IMITREX 4 MG/0.5 ML PEN INJECT

Drug Details

General

Brand Name: IMITREX 4 MG/0.5 ML PEN INJECT
Generic Name: sumatriptan succinate
Manufacturer: GLAXOSMITHKLINE
NDC: 00173073900
Package size: 1ML

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: 472.8598
Retail Pharmacy Eff Date: 01/09/2024
Specialty Pharmacy Cost: 443.9092
Specialty Pharmacy Eff Date: 01/09/2024
Long-term Care Pharmacy Cost: 466.10466
Long-term Care Pharmacy Eff Date: 01/09/2024
340B Rate: 207.4793
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.