PORTIA-28 TABLET

Drug Details

General

Brand Name: PORTIA-28 TABLET
Generic Name: levonorgestrel/ethin.estradiol
Manufacturer: TEVA USA
NDC: 00555902058
Package size: 28EA

Drug Information

Family Planning drug: Yes
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: .14463
Retail Pharmacy Eff Date: 02/27/2024
Specialty Pharmacy Cost: .14209
Specialty Pharmacy Eff Date: 02/27/2024
Long-term Care Pharmacy Cost: .14115
Long-term Care Pharmacy Eff Date: 02/27/2024
340B Rate: .08901
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.