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