AMPHETAMINE SULFATE 5 MG TAB

Drug Details

General

Brand Name: AMPHETAMINE SULFATE 5 MG TAB
Generic Name: amphetamine sulfate
Manufacturer: BIONPHARMA INC.
NDC: 69452022720
Package size: 100EA

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*: 90%
Specialty Drug†: No

Drug Pricing

Retail Pharmacy Cost: 1.23166
Retail Pharmacy Eff Date: 11/28/2023
Specialty Pharmacy Cost: 1.15625
Specialty Pharmacy Eff Date: 11/28/2023
Long-term Care Pharmacy Cost: 1.21406
Long-term Care Pharmacy Eff Date: 11/28/2023
340B Rate: .54042
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.