TRICARE PRENATAL TABLET

Drug Details

General

Brand Name: TRICARE PRENATAL TABLET
Generic Name: prenatal vit103/iron fum/folic
Manufacturer: MEDECOR PHARMA
NDC: 67112010100
Package size: 100EA

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: .96288
Retail Pharmacy Eff Date: 05/23/2023
Specialty Pharmacy Cost: .94602
Specialty Pharmacy Eff Date: 05/23/2023
Long-term Care Pharmacy Cost: .93977
Long-term Care Pharmacy Eff Date: 05/23/2023
340B Rate: .42604
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.