GLECAPREVIR + PIBRENTASVIR
Manner of administration:Oral
Restriction
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: 1 | Max qty units: 84 | # of repeats: 1 | DPMQ: $16,846.67 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Maviret | |||||
Manner of administration:Oral
Restriction
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: 1 | Max qty units: 84 | # of repeats: 3 | DPMQ: $16,846.67 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Maviret | |||||
Manner of administration:Oral
Restriction
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: 1 | Max qty units: 84 | # of repeats: 3 | DPMQ: $16,895.55 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Maviret | |||||
Manner of administration:Oral
Restriction
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: 1 | Max qty units: 84 | # of repeats: 3 | DPMQ: $17,009.60 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Maviret | |||||
Manner of administration:Oral
Restriction
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: 1 | Max qty units: 84 | # of repeats: 2 | DPMQ: $16,846.67 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Maviret | |||||
Manner of administration:Oral
Restriction
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: 1 | Max qty units: 84 | # of repeats: 2 | DPMQ: $16,895.55 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Maviret | |||||
Manner of administration:Oral
Restriction
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: 1 | Max qty units: 84 | # of repeats: 1 | DPMQ: $17,009.60 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Maviret | |||||
Manner of administration:Oral
Restriction
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: 1 | Max qty units: 84 | # of repeats: 2 | DPMQ: $17,009.60 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Maviret | |||||
Manner of administration:Oral
Restriction
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: 1 | Max qty units: 84 | # of repeats: 1 | DPMQ: $16,895.55 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Maviret | |||||