Alabama Medicaid Maximum Allowable Cost List
Alabama Medicaid Maximum Allowable Cost List
Alabama Medicaid Maximum Allowable Cost List
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Drug Brand Name<br />
<strong>Alabama</strong> <strong>Medicaid</strong> <strong>Maximum</strong> <strong>Allowable</strong> <strong>Cost</strong> <strong>List</strong><br />
GCN - Generic Drug Description<br />
Drug Strength/Dosage<br />
Description<br />
Dose Form<br />
Description<br />
POLY-VITAMINS W/FLUORIDE FLUORIDE ION/MULTIVITAMINS 0.25MG/ML DROPS<br />
POLYVITAMINS W/FLUORIDE FLUORIDE ION/MULTIVITAMINS 0.25MG/ML DROPS<br />
POLYVITAMINS W/FLUORIDE FLUORIDE ION/MULTIVITAMINS 0.5MG/ML DROPS<br />
VI-DAYLIN/F FLUORIDE ION/MULTIVITAMINS 0.25MG/ML DROPS<br />
MULTI-VIT W/FLUORIDE & IRON FLUORIDE ION/MULTIVITS W-FE 0.5MG/ML DROPS<br />
MULTI-VIT/IRON & FLUORIDE FLUORIDE ION/MULTIVITS W-FE 0.25MG/ML DROPS<br />
MULTI-VIT/IRON & FLUORIDE FLUORIDE ION/MULTIVITS W-FE 0.5MG/ML DROPS<br />
MULTIVITA BETS W/FLUORIDE/IRON FLUORIDE ION/MULTIVITS W-FE 0.5MG TAB CHEW<br />
MULTI-VITA BETS/FLUORIDE/IRON FLUORIDE ION/MULTIVITS W-FE 1MG TAB CHEW<br />
MULTIVITAMIN W/FLUORIDE & IRON FLUORIDE ION/MULTIVITS W-FE 0.25MG/ML DROPS<br />
MULTIVITAMIN W/FLUORIDE & IRON FLUORIDE ION/MULTIVITS W-FE 0.5MG TAB CHEW<br />
MULTIVITAMIN W/FLUORIDE & IRON FLUORIDE ION/MULTIVITS W-FE 0.5MG/ML DROPS<br />
MULTIVITAMINS/FLUORIDE/IRON FLUORIDE ION/MULTIVITS W-FE 1MG TAB CHEW<br />
POLY-VI-FLOR W/IRON FLUORIDE ION/MULTIVITS W-FE 0.25MG/ML DROPS<br />
POLY-VI-FLOR W/IRON FLUORIDE ION/MULTIVITS W-FE 0.5MG TAB CHEW<br />
POLY-VITAMIN W/IRON & FLUORIDE FLUORIDE ION/MULTIVITS W-FE 0.25MG/ML DROPS<br />
POLY-VITAMIN W/IRON & FLUORIDE FLUORIDE ION/MULTIVITS W-FE 0.5MG/ML DROPS<br />
VI-DAYLIN/F + IRON FLUORIDE ION/MULTIVITS W-FE 0.25MG/ML DROPS<br />
ADC W/FLUORIDE FLUORIDE ION/VIT A,C&D 0.25MG/ML DROPS<br />
ADC W/FLUORIDE FLUORIDE ION/VIT A,C&D 0.5MG/ML DROPS<br />
ADC W/FLUORIDE FLUORIDE ION/VIT A,C&D 1MG TAB CHEW<br />
SOLUVITE-F FLUORIDE ION/VIT A,C&D 0.25MG/ML DROPS<br />
TRI-A-VITE W/FLUORIDE FLUORIDE ION/VIT A,C&D 1MG TAB CHEW<br />
TRI-VI-FLOR FLUORIDE ION/VIT A,C&D 0.25MG/ML DROPS<br />
TRI-VIT/FL FLUORIDE ION/VIT A,C&D 0.25MG/ML DROPS<br />
TRI-VIT/FL FLUORIDE ION/VIT A,C&D 0.5MG/ML DROPS<br />
TRI-VIT/FLUORIDE FLUORIDE ION/VIT A,C&D 1MG TAB CHEW<br />
TRI-VITA BETS W/FLUORIDE FLUORIDE ION/VIT A,C&D 1MG TAB CHEW<br />
TRI-VITAM W/FLUORIDE FLUORIDE ION/VIT A,C&D 0.25MG/ML DROPS<br />
TRI-VITAM W/FLUORIDE FLUORIDE ION/VIT A,C&D 0.5MG/ML DROPS<br />
TRI-VITAMIN W/FLUORIDE FLUORIDE ION/VIT A,C&D 0.25MG/ML DROPS<br />
TRI-VITAMIN W/FLUORIDE FLUORIDE ION/VIT A,C&D 0.5MG/ML DROPS<br />
TRI-VITAMINS W/FLUORIDE FLUORIDE ION/VIT A,C&D 0.25MG/ML DROPS<br />
TRI-VITAMINS W/FLUORIDE FLUORIDE ION/VIT A,C&D 0.5MG/ML DROPS<br />
TRI-VITE W/FLUORIDE FLUORIDE ION/VIT A,C&D 0.25MG/ML DROPS<br />
TRI-VITE W/FLUORIDE FLUORIDE ION/VIT A,C&D 0.5MG/ML DROPS<br />
VI-DAYLIN F ADC FLUORIDE ION/VIT A,C&D 0.25MG/ML DROPS<br />
FLUOROMETHOLONE FLUOROMETHOLONE 0.1% DROPS SUSP<br />
FLUOR-OP FLUOROMETHOLONE 0.1% DROPS SUSP<br />
FML FLUOROMETHOLONE 0.1% DROPS SUSP<br />
EFLONE FLUOROMETHOLONE ACETATE 0.1% DROPS SUSP<br />
ADRUCIL FLUOROURACIL 50MG/ML VIAL<br />
FLUOROURACIL FLUOROURACIL 50MG/ML VIAL<br />
FLUOXETINE HCL FLUOXETINE HCL 10MG CAPSULE<br />
FLUOXETINE HCL FLUOXETINE HCL 10MG TABLET<br />
FLUOXETINE HCL FLUOXETINE HCL 20MG CAPSULE<br />
FLUOXETINE HCL FLUOXETINE HCL 20MG TABLET<br />
FLUOXETINE HCL FLUOXETINE HCL 20MG/5ML SOLUTION<br />
FLUOXETINE HCL FLUOXETINE HCL 40MG CAPSULE<br />
PROZAC FLUOXETINE HCL 10MG CAPSULE<br />
PROZAC FLUOXETINE HCL 10MG TABLET<br />
PROZAC FLUOXETINE HCL 20MG CAPSULE<br />
PROZAC FLUOXETINE HCL 20MG/5ML SOLUTION<br />
PROZAC FLUOXETINE HCL 40MG CAPSULE<br />
SARAFEM FLUOXETINE HCL 10MG CAPSULE<br />
SARAFEM FLUOXETINE HCL 20MG CAPSULE<br />
FLUOXYMESTERONE FLUOXYMESTERONE 10MG TABLET<br />
HALOTESTIN FLUOXYMESTERONE 10MG TABLET<br />
FLUPHENAZINE DECANOATE FLUPHENAZINE DECANOATE 25MG/ML VIAL<br />
PROLIXIN DECANOATE FLUPHENAZINE DECANOATE 25MG/ML VIAL<br />
FLUPHENAZINE HCL FLUPHENAZINE HCL 10MG TABLET<br />
FLUPHENAZINE HCL FLUPHENAZINE HCL 1MG TABLET<br />
FLUPHENAZINE HCL FLUPHENAZINE HCL 2.5MG TABLET<br />
FLUPHENAZINE HCL FLUPHENAZINE HCL 2.5MG/5ML ELIXIR<br />
FLUPHENAZINE HCL FLUPHENAZINE HCL 2.5MG/ML VIAL<br />
FLUPHENAZINE HCL FLUPHENAZINE HCL 5MG TABLET<br />
FLUPHENAZINE HCL FLUPHENAZINE HCL 5MG/ML ORAL CONC.<br />
PERMITIL FLUPHENAZINE HCL 10MG TABLET<br />
PERMITIL FLUPHENAZINE HCL 2.5MG TABLET<br />
PERMITIL FLUPHENAZINE HCL 5MG TABLET<br />
PROLIXIN FLUPHENAZINE HCL 10MG TABLET<br />
PROLIXIN FLUPHENAZINE HCL 1MG TABLET<br />
PROLIXIN FLUPHENAZINE HCL 2.5MG TABLET<br />
PROLIXIN FLUPHENAZINE HCL 2.5MG/5ML ELIXIR<br />
PROLIXIN FLUPHENAZINE HCL 5MG TABLET<br />
Page 41<br />
MAC list as of February 03.xls
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