GLYCOPYRROLATE 4 MG/20 ML VIAL

Drug Details

General

Brand Name: GLYCOPYRROLATE 4 MG/20 ML VIAL
Generic Name: glycopyrrolate
Manufacturer: AMNEAL BIOSCIEN
NDC: 70121139707
Package size: 20ML

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: 6.07453
Retail Pharmacy Eff Date: 06/25/2018
Specialty Pharmacy Cost: 5.70262
Specialty Pharmacy Eff Date: 06/25/2018
Long-term Care Pharmacy Cost: 5.98775
Long-term Care Pharmacy Eff Date: 06/25/2018
340B Rate: 2.66535
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.