Alabama Medicaid Maximum Allowable Cost List

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Drug Brand Name Alabama Medicaid Maximum Allowable Cost List GCN - Generic Drug Description Drug Strength/Dosage Description Dose Form Description CLORPRES CHLORTHALIDONE/CLONIDINE HCL 0.2-15MG TABLET CLORPRES CHLORTHALIDONE/CLONIDINE HCL 0.3-15MG TABLET CHLORZOXAZONE CHLORZOXAZONE 250MG TABLET CHLORZOXAZONE CHLORZOXAZONE 500MG TABLET EZE D.S. CHLORZOXAZONE 500MG TABLET PARAFON FORTE DSC CHLORZOXAZONE 500MG TABLET CHOLINE MAG TRISALICYLATE CHOL SAL/MAGNESIUM SALICYLATE 1000MG TABLET CHOLINE MAG TRISALICYLATE CHOL SAL/MAGNESIUM SALICYLATE 500MG TABLET CHOLINE MAG TRISALICYLATE CHOL SAL/MAGNESIUM SALICYLATE 500MG/5ML LIQUID CHOLINE MAG TRISALICYLATE CHOL SAL/MAGNESIUM SALICYLATE 750MG TABLET TRICOSAL CHOL SAL/MAGNESIUM SALICYLATE 1000MG TABLET TRICOSAL CHOL SAL/MAGNESIUM SALICYLATE 500MG TABLET TRICOSAL CHOL SAL/MAGNESIUM SALICYLATE 750MG TABLET TRILISATE CHOL SAL/MAGNESIUM SALICYLATE 1000MG TABLET TRILISATE CHOL SAL/MAGNESIUM SALICYLATE 500MG TABLET TRILISATE CHOL SAL/MAGNESIUM SALICYLATE 500MG/5ML LIQUID TRILISATE CHOL SAL/MAGNESIUM SALICYLATE 750MG TABLET CHOLESTYRAMINE CHOLESTYRAMINE/SUCROSE 4G PACKET CHOLESTYRAMINE CHOLESTYRAMINE/SUCROSE 4G POWDER LOCHOLEST CHOLESTYRAMINE/SUCROSE 4G PACKET QUESTRAN CHOLESTYRAMINE/SUCROSE 4G PACKET QUESTRAN CHOLESTYRAMINE/SUCROSE 4G POWDER M.T.E.-6 CHROM/CU/MANG/NAI/SE/ZNSO4 HEP 5-.075-1/1 VIAL TRACE METALS CHROM/CUPRIC CL/MANG/ZINC CL 0.8-.2-.16 VIAL CHROMIUM CHROMIC CHLORIDE 4MCG/ML VIAL CHROMIUM CHLORIDE CHROMIC CHLORIDE 4MCG/ML VIAL ACID REDUCER CIMETIDINE 200MG TABLET CIMETIDINE CIMETIDINE 200MG TABLET CIMETIDINE CIMETIDINE 300MG TABLET CIMETIDINE CIMETIDINE 400MG TABLET CIMETIDINE CIMETIDINE 800MG TABLET HEARTBURN 200 CIMETIDINE 200MG TABLET HEARTBURN RELIEF CIMETIDINE 200MG TABLET HM HEARTBURN RELIEF CIMETIDINE 200MG TABLET SB CIMETIDINE CIMETIDINE 200MG TABLET TAGAMET CIMETIDINE 300MG TABLET TAGAMET CIMETIDINE 400MG TABLET TAGAMET CIMETIDINE 800MG TABLET TAGAMET HB CIMETIDINE 200MG TABLET CIMETIDINE CIMETIDINE HCL 150MG/ML VIAL CIMETIDINE HCL CIMETIDINE HCL 300MG/5ML LIQUID CISPLATIN CISPLATIN 1MG/ML VIAL PLATINOL-AQ CISPLATIN 1MG/ML VIAL K-LYTE/CL CIT AC/POT BICARB/POT CHLORIDE 25MEQ TABLET EFF POTASSIUM CHLORIDE CIT AC/POT BICARB/POT CHLORIDE 25MEQ TABLET EFF EFFER-K CIT AC/POTASSIUM BICARBONATE 25MEQ TABLET EFF K EFFERVESCENT CIT AC/POTASSIUM BICARBONATE 25MEQ TABLET EFF KLOR-CON/EF CIT AC/POTASSIUM BICARBONATE 25MEQ TABLET EFF K-LYTE CIT AC/POTASSIUM BICARBONATE 25MEQ TABLET EFF POTASSIUM CIT AC/POTASSIUM BICARBONATE 25MEQ TABLET EFF POTASSIUM BICARBONATE CIT AC/POTASSIUM BICARBONATE 25MEQ TABLET EFF CYTRA-K CITRIC ACID/POTASSIUM CITRATE 1002-3300 PACKET CYTRA-K CITRIC ACID/POTASSIUM CITRATE 334-1100/5 SOLUTION POTASSIUM CITRATE/CITRIC ACID CITRIC ACID/POTASSIUM CITRATE 334-1100/5 SOLUTION BICITRA CITRIC ACID/SODIUM CITRATE 334-500MG SOLUTION CYTRA-2 CITRIC ACID/SODIUM CITRATE 334-500MG SOLUTION ORACIT CITRIC ACID/SODIUM CITRATE 640-490MG SOLUTION SODIUM CITRATE & CITRIC ACID CITRIC ACID/SODIUM CITRATE 334-500MG SOLUTION CLADRIBINE CLADRIBINE 1MG/ML VIAL CLEMASTINE FUMARATE CLEMASTINE FUMARATE 0.67MG/5ML SYRUP CLEMASTINE FUMARATE CLEMASTINE FUMARATE 1.34MG TABLET CLEMASTINE FUMARATE CLEMASTINE FUMARATE 2.68MG TABLET DAILYHIST-D CLEMASTINE FUMARATE/PPA HCL 75-1.34MG TABLET SA CLEOCIN HCL CLINDAMYCIN HCL 150MG CAPSULE CLINDAMYCIN HCL CLINDAMYCIN HCL 150MG CAPSULE CLINDAMYCIN HCL CLINDAMYCIN HCL 300MG CAPSULE CLEOCIN PHOSPHATE CLINDAMYCIN PHOSPHATE 150MG/ML VIAL CLEOCIN T CLINDAMYCIN PHOSPHATE 1% GEL CLEOCIN T CLINDAMYCIN PHOSPHATE 1% MED. SWAB CLEOCIN T CLINDAMYCIN PHOSPHATE 1% SOLUTION CLINDA-DERM CLINDAMYCIN PHOSPHATE 1% SOLUTION CLINDAGEL CLINDAMYCIN PHOSPHATE 1% GEL CLINDAMYCIN PHOSPHATE CLINDAMYCIN PHOSPHATE 1% GEL CLINDAMYCIN PHOSPHATE CLINDAMYCIN PHOSPHATE 1% LOTION CLINDAMYCIN PHOSPHATE CLINDAMYCIN PHOSPHATE 1% MED. SWAB Page 22 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 CLINDAMYCIN PHOSPHATE CLINDAMYCIN PHOSPHATE 1% SOLUTION CLINDAMYCIN PHOSPHATE CLINDAMYCIN PHOSPHATE 150MG/ML VIAL CLINDETS CLINDAMYCIN PHOSPHATE 1% MED. SWAB CLINDAMYCIN INJ IN D5W CLINDAMYCIN PHOSPHATE/D5W 300MG/50ML PIGGYBACK CLINDAMYCIN INJ IN D5W CLINDAMYCIN PHOSPHATE/D5W 600MG/50ML PIGGYBACK CLINDAMYCIN INJ IN D5W CLINDAMYCIN PHOSPHATE/D5W 900MG/50ML PIGGYBACK CLOBETASOL PROPIONATE CLOBETASOL PROPIONATE 0.05% CREAM(GM) CLOBETASOL PROPIONATE CLOBETASOL PROPIONATE 0.05% GEL CLOBETASOL PROPIONATE CLOBETASOL PROPIONATE 0.05% OINT.(GM) CLOBETASOL PROPIONATE CLOBETASOL PROPIONATE 0.05% SOLUTION CLOBEVATE CLOBETASOL PROPIONATE 0.05% GEL CORMAX CLOBETASOL PROPIONATE 0.05% CREAM(GM) CORMAX CLOBETASOL PROPIONATE 0.05% OINT.(GM) CORMAX CLOBETASOL PROPIONATE 0.05% SOLUTION EMBELINE CLOBETASOL PROPIONATE 0.05% GEL EMBELINE CLOBETASOL PROPIONATE 0.05% OINT.(GM) EMBELINE CLOBETASOL PROPIONATE 0.05% SOLUTION TEMOVATE CLOBETASOL PROPIONATE 0.05% CREAM(GM) TEMOVATE CLOBETASOL PROPIONATE 0.05% GEL TEMOVATE CLOBETASOL PROPIONATE 0.05% OINT.(GM) TEMOVATE CLOBETASOL PROPIONATE 0.05% SOLUTION CLOBETASOL E CLOBETASOL PROPIONATE/EMOLL 0.05% CREAM(GM) CLOBETASOL PROPIONATE CLOBETASOL PROPIONATE/EMOLL 0.05% CREAM(GM) EMBELINE CLOBETASOL PROPIONATE/EMOLL 0.05% CREAM(GM) EMBELINE E CLOBETASOL PROPIONATE/EMOLL 0.05% CREAM(GM) TEMOVATE EMOLLIENT CLOBETASOL PROPIONATE/EMOLL 0.05% CREAM(GM) ANAFRANIL CLOMIPRAMINE HCL 25MG CAPSULE ANAFRANIL CLOMIPRAMINE HCL 50MG CAPSULE ANAFRANIL CLOMIPRAMINE HCL 75MG CAPSULE CLOMIPRAMINE HCL CLOMIPRAMINE HCL 25MG CAPSULE CLOMIPRAMINE HCL CLOMIPRAMINE HCL 50MG CAPSULE CLOMIPRAMINE HCL CLOMIPRAMINE HCL 75MG CAPSULE CEBERCLON CLONAZEPAM 0.5MG TABLET CEBERCLON CLONAZEPAM 1MG TABLET CLONAZEPAM CLONAZEPAM 0.5MG TABLET CLONAZEPAM CLONAZEPAM 1MG TABLET CLONAZEPAM CLONAZEPAM 2MG TABLET KLONOPIN CLONAZEPAM 0.5MG TABLET KLONOPIN CLONAZEPAM 1MG TABLET KLONOPIN CLONAZEPAM 2MG TABLET CATAPRES CLONIDINE HCL 0.1MG TABLET CATAPRES CLONIDINE HCL 0.2MG TABLET CATAPRES CLONIDINE HCL 0.3MG TABLET CLONIDINE HCL CLONIDINE HCL 0.1MG TABLET CLONIDINE HCL CLONIDINE HCL 0.2MG TABLET CLONIDINE HCL CLONIDINE HCL 0.3MG TABLET CLORAZEPATE DIPOTASSIUM CLORAZEPATE DIPOTASSIUM 15MG TABLET CLORAZEPATE DIPOTASSIUM CLORAZEPATE DIPOTASSIUM 3.75MG TABLET CLORAZEPATE DIPOTASSIUM CLORAZEPATE DIPOTASSIUM 7.5MG TABLET TRANXENE T-TAB CLORAZEPATE DIPOTASSIUM 15MG TABLET TRANXENE T-TAB CLORAZEPATE DIPOTASSIUM 3.75MG TABLET TRANXENE T-TAB CLORAZEPATE DIPOTASSIUM 7.5MG TABLET ANTI-FUNGAL CLOTRIMAZOLE 1% CREAM(GM) CLOTRIM ANTIFUNGAL CLOTRIMAZOLE 1% CREAM(GM) CLOTRIM VAGINAL CLOTRIMAZOLE 1% CREAM/APPL CLOTRIMAZOLE CLOTRIMAZOLE 1% CREAM(GM) CLOTRIMAZOLE CLOTRIMAZOLE 1% CREAM/APPL CLOTRIMAZOLE CLOTRIMAZOLE 1% SOLUTION CLOTRIMAZOLE CLOTRIMAZOLE 100MG TABLET CLOTRIMAZOLE 3 DAY CLOTRIMAZOLE 1% CREAM/APPL CLOTRIMAZOLE AF CLOTRIMAZOLE 1% CREAM(GM) CLOTRIMAZOLE-7 CLOTRIMAZOLE 100MG TABLET CRUEX CLOTRIMAZOLE 1% CREAM(GM) DESENEX CLOTRIMAZOLE 1% CREAM(GM) FEMCARE CLOTRIMAZOLE 1% CREAM/APPL FEMCARE CLOTRIMAZOLE 100MG TABLET FUNGOID CLOTRIMAZOLE 1% CREAM(GM) FUNGOID CLOTRIMAZOLE 1% SOLUTION GYNE-LOTRIMIN CLOTRIMAZOLE 1% CREAM/APPL GYNE-LOTRIMIN CLOTRIMAZOLE 1% CRM/PF APP GYNE-LOTRIMIN CLOTRIMAZOLE 100MG TABLET HM CLOTRIMAZOLE AF CLOTRIMAZOLE 1% CREAM(GM) LOTRIMIN CLOTRIMAZOLE 1% CREAM(GM) LOTRIMIN CLOTRIMAZOLE 1% SOLUTION LOTRIMIN AF CLOTRIMAZOLE 1% CREAM(GM) Page 23 MAC list as of February 03.xls
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Alabama Medicaid Maximum Allowable Cost List

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