Home » Montana Healthcare Programs » Medicaid Rx AAC Pricing

Medicaid Rx AAC Pricing

Montana Medicaid AAC Pricing

Last Updated: January 18, 2018
Current AAC Pricing PDF

Browse records in that    Search     
Generic NameBrand ReferenceStrengthDosage FormBrand/ GenericPackage SizeCase SizeAAC Rate
0.9 % SODIUM CHLORIDESODIUM CHLORIDE0.9 %INTRAVENOUS SOLUTIONGeneric250 0.01676
ABACAVIR SULFATE/DOLUTEGRAVIR SODIUM/LAMIVUDINETRIUMEQ600-50-300TABLETBrand  90.13739
ABACAVIR SULFATE/LAMIVUDINEEPZICOM600-300MGTABLETBrand  42.0598
ABATACEPTORENCIA125 MG/MLSYRINGE (ML)Brand  1003.18856
ACAMPROSATE CALCIUMCAMPRAL333 MGTABLET, DELAYED RELEASE (ENTERIC COATED)Generic  1.02274
ACARBOSEPRECOSE100 MGTABLETGeneric  0.2252
ACARBOSEPRECOSE25 MGTABLETGeneric  0.3196
ACEBUTOLOL HCLSECTRAL200 MGCAPSULEGeneric  0.1922
ACETAMINOPHEN WITH CODEINE PHOSPHATETYLENOL-CODEINE NO.3300MG-30MGTABLETGeneric  0.14419
ACETAMINOPHEN WITH CODEINE PHOSPHATETYLENOL-CODEINE NO.4300MG-60MGTABLETGeneric  0.25035
ACETAZOLAMIDEDIAMOX250 MGTABLETGeneric  2.20701
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
ACYCLOVIRZOVIRAX5 %CREAM (GRAM)Brand  155.40454
ACYCLOVIRZOVIRAX5 %OINTMENT (GRAM)Generic15 17.4493
ACYCLOVIRZOVIRAX5 %OINTMENT (GRAM)Generic30 12.5773
ACYCLOVIRZOVIRAX200 MGCAPSULEGeneric  0.13376
ACYCLOVIRZOVIRAX200 MG/5MLSUSPENSION, ORAL (FINAL DOSE FORM)Generic  0.5555
ACYCLOVIRZOVIRAX400 MGTABLETGeneric  0.11195
ACYCLOVIRZOVIRAX800 MGTABLETGeneric  0.245
ADALIMUMABHUMIRA40MG/0.8MLSYRINGE KIT (EA)Brand  2354.06099
ADALIMUMABHUMIRA PEN40MG/0.8MLPEN INJECTOR KIT (EA)Brand2 2341.28169
ADAPALENEDIFFERIN0.1 %CREAM (GRAM)Brand  11.4112
ADAPALENEDIFFERIN0.1 %CREAM (GRAM)Generic  4.17711
ADAPALENEDIFFERIN0.1 %GEL (GRAM)Brand  12.4042
ADAPALENEDIFFERIN0.1 %GEL (GRAM)Generic  2.203
ADAPALENEDIFFERIN0.1 %LOTION (ML)Brand  7.9236
ADAPALENEDIFFERIN0.3 %GEL (GRAM)Generic  3.37559
ADAPALENEDIFFERIN0.3 %GEL WITH PUMP (GRAM)Brand  11.9245
ADAPALENEDIFFERIN0.3 %GEL WITH PUMP (GRAM)Generic  5.4957
ADAPALENE/BENZOYL PEROXIDEEPIDUO0.1 %-2.5%GEL WITH PUMP (GRAM)Brand  8.69507
ADAPALENE/BENZOYL PEROXIDEEPIDUO FORTE0.3 %-2.5%GEL WITH PUMP (GRAM)Brand  10.2171
ALBENDAZOLEALBENZA200 MGTABLETBrand  179.1402
ALBIGLUTIDETANZEUM30MG/0.5MLPEN INJECTOR (EA)Brand  127.0055
ALBIGLUTIDETANZEUM50MG/0.5MLPEN INJECTOR (EA)Brand  125.648
ALBUTEROL SULFATEALBUTEROL SULFATE0.63MG/3MLVIAL, NEBULIZER (ML)Generic 00000250.24605
ALBUTEROL SULFATEALBUTEROL SULFATE1.25MG/3MLVIAL, NEBULIZER (ML)Generic 00000250.23962
ALBUTEROL SULFATEALBUTEROL SULFATE2.5 MG/3MLVIAL, NEBULIZER (ML)Generic 00000250.04004
ALBUTEROL SULFATEALBUTEROL SULFATE2.5 MG/3MLVIAL, NEBULIZER (ML)Generic 00000300.04047
ALBUTEROL SULFATEALBUTEROL SULFATE2.5 MG/3MLVIAL, NEBULIZER (ML)Generic 00000600.04228
ALBUTEROL SULFATEPROAIR HFA90 MCGHFA AEROSOL WITH ADAPTER (GRAM)Brand8.5 6.72865
ALBUTEROL SULFATEPROAIR RESPICLICK90 MCGAEROSOL POWDER, BREATH ACTIVATED (EA)Brand  53.84028
ALBUTEROL SULFATEPROVENTIL HFA90 MCGHFA AEROSOL WITH ADAPTER (GRAM)Brand6.7 11.40956
ALBUTEROL SULFATEVENTOLIN HFA90 MCGHFA AEROSOL WITH ADAPTER (GRAM)Brand18 2.8791
ALCAFTADINELASTACAFT0.25 %DROPSBrand  69.5781
ALENDRONATE SODIUMFOSAMAX10 MGTABLETGeneric  0.17345
ALENDRONATE SODIUMFOSAMAX35 MGTABLETGeneric  0.645
Page 1 of 55First   Previous   [1]  2  3  4  5  6  7  8  9  10  Next   Last