PERAMPANEL

PERAMPANEL (10159Q)

perampanel 12 mg tablet, 28
10159Q
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17517)

Indication: Intractable focal onset seizures
Treatment phase: Continuing treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 28 # of repeats: 5 DPMQ: $289.20 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Fycompa

PERAMPANEL (11409L)

perampanel 12 mg tablet, 28
11409L
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 7789)

Indication: Idiopathic generalised epilepsy with primary generalised tonic-clonic seizures
Treatment phase: Continuing treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 28 # of repeats: 5 DPMQ: $289.20 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Fycompa

PERAMPANEL (13865R)

perampanel 12 mg tablet, 28
13865R
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 17481)

Indication: Intractable focal onset seizures
Treatment phase: Continuing treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 56 # of repeats: 5 DPMQ: $569.62 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Fycompa

PERAMPANEL (14012L)

perampanel 12 mg tablet, 28
14012L
Body System:
Manner of administration:Oral
General Schedule
Authority Required (STREAMLINED)

Restriction (Streamlined authority code: 14847)

Indication: Idiopathic generalised epilepsy with primary generalised tonic-clonic seizures
Treatment phase: Continuing treatment
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 56 # of repeats: 5 DPMQ: $569.62 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Fycompa