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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52544093102 INFED INJ 50MG/ML 12/31/9999 2<strong>01</strong>236643502<strong>01</strong>15 INFERGEN INJ 15MCG 12/31/9999 2<strong>01</strong>236643502<strong>01</strong>96 INFERGEN INJ 15MCG 12/31/9999 2<strong>01</strong>2366435020209 INFERGEN INJ 9MCG 12/31/9999 2<strong>01</strong>2366435020295 INFERGEN INJ 9MCG 12/31/9999 2<strong>01</strong>2360977<strong>01</strong>14<strong>01</strong> INFUMORPH INJ 10MG/ML 12/31/9999 2<strong>01</strong>2360977<strong>01</strong>1474 INFUMORPH INJ 10MG/ML 12/31/9999 2<strong>01</strong>2360977<strong>01</strong>15<strong>01</strong> INFUMORPH INJ 25MG/ML 12/31/9999 2<strong>01</strong>2360977<strong>01</strong>1574 INFUMORPH INJ 25MG/ML 12/31/9999 2<strong>01</strong>23546435646<strong>01</strong> INFUVITE INJ 12/31/9999 2<strong>01</strong>23546435649<strong>01</strong> INFUVITE INJ ADULT 12/31/9999 2<strong>01</strong>2354643564902 INFUVITE INJ ADULT 12/31/9999 2<strong>01</strong>2354643564700 INFUVITE INJ PEDIATRI 12/31/9999 2<strong>01</strong>2300069<strong>01</strong>45<strong>01</strong> INLYTA TAB 1MG 12/31/9999 2<strong>01</strong>2300069<strong>01</strong>5111 INLYTA TAB 5MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>730791<strong>01</strong> INNOPRAN XL CAP 120MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>73079102 INNOPRAN XL CAP 120MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>730790<strong>01</strong> INNOPRAN XL CAP 80MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>73079002 INNOPRAN XL CAP 80MG 12/31/9999 2<strong>01</strong>2351552100507 INOSITOL POW HEXANICO 12/31/9999 2<strong>01</strong>23005363984<strong>01</strong> INOSITOL TAB 500MG 12/31/9999 2<strong>01</strong>23687120<strong>01</strong>3<strong>01</strong> INOVA KIT 4% 12/31/9999 2<strong>01</strong>23687120023<strong>01</strong> INOVA KIT 8% 12/31/9999 2<strong>01</strong>23687120<strong>01</strong>4<strong>01</strong> INOVA 4/1 KIT ACNE CON 12/31/9999 2<strong>01</strong>23687120021<strong>01</strong> INOVA 8/2 KIT ACNE CON 12/31/9999 2<strong>01</strong>23000251710<strong>01</strong> INSPRA TAB 25MG 12/31/9999 2<strong>01</strong>2300025171002 INSPRA TAB 25MG 12/31/9999 2<strong>01</strong>2300025171003 INSPRA TAB 25MG 12/31/9999 2<strong>01</strong>23000251720<strong>01</strong> INSPRA TAB 50MG 12/31/9999 2<strong>01</strong>2300025172003 INSPRA TAB 50MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>87074631 INSTA-GLUCOS GEL 40% 12/31/9999 2<strong>01</strong>230<strong>01</strong>87074633 INSTA-GLUCOS GEL 40% 12/31/9999 2<strong>01</strong>2368<strong>01</strong>6080055 INSULIN SYRG MIS 0.5/28G 12/31/9999 2<strong>01</strong>2368<strong>01</strong>6090055 INSULIN SYRG MIS 0.5/29G 12/31/9999 2<strong>01</strong>2368<strong>01</strong>608<strong>01</strong>05 INSULIN SYRG MIS 1ML/28G 12/31/9999 2<strong>01</strong>2368<strong>01</strong>609<strong>01</strong>05 INSULIN SYRG MIS 1ML/29G 12/31/9999 2<strong>01</strong>2352747071030 INTEGRA CAP 12/31/9999 2<strong>01</strong>2352747071060 INTEGRA CAP 12/31/9999 2<strong>01</strong>2352747071130 INTEGRA F CAP 12/31/9999 2<strong>01</strong>2352747071160 INTEGRA F CAP 12/31/9999 2<strong>01</strong>2352747071230 INTEGRA PLUS CAP 12/31/9999 2<strong>01</strong>2352747071260 INTEGRA PLUS CAP 12/31/9999 2<strong>01</strong>23000851136<strong>01</strong> INTEGRILIN INJ 0.75MG/1 12/31/9999 2<strong>01</strong>23000851177<strong>01</strong> INTEGRILIN INJ 2MG/ML 12/31/9999 2<strong>01</strong>2300085117702 INTEGRILIN INJ 2MG/ML 12/31/9999 2<strong>01</strong>23596760570<strong>01</strong> INTELENCE TAB 100MG 12/31/9999 2<strong>01</strong>23596760571<strong>01</strong> INTELENCE TAB 200MG 12/31/9999 2<strong>01</strong>23596760572<strong>01</strong> INTELENCE TAB 25MG 12/31/9999 2<strong>01</strong>2337205061026 INTENSE COUG LIQ RELIEVER 12/31/9999 2<strong>01</strong>2359<strong>01</strong>1025630 INTERMEZZO SUB 1.75MG 12/31/9999 2<strong>01</strong>2359<strong>01</strong>1025530 INTERMEZZO SUB 3.5MG 12/31/9999 2<strong>01</strong>2300338051902 INTRALIPID INJ 20% 12/31/9999 2<strong>01</strong>2300338051903 INTRALIPID INJ 20% 12/31/9999 2<strong>01</strong>2300338051904 INTRALIPID INJ 20% 12/31/9999 2<strong>01</strong>2300338051948 INTRALIPID INJ 20% 12/31/9999 2<strong>01</strong>2300338052003 INTRALIPID INJ 30% 12/31/9999 2<strong>01</strong>2300085057102 INTRON-A INJ 10MU 12/31/9999 2<strong>01</strong>23000851110<strong>01</strong> INTRON-A INJ 18MU 12/31/9999 2<strong>01</strong>23000851168<strong>01</strong> INTRON-A INJ 18MU 12/31/9999 2<strong>01</strong>23000851133<strong>01</strong> INTRON-A INJ 25MU 12/31/9999 2<strong>01</strong>23

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