TRIPROLIDINE 0.938 MG/ML DROPS

Drug Details

General

Brand Name: TRIPROLIDINE 0.938 MG/ML DROPS
Generic Name: triprolidine HCl
Manufacturer: WESTMINSTER PHA
NDC: 69367025330
Package size: 30ML

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: .54847
Retail Pharmacy Eff Date: 10/24/2023
Specialty Pharmacy Cost: .53887
Specialty Pharmacy Eff Date: 10/24/2023
Long-term Care Pharmacy Cost: .5353
Long-term Care Pharmacy Eff Date: 10/24/2023
340B Rate: .17916
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.