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 />
ORAMORPH SR MORPHINE SULFATE 60MG TABLET SA<br />
RMS-SUPPOSITORY MORPHINE SULFATE 10MG SUPP.RECT<br />
RMS-SUPPOSITORY MORPHINE SULFATE 20MG SUPP.RECT<br />
RMS-SUPPOSITORY MORPHINE SULFATE 30MG SUPP.RECT<br />
RMS-SUPPOSITORY MORPHINE SULFATE 5MG SUPP.RECT<br />
ROXANOL MORPHINE SULFATE 20MG/ML SOLUTION<br />
ROXANOL 100 MORPHINE SULFATE 20MG/ML SOLUTION<br />
ROXANOL-T MORPHINE SULFATE 20MG/ML SOLUTION<br />
CAROMEGA MULTIVITAMINS TABLET<br />
INFUVITE ADULT MULTIVITAMINS VIAL<br />
M.V.I. PEDIATRIC MULTIVITAMINS VIAL<br />
M.V.I.-12 MULTIVITAMINS VIAL<br />
MULTI-12 MULTIVITAMINS VIAL<br />
MULTIVITAMIN 12 MULTIVITAMINS VIAL<br />
STROVITE MULTIVITAMINS TABLET<br />
ELDERCAPS MULTIVITAMINS W-MINERALS CAPSULE<br />
ZODEAC-100 MULTIVITAMINS W-MINERALS TABLET<br />
LIVER,IRON & VITAMINS MULTIVITS W-FE,LIVER VIAL<br />
CENTAMIN MULTIVITS W-FE,OTHER MIN LIQUID<br />
GERAVINE MULTIVITS W-FE,OTHER MIN LIQUID<br />
STROVITE PLUS MULTIVITS W-FE,OTHER MIN TABLET<br />
CENTRUM MULTIVITS W-IRON,HEMATINIC 27-0.4MG TABLET<br />
CEFOL MULTIVITS,STRESS FORMULA TABLET<br />
B-COMPLEX PLUS VITAMIN MULTIVITS,THERAP W-FE,HEMATIN TABLET<br />
B-COMPLEX VITAMIN PLUS MULTIVITS,THERAP W-FE,HEMATIN 27-0.8MG TABLET<br />
B-PLEX PLUS MULTIVITS,THERAP W-FE,HEMATIN 27-0.8MG TABLET<br />
FORMULA B PLUS MULTIVITS,THERAP W-FE,HEMATIN 27-0.8MG TABLET<br />
THERAGRAN HEMATINIC MULTIVITS,THERAP W-FE,HEMATIN 66.7-.33MG TABLET<br />
THERAPEUTIC HEMATINIC MULTIVITS,THERAP W-FE,HEMATIN TABLET<br />
THEROBEC PLUS MULTIVITS,THERAP W-FE,HEMATIN 27-0.8MG TABLET<br />
VITALIZE PLUS MULTIVITS,THERAP W-FE,HEMATIN 27-0.8MG TABLET<br />
VITAPLEX PLUS MULTIVITS,THERAP W-FE,HEMATIN 27-0.8MG TABLET<br />
VITAROCA PLUS MULTIVITS,THERAP W-FE,HEMATIN 27-0.8MG TABLET<br />
SULFACETAMIDE W/PREDNISOLONE NA SULFACETM/PREDNIS SP 10-0.25% DROPS<br />
VASOCIDIN NA SULFACETM/PREDNIS SP 10-0.25% DROPS<br />
NABUMETONE NABUMETONE 500MG TABLET<br />
NABUMETONE NABUMETONE 750MG TABLET<br />
RELAFEN NABUMETONE 500MG TABLET<br />
RELAFEN NABUMETONE 750MG TABLET<br />
POTASSIUM CHL/NORMAL SALINE NACL 0.9%/POTASSIUM CHLORIDE 20MEQ/L IV SOLN.<br />
POTASSIUM CHL/NORMAL SALINE NACL 0.9%/POTASSIUM CHLORIDE 40MEQ/L IV SOLN.<br />
CORGARD NADOLOL 120MG TABLET<br />
CORGARD NADOLOL 160MG TABLET<br />
CORGARD NADOLOL 20MG TABLET<br />
CORGARD NADOLOL 40MG TABLET<br />
CORGARD NADOLOL 80MG TABLET<br />
NADOLOL NADOLOL 120MG TABLET<br />
NADOLOL NADOLOL 160MG TABLET<br />
NADOLOL NADOLOL 20MG TABLET<br />
NADOLOL NADOLOL 40MG TABLET<br />
NADOLOL NADOLOL 80MG TABLET<br />
NAFCILLIN SODIUM NAFCILLIN SODIUM 1G VIAL<br />
NAFCILLIN SODIUM NAFCILLIN SODIUM 2G VIAL<br />
NALLPEN NAFCILLIN SODIUM 10G VIAL<br />
NALLPEN NAFCILLIN SODIUM 2G PIGGYBACK<br />
NALLPEN NAFCILLIN SODIUM 2G VIAL<br />
NALLPEN NAFCILLIN SODIUM 500MG VIAL<br />
NALBUPHINE HCL NALBUPHINE HCL 10MG/ML AMPUL<br />
NALBUPHINE HCL NALBUPHINE HCL 10MG/ML VIAL<br />
NALBUPHINE HCL NALBUPHINE HCL 20MG/ML AMPUL<br />
NALBUPHINE HCL NALBUPHINE HCL 20MG/ML VIAL<br />
NUBAIN NALBUPHINE HCL 20MG/ML AMPUL<br />
NALOXONE HCL NALOXONE HCL 0.02MG/ML AMPUL<br />
NALOXONE HCL NALOXONE HCL 0.4MG/ML AMPUL<br />
NALOXONE HCL NALOXONE HCL 0.4MG/ML DISP SYRIN<br />
NALOXONE HCL NALOXONE HCL 0.4MG/ML VIAL<br />
NARCAN NALOXONE HCL 0.02MG/ML AMPUL<br />
NARCAN NALOXONE HCL 0.4MG/ML AMPUL<br />
NARCAN MULTIPLE DOSE NALOXONE HCL 0.4MG/ML VIAL<br />
PENTAZOCINE AND NALOXONE HCL NALOXONE HCL/PENTAZOCINE HCL 50-0.5MG TABLET<br />
PENTAZOCINE/NALOXONE NALOXONE HCL/PENTAZOCINE HCL 50-0.5MG TABLET<br />
TALWIN NX NALOXONE HCL/PENTAZOCINE HCL 50-0.5MG TABLET<br />
DEPADE NALTREXONE HCL 50MG TABLET<br />
NALTREXONE HYDROCHLORIDE NALTREXONE HCL 50MG TABLET<br />
REVIA NALTREXONE HCL 50MG TABLET<br />
Page 59<br />
MAC list as of February 03.xls
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