General Information

Generic Name: 
fluoxetine HCl
Manufacturer: 
AUROBINDO PHARM
NDC code: 
65862019401
Package Size: 
100
EA
Prescription/OTC: 
Prescription required
Family Planning drug: 
No
Diabetic Supply: 
No
HTW drug: 
Yes
HTWPlus drug: 
No
Long-acting reversible contraception product: 
No
Refill-to-soon Utilization*: 
75%

Drug Pricing

Retail Pharmacy Cost: 
.07627
Retail Pharmacy Eff Date: 
12/29/2020
Specialty Pharmacy Cost: 
.07493
Specialty Pharmacy Eff Date: 
12/29/2020
Long-term Care Pharmacy Cost: 
.07443
Long-term Care Pharmacy Eff Date: 
12/29/2020
340B Cost: 
.05018
Premium Preferred Generic Incentive†: 
No

Pharmacist Administered

Injection: 
No

 

* Impacts only claims paid by the Vendor Drug Program: traditional Medicaid, CSHCN, HTW, and KHC Programs.

† To learn about traditional Medicaid claim pricing and PPG pricing incentives please refer to the Drug Pricing & Reimbursement (PDF) chapter of the VDP Pharmacy Provider Procedure Manual.

‡ Please review the lists of DUR board-approved clinical prior authorizations that apply to traditional Medicaid and those that health plans may use. The Pharmacy Clinical Prior Authorization Assistance Chart (PDF) shows the prior authorization each health plan uses and how those authorizations relate to the authorizations used for traditional Medicaid claim processing. Refer to the MCO Resources for links to each health plan's active clinical prior authorizations.

Program Coverage

Medicaid

Effective date: 
08/01/2017
Compound-only use: 
No

CHIP

Effective date: 
08/01/2017
Compound-only use: 
No

CSHCN

Effective date: 
08/01/2017
Compound-only use: 
No

HTW Program

Effective date: 
08/01/2017
Compound-only use: 
No