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 />
LORTAB ACETAMINOPHEN/HYDROCODONE BIT 10-500MG TABLET<br />
LORTAB ACETAMINOPHEN/HYDROCODONE BIT 2.5-167/5 ELIXIR<br />
LORTAB ACETAMINOPHEN/HYDROCODONE BIT 2.5-500MG TABLET<br />
LORTAB ACETAMINOPHEN/HYDROCODONE BIT 5-500MG TABLET<br />
LORTAB ACETAMINOPHEN/HYDROCODONE BIT 7.5-500MG TABLET<br />
MARGESIC H ACETAMINOPHEN/HYDROCODONE BIT 5-500MG CAPSULE<br />
NORCO ACETAMINOPHEN/HYDROCODONE BIT 10-325MG TABLET<br />
NORCO ACETAMINOPHEN/HYDROCODONE BIT 5-325MG TABLET<br />
STAGESIC ACETAMINOPHEN/HYDROCODONE BIT 5-500MG CAPSULE<br />
VANACET ACETAMINOPHEN/HYDROCODONE BIT 5-500MG TABLET<br />
VICODIN ACETAMINOPHEN/HYDROCODONE BIT 5-500MG TABLET<br />
VICODIN ES ACETAMINOPHEN/HYDROCODONE BIT 7.5-750MG TABLET<br />
VICODIN HP ACETAMINOPHEN/HYDROCODONE BIT 10-660MG TABLET<br />
ENDOCET ACETAMINOPHEN/OXYCODONE HCL 10-650MG TABLET<br />
ENDOCET ACETAMINOPHEN/OXYCODONE HCL 5-325MG TABLET<br />
ENDOCET ACETAMINOPHEN/OXYCODONE HCL 7.5-500MG TABLET<br />
OXYCODONE W/ACETAMINOPHEN ACETAMINOPHEN/OXYCODONE HCL 5-325MG TABLET<br />
OXYCODONE W/ACETAMINOPHEN ACETAMINOPHEN/OXYCODONE HCL 5-500MG CAPSULE<br />
OXYCODONE/APAP ACETAMINOPHEN/OXYCODONE HCL 10-650MG TABLET<br />
OXYCODONE/APAP ACETAMINOPHEN/OXYCODONE HCL 7.5-500MG TABLET<br />
OXYCODONE-ACETAMINOPHEN ACETAMINOPHEN/OXYCODONE HCL 5-500MG CAPSULE<br />
PERCOCET ACETAMINOPHEN/OXYCODONE HCL 5-325MG TABLET<br />
ROXICET ACETAMINOPHEN/OXYCODONE HCL 5-325MG TABLET<br />
TYLOX ACETAMINOPHEN/OXYCODONE HCL 5-500MG CAPSULE<br />
PENTAZOCINE/ACETAMINOPHEN ACETAMINOPHEN/PENTAZOCINE HCL 25-650MG TABLET<br />
DOLOGESIC ACETAMINOPHEN/PHENYLTOLX CIT 500-30MG CAPSULE<br />
FLEXTRA-DS ACETAMINOPHEN/PHENYLTOLX CIT 500-50MG TABLET<br />
GENECAR ACETAMINOPHEN/PHENYLTOLX CIT 500-30MG TABLET<br />
HYFLEX-650 ACETAMINOPHEN/PHENYLTOLX CIT 650-60MG TABLET<br />
HYFLEX-DS ACETAMINOPHEN/PHENYLTOLX CIT 500-50MG TABLET<br />
RHINOFLEX ACETAMINOPHEN/PHENYLTOLX CIT 500-50MG TABLET<br />
DARVOCET-N 100 ACETAMINOPHEN/PROPOXYPHENE 100-650MG TABLET<br />
PROPOXYPHENE NAPSYLATE W/APAP ACETAMINOPHEN/PROPOXYPHENE 100-650MG TABLET<br />
PROPOXYPHENE NAPSYLATE W/APAP ACETAMINOPHEN/PROPOXYPHENE 50-325MG TABLET<br />
PROPOXYPHENE NAPSYLATE/APAP ACETAMINOPHEN/PROPOXYPHENE 100-650MG TABLET<br />
PROPOXYPHENE HCL W/APAP ACETAMINOPHEN/PROPOXYPHENE HCL 65-650MG TABLET<br />
PROPOXYPHENE HCL/APAP ACETAMINOPHEN/PROPOXYPHENE HCL 65-650MG TABLET<br />
LORSIN ACETAMINOPHN/CP/P-EPHED HCL 30-500-2MG TABLET<br />
ANABAR ACETAMINOPHN/P-TLOX/SAL-AMIDE 200-300-20 TABLET<br />
ASP ACETAMINOPHN/P-TLOX/SAL-AMIDE 200-300-20 CAPSULE<br />
CETAZONE-T ACETAMINOPHN/P-TLOX/SAL-AMIDE 200-300-20 TABLET<br />
ED-FLEX ACETAMINOPHN/P-TLOX/SAL-AMIDE 200-300-20 CAPSULE<br />
LOBAC ACETAMINOPHN/P-TLOX/SAL-AMIDE 200-300-20 CAPSULE<br />
ACETAZOLAMIDE ACETAZOLAMIDE 125MG TABLET<br />
ACETAZOLAMIDE ACETAZOLAMIDE 250MG TABLET<br />
DIAMOX ACETAZOLAMIDE 125MG TABLET<br />
DIAMOX ACETAZOLAMIDE 250MG TABLET<br />
ACETAZOLAMIDE SODIUM ACETAZOLAMIDE SODIUM 500MG VIAL<br />
ACIDIC VAGINAL ACETIC AC/OXYQUINOL/RICINOLEIC JELLY/APPL<br />
ACETASOL ACETIC ACID 2% SOLUTION<br />
ACETIC ACID ACETIC ACID 0.25% IRRIG SOLN<br />
ACETIC ACID ACETIC ACID 2% SOLUTION<br />
VASOLATE ACETIC ACID 2% SOLUTION<br />
VOSOL ACETIC ACID 2% SOLUTION<br />
ACETIC ACID/ALUMINUM ACETIC ACID/ALUMINUM ACETATE 2% DROPS<br />
BOROFAIR ACETIC ACID/ALUMINUM ACETATE 2% DROPS<br />
DOMEBORO ACETIC ACID/ALUMINUM ACETATE 2% DROPS<br />
ACETASOL HC ACETIC ACID/HYDROCORTISONE 2-1% DROPS<br />
ACETIC ACID/HYDROCORTISONE ACETIC ACID/HYDROCORTISONE 2-1% DROPS<br />
VOSOL HC ACETIC ACID/HYDROCORTISONE 2-1% DROPS<br />
ACETOHEXAMIDE ACETOHEXAMIDE 250MG TABLET<br />
ACETOHEXAMIDE ACETOHEXAMIDE 500MG TABLET<br />
ACETYLCYSTEINE ACETYLCYSTEINE 100MG/ML VIAL<br />
ACETYLCYSTEINE ACETYLCYSTEINE 100MG/ML VIAL-NEB.<br />
ACETYLCYSTEINE ACETYLCYSTEINE 200MG/ML VIAL<br />
MUCOMYST ACETYLCYSTEINE 200MG/ML VIAL<br />
MUCOMYST-10 ACETYLCYSTEINE 100MG/ML VIAL<br />
ACYCLOVIR ACYCLOVIR 200MG CAPSULE<br />
ACYCLOVIR ACYCLOVIR 200MG/5ML ORAL SUSP<br />
ACYCLOVIR ACYCLOVIR 400MG TABLET<br />
ACYCLOVIR ACYCLOVIR 800MG TABLET<br />
ZOVIRAX ACYCLOVIR 200MG CAPSULE<br />
ZOVIRAX ACYCLOVIR 400MG TABLET<br />
ZOVIRAX ACYCLOVIR 800MG TABLET<br />
ACYCLOVIR SODIUM ACYCLOVIR SODIUM 1000MG VIAL<br />
Page 5<br />
MAC list as of February 03.xls
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