OXYCODONE

oxycodone hydrochloride 5 mg tablet, 10

OXYCODONE (13233L)

oxycodone hydrochloride 5 mg tablet, 10
13233L
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Severe pain
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 10 # of repeats: 0 DPMQ: $20.95 Max safety net: $22.43 General Patient Charge: $25.00
Available brands
Oxycodone Viatris
ENDONE
*Additional charge for this brand is $1.00
 DPMQ: $21.95 Max safety net: $22.43 General Patient Charge: $26.00