|
Brand Name
|
Generic Name
|
Route of Administration
|
Lowest WAC Unit
|
Lowest AWP Unit
|
| Piqray (200 MG Daily Dose) |
Alpelisib |
|
$918.10 |
$1101.72 |
|
Manufacturer
|
NDC Number
|
Package Description
|
WAC Per Package
|
WAC Per Unit
|
Effective Date
|
AWP Per Package
|
AWP Per Unit
|
Effective Date
|
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|
Brand Name
|
Generic Name
|
Route of Administration
|
Lowest WAC Unit
|
Lowest AWP Unit
|
| Piqray (250 MG Daily Dose) |
Alpelisib |
|
$459.05 |
$550.86 |
|
Manufacturer
|
NDC Number
|
Package Description
|
WAC Per Package
|
WAC Per Unit
|
Effective Date
|
AWP Per Package
|
AWP Per Unit
|
Effective Date
|
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|
Brand Name
|
Generic Name
|
Route of Administration
|
Lowest WAC Unit
|
Lowest AWP Unit
|
| Piqray (300 MG Daily Dose) |
Alpelisib |
ORAL |
$459.05 |
$550.86 |
|
Manufacturer
|
NDC Number
|
Package Description
|
WAC Per Package
|
WAC Per Unit
|
Effective Date
|
AWP Per Package
|
AWP Per Unit
|
Effective Date
|
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