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SYSTANE HYDRATION PF PRESERVATIVE FREE Polyethylene Glycol 400 and Propylene 400 4 mg/mL; 3 mg/mL Solution/ Drops, 30 vials — NDC 00065-1437-04 package photo
Label image from the product's FDA listing (DailyMed) — may show a different pack size or an older label revision.

SYSTANE HYDRATION PF PRESERVATIVE FREE Polyethylene Glycol 400 and Propylene 400 4 mg/mL; 3 mg/mL Solution/ Drops, 30 vials — NDC 0065-1437-04 (Billing 00065-1437-04)

by Alcon Laboratories, Inc. · 30 VIAL, SINGLE-DOSE in 1 CARTON / .7 mL in 1 VIAL, SINGLE-DOSE

This is a package of 30 vials of SYSTANE HYDRATION PF PRESERVATIVE FREE Polyethylene Glycol 400 and Propylene 400 4 mg/mL; 3 mg/mL Solution/ Drops from Alcon Laboratories, Inc., marketed since Feb 2020 and currently FDA-listed; retail pharmacies pay about $0.3763 per vial (NADAC). It is the main listing for this product, which comes in 2 package sizes.

NDC 00065-1437-04
🏷️ FDA NDC (as labeled) 0065-1437-04 billing pads the labeler segment with a zero
This package
Contains30 vials Cost per ea$0.3763 NADAC Per package$11.29 / 30 vials Pack sizes2 compare ↓
Also priced by: Medicaid pays $0.7608/unit — full pricing hub ↓
Main listing for product 0065-1437 · Also comes in: 5 vials 0065-1437-05
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 0065-1437-04 alone.

Record
FDA NDC Directory package listing · Human OTC drug
Code segments
0065 labeler · 1437 product · 04 package
Package marketed since
Feb 1, 2020
Sample package
No — commercial package
Listing certified through
Dec 31, 2026
Billing quantity
30 EA per package
Barcode (UPC-A, from the NDC)
3 0065143704 1
Medicaid fills, this package
4,285 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) 0065-1437-04
Product NDC 0065-1437
11-digit billing NDC 00065143704
NCPDP billing unit EA — each (per item)
RxCUI 477589
UNII B697894SGQ, 6DC9Q167V3
Application # M018
SPL Set ID db3a6c68-320b-46b0-83fa-6c29297a84a6
DEA schedule Non-controlled
Marketing category OTC MONOGRAPH DRUG
Marketing status On market
FDA listing status Listed (active directory)
Marketing start 2020-02-01
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 Hydration 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 HYDRATION PF 0.4-0.3%
FDB brand name Systane Hydration Pf
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 0065-1437-04 — 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 → 00065-1437-04. 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 HYDRATION PF 0.4-0.3% Ingredient Propylene Glycol/Peg 400/Pf
🧪 What is this product?

Systane Hydration PF is an over-the-counter eye drop solution marketed as a preservative-free lubricant. It contains polyethylene glycol 400 and propylene glycol, which are humectant ingredients commonly used in artificial tear products to help lubricate and moisturize the eye surface. This type of product is typically used to relieve dryness and provide temporary comfort to dry or irritated 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 $0.376 $11.29 / 30 vials
Medicaid paysCMS SDUD · 12 mo $0.7608 $22.82 / 30 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
May 2021 Aug 2022 Mar 2026 Sep 2026 $0.490 $0.334
▲ Up 9% over the last 19 months.
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
00065-1437-04 You're viewing this Main listing 30 VIAL, SINGLE-DOSE in 1 CARTON / .7 mL in 1 VIAL, SINGLE-DOSE $0.3763 / ea $11.29 2020-02-01 — Active
00065-1437-05 0065-1437-05 5 VIAL, SINGLE-DOSE in 1 CARTON / .7 mL in 1 VIAL, SINGLE-DOSE — — 2020-02-01 — Active

In Medicaid, this is the most-dispensed pack of this product — about 100% of fills over the last four reported quarters. See all packs ↓

Pack size FAQ

What quantity is in this package?
This package contains 30 vials — 30 vial, single-dose in 1 carton / .7 ml in 1 vial, single-dose.
How does this package differ from NDC 00065-1437-05?
Both are SYSTANE HYDRATION PF PRESERVATIVE FREE 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 30 vials one, while NDC 00065-1437-05 is the 5 vials package.
What NDC number is used to bill for this package of SYSTANE HYDRATION PF PRESERVATIVE FREE 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 46%
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 44%
Sunmark Lubricating Tears 400 .4 g/100mL; .3 g/100mL 49348-0149-29 Strategic 1 bottle $0.332 — FDA listed save 12%
Sunmark Lubricant Eye Drops 400 .4 g/100mL; .3 g/100mL 49348-0947-29 Strategic 1 bottle $0.332 — FDA listed save 12%
Health Mart Lubricating Tears 400 .4 g/100mL; .3 g/100mL 62011-0254-01 Strategic 1 bottle $0.332 — FDA listed save 12%
Lubricant Eye Drops Solution 400 4 mg/mL; 3 mg/mL 50268-0126-15 AvPAK 1 bottle $0.363 — Availability likely save 4%
Leader Ultra Lubricating Eye Drops 400 .4 g/100mL; .3 g/100mL 70000-0457-01 Cardinal 1 bottle $0.363 — Availability likely save 4%
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 save 4%
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 save 4%
Quality Choice Lubricant Eye Drops High Performance 400 .4 g/100mL; .3 g/100mL 83324-0029-15 Chain 1 bottle $0.363 — Availability likely save 4%
Systane 400 4 mg/mL; 3 mg/mL 00065-0431-33 Alcon 30 vials $0.376 — Availability likely +0%
Systane Hydration Pf Preservative Free 400 4 mg/mL; 3 mg/mLthis 00065-1437-04 Alcon 30 vials $0.376 — Availability likely —
Systane Lubricant 400 4 mg/mL; 3 mg/mL 00065-0429-15 Alcon 1 bottle $0.702 — Availability likely +87%
Systane Ultra Preservative Free 400 4 mg/mL; 3 mg/mL 00065-1507-82 Alcon 1 bottle $1.155 — Availability likely +207%
Systane Hydration Pf Preservative Free 400 4 mg/mL; 3 mg/mL 00065-1510-06 Alcon 1 bottle $1.155 — Availability likely +207%
Systane Ultra 400 4 mg/mL; 3 mg/mL 00065-1431-01 Alcon 1 bottle — — FDA listed —
Systane ULTRA 400 4 mg/mL; 3 mg/mL 00065-1432-04 Alcon 5 vials — — 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

🏛️
2020
On the market since
Feb 2020
📍
2026
Currently FDA-listed
6 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.

Loading inactive ingredients from the official FDA label in the background. No external source is being called by this page request.
Where does this data come from?
Source: official FDA Structured Product Labeling (SPL) via DailyMed and the openFDA label index. Structured IACT rows and label-wide narrative are kept separate; availability and product-level specificity depend on the submitted label.

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 marketedFeb 2020
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 🎯 Purpose 📄 Do Not Use 📄 When Using This Product 📄 Stop Use and Ask a Doctor If 📄 Keep Out of Reach of Children 📄 Other Information 📄 Questions or Comments 📄 Package Label / Principal Display Panel
🎯 Indications and Usage 16 words ▾

Uses for use as a protectant against further irritation or to relieve dryness of the eye

⏱️ Dosage and Administration 12 words ▾

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

⚠️ Warnings 5 words ▾

Warnings For external use only

🧪 Active Ingredient 12 words ▾

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

🧪 Inactive Ingredients 28 words ▾

Inactive ingredients aminomethylpropanol, boric acid, hydroxypropyl guar, potassium chloride, purified water, sodium borate, sodium chloride, sodium hyaluronate, sorbitol. May contain hydrochloric acid and/or sodium hydroxide to adjust pH.

🎯 Purpose 12 words ▾

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

📄 Do Not Use 21 words ▾

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.

📄 Other Information 6 words ▾

Other information store at room temperature

📄 Questions or Comments 8 words ▾

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

📄 Package Label / Principal Display Panel 186 words ▾

PRINCIPAL DISPLAY PANEL SYSTANE ® Lubricant Eye Drops HYDRATION PF PRESERVATIVE-FREE DRY EYE RELIEF Convenient Single Vials On-the-Go Extra moisturizing for sensitive eyes Longer lasting hydration* VOTED PRODUCT OF THE YEAR Consumer Survey of Product Innovation 2021 ± Hydro Boost TECHNOLOGY Alcon STERILE 30 Vials 0.7 mL (0.02 FL OZ) Experience preservative-free relief that’s extra moisturizing for sensitive eyes Common Dry Eye Symptoms • Burning or stinging • Fluctuating vision • Irritation • Watery eyes TAMPER EVIDENT: For your protection, 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. * vs SYSTANE ® ULTRA Lubricant Eye Drops ± Winner Eye Care Category. Survey of 40,000 people by Kantar. www.alconpatents.com Made in France 436272-0221 SYSTANE ® Lubricant Eye Drops HYDRATION PF PRESERVATIVE-FREE DRY EYE RELIEF DIRECTIONS: Make sure container is intact before use.

To open, COMPLETELY TWIST OFF TAB. Do not pull off. Put 1 or 2 drops in the affected eye(s) as needed.

Throw away container. Do not reuse. ALCON Alcon Laboratories, Inc.

Fort Worth, TX 76134 USA LOT: EXP.:

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
4.3K
Units reimbursed last 4 qtrs
167.2K
Gross reimbursed last 4 qtrs
$127.2K
Avg / prescription
$29.69
Avg / unit
$0.7608
Latest quarter Q1 2026
1.4KRx
Medicaid pays / ea
$0.7608
gross reimbursed
vs
NADAC / ea
$0.3763
acquisition cost
=
Spread
+$0.3845
+102% 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 ⓘ
95% FFS
Fee-for-service · 4,060 Rx Managed care · 225 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: 3,688 units · 64.3 per 100k residents MN Wisconsin: 3,420 units · 57.9 per 100k residents WI Michigan: no data reported MI New York: 59,070 units · 302 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: 3,822 units · 32.4 per 100k residents OH Pennsylvania: no data reported PA New Jersey: no data reported NJ Massachusetts: no data reported MA California: 96,642 units · 248 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: 570 units · 15.8 per 100k residents 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
15.8302
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 302 /100k
2 California 248 /100k
3 Minnesota 64.3 /100k
4 Wisconsin 57.9 /100k
5 Ohio 32.4 /100k
6 Connecticut 15.8 /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.
30 vials this page00065-1437-04 4,285 Rx · $127,209
5 vials00065-1437-05 No Medicaid data
Drug total (last 4 qtrs): 4,285 Rx · 167,212 units · $127,209 gross reimbursed
Tap a pack size to open its page. Source: CMS State Drug Utilization Data, last 4 quarters.
← 00065-1433-02 · Alcon 00065-1502-10 · 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.