ACETAMINOP-CODEINE 120-12 MG/5

Drug Details

General

Brand Name: ACETAMINOP-CODEINE 120-12 MG/5
Generic Name: acetaminophen with codeine
Manufacturer: PHARM ASSOC INC
NDC: 00121050416
Package size: 473ML

Drug Information

Family Planning drug: No
Diabetic Supply Drug: No
HTW drug: No
HTWPlus drug: No
Long-acting reversible contraception product: No
Refill-to-soon Utilization*: 90%
Specialty Drug†: No

Drug Pricing

Retail Pharmacy Cost: .01449
Retail Pharmacy Eff Date: 08/29/2023
Specialty Pharmacy Cost: .01423
Specialty Pharmacy Eff Date: 08/29/2023
Long-term Care Pharmacy Cost: .01414
Long-term Care Pharmacy Eff Date: 08/29/2023
340B Rate: .00722
Premium Preferred Generic Incentive‡: No

* Impacts only claims paid by HHSC: traditional Medicaid, CSHCN, HTW, and KHC Programs.

† Refer to the Specialty Drug Handbook for more information..

‡ Refer to the Premium Preferred Generic Drugs section for information about traditional Medicaid claim pricing and PPG pricing incentives.