MAFENIDE ACETATE 50 GM POWD PK

Drug Details

General

Brand Name: MAFENIDE ACETATE 50 GM POWD PK
Generic Name: mafenide acetate
Manufacturer: INGENUS PHARMAC
NDC: 50742031025
Package size: 5EA
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%

Drug Pricing

Retail Pharmacy Cost: 107.8
Retail Pharmacy Eff Date: 06/12/2019
Specialty Pharmacy Cost: 101.2
Specialty Pharmacy Eff Date: 06/12/2019
Long-term Care Pharmacy Cost: 106.26
Long-term Care Pharmacy Eff Date: 06/18/2019
340B Cost: 47.3
Premium Preferred Generic Incentive†: Yes

Program Coverage

Medicaid

Effective date: 06/12/2019
Compound-only use: No

CHIP

Effective date: 06/12/2019
Compound-only use: No

CSHCN

Effective date: 06/12/2019
Compound-only use: No