IMITREX 5 MG NASAL SPRAY

Drug Details

General

Brand Name: IMITREX 5 MG NASAL SPRAY
Generic Name: sumatriptan
Manufacturer: GLAXOSMITHKLINE
NDC: 00173052400
Package size: 6EA

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: 88.6189
Retail Pharmacy Eff Date: 01/17/2023
Specialty Pharmacy Cost: 87.06806
Specialty Pharmacy Eff Date: 01/17/2023
Long-term Care Pharmacy Cost: 86.49204
Long-term Care Pharmacy Eff Date: 01/17/2023
340B Rate: 40.21933
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.