FOLIVANE-OB CAPSULE

Drug Details

General

Brand Name: FOLIVANE-OB CAPSULE
Generic Name: mvn-min 74/iron fum/iron/FA
Manufacturer: TRIGEN LABORATO
NDC: 13811053530
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*: 75%
Specialty Drug†: No

Drug Pricing

Retail Pharmacy Cost: .59616
Retail Pharmacy Eff Date: 08/24/2021
Specialty Pharmacy Cost: .55966
Specialty Pharmacy Eff Date: 08/24/2021
Long-term Care Pharmacy Cost: .58764
Long-term Care Pharmacy Eff Date: 08/24/2021
340B Rate: .26158
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.