Analysource Report 20210125094215

Analy$ource (Selected from FDB MedKnowledge (formerly known as NDDF Plus) data included with permission and copyright
Exported: 01/25/2021
Total NDCs: 47
Product Filter: Brand Name (ARANESP, FULPHILA, NEULASTA, NEUPOGEN, NIVESTYM, UDENYCA)
Historical Price Filters: Price Date Range (WAC Unit: 01/25/2016 - 01/25/2021), Price Date Range (ASP: 01/25/2016 - 01/25/2
NDC Brand Name Labeler Name

00069-0291-01 NIVESTYM PFIZER US PHARM
55513-0002-01 ARANESP AMGEN
55513-0190-01 NEULASTA AMGEN
55513-0209-01 NEUPOGEN AMGEN
67457-0833-06 FULPHILA MYLAN INSTITUTI
70114-0101-01 UDENYCA COHERUS BIOSCIE
as NDDF Plus) data included with permission and copyrighted by First Databank, Inc.)
UPOGEN, NIVESTYM, UDENYCA)

01/25/2021), Price Date Range (ASP: 01/25/2016 - 01/25/2021)
Latest Price Verification Date Current ASP Payment Limit

12/27/2019 $ 0.5230000 - 01/01/2021
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019 $ 0.5230000 - 01/01/2021
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019 $ 0.5230000 - 01/01/2021
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019 $ 0.5230000 - 01/01/2021
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019 $ 0.5230000 - 01/01/2021

12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019 $ 0.5230000 - 01/01/2021

12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3079.4880000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 0.9380000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 0.9380000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 0.9380000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 0.9380000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 0.9380000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 0.9380000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
07/09/2018 $ 248.1620000 - 01/01/2021
07/09/2018
07/09/2018
07/09/2018
07/09/2018
07/09/2018
07/09/2018
07/09/2018
07/09/2018
07/09/2018
04/28/2020 $ 267.7860000 - 01/01/2021
04/28/2020
04/28/2020
04/28/2020
04/28/2020
04/28/2020
04/28/2020
04/28/2020
ASP HCPCS Code Dosage Current WAC Package WAC Package Quantity
1 MCG $ 219.0000000 - 09/05/2018 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG $ 219.0000000 - 09/05/2018 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG $ 350.4000000 - 09/05/2018 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG $ 350.4000000 - 09/05/2018 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG $ 219.0000000 - 02/25/2019 1

1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG $ 350.4000000 - 02/25/2019 1

1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 193.5000000 - 01/17/2017 1
1 MCG $ 193.5000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 309.6000000 - 01/17/2017 1
1 MCG $ 309.6000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 464.4000000 - 01/17/2017 1
1 MCG $ 464.4000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 774.0000000 - 01/17/2017 1
1 MCG $ 774.0000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG $ 1548.0000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 309.6000000 - 01/17/2017 1
1 MCG $ 309.6000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 464.4000000 - 01/17/2017 1
1 MCG $ 464.4000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 774.0000000 - 01/17/2017 1
1 MCG $ 774.0000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 1161.0000000 - 01/17/2017 1
1 MCG $ 1161.0000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG $ 1548.0000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG $ 3870.0000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 1117.2000000 - 01/14/2016 1
$ 193.5000000 - 01/17/2017 1
1 MCG $ 193.5000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 77.4000000 - 01/17/2017 1
1 MCG $ 77.4000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 2322.0000000 - 01/17/2017 1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1 MCG $ 2322.0000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
6 MG $ 6231.0600000 - 01/01/2018 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
$ 531.4300000 - 10/19/2017 1
1 MCG $ 531.4300000 - 10/19/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG $ 531.4300000 - 10/19/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 314.8300000 - 10/19/2017 1
1 MCG $ 314.8300000 - 10/19/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 501.3300000 - 10/19/2017 1
1 MCG $ 501.3300000 - 10/19/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 333.7000000 - 10/19/2017 1
1 MCG $ 333.7100000 - 10/19/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG $ 333.7000000 - 10/19/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
0.5 MG $ 4175.0000000 - 07/09/2018 1
0.5 MG 1
0.5 MG 1
0.5 MG 1
0.5 MG 1
0.5 MG 1
0.5 MG 1
0.5 MG 1
0.5 MG 1
0.5 MG 1
0.5 MG $ 4175.0000000 - 12/07/2018 1
0.5 MG 1
0.5 MG 1
0.5 MG 1
0.5 MG 1
0.5 MG 1
0.5 MG 1
0.5 MG 1
WAC Package Unit of Measure Current WAC Unit WAC Unit Quantity
Syringe $ 438.0000000 - 09/05/2018 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 438.0000000 - 09/05/2018 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 438.0000000 - 09/05/2018 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 438.0000000 - 09/05/2018 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Vial $ 219.0000000 - 02/25/2019 1

Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial $ 219.0000000 - 02/25/2019 1

Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial $ 193.5000000 - 01/17/2017 1
Vial $ 193.5000000 - 01/17/2017 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial $ 309.6000000 - 01/17/2017 1
Vial $ 309.6000000 - 01/17/2017 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial $ 464.4000000 - 01/17/2017 1
Vial $ 464.4000000 - 01/17/2017 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial $ 774.0000000 - 01/17/2017 1
Vial $ 774.0000000 - 01/17/2017 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial $ 1548.0000000 - 01/17/20171
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Syringe $ 774.0000000 - 01/17/2017 1
Syringe $ 774.0000000 - 01/17/2017 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 1548.0000000 - 01/17/20171
Syringe $ 1548.0000000 - 01/17/20171
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 1548.0000000 - 01/17/20171
Syringe $ 1548.0000000 - 01/17/20171
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 3870.0000000 - 01/17/20171
Syringe $ 3870.0000000 - 01/17/20171
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 3870.0000000 - 01/17/20171
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 3870.0000000 - 01/17/20171
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Vial $ 1489.6000000 - 01/14/20161
Syringe $ 460.7142800 - 01/17/2017 1
Syringe $ 460.7142800 - 01/17/2017 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 193.5000000 - 01/17/2017 1
Syringe $ 193.5000000 - 01/17/2017 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Vial $ 2322.0000000 - 01/17/20171
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Syringe $ 3870.0000000 - 01/17/20171
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 10385.1000000 - 01/01/2011
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 664.2875000 - 10/19/2017 1
Syringe $ 664.2837500 - 10/19/2017 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 664.2875000 - 10/19/2017 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Vial $ 314.8300000 - 10/19/2017 1
Vial $ 314.8330000 - 10/19/2017 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial $ 313.3312500 - 10/19/2017 1
Vial $ 313.3306200 - 10/19/2017 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Syringe $ 667.4000000 - 10/19/2017 1
Syringe $ 667.4100000 - 10/19/2017 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 667.4000000 - 10/19/2017 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 6958.3333300 - 07/09/20181
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 6958.3333300 - 12/07/20181
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
WAC Unit Unit of Measure Generic Name Strength
Milliliter filgrastim-aafi 300 mcg/0.5 m
filgrastim-aafi 300 mcg/mL
Milliliter filgrastim-aafi 300 mcg/mL
filgrastim-aafi 480 mcg/1.6 m
Milliliter darbepoetin alfa in polysorbate 80 25 mcg/mL
Milliliter darbepoetin alfa in polysorbate 80 40 mcg/0.4 mL
Milliliter darbepoetin alfa in polysorbate 80 100 mcg/0.5 m
Milliliter darbepoetin alfa in polysorbate 80 150 mcg/0.75
Milliliter pegfilgrastim 6 mg/0.6 mL
Milliliter filgrastim 480 mcg/0.8 m
Milliliter filgrastim 300 mcg/mL
Milliliter pegfilgrastim-jmdb 6 mg/0.6 mL
Milliliter pegfilgrastim-cbqv 6 mg/0.6 mL
Dosage Form Package Size Unit Dose Indicator
SYRINGE (ML) .500 Non Unit Dose Products
VIAL (ML) 1.000 Non Unit Dose Products
SYRINGE (ML) 1.000 Non Unit Dose Products
VIAL (ML) .750 Non Unit Dose Products
Unit of Use Indicator ASP HCPCS Code USC Classification
Non Unit of Use Products Q5110 48200 - IMMUNE SYSTEM ADJUN
Non Unit of Use Products 48200 - IMMUNE SYSTEM ADJUN
Non Unit of Use Products 48140 - ERYTHROPOIETINS
Non Unit of Use Products J0881 48140 - ERYTHROPOIETINS
Non Unit of Use Products J2505 48200 - IMMUNE SYSTEM ADJUN
WAC Unit Effective Date WAC Unit Price WAC Unit Quantity
09/05/2018 438.0000000 1
09/05/2018 438.0000000 1
09/05/2018 438.0000000 1
09/05/2018 438.0000000 1
Not On File Not On File

02/25/2019 219.0000000 1
02/25/2019 219.0000000 1
01/17/2017 193.5000000 1
01/17/2017 193.5000000 1
01/17/2017 309.6000000 1
01/17/2017 309.6000000 1
01/17/2017 464.4000000 1
01/17/2017 464.4000000 1
01/17/2017 774.0000000 1
01/17/2017 774.0000000 1
01/17/2017 1548.0000000 1
01/17/2017 774.0000000 1
01/17/2017 774.0000000 1
01/17/2017 1548.0000000 1
01/17/2017 1548.0000000 1
01/17/2017 1548.0000000 1
01/17/2017 1548.0000000 1
01/17/2017 3870.0000000 1
01/17/2017 3870.0000000 1
01/17/2017 3870.0000000 1
01/17/2017 3870.0000000 1

01/17/2017 460.7142800 1
01/17/2017 460.7142800 1
01/17/2017 193.5000000 1
01/17/2017 193.5000000 1
01/17/2017 2322.0000000 1
01/17/2017 3870.0000000 1
01/01/2018 10385.1000000 1
07/20/2017 9900.0000000 1
01/13/2017 9455.5833300 1
07/21/2016 9013.8333300 1
10/19/2017 664.2875000 1
10/19/2017 664.2837500 1
10/19/2017 664.2875000 1
10/19/2017 314.8300000 1
10/19/2017 314.8330000 1
10/19/2017 313.3312500 1
10/19/2017 313.3306200 1
10/19/2017 667.4000000 1
10/19/2017 667.4100000 1
10/19/2017 667.4000000 1
07/09/2018 6958.3333300 1
12/07/2018 6958.3333300 1
WAC Unit Unit of Measure WAC Unit Price Change
Milliliter
Milliliter
Milliliter
Milliliter
Milliliter
Milliliter
Milliliter 7.3000000
Milliliter
Milliliter
WAC Unit Percent Change WAC Unit Filter Start Date
01/25/2016
01/25/2016
01/25/2016
01/25/2016
01/25/2016
01/25/2016
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3.92 01/25/2016
3.92 01/25/2016
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3.91 01/25/2016
3.91 01/25/2016
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3.92 01/25/2016
3.92 01/25/2016
01/25/2016
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3.92 01/25/2016
3.92 01/25/2016
01/25/2016
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3.92 01/25/2016
01/25/2016
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3.91 01/25/2016
3.91 01/25/2016
01/25/2016
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3.92 01/25/2016
3.92 01/25/2016
01/25/2016
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3.92 01/25/2016
3.92 01/25/2016
01/25/2016
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3.92 01/25/2016
3.92 01/25/2016
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3.92 01/25/2016
01/25/2016
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3.92 01/25/2016
01/25/2016
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3.92 01/25/2016
3.92 01/25/2016
01/25/2016
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01/25/2016
3.89 01/25/2016
3.89 01/25/2016
01/25/2016
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3.92 01/25/2016
01/25/2016
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3.92 01/25/2016
01/25/2016
01/25/2016
01/25/2016
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01/25/2016
01/25/2016
01/25/2016
4.90 01/25/2016
4.70 01/25/2016
4.90 01/25/2016
4.90 01/25/2016
01/25/2016
01/25/2016
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01/25/2016
2.90 01/25/2016
2.90 01/25/2016
01/25/2016
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01/25/2016
01/25/2016
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01/25/2016
01/25/2016
2.90 01/25/2016
01/25/2016
01/25/2016
01/25/2016
01/25/2016
01/25/2016
01/25/2016
01/25/2016
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01/25/2016
01/25/2016
01/25/2016
2.90 01/25/2016
2.90 01/25/2016
01/25/2016
01/25/2016
01/25/2016
01/25/2016
01/25/2016
01/25/2016
01/25/2016
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01/25/2016
01/25/2016
01/25/2016
01/25/2016
01/25/2016
2.90 01/25/2016
2.90 01/25/2016
01/25/2016
01/25/2016
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01/25/2016
01/25/2016
01/25/2016
2.90 01/25/2016
2.90 01/25/2016
01/25/2016
01/25/2016
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2.90 01/25/2016
01/25/2016
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01/25/2016
WAC Unit Start Price WAC Unit Filter End Date
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
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1548.0000000 07/01/2016
1548.0000000 04/01/2016
3870.0000000 Not On File
3870.0000000 01/01/2021
3870.0000000 10/01/2020
3870.0000000 07/01/2020
3870.0000000 04/01/2020
3870.0000000 01/01/2020
3870.0000000 10/01/2019
3870.0000000 07/01/2019
3870.0000000 04/01/2019
3870.0000000 01/01/2019
3870.0000000 10/01/2018
3870.0000000 07/01/2018
3870.0000000 04/01/2018
3870.0000000 01/01/2018
3870.0000000 10/01/2017
3870.0000000 07/01/2017
3870.0000000 04/01/2017
3870.0000000 01/01/2017
3870.0000000 10/01/2016
3870.0000000 07/01/2016
3870.0000000 04/01/2016
3870.0000000 01/01/2021
3870.0000000 10/01/2020
3870.0000000 07/01/2020
3870.0000000 04/01/2020
3870.0000000 01/01/2020
3870.0000000 10/01/2019
3870.0000000 07/01/2019
3870.0000000 04/01/2019
3870.0000000 01/01/2019
3870.0000000 10/01/2018
3870.0000000 07/01/2018
3870.0000000 04/01/2018
3870.0000000 01/01/2018
3870.0000000 10/01/2017
3870.0000000 07/01/2017
3870.0000000 04/01/2017
3870.0000000 01/01/2017
3870.0000000 10/01/2016
3870.0000000 07/01/2016
3870.0000000 04/01/2016
3870.0000000 01/01/2021
3870.0000000 10/01/2020
3870.0000000 07/01/2020
3870.0000000 04/01/2020
3870.0000000 01/01/2020
3870.0000000 10/01/2019
3870.0000000 07/01/2019
3870.0000000 04/01/2019
3870.0000000 01/01/2019
3870.0000000 10/01/2018
3870.0000000 07/01/2018
3870.0000000 04/01/2018
3870.0000000 01/01/2018
3870.0000000 10/01/2017
3870.0000000 07/01/2017
3870.0000000 04/01/2017
3870.0000000 01/01/2017
3870.0000000 10/01/2016
3870.0000000 07/01/2016
3870.0000000 04/01/2016
1489.6000000 Not On File
460.7142800 Not On File
460.7142800 01/01/2021
460.7142800 10/01/2020
460.7142800 07/01/2020
460.7142800 04/01/2020
460.7142800 01/01/2020
460.7142800 10/01/2019
460.7142800 07/01/2019
460.7142800 04/01/2019
460.7142800 01/01/2019
460.7142800 10/01/2018
460.7142800 07/01/2018
460.7142800 04/01/2018
460.7142800 01/01/2018
460.7142800 10/01/2017
460.7142800 07/01/2017
460.7142800 04/01/2017
460.7142800 01/01/2017
460.7142800 10/01/2016
460.7142800 07/01/2016
460.7142800 04/01/2016
193.5000000 Not On File
193.5000000 01/01/2021
193.5000000 10/01/2020
193.5000000 07/01/2020
193.5000000 04/01/2020
193.5000000 01/01/2020
193.5000000 10/01/2019
193.5000000 07/01/2019
193.5000000 04/01/2019
193.5000000 01/01/2019
193.5000000 10/01/2018
193.5000000 07/01/2018
193.5000000 04/01/2018
193.5000000 01/01/2018
193.5000000 10/01/2017
193.5000000 07/01/2017
193.5000000 04/01/2017
193.5000000 01/01/2017
193.5000000 10/01/2016
193.5000000 07/01/2016
193.5000000 04/01/2016
2322.0000000 10/01/2020
2322.0000000 07/01/2020
2322.0000000 04/01/2020
2322.0000000 01/01/2020
2322.0000000 10/01/2019
2322.0000000 07/01/2019
2322.0000000 04/01/2019
2322.0000000 01/01/2019
2322.0000000 10/01/2018
2322.0000000 07/01/2018
2322.0000000 04/01/2018
2322.0000000 01/01/2018
2322.0000000 10/01/2017
2322.0000000 07/01/2017
2322.0000000 04/01/2017
2322.0000000 01/01/2017
2322.0000000 10/01/2016
2322.0000000 07/01/2016
2322.0000000 04/01/2016
3870.0000000 01/01/2021
3870.0000000 10/01/2020
3870.0000000 07/01/2020
3870.0000000 04/01/2020
3870.0000000 01/01/2020
3870.0000000 10/01/2019
3870.0000000 07/01/2019
3870.0000000 04/01/2019
3870.0000000 01/01/2019
3870.0000000 10/01/2018
3870.0000000 07/01/2018
3870.0000000 04/01/2018
3870.0000000 01/01/2018
3870.0000000 10/01/2017
3870.0000000 07/01/2017
3870.0000000 04/01/2017
3870.0000000 01/01/2017
3870.0000000 10/01/2016
3870.0000000 07/01/2016
3870.0000000 04/01/2016
10385.1000000 01/01/2021
10385.1000000 10/01/2020
10385.1000000 07/01/2020
10385.1000000 04/01/2020
10385.1000000 01/01/2020
10385.1000000 10/01/2019
10385.1000000 07/01/2019
10385.1000000 04/01/2019
10385.1000000 01/01/2019
10385.1000000 10/01/2018
10385.1000000 07/01/2018
10385.1000000 04/01/2018
10385.1000000 01/01/2018
10385.1000000 10/01/2017
10385.1000000 07/01/2017
10385.1000000 04/01/2017
10385.1000000 01/01/2017
10385.1000000 10/01/2016
10385.1000000 07/01/2016
10385.1000000 04/01/2016
664.2875000 Not On File
664.2837500 01/01/2021
664.2837500 10/01/2020
664.2837500 07/01/2020
664.2837500 04/01/2020
664.2837500 01/01/2020
664.2837500 10/01/2019
664.2837500 07/01/2019
664.2837500 04/01/2019
664.2837500 01/01/2019
664.2837500 10/01/2018
664.2837500 07/01/2018
664.2837500 04/01/2018
664.2837500 01/01/2018
664.2837500 10/01/2017
664.2837500 07/01/2017
664.2837500 04/01/2017
664.2837500 01/01/2017
664.2837500 10/01/2016
664.2837500 07/01/2016
664.2837500 04/01/2016
664.2875000 01/01/2021
664.2875000 10/01/2020
664.2875000 07/01/2020
664.2875000 04/01/2020
664.2875000 01/01/2020
664.2875000 10/01/2019
664.2875000 07/01/2019
664.2875000 04/01/2019
664.2875000 01/01/2019
664.2875000 10/01/2018
664.2875000 07/01/2018
664.2875000 04/01/2018
664.2875000 01/01/2018
664.2875000 10/01/2017
664.2875000 07/01/2017
664.2875000 04/01/2017
664.2875000 01/01/2017
664.2875000 10/01/2016
664.2875000 07/01/2016
664.2875000 04/01/2016
314.8300000 Not On File
314.8330000 01/01/2021
314.8330000 10/01/2020
314.8330000 07/01/2020
314.8330000 04/01/2020
314.8330000 01/01/2020
314.8330000 10/01/2019
314.8330000 07/01/2019
314.8330000 04/01/2019
314.8330000 01/01/2019
314.8330000 10/01/2018
314.8330000 07/01/2018
314.8330000 04/01/2018
314.8330000 01/01/2018
314.8330000 10/01/2017
314.8330000 07/01/2017
314.8330000 04/01/2017
314.8330000 01/01/2017
314.8330000 10/01/2016
314.8330000 07/01/2016
314.8330000 04/01/2016
313.3312500 Not On File
313.3306200 01/01/2021
313.3306200 10/01/2020
313.3306200 07/01/2020
313.3306200 04/01/2020
313.3306200 01/01/2020
313.3306200 10/01/2019
313.3306200 07/01/2019
313.3306200 04/01/2019
313.3306200 01/01/2019
313.3306200 10/01/2018
313.3306200 07/01/2018
313.3306200 04/01/2018
313.3306200 01/01/2018
313.3306200 10/01/2017
313.3306200 07/01/2017
313.3306200 04/01/2017
313.3306200 01/01/2017
313.3306200 10/01/2016
313.3306200 07/01/2016
313.3306200 04/01/2016
667.4000000 Not On File
667.4100000 01/01/2021
667.4100000 10/01/2020
667.4100000 07/01/2020
667.4100000 04/01/2020
667.4100000 01/01/2020
667.4100000 10/01/2019
667.4100000 07/01/2019
667.4100000 04/01/2019
667.4100000 01/01/2019
667.4100000 10/01/2018
667.4100000 07/01/2018
667.4100000 04/01/2018
667.4100000 01/01/2018
667.4100000 10/01/2017
667.4100000 07/01/2017
667.4100000 04/01/2017
667.4100000 01/01/2017
667.4100000 10/01/2016
667.4100000 07/01/2016
667.4100000 04/01/2016
667.4000000 01/01/2021
667.4000000 10/01/2020
667.4000000 07/01/2020
667.4000000 04/01/2020
667.4000000 01/01/2020
667.4000000 10/01/2019
667.4000000 07/01/2019
667.4000000 04/01/2019
667.4000000 01/01/2019
667.4000000 10/01/2018
667.4000000 07/01/2018
667.4000000 04/01/2018
667.4000000 01/01/2018
667.4000000 10/01/2017
667.4000000 07/01/2017
667.4000000 04/01/2017
667.4000000 01/01/2017
667.4000000 10/01/2016
667.4000000 07/01/2016
667.4000000 04/01/2016
6958.3333300 01/01/2021
6958.3333300 10/01/2020
6958.3333300 07/01/2020
6958.3333300 04/01/2020
6958.3333300 01/01/2020
6958.3333300 10/01/2019
6958.3333300 07/01/2019
6958.3333300 04/01/2019
6958.3333300 01/01/2019
6958.3333300 10/01/2018
6958.3333300 01/01/2021
6958.3333300 10/01/2020
6958.3333300 07/01/2020
6958.3333300 04/01/2020
6958.3333300 01/01/2020
6958.3333300 10/01/2019
6958.3333300 07/01/2019
6958.3333300 04/01/2019
ASP Payment Limit ASP HCPCS Code Dosage
.5230000 1 MCG
.6210000 1 MCG
.6190000 1 MCG
.6260000 1 MCG
.6280000 1 MCG
.6350000 1 MCG
.6870000 1 MCG
.7330000 1 MCG
.7520000 1 MCG
.5230000 1 MCG
.6210000 1 MCG
.6190000 1 MCG
.6260000 1 MCG
.6280000 1 MCG
.6350000 1 MCG
.6870000 1 MCG
.7330000 1 MCG
.7520000 1 MCG
.5230000 1 MCG
.6210000 1 MCG
.6190000 1 MCG
.6260000 1 MCG
.6280000 1 MCG
.6350000 1 MCG
.6870000 1 MCG
.7330000 1 MCG
.7520000 1 MCG
.5230000 1 MCG
.6210000 1 MCG
.6190000 1 MCG
.6260000 1 MCG
.6280000 1 MCG
.6350000 1 MCG
.6870000 1 MCG
.7330000 1 MCG
.7520000 1 MCG
.5230000 1 MCG
.6210000 1 MCG
.6190000 1 MCG
.6260000 1 MCG
.6280000 1 MCG
.6350000 1 MCG
.6870000 1 MCG
.5230000 1 MCG
.6210000 1 MCG
.6190000 1 MCG
.6260000 1 MCG
.6280000 1 MCG
.6350000 1 MCG
.6870000 1 MCG
3.5580000 1 MCG
3.7160000 1 MCG
3.7860000 1 MCG
3.6700000 1 MCG
3.8200000 1 MCG
3.8520000 1 MCG
3.8270000 1 MCG
3.9670000 1 MCG
3.8320000 1 MCG
3.7730000 1 MCG
3.8380000 1 MCG
3.7790000 1 MCG
3.9040000 1 MCG
3.9540000 1 MCG
3.9020000 1 MCG
3.8540000 1 MCG
3.8520000 1 MCG
3.9330000 1 MCG
4.0120000 1 MCG
4.1410000 1 MCG
3.5580000 1 MCG
3.7160000 1 MCG
3.7860000 1 MCG
3.6700000 1 MCG
3.8200000 1 MCG
3.8520000 1 MCG
3.8270000 1 MCG
3.9670000 1 MCG
3.8320000 1 MCG
3.7730000 1 MCG
3.8380000 1 MCG
3.7790000 1 MCG
3.9040000 1 MCG
3.9540000 1 MCG
3.9020000 1 MCG
3.8540000 1 MCG
3.8520000 1 MCG
3.9330000 1 MCG
4.0120000 1 MCG
4.1410000 1 MCG
3.5580000 1 MCG
3.7160000 1 MCG
3.7860000 1 MCG
3.6700000 1 MCG
3.8200000 1 MCG
3.8520000 1 MCG
3.8270000 1 MCG
3.9670000 1 MCG
3.8320000 1 MCG
3.7730000 1 MCG
3.8380000 1 MCG
3.7790000 1 MCG
3.9040000 1 MCG
3.9540000 1 MCG
3.9020000 1 MCG
3.8540000 1 MCG
3.8520000 1 MCG
3.9330000 1 MCG
4.0120000 1 MCG
4.1410000 1 MCG
3.5580000 1 MCG
3.7160000 1 MCG
3.7860000 1 MCG
3.6700000 1 MCG
3.8200000 1 MCG
3.8520000 1 MCG
3.8270000 1 MCG
3.9670000 1 MCG
3.8320000 1 MCG
3.7730000 1 MCG
3.8380000 1 MCG
3.7790000 1 MCG
3.9040000 1 MCG
3.9540000 1 MCG
3.9020000 1 MCG
3.8540000 1 MCG
3.8520000 1 MCG
3.9330000 1 MCG
4.0120000 1 MCG
4.1410000 1 MCG
3.5580000 1 MCG
3.7160000 1 MCG
3.7860000 1 MCG
3.6700000 1 MCG
3.8200000 1 MCG
3.8520000 1 MCG
3.8270000 1 MCG
3.9670000 1 MCG
3.8320000 1 MCG
3.7730000 1 MCG
3.8380000 1 MCG
3.7790000 1 MCG
3.9040000 1 MCG
3.9540000 1 MCG
3.9020000 1 MCG
3.8540000 1 MCG
3.8520000 1 MCG
3.9330000 1 MCG
4.0120000 1 MCG
4.1410000 1 MCG
3.5580000 1 MCG
3.7160000 1 MCG
3.7860000 1 MCG
3.6700000 1 MCG
3.8200000 1 MCG
3.8520000 1 MCG
3.8270000 1 MCG
3.9670000 1 MCG
3.8320000 1 MCG
3.7730000 1 MCG
3.8380000 1 MCG
3.7790000 1 MCG
3.9040000 1 MCG
3.9540000 1 MCG
3.9020000 1 MCG
3.8540000 1 MCG
3.8520000 1 MCG
3.9330000 1 MCG
4.0120000 1 MCG
4.1410000 1 MCG
3.5580000 1 MCG
3.7160000 1 MCG
3.7860000 1 MCG
3.6700000 1 MCG
3.8200000 1 MCG
3.8520000 1 MCG
3.8270000 1 MCG
3.9670000 1 MCG
3.8320000 1 MCG
3.7730000 1 MCG
3.8380000 1 MCG
3.7790000 1 MCG
3.9040000 1 MCG
3.9540000 1 MCG
3.9020000 1 MCG
3.8540000 1 MCG
3.8520000 1 MCG
3.9330000 1 MCG
4.0120000 1 MCG
4.1410000 1 MCG
3.5580000 1 MCG
3.7160000 1 MCG
3.7860000 1 MCG
3.6700000 1 MCG
3.8200000 1 MCG
3.8520000 1 MCG
3.8270000 1 MCG
3.9670000 1 MCG
3.8320000 1 MCG
3.7730000 1 MCG
3.8380000 1 MCG
3.7790000 1 MCG
3.9040000 1 MCG
3.9540000 1 MCG
3.9020000 1 MCG
3.8540000 1 MCG
3.8520000 1 MCG
3.9330000 1 MCG
4.0120000 1 MCG
4.1410000 1 MCG
3.5580000 1 MCG
3.7160000 1 MCG
3.7860000 1 MCG
3.6700000 1 MCG
3.8200000 1 MCG
3.8520000 1 MCG
3.8270000 1 MCG
3.9670000 1 MCG
3.8320000 1 MCG
3.7730000 1 MCG
3.8380000 1 MCG
3.7790000 1 MCG
3.9040000 1 MCG
3.9540000 1 MCG
3.9020000 1 MCG
3.8540000 1 MCG
3.8520000 1 MCG
3.9330000 1 MCG
4.0120000 1 MCG
4.1410000 1 MCG
3.5580000 1 MCG
3.7160000 1 MCG
3.7860000 1 MCG
3.6700000 1 MCG
3.8200000 1 MCG
3.8520000 1 MCG
3.8270000 1 MCG
3.9670000 1 MCG
3.8320000 1 MCG
3.7730000 1 MCG
3.8380000 1 MCG
3.7790000 1 MCG
3.9040000 1 MCG
3.9540000 1 MCG
3.9020000 1 MCG
3.8540000 1 MCG
3.8520000 1 MCG
3.9330000 1 MCG
4.0120000 1 MCG
4.1410000 1 MCG
3.5580000 1 MCG
3.7160000 1 MCG
3.7860000 1 MCG
3.6700000 1 MCG
3.8200000 1 MCG
3.8520000 1 MCG
3.8270000 1 MCG
3.9670000 1 MCG
3.8320000 1 MCG
3.7730000 1 MCG
3.8380000 1 MCG
3.7790000 1 MCG
3.9040000 1 MCG
3.9540000 1 MCG
3.9020000 1 MCG
3.8540000 1 MCG
3.8520000 1 MCG
3.9330000 1 MCG
4.0120000 1 MCG
4.1410000 1 MCG
3.5580000 1 MCG
3.7160000 1 MCG
3.7860000 1 MCG
3.6700000 1 MCG
3.8200000 1 MCG
3.8520000 1 MCG
3.8270000 1 MCG
3.9670000 1 MCG
3.8320000 1 MCG
3.7730000 1 MCG
3.8380000 1 MCG
3.7790000 1 MCG
3.9040000 1 MCG
3.9540000 1 MCG
3.9020000 1 MCG
3.8540000 1 MCG
3.8520000 1 MCG
3.9330000 1 MCG
4.0120000 1 MCG
4.1410000 1 MCG
3.5580000 1 MCG
3.7160000 1 MCG
3.7860000 1 MCG
3.6700000 1 MCG
3.8200000 1 MCG
3.8520000 1 MCG
3.8270000 1 MCG
3.9670000 1 MCG
3.8320000 1 MCG
3.7730000 1 MCG
3.8380000 1 MCG
3.7790000 1 MCG
3.9040000 1 MCG
3.9540000 1 MCG
3.9020000 1 MCG
3.8540000 1 MCG
3.8520000 1 MCG
3.9330000 1 MCG
4.0120000 1 MCG
4.1410000 1 MCG
3.7160000 1 MCG
3.7860000 1 MCG
3.6700000 1 MCG
3.8200000 1 MCG
3.8520000 1 MCG
3.8270000 1 MCG
3.9670000 1 MCG
3.8320000 1 MCG
3.7730000 1 MCG
3.8380000 1 MCG
3.7790000 1 MCG
3.9040000 1 MCG
3.9540000 1 MCG
3.9020000 1 MCG
3.8540000 1 MCG
3.8520000 1 MCG
3.9330000 1 MCG
4.0120000 1 MCG
4.1410000 1 MCG
3.5580000 1 MCG
3.7160000 1 MCG
3.7860000 1 MCG
3.6700000 1 MCG
3.8200000 1 MCG
3.8520000 1 MCG
3.8270000 1 MCG
3.9670000 1 MCG
3.8320000 1 MCG
3.7730000 1 MCG
3.8380000 1 MCG
3.7790000 1 MCG
3.9040000 1 MCG
3.9540000 1 MCG
3.9020000 1 MCG
3.8540000 1 MCG
3.8520000 1 MCG
3.9330000 1 MCG
4.0120000 1 MCG
4.1410000 1 MCG
3079.4880000 6 MG
3571.6810000 6 MG
3807.2980000 6 MG
3983.1410000 6 MG
4257.0970000 6 MG
4432.5550000 6 MG
4528.3110000 6 MG
4655.4760000 6 MG
4681.8060000 6 MG
4687.7140000 6 MG
4720.8430000 6 MG
4500.8800000 6 MG
4442.3050000 6 MG
4320.7320000 6 MG
4247.2460000 6 MG
4191.3440000 6 MG
4117.2330000 6 MG
4040.6930000 6 MG
3986.8970000 6 MG
3898.4090000 6 MG
.9380000 1 MCG
.9250000 1 MCG
.9180000 1 MCG
.9390000 1 MCG
.9550000 1 MCG
.9640000 1 MCG
.9790000 1 MCG
.9960000 1 MCG
1.0040000 1 MCG
1.0160000 1 MCG
1.0230000 1 MCG
1.0190000 1 MCG
1.0020000 1 MCG
1.0070000 1 MCG
1.0080000 1 MCG
1.0090000 1 MCG
1.0010000 1 MCG
1.0030000 1 MCG
1.0030000 1 MCG
1.0060000 1 MCG
.9380000 1 MCG
.9250000 1 MCG
.9180000 1 MCG
.9390000 1 MCG
.9550000 1 MCG
.9640000 1 MCG
.9790000 1 MCG
.9960000 1 MCG
1.0040000 1 MCG
1.0160000 1 MCG
1.0230000 1 MCG
1.0190000 1 MCG
1.0020000 1 MCG
1.0070000 1 MCG
1.0080000 1 MCG
1.0090000 1 MCG
1.0010000 1 MCG
1.0030000 1 MCG
1.0030000 1 MCG
1.0060000 1 MCG
.9380000 1 MCG
.9250000 1 MCG
.9180000 1 MCG
.9390000 1 MCG
.9550000 1 MCG
.9640000 1 MCG
.9790000 1 MCG
.9960000 1 MCG
1.0040000 1 MCG
1.0160000 1 MCG
1.0230000 1 MCG
1.0190000 1 MCG
1.0020000 1 MCG
1.0070000 1 MCG
1.0080000 1 MCG
1.0090000 1 MCG
1.0010000 1 MCG
1.0030000 1 MCG
1.0030000 1 MCG
1.0060000 1 MCG
.9380000 1 MCG
.9250000 1 MCG
.9180000 1 MCG
.9390000 1 MCG
.9550000 1 MCG
.9640000 1 MCG
.9790000 1 MCG
.9960000 1 MCG
1.0040000 1 MCG
1.0160000 1 MCG
1.0230000 1 MCG
1.0190000 1 MCG
1.0020000 1 MCG
1.0070000 1 MCG
1.0080000 1 MCG
1.0090000 1 MCG
1.0010000 1 MCG
1.0030000 1 MCG
1.0030000 1 MCG
1.0060000 1 MCG
.9380000 1 MCG
.9250000 1 MCG
.9180000 1 MCG
.9390000 1 MCG
.9550000 1 MCG
.9640000 1 MCG
.9790000 1 MCG
.9960000 1 MCG
1.0040000 1 MCG
1.0160000 1 MCG
1.0230000 1 MCG
1.0190000 1 MCG
1.0020000 1 MCG
1.0070000 1 MCG
1.0080000 1 MCG
1.0090000 1 MCG
1.0010000 1 MCG
1.0030000 1 MCG
1.0030000 1 MCG
1.0060000 1 MCG
.9380000 1 MCG
.9250000 1 MCG
.9180000 1 MCG
.9390000 1 MCG
.9550000 1 MCG
.9640000 1 MCG
.9790000 1 MCG
.9960000 1 MCG
1.0040000 1 MCG
1.0160000 1 MCG
1.0230000 1 MCG
1.0190000 1 MCG
1.0020000 1 MCG
1.0070000 1 MCG
1.0080000 1 MCG
1.0090000 1 MCG
1.0010000 1 MCG
1.0030000 1 MCG
1.0030000 1 MCG
1.0060000 1 MCG
248.1620000 0.5 MG
269.0410000 0.5 MG
294.3440000 0.5 MG
307.5230000 0.5 MG
311.6180000 0.5 MG
327.4130000 0.5 MG
332.5470000 0.5 MG
350.1230000 0.5 MG
358.3540000 0.5 MG
368.7920000 0.5 MG
267.7860000 0.5 MG
286.6740000 0.5 MG
301.7980000 0.5 MG
321.8490000 0.5 MG
336.5200000 0.5 MG
347.0560000 0.5 MG
359.2070000 0.5 MG
358.3540000 0.5 MG
ASP Payment Limit Change ASP Payment Limit Percent Change
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.0020000 .32
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01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 No Data 01/25/2021
01/25/2016 No Data 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 No Data 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 4.1500000 01/25/2021
01/25/2016 3828.0950000 01/25/2021
01/25/2016 3828.0950000 01/25/2021
01/25/2016 3828.0950000 01/25/2021
01/25/2016 3828.0950000 01/25/2021
01/25/2016 3828.0950000 01/25/2021
01/25/2016 3828.0950000 01/25/2021
01/25/2016 3828.0950000 01/25/2021
01/25/2016 3828.0950000 01/25/2021
01/25/2016 3828.0950000 01/25/2021
01/25/2016 3828.0950000 01/25/2021
01/25/2016 3828.0950000 01/25/2021
01/25/2016 3828.0950000 01/25/2021
01/25/2016 3828.0950000 01/25/2021
01/25/2016 3828.0950000 01/25/2021
01/25/2016 3828.0950000 01/25/2021
01/25/2016 3828.0950000 01/25/2021
01/25/2016 3828.0950000 01/25/2021
01/25/2016 3828.0950000 01/25/2021
01/25/2016 3828.0950000 01/25/2021
01/25/2016 3828.0950000 01/25/2021
01/25/2016 No Data 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 No Data 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 No Data 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 No Data 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 1.0070000 01/25/2021
01/25/2016 No Data 01/25/2021
01/25/2016 No Data 01/25/2021
01/25/2016 No Data 01/25/2021
01/25/2016 No Data 01/25/2021
01/25/2016 No Data 01/25/2021
01/25/2016 No Data 01/25/2021
01/25/2016 No Data 01/25/2021
01/25/2016 No Data 01/25/2021
01/25/2016 No Data 01/25/2021
01/25/2016 No Data 01/25/2021
01/25/2016 No Data 01/25/2021
01/25/2016 No Data 01/25/2021
01/25/2016 No Data 01/25/2021
01/25/2016 No Data 01/25/2021
01/25/2016 No Data 01/25/2021
01/25/2016 No Data 01/25/2021
01/25/2016 No Data 01/25/2021
01/25/2016 No Data 01/25/2021
ASP End Price
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
No Data
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
No Data
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
0.5230000
No Data
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
No Data
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
No Data
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
No Data
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
No Data
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
No Data
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
No Data
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
No Data
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
No Data
No Data
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
No Data
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.7160000
3.7160000
3.7160000
3.7160000
3.7160000
3.7160000
3.7160000
3.7160000
3.7160000
3.7160000
3.7160000
3.7160000
3.7160000
3.7160000
3.7160000
3.7160000
3.7160000
3.7160000
3.7160000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3.5580000
3079.4880000
3079.4880000
3079.4880000
3079.4880000
3079.4880000
3079.4880000
3079.4880000
3079.4880000
3079.4880000
3079.4880000
3079.4880000
3079.4880000
3079.4880000
3079.4880000
3079.4880000
3079.4880000
3079.4880000
3079.4880000
3079.4880000
3079.4880000
No Data
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
No Data
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
No Data
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
No Data
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
0.9380000
248.1620000
248.1620000
248.1620000
248.1620000
248.1620000
248.1620000
248.1620000
248.1620000
248.1620000
248.1620000
267.7860000
267.7860000
267.7860000
267.7860000
267.7860000
267.7860000
267.7860000
267.7860000
Total NDCs: 47



12/27/2019 $ 0.5230000 - 01/01/2021
12/27/2019 $ 0.5230000 - 01/01/2021
12/27/2019 $ 0.5230000 - 01/01/2021
12/27/2019 $ 0.5230000 - 01/01/2021
12/27/2019 $ 0.5230000 - 01/01/2021
12/27/2019 $ 0.5230000 - 01/01/2021

09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018 $ 3079.4880000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 0.9380000 - 01/01/2021
09/24/2018 $ 0.9380000 - 01/01/2021
09/24/2018
09/24/2018 $ 0.9380000 - 01/01/2021
09/24/2018
09/24/2018 $ 0.9380000 - 01/01/2021
09/24/2018
09/24/2018 $ 0.9380000 - 01/01/2021
09/24/2018 $ 0.9380000 - 01/01/2021
07/09/2018 $ 248.1620000 - 01/01/2021
04/28/2020 $ 267.7860000 - 01/01/2021
1 MCG $ 219.0000000 - 09/05/2018 1
1 MCG $ 219.0000000 - 09/05/2018 1
1 MCG $ 350.4000000 - 09/05/2018 1
1 MCG $ 350.4000000 - 09/05/2018 1
1 MCG $ 219.0000000 - 02/25/2019 1
1 MCG $ 350.4000000 - 02/25/2019 1

$ 193.5000000 - 01/17/2017 1
1 MCG $ 193.5000000 - 01/17/2017 1
$ 309.6000000 - 01/17/2017 1
1 MCG $ 309.6000000 - 01/17/2017 1
$ 464.4000000 - 01/17/2017 1
1 MCG $ 464.4000000 - 01/17/2017 1
$ 774.0000000 - 01/17/2017 1
1 MCG $ 774.0000000 - 01/17/2017 1
1 MCG $ 1548.0000000 - 01/17/2017 1
$ 309.6000000 - 01/17/2017 1
1 MCG $ 309.6000000 - 01/17/2017 1
$ 464.4000000 - 01/17/2017 1
1 MCG $ 464.4000000 - 01/17/2017 1
$ 774.0000000 - 01/17/2017 1
1 MCG $ 774.0000000 - 01/17/2017 1
$ 1161.0000000 - 01/17/2017 1
1 MCG $ 1161.0000000 - 01/17/2017 1
1 MCG $ 1548.0000000 - 01/17/2017 1
1 MCG $ 3870.0000000 - 01/17/2017 1
$ 1117.2000000 - 01/14/2016 1
$ 193.5000000 - 01/17/2017 1
1 MCG $ 193.5000000 - 01/17/2017 1
$ 77.4000000 - 01/17/2017 1
1 MCG $ 77.4000000 - 01/17/2017 1
$ 2322.0000000 - 01/17/2017 1
1 MCG $ 2322.0000000 - 01/17/2017 1
6 MG $ 6231.0600000 - 01/01/2018 1
6 MG 1
6 MG 1
6 MG 1
$ 531.4300000 - 10/19/2017 1
1 MCG $ 531.4300000 - 10/19/2017 1
1 MCG $ 531.4300000 - 10/19/2017 1
$ 314.8300000 - 10/19/2017 1
1 MCG $ 314.8300000 - 10/19/2017 1
$ 501.3300000 - 10/19/2017 1
1 MCG $ 501.3300000 - 10/19/2017 1
$ 333.7000000 - 10/19/2017 1
1 MCG $ 333.7100000 - 10/19/2017 1
1 MCG $ 333.7000000 - 10/19/2017 1
0.5 MG $ 4175.0000000 - 07/09/2018 1
0.5 MG $ 4175.0000000 - 12/07/2018 1
Syringe $ 438.0000000 - 09/05/2018 1
Syringe $ 438.0000000 - 09/05/2018 1
Syringe $ 438.0000000 - 09/05/2018 1
Syringe $ 438.0000000 - 09/05/2018 1
Vial $ 219.0000000 - 02/25/2019 1
Vial $ 219.0000000 - 02/25/2019 1

Vial $ 193.5000000 - 01/17/2017 1
Vial $ 193.5000000 - 01/17/2017 1
Vial $ 309.6000000 - 01/17/2017 1
Vial $ 309.6000000 - 01/17/2017 1
Vial $ 464.4000000 - 01/17/2017 1
Vial $ 464.4000000 - 01/17/2017 1
Vial $ 774.0000000 - 01/17/2017 1
Vial $ 774.0000000 - 01/17/2017 1
Vial $ 1548.0000000 - 01/17/20171
Syringe $ 774.0000000 - 01/17/2017 1
Syringe $ 774.0000000 - 01/17/2017 1
Syringe $ 1548.0000000 - 01/17/20171
Syringe $ 1548.0000000 - 01/17/20171
Syringe $ 1548.0000000 - 01/17/20171
Syringe $ 1548.0000000 - 01/17/20171
Syringe $ 3870.0000000 - 01/17/20171
Syringe $ 3870.0000000 - 01/17/20171
Syringe $ 3870.0000000 - 01/17/20171
Syringe $ 3870.0000000 - 01/17/20171
Vial $ 1489.6000000 - 01/14/20161
Syringe $ 460.7142800 - 01/17/2017 1
Syringe $ 460.7142800 - 01/17/2017 1
Syringe $ 193.5000000 - 01/17/2017 1
Syringe $ 193.5000000 - 01/17/2017 1
Vial $ 2322.0000000 - 01/17/20171
Syringe $ 3870.0000000 - 01/17/20171
Syringe $ 10385.1000000 - 01/01/2011
Syringe 1
Syringe 1
Syringe 1
Syringe $ 664.2875000 - 10/19/2017 1
Syringe $ 664.2837500 - 10/19/2017 1
Syringe $ 664.2875000 - 10/19/2017 1
Vial $ 314.8300000 - 10/19/2017 1
Vial $ 314.8330000 - 10/19/2017 1
Vial $ 313.3312500 - 10/19/2017 1
Vial $ 313.3306200 - 10/19/2017 1
Syringe $ 667.4000000 - 10/19/2017 1
Syringe $ 667.4100000 - 10/19/2017 1
Syringe $ 667.4000000 - 10/19/2017 1
Syringe $ 6958.3333300 - 07/09/20181
Syringe $ 6958.3333300 - 12/07/20181
WAC Unit Effective Date WAC Unit Price WAC Unit Quantity
09/05/2018 438.0000000 1
09/05/2018 438.0000000 1
09/05/2018 438.0000000 1
09/05/2018 438.0000000 1
02/25/2019 219.0000000 1
02/25/2019 219.0000000 1
01/17/2017 193.5000000 1
01/17/2017 193.5000000 1
01/17/2017 309.6000000 1
01/17/2017 309.6000000 1
01/17/2017 464.4000000 1
01/17/2017 464.4000000 1
01/17/2017 774.0000000 1
01/17/2017 774.0000000 1
01/17/2017 1548.0000000 1
01/17/2017 774.0000000 1
01/17/2017 774.0000000 1
01/17/2017 1548.0000000 1
01/17/2017 1548.0000000 1
01/17/2017 1548.0000000 1
01/17/2017 1548.0000000 1
01/17/2017 3870.0000000 1
01/17/2017 3870.0000000 1
01/17/2017 3870.0000000 1
01/17/2017 3870.0000000 1
01/17/2017 460.7142800 1
01/17/2017 460.7142800 1
01/17/2017 193.5000000 1
01/17/2017 193.5000000 1
01/17/2017 2322.0000000 1
01/17/2017 3870.0000000 1
01/01/2018 10385.1000000 1
07/20/2017 9900.0000000 1
01/13/2017 9455.5833300 1
07/21/2016 9013.8333300 1
10/19/2017 664.2875000 1
10/19/2017 664.2837500 1
10/19/2017 664.2875000 1
10/19/2017 314.8300000 1
10/19/2017 314.8330000 1
10/19/2017 313.3312500 1
10/19/2017 313.3306200 1
10/19/2017 667.4000000 1
10/19/2017 667.4100000 1
10/19/2017 667.4000000 1
07/09/2018 6958.3333300 1
12/07/2018 6958.3333300 1
WAC Unit Unit of Measure WAC Unit Price Change
Milliliter
Milliliter
Milliliter
Milliliter
Milliliter
Milliliter
Milliliter
Milliliter
WAC Unit Percent Change WAC Unit Filter Start Date
01/25/2016
01/25/2016
01/25/2016
01/25/2016
01/25/2016
01/25/2016
01/25/2016
01/25/2016
3.92 01/25/2016
3.92 01/25/2016
3.91 01/25/2016
3.91 01/25/2016
3.92 01/25/2016
3.92 01/25/2016
3.92 01/25/2016
3.92 01/25/2016
3.92 01/25/2016
3.91 01/25/2016
3.91 01/25/2016
3.92 01/25/2016
3.92 01/25/2016
3.92 01/25/2016
3.92 01/25/2016
3.92 01/25/2016
3.92 01/25/2016
3.92 01/25/2016
3.92 01/25/2016
01/25/2016
3.92 01/25/2016
3.92 01/25/2016
3.89 01/25/2016
3.89 01/25/2016
3.92 01/25/2016
3.92 01/25/2016
4.90 01/25/2016
4.70 01/25/2016
4.90 01/25/2016
4.90 01/25/2016
2.90 01/25/2016
2.90 01/25/2016
2.90 01/25/2016
2.90 01/25/2016
2.90 01/25/2016
2.90 01/25/2016
2.90 01/25/2016
2.90 01/25/2016
2.90 01/25/2016
2.90 01/25/2016
01/25/2016
01/25/2016
WAC Unit Start Price WAC Unit Filter End Date
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
186.2000000 01/25/2021
186.2000000 01/25/2021
297.9500000 01/25/2021
297.9500000 01/25/2021
446.9000000 01/25/2021
446.9000000 01/25/2021
744.8000000 01/25/2021
744.8000000 01/25/2021
1489.6000000 01/25/2021
744.8750000 01/25/2021
744.8750000 01/25/2021
1489.6666600 01/25/2021
1489.6666600 01/25/2021
1489.6000000 01/25/2021
1489.6000000 01/25/2021
3724.0000000 01/25/2021
3724.0000000 01/25/2021
3724.0000000 01/25/2021
3724.0000000 01/25/2021
1489.6000000 01/25/2021
443.3333300 01/25/2021
443.3333300 01/25/2021
186.2500000 01/25/2021
186.2500000 01/25/2021
2234.4000000 01/25/2021
3724.0000000 01/25/2021
8592.7500000 01/25/2021
8592.7500000 01/25/2021
8592.7500000 01/25/2021
8592.7500000 01/25/2021
645.5625000 01/25/2021
645.5625000 01/25/2021
645.5625000 01/25/2021
305.9600000 01/25/2021
305.9600000 01/25/2021
304.5000000 01/25/2021
304.5000000 01/25/2021
648.6000000 01/25/2021
648.6000000 01/25/2021
648.6000000 01/25/2021
No Data 01/25/2021
No Data 01/25/2021
WAC Unit End Price
438.0000000
438.0000000
438.0000000
438.0000000
No Data
219.0000000
No Data
219.0000000
193.5000000
193.5000000
309.6000000
309.6000000
464.4000000
464.4000000
774.0000000
774.0000000
1548.0000000
774.0000000
774.0000000
1548.0000000
1548.0000000
1548.0000000
1548.0000000
3870.0000000
3870.0000000
3870.0000000
3870.0000000
1489.6000000
460.7142800
460.7142800
193.5000000
193.5000000
2322.0000000
3870.0000000
10385.1000000
10385.1000000
10385.1000000
10385.1000000
664.2875000
664.2837500
664.2875000
314.8300000
314.8330000
313.3312500
313.3306200
667.4000000
667.4100000
667.4000000
6958.3333300
6958.3333300
Total NDCs: 47



12/27/2019 $ 0.5230000 - 01/01/2021
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019 $ 0.5230000 - 01/01/2021
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019 $ 0.5230000 - 01/01/2021
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019 $ 0.5230000 - 01/01/2021
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019 $ 0.5230000 - 01/01/2021

12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019 $ 0.5230000 - 01/01/2021

12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
12/27/2019
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3.5580000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 3079.4880000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 0.9380000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 0.9380000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 0.9380000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 0.9380000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 0.9380000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018 $ 0.9380000 - 01/01/2021
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
09/24/2018
07/09/2018 $ 248.1620000 - 01/01/2021
07/09/2018
07/09/2018
07/09/2018
07/09/2018
07/09/2018
07/09/2018
07/09/2018
07/09/2018
07/09/2018
04/28/2020 $ 267.7860000 - 01/01/2021
04/28/2020
04/28/2020
04/28/2020
04/28/2020
04/28/2020
04/28/2020
04/28/2020
1 MCG $ 219.0000000 - 09/05/2018 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG $ 219.0000000 - 09/05/2018 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG $ 350.4000000 - 09/05/2018 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG $ 350.4000000 - 09/05/2018 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG $ 219.0000000 - 02/25/2019 1

1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG $ 350.4000000 - 02/25/2019 1

1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 193.5000000 - 01/17/2017 1
1 MCG $ 193.5000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 309.6000000 - 01/17/2017 1
1 MCG $ 309.6000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 464.4000000 - 01/17/2017 1
1 MCG $ 464.4000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 774.0000000 - 01/17/2017 1
1 MCG $ 774.0000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG $ 1548.0000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 309.6000000 - 01/17/2017 1
1 MCG $ 309.6000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 464.4000000 - 01/17/2017 1
1 MCG $ 464.4000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 774.0000000 - 01/17/2017 1
1 MCG $ 774.0000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 1161.0000000 - 01/17/2017 1
1 MCG $ 1161.0000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG $ 1548.0000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG $ 3870.0000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 1117.2000000 - 01/14/2016 1
$ 193.5000000 - 01/17/2017 1
1 MCG $ 193.5000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 77.4000000 - 01/17/2017 1
1 MCG $ 77.4000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 2322.0000000 - 01/17/2017 1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1 MCG $ 2322.0000000 - 01/17/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
6 MG $ 6231.0600000 - 01/01/2018 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
6 MG 1
$ 531.4300000 - 10/19/2017 1
1 MCG $ 531.4300000 - 10/19/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG $ 531.4300000 - 10/19/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 314.8300000 - 10/19/2017 1
1 MCG $ 314.8300000 - 10/19/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 501.3300000 - 10/19/2017 1
1 MCG $ 501.3300000 - 10/19/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
$ 333.7000000 - 10/19/2017 1
1 MCG $ 333.7100000 - 10/19/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG $ 333.7000000 - 10/19/2017 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
1 MCG 1
0.5 MG $ 4175.0000000 - 07/09/2018 1
0.5 MG 1
0.5 MG 1
0.5 MG 1
0.5 MG 1
0.5 MG 1
0.5 MG 1
0.5 MG 1
0.5 MG 1
0.5 MG 1
0.5 MG $ 4175.0000000 - 12/07/2018 1
0.5 MG 1
0.5 MG 1
0.5 MG 1
0.5 MG 1
0.5 MG 1
0.5 MG 1
0.5 MG 1
Syringe $ 438.0000000 - 09/05/2018 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 438.0000000 - 09/05/2018 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 438.0000000 - 09/05/2018 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 438.0000000 - 09/05/2018 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Vial $ 219.0000000 - 02/25/2019 1

Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial $ 219.0000000 - 02/25/2019 1

Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial $ 193.5000000 - 01/17/2017 1
Vial $ 193.5000000 - 01/17/2017 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial $ 309.6000000 - 01/17/2017 1
Vial $ 309.6000000 - 01/17/2017 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial $ 464.4000000 - 01/17/2017 1
Vial $ 464.4000000 - 01/17/2017 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial $ 774.0000000 - 01/17/2017 1
Vial $ 774.0000000 - 01/17/2017 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial $ 1548.0000000 - 01/17/20171
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Syringe $ 774.0000000 - 01/17/2017 1
Syringe $ 774.0000000 - 01/17/2017 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 1548.0000000 - 01/17/20171
Syringe $ 1548.0000000 - 01/17/20171
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 1548.0000000 - 01/17/20171
Syringe $ 1548.0000000 - 01/17/20171
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 3870.0000000 - 01/17/20171
Syringe $ 3870.0000000 - 01/17/20171
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 3870.0000000 - 01/17/20171
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 3870.0000000 - 01/17/20171
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Vial $ 1489.6000000 - 01/14/20161
Syringe $ 460.7142800 - 01/17/2017 1
Syringe $ 460.7142800 - 01/17/2017 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 193.5000000 - 01/17/2017 1
Syringe $ 193.5000000 - 01/17/2017 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Vial $ 2322.0000000 - 01/17/20171
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Syringe $ 3870.0000000 - 01/17/20171
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 10385.1000000 - 01/01/2011
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 664.2875000 - 10/19/2017 1
Syringe $ 664.2837500 - 10/19/2017 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 664.2875000 - 10/19/2017 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Vial $ 314.8300000 - 10/19/2017 1
Vial $ 314.8330000 - 10/19/2017 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial $ 313.3312500 - 10/19/2017 1
Vial $ 313.3306200 - 10/19/2017 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Vial 1
Syringe $ 667.4000000 - 10/19/2017 1
Syringe $ 667.4100000 - 10/19/2017 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 667.4000000 - 10/19/2017 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 6958.3333300 - 07/09/20181
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe $ 6958.3333300 - 12/07/20181
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
Syringe 1
ASP Payment Limit Effective Date ASP Payment Limit
01/01/2021 .5230000
10/01/2020 .6210000
07/01/2020 .6190000
04/01/2020 .6260000
01/01/2020 .6280000
10/01/2019 .6350000
07/01/2019 .6870000
04/01/2019 .7330000
01/01/2019 .7520000
01/01/2021 .5230000
10/01/2020 .6210000
07/01/2020 .6190000
04/01/2020 .6260000
01/01/2020 .6280000
10/01/2019 .6350000
07/01/2019 .6870000
04/01/2019 .7330000
01/01/2019 .7520000
01/01/2021 .5230000
10/01/2020 .6210000
07/01/2020 .6190000
04/01/2020 .6260000
01/01/2020 .6280000
10/01/2019 .6350000
07/01/2019 .6870000
04/01/2019 .7330000
01/01/2019 .7520000
01/01/2021 .5230000
10/01/2020 .6210000
07/01/2020 .6190000
04/01/2020 .6260000
01/01/2020 .6280000
10/01/2019 .6350000
07/01/2019 .6870000
04/01/2019 .7330000
01/01/2019 .7520000
01/01/2021 .5230000
10/01/2020 .6210000
07/01/2020 .6190000
04/01/2020 .6260000
01/01/2020 .6280000
10/01/2019 .6350000
07/01/2019 .6870000
01/01/2021 .5230000
10/01/2020 .6210000
07/01/2020 .6190000
04/01/2020 .6260000
01/01/2020 .6280000
10/01/2019 .6350000
07/01/2019 .6870000
01/01/2021 3.5580000
10/01/2020 3.7160000
07/01/2020 3.7860000
04/01/2020 3.6700000
01/01/2020 3.8200000
10/01/2019 3.8520000
07/01/2019 3.8270000
04/01/2019 3.9670000
01/01/2019 3.8320000
10/01/2018 3.7730000
07/01/2018 3.8380000
04/01/2018 3.7790000
01/01/2018 3.9040000
10/01/2017 3.9540000
07/01/2017 3.9020000
04/01/2017 3.8540000
01/01/2017 3.8520000
10/01/2016 3.9330000
07/01/2016 4.0120000
04/01/2016 4.1410000
01/01/2021 3.5580000
10/01/2020 3.7160000
07/01/2020 3.7860000
04/01/2020 3.6700000
01/01/2020 3.8200000
10/01/2019 3.8520000
07/01/2019 3.8270000
04/01/2019 3.9670000
01/01/2019 3.8320000
10/01/2018 3.7730000
07/01/2018 3.8380000
04/01/2018 3.7790000
01/01/2018 3.9040000
10/01/2017 3.9540000
07/01/2017 3.9020000
04/01/2017 3.8540000
01/01/2017 3.8520000
10/01/2016 3.9330000
07/01/2016 4.0120000
04/01/2016 4.1410000
01/01/2021 3.5580000
10/01/2020 3.7160000
07/01/2020 3.7860000
04/01/2020 3.6700000
01/01/2020 3.8200000
10/01/2019 3.8520000
07/01/2019 3.8270000
04/01/2019 3.9670000
01/01/2019 3.8320000
10/01/2018 3.7730000
07/01/2018 3.8380000
04/01/2018 3.7790000
01/01/2018 3.9040000
10/01/2017 3.9540000
07/01/2017 3.9020000
04/01/2017 3.8540000
01/01/2017 3.8520000
10/01/2016 3.9330000
07/01/2016 4.0120000
04/01/2016 4.1410000
01/01/2021 3.5580000
10/01/2020 3.7160000
07/01/2020 3.7860000
04/01/2020 3.6700000
01/01/2020 3.8200000
10/01/2019 3.8520000
07/01/2019 3.8270000
04/01/2019 3.9670000
01/01/2019 3.8320000
10/01/2018 3.7730000
07/01/2018 3.8380000
04/01/2018 3.7790000
01/01/2018 3.9040000
10/01/2017 3.9540000
07/01/2017 3.9020000
04/01/2017 3.8540000
01/01/2017 3.8520000
10/01/2016 3.9330000
07/01/2016 4.0120000
04/01/2016 4.1410000
01/01/2021 3.5580000
10/01/2020 3.7160000
07/01/2020 3.7860000
04/01/2020 3.6700000
01/01/2020 3.8200000
10/01/2019 3.8520000
07/01/2019 3.8270000
04/01/2019 3.9670000
01/01/2019 3.8320000
10/01/2018 3.7730000
07/01/2018 3.8380000
04/01/2018 3.7790000
01/01/2018 3.9040000
10/01/2017 3.9540000
07/01/2017 3.9020000
04/01/2017 3.8540000
01/01/2017 3.8520000
10/01/2016 3.9330000
07/01/2016 4.0120000
04/01/2016 4.1410000
01/01/2021 3.5580000
10/01/2020 3.7160000
07/01/2020 3.7860000
04/01/2020 3.6700000
01/01/2020 3.8200000
10/01/2019 3.8520000
07/01/2019 3.8270000
04/01/2019 3.9670000
01/01/2019 3.8320000
10/01/2018 3.7730000
07/01/2018 3.8380000
04/01/2018 3.7790000
01/01/2018 3.9040000
10/01/2017 3.9540000
07/01/2017 3.9020000
04/01/2017 3.8540000
01/01/2017 3.8520000
10/01/2016 3.9330000
07/01/2016 4.0120000
04/01/2016 4.1410000
01/01/2021 3.5580000
10/01/2020 3.7160000
07/01/2020 3.7860000
04/01/2020 3.6700000
01/01/2020 3.8200000
10/01/2019 3.8520000
07/01/2019 3.8270000
04/01/2019 3.9670000
01/01/2019 3.8320000
10/01/2018 3.7730000
07/01/2018 3.8380000
04/01/2018 3.7790000
01/01/2018 3.9040000
10/01/2017 3.9540000
07/01/2017 3.9020000
04/01/2017 3.8540000
01/01/2017 3.8520000
10/01/2016 3.9330000
07/01/2016 4.0120000
04/01/2016 4.1410000
01/01/2021 3.5580000
10/01/2020 3.7160000
07/01/2020 3.7860000
04/01/2020 3.6700000
01/01/2020 3.8200000
10/01/2019 3.8520000
07/01/2019 3.8270000
04/01/2019 3.9670000
01/01/2019 3.8320000
10/01/2018 3.7730000
07/01/2018 3.8380000
04/01/2018 3.7790000
01/01/2018 3.9040000
10/01/2017 3.9540000
07/01/2017 3.9020000
04/01/2017 3.8540000
01/01/2017 3.8520000
10/01/2016 3.9330000
07/01/2016 4.0120000
04/01/2016 4.1410000
01/01/2021 3.5580000
10/01/2020 3.7160000
07/01/2020 3.7860000
04/01/2020 3.6700000
01/01/2020 3.8200000
10/01/2019 3.8520000
07/01/2019 3.8270000
04/01/2019 3.9670000
01/01/2019 3.8320000
10/01/2018 3.7730000
07/01/2018 3.8380000
04/01/2018 3.7790000
01/01/2018 3.9040000
10/01/2017 3.9540000
07/01/2017 3.9020000
04/01/2017 3.8540000
01/01/2017 3.8520000
10/01/2016 3.9330000
07/01/2016 4.0120000
04/01/2016 4.1410000
01/01/2021 3.5580000
10/01/2020 3.7160000
07/01/2020 3.7860000
04/01/2020 3.6700000
01/01/2020 3.8200000
10/01/2019 3.8520000
07/01/2019 3.8270000
04/01/2019 3.9670000
01/01/2019 3.8320000
10/01/2018 3.7730000
07/01/2018 3.8380000
04/01/2018 3.7790000
01/01/2018 3.9040000
10/01/2017 3.9540000
07/01/2017 3.9020000
04/01/2017 3.8540000
01/01/2017 3.8520000
10/01/2016 3.9330000
07/01/2016 4.0120000
04/01/2016 4.1410000
01/01/2021 3.5580000
10/01/2020 3.7160000
07/01/2020 3.7860000
04/01/2020 3.6700000
01/01/2020 3.8200000
10/01/2019 3.8520000
07/01/2019 3.8270000
04/01/2019 3.9670000
01/01/2019 3.8320000
10/01/2018 3.7730000
07/01/2018 3.8380000
04/01/2018 3.7790000
01/01/2018 3.9040000
10/01/2017 3.9540000
07/01/2017 3.9020000
04/01/2017 3.8540000
01/01/2017 3.8520000
10/01/2016 3.9330000
07/01/2016 4.0120000
04/01/2016 4.1410000
01/01/2021 3.5580000
10/01/2020 3.7160000
07/01/2020 3.7860000
04/01/2020 3.6700000
01/01/2020 3.8200000
10/01/2019 3.8520000
07/01/2019 3.8270000
04/01/2019 3.9670000
01/01/2019 3.8320000
10/01/2018 3.7730000
07/01/2018 3.8380000
04/01/2018 3.7790000
01/01/2018 3.9040000
10/01/2017 3.9540000
07/01/2017 3.9020000
04/01/2017 3.8540000
01/01/2017 3.8520000
10/01/2016 3.9330000
07/01/2016 4.0120000
04/01/2016 4.1410000
01/01/2021 3.5580000
10/01/2020 3.7160000
07/01/2020 3.7860000
04/01/2020 3.6700000
01/01/2020 3.8200000
10/01/2019 3.8520000
07/01/2019 3.8270000
04/01/2019 3.9670000
01/01/2019 3.8320000
10/01/2018 3.7730000
07/01/2018 3.8380000
04/01/2018 3.7790000
01/01/2018 3.9040000
10/01/2017 3.9540000
07/01/2017 3.9020000
04/01/2017 3.8540000
01/01/2017 3.8520000
10/01/2016 3.9330000
07/01/2016 4.0120000
04/01/2016 4.1410000
10/01/2020 3.7160000
07/01/2020 3.7860000
04/01/2020 3.6700000
01/01/2020 3.8200000
10/01/2019 3.8520000
07/01/2019 3.8270000
04/01/2019 3.9670000
01/01/2019 3.8320000
10/01/2018 3.7730000
07/01/2018 3.8380000
04/01/2018 3.7790000
01/01/2018 3.9040000
10/01/2017 3.9540000
07/01/2017 3.9020000
04/01/2017 3.8540000
01/01/2017 3.8520000
10/01/2016 3.9330000
07/01/2016 4.0120000
04/01/2016 4.1410000
01/01/2021 3.5580000
10/01/2020 3.7160000
07/01/2020 3.7860000
04/01/2020 3.6700000
01/01/2020 3.8200000
10/01/2019 3.8520000
07/01/2019 3.8270000
04/01/2019 3.9670000
01/01/2019 3.8320000
10/01/2018 3.7730000
07/01/2018 3.8380000
04/01/2018 3.7790000
01/01/2018 3.9040000
10/01/2017 3.9540000
07/01/2017 3.9020000
04/01/2017 3.8540000
01/01/2017 3.8520000
10/01/2016 3.9330000
07/01/2016 4.0120000
04/01/2016 4.1410000
01/01/2021 3079.4880000
10/01/2020 3571.6810000
07/01/2020 3807.2980000
04/01/2020 3983.1410000
01/01/2020 4257.0970000
10/01/2019 4432.5550000
07/01/2019 4528.3110000
04/01/2019 4655.4760000
01/01/2019 4681.8060000
10/01/2018 4687.7140000
07/01/2018 4720.8430000
04/01/2018 4500.8800000
01/01/2018 4442.3050000
10/01/2017 4320.7320000
07/01/2017 4247.2460000
04/01/2017 4191.3440000
01/01/2017 4117.2330000
10/01/2016 4040.6930000
07/01/2016 3986.8970000
04/01/2016 3898.4090000
01/01/2021 .9380000
10/01/2020 .9250000
07/01/2020 .9180000
04/01/2020 .9390000
01/01/2020 .9550000
10/01/2019 .9640000
07/01/2019 .9790000
04/01/2019 .9960000
01/01/2019 1.0040000
10/01/2018 1.0160000
07/01/2018 1.0230000
04/01/2018 1.0190000
01/01/2018 1.0020000
10/01/2017 1.0070000
07/01/2017 1.0080000
04/01/2017 1.0090000
01/01/2017 1.0010000
10/01/2016 1.0030000
07/01/2016 1.0030000
04/01/2016 1.0060000
01/01/2021 .9380000
10/01/2020 .9250000
07/01/2020 .9180000
04/01/2020 .9390000
01/01/2020 .9550000
10/01/2019 .9640000
07/01/2019 .9790000
04/01/2019 .9960000
01/01/2019 1.0040000
10/01/2018 1.0160000
07/01/2018 1.0230000
04/01/2018 1.0190000
01/01/2018 1.0020000
10/01/2017 1.0070000
07/01/2017 1.0080000
04/01/2017 1.0090000
01/01/2017 1.0010000
10/01/2016 1.0030000
07/01/2016 1.0030000
04/01/2016 1.0060000
01/01/2021 .9380000
10/01/2020 .9250000
07/01/2020 .9180000
04/01/2020 .9390000
01/01/2020 .9550000
10/01/2019 .9640000
07/01/2019 .9790000
04/01/2019 .9960000
01/01/2019 1.0040000
10/01/2018 1.0160000
07/01/2018 1.0230000
04/01/2018 1.0190000
01/01/2018 1.0020000
10/01/2017 1.0070000
07/01/2017 1.0080000
04/01/2017 1.0090000
01/01/2017 1.0010000
10/01/2016 1.0030000
07/01/2016 1.0030000
04/01/2016 1.0060000
01/01/2021 .9380000
10/01/2020 .9250000
07/01/2020 .9180000
04/01/2020 .9390000
01/01/2020 .9550000
10/01/2019 .9640000
07/01/2019 .9790000
04/01/2019 .9960000
01/01/2019 1.0040000
10/01/2018 1.0160000
07/01/2018 1.0230000
04/01/2018 1.0190000
01/01/2018 1.0020000
10/01/2017 1.0070000
07/01/2017 1.0080000
04/01/2017 1.0090000
01/01/2017 1.0010000
10/01/2016 1.0030000
07/01/2016 1.0030000
04/01/2016 1.0060000
01/01/2021 .9380000
10/01/2020 .9250000
07/01/2020 .9180000
04/01/2020 .9390000
01/01/2020 .9550000
10/01/2019 .9640000
07/01/2019 .9790000
04/01/2019 .9960000
01/01/2019 1.0040000
10/01/2018 1.0160000
07/01/2018 1.0230000
04/01/2018 1.0190000
01/01/2018 1.0020000
10/01/2017 1.0070000
07/01/2017 1.0080000
04/01/2017 1.0090000
01/01/2017 1.0010000
10/01/2016 1.0030000
07/01/2016 1.0030000
04/01/2016 1.0060000
01/01/2021 .9380000
10/01/2020 .9250000
07/01/2020 .9180000
04/01/2020 .9390000
01/01/2020 .9550000
10/01/2019 .9640000
07/01/2019 .9790000
04/01/2019 .9960000
01/01/2019 1.0040000
10/01/2018 1.0160000
07/01/2018 1.0230000
04/01/2018 1.0190000
01/01/2018 1.0020000
10/01/2017 1.0070000
07/01/2017 1.0080000
04/01/2017 1.0090000
01/01/2017 1.0010000
10/01/2016 1.0030000
07/01/2016 1.0030000
04/01/2016 1.0060000
01/01/2021 248.1620000
10/01/2020 269.0410000
07/01/2020 294.3440000
04/01/2020 307.5230000
01/01/2020 311.6180000
10/01/2019 327.4130000
07/01/2019 332.5470000
04/01/2019 350.1230000
01/01/2019 358.3540000
10/01/2018 368.7920000
01/01/2021 267.7860000
10/01/2020 286.6740000
07/01/2020 301.7980000
04/01/2020 321.8490000
01/01/2020 336.5200000
10/01/2019 347.0560000
07/01/2019 359.2070000
04/01/2019 358.3540000
ASP HCPCS Code Dosage ASP Payment Limit Change
1 MCG -.0980000
1 MCG .0020000
1 MCG -.0070000
1 MCG -.0020000
1 MCG -.0070000
1 MCG -.0520000
1 MCG -.0460000
1 MCG -.0190000
1 MCG
1 MCG -.0980000
1 MCG .0020000
1 MCG -.0070000
1 MCG -.0020000
1 MCG -.0070000
1 MCG -.0520000
1 MCG -.0460000
1 MCG -.0190000
1 MCG
1 MCG -.0980000
1 MCG .0020000
1 MCG -.0070000
1 MCG -.0020000
1 MCG -.0070000
1 MCG -.0520000
1 MCG -.0460000
1 MCG -.0190000
1 MCG
1 MCG -.0980000
1 MCG .0020000
1 MCG -.0070000
1 MCG -.0020000
1 MCG -.0070000
1 MCG -.0520000
1 MCG -.0460000
1 MCG -.0190000
1 MCG
Not On File
1 MCG -.0980000
1 MCG .0020000
1 MCG -.0070000
1 MCG -.0020000
1 MCG -.0070000
1 MCG -.0520000
1 MCG
Not On File
1 MCG -.0980000
1 MCG .0020000
1 MCG -.0070000
1 MCG -.0020000
1 MCG -.0070000
1 MCG -.0520000
1 MCG
Not On File
1 MCG -.1580000
1 MCG -.0700000
1 MCG .1160000
1 MCG -.1500000
1 MCG -.0320000
1 MCG .0250000
1 MCG -.1400000
1 MCG .1350000
1 MCG .0590000
1 MCG -.0650000
1 MCG .0590000
1 MCG -.1250000
1 MCG -.0500000
1 MCG .0520000
1 MCG .0480000
1 MCG .0020000
1 MCG -.0810000
1 MCG -.0790000
1 MCG -.1290000
1 MCG -.0090000
Not On File
1 MCG -.1580000
1 MCG -.0700000
1 MCG .1160000
1 MCG -.1500000
1 MCG -.0320000
1 MCG .0250000
1 MCG -.1400000
1 MCG .1350000
1 MCG .0590000
1 MCG -.0650000
1 MCG .0590000
1 MCG -.1250000
1 MCG -.0500000
1 MCG .0520000
1 MCG .0480000
1 MCG .0020000
1 MCG -.0810000
1 MCG -.0790000
1 MCG -.1290000
1 MCG -.0090000
Not On File
1 MCG -.1580000
1 MCG -.0700000
1 MCG .1160000
1 MCG -.1500000
1 MCG -.0320000
1 MCG .0250000
1 MCG -.1400000
1 MCG .1350000
1 MCG .0590000
1 MCG -.0650000
1 MCG .0590000
1 MCG -.1250000
1 MCG -.0500000
1 MCG .0520000
1 MCG .0480000
1 MCG .0020000
1 MCG -.0810000
1 MCG -.0790000
1 MCG -.1290000
1 MCG -.0090000
Not On File
1 MCG -.1580000
1 MCG -.0700000
1 MCG .1160000
1 MCG -.1500000
1 MCG -.0320000
1 MCG .0250000
1 MCG -.1400000
1 MCG .1350000
1 MCG .0590000
1 MCG -.0650000
1 MCG .0590000
1 MCG -.1250000
1 MCG -.0500000
1 MCG .0520000
1 MCG .0480000
1 MCG .0020000
1 MCG -.0810000
1 MCG -.0790000
1 MCG -.1290000
1 MCG -.0090000
1 MCG -.1580000
1 MCG -.0700000
1 MCG .1160000
1 MCG -.1500000
1 MCG -.0320000
1 MCG .0250000
1 MCG -.1400000
1 MCG .1350000
1 MCG .0590000
1 MCG -.0650000
1 MCG .0590000
1 MCG -.1250000
1 MCG -.0500000
1 MCG .0520000
1 MCG .0480000
1 MCG .0020000
1 MCG -.0810000
1 MCG -.0790000
1 MCG -.1290000
1 MCG -.0090000
Not On File
1 MCG -.1580000
1 MCG -.0700000
1 MCG .1160000
1 MCG -.1500000
1 MCG -.0320000
1 MCG .0250000
1 MCG -.1400000
1 MCG .1350000
1 MCG .0590000
1 MCG -.0650000
1 MCG .0590000
1 MCG -.1250000
1 MCG -.0500000
1 MCG .0520000
1 MCG .0480000
1 MCG .0020000
1 MCG -.0810000
1 MCG -.0790000
1 MCG -.1290000
1 MCG -.0090000
Not On File
1 MCG -.1580000
1 MCG -.0700000
1 MCG .1160000
1 MCG -.1500000
1 MCG -.0320000
1 MCG .0250000
1 MCG -.1400000
1 MCG .1350000
1 MCG .0590000
1 MCG -.0650000
1 MCG .0590000
1 MCG -.1250000
1 MCG -.0500000
1 MCG .0520000
1 MCG .0480000
1 MCG .0020000
1 MCG -.0810000
1 MCG -.0790000
1 MCG -.1290000
1 MCG -.0090000
Not On File
1 MCG -.1580000
1 MCG -.0700000
1 MCG .1160000
1 MCG -.1500000
1 MCG -.0320000
1 MCG .0250000
1 MCG -.1400000
1 MCG .1350000
1 MCG .0590000
1 MCG -.0650000
1 MCG .0590000
1 MCG -.1250000
1 MCG -.0500000
1 MCG .0520000
1 MCG .0480000
1 MCG .0020000
1 MCG -.0810000
1 MCG -.0790000
1 MCG -.1290000
1 MCG -.0090000
Not On File
1 MCG -.1580000
1 MCG -.0700000
1 MCG .1160000
1 MCG -.1500000
1 MCG -.0320000
1 MCG .0250000
1 MCG -.1400000
1 MCG .1350000
1 MCG .0590000
1 MCG -.0650000
1 MCG .0590000
1 MCG -.1250000
1 MCG -.0500000
1 MCG .0520000
1 MCG .0480000
1 MCG .0020000
1 MCG -.0810000
1 MCG -.0790000
1 MCG -.1290000
1 MCG -.0090000
1 MCG -.1580000
1 MCG -.0700000
1 MCG .1160000
1 MCG -.1500000
1 MCG -.0320000
1 MCG .0250000
1 MCG -.1400000
1 MCG .1350000
1 MCG .0590000
1 MCG -.0650000
1 MCG .0590000
1 MCG -.1250000
1 MCG -.0500000
1 MCG .0520000
1 MCG .0480000
1 MCG .0020000
1 MCG -.0810000
1 MCG -.0790000
1 MCG -.1290000
1 MCG -.0090000
1 MCG -.1580000
1 MCG -.0700000
1 MCG .1160000
1 MCG -.1500000
1 MCG -.0320000
1 MCG .0250000
1 MCG -.1400000
1 MCG .1350000
1 MCG .0590000
1 MCG -.0650000
1 MCG .0590000
1 MCG -.1250000
1 MCG -.0500000
1 MCG .0520000
1 MCG .0480000
1 MCG .0020000
1 MCG -.0810000
1 MCG -.0790000
1 MCG -.1290000
1 MCG -.0090000
Not On File
Not On File
1 MCG -.1580000
1 MCG -.0700000
1 MCG .1160000
1 MCG -.1500000
1 MCG -.0320000
1 MCG .0250000
1 MCG -.1400000
1 MCG .1350000
1 MCG .0590000
1 MCG -.0650000
1 MCG .0590000
1 MCG -.1250000
1 MCG -.0500000
1 MCG .0520000
1 MCG .0480000
1 MCG .0020000
1 MCG -.0810000
1 MCG -.0790000
1 MCG -.1290000
1 MCG -.0090000
Not On File
1 MCG -.1580000
1 MCG -.0700000
1 MCG .1160000
1 MCG -.1500000
1 MCG -.0320000
1 MCG .0250000
1 MCG -.1400000
1 MCG .1350000
1 MCG .0590000
1 MCG -.0650000
1 MCG .0590000
1 MCG -.1250000
1 MCG -.0500000
1 MCG .0520000
1 MCG .0480000
1 MCG .0020000
1 MCG -.0810000
1 MCG -.0790000
1 MCG -.1290000
1 MCG -.0090000
1 MCG -.0700000
1 MCG .1160000
1 MCG -.1500000
1 MCG -.0320000
1 MCG .0250000
1 MCG -.1400000
1 MCG .1350000
1 MCG .0590000
1 MCG -.0650000
1 MCG .0590000
1 MCG -.1250000
1 MCG -.0500000
1 MCG .0520000
1 MCG .0480000
1 MCG .0020000
1 MCG -.0810000
1 MCG -.0790000
1 MCG -.1290000
1 MCG -.0090000
1 MCG -.1580000
1 MCG -.0700000
1 MCG .1160000
1 MCG -.1500000
1 MCG -.0320000
1 MCG .0250000
1 MCG -.1400000
1 MCG .1350000
1 MCG .0590000
1 MCG -.0650000
1 MCG .0590000
1 MCG -.1250000
1 MCG -.0500000
1 MCG .0520000
1 MCG .0480000
1 MCG .0020000
1 MCG -.0810000
1 MCG -.0790000
1 MCG -.1290000
1 MCG -.0090000
6 MG -492.1930000
6 MG -235.6170000
6 MG -175.8430000
6 MG -273.9560000
6 MG -175.4580000
6 MG -95.7560000
6 MG -127.1650000
6 MG -26.3300000
6 MG -5.9080000
6 MG -33.1290000
6 MG 219.9630000
6 MG 58.5750000
6 MG 121.5730000
6 MG 73.4860000
6 MG 55.9020000
6 MG 74.1110000
6 MG 76.5400000
6 MG 53.7960000
6 MG 88.4880000
6 MG 70.3140000
Not On File
1 MCG .0130000
1 MCG .0070000
1 MCG -.0210000
1 MCG -.0160000
1 MCG -.0090000
1 MCG -.0150000
1 MCG -.0170000
1 MCG -.0080000
1 MCG -.0120000
1 MCG -.0070000
1 MCG .0040000
1 MCG .0170000
1 MCG -.0050000
1 MCG -.0010000
1 MCG -.0010000
1 MCG .0080000
1 MCG -.0020000
1 MCG .0000000
1 MCG -.0030000
1 MCG -.0010000
1 MCG .0130000
1 MCG .0070000
1 MCG -.0210000
1 MCG -.0160000
1 MCG -.0090000
1 MCG -.0150000
1 MCG -.0170000
1 MCG -.0080000
1 MCG -.0120000
1 MCG -.0070000
1 MCG .0040000
1 MCG .0170000
1 MCG -.0050000
1 MCG -.0010000
1 MCG -.0010000
1 MCG .0080000
1 MCG -.0020000
1 MCG .0000000
1 MCG -.0030000
1 MCG -.0010000
Not On File
1 MCG .0130000
1 MCG .0070000
1 MCG -.0210000
1 MCG -.0160000
1 MCG -.0090000
1 MCG -.0150000
1 MCG -.0170000
1 MCG -.0080000
1 MCG -.0120000
1 MCG -.0070000
1 MCG .0040000
1 MCG .0170000
1 MCG -.0050000
1 MCG -.0010000
1 MCG -.0010000
1 MCG .0080000
1 MCG -.0020000
1 MCG .0000000
1 MCG -.0030000
1 MCG -.0010000
Not On File
1 MCG .0130000
1 MCG .0070000
1 MCG -.0210000
1 MCG -.0160000
1 MCG -.0090000
1 MCG -.0150000
1 MCG -.0170000
1 MCG -.0080000
1 MCG -.0120000
1 MCG -.0070000
1 MCG .0040000
1 MCG .0170000
1 MCG -.0050000
1 MCG -.0010000
1 MCG -.0010000
1 MCG .0080000
1 MCG -.0020000
1 MCG .0000000
1 MCG -.0030000
1 MCG -.0010000
Not On File
1 MCG .0130000
1 MCG .0070000
1 MCG -.0210000
1 MCG -.0160000
1 MCG -.0090000
1 MCG -.0150000
1 MCG -.0170000
1 MCG -.0080000
1 MCG -.0120000
1 MCG -.0070000
1 MCG .0040000
1 MCG .0170000
1 MCG -.0050000
1 MCG -.0010000
1 MCG -.0010000
1 MCG .0080000
1 MCG -.0020000
1 MCG .0000000
1 MCG -.0030000
1 MCG -.0010000
1 MCG .0130000
1 MCG .0070000
1 MCG -.0210000
1 MCG -.0160000
1 MCG -.0090000
1 MCG -.0150000
1 MCG -.0170000
1 MCG -.0080000
1 MCG -.0120000
1 MCG -.0070000
1 MCG .0040000
1 MCG .0170000
1 MCG -.0050000
1 MCG -.0010000
1 MCG -.0010000
1 MCG .0080000
1 MCG -.0020000
1 MCG .0000000
1 MCG -.0030000
1 MCG -.0010000
0.5 MG -20.8790000
0.5 MG -25.3030000
0.5 MG -13.1790000
0.5 MG -4.0950000
0.5 MG -15.7950000
0.5 MG -5.1340000
0.5 MG -17.5760000
0.5 MG -8.2310000
0.5 MG -10.4380000
0.5 MG
0.5 MG -18.8880000
0.5 MG -15.1240000
0.5 MG -20.0510000
0.5 MG -14.6710000
0.5 MG -10.5360000
0.5 MG -12.1510000
0.5 MG .8530000
0.5 MG
ASP Payment Limit Percent Change ASP Filter Start Date
-15.78 01/25/2016
.32 01/25/2016
-1.12 01/25/2016
-.32 01/25/2016
-1.10 01/25/2016
-7.57 01/25/2016
-6.28 01/25/2016
-2.53 01/25/2016
01/25/2016
-15.78 01/25/2016
.32 01/25/2016
-1.12 01/25/2016
-.32 01/25/2016
-1.10 01/25/2016
-7.57 01/25/2016
-6.28 01/25/2016
-2.53 01/25/2016
01/25/2016
-15.78 01/25/2016
.32 01/25/2016
-1.12 01/25/2016
-.32 01/25/2016
-1.10 01/25/2016
-7.57 01/25/2016
-6.28 01/25/2016
-2.53 01/25/2016
01/25/2016
-15.78 01/25/2016
.32 01/25/2016
-1.12 01/25/2016
-.32 01/25/2016
-1.10 01/25/2016
-7.57 01/25/2016
-6.28 01/25/2016
-2.53 01/25/2016
01/25/2016
01/25/2016
-15.78 01/25/2016
.32 01/25/2016
-1.12 01/25/2016
-.32 01/25/2016
-1.10 01/25/2016
-7.57 01/25/2016
01/25/2016
01/25/2016
-15.78 01/25/2016
.32 01/25/2016
-1.12 01/25/2016
-.32 01/25/2016
-1.10 01/25/2016
-7.57 01/25/2016
01/25/2016
01/25/2016
-4.25 01/25/2016
-1.85 01/25/2016
3.16 01/25/2016
-3.93 01/25/2016
-.83 01/25/2016
.65 01/25/2016
-3.53 01/25/2016
3.52 01/25/2016
1.56 01/25/2016
-1.69 01/25/2016
1.56 01/25/2016
-3.20 01/25/2016
-1.26 01/25/2016
1.33 01/25/2016
1.25 01/25/2016
.05 01/25/2016
-2.06 01/25/2016
-1.97 01/25/2016
-3.12 01/25/2016
-.22 01/25/2016
01/25/2016
-4.25 01/25/2016
-1.85 01/25/2016
3.16 01/25/2016
-3.93 01/25/2016
-.83 01/25/2016
.65 01/25/2016
-3.53 01/25/2016
3.52 01/25/2016
1.56 01/25/2016
-1.69 01/25/2016
1.56 01/25/2016
-3.20 01/25/2016
-1.26 01/25/2016
1.33 01/25/2016
1.25 01/25/2016
.05 01/25/2016
-2.06 01/25/2016
-1.97 01/25/2016
-3.12 01/25/2016
-.22 01/25/2016
01/25/2016
-4.25 01/25/2016
-1.85 01/25/2016
3.16 01/25/2016
-3.93 01/25/2016
-.83 01/25/2016
.65 01/25/2016
-3.53 01/25/2016
3.52 01/25/2016
1.56 01/25/2016
-1.69 01/25/2016
1.56 01/25/2016
-3.20 01/25/2016
-1.26 01/25/2016
1.33 01/25/2016
1.25 01/25/2016
.05 01/25/2016
-2.06 01/25/2016
-1.97 01/25/2016
-3.12 01/25/2016
-.22 01/25/2016
01/25/2016
-4.25 01/25/2016
-1.85 01/25/2016
3.16 01/25/2016
-3.93 01/25/2016
-.83 01/25/2016
.65 01/25/2016
-3.53 01/25/2016
3.52 01/25/2016
1.56 01/25/2016
-1.69 01/25/2016
1.56 01/25/2016
-3.20 01/25/2016
-1.26 01/25/2016
1.33 01/25/2016
1.25 01/25/2016
.05 01/25/2016
-2.06 01/25/2016
-1.97 01/25/2016
-3.12 01/25/2016
-.22 01/25/2016
-4.25 01/25/2016
-1.85 01/25/2016
3.16 01/25/2016
-3.93 01/25/2016
-.83 01/25/2016
.65 01/25/2016
-3.53 01/25/2016
3.52 01/25/2016
1.56 01/25/2016
-1.69 01/25/2016
1.56 01/25/2016
-3.20 01/25/2016
-1.26 01/25/2016
1.33 01/25/2016
1.25 01/25/2016
.05 01/25/2016
-2.06 01/25/2016
-1.97 01/25/2016
-3.12 01/25/2016
-.22 01/25/2016
01/25/2016
-4.25 01/25/2016
-1.85 01/25/2016
3.16 01/25/2016
-3.93 01/25/2016
-.83 01/25/2016
.65 01/25/2016
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3.52 01/25/2016
1.56 01/25/2016
-1.69 01/25/2016
1.56 01/25/2016
-3.20 01/25/2016
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1.33 01/25/2016
1.25 01/25/2016
.05 01/25/2016
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-1.97 01/25/2016
-3.12 01/25/2016
-.22 01/25/2016
01/25/2016
-4.25 01/25/2016
-1.85 01/25/2016
3.16 01/25/2016
-3.93 01/25/2016
-.83 01/25/2016
.65 01/25/2016
-3.53 01/25/2016
3.52 01/25/2016
1.56 01/25/2016
-1.69 01/25/2016
1.56 01/25/2016
-3.20 01/25/2016
-1.26 01/25/2016
1.33 01/25/2016
1.25 01/25/2016
.05 01/25/2016
-2.06 01/25/2016
-1.97 01/25/2016
-3.12 01/25/2016
-.22 01/25/2016
01/25/2016
-4.25 01/25/2016
-1.85 01/25/2016
3.16 01/25/2016
-3.93 01/25/2016
-.83 01/25/2016
.65 01/25/2016
-3.53 01/25/2016
3.52 01/25/2016
1.56 01/25/2016
-1.69 01/25/2016
1.56 01/25/2016
-3.20 01/25/2016
-1.26 01/25/2016
1.33 01/25/2016
1.25 01/25/2016
.05 01/25/2016
-2.06 01/25/2016
-1.97 01/25/2016
-3.12 01/25/2016
-.22 01/25/2016
01/25/2016
-4.25 01/25/2016
-1.85 01/25/2016
3.16 01/25/2016
-3.93 01/25/2016
-.83 01/25/2016
.65 01/25/2016
-3.53 01/25/2016
3.52 01/25/2016
1.56 01/25/2016
-1.69 01/25/2016
1.56 01/25/2016
-3.20 01/25/2016
-1.26 01/25/2016
1.33 01/25/2016
1.25 01/25/2016
.05 01/25/2016
-2.06 01/25/2016
-1.97 01/25/2016
-3.12 01/25/2016
-.22 01/25/2016
-4.25 01/25/2016
-1.85 01/25/2016
3.16 01/25/2016
-3.93 01/25/2016
-.83 01/25/2016
.65 01/25/2016
-3.53 01/25/2016
3.52 01/25/2016
1.56 01/25/2016
-1.69 01/25/2016
1.56 01/25/2016
-3.20 01/25/2016
-1.26 01/25/2016
1.33 01/25/2016
1.25 01/25/2016
.05 01/25/2016
-2.06 01/25/2016
-1.97 01/25/2016
-3.12 01/25/2016
-.22 01/25/2016
-4.25 01/25/2016
-1.85 01/25/2016
3.16 01/25/2016
-3.93 01/25/2016
-.83 01/25/2016
.65 01/25/2016
-3.53 01/25/2016
3.52 01/25/2016
1.56 01/25/2016
-1.69 01/25/2016
1.56 01/25/2016
-3.20 01/25/2016
-1.26 01/25/2016
1.33 01/25/2016
1.25 01/25/2016
.05 01/25/2016
-2.06 01/25/2016
-1.97 01/25/2016
-3.12 01/25/2016
-.22 01/25/2016
01/25/2016
01/25/2016
-4.25 01/25/2016
-1.85 01/25/2016
3.16 01/25/2016
-3.93 01/25/2016
-.83 01/25/2016
.65 01/25/2016
-3.53 01/25/2016
3.52 01/25/2016
1.56 01/25/2016
-1.69 01/25/2016
1.56 01/25/2016
-3.20 01/25/2016
-1.26 01/25/2016
1.33 01/25/2016
1.25 01/25/2016
.05 01/25/2016
-2.06 01/25/2016
-1.97 01/25/2016
-3.12 01/25/2016
-.22 01/25/2016
01/25/2016
-4.25 01/25/2016
-1.85 01/25/2016
3.16 01/25/2016
-3.93 01/25/2016
-.83 01/25/2016
.65 01/25/2016
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3.52 01/25/2016
1.56 01/25/2016
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1.56 01/25/2016
-3.20 01/25/2016
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1.33 01/25/2016
1.25 01/25/2016
.05 01/25/2016
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-.22 01/25/2016
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3.16 01/25/2016
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-.83 01/25/2016
.65 01/25/2016
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3.52 01/25/2016
1.56 01/25/2016
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1.56 01/25/2016
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1.33 01/25/2016
1.25 01/25/2016
.05 01/25/2016
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-.22 01/25/2016
-4.25 01/25/2016
-1.85 01/25/2016
3.16 01/25/2016
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-.83 01/25/2016
.65 01/25/2016
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3.52 01/25/2016
1.56 01/25/2016
-1.69 01/25/2016
1.56 01/25/2016
-3.20 01/25/2016
-1.26 01/25/2016
1.33 01/25/2016
1.25 01/25/2016
.05 01/25/2016
-2.06 01/25/2016
-1.97 01/25/2016
-3.12 01/25/2016
-.22 01/25/2016
-13.78 01/25/2016
-6.19 01/25/2016
-4.41 01/25/2016
-6.44 01/25/2016
-3.96 01/25/2016
-2.11 01/25/2016
-2.73 01/25/2016
-.56 01/25/2016
-.13 01/25/2016
-.70 01/25/2016
4.89 01/25/2016
1.32 01/25/2016
2.81 01/25/2016
1.73 01/25/2016
1.33 01/25/2016
1.80 01/25/2016
1.89 01/25/2016
1.35 01/25/2016
2.27 01/25/2016
1.84 01/25/2016
01/25/2016
1.41 01/25/2016
.76 01/25/2016
-2.24 01/25/2016
-1.68 01/25/2016
-.93 01/25/2016
-1.53 01/25/2016
-1.71 01/25/2016
-.80 01/25/2016
-1.18 01/25/2016
-.68 01/25/2016
.39 01/25/2016
1.70 01/25/2016
-.50 01/25/2016
-.10 01/25/2016
-.10 01/25/2016
.80 01/25/2016
-.20 01/25/2016
.00 01/25/2016
-.30 01/25/2016
-.10 01/25/2016
1.41 01/25/2016
.76 01/25/2016
-2.24 01/25/2016
-1.68 01/25/2016
-.93 01/25/2016
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-1.71 01/25/2016
-.80 01/25/2016
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-.68 01/25/2016
.39 01/25/2016
1.70 01/25/2016
-.50 01/25/2016
-.10 01/25/2016
-.10 01/25/2016
.80 01/25/2016
-.20 01/25/2016
.00 01/25/2016
-.30 01/25/2016
-.10 01/25/2016
01/25/2016
1.41 01/25/2016
.76 01/25/2016
-2.24 01/25/2016
-1.68 01/25/2016
-.93 01/25/2016
-1.53 01/25/2016
-1.71 01/25/2016
-.80 01/25/2016
-1.18 01/25/2016
-.68 01/25/2016
.39 01/25/2016
1.70 01/25/2016
-.50 01/25/2016
-.10 01/25/2016
-.10 01/25/2016
.80 01/25/2016
-.20 01/25/2016
.00 01/25/2016
-.30 01/25/2016
-.10 01/25/2016
01/25/2016
1.41 01/25/2016
.76 01/25/2016
-2.24 01/25/2016
-1.68 01/25/2016
-.93 01/25/2016
-1.53 01/25/2016
-1.71 01/25/2016
-.80 01/25/2016
-1.18 01/25/2016
-.68 01/25/2016
.39 01/25/2016
1.70 01/25/2016
-.50 01/25/2016
-.10 01/25/2016
-.10 01/25/2016
.80 01/25/2016
-.20 01/25/2016
.00 01/25/2016
-.30 01/25/2016
-.10 01/25/2016
01/25/2016
1.41 01/25/2016
.76 01/25/2016
-2.24 01/25/2016
-1.68 01/25/2016
-.93 01/25/2016
-1.53 01/25/2016
-1.71 01/25/2016
-.80 01/25/2016
-1.18 01/25/2016
-.68 01/25/2016
.39 01/25/2016
1.70 01/25/2016
-.50 01/25/2016
-.10 01/25/2016
-.10 01/25/2016
.80 01/25/2016
-.20 01/25/2016
.00 01/25/2016
-.30 01/25/2016
-.10 01/25/2016
1.41 01/25/2016
.76 01/25/2016
-2.24 01/25/2016
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-.93 01/25/2016
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-.80 01/25/2016
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-.68 01/25/2016
.39 01/25/2016
1.70 01/25/2016
-.50 01/25/2016
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.80 01/25/2016
-.20 01/25/2016
.00 01/25/2016
-.30 01/25/2016
-.10 01/25/2016
-7.76 01/25/2016
-8.60 01/25/2016
-4.29 01/25/2016
-1.31 01/25/2016
-4.82 01/25/2016
-1.54 01/25/2016
-5.02 01/25/2016
-2.30 01/25/2016
-2.83 01/25/2016
01/25/2016
-6.59 01/25/2016
-5.01 01/25/2016
-6.23 01/25/2016
-4.36 01/25/2016
-3.04 01/25/2016
-3.38 01/25/2016
.24 01/25/2016
01/25/2016
ASP Start Price ASP Filter End Date ASP End Price
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 No Data
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
No Data 01/25/2021 0.5230000
4.1500000 01/25/2021 3.5580000
4.1500000 01/25/2021 3.5580000
4.1500000 01/25/2021 3.5580000
4.1500000 01/25/2021 3.5580000
4.1500000 01/25/2021 3.5580000
4.1500000 01/25/2021 3.5580000
4.1500000 01/25/2021 3.5580000
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3828.0950000 01/25/2021 3079.4880000
3828.0950000 01/25/2021 3079.4880000
3828.0950000 01/25/2021 3079.4880000
3828.0950000 01/25/2021 3079.4880000
3828.0950000 01/25/2021 3079.4880000
3828.0950000 01/25/2021 3079.4880000
3828.0950000 01/25/2021 3079.4880000
3828.0950000 01/25/2021 3079.4880000
3828.0950000 01/25/2021 3079.4880000
3828.0950000 01/25/2021 3079.4880000
3828.0950000 01/25/2021 3079.4880000
3828.0950000 01/25/2021 3079.4880000
3828.0950000 01/25/2021 3079.4880000
3828.0950000 01/25/2021 3079.4880000
3828.0950000 01/25/2021 3079.4880000
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3828.0950000 01/25/2021 3079.4880000
3828.0950000 01/25/2021 3079.4880000
3828.0950000 01/25/2021 3079.4880000
3828.0950000 01/25/2021 3079.4880000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
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1.0070000 01/25/2021 0.9380000
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1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
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1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
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1.0070000 01/25/2021 0.9380000
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1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
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1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
1.0070000 01/25/2021 0.9380000
No Data 01/25/2021 248.1620000
No Data 01/25/2021 248.1620000
No Data 01/25/2021 248.1620000
No Data 01/25/2021 248.1620000
No Data 01/25/2021 248.1620000
No Data 01/25/2021 248.1620000
No Data 01/25/2021 248.1620000
No Data 01/25/2021 248.1620000
No Data 01/25/2021 248.1620000
No Data 01/25/2021 248.1620000
No Data 01/25/2021 267.7860000
No Data 01/25/2021 267.7860000
No Data 01/25/2021 267.7860000
No Data 01/25/2021 267.7860000
No Data 01/25/2021 267.7860000
No Data 01/25/2021 267.7860000
No Data 01/25/2021 267.7860000
No Data 01/25/2021 267.7860000

Analysource Report 20210125094215

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Analysource Report 20210125094215

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Analy$ource (Selected from FDB MedKnowledge (formerly known as NDDF Plus) data included with permission and copyright

NDC Brand Name Labeler Name

UPOGEN, NIVESTYM, UDENYCA)

Latest Price Verification Date Current ASP Payment Limit

12/27/2019 $ 0.5230000 - 01/01/2021

12/27/2019 $ 0.5230000 - 01/01/2021

1 MCG $ 219.0000000 - 02/25/2019 1

1 MCG $ 350.4000000 - 02/25/2019 1

Vial $ 219.0000000 - 02/25/2019 1

Vial $ 219.0000000 - 02/25/2019 1

Not On File Not On File

Not On File Not On File

NDC Brand Name Labeler Name

UPOGEN, NIVESTYM, UDENYCA)

Latest Price Verification Date Current ASP Payment Limit

12/27/2019 $ 0.5230000 - 01/01/2021

12/27/2019 $ 0.5230000 - 01/01/2021

1 MCG $ 219.0000000 - 02/25/2019 1

1 MCG $ 350.4000000 - 02/25/2019 1

Vial $ 219.0000000 - 02/25/2019 1

Vial $ 219.0000000 - 02/25/2019 1

NDC Brand Name Labeler Name

UPOGEN, NIVESTYM, UDENYCA)

Latest Price Verification Date Current ASP Payment Limit

12/27/2019 $ 0.5230000 - 01/01/2021

12/27/2019 $ 0.5230000 - 01/01/2021

1 MCG $ 219.0000000 - 02/25/2019 1

1 MCG $ 350.4000000 - 02/25/2019 1

Vial $ 219.0000000 - 02/25/2019 1

Vial $ 219.0000000 - 02/25/2019 1

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