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 VASOTEC ENALAPRIL MALEATE 20MG TABLET VASOTEC ENALAPRIL MALEATE 5MG TABLET ENALAPRIL MALEATE/HCTZ ENALAPRIL MALEATE/HCTZ 10-25MG TABLET ENALAPRIL MALEATE/HCTZ ENALAPRIL MALEATE/HCTZ 5-12.5MG TABLET VASERETIC ENALAPRIL MALEATE/HCTZ 10-25MG TABLET VASERETIC ENALAPRIL MALEATE/HCTZ 5-12.5MG TABLET ENALAPRILAT ENALAPRILAT DIHYDRATE 1.25MG/ML VIAL VASOTEC I.V. ENALAPRILAT DIHYDRATE 1.25MG/ML VIAL ETHRANE ENFLURANE GAS EPHEDRINE SULFATE EPHEDRINE SULFATE 50MG/ML AMPUL ADRENALIN CHLORIDE EPINEPHRINE 1MG/ML AMPUL ADRENALIN CHLORIDE EPINEPHRINE 1MG/ML VIAL EPINEPHRINE EPINEPHRINE 0.1MG/ML DISP SYRIN EPINEPHRINE EPINEPHRINE 1MG/ML AMPUL EPINEPHRINE EPINEPHRINE 1MG/ML VIAL LIDOCAINE HCL W/EPINEPHRINE EPINEPHRINE/LIDOCAINE HCL 0.5-0.0005 VIAL LIDOCAINE HCL W/EPINEPHRINE EPINEPHRINE/LIDOCAINE HCL 1.5-0.0005 AMPUL LIDOCAINE HCL W/EPINEPHRINE EPINEPHRINE/LIDOCAINE HCL 1.5-0.0005 VIAL LIDOCAINE HCL W/EPINEPHRINE EPINEPHRINE/LIDOCAINE HCL 1-0.0005% AMPUL LIDOCAINE HCL W/EPINEPHRINE EPINEPHRINE/LIDOCAINE HCL 1-0.001% VIAL LIDOCAINE HCL W/EPINEPHRINE EPINEPHRINE/LIDOCAINE HCL 2-0.0005% VIAL LIDOCAINE HCL W/EPINEPHRINE EPINEPHRINE/LIDOCAINE HCL 2-0.001% VIAL CALCIFEROL ERGOCALCIFEROL 8000 U/ML DROPS DRISDOL ERGOCALCIFEROL 50000 UNIT CAPSULE DRISDOL ERGOCALCIFEROL 8000 U/ML DROPS VITAMIN D ERGOCALCIFEROL 50000 UNIT CAPSULE VITAMIN D ERGOCALCIFEROL 8000 U/ML DROPS ERGOLOID MESYLATES ERGOLOID MESYLATES 1MG TAB SUBL ERGOLOID MESYLATES ERGOLOID MESYLATES 1MG TABLET ERYTHROMYCIN W/SULFISOXAZOLE ERY E-SUCC/SULFISOXAZOLE 200-600/5 SUSP RECON PEDIAZOLE ERY E-SUCC/SULFISOXAZOLE 200-600/5 SUSP RECON ERYC ERYTHROMYCIN BASE 250MG CAPSULE DR ERY-TAB ERYTHROMYCIN BASE 333MG TABLET DR ERYTHROMYCIN ERYTHROMYCIN BASE 5MG/G OINT.(GM) ERYTHROMYCIN BASE ERYTHROMYCIN BASE 250MG CAPSULE DR ROMYCIN ERYTHROMYCIN BASE 5MG/G OINT.(GM) A/T/S ERYTHROMYCIN BASE/ETHANOL 2% GEL A/T/S ERYTHROMYCIN BASE/ETHANOL 2% SOLUTION EMGEL ERYTHROMYCIN BASE/ETHANOL 2% GEL ERY ERYTHROMYCIN BASE/ETHANOL 2% MED. SWAB ERYCETTE ERYTHROMYCIN BASE/ETHANOL 2% MED. SWAB ERYDERM ERYTHROMYCIN BASE/ETHANOL 2% SOLUTION ERYGEL ERYTHROMYCIN BASE/ETHANOL 2% GEL ERYMAX ERYTHROMYCIN BASE/ETHANOL 2% SOLUTION ERYTHRA-DERM ERYTHROMYCIN BASE/ETHANOL 2% SOLUTION ERYTHROMYCIN ERYTHROMYCIN BASE/ETHANOL 2% SOLUTION ERYTHROMYCIN BASE ERYTHROMYCIN BASE/ETHANOL 2% GEL THERAMYCIN Z ERYTHROMYCIN BASE/ETHANOL 2% SOLUTION T-STAT ERYTHROMYCIN BASE/ETHANOL 2% MED. SWAB T-STAT ERYTHROMYCIN BASE/ETHANOL 2% SOLUTION ERYTHROMYCIN ESTOLATE ERYTHROMYCIN ESTOLATE 125MG/5ML ORAL SUSP E.E.S. 200 ERYTHROMYCIN ETHYLSUCCINATE 200MG/5ML ORAL SUSP E.E.S. 200 ERYTHROMYCIN ETHYLSUCCINATE 200MG/5ML SUSP RECON E.E.S. 400 ERYTHROMYCIN ETHYLSUCCINATE 400MG TABLET E.E.S. 400 ERYTHROMYCIN ETHYLSUCCINATE 400MG/5ML ORAL SUSP ERYPED 200 ERYTHROMYCIN ETHYLSUCCINATE 200MG/5ML SUSP RECON ERYTHROMYCIN ETHYLSUCCINATE ERYTHROMYCIN ETHYLSUCCINATE 200MG/5ML ORAL SUSP ERYTHROMYCIN ETHYLSUCCINATE ERYTHROMYCIN ETHYLSUCCINATE 200MG/5ML SUSP RECON ERYTHROMYCIN ETHYLSUCCINATE ERYTHROMYCIN ETHYLSUCCINATE 400MG TABLET ERYTHROMYCIN ETHYLSUCCINATE ERYTHROMYCIN ETHYLSUCCINATE 400MG/5ML ORAL SUSP ERYTHROCIN STEARATE ERYTHROMYCIN STEARATE 250MG TABLET ERYTHROCIN STEARATE ERYTHROMYCIN STEARATE 500MG TABLET ERYTHROMYCIN STEARATE ERYTHROMYCIN STEARATE 250MG TABLET ERYTHROMYCIN STEARATE ERYTHROMYCIN STEARATE 500MG TABLET MY-E FILM ERYTHROMYCIN STEARATE 250MG TABLET DEPO-TESTADIOL ESTRAD CYP/TESTOST CYP 50-2 VIAL DUO-CYP ESTRAD CYP/TESTOST CYP 50-2 VIAL ESTRADIOL/TESTOSTERONE ESTRAD VAL/TESTOST ENAN 90-4 VIAL ALORA ESTRADIOL .075MG/24H PATCH TDBW ALORA ESTRADIOL 0.05MG/24H PATCH TDBW ALORA ESTRADIOL 0.1MG/24HR PATCH TDBW ESCLIM ESTRADIOL .0375MG/24 PATCH TDBW ESCLIM ESTRADIOL .075MG/24H PATCH TDBW ESCLIM ESTRADIOL 0.05MG/24H PATCH TDBW ESCLIM ESTRADIOL 0.1MG/24HR PATCH TDBW Page 36 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 ESTRACE ESTRADIOL 0.5MG TABLET ESTRACE ESTRADIOL 1MG TABLET ESTRACE ESTRADIOL 2MG TABLET ESTRADERM ESTRADIOL 0.05MG/24H PATCH TDBW ESTRADERM ESTRADIOL 0.1MG/24HR PATCH TDBW ESTRADIOL ESTRADIOL 0.5MG TABLET ESTRADIOL ESTRADIOL 1MG TABLET ESTRADIOL ESTRADIOL 2MG TABLET ESTRADIOL TRANSDERMAL PATCH ESTRADIOL 0.05MG/24H PATCH TDWK ESTRADIOL TRANSDERMAL PATCH ESTRADIOL 0.1MG/24HR PATCH TDWK GYNODIOL ESTRADIOL 0.5MG TABLET GYNODIOL ESTRADIOL 1MG TABLET GYNODIOL ESTRADIOL 2MG TABLET VIVELLE ESTRADIOL .0375MG/24 PATCH TDBW VIVELLE ESTRADIOL .075MG/24H PATCH TDBW VIVELLE ESTRADIOL 0.05MG/24H PATCH TDBW VIVELLE ESTRADIOL 0.1MG/24HR PATCH TDBW VIVELLE-DOT ESTRADIOL .0375MG/24 PATCH TDBW VIVELLE-DOT ESTRADIOL .075MG/24H PATCH TDBW VIVELLE-DOT ESTRADIOL 0.05MG/24H PATCH TDBW VIVELLE-DOT ESTRADIOL 0.1MG/24HR PATCH TDBW DEPO-ESTRADIOL ESTRADIOL CYPIONATE 5MG/ML VIAL DELESTROGEN ESTRADIOL VALERATE 20MG/ML VIAL DELESTROGEN ESTRADIOL VALERATE 40MG/ML VIAL DIOVAL-40 ESTRADIOL VALERATE 40MG/ML VIAL DIOVAL-XX ESTRADIOL VALERATE 20MG/ML VIAL VALERGEN-20 ESTRADIOL VALERATE 20MG/ML VIAL SYNTEST D.S. ESTROGEN,ESTER/ME-TESTOSTERONE 2.5-1.25MG TABLET SYNTEST H.S. ESTROGEN,ESTER/ME-TESTOSTERONE 1.25-0.625 TABLET MENEST ESTROGENS,ESTERIFIED 0.3MG TABLET MENEST ESTROGENS,ESTERIFIED 0.625MG TABLET MENEST ESTROGENS,ESTERIFIED 2.5MG TABLET ESTRONE ESTRONE 5MG/ML VIAL KESTRONE-5 ESTRONE 5MG/ML VIAL ESTROPIPATE ESTROPIPATE 0.75MG TABLET ESTROPIPATE ESTROPIPATE 1.5MG TABLET ESTROPIPATE ESTROPIPATE 3MG TABLET OGEN ESTROPIPATE 0.75MG TABLET OGEN ESTROPIPATE 1.5MG TABLET OGEN ESTROPIPATE 3MG TABLET ORTHO-EST ESTROPIPATE 0.75MG TABLET ORTHO-EST ESTROPIPATE 1.5MG TABLET ETHAMBUTOL HCL ETHAMBUTOL HCL 100MG TABLET ETHAMBUTOL HCL ETHAMBUTOL HCL 400MG TABLET ETHAMBUTOL HYDROCHLORIDE ETHAMBUTOL HCL 400MG TABLET MYAMBUTOL ETHAMBUTOL HCL 400MG TABLET ETHAVERINE HCL ETHAVERINE HCL 100MG TABLET ETHAVEX-100 ETHAVERINE HCL 100MG TABLET ETHOSUXIMIDE ETHOSUXIMIDE 250MG CAPSULE ETHOSUXIMIDE ETHOSUXIMIDE 250MG/5ML SYRUP ALCOHOL,DEHYDRATED ETHYL ALCOHOL 98% AMPUL ETHANOL ETHYL ALCOHOL 98% AMPUL ZOVIA 1/35E ETHYNODIOL D-ETHINYL ESTRADIOL 1-0.035MG TABLET ZOVIA 1/50E ETHYNODIOL D-ETHINYL ESTRADIOL 1-0.05MG TABLET ETODOLAC ETODOLAC 200MG CAPSULE ETODOLAC ETODOLAC 300MG CAPSULE ETODOLAC ETODOLAC 400MG TAB.SR 24H ETODOLAC ETODOLAC 400MG TABLET ETODOLAC ETODOLAC 500MG TAB.SR 24H ETODOLAC ETODOLAC 500MG TABLET ETODOLAC ETODOLAC 600MG TAB.SR 24H LODINE ETODOLAC 200MG CAPSULE LODINE ETODOLAC 300MG CAPSULE LODINE ETODOLAC 400MG TABLET LODINE ETODOLAC 500MG TABLET LODINE XL ETODOLAC 400MG TAB.SR 24H AMIDATE ETOMIDATE 2MG/ML VIAL ETOMIDATE ETOMIDATE 2MG/ML VIAL ETOPOSIDE ETOPOSIDE 20MG/ML VIAL ETOPOSIDE ETOPOSIDE 50MG CAPSULE TOPOSAR ETOPOSIDE 20MG/ML VIAL VEPESID ETOPOSIDE 20MG/ML VIAL VINATAL FORTE FA/FE CARB-FESO4/PRENATAL VIT 60-1MG TABLET NATAFORT FA/FE CARB-FESO4/PV W-O CAL 60-1MG TABLET NATALCARE CFE FA/FE CARB-FESO4/PV W-O CAL 60-1MG TABLET Page 37 MAC list as of February 03.xls
Page 1 and 2: Drug Brand Name Alabama Medicaid Ma
Page 35: Drug Brand Name Alabama Medicaid Ma
Page 77: Drug Brand Name Alabama Medicaid Ma

Alabama Medicaid Maximum Allowable Cost List

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

Delete template?

Save as template?