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 SB CLOTRIMAZOLE CLOTRIMAZOLE 1% CREAM(GM) CLOZAPINE CLOZAPINE 100MG TABLET CLOZAPINE CLOZAPINE 25MG TABLET CLOZARIL CLOZAPINE 100MG TABLET CLOZARIL CLOZAPINE 25MG TABLET CORTANE-B CL-XYLENOL/HC/PRAMOX HCL/WATER 10-10-1/ML DROPS ZOTANE HC CL-XYLENOL/HC/PRAMOX HCL/WATER 10-10-1/ML DROPS IONIL T PLUS COAL TAR 2% SHAMPOO PC TAR COAL TAR SHAMPOO TEGRIN PSORIASIS COAL TAR 5% LOTION TERA-GEL TAR COAL TAR 0.5% SHAMPOO COCAINE HCL COCAINE HCL 10% SOLUTION COCAINE HCL COCAINE HCL 4% SOLUTION ANTITUSSIVE/DECONGESTANT COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP ANTITUSSIVE/DECONGESTANT COD/GUAIFENESIN/P-EPHED HCL 20MG SYRUP BIOTUSSIN DAC COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP CHERATUSSIN DAC COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP CODAFED COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP CODAFED COD/GUAIFENESIN/P-EPHED HCL 20MG SYRUP CO-HISTINE COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP CYCOFED COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP CYCOFED COD/GUAIFENESIN/P-EPHED HCL 20MG SYRUP DECOHISTINE COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP DEPROIST W/CODEINE COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP DIHISTINE COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP GUA PC COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP GUAIFENESIN DAC COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP GUAIFENESIN/P-EPHEDRINE/COD COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP GUIATUSS DAC COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP GUIATUSS-DAC COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP HALOTUSSIN-DAC COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP KG-FED COD/GUAIFENESIN/P-EPHED HCL 20MG SYRUP KG-FED PEDIATRIC COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP MYTUSSIN DAC COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP NOVAGEST COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP NOVAHISTINE COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP NUCODINE EXP COD/GUAIFENESIN/P-EPHED HCL 20MG SYRUP NUCODINE PED COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP NUCOFED COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP NUCOFED COD/GUAIFENESIN/P-EPHED HCL 20MG SYRUP NUCOTUSS COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP NUCOTUSS COD/GUAIFENESIN/P-EPHED HCL 20MG SYRUP PHENYLHISTINE COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP ROBAFEN-DAC COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP ROBITUSSIN-DAC COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP RYNA-CX COD/GUAIFENESIN/P-EPHED HCL 10MG SYRUP PROMETHAZINE VC W/CODEINE COD/PHENYLEPHRINE HCL/PROMETH 5-10-6.25 SYRUP CODEINE PHOSPHATE CODEINE PHOS 30MG/ML DISP SYRIN BRONTEX CODEINE PHOS/GUAIFENESIN 300-10MG TABLET CHERACOL CODEINE PHOS/GUAIFENESIN 100-10MG/5 SYRUP CHERATUSSIN AC CODEINE PHOS/GUAIFENESIN 100-10MG/5 SYRUP GUAIFENESIN W/CODEINE CODEINE PHOS/GUAIFENESIN 100-10MG/5 SYRUP GUAIFENESIN/CODEINE PHOSPHATE CODEINE PHOS/GUAIFENESIN 300-10MG TABLET GUIATUSS AC CODEINE PHOS/GUAIFENESIN 100-10MG/5 SYRUP GUIATUSSIN AC CODEINE PHOS/GUAIFENESIN 100-10MG/5 SYRUP MYTUSSIN AC CODEINE PHOS/GUAIFENESIN 100-10MG/5 SYRUP BIOTUSSIN AC CODEINE PHOSPHATE/GUAIFENESIN SYRUP BITEX CODEINE PHOSPHATE/GUAIFENESIN 150-5/10ML LIQUID BRONTEX CODEINE PHOSPHATE/GUAIFENESIN 150-5/10ML LIQUID BRON-TUSS CODEINE PHOSPHATE/GUAIFENESIN 150-5/10ML LIQUID DIABETIC TUSSIN C CODEINE PHOSPHATE/GUAIFENESIN SYRUP DURAGANIDIN NR CODEINE PHOSPHATE/GUAIFENESIN SYRUP GANI-TUSS NR CODEINE PHOSPHATE/GUAIFENESIN SYRUP GLYDEINE CODEINE PHOSPHATE/GUAIFENESIN SYRUP GUA C CODEINE PHOSPHATE/GUAIFENESIN SYRUP GUAIFEN-C CODEINE PHOSPHATE/GUAIFENESIN 150-5/10ML LIQUID GUAIFENESIN AC CODEINE PHOSPHATE/GUAIFENESIN SYRUP GUAIFENESIN W/CODEINE CODEINE PHOSPHATE/GUAIFENESIN SYRUP GUAIFENESIN/CODEINE PHOSPHATE CODEINE PHOSPHATE/GUAIFENESIN 300-10MG TABLET GUAL-CO CODEINE PHOSPHATE/GUAIFENESIN SYRUP HALOTUSSIN-AC CODEINE PHOSPHATE/GUAIFENESIN SYRUP IOPHEN CODEINE PHOSPHATE/GUAIFENESIN SYRUP IOPHEN C-NR CODEINE PHOSPHATE/GUAIFENESIN SYRUP IOPHEN-C NR CODEINE PHOSPHATE/GUAIFENESIN SYRUP ORGADIN-TUSS CODEINE PHOSPHATE/GUAIFENESIN SYRUP Page 24 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 ROBAFEN AC CODEINE PHOSPHATE/GUAIFENESIN SYRUP ROMILAR AC CODEINE PHOSPHATE/GUAIFENESIN SYRUP TUSSI-ORGANIDIN NR CODEINE PHOSPHATE/GUAIFENESIN SYRUP TUSSI-ORGANIDIN-S NR CODEINE PHOSPHATE/GUAIFENESIN SYRUP CODEINE SULFATE CODEINE SULF 30MG TABLET CODEINE SULFATE CODEINE SULF 60MG TABLET CODEINE SULFATE CODEINE SULFATE 30MG TABLET CODEINE SULFATE CODEINE SULFATE 60MG TABLET TRIACIN C CODEINE/P-EPHED HCL/TRIPROL 30-10-1.25 SYRUP PHENERGAN W/CODEINE CODEINE/PROMETHAZINE HCL 10-6.25/5 SYRUP PROMETHAZINE W/CODEINE CODEINE/PROMETHAZINE HCL 10-6.25/5 SYRUP PROMETHAZINE-CODEINE CODEINE/PROMETHAZINE HCL 10-6.25/5 SYRUP KG-FED CODEINE/PSEUDOEPHEDRINE HCL 60-20 SYRUP NUCOFED CODEINE/PSEUDOEPHEDRINE HCL 60-20 SYRUP COLCHICINE COLCHICINE 0.6MG TABLET COL-PROBENECID COLCHICINE/PROBENECID 0.5-500MG TABLET PROBENECID W/COLCHICINE COLCHICINE/PROBENECID 0.5-500MG TABLET COLISTIMETHATE SODIUM COLISTIMETHATE SODIUM 150MG VIAL CORTISONE ACETATE CORTISONE ACETATE 25MG TABLET C-PHED DM TANNATE CP/D-METHORP TAN/P-EPD TAN 25-75-4.5 ORAL SUSP TANAFED DM CP/D-METHORP TAN/P-EPD TAN 25-75-4.5 ORAL SUSP T-TANNA DM CP/D-METHORP TAN/P-EPD TAN 25-75-4.5 ORAL SUSP KIDCARE CP/D-METHORPHAN HB/P-EPHED HCL 5-15-1MG/5 LIQUID PEDIA RELIEF COLD & COUGH CP/D-METHORPHAN HB/P-EPHED HCL 5-15-1MG/5 LIQUID PEDIA RELIEF COUGH & COLD CP/D-METHORPHAN HB/P-EPHED HCL 5-15-1MG/5 LIQUID PEDIA RELIEF COUGH-COLD CP/D-METHORPHAN HB/P-EPHED HCL 5-15-1MG/5 LIQUID PEDIACOLD CP/D-METHORPHAN HB/P-EPHED HCL 5-15-1MG/5 LIQUID PEDIATRIC COUGH/COLD CP/D-METHORPHAN HB/P-EPHED HCL 5-15-1MG/5 LIQUID PEDIATRIC COUGH/COLD FORMULA CP/D-METHORPHAN HB/P-EPHED HCL 5-15-1MG/5 LIQUID TRIACTING COLD & COUGH CP/D-METHORPHAN HB/P-EPHED HCL 5-15-1MG/5 LIQUID TRIACTING M-SYM COLD/COUGH CP/D-METHORPHAN HB/P-EPHED HCL 5-15-1MG/5 LIQUID TRIAMINIC COLD & COUGH CP/D-METHORPHAN HB/P-EPHED HCL 5-15-1MG/5 LIQUID TRIAMINIC COLD/COUGH CP/D-METHORPHAN HB/P-EPHED HCL 5-15-1MG/5 LIQUID V-R PEDIA RELIEF COUGH/COLD CP/D-METHORPHAN HB/P-EPHED HCL 5-15-1MG/5 LIQUID MEDTUSSIN CP/HYDROCOD BIT/P-EPHED HCL SYRUP ED TUSS HC CP/HYDROCOD BIT/PHENYLEPH HCL 10-2.5-4 SYRUP TUSS-DS CP/HYDROCOD BIT/PHENYLEPH HCL 5-5-2 SYRUP COLDCOUGH HC CP/HYDROCODONE/P-EPHED HCL 15-3-2/5 LIQUID HISTINEX PV CP/HYDROCODONE/P-EPHED HCL 30-2.5-2/5 SYRUP HYCOFED CP/HYDROCODONE/P-EPHED HCL 30-2.5-2/5 LIQUID HYDRON PSC CP/HYDROCODONE/P-EPHED HCL 30-5-2MG/5 LIQUID HYDRO-TUSSIN HC CP/HYDROCODONE/P-EPHED HCL 15-3-2/5 LIQUID HYPHED CP/HYDROCODONE/P-EPHED HCL 30-2.5-2/5 SYRUP JAYCOF-HC CP/HYDROCODONE/P-EPHED HCL 15-3-2/5 LIQUID KG-TUSSIN CP/HYDROCODONE/P-EPHED HCL 30-2.5-2/5 SYRUP PANCOF HC CP/HYDROCODONE/P-EPHED HCL 15-3-2/5 LIQUID P-EPHED HCL/HYDROCOD BIT/CP CP/HYDROCODONE/P-EPHED HCL 15-3-2/5 LIQUID Q-V TUSSIN CP/HYDROCODONE/P-EPHED HCL 30-2.5-2/5 SYRUP TUSSEND CP/HYDROCODONE/P-EPHED HCL 30-2.5-2/5 SYRUP ATUSS HD CP/HYDROCODONE/PHENYLEPHRINE 10-2.5-4 SYRUP ATUSS MS CP/HYDROCODONE/PHENYLEPHRINE 10-5-2MG/5 SYRUP BALTUSSIN HC CP/HYDROCODONE/PHENYLEPHRINE 5-2.5-2 SYRUP B-TUSS CP/HYDROCODONE/PHENYLEPHRINE 5-5-2MG/5 LIQUID CHLORPHEN HD CP/HYDROCODONE/PHENYLEPHRINE 5-1.67-2 SYRUP CYTUSS HC CP/HYDROCODONE/PHENYLEPHRINE 5-2.5-2 SYRUP DURADAL HD CP/HYDROCODONE/PHENYLEPHRINE 5-1.67-2 SYRUP DURADAL HD PLUS CP/HYDROCODONE/PHENYLEPHRINE 5-2.5-2 SYRUP ED-TLC CP/HYDROCODONE/PHENYLEPHRINE 5-1.67-2 SYRUP EFASIN HD PLUS CP/HYDROCODONE/PHENYLEPHRINE 5-2.5-2 SYRUP EFASIN-HD CP/HYDROCODONE/PHENYLEPHRINE 5-1.67-2 SYRUP ENDAGEN-HD CP/HYDROCODONE/PHENYLEPHRINE 5-1.67-2 SYRUP ENPLUS-HD CP/HYDROCODONE/PHENYLEPHRINE 5-2.5-2 SYRUP H-C TUSSIVE CP/HYDROCODONE/PHENYLEPHRINE 5-2.5-2 SYRUP HIST-HC CP/HYDROCODONE/PHENYLEPHRINE 5-1.67-2 SYRUP HISTINEX HC CP/HYDROCODONE/PHENYLEPHRINE 5-2.5-2 SYRUP HIST-PLUS CP/HYDROCODONE/PHENYLEPHRINE 5-2.5-2 SYRUP HISTUSSIN HC CP/HYDROCODONE/PHENYLEPHRINE 5-2.5-2 SYRUP HYDROCODONE CP CP/HYDROCODONE/PHENYLEPHRINE 5-2.5-2 SYRUP HYDROCODONE HD CP/HYDROCODONE/PHENYLEPHRINE 5-1.67-2 SYRUP HYDROCODONE/PHENYLEPHRINE/CPM CP/HYDROCODONE/PHENYLEPHRINE 5-1.67-2 SYRUP HYPHEN-HD CP/HYDROCODONE/PHENYLEPHRINE 5-1.67-2 SYRUP IODAL HD CP/HYDROCODONE/PHENYLEPHRINE 5-1.67-2 SYRUP IOTUSSIN HC CP/HYDROCODONE/PHENYLEPHRINE 5-2.5-2 SYRUP KG-DAL HD CP/HYDROCODONE/PHENYLEPHRINE 5-1.67-2 SYRUP KG-DAL HD PLUS CP/HYDROCODONE/PHENYLEPHRINE 5-2.5-2 SYRUP Page 25 MAC list as of February 03.xls
Page 1 and 2: Drug Brand Name Alabama Medicaid Ma
Page 23: Drug Brand Name Alabama Medicaid Ma
Page 75 and 76:
Drug Brand Name Alabama Medicaid Ma
Page 77:
Drug Brand Name Alabama Medicaid Ma
show all

Alabama Medicaid Maximum Allowable Cost List

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?