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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59630091310 XODOL TAB 7.5-300 12/31/9999 2<strong>01</strong>2368453091310 XODOL TAB 7.5-300 05/12/2<strong>01</strong>3 2<strong>01</strong>2350242004062 XOLAIR SOL 150MG 12/31/9999 2<strong>01</strong>2313478000305 XOLEGEL GEL 2% 06/29/2<strong>01</strong>3 2<strong>01</strong>2366992031<strong>01</strong>0 XOLOX TAB 10-500MG 04/19/2020 2<strong>01</strong>2363402051124 XOPENEX NEB 0.31MG 12/31/9999 2<strong>01</strong>2363402051224 XOPENEX NEB 0.63MG 12/31/9999 2<strong>01</strong>2363402051324 XOPENEX NEB 1.25/3ML 12/31/9999 2<strong>01</strong>2363402051530 XOPENEX CONC NEB 1.25/0.5 12/31/9999 2<strong>01</strong>23634020510<strong>01</strong> XOPENEX HFA AER 12/31/9999 2<strong>01</strong>2300469<strong>01</strong>2599 XTANDI CAP 40MG 12/31/9999 2<strong>01</strong>2358980062510 X-VIATE CRE 40% 12/31/9999 2<strong>01</strong>2358980062530 X-VIATE CRE 40% 12/31/9999 2<strong>01</strong>2358980062570 X-VIATE CRE 40% 12/31/9999 2<strong>01</strong>2358980062415 X-VIATE GEL 40% 12/31/9999 2<strong>01</strong>2358980062380 X-VIATE LOT 40% 12/31/9999 2<strong>01</strong>2351552075405 XYLITOL POW 12/31/9999 2<strong>01</strong>2351552075408 XYLITOL POW 12/31/9999 2<strong>01</strong>2363323048157 XYLO/EPI INJ 0.5% 12/31/9999 2<strong>01</strong>2363323048320 XYLO/EPI INJ 2% 11/30/2<strong>01</strong>2 2<strong>01</strong>2363323048327 XYLO/EPI INJ 2% 12/31/9999 2<strong>01</strong>2363323048357 XYLO/EPI INJ 2% 12/31/9999 2<strong>01</strong>2363323048217 XYLO/EPI 1%- INJ 1:100000 12/31/9999 2<strong>01</strong>2363323048227 XYLO/EPI 1%- INJ 1:100000 12/31/9999 2<strong>01</strong>2363323048257 XYLO/EPI 1%- INJ 1:100000 12/31/9999 2<strong>01</strong>230<strong>01</strong>86033036 XYLOCAINE GEL 2% 12/31/9999 2<strong>01</strong>2363323047930 XYLOCAINE GEL 2% 06/30/2<strong>01</strong>3 2<strong>01</strong>230<strong>01</strong>86<strong>01</strong>35<strong>01</strong> XYLOCAINE INJ 0.5% 12/31/2<strong>01</strong>2 2<strong>01</strong>2363323048450 XYLOCAINE INJ 0.5% 05/30/2<strong>01</strong>4 2<strong>01</strong>2363323048457 XYLOCAINE INJ 0.5% 12/31/9999 2<strong>01</strong>230<strong>01</strong>86<strong>01</strong>10<strong>01</strong> XYLOCAINE INJ 1% 05/31/2<strong>01</strong>3 2<strong>01</strong>230<strong>01</strong>86<strong>01</strong>45<strong>01</strong> XYLOCAINE INJ 1% 05/31/2<strong>01</strong>3 2<strong>01</strong>2363323048520 XYLOCAINE INJ 1% 10/30/2<strong>01</strong>4 2<strong>01</strong>2363323048527 XYLOCAINE INJ 1% 12/31/9999 2<strong>01</strong>2363323048550 XYLOCAINE INJ 1% 03/30/2<strong>01</strong>5 2<strong>01</strong>2363323048557 XYLOCAINE INJ 1% 12/31/9999 2<strong>01</strong>230<strong>01</strong>86<strong>01</strong>55<strong>01</strong> XYLOCAINE INJ 2% 05/31/2<strong>01</strong>3 2<strong>01</strong>2363323048610 XYLOCAINE INJ 2% 05/30/2<strong>01</strong>4 2<strong>01</strong>2363323048617 XYLOCAINE INJ 2% 12/31/9999 2<strong>01</strong>2363323048620 XYLOCAINE INJ 2% 12/30/2<strong>01</strong>4 2<strong>01</strong>2363323048627 XYLOCAINE INJ 2% 12/31/9999 2<strong>01</strong>2363323048650 XYLOCAINE INJ 2% 03/30/2<strong>01</strong>4 2<strong>01</strong>2363323048657 XYLOCAINE INJ 2% 12/31/9999 2<strong>01</strong>2363323049889 XYLOCAINE INJ 2% 12/31/9999 2<strong>01</strong>230<strong>01</strong>86<strong>01</strong>37<strong>01</strong> XYLOCAINE INJ MPF 0.5% 03/31/2<strong>01</strong>3 2<strong>01</strong>2363323049150 XYLOCAINE INJ MPF 0.5% 11/30/2<strong>01</strong>3 2<strong>01</strong>2363323049157 XYLOCAINE INJ MPF 0.5% 12/31/9999 2<strong>01</strong>230<strong>01</strong>86<strong>01</strong>12<strong>01</strong> XYLOCAINE INJ -MPF 1% 12/31/2<strong>01</strong>2 2<strong>01</strong>230<strong>01</strong>86<strong>01</strong>1291 XYLOCAINE INJ -MPF 1% <strong>01</strong>/31/2<strong>01</strong>3 2<strong>01</strong>230<strong>01</strong>86021003 XYLOCAINE INJ -MPF 1% 02/28/2<strong>01</strong>3 2<strong>01</strong>230<strong>01</strong>86023003 XYLOCAINE INJ -MPF 1% 03/31/2<strong>01</strong>3 2<strong>01</strong>230<strong>01</strong>86027613 XYLOCAINE INJ -MPF 1% 05/31/2<strong>01</strong>3 2<strong>01</strong>230<strong>01</strong>86027713 XYLOCAINE INJ -MPF 1% 06/30/2<strong>01</strong>3 2<strong>01</strong>230<strong>01</strong>86027844 XYLOCAINE INJ -MPF 1% 12/31/9999 2<strong>01</strong>2363323049202 XYLOCAINE INJ -MPF 1% 04/30/2<strong>01</strong>5 2<strong>01</strong>2363323049205 XYLOCAINE INJ -MPF 1% 03/30/2<strong>01</strong>4 2<strong>01</strong>2363323049227 XYLOCAINE INJ -MPF 1% 12/31/9999 2<strong>01</strong>2363323049230 XYLOCAINE INJ -MPF 1% 06/30/2<strong>01</strong>4 2<strong>01</strong>2363323049231 XYLOCAINE INJ -MPF 1% 12/31/9999 2<strong>01</strong>2363323049237 XYLOCAINE INJ -MPF 1% 12/31/9999 2<strong>01</strong>23

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