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STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
ABACAVIR SULFATE 300 mg TAB TABLET $4.8560
ACAMPROSATE CALCIUM 333 mg TAB, DR TABLET $0.9000
ACARBOSE 100 mg TAB TABLET $0.4337
ACARBOSE 25 mg TAB TABLET $0.2400
ACARBOSE 50 mg TAB TABLET $0.2700
ACEBUTOLOL HCL 200 mg CAP CAPSULE $0.2668
ACEBUTOLOL HCL 400 mg CAP CAPSULE $0.3198
ACETAMINOPHEN W/CODEINE 300 mg; 15 mg TAB TABLET $0.4319
ACETAMINOPHEN W/CODEINE 300 mg; 30 mg TAB TABLET $0.1496
ACETAMINOPHEN W/CODEINE 300 mg; 60 mg TAB TABLET $0.2934
ACETAMINOPHEN 120 mg SUPP EACH $0.4800
ACETAMINOPHEN 160 mg/5 ml ELIXIR MILLILITER $0.0336
ACETAMINOPHEN 160 mg/5 ml SUSP MILLILITER $0.0203
ACETAMINOPHEN 325 mg TAB TABLET $0.0120
ACETAMINOPHEN 500 mg TAB TABLET $0.0240
ACETAMINOPHEN 80 mg/0.8 ml SUSP MILLILITER $0.1647
ACETAZOLAMIDE 250 mg TAB TABLET $3.1200
ACETAZOLAMIDE 500 mg CAP, ER CAPSULE $3.1364
ACETIC ACID\HYDROCORTISONE 2%-1% DROPS MILLILITER $13.2240
ACETIC ACID 2% SOLN MILLILITER $2.0800
ACETIC ACID 0.25% SOLN MILLILITER $0.0046
ACETYLCYSTEINE 100 mg/ml VIAL MILLILITER $0.4950
ACETYLCYSTEINE 200 mg/ml VIAL EACH $0.4634
ACITRETIN 10 mg CAP CAPSULE $26.7095
ACITRETIN 25 mg CAP CAPSULE $31.2750
ACYCLOVIR 200 mg/5 ml SOLN MILLILITER $0.8843
ACYCLOVIR 200 mg CAP CAPSULE $0.1602
ACYCLOVIR 400 mg TAB TABLET $0.1200
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
ACYCLOVIR 5% OINT GRAM $20.1210
ACYCLOVIR 800 mg TAB TABLET $0.5465
ADAPALENE 0.3% GEL GRAM $6.5550
ADAPALENE 0.1% CREAM GRAM $5.3100
ADAPALENE 0.1% GEL GRAM $3.2040
ADAPALENE 0.3% GEL PUMP GRAM $5.5200
ALBUTEROL SULFATE 4 mg TAB, ER TABLET $1.5360
ALBUTEROL SULFATE 8 mg TAB, ER TABLET $3.6150
ALBUTEROL SULFATE 2.5 mg/3 ml INH SOLN MILLILITER $0.0720
ALBUTEROL SULFATE 5 mg/ml INH SOLN MILLILITER $0.8100
ALBUTEROL SULFATE 0.63 mg/3 ml INH SOLN MILLILITER $0.4151
ALBUTEROL SULFATE 1.25 mg/3 ml INH SOLN MILLILITER $0.3240
ALBUTEROL SULFATE 2 mg/5 ml SYR MILLILITER $0.0134
ALBUTEROL SULFATE 4 mg TAB TABLET $5.6400
ALCLOMETASONE DIPROPIONATE 0.05% OINT GRAM $0.6450
ALCLOMETASONE DIPROPIONATE 0.05% CRM GRAM $1.4090
ALENDRONATE SODIUM 10 mg TAB TABLET $0.3020
ALENDRONATE SODIUM 35 mg TAB TABLET $0.4238
ALENDRONATE SODIUM 40 mg TAB TABLET $2.9400
ALENDRONATE SODIUM 5 mg TAB TABLET $0.1800
ALENDRONATE SODIUM 70 mg TAB TABLET $0.3488
ALFUZOSIN HCL 10 mg TAB, ER 24HR TABLET $0.1341
ALLOPURINOL 100 mg TAB TABLET $0.1440
ALLOPURINOL 300 mg TAB TABLET $0.2979
ALMOTRIPTAN MALATE 12.5 mg TAB TABLET $31.1400
ALMOTRIPTAN MALATE 6.25 mg TAB TABLET $31.1400
ALOSETRON HCL 0.5 mg TAB TABLET $25.5000
ALOSETRON HCL 1 mg TAB TABLET $37.4000
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
ALPRAZOLAM 2 mg TAB, ER TABLET $0.4440
ALPRAZOLAM 3 mg TAB, ER TABLET $0.6960
ALPRAZOLAM 0.25 mg TAB TABLET $0.0240
ALPRAZOLAM 0.5 mg TAB, ER TABLET $0.3450
ALPRAZOLAM 0.5 mg TAB TABLET $0.0300
ALPRAZOLAM 1 mg TAB, ER TABLET $0.3360
ALPRAZOLAM 1 mg TAB TABLET $0.0387
ALPRAZOLAM 2 mg TAB TABLET $0.0676
AMANTADINE HCL 100 mg CAP CAPSULE $1.4700
AMANTADINE HCL 50 mg/5 ml SYR MILLILITER $0.0480
AMILORIDE HCL 5 mg TAB TABLET $0.5400
AMINOCAPROIC ACID 500 mg TAB TABLET $6.5700
AMIODARONE HCL 200 mg TAB TABLET $0.1700
AMITRIPTYLINE HCL 10 mg TAB TABLET $0.1160
AMITRIPTYLINE HCL 100 mg TAB TABLET $1.0880
AMITRIPTYLINE HCL 150 mg TAB TABLET $1.9440
AMITRIPTYLINE HCL 25 mg TAB TABLET $0.2584
AMITRIPTYLINE HCL 50 mg TAB TABLET $0.5730
AMITRIPTYLINE HCL 75 mg TAB TABLET $0.0450
AMLODIPINE BESYLATE/BENAZEPRIL HCL 10 mg; 40 mg CAP CAPSULE $0.6480
AMLODIPINE BESYLATE/BENAZEPRIL HCL 5 mg; 40 mg CAP CAPSULE $0.5443
AMLODIPINE BESYLATE/BENAZEPRIL 10 mg; 20 mg CAP CAPSULE $0.1319
AMLODIPINE BESYLATE/BENAZEPRIL 2.5 mg; 10 mg CAP CAPSULE $0.6720
AMLODIPINE BESYLATE/BENAZEPRIL 5 mg; 10 mg CAP CAPSULE $0.4160
AMLODIPINE BESYLATE/BENAZEPRIL 5 mg; 20 mg CAP CAPSULE $0.0888
AMLODIPINE BESYLATE 10 mg TAB TABLET $0.0227
AMLODIPINE BESYLATE 2.5 mg TAB TABLET $0.0150
AMLODIPINE BESYLATE 5 mg TAB TABLET $0.0240
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
AMLODIPINE/VALSARTAN 10 mg; 160 mg TAB TABLET $1.2300
AMLODIPINE/VALSARTAN 10 mg; 320 mg TAB TABLET $0.6825
AMLODIPINE/VALSARTAN 5 mg; 160 mg TAB TABLET $0.5040
AMLODIPINE/VALSARTAN 5 mg; 320 mg TAB TABLET $4.9312
AMLODIPINE/VALSARTAN/HCT 5-160-12.5 TAB TABLET $6.6720
AMLODIPINE/VALSARTAN/HCT 5-160-25 TAB TABLET $6.6720
AMLODIPINE/VALSARTAN/HCT 10-160-25 TAB TABLET $4.6950
AMLODOPINE/VALSARTAN/HCT 10-320-25 TAB TABLET $5.9670
AMLODIPINE/VALSARTAN/HCT 10 mg; 160 mg TAB TABLET $4.7010
AMMONIUM LACTATE 12% LOT MILLILITER $0.0360
AMMONIUM LACTATE 12% CRM GRAM $0.0520
AMOX/POTASSIUM CLAVULANATE 200; 28.5 mg/5 ml PWDR for
ORAL SUSP MILLILITER $0.3449
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 $0.2364
AMOX/POTASSIUM CLAVULANATE 500; 125 mg TAB TABLET $1.1586
AMOX/POTASSIUM CLAVULANATE 600; 42.9 mg/5 ml PWDR for
ORAL SUSP MILLILITER $0.0660
AMOX/POTASSIUM CLAVULANATE 875; 125 mg TAB TABLET $0.5250
AMOXICILLIN (TRIHYDRATE) 250 mg CAP CAPSULE $0.1417
AMOXICILLIN (TRIHYDRATE) 500 mg CAP CAPSULE $0.1200
AMOXICILLIN OS 400 mg/5 ml SUSP RECON MILLILITER $0.0353
AMOXICILLIN TRIHYDRATE/ POTASSIUM CLAVULANATE
1000 mg; 62.5 mg TAB, SA TABLET $3.2341
AMOXICILLIN TRIHYDRATE/ POTASSIUM CLAVULANATE
250 ; 62.5 mg/5 ml SUSP MILLILITER $1.2702
AMOXICILLIN TRIHYDRATE/ POTASSIUM CLAVULANATE
250 mg; 125mg TAB TABLET $6.2142
AMOXICILLIN TRIHYDRATE 500 mg TAB TABLET $0.2641
AMOXICILLIN 125 mg/5 ml PWDR for
ORAL SUSP MILLILITER $0.0270
AMOXICILLIN 200 mg/5 ml SUSP MILLILITER $0.0957
AMOXICILLIN 250 mg/5 ml PWDR for
ORAL SUSP MILLILITER $0.0278
AMOXICILLIN 250 mg TAB, CHEW TABLET $0.3384
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
AMOXICILLIN 875 mg TAB TABLET $0.2036
AMPHET ASP/AMPHET/D-AMPHET 10 mg CAP, ER CAPSULE $4.6022
AMPHET ASP/AMPHET/D-AMPHET 15 mg CAP, ER CAPSULE $5.0925
AMPHET ASP/AMPHET/D-AMPHET 15 mg TAB TABLET $0.9785
AMPHET ASP/AMPHET/D-AMPHET 20 mg CAP, ER CAPSULE $3.6432
AMPHET ASP/AMPHET/D-AMPHET 25 mg CAP, ER CAPSULE $4.6025
AMPHET ASP/AMPHET/D-AMPHET 30 mg CAP, ER CAPSULE $4.6022
AMPHET ASP/AMPHET/D-AMPHET 5 mg CAP, ER CAPSULE $4.6800
AMPHETAMINE/D-AMPHETAMINE SALTS 10 mg TAB TABLET $0.9954
AMPHETAMINE/D-AMPHETAMINE SALTS 12.5 mg TAB TABLET $1.200
AMPHETAMINE/D-AMPHETAMINE SALTS 20 mg TAB TABLET $0.9954
AMPHETAMINE/D-AMPHETAMINE SALTS 30 mg TAB TABLET $0.6720
AMPHETAMINE/D-AMPHETAMINE SALTS 5 mg TAB TABLET $0.9954
AMPHETAMINE/D-AMPHETAMINE SALTS 7.5 mg TAB TABLET $1.200
AMPICILLIN SODIUM/SULBACTAM SODIUM 3 gm VIAL EACH $5.6280
AMPICILLIN TRIHYDRATE 250 mg CAP CAPSULE $0.1119
AMPICILLIN TRIHYDRATE 500 mg CAP CAPSULE $0.3220
ANAGRELIDE HCL 0.5 mg CAP CAPSULE $0.9756
ANAGRELIDE HCL 1 mg CAP CAPSULE $1.6782
ANASTROZOLE 1 mg TAB TABLET $0.1070
ANTIPYRINE/BENZOCAINE OTIC 5.4%; 1.4% OTIC SOLN MILLILITER $0.3650
ARIPIPRAZOLE 10 mg TAB TABLET $6.0240
ARIPIPRAZOLE 15 mg TAB TABLET $5.5650
ARIPIPRAZOLE 2 mg TAB TABLET $6.0284
ARIPIPRAZOLE 20 mg TAB TABLET $7.3200
ARIPIPRAZOLE 30 mg TAB TABLET $6.4650
ARIPIPRAZOLE 5 mg TAB TABLET $6.0284
ASPIRIN 325 mg TAB, EC TABLET $0.0150
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
ASPIRIN 325 mg TAB TABLET $0.0135
ASPIRIN 80 mg TAB, CHEW TABLET $0.0263
ASPIRIN 80 mg TAB, EC TABLET $0.0150
ASPIRIN/BUTALBITAL/CAFFEINE/CODEINE 30 mg CAP CAPSULE $2.1360
ASPIRIN/DIPYRIDAMOLE 25 mg; 200 mg CAP, ER 12HR CAPSULE $7.0680
ATENOLOL; CHLORTHAL 100 mg; 25 mg TAB TABLET $0.6000
ATENOLOL; CHLORTHAL 50 mg; 25 mg TAB TABLET $0.4829
ATENOLOL 100 mg TAB TABLET $0.0210
ATENOLOL 25 mg TAB TABLET $0.0120
ATENOLOL 50 mg TAB TABLET $0.0240
ATORVASTATIN CALCIUM 10 mg TAB TABLET $0.1433
ATORVASTATIN CALCIUM 20 mg TAB TABLET $0.1636
ATORVASTATIN CALCIUM 40 mg TAB TABLET $0.1636
ATORVASTATIN CALCIUM 80 mg TAB TABLET $0.2045
ATOVAQUONE 750 mg/5 ml SUSP, ORAL MILLILITER $5.4000
ATOVAQUONE/PROGUANIL HCL 250 mg; 100 mg TAB TABLET $6.1180
AZATHIOPRINE 50 mg TAB TABLET $0.4065
AZELASTINE HCL 0.05% DROPS MILLILITER $4.7760
AZELASTINE HCL 137 mcg AER GRAM $0.7556
AZELASTINE HCL 205.5 mcg SPRAY MILLILITER $3.1980
AZITHROMYCIN 100 mg/5 ml SUSP MILLILITER $1.3776
AZITHROMYCIN 200 mg/5 ml SUSP MILLILITER $0.6188
AZITHROMYCIN 250 mg TAB TABLET $0.4593
AZITHROMYCIN 500 mg TAB TABLET $0.8813
AZITHROMYCIN 600 mg TAB TABLET $4.1760
BACITRACIN ZINC 500 units/gm OINT GRAM $0.1757
BACITRACIN 500 units/gm OINT GRAM $0.0766
BACITRACIN/POLYMYXIN B SULFATE 500-10KU/G OINT GRAM $0.5336
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
BACLOFEN 10 mg TAB TABLET $0.1602
BACLOFEN 20 mg TAB TABLET $0.4440
BALSALAZIDE DISODIUM 750 mg CAP CAPSULE $0.8400
BENAZEPRIL HCL 10 mg TAB TABLET $0.0822
BENAZEPRIL HCL 20 mg TAB TABLET $0.0589
BENAZEPRIL HCL 40 mg TAB TABLET $0.0587
BENAZEPRIL HCL 5 mg TAB TABLET $0.0716
BENAZEPRIL/HCTZ 5 mg; 6.25 mg TAB TABLET $1.7880
BENAZEPRIL/HCTZ 10 mg; 12.5 mg TAB TABLET $0.7548
BENAZEPRIL/HCTZ 20 mg; 12.5 mg TAB TABLET $1.7862
BENAZEPRIL/HCTZ 20 mg; 25 mg TAB TABLET $1.7862
BENZONATATE 100 mg CAP CAPSULE $0.2760
BENZONATATE 200 mg CAP CAPSULE $0.4019
BENZOYL PEROXIDE 5% CLEANSER GRAM $0.0936
BENZOYL PEROXIDE 5% GEL GRAM $0.3150
BENZOYL PEROXIDE 10% CLEANSER GRAM $0.0600
BENZOYL PEROXIDE 10% GEL GRAM $0.2468
BENZOYL PEROXIDE 3% CLEANSER GRAM $0.2837
BENZOYL PEROXIDE 4% CLEANSER GRAM $0.0609
BENZOYL PEROXIDE 6% CLEANSER GRAM $0.1056
BENZOYL PEROXIDE 9% CLEANSER GRAM $0.3581
BENZTROPINE MESYLATE 0.5 mg TAB TABLET $0.1080
BENZTROPINE MESYLATE 1 mg TAB TABLET $0.1258
BENZTROPINE MESYLATE 2 mg TAB TABLET $0.2191
BETAMETHASONE DIPROPIONATE AUGMENTED 0.05% CRM GRAM $0.8850
BETAMETHASONE DIPROPIONATE 0.05% GRAM OINT $2.1120
BETAMETHASONE DIPROPIONATE 0.05%, 15 gm CRM GRAM $2.7300
BETAMETHASONE DIPROPIONATE 0.05%, 15 gm OINT GRAM $2.5984
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
BETAMETHASONE DIPROPIONATE 0.05%, 45 gm CRM GRAM $1.7620
BETAMETHASONE DIPROPIONATE 0.05%, 45 gm OINT GRAM $1.8360
BETAMETHASONE VALERATE 0.1% CRM GRAM $0.9513
BETAMETHASONE VALERATE 0.1% OINT GRAM $0.8921
BETAMETHASONE VALERATE 0.1%, 60 ml LOT MILLILITER $0.5442
BETHANECHOL CHLORIDE 10 mg TAB TABLET $0.5537
BETHANECHOL CHLORIDE 25 mg TAB TABLET $0.5297
BETHANECHOL CHLORIDE 5 mg TAB TABLET $0.0840
BETHANECHOL CHLORIDE 50 mg TAB TABLET $0.8238
BEXAROTENE 75 mg CAP CAPSULE $229.3500
BICALUTAMIDE 50 mg TAB TABLET $0.3000
BISACODYL 10 mg SUPP EACH $0.1050
BISACODYL 5 mg TAB, EC TABLET $0.0216
BISOPROLOL FUMARATE 10 mg TAB TABLET $0.7776
BISOPROLOL FUMARATE 5 mg TAB TABLET $0.3017
BISOPROLOL/HCTZ 10 mg; 6.25 mg TAB TABLET $0.0730
BISOPROLOL/HCTZ 2.5 mg; 6.25 mg TAB TABLET $0.0581
BISOPROLOL/HCTZ 5 mg; 6.25 mg TAB TABLET $0.0606
BLEOMYCIN SULFATE 15 unit VIAL EACH $60.5250
BLEOMYCIN SULFATE 30 unit VIAL EACH $96.1170
BRIMONIDINE TARTRATE 0.2% DROPS MILLILITER $1.5184
BROMFENAC SODIUM 0.09% DROPS MILLILITER $63.0600
BROMOCRIPTINE MESYLATE 2.5 mg TAB TABLET $2.8800
BROMOCRIPTINE MESYLATE 5 mg CAP CAPSULE $6.4500
BROMPHENIRAMINE MALEATE/PHENYLEPHRINE HCL/D-METHORPHAN HB
1-2.5-5/5 ml SOLN MILLILITER $0.0203
BUDESONIDE 3 mg CAP, ER CAPSULE $13.0775
BUDESONIDE 32 mcg AER GRAM $13.5300
BUMETANIDE 0.5 mg TAB TABLET $0.4440
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
BUMETANIDE 1 mg TAB TABLET $0.6054
BUMETANIDE 2 mg TAB TABLET $1.1232
BUPRENORPHINE HCL 2 mg TAB, SL TABLET $1.2000
BUPRENORPHINE HCL 8 mg TAB, SL TABLET $1.7196
BUPRENORPHINE HCL/NALOXONE HCL 2 mg; 0.5 mg TAB, SL TABLET $2.3400
BUPRENORPHINE HCL/NALOXONE HCL 8 mg; 2 mg TAB, SL TABLET $9.0750
BUPROPION HCL 100 mg TAB, SR TABLET $0.2640
BUPROPION HCL 100 mg TAB TABLET $0.7276
BUPROPION HCL 150 mg TAB, ER TABLET $0.9945
BUPROPION HCL 150 mg TAB, SA TABLET $0.8760
BUPROPION HCL 150 mg TAB, SR TABLET $0.1720
BUPROPION HCL 200 mg TAB, SR TABLET $0.5520
BUPROPION HCL 300 mg TAB, ER TABLET $1.1705
BUPROPION HCL 75 mg TAB TABLET $0.5455
BUSPIRONE HCL 10 mg TAB TABLET $0.0683
BUSPIRONE HCL 15 mg TAB TABLET $0.1418
BUSPIRONE HCL 30 mg TAB TABLET $0.6670
BUSPIRONE HCL 5 mg TAB TABLET $0.0514
BUTALBITAL/ACETAMINOPHEN/CAFFEINE 50 mg; 300 mg; 40 CAP CAPSULE $3.6720
BUTALBITAL/APAP/CAFFEINE COMPOUND 50 mg; 325 mg; 40 mg TAB TABLET $0.7920
BUTALBITAL/ASPIRIN/CAFFEINE 50 mg; 325 mg; 40 mg CAP CAPSULE $1.5000
BUTORPHANOL TARTRATE 10 mg/ml NASAL SPRAY MILLILITER $13.5300
CABERGOLINE 0.5 mg TAB TABLET $16.4280
CALCIPOTRIENE 0.005% SOLN MILLILITER $3.7560
CALCIPOTRIENE 0.005% CRM GRAM $5.4600
CALCIPOTRIENE/BETAMETHASONE 0.005-0.064% OINT GRAM $10.5750
CALCITONIN, SALMON, SYNTHETIC 200 units/dose SPRAY MILLILITER $14.9554
CALCITRIOL 0.25 mcg CAP CAPSULE $0.4650
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CALCITRIOL 0.5 mcg CAP CAPSULE $0.8124
CALCITRIOL 1 mcg/ml SOLN MILLILITER $8.6040
CALCIUM ACETATE 667 mg CAP CAPSULE $0.0720
CALCIUM CARBONATE 600 mg TAB TABLET $0.0300
CALCIUM CARBONATE 1250 mg TAB TABLET $0.0240
CALCIUM CARBONATE/CHOLECALCIFEROL (VITAMIN D3)
500 mg; 200 mg TAB TABLET $0.0316
CALCIUM CARBONATE/CHOLECALCIFEROL (VITAMIN D3)
600 mg; 400 mg TAB TABLET $0.0240
CALCIUM POLYCARBOPHIL 625 mg TAB TABLET $0.0764
CANDESARTAN CILEXETIL 16 mg TAB TABLET $1.3800
CANDESARTAN CILEXETIL 32 mg TAB TABLET $2.3080
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 $1.9050
CANDESARTAN/HYDROCHLOROTHIAZIDE 32 mg; 12.5 mg TAB TABLET $2.4150
CANDESARTAN/HYDROCHLOROTHIAZIDE 32 mg; 25 mg TAB TABLET $2.6250
CAPECITABINE 150 mg TAB TABLET $7.8840
CAPECITABINE 500 mg TAB TABLET $29.1574
CAPTOPRIL 100 mg TAB TABLET $1.4640
CAPTOPRIL 12.5 mg TAB TABLET $0.7500
CAPTOPRIL 25 mg TAB TABLET $1.1760
CAPTOPRIL 50 mg TAB TABLET $1.3800
CARBAMAZEPINE 100 mg/5 ml SUSP MILLILITER $0.1680
CARBAMAZEPINE 100 mg CAP, ER 12HR CAPSULE $1.6888
CARBAMAZEPINE 100 mg TAB, ER 12 HR TABLET $0.9450
CARBAMAZEPINE 100 mg TAB, CHEW TABLET $0.4440
CARBAMAZEPINE 200 mg CAP, ER 12HR CAPSULE $1.8840
CARBAMAZEPINE 200 mg TAB, SR 12HR TABLET $1.7280
CARBAMAZEPINE 200 mg TAB TABLET $0.8640
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CARBAMAZEPINE 300 mg CAP, ER 12HR CAPSULE $1.6888
CARBAMAZEPINE 400 mg TAB, SR 12HR TABLET $3.1920
CARBAMIDE PEROXIDE 6.5% DROPS MILLILITER $0.2590
CARBIDOPA 25 mg TAB TABLET $11.1501
CARBIDOPA/LEVODOPA 10 mg; 100 mg TAB, RAPID DISSOLVE
TABLET $1.0205
CARBIDOPA; LEVODOPA ER 25 mg; 100 mg TAB, ER TABLET $0.4291
CARBIDOPA; LEVODOPA ER 50 mg; 200 mg TAB, ER TABLET $0.4900
CARBIDOPA; LEVODOPA 10 mg; 100 mg TAB TABLET $0.1440
CARBIDOPA; LEVODOPA 25 mg; 100 mg TAB TABLET $0.1639
CARBIDOPA; LEVODOPA 25 mg; 250 mg TAB TABLET $0.2021
CARBINOXAMINE MALEATE 4 mg/5 ml LIQ MILLILITER $0.1740
CARBOPLATIN 10 mg/ml VIAL MILLILITER $2.6400
CARISOPRODOL 350 mg TAB TABLET $0.0621
CARTEOLOL HCL 1% SOLN MILLILITER $1.4160
CARVEDILOL 12.5 mg TAB TABLET $0.0365
CARVEDILOL 25 mg TAB TABLET $0.0412
CARVEDILOL 3.125 mg TAB TABLET $0.0202
CARVEDILOL 6.25 mg TAB TABLET $0.0355
CEFACLOR 250 mg CAP CAPSULE $2.0885
CEFACLOR 500 mg CAP CAPSULE $2.1600
CEFADROXIL HYDRATE 1 g TAB TABLET $3.9000
CEFADROXIL HYDRATE 250 mg/5 ml SUSP MILLILITER $0.6384
CEFADROXIL HYDRATE 500 mg/5 ml SUSP MILLILITER $0.8838
CEFADROXIL 500 mg CAP CAPSULE $0.3450
CEFAZOLIN SODIUM 1 gm VIAL EACH $1.1550
CEFAZOLIN SODIUM 10 gm VIAL EACH $11.5416
CEFDINIR 125 mg/5 ml SUSP MILLILITER $0.4472
CEFDINIR 250 mg/5 ml SUSP MILLILITER $0.0716
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CEFDINIR 300 mg CAP CAPSULE $1.5222
CEFEPIME HCL 2 gm VIAL MILLILITER $10.8581
CEFIXIME 100 mg/5 ml ORAL SUSP MILLILITER $3.8942
CEFIXIME 200 mg/5 ml ORAL SUSP MILLILITER $9.7428
CEFPODOXIME PROXETIL 100 mg/5 ml SUSP MILLILITER $1.7216
CEFPODOXIME 100 mg TAB TABLET $5.6591
CEFPROZIL 125 mg/5 ml SUSP MILLILITER $0.4395
CEFPROZIL 250 mg/5 ml SUSP MILLILITER $0.6402
CEFPROZIL 250 mg TAB TABLET $1.0800
CEFPROZIL 500 mg TAB TABLET $2.7300
CEFTAZIDIME PENTAHYDRATE 1 gm VIAL EACH $4.7250
CEFTAZIDIME PENTAHYDRATE 2 gm VIAL EACH $11.3148
CEFTAZIDIME PENTAHYDRATE 6 gm VIAL EACH $27.7830
CEFTRIAXONE SODIUM 1 gm VIAL EACH $2.4192
CEFTRIAXONE SODIUM 10 gm VIAL EACH $29.4000
CEFTRIAXONE SODIUM 2 gm VIAL EACH $4.4352
CEFTRIAXONE SODIUM 250 mg VIAL EACH $1.5926
CEFTRIAXONE SODIUM 500 mg VIAL EACH $1.8144
CEFUROXIME 250 mg TAB TABLET $1.2330
CEFUROXIME 500 mg TAB TABLET $3.2138
CELECOXIB 100 mg CAP CAPSULE $0.6803
CELECOXIB 200 mg CAP CAPSULE $1.1141
CELECOXIB 400 mg CAP CAPSULE $2.6400
CELECOXIB 50 mg CAP CAPSULE $0.5850
CEPHALEXIN 125 mg/5 ml SUSP MILLILITER $0.1994
CEPHALEXIN 250 mg CAP CAPSULE $0.1080
CEPHALEXIN 250 mg/5 ml SUSP RECON MILLILITER $0.2160
CEPHALEXIN 500 mg CAP CAPSULE $0.1601
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CETIRIZINE HCL 1 mg/ml SYR MILLILITER $0.0300
CETIRIZINE HCL 10 mg TAB, CHEW TABLET $4.0800
CETIRIZINE HCL 10 mg TAB TABLET $0.0735
CETIRIZINE HCL 5 mg TAB, CHEW TABLET $2.1608
CETIRIZINE HCL 5 mg TAB TABLET $0.0600
CEVIMELINE HCL 30 mg CAP CAPSULE $1.9610
CHLORDIAZEPOXIDE 10 mg CAP CAPSULE $0.1104
CHLORDIAZEPOXIDE 25 mg CAP CAPSULE $0.0972
CHLORDIAZEPOXIDE 5 mg CAP CAPSULE $0.1093
CHLORHEXIDINE 0.12% ORAL RINSE MILLILITER $0.0106
CHLORPROMAZINE HCL 10 mg TAB TABLET $3.0000
CHLORPROMAZINE HCL 25 mg TAB TABLET $3.9825
CHLORPROMAZINE HCL 50 mg TAB TABLET $5.7404
CHLORPROMAZINE HCL 100 mg TAB TABLET $6.3570
CHLORPROMAZINE HCL 200 mg TAB TABLET $9.0538
CHLORTHALIDONE 25 mg TAB TABLET $1.0427
CHLORTHALIDONE 50 mg TAB TABLET $1.2860
CHLORZOXAZONE 500 mg TAB TABLET $0.2855
CHOLECALCIFEROL (VITAMIN D3) 1,000 unit TAB TABLET $0.0219
CHOLESTYRAMINE 4 gm PWDR for
ORAL SUSP GRAM $0.2550
CHOLESTYRAMINE LITE 4 gm PWDR for
ORAL SUSP GRAM $0.30000
CHOLESTYRAMINE LITE 4 gm PWD PACKET EACH $2.2440
CHOLESTYRAMINE/SUCROSE 4 gm PWDR
PACKET EACH $2.6838
CICLOPIROX 0.77% GEL GRAM $1.5450
CICLOPIROX 1% SHAMPOO MILLILITER $0.4581
CICLOPIROX 8% TOP SOLN MILLILITER $2.4360
CICLOPIROX 0.77% CRM GRAM $0.4920
CICLOPIROX 0.77% TOP SUSP MILLILITER $0.2890
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CILOSTAZOL 100 mg TAB TABLET $0.1257
CILOSTAZOL 50 mg TAB TABLET $0.0845
CIMETIDINE 200 mg TAB TABLET $0.3150
CIMETIDINE 300 mg TAB TABLET $0.3711
CIMETIDINE 400 mg TAB TABLET $0.4200
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 TAB TABLET $0.1721
CIPROFLOXACIN 500 mg TAB TABLET $0.1661
CIPROFLOXACIN 750 mg TAB TABLET $0.6360
CITALOPRAM 10 mg/5 ml SOLN MILLILITER $0.2251
CITALOPRAM 10 mg TAB TABLET $0.0435
CITALOPRAM 20 mg TAB TABLET $0.0840
CITALOPRAM 40 mg TAB TABLET $0.0596
CLADRIBINE 10 mg/10 ml VIAL MILLILITER $28.3030
CLARITHROMYCIN 500 mg TAB, ER TABLET $4.0022
CLARITHROMYCIN 125 mg/5 ml SUSP MILLILITER $0.5438
CLARITHROMYCIN 250 mg/5 ml SUSP MILLILITER $1.0364
CLARITHROMYCIN 250 mg TAB TABLET $3.8400
CLARITHROMYCIN 500 mg TAB TABLET $0.7600
CLINDAMYCIN HCL 150 mg CAP CAPSULE $0.1313
CLINDAMYCIN HCL 300 mg CAP CAPSULE $0.2436
CLINDAMYCIN PALMITATE HCL 75 mg/5 ml SOLN MILLILITER $0.5073
CLINDAMYCIN PHOSPHATE 1% PLEDGET EACH $0.3725
CLINDAMYCIN PHOSPHATE 1% FOAM GRAM $5.1000
CLINDAMYCIN PHOSPHATE 1% TOP GEL GRAM $2.2455
CLINDAMYCIN PHOSPHATE 1% TOP LOTION MILLILITER $1.4996
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CLINDAMYCIN PHOSPHATE 1% TOP SOLN MILLILITER $1.1538
CLINDAMYCIN PHOSPHATE/BENZOYL PEROXIDE 1% - 5% GEL GRAM $5.6367
CLINDAMYCIN PHOSPHATE/BENZOYL PEROXIDE 1.2(1)%-5% GEL GRAM $3.3873
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 PHOSPHATE 2% VAG CRM MILLILITER $2.4882
CLINDAMYCIN PHOSPHATE 150 mg/ml VIAL MILLILITER $0.9231
CLOBETASOL PROPIONATE/EMOLLIENT 0.05% CRM GRAM $3.1800
CLOBETASOL PROPIONATE/EMOLLIENT 0.05% FOAM GRAM $4.0920
CLOBETASOL PROPIONATE 0.05% FOAM GRAM $5.8983
CLOBETASOL PROPIONATE 0.05% SHAMPOO MILLILITER $2.9100
CLOBETASOL PROPIONATE 0.05% CRM GRAM $2.7240
CLOBETASOL PROPIONATE 0.05% GEL GRAM $6.3703
CLOBETASOL PROPIONATE 0.05% OINT GRAM $4.0856
CLOBETASOL PROPIONATE 0.05% SPRAY MILLILITER $2.8840
CLOBETASOL PROPIONATE 0.05% TOP SOLN MILLILITER $2.4300
CLOMIPRAMINE HCL 25 mg CAP CAPSULE $9.0970
CLOMIPRAMINE HCL 50 mg CAP CAPSULE $9.0970
CLOMIPRAMINE HCL 75 mg CAP CAPSULE $9.0970
CLONAZEPAM ODT 0.125 mg TAB, ODT TABLET $0.9346
CLONAZEPAM ODT 0.25 mg TAB, ODT TABLET $1.0743
CLONAZEPAM ODT 0.5 mg TAB, ODT TABLET $0.7392
CLONAZEPAM ODT 1 mg TAB, ODT TABLET $0.8441
CLONAZEPAM ODT 2 mg TAB, ODT TABLET $1.6845
CLONAZEPAM 0.5 mg TAB TABLET $0.0150
CLONAZEPAM 1 mg TAB TABLET $0.0326
CLONAZEPAM 2 mg TAB TABLET $0.0417
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CLONIDINE HCL 0.1 mg TAB, ER 12HR TABLET $4.9050
CLONIDINE HCL 0.1 mg TAB TABLET $0.0240
CLONIDINE HCL 0.2 mg TAB TABLET $0.0375
CLONIDINE HCL 0.3 mg TAB TABLET $0.0720
CLONIDINE 0.1 mg/24hr PATCH PATCH $23.3625
CLONIDINE 0.2 mg/24hr PATCH PATCH $44.6850
CLONIDINE 0.3 mg/24hr PATCH PATCH $60.2250
CLOPIDOGREL 75 mg TAB TABLET $0.1140
CLORAZEPATE DIPOTASSIUM 15 mg TAB TABLET $0.4716
CLORAZEPATE DIPOTASSIUM 3.75 mg TAB TABLET $0.1640
CLORAZEPATE DIPOTASSIUM 7.5 mg TAB TABLET $0.3960
CLOTRIMAZOLE/ BETAMETHASONE DIPROPIONATE
1-0.05%; 15 gm CRM GRAM $0.5770
CLOTRIMAZOLE/ BETAMETHASONE DIPROPIONATE
1-0.05%; 45 gm CRM GRAM $0.5020
CLOTRIMAZOLE/ BETAMETHASONE DIPROPIONATE
1-0.05% LOT MILLILITER $4.8360
CLOTRIMAZOLE 1% CRM GRAM $0.5104
CLOTRIMAZOLE 10 mg LOZENGE EACH $0.4176
CLOTRIMAZOLE 1% SOLN MILLILITER $1.5690
CLOZAPINE 100 mg TAB TABLET $1.1200
CLOZAPINE 200 mg TAB TABLET $4.1850
CLOZAPINE 25 mg TAB TABLET $0.5340
COLESTIPOL HCL 1 gm TAB TABLET $1.0979
COLISTIMETHATE SODIUM 150 mg VIAL EACH $16.50000
CROMOLYN SODIUM 4% OPTH SOLN MILLILITER $0.7170
CROMOLYN SODIUM 20 mg/ml SOLN MILLILITER $1.4250
CYCLOBENZAPRINE HCL 5 mg TAB TABLET $0.0360
CYCLOBENZAPRINE HCL 10 mg TAB TABLET $0.0240
CYCLOPENTOLATE HCL 1% DROPS MILLILITER $2.4840
CYCLOSPORINE, MODIFIED 100 mg CAP CAPSULE $2.8001
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CYCLOSPORINE, MODIFIED 100 mg/ml SOLN MILLILITER $3.0000
CYCLOSPORINE, MODIFIED 25 mg CAP CAPSULE $0.8175
CYPROHEPTADINE HCL 2 mg/5 ml SYR MILLILITER $0.1282
CYPROHEPTADINE HCL 4 mg TAB TABLET $0.6438
CYTARABINE/PF 2 gm/20 ml VIAL MILLILITER $1.2150
DACARBAZINE 200 mg VIAL EACH $19.3650
DANAZOL 200 mg CAP CAPSULE $5.0627
DANTROLENE SODIUM 25 mg CAP CAPSULE $1.0500
DARIFENACIN HYDROBROMIDE 15 mg TAB, ER 24 HR TABLET $8.2920
DARIFENACIN HYDROBROMIDE 7.5 mg TAB, ER 24 HR TABLET $8.2920
DAUNORUBICIN HCL 5 mg/ml VIAL MILLILITER $24.8519
DEFEROXAMINE MESYLATE 2 gm VIAL EACH $43.2600
DEFEROXAMINE MESYLATE 500 mg VIAL EACH $13.5974
DEMECLOCYCLINE 150 mg TAB TABLET $10.0560
DEMECLOCYCLINE 300 mg TAB TABLET $10.0800
DESIPRAMINE HCL 10 mg TAB TABLET $0.9000
DESIPRAMINE HCL 25 mg TAB TABLET $1.1160
DESIPRAMINE HCL 50 mg TAB TABLET $2.0880
DESIPRAMINE HCL 75 mg TAB TABLET $2.3322
DESLORATADINE 5 mg TAB TABLET $0.4583
DESMOPRESSIN ACETATE 0.1 mg TAB TABLET $1.0844
DESMOPRESSIN ACETATE 0.2 mg TAB TABLET $1.0145
DESMOPRESSIN 0.1 mg/ml NASAL SPRAY MILLILITER $22.8000
DESOGESTREL/ETHINY ESTRADIOL (DESOGEN, ORTHO-CEPT, APRI)
0.15 mg; 30 mcg TAB TABLET $0.4216
DESOGESTREL/ETHINY ESTRADIOL (KARIVA, MIRCETTE)
0.15 mg; 20 mcg TAB TABLET $0.9240
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% LOT MILLILITER $2.1720
DESONIDE 0.05%; 15 gm CRM GRAM $4.8464
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
DESONIDE 0.05%; 60 gm CRM GRAM $3.6294
DESOXIMETASONE 0.05%; 15 gm CRM GRAM $3.4840
DESOXIMETASONE 0.05%; 15 gm GEL GRAM $4.6920
DESOXIMETASONE 0.05%; 60 gm CRM GRAM $7.3485
DESOXIMETASONE 0.05%; 60 gm GEL GRAM $3.1287
DESOXIMETASONE 0.25%; 15 gm CRM GRAM $2.5490
DESOXIMETASONE 0.25%; 15 gm OINT GRAM $7.3860
DESOXIMETASONE 0.25%; 60 gm CRM GRAM $1.3940
DESOXIMETASONE 0.25%; 60 gm OINT GRAM $7.0553
DEXAMETHASONE 4 mg TAB TABLET $0.1199
DEXMETHYLPHENIDATE HCL 5 mg CAP, ER CAPSULE $7.3050
DEXMETHYLPHENIDATE HCL 10 mg CAP, ER CAPSULE $6.2040
DEXMETHYLPHENIDATE HCL 15 mg CAP, ER CAPSULE $7.8150
DEXMETHYLPHENIDATE HCL 20 mg CAP, ER CAPSULE $7.1250
DEXMETHYLPHENIDATE HCL 30 mg CAP, ER CAPSULE $7.6950
DEXMETHYLPHENIDATE HCL 40 mg CAP, ER CAPSULE $9.5100
DEXMETHYLPHENIDATE HCL 10 mg TAB TABLET $1.0884
DEXMETHYLPHENIDATE HCL 2.5 mg TAB TABLET $0.5740
DEXMETHYLPHENIDATE HCL 5 mg TAB TABLET $0.9846
DEXTROAMPHETAMINE SULFATE 10 mg CAP, SA CAPSULE $3.3000
DEXTROAMPHETAMINE SULFATE 10 mg TAB TABLET $2.0760
DEXTROAMPHETAMINE SULFATE 15 mg CAP, SA CAPSULE $5.4424
DEXTROAMPHETAMINE SULFATE 5 mg CAP, SA CAPSULE $3.4021
DEXTROAMPHETAMINE SULFATE 5 mg TAB TABLET $0.7800
DEXTROMETHORPHAN POLISTIREX 30 mg/5 ml SUSP MILLILITER $0.1061
DIAZEPAM 10 mg TAB TABLET $0.0271
DIAZEPAM 2 mg TAB TABLET $0.0240
DIAZEPAM 5 mg TAB TABLET $0.0297
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
DICLOFENAC POTASSIUM 50 mg TAB TABLET $0.6000
DICLOFENAC SODIUM XR 100 mg TAB, XR TABLET $0.2698
DICLOFENAC SODIUM 0.1% DROPS MILLILITER $1.5173
DICLOFENAC SODIUM 3% GEL GRAM $9.1050
DICLOFENAC SODIUM 1.5% DROPS MILLILITER $1.2013
DICLOFENAC SODIUM 50 mg TAB, EC TABLET $0.2054
DICLOFENAC SODIUM 75 mg TAB, EC TABLET $0.1580
DICLOFENAC SODIUM/MISOPROSTOL 50 mg; 200 mg TAB, DR TABLET $2.5323
DICLOFENAC SODIUM/MISOPROSTOL 75 mg; 200 mg TAB, DR TABLET $2.5323
DICLOXACILLIN SODIUM 250 mg CAP CAPSULE $0.2751
DICLOXACILLIN SODIUM 500 mg CAP CAPSULE $0.7320
DICYCLOMINE HCL 10 mg CAP CAPSULE $0.0438
DICYCLOMINE HCL 20 mg TAB TABLET $0.1109
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% OINT GRAM $3.5595
DIFLUNISAL 500 mg TAB TABLET $1.5900
DIGOXIN 0.125 mg TAB TABLET $0.8456
DIGOXIN 0.250 mg TAB TABLET $0.8657
DILTIAZEM HCL 420 mg CAP, SA CAPSULE $2.5680
DILTIAZEM HCL 120 mg CAP, CR CAPSULE $0.6666
DILTIAZEM HCL 120 mg CAP, ER CAPSULE $0.6972
DILTIAZEM HCL 120 mg CAP, SR 12HR CAPSULE $3.2040
DILTIAZEM HCL 120 mg CAP, SR 24HR CAPSULE $0.3240
DILTIAZEM HCL 120 mg TAB TABLET $0.3240
DILTIAZEM HCL 180 mg CAP, CR CAPSULE $0.5640
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
DILTIAZEM HCL 180 mg CAP, SA CAPSULE $0.4560
DILTIAZEM HCL 180 mg CAP, SR 24HR CAPSULE $0.3840
DILTIAZEM HCL 240 mg CAP, CR CAPSULE $1.0650
DILTIAZEM HCL 240 mg CAP, SA CAPSULE $0.6972
DILTIAZEM HCL 240 mg CAP, SR 24HR CAPSULE $0.3840
DILTIAZEM HCL 30 mg TAB TABLET $0.2494
DILTIAZEM HCL 300 mg CAP, ER CAPSULE $0.8280
DILTIAZEM HCL 300 mg CAP, SR 24HR CAPSULE $0.5048
DILTIAZEM HCL 360 mg CAP, ER 24HR CAPSULE $9.5886
DILTIAZEM HCL 360 mg CAP, ER CAPSULE $0.5280
DILTIAZEM HCL 60 mg CAP, SR 12HR CAPSULE $2.1480
DILTIAZEM HCL 60 mg TAB TABLET $0.1699
DILTIAZEM HCL 90 mg CAP, SR 12HR CAPSULE $2.4600
DILTIAZEM HCL 90 mg TAB TABLET $0.4350
DIPHENHYDRAMINE HCL 12.5 mg/5 ml LIQ MILLILITER $0.0111
DIPHENHYDRAMINE 25 mg CAP CAPSULE $0.0300
DIPHENHYDRAMINE 50 mg CAP CAPSULE $0.0240
DIPHENOXYLATE HCL; ATROPINE SULFATE 2.5 mg; 0.025 mg TAB TABLET $0.4329
DIPYRIDAMOLE 25 mg TAB TABLET $0.0630
DIPYRIDAMOLE 50 mg TAB TABLET $0.2040
DIPYRIDAMOLE 75 mg TAB TABLET $0.2719
DISOPYRAMIDE 100 mg CAP CAPSULE $0.5520
DISULFIRAM 250 mg TAB TABLET $4.8958
DIVALPROEX SODIUM 125 mg CAP,
SPRINKLE CAPSULE $0.6720
DIVALPROEX SODIUM 125 mg TAB, EC TABLET $0.0720
DIVALPROEX SODIUM 250 mg TAB, EC TABLET $0.1380
DIVALPROEX SODIUM 250 mg TAB, ER TABLET $2.0040
DIVALPROEX SODIUM 500 mg TAB, EC TABLET $0.1720
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
DIVALPROEX SODIUM 500 mg TAB, ER TABLET $1.4067
D-METHORPHAN HB/P-EPD HCL/BPM 10 mg; 30 mg; 2
mg/5 ml SYR MILLILITER $0.2647
DOCUSATE CALCIUM 240 mg CAP CAPSULE $0.0600
DOCUSATE SODIUM 100 mg CAP CAPSULE $0.0334
DOCUSATE SODIUM 150 mg/15 ml LIQ MILLILITER $0.0137
DONEPEZIL HCL 10 mg TAB, RAPID DISSOLVE
TABLET $5.2848
DONEPEZIL HCL 10 mg TAB TABLET $0.0458
DONEPEZIL HCL 23 mg TAB TABLET $7.8240
DONEPEZIL HCL 5 mg TAB, RAPID DISSOLVE
TABLET $0.2786
DONEPEZIL HCL 5 mg TAB TABLET $0.0458
DORZOLAMIDE HCL 2% DROPS MILLILITER $1.3296
DOXAZOSIN MESYLATE 1 mg TAB TABLET $0.5520
DOXAZOSIN MESYLATE 2 mg TAB TABLET $0.5390
DOXAZOSIN MESYLATE 4 mg TAB TABLET $0.4734
DOXAZOSIN MESYLATE 8 mg TAB TABLET $0.1529
DOXEPIN HCL 10 mg/ml CONC MILLILITER $0.6000
DOXEPIN HCL 10 mg CAP CAPSULE $0.2916
DOXEPIN HCL 25 mg CAP CAPSULE $0.3170
DOXEPIN HCL 50 mg CAP CAPSULE $0.5700
DOXEPIN HCL 75 mg CAP CAPSULE $0.8700
DOXEPIN HCL 100 mg CAP CAPSULE $0.9450
DOXERCALCIFEROL 0.5 mcg CAP CAPSULE $11.8500
DOXERCALCIFEROL 1 mcg CAP CAPSULE $23.7000
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
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
DOXYCYCLINE HYCLATE 20 mg TAB TABLET $0.4440
DOXYCYCLINE HYCLATE 50 mg CAP CAPSULE $0.6840
DOXYCYCLINE HYCLATE 100 mg CAP CAPSULE $0.2640
DOXYCYCLINE HYCLATE 100 mg TAB TABLET $1.4760
DOXYCYCLINE MONOHYDRATE 50 mg TAB TABLET $0.4099
DOXYCYCLINE MONOHYDRATE 100 mg TAB TABLET $0.4808
DOXYCYCLINE MONOHYDRATE 150 mg CAP CAPSULE $14.4150
DOXYCYCLINE MONOHYDRATE 150 mg TAB TABLET $6.1440
DOXYCYCLINE MONOHYDRATE 50 mg CAP CAPSULE $0.3047
DRONABINOL 5 mg CAP CAPSULE $8.6880
DRONABINOL 10 mg CAP CAPSULE $9.2320
DRONABINOL 2.5 mg CAP CAPSULE $4.5600
DULOXETINE HCL 20 mg CAP CAPSULE $0.4166
DULOXETINE HCL 30 mg CAP CAPSULE $0.3800
DULOXETINE HCL 60 mg CAP CAPSULE $0.3320
DUTASTERIDE 0.5 mg CAP CAPSULE $0.3750
ECONAZOLE NITRATE 1% CRM GRAM $4.1640
ECONAZOLE NITRATE 1% CRM GRAM $3.6500
ECONAZOLE NITRATE 1% CRM GRAM $2.3465
ENALAPRIL MALEATE/HCTZ 10 mg; 25 mg TAB TABLET $0.1890
ENALAPRIL MALEATE/HCTZ 5 mg; 12.5 mg TAB TABLET $0.2040
ENALAPRIL MALEATE 10 mg TAB TABLET $0.1642
ENALAPRIL MALEATE 2.5 mg TAB TABLET $0.2372
ENALAPRIL MALEATE 20 mg TAB TABLET $0.5107
ENALAPRIL MALEATE 5 mg TAB TABLET $0.3750
ENALAPRILAT DIHYDRATE 1.25 mg/ml VIAL MILLILITER $3.0240
ENOXAPARIN SODIUM 100 mg/ml SYRN MILLILITER $14.2800
ENOXAPARIN SODIUM 120 mg/0.8 ml SYRN MILLILITER $21.4200
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
ENOXAPARIN SODIUM 150 mg/ml SYRN MILLILITER $20.9280
ENOXAPARIN SODIUM 30 mg/0.3 ml SYRN MILLILITER $34.4800
ENOXAPARIN SODIUM 300 mg/3 ml VIAL MILLILITER $35.2050
ENOXAPARIN SODIUM 40 mg/0.4 ml SYRN MILLILITER $14.2800
ENOXAPARIN SODIUM 60 mg/0.6 ml SYRN MILLILITER $34.5240
ENOXAPARIN SODIUM 80 mg/0.8 ml SYRN MILLILITER $14.2800
ENTACAPONE 200 mg TAB TABLET $2.3700
ENTACAVIR 0.5 mg TAB TABLET $36.0000
ENTACAVIR 1 mg TAB TABLET $45.0000
EPINASTINE HCL 0.05% DROPS MILLILITER $7.2750
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 $2.7750
EPLERENONE 50 mg TAB TABLET $2.4323
ERGOCALCIFEROL (VITAMIN D2) 1.25 mg (50,000 unit) CAP CAPSULE $0.2241
ERGOCALCIFEROL (VITAMIN D2) 8,000 units/ml DROPS MILLILITER $0.6750
ERYTHROMYCIN BASE/ETHANOL 2% GEL GRAM $5.3004
ERYTHROMYCIN 0.5% OPTH OINT GRAM $2.6288
ERYTHROMYCIN 2% SOLN MILLILITER $0.7712
ESCITALOPRAM OXALATE 10 mg TAB TABLET $0.0955
ESCITALOPRAM OXALATE 20 mg TAB TABLET $0.1078
ESCITALOPRAM OXALATE 5 mg/5 ml ORAL SOLN MILLILITER $0.7050
ESCITALOPRAM OXALATE 5 mg TAB TABLET $0.0931
ESOMEPRAZOLE MAGNESIUM 20 mg CAP, DR CAPSULE $5.0550
ESOMEPRAZOLE MAGNESIUM 40 mg CAP, DR CAPSULE $5.0557
ESTAZOLAM 1 mg TAB TABLET $0.6450
ESTAZOLAM 2 mg TAB TABLET $0.7200
ESTRADIOL 0.025 mg PATCH PATCH $18.5010
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
ESTRADIOL 0.05 mg PATCH PATCH $18.5010
ESTRADIOL 0.075 mg PATCH PATCH $18.5010
ESTRADIOL 0.1 mg PATCH PATCH $9.8040
ESTRADIOL 0.025 mg/24hr PATCH,
semiweekly PATCH $9.7920
ESTRADIOL 0.0375 mg/24hr PATCH,
semiweekly EACH $13.2660
ESTRADIOL 0.075 mg/24hr PATCH,
semiweekly EACH $12.7020
ESTRADIOL 0.05 mg/24hr PATCH,
semiweekly EACH $9.1919
ESTRADIOL/NORETHINDRONE ACETATE (ACTIVELLA)
1 mg; 0.5 mg TAB TABLET $4.1025
ESTRADIOL/ NORETHINDRONE ACETATE
0.5 mg; 0.1mg TAB TABLET $4.7239
ESTRADIOL 0.0375 mg/24hr PATCH EACH $18.5010
ESTRADIOL 0.06mg/24h PATCH, weekly EACH $16.4640
ESTRADIOL 0.1 mg/24hr PATCH PATCH $9.8040
ESTRADIOL 1 mg TAB TABLET $0.1086
ESTRADIOL 2 mg TAB TABLET $0.1325
ESTRADIOL 0.5 mg TAB TABLET $0.0528
ESTROPIPATE 0.75 mg TAB TABLET $0.4247
ESTROPIPATE 1.5 mg TAB TABLET $0.6000
ESZOPICLONE 1 mg TAB TABLET $0.6017
ESZOPICLONE 2 mg TAB TABLET $0.1320
ESZOPICLONE 3 mg TAB TABLET $0.4813
ETHAMBUTOL HCL 400 mg TAB TABLET $0.7320
ETHINYL ESTRADIOL/DROSPIRENONE (YASMIN, OCELLA)
0.03 mg; 3 mg TAB TABLET $1.2960
ETHINYL ESTRADIOL/DROSPIRENONE 0.02-3(24) TAB TABLET $1.8215
ETHOSUXIMIDE 250 mg/5 ml SYR MILLILITER $0.4168
ETHOSUXIMIDE 250 mg CAP CAPSULE $1.2431
ETHYNODIOL DIACETATE/ETHINYL ESTRADIOL
(DEMULEN 1/35, ZOVIA 1/35E) 1 mg; 35 mcg TAB TABLET $0.6565
ETHYNODIOL DIACETATE/ETHINYL ESTRADIOL (DEMULEN 1/50, ZOVIA 1/50E)
1 mg; 50 mcg TAB TABLET $0.8520
ETODOLAC 500 mg TAB, ER TABLET $2.5650
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
ETODOLAC 200 mg CAP CAPSULE $1.2484
ETODOLAC 300 mg CAP CAPSULE $1.5000
ETODOLAC 400 mg TAB TABLET $0.1996
ETODOLAC 400 mg TAB, ER TABLET $2.4150
ETODOLAC 500 mg TAB TABLET $0.9720
ETODOLAC 600 mg TAB, ER TABLET $3.2640
ETOPOSIDE 20 mg/ml VIAL MILLILITER $1.8300
ETOPOSIDE 50 mg CAP CAPSULE $67.2980
EXEMESTANE 25 mg TAB TABLET $9.2600
FAMCICLOVIR 125 mg TAB TABLET $1.0320
FAMCICLOVIR 250 mg TAB TABLET $0.5240
FAMCICLOVIR 500 mg TAB TABLET $1.0144
FAMOTIDINE/CALCIUM CARBONATE/MAGNESIUM 10-800-165 TAB, CHEW TABLET $0.3360
FAMOTIDINE 10 mg TAB TABLET $0.0842
FAMOTIDINE 20 mg TAB TABLET $0.0347
FAMOTIDINE 40 mg/5 ml SUSP MILLILITER $0.7950
FAMOTIDINE 40 mg TAB TABLET $0.0480
FELBAMATE 400 mg TAB TABLET $3.3450
FELBAMATE 600 mg/5 ml ORAL SUSP MILLILITER $2.3700
FELBAMATE 600 mg TAB TABLET $5.5560
FELODIPINE 10 mg TAB, ER TABLET $0.2154
FELODIPINE 2.5 mg TAB, ER TABLET $0.5050
FELODIPINE 5 mg TAB, ER TABLET $0.5040
FENOFIBRATE, MICRONIZED 130 mg CAP CAPSULE $2.2800
FENOFIBRATE, MICRONIZED 134 mg CAP CAPSULE $1.4760
FENOFIBRATE, MICRONIZED 200 mg CAP CAPSULE $2.3880
FENOFIBRATE, MICRONIZED 43 mg CAP CAPSULE $0.8100
FENOFIBRATE,MICRONIZED 67 mg CAP CAPSULE $1.8480
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
FENOFIBRATE, NANOCRYSTALLIZED 145 mg TAB TABLET $1.0800
FENOFIBRATE, NANOCRYSTALLIZED 48 mg TAB TABLET $0.4933
FENOFIBRATE 160 mg TAB TABLET $1.2000
FENOFIBRATE 54 mg TAB TABLET $1.0800
FENOFIBRIC ACID (CHOLINE) 135 mg CAP, DR CAPSULE $5.1840
FENOFIBRIC ACID (CHOLINE) 45 mg CAP, DR CAPSULE $1.7280
FENTANYL CITRATE 1,200 mcg LOZENGE EACH $20.6430
FENTANYL CITRATE 1,600 mcg LOZENGE EACH $34.8500
FENTANYL CITRATE 200 mcg LOZENGE EACH $19.7442
FENTANYL CITRATE 400 mcg LOZENGE EACH $25.0149
FENTANYL CITRATE 600 mcg LOZENGE EACH $30.6390
FENTANYL CITRATE 800 mcg LOZENGE EACH $36.3027
FENTANYL 100 mcg PATCH PATCH $12.8376
FENTANYL 12 mcg/hr PATCH PATCH $14.9500
FENTANYL 25 mcg PATCH PATCH $4.6968
FENTANYL 50 mcg PATCH PATCH $5.9520
FENTANYL 75 mcg PATCH PATCH $11.1120
FERROUS GLUCONATE 324 mg TAB TABLET $0.0677
FERROUS SULFATE 220 mg/5 ml ELIXIR MILLILITER $0.0120
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 $1.1288
FEXOFENADINE HCL 180 mg TAB TABLET $0.4950
FEXOFENADINE HCL 60 mg TAB TABLET $0.4200
FINASTERIDE 5 mg TAB TABLET $0.1800
FLAVOXATE HCL 100 mg TAB TABLET $0.7245
FLECAINIDE ACETATE 100 mg TAB TABLET $0.4200
FLECAINIDE ACETATE 150 mg TAB TABLET $1.1880
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
FLECAINIDE ACETATE 50 mg TAB TABLET $0.4080
FLUCONAZOLE IN SALINE, ISO-OSMOTIC 400 mg/200 ml IV MILLILITER $0.0580
FLUCONAZOLE 10 mg/ml SUSP MILLILITER $0.4303
FLUCONAZOLE 100 mg TAB TABLET $1.4660
FLUCONAZOLE 150 mg TAB TABLET $2.3280
FLUCONAZOLE 200 mg TAB TABLET $1.8584
FLUCONAZOLE 40 mg/ml SUSP MILLILITER $0.8980
FLUCONAZOLE 50 mg TAB TABLET $1.0350
FLUDARABINE PHOSPHATE 50 mg/2 ml VIAL MILLILITER $156.1920
FLUDARABINE PHOSPHATE 50 mg VIAL EACH $119.0700
FLUDROCORTISONE ACETATE 0.1 mg TAB TABLET $0.5484
FLUNISOLIDE 0.025% SPRAY MILLILITER $1.7606
FLUOCINONIDE ACETONIDE 0.01% OIL MILLILITER $2.0430
FLUOCINONIDE/EMOLLIENT 0.05% CRM GRAM $1.7048
FLUOCINONIDE 0.1% CRM GRAM $10.8251
FLUOCINONIDE 0.05% CRM GRAM $1.1660
FLUOCINONIDE 0.05% GEL GRAM $2.2208
FLUOCINONIDE 0.05% OINT GRAM $1.5120
FLUOCINONIDE 0.05% SOLN MILLILITER $1.3436
FLUOROURACIL 5% CREAM GRAM $5.6502
FLUOROURACIL 50 mg/ml; 10 ml VIAL MILLILITER $0.3282
FLUOROURACIL 50 mg/ml; 100 ml VIAL MILLILITER $0.3356
FLUOROURACIL 50 mg/ml; 50 ml VIAL MILLILITER $0.3911
FLUOXETINE HCL 10 mg CAP CAPSULE $0.0389
FLUOXETINE HCL 10 mg TAB TABLET $0.0389
FLUOXETINE HCL 20 mg/5 ml SYR SYRUP $0.0450
FLUOXETINE HCL 20 mg CAP CAPSULE $0.0360
FLUOXETINE HCL 20 mg TAB TABLET $0.0360
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
FLUOXETINE HCL 40 mg CAP CAPSULE $0.1722
FLUOXETINE HCL 90 mg CAP, DR CAPSULE $33.6750
FLUPHENAZINE 1 mg TAB TABLET $0.1200
FLUPHENAZINE 10 mg TAB TABLET $0.3360
FLUPHENAZINE 2.5 mg TAB TABLET $0.2436
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 $0.3900
FLURBIPROFEN 50 mg TAB TABLET $0.2700
FLUTICASONE PROPIONATE 0.005% OINT GRAM $0.5250
FLUTICASONE PROPIONATE 0.05% CRM GRAM $0.4200
FLUTICASONE PROPIONATE 50 mcg NASAL SPRAY GRAM $0.4403
FLUTICASONE PROPIONATE 50 mcg OTC NASAL
SPRAY GRAM $0.4928
FLUVASTATIN 80 mg TAB, ER 24HR TABLET $7.8205
FLUVOXAMINE 100 mg TAB TABLET $0.3179
FLUVOXAMINE 25 mg TAB TABLET $0.2370
FLUVOXAMINE 50 mg TAB TABLET $0.1992
FLUVOXAMINE MALEATE 100 mg CAP, ER 24HR CAPSULE $8.5050
FLUVOXAMINE MALEATE 150 mg CAP, ER 24HR CAPSULE $6.8040
FOLIC ACID/VITAMIN B COMP W-C 1 mg CAP CAPSULE $0.1920
FOLIC ACID 1 mg TAB TABLET $0.0138
FONDAPARINUX SODIUM 10 mg/0.8 ml SYRN MILLILITER $55.8960
FONDAPARINUX SODIUM 2.5 mg/0.5 ml SYRN MILLILITER $87.6709
FONDAPARINUX SODIUM 5 mg/0.4 ml SYRN MILLILITER $190.1400
FONDAPARINUX SODIUM 7.5 mg/0.6 ml SYRN MILLILITER $106.4640
FOSINOPRIL SODIUM/HCTZ 10 mg; 12.5 mg TAB TABLET $1.7760
FOSINOPRIL SODIUM/HCTZ 20 mg; 12.5 mg TAB TABLET $1.4040
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
FOSINOPRIL SODIUM 10 mg TAB TABLET $0.1193
FOSINOPRIL SODIUM 20 mg TAB TABLET $0.1237
FOSINOPRIL SODIUM 40 mg TAB TABLET $0.1677
FUROSEMIDE 10 mg/ml SOLN MILLILITER $0.1456
FUROSEMIDE 20 mg TAB TABLET $0.0136
FUROSEMIDE 40 mg TAB TABLET $0.0145
FUROSEMIDE 80 mg TAB TABLET $0.0600
GABAPENTIN 100 mg CAP CAPSULE $0.0450
GABAPENTIN 250 mg/5 ml SOLN MILLILITER $0.1650
GABAPENTIN 300 mg CAP CAPSULE $0.0578
GABAPENTIN 400 mg CAP CAPSULE $0.0999
GABAPENTIN 600 mg TAB TABLET $0.1950
GABAPENTIN 800 mg TAB TABLET $0.2040
GALANTAMINE HYDROBROMIDE 12 mg TAB TABLET $1.6264
GALANTAMINE HYDROBROMIDE 16 mg CAP, ER CAPSULE $2.7800
GALANTAMINE HYDROBROMIDE 24 mg CAP, ER CAPSULE $1.6800
GALANTAMINE HYDROBROMIDE 4 mg TAB TABLET $2.2000
GALANTAMINE HYDROBROMIDE 8 mg CAP, ER CAPSULE $1.6800
GALANTAMINE HYDROBROMIDE 8 mg TAB TABLET $1.6264
GATIFLOXACIN 0.5% DROPS MILLILITER $41.7408
GEMCITABINE HCL 1 gm VIAL EACH $56.7000
GEMCITABINE HCL 2 gm VIAL EACH $135.1356
GEMCITABINE HCL 200 mg VIAL EACH $11.7251
GEMFIBROZIL 600 mg TAB TABLET $0.1518
GENTAMICIN SULFATE 0.1% CRM 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 $1.6944
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
GENTAMICIN SULFATE 40 mg/ml VIAL MILLILITER $0.7650
GLIMEPIRIDE 1 mg TAB TABLET $0.0743
GLIMEPIRIDE 2 mg TAB TABLET $0.1286
GLIMEPIRIDE 4 mg TAB TABLET $0.2081
GLIPIZIDE/METFORMIN HCL 2.5 mg; 250 mg TAB TABLET $0.8132
GLIPIZIDE/METFORMIN HCL 2.5 mg; 500 mg TAB TABLET $0.3370
GLIPIZIDE/METFORMIN HCL 5 mg; 500 mg TAB TABLET $0.0506
GLIPIZIDE 10 mg TAB, SA TABLET $0.4566
GLIPIZIDE 10 mg TAB TABLET $0.0325
GLIPIZIDE 2.5 mg TAB, SA TABLET $0.2965
GLIPIZIDE 5 mg TAB, SA TABLET $0.2698
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 $0.1164
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 $0.1680
GLYBURIDE 5 mg TAB TABLET $0.2717
GLYCOPYRROLATE 1 mg TAB TABLET $0.4399
GLYCOPYRROLATE 2 mg TAB TABLET $0.6518
GRANISETRON HCL 1 mg/ml; MDV VIAL MILLILITER $8.2032
GRANISETRON HCL 1 mg/ml; SDV VIAL MILLILITER $9.0000
GRANISETRON HCL 1 mg TAB TABLET $1.8900
GRISEOFULVIN MICROSIZE 125 mg/5 ml SUSP MILLILITER $0.1136
GRISEOFULVIN ULTRAMICROSIZE 125 mg TAB TABLET $4.3412
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
GRISEOFULVIN ULTRAMICROSIZE 250 mg TAB TABLET $4.7400
GUAIFENESIN/DEXTROMETHORPHAN HBR/PHENYLEPHRINE
100-10-5 mg LIQ MILLILITER $0.0352
GUAIFENESIN/DEXTROMETHORPHAN HBR 100 mg; 10 mg/5 ml SYR MILLILITER $0.0240
GUAIFENESIN/DEXTROMETHORPHAN HBR 100 mg; 5 mg/5 ml LIQ MILLILITER $0.0200
GUAIFENESIN/DEXTROMETHORPHAN HBR 200 mg; 10 mg/5 ml LIQ MILLILITER $0.0226
GUAIFENESIN/DEXTROMETHORPHAN HBR 400 mg; 20 mg TAB TABLET $0.1309
GUAIFENESIN/PSEUDOEPHEDRINE HCL/CODEINE
100 mg; 30 mg; 10 mg SYR MILLILITER $0.1680
GUAIFENESIN; CODEINE PHOSPHATE (SUGAR FREE)
100 mg; 10 mg LIQ MILLILITER $0.0317
GUAIFENESIN; DEXTROMETHORPHAN HBR 100 mg; 10 mg LIQ MILLILITER $0.1002
GUAIFENESIN 100 mg/5 ml SOLN MILLILITER $0.0092
GUAIFENESIN 1200 mg TAB, ER TABLET $0.8400
GUAIFENESIN 200 mg TAB TABLET $0.0979
GUAIFENESIN 400 mg TAB TABLET $0.0837
GUANFACINE 1 mg TAB TABLET $0.0878
GUANFACINE 2 mg TAB TABLET $0.1220
HALOBETASOL PROPIONATE 0.05% CRM GRAM $3.2772
HALOBETASOL PROPIONATE 0.05% OINT GRAM $1.0610
HALOPERIDOL LACTATE 2 mg/ml; 120 ml CONC MILLILITER $0.0449
HALOPERIDOL 0.5 mg TAB TABLET $0.2477
HALOPERIDOL 1 mg TAB TABLET $0.3986
HALOPERIDOL 10 mg TAB TABLET $1.1652
HALOPERIDOL 2 mg TAB TABLET $0.5056
HALOPERIDOL 20 mg TAB TABLET $3.1320
HALOPERIDOL 5 mg TAB TABLET $0.6600
HC ACETATE/LIDOCAINE HCL 0.5%; 3% CRM GRAM $1.8435
HYDRALAZINE HCL 10 mg TAB TABLET $0.1258
HYDRALAZINE HCL 100 mg TAB TABLET $0.2280
HYDRALAZINE HCL 25 mg TAB TABLET $0.0750
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
HYDRALAZINE HCL 50 mg TAB TABLET $0.1799
HYDROCHLOROTHIAZIDE 12.5 mg CAP CAPSULE $0.0592
HYDROCHLOROTHIAZIDE 12.5 mg TAB TABLET $0.0720
HYDROCHLOROTHIAZIDE 25 mg TAB TABLET $0.0240
HYDROCHLOROTHIAZIDE 50 mg TAB TABLET $0.0177
HYDROCODONE BIT/ACETAMINOPHEN 10 mg; 300 mg TAB TABLET $2.2800
HYDROCODONE BIT/ACETAMINOPHEN 7.5 mg; 325 mg/15 ml SOLN MILLILITER $0.2760
HYDROCODONE BIT/HOMATROPINE 5 mg; 1.5 mg/5 ml SYR MILLILITER $0.1080
HYDROCODONE BITARTRATE/ HOMATROPINE METHYLBROMIDE
5 mg; 1.5 mg TAB TABLET $1.4172
HYDROCODONE POLISTRX/ CHLORPHENIRAMINE POLISTIREX
10-8 mg/5 ml SUSP MILLILITER $0.3926
HYDROCODONE/ACETAMINOPHEN 5 mg; 300 mg TAB TABLET $1.6200
HYDROCODONE/ACETAMINOPHEN 7.5 mg; 300 mg TAB TABLET $1.6800
HYDROCODONE/APAP 10 mg; 325 mg TAB TABLET $0.2520
HYDROCODONE/APAP 5 mg; 325 mg TAB TABLET $0.1691
HYDROCODONE/APAP 7.5 mg; 325 mg TAB TABLET $0.1080
HYDROCODONE/IBUPROFEN 7.5 mg; 200 mg TAB TABLET $0.3751
HYDROCORTISONE 1% CRM GRAM $0.0536
HYDROCORTISONE 1% RECTAL CRM GRAM $0.9300
HYDROCORTISONE 1% OINT GRAM $0.1778
HYDROCORTISONE 1% LOT MILLILITER $0.0720
HYDROCORTISONE 2.5% CRM GRAM $0.1080
HYDROCORTISONE 2.5% CRM-RECTAL GRAM $4.9565
HYDROCORTISONE 2.5% OINT GRAM $0.1339
HYDROCORTISONE 2.5% LOT MILLILITER $0.7741
HYDROCORTISONE 20 mg TAB TABLET $0.4443
HYDROCORTISONE BUTYRATE 0.1% CRM GRAM $4.9410
HYDROCORTISONE BUTYRATE/EMOLL 0.1% CRM GRAM $8.2800
HYDROCORTISONE VALERATE 0.2% CRM GRAM $5.8350
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
HYDROMORPHONE HCL 2 mg TAB TABLET $0.0806
HYDROMORPHONE HCL 4 mg TAB TABLET $0.1173
HYDROMORPHONE HCL 8 mg TAB TABLET $0.6720
HYDROMORPHONE HCL 12 mg TAB, ER 24HR TABLET $22.2138
HYDROMORPHONE HCL 16 mg TAB, ER 24HR TABLET $22.7613
HYDROMORPHONE HCL 8 mg TAB, ER 24HR TABLET $12.3765
HYDROXYCHLOROQUINE SULFATE 200 mg TAB TABLET $1.7820
HYDROXYUREA 500 mg CAP CAPSULE $0.4572
HYDROXYZINE HCL 10 mg TAB TABLET $0.1174
HYDROXYZINE HCL 25 mg TAB TABLET $0.1492
HYDROXYZINE HCL 50 mg TAB TABLET $0.2106
HYDROXYZINE PAM 25 mg CAP CAPSULE $0.0618
HYDROXYZINE PAM 50 mg CAP CAPSULE $0.0750
HYDROXYZINE 10 mg/5 ml SYR MILLILITER $0.0555
IBANDRONATE SODIUM 150 mg TAB TABLET $102.9560
IBANDRONATE SODIUM 3 mg/3 ml SYRN MILLILITER $117.1200
IBUPROFEN/OXYCODONE HCL 400 mg; 5 mg TAB TABLET $1.5462
IBUPROFEN/PSEUDOEPHEDRINE HCL 200 mg; 30 mg TAB TABLET $0.2012
IBUPROFEN 50 mg/1.25 ml SUSP MILLILITER $0.3220
IBUPROFEN 100 mg/5 ml ORAL SUSP MILLILITER $0.0365
IBUPROFEN 200 mg TAB TABLET $0.0383
IBUPROFEN 400 mg TAB TABLET $0.0600
IBUPROFEN 600 mg TAB TABLET $0.0720
IBUPROFEN 800 mg TAB TABLET $0.0750
INDAPAMIDE 1.25 mg TAB TABLET $0.3146
IDARUBICIN HCL 1 mg/ml VIAL MILLILITER $19.4670
IFOSFAMIDE 1 gm VIAL EACH $44.3940
IFOSFAMIDE 3 gm VIAL EACH $150.2790
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
IMATINIB MESYLATE 100 mg TAB TABLET $79.8490
IMATINIB MESYLATE 400 mg TAB TABLET $295.7070
IMIPENEM/CILASTATIN SODIUM 250 mg VIAL EACH $5.9063
IMIPENEM/CILASTATIN SODIUM 500 mg VIAL EACH $10.5000
IMIPRAMINE HCL 10 mg TAB TABLET $0.1410
IMIPRAMINE HCL 25 mg TAB TABLET $0.2075
IMIPRAMINE HCL 50 mg TAB TABLET $0.3096
IMIPRAMINE PAMOATE 100 mg CAP CAPSULE $18.2064
IMIPRAMINE PAMOATE 125 mg CAP CAPSULE $16.5944
IMIPRAMINE PAMOATE 150 mg CAP CAPSULE $14.1252
IMIPRAMINE PAMOATE 75 mg CAP CAPSULE $5.1600
IMIQUIMOD 5% CREAM GRAM $6.5270
INDAPAMIDE 2.5 mg TAB TABLET $0.3120
INDOMETHACIN SR 75 mg CAP, SR CAPSULE $3.0750
INDOMETHACIN 25 mg CAP CAPSULE $0.1440
INDOMETHACIN 50 mg CAP CAPSULE $0.0643
IPRATROPIUM BROMIDE 0.03% NASAL INH
SOLN MILLILITER $1.0356
IPRATROPIUM BROMIDE 0.06% NASAL INH
SOLN MILLILITER $2.0712
IPRATROPIUM BROMIDE 0.02% INH SOLN MILLILITER $0.0720
IPRATROPIUM/ALBUTEROL SULFATE 0.5 mg; 2.5 mg/3 ml SOLN MILLILITER $0.0960
IRBESARTAN/HYDROCHLOROTHIAZIDE 150 mg; 12.5 mg TAB TABLET $0.1800
IRBESARTAN/HYDROCHLOROTHIAZIDE 300 mg; 12.5 mg TAB TABLET $0.2964
IRBESARTAN 150 mg TAB TABLET $0.1223
IRBESARTAN 300 mg TAB TABLET $0.3120
IRBESARTAN 75 mg TAB TABLET $0.1440
IRINOTECAN HCL 100 mg/5 ml VIAL MILLILITER $5.9202
IRINOTECAN HCL 40 mg/2 ml VIAL MILLILITER $6.4793
IRON POLYSACCHARIDES COMPLEX 150 mg CAP CAPSULE $0.1427
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
IRON, CARBONYL/FOLIC ACID/MULTIVITAMINS W-MINERALS (ELITE-OB)
50 mg; 1.25 mg TAB TABLET $0.1800
ISONIAZID 300 mg TAB TABLET $0.1215
ISOSORBIDE DINITRATE 10 mg TAB TABLET $0.6480
ISOSORBIDE DINITRATE 20 mg TAB TABLET $0.8325
ISOSORBIDE DINITRATE 30 mg TAB TABLET $0.9750
ISOSORBIDE DINITRATE 40 mg TAB, ER 12HR TABLET $1.5150
ISOSORBIDE DINITRATE 5 mg TAB TABLET $0.6755
ISOSORBIDE MONONITRATE 10 mg TAB TABLET $0.3552
ISOSORBIDE MONONITRATE 120 mg TAB, ER TABLET $0.4200
ISOSORBIDE MONONITRATE 20 mg TAB TABLET $0.3965
ISOSORBIDE MONONITRATE 30 mg TAB, ER TABLET $0.2250
ISOSORBIDE MONONITRATE 60 mg TAB, ER TABLET $0.2340
ISOTRETINOIN 10 mg CAP CAPSULE $6.2136
ISOTRETINOIN 20 mg CAP CAPSULE $7.0191
ISOTRETINOIN 40 mg CAP CAPSULE $12.1920
ITRACONAZOLE 100 mg CAP CAPSULE $6.5000
KETOCONAZOLE 2% SHAMPOO MILLILITER $0.1101
KETOCONAZOLE 2% CRM GRAM $1.2660
KETOCONAZOLE 200 mg TAB TABLET $1.7848
KETOPROFEN 200 mg CAP, SR 24HR TABLET $8.3400
KETOPROFEN 50 mg CAP CAPSULE $0.3840
KETOPROFEN 75 mg CAP CAPSULE $0.4560
KETOROLAC TROMETHAMINE 0.4% DROPS MILLILITER $11.5440
KETOROLAC TROMETHAMINE 0.5% DROPS MILLILITER $1.6800
KETOROLAC TROMETHAMINE 10 mg TAB TABLET $0.8280
KETOROLAC TROMETHAMINE 60 mg/2 ml VIAL MILLILITER $0.5481
LABETALOL HCL 100 mg TAB TABLET $0.2863
LABETALOL HCL 200 mg TAB TABLET $0.4200
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
LABETALOL HCL 300 mg TAB TABLET $0.7500
LACTULOSE 10 gm/15 ml SOLN MILLILITER $0.0150
LACTULOSE 10 gm/15 ml SOLN MILLILITER $0.0150
LAMIVUDINE 100 mg TAB TABLET $11.9700
LAMIVUDINE/ZIDOVUDINE 150 mg; 300 mg TAB TABLET $3.8760
LAMOTRIGINE 100 mg TAB TABLET $0.0600
LAMOTRIGINE 100 mg TAB, ER 24HR TABLET $9.5525
LAMOTRIGINE 100 mg TAB, ODT TABLET $6.8640
LAMOTRIGINE 150 mg TAB TABLET $0.0755
LAMOTRIGINE 200 mg TAB TABLET $0.1092
LAMOTRIGINE 200 mg TAB, ER 24HR TABLET $9.7560
LAMOTRIGINE 200 mg TAB, ODT TABLET $11.8350
LAMOTRIGINE 25 mg TAB, CHEW TABLET $0.3646
LAMOTRIGINE 25 mg TAB TABLET $0.0532
LAMOTRIGINE 25 mg TAB, ER 24HR TABLET $5.7293
LAMOTRIGINE 25 mg TAB, ODT TABLET $5.6855
LAMOTRIGINE 300 mg TAB, ER 24HR TABLET $15.4050
LAMOTRIGINE 5 mg TAB, CHEW TABLET $0.3516
LAMOTRIGINE 50 mg TAB, ER 24HR TABLET $8.9400
LAMOTRIGINE 50 mg TAB, ODT TABLET $6.4320
LANSOPRAZOLE 15 mg CAP, DR CAPSULE $0.5520
LANSOPRAZOLE 30 mg CAP, DR CAPSULE $0.3941
LANSOPRAZOLE/AMOXICILLIN/ CLARITHROMYCIN
30-500-500 EACH COMBINATION
PACKAGE $5.4186
LATANOPROST 0.005% DROPS MILLILITER $2.8128
LEFLUNOMIDE 10 mg TAB TABLET $0.9110
LETROZOLE 2.5 mg TAB TABLET $0.0932
LEUCOVORIN CALCIUM 25 mg TAB TABLET $8.1282
LEUCOVORIN CALCIUM 5 mg TAB TABLET $0.7500
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
LEUPROLIDE ACETATE 1 mg/0.2 ml KIT EACH $228.7500
LEVALBUTEROL HCL 0.31 mg/3 ml VIAL MILLILITER $2.1736
LEVALBUTEROL HCL 0.63 mg/3 ml VIAL MILLILITER $1.5240
LEVALBUTEROL HCL 1.25 mg/3 ml VIAL MILLILITER $0.8073
LEVETIRACETAM 100 mg/ml SOLN MILLILITER $0.0600
LEVETIRACETAM 1000 mg TAB TABLET $0.5400
LEVETIRACETAM 250 mg TAB TABLET $0.0900
LEVETIRACETAM 500 mg/5 ml VIAL MILLILITER $1.3126
LEVETIRACETAM 500 mg TAB, ER 24HR TABLET $0.3600
LEVETIRACETAM 500 mg TAB TABLET $0.1440
LEVETIRACETAM 750 mg TAB, ER 24HR TABLET $0.6900
LEVETIRACETAM 750 mg TAB TABLET $0.2170
LEVOBUNOLOL HCL 0.5% OPTH SOLN MILLILITER $4.1280
LEVOCARNITINE 100 mg/ml LIQ MILLILITER $0.2409
LEVOCARNITINE 200 mg/ml VIAL MILLILITER $2.6712
LEVOCARNITINE 330 mg TAB TABLET $0.7200
LEVOCETIRIZINE DIHYDROCHLORIDE 2.5 mg/5 ml SOLN MILLILITER $0.7050
LEVOCETIRIZINE DIHYDROCHLORIDE 5 mg TAB TABLET $0.1702
LEVOFLOXACIN 250 mg/10 ml ORAL SOLN MILLILITER $1.3890
LEVOFLOXACIN 250 mg TAB TABLET $0.1758
LEVOFLOXACIN 500 mg TAB TABLET $0.2760
LEVOFLOXACIN 750 mg TAB TABLET $1.5240
LEVONORGESTREL/ETHINYL ESTRADIOL (ALESSE, LEVLITE, AVIANE)
0.1 mg; 20 mcg TAB TABLET $0.4097
LEVONORGESTREL/ETHINYL ESTRADIOL (LEVLEN, NORDETTE, LEVORA 0.15/30)
0.15 mg; 30 mcg TAB TABLET $0.3360
LEVONORGESTREL/ETHINYL ESTRADIOL (SEASONALE, JOLESSA, QUASENSE)
0.15 mg; 30 mcg TAB TABLET $0.8123
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 $0.6187
LEVONORGESTREL 1.5 mg TAB TABLET $32.4266
LEVONORGESTREL-ETH ESTRA/ETHINYL ESTRADIOL
100-20(84) TAB, DOSE
PACK TABLET $1.7836
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
LEVONORGESTREL-ETH ESTRA/ETHINYL ESTRADIOL
150-30 (84) TAB, DOSE
PACK, 3 MONTHS
TABLET $1.8240
LEVOTHYROXINE 100 mcg TAB TABLET $0.4180
LEVOTHYROXINE 112 mcg TAB TABLET $0.4782
LEVOTHYROXINE 125 mcg TAB TABLET $0.4848
LEVOTHYROXINE 137 mcg TAB TABLET $0.4915
LEVOTHYROXINE 150 mcg TAB TABLET $0.4990
LEVOTHYROXINE 175 mcg TAB TABLET $0.5930
LEVOTHYROXINE 200 mcg TAB TABLET $0.7266
LEVOTHYROXINE 25 mcg TAB TABLET $0.3146
LEVOTHYROXINE 300 mcg TAB TABLET $1.1700
LEVOTHYROXINE 50 mcg TAB TABLET $0.3611
LEVOTHYROXINE 75 mcg TAB TABLET $0.3990
LEVOTHYROXINE 88 mcg TAB TABLET $0.4104
LIDOCAINE 2% GEL GRAM $0.3750
LIDOCAINE 5% OINT GRAM $3.6128
LIDOCAINE HCL 2% VISCOUS
ORAL MILLILITER $0.0260
LIDOCAINE/PRILOCAINE 2.5-2.5% CRM GRAM $1.2960
LINEZOLID 600 mg TAB TABLET $200.8890
LIOTHYRONINE SODIUM 25 mcg TAB TABLET $0.7619
LIOTHYRONINE SODIUM 5 mcg TAB TABLET $0.5714
LIOTHYRONINE SODIUM 50 mcg TAB TABLET $1.3560
LISINOPRIL/HCTZ 10 mg; 12.5 mg TAB TABLET $0.0296
LISINOPRIL/HCTZ 20 mg; 12.5 mg TAB TABLET $0.0719
LISINOPRIL/HCTZ 20 mg; 25 mg TAB TABLET $0.0641
LISINOPRIL 10 mg TAB TABLET $0.0180
LISINOPRIL 2.5 mg TAB TABLET $0.0141
LISINOPRIL 20 mg TAB TABLET $0.0322
LISINOPRIL 30 mg TAB TABLET $0.0450
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
LISINOPRIL 40 mg TAB TABLET $0.0480
LISINOPRIL 5 mg TAB TABLET $0.0232
LITHIUM CARBONATE 150 mg CAP CAPSULE $0.0552
LITHIUM CARBONATE 300 mg CAP CAPSULE $0.0360
LITHIUM CARBONATE 300 mg TAB, ER TABLET $0.1922
LITHIUM CARBONATE 450 mg TAB, SA TABLET $0.2520
LITHIUM CITRATE 8 mEq/5 ml SYR MILLILITER $0.0450
LOPERAMIDE HCL 2 mg CAP CAPSULE $0.2527
LORATADINE 10 mg TAB, ODT TABLET $0.7866
LORATADINE 10 mg TAB TABLET $0.0632
LORATADINE 5 mg/5 ml SYR MILLILITER $0.0644
LORAZEPAM 0.5 mg TAB TABLET $0.0240
LORAZEPAM 1 mg TAB TABLET $0.0360
LORAZEPAM 2 mg/ml CONC MILLILITER $0.6010
LORAZEPAM 2 mg/ml VIAL MILLILITER $0.8898
LORAZEPAM 2 mg TAB TABLET $0.0480
LOSARTAN POTASSIUM/ HYDROCHLOROTHIAZIDE
100 mg; 25 mg TAB TABLET $0.0968
LOSARTAN POTASSIUM/ HYDROCHLOROTHIAZIDE
100 mg; 12.5 mg TAB TABLET $0.1310
LOSARTAN POTASSIUM/ HYDROCHLOROTHIAZIDE
50 mg; 12.5 mg TAB TABLET $0.0750
LOSARTAN POTASSIUM 100 mg TAB TABLET $0.0928
LOSARTAN POTASSIUM 25 mg TAB TABLET $0.0413
LOSARTAN POTASSIUM 50 mg TAB TABLET $0.0696
LOVASTATIN 10 mg TAB TABLET $0.0804
LOVASTATIN 20 mg TAB TABLET $0.1254
LOVASTATIN 40 mg TAB TABLET $0.0960
LOXAPINE SUCCINATE 10 mg CAP CAPSULE $0.4800
LOXAPINE SUCCINATE 25 mg CAP CAPSULE $0.7080
LOXAPINE SUCCINATE 5 mg CAP CAPSULE $0.4350
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
LOXAPINE SUCCINATE 50 mg CAP CAPSULE $1.2720
MAGNESIUM HYDROXIDE 400 mg/5 ml ORAL SUSP MILLILITER $0.0059
MAGNESIUM OXIDE 400 mg TAB TABLET $0.0150
MALATHION 0.5% LOT MILLILITER $3.6450
MECLIZINE HCL 12.5 mg TAB TABLET $0.0720
MECLIZINE HCL 25 mg TAB TABLET $0.1190
MEDROXYPROGESTERONE ACET 150 mg/ml SYRN EACH $95.1900
MEDROXYPROGESTERONE ACETATE 10 mg TAB TABLET $0.1680
MEDROXYPROGESTERONE ACETATE 2.5 mg TAB TABLET $0.1360
MEDROXYPROGESTERONE ACETATE 5 mg TAB TABLET $0.1560
MEFENAMIC ACID 250 mg CAP CAPSULE $7.6208
MEGESTROL ACETATE 20 mg TAB TABLET $0.2753
MEGESTROL ACETATE 40 mg/ml SUSP MILLILITER $0.0981
MEGESTROL ACETATE 40 mg TAB TABLET $0.2076
MEGESTROL ACETATE 625 mg/5 ml SUSP MILLILITER $6.0488
MELOXICAM 15 mg TAB TABLET $0.0300
MELOXICAM 7.5 mg TAB TABLET $0.0251
MEMANTINE HCL 10 mg TAB TABLET $0.4360
MEMANTINE HCL 5 mg TAB TABLET $0.4690
MEPERIDINE HCL 100 mg TAB TABLET $1.4700
MEPERIDINE HCL 50 mg TAB TABLET $0.7680
MERCAPTOPURINE 50 mg TAB TABLET $3.1650
MEROPENEM 1 gm VIAL EACH $10.9200
MEROPENEM 500 mg VIAL EACH $6.1688
MESALAMINE 4 gm/60 ml ENEMA MILLILITER $0.3000
METAXALONE 800 mg TAB TABLET $5.0883
METFORMIN HCL 1,000 mg TAB TABLET $12.7215
METFORMIN HCL 500 mg TAB, SR TABLET $0.0450
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
METFORMIN HCL 500 mg TAB TABLET $3.9150
METFORMIN HCL 750 mg TAB, SR TABLET $0.1315
METFORMIN 1000 mg TAB TABLET $0.0473
METFORMIN 500 mg TAB TABLET $0.0506
METFORMIN 850 mg TAB TABLET $0.0525
METHADONE HCL 10 mg/ml CONC MILLILITER $1.0115
METHADONE HCL 10 mg TAB TABLET $0.1229
METHADONE HCL 5 mg TAB TABLET $0.2171
METHAZOLAMIDE 50 mg TAB TABLET $4.9920
METHENAMINE HIPPURATE 1 gm TAB TABLET $2.2560
METHIMAZOLE 10 mg TAB TABLET $0.1320
METHIMAZOLE 5 mg TAB TABLET $0.0600
METHOCARBAMOL 500 mg TAB TABLET $0.0717
METHOCARBAMOL 750 mg TAB TABLET $0.0996
METHOTREXATE SODIUM/PF 25 mg/ml VIAL MILLILITER $1.1856
METHOTREXATE 2.5 mg TAB TABLET $1.3680
METHSCOPOLAMINE BROMIDE 5 mg TAB TABLET $1.7760
METHYLDOPA 250 mg TAB TABLET $0.1428
METHYLDOPA 500 mg TAB TABLET $0.1560
METHYLPHENIDATE HCL 10 mg CAP, ER CAPSULE $5.0527
METHYLPHENIDATE HCL 10 mg TAB TABLET $0.5732
METHYLPHENIDATE HCL 18 mg TAB, ER 24HR TABLET $7.4760
METHYLPHENIDATE HCL 20 mg CAP, ER CAPSULE $6.0064
METHYLPHENIDATE HCL 20 mg TAB TABLET $0.8384
METHYLPHENIDATE HCL 27 mg TAB, ER TABLET $6.5229
METHYLPHENIDATE HCL 30 mg CAP, ER CAPSULE $2.5560
METHYLPHENIDATE HCL 36 mg TAB, ER 24HR TABLET $6.7280
METHYLPHENIDATE HCL 40 mg CAP, ER CAPSULE $4.3950
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
METHYLPHENIDATE HCL 5 mg TAB TABLET $0.5040
METHYLPHENIDATE HCL 50 mg CAP, ER CAPSULE $5.4000
METHYLPHENIDATE HCL 54 mg TAB, ER 24HR TABLET $7.3209
METHYLPHENIDATE HCL 60 mg CAP, ER CAPSULE $5.4000
METHYLPREDNISOLONE DOSEPAK 4 mg TAB TABLET $1.0851
METHYLPREDNISOLONE 4 mg TAB TABLET $1.0800
METOCLOPRAMIDE HCL 10 mg TAB TABLET $0.0402
METOCLOPRAMIDE HCL 5 mg/5 ml SYR MILLILITER $0.0150
METOCLOPRAMIDE HCL 5 mg TAB TABLET $0.0450
METOLAZONE 10 mg TAB TABLET $2.1966
METOLAZONE 2.5 mg TAB TABLET $1.2342
METOLAZONE 5 mg TAB TABLET $1.3578
METOPROLOL/HYDROCHLOROTHIAZIDE 50 mg; 25 mg TAB TABLET $1.2000
METOPROLOL SUCCINATE 25 mg TAB, SA TABLET $0.2400
METOPROLOL SUCCINATE 100 mg TAB, SA TABLET $0.3916
METOPROLOL SUCCINATE 200 mg TAB, SA TABLET $0.5550
METOPROLOL SUCCINATE 50 mg TAB, ER TABLET $0.4080
METOPROLOL TARTRATE 100 mg TAB TABLET $0.0510
METOPROLOL TARTRATE 25 mg TAB TABLET $0.0276
METOPROLOL TARTRATE 50 mg TAB TABLET $0.0193
METRONIDAZOLE 0.75% VAG GEL GRAM $1.4379
METRONIDAZOLE 0.75% CRM GRAM $2.3315
METRONIDAZOLE 0.75% GEL GRAM $2.1636
METRONIDAZOLE 0.75% LOT MILLILITER $3.6651
METRONIDAZOLE 1% GEL GRAM $5.4720
METRONIDAZOLE 1% GEL GRAM $5.6422
METRONIDAZOLE 250 mg TAB TABLET $0.2502
METRONIDAZOLE 375 mg CAP CAPSULE $3.8850
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
METRONIDAZOLE 500 mg TAB TABLET $0.4184
MICONAZOLE NITRATE 2% CRM GRAM $0.1704
MICONAZOLE NITRATE 2% VAG CRM GRAM $0.1050
MIDODRINE HCL 10 mg TAB TABLET $1.7520
MIDODRINE HCL 2.5 mg TAB TABLET $1.0511
MIDODRINE HCL 5 mg TAB TABLET $0.4715
MILRINONE LACTATE 1 mg/ml VIAL MILLILITER $0.8204
MILRINONE LACTATE/D5W 20 mg/100 ml IV MILLILITER $0.1596
MILRINONE LACTATE/D5W 40 mg/200 ml IV MILLILITER $0.1675
MINOCYCLINE HCL 100 mg CAP CAPSULE $0.3300
MINOCYCLINE HCL 100 mg TAB TABLET $5.0040
MINOCYCLINE HCL 135 mg TAB, SR 24HR TABLET $3.7850
MINOCYCLINE HCL 45 mg TAB, SR 24HR TABLET $3.7850
MINOCYCLINE HCL 50 mg CAP CAPSULE $0.1920
MINOCYCLINE HCL 75 mg CAP CAPSULE $0.4200
MINOCYCLINE HCL 90 mg TAB, SR 24HR TABLET $5.9832
MINOXIDIL 10 mg TAB TABLET $0.2880
MINOXIDIL 2.5 mg TAB TABLET $0.1560
MIRTAZAPINE SOLTAB 15 mg TAB TABLET $0.3060
MIRTAZAPINE SOLTAB 30 mg TAB TABLET $0.3870
MIRTAZAPINE SOLTAB 45 mg TAB TABLET $0.8280
MIRTAZAPINE 15 mg TAB TABLET $0.1200
MIRTAZAPINE 30 mg TAB TABLET $0.1800
MIRTAZAPINE 45 mg TAB TABLET $0.4560
MIRTAZAPINE 7.5 mg TAB TABLET $1.4684
MISOPROSTOL 100 mcg TAB TABLET $0.4863
MISOPROSTOL 200 mcg TAB TABLET $0.9260
MITOMYCIN 20 mg VIAL EACH $410.0200
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
MITOMYCIN 40 mg VIAL EACH $820.0400
MITOMYCIN 5 mg VIAL EACH $102.5000
MITOXANTRONE HCL 2 mg/ml VIAL MILLILITER $25.4965
MODAFINIL 100 mg TAB TABLET $4.1375
MODAFINIL 200 mg TAB TABLET $5.1600
MOEXIPRIL HCL/HCTZ 15 mg; 12.5 mg TAB TABLET $0.7500
MOEXIPRIL HCL/HCTZ 15 mg; 25 mg TAB TABLET $0.6750
MOEXIPRIL HCL/HCTZ 7.5 mg; 12.5 mg TAB TABLET $0.6750
MOEXIPRIL HCL 7.5 mg TAB TABLET $1.0800
MOMETASONE FUROATE 50 mcg AER GRAM $12.2870
MOMETASONE FUROATE 0.1% CRM GRAM $0.2733
MOMETASONE FUROATE 0.1% OINT GRAM $0.2700
MOMETASONE FUROATE 0.1% SOLN MILLILITER $0.2620
MONTELUKAST SODIUM 10 mg TAB TABLET $0.2659
MONTELUKAST SODIUM 4 mg PACKET EACH $6.0360
MONTELUKAST SODIUM 4 mg TAB, CHEW TABLET $0.3146
MONTELUKAST SODIUM 5 mg TAB, CHEW TABLET $0.1582
MORPHINE SULFATE 10 mg/5 ml SOLN MILLILITER $0.0742
MORPHINE SULFATE 10 mg CAP, ER CAPSULE $3.4350
MORPHINE SULFATE 100 mg CAP, ER CAPSULE $19.1700
MORPHINE SULFATE 100 mg TAB, SR TABLET $2.4240
MORPHINE SULFATE 15 mg TAB, SR TABLET $0.4424
MORPHINE SULFATE 15 mg TAB TABLET $0.1367
MORPHINE SULFATE 20 mg CAP, ER CAPSULE $5.2800
MORPHINE SULFATE 20 mg/ml SOLN MILLILITER $0.4100
MORPHINE SULFATE 200 mg TAB, ER TABLET $2.8775
MORPHINE SULFATE 30 mg CAP, ER CAPSULE $4.8900
MORPHINE SULFATE 30 mg TAB, SR TABLET $0.8406
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
MORPHINE SULFATE 30 mg TAB TABLET $0.2307
MORPHINE SULFATE 50 mg CAP, ER CAPSULE $9.5850
MORPHINE SULFATE 60 mg CAP, ER CAPSULE $10.2900
MORPHINE SULFATE 60 mg TAB, SR TABLET $1.6440
MORPHINE SULFATE 80 mg CAP, ER CAPSULE $16.5546
MOXIFLOXACIN HCL 400 mg TAB TABLET $12.1460
MUPIROCIN 2% OINT GRAM $0.4473
MYCOPHENOLATE MOFETIL 250 mg CAP CAPSULE $0.3882
MYCOPHENOLATE MOFETIL 500 mg TAB TABLET $0.6000
MYCOPHENOLATE SODIUM 180 mg TAB, DR TABLET $5.5394
MYCOPHENOLATE SODIUM 360 mg TAB, DR TABLET $9.8700
NABUMETONE 500 mg TAB TABLET $0.2214
NABUMETONE 750 mg TAB TABLET $0.3278
NADOLOL 20 mg TAB TABLET $1.6300
NADOLOL 40 mg TAB TABLET $1.7760
NADOLOL 80 mg TAB TABLET $2.4300
NALTREXONE HCL 50 mg TAB TABLET $0.9907
NAPROXEN EC 375 mg TAB, DR TABLET $0.3240
NAPROXEN EC 500 mg TAB, DR TABLET $0.1913
NAPROXEN SODIUM 275 mg TAB TABLET $0.0738
NAPROXEN SODIUM 375 mg TAB, ER 24HR TABLET $15.7200
NAPROXEN SODIUM 550 mg TAB TABLET $2.3021
NAPROXEN 250 mg TAB TABLET $0.0488
NAPROXEN 375 mg TAB TABLET $0.0604
NAPROXEN 500 mg TAB TABLET $0.0750
NARATRIPTAN HCL 1 mg TAB TABLET $1.2750
NARATRIPTAN HCL 2.5 mg TAB TABLET $7.6080
NATEGLINIDE 120 mg TAB TABLET $0.9840
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
NATEGLINIDE 60 mg TAB TABLET $0.9750
NEOMYCIN SULFATE/BACITRACIN/POLYMYXIN B 3.5 mg/400 units/5,000
units per gm OINT GRAM $0.0864
NEOMYCIN/POLYMYXIN B/HC 0.1% OTIC SOLN MILLILITER $8.0580
NEOMYCIN/POLYMYXIN B/HC 3.5 mg; 10,000 units; 10
mg per ml OTIC SUSP MILLILITER $9.5490
NEOMYCIN/POLYMYXIN B/DEXAMETHASONE 0.1% OINT GRAM $6.9943
NEOMYCIN/POLYMYXIN B/DEXAMETHASONE 3.5 mg/10,000
units/0.1% per ml OPTH SUSP MILLILITER $4.1040
NEVIRAPINE 200 mg TAB TABLET $0.1950
NEVIRAPINE 400 mg TAB, ER 24HR TABLET $19.8150
NIACIN 1,000 mg TAB, ER 24HR TABLET $3.6762
NIACIN 500 mg TAB, ER 24HR TABLET $1.7562
NIACIN 500 mg TAB, SR TABLET $0.1589
NIACIN 750 mg TAB, ER 24HR TABLET $2.9626
NICOTINE 14 mg/24hr PATCH PATCH $2.0510
NICOTINE 21 mg/24hr PATCH PATCH $2.1150
NICOTINE 7 mg/24hr PATCH PATCH $2.1150
NICOTINE POLACRILEX 2 mg GUM EACH $0.2400
NIFEDIPINE CC 30 mg TAB TABLET $0.5401
NIFEDIPINE CC 60 mg TAB TABLET $0.4650
NIFEDIPINE CC 90 mg TAB TABLET $1.2840
NIFEDIPINE ER 30 mg TAB TABLET $0.3690
NIFEDIPINE ER 60 mg TAB TABLET $0.6480
NIFEDIPINE ER 90 mg TAB TABLET $0.6424
NIFEDIPINE 10 mg CAP CAPSULE $0.7875
NIMODIPINE 30 mg CAP CAPSULE $10.8750
NISOLDIPINE 17 mg TAB, ER 24HR TABLET $7.0800
NISOLDIPINE 25.5 mg TAB, ER 24HR TABLET $8.0352
NISOLDIPINE 34 mg TAB, ER 24HR TABLET $7.8150
NISOLDIPINE 8.5mg TAB, ER 24HR TABLET $5.7150
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
NITROFURANTOIN MACROCRYSTALS 100 mg CAP CAPSULE $1.3650
NITROFURANTOIN MACROCRYSTALS 50 mg CAP CAPSULE $0.7883
NITROFURANTOIN 100 mg CAP CAPSULE $2.1251
NITROGLYCERIN 0.2 mg/hr PATCH PATCH $0.6704
NITROGLYCERIN 0.4 mg/hr PATCH PATCH $0.7048
NITROGLYCERIN 0.6 mg/hr PATCH PATCH $1.2360
NITROGLYCERIN 2.5 mg CAP, SR CAPSULE $0.4200
NITROGLYCERIN 6.5 mg CAP, SR CAPSULE $0.4950
NIZATIDINE 150 mg/10 ml SOLN MILLILITER $0.6900
NIZATIDINE 150 mg CAP CAPSULE $0.3480
NIZATIDINE 300 mg CAP CAPSULE $0.7470
NORETH A-ET ESTRA/FE FUMARATE (LOESTRIN FE, JUNEL FE, MICROGESTIN FE)
1.5 mg; 0.03 mg TAB TABLET $0.3056
NORETH A-ET ESTRA/FE FUMARATE (LOESTRIN FE, JUNEL FE, MICROGESTIN FE)
1 mg; 0.02mg TAB TABLET $0.3056
NORETHINDRONE ACETATE 5 mg TAB TABLET $2.0724
NORETHINDRONE A-E ESTRADIOL (JUNEL, MICROGESTIN, LOESTRIN)
1.5 mg; 0.030 mg TAB TABLET $0.6000
NORETHINDRONE A-E ESTRADIOL (JUNEL, MICROGESTIN, LOESTRIN)
1 mg; 0.02mg TAB TABLET $0.6000
NORETHINDRONE A-E ESTRADIOL/FERROUS FUMARATE (ESTROSTEP FE, TRI-LEGEST FE,
TILIA FE) 5-7-9-7 TAB TABLET $0.9983
NORETHINDRONE (ERRIN, CAMILA, JOLIVETTE, ORTHO MICRONOR)
0.35 mg TAB TABLET $0.5489
NORETHINDRONE-E. ESTRADIOL-IRON 1 mg-20(24) TAB TABLET $2.2680
NORETHINDRONE/ETHINYL ESTRADIOL (BALZIVA, OVCON-35, ZENCHENT)
0.4 mg; 35 mcg TAB TABLET $1.1245
NORETHINDRONE/ETHINYL ESTRADIOL (BREVICON, MODICON, NECON 0.5/35)
0.5 mg; 35 mcg TAB TABLET $0.5160
NORETHINDRONE/ETHINYL ESTRADIOL (NECON 1/35, NORINYL 1+35, ORTHO-NOVUM 1/35)
1 mg; 35 mcg TAB TABLET $0.3156
NORETHINDRONE/ETHINYL ESTRADIOL (NECON 7/7/7, NORTREL 7/7/7, ORTHO-NOVUM 7/7/7)
0.5-35/0.75-35/1-35 mg-mcg
TAB TABLET $0.5348
NORETHINDRONE/MESTRANOL (NECON 1/50, NORINYL 1+50, ORTHO-NOVUM 1/50)
1 mg; 50 mcg TAB TABLET $0.8760
NORETHINDRONE-ETHINYL ESTRADIOL/FERROUS FUMARATE
0.4-35 TAB, CHEW TABLET $1.2840
NORETHINDRONE-ETHINYL ESTRADIOL 7-9-5 TAB TABLET $0.6480
NORGESTIMATE-ETHINYL ESTRADIOL (ORTHO-CYCLEN, SPRINTEC, MONONESSA)
0.25 mg; 35 mcg TAB TABLET $0.2664
NORGESTIMATE-ETHINYL ESTRADIOL (TRI-SPRINTEC, ORTHO TRI-CYCLEN, TRINESSA)
7-7-7 TAB TABLET $0.2690
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
NORGESTREL/ETHINYL ESTRADIOL (LO/OVRAL, LOW-OGESTREL)
0.3 mg; 30 mcg TAB TABLET $0.4682
NORETH-ETHINYL ESTRADIOL/IRON 0.8-25(24) TAB, CHEW TABLET $3.0120
NORGESTIMATE-ETHINYL ESTRADIOL 7 days x 3 LO TAB TABLET $0.3120
NORTRIPTYLINE HCL 10 mg/5 ml SOLN MILLILITER $0.4445
NORTRIPTYLINE HCL 10 mg CAP CAPSULE $0.1205
NORTRIPTYLINE HCL 25 mg CAP CAPSULE $0.2978
NORTRIPTYLINE HCL 50 mg CAP CAPSULE $0.2124
NORTRIPTYLINE HCL 75 mg CAP CAPSULE $0.2804
NYSTATIN 100,000 units/gm CRM GRAM $0.3888
NYSTATIN 100,000 units/gm OINT GRAM $0.9760
NYSTATIN 100,000 units/gm POWDER GRAM $0.8852
NYSTATIN 100,000 units/gm; 0.1% OINT GRAM $3.9777
NYSTATIN 100,000 units/gm; 0.1% CRM GRAM $3.6368
NYSTATIN 100,000 units/ml SUSP MILLILITER $0.1440
NYSTATIN 500k unit TAB TABLET $0.6305
OCTREOTIDE ACETATE 1000 mcg/ml INJ MILLILITER $36.0000
OCTREOTIDE ACETATE 100 mcg/ml VIAL EACH $5.4432
OCTREOTIDE ACETATE 200 mcg/ml VIAL MILLILITER $9.3000
OCTREOTIDE ACETATE 500 mcg/ml VIAL EACH $20.5632
OFLOXACIN 0.3% OPTH SOLN MILLILITER $2.2056
OFLOXACIN 0.3% OTIC SOLN MILLILITER $1.4232
OFLOXACIN 400 mg TAB TABLET $6.5666
OLANZAPINE 10 mg TABLET, RAPID
DISSOLVE TABLET $0.7440
OLANZAPINE 10 mg TABLET TABLET $0.3468
OLANZAPINE 10 mg VIAL EACH $45.1173
OLANZAPINE 15 mg TABLET, RAPID
DISSOLVE TABLET $1.9800
OLANZAPINE 15 mg TABLET TABLET $0.3684
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
OLANZAPINE 2.5 mg TABLET TABLET $0.1680
OLANZAPINE 20 mg TABLET, RAPID
DISSOLVE TABLET $2.6760
OLANZAPINE 20 mg TABLET TABLET $0.6840
OLANZAPINE 5 mg TABLET, RAPID
DISSOLVE TABLET $1.4760
OLANZAPINE 5 mg TABLET TABLET $0.2520
OLANZAPINE 7.5 mg TABLET TABLET $0.1680
OLANZAPINE/FLUOXETINE HCL 3 mg; 25 mg CAP CAPSULE $10.5720
OLOPATADINE HCL 0.1% DROPS MILLILITER $6.9654
OLOPATADINE HCL 0.6% AER GRAM $6.7023
OMEGA-3 ACID ETHYL ESTERS 1 gm CAP CAPSULE $1.8300
OMEPRAZOLE 10 mg CAP, DR CAPSULE $0.2568
OMEPRAZOLE 20 mg CAP, DR CAPSULE $0.0528
OMEPRAZOLE 20 mg TAB, DR TABLET $0.6836
OMEPRAZOLE 40 mg CAP, DR CAPSULE $0.1221
OMEPRAZOLE/SODIUM BICARBONATE 20 mg; 1.1 g CAP CAPSULE $10.8731
ONDANSETRON HCL 4 mg/5 ml SOLN MILLILITER $1.1440
ONDANSETRON HCL 4 mg TAB TABLET $0.1700
ONDANSETRON HCL 8 mg TAB TABLET $0.1575
ONDANSETRON 4 mg TAB, ODT TABLET $0.5344
ONDANSETRON 8 mg TAB, ODT TABLET $0.4920
ORPHENADRINE CITRATE 100 mg TAB, SR TABLET $0.6150
OXALIPLATIN 100 mg/20 ml VIAL EACH $8.7318
OXALIPLATIN 50 mg/10 ml VIAL EACH $8.7326
OXANDROLONE 10 mg TAB TABLET $18.2700
OXANDROLONE 2.5 mg TAB TABLET $3.4950
OXAPROZIN 600 mg TAB TABLET $1.1040
OXAZEPAM 10 mg CAP CAPSULE $0.9840
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
OXAZEPAM 15 mg CAP CAPSULE $0.4406
OXAZEPAM 30 mg CAP CAPSULE $1.7640
OXCARBAZEPINE 150 mg TAB TABLET $0.1146
OXCARBAZEPINE 300 mg/5 ml SUSP MILLILITER $0.6600
OXCARBAZEPINE 300 mg TAB TABLET $0.1818
OXCARBAZEPINE 600 mg TAB TABLET $0.4022
OXYBUTYNIN CHLORIDE 10 mg TAB, SA TABLET $0.8520
OXYBUTYNIN CHLORIDE 15 mg TAB, SA TABLET $0.8196
OXYBUTYNIN CHLORIDE 5 mg TAB, SA TABLET $0.7715
OXYBUTYNIN 5 mg TAB TABLET $0.3917
OXYBUTYNIN 5 mg/5 ml SYR MILLILITER $0.0248
OXYCODONE/APAP 10 mg; 325 mg TAB TABLET $0.8335
OXYCODONE/APAP 5 mg; 325 mg TAB TABLET $0.1680
OXYCODONE/APAP 7.5 mg; 325 mg TAB TABLET $0.7289
OXYCODONE HCL/ASPIRIN 4.8355-325 TAB TABLET $0.4176
OXYCODONE HCL 15 mg TAB TABLET $0.2405
OXYCODONE HCL 20 mg/ml SOLN MILLILITER $7.6563
OXYCODONE HCL 30 mg TAB TABLET $0.4860
OXYCODONE HCL 5 mg TAB TABLET $0.1680
OXYCODONE HCL 10 mg TAB, ER 12HR TABLET $3.0039
OXYCODONE HCL 20 mg TAB, ER 12HR TABLET $5.6022
OXYCODONE HCL 40 mg TAB, ER 12HR TABLET $7.2192
OXYCODONE HCL 80 mg TAB, ER 12HR TABLET $14.0309
OXYMORPHONE HCL 10 mg TAB TABLET $2.7960
OXYMORPHONE HCL 10 mg TAB, ER 12HR TABLET $3.8069
OXYMORPHONE HCL 20 mg TAB, ER 12HR TABLET $6.5700
OXYMORPHONE HCL 30 mg TAB, ER 12HR TABLET $3.7050
OXYMORPHONE HCL 40 mg TAB, ER 12HR TABLET $12.3600
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
OXYMORPHONE HCL 5 mg TAB TABLET $1.7700
OXYMORPHONE HCL 5 mg TAB, ER 12HR TABLET $1.9826
PACLITAXEL 6 mg/ml VIAL MILLILITER $2.1416
PALIPERIDONE 1.5 mg TAB, ER 24HR TABLET $24.7050
PALIPERIDONE 3 mg TAB, ER 24HR TABLET $24.7050
PALIPERIDONE 6 mg TAB, ER 24HR TABLET $19.7640
PALIPERIDONE 9 mg TAB, ER 24HR TABLET $37.0650
PAMIDRONATE DISODIUM 3 mg/ml VIAL MILLILITER $1.7399
PAMIDRONATE DISODIUM 9 mg/ml VIAL MILLILITER $8.2031
PANTOPRAZOLE SODIUM 20 mg TAB, EC TABLET $0.1348
PANTOPRAZOLE SODIUM 40 mg TAB, EC TABLET $0.0927
PARICALCITOL 1 mcg CAP CAPSULE $5.4341
PARICALCITOL 2 mcg CAP CAPSULE $10.9376
PARICALCITOL 4 mcg CAP CAPSULE $21.8750
PAROXETINE HCL 10 mg TAB TABLET $0.0750
PAROXETINE HCL 12.5 mg TAB TABLET $5.0565
PAROXETINE HCL 20 mg TAB TABLET $0.0750
PAROXETINE HCL 25 mg TAB TABLET $3.8115
PAROXETINE HCL 30 mg TAB TABLET $0.1904
PAROXETINE HCL 37.5 mg TAB, SR TABLET $5.4355
PAROXETINE HCL 40 mg TAB TABLET $0.1650
PEG 3350/SOD SULF ANHYD/SODIUM BICARBONATE/SOD CHLORIDE/KCL
236 gm; 22.74 gm SOLN MILLILITER $0.0046
PENICILLIN V POTASSIUM 125 mg/5 mlm 100 ml PWDR for
ORAL SOLN MILLILITER $0.0613
PENICILLIN V POTASSIUM 250 mg/5 ml SUSP RECON MILLILITER $0.0507
PENICILLIN V POTASSIUM 250 mg TAB TABLET $0.1650
PENICILLIN V POTASSIUM 500 mg TAB TABLET $0.2459
PENTAZOCINE/NALOXONE HCL 50 mg; 0.5 mg TAB TABLET $2.2680
PENTOXIFYLLINE 400 mg TAB, CR TABLET $0.1800
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
PERINDOPRIL ERBUMINE 2 mg TAB TABLET $0.6720
PERINDOPRIL ERBUMINE 4 mg TAB TABLET $0.4013
PERINDOPRIL ERBUMINE 8 mg TAB TABLET $0.7151
PERMETHRIN 1% LIQ MILLILITER $0.1080
PERMETHRIN 5% CRM GRAM $1.4785
PERPHENAZINE 2 mg TAB TABLET $1.4550
PERPHENAZINE 4 mg TAB TABLET $1.9800
PERPHENAZINE 8 mg TAB TABLET $2.3184
PHENAZOPYRIDINE HCL 100 mg TAB TABLET $1.1880
PHENAZOPYRIDINE HCL 200 mg TAB TABLET $1.9907
PHENELZINE SULFATE 15 mg TAB TABLET $0.8040
PHENOBARBITAL 15 mg TAB TABLET $0.0378
PHENOBARBITAL 16.2 mg TAB TABLET $0.5610
PHENOBARBITAL 20 mg/5 ml ELIXIR MILLILITER $0.2550
PHENYTOIN 50 mg TAB, CHEW TABLET $0.5684
PHENYTOIN SODIUM 100 mg CAP, ER CAPSULE $0.3582
PHENYTOIN SODIUM 125 mg/5 ml SUSP MILLILITER $0.1332
PILOCARPINE HCL 1% OPTH SOLN MILLILITER $4.5220
PILOCARPINE HCL 2% OPTH SOLN MILLILITER $3.3120
PILOCARPINE HCL 4% OPTH SOLN MILLILITER $7.8000
PILOCARPINE HCL 5 mg TAB TABLET $1.5533
PILOCARPINE HCL 7.5 mg TAB TABLET $2.3921
PIOGLITAZONE HCL/METFORMIN HCL 15 mg; 500 mg TAB TABLET $0.4200
PIOGLITAZONE HCL/METFORMIN HCL 15 mg; 850 mg TAB TABLET $0.4200
PIOGLITAZONE HCL 15 mg TAB TABLET $0.0888
PIOGLITAZONE HCL 30 mg TAB TABLET $0.1408
PIOGLITAZONE HCL 45 mg TAB TABLET $0.1532
PIOGLITAZONE HCL/GLIMEPIRIDE 30 mg; 2 mg TAB TABLET $14.3645
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
PIOGLITAZONE HCL/GLIMEPIRIDE 30 mg; 4 mg TAB TABLET $15.7050
PIPERACILLIN SODIUM/TAZOBACTAM SODIUM 2.25 gm VIAL EACH $5.7750
PIPERACILLIN SODIUM/TAZOBACTAM SODIUM 3.375 gm VIAL EACH $6.6150
PIPERACILLIN SODIUM/TAZOBACTAM SODIUM 4.5 gm VIAL EACH $15.2250
PIPERACILLIN SODIUM/TAZOBACTAM SODIUM 40.5 gm VIAL EACH $140.6376
PIROXICAM 10 mg CAP CAPSULE $1.1489
PIROXICAM 20 mg CAP CAPSULE $3.1680
POLYETHYLENE GLYCOL 17 gm PACKET EACH $1.4550
POLYETHYLENE GLYCOL NA POWDER GRAM $0.0300
POLYVINYL ALCOHOL 1.4% SOLN MILLILITER $0.2040
POTASSIUM BICARB/CITRATE 25 mEq EFFERV TAB TABLET $0.2700
POTASSIUM CHLORIDE 40 mEq/15 ml LIQ MILLILITER $0.4800
POTASSIUM CHLORIDE 10 mEq CAP, CR CAPSULE $0.8880
POTASSIUM CHLORIDE 10 mEq TAB, CR TABLET $0.3300
POTASSIUM CHLORIDE 10 mEq TAB, ER TABLET $0.3360
POTASSIUM CHLORIDE 20 mEq TAB, ER TABLET $0.4560
POTASSIUM CHLORIDE 20 mEq PWDR PCKT EACH $1.0605
POTASSIUM CHLORIDE 20 mEq/15 ml LIQ MILLILITER $0.2400
POTASSIUM CHLORIDE 20 mEq TAB, CR TABLET $0.3720
POTASSIUM CHLORIDE 8 mEq TAB, CR TABLET $0.5987
POTASSIUM CITRATE 15 mEq TAB, ER TABLET $2.3933
PRAMIPEXOLE DI-HCL 0.75 mg TAB TABLET $0.1680
PRAMIPEXOLE DI-HCL 0.375 mg TAB, ER 24HR TABLET $13.4550
PRAMIPEXOLE DI-HCL 0.75 mg TAB, ER 24HR TABLET $13.4550
PRAMIPEXOLE DI-HCL 1.5 mg TAB, ER 24HR TABLET $13.4550
PRAMIPEXOLE DI-HCL 3 mg TAB, ER 24HR TABLET $12.5575
PRAMIPEXOLE DIHYDROCHLORIDE 0.125 mg TAB TABLET $0.1200
PRAMIPEXOLE DIHYDROCHLORIDE 0.25 mg TAB TABLET $0.1655
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
PRAMIPEXOLE DIHYDROCHLORIDE 0.5 mg TAB TABLET $0.0971
PRAMIPEXOLE DIHYDROCHLORIDE 1 mg TAB TABLET $0.1200
PRAMIPEXOLE DIHYDROCHLORIDE 1.5 mg TAB TABLET $0.1200
PRAVASTATIN SODIUM 10 mg TAB TABLET $0.1800
PRAVASTATIN SODIUM 20 mg TAB TABLET $0.2040
PRAVASTATIN SODIUM 40 mg TAB TABLET $0.3960
PRAVASTATIN SODIUM 80 mg TAB TABLET $0.6240
PRAZOSIN HCL 1 mg CAP CAPSULE $0.3921
PRAZOSIN HCL 2 mg CAP CAPSULE $0.7425
PRAZOSIN HCL 5 mg CAP CAPSULE $1.1550
PREDNISOLONE ACETATE 1% OPTH SUSP MILLILITER $13.2720
PREDNISOLONE SODIUM PHOSPHATE 15 mg/5 ml SOLN MILLILITER $0.0902
PREDNISOLONE 15 mg/5 ml SYR MILLILITER $0.0600
PREDNISONE 1 mg TAB TABLET $0.1915
PREDNISONE 2.5 mg TAB TABLET $0.1368
PREDNISONE 5 mg TAB TABLET $0.1920
PREDNISONE 10 mg TAB TABLET $0.1249
PREDNISONE 10 mg TAB,
DOSE PACK TABLET $0.8600
PREDNISONE 20 mg TAB TABLET $0.2250
PNV WITH CA #37/IRON CARB & ASP GLY/FA/OMEGA-3 FATTY ACIDS
(ULTIMATECARE ONE) 27-1-330 mg CAP CAPSULE $0.1800
PNV #72/IRON, CARB & GLUC/FA/DSS/DHA (FOCALGIN 90 DHA)
90-1-300 mg COMBINATION
PACKAGE EACH $0.1800
PNV #73/IRON, CARB & GLUC/ FA/DSS/DHA (FOCALGIN CA)
35-1-50 mg COMBINATION
PACKAGE EACH $0.1800
PRENATAL VIT #16/IRON FUM & PS COMPLEX/FOLIC ACID/OMEGA-3 (TARON-C DHA, DOTHELLE DHA)
35-1-200 mg CAP CAPSULE $0.1800
PRENATAL VIT WITH CA #68/IRON FUMARATE/FOLIC ACID #1/DHA
(ZATEAN-PN PLUS) 28-1-300 mg CAP CAPSULE $0.1800
PRENATAL VIT WITH CALCIUM #66/IRON FUM/FOLIC ACID/DSS/DHA (VIRTPREX)
26-1.2-55 CAP CAPSULE $0.1800
PRENATAL VIT WITH CALCIUM #80/ IRON FUM/FOLIC ACID/DSS/DHA (VIRT-SELECT)
29-1.25-55 CAP CAPSULE $0.1800
PRENATAL VIT 27 WITH CALCIUM/ FERROUS FUM/FOLIC ACID (TRINATAL RX 1)
60 mg; 1 mg TAB TABLET $0.1800
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
PRENATAL VIT #15/IRON, CARBONYL/FOLIC ACID/DOCUSATE SOD (VIRT-ADVANCE)
90-1-50 mg TAB TABLET $0.1800
PRENATAL VIT # 16/IRON, CARBONYL/FOLIC ACID/DOCUSATE SOD (VIRT-VITE GT)
90-1-50 mg TAB TABLET $0.1800
PRENATAL VIT # 81/SODIUM FEREDETATE-IRON POLY/FA/OMEGA-3 (VENA-BAL DHA)
27-1-430 mg COMBINATION
PACKAGE EACH $0.1800
PRENATAL VIT COMB #2/IRON B-G SUC-P/FA/OMEGA-3 (COMPLETE NATAL DHA)
29-1-250 mg COMBINATION
PACKAGE EACH $0.1800
PRENATAL VIT COMB NO. 47/FERROUS FUMARATE/FA CMB #1/DHA
(ZATEAN-PN DHA, RULAVITE DHA, VIRT-PN DHA) 27-1-300 mg CAP CAPSULE $0.1800
PRENATAL VIT COMB #53/IRON B-G HCL SUC-P/FA/OMEGA-3 (TRIVEEN-DUO DHA)
29-1-400 mg COMBINATION
PACKAGE EACH $0.1800
PRENATAL VIT COMB #70/FERROUS FUM/FOLIC ACID/DHA (CALCIUM-PNV 28-1-250 MG)
28-1-250 mg CAP CAPSULE $0.1800
PRENATAL VIT COMB NO. 73/FERROUS FUMARATE/FOLIC ACID (VOL-NATE, VIRT NATE)
28 mg; 1 mg TAB TABLET $0.1800
PRENATAL VIT COMB #74/FERROUS FUM/FOLIC ACID (NIVA-PLUS)
27 mg; 1 mg TAB TABLET $0.1800
PRENATAL VIT COMB #76/IRON, CARBONYL/FOLIC ACID (PNV 29-1)
29 mg; 1 mg TAB TABLET $0.1800
PRENATAL VIT COMBO #14/FERROUS FUM/FOLIC ACID (COMPLETENATE)
29 mg; 1 mg TAB, CHEW TABLET $0.1800
PRENATAL VIT #15/IRON FUM & POLYSAC COMP/FA (FOLIVANE-OB)
85 mg; 1 mg CAP CAPSULE $0.1800
PRENATAL VITS WITHOUT CALC #5/FERROUS FUM/FOLIC ACID (PNV-VP-U)
106.5 mg; 1 mg CAP CAPSULE $0.1800
PRENATAL VIT #106/IRON/FOLATE NO. 6/DHA 27.5 mg; 1 mg CAP CAPSULE $0.1800
PRIMIDONE 50 mg TAB TABLET $0.0621
PRIMIDONE 250 mg TAB TABLET $0.1340
PROBENECID 0.5 gm TAB TABLET $0.7800
PROCHLORPERAZINE MALEATE 10 mg TAB TABLET $0.0584
PROCHLORPERAZINE MALEATE 25 mg SUPP EACH $9.3888
PROCHLORPERAZINE MALEATE 5 mg TAB TABLET $0.0421
PROGESTERONE, MICRONIZED 100 mg CAP CAPSULE $1.5012
PROGESTERONE, MICRONIZED 200 mg CAP CAPSULE $3.4114
PROMETHAZINE HCL 12.5 mg SUPP EACH $11.3400
PROMETHAZINE HCL 12.5 mg TAB TABLET $0.1314
PROMETHAZINE HCL 25 mg/ml AMPUL MILLILITER $1.1025
PROMETHAZINE HCL 25 mg/ml VIAL MILLILITER $1.2894
PROMETHAZINE HCL 25 mg SUPP EACH $10.9500
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
PROMETHAZINE HCL 25 mg TAB TABLET $0.0450
PROMETHAZINE HCL 50 mg/ml AMPUL MILLILITER $2.3310
PROMETHAZINE HCL 50 mg SUPP EACH $39.6000
PROMETHAZINE HCL 50 mg/ml VIAL MILLILITER $2.4192
PROMETHAZINE HCL 50 mg TAB TABLET $0.1682
PROMETHAZINE HCL 6.25 mg/5 ml SYR MILLILITER $0.0128
PROMETHAZINE W/DM 6.25-15/5 SYR MILLILITER $0.0153
PROMETHAZINE/CODEINE 10-6.25/5 ml SYR MILLILITER $0.0205
PROPAFENONE HCL 150 mg TAB TABLET $0.1920
PROPAFENONE HCL 225 mg CAP, ER 12HR CAPSULE $7.3970
PROPAFENONE HCL 225 mg TAB TABLET $0.3300
PROPAFENONE HCL 300 mg TAB TABLET $1.1640
PROPAFENONE HCL 325 mg CAP, ER 12HR CAPSULE $9.3715
PROPAFENONE HCL 425 mg CAP, ER 12HR CAPSULE $9.3715
PROPRANOLOL HCL 10 mg TAB TABLET $0.0401
PROPRANOLOL HCL 120 mg CAP, ER CAPSULE $2.4731
PROPRANOLOL HCL 20 mg TAB TABLET $0.2927
PROPRANOLOL HCL 40 mg TAB TABLET $0.3930
PROPRANOLOL HCL 60 mg CAP, ER CAPSULE $1.7155
PROPRANOLOL HCL 60 mg TAB TABLET $1.0080
PROPRANOLOL HCL 80 mg CAP, ER CAPSULE $2.0594
PROPRANOLOL HCL 80 mg TAB TABLET $0.4920
PROPRANOLOL HCL 160 mg CAP, ER CAPSULE $3.0824
PROPYLTHIOURACIL 50 mg TAB TABLET $0.7950
PROTRIPTYLINE HCL 10 mg TAB TABLET $2.2500
PROTRIPTYLINE HCL 5 mg TAB TABLET $1.7250
PSEUDOEPHEDRINE HCL/CETIRIZINE HCL 120 mg; 5 mg TAB TABLET $0.7956
PSEUDOEPHEDRINE HCL 120 MG TAB, ER TABLET $0.4428
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
PSEUDOEPHEDRINE HCL 30 mg/5 ml LIQ MILLILITER $0.0180
PSEUDOEPHEDRINE HCL 30 mg TAB TABLET $0.0374
PSEUDOEPHEDRINE HCL 60 mg TAB TABLET $0.0329
PSEUDOEPHEDRINE SULFATE/LORATADINE 240 mg; 10 mg TAB, SA TABLET $0.6480
PYRIDOSTIGMINE BROMIDE 60 mg TAB TABLET $0.6718
PYRIDOSTIGMINE BROMIDE 180 mg TAB TABLET $18.8640
QUETIAPINE FUMARATE 100 mg TAB TABLET $0.0768
QUETIAPINE FUMARATE 200 mg TAB TABLET $0.2760
QUETIAPINE FUMARATE 25 mg TAB TABLET $0.0438
QUETIAPINE FUMARATE 300 mg TAB TABLET $0.3960
QUETIAPINE FUMARATE 400 mg TAB TABLET $0.5160
QUETIAPINE FUMARATE 50 mg TAB TABLET $0.1147
QUINAPRIL HCL/HCTZ 10 mg; 12.5 mg TAB TABLET $0.7490
QUINAPRIL HCL/HCTZ 20 mg; 12.5 mg TAB TABLET $0.5040
QUINAPRIL HCL/HCTZ 20 mg; 25 mg TAB TABLET $0.6720
QUINAPRIL HCL 10 mg TAB TABLET $0.2160
QUINAPRIL HCL 20 mg TAB TABLET $0.1508
QUINAPRIL HCL 40 mg TAB TABLET $0.2256
QUINAPRIL HCL 5 mg TAB TABLET $0.1588
QUININE SULFATE 324 mg CAP CAPSULE $3.0450
RABEPRAZOLE SODIUM 20 mg TAB, DR TABLET $0.5905
RALOXIFENE HCL 60 mg TAB TABLET $3.0435
RAMIPRIL 1.25 mg CAP CAPSULE $1.5254
RAMIPRIL 10 mg CAP CAPSULE $0.0750
RAMIPRIL 2.5 mg CAP CAPSULE $0.0598
RAMIPRIL 5 mg CAP CAPSULE $0.1560
RANITIDINE HCL 150 mg/10 ml SYR MILLILITER $0.0324
RANITIDINE HCL 150 mg CAP CAPSULE $0.8280
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
RANITIDINE HCL 150 mg TAB TABLET $0.0673
RANITIDINE HCL 300 mg CAP CAPSULE $1.5076
RANITIDINE HCL 300 mg TAB TABLET $0.1540
REPAGLINIDE 0.5 mg TAB TABLET $0.4500
REPAGLINIDE 1 mg TAB TABLET $0.4800
REPAGLINIDE 2 mg TAB TABLET $0.4800
RIBAVIRIN 200 mg CAP CAPSULE $0.4394
RIBAVIRIN 200 mg TAB TABLET $0.7560
RIFAMPIN 150 mg CAP CAPSULE $19.3200
RIFAMPIN 300 mg CAP CAPSULE $0.9400
RILUZOLE 50 mg TAB TABLET $3.7650
RIMANTADINE HCL 100 mg TAB TABLET $3.2550
RISEDRONATE SODIUM 150 mg TAB TABLET $116.6250
RISEDRONATE SODIUM 35 mg TAB, DR TABLET $35.8600
RISEDRONATE SODIUM 35 mg TAB TABLET $48.9000
RISPERIDONE 0.25 mg TAB TABLET $0.1230
RISPERIDONE 0.5 mg TAB, ODT TABLET $0.6900
RISPERIDONE 0.5 mg TAB TABLET $0.0708
RISPERIDONE 1 mg/ml SOLN MILLILITER $5.9424
RISPERIDONE 1 mg TAB, ODT TABLET $2.2080
RISPERIDONE 1 mg TAB TABLET $0.1242
RISPERIDONE 2 mg TAB, ODT TABLET $2.1720
RISPERIDONE 2 mg TAB TABLET $0.0720
RISPERIDONE 3 mg TAB, ODT TABLET $5.6905
RISPERIDONE 3 mg TAB TABLET $0.2294
RISPERIDONE 4 mg TAB, ODT TABLET $8.7000
RISPERIDONE 4 mg TAB TABLET $0.3240
RIVASTIGMINE TARTRATE 1.5 mg CAP CAPSULE $0.7800
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
RIVASTIGMINE TARTRATE 3 mg CAP CAPSULE $2.3160
RIVASTIGMINE TARTRATE 4.5 mg CAP CAPSULE $0.7650
RIVASTIGMINE TARTRATE 6 mg CAP CAPSULE $0.7800
RIVASTIGMINE 13.3 mg/24hr PATCH EACH $9.8700
RIVASTIGMINE 4.6 mg/24hr PATCH EACH $9.8700
RIVASTIGMINE 9.5 mg/24hr PATCH EACH $9.8700
RIZATRIPTAN BENZOATE 10 mg TAB TABLET $2.0960
RIZATRIPTAN BENZOATE 5 mg TAB TABLET $1.7640
RIZATRIPTAN BENZOATE 10 mg TAB TAB, ODT $1.6500
RIZATRIPTAN BENZOATE 5 mg TAB TAB, ODT $1.6500
ROPINIROLE HCL 0.25 mg TAB TABLET $0.0840
ROPINIROLE HCL 0.5 mg TAB TABLET $0.0780
ROPINIROLE HCL 1 mg TAB TABLET $0.0930
ROPINIROLE HCL 2 mg TAB TABLET $0.1248
ROPINIROLE HCL 3 mg TAB TABLET $0.0960
ROPINIROLE HCL 4 mg TAB TABLET $0.0960
ROPINIROLE HCL 5 mg TAB TABLET $0.0966
ROPINIROLE HCL 12 mg TAB, ER TABLET $6.3840
ROPINIROLE HCL 2 mg TAB, ER TABLET $1.1280
ROPINIROLE HCL 4 mg TAB, ER TABLET $3.0120
ROPINIROLE HCL 6 mg TAB, ER TABLET $3.8550
ROPINIROLE HCL 8 mg TAB, ER TABLET $4.5240
SALICYLIC ACID 6% SHAMPOO GRAM $0.1320
SANCTURA 20 mg TAB TABLET $1.2386
SELEGILINE HCL 5 mg TAB TABLET $1.6392
SENNOSIDES A&B, CALCIUM 8.6 mg TAB TABLET $0.0271
SENNOSIDES/DOCUSATE SODIUM 8.6 mg; 50 mg TAB TABLET $0.0282
SERTRALINE HCL 100 mg TAB TABLET $0.0656
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
SERTRALINE HCL 20 mg/ml CONC MILLILITER $1.0532
SERTRALINE HCL 25 mg TAB TABLET $0.0450
SERTRALINE HCL 50 mg TAB TABLET $0.0776
SILDENAFIL CITRATE 20 mg TAB TABLET $0.3840
SILVER SULFADIAZINE 1% CRM GRAM $0.2397
SIMETHICONE 40 mg/0.6 ml DROPS MILLILITER $0.0908
SIMETHICONE 80 mg TAB, CHEW TABLET $0.0260
SIMVASTATIN 10 mg TAB TABLET $0.0240
SIMVASTATIN 20 mg TAB TABLET $0.0212
SIMVASTATIN 40 mg TAB TABLET $0.0480
SIMVASTATIN 5 mg TAB TABLET $0.0600
SIMVASTATIN 80 mg TAB TABLET $0.0684
SIROLIMUS 0.5 mg TAB TABLET $7.9788
SIROLIMUS 1 mg TAB TABLET $9.1390
SIROLIMUS 2 mg TAB TABLET $27.7800
SODIUM CHLORIDE/SODIUM BICARBONATE 420 g SOLN GRAM $0.0041
SODIUM CHLORIDE 0.9%; 100 ml IV MILLILITER $0.0155
SODIUM CHLORIDE 0.9%; 1000 ml IV MILLILITER $0.0024
SODIUM CHLORIDE 0.9%; 150 ml IV MILLILITER $0.0134
SODIUM CHLORIDE 0.9%; 25 ml IV MILLILITER $0.0641
SODIUM CHLORIDE 0.9%; 250 ml IV MILLILITER $0.0150
SODIUM CHLORIDE 0.9%; 50 ml IV MILLILITER $0.0300
SODIUM CHLORIDE 0.9%; 500 ml IV MILLILITER $0.0066
SODIUM FLUORIDE 0.5 mg TAB, CHEW TABLET $0.0300
SODIUM FLUORIDE 0.25 mg TAB, CHEW TABLET $0.0450
SODIUM FLUORIDE 0.5 mg/ml DROPS MILLILITER $0.2040
SODIUM FLUORIDE 1 mg TAB, CHEW TABLET $0.0450
SODIUM FLUORIDE 1.1% CRM GRAM $0.1080
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
SODIUM SULFATE/SODIUM CHLORIDE/SODIUM BICARBONATE/POTASSIUM
CHLORIDE/POLYETHYLENE GLYCOL N/A SOLN MILLILITER $0.0035
SODIUM POLYSTYRENE SULFONATE N/A POWDER GRAM $0.2280
SOTALOL HCL 120 mg TAB TABLET $0.2147
SOTALOL HCL 160 mg TAB TABLET $0.1650
SOTALOL HCL 240 mg TAB TABLET $0.1500
SOTALOL HCL 80 mg TAB TABLET $0.0756
SPIRONOLACTONE/HCTZ 25 mg; 25 mg TAB TABLET $1.1520
SPIRONOLACTONE 100 mg TAB TABLET $0.1856
SPIRONOLACTONE 25 mg TAB TABLET $0.0767
SPIRONOLACTONE 50 mg TAB TABLET $0.1151
STAVUDINE 15 mg CAP CAPSULE $6.3890
STAVUDINE 20 mg CAP CAPSULE $1.8240
STAVUDINE 30 mg CAP CAPSULE $3.0642
STAVUDINE 40 mg CAP CAPSULE $3.2640
SUCRALFATE 1 gm TAB TABLET $0.2544
SULFACETAMIDE SODIUM 10% OPTH SOLN MILLILITER $3.7632
SULFACETAMIDE SODIUM/SULFUR 10%-2% CRM GRAM $7.3950
SULFACETAMIDE SODIUM/SULFUR 10-5% (w/w) CLEANSER GRAM $0.3543
SULFASALAZINE 500 mg TAB, DR TABLET $0.2640
SULFASALAZINE 500 mg TAB TABLET $0.1714
SULINDAC 150 mg TAB TABLET $0.2100
SULINDAC 200 mg TAB TABLET $0.2550
SUMATRIPTAN SUCCINATE 100 mg TAB TABLET $0.8217
SUMATRIPTAN SUCCINATE 25 mg TAB TABLET $0.8100
SUMATRIPTAN SUCCINATE 4 mg/0.5 ml KIT EACH $231.8850
SUMATRIPTAN SUCCINATE 4 mg/0.5 ml REFILL EACH $219.6300
SUMATRIPTAN SUCCINATE 50 mg TAB TABLET $0.6480
SUMATRIPTAN SUCCINATE 6 mg/0.5 ml KIT EACH $157.5000
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
SUMATRIPTAN SUCCINATE 6 mg/0.5 ml REFILL EACH $179.8500
SUMATRIPTAN SUCCINATE 6 mg/0.5 ml VIAL MILLILITER $57.0600
SUMATRIPTAN 20 mg NASAL SPRAY MILLILITER $54.5550
SUMATRIPTAN 5 mg NASAL SPRAY MILLILITER $54.5550
TACROLIMUS ANHYDROUS 0.5 mg CAP CAPSULE $1.1520
TACROLIMUS ANHYDROUS 1 mg CAP CAPSULE $2.0040
TACROLIMUS ANHYDROUS 5 mg CAP CAPSULE $11.5560
TACROLIMUS 0.03% OINT GRAM $8.3400
TACROLIMUS 0.1% OINT GRAM $6.9750
TAMOXIFEN CITRATE 10 mg TAB TABLET $0.2160
TAMOXIFEN CITRATE 20 mg TAB TABLET $0.4356
TAMSULOSIN HCL 0.4 mg CAP, SR 24HR CAPSULE $0.2090
TELMISARTAN 20 mg TAB TABLET $0.8880
TELMISARTAN 40 mg TAB TABLET $3.1440
TELMISARTAN 80 mg TAB TABLET $5.5208
TELMISARTAN/HYDROCHLOROTHIAZIDE 40 mg; 12.5 mg TAB TABLET $2.6225
TELMISARTAN/HYDROCHLOROTHIAZIDE 80 mg; 25 mg TAB TABLET $2.6225
TELMISARTAN/HYDROCHLOROTHIAZIDE 80 mg; 12.5 mg TAB TABLET $3.1440
TEMAZEPAM 15 mg CAP CAPSULE $0.0589
TEMAZEPAM 22.5 mg CAP CAPSULE $5.0850
TEMAZEPAM 30 mg CAP CAPSULE $0.1096
TEMAZEPAM 7.5 mg CAP CAPSULE $6.1882
TEMOZOLOMIDE 100 mg CAP CAPSULE $126.5100
TEMOZOLOMIDE 140 mg CAP CAPSULE $204.6600
TEMOZOLOMIDE 180 mg CAP CAPSULE $263.1450
TEMOZOLOMIDE 20 mg CAP CAPSULE $29.2350
TEMOZOLOMIDE 250 mg CAP CAPSULE $465.5880
TEMOZOLOMIDE 5 mg CAP CAPSULE $7.2600
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
TERAZOSIN 1 mg CAP CAPSULE $0.1038
TERAZOSIN 10 mg CAP CAPSULE $0.0845
TERAZOSIN 2 mg CAP CAPSULE $0.1012
TERAZOSIN 5 mg CAP CAPSULE $0.0915
TERBINAFINE HCL 250 mg TAB TABLET $0.1650
TERBUTALINE SULFATE 2.5 mg TAB TABLET $1.1640
TERBUTALINE SULFATE 5 mg TAB TABLET $1.4154
TERCONAZOLE 0.4% CRM GRAM $0.8550
TERCONAZOLE 80 mg SUPP EACH $36.4800
TESTOSTERONE 1.25 gm (1%) GEL GRAM $2.7000
TESTOSTERONE 25 mg (1%) GEL GRAM $5.3250
TESTOSTERONE 50 mg (1%) GEL GRAM $2.5200
TESTOSTERONE 50 mg (1%) GEL GRAM $3.3420
TETRABENAZINE 12.5 mg TAB TABLET $69.3440
TETRABENAZINE 25 mg TAB TABLET $138.6990
TETRACYCLINE HCL 250 mg CAP CAPSULE $6.0480
TETRACYCLINE HCL 500 mg CAP CAPSULE $11.9160
THEOPHYLLINE 200 mg TAB, SR 12HR TABLET $0.4446
THEOPHYLLINE 300 mg TAB, SR 12HR TABLET $0.3632
THEOPHYLLINE ANHYDROUS 100 mg TAB, ER TABLET $0.4678
THIORIDAZINE HCL 10 mg TAB TABLET $0.4650
THIORIDAZINE HCL 100 mg TAB TABLET $0.9150
THIORIDAZINE HCL 25 mg TAB TABLET $0.5111
THIORIDAZINE HCL 50 mg TAB TABLET $0.3720
THIOTHIXENE 1 mg CAP CAPSULE $0.7650
THIOTHIXENE 10 mg CAP CAPSULE $2.1750
THIOTHIXENE 2 mg CAP CAPSULE $0.2649
THIOTHIXENE 5 mg CAP CAPSULE $1.5450
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
TIAGABINE HCL 2 mg TAB TABLET $7.3950
TIAGABINE HCL 4 mg TAB TABLET $6.5540
TICLOPIDINE HCL 250 mg TAB TABLET $1.5668
TIMOLOL MALEATE/DORZOLAMIDE HCL 0.5%-2% DROPS MILLILITER $1.0764
TIMOLOL MALEATE 0.25% GEL MILLILITER $21.0840
TIMOLOL MALEATE 0.25% OPTH SOLN MILLILITER $0.7689
TIMOLOL MALEATE 0.5% GEL MILLILITER $22.7016
TIMOLOL MALEATE 0.5% OPTH SOLN MILLILITER $0.8592
TIZANIDINE HCL 2 mg CAP CAPSULE $1.7160
TIZANIDINE HCL 2 mg TAB TABLET $0.1440
TIZANIDINE HCL 4 mg CAP CAPSULE $1.7040
TIZANIDINE HCL 4 mg TAB TABLET $0.1800
TIZANIDINE HCL 6 mg CAP CAPSULE $3.2520
TOBRAMYCIN IN 0.225% NACL 300 mg/5 ml AMPUL MILLILITER $18.7343
TOBRAMYCIN SULFATE/DEXAMETHASONE 0.3-0.1% SUSP MILLILITER $15.1200
TOBRAMYCIN SULFATE 1.2 gm VIAL EACH $101.9813
TOLCAPONE 100 mg TAB TABLET $128.4551
TOLNAFTATE 1% CRM GRAM $0.0800
TOLTERODINE TARTRATE 1 mg TAB TABLET $0.9900
TOLTERODINE TARTRATE 2 mg TAB TABLET $1.0650
TOLTERODINE TARTRATE 2 mg CAP, ER 24HR CAPSULE $5.5665
TOLTERODINE TARTRATE 4 mg CAP, ER 24HR CAPSULE $7.0080
TOPIRAMATE 100 mg TAB TABLET $0.0740
TOPIRAMATE 15 mg CAP,
SPRINKLES CAPSULE $1.2724
TOPIRAMATE 200 mg TAB TABLET $0.2328
TOPIRAMATE 25 mg CAP,
SPRINKLES CAPSULE $1.2084
TOPIRAMATE 25 mg TAB TABLET $0.0574
TOPIRAMATE 50 mg TAB TABLET $0.0882
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
TOPOTECAN HCL 4 mg VIAL EACH $157.5000
TORSEMIDE 10 mg TAB TABLET $0.0960
TORSEMIDE 100 mg TAB TABLET $0.2400
TORSEMIDE 20 mg TAB TABLET $0.0969
TORSEMIDE 5 mg TAB TABLET $0.1264
TRAMADOL HCL/APAP 37.5 mg; 325 mg TAB TABLET $0.3761
TRAMADOL HCL 100 mg TAB, SR TABLET $0.7750
TRAMADOL HCL 100 mg TAB TABLET $2.2930
TRAMADOL HCL 200 mg TAB, SR TABLET $3.5500
TRAMADOL HCL 300 mg TAB TABLET $4.8600
TRAMADOL HCL 300 mg TAB TABLET $9.5030
TRAMADOL 50 mg TAB TABLET $0.0227
TRANDOLAPRIL 1 mg TAB TABLET $0.6720
TRANDOLAPRIL 2 mg TAB TABLET $0.3163
TRANDOLAPRIL 4 mg TAB TABLET $0.5349
TRANEXAMIC ACID 650 mg TAB TABLET $3.5150
TRANYLCYPROMINE SULFATE 10 mg TAB TABLET $2.2118
TRAZODONE HCL 100 mg TAB TABLET $0.0509
TRAZODONE HCL 150 mg TAB TABLET $0.3430
TRAZODONE HCL 300 mg TAB TABLET $3.0300
TRAZODONE HCL 50 mg TAB TABLET $0.0631
TRETINOIN MICROSPHERES 0.04% GEL GRAM $12.0450
TRETINOIN MICROSPHERES 0.04% GEL GRAM $15.7485
TRETINOIN MICROSPHERES 0.1% GEL GRAM $7.3773
TRETINOIN MICROSPHERES 0.1% GEL GRAM $12.5988
TRETINOIN 10 mg CAP CAPSULE $18.9300
TRETINOIN 0.01% GEL GRAM $6.3150
TRETINOIN 0.025% CRM GRAM $5.5236
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
TRETINOIN 0.025% GEL GRAM $6.3710
TRETINOIN 0.05% CRM GRAM $6.6885
TRETINOIN 0.05% GEL GRAM $6.4067
TRETINOIN 0.1% CRM GRAM $4.9560
TRIAMCINOLONE ACETONIDE 0.025% LOT MILLILITER $0.4410
TRIAMCINOLONE ACETONIDE 0.1% CRM GRAM $0.2136
TRIAMCINOLONE ACETONIDE 0.1% OINT GRAM $0.3184
TRIAMCINOLONE ACETONIDE 0.1% PASTE GRAM $13.1850
TRIAMCINOLONE ACETONIDE 0.1% LOT MILLILITER $0.4410
TRIAMCINOLONE ACETONIDE 0.5% CRM GRAM $0.7390
TRIAMCINOLONE ACETONIDE 0.025%, 15 gm CRM GRAM $0.2928
TRIAMCINOLONE ACETONIDE 0.025%, 80 gm CRM GRAM $0.1251
TRIAMCINOLONE ACETONIDE 0.025%, 80 gm OINT GRAM $0.1050
TRIAMTERENE/HYDROCHLOROTHIAZIDE 37.5 mg; 25 mg CAP CAPSULE $0.1869
TRIAMTERENE/HYDROCHLOROTHIAZIDE 37.5 mg; 25 mg TAB TABLET $0.2270
TRIAMTERENE/HYDROCHLOROTHIAZIDE 75 mg; 50 mg TAB TABLET $0.0840
TRIAZOLAM 0.125 mg TAB TABLET $1.0515
TRIAZOLAM 0.25 mg TAB TABLET $1.0253
TRIFLUOPERAZINE HCL 1 mg TAB TABLET $0.8264
TRIFLUOPERAZINE HCL 10 mg TAB TABLET $2.3100
TRIFLUOPERAZINE HCL 2 mg TAB TABLET $1.2150
TRIFLUOPERAZINE HCL 5 mg TAB TABLET $1.2240
TRIHEXYPHENIDYL HCL 2 mg TAB TABLET $0.0660
TRIHEXYPHENIDYL HCL 5 mg TAB TABLET $0.1350
TRIMETHOBENZAMIDE HCL 300 mg CAP CAPSULE $1.2035
TRIMETHOPRIM AND SULFAMETHOXAZOLE 40 mg, 200 mg per 5 ml SUSP MILLILITER $0.2794
TRIMETHOPRIM AND SULFAMETHOXAZOLE DS 160 mg; 800 mg TAB TABLET $0.0600
TRIMETHOPRIM AND SULFAMETHOXAZOLE SS 80 mg; 400 mg TAB TABLET $0.1249
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
TRIMETHOPRIM/POLYMYXIN B 1 mg/10,000 units/ml OPTH SOLN MILLILITER $0.2412
TRIMETHOPRIM 100 mg TAB TABLET $0.3725
TROSPIUM CHLORIDE 60 mg CAP, ER 24HR CAPSULE $5.7240
URSODIOL 250 mg TAB TABLET $1.8240
URSODIOL 300 mg CAP CAPSULE $3.9720
URSODIOL 500 mg TAB TABLET $4.4640
VALACYCLOVIR HCL 1000 mg TAB TABLET $1.0559
VALACYCLOVIR HCL 500 mg TAB TABLET $0.3960
VALGANCICLOVIR HCL 450 mg TAB TABLET $55.9197
VALPROIC ACID 250 mg/5 ml SYR MILLILITER $0.0396
VALPROIC ACID 250 mg CAP CAPSULE $0.1920
VALSARTAN 160 mg TAB TABLET $0.3539
VALSARTAN/HYDROCHLOROTHIAZIDE 160 mg; 12.5 mg TAB TABLET $0.3371
VALSARTAN/HYDROCHLOROTHIAZIDE 160 mg; 25 mg TAB TABLET $0.3483
VALSARTAN/HYDROCHLOROTHIAZIDE 320 mg; 12.5 mg TAB TABLET $0.4180
VALSARTAN/HYDROCHLOROTHIAZIDE 320 mg; 25 mg TAB TABLET $0.4050
VALSARTAN/HYDROCHLOROTHIAZIDE 80 mg; 12.5 mg TAB TABLET $0.2979
VANCOMYCIN HCL 125 mg CAP CAPSULE $10.5000
VANCOMYCIN HCL 250 mg CAP CAPSULE $15.2306
VANCOMYCIN HCL 1 gm VIAL EACH $6.5310
VANCOMYCIN HCL 5 gm VIAL EACH $31.6050
VANCOMYCIN HCL 500 mg VIAL EACH $3.8536
VENLAFAXINE HCL 37.5 mg TAB TABLET $0.3000
VENLAFAXINE HCL 75 mg TAB TABLET $0.2420
VENLAFAXINE HCL 100 mg TAB TABLET $0.4080
VENLAFAXINE HCL 150 mg CAP, SA 24HR CAPSULE $0.2093
VENLAFAXINE HCL 150 mg TAB, ER TABLET $4.5720
VENLAFAXINE HCL 25 mg TAB TABLET $0.2640
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
VENLAFAXINE HCL 37.5 mg CAP, SA 24HR CAPSULE $0.1440
VENLAFAXINE HCL 37.5 mg TAB, ER TABLET $2.9636
VENLAFAXINE HCL 50 mg TAB TABLET $0.2160
VENLAFAXINE HCL 75 mg CAP, SA 24HR CAPSULE $0.1673
VENLAFAXINE HCL 75 mg TAB, ER TABLET $2.5360
VERAPAMIL HCL 100 mg CAP, ER CAPSULE $1.3350
VERAPAMIL HCL 120 mg CAP, SR CAPSULE $0.8213
VERAPAMIL HCL 120 mg TAB, SR TABLET $0.2364
VERAPAMIL HCL 120 mg TAB TABLET $0.0923
VERAPAMIL HCL 180 mg CAP, SR CAPSULE $0.8520
VERAPAMIL HCL 180 mg TAB, SR TABLET $0.2742
VERAPAMIL HCL 200 mg CAP, ER CAPSULE $1.9542
VERAPAMIL HCL 240 mg CAP, SR CAPSULE $0.9720
VERAPAMIL HCL 240 mg TAB, SR TABLET $0.0826
VERAPAMIL HCL 300 mg CAP, ER CAPSULE $4.3332
VERAPAMIL HCL 360 mg CAP, SR CAPSULE $2.8639
VERAPAMIL HCL 80 mg TAB TABLET $0.1080
VINCRISTINE SULFATE 1 mg/ml VIAL MILLILITER $8.1000
VINCRISTINE SULFATE 2 mg/2 ml VIAL MILLILITER $7.0274
VINORELBINE TARTRATE 10 mg/ml VIAL MILLILITER $23.6250
VINORELBINE TARTRATE 50 mg/5 ml VIAL MILLILITER $18.9000
VORICONAZOLE 200 mg TAB TABLET $31.6320
VORICONAZOLE 50 mg TAB TABLET $12.6974
WARFARIN SODIUM 1 mg TAB TABLET $0.1274
WARFARIN SODIUM 10 mg TAB TABLET $0.1500
WARFARIN SODIUM 2 mg TAB TABLET $0.1800
WARFARIN SODIUM 2.5 mg TAB TABLET $0.1369
WARFARIN SODIUM 3 mg TAB TABLET $0.2102
Effective June 10, 2016
STATE MAC LIST OFFICE OF MEDICAL ASSISTANCE PROGRAMS
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
WARFARIN SODIUM 4 mg TAB TABLET $0.1261
WARFARIN SODIUM 5 mg TAB TABLET $0.1842
WARFARIN SODIUM 6 mg TAB TABLET $0.1650
WARFARIN SODIUM 7.5 mg TAB TABLET $0.3614
ZAFIRLUKAST 10 mg TAB TABLET $1.6876
ZAFIRLUKAST 20 mg TAB TABLET $1.5504
ZALEPLON 10 mg CAP CAPSULE $0.1728
ZALEPLON 5 mg CAP CAPSULE $0.1724
ZIDOVUDINE 100 mg CAP CAPSULE $1.9200
ZIDOVUDINE 300 mg TAB TABLET $0.3600
ZIDOVUDINE 50 mg/5 ml SYR MILLILITER $0.2187
ZIPRASIDONE HCL 20 mg CAP CAPSULE $0.7320
ZIPRASIDONE HCL 40 mg CAP CAPSULE $0.9150
ZIPRASIDONE HCL 60 mg CAP CAPSULE $0.7800
ZIPRASIDONE HCL 80 mg CAP CAPSULE $0.8520
ZOLMITRIPTAN 2.5 mg TAB, ODT TABLET $11.1450
ZOLMITRIPTAN 2.5 mg TAB TABLET $10.0740
ZOLMITRIPTAN 5 mg TAB, ODT TABLET $11.8800
ZOLMITRIPTAN 5 mg TAB TABLET $11.1300
ZOLPIDEM TARTRATE 10 mg TAB TABLET $0.0338
ZOLPIDEM TARTRATE 12.5 mg TAB, ER TABLET $1.0284
ZOLPIDEM TARTRATE 5 mg TAB TABLET $0.0332
ZOLPIDEM TARTRATE 6.25 mg TAB, ER TABLET $4.0800
ZONISAMIDE 100 mg CAP CAPSULE $0.2034
ZONISAMIDE 25 mg CAP CAPSULE $0.0845
ZONISAMIDE 50 mg CAP CAPSULE $0.1350
Effective June 10, 2016
