RIZATRIPTAN

rizatriptan 10 mg wafer, 2

RIZATRIPTAN (9313E)

rizatriptan 10 mg wafer, 2
9313E
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Migraine attack
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 4 # of repeats: 5 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Maxalt
*Additional charge for this brand is $4.52
 DPMQ: $27.36 Max safety net: $24.38 General Patient Charge: $29.52
Rizatriptan Wafers-10mg
*Additional charge for this brand is $3.34
 DPMQ: $26.18 Max safety net: $24.38 General Patient Charge: $28.34