AVITA 0.025% CREAM

Drug Details

General

Brand Name: AVITA 0.025% CREAM
Generic Name: tretinoin
Manufacturer: MYLAN
NDC: 00378614145
Package size: 45GM

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*: 75%
Specialty Drug†: No

Drug Pricing

Retail Pharmacy Cost: 4.20179
Retail Pharmacy Eff Date: 05/22/2018
Specialty Pharmacy Cost: 3.94454
Specialty Pharmacy Eff Date: 05/22/2018
Long-term Care Pharmacy Cost: 4.14177
Long-term Care Pharmacy Eff Date: 05/22/2018
340B Rate: 1.84364
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.