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Allergy Chlorpheniramine Maleate 4 mg Tablet, 100-count — NDC 00904-0012-61 package photo
Label image from the product's FDA listing (DailyMed) — may show a different pack size or an older label revision.

Allergy Chlorpheniramine Maleate 4 mg Tablet, 100-count — NDC 0904-0012-61 (Billing 00904-0012-61)

by Major Pharmaceuticals · 10 BLISTER PACK in 1 CARTON / 10 TABLET in 1 BLISTER PACK

This is a package of 100 tablets of Allergy Chlorpheniramine Maleate 4 mg Tablet from Major Pharmaceuticals, marketed since Dec 1992 and currently FDA-listed; retail pharmacies pay about $0.0177 per tablet (NADAC).

NDC 00904-0012-61
🏷️ FDA NDC (as labeled) 0904-0012-61 billing pads the labeler segment with a zero
This package
Contains100-count Cost per ea$0.0177 NADAC Per package$1.77 / 100 tablets Pack sizes4 compare ↓
Also priced by: Medicaid pays $0.1887/unit — full pricing hub ↓
Product page 00904-0012-59 Also comes in: 24 tablets 0904-0012-24 100 tablets 0904-0012-59 1000 tablets 0904-0012-80
OTC On market Non-controlled ⇄ Compare with another NDC
🗂️ FDA directory synced Oct 1, 2026 · this listing last changed Aug 20, 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 0904-0012-61 alone.

Record
FDA NDC Directory package listing · Human OTC drug
Code segments
0904 labeler · 0012 product · 61 package
Package marketed since
Dec 19, 1992
Sample package
No — commercial package
Listing certified through
Dec 31, 2027
Billing quantity
100 EA per package
Barcode (UPC)
0309040012616, 0309040012593
Medicaid fills, this package
43 prescriptions in the last four reported quarters
FDA record last changed
Aug 20, 2026

Identity & classification

Regulatory identifiers FDA, NLM and CMS codes for this package

FDA NDC (as labeled) 0904-0012-61
Product NDC 0904-0012
11-digit billing NDC 00904001261
NCPDP billing unit EA — each (per item)
RxCUI 1363309
UNII V1Q0O9OJ9Z
UPC 0309040012616, 0309040012593
Application # M012
SPL Set ID 66b918d3-5c37-4889-b981-819ced8b6147
Established class (EPC) Histamine-1 Receptor Antagonist
Mechanism of action Histamine H1 Receptor Antagonists
DEA schedule Non-controlled
Marketing category OTC MONOGRAPH DRUG
Marketing status On market
FDA listing status Listed (active directory)
Marketing start 1992-12-19
Route ORAL
Dosage form TABLET
Substance CHLORPHENIRAMINE MALEATE

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

GCN Seq No 011640
GCN 46512
HICL code 004505
Ingredient (HICL) Chlorpheniramine Maleate
HIC1 code Z
Therapeutic class — broad (HIC1) Body As A Whole
HIC2 code Z2
Therapeutic class — intermediate (HIC2) Antihistamines, Antiserotonins, Immunosuppressants
HIC3 code Z2P
Therapeutic class — specific (HIC3) Antihistamines - 1St Generation
AHFS code 04:04.00.00
AHFS class First Generation Antihistamines
FDB label name ALLERGY 4 MG TABLET
FDB brand name Allergy
Legend status O — Over-the-counter (OTC) drug or device
Quick answers
  • GSN (GCN sequence number): 011640
  • GCN: 46512
  • HICL (First Databank): 004505
  • AHFS class code: 04:04.00.00
  • RxCUI (RxNorm): 1363309
Why two NDCs? The FDA registers this code as 0904-0012-61 — 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 → 00904-0012-61. 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.

RxNorm drug class

This medicine belongs to the Histamine-1 Receptor Antagonist class.

Pharmacologic class Histamine-1 Receptor Antagonist
Drug family (ATC) Substituted alkylamines
How it works Histamine H1 Receptor Antagonists
Where does this data come from?
Therapeutic classes from RxNorm RxClass (U.S. National Library of Medicine) — Established Pharmacologic Class (FDA), ATC drug family (WHO) and mechanism of action, matched by this product’s RxCUI.

Clinical

Label name ALLERGY 4 MG TABLET Ingredient Chlorpheniramine Maleate
📗 Our plain-language guide HelloPharmacist
  • It temporarily relieves allergy symptoms from hay fever and other upper respiratory allergies. That means sneezing, runny nose, itchy, watery eyes, and an itchy nose or throat. It...
  • It depends on the product. Regular tablets and the liquid are generally taken every 4 to 6 hours. The extended-release tablets are taken about every 12 hours. Check your package fo...
  • It can, and the drowsiness may be marked. Be careful driving or using machinery. Some people, especially children, can get excitable instead.
  • It's best to avoid alcohol, since it adds to drowsiness. Sedatives and tranquilizers can also increase drowsiness, so talk to me or your doctor before taking them together.
📖 Read our full Chlorpheniramine guide →

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 $0.018 $1.77 / 100 tablets
Medicaid paysCMS SDUD · 12 mo $0.1887 $18.87 / 100 tablets
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
Jan 2022 Aug 2022 Jan 2026 Sep 2026 $0.020 $0.015
▼ Down 8% over the last 24 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
00904-0012-24 0904-0012-24 2 BLISTER PACK in 1 CARTON / 12 TABLET in 1 BLISTER PACK $0.0177 / ea $0.43 1992-12-19 — Active
00904-0012-59 0904-0012-59 Main listing 1 BOTTLE, PLASTIC in 1 CARTON / 100 TABLET in 1 BOTTLE, PLASTIC $0.0177 / ea $1.77 1992-12-19 — Active
00904-0012-61 You're viewing this 10 BLISTER PACK in 1 CARTON / 10 TABLET in 1 BLISTER PACK $0.0177 / ea $1.77 1992-12-19 — Active
00904-0012-80 0904-0012-80 1000 TABLET in 1 BOTTLE, PLASTIC $0.0177 / ea $17.72 1992-12-19 — Active

This pack effectively ties for the lowest per-ea cost of the 4 priced pack sizes ($0.0177 NADAC).

This pack accounts for about 0.6% 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 is a 100-count package — 10 blister pack in 1 carton / 10 tablet in 1 blister pack.
How does this package differ from NDC 00904-0012-24?
Both are Allergy Chlorpheniramine Maleate 4 mg Tablet — the drug itself is identical. This page's package is the 100-count one, while NDC 00904-0012-24 is the 24 tablets package.
What NDC number is used to bill for this package of Allergy Chlorpheniramine Maleate 4 mg Tablet?
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
Allergy Relief 4 Hour 4 mg 70000-0160-01 Cardinal 24 tablets $0.018 — Discontinued save 1%
Allergy 4 mgthis 00904-0012-61 Major 100 tablets $0.018 — Availability likely —
Allergy Relief 4 mg 46122-0618-62 Amerisource 24 tablets $0.018 — Availability likely —
Allergy Relief 4 mg 70677-1016-01 Strategic 100 tablets $0.018 — Availability likely —
Allergy Relief 4 mg 83324-0068-24 Chain 24 tablets $0.018 — Availability likely —
Aller-chlor 4 mg 00536-1006-01 Rugby 100 tablets $0.018 — Availability likely —
Allergy Relief 4 mg 00363-1941-15 Walgreen 50 tablets — — FDA listed —
allergy relief 4 mg 11822-0662-01 Rite 100 tablets — — FDA listed —
Anti Allergy 4 mg 17714-0016-01 Advance 100 tablets — — FDA listed —
Allergy Relief 4 mg 36800-0694-08 Topco 24 tablets — — FDA listed —
Allergy 4 mg 37835-0633-01 Bi-Mart 100 tablets — — FDA listed —
Allergy 4 mg 41163-0194-08 United 24 tablets — — FDA listed —
Medique Chlorphen 4 mg 47682-0169-46 Unifirst 1 tablet — — FDA listed —
Allergy Time 4 mg 49483-0242-00 Time 100000 tablets — — FDA listed —
Allergy 4 mg 50090-0049-00 A-S 100 tablets — — FDA listed —
Allergy Relief 4 mg 50804-0277-93 Good 24 tablets — — FDA listed —
Sprinsol 4 mg 51467-0101-01 FORTUNE 24 tablets — — FDA listed —
Chlorpheniramine maleate 4mg 4 mg 53185-0277-24 Athlete's 24 tablets — — FDA listed —
Anti Allergy 4 mg 54738-0103-01 Richmond 100 tablets — — FDA listed —
Chlorpheniramine Maleate 4 mg 55289-0560-01 PD-Rx 100 tablets — — FDA listed —
Allergy Relief 4 Hour 4 mg 57896-0974-01 Geri-Care 100 tablets — — FDA listed —
Allergy Relief 4 mg 63868-0333-24 CHAIN 24 tablets — — FDA listed —
Allergy Relief 4 Hour 4 mg 67091-0203-24 WinCo 24 tablets — — FDA listed —
Allergy Relief 4 mg 68016-0683-81 Chain 100 tablets — — FDA listed —
Allergy 4 mg 68998-0277-93 Marc 24 tablets — — FDA listed —
Allergy 4 mg 69168-0277-93 Allegiant 24 tablets — — FDA listed —
Allergy Relief 4 mg 69842-0194-12 CVS 100 tablets — — FDA listed —
Chlorpheniramine Maleate 4 mg 71335-0963-01 Bryant 30 tablets — — FDA listed —
Allergy 4 mg 71335-2056-01 Bryant 30 tablets — — FDA listed —
Allergy Relief 4 mg 71335-2812-01 Bryant 100 tablets — — FDA listed —
Allergy Relief 4 Hour 4 mg 71335-3093-01 Bryant 30 tablets — — FDA listed —
Pharbechlor 4 mg 73057-0346-11 Ulai 1000 tablets — — FDA listed —
Allergy Relief 4 mg 79903-0074-12 WALMART 100 tablets — — 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

🏛️
1992
On the market since
Dec 1992
📍
2026
Currently FDA-listed
34 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.

What it looks like

Color yellow
ShapeRound
Imprint44;194
Size8 mm
ScoringScored — splits in 2
One label can cover several strengths, so colors may be combined — always confirm a loose pill against the dispensed prescription label or a pharmacist.
Where does this data come from?
Physical description (imprint, shape, color, scoring, coating) from this product’s FDA Structured Product Labeling (SPL), mirrored from DailyMed / openFDA.

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.

🧪 Avoiding an ingredient? See Chlorpheniramine inactive ingredients by manufacturer: every current product's list side by side, so you can ask your pharmacy for the version that does not list it.

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

  • UNII 3SY5LH9PMK
    Anhydrous lactose is a milk sugar with no water content. It acts as a filler and binder in tablets and capsules, adding bulk and helping ingredients stick together.
  • UNII CQ3XH3DET6
    D&C Yellow No. 10 Aluminum Lake is a yellow colorant made by combining a dye with aluminum salts. It's used in medicines to add color for product identification and visual appeal.
  • UNII 70097M6I30
    Magnesium stearate is a salt made from magnesium and stearic acid, a fatty substance. It's used in tablets and capsules as a lubricant and glidant to help ingredients flow smoothly during manufacturing and prevent sticking.
  • UNII OP1R32D61U
    Microcrystalline cellulose is a purified form of cellulose, a natural fiber from plant sources. It acts as a binder and filler in tablets and capsules, helping hold ingredients together and give the medicine its shape and size.
  • UNII O8232NY3SJ
    A plant-based carbohydrate derived from corn kernels. It acts as a filler to add bulk, a binder to hold ingredients together, and a disintegrant to help the tablet break apart in your stomach for absorption.

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

The official label also statescorn starch, D&C yellow #10 aluminum lake, lactose anhydrous, magnesium stearate, microcrystalline cellulose

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

LabelerMajor Pharmaceuticals
FDA applicationM012 (OTC MONOGRAPH DRUG)
Labeler code00904
First marketedDec 1992
Product typeHuman Otc Drug
Portfolio630 products on file

More NDCs from Major Pharmaceuticals labeler code 00904

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 📦 Storage and Handling 🧪 Active Ingredient 🧪 Inactive Ingredients 🎯 Purpose 📄 Do Not Use 📄 Ask a Doctor Before Use If 📄 Ask a Doctor or Pharmacist Before Use If 📄 When Using This Product 🤰 If Pregnant or Breast-Feeding 📄 Keep Out of Reach of Children 📄 Questions or Comments 📄 Package Label / Principal Display Panel
🎯 Indications and Usage 26 words ▾

Uses temporarily relieves these symptoms due to hay fever or other upper respiratory allergies: sneezing runny nose itchy, watery eyes itching of the nose or throat

⏱️ Dosage and Administration 58 words ▾

Directions take every 4 to 6 hours, or as directed by a doctor adults and children 12 years and over 1 tablet. Do not exceed 6 tablets in 24 hours. children 6 to under 12 years 1/2 tablet (break tablet in half). Do not exceed 3 whole tablets in 24 hours. children under 6 years do not use

⚠️ Warnings 115 words ▾

Warnings Do not use to make a child sleepy. Ask a doctor before use if you have a breathing problem such as emphysema or chronic bronchitis glaucoma difficulty in urination due to enlargement of the prostate gland Ask a doctor or pharmacist before use if you are taking sedatives or tranquilizers. When using this product drowsiness may occur avoid alcoholic beverages excitability may occur, especially in children use caution when driving a motor vehicle or operating machinery alcohol, sedatives, and tranquilizers may increase drowsiness If pregnant or breast-feeding, ask a health professional before use.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center right away.

📦 Storage and Handling 24 words ▾

Other information store at 25°C (77°F); excursions permitted between 15°-30°C (59°-86°F) protect from excessive moisture see end flap for expiration date and lot number

🧪 Active Ingredient 9 words ▾

Active ingredient (in each tablet) Chlorpheniramine maleate 4 mg

🧪 Inactive Ingredients 15 words ▾

Inactive ingredients corn starch, D&C yellow #10 aluminum lake, lactose anhydrous, magnesium stearate, microcrystalline cellulose

🎯 Purpose 2 words ▾

Purpose Antihistamine

📄 Do Not Use 8 words ▾

Do not use to make a child sleepy.

📄 Ask a Doctor Before Use If 28 words ▾

Ask a doctor before use if you have a breathing problem such as emphysema or chronic bronchitis glaucoma difficulty in urination due to enlargement of the prostate gland

📄 Ask a Doctor or Pharmacist Before Use If 14 words ▾

Ask a doctor or pharmacist before use if you are taking sedatives or tranquilizers.

📄 When Using This Product 33 words ▾

When using this product drowsiness may occur avoid alcoholic beverages excitability may occur, especially in children use caution when driving a motor vehicle or operating machinery alcohol, sedatives, and tranquilizers may increase drowsiness

🤰 If Pregnant or Breast-Feeding 10 words ▾

If pregnant or breast-feeding, ask a health professional before use.

📄 Keep Out of Reach of Children 21 words ▾

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center right away.

📄 Questions or Comments 4 words ▾

Questions or comments? 1-800-426-9391

📄 Package Label / Principal Display Panel 60 words ▾

Principal Display Panel NDC 0904-0012-59 MAJOR® 4 hour allergy tablets chlorpheniramine maleate 4 mg antihistamine relieves: sneezing, runny nose, itchy, watery eyes, itchy throat actual size 100 tablets Major 44-194 Major 44-194

Principal Display Panel - Unit Dose NDC 0904-0012-61 MAJOR® Unit Dose ALLERGY TABLETS CHLORPHENIRAMINE MALEATE Antihistamine 4 mg each Institutional Dispensing Only 100 TABLETS Major 44-194-DSP Major 44-194-DSP

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
43
Units reimbursed last 4 qtrs
1.5K
Gross reimbursed last 4 qtrs
$291.21
Avg / prescription
$6.77
Avg / unit
$0.1887
Latest quarter Q1 2026
16Rx
Medicaid pays / ea
$0.1887
gross reimbursed
vs
NADAC / ea
$0.0177
acquisition cost
=
Spread
+$0.1710
+966% 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 ⓘ
100% FFS
Fee-for-service · 43 Rx Managed care · 0 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: no data reported 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: no data reported OH Pennsylvania: no data reported PA New Jersey: no data reported NJ Massachusetts: no data reported MA California: 1,543 units · 4.0 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
4.04.0
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 California 4.0 /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.
100 tablets00904-0012-59 5,077 Rx · $47,738
1000 tablets00904-0012-80 1,357 Rx · $12,159
24 tablets00904-0012-24 1,201 Rx · $12,236
100 tablets this page00904-0012-61 43 Rx · $291
Drug total (last 4 qtrs): 7,678 Rx · 399,899 units · $72,425 gross reimbursed
Tap a pack size to open its page. Source: CMS State Drug Utilization Data, last 4 quarters.
← 00884-0293-01 · Pedinol 00904-0428-04 · Major →
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.