ANDRODERM 4 MG/24HR PATCH

Drug Details

General

Brand Name: ANDRODERM 4 MG/24HR PATCH
Generic Name: testosterone
Manufacturer: ALLERGAN INC.
NDC: 00023599230
Package size: 30EA

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: 19.6219
Retail Pharmacy Eff Date: 02/28/2023
Specialty Pharmacy Cost: 19.27851
Specialty Pharmacy Eff Date: 02/28/2023
Long-term Care Pharmacy Cost: 19.15097
Long-term Care Pharmacy Eff Date: 02/28/2023
340B Rate: 8.8279
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.