTIGMINE 1.5 MG CAPSULE
55111035260
CATAMARAN
(blank)
3/30/2017
RIVASTIGMINE 1.5 MG CAPSULE
55111035260
CATAMARAN
-
11/4/2016
RIVASTIGMINE 13.3 MG/24HR PTCH
00781731331
AETNA (ARGUS)
RXAETD
1/10/2017
RIVASTIGMINE 13.3 MG/24HR PTCH
00781731331
CATAMARAN
(blank)
3/3/2017
RIVASTIGMINE 13.3 MG/24HR PTCH
47781040503
CATAMARAN
-
3/20/2017
RIVASTIGMINE 3 MG CAPSULE
00781261560
AETNA (ARGUS)
RXAETD
1/10/2017
RIVASTIGMINE 4.5 MG CAPSULE
55111035460
CATAMARAN
(blank)
3/22/2017
RIVASTIGMINE 4.6 MG/24HR PATCH
00781730431
AETNA (ARGUS)
RXAETD
1/10/2017
RIVASTIGMINE 9.5 MG/24HR PATCH
47781030503
AETNA (ARGUS)
RXAETD
1/10/2017
RIVASTIGMINE 9.5 MG/24HR PATCH
47781030503
OPTUMRX
U0744260
2/17/2017
RIVASTIGMINE 9.5 MG/24HR PATCH
00781730931
CATAMARAN
(blank)
3/3/2017
RIVASTIGMINE 9.5 MG/24HR PATCH
00781730931
CATAMARAN
246534603CIGV
3/3/2017
RIVASTIGMINE 9.5 MG/24HR PATCH
00781730931
CATAMARAN
CIHSCARE
3/21/2017
ROPINIROLE HCL 0.5 MG TABLET
68462025401
NAVITUS HEALTH SOLNS
COD03
11/2/2016
ROPINIROLE HCL 2 MG TABLET
68462025601
PHS
40000015
4/6/2017
ROSUVASTATIN CALCIUM 10 MG TAB
16252061630
PHS
(blank)
4/6/2017
ROSUVASTATIN CALCIUM 20 MG TAB
57237017090
AETNA (ARGUS)
RXAETD
1/10/2017
ROSUVASTATIN CALCIUM 20 MG TAB
16252061730
NMHC
CALPANTH
5/18/2017
ROSUVASTATIN CALCIUM 5 MG TAB
16252061530
NMHC
HLHWF
11/30/2016
SALSALATE 500 MG TABLET
51293080305
CATAMARAN
CIHSCARE
3/20/2017
SALSALATE 750 MG TABLET
51293080405
NAVITUS HEALTH SOLNS
13DPEMH
11/2/2016
SALSALATE 750 MG TABLET
51293080401
NPS
UMR412591B
5/31/2017
SELEGILINE HCL 5 MG CAPSULE
67253070006
AETNA (ARGUS)
RXAETD
1/10/2017
SELEGILINE HCL 5 MG CAPSULE
67253070006
CATAMARAN
(blank)
3/20/2017
SELEGILINE HCL 5 MG CAPSULE
67253070006
CATAMARAN
246534622CIGP
3/29/2017
SELEGILINE HCL 5 MG TABLET
60505343803
AETNA (ARGUS)
RXAETD
1/10/2017
SELEGILINE HCL 5 MG TABLET
60505343803
PRIME THERAPEUTICS
-
3/31/2017
SELEGILINE HCL 5 MG TABLET
00378929091
AETNA (ARGUS)
RXAETD
4/25/2017
SELENIUM SULFIDE 2.25% SHAMPOO
42582090006
CITIZENSRX LLC
151
2/25/2017
4/21/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
SELENIUM SULFIDE 2.5% LOTION
45802004064
AETNA (ARGUS)
RXAETD
1/10/2017
SERTRALINE 20 MG/ML ORAL CONC
59762494001
CAREMARK
RX0825
3/28/2017
SERTRALINE HCL 100 MG TABLET
65862001305
CATAMARAN
(blank)
3/21/2017
SERTRALINE HCL 100 MG TABLET
65862001305
PRIME THERAPEUTICS
NDBCS
1/13/2017
SERTRALINE HCL 100 MG TABLET
59762491005
AETNA (ARGUS)
RXAETD
1/10/2017
SERTRALINE HCL 100 MG TABLET
59762491005
MERIDIANRX
MAGOLD
11/10/2016
SERTRALINE HCL 25 MG TABLET
59762496001
CAREMARK
788257
12/22/2016
SILDENAFIL 20 MG TABLET
68001017605
NMHC
IQCAL
4/20/2017
SILDENAFIL 20 MG TABLET
33342012110
AETNA (ARGUS)
RXAETD
1/10/2017
SIMVASTATIN 20 MG TABLET
68382006710
PRIME THERAPEUTICS
(blank)
1/13/2017
SIMVASTATIN 40 MG TABLET
68382006810
AETNA (ARGUS)
RXAETD
1/18/2017
SIROLIMUS 1 MG TABLET
55111065301
AETNA (ARGUS)
RXAETD
1/10/2017
SIROLIMUS 1 MG TABLET
55111065301
ARGUS
(blank)
12/5/2016
SIROLIMUS 2 MG TABLET
55111065401
NAVITUS HEALTH SOLNS
CHX
2/10/2017
SOD SULFACE-SULFUR 9-4.5% WASH
49908017380
CATAMARAN
-
3/21/2017
SOD SULFACET-SULFUR 10-5% CLSR
42582060023
NAVITUS HEALTH SOLNS
SGP
11/2/2016
SODIUM CHLORIDE 0.9% SYRINGE
68883090001
NMHC
CALPANTH
5/17/2017
SODIUM SULFACETAMIDE 10% LOTN
68682001004
CATAMARAN
CIHSCARE
3/23/2017
SODIUM SULFACET-SULFUR WASH
42192012116
PRIME THERAPEUTICS
(blank)
11/24/2016
SPIRONOLACTONE 100 MG TABLET
53746051501
AETNA (ARGUS)
RXAETD
1/10/2017
SPIRONOLACTONE 100 MG TABLET
53746051501
CIGNA
00611332
1/25/2017
SPIRONOLACTONE 100 MG TABLET
53746051501
OPTUMRX
PDPIND
2/3/2017
SPIRONOLACTONE 100 MG TABLET
53746051501
OPTUMRX
PDPIND
2/7/2017
SPIRONOLACTONE 100 MG TABLET
59746021801
OPTUMRX
PDPIND
2/7/2017
SPIRONOLACTONE 25 MG TABLET
53746051105
AETNA (ARGUS)
RXAETD
1/10/2017
SPIRONOLACTONE 50 MG TABLET
53746051405
CATAMARAN
335834
3/21/2017
SPIRONOLACTONE-HCTZ 25-25 TAB
53489014401
AETNA (ARGUS)
RXAETD
1/10/2017
SRONYX 0.10-0.02 MG TABLET
51862054506
CATAMARAN
072419
2/7/2017
SRONYX 0.10-0.02 MG TABLET
51862054506
OPTUMRX
SYH
3/29/2017
SUCRALFATE 1 GM TABLET
00591078001
OPTUMRX
CDJ
11/15/2016
SUCRALFATE 1 GM TABLET
00093221005
AETNA (ARGUS)
RXAETD
1/10/2017
SUCRALFATE 1 GM TABLET
00093221005
AETNA (ARGUS)
45060301000001
1/31/2017
SUCRALFATE 1 GM TABLET
00093221005
OPTUMRX
PDPIND
1/9/2017
SUCRALFATE 1 GM TABLET
00093221001
OPTUMRX
COS
1/9/2017
SUCRALFATE 1 GM TABLET
00591078005
AETNA (ARGUS)
RXAETD
4/4/2017
SUCRALFATE 1 GM TABLET
00591078005
CATAMARAN
00613420
1/9/2017
SUCRALFATE 1 GM TABLET
00591078005
CATAMARAN
044301
1/10/2017
SUCRALFATE 1 GM TABLET
00591389201
CAREMARK
RXCVSD
2/10/2017
SUCRALFATE 1 GM TABLET
00591389201
CATAMARAN
246534622CIGV
3/20/2017
SUCRALFATE 1 GM TABLET
00591389201
OPTUMRX
U0744260
2/13/2017
SUCRALFATE 1 GM TABLET
00591389201
RXWEST
1055
3/2/2017
SULFACETAMIDE 10% EYE DROPS
24208067004
AETNA (ARGUS)
RXAETD
1/10/2017
SULFACETAMIDE 10% EYE DROPS
24208067004
CATALYST (FUTURESCRIPTS)
-
11/15/2016
SULFACETAMIDE SOD 10% TOP SUSP
45802089626
AETNA (ARGUS)
RXAETD
1/31/2017
SULFACETAMIDE SOD 10% TOP SUSP
45802089626
CATAMARAN
(blank)
4/6/2017
SULFACETAMIDE SOD 10% TOP SUSP
45802089626
OPTUMRX
UHEALTH
3/24/2017
SULFACETAMIDE-SULFUR 10-5% CRM
44523060301
CITIZENSRX LLC
LSYA
2/8/2017
SULFAMETHOXAZOLE-TMP DS TABLET
61971012005
OPTUMRX
(blank)
3/1/2017
SULFAMETHOXAZOLE-TMP SUSP
65862049647
AETNA (ARGUS)
RXAETD
1/10/2017
SULFASALAZINE 500 MG TABLET
00591079601
AETNA (ARGUS)
RXAETD
1/18/2017
SULFASALAZINE 500 MG TABLET
00591079601
CIGNA
00600000
1/9/2017
SULFASALAZINE 500 MG TABLET
00591079605
EXPRESS SCRIPTS
DODA
2/20/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
SULFASALAZINE DR 500 MG TAB
59762010402
OPTUMRX
U0744260
MAC Effective Date
2/13/2017
SULFASALAZINE DR 500 MG TAB
59762010401
AETNA (ARGUS)
RXAETD
1/10/2017
SUMATRIPTAN 20 MG NASAL SPRAY
00781652386
NMHC
UCOP
5/26/2017
SUMATRIPTAN 5 MG NASAL SPRAY
00781652486
AETNA (ARGUS)
RXAETD
2/21/2017
SUMATRIPTAN 6 MG/0.5 ML INJECT
55111069312
CATAMARAN
3330370
1/9/2017
SUMATRIPTAN 6 MG/0.5 ML INJECT
55111069312
PRIME THERAPEUTICS
0857190001
3/24/2017
SUMATRIPTAN 6 MG/0.5 ML INJECT
47335027641
CATAMARAN
(blank)
3/21/2017
SUMATRIPTAN 6 MG/0.5 ML REFILL
00781317307
AETNA (ARGUS)
RXAETD
1/10/2017
SUMATRIPTAN 6 MG/0.5 ML REFILL
00781317307
OPTUMRX
PDPIND
1/13/2017
SUMATRIPTAN 6 MG/0.5 ML VIAL
00781317414
CAREMARK
788257
11/15/2016
SUMATRIPTAN 6 MG/0.5 ML VIAL
55150017301
OPTUMRX
PDPIND
3/24/2017
SYEDA 28 TABLET
00781565815
PRIME THERAPEUTICS
100HC-0010
11/4/2016
SYNTHROID 112 MCG TABLET
00074929690
MERIDIANRX
RXCOMPQL
3/10/2017
TACROLIMUS 0.03% OINTMENT
00168041760
AETNA (ARGUS)
RXAETD
1/10/2017
TACROLIMUS 0.1% OINTMENT
00168041630
AETNA (ARGUS)
RXAETD
12/27/2016
TACROLIMUS 0.1% OINTMENT
00168041699
CATAMARAN
-
4/13/2017
TACROLIMUS 0.5 MG CAPSULE
00781210201
AETNA (ARGUS)
RXAETD
1/10/2017
TACROLIMUS 0.5 MG CAPSULE
55111052501
RXWEST
RXWO4359
5/15/2017
TACROLIMUS 5 MG CAPSULE
00781210401
CATAMARAN
3338620
11/23/2016
TAMOXIFEN 20 MG TABLET
00093078256
NMHC
EGWPS015
10/31/2016
TAMOXIFEN 20 MG TABLET
00591247330
AETNA (ARGUS)
RXAETD
1/10/2017
TELMISARTAN 40 MG TABLET
67877048384
CATAMARAN
(blank)
3/23/2017
TELMISARTAN 80 MG TABLET
67877048484
AETNA (ARGUS)
RXAETD
1/10/2017
TELMISARTAN-AMLODIPINE 80-10
68180019906
AETNA (ARGUS)
RXAETD
2/7/2017
TELMISARTAN-AMLODIPINE 80-10
68180019906
CATAMARAN
(blank)
4/20/2017
TELMISARTAN-AMLODIPINE 80-5 MG
68180019806
CATAMARAN
-
3/20/2017
TELMISARTAN-AMLODIPINE 80-5 MG
00378107793
AETNA (ARGUS)
RXAETD
4/25/2017
TELMISARTAN-HCTZ 40-12.5 MG TB
00054054518
OPTUMRX
U0744260
2/13/2017
TELMISARTAN-HCTZ 40-12.5 MG TB
13668015930
MERIDIANRX
LYNDHURST
3/17/2017
TELMISARTAN-HCTZ 80-12.5 MG TB
00054054618
OPTUMRX
U0744260
2/17/2017
TELMISARTAN-HCTZ 80-25 MG TAB
00054054718
AETNA (ARGUS)
RXAETD
1/10/2017
TELMISARTAN-HCTZ 80-25 MG TAB
00054054718
CATAMARAN
(blank)
1/31/2017
TELMISARTAN-HCTZ 80-25 MG TAB
00054054718
CATAMARAN
3332245
2/16/2017
TEMAZEPAM 15 MG CAPSULE
00378401001
AETNA (ARGUS)
RXAETD
1/10/2017
TEMAZEPAM 22.5 MG CAPSULE
53489065007
CATAMARAN
3337998
3/21/2017
TEMAZEPAM 30 MG CAPSULE
00378505005
OPTUMRX
U0744260
2/17/2017
TEMAZEPAM 30 MG CAPSULE
00378505005
OPTUMRX
ERSTX
2/13/2017
TEMAZEPAM 7.5 MG CAPSULE
53489064801
AETNA (ARGUS)
RXAETD
1/18/2017
TEMOZOLOMIDE 100 MG CAPSULE
00781269375
CATAMARAN
4010MR
3/20/2017
TEMOZOLOMIDE 140 MG CAPSULE
00781269444
PRIME THERAPEUTICS
P92976
1/27/2017
TEMOZOLOMIDE 180 MG CAPSULE
00781269575
CATAMARAN
(blank)
11/4/2016
TEMOZOLOMIDE 180 MG CAPSULE
00781269575
CATAMARAN
3340414
2/24/2017
TEMOZOLOMIDE 180 MG CAPSULE
00781269544
NAVITUS HEALTH SOLNS
83505
11/8/2016
TEMOZOLOMIDE 20 MG CAPSULE
00781269244
MEDIMPACT
BHP01
3/21/2017
TERBINAFINE HCL 250 MG TABLET
69097085907
AETNA (ARGUS)
RXAETD
1/10/2017
TERBINAFINE HCL 250 MG TABLET
69097085907
OPTUMRX
U0744260
2/17/2017
TERBUTALINE SULFATE 2.5 MG TAB
00527131801
AETNA (ARGUS)
RXAETD
1/18/2017
TERBUTALINE SULFATE 2.5 MG TAB
00527131801
CATAMARAN
-
3/20/2017
TERCONAZOLE 0.4% CREAM
00168034646
CAREMARK
RX1113
10/31/2016
TERCONAZOLE 0.8% CREAM
00591319752
OPTUMRX
AMNJ
2/13/2017
TERCONAZOLE 0.8% CREAM
00591319752
CATALYST (FUTURESCRIPTS)
MDCMEDD
11/30/2016
TESTOSTERON CYP 2,000 MG/10 ML
00143972601
AETNA (ARGUS)
RXAETD
1/10/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
TESTOSTERON CYP 2,000 MG/10 ML
00143972601
CATAMARAN
-
MAC Effective Date
3/3/2017
TESTOSTERON CYP 2,000 MG/10 ML
00591412879
CATALYST
QCA
3/3/2017
TESTOSTERONE 25 MG/2.5 GM PKT
45802011665
PHS
26500006
4/6/2017
TESTOSTERONE 50 MG/5 GRAM GEL
66993093430
CATAMARAN
*NG*1283
3/3/2017
TESTOSTERONE 50 MG/5 GRAM GEL
66993093430
CATAMARAN
*NG*1283
4/5/2017
TESTOSTERONE 50 MG/5 GRAM PKT
00832112035
CAREMARK
RXBCID
1/3/2017
TESTOSTERONE CYP 200 MG/ML
00574082001
CATAMARAN
3339275
1/25/2017
TESTOSTERONE CYP 200 MG/ML
00574082001
CIGNA
3336542
1/25/2017
TESTOSTERONE CYP 200 MG/ML
00574082001
CIGNA
N/A
1/25/2017
TESTOSTERONE CYP 200 MG/ML
00574082001
OPTUMRX
COS
6/1/2017
TESTOSTERONE CYP 200 MG/ML
00574082010
AETNA (ARGUS)
RXAETD
1/10/2017
TESTOSTERONE MICRONIZED POWDER
52372081401
CAREMARK
(blank)
5/31/2017
TETRABENAZINE 12.5 MG TABLET
68682042112
OPTUMRX
COS
2/14/2017
TETRACYCLINE 250 MG CAPSULE
23155001701
CATAMARAN
(blank)
3/3/2017
TETRACYCLINE 500 MG CAPSULE
23155001801
AETNA (ARGUS)
RXAETD
1/18/2017
THEOPHYLLINE ER 300 MG TAB
62332002531
AETNA (ARGUS)
RXAETD
1/10/2017
THEOPHYLLINE ER 300 MG TAB
62332002531
CATAMARAN
(blank)
3/20/2017
THEOPHYLLINE ER 300 MG TAB
62332002531
OPTUMRX
COS
1/9/2017
THEOPHYLLINE ER 400 MG TABLET
29033000101
AETNA (ARGUS)
RXAETD
1/10/2017
THEOPHYLLINE ER 400 MG TABLET
29033000101
CATAMARAN
246534622CIGV
3/23/2017
THEOPHYLLINE ER 400 MG TABLET
29033000101
MERIDIANRX
(blank)
11/10/2016
THEOPHYLLINE ER 600 MG TABLET
29033000201
AETNA (ARGUS)
RXAETD
1/10/2017
THIORIDAZINE 100 MG TABLET
00378061801
CATAMARAN
(blank)
THIORIDAZINE 25 MG TABLET
00378061401
RXWEST
AUX1722
11/18/2016
THIORIDAZINE 25 MG TABLET
51079056620
AETNA (ARGUS)
RXAETD
1/10/2017
THIORIDAZINE 50 MG TABLET
00378061601
CATAMARAN
(blank)
1/20/2017
THIORIDAZINE 50 MG TABLET
00378061601
MERIDIANRX
MIMEDICAID
11/10/2016
THIOTHIXENE 10 MG CAPSULE
00378501001
AETNA (ARGUS)
RXAETD
1/10/2017
THIOTHIXENE 2 MG CAPSULE
00378200201
AETNA (ARGUS)
RXAETD
1/10/2017
THIOTHIXENE 2 MG CAPSULE
00378200201
CATAMARAN
-
3/20/2017
THIOTHIXENE 5 MG CAPSULE
00378300501
AETNA (ARGUS)
RXAETD
1/10/2017
THIOTHIXENE 5 MG CAPSULE
00378300501
CATAMARAN
2465346
3/23/2017
THIOTHIXENE 5 MG CAPSULE
00378300501
NPS
H5649004
3/21/2017
TIAGABINE HCL 4 MG TABLET
00093503156
AETNA (ARGUS)
RXAETD
1/10/2017
TIAGABINE HCL 4 MG TABLET
00093503156
CATAMARAN
(blank)
3/23/2017
TIAGABINE HCL 4 MG TABLET
00093503156
CATAMARAN
-
3/9/2017
TIMOLOL 0.25% GFS GEL-SOLUTION
61314022405
AETNA (ARGUS)
RXAETD
1/10/2017
TIMOLOL 0.5% EYE DROPS
61314022710
CAREMARK
SCB15
12/1/2016
TIMOLOL 0.5% EYE DROPS
61314022710
CATAMARAN
(blank)
3/23/2017
TIMOLOL 0.5% EYE DROPS
61314022710
OPTUMRX
ERSTX
2/13/2017
TIMOLOL 0.5% GEL-SOLUTION
25010081756
CATAMARAN
3337819ACT OA
1/10/2017
TIMOLOL 0.5% GFS GEL-SOLUTION
61314022505
OPTUMRX
AMNJ
2/7/2017
TIMOLOL 0.5% GFS GEL-SOLUTION
61314022505
PRIME THERAPEUTICS
(blank)
6/2/2017
TIMOLOL 0.5% GFS GEL-SOLUTION
61314022505
RXWEST
40192H
5/9/2017
TIZANIDINE HCL 2 MG CAPSULE
00591278886
AETNA (ARGUS)
RXAETD
1/10/2017
TIZANIDINE HCL 2 MG TABLET
55111017915
CATAMARAN
00884800
1/25/2017
TIZANIDINE HCL 4 MG CAPSULE
00591278986
AETNA (ARGUS)
RXAETD
1/10/2017
TIZANIDINE HCL 4 MG CAPSULE
00591278986
BCBS ALABAMA
45784
1/6/2017
TIZANIDINE HCL 4 MG CAPSULE
00591278986
RXWEST
RXW0757
5/30/2017
TIZANIDINE HCL 4 MG TABLET
29300016915
AETNA (ARGUS)
RXAETD
1/10/2017
TIZANIDINE HCL 6 MG CAPSULE
00591279086
OPTUMRX
COS
2/7/2017
TIZANIDINE HCL 6 MG CAPSULE
00591279086
CITIZENSRX LLC
1250009
2/9/2017
2/7/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
TIZANIDINE HCL 6 MG CAPSULE
60505265007
OPTUMRX
PDPIND
MAC Effective Date
2/3/2017
TOBRAMYCIN 0.3% EYE DROPS
61314064305
AETNA (ARGUS)
RXAETD
1/10/2017
TOBRAMYCIN-DEXAMETH OPHTH SUSP
24208029505
AETNA (ARGUS)
RXAETD
1/10/2017
TOBRAMYCIN-DEXAMETH OPHTH SUSP
24208029505
PHS
10004233
4/6/2017
TOBRAMYCIN-DEXAMETH OPHTH SUSP
24208029505
RXWEST
2012001
3/2/2017
TOLTERODINE TART ER 2 MG CAP
13668018930
MERIDIANRX
MAGOLD
3/31/2017
TOLTERODINE TART ER 2 MG CAP
00093205056
AETNA (ARGUS)
RXAETD
1/10/2017
TOLTERODINE TART ER 4 MG CAP
13668019090
AETNA (ARGUS)
RXAETD
1/10/2017
TOLTERODINE TARTRATE 1 MG TAB
59762017006
AETNA (ARGUS)
RXAETD
1/10/2017
TOLTERODINE TARTRATE 2 MG TAB
59762080002
AETNA (ARGUS)
RXAETD
1/10/2017
TOLTERODINE TARTRATE 2 MG TAB
59762080002
CATAMARAN
(blank)
3/3/2017
TOLTERODINE TARTRATE 2 MG TAB
59762080002
NMHC
(blank)
5/26/2017
TOPIRAMATE 100 MG TABLET
68462010910
NMHC
EGWPS032
1/20/2017
TOPIRAMATE 100 MG TABLET
68462010910
NAVITUS HEALTH SOLNS
83542
11/8/2016
TOPIRAMATE 25 MG TABLET
68462010810
OPTUMRX
ERSTX
2/17/2017
TRAMADOL ER 100 MG TABLET
10370022111
AETNA (ARGUS)
RXAETD
1/18/2017
TRAMADOL HCL ER 100 MG TABLET
68180069706
AETNA (ARGUS)
RXAETD
1/10/2017
TRAMADOL HCL ER 100 MG TABLET
68180069706
CAREMARK
UHSRX
2/17/2017
TRAMADOL HCL ER 100 MG TABLET
68180069706
OPTUMRX
02410073
11/16/2016
TRAMADOL HCL ER 100 MG TABLET
68180069706
OPTUMRX
ERSTX
2/13/2017
TRAMADOL HCL ER 200 MG TABLET
68180069806
OPTUMRX
ERSTX
2/13/2017
TRAMADOL HCL ER 300 MG TABLET
68180069906
CATAMARAN
00884800
2/3/2017
TRAMADOL HCL ER 300 MG TABLET
68180069906
OPTUMRX
02410073
1/17/2017
TRAMADOL HCL ER 300 MG TABLET
68180069906
OPTUMRX
LABCORP
1/9/2017
TRAMADOL-ACETAMINOPHN 37.5-325
53746061701
CATAMARAN
HTHSPRING
3/20/2017
TRANEXAMIC ACID 650 MG TABLET
00591372030
AETNA (ARGUS)
RXAETD
1/10/2017
TRANYLCYPROMINE SULF 10 MG TAB
00591559001
PRIME THERAPEUTICS
RXHRZN
1/13/2017
TRAZODONE 100 MG TABLET
50111043403
NMHC
EGWPS032
1/20/2017
TRAZODONE 100 MG TABLET
50111043402
AETNA (ARGUS)
RXAETD
1/18/2017
TRAZODONE 150 MG TABLET
50111044102
AETNA (ARGUS)
RXAETD
1/18/2017
TRAZODONE 150 MG TABLET
50111044102
EXPRESS SCRIPTS
180059D005
11/11/2016
TRAZODONE 150 MG TABLET
50111044102
CITIZENSRX LLC
1019
1/3/2017
TRAZODONE 150 MG TABLET
53489051701
PRIME THERAPEUTICS
HZRX
1/19/2017
TRAZODONE 300 MG TABLET
60505265901
AETNA (ARGUS)
RXAETD
1/10/2017
TRAZODONE 50 MG TABLET
50111043301
AETNA (ARGUS)
RXAETD
1/10/2017
TRETINOIN 0.01% GEL
66530025645
AETNA (ARGUS)
RXAETD
1/18/2017
TRETINOIN 0.01% GEL
66530025615
CATAMARAN
(blank)
4/28/2017
TRETINOIN 0.025% CREAM
00472011720
CATAMARAN
-
12/21/2016
TRETINOIN 0.025% CREAM
00472011720
OPTUMRX
(blank)
2/17/2017
TRETINOIN 0.025% CREAM
00472011720
PROCARE RX
63129500
11/30/2016
TRETINOIN 0.025% CREAM
00472011745
NPS
001
3/21/2017
TRETINOIN 0.05% CREAM
66530025445
CIGNA
N/A
12/21/2016
TRETINOIN 0.05% CREAM
66530025445
CATALYST (FUTURESCRIPTS)
(blank)
11/11/2016
TRETINOIN 0.05% GEL
66530026245
MERIDIANRX
QUICKEN
3/31/2017
TRETINOIN 0.1% CREAM
66530025545
AETNA (ARGUS)
RXAETD
1/10/2017
TRETINOIN 0.1% CREAM
66530025545
CATAMARAN
00600000
3/21/2017
TRETINOIN 0.1% CREAM
66530025545
CATAMARAN
00614866
1/9/2017
TRETINOIN 0.1% CREAM
66530025545
CIGNA
JTEKT
1/9/2017
TRETINOIN 0.1% CREAM
66530025545
PHS
38004001
4/28/2017
TRETINOIN 0.1% CREAM
43478024145
NPS
H5649001
3/29/2017
TRETINOIN 10 MG CAPSULE
00555080802
BCBS ALABAMA
76717000
12/27/2016
TRETINOIN GEL MICRO 0.1% TUBE
68682051384
AETNA (ARGUS)
RXAETD
1/18/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
TRIAMCINOLONE 0.1% CREAM
51672128202
CAREMARK
RX5707
11/16/2016
TRIAMCINOLONE 0.1% CREAM
51672128202
NAVITUS HEALTH SOLNS
70987
12/7/2016
TRIAMCINOLONE 0.1% OINTMENT
00713022880
OPTUMRX
ERSTX
2/13/2017
TRIAMCINOLONE 0.1% PASTE
51672126705
AETNA (ARGUS)
RXAETD
1/10/2017
TRIAMCINOLONE 0.1% PASTE
51672126705
CATAMARAN
00610001
1/9/2017
TRIAMCINOLONE 0.1% PASTE
64980032005
CATALYST
UVARX
2/7/2017
TRIAMCINOLONE 0.5% CREAM
45802006535
NMHC
GDYEAR
1/19/2017
TRIAMCINOLONE 0.5% CREAM
45802006535
PHS
-
4/6/2017
TRIAMCINOLONE 0.5% OINTMENT
68462079817
CITIZENSRX LLC
PNL100
4/19/2017
TRIAMTERENE-HCTZ 37.5-25 MG CP
00527163201
OPTUMRX
UHEALTH
10/31/2016
TRIAMTERENE-HCTZ 37.5-25 MG TB
68001021603
OPTUMRX
U0744260
2/13/2017
TRIAMTERENE-HCTZ 37.5-25 MG TB
68001021603
MERIDIANRX
(blank)
11/23/2016
TRIAMTERENE-HCTZ 37.5-25 MG TB
60505265605
BCBS ALABAMA
91061
1/27/2017
TRIAMTERENE-HCTZ 37.5-25 MG TB
68001021600
AETNA (ARGUS)
RXAETD
1/10/2017
TRIAMTERENE-HCTZ 50-25 MG CAP
00781271501
BENECARD PBF
10013
11/16/2016
TRIAMTERENE-HCTZ 50-25 MG CAP
00781271501
CATALYST (FUTURESCRIPTS)
(blank)
11/11/2016
TRIAZOLAM 0.125 MG TABLET
59762371704
CAREMARK
RX6155
3/29/2017
TRIAZOLAM 0.125 MG TABLET
59762371704
NPS
H0545001
11/14/2016
TRIAZOLAM 0.25 MG TABLET
59762371804
AETNA (ARGUS)
RXAETD
1/10/2017
TRIAZOLAM 0.25 MG TABLET
59762371804
OPTUMRX
PDPIND
12/2/2016
TRIAZOLAM 0.25 MG TABLET
59762371804
OPTUMRX
ERSTX
2/13/2017
TRIAZOLAM 0.25 MG TABLET
59762371804
PRIME THERAPEUTICS
(blank)
4/7/2017
TRIAZOLAM 0.25 MG TABLET
59762371803
AETNA (ARGUS)
RXAETD
4/11/2017
TRIAZOLAM 0.25 MG TABLET
59762371803
ARGUS
N/A
2/21/2017
TRIFLUOPERAZINE 10 MG TABLET
00781103601
CATAMARAN
-
3/30/2017
TRIFLUOPERAZINE 5 MG TABLET
00832049611
CATAMARAN
-
3/3/2017
TRIFLUOPERAZINE 5 MG TABLET
00832049611
MERIDIANRX
(blank)
4/13/2017
TRIFLURIDINE 1% EYE DROPS
61314004475
AETNA (ARGUS)
RXAETD
1/10/2017
TRIFLURIDINE 1% EYE DROPS
61314004475
NPS
H5649002
4/24/2017
TRIMETHOBENZAMIDE 300 MG CAP
43386066024
AETNA (ARGUS)
RXAETD
1/10/2017
TRINESSA TABLET
52544024828
AETNA (ARGUS)
RXAETD
1/10/2017
TRINESSA TABLET
52544024828
OPTUMRX
MET
3/24/2017
TROSPIUM CHLORIDE 20 MG TABLET
69097091203
MERIDIANRX
MIMEDICAID
2/16/2017
TROSPIUM CHLORIDE 20 MG TABLET
00574014560
AETNA (ARGUS)
RXAETD
1/10/2017
TROSPIUM CHLORIDE 20 MG TABLET
60505345406
CATAMARAN
(blank)
3/20/2017
TROSPIUM CHLORIDE ER 60 MG CAP
68001022804
AETNA (ARGUS)
RXAETD
1/10/2017
TROSPIUM CHLORIDE ER 60 MG CAP
68001022804
AETNA (ARGUS)
RXAETD
1/18/2017
UNITHROID 50 MCG TABLET
60846080201
OPTUMRX
COS
1/9/2017
UNITHROID 50 MCG TABLET
60846080201
PRIME THERAPEUTICS
(blank)
1/6/2017
UR N-C TABLET
51862017501
CAREMARK
RX2705
11/2/2016
UREA 39% CREAM
42792010108
OPTUMRX
01960240
2/17/2017
UREA 40% CREAM
54295030825
PRIME THERAPEUTICS
06706B0002
12/1/2016
UREA 40% CREAM
54295030825
WHI
213049
3/3/2017
URSODIOL 250 MG TABLET
68001022600
AETNA (ARGUS)
RXAETD
1/18/2017
URSODIOL 250 MG TABLET
68001022600
CAREMARK
RXCVSD
2/22/2017
URSODIOL 250 MG TABLET
68001022600
CIGNA
0192105
1/31/2017
URSODIOL 250 MG TABLET
00115152401
CATAMARAN
(blank)
4/6/2017
URSODIOL 300 MG CAPSULE
42806050301
AETNA (ARGUS)
RXAETD
1/10/2017
URSODIOL 300 MG CAPSULE
00527132601
CATAMARAN
(blank)
3/3/2017
URSODIOL 300 MG CAPSULE
00527132601
CATAMARAN
N/A
3/3/2017
URSODIOL 300 MG CAPSULE
00378173001
CATALYST
0992
4/25/2017
URSODIOL 300 MG CAPSULE
00378173001
CIGNA
3336620
5/3/2017
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
URSODIOL 300 MG CAPSULE
00378173001
OPTUMRX
PDPIND
5/2/2017
URSODIOL 500 MG TABLET
68001022700
CATAMARAN
(blank)
4/6/2017
URSODIOL 500 MG TABLET
68001022700
CATAMARAN
-
3/23/2017
VALACYCLOVIR HCL 1 GRAM TABLET
65862044930
OPTUMRX
ERSTX
2/13/2017
VALACYCLOVIR HCL 1 GRAM TABLET
65862044990
AETNA (ARGUS)
RXAETD
1/10/2017
VALACYCLOVIR HCL 500 MG TABLET
00378427577
CIGNA
0713607
2/3/2017
VALACYCLOVIR HCL 500 MG TABLET
65862044830
OPTUMRX
ERSTX
2/13/2017
VALACYCLOVIR HCL 500 MG TABLET
65862044890
AETNA (ARGUS)
RXAETD
1/10/2017
VALACYCLOVIR HCL 500 MG TABLET
65862044890
CATAMARAN
(blank)
3/21/2017
VALGANCICLOVIR 450 MG TABLET
68084096525
BCBS ALABAMA
(blank)
1/13/2017
VALGANCICLOVIR 450 MG TABLET
55111076260
AETNA (ARGUS)
RXAETD
1/10/2017
VALPROIC ACID 250 MG/5 ML SOLN
00121067516
AETNA (ARGUS)
RXAETD
1/10/2017
VALSARTAN 160 MG TABLET
51660014290
CIGNA
(blank)
1/25/2017
VALSARTAN 320 MG TABLET
51660014390
CATAMARAN
(blank)
3/20/2017
VALSARTAN 320 MG TABLET
00591217019
CATAMARAN
(blank)
3/20/2017
VALSARTAN-HCTZ 160-12.5 MG TAB
00591231619
CATAMARAN
(blank)
3/21/2017
VALSARTAN-HCTZ 320-25 MG TAB
00591231919
CATAMARAN
(blank)
5/18/2017
VALSARTAN-HCTZ 320-25 MG TAB
00591231919
CATAMARAN
3213484
1/25/2017
VANCOMYCIN 1 GM VIAL
00409653301
AETNA (ARGUS)
RXAETD
1/10/2017
VANCOMYCIN 1 GM VIAL
00409653301
CITIZENSRX LLC
LSYA
3/31/2017
VANCOMYCIN HCL 125 MG CAPSULE
47781072901
AETNA (ARGUS)
RXAETD
1/10/2017
VANCOMYCIN HCL 250 MG CAPSULE
66993021119
NMHC
CALPANTH
2/7/2017
VANCOMYCIN HCL 250 MG CAPSULE
68180016713
CATALYST
QCAQHP
3/8/2017
VANCOMYCIN HCL 250 MG CAPSULE
68180016713
RXWEST
RXW090
4/6/2017
VANCOMYCIN HCL 5 GM VIAL
25021015799
OPTUMRX
PDPIND
2/20/2017
VENLAFAXINE HCL 100 MG TABLET
68382010101
PRIME THERAPEUTICS
(blank)
12/16/2016
VENLAFAXINE HCL 37.5 MG TABLET
57664039388
OPTUMRX
UHEALTH
2/2/2017
VENLAFAXINE HCL 37.5 MG TABLET
68001015800
AETNA (ARGUS)
RXAETD
1/10/2017
VENLAFAXINE HCL 50 MG TABLET
68001015900
CATAMARAN
(blank)
3/23/2017
VENLAFAXINE HCL 50 MG TABLET
68001015900
OPTUMRX
PDPIND
2/7/2017
VENLAFAXINE HCL 75 MG TABLET
57664039588
MERIDIANRX
(blank)
10/31/2016
VENLAFAXINE HCL ER 150 MG TAB
00131326732
CATAMARAN
-
1/20/2017
VENLAFAXINE HCL ER 150 MG TAB
00131326732
OPTUMRX
PDPIND
3/3/2017
VENLAFAXINE HCL ER 150 MG TAB
00131326732
OPTUMRX
U0744260
2/13/2017
VENLAFAXINE HCL ER 150 MG TAB
13811071490
CATAMARAN
(blank)
3/30/2017
VENLAFAXINE HCL ER 225 MG TAB
00131326846
CAREMARK
RX6166
12/13/2016
VENLAFAXINE HCL ER 225 MG TAB
00131326832
OPTUMRX
PDPIND
2/14/2017
VENLAFAXINE HCL ER 225 MG TAB
13811071530
NPS
H0545001
4/24/2017
VENLAFAXINE HCL ER 37.5 MG CAP
00093738498
PRIME THERAPEUTICS
STMS
1/19/2017
VENLAFAXINE HCL ER 75 MG CAP
68382003516
OPTUMRX
U0744260
2/17/2017
VENLAFAXINE HCL ER 75 MG TAB
00131326646
CATAMARAN
GRXGN001
2/7/2017
VENTOLIN HFA 90 MCG INHALER
00173068220
MERIDIANRX
QUICKEN
2/10/2017
VERAPAMIL 360 MG CAP PELLET
00591288601
CIGNA
(blank)
2/3/2017
VERAPAMIL ER 120 MG CAPSULE
00378632001
AETNA (ARGUS)
RXAETD
1/10/2017
VERAPAMIL ER 120 MG CAPSULE
00378632001
AETNA (ARGUS)
RXAETD
3/14/2017
VERAPAMIL ER 120 MG CAPSULE
00378632001
RXWEST
22207691
12/16/2016
VERAPAMIL ER 240 MG TABLET
00093304501
AETNA (ARGUS)
RXAETD
1/10/2017
VERAPAMIL ER PM 200 MG CAPSULE
62175048637
AETNA (ARGUS)
RXAETD
1/10/2017
VERAPAMIL SR 180 MG CAPSULE
00591288201
AETNA (ARGUS)
RXAETD
2/14/2017
VERAPAMIL SR 180 MG CAPSULE
00591288201
CATAMARAN
(blank)
4/6/2017
VERAPAMIL SR 180 MG CAPSULE
00591288201
CATAMARAN
3340082
3/21/2017
VERAPAMIL SR 180 MG CAPSULE
00591288201
RXWEST
3D72012
12/23/2016
MAC Cases with Favorable Outcomes
Closed Cases From the Last 16 Weeks
March 2017 - June 2017
Press CTRL-F to Search
Favorable Cases by Month
700
600
500
400
300
592
200
221
170
Apr-17
May-17
100
23
0
Mar-17
Jun-17
Product Name
NDC
Payer Name
Group #
MAC Effective Date
VERAPAMIL SR 240 MG CAPSULE
00591288401
AETNA (ARGUS)
RXAETD
1/18/2017
VERAPAMIL SR 240 MG CAPSULE
00591288401
CATAMARAN
(blank)
3/20/2017
VESTURA 3 MG-0.02 MG TABLET
52544098231
CATAMARAN
3340218
2/3/2017
VESTURA 3 MG-0.02 MG TABLET
52544098231
CIGNA
3337519
2/7/2017
VESTURA 3 MG-0.02 MG TABLET
52544098231
PRIME THERAPEUTICS
107008
1/19/2017
VICODIN HP 10-300 MG TABLET
00074305413
AETNA (ARGUS)
RXAETD
5/16/2017
VIENVA-28 TABLET
00781557515
CATAMARAN
4006803
2/7/2017
VIENVA-28 TABLET
00781557515
CATAMARAN
4006803
3/21/2017
VIENVA-28 TABLET
00781557515
OPTUMRX
PDPIND
2/7/2017
VIORELE 28 DAY TABLET
68462031829
PRIME THERAPEUTICS
-
1/13/2017
VORICONAZOLE 200 MG TABLET
00093529056
AETNA (ARGUS)
RXAETD
1/10/2017
VORICONAZOLE 50 MG TABLET
00093528956
AETNA (ARGUS)
RXAETD
1/18/2017
WARFARIN SODIUM 1 MG TABLET
51672402703
CAREMARK
788257
11/15/2016
WARFARIN SODIUM 1 MG TABLET
51672402701
OPTUMRX
COS
1/9/2017
WARFARIN SODIUM 10 MG TABLET
51672403501
NMHC
(blank)
4/18/2017
WARFARIN SODIUM 3 MG TABLET
51672403003
AETNA (ARGUS)
RXAETD
1/10/2017
WARFARIN SODIUM 3 MG TABLET
00093171501
CATAMARAN
-
3/23/2017
WARFARIN SODIUM 4 MG TABLET
00093171601
AETNA (ARGUS)
RXAETD
1/10/2017
WARFARIN SODIUM 5 MG TABLET
51672403201
CAREMARK
788257
11/23/2016
XULANE PATCH
00378334053
CIGNA
3328569
11/4/2016
XYLON 10-200 MG TABLET
51021091090
AETNA (ARGUS)
RXAETD
3/29/2017
YUVAFEM 10 MCG VAGINAL INSERT
65162022621
PHS
(blank)
4/6/2017
YUVAFEM 10 MCG VAGINAL INSERT
65162022621
PHS
26500003
4/6/2017
ZAFIRLUKAST 20 MG TABLET
49884030402
AETNA (ARGUS)
RXAETD
1/10/2017
ZALEPLON 10 MG CAPSULE
00093526901
AETNA (ARGUS)
RXAETD
1/10/2017
ZALEPLON 10 MG CAPSULE
00093526901
CATALYST
QCA
4/6/2017
ZALEPLON 10 MG CAPSULE
00093526901
RXWEST
40192H
3/2/2017
ZARAH TABLET
51862003603
PRIME THERAPEUTICS
(blank)
1/13/2017
ZARAH TABLET
51862003603
PRIME THERAPEUTICS
96357
1/13/2017
ZARAH TABLET
51862003603
MAXOR PLUS
(blank)
4/17/2017
ZARAH TABLET
52544098131
AETNA (ARGUS)
RXAETD
1/10/2017
ZARAH TABLET
52544098131
PRIME THERAPEUTICS
(blank)
2/17/2017
ZENCHENT 0.4 MG-35 MCG TABLET
52544095328
CATAMARAN
00880800
1/25/2017
ZENCHENT 0.4 MG-35 MCG TABLET
52544095328
CATAMARAN
-
1/25/2017
ZENCHENT FE TABLET CHEWABLE
65162034784
RXWEST
326
5/15/2017
ZENCIA WASH
58980033690
OPTUMRX
DER
12/2/2016
ZIPRASIDONE HCL 20 MG CAPSULE
68001013606
OPTUMRX
(blank)
2/13/2017
ZIPRASIDONE HCL 20 MG CAPSULE
68001013606
RXAMERICA
RX8812
4/6/2017
ZIPRASIDONE HCL 20 MG CAPSULE
59762200101
OPTUMRX
PDPIND
5/31/2017
ZIPRASIDONE HCL 40 MG CAPSULE
68001013706
OPTUMRX
U0744260
2/13/2017
ZIPRASIDONE HCL 60 MG CAPSULE
59762200301
ARGUS
0271000
12/12/2016
ZIPRASIDONE HCL 60 MG CAPSULE
60505253006
HEALTHTRANS
BM2162
11/30/2016
ZIPRASIDONE HCL 60 MG CAPSULE
68001013806
NMHC
PURPRNCEM
1/6/2017
ZIPRASIDONE HCL 80 MG CAPSULE
68001013906
AETNA (ARGUS)
RXAETD
1/10/2017