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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
ABACAVIR SULFATE 20 mg/ml SOLN MILLILITER $0.5720
ABACAVIR SULFATE 300 mg TAB TABLET $1.1525
ABACAVIR SULFATE; LAMIVUDINE 600 mg; 300 mg TAB TABLET $3.3265
ABACAVIR; LAMIVUDINE; ZIDOVUDINE 150 mg; 300 mg TAB TABLET $24.3903
ACAMPROSATE CALCIUM 333 mg TAB DR TABLET $0.7115
ACARBOSE 100 mg TAB TABLET $0.2252
ACARBOSE 25 mg TAB TABLET $0.1825
ACARBOSE 50 mg TAB TABLET $0.1915
ACEBUTOLOL HCL 200 mg CAP CAPSULE $0.1922
ACEBUTOLOL HCL 400 mg CAP CAPSULE $0.2500
ACETAMINOPHEN W/CODEINE 120-12 mg/5 ml SOLN MILLILITER $0.0128
ACETAMINOPHEN W/CODEINE 300 mg; 15 mg TAB TABLET $0.1428
ACETAMINOPHEN W/CODEINE 300 mg; 30 mg TAB TABLET $0.1099
ACETAMINOPHEN W/CODEINE 300 mg; 60 mg TAB TABLET $0.2255
ACETAMINOPHEN 120 mg SUPP EACH $0.2365
ACETAMINOPHEN 160 mg TAB CHEW TABLET $0.0862
ACETAMINOPHEN 160 mg TAB RAPDIS TABLET $0.0715
ACETAMINOPHEN 160 mg/5 ml ELIXIR MILLILITER $0.0105
ACETAMINOPHEN 160 mg/5 ml LIQUID MILLILITER $0.0203
ACETAMINOPHEN 160 mg/5 ml SUSP MILLILITER $0.203
ACETAMINOPHEN 325 mg SUPP EACH $0.4579
ACETAMINOPHEN 325 mg TAB TABLET $0.0150
ACETAMINOPHEN 500 mg LIQUID MILLILITER $0.0158
ACETAMINOPHEN 500 mg TAB TABLET $0.0240
ACETAMINOPHEN 650 mg SUPP EACH $0.3275
ACETAMINOPHEN 650 mg TAB ER TABLET $0.0738
ACETAMINOPHEN 80 mg TAB CHEW TABLET $0.0386
ACETAMINOPHEN 80 mg TAB RAPDIS TABLET $0.0505
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
ACETAMINOPHEN 80 mg/0.8 ml SUSP MILLILITER $0.1647
ACETAZOLAMIDE 125 mg TAB TABLET $0.0812
ACETAZOLAMIDE 250 mg TAB TABLET $1.5625
ACETAZOLAMIDE 500 mg CAP ER CAPSULE $0.9405
ACETIC ACID 0.25% SOLN MILLILITER $0.0046
ACETIC ACID 2% SOLN MILLILITER $1.2487
ACETIC ACID\HYDROCORTISONE 2%-1% DROPS MILLILITER $5.8627
ACETYLCYSTEINE 100 mg/ml VIAL MILLILITER $0.4885
ACETYLCYSTEINE 200 mg/ml VIAL EACH $0.3045
ACETYLCYSTEINE 6 gm/30 ml VIAL MILLILITER $2.8500
ACITRETIN 10 mg CAP CAPSULE $14.1128
ACITRETIN 17.5 mg CAP CAPSULE $23.0775
ACITRETIN 25 mg CAP CAPSULE $15.0325
ACYCLOVIR 200 mg CAP CAPSULE $0.0975
ACYCLOVIR 200 mg/5 ml SOLN MILLILITER $0.4462
ACYCLOVIR 400 mg TAB TABLET $0.0575
ACYCLOVIR 5% OINT GRAM $3.9000
ACYCLOVIR 50 mg/ml VIAL MILLILITER $0.4500
ACYCLOVIR 800 mg TAB TABLET $0.1350
ADAPALENE 0.1% CREAM GRAM $2.7771
ADAPALENE 0.1% GEL GRAM $1.4055
ADAPALENE 0.3% GEL GRAM $2.5425
ADAPALENE 0.3% GEL PUMP GRAM $3.7895
ADAPALENE; BENZOYL PEROXIDE 0.1%; 2.5% GEP PUMP GRAM $1.1550
ALBUTEROL SULFATE 0.63 mg/3 ml INH SOLN MILLILITER $0.2665
ALBUTEROL SULFATE 1.25 mg/3 ml INH SOLN MILLILITER $0.2619
ALBUTEROL SULFATE 2.5 mg/3 ml INH SOLN MILLILITER $0.0320
ALBUTEROL SULFATE 2 mg/5 ml SYRINGE MILLILITER $0.0134
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
ALBUTEROL SULFATE 2 mg TAB TABLET $4.1965
ALBUTEROL SULFATE 4 mg TAB TABLET $3.2650
ALBUTEROL SULFATE 4 mg TAB ER TABLET $1.3345
ALBUTEROL SULFATE 5 mg/ml INH SOLN MILLILITER $0.8910
ALBUTEROL SULFATE 8 mg TAB ER TABLET $2.4100
ALCLOMETASONE DIPROPIONATE 0.05% CREAM GRAM $1.7258
ALCLOMETASONE DIPROPIONATE 0.05% OINT GRAM $0.7950
ALENDRONATE SODIUM 10 mg TAB TABLET $0.1650
ALENDRONATE SODIUM 35 mg TAB TABLET $0.4238
ALENDRONATE SODIUM 40 mg TAB TABLET $2.9400
ALENDRONATE SODIUM 5 mg TAB TABLET $0.1440
ALENDRONATE SODIUM 70 mg TAB TABLET $0.3000
ALFUZOSIN HCL 10 mg TAB ER 24HR TABLET $0.1341
ALLOPURINOL 100 mg TAB TABLET $0.0925
ALLOPURINOL 300 mg TAB TABLET $0.1525
ALMOTRIPTAN MALATE 12.5 mg TAB TABLET $21.2000
ALMOTRIPTAN MALATE 6.25 mg TAB TABLET $33.8701
ALOSETRON HCL 0.5 mg TAB TABLET $11.7935
ALOSETRON HCL 1 mg TAB TABLET $24.5885
ALPRAZOLAM 0.25 mg TAB TABLET $0.0185
ALPRAZOLAM 0.25 mg TAB ODT TABLET $1.1880
ALPRAZOLAM 0.5 mg TAB TABLET $0.0135
ALPRAZOLAM 0.5 mg TAB ER TABLET $0.1818
ALPRAZOLAM 0.5 mg TAB ODT TABLET $1.1760
ALPRAZOLAM 0.5 mg TAB TABLET $0.0274
ALPRAZOLAM 1 mg TAB ER TABLET $0.2059
ALPRAZOLAM 1 mg TAB ODT TABLET $1.5600
ALPRAZOLAM 1 mg TAB TABLET $0.0258
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
ALPRAZOLAM 2 mg TAB ER TABLET $0.1786
ALPRAZOLAM 2 mg TAB TABLET $0.0525
ALPRAZOLAM 3 mg TAB ODT TABLET $3.3550
ALPRAZOLAM 3 mg TAB ER TABLET $0.4000
AMANTADINE HCL 100 mg CAP CAPSULE $0.5500
AMANTADINE HCL 100 mg TAB TABLET $1.2000
AMANTADINE HCL 50 mg/5 ml SYRINGE MILLILITER $0.0205
AMIKAN SULFATE 500 mg/2 ml INJ MILLILITER $4.8000
AMILORIDE HCL 5 mg TAB TABLET $0.2739
AMILORIDE HCL; HYDROXHLOROTHIAZIDE 5 mg; 50 mg TAB TABLET $0.3658
AMIODARONE HCL 100 mg TAB TABLET $2.1985
AMIODARONE HCL 200 mg TAB TABLET $0.1235
AMIODARONE HCL 400 mg TAB TABLET $2.3455
AMITRIPTYLINE HCL 10 mg TAB TABLET $0.0995
AMITRIPTYLINE HCL 100 mg TAB TABLET $0.7535
AMITRIPTYLINE HCL 150 mg TAB TABLET $1.3625
AMITRIPTYLINE HCL 25 mg TAB TABLET $0.1620
AMITRIPTYLINE HCL 50 mg TAB TABLET $0.3485
AMITRIPTYLINE HCL 75 mg TAB TABLET $0.6245
AMITRIPTYLINE; CHLORDIAZEPOXIDE 12.5 mg; 5 mg TAB TABLET $1.1550
AMITRIPTYLINE; CHLORDIAZEPOXIDE 25 mg; 10 mg TAB TABLET $1.5872
AMLODIPINE/ATORVASTATIN 10 mg; 10 mg TAB TABLET $2.0500
AMLODIPINE/ATORVASTATIN 10 mg; 20 mg TAB TABLET $2.7500
AMLODIPINE/ATORVASTATIN 10 mg; 40 mg TAB TABLET $2.6850
AMLODIPINE/ATORVASTATIN 10 mg; 80 mg TAB TABLET $2.6850
AMLODIPINE/ATORVASTATIN 2.5 mg; 10 mg TAB TABLET $2.7500
AMLODIPINE/ATORVASTATIN 2.5 mg; 20 mg TAB TABLET $2.8000
AMLODIPINE/ATORVASTATIN 2.5 mg; 40 mg TAB TABLET $5.1000
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
AMLODIPINE/ATORVASTATIN 5 mg; 10 mg TAB TABLET $1.9755
AMLODIPINE/ATORVASTATIN 5 mg; 20 mg TAB TABLET $2.8555
AMLODIPINE/ATORVASTATIN 5 mg; 40 mg TAB TABLET $3.0355
AMLODIPINE/ATORVASTATIN 5 mg; 80 mg TAB TABLET $2.8500
AMLODIPINE BESYLATE/BENAZEPRIL HCL 10 mg; 40 mg CAP CAPSULE $0.2595
AMLODIPINE BESYLATE/BENAZEPRIL HCL 5 mg; 40 mg CAP CAPSULE $0.2045
AMLODIPINE BESYLATE/BENAZEPRIL 10 mg; 20 mg CAP CAPSULE $0.1722
AMLODIPINE BESYLATE/BENAZEPRIL 2.5 mg; 10 mg CAP CAPSULE $0.2135
AMLODIPINE BESYLATE/BENAZEPRIL 5 mg; 10 mg CAP CAPSULE $0.2176
AMLODIPINE BESYLATE/BENAZEPRIL 5 mg; 20 mg CAP CAPSULE $0.1681
AMLODIPINE BESYLATE 10 mg TAB TABLET $0.0195
AMLODIPINE BESYLATE 2.5 mg TAB TABLET $0.0150
AMLODIPINE BESYLATE 5 mg TAB TABLET $0.0150
AMLODIPINE BES/OLMESARTAN MED 10 mg; 20 mg TAB TABLET $0.5500
AMLODIPINE BES/OLMESARTAN MED 10 mg; 40 mg TAB TABLET $0.8685
AMLODIPINE BES/OLMESARTAN MED 5 mg; 20 mg TAB TABLET $0.6105
AMLODIPINE BES/OLMESARTAN MED 5 mg; 40 mg TAB TABLET $0.6750
AMLODIPINE/VALSARTAN 10 mg; 160 mg TAB TABLET $0.5145
AMLODIPINE/VALSARTAN 10 mg; 320 mg TAB TABLET $0.5820
AMLODIPINE/VALSARTAN 5 mg; 160 mg TAB TABLET $0.4250
AMLODIPINE/VALSARTAN 5 mg; 320 mg TAB TABLET $0.5435
AMLODIPINE/VALSARTAN/HCT 10 mg; 160 mg TAB TABLET $1.9985
AMLODIPINE/VALSARTAN/HCT 10-160-25 TAB TABLET $1.3125
AMLODOPINE/VALSARTAN/HCT 10-320-25 TAB TABLET $1.4735
AMLODIPINE/VALSARTAN/HCT 5-160-12.5 TAB TABLET $1.3035
AMLODIPINE/VALSARTAN/HCT 5-160-25 TAB TABLET $1.6400
AMMONIUM LACTATE 12% CREAM GRAM $0.0739
AMMONIUM LACTATE 12% LOT MILLILITER $0.0360
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
AMOX/POTASSIUM CLAVULANATE 200; 28.5 mg/5 ml PWDR for ORAL SUSP MILLILITER $0.0550
AMOX/POTASSIUM CLAVULANATE 200; 28.5 mg TAB CHEW TABLET $2.3755
AMOX/POTASSIUM CLAVULANATE 400; 57 mg/5 ml PWDR for ORAL SUSP MILLILITER $0.0750
AMOX/POTASSIUM CLAVULANATE 400; 57 mg TAB CHEW TABLET $2.0000
AMOX/POTASSIUM CLAVULANATE 500; 125 mg TAB TABLET $0.3015
AMOX/POTASSIUM CLAVULANATE 600; 42.9 mg/5 ml PWDR for ORAL SUSP MILLILITER $0.0675
AMOX/POTASSIUM CLAVULANATE 875; 125 mg TAB TABLET $0.2550
AMOXAPINE 50 mg TAB TABLET $0.8822
AMOXICILLIN (TRIHYDRATE) 250 mg CAP CAPSULE $0.0754
AMOXICILLIN (TRIHYDRATE) 500 mg CAP CAPSULE $0.0595
AMOXICILLIN OS 400 mg/5 ml SUSP RECON MILLILITER $0.0353
AMOXICILLIN TRIHYDRATE/ POTASSIUM CLAVULANATE 1000 mg; 62.5 mg TAB SA TABLET $5.1500
AMOXICILLIN TRIHYDRATE/ POTASSIUM CLAVULANATE 250 ; 62.5 mg/5 ml SUSP MILLILITER $0.4385
AMOXICILLIN TRIHYDRATE/ POTASSIUM CLAVULANATE 250 mg; 125mg TAB TABLET $4.1339
AMOXICILLIN TRIHYDRATE 500 mg TAB TABLET $0.2555
AMOXICILLIN 125 mg/5 ml PWDR for ORAL SUSP MILLILITER $0.0199
AMOXICILLIN 200 mg/5 ml SUSP MILLILITER $0.0299
AMOXICILLIN 250 mg/5 ml PWDR for ORAL SUSP MILLILITER $0.0278
AMOXICILLIN 250 mg TAB CHEW TABLET $0.2306
AMOXICILLIN 875 mg TAB TABLET $0.1343
AMPHET ASP/AMPHET/D-AMPHET 10 mg CAP ER CAPSULE $1.9670
AMPHET ASP/AMPHET/D-AMPHET 15 mg CAP ER CAPSULE $1.9775
AMPHET ASP/AMPHET/D-AMPHET 15 mg TAB TABLET $0.4735
AMPHET ASP/AMPHET/D-AMPHET 20 mg CAP ER CAPSULE $1.9099
AMPHET ASP/AMPHET/D-AMPHET 25 mg CAP ER CAPSULE $2.0156
AMPHET ASP/AMPHET/D-AMPHET 30 mg CAP ER CAPSULE $1.8855
AMPHET ASP/AMPHET/D-AMPHET 5 mg CAP ER CAPSULE $1.9200
AMPHETAMINE/D-AMPHETAMINE SALTS 10 mg TAB TABLET $0.500
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
AMPHETAMINE/D-AMPHETAMINE SALTS 12.5 mg TAB TABLET $0.6689
AMPHETAMINE/D-AMPHETAMINE SALTS 20 mg TAB TABLET $0.5079
AMPHETAMINE/D-AMPHETAMINE SALTS 30 mg TAB TABLET $0.5483
AMPHETAMINE/D-AMPHETAMINE SALTS 5 mg TAB TABLET $0.4515
AMPHETAMINE/D-AMPHETAMINE SALTS 7.5 mg TAB TABLET $0.6575
AMPICILLIN SODIUM 1 gm VIAL EACH $2.0500
AMPICILLIN SODIUM 10 gm VIAL EACH $33.5500
AMPICILLIN SODIUM 2 gm VIAL EACH $3.2500
AMPICILLIN SODIUM 250 mg VIAL EACH $0.8250
AMPICILLIN SODIUM 500 mg VIAL EACH $1.4050
AMPICILLIN SODIUM/SULBACTAM SODIUM 1.5 gm VIAL EACH $1.9500
AMPICILLIN SODIUM/SULBACTAM SODIUM 15 gm VIAL EACH $16.9550
AMPICILLIN SODIUM/SULBACTAM SODIUM 3 gm VIAL EACH $5.6280
AMPICILLIN TRIHYDRATE 250 mg CAP CAPSULE $0.0580
AMPICILLIN TRIHYDRATE 500 mg CAP CAPSULE $0.1118
ANAGRELIDE HCL 0.5 mg CAP CAPSULE $0.7000
ANAGRELIDE HCL 1 mg CAP CAPSULE $1.6782
APREPITANT 40 mg CAP CAPSULE $76.0000
APREPITANT 80 mg CAP CAPSULE $158.1294
APREPITANT 125 mg CAP CAPSULE $247.0687
APREPITANT 125 mg; 80 mg CAP CAPSULE $185.5601
ANASTROZOLE 1 mg TAB TABLET $0.1070
ARIPIPRAZOLE 1 mg/ml SOLN MILLILITER $2.8500
ARIPIPRAZOLE 10 mg TAB TABLET $0.3400
ARIPIPRAZOLE 10 mg TAB ODT TABLET $26.1890
ARIPIPRAZOLE 15 mg TAB TABLET $0.3400
ARIPIPRAZOLE 15 mg TAB ODT TABLET $28.4142
ARIPIPRAZOLE 2 mg TAB TABLET $0.3400
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
ARIPIPRAZOLE 20 mg TAB TABLET $0.5200
ARIPIPRAZOLE 30 mg TAB TABLET $0.5200
ARIPIPRAZOLE 5 mg TAB TABLET $0.3400
ARMODAFINIL 150 mg TAB TABLET $0.9500
ARMODAFINIL 200 mg TAB TABLET $1.1000
ARMODAFINIL 250 mg TAB TABLET $0.9500
ARMODAFINIL 50 mg TAB TABLET $0.3500
ASCORBIC ACID 1,000 mg TAB TABLET $0.0707
ASCORBIC ACID 500 mg TAB TABLET $0.0281
ASPIRIN 325 mg TAB EC TABLET $0.0150
ASPIRIN 325 mg TAB TABLET $0.0150
ASPIRIN 80 mg TAB CHEW TABLET $0.0300
ASPIRIN 80 mg TAB EC TABLET $0.0285
ASPIRIN/ACETAMINOPHEN/CAFFEINE 250-250-65 TAB TABLET $0.0350
ASPIRIN/BUTALBITAL/CAFFEINE/CODEINE 30 mg CAP CAPSULE $1.0443
ASPIRIN/DIPYRIDAMOLE 25 mg; 200 mg CAP ER 12HR CAPSULE $4.2884
ATAZANAVIR SULFATE 150 mg CAP CAPSULE $13.0662
ATAZANAVIR SULFATE 200 mg CAP CAPSULE $13.0662
ATAZANAVIR SULFATE 300 mg CAP CAPSULE $14.5000
ATENOLOL; CHLORTHAL 100 mg; 25 mg TAB TABLET $0.4095
ATENOLOL; CHLORTHAL 50 mg; 25 mg TAB TABLET $0.3750
ATENOLOL 100 mg TAB TABLET $0.0210
ATENOLOL 25 mg TAB TABLET $0.0150
ATENOLOL 50 mg TAB TABLET $0.0150
ATOMOXETINE HCL 10 mg CAP CAPSULE $1.9500
ATOMOXETINE HCL 100 mg CAP CAPSULE $2.3500
ATOMOXETINE HCL 18 mg CAP CAPSULE $1.9500
ATOMOXETINE HCL 25 mg CAP CAPSULE $1.9500
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
ATOMOXETINE HCL 40 mg CAP CAPSULE $2.0700
ATOMOXETINE HCL 60 mg CAP CAPSULE $2.0700
ATOMOXETINE HCL 80 mg CAP CAPSULE $2.3500
ATORVASTATIN CALCIUM 10 mg TAB TABLET $0.0615
ATORVASTATIN CALCIUM 20 mg TAB TABLET $0.0500
ATORVASTATIN CALCIUM 40 mg TAB TABLET $0.0500
ATORVASTATIN CALCIUM 80 mg TAB TABLET $0.1000
ATOVAQUONE 750 mg/5 ml SUSP ORAL MILLILITER $2.8015
ATOVAQUONE/PROGUANIL HCL 250 mg; 100 mg TAB TABLET $2.8500
ATOVAQUONE/PROGUANIL HCL 62.5 mg; 25 mg TAB TABLET $1.5500
AZACITIDINE 100 mg VIAL EACH $114.5000
AZATHIOPRINE 50 mg TAB TABLET $0.3305
AZELASTINE HCL 0.05% DROPS MILLILITER $1.9950
AZELASTINE HCL 137 mcg AER GRAM $0.4218
AZELASTINE HCL 205.5 mcg SPRAY MILLILITER $1.6285
AZITHROMYCIN 100 mg/5 ml SUSP MILLILITER $0.9500
AZITHROMYCIN 200 mg/5 ml (15 ml) SUSP MILLILITER $0.7723
AZITHROMYCIN 200 mg/5 ml (22.5 ml) SUSP MILLILITER $0.7460
AZITHROMYCIN 200 mg/5 ml (30 ml) SUSP MILLILITER $0.7460
AZITHROMYCIN 250 mg TAB TABLET $0.2833
AZITHROMYCIN 500 mg VIAL EACH $3.5020
AZITHROMYCIN 500 mg TAB TABLET $0.8813
AZITHROMYCIN 600 mg TAB TABLET $2.1185
BACITRACIN ZINC 500 units/gm OINT GRAM $0.1757
B-COMPLEX WITH VITAMIN C N/A TAB TABLET $0.0441
B COMP NO. 3/FOLIC/C/BIOTIN/ZINC 1 mg; 60 mg TAB TABLET $0.3295
BACITRACIN 500 units/gm OINT GRAM $0.0799
BACITRACIN 50,000 unit VIAL EACH $6.1599
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
BACITRACIN/POLYMYXIN B SULFATE 500-10KU/G; 28.35 gm tube OINT GRAM $0.5336
BACITRACIN/POLYMYXIN B SULFATE 500-10KU/G; 14.17 gm tube OINT GRAM $0.3317
BACITRACIN/POLYMYXIN B SULFATE 500-10KU/G; 3.5 gm tube OINT GRAM $0.0865
BACLOFEN 10 mg TAB TABLET $0.0957
BACLOFEN 20 mg TAB TABLET $0.1891
BALSALAZIDE DISODIUM 750 mg CAP CAPSULE $0.3755
BD AUTOSHIELD DUO NEEDLE (NDC 08290-3295-15) 5 mm x 30 g NEEDLE EACH $0.1800
BD LANCETS (NDC 08290-3220-65) 33 g LANCET EACH $0.0620
BD LANCETS, ULTRA-FINE (NDC 08290-3220-57) 33 g LANCET EACH $0.0620
BD INSULIN SYRINGE (NDC 08290-3249-09) 0.3 ml; 6 mm x 31 g SYRINGE EACH $0.1800
BD INSULIN SYRINGE (NDC 08290-3249-10)
0.3 ml; 6 mm x 31 g (1/2) SYRINGE EACH $0.1800
BD INSULIN SYRINGE (NDC 08290-3284-38) 0.3 ml; 8 mm x 31 g SYRINGE EACH $0.1800
BD INSULIN SYRINGE (NDC 08290-3284-40)
0.3 ml; 8 mm x 31 g (1/2) SYRINGE EACH $0.1800
BD UINSULIN SYRINGE (NDC 08290-3249-11) 0.5 ml; 6 mm x 31 g SYRINGE EACH $0.1800
BD INSULIN SYRINGE (NDC 08290-3284-68) 0.5 ml; 8 mm x 31 g SYRINGE EACH $0.1800
BD INSULIN SYRINGE (NDC 08290-3284-66)
0.5 ml; 12.7 mm x 30 g SYRINGE EACH $0.1800
BD INSULIN SYRINGE (NDC 08290-5932-01) 0.5 ml; 29 g x 1/2'’ SYRINGE EACH $0.1900
BD INSULIN SYRINGE (NDC 08290-3249-12) 1 ml; 6 mm x 31 g SYRINGE EACH $0.1800
BD INSULIN SYRINGE (NDC 08290-3256-57) 1 ml; 25 g x 5/8” SYRINGE EACH $0.1900
BD INSULIN SYRINGE (NDC 08290-3294-64) 1 ml; 29 g x 1/2” SYRINGE EACH $0.1900
BD INSULIN SYRINGE (NDC 08290-3282-89) 1 ml; 31 g x 5/32” SYRINGE EACH $0.1900
BD ULTRA-FINE PEN NEEDLE (NDC 08290-3201-22) 4 mm x 32 g NEEDLE EACH $0.1800
BD ULTRA-FINE PEN NEEDLE (NDC 08290-3201-19) 5 mm x 31 g NEEDLE EACH $0.1800
BENAZEPRIL HCL 10 mg TAB TABLET $0.0438
BENAZEPRIL HCL 20 mg TAB TABLET $0.0435
BENAZEPRIL HCL 40 mg TAB TABLET $0.0600
BENAZEPRIL HCL 5 mg TAB TABLET $0.0252
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
BENAZEPRIL/HCTZ 10 mg; 12.5 mg TAB TABLET $0.6235
BENAZEPRIL/HCTZ 20 mg; 12.5 mg TAB TABLET $0.0655
BENAZEPRIL/HCTZ 20 mg; 25 mg TAB TABLET $0.6055
BENAZEPRIL/HCTZ 5 mg; 6.25 mg TAB TABLET $1.1000
BENZONATATE 100 mg CAP CAPSULE $0.1500
BENZONATATE 200 mg CAP CAPSULE $0.2358
BENZOYL PEROXIDE 10% CLEANSER GRAM $0.0520
BENZOYL PEROXIDE 10% GEL GRAM $0.0725
BENZOYL PEROXIDE 10% LOTION MILLILITER $0.0799
BENZOYL PEROXIDE 2.5% GEL GRAM $0.2260
BENZOYL PEROXIDE 3% CLEANSER GRAM $0.2837
BENZOYL PEROXIDE 5% CLEANSER GRAM $0.0448
BENZOYL PEROXIDE 5% GEL GRAM $0.2335
BENZOYL PEROXIDE 5% LOTION MILLILITER $0.0837
BENZOYL PEROXIDE 6% CLEANSER GRAM $0.0755
BENZOYL PEROXIDE 9% CLEANSER GRAM $0.3581
BENZTROPINE MESYLATE 0.5 mg TAB TABLET $0.0945
BENZTROPINE MESYLATE 1 mg TAB TABLET $0.0933
BENZTROPINE MESYLATE 2 mg TAB TABLET $0.1145
BETAMETHASONE ACETATE, SOD PHOS 6 mg/ml VIAL EACH $7.6785
BETAMETHASONE/PROPYLENE GLYC 0.05% LOTION GRAM $1.9855
BETAMETHASONE DIPROPIONATE AUGMENTED 0.05% CREAM GRAM $0.3885
BETAMETHASONE DIPROPIONATE AUGMENTED 0.05% OINT GRAM $1.9200
BETAMETHASONE DIPROPIONATE 0.05%, 15 gm CREAM GRAM $1.5542
BETAMETHASONE DIPROPIONATE 0.05%, 15 gm OINT GRAM $2.1595
BETAMETHASONE DIPROPIONATE 0.05%, 45 gm CREAM GRAM $1.2952
BETAMETHASONE DIPROPIONATE 0.05%, 45 gm OINT GRAM $1.8360
BETAMETHASONE VALERATE 0.1% CREAM GRAM $0.9513
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
BETAMETHASONE VALERATE 0.1% OINT GRAM $0.6399
BETAMETHASONE VALERATE 0.1%, 60 ml LOTION MILLILITER $0.5442
BETAMETHASONE VALERATE 0.12% FOAM GRAM $0.7575
BETAXOLOL HCL 0.5% OPTH SOLN MILLILITER $7.2000
BETAXOLOL HCL 10 mg TAB TABLET $0.5500
BETAXOLOL HCL 20 mg TAB TABLET $0.8850
BETHANECHOL CHLORIDE 10 mg TAB TABLET $0.3925
BETHANECHOL CHLORIDE 25 mg TAB TABLET $0.4215
BETHANECHOL CHLORIDE 5 mg TAB TABLET $0.1050
BETHANECHOL CHLORIDE 50 mg TAB TABLET $0.8125
BEXAROTENE 75 mg CAP CAPSULE $229.3500
BICALUTAMIDE 50 mg TAB TABLET $0.2840
BISACODYL 10 mg SUPP EACH $0.1050
BISACODYL 5 mg TAB EC TABLET $0.0216
BISMUTH SUBSALICYLATE 262 mg TAB CHEW TABLET $0.0538
BISMUTH SUBSALICYLATE 262 mg; 15 ml SUSP MILLILLITER $0.0088
BISOPROLOL FUMARATE 10 mg TAB TABLET $0.2725
BISOPROLOL FUMARATE 5 mg TAB TABLET $0.2530
BISOPROLOL/HCTZ 10 mg; 6.25 mg TAB TABLET $0.0393
BISOPROLOL/HCTZ 2.5 mg; 6.25 mg TAB TABLET $0.0447
BISOPROLOL/HCTZ 5 mg; 6.25 mg TAB TABLET $0.0606
BIVALIRUDIN 250 mg VIAL EACH $135.2500
BLEOMYCIN SULFATE 15 unit VIAL EACH $60.5250
BLEOMYCIN SULFATE 30 unit VIAL EACH $96.1170
BRIMONIDINE TARTRATE 0.15% DROPS MILLILITER $20.7060
BRIMONIDINE TARTRATE 0.2% DROPS MILLILITER $0.4695
BROMFENAC SODIUM 0.09% DROPS MILLILITER $42.0400
BROMOCRIPTINE MESYLATE 2.5 mg TAB TABLET $2.3895
Effective September 7, 2018
-
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
BROMOCRIPTINE MESYLATE 5 mg CAP CAPSULE $5.6945
BROMPHENIRAMINE MALEATE/ PHENYLEPHRINE HCL/D-METHORPHAN HB 1-2.5-5/5 ml SOLN MILLILITER $0.0203
BUDESONIDE 0.25 mg/2 ml AMPUL MILLILITER $0.9600
BUDESONIDE 0.5 mg/2 ml AMPUL MILLILITER $1.2250
BUDESONIDE 1 mg/2 ml AMPUL MILLILITER $5.1550
BUDESONIDE 3 mg CAP, ER CAPSULE $3.8555
BUDESONIDE 32 mcg AER GRAM $1.6550
BUDESONIDE 32 mcg SPRAY PUMP EACH $1.6105
BUMETANIDE 0.5 mg TAB TABLET $0.5105
BUMETANIDE 1 mg TAB TABLET $0.4460
BUMETANIDE 2 mg TAB TABLET $0.9235
BUPRENORPHINE HCL 2 mg TAB SL TABLET $0.7055
BUPRENORPHINE HCL 8 mg TAB SL TABLET $1.2375
BUPRENORPHINE HCL/NALOXONE HCL 2 mg; 0.5 mg TAB SL TABLET $2.000
BUPRENORPHINE HCL/NALOXONE HCL 8 mg; 2 mg TAB SL TABLET $2.5555
BUPROPION HCL 100 mg TAB SR TABLET $0.1300
BUPROPION HCL 100 mg TAB TABLET $0.2750
BUPROPION HCL 150 mg TAB ER TABLET $0.2950
BUPROPION HCL 150 mg TAB SA TABLET $0.4950
BUPROPION HCL 150 mg TAB SR TABLET $0.0975
BUPROPION HCL 200 mg TAB SR TABLET $0.1950
BUPROPION HCL 300 mg TAB ER TABLET $0.3685
BUPROPION HCL 75 mg TAB TABLET $0.2707
BUSPIRONE HCL 10 mg TAB TABLET $0.0550
BUSPIRONE HCL 15 mg TAB TABLET $0.0605
BUSPIRONE HCL 30 mg TAB TABLET $0.3275
BUSPIRONE HCL 5 mg TAB TABLET $0.0325
BUSPIRONE HCL 7.5 mg TAB TABLET $0.5176
Effective September 7, 2018
-
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
BUTALBITAL/ACETAMINOPHEN 50 mg; 300 mg TAB TABLET $11.5735
BUTALBITAL/ACETAMINOPHEN 50 mg; 325 mg TAB TABLET $0.8885
BUTALBITAL/ACETAMINOPHEN/CAFFEINE 50 mg; 300 mg; 40 mg CAP CAPSULE $2.2000
BUTALBITAL/ACETAMINOPHEN/CAFFEINE 50 mg; 325 mg; 40 mg CAP CAPSULE $1.9546
BUTALBITAL/APAP/CAFFEINE COMPOUND 50 mg; 325 mg; 40 mg TAB TABLET $0.3655
BUTALBITAL/ASPIRIN/CAFFEINE 50 mg; 325 mg; 40 mg CAP CAPSULE $0.8695
BUTALBITAL/CAFFEINE/APAP/CODEINE 50 mg; 325 mg; 40 mg; 30 mg CAP CAPSULE $0.9435
BUTORPHANOL TARTRATE 10 mg/ml NASAL SPRAY MILLILITER $11.7260
CABERGOLINE 0.5 mg TAB TABLET $4.4125
CALCIPOTRIENE 0.005% CREAM GRAM $1.6945
CALCIPOTRIENE 0.005% OINT GRAM $2.5219
CALCIPOTRIENE 0.005% SOLN MILLILITER $1.6645
CALCIPOTRIENE/BETAMETHASONE 0.005-0.064% OINT GRAM $8.8475
CALCITONIN, SALMON, SYNTHETIC 200 units/dose SPRAY MILLILITER $8.8325
CALCITRIOL 0.25 mcg CAP CAPSULE $0.2225
CALCITRIOL 0.5 mcg CAP CAPSULE $0.4815
CALCITRIOL 1 mcg/ml SOLN MILLILITER $5.9045
CALCIUM ACETATE 667 mg CAP CAPSULE $0.1999
CALCIUM ACETATE 667 mg TAB TABLET $0.3700
CALCIUM CARBONATE 1250 mg TAB TABLET $0.0332
CALCIUM CARBONATE 200 (500) mg TAB CHEW TABLET $0.0150
CALCIUM CARBONATE 215 (500) mg TAB CHEW TABLET $0.0165
CALCIUM CARBONATE 300 (750) mg TAB CHEW TABLET $0.0284
CALCIUM CARBONATE 500 mg/ml ORAL SUSP MILLILITER $0.0201
CALCIUM CARBONATE 500 mg TAB TABLET $0.0332
CALCIUM CARBONATE 600 mg TAB TABLET $0.6420
CALCIUM CARBONATE/CHOLECALCIFEROL (VITAMIN D3) 500 mg; 200 mg TAB TABLET $0.0458
CALCIUM CARBONATE/CHOLECALCIFEROL (VITAMIN D3) 500 mg; 400 mg TAB TABLET $0.0488
Effective September 7, 2018
-
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CALCIUM CARBONATE/CHOLECALCIFEROL (VITAMIN D3) 600 mg; 400 mg TAB TABLET $0.0168
CALCIUM CARBONATE/CHOLECALCIFEROL (VITAMIN D3)/PHYTONADIONE (VITAMIN K1) 500-200-40 TAB CHEW TABLET $0.0971
CALCIUM/MAGNESIUM/ZINC N/A TAB TABLET $0.0332
CALCIUM POLYCARBOPHIL 625 mg TAB TABLET $0.0600
CANDESARTAN CILEXETIL 16 mg TAB TABLET $1.3800
CANDESARTAN CILEXETIL 32 mg TAB TABLET $2.0119
CANDESARTAN CILEXETIL 4 mg TAB TABLET $0.6997
CANDESARTAN CILEXETIL 8 mg TAB TABLET $0.7050
CANDESARTAN/HYDROCHLOROTHIAZIDE 16 mg; 12.5 mg TAB TABLET $2.3700
CANDESARTAN/HYDROCHLOROTHIAZIDE 32 mg; 12.5 mg TAB TABLET $2.0697
CANDESARTAN/HYDROCHLOROTHIAZIDE 32 mg; 25 mg TAB TABLET $2.6250
CAPECITABINE 150 mg TAB TABLET $2.5000
CAPECITABINE 500 mg TAB TABLET $4.5895
CAPTOPRIL 100 mg TAB TABLET $1.4640
CAPTOPRIL 12.5 mg TAB TABLET $0.7500
CAPTOPRIL 25 mg TAB TABLET $0.7395
CAPTOPRIL 50 mg TAB TABLET $1.1040
CAPTOPRIL /HYDROCHLOROTHIAZIDE 25 mg; 15 mg TAB TABLET $0.0263
CAPTOPRIL /HYDROCHLOROTHIAZIDE 25 mg; 25 mg TAB TABLET $0.0568
CAPTOPRIL /HYDROCHLOROTHIAZIDE 50 mg; 15 mg TAB TABLET $0.0665
CARBAMAZEPINE 100 mg TAB CHEW TABLET $0.3113
CARBAMAZEPINE 100 mg CAP ER 12HR CAPSULE $0.5155
CARBAMAZEPINE 100 mg TAB ER 12HR TABLET $0.7375
CARBAMAZEPINE 100 mg/5 ml SUSP MILLILITER $0.1374
CARBAMAZEPINE 200 mg CAP ER 12HR CAPSULE $0.6365
CARBAMAZEPINE 200 mg TAB TABLET $0.4065
CARBAMAZEPINE 200 mg TAB SR 12HR TABLET $1.2000
CARBAMAZEPINE 300 mg CAP ER 12HR CAPSULE $0.8235
Effective September 7, 2018
-
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CARBAMAZEPINE 400 mg TAB SR 12HR TABLET $2.4299
CARBAMIDE PEROXIDE 6.5% DROPS MILLILITER $0.1005
CARBIDOPA 25 mg TAB TABLET $3.5125
CARBIDOPA/LEVODOPA 10 mg; 100 mg TAB, RAPID DISSOLVE TABLET $0.6300
CARBIDOPA; LEVODOPA 10 mg; 100 mg TAB TABLET $0.1455
CARBIDOPA; LEVODOPA 25 mg; 100 mg TAB TABLET $0.0974
CARBIDOPA; LEVODOPA 25 mg; 100 mg TAB ODT TABLET $0.6850
CARBIDOPA; LEVODOPA 25 mg; 250 mg TAB TABLET $0.1700
CARBIDOPA; LEVODOPA 25 mg; 250 mg TAB ODT TABLET $0.8700
CARBIDOPA; LEVODOPA ER 25 mg; 100 mg TAB ER TABLET $0.1650
CARBIDOPA; LEVODOPA ER 50 mg; 200 mg TAB ER TABLET $0.3382
CARBIDOPA; LEVODOPA; ENTACAPONE 12.5 mg; 50 mg TAB TABLET $1.2960
CARBIDOPA; LEVODOPA; ENTACAPONE 18.75 mg; 75 mg TAB TABLET $1.2960
CARBIDOPA; LEVODOPA; ENTACAPONE 25; 100; 200 TAB TABLET $1.1635
CARBIDOPA; LEVODOPA; ENTACAPONE 31.25 mg; 125 mg TAB TABLET $1.2960
CARBIDOPA; LEVODOPA; ENTACAPONE 37.5 mg; 150 mg TAB TABLET $1.0825
CARBIDOPA; LEVODOPA; ENTACAPONE 50; 200; 200 TAB TABLET $1.2960
CARBINOXAMINE MALEATE 4 mg/5 ml LIQ MILLILITER $0.1000
CARBOPLATIN 10 mg/ml VIAL MILLILITER $1.5900
CARBOXYMETHYLCELLULOSE SODIUM 0.5% DROPERETTE EACH $0.1815
CARISOPRODOL 250 mg TAB TABLET $1.8175
CARISOPRODOL 350 mg TAB TABLET $0.0621
CARTEOLOL HCL 1% SOLN MILLILITER $0.9528
CARVEDILOL 12.5 mg TAB TABLET $0.0292
CARVEDILOL 20 mg CAP ER CAPSULE $6.4389
CARVEDILOL 25 mg TAB TABLET $0.0295
CARVEDILOL 3.125 mg TAB TABLET $0.0328
CARVEDILOL 6.25 mg TAB TABLET $0.0308
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CASPOFUNGIN ACETATE 50 mg VIAL EACH $74.5550
CASPOFUNGIN ACETATE 70 mg VIAL EACH $79.5550
CEFACLOR 250 mg CAP CAPSULE $0.7453
CEFACLOR 500 mg CAP CAPSULE $1.5665
CEFADROXIL HYDRATE 1 g TAB TABLET $3.9000
CEFADROXIL HYDRATE 250 mg/5 ml SUSP MILLILITER $0.1935
CEFADROXIL HYDRATE 500 mg/5 ml SUSP MILLILITER $0.2595
CEFADROXIL 500 mg CAP CAPSULE $0.2000
CEFAZOLIN SODIUM 1 gm VIAL EACH $1.1550
CEFAZOLIN SODIUM 10 gm VIAL EACH $11.5416
CEFAZOLIN SODIUM 500 mg VIAL EACH $1.6200
CEFDINIR 125 mg/5 ml SUSP MILLILITER $0.1950
CEFDINIR 250 mg/5 ml SUSP MILLILITER $0.1550
CEFDINIR 300 mg CAP CAPSULE $0.4500
CEFEPIME HCL 1 gm VIAL EACH $4.7150
CEFEPIME HCL 2 gm VIAL EACH $10.8581
CEFIXIME 100 mg/5 ml ORAL SUSP MILLILITER $3.1700
CEFIXIME 200 mg/5 ml ORAL SUSP MILLILITER $5.6945
CEFOTETAN DISODIUM 1 gm VIAL EACH $3.8995
CEFOXITIN SODIUM 2 gm VIAL EACH $8.3000
CEFOXITIN SODIUM 10 gm VIAL EACH $30.8000
CEFPODOXIME 100 mg TAB TABLET $3.9955
CEFPODOXIME 200 mg TAB TABLET $4.4915
CEFPODOXIME PROXETIL 100 mg/5 ml SUSP MILLILITER $1.2500
CEFPODOXIME PROXETIL 50 mg/5 ml SUSP MILLILITER $0.5800
CEFPROZIL 125 mg/5 ml SUSP MILLILITER $0.2175
CEFPROZIL 250 mg/5 ml SUSP MILLILITER $0.3367
CEFPROZIL 250 mg TAB TABLET $0.7400
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CEFPROZIL 500 mg TAB TABLET $1.3615
CEFTAZIDIME PENTAHYDRATE 1 gm VIAL EACH $6.7350
CEFTAZIDIME PENTAHYDRATE 2 gm VIAL EACH $11.3148
CEFTAZIDIME PENTAHYDRATE 6 gm VIAL EACH $27.7830
CEFTRIAXONE SODIUM 1 gm VIAL EACH $1.9923
CEFTRIAXONE SODIUM 10 gm VIAL EACH $20.7648
CEFTRIAXONE SODIUM 2 gm VIAL EACH $4.4352
CEFTRIAXONE SODIUM 250 mg VIAL EACH $1.5926
CEFTRIAXONE SODIUM 500 mg VIAL EACH $1.3095
CEFUROXIME 250 mg TAB TABLET $0.6785
CEFUROXIME 500 mg TAB TABLET $0.9005
CEFUROXIME SODIUM 7.5 gm VIAL EACH $19.9500
CELECOXIB 100 mg CAP CAPSULE $0.3300
CELECOXIB 200 mg CAP CAPSULE $0.2050
CELECOXIB 400 mg CAP CAPSULE $1.1025
CELECOXIB 50 mg CAP CAPSULE $0.3125
CEPHALEXIN 125 mg/5 ml SUSP MILLILITER $0.1075
CEPHALEXIN 250 mg CAP CAPSULE $0.0890
CEPHALEXIN 250 mg/5 ml SUSP RECON MILLILITER $0.1225
CEPHALEXIN 500 mg CAP CAPSULE $0.0877
CEPHALEXIN 750 mg CAP CAPSULE $6.0475
CETIRIZINE HCL 1 mg/ml SYRN MILLILITER $0.0300
CETIRIZINE HCL 10 mg TAB CHEW TABLET $3.2725
CETIRIZINE HCL 10 mg TAB TABLET $0.0735
CETIRIZINE HCL 5 mg TAB CHEW TABLET $1.6555
CETIRIZINE HCL 5 mg TAB TABLET $0.0600
CEVIMELINE HCL 30 mg CAP CAPSULE $1.1155
CHLORDIAZEPOXIDE 10 mg CAP CAPSULE $0.0700
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CHLORDIAZEPOXIDE 25 mg CAP CAPSULE $0.0700
CHLORDIAZEPOXIDE 5 mg CAP CAPSULE $0.0895
CHLORHEXIDINE 0.12% ORAL RINSE MILLILITER $0.0106
CHLORHEXIDINE GLUCONATE 4% LIQUID MILLILITER $0.0211
CHLOROQUINE PHOSPHATE 500 mg TAB TABLET $3.5550
CHLORPHENIRAMINE/PHENYLEPHRINE 4-10 mg/5 ml LIQUID MILLILITER $0.0503
CHLORPHENIRAMINE/PHENYLEPH/DM 4-10-15 mg/5 ml SYRINGE MILLILITER $0.0540
CHLORPHENIRAMINE/PSEUDOEPHED/DM 1-15-5mg/5 ml LIQUID MILLILITER $0.0196
CHLORPHENIRAMINE MALEATE 12 mg TAB ER TABLET $0.2325
CHLORPROMAZINE HCL 10 mg TAB TABLET $2.0895
CHLORPROMAZINE HCL 100 mg TAB TABLET $5.8550
CHLORPROMAZINE HCL 200 mg TAB TABLET $7.5850
CHLORPROMAZINE HCL 25 mg TAB TABLET $3.0585
CHLORPROMAZINE HCL 50 mg TAB TABLET $4.1705
CHLORTHALIDONE 25 mg TAB TABLET $0.4015
CHLORTHALIDONE 50 mg TAB TABLET $0.5355
CHLORZOXAZONE 500 mg TAB TABLET $0.2855
CHOLECALCIFEROL (VITAMIN D3) 1,000 unit TAB TABLET $0.0749
CHOLECALCIFEROL (VITAMIN D3) 1,000 unit TAB CHEW TABLET $0.1943
CHOLECALCIFEROL (VITAMIN D3) 2,000 unit CAP CAPSULE $0.0375
CHOLECALCIFEROL (VITAMIN D3) 400 unit CAP CAPSULE $0.0408
CHOLESTYRAMINE 4 gm PWDR for ORAL SUSP GRAM $0.1755
CHOLESTYRAMINE LITE 4 gm PWDR for ORAL SUSP GRAM $0.2185
CHOLESTYRAMINE LITE 4 gm PWD PACKET EACH $1.7925
CHOLESTYRAMINE/SUCROSE 4 gm PWDR PACKET EACH $1.2183
CICLOPIROX 0.77% CREAM GRAM $0.2699
CICLOPIROX 0.77% GEL GRAM $1.1895
CICLOPIROX 0.77% TOP SUSP MILLILITER $1.0385
Effective September 7, 2018
-
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CICLOPIROX 1% SHAMPOO MILLILITER $0.4335
CICLOPIROX 8% TOP SOLN MILLILITER $1.8720
CILOSTAZOL 100 mg TAB TABLET $0.1257
CILOSTAZOL 50 mg TAB TABLET $0.0845
CIMETIDINE 200 mg TAB TABLET $0.3150
CIMETIDINE 300 mg/5 ml SOLN MILLILITER $0.0850
CIMETIDINE 300 mg TAB TABLET $0.3066
CIMETIDINE 400 mg TAB TABLET $0.5665
CIMETIDINE 800 mg TAB TABLET $0.5656
CIPROFLOXACIN LACTATE/D5W 400 mg/200 ml IV MILLILITER $0.0210
CIPROFLOXACIN 0.3% SOLN MILLILITER $0.9450
CIPROFLOXACIN 250 mg/5 ml ORAL SUSP MILLILITER $0.8168
CIPROFLOXACIN 250 mg TAB TABLET $0.0945
CIPROFLOXACIN 500 mg/5 ml ORAL SUSP MILLILITER $0.9561
CIPROFLOXACIN 500 mg TAB TABLET $0.1175
CIPROFLOXACIN 750 mg TAB TABLET $0.4526
CISPLATIN 1 mg/ml SOLN MILLILITER $0.2025
CITALOPRAM 10 mg/5 ml SOLN MILLILITER $0.2563
CITALOPRAM 10 mg TAB TABLET $0.0348
CITALOPRAM 20 mg TAB TABLET $0.0295
CITALOPRAM 40 mg TAB TABLET $0.0375
CITRIC ACID/SODIUM CITRATE 334-500 mg SOLN MILLILITER $0.0259
CLADRIBINE 10 mg/10 ml VIAL MILLILITER $28.3030
CLARITHROMYCIN 125 mg/5 ml SUSP MILLILITER $0.8157
CLARITHROMYCIN 250 mg/5 ml SUSP MILLILITER $1.2246
CLARITHROMYCIN 250 mg TAB TABLET $0.5095
CLARITHROMYCIN 500 mg TAB TABLET $0.6265
CLARITHROMYCIN 500 mg TAB ER TABLET $2.7825
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CLINDAMYCIN HCL 150 mg CAP CAPSULE $0.1100
CLINDAMYCIN HCL 300 mg CAP CAPSULE $0.2129
CLINDAMYCIN PALMITATE HCL 75 mg/5 ml SOLN MILLILITER $0.2175
CLINDAMYCIN PHOSPHATE 1% FOAM GRAM $3.6805
CLINDAMYCIN PHOSPHATE 1% PLEDGET EACH $0.3545
CLINDAMYCIN PHOSPHATE 1% TOP GEL GRAM $1.4475
CLINDAMYCIN PHOSPHATE 1% TOP LOTION MILLILITER $1.1111
CLINDAMYCIN PHOSPHATE 1% TOP SOLN MILLILITER $0.4650
CLINDAMYCIN PHOSPHATE 150 mg/ml VIAL MILLILITER $0.9231
CLINDAMYCIN PHOSPHATE 2% VAG CREAM MILLILITER $1.7010
CLINDAMYCIN PHOSPHATE/ BENZOYL PEROXIDE 1% - 5% GEL GRAM $4.3575
CLINDAMYCIN PHOSPHATE/ BENZOYL PEROXIDE 1% - 5% GEL PUMP GRAM $5.1550
CLINDAMYCIN PHOSPHATE/ BENZOYL PEROXIDE 1.2(1)%-5% GEL GRAM $2.1045
CLINDAMYCIN PHOSPHATE/ DEXTROSE 5% IN WATER 300 mg/50 ml SOLN MILLILITER $0.1722
CLINDAMYCIN PHOSPHATE/ DEXTROSE 5% IN WATER 600 mg/50 ml SOLN MILLILITER $0.2597
CLINDAMYCIN PHOSPHATE/ DEXTROSE 5% IN WATER 900 mg/50 ml SOLN MILLILITER $0.3172
CLINDAMYCIN/TRETINOIN 1.2-0.025% GEL GRAM $10.0588
CLOBETASOL PROPIONATE/EMOLLIENT 0.05% CREAM GRAM $1.1815
CLOBETASOL PROPIONATE/EMOLLIENT 0.05% FOAM GRAM $2.6255
CLOBETASOL PROPIONATE 0.05% CREAM GRAM $1.0550
CLOBETASOL PROPIONATE 0.05% FOAM GRAM $2.4599
CLOBETASOL PROPIONATE 0.05% GEL GRAM $1.2825
CLOBETASOL PROPIONATE 0.05% LOTION MILLILITER $0.8515
CLOBETASOL PROPIONATE 0.05% OINT GRAM $0.4755
CLOBETASOL PROPIONATE 0.05% SHAMPOO MILLILITER $1.2700
CLOBETASOL PROPIONATE 0.05% SPRAY MILLILITER $2.4050
CLOBETASOL PROPIONATE 0.05% TOP SOLN MILLILITER $0.9535
CLOMIPRAMINE HCL 25 mg CAP CAPSULE $4.5125
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CLOMIPRAMINE HCL 50 mg CAP CAPSULE $4.2995
CLOMIPRAMINE HCL 75 mg CAP CAPSULE $4.7385
CLONAZEPAM ODT 0.125 mg TAB ODT TABLET $0.5000
CLONAZEPAM ODT 0.25 mg TAB ODT TABLET $0.6850
CLONAZEPAM ODT 0.5 mg TAB ODT TABLET $0.6500
CLONAZEPAM ODT 1 mg TAB ODT TABLET $0.6316
CLONAZEPAM ODT 2 mg TAB ODT TABLET $1.4000
CLONAZEPAM 0.5 mg TAB TABLET $0.0150
CLONAZEPAM 1 mg TAB TABLET $0.0281
CLONAZEPAM 2 mg TAB TABLET $0.0417
CLONIDINE HCL 0.1 mg TAB ER 12HR TABLET $2.2250
CLONIDINE HCL 0.1 mg TAB TABLET $0.0246
CLONIDINE HCL 0.2 mg TAB TABLET $0.0265
CLONIDINE HCL 0.3 mg TAB TABLET $0.0395
CLONIDINE 0.1 mg/24hr PATCH PATCH $10.5575
CLONIDINE 0.2 mg/24hr PATCH PATCH $16.0550
CLONIDINE 0.3 mg/24hr PATCH PATCH $22.2000
CLOPIDOGREL 300 mg TAB TABLET $10.2000
CLOPIDOGREL 75 mg TAB TABLET $0.0494
CLORAZEPATE DIPOTASSIUM 15 mg TAB TABLET $2.3935
CLORAZEPATE DIPOTASSIUM 3.75 mg TAB TABLET $0.9075
CLOTRIMAZOLE/ BETAMETHASONE DIPROPIONATE 1-0.05%; 15 gm CREAM GRAM $0.4225
CLOTRIMAZOLE/ BETAMETHASONE DIPROPIONATE 1-0.05%; 45 gm CREAM GRAM $0.4195
CLOTRIMAZOLE/ BETAMETHASONE DIPROPIONATE 1-0.05% LOTION MILLILITER $2.8545
CLOTRIMAZOLE 1% CREAM GRAM $0.0813
CLOTRIMAZOLE 1% VAG CREAM GRAM $0.0739
CLOTRIMAZOLE 1% SOLN MILLILITER $1.8005
CLOTRIMAZOLE 10 mg LOZENGE EACH $0.3585
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CLOZAPINE 100 mg TAB TABLET $0.6600
CLOZAPINE 100 mg TAB ODT TABLET $5.1909
CLOZAPINE 200 mg TAB TABLET $1.9485
CLOZAPINE 25 mg TAB TABLET $0.3145
CLOZAPINE 25 mg TAB ODT TABLET $2.0080
CLOZAPINE 50 mg TAB TABLET $0.7260
CODEINE PHOSPHATE/GUAIFENESIN 6.3-100/5 LIQUID MILLILITER $0.0489
CODEINE SULFATE 15 mg TAB TABLET $0.4374
CODEINE SULFATE 30 mg TAB TABLET $0.3315
CODEINE SULFATE 60 mg TAB TABLET $0.7832
COLCHICINE 0.6 mg TAB TABLET $4.8555
COLESTIPOL HCL 1 gm TAB TABLET $0.7365
COLESTIPOL HCL 5 gm PACKET EACH $2.7285
COLISTIMETHATE SODIUM 150 mg VIAL EACH $15.1800
CROMOLYN SODIUM 20 mg/ml SOLN MILLILITER $0.6625
CROMOLYN SODIUM 4% OPTH SOLN MILLILITER $0.4485
CYANOCOBALAMIN (VITAMIN B-12) 1,000 mcg TAB TABLET $0.0693
CYANOCOBALAMIN (VITAMIN B-12) 1,000 mcg/ml VIAL MILLILITER $2.0918
CYANOCOBALAMIN/FOLIC AC/VIT B6 1-2.5-25 mg TAB TABLET $0.4285
CYANOCOBALAMIN/FOLIC AC/VIT B6 2-2.5-25 mg TAB TABLET $0.3755
CYCLOBENZAPRINE HCL 10 mg TAB TABLET $0.0240
CYCLOBENZAPRINE HCL 5 mg TAB TABLET $0.0360
CYCLOBENZAPRINE HCL 7.5 mg TAB TABLET $2.6555
CYCLOPENTOLATE HCL 0.5% DROPS MILLILITER $4.1050
CYCLOPENTOLATE HCL 1% DROPS MILLILITER $2.4840
CYCLOPENTOLATE HCL 2% DROPS MILLILITER $2.9500
CYCLOPHOSPHAMIDE 1 gm VIAL EACH $360.0000
CYCLOPHOSPHAMIDE 2 gm VIAL EACH $719.7500
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CYCLOPHOSPHAMIDE 500 mg VIAL EACH $179.9500
CYCLOSPORINE, MODIFIED 100 mg CAP CAPSULE $1.8165
CYCLOSPORINE, MODIFIED 100 mg/ml SOLN MILLILITER $3.0000
CYCLOSPORINE, MODIFIED 25 mg CAP CAPSULE $0.5225
CYCLOSPORINE, MODIFIED 50 mg CAP CAPSULE $1.2960
CYCLOSPORINE 100 mg CAP CAPSULE $7.5635
CYCLOSPORINE 25 mg CAP CAPSULE $1.7640
CYPROHEPTADINE HCL 2 mg/5 ml SYRINGE MILLILITER $0.0755
CYPROHEPTADINE HCL 4 mg TAB TABLET $0.2785
CYTARABINE/PF 2 gm/20 ml VIAL MILLILITER $1.2150
D-ALPHA TOCOPHEROL (VITAMIN E) 400 unit CAP CAPSULE $0.0726
DACARBAZINE 200 mg VIAL EACH $19.3650
DANAZOL 200 mg CAP CAPSULE $3.5765
DANTROLENE SODIUM 100 mg CAP CAPSULE $1.2545
DANTROLENE SODIUM 25 mg CAP CAPSULE $0.5899
DANTROLENE SODIUM 50 mg CAP CAPSULE $1.1879
DAPSONE 100 mg TAB TABLET $1.8125
DAPSONE 25 mg TAB TABLET $1.4888
DAPSONE 5% GEL GRAM $5.7035
DAPTOMYCIN 500 mg VIAL EACH $222.7250
DARIFENACIN HYDROBROMIDE 15 mg TAB ER 24HR TABLET $5.2295
DARIFENACIN HYDROBROMIDE 7.5 mg TAB ER 24HR TABLET $5.8566
DAUNORUBICIN HCL 5 mg/ml VIAL MILLILITER $24.8519
DECITABINE 50 mg SOLN EACH $822.6555
DEFEROXAMINE MESYLATE 2 gm VIAL EACH $43.2600
DEFEROXAMINE MESYLATE 500 mg VIAL EACH $13.5974
DEMECLOCYCLINE 150 mg TAB TABLET $3.0165
DEMECLOCYCLINE 300 mg TAB TABLET $7.5299
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
DESIPRAMINE HCL 10 mg TAB TABLET $0.6292
DESIPRAMINE HCL 25 mg TAB TABLET $0.8225
DESIPRAMINE HCL 50 mg TAB TABLET $1.3865
DESIPRAMINE HCL 75 mg TAB TABLET $2.9153
DESLORATADINE 5 mg TAB TABLET $0.4215
DESMOPRESSIN 0.1 mg/ml NASAL SPRAY MILLILITER $17.5316
DESMOPRESSIN ACETATE 0.1 mg TAB TABLET $0.7229
DESMOPRESSIN ACETATE 0.2 mg TAB TABLET $0.6550
DESOGESTREL/ETHINY ESTRADIOL (KARIVA, MIRCETTE) 0.15 mg; 20 mcg TAB TABLET $0.6225
DESOGESTREL/ETHINY ESTRADIOL (DESOGEN, ORTHO-CEPT, APRI) 0.15 mg; 30 mcg TAB TABLET $0.3799
DESOGESTREL/ETHINY ESTRADIOL 7-7-7 (CYCLESSA, VELIVET)
0.1-25/0.125-25/0.15-25 mg-mcg TAB TABLET $0.4920
DESONIDE 0.05% (15 gm) CREAM GRAM $2.2245
DESONIDE 0.05% (60 gm) CREAM GRAM $1.3755
DESONIDE 0.05% LOTION MILLILITER $2.1720
DESOXIMETASONE 0.05%; 15 gm GEL GRAM $3.4550
DESOXIMETASONE 0.05%; 60 gm GEL GRAM $3.1287
DESOXIMETASONE 0.25%; 15 gm OINT GRAM $0.4550
DESOXIMETASONE 0.25%; 60 gm OINT GRAM $1.3271
DESOXIMETASONE 0.25% CREAM GRAM $0.7550
DESOXIMETASONE 0.5% CREAM GRAM $2.8550
DESOXIMETASONE 0.05% OINT GRAM $5.2144
DESVENLAFAXINE SUCCINATE 100 mg TAB ER 24HR TABLET $0.8155
DESVENLAFAXINE SUCCINATE 25 mg TAB ER 24HR TABLET $0.7955
DESVENLAFAXINE SUCCINATE 50 mg TAB ER 24HR TABLET $0.8000
DEXAMETHASONE 0.5 mg TAB TABLET $0.0674
DEXAMETHASONE 0.5 mg/5 ml SOLN MILLILITER $0.0356
DEXAMETHASONE 0.75 mg TAB TABLET $0.1142
DEXAMETHASONE 1.5 mg TAB TABLET $0.0920
Effective September 7, 2018
-
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
DEXAMETHASONE 4 mg TAB TABLET $0.1199
DEXAMETHASONE 4 mg/ml VIAL EACH $0.1756
DEXMETHYLPHENIDATE HCL (FOCALIN XR) 10 mg CAP ER CAPSULE $3.6388
DEXMETHYLPHENIDATE HCL (FOCALIN) 10 mg TAB TABLET $0.6955
DEXMETHYLPHENIDATE HCL (FOCALIN XR) 15 mg CAP ER CAPSULE $3.2500
DEXMETHYLPHENIDATE HCL (FOCALIN XR) 20 mg CAP ER CAPSULE $4.8550
DEXMETHYLPHENIDATE HCL (FOCALIN) 2.5 mg TAB TABLET $0.2725
DEXMETHYLPHENIDATE HCL (FOCALIN XR) 25 mg CAP ER CAPSULE $2.1050
DEXMETHYLPHENIDATE HCL (FOCALIN XR) 30 mg CAP ER CAPSULE $3.5550
DEXMETHYLPHENIDATE HCL (FOCALIN XR) 35 mg CAP ER CAPSULE $6.2198
DEXMETHYLPHENIDATE HCL (FOCALIN XR) 40 mg CAP ER CAPSULE $4.8805
DEXMETHYLPHENIDATE HCL (FOCALIN XR) 5 mg CAP ER CAPSULE $3.4550
DEXMETHYLPHENIDATE HCL (FOCALIN) 5 mg TAB TABLET $0.5125
DEXRAZOXANE HCL 250 mg VIAL EACH $227.0000
DEXRAZOXANE HCL 500 mg VIAL EACH $286.0000
DEXTRAN 70/HYPROMELLOSE 0.1%-0.3% DROPS MILLILITER $0.1864
DEXTROAMPHETAMINE SULFATE 10 mg CAP SA CAPSULE $1.7550
DEXTROAMPHETAMINE SULFATE 10 mg TAB TABLET $0.7665
DEXTROAMPHETAMINE SULFATE 15 mg CAP SA CAPSULE $1.8749
DEXTROAMPHETAMINE SULFATE 5 mg CAP SA CAPSULE $1.1725
DEXTROAMPHETAMINE SULFATE 5 mg TAB TABLET $1.1431
DEXTROAMPHETAMINE SULFATE 5 mg/5 ml SOLN MILLILITER $1.2995
DEXTROMETHORPHAN POLISTIREX 30 mg/5 ml SUSP MILLILITER $0.0800
DIAZEPAM 10 mg TAB TABLET $0.0271
DIAZEPAM 2 mg TAB TABLET $0.0240
DIAZEPAM 5 mg TAB TABLET $0.0185
DIAZEPAM 5 mg/ml SYRINGE EACH $12.9251
DIAZEPAM 5 mg/ml ORAL CONC MILLILITER $0.9485
Effective September 7, 2018
-
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
DICLOFENAC POTASSIUM 50 mg TAB TABLET $0.4950
DICLOFENAC SODIUM 0.1% DROPS MILLILITER $1.5173
DICLOFENAC SODIUM 1% GEL GRAM $0.2735
DICLOFENAC SODIUM 1.5% DROPS MILLILITER $0.3350
DICLOFENAC SODIUM 3% GEL GRAM $1.0695
DICLOFENAC SODIUM 50 mg TAB EC TABLET $0.1195
DICLOFENAC SODIUM 75 mg TAB EC TABLET $0.9855
DICLOFENAC SODIUM XR 100 mg TAB XR TABLET $0.1755
DICLOFENAC SODIUM/MISOPROSTOL 50 mg; 200 mg TAB DR TABLET $1.5500
DICLOFENAC SODIUM/MISOPROSTOL 75 mg; 200 mg TAB DR TABLET $1.5500
DICLOXACILLIN SODIUM 250 mg CAP CAPSULE $0.2990
DICLOXACILLIN SODIUM 500 mg CAP CAPSULE $0.5700
DICYCLOMINE HCL 10 mg CAP CAPSULE $0.0438
DICYCLOMINE HCL 20 mg TAB TABLET $0.0567
DIDANOSINE 125 mg CAP DR CAPSULE $1.9950
DIDANOSINE 200 mg CAP DR CAPSULE $6.4841
DIDANOSINE 250 mg CAP SA CAPSULE $5.8440
DIDANOSINE 400 mg CAP SA CAPSULE $4.3500
DIFLORASONE DIACETATE 0.05% CREAM GRAM $10.4165
DIFLORASONE DIACETATE 0.05% OINT GRAM $3.5595
DIFLUNISAL 500 mg TAB TABLET $1.0685
DIGOXIN 0.05 mg/ml SOLN MILLILITER $2.0999
DIGOXIN 0.125 mg TAB TABLET $0.4065
DIGOXIN 0.250 mg TAB TABLET $0.3945
DIHYDROERGOTAMINE MESYLATE 1 mg/ml AMPUL EACH $136.3090
DILTIAZEM HCL 120 mg CAP ER DEG CAPSULE $0.3435
DILTIAZEM HCL 120 mg CAP ER 12HR CAPSULE $3.1996
DILTIAZEM HCL (CARDIZEM) 120 mg TAB TABLET $0.3000
Effective September 7, 2018
-
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
DILTIAZEM HCL (CARDIZEM CD) 120 mg CAP ER 24HR CAPSULE $0.2545
DILTIAZEM HCL (TIAZAC ER) 120 mg CAP SA 24HR CAPSULE $0.2250
DILTIAZEM HCL 180 mg CAP ER DEG CAPSULE $0.4455
DILTIAZEM HCL (CARDIZEM CD) 180 mg CAP ER 24HR CAPSULE $0.2685
DILTIAZEM HCL (CARDIZEM LA) 180 mg TAB ER 24HR TABLET $1.9294
DILTIAZEM HCL (TIAZAC ER) 180 mg CAP SA 24HR CAPSULE $0.3785
DILTIAZEM HCL 240 mg CAP ER DEG CAPSULE $0.4825
DILTIAZEM HCL (CARDIZEM CD) 240 mg CAP ER 24HR CAPSULE $0.3158
DILTIAZEM HCL (CARDIZEM LA) 240 mg TAB ER 24HR TABLET $2.3400
DILTIAZEM HCL (TIAZAC ER) 240 mg CAP SA 24HR CAPSULE $0.3750
DILTIAZEM HCL (CARDIZEM) 30 mg TAB TABLET $0.1095
DILTIAZEM HCL (CARDIZEM CD) 300 mg CAP ER 24HR CAPSULE $0.4151
DILTIAZEM HCL (CARDIZEM LA) 300 mg TAB ER 24HR TABLET $3.0360
DILTIAZEM HCL (TIAZAC ER) 300 mg CAP SA 24HR CAPSULE $0.6025
DILTIAZEM HCL (CARDIZEM CD) 360 mg CAP ER 24HR CAPSULE $3.5425
DILTIAZEM HCL (CARDIZEM LA) 360 mg TAB ER 24HR TABLET $3.2710
DILTIAZEM HCL (TIAZAC ER) 360 mg CAP SA 24HR CAPSULE $0.5498
DILTIAZEM HCL (CARDIZEM LA) 420 mg TAB ER 24HR TABLET $3.2710
DILTIAZEM HCL (TIAZAC ER) 420 mg CAP SA 24HR CAPSULE $0.2265
DILTIAZEM HCL 5 mg/ml VIAL MILLILITER $0.2900
DILTIAZEM HCL 60 mg CAP ER 12HR CAPSULE $2.1480
DILTIAZEM HCL (CARDIZEM) 60 mg TAB TABLET $0.1699
DILTIAZEM HCL 90 mg CAP ER 12HR CAPSULE $2.4600
DILTIAZEM HCL (CARDIZEM) 90 mg TAB TABLET $0.2806
DIMENHYDRINATE 50 mg TAB TABLET $0.0532
DIPHENHYDRAMINE 25 mg CAP CAPSULE $0.0300
DIPHENHYDRAMINE 50 mg CAP CAPSULE $0.0235
DIPHENHYDRAMINE HCL 12.5 mg/5 ml LIQUID MILLILITER $0.0111
Effective September 7, 2018
-
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
DIPHENHYDRAMINE HCL 25 mg TAB TABLET $0.0300
DIPHENHYDRAMINE HCL 50 mg TAB TABLET $0.0220
DIPHENHYDRAMINE HCL 50 mg/ml SOLN MILLILITER $1.9300
DIPHENHYDRAMINE HCL 50 mg/ml VIAL EACH $0.6401
DIPHENHYDRAMINE HCL 6.25 mg/ml DROPS MILLILITER $1.6500
DIPHENHYDRAMINE HCL/ZINC ACET 2%-0.1% CREAM GRAM $0.0200
DIPHENOXYLATE HCL; ATROPINE SULFATE 2.5 mg; 0.025 mg TAB TABLET $0.3750
DIPYRIDAMOLE 25 mg TAB TABLET $0.2555
DIPYRIDAMOLE 50 mg TAB TABLET $0.0834
DIPYRIDAMOLE 75 mg TAB TABLET $0.1200
DISOPYRAMIDE 100 mg CAP CAPSULE $0.5520
DISULFIRAM 250 mg TAB TABLET $1.5665
DISULFIRAM 500 mg TAB TABLET $3.4555
DIVALPROEX SODIUM 125 mg CAP SPRINKLE CAPSULE $0.3599
DIVALPROEX SODIUM 125 mg TAB EC TABLET $0.0355
DIVALPROEX SODIUM 250 mg TAB EC TABLET $0.0692
DIVALPROEX SODIUM 250 mg TAB ER TABLET $0.3850
DIVALPROEX SODIUM 500 mg TAB EC TABLET $0.4250
DIVALPROEX SODIUM 500 mg TAB ER TABLET $0.3355
D-METHORPHAN HB/P-EPD HCL/BPM 10 mg; 30 mg; 2 mg/5 ml SYRINGE MILLILITER $0.1099
D-METHORPHAN/PE/ACETAMINOPHEN 10-5-325 mg CAP CAPSULE $0.1265
DOCETAXEL 20 mg/ml VIAL MILLILITER $26.5000
DOCETAXEL 80 mg/4 ml VIAL MILLILITER $21.3500
DOCETAXEL 80 mg/8 ml VIAL MILLILITER $17.6500
DOCETAXEL 20 mg/2 ml VIAL MILLILITER $17.7500
DOCETAXEL 160 mg/16 ml VIAL MILLILITER $34.7555
DOCUSATE CALCIUM 240 mg CAP CAPSULE $0.0600
DOCUSATE SODIUM 100 mg CAP CAPSULE $0.0175
Effective September 7, 2018
-
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
DOCUSATE SODIUM 100 mg TAB TABLET $0.0342
DOCUSATE SODIUM 150 mg/15 ml LIQ MILLILITER $0.0137
DOCUSATE SODIUM 250 mg CAP CAPSULE $0.0350
DOCUSATE SODIUM 283 mg ENEMA EACH $2.0647
DOCUSATE SODIUM 50 mg CAP CAPSULE $0.2760
DOCUSATE SODIUM 60 mg/15 ml SYRUP MILLILITER $0.0072
DOFETILIDE 125 mcg CAP CAPSULE $3.9788
DOFETILIDE 250 mcg CAP CAPSULE $4.3345
DOFETILIDE 500 mcg CAP CAPSULE $4.3345
DONEPEZIL HCL 10 mg TAB RAPDIS TABLET $0.2899
DONEPEZIL HCL 10 mg TAB TABLET $0.0458
DONEPEZIL HCL 23 mg TAB TABLET $1.5355
DONEPEZIL HCL 5 mg TAB RAPDIS TABLET $0.2100
DONEPEZIL HCL 5 mg TAB TABLET $0.0458
DORZOLAMIDE HCL 2% DROPS MILLILITER $1.2429
DOXAZOSIN MESYLATE 1 mg TAB TABLET $0.1055
DOXAZOSIN MESYLATE 2 mg TAB TABLET $0.1155
DOXAZOSIN MESYLATE 4 mg TAB TABLET $0.1355
DOXAZOSIN MESYLATE 8 mg TAB TABLET $0.1175
DOXEPIN HCL 10 mg/ml CONC MILLILITER $0.6000
DOXEPIN HCL 10 mg CAP CAPSULE $0.4412
DOXEPIN HCL 100 mg CAP CAPSULE $1.0895
DOXEPIN HCL 150 mg CAP CAPSULE $0.7380
DOXEPIN HCL 25 mg CAP CAPSULE $0.5105
DOXEPIN HCL 50 mg CAP CAPSULE $0.7530
DOXEPIN HCL 75 mg CAP CAPSULE $1.1329
DOXERCALCIFEROL 0.5 mcg CAP CAPSULE $11.8500
DOXERCALCIFEROL 1 mcg CAP CAPSULE $23.7000
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
DOXERCALCIFEROL 2.5 mcg CAP CAPSULE $27.2700
DOXORUBICIN HCL 10 mg/5 ml VIAL MILLILITER $2.2680
DOXORUBICIN HCL 2 mg/ml VIAL MILLILITER $1.6797
DOXORUBICIN HCL 20 mg/10 ml VIAL MILLILITER $2.6250
DOXORUBICIN HCL 50 mg/25 ml VIAL MILLILITER $3.5250
DOXORUBICIN HCL PEG-LIPOSOMAL 2 mg/ml VIAL MILLILITER $78.7555
DOXYCYCLINE HYCLATE 100 mg CAP CAPSULE $0.2689
DOXYCYCLINE HYCLATE 100 mg TAB TABLET $0.4550
DOXYCYCLINE HYCLATE 100 mg TAB EC TABLET $9.4050
DOXYCYCLINE HYCLATE 150 mg TAB TABLET $19.1000
DOXYCYCLINE HYCLATE 150 mg TAB EC TABLET $8.8255
DOXYCYCLINE HYCLATE 20 mg TAB TABLET $0.3135
DOXYCYCLINE HYCLATE 200 MG TAB DR TABLET $26.4555
DOXYCYCLINE HYCLATE 50 mg CAP CAPSULE $0.3915
DOXYCYCLINE HYCLATE 50 mg TAB DR TABLET $8.0555
DOXYCYCLINE HYCLATE 75 mg TAB TABLET $19.4555
DOXYCYCLINE HYCLATE 75 mg TAB DR TABLET $6.0555
DOXYCYCLINE MONOHYDRATE 100 mg CAP CAPSULE $0.3275
DOXYCYCLINE MONOHYDRATE 100 mg TAB TABLET $0.4525
DOXYCYCLINE MONOHYDRATE 150 mg CAP CAPSULE $14.4150
DOXYCYCLINE MONOHYDRATE 150 mg TAB TABLET $6.1440
DOXYCYCLINE MONOHYDRATE 25 mg/5 ml SUSP RECON MILLILITER $0.2700
DOXYCYCLINE MONOHYDRATE 50 mg CAP CAPSULE $0.2315
DOXYCYCLINE MONOHYDRATE 50 mg TAB TABLET $0.3005
DOXYCYCLINE MONOHYDRATE 75 mg CAP CAPSULE $8.8800
DOXYCYCLINE MONOHYDRATE 75 mg TAB TABLET $0.5550
DRONABINOL 10 mg CAP CAPSULE $5.6555
DRONABINOL 2.5 mg CAP CAPSULE $2.3580
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
DRONABINOL 5 mg CAP CAPSULE $5.6555
DROSPIR/ETH ESTRA/LEVOMEFOL CA 3-0.02(24) TAB TABLET $3.3555
DULOXETINE HCL 20 mg CAP CAPSULE $0.2275
DULOXETINE HCL 30 mg CAP CAPSULE $0.2255
DULOXETINE HCL 40 mg CAP DR CAPSULE $3.1550
DULOXETINE HCL 60 mg CAP CAPSULE $0.1915
DUTASTERIDE 0.5 mg CAP CAPSULE $0.2345
DUTASTERIDE/TAMSULOSIN HCL 0.5 mg; 0.4 mg CAP ER 24HR CAPSULE $2.8645
ECONAZOLE NITRATE 1% CREAM GRAM $1.1500
EFAVIRENZ 600 mg TAB TABLET $25.7010
ELETRIPTAN HBR 20 mg TAB TABLET $9.8550
ELETRIPTAN HBR 40 mg TAB TABLET $9.6500
ENALAPRIL MALEATE/HCTZ 10 mg; 25 mg TAB TABLET $0.1890
ENALAPRIL MALEATE/HCTZ 5 mg; 12.5 mg TAB TABLET $0.1382
ENALAPRIL MALEATE 10 mg TAB TABLET $0.1745
ENALAPRIL MALEATE 2.5 mg TAB TABLET $0.1645
ENALAPRIL MALEATE 20 mg TAB TABLET $0.2700
ENALAPRIL MALEATE 5 mg TAB TABLET $0.2025
ENALAPRILAT DIHYDRATE 1.25 mg/ml VIAL MILLILITER $3.0240
ENOXAPARIN SODIUM 100 mg/ml SYRINGE MILLILITER $6.9100
ENOXAPARIN SODIUM 120 mg/0.8 ml SYRINGE MILLILITER $11.9800
ENOXAPARIN SODIUM 150 mg/ml SYRINGE MILLILITER $12.6995
ENOXAPARIN SODIUM 30 mg/0.3 ml SYRINGE MILLILITER $10.3289
ENOXAPARIN SODIUM 300 mg/3 ml VIAL MILLILITER $35.2050
ENOXAPARIN SODIUM 40 mg/0.4 ml SYRINGE MILLILITER $8.9700
ENOXAPARIN SODIUM 60 mg/0.6 ml SYRINGE MILLILITER $9.5200
ENOXAPARIN SODIUM 80 mg/0.8 ml SYRINGE MILLILITER $6.9000
ENTACAPONE 200 mg TAB TABLET $0.7975
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
ENTECAVIR 0.5 mg TAB TABLET $3.3125
ENTECAVIR 1 mg TAB TABLET $2.2605
EPINASTINE HCL 0.05% DROPS MILLILITER $7.2750
EPINEPHRINE 0.3 mg/0.3 AUTO-INJ EACH $143.5286
EPINEPHRINE 1 mg/ml AMPUL EACH $2.4930
EPINEPHRINE 0.1 mg/ml SYRINGE MILLILITER $0.4500
EPIRUBICIN HCL 200 mg/100 ml VIAL MILLILITER $1.9688
EPIRUBICIN HCL 50 mg/25 ml VIAL MILLILITER $2.1175
EPLERENONE 25 mg TAB TABLET $1.5125
EPLERENONE 50 mg TAB TABLET $1.5755
ERGOCALCIFEROL (VITAMIN D2) 1.25 mg (50,000 unit) CAP CAPSULE $0.1355
ERGOCALCIFEROL (VITAMIN D2) 8,000 units/ml DROPS MILLILITER $0.6750
ERYTHROMYCIN 0.5% OPTH OINT GRAM $1.8501
ERYTHROMYCIN 2% SOLN MILLILITER $0.4189
ERYTHROMYCIN BASE 250 mg CAP DR CAPSULE $4.3800
ERYTHROMYCIN BASE 250 mg TAB TABLET $9.0744
ERYTHROMYCIN BASE 250 mg TAB DR TABLET $7.0665
ERYTHROMYCIN BASE 500 mg TAB TABLET $15.2750
ERYTHROMYCIN BASE 500 mg TAB DR TABLET $11.0351
ERYTHROMYCIN BASE/BENZOYL PEROXIDE 3%; 5% GEL GRAM $4.3750
ERYTHROMYCIN BASE/ETHANOL 2% GEL GRAM $1.7620
ERYTHROMYCIN BASE/ETHANOL 2% MED SWAB EACH $0.8950
ERYTHROMYCIN ETHYLSUCCINATE 200 mg/5 ml SUSP RECON MILLILITER $2.9750
ESCITALOPRAM OXALATE 10 mg TAB TABLET $0.0670
ESCITALOPRAM OXALATE 20 mg TAB TABLET $0.0795
ESCITALOPRAM OXALATE 5 mg/5 ml ORAL SOLN MILLILITER $0.4895
ESCITALOPRAM OXALATE 5 mg TAB TABLET $0.0931
ESOMEPRAZOLE MAGNESIUM 20 mg CAP DR CAPSULE $0.3570
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
ESOMEPRAZOLE MAGNESIUM 40 mg CAP DR CAPSULE $0.4570
ESTAZOLAM 1 mg TAB TABLET $0.5335
ESTAZOLAM 2 mg TAB TABLET $0.5365
ESTRADIOL 0.1% CREAM GRAM $5.3525
ESTRADIOL (CLIMARA) 0.1 mg PATCH EACH $13.6715
ESTRADIOL (CLIMARA) 0.025 mg PATCH EACH $12.9165
ESTRADIOL (CLIMARA) 0.0375 mg PATCH EACH $13.2900
ESTRADIOL (CLIMARA) 0.05 mg PATCH EACH $13.6195
ESTRADIOL (CLIMARA) 0.06mg PATCH EACH $13.7200
ESTRADIOL (CLIMARA) 0.075 mg PATCH EACH $14.3595
ESTRADIOL (VIVELLE-DOT) 0.1 mg/24hr PATCH EACH $8.9870
ESTRADIOL (VIVELLE-DOT) 0.025 mg/24hr PATCH EACH $8.4155
ESTRADIOL (VIVELLE-DOT) 0.0375 mg/24hr PATCH EACH $7.3495
ESTRADIOL (VIVELLE-DOT) 0.05 mg/24hr PATCH EACH $8.6765
ESTRADIOL (VIVELLE-DOT) 0.075 mg/24hr PATCH EACH $8.6775
ESTRADIOL/NORETHINDRONE ACETATE (ACTIVELLA) 0.5 mg; 0.1mg TAB TABLET $2.7595
ESTRADIOL/NORETHINDRONE ACETATE (ACTIVELLA) 1 mg; 0.5 mg TAB TABLET $2.2557
ESTRADIOL 0.5 mg TAB TABLET $0.0850
ESTRADIOL 1 mg TAB TABLET $0.1086
ESTRADIOL 10 mcg TAB TABLET $17.5917
ESTRADIOL 2 mg TAB TABLET $0.1325
ESTRADIOL VALERATE 20 mg/ml VIAL EACH $25.5558
ESTROPIPATE 0.75 mg TAB TABLET $0.3640
ESTROPIPATE 1.5 mg TAB TABLET $0.4935
ESZOPICLONE 1 mg TAB TABLET $0.1115
ESZOPICLONE 2 mg TAB TABLET $0.2275
ESZOPICLONE 3 mg TAB TABLET $0.2675
ETHACRYNIC ACID 25 mg TAB TABLET $17.1270
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
ETHAMBUTOL HCL 100 mg TAB TABLET $0.9858
ETHAMBUTOL HCL 400 mg TAB TABLET $0.7320
ETHINYL ESTRADIOL/DROSPIRENONE (YAZ) 0.02-3(24) TAB TABLET $0.8735
ETHINYL ESTRADIOL/DROSPIRENONE (YASMIN, OCELLA) 0.03 mg; 3 mg TAB TABLET $0.7200
ETHOSUXIMIDE 250 mg CAP CAPSULE $0.9884
ETHOSUXIMIDE 250 mg/5 ml SYRINGE MILLILITER $0.2333
ETHYNODIOL DIACETATE/ETHINYL ESTRADIOL (ZOVIA 1/35E) 1 mg; 35 mcg TAB TABLET $0.6565
ETHYNODIOL DIACETATE/ETHINYL ESTRADIOL (ZOVIA 1/50E) 1 mg; 50 mcg TAB TABLET $0.7925
ETODOLAC 200 mg CAP CAPSULE $0.7525
ETODOLAC 300 mg CAP CAPSULE $0.7525
ETODOLAC 400 mg TAB TABLET $0.4945
ETODOLAC 400 mg TAB ER TABLET $1.8665
ETODOLAC 500 mg TAB TABLET $0.7475
ETODOLAC 500 mg TAB ER TABLET $1.8165
ETODOLAC 600 mg TAB ER TABLET $1.9802
ETOPOSIDE 20 mg/ml VIAL MILLILITER $1.8300
ETOPOSIDE 50 mg CAP EACH $71.5000
EXEMESTANE 25 mg TAB TABLET $3.4865
EZETIMIBE/SIMVASTATIN 10 mg; 10 mg TAB TABLET $2.1500
EZETIMIBE/SIMVASTATIN 10 mg; 20 mg TAB TABLET $2.1500
EZETIMIBE/SIMVASTATIN 10 mg; 40 mg TAB TABLET $2.1500
EZETIMIBE/SIMVASTATIN 10 mg; 80 mg TAB TABLET $2.1500
EZETIMIBE 10 mg TAB TABLET $0.2466
FAMCICLOVIR 125 mg TAB TABLET $0.3345
FAMCICLOVIR 250 mg TAB TABLET $0.4665
FAMCICLOVIR 500 mg TAB TABLET $0.7125
FAMOTIDINE/CALCIUM CARBONATE/MAGNESIUM 10-800-165 TAB CHEW TABLET $0.2135
FAMOTIDINE 10 mg TAB TABLET $0.0842
Effective September 7, 2018
-
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
FAMOTIDINE 20 mg TAB TABLET $0.0347
FAMOTIDINE 40 mg/5 ml SUSP MILLILITER $0.7995
FAMOTIDINE 40 mg TAB TABLET $0.0480
FELBAMATE 400 mg TAB TABLET $1.9535
FELBAMATE 600 mg/5 ml ORAL SUSP MILLILITER $1.3125
FELBAMATE 600 mg TAB TABLET $3.3300
FELODIPINE 10 mg TAB ER TABLET $0.2154
FELODIPINE 2.5 mg TAB ER TABLET $0.1295
FELODIPINE 5 mg TAB ER TABLET $0.2167
FENOFIBRATE, MICRONIZED 130 mg CAP CAPSULE $2.2800
FENOFIBRATE, MICRONIZED 134 mg CAP CAPSULE $0.4745
FENOFIBRATE, MICRONIZED 200 mg CAP CAPSULE $0.8550
FENOFIBRATE, MICRONIZED 43 mg CAP CAPSULE $0.8100
FENOFIBRATE, MICRONIZED 67 mg CAP CAPSULE $0.3550
FENOFIBRATE, NANOCRYSTALLIZED 145 mg TAB TABLET $0.2955
FENOFIBRATE, NANOCRYSTALLIZED 48 mg TAB TABLET $0.3000
FENOFIBRATE 120 mg TAB TABLET $23.9479
FENOFIBRATE 160 mg TAB TABLET $0.3845
FENOFIBRATE 54 mg TAB TABLET $0.3015
FENOFIBRIC ACID (CHOLINE) 135 mg CAP DR CAPSULE $1.2500
FENOFIBRIC ACID (CHOLINE) 45 mg CAP DR CAPSULE $0.7145
FENTANYL CITRATE 1,200 mcg LOZENGE EACH $17.2550
FENTANYL CITRATE 1,600 mcg LOZENGE EACH $24.4550
FENTANYL CITRATE 200 mcg LOZENGE EACH $19.7442
FENTANYL CITRATE 400 mcg LOZENGE EACH $15.7236
FENTANYL CITRATE 600 mcg LOZENGE EACH $11.8550
FENTANYL CITRATE 800 mcg LOZENGE EACH $14.5211
FENTANYL CITRATE/PF 50 mcg/ml AMPUL EACH $0.7177
Effective September 7, 2018
-
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
FENTANYL CITRATE/PF 50 mcg/ml VIAL EACH $0.4065
FENTANYL 100 mcg PATCH PATCH $5.7550
FENTANYL 12 mcg PATCH PATCH $9.7035
FENTANYL 25 mcg PATCH PATCH $2.3550
FENTANYL 37.5 mcg PATCH PATCH $41.4956
FENTANYL 50 mcg PATCH PATCH $3.8550
FENTANYL 62.5 mcg PATCH PATCH $48.6500
FENTANYL 75 mcg PATCH PATCH $5.7550
FENTANYL 87.5 mg PATCH PATCH $66.2500
FERROUS GLUCONATE 324 mg TAB TABLET $0.0677
FERROUS SULFATE 15 mg/ml DROPS MILLILITER $0.0600
FERROUS SULFATE 220 mg/5 ml ELIXIR MILLILITER $0.0150
FERROUS SULFATE 325 mg TAB EC TABLET $0.1650
FERROUS SULFATE 325 mg TAB TABLET $0.0150
FEXOFENADINE HCL/ PSEUDOEPHEDRINE HCL 60 mg; 20 mg TAB ER 12HR TABLET $0.9600
FEXOFENADINE HCL 180 mg TAB TABLET $0.3960
FEXOFENADINE HCL 30 mg/5 ml ORAL SUSP MILLILITER $0.0629
FEXOFENADINE HCL 60 mg TAB TABLET $0.3360
FINASTERIDE 5 mg TAB TABLET $0.1126
FLAVOXATE HCL 100 mg TAB TABLET $0.7245
FLECAINIDE ACETATE 100 mg TAB TABLET $0.3215
FLECAINIDE ACETATE 150 mg TAB TABLET $0.3925
FLECAINIDE ACETATE 50 mg TAB TABLET $0.2365
FLUCONAZOLE IN SALINE, ISO-OSMOTIC 400 mg/200 ml IV MILLILITER $0.0580
FLUCONAZOLE 10 mg/ml SUSP MILLILITER $0.3095
FLUCONAZOLE 100 mg TAB TABLET $0.7125
FLUCONAZOLE 150 mg TAB TABLET $1.1890
FLUCONAZOLE 200 mg TAB TABLET $1.0565
Effective September 7, 2018
-
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
FLUCONAZOLE 40 mg/ml SUSP MILLILITER $0.7054
FLUCONAZOLE 50 mg TAB TABLET $0.6800
FLUCYTOSINE 250 mg CAP CAPSULE $59.0897
FLUCYTOSINE 500 mg CAP CAPSULE $62.0000
FLUDARABINE PHOSPHATE 50 mg VIAL EACH $119.0700
FLUDARABINE PHOSPHATE 50 mg/2 ml VIAL MILLILITER $156.1920
FLUDROCORTISONE ACETATE 0.1 mg TAB TABLET $0.3315
FLUMAZENIL 0.1 mg/ml VIAL MILLILITER $0.8500
FLUNISOLIDE 0.025% SPRAY MILLILITER $1.7606
FLUOCINONIDE 0.1% CREAM GRAM $1.4750
FLUOCINONIDE 0.05% CREAM GRAM $0.6775
FLUOCINONIDE 0.05% GEL GRAM $1.7165
FLUOCINONIDE 0.05% OINT GRAM $1.1125
FLUOCINONIDE 0.05% SOLN MILLILITER $0.9075
FLUOCINONIDE ACETONIDE 0.01% OIL MILLILITER $0.4465
FLUOCINONIDE ACETONIDE OIL 0.01% DROPS MILLILITER $6.3755
FLUOCINONIDE ACETONIDE SCALP OIL 0.01% OIL MILLILITER $0.7525
FLUOCINONIDE/EMOLLIENT 0.05% CREAM GRAM $1.0525
FLUORIDE (SODIUM) 1.1% GEL GRAM $0.0822
FLUOROURACIL 5% CREAM GRAM $2.7500
FLUOROURACIL 5% SOLN MILLILITER $5.0525
FLUOROURACIL 50 mg/ml; 10 ml VIAL MILLILITER $0.3282
FLUOROURACIL 50 mg/ml; 50 ml VIAL MILLILITER $0.3911
FLUOROURACIL 50 mg/ml; 100 ml VIAL MILLILITER $0.3356
FLUOXETINE HCL 10 mg CAP CAPSULE $0.0389
FLUOXETINE HCL 10 mg TAB TABLET $0.0389
FLUOXETINE HCL 20 mg CAP CAPSULE $0.0263
FLUOXETINE HCL 20 mg TAB TABLET $0.0263
Effective September 7, 2018
-
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
FLUOXETINE HCL 20 mg/5 ml SYRINGE SYRUP $0.0450
FLUOXETINE HCL 40 mg CAP CAPSULE $0.1215
FLUOXETINE HCL 60 mg TAB TABLET $5.9000
FLUOXETINE HCL 90 mg CAP DR CAPSULE $28.4275
FLUPHENAZINE 1 mg TAB TABLET $3.2857
FLUPHENAZINE 10 mg TAB TABLET $7.3734
FLUPHENAZINE 2.5 mg TAB TABLET $4.5420
FLUPHENAZINE 25 mg/ml INJ MILLILITER $15.6545
FLUPHENAZINE 5 mg TAB TABLET $0.1920
FLURAZEPAM HCL 15 mg CAP CAPSULE $0.4302
FLURAZEPAM HCL 30 mg CAP CAPSULE $0.5186
FLURBIPROFEN 100 mg TAB TABLET $0.3300
FLURBIPROFEN 50 mg TAB TABLET $0.2160
FLURBIPROFEN SODIUM 0.03% OPTH SOLN MILLILITER $1.1580
FLUTAMIDE 125 mg CAP CAPSULE $0.4305
FLUTICASONE PROPIONATE 0.005% OINT GRAM $0.4545
FLUTICASONE PROPIONATE 0.05% CREAM GRAM $0.2975
FLUTICASONE PROPIONATE 0.05% LOTION GRAM $3.1550
FLUTICASONE PROPIONATE 50 mcg NASAL SPRAY GRAM $0.2375
FLUTICASONE PROPIONATE 50 mcg NASAL SPRAY OTC GRAM $0.4928
FLUVASTATIN 80 mg TAB ER 24HR TABLET $5.2137
FLUVASTATIN SODIUM 20 mg CAP CAPSULE $2.5550
FLUVASTATIN SODIUM 40 mg CAP CAPSULE $2.5550
FLUVOXAMINE 100 mg TAB TABLET $0.2791
FLUVOXAMINE 25 mg TAB TABLET $0.1200
FLUVOXAMINE 50 mg TAB TABLET $0.1992
FLUVOXAMINE MALEATE 100 mg CAP ER 24HR CAPSULE $6.2595
FLUVOXAMINE MALEATE 150 mg CAP ER 24HR CAPSULE $6.3745
Effective September 7, 2018
-
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
FOLIC ACID/VITAMIN B COMP W-C 1 mg CAP CAPSULE $0.1500
FOLIC ACID 0.4 mg TAB TABLET $0.0110
FOLIC ACID 1 mg TAB TABLET $0.0138
FONDAPARINUX SODIUM 10 mg/0.8 ml SYRINGE MILLILITER $79.8480
FONDAPARINUX SODIUM 2.5 mg/0.5 ml SYRINGE MILLILITER $31.5885
FONDAPARINUX SODIUM 5 mg/0.4 ml SYRINGE MILLILITER $237.6750
FONDAPARINUX SODIUM 7.5 mg/0.6 ml SYRINGE MILLILITER $74.5555
FOSAMPRENAVIR 700 mg TAB TABLET $15.7483
FOSINOPRIL SODIUM/HCTZ 10 mg; 12.5 mg TAB TABLET $0.7440
FOSINOPRIL SODIUM/HCTZ 20 mg; 12.5 mg TAB TABLET $0.7440
FOSINOPRIL SODIUM 10 mg TAB TABLET $0.1193
FOSINOPRIL SODIUM 20 mg TAB TABLET $0.1237
FOSINOPRIL SODIUM 40 mg TAB TABLET $0.2097
FOSPHENYTOIN SODIUM 100 mg PE/2 VIAL MILLILITER $0.8675
FOSPHENYTOIN SODIUM 500 mg PE/10 VIAL MILLILITER $0.6000
FROVATRIPTAN SUCCINATE 2.5 mg TAB TABLET $30.3375
FUROSEMIDE 10 mg/ml SOLN MILLILITER $0.1162
FUROSEMIDE 10 mg/ml VIAL MILLILITER $0.8000
FUROSEMIDE 20 mg TAB TABLET $0.0136
FUROSEMIDE 40 mg TAB TABLET $0.0120
FUROSEMIDE 80 mg TAB TABLET $0.0340
GABAPENTIN 100 mg CAP CAPSULE $0.0295
GABAPENTIN 250 mg/5 ml SOLN MILLILITER $0.1257
GABAPENTIN 300 mg CAP CAPSULE $0.0473
GABAPENTIN 400 mg CAP CAPSULE $0.0666
GABAPENTIN 600 mg TAB TABLET $0.0570
GABAPENTIN 800 mg TAB TABLET $0.1298
GALANTAMINE HYDROBROMIDE 12 mg TAB TABLET $0.7625
Effective September 7, 2018
-
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
GALANTAMINE HYDROBROMIDE 16 mg CAP ER CAPSULE $1.1500
GALANTAMINE HYDROBROMIDE 24 mg CAP ER CAPSULE $1.6035
GALANTAMINE HYDROBROMIDE 4 mg TAB TABLET $0.7125
GALANTAMINE HYDROBROMIDE 8 mg CAP ER CAPSULE $1.6800
GALANTAMINE HYDROBROMIDE 8 mg TAB TABLET $0.5845
GATIFLOXACIN 0.5% DROPS MILLILITER $25.1595
GEMCITABINE HCL 1 gm VIAL EACH $45.5360
GEMCITABINE HCL 1 gm/26.3 ml VIAL MILLILITER $0.9000
GEMCITABINE HCL 2 gm VIAL EACH $135.1356
GEMCITABINE HCL 2 gm/52.6 ml VIAL MILLILITER $1.0550
GEMCITABINE HCL 200 mg VIAL EACH $11.7251
GEMFIBROZIL 600 mg TAB TABLET $0.1062
GENTAMICIN SULFATE 0.1% CREAM GRAM $2.3590
GENTAMICIN SULFATE 0.1% OINT GRAM $2.3550
GENTAMICIN SULFATE 0.3% OINT GRAM $3.5571
GENTAMICIN SULFATE 0.3% OPTH SOLN MILLILITER $0.8425
GENTAMICIN SULFATE 40 mg/ml VIAL MILLILITER $0.6000
GLATIRAMER ACETATE 20 mg/ml SYRINGE MILLILITER $66.0000
GLATIRAMER ACETATE 40 mg/ml SYRINGE EACH $160.0000
GLIMEPIRIDE 1 mg TAB TABLET $0.0743
GLIMEPIRIDE 2 mg TAB TABLET $0.1002
GLIMEPIRIDE 4 mg TAB TABLET $0.1114
GLIPIZIDE/METFORMIN HCL 2.5 mg; 250 mg TAB TABLET $0.4500
GLIPIZIDE/METFORMIN HCL 2.5 mg; 500 mg TAB TABLET $0.3370
GLIPIZIDE/METFORMIN HCL 5 mg; 500 mg TAB TABLET $0.3100
GLIPIZIDE 10 mg TAB SA TABLET $0.2575
GLIPIZIDE 10 mg TAB TABLET $0.0300
GLIPIZIDE 2.5 mg TAB SA TABLET $0.1700
Effective September 7, 2018
-
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
GLIPIZIDE 5 mg TAB SA TABLET $0.1670
GLIPIZIDE 5 mg TAB TABLET $0.0314
GLYBURIDE, MICRONIZED 1.5 mg TAB TABLET $0.0345
GLYBURIDE, MICRONIZED 3 mg TAB TABLET $0.0323
GLYBURIDE, MICRONIZED 6 mg TAB TABLET $0.1524
GLYBURIDE/METFORMIN HCL 1.25 mg; 250 mg TAB TABLET $0.0450
GLYBURIDE/METFORMIN HCL 2.5 mg; 500 mg TAB TABLET $0.0506
GLYBURIDE/METFORMIN HCL 5 mg; 500 mg TAB TABLET $0.0540
GLYBURIDE 1.25 mg TAB TABLET $0.1200
GLYBURIDE 2.5 mg TAB TABLET $0.0550
GLYBURIDE 5 mg TAB TABLET $0.0550
GLYCERIN Adult SUPP EACH $0.4228
GLYCERIN Pediatric SUPP EACH $0.0668
GLYCOPYRROLATE 0.2 mg/ml VIAL MILLILITER $7.0555
GLYCOPYRROLATE 1 mg TAB TABLET $0.2245
GLYCOPYRROLATE 2 mg TAB TABLET $0.3800
GRANISETRON HCL 1 mg TAB TABLET $1.8900
GRANISETRON HCL 1 mg/ml; MDV VIAL MILLILITER $8.2032
GRANISETRON HCL 1 mg/ml; SDV VIAL MILLILITER $9.0000
GRISEOFULVIN MICROSIZE 125 mg/5 ml SUSP MILLILITER $0.2378
GRISEOFULVIN MICROSIZE 500 mg TAB TABLET $6.4130
GRISEOFULVIN ULTRAMICROSIZE 125 mg TAB TABLET $2.6000
GRISEOFULVIN ULTRAMICROSIZE 250 mg TAB TABLET $3.3945
GUAIFENESIN 100 mg/5 ml SOLN MILLILITER $0.0072
GUAIFENESIN 1200 mg TAB ER TABLET $0.4800
GUAIFENESIN 200 mg TAB TABLET $0.0395
GUAIFENESIN 400 mg TAB TABLET $0.0890
GUAIFENESIN 600 mg TAB ER TABLET $0.4170
Effective September 7, 2018
-
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
GUAIFENESIN; CODEINE PHOSPHATE (SUGAR FREE) 100 mg; 10 mg LIQUID MILLILITER $0.0317
GUAIFENESIN/DEXTROMETHORPHAN HBR 100 mg; 5 mg/5 ml LIQUID MILLILITER $0.0200
GUAIFENESIN/DEXTROMETHORPHAN HBR 100 mg; 10 mg LIQUID MILLILITER $0.0175
GUAIFENESIN/DEXTROMETHORPHAN HBR 100 mg; 10 mg/5 ml SYRINGE MILLILITER $0.0085
GUAIFENESIN/DEXTROMETHORPHAN HBR 200 mg; 10 mg/5 ml LIQUID MILLILITER $0.0226
GUAIFENESIN/DEXTROMETHORPHAN HBR 400 mg; 20 mg TAB TABLET $0.0899
GUAIFENESIN/ DEXTROMETHORPHAN HBR/ PHENYLEPHRINE 100-10-5 mg LIQUID MILLILITER $0.0353
GUAIFENESIN/PHENYLEPHRINE HCL 400 mg; 10 mg TAB TABLET $0.1014
GUAIFENESIN/PSEUDOEPHEDRINE HCL 600 mg; 60 mg TAB ER 12HR TABLET $0.4200
GUAIFENESIN/PSEUDOEPHEDRINE HCL/ CODEINE 100 mg; 30 mg; 10 mg SYRINGE MILLILITER $0.1680
GUANFACINE 1 mg TAB TABLET $0.0702
GUANFACINE 1 mg TAB ER TABLET $0.4500
GUANFACINE 2 mg TAB TABLET $0.0900
GUANFACINE 2 mg TAB ER TABLET $0.5284
GUANFACINE 3 mg TAB ER TABLET $0.4705
GUANFACINE 4 mg TAB ER TABLET $0.5155
HALOBETASOL PROPIONATE 0.05% CREAM GRAM $2.4655
HALOBETASOL PROPIONATE 0.05% OINT GRAM $1.8935
HALOPERIDOL LACTATE 2 mg/ml; 120 ml CONC MILLILITER $0.0449
HALOPERIDOL 0.5 mg TAB TABLET $0.1975
HALOPERIDOL 1 mg TAB TABLET $0.3189
HALOPERIDOL 10 mg TAB TABLET $0.5255
HALOPERIDOL 2 mg TAB TABLET $0.3792
HALOPERIDOL 20 mg TAB TABLET $1.3329
HALOPERIDOL 5 mg TAB TABLET $0.4600
HALOPERIDOL DECANOATE 100 mg/ml VIAL MILLILITER $33.9555
HALOPERIDOL LACTATE 5 mg/ml VIAL MILLILITER $1.0329
HC ACETATE/LIDOCAINE HCL 0.5%; 3% CREAM GRAM $0.8252
Effective September 7, 2018
-
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
HEPARIN SODIUM, PORCINE 10,000/ml VIAL EACH $2.2225
HEPARIN SODIUM, PORCINE 20,000/ml VIAL EACH $9.2071
HEPARIN SODIUM, PORCINE 5,000/ml VIAL EACH $1.2792
HYDRALAZINE HCL 10 mg TAB TABLET $0.0448
HYDRALAZINE HCL 100 mg TAB TABLET $0.0900
HYDRALAZINE HCL 20 mg/ml VIAL MILLILITER $3.7500
HYDRALAZINE HCL 25 mg TAB TABLET $0.0542
HYDRALAZINE HCL 50 mg TAB TABLET $0.0607
HYDROCHLOROTHIAZIDE 12.5 mg CAP CAPSULE $0.0374
HYDROCHLOROTHIAZIDE 12.5 mg TAB TABLET $0.0720
HYDROCHLOROTHIAZIDE 25 mg TAB TABLET $0.0096
HYDROCHLOROTHIAZIDE 50 mg TAB TABLET $0.0177
HYDROCODONE/ACETAMINOPHEN 5 mg; 300 mg TAB TABLET $0.7748
HYDROCODONE/ACETAMINOPHEN 7.5 mg; 300 mg TAB TABLET $0.8144
HYDROCODONE BIT/ACETAMINOPHEN 10 mg; 300 mg TAB TABLET $1.3775
HYDROCODONE BIT/ACETAMINOPHEN 7.5 mg; 325 mg/15 ml SOLN MILLILITER $0.1269
HYDROCODONE BIT/HOMATROPINE 5 mg; 1.5 mg/5 ml SYRINGE MILLILITER $0.1080
HYDROCODONE BITARTRATE/ HOMATROPINE METHYLBROMIDE 5 mg; 1.5 mg TAB TABLET $0.7125
HYDROCODONE POLISTRX/ CHLORPHENIRAMINE POLISTIREX 10-8 mg/5 ml SUSP MILLILITER $0.3926
HYDROCODONE/APAP 10 mg; 325 mg TAB TABLET $0.1465
HYDROCODONE/APAP 5 mg; 325 mg TAB TABLET $0.1000
HYDROCODONE/APAP 7.5 mg; 325 mg TAB TABLET $0.1355
HYDROCODONE/CMP/PSEUDOEPHED 5; 4; 60 mg/5 ORAL SOLN MILLILITER $0.5729
HYDROCODONE/IBUPROFEN 10 mg; 200 mg TAB TABLET $2.0663
HYDROCODONE/IBUPROFEN 5 mg; 200 mg TAB TABLET $2.6500
HYDROCODONE/IBUPROFEN 7.5 mg; 200 mg TAB TABLET $0.2500
HYDROCORTISONE 0.5% OINT GRAM $0.1474
HYDROCORTISONE 1% CREAM GRAM $0.0395
Effective September 7, 2018
-
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
HYDROCORTISONE 1% CREAM/APPL GRAM $0.6500
HYDROCORTISONE 1% LOTION MILLILITER $0.0662
HYDROCORTISONE 1% OINT GRAM $0.1200
HYDROCORTISONE 100 mg/60 ml ENEMA MILLILITER $0.1077
HYDROCORTISONE 2.5% CREAM/APPL GRAM $0.6775
HYDROCORTISONE 2.5% CREAM GRAM $0.1100
HYDROCORTISONE 2.5% LOTION MILLILITER $0.2559
HYDROCORTISONE 2.5% OINT GRAM $0.1125
HYDROCORTISONE 10 mg TAB TABLET $0.1680
HYDROCORTISONE 20 mg TAB TABLET $0.3350
HYDROCORTISONE 5 mg TAB TABLET $0.1128
HYDROCORTISONE/ALOE 1% CREAM GRAM $0.0565
HYDROCORTISONE ACETATE 0.5% CREAM GRAM $0.0670
HYDROCORTISONE ACETATE 1% CREAM GRAM $0.0536
HYDROCORTISONE BUTYRATE 0.1%; 15 gm OINT GRAM $1.2224
HYDROCORTISONE BUTYRATE 0.1%; 20 ml SOLN MILLILITER $1.2224
HYDROCORTISONE BUTYRATE 0.1% CREAM GRAM $2.1895
HYDROCORTISONE/PRAMOXINE 1%-1% CREAM/APPL GRAM $1.2605
HYDROCORTISONE/PRAMOXINE 2.5%-1% CREAM/APPL GRAM $4.7875
HYDROCORTISONE BUTYRATE/EMOLLIENT 0.1% CREAM GRAM $2.9350
HYDROCORTISONE VALERATE 0.2% CREAM GRAM $1.3025
HYDROCORTISONE VALERATE 0.2% OINT GRAM $2.9555
HYDROMORPHONE HCL 1 mg/ml LIQUID MILLILITER $0.2455
HYDROMORPHONE HCL 2 mg TAB TABLET $0.0806
HYDROMORPHONE HCL 4 mg TAB TABLET $0.1173
HYDROMORPHONE HCL 8 mg TAB TABLET $0.2715
HYDROMORPHONE HCL 12 mg TAB ER 24HR TABLET $8.8455
HYDROMORPHONE HCL 16 mg TAB ER 24HR TABLET $11.8550
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
HYDROMORPHONE HCL 32 mg TAB ER 24HR TABLET $28.3550
HYDROMORPHONE HCL 8 mg TAB ER 24HR TABLET $6.4855
HYDROXOCOBALAMIN 1,000 mcg/ml VIAL EACH $1.0369
HYDROXYCHLOROQUINE SULFATE 200 mg TAB TABLET $0.3355
HYDROXYUREA 500 mg CAP CAPSULE $0.3045
HYDROXYZINE 10 mg/5 ml SYRINGE MILLILITER $0.0555
HYDROXYZINE HCL 10 mg TAB TABLET $0.0726
HYDROXYZINE HCL 25 mg TAB TABLET $0.0655
HYDROXYZINE HCL 50 mg TAB TABLET $0.1085
HYDROXYZINE PAMOATE 100 mg CAP CAPSULE $0.4315
HYDROXYZINE PAMOATE 25 mg CAP CAPSULE $0.0695
HYDROXYZINE PAMOATE 50 mg CAP CAPSULE $0.0750
IBANDRONATE SODIUM 150 mg TAB TABLET $8.7550
IBANDRONATE SODIUM 3 mg/3 ml SYRINGE MILLILITER $79.4280
IBUPROFEN/OXYCODONE HCL 400 mg; 5 mg TAB TABLET $1.5462
IBUPROFEN/PSEUDOEPHEDRINE HCL 200 mg; 30 mg TAB TABLET $0.1539
IBUPROFEN 100 mg/5 ml ORAL SUSP MILLILITER $0.0299
IBUPROFEN 100 mg TAB CHEW TABLET $0.1582
IBUPROFEN 200 mg CAP CAPSULE $0.0993
IBUPROFEN 200 mg TAB TABLET $0.0392
IBUPROFEN 400 mg TAB TABLET $0.0535
IBUPROFEN 50 mg/1.25 ml SUSP MILLILITER $0.2435
IBUPROFEN 600 mg TAB TABLET $0.0445
IBUPROFEN 800 mg TAB TABLET $0.0500
IDARUBICIN HCL 1 mg/ml VIAL MILLILITER $19.4670
IFOSFAMIDE 1 gm VIAL EACH $44.3940
IFOSFAMIDE 3 gm VIAL EACH $150.2790
IMATINIB MESYLATE 100 mg TAB TABLET $26.7550
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
IMATINIB MESYLATE 400 mg TAB TABLET $33.4565
IMIPENEM/CILASTATIN SODIUM 250 mg VIAL EACH $5.9063
IMIPENEM/CILASTATIN SODIUM 500 mg VIAL EACH $10.5000
IMIPRAMINE HCL 10 mg TAB TABLET $0.1140
IMIPRAMINE HCL 25 mg TAB TABLET $0.1574
IMIPRAMINE HCL 50 mg TAB TABLET $0.1825
IMIPRAMINE PAMOATE 100 mg CAP CAPSULE $6.3075
IMIPRAMINE PAMOATE 125 mg CAP CAPSULE $16.5944
IMIPRAMINE PAMOATE 150 mg CAP CAPSULE $6.4800
IMIPRAMINE PAMOATE 75 mg CAP CAPSULE $5.1600
IMIQUIMOD 5% CREAM GRAM $1.3915
INDAPAMIDE 1.25 mg TAB TABLET $0.3146
INDAPAMIDE 2.5 mg TAB TABLET $0.1985
INDOMETHACIN 25 mg CAP CAPSULE $0.0925
INDOMETHACIN 50 mg CAP CAPSULE $0.1398
INDOMETHACIN SR 75 mg CAP, SR CAPSULE $0.5845
INSULIN SYRINGE (NDC 11917-0048-15) 0.3 ml; 31 g x 5/16” SYRINGE EACH $0.1900
INSULIN SYRINGE (NDC 11917-0025-29) 1 ml SYRINGE EACH $0.1900
INSULIN SYRINGE (NDC 11917-0048-13) 1 ml; 31 g x 5/16” SYRINGE EACH $0.1900
INSULIN SYRINGE (NDC 11917-0025-28) 1/2 ml SYRINGE EACH $0.1900
INSULIN SYRINGE (NDC 11917-0025-27) 3/10 ml SYRINGE EACH $0.1900
IPRATROPIUM BROMIDE 0.02% INH SOLN MILLILITER $0.0595
IPRATROPIUM BROMIDE 0.03% NASAL INH SOLN MILLILITER $0.8329
IPRATROPIUM BROMIDE 0.06% NASAL INH SOLN MILLILITER $1.3708
IPRATROPIUM/ALBUTEROL SULFATE 0.5 mg; 2.5 mg/3 ml SOLN MILLILITER $0.0589
IRBESARTAN/HYDROCHLOROTHIAZIDE 150 mg; 12.5 mg TAB TABLET $0.0960
IRBESARTAN/HYDROCHLOROTHIAZIDE 300 mg; 12.5 mg TAB TABLET $0.2964
IRBESARTAN 150 mg TAB TABLET $0.1223
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
IRBESARTAN 300 mg TAB TABLET $0.1923
IRBESARTAN 75 mg TAB TABLET $0.0835
IRINOTECAN HCL 100 mg/5 ml VIAL MILLILITER $3.9300
IRINOTECAN HCL 40 mg/2 ml VIAL MILLILITER $6.4793
IRON CARB, GL/FA/B12/C/DOCUSATE (FOCALGIN DSS) 90-1-50 mg TAB TABLET $1.9865
IRON FM,PS NO.1/FOLIC/MV NO.18 (PUREVIT DUALFE PLUS, SE-TAN PLUS) 106 mg; 1 mg CAP CAPSULE $0.3895
IRON POLYSACCHARIDES COMPLEX 150 mg CAP CAPSULE $0.1427
ISONIAZID 300 mg TAB TABLET $0.1215
ISOSORBIDE DINITRATE 10 mg TAB TABLET $0.4825
ISOSORBIDE DINITRATE 20 mg TAB TABLET $0.5238
ISOSORBIDE DINITRATE 30 mg TAB TABLET $0.6270
ISOSORBIDE DINITRATE 40 mg TAB ER 12HR TABLET $1.5150
ISOSORBIDE DINITRATE 5 mg TAB TABLET $0.5338
ISOSORBIDE MONONITRATE 10 mg TAB TABLET $0.1920
ISOSORBIDE MONONITRATE 120 mg TAB ER TABLET $0.4200
ISOSORBIDE MONONITRATE 20 mg TAB TABLET $0.1560
ISOSORBIDE MONONITRATE 30 mg TAB ER TABLET $0.1582
ISOSORBIDE MONONITRATE 60 mg TAB ER TABLET $0.1695
ISOTRETINOIN 10 mg CAP CAPSULE $3.0509
ISOTRETINOIN 20 mg CAP CAPSULE $4.9785
ISOTRETINOIN 30 mg CAP CAPSULE $7.3005
ISOTRETINOIN 40 mg CAP CAPSULE $4.5000
ISRADIPINE 2.5 mg CAP CAPSULE $0.7675
ISRADIPINE 5 mg CAP CAPSULE $1.2625
ITRACONAZOLE 100 mg CAP CAPSULE $2.4940
IVERMECTIN 3 mg TAB TABLET $3.9125
KETOCONAZOLE 2% SHAMPOO MILLILITER $0.0734
KETOCONAZOLE 2% CREAM GRAM $0.8450
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
KETOCONAZOLE 200 mg TAB TABLET $1.2460
KETOPROFEN 200 mg CAP SR 24HR TABLET $6.6720
KETOPROFEN 50 mg CAP CAPSULE $0.3840
KETOPROFEN 75 mg CAP CAPSULE $0.4560
KETOROLAC TROMETHAMINE 0.4% DROPS MILLILITER $6.5885
KETOROLAC TROMETHAMINE 0.5% DROPS MILLILITER $1.4649
KETOROLAC TROMETHAMINE 10 mg TAB TABLET $0.8280
KETOROLAC TROMETHAMINE 30 mg/ml SOLN MILLILITER $1.3755
KETOROLAC TROMETHAMINE 60 mg/2 ml VIAL MILLILITER $1.2165
KETOTIFEN FUMARATE 0.025% DROPS MILLILITER $1.4600
LABETALOL HCL 100 mg TAB TABLET $0.1975
LABETALOL HCL 200 mg TAB TABLET $0.2596
LABETALOL HCL 300 mg TAB TABLET $0.2342
LACTULOSE 10 gm/15 ml SOLN MILLILITER $0.0150
LACTULOSE 10 gm/15 ml SOLN MILLILITER $0.0150
LAMIVUDINE 10 mg/ml SOLN MILLILITER $0.3902
LAMIVUDINE 100 mg TAB TABLET $3.1475
LAMIVUDINE 150 mg TAB TABLET $0.2389
LAMIVUDINE 300 mg TAB TABLET $2.4800
LAMIVUDINE/ZIDOVUDINE 150 mg; 300 mg TAB TABLET $1.2865
LAMOTRIGINE 100 mg TAB TABLET $0.0525
LAMOTRIGINE 100 mg TAB ER 24HR TABLET $3.7175
LAMOTRIGINE 100 mg TAB ODT TABLET $6.0855
LAMOTRIGINE 150 mg TAB TABLET $0.0645
LAMOTRIGINE 200 mg TAB TABLET $0.0755
LAMOTRIGINE 200 mg TAB ER 24HR TABLET $2.9555
LAMOTRIGINE 200 mg TAB ODT TABLET $8.1625
LAMOTRIGINE 250 mg TAB ER 24HR TABLET $10.9900
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
LAMOTRIGINE 25 mg TAB CHEW TABLET $0.2000
LAMOTRIGINE 25 mg TAB TABLET $0.0455
LAMOTRIGINE 25 mg TAB ER 24HR TABLET $1.8125
LAMOTRIGINE 25 mg (35) TAB TABLET $6.4150
LAMOTRIGINE 300 mg TAB ER 24HR TABLET $5.3065
LAMOTRIGINE 5 mg TAB CHEW TABLET $0.1750
LAMOTRIGINE 50 mg TAB ER 24HR TABLET $2.7750
LAMOTRIGINE 50 mg TAB ODT TABLET $6.4320
LANSOPRAZOLE 15 mg CAP DR CAPSULE $0.4299
LANSOPRAZOLE 15 mg TAB DR TABLET $10.6500
LANSOPRAZOLE 30 mg CAP DR CAPSULE $0.2075
LANSOPRAZOLE/AMOXICILLIN/ CLARITHROMYCIN 30-500-500 EACH
COMBINATION PACKAGE $2.9523
LANTHANUM CARBONATE 1,000 mg TAB CHEW TABLET $8.4968
LATANOPROST 0.005% DROPS MILLILITER $1.8288
LEFLUNOMIDE 10 mg TAB TABLET $2.6565
LEFLUNOMIDE 20 mg TAB TABLET $2.5765
LETROZOLE 2.5 mg TAB TABLET $0.1396
LEUCOVORIN CALCIUM 100 mg VIAL EACH $9.0000
LEUCOVORIN CALCIUM 25 mg TAB TABLET $5.9735
LEUCOVORIN CALCIUM 200 mg VIAL EACH $14.7000
LEUCOVORIN CALCIUM 350 mg VIAL EACH $17.0104
LEUCOVORIN CALCIUM 5 mg TAB TABLET $0.7500
LEUCOVORIN CALCIUM 50 mg VIAL EACH $6.0960
LEUPROLIDE ACETATE 1 mg/0.2 ml KIT EACH $228.7500
LEVALBUTEROL HCL 0.31 mg/3 ml VIAL MILLILITER $0.4248
LEVALBUTEROL HCL 0.63 mg/3 ml VIAL MILLILITER $0.4248
LEVALBUTEROL HCL 1.25 mg/0.5 ml VIAL EACH $3.9000
LEVALBUTEROL HCL 1.25 mg/3 ml VIAL MILLILITER $0.3689
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
LEVETIRACETAM 100 mg/ml SOLN MILLILITER $0.0375
LEVETIRACETAM 1,000 mg TAB TABLET $0.2189
LEVETIRACETAM 250 mg TAB TABLET $0.0900
LEVETIRACETAM 500 mg/5 ml VIAL MILLILITER $1.3126
LEVETIRACETAM 500 mg/5 ml SOLN MILLILITER $0.0352
LEVETIRACETAM 500 mg TAB ER 24HR TABLET $0.2721
LEVETIRACETAM 500 mg TAB TABLET $0.0901
LEVETIRACETAM 750 mg TAB ER 24HR TABLET $0.4956
LEVETIRACETAM 750 mg TAB TABLET $0.1485
LEVOBUNOLOL HCL 0.5% OPTH SOLN MILLILITER $0.4717
LEVOCARNITINE 100 mg/ml LIQUID MILLILITER $0.3000
LEVOCARNITINE 200 mg/ml VIAL MILLILITER $2.6712
LEVOCARNITINE 330 mg TAB TABLET $0.6338
LEVOCETIRIZINE DIHYDROCHLORIDE 2.5 mg/5 ml SOLN MILLILITER $0.3635
LEVOCETIRIZINE DIHYDROCHLORIDE 5 mg TAB TABLET $0.0900
LEVOFLOXACIN 0.5% DROPS MILLILITER $6.3035
LEVOFLOXACIN 250 mg/10 ml ORAL SOLN MILLILITER $0.9425
LEVOFLOXACIN 250 mg TAB TABLET $0.1265
LEVOFLOXACIN 500 mg TAB TABLET $0.1939
LEVOFLOXACIN 750 mg TAB TABLET $0.3055
LEVOLEUCOVORIN 50 mg VIAL EACH $104.6320
LEVONORGESTREL 1.5 mg TAB TABLET $16.6585
LEVONORGESTREL-ETH ESTRA (AMETHYST) 90 mcg; 20 mcg TAB TABLET $0.8640
LEVONORGESTREL/ETHINYL ESTRADIOL (ALESSE, LEVLITE, AVIANE) 0.1 mg; 20 mcg TAB TABLET $0.3465
LEVONORGESTREL/ETHINYL ESTRADIOL (LEVLEN, NORDETTE, LEVORA 0.15/30) 0.15 mg; 30 mcg TAB TABLET $0.2950
LEVONORGESTREL/ETHINYL ESTRADIOL (SEASONALE, JOLESSA, QUASENSE) 0.15 mg; 30 mcg TAB TABLET $0.4075
LEVONORGESTREL-ETH ESTRA/ETHINYL ESTRADIOL 100-20(84)
TAB DOSE PACK TABLET $1.3405
LEVONORGESTREL-ETH ESTRA/ETHINYL ESTRADIOL 150-30 (84)
TAB, DOSE PACK, 3 MONTHS
TABLET $1.2480
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
LEVONORGESTREL/ ETHINYL ESTRADIOL TRIPHASIC
(TRI-LEVLEN, TRIPHASIL, TRIVORA-28)
0.05 mg/30 mcg; 0.075 mg/40 mcg; 0.125
mg/30 mcg TAB TABLET $0.4855
LEVOTHYROXINE 100 mcg TAB TABLET $0.3725
LEVOTHYROXINE 100 mcg VIAL EACH $126.6555
LEVOTHYROXINE 112 mcg TAB TABLET $0.4125
LEVOTHYROXINE 125 mcg TAB TABLET $0.4375
LEVOTHYROXINE 137 mcg TAB TABLET $0.4915
LEVOTHYROXINE 150 mcg TAB TABLET $0.4565
LEVOTHYROXINE 175 mcg TAB TABLET $0.5930
LEVOTHYROXINE 200 mcg TAB TABLET $0.4291
LEVOTHYROXINE 25 mcg TAB TABLET $0.2785
LEVOTHYROXINE 300 mcg TAB TABLET $0.6485
LEVOTHYROXINE 50 mcg TAB TABLET $0.3150
LEVOTHYROXINE 75 mcg TAB TABLET $0.3482
LEVOTHYROXINE 88 mcg TAB TABLET $0.3675
LIDOCAINE 2% GEL GRAM $0.3008
LIDOCAINE 3% CREAM GRAM $1.1025
LIDOCAINE 4% CREAM GRAM $0.9125
LIDOCAINE 5% CREAM GRAM $0.8455
LIDOCAINE 5% OINT GRAM $0.7750
LIDOCAINE 5% PATCH EACH $2.3150
LIDOCAINE HCL 10 mg/ml VIAL EACH $0.0717
LIDOCAINE HCL 2% GEL MILLILITER $0.4700
LIDOCAINE HCL 2% VISCOUS ORAL MILLILITER $0.0260
LIDOCAINE HCL 4% SOLN MILLILITER $0.5500
LIDOCAINE/HYDROCORTISONE AC 3%-5% CREAM GRAM $1.1365
LIDOCAINE/PRILOCAINE 2.5-2.5% CREAM GRAM $0.3465
LINEZOLID 100 mg/5 ml SUSP RECON MILLILITER $2.7050
LINEZOLID 600 mg/300 ml IV MILLILITER $0.1350
Effective September 7, 2018
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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
LINEZOLID 600 mg TAB TABLET $2.0550
LIOTHYRONINE SODIUM 25 mcg TAB TABLET $0.5125
LIOTHYRONINE SODIUM 5 mcg TAB TABLET $0.4000
LIOTHYRONINE SODIUM 50 mcg TAB TABLET $0.8325
LISINOPRIL/HCTZ 10 mg; 12.5 mg TAB TABLET $0.0296
LISINOPRIL/HCTZ 20 mg; 12.5 mg TAB TABLET $0.0479
LISINOPRIL/HCTZ 20 mg; 25 mg TAB TABLET $0.0534
LISINOPRIL 10 mg TAB TABLET $0.0180
LISINOPRIL 2.5 mg TAB TABLET $0.0141
LISINOPRIL 20 mg TAB TABLET