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 />
DECA-DURABOLIN NANDROLONE DECANOATE 100MG/ML VIAL<br />
NANDROLONE DECANOATE NANDROLONE DECANOATE 100MG/ML VIAL<br />
NANDROLONE DECANOATE NANDROLONE DECANOATE 200MG/ML VIAL<br />
NANDROLONE DECANOATE NANDROLONE DECANOATE 50MG/ML VIAL<br />
AK-CON NAPHAZOLINE HCL 0.1% DROPS<br />
ALBALON NAPHAZOLINE HCL 0.1% DROPS<br />
ALLERSOL NAPHAZOLINE HCL 0.1% DROPS<br />
NAPHAZOLE NAPHAZOLINE HCL 0.1% DROPS<br />
NAPHAZOLINE HCL NAPHAZOLINE HCL 0.1% DROPS<br />
EC-NAPROSYN NAPROXEN 375MG TABLET DR<br />
EC-NAPROSYN NAPROXEN 500MG TABLET DR<br />
NAPROSYN NAPROXEN 250MG TABLET<br />
NAPROSYN NAPROXEN 375MG TABLET<br />
NAPROSYN NAPROXEN 500MG TABLET<br />
NAPROXEN NAPROXEN 125MG/5ML ORAL SUSP<br />
NAPROXEN NAPROXEN 250MG TABLET<br />
NAPROXEN NAPROXEN 375MG TABLET<br />
NAPROXEN NAPROXEN 375MG TABLET DR<br />
NAPROXEN NAPROXEN 500MG TABLET<br />
NAPROXEN NAPROXEN 500MG TABLET DR<br />
ANAPROX NAPROXEN SODIUM 275MG TABLET<br />
ANAPROX DS NAPROXEN SODIUM 550MG TABLET<br />
NAPROXEN SODIUM NAPROXEN SODIUM 220MG TABLET<br />
NAPROXEN SODIUM NAPROXEN SODIUM 275MG TABLET<br />
NAPROXEN SODIUM NAPROXEN SODIUM 550MG TABLET<br />
NAPROXEN SODIUM NAPROXEN SODIUM 550MG TABLET SA<br />
V-R NAPROXEN SODIUM NAPROXEN SODIUM 220MG TABLET<br />
ANTIBIOTIC NEOMY SULF/POLYMYXIN B SULFATE CREAM(GM)<br />
NEOMYCIN SULFATE NEOMYCIN SULFATE 500MG TABLET<br />
NEOSTIGMINE METHYLSULFATE NEOSTIGMINE METHYLSULFATE 1:1000 VIAL<br />
NEOSTIGMINE METHYLSULFATE NEOSTIGMINE METHYLSULFATE 1:2000 VIAL<br />
PROSTIGMIN NEOSTIGMINE METHYLSULFATE 1:1000 VIAL<br />
PROSTIGMIN NEOSTIGMINE METHYLSULFATE 1:2000 VIAL<br />
NIACIN NIACIN 125MG CAPSULE SA<br />
NIACIN NIACIN 250MG CAPSULE SA<br />
NIACIN TD NIACIN 250MG CAPSULE SA<br />
NIACOR NIACIN 500MG TABLET<br />
CARDENE NICARDIPINE HCL 20MG CAPSULE<br />
CARDENE NICARDIPINE HCL 30MG CAPSULE<br />
NICARDIPINE HCL NICARDIPINE HCL 20MG CAPSULE<br />
NICARDIPINE HCL NICARDIPINE HCL 30MG CAPSULE<br />
NIFEDICAL XL NIFEDIPINE 30MG TAB SA OSM<br />
NIFEDICAL XL NIFEDIPINE 60MG TAB SA OSM<br />
NIFEDIPINE NIFEDIPINE 10MG CAPSULE<br />
NIFEDIPINE NIFEDIPINE 20MG CAPSULE<br />
NIFEDIPINE NIFEDIPINE 30MG TABLET SA<br />
NIFEDIPINE NIFEDIPINE 60MG TABLET SA<br />
NIFEDIPINE NIFEDIPINE 90MG TABLET SA<br />
NIFEDIPINE ER NIFEDIPINE 30MG TAB SA OSM<br />
NIFEDIPINE ER NIFEDIPINE 60MG TAB SA OSM<br />
NIFEDIPINE ER NIFEDIPINE 90MG TAB SA OSM<br />
PROCARDIA NIFEDIPINE 10MG CAPSULE<br />
PROCARDIA NIFEDIPINE 20MG CAPSULE<br />
PROCARDIA XL NIFEDIPINE 30MG TAB SA OSM<br />
PROCARDIA XL NIFEDIPINE 60MG TAB SA OSM<br />
MACRODANTIN NITROFURANTOIN MACROCRYSTAL 100MG CAPSULE<br />
MACRODANTIN NITROFURANTOIN MACROCRYSTAL 50MG CAPSULE<br />
NITROFURANTOIN MACROCRYSTAL NITROFURANTOIN MACROCRYSTAL 100MG CAPSULE<br />
NITROFURANTOIN MACROCRYSTAL NITROFURANTOIN MACROCRYSTAL 50MG CAPSULE<br />
FURACIN NITROFURAZONE 0.2% OINT.(GM)<br />
NITROFURAZONE NITROFURAZONE 0.2% OINT.(GM)<br />
NITROFURAZONE NITROFURAZONE 0.2% SOLUTION<br />
MINITRAN NITROGLYCERIN 0.1MG/HR PATCH TD24<br />
MINITRAN NITROGLYCERIN 0.2MG/HR PATCH TD24<br />
MINITRAN NITROGLYCERIN 0.4MG/HR PATCH TD24<br />
MINITRAN NITROGLYCERIN 0.6MG/HR PATCH TD24<br />
NITREK NITROGLYCERIN 0.2MG/HR PATCH TD24<br />
NITREK NITROGLYCERIN 0.4MG/HR PATCH TD24<br />
NITREK NITROGLYCERIN 0.6MG/HR PATCH TD24<br />
NITRO-BID NITROGLYCERIN 2% OINT.(GM)<br />
NITRO-DUR NITROGLYCERIN 0.1MG/HR PATCH TD24<br />
NITRO-DUR NITROGLYCERIN 0.2MG/HR PATCH TD24<br />
NITRO-DUR NITROGLYCERIN 0.4MG/HR PATCH TD24<br />
NITRO-DUR NITROGLYCERIN 0.6MG/HR PATCH TD24<br />
NITROGLYCERIN NITROGLYCERIN 0.1MG/HR PATCH TD24<br />
Page 60<br />
MAC list as of February 03.xls