MIRENA 52 MG SYSTEM

Drug Details

General

Brand Name: MIRENA 52 MG SYSTEM
Generic Name: levonorgestrel
Manufacturer: BAYER,PHARM DIV
NDC: 50419042301
Package size: 1EA

Drug Information

Family Planning drug: Yes
Diabetic Supply Drug: No
HTW drug: Yes
HTWPlus drug: No
Long-acting reversible contraception product: Yes
Refill-to-soon Utilization*: 75%
Specialty Drug†: No

Drug Pricing

Retail Pharmacy Cost: 1133.6542
Retail Pharmacy Eff Date: 01/09/2024
Specialty Pharmacy Cost: 1064.2468
Specialty Pharmacy Eff Date: 01/09/2024
Long-term Care Pharmacy Cost: 1117.45914
Long-term Care Pharmacy Eff Date: 01/09/2024
340B Rate: 497.4197
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.