state mac list office of medical assistance programs
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STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
ABACAVIR SULFATE 20 mg/ml SOLN MILLILITER $0.5720
ABACAVIR SULFATE 300 mg TAB TABLET $0.3745
ABACAVIR SULFATE; LAMIVUDINE 600 mg; 300 mg TAB TABLET $2.0015
ABACAVIR; LAMIVUDINE; ZIDOVUDINE 150 mg; 300 mg TAB TABLET $24.3903
ABIRATERONE ACETATE 250 mg TAB TABLET $2.0450
ABIRATERONE ACETATE 500 mg TAB TABLET $140.3554
ACAMPROSATE CALCIUM 333 mg TAB DR TABLET $0.4245
ACARBOSE 100 mg TAB TABLET $0.2252
ACARBOSE 25 mg TAB TABLET $0.1230
ACARBOSE 50 mg TAB TABLET $0.1590
ACEBUTOLOL HCL 200 mg CAP CAPSULE $0.1922
ACEBUTOLOL HCL 400 mg CAP CAPSULE $0.2500
ACETAMINOPHEN W/CODEINE 120-12 mg/5 ml SOLN MILLILITER $0.2778
ACETAMINOPHEN W/CODEINE 300 mg/12.5 ml SOLN MILLILITER $0.1555
ACETAMINOPHEN W/CODEINE 300 mg; 15 mg TAB TABLET $0.1428
ACETAMINOPHEN W/CODEINE 300 mg; 30 mg TAB TABLET $0.1099
ACETAMINOPHEN W/CODEINE 300 mg; 60 mg TAB TABLET $0.2255
ACETAMINOPHEN/DIPHENHYDRAMINE 500 mg; 25 mg TAB TABLET $0.0425
ACETAMINOPHEN 1,000 mg/100 ml VIAL MILLILITER $0.3960
ACETAMINOPHEN 120 mg SUPP EACH $0.2365
ACETAMINOPHEN 160 mg TAB CHEW TABLET $0.0718
ACETAMINOPHEN 160 mg TAB RAPDIS TABLET $0.0715
ACETAMINOPHEN 160 mg/5 ml LIQUID MILLILITER $0.0203
ACETAMINOPHEN 160 mg/5 ml SUSP MILLILITER $0.2980
ACETAMINOPHEN 325 mg SUPP EACH $0.3816
ACETAMINOPHEN 325 mg TAB TABLET $0.0150
ACETAMINOPHEN 500 mg LIQUID MILLILITER $0.0158
ACETAMINOPHEN 500 mg CAP CAPSULE $0.0345
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
ACETAMINOPHEN 500 mg TAB TABLET $0.0240
ACETAMINOPHEN 650 mg SUPP EACH $0.3275
ACETAMINOPHEN 650 mg TAB ER TABLET $0.0738
ACETAMINOPHEN 80 mg TAB CHEW TABLET $0.0386
ACETAMINOPHEN 80 mg TAB RAPDIS TABLET $0.0505
ACETAMINOPHEN 80 mg/0.8 ml SUSP MILLILITER $0.1647
ACETAZOLAMIDE 125 mg TAB TABLET $0.6165
ACETAZOLAMIDE 250 mg TAB TABLET $0.3350
ACETAZOLAMIDE 500 mg CAP ER CAPSULE $0.3300
ACETIC ACID 0.25% SOLN MILLILITER $0.0046
ACETIC ACID 2% SOLN MILLILITER $1.2487
ACETIC ACID\HYDROCORTISONE 2%-1% DROPS MILLILITER $5.8627
ACETYLCYSTEINE 100 mg/ml VIAL MILLILITER $0.3908
ACETYLCYSTEINE 200 mg/ml VIAL EACH $0.3575
ACETYLCYSTEINE 6 gm/30 ml VIAL MILLILITER $2.8500
ACITRETIN 10 mg CAP CAPSULE $5.7674
ACITRETIN 17.5 mg CAP CAPSULE $23.0775
ACITRETIN 25 mg CAP CAPSULE $10.0665
ACYCLOVIR 200 mg CAP CAPSULE $0.0975
ACYCLOVIR 200 mg/5 ml SOLN MILLILITER $0.3555
ACYCLOVIR 400 mg TAB TABLET $0.0575
ACYCLOVIR 5% CREAM GRAM $114.9950
ACYCLOVIR 5% OINT GRAM $0.9567
ACYCLOVIR 50 mg/ml VIAL MILLILITER $0.4500
ACYCLOVIR 800 mg TAB TABLET $0.1350
ADAPALENE 0.1% CREAM GRAM $2.7771
ADAPALENE 0.1% GEL GRAM $0.8120
ADAPALENE 0.3% GEL GRAM $1.3170
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
ADAPALENE 0.3% GEL PUMP GRAM $3.6362
ADAPALENE; BENZOYL PEROXIDE 0.1%; 2.5% GEP PUMP GRAM $1.0550
ADEFOVIR DIPIVOXIL 10 mg TAB TABLET $22.8785
ADENOSINE 3 mg/ml VIAL MILLILITER $3.3393
ALBENDAZOLE 200 mg TAB TABLET $32.5800
ALBUTEROL SULFATE 0.63 mg/3 ml INH SOLN MILLILITER $0.2045
ALBUTEROL SULFATE 1.25 mg/3 ml INH SOLN MILLILITER $0.2065
ALBUTEROL SULFATE 2.5 mg/3 ml INH SOLN MILLILITER $0.0422
ALBUTEROL SULFATE 2 mg/5 ml SYRINGE MILLILITER $0.0134
ALBUTEROL SULFATE 2 mg TAB TABLET $1.8162
ALBUTEROL SULFATE 4 mg TAB TABLET $0.7650
ALBUTEROL SULFATE 4 mg TAB ER TABLET $1.3345
ALBUTEROL SULFATE 5 mg/ml INH SOLN MILLILITER $0.8910
ALBUTEROL SULFATE 8 mg TAB ER TABLET $2.4100
ALBUTEROL SULFATE (6.7 GM CANISTER)
90 mcg HFA AEROSOL W/ ADAPTER
GRAM $4.9785
ALBUTEROL SULFATE (8.5 GM CANISTER)
90 mcg HFA AEROSOL W/ ADAPTER
GRAM $3.5355
ALCLOMETASONE DIPROPIONATE 0.05% CREAM GRAM $1.3825
ALCLOMETASONE DIPROPIONATE 0.05% OINT GRAM $0.7950
ALENDRONATE SODIUM 10 mg TAB TABLET $0.1650
ALENDRONATE SODIUM 35 mg TAB TABLET $0.3368
ALENDRONATE SODIUM 40 mg TAB TABLET $2.9400
ALENDRONATE SODIUM 5 mg TAB TABLET $0.1440
ALENDRONATE SODIUM 70 mg TAB TABLET $0.2550
ALENDRONATE SODIUM 70 mg/75 ml SOLUTION MILLILITER $0.7183
ALFUZOSIN HCL 10 mg TAB ER 24HR TABLET $0.1341
ALISKIREN HEMIFUMARATE 150 mg TAB TABLET $4.9375
ALISKIREN HEMIFUMARATE 300 mg TAB TABLET $7.6425
ALLOPURINOL 100 mg TAB TABLET $0.0300
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
ALLOPURINOL 300 mg TAB TABLET $0.0750
ALMOTRIPTAN MALATE 12.5 mg TAB TABLET $20.0975
ALMOTRIPTAN MALATE 6.25 mg TAB TABLET $33.8701
ALOSETRON HCL 0.5 mg TAB TABLET $9.1190
ALOSETRON HCL 1 mg TAB TABLET $10.9413
ALPRAZOLAM 0.25 mg TAB TABLET $0.0185
ALPRAZOLAM 0.25 mg TAB ODT TABLET $1.0855
ALPRAZOLAM 0.5 mg TAB TABLET $0.0135
ALPRAZOLAM 0.5 mg TAB ER TABLET $0.1818
ALPRAZOLAM 0.5 mg TAB ODT TABLET $1.1760
ALPRAZOLAM 0.5 mg TAB TABLET $0.0274
ALPRAZOLAM 1 mg TAB ER TABLET $0.1212
ALPRAZOLAM 1 mg TAB ODT TABLET $1.1025
ALPRAZOLAM 1 mg TAB TABLET $0.0258
ALPRAZOLAM 2 mg TAB ER TABLET $0.1538
ALPRAZOLAM 2 mg TAB TABLET $0.0525
ALPRAZOLAM 3 mg TAB ODT TABLET $3.3550
ALPRAZOLAM 3 mg TAB ER TABLET $0.1725
AMANTADINE HCL 100 mg CAP CAPSULE $0.3075
AMANTADINE HCL 100 mg TAB TABLET $0.5560
AMANTADINE HCL 50 mg/5 ml SYRINGE MILLILITER $0.0205
AMBRISENTAN 10 mg TAB TABLET $36.6500
AMBRISENTAN 5 mg TAB TABLET $36.6500
AMIKACIN SULFATE 500 mg/2 ml INJ MILLILITER $3.5240
AMILORIDE HCL 5 mg TAB TABLET $0.2739
AMILORIDE HCL; HYDROXHLOROTHIAZIDE 5 mg; 50 mg TAB TABLET $0.3658
AMINOCAPROIC ACID 250 mg/ml SOLN MILLILITER $0.3085
AMIODARONE HCL 100 mg TAB TABLET $1.4250
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
AMIODARONE HCL 200 mg TAB TABLET $1.8700
AMIODARONE HCL 400 mg TAB TABLET $2.3455
AMIODARONE HCL 50 mg/ml SOLN MILLILITER $0.3735
AMITRIPTYLINE HCL 10 mg TAB TABLET $0.0300
AMITRIPTYLINE HCL 100 mg TAB TABLET $0.2550
AMITRIPTYLINE HCL 150 mg TAB TABLET $0.5655
AMITRIPTYLINE HCL 25 mg TAB TABLET $0.0553
AMITRIPTYLINE HCL 50 mg TAB TABLET $0.1775
AMITRIPTYLINE HCL 75 mg TAB TABLET $0.2550
AMITRIPTYLINE; CHLORDIAZEPOXIDE 12.5 mg; 5 mg TAB TABLET $1.1550
AMITRIPTYLINE; CHLORDIAZEPOXIDE 25 mg; 10 mg TAB TABLET $1.5872
AMLODIPINE/ATORVASTATIN 10 mg; 10 mg TAB TABLET $1.8875
AMLODIPINE/ATORVASTATIN 10 mg; 20 mg TAB TABLET $2.2735
AMLODIPINE/ATORVASTATIN 10 mg; 40 mg TAB TABLET $2.1650
AMLODIPINE/ATORVASTATIN 10 mg; 80 mg TAB TABLET $2.6850
AMLODIPINE/ATORVASTATIN 2.5 mg; 10 mg TAB TABLET $2.7500
AMLODIPINE/ATORVASTATIN 2.5 mg; 20 mg TAB TABLET $2.8000
AMLODIPINE/ATORVASTATIN 2.5 mg; 40 mg TAB TABLET $3.7481
AMLODIPINE/ATORVASTATIN 5 mg; 10 mg TAB TABLET $1.9755
AMLODIPINE/ATORVASTATIN 5 mg; 20 mg TAB TABLET $1.5527
AMLODIPINE/ATORVASTATIN 5 mg; 40 mg TAB TABLET $2.2450
AMLODIPINE/ATORVASTATIN 5 mg; 80 mg TAB TABLET $2.8500
AMLODIPINE BESYLATE/BENAZEPRIL HCL 10 mg; 40 mg CAP CAPSULE $0.1465
AMLODIPINE BESYLATE/BENAZEPRIL HCL 5 mg; 40 mg CAP CAPSULE $0.1385
AMLODIPINE BESYLATE/BENAZEPRIL 10 mg; 20 mg CAP CAPSULE $0.1212
AMLODIPINE BESYLATE/BENAZEPRIL 2.5 mg; 10 mg CAP CAPSULE $0.1143
AMLODIPINE BESYLATE/BENAZEPRIL 5 mg; 10 mg CAP CAPSULE $0.1052
AMLODIPINE BESYLATE/BENAZEPRIL 5 mg; 20 mg CAP CAPSULE $0.1110
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
AMLODIPINE BESYLATE 10 mg TAB TABLET $0.0195
AMLODIPINE BESYLATE 2.5 mg TAB TABLET $0.0150
AMLODIPINE BESYLATE 5 mg TAB TABLET $0.0150
AMLODIPINE BES/OLMESARTAN MED 10 mg; 20 mg TAB TABLET $0.5500
AMLODIPINE BES/OLMESARTAN MED 10 mg; 40 mg TAB TABLET $0.2550
AMLODIPINE BES/OLMESARTAN MED 5 mg; 20 mg TAB TABLET $0.2550
AMLODIPINE BES/OLMESARTAN MED 5 mg; 40 mg TAB TABLET $0.3150
AMLODIPINE/VALSARTAN 10 mg; 160 mg TAB TABLET $0.4130
AMLODIPINE/VALSARTAN 10 mg; 320 mg TAB TABLET $0.5820
AMLODIPINE/VALSARTAN 5 mg; 160 mg TAB TABLET $0.4250
AMLODIPINE/VALSARTAN 5 mg; 320 mg TAB TABLET $0.5435
AMLODIPINE/VALSARTAN/HCT 10 mg; 160 mg TAB TABLET $1.1175
AMLODIPINE/VALSARTAN/HCT 10-160-25 TAB TABLET $0.9534
AMLODOPINE/VALSARTAN/HCT 10-320-25 TAB TABLET $1.1635
AMLODIPINE/VALSARTAN/HCT 5-160-12.5 TAB TABLET $0.7700
AMLODIPINE/VALSARTAN/HCT 5-160-25 TAB TABLET $0.7445
AMMONIUM LACTATE 12% CREAM GRAM $0.0739
AMMONIUM LACTATE 12% LOT MILLILITER $0.0360
AMMONIUM & POTASSIUM IODIDES N/A TINCTURE MILLILITER $0.0662
AMOX/POTASSIUM CLAVULANATE 200; 28.5 mg/5 ml PWDR for
ORAL SUSP MILLILITER $0.0550
AMOX/POTASSIUM CLAVULANATE 200; 28.5 mg TAB CHEW TABLET $2.3755
AMOX/POTASSIUM CLAVULANATE 400; 57 mg/5 ml PWDR for
ORAL SUSP MILLILITER $0.0555
AMOX/POTASSIUM CLAVULANATE 400; 57 mg TAB CHEW TABLET $2.0000
AMOX/POTASSIUM CLAVULANATE 500; 125 mg TAB TABLET $0.2400
AMOX/POTASSIUM CLAVULANATE 600; 42.9 mg/5 ml PWDR for
ORAL SUSP MILLILITER $0.0334
AMOX/POTASSIUM CLAVULANATE 875; 125 mg TAB TABLET $0.2165
AMOXICILLIN (TRIHYDRATE) 250 mg CAP CAPSULE $0.0754
AMOXICILLIN (TRIHYDRATE) 500 mg CAP CAPSULE $0.1230
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
AMOXICILLIN OS 400 mg/5 ml SUSP RECON MILLILITER $0.0353
AMOXICILLIN TRIHYDRATE/ POTASSIUM CLAVULANATE
1000 mg; 62.5 mg TAB SA TABLET $4.8852
AMOXICILLIN TRIHYDRATE/ POTASSIUM CLAVULANATE
250 ; 62.5 mg/5 ml SUSP MILLILITER $0.4385
AMOXICILLIN TRIHYDRATE/ POTASSIUM CLAVULANATE
250 mg; 125mg TAB TABLET $1.5125
AMOXICILLIN TRIHYDRATE 500 mg TAB TABLET $0.1520
AMOXICILLIN 125 mg/5 ml PWDR for
ORAL SUSP MILLILITER $0.0199
AMOXICILLIN 200 mg/5 ml SUSP MILLILITER $0.0299
AMOXICILLIN 250 mg/5 ml PWDR for
ORAL SUSP MILLILITER $0.0165
AMOXICILLIN 250 mg TAB CHEW TABLET $0.2306
AMOXICILLIN 875 mg TAB TABLET $0.1195
AMPHET ASP/AMPHET/D-AMPHET 10 mg CAP ER CAPSULE $0.7775
AMPHET ASP/AMPHET/D-AMPHET 15 mg CAP ER CAPSULE $0.9845
AMPHET ASP/AMPHET/D-AMPHET 15 mg TAB TABLET $0.2655
AMPHET ASP/AMPHET/D-AMPHET 20 mg CAP ER CAPSULE $0.7775
AMPHET ASP/AMPHET/D-AMPHET 25 mg CAP ER CAPSULE $0.7705
AMPHET ASP/AMPHET/D-AMPHET 30 mg CAP ER CAPSULE $0.7775
AMPHET ASP/AMPHET/D-AMPHET 5 mg CAP ER CAPSULE $1.2555
AMPHETAMINE/D-AMPHETAMINE SALTS 10 mg TAB TABLET $0.2055
AMPHETAMINE/D-AMPHETAMINE SALTS 12.5 mg TAB TABLET $0.4555
AMPHETAMINE/D-AMPHETAMINE SALTS 20 mg TAB TABLET $0.2055
AMPHETAMINE/D-AMPHETAMINE SALTS 30 mg TAB TABLET $0.4415
AMPHETAMINE/D-AMPHETAMINE SALTS 5 mg TAB TABLET $0.1575
AMPHETAMINE/D-AMPHETAMINE SALTS 7.5 mg TAB TABLET $0.5035
AMPHETAMINE SULFATE 10 mg TAB TABLET $3.7125
AMPHETAMINE SULFATE 5 mg TAB TABLET $4.7835
AMPICILLIN SODIUM 1 gm VIAL EACH $2.0500
AMPICILLIN SODIUM 10 gm VIAL EACH $33.5500
AMPICILLIN SODIUM 2 gm VIAL EACH $3.2500
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
AMPICILLIN SODIUM 250 mg VIAL EACH $0.8250
AMPICILLIN SODIUM 500 mg VIAL EACH $1.1250
AMPICILLIN SODIUM/SULBACTAM SODIUM 1.5 gm VIAL EACH $1.9500
AMPICILLIN SODIUM/SULBACTAM SODIUM 15 gm VIAL EACH $16.9550
AMPICILLIN SODIUM/SULBACTAM SODIUM 3 gm VIAL EACH $5.6280
AMPICILLIN TRIHYDRATE 500 mg CAP CAPSULE $0.1115
ANAGRELIDE HCL 0.5 mg CAP CAPSULE $0.3860
ANAGRELIDE HCL 1 mg CAP CAPSULE $1.0025
APREPITANT 40 mg CAP CAPSULE $74.7045
APREPITANT 80 mg CAP CAPSULE $158.1294
APREPITANT 125 mg CAP CAPSULE $247.0687
APREPITANT 125 mg; 80 mg CAP CAPSULE $149.4000
ANASTROZOLE 1 mg TAB TABLET $0.1070
ARFORMOTEROL TARTRATE 15 mcg/2 ml SOLN MILLILITER $6.0415
ARIPIPRAZOLE 1 mg/ml SOLN MILLILITER $1.2150
ARIPIPRAZOLE 10 mg TAB TABLET $0.1890
ARIPIPRAZOLE 10 mg TAB ODT TABLET $26.1890
ARIPIPRAZOLE 15 mg TAB TABLET $0.1855
ARIPIPRAZOLE 15 mg TAB ODT TABLET $28.4142
ARIPIPRAZOLE 2 mg TAB TABLET $0.1655
ARIPIPRAZOLE 20 mg TAB TABLET $0.2458
ARIPIPRAZOLE 30 mg TAB TABLET $0.2456
ARIPIPRAZOLE 5 mg TAB TABLET $0.1830
ARMODAFINIL 150 mg TAB TABLET $0.9199
ARMODAFINIL 200 mg TAB TABLET $0.6095
ARMODAFINIL 250 mg TAB TABLET $0.8912
ARMODAFINIL 50 mg TAB TABLET $0.1465
ARSENIC TRIOXIDE 10 mg/10 ml SOLN MILLILITER $20.5750
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
ASCORBIC ACID 1,000 mg TAB TABLET $0.0707
ASCORBIC ACID 500 mg TAB TABLET $0.0281
ASENAPINE MALEATE 10 mg TAB SL TABLET $4.6690
ASENAPINE MALEATE 2.5 mg TAB SL TABLET $4.6850
ASENAPINE MALEATE 5 mg TAB SL TABLET $3.5199
ASPIRIN 325 mg TAB EC TABLET $0.0150
ASPIRIN 325 mg TAB TABLET $0.0150
ASPIRIN 80 mg TAB CHEW TABLET $0.0300
ASPIRIN 80 mg TAB EC TABLET $0.0075
ASPIRIN/ACETAMINOPHEN/CAFFEINE 250-250-65 TAB TABLET $0.0350
ASPIRIN/BUTALBITAL/CAFFEINE/CODEINE 30 mg CAP CAPSULE $1.0443
ASPIRIN/DIPYRIDAMOLE 25 mg; 200 mg CAP ER 12HR CAPSULE $0.8650
ATAZANAVIR SULFATE 150 mg CAP CAPSULE $4.5855
ATAZANAVIR SULFATE 200 mg CAP CAPSULE $3.9550
ATAZANAVIR SULFATE 300 mg CAP CAPSULE $5.9201
ATENOLOL; CHLORTHAL 100 mg; 25 mg TAB TABLET $0.4095
ATENOLOL; CHLORTHAL 50 mg; 25 mg TAB TABLET $0.3750
ATENOLOL 100 mg TAB TABLET $0.0210
ATENOLOL 25 mg TAB TABLET $0.0150
ATENOLOL 50 mg TAB TABLET $0.0150
ATOMOXETINE HCL 10 mg CAP CAPSULE $1.0150
ATOMOXETINE HCL 100 mg CAP CAPSULE $0.9510
ATOMOXETINE HCL 18 mg CAP CAPSULE $0.8602
ATOMOXETINE HCL 25 mg CAP CAPSULE $0.8530
ATOMOXETINE HCL 40 mg CAP CAPSULE $1.0660
ATOMOXETINE HCL 60 mg CAP CAPSULE $1.9015
ATOMOXETINE HCL 80 mg CAP CAPSULE $1.6652
ATORVASTATIN CALCIUM 10 mg TAB TABLET $0.0300
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
ATORVASTATIN CALCIUM 20 mg TAB TABLET $0.0300
ATORVASTATIN CALCIUM 40 mg TAB TABLET $0.0500
ATORVASTATIN CALCIUM 80 mg TAB TABLET $0.1000
ATOVAQUONE 750 mg/5 ml SUSP ORAL MILLILITER $1.0763
ATOVAQUONE/PROGUANIL HCL 250 mg; 100 mg TAB TABLET $2.6555
ATOVAQUONE/PROGUANIL HCL 62.5 mg; 25 mg TAB TABLET $0.9115
ATROPINE SULFATE 0.4 mg/ml VIAL MILLILITER $4.7225
AZACITIDINE 100 mg VIAL EACH $114.5000
AZATHIOPRINE 50 mg TAB TABLET $0.2700
AZELAIC ACID 15% GEL GRAM $1.1250
AZELASTINE HCL 0.05% DROPS MILLILITER $0.9375
AZELASTINE HCL 137 mcg AER GRAM $0.2825
AZELASTINE HCL 205.5 mcg SPRAY MILLILITER $0.4965
AZELASTINE HCL 137-50 mcg SPRAY GRAM $5.3250
AZELASTINE/FLUTICASONE 137-50 mcg SPRAY GRAM $4.9524
AZITHROMYCIN 100 mg/5 ml SUSP MILLILITER $0.4677
AZITHROMYCIN 200 mg/5 ml SUSP MILLILITER $0.3500
AZITHROMYCIN 250 mg TAB TABLET $0.2833
AZITHROMYCIN 500 mg VIAL EACH $3.5020
AZITHROMYCIN 500 mg TAB TABLET $0.7575
AZITHROMYCIN 600 mg TAB TABLET $1.4075
BACITRACIN ZINC 500 units/gm OINT GRAM $0.1757
B-COMPLEX WITH VITAMIN C N/A TAB TABLET $0.0441
B COMP NO. 3/FOLIC/C/BIOTIN/ZINC 1 mg; 60 mg TAB TABLET $0.3295
BACITRACIN 500 units/gm OINT GRAM $0.0799
BACITRACIN 50,000 unit VIAL EACH $6.1599
BACLOFEN 10 mg TAB TABLET $0.0772
BACLOFEN 20 mg TAB TABLET $0.0930
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
BACLOFEN 5 mg TAB TABLET $0.8156
BALSALAZIDE DISODIUM 750 mg CAP CAPSULE $0.3255
BD AUTOSHIELD DUO NEEDLE (NDC 08290-3295-15)
5 mm x 30 g NEEDLE EACH $0.1800
BD LANCETS (NDC 08290-3220-65)
33 g LANCET EACH $0.0620
BD LANCETS, ULTRA-FINE (NDC 08290-3220-57)
33 g LANCET EACH $0.0620
BD INSULIN SYRINGE (NDC 08290-3249-09)
0.3 ml; 6 mm x 31 g SYRINGE EACH $0.1800
BD INSULIN SYRINGE (NDC 08290-3249-10)
0.3 ml; 6 mm x 31 g (1/2)
SYRINGE EACH $0.1800
BD INSULIN SYRINGE (NDC 08290-3284-38)
0.3 ml; 8 mm x 31 g SYRINGE EACH $0.1800
BD INSULIN SYRINGE (NDC 08290-3284-40)
0.3 ml; 8 mm x 31 g (1/2)
SYRINGE EACH $0.1800
BD UINSULIN SYRINGE (NDC 08290-3249-11)
0.5 ml; 6 mm x 31 g SYRINGE EACH $0.1800
BD INSULIN SYRINGE (NDC 08290-3284-68)
0.5 ml; 8 mm x 31 g SYRINGE EACH $0.1800
BD INSULIN SYRINGE (NDC 08290-3284-66)
0.5 ml; 12.7 mm x 30 g
SYRINGE EACH $0.1800
BD INSULIN SYRINGE (NDC 08290-5932-01)
0.5 ml; 29 g x 1/2'’ SYRINGE EACH $0.1900
BD INSULIN SYRINGE (NDC 08290-3249-12)
1 ml; 6 mm x 31 g SYRINGE EACH $0.1800
BD INSULIN SYRINGE (NDC 08290-3256-57)
1 ml; 25 g x 5/8” SYRINGE EACH $0.1900
BD INSULIN SYRINGE (NDC 08290-3294-64)
1 ml; 29 g x 1/2” SYRINGE EACH $0.1900
BD INSULIN SYRINGE (NDC 08290-3282-89)
1 ml; 31 g x 5/32” SYRINGE EACH $0.1900
BD ULTRA-FINE PEN NEEDLE
(NDC 08290-3201-22) 4 mm x 32 g NEEDLE EACH $0.1800
BD ULTRA-FINE PEN NEEDLE (NDC 08290-3201-19)
5 mm x 31 g NEEDLE EACH $0.1800
BENAZEPRIL HCL 10 mg TAB TABLET $0.0292
BENAZEPRIL HCL 20 mg TAB TABLET $0.0435
BENAZEPRIL HCL 40 mg TAB TABLET $0.0600
BENAZEPRIL HCL 5 mg TAB TABLET $0.0252
BENAZEPRIL/HCTZ 10 mg; 12.5 mg TAB TABLET $0.6235
BENAZEPRIL/HCTZ 20 mg; 12.5 mg TAB TABLET $0.0655
BENAZEPRIL/HCTZ 20 mg; 25 mg TAB TABLET $0.4952
BENAZEPRIL/HCTZ 5 mg; 6.25 mg TAB TABLET $1.1000
BENZONATATE 100 mg CAP CAPSULE $0.0840
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
BENZONATATE 150 mg CAP CAPSULE $0.2375
BENZONATATE 200 mg CAP CAPSULE $0.1405
BENZOYL PEROXIDE 10% CLEANSER GRAM $0.0520
BENZOYL PEROXIDE 10% GEL GRAM $0.0725
BENZOYL PEROXIDE 10% LOTION MILLILITER $0.0799
BENZOYL PEROXIDE 2.5% GEL GRAM $0.2260
BENZOYL PEROXIDE 5% CLEANSER GRAM $0.0448
BENZOYL PEROXIDE 5% GEL GRAM $0.2335
BENZOYL PEROXIDE 5% LOTION MILLILITER $0.0837
BENZOYL PEROXIDE 6% CLEANSER GRAM $0.0755
BENZTROPINE MESYLATE 0.5 mg TAB TABLET $0.0945
BENZTROPINE MESYLATE 1 mg TAB TABLET $0.0933
BENZTROPINE MESYLATE 2 mg TAB TABLET $0.1145
BEPOTASTINE BESILATE 1.5% DROPS MILLILITER $40.7950
BETAMETHASONE ACETATE, SOD PHOS 6 mg/ml VIAL EACH $7.5550
BETAMETHASONE/PROPYLENE GLYC 0.05% LOTION GRAM $1.0276
BETAMETHASONE DIPROPIONATE AUGMENTED
0.05% CREAM GRAM $0.1245
BETAMETHASONE DIPROPIONATE AUGMENTED
0.05% OINT GRAM $1.0267
BETAMETHASONE DIPROPIONATE 0.05% CREAM GRAM $0.6510
BETAMETHASONE DIPROPIONATE 0.05% LOTION MILLILITER $0.4475
BETAMETHASONE DIPROPIONATE 0.05%, 15 gm OINT GRAM $2.1595
BETAMETHASONE DIPROPIONATE 0.05%, 45 gm OINT GRAM $1.0650
BETAMETHASONE VALERATE 0.1% CREAM GRAM $0.4145
BETAMETHASONE VALERATE 0.1% OINT GRAM $0.4665
BETAMETHASONE VALERATE 0.1%, 60 ml LOTION MILLILITER $0.5442
BETAMETHASONE VALERATE 0.12% FOAM GRAM $0.7575
BETAXOLOL HCL 0.5% OPTH SOLN MILLILITER $7.2000
BETAXOLOL HCL 10 mg TAB TABLET $0.5500
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
BETAXOLOL HCL 20 mg TAB TABLET $0.8850
BETHANECHOL CHLORIDE 10 mg TAB TABLET $0.1515
BETHANECHOL CHLORIDE 25 mg TAB TABLET $0.4215
BETHANECHOL CHLORIDE 5 mg TAB TABLET $0.1050
BETHANECHOL CHLORIDE 50 mg TAB TABLET $0.4242
BEXAROTENE 75 mg CAP CAPSULE $40.8295
BICALUTAMIDE 50 mg TAB TABLET $0.1765
BIMATOPROST 0.03% TAB TABLET $35.4500
BISACODYL 10 mg SUPP EACH $0.1050
BISACODYL 5 mg TAB EC TABLET $0.0216
BISMUTH SUBSALICYLATE 262 mg TAB CHEW TABLET $0.0538
BISMUTH SUBSALICYLATE 262 mg; 15 ml SUSP MILLILLITER $0.0088
BISMUTH SUBSALICYLATE 525 mg/15 ml LIQUID MILLILITER $0.0095
BISOPROLOL FUMARATE 10 mg TAB TABLET $0.2725
BISOPROLOL FUMARATE 5 mg TAB TABLET $0.2530
BISOPROLOL/HCTZ 10 mg; 6.25 mg TAB TABLET $0.0393
BISOPROLOL/HCTZ 2.5 mg; 6.25 mg TAB TABLET $0.0447
BISOPROLOL/HCTZ 5 mg; 6.25 mg TAB TABLET $0.0606
BIVALIRUDIN 250 mg VIAL EACH $135.2500
BLEOMYCIN SULFATE 15 unit VIAL EACH $60.5250
BLEOMYCIN SULFATE 30 unit VIAL EACH $96.1170
BOSENTAN 125 mg TAB TABLET $19.2500
BOSENTAN 62.5 mg TAB TABLET $19.2500
BRIMONIDINE TARTRATE 0.15% DROPS MILLILITER $20.7060
BRIMONIDINE TARTRATE 0.2% DROPS MILLILITER $0.3756
BROMFENAC SODIUM 0.09% DROPS MILLILITER $42.0400
BROMOCRIPTINE MESYLATE 2.5 mg TAB TABLET $1.6395
BROMOCRIPTINE MESYLATE 5 mg CAP CAPSULE $3.6395
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
BROMPHENIRAME/PSEUDOEPHEDRINE 1-15 mg/5 ml LIQUID MILLILITER $0.0095
BROMPHENIRAMINE/PHENYLEPHRINE 1-2.5 mg/5 ml LIQUID MILLILITER $0.0180
BROMPHENIRAMINE/PHENYLEPHRINE 4 mg ; 10 mg TAB TABLET $0.6445
BROMPHENIRAMINE MALEATE/ PHENYLEPHRINE HCL/D-METHORPHAN HB
1-2.5-5/5 ml SOLN MILLILITER $0.0203
BUDESONIDE 0.25 mg/2 ml AMPUL MILLILITER $0.6335
BUDESONIDE 0.5 mg/2 ml AMPUL MILLILITER $0.6735
BUDESONIDE 1 mg/2 ml AMPUL MILLILITER $3.3585
BUDESONIDE 3 mg CAP ER CAPSULE $0.9045
BUDESONIDE 32 mcg SPRAY PUMP EACH $1.1724
BUDESONIDE 9 mg TAB ER TABLET $25.6740
BUMETANIDE 0.5 mg TAB TABLET $0.3355
BUMETANIDE 1 mg TAB TABLET $0.2550
BUMETANIDE 2 mg TAB TABLET $0.3559
BUMETANIDE 0.25 mg/ml VIAL MILLILITER $0.4402
BUPIVACAINE HCL/EPINEPHRINE 0.25%-1:200,000 VIAL MILLILITER $0.1881
BUPRENORPHINE HCL 2 mg TAB SL TABLET $0.2345
BUPRENORPHINE HCL 8 mg TAB SL TABLET $0.7520
BUPRENORPHINE HCL 0.3 mg/ml VIAL MILLILITER $14.3950
BUPRENORPHINE HCL/NALOXONE HCL 2 mg; 0.5 mg FILM EACH $2.8265
BUPRENORPHINE HCL/NALOXONE HCL 2 mg; 0.5 mg TAB SL TABLET $1.0555
BUPRENORPHINE HCL/NALOXONE HCL 4 mg; 1 mg FILM EACH $4.9150
BUPRENORPHINE HCL/NALOXONE HCL 8 mg; 2 mg FILM EACH $4.4350
BUPRENORPHINE HCL/NALOXONE HCL 8 mg; 2 mg TAB SL TABLET $1.2550
BUPRENORPHINE HCL/NALOXONE HCL 12 mg; 3 mg FILM EACH $9.5575
BUPRENORPHINE 5 mcg/hr PATCH EACH $36.8225
BUPRENORPHINE 7.5 mcg/hr PATCH EACH $58.8520
BUPRENORPHINE 10 mcg/hr PATCH EACH $58.7240
BUPRENORPHINE 20 mcg/hr PATCH EACH $92.1855
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
BUPRENORPHINE 15 mcg/hr PATCH EACH $76.0875
BUPROPION HCL 100 mg TAB SR TABLET $0.0750
BUPROPION HCL 100 mg TAB TABLET $0.1765
BUPROPION HCL 150 mg TAB ER TABLET $0.1096
BUPROPION HCL 150 mg TAB SA TABLET $0.3572
BUPROPION HCL 150 mg TAB SR TABLET $0.0790
BUPROPION HCL 200 mg TAB SR TABLET $0.1575
BUPROPION HCL 300 mg TAB ER TABLET $0.1867
BUPROPION HCL 450 mg TAB ER TABLET $7.6550
BUPROPION HCL 75 mg TAB TABLET $0.0888
BUSPIRONE HCL 10 mg TAB TABLET $0.0290
BUSPIRONE HCL 15 mg TAB TABLET $0.0435
BUSPIRONE HCL 30 mg TAB TABLET $0.2205
BUSPIRONE HCL 5 mg TAB TABLET $0.0213
BUSPIRONE HCL 7.5 mg TAB TABLET $0.2752
BUSULFAN 60 mg/10 ml SOLN MILLILITER $21.5500
BUTALBITAL/ACETAMINOPHEN 50 mg; 300 mg TAB TABLET $6.8875
BUTALBITAL/ACETAMINOPHEN 50 mg; 325 mg TAB TABLET $0.8885
BUTALBITAL/ACETAMINOPHEN 50 mg; 300 mg CAP CAPSULE $10.9616
BUTALBITAL/ACETAMINOPHEN/CAFFEINE 50 mg; 300 mg; 40 mg CAP CAPSULE $0.5040
BUTALBITAL/ACETAMINOPHEN/CAFFEINE 50 mg; 325 mg; 40 mg CAP CAPSULE $1.6288
BUTALBITAL/ACETAMINOPHEN/CAFFEINE 50-325/15 SOLN MILLILITER $2.2985
BUTALBITAL/APAP/CAFFEINE COMPOUND 50 mg; 325 mg; 40 mg TAB TABLET $0.2199
BUTALBITAL/ASPIRIN/CAFFEINE 50 mg; 325 mg; 40 mg CAP CAPSULE $0.8695
BUTALBITAL/CAFFEINE/APAP/CODEINE 50 mg; 325 mg; 40
mg; 30 mg CAP CAPSULE $0.9251
BUTALBITAL/CAFFEINE/APAP/CODEINE 50 mg; 300 mg; 30 mg CAP CAPSULE $4.8785
BUTORPHANOL TARTRATE 10 mg/ml NASAL SPRAY MILLILITER $11.7260
CABERGOLINE 0.5 mg TAB TABLET $2.5150
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CAFFEINE CITRATE 60 mg/3 ml VIAL MILLILITER $7.4190
CALCIPOTRIENE 0.005% CREAM GRAM $1.1594
CALCIPOTRIENE 0.005% OINT GRAM $2.2095
CALCIPOTRIENE 0.005% SOLN MILLILITER $1.0575
CALCIPOTRIENE/BETAMETHASONE 0.005-0.064% OINT GRAM $4.6852
CALCIPOTRIENE/BETAMETHASONE 0.005-0.064% SUSP GRAM $7.3185
CALCITONIN, SALMON, SYNTHETIC 200 units/dose SPRAY MILLILITER $7.7135
CALCITRIOL 0.25 mcg CAP CAPSULE $0.2225
CALCITRIOL 0.5 mcg CAP CAPSULE $0.3180
CALCITRIOL 1 mcg/ml SOLN MILLILITER $4.7971
CALCIUM ACETATE 667 mg CAP CAPSULE $0.1746
CALCIUM ACETATE 667 mg TAB TABLET $0.3700
CALCIUM CARBONATE 1250 mg TAB TABLET $0.0332
CALCIUM CARBONATE 200 (500) mg TAB CHEW TABLET $0.0150
CALCIUM CARBONATE 215 (500) mg TAB CHEW TABLET $0.0138
CALCIUM CARBONATE 300 (750) mg TAB CHEW TABLET $0.0284
CALCIUM CARBONATE 320 (750) mg TAB CHEW TABLET $0.0320
CALCIUM CARBONATE 400 (1,000) mg TAB CHEW TABLET $0.0300
CALCIUM CARBONATE 500 mg/ml ORAL SUSP MILLILITER $0.0201
CALCIUM CARBONATE 500 mg TAB TABLET $0.0332
CALCIUM CARBONATE 600 mg TAB TABLET $0.0175
CALCIUM CARBONATE/CHOLECALCIFEROL (VITAMIN D3)
500 mg; 200 mg TAB TABLET $0.0458
CALCIUM CARBONATE/CHOLECALCIFEROL (VITAMIN D3)
500 mg; 400 mg TAB TABLET $0.0488
CALCIUM CARBONATE/CHOLECALCIFEROL (VITAMIN D3)
600 mg; 400 mg TAB TABLET $0.0168
CALCIUM CARBONATE/CHOLECALCIFEROL (VITAMIN D3)/PHYTONADIONE (VITAMIN K1)
500-200-40 TAB CHEW TABLET $0.0971
CALCIUM/MAGNESIUM/ZINC N/A TAB TABLET $0.0332
CALCIUM POLYCARBOPHIL 625 mg TAB TABLET $0.0600
CANDESARTAN CILEXETIL 16 mg TAB TABLET $0.7200
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CANDESARTAN CILEXETIL 32 mg TAB TABLET $1.0200
CANDESARTAN CILEXETIL 4 mg TAB TABLET $0.6997
CANDESARTAN CILEXETIL 8 mg TAB TABLET $0.7050
CANDESARTAN/HYDROCHLOROTHIAZIDE 16 mg; 12.5 mg TAB TABLET $0.4715
CANDESARTAN/HYDROCHLOROTHIAZIDE 32 mg; 12.5 mg TAB TABLET $1.3590
CANDESARTAN/HYDROCHLOROTHIAZIDE 32 mg; 25 mg TAB TABLET $1.5095
CAPECITABINE 150 mg TAB TABLET $0.2915
CAPECITABINE 500 mg TAB TABLET $0.4765
CAPTOPRIL 100 mg TAB TABLET $1.3205
CAPTOPRIL 12.5 mg TAB TABLET $0.4635
CAPTOPRIL 25 mg TAB TABLET $0.7395
CAPTOPRIL 50 mg TAB TABLET $0.8670
CAPTOPRIL /HYDROCHLOROTHIAZIDE 25 mg; 15 mg TAB TABLET $0.0263
CAPTOPRIL /HYDROCHLOROTHIAZIDE 25 mg; 25 mg TAB TABLET $0.0568
CAPTOPRIL /HYDROCHLOROTHIAZIDE 50 mg; 15 mg TAB TABLET $0.0665
CARBAMAZEPINE 100 mg TAB CHEW TABLET $0.2845
CARBAMAZEPINE 100 mg CAP ER 12HR CAPSULE $0.5155
CARBAMAZEPINE 100 mg TAB ER 12HR TABLET $0.6255
CARBAMAZEPINE 100 mg/5 ml SUSP MILLILITER $0.6049
CARBAMAZEPINE 200 mg CAP ER 12HR CAPSULE $0.6365
CARBAMAZEPINE 200 mg TAB TABLET $0.2850
CARBAMAZEPINE 200 mg TAB SR 12HR TABLET $1.1700
CARBAMAZEPINE 300 mg CAP ER 12HR CAPSULE $0.6365
CARBAMAZEPINE 400 mg TAB SR 12HR TABLET $2.1625
CARBAMIDE PEROXIDE 6.5% DROPS MILLILITER $0.1005
CARBIDOPA 25 mg TAB TABLET $3.5125
CARBIDOPA; LEVODOPA 10 mg; 100 mg TAB, RAPID DISSOLVE
TABLET $0.6300
CARBIDOPA; LEVODOPA 10 mg; 100 mg TAB TABLET $0.0922
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CARBIDOPA; LEVODOPA 25 mg; 100 mg TAB TABLET $0.0750
CARBIDOPA; LEVODOPA 25 mg; 100 mg TAB ODT TABLET $0.6850
CARBIDOPA; LEVODOPA 25 mg; 250 mg TAB TABLET $0.1255
CARBIDOPA; LEVODOPA 25 mg; 250 mg TAB ODT TABLET $0.8700
CARBIDOPA; LEVODOPA ER 25 mg; 100 mg TAB ER TABLET $0.1650
CARBIDOPA; LEVODOPA ER 50 mg; 200 mg TAB ER TABLET $0.3382
CARBIDOPA; LEVODOPA; ENTACAPONE 12.5 mg; 50 mg TAB TABLET $0.9550
CARBIDOPA; LEVODOPA; ENTACAPONE 18.75 mg; 75 mg TAB TABLET $1.2960
CARBIDOPA; LEVODOPA; ENTACAPONE 25; 100; 200 TAB TABLET $0.9870
CARBIDOPA; LEVODOPA; ENTACAPONE 31.25 mg; 125 mg TAB TABLET $0.9350
CARBIDOPA; LEVODOPA; ENTACAPONE 37.5 mg; 150 mg TAB TABLET $1.0825
CARBIDOPA; LEVODOPA; ENTACAPONE 50; 200; 200 TAB TABLET $0.8335
CARBINOXAMINE MALEATE 4 mg/5 ml LIQ MILLILITER $0.0712
CARBOPLATIN 10 mg/ml VIAL MILLILITER $0.7545
CARBOXYMETHYLCELLULOSE SODIUM 0.5% DROPS MILLILITER $0.2030
CARBOXYMETHYLCELLULOSE SODIUM 0.5% DROPERETTE EACH $0.1815
CARISOPRODOL 250 mg TAB TABLET $1.3335
CARISOPRODOL 350 mg TAB TABLET $0.0621
CARISOPRODOL/ASPIRIN/CODEINE 200-325-16 TAB TABLET $1.9000
CARMUSTINE 100 mg VIAL EACH $2925.00
CARTEOLOL HCL 1% SOLN MILLILITER $0.9528
CARVEDILOL 12.5 mg TAB TABLET $0.0195
CARVEDILOL 20 mg CAP ER CAPSULE $5.9530
CARVEDILOL 25 mg TAB TABLET $0.0295
CARVEDILOL 3.125 mg TAB TABLET $0.0150
CARVEDILOL 6.25 mg TAB TABLET $0.0308
CASPOFUNGIN ACETATE 50 mg VIAL EACH $74.5550
CASPOFUNGIN ACETATE 70 mg VIAL EACH $79.5550
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CASTOR OIL 100% OIL MILLILITER $0.0215
CEFACLOR 250 mg CAP CAPSULE $0.7453
CEFACLOR 500 mg CAP CAPSULE $1.1355
CEFADROXIL HYDRATE 1 g TAB TABLET $3.9000
CEFADROXIL HYDRATE 250 mg/5 ml SUSP MILLILITER $0.1935
CEFADROXIL HYDRATE 500 mg/5 ml SUSP MILLILITER $0.2595
CEFADROXIL 500 mg CAP CAPSULE $0.2000
CEFAZOLIN SODIUM 1 gm VIAL EACH $1.1550
CEFAZOLIN SODIUM 10 gm VIAL EACH $11.5416
CEFAZOLIN SODIUM 500 mg VIAL EACH $1.6200
CEFDINIR 125 mg/5 ml SUSP MILLILITER $0.0905
CEFDINIR 250 mg/5 ml SUSP MILLILITER $0.0809
CEFDINIR 300 mg CAP CAPSULE $0.4379
CEFEPIME HCL 1 gm VIAL EACH $4.7150
CEFEPIME HCL 2 gm VIAL EACH $10.8581
CEFIXIME 100 mg/5 ml ORAL SUSP MILLILITER $2.8775
CEFIXIME 200 mg/5 ml ORAL SUSP MILLILITER $5.6945
CEFIXIME 400 mg CAP CAPSULE $11.3300
CEFOTETAN DISODIUM 1 gm VIAL EACH $3.8995
CEFOXITIN SODIUM 2 gm VIAL EACH $8.3000
CEFOXITIN SODIUM 10 gm VIAL EACH $30.8000
CEFPODOXIME 100 mg TAB TABLET $2.9355
CEFPODOXIME 200 mg TAB TABLET $4.3805
CEFPODOXIME PROXETIL 100 mg/5 ml SUSP MILLILITER $1.2500
CEFPODOXIME PROXETIL 50 mg/5 ml SUSP MILLILITER $0.5800
CEFPROZIL 125 mg/5 ml SUSP MILLILITER $0.2175
CEFPROZIL 250 mg/5 ml SUSP MILLILITER $0.2130
CEFPROZIL 250 mg TAB TABLET $0.7400
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CEFPROZIL 500 mg TAB TABLET $0.9355
CEFTAZIDIME PENTAHYDRATE 1 gm VIAL EACH $5.3880
CEFTAZIDIME PENTAHYDRATE 2 gm VIAL EACH $11.3148
CEFTAZIDIME PENTAHYDRATE 6 gm VIAL EACH $27.7830
CEFTRIAXONE SODIUM 1 gm VIAL EACH $1.4885
CEFTRIAXONE SODIUM 10 gm VIAL EACH $20.7648
CEFTRIAXONE SODIUM 2 gm VIAL EACH $4.4352
CEFTRIAXONE SODIUM 250 mg VIAL EACH $1.5926
CEFTRIAXONE SODIUM 500 mg VIAL EACH $1.1805
CEFUROXIME 250 mg TAB TABLET $0.3660
CEFUROXIME 500 mg TAB TABLET $0.7175
CEFUROXIME SODIUM 1.5 G VIAl EACh $5.4299
CEFUROXIME SODIUM 7.5 gm VIAL EACH $19.9500
CEFUROXIME SODIUM 750 mg VIAL EACH $2.8225
CELECOXIB 100 mg CAP CAPSULE $0.0600
CELECOXIB 200 mg CAP CAPSULE $0.1450
CELECOXIB 400 mg CAP CAPSULE $0.4950
CELECOXIB 50 mg CAP CAPSULE $0.1500
CEPHALEXIN 125 mg/5 ml SUSP MILLILITER $0.0605
CEPHALEXIN 250 mg CAP CAPSULE $0.0890
CEPHALEXIN 250 mg/5 ml SUSP RECON MILLILITER $0.0665
CEPHALEXIN 500 mg CAP CAPSULE $0.0755
CEPHALEXIN 750 mg CAP CAPSULE $3.8152
CETIRIZINE HCL 1 mg/ml SYRN MILLILITER $0.0115
CETIRIZINE HCL 10 mg TAB CHEW TABLET $1.8075
CETIRIZINE HCL 10 mg TAB TABLET $0.0677
CETIRIZINE HCL 5 mg/5 ml SOLN MILLILITER $0.0235
CETIRIZINE HCL 5 mg TAB CHEW TABLET $1.3735
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CETIRIZINE HCL 5 mg TAB TABLET $0.0338
CEVIMELINE HCL 30 mg CAP CAPSULE $1.1155
CHLORDIAZEPOXIDE 10 mg CAP CAPSULE $0.0700
CHLORDIAZEPOXIDE 25 mg CAP CAPSULE $0.0700
CHLORDIAZEPOXIDE 5 mg CAP CAPSULE $0.0895
CHLORHEXIDINE 0.12% ORAL RINSE MILLILITER $0.0048
CHLORHEXIDINE GLUCONATE 4% LIQUID MILLILITER $0.0176
CHLOROQUINE PHOSPHATE 250 mg TAB TABLET $2.0080
CHLOROQUINE PHOSPHATE 500 mg TAB TABLET $3.5550
CHLORPHENIRAMINE/DEXTROMETHOPR 4 mg; 10 mg TAB TABLET $0.1700
CHLORPHENIRAMINE/DEXTROMETHOPR 4 mg; 30 mg TAB TABLET $0.0975
CHLORPHENIRAMINE/PHENYLEPHRINE 4-10 mg/5 ml LIQUID MILLILITER $0.0503
CHLORPHENIRAMINE/PHENYLEPH/DM 4-10-15 mg/5 ml SYRINGE MILLILITER $0.0540
CHLORPHENIRAMINE/PSEUDOEPHED/DM 1-15-5mg/5 ml LIQUID MILLILITER $0.0196
CHLORPHENIRAMINE MALEATE 4 mg TAB TABLET $0.0205
CHLORPROMAZINE HCL 10 mg TAB TABLET $1.5655
CHLORPROMAZINE HCL 100 mg TAB TABLET $3.2953
CHLORPROMAZINE HCL 200 mg TAB TABLET $6.6835
CHLORPROMAZINE HCL 25 mg TAB TABLET $1.8136
CHLORPROMAZINE HCL 50 mg TAB TABLET $2.7350
CHLORTHALIDONE 25 mg TAB TABLET $0.1870
CHLORTHALIDONE 50 mg TAB TABLET $0.3270
CHLORZOXAZONE 375 mg TAB TABLET $5.6725
CHLORZOXAZONE 500 mg TAB TABLET $0.2855
CHLORZOXAZONE 750 mg TAB TABLET $3.3425
CHOLECALCIFEROL (VITAMIN D3) 1,000 unit TAB TABLET $0.0749
CHOLECALCIFEROL (VITAMIN D3) 2,000 unit CAP CAPSULE $0.0375
CHOLESTYRAMINE 4 gm PWDR for
ORAL SUSP GRAM $0.1215
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CHOLESTYRAMINE LITE 4 gm PWDR for
ORAL SUSP GRAM $0.1415
CHOLESTYRAMINE LITE 4 gm PWD PACKET EACH $1.3725
CHOLESTYRAMINE/SUCROSE 4 gm PWDR
PACKET EACH $1.2183
CICLOPIROX 0.77% CREAM GRAM $0.1215
CICLOPIROX 0.77% GEL GRAM $0.5895
CICLOPIROX 0.77% TOP SUSP MILLILITER $0.9115
CICLOPIROX 1% SHAMPOO MILLILITER $0.3235
CICLOPIROX 8% TOP SOLN MILLILITER $1.5630
CIDOFOVIR 75 mg/ml VIAL MILLILITER $147.6500
CILOSTAZOL 100 mg TAB TABLET $0.1035
CILOSTAZOL 50 mg TAB TABLET $0.0845
CIMETIDINE 200 mg TAB TABLET $0.3150
CIMETIDINE 300 mg TAB TABLET $0.2556
CIMETIDINE 400 mg TAB TABLET $0.5665
CIMETIDINE 800 mg TAB TABLET $0.5656
CINACALCET HCL 30 mg TAB TABLET $1.9683
CINACALCET HCL 60 mg TAB TABLET $1.6770
CINACALCET HCL 90 mg TAB TABLET $3.5550
CIPROFLOXACIN IN 5% DEXTROSE 200 mg/0.1 L SOLN MILLILITER $0.0299
CIPROFLOXACIN/DEXAMETHASONE 0.3%-0.1% OTIC DROPS MILLILITER $22.1655
CIPROFLOXACIN LACTATE/D5W 400 mg/200 ml IV MILLILITER $0.0210
CIPROFLOXACIN 0.3% SOLN MILLILITER $0.9450
CIPROFLOXACIN 250 mg/5 ml ORAL SUSP MILLILITER $0.8168
CIPROFLOXACIN 250 mg TAB TABLET $0.0945
CIPROFLOXACIN 500 mg/5 ml ORAL SUSP MILLILITER $0.9561
CIPROFLOXACIN 500 mg TAB TABLET $0.1075
CIPROFLOXACIN 750 mg TAB TABLET $0.4526
CISPLATIN 1 mg/ml SOLN MILLILITER $0.2025
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CITALOPRAM 10 mg/5 ml SOLN MILLILITER $0.2563
CITALOPRAM 10 mg TAB TABLET $0.0348
CITALOPRAM 20 mg TAB TABLET $0.0295
CITALOPRAM 40 mg TAB TABLET $0.0375
CITRIC ACID/SODIUM CITRATE 334-500 mg SOLN MILLILITER $0.0259
CLADRIBINE 10 mg/10 ml VIAL MILLILITER $28.3030
CLARITHROMYCIN 125 mg/5 ml SUSP MILLILITER $0.8157
CLARITHROMYCIN 250 mg/5 ml SUSP MILLILITER $1.2246
CLARITHROMYCIN 250 mg TAB TABLET $0.5095
CLARITHROMYCIN 500 mg TAB TABLET $0.6265
CLARITHROMYCIN 500 mg TAB ER TABLET $2.7825
CLEMASTINE FUMARATE 1.34 mg TAB TABLET $0.1775
CLINDAMYCIN HCL 150 mg CAP CAPSULE $0.0972
CLINDAMYCIN HCL 300 mg CAP CAPSULE $0.1504
CLINDAMYCIN HCL 75 mg CAP CAPSULE $0.2000
CLINDAMYCIN PALMITATE HCL 75 mg/5 ml SOLN MILLILITER $0.1886
CLINDAMYCIN PHOSPHATE 1% FOAM GRAM $3.0020
CLINDAMYCIN PHOSPHATE 1% PLEDGET EACH $0.2754
CLINDAMYCIN PHOSPHATE 1% GEL GRAM $0.8465
CLINDAMYCIN PHOSPHATE 1% LOTION MILLILITER $0.7950
CLINDAMYCIN PHOSPHATE 1% SOLN MILLILITER $0.2285
CLINDAMYCIN PHOSPHATE 150 mg/ml VIAL MILLILITER $0.9231
CLINDAMYCIN PHOSPHATE 2% VAG CREAM GRAM $1.4150
CLINDAMYCIN PHOSPHATE/ BENZOYL PEROXIDE
1% - 5% GEL GRAM $1.1545
CLINDAMYCIN PHOSPHATE/ BENZOYL PEROXIDE
1% - 5% GEL PUMP GRAM $1.9815
CLINDAMYCIN PHOSPHATE/ BENZOYL PEROXIDE
1.2(1)%-5% GEL GRAM $1.0065
CLINDAMYCIN PHOSPHATE/ BENZOYL PEROXIDE
1.2%-2.5% GEL PUMP GRAM $2.2025
CLINDAMYCIN PHOSPHATE/ DEXTROSE 5% IN WATER
300 mg/50 ml SOLN MILLILITER $0.1722
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CLINDAMYCIN PHOSPHATE/ DEXTROSE 5% IN WATER
600 mg/50 ml SOLN MILLILITER $0.2597
CLINDAMYCIN PHOSPHATE/ DEXTROSE 5% IN WATER
900 mg/50 ml SOLN MILLILITER $0.3172
CLINDAMYCIN/TRETINOIN 1.2-0.025% GEL GRAM $10.0588
CLOBAZAM 20 mg TAB TABLET $0.6765
CLOBAZAM 10 mg TAB TABLET $0.3642
CLOBAZAM 2.5 mg/ml SUSP MILLILITER $0.7335
CLOBETASOL PROPIONATE/EMOLLIENT 0.05% CREAM GRAM $0.8161
CLOBETASOL PROPIONATE/EMOLLIENT 0.05% FOAM GRAM $2.6255
CLOBETASOL PROPIONATE 0.05% CREAM GRAM $0.5745
CLOBETASOL PROPIONATE 0.05% FOAM GRAM $1.1525
CLOBETASOL PROPIONATE 0.05% GEL GRAM $0.2765
CLOBETASOL PROPIONATE 0.05% LOTION MILLILITER $0.8515
CLOBETASOL PROPIONATE 0.05% OINT GRAM $0.4545
CLOBETASOL PROPIONATE 0.05% SHAMPOO MILLILITER $0.8685
CLOBETASOL PROPIONATE 0.05% SPRAY MILLILITER $0.7775
CLOBETASOL PROPIONATE 0.05% TOP SOLN MILLILITER $0.4380
CLOFARABINE 20 mg/20 ml SOLN MILLILITER $52.1500
CLOMIPRAMINE HCL 25 mg CAP CAPSULE $1.4865
CLOMIPRAMINE HCL 50 mg CAP CAPSULE $1.7525
CLOMIPRAMINE HCL 75 mg CAP CAPSULE $0.4005
CLONAZEPAM ODT 0.125 mg TAB ODT TABLET $0.5000
CLONAZEPAM ODT 0.25 mg TAB ODT TABLET $0.6850
CLONAZEPAM ODT 0.5 mg TAB ODT TABLET $0.5765
CLONAZEPAM ODT 1 mg TAB ODT TABLET $0.5265
CLONAZEPAM ODT 2 mg TAB ODT TABLET $0.8485
CLONAZEPAM 0.5 mg TAB TABLET $0.0150
CLONAZEPAM 1 mg TAB TABLET $0.0281
CLONAZEPAM 2 mg TAB TABLET $0.0417
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CLONIDINE HCL 0.1 mg TAB ER 12HR TABLET $0.3500
CLONIDINE HCL 0.1 mg TAB TABLET $0.0246
CLONIDINE HCL 0.2 mg TAB TABLET $0.0265
CLONIDINE HCL 0.3 mg TAB TABLET $0.0395
CLONIDINE 0.1 mg/24hr PATCH PATCH $7.7395
CLONIDINE 0.2 mg/24hr PATCH PATCH $9.1006
CLONIDINE 0.3 mg/24hr PATCH PATCH $12.8530
CLOPIDOGREL 300 mg TAB TABLET $0.9435
CLOPIDOGREL 75 mg TAB TABLET $0.0494
CLORAZEPATE DIPOTASSIUM 15 mg TAB TABLET $0.4716
CLORAZEPATE DIPOTASSIUM 3.75 mg TAB TABLET $0.9075
CLORAZEPATE DIPOTASSIUM 7.5 mg TAB TABLET $1.3625
CLOTRIMAZOLE/ BETAMETHASONE DIPROPIONATE
1-0.05%; 15 gm CREAM GRAM $0.2055
CLOTRIMAZOLE/ BETAMETHASONE DIPROPIONATE
1-0.05%; 45 gm CREAM GRAM $0.1935
CLOTRIMAZOLE/ BETAMETHASONE DIPROPIONATE
1-0.05% LOTION MILLILITER $2.4395
CLOTRIMAZOLE 1% CREAM GRAM $0.0813
CLOTRIMAZOLE 1% VAG CREAM GRAM $0.0739
CLOTRIMAZOLE 1% SOLN MILLILITER $1.3075
CLOTRIMAZOLE 10 mg LOZENGE EACH $0.3585
CLOZAPINE 100 mg TAB TABLET $0.5875
CLOZAPINE 100 mg TAB ODT TABLET $4.7245
CLOZAPINE 200 mg TAB TABLET $1.4145
CLOZAPINE 25 mg TAB TABLET $0.2900
CLOZAPINE 25 mg TAB ODT TABLET $2.0080
CLOZAPINE 50 mg TAB TABLET $0.5762
CODEINE PHOSPHATE/GUAIFENESIN 10-100 mg/5 LIQUID MILLILITER $0.1515
CODEINE PHOSPHATE/GUAIFENESIN 20-200 mg/10 LIQUID MILLILITER $0.0760
CODEINE PHOSPHATE/GUAIFENESIN 6.3-100/5 LIQUID MILLILITER $0.0489
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CODEINE SULFATE 15 mg TAB TABLET $0.4374
CODEINE SULFATE 30 mg TAB TABLET $0.3315
CODEINE SULFATE 60 mg TAB TABLET $0.7832
COLCHICINE 0.6 mg CAP CAPSULE $1.3850
COLCHICINE 0.6 mg TAB TABLET $0.8141
COLESEVELAM HCL 3.75 gm POWDER EACH $6.7830
COLESEVELAM HCL 625 mg TAB TABLET $0.3675
COLESTIPOL HCL 1 gm TAB TABLET $0.6335
COLESTIPOL HCL 5 gm PACKET EACH $2.0800
COLISTIMETHATE SODIUM 150 mg VIAL EACH $15.1800
COSYNTROPIN 0.25 mg VIAL EACH $23.5500
CROMOLYN SODIUM 20 mg/ml SOLN MILLILITER $0.2585
CROMOLYN SODIUM 4% OPTH SOLN MILLILITER $0.2625
CROMOLYN SODIUM 5.2 mg NASAL SPRAY MILLILITER $0.2085
CYANOCOBALAMIN (VITAMIN B-12) 1,000 mcg TAB TABLET $0.0554
CYANOCOBALAMIN (VITAMIN B-12) 1,000 mcg/ml VIAL MILLILITER $1.1015
CYANOCOBALAMIN/FOLIC AC/VIT B6 1-2.2-25 mg TAB TABLET $0.1560
CYANOCOBALAMIN/FOLIC AC/VIT B6 1-2.5-25 mg TAB TABLET $0.4285
CYANOCOBALAMIN/FOLIC AC/VIT B6 2-2.5-25 mg TAB TABLET $0.3755
CYCLOBENZAPRINE HCL 10 mg TAB TABLET $0.0240
CYCLOBENZAPRINE HCL 15 mg CAP ER CAPSULE $7.4050
CYCLOBENZAPRINE HCL 30 mg CAP ER CAPSULE $13.1075
CYCLOBENZAPRINE HCL 5 mg TAB TABLET $0.0360
CYCLOBENZAPRINE HCL 7.5 mg TAB TABLET $1.4415
CYCLOPENTOLATE HCL 0.5% DROPS MILLILITER $4.1050
CYCLOPENTOLATE HCL 1% DROPS MILLILITER $1.4055
CYCLOPENTOLATE HCL 2% DROPS MILLILITER $2.9500
CYCLOPHOSPHAMIDE 1 gm VIAL EACH $360.0000
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
CYCLOPHOSPHAMIDE 2 gm VIAL EACH $719.7500
CYCLOPHOSPHAMIDE 25 mg CAP CAPSULE $4.9500
CYCLOPHOSPHAMIDE 50 mg CAP CAPSULE $5.6950
CYCLOPHOSPHAMIDE 500 mg VIAL EACH $179.9500
CYCLOSERINE 250 mg CAP CAPSULE $57.7500
CYCLOSPORINE, MODIFIED 100 mg CAP CAPSULE $1.2515
CYCLOSPORINE, MODIFIED 100 mg/ml SOLN MILLILITER $2.6035
CYCLOSPORINE, MODIFIED 25 mg CAP CAPSULE $0.3505
CYCLOSPORINE, MODIFIED 50 mg CAP CAPSULE $0.8745
CYCLOSPORINE 100 mg CAP CAPSULE $5.9365
CYCLOSPORINE 25 mg CAP CAPSULE $1.7640
CYPROHEPTADINE HCL 2 mg/5 ml SYRINGE MILLILITER $0.0357
CYPROHEPTADINE HCL 4 mg TAB TABLET $0.0600
CYTARABINE/PF 100 mg/5 ml VIAL MILLILITER $0.7655
CYTARABINE/PF 2 gm/20 ml VIAL MILLILITER $1.2150
CYTARABINE/PF 20 mg/ml VIAL MILLILITER $0.6585
D-ALPHA TOCOPHEROL (VITAMIN E)
400 unit CAP CAPSULE $0.0726
DACARBAZINE 200 mg VIAL EACH $19.3650
DACTINOMYCIN 0.5 mg VIAL EACH $925.8500
DALFAMPRIDINE 10 mg TAB ER TABLET $0.8550
DANAZOL 100 mg CAP CAPSULE $3.8080
DANAZOL 200 mg CAP CAPSULE $3.5765
DANAZOL 50 mg CAP CAPSULE $3.0095
DANTROLENE SODIUM 100 mg CAP CAPSULE $1.2545
DANTROLENE SODIUM 20 mg VIAL EACH $69.6000
DANTROLENE SODIUM 25 mg CAP CAPSULE $0.5899
DANTROLENE SODIUM 50 mg CAP CAPSULE $1.1879
DAPSONE 100 mg TAB TABLET $0.6974
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
DAPSONE 25 mg TAB TABLET $0.7442
DAPSONE 5% GEL GRAM $2.8252
DAPTOMYCIN 350 mg VIAL EACH $40.1825
DAPTOMYCIN 500 mg VIAL EACH $28.2300
DARIFENACIN HYDROBROMIDE 15 mg TAB ER 24HR TABLET $0.4350
DARIFENACIN HYDROBROMIDE 7.5 mg TAB ER 24HR TABLET $1.8285
DAUNORUBICIN HCL 5 mg/ml VIAL MILLILITER $24.8519
DECITABINE 50 mg SOLN EACH $241.8185
DEFERASIROX 125 mg TAB DISP TABLET $2.5000
DEFERASIROX 180 mg GRANULES EACH $70.0500
DEFERASIROX 180 mg TAB TABLET $1.4500
DEFERASIROX 250 mg TAB DISP TABLET $5.0000
DEFERASIROX 500 mg TAB DISP TABLET $10.0000
DEFERASIROX 90 mg GRANULES EACH $35.0200
DEFERASIROX 90 mg TAB TABLET $7.6000
DEFERASIROX 360 mg GRANULES EACH $140.1150
DEFERASIROX 360 mg TAB TABLET $23.7055
DEFERIPRONE 500 mg TAB TABLET $60.2500
DEFEROXAMINE MESYLATE 2 gm VIAL EACH $25.1358
DEFEROXAMINE MESYLATE 500 mg VIAL EACH $12.2985
DEMECLOCYCLINE 150 mg TAB TABLET $3.0165
DEMECLOCYCLINE 300 mg TAB TABLET $5.3145
DESIPRAMINE HCL 10 mg TAB TABLET $0.4345
DESIPRAMINE HCL 100 mg TAB TABLET $0.3885
DESIPRAMINE HCL 150 mg TAB TABLET $1.0845
DESIPRAMINE HCL 25 mg TAB TABLET $0.1334
DESIPRAMINE HCL 50 mg TAB TABLET $0.6240
DESIPRAMINE HCL 75 mg TAB TABLET $2.1575
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
DESLORATADINE 5 mg TAB TABLET $0.2805
DESMOPRESSIN 0.1 mg/ml NASAL SPRAY MILLILITER $8.7690
DESMOPRESSIN ACETATE 0.1 mg TAB TABLET $0.2945
DESMOPRESSIN ACETATE 0.2 mg TAB TABLET $0.4805
DESOGESTREL/ETHINYL ESTRADIOL (KARIVA, MIRCETTE)
0.15 mg; 20 mcg TAB TABLET $0.3500
DESOGESTREL/ETHINYL ESTRADIOL (APRI)
0.15 mg; 30 mcg TAB TABLET $0.1600
DESONIDE 0.05% CREAM GRAM $0.5365
DESONIDE 0.05% LOTION MILLILITER $1.1150
DESONIDE 0.05%; 15 gm OINT GRAM $1.4250
DESONIDE 0.05%; 60 gm OINT GRAM $1.0850
DESOXIMETASONE 0.05%; 15 gm GEL GRAM $3.4550
DESOXIMETASONE 0.05%; 60 gm GEL GRAM $2.5030
DESOXIMETASONE 0.25% SPRAY MILLILITER $1.2835
DESOXIMETASONE 0.25% OINT GRAM $0.4000
DESOXIMETASONE 0.25% CREAM GRAM $0.4585
DESOXIMETASONE 0.5% CREAM GRAM $2.3565
DESOXIMETASONE 0.05% OINT GRAM $2.9805
DESVENLAFAXINE SUCCINATE 100 mg TAB ER 24HR TABLET $0.4050
DESVENLAFAXINE SUCCINATE 25 mg TAB ER 24HR TABLET $0.6054
DESVENLAFAXINE SUCCINATE 50 mg TAB ER 24HR TABLET $0.4300
DEXAMETHASONE 0.5 mg TAB TABLET $0.0674
DEXAMETHASONE 0.5 mg/5 ml SOLN MILLILITER $0.1055
DEXAMETHASONE 0.75 mg TAB TABLET $0.1000
DEXAMETHASONE 10 mg/ml VIAL MILLILITER $4.4000
DEXAMETHASONE 1.5 mg TAB TABLET $0.0767
DEXAMETHASONE 4 mg TAB TABLET $0.1199
DEXAMETHASONE 4 mg/ml VIAL EACH $0.1756
DEXAMETHASONE 6 mg TAB TABLET $0.5695
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
DEXAMETHASONE 1.5 mg (21) TAB TABLET $0.0767
DEXAMETHASONE 1.5 mg (51) TAB TABLET $0.0767
DEXAMETHASONE 1.5 mg (27) TAB TABLET $0.0767
DEXAMETHASONE 1.5 mg (49) TAB TABLET $0.0767
DEXAMETHASONE 1.5 mg (39) TAB TABLET $0.0767
DEXAMETHASONE 1.5 mg (35) TAB TABLET $0.0767
DEXAMETHASONE SODIUM PHOSPHATE 10 mg/ml SOLN MILLILITER $0.5500
DEXBROMPHENIRAMIN/PHENYLEPHRIN 2 mg; 10 mg TAB TABLET $0.6185
DEXMEDETOMIDINE HCL 200 mcg/2 ml SOLN MILLILITER $3.2950
DEXMEDETOMIDINE IN 0.9% NACL 200 mcg/50 SOLN MILLILITER $1.0385
DEXMEDETOMIDINE IN 0.9% NACL 400 mcg/100 SOLN MILLILITER $1.0750
DEXMETHYLPHENIDATE HCL (FOCALIN XR)
10 mg CAP ER CAPSULE $1.2525
DEXMETHYLPHENIDATE HCL (FOCALIN)
10 mg TAB TABLET $0.2550
DEXMETHYLPHENIDATE HCL (FOCALIN XR)
15 mg CAP ER CAPSULE $1.6555
DEXMETHYLPHENIDATE HCL (FOCALIN XR)
20 mg CAP ER CAPSULE $2.0955
DEXMETHYLPHENIDATE HCL (FOCALIN)
2.5 mg TAB TABLET $0.1520
DEXMETHYLPHENIDATE HCL (FOCALIN XR)
25 mg CAP ER CAPSULE $1.2125
DEXMETHYLPHENIDATE HCL (FOCALIN XR)
30 mg CAP ER CAPSULE $2.6350
DEXMETHYLPHENIDATE HCL (FOCALIN XR)
35 mg CAP ER CAPSULE $1.5965
DEXMETHYLPHENIDATE HCL (FOCALIN XR)
40 mg CAP ER CAPSULE $3.6950
DEXMETHYLPHENIDATE HCL (FOCALIN XR)
5 mg CAP ER CAPSULE $1.3555
DEXMETHYLPHENIDATE HCL (FOCALIN)
5 mg TAB TABLET $0.2475
DEXRAZOXANE HCL 250 mg VIAL EACH $215.8750
DEXRAZOXANE HCL 500 mg VIAL EACH $286.0000
DEXTRAN 70/HYPROMELLOSE 0.1%-0.3% DROPS MILLILITER $0.1864
DEXTROAMPHETAMINE SULFATE 10 mg CAP SA CAPSULE $1.1945
DEXTROAMPHETAMINE SULFATE 10 mg TAB TABLET $0.4855
DEXTROAMPHETAMINE SULFATE 15 mg CAP SA CAPSULE $1.2535
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
DEXTROAMPHETAMINE SULFATE 5 mg CAP SA CAPSULE $0.9545
DEXTROAMPHETAMINE SULFATE 5 mg TAB TABLET $0.2815
DEXTROAMPHETAMINE SULFATE 5 mg/5 ml SOLN MILLILITER $1.1825
DEXTROMETHORPHAN HBR 15 mg CAP CAPSULE $0.0922
DEXTROMETHORPHAN HB/DOXYLAMINE 15-6.25/15 ml LIQUID MILLILITER $0.0115
DEXTROMETHORPHAN HBR 15 mg/5 ml LIQUID MILLILITER $0.0165
DEXTROMETHORPHAN POLISTIREX 30 mg/5 ml SUSP MILLILITER $0.0572
DEXTROSE 5% IN WATER 5% SOLN MILLILITER $0.0141
DIAZEPAM 10 mg TAB TABLET $0.0271
DIAZEPAM 2 mg TAB TABLET $0.0240
DIAZEPAM 5 mg TAB TABLET $0.0185
DIAZEPAM 5 mg/ml SYRINGE EACH $12.9251
DIAZEPAM 5 mg/ml ORAL CONC MILLILITER $0.9485
DIAZOXIDE 50 mg/ml ORAL SUSP MILLILITER $7.4355
DIBUCAINE 1% OINTMENT GRAM $0.1126
DICLOFENAC POTASSIUM 50 mg TAB TABLET $0.4435
DICLOFENAC SODIUM 0.1% DROPS MILLILITER $1.5173
DICLOFENAC SODIUM 1% GEL GRAM $0.0660
DICLOFENAC SODIUM 1.5% DROPS MILLILITER $0.1515
DICLOFENAC SODIUM 3% GEL GRAM $0.3990
DICLOFENAC SODIUM 50 mg TAB EC TABLET $0.1195
DICLOFENAC SODIUM 75 mg TAB EC TABLET $0.0985
DICLOFENAC SODIUM XR 100 mg TAB XR TABLET $0.1755
DICLOFENAC SODIUM/MISOPROSTOL 50 mg; 200 mg TAB DR TABLET $1.5500
DICLOFENAC SODIUM/MISOPROSTOL 75 mg; 200 mg TAB DR TABLET $1.5500
DICLOXACILLIN SODIUM 250 mg CAP CAPSULE $0.2990
DICLOXACILLIN SODIUM 500 mg CAP CAPSULE $0.5700
DICYCLOMINE HCL 10 mg CAP CAPSULE $0.0438
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
DICYCLOMINE HCL 20 mg TAB TABLET $0.0567
DICYCLOMINE HCL 10 mg/5 ml SOLN MILLILITER $0.2015
DIDANOSINE 125 mg CAP DR CAPSULE $1.1596
DIDANOSINE 200 mg CAP DR CAPSULE $6.4841
DIDANOSINE 250 mg CAP SA CAPSULE $4.9895
DIDANOSINE 400 mg CAP SA CAPSULE $3.1975
DIFLORASONE DIACETATE 0.05% CREAM GRAM $10.4165
DIFLORASONE DIACETATE 0.05% OINT GRAM $3.5595
DIFLUNISAL 500 mg TAB TABLET $1.0685
DIGOXIN 0.05 mg/ml SOLN MILLILITER $2.0999
DIGOXIN 0.125 mg TAB TABLET $0.1605
DIGOXIN 0.250 mg TAB TABLET $0.2895
DIHYDROERGOTAMINE MESYLATE 1 mg/ml AMPUL EACH $85.4555
DIHYDROERGOTAMINE MESYLATE 4 mg/ml SPRAY MILLILITER $119.3562
DILTIAZEM HCL 120 mg CAP ER DEG CAPSULE $0.3435
DILTIAZEM HCL 120 mg CAP ER 12HR CAPSULE $3.1996
DILTIAZEM HCL (CARDIZEM)
120 mg TAB TABLET $0.3000
DILTIAZEM HCL (CARDIZEM CD)
120 mg CAP ER 24HR CAPSULE $0.1500
DILTIAZEM HCL (TIAZAC ER)
120 mg CAP SA 24HR CAPSULE $0.2250
DILTIAZEM HCL 180 mg CAP ER DEG CAPSULE $0.4455
DILTIAZEM HCL (CARDIZEM CD)
180 mg CAP ER 24HR CAPSULE $0.2251
DILTIAZEM HCL (CARDIZEM LA)
180 mg TAB ER 24HR TABLET $1.9294
DILTIAZEM HCL (TIAZAC ER)
180 mg CAP SA 24HR CAPSULE $0.3510
DILTIAZEM HCL 240 mg CAP ER DEG CAPSULE $0.4825
DILTIAZEM HCL (CARDIZEM CD)
240 mg CAP ER 24HR CAPSULE $0.2550
DILTIAZEM HCL (CARDIZEM LA)
240 mg TAB ER 24HR TABLET $2.3400
DILTIAZEM HCL (TIAZAC ER)
240 mg CAP SA 24HR CAPSULE $0.3750
DILTIAZEM HCL (CARDIZEM)
30 mg TAB TABLET $0.1095
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
DILTIAZEM HCL (CARDIZEM CD)
300 mg CAP ER 24HR CAPSULE $0.3150
DILTIAZEM HCL (CARDIZEM LA)
300 mg TAB ER 24HR TABLET $2.6707
DILTIAZEM HCL (TIAZAC ER)
300 mg CAP SA 24HR CAPSULE $0.5685
DILTIAZEM HCL (CARDIZEM CD)
360 mg CAP ER 24HR CAPSULE $1.6550
DILTIAZEM HCL (CARDIZEM LA)
360 mg TAB ER 24HR TABLET $3.2710
DILTIAZEM HCL (TIAZAC ER)
360 mg CAP SA 24HR CAPSULE $0.5498
DILTIAZEM HCL (CARDIZEM LA)
420 mg TAB ER 24HR TABLET $3.2710
DILTIAZEM HCL (TIAZAC ER)
420 mg CAP SA 24HR CAPSULE $0.2265
DILTIAZEM HCL 5 mg/ml VIAL MILLILITER $0.2900
DILTIAZEM HCL 60 mg CAP ER 12HR CAPSULE $1.4000
DILTIAZEM HCL (CARDIZEM)
60 mg TAB TABLET $0.1699
DILTIAZEM HCL 90 mg CAP ER 12HR CAPSULE $2.3545
DILTIAZEM HCL (CARDIZEM)
90 mg TAB TABLET $0.2806
DIMENHYDRINATE 50 mg TAB TABLET $0.0532
DIMETHYL FUMARATE 120 mg-240 mg CAP DR CAPSULE $7.5200
DIMETHYL FUMARATE 120 mg CAP DR CAPSULE $8.7500
DIMETHYL FUMARATE 240 mg CAP DR CAPSULE $3.6250
DIPHENHYDRAMINE 25 mg CAP CAPSULE $0.1397
DIPHENHYDRAMINE 50 mg CAP CAPSULE $0.0235
DIPHENHYDRAMINE HCL 12.5 mg/5 ml LIQUID MILLILITER $0.0111
DIPHENHYDRAMINE HCL 25 mg TAB TABLET $0.0300
DIPHENHYDRAMINE HCL 50 mg TAB TABLET $0.0220
DIPHENHYDRAMINE HCL 50 mg/30 ml LIQUID MILLILITER $0.0125
DIPHENHYDRAMINE HCL 50 mg/ml SOLN MILLILITER $1.6555
DIPHENHYDRAMINE HCL 50 mg/ml VIAL EACH $0.6401
DIPHENHYDRAMINE HCL 6.25 mg/ml DROPS MILLILITER $1.6500
DIPHENHYDRA/PHENYLEPH/ACETAMIN 12.5-5-325 TAB TABLET $0.0745
DIPHENHYDRAMINE HCL/ZINC ACET 2%-0.1% CREAM GRAM $0.0200
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
DIPHENOXYLATE HCL; ATROPINE SULFATE 2.5 mg; 0.025 mg TAB TABLET $0.2248
DIPYRIDAMOLE 25 mg TAB TABLET $0.2555
DIPYRIDAMOLE 50 mg TAB TABLET $0.0834
DIPYRIDAMOLE 75 mg TAB TABLET $0.1200
DISOPYRAMIDE 100 mg CAP CAPSULE $0.5520
DISULFIRAM 250 mg TAB TABLET $1.2379
DISULFIRAM 500 mg TAB TABLET $3.4555
DIVALPROEX SODIUM 125 mg CAP SPRINKLE CAPSULE $0.2970
DIVALPROEX SODIUM 125 mg TAB EC TABLET $0.0355
DIVALPROEX SODIUM 250 mg TAB EC TABLET $0.0692
DIVALPROEX SODIUM 250 mg TAB ER TABLET $0.1605
DIVALPROEX SODIUM 500 mg TAB EC TABLET $0.4250
DIVALPROEX SODIUM 500 mg TAB ER TABLET $0.2455
DM/ACETAMINOPHEN/DOXYLAMINE 15 mg-325 mg CAP CAPSULE $0.1635
DM/ACETAMINOPHEN/DOXYLAMINE 15-325/15 LIQUID MILLILITER $0.1635
D-METHORPHAN HB/P-EPD HCL/BPM 10 mg; 30 mg; 2
mg/5 ml SYRINGE MILLILITER $0.1099
D-METHORPHAN/PE/ACETAMINOPHEN 10-5-325 mg CAP CAPSULE $0.1265
D-METHORPHAN/PE/ACETAMINOPHEN 20-10-500 POWDER PACKET
EACH $0.4775
D-METHORPHAN/PE/ACETAMINOPHEN 20-10-650 TAB TABLET $0.0899
D-METHORPHAN/PE/ACETAMINOPHEN 5-325 mg/15 LIQUID MILLILITER $0.0140
DOCETAXEL 20 mg/ml VIAL MILLILITER $26.5000
DOCETAXEL 80 mg/4 ml VIAL MILLILITER $21.3500
DOCETAXEL 80 mg/8 ml VIAL MILLILITER $17.6500
DOCETAXEL 20 mg/2 ml VIAL MILLILITER $17.7500
DOCETAXEL 160 mg/16 ml VIAL MILLILITER $34.7555
DOCETAXEL 160 mg/8 ml VIAL MILLILITER $20.5417
DOCOSANOL 10% CREAM GRAM $6.2035
DOCUSATE CALCIUM 240 mg CAP CAPSULE $0.0600
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
DOCUSATE SODIUM 100 mg CAP CAPSULE $0.0175
DOCUSATE SODIUM 100 mg TAB TABLET $0.0342
DOCUSATE SODIUM 150 mg/15 ml LIQ MILLILITER $0.0137
DOCUSATE SODIUM 250 mg CAP CAPSULE $0.0350
DOCUSATE SODIUM 283 mg ENEMA EACH $2.0647
DOCUSATE SODIUM 50 mg CAP CAPSULE $0.2760
DOCUSATE SODIUM 60 mg/15 ml SYRUP MILLILITER $0.0072
DOFETILIDE 125 mcg CAP CAPSULE $1.2095
DOFETILIDE 250 mcg CAP CAPSULE $1.2752
DOFETILIDE 500 mcg CAP CAPSULE $0.9800
DONEPEZIL HCL 10 mg TAB RAPDIS TABLET $0.1765
DONEPEZIL HCL 10 mg TAB TABLET $0.0458
DONEPEZIL HCL 23 mg TAB TABLET $0.6995
DONEPEZIL HCL 5 mg TAB RAPDIS TABLET $0.2100
DONEPEZIL HCL 5 mg TAB TABLET $0.0458
DORZOLAMIDE HCL 2% DROPS MILLILITER $1.2429
DOXAZOSIN MESYLATE 1 mg TAB TABLET $0.0390
DOXAZOSIN MESYLATE 2 mg TAB TABLET $0.0300
DOXAZOSIN MESYLATE 4 mg TAB TABLET $0.1355
DOXAZOSIN MESYLATE 8 mg TAB TABLET $0.1175
DOXEPIN HCL 10 mg/ml CONC MILLILITER $0.6000
DOXEPIN HCL 10 mg CAP CAPSULE $0.3145
DOXEPIN HCL 100 mg CAP CAPSULE $0.7065
DOXEPIN HCL 150 mg CAP CAPSULE $0.6425
DOXEPIN HCL 25 mg CAP CAPSULE $0.3490
DOXEPIN HCL 3 mg TAB TABLET $8.69254
DOXEPIN HCL 50 mg CAP CAPSULE $0.5055
DOXEPIN HCL 6 mg TAB TABLET $7.6000
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
DOXEPIN HCL 75 mg CAP CAPSULE $0.4153
DOXERCALCIFEROL 0.5 mcg CAP CAPSULE $9.6520
DOXERCALCIFEROL 1 mcg CAP CAPSULE $17.0100
DOXERCALCIFEROL 2.5 mcg CAP CAPSULE $19.1560
DOXERCALCIFEROL 4 mcg/2 ml VIAL MILLILITER $1.6950
DOXORUBICIN HCL 10 mg VIAL MILLILITER $29.9950
DOXORUBICIN HCL 10 mg/5 ml VIAL MILLILITER $2.2680
DOXORUBICIN HCL 2 mg/ml VIAL MILLILITER $1.6797
DOXORUBICIN HCL 20 mg/10 ml VIAL MILLILITER $1.8475
DOXORUBICIN HCL 50 mg VIAL MILLILITER $299.8550
DOXORUBICIN HCL 50 mg/25 ml VIAL MILLILITER $0.7785
DOXORUBICIN HCL PEG-LIPOSOMAL 2 mg/ml VIAL MILLILITER $78.7555
DOXYCYCLINE HYCLATE 100 mg CAP CAPSULE $0.1050
DOXYCYCLINE HYCLATE 100 mg TAB TABLET $0.0555
DOXYCYCLINE HYCLATE 100 mg TAB EC TABLET $5.3715
DOXYCYCLINE HYCLATE 150 mg TAB TABLET $10.0555
DOXYCYCLINE HYCLATE 150 mg TAB EC TABLET $8.8255
DOXYCYCLINE HYCLATE 20 mg TAB TABLET $0.1935
DOXYCYCLINE HYCLATE 200 MG TAB DR TABLET $26.4555
DOXYCYCLINE HYCLATE 50 mg CAP CAPSULE $0.2580
DOXYCYCLINE HYCLATE 50 mg TAB DR TABLET $8.0555
DOXYCYCLINE HYCLATE 75 mg TAB TABLET $19.4555
DOXYCYCLINE HYCLATE 75 mg TAB DR TABLET $6.0555
DOXYCYCLINE MONOHYDRATE 100 mg CAP CAPSULE $0.3275
DOXYCYCLINE MONOHYDRATE 100 mg TAB TABLET $0.2250
DOXYCYCLINE MONOHYDRATE 150 mg CAP CAPSULE $14.4150
DOXYCYCLINE MONOHYDRATE 150 mg TAB TABLET $5.8035
DOXYCYCLINE MONOHYDRATE 25 mg/5 ml SUSP RECON MILLILITER $0.2700
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
DOXYCYCLINE MONOHYDRATE 50 mg CAP CAPSULE $0.1215
DOXYCYCLINE MONOHYDRATE 50 mg TAB TABLET $0.2505
DOXYCYCLINE MONOHYDRATE 75 mg CAP CAPSULE $8.8800
DOXYCYCLINE MONOHYDRATE 75 mg TAB TABLET $0.5550
DOXYLAMINE/PHENYLEPHRINE HCL 7.5 mg; 10 mg TAB TABLET $0.5336
DOXYLAMINE SUCCINATE/VIT B6 10 mg; 10 mg TAB ER TABLET $4.2065
DRONABINOL 10 mg CAP CAPSULE $3.0230
DRONABINOL 2.5 mg CAP CAPSULE $0.8400
DRONABINOL 5 mg CAP CAPSULE $2.2585
DROSPIR/ETH ESTRA/LEVOMEFOL CA 3-0.03(21) TAB TABLET $2.9400
DROSPIR/ETH ESTRA/LEVOMEFOL CA 3-0.02(24) TAB TABLET $2.1555
DROXIDOPA 100 mg CAP CAPSULE $3.7866
DROXIDOPA 200 mg CAP CAPSULE $7.0341
DROXIDOPA 300 mg CAP CAPSULE $11.6514
DULOXETINE HCL 20 mg CAP CAPSULE $0.0952
DULOXETINE HCL 30 mg CAP CAPSULE $0.0780
DULOXETINE HCL 40 mg CAP DR CAPSULE $2.1000
DULOXETINE HCL 60 mg CAP DR CAPSULE $0.0900
DUTASTERIDE 0.5 mg CAP CAPSULE $0.2345
DUTASTERIDE/TAMSULOSIN HCL 0.5 mg; 0.4 mg CAP ER 24HR CAPSULE $2.2755
ECONAZOLE NITRATE 1% CREAM GRAM $0.1850
EFAVIRENZ 600 mg TAB TABLET $6.2800
EFAVIRENZ/EMTRICIT/TENOFOVIR 600 mg; 200 mg TAB TABLET $6.7586
ELETRIPTAN HBR 20 mg TAB TABLET $1.8459
ELETRIPTAN HBR 40 mg TAB TABLET $2.4845
EMTRICITABINE/TENOFOVIR (TDF) 100 mg; 150 mg TAB TABLET $30.5250
EMTRICITABINE/TENOFOVIR (TDF) 133 mg; 200 mg TAB TABLET $30.5250
EMTRICITABINE/TENOFOVIR (TDF) 167 mg; 250 mg TAB TABLET $30.5250
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
EMTRICITABINE/TENOFOVIR 200 mg; 300 mg TAB TABLET $0.7569
ENALAPRIL MALEATE/HCTZ 10 mg; 25 mg TAB TABLET $0.1890
ENALAPRIL MALEATE/HCTZ 5 mg; 12.5 mg TAB TABLET $0.1382
ENALAPRIL MALEATE 10 mg TAB TABLET $0.1745
ENALAPRIL MALEATE 2.5 mg TAB TABLET $0.1215
ENALAPRIL MALEATE 20 mg TAB TABLET $0.1965
ENALAPRIL MALEATE 5 mg TAB TABLET $0.1705
ENALAPRILAT DIHYDRATE 1.25 mg/ml VIAL MILLILITER $3.0240
ENOXAPARIN SODIUM 100 mg/ml SYRINGE MILLILITER $8.3595
ENOXAPARIN SODIUM 120 mg/0.8 ml SYRINGE MILLILITER $9.6015
ENOXAPARIN SODIUM 150 mg/ml SYRINGE MILLILITER $9.6015
ENOXAPARIN SODIUM 30 mg/0.3 ml SYRINGE MILLILITER $9.6015
ENOXAPARIN SODIUM 300 mg/3 ml VIAL MILLILITER $9.6015
ENOXAPARIN SODIUM 40 mg/0.4 ml SYRINGE MILLILITER $9.6015
ENOXAPARIN SODIUM 60 mg/0.6 ml SYRINGE MILLILITER $8.2500
ENOXAPARIN SODIUM 80 mg/0.8 ml SYRINGE MILLILITER $9.6015
ENTACAPONE 200 mg TAB TABLET $0.3945
ENTECAVIR 0.5 mg TAB TABLET $0.7575
ENTECAVIR 1 mg TAB TABLET $1.2210
EPINASTINE HCL 0.05% DROPS MILLILITER $4.3685
EPINEPHRINE 0.3 mg/0.3 AUTO-INJ EACH $141.8900
EPINEPHRINE 1 mg/ml AMPUL EACH $2.4930
EPINEPHRINE 0.1 mg/ml SYRINGE MILLILITER $0.4500
EPINEPHRINE 0.15 mg/0.3 AUTO-INJ EACH $143.7500
EPIRUBICIN HCL 200 mg/100 ml VIAL MILLILITER $1.9688
EPIRUBICIN HCL 50 mg/25 ml VIAL MILLILITER $2.1175
EPLERENONE 25 mg TAB TABLET $0.6292
EPLERENONE 50 mg TAB TABLET $0.8552
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
EPTIFIBATIDE 2 mg/ml VIAL MILLILITER $11.4255
EPTIFIBATIDE 75 mg/100 ml VIAL MILLILITER $3.5951
ERLOTINIB HCL 150 mg TAB TABLET $14.9500
ERLOTINIB HCL 100 mg TAB TABLET $13.0000
ERLOTINIB HCL 25 mg TAB TABLET $9.9500
ERGOCALCIFEROL (VITAMIN D2) 1.25 mg (50,000 unit) CAP CAPSULE $0.0990
ERGOCALCIFEROL (VITAMIN D2) 8,000 units/ml DROPS MILLILITER $0.6750
ERTAPENEM 1 gm VIAL EACH $79.8345
ERYTHROMYCIN 0.5% OPTH OINT GRAM $1.8501
ERYTHROMYCIN 2% SOLN MILLILITER $0.4189
ERYTHROMYCIN BASE 250 mg CAP DR CAPSULE $4.3800
ERYTHROMYCIN BASE 250 mg TAB TABLET $9.0744
ERYTHROMYCIN BASE 250 mg TAB DR TABLET $4.7213
ERYTHROMYCIN BASE 500 mg TAB TABLET $10.0542
ERYTHROMYCIN BASE 500 mg TAB DR TABLET $11.0351
ERYTHROMYCIN BASE/BENZOYL PEROXIDE 3%; 5% GEL GRAM $1.8995
ERYTHROMYCIN BASE/ETHANOL 2% GEL GRAM $0.8552
ERYTHROMYCIN BASE/ETHANOL 2% MED SWAB EACH $0.8950
ERYTHROMYCIN ETHYLSUCCINATE 200 mg/5 ml SUSP RECON MILLILITER $2.1465
ERYTHROMYCIN ETHYLSUCCINATE 400 mg/5 ml SUSP MILLILITER $5.5425
ESCITALOPRAM OXALATE 10 mg TAB TABLET $0.0445
ESCITALOPRAM OXALATE 20 mg TAB TABLET $0.0569
ESCITALOPRAM OXALATE 5 mg/5 ml ORAL SOLN MILLILITER $0.3525
ESCITALOPRAM OXALATE 5 mg TAB TABLET $0.0300
ESOMEPRAZOLE MAGNESIUM 20 mg CAP DR CAPSULE $0.2795
ESOMEPRAZOLE MAGNESIUM 40 mg CAP DR CAPSULE $0.1500
ESOMEPRAZOLE SODIUM 40 mg VIAL EACH $7.5500
ESTAZOLAM 1 mg TAB TABLET $0.5335
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
ESTAZOLAM 2 mg TAB TABLET $0.5365
ESTRADIOL 0.1% CREAM GRAM $1.5500
ESTRADIOL (CLIMARA)
0.1 mg PATCH EACH $12.8748
ESTRADIOL (CLIMARA)
0.025 mg PATCH EACH $12.5905
ESTRADIOL (CLIMARA)
0.0375 mg PATCH EACH $12.1015
ESTRADIOL (CLIMARA)
0.05 mg PATCH EACH $13.3472
ESTRADIOL (CLIMARA)
0.06mg PATCH EACH $10.0005
ESTRADIOL (CLIMARA)
0.075 mg PATCH EACH $12.7545
ESTRADIOL (VIVELLE-DOT)
0.1 mg/24hr PATCH EACH $6.9075
ESTRADIOL (VIVELLE-DOT)
0.025 mg/24hr PATCH EACH $7.4925
ESTRADIOL (VIVELLE-DOT)
0.0375 mg/24hr PATCH EACH $7.3495
ESTRADIOL (VIVELLE-DOT)
0.05 mg/24hr PATCH EACH $7.1141
ESTRADIOL (VIVELLE-DOT)
0.075 mg/24hr PATCH EACH $6.8999
ESTRADIOL/NORETHINDRONE ACETATE (ACTIVELLA)
0.5 mg; 0.1mg TAB TABLET $1.2270
ESTRADIOL/NORETHINDRONE ACETATE (ACTIVELLA)
1 mg; 0.5 mg TAB TABLET $1.6245
ESTRADIOL 0.5 mg TAB TABLET $0.0850
ESTRADIOL 1 mg TAB TABLET $0.0852
ESTRADIOL 10 mcg TAB TABLET $10.1655
ESTRADIOL 2 mg TAB TABLET $0.0885
ESTRADIOL VALERATE 20 mg/ml VIAL EACH $18.3415
ESZOPICLONE 1 mg TAB TABLET $0.1115
ESZOPICLONE 2 mg TAB TABLET $0.2275
ESZOPICLONE 3 mg TAB TABLET $0.1445
ETHACRYNIC ACID 25 mg TAB TABLET $3.0000
ETHAMBUTOL HCL 100 mg TAB TABLET $0.3075
ETHAMBUTOL HCL 400 mg TAB TABLET $0.5225
ETHINYL ESTRADIOL/DROSPIRENONE (YAZ)
0.02-3(24) TAB TABLET $0.4305
ETHINYL ESTRADIOL/DROSPIRENONE (YASMIN, OCELLA)
0.03-3 TAB TABLET $0.1205
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
ETHOSUXIMIDE 250 mg CAP CAPSULE $0.3900
ETHOSUXIMIDE 250 mg/5 ml SYRINGE MILLILITER $0.1150
ETHYNODIOL DIACETATE/ETHINYL ESTRADIOL (ZOVIA 1/35E)
1 mg; 35 mcg TAB TABLET $0.3375
ETHYNODIOL DIACETATE/ETHINYL ESTRADIOL (ZOVIA 1/50E)
1 mg; 50 mcg TAB TABLET $0.5000
ETODOLAC 200 mg CAP CAPSULE $0.6105
ETODOLAC 300 mg CAP CAPSULE $0.2745
ETODOLAC 400 mg TAB TABLET $0.3855
ETODOLAC 400 mg TAB ER TABLET $1.6050
ETODOLAC 500 mg TAB TABLET $0.4275
ETODOLAC 500 mg TAB ER TABLET $1.3325
ETODOLAC 600 mg TAB ER TABLET $1.8445
ETONOGESTREL/ETHINYL ESTRADIOL .12-.015 mg VAGINAL
RING EACH $95.1500
ETOPOSIDE 20 mg/ml VIAL MILLILITER $1.4500
ETOPOSIDE 50 mg CAP EACH $71.5000
EVEROLIMUS 0.25 mg TAB TABLET $7.8850
EVEROLIMUS 0.5 mg TAB TABLET $15.7460
EVEROLIMUS 0.75 mg TAB TABLET $23.6210
EVEROLIMUS 5 mg TAB TABLET $232.4590
EVEROLIMUS 2.5 mg TAB TABLET $226.9726
EVEROLIMUS 7.5 mg TAB TABLET $237.4097
EXEMESTANE 25 mg TAB TABLET $1.6248
EZETIMIBE/SIMVASTATIN 10 mg; 10 mg TAB TABLET $1.1755
EZETIMIBE/SIMVASTATIN 10 mg; 20 mg TAB TABLET $0.6544
EZETIMIBE/SIMVASTATIN 10 mg; 40 mg TAB TABLET $0.8981
EZETIMIBE/SIMVASTATIN 10 mg; 80 mg TAB TABLET $1.3525
EZETIMIBE 10 mg TAB TABLET $0.1025
FAMCICLOVIR 125 mg TAB TABLET $0.2532
FAMCICLOVIR 250 mg TAB TABLET $0.4665
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
FAMCICLOVIR 500 mg TAB TABLET $0.7125
FAMOTIDINE/CALCIUM CARBONATE/MAGNESIUM
10-800-165 TAB CHEW TABLET $0.2135
FAMOTIDINE 10 mg TAB TABLET $0.0842
FAMOTIDINE 10 mg/ml VIAL MILLILITER $0.4588
FAMOTIDINE 20 mg TAB TABLET $0.0347
FAMOTIDINE 20 mg/2 ml VIAL MILLILITER $0.4234
FAMOTIDINE 40 mg/5 ml SUSP MILLILITER $0.7995
FAMOTIDINE 40 mg TAB TABLET $0.0480
FEBUXOSTAT 40 mg TAB TABLET $0.8550
FEBUXOSTAT 80 mg TAB TABLET $0.8550
FELBAMATE 400 mg TAB TABLET $1.9535
FELBAMATE 600 mg/5 ml ORAL SUSP MILLILITER $1.3125
FELBAMATE 600 mg TAB TABLET $2.2750
FELODIPINE 10 mg TAB ER TABLET $0.1215
FELODIPINE 2.5 mg TAB ER TABLET $0.1295
FELODIPINE 5 mg TAB ER TABLET $0.2167
FENOFIBRATE, MICRONIZED 130 mg CAP CAPSULE $0.9850
FENOFIBRATE, MICRONIZED 134 mg CAP CAPSULE $0.1845
FENOFIBRATE, MICRONIZED 200 mg CAP CAPSULE $0.3540
FENOFIBRATE, MICRONIZED 43 mg CAP CAPSULE $0.8100
FENOFIBRATE, MICRONIZED 67 mg CAP CAPSULE $0.2125
FENOFIBRATE, NANOCRYSTALLIZED 145 mg TAB TABLET $0.1516
FENOFIBRATE, NANOCRYSTALLIZED 48 mg TAB TABLET $0.1785
FENOFIBRATE 120 mg TAB TABLET $14.0080
FENOFIBRATE 160 mg TAB TABLET $0.3845
FENOFIBRATE 54 mg TAB TABLET $0.0963
FENOFIBRATE 40 mg TAB TABLET $8.3050
FENOFIBRIC ACID (CHOLINE) 135 mg CAP DR CAPSULE $0.7895
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
FENOFIBRIC ACID (CHOLINE) 45 mg CAP DR CAPSULE $0.4325
FENTANYL CITRATE 1,200 mcg LOZENGE EACH $17.2550
FENTANYL CITRATE 1,600 mcg LOZENGE EACH $24.4550
FENTANYL CITRATE 200 mcg LOZENGE EACH $19.7442
FENTANYL CITRATE 400 mcg LOZENGE EACH $15.7236
FENTANYL CITRATE 600 mcg LOZENGE EACH $11.8550
FENTANYL CITRATE 800 mcg LOZENGE EACH $14.5211
FENTANYL CITRATE/PF 50 mcg/ml AMPUL EACH $0.7177
FENTANYL CITRATE/PF 50 mcg/ml VIAL EACH $0.3610
FENTANYL 100 mcg PATCH PATCH $5.7550
FENTANYL 12 mcg PATCH PATCH $6.4930
FENTANYL 25 mcg PATCH PATCH $2.2215
FENTANYL 37.5 mcg PATCH PATCH $39.9425
FENTANYL 50 mcg PATCH PATCH $3.8550
FENTANYL 62.5 mcg PATCH PATCH $48.6500
FENTANYL 75 mcg PATCH PATCH $5.7550
FENTANYL 87.5 mg PATCH PATCH $66.2500
FERROUS FUMARATE 324 (106) mg TAB TABLET $0.2972
FERROUS GLUCONATE 324 mg TAB TABLET $0.0677
FERROUS SULFATE 15 mg/ml DROPS MILLILITER $0.0530
FERROUS SULFATE 220 mg/5 ml ELIXIR MILLILITER $0.0150
FERROUS SULFATE 325 mg TAB EC TABLET $0.1650
FERROUS SULFATE 325 mg TAB TABLET $0.0150
FEXOFENADINE HCL/ PSEUDOEPHEDRINE HCL
60 mg; 20 mg TAB ER 12HR TABLET $0.6220
FEXOFENADINE HCL 180 mg TAB TABLET $0.2028
FEXOFENADINE HCL 30 mg/5 ml ORAL SUSP MILLILITER $0.0629
FEXOFENADINE HCL 60 mg TAB TABLET $0.3360
FINASTERIDE 5 mg TAB TABLET $0.0600
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
FLAVOXATE HCL 100 mg TAB TABLET $0.7245
FLECAINIDE ACETATE 100 mg TAB TABLET $0.1500
FLECAINIDE ACETATE 150 mg TAB TABLET $0.2850
FLECAINIDE ACETATE 50 mg TAB TABLET $0.0900
FLOXURIDINE 500 mg SOLN MILLILITER $115.0000
FLUCONAZOLE IN SALINE, ISO-OSMOTIC 400 mg/200 ml IV MILLILITER $0.0580
FLUCONAZOLE 10 mg/ml SUSP MILLILITER $0.3095
FLUCONAZOLE 100 mg TAB TABLET $0.2891
FLUCONAZOLE 150 mg TAB TABLET $0.6585
FLUCONAZOLE 200 mg TAB TABLET $0.6530
FLUCONAZOLE 40 mg/ml SUSP MILLILITER $0.3412
FLUCONAZOLE 50 mg TAB TABLET $0.1720
FLUCYTOSINE 250 mg CAP CAPSULE $30.7599
FLUCYTOSINE 500 mg CAP CAPSULE $33.6137
FLUDARABINE PHOSPHATE 50 mg VIAL EACH $119.0700
FLUDARABINE PHOSPHATE 50 mg/2 ml VIAL MILLILITER $156.1920
FLUDROCORTISONE ACETATE 0.1 mg TAB TABLET $0.3315
FLUMAZENIL 0.1 mg/ml VIAL MILLILITER $0.8500
FLUNISOLIDE 0.025% SPRAY MILLILITER $1.7606
FLUOCINOLONE 0.1% CREAM GRAM $1.1715
FLUOCINOLONE 0.025% CREAM GRAM $1.3425
FLUOCINOLONE 0.025% OINT GRAM $1.1115
FLUOCINOLONE 0.01%; 60 ml SOLN MILLILITER $0.7115
FLUOCINOLONE ACETONIDE OIL 0.01% DROPS MILLILITER $1.5450
FLUOCINONIDE 0.1% CREAM GRAM $1.1650
FLUOCINONIDE 0.05% CREAM GRAM $0.6995
FLUOCINONIDE 0.05% GEL GRAM $0.9397
FLUOCINONIDE 0.05% OINT GRAM $0.3600
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
FLUOCINONIDE 0.05% SOLN MILLILITER $0.5374
FLUOCINONIDE ACETONIDE 0.01% OIL MILLILITER $0.1995
FLUOCINONIDE ACETONIDE SCALP OIL 0.01% OIL MILLILITER $0.3249
FLUOCINONIDE/EMOLLIENT 0.05% CREAM GRAM $0.7375
FLUORIDE (SODIUM) 1.1% GEL GRAM $0.0822
FLUOROMETHOLONE 0.1% DROPS MILLILITER $12.6900
FLUOROURACIL 5% CREAM GRAM $1.7917
FLUOROURACIL 5% SOLN MILLILITER $4.8115
FLUOROURACIL 50 mg/ml; 10 ml VIAL MILLILITER $0.2015
FLUOROURACIL 50 mg/ml; 20 ml SOLN MILLILITER $0.2325
FLUOROURACIL 50 mg/ml; 50 ml VIAL MILLILITER $0.3911
FLUOROURACIL 50 mg/ml; 100 ml VIAL MILLILITER $0.1445
FLUOXETINE HCL 10 mg CAP CAPSULE $0.0389
FLUOXETINE HCL 10 mg TAB TABLET $0.0389
FLUOXETINE HCL 20 mg CAP CAPSULE $0.0263
FLUOXETINE HCL 20 mg TAB TABLET $0.0263
FLUOXETINE HCL 20 mg/5 ml SYRINGE SYRUP $0.0450
FLUOXETINE HCL 40 mg CAP CAPSULE $0.0450
FLUOXETINE HCL 60 mg TAB TABLET $1.1250
FLUOXETINE HCL 90 mg CAP DR CAPSULE $25.74000
FLUPHENAZINE 1 mg TAB TABLET $2.2500
FLUPHENAZINE 10 mg TAB TABLET $5.9500
FLUPHENAZINE 2.5 mg TAB TABLET $2.9500
FLUPHENAZINE 25 mg/ml INJ MILLILITER $12.2500
FLUPHENAZINE 5 mg TAB TABLET $0.1920
FLURAZEPAM HCL 15 mg CAP CAPSULE $0.4302
FLURAZEPAM HCL 30 mg CAP CAPSULE $0.5186
FLURBIPROFEN 100 mg TAB TABLET $0.3300
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
FLURBIPROFEN SODIUM 0.03% OPTH SOLN MILLILITER $1.1580
FLUTAMIDE 125 mg CAP CAPSULE $0.4305
FLUTICASONE PROPIONATE 0.005% OINT GRAM $0.3015
FLUTICASONE PROPIONATE 0.05% CREAM GRAM $0.2295
FLUTICASONE PROPIONATE 0.05% LOTION GRAM $3.1550
FLUTICASONE PROPIONATE 50 mcg NASAL SPRAY GRAM $0.2375
FLUTICASONE PROPIONATE 50 mcg NASAL SPRAY
OTC GRAM $0.4928
FLUTICASONE PROPIONATE/SALMETEROL 100-50 mcg BLISTER W/ INH
DEVICE EACH $2.0950
FLUTICASONE PROPIONATE/SALMETEROL 250-50 mcg BLISTER W/ INH
DEVICE EACH $2.5755
FLUTICASONE PROPIONATE/SALMETEROL 500-50 mcg BLISTER W/ INH
DEVICE EACH $2.6597
FLUVASTATIN 80 mg TAB ER 24HR TABLET $5.2137
FLUVASTATIN SODIUM 20 mg CAP CAPSULE $2.5550
FLUVASTATIN SODIUM 40 mg CAP CAPSULE $2.5550
FLUVOXAMINE 100 mg TAB TABLET $0.2791
FLUVOXAMINE 25 mg TAB TABLET $0.1200
FLUVOXAMINE 50 mg TAB TABLET $0.1992
FLUVOXAMINE MALEATE 100 mg CAP ER 24HR CAPSULE $3.9925
FLUVOXAMINE MALEATE 150 mg CAP ER 24HR CAPSULE $4.4115
FOLIC ACID/VITAMIN B COMP W-C 1 mg CAP CAPSULE $0.1350
FOLIC ACID 0.4 mg TAB TABLET $0.0110
FOLIC ACID 0.8 mg TAB TABLET $0.0110
FOLIC ACID 1 mg TAB TABLET $0.0110
FOMEPIZOLE 1 G/ml VIAL MILLILITER $551.9500
FONDAPARINUX SODIUM 10 mg/0.8 ml SYRINGE MILLILITER $51.6490
FONDAPARINUX SODIUM 2.5 mg/0.5 ml SYRINGE MILLILITER $28.9044
FONDAPARINUX SODIUM 5 mg/0.4 ml SYRINGE MILLILITER $122.8500
FONDAPARINUX SODIUM 7.5 mg/0.6 ml SYRINGE MILLILITER $64.0595
FORMOTEROL FUMARATE 20 mcg/2 ml SOLN MILLILITER $7.8596
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
FOSAMPRENAVIR 700 mg TAB TABLET $12.6245
FOSAPREPITANT DIMEGLUMINE 150 mg VIAL EACH $144.5255
FOSINOPRIL SODIUM/HCTZ 10 mg; 12.5 mg TAB TABLET $0.4275
FOSINOPRIL SODIUM/HCTZ 20 mg; 12.5 mg TAB TABLET $0.6521
FOSINOPRIL SODIUM 10 mg TAB TABLET $0.1193
FOSINOPRIL SODIUM 20 mg TAB TABLET $0.1237
FOSINOPRIL SODIUM 40 mg TAB TABLET $0.2097
FOSPHENYTOIN SODIUM 100 mg PE/2 VIAL MILLILITER $0.8675
FOSPHENYTOIN SODIUM 500 mg PE/10 VIAL MILLILITER $0.6000
FROVATRIPTAN SUCCINATE 2.5 mg TAB TABLET $11.4025
FULVESTRANT 250 mg/5 ml SOLN MILLILITER $115.8500
FUROSEMIDE 10 mg/ml SOLN MILLILITER $0.5152
FUROSEMIDE 10 mg/ml VIAL MILLILITER $0.8000
FUROSEMIDE 20 mg TAB TABLET $0.0136
FUROSEMIDE 40 mg TAB TABLET $0.0120
FUROSEMIDE 80 mg TAB TABLET $0.0340
GABAPENTIN 100 mg CAP CAPSULE $0.0295
GABAPENTIN (NEURONTIN SOLUTION)
250 mg/5 ml SOLN MILLILITER $0.1055
GABAPENTIN 250 mg/5 ml SOLN MILLILITER $0.3250
GABAPENTIN 300 mg/6 ml SOLN MILLILITER $0.3333
GABAPENTIN 300 mg CAP CAPSULE $0.0473
GABAPENTIN 400 mg CAP CAPSULE $0.0632
GABAPENTIN 600 mg TAB TABLET $0.0570
GABAPENTIN 800 mg TAB TABLET $0.1298
GALANTAMINE HYDROBROMIDE 12 mg TAB TABLET $0.5005
GALANTAMINE HYDROBROMIDE 16 mg CAP ER CAPSULE $0.9568
GALANTAMINE HYDROBROMIDE 24 mg CAP ER CAPSULE $0.9568
GALANTAMINE HYDROBROMIDE 4 mg TAB TABLET $0.4805
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
GALANTAMINE HYDROBROMIDE 8 mg CAP ER CAPSULE $1.1950
GALANTAMINE HYDROBROMIDE 8 mg TAB TABLET $0.4645
GATIFLOXACIN 0.5% DROPS MILLILITER $13.9972
GEMCITABINE HCL 1 gm VIAL EACH $45.5360
GEMCITABINE HCL 1 gm/26.3 ml VIAL MILLILITER $0.9000
GEMCITABINE HCL 2 gm VIAL EACH $135.1356
GEMCITABINE HCL 2 gm/52.6 ml VIAL MILLILITER $1.0550
GEMCITABINE HCL 200 mg VIAL EACH $7.5355
GEMCITABINE HCL 200 mg/5.26 ml VIAL MILLILITER $1.3250
GEMFIBROZIL 600 mg TAB TABLET $0.1062
GENTAMICIN SULFATE 0.1% CREAM GRAM $1.6775
GENTAMICIN SULFATE 0.1% OINT GRAM $1.3900
GENTAMICIN SULFATE 0.3% DROPS MILLILITER $0.5000
GENTAMICIN SULFATE 0.3% OINT GRAM $3.5571
GENTAMICIN SULFATE 0.3% OPTH SOLN MILLILITER $0.7165
GENTAMICIN SULFATE 40 mg/ml VIAL MILLILITER $0.4800
GLATIRAMER ACETATE 20 mg/ml SYRINGE MILLILITER $44.7555
GLATIRAMER ACETATE 40 mg/ml SYRINGE EACH $127.0000
GLIMEPIRIDE 1 mg TAB TABLET $0.0150
GLIMEPIRIDE 2 mg TAB TABLET $0.0255
GLIMEPIRIDE 4 mg TAB TABLET $0.0150
GLIPIZIDE/METFORMIN HCL 2.5 mg; 250 mg TAB TABLET $0.4500
GLIPIZIDE/METFORMIN HCL 2.5 mg; 500 mg TAB TABLET $0.1620
GLIPIZIDE/METFORMIN HCL 5 mg; 500 mg TAB TABLET $0.1575
GLIPIZIDE 10 mg TAB SA TABLET $0.1850
GLIPIZIDE 10 mg TAB TABLET $0.0300
GLIPIZIDE 2.5 mg TAB SA TABLET $0.1275
GLIPIZIDE 5 mg TAB SA TABLET $0.1355
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
GLIPIZIDE 5 mg TAB TABLET $0.0314
GLYBURIDE, MICRONIZED 1.5 mg TAB TABLET $0.0345
GLYBURIDE, MICRONIZED 3 mg TAB TABLET $0.0323
GLYBURIDE, MICRONIZED 6 mg TAB TABLET $0.0660
GLYBURIDE/METFORMIN HCL 1.25 mg; 250 mg TAB TABLET $0.0450
GLYBURIDE/METFORMIN HCL 2.5 mg; 250 mg TAB TABLET $0.2490
GLYBURIDE/METFORMIN HCL 2.5 mg; 500 mg TAB TABLET $0.0506
GLYBURIDE/METFORMIN HCL 5 mg; 500 mg TAB TABLET $0.0256
GLYBURIDE 1.25 mg TAB TABLET $0.0450
GLYBURIDE 2.5 mg TAB TABLET $0.0336
GLYBURIDE 5 mg TAB TABLET $0.0550
GLYCERIN Adult SUPP EACH $0.4228
GLYCERIN Pediatric SUPP EACH $0.0668
GLYCERIN 99.5% LIQUID MILLILITER $0.0265
GLYCOPYRROLATE 0.2 mg/ml VIAL MILLILITER $1.9850
GLYCOPYRROLATE 1 mg TAB TABLET $0.1200
GLYCOPYRROLATE 2 mg TAB TABLET $0.3651
GRANISETRON HCL 1 mg TAB TABLET $1.8900
GRANISETRON HCL 1 mg/ml; MDV VIAL MILLILITER $8.2032
GRANISETRON HCL 1 mg/ml; SDV VIAL MILLILITER $6.6000
GRISEOFULVIN MICROSIZE 125 mg/5 ml SUSP MILLILITER $0.1835
GRISEOFULVIN MICROSIZE 500 mg TAB TABLET $6.4130
GRISEOFULVIN ULTRAMICROSIZE 125 mg TAB TABLET $2.6000
GRISEOFULVIN ULTRAMICROSIZE 250 mg TAB TABLET $2.9445
GUAIFEN/DEXTROMETHORPHAN/PE 5-2.5 mg/5 LIQUID MILLILITER $0.0355
GUAIFEN/DEXTROMETHORPHAN/PE 18-10 mg/15 LIQUID MILLILITER $0.0980
GUAIFEN/DEXTROMETHORPHAN/PE 385-17.5 mg TAB TABLET $0.6278
GUAIFEN/PHENYLEPH/ACETAMINOPHN 200-5-325 TAB TABLET $0.6205
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
GUAIFENESIN 100 mg/5 ml SOLN MILLILITER $0.0072
GUAIFENESIN 1200 mg TAB ER TABLET $0.4800
GUAIFENESIN 200 mg TAB TABLET $0.0395
GUAIFENESIN 400 mg TAB TABLET $0.0890
GUAIFENESIN 600 mg TAB ER TABLET $0.3125
GUAIFENESIN; CODEINE PHOSPHATE (SUGAR FREE)
100 mg; 10 mg LIQUID MILLILITER $0.0317
GUAIFENESIN/DEXTROMETHORPHAN 1,200-60 mg TAB ER TABLET $0.6205
GUAIFENESIN/DEXTROMETHORPHAN HBR 100 mg; 5 mg/5 ml LIQUID MILLILITER $0.0200
GUAIFENESIN/DEXTROMETHORPHAN HBR 100 mg; 10 mg LIQUID MILLILITER $0.0175
GUAIFENESIN/DEXTROMETHORPHAN HBR 100 mg; 10 mg/5 ml SYRINGE MILLILITER $0.0085
GUAIFENESIN/DEXTROMETHORPHAN HBR 200 mg; 10 mg/5 ml LIQUID MILLILITER $0.0226
GUAIFENESIN/DEXTROMETHORPHAN HBR 400 mg; 20 mg TAB TABLET $0.0899
GUAIFENESIN/ DEXTROMETHORPHAN HBR/ PHENYLEPHRINE
100-10-5 mg LIQUID MILLILITER $0.0353
GUAIFENESIN/PHENYLEPHRINE HCL 400 mg; 10 mg TAB TABLET $0.1014
GUAIFENESIN/PSEUDOEPHEDRINE HCL 600 mg; 60 mg TAB ER 12HR TABLET $0.4200
GUAIFENESIN/PSEUDOEPHEDRINE HCL/ CODEINE
100 mg; 30 mg; 10 mg SYRINGE MILLILITER $0.1680
GUANFACINE 1 mg TAB TABLET $0.4035
GUANFACINE 1 mg TAB ER TABLET $0.1665
GUANFACINE 2 mg TAB TABLET $0.6755
GUANFACINE 2 mg TAB ER TABLET $0.2250
GUANFACINE 3 mg TAB ER TABLET $0.2400
GUANFACINE 4 mg TAB ER TABLET $0.1995
HALOBETASOL PROPIONATE 0.05% CREAM GRAM $0.9215
HALOBETASOL PROPIONATE 0.05% OINT GRAM $1.2050
HALOPERIDOL LACTATE 2 mg/ml; 120 ml CONC MILLILITER $0.2500
HALOPERIDOL 0.5 mg TAB TABLET $0.1975
HALOPERIDOL 1 mg TAB TABLET $0.3189
HALOPERIDOL 10 mg TAB TABLET $0.4359
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
HALOPERIDOL 2 mg TAB TABLET $0.3792
HALOPERIDOL 20 mg TAB TABLET $0.9825
HALOPERIDOL 5 mg TAB TABLET $0.3425
HALOPERIDOL DECANOATE 100 mg/ml VIAL MILLILITER $31.9800
HALOPERIDOL DECANOATE 50 mg/ml VIAL MILLILITER $8.5410
HALOPERIDOL LACTATE 5 mg/ml VIAL MILLILITER $0.8275
HC ACETATE/LIDOCAINE HCL 0.5%; 3% CREAM GRAM $0.8252
HEPARIN SODIUM, PORCINE 10,000/ml VIAL EACH $1.8925
HEPARIN SODIUM, PORCINE 20,000/ml VIAL EACH $6.9420
HEPARIN SODIUM, PORCINE 5,000/ml VIAL EACH $1.0779
HEPARIN SODIUM, PORCINE 1,000/ml SOLN MILLILITER $0.1650
HYDRALAZINE HCL 10 mg TAB TABLET $0.0448
HYDRALAZINE HCL 100 mg TAB TABLET $0.0900
HYDRALAZINE HCL 20 mg/ml VIAL MILLILITER $3.7500
HYDRALAZINE HCL 25 mg TAB TABLET $0.0300
HYDRALAZINE HCL 50 mg TAB TABLET $0.0545
HYDROCHLOROTHIAZIDE 12.5 mg CAP CAPSULE $0.0374
HYDROCHLOROTHIAZIDE 12.5 mg TAB TABLET $0.0375
HYDROCHLOROTHIAZIDE 25 mg TAB TABLET $0.0096
HYDROCHLOROTHIAZIDE 50 mg TAB TABLET $0.0177
HYDROCODONE/ACETAMINOPHEN 2.5-108/5 SOLN MILLILITER $0.6175
HYDROCODONE/ACETAMINOPHEN 5 mg; 300 mg TAB TABLET $0.1945
HYDROCODONE/ACETAMINOPHEN 5-217 mg/10 SOLN MILLILITER $0.3185
HYDROCODONE/ACETAMINOPHEN 7.5 mg; 300 mg TAB TABLET $0.6575
HYDROCODONE/ACETAMINOPHEN 7.5-325/15 SOLN MILLILITER $0.2175
HYDROCODONE BIT/ACETAMINOPHEN 10 mg; 300 mg TAB TABLET $0.5585
HYDROCODONE BIT/ACETAMINOPHEN 7.5 mg; 325 mg/15 ml SOLN MILLILITER $0.0845
HYDROCODONE BIT/HOMATROPINE 5 mg; 1.5 mg/5 ml SYRINGE MILLILITER $0.1080
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
HYDROCODONE BITARTRATE/ HOMATROPINE METHYLBROMIDE
5 mg; 1.5 mg TAB TABLET $0.7125
HYDROCODONE POLISTRX/ CHLORPHENIRAMINE POLISTIREX
10-8 mg/5 ml SUSP MILLILITER $0.2915
HYDROCODONE/APAP 10 mg; 325 mg TAB TABLET $0.0845
HYDROCODONE/APAP 5 mg; 325 mg TAB TABLET $0.0455
HYDROCODONE/APAP 7.5 mg; 325 mg TAB TABLET $0.0695
HYDROCODONE/CMP/PSEUDOEPHED 5; 4; 60 mg/5 ORAL SOLN MILLILITER $0.5729
HYDROCODONE/IBUPROFEN 10 mg; 200 mg TAB TABLET $2.0663
HYDROCODONE/IBUPROFEN 5 mg; 200 mg TAB TABLET $2.6500
HYDROCODONE/IBUPROFEN 7.5 mg; 200 mg TAB TABLET $0.2500
HYDROCORTISONE 0.5% CREAM GRAM $0.0980
HYDROCORTISONE 0.5% OINT GRAM $0.1100
HYDROCORTISONE 1% CREAM GRAM $0.0395
HYDROCORTISONE 1% CREAM/APPL GRAM $0.6500
HYDROCORTISONE 1% LOTION MILLILITER $0.0662
HYDROCORTISONE 1% OINT GRAM $0.0765
HYDROCORTISONE 100 mg/60 ml ENEMA MILLILITER $0.0743
HYDROCORTISONE 2.5% CREAM/APPL GRAM $0.4550
HYDROCORTISONE 2.5% CREAM GRAM $0.1100
HYDROCORTISONE 2.5% LOTION MILLILITER $0.1450
HYDROCORTISONE 2.5% OINT GRAM $0.0865
HYDROCORTISONE 10 mg TAB TABLET $0.1680
HYDROCORTISONE 20 mg TAB TABLET $0.3350
HYDROCORTISONE 5 mg TAB TABLET $0.1128
HYDROCORTISONE/ALOE 1% CREAM GRAM $0.0565
HYDROCORTISONE ACETATE 0.5% CREAM GRAM $0.0670
HYDROCORTISONE ACETATE 1% CREAM GRAM $0.0536
HYDROCORTISONE BUTYRATE 1% LOTION MILLILITER $6.4925
HYDROCORTISONE BUTYRATE 0.1% CREAM GRAM $1.4045
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
HYDROCORTISONE BUTYRATE 0.1%; 15 gm OINT GRAM $1.2224
HYDROCORTISONE BUTYRATE 0.1%; 20 ml SOLN MILLILITER $1.2224
HYDROCORTISONE/PRAMOXINE 1%-1% CREAM/APPL GRAM $1.2605
HYDROCORTISONE/PRAMOXINE 2.5%-1% CREAM/APPL GRAM $4.7875
HYDROCORTISONE BUTYRATE/EMOLLIENT 0.1% CREAM GRAM $2.9350
HYDROCORTISONE VALERATE 0.2% CREAM GRAM $0.8875
HYDROCORTISONE VALERATE 0.2% OINT GRAM $2.8215
HYDROMORPHONE HCL 1 mg/ml LIQUID MILLILITER $0.2455
HYDROMORPHONE HCL 2 mg TAB TABLET $0.0806
HYDROMORPHONE HCL 4 mg TAB TABLET $0.1173
HYDROMORPHONE HCL 8 mg TAB TABLET $0.2715
HYDROMORPHONE HCL 12 mg TAB ER 24HR TABLET $8.8455
HYDROMORPHONE HCL 16 mg TAB ER 24HR TABLET $7.7075
HYDROMORPHONE HCL 32 mg TAB ER 24HR TABLET $28.3550
HYDROMORPHONE HCL 8 mg TAB ER 24HR TABLET $6.4855
HYDROXOCOBALAMIN 1,000 mcg/ml VIAL EACH $1.0369
HYDROXYCHLOROQUINE SULFATE 200 mg TAB TABLET $0.2615
HYDROXYPROGESTERONE CAPROATE/PF 250 mg/ml VIAL MILLILITER $285.0000
HYDROXYPROGESTERONE CAPROATE 1.25 gm/5 ml VIAL MILLILITER $236.8500
HYDROXYPROGESTERONE CAPROATE 1,250 mg/5 ml VIAL MILLILITER $352.4425
HYDROXYUREA 500 mg CAP CAPSULE $0.2165
HYDROXYZINE 10 mg/5 ml SYRINGE MILLILITER $0.0269
HYDROXYZINE HCL 10 mg TAB TABLET $0.0375
HYDROXYZINE HCL 25 mg TAB TABLET $0.0445
HYDROXYZINE HCL 50 mg TAB TABLET $0.0765
HYDROXYZINE PAMOATE 100 mg CAP CAPSULE $0.4315
HYDROXYZINE PAMOATE 25 mg CAP CAPSULE $0.0695
HYDROXYZINE PAMOATE 50 mg CAP CAPSULE $0.0750
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
IBANDRONATE SODIUM 150 mg TAB TABLET $5.6025
IBANDRONATE SODIUM 3 mg/3 ml SYRINGE MILLILITER $41.1525
IBUPROFEN/DIPHENHYDRAMINE CIT 200 mg; 38 mg TAB TABLET $0.1195
IBUPROFEN/OXYCODONE HCL 400 mg; 5 mg TAB TABLET $1.5462
IBUPROFEN/PSEUDOEPHEDRINE HCL 200 mg; 30 mg TAB TABLET $0.1539
IBUPROFEN 100 mg/5 ml ORAL SUSP MILLILITER $0.0299
IBUPROFEN 100 mg TAB CHEW TABLET $0.1318
IBUPROFEN 200 mg CAP CAPSULE $0.0993
IBUPROFEN 200 mg TAB TABLET $0.0392
IBUPROFEN 400 mg TAB TABLET $0.0535
IBUPROFEN 50 mg/1.25 ml SUSP MILLILITER $0.2435
IBUPROFEN 600 mg TAB TABLET $0.0445
IBUPROFEN 800 mg TAB TABLET $0.0500
ICATIBANT 30 mg/3 ml SOLN MILLILITER $1145.75
ICOSAPENT ETHYL 1 gm CAP CAPSULE $2.4598
IDARUBICIN HCL 1 mg/ml VIAL MILLILITER $19.4670
IFOSFAMIDE 1 gm VIAL EACH $26.1820
IFOSFAMIDE 3 gm VIAL EACH $150.2790
IFOSFAMIDE 1 gm/20 ml SOLN MILLILITER $3.6500
IFOSFAMIDE 3 gm/60 ml SOLN MILLILITER $2.4500
IMATINIB MESYLATE 100 mg TAB TABLET $1.6125
IMATINIB MESYLATE 400 mg TAB TABLET $3.3930
IMIPENEM/CILASTATIN SODIUM 250 mg VIAL EACH $5.9063
IMIPENEM/CILASTATIN SODIUM 500 mg VIAL EACH $10.5000
IMIPRAMINE HCL 10 mg TAB TABLET $0.1140
IMIPRAMINE HCL 25 mg TAB TABLET $0.0905
IMIPRAMINE HCL 50 mg TAB TABLET $0.1230
IMIPRAMINE PAMOATE 100 mg CAP CAPSULE $3.5805
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
IMIPRAMINE PAMOATE 125 mg CAP CAPSULE $8.2500
IMIPRAMINE PAMOATE 150 mg CAP CAPSULE $6.4800
IMIPRAMINE PAMOATE 75 mg CAP CAPSULE $3.7765
IMIQUIMOD 5% CREAM GRAM $0.9363
INDAPAMIDE 1.25 mg TAB TABLET $0.1050
INDAPAMIDE 2.5 mg TAB TABLET $0.1193
INDOMETHACIN 25 mg CAP CAPSULE $0.0459
INDOMETHACIN 50 mg CAP CAPSULE $0.0542
INDOMETHACIN SR 75 mg CAP, SR CAPSULE $0.4415
INSULIN SYRINGE (NDC 11917-0048-15)
0.3 ml; 31 g x 5/16” SYRINGE EACH $0.1900
INSULIN SYRINGE (NDC 11917-0025-29)
1 ml SYRINGE EACH $0.1900
INSULIN SYRINGE (NDC 11917-0048-13)
1 ml; 31 g x 5/16” SYRINGE EACH $0.1900
INSULIN SYRINGE (NDC 11917-0025-28)
1/2 ml SYRINGE EACH $0.1900
INSULIN SYRINGE (NDC 11917-0025-27)
3/10 ml SYRINGE EACH $0.1900
IODINE/SODIUM IODIDE 2% TINCTURE MILLILITER $0.0678
IPRATROPIUM BROMIDE 0.02% INH SOLN MILLILITER $0.0425
IPRATROPIUM BROMIDE 0.03% NASAL INH
SOLN MILLILITER $0.7795
IPRATROPIUM BROMIDE 0.06% NASAL INH
SOLN MILLILITER $1.3708
IPRATROPIUM/ALBUTEROL SULFATE 0.5 mg; 2.5 mg/3 ml SOLN MILLILITER $0.0589
IRBESARTAN/HYDROCHLOROTHIAZIDE 150 mg; 12.5 mg TAB TABLET $0.0960
IRBESARTAN/HYDROCHLOROTHIAZIDE 300 mg; 12.5 mg TAB TABLET $0.2964
IRBESARTAN 150 mg TAB TABLET $0.1223
IRBESARTAN 300 mg TAB TABLET $0.1923
IRBESARTAN 75 mg TAB TABLET $0.0835
IRINOTECAN HCL 100 mg/5 ml VIAL MILLILITER $3.6405
IRINOTECAN HCL 40 mg/2 ml VIAL MILLILITER $6.4793
IRON CARB, GL/FA/B12/C/DOCUSATE (FOCALGIN DSS)
90-1-50 mg TAB TABLET $1.9865
IRON FM,PS NO.1/FOLIC/MV NO.18 (PUREVIT DUALFE PLUS, SE-TAN PLUS)
106 mg; 1 mg CAP CAPSULE $0.3895
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
IRON POLYSACCHARIDES COMPLEX 150 mg CAP CAPSULE $0.1120
IRON PS COMPLEX/B12/FOLIC ACID 150-25-1 CAP CAPSULE $0.1616
ISONIAZID 300 mg TAB TABLET $0.1215
ISOPROTERENOL HCL 0.2 mg/ml VIAL MILLILITER $44.6875
ISOSORBIDE DINITRATE 10 mg TAB TABLET $0.2615
ISOSORBIDE DINITRATE 20 mg TAB TABLET $0.3435
ISOSORBIDE DINITRATE 30 mg TAB TABLET $0.6270
ISOSORBIDE DINITRATE 5 mg TAB TABLET $0.3300
ISOSORBIDE MONONITRATE 10 mg TAB TABLET $0.1920
ISOSORBIDE MONONITRATE 120 mg TAB ER TABLET $0.4200
ISOSORBIDE MONONITRATE 20 mg TAB TABLET $0.1560
ISOSORBIDE MONONITRATE 30 mg TAB ER TABLET $0.0675
ISOSORBIDE MONONITRATE 60 mg TAB ER TABLET $0.1050
ISOTRETINOIN 10 mg CAP CAPSULE $2.2952
ISOTRETINOIN 20 mg CAP CAPSULE $2.4958
ISOTRETINOIN 25 mg CAP CAPSULE $28.9420
ISOTRETINOIN 30 mg CAP CAPSULE $3.0350
ISOTRETINOIN 35 mg CAP CAPSULE $28.9420
ISOTRETINOIN 40 mg CAP CAPSULE $2.7958
ISRADIPINE 2.5 mg CAP CAPSULE $0.7675
ISRADIPINE 5 mg CAP CAPSULE $1.2625
ITRACONAZOLE 100 mg CAP CAPSULE $0.9078
ITRACONAZOLE 10 mg/ml SOLN MILLILITER $1.7850
IVERMECTIN 3 mg TAB TABLET $3.9125
KETOCONAZOLE 2% SHAMPOO MILLILITER $0.0590
KETOCONAZOLE 2% CREAM GRAM $0.3975
KETOCONAZOLE 200 mg TAB TABLET $1.2460
KETOPROFEN 200 mg CAP SR 24HR TABLET $6.6720
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
KETOPROFEN 50 mg CAP CAPSULE $0.3840
KETOPROFEN 75 mg CAP CAPSULE $0.4560
KETOROLAC TROMETHAMINE 0.4% DROPS MILLILITER $6.5885
KETOROLAC TROMETHAMINE 0.5% DROPS MILLILITER $1.4649
KETOROLAC TROMETHAMINE 10 mg TAB TABLET $0.7385
KETOROLAC TROMETHAMINE 15 mg/ml VIAL MILLILITER $1.7904
KETOROLAC TROMETHAMINE 30 mg/ml SOLN MILLILITER $1.0789
KETOROLAC TROMETHAMINE 30 mg/ml SYRINGE MILLILITER $3.8000
KETOROLAC TROMETHAMINE 60 mg/2 ml VIAL MILLILITER $1.0365
KETOTIFEN FUMARATE 0.025% DROPS MILLILITER $1.0885
LABETALOL HCL 100 mg TAB TABLET $0.0900
LABETALOL HCL 200 mg TAB TABLET $0.1385
LABETALOL HCL 300 mg TAB TABLET $0.2342
LACTULOSE 10 gm/15 ml SOLN MILLILITER $0.0150
LACTULOSE 10 gm/15 ml SOLN MILLILITER $0.0150
LACTULOSE 10 gm/15 ml SOLN MILLILITER $0.0675
LACTULOSE 20 gm/30 ml SOLN MILLILITER $0.0288
LAMIVUDINE 10 mg/ml SOLN MILLILITER $0.2645
LAMIVUDINE 100 mg TAB TABLET $2.3555
LAMIVUDINE 150 mg TAB TABLET $0.2389
LAMIVUDINE 300 mg TAB TABLET $1.0375
LAMIVUDINE/ZIDOVUDINE 150 mg; 300 mg TAB TABLET $0.6985
LAMOTRIGINE 100 mg TAB TABLET $0.0525
LAMOTRIGINE 100 mg TAB ER 24HR TABLET $1.3635
LAMOTRIGINE 100 mg TAB ODT TABLET $5.1325
LAMOTRIGINE 150 mg TAB TABLET $0.0645
LAMOTRIGINE 200 mg TAB TABLET $0.0755
LAMOTRIGINE 200 mg TAB ER 24HR TABLET $1.9023
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
LAMOTRIGINE 200 mg TAB ODT TABLET $6.3132
LAMOTRIGINE 250 mg TAB ER 24HR TABLET $4.9995
LAMOTRIGINE 25 mg TAB CHEW TABLET $0.1775
LAMOTRIGINE 25 mg TAB TABLET $0.0320
LAMOTRIGINE 25 mg TAB ER 24HR TABLET $1.3795
LAMOTRIGINE 25 mg TAB ODT TABLET $4.4155
LAMOTRIGINE 25 mg (35) TAB TABLET $6.4150
LAMOTRIGINE 300 mg TAB ER 24HR TABLET $2.2250
LAMOTRIGINE 5 mg TAB CHEW TABLET $0.1525
LAMOTRIGINE 50 mg TAB ER 24HR TABLET $1.5232
LAMOTRIGINE 50 mg TAB ODT TABLET $3.8505
LANSOPRAZOLE 15 mg CAP DR CAPSULE $0.2215
LANSOPRAZOLE 15 mg TAB DR TABLET $5.1445
LANSOPRAZOLE 30 mg CAP DR CAPSULE $0.0655
LANSOPRAZOLE 30 mg TAB ODT TABLET $5.7045
LANSOPRAZOLE/AMOXICILLIN/ CLARITHROMYCIN
30-500-500 EACH COMBINATION
PACKAGE $2.5725
LANTHANUM CARBONATE 1,000 mg TAB CHEW TABLET $7.9500
LATANOPROST 0.005% DROPS MILLILITER $1.8288
LEFLUNOMIDE 10 mg TAB TABLET $0.7650
LEFLUNOMIDE 20 mg TAB TABLET $1.0175
LETROZOLE 2.5 mg TAB TABLET $0.1155
LEUCOVORIN CALCIUM 100 mg VIAL EACH $1.1735
LEUCOVORIN CALCIUM 10 mg TAB TABLET $5.4972
LEUCOVORIN CALCIUM 15 mg TAB TABLET $4.9585
LEUCOVORIN CALCIUM 25 mg TAB TABLET $5.6675
LEUCOVORIN CALCIUM 200 mg VIAL EACH $14.7000
LEUCOVORIN CALCIUM 350 mg VIAL EACH $14.9265
LEUCOVORIN CALCIUM 5 mg TAB TABLET $0.6000
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
LEUCOVORIN CALCIUM 50 mg VIAL EACH $6.0960
LEUCOVORIN CALCIUM 500 mg VIAL EACH $94.8950
LEUPROLIDE ACETATE 1 mg/0.2 ml KIT EACH $148.2500
LEVALBUTEROL HCL 0.31 mg/3 ml VIAL MILLILITER $0.3035
LEVALBUTEROL HCL 0.63 mg/3 ml VIAL MILLILITER $0.2115
LEVALBUTEROL HCL 1.25 mg/0.5 ml VIAL EACH $3.3595
LEVALBUTEROL HCL 1.25 mg/3 ml VIAL MILLILITER $0.2030
LEVETIRACETAM 100 mg/ml SOLN MILLILITER $0.0375
LEVETIRACETAM 1,000 mg TAB TABLET $0.2189
LEVETIRACETAM 250 mg TAB TABLET $0.0775
LEVETIRACETAM 500 mg/5 ml VIAL MILLILITER $1.3126
LEVETIRACETAM 500 mg/5 ml SOLN MILLILITER $0.0352
LEVETIRACETAM 500 mg TAB ER 24HR TABLET $0.2225
LEVETIRACETAM 500 mg TAB TABLET $0.0901
LEVETIRACETAM 750 mg TAB ER 24HR TABLET $0.4956
LEVETIRACETAM 750 mg TAB TABLET $0.1485
LEVOBUNOLOL HCL 0.5% OPTH SOLN MILLILITER $0.4717
LEVOCARNITINE 100 mg/ml LIQUID MILLILITER $0.2409
LEVOCARNITINE 200 mg/ml VIAL MILLILITER $2.6712
LEVOCETIRIZINE DIHYDROCHLORIDE 2.5 mg/5 ml SOLN MILLILITER $0.2375
LEVOCETIRIZINE DIHYDROCHLORIDE 5 mg TAB TABLET $0.0605
LEVOFLOXACIN 0.5% DROPS MILLILITER $6.3035
LEVOFLOXACIN 250 mg/10 ml ORAL SOLN MILLILITER $0.9510
LEVOFLOXACIN 250 mg TAB TABLET $0.1265
LEVOFLOXACIN 25 mg/ml VIAL MILLILITER $1.4000
LEVOFLOXACIN 500 mg TAB TABLET $0.1500
LEVOFLOXACIN 750 mg TAB TABLET $0.3055
LEVOFLOXACIN IN DEXTROSE 5% 250 mg/50 ml SOLN MILLILITER $0.0559
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
LEVOFLOXACIN IN DEXTROSE 5% 500 mg/100 ml SOLN MILLILITER $0.0275
LEVOFLOXACIN IN DEXTROSE 5% 750 mg/150 ml SOLN MILLILITER $0.0230
LEVOLEUCOVORIN 50 mg VIAL EACH $104.6320
LEVOLEUCOVORIN CALCIUM 10 mg/ml SOLN MILLILITER $6.5500
LEVONORGESTREL 1.5 mg TAB TABLET $10.3075
LEVONORGESTREL-ETH ESTRA (AMETHYST)
90 mcg; 20 mcg TAB TABLET $0.7155
LEVONORGESTREL/ETHINYL ESTRADIOL
(SEASONALE, JOLESSA, QUASENSE) 0.15 mg; 30 mcg TAB TABLET $0.1175
LEVONORGESTREL-ETH ESTRA/ETHINYL ESTRADIOL
100-20(84) TAB DOSE
PACK TABLET $0.3699
LEVONORGESTREL-ETH ESTRA/ETHINYL ESTRADIOL
150-30 (84) TAB, DOSE
PACK, 3 MONTHS
TABLET $0.3564
LEVORPHANOL 2 mg TAB TABLET $44.2500
LEVOTHYROXINE 100 mcg TAB TABLET $0.2250
LEVOTHYROXINE 100 mcg VIAL EACH $99.1940
LEVOTHYROXINE 112 mcg TAB TABLET $0.2515
LEVOTHYROXINE 125 mcg TAB TABLET $0.2425
LEVOTHYROXINE 137 mcg TAB TABLET $0.2315
LEVOTHYROXINE 150 mcg TAB TABLET $0.1515
LEVOTHYROXINE 175 mcg TAB TABLET $0.3335
LEVOTHYROXINE 200 mcg TAB TABLET $0.2800
LEVOTHYROXINE 25 mcg TAB TABLET $0.1765
LEVOTHYROXINE 300 mcg TAB TABLET $0.2500
LEVOTHYROXINE 50 mcg TAB TABLET $0.2099
LEVOTHYROXINE 75 mcg TAB TABLET $0.2505
LEVOTHYROXINE 88 mcg TAB TABLET $0.2759
LIDOCAINE 2% GEL GRAM $0.3008
LIDOCAINE 3% CREAM GRAM $0.6785
LIDOCAINE 4% CREAM GRAM $0.7235
LIDOCAINE 4% PATCH EACH $1.0500
LIDOCAINE 5% CREAM GRAM $0.4265
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
LIDOCAINE 5% OINT GRAM $0.2955
LIDOCAINE 5% PATCH EACH $2.2595
LIDOCAINE HCL 10 mg/ml VIAL EACH $0.0717
LIDOCAINE HCL 2% GEL MILLILITER $0.4700
LIDOCAINE HCL 2% VISCOUS ORAL MILLILITER $0.0260
LIDOCAINE HCL 4% CREAM GRAM $0.7235
LIDOCAINE HCL 4% SOLN MILLILITER $0.4800
LIDOCAINE HCL/PF 10 mg/ml VIAL MILLILITER $0.0820
LIDOCAINE/HYDROCORTISONE AC 3%-5% CREAM GRAM $1.1365
LIDOCAINE/PRILOCAINE 2.5-2.5% CREAM GRAM $0.2055
LINEZOLID 100 mg/5 ml SUSP RECON MILLILITER $2.7050
LINEZOLID 600 mg/300 ml IV MILLILITER $0.1350
LINEZOLID 600 mg TAB TABLET $2.0550
LIOTHYRONINE SODIUM 25 mcg TAB TABLET $0.5125
LIOTHYRONINE SODIUM 5 mcg TAB TABLET $0.4000
LIOTHYRONINE SODIUM 50 mcg TAB TABLET $0.8325
LISINOPRIL/HCTZ 10 mg; 12.5 mg TAB TABLET $0.0296
LISINOPRIL/HCTZ 20 mg; 12.5 mg TAB TABLET $0.0330
LISINOPRIL/HCTZ 20 mg; 25 mg TAB TABLET $0.0389
LISINOPRIL 10 mg TAB TABLET $0.0180
LISINOPRIL 2.5 mg TAB TABLET $0.0141
LISINOPRIL 20 mg TAB TABLET $0.0220
LISINOPRIL 30 mg TAB TABLET $0.0450
LISINOPRIL 40 mg TAB TABLET $0.0435
LISINOPRIL 5 mg TAB TABLET $0.0155
LITHIUM CARBONATE 150 mg CAP CAPSULE $0.0552
LITHIUM CARBONATE 300 mg CAP CAPSULE $0.0360
LITHIUM CARBONATE 300 mg TAB TABLET $0.1666
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
LITHIUM CARBONATE 300 mg TAB ER TABLET $0.1355
LITHIUM CARBONATE 450 mg TAB,SA TABLET $0.1955
LITHIUM CARBONATE 600 mg CAP CAPSULE $0.1080
LITHIUM CITRATE 8 mEq/5 ml SYRINGE MILLILITER $0.2273
L-NORGEST/E. ESTRADIOL-E. ESTRAD (FAYOSIM)
0.15 mg(84) TBDSPK 3MO TABLET $2.4075
LOPERAMIDE HCL 1 mg/4 ml LIQUID MILLILITER $0.0362
LOPERAMIDE HCL 1 mg/7.5 ml LIQUID MILLILITER $0.0248
LOPERAMIDE HCL 2 mg CAP CAPSULE $0.1185
LOPERAMIDE HCL 2 mg TAB TABLET $0.1030
LOPINAVIR-RITONAVIR 400-100/5 SOLN MILLILITER $2.5300
LORATADINE 10 mg TAB ODT TABLET $0.2645
LORATADINE 10 mg TAB TABLET $0.0465
LORATADINE 5 mg/5 ml SYRINGE MILLILITER $0.0368
LORATADINE-PSEUDOEPHEDRINE 5 mg; 120 mg TAB ER TABLET $0.7955
LORAZEPAM 0.5 mg TAB TABLET $0.0240
LORAZEPAM 1 mg TAB TABLET $0.0274
LORAZEPAM 2 mg/ml CONC MILLILITER $0.6010
LORAZEPAM 2 mg/ml VIAL MILLILITER $0.6575
LORAZEPAM 2 mg TAB TABLET $0.0450
LOSARTAN POTASSIUM 100 mg TAB TABLET $0.0462
LOSARTAN POTASSIUM 25 mg TAB TABLET $0.0385
LOSARTAN POTASSIUM 50 mg TAB TABLET $0.0355
LOSARTAN POTASSIUM-HCTZ 100 mg; 12.5 mg TAB TABLET $0.1310
LOSARTAN POTASSIUM-HCTZ 100 mg; 25 mg TAB TABLET $0.0775
LOSARTAN POTASSIUM-HCTZ 50 mg; 12.5 mg TAB TABLET $0.0750
LOTEPREDNOL ETABONATE 0.5% DROPS MILLILITER $31.5850
LOTEPREDNOL ETABONATE 0.5% DROPS, GEL GRAM $33.4180
LOVASTATIN 10 mg TAB TABLET $0.0325
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
LOVASTATIN 20 mg TAB TABLET $0.0400
LOVASTATIN 40 mg TAB TABLET $0.0420
LOXAPINE SUCCINATE 10 mg CAP CAPSULE $0.4100
LOXAPINE SUCCINATE 25 mg CAP CAPSULE $0.6476
LOXAPINE SUCCINATE 5 mg CAP CAPSULE $0.2465
LOXAPINE SUCCINATE 50 mg CAP CAPSULE $0.8115
MAGNESIUM 250 mg TAB TABLET $0.0249
MAG CARB/ALUMINUM HYDROX/ALGIN 358-95/15 LIQUID MILLILITER $0.0127
MAGNESIUM CARB/ALUMINUM HYDROX 105-106 mg TAB CHEW TABLET $0.0300
MAGNESIUM CITRTATE N/A SOLN MILLILITER $0.0050
MAGNESIUM HYDROXIDE 400 mg/5 ml ORAL SUSP MILLILITER $0.0059
MAG HYDROX/ALUMINUM HYD/SIMETH 200-200-20 ORAL SUSP MILLILITER $0.0074
MAG HYDROX/ALUMINUM HYD/SIMETH 200-200-25 ORAL SUSP MILLILITER $0.0247
MAG HYDROX/ALUMINUM HYD/SIMETH 400-400-40 ORAL SUSP MILLILITER $0.0080
MAGNESIUM SULFATE 495 mg/5 gm GRANULES GRAM $0.0170
MALATHION 0.5% LOT MILLILITER $3.5915
MECLIZINE HCL 12.5 mg TAB TABLET $0.0720
MECLIZINE HCL 25 mg TAB TABLET $0.1275
MECLIZINE HCL 25 mg TAB CHEW TABLET $0.0175
MEDROXYPROGESTERONE ACETATE 150 mg/ml SYRINGE EACH $35.6800
MEDROXYPROGESTERONE ACETATE 150 mg/ml VIAL MILLILITER $24.3230
MEDROXYPROGESTERONE ACETATE 10 mg TAB TABLET $0.1680
MEDROXYPROGESTERONE ACETATE 2.5 mg TAB TABLET $0.1360
MEDROXYPROGESTERONE ACETATE 5 mg TAB TABLET $0.1560
MEFENAMIC ACID 250 mg CAP CAPSULE $1.7265
MEFLOQUINE HCL 250 mg TAB TABLET $3.3525
MEGESTROL ACETATE 20 mg TAB TABLET $0.1250
MEGESTROL ACETATE 40 mg/ml SUSP MILLILITER $0.0981
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
MEGESTROL ACETATE 40 mg TAB TABLET $0.2076
MEGESTROL ACETATE 400 mg/10 ml SUSP MILLILITER $0.3760
MEGESTROL ACETATE 625 mg/5 ml SUSP MILLILITER $1.6350
MELOXICAM 15 mg TAB TABLET $0.0195
MELOXICAM 7.5 mg TAB TABLET $0.0195
MELOXICAM, SUBMICRONIZED 5 mg CAP CAPSULE $24.5900
MELOXICAM, SUBMICRONIZED 10 mg CAP CAPSULE $24.5900
MELPHALAN 50 mg VIAL EACH $260.0000
MEMANTINE HCL 10 mg TAB TABLET $0.0895
MEMANTINE HCL 2 mg/ml SOLN MILLILITER $1.2000
MEMANTINE HCL 5 mg TAB TABLET $0.1265
MEMANTINE HCL 7 mg CAP ER CAPSULE $1.9975
MEMANTINE HCL 14 mg CAP ER CAPSULE $1.3125
MEMANTINE HCL 21 mg CAP ER CAPSULE $1.5556
MEMANTINE HCL 28 mg CAP ER CAPSULE $1.3125
MENTHOL/CAMPHOR 0.5%-0.5% LOTION MILLILITER $0.0266
MEPERIDINE HCL 100 mg TAB TABLET $1.0250
MEPERIDINE HCL 50 mg TAB TABLET $0.5175
MEPROBAMATE 400 mg TAB TABLET $2.9699
MERCAPTOPURINE 50 mg TAB TABLET $0.7189
MEROPENEM 1 gm VIAL EACH $10.9200
MEROPENEM 500 mg VIAL EACH $6.1688
MESALAMINE 0.375 g CAP ER CAPSULE $2.3460
MESALAMINE 1.2 gm TAB DR TABLET $2.9575
MESALAMINE 1,000 mg SUPP EACH $4.5405
MESALAMINE 4 gm/60 ml ENEMA MILLILITER $0.1317
MESALAMINE 4 gm/60 ml ENEMA KIT EACH $130.5365
MESALAMINE 400 mg CAP DR CAPSULE $1.8365
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
MESALAMINE 800 mg TAB DR EC TABLET $4.9645
MESNA 100 mg/ml VIAL MILLILITER $1.1000
METAXALONE 800 mg TAB TABLET $0.5055
METFORMIN HCL (FORTAMET ER)
1,000 mg TAB ER 24HR TABLET $1.1430
METFORMIN HCL (GLUMETZA ER)
1,000 mg TAB ER 24HR TABLET $7.1185
METFORMIN HCL (FORTAMET ER)
500 mg TAB ER 24HR TABLET $1.1290
METFORMIN HCL (GLUCOPHAGE XR)
500 mg TAB ER 24HR TABLET $0.0285
METFORMIN HCL (GLUMETZA ER)
500 mg TAB ER 24HR TABLET $4.3695
METFORMIN HCL 750 mg TAB ER 24HR TABLET $0.0675
METFORMIN 1,000 mg TAB TABLET $0.0237
METFORMIN 500 mg TAB TABLET $0.0188
METFORMIN 850 mg TAB TABLET $0.0404
METH/MEBLUE/SOD PHOS/PSAL/HYSO 81-0.12 mg TAB TABLET $6.1822
METHADONE HCL 10 mg/ml CONC MILLILITER $0.0494
METHADONE HCL 10 mg/5 ml SOLN MILLILITER $0.4825
METHADONE HCL 10 mg TAB TABLET $0.1324
METHADONE HCL 5 mg TAB TABLET $0.1275
METHADONE HCL 5 mg/5 ml SOLN MILLILITER $0.2412
METHAMPHETAMINE HCL 5 mg TAB TABLET $3.5985
METHAZOLAMIDE 25 mg TAB TABLET $3.1095
METHAZOLAMIDE 50 mg TAB TABLET $3.5890
METHENAMINE HIPPURATE 1 gm TAB TABLET $1.0925
METHENAMINE MD 1 gm TAB TABLET $0.9000
METHENAMINE MD 500 mg TAB TABLET $0.6300
METHIMAZOLE 10 mg TAB TABLET $0.0750
METHIMAZOLE 5 mg TAB TABLET $0.0555
METHOCARBAMOL 100 mg/ml VIAL MILLILITER $2.2087
METHOCARBAMOL 500 mg TAB TABLET $0.0575
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
METHOCARBAMOL 750 mg TAB TABLET $0.0755
METHOTREXATE SODIUM 25 mg/ml VIAL MILLILITER $1.8840
METHOTREXATE SODIUM/PF 1 G VIAL EACH $62.4950
METHOTREXATE SODIUM/PF 25 mg/ml VIAL MILLILITER $1.4160
METHOTREXATE 2.5 mg TAB TABLET $0.5325
METHOXSALEN 10 mg CAP CAPSULE $46.3555
METHSCOPOLAMINE BROMIDE 2.5 mg TAB TABLET $0.7815
METHSCOPOLAMINE BROMIDE 5 mg TAB TABLET $1.5055
METHYLCELLULOSE 500 mg TAB TABLET $0.0545
METHYLDOPA 250 mg TAB TABLET $0.0615
METHYLDOPA 500 mg TAB TABLET $0.1005
METHYLERGONOVINE MALEATE 0.2 mg TAB TABLET $29.4645
METHYLERGONOVINE MALEATE 0.2 mg/ml SOLN MILLILITER $13.2800
METHYLERGONOVINE MALEATE 16 mg TAB TABLET $2.0550
METHYLPHENIDATE HCL (APTENSIO XR)
10 mg CAP ER CAPSULE $6.0450
METHYLPHENIDATE HCL (METADATE CD)
10 mg CAP ER CAPSULE $1.5174
METHYLPHENIDATE HCL (RITALIN LA)
10 mg CAP CAPSULE $2.8425
METHYLPHENIDATE HCL (RITALIN)
10 mg TAB TABLET $0.1325
METHYLPHENIDATE HCL 10 mg TAB CHEW TABLET $3.1500
METHYLPHENIDATE HCL 10 mg TAB ER TABLET $0.6479
METHYLPHENIDATE HCL (METHYLIN)
10 mg/5 ml SOLN ORAL MILLILITER $0.1470
METHYLPHENIDATE HCL (APTENSIO XR)
15 mg CAP ER CAPSULE $6.0450
METHYLPHENIDATE HCL (CONCERTA ER)
18 mg TAB ER 24HR TABLET $2.6500
METHYLPHENIDATE HCL (APTENSIO XR)
20 mg CAP ER CAPSULE $6.0450
METHYLPHENIDATE HCL (RITALIN ER)
20 mg CAP ER CAPSULE $2.5135
METHYLPHENIDATE HCL (RITALIN LA)
20 mg CAP ER CAPSULE $2.0255
METHYLPHENIDATE HCL (METADATE CD)
20 mg CAP ER CAPSULE $1.4335
METHYLPHENIDATE HCL (RITALIN)
20 mg TAB TABLET $0.2695
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
METHYLPHENIDATE HCL (METADATE ER)
20 mg TAB ER TABLET $0.7385
METHYLPHENIDATE HCL 2.5 mg TAB CHEW TABLET $1.8500
METHYLPHENIDATE HCL (CONCERTA ER)
27 mg TAB ER TABLET $2.9395
METHYLPHENIDATE HCL (APTENSIO XR)
30 mg CAP ER CAPSULE $6.0450
METHYLPHENIDATE HCL (METADATE CD)
30 mg CAP ER CAPSULE $1.4860
METHYLPHENIDATE HCL (RITALIN LA)
30 mg CAP ER CAPSULE $3.2395
METHYLPHENIDATE HCL (CONCERTA ER)
36 mg TAB ER 24HR TABLET $2.9500
METHYLPHENIDATE HCL (APTENSIO XR)
40 mg CAP ER CAPSULE $6.0450
METHYLPHENIDATE HCL (METADATE CD)
40 mg CAP ER CAPSULE $2.4264
METHYLPHENIDATE HCL (RITALIN LA)
40 mg CAP ER CAPSULE $1.1887
METHYLPHENIDATE HCL (RITALIN)
5 mg TAB TABLET $0.1215
METHYLPHENIDATE HCL 5 mg TAB CHEW TABLET $2.7000
METHYLPHENIDATE HCL (METHYLIN)
5 mg/5 ml SOLN ORAL MILLILITER $0.1035
METHYLPHENIDATE HCL (APTENSIO XR)
50 mg CAP ER CAPSULE $6.0450
METHYLPHENIDATE HCL (METADATE CD)
50 mg CAP ER CAPSULE $3.3245
METHYLPHENIDATE HCL (CONCERTA ER)
54 mg TAB ER 24HR TABLET $2.9500
METHYLPHENIDATE HCL (APTENSIO XR)
60 mg CAP ER CAPSULE $6.0450
METHYLPHENIDATE HCL (METADATE CD)
60 mg CAP ER CAPSULE $2.4179
METHYLPHENIDATE HCL (RITALIN LA)
60 mg CAP ER CAPSULE $7.4245
METHYLPHENIDATE HCL (RELEXXII ER)
72 mg TAB ER TABLET $7.5000
METHYLPREDNISOLONE 16 mg TAB TABLET $2.0550
METHYLPREDNISOLONE 32 mg TAB TABLET $2.9875
METHYLPREDNISOLONE 4 mg TAB TABLET $0.2175
METHYLPREDNISOLONE 8 mg TAB TABLET $1.2150
METHYLPREDNISOLONE ACETATE 40 mg/ml VIAL MILLILITER $5.7000
METHYLPREDNISOLONE ACETATE 80 mg/ml VIAL MILLILITER $6.8400
METHYLPREDNISOLONE DOSEPAK 4 mg TAB TABLET $0.1650
METHYLPREDNISOLONE SOD SUCC 1,000 mg VIAL EACH $24.1000
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
METHYLPREDNISOLONE SOD SUCC 125 mg VIAL EACH $9.1500
METHYLPREDNISOLONE SOD SUCC 40 mg VIAL EACH $3.9500
METHYLTESTOSTERONE 10 mg CAP CAPSULE $68.7350
METOCLOPRAMIDE HCL 10 mg TAB TABLET $0.0300
METOCLOPRAMIDE HCL 10 mg/10 ml SOLN MILLILITER $0.3199
METOCLOPRAMIDE HCL 5 mg/5 ml SYRINGE MILLILITER $0.0150
METOCLOPRAMIDE HCL 5 mg/ml VIAL EACH $0.5022
METOCLOPRAMIDE HCL 5 mg TAB TABLET $0.0342
METOLAZONE 10 mg TAB TABLET $0.9024
METOLAZONE 2.5 mg TAB TABLET $1.0285
METOLAZONE 5 mg TAB TABLET $0.6475
METOPROLOL-HCTZ 100 mg; 25 mg TAB TABLET $1.2132
METOPROLOL-HCTZ 100 mg; 50 mg TAB TABLET $1.4500
METOPROLOL-HCTZ 50 mg; 25 mg TAB TABLET $0.7679
METOPROLOL SUCCINATE 25 mg TAB SA TABLET $0.1245
METOPROLOL SUCCINATE 100 mg TAB SA TABLET $0.1835
METOPROLOL SUCCINATE 200 mg TAB SA TABLET $0.3775
METOPROLOL SUCCINATE 50 mg TAB ER TABLET $0.1100
METOPROLOL TARTRATE 100 mg TAB TABLET $0.0300
METOPROLOL TARTRATE 25 mg TAB TABLET $0.0168
METOPROLOL TARTRATE 37.5 mg TAB TABLET $0.0655
METOPROLOL TARTRATE 50 mg TAB TABLET $0.0240
METOPROLOL TARTRATE 75 mg TAB TABLET $0.2025
METRONIDAZOLE 0.75% CREAM GRAM $0.8723
METRONIDAZOLE 0.75% GEL GRAM $0.5865
METRONIDAZOLE 0.75% LOTION MILLILITER $2.1215
METRONIDAZOLE 0.75% VAG GEL GRAM $0.7375
METRONIDAZOLE 1% GEL GRAM $1.0905
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
METRONIDAZOLE 1% GEL PUMP GRAM $1.6275
METRONIDAZOLE 250 mg TAB TABLET $0.1935
METRONIDAZOLE 375 mg CAP CAPSULE $3.8850
METRONIDAZOLE 500 mg TAB TABLET $0.1229
MEXILETINE HCL 200 mg CAP CAPSULE $0.7470
MICAFUNGIN SODIUM 50 mg SOLUTION EACH $91.6300
MICAFUNGIN SODIUM 100 mg SOLUTION EACH $183.2600
MICONAZOLE NITRATE 100 mg VAG SUPP EACH $0.7396
MICONAZOLE NITRATE 1,200-2% EACH CREAM $13.0100
MICONAZOLE NITRATE 2% AER POWDER GRAM $0.0302
MICONAZOLE NITRATE 2% CREAM GRAM $0.1200
MICONAZOLE NITRATE 2% POWDER GRAM $0.0807
MICONAZOLE NITRATE 2% VAG CREAM GRAM $0.1050
MICONAZOLE NITRATE 200 mg-2% KIT EACH $7.5955
MICONAZOLE NITRATE 200 mg VAG SUPP EACH $11.2415
MIDAZOLAM HCL 2 mg/ml SYRUP MILLILITER $0.6205
MIDODRINE HCL 10 mg TAB TABLET $0.4030
MIDODRINE HCL 2.5 mg TAB TABLET $0.3275
MIDODRINE HCL 5 mg TAB TABLET $0.2820
MIGLITOL 25 mg TAB TABLET $2.0400
MIGLITOL 50 mg TAB TABLET $2.2502
MIGLITOL 100 mg TAB TABLET $2.6553
MIGLUSTAT 100 mg CAP CAPSULE $260.8700
MILRINONE LACTATE 1 mg/ml VIAL MILLILITER $0.2955
MILRINONE LACTATE/D5W 20 mg/100 ml IV MILLILITER $0.1596
MILRINONE LACTATE/D5W 40 mg/200 ml IV MILLILITER $0.1675
MINERAL OIL/PETRALATUM, WHITE 15%-83% OINT GRAM $0.6855
MINERAL OIL N/A OIL MILLILITER $0.0120
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
MINOCYCLINE HCL 100 mg CAP CAPSULE $0.3300
MINOCYCLINE HCL 100 mg TAB TABLET $1.8725
MINOCYCLINE HCL 105 mg TAB ER TABLET $4.8335
MINOCYCLINE HCL 115 mg TAB ER TABLET $6.6455
MINOCYCLINE HCL 135 mg TAB SR 24HR TABLET $3.7850
MINOCYCLINE HCL 45 mg TAB SR 24HR TABLET $3.7850
MINOCYCLINE HCL 50 mg CAP CAPSULE $0.1919
MINOCYCLINE HCL 50 mg TAB TABLET $0.9599
MINOCYCLINE HCL 55 mg TAB ER TABLET $20.4805
MINOCYCLINE HCL 65 mg TAB ER TABLET $6.6445
MINOCYCLINE HCL 75 mg CAP CAPSULE $0.4200
MINOCYCLINE HCL 75 mg TAB TABLET $1.8500
MINOCYCLINE HCL 80 mg TAB ER TABLET $3.4255
MINOCYCLINE HCL 90 mg TAB SR 24HR TABLET $5.9832
MINOXIDIL 10 mg TAB TABLET $0.1600
MINOXIDIL 2.5 mg TAB TABLET $0.0955
MIRTAZAPINE SOLTAB 15 mg TAB TABLET $0.5645
MIRTAZAPINE SOLTAB 30 mg TAB TABLET $0.6535
MIRTAZAPINE SOLTAB 45 mg TAB TABLET $0.7325
MIRTAZAPINE 15 mg TAB TABLET $0.0795
MIRTAZAPINE 30 mg TAB TABLET $0.1040
MIRTAZAPINE 45 mg TAB TABLET $0.1146
MIRTAZAPINE 7.5 mg TAB TABLET $0.7445
MISOPROSTOL 100 mcg TAB TABLET $0.4188
MISOPROSTOL 200 mcg TAB TABLET $0.7078
MITOMYCIN 20 mg VIAL EACH $139.2800
MITOMYCIN 40 mg VIAL EACH $262.5120
MITOMYCIN 5 mg VIAL EACH $102.5000
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
MITOXANTRONE HCL 2 mg/ml VIAL MILLILITER $25.4965
MODAFINIL 100 mg TAB TABLET $0.4365
MODAFINIL 200 mg TAB TABLET $0.4025
MOEXIPRIL HCL 7.5 mg TAB TABLET $0.6400
MOMETASONE FUROATE 50 mcg AER GRAM $1.8075
MOMETASONE FUROATE 0.1% CREAM GRAM $0.3050
MOMETASONE FUROATE 0.1% OINT GRAM $0.2025
MOMETASONE FUROATE 0.1% SOLN MILLILITER $0.2620
MONTELUKAST SODIUM 10 mg TAB TABLET $0.0565
MONTELUKAST SODIUM 4 mg PACKET EACH $0.8740
MONTELUKAST SODIUM 4 mg TAB CHEW TABLET $0.0675
MONTELUKAST SODIUM 5 mg TAB CHEW TABLET $0.0825
MORPHINE SULFATE 10 mg/5 ml SOLN MILLILITER $0.0863
MORPHINE SULFATE 10 mg CAP ER CAPSULE $2.2455
MORPHINE SULFATE 100 mg CAP ER CAPSULE $10.2955
MORPHINE SULFATE 100 mg TAB SR TABLET $1.0060
MORPHINE SULFATE 120 mg CAP ER 24HR CAPSULE $18.8204
MORPHINE SULFATE 15 mg TAB SR TABLET $0.2000
MORPHINE SULFATE 15 mg TAB TABLET $0.2475
MORPHINE SULFATE 20 mg CAP ER CAPSULE $2.5665
MORPHINE SULFATE 20 mg/ml SOLN MILLILITER $0.2365
MORPHINE SULFATE 20 mg/5 ml SOLN MILLILITER $0.1005
MORPHINE SULFATE 200 mg TAB ER TABLET $2.1439
MORPHINE SULFATE 30 mg CAP ER CAPSULE $1.8550
MORPHINE SULFATE 30 mg TAB SR TABLET $0.2425
MORPHINE SULFATE 30 mg TAB TABLET $0.3275
MORPHINE SULFATE 50 mg CAP ER CAPSULE $3.4345
MORPHINE SULFATE 60 mg CAP ER CAPSULE $4.4635
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
MORPHINE SULFATE 60 mg TAB SR TABLET $0.5683
MORPHINE SULFATE 80 mg CAP ER CAPSULE $10.6495
MOXIFLOXACIN HCL 0.5% DROPS MILLILITER $5.5545
MOXIFLOXACIN HCL 400 mg TAB TABLET $1.5475
MULTIVITAMIN N/A TAB CHEW TABLET $0.0240
MULTIVITAMIN TABLET N/A TAB TABLET $0.0251
MULTIVITAMIN WITH FOLIC ACID 400 mcg TAB TABLET $0.0367
MULTIVITAMIN WITH IRON N/A TAB TABLET $0.0291
MULTIVITAMIN WITH IRON N/A TAB CHEW TABLET $0.0342
MULTIVITAMIN WITH IRON, HEMATINIC N/A TAB TABLET $0.0312
MULTIVITAMIN WITH IRON-MINERALS N/A TAB TABLET $0.0767
MULTIVITAMIN WITH MINERALS N/A TAB TABLET $0.0568
MULTIVITAMIN WITH MINERALS/LUTEIN N/A TAB TABLET $0.0665
MULTIVITAMIN/CALCIUM/MULTINERAL/ FOLIC ACID/LUTEIN
18-500-300 mg CAP CAPLET $0.0389
MULTIVITAMIN/IRON SULFATE/FOLIC ACID 15 mg-0.4 mg TAB TABLET $0.0184
MULTIVITAMIN/IRON/FOLIC ACID 18 mg; 0.4 mg TAB TABLET $0.0472
MULTIVITAMIN/MULTIMINERAL/FOLIC ACID/ LYCOPEN/LUTEIN
0.4-300-250 TAB TABLET $0.0716
MULTIVITAMIN/MULTIMINERAL/LUTEIN/ HERBAL COMPLEX NO. 178
200-175 mcg TAB TABLET $0.0925
MULTIVITAMIN, THERAPEUTIC WITH IRON AND MINERALS
N/A TAB TABLET $0.0510
MUPIROCIN 2% CREAM GRAM $6.6134
MUPIROCIN 2% OINT GRAM $0.1720
MYCOPHENOLATE MOFETIL 200 mg/ml SUSP RECON MILLILITER $4.3750
MYCOPHENOLATE MOFETIL 250 mg CAP CAPSULE $0.1455
MYCOPHENOLATE MOFETIL 500 mg TAB TABLET $0.1855
MYCOPHENOLATE SODIUM 180 mg TAB DR TABLET $0.6000
MYCOPHENOLATE SODIUM 360 mg TAB DR TABLET $1.5940
NABUMETONE 500 mg TAB TABLET $0.1358
NABUMETONE 750 mg TAB TABLET $0.1800
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
NADOLOL 20 mg TAB TABLET $0.4620
NADOLOL 40 mg TAB TABLET $0.4750
NADOLOL 80 mg TAB TABLET $0.4960
NAFCILLIN SODIUM 1 gm VIAL EACH $8.0555
NAFCILLIN SODIUM 10 gm VIAL EACH $49.2555
NAFCILLIN SODIUM 2 gm VIAL EACH $8.5555
NAFTIFINE HCL 2% CREAM GRAM $4.4860
NALOXONE HCL 0.4 mg/ml VIAL MILLILITER $5.8000
NALOXONE HCL 2 mg/2 ml SYRINGE MILLILITER $16.2938
NALTREXONE HCL 50 mg TAB TABLET $0.5965
NAPHAZOLINE HCL/GLYCERIN 0.012-0.2% DROPS MILLILITER $0.1275
NAPROXEN EC 375 mg TAB DR TABLET $0.1335
NAPROXEN EC 500 mg TAB DR TABLET $0.1913
NAPROXEN SODIUM 220 mg CAP CAPSULE $0.1375
NAPROXEN SODIUM 220 mg TAB TABLET $0.0600
NAPROXEN SODIUM 275 mg TAB TABLET $0.2865
NAPROXEN SODIUM 375 mg TAB ER 24HR TABLET $7.5550
NAPROXEN SODIUM 550 mg TAB TABLET $0.3975
NAPROXEN SODIUM/PSEUDOEPHEDRIN 220-120 mg TAB TABLET $0.2515
NAPROXEN 125 mg/5 ml SUSPENSION MILLILITER $1.7425
NAPROXEN 250 mg TAB TABLET $0.0488
NAPROXEN 375 mg TAB TABLET $0.0604
NAPROXEN 500 mg TAB TABLET $0.0610
NARATRIPTAN HCL 1 mg TAB TABLET $1.0200
NARATRIPTAN HCL 2.5 mg TAB TABLET $1.2250
NATEGLINIDE 120 mg TAB TABLET $0.4685
NATEGLINIDE 60 mg TAB TABLET $0.2035
NEOMYCIN SULFATE 500 mg TAB TABLET $0.6300
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
NEOMYCIN SULFATE/ BACITRACIN/POLYMYXIN
3.5 mg/400 units/5,000 units per gm
OINT GRAM $0.1095
NEOMYCIN SULFATE/ BACITRACIN/POLYMYXIN B
3.5 mg-400 OINT GRAM $7.1205
NEOMYCIN/BACIT/P-MYX/HYDROCORT 3.5-10K-1 OPTH OINT GRAM $3.3750
NEOMYCIN/BACITRC/POLYMYX/PRAMOX 3.5-10K-10 OPTH OINT GRAM $0.1325
NEOMYCIN/POLYMYXIN B 40-200 k/ml AMPUL EACH $8.1250
NEOMYCIN/POLYMYXIN B/HC 0.1% OTIC SOLN MILLILITER $2.4585
NEOMYCIN/POLYMYXIN B/HC 3.5 mg; 10,000 units; 10
mg per ml OTIC SUSP MILLILITER $5.1593
NEOMYCIN/POLYMYXIN B/ DEXAMETHASONE
0.1% OINT GRAM $3.2025
NEOMYCIN/POLYMYXIN B/ DEXAMETHASONE
3.5 mg/10,000 units/0.1% per ml
OPTH SUSP MILLILITER $2.6695
NEOMYCIN SULFATE/POLYMYXIN B SULFATE/GRAMICIDIN D
1.27 mg-10k DROPS MILLILITER $3.7550
NEVIRAPINE 100 mg TAB ER TABLET $5.2655
NEVIRAPINE 200 mg TAB TABLET $0.1025
NEVIRAPINE 400 mg TAB ER 24HR TABLET $1.6965
NIACIN 1,000 mg TAB ER 24HR TABLET $0.4920
NIACIN 500 mg CAP ER CAPSULE $0.0615
NIACIN 500 mg TAB ER 24HR TABLET $0.4748
NIACIN 500 mg TAB TABLET $0.0190
NIACIN 500 mg TAB SR TABLET $0.1589
NIACIN 750 mg TAB ER 24HR TABLET $0.3600
NIACIN 750 mg TAB TABLET $0.0885
NICARDIPINE HCL 20 mg CAP CAPSULE $1.5335
NICARDIPINE HCL 30 mg CAP CAPSULE $2.3125
NICOTINE 14 mg/24hr PATCH PATCH $1.4800
NICOTINE 21 mg/24hr PATCH PATCH $1.4800
NICOTINE 7 mg/24hr PATCH PATCH $1.4800
NICOTINE 21-14-7 mg TRANSDERMAL
SYSTEM EACH $0.8828
NICOTINE POLACRILEX 2 mg GUM EACH $0.2033
NICOTINE POLACRILEX 2 mg LOZENGE EACH $0.3745
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
NICOTINE POLACRILEX 2 mg MINI LOZENGE EACH $0.6750
NICOTINE POLACRILEX 4 mg GUM EACH $0.2598
NICOTINE POLACRILEX 4 mg LOZENGE EACH $0.3875
NICOTINE POLACRILEX 4 mg MINI LOZENGE EACH $0.4950
NIFEDIPINE 20 mg CAP CAPSULE $1.4895
NIFEDIPINE CC 30 mg TAB TABLET $0.1050
NIFEDIPINE CC 60 mg TAB TABLET $0.1200
NIFEDIPINE CC 90 mg TAB TABLET $0.4000
NIFEDIPINE ER 30 mg TAB TABLET $0.1755
NIFEDIPINE ER 60 mg TAB TABLET $0.2422
NIFEDIPINE ER 90 mg TAB TABLET $0.4135
NIFEDIPINE 10 mg CAP CAPSULE $0.5200
NILUTAMIDE 150 mg TAB TABLET $0.1025
NIMODIPINE 30 mg CAP CAPSULE $6.3715
NISOLDIPINE 17 mg TAB ER 24HR TABLET $4.2785
NISOLDIPINE 25.5 mg TAB ER 24HR TABLET $8.0352
NISOLDIPINE 34 mg TAB ER 24HR TABLET $5.3585
NISOLDIPINE 8.5mg TAB ER 24HR TABLET $3.5860
NITISINONE 2 mg CAP CAPSULE $72.4052
NITISINONE 5 mg CAP CAPSULE $179.8200
NITISINONE 10 mg CAP CAPSULE $359.6500
NITROFURANTOIN MACROCRYSTALS 100 mg CAP CAPSULE $0.6310
NITROFURANTOIN MACROCRYSTALS 50 mg CAP CAPSULE $0.5675
NITROFURANTOIN MACROCRYSTALS 25 mg CAP CAPSULE $3.4164
NITROFURANTOIN 100 mg CAP CAPSULE $0.4475
NITROGLYCERIN 0.1 mg/hr PATCH PATCH $0.4665
NITROGLYCERIN 0.2 mg/hr PATCH PATCH $0.3695
NITROGLYCERIN 0.3 mg TAB SL TABLET $0.2395
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
NITROGLYCERIN 0.4 mg/hr PATCH PATCH $0.5080
NITROGLYCERIN 0.4 mg TAB SL TABLET $0.3205
NITROGLYCERIN 0.6 mg/hr PATCH PATCH $0.7025
NITROGLYCERIN 0.6 mg TAB SL TABLET $0.2055
NITROGLYCERIN 2.5 mg CAP SR CAPSULE $0.4200
NITROGLYCERIN 6.5 mg CAP SR CAPSULE $0.4950
NITROGLYCERIN 400 mcg/spray SPRAY GRAM $13.5546
NITROPRUSSIDE SODIUM 25 mg/ml VIAL MILLILITER $8.7455
NIZATIDINE 150 mg/10 ml SOLN MILLILITER $0.8445
NIZATIDINE 150 mg CAP CAPSULE $0.2265
NIZATIDINE 300 mg CAP CAPSULE $0.4400
NORETHINDRONE (ERRIN, CAMILA, JOLIVETTE,
ORTHO MICRONOR)
0.35 mg TAB TABLET $0.1200
NORETHINDRONE ACETATE 5 mg TAB TABLET $0.5500
NORETHINDRONE AC-ETHY ESTRADIOL
(FYAVOLV) 0.5 mg; 2.5 mcg TAB TABLET $1.5250
NORETHINDRONE AC-ETHY ESTRADIOL
(FYAVOLV) 1 mg; 5 mcg TAB TABLET $1.2215
NORETHINDRONE A-E ESTRADIOL/FERROUS FUMARATE
(ESTROSTEP FE, TRI-LEGEST FE, TILIA FE)
5-7-9-7 TAB TABLET $0.7500
NORETH A-ET ESTRA/FE FUMARATE (LOESTRIN FE, JUNEL FE, MICROGESTIN FE)
1 mg; 0.02 mg TAB TABLET $0.2250
NORETH A-ET ESTRA/FE FUMARATE (LOESTRIN FE, JUNEL FE, MICROGESTIN FE)
1.5 mg; 0.03 mg TAB TABLET $0.2250
NORETHINDRONE-E. ESTRADIOL-IRON 1 mg-20(24) TAB TABLET $0.8550
NORETHINDRONE-E. ESTRADIOL-IRON 1 mg-20(24) TAB CHEW TABLET $4.0545
NORETHINDRONE/ETHINYL ESTRADIOL
(BALZIVA, OVCON-35, ZENCHENT) 0.4 mg; 35 mcg TAB TABLET $0.1905
NORETHINDRONE/ETHINYL ESTRADIOL (NECON 1/35, NORINYL 1+35,
ORTHO-NOVUM 1/35)
1 mg; 35 mcg TAB TABLET $0.2215
NORETHINDRONE/ETHINYL ESTRADIOL (NECON 7/7/7, NORTREL 7/7/7,
ORTHO-NOVUM 7/7/7)
0.5-35/0.75-35/1-35 mg-mcg
TAB TABLET $0.2500
NORETHINDRONE-ETHINYL ESTRADIOL/FERROUS FUMARATE
0.4-35 TAB CHEW TABLET $0.5615
NORGESTIMATE-ETHINYL ESTRADIOL (TRI-SPRINTEC, ORTHO TRI-CYCLEN, TRINESSA)
7-7-7 TAB TABLET $0.1975
NORGESTREL/ETHINYL ESTRADIOL (LO/OVRAL, LOW-OGESTREL)
0.3 mg; 30 mcg TAB TABLET $0.3500
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
NORETH-ETHINYL ESTRADIOL/IRON 0.8-25(24) TAB CHEW TABLET $2.0835
NORGESTREL/ETHINYL ESTRADIOL
(OGESTREL) 0.5 mg; 50 mcg TAB TABLET $0.6865
NORTRIPTYLINE HCL 10 mg/5 ml SOLN MILLILITER $0.2155
NORTRIPTYLINE HCL 10 mg CAP CAPSULE $0.0705
NORTRIPTYLINE HCL 25 mg CAP CAPSULE $0.0955
NORTRIPTYLINE HCL 50 mg CAP CAPSULE $0.0905
NORTRIPTYLINE HCL 75 mg CAP CAPSULE $0.1655
NYSTATIN 100,000 units/gm CREAM GRAM $0.2640
NYSTATIN 100,000 units/gm; 0.1% CREAM GRAM $3.6368
NYSTATIN 100,000 units/gm OINT GRAM $0.2500
NYSTATIN 100,000 units/gm; 0.1% OINT GRAM $3.7855
NYSTATIN 100,000 units/gm POWDER GRAM $0.2500
NYSTATIN 100,000 units/ml SUSP MILLILITER $0.1020
NYSTATIN 500k unit TAB TABLET $0.3582
NYSTATIN/TRIAMCINOLONE 100,000 units/gm; 0.1% CREAM GRAM $0.3655
NYSTATIN/TRIAMCINOLONE 100,000 units/gm; 0.1% OINT GRAM $0.3355
OCTREOTIDE ACETATE 1000 mcg/ml INJ MILLILITER $36.0000
OCTREOTIDE ACETATE 100 mcg/ml VIAL EACH $2.9295
OCTREOTIDE ACETATE 200 mcg/ml VIAL MILLILITER $6.3965
OCTREOTIDE ACETATE 50 mcg/ml VIAL EACH $2.2621
OCTREOTIDE ACETATE 500 mcg/ml AMPUL MILLILITER $128.4684
OCTREOTIDE ACETATE 500 mcg/ml VIAL MILLILITER $15.0085
OFLOXACIN 0.3% OPTH SOLN MILLILITER $1.9355
OFLOXACIN 0.3% OTIC SOLN MILLILITER $1.8720
OFLOXACIN 400 mg TAB TABLET $3.1615
OLANZAPINE 10 mg TAB RAPDIS TABLET $0.5495
OLANZAPINE 10 mg TABLET TABLET $0.1135
OLANZAPINE 10 mg VIAL EACH $26.9765
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
OLANZAPINE 15 mg TAB RAPDIS TABLET $0.8295
OLANZAPINE 15 mg TABLET TABLET $0.1595
OLANZAPINE 2.5 mg TABLET TABLET $0.0765
OLANZAPINE 20 mg TAB RAPDIS TABLET $0.1855
OLANZAPINE 20 mg TABLET TABLET $0.2125
OLANZAPINE 5 mg TAB RAPDIS TABLET $0.4425
OLANZAPINE 5 mg TABLET TABLET $0.0885
OLANZAPINE 7.5 mg TABLET TABLET $0.0765
OLANZAPINE/FLUOXETINE HCL 12 mg; 25 mg CAP CAPSULE $6.7120
OLANZAPINE/FLUOXETINE HCL 12 mg; 50 mg CAP CAPSULE $8.9825
OLANZAPINE/FLUOXETINE HCL 3 mg; 25 mg CAP CAPSULE $3.4545
OLANZAPINE/FLUOXETINE HCL 6 mg; 25 mg CAP CAPSULE $5.0775
OLANZAPINE/FLUOXETINE HCL 6 mg; 50 mg CAP CAPSULE $5.0775
OLMESARTAN MEDOXOMIL 20 mg TAB TABLET $0.0688
OLMESARTAN MEDOXOMIL 40 mg TAB TABLET $0.1200
OLMESARTAN MEDOXOMIL 5 mg TAB TABLET $0.0450
OLMESARTAN/AMLODIPIN/HCTHIAZID 20-5-12.5 TAB TABLET $1.3865
OLMESARTAN/AMLODIPIN/HCTHIAZID 40-5-12.5 TAB TABLET $1.7750
OLMESARTAN/AMLODIPIN/HCTHIAZID 40-5-25 TAB TABLET $1.4565
OLMESARTAN/AMLODIPIN/HCTHIAZID 40-10-12.5 TAB TABLET $1.7058
OLMESARTAN/AMLODIPIN/HCTHIAZID 40-10-25 TAB TABLET $1.9465
OLMESARTAN/HYDROCHLOROTHIAZIDE 20 mg; 12.5 mg TAB TABLET 0.1401
OLMESARTAN/HYDROCHLOROTHIAZIDE 40 mg; 12.5 mg TAB TABLET $0.1951
OLMESARTAN/HYDROCHLOROTHIAZIDE 40 mg; 25 mg TAB TABLET $0.1951
OLOPATADINE HCL 0.1% DROPS MILLILITER $2.1745
OLOPATADINE HCL 0.2% DROPS MILLILITER $2.9640
OLOPATADINE HCL 0.6% AER GRAM $0.1335
OMEGA-3 ACID ETHYL ESTERS 1 gm CAP CAPSULE $0.2317
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
OMEPRAZOLE 10 mg CAP DR CAPSULE $0.1462
OMEPRAZOLE 20 mg CAP DR CAPSULE $0.0225
OMEPRAZOLE 20 mg TAB DR TABLET $0.4445
OMEPRAZOLE 40 mg CAP DR CAPSULE $0.0622
OMEPRAZOLE MAGNESIUM 20 mg CAP DR CAPSULE $0.6050
OMEPRAZOLE/SODIUM BICARBONATE 20 mg; 1.1 g CAP CAPSULE $0.5550
OMEPRAZOLE/SODIUM BICARBONATE 20 mg; 1,680 mg POWDER EACH $34.4555
OMEPRAZOLE/SODIUM BICARBONATE 40 mg; 1,680 mg PACKET EACH $18.5165
OMEPRAZOLE/SODIUM BICARBONATE 40 mg; 1.1 g CAP CAPSULE $1.2385
ONDANSETRON HCL 4 mg/5 ml SOLN MILLILITER $0.1685
ONDANSETRON HCL 4 mg/2 ml; SDV VIAL MILLILITER $0.1895
ONDANSETRON HCL 4 mg TAB TABLET $0.0488
ONDANSETRON HCL 8 mg TAB TABLET $0.0545
ONDANSETRON 4 mg TAB ODT TABLET $0.1675
ONDANSETRON 8 mg TAB ODT TABLET $0.0384
OPIUM TINCTURE 10 mg/ml TINCTURE MILLILITER $2.9900
ORPHENADRINE CITRATE 100 mg TAB SR TABLET $0.3005
ORPHENADRINE CITRATE 30 mg/ml VIAL MILLILITER $3.1700
OSELTAMIVIR PHOSPHATE 30 mg CAP CAPSULE $2.8500
OSELTAMIVIR PHOSPHATE 45 mg CAP CAPSULE $3.1500
OSELTAMIVIR PHOSPHATE 6 mg/ml SUSP RECON MILLILITER $0.5043
OSELTAMIVIR PHOSPHATE 75 mg CAP CAPSULE $2.2252
OXACILLIN 1 gm VIAL EACH $8.9000
OXACILLIN 2 gm VIAL EACH $11.2500
OXACILLIN 10 gm VIAL EACH $53.2500
OXALIPLATIN 100 mg VIAL EACH $124.0000
OXALIPLATIN 100 mg/20 ml VIAL EACH $4.0875
OXALIPLATIN 50 mg VIAL EACH $20.0000
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
OXANDROLONE 10 mg TAB TABLET $18.2700
OXANDROLONE 2.5 mg TAB TABLET $3.4950
OXAPROZIN 600 mg TAB TABLET $0.9200
OXAZEPAM 10 mg CAP CAPSULE $0.4735
OXAZEPAM 15 mg CAP CAPSULE $0.4406
OXAZEPAM 30 mg CAP CAPSULE $1.2905
OXCARBAZEPINE 150 mg TAB TABLET $0.1146
OXCARBAZEPINE 300 mg/5 ml SUSP MILLILITER $0.2490
OXCARBAZEPINE 300 mg TAB TABLET $0.1405
OXCARBAZEPINE 600 mg TAB TABLET $0.2490
OXICONAZOLE NITRATE 1% CREAM GRAM $3.4625
OXYBUTYNIN CHLORIDE 10 mg TAB SA TABLET $0.1440
OXYBUTYNIN CHLORIDE 15 mg TAB SA TABLET $.1650
OXYBUTYNIN CHLORIDE 5 mg TAB SA TABLET $0.1850
OXYBUTYNIN 5 mg TAB TABLET $0.0780
OXYBUTYNIN 5 mg/5 ml SYRINGE MILLILITER $0.0248
OXYCODONE/APAP 10 mg; 325 mg TAB TABLET $0.1360
OXYCODONE/APAP 2.5 mg; 325 mg TAB TABLET $1.3815
OXYCODONE/APAP 5 mg; 325 mg TAB TABLET $0.0500
OXYCODONE/APAP 7.5 mg; 325 mg TAB TABLET $0.1055
OXYCODONE HCL 10 mg TAB TABLET $0.0800
OXYCODONE HCL 10 mg TAB ER 12HR TABLET $2.1550
OXYCODONE HCL 15 mg TAB TABLET $0.1355
OXYCODONE HCL 20 mg/ml SOLN MILLILITER $1.5585
OXYCODONE HCL 20 mg TAB TABLET $0.2285
OXYCODONE HCL 20 mg TAB ER 12HR TABLET $3.6543
OXYCODONE HCL 30 mg TAB TABLET $0.1955
OXYCODONE HCL 40 mg TAB ER 12HR TABLET $4.8625
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
OXYCODONE HCL 5 mg/5 ml SOLN MILLILITER $0.1245
OXYCODONE HCL 5 mg CAP CAPSULE $0.5842
OXYCODONE HCL 5 mg TAB TABLET $0.0585
OXYCODONE HCL 80 mg TAB ER 12HR TABLET $7.2823
OXYMETAZOLINE HCL 0.05% NASAL SPRAY MILLILITER $0.1307
OXYMORPHONE HCL 10 mg TAB TABLET $1.1425
OXYMORPHONE HCL 10 mg TAB ER 12HR TABLET $3.1287
OXYMORPHONE HCL 15 mg TAB ER 12HR TABLET $5.9295
OXYMORPHONE HCL 20 mg TAB ER 12HR TABLET $5.4839
OXYMORPHONE HCL 30 mg TAB ER 12HR TABLET $7.1268
OXYMORPHONE HCL 40 mg TAB ER 12HR TABLET $8.5855
OXYMORPHONE HCL 5 mg TAB TABLET $0.5345
OXYMORPHONE HCL 5 mg TAB ER 12HR TABLET $1.6095
OXYMORPHONE HCL 7.5 mg TAB ER 12HR TABLET $3.1805
PACLITAXEL 6 mg/ml VIAL MILLILITER $0.9435
PALIPERIDONE 1.5 mg TAB ER 24HR TABLET $4.8300
PALIPERIDONE 3 mg TAB ER 24HR TABLET $6.2105
PALIPERIDONE 6 mg TAB ER 24HR TABLET $5.8442
PALIPERIDONE 9 mg TAB ER 24HR TABLET $8.0200
PALONOSETRON 0.25 mg/5 ml VIAL MILLILITER $8.7950
PAMIDRONATE DISODIUM 3 mg/ml VIAL MILLILITER $1.2625
PAMIDRONATE DISODIUM 9 mg/ml VIAL MILLILITER $8.2031
PANTOPRAZOLE SODIUM 20 mg TAB EC TABLET $0.0550
PANTOPRAZOLE SODIUM 40 mg TAB EC TABLET $0.0575
PANTOPRAZOLE SODIUM 40 mg VIAL EACH $2.9999
PARICALCITOL 1 mcg CAP CAPSULE $1.0255
PARICALCITOL 2 mcg CAP CAPSULE $2.7720
PARICALCITOL 2 mcg/ml VIAL MILLILITER $3.9667
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
PARICALCITOL 4 mcg CAP CAPSULE $11.0145
PARICALCITOL 5 mcg/ml VIAL MILLILITER $9.8750
PAROMOMYCIN 250 mg CAP CAPSULE $3.7450
PAROXETINE HCL 10 mg TAB TABLET $0.0450
PAROXETINE HCL 12.5 mg TAB ER TABLET $0.9765
PAROXETINE HCL 20 mg TAB TABLET $0.0699
PAROXETINE HCL 25 mg TAB ER TABLET $1.0500
PAROXETINE HCL 30 mg TAB TABLET $0.1200
PAROXETINE HCL 37.5 mg TAB ER TABLET $0.7335
PAROXETINE HCL 40 mg TAB TABLET $0.1110
PAROXETINE MESYLATE 7.5 mg CAP CAPSULE $2.5675
PEG3350/SOD SUL/NACL/KCI/ASB/C (MOVIPREP)
7.5-2.691G POWDER EACH $73.9500
PED MVIT A,C,D3 NO. 21/FLUORIDE (TRI-VIT-FLUOR)
0.25 mg/ml DROPS MILLILITER $0.1334
PEDI MULTIVIT NO. 17 W-FLUORIDE 0.25 mg TAB CHEW TABLET $0.0519
PEDI MULTIVIT NO. 17 W-FLUORIDE 0.5 mg TAB CHEW TABLET $0.0519
PEDI MULTIVIT NO. 17 W-FLUORIDE 1 mg TAB CHEW TABLET $0.0622
PEDI MULTIVIT NO. 2 W-FLUORIDE 0.25 mg/ml DROPS MILLILITER $0.2076
PEDI MULTIVIT NO. 2 W-FLUORIDE 0.5 mg/ml DROPS MILLILITER $0.2120
PEDI MULTIVIT NO. 45/FLUORIDE/IRON 0.25-10/ml DROPS MILLILITER $0.1500
PEG 3350/SOD SULF ANHYD/SODIUM BICARBONATE/SOD CHLORIDE/KCL
236 gm; 22.74 gm SOLN MILLILITER $0.0046
PENICILLAMINE 250 mg CAPSULE CAP $65.2500
PENICILLIN G POTASSIUM 20 mm unit VIAL EACH $51.6500
PENICILLIN G POTASSIUM 5 mm unit VIAL EACH $9.0000
PENICILLIN V POTASSIUM 125 mg/5 mlm 100 ml PWDR for
ORAL SOLN MILLILITER $0.0613
PENICILLIN V POTASSIUM 250 mg/5 ml SUSP RECON MILLILITER $0.0507
PENICILLIN V POTASSIUM 250 mg TAB TABLET $0.0600
PENICILLIN V POTASSIUM 500 mg TAB TABLET $0.1045
PENTAZOCINE/NALOXONE HCL 50 mg; 0.5 mg TAB TABLET $1.7750
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
PENTOXIFYLLINE 400 mg TAB CR TABLET $0.1675
PERINDOPRIL ERBUMINE 2 mg TAB TABLET $0.4155
PERINDOPRIL ERBUMINE 4 mg TAB TABLET $0.4013
PERINDOPRIL ERBUMINE 8 mg TAB TABLET $0.4995
PERMETHRIN 1% LIQUID MILLILITER $0.1080
PERMETHRIN 5% CREAM GRAM $0.2915
PERPHENAZINE 16 mg TAB TABLET $0.5800
PERPHENAZINE 2 mg TAB TABLET $0.2235
PERPHENAZINE 4 mg TAB TABLET $0.4568
PERPHENAZINE 8 mg TAB TABLET $0.0225
PHENAZOPYRIDINE HCL 100 mg TAB TABLET $0.5925
PHENAZOPYRIDINE HCL 200 mg TAB TABLET $0.6844
PHENAZOPYRIDINE HCL 95 mg TAB TABLET $0.1065
PHENAZOPYRIDINE HCL 97.5 mg TAB TABLET $0.1775
PHENAZOPYRIDINE HCL 99.5 mg TAB TABLET $0.2500
PHENELZINE SULFATE 15 mg TAB TABLET $0.5329
PHENOBARBITAL 15 mg TAB TABLET $0.0378
PHENOBARBITAL 16.2 mg TAB TABLET $0.2555
PHENOBARBITAL 20 mg/5 ml ELIXIR MILLILITER $0.1000
PHENOBARBITAL 32.4 mg TAB TABLET $0.4733
PHENOBARBITAL 64.8 mg TAB TABLET $0.4055
PHENOBARBITAL 97.2 mg TAB TABLET $0.4250
PHENOBARBITAL 100 mg TAB TABLET $0.4105
PHENOBARBITAL SODIUM 130 mg/ml VIAL MILLILITER $65.0982
PHENOBARBITAL SODIUM 65 mg/ml VIAL MILLILITER $25.0800
PHENOXYBENZAMINE HCL 10 mg CAP CAPSULE $49.9055
PHENTOLAMINE MESYLATE 27 mg-1 mg TAB TABLET $375.5000
PHENYLEPHRINE HCL/ACETAMINOPHEN 5 mg; 325 mg TAB TABLET $0.0549
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
PHENYLEPHRINE/ACETAMINOPHEN/CPM 5-325-2 mg TAB TABLET $0.0725
PHENYLEPHRINE HCL/COCOA BUTTER 0.25-88.44 SUPPOSITORY EACH $0.2000
PHENYLEPHRINE/DIPHENHYDRAMINE 2.5-6.25/5 LIQUID MILLILITER $0.0311
PHENYLEPHRINE/DM/ACETAMINOP/GG 5-325-200 TAB TABLET $0.1700
PHENYLEPH/MINERAL OIL/PETROLAT 0.25%-14% OINT GRAM $0.0430
PHENYLEPHRINE HCL/PROMETH HCL 5-6.25 mg/5 ml SYRINGE MILLILITER $0.1907
PHENYLEPHRINE HCL 10 mg TAB TABLET $0.0440
PHENYLEPHRINE HCL 1% NASAL SPRAY MILLILITER $0.0588
PHENYLEPHRINE HCL 1% DROPS MILLILITER $0.0650
PHENYLEPHRINE HCL 1% SUPPOSITORY EACH $0.1086
PHENYTOIN 50 mg TAB CHEW TABLET $0.2550
PHENYTOIN 100 mg/4 ml SUSPENSION MILLILITER $1.6188
PHENYTOIN SODIUM 100 mg CAP ER CAPSULE $0.1662
PHENYTOIN SODIUM 125 mg/5 ml SUSP MILLILITER $0.0795
PHENYTOIN SODIUM EXTENDED 200 mg CAP CAPSULE $1.0515
PHENYTOIN SODIUM EXTENDED 300 mg CAP CAPSULE $1.0140
PHOSPHORATED CARBO (DEXT-FRUCT) N/A LIQUID MILLILITER $0.0165
PHYTONADIONE (VIT K1) 5 mg TAB TABLET $40.8375
PILOCARPINE HCL 1% OPTH SOLN MILLILITER $4.1696
PILOCARPINE HCL 2% OPTH SOLN MILLILITER $3.3120
PILOCARPINE HCL 4% OPTH SOLN MILLILITER $4.6425
PILOCARPINE HCL 5 mg TAB TABLET $0.3829
PILOCARPINE HCL 7.5 mg TAB TABLET $0.6825
PIMECROLIMUS 1% CREAM GRAM $5.6075
PINDOLOL 10 mg TAB TABLET $0.7526
PINDOLOL 5 mg TAB TABLET $0.6285
PIOGLITAZONE HCL/METFORMIN HCL 15 mg; 500 mg TAB TABLET $0.4500
PIOGLITAZONE HCL/METFORMIN HCL 15 mg; 850 mg TAB TABLET $0.4500
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
PIOGLITAZONE HCL 15 mg TAB TABLET $0.0600
PIOGLITAZONE HCL 30 mg TAB TABLET $0.0600
PIOGLITAZONE HCL 45 mg TAB TABLET $0.0840
PIOGLITAZONE HCL/GLIMEPIRIDE 30 mg; 2 mg TAB TABLET $8.7850
PIOGLITAZONE HCL/GLIMEPIRIDE 30 mg; 4 mg TAB TABLET $8.7850
PIPERACILLIN SODIUM/ TAZOBACTAM SODIUM
2.25 gm VIAL EACH $5.7750
PIPERACILLIN SODIUM/ TAZOBACTAM SODIUM
3.375 gm VIAL EACH $4.3000
PIPERACILLIN SODIUM/ TAZOBACTAM SODIUM
4.5 gm VIAL EACH $7.4900
PIPERACILLIN SODIUM/ TAZOBACTAM SODIUM
40.5 gm VIAL EACH $140.6376
PIPERONYL BUTOXIDE/PYRETHRINS 4%-0.33% SHAMPOO MILLILITER $0.0350
PIROXICAM 10 mg CAP CAPSULE $0.2555
PIROXICAM 20 mg CAP CAPSULE $0.3945
PODOFILOX 0.5% SOLN MILLILITER $12.7500
POLYETHYLENE GLYCOL 17 gm PACKET EACH $1.1961
POLYETHYLENE GLYCOL NA POWDER GRAM $0.0195
POLYVINYL ALCOHOL 1.4% SOLN MILLILITER $0.1500
POSACONAZOLE 100 mg TAB DR TABLET $37.3685
POTASSIUM BICARB/CITRATE 25 mEq EFFERV TAB TABLET $0.2700
POTASSIUM CHLORIDE 10 mEq CAP CR CAPSULE $0.1555
POTASSIUM CHLORIDE 10 mEq TAB CR TABLET $0.1835
POTASSIUM CHLORIDE 10 mEq TAB ER TABLET $0.1410
POTASSIUM CHLORIDE 15 mEq TAB ER TABLET $0.8218
POTASSIUM CHLORIDE 20 mEq TAB ER TABLET $0.2280
POTASSIUM CHLORIDE 20 mEq PWDR PCKT EACH $1.0605
POTASSIUM CHLORIDE 20 mEq/15 ml LIQUID MILLILITER $0.2425
POTASSIUM CHLORIDE 20 mEq TAB CR TABLET $0.2233
POTASSIUM CHLORIDE 40 mEq/15 ml LIQUID MILLILITER $0.5350
POTASSIUM CHLORIDE 8 mEq TAB CR TABLET $0.2220
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
POTASSIUM CHLORIDE 8 mEq CAP ER CAPSULE $0.1680
POTASSIUM CITRATE 10 mEq TAB ER TABLET $0.5265
POTASSIUM CITRATE 15 mEq TAB ER TABLET $0.8790
POTASSIUM CITRATE 5 mEq TAB ER TABLET $0.5962
POTASSIUM CITRATE/CITRIC ACID 1,100-334/5 SOLN MILLILITER $0.0789
POVIDONE-IODINE 10% SOLN GRAM $0.0177
PRAMIPEXOLE DI-HCL 0.375 mg TAB ER 24HR TABLET $8.6500
PRAMIPEXOLE DI-HCL 0.75 mg TAB TABLET $0.1217
PRAMIPEXOLE DI-HCL 0.75 mg TAB ER 24HR TABLET $6.0521
PRAMIPEXOLE DI-HCL 1.5 mg TAB ER 24HR TABLET $7.4584
PRAMIPEXOLE DI-HCL 2.25 mg TAB ER TABLET $10.8950
PRAMIPEXOLE DI-HCL 3 mg TAB ER 24HR TABLET $7.8215
PRAMIPEXOLE DIHYDROCHLORIDE 0.125 mg TAB TABLET $0.0300
PRAMIPEXOLE DIHYDROCHLORIDE 0.25 mg TAB TABLET $0.0300
PRAMIPEXOLE DIHYDROCHLORIDE 0.5 mg TAB TABLET $0.0515
PRAMIPEXOLE DIHYDROCHLORIDE 1 mg TAB TABLET $0.0450
PRAMIPEXOLE DIHYDROCHLORIDE 1.5 mg TAB TABLET $0.0585
PRAMIPEXOLE DIHYDROCHLORIDE 4.5 mg TAB ER TABLET $9.2000
PRASUGREL HCL 10 mg TAB TABLET $0.3145
PRASUGREL HCL 5 mg TAB TABLET $0.3570
PRAVASTATIN SODIUM 10 mg TAB TABLET $0.0725
PRAVASTATIN SODIUM 20 mg TAB TABLET $0.0725
PRAVASTATIN SODIUM 40 mg TAB TABLET $0.0725
PRAVASTATIN SODIUM 80 mg TAB TABLET $0.1505
PRAZOSIN HCL 1 mg CAP CAPSULE $0.1800
PRAZOSIN HCL 2 mg CAP CAPSULE $0.2250
PRAZOSIN HCL 5 mg CAP CAPSULE $0.3825
PREDNISOLONE ACETATE 1% OPTH SUSP MILLILITER $5.3046
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
PREDNISOLONE SODIUM PHOSPHATE 1% DROPS MILLILITER $4.7525
PREDNISOLONE SODIUM PHOSPHATE 10 mg TAB ODT TABLET $8.4800
PREDNISOLONE SODIUM PHOSPHATE 10 mg/5 ml SOLN MILLILITER $2.5750
PREDNISOLONE SODIUM PHOSPHATE 15 mg TAB ODT TABLET $14.1400
PREDNISOLONE SODIUM PHOSPHATE 15 mg/5 ml SOLN MILLILITER $0.0625
PREDNISOLONE SODIUM PHOSPHATE 20 mg/5 ml SOLN MILLILITER $3.6015
PREDNISOLONE SODIUM PHOSPHATE 25 mg/5 ml SOLN MILLILITER $1.2373
PREDNISOLONE SODIUM PHOSPHATE 30 mg TAB ODT TABLET $18.1800
PREDNISOLONE SODIUM PHOSPHATE 5 mg/5 ml SOLN MILLILITER $0.5465
PREDNISOLONE 15 mg/5 ml SYRINGE MILLILITER $0.0340
PREDNISONE 1 mg TAB TABLET $0.0450
PREDNISONE 10 mg TAB TABLET $0.0985
PREDNISONE 10 mg TAB DOSE
PAK TABLET $0.8600
PREDNISONE 2.5 mg TAB TABLET $0.1368
PREDNISONE 20 mg TAB TABLET $0.1135
PREDNISONE 5 mg TAB TABLET $0.0775
PREDNISONE 5 mg TAB DOSE
PAK TABLET $0.6529
PREDNISONE 50 mg TAB ER 24HR TABLET $0.2840
PREGABALIN 25 mg CAP CAPSULE $0.1347
PREGABALIN 50 mg CAP CAPSULE $0.0455
PREGABALIN 75 mg CAP CAPSULE $0.0555
PREGABALIN 100 mg CAP CAPSULE $0.0657
PREGABALIN 150 mg CAP CAPSULE $0.0695
PREGABALIN 20 mg/ml SOLN MILLILITER $0.1665
PREGABALIN 200 mg CAP CAPSULE $0.1450
PREGABALIN 300 mg CAP CAPSULE $0.1665
PREGABALIN 225 mg CAP CAPSULE $0.1459
PREGABALIN 82.5 mg TAB ER TABLET $9.0980
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
PREGABALIN 165 mg TAB ER TABLET $9.0980
PREGABALIN 330 mg TAB ER TABLET $9.0980
PRENATAL VIT #72/IRON, CARB & GLUC/FA/DSS/DHA (FOCALGIN 90 DHA)
90-1-300 mg COMBINATION
PACKAGE EACH $0.1800
PRENATAL VIT #73/IRON, CARB & GLUC/ FA/DSS/DHA
(FOCALGIN CA)
35-1-50 mg COMBINATION
PACKAGE EACH $0.1800
PRENATAL VIT #16/IRON FUM & PS COMPLEX/FOLIC ACID/OMEGA-3
(TARON-C DHA, DOTHELLE DHA)
35-1-200 mg CAP CAPSULE $0.1800
PRENATAL VIT WITH CA #68/IRON FUMARATE/FOLIC ACID #1/DHA
(ZATEAN-PN PLUS)
28-1-300 mg CAP CAPSULE $0.1800
PRENATAL VIT WITH CALCIUM #66/IRON FUM/FOLIC ACID/DSS/DHA
(VIRTPREX)
26-1.2-55 CAP CAPSULE $0.1800
PRENATAL VIT WITH CALCIUM #80/ IRON FUM/FOLIC ACID/DSS/DHA
(VIRT-SELECT)
29-1.25-55 CAP CAPSULE $0.1800
PRENATAL VIT 27 WITH CALCIUM/ FERROUS FUM/FOLIC ACID
(TRINATAL RX 1)
60 mg; 1 mg TAB TABLET $0.1800
PRENATAL VIT #15/IRON, CARBONYL/FOLIC ACID/DOCUSATE SOD
(VIRT-ADVANCE)
90-1-50 mg TAB TABLET $0.1800
PRENATAL VIT # 16/IRON, CARBONYL/FOLIC ACID/DOCUSATE SOD
(VIRT-VITE GT)
90-1-50 mg TAB TABLET $0.1800
PRENATAL VIT COMB #2/IRON B-G SUC-P/FA/OMEGA-3
(COMPLETE NATAL DHA)
29-1-250 mg COMBINATION
PACKAGE EACH $0.1800
PRENATAL VIT COMB NO. 47/FERROUS FUMARATE/FA CMB #1/DHA
(ZATEAN-PN DHA, RULAVITE DHA, VIRT-PN DHA)
27-1-300 mg CAP CAPSULE $0.1800
PRENATAL VIT COMB #53/IRON B-G HCL SUC-P/FA/OMEGA-3 (TRIVEEN-DUO DHA)
29-1-400 mg COMBINATION
PACKAGE EACH $0.1800
PRENATAL VIT COMB NO. 73/FERROUS FUMARATE/FOLIC ACID
(VOL-NATE, VIRT NATE) 28 mg; 1 mg TAB TABLET $0.1800
PRENATAL VIT COMB #74/FERROUS FUM/FOLIC ACID
(NIVA-PLUS)
27 mg; 1 mg TAB TABLET $0.1800
PRENATAL VIT COMB #76/IRON, CARBONYL/FOLIC ACID
(PNV 29-1)
29 mg; 1 mg TAB TABLET $0.1800
PRENATAL VIT COMBO #14/FERROUS FUM/FOLIC ACID (COMPLETENATE)
29 mg; 1 mg TAB CHEW TABLET $0.1800
PRENATAL VIT #15/IRON FUM & POLYSAC COMP/FA
(FOLIVANE-OB)
85 mg; 1 mg CAP CAPSULE $0.1800
PRENATAL VIT NO. 123/IRON/FOLIC ACID
(ELITE-OB) 50-1.25 mg TAB TABLET $0.1800
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
PRIMIDONE 250 mg TAB TABLET $0.1340
PRIMIDONE 50 mg TAB TABLET $0.0621
PROBENECID 0.5 gm TAB TABLET $0.4745
PROBENECID/COLCHICINE 500 mg; 0.5 mg TAB TABLET $0.6485
PROCHLORPERAZINE EDISYLATE 10 mg/2 ml VIAL MILLILITER $2.8850
PROCHLORPERAZINE MALEATE 10 mg TAB TABLET $0.0584
PROCHLORPERAZINE MALEATE 25 mg SUPP EACH $7.1345
PROCHLORPERAZINE MALEATE 5 mg TAB TABLET $0.0421
PROGESTERONE 50 mg/ml OIL MILLILITER $2.3000
PROGESTERONE, MICRONIZED 100 mg CAP CAPSULE $0.2100
PROGESTERONE, MICRONIZED 200 mg CAP CAPSULE $0.6265
PROMETHAZINE HCL 12.5 mg SUPP EACH $2.9895
PROMETHAZINE HCL 12.5 mg TAB TABLET $0.0675
PROMETHAZINE HCL 25 mg/ml AMPUL MILLILITER $1.1025
PROMETHAZINE HCL 25 mg/ml VIAL MILLILITER $1.0865
PROMETHAZINE HCL 25 mg SUPP EACH $4.8255
PROMETHAZINE HCL 25 mg TAB TABLET $0.0392
PROMETHAZINE HCL 50 mg/ml AMPUL MILLILITER $2.3310
PROMETHAZINE HCL 50 mg SUPP EACH $24.4775
PROMETHAZINE HCL 50 mg/ml VIAL MILLILITER $2.4192
PROMETHAZINE HCL 50 mg TAB TABLET $0.0750
PROMETHAZINE HCL 6.25 mg/5 ml SYRINGE MILLILITER $0.0120
PROMETHAZINE W/DM 6.25-15/5 SYRINGE MILLILITER $0.0153
PROMETHAZINE/CODEINE 10-6.25/5 ml SYRINGE MILLILITER $0.0205
PROPAFENONE HCL 150 mg TAB TABLET $0.1920
PROPAFENONE HCL 225 mg CAP ER 12HR CAPSULE $1.1224
PROPAFENONE HCL 225 mg TAB TABLET $0.2700
PROPAFENONE HCL 300 mg TAB TABLET $0.4926
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
PROPAFENONE HCL 325 mg CAP ER 12HR CAPSULE $1.2720
PROPAFENONE HCL 425 mg CAP ER 12HR CAPSULE $3.0290
PROPARACAINE HCL 0.5% DROPS MILLILITER $1.4745
PROPRANOLOL HCL 10 mg TAB TABLET $0.0746
PROPRANOLOL HCL 120 mg CAP ER CAPSULE $0.4267
PROPRANOLOL HCL 160 mg CAP ER CAPSULE $0.8591
PROPRANOLOL HCL 20 mg/5 ml SOLN MILLILITER $0.1115
PROPRANOLOL HCL 20 mg TAB TABLET $0.1245
PROPRANOLOL HCL 40 mg TAB TABLET $0.1690
PROPRANOLOL HCL 60 mg CAP ER CAPSULE $0.5649
PROPRANOLOL HCL 60 mg TAB TABLET $0.2395
PROPRANOLOL HCL 80 mg CAP ER CAPSULE $0.4040
PROPRANOLOL HCL 80 mg TAB TABLET $0.1560
PROPYLENE GLYCOL/PEG 400 0.3%-0.4% DROPS MILLILITER $0.2625
PROPYLTHIOURACIL 50 mg TAB TABLET $0.6355
PROTRIPTYLINE HCL 10 mg TAB TABLET $1.6795
PROTRIPTYLINE HCL 5 mg TAB TABLET $1.7250
PSEUDOEPHEDRINE HCL 15 mg/5 ml LIQUID MILLILITER $0.0105
PSEUDOEPHEDRINE HCL 120 mg TAB ER TABLET $0.3355
PSEUDOEPHEDRINE HCL 30 mg TAB TABLET $0.0452
PSEUDOEPHEDRINE HCL 60 mg TAB TABLET $0.0329
PSEUDOEPHEDRINE HCL/CETIRIZINE HCL 120 mg; 5 mg TAB TABLET $0.6795
PSEUDOEPHEDRINE SULFATE/LORATADINE 240 mg; 10 mg TAB SA TABLET $0.4320
PSYLLIUM HUSK 0.52 G CAP CAPSULE $0.0530
PSYLLIUM HUSK (WITH ASPARTAME) 3.4 G/5.8 G POWDER GRAM $0.0185
PSYLLIUM HUSK (WITH SUGAR) 3.4 G/7 G POWDER GRAM $0.0125
PSYLLIUM HUSK (WITH SUGAR) 3.4 g/12 G POWDER GRAM $0.0084
PSYLLIUM SEED N/A POWDER GRAM $0.0346
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
PSYLLIUM SEED (WITH DEXTROSE) N/A POWDER GRAM $0.0137
PSYLLIUM SEED (WITH SUGAR) N/A POWDER GRAM $0.0122
PYRAZINAMIDE 500 mg TAB TABLET $2.7466
PYRIDOSTIGMINE BROMIDE 180 mg TAB TABLET $2.5050
PYRIDOSTIGMINE BROMIDE 60 mg TAB TABLET $0.3665
PYRIDOSTIGMINE BROMIDE 60 mg/5 ml SYRUP MILLILITER $2.3300
PYRIDOXINE HCL (VITAMIN B-6)
100 mg TAB TABLET $0.0332
QUETIAPINE FUMARATE 100 mg TAB TABLET $0.0665
QUETIAPINE FUMARATE 150 mg TAB ER 24HR TABLET $0.2340
QUETIAPINE FUMARATE 200 mg TAB TABLET $0.0855
QUETIAPINE FUMARATE 200 mg TAB ER 24HR TABLET $0.2215
QUETIAPINE FUMARATE 25 mg TAB TABLET $0.0315
QUETIAPINE FUMARATE 300 mg TAB TABLET $0.1297
QUETIAPINE FUMARATE 300 mg TAB ER 24HR TABLET $0.3231
QUETIAPINE FUMARATE 400 mg TAB TABLET $0.1615
QUETIAPINE FUMARATE 400 mg TAB ER 24HR TABLET $0.4545
QUETIAPINE FUMARATE 50 mg TAB TABLET $0.0330
QUETIAPINE FUMARATE 50 mg TAB ER 24HR TABLET $0.1295
QUINAPRIL HCL/HCTZ 10 mg; 12.5 mg TAB TABLET $0.3625
QUINAPRIL HCL/HCTZ 20 mg; 12.5 mg TAB TABLET $0.2760
QUINAPRIL HCL/HCTZ 20 mg; 25 mg TAB TABLET $0.1675
QUINAPRIL HCL 10 mg TAB TABLET $0.0663
QUINAPRIL HCL 20 mg TAB TABLET $0.1015
QUINAPRIL HCL 40 mg TAB TABLET $0.1015
QUINAPRIL HCL 5 mg TAB TABLET $0.0663
QUININE SULFATE 324 mg CAP CAPSULE $1.5045
RABEPRAZOLE SODIUM 20 mg TAB DR TABLET $0.1800
RALOXIFENE HCL 60 mg TAB TABLET $0.3150
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
RAMELTON 8 mg TAB TABLET $1.8600
RAMIPRIL 1.25 mg CAP CAPSULE $0.0975
RAMIPRIL 10 mg CAP CAPSULE $0.0750
RAMIPRIL 2.5 mg CAP CAPSULE $0.0598
RAMIPRIL 5 mg CAP CAPSULE $0.0450
RANITIDINE HCL 150 mg CAP CAPSULE $0.2625
RANITIDINE HCL 150 mg TAB TABLET $0.0395
RANITIDINE HCL 150 mg/10 ml SYRINGE MILLILITER $0.0225
RANITIDINE HCL 300 mg CAP CAPSULE $0.5825
RANITIDINE HCL 300 mg TAB TABLET $0.0685
RANITIDINE HCL 75 mg TAB TABLET $0.0655
RANOLAZINE 500 mg TAB ER TABLET $0.3524
RANOLAZINE 1,000 mg TAB ER TABLET $0.6065
RASAGILINE MESYLATE 0.5 mg TAB TABLET $2.6907
RASAGILINE MESYLATE 1 mg TAB TABLET $1.6305
RELION INSULIN SYRINGE (NDC 81131-0311-70)
0.5 ml; 30 g x 5/16” SYRINGE EACH $0.1900
RELION INSULIN SYRINGE (NDC 81131-0311-76)
0.5 ml; 31 g x 5/16” SYRINGE EACH $0.1900
RELION INSULIN SYRINGE (NDC 81131-0311-68)
1 ml; 30 g x 5/16” SYRINGE EACH $0.1900
RELION INSULIN SYRINGE (NDC 81131-0311-74)
1 ml; 31 g x 5/16” SYRINGE EACH $0.1900
RELION PEN NEEDLES (NDC 08396-9009-34)
32 g x 5/32” NEEDLE EACH $0.1900
REPAGLINIDE 0.5 mg TAB TABLET $0.1875
REPAGLINIDE 1 mg TAB TABLET $0.1155
REPAGLINIDE 2 mg TAB TABLET $0.1050
RIBAVIRIN 200 mg CAP CAPSULE $0.4394
RIBAVIRIN 200 mg TAB TABLET $0.4695
RIFABUTIN 150 mg CAP CAPSULE $11.3500
RIFAMPIN 150 mg CAP CAPSULE $0.8085
RIFAMPIN 300 mg CAP CAPSULE $0.7075
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
RIFAMPIN 600 mg VIAL EACH $83.3500
RILUZOLE 50 mg TAB TABLET $0.4345
RIMANTADINE HCL 100 mg TAB TABLET $1.7590
RINGER’S SOLUTION, LACTATED N/A IRRIG SOLN MILLILITER $0.0032
RINGER’S SOLUTION, LACTATED N/A IV SOLN MILLILITER $0.0022
RISEDRONATE SODIUM 150 mg TAB TABLET $11.1345
RISEDRONATE SODIUM 30 mg TAB TABLET $24.2500
RISEDRONATE SODIUM 35 mg TAB DR TABLET $27.2275
RISEDRONATE SODIUM 35 mg TAB TABLET $2.2650
RISEDRONATE SODIUM 5 mg TAB TABLET $4.7555
RISPERIDONE 0.25 mg TAB ODT TABLET $2.0455
RISPERIDONE 0.25 mg TAB TABLET $0.0150
RISPERIDONE 0.5 mg TAB ODT TABLET $0.4575
RISPERIDONE 0.5 mg TAB TABLET $0.0270
RISPERIDONE 1 mg/ml SOLN MILLILITER $0.3175
RISPERIDONE 1 mg TAB ODT TABLET $0.8725
RISPERIDONE 1 mg TAB TABLET $0.0473
RISPERIDONE 2 mg TAB ODT TABLET $0.7162
RISPERIDONE 2 mg TAB TABLET $0.0635
RISPERIDONE 3 mg TAB ODT TABLET $1.5585
RISPERIDONE 3 mg TAB TABLET $0.0600
RISPERIDONE 4 mg TAB ODT TABLET $1.9065
RISPERIDONE 4 mg TAB TABLET $0.0945
RITONAVIR 100 mg TAB TABLET $1.2100
RIVASTIGMINE 13.3 mg/24hr PATCH EACH $4.3945
RIVASTIGMINE 4.6 mg/24hr PATCH EACH $3.4445
RIVASTIGMINE 9.5 mg/24hr PATCH EACH $3.7035
RIVASTIGMINE TARTRATE 1.5 mg CAP CAPSULE $0.3882
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
RIVASTIGMINE TARTRATE 3 mg CAP CAPSULE $0.3255
RIVASTIGMINE TARTRATE 4.5 mg CAP CAPSULE $0.3845
RIVASTIGMINE TARTRATE 6 mg CAP CAPSULE $0.4040
RIZATRIPTAN BENZOATE 10 mg TAB TABLET $0.5832
RIZATRIPTAN BENZOATE 5 mg TAB TABLET $0.8055
RIZATRIPTAN BENZOATE 10 mg TAB TAB ODT $0.8945
RIZATRIPTAN BENZOATE 5 mg TAB TAB ODT $0.9862
ROCURONIUM BROMIDE 10 mg/ml VIAL MILLILITER $0.5635
ROPINIROLE HCL 0.25 mg TAB TABLET $0.0248
ROPINIROLE HCL 0.5 mg TAB TABLET $0.0254
ROPINIROLE HCL 1 mg TAB TABLET $0.0569
ROPINIROLE HCL 2 mg TAB TABLET $0.0628
ROPINIROLE HCL 3 mg TAB TABLET $0.0705
ROPINIROLE HCL 4 mg TAB TABLET $0.0576
ROPINIROLE HCL 5 mg TAB TABLET $0.0705
ROPINIROLE HCL 12 mg TAB ER TABLET $2.6361
ROPINIROLE HCL 2 mg TAB ER TABLET $0.4950
ROPINIROLE HCL 4 mg TAB ER TABLET $1.0005
ROPINIROLE HCL 6 mg TAB ER TABLET $1.9350
ROPINIROLE HCL 8 mg TAB ER TABLET $0.9895
ROPIVACAINE HCL/PF 2 mg/ml VIAL MILLILITER $0.2607
ROPIVACAINE HCL/PF 5 mg/ml VIAL MILLILITER $0.3528
ROSUVASTATIN CALCIUM 10 mg TAB TABLET $0.0855
ROSUVASTATIN CALCIUM 20 mg TAB TABLET $0.0600
ROSUVASTATIN CALCIUM 40 mg TAB TABLET $0.1415
ROSUVASTATIN CALCIUM 5 mg TAB TABLET $0.0550
RUFINAMIDE 40 mg/ml SUSP MILLILITER $3.1590
RUFINAMIDE 200 mg TAB TABLET $7.5575
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
RUFINAMIDE 400 mg TAB TABLET $13.1200
SALICYLIC ACID 27.5% LIQUID-FILM MILLILITER $4.8025
SALICYLIC ACID 6% CREAM MILLILITER $0.0565
SALICYLIC ACID 6% SHAMPOO GRAM $0.1320
SALSALATE 500 mg TAB TABLET $0.5695
SALSALATE 750 mg TAB TABLET $0.5500
SANCTURA 20 mg TAB TABLET $0.4935
SAPROPTERIN DIHYDROCHLORIDE 100 mg TAB SOLUBLE TABLET $32.2000
SAPROPTERIN DIHYDROCHLORIDE 100 mg POWDER EACH $30.6200
SCOPOLAMINE 1 mg/3 day PATCH EACH $12.6282
SELEGILINE HCL 5 mg CAP CAPSULE $1.0675
SELEGILINE HCL 5 mg TAB TABLET $0.9455
SELENIUM SULFIDE 2.25% SHAMPOO GRAM $0.5000
SELENIUM SULFIDE 2.25% LOTION GRAM $0.0849
SENNOSIDES 25 mg TAB TABLET $0.1075
SENNOSIDES 8.8 mg/5 ml SYRUP MILLILITER $0.0487
SENNOSIDES A&B, CALCIUM 8.6 mg TAB TABLET $0.0197
SENNOSIDES/DOCUSATE SODIUM 8.6 mg; 50 mg TAB TABLET $0.0282
SERTRALINE HCL 100 mg TAB TABLET $0.0496
SERTRALINE HCL 20 mg/ml CONC MILLILITER $0.4695
SERTRALINE HCL 25 mg TAB TABLET $0.0345
SERTRALINE HCL 50 mg TAB TABLET $0.0396
SEVELAMER CARBONATE 0.8 gm POWD PACK EACH $9.4600
SEVELAMER CARBONATE 2.4 gm POWD PACK EACH $9.9355
SEVELAMER CARBONATE 800 mg TAB TABLET $0.3180
SEVOFLURANE N/A LIQUID MILLILITER $0.5200
SILDENAFIL CITRATE 20 mg TAB TABLET $0.0885
SILDENAFIL CITRATE 10 mg/ml SUSP MILLILITER $17.4075
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
SILODOSIN 4 mg CAP CAPSULE $1.0800
SILODOSIN 8 mg CAP CAPSULE $0.9385
SILVER SULFADIAZINE 1% CREAM GRAM $0.1500
SIMETHICONE 125 mg CAP CAPSULE $0.0923
SIMETHICONE 125 mg TAB CHEW TABLET $0.0440
SIMETHICONE 180 mg CAP CAPSULE $0.0562
SIMETHICONE 40 mg/0.6 ml DROPS MILLILITER $0.0720
SIMETHICONE 80 mg TAB CHEW TABLET $0.0260
SIMVASTATIN 10 mg TAB TABLET $0.0360
SIMVASTATIN 20 mg TAB TABLET $0.0212
SIMVASTATIN 40 mg TAB TABLET $0.0371
SIMVASTATIN 5 mg TAB TABLET $0.0200
SIMVASTATIN 80 mg TAB TABLET $0.0903
SIROLIMUS 0.5 mg TAB TABLET $3.9635
SIROLIMUS 1 mg TAB TABLET $5.7690
SIROLIMUS 2 mg TAB TABLET $11.6595
SIROLIMUS 1 mg/ml SOLN MILLILITER $15.6500
SODIUM BENZOATE/SOD PHENYLACET 10-10% SOLN MILLILITER $202.4500
SODIUM BICARBONATE 1 mEq/ml VIAL EACH $0.2064
SODIUM BICARBONATE 650 mg TAB TABLET $0.0135
SODIUM CHLORIDE 0.9% IV SOLN MILLILITER $0.0041
SODIUM CHLORIDE 0.9% VIAL MILLILITER $0.0430
SODIUM CHLORIDE 5% DROPS MILLILITER $0.3475
SODIUM CHLORIDE 2.5 mEq/ml SOLN MILLILITER $0.0778
SODIUM CHLORIDE 4 mEq/ml SOLN MILLILITER $0.0921
SODIUM CHLORIDE IRRIG SOLUTION 0.9% IRRIG SOLN MILLILITER $0.0058
SODIUM CHLORIDE/SODIUM BICARBONATE 420 g SOLN GRAM $0.0041
SODIUM CHLORIDE FOR INHALATION 0.9% VIAL MILLILITER $0.0850
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
SODIUM FERRIC GLUCONATE COMPLEX 62.5 mg/5ml SOLN MILLILITER $1.6000
SODIUM FLUORIDE 0.5 mg TAB CHEW TABLET $0.0300
SODIUM FLUORIDE 0.25 mg TAB CHEW TABLET $0.0450
SODIUM FLUORIDE 0.5 mg/ml DROPS MILLILITER $0.1355
SODIUM FLUORIDE 1 mg TAB, CHEW TABLET $0.0450
SODIUM FLUORIDE 1.1% CREAM GRAM $0.0720
SODIUM PHENYLBUTYRATE 0.94 g/g POWDER GRAM $17.7000
SODIUM SULFATE/SODIUM CHLORIDE/ SODIUM BICARBONATE/POTASSIUM CHLORIDE/POLYETHYLENE GLYCOL
N/A SOLN MILLILITER $0.0035
SODIUM PHOSPHATE, MONO-DIBASIC 19 g-7 g/118 ENEMA MILLILITER $0.0065
SOD PHOS DI, MONO/K PHOS MONO 250 mg CAP CAPLET $0.3100
SODIUM POLYSTYRENE SULFONATE N/A POWDER GRAM $0.0955
SODIUM POLYSTYRENE SULFONATE 15 gm/60 ml ORAL SUSP MILLILITER $0.0606
SOD/POT/K CIT/SOD CIT/CIT ACID 500-550/5 SOLN MILLILITER $0.0385
SOLIFENACIN SUCCINATE 10 mg TAB TABLET $0.1950
SOLIFENACIN SUCCINATE 5 mg TAB TABLET $0.1800
SOTALOL HCL 120 mg TAB TABLET $0.1190
SOTALOL HCL 160 mg TAB TABLET $0.1800
SOTALOL HCL 240 mg TAB TABLET $0.1500
SOTALOL HCL 80 mg TAB TABLET $0.0540
SPIRONOLACTONE/HCTZ 25 mg; 25 mg TAB TABLET $0.6054
SPIRONOLACTONE 100 mg TAB TABLET $0.1856
SPIRONOLACTONE 25 mg TAB TABLET $0.0534
SPIRONOLACTONE 50 mg TAB TABLET $0.1151
STAVUDINE 15 mg CAP CAPSULE $1.2625
STAVUDINE 20 mg CAP CAPSULE $0.8880
STAVUDINE 30 mg CAP CAPSULE $1.3345
STAVUDINE 40 mg CAP CAPSULE $0.8160
SUCRALFATE 1 gm TAB TABLET $0.1650
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
SUCRALFATE 1 gm/10ml SUSP MILLILITER $0.3845
SULFACETAMIDE SODIUM 10% OPTH SOLN MILLILITER $2.3885
SULFACETAMIDE SODIUM 10% TOP SUSP MILLILITER $0.6865
SULFACETAMIDE SODIUM/SULFUR 10%-2% CREAM GRAM $7.3950
SULFACETAMIDE SODIUM/SULFUR 10-5% (w/w) CLEANSER GRAM $0.1443
SULFACETAMIDE SODIUM/SULFUR 9%-4.5% CLEANSER GRAM $0.2277
SULFACETAMIDE SODIUM/SULFUR 9.8%-4.8% CLEANSER GRAM $0.6841
SULFACETAMIDE/PREDNISOLONE SP 10%-0.23% DROPS MILLILITER $1.7824
SULFADIAZINE 500 mg TAB TABLET $3.6700
SULFASALAZINE 500 mg TAB TABLET $0.1714
SULFASALAZINE 500 mg TAB DR TABLET $0.1645
SULINDAC 150 mg TAB TABLET $0.1455
SULINDAC 200 mg TAB TABLET $0.1825
SUMATRIPTAN SUCC/NAPROXEN SOD 85 mg; 500 mg TAB TABLET $20.3700
SUMATRIPTAN SUCCINATE 100 mg TAB TABLET $0.5552
SUMATRIPTAN SUCCINATE 25 mg TAB TABLET $0.4085
SUMATRIPTAN SUCCINATE 4 mg/0.5 ml KIT EACH $140.2500
SUMATRIPTAN SUCCINATE 4 mg/0.5 ml REFILL EACH $190.9500
SUMATRIPTAN SUCCINATE 4 mg/0.5 ml SOLN MILLILITER $128.0965
SUMATRIPTAN SUCCINATE 50 mg TAB TABLET $0.4995
SUMATRIPTAN SUCCINATE 6 mg/0.5 ml KIT EACH $75.8015
SUMATRIPTAN SUCCINATE 6 mg/0.5 ml REFILL EACH $105.9533
SUMATRIPTAN SUCCINATE 6 mg/0.5 ml VIAL MILLILITER $22.4170
SUMATRIPTAN 20 mg NASAL SPRAY MILLILITER $38.5123
SUMATRIPTAN 5 mg NASAL SPRAY MILLILITER $41.6225
TACROLIMUS 0.03% OINT GRAM $2.6143
TACROLIMUS 0.1% OINT GRAM $2.0345
TADALAFIL 10 mg TAB TABLET $0.5240
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
TADALAFIL 5 mg TAB TABLET $0.1510
TADALAFIL 20 mg TAB TABLET $0.7705
TADALAFIL 2.5 mg TAB TABLET $0.8365
TAMOXIFEN CITRATE 10 mg TAB TABLET $0.2700
TAMOXIFEN CITRATE 20 mg TAB TABLET $0.4900
TAMSULOSIN HCL 0.4 mg CAP SR 24HR CAPSULE $0.0675
TAVABOROLE 5% TOP SOLN MILLILITER $92.5400
TAZAROTENE 0.1% CREAM GRAM $2.9550
TELMISARTAN 20 mg TAB TABLET $0.2575
TELMISARTAN 40 mg TAB TABLET $0.2100
TELMISARTAN 80 mg TAB TABLET $0.2575
TELMISARTAN/HYDROCHLOROTHIAZIDE 40 mg; 12.5 mg TAB TABLET $0.7175
TELMISARTAN/HYDROCHLOROTHIAZIDE 80 mg; 12.5 mg TAB TABLET $0.5890
TELMISARTAN/HYDROCHLOROTHIAZIDE 80 mg; 25 mg TAB TABLET $1.0255
TELMISARTAN/AMLODIPINE 80 mg; 10 mg TAB TABLET $5.7300
TELMISARTAN/AMLODIPINE 80 mg; 5 mg TAB TABLET $3.0815
TELMISARTAN/AMLODIPINE 40 mg; 5 mg TAB TABLET $2.4925
TEMAZEPAM 15 mg CAP CAPSULE $0.0589
TEMAZEPAM 22.5 mg CAP CAPSULE $3.0715
TEMAZEPAM 30 mg CAP CAPSULE $0.0644
TEMAZEPAM 7.5 mg CAP CAPSULE $1.6310
TEMOZOLOMIDE 100 mg CAP CAPSULE $7.8635
TEMOZOLOMIDE 140 mg CAP CAPSULE $11.9850
TEMOZOLOMIDE 180 mg CAP CAPSULE $14.6400
TEMOZOLOMIDE 20 mg CAP CAPSULE $1.7035
TEMOZOLOMIDE 250 mg CAP CAPSULE $15.9165
TEMOZOLOMIDE 5 mg CAP CAPSULE $0.9165
TEMSIROLIMUS FDN 30 mg/3 VIAL MILLILITER $975.000
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
TENOFOVIR DISOPROXIL FUMARATE 300 mg TAB TABLET $0.3950
TERAZOSIN 1 mg CAP CAPSULE $0.1038
TERAZOSIN 10 mg CAP CAPSULE $0.0845
TERAZOSIN 2 mg CAP CAPSULE $0.1012
TERAZOSIN 5 mg CAP CAPSULE $0.0915
TERBINAFINE HCL 250 mg TAB TABLET $0.1345
TERBINAFINE HCL 1% CREAM GRAM $0.3280
TERBUTALINE SULFATE 1 mg/ml SOLN MILLILITER $7.9300
TERBUTALINE SULFATE 5 mg TAB TABLET $0.9600
TERCONAZOLE 0.4% CREAM GRAM $0.4488
TERCONAZOLE 0.8% CREAM GRAM $1.1632
TERCONAZOLE 80 mg SUPP EACH $23.7928
TESTOSTERONE 1.25 gm (1%) GEL GRAM $0.8525
TESTOSTERONE 1.25 gm-1.62% GEL GRAM $10.3175
TESTOSTERONE 1.62% GEL PUMP GRAM $0.7426
TESTOSTERONE 10 mg (2%) GEL GRAM $5.4655
TESTOSTERONE 200 mg/ml (1 ml) VIAL MILLILITER $15.2844
TESTOSTERONE 200 mg/ml (10 ml) VIAL MILLILITER $4.9570
TESTOSTERONE 2.5 gm-1.62% GEL GRAM $9.4045
TESTOSTERONE 25 mg (1%) GEL GRAM $1.6650
TESTOSTERONE 30 mg/1.5 ml TRANSDERMAL
PUMP EACH $1.0575
TESTOSTERONE 50 mg (1%) GEL GRAM $1.1129
TESTOSTERONE 50 mg (1%) GEL PACKET GRAM $1.0348
TESTOSTERONE CYPIONATE 100 mg/ml VIAL EACH $3.5450
TESTOSTERONE CYPIONATE 200 mg/ml (1 ml) VIAL MILLILITER $9.9500
TESTOSTERONE CYPIONATE 200 mg/ml (10 ml) VIAL MILLILITER $3.9500
TESTOSTERONE ENANTHATE 200 mg/ml VIAL EACH $11.7355
TETRABENAZINE 12.5 mg TAB TABLET $6.0650
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
TETRABENAZINE 25 mg TAB TABLET $2.5155
TETRACAINE HCL 0.5% DROPS MILLILITER $0.5355
TETRACYCLINE HCL 250 mg CAP CAPSULE $0.2445
TETRACYCLINE HCL 500 mg CAP CAPSULE $1.2350
TETRAHYDROZ/DEXT 70/PEG 400/PV 0.05-.1-1% DROPS MILLILITER $0.0932
TETRAHYDROZOLINE HCL 0.05% DROPS MILLILITER $0.0795
THEOPHYLLINE 200 mg TAB SR 12HR TABLET $0.4446
THEOPHYLLINE 300 mg TAB SR 12HR TABLET $0.4455
THEOPHYLLINE ANHYDROUS 100 mg TAB ER TABLET $0.3603
THEOPHYLLINE ANHYDROUS 400 mg TAB ER TABLET $0.5100
THEOPHYLLINE ANHYDROUS 600 mg TAB ER TABLET $0.8100
THEOPHYLLINE ANHYDROUS 80 mg/15 ml LIQUID MILLILITER $0.1575
THIAMINE HCL (VITAMIN B-1)
100 mg TAB TABLET $0.0299
THIAMINE HCL (VITAMIN B-1)
50 mg TAB TABLET $0.0237
THIAMINE HCL (VITAMIN B-1)
100 mg/ml VIAL MILLILITER $4.0407
THIORIDAZINE HCL 10 mg TAB TABLET $0.4650
THIORIDAZINE HCL 100 mg TAB TABLET $0.9150
THIORIDAZINE HCL 25 mg TAB TABLET $0.5111
THIORIDAZINE HCL 50 mg TAB TABLET $0.3720
THIOTEPA 15 mg VIAL EACH $701.6550
THIOTHIXENE 1 mg CAP CAPSULE $0.7650
THIOTHIXENE 10 mg CAP CAPSULE $2.1750
THIOTHIXENE 2 mg CAP CAPSULE $1.1346
THIOTHIXENE 5 mg CAP CAPSULE $1.5450
THYROID, PORK 120 mg TAB TABLET $0.9750
THYROID, PORK 15 mg TAB TABLET $0.3225
THYROID, PORK 30 mg TAB TABLET $0.3899
THYROID, PORK 60 mg TAB TABLET $0.4205
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
THYROID, PORK 90 mg TAB TABLET $0.7126
TIAGABINE HCL 2 mg TAB TABLET $4.0915
TIAGABINE HCL 4 mg TAB TABLET $3.7765
TIGECYCLINE 50 mg VIAL EACH $74.0850
TIMOLOL MALEATE/DORZOLAMIDE HCL 0.5%-2% DROPS MILLILITER $0.8970
TIMOLOL MALEATE/PF 0.5% SOLN EACH $5.4250
TIMOLOL MALEATE 0.25% GEL MILLILITER $21.0452
TIMOLOL MALEATE 0.25% OPTH SOLN MILLILITER $0.5079
TIMOLOL MALEATE 0.5% GEL MILLILITER $22.0275
TIMOLOL MALEATE 0.5% OPTH SOLN MILLILITER $0.6605
TIMOLOL MALEATE 5 mg TAB TABLET $0.9950
TINIDAZOLE 250 mg TAB TABLET $1.9142
TINIDAZOLE 500 mg TAB TABLET $1.8335
TIOCONAZOLE 6.5% OINT GRAM $2.1545
TIZANIDINE HCL 2 mg CAP CAPSULE $0.1935
TIZANIDINE HCL 2 mg TAB TABLET $0.0645
TIZANIDINE HCL 4 mg CAP CAPSULE $0.1212
TIZANIDINE HCL 4 mg TAB TABLET $0.0300
TIZANIDINE HCL 6 mg CAP CAPSULE $0.5580
TOBRAMYCIN 300 mg/4 ml AMPUL MILLILITER $18.7225
TOBRAMYCIN 0.3% DROPS MILLILITER $0.9600
TOBRAMYCIN IN 0.225% NACL 300 mg/5 ml AMPUL MILLILITER $3.7754
TOBRAMYCIN SULFATE 1.2 gm VIAL EACH $101.9813
TOBRAMYCIN SULFATE 40 mg/ml VIAL MILLILITER $0.6773
TOBRAMYCIN SULFATE/DEXAMETHASONE 0.3-0.1% SUSP MILLILITER $13.6896
TOLCAPONE 100 mg TAB TABLET $119.9915
TOLNAFTATE 1% CREAM GRAM $0.0800
TOLNAFTATE 1% POWDER GRAM $0.0576
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
TOLNAFTATE 1% AEROSOL POWDER
GRAM $0.0265
TOLTERODINE TARTRATE 1 mg TAB TABLET $0.7465
TOLTERODINE TARTRATE 2 mg TAB TABLET $0.5550
TOLTERODINE TARTRATE 2 mg CAP ER 24HR CAPSULE $1.6005
TOLTERODINE TARTRATE 4 mg CAP ER 24HR CAPSULE $1.2615
TOLVAPTAN 30 mg TAB TABLET $366.8655
TOPIRAMATE 100 mg TAB TABLET $0.0665
TOPIRAMATE 15 mg CAP SPRINKLE CAPSULE $0.3476
TOPIRAMATE 200 mg TAB TABLET $0.0965
TOPIRAMATE 25 mg CAP SPRINKLE CAPSULE $0.3545
TOPIRAMATE 25 mg TAB TABLET $0.0285
TOPIRAMATE 50 mg TAB TABLET $0.0325
TOPOTECAN HCL 4 mg VIAL EACH $157.5000
TOPOTECAN HCL 4 mg/4 ml VIAL MILLILITER $11.2150
TOREMIFENE CITRATE 60 mg TAB TABLET $25.5500
TORSEMIDE 10 mg TAB TABLET $0.0675
TORSEMIDE 100 mg TAB TABLET $0.1875
TORSEMIDE 20 mg TAB TABLET $0.0866
TORSEMIDE 5 mg TAB TABLET $0.0665
TRAMADOL 50 mg TAB TABLET $0.0176
TRAMADOL HCL (ULTRAM ER)
100 mg TAB ER 24HR TABLET $0.7745
TRAMADOL HCL (RYZOLT ER)
100 mg TAB ER 24HR TABLET $1.4035
TRAMADOL HCL (ULTRAM ER)
200 mg TAB ER 24HR TABLET $1.3200
TRAMADOL HCL (RYZOLT ER)
200 mg TAB ER 24HR TABLET $2.0035
TRAMADOL HCL (ULTRAM ER)
300 mg TAB ER 24HR TABLET $2.2566
TRAMADOL HCL (RYZOLT ER)
300 mg TAB ER 24HR TABLET $3.1935
TRAMADOL HCL/APAP 37.5 mg; 325 mg TAB TABLET $0.1200
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
TRANDOLAPRIL 1 mg TAB TABLET $0.1910
TRANDOLAPRIL 2 mg TAB TABLET $0.1290
TRANDOLAPRIL 4 mg TAB TABLET $0.1910
TRANDOLAPRIL/VERAPAMIL HCL 2 mg; 180 mg TAB ER TABLET $4.8330
TRANDOLAPRIL/VERAPAMIL HCL 1 mg; 240 mg TAB ER TABLET $3.4915
TRANDOLAPRIL/VERAPAMIL HCL 2 mg; 240 mg TAB ER TABLET $3.5000
TRANDOLAPRIL/VERAPAMIL HCL 4 mg; 240 mg TAB ER TABLET $4.8330
TRANEXAMIC ACID 1,000 mg/10 ml VIAL MILLILITER $1.9000
TRANEXAMIC ACID 650 mg TAB TABLET $1.5565
TRANYLCYPROMINE SULFATE 10 mg TAB TABLET $1.1175
TRAVOPROST 0.004% DROPS MILLILITER $45.6355
TRAZODONE HCL 100 mg TAB TABLET $0.0625
TRAZODONE HCL 150 mg TAB TABLET $0.0900
TRAZODONE HCL 300 mg TAB TABLET $1.2695
TRAZODONE HCL 50 mg TAB TABLET $0.0475
TREPROSTINIL SODIUM 1 mg/ml VIAL MILLILITER $37.7755
TREPROSTINIL SODIUM 2.5 mg/ml VIAL MILLILITER $94.4285
TREPROSTINIL SODIUM 5 mg/ml VIAL MILLILITER $188.8565
TREPROSTINIL SODIUM 10 mg/ml VIAL MILLILITER $377.7135
TRETINOIN MICROSPHERES 0.04% GEL GRAM $7.2525
TRETINOIN MICROSPHERES 0.04% GEL GRAM $6.2735
TRETINOIN MICROSPHERES 0.1% GEL GRAM $7.7465
TRETINOIN MICROSPHERES 0.1% GEL GRAM $4.9295
TRETINOIN 10 mg CAP CAPSULE $18.8855
TRETINOIN 0.01% GEL GRAM $2.1045
TRETINOIN 0.025% CREAM GRAM $1.4050
TRETINOIN 0.025% GEL GRAM $2.1985
TRETINOIN 0.05% CREAM GRAM $2.0000
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
TRETINOIN 0.05% GEL GRAM $4.3315
TRETINOIN 0.1% CREAM GRAM $1.8925
TRIAMCINOLONE ACETONIDE 0.025% LOTION MILLILITER $0.3885
TRIAMCINOLONE ACETONIDE 0.1% CREAM GRAM $0.0388
TRIAMCINOLONE ACETONIDE 0.1% LOTION MILLILITER $0.2795
TRIAMCINOLONE ACETONIDE 0.1% OINT GRAM $0.0545
TRIAMCINOLONE ACETONIDE 0.1% PASTE GRAM $4.0500
TRIAMCINOLONE ACETONIDE 0.147 mg/g AEROSOL GRAM $2.8550
TRIAMCINOLONE ACETONIDE 0.5% CREAM GRAM $0.1605
TRIAMCINOLONE ACETONIDE 0.025% (15 gm) CREAM GRAM $0.1630
TRIAMCINOLONE ACETONIDE 0.025% CREAM GRAM $0.0805
TRIAMCINOLONE ACETONIDE 0.025% OINT GRAM $0.0935
TRIAMCINOLONE ACETONIDE 0.5% OINT GRAM $0.2580
TRIAMCINOLONE ACETONIDE 55 mcg NASAL SPRAY
MILLILITER $0.6625
TRIAMCINOLONE ACETONIDE 40 mg/ml SUSP MILLILITER $6.4500
TRIAMTERENE/HYDROCHLOROTHIAZIDE 37.5 mg; 25 mg CAP CAPSULE $0.1643
TRIAMTERENE/HYDROCHLOROTHIAZIDE 37.5 mg; 25 mg TAB TABLET $0.0810
TRIAMTERENE/HYDROCHLOROTHIAZIDE 75 mg; 50 mg TAB TABLET $0.0840
TRIAZOLAM 0.125 mg TAB TABLET $1.0515
TRIAZOLAM 0.25 mg TAB TABLET $1.0150
TRIENTINE HCL 250 mg CAP CAPSULE $50.0000
TRIFLUOPERAZINE HCL 1 mg TAB TABLET $0.5800
TRIFLUOPERAZINE HCL 10 mg TAB TABLET $1.3403
TRIFLUOPERAZINE HCL 2 mg TAB TABLET $0.7500
TRIFLUOPERAZINE HCL 5 mg TAB TABLET $0.8935
TRIFLURIDINE 1% DROPS MILLILITER $16.9400
TRIHEXYPHENIDYL HCL 2 mg TAB TABLET $0.0660
TRIHEXYPHENIDYL HCL 2 mg/5 ml ELIXIR MILLILITER $0.0505
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
TRIHEXYPHENIDYL HCL 5 mg TAB TABLET $0.1350
TRIMETHOBENZAMIDE HCL 300 mg CAP CAPSULE $1.2035
TRIMETHOPRIM AND SULFAMETHOXAZOLE 40 mg, 200 mg per 5 ml SUSP MILLILITER $0.1005
TRIMETHOPRIM AND SULFAMETHOXAZOLE DS
160 mg; 800 mg TAB TABLET $0.0575
TRIMETHOPRIM AND SULFAMETHOXAZOLE SS
80 mg; 400 mg TAB TABLET $0.0435
TRIMETHOPRIM/POLYMYXIN B 1 mg/10,000 units/ml OPTH SOLN MILLILITER $0.4824
TRIMETHOPRIM 100 mg TAB TABLET $0.2388
TRIMIPRAMINE MALEATE 100 mg CAP CAPSULE $3.7555
TRIMIPRAMINE MALEATE 25 mg CAP CAPSULE $3.1555
TRIMIPRAMINE MALEATE 50 mg CAP CAPSULE $4.4555
TRIPROLIDINE/PSEUDOEPHEDRINE 2.5 mg; 60 mg TAB TABLET $0.0713
TRIPROLIDINE HCL 0.625 mg/ml DROPS MILLILITER $1.2000
TRIPROLIDINE HCL 0.313 mg/ml DROPS MILLILITER $1.5000
TRIPROLIDINE HCL 0.938 mg/ml DROPS MILLILITER $0.4935
TRIPROLIDINE HCL 2.5 mg/5 ml LIQUID MILLILITER $0.1788
TROSPIUM CHLORIDE 60 mg CAP ER 24HR CAPSULE $3.6255
TRUEPLUS LANCETS (NDC 56151-0147-01)
33 g LANCET EACH $0.0620
TRUEPLUS SYRINGE (NDC 56151-1731-01)
0.3 ml; 31 g x 5/16” SYRINGE EACH $0.1900
TRUEPLUS SYRINGE (NDC 56151-1712-01)
0.5 ml; 29 g x 1/2" SYRINGE EACH $0.1900
TRUEPLUS SYRINGE (NDC 56151-1722-01)
0.5 ml; 30 g x 5/16” SYRINGE EACH $0.1900
TRUEPLUS SYRINGE (NDC 56151-1732-01)
0.5 ml; 31 g x 5/16” SYRINGE EACH $0.1900
TRUEPLUS SYRINGE (NDC 56151-1733-01)
1 ml; 31 g x 5/16” SYRINGE EACH $0.1900
ULTRA COMFORT SYRINGE (NDC 08396-8009-00)
0.3 ml; 31 g x 5/16” (1/2)
SYRINGE EACH $0.1900
ULTRA COMFORT SYRINGE (NDC 08396-8007-00)
0.5 ml; 30 g x 5/16” SYRINGE EACH $0.1900
ULTRA COMFORT SYRINGE (NDC 08396-8010-00
0.5 ml; 31 g x 5/16” SYRINGE EACH $0.1900
URSODIOL 250 mg TAB TABLET $0.5265
URSODIOL 300 mg CAP CAPSULE $0.5790
URSODIOL 500 mg TAB TABLET $1.3135
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
VALACYCLOVIR HCL 1,000 mg TAB TABLET $0.4849
VALACYCLOVIR HCL 500 mg TAB TABLET $0.2675
VALGANCICLOVIR HCL 450 mg TAB TABLET $3.4815
VALGANCICLOVIR HCL 50 mg/ml SOLN MILLILITER $8.5095
VALPROIC ACID 250 mg/5 ml SYRINGE MILLILITER $0.0150
VALPROIC ACID 250 mg CAP CAPSULE $0.1548
VALPROIC ACID (AS SODIUM SALT) 250 mg/5 ml SOLN MILLILITER $0.1385
VALPROIC ACID (AS SODIUM SALT) 500 mg/10 ml SOLN MILLILITER $0.0960
VALSARTAN 160 mg TAB TABLET $0.1200
VALSARTAN 320 mg TAB TABLET $0.1289
VALSARTAN 40 mg TAB TABLET $0.0875
VALSARTAN 80 mg TAB TABLET $0.0700
VALSARTAN/HYDROCHLOROTHIAZIDE 160 mg; 12.5 mg TAB TABLET $0.1956
VALSARTAN/HYDROCHLOROTHIAZIDE 160 mg; 25 mg TAB TABLET $0.2553
VALSARTAN/HYDROCHLOROTHIAZIDE 320 mg; 12.5 mg TAB TABLET $0.2285
VALSARTAN/HYDROCHLOROTHIAZIDE 320 mg; 25 mg TAB TABLET $0.2335
VALSARTAN/HYDROCHLOROTHIAZIDE 80 mg; 12.5 mg TAB TABLET $0.1365
VANCOMYCIN HCL 125 mg CAP CAPSULE $1.9814
VANCOMYCIN HCL 250 mg CAP CAPSULE $3.3735
VANCOMYCIN HCL 1 gm VIAL EACH $4.7350
VANCOMYCIN HCL 5 gm VIAL EACH $19.6419
VANCOMYCIN HCL 10 gm VIAL EACH $33.3500
VANCOMYCIN HCL 500 mg VIAL EACH $3.8536
VENLAFAXINE HCL 100 mg TAB TABLET $0.0945
VENLAFAXINE HCL 150 mg CAP SA 24HR CAPSULE $0.1515
VENLAFAXINE HCL 150 mg TAB ER TABLET $1.7500
VENLAFAXINE HCL 25 mg TAB TABLET $0.0850
VENLAFAXINE HCL 225 mg TAB ER TABLET $2.4650
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
VENLAFAXINE HCL 37.5 mg CAP SA 24HR CAPSULE $0.0955
VENLAFAXINE HCL 37.5 mg TAB TABLET $0.0600
VENLAFAXINE HCL 37.5 mg TAB ER TABLET $2.2855
VENLAFAXINE HCL 50 mg TAB TABLET $0.0725
VENLAFAXINE HCL 75 mg CAP SA 24HR CAPSULE $0.0930
VENLAFAXINE HCL 75 mg TAB TABLET $0.0690
VENLAFAXINE HCL 75 mg TAB ER TABLET $2.0845
VENLAFAXINE HCL 750 mg VIAL EACH $10.0955
VERAPAMIL HCL 100 mg CAP ER CAPSULE $0.7855
VERAPAMIL HCL 120 mg CAP SR CAPSULE $0.8213
VERAPAMIL HCL 120 mg TAB SR TABLET $0.1745
VERAPAMIL HCL 120 mg TAB TABLET $0.0923
VERAPAMIL HCL 180 mg CAP SR CAPSULE $0.6435
VERAPAMIL HCL 180 mg TAB SR TABLET $0.1435
VERAPAMIL HCL 2.5 mg/ml VIAL MILLILITER $7.3290
VERAPAMIL HCL 200 mg CAP ER CAPSULE $1.1625
VERAPAMIL HCL 240 mg CAP SR CAPSULE $0.1665
VERAPAMIL HCL 240 mg TAB SR TABLET $0.1032
VERAPAMIL HCL 300 mg CAP ER CAPSULE $1.6215
VERAPAMIL HCL 360 mg CAP SR CAPSULE $4.2588
VERAPAMIL HCL 40 mg TAB TABLET $0.1310
VERAPAMIL HCL 80 mg TAB TABLET $0.0440
VIGABATRIN 500 mg POWDER EACH $64.9100
VIGABATRIN 500 mg TAB TABLET $109.9900
VINCRISTINE SULFATE 1 mg/ml VIAL MILLILITER $5.1000
VINCRISTINE SULFATE 2 mg/2 ml VIAL MILLILITER $7.0274
VINORELBINE TARTRATE 10 mg/ml VIAL MILLILITER $23.6250
VINORELBINE TARTRATE 50 mg/5 ml VIAL MILLILITER $11.6725
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
VITAMIN A/VITAMIN C/ VITAMIN E/ZINC/COPPER
14,320-226 CAP CAPSULE $0.2122
VITAMIN A AND D/WHITE PET/LANOLIN N/A OINT GRAM $0.0220
VITAMIN B COMPLEX N/A CAP CAPSULE $0.0281
VIT B COMP NO. 3/FOLIC/C/BIOTIN 1 mg; 60 mg TAB TABLET $0.1493
VITAMIN C/VITAMIN E ACETATE/ LUTEIN/COPPER/ZINC
226-200-5 CAP CAPSULE $00.1721
VORICONAZOLE 200 mg TAB TABLET $2.5650
VORICONAZOLE 200 mg VIAL EACH $29.5500
VORICONAZOLE 200 mg/5 ml SUSP MILLILITER $9.4750
VORICONAZOLE 50 mg TAB TABLET $2.2265
WARFARIN SODIUM 1 mg TAB TABLET $0.0685
WARFARIN SODIUM 10 mg TAB TABLET $0.0685
WARFARIN SODIUM 2 mg TAB TABLET $0.1050
WARFARIN SODIUM 2.5 mg TAB TABLET $0.0645
WARFARIN SODIUM 3 mg TAB TABLET $0.0955
WARFARIN SODIUM 4 mg TAB TABLET $0.0775
WARFARIN SODIUM 5 mg TAB TABLET $0.0540
WARFARIN SODIUM 6 mg TAB TABLET $0.0725
WARFARIN SODIUM 7.5 mg TAB TABLET $0.0725
WATER FOR INJECTION, STERILE N/A VIAL EACH $0.1006
ZAFIRLUKAST 10 mg TAB TABLET $1.0645
ZAFIRLUKAST 20 mg TAB TABLET $0.5330
ZALEPLON 10 mg CAP CAPSULE $0.1728
ZALEPLON 5 mg CAP CAPSULE $0.1724
ZIDOVUDINE 100 mg CAP CAPSULE $1.3950
ZIDOVUDINE 300 mg TAB TABLET $0.2345
ZIDOVUDINE 50 mg/5 ml SYRINGE MILLILITER $0.1235
ZILEUTON 600 mg TAB ER 12HR TABLET $13.5020
ZINC OXIDE 20% OINT GRAM $0.0133
STATE MAC LIST
OFFICE OF MEDICAL ASSISTANCE PROGRAMS
Effective September 10, 2021
NAME OF GENERIC DRUG STRENGTH FORM UNIT Final Price
ZIPRASIDONE HCL 20 mg CAP CAPSULE $0.2625
ZIPRASIDONE HCL 40 mg CAP CAPSULE $0.2445
ZIPRASIDONE HCL 60 mg CAP CAPSULE $0.2550
ZIPRASIDONE HCL 80 mg CAP CAPSULE $0.3155
ZIPRASIDONE HCL 20 mg/ml VIAL EACH $42.2633
ZOLEDRONIC ACID 4 mg/5 ml VIAL MILLILITER $7.4000
ZOLEDRONIC ACID/MANNITOL-WATER (RECLAST)
5 mg/100 ml SOLN MILLILITER $1.1000
ZOLEDRONIC ACID/MANNITOL-WATER 5 mg/100 ml SOLN MILLILITER $1.1000
ZOLMITRIPTAN 2.5 mg TAB ODT TABLET $2.5935
ZOLMITRIPTAN 2.5 mg TAB TABLET $1.2275
ZOLMITRIPTAN 5 mg TAB ODT TABLET $2.8115
ZOLMITRIPTAN 5 mg TAB TABLET $1.1475
ZOLPIDEM TARTRATE 10 mg TAB TABLET $0.0275
ZOLPIDEM TARTRATE 1.75 mg TAB SL TABLET $6.7865
ZOLPIDEM TARTRATE 12.5 mg TAB ER TABLET $0.2165
ZOLPIDEM TARTRATE 3.5 mg TAB SL TABLET $5.8565
ZOLPIDEM TARTRATE 5 mg TAB TABLET $0.0318
ZOLPIDEM TARTRATE 6.25 mg TAB ER TABLET $0.1595
ZONISAMIDE 100 mg CAP CAPSULE $0.1201
ZONISAMIDE 25 mg CAP CAPSULE $0.0845
ZONISAMIDE 50 mg CAP CAPSULE $0.1350