M-DRYL 12.5 MG/5 ML SOLUTION

Drug Details

General

Brand Name: M-DRYL 12.5 MG/5 ML SOLUTION
Generic Name: diphenhydramine HCl
Manufacturer: METHOD PHARMACE
NDC: 58657052804
Package size: 120ML

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: .02761
Specialty Pharmacy Cost: .02714
Long-term Care Pharmacy Cost: .02695
340B Rate: .01215
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.