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 GUAIATUSSIN GUAIFENESIN 100MG/5ML SYRUP GUAIBID LA GUAIFENESIN 600MG TABLET SA GUAIFENESIN GUAIFENESIN 100MG/5ML LIQUID GUAIFENESIN GUAIFENESIN 100MG/5ML SYRUP GUAIFENESIN GUAIFENESIN 1200MG TAB.SR 12H GUAIFENESIN GUAIFENESIN 200MG TABLET GUAIFENESIN GUAIFENESIN 600MG TABLET SA GUAIFENESIN ER GUAIFENESIN 600MG TABLET SA GUAIFENESIN LA GUAIFENESIN 1200MG TAB.SR 12H GUAIFENESIN LA GUAIFENESIN 600MG TABLET SA GUAIFENESIN NR GUAIFENESIN 100MG/5ML LIQUID GUAIFENESIN-SR GUAIFENESIN 1200MG TAB.SR 12H GUAIFENESIN-SR GUAIFENESIN 600MG TABLET SA GUAIFENEX LA GUAIFENESIN 600MG TABLET SA GUA-SR GUAIFENESIN 600MG TABLET SA GUIADRINE G-1200 GUAIFENESIN 1200MG TAB.SR 12H GUIATUSS GUAIFENESIN 100MG/5ML SYRUP HM TUSSIN GUAIFENESIN 100MG/5ML SYRUP HM TUSSIN COUGH GUAIFENESIN 100MG/5ML SYRUP HUMIBID L.A. GUAIFENESIN 600MG TABLET SA IODROL NR GUAIFENESIN 200MG TABLET IOPHEN NR GUAIFENESIN 100MG/5ML LIQUID IOPHEN-NR GUAIFENESIN 100MG/5ML LIQUID KOMATUSSIN GUAIFENESIN 100MG/5ML SYRUP LIQUIBID GUAIFENESIN 600MG TABLET SA LIQUIBID 1200 GUAIFENESIN 1200MG TAB.SR 12H MONAFED GUAIFENESIN 600MG TABLET SA MUCO-FEN 1200 GUAIFENESIN 1200MG TAB.SR 12H NALDECON SENIOR EX GUAIFENESIN 200MG/5ML LIQUID ORGADIN GUAIFENESIN 100MG/5ML LIQUID ORGAN-I NR GUAIFENESIN 200MG TABLET ORGANIDIN NR GUAIFENESIN 100MG/5ML LIQUID ORGANIDIN NR GUAIFENESIN 200MG TABLET PEDIATRIC COUGH/COLD GUAIFENESIN 100MG/5ML SYRUP PHANASIN GUAIFENESIN 100MG/5ML SYRUP PHARMASIN GUAIFENESIN 100MG/5ML SYRUP Q-BID LA GUAIFENESIN 600MG TABLET SA Q-TUSSIN GUAIFENESIN 100MG/5ML SYRUP REFENESEN GUAIFENESIN 200MG TABLET RESPA-GF GUAIFENESIN 600MG TABLET SA RI-TUSSIN GUAIFENESIN 100MG/5ML SYRUP ROBAFEN GUAIFENESIN 100MG/5ML SYRUP ROBITUSSIN GUAIFENESIN 100MG/5ML SYRUP SCOT-TUSSIN GUAIFENESIN 100MG/5ML LIQUID SILTUSSIN DAS GUAIFENESIN 100MG/5ML LIQUID SILTUSSIN SA GUAIFENESIN 100MG/5ML SYRUP TUSSIN GUAIFENESIN 100MG/5ML SYRUP TUSSIN COUGH GUAIFENESIN 100MG/5ML SYRUP TUSSIN EXPECTORANT GUAIFENESIN 100MG/5ML SYRUP TUSSIN HONEY GUAIFENESIN 100MG/5ML SYRUP UNI-TUSSIN GUAIFENESIN 100MG/5ML SYRUP COLDCOUGH XP GUAIFENESIN/HCOD/P-EPHED HCL 100-15-3/5 LIQUID DECONAMINE CX GUAIFENESIN/HCOD/P-EPHED HCL 200-60-5 EXPECT. DECONAMINE CX GUAIFENESIN/HCOD/P-EPHED HCL 300-30-5 TABLET DETUSSIN GUAIFENESIN/HCOD/P-EPHED HCL 200-60-5 EXPECT. DRITUSS HD GUAIFENESIN/HCOD/P-EPHED HCL 100-30-2.5 ELIXIR DURATUSS HD GUAIFENESIN/HCOD/P-EPHED HCL 100-30-2.5 ELIXIR ENTUSS-D GUAIFENESIN/HCOD/P-EPHED HCL 100-30-2.5 SOLUTION ENTUSS-D GUAIFENESIN/HCOD/P-EPHED HCL 300-30-5 TABLET GUAIFENESIN/P-EPHED HCL/HCOD GUAIFENESIN/HCOD/P-EPHED HCL 100-15-3/5 LIQUID HYDRO-TUSSIN HD GUAIFENESIN/HCOD/P-EPHED HCL 100-30-2.5 SOLUTION HYDRO-TUSSIN XP GUAIFENESIN/HCOD/P-EPHED HCL 100-15-3/5 LIQUID JAYCOF-XP GUAIFENESIN/HCOD/P-EPHED HCL 100-15-3/5 LIQUID KG-TUSS HD GUAIFENESIN/HCOD/P-EPHED HCL 100-30-2.5 SOLUTION MED-HIST GUAIFENESIN/HCOD/P-EPHED HCL 200-60-5 EXPECT. MEDTUSS HD GUAIFENESIN/HCOD/P-EPHED HCL 100-30-2.5 ELIXIR NALEX GUAIFENESIN/HCOD/P-EPHED HCL 200-60-5 EXPECT. PANCOF XP GUAIFENESIN/HCOD/P-EPHED HCL 100-15-3/5 LIQUID POLY-TUSSIN XP GUAIFENESIN/HCOD/P-EPHED HCL 200-60-5 EXPECT. SU-TUSS HD GUAIFENESIN/HCOD/P-EPHED HCL 100-30-2.5 ELIXIR TUSSADUR-HD GUAIFENESIN/HCOD/P-EPHED HCL 100-30-2.5 SOLUTION TUSS-AX GUAIFENESIN/HCOD/P-EPHED HCL 200-60-5 EXPECT. TUSSEND GUAIFENESIN/HCOD/P-EPHED HCL 100-30-2.5 SOLUTION VANACON GUAIFENESIN/HCOD/P-EPHED HCL 200-60-5 EXPECT. CLEARTUSS DH GUAIFENESIN/HYDROCOD BIT 100-5/5ML SYRUP Page 44 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 CODICLEAR DH GUAIFENESIN/HYDROCOD BIT 100-5/5ML SYRUP CODOTUSS GUAIFENESIN/HYDROCOD BIT 100-5/5ML SYRUP CO-TUSSIN GUAIFENESIN/HYDROCOD BIT 100-5/5ML SYRUP COTUSS-V GUAIFENESIN/HYDROCOD BIT 100-5/5ML SYRUP FENTUSS GUAIFENESIN/HYDROCOD BIT 100-5/5ML SYRUP G-TUSS GUAIFENESIN/HYDROCOD BIT 100-5/5ML SYRUP HYCOSIN GUAIFENESIN/HYDROCOD BIT 100-5/5ML SYRUP HYCOTUSS GUAIFENESIN/HYDROCOD BIT 100-5/5ML SYRUP HYDROCODONE GF GUAIFENESIN/HYDROCOD BIT 100-5/5ML SYRUP HYDROCODONE W/GUAIFENESIN GUAIFENESIN/HYDROCOD BIT 100-5/5ML SYRUP HYDRO-TUSS GUAIFENESIN/HYDROCOD BIT 100-5/5ML SYRUP HYDROTUSS GUAIFENESIN/HYDROCOD BIT 100-5/5ML SYRUP KWELCOF GUAIFENESIN/HYDROCOD BIT 100-5/5ML SYRUP M-CLEAR GUAIFENESIN/HYDROCOD BIT 100-5/5ML SYRUP MEDCODIN GUAIFENESIN/HYDROCOD BIT 100-5/5ML SYRUP PNEUMOTUSSIN HC GUAIFENESIN/HYDROCOD BIT 100-5/5ML SYRUP VICOCLEAR DH GUAIFENESIN/HYDROCOD BIT 100-5/5ML SYRUP VICODIN TUSS GUAIFENESIN/HYDROCOD BIT 100-5/5ML SYRUP VI-Q-TUSS GUAIFENESIN/HYDROCOD BIT 100-5/5ML SYRUP VITUSSIN GUAIFENESIN/HYDROCOD BIT 100-5/5ML SYRUP ABLETEX PSE GUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H AMI-TEX PSE GUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H BOCA-TEX PSE GUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H G-PHED-PD GUAIFENESIN/P-EPHED HCL 300-60MG CAPSULE SA GUAIFEN PSE GUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H GUAIFENESIN 600/PSE 120 GUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H GUAIFENESIN W/PSEUDOEPHEDRINE GUAIFENESIN/P-EPHED HCL 300-60MG CAPSULE SA GUAIFENESIN W/PSEUDOEPHEDRINE GUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H GUAIFENESIN-P-PD GUAIFENESIN/P-EPHED HCL 300-60MG CAPSULE SA GUAIFENEX PSE GUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H GUAIFEN-PSE GUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H GUAIMAX-D GUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H GUAIPAX PSE GUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H GUAI-VENT/PSE GUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H IOTEX PSE GUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H MIRAPHEN PSE GUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H NALEX JR GUAIFENESIN/P-EPHED HCL 300-60MG CAPSULE SA PSE 120 GUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H PSEUDOEPHEDRINE W/GUAIFENESIN GUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H PSEUDO-G/PSI GUAIFENESIN/P-EPHED HCL 600-120MG TAB.SR 12H PSEUDOVENT PED GUAIFENESIN/P-EPHED HCL 300-60MG CAPSULE SA SINUFED TIMECELLES GUAIFENESIN/P-EPHED HCL 300-60MG CAPSULE SA MEDEX-LA GUAIFENESIN/PPA HCL 400-75MG TABLET SA BRONCOMAR GG GUAIFENESIN/THEOPHYLLINE 90-150 ELIXIR THEOLATE GUAIFENESIN/THEOPHYLLINE 90-150 ELIXIR THEOMAR GG GUAIFENESIN/THEOPHYLLINE 90-150 LIQUID GUANABENZ ACETATE GUANABENZ ACETATE 4MG TABLET GUANABENZ ACETATE GUANABENZ ACETATE 8MG TABLET GUANFACINE HCL GUANFACINE HCL 1MG TABLET GUANFACINE HCL GUANFACINE HCL 2MG TABLET TENEX GUANFACINE HCL 1MG TABLET TENEX GUANFACINE HCL 2MG TABLET HALOPERIDOL HALOPERIDOL 0.5MG TABLET HALOPERIDOL HALOPERIDOL 10MG TABLET HALOPERIDOL HALOPERIDOL 1MG TABLET HALOPERIDOL HALOPERIDOL 20MG TABLET HALOPERIDOL HALOPERIDOL 2MG TABLET HALOPERIDOL HALOPERIDOL 5MG TABLET HALDOL DECANOATE 100 HALOPERIDOL DECANOATE 100MG/ML VIAL HALDOL DECANOATE 50 HALOPERIDOL DECANOATE 50MG/ML VIAL HALOPERIDOL DECANOATE HALOPERIDOL DECANOATE 100MG/ML VIAL HALOPERIDOL DECANOATE HALOPERIDOL DECANOATE 50MG/ML VIAL HALDOL HALOPERIDOL LACTATE 5MG/ML VIAL HALOPERIDOL LACTATE HALOPERIDOL LACTATE 2MG/ML ORAL CONC. HALOPERIDOL LACTATE HALOPERIDOL LACTATE 5MG/ML VIAL ANTIBIOTIC EAR SOLUTION HC/NEOMY SULF/POLYMYX B SULF 1% SOLUTION ANTIBIOTIC EAR SUSPENSION HC/NEOMY SULF/POLYMYX B SULF 3.5-10M-1 DROPS SUSP CORTISPORIN HC/NEOMY SULF/POLYMYX B SULF DROPS SUSP CORTISPORIN HC/NEOMY SULF/POLYMYX B SULF 1% SOLUTION CORTISPORIN HC/NEOMY SULF/POLYMYX B SULF 3.5-10M-1 DROPS SUSP CORTOMYCIN HC/NEOMY SULF/POLYMYX B SULF 1% SOLUTION CORTOMYCIN HC/NEOMY SULF/POLYMYX B SULF 3.5-10M-1 DROPS SUSP NEOMYCIN/POLYMYXIN/HC HC/NEOMY SULF/POLYMYX B SULF 1% SOLUTION NEOMYCIN/POLYMYXIN/HC HC/NEOMY SULF/POLYMYX B SULF 3.5-10M-1 DROPS SUSP OTIMAR HC/NEOMY SULF/POLYMYX B SULF 1% SOLUTION Page 45 MAC list as of February 03.xls
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Alabama Medicaid Maximum Allowable Cost List

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