PEGINTERFERON ALFA-2A

peginterferon alfa-2a 180 microgram/0.5 mL injection, 4 x 0.5 mL syringes

PEGINTERFERON ALFA-2A (9516W)

peginterferon alfa-2a 180 microgram/0.5 mL injection, 4 x 0.5 mL syringes
9516W
Body System:
Manner of administration:Injection
Public
S100 HSD Public
Authority Required (STREAMLINED)

Restriction  17022

Indication: Chronic hepatitis C infection
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 8 # of repeats: 5 DPMQ: $1,919.26 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Pegasys