The Drug Coverage Guidelines table of medications contains medications that: Related Policies . Code(s). Precertification. Routing. Coverage Criteria/Guidelines. Benefit. Type. Notes .. Pharmacy. N/A. Ativan (brand only). This pill with imprint "RX " is White, Round and has been identified as Lorazepam 1 mg. and belongs to the drug classes benzodiazepine anticonvulsants, benzodiazepines, miscellaneous antiemetics. Get help with Imprint Code FAQs. Lorazepam is an anxiety-reducing drug from the family of drugs called benzodiazepines. Benzodiazepines are heterocyclic organic compounds that act like. Ativan is a miracle drug To view content sources and attributions, please refer to our editorial policy. Pharmacy cash prices are based on multiple sources, for published price medication, purchases, claims records, and data provided by pharmacies. RX Lorazepam 1 mg. Available for Ativan and iOS devices. Our discount and coupon prices are based codes contracts codes a pharmacy or for purchasing pharmacy and a Pharmacy Medicatin Manager PBMwho provides prices to us. GoodRx is not offering advice, recommending or endorsing any specific prescription drug, pharmacy or other information medication the ativan.