Interchangeable Grouping
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92:00 UNCLASSIFIED THERAPEUTIC AGENTS
LU Criteria Text
GLATIRAMER ACETATE
20mg/mL Inj Sol Pref Syr-1mL Pk
Interchangeables found: 2
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DIN/ PIN/ NPN
Brand Name
Drug Benefit Price or Unit Price
Amount MOH Pays:
02245619
Copaxone
50.6522
27.8587
02541440
Glatiramer Acetate Injection
27.8587
27.8587
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