ALAHIST DM 2-15-7.5 MG/5 ML LQ

Drug Details

Brand Name: ALAHIST DM 2-15-7.5 MG/5 ML LQ

Generic Name: d-methorphan/pe/dexbromphenir

Manufacturer: POLY PHARMACEUT

NDC: 50991082616

Package size: 473ML

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

Retail Pharmacy Cost: .04468

Retail Pharmacy Eff Date: 01/23/2024

Specialty Pharmacy Cost: .04389

Specialty Pharmacy Eff Date: 01/23/2024

Long-term Care Pharmacy Cost: .0436

Long-term Care Pharmacy Eff Date: 01/23/2024

340B Rate: .02293

Premium Preferred Generic Incentive‡: No

Effective date: 12/13/2016

End date: 04/30/2025

End reason: No Longer Rebatable

Compound-only use: No

PDL PA Required: No

PDL Class: COUGH AND COLD: NON-NARCOTIC

FFS Clinical PA Required‡: Yes

Dextromethorphan Overutilization (PDF)
Eff. Date: 07/16/2012
End Date: 04/30/2025

Part B Cost-share Drug**: No

Part D Wrap-around Drug***: Yes

Effective date: 12/13/2016

End date: 04/30/2025

End reason: No Longer Rebatable

Compound-only use: No

04/30/2025