DEFERASIROX
Body System:
Manner of administration:Oral
Restriction
Indication: Chronic iron overload
Treatment phase: Initial treatment
Restriction
Indication: Chronic iron overload
Treatment phase: Initial treatment
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 6 | Max qty units: 180 | # of repeats: 5 | DPMQ: $87.06 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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Body System:
Manner of administration:Oral
Restriction
Indication: Chronic iron overload
Treatment phase: Initial treatment
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 6 | Max qty units: 180 | # of repeats: 2 | DPMQ: $87.06 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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Body System:
Manner of administration:Oral
Restriction (Streamlined authority code: 8328)
Indication: Chronic iron overload
Treatment phase: Continuing treatment
Restriction (Streamlined authority code: 8329)
Indication: Chronic iron overload
Treatment phase: Continuing treatment
Restriction (Streamlined authority code: 8326)
Indication: Chronic iron overload
Treatment phase: Continuing treatment
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 6 | Max qty units: 180 | # of repeats: 2 | DPMQ: $87.06 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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Body System:
Manner of administration:Oral
Restriction
Indication: Chronic iron overload
Treatment phase: Initial treatment
Restriction
Indication: Chronic iron overload
Treatment phase: Initial treatment
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 6 | Max qty units: 180 | # of repeats: 5 | DPMQ: $99.96 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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Body System:
Manner of administration:Oral
Restriction (Streamlined authority code: 9302)
Indication: Chronic iron overload
Treatment phase: Continuing treatment
Restriction (Streamlined authority code: 9222)
Indication: Chronic iron overload
Treatment phase: Continuing treatment
Restriction (Streamlined authority code: 9258)
Indication: Chronic iron overload
Treatment phase: Continuing treatment
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 6 | Max qty units: 180 | # of repeats: 2 | DPMQ: $99.96 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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Body System:
Manner of administration:Oral
Restriction
Indication: Chronic iron overload
Treatment phase: Initial treatment
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 6 | Max qty units: 180 | # of repeats: 2 | DPMQ: $99.96 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
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