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Systane ULTRA polyethylene glycol 400 and propylene 400 4 mg/mL; 3 mg/mL Solution/ Drops, 60 vials — NDC 00065-1432-05 package photo
Label image from the product's FDA listing (DailyMed) — may show a different pack size or an older label revision.

Systane ULTRA polyethylene glycol 400 and propylene 400 4 mg/mL; 3 mg/mL Solution/ Drops, 60 vials — NDC 0065-1432-05 (Billing 00065-1432-05)

by Alcon Laboratories, Inc. · 60 VIAL in 1 CARTON / .7 mL in 1 VIAL

This is a package of 60 vials of Systane ULTRA polyethylene glycol 400 and propylene 400 4 mg/mL; 3 mg/mL Solution/ Drops from Alcon Laboratories, Inc., marketed since Jul 2009 and currently FDA-listed; retail pharmacies pay about $0.3601 per vial (NADAC).

NDC 00065-1432-05
🏷️ FDA NDC (as labeled) 0065-1432-05 billing pads the labeler segment with a zero
This package
Contains60 vials Cost per ea$0.3601 NADAC Per package$21.61 / 60 vials Pack sizes3 compare ↓
Also priced by: Medicaid pays $0.6047/unit — full pricing hub ↓
Product page 00065-1432-06 Also comes in: 5 vials 0065-1432-04 25 vials 0065-1432-06
OTC On market Non-controlled ⇄ Compare with another NDC
🗂️ FDA directory synced Oct 1, 2026 · this listing last changed Jul 24, 2026 · sources: openFDA · FDA label (DailyMed) · FDA Orange & Purple Book · First Databank · CMS NADAC, ASP, Medicare & Medicaid · RxNorm
📋 All sources & update times →

This page is curated, coded, and maintained by

Compiled from public FDA, CMS, DailyMed, NADAC, and related drug data sources. Editorial policy

NDC database record

One package, one record: these facts belong to NDC 0065-1432-05 alone.

Record
FDA NDC Directory package listing · Human OTC drug
Code segments
0065 labeler · 1432 product · 05 package
Package marketed since
Jul 27, 2009
Sample package
No — commercial package
Listing certified through
Dec 31, 2026
Billing quantity
60 EA per package
Barcode (UPC-A, from the NDC)
3 0065143205 3
Medicaid fills, this package
808 prescriptions in the last four reported quarters
FDA record last changed
Jul 24, 2026
⚠️
Other active recalls for Polyethylene Glycol 400 And Propylene Glycol (different manufacturers) — 1 · tap to view
These affect other manufacturers’ products for the same ingredient — not necessarily the exact NDC on this page.
Class II · Apr 23, 2025 — cGMP deviations and lack of assurance of sterility. (BRS Analytical Services, LLC) · FDA recall D-0407-2025
Each entry is an official FDA enforcement report — look up any recall number in the FDA recall database ↗

Identity & classification

Regulatory identifiers FDA, NLM and CMS codes for this package

FDA NDC (as labeled) 0065-1432-05
Product NDC 0065-1432
11-digit billing NDC 00065143205
NCPDP billing unit EA — each (per item)
RxCUI 477589
UNII B697894SGQ, 6DC9Q167V3
Application # M018
SPL Set ID a5c1c194-3db5-4f18-9cd1-97f7f84c3cff
DEA schedule Non-controlled
Marketing category OTC MONOGRAPH DRUG
Marketing status On market
FDA listing status Listed (active directory)
Marketing start 2009-07-27
Route OPHTHALMIC
Dosage form SOLUTION/ DROPS
Substance POLYETHYLENE GLYCOL 400; PROPYLENE GLYCOL

Drug-database identifiers Medi-Span GPI and First Databank GCN / HICL / AHFS classification

GPI-14 86209902482022
GPI class Systane Ultra PF
GCN Seq No 058288
GCN 23696
HICL code 038529
Ingredient (HICL) Propylene Glycol/Peg 400/Pf
HIC1 code Q
Therapeutic class — broad (HIC1) Ear/Eye/Nose/Rectum/Topical/Vagina/Other
HIC2 code Q6
Therapeutic class — intermediate (HIC2) Ophthalmic Preparations
HIC3 code Q6T
Therapeutic class — specific (HIC3) Artificial Tears
AHFS code 52:92.00.00
AHFS class Eent Drugs, Miscellaneous
FDB label name SYSTANE ULTRA 0.4-0.3% EYE DRP
FDB brand name Systane Ultra
Legend status O — Over-the-counter (OTC) drug or device
Quick answers
  • GSN (GCN sequence number): 058288
  • GCN: 23696
  • GPI-14 (Medi-Span): 86209902482022
  • HICL (First Databank): 038529
  • AHFS class code: 52:92.00.00
  • RxCUI (RxNorm): 477589
Why two NDCs? The FDA registers this code as 0065-1432-05 — a 4-4-2 layout, and that's what's printed on the package and shown on DailyMed. For insurance claims, every NDC is standardized to a uniform 11-digit 5-4-2 format by adding a zero to the labeler segment → 00065-1432-05. Same drug, same package — only the format differs.
Where does this data come from?
Identifiers from the FDA openFDA NDC Directory and Structured Product Labeling; RxCUI from RxNorm (NLM); GPI from Medi-Span; GCN / HIC / AHFS / legend from First Databank.

Clinical

Label name SYSTANE ULTRA 0.4-0.3% EYE DRP Ingredient Propylene Glycol/Peg 400/Pf
🧪 What is this product?

Systane ULTRA is an over-the-counter eye drop solution marketed under FDA's OTC monograph rules for ophthalmic products. It contains two lubricating agents, polyethylene glycol 400 and propylene glycol, which are typically used to moisturize and relieve dryness and irritation of the eye surface. This product functions as an artificial tear replacement for temporary comfort of dry eyes.

Supplement & herbal interactions

🌿 Drug–supplement interaction checker →
Where does this data come from?
Plain-language summary from MedlinePlus (U.S. National Library of Medicine); supplement & herbal interactions and nutrient depletion data from the Natural Medicines database; our full guide is HelloPharmacist editorial content.

Pricing

A drug doesn't have one price. Each row is a different public payment system, and none is what you'd pay at the counter — that depends on your insurance. The ⓘ on each row explains what it measures.

Price systemPer eaPer package
Retail pharmacies payNADAC · weekly $0.360 $21.61 / 60 vials
Medicaid paysCMS SDUD · 12 mo $0.6047 $36.28 / 60 vials
Medicare drug plans payPart D · quarterly No Part D plan price is available for this NDC in our data.
NADAC price history (per ea) — tap or hover for the price & month
Oct 2025 $0.360 $0.360
Where does this data come from?
NADAC (National Average Drug Acquisition Cost) is the CMS weekly pharmacy-acquisition-cost survey — what pharmacies pay. ASP (Average Sales Price) is the CMS Medicare Part B drug-payment file, published quarterly. Medicaid pays is computed by us from CMS State Drug Utilization Data (total reimbursed ÷ units, trailing 12 months) — gross of rebates and inclusive of dispensing fees, so it reflects what Medicaid paid, not an acquisition cost. Medicare drug plans pay is the median negotiated point-of-sale unit cost across plans listing this NDC in the CMS quarterly Prescription Drug Plan pricing files, before rebates. The VA pays is the federal contract price (FSS, and the statutory Big 4 ceiling where listed) from the VA National Acquisition Center pharmaceutical price file. All are free public government data; each measures a different payer, so the figures are not directly comparable.

Packaging — all sizes for this product

Package NDCDescription Per unit Per pack Marketing startMarketing endStatus
00065-1432-04 0065-1432-04 5 VIAL in 1 CARTON / .7 mL in 1 VIAL — — 2009-07-27 — Active
00065-1432-05 You're viewing this 60 VIAL in 1 CARTON / .7 mL in 1 VIAL $0.3601 / ea $21.60 2009-07-27 — Active
00065-1432-06 0065-1432-06 Main listing 25 VIAL in 1 CARTON / .7 mL in 1 VIAL $0.4408 / ea $11.02 2009-07-27 — Active

This pack has the lowest per-ea cost of the 2 priced pack sizes ($0.3601 NADAC).

This pack accounts for about 11% of this product's recent Medicaid fills; most go to a different pack size. See all packs ↓

Pack size FAQ

What quantity is in this package?
This package contains 60 vials — 60 vial in 1 carton / .7 ml in 1 vial.
How does this package differ from NDC 00065-1432-04?
Both are Systane ULTRA polyethylene glycol 400 and propylene 400 4 mg/mL; 3 mg/mL Solution/ Drops — the drug itself is identical. This page's package is the 60 vials one, while NDC 00065-1432-04 is the 5 vials package.
What NDC number is used to bill for this package of Systane ULTRA polyethylene glycol 400 and propylene 400 4 mg/mL; 3 mg/mL Solution/ Drops?
Use the 11-digit billing form listed in the identifiers section of this page. Pharmacy and medical claims use the 11-digit form; the FDA label may print a shorter form of the same code.

Prices are the latest CMS NADAC pharmacy acquisition cost per NDC; per-pack figures are per-unit × pack quantity, shown only when the pack is denominated in the same measure NADAC prices.

Therapeutic equivalents

ProductLabelerPackNADAC/unitTEStatusPrice vs. this
Leader Lubricant Eye Drops 30ct 400 .4 g/100mL; .3 g/100mL 70000-0017-01 CARDINAL 30 vials $0.204 — Availability likely save 43%
Leader Preservative-Free Ultra Lubricating Eye Drops 400 .4 g/100mL; .3 g/100mL 70000-0501-01 Cardinal 25 vials $0.211 — Availability likely save 41%
Sunmark Lubricating Tears 400 .4 g/100mL; .3 g/100mL 49348-0149-29 Strategic 1 bottle $0.332 — FDA listed save 8%
Sunmark Lubricant Eye Drops 400 .4 g/100mL; .3 g/100mL 49348-0947-29 Strategic 1 bottle $0.332 — FDA listed save 8%
Health Mart Lubricating Tears 400 .4 g/100mL; .3 g/100mL 62011-0254-01 Strategic 1 bottle $0.332 — FDA listed save 8%
Systane ULTRA 400 4 mg/mL; 3 mg/mLthis 00065-1432-05 Alcon 60 vials $0.360 — FDA listed —
Lubricant Eye Drops Solution 400 4 mg/mL; 3 mg/mL 50268-0126-15 AvPAK 1 bottle $0.363 — Availability likely +1%
Leader Ultra Lubricating Eye Drops 400 .4 g/100mL; .3 g/100mL 70000-0457-01 Cardinal 1 bottle $0.363 — Availability likely +1%
Foster and Thrive Lubricating Tears Lubricant Eye Drops 400 .4 g/100mL; .3 g/100mL 70677-1160-01 Strategic 1 bottle $0.363 — Availability likely +1%
Foster and Thrive Long Lasting Lubricant Eye Drops .3 g/100mL; 400 .4 g/100mL 70677-1162-01 Strategic 1 bottle $0.363 — Availability likely +1%
Quality Choice Lubricant Eye Drops High Performance 400 .4 g/100mL; .3 g/100mL 83324-0029-15 Chain 1 bottle $0.363 — Availability likely +1%
Systane 400 4 mg/mL; 3 mg/mL 00065-0431-33 Alcon 30 vials $0.376 — Availability likely +4%
Systane Hydration Pf Preservative Free 400 4 mg/mL; 3 mg/mL 00065-1437-04 Alcon 30 vials $0.376 — Availability likely +4%
Systane Lubricant 400 4 mg/mL; 3 mg/mL 00065-0429-15 Alcon 1 bottle $0.702 — Availability likely +95%
Systane Ultra Preservative Free 400 4 mg/mL; 3 mg/mL 00065-1507-82 Alcon 1 bottle $1.155 — Availability likely +221%
Systane Hydration Pf Preservative Free 400 4 mg/mL; 3 mg/mL 00065-1510-06 Alcon 1 bottle $1.155 — Availability likely +221%
Systane Ultra 400 4 mg/mL; 3 mg/mL 00065-1431-01 Alcon 1 bottle — — FDA listed —
Walgreens Lubricant Eye Drops High Performance 15mL and twin pack .3 g/100mL; 400 .4 g/100mL 00363-4549-01 Walgreen 1 bottle — — FDA listed —
Walgreens Lubricant Eye Drops Dry Eye 15mL and twin pack 400 .4 g/100mL; .3 g/100mL 00363-4551-01 Walgreen 1 bottle — — FDA listed —
Walgreens Lubricant 3 mg/mL; 400 4 mg/mL 00363-6153-05 Walgreens 1 bottle — — FDA listed —
Walgreens Ultra Lubricant 400 4 mg/mL; 3 mg/mL 00363-6154-05 Walgreens 1 bottle — — FDA listed —
Target Lubricant Eye Drops High Performance 400 .4 g/100mL; .3 g/100mL 11673-0101-01 Target 1 bottle — — FDA listed —
Target Lubricant Eye Drops High Performance 400 .4 g/100mL; .3 g/100mL 11673-0110-01 Target 2 bottles — — FDA listed —
Rite Aid Hydration Lubricant Eye Drops .3 g/100mL; 400 .4 g/100mL 11822-0203-01 Rite 1 bottle — — FDA listed —
Signature Care Eye Drops High Performance 400 .4 g/100mL; .3 g/100mL 21130-0702-01 Better 1 bottle — — FDA listed —
Signature Care Lubricant Eye Drops Long Lasting 400 .4 g/100mL; .3 g/100mL 21130-0756-01 Better 1 bottle — — FDA listed —
Kroger High Performance Lubricant Eye Drops .3 g/100mL; 400 .4 g/100mL 30142-0333-01 Kroger 1 bottle — — FDA listed —
Topcare Health Lubricant Eye Drops .3 g/100mL; 400 .4 g/100mL 36800-0978-01 Topco 1 bottle — — FDA listed —
Meijer Lubricant Eye Drops .3 g/100mL; 400 .4 g/100mL 41250-0319-01 Meijer 1 bottle — — FDA listed —
Meijer Ultra Lubricant Eye Drops High Performance 400 .4 g/100mL; .3 g/100mL 41250-0937-01 Meijer 1 bottle — — FDA listed —
Equate Lubricant Eye Drops High Performance .3 g/100mL; 400 .4 g/100mL 49035-0282-01 Wal-Mart 2 bottles — — FDA listed —
Equate Lubricant Eye Drops 400 .4 g/100mL; .3 g/100mL 49035-0528-02 Wal-Mart 2 bottles — — FDA listed —
GoodSense Ultra Lubricant Eye Drops .3 g/100mL; 400 .4 g/100mL 50804-0160-01 Geiss, 1 bottle — — FDA listed —
CVS Hydration Eye Drops .3 g/100mL; 400 .4 g/100mL 51316-0615-10 CVS 1 bottle — — FDA listed —
CVS Health Fast Acting Lubricant Eye Drops .3 g/100mL; 400 .4 g/100mL 51316-0659-01 CVS 1 bottle — — FDA listed —
Retaine Ultra PF 400 4 mg/mL; 3 mg/mL 54799-0470-10 OCuSOFT 10 ml — — FDA listed —
Exchange Select High Performance Lubricant Eye Drops .3 g/100mL; 400 .4 g/100mL 55301-0347-01 Army 1 bottle — — FDA listed —
Medics Choice Fresh and Soothe Lubricant Eye Drops .3 g/100mL; 400 .4 g/100mL 55651-0999-01 KC 1 bottle — — FDA listed —
DG Lubricant Eye Drops 400 .4 g/100mL; .3 g/100mL 55910-0364-01 Dolgencorp 1 bottle — — FDA listed —
Publix High Performance Eye Drops .3 g/100mL; 400 .4 g/100mL 56062-0790-01 Publix 1 bottle — — FDA listed —
Harris Teeter Ultra Lubricant Eye Drops .3 g/100mL; 400 .4 g/100mL 69256-0980-01 Harris 1 bottle — — FDA listed —
CVS Lubricant Eye Drops Original 400 .4 g/100mL; .3 g/100mL 69842-0746-01 CVS 30 vials — — FDA listed —
Equate Lubricant Eye Drops 400 .4 g/100mL; .3 g/100mL 79903-0131-30 Walmart, 30 vials — — FDA listed —
Avenova Lubricant Eye Drops High Performance 400 .4 g/100mL; .3 g/100mL 81963-0101-10 NovaBay 2 bottles — — FDA listed —
CorneaCare Recover Lubricant Eye Drops 400 .4 g/100mL; .3 g/100mL 82875-0002-01 CorneaCare 1 bottle — — FDA listed —
Quality Choice Lubricant Eye Drops Long Lasting 400 .4 g/100mL; .3 g/100mL 83324-0030-15 Chain 1 bottle — — FDA listed —
Archies Dry Eye Relief 400 .4 g/100mL; .3 g/100mL 83737-0001-30 Archie's 30 vials — — FDA listed —
About this product: other versions of the same ingredient, strength and form are listed above, least expensive first, with FDA equivalence ratings where available.
Where does this data come from?
Equivalents are other NDCs of the same ingredient, form and route from the openFDA NDC Directory, ranked least-expensive-first by NADAC. Therapeutic-equivalence (AB) ratings come from the FDA Orange Book; biologics use the FDA Purple Book for biosimilar & interchangeable status.

Availability & generic status

🏛️
2009
On the market since
Jul 2009
📍
2026
Currently FDA-listed
17 years listed
🔒
·
No generic listed yet
brand only
ℹ️No FDA-approved generic found

We did not find an FDA-approved generic match for this exact strength, form and route.

Where does this data come from?
Patents and exclusivity from the FDA Orange Book (small-molecule drugs), refreshed from public FDA data. Generic launch timing is an estimate, not a guarantee.

Inactive Ingredients / Excipients

Inactive ingredients, also called excipients, are components of the drug product other than the active ingredient. They may include fillers, dyes, coatings, preservatives, flavors, or other formulation ingredients.

💡 Tap an ingredient (hover on desktop) to see what it is and why it’s used.

  • UNII LU49E6626Q
    A synthetic organic compound used as a pH buffer and neutralizing agent in medicines. It helps maintain the proper acidity level in liquid formulations to improve stability and comfort.
  • UNII R57ZHV85D4
    Boric acid is a weak acid derived from boron. In medicines, it typically serves as a buffer to help maintain the product's pH level and may act as a preservative in certain formulations.
  • UNII E89I1637KE
    Guar gum is a natural thickener made from guar bean seeds. It's used in medicines as a binder and thickening agent to hold ingredients together and create the right texture and consistency.
  • UNII QTT17582CB
    A strong acid used to adjust and maintain the proper pH level in liquid medicines, ensuring stability and preventing breakdown of active ingredients.
  • UNII 660YQ98I10
    Potassium chloride is a mineral salt used in medicines as a buffer and to help maintain the proper pH balance and stability of the formulation during storage and use.
  • UNII 451W47IQ8X
    Sodium chloride is common table salt. It's used in medicines as a buffer to maintain proper pH, as a filler to add bulk, or to adjust the osmotic balance in liquid formulations.
  • UNII 55X04QC32I
    A strong alkaline chemical used to adjust and maintain the pH balance of liquid medicines. It helps keep the medicine stable and ensures it stays effective during storage.
  • UNII 506T60A25R
    Sorbitol is a natural sugar alcohol derived from glucose. It serves as a sweetener, humectant, and bulking agent in medications to improve taste and help maintain moisture in the product.
  • UNII 059QF0KO0R
    Water is a liquid solvent that dissolves and mixes ingredients together in liquid medicines, syrups, and injections. It helps distribute the active drug evenly throughout the product.

9 inactive ingredients listed in the exact product block matched to this NDC.

The official label also statesAminomethylpropanol, boric acid, hydroxypropyl guar, potassium chloride, purified water, sodium chloride, sorbitol. May contain hydrochloric acid and/or sodium hydroxide to adjust pH.

Label-section wording can be broader than the structured product block and may mention additional formulation ingredients.

Where does this data come from?
Data sourced from official FDA Structured Product Labeling (SPL) via DailyMed — ingredient classCode="IACT" elements from the exact product block matched by this NDC. Label-section narrative from DailyMed / the openFDA label index is shown separately when available.

Inactive ingredient FAQ

Are inactive ingredients the same for every manufacturer?
No. Inactive ingredients can differ by manufacturer, dosage form, strength, and package / product version.
Why might an inactive ingredient be missing?
Some SPLs do not provide a complete structured inactive-ingredient list, and older or unusual labels may only include the information in narrative text.
Can inactive ingredients matter?
Yes. They can matter for allergies, intolerances, dyes, gluten / lactose concerns, preservatives, and formulation differences — but confirm with a pharmacist or the manufacturer when it’s clinically important.

Manufacturer & labeler

LabelerAlcon Laboratories, Inc.
FDA applicationM018 (OTC MONOGRAPH DRUG)
Labeler code00065
First marketedJul 2009
Product typeHuman Otc Drug
Portfolio55 products on file

More NDCs from Alcon Laboratories, Inc. labeler code 00065

The labeler markets the product; the application holder owns the FDA approval. They’re often the same company but can differ (e.g. a repackager or an authorized generic). A mailing address / phone appears here when the manufacturer includes it in the product’s FDA label (not all do).
Where does this data come from?
Labeler, application holder and registered establishment from the FDA openFDA NDC Directory and Drugs@FDA; address/contact from the product’s FDA label.

FDA label — Drug Facts FDA SPL

The complete FDA label for this product — the official Drug Facts labeling, verbatim, section by section. Jump with a chip, search within the label, or expand everything.
🎯 Indications and Usage ⏱️ Dosage and Administration ⚠️ Warnings 🧪 Active Ingredient 🧪 Inactive Ingredients 📄 Do Not Use 📄 When Using This Product 📄 Stop Use and Ask a Doctor If 📄 Keep Out of Reach of Children 📄 Questions or Comments 📄 Package Label / Principal Display Panel
🎯 Indications and Usage 34 words ▾

Uses For the temporary relief of burning and irritation due to dryness of the eye for temporary relief of discomfort due to minor irritation of the eye or to exposure to wind or sun

⏱️ Dosage and Administration 12 words ▾

Directions Put 1 or 2 drops in the affected eye(s) as needed.

⚠️ Warnings 101 words ▾

Warnings For external use only. Do not use if this product changes color or becomes cloudy if you are sensitive to any ingredient in this product When using this product do not touch tip of container to any surface to avoid contamination do not reuse once opened, discard Stop use and ask a doctor if you experience any of the following: eye pain changes in vision Continued redness or irritation of the eye Condition worsens or persists for more than 72 hours Keep out of reach of children. If swallowed, get medical help or contact a Poison Control Center right away.

🧪 Active Ingredient 12 words ▾

Active Ingredients Purpose Polyethylene Glycol 400 0.4% Lubricant Propylene Glycol 0.3% Lubricant

🧪 Inactive Ingredients 24 words ▾

Inactive Ingredients Aminomethylpropanol, boric acid, hydroxypropyl guar, potassium chloride, purified water, sodium chloride, sorbitol. May contain hydrochloric acid and/or sodium hydroxide to adjust pH.

📄 Do Not Use 25 words ▾

For external use only. Do not use if this product changes color or becomes cloudy if you are sensitive to any ingredient in this product

📄 When Using This Product 22 words ▾

When using this product do not touch tip of container to any surface to avoid contamination do not reuse once opened, discard

📄 Stop Use and Ask a Doctor If 34 words ▾

Stop use and ask a doctor if you experience any of the following: eye pain changes in vision Continued redness or irritation of the eye Condition worsens or persists for more than 72 hours

📄 Keep Out of Reach of Children 19 words ▾

Keep out of reach of children. If swallowed, get medical help or contact a Poison Control Center right away.

📄 Questions or Comments 7 words ▾

Questions? In the U.S. call 1-800-757-9195 www.systane.com

📄 Package Label / Principal Display Panel 151 words ▾

PRINCIPAL DISPLAY PANEL Systane ® LUBRICANT EYE DROPS ULTRA PF PRESERVATIVE-FREE DRY EYE RELIEF Convenient Single Vials On-The-Go Great for sensitive eyes Fast-acting hydration and lasting relief Moisture-rich formula #1 Doctor Recommended Brand 1 STERILE 60 Vials 0.7 mL Each Alcon SIDE DISPLAY PANEL Systane ® LUBRICANT EYE DROPS ULTRA PF PRESERVATIVE-FREE DRY EYE RELIEF Convenient Single Vials On-The-Go Open your eyes to a breakthrough in comfort with SYSTANE ® ULTRA Lubricant Eye Drops. SYSTANE ® ULTRA preservative-free vials elevates the science of dry eye therapy to a new level so you can have relief from dry eye anytime, anywhere.

From first blink eyes feel lubricated and refreshed. Feel the difference in dry eye relief with SYSTANE ® ULTRA TAMPER EVIDENT: Do not use if vial is damaged or opened at time of purchase. 1 Based on a survey of eye care professionals.

Data on file. www.alconpatents.com Made in France W435221-0919

Source: FDA Structured Product Labeling, mirrored from DailyMed / openFDA. Prefer the government’s original formatting? View this label on DailyMed ↗

Medicaid utilization & spend

📍 This exact package only: Medicaid data is reported per full 11-digit NDC — labeler, product and pack size — so every number here is for this package alone, not the drug overall. Other pack sizes report separately.
💊 Pharmacy benefit only: These are Medicaid outpatient pharmacy claims, billed by NDC. They exclude the medical benefit — clinic- or hospital-administered drugs billed under HCPCS J-codes — so drugs used mostly that way (e.g. Avastin, Lucentis, Keytruda) can look low or missing here. That’s expected, not an error.
📅 Q1 2025 – Q1 2026 · 5 quarters of data
ⓘ The newest quarter is usually incomplete when first published; states restate recent quarters in later CMS releases, so the latest figures typically revise upward. State coverage-policy changes can also shift quarter-to-quarter totals.
Prescriptions last 4 qtrs
808
Units reimbursed last 4 qtrs
42K
Gross reimbursed last 4 qtrs
$25.4K
Avg / prescription
$31.41
Avg / unit
$0.6047
Latest quarter Q1 2026
56Rx
Medicaid pays / ea
$0.6047
gross reimbursed
vs
NADAC / ea
$0.3601
acquisition cost
=
Spread
+$0.2446
+68% vs cost
What Medicaid paid per ea (before rebates; includes the pharmacy’s dispensing fee) compared with NADAC — the average price pharmacies pay to buy the drug. A positive spread means Medicaid reimbursed more than the purchase price, before manufacturer rebates.
Fee-for-service vs managed care ⓘ
85% FFS 15% MCO
Fee-for-service · 686 Rx Managed care · 122 Rx
State Medicaid map
Alaska: no data reported AK Maine: no data reported ME Washington: no data reported WA Idaho: no data reported ID Montana: no data reported MT North Dakota: no data reported ND Minnesota: no data reported MN Wisconsin: no data reported WI Michigan: no data reported MI New York: 26,470 units · 135 per 100k residents NY Vermont: no data reported VT New Hampshire: no data reported NH Oregon: no data reported OR Nevada: no data reported NV Wyoming: no data reported WY South Dakota: no data reported SD Iowa: no data reported IA Illinois: no data reported IL Indiana: no data reported IN Ohio: 3,864 units · 32.8 per 100k residents OH Pennsylvania: no data reported PA New Jersey: no data reported NJ Massachusetts: no data reported MA California: 11,634 units · 29.9 per 100k residents CA Utah: no data reported UT Colorado: no data reported CO Nebraska: no data reported NE Missouri: no data reported MO Kentucky: no data reported KY West Virginia: no data reported WV Virginia: no data reported VA Maryland: no data reported MD Connecticut: no data reported CT Rhode Island: no data reported RI Arizona: no data reported AZ New Mexico: no data reported NM Kansas: no data reported KS Arkansas: no data reported AR Tennessee: no data reported TN North Carolina: no data reported NC South Carolina: no data reported SC Delaware: no data reported DE Oklahoma: no data reported OK Louisiana: no data reported LA Mississippi: no data reported MS Alabama: no data reported AL Georgia: no data reported GA D.C.: no data reported DC Hawaii: no data reported HI Texas: no data reported TX Florida: no data reported FL
Units reimbursed · per 100k residents
29.9135
gray = no data reported ⓘ
Colors are per 100,000 residents, so big states don’t automatically dominate. Tap or hover a state for its actual totals.
Tap or hover a state
…for its Medicaid breakdown
🏆 Top states by units · per 100k residents
1 New York 135 /100k
2 Ohio 32.8 /100k
3 California 29.9 /100k
National units — by quarter
💵 About the dollar figures: “reimbursed” is what Medicaid paid pharmacies before confidential manufacturer rebates, so the program’s real net cost is lower than these numbers. Fee-for-service and managed-care claims are combined unless split above. Source: CMS State Drug Utilization Data; per-100k rates use 2023 Census population estimates.

Medicaid utilization by pack size

Medicaid (SDUD) totals over the four most recent reported quarters for every package size of this drug — handy when a specific package (e.g. a starter/titration pack) carries little or no Medicaid volume on its own.
25 vials00065-1432-06 6,428 Rx · $186,332
60 vials this page00065-1432-05 808 Rx · $25,377
5 vials00065-1432-04 No Medicaid data
Drug total (last 4 qtrs): 7,236 Rx · 260,675 units · $211,708 gross reimbursed
Tap a pack size to open its page. Source: CMS State Drug Utilization Data, last 4 quarters.
← 00065-1431-01 · Alcon 00065-1433-02 · Alcon →
For educational and professional reference only — not medical advice. Pricing reflects published NADAC and CMS ASP (free public data) and may differ from your acquisition cost; always verify before billing or dispensing.