TennCare Program TN MAC Price Change List As of: 03/30/2017
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- Hugh Sanders
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1 1 TN List Run : 03/30/17 Old PRAZOSIN HCL 5 MG CAPSULE ORAL 03/29/ ( 1.2) CAPTOPRIL 12.5 MG TABLET ORAL 07/07/ ( 2.9) ISOSORBIDE DINITRATE 5 MG TABLET ORAL 03/29/ ( 0.1) NIFEDIPINE 10 MG CAPSULE ORAL 03/29/ ( 9.8) DILTIAZEM HCL 60 MG TABLET ORAL 03/29/ ( 1.1) DILTIAZEM HCL 90 MG TABLET ORAL 03/29/ ( 3.5) DISULFIRAM 500 MG TABLET ORAL 02/02/ SODIUM CHLORIDE 0.9 SYRINGE INJECTION 04/19/ URSODIOL 300 MG CAPSULE ORAL 01/03/ ( 7.7) CHOLESTYRAMINE/ASPARTAME 4 G POWD PACK ORAL 09/08/ NORETHINDRONE AC-ETH ESTRADIOL 1MG-20MCG TABLET ORAL 03/29/ ( 31.0) HYDROXYZINE HCL 10 MG TABLET ORAL 12/21/ HYDROXYZINE PAMOATE 25 MG CAPSULE ORAL 03/29/ ( 5.7) HYDROXYZINE PAMOATE 50 MG CAPSULE ORAL 03/29/ ( 7.2) PROCHLORPERAZINE 25 MG SUPP.RECT RECTAL 04/28/ ( 3.4) THIORIDAZINE HCL 100 MG TABLET ORAL 03/28/ MORPHINE SULFATE 100 MG/5ML SOLUTION ORAL 09/06/ OXYCODONE HCL 5 MG/5 ML SOLUTION ORAL 05/26/ PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE ORAL 08/23/ PHENYTOIN 125 MG/5ML ORAL SUSP ORAL 03/29/ ( 0.4)
2 2 TN List Run : 03/30/17 Old CARBAMAZEPINE 200 MG TABLET ORAL 06/02/ ( 0.0) TRIHEXYPHENIDYL HCL 5 MG TABLET ORAL 03/29/ BACLOFEN 10 MG TABLET ORAL 05/19/ ( 10.0) MECLIZINE HCL 12.5 MG TABLET ORAL 01/12/ ( 9.6) PYRIDOSTIGMINE BROMIDE 60 MG TABLET ORAL 05/26/ ( 36.6) PYRIDOSTIGMINE BROMIDE 180 MG TABLET ER ORAL 03/01/ ( 2.5) DEXTROAMPHETAMINE/AMPHETAMINE 10 MG TABLET ORAL 02/21/ ( 0.5) DEXTROAMPHETAMINE SULFATE 5 MG TABLET ORAL 03/29/ ALBUTEROL SULFATE 4 MG TABLET ORAL 03/29/ ( 0.2) LABETALOL HCL 300 MG TABLET ORAL 03/29/ ( 14.5) TRETINOIN CREAM (G) TOPICAL 04/19/ GEMFIBROZIL 600 MG TABLET ORAL 08/18/ ( 15.4) BROMOCRIPTINE MESYLATE 5 MG CAPSULE ORAL 03/29/ ( 0.7) BROMOCRIPTINE MESYLATE 2.5 MG TABLET ORAL 03/29/ BETAMETH ACET/BETAMET SOD PHOS 6 MG/ML VIAL INJECTION 03/29/ SPIRONOLACTONE 100 MG TABLET ORAL 07/12/ ( 13.9) SPIRONOLACTONE 50 MG TABLET ORAL 03/29/ TERCONAZOLE 0.4 CREAM/APPL VAGINAL 03/28/ NYSTATIN /G OINT. (G) TOPICAL 03/29/ ( 0.2) CLOTRIMAZOLE 1 CREAM (G) TOPICAL 03/29/
3 3 TN List Run : 03/30/17 Old HYDROCORTISONE VALERATE 0.2 OINT. (G) TOPICAL 03/29/ BETAMETHASONE/PROPYLENE GLYC 0.05 CREAM (G) TOPICAL 03/29/ BETAMETHASONE DIPROPIONATE 0.05 OINT. (G) TOPICAL 03/29/ ( 41.9) TRIAMCINOLONE ACETONIDE 0.5 CREAM (G) TOPICAL 03/29/ ( 1.7) FLUOCINONIDE 0.05 CREAM (G) TOPICAL 09/29/ ( 0.2) DESONIDE 0.05 OINT. (G) TOPICAL 03/29/ ( 0.1) ALCLOMETASONE DIPROPIONATE 0.05 CREAM (G) TOPICAL 08/30/ TIMOLOL MALEATE 0.5 DROPS OPHTHALMIC 03/29/ CYCLOPENTOLATE HCL 2 DROPS OPHTHALMIC 03/29/ ( 27.7) ACETAZOLAMIDE SODIUM 500 MG VIAL INJECTION 03/29/ CHLORTHALIDONE 25 MG TABLET ORAL 03/29/ ( 0.6) INDOMETHACIN 75 MG CAPSULE ER ORAL 09/06/ ( 0.1) MEGESTROL ACETATE 40 MG TABLET ORAL 03/29/ ( 0.0) DICLOXACILLIN SODIUM 500 MG CAPSULE ORAL 03/29/ ( 2.3) MINOCYCLINE HCL 50 MG CAPSULE ORAL 10/06/ NEOMYCIN SULFATE 500 MG TABLET ORAL 03/29/ ( 6.1) CLINDAMYCIN HCL 300 MG CAPSULE ORAL 05/12/ ( 5.8) SULFASALAZINE 500 MG TABLET ORAL 07/21/ NITROFURANTOIN ROCRYSTAL 25 MG CAPSULE ORAL 12/21/ ( 0.1) METRONIDAZOLE 250 MG TABLET ORAL 03/29/
4 4 TN List Run : 03/30/17 Old AZATHIOPRINE 50 MG TABLET ORAL 03/29/ ( 1.0) PROPAFENONE HCL 300 MG TABLET ORAL 03/29/ NORGESTIMATE-ETHINYL ESTRADIOL TABLET ORAL 03/29/ ( 0.7) FLUCONAZOLE 100 MG TABLET ORAL 11/17/ ( 3.4) FENTANYL 25 MCG/HR PATCH TD72 TRANSDERM 03/21/ ( 0.4) RANITIDINE HCL 300 MG CAPSULE ORAL 03/29/ DILTIAZEM HCL 300 MG CAP ER 24H ORAL 03/01/ ( 16.7) METOPROLOL SUCCINATE 50 MG TAB ER 24H ORAL 03/29/ ( 2.1) METOPROLOL SUCCINATE 100 MG TAB ER 24H ORAL 03/29/ ( 4.6) ITRACONAZOLE 100 MG CAPSULE ORAL 03/29/ ( 24.9) OXAPROZIN 600 MG TABLET ORAL 08/18/ LAMOTRIGINE 100 MG TABLET ORAL 03/29/ ( 18.6) BUDESONIDE 1 MG/2 ML AMPUL-NEB INHALATION 03/29/ ( 5.0) TINIDAZOLE 500 MG TABLET ORAL 03/29/ ( 3.9) ACITRETIN 25 MG CAPSULE ORAL 03/29/ ( 0.0) NIFEDIPINE 30 MG TAB ER 24 ORAL 03/29/ NIFEDIPINE 90 MG TAB ER 24 ORAL 08/18/ ( 1.8) IPRATROPIUM BROMIDE 0.2 MG/ML SOLUTION INHALATION 03/29/ ( 1.2) PILOCARPINE HCL 5 MG TABLET ORAL 01/12/ CLARITHROMYCIN 250 MG/5ML SUSP RECON ORAL 03/29/
5 5 TN List Run : 03/30/17 Old TACROLIMUS 1 MG CAPSULE ORAL 09/13/ GLIPIZIDE 5 MG TAB ER 24 ORAL 03/29/ ( 6.5) MOEXIPRIL HCL 15 MG TABLET ORAL 01/12/ ( 5.0) SOTALOL HCL 120 MG TABLET ORAL 03/29/ LAMIVUDINE 10 MG/ML SOLUTION ORAL 03/28/ ( 21.0) OXYCODONE HCL 5 MG CAPSULE ORAL 03/22/ ( 13.2) TOPIRAMATE 50 MG TABLET ORAL 03/29/ RISPERIDONE 1 MG/ML SOLUTION ORAL 03/28/ DOXYCYCLINE MONOHYDRATE 100 MG TABLET ORAL 03/29/ BUPRENORPHINE HCL 2 MG TAB SUBL SUBLINGUAL 03/29/ ( 0.5) DONEPEZIL HCL 5 MG TABLET ORAL 03/29/ ( 1.8) LEVOFLOXACIN 250 MG TABLET ORAL 03/29/ ( 12.8) ATORVASTATIN CALCIUM 20 MG TABLET ORAL 04/18/ ( 22.2) OMEPRAZOLE 20 MG CAPSULE DR ORAL 03/29/ CANDESARTAN CILEXETIL 4 MG TABLET ORAL 03/29/ CICLOPIROX 8 SOLUTION TOPICAL 03/29/ ( 7.0) OLANZAPINE 20 MG TABLET ORAL 02/21/ ( 5.0) CELECOXIB 100 MG CAPSULE ORAL 03/29/ ( 18.4) TACROLIMUS 0.5 MG CAPSULE ORAL 04/11/ ( 48.8) LEVALBUTEROL HCL 0.63MG/3ML VIAL-NEB INHALATION 10/27/ ( 21.7)
6 6 TN List Run : 03/30/17 Old IRBESARTAN/HYDROCHLOROTHIAZIDE MG TABLET ORAL 03/29/ IVERMECTIN 3 MG TABLET ORAL 03/29/ ( 0.0) EXEMESTANE 25 MG TABLET ORAL 08/04/ ( 24.5) LEUCOVORIN CALCIUM 5 MG TABLET ORAL 03/29/ ( 6.3) ZONISAMIDE 100 MG CAPSULE ORAL 03/29/ ( 4.4) OLANZAPINE 5 MG TAB RAPDIS ORAL 03/14/ ( 0.1) METHYLPHENIDATE HCL 36 MG TAB ER 24 ORAL 03/29/ AMITRIPTYLINE HCL 25 MG TABLET ORAL 08/04/ ( 2.7) IMIPRAMINE HCL 25 MG TABLET ORAL 03/28/ ( 20.8) CLOMIPRAMINE HCL 50 MG CAPSULE ORAL 08/18/ ( 0.7) CLOMIPRAMINE HCL 75 MG CAPSULE ORAL 01/12/ CITALOPRAM HYDROBROMIDE 10 MG/5 ML SOLUTION ORAL 03/29/ ( 0.1) FLUOXETINE HCL 20 MG TABLET ORAL 11/03/ ( 11.0) BUPROPION HCL 100 MG TABLET ER ORAL 02/07/ ( 11.3) PHENELZINE SULFATE 15 MG TABLET ORAL 03/29/ ( 0.2) MIRTAZAPINE 15 MG TABLET ORAL 03/29/ ( 13.3) CLOBETASOL PROPIONATE 0.05 FOAM TOPICAL 06/28/ ( 3.0) DEXTROAMPHETAMINE/AMPHETAMINE 12.5 MG TABLET ORAL 03/29/ ( 0.2) TOLTERODINE TARTRATE 4 MG CAP ER 24H ORAL 03/29/ ( 4.6) ALENDRONATE SODIUM 35 MG TABLET ORAL 03/29/ ( 13.1)
7 7 TN List Run : 03/30/17 Old MIRTAZAPINE 15 MG TAB RAPDIS ORAL 03/29/ ( 1.6) NYSTATIN/TRIAMCIN CREAM (G) TOPICAL 03/29/ NEOMYCIN SU/BACITRA/POLYMYXIN 3.5MG-400 OINT. (G) OPHTHALMIC 03/29/ ( 0.8) ALBUTEROL SULFATE 0.63MG/3ML VIAL-NEB INHALATION 03/29/ ( 8.3) PHENYTOIN SODIUM EXTENDED 200 MG CAPSULE ORAL 01/05/ PRAVASTATIN SODIUM 80 MG TABLET ORAL 08/09/ ( 45.8) RISEDRONATE SODIUM 35 MG TABLET ORAL 03/28/ ( 25.4) VORICONAZOLE 200 MG TABLET ORAL 02/28/ ( 4.1) EPLERENONE 25 MG TABLET ORAL 03/29/ ( 4.2) METAXALONE 800 MG TABLET ORAL 03/29/ ( 0.1) RISPERIDONE 0.5 MG TAB RAPDIS ORAL 08/30/ ( 1.1) LEVONORGESTREL-ETHIN ESTRADIOL TBDSPK 3MO ORAL 03/29/ ( 0.7) HYDROCODONE/ACETAMINOPHEN /15 SOLUTION ORAL 03/29/ AMLODIPINE/ATORVASTATIN 5 MG-40 MG TABLET ORAL 10/27/ ( 1.6) AMLODIPINE/ATORVASTATIN 10 MG-20MG TABLET ORAL 01/26/ ( 4.6) MESALAMINE 800 MG TABLET DR ORAL 03/29/ ( 0.0) DULOXETINE HCL 20 MG CAPSULE DR ORAL 07/14/ ( 1.0) DULOXETINE HCL 60 MG CAPSULE DR ORAL 08/09/ ( 8.9) CEFDINIR 250 MG/5ML SUSP RECON ORAL 03/28/ ( 25.5) FLUDARABINE PHOSPHATE 50 MG/2 ML VIAL INTRAVEN 03/29/
8 8 TN List Run : 03/30/17 Old FENOFIBRATE,MICRONIZED 43 MG CAPSULE ORAL 03/29/ ( 22.7) DARIFENACIN HYDROBROMIDE 7.5 MG TAB ER 24H ORAL 03/29/ ENTECAVIR 0.5 MG TABLET ORAL 03/29/ ( 5.9) FENTANYL 12 MCG/HR PATCH TD72 TRANSDERM 03/21/ ( 0.0) SILDENAFIL CITRATE 20 MG TABLET ORAL 07/07/ ( 9.8) RISPERIDONE 4 MG TAB RAPDIS ORAL 03/21/ FENOFIBRATE NANOCRYSTALLIZED 145MG TABLET ORAL 02/28/ ( 3.5) CHOLESTYRAMINE/ASPARTAME 4 G POWDER ORAL 03/29/ ROPINIROLE HCL 4 MG TAB ER 24H ORAL 03/29/ AMLODIPINE/VALSARTAN/HCTHIAZID MG TABLET ORAL 03/29/ ( 10.0) AMLODIPINE/VALSARTAN/HCTHIAZID TABLET ORAL 03/29/ ( 10.0) LAMOTRIGINE 50(42)-100 TB RD DSPK ORAL 03/29/ DROSPIR/ETH ESTRA/LEVOMEFOL CA (24) TABLET ORAL 03/29/
TN Cover Rx Tennessee CoverRx MAC Price Change List As of: 04/26/2018
1 Tennessee CoverRx List Run : 04/26/18 Dosage Form amiodarone HCl 200 MG TABLET ORAL 04/25/2018 0.16102 0.14405 11.8 hydralazine HCl 100 MG TABLET ORAL 04/25/2015 0.11390 0.10854 4.9 hydralazine HCl 25
Nebraska Medicaid Program NE Weekly MAC Price Change List For Period: 12/14/ /20/2017
1 Medicaid Run : 12/21/17 NE Weekly List Old AMIODARONE HCL 200 MG TABLET ORAL 12/20/2017 0.15321 0.14370 6.6 HYDRALAZINE HCL 10 MG TABLET ORAL 12/20/2017 0.05226 0.05213 0.2 LISINOPRIL 10 MG TABLET ORAL
Alaska Medicaid 90 Day** Generic Prescription Medication List
1 ACYCLOVIR 200 MG CAPSULE BUPROPION HCL 150 MG TAB ER 24H ACYCLOVIR 200 MG/5ML BUPROPION HCL 150 MG TABLET ER ACYCLOVIR 400 MG TABLET BUPROPION HCL 150 MG TABLET ER ACYCLOVIR 800 MG TABLET BUPROPION HCL
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Allergy, Cold & Flu Antibiotic Treatments Arthritis & Pain Benzonatate 100mg cap 14 42 Diphenhydramine HCl Cap 50 MG 30 90 Diphenhydramine HCl Inj 50MG/ML 1 3 Diphenhydramine HCl Liquid 12.5 MG/5ML 720ml
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Allergy, Cold & Flu Antibiotic Treatments Arthritis & Pain Benzonatate 100mg cap 14 42 Diphenhydramine HCl Cap 50 MG 30 90 Diphenhydramine HCl Inj 50MG/ML 1 3 Diphenhydramine HCl Liquid 12.5 MG/5ML 720ml
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Allergies & Cold and Flu Benzonatate 100mg 14 42 Ceron DM syrup 120ml 360ml Ceron drops* 30ml 90ml Dec-Chlorphen drops* 30ml 90ml Dec-Chlorphen DM syrup* 118ml 354ml Loratadine 10mg 30 90 Promethazine
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Analgesics Opioid Analgesics, Long-acting fentanyl 100 mcg/hr patch td72 morphine sulfate 30 mg tablet er Opioid Analgesics, Short-acting fentanyl citrate 200 mcg lozenge hd hydrocodone/acetaminophen 5
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Allergies & Cold and Flu Benzonatate 100mg 14 Ceron DM syrup Ceron drops Dec-Chlorphen drops Dec-Chlorphen DM syrup 118ml* Loratadine 10mg Promethazine DM syrup Trivent DPC syrup * Antibiotic Treatments
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Drug Category Allergy, Cold & Flu Antibiotic Treatments Arthritis & Pain Riesbeck's Benzonatate 100mg cap 14 42 Diphenhydramine HCl Cap 50 MG 30 90 Diphenhydramine HCl Liquid 12.5 MG/5ML 720ml 2160ml Hydroxyzine
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Allergies & Cold and Flu $4, 30-day $10, 90-day Benzonatate 100mg cap 14 42 Loratadine 10mg tab 30 90 Promethazine DM syrup 120ml 360ml Antibiotic Treatments Amoxicillin 125mg/5ml susp (80ml bottle) 1
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GENERIC DRUG PACKAGE SIZE SMAC EFFECTIVE DATE ABACAVIR SULFATE 300 MG TAB 0000 2.34765 05/05/2017 ACAMPROSATE CALCIUM 333 MG TAB DR 0000 0.95908 01/05/2017 ACARBOSE 100 MG TAB 0000 0.38753 03/05/2017 ACARBOSE
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GENERIC DRUG PACKAGE SIZE SMAC EFFECTIVE DATE ABACAVIR SULFATE 300 MG TAB 0000 1.71356 06/05/2017 ACAMPROSATE CALCIUM 333 MG TAB DR 0000 0.95908 01/05/2017 ACARBOSE 100 MG TAB 0000 0.38753 03/05/2017 ACARBOSE
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ABACAVIR SULFATE 300 MG TAB 0000 4.94966 02/05/2016 ACAMPROSATE CALCIUM 333 MG TAB DR 0000 1.07161 11/05/2015 ACARBOSE 100 MG TAB 0000 0.47754 11/05/2015 ACARBOSE 25 MG TAB 0000 0.41100 08/05/2015 ACARBOSE
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Antibiotics Qty* DRUG NAME $0.00 Copay $ 4.00 $ 10.00 AMOXICILLIN 125 MG/5 ML (150 ML BOTTLE) 150 AMOXICILLIN 125 MG/5 ML (100 ML BOTTLE) 100 AMOXICILLIN 125 MG/5 ML (80 ML BOTTLE) 80 AMOXICILLIN 200 MG/5
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ABACAVIR SULFATE 300 MG TAB 0000 4.94966 02/05/2016 ACAMPROSATE CALCIUM 333 MG TAB DR 0000 1.07161 11/05/2015 ACARBOSE 100 MG TAB 0000 0.47754 11/05/2015 ACARBOSE 25 MG TAB 0000 0.41100 08/05/2015 ACARBOSE
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ABACAVIR SULFATE 300 mg TAB TABLET $5.4480 ACARBOSE 100 mg TAB TABLET $0.4337 ACARBOSE 25 mg TAB TABLET $0.5040 ACARBOSE 50 mg TAB TABLET $0.3904 ACEBUTOLOL HCL 200 mg CAP CAPSULE $0.2668 ACEBUTOLOL HCL
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Antibiotics Antifungal Antiviral Arthritis/ Pain 30 Day Qty* Free AMOXICILLIN 125 MG/5 ML (150 ML BOTTLE) AMOXICILLIN 125 MG/5 ML (100 ML BOTTLE) AMOXICILLIN 125 MG/5 ML (80 ML BOTTLE) AMOXICILLIN 200
While there is around a 3% increase shown in costs for Category M lines, I think this is due to the inclusion of more lines in Category M.
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DT Description Price Category Price change Percentage BNF 1.2 Mebeverine 135mg tablets (100) 702 M %
December 16 No Category M changes so the reductions imposed in May which were only supposed to last until September continue As in November, most changes are Category A lines with a few Category C. Significant
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MUTUAL SKU NO. DESCRIPTION VENDOR NAME NDC DISCOUNT PERCENTAGE 229-104 ACETIC ACID HC OTIC SOLUTION 2% 10 ML TARO TARO PHARMACEUTICALS USA 51672-3007-01 5% 214-270 ACYCLOVIR CAP 200 MG 100 QUINN QUINN
DT Description Price Category Price change
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DT Description Price Category Price change Percentage
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