DABIGATRAN

dabigatran etexilate 110 mg capsule, 60

DABIGATRAN (2753X)

dabigatran etexilate 110 mg capsule, 60
2753X
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 4269)

Indication: Prevention of stroke or systemic embolism
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 60 # of repeats: 5 DPMQ: $43.27 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
ARX-Dabigatran
Dabigatran Sandoz
Dabigatran Viatris
PHARMACOR DABIGATRAN
Pradaxa
*Additional charge for this brand is $7.39
 DPMQ: $50.66 Max safety net: $25.00 General Patient Charge: $32.39