BISACODYL

BISACODYL (10578R)

bisacodyl 10 mg suppository, 10
10578R
Body System:
Manner of administration:Rectal
Repatriation Pharmaceutical Benefits
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 3 Max qty units: 3 # of repeats: 5 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Dulcolax DPMQ: $28.05 Max safety net: $7.70 General Patient Charge: $7.70
Petrus Bisacodyl Suppositories DPMQ: $26.85 Max safety net: $7.70 General Patient Charge: $7.70

BISACODYL (10580W)

bisacodyl 10 mg suppository, 12
10580W
Body System:
Manner of administration:Rectal
Repatriation Pharmaceutical Benefits
No restrictions
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 3 Max qty units: 3 # of repeats: 4 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Petrus Bisacodyl Suppositories DPMQ: $25.59 Max safety net: $7.70 General Patient Charge: $7.70

BISACODYL (1258F)

bisacodyl 10 mg suppository, 12
1258F
Body System:
Manner of administration:Rectal
General Schedule
Restricted Benefit

Restriction

Indication: Constipation

Restriction

Indication: Constipation

Restriction

Indication: Constipation

Restriction

Indication: Constipation

Restriction

Indication: Terminal malignant neoplasia

Restriction

Indication: Anorectal congenital abnormalities

Restriction

Indication: Megacolon
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 3 Max qty units: 3 # of repeats: 4 DPMQ: $25.59 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Petrus Bisacodyl Suppositories

BISACODYL (1259G)

bisacodyl 5 mg enteric tablet, 200
1259G
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Constipation

Restriction

Indication: Constipation

Restriction

Indication: Constipation

Restriction

Indication: Constipation

Restriction

Indication: Terminal malignant neoplasia

Restriction

Indication: Anorectal congenital abnormalities

Restriction

Indication: Megacolon
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 1 Max qty units: 200 # of repeats: 2 DPMQ: $20.61 Max safety net: $22.15 General Patient Charge: $24.94
Available brands
Lax-Tab

BISACODYL (1260H)

bisacodyl 10 mg suppository, 10
1260H
Body System:
Manner of administration:Rectal
General Schedule
Restricted Benefit

Restriction

Indication: Constipation

Restriction

Indication: Constipation

Restriction

Indication: Constipation

Restriction

Indication: Constipation

Restriction

Indication: Terminal malignant neoplasia

Restriction

Indication: Anorectal congenital abnormalities

Restriction

Indication: Megacolon
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 3 Max qty units: 3 # of repeats: 5 DPMQ: $26.85 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Petrus Bisacodyl Suppositories
Dulcolax
*Additional charge for this brand is $1.20
 DPMQ: $28.05 Max safety net: $25.00 General Patient Charge: $26.20

BISACODYL (14305X)

bisacodyl 10 mg suppository, 12
14305X
Body System:
Manner of administration:Rectal
General Schedule
Restricted Benefit

Restriction

Indication: Constipation

Restriction

Indication: Constipation

Restriction

Indication: Constipation

Restriction

Indication: Constipation

Restriction

Indication: Terminal malignant neoplasia

Restriction

Indication: Anorectal congenital abnormalities

Restriction

Indication: Megacolon
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 6 Max qty units: 6 # of repeats: 4 DPMQ: $36.78 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Petrus Bisacodyl Suppositories

BISACODYL (14446H)

bisacodyl 5 mg enteric tablet, 200
14446H
Body System:
Manner of administration:Oral
General Schedule
Restricted Benefit

Restriction

Indication: Constipation

Restriction

Indication: Constipation

Restriction

Indication: Constipation

Restriction

Indication: Constipation

Restriction

Indication: Terminal malignant neoplasia

Restriction

Indication: Anorectal congenital abnormalities

Restriction

Indication: Megacolon
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 2 Max qty units: 400 # of repeats: 2 DPMQ: $26.86 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Lax-Tab

BISACODYL (14447J)

bisacodyl 10 mg suppository, 10
14447J
Body System:
Manner of administration:Rectal
General Schedule
Restricted Benefit

Restriction

Indication: Constipation

Restriction

Indication: Constipation

Restriction

Indication: Constipation

Restriction

Indication: Constipation

Restriction

Indication: Terminal malignant neoplasia

Restriction

Indication: Anorectal congenital abnormalities

Restriction

Indication: Megacolon
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 6 Max qty units: 6 # of repeats: 5 DPMQ: $39.30 Max safety net: $25.00 General Patient Charge: $25.00
Available brands
Petrus Bisacodyl Suppositories
Dulcolax
*Additional charge for this brand is $2.40
 DPMQ: $41.70 Max safety net: $25.00 General Patient Charge: $27.40

BISACODYL (14567Q)

bisacodyl 10 mg suppository, 10
14567Q
Body System:
Manner of administration:Rectal
Repatriation Pharmaceutical Benefits
Restricted Benefit

Restriction

Indication: The condition must be stable for the prescriber to consider the listed maximum quantity of this medicine suitable for this patient.
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 6 Max qty units: 6 # of repeats: 5 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Dulcolax DPMQ: $41.70 Max safety net: $7.70 General Patient Charge: $7.70
Petrus Bisacodyl Suppositories DPMQ: $39.30 Max safety net: $7.70 General Patient Charge: $7.70

BISACODYL (14572Y)

bisacodyl 10 mg suppository, 12
14572Y
Body System:
Manner of administration:Rectal
Repatriation Pharmaceutical Benefits
Restricted Benefit

Restriction

Indication: The condition must be stable for the prescriber to consider the listed maximum quantity of this medicine suitable for this patient.
Quantities & Cost
Max qty packs Max qty units # of repeats DPMQ Max safety net General Patient Charge
Max qty packs: 6 Max qty units: 6 # of repeats: 4 DPMQ: - Max safety net: - General Patient Charge: -
Available brands
Petrus Bisacodyl Suppositories DPMQ: $36.78 Max safety net: $7.70 General Patient Charge: $7.70