ALAHIST CF TABLET

Drug Details

General

Brand Name: ALAHIST CF TABLET
Generic Name: d-methorphan/pe/dexbromphenir
Manufacturer: POLY PHARMACEUT
NDC: 50991078490
Package size: 90EA

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†: No

Drug Pricing

Retail Pharmacy Cost: .6285
Retail Pharmacy Eff Date: 11/28/2023
Specialty Pharmacy Cost: .59002
Specialty Pharmacy Eff Date: 11/28/2023
Long-term Care Pharmacy Cost: .61952
Long-term Care Pharmacy Eff Date: 11/28/2023
340B Rate: .27577
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.