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 />
GUAIATUSSIN GUAIFENESIN 100MG/5ML SYRUP<br />
GUAIBID LA GUAIFENESIN 600MG TABLET SA<br />
GUAIFENESIN GUAIFENESIN 100MG/5ML LIQUID<br />
GUAIFENESIN GUAIFENESIN 100MG/5ML SYRUP<br />
GUAIFENESIN GUAIFENESIN 1200MG TAB.SR 12H<br />
GUAIFENESIN GUAIFENESIN 200MG TABLET<br />
GUAIFENESIN GUAIFENESIN 600MG TABLET SA<br />
GUAIFENESIN ER GUAIFENESIN 600MG TABLET SA<br />
GUAIFENESIN LA GUAIFENESIN 1200MG TAB.SR 12H<br />
GUAIFENESIN LA GUAIFENESIN 600MG TABLET SA<br />
GUAIFENESIN NR GUAIFENESIN 100MG/5ML LIQUID<br />
GUAIFENESIN-SR GUAIFENESIN 1200MG TAB.SR 12H<br />
GUAIFENESIN-SR GUAIFENESIN 600MG TABLET SA<br />
GUAIFENEX LA GUAIFENESIN 600MG TABLET SA<br />
GUA-SR GUAIFENESIN 600MG TABLET SA<br />
GUIADRINE G-1200 GUAIFENESIN 1200MG TAB.SR 12H<br />
GUIATUSS GUAIFENESIN 100MG/5ML SYRUP<br />
HM TUSSIN GUAIFENESIN 100MG/5ML SYRUP<br />
HM TUSSIN COUGH GUAIFENESIN 100MG/5ML SYRUP<br />
HUMIBID L.A. GUAIFENESIN 600MG TABLET SA<br />
IODROL NR GUAIFENESIN 200MG TABLET<br />
IOPHEN NR GUAIFENESIN 100MG/5ML LIQUID<br />
IOPHEN-NR GUAIFENESIN 100MG/5ML LIQUID<br />
KOMATUSSIN GUAIFENESIN 100MG/5ML SYRUP<br />
LIQUIBID GUAIFENESIN 600MG TABLET SA<br />
LIQUIBID 1200 GUAIFENESIN 1200MG TAB.SR 12H<br />
MONAFED GUAIFENESIN 600MG TABLET SA<br />
MUCO-FEN 1200 GUAIFENESIN 1200MG TAB.SR 12H<br />
NALDECON SENIOR EX GUAIFENESIN 200MG/5ML LIQUID<br />
ORGADIN GUAIFENESIN 100MG/5ML LIQUID<br />
ORGAN-I NR GUAIFENESIN 200MG TABLET<br />
ORGANIDIN NR GUAIFENESIN 100MG/5ML LIQUID<br />
ORGANIDIN NR GUAIFENESIN 200MG TABLET<br />
PEDIATRIC COUGH/COLD GUAIFENESIN 100MG/5ML SYRUP<br />
PHANASIN GUAIFENESIN 100MG/5ML SYRUP<br />
PHARMASIN GUAIFENESIN 100MG/5ML SYRUP<br />
Q-BID LA GUAIFENESIN 600MG TABLET SA<br />
Q-TUSSIN GUAIFENESIN 100MG/5ML SYRUP<br />
REFENESEN GUAIFENESIN 200MG TABLET<br />
RESPA-GF GUAIFENESIN 600MG TABLET SA<br />
RI-TUSSIN GUAIFENESIN 100MG/5ML SYRUP<br />
ROBAFEN GUAIFENESIN 100MG/5ML SYRUP<br />
ROBITUSSIN GUAIFENESIN 100MG/5ML SYRUP<br />
SCOT-TUSSIN GUAIFENESIN 100MG/5ML LIQUID<br />
SILTUSSIN DAS GUAIFENESIN 100MG/5ML LIQUID<br />
SILTUSSIN SA GUAIFENESIN 100MG/5ML SYRUP<br />
TUSSIN GUAIFENESIN 100MG/5ML SYRUP<br />
TUSSIN COUGH GUAIFENESIN 100MG/5ML SYRUP<br />
TUSSIN EXPECTORANT GUAIFENESIN 100MG/5ML SYRUP<br />
TUSSIN HONEY GUAIFENESIN 100MG/5ML SYRUP<br />
UNI-TUSSIN GUAIFENESIN 100MG/5ML SYRUP<br />
COLDCOUGH XP GUAIFENESIN/HCOD/P-EPHED HCL 100-15-3/5 LIQUID<br />
DECONAMINE CX GUAIFENESIN/HCOD/P-EPHED HCL 200-60-5 EXPECT.<br />
DECONAMINE CX GUAIFENESIN/HCOD/P-EPHED HCL 300-30-5 TABLET<br />
DETUSSIN GUAIFENESIN/HCOD/P-EPHED HCL 200-60-5 EXPECT.<br />
DRITUSS HD GUAIFENESIN/HCOD/P-EPHED HCL 100-30-2.5 ELIXIR<br />
DURATUSS HD GUAIFENESIN/HCOD/P-EPHED HCL 100-30-2.5 ELIXIR<br />
ENTUSS-D GUAIFENESIN/HCOD/P-EPHED HCL 100-30-2.5 SOLUTION<br />
ENTUSS-D GUAIFENESIN/HCOD/P-EPHED HCL 300-30-5 TABLET<br />
GUAIFENESIN/P-EPHED HCL/HCOD GUAIFENESIN/HCOD/P-EPHED HCL 100-15-3/5 LIQUID<br />
HYDRO-TUSSIN HD GUAIFENESIN/HCOD/P-EPHED HCL 100-30-2.5 SOLUTION<br />
HYDRO-TUSSIN XP GUAIFENESIN/HCOD/P-EPHED HCL 100-15-3/5 LIQUID<br />
JAYCOF-XP GUAIFENESIN/HCOD/P-EPHED HCL 100-15-3/5 LIQUID<br />
KG-TUSS HD GUAIFENESIN/HCOD/P-EPHED HCL 100-30-2.5 SOLUTION<br />
MED-HIST GUAIFENESIN/HCOD/P-EPHED HCL 200-60-5 EXPECT.<br />
MEDTUSS HD GUAIFENESIN/HCOD/P-EPHED HCL 100-30-2.5 ELIXIR<br />
NALEX GUAIFENESIN/HCOD/P-EPHED HCL 200-60-5 EXPECT.<br />
PANCOF XP GUAIFENESIN/HCOD/P-EPHED HCL 100-15-3/5 LIQUID<br />
POLY-TUSSIN XP GUAIFENESIN/HCOD/P-EPHED HCL 200-60-5 EXPECT.<br />
SU-TUSS HD GUAIFENESIN/HCOD/P-EPHED HCL 100-30-2.5 ELIXIR<br />
TUSSADUR-HD GUAIFENESIN/HCOD/P-EPHED HCL 100-30-2.5 SOLUTION<br />
TUSS-AX GUAIFENESIN/HCOD/P-EPHED HCL 200-60-5 EXPECT.<br />
TUSSEND GUAIFENESIN/HCOD/P-EPHED HCL 100-30-2.5 SOLUTION<br />
VANACON GUAIFENESIN/HCOD/P-EPHED HCL 200-60-5 EXPECT.<br />
CLEARTUSS DH GUAIFENESIN/HYDROCOD BIT 100-5/5ML SYRUP<br />
Page 44<br />
MAC list as of February 03.xls