DONEPEZIL
donepezil hydrochloride 5 mg tablet, 28
DONEPEZIL (8495D)
8495D
Body System:
Manner of administration:Oral
Restriction
Indication: Mild to moderately severe Alzheimer disease
Treatment phase: Initial
Restriction
Indication: Mild to moderately severe Alzheimer disease
Treatment phase: Initial
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
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| Max qty packs: 1 | Max qty units: 28 | # of repeats: 5 | DPMQ: $18.70 | Max safety net: $20.24 | General Patient Charge: $23.03 |
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DPMQ: $23.10 | Max safety net: $20.24 | General Patient Charge: $27.43 | ||