TENOFOVIR DISOPROXIL + EMTRICITABINE
tenofovir disoproxil fumarate 300 mg + emtricitabine 200 mg tablet, 30
Manner of administration:Oral
Restriction (Streamlined authority code: 6985)
Indication: HIV infection
Treatment phase: Initial
Restriction (Streamlined authority code: 6986)
Indication: HIV infection
Treatment phase: Continuing
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 60 | # of repeats: 5 | DPMQ: $52.88 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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tenofovir disoproxil maleate 300 mg + emtricitabine 200 mg tablet, 30
Manner of administration:Oral
Restriction (Streamlined authority code: 6985)
Indication: HIV infection
Treatment phase: Initial
Restriction (Streamlined authority code: 6986)
Indication: HIV infection
Treatment phase: Continuing
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 60 | # of repeats: 5 | DPMQ: $52.88 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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tenofovir disoproxil fumarate 300 mg + emtricitabine 200 mg tablet, 30
Manner of administration:Oral
Restriction
Indication: Pre-exposure prophylaxis (PrEP) against human immunodeficiency virus (HIV) infection
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: 5 | DPMQ: $35.29 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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tenofovir disoproxil maleate 300 mg + emtricitabine 200 mg tablet, 30
Manner of administration:Oral
Restriction
Indication: Pre-exposure prophylaxis (PrEP) against human immunodeficiency virus (HIV) infection
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: 5 | DPMQ: $35.29 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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tenofovir disoproxil succinate 301 mg + emtricitabine 200 mg tablet, 30
Manner of administration:Oral
Restriction (Streamlined authority code: 6985)
Indication: HIV infection
Treatment phase: Initial
Restriction (Streamlined authority code: 6986)
Indication: HIV infection
Treatment phase: Continuing
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 2 | Max qty units: 60 | # of repeats: 5 | DPMQ: $52.88 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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tenofovir disoproxil succinate 301 mg + emtricitabine 200 mg tablet, 30
Manner of administration:Oral
Restriction
Indication: Pre-exposure prophylaxis (PrEP) against human immunodeficiency virus (HIV) infection
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: 5 | DPMQ: $35.29 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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