GLYCOMACROPEPTIDE AND ESSENTIAL AMINO ACIDS WITH VITAMINS AND MINERALS
glycomacropeptide and essential amino acids with vitamins and minerals containing
15 g of protein equivalent oral liquid, 30 x 250 mL cartons
Body System:
Manner of administration:Oral
Restriction
Indication: Phenylketonuria
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 4 | Max qty units: 4 | # of repeats: 5 | DPMQ: $2,327.28 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| PKU Glytactin RTD 15 | |||||
glycomacropeptide and essential amino acids with vitamins and minerals containing
15 g of protein equivalent oral liquid, 30 x 250 mL cartons
Body System:
Manner of administration:Oral
Restriction
Indication: Tyrosinaemia
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 4 | Max qty units: 4 | # of repeats: 5 | DPMQ: $2,967.36 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Tylactin RTD | |||||
glycomacropeptide and essential amino acids with vitamins and minerals containing
15 g of protein equivalent oral liquid, 30 x 250 mL cartons
Body System:
Manner of administration:Oral
Restriction
Indication: Phenylketonuria
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 4 | Max qty units: 4 | # of repeats: 5 | DPMQ: $2,327.28 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| PKU Glytactin RTD 15 Lite | |||||