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

51552028104 BORAX GRA 12/31/9999 2012351552028106 BORAX GRA 12/31/9999 2012351552028108 BORAX GRA 12/31/9999 2012349348071236 BORIC ACID POW 12/31/9999 2012363868020506 BORIC ACID POW 12/31/9999 2012300069013501 BOSULIF TAB 100MG 12/31/9999 2012300069013601 BOSULIF TAB 500MG 12/31/9999 2012351552123007 BOSWELLIA POW SERRATA 12/31/9999 2012300023114501 BOTOX INJ 100UNIT 12/31/9999 2012300023392102 BOTOX INJ 200UNIT 12/31/9999 2012300023923201 BOTOX COSMET INJ 100UNIT 12/31/9999 2012300023391950 BOTOX COSMET INJ 50UNIT 12/31/9999 2012342192010406 BP 10-1 EMU 12/31/9999 2012342192010316 BP CLEANSING EMU 10-4% 12/31/9999 2012342192032430 BP FOLINATAL TAB PLUS B 12/31/9999 2012342192031830 BP MULTINATL CHW PLUS 12/31/9999 2012342192031930 BP MULTINATL TAB PLUS 12/31/9999 2012342192030401 BP POLY-650 TAB 12/31/9999 2012342192030160 BP VIT 3 CAP 12/31/9999 2012310267102501 B-PLEX TAB 12/31/9999 2012310267102505 B-PLEX TAB 12/31/9999 2012310267102701 B-PLEX PLUS TAB 12/31/9999 2012310267102705 B-PLEX PLUS TAB 12/31/9999 2012344183031316 BPM-PE-DM LIQ 4-10-20 12/31/9999 2012344183031116 BPM-PSE-DM LIQ 4-20-20 12/31/9999 2012342192010515 BPO GEL 4% 12/31/9999 2012342192010615 BPO GEL 8% 12/31/9999 2012342192011003 BPO CREAMY KIT 4% WASH 12/31/9999 2012342192011103 BPO CREAMY KIT 8% WASH 12/31/9999 2012355566850502 BRAVELLE INJ 75UNIT 12/31/9999 2012355566850506 BRAVELLE INJ 75UNIT 12/31/9999 2012310019011501 BREVIBLOC INJ 10MG/ML 12/31/9999 2012310019011539 BREVIBLOC INJ 10MG/ML 12/31/9999 2012310019007587 BREVIBLOC SOL 12/31/9999 2012310019005561 BREVIBLOC SOL 10MG/ML 12/31/9999 2012352544025428 BREVICON TAB 0.5/35 12/31/9999 2012342023010601 BREVITAL SOD INJ 2.5GM 12/31/9999 2012342023010501 BREVITAL SOD INJ 500MG 12/31/9999 2012368462031629 BRIELLYN TAB 12/31/9999 2012351552061406 BRIJ 35 LIQ 12/31/9999 2012351552061506 BRIJ 700 LIQ 12/31/9999 2012351552100706 BRIJ 93 LIQ 12/31/9999 2012300186077739 BRILINTA TAB 90MG 12/31/9999 2012300186077760 BRILINTA TAB 90MG 12/31/9999 2012361314014405 BRIMONIDINE SOL 0.15% 12/31/9999 2012361314014410 BRIMONIDINE SOL 0.15% 12/31/9999 2012361314014415 BRIMONIDINE SOL 0.15% 12/31/9999 2012317478071510 BRIMONIDINE SOL 0.2% OP 12/31/9999 2012317478071511 BRIMONIDINE SOL 0.2% OP 12/31/9999 2012317478071512 BRIMONIDINE SOL 0.2% OP 12/31/9999 2012324208041105 BRIMONIDINE SOL 0.2% OP 12/31/9999 2012324208041110 BRIMONIDINE SOL 0.2% OP 12/31/9999 2012324208041115 BRIMONIDINE SOL 0.2% OP 12/31/9999 2012360758086605 BRIMONIDINE SOL 0.2% OP 12/31/9999 2012360758086610 BRIMONIDINE SOL 0.2% OP 12/31/9999 2012360758086615 BRIMONIDINE SOL 0.2% OP 12/31/9999 2012361314014305 BRIMONIDINE SOL 0.2% OP 12/31/9999 2012361314014310 BRIMONIDINE SOL 0.2% OP 12/31/9999 2012361314014315 BRIMONIDINE SOL 0.2% OP 12/31/9999 2012300536088085 BROMALINE SOL 1-15/5ML 03/31/2013 20123