AMLODIPINE BESYLATE 10 MG TAB

Drug Details

General

Brand Name: AMLODIPINE BESYLATE 10 MG TAB
Generic Name: amlodipine besylate
Manufacturer: CIPLA USA, INC.
NDC: 69097083815
Package size: 1000EA

Drug Information

Family Planning drug: No
Diabetic Supply Drug: No
HTW drug: Yes
HTWPlus drug: No
Long-acting reversible contraception product: No
Refill-to-soon Utilization*: 75%
Specialty Drug†: No

Drug Pricing

Retail Pharmacy Cost: .0512
Retail Pharmacy Eff Date: 03/05/2024
Specialty Pharmacy Cost: .04807
Specialty Pharmacy Eff Date: 03/05/2024
Long-term Care Pharmacy Cost: .05047
Long-term Care Pharmacy Eff Date: 03/05/2024
340B Rate: .02246
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.