Antihistamines and Combinations Page 1 of 2
Antihistamines and Combinations Page 1 of 2
Antihistamines and Combinations Page 1 of 2
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1 Alabama Medicaid Agency<br />
Cough <strong>and</strong> Cold Covered Products<br />
Therapeutic Listing<br />
Updated Quarterly<br />
Last Updated 09/19/06<br />
Br<strong>and</strong> Name/Generic Name GEN Code Description Strength Form Code Br<strong>and</strong> Name/Generic Name GEN Code Description Strength Form Code<br />
<strong>Antihistamines</strong> <strong>and</strong> <strong>Combinations</strong> <strong>Page</strong> 1 <strong>of</strong> 2<br />
12 HOUR COLD PSEUDOEPHEDRINE HCL 120MG TABLET SA NASAL DECONGESTANT PSEUDOEPHEDRINE HCL 120MG TABLET SA<br />
12 HOUR SINUS DECONGESTANT PSEUDOEPHEDRINE HCL 120MG TABLET SA NOHIST-EXT CHLOR-MAL/METHSCOPOLAMINE 8-2.5MG TAB.SR 12H<br />
AEROHIST PLUS CHLOR-MAL/PHENYLEPHRINE/SCO20-8-2.5MG TAB.SR 12H NOREL SR APAP/CP/P-TLOX/PHENYLEPHRINE40-325-8MG TAB.SR 12H<br />
AEROKID CHLOR-MAL/PHENYLEPHRINE/SCO10-4-1.25 SYRUP NOVAHISTINE CHLOR-MAL/PHENYLEPHRINE HCL5-2MG/5ML ELIXIR<br />
AH-CHEW CHLOR-MAL/PHENYLEPHRINE/SCO10-2-1.25 TAB CHEW OMNIHIST L.A. CHLOR-MAL/PHENYLEPHRINE/SCO20-8-2.5MG TAB.SR 12H<br />
AMDRY-C CHLOR-MAL/P-EPHED HCL/SCOP 120-8-2.5 TAB.SR 12H PCM CHLOR-MAL/PHENYLEPHRINE/SCO10-2-1.25 TAB CHEW<br />
AMDRY-D METHSCOPOLAMN/P-EPHED HCL 120-2.5MG TAB.SR 12H PCM ALLERGY CHLOR-MAL/PHENYLEPHRINE/SCO20-12-2.5 TAB.SR 12H<br />
APHEDRID P-EPHED HCL/TRIPROLIDINE HCL 30-1.25/5 SYRUP PCM LA CHLOR-MAL/P-EPHED HCL/SCOP 60-8-1.25 TAB.SR 12H<br />
APHEDRID P-EPHED HCL/TRIPROLIDINE HCL 60-2.5MG TABLET PEDIACARE PSEUDOEPHEDRINE HCL 9.4MG/ML DROPS<br />
BELLAHIST-D LA BELLAD ALK/CPMM/PHENYLEPHRI 20-8MG TAB.SR 12H PEDIATRIC DECONGESTANT PSEUDOEPHEDRINE HCL 9.4MG/ML DROPS<br />
BIOFED PSEUDOEPHEDRINE HCL 30MG/5ML SYRUP P-EPHED HCL/CHLOR-MAL/SCOP CHLOR-MAL/P-EPHED HCL/SCOP 120-8-2.5 TAB.SR 12H<br />
BIOFED-PE P-EPHED HCL/TRIPROLIDINE HCL 30-1.25/5 SYRUP PHENYLEPHRINE CM CHLOR-MAL/PHENYLEPHRINE/SCO40-8-2.5MG TAB.SR 12H<br />
BROMDEC CARBINOX MAL/P-EPHED HCL 15-1MG/ML DROPS PREHIST D CHLOR-MAL/PHENYLEPHRINE/SCO20-8-2.5MG TAB.SR 12H<br />
BROMTAPP PED DECONGESTANT PSEUDOEPHEDRINE HCL 9.4MG/ML DROPS PSE 120/MSC 2.5 METHSCOPOLAMN/P-EPHED HCL 120-2.5MG TAB.SR 12H<br />
CHILDREN'S NASAL DECONGESTAPSEUDOEPHEDRINE HCL 15MG/5ML LIQUID PSEUDAFEN PSEUDOEPHEDRINE HCL 30MG TABLET<br />
CHILDREN'S SILFEDRINE PSEUDOEPHEDRINE HCL 15MG/5ML LIQUID PSEUDAFEN PSEUDOEPHEDRINE HCL 60MG TABLET<br />
CHILDREN'S SUPHEDRIN PSEUDOEPHEDRINE HCL 15MG/5ML LIQUID PSEUDO CM CHLOR-MAL/P-EPHED HCL/SCOP 120-8-2.5 TAB.SR 12H<br />
CHLOR-MES D CHLOR-MAL/PHENYLEPHRINE/SCO10-2-0.625 SYRUP PSEUDOEPHEDRINE HCL PSEUDOEPHEDRINE HCL 30MG TABLET<br />
COLDAMINE CHLOR-MAL/P-EPHED HCL/SCOP 90-8-2.5MG TAB.SR 12H PSEUDOEPHEDRINE HCL PSEUDOEPHEDRINE HCL 60MG TABLET<br />
CONGESTACLEAR PSEUDOEPHEDRINE HCL 30MG TABLET PSEUDOEPHEDRINE HCL PSEUDOEPHEDRINE HCL 30MG/5ML SYRUP<br />
CPM 8/PE 20/MSC 1.25 CHLOR-MAL/PHENYLEPHRINE/SCO20-8-1.25 TAB.SR 12H PSEUDOGEST PSEUDOEPHEDRINE HCL 30MG/5ML SYRUP<br />
CPM 8/PSE 90/MSC 2.5 CHLOR-MAL/P-EPHED HCL/SCOP 90-8-2.5MG TAB.SR 12H PSEUDOTABS PSEUDOEPHEDRINE HCL 30MG TABLET<br />
DECONGESTANT P-EPHED HCL/TRIPROLIDINE HCL 60-2.5MG TABLET PSEUDOX M CARBINOX MAL/P-EPHED HCL/SCO15-2-1.25 SYRUP<br />
DECONGESTANT PSEUDOEPHEDRINE HCL 30MG TABLET PSEUPHEDRIN PSEUDOEPHEDRINE HCL 15MG/5ML LIQUID<br />
DECONGESTANT/ANTIHISTAMINE P-EPHED HCL/TRIPROLIDINE HCL 60-2.5MG TABLET QUAD TANN CAR-B-PEN TA/CP/EPHED TAN/PE 60-10-10-5 TABLET<br />
DEHISTINE CHLOR-MAL/PHENYLEPHRINE/SCO10-2-1.25 SOLUTION QUAD TANN PEDIATRIC CAR-B-PEN TA/CP/EPHED TAN/PE 30-5-5-4/5 ORAL SUSP<br />
DENAZE CHLOR-MAL/PHENYLEPHRINE/SCO10-4-1.25 SYRUP QUADTANN CAR-B-PEN TA/CP/EPHED TAN/PE 30-5-5-4/5 ORAL SUSP<br />
DIBROMM PSEUDOEPHEDRINE HCL 120MG TABLET SA QUAD-TUSS TANNATE CAR-B-PEN TA/CP/EPHED TAN/PE 30-5-5-4/5 ORAL SUSP<br />
DIMETAPP PSEUDOEPHEDRINE HCL 120MG TABLET SA QV-ALLERGY CHLOR-MAL/PHENYLEPHRINE/SCO10-2-0.625 SYRUP<br />
DIMETAPP DECONGESTANT PSEUDOEPHEDRINE HCL 9.4MG/ML DROPS RALIX CHLOR-MAL/PHENYLEPHRINE/SCO40-8-2.5MG TAB.SR 12H<br />
DRIHIST SR CHLOR-MAL/PHENYLEPHRINE/SCO20-8-2.5MG TAB.SR 12H RIDAFED PSEUDOEPHEDRINE HCL 30MG TABLET<br />
DURADRYL CHLOR-MAL/PHENYLEPHRINE/SCO10-2-1.25 SOLUTION RITIFED P-EPHED HCL/TRIPROLIDINE HCL 30-1.25/5 SYRUP<br />
EXTENDRYL SR CHLOR-MAL/PHENYLEPHRINE/SCO20-8-2.5MG TAB.SR 12H RU-TUSS BELL ALK/CHLOR-MAL/P-EPHED HC90-8-0.24 TAB.SR 12H<br />
GENAPHED PSEUDOEPHEDRINE HCL 30MG TABLET SB ANTIHISTAMINE P-EPHED HCL/TRIPROLIDINE HCL 60-2.5MG TABLET<br />
GILCHEW IR PHENYLEPHRINE HCL 10MG TAB CHEW SILAMINIC CHLOR-MAL/PPA HCL SYRUP<br />
HISTACOL LA BELLAD ALK/CPMM/PHENYLEPHRI 20-8MG TAB.SR 12H SINUS 12 HOUR PSEUDOEPHEDRINE HCL 120MG TABLET SA<br />
HISTADE MX CHLOR-MAL/P-EPHED HCL/SCOP 120-8-2.5 TAB.SR 12H STAHIST ATP/CPMM/HYOS/P-EPHED HCL/SC90-8-0.04 TAB.SR 12H<br />
HISTATAB PH CHLOR-MAL/PHENYLEPHRINE/SCO20-8-1.25 TAB.SR 12H SUDAFED PSEUDOEPHEDRINE HCL 30MG TABLET<br />
HISTA-VENT DA CHLOR-MAL/PHENYLEPHRINE/SCO20-8-2.5MG TAB.SR 12H SUDAFED PSEUDOEPHEDRINE HCL 120MG TABLET SA<br />
HISTA-VENT PSE CHLOR-MAL/P-EPHED HCL/SCOP 120-8-2.5 TAB.SR 12H SUDAFED PSEUDOEPHEDRINE HCL 240MG TAB.SR 24H<br />
KIDCARE PSEUDOEPHEDRINE HCL 9.4MG/ML DROPS SUDOGEST PSEUDOEPHEDRINE HCL 30MG TABLET<br />
LONG ACTING DECONGESTANT P-EPHED HCL/TRIPROLIDINE HCL 60-2.5MG TABLET SUDOGEST PSEUDOEPHEDRINE HCL 60MG TABLET<br />
MEDI-PHEDRINE PSEUDOEPHEDRINE HCL 120MG TABLET SA SUDOGEST CHILDREN'S PSEUDOEPHEDRINE HCL 30MG/5ML SYRUP<br />
MEDI-PHEDRINE PSEUDOEPHEDRINE HCL 30MG TABLET SUDOPHED PSEUDOEPHEDRINE HCL 30MG TABLET<br />
NACON CARBINOX MAL/P-EPHED HCL/SCO90-8-2.5MG TAB.SR 12H SUPHEDRIN PSEUDOEPHEDRINE HCL 30MG/5ML SYRUP<br />
NASAL & SINUS DECONGESTANT PSEUDOEPHEDRINE HCL 30MG TABLET SUPHEDRIN PSEUDOEPHEDRINE HCL 30MG TABLET
2 Alabama Medicaid Agency<br />
Cough <strong>and</strong> Cold Covered Products<br />
Therapeutic Listing<br />
Updated Quarterly<br />
Last Updated 09/19/06<br />
Br<strong>and</strong> Name/Generic Name GEN Code Description Strength Form Code Br<strong>and</strong> Name/Generic Name GEN Code Description Strength Form Code<br />
<strong>Antihistamines</strong> <strong>and</strong> <strong>Combinations</strong> <strong>Page</strong> 2 <strong>of</strong> 2<br />
SUPHEDRIN 12 HOUR PSEUDOEPHEDRINE HCL 120MG TABLET SA<br />
SUPHEDRINE PSEUDOEPHEDRINE HCL 30MG TABLET<br />
TANA R-12 PHENYLEPHRINE/PYRIL TAN 5-30MG/5MLORAL SUSP<br />
TANATAN RF CHLOR-TAN/PHENYLEPHRINE 5-4.5MG/5 ORAL SUSP<br />
TANAVAN PHENYLEPHRINE/PYRIL TAN 12.5-30/5 ORAL SUSP<br />
TETRA TANNATE CAR-B-PEN TA/CP/EPHED TAN/PE 30-5-5-4/5 ORAL SUSP<br />
TRI-FED P-EPHED HCL/TRIPROLIDINE HCL 60-2.5MG TABLET<br />
TRIPROLIDINE W/PSEUDOEPHEDRP-EPHED HCL/TRIPROLIDINE HCL 30-1.25/5 SYRUP<br />
TRIPROLIDINE W/PSEUDOEPHEDRP-EPHED HCL/TRIPROLIDINE HCL 60-2.5MG TABLET<br />
TRI-PSEUDATED P-EPHED HCL/TRIPROLIDINE HCL 60-2.5MG TABLET<br />
TRISUDEX P-EPHED HCL/TRIPROLIDINE HCL 60-2.5MG TABLET<br />
TYLENOL SIMPLY STUFFY PSEUDOEPHEDRINE HCL 15MG/5ML LIQUID<br />
TYLENOL SIMPLY STUFFY PSEUDOEPHEDRINE HCL 30MG TABLET<br />
UNIFED PSEUDOEPHEDRINE HCL 30MG/5ML SYRUP<br />
VALU-TAPP DECONGESTANT PSEUDOEPHEDRINE HCL 9.4MG/ML DROPS<br />
V-R PEDIA RELIEF PSEUDOEPHEDRINE HCL 9.4MG/ML DROPS<br />
WE ALLERGY CHLOR-MAL/PHENYLEPHRINE/SCO10-2-0.625 SYRUP<br />
XIRAL CHLOR-MAL/P-EPHED HCL/SCOP 120-8-2.5 TAB.SR 12H
3 Alabama Medicaid Agency<br />
Cough <strong>and</strong> Cold Covered Products<br />
Therapeutic Listing<br />
Updated Quarterly<br />
Last Updated 09/19/06<br />
Br<strong>and</strong> Name/Generic Name GEN Code Description Strength Form Code Br<strong>and</strong> Name/Generic Name GEN Code Description Strength Form Code<br />
Antitussives <strong>and</strong> <strong>Combinations</strong> <strong>Page</strong> 1 <strong>of</strong> 6<br />
ABER-TUSS HC CP/HYDROCODONE/PHENYLEPHR 10-2.5-2/5 SYRUP CANGES-HC BPM/HYDROCODONE/PHENYLEPH7.5-2.5-2 LIQUID<br />
A-DEX DM D-CP/D-METHORP TAN/P-EPD TAN 25-75-2.5 ORAL SUSP CANGES-HC NR BPM/HYDROCODONE/PHENYLEPH7.5-2.5-4 SOLUTION<br />
ALLANHIST PDX BPM/D-METHORPHAN HB/GUAIFEN50-5-5-2/5 SYRUP CANGES-XP GUAIFENESIN/HYDROCODONE BIT150-5MG/5 LIQUID<br />
ALLANHIST PDX BPM/D-METHORPHAN HB/P-EPD H 3-12.5-1/1 DROPS CARB PSE 12 DM CARBINOX/DM TAN/P-EPD TAN 45.2-3.2/5 ORAL SUSP<br />
ALLANVAN-DM DM TAN/PE TAN/PYRILAMINE TANN25-12.5-30 ORAL SUSP CARB PSEUDO-TAN CAR-B-PEN TA/P-EPD TAN 25-75MG/5 ORAL SUSP<br />
ALTARUSSIN DM D-METHORPHAN HB/GUAIFENESIN100-10/5ML SYRUP CARBAXEFED DM RF CARBINOX/DM HB/P-EPHED HCL 4-15-1MG/1 DROPS<br />
AMBI 1000/55 D-METHORPHAN HB/GUAIFENESIN1000-55MG TAB.SR 12H CARBODEX DM CARBINOX/DM HB/P-EPHED HCL 4-15-1MG/1 DROPS<br />
AMBI 45/800/30 DM HB/GUAIFEN/P-EPHEDRINE 800-30-45 TAB.SR 12H CARBODEX DM BPM/D-METHORPHAN HB/P-EPD H 15-45-4/5 SYRUP<br />
AMBI 60/1000/30 DM HB/GUAIFEN/P-EPHEDRINE 1000-30-60 TAB.SR 12H CAR-B-PEN TA/CHLOR-TAN CAR-B-PEN TA/CHLOR-TAN 60-5MG TABLET<br />
AMBI 60/580/30 DM HB/GUAIFEN/P-EPHEDRINE 580-30-60 TAB.SR 12H CARB-PHENYL-12 CAR-B-PEN TA/PHENYLEPHRINE 30-30MG/5 ORAL SUSP<br />
AMBI 80/700/40 DM HB/GUAIFEN/P-EPHEDRINE 700-40-80 TAB.SR 12H CARDEC DM BPM/D-METHORPHAN HB/P-EPD H 15-45-4/5 SYRUP<br />
AMERITUSSIN DM D-METHORPHAN HB/GUAIFENESIN100-10/5ML SYRUP CERON-DM CHLORPHENIR/D-METHORPHAN H 15-12.5-4 SYRUP<br />
AMIBID DM D-METHORPHAN HB/GUAIFENESIN600-30MG TAB.SR 12H CERON-DM CHLORPHENIR/D-METHORPHAN H 3-3.5-1/ML DROPS<br />
ANAPLEX DMX BPM/D-METHORP TAN/P-EPD TAN 60-90-8/5 ORAL SUSP CHERACOL D D-METHORPHAN HB/GUAIFENESIN100-10MG/5 LIQUID<br />
ANDEHIST DM BPM/D-METHORPHAN HB/P-EPD H 15-60-4/5 SYRUP CHERATUSSIN DAC COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP<br />
ANDEHIST-DM CARBINOX/DM HB/P-EPHED HCL 4-15-1MG/1 DROPS CLEARTUSS DH GUAIFENESIN/HYDROCOD BIT 100-5/5ML SYRUP<br />
ANTITUSSIVE/DECONGESTANT COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP CODAFED COD/GUAIFENESIN/P-EPHED HCL 100-30-10 SYRUP<br />
ANTITUSSIVE/DECONGESTANT COD/GUAIFENESIN/P-EPHED HCL 20MG SYRUP CODAFED COD/GUAIFENESIN/P-EPHED HCL 200-60-20 SYRUP<br />
AQUABID-DM D-METHORPHAN HB/GUAIFENESIN600-30MG TAB.SR 12H CODAL-DH HYDROCODONE/PHENYLEPHRINE 5-1.66MG/5 SYRUP<br />
BENYLIN DEXTROMETHORPHAN HBR 7.5MG/5ML SYRUP CODAL-DM D-METHORPHAN HB/PE/PYRIL 10-5-8.33 SYRUP<br />
BENYLIN D-METHORPHAN HB/GUAIFENESIN100-5MG/5 SYRUP CODICLEAR DH GUAIFENESIN/HYDROCODONE BIT100-3.5/5 SYRUP<br />
BENZONATATE BENZONATATE 100MG CAPSULE CODITUSS DH HYDROCODONE/PHENYLEPHRINE 5-1.66MG/5 SYRUP<br />
BENZONATATE BENZONATATE 200MG CAPSULE COFEX-DM D-METHORPHAN HB/GUAIFENESIN1000-55MG TAB.SR 12H<br />
BETATAN BPM/CAR-B-PEN TA/PHENYLEPHR 30-7.5-4/5 ORAL SUSP CO-HISTINE COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP<br />
BIODEC-DM CARBINOX/DM HB/P-EPHED HCL DROPS COLDCOUGH CP/DHCODEINE BT/P-EPHED HCL 15-7.5-2/5 SYRUP<br />
BIOTUSS-DM D-METHORPHAN HB/GUAIFENESIN100-15/5ML SYRUP COLDCOUGH HC CP/HYDROCODONE/P-EPHED HCL 15-3-2/5 LIQUID<br />
BIOTUSSIN AC CODEINE PHOSPHATE/GUAIFENES SYRUP COLDCOUGH HCM HYDROCODONE BIT/P-EPHED HCL15-3MG/5MLSYRUP<br />
BIOTUSSIN DAC COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP COLDCOUGH PD CP/DHCODEINE BT/PHENYLEPHRI 7.5-3-2/5 SYRUP<br />
BPM PE HC BPM/HYDROCODONE/PHENYLEPH7.5-2.5-4 SOLUTION COLDEC DM BPM/D-METHORPHAN HB/P-EPD H 15-45-4/5 SYRUP<br />
BROM TANN-DM TANN-PSE TANN BPM/D-METHORP TAN/P-EPD TAN 60-90-8/5 ORAL SUSP COLDMIST DM DM HB/GUAIFEN/P-EPHEDRINE 595-32-48 TAB.SR 12H<br />
BROMANATE DX BPM/D-METHORPHAN HB/P-EPD H 10-30-2/5 SYRUP COLDMIST DM DM HB/GUAIFEN/P-EPHEDRINE 100-15-40 SYRUP<br />
BROMATAN-DM BR-PHENIR/D-METHORP TAN/PE 20-20-8/5 ORAL SUSP COLDTUSS-DR CHLORPHENIR/D-METHORPHAN H 15-6-2MG/5 SYRUP<br />
BROMATANE DX BPM/D-METHORPHAN HB/P-EPD H 10-30-2/5 SYRUP CONDASIN GUAIFENESIN/HYDROCODONE BIT100-3.5/5 SYRUP<br />
BROMAXEFED DM RF BPM/D-METHORPHAN HB/P-EPD H 15-45-4/5 SYRUP CORDRON-12 DM CARBINOX/DM TAN/P-EPD TAN 45.2-3.6/5 ORAL SUSP<br />
BROMCOMP HC BPM/HYDROCODONE/P-EPHED HC30-2.5-3/5 SYRUP CORDRON-DM CARBINOX/DM HB/P-EPHED HCL 15-15-3/5 LIQUID<br />
BROMDEC DM CARBINOX/DM HB/P-EPHED HCL 4-15-1/ML DROPS CORDRON-DM NR CARBINOX/DM HB/P-EPHED HCL 15-12.5-3 LIQUID<br />
BROMETANE DX BPM/D-METHORPHAN HB/P-EPD H 10-30-2/5 SYRUP CORDRON-HC CP/HYDROCODONE/P-EPHED HCL 20-1.67/5 LIQUID<br />
BROMHIST PDX BPM/D-METHORPHAN HB/P-EPD H 3-12.5-1/1 DROPS CORDRON-HC NR CP/HYDROCODONE/P-EPHED HCL 17.5-1.67 LIQUID<br />
BROMHIST-DM BPM/D-METHORPHAN HB/P-EPD H 4-15-1MG/1 DROPS CORFEN-DM CHLORPHENIR/D-METHORPHAN H 15-10-4/5 SOLUTION<br />
BROMOPHED DX BPM/D-METHORPHAN HB/P-EPD H 10-30-2/5 SYRUP COTUSS EX HYDROCODONE BIT/POT GUAIACO120-2.5/5 SYRUP<br />
BROMPHENEX DM BPM/D-METHORPHAN HB/P-EPD H 30-60-4/5 SYRUP COTUSS HD CP/HYDROCODONE/PHENYLEPHR 10-2.5-4 SYRUP<br />
BROMPHENEX HD BPM/HYDROCODONE/P-EPHED HC30-1.7-2/5 SOLUTION COTUSS MS CP/HYDROCODONE/PHENYLEPHR 10-5-2MG/5 SYRUP<br />
BROMPHENIRAMINE-HYDROCOD-PBPM/HYDROCODONE/P-EPHED HC30-2.5-3/5 SYRUP COTUSS-V GUAIFENESIN/HYDROCODONE BIT100-5MG/5 SYRUP<br />
BROMPLEX DM BPM/D-METHORPHAN HB/P-EPD H 30-60-4/5 SYRUP COUGH & COLD CHLOR-MAL/DEXTROMETHORPHA 30-4MG TABLET<br />
BROMPLEX HD BPM/HYDROCODONE/P-EPHED HC30-1.7-2/5 SOLUTION COUGH CONTROL DM D-METHORPHAN HB/GUAIFENESIN100-10/5ML SYRUP<br />
BROMTUSS DM BR-PHENIR/D-METHORPHAN HB/P 15-7.5-2/5 LIQUID COUGH-EX D-METHORPHAN HB/GUAIFENESIN200-15MG TABLET
4 Alabama Medicaid Agency<br />
Cough <strong>and</strong> Cold Covered Products<br />
Therapeutic Listing<br />
Updated Quarterly<br />
Last Updated 09/19/06<br />
Br<strong>and</strong> Name/Generic Name GEN Code Description Strength Form Code Br<strong>and</strong> Name/Generic Name GEN Code Description Strength Form Code<br />
Antitussives <strong>and</strong> <strong>Combinations</strong> <strong>Page</strong> 2 <strong>of</strong> 6<br />
COUGHTUSS<br />
CP/HYDROCODONE/PHENYLEPHR 5-5-2MG/5 LIQUID<br />
CP DEC-DM CHLORPHENIR/D-METHORPHAN H 15-12.5-4 SYRUP DUR-TANN DM BR-PHENIR/D-METHORP TAN/PE 20-20-8/5 ORAL SUSP<br />
CP DEC-DM CHLORPHENIR/D-METHORPHAN H 3-3.5-1/ML DROPS DYNATUSS CARBINOX/DM HB/P-EPHED HCL 15-60-4/5 SYRUP<br />
C-PHED DPD TANNATE D-CP/D-METHORP TAN/P-EPD TAN 25-75-2.5 ORAL SUSP ED TUSS HC CP/HYDROCODONE/PHENYLEPHR 10-2.5-4 SYRUP<br />
C-PHEN DM CHLORPHENIR/D-METHORPHAN H 3-3.5-1/ML DROPS ED-A-HIST DM CHLORPHENIR/D-METHORPHAN H 15-10-4/5 SOLUTION<br />
C-PHEN DM CHLORPHENIR/D-METHORPHAN H 15-12.5-4 SYRUP ED-DM CHLORPHENIR/D-METHORPHAN H 30-30-4MG TAB CHEW<br />
C-TANNA 12 CAR-B-PEN TA/CHLOR-TAN 30-4MG/5MLORAL SUSP ED-TLC CP/HYDROCODONE/PHENYLEPHR 5-1.67-2/5 SYRUP<br />
C-TANNA 12D CAR-B-PEN TA/PHENYLEPHRINE/P 30-5-30/5 ORAL SUSP EFASIN HD PLUS CP/HYDROCODONE/PHENYLEPHR 5-2.5-2 SYRUP<br />
CYCOFED COD/GUAIFENESIN/P-EPHED HCL 20MG SYRUP ENDACOF GUAIFENESIN/HYDROCODONE BIT300-2.5MG TABLET<br />
CYCOFED COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP ENDACOF-DM BPM/D-METHORPHAN HB/P-EPD H 30-60-4/5 SYRUP<br />
CYTUSS HC CP/HYDROCODONE/PHENYLEPHR 5-2.5-2 SYRUP ENDACOF-HC BPM/HYDROCODONE/P-EPHED HC30-1.7-2/5 SOLUTION<br />
DACEX-A CARBINOX/D-METHORPHAN HB/PE2-2-1MG/ML DROPS ENDACOF-PD BPM/D-METHORPHAN HB/P-EPD H 3-12.5-1/1 DROPS<br />
DECAHIST-DM CARBINOX/DM HB/P-EPHED HCL 15-15-2/5 SYRUP ENDACOF-PLUS D-CP/HYDROCODONE/PHENYLEPH5-4-2MG/5 LIQUID<br />
DEC-CHLORPHEN DM CHLORPHENIR/D-METHORPHAN H 15-12.5-4 SYRUP ENDACOF-XP GUAIFENESIN/HYDROCODONE BIT200-2.5/5 SYRUP<br />
DEC-CHLORPHEN DM CHLORPHENIR/D-METHORPHAN H 3-3.5-1/ML DROPS ENDAGEN-HD CP/HYDROCODONE/PHENYLEPHR 5-1.67-2/5 SYRUP<br />
DE-CHLOR DM CHLORPHENIR/D-METHORPHAN H 15-10-2/5 SYRUP ENPLUS-HD CP/HYDROCODONE/PHENYLEPHR 5-2.5-2 SYRUP<br />
DE-CHLOR DR CHLORPHENIR/D-METHORPHAN H 15-6-2MG/5 SYRUP ENTAB-DM D-METHORPHAN HB/GUAIFENESIN1200-60MG TAB.SR 12H<br />
DE-CHLOR HC CP/HYDROCODONE/PHENYLEPHR 10-2.5-2/5 SYRUP ENTUSS GUAIFENESIN/HYDROCODONE BIT300MG-5MGTABLET<br />
DE-CHLOR HD CP/HYDROCODONE/PHENYLEPHR 10-2.5-4 SYRUP ENTUSS HYDROCODONE BIT/POT GUAIACO300-5MG/5 SOLUTION<br />
DE-CHLOR MR HYDROCODONE/PHENYLEPHRINE 5-5-5MG/5 SYRUP ENTUSS-D GUAIFENESIN/HCOD/P-EPHED HCL300-30-5 TABLET<br />
DE-CHLOR NX HYDROCODONE BIT/POT GUAIACO150-3MG/5 SYRUP ENTUSS-D GUAIFENESIN/HCOD/P-EPHED HCL100-30-2.5 SOLUTION<br />
DECOHISTINE COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP EXECLEAR GUAIFENESIN/HYDROCODONE BIT100-3.5/5 SYRUP<br />
DECONAMINE CX GUAIFENESIN/HCOD/P-EPHED HCL300-30-5 TABLET EXECOF-XP GUAIFENESIN/HYDROCODONE BIT90-3MG/5MLSYRUP<br />
DECONAMINE CX GUAIFENESIN/HCOD/P-EPHED HCL200-60-5 EXPECT. EXEFEN-DM D-METHORPHAN HB/GUAIFENESIN1000-55MG TAB.SR 12H<br />
DELSYM DEXTROMETHORPHAN POLISTIRE30MG/5ML SUS.12H SR EXPECTORANT DM D-METHORPHAN HB/GUAIFENESIN100-10/5ML SYRUP<br />
DETUSS CP/HYDROCODONE/P-EPHED HCL 30-5-2MG/5 LIQUID EXPECTORANT DM CLEAR D-METHORPHAN HB/GUAIFENESIN100-10/5ML SYRUP<br />
DETUSSIN HYDROCODONE BIT/P-EPHED HCL60-5MG/5MLSOLUTION EXRATUSS CAR-B-PEN TA/CP/PHENYLEPHRIN30-12.5-4 ORAL SUSP<br />
DEX PC CHLORPHENIR/D-METHORPHAN H 15-6-2MG/5 SYRUP EXTRA STRENGTH COUGH CHLOR-MAL/DEXTROMETHORPHA LIQUID<br />
DIABETIC FORMULA D-METHORPHAN HB/GUAIFENESIN100-10/5ML SYRUP EXTUSS LA D-METHORPHAN HB/GUAIFENESIN650-30MG TAB.SR 12H<br />
DIABETIC TUSSIN DM D-METHORPHAN HB/GUAIFENESIN100-10/5ML SYRUP FLUTUSS HC BPM/HYDROCODONE/PHENYLEPH7.5-2.5-2 LIQUID<br />
DIABETIC TUSSIN MAX-STRENGTHD-METHORPHAN HB/GUAIFENESIN200-10MG/5 LIQUID FLUTUSS HC BPM/HYDROCODONE/PHENYLEPH7.5-2.5-4 SOLUTION<br />
DIHISTINE COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP GANI-TUSS NR CODEINE PHOS/GUAIFENESIN 100-10MG/5 LIQUID<br />
DIHYDRO-CP CP/DHCODEINE BT/P-EPHED HCL 15-7.5-2/5 SYRUP GANI-TUSS-DM NR D-METHORPHAN HB/GUAIFENESIN100-10MG/5 LIQUID<br />
DIMETAPP D-METHORPHAN HB/P-EPHED HCL7.5-15MG/5 SYRUP G-BID DM D-METHORPHAN HB/GUAIFENESIN1200-60MG TAB.SR 12H<br />
DM D-METHORPHAN HB/GUAIFENESIN600-30MG TAB.SR 12H GENATUSS DM D-METHORPHAN HB/GUAIFENESIN100-10/5ML SYRUP<br />
D-METHORPHAN HB/PE/CP CHLORPHENIR/D-METHORPHAN H 15-10-4/5 SOLUTION GENECOF-HC CP/HYDROCODONE/P-EPHED HCL 15-2.5-2/5 LIQUID<br />
D-METHORPHAN HB/PE/CPM LIQ CHLORPHENIR/D-METHORPHAN H 15-10-2/5 SYRUP GESTUSS-HC DPHA/HYDROCODONE/PHENYLEP 5-3.5-12.5 SYRUP<br />
DONATUSSIN DM CHLORPHENIR/D-METHORPHAN H 3-1.5-1/ML DROPS GFN 1000/DM 50 D-METHORPHAN HB/GUAIFENESIN1000-50MG TAB.SR 12H<br />
DOUBLE-TUSSIN DM D-METHORPHAN HB/GUAIFENESIN200-30/5ML LIQUID GFN 1000/DM 60 D-METHORPHAN HB/GUAIFENESIN1000-60MG TAB.SR 12H<br />
DRITUSS DM D-METHORPHAN HB/GUAIFENESIN200-20/5ML ELIXIR GFN 1200/DM 60 D-METHORPHAN HB/GUAIFENESIN1200-60MG TAB.SR 12H<br />
DRITUSS HD GUAIFENESIN/HCOD/P-EPHED HCL100-30-2.5 ELIXIR GFN 500/DM 30 D-METHORPHAN HB/GUAIFENESIN500-30MG TAB.SR 12H<br />
DROCON-CS BPM/HYDROCODONE/P-EPHED HC30-2.5-2/5 SYRUP GFN 550/PSE 60/DM 30 DM HB/GUAIFEN/P-EPHEDRINE 550-30-60 TAB.SR 12H<br />
DROTUSS CP/GUAIFEN/HCOD/P-EPHED HCL 15-2.5-2/5 LIQUID GFN 595/PSE 48/DM 32 TAB DM HB/GUAIFEN/P-EPHEDRINE 595-32-48 TAB.SR 12H<br />
DROTUSS-CP CP/HYDROCODONE/PHENYLEPHR 5-5-2MG/5 LIQUID GFN 800/DM 30 D-METHORPHAN HB/GUAIFENESIN800MG-30M TAB.SR 12H<br />
D-TANN CT CAR-B-PEN TA/DP-HYDRAMINE/PE 30-7.5-25 ORAL SUSP GFN 800/PSE 60/DM 30 DM HB/GUAIFEN/P-EPHEDRINE 800-30-60 TAB.SR 12H<br />
D-TANN HC DPHA/HCOD TAN/PHENYLEPHRINE7.5-3.5-25 ORAL SUSP GFN600/PSE60/DM30 DM HB/GUAIFEN/P-EPHEDRINE 600-30-60 TAB.SR 12H
5 Alabama Medicaid Agency<br />
Cough <strong>and</strong> Cold Covered Products<br />
Therapeutic Listing<br />
Updated Quarterly<br />
Last Updated 09/19/06<br />
Br<strong>and</strong> Name/Generic Name GEN Code Description Strength Form Code Br<strong>and</strong> Name/Generic Name GEN Code Description Strength Form Code<br />
Antitussives <strong>and</strong> <strong>Combinations</strong> <strong>Page</strong> 3 <strong>of</strong> 6<br />
GFN-DM-PSE DM HB/GUAIFEN/P-EPHEDRINE 1200-60-60 TAB.SR 12H HISTINEX HC CP/HYDROCODONE/PHENYLEPHR 5-2.5-2 SYRUP<br />
GUA C CODEINE PHOSPHATE/GUAIFENES SYRUP HISTINEX PV CP/HYDROCODONE/P-EPHED HCL 30-2.5-2/5 SYRUP<br />
GUA PC COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP HIST-PLUS CP/HYDROCODONE/PHENYLEPHR 5-2.5-2 SYRUP<br />
GUAIASORB D-METHORPHAN HB/GUAIFENESIN100-10/5ML SYRUP HISTUSSIN D HYDROCODONE BIT/P-EPHED HCL60-5MG/5MLSOLUTION<br />
GUAIATUSSIN-DM D-METHORPHAN HB/GUAIFENESIN100-10/5ML SYRUP HISTUSSIN HC CP/HYDROCODONE/PHENYLEPHR 5-2.5-2 SYRUP<br />
GUAIFEN/DM HB/P-EPHEDRINE DM HB/GUAIFEN/P-EPHEDRINE 595-32-48 TAB.SR 12H HOLD DEXTROMETHORPHAN HBR 5MG LOZENGE<br />
GUAIFEN-C CODEINE PHOSPHATE/GUAIFENES150-5/10ML LIQUID HONEY TUSSIN COUGH DEXTROMETHORPHAN HBR 10MG/5ML SYRUP<br />
GUAIFEN-DEXTROM-PSEUDOEPHEDM HB/GUAIFEN/P-EPHEDRINE 800-60-90 TAB.SR 12H HT-TUSS DM D-METHORPHAN HB/GUAIFENESIN200-20/5ML ELIXIR<br />
GUAIFEN-DEXTROM-PSEUDOEPHEDM HB/GUAIFEN/P-EPHEDRINE 800-60-90 TAB.SR 12H HYDEX PD D-CP/HYDROCODONE/PHENYLEPH5-4-2MG/5 LIQUID<br />
GUAIFEN-DEXTRO-PSEUDO DM HB/GUAIFEN/P-EPHEDRINE 100-15-40 SYRUP HYDONE HYDROCODONE BIT/POT GUAIACO300-5MG/5 SOLUTION<br />
GUAIFENESIN AC CODEINE PHOSPHATE/GUAIFENES SYRUP HYDRO PC II CP/HYDROCODONE/PHENYLEPHR 7.5-2-2/5 SYRUP<br />
GUAIFENESIN DAC COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP HYDRO PRO DM DM HB/GUAIFEN/P-EPHEDRINE 600-30-60 TAB.SR 12H<br />
GUAIFENESIN DM D-METHORPHAN HB/GUAIFENESIN100-10MG/5 LIQUID HYDROCOD BIT/PHENYLEPHRINECP/HYDROCODONE/PHENYLEPHR 10-2.5-4 SYRUP<br />
GUAIFENESIN DM D-METHORPHAN HB/GUAIFENESIN600-30MG TAB.SR 12H HYDROCODONE BIT-GUAIFENES GUAIFENESIN/HYDROCODONE BIT100-3.5/5 SYRUP<br />
GUAIFENESIN DM D-METHORPHAN HB/GUAIFENESIN1000-60MG TAB.SR 12H HYDROCODONE BT/HOMATROPI HOMATROPINE/HYDROCODONE B 5-1.5MG TABLET<br />
GUAIFENESIN DM NR D-METHORPHAN HB/GUAIFENESIN100-10/5ML LIQUID HYDROCODONE COMPOUND HOMATROPINE/HYDROCODONE B 5-1.5MG/5 SYRUP<br />
GUAIFENESIN W/CODEINE CODEINE PHOS/GUAIFENESIN 100-10MG/5 LIQUID HYDROCODONE CP CP/HYDROCODONE/PHENYLEPHR 5-2.5-2 SYRUP<br />
GUAIFENESIN W/DEXTROMETHORD-METHORPHAN HB/GUAIFENESIN600-30MG TAB.SR 12H HYDROCODONE GF GUAIFENESIN/HYDROCODONE BIT100-5MG/5 SYRUP<br />
GUAIFENESIN W/DEXTROMETHORD-METHORPHAN HB/GUAIFENESIN100-10/5ML LIQUID HYDROCODONE HD CP/HYDROCODONE/PHENYLEPHR 5-1.67-2/5 SYRUP<br />
GUAIFENESIN W/DM D-METHORPHAN HB/GUAIFENESIN100-10/5ML SYRUP HYDROCODONE W/GUAIFENESINGUAIFENESIN/HYDROCOD BIT 100-5/5ML SYRUP<br />
GUAIFENESIN/CODEINE PHOSPHACODEINE PHOSPHATE/GUAIFENES300-10MG TABLET HYDROCODONE/PHENYLEPHRINCP/HYDROCODONE/PHENYLEPHR 5-1.67-2 SYRUP<br />
GUAIFENESIN/DEXTROMETHORPHD-METHORPHAN HB/GUAIFENESIN600-30MG TAB.SR 12H HYDRO-DP DPHA/HYDROCODONE/PHENYLEP 7.5-2-12.5 SYRUP<br />
GUAIFENESIN/D-METHORPHAN D-METHORPHAN HB/GUAIFENESIN1200-60MG TAB.SR 12H HYDROMET HOMATROPINE/HYDROCODONE B 5-1.5MG/5 SYRUP<br />
GUAIFENESIN/D-METHORPHAN HBD-METHORPHAN HB/GUAIFENESIN1000-60MG TAB.SR 12H HYDRON CP CP/HYDROCODONE/PHENYLEPHR 10-5-2MG/5 SYRUP<br />
GUAIFENESIN/P-EPHEDRINE/COD COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP HYDRON EX HYDROCODONE BIT/POT GUAIACO120-2.5/5 SYRUP<br />
GUAIFENESIN-CODEINE CODEINE PHOS/GUAIFENESIN 100-10MG/5 SYRUP HYDRON KGS HYDROCODONE BIT/POT GUAIACO300-5MG/5 SYRUP<br />
GUAIFENESIN-DEXTROMETHORPHD-METHORPHAN HB/GUAIFENESIN1200-20MG TAB.SR 12H HYDRON PSC CP/HYDROCODONE/P-EPHED HCL 30-5-2MG/5 LIQUID<br />
GUAIFENESIN-DEXTROMETHORPHD-METHORPHAN HB/GUAIFENESIN1200-60MG TAB.SR 12H HYDRO-PC II PLUS CP/HYDROCODONE/PHENYLEPHR 7.5-3.5-2 SYRUP<br />
GUAIFENESIN-DM D-METHORPHAN HB/GUAIFENESIN100-10/5ML SYRUP HYDROPHENE DH HYDROCODONE/PHENYLEPHRINE 5-1.66MG/5 SYRUP<br />
GUAIFENESIN-DM NR D-METHORPHAN HB/GUAIFENESIN100-10MG/5 LIQUID HYDRO-TUSS GUAIFENESIN/HYDROCODONE BIT100-5MG/5 SYRUP<br />
GUAIFENEX DM D-METHORPHAN HB/GUAIFENESIN600-30MG TAB.SR 12H HYDRO-TUSSIN DHC CP/DHCODEINE BT/P-EPHED HCL 15-7.5-2/5 SYRUP<br />
GUAI-PSE-DM DM HB/GUAIFEN/P-EPHEDRINE 800-30-60 TAB.SR 12H HYDRO-TUSSIN DM D-METHORPHAN HB/GUAIFENESIN200-20/5ML ELIXIR<br />
GUAL-CO CODEINE PHOS/GUAIFENESIN 100-10MG/5 LIQUID HYDRO-TUSSIN HC CP/HYDROCODONE/P-EPHED HCL 15-3-2/5 LIQUID<br />
GUAL-DEX D-METHORPHAN HB/GUAIFENESIN100-10MG/5 LIQUID HYDRO-TUSSIN HD GUAIFENESIN/HCOD/P-EPHED HCL100-30-2.5 SOLUTION<br />
GUIA-D D-METHORPHAN HB/GUAIFENESIN1000-60MG TAB.SR 12H HYDRO-TUSSIN HG GUAIFENESIN/HYDROCODONE BIT100-3.5/5 SYRUP<br />
GUIATUSS AC CODEINE PHOS/GUAIFENESIN 100-10MG/5 SYRUP HYDRO-TUSSIN XP GUAIFENESIN/HCOD/P-EPHED HCL100-15-3/5 LIQUID<br />
GUIATUSS CLEAR DM D-METHORPHAN HB/GUAIFENESIN100-10/5ML SYRUP HY-KXP HYDROCODONE BIT/POT GUAIACO300-4.5/5 SYRUP<br />
GUIATUSS DAC COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP HYPHED CP/HYDROCODONE/P-EPHED HCL 30-2.5-2/5 SYRUP<br />
GUIATUSS DM D-METHORPHAN HB/GUAIFENESIN100-10/5ML SYRUP IOBID DM D-METHORPHAN HB/GUAIFENESIN600-30MG TAB.SR 12H<br />
GUIATUSS-DAC COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP IOPHEN-C NR CODEINE PHOS/GUAIFENESIN 100-10MG/5 LIQUID<br />
HALOTUSSIN-AC CODEINE PHOSPHATE/GUAIFENES SYRUP IOPHEN-DM NR D-METHORPHAN HB/GUAIFENESIN100-10MG/5 LIQUID<br />
HALOTUSSIN-DAC COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP KG-DAL HD CP/HYDROCODONE/PHENYLEPHR 5-1.67-2 SYRUP<br />
H-C TUSSIVE CP/HYDROCODONE/PHENYLEPHR 5-2.5-2 SYRUP KG-DAL HD PLUS CP/HYDROCODONE/PHENYLEPHR 5-2.5-2 SYRUP<br />
HC TUSSIVE-D HYDROCODONE BIT/P-EPHED HCL60-5MG/5MLSOLUTION KG-FED CODEINE/PSEUDOEPHEDRINE HC 60-20 SYRUP<br />
HISTACOL BD BPM/D-METHORPHAN HB/P-EPD H 3-12.5-1/1 DROPS KG-FED COD/GUAIFENESIN/P-EPHED HCL 20MG SYRUP<br />
HIST-HC CP/HYDROCODONE/PHENYLEPHR 5-1.67-2 SYRUP KG-FED PEDIATRIC COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP
6 Alabama Medicaid Agency<br />
Cough <strong>and</strong> Cold Covered Products<br />
Therapeutic Listing<br />
Updated Quarterly<br />
Last Updated 09/19/06<br />
Br<strong>and</strong> Name/Generic Name GEN Code Description Strength Form Code Br<strong>and</strong> Name/Generic Name GEN Code Description Strength Form Code<br />
Antitussives <strong>and</strong> <strong>Combinations</strong> <strong>Page</strong> 4 <strong>of</strong> 6<br />
KGS-HC HYDROCODONE BIT/POT GUAIACO350-5MG/5 SYRUP PEDIACOLD CP/D-METHORPHAN HB/P-EPHED H5-15-1MG/5 LIQUID<br />
KG-TUSS HD GUAIFENESIN/HCOD/P-EPHED HCL100-30-2.5 SOLUTION PEDIAHIST DM BPM/D-METHORPHAN HB/P-EPD H 4-15-1MG/1 DROPS<br />
KIDCARE CP/D-METHORPHAN HB/P-EPHED H5-15-1MG/5 LIQUID PEDIATEX 12 DM CARBINOX/DM TAN/P-EPD TAN 45.2-3.6/5 ORAL SUSP<br />
KITA LA TOS D-METHORPHAN HB/GUAIFENESIN100-10/5ML SYRUP PEDIATEX DM CARBINOX/DM HB/P-EPHED HCL 15-2.67/5 SOLUTION<br />
KOMATUSSIN DM D-METHORPHAN HB/GUAIFENESIN100-10/5ML SYRUP PEDIATEX DM CARBINOX/DM HB/P-EPHED HCL 15-12.5-3 LIQUID<br />
KOSHER CARE DM D-METHORPHAN HB/GUAIFENESIN100-10MG/5 LIQUID PEDIATEX HC CP/HYDROCODONE/P-EPHED HCL 17.5-1.67 LIQUID<br />
KWELCOF GUAIFENESIN/HYDROCOD BIT 100-5/5ML SYRUP PHENYLEPH/HCOD BT/CP CP/HYDROCODONE/PHENYLEPHR 10-5-2MG/5 SYRUP<br />
L-ALL 12 CAR-B-PEN TA/PHENYLEPHRINE 30-30MG/5 ORAL SUSP PHENYLEPH/HCOD BT/CP CP/HYDROCODONE/PHENYLEPHR 5-5-2MG/5 LIQUID<br />
LIQUICOUGH DM DM HB/GUAIFEN/P-EPHEDRINE 200-15-32 LIQUID PHENYLEPHRINE HD HYDROCODONE/PHENYLEPHRINE 5-2.5MG/5 LIQUID<br />
LIQUICOUGH DM DM HB/GUAIFEN/P-EPHEDRINE 175-15-32 SOLUTION PHENYLHISTINE COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP<br />
LIQUICOUGH HC CP/HYDROCODONE/PHENYLEPHR 8-3.5-2.5 SYRUP PHLEMEX D-METHORPHAN HB/GUAIFENESIN1200-20MG TAB.SR 12H<br />
MARCOF HYDROCODONE BIT/POT GUAIACO350-5MG/5 SYRUP POLY-TUSSIN HYDROCODONE/PHENYLEPHRINE 5-6-12MG/5 LIQUID<br />
MAXIPHEN ADT CP/D-METHORP TAN/PHENYLEPHR30-20-2MG TABLET POLY-TUSSIN HD CP/HYDROCODONE/PHENYLEPHR 5-6-2MG/5 SYRUP<br />
MAXI-TUSS DM D-METHORPHAN HB/GUAIFENESIN200-20/5ML LIQUID POT GUAIACO/HYDROCODONE BHYDROCODONE BIT/POT GUAIACO300-4.5/5 SYRUP<br />
MAXI-TUSS HC CP/HYDROCODONE/PHENYLEPHR 10-2.5-4 SYRUP POT GUAIACO-HYDROCODONE BHYDROCODONE BIT/POT GUAIACO120-2.5/5 SYRUP<br />
M-CLEAR HYDROCODONE BIT/POT GUAIACO400-5MG/5 SYRUP PRO-CLEAR HYDROCODONE BIT/POT GUAIACO350-3MG/5 SYRUP<br />
M-CLEAR JR HYDROCODONE BIT/POT GUAIACO175-2.5/5 SYRUP PRODEC-DM CARBINOX/DM HB/P-EPHED HCL 4-25-2/ML DROPS<br />
MEDI-TUSSIN COUGH/COLD D-METHORPHAN HB/P-EPHED HCL7.5-15MG/5 SYRUP PROMETHAZINE DM D-METHORPHAN HB/PROMETH HC15-6.25/5 SYRUP<br />
MEDTUSSIN CP/HYDROCOD BIT/P-EPHED HCL SYRUP PROMETHAZINE VC W/CODEINE COD/PHENYLEPHRINE HCL/PROME5-10-6.25 SYRUP<br />
M-END BPM/HYDROCODONE/P-EPHED HC15-2.5-2/5 LIQUID PROMETHAZINE W/CODEINE CODEINE/PROMETHAZINE HCL 10-6.25/5 SYRUP<br />
M-END MAX BPM/HYDROCODONE/PHENYLEPH7.5-5-2/5 LIQUID PROMETHAZINE W/DM D-METHORPHAN HB/PROMETH HC15-6.25/5 SYRUP<br />
MINDAL DM D-METHORPHAN HB/GUAIFENESIN500-30MG TAB.SR 12H PROMETHAZINE-CODEINE CODEINE/PROMETHAZINE HCL 10-6.25/5 SYRUP<br />
MINTAB DM D-METHORPHAN HB/GUAIFENESIN200-10MG/5 SYRUP PRO-RED HYDROCODONE/PHENYLEPHRINE 5-2-8.33/5 SYRUP<br />
MINTEX DM CARBINOX/DM HB/P-EPHED HCL 15-12.5-3 LIQUID PSE BPM HD BPM/HYDROCODONE/P-EPHED HC30-1.7-2/5 SOLUTION<br />
MINTEX HC CARBINOX/HCOD BT/P-EPHED HCL30-5-2MG/5 LIQUID PSE BROM BPM/D-METHORPHAN HB/P-EPD H 30-60-4/5 SYRUP<br />
MINTUSS DR CHLORPHENIR/D-METHORPHAN H 15-6-2MG/5 SYRUP PSE CARB DM CARBINOX/DM HB/P-EPHED HCL 3.5-25-2/1 DROPS<br />
MINTUSS HC CP/HYDROCODONE/PHENYLEPHR 10-2.5-2/5 SYRUP PSE CARBINOXAMINE DM CARBINOX/DM HB/P-EPHED HCL 12.5-60-4 SYRUP<br />
MINTUSS HD CP/HYDROCODONE/PHENYLEPHR 10-2.5-4 SYRUP PSEUDO CARB DM CARBINOX/DM HB/P-EPHED HCL 15-12.5-3 LIQUID<br />
MINTUSS MR HYDROCODONE/PHENYLEPHRINE 5-5-5MG/5 SYRUP PSEUDO COUGH DM HB/GUAIFEN/P-EPHEDRINE 175-15-32 SOLUTION<br />
MINTUSS MS CP/HYDROCODONE/PHENYLEPHR 10-5-2MG/5 SYRUP PSEUDO DM GG DM HB/GUAIFEN/P-EPHEDRINE 100-15-40 SYRUP<br />
MINTUSS NX HYDROCODONE BIT/POT GUAIACO150-3MG/5 SYRUP PSEUDO MAX DMX DM HB/GUAIFEN/P-EPHEDRINE 700-40-80 TAB.SR 12H<br />
MONAFED DM D-METHORPHAN HB/GUAIFENESIN600-30MG TAB.SR 12H PSEUDOEPHEDRINE/GUAIFENESDM HB/GUAIFEN/P-EPHEDRINE 800-30-45 TAB.SR 12H<br />
MUCINEX DM D-METHORPHAN HB/GUAIFENESIN600-30MG TAB.SR 12H PSEUDOVENT DM DM HB/GUAIFEN/P-EPHEDRINE 595-32-48 TAB.SR 12H<br />
MYPHETANE DX BPM/D-METHORPHAN HB/P-EPD H 10-30-2/5 SYRUP PULMARI BPM/CAR-B-PEN TA/PHENYLEPHR 30-7.5-4/5 ORAL SUSP<br />
MYTUSSIN DAC COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP PULMOVITAL D-METHORPHAN HB/GUAIFENESIN100-15/5ML LIQUID<br />
MYTUSSIN DM D-METHORPHAN HB/GUAIFENESIN100-15/5ML SYRUP Q-TUSSIN DM D-METHORPHAN HB/GUAIFENESIN100-10/5ML SYRUP<br />
NALDECON DX D-METHORPHAN HB/GUAIFENESIN200-10MG/5 LIQUID QUINDAL-HD CP/HYDROCODONE/PHENYLEPHR 7.5-2-2/5 SYRUP<br />
NALSPAN SENIOR DX D-METHORPHAN HB/GUAIFENESIN200-10/5ML LIQUID Q-V TUSSIN CP/HYDROCODONE/P-EPHED HCL 30-2.5-2/5 SYRUP<br />
NARCOF GUAIFENESIN/HYDROCODONE BIT100-3.5/5 SYRUP RECOFEN D D-METHORPHAN HB/GUAIFENESIN100-5/5ML LIQUID<br />
NOLAMINE DEX D-METHORPHAN HB/GUAIFENESIN200-10/5ML LIQUID RELACON LAX D-METHORPHAN HB/GUAIFENESIN835MG-30M TAB.SR 12H<br />
NOVAGEST COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP RELACON-DM DM HB/GUAIFEN/P-EPHEDRINE 200-15-40 SYRUP<br />
PANCOF XP GUAIFENESIN/HYDROCODONE BIT90-3MG/5MLSYRUP RELACON-DM NR DM HB/GUAIFEN/P-EPHEDRINE 200-15-32 LIQUID<br />
PD-COF CHLORPHENIR/D-METHORPHAN H 15-12.5-4 SYRUP RELACON-HC CP/HYDROCODONE/PHENYLEPHR 10-3.5-2.5 SYRUP<br />
PD-COF CHLORPHENIR/D-METHORPHAN H 3-3.5-1/ML DROPS RELACON-HC NR CP/HYDROCODONE/PHENYLEPHR 8-3.5-2.5 SYRUP<br />
PEDIA RELIEF COLD & COUGH CP/D-METHORPHAN HB/P-EPHED H5-15-1MG/5 LIQUID RELASIN DM DM HB/GUAIFEN/P-EPHEDRINE 175-15-32 SOLUTION<br />
PEDIACARE D-METHORPHAN HB/P-EPHED HCL7.5-15MG/5 SYRUP RELASIN HC CP/HYDROCODONE/PHENYLEPHR 8-3.25-2.5 SOLUTION
7 Alabama Medicaid Agency<br />
Cough <strong>and</strong> Cold Covered Products<br />
Therapeutic Listing<br />
Updated Quarterly<br />
Last Updated 09/19/06<br />
Br<strong>and</strong> Name/Generic Name GEN Code Description Strength Form Code Br<strong>and</strong> Name/Generic Name GEN Code Description Strength Form Code<br />
Antitussives <strong>and</strong> <strong>Combinations</strong> <strong>Page</strong> 5 <strong>of</strong> 6<br />
RE-TANN CAR-B-PEN TA/P-EPD TAN 25-75MG/5 ORAL SUSP TOLU-SED DM D-METHORPHAN HB/GUAIFENESIN100-10/5ML LIQUID<br />
RINDAL HD CP/HYDROCODONE/PHENYLEPHR 5-1.67-2/5 SYRUP TRIACTIN COLD-COUGH CP/D-METHORPHAN HB/P-EPHED H5-15-1MG/5 LIQUID<br />
RINDAL HD PLUS CP/HYDROCODONE/PHENYLEPHR 7.5-3.5-2 SYRUP TRIACTING COLD & COUGH CP/D-METHORPHAN HB/P-EPHED H5-15-1MG/5 LIQUID<br />
RINDAL HPD DPHA/HYDROCODONE/PHENYLEP 7.5-2-12.5 SYRUP TRIACTING M-SYM COLD/COUGHCP/D-METHORPHAN HB/P-EPHED H5-15-1MG/5 LIQUID<br />
RI-TUSSIN DM D-METHORPHAN HB/GUAIFENESIN100-10/5ML SYRUP TRIAMINIC D-METHORPHAN HB/P-EPHED HCL5-15MG/5MLSYRUP<br />
ROBAFEN AC CODEINE PHOS/GUAIFENESIN 100-10MG/5 SYRUP TRIAMINIC D-METHORPHAN HB/P-EPHED HCL7.5-15MG/5 SYRUP<br />
ROBAFEN-DAC COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP TRIAMINIC COLD/COUGH CP/D-METHORPHAN HB/P-EPHED H5-15-1MG/5 LIQUID<br />
ROBAFEN-DM D-METHORPHAN HB/GUAIFENESIN100-10/5ML SYRUP TRICOF CP/DHCODEINE BT/P-EPHED HCL 15-7.5-2/5 SYRUP<br />
ROBAFEN-DM CLEAR D-METHORPHAN HB/GUAIFENESIN100-10/5ML SYRUP TRICOLD CARBINOX/D-METHORPHAN HB/PE2-2-1MG/ML DROPS<br />
ROBITUSSIN DEXTROMETHORPHAN HBR 15MG/5ML SYRUP TRIDAL HD CP/HYDROCODONE/PHENYLEPHR 7.5-2-2/5 SYRUP<br />
ROBITUSSIN D-METHORPHAN HB/P-EPHED HCL15-30MG/5 LIQUID TRIDAL HD PLUS CP/HYDROCODONE/PHENYLEPHR 7.5-3.5-2 SYRUP<br />
ROBITUSSIN BPM/D-METHORPHAN HB/P-EPD H 10-30-2/5 SYRUP TRIONATE CAR-B-PEN TA/CHLOR-TAN 30-4MG/5MLORAL SUSP<br />
ROBITUSSIN PEDIATRIC D-METHORPHAN HB/P-EPHED HCL7.5-15MG/5 SYRUP TRIONATE NF CAR-B-PEN TA/CHLOR-TAN 60-5MG TABLET<br />
ROBITUSSIN-DM D-METHORPHAN HB/GUAIFENESIN100-10/5ML SYRUP TRITAL DM CHLORPHENIR/D-METHORPHAN H 15-10-4/5 SOLUTION<br />
ROMILAR AC CODEINE PHOSPHATE/GUAIFENES SYRUP TRITUSS-A CARBINOX/D-METHORPHAN HB/PE2-2-1MG/ML DROPS<br />
RONDEX-DM CHLORPHENIR/D-METHORPHAN H 3-3.5-1/ML DROPS TRITUSSIN CP/HYDROCODONE/PHENYLEPHR 5-5-2MG/5 SYRUP<br />
RONDEX-DM CHLORPHENIR/D-METHORPHAN H 15-12.5-4 SYRUP TRI-VENT DM DM HB/GUAIFEN/P-EPHEDRINE 100-15-40 SYRUP<br />
RU-TUSS DM DM HB/GUAIFEN/P-EPHEDRINE 100-15-45 LIQUID TRI-VENT DPC CHLORPHENIR/D-METHORPHAN H 15-6-2MG/5 SYRUP<br />
SCOT-TUSSIN DEXTROMETHORPHAN HBR 10MG/5ML LIQUID TRI-VENT HC CARBINOX/HCOD BT/P-EPHED HCL30-5-2MG/5 LIQUID<br />
SCOT-TUSSIN DM CHLOR-MAL/DEXTROMETHORPHA 15-2MG/5MLLIQUID T-TANNA DM CP/D-METHORP TAN/P-EPD TAN 25-75-4.5 ORAL SUSP<br />
SCOT-TUSSIN DM2 D-METHORPHAN HB/GUAIFENESIN100-15/5ML SYRUP TUSANA-D CP/HYDROCODONE/PHENYLEPHR 12-6-2MG/5 LIQUID<br />
SCOT-TUSSIN SENIOR D-METHORPHAN HB/GUAIFENESIN200-15/5ML LIQUID TUSDEC-DM BR-PHENIR/D-METHORPHAN HB/P 15-7.5-2/5 LIQUID<br />
SILDEC PE-DM CHLORPHENIR/D-METHORPHAN H 3-3.5-1/ML DROPS TUSDEC-HC HYDROCODONE/PHENYLEPHRINE 7.5-3.75/5 LIQUID<br />
SILDEC PE-DM CHLORPHENIR/D-METHORPHAN H 15-12.5-4 SYRUP TUSNEL DIABETIC D-METHORPHAN HB/GUAIFENESIN100-10MG/5 LIQUID<br />
SILDEC-DM BPM/D-METHORPHAN HB/P-EPD H 15-45-4/5 SYRUP TUSSADUR-HD GUAIFENESIN/HCOD/P-EPHED HCL100-30-2.5 ELIXIR<br />
SILDEC-DM CARBINOX/DM HB/P-EPHED HCL 4-15-1MG/1 DROPS TUSSALL D-BP/D-METHORPHAN HB/PE 20-10-2/5 SYRUP<br />
SILPHEN DM DEXTROMETHORPHAN HBR 10MG/5ML SYRUP TUSSALL-ER D-BP/D-METHORPHAN HB/PE 30-20-6MG TAB.SR 12H<br />
SILTUSSIN DM D-METHORPHAN HB/GUAIFENESIN100-10/5ML SYRUP TUSS-AX GUAIFENESIN/HCOD/P-EPHED HCL200-60-5 EXPECT.<br />
SILTUSSIN DM DAS COUGH FORM D-METHORPHAN HB/GUAIFENESIN100-10MG/5 LIQUID TUSS-DS CP/HYDROCOD BIT/PHENYLEPH H 5-5-2 SYRUP<br />
SIMUC-DM D-METHORPHAN HB/GUAIFENESIN225-25MG/5 SOLUTION TUSSEND GUAIFENESIN/HCOD/P-EPHED HCL100-30-2.5 SOLUTION<br />
STATUSS DM CHLORPHENIR/D-METHORPHAN H 15-10-2/5 SYRUP TUSS-ES CP/HYDROCODONE/PHENYLEPHR 5-6-2MG/5 SYRUP<br />
SUCRETS DEXTROMETHORPHAN HBR 5MG LOZENGE TUSS-HC CP/HYDROCODONE/PHENYLEPHR 5-2.5-2 SYRUP<br />
SU-TUSS DM D-METHORPHAN HB/GUAIFENESIN200-20/5ML ELIXIR TUSSI-BID D-METHORPHAN HB/GUAIFENESIN1200-60MG TAB.SR 12H<br />
SU-TUSS HD GUAIFENESIN/HCOD/P-EPHED HCL100-30-2.5 ELIXIR TUSSID DM D-METHORPHAN HB/GUAIFENESIN100-10/5ML SYRUP<br />
TANA T-12 CAR-B-PEN TA/CHLOR-TAN 30-4MG/5MLORAL SUSP TUSSIGON HOMATROPINE/HYDROCODONE B 5-1.5MG TABLET<br />
TANACOF-DM D-CP/D-METHORP TAN/P-EPD TAN 25-75-2.5 ORAL SUSP TUSSIN COUGH-COLD D-METHORPHAN HB/P-EPHED HCL15-30MG/5 LIQUID<br />
TANNATE 12 S CAR-B-PEN TA/CHLOR-TAN 30-4MG/5MLORAL SUSP TUSSIN DM D-METHORPHAN HB/GUAIFENESIN100-10/5ML SYRUP<br />
TANNATE 12D S CAR-B-PEN TA/PHENYLEPHRINE/P 30-5-30/5 ORAL SUSP TUSSIN DM CLEAR D-METHORPHAN HB/GUAIFENESIN100-10/5ML SYRUP<br />
TANNATE DMP-DEX D-CP/D-METHORP TAN/P-EPD TAN 25-75-2.5 ORAL SUSP TUSSIN MAXIMUM STRENGTH DEXTROMETHORPHAN HBR 15MG/5ML SYRUP<br />
TANNATE-12 CAR-B-PEN TA/CP/PHENYLEPHRIN30-5-4/5ML ORAL SUSP TUSSIN MAXIMUM STRENGTH COD-METHORPHAN HB/P-EPHED HCL15-30MG/5 LIQUID<br />
TANNATE-V-DM DM TAN/PE TAN/PYRILAMINE TANN25-12.5-30 ORAL SUSP TUSSIN PEDIATRIC COUGH & CO D-METHORPHAN HB/P-EPHED HCL7.5-15MG/5 SYRUP<br />
TANNIC-12 CAR-B-PEN TA/CP/PHENYLEPHRIN30-5-4/5ML ORAL SUSP TUSSIN-DM CLEAR D-METHORPHAN HB/GUAIFENESIN100-10/5ML SYRUP<br />
TANNIC-12 CAR-B-PEN TA/CHLOR-TAN 60-5MG TABLET TUSSITAB D-METHORPHAN HB/GUAIFENESIN1200-60MG TAB.SR 12H<br />
TANNIC-12 S CAR-B-PEN TA/CHLOR-TAN 30-4MG/5MLORAL SUSP TUSSIVE HC CP/HYDROCODONE/PHENYLEPHR 5-2.5-2 SYRUP<br />
TANNIHIST-12 D CAR-B-PEN TA/PHENYLEPHRINE/P 30-5-30/5 ORAL SUSP TUSSIZONE-12 RF CAR-B-PEN TA/CHLOR-TAN 60-5MG TABLET<br />
TANNIHIST-12 D CAR-B-PEN TA/PHENYLEPHRINE/P 30-5-30/5 ORAL SUSP TUSSIZONE-12 RF CAR-B-PEN TA/CHLOR-TAN 30-4MG/5MLORAL SUSP
8 Alabama Medicaid Agency<br />
Cough <strong>and</strong> Cold Covered Products<br />
Therapeutic Listing<br />
Updated Quarterly<br />
Last Updated 09/19/06<br />
Br<strong>and</strong> Name/Generic Name GEN Code Description Strength Form Code Br<strong>and</strong> Name/Generic Name GEN Code Description Strength Form Code<br />
Antitussives <strong>and</strong> <strong>Combinations</strong> <strong>Page</strong> 6 <strong>of</strong> 6<br />
TUSS-PD CP/HYDROCODONE/PHENYLEPHR 5-1.67-2 SYRUP<br />
TUSS-S<br />
HYDROCODONE BIT/P-EPHED HCL60-5MG/5MLSYRUP<br />
ULTRATUSS 12 S<br />
CAR-B-PEN TA/CP/PHENYLEPHRIN30-5-4/5ML ORAL SUSP<br />
UNI TUSS HC CP/HYDROCODONE/PHENYLEPHR 5-2.5-2 SYRUP<br />
UNI-COF CP/DHCODEINE BT/P-EPHED HCL 15-7.5-2/5 SYRUP<br />
UNI-HIST DM<br />
BPM/D-METHORPHAN HB/P-EPD H 4-15-1MG/1 DROPS<br />
UNI-HIST PDX BPM/D-METHORPHAN HB/GUAIFEN50-5-5-2/5 SYRUP<br />
UNI-TANN CS<br />
CAR-B-PEN TA/DP-HYDRAMINE/PE 30-10-25MG TAB CHEW<br />
UNI-TANN CS CAR-B-PEN TA/DP-HYDRAMINE/PE 30-7.5-25 ORAL SUSP<br />
UNI-TRICOF HC CP/HYDROCODONE/PHENYLEPHR 5-1.67-2/5 LIQUID<br />
UNI-TUSS DM<br />
CHLORPHENIR/D-METHORPHAN H 15-5-2MG/5 SYRUP<br />
UNI-TUSSIN DM<br />
D-METHORPHAN HB/GUAIFENESIN100-15/5ML SYRUP<br />
VANACON GUAIFENESIN/HCOD/P-EPHED HCL200-60-5 EXPECT.<br />
VANEX HD CP/HYDROCODONE/PHENYLEPHR 5-1.67-2/5 SYRUP<br />
VICKS PEDIATRIC 44E<br />
D-METHORPHAN HB/GUAIFENESIN100-10/5ML SYRUP<br />
VICOCLEAR DH<br />
GUAIFENESIN/HYDROCODONE BIT100-5MG/5 SYRUP<br />
VI-Q-TUSS<br />
GUAIFENESIN/HYDROCODONE BIT100-5MG/5 SYRUP<br />
VIRATAN-DM DM TAN/PE TAN/PYRILAMINE TANN25-12.5-30 ORAL SUSP<br />
VIRATAN-DM<br />
DM TAN/PE TAN/PYRILAMINE TANN25-25-30MG TAB CHEW<br />
VISVEX HC BPM/HYDROCODONE/P-EPHED HC30-2.5-3/5 SYRUP<br />
VITUSSIN<br />
GUAIFENESIN/HYDROCODONE BIT100-5MG/5 SYRUP<br />
V-R PEDIA RELIEF COUGH/COLD CP/D-METHORPHAN HB/P-EPHED H5-15-1MG/5 LIQUID<br />
WELLTUSS HC CP/HYDROCODONE/P-EPHED HCL 15-3-2/5 LIQUID<br />
X-HIST DM<br />
CARBINOX/D-METHORPHAN HB/PE3-2-2MG/ML DROPS<br />
XPECT-HC<br />
GUAIFENESIN/HYDROCODONE BIT600MG-5MGTAB.SR 12H<br />
Y-COF DM D-BP/D-METHORPHAN HB/PE 30-20-6MG TAB.SR 12H<br />
Z-COF DM DM HB/GUAIFEN/P-EPHEDRINE 175-15-32 SOLUTION<br />
Z-COF DM DM HB/GUAIFEN/P-EPHEDRINE 200-15-32 LIQUID<br />
Z-COF DMX DM HB/GUAIFEN/P-EPHEDRINE 200-15-36 LIQUID<br />
Z-COF HC CP/HYDROCODONE/PHENYLEPHR 8-3.25-2.5 SOLUTION<br />
Z-COF HC CP/HYDROCODONE/PHENYLEPHR 8-3.5-2.5 SYRUP<br />
Z-COF LAX<br />
D-METHORPHAN HB/GUAIFENESIN835MG-30M TAB.SR 12H<br />
ZTUSS GUAIFENESIN/HCOD/P-EPHED HCL300-30-5 TABLET<br />
ZTUSS CP/GUAIFEN/HCOD/P-EPHED HCL 15-2.5-2/5 LIQUID<br />
ZTUSS ZT<br />
GUAIFENESIN/HYDROCODONE BIT300MG-5MGTABLET
9 Alabama Medicaid Agency<br />
Cough <strong>and</strong> Cold Covered Products<br />
Therapeutic Listing<br />
Updated Quarterly<br />
Last Updated 09/19/06<br />
Br<strong>and</strong> Name/Generic Name GEN Code Description Strength Form Code Br<strong>and</strong> Name/Generic Name GEN Code Description Strength Form Code<br />
Expectorants <strong>and</strong> <strong>Combinations</strong> <strong>Page</strong> 1 <strong>of</strong> 3<br />
ABER-FED GUAIFENESIN/P-EPHED HCL 500-60MG TAB.SR 12H DURATUSS GUAIFENESIN/PHENYLEPHRINE HC900-25MG TAB.SR 12H<br />
ABLETEX PSE GUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H DURATUSS GP GUAIFENESIN/PHENYLEPHRINE HC1200-25MG TAB.SR 12H<br />
ALATUSS D-METHORPHAN HB/GUAIFEN/PE 100-10-5 SYRUP DURATUSS HD GUAIFENESIN/HCOD/PHENYLEPHR225-10-2.5 SOLUTION<br />
ALDEX G GUAIFENESIN/PHENYLEPHRINE HC835MG-25M TAB.SR 12H DYNATUSS HC GUAIFENESIN/HCOD/PHENYLEPHR50-7.5-2.5 SYRUP<br />
ALTARUSSIN GUAIFENESIN 100MG/5ML SYRUP DYNATUSS-EX D-METHORPHAN HB/GUAIFEN/PE 200-30-10 SYRUP<br />
ALTEX-PSE GUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H EXEFEN-PD GUAIFENESIN/PHENYLEPHRINE HC600-10MG TAB.SR 12H<br />
AMBI 45/800 GUAIFENESIN/P-EPHED HCL 800-45MG TAB.SR 12H EXPECTORANT GUAIFENESIN 100MG/5ML SYRUP<br />
AMBI 5/15/100 GUAIFENESIN/HCOD/PHENYLEPHR100-15-5/5 LIQUID FENESIN GUAIFENESIN 600MG TABLET SA<br />
AMBI 60-580 GUAIFENESIN/P-EPHED HCL 580-60MG TABLET FORMULA D DM HB/GUAIFEN/P-EPHEDRINE 67-10 LIQUID<br />
AMBI 80/780 GUAIFENESIN/P-EPHED HCL 780MG-80M TAB.SR 12H G PHEN DM D-METHORPHAN HB/GUAIFEN/PE 600-60-40 TAB.SR 12H<br />
AMIBID LA GUAIFENESIN 600MG TABLET SA GANIDIN NR GUAIFENESIN 100MG/5ML LIQUID<br />
AMIDAL GUAIFENESIN/PHENYLEPHRINE HC300-20MG TABLET SA GDP-EX D-METHORPHAN HB/GUAIFEN/PE 200-30-10 LIQUID<br />
AMI-TEX LA GUAIFENESIN/PHENYLEPHRINE HC600-30MG TAB.SR 12H GEE-GEE GUAIFENESIN 200MG TABLET<br />
AMI-TEX PSE GUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H GENERIC ENTEX LA GUAIFENESIN/PHENYLEPHRINE HC400MG-30M CAP.SR 12H<br />
ANATUSS DM DM HB/GUAIFEN/P-EPHEDRINE 100-10-30 SYRUP GFN 1200/DM 20/PE 40 D-METHORPHAN HB/GUAIFEN/PE 1200-20-40 TAB.SR 12H<br />
ANEXTUSS D-METHORPHAN HB/GUAIFEN/PE 600-60-40 TAB.SR 12H GFN 1200/PHENYLEPHRINE 40 GUAIFENESIN/PHENYLEPHRINE HC1200-40MG TAB.SR 12H<br />
AQUAMIST GUAIFENESIN 600MG TABLET SA GFN 1200/PSE 50 GUAIFENESIN/P-EPHED HCL 1200-50MG TAB.SR 12H<br />
BENADRILINA GUAIFENESIN 100MG/5ML SYRUP GFN 600/PHENYLEPHRINE 20 GUAIFENESIN/PHENYLEPHRINE HC600-20MG TAB.SR 12H<br />
BENYLIN DM HB/GUAIFEN/P-EPHEDRINE 100-5-15/5 SYRUP GFN 600/PHENYLEPHRINE 40 GUAIFENESIN/PHENYLEPHRINE HC600-40MG TAB.SR 12H<br />
BROMHIST-DM BPM/DM HB/GUAIFEN/P-EPHEDRIN50-5-30-2 SYRUP GFN 800/PE 25 GUAIFENESIN/PHENYLEPHRINE HC800-25MG TAB.SR 12H<br />
CARBETAPLEX CAR-B-PENTANE/GUAIFEN/PE 100-20-15 SYRUP GFN/PSE GUAIFENESIN/P-EPHED HCL 1200-120MGTAB.SR 12H<br />
CHLORDEX GP CP/D-METHORPHAN HB/GUAIFEN/P7.5-10-2/5 SYRUP GG 200 NR GUAIFENESIN 200MG TABLET<br />
CONTAC APAP/DM HB/GUAIFEN/P-EPHEDRI LIQUID GOLDLINE COUGH D-METHORPHAN HB/GUAIFEN/PE 100-10-5 SYRUP<br />
COUGH CONTROL GUAIFENESIN 100MG/5ML SYRUP GP-1200 GUAIFENESIN/PHENYLEPHRINE HC1200-40MG TAB.SR 12H<br />
COUGH FORMULA 4-M APAP/DM HB/GUAIFEN/P-EPHEDRI LIQUID G-PHED-PD GUAIFENESIN/P-EPHED HCL 300-60MG CAPSULE SA<br />
CRANTEX GUAIFENESIN/PHENYLEPHRINE HC100-7.5/5 SYRUP GUAIATUSSIN GUAIFENESIN 100MG/5ML SYRUP<br />
CRANTEX ER GUAIFENESIN/PHENYLEPHRINE HC300-10MG CAP.SR 12H GUAIFED GUAIFENESIN/P-EPHED HCL 200-30/5ML SYRUP<br />
CRANTEX HC GUAIFENESIN/HCOD/PHENYLEPHR100-7.5-5 SYRUP GUAIFEN DM D-METHORPHAN HB/GUAIFEN/PE 1200-20-40 TAB.SR 12H<br />
CRANTEX LA GUAIFENESIN/PHENYLEPHRINE HC600-30MG TAB.SR 12H GUAIFENESIN GUAIFENESIN 200MG TABLET<br />
CRANTEX LAC GUAIFENESIN/PHENYLEPHRINE HC400MG-30M CAP.SR 12H GUAIFENESIN GUAIFENESIN 100MG/5ML SYRUP<br />
DACEX-DM D-METHORPHAN HB/GUAIFEN/PE 25-12.5/5 SYRUP GUAIFENESIN GUAIFENESIN 600MG TABLET SA<br />
DACEX-PE D-METHORPHAN HB/GUAIFEN/PE 600-30-10 TAB.SR 12H GUAIFENESIN GUAIFENESIN 1200MG TAB.SR 12H<br />
DE-CHLOR G GUAIFENESIN/HCOD/PHENYLEPHR100-10-2/5 SYRUP GUAIFENESIN 600/PSE 120 GUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H<br />
DECONEX GUAIFENESIN/PHENYLEPHRINE HC900-30MG TAB.SR 12H GUAIFENESIN LA GUAIFENESIN 600MG TABLET SA<br />
DECONGESTANT COUGH FORMULDM HB/GUAIFEN/P-EPHEDRINE 67-10 LIQUID GUAIFENESIN NR GUAIFENESIN 100MG/5ML LIQUID<br />
DECONGESTANT D DM HB/GUAIFEN/P-EPHEDRINE 67-10 LIQUID GUAIFENESIN PSE GUAIFENESIN/P-EPHED HCL 1200-120MGTAB.SR 12H<br />
DECONGESTANT II GUAIFENESIN/P-EPHED HCL 600MG-60M TAB.SR 12H GUAIFENESIN W/PSEUDOEPHED GUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H<br />
DEXATUSS CA/D-METHORPHAN HB/GUAIFEN/P LIQUID GUAIFENESIN W/PSEUDOEPHED GUAIFENESIN/P-EPHED HCL 600MG-60M TAB.SR 12H<br />
DEXCON-DM D-METHORPHAN HB/GUAIFEN/PE 100-20-10 SYRUP GUAIFENESIN W/PSEUDOEPHED GUAIFENESIN/P-EPHED HCL 1200-120MGTAB.SR 12H<br />
DEXCON-PE D-METHORPHAN HB/GUAIFEN/PE 550-25-20 TAB.SR 12H GUAIFENESIN W/PSEUDOEPHED GUAIFENESIN/P-EPHED HCL 300-60MG CAPSULE SA<br />
D-FEDA II GUAIFENESIN/P-EPHED HCL 600MG-60M TAB.SR 12H GUAIFENESIN/P-EPHED HCL GUAIFENESIN/P-EPHED HCL 500-60MG TAB.SR 12H<br />
DIABETIC FORMULA GUAIFENESIN 100MG/5ML SYRUP GUAIFENESIN/PHENYLEPHRINE GUAIFENESIN/PHENYLEPHRINE HC600-40MG TAB.SR 12H<br />
DIABETIC TUSSIN EX GUAIFENESIN 100MG/5ML SYRUP GUAIFENESIN/PSEUDOEPHEDRINGUAIFENESIN/P-EPHED HCL 1200-120MGTAB.SR 12H<br />
DONATUSSIN DC GUAIFENESIN/HCOD/PHENYLEPHR50-7.5-2.5 SYRUP GUAIFENESIN-P-EPHED HCL GUAIFENESIN/P-EPHED HCL 1200-50MG TAB.SR 12H<br />
DUOMAX GUAIFENESIN/PHENYLEPHRINE HC1200-40MG TAB.SR 12H GUAIFENESIN-PHENYLEPHRINE GUAIFENESIN/PHENYLEPHRINE HC900-25MG TAB.SR 12H<br />
DURAPHEN DM D-METHORPHAN HB/GUAIFEN/PE 1200-20-40 TAB.SR 12H GUAIFENESIN-PHENYLEPHRINE GUAIFENESIN/PHENYLEPHRINE HC600-40MG TAB.SR 12H
10 Alabama Medicaid Agency<br />
Cough <strong>and</strong> Cold Covered Products<br />
Therapeutic Listing<br />
Updated Quarterly<br />
Last Updated 09/19/06<br />
Br<strong>and</strong> Name/Generic Name GEN Code Description Strength Form Code Br<strong>and</strong> Name/Generic Name GEN Code Description Strength Form Code<br />
Expectorants <strong>and</strong> <strong>Combinations</strong> <strong>Page</strong> 2 <strong>of</strong> 3<br />
GUAIFENESIN-PHENYLEPHRINE H GUAIFENESIN/PHENYLEPHRINE HC1200-25MG TAB.SR 12H NALDECON-DX D-METHORPHAN HB/GUAIFEN/PPA LIQUID<br />
GUAIFENESIN-PHENYLEPHRINE-H GUAIFENESIN/HCOD/PHENYLEPHR100-10-2/5 SYRUP NALPHEN DX D-METHORPHAN HB/GUAIFEN/PPA100MG/5ML SYRUP<br />
GUAIFENESIN-PSEUDOEPHEDRINEGUAIFENESIN/P-EPHED HCL 800-90MG TAB.SR 12H NASEX GUAIFENESIN/PHENYLEPHRINE HC650-25MG TAB.SR 12H<br />
GUAIFENESIN-PSEUDOEPHEDRINEGUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H NASEX-G GUAIFENESIN/PHENYLEPHRINE HC835MG-25M TAB.SR 12H<br />
GUAIFENESIN-PSEUDOEPHEDRINEGUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H NESCON-PD GUAIFENESIN/PHENYLEPHRINE HC275-25MG TAB.SR 12H<br />
GUAIFENESIN-PSEUDOEPHEDRINEGUAIFENESIN/P-EPHED HCL 800-90MG TAB.SR 12H NON-DRYING SINUS GUAIFENESIN/P-EPHED HCL 200-30MG CAPSULE<br />
GUAIFENESIN-SR GUAIFENESIN 600MG TABLET SA NOVAGEST DEX DM HB/GUAIFEN/P-EPHEDRINE 100-10-30 LIQUID<br />
GUAIFENEX G GUAIFENESIN 1200MG TAB.SR 12H ORGADIN GUAIFENESIN 100MG/5ML LIQUID<br />
GUAIFENEX GP GUAIFENESIN/P-EPHED HCL 1200-120MGTAB.SR 12H PDM GG D-METHORPHAN HB/GUAIFEN/PE 200-30-10 SYRUP<br />
GUAIFENEX LA GUAIFENESIN 600MG TABLET SA PDM GG D-METHORPHAN HB/GUAIFEN/PE 50-5-2.5/1 DROPS<br />
GUAIFENEX PSE GUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H PEDIATRIC COUGH/COLD GUAIFENESIN 100MG/5ML SYRUP<br />
GUAIFENEX PSE GUAIFENESIN/P-EPHED HCL 600MG-60M TAB.SR 12H PENDEX GUAIFENESIN/PHENYLEPHRINE HC600-10MG TAB.SR 12H<br />
GUAIF-PHENYLPHRINE HCL GUAIFENESIN/PHENYLEPHRINE HC100-7.5/5 SYRUP PHANASIN GUAIFENESIN 100MG/5ML SYRUP<br />
GUAIF-PHENYLPHRINE HCL GUAIFENESIN/PHENYLEPHRINE HC1200-40MG TAB.SR 12H PHARMASIN GUAIFENESIN 100MG/5ML SYRUP<br />
GUAIMAX-D GUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H PHENAVENT GUAIFENESIN/PHENYLEPHRINE HC400-15MG CAP.SR 12H<br />
GUAIPHEN-D GUAIFENESIN/PHENYLEPHRINE HC600-40MG TAB.SR 12H PHENAVENT D GUAIFENESIN/PHENYLEPHRINE HC1200-40MG TAB.SR 12H<br />
GUAIPHEN-D GUAIFENESIN/PHENYLEPHRINE HC1200-40MG TAB.SR 12H PHENAVENT LA GUAIFENESIN/PHENYLEPHRINE HC400MG-30M CAP.SR 12H<br />
GUAIPHEN-PD GUAIFENESIN/PHENYLEPHRINE HC275-25MG TAB.SR 12H PHENAVENT LA GUAIFENESIN/PHENYLEPHRINE HC600-30MG TAB.SR 12H<br />
GUAPETEX GUAIFENESIN/PHENYLEPHRINE HC100-7.5/5 SYRUP PHENAVENT PED GUAIFENESIN/PHENYLEPHRINE HC200-7.5MG CAP.SR 12H<br />
GUA-SR GUAIFENESIN 600MG TABLET SA PHENCARB GG CAR-B-PENTANE/GUAIFEN/PE 100-20-10 SYRUP<br />
GUIADEX PD GUAIFENESIN/PHENYLEPHRINE HC600-10MG TAB.SR 12H PHENYLEPHRINE HCL/GUAIFENEGUAIFENESIN/PHENYLEPHRINE HC600-20MG TAB.SR 12H<br />
GUIATUSS GUAIFENESIN 100MG/5ML SYRUP PHENYLEPHRINE HCL-GUAIFENEGUAIFENESIN/PHENYLEPHRINE HC900-25MG TAB.SR 12H<br />
HM TUSSIN GUAIFENESIN 100MG/5ML SYRUP PHENYLEPHRINE/GUAIFENESIN GUAIFENESIN/PHENYLEPHRINE HC600-30MG TAB.SR 12H<br />
HM TUSSIN COUGH GUAIFENESIN 100MG/5ML SYRUP PHENYLEPHRINE-GUAIFENESIN GUAIFENESIN/PHENYLEPHRINE HC600-15MG TABLET SA<br />
HYDRO GP GUAIFENESIN/HCOD/PHENYLEPHR50-7.5-2.5 SYRUP PHLEMEX FORTE D-METHORPHAN HB/GUAIFEN/PE 1200-30-30 TAB.SR 12H<br />
HYDROFED GUAIFENESIN/HCOD/PHENYLEPHR150-6-2.5 SYRUP POT GUAIACO/PHENYLEPHRINE PHENYLEPHRINE HCL/POT GUAIAC75-5MG/5MLLIQUID<br />
HYTUSS GUAIFENESIN 100MG TABLET PROFED GUAIFENESIN/P-EPHED HCL 600MG-60M TAB.SR 12H<br />
IODROL NR GUAIFENESIN 200MG TABLET PROSET D GUAIFENESIN/PHENYLEPHRINE HC600-20MG TAB.SR 12H<br />
IOPHEN NR GUAIFENESIN 100MG/5ML LIQUID PSEUDOEPHEDRINE W/GUAIFEN GUAIFENESIN/P-EPHED HCL 800-45MG TAB.SR 12H<br />
IOSAL II GUAIFENESIN/P-EPHED HCL 600MG-60M TAB.SR 12H PSEUDO-G/PSI GUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H<br />
IOTEX PSE GUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H PSEUDOVENT PED GUAIFENESIN/P-EPHED HCL 300-60MG CAPSULE SA<br />
KGS-PE PHENYLEPHRINE HCL/POT GUAIAC75-5MG/5MLLIQUID Q-TUSSIN GUAIFENESIN 100MG/5ML SYRUP<br />
KOMATUSSIN GUAIFENESIN 100MG/5ML SYRUP QUAL-TUSSIN CP/GUAIFEN/PHENYLEPHRINE 20-2-1/ML DROPS<br />
LEV/PSE/GG GUAIFENESIN/P-EPHED HCL 400MG-90M CAP.SR 12H QUAL-TUSSIN CP/D-METHORPHAN HB/GUAIFEN/P7.5-10-2/5 SYRUP<br />
LEVALL G GUAIFENESIN/P-EPHED HCL 400MG-90M CAP.SR 12H QUAL-TUSSIN DC GUAIFENESIN/HCOD/PHENYLEPHR50-7.5-2.5 SYRUP<br />
LUSONAL PHENYLEPHRINE HCL/POT GUAIAC100-7.5/5 LIQUID QUINDAL GUAIFENESIN/PHENYLEPHRINE HC300-20MG TABLET SA<br />
MAXIPHEN DM D-METHORPHAN HB/GUAIFEN/PE 1000-60-40 TAB.SR 12H QUINTEX GUAIFENESIN/PHENYLEPHRINE HC100-7.5/5 SYRUP<br />
MEDI-TUSSIN SEVERE CONGESTIOGUAIFENESIN/P-EPHED HCL 200-30MG CAPSULE REFENESEN GUAIFENESIN 200MG TABLET<br />
MINDAL GUAIFENESIN/P-EPHED HCL 500-60MG TAB.SR 12H RESPA-GF GUAIFENESIN 600MG TABLET SA<br />
MINTUSS G GUAIFENESIN/HCOD/PHENYLEPHR100-10-2/5 SYRUP RI-TUSSIN GUAIFENESIN 100MG/5ML SYRUP<br />
MONAFED GUAIFENESIN 600MG TABLET SA ROBAFEN GUAIFENESIN 100MG/5ML SYRUP<br />
MUCINEX GUAIFENESIN 600MG TABLET SA ROBITUSSIN GUAIFENESIN/P-EPHED HCL 200-30MG CAPSULE<br />
MUCINEX D GUAIFENESIN/P-EPHED HCL 600MG-60M TAB.SR 12H ROBITUSSIN GUAIFENESIN 100MG/5ML SYRUP<br />
MULTI-SYMPTOM APAP/DM HB/GUAIFEN/P-EPHEDRI LIQUID ROLATUSS DM HB/GUAIFEN/P-EPHEDRINE 100-10-30 LIQUID<br />
MULTI-SYMPTOM COUGH FORMULAPAP/DM HB/GUAIFEN/P-EPHEDRI LIQUID SCOT-TUSSIN GUAIFENESIN 100MG/5ML LIQUID<br />
NALDECON SENIOR EX GUAIFENESIN 200MG/5ML LIQUID SEUDAFAIRE DM HB/GUAIFEN/P-EPHEDRINE 100-5-15/5 SYRUP
11 Alabama Medicaid Agency<br />
Cough <strong>and</strong> Cold Covered Products<br />
Therapeutic Listing<br />
Updated Quarterly<br />
Last Updated 09/19/06<br />
Br<strong>and</strong> Name/Generic Name GEN Code Description Strength Form Code Br<strong>and</strong> Name/Generic Name GEN Code Description Strength Form Code<br />
Expectorants <strong>and</strong> <strong>Combinations</strong> <strong>Page</strong> 3 <strong>of</strong> 3<br />
SEVERE CONGESTION GUAIFENESIN/P-EPHED HCL 200-30MG CAPSULE<br />
SIL-TEX GUAIFENESIN/PHENYLEPHRINE HC100-7.5/5 SYRUP<br />
SILTUSSIN DAS GUAIFENESIN 100MG/5ML LIQUID<br />
SILTUSSIN SA GUAIFENESIN 100MG/5ML SYRUP<br />
SIMUC<br />
GUAIFENESIN/PHENYLEPHRINE HC900-25MG TAB.SR 12H<br />
SIMUC-HD GUAIFENESIN/HCOD/PHENYLEPHR225-10-2.5 SOLUTION<br />
SINUFED TIMECELLES GUAIFENESIN/P-EPHED HCL 300-60MG CAPSULE SA<br />
SINUTAB NON-DRYING GUAIFENESIN/P-EPHED HCL 200-30MG CAPSULE<br />
SINUTUSS DM D-METHORPHAN HB/GUAIFEN/PE 600-30-15 TABLET SA<br />
SUDAFED NON-DRYING SINUS GUAIFENESIN/P-EPHED HCL 200-30MG CAPSULE<br />
TRITUSS D-METHORPHAN HB/GUAIFEN/PE 25-12.5/5 SYRUP<br />
TRITUSS-ER D-METHORPHAN HB/GUAIFEN/PE 600-30-10 TAB.SR 12H<br />
TUSSAFED-EX D-METHORPHAN HB/GUAIFEN/PE 50-5-2.5/1 DROPS<br />
TUSSAFED-HC GUAIFENESIN/HCOD/PHENYLEPHR50-7.5-2.5 SYRUP<br />
TUSSAPHEN D-METHORPHAN HB/GUAIFEN/PE 100-10-5 SYRUP<br />
TUSSAPHEN DM D-METHORPHAN HB/GUAIFEN/PE 100-10-5 SYRUP<br />
TUSSBID<br />
GUAIFENESIN/PHENYLEPHRINE HC400-15MG CAP.SR 12H<br />
TUSSEDYN D-METHORPHAN HB/GUAIFEN/PE 100-10-5 SYRUP<br />
TUSSEX D-METHORPHAN HB/GUAIFEN/PE 100-10-5 SYRUP<br />
TUSSEX COUGH D-METHORPHAN HB/GUAIFEN/PE 100-10-5 SYRUP<br />
TUSSIN GUAIFENESIN 100MG/5ML SYRUP<br />
TUSSIN HONEY GUAIFENESIN 100MG/5ML SYRUP<br />
TUSSIN SEVERE GUAIFENESIN/P-EPHED HCL 200-30MG CAPSULE<br />
TUSSIN SEVERE CONGESTION GUAIFENESIN/P-EPHED HCL 200-30MG CAPSULE<br />
UNI-LEV GUAIFENESIN/HCOD/PHENYLEPHR100-15-5/5 SYRUP<br />
UNI-TUSSIN GUAIFENESIN 100MG/5ML SYRUP<br />
WELLBID-D<br />
GUAIFENESIN/PHENYLEPHRINE HC600-40MG TAB.SR 12H<br />
WELLBID-D 1200<br />
GUAIFENESIN/PHENYLEPHRINE HC1200-40MG TAB.SR 12H<br />
XEDEC<br />
GUAIFENESIN/PHENYLEPHRINE HC800-20MG TAB SR 8HR<br />
XPECT-PE<br />
GUAIFENESIN/PHENYLEPHRINE HC1200-25MG TAB.SR 12H<br />
ZEPHREX-LA GUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H
12 Alabama Medicaid Agency<br />
Cough <strong>and</strong> Cold Covered Products<br />
Therapeutic Listing<br />
Updated Quarterly<br />
Last Updated 09/19/06
13 Alabama Medicaid Agency<br />
Cough <strong>and</strong> Cold Covered Products<br />
Therapeutic Listing<br />
Updated Quarterly<br />
Last Updated 09/19/06
14 Alabama Medicaid Agency<br />
Cough <strong>and</strong> Cold Covered Products<br />
Therapeutic Listing<br />
Updated Quarterly<br />
Last Updated 09/19/06
15 Alabama Medicaid Agency<br />
Cough <strong>and</strong> Cold Covered Products<br />
Therapeutic Listing<br />
Updated Quarterly<br />
Last Updated 09/19/06
16 Alabama Medicaid Agency<br />
Cough <strong>and</strong> Cold Covered Products<br />
Therapeutic Listing<br />
Updated Quarterly<br />
Last Updated 09/19/06
17 Alabama Medicaid Agency<br />
Cough <strong>and</strong> Cold Covered Products<br />
Therapeutic Listing<br />
Updated Quarterly<br />
Last Updated 09/19/06
18 Alabama Medicaid Agency<br />
Cough <strong>and</strong> Cold Covered Products<br />
Therapeutic Listing<br />
Updated Quarterly<br />
Last Updated 09/19/06
19 Alabama Medicaid Agency<br />
Cough <strong>and</strong> Cold Covered Products<br />
Therapeutic Listing<br />
Updated Quarterly<br />
Last Updated 09/19/06
20 Alabama Medicaid Agency<br />
Cough <strong>and</strong> Cold Covered Products<br />
Therapeutic Listing<br />
Updated Quarterly<br />
Last Updated 09/19/06<br />
A<br />
A
21 Alabama Medicaid Agency<br />
Cough <strong>and</strong> Cold Covered Products<br />
Therapeutic Listing<br />
Updated Quarterly<br />
Last Updated 09/19/06<br />
A
22 Alabama Medicaid Agency<br />
Cough <strong>and</strong> Cold Covered Products<br />
Therapeutic Listing<br />
Updated Quarterly<br />
Last Updated 09/19/06