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Page 1 of 1 Medicaid Claims January - March 2008 WAC = Wholesaler Acquisition Cost MAC = Maximum Allowable Cost NDC's with $1,000 or more in claims Generic Code is the generic ID code TC3 is the therapeutic classification sy 4/22/2008 Generic Code and TC3 can be used to sort and group like i AWP = Average Wholesale Price NDC Drug Name Wac Price Smac Price Fmac Price Awp Price TC3 Paid Amt Claims Ct Drug Qty Days Supp 00603702073 A-B OTIC EAR DROPS 0.16850 0.20533 14019 Q8H $28,379.99 4,304 64,800 52,478 57665010141 ABELCET 5 MG/ML VIAL P-F 9.25000 12.00000 07382 W3A $13,698.86 1 1,400 14 57665010141 ABELCET 5 MG/ML VIAL P-F 9.25000 12.00000 07382 C5K $1,726.44 2 200 14 Generic Code

€¦ · XLS file · Web view · 2008-04-23imitrex 6 mg/0.5 ml kit ref 24708 00173047900 imitrex 6 mg/0.5 ml syrng k 50741 00173048900 zofran 4 mg/5 ml oral soln 00173050100 retrovir

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Page 1: €¦ · XLS file · Web view · 2008-04-23imitrex 6 mg/0.5 ml kit ref 24708 00173047900 imitrex 6 mg/0.5 ml syrng k 50741 00173048900 zofran 4 mg/5 ml oral soln 00173050100 retrovir

Page 1 of 1

Medicaid Claims January - March 2008 WAC = Wholesaler Acquisition Cost MAC = Maximum Allowable Cost NDC's with $1,000 or more in claims Generic Code is the generic ID code TC3 is the therapeutic classification system

4/22/2008 Generic Code and TC3 can be used to sort and group like items AWP = Average Wholesale Price

NDC Drug Name Wac Price Smac Price Fmac Price Awp Price TC3 Paid Amt Claims Ct Drug Qty Days Supp

00603702073 A-B OTIC EAR DROPS 0.16850 0.20533 14019 Q8H $28,379.99 4,304 64,800 52,47857665010141 ABELCET 5 MG/ML VIAL P-F 9.25000 12.00000 07382 W3A $13,698.86 1 1,400 1457665010141 ABELCET 5 MG/ML VIAL P-F 9.25000 12.00000 07382 C5K $1,726.44 2 200 14

Generic Code

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