ACTHAR GEL 400 UNIT/5 ML VIAL

Drug Details

General

Brand Name: ACTHAR GEL 400 UNIT/5 ML VIAL
Generic Name: corticotropin
Manufacturer: MALLINCKRODT PH
NDC: 63004871001
Package size: 5ML

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*: 75%
Specialty Drug†: Yes

Drug Pricing

Retail Pharmacy Cost: 8620.864
Retail Pharmacy Eff Date: 01/09/2024
Specialty Pharmacy Cost: 8093.056
Specialty Pharmacy Eff Date: 01/09/2024
Long-term Care Pharmacy Cost: 8497.7088
Long-term Care Pharmacy Eff Date: 01/09/2024
340B Rate: 3782.624
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.