drug form current mac effective date price date updated...2012/04/06 · drug form current mac...
TRANSCRIPT
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
1ST CHOICE LANCETS SUPER (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
1ST CHOICE LANCETS THIN (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
1ST CHOICE LANCETS ULTRA (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
1ST TIER UNILET COMFORTOU (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
4-N-1 (Dimethicone Cream 1%) CREA 0.06060 04/28/2005 12/15/2010
A & D ZINC OXIDE (Dimethicone-Zinc Oxide-Vitamin
A-Vitamin D
CREA 0.02730 04/28/2005 04/25/2005
A + D PERSONAL CARE LOTIO (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008
A+D FIRST AID (Skin Protectants Misc - Ointment***) OINT 0.03040 04/28/2005 03/13/2007
A1C NOW (Blood Glucose Monitoring Kit w/ Device***) KIT 0.71000 10/01/2003 04/07/2004
ABSORBASE (Skin Protectants Misc - Ointment***) OINT 0.03040 04/28/2005 04/25/2005
Acarbose Tab 100 MG TABS 0.65500 06/26/2008 06/16/2008
Acarbose Tab 25 MG TABS 0.51063 12/09/2011 12/07/2011
Acarbose Tab 50 MG TABS 0.46964 02/25/2011 02/11/2011
ACCU-CHEK ACTIVE STRIPS (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012
ACCU-CHEK ADVANTAGE DIABE (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 04/07/2004
ACCU-CHEK ADVANTAGE TEST (Glucose Blood Test
Strip)
STRP 1.08074 03/09/2012 04/09/2012
ACCU-CHEK AVIVA (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012
ACCU-CHEK AVIVA PLUS (Blood Glucose Monitoring Kit w/
Device
KIT 0.71000 10/01/2003 02/29/2012
ACCU-CHEK AVIVA PLUS (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012
ACCU-CHEK COMFORT CURVE T (Glucose Blood Test
Strip)
STRP 1.08074 03/09/2012 04/09/2012
ACCU-CHEK COMPACT STRIPS (Glucose Blood Test
Strip)
STRP 1.08074 03/09/2012 04/09/2012
ACCU-CHEK COMPACT TEST DR (Glucose Blood Test
Strip)
STRP 1.08074 03/09/2012 04/09/2012
ACCU-CHEK FASTCLIX LANCET (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
ACCU-CHEK MULTICLIX LANCE (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
ACCU-CHEK NANO SMARTVIEW (Blood Glucose
Monitoring Kit w/ De
KIT 0.71000 10/01/2003 02/08/2012
ACCU-CHEK SAFE-T-PRO LANC (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
ACCU-CHEK SAFE-T-PRO PLUS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
ACCU-CHEK SMARTVIEW STRIP (Glucose Blood Test
Strip)
STRP 1.08074 03/09/2012 04/09/2012
ACCU-CHEK SOFT TOUCH LANC (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
ACCU-CHEK SOFTCLIX LANCET (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
ACCU-CHEK VOICEMATE (Blood Glucose Monitoring Kit w/
Device*
KIT 0.71000 10/01/2003 04/07/2004
ACCUTREND GLUCOSE (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012
Acebutolol HCl Cap 200 MG CAPS 0.18512 01/13/2012 01/09/2012
Acebutolol HCl Cap 400 MG CAPS 0.26985 06/26/2009 06/09/2009
ACERFLEX (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 05/16/2011
Acetaminophen Cap 500 MG CAPS 0.03450 03/13/2008 03/05/2008
Page 1 of 1134/17/2012
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Acetaminophen Chew Tab 160 MG CHEW 0.10010 03/13/2008 03/05/2008
Acetaminophen Chew Tab 80 MG CHEW 0.04180 03/13/2008 03/05/2008
Acetaminophen Elixir 160 MG/5ML ELIX 0.01230 03/13/2008 03/05/2008
Acetaminophen Liquid 160 MG/5ML LIQD 0.00772 08/27/2010 08/25/2010
Acetaminophen Liquid 167 MG/5ML LIQD 0.01930 04/28/2005 08/09/2005
Acetaminophen Soln 100 MG/ML SOLN 0.04507 04/24/2009 04/13/2009
Acetaminophen Soln 160 MG/5ML SOLN 0.01230 03/13/2008 02/22/2012
Acetaminophen Suppos 120 MG SUPP 0.25480 12/25/2009 12/16/2009
Acetaminophen Suppos 325 MG SUPP 0.35690 03/13/2008 03/05/2008
Acetaminophen Suppos 650 MG SUPP 0.26585 08/27/2010 08/25/2010
Acetaminophen Susp 160 MG/5ML SUSP 0.01509 03/25/2011 03/21/2011
Acetaminophen Susp 80 MG/0.8ML SUSP 0.02060 04/28/2005 04/25/2005
Acetaminophen Susp 80 MG/0.8ML SUSP 0.04507 04/24/2009 04/13/2009
Acetaminophen Tab 325 MG TABS 0.00686 08/27/2010 08/25/2010
Acetaminophen Tab 500 MG TABS 0.01092 01/13/2012 01/09/2012
Acetaminophen Tab CR 650 MG TBCR 0.05936 03/13/2008 03/05/2008
Acetaminophen w/ Codeine Soln 120-12 MG/5ML SOLN 0.01600 04/15/2002 02/22/2012
Acetaminophen w/ Codeine Tab 300-15 MG TABS 0.15000 01/22/2002 02/22/2012
Acetaminophen w/ Codeine Tab 300-30 MG TABS 0.12455 07/28/2010 08/25/2010
Acetaminophen w/ Codeine Tab 300-60 MG TABS 0.13400 12/27/2007 12/14/2007
Acetaminophen-Isometheptene-Dichloral Cap 325-65-100
MG
CAPS 0.98020 10/14/2011 10/12/2011
Acetazolamide Cap SR 12HR 500 MG CP12 3.28094 02/10/2012 02/09/2012
Acetazolamide Tab 125 MG TABS 0.41000 02/07/2012 03/06/2012
Acetazolamide Tab 250 MG TABS 0.42000 06/13/2011 08/16/2011
Acetic Acid 2% in Aluminum Acetate Otic Soln SOLN 0.09490 08/27/2010 08/25/2010
Acetic Acid Otic Soln 2% SOLN 1.55420 11/27/2010 11/16/2010
Acetylcysteine Inhal Soln 10% SOLN 0.20540 04/24/2009 04/13/2009
Acetylcysteine Inhal Soln 20% SOLN 0.24093 05/28/2010 05/26/2010
ACID BLOCKERS DEPLETION (Nutritional Supplement
Therapy Pack
MISC 8.07500 12/20/2006 08/05/2009
ACTEMRA (Tocilizumab IV Inj 400 MG/20ML) SOLN 68.77961 04/13/2012 04/09/2012
ACTEMRA (Tocilizumab IV Inj 80 MG/4ML) SOLN 68.77795 04/13/2012 04/09/2012
ACTHAR HP (Corticotropin Inj Gel 80 Unit/ML) GEL 4,675.00000 11/28/2009 11/19/2009
ACTI-LANCE LANCETS 28G (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
ACTI-LANCE LITE SAFETY LA (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
ACTI-LANCE SPECIAL SAFETY (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
ACTI-LANCE UNIVERSAL SAFE (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
ACTIQ (Fentanyl Citrate Lollipop 1200 MCG) LPOP 25.20000 01/23/2009 01/09/2009
ACTIQ (Fentanyl Citrate Lollipop 1600 MCG) LPOP 29.05000 01/23/2009 01/09/2009
ACTIQ (Fentanyl Citrate Lollipop 200 MCG) LPOP 11.05000 01/23/2009 01/09/2009
ACTIQ (Fentanyl Citrate Lollipop 400 MCG) LPOP 13.75000 01/23/2009 01/09/2009
ACTIQ (Fentanyl Citrate Lollipop 600 MCG) LPOP 16.15000 01/23/2009 01/09/2009
ACTIQ (Fentanyl Citrate Lollipop 800 MCG) LPOP 19.15000 01/23/2009 01/09/2009
Page 2 of 1134/17/2012
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
ACURA BLOOD GLUCOSE MONIT (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 09/10/2009
ACURA BLOOD GLUCOSE TEST (Glucose Blood Test
Strip)
STRP 1.08074 03/09/2012 04/09/2012
ACURA PLUS BLOOD GLUCOSE (Blood Glucose Monitoring
Kit w/ De
KIT 0.71000 10/01/2003 07/28/2010
Acyclovir Cap 200 MG CAPS 0.08550 08/29/2008 07/31/2008
Acyclovir Susp 200 MG/5ML SUSP 0.20262 07/29/2011 07/12/2011
Acyclovir Tab 400 MG TABS 0.12455 07/14/2010 08/25/2010
Acyclovir Tab 800 MG TABS 0.19550 08/29/2008 07/31/2008
Adapalene Cream 0.1% CREA 5.14889 02/10/2012 02/09/2012
Adapalene Gel 0.1% GEL 2.85250 01/28/2011 01/14/2011
ADULT GROWTH HORMONE SUPP (Nutritional Supplement
Therapy Pa
MISC 8.07500 12/20/2006 08/05/2009
ADULT ONE DAILY GUMMIES (Multiple Vitamins w/ Minerals
Chew
CHEW 0.29485 03/20/2008 01/19/2011
ADVANCE INTUITION BLOOD G (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 04/23/2010 04/19/2010
ADVANCE INTUITION TEST ST (Glucose Blood Test
Strip)
STRP 1.08074 03/09/2012 04/09/2012
ADVANCE MICRO-DRAW TEST S (Glucose Blood Test
Strip)
STRP 1.08074 03/09/2012 04/09/2012
ADVANCED DIABETIC MULTIVI (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 08/12/2009
ADVATE (Antihemophilic Factor rAHF-PFM For Inj 1000 Unit) SOLR 1.03365 04/23/2010 04/19/2010
ADVATE (Antihemophilic Factor rAHF-PFM For Inj 1500 Unit) SOLR 1.03365 04/23/2010 04/19/2010
ADVATE (Antihemophilic Factor rAHF-PFM For Inj 2000 Unit) SOLR 1.03365 04/23/2010 04/19/2010
ADVATE (Antihemophilic Factor rAHF-PFM For Inj 250 Unit) SOLR 1.03365 04/23/2010 04/19/2010
ADVATE (Antihemophilic Factor rAHF-PFM For Inj 3000 Unit) SOLR 1.03365 04/23/2010 04/19/2010
ADVATE (Antihemophilic Factor rAHF-PFM For Inj 500 Unit) SOLR 1.03365 04/23/2010 04/19/2010
ADVERA (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012
ADVIL (Ibuprofen Tab 200 MG) TABS 0.04570 03/20/2008 03/14/2008
ADVOCATE BLOOD GLUCOSE MO (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 03/17/2010
ADVOCATE LANCETS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
ADVOCATE REDI-CODE (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012
ADVOCATE REDI-CODE/TALKIN (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 10/01/2003 03/31/2010
ADVOCATE SAFETY LANCETS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
ADVOCATE TEST STRIPS (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012
AF CAPSICUM OLEORESIN (Capsicum Oleoresin Cream
0.075%)
CREA 0.16320 04/28/2005 04/25/2005
AF LANCETS SUPER THIN (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
AFINITOR (Everolimus Tab 10 MG) TABS 266.31588 04/13/2012 04/09/2012
AFINITOR (Everolimus Tab 5 MG) TABS 252.51742 04/13/2012 04/09/2012
AK-CON (Naphazoline HCl Ophth Soln 0.1%) SOLN 0.24500 04/15/2002 02/22/2012
AKWA TEARS (Artificial Tear Ophth Ointment***) OINT 0.94400 03/13/2008 03/05/2008
Page 3 of 1134/17/2012
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Albuterol Sulfate Soln Nebu 0.083% (2.5 MG/3ML) NEBU 0.04911 09/24/2010 09/17/2010
Albuterol Sulfate Soln Nebu 0.5% (5 MG/ML) NEBU 0.49000 09/26/2011 11/07/2011
Albuterol Sulfate Soln Nebu 0.63 MG/3ML (Base Equiv) NEBU 0.46500 07/28/2011 08/16/2011
Albuterol Sulfate Soln Nebu 1.25 MG/3ML (Base Equiv) NEBU 0.41450 09/24/2010 09/17/2010
Albuterol Sulfate Syrup 2 MG/5ML SYRP 0.01017 09/24/2010 09/17/2010
Albuterol Sulfate Tab 2 MG TABS 0.08025 08/26/2011 08/16/2011
Albuterol Sulfate Tab 4 MG TABS 0.09376 11/11/2011 11/07/2011
Albuterol Sulfate Tab SR 12HR 4 MG TB12 0.77520 04/13/2012 04/09/2012
Alclometasone Dipropionate Cream 0.05% CREA 0.68185 12/25/2009 12/16/2009
Alclometasone Dipropionate Oint 0.05% OINT 0.68185 12/25/2009 12/16/2009
Alendronate Sodium Tab 10 MG TABS 0.16863 08/26/2011 08/16/2011
Alendronate Sodium Tab 35 MG TABS 0.62773 04/13/2012 04/09/2012
Alendronate Sodium Tab 40 MG TABS 5.55695 03/27/2009 03/09/2009
Alendronate Sodium Tab 5 MG TABS 0.19460 09/24/2010 09/17/2010
Alendronate Sodium Tab 70 MG TABS 0.71314 04/29/2011 04/15/2011
ALEVE (Naproxen Sodium Tab 220 MG) TABS 0.06800 03/20/2008 03/14/2008
ALEVE ARTHRITIS (Naproxen Sodium Tab 220 MG) TABS 0.06800 03/20/2008 07/20/2011
Alfuzosin HCl Tab SR 24HR 10 MG TB24 0.50556 02/10/2012 02/09/2012
ALIMENTUM (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 01/15/2007
ALIMENTUM (Infant Foods Powder**) POWD 0.04649 04/24/2008 07/09/2008
ALITRAQ (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 07/12/2011
ALKERAN (Melphalan Tab 2 MG) TABS 4.71440 07/30/2010 07/26/2010
Allopurinol Tab 100 MG TABS 0.02531 01/13/2012 01/09/2012
Allopurinol Tab 300 MG TABS 0.06729 02/25/2011 02/11/2011
ALOE AFTERSUN LOTION (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008
ALOE VESTA 2-N-1 PROTECTI (Skin Protectants Misc -
Ointment*
OINT 0.03040 04/28/2005 09/12/2006
ALOE VESTA PROTECTIVE (Skin Protectants Misc -
Ointment***)
OINT 0.03040 04/28/2005 10/21/2009
ALOXI (Palonosetron HCl IV Soln 0.25 MG/5ML (Base
Equivalent
SOLN 73.90320 04/13/2012 04/09/2012
ALPHANATE/VON WILLEBRAND (Antihemophilic
Factor/VWF (Human)
SOLR 0.79520 12/24/2010 12/15/2010
ALPHANATE/VON WILLEBRAND (Antihemophilic
Factor/VWF (Human)
SOLR 0.79520 12/24/2010 12/15/2010
ALPHANATE/VON WILLEBRAND (Antihemophilic
Factor/VWF (Human)
SOLR 0.79520 12/24/2010 12/15/2010
ALPHANATE/VON WILLEBRAND (Antihemophilic
Factor/VWF (Human)
SOLR 0.79520 12/24/2010 12/15/2010
ALPHANINE SD (Coagulation Factor IX For Inj 1000 Unit) SOLR 0.74750 12/24/2010 12/15/2010
ALPHANINE SD (Coagulation Factor IX For Inj 1500 Unit) SOLR 0.74750 12/24/2010 12/15/2010
ALPHANINE SD (Coagulation Factor IX For Inj 500 Unit) SOLR 0.74750 12/24/2010 12/15/2010
Alprazolam Orally Disintegrating Tab 0.25 MG TBDP 1.55760 04/29/2011 04/15/2011
Alprazolam Orally Disintegrating Tab 1 MG TBDP 1.87452 12/24/2010 12/15/2010
Alprazolam Orally Disintegrating Tab 2 MG TBDP 4.19515 04/13/2012 04/09/2012
Alprazolam Tab 0.25 MG TABS 0.02956 07/23/2010 07/21/2010
Page 4 of 1134/17/2012
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Alprazolam Tab 0.5 MG TABS 0.03540 10/29/2010 10/25/2010
Alprazolam Tab 1 MG TABS 0.01937 01/13/2012 01/09/2012
Alprazolam Tab 2 MG TABS 0.07527 05/27/2011 05/16/2011
Alprazolam Tab SR 24HR 0.5 MG TB24 0.36958 04/13/2012 04/09/2012
Alprazolam Tab SR 24HR 1 MG TB24 0.74000 01/06/2012 02/09/2012
Alprazolam Tab SR 24HR 2 MG TB24 0.57375 04/13/2012 04/09/2012
Alprazolam Tab SR 24HR 3 MG TB24 1.15000 01/30/2012 03/06/2012
ALSOY SOY FORMULA (Infant Foods Conc**) CONC 0.01190 04/28/2005 04/25/2005
ALSOY SOY FORMULA (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 01/15/2007
ALSOY SOY FORMULA (Infant Foods Powder**) POWD 0.04649 04/24/2008 07/09/2008
ALSUMA (Sumatriptan Succinate Inj 6 MG/0.5ML) SOLN 136.79400 10/29/2010 10/27/2010
Alum & Mag Hydroxide-Simethicone Susp 200-200-20
MG/5ML
LIQD 0.00420 03/13/2008 02/22/2012
Alum & Mag Hydroxide-Simethicone Susp 200-200-20
MG/5ML
SUSP 0.00420 03/13/2008 02/22/2012
Alum & Mag Hydroxide-Simethicone Susp 400-400-40
MG/5ML
LIQD 0.00690 03/13/2008 03/05/2008
Alum & Mag Hydroxide-Simethicone Susp 400-400-40
MG/5ML
SUSP 0.00690 03/13/2008 03/05/2008
Aluminum Chloride Soln 20% SOLN 0.15656 02/25/2011 02/11/2011
Aluminum Hydroxide Gel Susp 320 MG/5ML SUSP 0.01156 03/13/2008 03/05/2008
Amantadine HCl Cap 100 MG CAPS 0.29500 08/24/2006 08/23/2006
Amantadine HCl Syrup 50 MG/5ML SYRP 0.04398 12/24/2010 12/15/2010
AMBI ESSENTIALS DAILY MOI (Emollient - Lotion**) LOTN 0.01940 03/13/2008 09/29/2010
AMBI EVEN & CLEAR DAILY M (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/24/2010
AMBI SOFT & EVEN CREAMY O (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/24/2010
AMBIEN (Zolpidem Tartrate Tab 5 MG) TABS 0.13650 04/23/2010 04/19/2010
Amcinonide Cream 0.1% CREA 0.79540 08/27/2010 08/25/2010
Amiloride & Hydrochlorothiazide Tab 5-50 MG TABS 0.05525 08/26/2011 08/16/2011
Amiloride HCl Tab 5 MG TABS 0.66044 04/13/2012 04/09/2012
Amino Acids Tab*** TABS 0.41080 04/28/2005 04/25/2005
Aminocaproic Acid Inj 250 MG/ML SOLN 0.07275 11/11/2011 11/07/2011
Aminocaproic Acid Syrup 25% SYRP 0.96940 04/29/2011 04/15/2011
Amiodarone HCl Tab 200 MG TABS 0.15959 04/13/2012 04/09/2012
Amiodarone HCl Tab 400 MG TABS 2.85000 11/15/2011 12/07/2011
Amitriptyline HCl Tab 10 MG TABS 0.02007 03/25/2011 03/21/2011
Amitriptyline HCl Tab 100 MG TABS 0.05785 02/25/2011 02/11/2011
Amitriptyline HCl Tab 150 MG TABS 0.10013 04/13/2012 04/09/2012
Amitriptyline HCl Tab 25 MG TABS 0.02732 08/27/2010 08/25/2010
Amitriptyline HCl Tab 50 MG TABS 0.03200 04/15/2002 02/22/2012
Amitriptyline HCl Tab 75 MG TABS 0.04413 08/26/2011 08/16/2011
AMLACTIN XL (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008
Amlodipine Besylate Tab 10 MG TABS 0.04348 04/29/2011 04/15/2011
Amlodipine Besylate Tab 2.5 MG TABS 0.02933 02/25/2011 02/11/2011
Amlodipine Besylate Tab 5 MG TABS 0.02663 02/25/2011 02/11/2011
Page 5 of 1134/17/2012
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Amlodipine Besylate-Benazepril HCl Cap 10-20 MG CAPS 0.83300 04/13/2012 04/09/2012
Amlodipine Besylate-Benazepril HCl Cap 2.5-10 MG CAPS 1.05550 06/26/2009 06/09/2009
Amlodipine Besylate-Benazepril HCl Cap 5-10 MG CAPS 1.06850 06/26/2009 06/09/2009
Amlodipine Besylate-Benazepril HCl Cap 5-20 MG CAPS 1.19211 02/10/2012 02/09/2012
Amoxicillin & K Clavulanate Chew Tab 200-28.5 MG CHEW 0.22200 05/25/2006 05/19/2006
Amoxicillin & K Clavulanate Chew Tab 400-57 MG CHEW 1.11200 04/29/2011 04/15/2011
Amoxicillin & K Clavulanate For Susp 200-28.5 MG/5ML SUSR 0.11591 02/10/2012 02/09/2012
Amoxicillin & K Clavulanate For Susp 250-62.5 MG/5ML SUSR 0.74500 06/25/2010 06/18/2010
Amoxicillin & K Clavulanate For Susp 400-57 MG/5ML SUSR 0.15025 02/10/2012 02/09/2012
Amoxicillin & K Clavulanate For Susp 600-42.9 MG/5ML SUSR 0.21540 09/01/2011 09/15/2011
Amoxicillin & K Clavulanate Tab 250-125 MG TABS 2.48000 02/23/2007 02/12/2007
Amoxicillin & K Clavulanate Tab 500-125 MG TABS 0.81575 06/26/2009 06/09/2009
Amoxicillin & K Clavulanate Tab 875-125 MG TABS 0.91352 03/25/2011 03/21/2011
Amoxicillin (Trihydrate) Cap 250 MG CAPS 0.06500 04/15/2002 02/22/2012
Amoxicillin (Trihydrate) Cap 500 MG CAPS 0.07301 08/27/2010 08/25/2010
Amoxicillin (Trihydrate) Chew Tab 125 MG CHEW 0.09000 04/15/2002 02/22/2012
Amoxicillin (Trihydrate) Chew Tab 250 MG CHEW 0.15950 01/30/2003 04/07/2004
Amoxicillin (Trihydrate) For Susp 125 MG/5ML SUSR 0.01427 08/27/2010 08/25/2010
Amoxicillin (Trihydrate) For Susp 200 MG/5ML SUSR 0.02535 01/13/2012 01/09/2012
Amoxicillin (Trihydrate) For Susp 250 MG/5ML SUSR 0.02990 03/29/2011 05/16/2011
Amoxicillin (Trihydrate) For Susp 400 MG/5ML SUSR 0.04328 02/25/2011 02/11/2011
Amoxicillin (Trihydrate) Tab 500 MG TABS 0.18070 12/09/2011 12/07/2011
Amoxicillin (Trihydrate) Tab 875 MG TABS 0.22132 04/13/2012 04/09/2012
Amphetamine-Dextroamphetamine Tab 10 MG TABS 1.06000 09/22/2011 10/12/2011
Amphetamine-Dextroamphetamine Tab 12.5 MG TABS 0.40500 06/28/2007 06/13/2007
Amphetamine-Dextroamphetamine Tab 15 MG TABS 1.05000 01/04/2012 02/09/2012
Amphetamine-Dextroamphetamine Tab 20 MG TABS 1.12837 04/13/2012 04/09/2012
Amphetamine-Dextroamphetamine Tab 30 MG TABS 1.21000 01/30/2012 03/06/2012
Amphetamine-Dextroamphetamine Tab 5 MG TABS 1.14000 01/06/2012 02/09/2012
Amphetamine-Dextroamphetamine Tab 7.5 MG TABS 0.41500 06/28/2007 06/13/2007
Ampicillin & Sulbactam Sodium For Inj 1-0.5 GM SOLR 4.84900 12/25/2009 12/16/2009
Ampicillin & Sulbactam Sodium For Inj 2-1 GM SOLR 6.39600 11/11/2011 11/07/2011
Ampicillin & Sulbactam Sodium For IV Soln 1-0.5 GM SOLR 4.84900 12/25/2009 12/16/2009
Ampicillin & Sulbactam Sodium For IV Soln 10-5 GM SOLR 46.74800 12/25/2009 12/16/2009
Ampicillin & Sulbactam Sodium For IV Soln 2-1 GM SOLR 8.00800 12/25/2009 12/16/2009
Ampicillin Cap 250 MG CAPS 0.08600 01/13/2012 01/09/2012
Ampicillin Cap 500 MG CAPS 0.14613 02/10/2012 02/09/2012
Ampicillin For Susp 125 MG/5ML SUSR 0.02030 12/07/2000 02/22/2012
Ampicillin For Susp 250 MG/5ML SUSR 0.01950 04/15/2002 02/22/2012
AMPYRA (Dalfampridine Tab SR 12HR 10 MG) TB12 17.53223 01/28/2011 01/14/2011
Anagrelide HCl Cap 0.5 MG CAPS 0.16750 01/23/2009 01/09/2009
Anagrelide HCl Cap 1 MG CAPS 0.32550 01/23/2009 01/09/2009
Anastrozole Tab 1 MG TABS 0.17680 01/13/2012 01/09/2012
ANTABUSE (Disulfiram Tab 250 MG) TABS 3.24000 03/26/2010 03/12/2010
Page 6 of 1134/17/2012
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
ANTIOXIDANT FORTE (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 03/14/2008
ANTI-SEIZURE DEPLETION (Nutritional Supplement
Therapy Pack*
MISC 8.07500 12/20/2006 08/05/2009
ANTI-SEIZURE SUPPORT (Nutritional Supplement Therapy
Pack**)
MISC 8.07500 12/20/2006 08/05/2009
ANTIVERT (Meclizine HCl Tab 12.5 MG) TABS 0.02920 04/23/2010 04/19/2010
ANTIVERT (Meclizine HCl Tab 25 MG) TABS 0.04090 04/23/2010 04/19/2010
ANTIVERT (Meclizine HCl Tab 25 MG) TABS 0.04203 03/20/2008 08/04/2010
APATATE FORTE (Multiple Vitamins w/ Minerals Liquid**) LIQD 0.02464 03/20/2008 03/14/2008
APEXICON E (Diflorasone Diacetate Emollient Base Cream
0.05%
CREA 1.35900 09/27/2007 09/21/2007
AQUA LACTEN (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008
AQUADEKS (Multiple Vitamins w/ Minerals Chew Tab**) CHEW 0.29485 03/20/2008 11/24/2010
AQUADERM TREATMENT/MOISTU (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008
AQUAMED (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008
AQUAPHILIC (Emollient - Ointment**) OINT 0.04583 03/13/2008 03/05/2008
AQUAPHOR (Emollient - Ointment**) OINT 0.04583 03/13/2008 03/05/2008
AQUAPHOR ADVANCED THERAPY (Emollient - Ointment**) OINT 0.04583 03/13/2008 09/21/2011
AQUAPHOR LIP REPAIR (Skin Protectants Misc -
Ointment***)
OINT 0.03040 04/28/2005 02/15/2012
ARALAST NP (Alpha1-Proteinase Inhibitor (Human) For IV
Soln
SOLR 0.43160 01/28/2011 01/14/2011
ARALAST NP (Alpha1-Proteinase Inhibitor (Human) For IV
Soln
SOLR 0.42330 07/30/2010 07/26/2010
ARALAST NP (Alpha1-Proteinase Inhibitor (Human) For IV
Soln
SOLR 0.43160 01/28/2011 01/14/2011
ARALAST NP (Alpha1-Proteinase Inhibitor (Human) For IV
Soln
SOLR 0.43160 07/30/2010 07/26/2010
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate
80 Soln I
SOLN 1,192.41120 04/13/2012 04/09/2012
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate
80 Soln I
SOLN 596.20560 04/13/2012 04/09/2012
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate
80 Soln I
SOLN 2,981.02800 04/13/2012 04/09/2012
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate
80 Soln I
SOLN 1,192.41120 04/13/2012 04/09/2012
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate
80 Soln I
SOLN 2,981.02800 04/13/2012 04/09/2012
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate
80 Soln I
SOLN 1,192.41120 04/13/2012 04/09/2012
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate
80 Soln I
SOLN 354.88429 04/13/2012 04/09/2012
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate
80 Soln I
SOLN 149.05140 04/13/2012 04/09/2012
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate
80 Soln I
SOLN 2,981.02800 04/13/2012 04/09/2012
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate
80 Soln I
SOLN 1,788.61680 04/13/2012 04/09/2012
Page 7 of 1134/17/2012
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate
80 Soln I
SOLN 596.23050 04/13/2012 04/09/2012
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate
80 Soln I
SOLN 238.49220 04/13/2012 04/09/2012
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate
80 Soln I
SOLN 2,981.02800 04/13/2012 04/09/2012
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate
80 Soln I
SOLN 1,192.37800 04/13/2012 04/09/2012
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate
80 Soln I
SOLN 357.71340 04/13/2012 04/09/2012
ARIXTRA (Fondaparinux Sodium Inj 2.5 MG/0.5ML) SOLN 100.80350 04/13/2012 04/09/2012
Artificial Tear Ophth Ointment*** OINT 0.94400 03/13/2008 03/05/2008
Artificial Tear Ophth Solution*** SOLN 0.23859 03/13/2008 03/05/2008
ASCENSIA AUTODISC TEST ST (Glucose Blood Test Disk) DISK 0.74500 11/22/2007 11/15/2007
Ascorbic Acid Cap CR 500 MG CPCR 0.01400 01/01/1988 02/22/2012
Ascorbic Acid Chew Tab 250 MG CHEW 0.02545 03/13/2008 03/05/2008
Ascorbic Acid Chew Tab 500 MG CHEW 0.04215 03/13/2008 03/05/2008
Ascorbic Acid Chew Tab 500 MG CHEW 0.04220 04/23/2010 04/19/2010
Ascorbic Acid Syrup 500 MG/5ML SYRP 0.03598 09/22/2011 10/12/2011
Ascorbic Acid Tab 1000 MG TABS 0.04950 03/13/2008 03/05/2008
Ascorbic Acid Tab 250 MG TABS 0.01650 03/13/2008 03/05/2008
Ascorbic Acid Tab 500 MG TABS 0.02710 03/13/2008 03/05/2008
Ascorbic Acid Tab CR 1000 MG TBCR 0.04950 03/13/2008 03/05/2008
Ascorbic Acid Tab CR 500 MG TBCR 0.01400 01/01/1988 02/22/2012
A-SOY (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012
ASPERCREME/ALOE (Trolamine Salicylate Cream 10%) CREA 0.04250 04/28/2005 04/25/2005
Aspirin Buffered (Ca Carb-Mg Carb-Mg Ox) Tab 325 MG TABS 0.01833 08/27/2010 08/25/2010
Aspirin Chew Tab 81 MG CHEW 0.03650 08/29/2008 07/31/2008
Aspirin Tab 81 MG TABS 0.01655 08/29/2008 07/31/2008
Aspirin Tab Delayed Release 325 MG TBEC 0.01920 03/13/2008 03/05/2008
Aspirin Tab Delayed Release 81 MG TBEC 0.00780 11/27/2010 11/16/2010
Aspirin-Acetaminophen-Caffeine Tab 250-250-65 MG TABS 0.02925 12/24/2010 12/15/2010
ASSURE 3 TEST STRIPS (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012
ASSURE 4 TEST STRIPS (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012
ASSURE HAEMOLANCE PLUS HI (Lancets***) MISC 0.08772 06/17/2011 03/07/2012
ASSURE HAEMOLANCE PLUS LO (Lancets***) MISC 0.08772 06/17/2011 03/07/2012
ASSURE HAEMOLANCE PLUS MI (Lancets***) MISC 0.08772 06/17/2011 03/07/2012
ASSURE HAEMOLANCE PLUS NO (Lancets***) MISC 0.08772 06/17/2011 03/07/2012
ASSURE HAEMOLANCE PLUS PE (Lancets***) MISC 0.08772 06/17/2011 03/07/2012
ASSURE II (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012
ASSURE II CHECK STRIP (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012
ASSURE II TEST STRIPS (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012
ASSURE LANCE LANCETS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
ASSURE LANCETS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
Page 8 of 1134/17/2012
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
ASSURE PLATINUM TEST STRI (Glucose Blood Test
Strip)
STRP 1.08074 03/09/2012 04/09/2012
ASSURE PRO TEST STRIPS (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012
AT LAST LANCETS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
AT LAST TEST STRIPS (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012
Atenolol & Chlorthalidone Tab 100-25 MG TABS 0.11700 04/13/2012 04/09/2012
Atenolol & Chlorthalidone Tab 50-25 MG TABS 0.06438 12/09/2011 12/07/2011
Atenolol Tab 100 MG TABS 0.03289 02/25/2011 02/11/2011
Atenolol Tab 25 MG TABS 0.01982 02/25/2011 02/11/2011
Atenolol Tab 50 MG TABS 0.02460 11/27/2010 11/16/2010
Atorvastatin Calcium Tab 10 MG (Base Equivalent) TABS 2.65000 01/13/2012 01/09/2012
Atorvastatin Calcium Tab 20 MG (Base Equivalent) TABS 3.34000 01/13/2012 01/09/2012
Atorvastatin Calcium Tab 40 MG (Base Equivalent) TABS 4.23935 04/13/2012 04/09/2012
Atorvastatin Calcium Tab 80 MG (Base Equivalent) TABS 4.55161 04/13/2012 04/09/2012
Atropine Sulfate Ophth Soln 1% SOLN 2.79717 07/29/2011 07/12/2011
Attapulgite Liq 750 MG/15ML LIQD 0.01200 04/28/2005 04/25/2005
AURORA HEALTHCARE LANCETS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
AURORA LANCET SUPER THIN (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
AURORA LANCET THIN 23G (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
AVEENO CONTINUOUS RADIANC (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/24/2010
AVEENO DAILY FIRMING (Emollient - Lotion**) LOTN 0.01940 03/13/2008 11/24/2010
AVEENO DAILY MOISTURIZING (Dimethicone Lotion 1.3%) LOTN 0.01940 03/13/2008 03/05/2008
AVEENO DAILY MOISTURIZING (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/24/2010
AVEENO POSITIVELY AGELESS (Emollient - Lotion**) LOTN 0.01940 03/13/2008 04/21/2010
AVEENO POSITIVELY RADIANT (Emollient - Lotion**) LOTN 0.01940 03/13/2008 04/21/2010
AVEENO POSITIVELY SMOOTH (Emollient - Lotion**) LOTN 0.01940 03/13/2008 11/24/2010
AVEENO STRESS RELIEF MOIS (Emollient - Lotion**) LOTN 0.01940 03/13/2008 04/21/2010
AVONEX (Interferon Beta-1a For IM Inj Kit 30MCG
(33MCG(6.6 M
KIT 719.11200 01/28/2011 01/14/2011
AVONEX (Interferon Beta-1a IM Inj Kit 30 MCG/0.5ML) KIT 762.43800 06/20/2011 08/16/2011
AVONEX PEN (Interferon Beta-1a IM Inj Kit 30
MCG/0.5ML)
KIT 762.43800 06/20/2011 04/04/2012
Azathioprine Tab 50 MG TABS 0.15419 08/26/2011 08/16/2011
Azelastine HCl Nasal Spray 137 MCG/SPRAY (1 MG/ML) SOLN 0.76350 04/29/2011 04/15/2011
Azelastine HCl Ophth Soln 0.05% SOLN 11.28465 10/29/2010 10/25/2010
Azithromycin For Susp 100 MG/5ML SUSR 0.91256 04/29/2011 04/15/2011
Azithromycin For Susp 200 MG/5ML SUSR 0.66085 08/26/2011 08/16/2011
Azithromycin IV For Soln 500 MG SOLR 9.47700 12/25/2009 12/16/2009
Azithromycin Tab 250 MG TABS 0.70523 11/27/2010 11/16/2010
Azithromycin Tab 500 MG TABS 1.44155 01/13/2012 01/09/2012
Azithromycin Tab 600 MG TABS 3.65450 06/09/2010 07/21/2010
BABYS ONLY ORGANIC/DAIRY (Infant Foods Powder**) POWD 0.04649 04/24/2008 06/16/2010
BABYS ONLY ORGANIC/LACTOS (Infant Foods Powder**) POWD 0.04649 04/24/2008 06/16/2010
BABYS ONLY ORGANIC/SOY (Infant Foods Powder**) POWD 0.04649 04/24/2008 06/16/2010
BACIGUENT (Bacitracin Oint 500 Unit/GM) OINT 0.08300 03/13/2008 03/05/2008
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Bacitracin Oint 500 Unit/GM OINT 0.08300 03/13/2008 03/05/2008
Bacitracin Ophth Oint 500 Unit/GM OINT 4.05910 05/28/2010 05/26/2010
Bacitracin Zinc Oint 500 Unit/GM OINT 0.08300 03/13/2008 03/05/2008
Bacitracin-Polymyxin B Oint*** OINT 0.15070 12/01/1993 02/22/2012
Bacitracin-Polymyxin B Ophth Oint OINT 4.07320 03/04/2011 04/15/2011
Bacitracin-Polymyxin-Neomycin-HC Ophth Oint 1% OINT 2.44285 05/28/2010 05/26/2010
Baclofen Powder POWD 2.37120 05/28/2010 05/26/2010
Baclofen Tab 10 MG TABS 0.05235 02/25/2011 02/11/2011
Baclofen Tab 20 MG TABS 0.06760 01/13/2012 01/09/2012
BACMIN (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 03/14/2008
Balsalazide Disodium Cap 750 MG CAPS 0.27818 08/26/2011 08/16/2011
BARACLUDE (Entecavir Oral Soln 0.05 MG/ML) SOLN 2.84567 04/13/2012 04/09/2012
BARACLUDE (Entecavir Tab 0.5 MG) TABS 28.45738 04/13/2012 04/09/2012
BARACLUDE (Entecavir Tab 1 MG) TABS 28.45738 04/13/2012 04/09/2012
BASIC AM (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 08/05/2009
BASIC PM (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 08/05/2009
BAYER BREEZE 2 BLOOD GLUC (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 04/23/2010 04/19/2010
BAYER CONTOUR BLOOD GLUCO (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 08/20/2008
BAYER CONTOUR BLOOD GLUCO (Glucose Blood Test
Strip)
STRP 1.08074 03/09/2012 04/09/2012
BAYER MICROLET LANCETS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
BCAD 1 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 05/16/2011
BCAD 2 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 05/16/2011
B-Complex Vitamin Cap** CAPS 0.03890 03/13/2008 03/05/2008
B-Complex Vitamin Tab CR** TBCR 0.02250 01/01/1988 02/22/2012
B-Complex Vitamin Tab** TABS 0.03270 03/13/2008 03/05/2008
B-Complex w/ C & E + Zn Tab*** TABS 0.02200 10/01/1997 02/22/2012
B-Complex w/ C & Folic Acid Cap 1 MG*** CAPS 0.16675 06/24/2011 06/14/2011
B-Complex w/ C & Folic Acid Tab 0.8 MG*** TABS 0.08400 03/13/2008 03/05/2008
B-Complex w/ C & Folic Acid Tab 1 MG*** TABS 0.12100 08/29/2008 07/31/2008
B-Complex w/ C & Folic Acid Tab*** TABS 0.02200 10/01/1997 02/22/2012
B-Complex w/ C Cap** CAPS 0.02200 01/01/1988 02/22/2012
B-Complex w/ C Tab CR** TBCR 0.02200 01/01/1988 02/22/2012
B-Complex w/ C Tab** TABS 0.02200 10/01/1997 02/22/2012
B-Complex w/ Folic Acid Tab CR** TBCR 0.02250 01/01/1988 02/22/2012
B-Complex w/ Folic Acid Tab** TABS 0.02250 01/01/1988 02/22/2012
B-Complex w/Biotin & Folic Acid Tab CR*** TBCR 0.02250 01/01/1988 02/22/2012
B-Complex w/Biotin & Folic Acid Tab*** TABS 0.02250 01/01/1988 02/22/2012
BD GLUCOSE (Glucose Chew Tab 5 GM) CHEW 0.15300 04/28/2005 04/25/2005
BD LANCET ULTRAFINE 30G (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
BD LANCET ULTRAFINE 33G (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
BD LATITUDE DIABETES MANA (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 10/01/2003 04/07/2004
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
BD LOGIC BLOOD GLUCOSE MO (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 04/23/2010 04/19/2010
BD MICROTAINER LANCETS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
BD TEST STRIPS (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012
BD ULTRA FINE LANCETS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
BEBULIN (Factor IX Complex For Inj 200-1200 Unit) SOLR 0.94350 06/26/2009 06/01/2011
BEBULIN VH (Factor IX Complex For Inj 200-1200 Unit) SOLR 0.94350 06/26/2009 06/09/2009
BENADRYL (Diphenhydramine HCl Cap 25 MG) CAPS 0.05620 03/13/2008 03/05/2008
BENADRYL (Diphenhydramine HCl Tab 25 MG) TABS 0.05620 03/13/2008 03/05/2008
BENADRYL ALLERGY (Diphenhydramine HCl Cap 25 MG) CAPS 0.05620 03/13/2008 03/05/2008
BENADRYL ALLERGY (Diphenhydramine HCl Tab 25 MG) TABS 0.05620 03/13/2008 03/05/2008
BENADRYL ALLERGY CHILDREN (Diphenhydramine HCl
Liquid 12.5 M
LIQD 0.01872 03/13/2008 06/03/2009
BENADRYL DYE-FREE ALLERGY (Diphenhydramine HCl
Cap 25 MG)
CAPS 0.05620 03/13/2008 03/05/2008
Benazepril & Hydrochlorothiazide Tab 10-12.5 MG TABS 0.13679 08/26/2011 08/16/2011
Benazepril & Hydrochlorothiazide Tab 20-12.5 MG TABS 0.14937 11/11/2011 11/07/2011
Benazepril & Hydrochlorothiazide Tab 20-25 MG TABS 0.15431 01/13/2012 01/09/2012
Benazepril & Hydrochlorothiazide Tab 5-6.25 MG TABS 0.14950 11/11/2011 11/07/2011
Benazepril HCl Tab 10 MG TABS 0.06499 10/14/2011 10/12/2011
Benazepril HCl Tab 20 MG TABS 0.06543 04/29/2011 04/15/2011
Benazepril HCl Tab 40 MG TABS 0.06488 08/26/2011 08/16/2011
Benazepril HCl Tab 5 MG TABS 0.10300 01/28/2011 01/14/2011
BENEFIX (Coagulation Factor IX (Recombinant) For Inj 1000
Un
SOLR 1.07900 01/01/2012 02/15/2012
BENEFIX (Coagulation Factor IX (Recombinant) For Inj 2000
Un
SOLR 1.07900 01/01/2012 02/15/2012
BENEFIX (Coagulation Factor IX (Recombinant) For Inj 250
Uni
SOLR 0.83750 07/24/2009 08/17/2011
BENEFIX (Coagulation Factor IX (Recombinant) For Inj 500
Uni
SOLR 1.07900 01/01/2012 02/15/2012
BENGAY ARTHRITIS FORMULA (Menthol-Methyl Salicylate
Cream***
CREA 0.02880 04/28/2005 04/25/2005
BENGAY GREASELESS (Menthol-Methyl Salicylate
Cream***)
CREA 0.02880 04/28/2005 04/25/2005
BENGAY ULTRA STRENGTH (Camphor-Menthol-Methyl
Salicylate Cre
CREA 0.02880 04/28/2005 04/25/2005
BENLYSTA (Belimumab For IV Soln 120 MG) SOLR 441.41060 04/13/2012 04/09/2012
BENLYSTA (Belimumab For IV Soln 400 MG) SOLR 1,471.34930 04/13/2012 04/09/2012
BENZAMYCIN (Benzoyl Peroxide-Erythromycin Gel 5-3%) GEL 0.96550 05/28/2010 05/26/2010
Benzocaine-Antipyrine Otic Soln 1.4-5.4% SOLN 0.83373 08/05/2009 09/18/2009
Benzonatate Cap 100 MG CAPS 0.12155 12/25/2009 12/16/2009
Benzonatate Cap 200 MG CAPS 0.13572 04/29/2011 04/15/2011
Benzoyl Peroxide Cream 10% CREA 0.16940 04/28/2005 01/23/2007
Benzoyl Peroxide Gel 10% GEL 0.23159 05/03/2011 06/14/2011
Benzoyl Peroxide Gel 5% GEL 0.28966 06/06/2011 08/16/2011
Benzoyl Peroxide Liq 10% LIQD 0.08642 04/13/2012 04/09/2012
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Benzoyl Peroxide Liq 5% LIQD 0.08855 10/23/2009 10/16/2009
Benzoyl Peroxide Liq 7% LIQD 0.21285 10/14/2011 10/12/2011
Benzoyl Peroxide Lotion 5% LOTN 0.09450 02/27/2009 02/10/2009
Benzoyl Peroxide Lotion 6% LOTN 0.21965 10/14/2011 10/12/2011
Benzoyl Peroxide Pad 3% PADS 2.59177 05/28/2010 05/26/2010
Benzoyl Peroxide Pad 6% PADS 2.59177 05/28/2010 05/26/2010
Benzoyl Peroxide-Erythromycin Gel 5-3% GEL 0.86564 02/25/2011 02/11/2011
Benztropine Mesylate Tab 0.5 MG TABS 0.04500 06/01/2002 02/22/2012
Benztropine Mesylate Tab 1 MG TABS 0.04800 04/15/2002 02/22/2012
Benztropine Mesylate Tab 2 MG TABS 0.06968 01/13/2012 01/09/2012
BETA CARE (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008
BETADINE (Povidone-Iodine Soln 10%) SOLN 0.01751 03/20/2008 03/14/2008
Betahistine Hydrochloride (Bulk) Powder POWD 4.24550 05/28/2010 05/26/2010
Betamethasone Dipropionate Augmented Cream 0.05% CREA 0.32891 02/10/2012 02/09/2012
Betamethasone Dipropionate Augmented Gel 0.05% GEL 0.12249 12/25/2009 12/16/2009
Betamethasone Dipropionate Augmented Lotion 0.05% LOTN 1.41400 09/27/2007 09/21/2007
Betamethasone Dipropionate Augmented Oint 0.05% OINT 1.81000 08/19/2011 09/15/2011
Betamethasone Dipropionate Cream 0.05% CREA 1.33000 06/17/2011 07/12/2011
Betamethasone Dipropionate Lotion 0.05% LOTN 0.14370 01/22/2002 02/22/2012
Betamethasone Dipropionate Oint 0.05% OINT 1.59400 12/20/2010 02/11/2011
Betamethasone Valerate Cream 0.1% CREA 0.11970 03/07/2011 04/15/2011
Betamethasone Valerate Lotion 0.1% LOTN 0.06450 01/23/2009 01/09/2009
Betamethasone Valerate Oint 0.1% OINT 0.88000 06/21/2011 07/12/2011
BETASERON (Interferon Beta-1b For Inj 0.3 MG) SOLR 204.09463 01/28/2011 01/14/2011
Betaxolol HCl Tab 10 MG TABS 1.06331 04/29/2011 04/15/2011
Bethanechol Chloride Tab 10 MG TABS 0.16601 12/25/2009 12/16/2009
Bethanechol Chloride Tab 25 MG TABS 0.29000 02/16/2012 03/06/2012
Bethanechol Chloride Tab 5 MG TABS 0.25230 02/11/1997 02/22/2012
Bethanechol Chloride Tab 50 MG TABS 0.41548 12/25/2009 12/16/2009
Bicalutamide Tab 50 MG TABS 0.48566 02/10/2012 02/09/2012
Bioflavonoid Products Tab** TABS 0.01400 01/01/1988 02/22/2012
BIOSCANNER GLUCOSE TEST S (Glucose Blood Test
Strip)
STRP 1.08074 03/09/2012 04/09/2012
BIOSUPP (Multiple Vitamins w/ Minerals Liquid**) LIQD 0.02464 03/20/2008 11/04/2009
BIOTECT PLUS (Multiple Vitamins w/ Minerals Liquid**) LIQD 0.02464 03/20/2008 11/04/2009
Biotin Tab 5 MG TABS 0.23360 04/28/2005 04/25/2005
Bisacodyl Suppos 10 MG SUPP 0.19380 03/13/2008 03/05/2008
Bisacodyl Tab Delayed Release 5 MG TBEC 0.04600 03/13/2008 03/05/2008
Bismuth Subsalicylate Chew Tab 262 MG CHEW 0.06830 03/13/2008 03/05/2008
Bismuth Subsalicylate Susp 262 MG/15ML SUSP 0.00915 03/13/2008 03/05/2008
Bismuth Subsalicylate Susp 525 MG/15ML SUSP 0.01640 04/28/2005 04/25/2005
Bismuth Subsalicylate Tab 262 MG TABS 0.06450 03/13/2008 03/05/2008
Bisoprolol & Hydrochlorothiazide Tab 10-6.25 MG TABS 0.06619 08/26/2011 08/16/2011
Bisoprolol & Hydrochlorothiazide Tab 2.5-6.25 MG TABS 0.06188 02/25/2011 02/11/2011
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Bisoprolol & Hydrochlorothiazide Tab 5-6.25 MG TABS 0.05530 08/26/2011 08/16/2011
Bisoprolol Fumarate Tab 10 MG TABS 0.67125 04/13/2012 04/09/2012
Bisoprolol Fumarate Tab 5 MG TABS 0.61936 02/10/2012 02/09/2012
BL TEST STRIP (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012
Blood Glucose Monitoring Kit w/ Device*** KIT 0.71000 10/01/2003 04/07/2004
BLUE-EMU SUPER STRENGTH (Liniments & Rubs -
Cream**)
CREA 0.02880 04/28/2005 11/19/2009
BONINE (Meclizine HCl Chew Tab 25 MG) CHEW 0.06215 03/20/2008 03/14/2008
BOOST (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012
BOOST DIABETIC (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012
BOOST GLUCOSE CONTROL (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/22/2012
BOOST HIGH PROTEIN (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012
BOOST KID ESSENTIALS 1.0 (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/22/2012
BOOST KID ESSENTIALS 1.5 (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/22/2012
BOOST KIDS ESSENTIALS (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012
BOOST PLUS (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012
BOOST PUDDING (Nutritional Supplement Pudding**) PUDG 0.01090 04/28/2005 04/25/2005
BOOST SMOOTHIE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012
BOOST VHC (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012
BOOST/BENEFIBER (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012
BOTOX (OnabotulinumtoxinA For Inj 100 Unit) SOLR 522.90000 01/28/2011 01/14/2011
BOTOX (OnabotulinumtoxinA For Inj 200 Unit) SOLR 1,045.80000 01/28/2011 01/14/2011
BOTOX COSMETIC (OnabotulinumtoxinA (Cosmetic) For Inj
100 Un
SOLR 522.90000 01/28/2011 01/14/2011
BOTOX COSMETIC (OnabotulinumtoxinA (Cosmetic) For Inj
50 Uni
SOLR 287.84400 01/28/2011 04/13/2011
BRIGHT BEGINNINGS SOY (Infant Foods Liquid**) LIQD 0.01680 04/23/2010 04/19/2010
Brimonidine Tartrate Ophth Soln 0.15% SOLN 11.94200 12/01/2010 01/14/2011
Brimonidine Tartrate Ophth Soln 0.2% SOLN 0.92981 02/10/2012 02/09/2012
Bromocriptine Mesylate Cap 5 MG CAPS 4.56105 10/14/2011 10/12/2011
Bromocriptine Mesylate Tab 2.5 MG TABS 0.92560 01/28/2011 01/14/2011
Budesonide Cap SR 24HR 3 MG CP24 14.81766 01/13/2012 01/09/2012
Budesonide Inhalation Susp 0.25 MG/2ML SUSP 2.30150 12/27/2008 12/08/2008
Budesonide Inhalation Susp 0.5 MG/2ML SUSP 2.70550 12/27/2008 12/08/2008
BUFFERIN (Aspirin Buffered (Ca Carb-Mg Carb-Mg Ox) Tab
325 M
TABS 0.03544 03/13/2008 03/05/2008
BUFFERIN LOW DOSE (Aspirin Buffered (Ca Carb-Mg
Carb-Mg Ox)
TABS 0.02030 03/13/2008 04/07/2010
BULLSEYE MINI SAFETY LANC (Lancets***) MISC 0.08772 06/17/2011 11/30/2011
BULLSEYE SAFETY LANCETS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
Bumetanide Tab 0.5 MG TABS 0.12500 04/15/2002 02/22/2012
Bumetanide Tab 1 MG TABS 0.12857 02/25/2011 02/11/2011
Bumetanide Tab 2 MG TABS 0.16532 01/28/2011 01/14/2011
Page 13 of 1134/17/2012
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
BUPHENYL (Sodium Phenylbutyrate Oral Powder***) POWD 15.11688 08/15/2011 08/16/2011
BUPHENYL (Sodium Phenylbutyrate Tab 500 MG) TABS 6.45250 11/28/2009 11/19/2009
Bupivacaine HCl Inj 0.25% SOLN 0.05460 12/25/2009 12/16/2009
Bupivacaine HCl Inj 0.5% SOLN 0.06370 12/25/2009 12/16/2009
Bupivacaine HCl Preservative Free (PF) Inj 0.25% SOLN 0.05460 12/25/2009 12/16/2009
Bupivacaine HCl Preservative Free (PF) Inj 0.5% SOLN 0.06370 12/25/2009 12/16/2009
Buprenorphine HCl Inj 0.3 MG/ML (Base Equiv) SOLN 3.21100 05/27/2011 05/16/2011
Buprenorphine HCl SL Tab 2 MG (Base Equiv) SUBL 1.56833 04/13/2012 04/09/2012
Buprenorphine HCl SL Tab 8 MG (Base Equiv) SUBL 2.71490 04/29/2011 04/15/2011
Bupropion HCl (Smoking Deterrent) Tab SR 12HR 150 MG TB12 0.70180 04/29/2011 04/15/2011
Bupropion HCl Tab 100 MG TABS 0.47625 04/13/2012 04/09/2012
Bupropion HCl Tab 75 MG TABS 0.41000 01/27/2012 02/09/2012
Bupropion HCl Tab SR 12HR 100 MG TB12 0.41243 07/29/2011 07/12/2011
Bupropion HCl Tab SR 12HR 150 MG TB12 0.34529 02/10/2012 02/09/2012
Bupropion HCl Tab SR 12HR 200 MG TB12 0.81500 02/24/2012 03/06/2012
Bupropion HCl Tab SR 24HR 150 MG TB24 0.73562 12/24/2010 12/15/2010
Bupropion HCl Tab SR 24HR 300 MG TB24 0.79340 04/29/2011 04/15/2011
Buspirone HCl Tab 10 MG TABS 0.04931 02/25/2011 02/11/2011
Buspirone HCl Tab 15 MG TABS 0.07477 05/27/2011 05/16/2011
Buspirone HCl Tab 30 MG TABS 0.61000 01/03/2012 02/09/2012
Buspirone HCl Tab 5 MG TABS 0.03289 02/25/2011 02/11/2011
Buspirone HCl Tab 7.5 MG TABS 0.60000 08/12/2004 09/16/2004
Butalbital-Acetaminophen Tab 50-325 MG TABS 0.33423 03/25/2011 03/21/2011
Butalbital-Acetaminophen-Caff w/ COD Cap 50-325-40-30
MG
CAPS 0.11400 03/27/2008 03/20/2008
Butalbital-Acetaminophen-Caffeine Cap 50-325-40 MG CAPS 0.26900 08/24/2006 08/23/2006
Butalbital-Acetaminophen-Caffeine Tab 50-325-40 MG TABS 0.05696 12/09/2011 12/07/2011
Butalbital-Acetaminophen-Caffeine Tab 50-500-40 MG TABS 0.09165 01/13/2012 01/09/2012
Butalbital-Aspirin-Caff w/ Codeine Cap 50-325-40-30 MG CAPS 0.70400 03/27/2008 03/20/2008
Butalbital-Aspirin-Caffeine Cap 50-325-40 MG CAPS 0.35600 08/24/2006 08/23/2006
Butalbital-Aspirin-Caffeine Tab 50-325-40 MG TABS 0.10969 07/29/2011 07/12/2011
Butorphanol Tartrate Nasal Soln 10 MG/ML SOLN 7.03500 07/29/2011 07/12/2011
Cabergoline Tab 0.5 MG TABS 14.12370 06/10/2011 07/12/2011
Caffeine Citrate Inj 60 MG/3ML (10 MG/ML Base Equiv) SOLN 11.48333 06/24/2011 06/14/2011
Caffeine Citrate Oral Soln 60 MG/3ML (10 MG/ML Base
Equiv)
SOLN 12.70000 05/22/2008 05/12/2008
CALCILO XD (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 05/16/2011
CALCI-MIX (Calcium Carbonate Cap 1250 MG (500 MG
Elemental C
CAPS 0.11650 04/28/2005 03/18/2009
Calcipotriene Soln 0.005% (50 MCG/ML) SOLN 2.25312 02/10/2012 02/09/2012
Calcitonin (Salmon) Nasal Soln 200 Unit/ACT SOLN 13.82000 09/27/2007 12/17/2008
Calcitriol Cap 0.25 MCG CAPS 0.69995 01/29/2010 01/22/2010
Calcitriol Cap 0.5 MCG CAPS 1.28500 03/20/2012 04/09/2012
Calcitriol Oral Soln 1 MCG/ML SOLN 8.46208 07/29/2011 07/12/2011
Page 14 of 1134/17/2012
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Calcium Acetate (Phosphate Binder) Cap 667 MG (169 MG
Ca)
CAPS 0.59118 01/13/2012 01/09/2012
Calcium Carbonate (Antacid) Chew Tab 420 MG CHEW 0.02500 06/01/2002 02/22/2012
Calcium Carbonate (Antacid) Chew Tab 500 MG CHEW 0.02363 03/13/2008 03/05/2008
Calcium Carbonate (Antacid) Chew Tab 750 MG CHEW 0.04025 03/13/2008 03/05/2008
Calcium Carbonate (Antacid) Tab 648 MG TABS 0.00640 04/28/2005 04/25/2005
Calcium Carbonate (Antacid) Tab 648 MG TABS 0.01613 03/13/2008 03/05/2008
Calcium Carbonate Chew Tab 1250 MG (500 MG Elemental
Ca)
CHEW 0.06222 03/13/2008 03/05/2008
Calcium Carbonate Susp 1250 MG/5ML (500 MG/5ML
Elemental Ca)
SUSP 0.01800 03/13/2008 03/05/2008
Calcium Carbonate Tab 1250 MG (500 MG Elemental Ca) TABS 0.07990 05/02/2008 06/16/2008
Calcium Carbonate Tab 1500 MG (600 MG Elemental Ca) TABS 0.05700 03/13/2008 03/05/2008
Calcium Carbonate Tab 600 MG TABS 0.05700 03/13/2008 02/22/2012
Calcium Carbonate-Cholecalciferol Tab 250 MG-250 Unit TABS 0.02833 03/13/2008 03/05/2008
Calcium Carbonate-Cholecalciferol Tab 500 MG-125 Unit TABS 0.02087 03/13/2008 03/05/2008
Calcium Carbonate-Cholecalciferol Tab 500 MG-200 Unit TABS 0.02087 03/13/2008 03/05/2008
Calcium Carbonate-Cholecalciferol Tab 500 MG-400 Unit TABS 0.02087 03/13/2008 03/05/2008
Calcium Carbonate-Cholecalciferol Tab 500 MG-400 Unit TABS 0.02090 04/23/2010 04/19/2010
Calcium Carbonate-Cholecalciferol Tab 600 MG-200 Unit TABS 0.10445 03/13/2008 03/05/2008
Calcium Carbonate-Cholecalciferol Tab 600 MG-400 Unit TABS 0.04283 03/13/2008 03/05/2008
Calcium Carbonate-Ergocalciferol Tab 500MG-200 Unit TABS 0.02087 03/13/2008 03/05/2008
Calcium Carbonate-Vitamin D Tab 250 MG-125 Unit TABS 0.03500 03/13/2008 03/05/2008
Calcium Carbonate-Vitamin D Tab 500 MG-125 Unit TABS 0.03500 03/13/2008 03/05/2008
Calcium Carbonate-Vitamin D Tab 500 MG-200 Unit TABS 0.03500 03/13/2008 03/05/2008
Calcium Carbonate-Vitamin D Tab 500 MG-400 Unit TABS 0.02087 03/13/2008 03/05/2008
Calcium Carbonate-Vitamin D Tab 500 MG-400 Unit TABS 0.03500 03/13/2008 12/03/2008
Calcium Carbonate-Vitamin D Tab 600 MG-125 Unit TABS 0.03500 03/13/2008 03/05/2008
Calcium Carbonate-Vitamin D Tab 600 MG-200 Unit TABS 0.03500 03/13/2008 03/05/2008
Calcium Carbonate-Vitamin D Tab 600 MG-400 Unit TABS 0.03500 03/13/2008 03/05/2008
Calcium Carb-Vit D w/ Minerals Chew Tab 600 MG-400
Unit***
CHEW 0.09205 03/13/2008 11/12/2008
Calcium Carb-Vit D w/ Minerals Tabs 600 MG-200 Unit*** TABS 0.07814 03/13/2008 03/05/2008
Calcium Carb-Vit D w/ Minerals Tabs 600 MG-400 Unit*** TABS 0.09205 03/13/2008 03/05/2008
Calcium Citrate Malate-Cholecalciferol Tab 250 MG-100 Unit TABS 0.02833 03/13/2008 03/05/2008
Calcium Citrate Tab 950 MG (200 MG Elemental Ca) TABS 0.03450 03/13/2008 03/05/2008
Calcium Citrate-Vitamin D Tab 200 MG-125 Unit (Elemental
Ca)
TABS 0.03450 03/13/2008 03/05/2008
Calcium Citrate-Vitamin D Tab 200 MG-250 Unit (Elemental
Ca)
TABS 0.05485 03/13/2008 03/05/2008
Calcium Citrate-Vitamin D Tab 315 MG-200 Unit (Elemental
Ca)
TABS 0.07597 03/13/2008 03/05/2008
Calcium Citrate-Vitamin D Tab 315 MG-250 Unit (Elemental
Ca)
TABS 0.07597 03/13/2008 03/05/2008
Calcium Gluconate Tab 500 MG TABS 0.15000 09/13/2004 05/15/2007
Calcium Gluconate Tab 650 MG TABS 0.01580 04/28/2005 04/25/2005
Page 15 of 1134/17/2012
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Calcium Lactate Tab 650 MG TABS 0.02630 04/28/2005 04/25/2005
Calcium Polycarbophil Tab 625 MG TABS 0.09185 03/13/2008 03/05/2008
Calcium Tab 600 MG TABS 0.02500 01/01/1988 02/22/2012
Calcium w/ Vitamin D & K Chew Tab 500 MG-100 Unit-40
MCG
CHEW 0.08476 03/13/2008 03/05/2008
Calcium w/ Vitamin D Tab 600 MG-200 Unit TABS 0.04283 03/13/2008 03/05/2008
CAL-DAY 1000 (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 10/21/2009
CALTRATE 600+D PLUS (Calcium Carb-Vit D w/ Minerals
Chew Tab
CHEW 0.09210 05/28/2010 05/26/2010
CALTRATE 600+D PLUS (Calcium Carb-Vit D w/ Minerals
Tabs 600
TABS 0.09205 03/13/2008 03/05/2008
CAM (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008
CAMINO PRO 15 (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012
CAMINO PRO 15 BETTERMILK (Nutritional Supplement
Pack**)
PACK 9.02000 06/15/2011 07/12/2011
CAMINO-PRO RESTORE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012
Camphor & Menthol Lotion 0.5-0.5% LOTN 0.03110 04/28/2005 04/25/2005
Camphor-Menthol-Methyl Salicylate Cream 4-10-30% CREA 0.02880 04/28/2005 04/25/2005
Capsaicin Cream 0.025% CREA 0.10050 03/13/2008 03/05/2008
Capsaicin Cream 0.075% CREA 0.06771 02/10/2012 02/09/2012
Capsicum Oleoresin Cream 0.025% CREA 0.10050 04/28/2005 03/05/2008
Captopril & Hydrochlorothiazide Tab 25-25 MG TABS 0.06521 01/28/2011 01/14/2011
Captopril & Hydrochlorothiazide Tab 50-25 MG TABS 0.32084 08/27/2010 08/25/2010
Captopril Tab 100 MG TABS 0.07163 01/13/2012 01/09/2012
Captopril Tab 12.5 MG TABS 0.01346 08/27/2010 08/25/2010
Captopril Tab 25 MG TABS 0.01775 08/27/2010 08/25/2010
Captopril Tab 50 MG TABS 0.03120 08/27/2010 08/25/2010
CAPZASIN-P (Capsaicin Cream 0.035%) CREA 0.18740 04/28/2005 04/25/2005
Carbamazepine Cap SR 12HR 200 MG CP12 1.54365 02/10/2012 02/09/2012
Carbamazepine Cap SR 12HR 300 MG CP12 1.48000 04/13/2012 04/09/2012
Carbamazepine Chew Tab 100 MG CHEW 0.07241 08/27/2010 08/25/2010
Carbamazepine Susp 100 MG/5ML SUSP 0.12949 06/27/2011 07/12/2011
Carbamazepine Tab 200 MG TABS 0.04144 08/27/2010 08/25/2010
Carbamazepine Tab SR 12HR 200 MG TB12 0.75575 01/29/2010 01/22/2010
Carbamazepine Tab SR 12HR 400 MG TB12 1.47230 03/28/2011 04/15/2011
Carbamide Peroxide 6.5% Otic Soln SOLN 0.09967 01/28/2011 01/14/2011
Carbidopa & Levodopa Orally Disintegrating Tab 25-100 MG TBDP 1.14127 10/14/2011 10/12/2011
Carbidopa & Levodopa Tab 10-100 MG TABS 0.18780 01/28/2011 01/14/2011
Carbidopa & Levodopa Tab 25-100 MG TABS 0.16523 01/28/2011 01/14/2011
Carbidopa & Levodopa Tab 25-250 MG TABS 0.24200 08/24/2006 08/23/2006
Carbidopa & Levodopa Tab CR 25-100 MG TBCR 0.22750 01/13/2012 01/09/2012
Carbidopa & Levodopa Tab CR 50-200 MG TBCR 0.31025 01/13/2012 01/09/2012
Carboplatin IV Soln 150 MG/15ML SOLN 1.20553 12/25/2009 12/16/2009
Carboplatin IV Soln 450 MG/45ML SOLN 1.20553 12/25/2009 12/16/2009
Carboplatin IV Soln 50 MG/5ML SOLN 1.20553 12/25/2009 12/16/2009
Page 16 of 1134/17/2012
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Carboplatin IV Soln 600 MG/60ML SOLN 1.20553 12/25/2009 12/16/2009
Carboxymethylcellulose Sodium Ophth Soln 0.5% SOLN 0.48950 07/06/2011 09/15/2011
CARDENZ (Multiple Vitamin Tab**) TABS 0.02140 03/20/2008 03/14/2008
CAREONE LANCET THIN (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
CAREONE LANCET ULTRA THIN (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
Carisoprodol Tab 350 MG TABS 0.05785 12/25/2009 12/16/2009
Carisoprodol w/ Aspirin Tab 200-325 MG TABS 0.31000 04/15/2002 02/22/2012
CARMOL 20 (Urea Cream 20%) CREA 0.08452 03/20/2008 03/14/2008
CARNATION INSTANT BREAKFA (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/22/2012
CAROMEGA (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 03/14/2008
CARRINGTON ORAL WOUND RIN (Oral Wound Care
Products - For So
SOLR 0.10360 04/28/2005 04/25/2005
Carteolol HCl Ophth Soln 1% SOLN 1.65667 12/09/2011 12/07/2011
Carvedilol Tab 12.5 MG TABS 0.04859 08/27/2010 08/25/2010
Carvedilol Tab 25 MG TABS 0.05453 08/27/2010 08/25/2010
Carvedilol Tab 3.125 MG TABS 0.04968 08/27/2010 08/25/2010
Carvedilol Tab 6.25 MG TABS 0.04733 04/29/2011 04/15/2011
CAVAN PRENATAL/EC CALCIUM (Prenatal w/o A Vit w/ Fe
Fumarate
TBEC 0.18187 01/23/2009 07/08/2009
CAYSTON (Aztreonam Lysine For Inhal Soln 75 MG (Base
Equival
SOLR 52.49157 01/28/2011 01/14/2011
CEENU (Lomustine Cap 10 MG) CAPS 8.78721 04/13/2012 04/09/2012
CEENU (Lomustine Cap 40 MG) CAPS 26.46165 04/13/2012 04/09/2012
Cefaclor Cap 250 MG CAPS 0.36000 10/31/2005 10/28/2005
Cefaclor Cap 500 MG CAPS 0.56000 10/31/2005 10/28/2005
Cefadroxil Cap 500 MG CAPS 0.18125 04/13/2012 04/09/2012
Cefadroxil For Susp 250 MG/5ML SUSR 0.40300 12/09/2011 12/07/2011
Cefadroxil For Susp 500 MG/5ML SUSR 0.69720 03/27/2008 03/20/2008
Cefadroxil Tab 1 GM TABS 3.15000 07/07/2003 02/06/2007
Cefazolin Sodium For Inj 1 GM SOLR 0.92300 10/14/2011 10/12/2011
Cefazolin Sodium For Inj 10 GM SOLR 10.20500 12/25/2009 12/16/2009
Cefazolin Sodium For IV Soln 1 GM SOLR 1.36500 12/25/2009 12/16/2009
Cefdinir Cap 300 MG CAPS 1.95000 10/12/2011 11/07/2011
Cefdinir For Susp 125 MG/5ML SUSR 0.30207 10/14/2011 10/12/2011
Cefdinir For Susp 250 MG/5ML SUSR 0.48738 04/13/2012 04/09/2012
Cefepime HCl For Inj 1 GM SOLR 7.91570 05/28/2010 05/26/2010
Cefepime HCl For Inj 2 GM SOLR 13.10920 09/24/2010 09/17/2010
Cefpodoxime Proxetil For Susp 100 MG/5ML SUSR 0.81757 03/26/2010 03/12/2010
Cefpodoxime Proxetil For Susp 50 MG/5ML SUSR 0.47995 10/23/2009 10/16/2009
Cefpodoxime Proxetil Tab 100 MG TABS 4.14000 08/03/2011 09/15/2011
Cefpodoxime Proxetil Tab 200 MG TABS 5.30000 02/08/2012 03/06/2012
Cefprozil For Susp 125 MG/5ML SUSR 0.13572 06/24/2011 06/14/2011
Cefprozil For Susp 250 MG/5ML SUSR 0.56500 12/27/2011 02/15/2012
Cefprozil Tab 250 MG TABS 1.09500 07/29/2011 07/12/2011
Page 17 of 1134/17/2012
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Cefprozil Tab 500 MG TABS 1.56231 01/28/2011 01/14/2011
Ceftazidime For Inj 1 GM SOLR 4.95300 05/28/2010 05/26/2010
Ceftazidime For Inj 2 GM SOLR 11.54400 05/28/2010 05/26/2010
Ceftazidime For Inj 6 GM SOLR 24.36200 05/28/2010 05/26/2010
Ceftazidime For IV Soln 1 GM SOLR 5.23900 12/25/2009 12/16/2009
Ceftazidime For IV Soln 2 GM SOLR 13.67600 12/25/2009 12/16/2009
Ceftriaxone Sodium For Inj 1 GM SOLR 2.55450 09/24/2010 09/17/2010
Ceftriaxone Sodium For Inj 10 GM SOLR 37.70000 12/25/2009 12/16/2009
Ceftriaxone Sodium For Inj 2 GM SOLR 4.79700 05/28/2010 05/26/2010
Ceftriaxone Sodium For Inj 250 MG SOLR 1.65450 09/24/2010 09/17/2010
Ceftriaxone Sodium For Inj 500 MG SOLR 1.71600 08/27/2010 08/25/2010
Ceftriaxone Sodium For IV Soln 1 GM SOLR 4.14500 09/24/2010 09/17/2010
Ceftriaxone Sodium For IV Soln 2 GM SOLR 4.88800 12/25/2009 12/16/2009
Cefuroxime Axetil Tab 250 MG TABS 0.30215 07/29/2011 07/12/2011
Cefuroxime Axetil Tab 500 MG TABS 0.50050 04/13/2012 04/09/2012
CELLCEPT (Mycophenolate Mofetil Cap 250 MG) CAPS 5.04016 04/13/2012 04/09/2012
CELLCEPT (Mycophenolate Mofetil For Oral Susp 200
MG/ML)
SUSR 5.19045 04/13/2012 04/09/2012
CELLUVISC (Carboxymethylcellulose Sodium Ophth Soln
1%)
SOLN 0.30762 03/13/2008 03/05/2008
CENTRUM (Multiple Vitamins w/ Minerals Chew Tab**) CHEW 0.29485 03/20/2008 03/14/2008
CENTRUM (Multiple Vitamins w/ Minerals Liquid**) LIQD 0.02464 03/20/2008 07/28/2010
CENTRUM (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 03/14/2008
CENTRUM CARDIO (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 06/17/2009
CENTRUM SILVER (Multiple Vitamins w/ Minerals Chew
Tab**)
CHEW 0.29485 03/20/2008 03/14/2008
CENTRUM SILVER (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 03/14/2008
CENTRUM SILVER ULTRA MENS (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 11/19/2009
CENTRUM SILVER ULTRA WOME (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 11/19/2009
CENTRUM SPECIALIST HEART (Multiple Vitamins w/
Minerals Tab*
TABS 0.07430 03/20/2008 01/11/2012
CENTRUM SPECIALIST VISION (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 01/11/2012
CENTRUM ULTRA WOMENS (Multiple Vitamins w/ Minerals
Tab**)
TABS 0.07430 03/20/2008 11/19/2009
Cephalexin Cap 250 MG CAPS 0.10500 12/27/2008 12/08/2008
Cephalexin Cap 500 MG CAPS 0.12500 12/27/2008 12/08/2008
Cephalexin For Susp 125 MG/5ML SUSR 0.03020 04/02/2001 02/22/2012
Cephalexin For Susp 250 MG/5ML SUSR 0.06266 04/29/2011 04/15/2011
CERALYTE 70 (Oral Electrolyte Solution***) SOLN 0.00560 04/28/2005 03/05/2008
CERASPORT (Oral Electrolyte Solution***) SOLN 0.00560 04/28/2005 02/18/2010
CERAVE (Emollient - Lotion**) LOTN 0.01940 03/13/2008 05/11/2011
CERAVE AM SPF 30 (Emollient - Lotion**) LOTN 0.01940 03/13/2008 07/08/2010
CERAVE PM (Emollient - Lotion**) LOTN 0.01940 03/13/2008 01/20/2010
Page 18 of 1134/17/2012
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
CERAVE SA RENEWING (Emollient - Lotion**) LOTN 0.01940 03/13/2008 12/21/2011
CETAKLENZ (Soap & Cleansers - Liquid***) LIQD 0.01940 03/13/2008 05/28/2008
CETAPHIL DAILY ADVANCE UL (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008
CETAPHIL DAILY FACIAL MOI (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008
CETAPHIL GENTLE CLEANSER (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008
CETAPHIL MOISTURIZING (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008
CETAPHIL RESTORADERM (Emollient - Lotion**) LOTN 0.01940 03/13/2008 07/14/2010
Cetirizine HCl Chew Tab 10 MG CHEW 0.57308 07/24/2009 07/17/2009
Cetirizine HCl Chew Tab 5 MG CHEW 0.57308 07/24/2009 07/17/2009
Cetirizine HCl Syrup 1 MG/ML (5 MG/5ML) SOLN 0.04100 09/22/2011 10/12/2011
Cetirizine HCl Syrup 1 MG/ML (5 MG/5ML) SYRP 0.04100 09/22/2011 10/12/2011
Cetirizine HCl Tab 10 MG TABS 0.05785 01/28/2011 01/14/2011
Cetirizine HCl Tab 5 MG TABS 0.12754 04/24/2009 04/13/2009
Cetirizine-Pseudoephedrine Tab SR 12HR 5-120 MG TB12 0.60558 08/27/2010 08/25/2010
CHAPSTICK OVERNIGHT (Skin Protectants Misc -
Ointment***)
OINT 0.03040 04/28/2005 01/13/2010
CHAPSTICK ULTRA MOISTURE (Skin Protectants Misc -
Ointment**
OINT 0.03040 04/28/2005 02/16/2011
CHAPSTICK ULTRASMOOTH FOR (Skin Protectants Misc -
Ointment*
OINT 0.03040 04/28/2005 07/28/2010
CHAPSTICK ULTRASMOOTH NOU (Skin Protectants Misc -
Ointment*
OINT 0.03040 04/28/2005 07/28/2010
CHAPSTICK ULTRASMOOTH REJ (Skin Protectants Misc -
Ointment*
OINT 0.03040 04/28/2005 07/28/2010
CHAPSTICK ULTRASMOOTH SOO (Skin Protectants Misc -
Ointment*
OINT 0.03040 04/28/2005 07/28/2010
CHEMET (Succimer Cap 100 MG) CAPS 7.13800 07/30/2010 07/26/2010
Chlordiazepoxide HCl Cap 10 MG CAPS 0.07000 04/15/2002 02/22/2012
Chlordiazepoxide HCl Cap 25 MG CAPS 0.08000 04/15/2002 02/22/2012
Chlordiazepoxide HCl Cap 5 MG CAPS 0.08900 04/15/2002 02/22/2012
Chlordiazepoxide-Amitriptyline Tab 10-25 MG TABS 0.94600 08/01/2003 04/07/2004
Chlorhexidine Gluconate Liquid 4% LIQD 0.01798 03/13/2008 03/05/2008
Chlorhexidine Gluconate Soln 0.12% SOLN 0.00591 02/25/2011 02/11/2011
Chloroquine Phosphate Tab 250 MG TABS 1.35637 11/11/2011 11/07/2011
Chloroquine Phosphate Tab 500 MG TABS 2.27318 08/26/2011 08/16/2011
Chlorothiazide Tab 250 MG TABS 0.11256 01/28/2011 01/14/2011
Chlorothiazide Tab 500 MG TABS 0.15000 04/03/2001 02/22/2012
Chlorpheniramine Maleate Syrup 2 MG/5ML SYRP 0.01750 03/13/2008 03/05/2008
Chlorpheniramine Maleate Tab 4 MG TABS 0.00599 08/27/2010 08/25/2010
Chlorpheniramine Maleate Tab CR 12 MG TBCR 0.36000 04/28/2005 06/09/2010
Chlorpromazine HCl Tab 10 MG TABS 0.13438 07/29/2011 07/12/2011
Chlorpromazine HCl Tab 100 MG TABS 1.53550 11/08/2011 01/09/2012
Chlorpromazine HCl Tab 200 MG TABS 2.19000 01/01/2012 03/06/2012
Chlorpromazine HCl Tab 25 MG TABS 0.73827 04/13/2012 04/09/2012
Chlorpromazine HCl Tab 50 MG TABS 1.15000 01/05/2012 02/09/2012
Chlorpropamide Tab 100 MG TABS 0.16000 04/15/2002 02/22/2012
Page 19 of 1134/17/2012
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Chlorpropamide Tab 250 MG TABS 0.34000 04/15/2002 02/22/2012
Chlorthalidone Tab 25 MG TABS 0.41000 02/23/2012 03/06/2012
Chlorthalidone Tab 50 MG TABS 0.46480 10/04/2011 10/12/2011
CHLOR-TRIMETON (Chlorpheniramine Maleate Syrup 2
MG/5ML)
SYRP 0.01750 03/13/2008 03/05/2008
CHLOR-TRIMETON (Chlorpheniramine Maleate Tab 4 MG) TABS 0.02960 03/13/2008 03/05/2008
CHLOR-TRIMETON ALLERGY (Chlorpheniramine Maleate
Tab CR 12 M
TBCR 0.36000 04/28/2005 04/25/2005
Chlorzoxazone Tab 500 MG TABS 0.04381 01/13/2012 01/09/2012
CHOICE DM (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012
CHOICE DM COMPLETE FORA G (Glucose Blood Test
Strip)
STRP 1.08074 03/09/2012 04/09/2012
CHOICE DM FORA G20 TEST S (Glucose Blood Test
Strip)
STRP 1.08074 03/09/2012 04/09/2012
CHOICE DM TF (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012
Cholecalciferol Cap 1000 Unit CAPS 0.03550 11/28/2009 11/19/2009
Cholecalciferol Cap 400 Unit CAPS 0.02008 03/13/2008 05/11/2011
Cholecalciferol Cap 400 Unit CAPS 0.03760 04/23/2010 04/19/2010
Cholecalciferol Tab 1000 Unit TABS 0.03550 11/28/2009 11/19/2009
Cholecalciferol Tab 400 Unit TABS 0.03764 03/13/2008 03/05/2008
Cholestyramine Light Powder 4 GM/DOSE POWD 0.13488 07/29/2011 07/12/2011
Cholestyramine Light Powder Packets 4 GM PACK 0.76600 02/28/2008 03/05/2008
Cholestyramine Powder 4 GM/DOSE POWD 0.07414 02/10/2012 02/09/2012
Cholestyramine Powder Packets 4 GM PACK 0.88500 02/23/2007 02/12/2007
Choline & Magnesium Salicylates Tab 1000 MG TABS 0.23000 02/23/2007 02/12/2007
Choline & Magnesium Salicylates Tab 500 MG TABS 0.10075 05/28/2010 05/26/2010
Choline & Magnesium Salicylates Tab 750 MG TABS 0.10725 08/27/2010 08/25/2010
Chorionic Gonadotropin For Inj 10000 Unit SOLR 55.75500 04/29/2011 04/15/2011
Ciclopirox Gel 0.77% GEL 1.23750 04/13/2012 04/09/2012
Ciclopirox Olamine Cream 0.77% (Base Equiv) CREA 0.27436 07/29/2011 07/12/2011
Ciclopirox Olamine Susp 0.77% (Base Equiv) SUSP 0.72725 07/29/2011 07/12/2011
Ciclopirox Shampoo 1% SHAM 0.83328 04/13/2012 04/09/2012
Ciclopirox Solution 8% SOLN 1.02273 04/13/2012 04/09/2012
Cilostazol Tab 100 MG TABS 0.16597 01/13/2012 01/09/2012
Cilostazol Tab 50 MG TABS 0.16708 08/26/2011 08/16/2011
Cimetidine HCl Soln 300 MG/5ML SOLN 0.03677 08/26/2011 08/16/2011
Cimetidine Tab 200 MG TABS 0.06613 08/26/2011 08/16/2011
Cimetidine Tab 300 MG TABS 0.06335 01/23/2009 01/09/2009
Cimetidine Tab 400 MG TABS 0.06293 01/23/2009 01/09/2009
Cimetidine Tab 800 MG TABS 0.12666 01/23/2009 01/09/2009
CIMZIA (Certolizumab Pegol For Inj Kit 2 X 200 MG) KIT 1,960.56790 04/13/2012 04/09/2012
CIMZIA (Certolizumab Pegol Inj Kit 2 X 200 MG/ML) KIT 1,960.56790 04/13/2012 04/09/2012
CIMZIA STARTER KIT (Certolizumab Pegol Inj Kit 6 X 200
MG/ML
KIT 5,881.71200 04/13/2012 04/09/2012
CINRYZE (C1 Esterase Inhibitor (Human) For IV Inj 500 Unit) SOLR 2,076.51060 01/28/2011 01/14/2011
Page 20 of 1134/17/2012
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Ciprofloxacin 400 MG/200ML in D5W SOLN 0.01428 01/13/2012 01/09/2012
Ciprofloxacin HCl Ophth Soln 0.3% SOLN 0.88205 03/25/2011 03/21/2011
Ciprofloxacin HCl Tab 100 MG (Base Equiv) TABS 0.44600 04/26/2007 04/19/2007
Ciprofloxacin HCl Tab 250 MG (Base Equiv) TABS 0.07660 08/29/2008 07/31/2008
Ciprofloxacin HCl Tab 500 MG (Base Equiv) TABS 0.12550 08/29/2008 07/31/2008
Ciprofloxacin HCl Tab 750 MG (Base Equiv) TABS 0.21500 10/31/2005 10/28/2005
Citalopram Hydrobromide Oral Soln 10 MG/5ML SOLN 0.15841 08/26/2011 08/16/2011
Citalopram Hydrobromide Tab 10 MG (Base Equiv) TABS 0.03042 01/13/2012 01/09/2012
Citalopram Hydrobromide Tab 20 MG (Base Equiv) TABS 0.04956 08/27/2010 08/25/2010
Citalopram Hydrobromide Tab 40 MG (Base Equiv) TABS 0.05839 04/29/2011 04/15/2011
CITRUCEL (Methylcellulose Tab 500 MG) TABS 0.10545 03/20/2008 03/14/2008
CITRUCEL CLEAR-MIX (Methylcellulose Powder Laxative) POWD 0.02291 07/28/2011 10/12/2011
CITRUCEL FIBER LAXATIVE (Methylcellulose Powder
Laxative)
POWD 0.02291 07/28/2011 10/12/2011
CITRUCEL FIBERSHAKE (Methylcellulose Powder Laxative) POWD 0.02291 07/28/2011 10/12/2011
Clarithromycin For Susp 125 MG/5ML SUSR 0.30100 07/29/2011 07/12/2011
Clarithromycin For Susp 250 MG/5ML SUSR 0.55665 08/27/2010 08/25/2010
Clarithromycin Tab 250 MG TABS 0.38526 01/28/2011 01/14/2011
Clarithromycin Tab 500 MG TABS 3.98000 10/13/2011 11/07/2011
Clarithromycin Tab SR 24HR 500 MG TB24 2.50200 01/28/2011 01/14/2011
CLARITIN (Loratadine Syrup 5 MG/5ML) SYRP 0.03850 04/23/2010 04/19/2010
CLARITIN (Loratadine Tab 10 MG) TABS 0.10500 05/28/2010 05/26/2010
CLARITIN (Loratadine Tab 10 MG) TABS 0.27350 03/20/2008 03/28/2012
CLARITIN REDITABS (Loratadine Rapidly-Disintegrating Tab
10
TBDP 0.10500 04/23/2010 04/19/2010
CLEAN & CLEAR MORNING BUR (Emollient - Lotion**) LOTN 0.01940 03/13/2008 05/05/2010
CLEAN & CLEAR SOFT MOISTU (Emollient - Lotion**) LOTN 0.01940 03/13/2008 11/24/2010
CLEANLET LANCETS 28G (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
CLEAR EYES REDNESS RELIEF (Naphazoline-Glycerin
Ophth Soln 0
SOLN 0.17790 04/28/2005 04/25/2005
Clemastine Fumarate Syrup 0.67 MG/5ML (0.5 MG/5ML Base
Eq)
SYRP 0.04950 01/28/2011 01/14/2011
Clemastine Fumarate Tab 1.34 MG (1 MG Base Equiv) TABS 0.14420 03/13/2008 03/05/2008
Clemastine Fumarate Tab 2.68 MG TABS 0.22800 03/27/2008 03/20/2008
CLEVER CHEK AUTO CODE VOI (Blood Glucose Monitoring
Devices*
DEVI 0.71000 10/01/2003 02/12/2008
CLEVER CHEK AUTO-CODE BLO (Blood Glucose
Monitoring Devices*
DEVI 0.71000 10/01/2003 09/17/2008
CLEVER CHEK AUTO-CODE TES (Glucose Blood Test
Strip)
STRP 1.08074 03/09/2012 04/09/2012
CLEVER CHEK AUTO-CODE VOI (Blood Glucose Monitoring
Devices*
DEVI 0.71000 10/01/2003 09/17/2008
CLEVER CHEK AUTO-CODE VOI (Glucose Blood Test
Strip)
STRP 1.08074 03/09/2012 04/09/2012
CLEVER CHEK BLOOD GLUCOSE (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 09/05/2007
CLEVER CHEK LANCETS ULTRA (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
Page 21 of 1134/17/2012
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
CLEVER CHEK TEST STRIPS (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012
CLEVER CHOICE AUTO-CODE P (Glucose Blood Test
Strip)
STRP 1.08074 03/09/2012 04/09/2012
CLEVER CHOICE MICRO BLOOD (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 03/21/2011
CLEVER CHOICE MICRO TEST (Glucose Blood Test
Strip)
STRP 1.08074 03/09/2012 04/09/2012
Clidinium & Chlordiazepoxide Cap 2.5-5 MG CAPS 1.02700 10/14/2011 10/12/2011
Clindamycin HCl Cap 150 MG CAPS 0.09563 12/24/2010 12/15/2010
Clindamycin HCl Cap 300 MG CAPS 0.30620 07/29/2011 07/12/2011
Clindamycin HCl Cap 75 MG CAPS 0.45743 11/11/2011 11/07/2011
Clindamycin Phosphate Foam 1% FOAM 2.86039 07/29/2011 07/12/2011
Clindamycin Phosphate Gel 1% GEL 0.49330 08/12/2011 09/15/2011
Clindamycin Phosphate Lotion 1% LOTN 0.24592 02/10/2012 02/09/2012
Clindamycin Phosphate Soln 1% SOLN 0.15125 04/13/2012 04/09/2012
Clindamycin Phosphate Swab 1% SWAB 0.44000 10/05/2011 12/07/2011
Clindamycin Phosphate Vaginal Cream 2% CREA 0.75710 03/27/2008 03/20/2008
CLINDAREACH (Clindamycin Phosphate Swab Kit 1%) KIT 0.30900 09/27/2007 09/21/2007
CLINICAL NUTRIENTS 45-PLU (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 12/07/2011
CLINICAL NUTRIENTS 50-PLU (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 12/07/2011
CLINICAL NUTRIENTS FOR FE (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 12/07/2011
CLINICAL NUTRIENTS FOR MA (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 12/07/2011
CLINICAL NUTRIENTS FOR ME (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 12/07/2011
CLINICAL NUTRIENTS FOR WO (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 12/07/2011
Clobetasol Propionate Cream 0.05% CREA 0.41000 09/12/2011 10/12/2011
Clobetasol Propionate Emollient Base Cream 0.05% CREA 0.23515 08/26/2011 08/16/2011
Clobetasol Propionate Foam 0.05% FOAM 2.06150 02/10/2012 02/09/2012
Clobetasol Propionate Gel 0.05% GEL 0.32448 04/13/2012 04/09/2012
Clobetasol Propionate Oint 0.05% OINT 0.34000 02/10/2012 03/06/2012
Clobetasol Propionate Soln 0.05% SOLN 0.26500 03/02/2012 04/09/2012
Clomiphene Citrate Tab 50 MG TABS 1.72970 09/24/2010 09/17/2010
Clomipramine HCl Cap 25 MG CAPS 0.31500 12/15/2011 02/09/2012
Clomipramine HCl Cap 50 MG CAPS 0.13625 01/28/2011 01/14/2011
Clomipramine HCl Cap 75 MG CAPS 0.50000 11/11/2011 12/07/2011
Clonazepam Orally Disintegrating Tab 0.125 MG TBDP 0.85600 12/27/2007 12/14/2007
Clonazepam Orally Disintegrating Tab 0.25 MG TBDP 0.85600 12/27/2007 12/14/2007
Clonazepam Orally Disintegrating Tab 0.5 MG TBDP 0.85600 12/27/2007 12/14/2007
Clonazepam Orally Disintegrating Tab 1 MG TBDP 0.99200 12/27/2007 12/14/2007
Clonazepam Orally Disintegrating Tab 2 MG TBDP 1.35500 12/27/2007 12/14/2007
Clonazepam Tab 0.5 MG TABS 0.01801 03/25/2011 03/21/2011
Page 22 of 1134/17/2012
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Clonazepam Tab 1 MG TABS 0.02930 02/25/2011 02/11/2011
Clonazepam Tab 2 MG TABS 0.04350 10/29/2010 10/25/2010
Clonidine HCl Tab 0.1 MG TABS 0.03649 04/29/2011 04/15/2011
Clonidine HCl Tab 0.2 MG TABS 0.03250 01/13/2012 01/09/2012
Clonidine HCl Tab 0.3 MG TABS 0.06392 08/27/2010 08/25/2010
Clonidine HCl TD Patch Weekly 0.1 MG/24HR PTWK 23.12500 01/13/2012 01/09/2012
Clonidine HCl TD Patch Weekly 0.2 MG/24HR PTWK 38.96354 02/10/2012 02/09/2012
Clonidine HCl TD Patch Weekly 0.3 MG/24HR PTWK 51.57917 02/10/2012 02/09/2012
Clorazepate Dipotassium Tab 15 MG TABS 0.15605 08/26/2011 08/16/2011
Clorazepate Dipotassium Tab 3.75 MG TABS 0.09167 11/11/2011 11/07/2011
Clorazepate Dipotassium Tab 7.5 MG TABS 0.09487 04/13/2012 04/09/2012
Clotrimazole Cream 1% CREA 0.34000 02/03/2012 03/06/2012
Clotrimazole Soln 1% SOLN 0.24959 04/13/2012 04/09/2012
Clotrimazole Troche 10 MG LOZG 0.64286 04/13/2012 04/09/2012
Clotrimazole Troche 10 MG TROC 0.64286 04/13/2012 04/09/2012
Clotrimazole Vaginal Cream 1% CREA 0.11556 01/28/2011 01/14/2011
Clotrimazole Vaginal Cream 2% CREA 0.35240 03/13/2008 03/05/2008
Clotrimazole w/ Betamethasone Cream 1-0.05% CREA 1.24511 02/10/2012 02/09/2012
Clotrimazole w/ Betamethasone Lotion 1-0.05% LOTN 0.63967 04/29/2011 04/15/2011
Clozapine Tab 100 MG TABS 1.01562 12/24/2010 12/15/2010
Clozapine Tab 200 MG TABS 2.51200 11/22/2007 11/15/2007
Clozapine Tab 25 MG TABS 0.47750 04/24/2009 04/13/2009
Clozapine Tab 50 MG TABS 0.79200 09/27/2007 09/21/2007
COAGUCHEK LANCETS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
Coal Tar Shampoo 0.5% SHAM 0.02261 03/13/2008 03/05/2008
Coenzyme Q10 Cap 100 MG CAPS 0.42075 08/14/2010 09/17/2010
Coenzyme Q10 Cap 30 MG CAPS 0.32577 03/13/2008 03/05/2008
Coenzyme Q10 Cap 50 MG CAPS 0.17404 03/13/2008 03/05/2008
Coenzyme Q10 Oral Powder POWD 0.06700 04/28/2005 04/25/2005
Coenzyme Q10 Tab 200 MG TABS 1.51270 04/28/2005 04/25/2005
Coenzyme Q10 Tab 60 MG TABS 0.39217 03/13/2008 03/05/2008
COLACE (Docusate Sodium Cap 100 MG) CAPS 0.03000 03/13/2008 03/05/2008
COLACE (Docusate Sodium Cap 50 MG) CAPS 0.07520 04/28/2005 04/25/2005
COLACE (Docusate Sodium Syrup 60 MG/15ML) SYRP 0.00521 03/13/2008 03/05/2008
Colchicine w/ Probenecid Tab 0.5-500 MG TABS 0.62623 01/13/2012 01/09/2012
Colestipol HCl Granule Packets 5 GM PACK 0.23500 11/29/2008 11/12/2008
Colestipol HCl Granules 5 GM GRAN 0.18500 11/29/2008 11/12/2008
Colestipol HCl Tab 1 GM TABS 0.52490 04/13/2012 04/09/2012
Colistimethate Sodium For Inj 150 MG SOLR 14.87200 01/13/2012 01/09/2012
COMFORT ASSURED LANCETS M (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
COMFORT ASSURED LANCETS S (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
COMFORT LANCETS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
COMPLEAT (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012
Page 23 of 1134/17/2012
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
COMPLEAT CLOSED SYSTEM (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/22/2012
COMPLETE AMINO ACID MIX (Amino Acids Oral Powder***) POWD 0.43345 08/24/2010 09/17/2010
COMPLETENATE (Prenatal Vit w/ Fe Fumarate-FA Chew
Tab 29-1 M
CHEW 0.29950 08/29/2008 03/04/2009
COMPLEX 15 (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008
COMPLEX ESSENTIAL MSD (Amino Acids Oral Powder***) POWD 0.19640 04/28/2005 07/08/2008
COMPLEX JUNIOR MSD (Amino Acids Oral Powder***) POWD 0.19640 04/28/2005 06/30/2010
COMPLEX MSUD (Amino Acids Oral Powder***) POWD 0.19640 04/28/2005 04/25/2005
CO-NATAL FA (Prenatal Vit w/ Fe Fumarate-FA Tab 29-1
MG***)
TABS 0.15587 01/23/2009 01/09/2009
CONTOUR BLOOD GLUCOSE MON (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 04/08/2009
CONTOUR USB BLOOD GLUCOSE (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 11/25/2009
CONTROL AST (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012
CONTROL BLOOD GLUCOSE MON (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 04/23/2010 04/19/2010
CONTROL TEST STRIPS (Glucose Blood Test Strip) STRP 1.08074 03/09/2012 04/09/2012
COOL BOTTOMS (Dimethicone Cream 1%) CREA 0.06060 04/28/2005 08/18/2010
COPEGUS (Ribavirin Tab 200 MG) TABS 1.05475 10/23/2009 10/16/2009
CORN HUSKERS (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008
Cosyntropin For Inj 0.25 MG SOLR 104.26000 10/14/2011 10/12/2011
CRINONE (Progesterone Vaginal Gel 8%) GEL 8.57056 04/13/2012 04/09/2012
CRITIC-AID CLEAR MOISTURE (Skin Protectants Misc -
Ointment*
OINT 0.03040 04/28/2005 04/15/2008
CRITICARE HN (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012
Cromolyn Sodium Nasal Aerosol Soln 5.2 MG/ACT (4%) AERS 0.38197 03/13/2008 03/05/2008
Cromolyn Sodium Ophth Soln 4% SOLN 0.62075 08/26/2011 08/16/2011
Cromolyn Sodium Soln Nebu 20 MG/2ML NEBU 0.16000 06/01/2002 02/22/2012
CRUCIAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012
CVS BLOOD GLUCOSE STRIPS (Glucose Blood Test
Strip)
STRP 1.08074 03/09/2012 04/09/2012
CVS GENTLE SKIN CLEANSER (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008
CVS LANCETS 21G (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
CVS LANCETS MICRO THIN 33 (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
CVS LANCETS ORIGINAL (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
CVS LANCETS THIN (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
CVS LANCETS THIN 26G (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
CVS LANCETS ULTRA THIN 30 (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
CVS MINERAL OIL (Mineral Oil) OIL 0.01529 03/20/2008 02/22/2012
CVS NUTRITION LIQUID (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012
CVS NUTRITION PLUS (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012
CVS PRENATAL (Prenatal Vit w/ Fe Fumarate-FA Tab 28-0.8
MG**
TABS 0.07255 02/27/2009 02/10/2009
CVS ULTRA THIN LANCETS (Lancets***) MISC 0.08772 06/17/2011 09/15/2011
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
CVS VITAMIN D3 (Cholecalciferol Cap 400 Unit) CAPS 0.02008 03/13/2008 02/15/2012
Cyanocobalamin Inj 1000 MCG/ML SOLN 1.06141 11/11/2011 11/07/2011
Cyanocobalamin Tab 100 MCG TABS 0.03928 03/13/2008 03/05/2008
Cyanocobalamin Tab 1000 MCG TABS 0.06574 03/13/2008 03/05/2008
Cyanocobalamin Tab 250 MCG TABS 0.06237 03/13/2008 03/05/2008
Cyanocobalamin Tab 500 MCG TABS 0.05766 03/13/2008 03/05/2008
CYCLINEX-1 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 05/16/2011
CYCLINEX-2 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 05/16/2011
Cyclobenzaprine HCl Tab 10 MG TABS 0.02265 01/13/2012 01/09/2012
Cyclobenzaprine HCl Tab 5 MG TABS 0.03579 04/13/2012 04/09/2012
Cyclopentolate HCl Ophth Soln 1% SOLN 0.41687 05/28/2010 05/26/2010
Cyclophosphamide For Inj 1 GM SOLR 43.88210 07/30/2010 07/26/2010
Cyclophosphamide For Inj 2 GM SOLR 43.88210 07/30/2010 07/26/2010
Cyclophosphamide Tab 25 MG TABS 1.73470 07/30/2010 07/26/2010
Cyclophosphamide Tab 50 MG TABS 3.18720 07/30/2010 07/26/2010
Cyclosporine Cap 100 MG CAPS 2.85550 03/26/2010 03/12/2010
Cyclosporine Cap 25 MG CAPS 0.77655 03/26/2010 03/12/2010
Cyclosporine Modified Cap 100 MG CAPS 2.42500 11/27/2010 11/16/2010
Cyclosporine Modified Cap 25 MG CAPS 0.70729 04/13/2012 04/09/2012
Cyclosporine Modified Oral Soln 100 MG/ML SOLN 3.18225 07/29/2011 07/12/2011
Cyproheptadine HCl Syrup 2 MG/5ML SYRP 0.09790 02/06/2012 03/06/2012
Cyproheptadine HCl Tab 4 MG TABS 0.09494 12/09/2011 12/07/2011
CYSTADANE (Betaine Powder For Oral Solution***) POWD 4.28229 04/13/2012 04/09/2012
Cytarabine For Inj 100 MG SOLR 3.98400 04/13/2012 04/09/2012
Cytarabine Inj 100 MG/ML SOLN 0.65404 04/13/2012 04/09/2012
D.H.E. 45 (Dihydroergotamine Mesylate Inj 1 MG/ML) SOLN 36.52000 04/13/2012 04/09/2012
D400 (Cholecalciferol Cap 400 Unit) CAPS 0.03760 04/23/2010 04/19/2010
DAILY CONDITIONING TREATM (Emollient - Ointment**) OINT 0.04583 03/13/2008 03/05/2008
Danazol Cap 200 MG CAPS 2.91562 12/24/2010 12/15/2010
Dantrolene Sodium Cap 100 MG CAPS 1.50600 03/27/2008 03/20/2008
Dantrolene Sodium Cap 50 MG CAPS 1.39360 02/10/2011 03/21/2011
DEBROX (Carbamide Peroxide 6.5% Otic Soln) SOLN 0.14970 03/13/2008 03/05/2008
Deferoxamine Mesylate For Inj 2 GM SOLR 39.32000 06/25/2010 06/18/2010
Deferoxamine Mesylate For Inj 500 MG SOLR 10.14000 06/25/2010 06/18/2010
Demeclocycline HCl Tab 150 MG TABS 6.20000 05/26/2005 05/23/2005
Demeclocycline HCl Tab 300 MG TABS 2.81802 05/27/2011 05/16/2011
DEPO-PROVERA CONTRACEPTIV (Medroxyprogesterone
Acetate IM Su
SUSP 68.22600 07/30/2010 07/26/2010
DEQUASINE (Amino Acids Tab***) TABS 0.41080 04/28/2005 04/25/2005
DERMADROX (Skin Protectants Misc - Ointment***) OINT 0.03040 04/28/2005 04/25/2005
DERMAL THERAPY EXTRA STRE (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008
DERMAL THERAPY FACE CARE (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008
DERMAL THERAPY FOOT MASSA (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008
DERMAL THERAPY HAND, ELBO (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008
Page 25 of 1134/17/2012
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
DERMAL THERAPY HEEL CARE (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008
DERMAVITE (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 03/14/2008
Desipramine HCl Tab 10 MG TABS 0.71235 08/20/2009 09/18/2009
Desipramine HCl Tab 100 MG TABS 0.62500 03/27/2008 03/20/2008
Desipramine HCl Tab 150 MG TABS 4.46500 03/05/2012 04/09/2012
Desipramine HCl Tab 25 MG TABS 0.97520 01/23/2012 03/06/2012
Desipramine HCl Tab 50 MG TABS 1.74530 10/21/2011 11/07/2011
Desipramine HCl Tab 75 MG TABS 2.24000 11/11/2011 12/07/2011
Desmopressin Acetate Nasal Spray Soln 0.01% SOLN 12.56615 05/28/2010 05/26/2010
Desmopressin Acetate Nasal Spray Soln 0.01%
(Refrigerated)
SOLN 13.88000 10/29/2010 10/25/2010
Desmopressin Acetate Tab 0.1 MG TABS 1.26500 03/24/2012 04/09/2012
Desmopressin Acetate Tab 0.2 MG TABS 1.31000 03/29/2012 04/09/2012
Desogest-Eth Estrad & Eth Estrad Tab 0.15-0.02/0.01
MG(21/5)
TABS 1.33000 07/10/2011 08/16/2011
Desogest-Ethin Est Tab
0.1-0.025/0.125-0.025/0.15-0.025MG-MG
TABS 0.92600 08/24/2006 08/23/2006
Desogestrel & Ethinyl Estradiol Tab 0.15 MG-30 MCG TABS 0.62351 12/24/2010 12/15/2010
Desonide Cream 0.05% CREA 0.82000 05/31/2011 10/12/2011
Desonide Lotion 0.05% LOTN 1.35000 02/27/2012 04/09/2012
Desonide Oint 0.05% OINT 0.32000 01/26/2012 03/06/2012
Desoximetasone Cream 0.05% CREA 1.89267 08/27/2010 08/25/2010
Desoximetasone Cream 0.25% CREA 1.31474 04/13/2012 04/09/2012
Desoximetasone Gel 0.05% GEL 2.24423 03/25/2011 03/21/2011
Desoximetasone Oint 0.25% OINT 2.27838 08/27/2010 08/25/2010
Dexamethasone Elixir 0.5 MG/5ML ELIX 0.03960 01/22/2002 02/22/2012
Dexamethasone Sodium Phosphate Ophth Soln 0.1% SOLN 2.41406 08/26/2011 08/16/2011
Dexamethasone Tab 0.5 MG TABS 0.06750 03/27/2008 03/20/2008
Dexamethasone Tab 0.75 MG TABS 0.06400 04/15/2002 02/22/2012
Dexamethasone Tab 4 MG TABS 0.10036 11/27/2010 11/16/2010
Dexamethasone Tab 6 MG TABS 0.44500 03/27/2008 03/20/2008
Dexmethylphenidate HCl Tab 10 MG TABS 1.07500 03/14/2012 04/09/2012
Dexmethylphenidate HCl Tab 2.5 MG TABS 0.47500 03/27/2008 03/20/2008
Dexmethylphenidate HCl Tab 5 MG TABS 0.66100 03/27/2008 03/20/2008
Dextroamphetamine Sulfate Cap SR 24HR 10 MG CP24 1.52500 07/22/2008 09/15/2008
Dextroamphetamine Sulfate Cap SR 24HR 15 MG CP24 4.63000 10/04/2011 11/07/2011
Dextroamphetamine Sulfate Cap SR 24HR 5 MG CP24 0.50000 12/29/2005 12/27/2005
Dextroamphetamine Sulfate Tab 10 MG TABS 0.24000 10/26/2006 10/20/2006
Dextroamphetamine Sulfate Tab 10 MG TABS 0.31000 11/07/2011 12/07/2011
Dextroamphetamine Sulfate Tab 5 MG TABS 0.20000 10/26/2006 10/20/2006
Dextromethorphan-Guaifenesin Liquid 10-100 MG/5ML LIQD 0.02981 03/13/2008 03/05/2008
Dextromethorphan-Guaifenesin Syrup 10-100 MG/5ML SYRP 0.00819 11/27/2010 11/16/2010
Dextromethorphan-Guaifenesin Tab 20-400 MG TABS 0.07778 08/27/2010 08/25/2010
Dextrose Inj 5% SOLN 0.00449 10/29/2010 10/25/2010
DHS TAR (Coal Tar Shampoo 0.5%) SHAM 0.02261 03/13/2008 03/05/2008
Page 26 of 1134/17/2012
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
DHS TAR GEL (Coal Tar Shampoo 0.5%) SHAM 0.02261 03/13/2008 03/05/2008
DIABETA (Glyburide Tab 2.5 MG) TABS 0.18000 12/28/2001 04/07/2004
DIABETIC TF (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/22/2012
DIABETIDERM (Emollient - Lotion**) LOTN 0.01940 03/13/2008 03/05/2008
DIABETIDERM HAND & BODY (Emollient - Lotion**) LOTN 0.01940 03/13/2008 12/28/2011
DIABETISOUR