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Medicaid Rx AAC Pricing

Montana Medicaid AAC Pricing

Last Updated: November 14, 2018
Current AAC Pricing PDF


Generic NameBrand ReferenceStrengthDosage FormBrand/ GenericPackage SizeCase SizeAAC RateChange
0.9 % sodium chlorideSODIUM CHLORIDE0.9 %INTRAVENOUS SOLUTIONGeneric250 $0.01676 
abacavir sulfate/dolutegravir sodium/lamivudineTRIUMEQ600-50-300TABLETBrand  $90.25733 
abacavir sulfate/lamivudineEPZICOM600-300MGTABLETBrand  $42.05980 
abacavir sulfate/lamivudineEPZICOM600-300MGTABLETGeneric  $5.37749 
abataceptORENCIA125 MG/MLSYRINGE (ML)Brand  $990.74500 
abataceptORENCIA CLICKJECT125 MG/MLAUTO INJCTBrand  $1,009.67833 
acamprosate calciumCAMPRAL333 MGTABLET, DELAYED RELEASE (ENTERIC COATED)Generic  $0.75750 
acarbosePRECOSE100 MGTABLETGeneric  $0.22520 
acarbosePRECOSE25 MGTABLETGeneric  $0.31960 
acebutolol hclSECTRAL200 MGCAPSULEGeneric  $0.19220 
acetaminophen with codeine phosphateTYLENOL-CODEINE NO.3300MG-30MGTABLETGeneric  $0.11165 
acetaminophen with codeine phosphateTYLENOL-CODEINE NO.4300MG-60MGTABLETGeneric  $0.22918 
acetazolamideDIAMOX250 MGTABLETGeneric  $1.27414 
acetazolamideDIAMOX SEQUELS500 MGCAPSULE, EXTENDED RELEASEGeneric  $1.41540 
acetic acidVOSOL2 %SOLUTION, NON-ORALGeneric  $1.24870 
acetic acid/hydrocortisoneVOSOL HC2 %-1 %DROPSGeneric  $7.60575 
acetylcysteineACETYLCYSTEINE200 MG/MLVIAL (ML)Generic30 $0.48240 
acetylcysteineMUCOMYST200 MG/MLVIALGeneric4 $1.77667 
acitretinSORIATANE25 MGCAPSULEGeneric  $21.79810 
aclidinium bromideTUDORZA PRESSAIR400 MCGAER POW BABrand  $334.68000 
acyclovirZOVIRAX5 %CREAM (GRAM)Brand  $147.56000 
acyclovirZOVIRAX5 %OINTMENT (GRAM)Generic15 $17.44930 
acyclovirZOVIRAX5 %OINTMENT (GRAM)Generic30 $5.11553 
acyclovirZOVIRAX200 MGCAPSULEGeneric  $0.08892 
acyclovirZOVIRAX200 MG/5MLSUSPENSION, ORAL (FINAL DOSE FORM)Generic  $0.58665 
acyclovirZOVIRAX400 MGTABLETGeneric  $0.08401 
acyclovirZOVIRAX800 MGTABLETGeneric  $0.19135 
adalimumabHUMIRA40MG/0.8MLSYRINGE KIT (EA)Brand  $2,351.43167 
adalimumabHUMIRA PEN40MG/0.8MLPEN IJ KITBrand6 $2,387.07848 
adalimumabHUMIRA PEN40MG/0.8MLPEN INJECTOR KIT (EA)Brand2 $2,362.93500 
adapaleneDIFFERIN0.1 %CREAM (GRAM)Brand  $11.41120 
adapaleneDIFFERIN0.1 %CREAM (GRAM)Generic  $3.42489 
adapaleneDIFFERIN0.1 %GEL (GRAM)Brand  $12.40420 
adapaleneDIFFERIN0.1 %GEL (GRAM)Generic  $2.20300 
adapaleneDIFFERIN0.1 %LOTION (ML)Brand  $7.92360 
adapaleneDIFFERIN0.3 %GEL (GRAM)Generic  $3.37559 
adapaleneDIFFERIN0.3 %GEL WITH PUMP (GRAM)Brand  $11.92450 
adapaleneDIFFERIN0.3 %GEL WITH PUMP (GRAM)Generic  $5.49570 
adapalene/benzoyl peroxideEPIDUO0.1 %-2.5%GEL W/PUMPGeneric  $1.85178 
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  $11.22778 
albendazoleALBENZA200 MGTABLETBrand  $216.36553 
albiglutideTANZEUM30MG/0.5MLPEN INJECTOR (EA)Brand  $127.00550 
albiglutideTANZEUM50MG/0.5MLPEN INJECTOR (EA)Brand  $125.64800 
albuterol sulfateACCUNEB0.63MG/3MLVIAL-NEBGeneric 0000030$0.27474 
albuterol sulfateALBUTEROL SULFATE0.63MG/3MLVIAL, NEBULIZER (ML)Generic 0000025$0.24605 
albuterol sulfateALBUTEROL SULFATE1.25MG/3MLVIAL, NEBULIZER (ML)Generic 0000025$0.19480 
albuterol sulfateALBUTEROL SULFATE2.5 MG/3MLVIAL, NEBULIZER (ML)Generic 0000025$0.03984 
albuterol sulfateALBUTEROL SULFATE2.5 MG/3MLVIAL, NEBULIZER (ML)Generic 0000030$0.03941 
albuterol sulfateALBUTEROL SULFATE2.5 MG/3MLVIAL, NEBULIZER (ML)Generic 0000060$0.03703 
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