INDIANA MEDICAID UPDATE August 28, 1998 TO: All Indiana Medicaid Pharmacy Providers SUBJECT: Updated and Revised "FUL" List Accompanying this bulletin are COMPREHENSIVE updated and revised "FUL" (Attachment A) list. Please incorporate the list into the appropriate section in Chapter 11P (Pharmacy Specific Billing Procedures) of the Indiana Medical Assistance Programs Provider Manual. For products, that have an updated FUL pricing, the new pricing will be effective on September 1, 1998. If you have any questions regarding the attached lists or the text of this bulletin, please contact EDS Provider Assistance at 1-800-577-1278. E98-28 EDS P. O. Box 68420 Indianapolis, IN 46268-0420 1-800-577-1278
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ATTACHMENT A HCFA MAXIMUM ALLOWABLE COST MAC pricing indicators include the following: + increase in MAC unit price - decrease in MAC unit price NEW an addition to the MAC listing Please note that drugs deleted from MAC are not included on this listing. 3
Acebutolol Hydrochloride Eq. 200 mg base, Capsule, Oral 100 0.8025 09/01/98 NEW Eq. 400 mg base, Capsule, Oral 100 1.0703 10/01/97 Acetaminophen: Butalbital: Caffeine 325mg; 50mg; 40mg; Capsule, Oral 100 0.1223 10/01/97 325mg; 50mg; 40mg; Tablet, Oral 100 0.0428 10/01/97 Acetaminophen: Codeine Phosphate 300mg; 15mg; Tablet, Oral 100 0.0554 07/01/94 300mg; 30mg; Tablet, Oral 100 0.0875 07/01/95 300mg; 60mg; Tablet, Oral 100 0.1337 09/01/98 + Acetaminophen: Hydrocodone Bitartrate 500mg; 5mg; Capsule, Oral 100 0.2025 09/01/98 + 500mg; 2.5mg, Tablet, Oral 100 0.2498 10/01/97 500mg; 5mg, Tablet, Oral 100 0.0491 10/01/97 500mg; 7.5mg; Tablet, Oral 100 0.1837 09/01/98 + 650mg; 7.5mg; Tablet, Oral 100 0.1462 09/01/98-650mg; 10mg; Tablet, Oral 100 0.2235 09/01/98-750mg; 7.5mg; Tablet, Oral 100 0.1462 09/01/98 - Acetaminophen: Oxycodone Hydrochloride 325mg; 5mg; Tablet, Oral 100 0.0825 09/01/98-500mg; 5mg; Capsule, Oral 100 0.2919 09/01/98 - Acetaminophen: Propoxyphene Hydrochloride 650mg; 65mg; Tablet, Oral 100 0.1313 10/01/97 Acetaminophen: Propoxyphene Napsylate 650mg; 100mg; Tablet, Oral 100 0.0638 10/01/97 Acetic Acid, Glacial 2%, Solution/Drops, Otic, 15ml 0.1250 08/01/96 Acetic Acid, Glacial; Hydrocortisone 2%; 1%, solutions/drops, Otic 10ml 0.4275 10/01/97 Acetylcysteine 10%, Solution, Inhalation 4 ml 0.6330 10/01/97 10%, Solution, Inhalation 10 ml 0.3345 09/01/98-10%, Solution, Inhalation 30 ml 0.4565 09/01/98 + 20%, Solution, Inhalation 4 ml 0.9143 09/01/98 + 20%, Solution, Inhalation 10 ml 0.3405 09/01/98-20%, Solution, Inhalation 30 ml 0.4410 09/01/98 + 4
Acyclovir 200 mg. Capsule, Oral 100 0.3440 09/01/98 NEW 400 mg. Tablet, Oral 100 0.6266 09/01/98 NEW 800 mg, Tablet, Oral 100 1.2680 09/01/98 NEW Albuterol Eq. 90 mcg. Solution, Aerosol Inhalation Refill 17 gm 0.4394 09/01/98 NEW Eq. 90 mcg. Solution, Aerosol Inhalation 17 gm 0.4394 09/01/98 NEW Albuterol Sulfate Eq. 0.083% base, Solution, Inhalation 3 ml 0.1990 10/01/97 Eq 2 mg base/5ml, Syrup, Oral 480 ml 0.0111 09/01/98 NEW Eq 2mg base; Tablet, 100 EA, Oral 0.0267 10/01/97 Eq 4mg base; Tablet, 100 EA, Oral 0.0378 10/01/97 Allopurinol 100mg; Tablet, Oral 100 0.0323 07/01/94 300mg; Tablet, Oral 100 0.0677 10/01/97 Alprazolam 0.25mg; Tablet, Oral 100 0.0567 09/01/98 + 0.5mg; Tablet, Oral 100 0.0646 09/01/98 + 1mg; Tablet, Oral 100 0.0880 09/01/98 + 2mg; Tablet, Oral 100 0.1537 10/01/97 Amantadine Hydrochloride 100mg; Capsule, Oral 100 0.1762 09/01/98 + 50mg/5ml; Syrup, Oral 480 ml 0.0623 10/01/97 Amiloride Hydrochloride 5 mg, Tablet, Oral 100 0.3743 09/01/98 NEW Amiloride Hydrochloride; Hydrochlorothiazide Eq 5mg Anhydrous; 50mg; Tablet, Oral 100 0.0642 10/01/97 Aminophylline 100mg; Tablet, Oral 100 0.0332 09/01/98 - Amitriptyline Hydrochloride 10mg; Tablet, Oral 100 0.0199 09/01/98 + 25mg; Tablet, Oral 100 0.0165 10/01/97 50mg; Tablet, Oral 100 0.0219 10/01/97 75mg; Tablet, Oral 100 0.0312 10/01/97 100mg; Tablet, Oral 100 0.0353 10/01/97 150mg; Tablet, Oral 100 0.0675 10/01/97 5
Amitriptyline Hydrochloride; Perphenazine 10mg; 2mg; Tablet, Oral 100 0.0494 10/01/97 10mg; 4mg; Tablet, Oral 100 0.0591 10/01/97 25mg; 2mg; Tablet, Oral 100 0.0585 10/01/97 25mg;4mg Tablet, Oral 100 0.0710 09/01/98 NEW Amoxapine 25mg; Tablet, Oral 100 0.3825 10/01/97 50mg; Tablet, Oral 100 0.6128 10/01/97 100mg; Tablet, Oral 100 1.0388 10/01/97 150mg; Tablet, Oral 30 1.5975 10/01/97 Amoxicillin 250mg; Capsule, Oral 100 0.0735 10/01/97 500mg; Capsule, Oral 100 0.3119 09/01/98 + 125mg/5ml; Powder for reconstitution, Oral 80ml 0.0281 12/01/93 125mg/5ml; Powder for reconstitution, Oral 100ml 0.0165 10/01/97-125mg/5ml; Powder for reconstitution, Oral 150ml 0.0129 08/01/96 250mg/5ml; Powder for reconstitution, Oral 80ml 0.0540 01/01/96 250mg/5ml; Powder for reconstitution, Oral 100ml 0.0255 12/01/92 250mg/5ml; Powder for reconstitution, Oral 150ml 0.0185 08/01/96 Ampicillin/Ampicillin Trihydrate Eq 250mg base; Capsule, Oral 100 0.1042 09/01/98 + Eq 500mg base; Capsule, Oral 100 0.1343 12/01/92 Eq 125mg base/5ml; Powder for reconstitution, 0.0225 01/01/95 100 ML, Oral Eq 125mg base/5ml; Powder for reconstitution, 0.0199 09/01/98 + 200 ML, Oral Eq 250mg base/5ml; Powder for reconstitution, 0.0315 01/01/95 100 ML, Oral Eq 250mg base/5ml; Powder for reconstitution, 0.0274 10/01/97 200 ML, Oral Aspirin: Butalbital: Caffeine 325mg; 50mg; 40mg; Tablet, Oral 100 0.0488 09/01/98 + 325mg; 50mg; 40mg; Capsule, Oral 100 0.3443 09/01/98 NEW Aspirin: Caffeine: Propoxyphene Hydrochloride 389mg; 32.4mg; 65mg; Capsule, 100 EA, Oral 0.1689 01/01/96 Aspirin: Carisoprodol 325mg; 200mg; Tablet, 100 EA, Oral 0.4314 10/01/97 Aspirin: Methocarbamol 325mg; 400mg; Tablet, 100 EA, Oral 0.1445 10/01/97 Aspirin, Oxycodone Hydrochloride: Oxycodone Terephthalate 6
325mg; 4.5mg, 0.38mg, Tablet, Oral 100 0.1964 09/01/98 + Atenolol 25mg; Tablet, Oral 100 0.0413 09/01/98-50mg; Tablet, Oral 100 0.0435 10/01/97 100mg; Tablet, Oral 100 0.0590 10/01/97 Atenolol: Chlorthalidone 50mg; 25mg; Tablet, Oral 100 0.1725 09/01/98-100mg; 25mg; Tablet, Oral 100 0.2625 09/01/98 - Bacitracin Zinc: Neomycin Sulfate: Polymyxin B Sulfate 400 units/gm; Eq 3.5mg base/gm; 10,000 units/gm; 0.7286 10/01/97 Ointment, 3.5 Gm, Ophthalmic Baclofen 10mg; Tablet, 100 EA, Oral 0.0800 10/01/97 20mg; Tablet, 100 EA, Oral 0.1505 10/01/97 Benzonate 100mg, Capsule, Oral 100 0.3638 09/01/98 NEW Benztropine Mesylate 0.5mg; Tablet, Oral 100 0.0222 10/01/97 1mg; Tablet, Oral 100 0.0360 09/01/98 + 2mg; Tablet, Oral 100 0.0397 09/01/98 + Betamethasone Dipropionate Eq 0.05% base; Cream, 15 GM, Topical 0.2250 01/01/95 Eq 0.05% base; Cream, 45 GM, Topical 0.1317 10/01/97 Eq 0.05% base; Lotion, 20 ML, Topical 0.1598 07/01/95 Eq 0.05% base; Lotion, 60 ML, Topical 0.1595 07/01/95 Betamethasone Valerate Eq 0.1% base; Cream, 15GM, Topical 0.1200 10/01/97 Eq 0.1% base;cream, 45 GM, Topical 0.0733 08/01/96 Eq 0.1% base; Lotion, 60 ML, Topical 0.1112 01/01/96 Bethanechol Chloride 10mg; Tablet, Oral 100 0.0390 09/01/98 + 25mg; Tablet, Oral 100 0.0443 09/01/98 + 50mg; Tablet, Oral 100 0.1800 09/01/98 + Bromodiphenhydramine Hydrochloride: Codeine Phosphate 12.5mg/5ml; 10mg/5ml; Syrup, Oral 480ml 0.0186 09/01/98 - Brompheniramine Maleate: Codeine Phosphate: Phenylpropanolamine Hydrochloride 2mg/5ml; 10mg/5ml; 12.5mg/5ml; Syrup, Oral 480ml 0.0244 09/01/98 + 7
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Brompheniramine Maleate; Dextromethorphan Hydrobromide: Pseudoephedrine Hydrochloride 2mg/5ml; 10mg/5ml; 30mg/5ml; Syrup, Oral 480ml 0.0136 09/01/98 + Bumetanide 0.5mg, Tablet, Oral 100 0.1463 10/01/97 1mg, Tablet, Oral 100 0.1725 09/01/98-2mg, Tablet, Oral 100 0.2138 09/01/98 + Captopril 12.5 mg, Tablet, Oral 100 0.0375 10/01/97 25 mg, Tablet, Oral 100 0.0545 09/01/98-50 mg, Tablet, Oral 100 0.0990 10/01/97 100 mg, Tablet, Oral 100 0.1883 10/01/97 Carbamazepine 100mg; Tablet, chewable, 100 EA, Oral 0.1467 08/01/96 200mg; Tablet, 100 EA, Oral 0.1275 10/01/97 Carbidopa; Levodopa 10mg; 100mg, Tablet, 100 EA, Oral 0.2553 10/01/97 25mg; 100mg, Tablet, 100 EA, Oral 0.2754 10/01/97 25mg; 250mg, Tablet, 100 EA, Oral 0.3255 10/01/97 Carisoprodol 350mg; Tablet, 100 EA, Oral 0.0588 10/01/97 Cefaclor Eq. 250mg base, Capsule, Oral 100 1.1948 09/01/98 NEW Eq. 500mg base, Capsule, Oral 100 2.3985 09/01/98 NEW Eq. 125mg base/5ml, Powder for reconstitution, Oral 75ML 0.1350 10/01/97 Eq. 125mg base/5ml, Powder for reconstitution, Oral 150ML 0.1419 10/01/97 Eq. 187mg base/5ml, Powder for reconstitution, Oral 50ML 0.2025 10/01/97 Eq. 187mg base, 5ML, Powder for reconstitution, Oral 100ML 0.2130 10/01/97 Eq. 250mg base/5ml, Powder for reconstitution, Oral 75ML 0.2550 09/01/98 - Eq. 250mg base/5ml, Powder for reconstitution, Oral 150ML 0.2424 09/01/98 - Eq. 375mg base/5ml, Powder for reconstitution, Oral 50ML 0.3825 09/01/98 - Eq. 375mg base/5ml, Powder for reconstitution, Oral 100ML 0.3637 09/01/98 - Cephalexin Eq 250mg base; Capsule, Oral 100 0.1103 10/01/97 - Eq 500mg base; Capsule, Oral 100 0.2025 09/01/98 - Eq 250mg base; Tablet, Oral 100 0.3593 09/01/98 + Eq 125mg base/5ml; Powder for Reconstitution, Oral 100 ml 0.0255 10/01/97-9
Cephalexin (continued) Eq 125mg base/5ml; Powder for Reconstitution, Oral 200 ml 0.0210 10/01/97 Eq 250mg base/5ml; Powder for Reconstitution, Oral 100 ml 0.0789 09/01/98 + Eq 250mg base/5ml; Powder for Reconstitution, 0.0315 09/01/98 + Oral 200 ml Cephradine 250mg; Capsule, Oral 100 0.3656 09/01/98 + Chlordiazepoxide Hydrochloride 5mg; Capsule, Oral 100 0.0368 09/01/98 + 10mg; Capsule, Oral 100 0.0315 08/01/96 25mg; Capsule, Oral 100 0.0371 08/01/96 Chlorhexidine Gluconate 0.12%, Solution, Dental 480 ML 0.0109 10/01/97 Chlorothiazide 250mg; Tablet, Oral 100 0.0518 09/01/98 + 500mg; Tablet, Oral 100 0.0576 01/01/95 Chlorpheniramine Maleate 4mg; Tablet, Oral 100 0.0103 12/01/93 Chlorpropamide 100mg; Tablet, Oral 100 0.2315 09/01/98 + 250mg; Tablet, Oral 100 0.4897 09/01/98 + Chlorthalidone 25mg; Tablet, Oral 100 0.0278 10/01/97 50mg; Tablet, Oral 100 0.0417 10/01/97 Chlorzoxazone 500mg; Tablet, Oral 100 0.0848 10/01/97 Cholestyramine Eq. 4gm Resin/Packet, Powder, Oral 60 pk 0.9474 09/01/98 - Eq. 4gm Resin/Scoopful, Powder, Oral 239.4gm 0.1585 10/01/97 Cimetidine 200mg; Tablet, Oral 100 0.1365 10/01/97 300mg; Tablet, Oral 100 0.1553 10/01/97 400mg; Tablet, Oral 100 0.1770 10/01/97 800mg; Tablet, Oral 100 0.4155 10/01/97 Clemastine Fumarate 2.68mg; Tablet, Oral 100 0.3822 10/01/97 10
Clindamycin Phosphate Eq. 1% base, Solution, Topical 30ml 0.2490 09/01/98 + Eq. 1% base, Solution, Topical 60ml 0.1872 09/01/98 + Clomipramine Hydrochloride 25mg, Capsule, Oral 100 0.5896 09/01/98-50mg, Capsule, Oral 100 0.7909 09/01/98-75mg, Capsule, Oral 100 1.0192 09/01/98 - Clonazepam 0.5mg, Tablet, Oral 100 0.4146 09/01/98 - Clonidine Hydrochloride 0.1mg; Tablet, Oral 100 0.0240 01/01/96 0.2mg; Tablet, Oral 100 0.0270 01/01/96 0.3mg; Tablet, Oral 100 0.0338 01/01/96 Clorazepate Dipotassium 3.75mg; Tablet, Oral 100 1.0363 09/01/98 + 7.5mg; Tablet, Oral 100 1.2894 09/01/98 + 15mg; Tablet, Oral 100 1.7494 09/01/98 + Clotrimazole 1%, Solution, 10ml, Topical 0.6900 10/01/97 Cloxacillin Sodium Eq 250mg base; Capsule, Oral 100 0.1553 10/01/97 Eq 500mg base; Capsule, Oral 100 0.2992 09/01/98 + Codeine Phosphate: Phenylephrine Hydrochloride: Promethazine Hydrochloride 10mg/5ml; 5mg/5ml; 6.25mg/5ml; Syrup, Oral 480ml 0.0123 10/01/97 Codeine Phosphate: Promethazine Hydrochloride 10mg/5ml; 6.25mg/5ml; Syrup, Oral 480ml 0.0111 12/01/93 Codeine Phosphate; Pseudoephedrine Hydrochloride: Triprolidine Hydrochloride 10mg/5ml; 30mg/5ml; 1.25mg/5ml; Syrup, 0.0103 01/01/95 Oral 480ml Cyclobenzaprine Hydrochloride 10mg; Tablet, Oral 100 0.0891 10/01/97 Cyproheptadine Hydrochloride 2mg/5ml, Syrup, Oral 480ml 0.0133 09/01/98 NEW 4mg; Tablet, Oral 100 0.0159 10/01/97 11
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Danazol 200mg, Capsule, Oral 100 2.0999 09/01/98 NEW Desipramine Hydrochloride 10mg; Tablet, Oral 100 0.1484 10/01/97 25mg; Tablet, Oral 100 0.0638 10/01/97 50mg; Tablet, Oral 100 0.0983 10/01/97 Desipramine Hydrochloride (continued) 75mg; Tablet, Oral 100 0.1163 10/01/97 100mg; Tablet, Oral 100 0.4089 08/01/96 Desoximetasone 0.25% Cream, Topical 15gm 0.6780 09/01/98 NEW 0.25% Cream, Topical 60gm 0.4052 09/01/98 NEW Dexamethasone 0.5mg/5ml; Elixir, Oral 100ml 0.1118 08/01/96 Dexamethasone: Neomycin Sulfate: Polymyxin B Sulfate 0.1%; Eq 3.5mg base/gm; 10,000 units/gm; Ointment, 3.5 GM, ophthalmic 1.2000 01/01/97 Dexamethasone Sodium Phosphate Eq. 0.05% Phosphte, Ointment, Opthalmic 3.5gm 1.3114 09/01/98 NEW Eq 0.1% Phosphate, Solution/Drops, Opthalmic 5ml 0.4800 09/01/98 - Dexamethasone Sodium Phosphate: Neomycin Sulfate Eq 0.1% Phosphate; Eq 3.5mg base/ml Solution/Drops, 5 ML, Ophthalmic 0.8460 10/01/97 Dextromethorphan Hydrobromide: Promethazine Hydrochloride 15mg/5ml; 6.25mg/5ml; Syrup, 480 ML, Oral 0.0103 10/01/97 Diazepam 2mg; Tablet, Oral 100 0.0209 08/01/96 5mg; Tablet, Oral 100 0.0465 09/01/98 + 10mg; Tablet, Oral 100 0.0266 09/01/98 + Diclofenac Sodium 50mg, Tablet, Delayed release, Oral 100 0.7490 09/01/98-75mg, Tablet, Delayed release, Oral 100 0.9219 10/01/97 Dicloxacillin Sodium Eq 250mg base; Capsule, Oral 100 0.3743 09/01/98 + Eq 500mg base, Capsule, Oral 100 0.6585 09/01/98 + 13
Dicyclomine Hydrochloride 10mg, Capsule, Oral 100 0.1763 10/01/97 20mg, Tablet, Oral 100 0.0405 09/01/98 - Diethylpropion Hydrochloride 25mg; Tablet, Oral 100 0.0713 09/01/98 + Diltiazem Hydrochloride 30mg; Tablet, Oral 100 0.0818 10/01/97 60mg; Tablet, Oral 100 0.1380 10/01/97 90mg; Tablet, Oral 100 0.1941 10/01/97 120mg; Tablet, Oral 100 0.2379 10/01/97 Diphenhydramine Hydrochloride 25mg; Capsule, Oral 100 0.0132 09/01/98 50mg; Capsule, Oral 100 0.0191 09/01/98 12.5mg/5ml; Elixir, Oral 480ml 0.0061 12/01/93 Dipivefrin Hydrochloride 0.1%, Solution/Drops, Ophthalmic 5ml 2.1900 01/01/97 0.1%, Solution/Drops, Ophthalmic 10ml 2.0250 01/01/97 0.1%, Solution/Drops, Ophthalmic 15ml 2.0100 10/01/97 Dipyridamole 25mg; Tablet, Oral 100 0.0252 10/01/97 50mg; Tablet, Oral 100 0.0413 01/01/95 75mg; Tablet, Oral 100 0.0593 07/01/95 Disopyramide Phosphate Eq 100mg base; Capsule, Oral 100 0.2730 09/01/98 + Eq 150mg base; Capsule, Oral 100 0.3120 09/01/98 + Doxepin Hydrochloride Eq 10mg base; Capsule, Oral 100 0.0398 08/01/96 Eq 25mg base, Capsule, Oral 100 0.0443 08/01/96 Eq 50mg base; Capsule, Oral 100 0.0645 10/01/97 Eq 75mg base; Capsule, Oral 100 0.0818 09/01/98 - Eq 100mg base; Capsule, Oral 100 0.1043 10/01/97 Eq 150mg base, Capsule, Oral 100 0.2543 10/01/97 Eq 10mg base/ml; Concentrate, Oral 120 0.1362 12/01/93 Doxycycline Hyclate Eq 100mg base; Capsule, Oral 50 0.0852 09/01/98 + Eq 100mg base; Tablet, Oral 50 0.0891 10/01/97 14
Erythromycin 250mg; Capsule, delayed release pellets, Oral 100 0.1793 10/01/97 2%; Gel, Topical 30gm 0.6270 09/01/98 + 0.5% Ointment, Opthalmic 3,5gm 1.0071 09/01/98 + 2%; Solution, Topical 60ml 0.0570 09/01/98-2%; Swab, Topical 60 0.2822 10/01/97 Erythromycin Estolate Eq 250mg base; Capsule, Oral 100 0.2903 09/01/98 + Eq 125mg base/5ml, Suspension, Oral 480ml 0.0623 09/01/98 NEW Erythromycin Ethylsuccinate Eq 200mg base/5ml; Suspension, Oral 480ml 0.0253 10/01/97 Eq 400mg base/5ml; Suspension, Oral 480ml 0.0436 08/01/96 Erythromycin Ethylsuccinate; Sulfisoxazole Acetyl Eq. 200mg base/5ml, Eq. 600mg base/5ml, Granule, Oral 100ml 0.0746 10/01/97 Eq. 200mg base/5ml, Eq. 600mg base/5ml, Granule, Oral 150ml 0.0715 10/01/97 Eq. 200mg base/5ml, Eq. 600mg base/5ml, Granule, Oral 200ml 0.0683 10/01/97 Estradiol 0.5mg, Tablet, Oral 100 0.2152 09/01/98 NEW 1mg, Tablet, Oral 100 0.2887 09/01/98 NEW 2mg, Tablet, Oral 100 0.4192 09/01/98 NEW Estropipate 0.75mg; Tablet, Oral 100 0.4672 09/01/98 + 1.5mg, Tablet, Oral 100 0.4192 09/01/98 + 3mg; Tablet, Oral 100 1.0939 09/01/98 - Ethinyl Estradiol; Levonorgestrel 0.03mg;0.15mg, Tablet, Oral 28-28 0.0536 09/01/98 NEW Ethinyl Estradiol: Norethindrone 0.035mg; 0.5mg; Tablet, 21 EA, Oral-21 1.0743 01/01/97 0.035mg; 0.5mg; Tablet, 28 EA, Oral-28 0.4025 08/01/96 0.035mg; 1mg; Tablet, 21 EA, Oral-21 0.5367 08/01/96 0.035mg; 1mg; Tablet, 28 EA, Oral-28 0.3828 01/01/95 Etodolac 300mg, Capsule, Oral 100 0.5932 09/01/98 NEW 400mg, Tablet, Oral 100 0.5823 09/01/98 NEW Fenoprofen Calcium Eq 600mg base; Tablet, Oral 100 0.2085 09/01/98 + 15
Fluocinolone Acetonide 0.01%; Cream, Topical 15gm 0.0840 12/01/92 0.01%; Cream, Topical 60gm 0.0413 12/01/92 0.025%; Cream, Topical 15gm 0.1050 07/01/94 0.025%; Cream, Topical 60gm 0.0575 10/01/97 0.025%; Ointment, Topical 60gm 0.1445 09/01/98 + 0.01%, Solution, Topical 20ml 0.1763 09/01/98 NEW 0.01%, Solution, Topical 60ml 0.0938 09/01/98 NEW Fluocinonide 0.05%; Cream, Topical 15gm 0.1810 10/01/97 0.05%; Cream, Topical 30gm 0.1255 10/01/97 0.05%; Cream, Topical 60gm 0.1345 10/01/97 0.05%; Cream, Topical 120gm 0.2036 10/01/97 0.05%; Gel, Topical 60gm 0.5978 07/01/95 0.05%, Ointment, Topical 15gm 1.0030 09/01/98 NEW 0.05%, Ointment, Topical 30gm 0.5463 09/01/98 NEW 0.05%, Ointment, Topical 60gm 0.5777 09/01/98 NEW 0.05%; Solution, Topical 60ml 0.2420 10/01/97 Fluorometholone 0.1%, Suspension/Drops, Opthalmic 5ml 2.5050 09/01/98 NEW 0.1%, Suspension/Drops, Opthalmic 10ml 1.9875 09/01/98 NEW 0.1%, Suspension/Drops, Opthalmic 15ml 1.6500 09/01/98 NEW Fluphenazine Hydrochloride 1mg; Tablet, Oral 100 0.1881 10/01/97 2.5mg; Tablet, Oral 100 0.2691 10/01/97 5mg; Tablet, Oral 100 0.3521 10/01/97 10mg; Tablet, Oral 100 0.4224 10/01/97 Flurazepam Hydrochloride 15mg; Capsule, 100 EA, Oral 0.0525 07/01/94 30mg; Capsule, 100 EA, Oral 0.0675 07/01/94 Flurbiprofen 50mg, Tablet, Oral 100 0.6021 10/01/97 100mg, Tablet, Oral 100 0.3474 09/01/98 - Folic Acid 1mg; Tablet, Oral 100 0.0195 09/01/98-1mg; Tablet, Oral 1000 0.0053 09/01/98 - Furosemide 10mg/ml; Solution, Oral 60ml 0.1142 10/01/97 20mg; Tablet, Oral 100 0.0210 01/01/97 40mg; Tablet, Oral 100 0.0254 01/01/97 16
80mg; Tablet, Oral 100 0.0473 10/01/97 Gemfibrozil 600mg; Tablet, Oral 60 0.1800 01/01/97 Glipizide 5mg, Tablet, Oral 100 0.0653 01/01/97 10mg, Tablet, Oral 100 0.0930 09/01/98 - Gramicidin; Neomycin Sulfate; Polymyxin B Sulfate 0.025mg/ml;Eq. 1.75 mg base/ml; 10,000 units/ml 0.5025 08/01/96 Solution/Drops, Opthalmic 10ml Griseofulvin, Ultramicrocrystalline 250mg, Tablet, Oral 100 0.5093 10/01/97 330mg, Tablet, Oral 100 0.6690 09/01/98 + Guanabenz Acetate Eq. 4mg base, Tablet, Oral 100 0.4125 10/01/97 Eq. 8 mg base, Tablet, Oral 100 0.5813 10/01/97 Guanfacine Hydrochloride Eq. 1mg base, Tablet, Oral 100 0.6293 09/01/98 NEW Eq. 2mg base, Tablet, Oral 100 0.8843 09/01/98 NEW Haloperidol 0.5mg; Tablet, Oral 100 0.0188 07/01/94 1mg; Tablet, Oral 100 0.0225 09/01/98 + 2mg; Tablet, Oral 100 0.0240 09/01/98 + 5mg; Tablet, Oral 100 0.0293 07/01/94 10mg; Tablet, Oral 100 0.0494 09/01/98 + 20mg; Tablet, Oral 100 0.1788 09/01/98 + Homatropine Methylbromide; Hydrocodone Bitartrate 1.5mg/5ml;5mg/5ml, Syrup, Oral 480ml 0.0175 09/01/98 NEW Hydralazine Hydrochloride 10mg; Tablet, Oral 100 0.0210 09/01/98 + 25mg; Tablet, Oral 100 0.0375 09/01/98 + 50mg; Tablet, Oral 100 0.0525 09/01/98 + 100mg; Tablet, Oral 100 0.0855 09/01/98 + Hydralazine Hydrochloride: Hydrochlorothiazide 25mg; 25mg; Capsule, Oral 100 0.0675 10/01/97 50mg; 50mg; Capsule, Oral 100 0.0845 10/01/97 Hydrochlorothiazide 25mg; Tablet, Oral 100 0.0149 10/01/97 17
50mg; Tablet, Oral 100 0.0278 09/01/98 + 100mg; Tablet, Oral 100 0.0585 09/01/98 + Hydrochlorothiazide: Propranolol Hydrochloride 25mg; 40mg; Tablet, Oral 100 0.0510 10/01/97 25mg; 80mg; Tablet, Oral 100 0.0743 10/01/97 Hydrochlorothiazide: Spironolactone 25mg; 25mg; Tablet, Oral 100 0.3603 09/01/98 + Hydrochlorothiazide: Triamterene 25mg; 50mg, Capsule, Oral 100 0.1350 09/01/98 NEW 25mg; 37.5mg; Tablet, Oral 100 0.2393 10/01/97 50mg; 75mg; Tablet, Oral 100 0.0458 10/01/97 Hydrocortisone 0.5%, Cream, Topical 30gm 0.0290 09/01/98 + 2.5%, Cream, Topical 20gm 0.2063 09/01/98 + 2.5%, Cream, Topical 30gm 0.1420 09/01/98 + 2.5%, Cream, Topical 454gm 0.1927 09/01/98 NEW 1%; Lotion, Topical 60ml 0.0725 01/01/97 1%; Lotion, Topical 120ml 0.0506 01/01/95 1%, Ointment, Topical 30gm 0.0725 09/01/98 NEW 2.5%; Ointment, Topical 20gm 0.2250 09/01/98 - Hydroxychloroquine Sulfate 200mg, Tablet, Oral 100 0.7763 10/01/97 Hydroxyzine Hydrochloride 10mg/5ml; Syrup, Oral 480ml 0.0141 01/01/97 10mg; Tablet, Oral 100 0.0195 10/01/97 25mg; Tablet, Oral 100 0.0236 10/01/97 50mg; Tablet, Oral 100 0.0315 10/01/97 Hydroxyzine Pamoate Eq 25mg hcl; Capsule, Oral 100 0.0768 10/01/97 Eq 50mg hcl; Capsule, Oral 100 0.0983 10/01/97 Eq 100mg hcl; Capsule, Oral 100 0.2243 08/01/96 Ibuprofen 400mg; Tablet, Oral 100 0.0338 08/01/96 600mg; Tablet, Oral 100 0.0399 10/01/97 800mg; Tablet, Oral 100 0.0563 10/01/97 Indapamide 1.25mg; Tablet, Oral 100 0.3938 09/01/98 + 2.5mg; Tablet, Oral 100 0.1988 10/01/97 Indomethacin 18
25mg; Capsule, Oral 100 0.0299 10/01/97 50mg; Capsule, Oral 100 0.0426 10/01/97 75mg, Capsule, Extended Release, Oral 100 0.4731 09/01/98 NEW Isoniazid 100mg; Tablet, Oral 100 0.0218 09/01/98-300mg; Tablet, Oral 100 0.0353 09/01/98 - Isosorbide Dinitrate 2.5mg; Tablet, 100 EA, sublingual 0.0338 10/01/97 5mg; Tablet, 100 EA, Oral 0.0188 10/01/97 5mg; Tablet, 100 EA, Sublingual 0.0338 10/01/97 10mg; Tablet, 100 EA, Oral 0.0188 10/01/97 20mg; Tablet, 100 EA, Oral 0.0218 07/01/94 30mg; Tablet, 100 EA, Oral 0.0263 10/01/97 Lactulose 10gm/15ml, Solution, Oral 480ml 0.0228 10/01/97 Leucovorin Calcium Eq 5mg base; Tablet, Oral 100 2.0993 07/01/95 Eq 25mg base; Tablet, Oral 25 15.8910 10/01/97 Levobunolol Hydrochloride 0.5%, Solution/Drops, Ophthalmic 5ml 2.0310 09/01/98 NEW 0.5%; Solution/Drops, Ophthalmic 10 ML 1.9350 10/01/97 0.5%; Solution/Drops, Ophthalmic 15 ML 2.0750 10/01/97 Lidocaine Hydrochloride 2%; Solution, Oral 100ml 0.0270 10/01/97 Lindane 1%; Lotion, Topical 60ml 0.0650 09/01/98 + 1%; Lotion, Topical 480ml 0.0544 09/01/98 + 1%; Shampoo, Topical 60ml 0.0687 09/01/98 + 1%; Shampoo, Topical 480ml 0.0619 09/01/98 + Lithium Carbonate 300mg; Capsule, Oral 100 0.0525 01/01/96 300mg; Capsule, Oral 1000 0.0396 10/01/97 Lithium Citrate Eq. 300mg Carbonate/5ml, Syrup, Oral 480ml 0.0280 09/01/98 NEW Loperamide Hydrochloride 2mg; Capsule, 100 EA, Oral 0.1455 10/01/97 Lorazepam 0.5mg; Tablet, Oral 100 0.5088 09/01/98 + 19
1mg; Tablet, Oral 100 0.6684 09/01/98 + 2mg; Tablet, Oral 100 0.9910 09/01/98 + 20
Loxapine Succinate Eq. 5mg base, Capsule, Oral 100 0.4620 09/01/98 NEW Eq. 10mg base, Capsule, Oral 100 0.6353 09/01/98 NEW Eq. 25mg base, Capsule, Oral 100 0.9648 09/01/98 NEW Eq. 50mg base, Capsule, Oral 100 1.3050 09/01/98 NEW Maprotiline Hydrochloride 25mg; Tablet, Oral 100 0.1943 09/01/98-50mg; Tablet, Oral 100 0.2910 09/01/98-75mg; Tablet, Oral 100 0.4163 09/01/98 - Meclizine Hydrochloride 12.5mg; Tablet, Oral 100 0.0285 09/01/98 + 25mg; Tablet, 100 EA, Oral 0.0255 10/01/97 Meclofenamate Sodium Eq 50mg base; Capsule, Oral 100 0.1706 09/01/98 + Eq 100 mg base; Capsule, Oral 100 0.2579 10/01/97 Medroxyprogesterone Acetate 10mg, Tablet, Oral 100 0.1988 09/01/98 NEW Megestrol Acetate 20mg; Tablet, Oral 100 0.4140 10/01/97 40mg; Tablet, Oral 100 0.6707 10/01/97 Meprobamate 200mg; Tablet, Oral 100 0.0398 07/01/94 400mg; Tablet, Oral 100 0.0480 08/01/96 Mestranol: Norethindrone 0.05mg; 1mg; Tablet, 21 EA, Oral-21 0.5367 08/01/96 0.05mg; 1mg; Tablet, 28 EA, Oral-28 0.3828 01/01/95 Metaproterenol Sulfate 10mg/5ml; Syrup, 480 ML, Oral 0.0134 10/01/97 10mg; Tablet, 100 EA, Oral 0.0743 07/01/94 20mg; Tablet, 100 EA, Oral 0.1328 07/01/95 Methadone Hydrochloride 10mg/ml; Concentrate, 946 ML, Oral 0.1046 10/01/97 Methazolamide 25mg; Tablet, 100 EA, Oral 0.3248 10/01/97 50mg; Tablet, 100 EA, Oral 0.4212 10/01/97 Methocarbamol 500mg; Tablet, 100 EA, Oral 0.0627 10/01/97 21
750mg; Tablet, 100 EA, Oral 0.0870 10/01/97 Methotrexate Sodium Eq. 2.5mg base, Tablet, Oral 100 1.6599 10/01/97 Methyclothiazide 5mg; Tablet, 100 EA, Oral 0.4120 09/01/98 + Methyldopa 125mg; Tablet, Oral 100 0.0615 01/01/96 250mg; Tablet, Oral 100 0.0773 09/01/98 + 500mg; Tablet, Oral 100 0.1335 09/01/98 + Methylphenidate Hydrochloride 5mg, Tablet, Oral 100 0.2877 09/01/98 NEW 10mg, Tablet, Oral 100 0.4023 09/01/98 NEW 20mg, Tablet, Oral 100 0.5886 09/01/98 NEW Methylprednisolone 4mg, Tablet, Oral 100 0.4436 09/01/98 NEW Metoclopramide Hydrochloride Eq 5mg base; Tablet, Oral 100 0.0987 10/01/97 Eq 10mg base; Tablet, Oral 100 0.0188 08/01/96 Metoprolol Tartrate 50mg; Tablet, Oral 100 0.0645 09/01/98-100mg; Tablet, Oral 100 0.0878 09/01/98 - Metronidazole 250mg; Tablet, Oral 100 0.0299 09/01/98-500mg; Tablet, Oral 100 0.0593 09/01/98 - Mexiletine Hydrochloride 150mg; Capsule, Oral 100 0.8223 09/01/98 + 200mg; Capsule, Oral 100 0.9795 09/01/98 + 250mg; Capsule, Oral 100 1.1376 09/01/98 + Minocycline Hydrochloride Eq 50mg base; Capsule, 100 EA, Oral 0.4043 10/01/97 Eq 100mg base; Capsule, 50 EA, Oral 0.8085 10/01/97 Minoxidil 2.5mg; Tablet, Oral 100 0.1095 09/01/98 + 10mg, Tablet, Oral 100 0.1437 10/01/97 Nadolol 20mg, Tablet, Oral 100 0.4725 10/01/97 40mg, Tablet, Oral 100 0.5093 10/01/97 22
80mg, Tablet, Oral 100 0.6593 10/01/97 Naphazoline Hydrochloride 0.1%; Solution/Drops, Ophthalmic 15ml 0.3150 01/01/96 Naproxen 250mg; Tablet, Oral 100 0.1215 09/01/98 + 375mg; Tablet, Oral 100 0.2142 09/01/98 + 500mg; Tablet, Oral 100 0.1823 08/01/96 Naproxen Sodium Eq 250mg base; Tablet, Oral 100 0.1407 10/01/97 Eq 500mg base; Tablet, Oral 100 0.2195 10/01/97 Niacin 500mg; Tablet, Oral 100 0.0299 07/01/94 Nifedipine 10mg; Capsule, Oral 100 0.0897 09/01/98 + 20mg, Capsule, Oral 100 0.1735 09/01/98 NEW Nitrofurantoin, Macrocrystalline 50mg, Capsule, Oral 100 0.5084 10/01/97-100mg, Capsule, Oral 100 0.8184 09/01/98 NEW Nortriptyline Hydrochloride Eq 10mg base; Capsule, Oral 100 0.0986 09/01/98 - Eq 25mg base; Capsule, Oral 100 0.1495 09/01/98 - Eq 50mg base; Capsule, Oral 100 0.1830 10/01/97 Eq 75mg base; Capsule, Oral 100 0.2342 10/01/97 Nystatin 100,000 units/gm; Cream, Topical 15gm 0.0970 12/01/93 100,000 units/gm; Cream, Topical 30gm 0.0725 07/01/94 100,000 units/gm; Ointment, Topical 15gm 0.0970 12/01/92 100,000 units/gm; Ointment, Topical 30gm 0.1200 01/01/95 100,000 units/ml; Suspension, Oral 60ml 0.0520 08/01/96 100,000 units/ml; Suspension, Oral 480ml 0.0354 10/01/97 500,000 units; Tablet, Oral 100 0.1193 12/01/92 Nystatin: Triamcinolone Acetonide 100,000 units/gm; 0.1%; Cream, Topical 15gm 0.0980 10/01/97 100,000 units/gm; 0.1%; Cream, Topical 30gm 0.0955 10/01/97 100,000 units/gm; 0.1%; Cream, Topical 60gm 0.0732 10/01/97 100,000 units/gm; 0.1%; Ointment, Topical 15gm 0.0990 10/01/97 100,000 units/gm; 0.1%; Ointment, Topical 30gm 0.0975 08/01/96 100,000 units/gm; 0.1%; Ointment, Topical 60gm 0.0800 07/01/95 23
24
Oxacillin Sodium Eq 250mg base/5ml; Powder for Reconstitution, Oral 100ml 0.0525 07/01/94 Oxazepam 10mg; Capsule, Oral 100 0.0593 09/01/98 + 15mg; Capsule, Oral 100 0.0683 09/01/98-30mg; Capsule, Oral 100 0.0893 09/01/98 + Oxybutynin Chloride 5mg; Tablet, 100 EA, Oral 0.1463 09/01/98 - Penicillin V Potassium Eq 125mg base/5ml; Powder for Reconstitution, 0.0218 09/01/98 + Oral 100ml Eq 125mg base/5ml; Powder for Reconstitution, 0.0131 09/01/98 + Oral 200ml Eq 250mg base/5ml; Powder for Reconstitution, 0.0246 09/01/98 + Oral 100ml Eq 250mg base/5ml; Powder for Reconstitution, 0.0188 09/01/98 + Oral 200ml Eq 250mg base; Tablet, Oral 100 0.0578 09/01/98 + Eq 500mg base; Tablet, Oral 100 0.0818 01/01/95 Perphenazine 2mg; Tablet, Oral 100 0.2093 09/01/98-4mg; Tablet, Oral 100 0.2843 09/01/98-8mg; Tablet, Oral 100 0.3293 09/01/98-16mg; Tablet, Oral 100 0.6713 01/01/97 Phendimetrazine Tartrate* 35mg; Tablet, Oral 100 0.0750 08/01/96 Phentermine Hydrochloride* 30mg; Capsule, Oral 100 0.0975 09/01/98 + 37.5mg; Capsule, Oral 100 0.1403 01/01/97 37.5mg; Tablet, Oral 100 0.1818 09/01/98 + Phenylephrine Hydrochloride: Promethazine Hydrochloride 5mg/5ml; 6.25mg/5ml; Syrup, Oral 480ml 0.0083 09/01/98 + Pindolol 5mg; Tablet, Oral 100 0.1343 09/01/98-10mg; Tablet, Oral 100 0.1745 09/01/98 - * These items are non-covered under Indiana Medicaid. The FUL rates are for informational purposes only. 25
Piroxicam 10mg; Capsule, Oral 100 0.0788 10/01/97 20mg; Capsule, Oral 100 0.0830 10/01/97 Potassium Chloride 8meq; Tablet, extended release, Oral 100 0.0765 10/01/97 Prazosin Hydrochloride Eq 1mg base; Capsule, Oral 100 0.0698 09/01/98 + Eq 2mg base; Capsule, Oral 100 0.0720 01/01/97 Eq 5mg base; Capsule, Oral 100 0.1388 09/01/98 + Prednisolone Acetate 1% Suspension/Drops, Ophthalmic 5ml 1.8900 09/01/98 NEW 1% Suspension/Drops, Ophthalmic 10ml 1.6200 09/01/98 NEW Prednisolone Sodium Phosphate Eq 1% Phosphate; Solution/Drops, Ophthalmic 5ml 1.2180 10/01/97 Eq 1% Phosphate; Solution/Drops, Opthalmic 15ml 0.3750 01/01/97 Prednisolone Sodium Phosphate: Sulfacetamide Sodium Eq.25% Phosphate; 10% Solution/Drops, Ophthalmic 5ml 2.2320 10/01/97 Eq.25% Phosphate; 10% Solution/Drops, Ophthalmic 10ml 1.3035 09/01/98 + Prednisone 5mg; Tablet, Oral 100 0.0240 10/01/97 10mg; Tablet, Oral 100 0.0449 10/01/97 20mg; Tablet, Oral 100 0.0720 10/01/97 50mg; Tablet, Oral 100 0.2063 09/01/98 + Primidone 250mg; Tablet, Oral 100 0.2816 10/01/97 Probenecid 500mg; Tablet, Oral 0.1200 09/01/98 + Procainamide Hydrochloride 500mg; Tablet, extended release, Oral 100 0.1635 10/01/97 750mg; Tablet, extended release, Oral 100 0.2475 10/01/97 Prochlorperazine Maleate Eq 5mg base, Tablet, Oral 100 0.5392 09/01/98 - Eq 10mg base, Tablet, Oral 100 0.8092 09/01/98 - Promethazine Hydrochloride 6.25mg/5ml; Syrup, Oral 480ml 0.0078 09/01/98 + Proparacaine Hydrochloride 26
0.5%, Solution/Drops, Ophthalmic 15ml 0.4990 10/01/97 Propoxyphene Hydrochloride 65mg; Capsule, Oral 100 0.0488 01/01/95 Propranolol Hydrochloride 60mg, Capsule, Extended Release, Oral 100 0.4163 09/01/98 NEW 80mg, Capsule, Extended Release, Oral 100 0.4725 09/01/98 NEW 120mg, Capsule, Extended Release, Oral 100 0.6188 09/01/98 NEW 160mg, Capsule, Extended Release, Oral 100 0.8243 09/01/98 NEW 10mg; Tablet, Oral 100 0.0116 10/01/97 20mg; Tablet, Oral 100 0.0135 10/01/97 40mg; Tablet, Oral 100 0.0204 10/01/97 60mg; Tablet, Oral 100 0.0327 09/01/98 + 80mg; Tablet, Oral 100 0.0322 09/01/98 + Pseudoephedrine Hydrochloride: Triprolidine Hydrochloride 60mg; 2.5mg; Tablet, 100 EA, Oral 0.0273 10/01/97 Quinidine Gluconate 324mg; Tablet, extended release, 100 EA, Oral 0.1512 09/01/98 + Quinidine Sulfate 200mg; Tablet, 100 EA, Oral 0.0962 08/01/96 300mg; Tablet, 100 EA, Oral 0.1493 12/01/93 Ranitidine Hydrochloride Eq. 300mg base, Tablet, Oral 100 1.1143 09/01/98 NEW Selegiline Hydrochloride 5mg, Tablet, Oral 60 0.8300 09/01/98-5mg, Tablet, Oral 500 1.7500 09/01/98 - Selenium Sulfide 2.5%; Lotion/Shampoo, Topical 120ml 0.0263 09/01/98 - Silver Sulfadiazine 1%; Cream, Topical 20gm 0.1695 08/01/96 1%; Cream, Topical 50gm 0.1110 07/01/95 1%; Cream, Topical 85gm 0.1168 08/01/96 1%; Cream, Topical 400gm 0.0635 08/01/96 Spironolactone 25mg; Tablet, Oral 100 0.3351 09/01/98 + Sulfacetamide Sodium 10%; Ointment, Ophthalmic 3.5gm 1.4529 09/01/98 + 10%; Solution/Drops, Ophthalmic 2ml 0.7781 09/01/98-10%; Solution/Drops, Ophthalmic 5ml 0.3225 09/01/98-27
10%; Solution/Drops, Ophthalmic 15ml 0.0969 09/01/98 - Sulfamethoxazole: Trimethoprim 200mg/5ml; 40mg/5ml; Suspension, Oral 473ml 0.0459 09/01/98 + 200mg/5ml; 40mg/5ml; Suspension, Oral 480ml 0.0224 10/01/97 400mg; 80mg; Tablet, Oral 100 0.0612 10/01/97 800mg; 160mg; Tablet Oral 100 0.0893 07/01/94 Sulfasalazine 500mg, Tablet, Oral 100 0.1425 10/01/97 Sulfinpyrazone 200mg; Capsule, Oral 100 0.1643 08/01/96 Sulfisoxazole 500 mg; Tablet, Oral 100 0.0788 01/01/97 Sulindac 150mg; Tablet, Oral 100 0.1754 10/01/97 200mg; Tablet, Oral 100 0.2331 10/01/97 Temazepam 15mg; Capsule, Oral 100 0.0375 09/01/98-30mg; Capsule, Oral 100 0.0540 09/01/98 - Tetracycline Hydrochloride 250mg; Capsule, Oral 100 0.0375 09/01/98-500mg; Capsule, Oral 100 0.0578 09/01/98 + Theophylline 80mg/15ml; Elixir, Oral 480ml 0.0055 12/01/93 100mg, Tablet, Extended Release, Oral 100 0.0480 09/01/98 NEW 200mg, Tablet, Extended Release, Oral 100 0.0620 09/01/98 NEW 300mg, Tablet, Extended Release, Oral 100 0.0815 09/01/98 NEW Thioridazine Hydrochloride 30mg/ml; Concentrate, Oral 120 ml 0.1013 10/01/97 10mg; Tablet, Oral 100 0.0352 09/01/98 + 15mg; Tablet, Oral 100 0.0459 09/01/98 + 25mg; Tablet, Oral 100 0.0497 09/01/98 + 50mg; Tablet, Oral 100 0.0663 09/01/98 + 100mg; Tablet, Oral 100 0.1156 09/01/98 + 150mg; Tablet, Oral 100 0.1929 09/01/98 + 200mg; Tablet, Oral 100 0.2406 09/01/98 + Thiothixene 1mg; Capsule, Oral 100 0.1343 10/01/97 2mg; Capsule, Oral 100 0.1658 10/01/97 28
5mg; Capsule, Oral 100 0.2012 10/01/97 10mg; Capsule, Oral 100 0.3326 10/01/97 Thiothixene Hydrochloride Eq 5mg base/ml; Concentrate, Oral 120ml 0.2094 07/01/94 Timolol Maleate Eq. 0.25% base, Solution/Drops, Ophthalmic 5ml 1.8450 09/01/98 NEW Eq. 0.25% base, Solution/Drops, Ophthalmic 10ml 1.2150 09/01/98 NEW Eq. 0.25% base, Solution/Drops, Ophthalmic 15ml 1.2150 09/01/98 NEW Eq. 0.5% base, Solution/Drops, Ophthalmic 5ml 2.3100 09/01/98 NEW Eq. 0.5% base, Solution/Drops, Ophthalmic 10ml 1.5195 09/01/98 NEW Eq. 0.5% base, Solution/Drops, Ophthalmic 15ml 1.0250 09/01/98 NEW 5mg; Tablet, Oral 100 0.1832 10/01/97 10mg; Tablet, Oral 100 0.2568 10/01/97 20mg; Tablet, Oral 100 0.5241 10/01/97 Tobramycin 0.3%, Solution/Drops, Ophthalmic 5 ml 0.8070 01/01/97 Tolazamide 100mg; Tablet, Oral 100 0.1166 09/01/98 + 250mg; Tablet, Oral 100 0.3064 09/01/98 + Tolbutamide 500mg; Tablet, Oral 100 0.2892 09/01/98 + Tolmetin Sodium Eq 400mg base; Capsule, Oral 100 0.2625 08/01/96 Eq 600mg base; Tablet, Oral 100 0.9195 10/01/97 Trazodone Hydrochloride 50mg; Tablet, Oral 100 0.0644 09/01/98 + 100mg; Tablet, Oral 100 0.0975 10/01/97 150mg, Tablet, Oral 100 0.4943 09/01/98 NEW Triamcinolone Acetonide 0.025%; Cream, Topical 15gm 0.0650 10/01/97 0.025%; Cream, Topical 80gm 0.0300 09/01/98-0.1%; Cream, Topical 15gm 0.0670 10/01/97 0.1%; Cream, Topical 80gm 0.0302 10/01/97 0.1%; Cream, Topical 454gm 0.0314 10/01/97 0.1%; Cream, Topical 2270gm 0.0271 09/01/98-0.5%; Cream, Topical 15gm 0.1300 10/01/97 0.1%; Lotion, Topical 60ml 0.1150 12/01/92 0.025%; Ointment, Topical 15gm 0.0580 10/01/97 0.025%; Ointment, Topical 80gm 0.0407 09/01/98 + 0.1%; Ointment, Topical 15gml 0.0750 12/01/92 29
0.1%; Ointment, Topical 454gm 0.0314 10/01/97 0.1%; Paste, Dental 5gm 0.7650 08/01/96 30
Triazolam 0.125mg, Tablet, 100 EA, Oral 0.4842 10/01/97 0.25mg, Tablet, 100 EA, Oral 0.5286 10/01/97 Trifluoperazine Hydrochloride Eq 1mg base, Tablet, 100 EA, Oral 0.3207 10/01/97 Eq 2mg base, Tablet, 100 EA, Oral 0.4683 10/01/97 Eq 5mg base, Tablet, 100 EA, Oral 0.5631 10/01/97 Eq 10mg base, Tablet, 100 EA, Oral 0.7133 10/01/97 Trihexyphenidyl Hydrochloride 2mg, Tablet, Oral 100 0.1424 09/01/98 NEW Trimethoprim 100mg, Tablet, 100 EA, Oral 0.1493 10/01/97 200mg; Tablet, 100 EA, Oral 0.2210 10/01/97 Triple Sulfa (Sulfabenzamide; Sulfacetamide; Sulfathiazole) 3.7%; 2.86%; 3.42%, Cream, Vaginal 78gm 0.0688 09/01/98 + Tropicamide 0.5%; Solution/Drops, Ophthalmic15ml 0.5950 10/01/97 1% Solution/Drops, Ophthalmic 15ml 0.6250 09/01/98 NEW Valproic Acid 250mg; Capsule, 100 EA, Oral 0.1178 10/01/97 250mg/5ml; Syrup, 480 ML, Oral 0.0594 01/01/97 Verapamil Hydrochloride 40mg; Tablet, Oral 100 0.1464 10/01/97 80mg; Tablet, Oral 100 0.0480 10/01/97 120mg, Tablet, Extended Release, Oral 100 1.1573 09/01/98 NEW 180mg, Tablet, Extended Release, Oral 100 0.2888 09/01/98 NEW 120mg; Tablet, Oral 100 0.0800 10/01/97 240mg; Tablet, Extended Release, Oral 100 0.3113 10/01/97 31