EXEMESTANE

exemestane 25 mg tablet, 30

EXEMESTANE (14036R)

exemestane 25 mg tablet, 30
14036R
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Metastatic (Stage IV) breast cancer
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 60 # of repeats: 5 DPMQ: $87.76 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
APO-Exemestane
EXEMESTANE-WGR
Exemestane GH
Exemestane Sandoz
Aromasin
*Additional charge for this brand is $5.30
 DPMQ: $93.06 Max safety net: $25.00 General Patient Charge: $30.30