TN Cover Rx Tennessee CoverRx MAC Price Change List As of: 04/26/2018
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- Hillary Weaver
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1 1 Tennessee CoverRx List Run : 04/26/18 Dosage Form amiodarone HCl 200 MG TABLET ORAL 04/25/ hydralazine HCl 100 MG TABLET ORAL 04/25/ hydralazine HCl 25 MG TABLET ORAL 09/06/ ( 3.6) hydralazine HCl 50 MG TABLET ORAL 07/11/ ( 3.5) captopril 25 MG TABLET ORAL 07/07/ ( 1.9) isosorbide dinitrate 20 MG TABLET ORAL 04/25/ ( 0.0) disulfiram 250 MG TABLET ORAL 09/08/ potassium chloride 20 MEQ PACKET ORAL 04/25/ ( 10.0) potassium chloride 8 MEQ TABLET ER ORAL 07/07/ ( 4.4) magnesium citrate SOLUTION ORAL 04/25/ ( 19.7) estradiol 0.1MG/24HR PATCH TDSW TRANSDERM 01/10/ ( 0.2) norethindrone 0.35 MG TABLET ORAL 04/18/ ( 0.3) bupivacaine HCl 2.5 MG/ML VIAL INJECTION 04/25/ bupivacaine HCl 5 MG/ML VIAL INJECTION 04/25/ hydroxyzine HCl 50 MG TABLET ORAL 07/07/ ( 9.8) clorazepate dipotassium 3.75 MG TABLET ORAL 05/16/ ( 2.3) lorazepam 0.5 MG TABLET ORAL 04/25/ ( 8.7) diazepam 5 MG/ML ORAL CONC ORAL 04/25/ diazepam 2 MG TABLET ORAL 04/25/ alprazolam 0.25 MG TABLET ORAL 04/26/ ( 7.8) fluphenazine HCl 10 MG TABLET ORAL 04/20/
2 2 Tennessee CoverRx List Run : 04/26/18 Dosage Form fluphenazine HCl 5 MG TABLET ORAL 01/10/ perphenazine 2 MG TABLET ORAL 04/25/ perphenazine 8 MG TABLET ORAL 04/25/ promethazine HCl 12.5 MG SUPP.RECT RECTAL 09/22/ promethazine HCl 25 MG SUPP.RECT RECTAL 09/06/ methylphenidate HCl 10 MG TABLET ORAL 03/20/ ( 8.4) methylphenidate HCl 20 MG TABLET ORAL 10/03/ acetaminophen with codeine 300MG-30MG TABLET ORAL 05/26/ acetaminophen with codeine 300MG-60MG TABLET ORAL 04/25/ ( 10.0) oxycodone HCl/acetaminophen 5 MG-325MG TABLET ORAL 10/03/ butalbital/aspirin/caffeine CAPSULE ORAL 07/05/ acetaminophen 650 MG SUPP.RECT RECTAL 04/24/ naltrexone HCl 50 MG TABLET ORAL 04/25/ ( 1.3) valproic acid 250 MG CAPSULE ORAL 03/14/ ethosuximide 250 MG CAPSULE ORAL 04/25/ carbamazepine 100 MG TAB CHEW ORAL 04/19/ ( 4.4) clonazepam 0.5 MG TABLET ORAL 04/25/ amantadine HCl 100 MG CAPSULE ORAL 05/26/ ( 1.5) benztropine mesylate 0.5 MG TABLET ORAL 07/21/ ( 6.0) benztropine mesylate 2 MG TABLET ORAL 07/07/ ( 3.0) orphenadrine citrate 100 MG TABLET ER ORAL 01/06/ ( 0.1)
3 3 Tennessee CoverRx List Run : 04/26/18 Dosage Form dronabinol 10 MG CAPSULE ORAL 04/25/ dronabinol 2.5 MG CAPSULE ORAL 04/25/ meclizine HCl 25 MG TABLET ORAL 05/26/ oxybutynin chloride 5 MG TABLET ORAL 05/12/ ( 7.4) dextroamphetamine sulfate 10 MG TABLET ORAL 04/25/ labetalol HCl 200 MG TABLET ORAL 04/25/ ( 0.0) phentolamine mesylate 5 MG VIAL INJECTION 04/25/ ( 5.9) nadolol 20 MG TABLET ORAL 04/19/ nadolol 80 MG TABLET ORAL 04/25/ salicylic acid 10 CREAM (G) TOPICAL 04/25/ tretinoin 0.1 CREAM (G) TOPICAL 01/06/ urea 20 CREAM (G) TOPICAL 05/05/ danazol 200 MG CAPSULE ORAL 11/22/ ( 2.2) liothyronine sodium 25 MCG TABLET ORAL 03/06/ ( 2.3) dexamethasone 0.5 MG/5ML ELIXIR ORAL 08/18/ nystatin /G POWDER TOPICAL 01/16/ ( 0.4) econazole nitrate 1 CREAM (G) TOPICAL 04/09/ ( 2.0) fluocinonide 0.05 CREAM (G) TOPICAL 09/29/ ( 2.0) fluocinonide 0.05 OINT. (G) TOPICAL 04/24/ ( 44.6) desonide 0.05 OINT. (G) TOPICAL 04/25/ ( 3.2) silver sulfadiazine 1 CREAM (G) TOPICAL 06/20/ ( 0.0)
4 4 Tennessee CoverRx List Run : 04/26/18 Dosage Form clindamycin phosphate 1 GEL (GRAM) TOPICAL 05/05/ clindamycin phosphate 1 SOLUTION TOPICAL 07/21/ ( 4.1) erythromycin base 5 MG/GRAM OINT. (G) OPHTHALMIC 04/03/ ( 13.7) amiloride/hydrochlorothiazide 5 MG-50 MG TABLET ORAL 04/25/ furosemide 10 MG/ML SOLUTION ORAL 04/25/ ( 1.5) amiloride HCl 5 MG TABLET ORAL 04/10/ probenecid 500 MG TABLET ORAL 04/25/ indomethacin 75 MG CAPSULE ER ORAL 09/06/ rifampin 300 MG CAPSULE ORAL 01/10/ ( 36.5) clindamycin HCl 150 MG CAPSULE ORAL 04/19/ ( 20.7) clindamycin HCl 300 MG CAPSULE ORAL 05/12/ ( 5.8) sulfasalazine 500 MG TABLET ORAL 07/21/ ciprofloxacin HCl 250 MG TABLET ORAL 08/15/ ciprofloxacin HCl 750 MG TABLET ORAL 04/25/ ( 6.9) nystatin /ML ORAL SUSP ORAL 01/10/ ( 1.8) diphenhydramine HCl 25 MG CAPSULE ORAL 05/16/ norgestimate-ethinyl estradiol TABLET ORAL 04/25/ ( 23.5) verapamil HCl 180 MG TABLET ER ORAL 07/11/ ( 0.1) clobetasol propionate 0.05 SOLUTION TOPICAL 03/21/ ( 11.5) alprazolam 2 MG TABLET ORAL 03/20/ ( 5.0)
5 5 Tennessee CoverRx List Run : 04/26/18 Dosage Form halobetasol propionate 0.05 CREAM (G) TOPICAL 07/21/ ( 1.0) fentanyl 50MCG/HR PATCH TD72 TRANSDERM 03/21/ etodolac 300 MG CAPSULE ORAL 04/25/ pravastatin sodium 10 MG TABLET ORAL 07/25/ ondansetron HCl 8 MG TABLET ORAL 09/06/ ( 2.0) diltiazem HCl 180 MG CAP ER DEG ORAL 04/24/ amlodipine besylate 2.5 MG TABLET ORAL 10/18/ norgestimate-ethinyl estradiol 7DAYSX3 28 TABLET ORAL 05/24/ ( 27.7) amiodarone HCl 100 MG TABLET ORAL 01/10/ ( 4.3) bisoprolol fumarate 5 MG TABLET ORAL 04/25/ clobetasol propionate 0.05 LOTION TOPICAL 04/25/ ( 3.5) tinidazole 500 MG TABLET ORAL 04/25/ desmopressin acetate 0.1 MG TABLET ORAL 04/24/ nifedipine 30 MG TAB ER 24 ORAL 04/25/ nifedipine 60 MG TAB ER 24 ORAL 04/25/ ( 1.3) pravastatin sodium 40 MG TABLET ORAL 03/15/ ( 20.2) megestrol acetate 400MG/10ML ORAL SUSP ORAL 04/25/ ( 1.9) calcipotriene CREAM (G) TOPICAL 03/21/ timolol maleate 0.5 SOL-GEL OPHTHALMIC 04/25/ torsemide 20 MG TABLET ORAL 04/25/
6 6 Tennessee CoverRx List Run : 04/26/18 Dosage Form cetirizine HCl 1 MG/ML SOLUTION ORAL 04/25/ ( 3.4) benazepril/hydrochlorothiazide 20 MG-25MG TABLET ORAL 04/24/ ( 20.1) clobetasol propionate 0.05 GEL (GRAM) TOPICAL 06/19/ potassium chloride 20 MEQ TAB ER PRT ORAL 04/25/ ( 0.4) sotalol HCl 120 MG TABLET ORAL 04/25/ ( 20.0) fosinopril sodium 40 MG TABLET ORAL 04/25/ riluzole 50 MG TABLET ORAL 04/25/ ( 3.2) cromolyn sodium 20 MG/ML ORAL CONC ORAL 08/18/ ( 2.9) amoxicillin/potassium clav MG/5 SUSP RECON ORAL 07/03/ ( 0.1) medroxyprogesterone acetate 150 MG/ML SYRINGE INTRAMUSC 04/11/ ( 7.1) pantoprazole sodium 40 MG TABLET DR ORAL 04/10/ ammonium lactate 12 CREAM (G) TOPICAL 04/25/ ( 1.5) olanzapine 2.5 MG TABLET ORAL 07/25/ ( 15.9) buprenorphine HCl 2 MG TAB SUBL SUBLINGUAL 04/25/ levofloxacin 250 MG TABLET ORAL 04/25/ ( 7.4) hydrocodone/acetaminophen 10MG-325MG TABLET ORAL 05/03/ ( 0.6) alendronate sodium 5 MG TABLET ORAL 04/25/ ( 1.5) memantine HCl 10 MG TABLET ORAL 01/12/ niacin 1000 MG TAB ER 24H ORAL 04/25/ ( 1.8) tiagabine HCl 4 MG TABLET ORAL 05/17/
7 7 Tennessee CoverRx List Run : 04/26/18 Dosage Form raloxifene HCl 60 MG TABLET ORAL 10/03/ ( 24.9) cilostazol 100 MG TABLET ORAL 04/25/ repaglinide 2 MG TABLET ORAL 04/25/ pramipexole di-hcl 0.5 MG TABLET ORAL 04/24/ ( 20.9) diclofenac sodium 3 GEL (GRAM) TOPICAL 05/30/ ( 20.3) telmisartan 80 MG TABLET ORAL 01/16/ ( 1.0) abacavir sulfate 20 MG/ML SOLUTION ORAL 04/25/ ondansetron 4 MG TAB RAPDIS ORAL 04/16/ temozolomide 5 MG CAPSULE ORAL 04/25/ ( 15.0) temozolomide 20 MG CAPSULE ORAL 04/25/ ( 11.2) temozolomide 100 MG CAPSULE ORAL 01/19/ ( 14.5) propranolol HCl 1 MG/ML VIAL INTRAVEN 04/24/ progesterone, micronized 100 MG CAPSULE ORAL 04/25/ ( 0.1) progesterone, micronized 200 MG CAPSULE ORAL 04/25/ ( 15.6) zolmitriptan 2.5 MG TAB RAPDIS ORAL 04/25/ tiagabine HCl 2 MG TABLET ORAL 08/25/ atorvastatin calcium 80 MG TABLET ORAL 04/24/ nortriptyline HCl 50 MG CAPSULE ORAL 01/24/ ( 2.5) doxepin HCl 10 MG CAPSULE ORAL 03/07/ ( 36.2) doxepin HCl 100 MG CAPSULE ORAL 04/07/ ( 2.4)
8 8 Tennessee CoverRx List Run : 04/26/18 Dosage Form doxepin HCl 25 MG CAPSULE ORAL 04/25/ ( 36.4) doxepin HCl 50 MG CAPSULE ORAL 04/07/ ( 36.5) doxepin HCl 75 MG CAPSULE ORAL 04/25/ ( 56.1) bupropion HCl 100 MG TAB ER 12H ORAL 02/07/ oxycodone HCl 15 MG TABLET ORAL 02/20/ ( 2.9) oxycodone HCl 30 MG TABLET ORAL 04/21/ ( 4.5) clobetasol propionate 0.05 FOAM TOPICAL 06/28/ ( 1.5) galantamine HBr 8 MG TABLET ORAL 10/17/ ( 0.1) dextroamphetamine/amphetamine 7.5 MG TABLET ORAL 06/27/ ( 4.8) tolterodine tartrate 4 MG CAP ER 24H ORAL 04/25/ ( 8.9) tolterodine tartrate 2 MG CAP ER 24H ORAL 04/25/ ( 8.7) tacrolimus 0.1 OINT. (G) TOPICAL 04/25/ ( 0.4) metoprolol succinate 25 MG TAB ER 24H ORAL 04/10/ ( 29.2) desloratadine 5 MG TABLET ORAL 04/25/ ( 0.7) calcipotriene/betamethasone OINT. (G) TOPICAL 04/25/ hydrocodone bit/homatrop me-br MG/5 SYRUP ORAL 12/02/ ( 5.3) zolmitriptan 5 MG TAB RAPDIS ORAL 04/25/ albuterol sulfate 1.25MG/3ML VIAL-NEB INHALATION 04/25/ ( 2.4) oxycodone HCl/acetaminophen MG TABLET ORAL 06/06/ ( 4.1) oxycodone HCl/acetaminophen 10MG-325MG TABLET ORAL 05/23/
9 9 Tennessee CoverRx List Run : 04/26/18 Dosage Form eplerenone 50 MG TABLET ORAL 04/25/ ( 3.4) aripiprazole 20 MG TABLET ORAL 12/26/ ( 14.3) aripiprazole 30 MG TABLET ORAL 04/24/ ( 23.9) risperidone 2 MG TAB RAPDIS ORAL 08/04/ diltiazem HCl 360 MG TAB ER 24H ORAL 11/03/ bupropion HCl 150 MG TAB ER 24H ORAL 06/07/ ( 17.9) methylphenidate HCl 20 MG CPBP ORAL 05/17/ methylphenidate HCl 40 MG CPBP ORAL 08/02/ ( 2.9) ezetimibe/simvastatin 10 MG-40MG TABLET ORAL 04/25/ ( 1.4) duloxetine HCl 60 MG CAPSULE DR ORAL 08/09/ ( 3.5) fenofibrate,micronized 130 MG CAPSULE ORAL 08/04/ aripiprazole 1 MG/ML SOLUTION ORAL 01/30/ ( 22.1) entecavir 0.5 MG TABLET ORAL 04/25/ fluocinolone/shower cap 0.01 OIL TOPICAL 04/25/ rasagiline mesylate 1 MG TABLET ORAL 04/25/ hydrocodone/acetaminophen 5 MG-300MG TABLET ORAL 04/25/ dapsone 5 GEL (GRAM) TOPICAL 04/25/ fenofibrate nanocrystallized 145MG TABLET ORAL 02/28/ amlodipine besylate/valsartan 10MG-160MG TABLET ORAL 04/25/ ( 0.0) amlodipine bes/olmesartan med 5 MG-40 MG TABLET ORAL 05/09/ ( 17.6)
10 10 Tennessee CoverRx List Run : 04/26/18 Dosage Form desvenlafaxine succinate 50 MG TAB ER 24H ORAL 04/25/ lamotrigine 200 MG TAB ER 24 ORAL 01/30/ guanfacine HCl 1 MG TAB ER 24H ORAL 01/16/ ( 1.9) guanfacine HCl 2 MG TAB ER 24H ORAL 01/10/ mecobal/levomefolat Ca/B6 phos MG TABLET ORAL 04/25/ ( 4.1) gatifloxacin 0.5 DROPS OPHTHALMIC 04/25/ ( 2.4) clonidine HCl 0.1 MG TAB ER 12H ORAL 04/25/ ( 5.7) Addition iron/fa/c/e/b12/bio/copper/dss TABLET ORAL 04/25/
TennCare Program TN MAC Price Change List As of: 03/30/2017
1 TN List Run : 03/30/17 Old PRAZOSIN HCL 5 MG CAPSULE ORAL 03/29/2017 1.11209 1.12560 ( 1.2) CAPTOPRIL 12.5 MG TABLET ORAL 07/07/2015 1.07191 1.10416 ( 2.9) ISOSORBIDE DINITRATE 5 MG TABLET ORAL 03/29/2017
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
Riesbeck's Pharmacy Reward Club Generic Medication List October 2017
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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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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Acyclovir Capsules 200mg Viruses 30 90 Albuterol Syrup 2mg/5ml Asthma 120 360 Albuterol Sulfate Solution 0.05% * Asthma ----- ----- 20 60 Albuterol Sulfate Solution 0.083% Asthma ----- ----- 75 225 Alendronate
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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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AMANTADINE 50 MG/5 ML SYRUP ACYCLOVIR 200 MG CAPSULES ACYCLOVIR 400 MG TABLETS ACYCLOVIR 800 MG TABLETS 30 90
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
Allergy, Cough and Cold. Analgesic. Anti-Anxiety. Antibiotic
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ASEBP Pantoprazole Sodium 40 mg (generic) $0.2016 ASEBP Dexlansoprazole 30 mg Dexlansoprazole 60 mg Esomeprazole 10 mg Esomeprazole 20 mg Esomeprazole 40 mg Lansoprazole 15 mg Lansoprazole 30 mg Omeprazole
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Everyday Low Cost Generics
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
November 2016 CAPS Monthly Product Promotions
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
North Carolina Department of Health and Human Services State Maximum Allowable Cost (SMAC) Rate Listing for Generic Drugs
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
Members enjoy more Pharmacy savings *
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DT Description Price Category Price change Percentage BNF 1.2 Mebeverine 135mg tablets (100) 759 M %
June 2016 On 13th May, the DH announced that there would be reductions to Category M prices from June until September. http://psnc.org.uk/our-news/contractor-notice-category-m-price-reduction/ This has
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
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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PACKAGE GENERIC DRUG. Page 1 of 39
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
PACKAGE SIZE SMAC GENERIC DRUG
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
ABILIFY INJ. Products Affected Step 2: ABILIFY MAINTENA PREFILLED SYRINGE 300 MG INTRAMUSCULAR ABILIFY MAINTENA PREFILLED SYRINGE 400 MG INTRAMUSCULAR
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