Alabama Medicaid Maximum Allowable Cost List

More documents

Recommendations

Info

Drug Brand Name Alabama Medicaid Maximum Allowable Cost List GCN - Generic Drug Description Drug Strength/Dosage Description Dose Form Description BUTORPHANOL TARTRATE BUTORPHANOL TARTRATE 2MG/ML VIAL STADOL BUTORPHANOL TARTRATE 1MG/ML VIAL STADOL BUTORPHANOL TARTRATE 2MG/ML VIAL CALCIUM 600+MINERALS CA CARBONATE/MIN/VITAMIN D2 TABLET DEXATUSS CA/D-METHORPHAN HB/GUAIFEN/POT LIQUID CARENATE 600 CA/DOSS/FA/IRON,CARB/P-NAT VIT 90-1-600MG COMBO. PKG CYTRA-3 CA/K CIT/POTASS/SOD/SODIUM CIT 500-550/5 SYRUP TRICITRATES CA/K CIT/POTASS/SOD/SODIUM CIT 500-550/5 SOLUTION AKORN BALANCED SALT CAL/MAGNESIUM/POTASSIUM/SODIUM SOLUTION AMO ENDOSOL CAL/MAGNESIUM/POTASSIUM/SODIUM SOLUTION BALANCED SALT CAL/MAGNESIUM/POTASSIUM/SODIUM SOLUTION BSS CAL/MAGNESIUM/POTASSIUM/SODIUM SOLUTION CALCITRIOL CALCITRIOL 0.25MCG CAPSULE CALCITRIOL CALCITRIOL 0.5MCG CAPSULE ANATACID CALCIUM CARBONATE 500MG TAB CHEW ANTACID CALCIUM CARBONATE 500MG TAB CHEW ANTACID CALCIUM CARBONATE 750MG TAB CHEW ANTACID EXTRA STRENGTH CALCIUM CARBONATE 750MG TAB CHEW CAL-600 CALCIUM CARBONATE 1.5G TABLET CALCARB 600 CALCIUM CARBONATE 1.5G TABLET CAL-CARB FORTE CALCIUM CARBONATE 1.25G TABLET CALCICARB CALCIUM CARBONATE 650MG TABLET CALCI-CHEW CALCIUM CARBONATE 1.25G TAB CHEW CALCIUM CALCIUM CARBONATE 1.5G TABLET CALCIUM CALCIUM CARBONATE 600MG TABLET CALCIUM 500 CALCIUM CARBONATE 1.25G TABLET CALCIUM 600 CALCIUM CARBONATE 1.5G TABLET CALCIUM ANTACID CALCIUM CARBONATE 500MG TAB CHEW CALCIUM ANTACID EXTRA STRENGTH CALCIUM CARBONATE 750MG TAB CHEW CALCIUM CARBONATE CALCIUM CARBONATE 1.25G TAB CHEW CALCIUM CARBONATE CALCIUM CARBONATE 1.25G TABLET CALCIUM CARBONATE CALCIUM CARBONATE 1.5G TABLET CALCIUM CARBONATE CALCIUM CARBONATE 500MG TAB CHEW CALCIUM CARBONATE CALCIUM CARBONATE 600MG TABLET CALCIUM CARBONATE CALCIUM CARBONATE 650MG TABLET CALCIUM CARBONATE 600 CALCIUM CARBONATE 1.5G TABLET CALCIUM OYSTER SHELL CALCIUM CARBONATE 1.25G TABLET CALCIUM-600 CALCIUM CARBONATE 1.5G TABLET CALTRATE-600 CALCIUM CARBONATE 1.5G TABLET CALTREX-600 CALCIUM CARBONATE 1.5G TABLET CHEWABLE ANTACID CALCIUM CARBONATE 500MG TAB CHEW DICARBOSIL CALCIUM CARBONATE 500MG TAB CHEW HM ANTACID CALCIUM CARBONATE 500MG TAB CHEW HM CALCIUM ANTACID CALCIUM CARBONATE 500MG TAB CHEW MYLANTA CALCIUM CARBONATE 750MG TAB CHEW OS-CAL 500 CALCIUM CARBONATE 1.25G TAB CHEW OS-CAL 500 CALCIUM CARBONATE 1.25G TABLET OYSCO-500 CALCIUM CARBONATE 1.25G TABLET OYST-CAL-500 CALCIUM CARBONATE 1.25G TABLET OYSTER SHELL CALCIUM CARBONATE 1.25G TABLET OYSTER SHELL CALCIUM CALCIUM CARBONATE 1.25G TABLET OYSTER TABS CALCIUM CARBONATE 1.25G TABLET SB ANTACID CALCIUM CARBONATE 500MG TAB CHEW SB ANTACID CALCIUM CARBONATE 750MG TAB CHEW SB OYSTER CALCIUM CALCIUM CARBONATE 1.25G TABLET TITRALAC EXTRA STRENGTH CALCIUM CARBONATE 750MG TAB CHEW TUMS CALCIUM CARBONATE 500MG TAB CHEW TUMS CALCIUM CARBONATE 750MG TAB CHEW TUMS 500 CALCIUM CARBONATE 1.25G TAB CHEW TUMS CALCIUM FOR LIFE CALCIUM CARBONATE 750MG TAB CHEW TUMS CALCIUM FOR LIFE PMS CALCIUM CARBONATE 750MG TAB CHEW UNI-CAL 500 CALCIUM CARBONATE 1.25G TABLET V-R ANTACID CALCIUM CARBONATE 750MG TAB CHEW VR CALCIUM CALCIUM CARBONATE 1.25G TABLET X-STRENGTH ANTACID CALCIUM CARBONATE 750MG TAB CHEW ANTACID CALCIUM CARBONATE/MAG CARB 311-232MG TABLET MI-ACID CALCIUM CARBONATE/MAG CARB 311-232MG TABLET MYLANTA CALCIUM CARBONATE/MAG CARB 311-232MG TABLET CALCIUM CHLORIDE CALCIUM CHLORIDE 100MG/ML DISP SYRIN CALCIUM CHLORIDE CALCIUM CHLORIDE 100MG/ML VIAL CALCITRATE CALCIUM CITRATE 950MG TABLET CALCIUM CITRATE CALCIUM CITRATE 200MG TABLET CALCIUM CITRATE CALCIUM CITRATE 950MG TABLET CITRACAL CALCIUM CITRATE 200MG TABLET CITRUS CALCIUM CALCIUM CITRATE 200MG TABLET Page 16 MAC list as of February 03.xls
Drug Brand Name Alabama Medicaid Maximum Allowable Cost List GCN - Generic Drug Description Drug Strength/Dosage Description Dose Form Description CALCIUM CITRATE W/VITAMIN D CALCIUM CITRATE/ERGOCALCIFEROL 1500-200 TABLET CALCIUM CITRATE + D CALCIUM CITRATE/VITAMIN D3 315MG-200 TABLET CALCIUM CITRATE W/VITAMIN D CALCIUM CITRATE/VITAMIN D3 315MG-200 TABLET CALCIUM CITRATE+D CALCIUM CITRATE/VITAMIN D3 315MG-200 TABLET CITRACAL + D CALCIUM CITRATE/VITAMIN D3 315MG-200 TABLET CALCIQUID CALCIUM GLUBIONATE 1.8G/5ML SYRUP CALCIUM GLUCONATE CALCIUM GLUCONATE 100MG/ML AMPUL CALCIUM GLUCONATE CALCIUM GLUCONATE 100MG/ML VIAL CALCIUM GLUCONATE CALCIUM GLUCONATE 500MG TABLET CALCIUM GLUCONATE CALCIUM GLUCONATE 650MG TABLET CAPOTEN CAPTOPRIL 100MG TABLET CAPOTEN CAPTOPRIL 12.5MG TABLET CAPOTEN CAPTOPRIL 25MG TABLET CAPOTEN CAPTOPRIL 50MG TABLET CAPTOPRIL CAPTOPRIL 100MG TABLET CAPTOPRIL CAPTOPRIL 12.5MG TABLET CAPTOPRIL CAPTOPRIL 25MG TABLET CAPTOPRIL CAPTOPRIL 50MG TABLET CAPOZIDE CAPTOPRIL/HYDROCHLOROTHIAZIDE 25-15MG TABLET CAPOZIDE CAPTOPRIL/HYDROCHLOROTHIAZIDE 25-25MG TABLET CAPOZIDE CAPTOPRIL/HYDROCHLOROTHIAZIDE 50-15MG TABLET CAPOZIDE CAPTOPRIL/HYDROCHLOROTHIAZIDE 50-25MG TABLET CAPTOPRIL/HYDROCHLOROTHIAZIDE CAPTOPRIL/HYDROCHLOROTHIAZIDE 25-15MG TABLET CAPTOPRIL/HYDROCHLOROTHIAZIDE CAPTOPRIL/HYDROCHLOROTHIAZIDE 25-25MG TABLET CAPTOPRIL/HYDROCHLOROTHIAZIDE CAPTOPRIL/HYDROCHLOROTHIAZIDE 50-15MG TABLET CAPTOPRIL/HYDROCHLOROTHIAZIDE CAPTOPRIL/HYDROCHLOROTHIAZIDE 50-25MG TABLET CARBASTAT CARBACHOL 0.01% VIAL CARBOPTIC CARBACHOL 3% DROPS MIOSTAT CARBACHOL 0.01% VIAL CARBAMAZEPINE CARBAMAZEPINE 100MG TAB CHEW CARBAMAZEPINE CARBAMAZEPINE 100MG/5ML ORAL SUSP CARBAMAZEPINE CARBAMAZEPINE 200MG TABLET EPITOL CARBAMAZEPINE 200MG TABLET TEGRETOL CARBAMAZEPINE 100MG TAB CHEW TEGRETOL CARBAMAZEPINE 200MG TABLET ATAMET CARBIDOPA/LEVODOPA 25-100MG TABLET ATAMET CARBIDOPA/LEVODOPA 25-250MG TABLET CARBIDOPA/LEVODOPA CARBIDOPA/LEVODOPA 10-100MG TABLET CARBIDOPA/LEVODOPA CARBIDOPA/LEVODOPA 25-100MG TABLET CARBIDOPA/LEVODOPA CARBIDOPA/LEVODOPA 25-100MG TABLET SA CARBIDOPA/LEVODOPA CARBIDOPA/LEVODOPA 25-250MG TABLET CARBIDOPA/LEVODOPA CARBIDOPA/LEVODOPA 50-200MG TABLET SA SINEMET-10/100 CARBIDOPA/LEVODOPA 10-100MG TABLET SINEMET-25/100 CARBIDOPA/LEVODOPA 25-100MG TABLET SINEMET-25/250 CARBIDOPA/LEVODOPA 25-250MG TABLET ANDEHIST CARBINOX MAL/P-EPHED HCL 15-1MG/ML DROPS ANDEHIST CARBINOX MAL/P-EPHED HCL 15-2MG/ML DROPS BIODEC CARBINOX MAL/P-EPHED HCL DROPS CARBINOXAMINE CARBINOX MAL/P-EPHED HCL 25-2MG/ML DROPS CARBINOXAMINE CARBINOX MAL/P-EPHED HCL 60-4MG/5ML SYRUP CARBINOXAMINE PSE CARBINOX MAL/P-EPHED HCL 15-2MG/5ML SYRUP CARDEC CARBINOX MAL/P-EPHED HCL 15-1MG/ML DROPS CARDEC-S CARBINOX MAL/P-EPHED HCL 60-4MG/5ML SYRUP COLDEC CARBINOX MAL/P-EPHED HCL 60-4MG TABLET COLDEC D CARBINOX MAL/P-EPHED HCL 90-8MG TABLET SA COLDEC TR CARBINOX MAL/P-EPHED HCL 120-8MG TAB.SR 12H CYDEC CARBINOX MAL/P-EPHED HCL 60-4MG/5ML SYRUP DURA-RON CARBINOX MAL/P-EPHED HCL 60-4MG/5ML SYRUP HYDRO-TUSSIN CBX CARBINOX MAL/P-EPHED HCL 15-2MG/5ML SYRUP PALGIC DS CARBINOX MAL/P-EPHED HCL 15-2MG/5ML SYRUP P-EPHED HCL/CARBINOX MAL CARBINOX MAL/P-EPHED HCL 15-2MG/5ML SYRUP RONDAMINE CARBINOX MAL/P-EPHED HCL 120-8MG TAB.SR 12H RONDAMINE CARBINOX MAL/P-EPHED HCL 60-4MG TABLET RONDEC CARBINOX MAL/P-EPHED HCL 60-4MG TABLET RONDEC-TR CARBINOX MAL/P-EPHED HCL 120-8MG TAB.SR 12H ANDEHIST-DM CARBINOX/DM HB/P-EPHED HCL 4-15-1/ML DROPS ANDEHIST-DM CARBINOX/DM HB/P-EPHED HCL 4-15-2/ML DROPS BIODEC-DM CARBINOX/DM HB/P-EPHED HCL DROPS BIODEC-DM CARBINOX/DM HB/P-EPHED HCL SYRUP CARBAXEFED DM RF CARBINOX/DM HB/P-EPHED HCL 4-15-1/ML DROPS CARBINOXAMINE COMPOUND CARBINOX/DM HB/P-EPHED HCL 15-60-4/5 SYRUP CARBINOXAMINE COMPOUND CARBINOX/DM HB/P-EPHED HCL 4-25-2/ML DROPS CARBODEX DM CARBINOX/DM HB/P-EPHED HCL 4-15-1/ML DROPS CARBOFED DM CARBINOX/DM HB/P-EPHED HCL 4-15-1/ML DROPS CARDEC DM CARBINOX/DM HB/P-EPHED HCL 4-15-1/ML DROPS Page 17 MAC list as of February 03.xls
Page 1 and 2: Drug Brand Name Alabama Medicaid Ma
Page 15: Drug Brand Name Alabama Medicaid Ma
Page 67 and 68:
Drug Brand Name Alabama Medicaid Ma
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77:
show all

Alabama Medicaid Maximum Allowable Cost List

Create successful ePaper yourself

Delete template?

Save as template?