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

00245017830 PRENEXA CAP 12/31/9999 2012300573283010 PREP H HC CRE 1% 12/31/9999 2012300573286908 PREPARATIO H CRE TOTABLE 12/31/9999 2012300573284010 PREPARATIO H GEL 12/31/9999 2012300573284020 PREPARATIO H GEL 12/31/9999 2012300573284108 PREPARATIO H GEL TOTABLE 12/31/9999 2012300573055807 PREPARATIO H PAD TOTABLE 12/31/9999 2012300573286810 PREPARATION CRE H 12/31/9999 2012300573286820 PREPARATION CRE H 12/31/9999 2012300573287110 PREPARATION OIN H 12/31/9999 2012300573287120 PREPARATION OIN H 12/31/9999 2012300573055607 PREPARATION PAD H 12/31/9999 2012300573055610 PREPARATION PAD H 12/31/9999 2012300573055620 PREPARATION PAD H 12/31/9999 2012300573288310 PREPARATION SUP H 12/31/9999 2012300573288320 PREPARATION SUP H 12/31/9999 2012300573288330 PREPARATION SUP H 12/31/9999 2012345802035410 PREP-HEM OIN 12/31/9999 2012300009335901 PREPIDIL GEL .5MG/3GM 12/31/9999 2012300009335902 PREPIDIL GEL 0.5MG/3G 12/31/9999 2012352544007960 PREQUE 10 TAB 12/31/9999 2012359702071060 PREQUE 10 TAB 12/31/9999 2012364764054130 PREVACID CAP 15MG DR 12/31/9999 2012364764004613 PREVACID CAP 30MG DR 12/31/9999 2012364764004619 PREVACID CAP 30MG DR 10/31/2013 2012364764054311 PREVACID TAB 15MG STB 12/31/9999 2012364764054411 PREVACID TAB 30MG STB 12/31/9999 2012300067628614 PREVACID 24H CAP 15MG DR 12/31/9999 2012300067628628 PREVACID 24H CAP 15MG DR 12/31/9999 2012300067628642 PREVACID 24H CAP 15MG DR 12/31/9999 2012300245003623 PREVALITE POW 4GM 12/31/9999 2012300245003642 PREVALITE POW 4GM PK 12/31/9999 2012300245003660 PREVALITE POW 4GM PK 12/31/9999 2012300126028666 PREVIDENT CRE 5000 PLS 12/31/9999 2012300126028733 PREVIDENT CRE 5000 PLS 12/31/9999 2012300126028766 PREVIDENT CRE 5000 PLS 12/31/9999 2012300126028866 PREVIDENT CRE 5000 PLS 12/31/9999 2012300126028802 PREVIDENT GEL 1.1% BER 12/31/9999 2012300126008802 PREVIDENT GEL 1.1% MIN 12/31/9999 2012300126001661 PREVIDENT PST 1.1% 12/31/9999 2012300126007592 PREVIDENT PST 5000 BST 12/31/9999 2012300126007692 PREVIDENT PST 5000 BST 12/31/9999 2012300126007061 PREVIDENT PST 5000 SEN 12/31/9999 2012300126017916 PREVIDENT SOL RINSE 12/31/9999 2012300603764217 PREVIFEM TAB 12/31/9999 2012364764070201 PREVPAC MIS 12/31/9999 2012359676056401 PREZISTA TAB 150MG 12/31/9999 2012359676056101 PREZISTA TAB 400MG 12/31/9999 2012359676056201 PREZISTA TAB 600MG 12/31/9999 2012359676056301 PREZISTA TAB 75MG 12/31/9999 2012318860072010 PRIALT INJ 100MCG 12/31/9999 2012359075072010 PRIALT INJ 100MCG 04/01/2013 2012318860072310 PRIALT INJ 25MCG/ML 12/31/9999 2012318860072210 PRIALT INJ 500MCG 12/31/9999 2012359075072210 PRIALT INJ 500MCG 04/01/2013 2012300088210003 PRIFTIN TAB 150MG 12/31/9999 2012300186060631 PRILOSEC CAP 10MG 12/31/9999 2012300186060682 PRILOSEC CAP 10MG 12/31/9999 2012300186074231 PRILOSEC CAP 20MG 12/31/9999 2012300186074282 PRILOSEC CAP 20MG 12/31/9999 20123