ASA-BUTALB-CAFF-COD #3 CAPSULE

Drug Details

General

Brand Name: ASA-BUTALB-CAFF-COD #3 CAPSULE
Generic Name: codeine/butalbital/ASA/caffein
Manufacturer: AMNEAL PHARMACE
NDC: 69238199301
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: 1.37682
Retail Pharmacy Eff Date: 02/27/2024
Specialty Pharmacy Cost: 1.35272
Specialty Pharmacy Eff Date: 02/27/2024
Long-term Care Pharmacy Cost: 1.34377
Long-term Care Pharmacy Eff Date: 02/27/2024
340B Rate: .94251
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.