Department of Public Health and Human Services

Home » Montana Healthcare Programs » Medicaid Rx AAC Pricing

Main Content

Medicaid Rx AAC Pricing

Montana Medicaid AAC Pricing

Last Updated: March 22, 2017
Current AAC Pricing PDF

Browse records in that    Search     
Generic NameBrand ReferenceStrengthDosage FormBrand/ GenericPackage SizeCase SizeAAC Rate
ABACAVIR SULFATE/LAMIVUDINEEPZICOM600-300MGTABLETBrand  42.0598
ABATACEPTORENCIA125 MG/MLSYRINGE (ML)Brand  929.7385
ACARBOSEPRECOSE100 MGTABLETGeneric  0.2252
ACARBOSEPRECOSE25 MGTABLETGeneric  0.3196
ACEBUTOLOL HCLSECTRAL200 MGCAPSULEGeneric  0.1922
ACETAMINOPHEN WITH CODEINE PHOSPHATEACETAMINOPHEN-CODEINE120-12MG/5SOLUTION, ORALGeneric  0.0113
ACETAMINOPHEN WITH CODEINE PHOSPHATETYLENOL-CODEINE NO.3300MG-30MGTABLETGeneric  0.1405
ACETAMINOPHEN WITH CODEINE PHOSPHATETYLENOL-CODEINE NO.4300MG-60MGTABLETGeneric  0.259
ACETAZOLAMIDEDIAMOX250 MGTABLETGeneric  1.9192
ACETAZOLAMIDEDIAMOX SEQUELS500 MGCAPSULE, EXTENDED RELEASEGeneric  2.4455
ACETIC ACIDVOSOL2 %SOLUTION, NON-ORALGeneric  1.2487
ACETIC ACID/HYDROCORTISONEVOSOL HC2 %-1 %DROPSGeneric  5.8627
ACETYLCYSTEINEACETYLCYSTEINE200 MG/MLVIAL (ML)Generic30 0.4824
ACITRETINSORIATANE25 MGCAPSULEGeneric  21.7981
ACYCLOVIRZOVIRAX200 MGCAPSULEGeneric  0.1302
ACYCLOVIRZOVIRAX200 MG/5MLSUSPENSION, ORAL (FINAL DOSE FORM)Generic  0.5555
ACYCLOVIRZOVIRAX400 MGTABLETGeneric  0.1084
ACYCLOVIRZOVIRAX5 %OINTMENT (GRAM)Generic15 17.4493
ACYCLOVIRZOVIRAX5 %OINTMENT (GRAM)Generic30 12.5773
ACYCLOVIRZOVIRAX5 %CREAM (GRAM)Brand  142.5127
ACYCLOVIRZOVIRAX800 MGTABLETGeneric  0.2879
ADALIMUMABHUMIRA40MG/0.8MLSYRINGE KIT (EA)Brand  2160.66
ADALIMUMABHUMIRA PEN40MG/0.8MLPEN INJECTOR KIT (EA)Brand2 2165.66
ADAPALENEDIFFERIN0.1 %LOTION (ML)Brand  7.9236
ADAPALENEDIFFERIN0.1 %GEL (GRAM)Generic  2.3411
ADAPALENEDIFFERIN0.1 %GEL (GRAM)Brand  12.4042
ADAPALENEDIFFERIN0.1 %CREAM (GRAM)Generic  4.4108
ADAPALENEDIFFERIN0.1 %CREAM (GRAM)Brand  11.4112
ADAPALENEDIFFERIN0.3 %GEL WITH PUMP (GRAM)Generic  5.4957
ADAPALENEDIFFERIN0.3 %GEL WITH PUMP (GRAM)Brand  11.9245
ADAPALENEDIFFERIN0.3 %GEL (GRAM)Generic  2.7331
ADAPALENE/BENZOYL PEROXIDEEPIDUO0.1 %-2.5%GEL WITH PUMP (GRAM)Brand  8.8638
ADAPALENE/BENZOYL PEROXIDEEPIDUO FORTE0.3 %-2.5%GEL WITH PUMP (GRAM)Brand  9.297
ALBENDAZOLEALBENZA200 MGTABLETBrand  164.349
ALBIGLUTIDETANZEUM30MG/0.5MLPEN INJECTOR (EA)Brand  115.2485
ALBIGLUTIDETANZEUM50MG/0.5MLPEN INJECTOR (EA)Brand  116.2843
ALBUTEROL SULFATEACCUNEB0.63MG/3MLVIAL, NEBULIZER (ML)Generic  0.2737
ALBUTEROL SULFATEACCUNEB1.25MG/3MLVIAL, NEBULIZER (ML)Generic  0.2516
ALBUTEROL SULFATEALBUTEROL SULFATE1.25MG/3MLVIAL, NEBULIZER (ML)Generic 00000250.2378
ALBUTEROL SULFATEALBUTEROL SULFATE2.5 MG/3MLVIAL, NEBULIZER (ML)Generic 00000250.0391
ALBUTEROL SULFATEALBUTEROL SULFATE2.5 MG/3MLVIAL, NEBULIZER (ML)Generic 00000600.0394
ALBUTEROL SULFATEPROAIR HFA90 MCGHFA AEROSOL WITH ADAPTER (GRAM)Brand8.5 6.3441
ALBUTEROL SULFATEPROAIR RESPICLICK90 MCGAEROSOL POWDER, BREATH ACTIVATED (EA)Brand  51.7165
ALBUTEROL SULFATEPROVENTIL2.5 MG/3MLVIAL, NEBULIZER (ML)Generic  0.0367
ALBUTEROL SULFATEPROVENTIL HFA90 MCGHFA AEROSOL WITH ADAPTER (GRAM)Brand6.7 10.7879
ALBUTEROL SULFATEVENTOLIN HFA90 MCGHFA AEROSOL WITH ADAPTER (GRAM)Brand18 2.7854
ALCAFTADINELASTACAFT0.25 %DROPSBrand  63.5419
ALCLOMETASONE DIPROPIONATEACLOVATE0.05 %CREAM (GRAM)Generic  1.6139
ALCLOMETASONE DIPROPIONATEACLOVATE0.05 %OINTMENT (GRAM)Generic  0.901
ALENDRONATE SODIUMFOSAMAX10 MGTABLETGeneric  0.1293
Page 1 of 51First   Previous   [1]  2  3  4  5  6  7  8  9  10  Next   Last