BRIMONIDINE
brimonidine tartrate 0.2% eye drops, 5 mL
BRIMONIDINE (14497B)
14497B
Body System:
Manner of administration:Application To The Eye
Restriction
Indication: The condition must be stable for the prescriber to consider the listed maximum quantity
of this medicine suitable for this patient.
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 2 | # of repeats: 5 | DPMQ: $30.14 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $32.10 | Max safety net: $25.00 | General Patient Charge: $26.96 | ||