PRAMIPEXOLE

pramipexole dihydrochloride monohydrate 125 microgram tablet, 30

PRAMIPEXOLE (9393J)

pramipexole dihydrochloride monohydrate 125 microgram tablet, 30
9393J
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Primary severe restless legs 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: 30 # of repeats: 2 DPMQ: $17.24 Max safety net: $18.72 General Patient Charge: $21.51
Available brands
APO-Pramipexole
Simipex 0.125
Simpral
Sifrol
*Additional charge for this brand is $3.58
 DPMQ: $20.82 Max safety net: $18.72 General Patient Charge: $25.09