DEFERASIROX
deferasirox 250 mg dispersible tablet, 28
DEFERASIROX (11238L)
11238L
Body System:
Manner of administration:Oral
Restriction 9302
Indication: Chronic iron overload
Treatment phase: Continuing treatment
Restriction 9222
Indication: Chronic iron overload
Treatment phase: Continuing treatment
Restriction 9258
Indication: Chronic iron overload
Treatment phase: Continuing treatment
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 6 | Max qty units: 168 | # of repeats: 2 | DPMQ: $137.28 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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