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Drug Form Current MAC
Price
Effective
Date
Date
Updated
1ST CHOICE LANCETS SUPER (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
1ST CHOICE LANCETS THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
1ST CHOICE LANCETS ULTRA (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
1ST TIER UNILET COMFORTOU (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
4-N-1 (Dimethicone Cream 1%) CREA 0.06060 04/28/2005 02/19/2013
80% PROTEIN SUPPLEMENT (Nutritional Supplement
Powder**)
POWD 0.20315 04/05/2011 02/19/2013
A & D ZINC OXIDE (Dimethicone-Zinc Oxide-Vitamin
A-Vitamin D
CREA 0.02730 04/28/2005 02/19/2013
A + D PERSONAL CARE LOTIO (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
A+D FIRST AID (Skin Protectants Misc - Ointment***) OINT 0.03040 04/28/2005 02/19/2013
A1C NOW (Blood Glucose Monitoring Kit w/ Device***) KIT 0.71000 10/01/2003 02/19/2013
A1C NOW SELFCHECK (Blood Glucose Monitoring Kit w/
Device***
KIT 0.71000 10/01/2003 02/19/2013
ABSORBASE (Skin Protectants Misc - Ointment***) OINT 0.03040 04/28/2005 02/19/2013
Acarbose Tab 100 MG TABS 0.65500 02/22/2013 02/19/2013
Acarbose Tab 25 MG TABS 0.51063 02/22/2013 02/19/2013
Acarbose Tab 50 MG TABS 0.46964 02/22/2013 02/19/2013
ACCU-CHEK ACTIVE STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ACCU-CHEK ADVANTAGE DIABE (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
ACCU-CHEK ADVANTAGE TEST (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ACCU-CHEK AVIVA (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ACCU-CHEK AVIVA PLUS (Blood Glucose Monitoring Kit w/
Device
KIT 0.71000 10/01/2003 02/19/2013
ACCU-CHEK AVIVA PLUS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ACCU-CHEK COMFORT CURVE T (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
ACCU-CHEK COMPACT STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ACCU-CHEK COMPACT TEST DR (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
ACCU-CHEK FASTCLIX LANCET (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ACCU-CHEK INSTANT GLUCOSE (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
ACCU-CHEK INSTANT PLUS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ACCU-CHEK MULTICLIX LANCE (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ACCU-CHEK NANO SMARTVIEW (Blood Glucose
Monitoring Kit w/ De
KIT 0.71000 10/01/2003 02/19/2013
ACCU-CHEK SAFE-T-PRO LANC (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ACCU-CHEK SAFE-T-PRO PLUS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ACCU-CHEK SMARTVIEW STRIP (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ACCU-CHEK SOFT TOUCH LANC (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ACCU-CHEK SOFTCLIX LANCET (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ACCU-CHEK VOICEMATE (Blood Glucose Monitoring Kit w/
Device*
KIT 0.71000 10/01/2003 02/19/2013
ACCUTREND GLUCOSE (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
Page 1 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Acebutolol HCl Cap 200 MG CAPS 0.18512 02/22/2013 02/19/2013
Acebutolol HCl Cap 400 MG CAPS 0.26985 02/22/2013 02/19/2013
ACERFLEX (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
Acetaminophen Cap 500 MG CAPS 0.03450 02/22/2013 02/19/2013
Acetaminophen Chew Tab 160 MG CHEW 0.10010 02/22/2013 02/19/2013
Acetaminophen Chew Tab 80 MG CHEW 0.04180 02/22/2013 02/19/2013
Acetaminophen Elixir 160 MG/5ML ELIX 0.01230 02/22/2013 02/19/2013
Acetaminophen Liquid 160 MG/5ML LIQD 0.00772 02/22/2013 02/19/2013
Acetaminophen Liquid 167 MG/5ML LIQD 0.01930 02/22/2013 02/19/2013
Acetaminophen Soln 100 MG/ML SOLN 0.04507 02/22/2013 02/19/2013
Acetaminophen Soln 160 MG/5ML SOLN 0.01230 02/22/2013 02/19/2013
Acetaminophen Suppos 120 MG SUPP 0.25480 02/22/2013 02/19/2013
Acetaminophen Suppos 650 MG SUPP 0.26585 02/22/2013 02/19/2013
Acetaminophen Susp 160 MG/5ML SUSP 0.01509 02/22/2013 02/19/2013
Acetaminophen Susp 80 MG/0.8ML SUSP 0.02060 02/22/2013 02/19/2013
Acetaminophen Tab 325 MG TABS 0.00686 02/22/2013 02/19/2013
Acetaminophen Tab 500 MG TABS 0.01092 02/22/2013 02/19/2013
Acetaminophen Tab CR 650 MG TBCR 0.05936 02/22/2013 02/19/2013
Acetaminophen w/ Codeine Soln 120-12 MG/5ML SOLN 0.01600 02/22/2013 02/19/2013
Acetaminophen w/ Codeine Tab 300-15 MG TABS 0.15000 02/22/2013 02/19/2013
Acetaminophen w/ Codeine Tab 300-30 MG TABS 0.12455 02/22/2013 02/19/2013
Acetaminophen w/ Codeine Tab 300-60 MG TABS 0.27335 02/22/2013 02/19/2013
Acetaminophen w/ Hydrocodone Tab 500-2.5 MG TABS 0.11650 02/22/2013 02/19/2013
Acetaminophen-Isometheptene-Dichloral Cap 325-65-100
MG
CAPS 0.98020 02/22/2013 02/19/2013
Acetazolamide Cap SR 12HR 500 MG CP12 2.91912 06/14/2013 06/10/2013
Acetazolamide Tab 125 MG TABS 0.41000 02/22/2013 02/19/2013
Acetazolamide Tab 250 MG TABS 0.72000 06/04/2013 08/06/2013
Acetic Acid 2% in Aluminum Acetate Otic Soln SOLN 0.09490 02/22/2013 02/19/2013
Acetic Acid Irrigation Soln 0.25% SOLN 0.03840 08/09/2013 08/06/2013
Acetic Acid Otic Soln 2% SOLN 1.55420 02/22/2013 02/19/2013
Acetylcysteine Inhal Soln 10% SOLN 0.20540 02/22/2013 02/19/2013
Acetylcysteine Inhal Soln 20% SOLN 0.24093 02/22/2013 02/19/2013
ACID BLOCKERS DEPLETION (Nutritional Supplement
Therapy Pack
MISC 8.07500 12/20/2006 02/19/2013
ACTEMRA (Tocilizumab IV Inj 400 MG/20ML) SOLN 68.77961 04/13/2012 02/19/2013
ACTEMRA (Tocilizumab IV Inj 80 MG/4ML) SOLN 68.77795 04/13/2012 02/19/2013
ACTHAR (Corticotropin Inj Gel 80 Unit/ML) GEL 5,999.90400 06/07/2013 08/07/2013
ACTHAR HP (Corticotropin Inj Gel 80 Unit/ML) GEL 5,999.90400 06/07/2013 08/07/2013
ACTI-LANCE LANCETS 28G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ACTI-LANCE LITE SAFETY LA (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ACTI-LANCE SPECIAL SAFETY (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ACTI-LANCE UNIVERSAL SAFE (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ACTIQ (Fentanyl Citrate Lollipop 1200 MCG) LPOP 25.20000 01/23/2009 02/19/2013
ACTIQ (Fentanyl Citrate Lollipop 1600 MCG) LPOP 29.05000 01/23/2009 02/19/2013
Page 2 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
ACTIQ (Fentanyl Citrate Lollipop 200 MCG) LPOP 11.05000 01/23/2009 02/19/2013
ACTIQ (Fentanyl Citrate Lollipop 400 MCG) LPOP 13.75000 01/23/2009 02/19/2013
ACTIQ (Fentanyl Citrate Lollipop 600 MCG) LPOP 16.15000 01/23/2009 02/19/2013
ACTIQ (Fentanyl Citrate Lollipop 800 MCG) LPOP 19.15000 01/23/2009 02/19/2013
ACURA BLOOD GLUCOSE MONIT (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
ACURA BLOOD GLUCOSE TEST (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ACURA PLUS BLOOD GLUCOSE (Blood Glucose Monitoring
Kit w/ De
KIT 0.71000 10/01/2003 02/19/2013
Acyclovir Cap 200 MG CAPS 0.08550 02/22/2013 02/19/2013
Acyclovir Susp 200 MG/5ML SUSP 0.20262 02/22/2013 02/19/2013
Acyclovir Tab 400 MG TABS 0.20500 02/22/2013 02/19/2013
Acyclovir Tab 800 MG TABS 0.32377 08/28/2013 10/09/2013
Adapalene Cream 0.1% CREA 4.11270 04/12/2013 04/09/2013
Adapalene Gel 0.1% GEL 2.55000 04/12/2013 04/09/2013
ADCETRIS (Brentuximab Vedotin For IV Soln 50 MG) SOLR 5,008.88400 09/13/2013 09/09/2013
ADEKS (Multiple Vitamins w/ Minerals Chew Tab**) CHEW 0.29485 03/20/2008 02/19/2013
ADULT GROWTH HORMONE SUPP (Nutritional Supplement
Therapy Pa
MISC 8.07500 12/20/2006 02/19/2013
ADULT ONE DAILY GUMMIES (Multiple Vitamins w/ Minerals
Chew
CHEW 0.29485 03/20/2008 02/19/2013
ADVANCE INTUITION BLOOD G (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 04/23/2010 02/19/2013
ADVANCE INTUITION TEST ST (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ADVANCE MICRO-DRAW TEST S (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ADVANCED DIABETIC MULTIVI (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
ADVANTAGE INFANT FORMULA/ (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
ADVATE (Antihemophilic Factor rAHF-PFM For Inj 1000 Unit) SOLR 1.03365 04/23/2010 02/19/2013
ADVATE (Antihemophilic Factor rAHF-PFM For Inj 1500 Unit) SOLR 1.03365 04/23/2010 02/19/2013
ADVATE (Antihemophilic Factor rAHF-PFM For Inj 2000 Unit) SOLR 1.03365 04/23/2010 02/19/2013
ADVATE (Antihemophilic Factor rAHF-PFM For Inj 250 Unit) SOLR 1.03365 04/23/2010 02/19/2013
ADVATE (Antihemophilic Factor rAHF-PFM For Inj 3000 Unit) SOLR 1.03365 04/23/2010 02/19/2013
ADVATE (Antihemophilic Factor rAHF-PFM For Inj 500 Unit) SOLR 1.03365 04/23/2010 02/19/2013
ADVERA (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
ADVIL (Ibuprofen Tab 200 MG) TABS 0.04570 03/20/2008 02/19/2013
ADVOCATE BLOOD GLUCOSE MO (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
ADVOCATE LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ADVOCATE REDI-CODE (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ADVOCATE REDI-CODE/TALKIN (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
ADVOCATE SAFETY LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ADVOCATE TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
AF CAPSICUM OLEORESIN (Capsicum Oleoresin Cream
0.075%)
CREA 0.16320 04/28/2005 02/19/2013
AF LANCETS SUPER THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
Page 3 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
AFINITOR (Everolimus Tab 10 MG) TABS 295.84750 07/02/2013 08/06/2013
AFINITOR (Everolimus Tab 5 MG) TABS 280.53170 07/02/2013 08/06/2013
AF-NATURAL VEGETABLE (Psyllium Powder 28%) POWD 0.01200 03/20/2008 02/19/2013
AGAMATRIX AMP NO CODE TES (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
AGAMATRIX JAZZ (Blood Glucose Monitoring Kit w/
Device***)
KIT 0.71000 10/01/2003 02/19/2013
AGAMATRIX JAZZ TEST STRIP (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
AGAMATRIX KEYNOTE TEST ST (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
AGAMATRIX PRESTO (Blood Glucose Monitoring Kit w/
Device***)
KIT 0.71000 10/01/2003 02/19/2013
AGAMATRIX PRESTO TEST STR (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
AGAMATRIX ULTRA-THIN LANC (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ALA DERM (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
ALBALON (Naphazoline HCl Ophth Soln 0.1%) SOLN 0.24500 04/15/2002 02/19/2013
ALBERTSONS TEST STRIP (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ALBERTSONS ULTRA THIN LAN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ALBUMAX (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
Albuterol Inhal Aerosol 90 MCG/ACT AERS 0.84850 02/22/2013 02/19/2013
Albuterol Sulfate Soln Nebu 0.083% (2.5 MG/3ML) NEBU 0.04911 02/22/2013 02/19/2013
Albuterol Sulfate Soln Nebu 0.5% (5 MG/ML) NEBU 0.49000 02/22/2013 02/19/2013
Albuterol Sulfate Soln Nebu 0.63 MG/3ML (Base Equiv) NEBU 0.41150 02/22/2013 02/19/2013
Albuterol Sulfate Soln Nebu 1.25 MG/3ML (Base Equiv) NEBU 0.41450 02/22/2013 02/19/2013
Albuterol Sulfate Syrup 2 MG/5ML SYRP 0.01017 02/22/2013 02/19/2013
Albuterol Sulfate Tab 2 MG TABS 4.09500 06/29/2013 09/09/2013
Albuterol Sulfate Tab 4 MG TABS 0.09376 02/22/2013 02/19/2013
Albuterol Sulfate Tab SR 12HR 4 MG TB12 0.77520 02/22/2013 02/19/2013
Albuterol Sulfate Tab SR 12HR 8 MG TB12 1.81237 02/22/2013 02/19/2013
Alclometasone Dipropionate Cream 0.05% CREA 2.53000 07/09/2013 09/09/2013
Alclometasone Dipropionate Oint 0.05% OINT 0.68185 02/22/2013 02/19/2013
Alendronate Sodium Tab 10 MG TABS 0.16863 02/22/2013 02/19/2013
Alendronate Sodium Tab 35 MG TABS 0.62773 02/22/2013 02/19/2013
Alendronate Sodium Tab 40 MG TABS 4.58750 02/22/2013 02/19/2013
Alendronate Sodium Tab 5 MG TABS 0.19460 02/22/2013 02/19/2013
Alendronate Sodium Tab 70 MG TABS 0.71314 02/22/2013 02/19/2013
ALEVE (Naproxen Sodium Tab 220 MG) TABS 0.06800 03/20/2008 02/19/2013
ALEVE ARTHRITIS (Naproxen Sodium Tab 220 MG) TABS 0.06800 03/20/2008 02/19/2013
Alfuzosin HCl Tab SR 24HR 10 MG TB24 0.36979 02/22/2013 02/19/2013
ALIMENTUM (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ALIMENTUM (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
ALITRAQ (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
ALIVE MENS ENERGY (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
ALIVE ONCE DAILY WOMENS 5 (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
ALIVE WOMENS 50+ (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
Page 4 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
ALIVE WOMENS ENERGY (Multiple Vitamins w/ Minerals
Tab**)
TABS 0.07430 03/20/2008 02/19/2013
ALKERAN (Melphalan Tab 2 MG) TABS 4.71440 07/30/2010 02/19/2013
Allopurinol Tab 100 MG TABS 0.02531 02/22/2013 02/19/2013
Allopurinol Tab 300 MG TABS 0.06729 02/22/2013 02/19/2013
ALOE AFTERSUN LOTION (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
ALOE VESTA 2-N-1 PROTECTI (Skin Protectants Misc -
Ointment*
OINT 0.03040 04/28/2005 02/19/2013
ALOE VESTA PROTECTIVE (Skin Protectants Misc -
Ointment***)
OINT 0.03040 04/28/2005 02/19/2013
ALOXI (Palonosetron HCl IV Soln 0.25 MG/5ML (Base
Equivalent
SOLN 73.90320 04/13/2012 02/19/2013
ALPHA GLOW BODY CARE/SPF (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
ALPHANATE (Antihemophilic Factor (Human) For Inj
1000-1500 U
SOLR 0.79520 12/24/2010 02/19/2013
ALPHANATE (Antihemophilic Factor (Human) For Inj 250-500
Uni
SOLR 0.79520 12/24/2010 02/19/2013
ALPHANATE/VON WILLEBRAND (Antihemophilic
Factor/VWF (Human)
SOLR 0.79520 12/24/2010 02/19/2013
ALPHANATE/VON WILLEBRAND (Antihemophilic
Factor/VWF (Human)
SOLR 0.79520 12/24/2010 02/19/2013
ALPHANATE/VON WILLEBRAND (Antihemophilic
Factor/VWF (Human)
SOLR 0.79520 12/24/2010 02/19/2013
ALPHANATE/VON WILLEBRAND (Antihemophilic
Factor/VWF (Human)
SOLR 0.79520 12/24/2010 02/19/2013
ALPHANINE SD (Coagulation Factor IX For Inj 1000 Unit) SOLR 0.74750 12/24/2010 02/19/2013
ALPHANINE SD (Coagulation Factor IX For Inj 1500 Unit) SOLR 0.74750 12/24/2010 02/19/2013
ALPHANINE SD (Coagulation Factor IX For Inj 250-1500
Unit)
SOLR 0.74750 12/24/2010 02/19/2013
ALPHANINE SD (Coagulation Factor IX For Inj 500 Unit) SOLR 0.74750 12/24/2010 02/19/2013
Alprazolam Orally Disintegrating Tab 0.25 MG TBDP 1.31066 02/22/2013 02/19/2013
Alprazolam Orally Disintegrating Tab 1 MG TBDP 1.87452 02/22/2013 02/19/2013
Alprazolam Orally Disintegrating Tab 2 MG TBDP 3.64684 02/22/2013 02/19/2013
Alprazolam Tab 0.25 MG TABS 0.02956 02/22/2013 02/19/2013
Alprazolam Tab 0.5 MG TABS 0.03540 02/22/2013 02/19/2013
Alprazolam Tab 1 MG TABS 0.01937 02/22/2013 02/19/2013
Alprazolam Tab 2 MG TABS 0.07527 02/22/2013 02/19/2013
Alprazolam Tab SR 24HR 0.5 MG TB24 0.36958 02/22/2013 02/19/2013
Alprazolam Tab SR 24HR 1 MG TB24 0.47500 02/22/2013 02/19/2013
Alprazolam Tab SR 24HR 2 MG TB24 0.71250 02/22/2013 02/19/2013
Alprazolam Tab SR 24HR 3 MG TB24 0.97254 02/22/2013 02/19/2013
ALSOY SOY FORMULA (Infant Foods Conc**) CONC 0.01190 04/28/2005 02/19/2013
ALSOY SOY FORMULA (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ALSOY SOY FORMULA (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
ALSUMA (Sumatriptan Succinate Inj 6 MG/0.5ML) SOLN 136.79400 10/29/2010 02/19/2013
Alum & Mag Hydroxide-Simethicone Susp 200-200-20
MG/5ML
LIQD 0.00420 02/22/2013 02/19/2013
Page 5 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Alum & Mag Hydroxide-Simethicone Susp 200-200-20
MG/5ML
SUSP 0.00420 02/22/2013 02/19/2013
Alum & Mag Hydroxide-Simethicone Susp 400-400-40
MG/5ML
LIQD 0.00690 02/22/2013 02/19/2013
Alum & Mag Hydroxide-Simethicone Susp 400-400-40
MG/5ML
SUSP 0.00690 02/22/2013 02/19/2013
Aluminum & Magnesium Hydroxides Susp 225-200 MG/5ML SUSP 0.00420 02/22/2013 02/19/2013
Aluminum Chloride Soln 20% SOLN 0.15656 02/22/2013 02/19/2013
Aluminum Hydroxide Gel Susp 320 MG/5ML SUSP 0.01156 02/22/2013 02/19/2013
Aluminum Hydroxide Gel Susp 600 MG/5ML SUSP 0.01350 02/22/2013 02/19/2013
Amantadine HCl Cap 100 MG CAPS 1.46903 10/11/2013 10/09/2013
Amantadine HCl Syrup 50 MG/5ML SYRP 0.04398 02/22/2013 02/19/2013
AMBI ESSENTIALS DAILY MOI (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
AMBI EVEN & CLEAR DAILY M (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
AMBI SOFT & EVEN CREAMY O (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
AMBIEN (Zolpidem Tartrate Tab 5 MG) TABS 0.13650 04/23/2010 02/19/2013
Amcinonide Cream 0.1% CREA 0.79540 02/22/2013 02/19/2013
AMETHYST (Levonorgestrel-Ethinyl Estradiol (Continuous)
Tab
TABS 1.90868 07/13/2012 02/19/2013
Amiloride & Hydrochlorothiazide Tab 5-50 MG TABS 0.23500 10/30/2013 11/05/2013
Amiloride HCl Tab 5 MG TABS 0.58131 10/11/2013 10/09/2013
Amino Acids Tab*** TABS 0.41080 02/22/2013 02/19/2013
Aminocaproic Acid Inj 250 MG/ML SOLN 0.07275 02/22/2013 02/19/2013
Aminocaproic Acid Syrup 25% SYRP 2.39000 10/08/2013 11/05/2013
Aminocaproic Acid Tab 500 MG TABS 1.80000 02/22/2013 02/19/2013
Aminophylline Tab 100 MG TABS 0.02780 02/22/2013 02/19/2013
Aminophylline Tab 200 MG TABS 0.03900 02/22/2013 02/19/2013
Amiodarone HCl Tab 200 MG TABS 0.15959 02/22/2013 02/19/2013
Amiodarone HCl Tab 400 MG TABS 2.85000 02/22/2013 02/19/2013
Amitriptyline HCl Tab 10 MG TABS 0.02007 02/22/2013 02/19/2013
Amitriptyline HCl Tab 100 MG TABS 0.05785 02/22/2013 02/19/2013
Amitriptyline HCl Tab 150 MG TABS 0.10013 02/22/2013 02/19/2013
Amitriptyline HCl Tab 25 MG TABS 0.02732 02/22/2013 02/19/2013
Amitriptyline HCl Tab 50 MG TABS 0.03200 02/22/2013 02/19/2013
Amitriptyline HCl Tab 75 MG TABS 0.04413 02/22/2013 02/19/2013
AMLACTIN XL (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
Amlodipine Besylate Tab 10 MG TABS 0.04348 02/22/2013 02/19/2013
Amlodipine Besylate Tab 2.5 MG TABS 0.02933 02/22/2013 02/19/2013
Amlodipine Besylate Tab 5 MG TABS 0.02663 02/22/2013 02/19/2013
Amlodipine Besylate-Atorvastatin Calcium Tab 10-10 MG TABS 4.16875 10/11/2013 10/09/2013
Amlodipine Besylate-Atorvastatin Calcium Tab 10-40 MG TABS 5.55500 09/13/2013 09/09/2013
Amlodipine Besylate-Atorvastatin Calcium Tab 5-10 MG TABS 4.06230 09/13/2013 09/09/2013
Amlodipine Besylate-Atorvastatin Calcium Tab 5-20 MG TABS 5.56013 09/13/2013 09/09/2013
Amlodipine Besylate-Atorvastatin Calcium Tab 5-40 MG TABS 5.56006 09/13/2013 09/09/2013
Amlodipine Besylate-Benazepril HCl Cap 10-20 MG CAPS 0.49455 10/11/2013 10/09/2013
Page 6 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Amlodipine Besylate-Benazepril HCl Cap 10-40 MG CAPS 0.85186 10/11/2013 10/09/2013
Amlodipine Besylate-Benazepril HCl Cap 2.5-10 MG CAPS 0.72829 10/11/2013 10/09/2013
Amlodipine Besylate-Benazepril HCl Cap 5-10 MG CAPS 0.63832 10/11/2013 10/09/2013
Amlodipine Besylate-Benazepril HCl Cap 5-20 MG CAPS 0.47000 11/08/2013 11/05/2013
Amlodipine Besylate-Benazepril HCl Cap 5-40 MG CAPS 0.63925 10/11/2013 10/09/2013
Amoxicillin & K Clavulanate Chew Tab 200-28.5 MG CHEW 0.97900 02/22/2013 04/09/2013
Amoxicillin & K Clavulanate Chew Tab 400-57 MG CHEW 1.11200 02/22/2013 02/19/2013
Amoxicillin & K Clavulanate For Susp 200-28.5 MG/5ML SUSR 0.11591 02/22/2013 02/19/2013
Amoxicillin & K Clavulanate For Susp 250-62.5 MG/5ML SUSR 0.74500 02/22/2013 02/19/2013
Amoxicillin & K Clavulanate For Susp 400-57 MG/5ML SUSR 0.20100 04/23/2013 05/06/2013
Amoxicillin & K Clavulanate For Susp 600-42.9 MG/5ML SUSR 0.17077 02/22/2013 02/19/2013
Amoxicillin & K Clavulanate Tab 250-125 MG TABS 4.66000 02/22/2013 02/19/2013
Amoxicillin & K Clavulanate Tab 500-125 MG TABS 0.81575 02/22/2013 02/19/2013
Amoxicillin & K Clavulanate Tab 875-125 MG TABS 0.91352 02/22/2013 02/19/2013
Amoxicillin (Trihydrate) Cap 250 MG CAPS 0.06500 02/22/2013 02/19/2013
Amoxicillin (Trihydrate) Cap 500 MG CAPS 0.07301 02/22/2013 02/19/2013
Amoxicillin (Trihydrate) Chew Tab 125 MG CHEW 0.09000 02/22/2013 02/19/2013
Amoxicillin (Trihydrate) Chew Tab 200 MG CHEW 0.18500 02/22/2013 02/19/2013
Amoxicillin (Trihydrate) Chew Tab 250 MG CHEW 0.15950 02/22/2013 02/19/2013
Amoxicillin (Trihydrate) Chew Tab 400 MG CHEW 0.18000 02/22/2013 02/19/2013
Amoxicillin (Trihydrate) For Susp 125 MG/5ML SUSR 0.01427 02/22/2013 02/19/2013
Amoxicillin (Trihydrate) For Susp 200 MG/5ML SUSR 0.02535 02/22/2013 02/19/2013
Amoxicillin (Trihydrate) For Susp 250 MG/5ML SUSR 0.02990 02/22/2013 02/19/2013
Amoxicillin (Trihydrate) For Susp 400 MG/5ML SUSR 0.03772 02/22/2013 02/19/2013
Amoxicillin (Trihydrate) Tab 500 MG TABS 0.18070 02/22/2013 02/19/2013
Amoxicillin (Trihydrate) Tab 875 MG TABS 0.22132 02/22/2013 02/19/2013
Amphetamine-Dextroamphetamine Tab 10 MG TABS 1.06000 02/22/2013 02/19/2013
Amphetamine-Dextroamphetamine Tab 12.5 MG TABS 0.40500 02/22/2013 02/19/2013
Amphetamine-Dextroamphetamine Tab 15 MG TABS 1.05000 02/22/2013 02/19/2013
Amphetamine-Dextroamphetamine Tab 20 MG TABS 1.12837 02/22/2013 02/19/2013
Amphetamine-Dextroamphetamine Tab 30 MG TABS 1.06000 09/13/2013 09/09/2013
Amphetamine-Dextroamphetamine Tab 5 MG TABS 1.06004 02/22/2013 02/19/2013
Amphetamine-Dextroamphetamine Tab 7.5 MG TABS 1.10050 02/22/2013 02/19/2013
Ampicillin & Sulbactam Sodium For Inj 1-0.5 GM SOLR 4.84900 02/22/2013 02/19/2013
Ampicillin & Sulbactam Sodium For Inj 10-5 GM SOLR 46.74800 02/22/2013 02/19/2013
Ampicillin & Sulbactam Sodium For Inj 2-1 GM SOLR 6.39600 02/22/2013 02/19/2013
Ampicillin & Sulbactam Sodium For IV Soln 1-0.5 GM SOLR 4.84900 02/22/2013 02/19/2013
Ampicillin & Sulbactam Sodium For IV Soln 10-5 GM SOLR 46.74800 02/22/2013 02/19/2013
Ampicillin & Sulbactam Sodium For IV Soln 2-1 GM SOLR 8.00800 02/22/2013 02/19/2013
Ampicillin Cap 250 MG CAPS 0.08600 02/22/2013 02/19/2013
Ampicillin Cap 500 MG CAPS 0.14613 02/22/2013 02/19/2013
Ampicillin For Susp 125 MG/5ML SUSR 0.02040 02/22/2013 02/19/2013
Ampicillin For Susp 250 MG/5ML SUSR 0.01950 02/22/2013 02/19/2013
AMPYRA (Dalfampridine Tab SR 12HR 10 MG) TB12 24.00300 01/01/2013 09/09/2013
Page 7 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Anagrelide HCl Cap 0.5 MG CAPS 0.16750 02/22/2013 02/19/2013
Anagrelide HCl Cap 1 MG CAPS 0.32550 02/22/2013 02/19/2013
Anastrozole Tab 1 MG TABS 0.33541 02/22/2013 02/19/2013
ANTIOXIDANT FORTE (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
ANTIOXIDANT ULTRA FORMULA (Multiple Vitamins w/
Minerals Cap
CAPS 0.51325 04/27/2011 02/19/2013
ANTIPHLOGISTINE (Liniments & Rubs - Cream**) CREA 0.02880 04/28/2005 02/19/2013
Antipyrine-Benzocaine Otic Soln 54-14 MG/ML (5.4-1.4%) SOLN 0.79193 02/22/2013 02/19/2013
ANTI-SEIZURE DEPLETION (Nutritional Supplement
Therapy Pack*
MISC 8.07500 12/20/2006 02/19/2013
ANTI-SEIZURE SUPPORT (Nutritional Supplement Therapy
Pack**)
MISC 8.07500 12/20/2006 02/19/2013
ANTIVERT (Meclizine HCl Tab 12.5 MG) TABS 0.02920 04/23/2010 02/19/2013
ANTIVERT (Meclizine HCl Tab 25 MG) TABS 0.04090 04/23/2010 02/19/2013
ANTIVERT (Meclizine HCl Tab 25 MG) TABS 0.04203 03/20/2008 02/19/2013
APATATE FORTE (Multiple Vitamins w/ Minerals Liquid**) LIQD 0.02464 03/20/2008 02/19/2013
APEXICON E (Diflorasone Diacetate Emollient Base Cream
0.05%
CREA 1.35900 09/27/2007 02/19/2013
APOKYN (Apomorphine Hydrochloride Inj 10 MG/ML) SOLN 330.34000 02/08/2013 02/20/2013
AP-ZEL (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
AQUA GLYCOLIC (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
AQUA GLYCOLIC HAND & BODY (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
AQUA LACTEN (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
AQUA MED (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
AQUADEKS (Multiple Vitamins w/ Minerals Cap**) CAPS 0.51325 04/27/2011 02/19/2013
AQUADEKS (Multiple Vitamins w/ Minerals Chew Tab**) CHEW 0.56000 01/14/2013 02/20/2013
AQUADERM TREATMENT/MOISTU (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
AQUAMED (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
AQUAPHILIC (Emollient - Ointment**) OINT 0.04583 03/13/2008 02/19/2013
AQUAPHOR (Emollient - Ointment**) OINT 0.04583 03/13/2008 02/19/2013
AQUAPHOR ADVANCED THERAPY (Emollient - Ointment**) OINT 0.04583 03/13/2008 02/19/2013
AQUAPHOR LIP REPAIR (Skin Protectants Misc -
Ointment***)
OINT 0.03040 04/28/2005 02/19/2013
AQUASITE (Artificial Tear Ophth Solution***) SOLN 0.23859 03/13/2008 02/19/2013
ARALAST (Alpha1-Proteinase Inhibitor (Human) For IV Soln
400
SOLR 0.42330 07/30/2010 02/19/2013
ARALAST (Alpha1-Proteinase Inhibitor (Human) For IV Soln
800
SOLR 0.43160 07/30/2010 02/19/2013
ARALAST NP (Alpha1-Proteinase Inhibitor (Human) For IV
Soln
SOLR 0.43160 01/28/2011 02/19/2013
ARALAST NP (Alpha1-Proteinase Inhibitor (Human) For IV
Soln
SOLR 0.42330 07/30/2010 02/19/2013
ARALAST NP (Alpha1-Proteinase Inhibitor (Human) For IV
Soln
SOLR 0.43160 01/28/2011 02/19/2013
ARALAST NP (Alpha1-Proteinase Inhibitor (Human) For IV
Soln
SOLR 0.43160 07/30/2010 02/19/2013
Page 8 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate 80
Soln I
SOLN 1,192.41120 04/13/2012 02/19/2013
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate 80
Soln I
SOLN 596.20560 04/13/2012 02/19/2013
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate 80
Soln I
SOLN 2,981.02800 04/13/2012 02/19/2013
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate 80
Soln I
SOLN 1,192.41120 04/13/2012 02/19/2013
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate 80
Soln I
SOLN 2,981.02800 04/13/2012 02/19/2013
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate 80
Soln I
SOLN 1,192.41120 04/13/2012 02/19/2013
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate 80
Soln I
SOLN 354.88429 04/13/2012 02/19/2013
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate 80
Soln I
SOLN 160.15600 03/07/2013 05/06/2013
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate 80
Soln I
SOLN 2,981.02800 04/13/2012 02/19/2013
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate 80
Soln I
SOLN 1,788.61680 04/13/2012 02/19/2013
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate 80
Soln I
SOLN 596.23050 04/13/2012 02/19/2013
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate 80
Soln I
SOLN 238.49220 04/13/2012 02/19/2013
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate 80
Soln I
SOLN 2,981.02800 04/13/2012 02/19/2013
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate 80
Soln I
SOLN 1,192.37800 04/13/2012 02/19/2013
ARANESP ALBUMIN FREE (Darbepoetin Alfa-Polysorbate 80
Soln I
SOLN 357.71340 04/13/2012 02/19/2013
ARANESP ALBUMIN FREE SURE (Darbepoetin
Alfa-Polysorbate 80 S
SOLN 1,192.41120 04/13/2012 02/19/2013
ARANESP ALBUMIN FREE SURE (Darbepoetin
Alfa-Polysorbate 80 S
SOLN 2,981.02800 04/13/2012 02/19/2013
ARANESP ALBUMIN FREE SURE (Darbepoetin
Alfa-Polysorbate 80 S
SOLN 2,981.02800 04/13/2012 02/19/2013
ARANESP ALBUMIN FREE SURE (Darbepoetin
Alfa-Polysorbate 80 S
SOLN 357.71340 04/13/2012 02/19/2013
ARANESP ALBUMIN FREE SURE (Darbepoetin
Alfa-Polysorbate 80 S
SOLN 2,981.02800 04/13/2012 02/19/2013
ARANESP ALBUMIN FREE SURE (Darbepoetin
Alfa-Polysorbate 80 S
SOLN 596.20560 04/13/2012 02/19/2013
ARANESP ALBUMIN FREE SURE (Darbepoetin
Alfa-Polysorbate 80 S
SOLN 1,192.41120 04/13/2012 02/19/2013
ARGINAID EXTRA (Nutritional Supplement Liquid**) LIQD 0.01420 05/28/2010 02/19/2013
ARIXTRA (Fondaparinux Sodium Inj 2.5 MG/0.5ML) SOLN 100.80350 04/13/2012 02/19/2013
Artificial Tear Ophth Ointment*** OINT 2.67460 05/10/2013 08/06/2013
Artificial Tear Ophth Solution*** SOLN 0.23859 02/22/2013 02/19/2013
ASCENSIA AUTODISC TEST ST (Glucose Blood Test Disk) DISK 0.74500 11/22/2007 02/19/2013
Page 9 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
ASCENSIA BREEZE MONITOR (Blood Glucose Monitoring
Kit w/ Dev
KIT 0.71000 10/01/2003 02/19/2013
ASCENSIA ELITE TEST STRIP (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ASCENSIA ELITE XL DIABETE (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
Ascorbic Acid Cap CR 500 MG CPCR 0.01400 02/22/2013 02/19/2013
Ascorbic Acid Chew Tab 250 MG CHEW 0.02545 02/22/2013 02/19/2013
Ascorbic Acid Chew Tab 500 MG CHEW 0.04220 02/22/2013 02/19/2013
Ascorbic Acid Syrup 500 MG/5ML SYRP 0.03598 02/22/2013 02/19/2013
Ascorbic Acid Tab 1000 MG TABS 0.04950 02/22/2013 02/19/2013
Ascorbic Acid Tab 250 MG TABS 0.01650 02/22/2013 02/19/2013
Ascorbic Acid Tab 500 MG TABS 0.02710 02/22/2013 02/19/2013
Ascorbic Acid Tab CR 1000 MG TBCR 0.04950 02/22/2013 02/19/2013
Ascorbic Acid Tab CR 500 MG TBCR 0.01400 02/22/2013 02/19/2013
A-SOY (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
ASPERCREME/ALOE (Trolamine Salicylate Cream 10%) CREA 0.04250 04/28/2005 02/19/2013
Aspirin Buffered (Ca Carb-Mg Carb-Mg Ox) Tab 325 MG TABS 0.01833 02/22/2013 02/19/2013
Aspirin Buffered (Mg Carbonate-Al Aminoace) Tab 325 MG TABS 0.03544 02/22/2013 02/19/2013
Aspirin Chew Tab 81 MG CHEW 0.03650 02/22/2013 02/19/2013
Aspirin Tab 325 MG TABS 0.00510 02/22/2013 02/19/2013
Aspirin Tab 81 MG TABS 0.01655 02/22/2013 02/19/2013
Aspirin Tab Delayed Release 325 MG TBEC 0.01920 02/22/2013 02/19/2013
Aspirin Tab Delayed Release 81 MG TBEC 0.00780 02/22/2013 02/19/2013
Aspirin-Acetaminophen-Caffeine Tab 250-250-65 MG TABS 0.02925 02/22/2013 02/19/2013
Aspirin-Caffeine-Butalbital Tab 325-40-50 MG TABS 0.10969 02/22/2013 02/19/2013
ASSURE 3 TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ASSURE 4 TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ASSURE HAEMOLANCE PLUS HI (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ASSURE HAEMOLANCE PLUS LO (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ASSURE HAEMOLANCE PLUS MI (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ASSURE HAEMOLANCE PLUS NO (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ASSURE HAEMOLANCE PLUS PE (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ASSURE II (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ASSURE II CHECK STRIP (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ASSURE II TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ASSURE LANCE LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ASSURE LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ASSURE PLATINUM TEST STRI (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ASSURE PRO TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
AT LAST LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
AT LAST TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
Atenolol & Chlorthalidone Tab 100-25 MG TABS 0.11700 02/22/2013 02/19/2013
Atenolol & Chlorthalidone Tab 50-25 MG TABS 0.12500 07/08/2013 10/09/2013
Atenolol Tab 100 MG TABS 0.03289 02/22/2013 02/19/2013
Atenolol Tab 25 MG TABS 0.01982 02/22/2013 02/19/2013
Page 10 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Atenolol Tab 50 MG TABS 0.02460 02/22/2013 02/19/2013
Atorvastatin Calcium Tab 10 MG (Base Equivalent) TABS 0.22040 02/22/2013 02/19/2013
Atorvastatin Calcium Tab 20 MG (Base Equivalent) TABS 0.31350 02/22/2013 02/19/2013
Atorvastatin Calcium Tab 40 MG (Base Equivalent) TABS 0.31350 02/22/2013 02/19/2013
Atorvastatin Calcium Tab 80 MG (Base Equivalent) TABS 0.31350 02/22/2013 02/19/2013
Atovaquone-Proguanil HCl Tab 250-100 MG TABS 5.43035 08/09/2013 08/06/2013
Atropine Sulfate Ophth Oint 1% OINT 0.65000 02/22/2013 02/19/2013
Atropine Sulfate Ophth Soln 1% SOLN 2.51333 02/22/2013 02/19/2013
Attapulgite Liq 750 MG/15ML LIQD 0.01200 02/22/2013 02/19/2013
AURORA HEALTHCARE LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
AURORA LANCET SUPER THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
AURORA LANCET THIN 23G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
AVEENO CONTINUOUS RADIANC (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
AVEENO DAILY FIRMING (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
AVEENO DAILY MOISTURIZING (Dimethicone Lotion 1.3%) LOTN 0.01940 03/13/2008 02/19/2013
AVEENO DAILY MOISTURIZING (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
AVEENO POSITIVELY AGELESS (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
AVEENO POSITIVELY NOURISH (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
AVEENO POSITIVELY RADIANT (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
AVEENO POSITIVELY SMOOTH (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
AVEENO STRESS RELIEF MOIS (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
AVONEX (Interferon Beta-1a For IM Inj Kit 30MCG
(33MCG(6.6 M
KIT 1,047.79200 06/28/2013 08/07/2013
AVONEX (Interferon Beta-1a IM Inj Kit 30 MCG/0.5ML) KIT 4,526.82000 11/16/2013 12/06/2013
AVONEX PEN (Interferon Beta-1a IM Inj Kit 30
MCG/0.5ML)
KIT 4,526.82000 11/16/2013 12/06/2013
Azathioprine Tab 50 MG TABS 0.15419 02/22/2013 02/19/2013
Azelastine HCl Nasal Spray 137 MCG/SPRAY (1 MG/ML) SOLN 1.54000 03/05/2013 04/09/2013
Azelastine HCl Ophth Soln 0.05% SOLN 9.47710 08/09/2013 08/06/2013
Azithromycin For Susp 100 MG/5ML SUSR 0.88561 02/22/2013 02/19/2013
Azithromycin For Susp 200 MG/5ML SUSR 0.63004 02/22/2013 02/19/2013
Azithromycin IV For Soln 500 MG SOLR 9.47700 02/22/2013 02/19/2013
Azithromycin Tab 250 MG TABS 0.70523 02/22/2013 02/19/2013
Azithromycin Tab 500 MG TABS 1.44155 02/22/2013 02/19/2013
Azithromycin Tab 600 MG TABS 3.65450 02/22/2013 02/19/2013
B-50 FORMULA (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
BABYS ONLY ORGANIC/DAIRY (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
BABYS ONLY ORGANIC/DHA & (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
BABYS ONLY ORGANIC/LACTOS (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
BABYS ONLY ORGANIC/SOY (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
BACIGUENT (Bacitracin Oint 500 Unit/GM) OINT 0.08300 03/13/2008 02/19/2013
Bacitracin Oint 500 Unit/GM OINT 0.08300 02/22/2013 02/19/2013
Bacitracin Zinc Oint 500 Unit/GM OINT 0.08300 02/22/2013 02/19/2013
Bacitracin-Polymyxin B Oint*** OINT 0.15070 02/22/2013 02/19/2013
Bacitracin-Polymyxin B Ophth Oint OINT 4.07320 02/22/2013 02/19/2013
Page 11 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Bacitracin-Polymyxin-Neomycin-HC Ophth Oint 1% OINT 2.44285 02/22/2013 02/19/2013
Baclofen Powder POWD 2.37120 02/22/2013 02/19/2013
Baclofen Tab 10 MG TABS 0.05235 02/22/2013 02/19/2013
Baclofen Tab 20 MG TABS 0.07359 03/12/2013 04/09/2013
BACMIN (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
BALNEOL (Incontinent Cleanser - Lotion***) LOTN 0.01940 03/13/2008 02/19/2013
Balsalazide Disodium Cap 750 MG CAPS 0.22313 02/22/2013 02/19/2013
BARACLUDE (Entecavir Oral Soln 0.05 MG/ML) SOLN 3.31890 01/01/2013 02/20/2013
BARACLUDE (Entecavir Tab 0.5 MG) TABS 34.51000 07/01/2013 10/09/2013
BARACLUDE (Entecavir Tab 1 MG) TABS 34.51000 07/01/2013 10/09/2013
BASIC AM (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
BASIC PM (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
BAYER BREEZE 2 BLOOD GLUC (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
BAYER BREEZE 2 BLOOD GLUC (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 04/23/2010 02/19/2013
BAYER CONTOUR BLOOD GLUCO (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
BAYER CONTOUR BLOOD GLUCO (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
BAYER CONTOUR LINK BLOOD (Blood Glucose Monitoring
Kit w/ De
KIT 0.71000 10/01/2003 02/19/2013
BAYER CONTOUR NEXT BLOOD (Blood Glucose Monitoring
Kit w/ De
KIT 0.71000 10/01/2003 02/19/2013
BAYER CONTOUR NEXT BLOOD (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
BAYER CONTOUR NEXT EZ BLO (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
BAYER CONTOUR NEXT LINK B (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
BAYER CONTOUR NEXT USB BL (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
BAYER CONTOUR USB BLOOD G (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
BAYER MICROLET LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
BCAD 1 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
BCAD 2 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
B-Complex Vitamin Cap** CAPS 0.03890 02/22/2013 02/19/2013
B-Complex Vitamin Tab CR** TBCR 0.02250 02/22/2013 02/19/2013
B-Complex Vitamin Tab** TABS 0.03270 02/22/2013 02/19/2013
B-Complex w/ C & E + Zn Tab*** TABS 0.02200 02/22/2013 02/19/2013
B-Complex w/ C & E Tab*** TABS 0.02200 02/22/2013 02/19/2013
B-Complex w/ C & Folic Acid Cap 1 MG*** CAPS 0.15229 02/22/2013 02/19/2013
B-Complex w/ C & Folic Acid Tab 0.8 MG*** TABS 0.08400 02/22/2013 02/19/2013
B-Complex w/ C & Folic Acid Tab 1 MG*** TABS 0.12100 02/22/2013 02/19/2013
B-Complex w/ C & Folic Acid Tab*** TABS 0.02200 02/22/2013 02/19/2013
B-Complex w/ C Cap** CAPS 0.02200 02/22/2013 02/19/2013
B-Complex w/ C Tab CR** TBCR 0.02200 02/22/2013 02/19/2013
Page 12 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
B-Complex w/ C Tab** TABS 0.02200 02/22/2013 02/19/2013
B-Complex w/ Folic Acid Tab CR** TBCR 0.02250 02/22/2013 02/19/2013
B-Complex w/ Folic Acid Tab** TABS 0.02250 02/22/2013 02/19/2013
B-Complex w/Biotin & Folic Acid Tab CR*** TBCR 0.02250 02/22/2013 02/19/2013
B-Complex w/Biotin & Folic Acid Tab*** TABS 0.03270 02/22/2013 02/19/2013
BD GENIE (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
BD GENIE LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
BD GLUCOSE (Glucose Chew Tab 5 GM) CHEW 0.15300 04/28/2005 02/19/2013
BD LANCET ULTRAFINE 30G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
BD LANCET ULTRAFINE 33G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
BD LATITUDE DIABETES MANA (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
BD LATITUDE DIABETES MANA (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 04/23/2010 02/19/2013
BD LOGIC BLOOD GLUCOSE MO (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 04/23/2010 02/19/2013
BD MICROTAINER LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
BD TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
BD ULTRA FINE LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
BEBULIN (Factor IX Complex For Inj 200-1200 Unit) SOLR 0.94350 06/26/2009 02/19/2013
BEBULIN VH (Factor IX Complex For Inj 200-1200 Unit) SOLR 0.94350 06/26/2009 02/19/2013
BENADRYL (Diphenhydramine HCl Cap 25 MG) CAPS 0.05620 03/13/2008 02/19/2013
BENADRYL (Diphenhydramine HCl Tab 25 MG) TABS 0.05620 03/13/2008 02/19/2013
BENADRYL ALLERGY (Diphenhydramine HCl Cap 25 MG) CAPS 0.05620 03/13/2008 02/19/2013
BENADRYL ALLERGY (Diphenhydramine HCl Tab 25 MG) TABS 0.05620 03/13/2008 02/19/2013
BENADRYL ALLERGY CHILDREN (Diphenhydramine HCl
Liquid 12.5 M
LIQD 0.01872 03/13/2008 02/19/2013
BENADRYL DYE-FREE ALLERGY (Diphenhydramine HCl
Cap 25 MG)
CAPS 0.05620 03/13/2008 02/19/2013
Benazepril & Hydrochlorothiazide Tab 10-12.5 MG TABS 0.34500 12/17/2012 02/20/2013
Benazepril & Hydrochlorothiazide Tab 10-12.5 MG TABS 0.34500 02/22/2013 02/20/2013
Benazepril & Hydrochlorothiazide Tab 20-12.5 MG TABS 0.14937 02/22/2013 02/19/2013
Benazepril & Hydrochlorothiazide Tab 20-25 MG TABS 0.15431 02/22/2013 02/19/2013
Benazepril & Hydrochlorothiazide Tab 5-6.25 MG TABS 0.14950 02/22/2013 02/19/2013
Benazepril HCl Tab 10 MG TABS 0.06499 02/22/2013 02/19/2013
Benazepril HCl Tab 20 MG TABS 0.06543 02/22/2013 02/19/2013
Benazepril HCl Tab 40 MG TABS 0.06488 02/22/2013 02/19/2013
Benazepril HCl Tab 5 MG TABS 0.06313 02/22/2013 02/19/2013
BENECALORIE (Nutritional Supplement Liquid**) LIQD 0.03350 06/02/2010 02/19/2013
BENEFIX (Coagulation Factor IX (Recombinant) For Inj 1000
Un
SOLR 1.12880 01/01/2013 02/20/2013
BENEFIX (Coagulation Factor IX (Recombinant) For Inj 2000
Un
SOLR 1.12880 01/01/2013 02/20/2013
BENEFIX (Coagulation Factor IX (Recombinant) For Inj 250
Uni
SOLR 0.83750 07/24/2009 02/19/2013
BENEFIX (Coagulation Factor IX (Recombinant) For Inj 500
Uni
SOLR 1.12880 01/01/2013 02/20/2013
Page 13 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
BENEPROTEIN (Protein Oral Powder***) POWD 0.06700 04/28/2005 02/19/2013
BENGAY ARTHRITIS FORMULA (Menthol-Methyl Salicylate
Cream***
CREA 0.02880 04/28/2005 02/19/2013
BENGAY GREASELESS (Menthol-Methyl Salicylate
Cream***)
CREA 0.02880 04/28/2005 02/19/2013
BENGAY ULTRA STRENGTH (Camphor-Menthol-Methyl
Salicylate Cre
CREA 0.02880 04/28/2005 02/19/2013
BENLYSTA (Belimumab For IV Soln 120 MG) SOLR 448.03400 06/28/2013 08/07/2013
BENLYSTA (Belimumab For IV Soln 400 MG) SOLR 1,493.41900 06/28/2013 08/07/2013
BENZAC AC (Benzoyl Peroxide Gel 10%) GEL 0.06920 05/28/2010 02/19/2013
BENZAC AC (Benzoyl Peroxide Gel 5%) GEL 0.22500 05/28/2010 02/19/2013
BENZAGEL-10 (Benzoyl Peroxide Gel 10%) GEL 0.06920 05/28/2010 02/19/2013
BENZAGEL-5 (Benzoyl Peroxide Gel 5%) GEL 0.22500 05/28/2010 02/19/2013
BENZAMYCIN (Benzoyl Peroxide-Erythromycin Gel 5-3%) GEL 0.96550 05/28/2010 02/19/2013
Benzonatate Cap 100 MG CAPS 0.12155 02/22/2013 02/19/2013
Benzonatate Cap 200 MG CAPS 0.13572 02/22/2013 02/19/2013
Benzoyl Peroxide Cream 10% CREA 0.16940 02/22/2013 02/19/2013
Benzoyl Peroxide Gel 10% GEL 0.16089 02/22/2013 02/19/2013
Benzoyl Peroxide Gel 2.5% GEL 0.25500 02/22/2013 02/19/2013
Benzoyl Peroxide Gel 5% GEL 0.11012 02/22/2013 02/19/2013
Benzoyl Peroxide Liq 10% LIQD 0.07002 02/22/2013 02/19/2013
Benzoyl Peroxide Liq 2.5% LIQD 0.06600 02/22/2013 02/19/2013
Benzoyl Peroxide Liq 5% LIQD 0.08855 02/22/2013 02/19/2013
Benzoyl Peroxide Liq 7% LIQD 0.21285 02/22/2013 02/19/2013
Benzoyl Peroxide Lotion 5% LOTN 0.09450 02/22/2013 02/19/2013
Benzoyl Peroxide Lotion 6% LOTN 0.21965 02/22/2013 02/19/2013
Benzoyl Peroxide Pad 3% PADS 2.59177 02/22/2013 02/19/2013
Benzoyl Peroxide Pad 6% PADS 2.59177 02/22/2013 02/19/2013
Benzoyl Peroxide-Erythromycin Gel 5-3% GEL 0.86564 02/22/2013 02/19/2013
Benztropine Mesylate Tab 0.5 MG TABS 0.14500 10/28/2013 11/05/2013
Benztropine Mesylate Tab 1 MG TABS 0.16500 09/19/2013 11/05/2013
Benztropine Mesylate Tab 2 MG TABS 0.09500 09/09/2013 11/05/2013
BETA CARE (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
BETADINE (Povidone-Iodine Soln 10%) SOLN 0.01751 03/20/2008 02/19/2013
Betahistine Hydrochloride (Bulk) Powder POWD 4.24550 02/22/2013 02/19/2013
Betamethasone Dipropionate Augmented Cream 0.05% CREA 0.31358 02/22/2013 02/19/2013
Betamethasone Dipropionate Augmented Gel 0.05% GEL 1.33584 02/22/2013 02/19/2013
Betamethasone Dipropionate Augmented Lotion 0.05% LOTN 1.37417 02/22/2013 02/19/2013
Betamethasone Dipropionate Augmented Oint 0.05% OINT 3.14000 06/11/2013 08/06/2013
Betamethasone Dipropionate Cream 0.05% CREA 1.56000 02/22/2013 02/19/2013
Betamethasone Dipropionate Lotion 0.05% LOTN 0.60000 12/07/2012 05/15/2013
Betamethasone Dipropionate Oint 0.05% OINT 2.50670 07/11/2013 09/09/2013
Betamethasone Dipropionate Oint 0.05% OINT 2.62000 02/11/2013 03/04/2013
Betamethasone Valerate Cream 0.1% CREA 0.66000 12/07/2012 05/15/2013
Betamethasone Valerate Cream 0.1% CREA 1.29740 09/17/2013 10/09/2013
Page 14 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Betamethasone Valerate Lotion 0.1% LOTN 0.73500 02/22/2013 02/19/2013
Betamethasone Valerate Oint 0.1% OINT 0.88000 02/22/2013 02/19/2013
BETASERON (Interferon Beta-1b For Inj 0.3 MG) SOLR 306.59489 06/07/2013 08/06/2013
BETASERON W/DILUENT (Interferon Beta-1b For Inj 0.3
MG)
SOLR 306.59489 06/07/2013 08/06/2013
Betaxolol HCl Ophth Soln 0.5% SOLN 11.22722 06/14/2013 06/10/2013
Betaxolol HCl Tab 10 MG TABS 0.92292 02/22/2013 02/19/2013
Bethanechol Chloride Tab 10 MG TABS 0.13025 02/22/2013 02/19/2013
Bethanechol Chloride Tab 25 MG TABS 0.21616 02/22/2013 02/19/2013
Bethanechol Chloride Tab 5 MG TABS 0.25230 02/22/2013 02/19/2013
Bethanechol Chloride Tab 50 MG TABS 0.41548 02/22/2013 02/19/2013
BG STAR BLOOD GLUCOSE TES (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
Bicalutamide Tab 50 MG TABS 0.48566 02/22/2013 02/19/2013
BIFIDO-GENIC GROWTH FACTO (Nutritional Supplement
Powder**)
POWD 0.20315 04/05/2011 02/19/2013
BIO-35 GLUTEN-FREE (Multiple Vitamins w/ Minerals Cap**) CAPS 0.51325 04/27/2011 02/19/2013
BIO-35 IRON FREE (Multiple Vitamins w/ Minerals Cap**) CAPS 0.51325 04/27/2011 02/19/2013
BIOCAL (Multiple Vitamins w/ Minerals Cap**) CAPS 0.51325 04/27/2011 02/19/2013
Bioflavonoid Products Chew Tab** CHEW 0.04215 02/22/2013 02/19/2013
Bioflavonoid Products Tab** TABS 0.01400 02/22/2013 02/19/2013
BIOSCANNER GLUCOSE TEST S (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
BIOSUPP (Multiple Vitamins w/ Minerals Liquid**) LIQD 0.02464 03/20/2008 02/19/2013
BIOTECT PLUS (Multiple Vitamins w/ Minerals Cap**) CAPS 0.51325 04/27/2011 02/19/2013
BIOTECT PLUS (Multiple Vitamins w/ Minerals Liquid**) LIQD 0.02464 03/20/2008 02/19/2013
Biotin Tab 5 MG TABS 0.23360 02/22/2013 02/19/2013
Bisacodyl Suppos 10 MG SUPP 0.19380 02/22/2013 02/19/2013
Bisacodyl Tab Delayed Release 5 MG TBEC 0.04600 02/22/2013 02/19/2013
Bismuth Subsalicylate Chew Tab 262 MG CHEW 0.06830 02/22/2013 02/19/2013
Bismuth Subsalicylate Chew Tab 300 MG CHEW 0.07910 02/22/2013 02/19/2013
Bismuth Subsalicylate Susp 262 MG/15ML SUSP 0.00915 02/22/2013 02/19/2013
Bismuth Subsalicylate Susp 525 MG/15ML SUSP 0.01640 02/22/2013 02/19/2013
Bismuth Subsalicylate Tab 262 MG TABS 0.06450 02/22/2013 02/19/2013
Bisoprolol & Hydrochlorothiazide Tab 10-6.25 MG TABS 0.06619 02/22/2013 02/19/2013
Bisoprolol & Hydrochlorothiazide Tab 2.5-6.25 MG TABS 0.06188 02/22/2013 02/19/2013
Bisoprolol & Hydrochlorothiazide Tab 5-6.25 MG TABS 0.05530 02/22/2013 02/19/2013
Bisoprolol Fumarate Tab 10 MG TABS 0.67125 02/22/2013 02/19/2013
Bisoprolol Fumarate Tab 5 MG TABS 0.61936 02/22/2013 02/19/2013
BIVIGAM (Immune Globulin (Human) IV Soln 10 GM/100ML) SOLN 7.50000 04/01/2005 02/19/2013
BIVIGAM (Immune Globulin (Human) IV Soln 5 GM/50ML) SOLN 7.50000 04/01/2005 02/19/2013
BL LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
BL LANCETS SUPER THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
BL LANCETS THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
BL TEST STRIP (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
Blood Glucose Monitoring Kit w/ Device*** KIT 0.71000 02/22/2013 02/19/2013
Page 15 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
BLUE-EMU SUPER STRENGTH (Liniments & Rubs -
Cream**)
CREA 0.02880 04/28/2005 02/19/2013
BONINE (Meclizine HCl Chew Tab 25 MG) CHEW 0.06215 03/20/2008 02/19/2013
BOOST (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
BOOST BREEZE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
BOOST DIABETIC (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
BOOST GLUCOSE CONTROL (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
BOOST HIGH PROTEIN (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
BOOST KID ESSENTIALS 1.0 (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
BOOST KID ESSENTIALS 1.5 (Nutritional Supplement
Liquid**)
LIQD 0.00883 01/04/2008 02/19/2013
BOOST KID ESSENTIALS 1.5 (Nutritional Supplement
Liquid**)
LIQD 0.00919 03/19/2009 02/19/2013
BOOST KID ESSENTIALS 1.5 (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
BOOST KIDS ESSENTIALS (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
BOOST PLUS (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
BOOST PUDDING (Nutritional Supplement Pudding**) PUDG 0.01090 04/28/2005 02/19/2013
BOOST SMOOTHIE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
BOOST VHC (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
BOOST/BENEFIBER (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
BOTOX (OnabotulinumtoxinA For Inj 100 Unit) SOLR 522.90000 01/28/2011 02/19/2013
BOTOX COSMETIC (OnabotulinumtoxinA (Cosmetic) For Inj
100 Un
SOLR 522.90000 01/28/2011 02/19/2013
BOTOX COSMETIC (OnabotulinumtoxinA (Cosmetic) For Inj
50 Uni
SOLR 287.84400 01/28/2011 02/19/2013
BRETHINE (Terbutaline Sulfate Inj 1 MG/ML) SOLN 3.98400 07/30/2010 02/19/2013
BRETHINE (Terbutaline Sulfate Tab 2.5 MG) TABS 0.35690 07/30/2010 02/19/2013
BRETHINE (Terbutaline Sulfate Tab 5 MG) TABS 0.51460 07/30/2010 02/19/2013
BRIGHT BEGINNINGS (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
BRIGHT BEGINNINGS SOY (Infant Foods Liquid**) LIQD 0.01680 04/23/2010 02/19/2013
BRIGHT BEGINNINGS WITH FI (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
Brimonidine Tartrate Ophth Soln 0.15% SOLN 11.94200 02/22/2013 02/19/2013
Brimonidine Tartrate Ophth Soln 0.2% SOLN 0.92981 02/22/2013 02/19/2013
BRITE LIFE BLOOD GLUCOSE (Blood Glucose Monitoring
Kit w/ De
KIT 0.71000 10/01/2003 02/19/2013
Bromocriptine Mesylate Cap 5 MG CAPS 3.49379 02/22/2013 02/19/2013
Bromocriptine Mesylate Tab 2.5 MG TABS 0.92560 02/22/2013 02/19/2013
Budesonide Cap SR 24HR 3 MG CP24 11.07000 03/08/2013 03/04/2013
Budesonide Inhalation Susp 0.25 MG/2ML SUSP 2.30150 02/22/2013 02/19/2013
Budesonide Inhalation Susp 0.5 MG/2ML SUSP 4.01970 02/22/2013 02/19/2013
BUFFERIN (Aspirin Buffered (Ca Carb-Mg Carb-Mg Ox) Tab
325 M
TABS 0.03544 03/13/2008 02/19/2013
Page 16 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
BUFFERIN LOW DOSE (Aspirin Buffered (Ca Carb-Mg
Carb-Mg Ox)
TABS 0.02030 03/13/2008 02/19/2013
BULLSEYE MINI SAFETY LANC (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
BULLSEYE SAFETY LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
Bumetanide Tab 0.5 MG TABS 0.11388 02/22/2013 02/19/2013
Bumetanide Tab 1 MG TABS 0.12857 02/22/2013 02/19/2013
Bumetanide Tab 2 MG TABS 0.16532 02/22/2013 02/19/2013
BUPHENYL (Sodium Phenylbutyrate Oral Powder 3
GM/Teaspoonful
POWD 15.11688 08/15/2011 02/19/2013
BUPHENYL (Sodium Phenylbutyrate Tab 500 MG) TABS 6.45250 11/28/2009 02/19/2013
Bupivacaine HCl Inj 0.25% SOLN 0.05460 02/22/2013 02/19/2013
Bupivacaine HCl Inj 0.5% SOLN 0.06370 02/22/2013 02/19/2013
Bupivacaine HCl Preservative Free (PF) Inj 0.25% SOLN 0.05460 02/22/2013 02/19/2013
Bupivacaine HCl Preservative Free (PF) Inj 0.5% SOLN 0.06370 02/22/2013 02/19/2013
Buprenorphine HCl Inj 0.3 MG/ML (Base Equiv) SOLN 3.21100 02/22/2013 02/19/2013
Buprenorphine HCl SL Tab 2 MG (Base Equiv) SUBL 1.91400 06/05/2013 07/09/2013
Buprenorphine HCl SL Tab 8 MG (Base Equiv) SUBL 2.71490 02/22/2013 02/19/2013
Bupropion HCl (Smoking Deterrent) Tab SR 12HR 150 MG TB12 0.70180 02/22/2013 02/19/2013
Bupropion HCl Tab 100 MG TABS 0.73066 12/13/2013 12/06/2013
Bupropion HCl Tab 75 MG TABS 0.39565 02/22/2013 02/19/2013
Bupropion HCl Tab SR 12HR 100 MG TB12 0.35386 02/22/2013 02/19/2013
Bupropion HCl Tab SR 12HR 150 MG TB12 0.34529 02/22/2013 02/19/2013
Bupropion HCl Tab SR 12HR 200 MG TB12 0.56965 12/13/2013 12/06/2013
Bupropion HCl Tab SR 24HR 150 MG TB24 0.63977 08/09/2013 08/06/2013
Bupropion HCl Tab SR 24HR 300 MG TB24 0.79340 02/22/2013 02/19/2013
Buspirone HCl Tab 10 MG TABS 0.10500 09/12/2013 10/09/2013
Buspirone HCl Tab 15 MG TABS 0.07477 02/22/2013 02/19/2013
Buspirone HCl Tab 30 MG TABS 0.74500 02/22/2013 02/20/2013
Buspirone HCl Tab 5 MG TABS 0.05320 03/18/2013 04/09/2013
Buspirone HCl Tab 7.5 MG TABS 0.99000 07/10/2013 08/06/2013
Butalbital-Acetaminophen Tab 50-325 MG TABS 0.33423 02/22/2013 02/19/2013
Butalbital-Acetaminophen-Caff w/ COD Cap 50-325-40-30
MG
CAPS 0.23750 02/22/2013 02/19/2013
Butalbital-Acetaminophen-Caffeine Cap 50-325-40 MG CAPS 0.26900 02/22/2013 02/19/2013
Butalbital-Acetaminophen-Caffeine Tab 50-325-40 MG TABS 0.05696 02/22/2013 02/19/2013
Butalbital-Acetaminophen-Caffeine Tab 50-500-40 MG TABS 0.09165 02/22/2013 02/19/2013
Butalbital-Aspirin-Caff w/ Codeine Cap 50-325-40-30 MG CAPS 0.70400 02/22/2013 02/19/2013
Butalbital-Aspirin-Caffeine Cap 50-325-40 MG CAPS 0.35600 02/22/2013 02/19/2013
Butorphanol Tartrate Nasal Soln 10 MG/ML SOLN 7.03500 02/22/2013 02/19/2013
Cabergoline Tab 0.5 MG TABS 12.48000 09/13/2013 09/09/2013
Caffeine Citrate Inj 60 MG/3ML (10 MG/ML Base Equiv) SOLN 11.48333 02/22/2013 02/19/2013
Caffeine Citrate Oral Soln 60 MG/3ML (10 MG/ML Base
Equiv)
SOLN 12.70000 02/22/2013 02/19/2013
CALCILO XD (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
CALCI-MIX (Calcium Carbonate Cap 1250 MG (500 MG
Elemental C
CAPS 0.11650 04/28/2005 02/19/2013
Page 17 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Calcipotriene Cream 0.005% CREA 5.10000 09/13/2013 09/09/2013
Calcipotriene Soln 0.005% (50 MCG/ML) SOLN 2.25312 02/22/2013 02/19/2013
Calcitonin (Salmon) Nasal Soln 200 Unit/ACT SOLN 13.82000 02/22/2013 02/19/2013
Calcitriol Cap 0.25 MCG CAPS 0.67178 02/22/2013 02/19/2013
Calcitriol Cap 0.5 MCG CAPS 1.06552 11/08/2013 11/05/2013
Calcitriol Oral Soln 1 MCG/ML SOLN 8.46208 02/22/2013 02/19/2013
Calcium Acetate (Phosphate Binder) Cap 667 MG (169 MG
Ca)
CAPS 0.59118 02/22/2013 02/19/2013
Calcium Carbonate (Antacid) Chew Tab 1000 MG CHEW 0.05450 02/22/2013 02/19/2013
Calcium Carbonate (Antacid) Chew Tab 420 MG CHEW 0.02500 02/22/2013 02/19/2013
Calcium Carbonate (Antacid) Chew Tab 500 MG CHEW 0.01259 02/22/2013 02/19/2013
Calcium Carbonate (Antacid) Chew Tab 750 MG CHEW 0.04025 02/22/2013 02/19/2013
Calcium Carbonate (Antacid) Tab 648 MG TABS 0.01613 02/22/2013 02/19/2013
Calcium Carbonate (Antacid) Tab 650 MG TABS 0.01613 02/22/2013 02/19/2013
Calcium Carbonate Chew Tab 1250 MG (500 MG Elemental
Ca)
CHEW 0.06222 02/22/2013 02/19/2013
Calcium Carbonate Susp 1250 MG/5ML (500 MG/5ML
Elemental Ca)
SUSP 0.01800 02/22/2013 02/19/2013
Calcium Carbonate Tab 1250 MG (500 MG Elemental Ca) TABS 0.07990 02/22/2013 02/19/2013
Calcium Carbonate Tab 1500 MG (600 MG Elemental Ca) TABS 0.05700 02/22/2013 02/19/2013
Calcium Carbonate Tab 600 MG TABS 0.04575 02/22/2013 02/19/2013
Calcium Carbonate Tab 650 MG TABS 0.00640 02/22/2013 02/19/2013
Calcium Carbonate-Cholecalciferol Tab 250 MG-250 Unit TABS 0.02833 02/22/2013 02/19/2013
Calcium Carbonate-Cholecalciferol Tab 500 MG-125 Unit TABS 0.02087 02/22/2013 02/19/2013
Calcium Carbonate-Cholecalciferol Tab 500 MG-200 Unit TABS 0.02087 02/22/2013 02/19/2013
Calcium Carbonate-Cholecalciferol Tab 500 MG-400 Unit TABS 0.02087 02/22/2013 02/19/2013
Calcium Carbonate-Cholecalciferol Tab 600 MG-200 Unit TABS 0.10445 02/22/2013 02/19/2013
Calcium Carbonate-Cholecalciferol Tab 600 MG-400 Unit TABS 0.03488 02/22/2013 02/19/2013
Calcium Carbonate-Ergocalciferol Tab 250 MG-125 Unit TABS 0.02833 02/22/2013 02/19/2013
Calcium Carbonate-Ergocalciferol Tab 500MG-200 Unit TABS 0.02087 02/22/2013 02/19/2013
Calcium Carbonate-Vitamin D Tab 250 MG-125 Unit TABS 0.03500 02/22/2013 02/19/2013
Calcium Carbonate-Vitamin D Tab 500 MG-125 Unit TABS 0.03500 02/22/2013 02/19/2013
Calcium Carbonate-Vitamin D Tab 500 MG-200 Unit TABS 0.03500 02/22/2013 02/19/2013
Calcium Carbonate-Vitamin D Tab 500 MG-400 Unit TABS 0.03500 02/22/2013 02/19/2013
Calcium Carbonate-Vitamin D Tab 600 MG-125 Unit TABS 0.03500 02/22/2013 02/19/2013
Calcium Carbonate-Vitamin D Tab 600 MG-200 Unit TABS 0.03500 02/22/2013 02/19/2013
Calcium Carbonate-Vitamin D Tab 600 MG-400 Unit TABS 0.03488 02/22/2013 02/19/2013
Calcium Carb-Vit D w/ Minerals Chew Tab 600 MG-400
Unit***
CHEW 0.09205 02/22/2013 02/19/2013
Calcium Carb-Vit D w/ Minerals Tabs 600 MG-200 Unit*** TABS 0.07814 02/22/2013 02/19/2013
Calcium Carb-Vit D w/ Minerals Tabs 600 MG-400 Unit*** TABS 0.09205 02/22/2013 02/19/2013
Calcium Citrate Malate-Cholecalciferol Tab 250 MG-100 Unit TABS 0.02833 02/22/2013 02/19/2013
Calcium Citrate Tab 950 MG (200 MG Elemental Ca) TABS 0.03450 02/22/2013 02/19/2013
Calcium Citrate-Vitamin D Tab 1500 MG-200 Unit TABS 0.07531 02/22/2013 02/19/2013
Calcium Citrate-Vitamin D Tab 200 MG-125 Unit (Elemental
Ca)
TABS 0.03450 02/22/2013 02/19/2013
Page 18 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Calcium Citrate-Vitamin D Tab 200 MG-200 Unit (Elemental
Ca)
TABS 0.05485 02/22/2013 02/19/2013
Calcium Citrate-Vitamin D Tab 200 MG-250 Unit (Elemental
Ca)
TABS 0.05485 02/22/2013 02/19/2013
Calcium Citrate-Vitamin D Tab 315 MG-200 Unit (Elemental
Ca)
TABS 0.07597 02/22/2013 02/19/2013
Calcium Citrate-Vitamin D Tab 315 MG-250 Unit (Elemental
Ca)
TABS 0.06500 02/22/2013 02/19/2013
Calcium Gluconate Tab 500 MG TABS 0.15000 02/22/2013 02/19/2013
Calcium Gluconate Tab 650 MG TABS 0.01580 02/22/2013 02/19/2013
Calcium Lactate Tab 648 MG (84 MG Elemental Ca) TABS 0.02630 02/22/2013 02/19/2013
Calcium Lactate Tab 650 MG TABS 0.02630 02/22/2013 02/19/2013
Calcium Polycarbophil Tab 625 MG TABS 0.09185 02/22/2013 02/19/2013
Calcium Tab 600 MG TABS 0.02500 02/22/2013 02/19/2013
Calcium w/ Vitamin D & K Chew Tab 500 MG-100 Unit-40
MCG
CHEW 0.08476 02/22/2013 02/19/2013
Calcium w/ Vitamin D Tab 600 MG-125 Unit TABS 0.04283 02/22/2013 02/19/2013
Calcium w/ Vitamin D Tab 600 MG-200 Unit TABS 0.04283 02/22/2013 02/19/2013
CAL-DAY 1000 (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
CALPHRON (Calcium Acetate Tab 667 MG) TABS 0.08938 11/27/2010 02/19/2013
CALTRATE 600+D (Calcium Carbonate-Cholecalciferol Tab
600 MG
TABS 0.05900 07/18/2012 02/19/2013
CALTRATE 600+D PLUS (Calcium Carb-Vit D w/ Minerals
Chew Tab
CHEW 0.09210 05/28/2010 02/19/2013
CALTRATE 600+D PLUS MINER (Calcium Carb-Vit D w/
Minerals Ta
TABS 0.09205 03/13/2008 02/19/2013
CAM (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
CAMINO PRO 15 (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
CAMINO PRO COMPLETE/GLYTA (Nutritional Supplement
Bar**)
BAR 0.46070 04/28/2005 02/19/2013
CAMINO PRO RESTORE/GLYTAC (Nutritional Supplement
Liquid**)
LIQD 0.00720 04/28/2005 02/19/2013
CAMINO PRO RESTORE/GLYTAC (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
Camphor & Menthol Lotion 0.5-0.5% LOTN 0.03110 02/22/2013 02/19/2013
Camphor-Menthol-Methyl Salicylate Cream 4-10-30% CREA 0.02880 02/22/2013 02/19/2013
Candesartan Cilexetil Tab 32 MG TABS 3.94680 09/13/2013 09/09/2013
Candesartan Cilexetil Tab 4 MG TABS 2.91500 09/13/2013 09/09/2013
Candesartan Cilexetil-Hydrochlorothiazide Tab 16-12.5 MG TABS 2.02290 09/13/2013 09/09/2013
Candesartan Cilexetil-Hydrochlorothiazide Tab 32-12.5 MG TABS 2.02290 09/13/2013 09/09/2013
Candesartan Cilexetil-Hydrochlorothiazide Tab 32-25 MG TABS 3.03985 09/13/2013 09/09/2013
CAPOZIDE (Captopril & Hydrochlorothiazide Tab 25-25 MG) TABS 0.24000 09/24/2012 02/19/2013
Capsaicin Cream 0.025% CREA 0.10050 02/22/2013 02/19/2013
Capsaicin Cream 0.075% CREA 0.06771 02/22/2013 02/19/2013
Capsicum Oleoresin Cream 0.025% CREA 0.10050 02/22/2013 02/19/2013
Capsicum Oleoresin Cream 0.075% CREA 0.16320 02/22/2013 02/19/2013
Captopril & Hydrochlorothiazide Tab 25-15 MG TABS 0.32500 07/15/2013 08/06/2013
Page 19 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Captopril & Hydrochlorothiazide Tab 25-25 MG TABS 0.24000 02/22/2013 02/19/2013
Captopril & Hydrochlorothiazide Tab 50-15 MG TABS 0.14030 02/22/2013 02/19/2013
Captopril & Hydrochlorothiazide Tab 50-25 MG TABS 0.32084 02/22/2013 02/19/2013
Captopril Tab 100 MG TABS 0.93000 10/28/2013 12/06/2013
Captopril Tab 12.5 MG TABS 0.01346 02/22/2013 02/19/2013
Captopril Tab 25 MG TABS 0.01775 02/22/2013 02/19/2013
Captopril Tab 50 MG TABS 0.03120 02/22/2013 02/19/2013
CAPZASIN-P (Capsaicin Cream 0.035%) CREA 0.18740 04/28/2005 02/19/2013
Carbamazepine Cap SR 12HR 100 MG CP12 1.36552 08/09/2013 08/06/2013
Carbamazepine Cap SR 12HR 200 MG CP12 1.54365 02/22/2013 02/19/2013
Carbamazepine Cap SR 12HR 300 MG CP12 1.48000 02/22/2013 02/19/2013
Carbamazepine Chew Tab 100 MG CHEW 0.07241 02/22/2013 02/19/2013
Carbamazepine Susp 100 MG/5ML SUSP 0.12949 02/22/2013 02/19/2013
Carbamazepine Tab 200 MG TABS 0.04144 02/22/2013 02/19/2013
Carbamazepine Tab SR 12HR 200 MG TB12 0.75575 02/22/2013 02/19/2013
Carbamazepine Tab SR 12HR 400 MG TB12 2.12000 09/09/2013 11/05/2013
Carbamide Peroxide 6.5% Otic Soln SOLN 0.09967 02/22/2013 02/19/2013
Carbidopa & Levodopa Orally Disintegrating Tab 25-100 MG TBDP 1.02924 02/22/2013 02/20/2013
Carbidopa & Levodopa Tab 10-100 MG TABS 0.15363 02/22/2013 02/19/2013
Carbidopa & Levodopa Tab 25-100 MG TABS 0.16523 02/22/2013 02/19/2013
Carbidopa & Levodopa Tab 25-250 MG TABS 0.24200 02/22/2013 02/19/2013
Carbidopa & Levodopa Tab CR 25-100 MG TBCR 0.22750 02/22/2013 02/19/2013
Carbidopa & Levodopa Tab CR 50-200 MG TBCR 0.54630 07/11/2013 08/06/2013
Carbidopa-Levodopa-Entacapone Tabs 25-100-200 MG TABS 3.06482 09/13/2013 09/09/2013
Carbidopa-Levodopa-Entacapone Tabs 37.5-150-200 MG TABS 3.06482 09/13/2013 09/09/2013
Carbidopa-Levodopa-Entacapone Tabs 50-200-200 MG TABS 2.80555 09/13/2013 09/09/2013
Carboplatin IV Soln 150 MG/15ML SOLN 1.20553 02/22/2013 02/19/2013
Carboplatin IV Soln 450 MG/45ML SOLN 1.20553 02/22/2013 02/19/2013
Carboplatin IV Soln 50 MG/5ML SOLN 1.20553 02/22/2013 02/19/2013
Carboplatin IV Soln 600 MG/60ML SOLN 1.20553 02/22/2013 02/19/2013
Carboxymethylcellulose Sodium Ophth Soln 0.5% SOLN 0.48950 02/22/2013 02/19/2013
CARDENZ (Multiple Vitamin Tab**) TABS 0.02140 03/20/2008 02/19/2013
CARDIODAILY (Multiple Vitamins w/ Minerals Cap**) CAPS 0.51325 04/27/2011 02/19/2013
CAREONE LANCET (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
CAREONE LANCET THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
CAREONE LANCET ULTRA THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
CARESENS N BLOOD GLUCOSE (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
Carisoprodol Tab 350 MG TABS 0.05785 02/22/2013 02/19/2013
Carisoprodol w/ Aspirin Tab 200-325 MG TABS 0.31000 02/22/2013 02/19/2013
CARMOL 20 (Urea Cream 20%) CREA 0.08452 03/20/2008 02/19/2013
CARNATION INSTANT BREAKFA (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
CAROMEGA (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
CARRINGTON ORAL WOUND RIN (Oral Wound Care
Products - For So
SOLR 0.10360 04/28/2005 02/19/2013
Page 20 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Carteolol HCl Ophth Soln 1% SOLN 1.65667 02/22/2013 02/19/2013
Carvedilol Tab 12.5 MG TABS 0.04859 02/22/2013 02/19/2013
Carvedilol Tab 25 MG TABS 0.04293 02/22/2013 02/19/2013
Carvedilol Tab 3.125 MG TABS 0.04968 02/22/2013 02/19/2013
Carvedilol Tab 6.25 MG TABS 0.04733 02/22/2013 02/19/2013
Casanthranol-DSS Cap 30-100 MG CAPS 0.02862 02/22/2013 02/19/2013
CAVAN PRENATAL/EC CALCIUM (Prenatal w/o A Vit w/ Fe
Fumarate
TBEC 0.18187 01/23/2009 02/19/2013
CAYSTON (Aztreonam Lysine For Inhal Soln 75 MG (Base
Equival
SOLR 67.33590 01/01/2013 03/04/2013
CEENU (Lomustine Cap 10 MG) CAPS 8.78721 04/13/2012 02/19/2013
CEENU (Lomustine Cap 40 MG) CAPS 26.46165 04/13/2012 02/19/2013
Cefaclor Cap 250 MG CAPS 0.36000 02/22/2013 02/19/2013
Cefaclor Cap 500 MG CAPS 0.56000 02/22/2013 02/19/2013
Cefaclor For Susp 125 MG/5ML SUSR 0.09000 02/22/2013 02/19/2013
Cefaclor For Susp 375 MG/5ML SUSR 0.18000 02/22/2013 02/19/2013
Cefadroxil Cap 500 MG CAPS 0.18125 02/22/2013 02/19/2013
Cefadroxil For Susp 250 MG/5ML SUSR 0.40300 02/22/2013 02/19/2013
Cefadroxil For Susp 500 MG/5ML SUSR 0.43578 08/09/2013 08/06/2013
Cefadroxil Tab 1 GM TABS 3.15000 02/22/2013 02/19/2013
Cefazolin Sodium For Inj 1 GM SOLR 0.92300 02/22/2013 02/19/2013
Cefazolin Sodium For Inj 10 GM SOLR 8.51282 11/08/2013 11/05/2013
Cefazolin Sodium For IV Soln 1 GM SOLR 1.36500 02/22/2013 02/19/2013
Cefdinir Cap 300 MG CAPS 1.59536 03/08/2013 03/04/2013
Cefdinir For Susp 125 MG/5ML SUSR 0.55153 09/13/2013 09/09/2013
Cefdinir For Susp 250 MG/5ML SUSR 1.02350 02/22/2013 02/19/2013
Cefepime HCl For Inj 1 GM SOLR 5.63420 02/22/2013 02/19/2013
Cefepime HCl For Inj 2 GM SOLR 13.10920 02/22/2013 02/19/2013
Cefpodoxime Proxetil For Susp 100 MG/5ML SUSR 1.16000 04/03/2013 05/06/2013
Cefpodoxime Proxetil For Susp 50 MG/5ML SUSR 0.47995 02/22/2013 02/19/2013
Cefpodoxime Proxetil Tab 100 MG TABS 3.94842 02/22/2013 02/19/2013
Cefpodoxime Proxetil Tab 200 MG TABS 7.36000 02/19/2013 03/04/2013
Cefpodoxime Proxetil Tab 200 MG TABS 7.36000 02/22/2013 03/04/2013
Cefprozil For Susp 125 MG/5ML SUSR 0.13572 02/22/2013 02/19/2013
Cefprozil For Susp 250 MG/5ML SUSR 0.60000 02/07/2013 03/04/2013
Cefprozil For Susp 250 MG/5ML SUSR 0.60000 02/22/2013 03/04/2013
Cefprozil Tab 250 MG TABS 1.09500 02/22/2013 02/19/2013
Cefprozil Tab 500 MG TABS 2.18000 07/10/2013 08/06/2013
Ceftazidime For Inj 1 GM SOLR 4.95300 02/22/2013 02/19/2013
Ceftazidime For Inj 2 GM SOLR 11.54400 02/22/2013 02/19/2013
Ceftazidime For Inj 6 GM SOLR 24.36200 02/22/2013 02/19/2013
Ceftazidime For IV Soln 1 GM SOLR 5.23900 02/22/2013 02/19/2013
Ceftazidime For IV Soln 2 GM SOLR 13.67600 02/22/2013 02/19/2013
Ceftriaxone Sodium For Inj 1 GM SOLR 2.55450 02/22/2013 02/19/2013
Ceftriaxone Sodium For Inj 10 GM SOLR 37.70000 02/22/2013 02/19/2013
Page 21 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Ceftriaxone Sodium For Inj 2 GM SOLR 4.79700 02/22/2013 02/19/2013
Ceftriaxone Sodium For Inj 250 MG SOLR 1.65450 02/22/2013 02/19/2013
Ceftriaxone Sodium For Inj 500 MG SOLR 1.71600 02/22/2013 02/19/2013
Ceftriaxone Sodium For IV Soln 1 GM SOLR 4.14500 02/22/2013 02/19/2013
Ceftriaxone Sodium For IV Soln 2 GM SOLR 4.88800 02/22/2013 02/19/2013
Cefuroxime Axetil Tab 250 MG TABS 0.30215 02/22/2013 02/19/2013
Cefuroxime Axetil Tab 500 MG TABS 0.82363 02/22/2013 02/19/2013
CELLCEPT (Mycophenolate Mofetil For Oral Susp 200
MG/ML)
SUSR 6.16680 01/03/2013 02/20/2013
CELLULAR SECURITY (Multiple Vitamins w/ Minerals Cap**) CAPS 0.51325 04/27/2011 02/19/2013
CELLUVISC (Carboxymethylcellulose Sodium Ophth Soln
1%)
SOLN 0.47264 04/23/2012 02/19/2013
CENTRUM (Multiple Vitamins w/ Minerals Chew Tab**) CHEW 0.29485 03/20/2008 02/19/2013
CENTRUM (Multiple Vitamins w/ Minerals Liquid**) LIQD 0.02464 03/20/2008 02/19/2013
CENTRUM (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
CENTRUM CARB ASSIST (Multiple Vitamins w/ Minerals
Tab**)
TABS 0.07430 03/20/2008 02/19/2013
CENTRUM CARDIO (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
CENTRUM FLAVOR BURST (Multiple Vitamins w/ Minerals
Chew Tab
CHEW 0.29485 03/20/2008 02/19/2013
CENTRUM SILVER (Multiple Vitamins w/ Minerals Chew
Tab**)
CHEW 0.29485 03/20/2008 02/19/2013
CENTRUM SILVER (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
CENTRUM SILVER ULTRA MENS (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
CENTRUM SILVER ULTRA WOME (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
CENTRUM SPECIALIST HEART (Multiple Vitamins w/
Minerals Tab*
TABS 0.07430 03/20/2008 02/19/2013
CENTRUM SPECIALIST IMMUNE (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
CENTRUM SPECIALIST VISION (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
CENTRUM ULTRA MENS (Multiple Vitamins w/ Minerals
Tab**)
TABS 0.07430 03/20/2008 02/19/2013
CENTRUM ULTRA WOMENS (Multiple Vitamins w/ Minerals
Tab**)
TABS 0.07430 03/20/2008 02/19/2013
Cephalexin Cap 250 MG CAPS 0.10500 02/22/2013 02/19/2013
Cephalexin Cap 500 MG CAPS 0.11385 02/22/2013 02/19/2013
Cephalexin For Susp 125 MG/5ML SUSR 0.07769 11/21/2013 12/06/2013
Cephalexin For Susp 250 MG/5ML SUSR 0.06266 02/22/2013 02/19/2013
CERALYTE 50 (Oral Electrolyte Solution***) SOLN 0.00560 04/28/2005 02/19/2013
CERALYTE 70 (Oral Electrolyte Solution***) SOLN 0.00560 04/28/2005 02/19/2013
CERASPORT (Oral Electrolyte Solution***) SOLN 0.00560 04/28/2005 02/19/2013
CERASPORT EX1 (Oral Electrolyte Solution***) SOLN 0.00560 04/28/2005 02/19/2013
CERAVE (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
CERAVE AM SPF 30 (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
Page 22 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
CERAVE PM (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
CERAVE SA RENEWING (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
CERTAVITE SENIOR/ANTIOXID (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
CETAKLENZ (Soap & Cleansers - Liquid***) LIQD 0.01940 03/13/2008 02/19/2013
CETAPHIL DAILY ADVANCE UL (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
CETAPHIL DAILY FACIAL MOI (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
CETAPHIL DERMACONTROL MOI (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
CETAPHIL GENTLE CLEANSER (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
CETAPHIL MOISTURIZING (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
CETAPHIL RESTORADERM (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
Cetirizine HCl Chew Tab 10 MG CHEW 0.57308 02/22/2013 02/19/2013
Cetirizine HCl Chew Tab 5 MG CHEW 0.57308 02/22/2013 02/19/2013
Cetirizine HCl Syrup 1 MG/ML (5 MG/5ML) SOLN 0.04100 02/22/2013 02/19/2013
Cetirizine HCl Syrup 1 MG/ML (5 MG/5ML) SYRP 0.04100 02/22/2013 02/19/2013
Cetirizine HCl Tab 10 MG TABS 0.05785 02/22/2013 02/19/2013
Cetirizine HCl Tab 5 MG TABS 0.07158 02/22/2013 02/19/2013
Cetirizine-Pseudoephedrine Tab SR 12HR 5-120 MG TB12 0.60558 02/22/2013 02/19/2013
CHAPSTICK OVERNIGHT (Skin Protectants Misc -
Ointment***)
OINT 0.03040 04/28/2005 02/19/2013
CHAPSTICK ULTRA MOISTURE (Skin Protectants Misc -
Ointment**
OINT 0.03040 04/28/2005 02/19/2013
CHAPSTICK ULTRASMOOTH FOR (Skin Protectants Misc -
Ointment*
OINT 0.03040 04/28/2005 02/19/2013
CHAPSTICK ULTRASMOOTH NOU (Skin Protectants Misc -
Ointment*
OINT 0.03040 04/28/2005 02/19/2013
CHAPSTICK ULTRASMOOTH REJ (Skin Protectants Misc -
Ointment*
OINT 0.03040 04/28/2005 02/19/2013
CHAPSTICK ULTRASMOOTH SOO (Skin Protectants Misc -
Ointment*
OINT 0.03040 04/28/2005 02/19/2013
CHEMET (Succimer Cap 100 MG) CAPS 8.20960 09/16/2013 09/17/2013
Chlordiazepoxide HCl Cap 10 MG CAPS 0.07000 02/22/2013 02/19/2013
Chlordiazepoxide HCl Cap 25 MG CAPS 0.08000 02/22/2013 02/19/2013
Chlordiazepoxide HCl Cap 5 MG CAPS 0.08900 02/22/2013 02/19/2013
Chlordiazepoxide-Amitriptyline Tab 10-25 MG TABS 0.85530 02/22/2013 02/19/2013
Chlordiazepoxide-Amitriptyline Tab 5-12.5 MG TABS 1.02580 07/18/2013 08/06/2013
Chlorhexidine Gluconate Liquid 4% LIQD 0.01798 02/22/2013 02/19/2013
Chlorhexidine Gluconate Soln 0.12% SOLN 0.00591 02/22/2013 02/19/2013
Chloroquine Phosphate Tab 250 MG TABS 1.35637 02/22/2013 02/19/2013
Chloroquine Phosphate Tab 500 MG TABS 2.00964 02/08/2013 02/20/2013
Chloroquine Phosphate Tab 500 MG TABS 2.00964 02/22/2013 02/20/2013
Chlorothiazide Tab 250 MG TABS 0.11256 02/22/2013 02/19/2013
Chlorothiazide Tab 500 MG TABS 0.27399 02/22/2013 02/19/2013
Chlorpheniramine Maleate Syrup 2 MG/5ML SYRP 0.01750 02/22/2013 02/19/2013
Chlorpheniramine Maleate Tab 4 MG TABS 0.00599 02/22/2013 02/19/2013
Chlorpheniramine Maleate Tab CR 12 MG TBCR 0.36000 02/22/2013 02/19/2013
Page 23 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Chlorpromazine HCl Tab 10 MG TABS 0.79000 10/23/2013 11/05/2013
Chlorpromazine HCl Tab 100 MG TABS 2.22000 07/18/2013 09/09/2013
Chlorpromazine HCl Tab 200 MG TABS 3.31078 09/03/2013 10/09/2013
Chlorpromazine HCl Tab 25 MG TABS 0.84469 02/22/2013 02/19/2013
Chlorpromazine HCl Tab 50 MG TABS 1.53760 07/15/2013 10/09/2013
Chlorpropamide Tab 100 MG TABS 0.16000 02/22/2013 02/19/2013
Chlorpropamide Tab 250 MG TABS 0.34000 02/22/2013 02/19/2013
Chlorthalidone Tab 25 MG TABS 0.41000 02/22/2013 02/19/2013
Chlorthalidone Tab 50 MG TABS 0.46480 02/22/2013 02/19/2013
CHLOR-TRIMETON (Chlorpheniramine Maleate Syrup 2
MG/5ML)
SYRP 0.01750 03/13/2008 02/19/2013
CHLOR-TRIMETON (Chlorpheniramine Maleate Tab 4 MG) TABS 0.02960 03/13/2008 02/19/2013
CHLOR-TRIMETON ALLERGY (Chlorpheniramine Maleate
Tab CR 12 M
TBCR 0.36000 04/28/2005 02/19/2013
Chlorzoxazone Tab 250 MG TABS 0.04800 02/22/2013 02/19/2013
Chlorzoxazone Tab 500 MG TABS 0.25000 05/29/2013 08/06/2013
CHOICE DM (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
CHOICE DM FORA G20 TEST S (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
CHOICE DM TF (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
Cholecalciferol Cap 1000 Unit CAPS 0.03550 02/22/2013 02/19/2013
Cholecalciferol Cap 400 Unit CAPS 0.03760 02/22/2013 02/19/2013
Cholecalciferol Tab 1000 Unit TABS 0.03550 02/22/2013 02/19/2013
Cholecalciferol Tab 400 Unit TABS 0.03764 02/22/2013 02/19/2013
Cholestyramine Light Powder 4 GM/DOSE POWD 0.32512 11/04/2013 12/06/2013
Cholestyramine Light Powder Packets 4 GM PACK 0.76600 02/22/2013 02/19/2013
Cholestyramine Powder 4 GM/DOSE POWD 0.19500 10/14/2013 12/06/2013
Cholestyramine Powder Packets 4 GM PACK 0.88500 02/22/2013 02/19/2013
Choline & Magnesium Salicylates Tab 1000 MG TABS 0.23000 02/22/2013 02/19/2013
Choline & Magnesium Salicylates Tab 500 MG TABS 0.10075 02/22/2013 02/19/2013
Choline & Magnesium Salicylates Tab 750 MG TABS 0.10725 02/22/2013 02/19/2013
Choline Fenofibrate Cap DR 45 MG (Fenofibric Acid Equiv) CPDR 1.65033 09/13/2013 09/09/2013
Chorionic Gonadotropin For Inj 10000 Unit SOLR 55.75500 02/22/2013 02/19/2013
Ciclopirox Gel 0.77% GEL 2.22000 09/25/2013 11/05/2013
Ciclopirox Olamine Cream 0.77% (Base Equiv) CREA 0.41711 02/08/2013 02/20/2013
Ciclopirox Olamine Cream 0.77% (Base Equiv) CREA 0.41711 02/22/2013 02/20/2013
Ciclopirox Olamine Susp 0.77% (Base Equiv) SUSP 0.65726 02/22/2013 02/19/2013
Ciclopirox Shampoo 1% SHAM 0.79229 02/22/2013 02/19/2013
Ciclopirox Solution 8% SOLN 1.02273 02/22/2013 02/19/2013
Cilostazol Tab 100 MG TABS 0.16597 02/22/2013 02/19/2013
Cilostazol Tab 50 MG TABS 0.16708 02/22/2013 02/19/2013
Cimetidine HCl Soln 300 MG/5ML SOLN 0.03677 02/22/2013 02/19/2013
Cimetidine Tab 200 MG TABS 0.06613 02/22/2013 02/19/2013
Cimetidine Tab 300 MG TABS 0.19648 08/06/2013 09/09/2013
Cimetidine Tab 400 MG TABS 0.06293 02/22/2013 02/19/2013
Cimetidine Tab 800 MG TABS 0.47344 02/22/2013 02/19/2013
Page 24 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
CIMZIA (Certolizumab Pegol For Inj Kit 2 X 200 MG) KIT 2,509.62120 10/01/2013 12/06/2013
CIMZIA (Certolizumab Pegol Inj Kit 2 X 200 MG/ML) KIT 2,509.62120 10/01/2013 12/06/2013
CIMZIA STARTER KIT (Certolizumab Pegol Inj Kit 6 X 200
MG/ML
KIT 5,881.71200 04/13/2012 02/19/2013
CINRYZE (C1 Esterase Inhibitor (Human) For IV Inj 500 Unit) SOLR 2,076.51060 01/28/2011 02/19/2013
Ciprofloxacin 400 MG/200ML in D5W SOLN 0.01428 02/22/2013 02/19/2013
Ciprofloxacin HCl Ophth Soln 0.3% SOLN 0.88205 02/22/2013 02/19/2013
Ciprofloxacin HCl Tab 100 MG (Base Equiv) TABS 0.44600 02/22/2013 02/19/2013
Ciprofloxacin HCl Tab 250 MG (Base Equiv) TABS 0.07660 02/22/2013 02/19/2013
Ciprofloxacin HCl Tab 500 MG (Base Equiv) TABS 0.12550 02/22/2013 02/19/2013
Ciprofloxacin HCl Tab 750 MG (Base Equiv) TABS 0.21500 02/22/2013 02/19/2013
Citalopram Hydrobromide Oral Soln 10 MG/5ML SOLN 0.19270 02/22/2013 02/19/2013
Citalopram Hydrobromide Tab 10 MG (Base Equiv) TABS 0.03042 02/22/2013 02/19/2013
Citalopram Hydrobromide Tab 20 MG (Base Equiv) TABS 0.04956 02/22/2013 02/19/2013
Citalopram Hydrobromide Tab 40 MG (Base Equiv) TABS 0.05839 02/22/2013 02/19/2013
CITRACAL MAXIMUM (Calcium Citrate-Vitamin D Tab 315
MG-250 U
TABS 0.07597 03/13/2008 02/19/2013
CITRACAL PETITES/VITAMIN (Calcium Citrate-Vitamin D
Tab 200
TABS 0.05485 03/13/2008 02/19/2013
CITRACAL/VITAMIN D (Calcium Citrate-Vitamin D Tab 250
MG-200
TABS 0.06080 04/28/2005 02/19/2013
CITRUCEL (Methylcellulose Tab 500 MG) TABS 0.10545 03/20/2008 02/19/2013
CITRUCEL CLEAR-MIX (Methylcellulose Powder Laxative) POWD 0.02291 07/28/2011 02/19/2013
CITRUCEL FIBER LAXATIVE (Methylcellulose Powder
Laxative)
POWD 0.02291 07/28/2011 02/19/2013
CITRUCEL FIBERSHAKE (Methylcellulose Powder Laxative) POWD 0.02291 07/28/2011 02/19/2013
CLARAVIS (Isotretinoin Cap 30 MG) CAPS 13.19920 01/13/2012 02/19/2013
Clarithromycin For Susp 125 MG/5ML SUSR 0.30100 02/22/2013 02/19/2013
Clarithromycin For Susp 250 MG/5ML SUSR 0.55665 02/22/2013 02/19/2013
Clarithromycin Tab 250 MG TABS 2.92133 09/12/2013 10/09/2013
Clarithromycin Tab 500 MG TABS 2.72610 08/09/2013 08/06/2013
Clarithromycin Tab SR 24HR 500 MG TB24 2.50200 02/22/2013 02/19/2013
CLARITIN (Loratadine Syrup 5 MG/5ML) SYRP 0.03850 04/23/2010 02/19/2013
CLARITIN (Loratadine Syrup 5 MG/5ML) SYRP 0.05480 03/20/2008 02/19/2013
CLARITIN (Loratadine Tab 10 MG) TABS 0.10500 05/28/2010 02/19/2013
CLARITIN (Loratadine Tab 10 MG) TABS 0.10500 05/29/2010 02/19/2013
CLARITIN (Loratadine Tab 10 MG) TABS 0.27350 03/20/2008 02/19/2013
CLARITIN REDITABS (Loratadine Rapidly-Disintegrating Tab
10
TBDP 0.10500 04/23/2010 02/19/2013
CLARITIN REDITABS (Loratadine Rapidly-Disintegrating Tab
10
TBDP 0.27350 03/20/2008 02/19/2013
CLASSIC PRENATAL (Prenatal Vit w/ Fe Fumarate-FA Tab
28-0.8
TABS 0.07255 02/27/2009 02/19/2013
CLEAN & CLEAR MORNING BUR (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
CLEAN & CLEAR SOFT MOISTU (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
CLEANLET LANCETS 28G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
Page 25 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
CLEAR EYES REDNESS RELIEF (Naphazoline-Glycerin
Ophth Soln 0
SOLN 0.17790 04/28/2005 02/19/2013
Clemastine Fumarate Syrup 0.67 MG/5ML (0.5 MG/5ML Base
Eq)
SYRP 0.04950 02/22/2013 02/19/2013
Clemastine Fumarate Tab 1.34 MG (1 MG Base Equiv) TABS 0.14420 02/22/2013 02/19/2013
Clemastine Fumarate Tab 2.68 MG TABS 0.22800 02/22/2013 02/19/2013
CLEVER CHEK AUTO CODE VOI (Blood Glucose Monitoring
Devices*
DEVI 0.71000 10/01/2003 02/19/2013
CLEVER CHEK AUTO-CODE BLO (Blood Glucose
Monitoring Devices*
DEVI 0.71000 10/01/2003 02/19/2013
CLEVER CHEK AUTO-CODE TES (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
CLEVER CHEK AUTO-CODE VOI (Blood Glucose Monitoring
Devices*
DEVI 0.71000 10/01/2003 02/19/2013
CLEVER CHEK AUTO-CODE VOI (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
CLEVER CHEK BLOOD GLUCOSE (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
CLEVER CHEK LANCETS ULTRA (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
CLEVER CHEK TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
CLEVER CHOICE AUTO-CODE P (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
CLEVER CHOICE MICRO BLOOD (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
CLEVER CHOICE MICRO TEST (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
Clidinium & Chlordiazepoxide Cap 2.5-5 MG CAPS 1.02700 02/22/2013 02/19/2013
Clindamycin HCl Cap 150 MG CAPS 0.14050 04/15/2013 05/06/2013
Clindamycin HCl Cap 300 MG CAPS 0.30620 02/22/2013 02/19/2013
Clindamycin HCl Cap 75 MG CAPS 0.45743 02/22/2013 02/19/2013
Clindamycin Palmitate HCl For Soln 75 MG/5ML (Base Equiv) SOLR 0.40298 11/08/2013 11/05/2013
Clindamycin Phosphate Foam 1% FOAM 2.86039 02/22/2013 02/19/2013
Clindamycin Phosphate Gel 1% GEL 1.78600 02/22/2013 02/20/2013
Clindamycin Phosphate Gel 1% GEL 1.90000 12/07/2012 05/06/2013
Clindamycin Phosphate Lotion 1% LOTN 1.30000 02/22/2013 03/04/2013
Clindamycin Phosphate Soln 1% SOLN 1.06000 01/31/2013 03/04/2013
Clindamycin Phosphate Soln 1% SOLN 1.06000 02/22/2013 03/04/2013
Clindamycin Phosphate Swab 1% SWAB 0.44000 02/22/2013 02/19/2013
Clindamycin Phosphate Vaginal Cream 2% CREA 1.87600 02/22/2013 02/20/2013
Clindamycin Phosphate-Benzoyl Peroxide Gel 1-5% GEL 3.37064 02/22/2013 02/19/2013
CLINDAREACH (Clindamycin Phosphate Swab Kit 1%) KIT 0.30900 09/27/2007 02/19/2013
CLINICAL NUTRIENTS 45-PLU (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
CLINICAL NUTRIENTS 50-PLU (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
CLINICAL NUTRIENTS ANTIOX (Multiple Vitamins w/
Minerals Cap
CAPS 0.51325 04/27/2011 02/19/2013
CLINICAL NUTRIENTS FOR FE (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
CLINICAL NUTRIENTS FOR MA (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
Page 26 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
CLINICAL NUTRIENTS FOR ME (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
CLINICAL NUTRIENTS FOR WO (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
Clobetasol Propionate Cream 0.05% CREA 0.41000 02/22/2013 02/19/2013
Clobetasol Propionate Emollient Base Cream 0.05% CREA 0.23515 02/22/2013 02/19/2013
Clobetasol Propionate Foam 0.05% FOAM 4.50000 11/12/2013 12/06/2013
Clobetasol Propionate Gel 0.05% GEL 0.32448 02/22/2013 02/19/2013
Clobetasol Propionate Oint 0.05% OINT 0.34000 02/22/2013 02/19/2013
Clobetasol Propionate Soln 0.05% SOLN 0.26500 02/22/2013 02/19/2013
Clomiphene Citrate Tab 50 MG TABS 1.72970 02/22/2013 02/19/2013
Clomipramine HCl Cap 25 MG CAPS 8.96000 09/03/2013 11/05/2013
Clomipramine HCl Cap 50 MG CAPS 8.72000 07/19/2013 08/06/2013
Clomipramine HCl Cap 75 MG CAPS 8.13133 12/13/2013 12/06/2013
Clonazepam Orally Disintegrating Tab 0.125 MG TBDP 0.63513 11/08/2013 11/05/2013
Clonazepam Orally Disintegrating Tab 0.25 MG TBDP 0.85600 02/22/2013 02/19/2013
Clonazepam Orally Disintegrating Tab 0.5 MG TBDP 0.85600 02/22/2013 02/19/2013
Clonazepam Orally Disintegrating Tab 1 MG TBDP 0.99200 02/22/2013 02/19/2013
Clonazepam Orally Disintegrating Tab 2 MG TBDP 1.35500 02/22/2013 02/19/2013
Clonazepam Tab 0.5 MG TABS 0.01801 02/22/2013 02/19/2013
Clonazepam Tab 1 MG TABS 0.02930 02/22/2013 02/19/2013
Clonazepam Tab 2 MG TABS 0.04350 02/22/2013 02/19/2013
Clonidine HCl Tab 0.1 MG TABS 0.03649 02/22/2013 02/19/2013
Clonidine HCl Tab 0.2 MG TABS 0.03250 02/22/2013 02/19/2013
Clonidine HCl Tab 0.3 MG TABS 0.06392 02/22/2013 02/19/2013
Clonidine HCl TD Patch Weekly 0.1 MG/24HR PTWK 19.91346 08/09/2013 08/06/2013
Clonidine HCl TD Patch Weekly 0.2 MG/24HR PTWK 31.19828 12/13/2013 12/06/2013
Clonidine HCl TD Patch Weekly 0.3 MG/24HR PTWK 44.52153 12/13/2013 12/06/2013
Clopidogrel Bisulfate Tab 75 MG (Base Equiv) TABS 0.27000 02/22/2013 02/19/2013
Clorazepate Dipotassium Tab 15 MG TABS 0.42000 05/13/2013 07/09/2013
Clorazepate Dipotassium Tab 3.75 MG TABS 0.09167 02/22/2013 02/19/2013
Clorazepate Dipotassium Tab 7.5 MG TABS 0.18362 02/22/2013 02/19/2013
Clotrimazole Cream 1% CREA 0.79500 08/22/2013 09/09/2013
Clotrimazole Soln 1% SOLN 0.21209 02/22/2013 02/19/2013
Clotrimazole Troche 10 MG LOZG 0.64286 02/22/2013 02/19/2013
Clotrimazole Troche 10 MG TROC 0.64286 02/22/2013 02/19/2013
Clotrimazole Vaginal Cream 1% CREA 0.09694 02/22/2013 02/19/2013
Clotrimazole Vaginal Cream 2% CREA 0.35240 02/22/2013 02/19/2013
Clotrimazole w/ Betamethasone Cream 1-0.05% CREA 1.24511 02/22/2013 02/19/2013
Clotrimazole w/ Betamethasone Lotion 1-0.05% LOTN 3.98000 07/05/2013 08/06/2013
Clozapine Tab 100 MG TABS 1.01562 02/22/2013 02/19/2013
Clozapine Tab 200 MG TABS 2.51200 02/22/2013 02/19/2013
Clozapine Tab 25 MG TABS 0.47750 02/22/2013 02/19/2013
Clozapine Tab 50 MG TABS 0.79200 02/22/2013 02/19/2013
COAGUCHEK LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
Page 27 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
COAGUCHEK XS PRO SYSTEM (PT/INR Testing Monitor -
Kit***)
KIT 0.71000 10/01/2003 02/19/2013
Coal Tar Shampoo 0.5% SHAM 0.02261 02/22/2013 02/19/2013
Coenzyme Q10 Cap 100 MG CAPS 0.42075 02/22/2013 02/19/2013
Coenzyme Q10 Cap 30 MG CAPS 0.32577 02/22/2013 02/19/2013
Coenzyme Q10 Cap 50 MG CAPS 0.17404 02/22/2013 02/19/2013
Coenzyme Q10 Oral Powder POWD 0.06700 02/22/2013 02/19/2013
Coenzyme Q10 Tab 200 MG TABS 1.51270 02/22/2013 02/19/2013
Coenzyme Q10 Tab 60 MG TABS 0.39217 02/22/2013 02/19/2013
COLACE (Docusate Sodium Cap 100 MG) CAPS 0.03000 03/13/2008 02/19/2013
COLACE (Docusate Sodium Cap 50 MG) CAPS 0.07520 04/28/2005 02/19/2013
COLACE (Docusate Sodium Liquid 150 MG/15ML) LIQD 0.01010 03/13/2008 02/19/2013
COLACE (Docusate Sodium Syrup 60 MG/15ML) SYRP 0.00521 03/13/2008 02/19/2013
Colchicine Tab 0.6 MG TABS 0.53679 02/22/2013 02/19/2013
Colchicine w/ Probenecid Tab 0.5-500 MG TABS 0.82500 02/22/2013 02/19/2013
Colestipol HCl Granule Packets 5 GM PACK 1.86000 09/26/2013 10/09/2013
Colestipol HCl Granules 5 GM GRAN 0.18500 02/22/2013 02/19/2013
Colestipol HCl Tab 1 GM TABS 0.52490 02/22/2013 02/19/2013
Colistimethate Sodium For Inj 150 MG SOLR 14.87200 02/22/2013 02/19/2013
COMFORT ASSURED LANCETS M (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
COMFORT ASSURED LANCETS S (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
COMFORT LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
COMPLEAT (Nutritional Supplement Liquid**) LIQD 0.01404 04/17/2007 02/19/2013
COMPLEAT (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
COMPLEAT CLOSED SYSTEM (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
COMPLEAT PEDIATRIC (Nutritional Supplement Liquid**) LIQD 0.01150 04/08/2008 02/19/2013
COMPLEAT PEDIATRIC REDUCE (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
COMPLETE AMINO ACID MIX (Amino Acids Oral Powder***) POWD 0.33438 06/27/2012 02/19/2013
COMPLETENATE (Prenatal Vit w/ Fe Fumarate-FA Chew Tab
29-1 M
CHEW 0.29950 08/29/2008 02/19/2013
COMPLEX 15 (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
COMPLEX ESSENTIAL MSD (Amino Acids Oral Powder***) POWD 0.33438 06/27/2012 02/19/2013
COMPLEX JUNIOR MSD (Amino Acids Oral Powder***) POWD 0.33438 06/27/2012 02/19/2013
COMPLEX MSUD (Amino Acids Oral Powder***) POWD 0.33438 06/27/2012 02/19/2013
COMPLEX MSUD (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
CO-NATAL FA (Prenatal Vit w/ Fe Fumarate-FA Tab 29-1
MG***)
TABS 0.15587 01/23/2009 02/19/2013
CONTOUR BLOOD GLUCOSE MON (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
CONTROL AST (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
CONTROL BLOOD GLUCOSE MON (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 04/23/2010 02/19/2013
CONTROL TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
COOL BOTTOMS (Dimethicone Cream 1%) CREA 0.06060 04/28/2005 02/19/2013
Page 28 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
COPAXONE (Glatiramer Acetate Inj Kit 20 MG/ML) KIT 4,586.07370 01/01/2013 02/20/2013
COPEGUS (Ribavirin Tab 200 MG) TABS 1.05475 10/23/2009 02/19/2013
CORN HUSKERS (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
Cortisone Acetate Tab 25 MG TABS 0.35000 02/22/2013 02/19/2013
CORTISPORIN (Neomycin-Polymyxin-HC Ophth Susp) SUSP 12.05000 02/25/2012 02/19/2013
Cosyntropin For Inj 0.25 MG SOLR 104.26000 02/22/2013 02/19/2013
CRINONE (Progesterone Vaginal Gel 8%) GEL 8.57056 04/13/2012 02/19/2013
CRINONE (Progesterone Vaginal Gel 8%) GEL 11.85278 09/05/2013 10/09/2013
CRITIC-AID CLEAR MOISTURE (Skin Protectants Misc -
Ointment*
OINT 0.03040 04/28/2005 02/19/2013
CRITICARE HN (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
Cromolyn Sodium Nasal Aerosol Soln 5.2 MG/ACT (4%) AERS 0.38197 02/22/2013 02/19/2013
Cromolyn Sodium Ophth Soln 4% SOLN 0.62075 02/22/2013 02/19/2013
Cromolyn Sodium Soln Nebu 20 MG/2ML NEBU 0.16000 02/22/2013 02/19/2013
CRUCIAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
CVS BLOOD GLUCOSE STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
CVS BLOOD GLUCOSE TEST (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
CVS LANCETS 21G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
CVS LANCETS MICRO THIN 33 (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
CVS LANCETS ORIGINAL (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
CVS LANCETS THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
CVS LANCETS THIN 26G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
CVS LANCETS ULTRA THIN 30 (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
CVS MINERAL OIL (Mineral Oil) OIL 0.01529 03/20/2008 02/19/2013
CVS NATURAL FIBER SUPPLEM (Psyllium Powder Packet
58.6%)
PACK 0.22885 03/20/2008 02/19/2013
CVS NUTRITION LIQUID (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
CVS NUTRITION PLUS (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
CVS PRENATAL (Prenatal Vit w/ Fe Fumarate-FA Tab 28-0.8
MG**
TABS 0.07255 02/27/2009 02/19/2013
CVS SPECTRAVITE ULTRA MEN (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
CVS ULTRA THIN LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
CVS VITAMIN D3 (Cholecalciferol Cap 400 Unit) CAPS 0.02008 03/13/2008 02/19/2013
Cyanocobalamin Inj 1000 MCG/ML SOLN 2.08780 05/15/2013 06/11/2013
Cyanocobalamin Tab 100 MCG TABS 0.03928 02/22/2013 02/19/2013
Cyanocobalamin Tab 1000 MCG TABS 0.06574 02/22/2013 02/19/2013
Cyanocobalamin Tab 250 MCG TABS 0.06237 02/22/2013 02/19/2013
Cyanocobalamin Tab 500 MCG TABS 0.05766 02/22/2013 02/19/2013
CYCLINEX-1 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
CYCLINEX-2 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
Cyclobenzaprine HCl Tab 10 MG TABS 0.02265 02/22/2013 02/19/2013
Cyclobenzaprine HCl Tab 5 MG TABS 0.03579 02/22/2013 02/19/2013
Cyclopentolate HCl Ophth Soln 1% SOLN 6.09000 02/28/2013 03/04/2013
Cyclophosphamide For Inj 1 GM SOLR 43.88210 02/22/2013 02/19/2013
Page 29 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Cyclophosphamide For Inj 2 GM SOLR 879.98500 05/28/2013 07/09/2013
Cyclophosphamide Tab 25 MG TABS 1.73470 02/22/2013 02/19/2013
Cyclophosphamide Tab 50 MG TABS 3.18720 02/22/2013 02/19/2013
Cyclosporine Cap 100 MG CAPS 5.73072 08/09/2013 08/06/2013
Cyclosporine Modified Cap 100 MG CAPS 3.11526 07/12/2013 07/08/2013
Cyclosporine Modified Cap 25 MG CAPS 0.70729 02/22/2013 02/19/2013
Cyproheptadine HCl Syrup 2 MG/5ML SYRP 0.09790 02/22/2013 02/19/2013
Cyproheptadine HCl Tab 4 MG TABS 0.24500 05/17/2013 06/11/2013
CYSTADANE (Betaine Powder For Oral Solution***) POWD 4.28229 04/13/2012 02/19/2013
Cytarabine For Inj 100 MG SOLR 3.98400 02/22/2013 02/19/2013
CYTOXAN (Cyclophosphamide For Inj 2 GM) SOLR 43.88210 07/30/2010 02/19/2013
CYTRA-K (Potassium Citrate & Citric Acid Soln 1100-334
MG/5M
SOLN 0.03020 06/24/2011 02/19/2013
D.H.E. 45 (Dihydroergotamine Mesylate Inj 1 MG/ML) SOLN 36.52000 04/13/2012 02/19/2013
DACRIOSE (Ophthalmic Irrigation Solution***) SOLN 0.02410 04/28/2005 02/19/2013
DAILY CONDITIONING TREATM (Emollient - Ointment**) OINT 0.04583 03/13/2008 02/19/2013
Danazol Cap 200 MG CAPS 2.91562 02/22/2013 02/19/2013
Dantrolene Sodium Cap 100 MG CAPS 1.50600 02/22/2013 02/19/2013
Dantrolene Sodium Cap 25 MG CAPS 0.98180 02/22/2013 02/19/2013
Dantrolene Sodium Cap 50 MG CAPS 1.39360 02/22/2013 02/19/2013
DAZIDOX (Oxycodone HCl Tab 10 MG) TABS 0.35775 05/22/2009 02/19/2013
DAZIDOX (Oxycodone HCl Tab 20 MG) TABS 0.63535 05/22/2009 02/19/2013
DD LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
DD THIN LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
DE LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
DE THIN LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
DEBROX (Carbamide Peroxide 6.5% Otic Soln) SOLN 0.14970 03/13/2008 02/19/2013
DECUBI-VITE (Multiple Vitamins w/ Minerals Cap**) CAPS 0.51325 04/27/2011 02/19/2013
Deferoxamine Mesylate For Inj 2 GM SOLR 39.32000 02/22/2013 02/19/2013
Deferoxamine Mesylate For Inj 500 MG SOLR 10.14000 02/22/2013 02/19/2013
Demeclocycline HCl Tab 150 MG TABS 2.72788 02/22/2013 02/20/2013
Demeclocycline HCl Tab 300 MG TABS 9.43500 09/19/2013 11/05/2013
DEPO-PROVERA CONTRACEPTIV (Medroxyprogesterone
Acetate IM Su
SUSP 68.22600 07/30/2010 02/19/2013
DEQUASINE (Amino Acids Tab***) TABS 0.41080 04/28/2005 02/19/2013
DERMADROX (Skin Protectants Misc - Ointment***) OINT 0.03040 04/28/2005 02/19/2013
DERMAL THERAPY EXTRA STRE (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
DERMAL THERAPY FACE CARE (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
DERMAL THERAPY FOOT MASSA (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
DERMAL THERAPY HAND, ELBO (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
DERMAL THERAPY HEEL CARE (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
DERMAVITE (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
Desipramine HCl Tab 10 MG TABS 0.71235 02/22/2013 02/19/2013
Desipramine HCl Tab 100 MG TABS 3.19000 05/13/2013 06/11/2013
Desipramine HCl Tab 150 MG TABS 4.46500 02/22/2013 02/19/2013
Page 30 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Desipramine HCl Tab 25 MG TABS 0.97520 02/22/2013 02/19/2013
Desipramine HCl Tab 50 MG TABS 2.25000 08/08/2013 11/05/2013
Desipramine HCl Tab 75 MG TABS 2.24000 02/22/2013 02/19/2013
Desloratadine Tab 5 MG TABS 1.31714 08/09/2013 08/06/2013
Desmopressin Acetate Nasal Spray Soln 0.01% SOLN 12.56615 02/22/2013 02/19/2013
Desmopressin Acetate Nasal Spray Soln 0.01%
(Refrigerated)
SOLN 29.25835 08/09/2013 08/06/2013
Desmopressin Acetate Tab 0.1 MG TABS 1.26500 02/22/2013 02/19/2013
Desmopressin Acetate Tab 0.2 MG TABS 1.08000 09/13/2013 09/09/2013
Desogest-Eth Estrad & Eth Estrad Tab 0.15-0.02/0.01
MG(21/5)
TABS 1.33000 02/22/2013 02/19/2013
Desogest-Ethin Est Tab
0.1-0.025/0.125-0.025/0.15-0.025MG-MG
TABS 0.92600 02/22/2013 02/19/2013
Desogestrel & Ethinyl Estradiol Tab 0.15 MG-30 MCG TABS 0.62351 02/22/2013 02/19/2013
Desonide Cream 0.05% CREA 4.26000 06/19/2013 07/09/2013
Desonide Lotion 0.05% LOTN 3.46500 09/30/2013 11/05/2013
Desonide Oint 0.05% OINT 3.26000 07/01/2013 08/06/2013
Desoximetasone Cream 0.05% CREA 3.40435 02/22/2013 02/19/2013
Desoximetasone Cream 0.25% CREA 1.31850 07/12/2013 07/08/2013
Desoximetasone Gel 0.05% GEL 2.24423 02/22/2013 02/19/2013
Desoximetasone Oint 0.25% OINT 4.74500 07/28/2013 09/09/2013
DESQUAM-E (Benzoyl Peroxide Gel 5%) GEL 0.22500 05/28/2010 02/19/2013
DESQUAM-X (Benzoyl Peroxide Gel 10%) GEL 0.06920 05/28/2010 02/19/2013
DESQUAM-X (Benzoyl Peroxide Gel 5%) GEL 0.22500 05/28/2010 02/19/2013
Dexamethasone Elixir 0.5 MG/5ML ELIX 0.23000 07/06/2013 09/09/2013
Dexamethasone Sodium Phosphate Ophth Soln 0.1% SOLN 2.41406 02/22/2013 02/19/2013
Dexamethasone Tab 0.5 MG TABS 0.06750 02/22/2013 02/19/2013
Dexamethasone Tab 0.75 MG TABS 0.06400 02/22/2013 02/19/2013
Dexamethasone Tab 4 MG TABS 0.10036 02/22/2013 02/19/2013
Dexamethasone Tab 6 MG TABS 0.44500 02/22/2013 02/19/2013
Dexchlorpheniramine Maleate Tab CR 6 MG TBCR 0.32500 02/22/2013 02/19/2013
Dexmethylphenidate HCl Tab 10 MG TABS 1.07500 02/22/2013 02/19/2013
Dexmethylphenidate HCl Tab 2.5 MG TABS 0.47500 02/22/2013 02/19/2013
Dexmethylphenidate HCl Tab 5 MG TABS 0.66100 02/22/2013 02/19/2013
Dextroamphetamine Sulfate Cap SR 24HR 10 MG CP24 1.52500 02/22/2013 02/19/2013
Dextroamphetamine Sulfate Cap SR 24HR 15 MG CP24 4.63000 02/22/2013 02/19/2013
Dextroamphetamine Sulfate Cap SR 24HR 5 MG CP24 0.50000 02/22/2013 02/19/2013
Dextroamphetamine Sulfate Tab 10 MG TABS 1.95300 07/29/2013 09/09/2013
Dextroamphetamine Sulfate Tab 5 MG TABS 1.90300 02/22/2013 02/19/2013
Dextromethorphan-Guaifenesin Liquid 10-100 MG/5ML ELIX 0.00819 02/22/2013 02/19/2013
Dextromethorphan-Guaifenesin Liquid 10-100 MG/5ML LIQD 0.00819 02/22/2013 02/19/2013
Dextromethorphan-Guaifenesin Liquid 10-100 MG/5ML SOLN 0.00819 02/22/2013 02/19/2013
Dextromethorphan-Guaifenesin Liquid 10-100 MG/5ML SYRP 0.00819 02/22/2013 02/19/2013
Dextromethorphan-Guaifenesin Syrup 10-100 MG/5ML SYRP 0.00819 02/22/2013 02/19/2013
Dextromethorphan-Guaifenesin Tab 20-400 MG TABS 0.07778 02/22/2013 02/19/2013
Page 31 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Dextrose Inj 5% SOLN 0.00449 02/22/2013 02/19/2013
DEXTROSTAT (Dextroamphetamine Sulfate Tab 10 MG) TABS 0.31000 11/07/2011 02/19/2013
DHS TAR (Coal Tar Shampoo 0.5%) SHAM 0.02261 03/13/2008 02/19/2013
DHS TAR GEL (Coal Tar Shampoo 0.5%) SHAM 0.02261 03/13/2008 02/19/2013
DIABETA (Glyburide Tab 2.5 MG) TABS 0.18000 12/28/2001 02/19/2013
DIABETIC STERILE LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
DIABETIC TF (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
DIABETIC.COM STARTER KIT (Blood Glucose Monitoring Kit
w/ De
KIT 0.71000 10/01/2003 02/19/2013
DIABETIC.COM TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
DIABETIDERM (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
DIABETIDERM HAND & BODY (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
DIABETISHIELD (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
DIABETISOURCE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
DIABETISOURCE AC (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
DIABEVITE (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
Diaper Rash Products - Ointment** OINT 0.02350 02/22/2013 02/19/2013
DIASENSE MULTIVITAMIN (Multiple Vitamins w/ Minerals
Tab**)
TABS 0.07430 03/20/2008 02/19/2013
DIASTAR EASY TEST II LANC (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
DIASTAR EASY TEST LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
Diazepam Inj 5 MG/ML SOLN 0.80210 02/22/2013 02/19/2013
Diazepam Tab 10 MG TABS 0.03463 02/22/2013 02/19/2013
Diazepam Tab 2 MG TABS 0.03488 02/22/2013 02/19/2013
Diazepam Tab 5 MG TABS 0.02458 02/22/2013 02/19/2013
Dibucaine Oint 1% OINT 0.06500 02/22/2013 02/19/2013
DICAL-D (Calcium & Phosphorus w/ Vitamin D Tab 105
MG-81 MG-
TABS 0.01910 04/28/2005 02/19/2013
Diclofenac Potassium Tab 50 MG TABS 0.13065 02/22/2013 02/19/2013
Diclofenac Sodium Ophth Soln 0.1% SOLN 2.55042 02/22/2013 02/19/2013
Diclofenac Sodium Tab Delayed Release 25 MG TBEC 0.19000 02/22/2013 02/19/2013
Diclofenac Sodium Tab Delayed Release 50 MG TBEC 0.35706 02/22/2013 02/19/2013
Diclofenac Sodium Tab Delayed Release 75 MG TBEC 0.34413 02/22/2013 02/19/2013
Diclofenac Sodium Tab SR 24HR 100 MG TB24 0.42237 02/22/2013 02/19/2013
Diclofenac w/ Misoprostol Tab Delayed Release 75-0.2 MG TBEC 2.30000 11/08/2013 11/05/2013
Dicloxacillin Sodium Cap 250 MG CAPS 0.27170 02/22/2013 02/19/2013
Dicloxacillin Sodium Cap 500 MG CAPS 0.49800 02/22/2013 02/19/2013
Dicyclomine HCl Cap 10 MG CAPS 0.03810 02/22/2013 02/19/2013
Dicyclomine HCl Tab 20 MG TABS 0.09520 08/12/2013 10/09/2013
Didanosine Delayed Release Capsule 200 MG CPDR 3.64700 02/22/2013 02/19/2013
Didanosine Delayed Release Capsule 250 MG CPDR 4.63500 02/22/2013 02/19/2013
Didanosine Delayed Release Capsule 400 MG CPDR 7.21500 02/22/2013 02/19/2013
DIDGET (Blood Glucose Monitoring Kit w/ Device***) KIT 0.71000 10/01/2003 02/19/2013
Diethylpropion HCl Tab 25 MG TABS 0.39380 02/22/2013 02/19/2013
Diethylpropion HCl Tab SR 24HR 75 MG TB24 0.67000 02/22/2013 02/19/2013
Page 32 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
DIFICID (Fidaxomicin Tab 200 MG) TABS 139.44000 04/13/2012 02/19/2013
Diflorasone Diacetate Cream 0.05% CREA 0.99700 02/22/2013 02/19/2013
Diflorasone Diacetate Oint 0.05% OINT 2.82700 02/22/2013 02/19/2013
Diflunisal Tab 500 MG TABS 1.05000 02/22/2013 02/19/2013
Digoxin Tab 0.125 MG TABS 0.11550 02/22/2013 02/19/2013
Digoxin Tab 0.25 MG TABS 0.90000 11/25/2013 12/06/2013
Diltiazem HCl Cap SR 12HR 120 MG CP12 0.75000 02/22/2013 02/19/2013
Diltiazem HCl Cap SR 12HR 60 MG CP12 0.89950 02/22/2013 02/19/2013
Diltiazem HCl Cap SR 12HR 90 MG CP12 0.60000 02/22/2013 02/19/2013
Diltiazem HCl Cap SR 24HR 120 MG CP24 0.49885 02/22/2013 02/19/2013
Diltiazem HCl Cap SR 24HR 180 MG CP24 0.44600 02/22/2013 02/19/2013
Diltiazem HCl Cap SR 24HR 240 MG CP24 0.69000 02/22/2013 02/19/2013
Diltiazem HCl Coated Beads Cap SR 24HR 120 MG CP24 0.41775 02/22/2013 02/19/2013
Diltiazem HCl Coated Beads Cap SR 24HR 180 MG CP24 0.56457 02/22/2013 02/19/2013
Diltiazem HCl Coated Beads Cap SR 24HR 240 MG CP24 0.66033 02/22/2013 02/19/2013
Diltiazem HCl Coated Beads Cap SR 24HR 300 MG CP24 0.88008 02/22/2013 02/19/2013
Diltiazem HCl Coated Beads Tab SR 24HR 180 MG TB24 3.10567 02/22/2013 02/19/2013
Diltiazem HCl Coated Beads Tab SR 24HR 240 MG TB24 2.40000 02/22/2013 02/19/2013
Diltiazem HCl Coated Beads Tab SR 24HR 360 MG TB24 4.25000 10/11/2013 10/09/2013
Diltiazem HCl Extended Release Beads Cap SR 24HR 120
MG
CP24 0.55500 02/22/2013 02/19/2013
Diltiazem HCl Extended Release Beads Cap SR 24HR 180
MG
CP24 0.51005 02/22/2013 02/19/2013
Diltiazem HCl Extended Release Beads Cap SR 24HR 240
MG
CP24 0.72205 02/22/2013 02/19/2013
Diltiazem HCl Extended Release Beads Cap SR 24HR 300
MG
CP24 0.93075 02/22/2013 02/19/2013
Diltiazem HCl Extended Release Beads Cap SR 24HR 360
MG
CP24 0.95755 02/22/2013 02/19/2013
Diltiazem HCl Extended Release Beads Cap SR 24HR 420
MG
CP24 1.17505 02/22/2013 02/19/2013
Diltiazem HCl Tab 120 MG TABS 0.13231 02/22/2013 02/19/2013
Diltiazem HCl Tab 30 MG TABS 0.03692 02/22/2013 02/19/2013
Diltiazem HCl Tab 60 MG TABS 0.05875 02/22/2013 02/19/2013
Diltiazem HCl Tab 90 MG TABS 0.09675 02/22/2013 02/19/2013
Dimethicone-Zinc Oxide-Vitamin A-Vitamin D Cream
1-10%***
CREA 0.02730 02/22/2013 02/19/2013
DINO-LIFE W/IRON & ZINC (Pediatric Multiple Vitamins w/
Iron
CHEW 0.01450 01/01/1988 02/19/2013
Diphenhydramine HCl (Sleep) Cap 50 MG CAPS 0.05210 02/22/2013 02/19/2013
Diphenhydramine HCl Cap 25 MG CAPS 0.01105 02/22/2013 02/19/2013
Diphenhydramine HCl Cap 50 MG CAPS 0.02275 02/22/2013 02/19/2013
Diphenhydramine HCl Elixir 12.5 MG/5ML ELIX 0.01670 02/22/2013 02/19/2013
Diphenhydramine HCl Inj 50 MG/ML SOLN 0.85000 02/22/2013 02/19/2013
Diphenhydramine HCl Liquid 12.5 MG/5ML LIQD 0.00585 02/22/2013 02/19/2013
Diphenhydramine HCl Syrup 12.5 MG/5ML SYRP 0.01080 02/22/2013 02/19/2013
Page 33 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Diphenhydramine HCl Tab 25 MG TABS 0.01690 02/22/2013 02/19/2013
Diphenhydramine-Acetaminophen Tab 25-500 MG (sleep) TABS 0.08157 02/22/2013 02/19/2013
Diphenoxylate w/ Atropine Liq 2.5-0.025 MG/5ML LIQD 0.09100 02/22/2013 02/19/2013
Diphenoxylate w/ Atropine Tab 2.5-0.025 MG TABS 0.13000 02/22/2013 02/19/2013
Dipivefrin HCl Ophth Soln 0.1% SOLN 0.87000 02/22/2013 02/19/2013
Dipyridamole Tab 25 MG TABS 0.10356 02/22/2013 02/19/2013
Dipyridamole Tab 50 MG TABS 0.20706 02/22/2013 02/19/2013
Dipyridamole Tab 75 MG TABS 0.33000 10/11/2013 10/09/2013
DISCOUNT DRUG MART TEST S (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
DISCOUNT DRUG MART VALUE (Blood Glucose Monitoring
Kit w/ De
KIT 0.71000 10/01/2003 02/19/2013
Disopyramide Phosphate Cap 100 MG CAPS 0.34820 02/22/2013 02/19/2013
Disopyramide Phosphate Cap 150 MG CAPS 0.39866 02/22/2013 02/19/2013
Disopyramide Phosphate Cap SR 12HR 150 MG CP12 0.85600 02/22/2013 02/19/2013
Disulfiram Tab 250 MG TABS 2.66000 04/12/2013 04/09/2013
Disulfiram Tab 500 MG TABS 4.86000 02/08/2013 02/20/2013
Divalproex Sodium Cap Sprinkle 125 MG CPSP 0.44647 02/22/2013 02/19/2013
Divalproex Sodium Tab Delayed Release 125 MG TBEC 0.06324 02/22/2013 02/19/2013
Divalproex Sodium Tab Delayed Release 250 MG TBEC 0.09780 02/22/2013 02/19/2013
Divalproex Sodium Tab Delayed Release 500 MG TBEC 0.15943 02/22/2013 02/19/2013
Divalproex Sodium Tab SR 24 HR 250 MG TB24 1.95800 09/18/2013 10/09/2013
Divalproex Sodium Tab SR 24 HR 500 MG TB24 3.26000 08/06/2013 09/09/2013
Docusate Calcium Cap 240 MG CAPS 0.06595 02/22/2013 02/19/2013
Docusate Sodium Cap 100 MG CAPS 0.01733 02/22/2013 02/19/2013
Docusate Sodium Cap 250 MG CAPS 0.06500 02/22/2013 02/19/2013
Docusate Sodium Cap 50 MG CAPS 0.07520 02/22/2013 02/19/2013
Docusate Sodium Liquid 150 MG/15ML LIQD 0.01010 02/22/2013 02/19/2013
Docusate Sodium Syrup 60 MG/15ML SYRP 0.00521 02/22/2013 02/19/2013
Donepezil Hydrochloride Orally Disintegrating Tab 10 MG TBDP 0.94346 02/22/2013 02/19/2013
Donepezil Hydrochloride Orally Disintegrating Tab 5 MG TBDP 1.30000 02/22/2013 02/19/2013
Donepezil Hydrochloride Tab 10 MG TABS 0.15190 02/22/2013 02/19/2013
Donepezil Hydrochloride Tab 5 MG TABS 0.16900 02/22/2013 02/19/2013
Dorzolamide HCl Ophth Soln 2% SOLN 1.95159 02/22/2013 02/19/2013
Dorzolamide HCl-Timolol Maleate Ophth Soln 22.3-6.8
MG/ML
SOLN 2.97241 02/22/2013 02/19/2013
DOVONEX (Calcipotriene Cream 0.005%) CREA 3.59040 03/26/2010 02/19/2013
Doxazosin Mesylate Tab 1 MG TABS 0.04628 02/22/2013 02/19/2013
Doxazosin Mesylate Tab 2 MG TABS 0.57500 10/16/2013 12/06/2013
Doxazosin Mesylate Tab 4 MG TABS 0.61000 10/12/2013 11/05/2013
Doxazosin Mesylate Tab 8 MG TABS 0.61000 10/09/2013 12/06/2013
Doxepin HCl Cap 10 MG CAPS 0.11527 02/22/2013 02/19/2013
Doxepin HCl Cap 100 MG CAPS 0.51000 10/28/2013 11/05/2013
Doxepin HCl Cap 150 MG CAPS 0.37150 02/22/2013 02/19/2013
Doxepin HCl Cap 25 MG CAPS 0.21000 04/23/2013 05/06/2013
Doxepin HCl Cap 50 MG CAPS 0.27240 05/01/2013 07/09/2013
Page 34 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Doxepin HCl Cap 75 MG CAPS 0.43065 10/17/2013 12/06/2013
Doxepin HCl Conc 10 MG/ML CONC 0.05363 02/22/2013 02/19/2013
Doxorubicin HCl Inj 2 MG/ML SOLN 1.01400 02/22/2013 02/19/2013
Doxycycline Hyclate Cap 100 MG CAPS 4.22000 10/11/2013 10/09/2013
Doxycycline Hyclate Cap 50 MG CAPS 1.35000 07/23/2013 09/09/2013
Doxycycline Hyclate Tab 100 MG TABS 4.10000 10/11/2013 10/09/2013
Doxycycline Hyclate Tab 20 MG TABS 0.36543 02/22/2013 02/19/2013
Doxycycline Hyclate Tab Delayed Release 150 MG TBEC 12.37797 04/12/2013 04/09/2013
Doxycycline Monohydrate Cap 100 MG CAPS 0.64500 02/22/2013 02/19/2013
Doxycycline Monohydrate Cap 50 MG CAPS 0.36849 08/09/2013 08/06/2013
Doxycycline Monohydrate Tab 100 MG TABS 0.85400 02/22/2013 02/19/2013
Doxycycline Monohydrate Tab 50 MG TABS 1.99758 02/22/2013 02/19/2013
DR LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
DR THIN LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
DRISDOL (Ergocalciferol Cap 50000 Unit) CAPS 1.15255 11/28/2009 02/19/2013
Dronabinol Cap 10 MG CAPS 11.01000 09/13/2013 09/09/2013
Dronabinol Cap 2.5 MG CAPS 3.24000 04/12/2013 04/09/2013
Dronabinol Cap 5 MG CAPS 6.17480 02/22/2013 02/19/2013
DROPLET LANCETS ULTRA THI (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
Drospirenone-Ethinyl Estradiol Tab 3-0.02 MG TABS 2.01550 02/22/2013 02/19/2013
Drospirenone-Ethinyl Estradiol Tab 3-0.03 MG TABS 1.68250 02/22/2013 02/19/2013
DROXIA (Hydroxyurea Cap 200 MG) CAPS 0.75530 07/30/2010 02/19/2013
DROXIA (Hydroxyurea Cap 300 MG) CAPS 0.75530 07/30/2010 02/19/2013
DROXIA (Hydroxyurea Cap 400 MG) CAPS 0.80510 07/30/2010 02/19/2013
DRUG EMP STARTER KIT (Blood Glucose Monitoring Kit w/
Device
KIT 0.71000 10/01/2003 02/19/2013
DRUG EMPORIUM TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
DRUG MART LANCETS THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
DRUG MART LANCETS ULTRA T (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
DRUG MART UNILET LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
DUANE READE LANCET ALTERN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
DUANE READE LANCET SUPER (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
DUANE READE LANCET ULTRA (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
DUANE READE STARTER KIT (Blood Glucose Monitoring Kit
w/ Dev
KIT 0.71000 10/01/2003 02/19/2013
DUANE READE TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
DULCOLAX (Bisacodyl Suppos 10 MG) SUPP 0.19380 03/13/2008 02/19/2013
DULCOLAX (Bisacodyl Tab Delayed Release 5 MG) TBEC 0.04600 03/13/2008 02/19/2013
DUOCAL (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
DUO-CARE TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
DUO-VIL (Perphenazine-Amitriptyline Tab 2-10 MG) TABS 0.07040 01/22/2002 02/19/2013
DUO-VIL (Perphenazine-Amitriptyline Tab 2-25 MG) TABS 0.08690 01/22/2002 02/19/2013
DURAVITE (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
DYNACIN (Minocycline HCl Tab 50 MG) TABS 0.13500 02/24/2005 02/19/2013
EAA SUPPLEMENT (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
Page 35 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
EASY CHECK BLOOD GLUCOSE (Blood Glucose Monitoring
Kit w/ De
KIT 0.71000 10/01/2003 02/19/2013
EASY CHECK GLUCOSE TEST S (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
EASY COMFORT LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
EASY PLUS BLOOD GLUCOSE M (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
EASY PLUS BLOOD GLUCOSE T (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
EASY STEP BLOOD GLUCOSE M (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
EASY STEP TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
EASY TALK BLOOD GLUCOSE M (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
EASY TALK BLOOD GLUCOSE T (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
EASY TOUCH GLUCOSE MONITO (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
EASY TOUCH GLUCOSE TEST S (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
EASY TOUCH LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
EASY TOUCH LANCETS 28G/TW (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
EASY TOUCH LANCETS 30G/TW (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
EASY TOUCH LANCETS 32G/TW (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
EASY TOUCH LANCETS 33G/TW (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
EASY TOUCH SAFETY LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
EASY TRAK BLOOD GLUCOSE M (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
EASY TRAK BLOOD GLUCOSE T (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
EASY TWIST & CAP LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
EASYGLUCO (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
EASYMAX 15 TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/28/2013
EASYMAX L BLOOD GLUCOSE S (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
EASYMAX N BLOOD GLUCOSE S (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
EASYMAX NG SELF-MONITORIN (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/28/2013
EASYMAX TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
EASYMAX V BLOOD GLUCOSE S (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
EASYMAX V2 SELF-MONITORIN (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
EASYPLUS BLOOD GLUCOSE TE (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
EASYPLUS R13N SELF-MONITO (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
EASYPLUS V SELF-MONITORIN (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
EASYPRO BLOOD GLUCOSE MON (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 04/23/2010 02/19/2013
EASYPRO BLOOD GLUCOSE TES (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
Page 36 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
EASYPRO PLUS (Blood Glucose Monitoring Kit w/ Device***) KIT 0.71000 10/01/2003 02/19/2013
EASYPRO PLUS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
EASYTEST II LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
EASYTEST LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ECLIPSE BLOOD GLUCOSE MON (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
ECLIPSE TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
Econazole Nitrate Cream 1% CREA 0.20610 02/22/2013 02/19/2013
ECOTRIN REGULAR STRENGTH (Aspirin Tab Delayed
Release 325 MG
TBEC 0.01920 03/13/2008 02/19/2013
EFUDEX (Fluorouracil Soln 2%) SOLN 6.27480 04/13/2012 02/19/2013
EGG/PRO (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
EGRIFTA (Tesamorelin Acetate For Inj 1 MG (Base Equiv)) SOLR 32.60904 11/11/2011 02/19/2013
ELECARE (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
ELECARE JR (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
ELECARE/DHA/ARA (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
ELEMENT AUTOCODE SYSTEM (Blood Glucose Monitoring
Kit w/ Dev
KIT 0.71000 10/01/2003 02/19/2013
ELEMENT PLUS TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ELEMENT TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ELOXATIN (Oxaliplatin IV Soln 100 MG/20ML) SOLN 104.71737 04/13/2012 02/19/2013
ELOXATIN (Oxaliplatin IV Soln 200 MG/40ML) SOLN 104.71737 04/13/2012 02/19/2013
ELOXATIN (Oxaliplatin IV Soln 50 MG/10ML) SOLN 104.71778 04/13/2012 02/19/2013
EMBRACE BLOOD GLUCOSE TES (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
EMCYT (Estramustine Phosphate Sodium Cap 140 MG) CAPS 6.45690 04/13/2012 02/19/2013
EMLA/TEGADERM (Lidocaine-Prilocaine Kit 2.5-2.5%) KIT 0.30400 10/29/2010 02/19/2013
EMOLLIA-LOTION (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
Emollient - Lotion** LOTN 0.01940 02/22/2013 02/19/2013
Emollient - Ointment** OINT 0.04583 02/22/2013 02/19/2013
Enalapril Maleate & Hydrochlorothiazide Tab 10-25 MG TABS 0.07806 02/22/2013 02/19/2013
Enalapril Maleate & Hydrochlorothiazide Tab 5-12.5 MG TABS 0.08242 02/22/2013 02/19/2013
Enalapril Maleate Tab 10 MG TABS 0.14500 10/24/2013 12/06/2013
Enalapril Maleate Tab 2.5 MG TABS 0.11000 11/25/2013 12/06/2013
Enalapril Maleate Tab 20 MG TABS 0.18648 09/25/2013 10/09/2013
Enalapril Maleate Tab 5 MG TABS 0.12000 10/22/2013 12/06/2013
ENBREL (Etanercept For Subcutaneous Inj Kit 25 MG) KIT 294.25160 06/21/2013 08/06/2013
ENBREL (Etanercept Subcutaneous Inj 50 MG/ML) SOLN 600.50700 06/21/2013 08/06/2013
ENBREL SURECLICK (Etanercept Subcutaneous Inj 50
MG/ML)
SOLN 600.50700 06/21/2013 08/06/2013
ENEGEL LV (Lubricant Gels - Gel***) GEL 0.01780 04/28/2005 02/19/2013
ENFAGROW PREMIUM LIPIL (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
ENFAGROW PREMIUM NEXT STE (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ENFAGROW PREMIUM OLDER TO (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ENFAGROW PREMIUM OLDER TO (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
ENFAGROW PREMIUM TODDLER (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
ENFAGROW SOY TODDLER (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
ENFAGROW TODDLER TRANSITI (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
ENFALYTE (Oral Electrolyte Solution***) SOLN 0.00560 04/28/2005 02/19/2013
ENFAMIL 22 (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ENFAMIL AR LIPIL (Infant Foods Conc**) CONC 0.01190 04/28/2005 02/19/2013
ENFAMIL AR LIPIL (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ENFAMIL AR LIPIL (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
ENFAMIL AR/SPIT-UP (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ENFAMIL AR/SPIT-UP (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
ENFAMIL ENFACARE (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ENFAMIL ENFACARE (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
ENFAMIL ENFACARE LIPIL (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
ENFAMIL ENFALYTE (Oral Electrolyte Solution***) SOLN 0.00560 04/28/2005 02/19/2013
ENFAMIL GENTLEASE (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
ENFAMIL GENTLEASE FUSSINE (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
ENFAMIL GENTLEASE LIPIL (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ENFAMIL GENTLEASE LIPIL (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
ENFAMIL GENTLEASE/FUSSINE (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ENFAMIL HUMAN MILK FORTIF (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ENFAMIL LACTOFREE LIPIL (Infant Foods Conc**) CONC 0.01190 04/28/2005 02/19/2013
ENFAMIL LACTOFREE LIPIL (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ENFAMIL LACTOFREE LIPIL (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
ENFAMIL LIPIL (Infant Foods Conc**) CONC 0.01190 04/28/2005 02/19/2013
ENFAMIL LIPIL (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ENFAMIL LIPIL ENFACARE (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ENFAMIL LIPIL WITH IRON (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ENFAMIL LIPIL WITH IRON (Infant Foods Liquid**) LIQD 0.02756 08/28/2013 09/09/2013
ENFAMIL LIPIL/IRON (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
ENFAMIL LIPIL/IRON PREMAT (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ENFAMIL NUTRAMIGEN AA LIP (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
ENFAMIL NUTRAMIGEN AA LIP (Infant Foods Powder**) POWD 0.09208 06/01/2010 02/19/2013
ENFAMIL NUTRAMIGEN LIPIL (Infant Foods Conc**) CONC 0.01190 04/28/2005 02/19/2013
ENFAMIL NUTRAMIGEN LIPIL (Infant Foods Conc**) CONC 0.01908 01/03/2010 02/19/2013
ENFAMIL NUTRAMIGEN LIPIL (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ENFAMIL NUTRAMIGEN LIPIL (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
ENFAMIL NUTRAMIGEN LIPIL (Infant Foods Powder**) POWD 0.04650 04/23/2010 02/19/2013
ENFAMIL NUTRAMIGEN LIPIL (Infant Foods Powder**) POWD 0.06360 05/12/2010 02/19/2013
ENFAMIL NUTRAMIGEN LIPIL (Infant Foods Powder**) POWD 0.06904 12/07/2011 02/19/2013
ENFAMIL PREGESTIMIL LIPIL (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ENFAMIL PREMATURE (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ENFAMIL PREMATURE LIPIL N (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ENFAMIL PREMATURE LIPIL/L (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ENFAMIL PREMIUM INFANT (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ENFAMIL PREMIUM INFANT (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
ENFAMIL PREMIUM LIPIL (Infant Foods Conc**) CONC 0.01190 04/28/2005 02/19/2013
ENFAMIL PREMIUM LIPIL (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ENFAMIL PREMIUM LIPIL (Infant Foods Packet**) PACK 0.04649 04/24/2008 02/19/2013
ENFAMIL PREMIUM NEWBORN (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ENFAMIL PREMIUM NEWBORN (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
ENFAMIL PROSOBEE LIPIL (Infant Foods Conc**) CONC 0.01190 04/28/2005 02/19/2013
ENFAMIL PROSOBEE LIPIL (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ENFAMIL PROSOBEE LIPIL (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
ENFAMIL PROSOBEE SOY (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
ENFAMIL PROSOBEE/SENSITIV (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ENFAMIL RESTFULL LIPIL (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
ENFAMIL WITH IRON 24 (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ENFAPORT LIPIL (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ENGERIX-B (Hepatitis B Vaccine (Recombinant) Susp 10
MCG/0.5
SUSP 42.31340 04/13/2012 02/19/2013
ENGERIX-B (Hepatitis B Vaccine (Recombinant) Susp 20
MCG/ML)
SUSP 52.16550 04/13/2012 02/19/2013
ENGERIX-B SDV (Hepatitis B Vaccine (Recombinant) Susp
20 MCG
SUSP 52.16550 04/13/2012 02/19/2013
ENLIVE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
Enoxaparin Sodium Inj 100 MG/ML SOLN 43.91042 10/11/2013 10/09/2013
Enoxaparin Sodium Inj 120 MG/0.8ML SOLN 75.00000 10/11/2013 10/09/2013
Enoxaparin Sodium Inj 150 MG/ML SOLN 64.81286 11/08/2013 11/05/2013
Enoxaparin Sodium Inj 30 MG/0.3ML SOLN 42.00000 12/13/2013 12/06/2013
Enoxaparin Sodium Inj 40 MG/0.4ML SOLN 30.12750 02/22/2013 02/19/2013
Enoxaparin Sodium Inj 60 MG/0.6ML SOLN 50.14880 02/22/2013 02/19/2013
Enoxaparin Sodium Inj 80 MG/0.8ML SOLN 52.38906 12/13/2013 12/06/2013
ENSURE (Nutritional Supplement Bar**) BAR 0.46070 04/28/2005 02/19/2013
ENSURE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
ENSURE (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
ENSURE BONE HEALTH REVIGO (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
ENSURE CLEAR (Nutritional Supplement Liquid**) LIQD 0.00720 04/28/2005 02/19/2013
ENSURE CLEAR (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
ENSURE CLINICAL STRENGTH (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
ENSURE COMPLETE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
ENSURE COMPLETE NUTRITION (Nutritional Supplement
Liquid**)
LIQD 0.00720 04/28/2005 02/19/2013
ENSURE COMPLETE NUTRITION (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
ENSURE ENLIVE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
ENSURE HEALTHY MOM (Nutritional Supplement Bar**) BAR 0.46070 04/28/2005 02/19/2013
ENSURE HEALTHY MOM (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
ENSURE HIGH CALCIUM (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
ENSURE HIGH PROTEIN (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
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Price
Effective
Date
Date
Updated
ENSURE IMMUNE HEALTH (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
ENSURE MUSCLE HEALTH REVI (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
ENSURE NUTRITION SHAKE (Nutritional Supplement
Liquid**)
LIQD 0.00720 04/28/2005 02/19/2013
ENSURE PLUS (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
ENSURE PLUS HN (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
ENSURE PUDDING (Nutritional Supplement Pudding**) PUDG 0.01090 04/28/2005 02/19/2013
ENSURE/FIBER (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
ENUCLENE (Tyloxapol Ophth Soln 0.25%) SOLN 0.52420 04/28/2005 02/19/2013
ENVISION AUTOCODE (Blood Glucose Monitoring Kit w/
Device***
KIT 0.71000 10/01/2003 02/19/2013
ENVISION AUTOCODE TEST ST (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
EO28 SPLASH (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
EO28 SPLASH (Nutritional Supplement Liquid**) LIQD 0.06930 05/28/2010 02/19/2013
EPILYT (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
Epinastine HCl Ophth Soln 0.05% SOLN 11.80800 08/09/2013 08/06/2013
Epinephrine HCl Inj 1 MG/ML SOLN 0.68944 02/22/2013 02/19/2013
Eplerenone Tab 25 MG TABS 1.96650 02/22/2013 02/19/2013
Eplerenone Tab 50 MG TABS 1.92042 02/22/2013 02/19/2013
EPOGEN (Epoetin Alfa Inj 10000 Unit/ML) SOLN 169.22040 04/13/2012 02/19/2013
EPOGEN (Epoetin Alfa Inj 2000 Unit/ML) SOLN 33.84464 04/13/2012 02/19/2013
EPOGEN (Epoetin Alfa Inj 20000 Unit/ML) SOLN 385.05000 04/02/2013 07/09/2013
EPOGEN (Epoetin Alfa Inj 3000 Unit/ML) SOLN 50.76556 04/13/2012 02/19/2013
EPOGEN (Epoetin Alfa Inj 4000 Unit/ML) SOLN 77.01000 04/02/2013 05/06/2013
EPOGEN (Epoetin Alfa Inj 40000 Unit/ML) SOLN 734.25100 10/02/2012 02/19/2013
EPULOR (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
EQL COLOR LANCETS 21G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
EQL COLOR LANCETS MICRO T (Lancets***) MISC 0.08772 06/17/2011 02/28/2013
EQL MEGA SELECT MENS (Multiple Vitamins w/ Minerals
Tab**)
TABS 0.07430 03/20/2008 02/19/2013
EQL MEGA SELECT WOMENS (Multiple Vitamins w/
Minerals Tab**)
TABS 0.07430 03/20/2008 02/19/2013
EQL ONE DAILY DIET SUPPOR (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
EQL ONE DAILY MENS (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
EQL ONE DAILY MENS 50+ AD (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
EQL PEDIATRIC BALANCED NU (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
EQL PRENATAL FORMULA (Prenatal Vit w/ Fe Fumarate-FA
Tab 28-
TABS 0.07255 02/27/2009 02/19/2013
EQL PROTECTAVISION (Multiple Vitamins w/ Minerals
Cap**)
CAPS 0.51325 04/27/2011 02/19/2013
EQL SUPER THIN LANCETS 30 (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
EQL THIN LANCETS 26G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
EQL TRUE2GO BLOOD GLUCOSE (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
EQL TRUETEST BLOOD GLUCOS (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
EQL TRUETRACK TEST (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
EQUALYTE (Oral Electrolyte Solution***) SOLN 0.00560 04/28/2005 02/19/2013
EQUATE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
EQUATE PLUS (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
Ergocalciferol Cap 50000 Unit CAPS 0.42332 02/22/2013 02/19/2013
Ergocalciferol Soln 8000 Unit/ML SOLN 1.47885 02/22/2013 02/19/2013
Ergoloid Mesylates Tab 1 MG TABS 0.08730 02/22/2013 02/19/2013
Ergotamine w/ Caffeine Tab 1-100 MG TABS 0.66845 02/22/2013 02/19/2013
ERIVEDGE (Vismodegib Cap 150 MG) CAPS 266.78571 04/13/2012 02/19/2013
ERYTHROCIN STEARATE (Erythromycin Stearate Tab 250
MG)
TABS 1.84111 10/29/2012 02/19/2013
ERYTHROCIN STEARATE (Erythromycin Stearate Tab 250
MG)
TABS 2.36500 08/01/2013 09/09/2013
ERYTHROCIN STEARATE (Erythromycin Stearate Tab 500
MG)
TABS 0.24180 12/07/2000 02/19/2013
Erythromycin Ethylsuccinate Susp 200 MG/5ML SUSP 0.03760 02/22/2013 02/19/2013
Erythromycin Ethylsuccinate Tab 400 MG TABS 0.23450 02/22/2013 02/19/2013
Erythromycin Gel 2% GEL 0.42500 02/22/2013 02/19/2013
Erythromycin Ophth Oint 5 MG/GM OINT 3.68750 02/22/2013 02/19/2013
Erythromycin Pads 2% PADS 1.31350 02/22/2013 02/19/2013
Erythromycin Soln 2% SOLN 0.63534 02/22/2013 02/19/2013
Erythromycin Stearate Tab 250 MG TABS 1.84111 02/22/2013 02/19/2013
Erythromycin Stearate Tab 500 MG TABS 0.24180 02/22/2013 02/19/2013
Erythromycin w/ Delayed Release Particles Cap 250 MG CPEP 0.18890 02/22/2013 02/19/2013
Erythromycin-Sulfisoxazole For Susp 200-600 MG/5ML SUSR 0.11100 02/22/2013 02/19/2013
Escitalopram Oxalate Soln 5 MG/5ML (Base Equiv) SOLN 0.42073 08/09/2013 08/06/2013
Escitalopram Oxalate Tab 10 MG (Base Equiv) TABS 0.17290 02/22/2013 02/19/2013
Escitalopram Oxalate Tab 20 MG (Base Equiv) TABS 0.19344 02/22/2013 02/19/2013
Escitalopram Oxalate Tab 5 MG (Base Equiv) TABS 0.16055 02/22/2013 02/19/2013
ESOTERICA DRY SKIN TREATM (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
ESSENTIAL AMINO ACID MIX (Amino Acids Oral Powder***) POWD 0.33438 06/27/2012 02/19/2013
Estazolam Tab 1 MG TABS 0.31700 02/22/2013 02/19/2013
Estazolam Tab 2 MG TABS 0.31754 02/22/2013 02/19/2013
Estradiol & Norethindrone Acetate Tab 1-0.5 MG TABS 1.90804 02/22/2013 02/19/2013
Estradiol Tab 0.5 MG TABS 0.03198 02/22/2013 02/19/2013
Estradiol Tab 1 MG TABS 0.21000 09/29/2013 11/05/2013
Estradiol Tab 2 MG TABS 0.04650 02/22/2013 02/19/2013
Estradiol TD Patch Weekly 0.025 MG/24HR PTWK 7.24000 02/22/2013 02/19/2013
Estradiol TD Patch Weekly 0.0375 MG/24HR (37.5
MCG/24HR)
PTWK 7.85424 02/22/2013 02/19/2013
Estradiol TD Patch Weekly 0.05 MG/24HR PTWK 6.45000 02/22/2013 02/19/2013
Estradiol TD Patch Weekly 0.06 MG/24HR PTWK 7.75320 02/22/2013 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Estradiol TD Patch Weekly 0.075 MG/24HR PTWK 7.90231 02/22/2013 02/19/2013
Estradiol TD Patch Weekly 0.1 MG/24HR PTWK 12.89750 02/22/2013 02/19/2013
Estropipate Tab 0.75 MG TABS 0.09130 02/22/2013 02/19/2013
Estropipate Tab 1.5 MG TABS 0.33000 04/29/2013 06/11/2013
Estropipate Tab 3 MG TABS 0.13000 02/22/2013 02/19/2013
Ethambutol HCl Tab 400 MG TABS 1.29700 02/22/2013 02/19/2013
Ethosuximide Cap 250 MG CAPS 0.98413 02/22/2013 02/19/2013
Ethosuximide Soln 250 MG/5ML SOLN 0.30000 03/01/2013 04/09/2013
Ethynodiol Diacetate & Ethinyl Estradiol Tab 1 MG-35 MCG TABS 0.81550 02/22/2013 02/19/2013
Etodolac Cap 200 MG CAPS 0.36000 02/22/2013 02/19/2013
Etodolac Cap 300 MG CAPS 1.34000 02/22/2013 02/19/2013
Etodolac Tab 400 MG TABS 0.66700 11/04/2013 12/06/2013
Etodolac Tab 500 MG TABS 0.82500 10/18/2013 11/05/2013
Etodolac Tab SR 24HR 400 MG TB24 0.62488 02/22/2013 02/19/2013
Etodolac Tab SR 24HR 500 MG TB24 0.85000 02/22/2013 02/19/2013
Etodolac Tab SR 24HR 600 MG TB24 1.33500 02/22/2013 02/19/2013
Etoposide Cap 50 MG CAPS 59.88000 04/22/2013 06/11/2013
Etoposide Inj 20 MG/ML SOLN 1.14400 02/22/2013 02/19/2013
EUCERIN (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
EUCERIN DAILY PROTECTION/ (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
EUCERIN ORIGINAL HEALING (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
EUCERIN PLUS (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
EVENCARE + BLOOD GLUCOSE (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
EVENCARE BLOOD GLUCOSE TE (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
EVENCARE G2 TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
EVENCARE G3 TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
EVOLUTION AUTOCODE (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
EXACTECH R-S-G TEST STRIP (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
EXACTECH TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
EXCEL G TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
Exemestane Tab 25 MG TABS 5.59823 02/22/2013 02/19/2013
EXJADE (Deferasirox Tab For Oral Susp 125 MG) TBSO 21.25796 12/06/2012 02/19/2013
EXJADE (Deferasirox Tab For Oral Susp 250 MG) TBSO 42.51482 12/06/2012 02/19/2013
EXJADE (Deferasirox Tab For Oral Susp 500 MG) TBSO 85.02852 12/06/2012 02/19/2013
EXPRESS MED STARTER KIT (Blood Glucose Monitoring Kit
w/ Dev
KIT 0.71000 10/01/2003 02/19/2013
EXPRESS MED TEST STRIP PA (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
EYEAID IRRIGATING SOLUTIO (Ophthalmic Irrigation
Solution***
SOLN 0.02410 04/28/2005 02/19/2013
E-Z JECT LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
E-Z JECT LANCETS 21G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
E-Z JECT LANCETS COLOR (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
E-Z JECT LANCETS SUPER TH (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
E-Z JECT LANCETS THIN 26G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
E-Z JECT THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
EZ SMART BLOOD GLUCOSE LA (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
EZ SMART BLOOD GLUCOSE TE (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
EZ SMART PLUS BLOOD GLUCO (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
E-ZJECT LANCETS MICRO-THI (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
EZ-LETS LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
EZ-LETS LANCETS 21G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
EZ-LETS LANCETS 23G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
EZ-LETS LANCETS 26G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
EZ-LETS LANCETS 26G SUPER (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
EZ-LETS LANCETS 28G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
EZ-LETS LANCETS 28G ULTRA (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
EZ-LETS LANCETS 30G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
E-Z-THIK (Starch Oral Thickening Powder) POWD 0.02350 03/20/2008 02/19/2013
F.A.A. (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
FABRAZYME (Agalsidase beta For IV Soln 35 MG) SOLR 4,528.00000 11/28/2009 02/19/2013
FABRAZYME (Agalsidase beta For IV Soln 5 MG) SOLR 650.00000 11/28/2009 02/19/2013
Famciclovir Tab 125 MG TABS 1.19185 02/22/2013 02/19/2013
Famciclovir Tab 250 MG TABS 0.94776 07/12/2013 07/08/2013
Famciclovir Tab 500 MG TABS 1.77262 10/11/2013 10/09/2013
Famotidine For Susp 40 MG/5ML SUSR 1.29000 09/13/2013 09/09/2013
Famotidine Tab 10 MG TABS 0.07732 02/22/2013 02/19/2013
Famotidine Tab 20 MG TABS 0.04373 02/22/2013 02/19/2013
Famotidine Tab 40 MG TABS 0.06452 02/22/2013 02/19/2013
FASTTAKE COMPACT MONITORI (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
FASTTAKE TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
FEIBA NF (Antiinhibitor Coagulant Complex For Inj**) SOLR 1.43550 12/24/2010 02/19/2013
FEIBA VH IMMUNO (Antiinhibitor Coagulant Complex For
Inj**)
SOLR 1.43550 12/24/2010 02/19/2013
Felbamate Tab 600 MG TABS 4.42533 08/09/2013 08/06/2013
Felodipine Tab SR 24HR 10 MG TB24 1.05076 02/22/2013 02/19/2013
Felodipine Tab SR 24HR 2.5 MG TB24 0.65400 02/22/2013 02/19/2013
Felodipine Tab SR 24HR 5 MG TB24 0.62400 02/22/2013 02/19/2013
FEMTABS (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
Fenofibrate Micronized Cap 134 MG CAPS 1.16500 02/22/2013 02/19/2013
Fenofibrate Micronized Cap 200 MG CAPS 1.70251 02/22/2013 02/19/2013
Fenofibrate Micronized Cap 67 MG CAPS 0.64500 02/22/2013 02/19/2013
Fenofibrate Tab 160 MG TABS 1.20446 03/08/2013 03/04/2013
Fenofibrate Tab 48 MG TABS 1.29379 10/11/2013 10/09/2013
Fenofibrate Tab 54 MG TABS 0.62406 02/22/2013 02/19/2013
Fenoprofen Calcium Tab 600 MG TABS 0.24000 02/22/2013 02/19/2013
Fentanyl Citrate Lollipop 1200 MCG LPOP 19.50000 06/14/2013 06/10/2013
Fentanyl Citrate Lollipop 1600 MCG LPOP 24.83833 02/22/2013 02/19/2013
Fentanyl Citrate Lollipop 200 MCG LPOP 8.70000 06/14/2013 06/10/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Fentanyl Citrate Lollipop 400 MCG LPOP 11.75000 06/14/2013 06/10/2013
Fentanyl Citrate Lollipop 600 MCG LPOP 12.90000 06/14/2013 06/10/2013
Fentanyl Citrate Lollipop 800 MCG LPOP 15.50000 06/14/2013 06/10/2013
Fentanyl TD Patch 72HR 100 MCG/HR PT72 18.18734 10/11/2013 10/09/2013
Fentanyl TD Patch 72HR 12 MCG/HR PT72 16.40000 05/07/2013 06/11/2013
Fentanyl TD Patch 72HR 25 MCG/HR PT72 5.64292 02/22/2013 02/19/2013
Fentanyl TD Patch 72HR 50 MCG/HR PT72 9.45165 03/08/2013 03/04/2013
Fentanyl TD Patch 72HR 75 MCG/HR PT72 15.66000 07/12/2013 07/08/2013
FEOSOL (Ferrous Sulfate Dried Tab 200 MG (65 MG
Elemental Fe
TABS 0.06600 04/28/2005 02/19/2013
FERGON (Ferrous Gluconate Tab 240 MG (27 MG Elemental
Fe))
TABS 0.04440 04/28/2005 02/19/2013
FER-IN-SOL (Ferrous Sulfate Soln 75 MG/ML (15 MG/ML
Elementa
SOLN 0.06070 03/13/2008 02/19/2013
FERRIPROX (Deferiprone Tab 500 MG) TABS 31.55328 04/13/2012 02/19/2013
Ferrous Fumarate Tab 325 MG (106 MG Elemental Fe) TABS 0.01810 02/22/2013 02/19/2013
Ferrous Gluconate Tab 225 MG (27 MG Fe Equivalent) TABS 0.03610 02/22/2013 02/19/2013
Ferrous Gluconate Tab 240 MG (27 MG Elemental Fe) TABS 0.04440 02/22/2013 02/19/2013
Ferrous Gluconate Tab 246 MG (27 MG Elemental Fe) TABS 0.03610 02/22/2013 02/19/2013
Ferrous Gluconate Tab 246 MG (28 MG Elemental Fe) TABS 0.01340 02/22/2013 02/19/2013
Ferrous Gluconate Tab 300 MG TABS 0.08210 02/22/2013 02/19/2013
Ferrous Gluconate Tab 324 MG (37.5 MG Elemental Iron) TABS 0.04460 02/22/2013 02/19/2013
Ferrous Gluconate Tab 324 MG (38 MG Elemental Iron) TABS 0.03727 02/22/2013 02/19/2013
Ferrous Gluconate Tab 325 MG TABS 0.04460 02/22/2013 02/19/2013
Ferrous Gluconate Tab 325 MG (36 MG Elemental Fe) TABS 0.04460 02/22/2013 02/19/2013
Ferrous Gluconate Tab 325 MG (37.5 MG Elemental Fe) TABS 0.04460 02/22/2013 02/19/2013
Ferrous Sulfate Dried Tab CR 160 MG (50 MG Fe Equivalent) TBCR 0.12550 02/22/2013 02/19/2013
Ferrous Sulfate Elixir 220 MG/5ML (44 MG/5ML Elemental
Fe)
ELIX 0.00790 02/22/2013 02/19/2013
Ferrous Sulfate Soln 75 MG/0.6ML SOLN 0.06070 02/22/2013 02/19/2013
Ferrous Sulfate Soln 75 MG/ML (15 MG/ML Elemental Fe) SOLN 0.06070 02/22/2013 02/19/2013
Ferrous Sulfate Syrup 300 MG/5ML (60 MG/5ML Elemental
Fe)
SYRP 0.06980 02/22/2013 02/19/2013
Ferrous Sulfate Tab 28 MG (Elemental Fe) TABS 0.04120 02/22/2013 02/19/2013
Ferrous Sulfate Tab 325 MG (65 MG Elemental Fe) TABS 0.01586 02/22/2013 02/19/2013
Ferrous Sulfate Tab EC 324 MG (65 MG Fe Equivalent) TBEC 0.03390 02/22/2013 02/19/2013
Ferrous Sulfate Tab EC 325 MG (65 MG Fe Equivalent) TBEC 0.03390 02/22/2013 02/19/2013
Ferrous Sulfate-Vit C-Folic Acid Tab CR 105-500-0.8 MG TBCR 0.06610 02/22/2013 02/19/2013
FEVERALL INFANTS (Acetaminophen Suppos 80 MG) SUPP 0.68255 03/13/2008 02/19/2013
Fexofenadine HCl Tab 180 MG TABS 0.57360 02/22/2013 02/19/2013
Fexofenadine HCl Tab 30 MG TABS 0.28456 02/22/2013 02/19/2013
Fexofenadine HCl Tab 60 MG TABS 0.36524 02/22/2013 02/19/2013
FIBER FORMULA (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
FIBERCON (Calcium Polycarbophil Tab 625 MG) TABS 0.09185 03/13/2008 02/19/2013
FIBER-PRO (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
FIBERSOURCE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
FIBERSOURCE CLOSED SYSTEM (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
FIBERSOURCE HN (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
FIBERSOURCE HN CLOSED SYS (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
FIBER-STAT (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
FIFTY50 GLUCOSE METER 2.0 (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
FIFTY50 GLUCOSE TEST STRI (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
FIFTY50 SAFETY SEAL LANCE (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
Finasteride Tab 5 MG TABS 0.26000 11/08/2013 11/05/2013
FINE 30 (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
FINGERSTIX LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
FIORICET (Butalbital-Acetaminophen-Caffeine Tab
50-325-40 MG
TABS 0.08870 04/23/2010 02/19/2013
FIRMAGON (Degarelix Acetate For Inj 80 MG (Base Equiv)) SOLR 338.64000 07/30/2010 02/19/2013
FIRST CHOICE LANCETS COLO (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
FIRST CHOICE LANCETS THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
FITNESS TABS FOR MEN AM/P (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
FITNESS TABS FOR WOMEN A (Multiple Vitamins w/
Minerals Tab*
TABS 0.07430 03/20/2008 02/19/2013
FLEBOGAMMA (Immune Globulin (Human) IV Soln 10
GM/200ML)
SOLN 5.72500 06/02/2013 08/07/2013
FLEBOGAMMA (Immune Globulin (Human) IV Soln 2.5
GM/50ML)
SOLN 5.72500 06/01/2013 08/07/2013
FLEBOGAMMA (Immune Globulin (Human) IV Soln 5
GM/100ML)
SOLN 5.72500 06/01/2013 08/07/2013
FLEBOGAMMA DIF (Immune Globulin (Human) IV Soln 10
GM/100ML)
SOLN 7.50000 04/01/2005 02/19/2013
FLEBOGAMMA DIF (Immune Globulin (Human) IV Soln 10
GM/200ML)
SOLN 5.72500 06/02/2013 08/07/2013
FLEBOGAMMA DIF (Immune Globulin (Human) IV Soln 2.5
GM/50ML)
SOLN 5.72500 06/01/2013 08/07/2013
FLEBOGAMMA DIF (Immune Globulin (Human) IV Soln 20
GM/200ML)
SOLN 7.50000 04/01/2005 02/19/2013
FLEBOGAMMA DIF (Immune Globulin (Human) IV Soln 5
GM/100ML)
SOLN 5.72500 06/01/2013 08/07/2013
FLEBOGAMMA DIF (Immune Globulin (Human) IV Soln 5
GM/50ML)
SOLN 7.50000 04/01/2005 02/19/2013
Flecainide Acetate Tab 100 MG TABS 0.31163 02/22/2013 02/19/2013
Flecainide Acetate Tab 150 MG TABS 0.69040 02/22/2013 02/19/2013
Flecainide Acetate Tab 50 MG TABS 0.24167 02/22/2013 02/19/2013
FLEET ENEMA (Sodium Phosphates - Enema***) ENEM 0.01138 03/20/2008 02/19/2013
FLEET ENEMA SIX PACK (Sodium Phosphates - Enema***) ENEM 0.01138 03/20/2008 02/19/2013
FLEET MINERAL OIL (Mineral Oil Enema) ENEM 0.01031 03/20/2008 02/19/2013
FLEET OIL (Mineral Oil Enema) ENEM 0.01031 03/20/2008 02/19/2013
FLEET PEDIATRIC (Sodium Phosphates - Enema***) ENEM 0.01832 05/22/2012 02/19/2013
Page 45 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
FLEET PHOSPHO SODA (Sodium Phosphates - Soln***) SOLN 0.06425 03/20/2008 02/19/2013
FLEET PHOSPHO-SODA (Sodium Phosphates - Soln***) SOLN 0.06425 03/20/2008 02/19/2013
FLOMAX (Tamsulosin HCl Cap 0.4 MG) CAPS 0.21000 07/28/2005 02/19/2013
FLOMAX (Tamsulosin HCl Cap 0.4 MG) CAPS 0.21000 04/23/2010 02/19/2013
Fluconazole For Susp 10 MG/ML SUSR 0.28830 02/22/2013 02/19/2013
Fluconazole For Susp 40 MG/ML SUSR 0.88050 04/22/2013 06/11/2013
Fluconazole Tab 100 MG TABS 1.76000 07/08/2013 10/09/2013
Fluconazole Tab 150 MG TABS 1.95000 08/29/2013 09/09/2013
Fluconazole Tab 200 MG TABS 2.92000 08/20/2013 09/09/2013
Fluconazole Tab 50 MG TABS 0.11834 02/22/2013 02/19/2013
Fludarabine Phosphate For Inj 50 MG SOLR 180.84300 02/22/2013 02/19/2013
Fludarabine Phosphate Inj 25 MG/ML SOLN 178.92550 02/22/2013 02/19/2013
Fludrocortisone Acetate Tab 0.1 MG TABS 0.52000 02/22/2013 02/19/2013
Flunisolide Nasal Soln 25 MCG/ACT (0.025%) SOLN 0.63750 02/22/2013 02/19/2013
Fluocinolone Acetonide Cream 0.01% CREA 1.86366 02/22/2013 02/19/2013
Fluocinolone Acetonide Cream 0.025% CREA 1.37372 02/22/2013 02/19/2013
Fluocinolone Acetonide Oil 0.01% OIL 1.38500 10/03/2013 11/05/2013
Fluocinolone Acetonide Oint 0.025% OINT 1.46840 04/17/2013 05/06/2013
Fluocinolone Acetonide Soln 0.01% SOLN 2.61000 02/16/2013 03/04/2013
Fluocinolone Acetonide Soln 0.01% SOLN 2.61000 02/22/2013 03/04/2013
Fluocinonide Cream 0.05% CREA 0.35917 02/22/2013 02/19/2013
Fluocinonide Emulsified Base Cream 0.05% CREA 0.62000 12/07/2012 05/15/2013
Fluocinonide Gel 0.05% GEL 0.27083 02/22/2013 02/19/2013
Fluocinonide Oint 0.05% OINT 0.73986 01/10/2013 02/20/2013
Fluocinonide Oint 0.05% OINT 0.73986 02/22/2013 02/20/2013
Fluocinonide Soln 0.05% SOLN 1.36000 01/10/2013 02/20/2013
Fluocinonide Soln 0.05% SOLN 1.36000 02/22/2013 02/20/2013
Fluorometholone Ophth Susp 0.1% SUSP 1.77754 02/22/2013 02/19/2013
Fluorouracil Cream 5% CREA 5.64965 02/22/2013 02/19/2013
Fluorouracil Inj 2.5 GM/50ML (50 MG/ML) SOLN 0.27000 02/22/2013 02/19/2013
Fluorouracil Inj 5 GM/100ML (50 MG/ML) SOLN 0.18163 02/22/2013 02/19/2013
Fluorouracil Soln 5% SOLN 9.30360 02/22/2013 02/19/2013
Fluoxetine HCl (PMDD) Cap 10 MG CAPS 0.04061 02/08/2013 02/20/2013
Fluoxetine HCl (PMDD) Cap 20 MG CAPS 0.05359 02/22/2013 02/19/2013
Fluoxetine HCl Cap 10 MG CAPS 0.03342 02/22/2013 02/19/2013
Fluoxetine HCl Cap 20 MG CAPS 0.02956 02/22/2013 02/19/2013
Fluoxetine HCl Cap 40 MG CAPS 0.25425 02/22/2013 02/19/2013
Fluoxetine HCl Cap Delayed Release 90 MG CPDR 25.64925 02/22/2013 02/19/2013
Fluoxetine HCl Solution 20 MG/5ML SOLN 0.04066 02/22/2013 02/19/2013
Fluoxetine HCl Tab 10 MG TABS 0.06063 02/22/2013 02/19/2013
Fluoxetine HCl Tab 20 MG TABS 0.20000 02/22/2013 02/19/2013
Fluphenazine Decanoate Inj 25 MG/ML SOLN 18.01000 04/18/2013 05/06/2013
Fluphenazine HCl Tab 1 MG TABS 0.06561 02/22/2013 02/19/2013
Fluphenazine HCl Tab 10 MG TABS 0.31000 04/11/2013 06/11/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Fluphenazine HCl Tab 2.5 MG TABS 0.07540 02/22/2013 02/19/2013
Fluphenazine HCl Tab 5 MG TABS 0.10000 02/22/2013 02/19/2013
Flurazepam HCl Cap 15 MG CAPS 0.07500 02/22/2013 02/19/2013
Flurazepam HCl Cap 30 MG CAPS 0.09220 02/22/2013 02/19/2013
Flurbiprofen Sodium Ophth Soln 0.03% SOLN 1.86816 02/22/2013 02/19/2013
Flurbiprofen Tab 100 MG TABS 0.24380 05/28/2013 07/09/2013
Flurbiprofen Tab 50 MG TABS 0.19500 02/22/2013 02/19/2013
Flutamide Cap 125 MG CAPS 0.71493 02/22/2013 02/19/2013
Fluticasone Propionate Cream 0.05% CREA 0.53442 02/22/2013 02/19/2013
Fluticasone Propionate Nasal Susp 50 MCG/ACT SUSP 1.11024 11/08/2013 11/05/2013
Fluticasone Propionate Oint 0.005% OINT 0.51150 02/22/2013 02/19/2013
Fluvastatin Sodium Cap 20 MG CAPS 3.23686 09/13/2013 09/09/2013
Fluvastatin Sodium Cap 40 MG CAPS 3.23686 09/13/2013 09/09/2013
Fluvastatin Sodium Tab SR 24 HR 80 MG TB24 0.14350 02/22/2013 02/19/2013
Fluvoxamine Maleate Tab 100 MG TABS 0.28340 02/22/2013 02/19/2013
Fluvoxamine Maleate Tab 25 MG TABS 0.23590 02/22/2013 02/19/2013
Fluvoxamine Maleate Tab 50 MG TABS 0.30908 02/22/2013 02/19/2013
FOLCAPS CARE ONE (Prenatal w/Fe Cbnyl-Fe Asp
Glyc-FA-DSS-Ome
CAPS 0.11230 04/01/2008 02/19/2013
Folic Acid Tab 1 MG TABS 0.02970 02/22/2013 02/19/2013
Folic Acid Tab 400 MCG TABS 0.01810 02/22/2013 02/19/2013
Folic Acid Tab 800 MCG TABS 0.02039 02/22/2013 02/19/2013
Folic Acid-Vit B6-Vit B12-Omega 3-Phytosterols Cap 1 MG*** CAPS 0.99840 02/22/2013 02/19/2013
Folic Acid-Vitamin B6-Vitamin B12 Tab 2.2-25-1 MG TABS 0.21409 02/22/2013 02/19/2013
FOLLOW-UP (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
FOLLOW-UP SOY (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
FOLLOW-UP W/FE (Infant Foods Conc**) CONC 0.01190 04/28/2005 02/19/2013
FOLLOW-UP W/FE (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
FOLLOW-UP W/FE (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
Fondaparinux Sodium Inj 10 MG/0.8ML SOLN 84.68594 02/22/2013 02/19/2013
Fondaparinux Sodium Inj 2.5 MG/0.5ML SOLN 48.55750 02/22/2013 02/19/2013
Fondaparinux Sodium Inj 5 MG/0.4ML SOLN 257.34000 02/22/2013 02/19/2013
Fondaparinux Sodium Inj 7.5 MG/0.6ML SOLN 125.12000 02/22/2013 02/19/2013
FOOD ALLERGY FORMULA (Nutritional Supplement
Powder**)
POWD 0.20315 04/05/2011 02/19/2013
FORA D10 BLOOD GLUCOSE TE (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
FORA D15C BLOOD GLUCOSE T (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
FORA D15G BLOOD GLUCOSE T (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
FORA D15Z BLOOD GLUCOSE T (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
FORA D20 BLOOD GLUCOSE TE (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
FORA G20 BLOOD GLUCOSE MO (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
FORA G20 BLOOD GLUCOSE TE (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
FORA G30A BLOOD GLUCOSE T (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
FORA G71A BLOOD GLUCOSE M (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
FORA G71A BLOOD GLUCOSE T (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
FORA G90 BLOOD GLUCOSE TE (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
FORA GD20 TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
FORA LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
FORA V10 BLOOD GLUCOSE TE (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
FORA V12 BLOOD GLUCOSE TE (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
FORA V20 BLOOD GLUCOSE TE (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
FORA V22 BLOOD GLUCOSE MO (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
FORA V22 BLOOD GLUCOSE TE (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
FORA V30A BLOOD GLUCOSE M (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
FORA V30A BLOOD GLUCOSE T (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
FORACARE GD40 (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
FORACARE PREMIUM V10 TEST (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
FORMULA 405 BODY SMOOTHIN (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
FORMULA 405 MOISTURIZING (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
FORTA DRINK (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
FORTA SHAKE (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
FORTAVIT (Multiple Vitamins w/ Minerals Cap**) CAPS 0.51325 04/27/2011 02/19/2013
FORTAVIT (Multiple Vitamins w/ Minerals Liquid**) LIQD 0.02464 03/20/2008 02/19/2013
FORTEO (Teriparatide (Recombinant) Inj 600 MCG/2.4ML) SOLN 539.62400 05/15/2013 06/11/2013
FORTEO (Teriparatide (Recombinant) Inj 750 MCG/3ML) SOLN 428.46675 05/17/2011 02/19/2013
FORTICAL (Calcitonin (Salmon) Nasal Soln 200 Unit/ACT) SOLN 13.82000 09/27/2007 02/19/2013
FOSFREE (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
FOSGLUTEN REFORZADO (Multiple Vitamins w/ Minerals
Tab**)
TABS 0.07430 03/20/2008 02/19/2013
Fosinopril Sodium & Hydrochlorothiazide Tab 10-12.5 MG TABS 0.88800 02/22/2013 02/19/2013
Fosinopril Sodium & Hydrochlorothiazide Tab 20-12.5 MG TABS 0.88800 02/22/2013 02/19/2013
Fosinopril Sodium Tab 10 MG TABS 0.16918 02/22/2013 02/19/2013
Fosinopril Sodium Tab 20 MG TABS 0.15060 02/22/2013 02/19/2013
Fosinopril Sodium Tab 40 MG TABS 0.14937 02/22/2013 02/19/2013
FP LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
FP LANCETS SUPER THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
FP LANCETS THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
FRAGMIN (Dalteparin Sodium Inj 10000 Unit/ML) SOLN 64.25860 04/13/2012 02/19/2013
FRAGMIN (Dalteparin Sodium Inj 12500 Unit/0.5ML) SOLN 160.63820 04/13/2012 02/19/2013
FRAGMIN (Dalteparin Sodium Inj 15000 Unit/0.6ML) SOLN 160.63266 04/13/2012 02/19/2013
FRAGMIN (Dalteparin Sodium Inj 18000 Unit/0.72ML) SOLN 160.65111 04/13/2012 02/19/2013
FRAGMIN (Dalteparin Sodium Inj 2500 Unit/0.2ML) SOLN 99.06050 04/13/2012 02/19/2013
FRAGMIN (Dalteparin Sodium Inj 25000 Unit/ML) SOLN 145.34174 04/13/2012 02/19/2013
FRAGMIN (Dalteparin Sodium Inj 5000 Unit/0.2ML) SOLN 160.64650 04/13/2012 02/19/2013
FRAGMIN (Dalteparin Sodium Inj 7500 Unit/0.3ML) SOLN 160.66034 04/13/2012 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
FREEDAVITE (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
FREESTYLE FREEDOM (Blood Glucose Monitoring Kit w/
Device***
KIT 0.71000 10/01/2003 02/19/2013
FREESTYLE FREEDOM LITE (Blood Glucose Monitoring Kit
w/ Devi
KIT 0.71000 10/01/2003 02/19/2013
FREESTYLE FREEDOM LITE (Blood Glucose Monitoring Kit
w/ Devi
KIT 15.30000 07/01/2010 02/19/2013
FREESTYLE INSULINX BLOOD (Blood Glucose Monitoring
Kit w/ De
KIT 0.71000 10/01/2003 02/19/2013
FREESTYLE INSULINX BLOOD (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
FREESTYLE INSULINX BLOOD (Glucose Blood Test Strip) STRP 1.28234 03/05/2013 04/09/2013
FREESTYLE INSULINX BLOOD (Glucose Blood Test Strip) STRP 1.40410 10/16/2013 11/05/2013
FREESTYLE LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
FREESTYLE LITE TEST STRIP (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
FREESTYLE LITE TEST STRIP (Glucose Blood Test Strip) STRP 1.13990 10/08/2013 11/05/2013
FREESTYLE LITE TEST STRIP (Glucose Blood Test Strip) STRP 1.16263 05/12/2012 02/19/2013
FREESTYLE SIDEKICK II VAL (Blood Glucose Monitoring Kit
w/ D
KIT 0.71000 10/01/2003 02/19/2013
FREESTYLE TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
FREESTYLE TEST STRIPS (Glucose Blood Test Strip) STRP 1.01670 05/12/2012 02/19/2013
FREESTYLE TEST STRIPS (Glucose Blood Test Strip) STRP 1.14895 06/12/2012 02/19/2013
FREESTYLE UNISTICK II LAN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
FULL SPECTRUM B/VITAMIN C (B-Complex w/ C & Folic
Acid Tab 0
TABS 0.08400 03/13/2008 02/19/2013
Furosemide Inj 10 MG/ML SOLN 0.07410 02/22/2013 02/19/2013
Furosemide Oral Soln 10 MG/ML SOLN 0.07735 02/22/2013 02/19/2013
Furosemide Tab 20 MG TABS 0.01761 02/22/2013 02/19/2013
Furosemide Tab 40 MG TABS 0.01718 02/22/2013 02/19/2013
Furosemide Tab 80 MG TABS 0.03412 02/22/2013 02/19/2013
FUZEON (Enfuvirtide For Inj Kit 90 MG) KIT 2,777.33770 01/03/2013 02/20/2013
GA (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
GA DIET (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
GA EXPRESS15 (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
GA GEL (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
Gabapentin Cap 100 MG CAPS 0.05249 02/22/2013 02/19/2013
Gabapentin Cap 300 MG CAPS 0.07540 02/22/2013 02/19/2013
Gabapentin Cap 400 MG CAPS 0.12000 10/11/2013 10/09/2013
Gabapentin Oral Soln 250 MG/5ML SOLN 0.17500 02/22/2013 02/19/2013
Gabapentin Tab 400 MG TABS 1.19000 02/22/2013 02/19/2013
Gabapentin Tab 600 MG TABS 0.33498 02/08/2013 02/20/2013
Gabapentin Tab 600 MG TABS 0.33498 02/22/2013 02/20/2013
Gabapentin Tab 800 MG TABS 0.36809 08/09/2013 08/06/2013
GABITRIL (Tiagabine HCl Tab 4 MG) TABS 0.02110 04/28/2005 02/19/2013
Galantamine Hydrobromide Cap SR 24HR 16 MG CP24 2.57000 02/22/2013 02/19/2013
Galantamine Hydrobromide Cap SR 24HR 24 MG CP24 2.28500 02/22/2013 02/19/2013
Galantamine Hydrobromide Cap SR 24HR 8 MG CP24 2.17400 02/22/2013 02/19/2013
Page 49 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Galantamine Hydrobromide Tab 12 MG TABS 1.87400 02/22/2013 02/19/2013
Galantamine Hydrobromide Tab 4 MG TABS 1.81300 02/22/2013 02/19/2013
Galantamine Hydrobromide Tab 8 MG TABS 1.62250 02/22/2013 02/19/2013
Gamma-Aminobutyric Acid Oral Powder POWD 0.06700 02/22/2013 02/19/2013
GAMMAGARD LIQUID (Immune Globulin (Human) IV or
Subcutaneous
SOLN 7.50000 12/02/2004 02/19/2013
GAMMAGARD LIQUID (Immune Globulin (Human) IV or
Subcutaneous
SOLN 7.50000 12/02/2004 02/19/2013
GAMMAGARD LIQUID (Immune Globulin (Human) IV or
Subcutaneous
SOLN 7.50000 12/02/2004 02/19/2013
GAMMAGARD LIQUID (Immune Globulin (Human) IV or
Subcutaneous
SOLN 7.50000 12/02/2004 02/19/2013
GAMMAGARD LIQUID (Immune Globulin (Human) IV or
Subcutaneous
SOLN 12.08248 01/01/2013 02/20/2013
GAMMAGARD LIQUID (Immune Globulin (Human) IV or
Subcutaneous
SOLN 7.50000 12/02/2004 02/19/2013
GAMMAGARD S/D (Immune Globulin (Human) IV For Soln
0.5 GM)
SOLR 76.94930 04/13/2012 02/19/2013
GAMMAGARD S/D (Immune Globulin (Human) IV For Soln
10 GM)
SOLR 1,291.71240 01/01/2013 02/20/2013
GAMMAGARD S/D (Immune Globulin (Human) IV For Soln
2.5 GM)
SOLR 187.50000 05/01/2005 02/19/2013
GAMMAGARD S/D (Immune Globulin (Human) IV For Soln 5
GM)
SOLR 645.85620 01/01/2013 02/20/2013
GAMMAGARD S/D IGA LESS TH (Immune Globulin (Human)
IV For So
SOLR 1,291.71240 01/01/2013 02/20/2013
GAMMAGARD S/D IGA LESS TH (Immune Globulin (Human)
IV For So
SOLR 645.85620 01/01/2013 02/20/2013
GAMMAPLEX (Immune Globulin (Human) IV Soln 10
GM/200ML)
SOLN 5.72500 06/02/2013 08/07/2013
GAMMAPLEX (Immune Globulin (Human) IV Soln 2.5
GM/50ML)
SOLN 5.72500 06/01/2013 08/07/2013
GAMMAPLEX (Immune Globulin (Human) IV Soln 5
GM/100ML)
SOLN 5.72500 06/01/2013 08/07/2013
GAMUNEX (Immune Globulin (Human) IV Soln 1 GM/10ML) SOLN 7.50000 04/01/2005 02/19/2013
GAMUNEX (Immune Globulin (Human) IV Soln 10
GM/100ML)
SOLN 7.50000 04/01/2005 02/19/2013
GAMUNEX (Immune Globulin (Human) IV Soln 2.5
GM/25ML)
SOLN 7.50000 04/01/2005 02/19/2013
GAMUNEX (Immune Globulin (Human) IV Soln 20
GM/200ML)
SOLN 7.50000 04/01/2005 02/19/2013
GAMUNEX (Immune Globulin (Human) IV Soln 5 GM/50ML) SOLN 7.50000 04/01/2005 02/19/2013
Ganciclovir Cap 500 MG CAPS 6.15000 02/22/2013 02/19/2013
GAS-X (Simethicone Chew Tab 80 MG) CHEW 0.04539 03/20/2008 02/19/2013
GAS-X EXTRA STRENGTH (Simethicone Chew Tab 125
MG)
CHEW 0.07284 03/20/2008 02/19/2013
GEL-KAM (Stannous Fluoride Gel 0.4%) GEL 0.06033 03/20/2008 02/19/2013
Gemcitabine HCl For Inj 1 GM SOLR 371.23000 02/22/2013 02/19/2013
Gemcitabine HCl For Inj 200 MG SOLR 74.85000 02/22/2013 02/19/2013
Page 50 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Gemfibrozil Tab 600 MG TABS 0.14453 02/22/2013 02/19/2013
GENOTROPIN INTRA-MIX (Somatropin For Inj 5.8 MG) SOLR 270.67020 07/01/2013 08/07/2013
GENOTROPIN (Somatropin For Inj 12 MG (13.8 MG Overfill)) SOLR 1,002.24160 07/01/2013 08/06/2013
GENOTROPIN (Somatropin For Subcutaneous Inj 5 MG) SOLR 417.58960 07/01/2013 08/06/2013
GENOTROPIN MINIQUICK (Somatropin For Inj 0.2 MG) SOLR 13.90013 11/11/2011 02/19/2013
GENOTROPIN MINIQUICK (Somatropin For Inj 0.4 MG) SOLR 27.79789 11/11/2011 02/19/2013
GENOTROPIN MINIQUICK (Somatropin For Inj 0.6 MG) SOLR 54.62000 07/01/2013 10/09/2013
GENOTROPIN MINIQUICK (Somatropin For Inj 0.8 MG) SOLR 72.82657 07/01/2013 08/06/2013
GENOTROPIN MINIQUICK (Somatropin For Inj 1 MG) SOLR 91.03550 07/01/2013 08/06/2013
GENOTROPIN MINIQUICK (Somatropin For Inj 1.2 MG) SOLR 109.24100 07/01/2013 08/07/2013
GENOTROPIN MINIQUICK (Somatropin For Inj 1.4 MG) SOLR 127.44530 07/01/2013 08/07/2013
GENOTROPIN MINIQUICK (Somatropin For Inj 1.6 MG) SOLR 145.65070 07/01/2013 08/07/2013
GENOTROPIN MINIQUICK (Somatropin For Inj 1.8 MG) SOLR 163.86210 07/01/2013 08/07/2013
GENOTROPIN MINIQUICK (Somatropin For Inj 2 MG) SOLR 182.06640 07/01/2013 08/07/2013
Gentamicin Sulfate Cream 0.1% CREA 0.85416 02/22/2013 02/19/2013
Gentamicin Sulfate Oint 0.1% OINT 0.65000 05/30/2013 08/06/2013
Gentamicin Sulfate Ophth Oint 0.3% OINT 3.37780 02/22/2013 02/19/2013
Gentamicin Sulfate Ophth Soln 0.3% SOLN 1.52250 02/22/2013 02/19/2013
GENTEAL (Artificial Tear Ophth Gel***) GEL 0.74780 04/28/2005 02/19/2013
GENTEAL (Hypromellose Ophth Soln 0.3%) SOLN 0.40323 03/13/2008 02/19/2013
GENTEAL MILD (Hypromellose Ophth Soln 0.2%) SOLN 0.40982 03/13/2008 02/19/2013
GENTEAL MILD TO MODERATE (Hypromellose Ophth Soln
0.3%)
SOLN 0.40323 03/13/2008 02/19/2013
GENTLE-LET GP LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
GENTLE-LET LANCETS GENERA (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
GENTLE-LET LANCETS SAFETY (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
GERBER GOOD START 2 GENTL (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
GERBER GOOD START 2 PROTE (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
GERBER GOOD START 2 SOY/I (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
GERBER GOOD START GENTLE/ (Infant Foods Conc**) CONC 0.01190 04/28/2005 02/19/2013
GERBER GOOD START GENTLE/ (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
GERBER GOOD START GENTLE/ (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
GERBER GOOD START NOURISH (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
GERBER GOOD START NOURISH (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
GERBER GOOD START PREMATU (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
GERBER GOOD START PROTECT (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
GERBER GOOD START SOOTHE (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
GERBER GOOD START SOY/IRO (Infant Foods Conc**) CONC 0.01190 04/28/2005 02/19/2013
GERBER GOOD START SOY/IRO (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
GERBER GOOD START SOY/IRO (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
GERI PROTECT (Skin Protectants Misc - Ointment***) OINT 0.03040 04/28/2005 02/19/2013
GERI-FREEDA SENIOR FORMUL (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
GERI-SOFT (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
GERI-SS (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
Page 51 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
GERITOL EXTEND (Multiple Vitamins w/ Iron Tab**) TABS 0.04080 03/20/2008 02/19/2013
GIANT EAGLE LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
GIANT EAGLE LANCETS COLOR (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
GIANT EAGLE PHARMACY TEST (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
GIANT EAGLE PHARMACY VALU (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
GILENYA (Fingolimod HCl Cap 0.5 MG (Base Equiv)) CAPS 164.88039 01/03/2013 02/20/2013
GLASSIA (Alpha1-Proteinase Inhibitor (Human) Inj 1000
MG/50M
SOLN 0.45650 01/28/2011 02/19/2013
GLEEVEC (Imatinib Mesylate Tab 100 MG (Base Equivalent)) TABS 58.92179 12/06/2012 02/19/2013
GLEEVEC (Imatinib Mesylate Tab 100 MG (Base Equivalent)) TABS 64.22400 08/02/2013 09/09/2013
GLEEVEC (Imatinib Mesylate Tab 400 MG (Base Equivalent)) TABS 231.42500 08/02/2013 10/09/2013
GLIADEL WAFER (Carmustine in Polifeprosan Intracranial
Impla
WAFR 3,150.97050 07/30/2010 02/19/2013
Glimepiride Tab 1 MG TABS 0.03007 02/22/2013 02/19/2013
Glimepiride Tab 2 MG TABS 0.03750 02/22/2013 02/19/2013
Glimepiride Tab 4 MG TABS 0.07359 02/22/2013 02/19/2013
Glipizide Tab 10 MG TABS 0.04253 02/22/2013 02/19/2013
Glipizide Tab 5 MG TABS 0.02961 02/22/2013 02/19/2013
Glipizide Tab SR 24HR 10 MG TB24 0.36545 02/22/2013 02/19/2013
Glipizide Tab SR 24HR 2.5 MG TB24 0.18000 02/22/2013 02/19/2013
Glipizide Tab SR 24HR 5 MG TB24 0.18975 02/22/2013 02/19/2013
Glipizide-Metformin HCl Tab 2.5-250 MG TABS 0.57260 02/22/2013 02/19/2013
Glipizide-Metformin HCl Tab 2.5-500 MG TABS 0.52025 02/22/2013 02/19/2013
Glipizide-Metformin HCl Tab 5-500 MG TABS 0.67150 02/22/2013 02/19/2013
GLOBAL INJECT EASE LANCET (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
GLUCERNA (Nutritional Supplement Bar**) BAR 0.46070 04/28/2005 02/19/2013
GLUCERNA (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
GLUCERNA 1.0 CAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
GLUCERNA 1.0 CAL/FIBER (Nutritional Supplement Liquid**) LIQD 0.00720 04/28/2005 02/19/2013
GLUCERNA 1.0 CAL/FIBER (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
GLUCERNA 1.2 CAL (Nutritional Supplement Liquid**) LIQD 0.00720 04/28/2005 02/19/2013
GLUCERNA 1.2 CAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
GLUCERNA 1.5 CAL (Nutritional Supplement Liquid**) LIQD 0.00720 04/28/2005 02/19/2013
GLUCERNA 1.5 CAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
GLUCERNA CRISPY DELIGHTS (Nutritional Supplement
Bar**)
BAR 0.46070 04/28/2005 02/19/2013
GLUCERNA HUNGER SMART SHA (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
GLUCERNA MEAL (Nutritional Supplement Bar**) BAR 0.46070 04/28/2005 02/19/2013
GLUCERNA MEAL REPLACEMENT (Nutritional Supplement
Bar**)
BAR 0.46070 04/28/2005 02/19/2013
GLUCERNA MINI SNACK (Nutritional Supplement Bar**) BAR 0.46070 04/28/2005 02/19/2013
GLUCERNA OS (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
GLUCERNA SELECT (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
GLUCERNA SHAKE (Nutritional Supplement Liquid**) LIQD 0.00720 04/28/2005 02/19/2013
Page 52 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
GLUCERNA SHAKE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
GLUCERNA SNACK (Nutritional Supplement Bar**) BAR 0.46070 04/28/2005 02/19/2013
GLUCERNA SNACK SHAKE (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
GLUCERNA WEIGHT LOSS SHAK (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
GLUCO BURST (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
GLUCO PERFECT 3 TEST STRI (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/28/2013
GLUCOCARD 01 BLOOD GLUCOS (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
GLUCOCARD 01 SENSOR (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
GLUCOCARD 01 TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
GLUCOCARD 01-MINI BLOOD G (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
GLUCOCARD EXPRESSION AUDI (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
GLUCOCARD EXPRESSION BLOO (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
GLUCOCARD VITAL BLOOD GLU (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
GLUCOCARD VITAL TEST STRI (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
GLUCOCARD X-METER (Blood Glucose Monitoring Kit w/
Device***
KIT 0.71000 10/01/2003 02/19/2013
GLUCOCARD X-SENSOR (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
GLUCOCOM BLOOD GLUCOSE MO (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 04/23/2010 02/19/2013
GLUCOCOM LANCETS 28G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
GLUCOCOM LANCETS 30G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
GLUCOCOM LANCETS 33G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
GLUCOCOM TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
GLUCOFILM TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
GLUCOLAB TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
GLUCOMETER DEX TEST SENSO (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
GLUCOMETER ELITE (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
GLUCOMETER ELITE CLASSIC (Blood Glucose Monitoring
Kit w/ De
KIT 0.71000 10/01/2003 02/19/2013
GLUCOMETER ENCORE QA+ SYS (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 04/23/2010 02/19/2013
GLUCOMETER ENCORE TEST ST (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
Glucosamine Sulfate Cap 500 MG CAPS 0.13817 02/22/2013 02/19/2013
Glucosamine Sulfate Cap 750 MG CAPS 0.10633 02/22/2013 02/19/2013
Glucosamine Sulfate Tab 750 MG TABS 0.07783 02/22/2013 02/19/2013
Glucosamine-Chondroitin Cap 500-400 MG CAPS 0.17500 02/22/2013 02/19/2013
Glucosamine-Chondroitin Tab 500-400 MG TABS 0.17500 02/22/2013 02/19/2013
Glucosamine-Chondroitin Tab 750-600 MG TABS 0.18410 02/22/2013 02/19/2013
Glucosamine-Chondroitin-Vit C-Manganese Cap*** CAPS 0.15500 02/22/2013 02/19/2013
Page 53 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Glucosamine-Chondroitin-Vit C-Manganese Tab*** TABS 0.18410 02/22/2013 02/19/2013
Glucose Blood Test Strip STRP 0.74500 02/22/2013 02/19/2013
Glucose Gel 40% GEL 0.08970 02/22/2013 02/19/2013
GLUCOSOURCE LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
GLUCOSTIX (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
GLUTARADE AMINO ACID BLEN (Amino Acids Oral
Powder***)
POWD 0.33438 06/27/2012 02/19/2013
GLUTARADE JUNIOR GA-1 (Amino Acids Oral Powder***) POWD 0.33438 06/27/2012 02/19/2013
GLUTAREX-1 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
GLUTAREX-2 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
GLUTASORB (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
Glyburide Micronized Tab 1.5 MG TABS 0.03659 02/22/2013 02/19/2013
Glyburide Micronized Tab 3 MG TABS 0.03081 02/22/2013 02/19/2013
Glyburide Micronized Tab 6 MG TABS 0.05788 02/22/2013 02/19/2013
Glyburide Tab 1.25 MG TABS 0.09620 02/22/2013 02/19/2013
Glyburide Tab 2.5 MG TABS 0.15068 02/22/2013 02/19/2013
Glyburide Tab 5 MG TABS 0.22667 02/22/2013 02/19/2013
Glyburide-Metformin Tab 1.25-250 MG TABS 0.02988 02/22/2013 02/19/2013
Glyburide-Metformin Tab 2.5-500 MG TABS 0.07485 02/22/2013 02/19/2013
Glyburide-Metformin Tab 5-500 MG TABS 0.07738 02/22/2013 02/19/2013
GLYCERIN ADULT (Glycerin Suppos 2 GM) SUPP 0.07040 04/28/2005 02/19/2013
Glycerin Suppos 1.2 GM SUPP 0.07360 02/22/2013 02/19/2013
Glycerin Suppos 1.5 GM SUPP 0.07360 02/22/2013 02/19/2013
Glycerin Suppos 2 GM SUPP 0.04980 02/22/2013 02/19/2013
Glycerin Suppos 2.1 GM SUPP 0.04980 02/22/2013 02/19/2013
Glycerin Suppos 3 GM SUPP 0.04980 02/22/2013 02/19/2013
Glycerin Suppos 80.7% SUPP 0.04980 02/22/2013 02/19/2013
Glycopyrrolate Inj 0.2 MG/ML SOLN 1.35929 02/22/2013 02/19/2013
Glycopyrrolate Tab 1 MG TABS 0.53100 02/22/2013 02/19/2013
Glycopyrrolate Tab 2 MG TABS 0.54413 02/22/2013 02/19/2013
GLYCOSADE (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
GLYTACTIN BETTERMILK 15 (Nutritional Supplement
Pack**)
PACK 9.02000 06/15/2011 02/19/2013
GLYTROL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
GNP ADVANCED RECOVERY (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
GNP DAIRY-RELIEF (Lactase Chew Tab 3000 Unit) CHEW 0.11500 03/20/2008 02/19/2013
GNP LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
GNP LANCETS 21G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
GNP LANCETS MICRO THIN 33 (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
GNP LANCETS SUPER THIN 30 (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
GNP LANCETS THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
GNP LANCETS THIN 26G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
GNP MICRO THIN LANCETS 33 (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
GNP MINERAL OIL HEAVY (Mineral Oil) OIL 0.01529 03/20/2008 02/19/2013
Page 54 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
GNP PRENATAL VITAMINS (Prenatal Vit w/ Fe Fumarate-FA
Tab 28
TABS 0.07255 02/27/2009 02/19/2013
GNP SUPER THIN LANCETS/30 (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
GNP TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
GNP TRUEREAD (Blood Glucose Monitoring Kit w/
Device***)
KIT 0.71000 10/01/2003 02/19/2013
GNP TRUEREAD (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
GNP TRUETRACK SMART SYSTE (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
GOLD BOND MEDICATED BODY (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
GOLD BOND ULTIMATE (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
GOLD BOND ULTIMATE HEALIN (Emollient - Ointment**) OINT 0.04583 03/13/2008 02/19/2013
GOLD BOND ULTIMATE PROTEC (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
GOLD BOND ULTIMATE RESTOR (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
GOLD BOND ULTIMATE SHEER (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
GOLD BOND ULTIMATE SOFTEN (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
GOLD BOND ULTIMATE SOOTHI (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
GOOD START (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
GOOD START (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
GOOD START 2 ESSENTIALS S (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
GOOD START 2 ESSENTIALS W (Infant Foods Conc**) CONC 0.01190 04/28/2005 02/19/2013
GOOD START 2 ESSENTIALS W (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
GOOD START 2 ESSENTIALS W (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
GOOD START 2 SUPREME W/IR (Infant Foods Conc**) CONC 0.01190 04/28/2005 02/19/2013
GOOD START 2 SUPREME W/IR (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
GOOD START 2 SUPREME W/IR (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
GOOD START ESSENTIALS SOY (Infant Foods Conc**) CONC 0.01190 04/28/2005 02/19/2013
GOOD START ESSENTIALS SOY (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
GOOD START ESSENTIALS SOY (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
GOOD START ESSENTIALS W/I (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
GOOD START GENTLE PLUS (Infant Foods Conc**) CONC 0.01190 04/28/2005 02/19/2013
GOOD START GENTLE PLUS (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
GOOD START SOY PLUS 2 (Infant Foods Powder**) POWD 0.04650 04/23/2010 02/19/2013
GOOD START SUPREME DHA/AR (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
GOOD START SUPREME NATURA (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
GOOD START SUPREME SOY/IR (Infant Foods Conc**) CONC 0.01190 04/28/2005 02/19/2013
GOOD START SUPREME SOY/IR (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
GOOD START SUPREME SOY/IR (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
GOOD START SUPREME W/IRON (Infant Foods Conc**) CONC 0.01190 04/28/2005 02/19/2013
GOOD START SUPREME W/IRON (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
GOOD START SUPREME W/IRON (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
GOOD START W/FE (Infant Foods Conc**) CONC 0.01190 04/28/2005 02/19/2013
GOOD START W/FE (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
GOOD START W/FE (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
Granisetron HCl Tab 1 MG TABS 6.69100 06/14/2013 06/10/2013
Page 55 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Griseofulvin Microsize Susp 125 MG/5ML SUSP 0.12137 02/22/2013 02/19/2013
Griseofulvin Ultramicrosize Tab 250 MG TABS 5.17000 08/09/2013 08/06/2013
GRX VITAMIN E (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
Guaifenesin Liquid 100 MG/5ML LIQD 0.00585 02/22/2013 02/19/2013
Guaifenesin Liquid 100 MG/5ML SOLN 0.00585 02/22/2013 02/19/2013
Guaifenesin Syrup 100 MG/5ML SYRP 0.00585 02/22/2013 02/19/2013
Guaifenesin-Codeine Soln 100-10 MG/5ML LIQD 0.01088 02/22/2013 02/19/2013
Guaifenesin-Codeine Soln 100-10 MG/5ML SOLN 0.01088 02/22/2013 02/19/2013
Guaifenesin-Codeine Soln 100-10 MG/5ML SYRP 0.01088 02/22/2013 02/19/2013
Guanfacine HCl Tab 1 MG TABS 0.08270 02/22/2013 02/19/2013
Guanfacine HCl Tab 2 MG TABS 0.12560 02/22/2013 02/19/2013
GUARDIAN REAL-TIME STARTE (Continuous Blood
Glucose Monitor/
KIT 0.71000 10/01/2003 02/19/2013
GYNE-LOTRIMIN (Clotrimazole Vaginal Cream 1%) CREA 0.14028 03/13/2008 02/19/2013
GYNE-LOTRIMIN 3 (Clotrimazole Vaginal Cream 2%) CREA 0.35240 03/13/2008 02/19/2013
H&H THINLET LANCETS 26G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
H&H THINLET SUPER THIN LA (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
HAEMOLANCE (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
HAEMOLANCE LOW FLOW LANCE (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
HAEMOLANCE PLUS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
HAEMOLANCE PLUS HIGH FLOW (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
HAEMOLANCE PLUS LOW FLOW (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
HAEMOLANCE PLUS MAX FLOW (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
HAEMOLANCE PLUS PEDIATRIC (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
HAIR-VITES (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
Halobetasol Propionate Cream 0.05% CREA 4.05000 07/11/2013 09/09/2013
Halobetasol Propionate Oint 0.05% OINT 4.03000 08/15/2013 09/09/2013
Haloperidol Decanoate IM Soln 100 MG/ML SOLN 41.34240 02/22/2013 02/19/2013
Haloperidol Decanoate IM Soln 50 MG/ML SOLN 22.55000 02/22/2013 02/19/2013
Haloperidol Lactate Inj 5 MG/ML SOLN 1.43000 02/22/2013 02/19/2013
Haloperidol Lactate Oral Conc 2 MG/ML CONC 0.10713 02/22/2013 02/19/2013
Haloperidol Tab 0.5 MG TABS 0.03500 02/22/2013 02/19/2013
Haloperidol Tab 1 MG TABS 0.09000 02/22/2013 02/19/2013
Haloperidol Tab 10 MG TABS 0.75685 02/22/2013 02/19/2013
Haloperidol Tab 2 MG TABS 0.12909 02/22/2013 02/19/2013
Haloperidol Tab 5 MG TABS 0.24700 03/14/2013 04/09/2013
HCU COOLER (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
HCU COOLER (Nutritional Supplement Liquid**) LIQD 0.06928 10/03/2008 02/19/2013
HCU EXPRESS (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
HCU GEL (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
HCY 1 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
HCY 1 DIET (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
HCY 2 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
HEALTH ALLIANCE STRIP (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
Page 56 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
HEALTH SOURCE SOY PROTEIN (Nutritional Supplement
Powder**)
POWD 0.20315 04/05/2011 02/19/2013
HEALTHWISE LANCETS 30G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
HEALTHY ACCENTS NUTRA FIT (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
HEALTHY ACCENTS UNILET LA (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
HEARTBAR (Nutritional Supplement Bar**) BAR 0.46070 04/28/2005 02/19/2013
H-E-B INCONTROL LANCETS S (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
H-E-B INCONTROL LANCETS U (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
HELIXATE FS (Antihemophilic Factor (Recombinant) For Inj
Kit
KIT 0.88000 08/26/2011 02/19/2013
HELIXATE FS (Antihemophilic Factor (Recombinant) For Inj
Kit
KIT 0.88000 08/26/2011 02/19/2013
HELIXATE FS (Antihemophilic Factor (Recombinant) For Inj
Kit
KIT 0.88000 08/26/2011 02/19/2013
HELIXATE FS (Antihemophilic Factor (Recombinant) For Inj
Kit
KIT 0.88000 08/26/2011 02/19/2013
HELIXATE FS (Antihemophilic Factor (Recombinant) For Inj
Kit
KIT 0.88000 08/26/2011 02/19/2013
HEMOCYTE (Ferrous Fumarate Tab 325 MG (106 MG
Elemental Fe))
TABS 0.17490 04/28/2005 02/19/2013
HEMOFIL M (Antihemophilic Factor (Human) For Inj
1501-2000 U
SOLR 0.74460 06/26/2009 02/19/2013
HEMOFIL M (Antihemophilic Factor (Human) For Inj
1701-2000 U
SOLR 0.74460 06/26/2009 02/19/2013
HEMOFIL M (Antihemophilic Factor (Human) For Inj 220-400
Uni
SOLR 0.74460 06/26/2009 02/19/2013
HEMOFIL M (Antihemophilic Factor (Human) For Inj 401-800
Uni
SOLR 0.74460 06/26/2009 02/19/2013
HEMOFIL M (Antihemophilic Factor (Human) For Inj
801-1500 Un
SOLR 0.74460 06/26/2009 02/19/2013
HEMOFIL M (Antihemophilic Factor (Human) For Inj
801-1700 Un
SOLR 0.74460 06/26/2009 02/19/2013
Heparin Sodium (Porcine) Inj 10000 Unit/ML SOLN 4.40804 02/22/2013 02/19/2013
Heparin Sodium (Porcine) Inj 5000 Unit/ML SOLN 1.88800 12/13/2013 12/06/2013
Heparin Sodium (Porcine) Lock Flush IV Soln 10 Unit/ML SOLN 0.02990 12/25/2009 02/19/2013
Heparin Sodium (Porcine) Lock Flush IV Soln 10 Unit/ML SOLN 0.17900 07/27/2006 02/19/2013
Heparin Sodium (Porcine) Lock Flush IV Soln 10 Unit/ML SOLN 0.28300 07/27/2006 02/19/2013
Heparin Sodium (Porcine) Lock Flush IV Soln 10 Unit/ML SOLN 0.64600 07/27/2006 02/19/2013
Heparin Sodium (Porcine) Lock Flush IV Soln 10 Unit/ML SOLN 0.64600 05/28/2010 02/19/2013
Heparin Sodium (Porcine) Lock Flush IV Soln 100 Unit/ML SOLN 0.03857 12/25/2009 02/19/2013
Heparin Sodium (Porcine) Lock Flush IV Soln 100 Unit/ML SOLN 0.04940 01/28/2011 02/19/2013
Heparin Sodium (Porcine) Lock Flush IV Soln 100 Unit/ML SOLN 0.31980 12/25/2009 02/19/2013
HEPATIC-AID II (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
HEPSERA (Adefovir Dipivoxil Tab 10 MG) TABS 34.94742 01/01/2013 02/20/2013
HERCEPTIN (Trastuzumab For IV Soln 440 MG) SOLR 3,396.14420 07/02/2013 08/06/2013
HIBICLENS (Chlorhexidine Gluconate Liquid 4%) LIQD 0.01798 03/13/2008 02/19/2013
HI-CAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
Page 57 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
HIZENTRA (Immune Globulin (Human) Subcutaneous Inj 1
GM/5ML)
SOLN 25.09920 04/13/2012 02/19/2013
HIZENTRA (Immune Globulin (Human) Subcutaneous Inj 2
GM/10ML
SOLN 25.09920 04/13/2012 02/19/2013
HIZENTRA (Immune Globulin (Human) Subcutaneous Inj 4
GM/20ML
SOLN 25.09920 04/13/2012 02/19/2013
HM COMPLETE (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
HM COMPLETE 50+ MENS ULTI (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
HM COMPLETE 50+ WOMENS UL (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
HM HAIR/SKIN/NAILS (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
HM LANCETS MICRO THIN 33G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
HM LANCETS ULTRA THIN 30G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
HM MINERAL OIL (Mineral Oil) OIL 0.01529 03/20/2008 02/19/2013
HM ONE DAILY MENS (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
HM ONE DAILY WOMENS (Multiple Vitamins w/ Minerals
Tab**)
TABS 0.07430 03/20/2008 02/19/2013
HOM 2 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
HOMINEX-1 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
HOMINEX-2 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
HONEY BEARS (Pediatric Vitamin Chew Tab**) CHEW 0.01450 01/01/1988 02/19/2013
HONEY BEARS W/IRON AND ZI (Pediatric Multiple Vitamins
w/ Ir
CHEW 0.01450 01/01/1988 02/19/2013
HUMATE-P (Antihemophilic Factor/VWF (Human) For Inj
1000-200
SOLR 0.85547 06/26/2009 02/19/2013
HUMATE-P (Antihemophilic Factor/VWF (Human) For Inj
1000-240
SOLR 0.80000 12/24/2010 02/19/2013
HUMATE-P (Antihemophilic Factor/VWF (Human) For Inj
250-500
SOLR 0.85547 06/26/2009 02/19/2013
HUMATE-P (Antihemophilic Factor/VWF (Human) For Inj
250-600
SOLR 0.80000 12/24/2010 02/19/2013
HUMATE-P (Antihemophilic Factor/VWF (Human) For Inj
500-1000
SOLR 0.85547 06/26/2009 02/19/2013
HUMATE-P (Antihemophilic Factor/VWF (Human) For Inj
500-1200
SOLR 0.80000 12/24/2010 02/19/2013
HUMATROPE (Somatropin For Inj 12 MG (36 Unit)) SOLR 832.05840 11/11/2011 02/19/2013
HUMATROPE (Somatropin For Inj 24 MG) SOLR 1,664.11680 11/11/2011 02/19/2013
HUMATROPE (Somatropin For Inj 5 MG) SOLR 346.69100 11/11/2011 02/19/2013
HUMATROPE (Somatropin For Inj 5 MG) SOLR 405.87000 10/03/2013 11/05/2013
HUMATROPE (Somatropin For Inj 6 MG (18 Unit)) SOLR 416.02920 11/11/2011 02/19/2013
HUMATROPE COMBO PACK (Somatropin For Inj 5 MG) SOLR 346.69100 11/11/2011 02/19/2013
HUMATROPE COMBO PACK (Somatropin For Inj 5 MG) SOLR 405.87000 10/03/2013 11/05/2013
HUMIRA (Adalimumab Inj Kit 40 MG/0.8ML (50 MG/ML)) KIT 1,165.85000 07/03/2013 08/06/2013
HUMIRA PEN (Adalimumab Inj Kit 40 MG/0.8ML (50 MG/ML)) KIT 1,165.85000 07/03/2013 08/06/2013
HUMIRA PEN-CROHNS DISEASE (Adalimumab Inj Kit 40
MG/0.8ML (5
KIT 1,165.85000 07/03/2013 08/06/2013
Page 58 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
HUMIRA PEN-PSORIASIS STAR (Adalimumab Inj Kit 40
MG/0.8ML (5
KIT 1,165.85000 07/03/2013 08/06/2013
HYALEX (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
HYCAMTIN (Topotecan HCl For Inj 4 MG) SOLR 1,119.29650 04/13/2012 02/19/2013
Hydralazine HCl Tab 10 MG TABS 0.12265 02/22/2013 02/19/2013
Hydralazine HCl Tab 100 MG TABS 0.17879 02/22/2013 02/19/2013
Hydralazine HCl Tab 25 MG TABS 0.12372 02/22/2013 02/19/2013
Hydralazine HCl Tab 50 MG TABS 0.13886 02/22/2013 02/19/2013
HYDRISINOL (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
Hydrochlorothiazide Cap 12.5 MG CAPS 0.04878 02/22/2013 02/19/2013
Hydrochlorothiazide Tab 12.5 MG TABS 0.19400 02/22/2013 02/19/2013
Hydrochlorothiazide Tab 25 MG TABS 0.01430 02/22/2013 02/19/2013
Hydrochlorothiazide Tab 50 MG TABS 0.02834 02/22/2013 02/19/2013
Hydrocodone w/ Homatropine Syrup 5-1.5 MG/5ML SYRP 0.02800 02/22/2013 02/19/2013
Hydrocodone-Acetaminophen Cap 5-500 MG CAPS 0.19430 02/22/2013 02/19/2013
Hydrocodone-Acetaminophen Soln 7.5-325 MG/15ML SOLN 0.21998 08/09/2013 08/06/2013
Hydrocodone-Acetaminophen Soln 7.5-500 MG/15ML SOLN 0.02637 02/22/2013 02/19/2013
Hydrocodone-Acetaminophen Tab 10-325 MG TABS 0.13876 02/22/2013 02/19/2013
Hydrocodone-Acetaminophen Tab 10-500 MG TABS 0.19960 06/14/2013 08/06/2013
Hydrocodone-Acetaminophen Tab 10-650 MG TABS 0.05346 02/22/2013 02/19/2013
Hydrocodone-Acetaminophen Tab 10-660 MG TABS 0.24000 07/31/2013 10/09/2013
Hydrocodone-Acetaminophen Tab 10-750 MG TABS 0.54500 02/22/2013 02/19/2013
Hydrocodone-Acetaminophen Tab 5-300 MG TABS 1.47889 08/09/2013 08/06/2013
Hydrocodone-Acetaminophen Tab 5-325 MG TABS 0.17743 02/22/2013 02/19/2013
Hydrocodone-Acetaminophen Tab 5-500 MG TABS 0.06800 01/08/2013 02/20/2013
Hydrocodone-Acetaminophen Tab 5-500 MG TABS 0.06800 02/22/2013 02/20/2013
Hydrocodone-Acetaminophen Tab 7.5-300 MG TABS 1.53889 08/09/2013 08/06/2013
Hydrocodone-Acetaminophen Tab 7.5-325 MG TABS 0.19516 02/22/2013 02/19/2013
Hydrocodone-Acetaminophen Tab 7.5-500 MG TABS 0.14200 10/19/2013 11/05/2013
Hydrocodone-Acetaminophen Tab 7.5-650 MG TABS 0.05450 02/22/2013 02/19/2013
Hydrocodone-Acetaminophen Tab 7.5-750 MG TABS 0.07692 02/22/2013 02/19/2013
Hydrocodone-Ibuprofen Tab 7.5-200 MG TABS 0.26042 02/22/2013 02/19/2013
Hydrocortisone Acetate Lotion 2% LOTN 1.10782 02/22/2013 02/19/2013
Hydrocortisone Acetate Powder POWD 0.94640 02/22/2013 02/19/2013
Hydrocortisone Acetate Suppos 30 MG SUPP 2.27500 02/22/2013 02/19/2013
Hydrocortisone Butyrate Cream 0.1% CREA 0.83635 02/22/2013 02/19/2013
Hydrocortisone Butyrate Oint 0.1% OINT 0.51307 02/22/2013 02/19/2013
Hydrocortisone Butyrate Soln 0.1% SOLN 0.25379 02/22/2013 02/19/2013
Hydrocortisone Cream 0.5% CREA 0.05350 02/22/2013 02/19/2013
Hydrocortisone Cream 1% CREA 0.07497 02/22/2013 02/19/2013
Hydrocortisone Cream 2.5% CREA 0.09989 02/22/2013 02/19/2013
Hydrocortisone Enema 100 MG/60ML ENEM 0.06518 02/22/2013 02/19/2013
Hydrocortisone Lotion 1% LOTN 0.05600 02/22/2013 02/19/2013
Hydrocortisone Lotion 2.5% LOTN 0.26360 02/22/2013 02/19/2013
Hydrocortisone Oint 0.5% OINT 0.06780 02/22/2013 02/19/2013
Page 59 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Hydrocortisone Oint 1% OINT 0.04185 02/22/2013 02/19/2013
Hydrocortisone Oint 2.5% OINT 0.10022 02/22/2013 02/19/2013
Hydrocortisone Powder POWD 0.93600 02/22/2013 02/19/2013
Hydrocortisone Rectal Cream 1% CREA 0.06791 02/22/2013 02/19/2013
Hydrocortisone Rectal Cream 2.5% CREA 0.42500 09/20/2013 11/05/2013
Hydrocortisone Sodium Succinate For Inj 100 MG SOLR 2.52200 02/22/2013 02/19/2013
Hydrocortisone Tab 10 MG TABS 0.44475 02/22/2013 02/19/2013
Hydrocortisone Tab 20 MG TABS 0.74885 12/13/2013 12/06/2013
Hydrocortisone Tab 5 MG TABS 0.29493 02/22/2013 02/19/2013
Hydrocortisone Valerate Cream 0.2% CREA 0.80500 06/04/2013 07/09/2013
Hydrocortisone Valerate Cream 0.2% CREA 1.81000 11/05/2013 12/06/2013
Hydrocortisone Valerate Cream 0.2% CREA 2.73000 10/31/2013 12/06/2013
Hydrocortisone Valerate Oint 0.2% OINT 2.49000 01/06/2013 02/20/2013
Hydrocortisone Valerate Oint 0.2% OINT 2.49000 02/22/2013 02/20/2013
Hydrocortisone Valerate Oint 0.2% OINT 2.63500 11/13/2013 12/06/2013
Hydrocortisone Valerate Oint 0.2% OINT 4.79400 05/20/2013 07/09/2013
Hydrocortisone w/ Acetic Acid Otic Soln 1-2% SOLN 11.33520 07/12/2013 07/08/2013
Hydrocortisone-Aloe Vera Cream 0.5% CREA 0.06600 02/22/2013 02/19/2013
Hydrocortisone-Aloe Vera Cream 1% CREA 0.07497 02/22/2013 02/19/2013
Hydromorphone HCl Inj 10 MG/ML SOLN 1.80960 02/22/2013 02/19/2013
Hydromorphone HCl Inj 2 MG/ML SOLN 0.44720 02/22/2013 02/19/2013
Hydromorphone HCl Preservative Free (PF) Inj 10 MG/ML SOLN 1.80960 02/22/2013 02/19/2013
Hydromorphone HCl Preservative Free (PF) Inj 2 MG/ML SOLN 0.44720 02/22/2013 02/19/2013
Hydromorphone HCl Tab 2 MG TABS 0.18000 01/23/2013 02/20/2013
Hydromorphone HCl Tab 2 MG TABS 0.18000 02/22/2013 02/20/2013
Hydromorphone HCl Tab 4 MG TABS 0.21000 01/17/2013 02/20/2013
Hydromorphone HCl Tab 4 MG TABS 0.21000 02/22/2013 02/20/2013
Hydromorphone HCl Tab 8 MG TABS 0.54802 02/22/2013 02/19/2013
Hydroxychloroquine Sulfate Tab 200 MG TABS 0.13256 02/22/2013 02/19/2013
Hydroxyprogesterone Caproate (Bulk) Powder POWD 10.45800 02/22/2013 02/19/2013
Hydroxyurea Cap 500 MG CAPS 0.38750 02/22/2013 02/19/2013
Hydroxyzine HCl IM Soln 50 MG/ML SOLN 1.10500 02/22/2013 02/19/2013
Hydroxyzine HCl Syrup 10 MG/5ML SOLN 0.06910 02/22/2013 02/19/2013
Hydroxyzine HCl Syrup 10 MG/5ML SYRP 0.06910 02/22/2013 02/19/2013
Hydroxyzine HCl Tab 10 MG TABS 0.09194 02/22/2013 02/19/2013
Hydroxyzine HCl Tab 25 MG TABS 0.09874 02/22/2013 02/19/2013
Hydroxyzine HCl Tab 50 MG TABS 0.16536 02/22/2013 02/19/2013
Hydroxyzine Pamoate Cap 100 MG CAPS 0.30388 02/22/2013 02/19/2013
Hydroxyzine Pamoate Cap 25 MG CAPS 0.05450 02/22/2013 02/19/2013
Hydroxyzine Pamoate Cap 50 MG CAPS 0.18000 01/21/2013 03/04/2013
Hydroxyzine Pamoate Cap 50 MG CAPS 0.18000 02/22/2013 03/04/2013
Hyoscyamine Sulfate Elixir 0.125 MG/5ML ELIX 0.08078 02/22/2013 02/19/2013
Hyoscyamine Sulfate Soln 0.125 MG/ML SOLN 1.68913 02/22/2013 02/19/2013
Hyoscyamine Sulfate Tab 0.125 MG TABS 0.47229 02/22/2013 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Hyoscyamine Sulfate Tab Disp 0.125 MG TBDP 0.45500 02/22/2013 02/19/2013
Hyoscyamine Sulfate Tab SL 0.125 MG SUBL 0.47082 02/22/2013 02/19/2013
Hyoscyamine Sulfate Tab SR 12HR 0.375 MG TB12 0.74818 02/22/2013 02/19/2013
HYPERRHO S/D (Rho D Immune Globulin (Human) IM Inj
300 MCG)
INJ 91.52410 04/13/2012 02/19/2013
Hypromellose Ophth Soln 0.3% SOLN 0.40323 02/22/2013 02/19/2013
Hypromellose Ophth Soln 0.4% SOLN 0.23859 02/22/2013 02/19/2013
HYTRIN (Terazosin HCl Cap 1 MG) CAPS 0.30000 12/28/2001 02/19/2013
HYTRIN (Terazosin HCl Cap 2 MG) CAPS 0.30000 12/28/2001 02/19/2013
HY-VEE LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
HY-VEE THIN LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
I.S.P. HAND & BODY (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
Ibandronate Sodium Tab 150 MG (Base Equivalent) TABS 64.00127 08/09/2013 08/06/2013
IBG STAR BLOOD GLUCOSE MO (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
Ibuprofen Chew Tab 100 MG CHEW 0.14630 02/22/2013 02/19/2013
Ibuprofen Susp 100 MG/5ML SUSP 0.05000 11/20/2013 12/06/2013
Ibuprofen Susp 40 MG/ML SUSP 0.24630 02/22/2013 02/19/2013
Ibuprofen Tab 200 MG TABS 0.01567 02/22/2013 02/19/2013
Ibuprofen Tab 400 MG TABS 0.02275 02/22/2013 02/19/2013
Ibuprofen Tab 600 MG TABS 0.03055 02/22/2013 02/19/2013
Ibuprofen Tab 800 MG TABS 0.03912 02/22/2013 02/19/2013
ICAPS AREDS FORMULA (Multiple Vitamins w/ Minerals
Tab**)
TABS 0.07430 03/20/2008 02/19/2013
ICAPS PLUS (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
Imipramine HCl Tab 10 MG TABS 0.12187 02/22/2013 02/19/2013
Imipramine HCl Tab 25 MG TABS 0.18538 02/22/2013 02/19/2013
Imipramine HCl Tab 50 MG TABS 0.21556 02/22/2013 02/19/2013
Imiquimod Cream 5% CREA 15.24644 08/09/2013 08/06/2013
IMMULIFE (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
IMMUNOCAL (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
IMMUNOPRO RX (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
IMOVAX RABIES (H.D.C.V.) (Rabies Virus Vaccine, HDC Inj) INJ 236.06000 06/28/2013 07/09/2013
IMOVAX RABIES (Rabies Virus Vaccine, HDC Inj) INJ 236.06000 06/28/2013 07/09/2013
IMPACT (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
IMPACT 1.5 (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
IMPACT ADVANCED RECOVERY (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
IMPACT GLUTAMINE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
IMPACT PEPTIDE 1.5 (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
IMPACT/FIBER (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
IMPACT/FIBER (Nutritional Supplement Liquid**) LIQD 0.01420 05/28/2010 02/19/2013
IMPRUV (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
IMUPLUS (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
INATAL ADVANCE (Prenatal Vit w/ DSS-Iron Carbonyl-FA Tab
90-
TABS 0.16250 01/23/2009 02/19/2013
Page 61 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
INATAL GT (Prenatal Vit w/ DSS-Iron Carbonyl-FA Tab 90-1
MG*
TABS 0.16250 01/23/2009 02/19/2013
INATAL ULTRA (Prenatal Vit w/ DSS-Iron Carbonyl-FA Tab
90-1
TABS 0.16250 01/23/2009 02/19/2013
INCIVEK (Telaprevir Tab 375 MG) TABS 130.73400 08/01/2013 09/09/2013
INCRELEX (Mecasermin Inj 40 MG/4ML (10 MG/ML)) SOLN 245.63850 11/11/2011 02/19/2013
Indapamide Tab 1.25 MG TABS 0.03313 02/22/2013 02/19/2013
Indapamide Tab 2.5 MG TABS 0.05063 02/22/2013 02/19/2013
INDERAL LA (Propranolol HCl Cap SR 24HR 80 MG) CP24 0.77360 04/23/2010 02/19/2013
Indomethacin Cap 25 MG CAPS 0.14690 02/22/2013 02/19/2013
Indomethacin Cap 50 MG CAPS 0.17945 02/22/2013 02/19/2013
Indomethacin Cap CR 75 MG CPCR 1.74893 02/22/2013 02/19/2013
Infant Foods Liquid** LIQD 0.01680 02/22/2013 02/19/2013
INFINITY BLOOD GLUCOSE MO (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
INFINITY BLOOD GLUCOSE TE (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
INLYTA (Axitinib Tab 1 MG) TABS 48.80400 04/13/2012 02/19/2013
INLYTA (Axitinib Tab 5 MG) TABS 146.41200 04/13/2012 02/19/2013
INNOHEP (Tinzaparin Sodium Inj 20000 anti-Xa Unit/ML) SOLN 87.15000 04/13/2012 02/19/2013
INTROLITE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
INVEGA SUSTENNA (Paliperidone Palmitate IM
Extended-Release
SUSP 1,175.28000 07/02/2013 08/06/2013
INVEGA SUSTENNA (Paliperidone Palmitate IM
Extended-Release
SUSP 1,175.25786 07/02/2013 08/06/2013
INVEGA SUSTENNA (Paliperidone Palmitate IM
Extended-Release
SUSP 1,175.14720 07/02/2013 08/06/2013
INVEGA SUSTENNA (Paliperidone Palmitate IM
Extended-Release
SUSP 1,175.24680 07/02/2013 08/06/2013
INVEGA SUSTENNA (Paliperidone Palmitate IM
Extend-Release Su
SUSP 1,175.22466 07/02/2013 08/06/2013
Iodoquinol-HC Cream 1% CREA 0.76673 02/22/2013 02/19/2013
Ipratropium Bromide Inhal Soln 0.02% SOLN 0.06850 02/22/2013 02/19/2013
Ipratropium Bromide Nasal Soln 0.03% (21 MCG/SPRAY) SOLN 0.24375 02/22/2013 02/19/2013
Ipratropium Bromide Nasal Soln 0.06% (42 MCG/SPRAY) SOLN 0.61235 02/22/2013 02/19/2013
Ipratropium-Albuterol Nebu Soln 0.5-2.5(3) MG/3ML SOLN 0.10750 02/22/2013 02/19/2013
Irbesartan Tab 150 MG TABS 0.35000 02/22/2013 02/19/2013
Irbesartan Tab 300 MG TABS 0.53863 03/08/2013 03/04/2013
Irbesartan Tab 75 MG TABS 0.28860 02/22/2013 02/19/2013
Irbesartan-Hydrochlorothiazide Tab 150-12.5 MG TABS 0.55000 03/08/2013 03/04/2013
Irbesartan-Hydrochlorothiazide Tab 300-12.5 MG TABS 0.86500 03/08/2013 03/04/2013
Irinotecan HCl Inj 100 MG/5ML (20 MG/ML) SOLN 7.88060 02/22/2013 02/19/2013
Irinotecan HCl Inj 40 MG/2ML (20 MG/ML) SOLN 7.88060 02/22/2013 02/19/2013
Irinotecan HCl Inj 500 MG/25ML (20 MG/ML) SOLN 7.88060 02/22/2013 02/19/2013
Iron Polysacch Complex-Vit B12-FA Cap 150-0.025-1 MG CAPS 0.14242 02/22/2013 02/19/2013
Iron w/ Vitamin Tab CR** TBCR 0.06330 02/22/2013 02/19/2013
ISOCAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
Page 62 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
ISOCAL HN (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
ISOCAL HN PLUS (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
ISOMIL 2 (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
ISOMIL ADVANCE (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
ISOMIL ADVANCE SOY FORMUL (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ISOMIL DF (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ISOMIL SF (Infant Foods Conc**) CONC 0.01190 04/28/2005 02/19/2013
ISOMIL SOY FORMULA/IRON (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ISOMIL SOY W/IRON (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
ISOMIL/IRON (Infant Foods Conc**) CONC 0.01190 04/28/2005 02/19/2013
ISOMIL/IRON (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
ISOMIL/IRON (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
Isoniazid Tab 100 MG TABS 0.02180 02/22/2013 02/19/2013
Isoniazid Tab 300 MG TABS 0.20286 07/12/2013 07/08/2013
ISOPTO TEARS (Hypromellose Ophth Soln 0.5%) SOLN 0.75310 04/28/2005 02/19/2013
Isosorbide Dinitrate SL Tab 2.5 MG SUBL 0.04880 02/22/2013 02/19/2013
Isosorbide Dinitrate SL Tab 5 MG SUBL 0.08940 02/22/2013 02/19/2013
Isosorbide Dinitrate Tab 10 MG TABS 0.03500 02/22/2013 02/19/2013
Isosorbide Dinitrate Tab 20 MG TABS 0.80862 05/07/2013 08/06/2013
Isosorbide Dinitrate Tab 30 MG TABS 0.66069 10/11/2013 10/09/2013
Isosorbide Dinitrate Tab 5 MG TABS 0.01500 02/22/2013 02/19/2013
Isosorbide Dinitrate Tab CR 40 MG TBCR 0.65500 02/22/2013 02/19/2013
Isosorbide Mononitrate Tab 10 MG TABS 0.21836 02/22/2013 02/19/2013
Isosorbide Mononitrate Tab 20 MG TABS 0.09695 02/22/2013 02/19/2013
Isosorbide Mononitrate Tab SR 24HR 120 MG TB24 0.39644 02/22/2013 02/19/2013
Isosorbide Mononitrate Tab SR 24HR 30 MG TB24 0.24528 02/22/2013 02/19/2013
Isosorbide Mononitrate Tab SR 24HR 60 MG TB24 0.25414 02/22/2013 02/19/2013
ISOSOURCE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
ISOSOURCE 1.5 CAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
ISOSOURCE CLOSED SYSTEM (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
ISOSOURCE HN (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
ISOSOURCE VHN (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
Isotretinoin Cap 10 MG CAPS 7.59231 02/22/2013 02/19/2013
Isotretinoin Cap 20 MG CAPS 6.69000 07/12/2013 07/08/2013
Isotretinoin Cap 30 MG CAPS 13.19920 02/22/2013 02/19/2013
Isotretinoin Cap 40 MG CAPS 8.16000 04/25/2013 05/06/2013
Isradipine Cap 2.5 MG CAPS 1.06200 02/22/2013 02/19/2013
Isradipine Cap 5 MG CAPS 1.50300 02/22/2013 02/19/2013
Itraconazole Cap 100 MG CAPS 5.60000 02/22/2013 02/19/2013
I-VALEX-1 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
I-VALEX-2 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
IVEEGAM EN (Immune Globulin (Human) IV For Soln 5 GM) SOLR 645.85620 01/01/2013 02/20/2013
JEVITY (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
JEVITY 1 CAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
Page 63 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
JEVITY 1 CAL/FIBER (Nutritional Supplement Liquid**) LIQD 0.00720 04/28/2005 02/19/2013
JEVITY 1 CAL/FIBER (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
JEVITY 1.2 CAL (Nutritional Supplement Liquid**) LIQD 0.00720 04/28/2005 02/19/2013
JEVITY 1.2 CAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
JEVITY 1.2 CAL/FIBER (Nutritional Supplement Liquid**) LIQD 0.00720 04/28/2005 02/19/2013
JEVITY 1.2 CAL/FIBER (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
JEVITY 1.5 CAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
JEVITY 1.5 CAL/FIBER (Nutritional Supplement Liquid**) LIQD 0.00720 04/28/2005 02/19/2013
JEVITY 1.5 CAL/FIBER (Nutritional Supplement Liquid**) LIQD 0.00720 04/28/2005 02/28/2013
JEVITY 1.5 CAL/FIBER (Nutritional Supplement Liquid**) LIQD 0.00960 05/24/2005 02/19/2013
JEVITY 1.5 CAL/FIBER (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
JINTELI (Norethindrone Acetate-Ethinyl Estradiol Tab 1 MG-5 TABS 2.21976 10/12/2012 02/19/2013
JOHNSON & JOHNSON SOOTHIN (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
JOHNSONS BODY CARE 24 HOU (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
JOHNSONS BODY CARE BE RAD (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
JOHNSONS BODY CARE DEEP H (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
JOHNSONS BODY CARE FEELIN (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
JOHNSONS BODY CARE FOREVE (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
JOHNSONS BODY CARE MELT A (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
JOHNSONS SOFTLOTION (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
JUICE PLUS FIBRE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
JUVEN (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
JUVEN (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
JUVEN REVIGOR (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
KALBITOR (Ecallantide Inj 10 MG/ML) SOLN 3,486.00000 09/13/2013 09/09/2013
KALYDECO (Ivacaftor Tab 150 MG) TABS 406.70000 04/13/2012 02/19/2013
KAOPECTATE (Attapulgite Liq 750 MG/15ML) LIQD 0.01200 04/28/2005 02/19/2013
KEPPRA (Levetiracetam Tab 500 MG) TABS 0.36560 05/28/2010 02/19/2013
KERI ADVANCED MOISTURE TH (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
KERI NOURISHING SHEA BUTT (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
KERI ORIGINAL (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
KERI OVERNIGHT (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
KERI OVERNIGHT DEEP CONDI (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
KERI RENEWAL MILK BODY (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
KERI RENEWAL SKIN FIRMING (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
KERI RENEWAL STRETCH MARK (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
KERI SENSITIVE SKIN (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
KERI SHAVE MINIMIZING MOI (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
KERI SILKY SMOOTH (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
KERR DRUG STARTER KIT (Blood Glucose Monitoring Kit
w/ Devic
KIT 0.71000 10/01/2003 02/19/2013
KERR DRUG TEST STRIP PACK (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
KETOCAL (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
KETOCAL 3:1 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
KETOCAL 4:1 (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
KETOCAL 4:1 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
Ketoconazole Cream 2% CREA 0.22815 02/22/2013 02/19/2013
Ketoconazole Shampoo 2% SHAM 0.10450 02/22/2013 02/19/2013
Ketoconazole Tab 200 MG TABS 0.24710 02/22/2013 02/19/2013
KETONEX-1 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
KETONEX-2 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
Ketoprofen Cap 50 MG CAPS 0.08250 02/22/2013 02/19/2013
Ketoprofen Cap 75 MG CAPS 0.09862 02/22/2013 02/19/2013
Ketoprofen Cap SR 24HR 200 MG CP24 5.99000 05/03/2013 07/09/2013
Ketorolac Tromethamine IM Inj 30 MG/ML SOLN 0.81555 02/22/2013 02/19/2013
Ketorolac Tromethamine IM Inj 60 MG/2ML (30 MG/ML) SOLN 0.73620 02/22/2013 02/19/2013
Ketorolac Tromethamine Inj 30 MG/ML SOLN 0.81555 02/22/2013 02/19/2013
Ketorolac Tromethamine Inj 300 MG/10ML (30 MG/ML) SOLN 0.81555 02/22/2013 02/19/2013
Ketorolac Tromethamine Ophth Soln 0.4% SOLN 1.97250 02/22/2013 02/19/2013
Ketorolac Tromethamine Ophth Soln 0.5% SOLN 2.46750 02/22/2013 02/19/2013
Ketorolac Tromethamine Tab 10 MG TABS 0.55396 09/19/2013 10/09/2013
Ketotifen Fumarate Ophth Soln 0.025% (Base Equiv) SOLN 0.88540 02/22/2013 02/19/2013
KETOVOLVE 4:1 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
KINDERCAL (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
KINDERCAL TF (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
KINDERCAL TF/FIBER (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
KINDERCAL/FIBER (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
KINNEY LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
KINNEY THIN LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
KINRAY PREFERRED PLUS (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
KINRAY TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
KINRAY VALUE PACK (Blood Glucose Monitoring Kit w/
Device***
KIT 0.71000 10/01/2003 02/19/2013
KOATE-DVI (Antihemophilic Factor (Human) For Inj 1000
Unit)
SOLR 0.68720 06/26/2009 02/19/2013
KOATE-DVI (Antihemophilic Factor (Human) For Inj 250 Unit) SOLR 0.68720 06/26/2009 02/19/2013
KOATE-DVI (Antihemophilic Factor (Human) For Inj 500 Unit) SOLR 0.68720 06/26/2009 02/19/2013
KOGENATE FS (Antihemophilic Factor (Recombinant) For Inj
Kit
KIT 0.88000 08/26/2011 02/19/2013
KOGENATE FS (Antihemophilic Factor (Recombinant) For Inj
Kit
KIT 0.88000 08/26/2011 02/19/2013
KOGENATE FS (Antihemophilic Factor (Recombinant) For Inj
Kit
KIT 0.88000 08/26/2011 02/19/2013
KOGENATE FS (Antihemophilic Factor (Recombinant) For Inj
Kit
KIT 0.88000 08/26/2011 02/19/2013
KOGENATE FS (Antihemophilic Factor (Recombinant) For Inj
Kit
KIT 0.88000 08/26/2011 02/19/2013
KOGENATE FS BIO-SET (Antihemophilic Factor
(Recombinant) For
KIT 0.88000 08/26/2011 02/19/2013
KOGENATE FS BIO-SET (Antihemophilic Factor
(Recombinant) For
KIT 0.88000 08/26/2011 02/19/2013
Page 65 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
KOGENATE FS BIO-SET (Antihemophilic Factor
(Recombinant) For
KIT 0.88000 08/26/2011 02/19/2013
KOGENATE FS BIO-SET (Antihemophilic Factor
(Recombinant) For
KIT 0.88000 08/26/2011 02/19/2013
KOGENATE FS BIO-SET (Antihemophilic Factor
(Recombinant) For
KIT 0.88000 08/26/2011 02/19/2013
KONSYL (Psyllium Powder Packet 28.3%) PACK 0.22920 04/28/2005 02/19/2013
K-PAX IMMUNE BOOSTER PROT (Nutritional Supplement
Powder**)
POWD 0.20315 04/05/2011 02/19/2013
K-PAX IMMUNE SUPPORT FORM (Multiple Vitamins w/
Minerals Cap
CAPS 0.51325 04/27/2011 02/19/2013
K-PAX IMMUNE SUPPORT FORM (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
KROGER BLOOD GLUCOSE MONI (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
KROGER BLOOD GLUCOSE TEST (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
KROGER LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
KROGER LANCETS 21G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
KROGER LANCETS MICRO THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
KROGER LANCETS SUPER THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
KROGER LANCETS THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
KROGER LANCETS THIN 26G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
KROGER LANCETS ULTRATHIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
KROGER PREMIUM BLOOD GLUC (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
KROGER PREMIUM BLOOD GLUC (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
KROGER TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
KUVAN (Sapropterin Dihydrochloride Soluble Tab 100 MG) TBSO 30.53755 11/28/2009 02/19/2013
Labetalol HCl Tab 100 MG TABS 0.31052 04/26/2013 06/11/2013
Labetalol HCl Tab 200 MG TABS 0.41563 04/12/2013 04/09/2013
Labetalol HCl Tab 300 MG TABS 0.67000 02/01/2013 03/04/2013
Labetalol HCl Tab 300 MG TABS 0.67000 02/22/2013 03/04/2013
LAC-HYDRIN (Lactic Acid (Ammonium Lactate) Cream 12%) CREA 0.04460 03/20/2008 02/19/2013
LAC-HYDRIN (Lactic Acid (Ammonium Lactate) Cream 12%) CREA 0.14965 02/05/2010 02/19/2013
LAC-HYDRIN (Lactic Acid (Ammonium Lactate) Lotion 12%) LOTN 0.04600 03/20/2008 02/19/2013
LAC-HYDRIN TWELVE (Lactic Acid (Ammonium Lactate)
Lotion 12%
LOTN 0.04600 03/20/2008 02/19/2013
LACTAID (Lactase Tab 3000 Unit) TABS 0.11500 03/20/2008 02/19/2013
LACTAID FAST ACT (Lactase Chew Tab 9000 Unit) CHEW 0.11500 03/20/2008 02/19/2013
LACTAID FAST ACT (Lactase Tab 9000 Unit) TABS 0.11500 03/20/2008 02/19/2013
LACTAID ULTRA (Lactase Tab 9000 Unit) TABS 0.11500 03/20/2008 02/19/2013
Lactase Chew Tab 9000 Unit CHEW 0.11500 02/22/2013 02/19/2013
Lactase Tab 3000 Unit TABS 0.07479 02/22/2013 02/19/2013
Lactase Tab 4500 Unit TABS 0.12220 02/22/2013 02/19/2013
Lactase Tab 9000 Unit TABS 0.11500 02/22/2013 02/19/2013
Page 66 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Lactated Ringer's Solution SOLN 0.00205 02/22/2013 02/19/2013
Lactic Acid (Ammonium Lactate) Cream 12% CREA 0.04364 02/22/2013 02/19/2013
Lactic Acid (Ammonium Lactate) Lotion 10% LOTN 0.06869 02/22/2013 02/19/2013
Lactic Acid (Ammonium Lactate) Lotion 12% LOTN 0.61000 10/24/2013 12/06/2013
Lactic Acid (Ammonium Lactate) Lotion 5% LOTN 0.05679 02/22/2013 02/19/2013
Lactic Acid w/ Vitamin E Cream 10%-3500 Unit/30GM CREA 0.12324 02/22/2013 02/19/2013
LACTICARE (Lactic Acid (Ammonium Lactate) Lotion 5%) LOTN 0.05679 03/20/2008 02/19/2013
Lactobacillus Tab** TABS 0.03640 02/22/2013 02/19/2013
LACTRASE (Lactase Cap 250 MG) CAPS 0.35560 10/09/2008 02/19/2013
Lactulose (Encephalopathy) Solution 10 GM/15ML SOLN 0.03200 10/24/2013 11/05/2013
Lactulose Solution 10 GM/15ML SOLN 0.01775 03/25/2013 04/09/2013
LADY LITE LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
Lamivudine-Zidovudine Tab 150-300 MG TABS 9.93057 10/11/2013 10/09/2013
Lamotrigine Tab 100 MG TABS 0.07734 02/22/2013 02/19/2013
Lamotrigine Tab 150 MG TABS 0.11093 02/22/2013 02/19/2013
Lamotrigine Tab 200 MG TABS 0.11244 02/22/2013 02/19/2013
Lamotrigine Tab 25 MG TABS 0.07001 02/22/2013 02/19/2013
Lamotrigine Tab 25 MG (35) Starter Kit KIT 0.15755 02/22/2013 02/19/2013
Lamotrigine Tab Chewable Dispersible 25 MG CHEW 0.28500 02/22/2013 02/19/2013
Lamotrigine Tab Chewable Dispersible 5 MG CHEW 0.28500 02/22/2013 02/19/2013
LANAFLEX (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
LANAPHILIC (Emollient - Ointment**) OINT 0.04583 03/13/2008 02/19/2013
LANAPHILIC/UREA (Emollient - Ointment**) OINT 0.04583 03/13/2008 02/19/2013
LANCETS ULTRA THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
LANCETS ULTRA THIN 30G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
Lancets*** MISC 0.08772 02/22/2013 02/19/2013
LANOXIN (Digoxin Tab 0.25 MG) TABS 0.11550 04/23/2010 02/19/2013
Lansoprazole Cap Delayed Release 15 MG CPDR 0.93212 06/14/2013 06/10/2013
Lansoprazole Cap Delayed Release 30 MG CPDR 0.92503 10/11/2013 10/09/2013
Lansoprazole Tab Delayed Release Orally Disintegrating 15
MG
TBDP 4.05744 02/22/2013 02/19/2013
Lansoprazole Tab Delayed Release Orally Disintegrating 30
MG
TBDP 4.30000 02/22/2013 02/19/2013
LANTISEPTIC SKIN PROTECTA (Skin Protectants Misc -
Ointment*
OINT 0.03040 04/28/2005 02/19/2013
Latanoprost Ophth Soln 0.005% SOLN 6.24800 02/22/2013 02/19/2013
LAVOPTIK EYE WASH (Ophthalmic Irrigation Solution***) SOLN 0.02410 04/28/2005 02/19/2013
LEADER LANCETS COLORED (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
LEADER SUPER THIN LANCET (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
LEADER THIN LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
Leflunomide Tab 10 MG TABS 0.44575 02/22/2013 02/19/2013
Leflunomide Tab 20 MG TABS 0.40565 02/22/2013 02/19/2013
L-EMENTAL (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
L-EMENTAL HEPATIC (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
L-EMENTAL PEDIATRIC (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
Page 67 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
L-EMENTAL PLUS (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
LETAIRIS (Ambrisentan Tab 10 MG) TABS 164.00000 09/25/2009 02/19/2013
LETAIRIS (Ambrisentan Tab 5 MG) TABS 164.00000 09/25/2009 02/19/2013
Letrozole Tab 2.5 MG TABS 0.20540 02/22/2013 02/19/2013
Leucovorin Calcium For Inj 100 MG SOLR 8.14320 11/08/2013 11/05/2013
Leucovorin Calcium For Inj 200 MG SOLR 16.91000 11/08/2013 11/05/2013
Leucovorin Calcium For Inj 50 MG SOLR 6.78000 11/08/2013 11/05/2013
Leucovorin Calcium Inj 10 MG/ML SOLN 0.45816 02/22/2013 02/19/2013
Leucovorin Calcium Tab 10 MG TABS 6.22673 02/22/2013 02/19/2013
Leucovorin Calcium Tab 25 MG TABS 6.59900 02/22/2013 02/19/2013
Leucovorin Calcium Tab 5 MG TABS 0.96875 02/22/2013 02/19/2013
LEU-FREE COOLER (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
LEUKERAN (Chlorambucil Tab 2 MG) TABS 3.20380 07/30/2010 02/19/2013
Levalbuterol HCl Soln Nebu Conc 1.25 MG/0.5ML (Base
Equiv)
NEBU 3.21500 02/22/2013 02/19/2013
Levetiracetam Oral Soln 100 MG/ML SOLN 0.12435 02/22/2013 02/19/2013
Levetiracetam Tab 1000 MG TABS 0.57856 02/22/2013 02/19/2013
Levetiracetam Tab 250 MG TABS 0.16965 02/22/2013 02/19/2013
Levetiracetam Tab 500 MG TABS 0.19164 02/22/2013 02/19/2013
Levetiracetam Tab 750 MG TABS 0.31417 02/22/2013 02/19/2013
Levetiracetam Tab SR 24HR 500 MG TB24 0.49000 02/22/2013 02/19/2013
Levetiracetam Tab SR 24HR 750 MG TB24 0.69000 02/22/2013 02/19/2013
Levobunolol HCl Ophth Soln 0.25% SOLN 0.94000 02/22/2013 02/19/2013
Levobunolol HCl Ophth Soln 0.5% SOLN 0.48890 02/22/2013 02/19/2013
Levocarnitine Cap 250 MG CAPS 0.53818 02/22/2013 02/19/2013
Levocarnitine Oral Soln 1 GM/10ML (10%) SOLN 0.19400 02/22/2013 02/19/2013
Levocarnitine Tab 330 MG TABS 0.62340 02/22/2013 02/19/2013
Levocetirizine Dihydrochloride Soln 2.5 MG/5ML (0.5 MG/ML) SOLN 0.42546 08/09/2013 08/06/2013
Levocetirizine Dihydrochloride Tab 5 MG TABS 0.39364 02/22/2013 02/19/2013
Levofloxacin Tab 250 MG TABS 0.22802 02/22/2013 02/19/2013
Levofloxacin Tab 500 MG TABS 0.28713 02/22/2013 02/19/2013
Levofloxacin Tab 750 MG TABS 0.57005 02/22/2013 02/19/2013
Levonorgestrel & Ethinyl Estradiol (91-Day) Tab 0.15-0.03 MG TABS 1.14300 02/22/2013 02/19/2013
Levonorgestrel & Ethinyl Estradiol Tab 0.1 MG-20 MCG TABS 0.68498 02/22/2013 02/19/2013
Levonorgestrel & Ethinyl Estradiol Tab 0.15 MG-30 MCG TABS 0.55815 02/22/2013 02/19/2013
Levonorgestrel Tab 0.75 MG TABS 15.22415 02/22/2013 02/19/2013
Levonorgestrel Tab 1.5 MG TABS 28.06100 09/13/2013 09/09/2013
Levonorgestrel-Eth Estra Tab
0.05-30/0.075-40/0.125-30MG-MCG
TABS 0.73700 02/22/2013 02/19/2013
Levonorg-Eth Est Tab 0.15-0.03MG(84) & Eth Est Tab
0.01MG(7)
TABS 2.40000 02/22/2013 02/19/2013
Levothyroxine Sodium Tab 100 MCG TABS 0.29311 09/23/2013 12/06/2013
Levothyroxine Sodium Tab 100 MCG TABS 0.46618 03/14/2013 04/09/2013
Levothyroxine Sodium Tab 112 MCG TABS 0.37843 09/23/2013 12/06/2013
Levothyroxine Sodium Tab 125 MCG TABS 0.38370 09/23/2013 12/06/2013
Page 68 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Levothyroxine Sodium Tab 137 MCG TABS 0.37843 09/23/2013 12/06/2013
Levothyroxine Sodium Tab 150 MCG TABS 0.39492 09/23/2013 12/06/2013
Levothyroxine Sodium Tab 175 MCG TABS 0.46940 09/23/2013 12/06/2013
Levothyroxine Sodium Tab 200 MCG TABS 0.48930 09/23/2013 12/06/2013
Levothyroxine Sodium Tab 25 MCG TABS 0.08814 01/13/2012 02/19/2013
Levothyroxine Sodium Tab 25 MCG TABS 0.26500 09/23/2013 12/06/2013
Levothyroxine Sodium Tab 25 MCG TABS 0.26500 10/22/2013 12/06/2013
Levothyroxine Sodium Tab 25 MCG TABS 0.35530 10/26/2012 02/19/2013
Levothyroxine Sodium Tab 300 MCG TABS 0.57277 09/23/2013 12/06/2013
Levothyroxine Sodium Tab 50 MCG TABS 0.09523 11/27/2010 02/19/2013
Levothyroxine Sodium Tab 50 MCG TABS 0.26900 09/23/2013 12/06/2013
Levothyroxine Sodium Tab 50 MCG TABS 0.40333 10/10/2012 02/19/2013
Levothyroxine Sodium Tab 75 MCG TABS 0.31000 09/23/2013 12/06/2013
Levothyroxine Sodium Tab 88 MCG TABS 0.30100 09/23/2013 12/06/2013
Levothyroxine Sodium Tab 88 MCG TABS 0.48400 03/12/2013 04/09/2013
LIBERTY NEXT GENERATION B (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
LIBERTY TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
Lidocaine Anorectal Cream 5% CREA 1.50940 02/22/2013 02/19/2013
Lidocaine HCl Cream 3% CREA 1.70000 02/22/2013 02/19/2013
Lidocaine HCl Gel 2% GEL 0.27560 02/22/2013 02/19/2013
Lidocaine HCl Laryngotracheal Soln 4% SOLN 0.10019 02/22/2013 02/19/2013
Lidocaine HCl Local Inj 1% SOLN 0.02262 02/22/2013 02/19/2013
Lidocaine HCl Local Inj 2% SOLN 0.02574 02/22/2013 02/19/2013
Lidocaine HCl Local Preservative Free (PF) Inj 2% SOLN 0.02574 02/22/2013 02/19/2013
Lidocaine HCl Soln 4% SOLN 0.10019 02/22/2013 02/19/2013
Lidocaine HCl Viscous Soln 2% SOLN 0.02780 02/22/2013 02/19/2013
Lidocaine Oint 5% OINT 1.62000 09/17/2013 11/05/2013
Lidocaine-Hydrocortisone Acetate Rectal Cream 3-0.5% CREA 1.65937 02/22/2013 02/19/2013
Lidocaine-Hydrocortisone Acetate Rectal Cream Kit 3-0.5% KIT 7.69340 02/22/2013 02/19/2013
Lidocaine-Prilocaine Cream 2.5-2.5% CREA 0.65098 02/22/2013 02/19/2013
Lidocaine-Prilocaine Kit 2.5-2.5% KIT 33.40800 02/22/2013 04/09/2013
LIFE MED BLOOD GLUCOSE MO (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
LIFE MEDICAL TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
LIFE PACK WOMENS (Multiple Vitamins w/ Minerals
Combination
MISC 0.11230 04/01/2008 02/19/2013
LIFESCAN UNISTIK 2 DEEP P (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
LIFESCAN UNISTIK II LANCE (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
Lindane Lotion 1% LOTN 1.76000 02/22/2013 02/19/2013
Lindane Shampoo 1% SHAM 1.67670 02/22/2013 02/19/2013
Liniments & Rubs - Cream** CREA 0.02880 02/22/2013 02/19/2013
Liniments & Rubs - Lotion** LOTN 0.02880 02/22/2013 02/19/2013
Liniments & Rubs - Ointment** OINT 0.02880 02/22/2013 02/19/2013
Liothyronine Sodium Tab 25 MCG TABS 0.82000 02/22/2013 02/19/2013
Liothyronine Sodium Tab 5 MCG TABS 0.64040 02/22/2013 02/19/2013
Page 69 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Liothyronine Sodium Tab 50 MCG TABS 1.25696 02/22/2013 02/19/2013
LIPISTART (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
LIPOMUL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
LIPRAM-PN20 (Amy-Lip-Prot DR Particles Cap
56000-20000-44000
CPEP 0.82350 11/13/2007 02/19/2013
Lisinopril & Hydrochlorothiazide Tab 10-12.5 MG TABS 0.05262 02/22/2013 02/19/2013
Lisinopril & Hydrochlorothiazide Tab 20-12.5 MG TABS 0.06211 02/22/2013 02/19/2013
Lisinopril & Hydrochlorothiazide Tab 20-25 MG TABS 0.07003 02/22/2013 02/19/2013
Lisinopril Tab 10 MG TABS 0.02809 02/22/2013 02/19/2013
Lisinopril Tab 2.5 MG TABS 0.02985 02/22/2013 02/19/2013
Lisinopril Tab 20 MG TABS 0.04489 02/22/2013 02/19/2013
Lisinopril Tab 30 MG TABS 0.08872 02/22/2013 02/19/2013
Lisinopril Tab 40 MG TABS 0.06916 02/22/2013 02/19/2013
Lisinopril Tab 5 MG TABS 0.02405 02/22/2013 02/19/2013
LITE TOUCH LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
Lithium Carbonate Cap 150 MG CAPS 0.09087 02/22/2013 02/19/2013
Lithium Carbonate Cap 300 MG CAPS 0.03598 02/22/2013 02/19/2013
Lithium Carbonate Cap 600 MG CAPS 0.18052 02/22/2013 02/19/2013
Lithium Carbonate Tab 300 MG TABS 0.19929 02/22/2013 02/19/2013
Lithium Carbonate Tab CR 300 MG TBCR 0.24433 02/22/2013 02/19/2013
Lithium Carbonate Tab CR 450 MG TBCR 0.38900 02/22/2013 02/19/2013
Lithium Citrate Oral Soln 8 mEq/5ML SOLN 0.18900 02/22/2013 02/19/2013
Lithium Citrate Oral Soln 8 mEq/5ML SYRP 0.18900 02/22/2013 02/19/2013
LIVE BETTER LANCET SUPER (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
LIVE BETTER LANCET ULTRA (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
LMD (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
LMD DIET (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
LMX 5 (Lidocaine Anorectal Cream 5%) CREA 1.50940 04/28/2005 02/19/2013
LOMOTIL (Diphenoxylate w/ Atropine Liq 2.5-0.025 MG/5ML) LIQD 0.09100 06/08/1992 02/19/2013
LONG STARTER KIT (Blood Glucose Monitoring Kit w/
Device***)
KIT 0.71000 10/01/2003 02/19/2013
LONG TEST STRIP (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
LONGS LANCETS STANDARD (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
LONGS LANCETS THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
LONGS LANCETS ULTRA THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
Loperamide HCl Cap 2 MG CAPS 0.30500 10/21/2013 12/06/2013
Loperamide HCl Liq 1 MG/5ML (0.2 MG/ML) LIQD 0.03310 02/22/2013 02/19/2013
Loperamide HCl Liq 1 MG/7.5ML SUSP 0.03310 02/22/2013 02/19/2013
Loperamide HCl Tab 2 MG TABS 0.12000 02/22/2013 02/19/2013
LOPHLEX (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
LOPHLEX LQ 20 (Nutritional Supplement Liquid**) LIQD 0.04488 11/02/2012 02/20/2013
Loratadine Rapidly-Disintegrating Tab 10 MG TBDP 0.27000 02/22/2013 02/19/2013
Loratadine Syrup 5 MG/5ML SOLN 0.07124 02/22/2013 02/19/2013
Loratadine Syrup 5 MG/5ML SYRP 0.07124 02/22/2013 02/19/2013
Loratadine Tab 10 MG TABS 0.05575 02/22/2013 02/19/2013
Page 70 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Lorazepam Conc 2 MG/ML CONC 0.98536 02/22/2013 02/19/2013
Lorazepam Inj 2 MG/ML SOLN 1.04744 02/22/2013 02/19/2013
Lorazepam Tab 0.5 MG TABS 0.03809 02/22/2013 02/19/2013
Lorazepam Tab 1 MG TABS 0.03524 02/22/2013 02/19/2013
Lorazepam Tab 2 MG TABS 0.05616 02/22/2013 02/19/2013
LORTAB (Hydrocodone-Acetaminophen Tab 5-500 MG) TABS 0.06550 05/28/2010 02/19/2013
Losartan Potassium & Hydrochlorothiazide Tab 100-12.5 MG TABS 0.15944 02/22/2013 02/19/2013
Losartan Potassium & Hydrochlorothiazide Tab 100-25 MG TABS 0.16542 02/22/2013 02/19/2013
Losartan Potassium & Hydrochlorothiazide Tab 50-12.5 MG TABS 0.10667 02/22/2013 02/19/2013
Losartan Potassium Tab 100 MG TABS 0.12153 02/22/2013 02/19/2013
Losartan Potassium Tab 25 MG TABS 0.06154 02/22/2013 02/19/2013
Losartan Potassium Tab 50 MG TABS 0.08864 02/22/2013 02/19/2013
LOTRIMIN AF (Clotrimazole Cream 1%) CREA 0.16850 04/23/2010 02/19/2013
LOTRIMIN AF FOR HER (Clotrimazole Cream 1%) CREA 0.16850 04/23/2010 02/19/2013
LOTRIMIN AF JOCK ITCH (Clotrimazole Cream 1%) CREA 0.16850 04/23/2010 02/19/2013
Lovastatin Tab 10 MG TABS 0.09089 02/22/2013 02/19/2013
Lovastatin Tab 20 MG TABS 0.09200 02/22/2013 02/19/2013
Lovastatin Tab 40 MG TABS 0.11652 02/22/2013 02/19/2013
LOVENOX (Enoxaparin Sodium Inj 100 MG/ML) SOLN 82.45500 05/18/2012 02/19/2013
LOVENOX (Enoxaparin Sodium Inj 120 MG/0.8ML) SOLN 123.72395 05/18/2012 02/19/2013
LOVENOX (Enoxaparin Sodium Inj 150 MG/ML) SOLN 123.72600 05/18/2012 02/19/2013
LOVENOX (Enoxaparin Sodium Inj 30 MG/0.3ML) SOLN 74.87430 07/30/2010 02/19/2013
LOVENOX (Enoxaparin Sodium Inj 30 MG/0.3ML) SOLN 82.36300 05/30/2013 07/09/2013
LOVENOX (Enoxaparin Sodium Inj 300 MG/3ML) SOLN 74.87430 07/30/2010 02/19/2013
LOVENOX (Enoxaparin Sodium Inj 40 MG/0.4ML) SOLN 82.35700 05/18/2012 02/19/2013
LOVENOX (Enoxaparin Sodium Inj 60 MG/0.6ML) SOLN 82.45700 05/18/2012 02/19/2013
LOVENOX (Enoxaparin Sodium Inj 80 MG/0.8ML) SOLN 74.87430 07/30/2010 02/19/2013
LOVENOX (Enoxaparin Sodium Inj 80 MG/0.8ML) SOLN 82.45700 05/18/2012 02/19/2013
Loxapine Succinate Cap 10 MG CAPS 0.50164 02/22/2013 02/19/2013
Loxapine Succinate Cap 25 MG CAPS 0.78182 02/22/2013 02/19/2013
Loxapine Succinate Cap 5 MG CAPS 0.36179 02/08/2013 02/20/2013
Loxapine Succinate Cap 5 MG CAPS 0.36179 02/22/2013 02/20/2013
Loxapine Succinate Cap 50 MG CAPS 1.09085 02/22/2013 02/19/2013
Lubricant Gels - Gel*** GEL 0.01780 02/22/2013 02/19/2013
LUBRIDERM (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
LUBRIDERM ADVANCED THERAP (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
LUBRIDERM DAILY MOISTURE (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
LUBRIDERM DAILY MOISTURE/ (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
LUBRIDERM INTENSE SKIN RE (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
LUBRIDERM MENS 3-IN-1 (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
LUBRIDERM SERIOUSLY SENSI (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
LUBRIDERM SKIN NOURISHING (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
LUBRIDERM SOOTHING RELIEF (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
LUBRISOFT (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
Page 71 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
LUPRON DEPOT (Leuprolide Acetate (3 Month) For Inj Kit
11.25
KIT 2,395.64560 01/03/2013 03/04/2013
LUPRON DEPOT (Leuprolide Acetate (3 Month) For Inj Kit
22.5
KIT 2,854.74350 01/03/2013 02/20/2013
LUPRON DEPOT (Leuprolide Acetate (4 Month) For Inj Kit 30
MG
KIT 3,806.33020 01/03/2013 02/20/2013
LUPRON DEPOT (Leuprolide Acetate For Inj Kit 3.75 MG) KIT 798.53470 01/03/2013 02/20/2013
LUPRON DEPOT-PED (Leuprolide Acetate (3 Month) For Inj
Pedia
KIT 5,232.13740 01/03/2013 02/20/2013
LUPRON DEPOT-PED (Leuprolide Acetate (3 Month) For Inj
Pedia
KIT 5,762.66510 01/03/2013 02/20/2013
LUPRON DEPOT-PED (Leuprolide Acetate For Inj Pediatric
Kit 1
KIT 1,744.04580 01/03/2013 02/20/2013
LUPRON DEPOT-PED (Leuprolide Acetate For Inj Pediatric
Kit 1
KIT 1,920.88560 01/03/2013 02/20/2013
LUPRON DEPOT-PED (Leuprolide Acetate For Inj Pediatric
Kit 7
KIT 960.64200 01/03/2013 02/20/2013
LYSIPLEX (Multiple Vitamin Tab**) TABS 0.02140 03/20/2008 02/19/2013
MAALOX MAX (Calcium Carbonate-Simethicone Chew Tab
1000-60 M
CHEW 0.04240 04/28/2005 02/19/2013
MACULAR VITAMIN BENEFIT (Multiple Vitamins w/ Minerals
Tab**
TABS 0.07430 03/20/2008 02/19/2013
Magnesium Chloride Tab CR 535 MG (64 MG Elemental Mg) TBCR 0.10710 02/22/2013 02/19/2013
Magnesium Citrate Soln SOLN 0.00475 02/22/2013 02/19/2013
Magnesium Gluconate Tab 500 MG TABS 0.07837 02/22/2013 02/19/2013
Magnesium Hydroxide Susp 400 MG/5ML SUSP 0.00676 02/22/2013 02/19/2013
Magnesium Oxide Tab 250 MG TABS 0.06200 02/22/2013 02/19/2013
Magnesium Oxide Tab 250 MG (Mg Supplement) TABS 0.04317 02/22/2013 02/19/2013
Magnesium Oxide Tab 400 MG TABS 0.07476 02/22/2013 02/19/2013
Magnesium Oxide Tab 400 MG (241.3 MG Elemental Mg) TABS 0.07476 02/22/2013 02/19/2013
Magnesium Oxide Tab 500 MG (Mg Supplement) TABS 0.06187 02/22/2013 02/19/2013
Magnesium Sulfate Inj 50% SOLN 0.03848 02/22/2013 02/19/2013
Magnesium Tab 250 MG TABS 0.04990 02/22/2013 02/19/2013
Magnesium Tab 30 MG TABS 0.04070 02/22/2013 02/19/2013
MAGONATE (Magnesium Gluconate Liquid 1000 MG/5ML
(54 MG/5ML
LIQD 0.03980 04/28/2005 02/19/2013
MAG-OX 400 (Magnesium Oxide Tab 400 MG) TABS 0.06195 03/20/2008 02/19/2013
MAINTAIN (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
MAJOR COMFORT LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
Malathion Lotion 0.5% LOTN 2.61500 02/22/2013 02/19/2013
Maprotiline HCl Tab 25 MG TABS 0.23970 02/22/2013 02/19/2013
MATULANE (Procarbazine HCl Cap 50 MG) CAPS 46.21440 07/30/2010 02/19/2013
MAXAM (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
MAXIMA BLOOD GLUCOSE MONI (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
MAXIMA BLOOD GLUCOSE TEST (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
MAXIMA METER KIT (Blood Glucose Monitoring Kit w/
Device***)
KIT 0.71000 10/01/2003 02/19/2013
MAXIMA STARTER KIT (Blood Glucose Monitoring Kit w/
Device**
KIT 0.71000 10/01/2003 02/19/2013
MCT OIL (Medium Chain Triglycerides Oral Oil) OIL 0.04870 04/28/2005 02/19/2013
MCT PRO-CAL (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
MCT PROCAL (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
Mebendazole Chew Tab 100 MG CHEW 3.65290 02/22/2013 02/19/2013
Meclizine HCl Chew Tab 25 MG CHEW 0.03939 02/22/2013 02/19/2013
Meclizine HCl Tab 12.5 MG TABS 0.05150 02/22/2013 02/19/2013
Meclizine HCl Tab 25 MG TABS 0.32000 02/22/2013 02/19/2013
MEDICHOICE PRE-SET SAFETY (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
MEDICHOICE SAFETY LANCET (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
MEDICINE SHOPPE LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
MEDICINE SHOPPE LANCETS T (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
MEDI-LANCE LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
MEDISENSE THIN LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
MEDLANCE PLUS LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
MEDLANCE PLUS LANCETS LIT (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
MEDLANCE PLUS SUPERLITE 3 (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
MEDLANCE PLUS UNIVERSAL L (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
MEDLANCE PLUS/LITE 25G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
MEDLANCE/EXTRA (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
MEDLANCE/LITE (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
MEDLANCE/UNIVERSAL (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
Medroxyprogesterone Acetate IM Susp 150 MG/ML SUSP 46.87334 02/22/2013 02/19/2013
Medroxyprogesterone Acetate Tab 10 MG TABS 0.06217 02/22/2013 02/19/2013
Medroxyprogesterone Acetate Tab 2.5 MG TABS 0.05125 02/22/2013 02/19/2013
Medroxyprogesterone Acetate Tab 5 MG TABS 0.08900 02/22/2013 02/19/2013
Mefenamic Acid Cap 250 MG CAPS 12.51000 11/08/2013 11/05/2013
Mefloquine HCl Tab 250 MG TABS 4.95041 02/08/2013 02/20/2013
Mefloquine HCl Tab 250 MG TABS 4.95041 02/22/2013 02/20/2013
MEGA MULTIVITAMIN FOR MEN (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
MEGA MULTIVITAMIN FOR WOM (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
MEGACE ES (Megestrol Acetate Susp 625 MG/5ML) SUSP 3.62710 07/30/2010 02/19/2013
MEGACE ES (Megestrol Acetate Susp 625 MG/5ML) SUSP 4.57400 09/11/2013 11/05/2013
MEGAVITE FRUITS & VEGGIES (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
Megestrol Acetate Susp 40 MG/ML SUSP 0.08301 02/22/2013 02/19/2013
Megestrol Acetate Tab 20 MG TABS 0.12563 02/22/2013 02/19/2013
Megestrol Acetate Tab 40 MG TABS 0.22456 02/22/2013 02/19/2013
MEIJER BLOOD GLUCOSE MONI (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
MEIJER BLOOD GLUCOSE TEST (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
MEIJER COLOR LANCETS UNIV (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
MEIJER LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
MEIJER LANCETS THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
MEIJER LANCETS UNIVERSAL (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
MEIJER PREMIUM BLOOD GLUC (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
MEIJER PREMIUM BLOOD GLUC (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
MEIJER STARTER KIT (Blood Glucose Monitoring Kit w/
Device**
KIT 0.71000 10/01/2003 02/19/2013
MEIJER SUPER THIN LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
MEIJER TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
MEIJER TRUE2GO BLOOD GLUC (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
MEIJER TRUERESULT BLOOD G (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
MEIJER TRUETEST BLOOD GLU (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
MEIJER TRUETRACK BLOOD GL (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
MEIJER TRUETRACK BLOOD GL (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
Melatonin Cap 1 MG CAPS 0.07185 02/22/2013 02/19/2013
Melatonin Cap 3 MG CAPS 0.11966 02/22/2013 02/19/2013
Melatonin Liquid 1 MG/4ML LIQD 0.06321 02/22/2013 02/19/2013
Melatonin Lozenge 3 MG LOZG 0.10633 02/22/2013 02/19/2013
Melatonin SL Tab 5 MG SUBL 0.23194 02/22/2013 02/19/2013
Melatonin Tab 1 MG TABS 0.05950 02/22/2013 02/19/2013
Melatonin Tab 3 MG TABS 0.08271 02/22/2013 02/19/2013
Meloxicam Tab 15 MG TABS 0.03060 02/22/2013 02/19/2013
Meloxicam Tab 7.5 MG TABS 0.03065 02/22/2013 02/19/2013
MENOMUNE-A/C/Y/W-135 (Meningococcal Vaccine A, C, Y,
and W-1
INJ 113.36140 04/13/2012 02/19/2013
MENS 50+ ADVANCED (Multiple Vitamins w/ Minerals Cap**) CAPS 0.51325 04/27/2011 02/19/2013
MENS 50+ MULTI VITAMIN & (Multiple Vitamins w/ Minerals
Tab*
TABS 0.07430 03/20/2008 02/19/2013
MENS MULTI VITAMIN & MINE (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
MENS PACK (Multiple Vitamins w/ Minerals Combination
Therapy
MISC 0.11230 05/28/2010 02/19/2013
Menthol-Methyl Salicylate Cream*** CREA 0.02880 02/22/2013 02/19/2013
Menthol-Methyl Salicylate Ointment*** OINT 0.02880 02/22/2013 02/19/2013
Meperidine HCl Tab 100 MG TABS 0.39700 02/22/2013 02/19/2013
Meperidine HCl Tab 50 MG TABS 0.20308 02/22/2013 02/19/2013
Meprobamate Tab 200 MG TABS 0.97563 02/22/2013 02/19/2013
Meprobamate Tab 400 MG TABS 1.19780 02/22/2013 02/19/2013
Mercaptopurine Tab 50 MG TABS 1.12549 02/22/2013 02/19/2013
MERITENE (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
Meropenem IV For Soln 1 GM SOLR 38.00000 02/22/2013 02/19/2013
Meropenem IV For Soln 500 MG SOLR 18.50000 02/22/2013 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Mesalamine Enema 4 GM ENEM 0.13450 02/22/2013 02/19/2013
Mesalamine Rectal Enema 4 GM & Cleanser Wipe Kit** KIT 145.00000 02/22/2013 02/20/2013
METAFORM (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
METAMUCIL (Psyllium Cap 0.52 GM) CAPS 0.01200 03/20/2008 02/19/2013
METAMUCIL (Psyllium Powder 48.57%) POWD 0.01620 04/28/2005 02/19/2013
METAMUCIL (Psyllium Wafer**) WAFR 0.14840 04/28/2005 02/19/2013
METAMUCIL MULTIHEALTH FIB (Psyllium Powder 63%) POWD 0.01720 04/28/2005 02/19/2013
METAMUCIL MULTIHEALTH FIB (Psyllium Powder Packet
58.12%)
PACK 0.22885 03/20/2008 02/19/2013
METAMUCIL ORIGINAL TEXTUR (Psyllium Powder 48.57%) POWD 0.01620 04/28/2005 02/19/2013
METAMUCIL SMOOTH TEXTURE (Psyllium Powder 63%) POWD 0.01720 04/28/2005 02/19/2013
METAMUCIL SMOOTH TEXTURE (Psyllium Powder Packet
28%)
PACK 0.22920 04/28/2005 02/19/2013
Metaproterenol Sulfate Syrup 10 MG/5ML SYRP 0.05860 02/22/2013 02/19/2013
Metformin HCl Tab 1000 MG TABS 0.04939 02/22/2013 02/19/2013
Metformin HCl Tab 500 MG TABS 0.02850 02/22/2013 02/19/2013
Metformin HCl Tab 850 MG TABS 0.03821 02/22/2013 02/19/2013
Metformin HCl Tab SR 24HR 500 MG TB24 0.05312 02/22/2013 02/19/2013
Metformin HCl Tab SR 24HR 750 MG TB24 0.12221 02/22/2013 02/19/2013
Methadone HCl Conc 10 MG/ML CONC 0.07060 02/22/2013 02/19/2013
Methadone HCl Tab 10 MG TABS 0.10261 02/22/2013 02/19/2013
Methadone HCl Tab 5 MG TABS 0.05593 02/22/2013 02/19/2013
Methadone HCl Tab For Oral Susp 40 MG TBSO 0.09527 02/22/2013 02/19/2013
Methamphetamine HCl Tab 5 MG TABS 3.74673 02/22/2013 02/19/2013
Methazolamide Tab 25 MG TABS 0.31500 02/22/2013 02/19/2013
Methazolamide Tab 50 MG TABS 0.14830 02/22/2013 02/19/2013
Methenamine Hippurate Tab 1 GM TABS 1.68000 02/22/2013 02/19/2013
Methimazole Tab 10 MG TABS 0.24988 02/22/2013 02/19/2013
Methimazole Tab 5 MG TABS 0.15301 02/22/2013 02/19/2013
METHIONAID (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
Methocarbamol Tab 500 MG TABS 0.12300 04/05/2013 05/06/2013
Methocarbamol Tab 750 MG TABS 0.12475 02/22/2013 02/19/2013
Methotrexate Sodium Inj PF 25 MG/ML SOLN 2.04450 02/22/2013 02/19/2013
Methotrexate Sodium Tab 2.5 MG (Base Equiv) TABS 2.45000 11/05/2013 12/06/2013
Methscopolamine Bromide Tab 2.5 MG TABS 1.73901 02/22/2013 02/19/2013
Methyclothiazide Tab 5 MG TABS 0.32000 02/22/2013 02/19/2013
Methylcellulose Powder Laxative POWD 0.01324 02/22/2013 02/19/2013
Methylcellulose Tab 500 MG TABS 0.10545 02/22/2013 02/19/2013
Methyldopa & Hydrochlorothiazide Tab 250-15 MG TABS 0.42630 02/22/2013 02/19/2013
Methyldopa & Hydrochlorothiazide Tab 250-25 MG TABS 0.15690 02/22/2013 02/19/2013
Methyldopa Tab 250 MG TABS 0.11089 02/22/2013 02/19/2013
Methyldopa Tab 500 MG TABS 0.20144 02/22/2013 02/19/2013
Methylergonovine Maleate Tab 0.2 MG TABS 5.77000 04/18/2013 05/06/2013
Methylphenidate HCl Cap SR 24HR 20 MG CP24 3.95000 04/12/2013 04/09/2013
Methylphenidate HCl Cap SR 24HR 40 MG CP24 4.21149 08/09/2013 08/06/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Methylphenidate HCl Tab 10 MG TABS 0.91663 05/23/2013 06/11/2013
Methylphenidate HCl Tab 20 MG TABS 1.34200 05/03/2013 07/09/2013
Methylphenidate HCl Tab 5 MG TABS 0.62000 10/11/2013 10/09/2013
Methylphenidate HCl Tab CR 10 MG TBCR 1.18000 06/25/2013 08/06/2013
Methylphenidate HCl Tab CR 20 MG TBCR 2.03000 07/06/2013 08/06/2013
Methylprednisolone Sodium Succinate For Inj 40 MG SOLR 2.35300 02/22/2013 02/19/2013
Methylprednisolone Tab 4 MG TABS 1.11840 12/13/2013 12/06/2013
Methylprednisolone Tab 4 MG Dose Pack TABS 1.07000 02/22/2013 02/19/2013
Metoclopramide HCl Soln 5 MG/5ML (10 MG/10ML) SOLN 0.01374 02/22/2013 02/19/2013
Metoclopramide HCl Tab 10 MG TABS 0.04870 02/22/2013 02/19/2013
Metoclopramide HCl Tab 5 MG TABS 0.04653 02/22/2013 02/19/2013
Metolazone Tab 10 MG TABS 0.66462 02/22/2013 02/19/2013
Metolazone Tab 2.5 MG TABS 0.41358 02/22/2013 02/19/2013
Metolazone Tab 5 MG TABS 1.05000 10/02/2013 12/06/2013
Metoprolol Succinate Tab SR 24HR 100 MG TB24 0.85611 08/09/2013 08/06/2013
Metoprolol Succinate Tab SR 24HR 200 MG TB24 1.29983 12/13/2013 12/06/2013
Metoprolol Succinate Tab SR 24HR 25 MG TB24 0.60000 11/08/2013 11/05/2013
Metoprolol Succinate Tab SR 24HR 50 MG TB24 0.48000 11/08/2013 11/05/2013
Metoprolol Tartrate Tab 100 MG TABS 0.08900 10/10/2013 12/06/2013
Metoprolol Tartrate Tab 25 MG TABS 0.03440 02/22/2013 02/19/2013
Metoprolol Tartrate Tab 50 MG TABS 0.02554 02/22/2013 02/19/2013
Metronidazole Cream 0.75% CREA 2.71000 02/22/2013 02/19/2013
Metronidazole Gel 0.75% GEL 2.73000 12/07/2012 05/15/2013
Metronidazole in NaCl 0.79% IV Soln 500 MG/100ML SOLN 0.01545 02/22/2013 02/19/2013
Metronidazole Lotion 0.75% LOTN 3.29000 06/21/2013 07/09/2013
Metronidazole Tab 250 MG TABS 0.32000 02/22/2013 02/19/2013
Metronidazole Tab 500 MG TABS 0.50200 02/22/2013 02/19/2013
Metronidazole Vaginal Gel 0.75% GEL 0.38450 02/22/2013 02/19/2013
Mexiletine HCl Cap 150 MG CAPS 0.33750 02/11/2013 03/04/2013
Mexiletine HCl Cap 150 MG CAPS 0.33750 02/22/2013 03/04/2013
Mexiletine HCl Cap 200 MG CAPS 0.26500 02/22/2013 02/19/2013
Mexiletine HCl Cap 250 MG CAPS 0.33500 02/22/2013 02/19/2013
MICATIN (Miconazole Nitrate Cream 2%) CREA 0.09870 03/20/2008 02/19/2013
MICATIN JOCK ITCH CREAM (Miconazole Nitrate Cream
2%)
CREA 0.09870 03/20/2008 02/19/2013
Miconazole Nitrate Cream 2% CREA 0.05542 02/22/2013 02/19/2013
Miconazole Nitrate Vaginal Cream 2% CREA 0.12930 02/22/2013 02/19/2013
Miconazole Nitrate Vaginal Cream 4% (200 MG/5GM) CREA 0.44677 02/22/2013 02/19/2013
Miconazole Nitrate Vaginal Kit KIT 8.31000 02/22/2013 02/19/2013
Miconazole Nitrate Vaginal Supp 200 MG & 2% Cream 9 GM
Kit
KIT 8.31000 02/22/2013 02/19/2013
Miconazole Nitrate Vaginal Suppos 100 MG SUPP 0.54786 02/22/2013 02/19/2013
MICRODOT BLOOD GLUCOSE MO (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
MICRODOT TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
MICROLET LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
MICRONASE (Glyburide Tab 2.5 MG) TABS 0.18000 12/28/2001 02/19/2013
MICROTAINER SAFETY FLOW L (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
MIDAMOR (Amiloride HCl Tab 5 MG) TABS 0.90242 03/06/2009 02/19/2013
Midazolam HCl Inj 10 MG/2ML (Base Equivalent) SOLN 0.43550 02/22/2013 02/19/2013
Midazolam HCl Inj 2 MG/2ML (Base Equivalent) SOLN 0.25350 02/22/2013 02/19/2013
Midazolam HCl Inj 25 MG/5ML (Base Equivalent) SOLN 0.88400 02/22/2013 02/19/2013
Midazolam HCl Inj 5 MG/ML (Base Equivalent) SOLN 0.88400 02/22/2013 02/19/2013
Midazolam HCl Inj 50 MG/10ML (Base Equivalent) SOLN 0.66690 02/22/2013 02/19/2013
Midazolam HCl Syrup 2 MG/ML (Base Equivalent) SYRP 0.71611 02/22/2013 02/19/2013
Midodrine HCl Tab 10 MG TABS 0.85445 02/22/2013 02/19/2013
Midodrine HCl Tab 2.5 MG TABS 0.30375 02/22/2013 02/19/2013
Midodrine HCl Tab 5 MG TABS 0.47733 02/22/2013 02/19/2013
MILCO-B-FORTE (B-Complex w/ C & Folic Acid Tab***) TABS 0.14060 04/28/2005 02/19/2013
MILK OF MAGNESIA CONCENTR (Magnesium Hydroxide
Susp Concentr
SUSP 0.01720 04/28/2005 02/19/2013
Mineral Oil OIL 0.01529 02/22/2013 02/19/2013
Mineral Oil (Bulk) OIL 0.01529 02/22/2013 02/19/2013
Mineral Oil Enema ENEM 0.01031 02/22/2013 02/19/2013
MINOCIN (Minocycline HCl Cap 100 MG) CAPS 0.30557 02/26/2010 02/19/2013
Minocycline HCl Cap 100 MG CAPS 0.28783 02/22/2013 02/19/2013
Minocycline HCl Cap 50 MG CAPS 0.12330 02/22/2013 02/19/2013
Minocycline HCl Cap 75 MG CAPS 0.33238 02/22/2013 02/19/2013
Minocycline HCl Tab 100 MG TABS 1.72432 10/11/2013 10/09/2013
Minocycline HCl Tab SR 24HR 135 MG TB24 10.48000 02/22/2013 02/19/2013
Minocycline HCl Tab SR 24HR 45 MG TB24 10.48000 02/22/2013 02/19/2013
Minocycline HCl Tab SR 24HR 90 MG TB24 11.60000 02/22/2013 02/19/2013
Minoxidil Tab 10 MG TABS 0.26096 02/22/2013 02/19/2013
Minoxidil Tab 2.5 MG TABS 0.15625 02/22/2013 02/19/2013
MIRALAX (Polyethylene Glycol 3350 Oral Powder) POWD 0.03350 03/20/2008 02/19/2013
MIRENA (Levonorgestrel Releasing IUD 20 MCG/24HR (52
MG Tota
IUD 700.23780 04/13/2012 02/19/2013
Mirtazapine Orally Disintegrating Tab 15 MG TBDP 1.01625 02/22/2013 02/19/2013
Mirtazapine Orally Disintegrating Tab 30 MG TBDP 1.07375 02/22/2013 02/19/2013
Mirtazapine Orally Disintegrating Tab 45 MG TBDP 1.08853 02/22/2013 02/19/2013
Mirtazapine Tab 15 MG TABS 0.11640 02/22/2013 02/19/2013
Mirtazapine Tab 30 MG TABS 0.15966 02/22/2013 02/19/2013
Mirtazapine Tab 45 MG TABS 0.26600 02/22/2013 02/19/2013
Mirtazapine Tab 7.5 MG TABS 0.14444 02/22/2013 02/20/2013
Misoprostol Tab 100 MCG TABS 0.52000 03/11/2013 05/06/2013
Misoprostol Tab 200 MCG TABS 0.83600 01/09/2013 02/20/2013
Misoprostol Tab 200 MCG TABS 0.83600 02/22/2013 02/20/2013
Mitoxantrone HCl Inj Conc 20 MG/10ML (2 MG/ML) CONC 41.73000 02/22/2013 02/19/2013
Mitoxantrone HCl Inj Conc 25 MG/12.5ML (2 MG/ML) CONC 41.73000 02/22/2013 02/19/2013
Mitoxantrone HCl Inj Conc 30 MG/15ML (2 MG/ML) CONC 41.73000 02/22/2013 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
MMA/PA COOLER (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
MMA/PA GEL (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
MOBISYL (Trolamine Salicylate Cream 10%) CREA 0.04250 04/28/2005 02/19/2013
Modafinil Tab 100 MG TABS 12.50316 10/11/2013 10/09/2013
Modafinil Tab 200 MG TABS 17.75146 08/09/2013 08/06/2013
MODULEN IBD (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
Moexipril HCl Tab 15 MG TABS 0.29200 02/22/2013 02/19/2013
Moexipril HCl Tab 7.5 MG TABS 0.28719 02/22/2013 02/19/2013
Moexipril-Hydrochlorothiazide Tab 15-12.5 MG TABS 0.59644 02/22/2013 02/19/2013
Moexipril-Hydrochlorothiazide Tab 15-25 MG TABS 0.50412 02/22/2013 02/19/2013
Moexipril-Hydrochlorothiazide Tab 7.5-12.5 MG TABS 0.67900 02/22/2013 02/19/2013
MOISTUREL (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
Mometasone Furoate Cream 0.1% CREA 0.34025 02/22/2013 02/19/2013
Mometasone Furoate Oint 0.1% OINT 0.54649 11/08/2013 11/05/2013
Mometasone Furoate Solution 0.1% (Lotion) SOLN 0.22323 02/22/2013 02/19/2013
MONARC-M (Antihemophilic Factor (Human) For Inj
1701-2000 Un
SOLR 0.65280 06/26/2009 02/19/2013
MONARC-M (Antihemophilic Factor (Human) For Inj 220-400
Unit
SOLR 0.65280 06/26/2009 02/19/2013
MONARC-M (Antihemophilic Factor (Human) For Inj 401-800
Unit
SOLR 0.65280 06/26/2009 02/19/2013
MONARC-M (Antihemophilic Factor (Human) For Inj
801-1700 Uni
SOLR 0.65280 06/26/2009 02/19/2013
MONISTAT 3 (Miconazole Nitrate Vaginal Cream 4% (200
MG/5GM)
CREA 0.44677 03/20/2008 02/19/2013
MONISTAT 3 COMBINATION PA (Miconazole Nitrate Vaginal
Kit)
KIT 8.31000 03/20/2008 02/19/2013
MONISTAT 3 COMBINATION PA (Miconazole Nitrate Vaginal
Supp 2
KIT 8.31000 03/20/2008 02/19/2013
MONISTAT 7 (Miconazole Nitrate Vaginal Suppos 100 MG) SUPP 0.54790 04/23/2010 02/19/2013
MONOCLATE-P (Antihemophilic Factor (Human) For Inj Kit
1000
KIT 0.61850 12/24/2010 02/19/2013
MONOCLATE-P (Antihemophilic Factor (Human) For Inj Kit
1500
KIT 0.61850 12/24/2010 02/19/2013
MONOCLATE-P (Antihemophilic Factor (Human) For Inj Kit
250 U
KIT 0.61850 12/24/2010 02/19/2013
MONOCLATE-P (Antihemophilic Factor (Human) For Inj Kit
500 U
KIT 0.61850 12/24/2010 02/19/2013
MONOGEN (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
MONOLET LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
MONOLET NEOLET LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
MONOLET OPD LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
MONOLET THIN LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
MONOLETTOR SAFETY LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
MONONINE (Coagulation Factor IX For Inj 1000 Unit) SOLR 0.74750 12/24/2010 02/19/2013
MONONINE (Coagulation Factor IX For Inj 250 Unit) SOLR 0.92237 06/26/2009 02/19/2013
MONONINE (Coagulation Factor IX For Inj 500 Unit) SOLR 0.74750 12/24/2010 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Montelukast Sodium Chew Tab 4 MG (Base Equiv) CHEW 0.44000 02/22/2013 02/19/2013
Montelukast Sodium Chew Tab 5 MG (Base Equiv) CHEW 0.44000 02/22/2013 02/19/2013
Montelukast Sodium Tab 10 MG (Base Equiv) TABS 0.44000 02/22/2013 02/19/2013
Morphine Sulfate (Concentrate) Oral Soln 20 MG/ML SOLN 0.46278 08/09/2013 08/06/2013
Morphine Sulfate Cap SR 24HR 20 MG CP24 4.74780 02/22/2013 02/19/2013
Morphine Sulfate Cap SR 24HR 30 MG CP24 5.39488 02/22/2013 02/19/2013
Morphine Sulfate Cap SR 24HR 50 MG CP24 9.03158 02/22/2013 02/19/2013
Morphine Sulfate Cap SR 24HR 60 MG CP24 9.98000 02/22/2013 02/19/2013
Morphine Sulfate Cap SR 24HR 80 MG CP24 13.32512 02/22/2013 02/19/2013
Morphine Sulfate Inj 10 MG/ML SOLN 0.79875 02/22/2013 02/19/2013
Morphine Sulfate IV Soln 50 MG/ML SOLN 0.47996 02/22/2013 02/19/2013
Morphine Sulfate Oral Soln 10 MG/5ML SOLN 0.08714 08/09/2013 08/06/2013
Morphine Sulfate Oral Soln 20 MG/5ML SOLN 0.07870 02/22/2013 02/19/2013
Morphine Sulfate Tab 30 MG TABS 0.15000 02/22/2013 02/19/2013
Morphine Sulfate Tab CR 100 MG TBCR 2.61000 10/01/2013 11/05/2013
Morphine Sulfate Tab CR 15 MG TBCR 0.52500 09/26/2013 11/05/2013
Morphine Sulfate Tab CR 200 MG TBCR 4.86000 10/14/2013 11/05/2013
Morphine Sulfate Tab CR 30 MG TBCR 0.96070 10/08/2013 12/06/2013
Morphine Sulfate Tab CR 60 MG TBCR 1.72500 10/31/2013 11/05/2013
Morphine Sulfate Tab Sol 30 MG TBSO 0.20000 02/22/2013 02/19/2013
Morphine Sulfate Tab SR 12HR 100 MG TB12 0.83569 02/22/2013 02/19/2013
Morphine Sulfate Tab SR 12HR 15 MG TB12 0.22943 02/22/2013 02/19/2013
Morphine Sulfate Tab SR 12HR 200 MG TB12 1.43280 02/22/2013 02/19/2013
Morphine Sulfate Tab SR 12HR 30 MG TB12 0.32968 02/22/2013 02/19/2013
Morphine Sulfate Tab SR 12HR 60 MG TB12 0.52321 02/22/2013 02/19/2013
MOTHERS FRIEND (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
MS CONTIN (Morphine Sulfate Tab CR 100 MG) TBCR 1.18500 05/28/2010 02/19/2013
MS CONTIN (Morphine Sulfate Tab CR 60 MG) TBCR 0.61500 04/23/2010 02/19/2013
MSUD 2 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
MSUD AID (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
MSUD ANALOG (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
MSUD COOLER (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
MSUD EXPRESS (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
MSUD GEL (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
MSUD MAXAMAID (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
MSUD MAXAMUM (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
MULTI PRENATAL (Prenatal Vit w/ Fe Fumarate-FA Tab
27-0.8 MG
TABS 0.03965 01/23/2009 02/19/2013
MULTI-BETIC (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
MULTI-BETIC DIABETES (Multiple Vitamins w/ Minerals
Tab**)
TABS 0.07430 03/20/2008 02/19/2013
MULTI-NATE 30 DHA (Prenat-Fe Bis-Fe Prot Succ-FA-Ca
Tab & Om
MISC 0.51442 01/23/2009 02/19/2013
Multiple Vitamin Cap** CAPS 0.01190 02/22/2013 02/19/2013
Multiple Vitamin Inj** INJ 0.70278 02/22/2013 02/19/2013
Page 79 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Multiple Vitamin Liquid** LIQD 0.02479 02/22/2013 02/19/2013
Multiple Vitamin Tab** TABS 0.02140 02/22/2013 02/19/2013
Multiple Vitamins w/ Iron Tab** TABS 0.04080 02/22/2013 02/19/2013
Multiple Vitamins w/ Minerals Cap** CAPS 0.08138 02/22/2013 02/19/2013
Multiple Vitamins w/ Minerals Chew Tab** CHEW 0.07430 02/22/2013 02/19/2013
Multiple Vitamins w/ Minerals Liquid** LIQD 0.02464 02/22/2013 02/19/2013
Multiple Vitamins w/ Minerals Tab CR** TBCR 0.01190 02/22/2013 02/19/2013
Multiple Vitamins w/ Minerals Tab** TABS 0.07430 02/22/2013 02/19/2013
MULTI-VITAMIN MONOCAPS (Multiple Vitamins w/ Minerals
Tab**)
TABS 0.07430 03/20/2008 02/19/2013
Mupirocin Oint 2% OINT 0.38562 02/22/2013 02/19/2013
MURO 128 (Sodium Chloride Hypertonic Ophth Oint 5%) OINT 2.82175 03/20/2008 02/19/2013
MURO 128 (Sodium Chloride Hypertonic Ophth Soln 5%) SOLN 0.67835 03/20/2008 02/19/2013
MUROCEL (Methylcellulose Ophth Soln 1%) SOLN 0.45160 04/28/2005 02/19/2013
MUSCLE BUILD-UP (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
MUSCLE POWER (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
M-VIT (Prenatal Vit w/ Fe Fumarate-FA Tab 27-1 MG***) TABS 0.07324 03/28/2011 02/19/2013
MYCELEX OTC (Clotrimazole Cream 1%) CREA 0.16850 04/23/2010 02/19/2013
MYCELEX OTC (Clotrimazole Soln 1%) SOLN 0.37400 04/28/2005 02/19/2013
MYCELEX-7 (Clotrimazole Vaginal Cream 1%) CREA 0.14028 03/13/2008 02/19/2013
Mycophenolate Mofetil Cap 250 MG CAPS 0.33562 07/12/2013 07/08/2013
Mycophenolate Mofetil Tab 500 MG TABS 0.53482 07/12/2013 07/08/2013
MYGLUCOHEALTH BLOOD GLUCO (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
MYGLUCOHEALTH BLOOD GLUCO (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
MYGLUCOHEALTH MGH SOFTLAN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
MYLANTA (Alum & Mag Hydroxide-Simethicone Susp
200-200-20 MG
SUSP 0.00530 03/13/2008 02/19/2013
MYLANTA DOUBLE-STRENGTH (Alum & Mag
Hydroxide-Simethicone Su
SUSP 0.00690 03/13/2008 02/19/2013
MYLANTA GAS (Simethicone Chew Tab 125 MG) CHEW 0.07284 03/20/2008 02/19/2013
MYLANTA MAXIMUM STRENGTH (Alum & Mag
Hydroxide-Simethicone S
SUSP 0.00690 03/13/2008 02/19/2013
MYLICON (Simethicone Susp 40 MG/0.6ML) SUSP 0.12622 03/20/2008 02/19/2013
MYLICON INFANTS GAS RELIE (Simethicone Susp 40
MG/0.6ML)
SUSP 0.12622 03/20/2008 02/19/2013
MYNATAL ADVANCE (Prenatal Vit w/ DSS-Iron Carbonyl-FA
Tab 90
TABS 0.16250 01/23/2009 02/19/2013
MYNATAL PLUS (Prenatal Vit w/ Fe Fumarate-FA Tab 65-1
MG***)
TABS 0.16510 08/29/2008 02/19/2013
MYNATAL ULTRACAPLET (Prenatal Vit w/ DSS-Iron
Carbonyl-FA Ta
TABS 0.16250 01/23/2009 02/19/2013
MYNATAL-Z (Prenatal Vit w/ Fe Fumarate-FA Tab 65-1
MG***)
TABS 0.16510 08/29/2008 02/19/2013
MYOFLEX (Trolamine Salicylate Cream 10%) CREA 0.04250 04/28/2005 02/19/2013
Nabumetone Tab 500 MG TABS 0.23322 02/22/2013 02/19/2013
Page 80 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Nabumetone Tab 750 MG TABS 0.23864 02/22/2013 02/19/2013
Nadolol Tab 160 MG TABS 0.38000 02/22/2013 02/19/2013
Nadolol Tab 20 MG TABS 2.13000 08/07/2013 09/09/2013
Nadolol Tab 40 MG TABS 3.01000 01/10/2013 02/20/2013
Nadolol Tab 40 MG TABS 3.01000 02/22/2013 02/20/2013
Nadolol Tab 80 MG TABS 3.47000 04/01/2013 04/09/2013
Naltrexone HCl Tab 50 MG TABS 1.14500 02/22/2013 02/19/2013
NAN (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
Naphazoline HCl Ophth Soln 0.1% SOLN 0.24500 04/15/2002 02/19/2013
Naphazoline w/ Pheniramine Ophth Soln 0.025-0.3% SOLN 0.35267 02/22/2013 02/19/2013
NAPHCON (Naphazoline HCl Ophth Soln 0.012%) SOLN 0.17790 04/28/2005 02/19/2013
NAPHCON-A (Naphazoline w/ Pheniramine Ophth Soln
0.025-0.3%)
SOLN 0.35267 03/20/2008 02/19/2013
Naproxen Sodium Tab 220 MG TABS 0.06800 02/22/2013 02/19/2013
Naproxen Sodium Tab 275 MG TABS 0.09521 02/22/2013 02/19/2013
Naproxen Sodium Tab 550 MG TABS 0.10161 02/22/2013 02/19/2013
Naproxen Susp 125 MG/5ML SUSP 0.07523 02/22/2013 02/19/2013
Naproxen Tab 250 MG TABS 0.05148 02/22/2013 02/19/2013
Naproxen Tab 375 MG TABS 0.05789 02/22/2013 02/19/2013
Naproxen Tab 500 MG TABS 0.04492 02/22/2013 02/19/2013
Naproxen Tab EC 375 MG TBEC 0.13650 02/22/2013 02/19/2013
Naproxen Tab EC 500 MG TBEC 0.15681 02/22/2013 02/19/2013
Naratriptan HCl Tab 1 MG (Base Equiv) TABS 6.17640 04/12/2013 04/09/2013
Naratriptan HCl Tab 2.5 MG (Base Equiv) TABS 5.52886 11/08/2013 11/05/2013
NASAL DECONGESTANT (Pseudoephedrine HCl Syrup 30
MG/5ML)
SYRP 0.01848 03/20/2008 02/19/2013
NASALCROM (Cromolyn Sodium Nasal Aerosol Soln 5.2
MG/ACT (4%
AERS 0.38197 03/13/2008 02/19/2013
Nateglinide Tab 120 MG TABS 0.95450 02/22/2013 02/19/2013
Nateglinide Tab 60 MG TABS 0.98450 02/22/2013 02/19/2013
NATRUL-CHEWS (Multiple Vitamins w/ Minerals Chew Tab**) CHEW 0.29485 03/20/2008 02/19/2013
NATRUL-MEGA-75 (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
NATRUL-VITES (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
NAVARRO BLOOD GLUCOSE TES (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
NECON 10/11-28 (Norethindrone-Eth Estradiol Tab
0.5-35/1-35
TABS 0.86000 12/28/2001 02/19/2013
Nefazodone HCl Tab 100 MG TABS 0.56000 02/22/2013 04/09/2013
Nefazodone HCl Tab 150 MG TABS 0.47500 02/22/2013 02/19/2013
Nefazodone HCl Tab 200 MG TABS 0.46900 02/22/2013 02/19/2013
Nefazodone HCl Tab 250 MG TABS 0.62000 02/22/2013 04/09/2013
Nefazodone HCl Tab 50 MG TABS 0.53000 02/22/2013 02/19/2013
NEOCATE INFANT DHA/ARA (Nutritional Supplement
Powder**)
POWD 0.20315 04/05/2011 02/19/2013
NEOCATE INFANT FORMULA (Nutritional Supplement
Powder**)
POWD 0.20315 04/05/2011 02/19/2013
Page 81 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
NEOCATE JUNIOR (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
NEOCATE JUNIOR/PREBIOTICS (Nutritional Supplement
Powder**)
POWD 0.20315 04/05/2011 02/19/2013
NEOCATE NUTRA (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
NEOCATE ONE + (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
Neomycin Sulfate Tab 500 MG TABS 0.99092 02/22/2013 02/19/2013
Neomycin-Bacitrac Zn-Polymyx 5(3.5)MG-400Unt-10000Unt
Op Oin
OINT 3.91990 02/22/2013 02/19/2013
Neomycin-Bacitracin-Polymyxin Oint*** OINT 0.07143 02/22/2013 02/19/2013
Neomycin-Bacitracin-Polymyxin-Pramoxine Oint 1% OINT 0.06350 02/22/2013 02/19/2013
Neomycin-Polymyx-Gramicid Op Sol
1.75-10000-0.25MG-UNT-MG/ML
SOLN 4.92000 07/17/2013 10/09/2013
Neomycin-Polymyxin B GU Irrigation Soln SOLN 8.06000 02/22/2013 02/19/2013
Neomycin-Polymyxin-Dexamethasone Ophth Oint 0.1% OINT 3.65000 02/22/2013 02/19/2013
Neomycin-Polymyxin-Dexamethasone Ophth Susp 0.1% SUSP 2.26600 02/22/2013 02/19/2013
Neomycin-Polymyxin-HC Ophth Susp SUSP 12.05000 02/22/2013 02/19/2013
Neomycin-Polymyxin-HC Otic Soln 1% SOLN 2.14000 08/29/2013 09/09/2013
Neomycin-Polymyxin-HC Otic Susp 3.5 MG/ML-10000
Unit/ML-1%
SUSP 1.79265 02/22/2013 02/19/2013
NEORAL (Cyclosporine Modified Oral Soln 100 MG/ML) SOLN 6.09486 01/03/2013 02/20/2013
NEOSALUS (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
NEOSPORIN ORIGINAL (Neomycin-Bacitracin-Polymyxin
Oint***)
OINT 0.14310 03/20/2008 02/19/2013
NEOSURE ADVANCE (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
NEPHRO-VITE (B-Complex w/ C & Folic Acid Tab 0.8 MG***) TABS 0.08400 03/13/2008 02/19/2013
NEPRO (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NEPRO (Nutritional Supplement Liquid**) LIQD 0.06930 05/28/2010 02/19/2013
NEPRO WITH CARB STEADY (Nutritional Supplement
Liquid**)
LIQD 0.00720 04/28/2005 02/19/2013
NEPRO WITH CARB STEADY (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
NEPRO WITH CARB STEADY (Nutritional Supplement
Liquid**)
LIQD 0.01431 06/01/2010 02/19/2013
NEPRO WITH CARB STEADY (Nutritional Supplement
Liquid**)
LIQD 0.06930 05/28/2010 02/19/2013
NETGROUP LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
NEULASTA (Pegfilgrastim Inj 6 MG/0.6ML) SOLN 6,004.22000 04/13/2012 02/19/2013
NEUPOGEN (Filgrastim Inj 300 MCG/0.5ML (600 MCG/ML)) SOLN 617.81800 07/19/2013 08/06/2013
NEUPOGEN (Filgrastim Inj 300 MCG/ML) SOLN 291.42960 07/19/2013 10/09/2013
NEUPOGEN (Filgrastim Inj 480 MCG/0.8ML (600 MCG/ML)) SOLN 575.19000 07/20/2012 02/19/2013
NEUPOGEN (Filgrastim Inj 480 MCG/0.8ML (600 MCG/ML)) SOLN 614.90500 07/19/2013 09/09/2013
NEUPOGEN (Filgrastim Inj 480 MCG/1.6ML (300 MCG/ML)) SOLN 290.02275 07/19/2013 10/09/2013
NEUTEK 2TEK TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
NEUTRAPHOR (Dimethicone Cream 1%) CREA 0.06060 04/28/2005 02/19/2013
NEUTRAPHORUS REX (Dimethicone Cream 1%) CREA 0.06060 04/28/2005 02/19/2013
NEUTRA-PHOS (Potassium & Sodium Phosphates Powder
Pack 278-1
PACK 0.45878 03/20/2008 02/19/2013
Page 82 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
NEUTRA-PHOS-K (Potassium Phosphate Powder Pack
556-250 MG)
PACK 0.44320 04/28/2005 02/19/2013
NEUTROGENA HEALTHY SKIN F (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
NEUTROGENA MOISTURE SENSI (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
NEUTROGENA ON-THE-SPOT AC (Benzoyl Peroxide Cream
2.5%)
CREA 0.25500 08/29/2008 02/19/2013
NEUTROGENA T/GEL (Coal Tar Shampoo 0.5%) SHAM 0.02261 03/13/2008 02/19/2013
NEUTROGENA T/GEL STUBBORN (Coal Tar Shampoo
0.5%)
SHAM 0.02261 03/13/2008 02/19/2013
Nevirapine Tab 200 MG TABS 0.22000 02/22/2013 02/19/2013
NEXAVAR (Sorafenib Tosylate Tab 200 MG (Base
Equivalent))
TABS 69.53450 04/13/2012 02/19/2013
NEXGEN TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
Niacin Cap CR 250 MG CPCR 0.05797 02/22/2013 02/19/2013
Niacin Cap CR 500 MG CPCR 0.06311 02/22/2013 02/19/2013
Niacin Tab 100 MG TABS 0.01180 02/22/2013 02/19/2013
Niacin Tab 250 MG TABS 0.02150 02/22/2013 02/19/2013
Niacin Tab 50 MG TABS 0.01340 02/22/2013 02/19/2013
Niacin Tab 500 MG TABS 0.02580 02/22/2013 02/19/2013
Niacin Tab CR 1000 MG TBCR 0.06600 02/22/2013 02/19/2013
Niacin Tab CR 250 MG TBCR 0.07291 02/22/2013 02/19/2013
Niacin Tab CR 500 MG TBCR 0.05066 02/22/2013 02/19/2013
Niacin Tab CR 750 MG TBCR 0.06310 02/22/2013 02/19/2013
Niacinamide Tab 500 MG TABS 0.02990 02/22/2013 02/19/2013
Nicardipine HCl Cap 20 MG CAPS 0.08520 02/22/2013 02/19/2013
Nicardipine HCl Cap 30 MG CAPS 0.32000 02/22/2013 02/19/2013
NICAZEL (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
NICORETTE (Nicotine Polacrilex Gum 2 MG) GUM 0.21480 05/28/2010 02/19/2013
NICORETTE (Nicotine Polacrilex Gum 2 MG) GUM 0.24650 12/27/2008 02/19/2013
NICORETTE REFILL (Nicotine Polacrilex Gum 2 MG) GUM 0.21480 05/28/2010 02/19/2013
NICORETTE STARTER KIT (Nicotine Polacrilex Gum 2 MG) GUM 0.21480 05/28/2010 02/19/2013
Nicotine Polacrilex Gum 2 MG GUM 0.21480 02/22/2013 02/19/2013
Nicotine Polacrilex Gum 4 MG GUM 0.26720 02/22/2013 02/19/2013
Nicotine Polacrilex Lozenge 2 MG LOZG 0.42639 02/22/2013 02/19/2013
Nicotine Polacrilex Lozenge 4 MG LOZG 0.46158 02/22/2013 02/19/2013
Nicotine TD Patch 24HR 14 MG/24HR PT24 1.85620 02/22/2013 02/19/2013
Nicotine TD Patch 24HR 21 MG/24HR PT24 1.56500 02/22/2013 02/19/2013
Nicotine TD Patch 24HR 7 MG/24HR PT24 1.91000 02/22/2013 02/19/2013
Nifedipine Cap 10 MG CAPS 0.70700 02/22/2013 02/19/2013
Nifedipine Cap 20 MG CAPS 1.25530 02/22/2013 02/19/2013
Nifedipine Tab SR 24HR 30 MG TB24 0.51500 02/22/2013 02/19/2013
Nifedipine Tab SR 24HR 60 MG TB24 0.97850 02/22/2013 02/19/2013
Nifedipine Tab SR 24HR 90 MG TB24 1.69400 02/22/2013 02/19/2013
Nifedipine Tab SR 24HR Osmotic 30 MG TB24 0.43472 02/22/2013 02/19/2013
Nifedipine Tab SR 24HR Osmotic 60 MG TB24 0.85412 02/22/2013 02/19/2013
Page 83 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Nifedipine Tab SR 24HR Osmotic 90 MG TB24 0.98782 02/22/2013 02/19/2013
Nisoldipine Tab SR 24HR 17 MG TB24 4.86558 11/08/2013 11/05/2013
Nisoldipine Tab SR 24HR 25.5 MG TB24 6.55000 02/22/2013 02/19/2013
Nisoldipine Tab SR 24HR 34 MG TB24 6.55000 02/22/2013 02/19/2013
Nisoldipine Tab SR 24HR 8.5 MG TB24 4.77000 02/22/2013 02/19/2013
Nitrofurantoin Macrocrystalline Cap 100 MG CAPS 2.31250 02/22/2013 02/19/2013
Nitrofurantoin Macrocrystalline Cap 50 MG CAPS 0.94000 02/22/2013 02/19/2013
Nitrofurantoin Monohydrate Macrocrystalline Cap 100 MG CAPS 2.31250 02/22/2013 02/19/2013
Nitrofurantoin Susp 25 MG/5ML SUSP 1.82443 07/12/2013 07/08/2013
Nitroglycerin Cap CR 2.5 MG CPCR 0.06100 02/22/2013 02/19/2013
Nitroglycerin Cap CR 6.5 MG CPCR 0.07900 02/22/2013 02/19/2013
Nitroglycerin Cap CR 9 MG CPCR 0.11300 02/22/2013 02/19/2013
Nitroglycerin SL Tab 0.3 MG SUBL 0.05500 02/22/2013 02/19/2013
Nitroglycerin SL Tab 0.6 MG SUBL 0.05500 02/22/2013 02/19/2013
Nitroglycerin TD Patch 24HR 0.1 MG/HR PT24 0.62500 02/22/2013 02/19/2013
Nitroglycerin TD Patch 24HR 0.2 MG/HR PT24 0.54291 02/22/2013 02/19/2013
Nitroglycerin TD Patch 24HR 0.4 MG/HR PT24 0.52726 02/22/2013 02/19/2013
Nitroglycerin TD Patch 24HR 0.6 MG/HR PT24 0.93708 02/22/2013 02/19/2013
NITRO-PRO (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NIVEA (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
NIVEA EXTRA ENRICHED (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
NIVEA EXTRA ENRICHED LOTI (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
NIVEA GENTLE BODY EXFOLIA (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
NIVEA LIGHT (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
NIVEA ORIGINAL (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
NIVEA ORIGINAL MOISTURE (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
NIVEA VISAGE (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
NIX COMPLETE LICE SYSTEM (Permethrin Creme Rinse
1%)
LIQD 0.10546 03/20/2008 02/19/2013
NIX CREME RINSE (Permethrin Creme Rinse 1%) LIQD 0.10546 03/20/2008 02/19/2013
Nizatidine Cap 150 MG CAPS 0.32351 02/22/2013 02/19/2013
Nizatidine Cap 300 MG CAPS 0.72724 02/22/2013 02/19/2013
Nizatidine Oral Soln 15 MG/ML SOLN 0.69823 02/22/2013 02/19/2013
NIZORAL A-D (Ketoconazole Shampoo 1%) SHAM 0.06388 03/20/2008 02/19/2013
NO IRON MULTIPLE VITAMIN/ (Multiple Vitamins w/ Minerals
Tab
TABS 0.07430 03/20/2008 02/19/2013
NORDITROPIN CARTRIDGE (Somatropin Inj 15 MG/1.5ML) SOLN 805.68654 12/27/2012 02/20/2013
NORDITROPIN CARTRIDGE (Somatropin Inj 5 MG/1.5ML) SOLN 268.56030 12/27/2012 03/04/2013
NORDITROPIN FLEXPRO (Somatropin Inj 10 MG/1.5ML) SOLN 537.12066 12/27/2012 02/20/2013
NORDITROPIN FLEXPRO (Somatropin Inj 15 MG/1.5ML) SOLN 805.68654 12/27/2012 02/20/2013
NORDITROPIN FLEXPRO (Somatropin Inj 5 MG/1.5ML) SOLN 268.56030 12/27/2012 03/04/2013
NORDITROPIN NORDIFLEX PEN (Somatropin Inj 10
MG/1.5ML)
SOLN 537.12066 12/27/2012 02/20/2013
NORDITROPIN NORDIFLEX PEN (Somatropin Inj 15
MG/1.5ML)
SOLN 805.68654 12/27/2012 02/20/2013
Page 84 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
NORDITROPIN NORDIFLEX PEN (Somatropin Inj 30
MG/3ML)
SOLN 697.20000 11/11/2011 02/19/2013
NORDITROPIN NORDIFLEX PEN (Somatropin Inj 5
MG/1.5ML)
SOLN 268.56030 12/27/2012 03/04/2013
Norethindrone & Ethinyl Estradiol Tab 0.4 MG-35 MCG TABS 1.01310 02/22/2013 02/20/2013
Norethindrone & Ethinyl Estradiol Tab 0.5 MG-35 MCG TABS 0.86333 02/22/2013 02/19/2013
Norethindrone & Ethinyl Estradiol Tab 1 MG-35 MCG TABS 0.69172 02/22/2013 02/19/2013
Norethindrone Ace & Ethinyl Estradiol Tab 1 MG-20 MCG TABS 1.03450 02/22/2013 02/19/2013
Norethindrone Ace & Ethinyl Estradiol Tab 1.5 MG-30 MCG TABS 0.88413 02/22/2013 02/19/2013
Norethindrone Ace & Ethinyl Estradiol-FE Tab 1 MG-20 MCG TABS 0.74450 02/22/2013 02/19/2013
Norethindrone Ace & Ethinyl Estradiol-FE Tab 1.5 MG-30
MCG
TABS 0.59690 02/22/2013 02/19/2013
Norethindrone Acetate Tab 5 MG TABS 1.77800 02/22/2013 02/19/2013
Norethindrone Acetate-Ethinyl Estradiol Tab 1 MG-5 MCG TABS 2.21976 02/22/2013 02/19/2013
Norethindrone Ac-Ethinyl Estrad-Fe Tab 1-20/1-30/1-35
MG-MCG
TABS 1.43244 02/22/2013 02/19/2013
Norethindrone Tab 0.35 MG TABS 0.79562 02/22/2013 02/19/2013
Norethindrone-Eth Estradiol Tab 0.5-35/0.75-35/1-35
MG-MCG
TABS 0.73292 02/22/2013 02/19/2013
Norethindrone-Eth Estradiol Tab 0.5-35/1-35/0.5-35 MG-MCG TABS 0.73313 02/22/2013 02/19/2013
Norgestimate & Ethinyl Estradiol Tab 0.25 MG-35 MCG TABS 0.40523 02/22/2013 02/19/2013
Norgestimate-Eth Estrad Tab 0.18-35/0.215-35/0.25-35
MG-MCG
TABS 0.45250 02/22/2013 02/19/2013
Norgestrel & Ethinyl Estradiol Tab 0.3 MG-30 MCG TABS 0.66252 02/22/2013 02/19/2013
NORPRAMIN (Desipramine HCl Tab 50 MG) TABS 1.44450 06/14/2010 02/19/2013
Nortriptyline HCl Cap 10 MG CAPS 0.09983 02/22/2013 02/19/2013
Nortriptyline HCl Cap 25 MG CAPS 0.12050 02/22/2013 02/19/2013
Nortriptyline HCl Cap 50 MG CAPS 0.16500 02/22/2013 02/19/2013
Nortriptyline HCl Cap 75 MG CAPS 0.27500 02/22/2013 02/19/2013
Nortriptyline HCl Soln 10 MG/5ML SOLN 0.21500 07/13/2013 08/06/2013
NOVA MAX BLOOD GLUCOSE MO (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
NOVA MAX GLUCOSE TEST STR (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
NOVA SAFETY LANCETS 23G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
NOVA SAFETY LANCETS 28G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
NOVA SUREFLEX LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
NOVASOURCE PULMONARY (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
NOVASOURCE RENAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NOVASOURCE RENAL (Nutritional Supplement Liquid**) LIQD 0.01423 09/15/2009 02/19/2013
NOVOSEVEN (Coagulation Factor VIIa (Recomb) For Inj 1.2
MG (
SOLR 1.17560 06/26/2009 02/19/2013
NOVOSEVEN (Coagulation Factor VIIa (Recomb) For Inj 2.4
MG (
SOLR 1.17560 06/26/2009 02/19/2013
NOVOSEVEN (Coagulation Factor VIIa (Recomb) For Inj 4.8
MG (
SOLR 1.17560 06/26/2009 02/19/2013
Page 85 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
NOVOSEVEN RT (Coagulation Factor VIIa (Recomb) For Inj
1 MG
SOLR 1.66000 11/01/2011 02/19/2013
NOVOSEVEN RT (Coagulation Factor VIIa (Recomb) For Inj
2 MG
SOLR 1.66000 11/01/2011 02/19/2013
NOVOSEVEN RT (Coagulation Factor VIIa (Recomb) For Inj
5 MG
SOLR 1.66000 11/01/2011 02/19/2013
NOVOSEVEN RT (Coagulation Factor VIIa (Recomb) For Inj
8 MG
SOLR 1.66000 11/01/2011 02/19/2013
NOVOSEVEN RT (Coagulation Factor VIIa (Recomb) For Inj
8 MG
SOLR 1.66000 07/12/2013 07/09/2013
NU/TASTE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NUBASICS (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NUBASICS PLUS (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NUPRIN (Ibuprofen Tab 200 MG) TABS 0.04570 03/20/2008 02/19/2013
NUTRA BALANCE DIABETIC NU (Nutritional Supplement
Bar**)
BAR 0.46070 04/28/2005 02/19/2013
NUTRA SHAKE/FRUIT PLUS (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
NUTRA/SHAKE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NUTRA/SHAKE CITRUS (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NUTRA/SHAKE FIBRE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NUTRA/SHAKE FREE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NUTRA/SHAKE SUPREME (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NUTRADERM (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
NUTRADERM ADVANCED FORMUL (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
NUTRADERM-30 (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
NUTRAMENT (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NUTRAMINE (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
NUTRAMINE AMINO BITES CHO (Nutritional Supplement
Pack**)
PACK 9.02000 06/15/2011 02/19/2013
NUTRAMINE AMINO BITES MIX (Nutritional Supplement
Pack**)
PACK 9.02000 06/15/2011 02/19/2013
NUTRAMINE AMINO BITES PEA (Nutritional Supplement
Pack**)
PACK 9.02000 06/15/2011 02/19/2013
NUTRAMINE AMINO BITES RAS (Nutritional Supplement
Pack**)
PACK 9.02000 06/15/2011 02/19/2013
NUTRAMINE APPLE AMINO BIT (Nutritional Supplement
Pack**)
PACK 9.02000 06/15/2011 02/19/2013
NUTRAMINE BANANA AMINO B (Nutritional Supplement
Pack**)
PACK 9.02000 06/15/2011 02/19/2013
NUTRAMINE CHOCOLATE AMINO (Nutritional Supplement
Pack**)
PACK 9.02000 06/15/2011 02/19/2013
NUTRAMINE MANGO AMINO BI (Nutritional Supplement
Pack**)
PACK 9.02000 06/15/2011 02/19/2013
NUTRAMINE MIXED FLAVORS A (Nutritional Supplement
Pack**)
PACK 9.02000 06/15/2011 02/19/2013
NUTRAMINE PEACHES & CREAM (Nutritional Supplement
Pack**)
PACK 9.02000 06/15/2011 02/19/2013
Page 86 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
NUTRAMINE PINEAPPLE AMINO (Nutritional Supplement
Pack**)
PACK 9.02000 06/15/2011 02/19/2013
NUTRAMINE T (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
NUTRAMINE T AMINO BITES (Nutritional Supplement
Pack**)
PACK 9.02000 06/15/2011 02/19/2013
NUTRAMINE T AMINO BITES M (Nutritional Supplement
Pack**)
PACK 9.02000 06/15/2011 02/19/2013
NUTRASENTIALS (Amino Acids Oral Powder***) POWD 0.33438 06/27/2012 02/19/2013
NUTREN 1.0 (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NUTREN 1.0/FIBER (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NUTREN 1.0/FIBER/ULTRAPAK (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
NUTREN 1.5 (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NUTREN 1.5 FIBER (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NUTREN 2.0 (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NUTREN GLYTROL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NUTREN JUNIOR (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NUTREN JUNIOR/FIBER (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NUTREN PULMONARY (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NUTREN RENAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NUTREN REPLETE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NUTREN REPLETE FIBER (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NUTRICAP (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
NUTRIHEAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NUTRIHEP (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NUTRIRENAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
Nutritional Supplement Liquid** LIQD 0.01410 02/22/2013 02/19/2013
Nutritional Supplement Powder** POWD 0.20315 02/22/2013 02/19/2013
NUTRIVENT (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NUTRIVENT 1.5 (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
NUTRIVIR (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
NUTRIVIR NSA (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
NUTROPIN (Somatropin For Inj 10 MG) SOLR 703.41670 11/11/2011 02/19/2013
NUTROPIN (Somatropin For Subcutaneous Inj 5 MG) SOLR 417.58960 07/01/2013 08/06/2013
NUTROPIN AQ (Somatropin Inj 10 MG/2ML) SOLN 406.96560 12/18/2012 02/20/2013
NUTROPIN AQ NUSPIN 10 (Somatropin Inj 10 MG/2ML) SOLN 406.96560 12/18/2012 02/20/2013
NUTROPIN AQ NUSPIN 20 (Somatropin Inj 20 MG/2ML) SOLN 813.93120 12/18/2012 02/20/2013
NUTROPIN AQ NUSPIN 5 (Somatropin Inj 5 MG/2ML) SOLN 174.47015 11/11/2011 02/19/2013
NUTROPIN AQ PEN (Somatropin Inj 10 MG/2ML) SOLN 406.96560 12/18/2012 02/20/2013
NUTROPIN AQ PEN (Somatropin Inj 20 MG/2ML) SOLN 813.93120 12/18/2012 02/20/2013
Nystatin Cream 100000 Unit/GM CREA 0.86800 02/22/2013 02/19/2013
Nystatin Oint 100000 Unit/GM OINT 0.62000 12/07/2012 05/15/2013
Nystatin Susp 100000 Unit/ML SUSP 0.15551 08/09/2013 08/06/2013
Nystatin Tab 500000 Unit TABS 0.42100 02/22/2013 02/19/2013
Nystatin Topical Powder** POWD 0.99000 02/22/2013 02/19/2013
Page 87 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Nystatin-Triamcinolone Cream 100000-0.1 Unit/GM-% CREA 4.07000 06/06/2013 07/09/2013
Nystatin-Triamcinolone Oint 100000-0.1 Unit/GM-% OINT 0.09750 02/22/2013 02/19/2013
OA 1 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
OA 1 DIET (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
OA 2 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
OA 2 DIET (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
O-CAL FA (Prenatal Vit w/ Fe Fumarate-FA Tab 27-1 MG***) TABS 0.07324 03/28/2011 02/19/2013
OCEAN NASAL SPRAY (Saline Nasal Spray 0.65%) SOLN 0.03390 03/20/2008 02/19/2013
OCTAGAM (Immune Globulin (Human) IV Soln 1 GM/20ML) SOLN 5.72492 08/09/2013 08/07/2013
OCTAGAM (Immune Globulin (Human) IV Soln 10
GM/200ML)
SOLN 5.72500 06/02/2013 08/07/2013
OCTAGAM (Immune Globulin (Human) IV Soln 2.5
GM/50ML)
SOLN 5.72500 06/01/2013 08/07/2013
OCTAGAM (Immune Globulin (Human) IV Soln 25
GM/500ML)
SOLN 5.72500 08/09/2013 08/07/2013
OCTAGAM (Immune Globulin (Human) IV Soln 5 GM/100ML) SOLN 5.72500 06/01/2013 08/07/2013
OCTOGEN-2 HEATING RUB (Liniments & Rubs - Cream**) CREA 0.02880 04/28/2005 02/19/2013
Octreotide Acetate Inj 100 MCG/ML (0.1 MG/ML) SOLN 4.55000 02/22/2013 02/19/2013
Octreotide Acetate Inj 1000 MCG/ML (1 MG/ML) SOLN 72.80000 02/22/2013 02/19/2013
Octreotide Acetate Inj 200 MCG/ML (0.2 MG/ML) SOLN 9.10000 02/22/2013 02/19/2013
Octreotide Acetate Inj 50 MCG/ML (0.05 MG/ML) SOLN 5.72000 02/22/2013 02/19/2013
Octreotide Acetate Inj 500 MCG/ML (0.5 MG/ML) SOLN 21.45000 02/22/2013 02/19/2013
OCUFLOX (Ofloxacin Ophth Soln 0.3%) SOLN 0.82780 04/23/2010 02/19/2013
OCUVITE ADULT 50+ (Multiple Vitamins w/ Minerals Cap**) CAPS 0.51325 04/27/2011 02/19/2013
OCUVITE ADULT FORMULA (Multiple Vitamins w/ Minerals
Cap**)
CAPS 0.51325 04/27/2011 02/19/2013
OCUVITE LUTEIN (Multiple Vitamins w/ Minerals Cap**) CAPS 0.51325 04/27/2011 02/19/2013
Ofloxacin Ophth Soln 0.3% SOLN 0.65284 02/22/2013 02/19/2013
Ofloxacin Otic Soln 0.3% SOLN 1.78000 09/25/2013 10/09/2013
Ofloxacin Tab 200 MG TABS 2.47300 02/22/2013 02/19/2013
Ofloxacin Tab 300 MG TABS 2.72700 02/22/2013 02/19/2013
Ofloxacin Tab 400 MG TABS 2.72300 02/22/2013 02/19/2013
Olanzapine Orally Disintegrating Tab 10 MG TBDP 3.59748 05/10/2013 05/07/2013
Olanzapine Orally Disintegrating Tab 15 MG TBDP 6.04000 09/13/2013 09/09/2013
Olanzapine Orally Disintegrating Tab 20 MG TBDP 5.51000 07/12/2013 07/08/2013
Olanzapine Orally Disintegrating Tab 5 MG TBDP 2.28862 09/13/2013 09/09/2013
Olanzapine Tab 10 MG TABS 0.42162 02/22/2013 02/19/2013
Olanzapine Tab 15 MG TABS 0.63005 02/22/2013 02/19/2013
Olanzapine Tab 2.5 MG TABS 0.25045 02/22/2013 02/19/2013
Olanzapine Tab 20 MG TABS 0.70500 03/08/2013 03/04/2013
Olanzapine Tab 5 MG TABS 0.27603 02/22/2013 02/19/2013
Olanzapine Tab 7.5 MG TABS 0.34060 02/22/2013 02/19/2013
Omega-3 Fatty Acids Cap 1000 MG** CAPS 0.09455 02/22/2013 02/19/2013
Omega-3 Fatty Acids Cap 500 MG** CAPS 0.11900 02/22/2013 02/19/2013
Omeprazole Cap Delayed Release 10 MG CPDR 0.34142 02/22/2013 02/19/2013
Page 88 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Omeprazole Cap Delayed Release 20 MG CPDR 0.12125 02/22/2013 02/19/2013
Omeprazole Cap Delayed Release 40 MG CPDR 0.29582 02/22/2013 02/19/2013
Omeprazole-Sodium Bicarbonate Cap 20-1100 MG CAPS 5.38000 02/22/2013 02/19/2013
Omeprazole-Sodium Bicarbonate Cap 40-1100 MG CAPS 5.35694 02/22/2013 02/19/2013
OMNI GEL (Stannous Fluoride Gel 0.4%) GEL 0.06033 03/20/2008 02/19/2013
OMNICAP (Multiple Vitamin Tab**) TABS 0.02140 03/20/2008 02/19/2013
OMNITROPE (Somatropin For Inj 5.8 MG) SOLR 270.67020 07/01/2013 08/07/2013
OMNITROPE (Somatropin Inj 10 MG/1.5ML) SOLN 537.12066 12/27/2012 02/20/2013
OMNITROPE (Somatropin Inj 5 MG/1.5ML) SOLN 268.56030 12/27/2012 03/04/2013
OMSOLITE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
ON CALL LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ON CALL PLUS BLOOD GLUCOS (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
ON CALL PLUS BLOOD GLUCOS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ON CALL PLUS LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ON CALL VIVID BLOOD GLUCO (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
ON CALL VIVID BLOOD GLUCO (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ONCASPAR (Pegaspargase Inj 750 Unit/ML) SOLN 1,129.46400 04/13/2012 02/19/2013
ONCOVITE (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
Ondansetron HCl Inj 4 MG/2ML (2 MG/ML) SOLN 0.14960 02/22/2013 02/19/2013
Ondansetron HCl Inj 40 MG/20ML (2 MG/ML) SOLN 0.14960 02/22/2013 02/19/2013
Ondansetron HCl Oral Soln 4 MG/5ML SOLN 1.05000 04/12/2013 04/09/2013
Ondansetron HCl Tab 24 MG TABS 4.02100 02/22/2013 02/19/2013
Ondansetron HCl Tab 4 MG TABS 0.19192 02/22/2013 02/19/2013
Ondansetron HCl Tab 8 MG TABS 0.22411 02/22/2013 02/19/2013
Ondansetron Orally Disintegrating Tab 4 MG TBDP 0.67000 08/26/2013 10/09/2013
Ondansetron Orally Disintegrating Tab 8 MG TBDP 0.45562 02/22/2013 02/19/2013
ONE DAILY MENS FORMULA W/ (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
ONE-A-DAY 50 PLUS (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
ONE-A-DAY ENERGY (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
ONE-A-DAY ESSENTIAL (Multiple Vitamin Tab**) TABS 0.02140 03/20/2008 02/19/2013
ONE-A-DAY MAXIMUM FORMULA (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
ONE-A-DAY MENOPAUSE FORMU (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
ONE-A-DAY MENS (Multiple Vitamin Tab**) TABS 0.02140 03/20/2008 02/19/2013
ONE-A-DAY MENS 50+ ADVANT (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
ONE-A-DAY MENS HEALTH FOR (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
ONE-A-DAY MENS PRO EDGE (Multiple Vitamins w/
Minerals Tab**
TABS 0.07430 03/20/2008 02/19/2013
ONE-A-DAY MENS VITACRAVES (Multiple Vitamins w/
Minerals Che
CHEW 0.29485 03/20/2008 02/19/2013
Page 89 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
ONE-A-DAY TEEN ADVANTAGE (Multiple Vitamins w/
Minerals Tab*
TABS 0.07430 03/20/2008 02/19/2013
ONE-A-DAY VITACRAVES (Multiple Vitamins w/ Minerals
Chew Tab
CHEW 0.29485 03/20/2008 02/19/2013
ONE-A-DAY VITACRAVES GUMM (Multiple Vitamins w/
Minerals Che
CHEW 0.29485 03/20/2008 02/19/2013
ONE-A-DAY VITACRAVES SOUR (Multiple Vitamins w/
Minerals Che
CHEW 0.29485 03/20/2008 02/19/2013
ONE-A-DAY WEIGHT SMART AD (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
ONE-A-DAY WOMENS 50+ ADVA (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
ONE-A-DAY WOMENS ACTIVE M (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
ONE-A-DAY WOMENS PETITES (Multiple Vitamins w/
Minerals Tab*
TABS 0.07430 03/20/2008 02/19/2013
ONE-A-DAY WOMENS PLUS HEA (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
ONE-A-DAY WOMENS VITACRAV (Multiple Vitamins w/
Minerals Che
CHEW 0.29485 03/20/2008 02/19/2013
ONETOUCH BASIC SYSTEM (Blood Glucose Monitoring Kit
w/ Devic
KIT 0.71000 10/01/2003 02/19/2013
ONETOUCH BASIC/PROFILE TE (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ONETOUCH BASIC/PROFILE/ON (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ONETOUCH CLUB LANCETS FIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ONETOUCH COMBO PACK (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ONETOUCH DELICA LANCETS E (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ONETOUCH DELICA LANCETS F (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ONETOUCH FINEPOINT LANCET (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ONETOUCH LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ONETOUCH PROFILE SYSTEM (Blood Glucose Monitoring
Kit w/ Dev
KIT 0.71000 10/01/2003 02/19/2013
ONETOUCH TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ONETOUCH ULTRA 2 (Blood Glucose Monitoring Kit w/
Device***)
KIT 0.71000 10/01/2003 02/19/2013
ONETOUCH ULTRA 2 (Blood Glucose Monitoring Kit w/
Device***)
KIT 57.10000 05/05/2010 02/19/2013
ONETOUCH ULTRA BLUE (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ONETOUCH ULTRA BLUE (Glucose Blood Test Strip) STRP 1.12400 05/12/2012 02/19/2013
ONETOUCH ULTRA BLUE (Glucose Blood Test Strip) STRP 1.19340 02/25/2013 04/09/2013
ONETOUCH ULTRA BLUE (Glucose Blood Test Strip) STRP 1.19340 02/28/2013 04/09/2013
ONETOUCH ULTRA MINI (Blood Glucose Monitoring Kit w/
Device*
KIT 0.71000 10/01/2003 02/19/2013
ONETOUCH ULTRA MINI (Blood Glucose Monitoring Kit w/
Device*
KIT 0.71000 04/23/2010 02/19/2013
ONETOUCH ULTRA SYSTEM KIT (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
ONETOUCH ULTRALINK SYSTEM (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
Page 90 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
ONETOUCH ULTRASMART (Blood Glucose Monitoring Kit
w/ Device*
KIT 0.71000 10/01/2003 02/19/2013
ONETOUCH ULTRASOFT LANCET (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ONETOUCH VERIO IQ BLOOD G (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
ONETOUCH VERIO TEST STRIP (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
Ophthalmic Irrigation Solution*** SOLN 0.01334 02/22/2013 02/19/2013
Opium Tincture 1% (10 MG/ML) (Morphine Equiv) TINC 4.95763 02/22/2013 02/19/2013
OPTIMENTAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
OPTIMENTAL (Nutritional Supplement Liquid**) LIQD 0.02746 03/24/2010 02/19/2013
OPTIMUM AIRVITES (Multiple Vitamins w/ Minerals Chew
Tab**)
CHEW 0.29485 03/20/2008 02/19/2013
OPTISOURCE (Multiple Vitamins w/ Minerals Chew Tab**) CHEW 0.29485 03/20/2008 02/19/2013
OPTIUM BLOOD GLUCOSE MONI (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
OPTIUM TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
OPTIUMEZ TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
OPTIVITE P.M.T. (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
OPTI-WOMAN (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
Oral Electrolyte Solution*** SOLN 0.00560 02/22/2013 02/19/2013
ORAMORPH SR (Morphine Sulfate Tab CR 100 MG) TBCR 1.18500 05/28/2010 02/19/2013
ORAMORPH SR (Morphine Sulfate Tab CR 60 MG) TBCR 0.61500 04/23/2010 02/19/2013
ORENCIA (Abatacept For IV Soln 250 MG) SOLR 641.10800 08/15/2013 09/09/2013
ORFADIN (Nitisinone Cap 5 MG) CAPS 148.29222 04/13/2012 02/19/2013
ORFADIN (Nitisinone Cap 5 MG) CAPS 173.04033 10/01/2013 10/09/2013
ORGANIC PEDIA SMART (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
Orphenadrine Citrate Tab SR 12HR 100 MG TB12 0.44788 02/22/2013 02/19/2013
ORPHENADRINE COMPOUND DS (Orphenadrine w/ Aspirin
& Caffeine
TABS 0.85000 04/15/2002 02/19/2013
Orphenadrine w/ Aspirin & Caffeine Tab 25-385-30 MG TABS 0.60000 02/22/2013 02/19/2013
Orphenadrine w/ Aspirin & Caffeine Tab 50-770-60 MG TABS 0.85000 02/22/2013 02/19/2013
ORTHOVISC (Hyaluronan Intra-articular Inj 15 MG/ML) SOLN 136.95000 04/13/2012 02/19/2013
OS 2 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
OS-CAL (Calcium Carbonate-Cholecalciferol Chew Tab 500
MG-60
CHEW 0.09901 03/13/2008 02/19/2013
OS-CAL 500+D (Calcium Carbonate-Vitamin D Chew Tab 500
MG-50
CHEW 0.09901 03/13/2008 02/19/2013
OS-CAL ULTRA (Calcium Carbonate-Vit D-C-E w/ Minerals
Tabs 6
TABS 0.08770 04/28/2005 02/19/2013
OSMOLITE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
OSMOLITE 1 CAL (Nutritional Supplement Liquid**) LIQD 0.00720 04/28/2005 02/19/2013
OSMOLITE 1 CAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
OSMOLITE 1.2 CAL (Nutritional Supplement Liquid**) LIQD 0.00720 04/28/2005 02/19/2013
OSMOLITE 1.2 CAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
OSMOLITE 1.5 CAL (Nutritional Supplement Liquid**) LIQD 0.00720 04/28/2005 02/19/2013
OSMOLITE 1.5 CAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
OSMOLITE HN (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
OSMOLITE HN PLUS (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
Oxaliplatin IV Soln 100 MG/20ML SOLN 60.10000 02/22/2013 02/19/2013
Oxaliplatin IV Soln 50 MG/10ML SOLN 60.10000 02/22/2013 02/19/2013
Oxaliplatin For IV Inj 100 MG SOLR 1,607.58000 02/22/2013 02/19/2013
Oxaliplatin For IV Inj 50 MG SOLR 772.20000 02/22/2013 02/19/2013
Oxandrolone Tab 10 MG TABS 11.64530 02/22/2013 02/19/2013
Oxandrolone Tab 2.5 MG TABS 3.19985 02/22/2013 02/19/2013
Oxaprozin Tab 600 MG TABS 2.60000 12/07/2012 05/15/2013
Oxazepam Cap 10 MG CAPS 0.86000 02/22/2013 02/19/2013
Oxazepam Cap 15 MG CAPS 1.05390 05/22/2013 06/11/2013
Oxazepam Cap 30 MG CAPS 1.58000 02/22/2013 02/19/2013
Oxcarbazepine Susp 300 MG/5ML (60 MG/ML) SUSP 0.68550 03/21/2013 04/09/2013
Oxcarbazepine Tab 150 MG TABS 0.20263 02/22/2013 02/19/2013
Oxcarbazepine Tab 300 MG TABS 0.31523 02/22/2013 02/19/2013
Oxcarbazepine Tab 600 MG TABS 0.45000 04/12/2013 04/09/2013
OXEPA (Nutritional Supplement Liquid**) LIQD 0.00720 04/28/2005 02/19/2013
OXEPA (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
Oxybutynin Chloride Syrup 5 MG/5ML SYRP 0.02410 02/22/2013 02/19/2013
Oxybutynin Chloride Tab 5 MG TABS 0.40120 07/02/2013 09/09/2013
Oxybutynin Chloride Tab 5 MG TABS 0.50200 10/05/2013 11/05/2013
Oxybutynin Chloride Tab SR 24HR 10 MG TB24 1.32425 02/22/2013 02/19/2013
Oxybutynin Chloride Tab SR 24HR 15 MG TB24 1.22314 11/08/2013 11/05/2013
Oxybutynin Chloride Tab SR 24HR 5 MG TB24 1.24827 02/22/2013 02/19/2013
Oxycodone HCl Cap 5 MG CAPS 0.13100 02/22/2013 02/19/2013
Oxycodone HCl Conc 20 MG/ML CONC 6.13800 05/07/2013 07/09/2013
Oxycodone HCl Powder POWD 13.11500 02/22/2013 02/19/2013
Oxycodone HCl Soln 5 MG/5ML SOLN 0.24795 05/30/2013 06/11/2013
Oxycodone HCl Tab 10 MG TABS 0.27889 10/11/2013 10/09/2013
Oxycodone HCl Tab 15 MG TABS 0.27000 02/20/2013 03/04/2013
Oxycodone HCl Tab 15 MG TABS 0.27000 02/22/2013 03/04/2013
Oxycodone HCl Tab 20 MG TABS 0.36254 12/13/2013 12/06/2013
Oxycodone HCl Tab 30 MG TABS 0.36000 02/22/2013 02/19/2013
Oxycodone HCl Tab 5 MG TABS 0.12100 02/22/2013 02/19/2013
Oxycodone HCl Tab SR 12HR 10 MG TB12 1.16500 02/22/2013 02/19/2013
Oxycodone HCl Tab SR 12HR 20 MG TB12 2.47500 02/22/2013 02/19/2013
Oxycodone HCl Tab SR 12HR 40 MG TB12 4.20500 02/22/2013 02/19/2013
Oxycodone HCl Tab SR 12HR 80 MG TB12 8.10250 02/22/2013 02/19/2013
Oxycodone w/ Acetaminophen Cap 5-500 MG CAPS 0.09425 02/22/2013 02/19/2013
Oxycodone w/ Acetaminophen Tab 10-325 MG TABS 0.37528 02/22/2013 02/19/2013
Oxycodone w/ Acetaminophen Tab 10-650 MG TABS 0.43813 02/22/2013 02/19/2013
Oxycodone w/ Acetaminophen Tab 2.5-325 MG TABS 1.62188 02/22/2013 02/19/2013
Oxycodone w/ Acetaminophen Tab 5-325 MG TABS 0.04387 02/22/2013 02/19/2013
Oxycodone w/ Acetaminophen Tab 7.5-325 MG TABS 0.73500 10/23/2013 12/06/2013
Page 92 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Oxycodone w/ Acetaminophen Tab 7.5-500 MG TABS 0.39555 02/22/2013 02/19/2013
Oxycodone w/ Aspirin Tab Full Strength TABS 0.43950 02/22/2013 02/19/2013
Oxycodone-Aspirin Tab 4.8355-325 MG TABS 0.43950 02/22/2013 02/19/2013
OXYCONTIN (Oxycodone HCl Tab ER 12HR Deter 40 MG) T12A 4.20500 04/23/2010 02/19/2013
OXYCONTIN (Oxycodone HCl Tab ER 12HR Deter 80 MG) T12A 8.10250 05/28/2010 02/19/2013
OXYCONTIN (Oxycodone HCl Tab SR 12HR 80 MG) TB12 8.10250 05/28/2010 02/19/2013
Oxymorphone HCl Tab 10 MG TABS 4.64000 02/22/2013 02/19/2013
Oxymorphone HCl Tab 5 MG TABS 2.70313 02/22/2013 02/19/2013
Oxymorphone HCl Tab SR 12HR 15 MG TB12 4.13420 02/22/2013 02/19/2013
Oxymorphone HCl Tab SR 12HR 7.5 MG TB12 2.29390 02/22/2013 02/19/2013
Oyster Shell Calcium Tab 500 MG TABS 0.03228 02/22/2013 02/19/2013
P D NATAL VITAMINS/FOLIC (Prenatal Multivitamins &
Minerals
TABS 0.08640 07/01/1998 02/19/2013
PACQUIN PLUS HAND & BODY (Dimethicone Cream 1%) CREA 0.06060 04/28/2005 02/19/2013
PALOMAR E (Skin Protectants Misc - Ointment***) OINT 0.03040 04/28/2005 02/19/2013
Pamidronate Disodium For Inj 30 MG SOLR 52.00000 02/22/2013 02/19/2013
Pamidronate Disodium For Inj 90 MG SOLR 156.00000 02/22/2013 02/19/2013
Pamidronate Disodium IV Soln 3 MG/ML SOLN 3.55000 02/22/2013 02/19/2013
Pamidronate Disodium IV Soln 6 MG/ML SOLN 2.40534 02/22/2013 02/19/2013
Pantoprazole Sodium EC Tab 20 MG (Base Equiv) TBEC 0.13410 02/22/2013 02/19/2013
Pantoprazole Sodium EC Tab 40 MG (Base Equiv) TBEC 0.13290 02/22/2013 02/19/2013
PARADIGM LINK BLOOD GLUCO (Blood Glucose Monitoring
Kit w/ D
KIT 101.99150 05/04/2006 02/19/2013
Paregoric 2 MG/5ML TINC 0.27073 02/22/2013 02/19/2013
Paromomycin Sulfate Cap 250 MG CAPS 3.75000 03/07/2013 05/06/2013
Paroxetine HCl Oral Susp 10 MG/5ML (Base Equiv) SUSP 0.50300 02/22/2013 02/19/2013
Paroxetine HCl Tab 10 MG TABS 0.12061 02/22/2013 02/19/2013
Paroxetine HCl Tab 20 MG TABS 0.13564 02/22/2013 02/19/2013
Paroxetine HCl Tab 30 MG TABS 0.13823 02/22/2013 02/19/2013
Paroxetine HCl Tab 40 MG TABS 0.17203 02/22/2013 02/19/2013
Paroxetine HCl Tab SR 24HR 12.5 MG TB24 2.34223 06/14/2013 06/10/2013
Paroxetine HCl Tab SR 24HR 25 MG TB24 2.27055 11/08/2013 11/05/2013
Paroxetine HCl Tab SR 24HR 37.5 MG TB24 2.58247 12/13/2013 12/06/2013
PARVA-CAL (Calcium-Ergocalciferol Tab 500 MG-200 Unit) TABS 0.02087 03/13/2008 02/19/2013
PARVLEX (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
PC LANCETS SUPER THIN 30G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
P-D NATAL PLUS W/FOLIC (Prenatal Multivitamins &
Minerals w/
TABS 0.08640 07/01/1998 02/19/2013
PEDIA-LAX (Glycerin Suppos 1 GM) SUPP 0.07360 03/13/2008 02/19/2013
PEDIALYTE (Oral Electrolyte Solution***) SOLN 0.00560 04/28/2005 02/19/2013
PEDIALYTE FREEZER POPS (Oral Electrolyte Solution***) SOLN 0.00560 04/28/2005 02/19/2013
PEDIALYTE SINGLES (Oral Electrolyte Solution***) SOLN 0.00560 04/28/2005 02/19/2013
PEDIASURE (Nutritional Supplement Liquid**) LIQD 0.00840 03/09/2006 02/19/2013
PEDIASURE (Nutritional Supplement Liquid**) LIQD 0.00870 03/09/2006 02/19/2013
PEDIASURE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
PEDIASURE 1.0 CAL/FIBER (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
PEDIASURE 1.5 CAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PEDIASURE 1.5 CAL WITH FI (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
PEDIASURE 1.5 CAL/FIBER (Nutritional Supplement
Liquid**)
LIQD 0.00720 04/28/2005 02/19/2013
PEDIASURE 1.5 CAL/FIBER (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
PEDIASURE ENTERAL FORMULA (Nutritional Supplement
Liquid**)
LIQD 0.00720 04/28/2005 02/19/2013
PEDIASURE ENTERAL FORMULA (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
PEDIASURE NUTRIPALS (Nutritional Supplement Bar**) BAR 0.46070 04/28/2005 02/19/2013
PEDIASURE NUTRIPALS (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PEDIASURE PEDIATRIC (Nutritional Supplement Liquid**) LIQD 0.00851 11/25/2005 02/19/2013
PEDIASURE PEPTIDE 1.0 CAL (Nutritional Supplement
Liquid**)
LIQD 0.00720 04/28/2005 02/19/2013
PEDIASURE PEPTIDE 1.0 CAL (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
PEDIASURE PEPTIDE 1.0 CAL (Nutritional Supplement
Liquid**)
LIQD 0.01560 01/01/2012 02/19/2013
PEDIASURE PEPTIDE 1.5 CAL (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
PEDIASURE SHAKE WITH FIBE (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
PEDIASURE SIDEKICKS (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PEDIASURE SIDEKICKS CLEAR (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
PEDIASURE SIDEKICKS SHAKE (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
PEDIASURE WITH FIBER (Nutritional Supplement Liquid**) LIQD 0.00880 03/09/2006 02/19/2013
PEDIASURE WITH FIBER (Nutritional Supplement Liquid**) LIQD 0.00900 03/09/2006 02/19/2013
PEDIASURE WITH FIBER (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
Pediatric Multiple Vitamin Chew Tab** CHEW 0.01450 02/22/2013 02/19/2013
Pediatric Multiple Vitamin w/ C & FA Chew Tab** CHEW 0.02855 02/22/2013 02/19/2013
Pediatric Multiple Vitamin w/ C Liqd 60 MG/5ML** LIQD 0.01490 02/22/2013 02/19/2013
Pediatric Multiple Vitamin w/ C Liqd 60 MG/5ML** SYRP 0.01490 02/22/2013 02/19/2013
Pediatric Multiple Vitamin w/ C Soln 35 MG/ML** SOLN 0.08669 02/22/2013 02/19/2013
Pediatric Multiple Vitamin w/ Extra C & FA Chew Tab** CHEW 0.07640 02/22/2013 02/19/2013
Pediatric Multiple Vitamin w/ Minerals & C Chew Tab 60 MG** CHEW 0.01747 02/22/2013 02/19/2013
Pediatric Multiple Vitamins w/ Fl-Fe Chew Tab 1-12 MG** CHEW 0.01900 02/22/2013 02/19/2013
Pediatric Multiple Vitamins w/ Fl-Fe Drops 0.25-10 MG/ML** SOLN 0.11440 02/22/2013 02/19/2013
Pediatric Multiple Vitamins w/ Fluoride Chew Tab 0.25 MG*** CHEW 0.17771 02/22/2013 02/19/2013
Pediatric Multiple Vitamins w/ Fluoride Chew Tab 0.5 MG*** CHEW 0.16081 02/22/2013 02/19/2013
Pediatric Multiple Vitamins w/ Fluoride Chew Tab 1 MG*** CHEW 0.16081 02/22/2013 02/19/2013
Pediatric Multiple Vitamins w/ Fluoride Soln 0.25 MG/ML*** SOLN 0.10270 02/22/2013 02/19/2013
Pediatric Multiple Vitamins w/ Fluoride Soln 0.5 MG/ML*** SOLN 0.10270 02/22/2013 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Pediatric Multiple Vitamins w/ Iron Chew Tab 15 MG** CHEW 0.03479 02/22/2013 02/19/2013
Pediatric Multiple Vitamins w/ Iron Chew Tab 18 MG** CHEW 0.10262 02/22/2013 02/19/2013
Pediatric Multiple Vitamins w/ Iron Drops 10 MG/ML** SOLN 0.08108 02/22/2013 02/19/2013
PEDIATRIC PEPTINEX DT (Nutritional Supplement Liquid**) LIQD 0.01420 05/28/2010 02/19/2013
PEDIATRIC PEPTINEX DT/FIB (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
Pediatric Vitamins ACD Fluoride & Fe Drops 0.25-10
MG/ML***
SOLN 0.12480 02/22/2013 02/19/2013
Pediatric Vitamins ACD w/ Fluoride Soln 0.25 MG/ML*** SOLN 0.18550 02/22/2013 02/19/2013
Pediatric Vitamins ACD w/ Fluoride Soln 0.5 MG/ML*** SOLN 0.10270 02/22/2013 02/19/2013
Pediatric Vitamins ADC Drops 1500 Unit-400 Unit-35
MG/ML***
SOLN 0.07766 02/22/2013 02/19/2013
PEG 3350-KCl-Na Bicarb-NaCl-Na Sulfate For Soln 236 GM SOLR 0.00353 02/22/2013 02/19/2013
PEG 3350-KCl-Na Bicarb-NaCl-Na Sulfate For Soln 240 GM SOLR 0.00360 02/22/2013 02/19/2013
PEG 3350-KCl-Sod Bicarb-NaCl For Soln 420 GM SOLR 0.00494 02/22/2013 02/19/2013
PEGASYS (Peginterferon alfa-2a Inj 180 MCG/ML) SOLN 717.92510 06/04/2013 08/06/2013
PEGASYS (Peginterferon alfa-2a Inj Kit 180 MCG/0.5ML) KIT 2,871.66720 06/04/2013 08/06/2013
PEG-INTRON (Peginterferon alfa-2b For Inj Kit 120
MCG/0.5ML)
KIT 702.36883 08/01/2013 10/09/2013
PEG-INTRON (Peginterferon alfa-2b For Inj Kit 150
MCG/0.5ML)
KIT 737.47990 08/01/2013 10/09/2013
PEG-INTRON (Peginterferon alfa-2b For Inj Kit 50
MCG/0.5ML)
KIT 637.08310 08/01/2013 10/09/2013
PEG-INTRON (Peginterferon alfa-2b For Inj Kit 80
MCG/0.5ML)
KIT 668.88870 08/01/2013 10/09/2013
PEG-INTRON REDIPEN (Peginterferon alfa-2b For Inj Kit
120 MC
KIT 702.36883 08/01/2013 10/09/2013
PEG-INTRON REDIPEN (Peginterferon alfa-2b For Inj Kit
150 MC
KIT 737.47990 08/01/2013 10/09/2013
PEG-INTRON REDIPEN (Peginterferon alfa-2b For Inj Kit 50
MCG
KIT 637.08310 08/01/2013 10/09/2013
PEG-INTRON REDIPEN (Peginterferon alfa-2b For Inj Kit 80
MCG
KIT 668.88870 08/01/2013 10/09/2013
PEG-INTRON REDIPEN PAK 4 (Peginterferon alfa-2b For Inj
Kit
KIT 702.36883 08/01/2013 10/09/2013
PEG-INTRON REDIPEN PAK 4 (Peginterferon alfa-2b For Inj
Kit
KIT 737.47990 08/01/2013 10/09/2013
PEG-INTRON REDIPEN PAK 4 (Peginterferon alfa-2b For Inj
Kit
KIT 637.08310 08/01/2013 10/09/2013
PEG-INTRON REDIPEN PAK 4 (Peginterferon alfa-2b For Inj
Kit
KIT 668.88870 08/01/2013 10/09/2013
PELEVERUS (Skin Protectants Misc - Ointment***) OINT 0.03040 04/28/2005 02/19/2013
PELEVERUS CLEAR (Skin Protectants Misc - Ointment***) OINT 0.03040 04/28/2005 02/19/2013
PELEVERUS GOLD (Skin Protectants Misc - Ointment***) OINT 0.03040 04/28/2005 02/19/2013
Penicillin G Potassium For Inj 5000000 Unit SOLR 8.65150 02/22/2013 02/19/2013
Penicillin V Potassium For Soln 125 MG/5ML SOLR 0.02150 02/22/2013 02/19/2013
Penicillin V Potassium For Soln 250 MG/5ML SOLR 0.03749 04/02/2013 05/06/2013
Penicillin V Potassium Tab 250 MG TABS 0.08269 02/22/2013 02/19/2013
Page 95 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Penicillin V Potassium Tab 500 MG TABS 0.19787 02/22/2013 02/19/2013
PENTAM 300 (Pentamidine Isethionate For Soln 300 MG) SOLR 81.96250 04/13/2012 02/19/2013
Pentazocine w/ Naloxone Tab 50-0.5 MG TABS 1.02000 02/22/2013 02/19/2013
Pentoxifylline Tab CR 400 MG TBCR 0.13000 02/22/2013 02/19/2013
PEPCID AC (Famotidine Tab 10 MG) TABS 0.13640 04/23/2010 02/19/2013
PEPDITE JUNIOR (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
PEPTAMEN (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PEPTAMEN (Nutritional Supplement Liquid**) LIQD 0.02550 05/28/2010 02/19/2013
PEPTAMEN 1.5 (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PEPTAMEN 1.5 (Nutritional Supplement Liquid**) LIQD 0.02550 09/09/2008 02/19/2013
PEPTAMEN 1.5 CAL/PREBIO1 (Nutritional Supplement
Liquid**)
LIQD 0.00720 04/28/2005 02/19/2013
PEPTAMEN AF (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PEPTAMEN AF (Nutritional Supplement Liquid**) LIQD 0.02550 05/28/2010 02/19/2013
PEPTAMEN BARIATRIC (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PEPTAMEN JUNIOR (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PEPTAMEN JUNIOR (Nutritional Supplement Liquid**) LIQD 0.02550 05/28/2010 02/19/2013
PEPTAMEN JUNIOR (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
PEPTAMEN JUNIOR 1 CAL/PRE (Nutritional Supplement
Liquid**)
LIQD 0.00720 04/28/2005 02/28/2013
PEPTAMEN JUNIOR 1 CAL/PRE (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/28/2013
PEPTAMEN JUNIOR 1.5 (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PEPTAMEN JUNIOR 1.5 (Nutritional Supplement Liquid**) LIQD 0.03208 01/20/2012 02/19/2013
PEPTAMEN JUNIOR FIBER (Nutritional Supplement Liquid**) LIQD 0.02550 05/28/2010 02/19/2013
PEPTAMEN OS (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PEPTAMEN OS 1.5 (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PEPTAMEN VHP (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PEPTAMEN/PREBIO1 (Nutritional Supplement Liquid**) LIQD 0.01420 05/28/2010 02/19/2013
PEPTAMEN/PREBIO1 (Nutritional Supplement Liquid**) LIQD 0.02550 05/28/2010 02/19/2013
PEPTINEX 1.0 (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PEPTINEX 1.5 (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PEPTINEX DT (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PEPTINEX DT (Nutritional Supplement Liquid**) LIQD 0.01420 05/28/2010 02/19/2013
PEPTINEX DT WITH PREBIOTI (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
PEPTO BISMOL (Bismuth Subsalicylate Tab 262 MG) TABS 0.06450 03/13/2008 02/19/2013
PEPTO-BISMOL (Bismuth Subsalicylate Chew Tab 262 MG) CHEW 0.06830 03/13/2008 02/19/2013
PEPTO-BISMOL (Bismuth Subsalicylate Susp 262 MG/15ML) SUSP 0.00915 03/13/2008 02/19/2013
PEPTO-BISMOL INSTACOOL (Bismuth Subsalicylate Chew
Tab 262 M
CHEW 0.06830 03/13/2008 02/19/2013
PEPTO-BISMOL MAX STRENGTH (Bismuth Subsalicylate
Susp 525 MG
SUSP 0.01640 04/28/2005 02/19/2013
PEPTO-BISMOL TO-GO (Bismuth Subsalicylate Chew Tab
262 MG)
CHEW 0.06830 03/13/2008 02/19/2013
PERATIVE (Nutritional Supplement Liquid**) LIQD 0.00720 04/28/2005 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
PERATIVE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PERFECT LANCETS 30G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
PERFECT PRESSURE ACTIVATE (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
PERIFLEX (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
PERIFLEX ADVANCE (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
PERIFLEX INFANT (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
PERIFLEX JUNIOR (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
Permethrin Aerosol 0.5% AERO 0.02400 02/22/2013 02/19/2013
Permethrin Cream 5% CREA 1.52000 07/11/2013 08/06/2013
Permethrin Creme Rinse 1% LIQD 0.10546 02/22/2013 02/19/2013
Permethrin Lotion 1% LOTN 0.10978 02/22/2013 02/19/2013
Perphenazine Tab 16 MG TABS 1.39240 02/22/2013 02/19/2013
Perphenazine Tab 2 MG TABS 0.92500 08/01/2013 11/05/2013
Perphenazine Tab 4 MG TABS 1.29000 06/20/2013 08/06/2013
Perphenazine Tab 8 MG TABS 1.26246 02/22/2013 02/19/2013
Perphenazine-Amitriptyline Tab 2-10 MG TABS 0.07040 02/22/2013 02/19/2013
Perphenazine-Amitriptyline Tab 2-25 MG TABS 0.08690 02/22/2013 02/19/2013
Perphenazine-Amitriptyline Tab 4-10 MG TABS 0.05910 02/22/2013 02/19/2013
Perphenazine-Amitriptyline Tab 4-25 MG TABS 0.65067 02/22/2013 02/19/2013
PERRY PRENATAL (Prenatal Vit w/ Fe Fumarate-FA Cap
13.5-0.4
CAPS 0.08640 07/01/1998 02/19/2013
PETERSONS (Emollient - Ointment**) OINT 0.04583 03/13/2008 02/19/2013
PFD 1 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
PFD 2 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
PFIZERPEN-G (Penicillin G Potassium For Inj 5000000 Unit) SOLR 8.65150 09/24/2010 02/19/2013
PHARMACIST CHOICE AUTOCOD (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
PHARMACIST CHOICE AUTOCOD (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
PHARMACIST CHOICE ULTRA T (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
PHARMACY COUNTER LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
Phenazopyridine HCl Tab 100 MG TABS 0.11050 02/22/2013 02/19/2013
Phenazopyridine HCl Tab 200 MG TABS 0.06270 02/22/2013 02/19/2013
Phenazopyridine-Butabarbital-Hyoscyamine Tab 150-15-0.3
MG
TABS 0.91500 02/22/2013 02/19/2013
Phendimetrazine Tartrate Tab 35 MG TABS 0.18330 02/22/2013 02/19/2013
Phenelzine Sulfate Tab 15 MG TABS 0.86472 02/22/2013 02/19/2013
PHENEX-1 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
PHENEX-2 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
Phenobarbital Elixir 20 MG/5ML ELIX 0.14115 06/18/2013 07/09/2013
Phenobarbital Elixir 20 MG/5ML SOLN 0.14115 06/18/2013 07/09/2013
Phenobarbital Tab 100 MG TABS 0.04005 02/22/2013 02/19/2013
Phenobarbital Tab 15 MG TABS 0.00380 02/22/2013 02/19/2013
Phenobarbital Tab 16.2 MG TABS 0.00380 02/22/2013 02/19/2013
Phenobarbital Tab 30 MG TABS 0.07486 02/22/2013 02/19/2013
Page 97 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Phenobarbital Tab 32.4 MG TABS 0.13424 02/22/2013 02/19/2013
Phenobarbital Tab 60 MG TABS 0.22968 02/22/2013 02/19/2013
Phenobarbital Tab 64.8 MG TABS 0.16774 02/22/2013 02/19/2013
Phentermine HCl Cap 30 MG CAPS 0.28366 02/22/2013 02/19/2013
Phentermine HCl Cap 37.5 MG CAPS 1.25830 02/22/2013 02/19/2013
Phentermine HCl Tab 37.5 MG TABS 0.14063 02/22/2013 02/19/2013
PHENYLADE (Amino Acids Oral Powder***) POWD 0.33438 06/27/2012 02/19/2013
PHENYLADE DRINK MIX (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
PHENYLADE ESSENTIAL DRINK (Nutritional Supplement
Pack**)
PACK 9.02000 06/15/2011 02/19/2013
PHENYLADE ESSENTIAL DRINK (Nutritional Supplement
Powder**)
POWD 0.20315 04/05/2011 02/19/2013
PHENYLADE MTE (Amino Acids Oral Powder***) POWD 0.33438 06/27/2012 02/19/2013
PHENYLADE PHEBLOC (Amino Acids Oral Powder***) POWD 0.33438 06/27/2012 02/19/2013
PHENYLADE PHEBLOC (Amino Acids Tab***) TABS 0.41080 04/28/2005 02/19/2013
PHENYLADE RTD PKU 10 (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PHENYLADE40 DRINK MIX (Amino Acids Pack***) PACK 0.19640 04/28/2005 02/19/2013
PHENYLADE60 DRINK MIX (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
PHENYLADE60 DRINK MIX (Nutritional Supplement
Powder**)
POWD 0.20315 04/05/2011 02/19/2013
PHENYLENE (Dietary Management Product - Powder***) POWD 0.06700 04/28/2005 02/19/2013
PHENYLENE 75 (Dietary Management Product - Powder***) POWD 0.06700 04/28/2005 02/19/2013
Phenylephrine-Brompheniramine-DM Elixir 2.5-1-5 MG/5ML ELIX 0.01520 02/22/2013 02/19/2013
PHENYL-FREE 1 (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
PHENYL-FREE 2 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
PHENYL-FREE 2HP (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
Phenytoin Chew Tab 50 MG CHEW 0.42126 08/09/2013 08/06/2013
Phenytoin Sodium Extended Cap 100 MG CAPS 0.12545 02/22/2013 02/19/2013
Phenytoin Sodium Extended Cap 200 MG CAPS 0.75848 02/22/2013 02/19/2013
Phenytoin Sodium Extended Cap 300 MG CAPS 1.06375 02/22/2013 02/19/2013
Phenytoin Susp 125 MG/5ML SUSP 0.11360 02/22/2013 02/19/2013
PHILLIPS MILK OF MAGNESIA (Magnesium Hydroxide Susp
800 MG/5
SUSP 0.01720 04/28/2005 02/19/2013
PHLEXY-10 (Nutritional Supplement Bar**) BAR 0.46070 04/28/2005 02/19/2013
PHLEXY-10 (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
PHOS FLUR (Sodium Fluoride Rinse 0.044%) SOLN 0.01749 03/20/2008 02/19/2013
PHOS-NAK POWDER CONCENTRA (Potassium & Sodium
Phosphates Pow
PACK 0.32980 04/28/2005 02/19/2013
PHYTOFUSION (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
Pilocarpine HCl Ophth Soln 0.5% SOLN 0.21000 02/22/2013 02/19/2013
Pilocarpine HCl Ophth Soln 1% SOLN 0.16000 02/22/2013 02/19/2013
Pilocarpine HCl Ophth Soln 2% SOLN 0.20000 02/22/2013 02/19/2013
Pilocarpine HCl Ophth Soln 3% SOLN 0.33000 02/22/2013 02/19/2013
Pilocarpine HCl Ophth Soln 4% SOLN 0.29000 02/22/2013 02/19/2013
Pilocarpine HCl Ophth Soln 6% SOLN 0.52500 02/22/2013 02/19/2013
Pilocarpine HCl Tab 5 MG TABS 0.34000 04/11/2013 05/06/2013
Page 98 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Pindolol Tab 10 MG TABS 0.13000 02/22/2013 02/19/2013
Pindolol Tab 5 MG TABS 0.89500 04/25/2013 06/11/2013
Pioglitazone HCl Tab 15 MG (Base Equiv) TABS 0.20870 04/12/2013 04/09/2013
Pioglitazone HCl Tab 30 MG (Base Equiv) TABS 0.46250 04/12/2013 04/09/2013
Pioglitazone HCl Tab 45 MG (Base Equiv) TABS 0.51250 04/12/2013 04/09/2013
Piroxicam Cap 10 MG CAPS 0.89300 04/04/2013 06/11/2013
Piroxicam Cap 20 MG CAPS 1.64089 11/08/2013 11/05/2013
PIVOT 1.5 CAL (Nutritional Supplement Liquid**) LIQD 0.00720 04/28/2005 02/19/2013
PIVOT 1.5 CAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PKU 2 (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
PKU 2 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
PKU 3 (Nutritional Supplement Powder**) POWD 0.22070 04/29/2013 05/06/2013
PKU COOLER 10 (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PKU COOLER 15 (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PKU COOLER 20 (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PKU COOLER 20 (Nutritional Supplement Liquid**) LIQD 0.04710 09/17/2010 02/19/2013
PKU EXPRESS (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
PKU GEL (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
PKU LOPHLEX LQ 20 (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PKU LOPHLEX LQ 20 (Nutritional Supplement Liquid**) LIQD 0.04488 11/09/2012 02/19/2013
PKU TRIO (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
PLENAXIS (Abarelix For IM Inj Susp 100 MG) SUSR 644.76890 07/30/2010 02/19/2013
PNEUMOVAX 23/1 DOSE (Pneumococcal Vaccine Polyvalent
Inj 25
INJ 128.32796 11/15/2012 02/19/2013
PNEUMOVAX 23/5 DOSE (Pneumococcal Vaccine Polyvalent
Inj 25
INJ 128.32796 11/15/2012 02/19/2013
PNV FOLIC ACID + IRON MUL (Prenatal Vit w/ Fe
Fumarate-FA Ta
TABS 0.07324 03/28/2011 02/19/2013
POCKETCHEM EZ BLOOD GLUCO (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
POCKETCHEM EZ BLOOD GLUCO (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
Podofilox Soln 0.5% SOLN 14.12571 06/14/2013 06/10/2013
POLYCAL (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
Polyethylene Glycol 3350 Oral Packet PACK 1.42505 02/22/2013 02/19/2013
Polyethylene Glycol 3350 Oral Powder POWD 0.03960 02/22/2013 02/19/2013
Polyethylene Glycol-Polyvinyl Alcohol Ophth Soln 1-1% SOLN 0.22995 02/22/2013 02/19/2013
POLYGAM S/D (Immune Globulin (Human) IV For Soln 10
GM)
SOLR 1,291.71240 01/01/2013 02/20/2013
POLYGAM S/D (Immune Globulin (Human) IV For Soln 5
GM)
SOLR 645.85620 01/01/2013 02/20/2013
Polymyxin B-Trimethoprim Ophth Soln 10000 Unit/ML-0.1% SOLN 0.97000 02/22/2013 02/19/2013
Polysaccharide Iron Complex Cap 150 MG (Iron Equivalent) CAPS 0.12559 02/22/2013 02/19/2013
POLYTAR (Coal Tar-Juniper Tar-Pine Tar Shampoo***) SHAM 0.04490 04/28/2005 02/19/2013
POLY-VI-FLOR (Ped Multiple Vit w/ Fluoride Biphasic Chew
Tab
CHEW 0.21493 05/27/2011 02/19/2013
Page 99 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
POLY-VI-FLOR (Ped Multiple Vit w/ Fluoride Biphasic Chew
Tab
CHEW 0.16081 12/09/2011 02/19/2013
POLY-VI-FLOR (Ped Multiple Vit w/ Fluoride Biphasic Chew
Tab
CHEW 0.16081 12/09/2011 02/19/2013
Polyvinyl Alcohol Ophth Soln 1.4% SOLN 0.14917 02/22/2013 02/19/2013
Polyvinyl Alcohol-Povidone Ophth Soln 1.4-0.6% SOLN 0.23804 02/22/2013 02/19/2013
POLY-VI-SOL (Pediatric Multiple Vitamin w/ C Soln 35
MG/ML**
SOLN 0.08669 03/20/2008 02/19/2013
POLY-VI-SOL/IRON (Pediatric Multiple Vitamins w/ Iron
Drops
SOLN 0.08108 03/20/2008 02/19/2013
PORTAGEN (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
Pot Phos Monobasic w/Sod Phos Di & Monobas Tab
155-852-130MG
TABS 0.17733 02/22/2013 02/19/2013
Potassium Bicarbonate Effer Tab 25 mEq TBEF 0.19875 02/22/2013 02/19/2013
Potassium Chloride Cap CR 10 mEq CPCR 0.59569 10/11/2013 10/09/2013
Potassium Chloride Cap CR 8 mEq CPCR 0.86475 02/22/2013 02/19/2013
Potassium Chloride Inj 2 mEq/ML SOLN 0.03136 02/22/2013 02/19/2013
Potassium Chloride Microencapsulated Crys CR Tab 10 mEq TBCR 0.49500 12/07/2012 05/15/2013
Potassium Chloride Microencapsulated Crys CR Tab 20 mEq TBCR 0.38638 02/22/2013 02/19/2013
Potassium Chloride Oral Liq 10% (20 MEQ/15ML) ELIX 0.00590 02/22/2013 02/19/2013
Potassium Chloride Oral Liq 10% (20 MEQ/15ML) LIQD 0.00590 02/22/2013 02/19/2013
Potassium Chloride Oral Liq 10% (20 MEQ/15ML) SOLN 0.00590 02/22/2013 02/19/2013
Potassium Chloride Oral Liq 10% (20 MEQ/15ML) SYRP 0.00590 02/22/2013 02/19/2013
Potassium Chloride Oral Liq 20% (40 MEQ/15ML) LIQD 0.03000 03/22/2013 04/09/2013
Potassium Chloride Powder Packet 20 mEq PACK 1.38000 05/20/2013 07/09/2013
Potassium Chloride Tab CR 10 mEq TBCR 0.35139 02/22/2013 02/19/2013
Potassium Chloride Tab CR 8 mEq (600 MG) TBCR 0.38350 02/22/2013 02/19/2013
Potassium Citrate & Citric Acid Soln 1100-334 MG/5ML SOLN 0.03020 02/22/2013 02/19/2013
Potassium Citrate Tab CR 10 MEQ (1080 MG) TBCR 0.52312 02/22/2013 02/19/2013
Potassium Citrate Tab CR 5 MEQ (540 MG) TBCR 0.37687 02/22/2013 02/19/2013
Povidone-Iodine Soln 10% SOLN 0.01750 02/22/2013 02/19/2013
PPA/MMA EXPRESS (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
PR NATAL 400 (Prenat-Fe Bis-Fe Prot Succ-FA-Ca Tab &
Omega 3
MISC 0.51442 01/23/2009 02/19/2013
Pramipexole Dihydrochloride Tab 0.125 MG TABS 0.09158 02/22/2013 02/19/2013
Pramipexole Dihydrochloride Tab 0.25 MG TABS 0.08785 02/22/2013 02/19/2013
Pramipexole Dihydrochloride Tab 0.5 MG TABS 0.08392 02/22/2013 02/19/2013
Pramipexole Dihydrochloride Tab 0.75 MG TABS 0.12387 02/22/2013 02/19/2013
Pramipexole Dihydrochloride Tab 1 MG TABS 0.10168 02/22/2013 02/19/2013
Pramipexole Dihydrochloride Tab 1.5 MG TABS 0.15208 02/22/2013 02/19/2013
Pravastatin Sodium Tab 10 MG TABS 0.44000 08/12/2013 09/09/2013
Pravastatin Sodium Tab 20 MG TABS 0.35221 08/15/2013 10/09/2013
Pravastatin Sodium Tab 40 MG TABS 0.62500 10/08/2013 11/05/2013
Pravastatin Sodium Tab 80 MG TABS 0.56000 07/03/2013 09/09/2013
Prazosin HCl Cap 1 MG CAPS 0.29500 10/29/2013 11/05/2013
Prazosin HCl Cap 2 MG CAPS 0.27500 04/02/2013 05/06/2013
Page 100 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Prazosin HCl Cap 5 MG CAPS 0.58672 11/08/2013 11/05/2013
PRECISION LINK (Blood Glucose Monitoring Kit w/
Device***)
KIT 0.71000 10/01/2003 02/19/2013
PRECISION PCX (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
PRECISION PCX PLUS TEST S (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
PRECISION POINT OF CARE T (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
PRECISION QID TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
PRECISION SOF-TACT TEST S (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
PRECISION THIN LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
PRECISION THINS GP LANCET (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
PRECISION ULTRA LANCET (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
PRECISION XTRA (Ketone Blood Test Strip) STRP 4.14456 08/26/2013 10/09/2013
PRECISION XTRA BLOOD GLUC (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
PRED FORTE (Prednisolone Acetate Ophth Susp 1%) SUSP 1.35800 05/28/2010 02/19/2013
Prednisolone Acetate Ophth Susp 1% SUSP 8.96000 09/20/2013 10/09/2013
Prednisolone Sod Phosph Oral Soln 6.7 MG/5ML (5 MG/5ML
Base)
SOLN 0.59279 04/20/2013 07/09/2013
Prednisolone Sod Phosphate Oral Soln 15 MG/5ML (Base
Equiv)
SOLN 0.09470 02/22/2013 02/19/2013
Prednisolone Sodium Phosphate Ophth Soln 1% SOLN 1.38000 02/22/2013 02/19/2013
Prednisolone Syrup 15 MG/5ML (USP Solution Equivalent) SOLN 0.03850 02/22/2013 02/19/2013
Prednisolone Syrup 15 MG/5ML (USP Solution Equivalent) SYRP 0.03850 02/22/2013 02/19/2013
Prednisone Tab 1 MG TABS 0.06440 06/24/2013 08/06/2013
Prednisone Tab 10 MG TABS 0.18000 11/06/2013 12/06/2013
Prednisone Tab 10 MG Dose Pack TABS 0.47210 02/08/2013 02/20/2013
Prednisone Tab 2.5 MG TABS 0.03438 02/22/2013 02/19/2013
Prednisone Tab 20 MG TABS 0.04303 02/22/2013 02/19/2013
Prednisone Tab 5 MG TABS 0.17500 09/17/2013 10/09/2013
PREFERRED PLUS LANCETS CO (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
PREFERRED PLUS LANCETS SU (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
PREFERRED PLUS LANCETS TH (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
PREGESTIMIL (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
PREGESTIMIL (Infant Foods Powder**) POWD 0.07700 12/28/2011 02/19/2013
PREMIUM INFANT FORMULA/IR (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
PRENACARE (Prenatal Vit w/ DSS-Iron Carbonyl-FA Tab
90-1 MG*
TABS 0.16250 01/23/2009 02/19/2013
PRENAPLUS (Prenatal Vit w/ Fe Fumarate-FA Tab 27-1
MG***)
TABS 0.07324 03/28/2011 02/19/2013
PRENATABS FA (Prenatal Vit w/ Fe Fumarate-FA Tab 29-1
MG***)
TABS 0.15587 01/23/2009 02/19/2013
PRENATABS RX (Prenatal Vit w/ Iron Carbonyl-FA Tab 29-1
MG**
TABS 0.17167 05/11/2012 02/19/2013
PRENATAL (Prenatal Multivitamins & Minerals w/Iron & FA
Tab
TABS 0.08640 07/01/1998 02/19/2013
PRE-NATAL (Prenatal Multivitamins & Minerals w/Iron & FA
Tab
TABS 0.08640 07/01/1998 02/19/2013
Page 101 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
PRENATAL (Prenatal Vit w/ Fe Fumarate-FA Tab 27-0.8
MG***)
TABS 0.03965 01/23/2009 02/19/2013
PRENATAL (Prenatal Vit w/ Fe Fumarate-FA Tab 27-0.8
MG***)
TABS 0.07260 04/23/2010 02/19/2013
PRENATAL (Prenatal Vit w/ Fe Fumarate-FA Tab 28-0.8
MG***)
TABS 0.07255 02/27/2009 02/19/2013
PRENATAL 19 (Prenatal Vit w/ DSS-Fe Fumarate-FA Tab
29-1 MG*
TABS 0.28847 01/23/2009 02/19/2013
PRENATAL 19 (Prenatal Vit w/ Fe Fumarate-FA Chew Tab
29-1 MG
CHEW 0.29950 08/29/2008 02/19/2013
PRENATAL AD (Prenatal Vit w/ DSS-Iron Carbonyl-FA Tab
90-1 M
TABS 0.16250 01/23/2009 02/19/2013
PRENATAL AND IRON (Prenatal Multivitamins & Minerals
w/Iron
TABS 0.08640 07/01/1998 02/19/2013
PRE-NATAL FORMULA (Prenatal Multivitamins & Minerals
w/Iron
TABS 0.08640 07/01/1998 02/19/2013
PRENATAL FORMULA (Prenatal Vit w/ Fe Fumarate-FA Tab
27-1 MG
TABS 0.07324 03/28/2011 02/19/2013
PRENATAL FORMULA (Prenatal Vit w/ Fe Fumarate-FA Tab
28-0.8
TABS 0.07255 02/27/2009 02/19/2013
PRENATAL FORTE (Prenatal Multivitamins & Minerals w/Iron
& F
TABS 0.08640 07/01/1998 02/19/2013
PRENATAL LOW IRON (Prenatal Vit w/ Fe Fumarate-FA Tab
27-0.8
TABS 0.03965 01/23/2009 02/19/2013
PRENATAL LOW IRON (Prenatal Vit w/ Fe Fumarate-FA Tab
27-1 M
TABS 0.07324 03/28/2011 02/19/2013
Prenatal Multivitamins & Minerals w/Iron & FA Tab 0.8 MG*** TABS 0.08640 02/22/2013 02/19/2013
PRENATAL MULTIVITAMIN-ULT (Prenatal Vit w/ DSS-Iron
Carbonyl
TABS 0.16250 01/23/2009 02/19/2013
PRENATAL ONE DAILY (Prenatal Vit w/ Fe Fumarate-FA Tab
27-0.
TABS 0.04900 03/20/2008 02/19/2013
PRENATAL PLUS (Prenatal Vit w/ Fe Fumarate-FA Tab 27-1
MG***
TABS 0.07324 03/28/2011 02/19/2013
PRENATAL PLUS IRON (Prenatal Vit w/ Iron Carbonyl-FA Tab
29-
TABS 0.17167 05/11/2012 02/19/2013
PRENATAL PLUS/IRON (Prenatal Vit w/ Fe Fumarate-FA Tab
27-1
TABS 0.07324 03/28/2011 02/19/2013
Prenatal Vit w/ DSS-Iron Carbonyl-FA Tab 90-1 MG*** TABS 0.16250 02/22/2013 02/19/2013
Prenatal Vit w/ Fe Fumarate-FA Chew Tab 29-1 MG*** CHEW 0.29950 02/22/2013 02/19/2013
Prenatal Vit w/ Fe Fumarate-FA Tab 27-0.8 MG*** TABS 0.03965 02/22/2013 02/19/2013
Prenatal Vit w/ Fe Fumarate-FA Tab 27-1 MG*** TABS 0.07324 02/22/2013 02/19/2013
Prenatal Vit w/ Fe Fumarate-FA Tab 28-0.8 MG*** TABS 0.07255 02/22/2013 02/19/2013
Prenatal Vit w/ Fe Fumarate-FA Tab 28-1 MG*** TABS 0.18187 02/22/2013 02/19/2013
Prenatal Vit w/ Fe Fumarate-FA Tab 29-1 MG*** TABS 0.15587 02/22/2013 02/19/2013
Prenatal Vit w/ Fe Fumarate-FA Tab 65-1 MG*** TABS 0.16510 02/22/2013 02/19/2013
Prenatal Vit w/ Iron Carbonyl-FA Tab 29-1 MG*** TABS 0.19919 02/22/2013 02/19/2013
Prenatal Vit w/ Sel-Fe Fumarate-FA Tab 27-1 MG*** TABS 0.07800 02/22/2013 02/19/2013
PRENATAL VITAMINS PLUS (Prenatal Vit w/ Fe Fumarate-FA
Tab 2
TABS 0.07324 03/28/2011 02/19/2013
Page 102 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
PRENATAL/FOLIC ACID (Prenatal Vit w/ Fe Fumarate-FA Tab
27-1
TABS 0.07324 03/28/2011 02/19/2013
Prenat-Fe Bis-Fe Prot Succ-FA-Ca Tab & Omega 3 Cap 400
Pk**
MISC 0.51442 02/22/2013 02/19/2013
PRESERVISION AREDS (Multiple Vitamins w/ Minerals
Cap**)
CAPS 0.51325 04/27/2011 02/19/2013
PRESERVISION AREDS 2 (Multiple Vitamins w/ Minerals
Cap**)
CAPS 0.51325 04/27/2011 02/19/2013
PRESERVISION/LUTEIN (Multiple Vitamins w/ Minerals
Cap**)
CAPS 0.51325 04/27/2011 02/19/2013
PRESTIGE LX STARTER KIT (Blood Glucose Monitoring Kit
w/ Dev
KIT 0.71000 10/01/2003 02/19/2013
PRESTIGE SMART SYSTEM CO- (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
PRESTIGE SMART SYSTEM IQ (Blood Glucose Monitoring
Kit w/ De
KIT 0.71000 10/01/2003 02/19/2013
PRESTIGE SMART SYSTEM VAL (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
PRESTIGE SMART SYSTEM/MET (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 04/23/2010 02/19/2013
PRESTIGE TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
PRESTIGE VALUE PACK (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
PRILOSEC OTC (Omeprazole Magnesium Delayed Release
Tab 20 MG
TBEC 0.57785 03/20/2008 02/19/2013
Primidone Tab 250 MG TABS 0.19519 02/22/2013 02/19/2013
Primidone Tab 50 MG TABS 0.11498 02/22/2013 02/19/2013
PRIVIGEN (Immune Globulin (Human) IV Soln 10
GM/100ML)
SOLN 7.50000 04/01/2005 02/19/2013
PRIVIGEN (Immune Globulin (Human) IV Soln 20
GM/200ML)
SOLN 7.50000 04/01/2005 02/19/2013
PRIVIGEN (Immune Globulin (Human) IV Soln 5 GM/50ML) SOLN 7.50000 04/01/2005 02/19/2013
PROBALANCE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
Probenecid Tab 500 MG TABS 0.37921 02/22/2013 02/19/2013
Procainamide HCl Cap 250 MG CAPS 0.46900 02/22/2013 02/19/2013
PRO-CAL (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
PRO-CAL (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
PRO-CAL (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
PROCERV HP (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
PROCHIEVE (Progesterone Vaginal Gel 8%) GEL 8.57056 04/13/2012 02/19/2013
PROCHIEVE (Progesterone Vaginal Gel 8%) GEL 11.85278 09/05/2013 10/09/2013
Prochlorperazine Maleate Tab 10 MG TABS 0.05200 02/22/2013 02/19/2013
Prochlorperazine Maleate Tab 5 MG TABS 0.04463 02/22/2013 02/19/2013
Prochlorperazine Suppos 25 MG SUPP 7.05000 09/24/2013 11/05/2013
PROCRIT (Epoetin Alfa Inj 10000 Unit/ML) SOLN 169.22040 04/13/2012 02/19/2013
PROCRIT (Epoetin Alfa Inj 2000 Unit/ML) SOLN 33.84464 04/13/2012 02/19/2013
PROCRIT (Epoetin Alfa Inj 20000 Unit/ML) SOLN 385.05000 04/02/2013 07/09/2013
PROCRIT (Epoetin Alfa Inj 3000 Unit/ML) SOLN 50.76556 04/13/2012 02/19/2013
PROCRIT (Epoetin Alfa Inj 4000 Unit/ML) SOLN 77.01000 04/02/2013 05/06/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
PROCRIT (Epoetin Alfa Inj 40000 Unit/ML) SOLN 734.25100 10/02/2012 02/19/2013
PROCRIT (Epoetin Alfa Inj 40000 Unit/ML) SOLN 770.10700 04/02/2013 06/11/2013
PROCTOCORT (Hydrocortisone Rectal Cream 1%) CREA 0.06791 03/13/2008 02/19/2013
PRODIGY ADJUSTABLE DEPTH (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
PRODIGY AUTOCODE BLOOD GL (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
PRODIGY AUTOCODE BLOOD GL (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
PRODIGY AUTOCODE PRO BLOO (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
PRODIGY BLOOD GLUCOSE MON (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 04/23/2010 02/19/2013
PRODIGY BLOOD GLUCOSE TES (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
PRODIGY EJECT BLOOD GLUCO (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
PRODIGY NO CODING BLOOD G (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
PRODIGY POCKET BLOOD GLUC (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
PRODIGY POCKET PRO BLOOD (Blood Glucose Monitoring
Kit w/ De
KIT 0.71000 10/01/2003 02/19/2013
PRODIGY PREFERRED BLOOD G (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
PRODIGY PRESSURE ACTIVATE (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
PRODIGY SAFETY LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
PRODIGY TWIST TOP LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
PRODIGY VOICE BLOOD GLUCO (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
PRODIGY VOICE BLOOD GLUCO (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
PRODUCT 3232A (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
PROFILNINE SD (Factor IX Complex For Inj 1000 Unit) SOLR 0.62217 06/26/2009 02/19/2013
PROFILNINE SD (Factor IX Complex For Inj 1000-1500 Unit) SOLR 0.62217 12/24/2010 02/19/2013
PROFILNINE SD (Factor IX Complex For Inj 1500 Unit) SOLR 0.62217 06/26/2009 02/19/2013
PROFILNINE SD (Factor IX Complex For Inj 500 Unit) SOLR 0.62217 06/26/2009 02/19/2013
Progesterone IM in Oil 50 MG/ML OIL 2.49813 02/22/2013 02/19/2013
Progesterone Micronized Cap 100 MG CAPS 1.42936 08/09/2013 08/06/2013
Progesterone Powder POWD 0.47840 02/22/2013 02/19/2013
PROGRAF (Tacrolimus Cap 0.5 MG) CAPS 1.97407 04/13/2012 02/19/2013
PROGRAF (Tacrolimus Cap 1 MG) CAPS 3.94814 04/13/2012 02/19/2013
PROGRAF (Tacrolimus Cap 5 MG) CAPS 19.74072 04/13/2012 02/19/2013
PROLASTIN (Alpha1-Proteinase Inhibitor (Human) For IV
Soln 1
SUSR 0.37392 10/23/2009 02/19/2013
PROLASTIN (Alpha1-Proteinase Inhibitor (Human) For IV
Soln 5
SOLR 0.37392 01/28/2011 02/19/2013
PROLASTIN-C (Alpha1-Proteinase Inhibitor (Human) For IV
Soln
SOLR 0.37392 01/28/2011 02/19/2013
Promethazine & Phenylephrine Syrup 6.25-5 MG/5ML SYRP 0.01558 02/22/2013 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Promethazine HCl (Bulk) Powder POWD 0.40664 02/22/2013 02/19/2013
Promethazine HCl Inj 25 MG/ML SOLN 1.11748 02/22/2013 02/19/2013
Promethazine HCl Suppos 12.5 MG SUPP 10.35000 11/04/2013 12/06/2013
Promethazine HCl Suppos 25 MG SUPP 9.01000 06/26/2013 09/09/2013
Promethazine HCl Suppos 50 MG SUPP 0.17000 02/22/2013 02/19/2013
Promethazine HCl Syrup 6.25 MG/5ML SOLN 0.01558 02/22/2013 02/19/2013
Promethazine HCl Syrup 6.25 MG/5ML SYRP 0.01558 02/22/2013 02/19/2013
Promethazine HCl Tab 12.5 MG TABS 0.13251 02/22/2013 02/19/2013
Promethazine HCl Tab 25 MG TABS 0.15030 06/03/2013 08/06/2013
Promethazine HCl Tab 50 MG TABS 0.18352 02/22/2013 02/19/2013
Promethazine w/ Codeine Syrup 6.25-10 MG/5ML SYRP 0.01640 02/22/2013 02/19/2013
Promethazine-DM Syrup 6.25-15 MG/5ML SYRP 0.01971 02/22/2013 02/19/2013
PROMOD (Nutritional Supplement Liquid**) LIQD 0.02445 03/23/2010 02/19/2013
PROMOD (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
PROMOTE (Nutritional Supplement Liquid**) LIQD 0.00720 04/28/2005 02/19/2013
PROMOTE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PROMOTE WITH FIBER (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PROMOTE/FIBER (Nutritional Supplement Liquid**) LIQD 0.00720 04/28/2005 02/19/2013
PROMOTE/FIBER (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PROMOTE-RTU (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PRONTO (Pyrethrins-Piperonyl Butoxide Shampoo 0.33-4%) SHAM 0.04977 03/20/2008 02/19/2013
PRONUTRA (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
Propafenone HCl Cap SR 12HR 225 MG CP12 5.58334 02/22/2013 02/19/2013
Propafenone HCl Cap SR 12HR 325 MG CP12 7.70375 02/22/2013 02/19/2013
Propafenone HCl Cap SR 12HR 425 MG CP12 7.70375 02/22/2013 02/19/2013
Propafenone HCl Tab 150 MG TABS 0.14588 02/22/2013 02/19/2013
Propafenone HCl Tab 225 MG TABS 0.33992 02/22/2013 02/19/2013
Propafenone HCl Tab 300 MG TABS 0.84351 02/22/2013 02/19/2013
Proparacaine HCl Ophth Soln 0.5% SOLN 0.19507 02/22/2013 02/19/2013
PRO-PHREE (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
PROPIMEX-1 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
PROPIMEX-2 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
PROPLEX T FACTOR IX COMP (Factor IX Complex For Inj
700-3900
SOLR 0.49800 07/30/2010 02/19/2013
Propoxyphene HCl Cap 65 MG CAPS 0.15251 02/22/2013 02/19/2013
Propoxyphene HCl w/ APAP Tab 65-650 MG TABS 0.16880 02/22/2013 02/19/2013
Propoxyphene-N w/ Acetaminophen Tab 100-500 MG TABS 0.93400 02/22/2013 02/19/2013
Propoxyphene-N w/ Acetaminophen Tab 100-650 MG TABS 0.04522 02/22/2013 02/19/2013
Propoxyphene-N w/ Acetaminophen Tab 50-325 MG TABS 0.36030 02/22/2013 02/19/2013
Propranolol & Hydrochlorothiazide Tab 40-25 MG TABS 0.07710 02/22/2013 02/19/2013
Propranolol & Hydrochlorothiazide Tab 80-25 MG TABS 0.11700 02/22/2013 02/19/2013
Propranolol HCl Cap SR 24HR 120 MG CP24 0.84000 07/05/2013 09/09/2013
Propranolol HCl Cap SR 24HR 160 MG CP24 1.39500 04/24/2013 06/11/2013
Propranolol HCl Cap SR 24HR 60 MG CP24 0.75000 04/29/2013 06/11/2013
Propranolol HCl Cap SR 24HR 80 MG CP24 0.76219 06/18/2013 07/09/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Propranolol HCl Tab 10 MG TABS 0.03186 02/22/2013 02/19/2013
Propranolol HCl Tab 20 MG TABS 0.02626 02/22/2013 02/19/2013
Propranolol HCl Tab 40 MG TABS 0.04221 02/22/2013 02/19/2013
Propranolol HCl Tab 60 MG TABS 0.71238 02/22/2013 02/19/2013
Propranolol HCl Tab 80 MG TABS 0.06214 02/22/2013 02/19/2013
Propylene Glycol-Glycerin Ophth Soln 1-0.3% SOLN 0.24650 02/22/2013 02/19/2013
Propylthiouracil Tab 50 MG TABS 0.49900 06/18/2013 07/09/2013
PROSHIELD PLUS SKIN PROTE (Dimethicone Cream 1%) CREA 0.06060 04/28/2005 02/19/2013
PROSOURCE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PROSOURCE (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
PROSOURCE NO CARB (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PROSOURCE PLUS (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PROSOURCE ZAC (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PROSURE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PROTAIN XL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PROTECT CARDIO AF (Multiple Vitamins w/ Minerals Cap**) CAPS 0.51325 04/27/2011 02/19/2013
PROTECT PLUS (Multiple Vitamins w/ Minerals Cap**) CAPS 0.51325 04/27/2011 02/19/2013
PROTECT PLUS (Multiple Vitamins w/ Minerals Liquid**) LIQD 0.02464 03/20/2008 02/19/2013
PROTECT PLUS AF (Multiple Vitamins w/ Minerals Cap**) CAPS 0.51325 04/27/2011 02/19/2013
PROTECT PLUS NR (Multiple Vitamins w/ Minerals Cap**) CAPS 0.51325 04/27/2011 02/19/2013
PROTEGRA (Multiple Vitamins w/ Minerals Cap**) CAPS 0.08140 08/27/2010 02/19/2013
PROTEIN FORTIFIER (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/28/2013
PROTIFAR (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
PROTONIX (Pantoprazole Sodium EC Tab 40 MG (Base
Equiv))
TBEC 2.07500 04/23/2010 02/19/2013
Protriptyline HCl Tab 10 MG TABS 1.81922 02/22/2013 02/19/2013
Protriptyline HCl Tab 5 MG TABS 1.43575 02/22/2013 02/19/2013
PROVENTIL (Albuterol Inhal Aerosol 90 MCG/ACT) AERS 0.49000 07/07/2003 02/19/2013
PROVENTIL (Albuterol Sulfate Soln Nebu 0.083% (2.5
MG/3ML))
NEBU 0.08000 07/07/2003 02/19/2013
PROVIGIL (Modafinil Tab 100 MG) TABS 0.05410 04/28/2005 02/19/2013
PROVIMIN (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
PRUET DHA (Prenat-Fe Bis-Fe Prot Succ-FA-Ca Tab &
Omega 3 Ca
MISC 0.51442 01/23/2009 02/19/2013
Pseudoeph-Chlorphen-DM w/ APAP Tab 30-2-15-500 MG TABS 0.00810 02/22/2013 02/19/2013
Pseudoephed-Bromphen-DM Syrup 30-2-10 MG/5ML SYRP 0.03580 02/22/2013 02/19/2013
Pseudoephedrine HCl Cap SR 12HR 120 MG CP12 0.27700 02/22/2013 02/19/2013
Pseudoephedrine HCl Liq 15 MG/5ML LIQD 0.02380 02/22/2013 02/19/2013
Pseudoephedrine HCl Liq 30 MG/5ML LIQD 0.00841 02/22/2013 02/19/2013
Pseudoephedrine HCl Soln 7.5 MG/0.8ML SOLN 0.17540 02/22/2013 02/19/2013
Pseudoephedrine HCl Syrup 30 MG/5ML SYRP 0.01848 02/22/2013 02/19/2013
Pseudoephedrine HCl Tab 30 MG TABS 0.03500 02/22/2013 02/19/2013
Pseudoephedrine HCl Tab 60 MG TABS 0.02912 02/22/2013 02/19/2013
Pseudoephedrine HCl Tab SR 12HR 120 MG TB12 0.26920 02/22/2013 02/19/2013
Pseudoephedrine HCl Tab SR 12HR 120 MG TB12 0.27700 03/20/2008 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
PSS SELECT GP LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
PSS SELECT SAFETY LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
Psyllium Cap 0.52 GM CAPS 0.04125 02/22/2013 02/19/2013
Psyllium Powder 28% POWD 0.01200 02/22/2013 02/19/2013
Psyllium Powder 28.3% POWD 0.01720 02/22/2013 02/19/2013
Psyllium Powder 30% POWD 0.01120 02/22/2013 02/19/2013
Psyllium Powder 30.9% POWD 0.01120 02/22/2013 02/19/2013
Psyllium Powder 33% POWD 0.01200 02/22/2013 02/19/2013
Psyllium Powder 48.57% POWD 0.01620 02/22/2013 02/19/2013
Psyllium Powder 50% POWD 0.01200 02/22/2013 02/19/2013
Psyllium Powder 58.6% POWD 0.01720 02/22/2013 02/19/2013
PTS PANELS GLUCOSE TEST (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
PULMOCARE (Nutritional Supplement Liquid**) LIQD 0.00720 04/28/2005 02/19/2013
PULMOCARE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
PULMOZYME (Dornase Alfa Inhal Soln 1 MG/ML) SOLN 31.46740 01/03/2013 02/20/2013
PURPOSE MOISTURIZER (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
PX LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
PX LANCETS ULTRA THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
PX PRENATAL MULTIVITAMINS (Prenatal Vit w/ Fe
Fumarate-FA Ta
TABS 0.07255 02/27/2009 02/19/2013
Pyrethrins-Piperonyl Butoxide Liq 0.3-3% LIQD 0.06729 02/22/2013 02/19/2013
Pyrethrins-Piperonyl Butoxide Liq 0.33-4% LIQD 0.09099 02/22/2013 02/19/2013
Pyrethrins-Piperonyl Butoxide Liq 0.33-4% SHAM 0.09099 02/22/2013 02/19/2013
Pyrethrins-Piperonyl Butoxide Shampoo 0.3-3% SHAM 0.04062 02/22/2013 02/19/2013
Pyrethrins-Piperonyl Butoxide Shampoo 0.33-4% SHAM 0.03030 02/22/2013 02/19/2013
Pyridostigmine Bromide Tab 60 MG TABS 0.27263 02/22/2013 02/19/2013
Pyridoxine HCl Tab 100 MG TABS 0.02610 02/22/2013 02/19/2013
Pyridoxine HCl Tab 25 MG TABS 0.01864 02/22/2013 02/19/2013
Pyridoxine HCl Tab 50 MG TABS 0.02120 02/22/2013 02/19/2013
QC LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
QC LANCETS SUPER THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
QC LANCETS THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
QC LANCETS ULTRA THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
QC MINERAL OIL HEAVY (Mineral Oil) OIL 0.01529 03/20/2008 02/19/2013
QC PRENATAL (Prenatal Vit w/ Fe Fumarate-FA Tab 28-0.8
MG***
TABS 0.03965 01/23/2009 02/19/2013
QUALAQUIN (Quinine Sulfate Cap 324 MG) CAPS 0.31000 05/26/2005 02/19/2013
QUENCH (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
Quetiapine Fumarate Tab 100 MG TABS 0.26000 02/22/2013 02/19/2013
Quetiapine Fumarate Tab 200 MG TABS 0.49400 02/22/2013 02/19/2013
Quetiapine Fumarate Tab 25 MG TABS 0.15938 02/22/2013 02/19/2013
Quetiapine Fumarate Tab 300 MG TABS 0.57736 04/12/2013 04/09/2013
Quetiapine Fumarate Tab 400 MG TABS 0.55125 12/13/2013 12/06/2013
Quetiapine Fumarate Tab 50 MG TABS 0.25610 02/22/2013 02/19/2013
QUICKTEK (Blood Glucose Monitoring Kit w/ Device***) KIT 0.71000 10/01/2003 02/19/2013
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Price
Effective
Date
Date
Updated
QUICKTEK TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
QUIN B STRONG (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
Quinapril HCl Tab 10 MG TABS 0.11278 02/22/2013 02/19/2013
Quinapril HCl Tab 20 MG TABS 0.09653 02/22/2013 02/19/2013
Quinapril HCl Tab 40 MG TABS 0.21000 04/13/2013 05/06/2013
Quinapril HCl Tab 5 MG TABS 0.08710 02/22/2013 02/19/2013
Quinapril-Hydrochlorothiazide Tab 20-25 MG TABS 0.73764 02/22/2013 02/19/2013
Quinidine Gluconate Tab CR 324 MG TBCR 0.52300 02/22/2013 02/19/2013
Quinidine Sulfate Tab 200 MG TABS 0.18270 02/22/2013 02/19/2013
Quinidine Sulfate Tab 300 MG TABS 0.18270 02/22/2013 02/19/2013
QUINTABS (Multiple Vitamin Tab**) TABS 0.02140 03/20/2008 02/19/2013
QUINTABS-M (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
QUINTET AC BLOOD GLUCOSE (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
QUINTET BLOOD GLUCOSE TES (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
RA BALANCED NUTRITIONAL (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
RA BALANCED NUTRITIONAL P (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
RA CALCIUM HI-CAL/VITAMIN (Calcium w/ Vitamin D Tab
500 MG-1
TABS 0.02087 03/13/2008 02/19/2013
RA CALCIUM HI-CAL/VITAMIN (Calcium-Cholecalciferol Tab
500 M
TABS 0.02087 03/13/2008 02/19/2013
RA CALCIUM HI-CAL/VITAMIN (Calcium-Ergocalciferol Tab
250 MG
TABS 0.02833 03/13/2008 02/19/2013
RA CENTRAL-VITE UNDER 50 (Multiple Vitamins w/
Minerals Tab*
TABS 0.07430 03/20/2008 02/19/2013
RA E-ZJECT COLOR LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
RA E-ZJECT LANCETS 28G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
RA E-ZJECT LANCETS THIN 2 (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
RA E-ZJECT LANCETS ULTRA (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
RA GENTLE INFANT FORMULA/ (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
RA IMMUNE SUPPORT INFANT (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
RA INFANT FORMULA/IRON (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
RA LANCETS ALTERNATE SITE (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
RA LANCETS THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
RA LANCETS ULTRA THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
RA LOTION (Resorcinol-Alcohol Lotion***) LOTN 0.02740 04/28/2005 02/19/2013
RA MILK BASED INFANT FORM (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
RA MINERAL OIL (Mineral Oil) OIL 0.01529 03/20/2008 02/19/2013
RA NUTRITIONAL SUPPLEMENT (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
RA NUTRITIONAL SUPPORT (Nutritional Supplement
Powder**)
POWD 0.20315 04/05/2011 02/19/2013
RA OMEPRAZOLE (Omeprazole Delayed Release Tab 20
MG)
TBEC 0.53640 04/28/2005 02/19/2013
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Price
Effective
Date
Date
Updated
RA OYSTER SHELL CALCIUM/V (Calcium
Carbonate-Ergocalciferol
TABS 0.02833 03/13/2008 02/19/2013
RA PRENATAL (Prenatal Vit w/ Fe Fumarate-FA Tab 28-0.8
MG***
TABS 0.07255 02/27/2009 02/19/2013
RA RENEWAL ADVANCED HEALI (Skin Protectants Misc -
Ointment*
OINT 0.03040 04/28/2005 02/19/2013
RA RENEWAL DRY SKIN THERA (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
RA SOY INFANT FORMULA/IRO (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
RA TRUE2GO BLOOD GLUCOSE (Blood Glucose Monitoring
Kit w/ De
KIT 0.71000 10/01/2003 02/19/2013
RA TRUERESULT BLOOD GLUCO (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
RA TRUETEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
RA TUGABOOS INFANT FORMUL (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
RA TUGABOOS SENSITIVITY I (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
RADIAGUARD ADVANCED (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
RAGUS (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
Ramipril Cap 1.25 MG CAPS 0.10250 02/22/2013 02/19/2013
Ramipril Cap 10 MG CAPS 0.13322 02/22/2013 02/19/2013
Ramipril Cap 2.5 MG CAPS 0.13370 02/22/2013 02/19/2013
Ramipril Cap 5 MG CAPS 0.13142 02/22/2013 02/19/2013
Ranitidine HCl Cap 150 MG CAPS 0.12000 02/22/2013 02/19/2013
Ranitidine HCl Cap 300 MG CAPS 0.20000 02/22/2013 02/19/2013
Ranitidine HCl Inj 50 MG/2ML (25 MG/ML) SOLN 2.16450 02/22/2013 02/19/2013
Ranitidine HCl Syrup 15 MG/ML (75 MG/5ML) SYRP 0.04313 02/22/2013 02/19/2013
Ranitidine HCl Tab 150 MG TABS 0.09228 10/15/2013 11/06/2013
Ranitidine HCl Tab 300 MG TABS 0.18500 09/30/2013 11/05/2013
Ranitidine HCl Tab 75 MG TABS 0.12458 02/22/2013 02/19/2013
RAPAMUNE (Sirolimus Tab 1 MG) TABS 12.73300 01/01/2013 04/09/2013
RCF (Infant Foods Conc**) CONC 0.01190 04/28/2005 02/19/2013
RE PRENATAL MULTIVITAMIN (Prenatal Vit w/ Fe
Fumarate-FA Che
CHEW 0.29950 08/29/2008 02/19/2013
RE/NEPH (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
RE/NEPH HP/HC (Nutritional Supplement Liquid** (Frozen)) LIQD 0.00720 04/28/2005 02/19/2013
RE/NEPH LP/HC (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
RE/NEPH REDUCED SUGAR (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
REALITY LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
REALITY TRIGGER LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
REBIF (Interferon Beta-1a Inj 22 MCG/0.5ML (12MU/ML) (44
MCG
SOLN 691.40660 08/01/2013 10/09/2013
REBIF (Interferon Beta-1a Inj 44 MCG/0.5ML (24MU/ML) (88
MCG
SOLN 750.32000 08/01/2013 10/09/2013
REBIF REBIDOSE (Interferon Beta-1a Inj 22 MCG/0.5ML
(12MU/ML
SOLN 691.40660 08/01/2013 10/09/2013
REBIF REBIDOSE (Interferon Beta-1a Inj 44 MCG/0.5ML
(24MU/ML
SOLN 750.32000 08/01/2013 10/09/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
REBIF REBIDOSE TITRATION (Interferon Beta-1a Inj 6 X 8.8
MCG
SOLN 987.72371 08/01/2013 10/09/2013
REBIF TITRATION PACK (Interferon Beta-1a Inj 6 X 8.8
MCG/0.2
SOLN 987.72371 08/01/2013 10/09/2013
RECANCOSTAT (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
RECOMBINATE (Antihemophilic Factor (Recombinant) For
Inj 124
SOLR 1.01350 12/24/2010 02/19/2013
RECOMBINATE (Antihemophilic Factor (Recombinant) For
Inj 180
SOLR 1.01350 12/24/2010 02/19/2013
RECOMBINATE (Antihemophilic Factor (Recombinant) For
Inj 220
SOLR 1.01350 12/24/2010 02/19/2013
RECOMBINATE (Antihemophilic Factor (Recombinant) For
Inj 401
SOLR 1.01350 12/24/2010 02/19/2013
RECOMBINATE (Antihemophilic Factor (Recombinant) For
Inj 801
SOLR 1.01350 12/24/2010 02/19/2013
RECTICARE (Lidocaine Anorectal Cream 5%) CREA 1.50940 04/28/2005 02/19/2013
REFACTO (Antihemophilic Factor (Recombinant) For Inj Kit
100
KIT 0.88000 08/26/2011 02/19/2013
REFACTO (Antihemophilic Factor (Recombinant) For Inj Kit
200
KIT 0.88000 08/26/2011 02/19/2013
REFACTO (Antihemophilic Factor (Recombinant) For Inj Kit
250
KIT 0.88000 08/26/2011 02/19/2013
REFACTO (Antihemophilic Factor (Recombinant) For Inj Kit
500
KIT 0.88000 08/26/2011 02/19/2013
REFRESH (Polyvinyl Alcohol-Povidone Ophth Soln 1.4-0.6%) SOLN 0.23804 03/20/2008 02/19/2013
REFRESH CELLUVISC (Carboxymethylcellulose Sodium
Ophth Soln
SOLN 0.47264 04/23/2012 02/19/2013
REFRESH DRY EYE THERAPY (Glycerin-Polysorbate 80
Ophth Soln
SOLN 0.55109 03/13/2008 02/19/2013
REFRESH ENDURA (Glycerin-Polysorbate 80 Ophth Soln
1-1%)
SOLN 0.55109 03/13/2008 02/19/2013
REFRESH LIQUIGEL (Carboxymethylcellulose Sodium Ophth
Soln 1
SOLN 0.47264 04/23/2012 02/19/2013
REFRESH P.M. (Artificial Tear Ophth Ointment***) OINT 0.94400 03/13/2008 02/19/2013
REFRESH PLUS (Carboxymethylcellulose Sodium Ophth
Soln 0.5%)
SOLN 0.21960 01/15/2009 02/19/2013
REFRESH PLUS (Carboxymethylcellulose Sodium Ophth
Soln 0.5%)
SOLN 0.21960 05/28/2010 02/19/2013
REFUAH PLUS BLOOD GLUCOSE (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
REFUAH PLUS BLOOD GLUCOSE (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
REGULAR WATE-ON (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
RELION BLOOD GLUCOSE TEST (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
RELION CONFIRM BLOOD GLUC (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
RELION CONFIRM/MICRO TEST (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
RELION LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
RELION LANCETS STANDARD 2 (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
RELION LANCETS THIN 26G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
Page 110 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
RELION LANCETS ULTRA-THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
RELION MICRO BLOOD GLUCOS (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
RELION PRIME BLOOD GLUCOS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
RELION THIN LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
RELION ULTIMA BLOOD GLUCO (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
RELION ULTIMA TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
RELION ULTRA THIN LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
RELION ULTRA THIN PLUS LA (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
RELISTOR (Methylnaltrexone Bromide Inj 12 MG/0.6ML (20
MG/ML
SOLN 98.85300 06/14/2013 08/06/2013
RELISTOR (Methylnaltrexone Bromide Inj 8 MG/0.4ML (20
MG/ML)
SOLN 148.27950 06/14/2013 08/06/2013
RELISTOR (Methylnaltrexone Bromide Inj Kit 12 MG/0.6ML) KIT 59.31180 06/14/2013 08/06/2013
REMEDY CLEAR-AID (Skin Protectants Misc - Ointment***) OINT 0.03040 04/28/2005 02/19/2013
REMEDY NUTRASHIELD (Dimethicone Cream 1%) CREA 0.06060 04/28/2005 02/19/2013
REMICADE (Infliximab For IV Inj 100 MG) SOLR 840.17500 09/04/2013 10/09/2013
RENALCAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
RENAPLEX-D (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
RENASTART (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
RENASTART (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
RE-NATA 29 OB (Prenatal Vit w/ Iron Carbonyl-FA Tab 29-1
MG*
TABS 0.17167 05/11/2012 02/19/2013
RENEW ADVANCED LANCING CA (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
REPLACE (Multiple Vitamins w/ Minerals Cap**) CAPS 0.51325 04/27/2011 02/19/2013
REPLETE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
REPLETE/FIBER (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
REPLETE/FIBER/ULTRAPAK (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
REQ 49+ (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
RESOURCE 2.0 (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
RESOURCE ARGINAID (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
RESOURCE BREEZE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
RESOURCE DAIRY THICK HONE (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
RESOURCE DIABETIC TF (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
RESOURCE GLUTASOLVE (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
RESOURCE JUST FOR KIDS (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
RESOURCE JUST FOR KIDS 1. (Nutritional Supplement
Liquid**)
LIQD 0.00972 05/21/2007 02/19/2013
RESOURCE JUST FOR KIDS WI (Nutritional Supplement
Liquid**)
LIQD 0.00977 05/14/2007 02/19/2013
RESOURCE JUST FOR KIDS WI (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
RESOURCE OPTISOURCE HIGH (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
RESOURCE SUPPORT (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
RESOURCE THICKENUP (Starch Oral Thickening Powder) POWD 0.02350 03/20/2008 02/19/2013
RESOURCE THICKENUP THICKE (Nutritional Supplement
Liquid**)
LIQD 0.00720 04/28/2005 02/19/2013
RESOURCE THICKENUP THICKE (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
RESPALOR (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
RESTORE-X (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
RESURGEX (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
RESURGEX PLUS (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
RESURGEX SELECT (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
REVEAL BLOOD GLUCOSE MONI (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
REVEAL BLOOD GLUCOSE TEST (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
REVLIMID (Lenalidomide Cap 10 MG) CAPS 393.81857 10/31/2012 02/19/2013
REVLIMID (Lenalidomide Cap 15 MG) CAPS 395.42478 10/31/2012 02/19/2013
REVLIMID (Lenalidomide Cap 25 MG) CAPS 399.31260 10/31/2012 02/19/2013
REVLIMID (Lenalidomide Cap 5 MG) CAPS 387.16951 10/31/2012 02/19/2013
RHOGAM HUMAN (Rho D Immune Globulin (Human) IM Inj
300 MCG)
INJ 91.52410 04/13/2012 02/19/2013
RHOGAM ULTRA-FILTERED PLU (Rho D Immune Globulin
(Human) IM
INJ 91.52410 04/13/2012 02/19/2013
RIASTAP (Fibrinogen Conc (Human) Inj Approximately 1 GM
(900
SOLR 0.87200 12/24/2010 02/19/2013
RIBAPAK (Ribavirin Tab 400 MG) TABS 3.56550 05/22/2009 02/19/2013
RIBAPAK (Ribavirin Tab 600 MG) TABS 6.99550 08/29/2008 02/19/2013
RIBASPHERE (Ribavirin Tab 400 MG) TABS 3.56550 05/22/2009 02/19/2013
RIBASPHERE (Ribavirin Tab 600 MG) TABS 6.99550 08/29/2008 02/19/2013
RIBATAB (Ribavirin Tab 400 MG) TABS 3.56550 05/22/2009 02/19/2013
RIBATAB (Ribavirin Tab 600 MG) TABS 6.99550 08/29/2008 02/19/2013
Ribavirin Cap 200 MG CAPS 0.55000 04/12/2013 04/09/2013
Ribavirin Tab 200 MG TABS 0.60089 02/22/2013 02/19/2013
Ribavirin Tab 400 MG TABS 3.56550 02/22/2013 02/19/2013
Ribavirin Tab 600 MG TABS 6.99550 02/22/2013 02/19/2013
Riboflavin Tab 100 MG TABS 0.03360 02/22/2013 02/19/2013
RID (Permethrin Aerosol 0.5%) AERO 0.02400 04/28/2005 02/19/2013
RID (Pyrethrins-Piperonyl Butoxide Liq 0.3-3%) LIQD 0.06729 03/20/2008 02/19/2013
RID (Pyrethrins-Piperonyl Butoxide Liq 0.33-4%) LIQD 0.09099 03/20/2008 02/19/2013
RID LICE KILLING MOUSSE (Pyrethrins-Piperonyl Butoxide
Foam
FOAM 0.06310 04/28/2005 02/19/2013
Rifampin Cap 150 MG CAPS 0.75014 02/22/2013 02/19/2013
Rifampin Cap 300 MG CAPS 1.42000 11/12/2013 12/06/2013
RIGHT STEP PRENATAL (Prenatal Vit w/ Fe Fumarate-FA
Tab 27-0
TABS 0.03970 04/23/2010 02/19/2013
RIGHTEST GL300 LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
Page 112 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
RIGHTEST GM100 BLOOD GLUC (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
RIGHTEST GM300 BLOOD GLUC (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
RIGHTEST GM550 BLOOD GLUC (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
RIGHTEST GS100 BLOOD GLUC (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
RIGHTEST GS300 BLOOD GLUC (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
RIGHTEST GS550 BLOOD GLUC (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
RILUTEK (Riluzole Tab 50 MG) TABS 34.46100 04/05/2013 05/06/2013
Rimantadine Hydrochloride Tab 100 MG TABS 1.10600 02/22/2013 02/19/2013
Risperidone Orally Disintegrating Tab 0.5 MG TBDP 1.48278 02/22/2013 02/19/2013
Risperidone Orally Disintegrating Tab 1 MG TBDP 2.14101 08/09/2013 08/06/2013
Risperidone Orally Disintegrating Tab 2 MG TBDP 2.28439 12/13/2013 12/06/2013
Risperidone Orally Disintegrating Tab 3 MG TBDP 5.70888 08/09/2013 08/06/2013
Risperidone Orally Disintegrating Tab 4 MG TBDP 8.33117 08/09/2013 08/06/2013
Risperidone Soln 1 MG/ML SOLN 0.74850 02/22/2013 02/19/2013
Risperidone Tab 0.25 MG TABS 0.07642 02/22/2013 02/19/2013
Risperidone Tab 0.5 MG TABS 0.13073 02/22/2013 02/19/2013
Risperidone Tab 1 MG TABS 0.16431 02/22/2013 02/19/2013
Risperidone Tab 2 MG TABS 0.20255 02/22/2013 02/19/2013
Risperidone Tab 3 MG TABS 0.20583 02/22/2013 02/19/2013
Risperidone Tab 4 MG TABS 0.24323 02/22/2013 02/19/2013
RITUXAN (Rituximab For IV Inj Conc 10 MG/ML) CONC 66.50591 07/02/2013 08/07/2013
Rivastigmine Tartrate Cap 1.5 MG CAPS 2.17690 05/10/2013 05/07/2013
Rivastigmine Tartrate Cap 3 MG CAPS 2.34470 05/10/2013 05/07/2013
Rivastigmine Tartrate Cap 4.5 MG CAPS 2.65351 02/08/2013 02/20/2013
Rivastigmine Tartrate Cap 4.5 MG CAPS 2.65351 02/22/2013 02/20/2013
Rivastigmine Tartrate Cap 6 MG CAPS 2.54292 02/22/2013 02/19/2013
RIXUBIS (Coagulation Factor IX (Recombinant) For Inj 1000
Un
SOLR 1.12880 01/01/2013 02/20/2013
RIXUBIS (Coagulation Factor IX (Recombinant) For Inj 2000
Un
SOLR 1.12880 01/01/2013 02/20/2013
RIXUBIS (Coagulation Factor IX (Recombinant) For Inj 500
Uni
SOLR 1.12880 01/01/2013 02/20/2013
Rizatriptan Benzoate Tab 10 MG TABS 1.85000 11/08/2013 11/05/2013
Rizatriptan Benzoate Tab 5 MG TABS 2.11559 07/12/2013 07/08/2013
ROBITUSSIN CHEST CONGESTI (Guaifenesin Syrup 100
MG/5ML)
SYRP 0.01800 03/13/2008 02/19/2013
ROBITUSSIN DM (Dextromethorphan-Guaifenesin Syrup
10-100 MG/
SYRP 0.02981 03/13/2008 02/19/2013
ROBITUSSIN PEAK COLD DM
(Dextromethorphan-Guaifenesin Syrup
SYRP 0.02981 03/13/2008 02/19/2013
ROC COMPLETELIFT SERUM (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
ROC DEEP WRINKLE SERUM (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
ROC MULTI CORREXION LIFT (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
ROC MULTI CORREXION TONE (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Ropinirole Hydrochloride Tab 0.25 MG TABS 0.18177 02/22/2013 02/19/2013
Ropinirole Hydrochloride Tab 0.5 MG TABS 0.21330 02/22/2013 02/19/2013
Ropinirole Hydrochloride Tab 1 MG TABS 0.21378 02/22/2013 02/19/2013
Ropinirole Hydrochloride Tab 2 MG TABS 0.26000 06/19/2013 08/06/2013
Ropinirole Hydrochloride Tab 3 MG TABS 0.18161 02/22/2013 02/19/2013
Ropinirole Hydrochloride Tab 4 MG TABS 0.20121 02/22/2013 02/19/2013
Ropinirole Hydrochloride Tab 5 MG TABS 0.22558 02/22/2013 02/19/2013
ROXICODONE INTENSOL (Oxycodone HCl Conc 20
MG/ML)
CONC 2.68000 10/01/2011 02/19/2013
S.O.S. 10 (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
S.O.S. 15 (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
S.O.S. 20 (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
S.O.S. 25 (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
SABRIL (Vigabatrin Powd Pack 500 MG) PACK 3.12350 03/05/2010 02/19/2013
SABRIL (Vigabatrin Tab 500 MG) TABS 3.12350 03/05/2010 02/19/2013
SAFE-T-LANCE LOW FLOW 25G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SAFE-T-LANCE NORMAL FLOW (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SAFE-T-LANCE PLUS SAFETY (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SAFETY LANCET 2MM (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SAFETY LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SAFETY LANCETS 21G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SAFETY LET LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SAFETY SEAL LANCETS 28G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SAFETY SEAL LANCETS 30G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SAIZEN (Somatropin (Non-Refrigerated) For Inj 5 MG) SOLR 398.89800 11/28/2012 02/19/2013
SAIZEN (Somatropin (Non-Refrigerated) For Inj 5 MG) SOLR 422.85180 07/26/2013 10/09/2013
SAIZEN (Somatropin (Non-Refrigerated) For Inj 8.8 MG) SOLR 676.56620 07/26/2013 10/09/2013
SAIZEN CLICK.EASY (Somatropin (Non-Refrigerated) For Inj
8.8
SOLR 676.56620 07/26/2013 10/09/2013
Salicylic Acid Lotion 6% LOTN 0.08792 02/22/2013 02/19/2013
Salicylic Acid Shampoo 6% SHAM 0.14124 02/22/2013 02/19/2013
Saline Injection Bacteriostatic SOLN 0.11379 02/11/2013 03/04/2013
Saline Injection Bacteriostatic SOLN 0.11379 02/22/2013 03/04/2013
Saline Nasal Spray 0.65% SOLN 0.02275 02/22/2013 02/19/2013
Salsalate Tab 500 MG TABS 0.29531 02/22/2013 02/19/2013
Salsalate Tab 750 MG TABS 0.15060 04/01/2013 06/11/2013
SANDIMMUNE (Cyclosporine Cap 25 MG) CAPS 2.42360 01/03/2013 02/20/2013
SANDIMMUNE (Cyclosporine Oral Soln 100 MG/ML) SOLN 9.31459 01/03/2013 02/20/2013
SANDOSTATIN LAR DEPOT (Octreotide Acetate For IM Inj
Kit 20
KIT 2,581.49920 01/03/2013 02/20/2013
SANDOSTATIN LAR DEPOT (Octreotide Acetate For IM Inj
Kit 20
KIT 2,662.36610 10/04/2013 12/06/2013
SANDOSTATIN LAR DEPOT (Octreotide Acetate For IM Inj
Kit 30
KIT 3,865.62540 01/03/2013 02/20/2013
SANDOSTATIN LAR DEPOT (Octreotide Acetate For IM Inj
Kit 30
KIT 3,986.69750 10/04/2013 12/06/2013
Page 114 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
SARNA (Camphor & Menthol Lotion 0.5-0.5%) LOTN 0.03110 04/28/2005 02/19/2013
SAVISION (Multiple Vitamins w/ Minerals Cap**) CAPS 0.51325 04/27/2011 02/19/2013
SB LANCETS THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SB LANCETS ULTRA THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SCANDICAL (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
SCANDISHAKE (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
SCANDISHAKE (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
Selegiline HCl Cap 5 MG CAPS 0.35200 02/22/2013 02/19/2013
Selegiline HCl Tab 5 MG TABS 1.49837 10/11/2013 10/09/2013
Selenium Sulfide Lotion 1% LOTN 0.01910 02/22/2013 02/19/2013
Selenium Sulfide Lotion 1% SHAM 0.01910 02/22/2013 02/19/2013
Selenium Sulfide Lotion 2.5% LOTN 0.07900 02/22/2013 02/19/2013
Selenium Tab 50 MCG TABS 0.02969 02/22/2013 02/19/2013
SELSUN BLUE (Selenium Sulfide Lotion 1%) LOTN 0.01910 03/20/2008 02/19/2013
SELSUN BLUE DAILY (Selenium Sulfide Lotion 1%) LOTN 0.01910 03/20/2008 02/19/2013
SELSUN BLUE MEDICATED (Selenium Sulfide Lotion 1%) LOTN 0.01910 03/20/2008 02/19/2013
SELSUN BLUE MOISTURIZING (Selenium Sulfide Lotion
1%)
LOTN 0.01910 03/20/2008 02/19/2013
SE-NATAL 19 (Prenatal Vit w/ DSS-Fe Fumarate-FA Tab 29-1
MG*
TABS 0.28847 01/23/2009 02/19/2013
SE-NATAL 19 (Prenatal Vit w/ Fe Fumarate-FA Chew Tab
29-1 MG
CHEW 0.29950 08/29/2008 02/19/2013
SENETONIC (Multiple Vitamins w/ Minerals Liquid**) LIQD 0.02464 03/20/2008 02/19/2013
SENIOR TOPIX TERIX (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
Senna Tab 187 MG TABS 0.03800 02/22/2013 02/19/2013
Sennosides Syrup 8.8 MG/5ML LIQD 0.05850 02/22/2013 02/19/2013
Sennosides Syrup 8.8 MG/5ML SYRP 0.05850 02/22/2013 02/19/2013
Sennosides Tab 8.6 MG TABS 0.03800 02/22/2013 02/19/2013
Sennosides-Docusate Sodium Tab 8.6-50 MG TABS 0.05000 02/22/2013 02/19/2013
SENOKOT (Sennosides Tab 8.6 MG) TABS 0.03800 03/20/2008 02/19/2013
SENOKOT S (Sennosides-Docusate Sodium Tab 8.6-50 MG) TABS 0.09222 03/20/2008 02/19/2013
SENOKOT TO GO (Sennosides Tab 8.6 MG) TABS 0.03800 03/20/2008 02/19/2013
SENTRY STARTER KIT (Blood Glucose Monitoring Kit w/
Device**
KIT 0.71000 10/01/2003 02/19/2013
SENTRY TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
SEROSTIM (Somatropin (Non-Refrigerated) For
Subcutaneous Inj
SOLR 216.42250 11/28/2012 02/19/2013
SEROSTIM (Somatropin (Non-Refrigerated) For
Subcutaneous Inj
SOLR 268.92000 11/28/2012 02/19/2013
SEROSTIM (Somatropin (Non-Refrigerated) For
Subcutaneous Inj
SOLR 285.05520 07/26/2013 10/09/2013
SEROSTIM (Somatropin (Non-Refrigerated) For
Subcutaneous Inj
SOLR 322.70400 11/28/2012 02/19/2013
SEROSTIM (Somatropin (Non-Refrigerated) For
Subcutaneous Inj
SOLR 342.06671 07/26/2013 10/09/2013
SEROSTIM (Somatropin (Non-Refrigerated) For
Subcutaneous Inj
SOLR 828.67200 11/28/2012 02/19/2013
Page 115 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Sertraline HCl Oral Conc 20 MG/ML CONC 0.70188 02/22/2013 02/19/2013
Sertraline HCl Tab 100 MG TABS 0.07562 02/22/2013 02/19/2013
Sertraline HCl Tab 25 MG TABS 0.07841 02/22/2013 02/19/2013
Sertraline HCl Tab 50 MG TABS 0.08580 02/22/2013 02/19/2013
SG MINERAL OIL HEAVY (Mineral Oil) OIL 0.01529 03/20/2008 02/19/2013
SHEPARDS (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
SHOPRITE TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
SHOPRITE VALUE PACK (Blood Glucose Monitoring Kit w/
Device*
KIT 0.71000 10/01/2003 02/19/2013
SIDEROL (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
Sildenafil Citrate Tab 20 MG TABS 0.85000 03/08/2013 03/04/2013
Silver Sulfadiazine Cream 1% CREA 0.25000 12/07/2012 05/15/2013
Simethicone Cap 125 MG CAPS 0.02200 02/22/2013 02/19/2013
Simethicone Chew Tab 125 MG CHEW 0.07284 02/22/2013 02/19/2013
Simethicone Chew Tab 80 MG CHEW 0.02327 02/22/2013 02/19/2013
Simethicone Susp 40 MG/0.6ML SUSP 0.05709 02/22/2013 02/19/2013
SIMILAC (Infant Foods Conc**) CONC 0.01190 04/28/2005 02/19/2013
SIMILAC (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
SIMILAC (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
SIMILAC 2 ADVANCE (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
SIMILAC 2/IRON (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
SIMILAC ADVANCE COMPLETE (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
SIMILAC ADVANCE EARLY SHI (Infant Foods Conc**) CONC 0.01190 04/28/2005 02/19/2013
SIMILAC ADVANCE EARLY SHI (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
SIMILAC ADVANCE EARLY SHI (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
SIMILAC ADVANCE KOSHER (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
SIMILAC ADVANCE ORGANIC E (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
SIMILAC ADVANCE/IRON (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
SIMILAC ADVANCE/IRON (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
SIMILAC ALIMENTUM ADVANCE (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
SIMILAC ALIMENTUM-IRON (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
SIMILAC EXPERT CARE ALIME (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
SIMILAC EXPERT CARE ALIME (Infant Foods Powder**) POWD 0.05900 02/06/2010 02/19/2013
SIMILAC EXPERT CARE NEOSU (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
SIMILAC EXPERT CARE NEOSU (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
SIMILAC EXPERT CARE/DIARR (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
SIMILAC FOR SPIT-UP (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
SIMILAC FOR SPIT-UP EARLY (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
SIMILAC GO & GROW EARLY S (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
SIMILAC HUMAN MILK FORTIF (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
SIMILAC ISOMIL 2 ADVANCE (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
SIMILAC ISOMIL ADVANCE (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
SIMILAC ISOMIL SOY EARLY (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
SIMILAC LACTOSE FREE (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
SIMILAC LACTOSE FREE ADVA (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
SIMILAC LACTOSE FREE ADVA (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
SIMILAC LOW IRON (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
SIMILAC LOW-IRON (Infant Foods Conc**) CONC 0.01190 04/28/2005 02/19/2013
SIMILAC LOW-IRON (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
SIMILAC LOW-IRON (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
SIMILAC NATURAL CARE (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
SIMILAC NEOSURE (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
SIMILAC NEOSURE ADVANCE/I (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
SIMILAC ORGANIC/IRON (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
SIMILAC ORGANIC/IRON (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
SIMILAC PM 60/40 (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
SIMILAC SENSITIVE (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
SIMILAC SENSITIVE EARLY S (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
SIMILAC SENSITIVE EARLY S (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
SIMILAC SENSITIVE FOR SPI (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
SIMILAC SENSITIVE ISOMIL (Infant Foods Conc**) CONC 0.01190 04/28/2005 02/19/2013
SIMILAC SENSITIVE ISOMIL (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
SIMILAC SENSITIVE ISOMIL (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
SIMILAC SENSITIVE/FUSSINE (Infant Foods Conc**) CONC 0.01190 04/28/2005 02/19/2013
SIMILAC SENSITIVE/SPIT-UP (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
SIMILAC SPECIAL CARE (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
SIMILAC SPECIAL CARE PREM (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
SIMILAC SPECIAL CARE/IRON (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
SIMILAC SPECIAL CARE/LOW (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
SIMILAC W/IRON (Infant Foods Conc**) CONC 0.01190 04/28/2005 02/19/2013
SIMILAC/IRON (Infant Foods Conc**) CONC 0.01190 04/28/2005 02/19/2013
SIMILAC/IRON (Infant Foods Liquid**) LIQD 0.01680 12/27/2006 02/19/2013
SIMILAC/IRON (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
SIMPONI (Golimumab Subcutaneous Inj 50 MG/0.5ML) SOLN 5,050.91520 08/06/2013 10/09/2013
Simvastatin Tab 10 MG TABS 0.03698 02/22/2013 02/19/2013
Simvastatin Tab 20 MG TABS 0.04321 02/22/2013 02/19/2013
Simvastatin Tab 40 MG TABS 0.06528 02/22/2013 02/19/2013
Simvastatin Tab 5 MG TABS 0.04945 02/22/2013 02/19/2013
Simvastatin Tab 80 MG TABS 0.09421 02/22/2013 02/19/2013
SINGLE-LET (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
Skin Protectants Misc - Ointment*** OINT 0.03040 02/22/2013 02/19/2013
SKIN REPAIR (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
SLO-NIACIN (Niacin Tab CR 500 MG) TBCR 0.05066 03/20/2008 02/19/2013
SLO-NIACIN (Niacin Tab CR 750 MG) TBCR 0.06310 04/28/2005 02/19/2013
SLOW-MAG (Magnesium Chloride Tab CR 535 MG (64 MG
Elemental
TBCR 0.10710 03/20/2008 02/19/2013
SLOW-MAG (Magnesium Cl-Ca Carbonate Tab DR 71.5-119
MG (Elem
TBEC 0.10710 03/20/2008 02/19/2013
SM GLUCOSE TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
SM LANCETS 21G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
SM MICRO THIN LANCETS 33G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SM MINERAL OIL (Mineral Oil) OIL 0.01529 03/20/2008 02/19/2013
SM NUTRI-DRINK (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
SM NUTRI-DRINK + (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
SM PRENATAL VITAMINS (Prenatal Vit w/ Fe Fumarate-FA
Tab 28-
TABS 0.07255 02/27/2009 02/19/2013
SM SUPER THIN LANCETS 30G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SM THIN LANCETS 26G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SMART DIABETES VANTAGE UN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SMART DIABETES XPRES BLOO (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
SMART DIABETES XPRES BLOO (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
SMART SENSE COLOR LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SMART SENSE STANDARD LANC (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SMART SENSE SUPER THIN LA (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SMART SENSE THIN LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SMARTEST BLOOD GLUCOSE TE (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
SMARTEST EJECT STARTER KI (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
SMARTEST LANCETS 28G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SMARTEST PERSONA STARTER (Blood Glucose
Monitoring Kit w/ De
KIT 0.71000 10/01/2003 02/19/2013
SMARTEST PRONTO STARTER (Blood Glucose Monitoring
Kit w/ Dev
KIT 0.71000 10/01/2003 02/19/2013
SMARTEST PROTEGE STARTER (Blood Glucose
Monitoring Kit w/ De
KIT 0.71000 10/01/2003 02/19/2013
SOBA LANCETS COLORED (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SOBA THIN LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
Sodium Bicarbonate Inj 8.4% SOLN 0.01733 02/22/2013 02/19/2013
Sodium Bicarbonate Tab 325 MG TABS 0.02043 02/22/2013 02/19/2013
Sodium Bicarbonate Tab 650 MG TABS 0.01930 02/22/2013 02/19/2013
Sodium Chloride Aero Soln 0.9% AERS 0.02435 02/22/2013 02/19/2013
Sodium Chloride Flush IV Soln 0.9% SOLN 0.00203 02/22/2013 02/19/2013
Sodium Chloride Hypertonic Ophth Oint 5% OINT 2.82175 02/22/2013 02/19/2013
Sodium Chloride Hypertonic Ophth Soln 5% SOLN 0.67835 02/22/2013 02/19/2013
Sodium Chloride Inj 0.9% SOLN 0.02514 02/22/2013 02/19/2013
Sodium Chloride Inj 4 mEq/ML (23.4%) SOLN 0.09604 01/17/2013 03/04/2013
Sodium Chloride Inj 4 mEq/ML (23.4%) SOLN 0.09604 02/22/2013 03/04/2013
Sodium Chloride Irrigation Soln 0.9% SOLN 0.00203 02/22/2013 02/19/2013
Sodium Chloride IV Soln 0.9% SOLN 0.00203 02/22/2013 02/19/2013
Sodium Chloride Soln Nebu 0.9% NEBU 0.04639 02/22/2013 02/19/2013
Sodium Chloride Tab 1 GM TABS 0.04563 02/22/2013 02/19/2013
Sodium Citrate & Citric Acid Soln 500-334 MG/5ML SOLN 0.01646 02/22/2013 02/19/2013
Sodium Fluoride Chew Tab 0.25 MG F (from 0.55 MG NaF) CHEW 0.04095 02/22/2013 02/19/2013
Sodium Fluoride Chew Tab 0.5 MG F (from 1.1 MG NaF) CHEW 0.02599 02/22/2013 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Sodium Fluoride Chew Tab 1 MG F (from 2.2 MG NaF) CHEW 0.00189 02/22/2013 02/19/2013
Sodium Fluoride Cream 1.1% CREA 0.07571 02/22/2013 02/19/2013
Sodium Fluoride Gel 1.1% (0.5% F) GEL 0.06328 02/22/2013 02/19/2013
Sodium Fluoride Rinse 0.2% SOLN 0.01756 02/22/2013 02/19/2013
Sodium Fluoride Soln 0.5 MG/ML F (from 1.1 MG/ML NaF) SOLN 0.16980 02/22/2013 02/19/2013
Sodium Phosphates - Enema*** ENEM 0.01138 02/22/2013 02/19/2013
Sodium Phosphates - Soln*** SOLN 0.06425 02/22/2013 02/19/2013
Sodium Polystyrene Sulfonate Oral Susp 15 GM/60ML SUSP 0.07401 02/22/2013 02/19/2013
Sodium Polystyrene Sulfonate Powder** POWD 0.23634 02/22/2013 02/19/2013
SOL CARB (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
SOLO (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
SOLUS V2 AUDIBLE BLOOD GL (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
SOLUS V2 AUDIBLE TEST (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
SOLUS V2 TWIST LANCETS 30 (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SOOTHE & COOL FREE MEDSEP (Skin Protectants Misc -
Ointment*
OINT 0.03040 04/28/2005 02/19/2013
SOOTHE & COOL FREE MOISTU (Skin Protectants Misc -
Ointment*
OINT 0.03040 04/28/2005 02/19/2013
SOOTHE & COOL FREE SKIN P (Skin Protectants Misc -
Ointment*
OINT 0.03040 04/28/2005 02/19/2013
SOOTHE & COOL MOISTURE BA (Skin Protectants Misc -
Ointment*
OINT 0.03040 04/28/2005 02/19/2013
SOOTHE & COOL MOISTURIZIN (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
SORBIDON HYDRATE (Skin Protectants Misc - Cream***) CREA 0.03040 04/28/2005 02/19/2013
Sorbitol Oral Solution 70% SOLN 0.01100 02/22/2013 02/19/2013
Sorbitol Solution (Bulk) SOLN 0.01100 02/22/2013 02/19/2013
Sotalol HCl (AFIB/AFL) Tab 120 MG TABS 0.17314 02/22/2013 02/19/2013
Sotalol HCl (AFIB/AFL) Tab 160 MG TABS 0.39000 02/22/2013 02/19/2013
Sotalol HCl (AFIB/AFL) Tab 80 MG TABS 0.12096 02/22/2013 02/19/2013
Sotalol HCl Tab 120 MG TABS 0.17314 02/22/2013 02/19/2013
Sotalol HCl Tab 160 MG TABS 0.21363 02/22/2013 02/19/2013
Sotalol HCl Tab 240 MG TABS 0.33276 02/22/2013 02/19/2013
Sotalol HCl Tab 80 MG TABS 0.09463 02/22/2013 02/19/2013
SOURCE COOKIE BAR (Nutritional Supplement Bar**) BAR 0.46070 04/28/2005 02/19/2013
SOURCECF (Multiple Vitamins w/ Minerals Cap**) CAPS 0.51325 04/27/2011 02/19/2013
SOURCECF (Multiple Vitamins w/ Minerals Chew Tab**) CHEW 0.29485 03/20/2008 02/19/2013
SOURCECF PEDIATRIC (Pediatric Multiple Vitamin w/
Minerals L
LIQD 0.02464 03/20/2008 02/19/2013
SOY PROTEIN SHAKE (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
SOYPRO (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
Speciality Vitamin Product Cap** CAPS 0.02150 02/22/2013 02/19/2013
Speciality Vitamin Product Tab** TABS 0.01190 02/22/2013 02/19/2013
Spironolactone & Hydrochlorothiazide Tab 25-25 MG TABS 0.66900 06/06/2013 07/09/2013
Spironolactone Powder POWD 2.34000 02/22/2013 02/19/2013
Spironolactone Tab 100 MG TABS 0.50262 02/22/2013 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Spironolactone Tab 25 MG TABS 0.10399 02/22/2013 02/19/2013
Spironolactone Tab 50 MG TABS 0.27225 02/22/2013 02/19/2013
SPORTSCREME (Trolamine Salicylate Cream 10%) CREA 0.04250 04/28/2005 02/19/2013
SPRYCEL (Dasatinib Tab 100 MG) TABS 284.92682 12/21/2012 02/20/2013
SPRYCEL (Dasatinib Tab 140 MG) TABS 284.92682 12/21/2012 02/20/2013
SPRYCEL (Dasatinib Tab 20 MG) TABS 73.33700 12/21/2012 02/20/2013
SPRYCEL (Dasatinib Tab 50 MG) TABS 146.67345 12/21/2012 02/20/2013
SPRYCEL (Dasatinib Tab 70 MG) TABS 146.67345 12/21/2012 02/20/2013
SPRYCEL (Dasatinib Tab 80 MG) TABS 284.92682 12/21/2012 02/20/2013
ST IVES SWISS FORMULA 24 (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
Stannous Fluoride Gel 0.4% GEL 0.06033 02/22/2013 02/19/2013
Starch-Maltodextrin Oral Thickening Powder POWD 0.01832 02/22/2013 02/19/2013
Stavudine Cap 15 MG CAPS 1.18500 02/22/2013 02/19/2013
Stavudine Cap 20 MG CAPS 1.21300 02/22/2013 02/19/2013
Stavudine Cap 30 MG CAPS 0.86000 07/12/2013 07/08/2013
Stavudine Cap 40 MG CAPS 1.43450 02/22/2013 02/19/2013
STERILANCE TL (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
STIMATE (Desmopressin Acetate Nasal Soln 1.5 MG/ML) SOLN 225.30650 09/25/2009 02/19/2013
STRESSTABS/IRON (Multiple Vitamins w/ Iron Tab**) TABS 0.04080 03/20/2008 02/19/2013
STRESSTABS/ZINC (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
STROVITE ADVANCE (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
STROVITE FORTE (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
STROVITE ONE (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
SUBDUE (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
SUBDUE PLUS (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
Sucralfate Tab 1 GM TABS 0.26000 02/22/2013 02/19/2013
SUDAFED (Pseudoephedrine HCl Tab 30 MG) TABS 0.03500 03/20/2008 02/19/2013
SUDAFED CHILDRENS (Pseudoephedrine HCl Liq 15
MG/5ML)
LIQD 0.02380 04/28/2005 02/19/2013
SUDAFED CONGESTION (Pseudoephedrine HCl Tab 30
MG)
TABS 0.03500 03/20/2008 02/19/2013
SUDAFED NASAL DECONGESTAN (Pseudoephedrine HCl
Tab 30 MG)
TABS 0.03500 03/20/2008 02/19/2013
Sulfacetamide Sodium Lotion 10% (Acne) LOTN 0.62192 02/22/2013 02/19/2013
Sulfacetamide Sodium Lotion 10% (Acne) SUSP 0.62192 02/22/2013 02/19/2013
Sulfacetamide Sodium Ophth Soln 10% SOLN 3.22000 12/07/2012 05/15/2013
Sulfacetamide Sodium w/ Sulfur Emulsion 10-5% EMUL 0.13190 02/22/2013 02/19/2013
Sulfacetamide Sodium w/ Sulfur Lotion 10-5% LOTN 0.70410 02/22/2013 02/19/2013
Sulfacetamide Sodium-Prednisolone Ophth Soln
10-0.23(0.25)%
SOLN 2.86230 02/22/2013 02/19/2013
Sulfamethoxazole-Trimethoprim Susp 200-40 MG/5ML SUSP 0.06065 01/03/2013 02/20/2013
Sulfamethoxazole-Trimethoprim Susp 200-40 MG/5ML SUSP 0.06065 02/22/2013 02/20/2013
Sulfamethoxazole-Trimethoprim Tab 400-80 MG TABS 0.08359 02/22/2013 02/19/2013
Sulfamethoxazole-Trimethoprim Tab 800-160 MG TABS 0.07372 02/22/2013 02/19/2013
Sulfasalazine Tab 500 MG TABS 0.14500 02/22/2013 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Sulfasalazine Tab Delayed Release 500 MG TBEC 0.25764 02/22/2013 02/19/2013
Sulindac Tab 150 MG TABS 0.14599 02/22/2013 02/19/2013
Sulindac Tab 200 MG TABS 0.16336 02/22/2013 02/19/2013
Sumatriptan Succinate Inj 4 MG/0.5ML SOLN 175.00000 02/22/2013 02/19/2013
Sumatriptan Succinate Inj 6 MG/0.5ML SOLN 136.79400 02/22/2013 02/19/2013
Sumatriptan Succinate Tab 100 MG TABS 1.03678 02/22/2013 02/19/2013
Sumatriptan Succinate Tab 25 MG TABS 1.30277 02/22/2013 02/19/2013
Sumatriptan Succinate Tab 50 MG TABS 1.61000 10/23/2013 12/06/2013
SUPER ANTIOXIDANT (Multiple Vitamins w/ Minerals Cap**) CAPS 0.51325 04/27/2011 02/19/2013
SUPER GINSENG MULTIVITAMI (Multiple Vitamins w/
Minerals Cap
CAPS 0.51325 04/27/2011 02/19/2013
SUPER THIN LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SUPER WATE-ON (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
SUPER WATE-ON SHAKE MIX (Nutritional Supplement
Powder**)
POWD 0.20315 04/05/2011 02/19/2013
SUPER-AMINO 1600 (Amino Acids Tab***) TABS 0.41080 04/28/2005 02/19/2013
SUPERB NAILS (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
SUPLENA (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
SUPLENA RTU (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
SUPLENA WITH CARB STEADY (Nutritional Supplement
Liquid**)
LIQD 0.01410 04/28/2005 02/19/2013
SUPPORT (Multiple Vitamins w/ Minerals Liquid**) LIQD 0.02464 03/20/2008 02/19/2013
SUPREME TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
SURE COMFORT LANCETS 28G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SURE COMFORT LANCETS 30G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SURE EDGE BLOOD GLUCOSE T (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
SURECHEK BLOOD GLUCOSE MO (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
SURECHEK BLOOD GLUCOSE TE (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
SURE-LANCE FLAT LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SURE-LANCE LANCETS 26G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SURE-LANCE THIN LANCETS 2 (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SURE-LANCE ULTRA THIN LAN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SURELITE LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SURESTEP PRO TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
SURESTEP TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
SURE-TEST EASYPLUS MINI B (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
SURE-TOUCH LANCETS UNIVER (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
SUTENT (Sunitinib Malate Cap 12.5 MG (Base Equivalent)) CAPS 103.78171 01/01/2013 02/20/2013
SUTENT (Sunitinib Malate Cap 25 MG (Base Equivalent)) CAPS 207.56314 01/01/2013 02/20/2013
SUTENT (Sunitinib Malate Cap 50 MG (Base Equivalent)) CAPS 382.80400 01/01/2013 02/20/2013
SYLATRON (Peginterferon alfa-2b For Inj Kit 4 X 296 MCG) KIT 3,755.45950 02/08/2013 02/20/2013
SYLATRON (Peginterferon alfa-2b For Inj Kit 4 X 444 MCG) KIT 5,633.18510 02/08/2013 02/20/2013
SYNAGIS (Palivizumab IM Soln 100 MG/ML) SOLN 2,363.76000 12/02/2013 11/26/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
SYNAGIS (Palivizumab IM Soln 50 MG/0.5ML) SOLN 2,503.62000 12/02/2013 11/26/2013
SYNALAR (Fluocinolone Acetonide Cream 0.025%) CREA 1.37372 06/08/2012 02/19/2013
SYNALAR (Fluocinolone Acetonide Oint 0.025%) OINT 0.42333 07/15/2010 02/28/2013
SYNALAR (Fluocinolone Acetonide Soln 0.01%) SOLN 1.52405 09/20/2012 02/19/2013
SYNDION (Multiple Vitamins w/ Minerals Cap**) CAPS 0.51325 04/27/2011 02/19/2013
SYNDION (Multiple Vitamins w/ Minerals Liquid**) LIQD 0.02464 03/20/2008 02/19/2013
SYNDION-SF (Multiple Vitamins w/ Minerals Liquid**) LIQD 0.02464 03/20/2008 02/19/2013
SYNVISC (Hylan Intra-articular Inj 8 MG/ML) INJ 165.26260 07/12/2013 09/09/2013
SYNVISC ONE (Hylan Intra-articular Inj 8 MG/ML) INJ 165.26260 07/12/2013 09/09/2013
TABLOID (Thioguanine Tab 40 MG) TABS 10.00000 12/17/2012 02/19/2013
Tacrolimus Cap 0.5 MG CAPS 1.02466 12/13/2013 12/06/2013
Tacrolimus Cap 1 MG CAPS 1.79705 11/08/2013 11/05/2013
Tacrolimus Cap 5 MG CAPS 14.62428 02/22/2013 02/19/2013
TAGAMET HB (Cimetidine Tab 200 MG) TABS 0.18810 04/28/2005 02/19/2013
TALWIN NX (Pentazocine w/ Naloxone Tab 50-0.5 MG) TABS 1.05450 05/11/2010 02/19/2013
Tamoxifen Citrate Tab 10 MG (Base Equivalent) TABS 0.13355 02/22/2013 02/19/2013
Tamoxifen Citrate Tab 20 MG (Base Equivalent) TABS 0.41398 02/04/2013 03/04/2013
Tamoxifen Citrate Tab 20 MG (Base Equivalent) TABS 0.41398 02/22/2013 03/04/2013
Tamsulosin HCl Cap 0.4 MG CAPS 0.22963 02/22/2013 02/19/2013
TAPAZOLE (Methimazole Tab 10 MG) TABS 0.40000 07/07/2003 02/19/2013
TAPAZOLE (Methimazole Tab 5 MG) TABS 0.25000 07/07/2003 02/19/2013
TARAPHILIC (Emollient - Ointment**) OINT 0.04583 03/13/2008 02/19/2013
TARCEVA (Erlotinib Tab 100 MG) TABS 147.47828 04/13/2012 02/19/2013
TARCEVA (Erlotinib Tab 150 MG) TABS 190.96200 07/23/2013 08/06/2013
TARON-EC CAL (Prenatal w/o A Vit w/ Fe Fumarate-FA Tab
DR 30
TBEC 0.18187 01/23/2009 02/19/2013
TASIGNA (Nilotinib Cap 150 MG) CAPS 71.23297 12/06/2012 02/19/2013
TASIGNA (Nilotinib Cap 200 MG) CAPS 71.23282 12/06/2012 02/19/2013
TAVIST ALLERGY (Clemastine Fumarate Tab 1.34 MG (1 MG
Base E
TABS 0.14420 03/13/2008 02/19/2013
Tea Tree Oil*** OIL 0.12500 02/22/2013 02/19/2013
TEARS AGAIN NIGHT & DAY (Artificial Tear Ophth Gel***) GEL 0.74780 04/28/2005 02/19/2013
TECHLITE AST LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
TECHLITE LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
TEGRIN-LT LICE TREATMENT (Pyrethrins-Piperonyl
Butoxide Sham
SHAM 0.04062 03/20/2008 02/19/2013
TELCARE BLOOD GLUCOSE MON (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
TELCARE BLOOD GLUCOSE TES (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
Temazepam Cap 15 MG CAPS 0.06500 02/22/2013 02/19/2013
Temazepam Cap 30 MG CAPS 0.08710 02/22/2013 02/19/2013
TEMODAR (Temozolomide Cap 140 MG) CAPS 302.47394 12/05/2012 02/19/2013
TEMODAR (Temozolomide Cap 180 MG) CAPS 388.89472 12/05/2012 02/19/2013
TEMODAR (Temozolomide Cap 250 MG) CAPS 540.27688 12/05/2012 02/20/2013
Temozolomide Cap 100 MG CAPS 103.55000 10/11/2013 10/09/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Temozolomide Cap 20 MG CAPS 20.75000 10/11/2013 10/09/2013
Temozolomide Cap 5 MG CAPS 5.21000 10/11/2013 10/09/2013
Terazosin HCl Cap 1 MG CAPS 0.06656 02/22/2013 02/19/2013
Terazosin HCl Cap 10 MG CAPS 0.08466 02/22/2013 02/19/2013
Terazosin HCl Cap 2 MG CAPS 0.08466 02/22/2013 02/19/2013
Terazosin HCl Cap 5 MG CAPS 0.08218 02/22/2013 02/19/2013
Terbinafine HCl Tab 250 MG TABS 0.18014 02/22/2013 02/19/2013
Terbutaline Sulfate Tab 2.5 MG TABS 0.31374 02/22/2013 02/19/2013
Terbutaline Sulfate Tab 5 MG TABS 0.42438 02/22/2013 02/19/2013
Terconazole Vaginal Cream 0.4% CREA 0.80833 08/06/2013 10/09/2013
Terconazole Vaginal Cream 0.8% CREA 0.58381 02/22/2013 02/19/2013
Terconazole Vaginal Suppos 80 MG SUPP 10.55670 02/22/2013 02/19/2013
Testosterone Cypionate IM in Oil 100 MG/ML OIL 5.38200 02/22/2013 02/19/2013
Testosterone Cypionate IM in Oil 200 MG/ML OIL 13.52611 04/12/2013 04/09/2013
Testosterone Enanthate IM in Oil 200 MG/ML OIL 13.19356 02/22/2013 02/19/2013
Testosterone Powder POWD 0.19136 02/22/2013 02/19/2013
Testosterone Propionate Powder POWD 1.55480 02/22/2013 02/19/2013
Tetracaine HCl Ophth Soln 0.5% SOLN 0.73147 02/22/2013 02/19/2013
Tetracycline HCl Cap 250 MG CAPS 2.85000 10/18/2013 12/06/2013
Tetracycline HCl Cap 500 MG CAPS 0.05856 02/22/2013 02/19/2013
Tetrahydroz-Dextran-PEG-Povidone Ophth Soln
0.05-0.1-1-1%
SOLN 0.16942 02/22/2013 02/19/2013
Tetrahydrozoline HCl Ophth Soln 0.05% SOLN 0.16942 02/22/2013 02/19/2013
Tetrahydrozoline w/ Polyethylene Glycol Ophth Soln 0.05-1% SOLN 0.10770 02/22/2013 02/19/2013
TEV-TROPIN (Somatropin For Subcutaneous Inj 5 MG) SOLR 417.58960 07/01/2013 08/06/2013
TGT BLOOD GLUCOSE MONITOR (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
TGT BLOOD GLUCOSE TEST ST (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
TGT LANCET ALTERNATE SITE (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
TGT LANCET MICRO THIN 33G (Lancets***) MISC 0.08772 06/17/2011 02/28/2013
TGT LANCET SUPER THIN 30G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
TGT LANCET THIN 23G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
TGT LANCET THIN 26G (Lancets***) MISC 0.08772 06/17/2011 02/28/2013
TGT LANCET ULTRA THIN 28G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
TGT LANCET ULTRA THIN 30G (Lancets***) MISC 0.08772 06/17/2011 02/28/2013
TH MINERAL OIL (Mineral Oil) OIL 0.01529 03/20/2008 02/19/2013
THALOMID (Thalidomide Cap 100 MG) CAPS 245.48697 10/31/2012 02/19/2013
THALOMID (Thalidomide Cap 150 MG) CAPS 262.48631 10/31/2012 02/19/2013
THALOMID (Thalidomide Cap 200 MG) CAPS 279.49657 10/31/2012 02/19/2013
THALOMID (Thalidomide Cap 50 MG) CAPS 166.35524 10/31/2012 02/19/2013
Theophylline Tab SR 12HR 100 MG TB12 0.11840 02/22/2013 02/19/2013
Theophylline Tab SR 12HR 200 MG TB12 0.16070 02/22/2013 02/19/2013
Theophylline Tab SR 12HR 300 MG TB12 0.19844 02/22/2013 02/19/2013
Theophylline Tab SR 12HR 450 MG TB12 0.45050 02/22/2013 02/19/2013
Theophylline Tab SR 24HR 400 MG TB24 0.93100 02/22/2013 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Theophylline Tab SR 24HR 600 MG TB24 1.55000 07/10/2013 08/06/2013
THERA M PLUS (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
THERA/BETA-CAROTENE (Multiple Vitamin Tab**) TABS 0.02140 03/20/2008 02/19/2013
THERABETIC MULTI-VITAMIN (Multiple Vitamins w/ Minerals
Tab*
TABS 0.07430 03/20/2008 02/19/2013
THERABETIC SKIN CARE (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
THERAGRAN-M (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
THERAGRAN-M ADVANCED (Multiple Vitamins w/ Minerals
Tab**)
TABS 0.07430 03/20/2008 02/19/2013
THERAGRAN-M ADVANCED 50 P (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
THERAGRAN-M PREMIER (Multiple Vitamins w/ Minerals
Tab**)
TABS 0.07430 03/20/2008 02/19/2013
THERAGRAN-M PREMIER 50 PL (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
THERA-M (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
THERAMILL FORTE (Multiple Vitamins w/ Minerals Cap**) CAPS 0.08140 08/27/2010 02/19/2013
THERANATAL CORE NUTRITION (Prenatal Vit w/ Fe
Fumarate-FA Ta
TABS 0.07324 03/28/2011 02/19/2013
THERAPEUTIC LIQUID (Multiple Vitamins w/ Minerals
Liquid**)
SOLN 0.02464 03/20/2008 02/19/2013
THERAPLEX CLEARLOTION (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
THERAPLEX HYDROLOTION (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
THERA-TABS M (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
THERATEARS (Carboxymethylcellulose Sodium Ophth Soln
0.25%)
SOLN 0.35280 04/28/2005 02/19/2013
Thiamine HCl Tab 100 MG TABS 0.02230 02/22/2013 02/19/2013
Thiamine HCl Tab 50 MG TABS 0.01370 02/22/2013 02/19/2013
Thiamine Mononitrate Tab 100 MG TABS 0.02230 02/22/2013 02/19/2013
THICK-IT #2 (Starch Oral Thickening Powder) POWD 0.02350 03/20/2008 02/19/2013
THICK-IT ORIGINAL (Starch-Maltodextrin Oral Thickening
Powde
PACK 0.23528 03/20/2008 02/19/2013
THICK-IT ORIGINAL (Starch-Maltodextrin Oral Thickening
Powde
POWD 0.02038 03/15/2012 02/19/2013
THINLETS GP LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
THINLETS LANCET (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
Thioridazine HCl Tab 10 MG TABS 0.09707 02/22/2013 02/19/2013
Thioridazine HCl Tab 100 MG TABS 0.49500 08/15/2013 10/09/2013
Thioridazine HCl Tab 25 MG TABS 0.11875 02/22/2013 02/19/2013
Thioridazine HCl Tab 50 MG TABS 0.17937 02/22/2013 02/19/2013
Thiothixene Cap 1 MG CAPS 0.07813 02/22/2013 02/19/2013
Thiothixene Cap 10 MG CAPS 0.53000 11/08/2013 12/06/2013
Thiothixene Cap 2 MG CAPS 0.27000 04/03/2013 05/06/2013
Thiothixene Cap 5 MG CAPS 0.41000 04/23/2013 05/06/2013
THYROGEN (Thyrotropin Alfa For Inj 1.1 MG) SOLR 993.01200 04/13/2012 02/19/2013
Ticlopidine HCl Tab 250 MG TABS 0.58000 02/22/2013 02/19/2013
TIKOSYN (Dofetilide Cap 125 MCG (0.125 MG)) CAPS 2.82777 09/25/2009 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
TIKOSYN (Dofetilide Cap 250 MCG (0.25 MG)) CAPS 4.13064 01/01/2013 02/20/2013
TIKOSYN (Dofetilide Cap 500 MCG (0.5 MG)) CAPS 2.82777 09/25/2009 02/19/2013
Timolol Maleate Ophth Gel Forming Soln 0.25% SOLG 3.75000 02/22/2013 02/19/2013
Timolol Maleate Ophth Gel Forming Soln 0.5% SOLG 7.62465 08/09/2013 08/06/2013
Timolol Maleate Ophth Soln 0.25% SOLN 0.55900 02/22/2013 02/19/2013
Timolol Maleate Ophth Soln 0.5% SOLN 1.10300 02/22/2013 02/19/2013
TINACTIN (Tolnaftate Aerosol 1%) AERO 0.03540 04/28/2005 02/19/2013
TINACTIN (Tolnaftate Aerosol Pow 1%) AERP 0.04290 03/20/2008 02/19/2013
TINACTIN (Tolnaftate Cream 1%) CREA 0.13900 03/20/2008 02/19/2013
TINACTIN DEODORANT (Tolnaftate Aerosol Pow 1%) AERP 0.04290 03/20/2008 02/19/2013
TINACTIN JOCK ITCH (Tolnaftate Aerosol Pow 1%) AERP 0.04290 03/20/2008 02/19/2013
TINACTIN JOCK ITCH (Tolnaftate Cream 1%) CREA 0.13900 03/20/2008 02/19/2013
Tizanidine HCl Cap 2 MG CAPS 1.65000 10/11/2013 10/09/2013
Tizanidine HCl Cap 4 MG CAPS 2.41841 11/08/2013 11/05/2013
Tizanidine HCl Cap 6 MG CAPS 4.59000 02/22/2013 02/19/2013
Tizanidine HCl Tab 2 MG TABS 0.26000 05/21/2013 06/11/2013
Tizanidine HCl Tab 4 MG TABS 0.29287 06/03/2013 07/09/2013
TOBI (Tobramycin Nebu Soln 300 MG/5ML) NEBU 23.75128 01/03/2013 02/20/2013
Tobramycin Sulfate For Inj 1.2 GM SOLR 101.01000 02/22/2013 02/19/2013
Tobramycin Sulfate Inj 1.2 GM/30ML (40 MG/ML) SOLN 0.67297 02/22/2013 02/19/2013
Tobramycin Sulfate Inj 2 GM/50ML (40 MG/ML) SOLN 0.67297 02/22/2013 02/19/2013
Tobramycin Sulfate Inj 80 MG/2ML (40 MG/ML) SOLN 0.67297 02/22/2013 02/19/2013
Tobramycin Sulfate Ophth Soln 0.3% SOLN 1.86780 02/22/2013 02/19/2013
Tobramycin-Dexamethasone Ophth Susp 0.3-0.1% SUSP 11.85462 02/22/2013 02/19/2013
TOBREX (Tobramycin Sulfate Ophth Soln 0.3%) SOLN 0.38330 04/23/2010 02/19/2013
TODAYS HEALTH SUPER THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
TODAYS HEALTH ULTRA THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
TOFRANIL (Imipramine HCl Tab 25 MG) TABS 0.20980 04/23/2010 02/19/2013
TOFRANIL (Imipramine HCl Tab 25 MG) TABS 0.35130 02/04/2003 02/19/2013
Tolazamide Tab 250 MG TABS 0.18640 02/22/2013 02/19/2013
Tolazamide Tab 500 MG TABS 0.72640 02/22/2013 02/19/2013
TOLEREX (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
Tolmetin Sodium Cap 400 MG CAPS 0.70300 02/22/2013 02/19/2013
Tolmetin Sodium Tab 200 MG TABS 0.66200 02/22/2013 02/19/2013
Tolmetin Sodium Tab 600 MG TABS 2.88904 02/22/2013 02/19/2013
Tolnaftate Aerosol 1% AERO 0.03540 02/22/2013 02/19/2013
Tolnaftate Aerosol Pow 1% AERP 0.04290 02/22/2013 02/19/2013
Tolnaftate Cream 1% CREA 0.13900 02/22/2013 02/19/2013
TOPAMAX (Topiramate Tab 25 MG) TABS 0.12870 04/23/2010 02/19/2013
TOPICORT (Desoximetasone Cream 0.05%) CREA 3.40435 08/06/2012 02/19/2013
Topiramate Sprinkle Cap 15 MG CPSP 0.49375 02/22/2013 02/19/2013
Topiramate Sprinkle Cap 25 MG CPSP 0.55540 02/22/2013 02/19/2013
Topiramate Tab 100 MG TABS 0.11745 02/22/2013 02/19/2013
Topiramate Tab 200 MG TABS 0.14625 02/22/2013 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Topiramate Tab 25 MG TABS 0.03272 02/22/2013 02/19/2013
Topiramate Tab 50 MG TABS 0.08555 02/22/2013 02/19/2013
TORISEL (Temsirolimus Soln For IV Infusion 25 MG/ML) SOLN 1,372.03980 07/01/2013 08/07/2013
Torsemide Tab 10 MG TABS 0.10953 02/22/2013 02/19/2013
Torsemide Tab 100 MG TABS 0.36363 02/22/2013 02/19/2013
Torsemide Tab 20 MG TABS 0.11588 02/22/2013 02/19/2013
Torsemide Tab 5 MG TABS 0.16350 02/22/2013 02/19/2013
TRACLEER (Bosentan Tab 125 MG) TABS 95.11800 02/25/2011 02/19/2013
TRACLEER (Bosentan Tab 125 MG) TABS 113.54400 08/30/2013 10/09/2013
TRACLEER (Bosentan Tab 62.5 MG) TABS 82.00011 09/25/2009 02/19/2013
TRACLEER (Bosentan Tab 62.5 MG) TABS 113.54400 08/30/2013 10/09/2013
Tramadol HCl Tab 50 MG TABS 0.02781 02/22/2013 02/19/2013
Tramadol HCl Tab SR 24HR 100 MG TB24 2.63468 02/22/2013 02/19/2013
Tramadol HCl Tab SR 24HR 200 MG TB24 4.02740 02/22/2013 02/19/2013
Tramadol-Acetaminophen Tab 37.5-325 MG TABS 0.25990 02/22/2013 02/19/2013
Trandolapril Tab 1 MG TABS 0.21365 02/22/2013 02/19/2013
Trandolapril Tab 2 MG TABS 0.21365 02/22/2013 02/19/2013
Trandolapril Tab 4 MG TABS 0.21365 02/22/2013 02/19/2013
TRANXENE T (Clorazepate Dipotassium Tab 7.5 MG) TABS 0.25000 07/07/2003 02/19/2013
Tranylcypromine Sulfate Tab 10 MG TABS 1.60540 09/10/2013 10/09/2013
TRAUMACAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
TRAVASORB MCT (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
Trazodone HCl Tab 100 MG TABS 0.05122 02/22/2013 02/19/2013
Trazodone HCl Tab 150 MG TABS 0.08944 02/22/2013 02/19/2013
Trazodone HCl Tab 300 MG TABS 2.19790 02/22/2013 02/19/2013
Trazodone HCl Tab 50 MG TABS 0.02475 02/22/2013 02/19/2013
TRELSTAR DEPOT (Triptorelin Pamoate For IM Susp 3.75
MG)
SUSR 722.10000 07/30/2010 02/19/2013
TRELSTAR DEPOT MIXJECT (Triptorelin Pamoate For IM
Susp 3.75
SUSR 722.10000 07/30/2010 02/19/2013
TRELSTAR LA (Triptorelin Pamoate For IM Susp 11.25 MG) SUSR 2,166.30000 07/30/2010 02/19/2013
TRELSTAR LA MIXJECT (Triptorelin Pamoate For IM Susp
11.25 M
SUSR 2,166.30000 07/30/2010 02/19/2013
TRELSTAR MIXJECT (Triptorelin Pamoate For IM Susp 22.5
MG)
SUSR 4,541.76000 07/30/2010 02/19/2013
Tretinoin Cap 10 MG CAPS 20.94000 05/23/2013 08/06/2013
Tretinoin Cream 0.025% CREA 0.68177 02/22/2013 02/19/2013
Tretinoin Cream 0.05% CREA 1.80000 04/03/2013 04/09/2013
Tretinoin Cream 0.05% CREA 1.92000 08/30/2013 11/05/2013
Tretinoin Cream 0.1% CREA 1.94000 11/08/2013 12/06/2013
Tretinoin Gel 0.01% GEL 0.97472 02/22/2013 02/19/2013
Tretinoin Gel 0.025% GEL 1.05675 02/22/2013 02/19/2013
TRETIN-X (Tretinoin Cream 0.025% w/ Cleanser &
Moisturizer K
KIT 1.17000 12/28/2001 02/19/2013
TRETIN-X (Tretinoin Cream 0.05% w/ Cleanser & Moisturizer
Ki
KIT 1.30000 12/28/2001 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
TRETIN-X (Tretinoin Cream 0.1% w/ Cleanser & Moisturizer
Kit
KIT 1.53000 12/28/2001 02/19/2013
TRETIN-X (Tretinoin Gel 0.025% w/ Cleanser & Moisturizer
Kit
KIT 1.17000 12/28/2001 02/19/2013
TRIADVANCE (Prenatal Vit w/ DSS-Iron Carbonyl-FA Tab
90-1 MG
TABS 0.16250 01/23/2009 02/19/2013
Triamcinolone Acetonide Cream 0.025% CREA 0.03640 02/22/2013 02/19/2013
Triamcinolone Acetonide Cream 0.1% CREA 0.27462 02/22/2013 02/19/2013
Triamcinolone Acetonide Cream 0.5% CREA 0.48243 02/22/2013 02/19/2013
Triamcinolone Acetonide Dental Paste 0.1% PSTE 9.25000 02/22/2013 02/19/2013
Triamcinolone Acetonide Lotion 0.025% LOTN 0.41436 02/22/2013 02/19/2013
Triamcinolone Acetonide Lotion 0.1% LOTN 0.59050 02/22/2013 02/19/2013
Triamcinolone Acetonide Nasal Inhal 55 MCG/ACT INHA 4.72380 08/09/2013 08/06/2013
Triamcinolone Acetonide Oint 0.025% OINT 0.02160 02/22/2013 02/19/2013
Triamcinolone Acetonide Oint 0.1% OINT 0.11250 02/22/2013 02/19/2013
Triamcinolone Acetonide Oint 0.5% OINT 0.48850 02/22/2013 02/19/2013
TRIAMINO (Amino Acids Tab***) TABS 0.41080 04/28/2005 02/19/2013
Triamterene & Hydrochlorothiazide Cap 37.5-25 MG CAPS 0.27575 02/22/2013 02/19/2013
Triamterene & Hydrochlorothiazide Cap 50-25 MG CAPS 0.34900 02/22/2013 02/19/2013
Triamterene & Hydrochlorothiazide Tab 37.5-25 MG TABS 0.16830 02/22/2013 02/19/2013
Triamterene & Hydrochlorothiazide Tab 75-50 MG TABS 0.03738 02/22/2013 02/19/2013
Triazolam Tab 0.125 MG TABS 0.20610 02/22/2013 02/19/2013
Triazolam Tab 0.25 MG TABS 0.65168 11/08/2013 11/05/2013
TRICARE (Prenatal Vit w/ Fe Fumarate-FA Tab 27-1 MG***) TABS 0.07324 03/28/2011 02/19/2013
Trifluoperazine HCl Tab 1 MG TABS 0.24330 02/22/2013 02/19/2013
Trifluoperazine HCl Tab 10 MG TABS 0.68575 02/22/2013 02/19/2013
Trifluoperazine HCl Tab 2 MG TABS 0.26338 02/22/2013 02/19/2013
Trifluoperazine HCl Tab 5 MG TABS 0.43737 02/22/2013 02/19/2013
Trifluridine Ophth Soln 1% SOLN 16.35250 02/22/2013 02/19/2013
Trihexyphenidyl HCl Elixir 0.4 MG/ML ELIX 0.04710 02/22/2013 02/19/2013
Trihexyphenidyl HCl Tab 2 MG TABS 0.05613 02/22/2013 02/19/2013
Trihexyphenidyl HCl Tab 5 MG TABS 0.12050 02/22/2013 02/19/2013
Trimethoprim Tab 100 MG TABS 0.34050 02/22/2013 02/19/2013
TRINATE (Prenatal Vit w/ Fe Fumarate-FA Tab 28-1 MG***) TABS 0.18187 01/23/2009 02/19/2013
TRIPHASIL 28 (Levonorgestrel-Eth Estra Tab
0.05-30/0.075-40/
TABS 0.79000 12/28/2001 02/19/2013
Triprolidine & Pseudoephedrine Syrup 1.25-30 MG/5ML SYRP 0.00740 02/22/2013 02/19/2013
Triprolidine & Pseudoephedrine Tab 2.5-60 MG TABS 0.03360 02/22/2013 02/19/2013
TRI-VI-SOL (Pediatric Vitamins ADC Drops 1500 Unit-400
Unit-
SOLN 0.07766 03/20/2008 02/19/2013
TRI-VI-SOL/IRON (Pediatric Vitamins ACD w/ Iron Drops 10
MG/
SOLN 0.08108 03/20/2008 02/19/2013
TRI-VI-SOL/IRON (Pediatric Vitamins ACD w/ Iron Drops 10
MG/
SOLN 0.08450 04/28/2005 02/19/2013
TRI-VIT/FLUORIDE/IRON (Pediatric Vitamins ACD Fluoride &
Fe
SOLN 0.12480 05/28/2010 02/19/2013
Page 127 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
TRIXAICIN (Capsicum Oleoresin Cream 0.025%) CREA 0.10050 04/28/2005 02/19/2013
TRIXAICIN (Capsicum Oleoresin Cream 0.025%) CREA 0.10050 03/13/2008 02/19/2013
TRI-ZEL (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
Trolamine Salicylate Cream 10% CREA 0.04250 02/22/2013 02/19/2013
TROPAZONE (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
Tropicamide Ophth Soln 0.5% SOLN 0.65500 02/22/2013 02/19/2013
Tropicamide Ophth Soln 1% SOLN 0.70000 02/22/2013 02/19/2013
TRUE CARE STARTER KIT (Blood Glucose Monitoring Kit w/
Devic
KIT 0.71000 10/01/2003 02/19/2013
TRUE CARE TEST STRIP PACK (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
TRUE2GO BLOOD GLUCOSE MON (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
TRUEPLUS LANCETS 28G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
TRUEPLUS LANCETS 28G SUPE (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
TRUEPLUS LANCETS 30G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
TRUEPLUS LANCETS 30G ULTR (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
TRUEPLUS LANCETS 33G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
TRUEPLUS LANCETS 33G MICR (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
TRUEPLUS SAFETY LANCETS 2 (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
TRUERESULT BLOOD GLUCOSE (Blood Glucose
Monitoring Kit w/ De
KIT 0.71000 10/01/2003 02/19/2013
TRUETEST BLOOD GLUCOSE T (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
TRUETEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
TRUETRACK BLOOD GLUCOSE M (Blood Glucose
Monitoring Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
TRUETRACK BLOOD GLUCOSE T (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
TRUETRACK SMART SYSTEM (Blood Glucose Monitoring
Kit w/ Devi
KIT 0.71000 10/01/2003 02/19/2013
TRUETRACK TEST (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
TRUVADA (Emtricitabine-Tenofovir Disoproxil Fumarate Tab
200
TABS 40.61383 01/01/2013 02/20/2013
TUMS (Calcium Carbonate (Antacid) Chew Tab 500 MG) CHEW 0.02363 03/13/2008 02/19/2013
TUMS CALCIUM FOR LIFE BON (Calcium Carbonate
(Antacid) Chew
CHEW 0.04025 03/13/2008 02/19/2013
TUMS E-X 750 (Calcium Carbonate (Antacid) Chew Tab 750
MG)
CHEW 0.04025 03/13/2008 02/19/2013
TUMS KIDS (Calcium Carbonate (Antacid) Chew Tab 750
MG)
CHEW 0.04025 03/13/2008 02/19/2013
TUMS LASTING EFFECTS (Calcium Carbonate (Antacid)
Chew Tab 5
CHEW 0.02363 03/13/2008 02/19/2013
TUMS SMOOTHIES (Calcium Carbonate (Antacid) Chew Tab
750 MG)
CHEW 0.04025 03/13/2008 02/19/2013
TUMS ULTRA 1000 (Calcium Carbonate (Antacid) Chew Tab
1000 M
CHEW 0.04216 03/13/2008 02/19/2013
T-VITES (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
TWOCAL HN (Nutritional Supplement Liquid**) LIQD 0.00720 04/28/2005 02/19/2013
TWOCAL HN (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
TYKERB (Lapatinib Ditosylate Tab 250 MG (Base Equiv)) TABS 31.16545 01/04/2013 02/20/2013
TYLENOL (Acetaminophen Liquid 167 MG/5ML) LIQD 0.01930 04/28/2005 02/19/2013
TYLENOL (Acetaminophen Tab 325 MG) TABS 0.01590 03/13/2008 02/19/2013
TYLENOL 8 HOUR (Acetaminophen Tab CR 650 MG) TBCR 0.05936 03/13/2008 02/19/2013
TYLENOL ARTHRITIS PAIN (Acetaminophen Tab CR 650
MG)
TBCR 0.05936 03/13/2008 02/19/2013
TYLENOL EXTRA STRENGTH (Acetaminophen Liquid 167
MG/5ML)
LIQD 0.01930 04/28/2005 02/19/2013
TYLENOL SORE THROAT DAYTI (Acetaminophen Liquid
167 MG/5ML)
LIQD 0.01930 04/28/2005 02/19/2013
TYR 2 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
TYR COOLER (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
TYR EXPRESS (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
TYR GEL (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
TYREX-1 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
TYREX-2 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
TYROS 1 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
TYROS 2 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
TYSABRI (Natalizumab for IV Inj Conc 300 MG/15ML) CONC 293.08960 06/28/2013 08/06/2013
TYVASO (Treprostinil Inhalation Solution 0.6 MG/ML) SOLN 158.58008 01/01/2013 02/20/2013
TYVASO REFILL (Treprostinil Inhalation Solution 0.6 MG/ML) SOLN 158.58008 01/01/2013 02/20/2013
TYVASO STARTER (Treprostinil Inhalation Solution 0.6
MG/ML)
SOLN 158.58008 01/01/2013 02/20/2013
UCD 2 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
UCD ANAMIX JUNIOR (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
UCD TRIO (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
U-LACTIN (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
ULTICARE THIN LANCETS 30G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ULTICARE THIN LANCETS ULT (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ULTILET BASIC LANCETS 30G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ULTILET CLASSIC LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ULTILET LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ULTILET SAFETY LANCETS 23 (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ULTIMA TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ULTRA BRIGHT BEGINNINGS S (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
ULTRA NATAL (Prenatal Vit w/ DSS-Iron Carbonyl-FA Tab
90-1 M
TABS 0.16250 01/23/2009 02/19/2013
ULTRA NATALCARE (Prenatal Vit w/ DSS-Iron Carbonyl-FA
Tab 90
TABS 0.16250 01/23/2009 02/19/2013
ULTRA TABS (Prenatal Vit w/ DSS-Iron Carbonyl-FA Tab 90-1
MG
TABS 0.16250 01/23/2009 02/19/2013
ULTRA THIN LANCETS 28G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ULTRA THIN LANCETS 30G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ULTRA TRAK PRO BLOOD GLUC (Blood Glucose Monitoring
Kit w/ D
KIT 0.71000 10/01/2003 02/19/2013
ULTRACAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
Page 129 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
ULTRACAL HN PLUS (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
ULTRACET (Tramadol-Acetaminophen Tab 37.5-325 MG) TABS 0.42000 04/23/2010 02/19/2013
ULTRAMINO SOY PROTEIN (Nutritional Supplement
Powder**)
POWD 0.20315 04/05/2011 02/19/2013
ULTRA-NATAL (Prenatal Vit w/ DSS-Iron Carbonyl-FA Tab
90-1 M
TABS 0.16250 01/23/2009 02/19/2013
ULTRA-THIN II AUTO LANCET (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ULTRA-THIN II LANCETS 28G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ULTRA-THIN II LANCETS 30G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ULTRA-THIN II LANCETS/28G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ULTRA-THIN II LANCETS/30G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ULTRA-THIN II SAFETY AUTO (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
ULTRATRAK PRO TEST STRIPS (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
ULTRATRAK ULTIMATE TEST S (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
UNIFIBER (Cellulose Powder) POWD 0.03614 03/13/2008 02/19/2013
UNILET COMFORTOUCH LANCET (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
UNILET EXCELITE (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
UNILET EXCELITE II (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
UNILET G.P. LANCET (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
UNILET G.P. SUPERLITE LAN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
UNILET GP 28 ULTRA THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
UNILET LANCET (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
UNILET SUPERLITE LANCET (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
UNISTIK 2 (Lancets Misc.***) MISC 0.10000 10/01/2003 02/19/2013
UNISTIK 3 (Lancets Misc.***) MISC 0.10000 10/01/2003 02/19/2013
UNIVERSAL 1 LANCETS THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
UNIVERSAL 1 LANCETS ULTRA (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
Urea Cream 20% CREA 0.18000 03/04/2013 04/09/2013
Urea Cream 40% CREA 0.11121 02/22/2013 02/19/2013
Urea Gel 40% GEL 2.31531 02/08/2013 02/20/2013
Urea Gel 40% GEL 2.31531 02/22/2013 02/20/2013
Urea Lotion 40% LOTN 0.07778 02/22/2013 02/19/2013
Ursodiol (Bulk) Powder POWD 1.52880 02/22/2013 02/19/2013
Ursodiol Cap 300 MG CAPS 0.35308 02/22/2013 02/19/2013
Ursodiol Tab 250 MG TABS 1.63193 04/12/2013 04/09/2013
Ursodiol Tab 500 MG TABS 2.76000 04/12/2013 04/09/2013
UTYMAX (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
Valacyclovir HCl Tab 1 GM TABS 1.84000 11/08/2013 11/05/2013
Valacyclovir HCl Tab 500 MG TABS 1.06000 11/08/2013 11/05/2013
VALCYTE (Valganciclovir HCl Tab 450 MG) TABS 56.58207 01/03/2013 02/20/2013
Valproate Sodium Syrup 250 MG/5ML (Base Equiv) SOLN 0.02042 02/22/2013 02/19/2013
Valproate Sodium Syrup 250 MG/5ML (Base Equiv) SYRP 0.02042 02/22/2013 02/19/2013
Valproic Acid Cap 250 MG CAPS 0.14560 02/22/2013 02/19/2013
Valsartan-Hydrochlorothiazide Tab 160-12.5 MG TABS 0.61000 05/10/2013 05/07/2013
Valsartan-Hydrochlorothiazide Tab 160-25 MG TABS 0.61000 05/10/2013 05/07/2013
Page 130 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Valsartan-Hydrochlorothiazide Tab 320-12.5 MG TABS 0.87500 05/10/2013 05/07/2013
Valsartan-Hydrochlorothiazide Tab 320-25 MG TABS 0.87500 05/10/2013 05/07/2013
Valsartan-Hydrochlorothiazide Tab 80-12.5 MG TABS 0.40000 05/10/2013 05/07/2013
VALUE HEALTH LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
VALUE PLUS LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
VALUE PLUS LANCETS STANDA (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
VALUE PLUS LANCETS SUPER (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
VALUE PLUS LANCETS THIN 2 (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
VALUMARK LANCET SUPER THI (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
VALUMARK LANCET ULTRA THI (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
Vancomycin HCl Cap 125 MG CAPS 21.02000 10/11/2013 10/09/2013
Vancomycin HCl Cap 250 MG CAPS 37.74754 11/08/2013 11/05/2013
Vancomycin HCl For Inj 1000 MG SOLR 5.77070 02/22/2013 02/19/2013
Vancomycin HCl For Inj 5000 MG SOLR 23.61169 12/13/2013 12/06/2013
VANICREAM LITE (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
VANTAS (Histrelin Acetate Implant Kit 50 MG) KIT 4,980.00000 07/30/2010 02/19/2013
VASELINE CONSTANT CARE (Skin Protectants Misc -
Ointment***)
OINT 0.03040 04/28/2005 02/19/2013
VASELINE INTENSIVE CARE (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
VASELINE INTENSIVE CARE A (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
VASELINE INTENSIVE CARE D (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
VASELINE INTENSIVE CARE E (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
VASELINE INTENSIVE CARE H (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
VASELINE INTENSIVE CARE O (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
VASOTEC (Enalapril Maleate Tab 10 MG) TABS 0.05160 04/23/2010 02/19/2013
VASOTEC (Enalapril Maleate Tab 20 MG) TABS 0.07340 04/23/2010 02/19/2013
VASOTEC (Enalapril Maleate Tab 5 MG) TABS 0.04520 04/23/2010 02/19/2013
VELCADE (Bortezomib For Inj 3.5 MG) SOLR 1,533.84000 01/02/2013 02/20/2013
Venlafaxine HCl Cap SR 24HR 150 MG (Base Equivalent) CP24 0.40770 02/22/2013 02/19/2013
Venlafaxine HCl Cap SR 24HR 37.5 MG (Base Equivalent) CP24 0.30737 02/22/2013 02/19/2013
Venlafaxine HCl Cap SR 24HR 75 MG (Base Equivalent) CP24 0.40703 02/22/2013 02/19/2013
Venlafaxine HCl Tab 100 MG TABS 0.31925 02/22/2013 02/19/2013
Venlafaxine HCl Tab 25 MG TABS 0.42986 02/22/2013 02/19/2013
Venlafaxine HCl Tab 37.5 MG TABS 0.25870 02/22/2013 02/19/2013
Venlafaxine HCl Tab 50 MG TABS 0.31040 02/22/2013 02/19/2013
Venlafaxine HCl Tab 75 MG TABS 0.34725 02/22/2013 02/19/2013
Venlafaxine HCl Tab SR 24HR 37.5 MG (Base Equivalent) TB24 2.55183 06/14/2013 06/10/2013
Venlafaxine HCl Tab SR 24HR 75 MG (Base Equivalent) TB24 2.29000 07/12/2013 07/08/2013
VENTAVIS (Iloprost Inhalation Solution 10 MCG/ML) SOLN 69.22200 04/13/2012 02/19/2013
VENTAVIS (Iloprost Inhalation Solution 20 MCG/ML) SOLN 69.22200 04/13/2012 02/19/2013
Verapamil HCl Cap SR 24HR 100 MG CP24 1.29243 02/22/2013 02/19/2013
Verapamil HCl Cap SR 24HR 120 MG CP24 0.36000 02/22/2013 02/19/2013
Verapamil HCl Cap SR 24HR 180 MG CP24 0.31925 02/22/2013 02/19/2013
Verapamil HCl Cap SR 24HR 200 MG CP24 1.72286 02/22/2013 02/19/2013
Verapamil HCl Cap SR 24HR 240 MG CP24 0.49000 02/22/2013 02/19/2013
Page 131 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Verapamil HCl Cap SR 24HR 300 MG CP24 2.15697 02/22/2013 02/19/2013
Verapamil HCl Cap SR 24HR 360 MG CP24 1.48000 02/22/2013 02/19/2013
Verapamil HCl Tab 120 MG TABS 0.07363 02/22/2013 02/19/2013
Verapamil HCl Tab 40 MG TABS 0.14000 02/22/2013 02/19/2013
Verapamil HCl Tab 80 MG TABS 0.03900 02/22/2013 02/19/2013
Verapamil HCl Tab CR 120 MG TBCR 0.28542 02/22/2013 02/19/2013
Verapamil HCl Tab CR 180 MG TBCR 0.24440 02/22/2013 02/19/2013
Verapamil HCl Tab CR 240 MG TBCR 0.17157 02/22/2013 02/19/2013
VESANOID (Tretinoin Cap 10 MG) CAPS 19.85000 03/16/2012 02/19/2013
VHC 2.25 (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
VIACTIV (Calcium w/ Vitamin D & K Chew Tab 500 MG-100
Unit-4
CHEW 0.08476 03/13/2008 02/19/2013
VIACTIV (Calcium w/ Vitamin D & K Chew Tab 500 MG-500
Unit-4
CHEW 0.08476 03/13/2008 02/19/2013
VIAGRA (Sildenafil Citrate Tab 25 MG) TABS 20.34801 04/13/2012 02/19/2013
VIAGRA (Sildenafil Citrate Tab 50 MG) TABS 26.56400 11/18/2013 12/06/2013
VICKS BABYRUB (Liniments & Rubs - Cream**) CREA 0.02880 04/28/2005 02/19/2013
VICON FORTE (Multiple Vitamins w/ Minerals Cap**) CAPS 0.08140 08/27/2010 02/19/2013
VICTORY AGM-4000 TEST STR (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
VICTRELIS (Boceprevir Cap 200 MG) CAPS 18.03500 08/27/2013 10/09/2013
VIDA MIA UNILET LANCETS S (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
VIDA MIA UNILET LANCETS U (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
VINATE GT (Prenatal Vit w/ DSS-Iron Carbonyl-FA Tab 90-1
MG*
TABS 0.16250 01/23/2009 02/19/2013
VINATE M (Prenatal Vit w/ Sel-Fe Fumarate-FA Tab 27-1
MG***)
TABS 0.07800 01/23/2009 02/19/2013
VINATE ULTRA (Prenatal Vit w/ DSS-Iron Carbonyl-FA Tab
90-1
TABS 0.16250 01/23/2009 02/19/2013
VIREAD (Tenofovir Disoproxil Fumarate Oral Powder 40
MG/GM)
POWD 7.53377 01/01/2013 02/20/2013
VIREAD (Tenofovir Disoproxil Fumarate Tab 150 MG) TABS 25.61021 01/01/2013 02/20/2013
VIREAD (Tenofovir Disoproxil Fumarate Tab 200 MG) TABS 25.61021 01/01/2013 02/20/2013
VIREAD (Tenofovir Disoproxil Fumarate Tab 250 MG) TABS 25.61021 01/01/2013 02/20/2013
VIREAD (Tenofovir Disoproxil Fumarate Tab 300 MG) TABS 27.63346 01/01/2013 02/20/2013
VISINE (Tetrahydrozoline HCl Ophth Soln 0.05%) SOLN 0.16942 03/20/2008 02/19/2013
VISINE ADVANCED RELIEF
(Tetrahydroz-Dextran-PEG-Povidone Oph
SOLN 0.10770 04/28/2005 02/19/2013
VISINE EXTRA (Tetrahydrozoline HCl Ophth Soln 0.05%) SOLN 0.16942 03/20/2008 02/19/2013
VITA-BOB (Multiple Vitamins w/ Minerals Cap**) CAPS 0.51325 04/27/2011 02/19/2013
VITACARE (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
VITAJOULE (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
VITAL 1.0 CAL (Nutritional Supplement Liquid**) LIQD 0.00720 04/28/2005 02/19/2013
VITAL 1.0 CAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
VITAL 1.5 CAL (Nutritional Supplement Liquid**) LIQD 0.00720 04/28/2005 02/19/2013
VITAL 1.5 CAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
VITAL AF 1.2 CAL (Nutritional Supplement Liquid**) LIQD 0.00720 04/28/2005 02/19/2013
Page 132 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
VITAL AF 1.2 CAL (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
VITAL HN (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
VITAL JR (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
VITAL JR (Nutritional Supplement Liquid**) LIQD 0.06930 05/28/2010 02/19/2013
VITALET PRO LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
VITALET PRO PLUS LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
VITALINE BIOTIN FORTE (B-Complex w/ C & Folic Acid Tab
0.8 M
TABS 0.08400 03/13/2008 02/19/2013
VITALINE TOTAL FORMULA 2 (Multiple Vitamins w/ Minerals
Tab*
TABS 0.07430 03/20/2008 02/19/2013
VITALINE TOTAL FORMULA 3 (Multiple Vitamins w/ Minerals
Tab*
TABS 0.07430 03/20/2008 02/19/2013
VITAMANIX ULTIMATE (Multiple Vitamins w/ Minerals Cap**) CAPS 0.51325 04/27/2011 02/19/2013
VITAMAX (Pediatric Multiple Vitamin w/ Minerals & C Chew
Tab
CHEW 0.01747 03/20/2008 02/19/2013
Vitamin A Cap 10000 Unit CAPS 0.04138 02/22/2013 02/19/2013
Vitamin E Cap 100 Unit CAPS 0.02990 02/22/2013 02/19/2013
Vitamin E Cap 1000 Unit CAPS 0.10001 02/22/2013 02/19/2013
Vitamin E Cap 200 Unit CAPS 0.03040 02/22/2013 02/19/2013
Vitamin E Cap 400 Unit CAPS 0.04990 02/22/2013 02/19/2013
Vitamins A & D Oint** OINT 0.02350 02/22/2013 02/19/2013
VITAMINS FOR HAIR (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
Vitamins w/ Lipotropics Cap** CAPS 0.02250 02/22/2013 02/19/2013
Vitamins w/ Lipotropics Tab CR** TBCR 0.02250 02/22/2013 02/19/2013
Vitamins w/ Lipotropics Tab** TABS 0.02250 02/22/2013 02/19/2013
VITA-NATAL (Prenatal Multivitamins & Minerals w/ Iron & FA
C
CAPS 0.16055 01/23/2009 02/19/2013
VITAPRO (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
VITAQUICK (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
VITAROCA PLUS (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
VITASANA (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
VITATRUM (Multiple Vitamins w/ Minerals Tab**) TABS 0.07430 03/20/2008 02/19/2013
VITRUM 50+ SENIOR MULTI (Multiple Vitamins w/ Minerals
Tab**
TABS 0.07430 03/20/2008 02/19/2013
VIVAGLOBIN (Immune Globulin (Human) Subcutaneous Inj
160 MG/
SOLN 19.12320 04/13/2012 02/19/2013
VIVITROL (Naltrexone For IM Extended Release Susp 380
MG)
SUSR 1,145.50000 10/04/2010 02/19/2013
VIVONEX PEDIATRIC (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
VIVONEX PLUS (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
VIVONEX RTF (Nutritional Supplement Liquid**) LIQD 0.01410 04/28/2005 02/19/2013
VIVONEX T.E.N. (Nutritional Supplement Pack**) PACK 9.02000 06/15/2011 02/19/2013
VOCAL POINT BLOOD GLUCOSE (Glucose Blood Test
Strip)
STRP 0.74500 05/11/2012 02/19/2013
VOL-PLUS (Prenatal Vit w/ Fe Fumarate-FA Tab 27-1 MG***) TABS 0.07324 03/28/2011 02/19/2013
VOL-TAB RX (Prenatal Vit w/ Iron Carbonyl-FA Tab 29-1
MG***)
TABS 0.17167 05/11/2012 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
Voriconazole Tab 200 MG TABS 28.32367 05/10/2013 05/07/2013
VOTRIENT (Pazopanib HCl Tab 200 MG (Base Equiv)) TABS 59.18191 01/04/2013 02/20/2013
W&F COLOR LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
W&F LANCETS 26G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
W&F LANCETS COLORED 21G (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
W&F LANCETS ULTRA THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
WAL-FLU SEVERE COLD NIGHT
(Pheniramine-Phenylephrine w/ APAP
PACK 0.02655 08/29/2008 02/19/2013
WALGREENS ADVANCED TRAVEL (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
WALGREENS COMFORT ASSURED (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
WALGREENS LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
WALGREENS THIN LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
WALGREENS ULTRA THIN LANC (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
Warfarin Sodium Tab 1 MG TABS 0.08997 02/22/2013 02/19/2013
Warfarin Sodium Tab 10 MG TABS 0.04875 02/22/2013 02/19/2013
Warfarin Sodium Tab 2 MG TABS 0.09701 02/22/2013 02/19/2013
Warfarin Sodium Tab 2.5 MG TABS 0.08560 02/22/2013 02/19/2013
Warfarin Sodium Tab 3 MG TABS 0.09721 02/22/2013 02/19/2013
Warfarin Sodium Tab 4 MG TABS 0.10745 02/22/2013 02/19/2013
Warfarin Sodium Tab 5 MG TABS 0.09125 02/22/2013 02/19/2013
Warfarin Sodium Tab 6 MG TABS 0.09487 02/22/2013 02/19/2013
Warfarin Sodium Tab 7.5 MG TABS 0.08633 02/22/2013 02/19/2013
Water For Injection SOLN 0.02080 02/22/2013 02/19/2013
Water For Irrigation, Sterile Irrigation Soln SOLN 0.00340 02/22/2013 02/19/2013
WAVESENSE AMP (Blood Glucose Monitoring Kit w/
Device***)
KIT 0.71000 10/01/2003 02/19/2013
WAVESENSE KEYNOTE (Blood Glucose Monitoring Kit w/
Device***
KIT 0.71000 10/01/2003 02/19/2013
WD LANCETS (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
WD LANCETS THIN (Lancets***) MISC 0.08772 06/17/2011 02/19/2013
WELLBUTRIN XL (Bupropion HCl Tab SR 24HR 300 MG) TB24 1.23570 05/28/2010 02/19/2013
White Petrolatum-Mineral Oil Ophth Ointment*** OINT 0.94400 02/22/2013 02/19/2013
WIBI (Emollient - Lotion**) LOTN 0.01940 03/13/2008 02/19/2013
WILATE (Antihemophilic Factor/VWF (Human) For Inj
450-450 Un
SOLR 1.10400 12/24/2010 02/19/2013
WILATE (Antihemophilic Factor/VWF (Human) For Inj
900-900 Un
SOLR 1.10400 12/24/2010 02/19/2013
WINN DIXIE MEDIC TEST STR (Glucose Blood Test Strip) STRP 0.74500 05/11/2012 02/19/2013
WINN DIXIE MEDIC VALUE (Blood Glucose Monitoring Kit w/
Devi
KIT 0.71000 10/01/2003 02/19/2013
WND 1 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
WND 2 (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
WOMENS 50+ MULTI VITAMIN (Multiple Vitamins w/
Minerals Tab*
TABS 0.07430 03/20/2008 02/19/2013
WOMENS BIOMULTIPLE (Multiple Vitamins w/ Minerals
Tab**)
TABS 0.07430 03/20/2008 02/19/2013
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Drug Form Current MAC
Price
Effective
Date
Date
Updated
WOMENS MULTI VITAMIN & MI (Multiple Vitamins w/
Minerals Tab
TABS 0.07430 03/20/2008 02/19/2013
XALKORI (Crizotinib Cap 200 MG) CAPS 180.46090 07/01/2013 08/07/2013
XALKORI (Crizotinib Cap 250 MG) CAPS 180.46090 07/01/2013 08/07/2013
XELODA (Capecitabine Tab 150 MG) TABS 9.93039 07/02/2013 08/06/2013
XELODA (Capecitabine Tab 500 MG) TABS 33.09735 07/02/2013 08/06/2013
XENAZINE (Tetrabenazine Tab 12.5 MG) TABS 43.03446 04/13/2012 02/19/2013
XENAZINE (Tetrabenazine Tab 25 MG) TABS 86.06893 04/13/2012 02/19/2013
XIAFLEX (Collagenase Clostridium Histolyticum For Inj 0.9
MG
SOLR 3,237.00000 02/08/2013 02/20/2013
XLEU ANALOG (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
XLEU MAXAMAID (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
XLEU MAXAMUM (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
XLYS XTRP ANALOG (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
XLYS-XTRP ANALOG (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
XLYS-XTRP MAXAMAID (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
XLYS-XTRP MAXAMUM (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
XMET ANALOG (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
XMET MAXAMAID (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
XMET MAXAMUM (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
XMET XCYS ANALOG (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
XMET XCYS MAXAMAID (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
XMTVI ANALOG (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
XMTVI MAXAMAID (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
XMTVI MAXAMUM (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
XODOL (Hydrocodone-Acetaminophen Tab 10-300 MG) TABS 0.15000 08/12/2004 02/19/2013
XOLAIR (Omalizumab For Inj 150 MG) SOLR 773.90030 10/01/2013 12/06/2013
XP MAXAMUM (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
XPHE MAXAMAID (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
XPHE MAXAMUM (Amino Acids Oral Powder***) POWD 0.20315 04/05/2011 02/19/2013
XPHE MAXAMUM (Amino Acids Oral Powder***) POWD 0.33438 06/27/2012 02/19/2013
XPHE-XTYR ANALOG (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
XPHE-XTYR MAXAMAID (Nutritional Supplement Powder**) POWD 0.20315 04/05/2011 02/19/2013
XPTM ANALOG (Infant Foods Powder**) POWD 0.04649 04/24/2008 02/19/2013
XTRACAL PLUS (Nutritional Supplement Liquid**) LIQD 9.02000 06/15/2011 02/19/2013
XYNTHA (Antihemophilic Factor Recombinant PAF For Inj Kit
10
KIT 1.03750 12/24/2010 02/19/2013
XYNTHA (Antihemophilic Factor Recombinant PAF For Inj Kit
20
KIT 1.03750 12/24/2010 02/19/2013
XYNTHA (Antihemophilic Factor Recombinant PAF For Inj Kit
25
KIT 1.03750 12/24/2010 02/19/2013
XYNTHA (Antihemophilic Factor Recombinant PAF For Inj Kit
50
KIT 1.03750 12/24/2010 02/19/2013
XYNTHA SOLOFUSE (Antihemophilic Factor Recombinant
PAF For I
KIT 1.03750 12/24/2010 02/19/2013
Page 135 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
XYNTHA SOLOFUSE (Antihemophilic Factor Recombinant
PAF For I
KIT 1.03750 12/24/2010 02/19/2013
XYNTHA SOLOFUSE (Antihemophilic Factor Recombinant
PAF For I
KIT 1.03750 12/24/2010 02/19/2013
XYNTHA SOLOFUSE (Antihemophilic Factor Recombinant
PAF For I
KIT 1.03750 05/27/2011 02/19/2013
XYNTHA SOLOFUSE (Antihemophilic Factor Recombinant
PAF For I
KIT 1.03750 12/24/2010 02/19/2013
XYREM (Sodium Oxybate Oral Solution 500 MG/ML) SOLN 12.48430 02/01/2013 05/06/2013
YELETS TEENAGE FORMULA (Multiple Vitamins w/ Minerals
Tab**)
TABS 0.07430 03/20/2008 02/19/2013
ZADITOR (Ketotifen Fumarate Ophth Soln 0.025% (Base
Equiv))
SOLN 0.88540 03/20/2008 02/19/2013
Zafirlukast Tab 10 MG TABS 1.04000 03/08/2013 03/04/2013
Zafirlukast Tab 20 MG TABS 1.12500 03/08/2013 03/04/2013
Zaleplon Cap 10 MG CAPS 0.27627 02/22/2013 02/20/2013
Zaleplon Cap 5 MG CAPS 0.23946 02/22/2013 02/19/2013
ZANTAC 75 (Ranitidine HCl Tab 75 MG) TABS 0.14300 03/20/2008 02/19/2013
ZAVESCA (Miglustat Cap 100 MG) CAPS 120.54100 10/23/2009 02/19/2013
ZELBORAF (Vemurafenib Tab 240 MG (Base Equivalent)) TABS 42.48189 04/13/2012 02/19/2013
ZEMAIRA (Alpha1-Proteinase Inhibitor (Human) For IV Soln
100
SOLR 0.37390 05/28/2010 02/19/2013
Zidovudine Cap 100 MG CAPS 1.58565 02/22/2013 02/19/2013
Zidovudine Syrup 10 MG/ML SYRP 0.19555 02/22/2013 02/19/2013
Zidovudine Tab 300 MG TABS 0.32291 02/22/2013 02/19/2013
ZIKS ARTHRITIS PAIN RELIE (Capsaicin-Menthol-Methyl
Salicyla
CREA 0.02880 04/28/2005 02/19/2013
Zinc Cap 50 MG CAPS 0.04950 02/22/2013 02/19/2013
Zinc Gluconate Tab 50 MG (Elemental Zn) TABS 0.02900 02/22/2013 02/19/2013
Zinc Oxide Oint 20% OINT 0.09000 02/22/2013 02/19/2013
Zinc Sulfate Cap 220 MG (50 MG Elemental Zn) CAPS 0.02990 02/22/2013 02/19/2013
Zinc Tab 50 MG TABS 0.03074 02/22/2013 02/19/2013
ZINECARD (Dexrazoxane For Inj 250 MG) SOLR 204.41240 04/13/2012 02/19/2013
Ziprasidone HCl Cap 20 MG CAPS 2.52039 08/09/2013 08/06/2013
Ziprasidone HCl Cap 40 MG CAPS 2.52755 08/09/2013 08/06/2013
Ziprasidone HCl Cap 60 MG CAPS 3.01112 08/09/2013 08/06/2013
Ziprasidone HCl Cap 80 MG CAPS 2.89957 08/09/2013 08/06/2013
ZOFRAN (Ondansetron HCl Inj 2 MG/ML) SOLN 0.14960 04/23/2010 02/19/2013
ZOFRAN (Ondansetron HCl Inj 4 MG/2ML (2 MG/ML)) SOLN 0.14960 04/23/2010 02/19/2013
ZOFRAN (Ondansetron HCl Inj 40 MG/20ML (2 MG/ML)) SOLN 0.14960 04/23/2010 02/19/2013
ZOLADEX (Goserelin Acetate Implant 10.8 MG) IMPL 1,235.82020 10/01/2013 12/06/2013
ZOLADEX (Goserelin Acetate Implant 3.6 MG) IMPL 411.93730 10/01/2013 12/06/2013
Zolmitriptan Orally Disintegrating Tab 2.5 MG TBDP 7.56800 09/13/2013 09/09/2013
Zolmitriptan Orally Disintegrating Tab 5 MG TBDP 8.66800 09/13/2013 09/09/2013
Zolmitriptan Tab 2.5 MG TABS 7.57163 09/13/2013 09/09/2013
Zolmitriptan Tab 5 MG TABS 8.66800 09/13/2013 09/09/2013
Page 136 of 13712/13/2013
Drug Form Current MAC
Price
Effective
Date
Date
Updated
Zolpidem Tartrate Tab 10 MG TABS 0.02565 02/22/2013 02/19/2013
Zolpidem Tartrate Tab 5 MG TABS 0.03000 02/22/2013 02/19/2013
Zolpidem Tartrate Tab CR 12.5 MG TBCR 2.67755 11/08/2013 11/05/2013
Zolpidem Tartrate Tab CR 6.25 MG TBCR 2.93479 11/08/2013 11/05/2013
Zonisamide Cap 100 MG CAPS 0.14445 02/22/2013 02/19/2013
Zonisamide Cap 25 MG CAPS 0.11749 11/08/2013 11/05/2013
Zonisamide Cap 50 MG CAPS 0.12555 02/22/2013 02/19/2013
ZORBTIVE (Somatropin (Non-Refrigerated) For
Subcutaneous Inj
SOLR 878.39256 07/26/2013 10/09/2013
ZOSTRIX (Capsaicin Cream 0.025%) CREA 0.10050 03/13/2008 02/19/2013
ZOSTRIX ARTHRITIS PAIN RE (Capsaicin Cream 0.025%) CREA 0.10050 03/13/2008 02/19/2013
ZOSTRIX DIABETIC FOOT PAI (Capsaicin Cream 0.075%) CREA 0.09360 04/23/2010 02/19/2013
ZOSTRIX FOOT PAIN RELIEF (Capsaicin Cream 0.075%) CREA 0.14160 03/13/2008 02/19/2013
ZOSTRIX HP (Capsaicin Cream 0.075%) CREA 0.09360 04/23/2010 02/19/2013
ZOSTRIX SPORTS (Capsaicin Cream 0.075%) CREA 0.09360 04/23/2010 02/19/2013
ZYDONE (Hydrocodone-Acetaminophen Tab 7.5-400 MG) TABS 0.32000 12/29/2005 02/19/2013
ZYPREXA RELPREVV (Olanzapine Pamoate For Extended
Rel IM Sus
SUSR 554.27400 04/13/2012 02/19/2013
ZYPREXA RELPREVV (Olanzapine Pamoate For Extended
Rel IM Sus
SUSR 791.82000 04/13/2012 02/19/2013
ZYPREXA RELPREVV (Olanzapine Pamoate For Extended
Rel IM Sus
SUSR 1,068.95700 04/13/2012 02/19/2013
ZYTIGA (Abiraterone Acetate Tab 250 MG) TABS 56.74371 10/15/2013 12/06/2013
ZYVOX (Linezolid For Susp 100 MG/5ML) SUSR 3.70246 01/01/2013 02/20/2013
ZYVOX (Linezolid Tab 600 MG) TABS 116.51200 07/01/2013 10/09/2013
Page 137 of 13712/13/2013