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

00781214801 LANSOPRAZOLE CAP 30MG DR 12/31/9999 2012300781235501 LANSOPRAZOLE CAP 30MG DR 01/31/2014 2012300781235510 LANSOPRAZOLE CAP 30MG DR 10/10/2013 2012351079012101 LANSOPRAZOLE CAP 30MG DR 12/31/9999 2012351079012108 LANSOPRAZOLE CAP 30MG DR 12/31/9999 2012355111039905 LANSOPRAZOLE CAP 30MG DR 12/31/9999 2012355111039990 LANSOPRAZOLE CAP 30MG DR 12/31/9999 2012363739055510 LANSOPRAZOLE CAP 30MG DR 12/31/9999 2012364679067001 LANSOPRAZOLE CAP 30MG DR 12/31/9999 2012364679067005 LANSOPRAZOLE CAP 30MG DR 12/31/9999 2012364679067007 LANSOPRAZOLE CAP 30MG DR 12/31/9999 2012368084046801 LANSOPRAZOLE CAP 30MG DR 12/31/9999 2012300781573313 LANSOPRAZOLE TAB 15MG ODT 12/31/9999 2012300781573413 LANSOPRAZOLE TAB 30MG ODT 12/31/9999 2012300088222033 LANTUS INJ 100/ML 12/31/9999 2012300088221905 LANTUS INJ SOLOSTAR 12/31/9999 2012300088222060 LANTUS INJ SOLOSTAR 12/31/9999 2012300088222052 LANTUS FOR INJ OPTICLIK 06/30/2013 2012300039006710 LASIX TAB 20MG 12/31/9999 2012300039006770 LASIX TAB 20MG 09/30/2014 2012300039006013 LASIX TAB 40MG 12/31/9999 2012300039006050 LASIX TAB 40MG 08/31/2014 2012300039006070 LASIX TAB 40MG 08/31/2014 2012300039006605 LASIX TAB 80MG 12/31/9999 2012300023429003 LASTACAFT SOL 0.25% 12/31/9999 2012300378964532 LATANOPROST SOL 0.005% 12/31/9999 2012300517083001 LATANOPROST SOL 0.005% 12/31/9999 2012300574401525 LATANOPROST SOL 0.005% 12/31/2012 2012324208046325 LATANOPROST SOL 0.005% 12/31/9999 2012359762033301 LATANOPROST SOL 0.005% 02/01/2014 2012359762033302 LATANOPROST SOL 0.005% 12/31/9999 2012360505056500 LATANOPROST SOL 0.005% 12/31/9999 2012360505056501 LATANOPROST SOL 0.005% 12/31/9999 2012361314054701 LATANOPROST SOL 0.005% 12/31/9999 2012361314054703 LATANOPROST SOL 0.005% 12/31/9999 2012358980077710 LATRIX SUS 50% 12/31/9999 2012358980077881 LATRIX XM EMU 45% 12/31/9999 2012363402031230 LATUDA TAB 120MG 12/31/9999 2012363402030230 LATUDA TAB 20MG 12/31/9999 2012363402030410 LATUDA TAB 40MG 12/31/9999 2012363402030430 LATUDA TAB 40MG 12/31/9999 2012363402030810 LATUDA TAB 80MG 12/31/9999 2012363402030830 LATUDA TAB 80MG 12/31/9999 2012351552041302 LAVENDER OIL 12/31/9999 2012351552041305 LAVENDER OIL 12/31/9999 2012351552041306 LAVENDER OIL 12/31/9999 2012366993092898 LAVOCLEN-4 KIT ACNE WSH 12/31/2013 2012366993092606 LAVOCLEN-4 LIQ CREM WSH 12/31/2013 2012366993092998 LAVOCLEN-8 KIT ACNE WSH 01/31/2013 2012366993092706 LAVOCLEN-8 LIQ CREM WSH 10/31/2013 2012349348053212 LAX/STL SOFT TAB 8.6-50MG 12/31/9999 2012337205029462 LAXATIVE TAB 25MG 12/31/9999 2012336800008663 LAXATIVE TAB 5MG EC 12/31/9999 2012363868054924 LAXATIVE TAB MAX-STR 12/31/9999 2012300884388602 LAZERCREME CRE 12/31/9999 2012300884398603 LAZERFORMALY SOL 10% 08/31/2013 2012300536741008 L-CARNITINE CAP 250MG 12/31/9999 2012300517205005 L-CYSTEINE INJ 50MG/ML 12/31/9999 2012366758000401 L-CYSTEINE INJ 50MG/ML 12/31/9999 2012366758000402 L-CYSTEINE INJ 50MG/ML 12/31/9999 20123