DORNASE ALFA

dornase alfa 2.5 mg/2.5 mL inhalation solution, 30 x 2.5 mL ampoules

DORNASE ALFA (6120D)

dornase alfa 2.5 mg/2.5 mL inhalation solution, 30 x 2.5 mL ampoules
6120D
Body System:
Manner of administration:Inhalation
Private
S100 HSD Private
Authority Required (STREAMLINED)

Restriction  9624

Indication: Cystic fibrosis

Restriction  9591

Indication: Cystic fibrosis

Restriction  9592

Indication: Cystic fibrosis
Treatment phase: Continuing treatment
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: $1,539.86 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Pulmozyme