POLYETHYLENE GLYCOL-400 + PROPYLENE GLYCOL

polyethylene glycol-400 0.4% + propylene glycol 0.3% eye drops, 15 mL

POLYETHYLENE GLYCOL-400 + PROPYLENE GLYCOL (8676P)

polyethylene glycol-400 0.4% + propylene glycol 0.3% eye drops, 15 mL
8676P
Body System:
Manner of administration:Application To The Eye
General Schedule
Restricted Benefit

Restriction

Indication: Severe dry eye syndrome
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 1 # of repeats: 5 DPMQ: $16.31 Max safety net: $17.79 General Patient Charge: $20.58
Available brands
Systane