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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52152<strong>01</strong>9302 LOXAPINE CAP 25MG 12/31/9999 2<strong>01</strong>2352152<strong>01</strong>9305 LOXAPINE CAP 25MG 12/31/9999 2<strong>01</strong>23003787050<strong>01</strong> LOXAPINE CAP 50MG 12/31/9999 2<strong>01</strong>23005271397<strong>01</strong> LOXAPINE CAP 50MG 12/31/9999 2<strong>01</strong>23005910372<strong>01</strong> LOXAPINE CAP 50MG 12/31/9999 2<strong>01</strong>23510790903<strong>01</strong> LOXAPINE CAP 50MG 12/31/9999 2<strong>01</strong>2351079090320 LOXAPINE CAP 50MG 12/31/9999 2<strong>01</strong>2352152<strong>01</strong>9402 LOXAPINE CAP 50MG 12/31/9999 2<strong>01</strong>2352152<strong>01</strong>9405 LOXAPINE CAP 50MG 12/31/9999 2<strong>01</strong>23003787005<strong>01</strong> LOXAPINE CAP 5MG 12/31/9999 2<strong>01</strong>23005271394<strong>01</strong> LOXAPINE CAP 5MG 12/31/9999 2<strong>01</strong>23005910369<strong>01</strong> LOXAPINE CAP 5MG 12/31/9999 2<strong>01</strong>2352152<strong>01</strong>9102 LOXAPINE CAP 5MG 12/31/9999 2<strong>01</strong>2352152<strong>01</strong>9105 LOXAPINE CAP 5MG 12/31/9999 2<strong>01</strong>23525440495<strong>01</strong> LOXITANE CAP 10MG 12/31/9999 2<strong>01</strong>23525440496<strong>01</strong> LOXITANE CAP 25MG 12/31/9999 2<strong>01</strong>23525440497<strong>01</strong> LOXITANE CAP 50MG 12/31/9999 2<strong>01</strong>23525440494<strong>01</strong> LOXITANE CAP 5MG 12/31/9999 2<strong>01</strong>2351552110404 L-PHENYLALAN POW 12/31/9999 2<strong>01</strong>2300536704906 L-TYROSINE TAB 500MG 12/31/9999 2<strong>01</strong>2337205063605 LUBRICANT DRO EYE 12/31/9999 2<strong>01</strong>23461220<strong>01</strong>805 LUBRICANT DRO EYE 12/31/9999 2<strong>01</strong>2300904516838 LUBRIFRESH OIN P.M. 12/31/9999 2<strong>01</strong>2300482<strong>01</strong>1812 LUBRIN SUP 12/31/9999 2<strong>01</strong>2300482<strong>01</strong>1819 LUBRIN SUP 12/31/9999 2<strong>01</strong>2300904530<strong>01</strong>6 LUBRISOFT LOT UNSCENTE 12/31/9999 2<strong>01</strong>23502420082<strong>01</strong> LUCENTIS SOL 0.3MG 12/31/9999 2<strong>01</strong>23502420080<strong>01</strong> LUCENTIS SOL 0.5MG 12/31/9999 2<strong>01</strong>23449461<strong>01</strong>503 LUDENT CHW 0.25MG F 12/31/9999 2<strong>01</strong>23449461<strong>01</strong>603 LUDENT CHW 0.5MG F 12/31/9999 2<strong>01</strong>23449461<strong>01</strong>703 LUDENT CHW 1MG F 12/31/9999 2<strong>01</strong>2300037052192 LUFYLLIN TAB 200MG 12/31/9999 2<strong>01</strong>2300037073192 LUFYLLIN TAB 400MG 12/31/9999 2<strong>01</strong>2300037054568 LUFYLLIN-GG ELX 100-100 12/31/9999 2<strong>01</strong>2338779059808 LUGOLS SOL 12/31/9999 2<strong>01</strong>2300023320503 LUMIGAN SOL 0.<strong>01</strong>% 12/31/9999 2<strong>01</strong>2300023320505 LUMIGAN SOL 0.<strong>01</strong>% 12/31/9999 2<strong>01</strong>2300023320508 LUMIGAN SOL 0.<strong>01</strong>% 12/31/9999 2<strong>01</strong>2300023918703 LUMIGAN SOL 0.03% 12/31/9999 2<strong>01</strong>2300023918705 LUMIGAN SOL 0.03% 12/31/9999 2<strong>01</strong>2300023918707 LUMIGAN SOL 0.03% 12/31/9999 2<strong>01</strong>2358468<strong>01</strong>60<strong>01</strong> LUMIZYME INJ 50MG 12/31/9999 2<strong>01</strong>2363402<strong>01</strong>9030 LUNESTA TAB 1MG 12/31/9999 2<strong>01</strong>2363402<strong>01</strong>9110 LUNESTA TAB 2MG 12/31/9999 2<strong>01</strong>2363402<strong>01</strong>9310 LUNESTA TAB 3MG 12/31/9999 2<strong>01</strong>2300074228203 LUPR DEP-PED INJ 11.25MG 12/31/9999 2<strong>01</strong>2300074377903 LUPR DEP-PED INJ 11.25MG 12/31/9999 2<strong>01</strong>2300074244003 LUPR DEP-PED INJ 15MG 12/31/9999 2<strong>01</strong>2300074969403 LUPR DEP-PED INJ 30MG 12/31/9999 2<strong>01</strong>2300074210803 LUPR DEP-PED INJ 7.5MG 12/31/9999 2<strong>01</strong>2300074366303 LUPRON DEPOT INJ 11.25MG 12/31/9999 2<strong>01</strong>2300074334603 LUPRON DEPOT INJ 22.5MG 12/31/9999 2<strong>01</strong>2300074364103 LUPRON DEPOT INJ 3.75MG 12/31/9999 2<strong>01</strong>2300074368303 LUPRON DEPOT INJ 30MG 12/31/9999 2<strong>01</strong>2300074347303 LUPRON DEPOT INJ 45MG 12/31/9999 2<strong>01</strong>2300074364203 LUPRON DEPOT INJ 7.5MG 12/31/9999 2<strong>01</strong>23233590<strong>01</strong>716 LUSAIR LIQ 12/31/9999 2<strong>01</strong>2351672132603 LUSTRA CRE 4% 12/31/9999 2<strong>01</strong>2351672132703 LUSTRA-AF CRE 4% 12/31/9999 2<strong>01</strong>2351672132802 LUSTRA-ULTRA CRE 4% 12/31/9999 2<strong>01</strong>23

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