TIKOSYN 500 MCG CAPSULE

Drug Details

General

Brand Name: TIKOSYN 500 MCG CAPSULE
Generic Name: dofetilide
Manufacturer: PFIZER US PHARM
NDC: 00069582043
Package size: 40EA

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: 10.6644
Retail Pharmacy Eff Date: 01/09/2024
Specialty Pharmacy Cost: 10.47777
Specialty Pharmacy Eff Date: 01/09/2024
Long-term Care Pharmacy Cost: 10.40845
Long-term Care Pharmacy Eff Date: 01/09/2024
340B Rate: 4.76493
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.