VITAFOL GUMMIES

Drug Details

General

Brand Name: VITAFOL GUMMIES
Generic Name: PNV 112/iron/folic/om3/dha/epa
Manufacturer: EXELTIS USA, IN
NDC: 00642012590
Package size: 90EA

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: 1.43014
Retail Pharmacy Eff Date: 01/16/2024
Specialty Pharmacy Cost: 1.40511
Specialty Pharmacy Eff Date: 01/16/2024
Long-term Care Pharmacy Cost: 1.39581
Long-term Care Pharmacy Eff Date: 01/16/2024
340B Rate: .64074
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.