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

67618015132 BETADINE SRG SOL 7.5% 12/31/9999 2012300023438505 BETAGAN SOL 0.5% OP 12/31/9999 2012300023438510 BETAGAN SOL 0.5% OP 12/31/9999 2012300023438515 BETAGAN SOL 0.5% OP 12/31/9999 2012338779104008 BETAINE POW ANHYDROU 12/31/9999 2012351552062801 BETAMETH ACE POW 12/31/9999 2012351552062802 BETAMETH ACE POW 12/31/9999 2012351552062805 BETAMETH ACE POW 12/31/9999 2012300168005515 BETAMETH DIP CRE 0.05% 12/31/9999 2012300168005546 BETAMETH DIP CRE 0.05% 12/31/9999 2012300472038015 BETAMETH DIP CRE 0.05% 12/31/9999 2012300472038045 BETAMETH DIP CRE 0.05% 12/31/9999 2012351672127401 BETAMETH DIP CRE 0.05% 12/31/9999 2012351672127406 BETAMETH DIP CRE 0.05% 12/31/9999 2012300168005760 BETAMETH DIP LOT 0.05% 12/31/9999 2012300472138202 BETAMETH DIP LOT 0.05% 12/31/9999 2012345802002146 BETAMETH DIP LOT 0.05% 12/31/9999 2012300168005615 BETAMETH DIP OIN 0.05% 12/31/9999 2012300168005646 BETAMETH DIP OIN 0.05% 12/31/9999 2012300472038115 BETAMETH DIP OIN 0.05% 12/31/9999 2012300472038145 BETAMETH DIP OIN 0.05% 12/31/9999 2012300168004015 BETAMETH VAL CRE 0.1% 12/31/9999 2012300168004046 BETAMETH VAL CRE 0.1% 12/31/9999 2012300472037015 BETAMETH VAL CRE 0.1% 12/31/9999 2012300472037045 BETAMETH VAL CRE 0.1% 12/31/9999 2012351672126901 BETAMETH VAL CRE 0.1% 12/31/9999 2012351672126906 BETAMETH VAL CRE 0.1% 12/31/9999 2012300168004160 BETAMETH VAL LOT 0.1% 12/31/9999 2012300472037202 BETAMETH VAL LOT 0.1% 12/31/9999 2012354879000460 BETAMETH VAL LOT 0.1% 12/31/9999 2012300168003315 BETAMETH VAL OIN 0.1% 12/31/9999 2012300168003346 BETAMETH VAL OIN 0.1% 12/31/9999 2012300472037115 BETAMETH VAL OIN 0.1% 12/31/9999 2012300472037145 BETAMETH VAL OIN 0.1% 12/31/9999 2012350419010910 BETAPACE TAB 120MG 12/31/9999 2012350419010610 BETAPACE TAB 160MG 12/31/9999 2012350419010710 BETAPACE TAB 240MG 12/31/9999 2012350419010510 BETAPACE TAB 80MG 12/31/9999 2012350419011906 BETAPACE AF TAB 120MG 12/31/9999 2012350419011606 BETAPACE AF TAB 160MG 12/31/9999 2012350419011506 BETAPACE AF TAB 80MG 12/31/9999 2012300517072001 BETA-PHOS/AC INJ 3-3MG/ML 12/31/9999 2012367618020001 BETASEPT LIQ 4% 12/31/9999 2012367618020004 BETASEPT LIQ 4% 12/31/9999 2012367618020008 BETASEPT LIQ 4% 12/31/9999 2012367618020016 BETASEPT LIQ 4% 12/31/9999 2012367618020030 BETASEPT LIQ 4% 12/31/9999 2012367618020032 BETASEPT LIQ 4% 12/31/9999 2012350419052335 BETASERON INJ 0.3MG 12/31/9999 2012300093067315 BETA-VAL CRE 0.1% 09/30/2013 2012300093067395 BETA-VAL CRE 0.1% 09/30/2013 2012300093067139 BETA-VAL LOT 0.1% 09/30/2013 2012317478070510 BETAXOLOL SOL 0.5% OP 12/31/9999 2012317478070511 BETAXOLOL SOL 0.5% OP 12/31/9999 2012361314024501 BETAXOLOL SOL 0.5% OP 12/31/9999 2012361314024502 BETAXOLOL SOL 0.5% OP 12/31/9999 2012361314024503 BETAXOLOL SOL 0.5% OP 12/31/9999 2012310702001301 BETAXOLOL TAB 10MG 12/31/9999 2012342806003801 BETAXOLOL TAB 10MG 12/31/9999 2012352152017902 BETAXOLOL TAB 10MG 12/31/9999 20123