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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0009363<strong>01</strong>95 ADAPALENE GEL 0.1% 12/31/9999 2<strong>01</strong>2351672415506 ADAPALENE GEL 0.1% 12/31/9999 2<strong>01</strong>2368462040355 ADAPALENE GEL 0.1% 12/31/9999 2<strong>01</strong>23511440050<strong>01</strong> ADCETRIS INJ 50MG 12/31/9999 2<strong>01</strong>2366302046760 ADCIRCA TAB 20MG 12/31/9999 2<strong>01</strong>2300555076402 ADDERALL TAB 10MG 12/31/9999 2<strong>01</strong>2300555076502 ADDERALL TAB 12.5MG 12/31/9999 2<strong>01</strong>2300555076602 ADDERALL TAB 15MG 12/31/9999 2<strong>01</strong>2300555076702 ADDERALL TAB 20MG 12/31/9999 2<strong>01</strong>2300555076802 ADDERALL TAB 30MG 12/31/9999 2<strong>01</strong>2300555076202 ADDERALL TAB 5MG 12/31/9999 2<strong>01</strong>2300555076302 ADDERALL TAB 7.5MG 12/31/9999 2<strong>01</strong>23540920383<strong>01</strong> ADDERALL XR CAP 10MG 12/31/9999 2<strong>01</strong>23540920385<strong>01</strong> ADDERALL XR CAP 15MG 12/31/9999 2<strong>01</strong>23540920387<strong>01</strong> ADDERALL XR CAP 20MG 12/31/9999 2<strong>01</strong>23540920389<strong>01</strong> ADDERALL XR CAP 25MG 12/31/9999 2<strong>01</strong>23540920391<strong>01</strong> ADDERALL XR CAP 30MG 12/31/9999 2<strong>01</strong>23540920381<strong>01</strong> ADDERALL XR CAP 5MG 12/31/9999 2<strong>01</strong>2300469823414 ADENOCARD INJ 12MG/4ML 12/31/9999 2<strong>01</strong>2300469823412 ADENOCARD INJ 6MG/2ML 12/31/9999 2<strong>01</strong>2300469087120 ADENOSCAN INJ 3MG/ML 12/31/9999 2<strong>01</strong>2300469087130 ADENOSCAN INJ 3MG/ML 12/31/9999 2<strong>01</strong>232502103<strong>01</strong>04 ADENOSINE INJ 12MG/4ML 12/31/9999 2<strong>01</strong>232502103<strong>01</strong>76 ADENOSINE INJ 12MG/4ML 12/31/9999 2<strong>01</strong>23553900068<strong>01</strong> ADENOSINE INJ 12MG/4ML 12/31/9999 2<strong>01</strong>2363323065104 ADENOSINE INJ 12MG/4ML 12/31/9999 2<strong>01</strong>2364679063002 ADENOSINE INJ 12MG/4ML 12/31/9999 2<strong>01</strong>2364679063008 ADENOSINE INJ 12MG/4ML 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9006302 ADENOSINE INJ 3MG/ML 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9006303 ADENOSINE INJ 3MG/ML 12/31/9999 2<strong>01</strong>23006416113<strong>01</strong> ADENOSINE INJ 6MG/2ML 12/31/9999 2<strong>01</strong>2300641611310 ADENOSINE INJ 6MG/2ML 12/31/9999 2<strong>01</strong>2317478054202 ADENOSINE INJ 6MG/2ML 12/31/9999 2<strong>01</strong>232502103<strong>01</strong>02 ADENOSINE INJ 6MG/2ML 12/31/9999 2<strong>01</strong>232502103<strong>01</strong>72 ADENOSINE INJ 6MG/2ML 12/31/9999 2<strong>01</strong>2355390006710 ADENOSINE INJ 6MG/2ML 12/31/9999 2<strong>01</strong>2363323065102 ADENOSINE INJ 6MG/2ML 12/31/9999 2<strong>01</strong>23646790630<strong>01</strong> ADENOSINE INJ 6MG/2ML 12/31/9999 2<strong>01</strong>2364679063007 ADENOSINE INJ 6MG/2ML 12/31/9999 2<strong>01</strong>23578440<strong>01</strong>9<strong>01</strong> ADIPEX-P CAP 37.5MG 12/31/9999 2<strong>01</strong>23578440009<strong>01</strong> ADIPEX-P TAB 37.5MG 12/31/9999 2<strong>01</strong>2310337081506 ADOXA CAP 150MG 12/31/9999 2<strong>01</strong>231033708<strong>01</strong>50 ADOXA TAB 75MG 12/31/9999 2<strong>01</strong>2342023<strong>01</strong><strong>01</strong><strong>01</strong> ADRENALIN INJ 1MG/ML 12/31/9999 2<strong>01</strong>2342023<strong>01</strong><strong>01</strong>10 ADRENALIN INJ 1MG/ML 12/31/9999 2<strong>01</strong>2342023<strong>01</strong>2225 ADRENALIN INJ 1MG/ML 12/31/9999 2<strong>01</strong>2342023<strong>01</strong>03<strong>01</strong> ADRENALIN SOL 1:1000 12/31/9999 2<strong>01</strong>23553900233<strong>01</strong> ADRIAMYC INJ 50MG 12/31/9999 2<strong>01</strong>2355390023110 ADRIAMYCIN INJ 10MG 12/31/9999 2<strong>01</strong>2355390023210 ADRIAMYCIN INJ 20MG 12/31/9999 2<strong>01</strong>2355390023610 ADRIAMYCIN INJ 2MG/ML 12/31/9999 2<strong>01</strong>23553900237<strong>01</strong> ADRIAMYCIN INJ 2MG/ML 12/31/9999 2<strong>01</strong>23553900238<strong>01</strong> ADRIAMYCIN INJ 2MG/ML 12/31/9999 2<strong>01</strong>23007033<strong>01</strong>513 ADRUCIL INJ 50MG/ML 12/31/9999 2<strong>01</strong>23007033<strong>01</strong>812 ADRUCIL INJ 50MG/ML 12/31/9999 2<strong>01</strong>23007033<strong>01</strong>912 ADRUCIL INJ 50MG/ML 12/31/9999 2<strong>01</strong>2337205022405 ADV FORMULA DRO EYE 12/31/9999 2<strong>01</strong>230<strong>01</strong>73069500 ADVAIR DISKU AER 100/50 12/31/9999 2<strong>01</strong>230<strong>01</strong>73069504 ADVAIR DISKU AER 100/50 12/31/9999 2<strong>01</strong>230<strong>01</strong>73069600 ADVAIR DISKU AER 250/50 12/31/9999 2<strong>01</strong>23

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