2020 Essential Asthma Drug Lists with WAC (Wholesale Acquisition Cost) as required by NRS 439B.630
NDC Drug WAC Manufacturer
00173-0695-00 ADVAIR 100-50 DISKUS $5.28 GLAXOSMITHKLINE
00173-0695-04 ADVAIR 100-50 DISKUS $10.84 GLAXOSMITHKLINE
00173-0696-00 ADVAIR 250-50 DISKUS $6.57 GLAXOSMITHKLINE
00173-0696-04 ADVAIR 250-50 DISKUS $10.84 GLAXOSMITHKLINE
00173-0697-00 ADVAIR 500-50 DISKUS $8.64 GLAXOSMITHKLINE
00173-0697-04 ADVAIR 500-50 DISKUS $17.66 GLAXOSMITHKLINE
00173-0716-20 ADVAIR HFA 115-21 MCG INHALE $32.83 GLAXOSMITHKLINE
00173-0716-22 ADVAIR HFA 115-21 MCG INHALE $26.56 GLAXOSMITHKLINE
00173-0717-20 ADVAIR HFA 230-21 MCG INHALE $43.17 GLAXOSMITHKLINE
00173-0717-22 ADVAIR HFA 230-21 MCG INHALE $39.39 GLAXOSMITHKLINE
00173-0715-20 ADVAIR HFA 45-21 MCG INHALER $26.42 GLAXOSMITHKLINE
00173-0715-22 ADVAIR HFA 45-21 MCG INHALER $26.56 GLAXOSMITHKLINE
59310-0812-06 AIRDUO RESPICLICK 113-14 MCG $320.23 TEVA SPECIALTY
59310-0822-06 AIRDUO RESPICLICK 232-14 MCG $320.23 TEVA SPECIALTY
59310-0805-06 AIRDUO RESPICLICK 55-14 MCG $320.23 TEVA SPECIALTY
00487-9901-30 ALBUTEROL 2.5 MG/0.5 ML SOL $0.38 NEPHRON CORP
50383-0741-20 ALBUTEROL 5 MG/ML SOLUTION $2.41 HI-TECH/AKORN C
00093-3174-31 ALBUTEROL HFA 90 MCG INHALER $4.23 TEVA USA
00254-1007-52 ALBUTEROL HFA 90 MCG INHALER $5.37 PAR PHARM.
66993-0019-68 ALBUTEROL HFA 90 MCG INHALER $2.00 PRASCO LABS
00378-6991-52 ALBUTEROL SUL 0.63 MG/3 ML S $0.44 MYLAN
00487-0301-01 ALBUTEROL SUL 0.63 MG/3 ML S $0.44 NEPHRON CORP
00591-3467-53 ALBUTEROL SUL 0.63 MG/3 ML S $0.44 ACTAVIS/TEVA
00378-6992-52 ALBUTEROL SUL 1.25 MG/3 ML S $0.44 MYLAN
00487-9904-01 ALBUTEROL SUL 1.25 MG/3 ML S $0.44 NEPHRON CORP
00487-9904-25 ALBUTEROL SUL 1.25 MG/3 ML S $0.44 NEPHRON CORP
00591-3468-53 ALBUTEROL SUL 1.25 MG/3 ML S $0.44 ACTAVIS/TEVA
00378-8270-52 ALBUTEROL SUL 2.5 MG/3 ML SO $0.05 MYLAN
00378-8270-55 ALBUTEROL SUL 2.5 MG/3 ML SO $0.07 MYLAN
00378-8270-91 ALBUTEROL SUL 2.5 MG/3 ML SO $0.05 MYLAN
00378-8270-93 ALBUTEROL SUL 2.5 MG/3 ML SO $0.07 MYLAN
00487-9501-01 ALBUTEROL SUL 2.5 MG/3 ML SO $0.07 NEPHRON CORP
00487-9501-03 ALBUTEROL SUL 2.5 MG/3 ML SO $0.05 NEPHRON CORP
00487-9501-25 ALBUTEROL SUL 2.5 MG/3 ML SO $0.05 NEPHRON CORP
00487-9501-60 ALBUTEROL SUL 2.5 MG/3 ML SO $0.05 NEPHRON CORP
00591-3797-30 ALBUTEROL SUL 2.5 MG/3 ML SO $0.05 ACTAVIS/TEVA
00591-3797-60 ALBUTEROL SUL 2.5 MG/3 ML SO $0.05 ACTAVIS/TEVA
00591-3797-83 ALBUTEROL SUL 2.5 MG/3 ML SO $0.05 ACTAVIS/TEVA
76204-0200-01 ALBUTEROL SUL 2.5 MG/3 ML SO $0.07 RITEDOSE PHARMA
76204-0200-25 ALBUTEROL SUL 2.5 MG/3 ML SO $0.05 RITEDOSE PHARMA
76204-0200-30 ALBUTEROL SUL 2.5 MG/3 ML SO $0.05 RITEDOSE PHARMA
76204-0200-60 ALBUTEROL SUL 2.5 MG/3 ML SO $0.05 RITEDOSE PHARMA
00472-0825-16 ALBUTEROL SULF 2 MG/5 ML SYR $0.05 ACTAVIS/TEVA
50383-0740-16 ALBUTEROL SULF 2 MG/5 ML SYR $0.10 HI-TECH/AKORN C
70752-0102-12 ALBUTEROL SULF 2 MG/5 ML SYR $0.07 QUAGEN PHARMACE
00378-0255-01 ALBUTEROL SULFATE 2 MG TAB $4.70 MYLAN
53489-0176-01 ALBUTEROL SULFATE 2 MG TAB $4.70 MUTUAL PHARM CO
64980-0442-01 ALBUTEROL SULFATE 2 MG TAB $4.70 RISING PHARM
69543-0290-10 ALBUTEROL SULFATE 2 MG TAB $0.99 VIRTUS PHARMACE
00378-0572-01 ALBUTEROL SULFATE 4 MG TAB $4.70 MYLAN
53489-0177-01 ALBUTEROL SULFATE 4 MG TAB $4.70 MUTUAL PHARM CO
64980-0443-01 ALBUTEROL SULFATE 4 MG TAB $4.70 RISING PHARM
69543-0291-10 ALBUTEROL SULFATE 4 MG TAB $0.99 VIRTUS PHARMACE
00378-4122-01 ALBUTEROL SULFATE ER 4 MG TA $1.43 MYLAN
70515-0712-01 ALVESCO 160 MCG INHALER $44.95 COVIS PHARMA
70515-0711-01 ALVESCO 80 MCG INHALER $44.95 COVIS PHARMA
00173-0869-06 ANORO ELLIPTA 62.5-25 MCG IN $7.24 GLAXOSMITHKLINE
00173-0869-10 ANORO ELLIPTA 62.5-25 MCG IN $7.03 GLAXOSMITHKLINE
63402-0675-30 ARCAPTA NEOHALER 75 MCG CAP $8.59 SUNOVION PHARMA
59310-0705-06 ARMONAIR RESPICLICK 55 MCG $169.28 TEVA SPECIALTY
00173-0874-10 ARNUITY ELLIPTA 100 MCG INH $5.96 GLAXOSMITHKLINE
00173-0874-14 ARNUITY ELLIPTA 100 MCG INH $5.96 GLAXOSMITHKLINE
00173-0876-10 ARNUITY ELLIPTA 200 MCG INH $7.98 GLAXOSMITHKLINE
00173-0876-14 ARNUITY ELLIPTA 200 MCG INH $7.98 GLAXOSMITHKLINE
00173-0888-10 ARNUITY ELLIPTA 50 MCG INH $5.96 GLAXOSMITHKLINE
00085-4333-01 ASMANEX HFA 100 MCG INHALER $14.72 MERCK SHARP & D
00085-4334-01 ASMANEX HFA 200 MCG INHALER $17.30 MERCK SHARP & D
00085-1461-02 ASMANEX TWISTHALER 110 MCG # $177.39 MERCK SHARP & D
00085-1341-02 ASMANEX TWISTHALER 220 MCG # $224.78 MERCK SHARP & D
00085-1341-06 ASMANEX TWISTHALER 220 MCG # $73.96 MERCK SHARP & D
00085-1341-07 ASMANEX TWISTHALER 220 MCG # $191.55 MERCK SHARP & D
00085-1341-01 ASMANEX TWISTHALR 220 MCG #1 $322.10 MERCK SHARP & D
00597-0087-17 ATROVENT 17 MCG HFA INHALER $31.89 BOEHRINGER ING.
00310-4600-12 BEVESPI AEROSPHERE INHALER $34.14 ASTRAZENECA
00310-4600-39 BEVESPI AEROSPHERE INHALER $34.14 ASTRAZENECA
00173-0859-10 BREO ELLIPTA 100-25 MCG INH $6.03 GLAXOSMITHKLINE
00173-0859-14 BREO ELLIPTA 100-25 MCG INH $4.98 GLAXOSMITHKLINE
00173-0882-10 BREO ELLIPTA 200-25 MCG INH $6.03 GLAXOSMITHKLINE
00173-0882-14 BREO ELLIPTA 200-25 MCG INH $4.98 GLAXOSMITHKLINE
63402-0911-30 BROVANA 15 MCG/2 ML SOLUTION $8.94 SUNOVION PHARMA
63402-0911-64 BROVANA 15 MCG/2 ML SOLUTION $8.94 SUNOVION PHARMA
00093-6815-73 BUDESONIDE 0.25 MG/2 ML SUSP $3.77 TEVA USA
00115-1687-74 BUDESONIDE 0.25 MG/2 ML SUSP $2.38 IMPAX GENERICS
00487-9601-01 BUDESONIDE 0.25 MG/2 ML SUSP $3.95 NEPHRON CORP
00487-9601-30 BUDESONIDE 0.25 MG/2 ML SUSP $2.38 NEPHRON CORP
00781-7515-87 BUDESONIDE 0.25 MG/2 ML SUSP $3.77 SANDOZ
69097-0318-87 BUDESONIDE 0.25 MG/2 ML SUSP $2.38 CIPLA USA, INC.
00093-6816-55 BUDESONIDE 0.5 MG/2 ML SUSP $4.43 TEVA USA
00093-6816-73 BUDESONIDE 0.5 MG/2 ML SUSP $4.43 TEVA USA
00115-1689-74 BUDESONIDE 0.5 MG/2 ML SUSP $2.50 IMPAX GENERICS
00487-9701-01 BUDESONIDE 0.5 MG/2 ML SUSP $4.65 NEPHRON CORP
00487-9701-30 BUDESONIDE 0.5 MG/2 ML SUSP $2.50 NEPHRON CORP
00781-7516-87 BUDESONIDE 0.5 MG/2 ML SUSP $4.43 SANDOZ
68180-0984-30 BUDESONIDE 0.5 MG/2 ML SUSP $2.50 LUPIN PHARMACEU
69097-0319-87 BUDESONIDE 0.5 MG/2 ML SUSP $2.50 CIPLA USA, INC.
00093-6817-73 BUDESONIDE 1 MG/2 ML INH SUS $9.23 TEVA USA
00781-7517-87 BUDESONIDE 1 MG/2 ML INH SUS $9.23 SANDOZ
69097-0321-87 BUDESONIDE 1 MG/2 ML INH SUS $5.21 CIPLA USA, INC.
59310-0610-31 CINQAIR 100 MG/10 ML VIAL $93.20 TEVA SPECIALTY
00172-6406-49 CROMOLYN 20 MG/2 ML NEB SOLN $2.72 TEVA USA
69784-0205-60 CROMOLYN 20 MG/2 ML NEB SOLN $9.04 WOODWARD PHARMA
00085-7206-01 DULERA 100 MCG-5 MCG INHALER $23.95 MERCK SHARP & D
00085-7206-07 DULERA 100 MCG-5 MCG INHALER $23.95 MERCK SHARP & D
00085-4610-01 DULERA 200 MCG-5 MCG INHALER $23.95 MERCK SHARP & D
00085-4610-05 DULERA 200 MCG-5 MCG INHALER $23.95 MERCK SHARP & D
00310-1730-30 FASENRA 30 MG/ML SYRINGE $4,969.18 ASTRAZENECA
00173-0602-00 FLOVENT 100 MCG DISKUS $4.01 GLAXOSMITHKLINE
00173-0602-02 FLOVENT 100 MCG DISKUS $3.21 GLAXOSMITHKLINE
00173-0601-00 FLOVENT 250 MCG DISKUS $5.37 GLAXOSMITHKLINE
00173-0601-02 FLOVENT 250 MCG DISKUS $4.30 GLAXOSMITHKLINE
00173-0600-02 FLOVENT 50 MCG DISKUS $3.05 GLAXOSMITHKLINE
00173-0719-20 FLOVENT HFA 110 MCG INHALER $21.51 GLAXOSMITHKLINE
00173-0720-20 FLOVENT HFA 220 MCG INHALER $33.41 GLAXOSMITHKLINE
00173-0718-20 FLOVENT HFA 44 MCG INHALER $18.19 GLAXOSMITHKLINE
66993-0584-97 FLUTICASONE-SALMETEROL 100-5 $4.75 PRASCO LABS
00093-3608-82 FLUTICASONE-SALMETEROL 113-1 $95.40 TEVA USA
00093-3609-82 FLUTICASONE-SALMETEROL 232-1 $95.40 TEVA USA
66993-0585-97 FLUTICASONE-SALMETEROL 250-5 $5.90 PRASCO LABS
66993-0586-97 FLUTICASONE-SALMETEROL 500-5 $7.76 PRASCO LABS
00093-3607-82 FLUTICASONE-SALMETEROL 55-14 $95.40 TEVA USA
00173-0873-06 INCRUSE ELLIPTA 62.5 MCG INH $10.41 GLAXOSMITHKLINE
00173-0873-10 INCRUSE ELLIPTA 62.5 MCG INH $11.46 GLAXOSMITHKLINE
00378-7970-52 IPRATROPIUM BR 0.02% SOLN $0.07 MYLAN
00378-7970-93 IPRATROPIUM BR 0.02% SOLN $0.07 MYLAN
00487-9801-01 IPRATROPIUM BR 0.02% SOLN $0.08 NEPHRON CORP
00487-9801-25 IPRATROPIUM BR 0.02% SOLN $0.07 NEPHRON CORP
00487-9801-30 IPRATROPIUM BR 0.02% SOLN $0.07 NEPHRON CORP
00487-9801-60 IPRATROPIUM BR 0.02% SOLN $0.07 NEPHRON CORP
00591-3798-30 IPRATROPIUM BR 0.02% SOLN $0.06 ACTAVIS/TEVA
00591-3798-60 IPRATROPIUM BR 0.02% SOLN $0.06 ACTAVIS/TEVA
00591-3798-83 IPRATROPIUM BR 0.02% SOLN $0.06 ACTAVIS/TEVA
00781-7157-29 IPRATROPIUM BR 0.02% SOLN $0.07 SANDOZ
76204-0100-01 IPRATROPIUM BR 0.02% SOLN $0.08 RITEDOSE PHARMA
76204-0100-25 IPRATROPIUM BR 0.02% SOLN $0.07 RITEDOSE PHARMA
76204-0100-30 IPRATROPIUM BR 0.02% SOLN $0.07 RITEDOSE PHARMA
76204-0100-60 IPRATROPIUM BR 0.02% SOLN $0.07 RITEDOSE PHARMA
00378-9671-30 IPRATROPIUM-ALBUTEROL 0.5-3( $0.17 MYLAN
00378-9671-60 IPRATROPIUM-ALBUTEROL 0.5-3( $0.17 MYLAN
00378-9671-93 IPRATROPIUM-ALBUTEROL 0.5-3( $0.17 MYLAN
00487-0201-01 IPRATROPIUM-ALBUTEROL 0.5-3( $0.17 NEPHRON CORP
00487-0201-03 IPRATROPIUM-ALBUTEROL 0.5-3( $0.10 NEPHRON CORP
00487-0201-60 IPRATROPIUM-ALBUTEROL 0.5-3( $0.10 NEPHRON CORP
00591-3817-39 IPRATROPIUM-ALBUTEROL 0.5-3( $0.13 ACTAVIS/TEVA
00591-3817-66 IPRATROPIUM-ALBUTEROL 0.5-3( $0.13 ACTAVIS/TEVA
00781-7146-63 IPRATROPIUM-ALBUTEROL 0.5-3( $0.17 SANDOZ
69097-0173-53 IPRATROPIUM-ALBUTEROL 0.5-3( $0.10 CIPLA USA, INC.
69097-0173-64 IPRATROPIUM-ALBUTEROL 0.5-3( $0.10 CIPLA USA, INC.
76204-0600-01 IPRATROPIUM-ALBUTEROL 0.5-3( $0.22 RITEDOSE PHARMA
76204-0600-05 IPRATROPIUM-ALBUTEROL 0.5-3( $0.13 RITEDOSE PHARMA
76204-0600-12 IPRATROPIUM-ALBUTEROL 0.5-3( $0.13 RITEDOSE PHARMA
76204-0600-30 IPRATROPIUM-ALBUTEROL 0.5-3( $0.13 RITEDOSE PHARMA
76204-0600-60 IPRATROPIUM-ALBUTEROL 0.5-3( $0.13 RITEDOSE PHARMA
00093-4145-56 LEVALBUTEROL 0.31 MG/3 ML SO $1.79 TEVA USA
00093-4145-64 LEVALBUTEROL 0.31 MG/3 ML SO $1.79 TEVA USA
66993-0021-27 LEVALBUTEROL 0.31 MG/3 ML SO $0.93 PRASCO LABS
76204-0700-25 LEVALBUTEROL 0.31 MG/3 ML SO $0.40 RITEDOSE PHARMA
00093-4146-56 LEVALBUTEROL 0.63 MG/3 ML SO $1.79 TEVA USA
00093-4146-64 LEVALBUTEROL 0.63 MG/3 ML SO $1.79 TEVA USA
00115-9931-78 LEVALBUTEROL 0.63 MG/3 ML SO $1.72 IMPAX GENERICS
00378-9691-52 LEVALBUTEROL 0.63 MG/3 ML SO $0.93 MYLAN
66993-0022-27 LEVALBUTEROL 0.63 MG/3 ML SO $0.93 PRASCO LABS
76204-0800-01 LEVALBUTEROL 0.63 MG/3 ML SO $0.53 RITEDOSE PHARMA
76204-0800-24 LEVALBUTEROL 0.63 MG/3 ML SO $0.83 RITEDOSE PHARMA
76204-0800-25 LEVALBUTEROL 0.63 MG/3 ML SO $0.40 RITEDOSE PHARMA
00093-4148-56 LEVALBUTEROL 1.25 MG/3 ML SO $1.79 TEVA USA
00378-9682-44 LEVALBUTEROL 1.25 MG/3 ML SO $1.79 MYLAN
00378-9692-52 LEVALBUTEROL 1.25 MG/3 ML SO $0.93 MYLAN
66993-0023-27 LEVALBUTEROL 1.25 MG/3 ML SO $0.93 PRASCO LABS
76204-0900-01 LEVALBUTEROL 1.25 MG/3 ML SO $0.53 RITEDOSE PHARMA
76204-0900-24 LEVALBUTEROL 1.25 MG/3 ML SO $0.83 RITEDOSE PHARMA
76204-0900-25 LEVALBUTEROL 1.25 MG/3 ML SO $0.40 RITEDOSE PHARMA
00378-6993-93 LEVALBUTEROL CONC 1.25 MG/0. $5.36 MYLAN
00591-2927-54 LEVALBUTEROL TAR HFA 45 MCG $3.93 ACTAVIS/TEVA
63402-0301-01 LONHALA MAGNAIR 25 MCG REFIL $18.88 SUNOVION PHARMA
63402-0201-00 LONHALA MAGNAIR 25 MCG START $18.88 SUNOVION PHARMA
00054-0259-13 MONTELUKAST SOD 10 MG TABLET $0.43 ROXANE/WEST-WAR
00054-0259-22 MONTELUKAST SOD 10 MG TABLET $0.43 ROXANE/WEST-WAR
00093-7426-10 MONTELUKAST SOD 10 MG TABLET $0.41 TEVA USA
00093-7426-56 MONTELUKAST SOD 10 MG TABLET $0.43 TEVA USA
00093-7426-98 MONTELUKAST SOD 10 MG TABLET $0.43 TEVA USA
00603-4655-28 MONTELUKAST SOD 10 MG TABLET $0.34 QUALITEST/PAR P
00781-5560-31 MONTELUKAST SOD 10 MG TABLET $1.31 SANDOZ
00781-5560-92 MONTELUKAST SOD 10 MG TABLET $1.31 SANDOZ
13668-0081-05 MONTELUKAST SOD 10 MG TABLET $0.75 TORRENT PHARMAC
13668-0081-30 MONTELUKAST SOD 10 MG TABLET $0.75 TORRENT PHARMAC
13668-0081-90 MONTELUKAST SOD 10 MG TABLET $0.75 TORRENT PHARMAC
16729-0119-10 MONTELUKAST SOD 10 MG TABLET $0.23 ACCORD HEALTHCA
16729-0119-15 MONTELUKAST SOD 10 MG TABLET $0.23 ACCORD HEALTHCA
16729-0119-17 MONTELUKAST SOD 10 MG TABLET $0.23 ACCORD HEALTHCA
27241-0018-03 MONTELUKAST SOD 10 MG TABLET $0.40 AJANTA PHARMA L
27241-0018-09 MONTELUKAST SOD 10 MG TABLET $0.40 AJANTA PHARMA L
27241-0018-90 MONTELUKAST SOD 10 MG TABLET $0.40 AJANTA PHARMA L
29300-0220-10 MONTELUKAST SOD 10 MG TABLET $0.22 UNICHEM PHARMAC
29300-0220-13 MONTELUKAST SOD 10 MG TABLET $0.25 UNICHEM PHARMAC
29300-0220-19 MONTELUKAST SOD 10 MG TABLET $0.25 UNICHEM PHARMAC
31722-0726-10 MONTELUKAST SOD 10 MG TABLET $0.20 CAMBER PHARMACE
31722-0726-30 MONTELUKAST SOD 10 MG TABLET $0.23 CAMBER PHARMACE
31722-0726-90 MONTELUKAST SOD 10 MG TABLET $0.20 CAMBER PHARMACE
33342-0102-07 MONTELUKAST SOD 10 MG TABLET $0.06 MACLEODS PHARMA
33342-0102-10 MONTELUKAST SOD 10 MG TABLET $0.06 MACLEODS PHARMA
33342-0102-15 MONTELUKAST SOD 10 MG TABLET $0.06 MACLEODS PHARMA
55111-0725-30 MONTELUKAST SOD 10 MG TABLET $0.43 DR.REDDY'S LAB
55111-0725-90 MONTELUKAST SOD 10 MG TABLET $0.43 DR.REDDY'S LAB
57237-0255-30 MONTELUKAST SOD 10 MG TABLET $0.06 RISING PHARM
62175-0210-32 MONTELUKAST SOD 10 MG TABLET $0.79 KREMERS/LANNETT
62175-0210-46 MONTELUKAST SOD 10 MG TABLET $0.79 KREMERS/LANNETT
65862-0574-90 MONTELUKAST SOD 10 MG TABLET $0.22 AUROBINDO PHARM
68001-0248-03 MONTELUKAST SOD 10 MG TABLET $0.41 BLUEPOINT LABOR
68001-0248-04 MONTELUKAST SOD 10 MG TABLET $0.43 BLUEPOINT LABOR
68001-0248-05 MONTELUKAST SOD 10 MG TABLET $0.43 BLUEPOINT LABOR
68001-0361-03 MONTELUKAST SOD 10 MG TABLET $0.13 BLUEPOINT LABOR
68001-0361-04 MONTELUKAST SOD 10 MG TABLET $0.13 BLUEPOINT LABOR
68001-0361-05 MONTELUKAST SOD 10 MG TABLET $0.16 BLUEPOINT LABOR
68645-0560-54 MONTELUKAST SOD 10 MG TABLET $0.43 LEGACY PHARMACE
69452-0105-13 MONTELUKAST SOD 10 MG TABLET $0.17 BIONPHARMA INC.
69452-0105-19 MONTELUKAST SOD 10 MG TABLET $0.11 BIONPHARMA INC.
69452-0105-32 MONTELUKAST SOD 10 MG TABLET $0.08 BIONPHARMA INC.
00093-7487-56 MONTELUKAST SOD 4 MG GRANULE $3.04 TEVA USA
13668-0531-94 MONTELUKAST SOD 4 MG GRANULE $4.50 TORRENT PHARMAC
27241-0015-31 MONTELUKAST SOD 4 MG GRANULE $3.00 AJANTA PHARMA L
55111-0763-03 MONTELUKAST SOD 4 MG GRANULE $4.53 DR.REDDY'S LAB
66993-0416-30 MONTELUKAST SOD 4 MG GRANULE $4.99 PRASCO LABS
00054-0288-13 MONTELUKAST SOD 4 MG TAB CHE $0.75 WEST-WARD/HIKMA
00054-0288-22 MONTELUKAST SOD 4 MG TAB CHE $0.75 WEST-WARD/HIKMA
00093-7424-56 MONTELUKAST SOD 4 MG TAB CHE $0.85 TEVA USA
00093-7424-98 MONTELUKAST SOD 4 MG TAB CHE $0.85 TEVA USA
00603-4653-16 MONTELUKAST SOD 4 MG TAB CHE $0.88 PAR PHARM.
00781-5554-31 MONTELUKAST SOD 4 MG TAB CHE $0.75 SANDOZ
00781-5554-92 MONTELUKAST SOD 4 MG TAB CHE $0.75 SANDOZ
13668-0079-30 MONTELUKAST SOD 4 MG TAB CHE $0.75 TORRENT PHARMAC
13668-0079-90 MONTELUKAST SOD 4 MG TAB CHE $0.75 TORRENT PHARMAC
27241-0016-03 MONTELUKAST SOD 4 MG TAB CHE $0.80 AJANTA PHARMA L
27241-0016-09 MONTELUKAST SOD 4 MG TAB CHE $0.80 AJANTA PHARMA L
31722-0727-30 MONTELUKAST SOD 4 MG TAB CHE $0.35 CAMBER PHARMACE
31722-0727-90 MONTELUKAST SOD 4 MG TAB CHE $0.34 CAMBER PHARMACE
33342-0110-07 MONTELUKAST SOD 4 MG TAB CHE $0.52 MACLEODS PHARMA
33342-0110-10 MONTELUKAST SOD 4 MG TAB CHE $0.50 MACLEODS PHARMA
57237-0212-30 MONTELUKAST SOD 4 MG TAB CHE $0.35 RISING PHARM
57237-0212-90 MONTELUKAST SOD 4 MG TAB CHE $0.34 RISING PHARM
65862-0567-90 MONTELUKAST SOD 4 MG TAB CHE $0.22 AUROBINDO PHARM
69452-0106-13 MONTELUKAST SOD 4 MG TAB CHE $0.21 BIONPHARMA INC.
69452-0106-19 MONTELUKAST SOD 4 MG TAB CHE $0.20 BIONPHARMA INC.
00054-0289-13 MONTELUKAST SOD 5 MG TAB CHE $0.85 ROXANE/WEST-WAR
00054-0289-22 MONTELUKAST SOD 5 MG TAB CHE $0.75 ROXANE/WEST-WAR
00093-7425-56 MONTELUKAST SOD 5 MG TAB CHE $0.85 TEVA USA
00093-7425-98 MONTELUKAST SOD 5 MG TAB CHE $0.85 TEVA USA
00781-5555-31 MONTELUKAST SOD 5 MG TAB CHE $0.75 SANDOZ
00781-5555-92 MONTELUKAST SOD 5 MG TAB CHE $0.75 SANDOZ
13668-0080-05 MONTELUKAST SOD 5 MG TAB CHE $0.75 TORRENT PHARMAC
13668-0080-30 MONTELUKAST SOD 5 MG TAB CHE $0.75 TORRENT PHARMAC
13668-0080-90 MONTELUKAST SOD 5 MG TAB CHE $0.75 TORRENT PHARMAC
27241-0017-03 MONTELUKAST SOD 5 MG TAB CHE $0.90 AJANTA PHARMA L
27241-0017-09 MONTELUKAST SOD 5 MG TAB CHE $0.90 AJANTA PHARMA L
31722-0728-30 MONTELUKAST SOD 5 MG TAB CHE $0.35 CAMBER PHARMACE
31722-0728-90 MONTELUKAST SOD 5 MG TAB CHE $0.34 CAMBER PHARMACE
33342-0111-07 MONTELUKAST SOD 5 MG TAB CHE $0.52 MACLEODS PHARMA
33342-0111-10 MONTELUKAST SOD 5 MG TAB CHE $0.50 MACLEODS PHARMA
57237-0213-30 MONTELUKAST SOD 5 MG TAB CHE $0.35 RISING PHARM
57237-0213-90 MONTELUKAST SOD 5 MG TAB CHE $0.34 RISING PHARM
65862-0568-90 MONTELUKAST SOD 5 MG TAB CHE $0.22 AUROBINDO PHARM
69452-0107-13 MONTELUKAST SOD 5 MG TAB CHE $0.21 BIONPHARMA INC.
69452-0107-19 MONTELUKAST SOD 5 MG TAB CHE $0.20 BIONPHARMA INC.
00173-0892-01 NUCALA 100 MG/ML AUTO-INJECT $3,021.21 GLAXOSMITHKLINE
00173-0881-01 NUCALA 100 MG/ML POWDER VIAL $3,021.21 GLAXOSMITHKLINE
49502-0605-30 PERFOROMIST 20 MCG/2 ML SOLN $8.68 MYLAN SPECIALTY
49502-0605-61 PERFOROMIST 20 MCG/2 ML SOLN $8.68 MYLAN SPECIALTY
59310-0579-22 PROAIR HFA 90 MCG INHALER $7.87 TEVA SPECIALTY
59310-0580-20 PROAIR RESPICLICK 90 MCG INH $62.52 TEVA SPECIALTY
00085-1132-01 PROVENTIL HFA 90 MCG INHALER $11.90 MERCK SHARP & D
00085-1132-04 PROVENTIL HFA 90 MCG INHALER $11.90 MERCK SHARP & D
00186-1988-04 PULMICORT 0.25 MG/2 ML RESPU $4.36 ASTRAZENECA
00186-1989-04 PULMICORT 0.5 MG/2 ML RESPUL $5.13 ASTRAZENECA
00186-1990-04 PULMICORT 1 MG/2 ML RESPULE $10.26 ASTRAZENECA
00186-0916-12 PULMICORT 180 MCG FLEXHALER $236.38 ASTRAZENECA
00186-0917-06 PULMICORT 90 MCG FLEXHALER $176.53 ASTRAZENECA
59310-0302-40 QVAR REDIHALER 40 MCG $17.94 TEVA SPECIALTY
59310-0304-80 QVAR REDIHALER 80 MCG $24.03 TEVA SPECIALTY
00173-0520-00 SEREVENT DISKUS 50 MCG $8.42 GLAXOSMITHKLINE
00173-0521-00 SEREVENT DISKUS 50 MCG $6.65 GLAXOSMITHKLINE
00006-9117-31 SINGULAIR 10 MG TABLET $7.61 MERCK SHARP & D
00006-9117-54 SINGULAIR 10 MG TABLET $7.61 MERCK SHARP & D
00597-0160-61 SPIRIVA RESPIMAT 1.25 MCG IN $113.81 BOEHRINGER ING.
00597-0100-31 SPIRIVA RESPIMAT 2.5 MCG INH $46.39 BOEHRINGER ING.
00597-0100-51 SPIRIVA RESPIMAT 2.5 MCG INH $18.75 BOEHRINGER ING.
00597-0100-61 SPIRIVA RESPIMAT 2.5 MCG INH $113.81 BOEHRINGER ING.
00597-0192-61 STRIVERDI RESPIMAT INHAL SPR $56.13 BOEHRINGER ING.
00186-0370-20 SYMBICORT 160-4.5 MCG INHALE $35.02 ASTRAZENECA
00186-0370-28 SYMBICORT 160-4.5 MCG INHALE $40.46 ASTRAZENECA
00186-0372-20 SYMBICORT 80-4.5 MCG INHALER $30.64 ASTRAZENECA
00186-0372-28 SYMBICORT 80-4.5 MCG INHALER $30.58 ASTRAZENECA
52244-0100-10 THEO-24 ER 100 MG CAPSULE $2.41 AUXILIUM/ENDO P
52244-0200-10 THEO-24 ER 200 MG CAPSULE $3.59 AUXILIUM/ENDO P
52244-0300-10 THEO-24 ER 300 MG CAPSULE $4.41 AUXILIUM/ENDO P
52244-0400-10 THEO-24 ER 400 MG CAPSULE $6.20 AUXILIUM/ENDO P
27808-0033-01 THEOPHYLLINE 80 MG/15 ML SOL $0.16 TRIS PHARMA INC
54838-0556-80 THEOPHYLLINE 80 MG/15 ML SOL $0.16 SILARX/LANNETT
50111-0482-02 THEOPHYLLINE ER 200 MG TABLE $0.41 TEVA USA
62332-0025-31 THEOPHYLLINE ER 300 MG TAB $3.44 ALEMBIC PHARMAC
00378-0486-01 THEOPHYLLINE ER 400 MG TABLE $1.22 MYLAN
42858-0701-01 THEOPHYLLINE ER 400 MG TABLE $1.04 RHODES PHARMACE
62332-0026-31 THEOPHYLLINE ER 450 MG TAB $4.84 ALEMBIC PHARMAC
42858-0702-01 THEOPHYLLINE ER 600 MG TABLE $1.50 RHODES PHARMACE
00173-0887-10 TRELEGY ELLIPTA 100-62.5-25 $9.55 GLAXOSMITHKLINE
00173-0887-14 TRELEGY ELLIPTA 100-62.5-25 $9.54 GLAXOSMITHKLINE
00173-0682-20 VENTOLIN HFA 90 MCG INHALER $3.08 GLAXOSMITHKLINE
00173-0682-24 VENTOLIN HFA 90 MCG INHALER $2.76 GLAXOSMITHKLINE
50242-0040-62 XOLAIR 150 MG/1.2 ML POWDER $1,128.48 GENENTECH, INC.
50242-0215-01 XOLAIR 150 MG/ML SYRINGE $1,128.48 GENENTECH, INC.
50242-0214-01 XOLAIR 75 MG/0.5 ML SYRINGE $1,128.48 GENENTECH, INC.
17478-0173-24 XOPENEX 0.63 MG/3 ML SOLUTIO $3.48 AKORN INC.
17478-0174-24 XOPENEX 1.25 MG/3 ML SOLUTIO $3.48 AKORN INC.
17478-0171-30 XOPENEX CONC 1.25 MG/0.5 ML $6.83 AKORN INC.
63402-0510-01 XOPENEX HFA 45 MCG INHALER $4.55 SUNOVION PHARMA
49884-0549-02 ZAFIRLUKAST 10 MG TABLET $1.52 PAR PHARM.
55111-0625-60 ZAFIRLUKAST 10 MG TABLET $1.80 DR.REDDY'S LAB
49884-0554-02 ZAFIRLUKAST 20 MG TABLET $1.52 PAR PHARM.
55111-0626-60 ZAFIRLUKAST 20 MG TABLET $1.80 DR.REDDY'S LAB
66993-0485-32 ZILEUTON ER 600 MG TABLET $26.82 PRASCO LABS

**WAC information selected from data provided by manufacturer, PBM or wholesaler reports.**