Frova Long Form 3-1-2013.xlsx
Frova Long Form 3-1-2013.xlsx
Frova Long Form 3-1-2013.xlsx
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Information for Vermont Prescribers of Prescription Drugs<br />
<strong>Frova</strong> ® (frovatriptan succinate ) Tablets<br />
-- This list does not imply that the products on this chart are interchangeable or have the same efficacy or safety.<br />
Please refer to each product's FDA-approved label and indication for further information.<br />
-- The prices listed below are Average Wholesale Prices ("AWP") as established and made available to the public by a third party publisher or<br />
as calculated from data made available to the public by a third party publisher. The price paid by consumers may be higher or lower than the<br />
prices listed below. Information about AWP of these drugs is being provided to Vermont prescribers pursuant to Vermont law, to give you<br />
information about the relative prices of marketed drugs and other drugs in the same therapeutic class.<br />
-- The prices listed here do not necessarily reflect price per dosage, price per course of treatment or the cost effectiveness, of all the products<br />
listed. For simplicity, only the smallest package sizes available for each product are included.<br />
Product Name<br />
Manufacturer NDC or UPC Pkg Size Pack Unit<br />
Marketed Product<br />
<strong>Frova</strong> 2.5 mg Tablet Endo Pharm Inc. 63481-0025-09 9 EA $478.39 $53.15<br />
Other Products<br />
Alsuma 6 mg/0.5 mL Pen Injector Pfizer Us Pharm 27505-0002-00 Non-Pill Product<br />
Amerge 1 mg Tablet Glaxosmithkline 00173-0561-00 9 EA $360.14 $40.02<br />
Amerge 2.5 mg Tablet Glaxosmithkline 00173-0562-00 9 EA $360.14 $40.02<br />
Axert 6.25 mg Tablet Janssen Pharm. 50458-0211-01 6 EA $242.63 $40.44<br />
Axert 12.5 mg Tablet Janssen Pharm. 50458-0210-01 12 EA $485.35 $40.45<br />
Imitrex 25 mg Tablet Glaxosmithkline 00173-0735-00 9 EA $299.23 $33.25<br />
Imitrex 50 mg Tablet Glaxosmithkline 00173-0736-01 9 EA $380.87 $42.32<br />
Imitrex 100 mg Tablet Glaxosmithkline 00173-0737-01 9 EA $380.87 $42.32<br />
Imitrex 4 mg/0.5 mL Cartridge Glaxosmithkline 00173-0739-02 Non-Pill Product<br />
Imitrex 6 mg/0.5 mL Cartridge Glaxosmithkline 00173-0478-00 Non-Pill Product<br />
Imitrex 4 mg/0.5 mL Pen Injector Glaxosmithkline 00173-0739-00 Non-Pill Product<br />
Imitrex 6 mg/0.5 mL Pen Injector Glaxosmithkline 00173-0479-00 Non-Pill Product<br />
Imitrex 5 mg Spray, Non-Aerosol Glaxosmithkline 00173-0524-00 Non-Pill Product<br />
Imitrex 20 mg Spray, Non-Aerosol Glaxosmithkline 00173-0523-00 Non-Pill Product<br />
Imitrex 6 mg/0.5 mL Vial Glaxosmithkline 00173-0449-02 Non-Pill Product<br />
Maxalt 5 mg Tablet Merck Sharp & D 00006-0266-18 18 EA $745.86 $41.44<br />
Maxalt 10 mg Tablet Merck Sharp & D 00006-0267-18 18 EA $745.86 $41.44<br />
Maxalt Mlt 5 mg Tablet, Disintegrating Merck Sharp & D 00006-3800-12 3 EA $117.38 $39.13<br />
Maxalt Mlt 10 mg Tablet, Disintegrating Merck Sharp & D 00006-3801-12 3 EA $117.38 $39.13<br />
Naratriptan 1 mg Tablet Northstar Rx Ll 16714-0290-02 9 EA $216.00 $24.00<br />
Naratriptan 2.5 mg Tablet Northstar Rx Ll 16714-0291-02 9 EA $235.40 $26.16<br />
Naratriptan Hcl 1 mg Tablet Heritage Pharma 23155-0054-19 9 EA $216.00 $24.00<br />
Naratriptan Hcl 1 mg Tablet Karalex Pharma, 42043-0130-09 9 EA $72.00 $8.00<br />
Naratriptan Hcl 1 mg Tablet Mylan 00378-4450-59 9 EA $118.27 $13.14<br />
Naratriptan Hcl 1 mg Tablet Paddock Labs. 00574-0214-09 9 EA $216.00 $24.00<br />
Naratriptan Hcl 1 mg Tablet Roxane Labs. 00054-0278-03 9 EA $118.27 $13.14<br />
Naratriptan Hcl 1 mg Tablet Teva Usa 00093-8522-90 9 EA $143.32 $15.92<br />
Naratriptan Hcl 2.5 mg Tablet Heritage Pharma 23155-0055-19 9 EA $216.00 $24.00<br />
Naratriptan Hcl 2.5 mg Tablet Karalex Pharma, 42043-0131-09 9 EA $72.00 $8.00<br />
Naratriptan Hcl 2.5 mg Tablet Mylan 00378-4451-59 9 EA $118.27 $13.14<br />
Naratriptan Hcl 2.5 mg Tablet Paddock Labs. 00574-0215-09 9 EA $216.00 $24.00<br />
Naratriptan Hcl 2.5 mg Tablet Roxane Labs. 00054-0279-03 9 EA $118.27 $13.14<br />
Naratriptan Hcl 2.5 mg Tablet Sandoz 00781-5527-37 9 EA $254.80 $28.31<br />
Naratriptan Hcl 2.5 mg Tablet Sun Pharmaceuti 62756-0437-69 9 EA $84.00 $9.33<br />
Naratriptan Hcl 2.5 mg Tablet Teva Usa 00093-8523-90 9 EA $143.32 $15.92<br />
Relpax 20 mg Tablet Pfizer Us Pharm 00049-2330-45 6 EA $233.38 $38.90<br />
Relpax 40 mg Tablet Pfizer Us Pharm 00049-2340-45 6 EA $233.38 $38.90<br />
Rizatriptan 5 mg Tablet Apotex Corp 60505-3698-01 18 EA $179.57 $9.98<br />
Rizatriptan 5 mg Tablet Aurobindo Pharm 65862-0599-12 12 EA $75.37 $6.28<br />
Rizatriptan 5 mg Tablet Breckenridge 51991-0354-78 18 EA $120.00 $6.67<br />
Rizatriptan 5 mg Tablet Glenmark Pharma 68462-0465-99 18 EA $31.52 $1.75<br />
Rizatriptan 5 mg Tablet Mylan 00378-1403-96 12 EA $43.00 $3.58<br />
Rizatriptan 5 mg Tablet Sandoz 00781-5485-64 30 EA $332.53 $11.08<br />
Rizatriptan 5 mg Tablet Teva Usa 00093-7471-43 18 EA $32.32 $1.80<br />
Source: First Databank, 3/2/2014. Reprinted with permission by First Databank Inc. All rights reserved. (c) 2014. Pg. 1 of 3
Product Name<br />
Manufacturer NDC or UPC Pkg Size Pack Unit<br />
Rizatriptan 5 mg Tablet, Disintegrating Apotex Corp 60505-3723-01 18 EA $71.82 $3.99<br />
Rizatriptan 5 mg Tablet, Disintegrating Aurobindo Pharm 65862-0625-12 12 EA $29.40 $2.45<br />
Rizatriptan 5 mg Tablet, Disintegrating Breckenridge 51991-0362-78 18 EA $120.00 $6.67<br />
Rizatriptan 5 mg Tablet, Disintegrating Glenmark Pharma 68462-0467-06 18 EA $31.52 $1.75<br />
Rizatriptan 5 mg Tablet, Disintegrating Mylan 00378-3701-59 9 EA $266.03 $29.56<br />
Rizatriptan 5 mg Tablet, Disintegrating Par Pharm. 49884-0580-94 18 EA $532.06 $29.56<br />
Rizatriptan 5 mg Tablet, Disintegrating Sandoz 00781-5425-64 30 EA $886.75 $29.56<br />
Rizatriptan 10 mg Tablet Apotex Corp 60505-3699-01 18 EA $179.57 $9.98<br />
Rizatriptan 10 mg Tablet Aurobindo Pharm 65862-0600-12 12 EA $106.50 $8.88<br />
Rizatriptan 10 mg Tablet Breckenridge 51991-0355-78 18 EA $120.00 $6.67<br />
Rizatriptan 10 mg Tablet Glenmark Pharma 68462-0466-99 18 EA $35.09 $1.95<br />
Rizatriptan 10 mg Tablet Mylan 00378-1404-96 12 EA $45.16 $3.76<br />
Rizatriptan 10 mg Tablet Sandoz 00781-5486-64 30 EA $332.53 $11.08<br />
Rizatriptan 10 mg Tablet Teva Usa 00093-7472-43 18 EA $32.32 $1.80<br />
Rizatriptan 10 mg Tablet, Disintegrating Apotex Corp 60505-3724-01 18 EA $71.82 $3.99<br />
Rizatriptan 10 mg Tablet, Disintegrating Aurobindo Pharm 65862-0626-12 12 EA $29.40 $2.45<br />
Rizatriptan 10 mg Tablet, Disintegrating Breckenridge 51991-0363-78 18 EA $120.00 $6.67<br />
Rizatriptan 10 mg Tablet, Disintegrating Glenmark Pharma 68462-0468-06 18 EA $35.09 $1.95<br />
Rizatriptan 10 mg Tablet, Disintegrating Mylan 00378-3702-59 9 EA $266.03 $29.56<br />
Rizatriptan 10 mg Tablet, Disintegrating Par Pharm. 49884-0581-94 18 EA $532.06 $29.56<br />
Rizatriptan 10 mg Tablet, Disintegrating Sandoz 00781-5426-64 30 EA $886.75 $29.56<br />
Sumatriptan 5 mg Spray, Non-Aerosol Sandoz 00781-6524-06 Non-Pill Product<br />
Sumatriptan 20 mg Spray, Non-Aerosol Sandoz 00781-6523-06 Non-Pill Product<br />
Sumatriptan 100 % Powder Medisca Inc. 38779-2707-01 Non-Pill Product<br />
Sumatriptan Succinate 25 mg Tablet Actavis Pharma, 16252-0590-99 9 EA $19.14 $2.13<br />
Sumatriptan Succinate 25 mg Tablet Ahp 68084-0339-97 27 EA $40.62 $1.50<br />
Sumatriptan Succinate 25 mg Tablet Aurobindo Pharm 65862-0146-36 9 EA $19.14 $2.13<br />
Sumatriptan Succinate 25 mg Tablet Dr.Reddy'S Lab 55111-0291-36 36 EA $164.21 $4.56<br />
Sumatriptan Succinate 25 mg Tablet Greenstone Llc. 59762-1850-09 9 EA $19.09 $2.12<br />
Sumatriptan Succinate 25 mg Tablet Mylan 00378-5630-59 9 EA $41.05 $4.56<br />
Sumatriptan Succinate 25 mg Tablet Northstar Rx Ll 16714-0531-11 9 EA $41.05 $4.56<br />
Sumatriptan Succinate 25 mg Tablet Ranbaxy Pharmac 63304-0097-19 9 EA $20.45 $2.27<br />
Sumatriptan Succinate 25 mg Tablet Sun Pharmaceuti 62756-0520-88 100 EA $202.02 $2.02<br />
Sumatriptan Succinate 50 mg Tablet Actavis Pharma, 16252-0591-99 9 EA $19.14 $2.13<br />
Sumatriptan Succinate 50 mg Tablet Aurobindo Pharm 65862-0147-36 9 EA $19.14 $2.13<br />
Sumatriptan Succinate 50 mg Tablet Dr.Reddy'S Lab 55111-0292-36 36 EA $149.76 $4.16<br />
Sumatriptan Succinate 50 mg Tablet Greenstone Llc. 59762-1851-09 9 EA $17.74 $1.97<br />
Sumatriptan Succinate 50 mg Tablet Mylan 00378-5631-59 9 EA $37.44 $4.16<br />
Sumatriptan Succinate 50 mg Tablet Northstar Rx Ll 16714-0532-11 9 EA $37.44 $4.16<br />
Sumatriptan Succinate 50 mg Tablet Ranbaxy Pharmac 63304-0098-19 9 EA $19.01 $2.11<br />
Sumatriptan Succinate 50 mg Tablet Sun Pharmaceuti 62756-0521-88 100 EA $202.02 $2.02<br />
Sumatriptan Succinate 100 mg Tablet Actavis Pharma, 16252-0592-99 9 EA $19.14 $2.13<br />
Sumatriptan Succinate 100 mg Tablet Aurobindo Pharm 65862-0148-36 9 EA $19.14 $2.13<br />
Sumatriptan Succinate 100 mg Tablet Dr.Reddy'S Lab 55111-0293-36 36 EA $149.76 $4.16<br />
Sumatriptan Succinate 100 mg Tablet Greenstone Llc. 59762-1852-09 9 EA $17.74 $1.97<br />
Sumatriptan Succinate 100 mg Tablet Mylan 00378-5632-59 9 EA $37.44 $4.16<br />
Sumatriptan Succinate 100 mg Tablet Northstar Rx Ll 16714-0533-11 9 EA $37.44 $4.16<br />
Sumatriptan Succinate 100 mg Tablet Ranbaxy Pharmac 63304-0099-19 9 EA $19.01 $2.11<br />
Sumatriptan Succinate 100 mg Tablet Sun Pharmaceuti 62756-0522-88 100 EA $202.02 $2.02<br />
Sumatriptan Succinate 4 mg/0.5 mL Cartridge Sandoz 00781-3170-07<br />
Sumatriptan Succinate 6 mg/0.5 mL Cartridge Sandoz 00781-3173-07<br />
Sumatriptan Succinate 4 mg/0.5 mL Pen Injector Sandoz 00781-3169-07<br />
Sumatriptan Succinate 6 mg/0.5 mL Pen Injector Dr.Reddy'S Lab 55111-0693-12<br />
Sumatriptan Succinate 6 mg/0.5 mL Pen Injector Sandoz 00781-3172-07<br />
Sumatriptan Succinate 6 mg/0.5 mL Pen Injector Sun Pharma Glob 47335-0276-41<br />
Sumatriptan Succinate 6 mg/0.5 mL Syringe Sagent Pharmace 25021-0703-70<br />
Sumatriptan Succinate 6 mg/0.5 mL Syringe App Pharmaceuti 63323-0273-01<br />
Sumatriptan Succinate 6 mg/0.5 mL Vial Auromedics Phar 55150-0173-01<br />
Sumatriptan Succinate 6 mg/0.5 mL Vial Cura Pharm 66860-0022-06<br />
Sumatriptan Succinate 6 mg/0.5 mL Vial Jhp Pharmaceuti 42023-0121-05<br />
Sumatriptan Succinate 6 mg/0.5 mL Vial Sagent Pharmace 25021-0703-60<br />
Sumatriptan Succinate 6 mg/0.5 mL Vial Sandoz 00781-3174-14<br />
Non-Pill Product<br />
Non-Pill Product<br />
Non-Pill Product<br />
Non-Pill Product<br />
Non-Pill Product<br />
Non-Pill Product<br />
Non-Pill Product<br />
Non-Pill Product<br />
Non-Pill Product<br />
Non-Pill Product<br />
Non-Pill Product<br />
Non-Pill Product<br />
Non-Pill Product<br />
Source: First Databank, 3/2/2014. Reprinted with permission by First Databank Inc. All rights reserved. (c) 2014. Pg. 2 of 3
Product Name<br />
Sumatriptan Succinate 6 mg/0.5 mL Vial Teva Parenteral 00703-7351-02<br />
Sumatriptan Succinate 6 mg/0.5 mL Vial West-Ward,Inc. 00143-9638-05<br />
Sumatriptan Succinate 100 % Powder A.P.I. Solution 46144-0114-10<br />
Sumatriptan Succinate 100 % Powder Diversified Pha 55812-0352-01<br />
Sumatriptan Succinate 100 % Powder Freedom Pharmac 52372-0674-01<br />
Sumatriptan Succinate 100 % Powder Professional Co 51927-4542-00<br />
Sumavel Dosepro 6 mg/0.5 mL Needle-Free Injector Zogenix, Inc. 43376-0106-06<br />
Manufacturer NDC or UPC Pkg Size Pack Unit<br />
Non-Pill Product<br />
Non-Pill Product<br />
Non-Pill Product<br />
Non-Pill Product<br />
Non-Pill Product<br />
Non-Pill Product<br />
Non-Pill Product<br />
Treximet 85 mg-500 mg Tablet Glaxosmithkline 00173-0750-49 9 EA $300.26 $33.36<br />
Zolmitriptan 2.5 mg Tablet Apotex Corp 60505-3693-00 6 EA $291.97 $48.66<br />
Zolmitriptan 2.5 mg Tablet Glenmark Pharma 68462-0497-76 6 EA $50.36 $8.39<br />
Zolmitriptan 2.5 mg Tablet Global Pharm 00115-0671-51 6 EA $288.73 $48.12<br />
Zolmitriptan 2.5 mg Tablet Mylan 00378-4260-56 6 EA $291.66 $48.61<br />
Zolmitriptan 5 mg Tablet Apotex Corp 60505-3694-00 3 EA $161.39 $53.80<br />
Zolmitriptan 5 mg Tablet Glenmark Pharma 68462-0498-33 3 EA $29.94 $9.98<br />
Zolmitriptan 5 mg Tablet Global Pharm 00115-0672-50 3 EA $159.60 $53.20<br />
Zolmitriptan 5 mg Tablet Mylan 00378-4261-53 3 EA $161.22 $53.74<br />
Zolmitriptan Odt 2.5 mg Tablet, Disintegrating Apotex Corp 60505-3718-00 6 EA $291.97 $48.66<br />
Zolmitriptan Odt 2.5 mg Tablet, Disintegrating Glenmark Pharma 68462-0499-76 6 EA $50.36 $8.39<br />
Zolmitriptan Odt 2.5 mg Tablet, Disintegrating Global Pharm 00115-0691-51 6 EA $288.73 $48.12<br />
Zolmitriptan Odt 2.5 mg Tablet, Disintegrating Zydus Pharmaceu 68382-0715-86 6 EA $291.97 $48.66<br />
Zolmitriptan Odt 5 mg Tablet, Disintegrating Apotex Corp 60505-3719-00 3 EA $161.39 $53.80<br />
Zolmitriptan Odt 5 mg Tablet, Disintegrating Glenmark Pharma 68462-0500-33 3 EA $29.94 $9.98<br />
Zolmitriptan Odt 5 mg Tablet, Disintegrating Global Pharm 00115-0692-50 3 EA $159.60 $53.20<br />
Zolmitriptan Odt 5 mg Tablet, Disintegrating Zydus Pharmaceu 68382-0717-82 3 EA $161.39 $53.80<br />
Zomig 2.5 mg Tablet Impax Pharmaceu 64896-0671-51 6 EA $456.10 $76.02<br />
Zomig 5 mg Tablet Impax Pharmaceu 64896-0672-50 3 EA $228.05 $76.02<br />
Zomig 2.5 mg Spray, Non-Aerosol Impax Pharmaceu 64896-0682-51 Non-Pill Product<br />
Zomig 5 mg Spray, Non-Aerosol Impax Pharmaceu 64896-0681-51 Non-Pill Product<br />
Zomig Zmt 2.5 mg Tablet, Disintegrating Impax Pharmaceu 64896-0691-51 6 EA $456.10 $76.02<br />
Zomig Zmt 5 mg Tablet, Disintegrating Impax Pharmaceu 64896-0692-50 3 EA $228.05 $76.02<br />
For more information about First Databank's Drug Pricing Policy, visit http://www.fdbhealth.com/policies/drug-pricing-policy/<br />
Source: First Databank, 3/2/2014. Reprinted with permission by First Databank Inc. All rights reserved. (c) 2014. Pg. 3 of 3
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