Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...
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Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...

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00008083721 EFFEXOR XR CAP 37.5MG 12/31/9999 2<strong>01</strong>2300008083722 EFFEXOR XR CAP 37.5MG 12/31/9999 2<strong>01</strong>2300008083303 EFFEXOR XR CAP 75MG 12/31/9999 2<strong>01</strong>2300008083320 EFFEXOR XR CAP 75MG 12/31/9999 2<strong>01</strong>2300008083321 EFFEXOR XR CAP 75MG 12/31/9999 2<strong>01</strong>2300008083322 EFFEXOR XR CAP 75MG 12/31/9999 2<strong>01</strong>231<strong>01</strong>58008404 EFFICOL EMU WHIP 12/31/9999 2<strong>01</strong>23000024759<strong>01</strong> EFFIENT TAB 10MG 07/31/2<strong>01</strong>3 2<strong>01</strong>2300002475930 EFFIENT TAB 10MG 08/31/2<strong>01</strong>3 2<strong>01</strong>2300002475977 EFFIENT TAB 10MG 07/31/2<strong>01</strong>3 2<strong>01</strong>23000025123<strong>01</strong> EFFIENT TAB 10MG 12/31/9999 2<strong>01</strong>2300002512330 EFFIENT TAB 10MG 12/31/9999 2<strong>01</strong>2300002512377 EFFIENT TAB 10MG 12/31/9999 2<strong>01</strong>2300002476030 EFFIENT TAB 5MG 07/31/2<strong>01</strong>3 2<strong>01</strong>2300002476076 EFFIENT TAB 5MG 02/28/2<strong>01</strong>3 2<strong>01</strong>23000025121<strong>01</strong> EFFIENT TAB 5MG 12/31/9999 2<strong>01</strong>2300002512130 EFFIENT TAB 5MG 12/31/9999 2<strong>01</strong>2300002512152 EFFIENT TAB 5MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>87320447 EFUDEX CRE 5% 12/31/9999 2<strong>01</strong>23440872<strong>01</strong>003 EGRIFTA INJ 1MG 12/31/9999 2<strong>01</strong>23540920700<strong>01</strong> ELAPRASE INJ 6MG/3ML 12/31/9999 2<strong>01</strong>2339506002260 ELDEPRYL CAP 5MG <strong>01</strong>/31/2<strong>01</strong>4 2<strong>01</strong>2349502042060 ELDEPRYL CAP 5MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>87051831 ELDOPAQUE CRE 2% 12/31/9999 2<strong>01</strong>230<strong>01</strong>87039531 ELDOPAQUE CRE 4% FORTE 12/31/9999 2<strong>01</strong>230<strong>01</strong>87038231 ELDOQUIN CRE 2% 12/31/9999 2<strong>01</strong>230<strong>01</strong>87039431 ELDOQUIN CRE 4% FORTE 12/31/9999 2<strong>01</strong>2300069<strong>01</strong>06<strong>01</strong> ELELYSO INJ 200UNIT 12/31/9999 2<strong>01</strong>230002392<strong>01</strong>05 ELESTAT DRO 0.05% 12/31/9999 2<strong>01</strong>2318860049002 ELESTRIN GEL 12/31/9999 2<strong>01</strong>23188600480<strong>01</strong> ELESTRIN GEL 0.06% 12/31/9999 2<strong>01</strong>2318860048060 ELESTRIN GEL 0.06% 12/31/9999 2<strong>01</strong>2300078037546 ELIDEL CRE 1% 07/31/2<strong>01</strong>3 2<strong>01</strong>2300078037549 ELIDEL CRE 1% 06/30/2<strong>01</strong>3 2<strong>01</strong>2300078037563 ELIDEL CRE 1% 06/30/2<strong>01</strong>3 2<strong>01</strong>230<strong>01</strong>875100<strong>01</strong> ELIDEL CRE 1% 12/31/9999 2<strong>01</strong>230<strong>01</strong>8751<strong>01</strong>02 ELIDEL CRE 1% 12/31/9999 2<strong>01</strong>230<strong>01</strong>87510203 ELIDEL CRE 1% 12/31/9999 2<strong>01</strong>2300024022205 ELIGARD INJ 22.5MG 12/31/9999 2<strong>01</strong>2300024061030 ELIGARD INJ 30MG 12/31/9999 2<strong>01</strong>2300024060545 ELIGARD INJ 45MG 12/31/9999 2<strong>01</strong>2300024079375 ELIGARD INJ 7.5MG 12/31/9999 2<strong>01</strong>2363717091002 ELIPHOS TAB 667MG 12/31/9999 2<strong>01</strong>2313811002960 ELITE OB CAP W/DHA 05/31/2<strong>01</strong>3 2<strong>01</strong>2300024515<strong>01</strong>0 ELITEK INJ 1.5MG 12/31/9999 2<strong>01</strong>2300024515175 ELITEK INJ 7.5MG 12/31/9999 2<strong>01</strong>2313811002710 ELITE-OB TAB 04/30/2<strong>01</strong>3 2<strong>01</strong>2349708064490 ELIXOPHYLLIN ELX 80/15ML 12/31/9999 2<strong>01</strong>2352544023854 ELLA TAB 30MG 12/31/9999 2<strong>01</strong>23000095091<strong>01</strong> ELLENCE INJ 2MG/ML 12/31/9999 2<strong>01</strong>23000095093<strong>01</strong> ELLENCE INJ 2MG/ML 12/31/9999 2<strong>01</strong>23504580098<strong>01</strong> ELMIRON CAP 100MG 12/31/9999 2<strong>01</strong>23000850567<strong>01</strong> ELOCON CRE 0.1% 12/31/9999 2<strong>01</strong>2300085056702 ELOCON CRE 0.1% 12/31/9999 2<strong>01</strong>23000850854<strong>01</strong> ELOCON LOT 0.1% 12/31/9999 2<strong>01</strong>2300085085402 ELOCON LOT 0.1% 12/31/9999 2<strong>01</strong>23000850370<strong>01</strong> ELOCON OIN 0.1% 12/31/9999 2<strong>01</strong>2300085037002 ELOCON OIN 0.1% 12/31/9999 2<strong>01</strong>2300024059120 ELOXATIN INJ 100MG 12/31/9999 2<strong>01</strong>2300024059240 ELOXATIN INJ 200MG 12/31/9999 2<strong>01</strong>23

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