ACETAMN-CAF-DIHYDRCODEIN 320.5

Drug Details

Brand Name: ACETAMN-CAF-DIHYDRCODEIN 320.5

Generic Name: acetaminophen/caff/dihydrocod

Manufacturer: XSPIRE PHARMA

NDC: 42195084010

Package size: 100EA

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

Retail Pharmacy Cost: 3.1752

Retail Pharmacy Eff Date: 03/10/2020

Specialty Pharmacy Cost: 2.9808

Specialty Pharmacy Eff Date: 03/10/2020

Long-term Care Pharmacy Cost: 3.12984

Long-term Care Pharmacy Eff Date: 03/10/2020

340B Rate: 1.3932

Premium Preferred Generic Incentive‡: No

Effective date: 08/11/2015

End date: 08/15/2045

End reason: No Longer Rebatable

Compound-only use: No

PDL PA Required: Yes

PDL Class: ANALGESICS: NARCOTICS SHORT

FFS Clinical PA Required‡: Yes

Part B Cost-share Drug**: No

Part D Wrap-around Drug***: No

Effective date: 08/11/2015

End date: 08/15/2045

End reason: No Longer Rebatable

Effective date: 08/11/2015

End date: 08/15/2045

End reason: No Longer Rebatable

Compound-only use: No

08/15/2045