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 />
ACYCLOVIR SODIUM ACYCLOVIR SODIUM 1G/40ML VIAL<br />
ACYCLOVIR SODIUM ACYCLOVIR SODIUM 500MG VIAL<br />
ACYCLOVIR SODIUM ACYCLOVIR SODIUM 500MG/20ML VIAL<br />
ACYCLOVIR SODIUM ACYCLOVIR SODIUM 50MG/ML VIAL<br />
ZOVIRAX ACYCLOVIR SODIUM 1000MG VIAL<br />
ZOVIRAX ACYCLOVIR SODIUM 500MG VIAL<br />
BUFFERED ASPIRIN AL AMINOACET/ASPIRIN/MAG CARB 325MG TABLET<br />
UNI-BUFF AL AMINOACET/ASPIRIN/MAG CARB 325MG TABLET<br />
ARTHRITIS PAIN FORMULA AL HYDROX/ASPIRIN/MAG HYDROX 325MG TABLET<br />
MAGNAPRIN AL HYDROX/ASPIRIN/MAG HYDROX 325MG TABLET<br />
ALAMAG PLUS AL HYDROX/MAG HYDROX/SIMETH 200-200-20 ORAL SUSP<br />
ALMACONE AL HYDROX/MAG HYDROX/SIMETH 200-200-20 ORAL SUSP<br />
ALMACONE-2 AL HYDROX/MAG HYDROX/SIMETH 400-400-40 ORAL SUSP<br />
ANTACID AL HYDROX/MAG HYDROX/SIMETH 200-200-20 ORAL SUSP<br />
ANTACID AL HYDROX/MAG HYDROX/SIMETH 400-400-40 ORAL SUSP<br />
ANTACID ANTI-GAS AL HYDROX/MAG HYDROX/SIMETH 200-200-20 ORAL SUSP<br />
ANTACID ANTI-GAS AL HYDROX/MAG HYDROX/SIMETH 400-400-40 ORAL SUSP<br />
ANTACID ANTI-GAS DOUBLE STR AL HYDROX/MAG HYDROX/SIMETH 400-400-40 ORAL SUSP<br />
ANTACID DOUBLE STRENGTH AL HYDROX/MAG HYDROX/SIMETH 400-400-40 ORAL SUSP<br />
ANTACID M AL HYDROX/MAG HYDROX/SIMETH 200-200-20 ORAL SUSP<br />
ANTACID M AL HYDROX/MAG HYDROX/SIMETH 400-400-40 ORAL SUSP<br />
ANTACID PLUS AL HYDROX/MAG HYDROX/SIMETH 200-200-25 TAB CHEW<br />
ANTACID W/SIMETHICONE AL HYDROX/MAG HYDROX/SIMETH 200-200-20 ORAL SUSP<br />
ANTACID W/SIMETHICONE AL HYDROX/MAG HYDROX/SIMETH 400-400-40 ORAL SUSP<br />
ANTACID/ANTI-GAS AL HYDROX/MAG HYDROX/SIMETH 200-200-20 ORAL SUSP<br />
ANTACID/ANTIGAS AL HYDROX/MAG HYDROX/SIMETH 200-200-20 ORAL SUSP<br />
ANTACID-ANTIGAS AL HYDROX/MAG HYDROX/SIMETH 200-200-20 ORAL SUSP<br />
GELUSIL AL HYDROX/MAG HYDROX/SIMETH 200-200-25 TAB CHEW<br />
GERI-LANTA AL HYDROX/MAG HYDROX/SIMETH 200-200-20 ORAL SUSP<br />
HM ANTACID/ANTIGAS AL HYDROX/MAG HYDROX/SIMETH 200-200-20 ORAL SUSP<br />
MAALOX MS AL HYDROX/MAG HYDROX/SIMETH 400-400-40 ORAL SUSP<br />
MAALOX QUICK DISSOLVE AL HYDROX/MAG HYDROX/SIMETH 200-200-25 TAB CHEW<br />
MASANTI AL HYDROX/MAG HYDROX/SIMETH 200-200-20 ORAL SUSP<br />
MASANTI AL HYDROX/MAG HYDROX/SIMETH 400-400-40 ORAL SUSP<br />
MASANTI II AL HYDROX/MAG HYDROX/SIMETH 400-400-40 ORAL SUSP<br />
MI ACID AL HYDROX/MAG HYDROX/SIMETH 200-200-20 ORAL SUSP<br />
MI-ACID II AL HYDROX/MAG HYDROX/SIMETH 400-400-40 ORAL SUSP<br />
MILANTEX AL HYDROX/MAG HYDROX/SIMETH 200-200-20 ORAL SUSP<br />
MINTOX PLUS AL HYDROX/MAG HYDROX/SIMETH 200-200-25 TAB CHEW<br />
MYLANTA AL HYDROX/MAG HYDROX/SIMETH 200-200-20 ORAL SUSP<br />
MYLANTA DOUBLE-STRENGTH AL HYDROX/MAG HYDROX/SIMETH 400-400-40 ORAL SUSP<br />
MYLANTEX DOUBLE-STRENGTH AL HYDROX/MAG HYDROX/SIMETH 400-400-40 ORAL SUSP<br />
RI-GEL AL HYDROX/MAG HYDROX/SIMETH 200-200-20 ORAL SUSP<br />
RI-GEL II AL HYDROX/MAG HYDROX/SIMETH 400-400-40 ORAL SUSP<br />
UNI-LAN AL HYDROX/MAG HYDROX/SIMETH 200-200-20 ORAL SUSP<br />
UNI-LAN II AL HYDROX/MAG HYDROX/SIMETH 200-200-20 ORAL SUSP<br />
URBAN AL HYDROX/MAG HYDROX/SIMETH 200-200-20 ORAL SUSP<br />
URBAN D.S. AL HYDROX/MAG HYDROX/SIMETH 400-400-40 ORAL SUSP<br />
ALAMAG AL HYDROX/MAGNESIUM HYDROXIDE 200-225/5 ORAL SUSP<br />
ANTACID AL HYDROX/MAGNESIUM HYDROXIDE 200-225 ORAL SUSP<br />
ANTACID AL HYDROX/MAGNESIUM HYDROXIDE 200-225/5 ORAL SUSP<br />
HM ANTACID AL HYDROX/MAGNESIUM HYDROXIDE 200-225/5 ORAL SUSP<br />
LIQUID ANTACID AL HYDROX/MAGNESIUM HYDROXIDE 200-225/5 ORAL SUSP<br />
MAALOX AL HYDROX/MAGNESIUM HYDROXIDE 200-225/5 ORAL SUSP<br />
MAGNESIUM HYDR/ALUMINUM HYDR AL HYDROX/MAGNESIUM HYDROXIDE 200-225 ORAL SUSP<br />
MALDROXAL AL HYDROX/MAGNESIUM HYDROXIDE 200-225/5 ORAL SUSP<br />
MINTOX AL HYDROX/MAGNESIUM HYDROXIDE 200-200 TAB CHEW<br />
MINTOX AL HYDROX/MAGNESIUM HYDROXIDE 200-225/5 ORAL SUSP<br />
RI-MOX AL HYDROX/MAGNESIUM HYDROXIDE 200-225/5 ORAL SUSP<br />
RULOX AL HYDROX/MAGNESIUM HYDROXIDE 200-225/5 ORAL SUSP<br />
RULOX NO.1 AL HYDROX/MAGNESIUM HYDROXIDE 200-200 TAB CHEW<br />
ALBUMARC ALBUMIN HUMAN 25% IV SOLN.<br />
ALBUMARC ALBUMIN HUMAN 5% IV SOLN.<br />
ALBUMIN ALBUMIN HUMAN 25% IV SOLN.<br />
ALBUMIN ALBUMIN HUMAN 25% VIAL<br />
ALBUMIN ALBUMIN HUMAN 5% IV SOLN.<br />
ALBUMINAR-25 ALBUMIN HUMAN 25% IV SOLN.<br />
ALBUMINAR-25 ALBUMIN HUMAN 25% VIAL<br />
ALBUMINAR-5 ALBUMIN HUMAN 5% IV SOLN.<br />
ALBURX ALBUMIN HUMAN 25% VIAL<br />
ALBURX ALBUMIN HUMAN 5% VIAL<br />
ALBUTEIN ALBUMIN HUMAN 25% IV SOLN.<br />
ALBUTEIN ALBUMIN HUMAN 25% VIAL<br />
ALBUTEIN ALBUMIN HUMAN 5% IV SOLN.<br />
BUMINATE ALBUMIN HUMAN 25% VIAL<br />
Page 6<br />
MAC list as of February 03.xls
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