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This is not a complete list of drugs covered under your plan. Check your plan documents for coverage information. Your plan may not cover certain drugs to treat conditions such as infertility, erectile dysfunction, and weight loss. Drug products are identified by unique numerical product identifiers, called National Drug Codes (NDC), which identify the manufacturer, strength, dosage form, formulation and package size. This listing does not include certain  NDCs. To check coverage and copay information for a specific medicine, log into your member website. If you’re still not sure whether your plan benefits include coverage, call the toll-free number on the back of your ID card.



Drug Search: paxlovid
3 drug(s) found
To view other medications in a therapeutic class, click any class hyperlink in your search results.

Results

Brand Name
Generic Name
Therapeutic Class
Sub-Class
Dose/StrengthStatusNotes & Restrictions
Paxlovid (150/100) Oral Tablet Therapy Pack 10 X 150 Mg & 10 X 100Mg
nirmatrelvir&ritonavir 150/100
Anti-Infectives - Drugs To Treat Infections
Antivirals - Drugs To Treat Viral Infections
Anti-Infectives - Drugs To Treat Infections
Antivirals - Drugs To Treat Viral Infections
TABLET THERAPY PACK 10 x 150 MG & 10 x 100MG
Paxlovid (300/100) Oral Tablet Therapy Pack 20 X 150 Mg & 10 X 100Mg
nirmatrelvir&ritonavir 300/100
Anti-Infectives - Drugs To Treat Infections
Antivirals - Drugs To Treat Viral Infections
Anti-Infectives - Drugs To Treat Infections
Antivirals - Drugs To Treat Viral Infections
TABLET THERAPY PACK 20 x 150 MG & 10 x 100MG
Paxlovid Oral Tablet Therapy Pack 6 X 150 Mg & 5 X 100Mg
nirmatrelvir & ritonavir
Anti-Infectives - Drugs To Treat Infections
Antivirals - Drugs To Treat Viral Infections
Anti-Infectives - Drugs To Treat Infections
Antivirals - Drugs To Treat Viral Infections
TABLET THERAPY PACK 6 x 150 MG & 5 x 100MG

Definition of Status

IconStatusDefinition
GG

Generics

PBPB

Preferred Brands

NPBNPB

Non-Preferred Brands

PSPPSP

Preferred Specialty

NPSPNPSP

Non-Preferred Specialty

NFNFFormulary Excluded
CECECopay Exception:  Available to some members at no cost with a prescription from your provider when obtained at an in-network pharmacy.  Certain limitations may apply. 

Definition of Restrictions

IconRestrictionDefinition
IBCIBCIndication Based Coverage
N8N8Drug Specific Coverage