AZACITIDINE 100 MG VIAL

Drug Details

General

Brand Name: AZACITIDINE 100 MG VIAL
Generic Name: azacitidine
Manufacturer: FRESENIUS KABI
NDC: 63323077139
Package size: 1EA

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: 117.6
Retail Pharmacy Eff Date: 12/20/2022
Specialty Pharmacy Cost: 110.4
Specialty Pharmacy Eff Date: 12/20/2022
Long-term Care Pharmacy Cost: 115.92
Long-term Care Pharmacy Eff Date: 12/20/2022
340B Rate: 51.6
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.